Coagulogram - a comprehensive analysis of blood coagulation parameters. Studies of venous blood by coagulometry help to assess the state and effectiveness of the functioning of various parts of such blood systems as coagulation, anticoagulation and fibrinolytic.
Coagulogram or hemostasiogram parameters are studied to assess the possible risk of hyper- and hypocoagulability, respectively, increased and decreased blood clotting ability, the likelihood of blood clots or bleeding.
How to prepare for a blood clotting test
This study is carried out strictly on an empty stomach, with a break after the last meal of at least 12 hours. At the last meal, it is recommended to exclude spicy, fatty, canned foods with an abundance of spices from the diet. Of the drinks, only pure, non-mineral water is allowed, juices, compotes, drinks and alcohol are excluded.
Immediately before the analysis, it is recommended to avoid physical, emotional and mental stress (fast walking, excitement), as well as smoking, for 30 minutes.
For current or recently completed anticoagulant treatment, the name, dosage, and duration of treatment should be reported to the specialist.
If during the blood sampling process there is a feeling of nausea, dizziness, deterioration of health, you must immediately inform the medical staff.
How is the analysis carried out?
Venous blood is collected from the cubital vein without a tourniquet. To comply with the rules of coagulology, two test tubes are filled, the biomaterial from the second in order of filling the container containing the coagulant is subject to research.
Where do they donate blood for a hemocualogram?
A blood test for a hemostasiogram is carried out in public and private clinics and laboratories, this analysis is one of the basic ones. All certified laboratories with the necessary set of reagents and equipment can analyze hemostasis.
The cost of the tests depends on the laboratory and the set of blood factors being evaluated.
How many days is a coagulogram done?
The blood test itself takes from 24 to 48 hours, which is due to the need to evaluate various indicators when interacting with reagents at certain intervals. With a high workload of laboratory assistants, the need to transport biomaterial, the study time may increase.
In what cases is a blood test prescribed for a coagulogram
Regardless of the presence of any symptoms and signs of blood coagulation pathologies, a hemostasis test is prescribed in preparation for surgery and during the gestational period. In this way, the likelihood of life-threatening risks of bleeding and thrombosis during surgery or delivery (naturally or with caesarean section) is assessed.
Other indications for this analysis are:
- gestosis of pregnancy, as well as repeated miscarriages;
- injuries accompanied by internal and / or external bleeding;
- the presence of a tendency to thrombosis, varicose veins, a tendency to thromboembolism;
- heart attack, history of stroke, pre-infarction conditions, ischemia, arrhythmia;
- pathology of the circulatory system;
- violations of the liver;
- control of the state during therapy with anticoagulants;
- hemorrhagic pathologies, chronic anemia, frequent nosebleeds, heavy menstruation, inclusions of blood in secretions (urine, feces), sudden loss of vision, etc.;
- long-term therapy with anabolic drugs, glucocorticosteroids, oral contraceptives;
- scheduled medical examination.
Components of the hemostasis system
The hemostasis system includes biological substances and biochemical mechanisms that maintain blood in a liquid state, as well as prevent and stop bleeding. The main function of the hemostasis system is to maintain a balance between coagulating and anticoagulant factors. The imbalance is realized by hypercoagulability (increased blood clotting, leading to the formation of blood clots) and hypocoagulation (reduced clotting, threatening prolonged bleeding).
Blood clotting is provided by two mechanisms: external and internal. With tissue injuries and violations of the walls of blood vessels, tissue thromboplastin (factor III) is released, which triggers the external process of blood coagulation. The internal mechanism requires contact between the collagen of the endothelium of the vascular walls and blood components.
Indicators and norms of hemostasis
When examining indicators, different laboratories may use different methods. Thus, the rate of the coagulation process varies from 5-10 to 8-12 minutes, depending on the chosen technique (according to Lee-White or Mass and Margot). The assessment of the conformity of results with the norm should be carried out in accordance with the standards of a particular laboratory.
Each norm of the coagulogram and its components in the table is given without taking into account age and sex indicators and individual characteristics. To decipher the indicators of hemostasis, you need to contact a specialist.
Deciphering indicators of hemostasis
What is included in the coagulogram study? The basic study of hemostasis includes several indicators evaluated in combination.
Blood clotting time
This indicator assesses the rate of formation of a fibrin clot at the site of injury and is assessed by the time interval between the onset of bleeding and cessation. For venous blood, the reference thrombus rate is 5 to 10 minutes.
Exceeding the indicator often indicates the presence of such diseases and conditions as thrombocytopenia, hemophilia, vitamin C deficiency, liver pathology, and also occurs during therapy with indirect anticoagulants (Trental, Warfarin, Aspirin, etc.). A value below normal indicates an accelerated ability to form clots, and may also decrease after extensive bleeding. In women, a decrease in clotting time is noted against the background of taking.
