With the continuous development of medicine, scientists have obtained many methods.

Test indicators help reveal a complete picture of a person’s health status, the presence of diseases, infections, pathologies, and the prevention of disease development.

One of the tests is a blood coagulogram.

What is a blood coagulogram?

Blood coagulogram is a test that shows blood clotting. In a broad sense, a coagulogram reveals platelet activity. Blood clotting is a particularly important indicator.

The blood clotting system is triggered in two ways: externally (outside the vessel, when a damaged area is detected) and internally (when blood cells are destroyed).

When the wall of a blood vessel is destroyed, a protein is released, which signals the need to activate the protective mechanism. Nearby platelets quickly change their shape, adhere to each other, forming a mesh.

The site of injury is quickly clogged by the formed plexus, stopping the blood and preventing the penetration of harmful bacteria from the outside.

The medical name for this important process for the body is hemostasis (a process that includes all stages of coagulation up to the dissolution of the protective clot).

However, in any system, even the strongest one, failures are possible.

Why is it necessary to do a blood coagulogram?

Disease Prevention

Thrombosis is a disease in which, without the need to activate the protective function, blood clots form.

Such blood clots are called emboli, the disease is thromboembolism.

Emboli can clog arterial vessels. The formation of obstruction (obstruction) by more than 90% causes a lack of oxygen (hypoxia), not to mention the accumulation of metabolic products. Brain hypoxia, for example, is a dangerous diagnosis, often leading to coma, which results in death in 80% of cases.

Biochemical screening of the health status of the expectant mother and child

The analysis is especially important for a pregnant woman. A blood coagulogram is recommended for women who have:

• liver diseases;
• bleeding disorders;
• varicose veins;
• immune diseases.

Bearing a fetus is a natural process associated with the formation of the uteroplacental circulation. During pregnancy, the body prepares for blood loss, which affects the increase in some coagulogram parameters.

If the expectant mother has serious abnormalities in blood clotting, the doctor will prescribe treatment. Impaired coagulation that is not determined in time can lead to serious consequences - miscarriage and premature birth.

A blood coagulogram is necessary not only to identify abnormalities in the hemostatic system, but also to establish a diagnosis of patients in some cases.

How to prepare for the analysis?

A coagulogram does not require special preparation. However, there are points that it is advisable to observe in order to pass the analysis well:

• food intake – 8 hours before blood sampling;
• It is recommended not to eat fatty foods;
• drink only water;
• It is recommended not to smoke for an hour before the test;
• before analysis, you must try to calm down emotionally and physically;
• if the patient is prescribed a course of medication that is not related to the reasons for the blood coagulation test, it is necessary to notify the doctor about this;
• If you experience a feeling of malaise or dizziness during the test, you should immediately inform the specialist taking the tests.

Causes of high and low blood coagulogram values

Coagulogram values ​​above normal indicate:

• infectious-toxic and septic disease;
• intoxication of the body;
• atherosclerotic vascular damage;
• endocrine pathology;
• the occurrence of disseminated intravascular coagulation (DIC syndrome), etc.

Coagulogram indicators are below normal:

• leukemia();
• vein thrombosis;
• various diseases of internal organs (digestive system);
• hereditary clotting defects;
• final phase of DIC syndrome, etc.

The listed diagnoses are few. It is important to remember that this is aggregate data. To identify the cause that violates the norms of hemostasis, it is necessary to decipher and specifically compare each indicator with the norm, taking into account the characteristics of the patient’s body.

Details about blood coagulogram parameters

• Fibrinogen (a protein produced in the liver and responsible for the final stage of blood clot formation):

Causes of low fibrinogen:

• donation, taking steroids, etc.
• chronically low levels of fibrinogen, impaired synthesis from birth;
• liver diseases;
• unbalanced diet.

Reduced protein concentrations characterize the inability to fully coagulate blood and a tendency to spontaneous bleeding.

Increased fibrinogen level:

• inflammatory processes, alas, the most varied - acute, infectious mononucleosis, etc.;
• massive tissue destruction (lung abscesses, gangrene, ulcers, etc.);
• tumor formation;
• , cerebrovascular accident;
• peripheral vascular diseases (atherosclerosis of the arteries, vascular damage in diabetes mellitus, thrombophlebitis, chronic venous insufficiency);

An increased or decreased fibrinogen level does not always indicate health problems.