PTI indicator
The prothrombin index shows the ratio of the blood clotting time of the studied and accepted standard. The most favorable indicator is considered to be 97-100%, corresponding to the general norm. However, deviations do not unequivocally indicate a deviation in the functioning of the body: in women, during gestation, during pregnancy, PTI can reach 150%, which is a physiological feature of the gestational period. On average, an excess of the normal range indicates the likelihood of thrombosis, a decrease indicates the risk of bleeding.
Thrombin time indicator
Thrombin time is the period required for the conversion of fibrin from fibrinogen. Thrombin time above normal indicates a reduced amount of fibrinogen in the blood, and also accompanies severe pathologies and liver diseases (cirrhosis).
An indicator below the norm is most often associated with an increased amount of fibrinogen.
APTT as a factor in controlling the intake of anticoagulants
APTT is measured based on the duration of clot formation during the reaction of the biomaterial with calcium. This indicator is especially relevant for monitoring and correcting therapy with direct coagulants (Heparin). It can also indicate DIC, the presence of autoimmune diseases, liver pathologies.
AVR
The AVR indicator allows us to assess the likelihood of pathologies such as thrombophilia, thrombocytopenia, and also changes during anticoagulant therapy, with significant internal injuries, burns.
A pronounced non-compliance with the norm is especially dangerous at an extremely low rate and indicates the development of a life-threatening condition - extensive and prolonged bleeding.
VLOOKUP
The CDF index is evaluated in correlation with the activated recalcification time. Low values indicate increased activity of hemostasis.
Estimation of the amount of fibrinogen
The fibrinogen protein belongs to blood coagulation factors I. It is produced in the liver and a change in its amount may indicate the pathology of this organ. Exceeding the norm of this indicator may accompany inflammatory diseases and tissue injuries, the deficiency is assessed as primary (genetic etiology) or secondary, provoked by excessive consumption in the process of hemostasis.
Thrombotest
Thrombotest is a method for visually assessing the amount of fibrinogen in a biomaterial. Normally, this indicator corresponds to level 4-5.
RFMC
Evaluation of the concentration of soluble febrin-monomer complexes is important in the diagnosis of DIC. The interpretation of indicators is also important in case of thrombosis, complicated pregnancy, impaired renal function, during the recovery period after invasive procedures, etc.
Antithrombin III
Glycoprotein related to natural anticoagulants. Its norms vary considerably depending on the age of the patient. The norm of antithrombin 3 in women also changes during pregnancy, which is not a pathological condition.
Causes of excess and deficiency of antithrombin III
D-dimer as an indicator of hemostasis
D-dimer is a breakdown product of fibrin; fibrinolytic activity of plasma is estimated by its amount. An increase indicates the presence of intravascular thrombosis, liver disease, ischemia or myocardial infarction, and can also be formed during prolonged smoking.
The deficiency of the indicator has no clinical significance.
Bleeding Time Estimation
In the study of this indicator, the period from the onset of bleeding to the formation of a clot in the capillary is studied. Method of carrying out: with a sharp sterile needle, a superficial injury is applied to the earlobe and the time from the beginning to the stop of bleeding is estimated. Diagnostic value has an indicator exceeding the norm.
Features of hemostasis of pregnant women: research and interpretation of results
Changes that occur during the gestational period are reflected in all body systems, including the process of hematopoiesis. During pregnancy, hemostasis norms change, and the assessment should be carried out on the basis of the compliance of the gestation period with the reference values.
The main factor in the change in blood coagulability is associated with increased risks of bleeding during abortion, placental abruption and during childbirth, in connection with which fibrinolysis is suppressed.
Hemostasis of the gestational period
The norm indicators change with an increase in the gestational age.
| Norm 1 trimester | Norm 2 trimesters | Norm 3 trimesters | |
| fibrinogen | 2,9-3,1 | 3,0-3,5 | 4,4-5,1 |
| APTT | 36-41 | 33,6-37,4 | 37-40 |
| AVR | 60-72 | 56,7-67,8 | 48,2-55,3 |
| PI | 85,4-90,1 | 91,2-100,4 | 105,8-110,6 |
| RFMC | 78-130 | 85-135 | 90-140 |
| Antithrombin III | 0,222 | 0,176 | 0,155 |
| platelets | 301-317 | 273-298 | 242-263 |
Before surgical interventions and when diagnosing various diseases, doctors refer patients to a blood test for clotting. This indicator is very important for the normal functioning of the whole organism as a whole, because with deviations in one direction or another, there is a risk of developing serious diseases. The results of the study will tell the doctor about the deviations existing in the body. Let's figure out what the norm of the coagulogram should be and what its main indicators tell the doctor.
Description of the analysis
A blood coagulogram is a study that shows how quickly a clot is formed. It should be noted that in most cases the patient is given a conventional coagulogram. It reports on the state of the hemostasis system, in particular on the number of platelets and their aggregation, capillary resistance and bleeding time, as well as some other blood parameters. However, sometimes a doctor may need a detailed coagulogram to make a diagnosis, which analyzes and deciphers a number of other factors.
Each of the decoding indicators correlates with certain functions of the human body. Therefore, a deviation from the norm of the coagulogram in one direction or another will tell you which organ or system is not working properly, and what should be given special attention. Deciphering the analysis is subject only to a specialist.
There is no need to try to diagnose yourself, because the result of treatment directly depends on the accuracy of the diagnosis.
For the convenience of analyzing the results of the study, a single table is made in which the obtained indicators and norms for each of them are entered. It should be noted that the diagnosis should be made taking into account the level of all indicators listed in the table. An analysis for blood clotting, the norm of which depends on age, is possible only in laboratory conditions.
So, let's take a closer look at what kind of analysis it is and with its main indicators.
Clotting time
This indicator is determined by the time interval between the moment of damage to the wall of the blood vessel (for example, a cut) and the moment the bleeding stops, which occurs due to the formation of a fibrin clot. It characterizes the efficiency of platelets. For capillary blood, the clotting time is 0.5-3 minutes, sometimes it can be extended up to 5 minutes. For venous blood, this indicator is normally 5-10 minutes.
An increase in the indicator above the specified norms indicates a decrease in the number of platelets, a lack of vitamin C, or liver diseases. It can also grow while taking contraceptives, anticoagulants.
Prothrombin index
This indicator correlates with prothrombin time (PT). PTI, like the previous indicator, is determined by the duration of blood clotting, however, this process occurs when calcium and thromboplastin are added to the test sample. Thus, the ability of blood to clot with a sufficient level of thromboplastin is being investigated.
The norms of the indicator depend on the age of the patient. For newborn children, IPT is 13-18 seconds, for school-age children - 12-16 seconds, for adults 11-15 seconds.
Deviation of PTI from these norms indicates chronic liver diseases, poor intestinal absorption, and the presence of dysbacteriosis. An increase in IPT in pregnant women is considered natural and normal.
This index is directly related to the level of vitamin K in the body.
The IPT evaluates the effectiveness of indirect anticoagulant therapy. If, while taking drugs, PV increases by 1.5-2 times, then the dosage is considered sufficient.
If the clotting time increases more than normal, then the risk of blood clots increases. The same result can cause the use of oral contraceptives. A very low PV indicates a risk of bleeding.
The value of the index is determined by the ratio of the PV of the blood plasma of a healthy person to the PV of the blood plasma of the test sample. Normal coagulogram PI should be 93-107%. In case of any deviations in the indicator, the patient is assigned an additional examination.
INR
The name of this indicator is an abbreviation for the International Normalized Ratio, but it is also called the prothrombin ratio. It was introduced by WHO in 1983 in order to unify the work of laboratories around the world, since each of them used different thromboplastins as reagents for research.
This indicator is calculated as the ratio of the patient's PT to the mean prothrombin time.
It is used to control the treatment of patients with indirect anticoagulants, such as phenylin or warfarin, that is, drugs that impair blood clotting. People who are indicated for therapy with these drugs should monitor INR at least once every three months. A decrease in INR indicates the low effectiveness of the drugs taken, a possible risk of vascular thromboembolism.
An increase in this indicator can be caused by liver disease, nephrotic syndrome, hereditary disorders of coagulation factors and can cause frequent bleeding.
The INR coagulogram is included in an extended study, which the doctor prescribes in addition to the main one.
APTT
This indicator is determined by the time required for the formation of a blood clot after the addition of special reagents to the plasma - activated partial thromboplastin time. APTT is the most accurate and sensitive element of the blood test, as it characterizes its ability to clot under the influence of plasma factors.
For a normal coagulogram, the APTT value is 30-50 seconds. Its value changes dramatically when any of the components of the coagulogram deviates from the hole by more than 30-40%. Too low a result indicates that the blood has increased clotting, which increases the risk of blood clots. Such an APTT result can be obtained in violation of the sampling technique for a blood test. Indicators above the norm may be signs of hemophilia, the 2nd and 3rd phases of the disseminated intravascular coagulation syndrome (DIC), an autoimmune disease, and severe liver pathology.
The value of APTT increases during treatment with heparin or its analogues.
APTT is a mandatory component of a standard coagulogram.
fibrinogen
This specific protein produced by the human liver is considered to be the first plasma coagulation factor. A fibrin clot, formed as a result of a series of chemical reactions, is the main component of a thrombus.
Normally, the protein concentration should be in the range of 5.9-11.7 µmol/l, which corresponds to 2-3.5 g/l. However, with liver diseases, its production is reduced. Low protein content can be caused by hereditary factors.
Protein concentration increases dramatically during acute infectious diseases or inflammatory processes (pneumonia, pyelonephritis, peritonitis), with a deficiency of thyroid hormones and in the presence of malignant neoplasms. Against the background of increased coagulability, there is a risk of developing complications in the work of the cardiovascular system.
The value of the coagulogram increases significantly during pregnancy, but this is normal, since in this way the body prepares for future blood loss. However, this indicator is necessarily controlled once every three months throughout the entire period of bearing the baby. There were fluctuations in the direction of increasing the concentration of fibrinogen in women during menstruation. In small children, normal protein coagulograms are significantly lower than in adults, and amount to 1.25-3 g / l.