A minor effect on the indicator in an adult can also be exerted by:

• smoking;
• taking hormonal-based contraceptives, estrogens;
• loads;
• stress;
• cholesterol;
• obesity.

In adults, the norm ranges from 2-4 g/l, in pregnant women up to 6 g/l, in children the fibrinogen content is 1.25–3 g/l.

• (aPTT):

Characterizes the period of time required for the platelet reaction. An increased thromboplastin time characterizes a tendency to uncontrolled bleeding and prolonged blood clotting.

Using the INR indicator, doctors evaluate the effect of prescribed medications.

• D-dimer:

After the destruction of the blood clot (during the breakdown of fibrin), a protein fragment - D-dimer - is observed in the blood. After restoration of the affected part of the body, the protein plasmin is formed, which destroys and destroys blood clots.

The number of fragments in the blood allows us to identify the work of two processes at once: the formation of blood clots and their dissolution (fibrinolysis). A balance is required between thrombus formation and fibrinolysis. Lack of balance informs hemostasis.

The norms for indicators in adults and children are presented in the table below. Deciphering the blood coagulogram will reveal the discrepancy between each indicator: what it is and how much it should be.

• Soluble fibrin-monomer complexes (SFMC):

Few people have heard of the RFMK blood test. The RFMC blood test is an additional indicator; it is included in the coagulogram and is considered an important laboratory test that characterizes the hemostatic system. Many experts consider the RFMK blood test to be an indicator of thrombinemia (the formation of small blood clots) and the onset of DIC.

Blood coagulogram indicators: norms for adults and children Table

To summarize, I would like to note: an accurate blood coagulogram can be interpreted by a good specialist - a doctor.

Only he will be able to identify deviations from the norm for each patient with high accuracy.

The medical history of each patient is a separate situation that requires detailed consideration.

Videos on the topic

Interesting

Many women are prescribed a biological fluid test called a coagulogram. It helps the attending physician determine the state of hemostasis and identify the presence of hyper- or hypocoagulation. In addition, it becomes easier for the patients themselves to understand the various symptoms if they know what kind of analysis it is - a coagulogram, what it is intended for, and how to decipher it correctly.

What is included in the coagulogram analysis?

Hemostasis is a system that is responsible for the normal consistency of blood, as well as its ability to clot. Any violation leads either to the formation of blood clots, which is typical for varicose veins, cardiovascular pathologies, and hepatological diseases, or to a decrease in the density of biological fluid (hemophilia, frequent bleeding due to minor vascular damage).

Thus, a coagulogram differs from a general and biochemical blood test in terms of indicators. It includes in the basic version:

1. PTI (prothrombin index), PTT (prothrombin time) or INR (international normalized ratio). The last test is considered the most informative and universal. These indicators allow you to calculate the period of time during which a blood clot forms at the site of injury.
2. Fibrinogen is a protein that is responsible for the appearance of blood clots as the final stage of the coagulation of biological fluid and is converted into fibrin.
3. Thrombin time. Shows the period during which fibrin is produced from fibrinogen.
4. APTT (activated partial thromboplastin time). The indicator allows you to record the time of formation of blood clots.

Additional information for a coagulogram is obtained from a blood test for the following parameters:

• plasma tolerance to heparin;
• protein C;
• D-dimer;
• plasma recalcification time (PRP), the activated parameter (APRP) is also taken into account;
• antithrombin;
• RFMC (soluble fibrin monomer complexes);
• lupus anticoagulant.

The listed additional indicators are required for a more accurate diagnosis if a specific disease is suspected, especially during pregnancy.

Preparation for coagulogram analysis

The only requirement for the patient before the study is to refuse to eat 8 hours before the collection of biological fluid. It is recommended to donate blood in the morning, but this is not a strict rule.

How long does a coagulogram analysis take?

The time required to calculate the quantitative indicators of the study is 1 working day. It may exceed the specified period depending on the equipment installed in the laboratory, as well as the need to transport the material (no more than 3-4 days).

Norms for coagulogram analysis

Decoding the study consists of comparing the obtained parameters with reference values.