Dimer
The dimer is the breakdown product of fibrin, which forms a blood clot. Its quantity makes it possible to judge the intensity of the processes of formation and disintegration of fibrin clots.
The dimer concentration is affected not only by blood clotting, but also by the size of the clot.
Exceeding the norm indicates the presence of hematomas, vein thrombosis, vascular thromboembolism, coronary heart disease, vascular problems caused by prolonged smoking, rheumatoid arthritis.
RFMC
The amount of soluble fibrin-monomeric complexes in the blood plasma makes it possible to estimate the rate of fibrin clot cleavage under the influence of plasmin and thrombin.
To diagnose diseases, the doctor pays attention to the upper threshold of the level of RFMK. Normal for 100 ml. should be 4 mg. RFMK. A higher content of complexes is fraught with the risk of intravascular thrombus formation.
An increase in the concentration of RFMK indicates the presence of:
- various thromboses,
- pregnancy complications,
- shock states,
- sepsis
- kidney failure,
- connective tissue pathologies.
A decrease in the concentration of RFMK is fixed during the administration of heparin, which makes it possible to identify patients in need of heparin therapy.
This indicator is not included in the standard examination factors, but is determined using an expanded coagulogram. Most often, it is examined before surgery.
AVR
Activated recalcification time reflects one of the stages of blood coagulation, showing how long fibrin is formed in calcium-rich and platelet-rich plasma. A period of 50-70 seconds is considered a normal indicator. Exceeding the norm may indicate hemophilia, and too short a time - an increased likelihood of blood clots.
fibrinolytic activity
We got acquainted only with the most basic indicators of the coagulogram, characterizing the general state of the hemostasis system, and allowing the doctor to diagnose a number of serious internal diseases. In the decoding of the analysis, there may be a much larger number of parameters under study, on the basis of which a decision will be made about the effectiveness of the therapy or the possibility of surgical intervention.
In contact with
Our organism protect numerous mechanisms that ensure homeostasis - the constant constancy of the internal environment of our body. One of the most important of them is the system of hemostasis or coagulation, which prevents blood loss when the integrity of the bloodstream is damaged. In the process of blood clotting and clot formation, there are dozens of reactions that can be influenced by hundreds of different chemicals. And in itself, this system includes a number of other regulatory mechanisms, some of which increase blood clotting, while others lower it.
Due to the great importance of the system hemostasis For the stable functioning of the body, various methods have been developed in clinical medicine to study this protective reaction of the body. The most common analysis for the study of blood clotting is the determination of the coagulogram, which includes determining the time required to stop bleeding and the number of various factors of this system. This study provides a lot of information about the state of the body as a whole, because the normal operation of the hemostasis system depends on the proper functioning of various organs and systems, so any disturbances in their work are reflected in the coagulogram.
There are a number testimony that warrant this study. Firstly, the determination is mandatory before surgical interventions - during operations, the integrity of the bloodstream is significantly violated, which must be eliminated by the hemostasis system. Otherwise, severe complications may develop in the postoperative period. Secondly, this analysis is often prescribed for pregnant women - due to strong hormonal changes, various blood clotting disorders are possible, both in the direction of its decrease and increase. Thirdly, the determination of the coagulogram is desirable for diseases of various organs that are somehow related to the process of blood clotting - first of all, these are the liver, spleen, bone marrow, and the cardiovascular system. Also, autoimmune diseases have their influence on the formation of blood clots. Finally, determining the activity of the blood coagulation system is useful and, in some cases, necessary before prescribing certain drugs - anticoagulants (for example, heparin), acetylsalicylic acid, hormonal contraceptives.
Donating blood for determination activity of the coagulation system requires some preparation. 8-12 hours before the study, you should not take food, alcoholic beverages, coffee or strong tea. Some of the parameters of the coagulogram have a certain instability, especially in stressful conditions for the body, therefore, before and during the test, one should not be nervous or subjected to heavy physical exertion. Immediately before blood sampling, a person is given a glass of clean water to drink - this increases the accuracy of the study. Blood is taken from a vein in the arm and immediately begin to determine the main indicators.
Exists basic and detailed blood test to determine the coagulogram. The norm of the basic coagulogram looks something like this:
Despite such a large number indicators, usually the form of the basic coagulogram contains only the main ones - fibrinogen concentration, clotting time, activated recalcification time (AVR), activated partial thromboplastin time (APTT), prothrombin index, thrombin time, the amount of soluble fibrin-monomeric complexes. Based on these values, one can indirectly determine the activity of a particular factor.
clotting time- one of the basic indicators, which is determined by one of the first. Its value depends on the type of material of the test tube in which the indicator is determined. In a glass container, the formation of a blood clot normally takes from 5 to 7 minutes, while in a silicone tube, the normal clotting time is 12-25 minutes. Due to such a large difference between the two norms of this indicator, depending on the material of the container, it is necessary to specify in the analysis form whether a silicone or non-silicone tube was used for this. The lengthening of this indicator indicates a decrease in the activity of the hemostasis system or an increase in the thrombolytic ability of the blood, and a more rapid formation of a blood clot indicates the opposite phenomenon - an increase in the activity of blood coagulation, or a decrease in the antithrombin system. The causes of these phenomena are determined by other indicators of the coagulogram.
fibrinogen concentration- one of the main proteins of the hemostasis system - is also a key indicator of the coagulogram. It is this soluble protein that, during the formation of a blood clot, turns into strands of insoluble fibrin, which forms a thrombus. The norm of its content is 2-4 g / l of blood plasma, which is a fairly high indicator. It is characteristic that in pregnant women on the eve of childbirth (in the third trimester), there is an increase in the content of fibrinogen up to 6 g / l, which is a normal preparation of the body for bleeding that accompanies the birth of a child. However, you should carefully monitor this indicator - its excessive increase can cause blood clotting right inside the bloodstream, which underlies the onset of DIC, often leading to death. In addition to pregnancy, the level of fibrinogen increases with various inflammatory processes, shocks of various origins, and endocrine disorders.
Decrease in this indicator coagulograms causes increased bleeding and an increase in blood clotting time. The cause of this condition may be some liver diseases (hepatitis, cirrhosis), lack of vitamins (K, C, B) and related diseases of the gastrointestinal tract (dysbacteriosis, Crohn's disease, malabsorption syndrome), taking certain drugs, as well as the second stage of DIC.
Activated Recalcification Time (ART) in a coagulogram, it characterizes how quickly the level of calcium ions (which are involved in the formation of a blood clot) in the blood plasma is restored. The normal phenomenon is the value of this indicator in the range from 1 to 2 minutes (60-120 seconds). An increase in the duration of recalcification indicates a reduced blood coagulation activity, which is a consequence of an insufficient number of platelets in the blood or their functional inferiority, a lack of the main factors of the hemostasis system, an increased activity of the antithrombin system, and also in the second stage of DIC, when there is an exhaustion of the entire blood coagulation system .
Decreasing time recalcification speaks of increased thrombosis - with thrombophlebitis and thrombosis.
Activated partial thromboplastin time (APTT)- characterizes the time it takes for the formation of a blood clot. The norm of this parameter of the coagulogram is 35-45 seconds, but when using some types of reagents, 28-35 seconds can also be considered the norm. A shortening of this time is not a characteristic clinical sign of any disorders, but a significant increase occurs with the use of anticoagulants (heparin), an acquired or congenital deficiency of the main blood coagulation factors (for example, hemophilia), with some autoimmune diseases (systemic lupus erythematosus).
Prothrombin index- the ratio of human plasma time to the reference value. This indicator of the coagulogram is expressed as a percentage and is normally 78-142%. The prothrombin index is the most accurate value that determines the efficiency of the entire hemostasis system. A decrease in this indicator is a sign of low blood clotting, which occurs as a result of a lack of key factors, vitamin K deficiency, diseases of the liver and gastrointestinal tract. An increase in the protombin index indicates a high risk of thrombosis and related disorders - myocardial infarction, stroke, kidney damage, thromboembolism of various vessels.
thrombin time- an indicator closely related to the level of fibrinogen in the blood. Physically, it represents the time during which a certain amount of fibrinogen passes into insoluble fibrin - the norm is from 10 to 20 seconds. With an increase in this time, a decrease in the level of fibrinogen is observed, or this phenomenon is due to the activity of fibrinolytic systems and factors - for example, in liver diseases, pancreatitis. Also, an increase in thrombin time occurs with the use of anticoagulants. A decrease in this indicator of the coagulogram is observed in the last trimester of pregnancy and other factors leading to an increase in the level of fibrinogen in the blood.
The amount of soluble fibrin-monomeric complexes- these proteins are a transitional link between fibrinogen and fibrin. The norm of their content in blood plasma is 3.36-4.0 mg per 100 ml of plasma. An increase in the number of these complexes indicates an increased activity of the hemostasis system. A decrease in this indicator is observed with a general decrease in the activity of the blood coagulation system. This indicator is the first to respond to the use of anticoagulants, therefore it is the most accurate and sensitive method for determining the effectiveness of anticoagulant therapy, which is widely used in clinical practice.
Typically, after analysis an extended study is performed to compile a basic coagulogram, which is used to confirm problems with blood clotting. The purpose of obtaining an extended coagulogram is to more accurately determine the causes of certain blood clotting disorders. As part of the extended analysis, a number of additional indicators are determined.
Protein C is one of the most important anticoagulant factors. Its level is expressed as a percentage of the reference indicator, the norm of determination in the extended coagulogram is 60-140%. With a decrease in this indicator, the blood coagulation system begins to prevail, which leads to increased thrombosis. The reason for the decrease may be liver disease and vitamin K deficiency, which often develops as a result of colon dysbacteriosis. Also, a decrease in the level of protein C may be due to genetic factors.