They are:

Blood is a mirror of the state of the human body. The laboratory technician can see everything in the blood: what the person ate, what he drank, whether he took any medications. There are many tests available to be performed in a laboratory. Coagulogram (hemostasiogram) is the result. It can be used to determine whether blood clotting is increased or decreased. The coagulation test is not prescribed as a standard test; it is used to clarify the diagnosis, subject to the presence of appropriate indications. And so let’s look at what kind of coagulogram analysis this is, how to decipher it in an adult, during pregnancy and in children.

During the process of stopping blood, coagulation factors interact. These are specific proteins of the body that are normally found in the blood. Factors are released from the damaged intima of the vessel, triggering a cascade of reactions during which proteins sequentially activate each other. As a result: fibrinogen turns into plasma-insoluble fibrin, which falls out in threads. Red and white blood cells and platelets get stuck in them, like in a spider's web. The resulting blood clot stops bleeding.

Hemostasis system

After restoring the integrity of the intima of the vessel, the process of fibrinolysis begins. There is no longer a need for a blood clot, and its separation will contribute to the blockage of some small vessel and the rupture of the latter.

To maintain balance, the anticoagulant system works in opposition to the blood coagulation system. Thanks to it, blood clots do not constantly form in the body, and the blood maintains its liquid state. The two systems balance each other. Because of this balance, blood constantly flows through the vessels, but when wounded, a person does not die from massive blood loss. A disturbance in the system contributes to either heavy bleeding during wounds or blood clotting in the vascular bed.

By analyzing the blood coagulogram, you can evaluate the functioning of the coagulation, anticoagulation systems and the fibrinolysis system. Deciphering a blood coagulogram and its interpretation is available only to a qualified attending physician.

Indications

Indications for a coagulogram study:

• assessment of the functioning of the hemostatic system, fibrinolysis and anticoagulant system;
• upcoming surgery;
• congenital diseases of the coagulation system;
• childbirth and caesarean section (also a kind of operation accompanied by blood loss);
• treatment with anticoagulants;
• to assess the tendency to thrombus formation in;
• varicose veins;
• chronic liver diseases;
• taking glucocorticosteroids, anabolic steroids, oral contraceptives;
• auxiliary diagnosis of autoimmune diseases (antiphospholipid syndrome with).

Preparation

Coagulogram analysis is not taken in the morning on an empty stomach. The day before, 10-12 hours before, you should exclude fried, spicy, fatty foods from your diet, and you should not drink alcohol. Immediately before the blood test for coagulogram, you can drink water and do not smoke. It is worth stopping taking all medications (including antibiotics for 1-2 weeks), hormonal contraceptives. If these measures are not followed, you may get a distorted result.

For a coagulogram, it is carried out using a special or regular syringe with a needle with a large lumen, without applying a tourniquet. It is important that the procedure is minimally traumatic for the vascular wall. The tube contains an anticoagulant to prevent blood clotting in vitro. The results of the coagulogram analysis take several days to prepare.

Decoding

A blood coagulogram evaluates basic and additional parameters. The normal coagulogram changes in a physiological state such as pregnancy. Let's look at the norms and interpretation of the blood coagulogram in the table.

The main parameters for deciphering a blood coagulogram in an adult include:

1. Blood clotting time. The value depends on the material of the test tube in which the analysis was carried out. In a non-silicone tube the normal value is 5-7 minutes, in a silicone tube - 20-25 minutes. The analysis form will indicate which tube was used during the test so that the doctor can evaluate the result.
2. Fibrinogen. The effectiveness of hemostasis depends on the concentration of this protein, since fibrin, the main component of a blood clot, is formed from it. In pregnant women it increases before childbirth. The body thus prepares for the programmed upcoming bleeding.

The level of fibrinogen in the blood increases in addition to the example given:

• for acute inflammation and infections;
• for acute pathologies of the heart or blood vessels;
• for diseases of the respiratory system;
• with extensive burns;
• after surgical operations;
• for endocrine disorders;
• after childbirth or caesarean section.

It is very important to monitor the fibrin content in the blood, because its uncontrolled increase will lead to a dangerous condition in which the blood begins to clot in intact vessels. It's called DIC and can be fatal.

A decrease in the level of fibrinogen in the blood occurs in the following cases:

• for liver diseases;
• taking anticoagulants, steroids;
• toxicosis;
• deficiency of B vitamins;
• deficiency of vitamins C.