D-dimer is a product of partial disintegration of a fibrin clot (thrombus), therefore, with increased thrombus formation, the level of this indicator also increases. The content norm - its amount should not exceed 500 ng / l. In pregnant women in the last trimester, due to a general increase in the activity of the hemostasis system, the level of D-dimers may slightly exceed the norm. In other cases, a significant increase in this indicator is a symptom of thrombophlebitis, disorders in decompensated diabetes mellitus, and toxicosis.
Antithrombin-3, as well as protein C, is an anticoagulant factor, the norm of which is from 75 to 110% of the reference value. A sharp decrease in the content of this factor plays a special role, since in such a situation the risk of thrombosis with the development of an embolism or even DIC increases significantly.
Antibodies to phospholipids also called lupus antibodies, are normally completely absent in the blood. Their appearance in plasma is a sign of systemic lupus erythematosus, a severe autoimmune disease. The determination of their content in plasma within the framework of an extended coagulogram is due to the fact that this type of antibody destroys platelets and thereby sharply reduces blood clotting.
Level platelets when determining the coagulogram, it is rarely determined, since often this value is already known from the general blood test. However, the role of platelets, the norm of which is 180-320 billion per liter, in the development of a blood clot is enormous, so it makes no sense to start any research without first determining their number.
Educational video of decoding the coagulogram in normal and abnormal conditions
You can download this video and view it from another video hosting on the page:.Why take a blood test for clotting? What are the indications for a coagulogram? What will the decoding of a blood coagulogram tell about? What pathological processes and diseases can be indicated by deviations of certain markers of blood coagulation from the reference values? We will try to answer these questions in as much detail as possible in this article, covering all indicators of blood coagulation.
So, coagulogram with decoding.
fibrinogen
This is the so-called factor I blood clotting. Transforming into fibrin - the insoluble basis of a blood clot - plays a key role in the formation of a blood clot and, thus, in stopping bleeding.
When is a plasma fibrinogen test indicated:
- As one of the examinations before surgical interventions.
- In the presence of inflammatory processes.
- With cardiovascular diseases.
- During pregnancy for prenatal diagnosis.
Table of reference values, hemostasiogram indicators:
What does an increase in the level of fibrinogen in the blood mean? Fibrinogen is elevated during the development of a heart attack, stroke, pneumonia, cancer, as well as acute inflammation, thyroid dysfunction, and amyloidosis. In addition, exceeding the norm may occur while taking estrogens and oral contraceptives, in case of burns and surgical interventions. Decoding of the analysis should be carried out by a doctor.
In the case of a low level of fibrinogen in the blood, a coagulogram may indicate:
- lack of vitamins B12 and C;
- serious pathologies of the liver with hepatitis or cirrhosis;
- DIC;
- embolism of newborns (in this case we are talking about embolism with amniotic fluid);
- toxicosis of pregnant women;
- myeloid leukemia;
- polycythemia.
Lower, compared with the norm, will be the level of fibrinogen in the blood plasma during the period of taking anabolics and androgens, as well as fish oil, as a result of snake venom poisoning.
Thrombin Time (TV)
This time is called thrombin because it characterizes the time period during which the fibrin already mentioned by us under the influence of calcium ions turns into a thrombus.
When a blood test is prescribed to determine thrombin time:
- when it is necessary to determine how sufficient the level of fibrinogen in the blood is and what its effectiveness is, that is, whether the fibrinogen present in the blood copes with its functions;
- to monitor the effectiveness of treatment with fibrinolytics;
- to control the condition of patients with DIC;
- with severe liver disease;
- to confirm miscarriages;
- to detect fibringen and (or) fibrin breakdown products in blood plasma.
Reference values of the blood coagulogram index:
If the TV on the coagulogram is lowered, this means that blood clots form very quickly, which is fraught with blockage of blood vessels and thrombosis, often leading to death.
Among the reasons for the increase in TV:
- congenital fibrinogen deficiency;
- autoimmune diseases;
- liver failure, hepatitis;
- the presence of DIC;
- general hypovitaminosis against the background of hypervitaminosis with vitamin K;
- therapy with direct anticoagulants;
- the development of infectious processes in the body;
- violation of blood circulation.
prothrombin time
This indicator of blood coagulation will tell us how quickly coagulation occurs and a blood clot is formed. Indications for referral for PTV test:
- general examination;
- preoperative examination;
- the likelihood of internal bleeding and hemorrhage;
- the likelihood of thrombosis;
- the assumption of violations of hemostasis;
- diagnostics of pathological processes in the liver;
- cardiovascular diseases;
- thromboembolism;
- therapy with direct and indirect anticoagulants;
- suspicion of chronic anemia;
- nosebleeds.
What are the normal values for the coagulogram index Prothrombin time? As a rule, it is 11-16 seconds. During pregnancy, the upper limit is a couple of seconds longer. However, different brands of laboratory equipment may have their own standard indicators depending on the methods and conditions of testing. Decoding of indicators should be carried out by a doctor. When PTV is lowered:
- in the last three months of pregnancy;
- with low-dose aspirin therapy;
- when using oral contraceptives;
- in the presence of polycythemia (an increase in the number of red blood cells in the blood);
- in case of deep vein thrombosis.
An increase in PTV compared to the standard value may mean:
- congenital or acquired insufficiency of certain blood coagulation factors;
- DIC;
- treatment with warfarin;
- progressive hypovitaminosis of vitamin K (against the background of pathologies of the pancreas and gallbladder, imbalance of microflora);
- an increase in antithrombin in the blood.
The deviation of PTV from the norm towards an increase may also be due to the intake of certain antibiotics, laxatives, hormonal drugs and aspirin).
Prothrombin index
Normally, this indicator of a blood test is 95–105%, when analyzing a blood sample according to Quick, it is 78–142%. If the indicator is below the reference value, this may be evidence of:
- insufficient amount of vitamin K, which affects blood clotting;
- treatment with coagulants;
- pathology in the liver;
- congenital or acquired lack of fibrinogen;
- congenital deficiency of certain blood clotting factors.
If the PTI on the coagulogram is higher than normal, then this may indicate a deficiency:
- congenital - prothrombin, plasma Ac-globulin, proaccelirin (labile factor), proconvertin (stable factor), Stuart-Prauer factor;
- acquired - coagulation factors caused by nephrotic syndrome, amyloidosis, impaired liver function;
- vitamin K.
And also take place against the background of therapy with direct anticoagulants, the presence of heparin in the blood, leukemia DIC, antibiotic treatment, taking anabolics, laxatives, aspirin, nicotinic acid, etc., taking hormonal contraceptives.
Activated partial thromboplastin time
The study of this indicator can be assigned to the patient along with the tests described above. This is usually due to the following reasons:
- bleeding;
- heart attack;
- intestinal necrosis;
- control of therapy in the presence of DIC;
- infertility, miscarriages, abortions;
- examination before surgery;
- diagnosis of hemophilia;
- thromboembolism;
- deep vein thrombosis;
- damage to the main vessels.
Normal APTT values:
An increase in the APTT value warns of the risk of bleeding against the background of:
- hemophilia;
- insufficient amount of vitamin K;
- the presence of lupus anticoagulant in the blood;
- genetic abnormalities;
- acute leukemia;
- DIC;
- postpartum hemorrhage.
APVT in the coagulogram below the norm indicates a predisposition to hemophilia, bleeding and thromboembolism as a result of antihemophilic globulin deficiency, thromboembolism, the initial stage of DIC in a child.
When assessing the APVT indicator in combination with PTT, the decoding of the blood coagulogram can be as follows:
- the norm of APVT with increased PTT means the likelihood of liver pathologies, vitamin K deficiency and weak function of blood coagulation factor VII;
- APVT rate + PTT rate in the presence of lupus anticoagulant in the sample is evidence of von Willebrand disease;
- elevated APVT and PTT, which means we can talk about serious problems with the liver, fibrinogen and prothrombin deficiency;
- normal PTT + a slight decrease in APTT indicate normal blood clotting or a slight lack of clotting factor.
D-dimer test These coagulation parameters are valuable for their high negative predictive value. The accuracy in this case is up to 98%.
How to evaluate the decoding of the coagulogram in this case? If the D-dimer coagulation parameters are normal, then thrombosis is excluded with practically the specified probability.
Elevated values will indicate that blood clotting is more active and there is a high risk of thrombosis.
A negative result of this test is extremely rare, only in 2% of cases. First of all, when obtaining such a result, possible errors are excluded even at the stage of material sampling, a re-analysis is done. And even then, the obtained value below the normative threshold may indicate a small thrombus size, a decrease in FAP (plasma fibrinolytic activity or the ability to spontaneously dissolve blood clots) or a high level of PAI–I plasmogen inhibitor activator. However, here begins the complex topic of genetics, and to understand it, you need a separate article.
Lupus anticoagulant
The specificity of this indicator is that, as such, it is of little significance for diagnosis on its own and is considered by experts as one of the factors in a series of tests. So, with a positive result of the analysis, one can assume the presence of blood clots, oncology, inflammation or AIDS. However, it is possible to make a correct diagnosis only by evaluating a set of indicators.
Coagulogram indicators proteins C
Deficiency of this protein argues the risk of thrombosis and is inherited. The probability of developing this pathology depends on the form of inheritance, which is determined in the process of genetic analysis. Depending on its result, DIC and neonatal purpura (with a homozygous form of gene carriage) may be detected at an early age, or the risk of thrombosis and low sensitivity in acticoagulant therapy in adolescence may increase.
When is a protein C test ordered?
- with thrombosis;
- if direct relatives have a congenital deficiency of this protein;
- on the results of other blood clotting tests.
Reference values of protein C in the coagulogram:
- activity - 70–130%;
- amount - > 3 mg / ml or 60 nmol / l.
Protein S
The normal values for these indicators of hemostasiogram in blood plasma are 140%, in free form - 65–144%. At the same time, you need to know that women have slightly less of this protein than men.
The lack of proteins S is the cause of venous thrombosis, especially at a young age.