1. Activated partial thromboplastin time (aPTT). This value reflects the time required for fibrin formation. Normal APTT values ​​are 35-45 s, when using certain reagents - 28-35 s. Shortening this time has no diagnostic value. A prolonged APTT indicates congenital disorders of the coagulation system or that the patient took anticoagulants the day before.
2. Prothrombin index (PTI), international normalized ratio (INR). A parameter by which the external coagulation pathway can be assessed. Equal to the time elapsed from damage to the vessel until the formation of a clot. The index can be calculated as the ratio of the reference time of a healthy person and the time of a given patient. The most universal indicator is the INR. Normal PTI values ​​are 78-142%.
3. Thrombin time. The parameter characterizes the time during which fibrinogen is converted into fibrin. The normal figure is 10-20 seconds.

An increase in value is observed in the analysis transcript when:

• liver diseases;
• pancreatitis;
• oncological diseases;
• taking anticoagulants;

Decrease in fibrinogen level:

• the last trimester of pregnancy and other conditions that increase the amount of fibrinogen in the blood.

As you can see, the coagulogram during pregnancy differs from normal. Only the attending physician can decipher the blood coagulogram analysis.

Additional coagulogram indicators include:

1. Antithrombin III. Determining antithrombin in the blood will help evaluate the functioning of the blood anticoagulation system.

An increase in the coagulogram level is observed when:

• severe infectious diseases;
• presence of acute hepatitis;
• in the presence of acute pancreatitis;
• treatment with anticoagulants and steroids.

Downgrade:

• congenital and hereditary deficiency of factors;
• heart pathology;
• last trimester of pregnancy;
• DIC syndrome.

1. Soluble fibrin-monomer complexes. The indicator gives an idea of ​​changes in the fibrin molecule under the influence of precursor factors.
2. Protein C. One of the most important anticoagulant factors. The norm in the extended study is 60-140%.
3. Fibrinogen B is normally absent;
4. . Or antibodies to phospholipids. Normally absent from the blood. This type of autoantibody causes platelet destruction and thereby reduces the blood's ability to clot;
5. D-dimer is a fibrin breakdown product. The concentration in the blood is proportional to the lysis of this protein. With increased thrombus formation, the indicator increases.
6. Heparin tolerance. The patient is given heparin. The blood is then drawn and the time of blood clot formation is determined. The normal value is 7-15 minutes.

This value increases when:

• oncological diseases;
• pregnancy;
• after surgery;
• for liver diseases (cirrhosis,).

1. Duke bleeding time. A finger is punctured and the researcher removes a drop of blood every 15 seconds, without touching the skin, until the bleeding stops. Normal value 2 minutes
2. Recalcification time. An indicator showing the formation of a fibrin clot. Activated recalcification time. The normal value is 50-70 seconds.
3. Fibrinolytic activity.
4. Blood clotting time. It is noted from the time of blood collection to the time when a blood clot forms in the test tube. To determine, the test tube is placed in a thermostat and set to 37 degrees. Normal values ​​are 5-7 minutes (if venous blood was taken).

Increase value:

• hypercoagulability;
• DIC syndrome;
• taking hormonal contraceptives.

1. Retraction of a blood clot. Reflects the ability of fibrin threads of a formed clot to contract. A decrease in the indicator occurs with an increase in the number of red blood cells. Decrease - with developing anemia.
2. . Platelets play a key role in hemostasis. When analyzing a coagulogram, this indicator is rarely determined. A platelet test is taken along with the CBC.
3. Thrombotest. Reflects the intensity of fibrin clot formation. I-III degree - the clot is loose and fragile. I-III degrees are characterized by the formation of an inferior, loose, free-floating clot. IV degree formed clot, glued to the wall of the test tube. VII degree - the clot can be separated from the wall only with a wire loop, elastic and very compacted.

The term “coagulogram” comes from the merger of two words: coagulum (coagulation) and gramma (image). It is a graphical expression of the result of a blood clotting test. Another name is hemostasiogram.

Deciphering the coagulogram allows you to determine the presence of abnormalities such as increased blood clotting (hypercoagulation) or decreased blood clotting (hypocoagulation). This test is not standard and is prescribed when it is necessary to evaluate the functioning of the blood coagulation system or hemostasis system.

Hemostasis is a whole complex of reactions occurring in the body when the vascular wall is damaged. This system performs the most important function - it prevents and stops bleeding. It ensures the presence of blood in the vascular bed and prevents death from blood loss.

Along with the coagulation system, the body has an anticoagulant system, thanks to which the blood has a liquid state, certain parameters and composition throughout life. These systems are in balance, which prevents blood clotting inside the vascular bed and at the same time promotes the formation of a clot when the integrity of the wall is violated. Disruption of this balance can lead to consequences such as blood loss and the formation of a blood clot inside the vessel.

With the participation of thrombin, soluble fibrinogen is converted into insoluble fibrin threads

When the vessel wall is damaged, the blood clotting mechanism is triggered. As a result, a blood clot – a thrombus – forms at the site of the vessel defect. This is a very complex process of interaction between the so-called blood clotting factors. The essence of coagulation lies in a cascade of reactions caused by the fact that proenzymes brought into an active state activate other coagulation factors. Plasma-soluble fibrinogen is eventually converted into insoluble fibrin, which appears as threads. Blood cells become entangled in them, thus forming a blood clot.

When the integrity of the vessel is restored, the dissolution of the fibrin clot begins - fibrinolysis. This process always accompanies coagulation and is an integral part of it.

Coagulogram indicators obtained during a blood test make it possible to evaluate the functioning of all three systems: coagulation, anticoagulation and fibrinolytic.

Only a doctor can decipher a coagulogram. At the same time, he will consider all indicators in aggregate.

Indications for analysis

• Assessment of the state of the coagulation system.
• Planned surgical intervention. Bleeding is possible during surgery, so it is necessary to obtain information about the state of the hemostatic system.
• Bearing the fetus. It is carried out every trimester, as well as for severe gestosis and fetoplacental insufficiency.
• Diseases associated with blood clotting disorders (hemophilia, von Willebrand disease, thrombocytopenia, thrombocytopathy and others).
• Independent childbirth and caesarean section.
• Monitoring treatment with heparin and indirect coagulants.
• Varicose veins.
• Tendency to thrombosis.
• There is a high probability of blood clots due to coronary artery disease, atrial fibrillation, strokes, and heart attacks.
• Acute inflammation.
• Pathologies with an autoimmune development mechanism.
• Chronic liver diseases.
• Taking glucocorticoids and anabolic steroids.
• Continuous use of oral contraceptives (analysis is carried out every 3 months).
• Diagnosis of thrombosis.
• Hirudotherapy.

How is it carried out and how to prepare?

Blood is taken in the morning on an empty stomach. On the eve of the analysis, you should not eat fried, fatty, spicy, smoked or drink alcohol. The last meal should take place at least 10-12 hours before the procedure. Before donating blood, you can only drink plain water and do not smoke. To avoid distorting the test result, you should stop taking blood thinning medications.

Blood for coagulation testing is taken from a vein

For the study, venous blood is used, which is taken using a vacuum method or a sterile syringe with a large-bore needle without applying a tourniquet. It is important that the procedure is not traumatic, otherwise there will be tissue thromboplastin in the test tube, and the results will be distorted. The test tube must contain an anticoagulant. Test results are usually ready in one to two days. After treatment with antibiotics, at least two weeks should pass. Hormonal contraceptives also influence the test result.

Coagulogram parameters

As a rule, a basic analysis is prescribed the first time. If deviations from the norm are found, an extensive study is carried out. The basic parameters include the following.

Fibrinogen. This protein is a valuable indicator of a coagulogram. It is involved in the formation of a blood clot. With its deficiency, the blood does not stop well. The norm is 2-4 g/liter. During pregnancy, its level gradually increases and in the third trimester reaches 6 g/liter. In newborns it is 1.25-3 g/liter.

A decrease in fibrinogen occurs in the following cases:

• in case of disturbances in the hemostasis system;
• toxicosis of pregnant women;
• severe hepatitis;
• liver cirrhosis;
• taking fish oil;
• deficiency of vitamins C and B;
• taking anticoagulants, anabolic steroids.

The fibrinogen content increases in the following cases:

• for acute inflammation and infections;
• during pregnancy;
• for strokes and heart attacks;
• with pneumonia;
• for burns;
• after surgical interventions;
• with hypothyroidism;
• after childbirth.

PTI (prothrombin index)– the ratio of the time it takes for a healthy person’s blood to clot to the time it takes for a particular patient’s blood to clot. It is an indicator of liver function. Normally it ranges from 90 to 110%. If the value is increased, there is a risk of blood clots; if it is decreased, bleeding is possible. During pregnancy, an increase is considered normal. PTI, PTT (prothrombin time) and INR (international normalized ratio) show how long it took for a clot to form at the site of the vessel defect. Using these parameters, the extrinsic pathway of blood coagulation is assessed. Usually one of them is carried out. INR is considered universal.

APTT (activated partial thromboplastin time). Gives an idea of ​​the internal pathway of blood coagulation. An indicator of the time it takes for blood clots to form. Used to monitor treatment with heparin drugs. It is one of the most sensitive indicators. Normally it is about 40 seconds. An increase in time may indicate liver disease or a lack of vitamin K.

Thrombin time. This parameter characterizes the final stage of hemostasis, that is, the period of time during which fibrinogen is converted into insoluble fibrin when exposed to thrombin. This indicator makes it possible to identify the likelihood of developing thrombosis, carry out differential diagnosis of various coagulopathies, and evaluate how effective heparin therapy is. Normally, the indicator should be 11-18 seconds. A value below normal indicates an excess of fibrinogen in the blood. An elevated value indicates liver failure or protein deficiency.

The blood test is interpreted by the attending physician. The interpretation of the result is carried out taking into account all parameters.

Blood clotting is a very complex process that involves numerous factors.

Additional coagulogram parameters

These include the following:

• Antithrombin is a factor in the anticoagulant system and prevents thrombus formation.
• Soluble fibrin-monomer complexes (SFMC) are an indicator of blood coagulation inside blood vessels. Gives an idea of ​​how fibrin molecules change under the influence of thrombin and plasmin.
• Protein C – deficiency leads to the formation of blood clots.
• Lupus anticoagulant - determined when autoimmune diseases are suspected.
• Plasma tolerance to heparin. This is an indicator of the thrombin level in the blood. During the analysis, heparin is injected into the blood plasma and the time during which a fibrin clot forms is determined. Normally it should be 7-15 minutes. With hypercoagulation during pregnancy, with cancer, after surgery, with cardiovascular pathologies, the time is less than normal. In case of liver diseases, the time period increases and exceeds 15 minutes.
• D-dimer - is formed during the breakdown of blood clots, with its help early diagnosis of thrombosis and prevention of thromboembolism is carried out.
• Duke bleeding time. This is a test for stopping time of capillary blood. Normally it should be about 2 minutes. To do this, a finger prick with a depth of 4 mm is made, then a drop of blood is removed using paper every 15 seconds, without the paper touching the finger. After removing the drops, it is timed to determine how long it will take for the next one to appear.
• Fibrinolytic activity - shows the ability of blood to dissolve clots. If blood clots break down faster than normal, this indicates a tendency to bleed.
• Recalcification time (RCT) is an indicator of the time it takes for a fibrin clot to form. Low values ​​may indicate the development of diseases such as hepatitis, liver cirrhosis, cardiac pathologies, including heart failure.
• Activated recalcification time (ATR). The norm is 50-70 seconds.
• Retraction of a blood clot. Shows how a blood clot shrinks. With anemia, this indicator increases. The decrease occurs when the level of red blood cells increases and platelets decrease.
• Thrombotest - shows how much fibrinogen is in the blood. Normal – grade IV-V test.
• Fibrinogen B is normally negative.
• Blood clotting time, that is, the time from the moment of venous blood collection to the formation of a clot in the test tube. Shows how platelets work. For determination, 1 milliliter of blood is placed in a test tube at a temperature of 37 degrees. The normal average is 5-7 minutes. If it takes longer, this may indicate liver damage, a lack of clotting factors, long-term use of anticoagulants, or low platelet levels. If coagulation occurs faster than normal, this indicates hypercoagulation, the development of disseminated intravascular coagulation syndrome, or is a consequence of taking hormonal contraceptives. For capillary blood this indicator ranges from 30 seconds to 5 minutes, for venous blood – from 5 to 10 minutes.

The process of blood clot formation

The table will help to more clearly present the norms of the main coagulogram indicators:

In conclusion

A coagulogram is not included in the standard examination, but the doctor may need it when preparing a patient for surgery, in the presence of autoimmune diseases, liver pathology, a tendency to bleeding, or varicose veins.

“Coagulogram - what is it?” - patients who are sent for such an analysis ask in surprise. Indeed, ordinary people encounter such research infrequently, usually during preparation for a planned operation. This term is familiar to all pregnant women. A coagulogram analysis during pregnancy is done every trimester.

Research is hidden under an incomprehensible word. The set of indicators studied may vary depending on the specific laboratory. The analysis can be indicative and detailed. In the first case, it is determined only in which direct link of the coagulation process the violation occurred. A detailed coagulogram is a type of study that, in addition to qualitative ones, also studies quantitative defects. With its help, it is possible to identify platelet disorders, various thrombophlebia, deficiency of certain clotting factors, etc.

The set of methods used to obtain the result depends on the clinical picture, type of pathology, and purposes of the analysis. It should be noted that deciphering a blood coagulogram is a great difficulty not only for a non-specialist, but sometimes also for a doctor. Typically, several well-chosen tests are required to make an accurate diagnosis.

Blood clotting process

Let's take a closer look at how the coagulation system functions. At the first stage, when there is chemical or mechanical damage to the walls of blood vessels, thromboplastin is released - a special substance that triggers coagulation reactions. Then the activation of coagulation factors occurs - special proteins that are always normally present in the blood and ensure the formation of a blood clot at the site of damage to the vessel wall.

Next, thrombin (a natural component of the coagulation system, formed from prothrombin) activates the inactive fibrinogen protein, converting it into active fibrin, which forms the basis of the clot. Blood elements, including platelets, become entangled in fibrin networks. As a result, the blood platelets contract and compress the clot, forming a mature thrombus that closes the damage to the vascular wall. In contrast to the blood coagulation system, the body also has an anticoagulation system. Together they allow the blood to be maintained in normal condition.

Coagulation testing in pregnant women

As already noted, every trimester, and in some cases more often, pregnant women undergo a coagulogram. Expectant mothers know firsthand what it is and why it is needed. The fact is that while carrying a baby, the activity of the coagulation system as a whole increases. This is a natural process associated with the appearance of the utero-placental circle of blood circulation. The expectant mother's body thus prepares for possible blood loss during childbirth.

To identify the characteristics of blood clotting disorders and some complications of pregnancy, a coagulogram is performed. The doctor may ask you to take a test at an unscheduled time if there are deviations from the norm in hemostasis parameters (components of blood and blood vessels, the interaction of which allows you to maintain the integrity of the vascular walls and stop bleeding in case of damage). Blood for research is taken in the morning on an empty stomach from a vein.

Interpretation of blood coagulogram

Only a specialist should study the results of the analysis. Without special knowledge, a person will not be able to decipher coagulogram indicators and assess the degree of their deviation from standard values. We will try to understand the intricacies of the process and tell you about the main parameters of the study.

1. Fibrinogen

This is a protein synthesized in the liver, which is converted under the influence of a certain blood factor into fibrin. This indicator necessarily includes fibrinogen - 2-4 g/l. If it is increased, it means that clotting is increased and there is a risk of blood clots. Typically, this situation is observed before childbirth, with pneumonia, after surgery, with acute infections and inflammation (tuberculosis, influenza), myocardial infarction and stroke (on the first day), with burns, hypothyroidism, taking oral contraceptives and estrogens. may be caused by toxicosis, cirrhosis of the liver or severe hepatitis, lack of vitamin B12 or C, taking androgens, anabolics, fish oil, anticoagulants.

2. Activated partial thromboplastin time (aPTT)

A coagulogram examines the time it takes for a blood clot to form after calcium chloride and other substances combine with plasma. If at least one coagulation factor is 30-40 percent below normal, the APTT level will change. On average, the norm is 30-40 seconds. The time may increase with a lack of vitamin K or liver disease. The reason for the increase in the duration of APTT and, as a result, the slowdown in coagulation may be hemophilia.

3. Lupus anticoagulant

This parameter always contains a coagulogram. What is this indicator? Now we'll tell you. These are IgC and IgM antibodies, leading to an increase in aPTT. Normally, pregnant women should not produce them. Antibodies appear in the case of autoimmune diseases, with gestosis. Pregnancy against the background of such a pathology often ends in spontaneous abortion, fetal death or placental infarction.

4. Prothrombin

It is a complex protein and is a precursor of thrombin (a protein that stimulates the formation of blood clots). This is one of the most important indicators of a coagulogram. Prothrombin with the participation of vitamin K is synthesized in the liver. By analyzing the value of this parameter, the doctor can identify pathologies of the gastrointestinal tract and liver.

5. Prothrombin time

The time during which a fibrin clot forms in plasma when thromboplastin and calcium chloride are added to it. This indicator is expressed in seconds and is normally 11-15.

6. Prothrombin index (PTI)

The coagulogram most often includes this parameter instead of the previous one. This is the ratio of the clotting time of the plasma of a healthy person and the plasma of a patient, expressed as a percentage. B should range from 93-107 percent. Factors of this indicator are synthesized in liver cells; in liver diseases, their quantity decreases, so PTI can, to some extent, serve as a parameter for determining the functional state of the organ.

If the PTI is increased, it means that coagulability is increased and there is a risk of developing thrombosis. Growth can be observed when taking oral contraceptives and in the last months of pregnancy. A decrease in the prothrombin index indicates a deterioration in blood clotting properties. The formation of prothrombin complex factors depends on vitamin K, so its deficiency and impaired absorption in the intestine (with dysbacteriosis, enterocolitis) can also lead to a decrease in PTI. This can also be caused by taking large doses of acetylsalicylic acid and diuretics.

7. Thrombin time

This is the time during which fibrinogen is transformed into fibrin. Its standard value is 15-18 seconds. An increase in this indicator is observed with congenital fibrinogen deficiency or with severe liver damage. A decrease in the parameter, that is, a reduction in thrombin time, indicates the presence of paraproteins (proteins of the immunoglobulin class) or an excess of fibrinogen. Typically, the value of the indicator is monitored during treatment with fibrinolytics or heparin.

8. Antithrombin III

It is a thrombin inhibitor, a protein of the anticoagulant system. It has a depressing effect on coagulation processes. The level of the indicator is determined by the binding of thrombin in the control sample (by inhibition). The normal value for antithrombin III is 71-115 percent. A decrease in the parameter by 50 percent of the norm entails a risk of thrombosis.

Determining this indicator is especially important for expectant mothers taking anticoagulants. These drugs are used when carrying a child, when there is a threat of miscarriage.

9. D-dimer

This is an important indicator for diagnosing thrombosis, which includes a coagulogram. What does this parameter demonstrate? It allows you to identify the processes of thrombus formation and fibrin dissolution. Normally, D-dimer is less than 248 ng/ml. The level of the indicator begins to gradually increase in the early stages of pregnancy. By childbirth, the value of the parameter can exceed the initial value by three to four times. This is considered the norm. A higher rate is found in women who have a complicated pregnancy (preeclampsia), as well as in those who suffer from kidney disease and diabetes.

10. Platelets

These are blood platelets that take part in ensuring hemostasis. They are formed in the bone marrow. The standard value is 150-400 thousand/µl. In some cases, healthy women may experience a decrease in platelet count to 130 thousand/μl. A significant decrease in the amount of these blood elements is called “thrombocytopenia” and occurs as a result of a decrease in the formation of blood platelets, an increase in their consumption or destruction. With insufficient nutrition, platelet formation decreases. In DIC syndrome, which will be discussed below, the consumption of the described formed blood cells increases.

11. DIC syndrome

The interaction of platelets, fibrinolysis and coagulation factors ensures a balance between the anticoagulant and coagulation systems. If any of these links are disrupted, quite serious complications can arise during pregnancy. The most dangerous of them is considered disseminated intravascular coagulation. It develops due to activation of the fibrinolysis and coagulation systems. In pregnant women, the causes of DIC syndrome can be amniotic fluid embolism, premature placental abruption, and endometritis.

12. Antiphospholipid syndrome (APS)

It is a complex of symptoms characterizing thrombosis (venous and arterial). Women with APS have a high risk of miscarriage and spontaneous abortion, because in this case the increase in the number of placental vessels is disrupted, and fetoplacental insufficiency develops. To diagnose antiphospholipid syndrome, in addition to increased thrombus formation, antibodies to the outer shell of membranes (phospholipids) are also determined.

In conclusion

The considered coagulogram indicators are not exhaustive. As noted above, the selection of specific parameters for the study depends on various factors. Test results can be obtained within a day after donating blood.