Plasma heparin tolerance
Normally, this indicator of the coagulogram is 7-15 minutes. If the upper limit of the reference value is exceeded, this indicates a decrease in heparin resistance, which is often the case in cases of liver disease. If the blood coagulogram shows that the test result did not reach the lower normal value, this may indicate oncology, diseases of the cardiovascular system, during pregnancy and in the postoperative period.
RFMK or soluble fibrin-monomer complex
The normal value of the test is 3.36-4 mg / 100 ml of plasma. If rfmk is elevated, this may indicate disturbances in the hemostasis system, thrombinemia (excessive number of microthrombi in the vessels).
RFMK can be below normal while taking anticoagulants, as a rule, if the recommended doses are violated, which makes the blood begin to clot poorly.
Duke bleeding time
Normally, bleeding in this sample stops completely within 1.5–2 minutes. This indicator of the coagulogram is diagnostically significant only with a comprehensive assessment of blood tests.
Coagulation according to Lee White
The reference values of the indicator fit into the time interval of 4–7 minutes for a glass tube and 15–25 for a silicone tube.
If this indicator of coagulability exceeded the norm, this may indicate a violation of the thyroid gland, anaphylactic shock, blood loss.
This phenomenon can also occur as a result of vascular manipulation.
Deceleration of clotting time in this test often indicates liver disease, severe infections, hemophilia and oncological heparin therapy and treatment with other anticoagulants.
Antithrombin III
This blood test for a coagulogram is indicated for:
- suggestion of venous thrombosis;
- after surgery for the removal of a blood clot;
- with low sensitivity to heparin,
- as well as in combination with tests for proteins C, S and lupus anticoagulants.
The values of the indicator are normal:
There is also a separate scale of standard values for pregnant women.
If this indicator of the oagulogram is elevated, this may mean:
- long-term therapy with warfarin, phenylin;
- lack of vitamin K in the body;
- the presence of acute viral hepatitis and other liver diseases;
- the course of the inflammatory process;
- period of menstruation in women.
Underestimated values indicate:
- predisposition to thrombotic processes;
- the last weeks of pregnancy;
- middle of the menstrual cycle.
Coagulation is a complex and very important process in the human body; a coagulogram blood test allows you to control it. Hemostasiogram in adults and children should be deciphered by a doctor. Yes, indeed, this is the lot of a specialist, and quite experienced and qualified. Without sufficient knowledge, it is simply impossible to interpret the indicators of the caogulogram correctly. Therefore, your own interpretation of the results of the coagulogram is not a reason to correct the treatment prescribed by the doctor, otherwise the results may be unpredictable.
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Any doctor starts treating a patient only after collecting anamnesis and a number of laboratory tests that allow making the correct diagnosis. Today we’ll talk about a coagulogram - what kind of analysis is it, and in what cases is it prescribed? Coagulation study is an important laboratory blood test that gives an idea of the development of the disease, allows you to make an accurate diagnosis and choose the best method of treatment.
Coagulogram: what is it?
Coagulogram (hemostasiogram) is a special study that allows you to determine the indicators of blood clotting. In simple terms, this is one that shows good or bad blood clotting. This study gives an idea of the state of hemostasis, and allows you to identify conditions such as hypo - or hypercoagulation.
Hypercoagulation (increased blood clotting) indicates the risk of thrombosis and the development of dangerous pathologies such as thromboembolism or thrombosis.
Good to know
Hypocoagulation (reduced clotting) - can lead to bleeding that threatens the life of the patient.
These indicators are very important to consider when preparing for surgery and other medical procedures. The result of the coagulogram helps to determine how the operation or the birth process will go, whether it will be possible to stop the bleeding and save the patient in emergency situations, when the time counts down to seconds.
Who is prescribed a coagulogram analysis?
Doctors advise doing a coagulation test before any surgery, but a coagulogram during pregnancy is of particular importance. For women who are carrying a child, this analysis is mandatory, during which it is taken three times, which allows you to timely identify and eliminate many problems, including such a dangerous condition as placental abruption. In addition, the following conditions are indications for a blood coagulation test:
- severe course of preeclampsia in a pregnant woman;
- preparation for surgical interventions (including caesarean section and childbirth);
- varicose veins and a high risk of thrombosis;
- taking certain drugs (hormones, anabolics, oral contraceptives) that affect blood clotting;
- severe liver damage (cirrhosis);
- inflammatory processes in the body, occurring in an acute form;
- cardiovascular pathologies, accompanied by a high risk of thrombosis (ischemic disease, atrial fibrillation);
A coagulogram is often prescribed to assess the general state of hemostasis, and is also used to monitor the patient's condition during therapy with anticoagulants - drugs that thin the blood.
It is worth thinking about conducting a coagulogram with such alarming signs as which are difficult to stop or the frequent appearance of hematomas on the body that form even in the absence of bruises. In addition, a coagulogram is recommended if you plan to resort to such an alternative method as hirudotherapy (leech treatment).
Coagulogram indicators
In expanded form, the analysis of the coagulogram in adults includes many indicators. Therefore, in practice, when conducting a study, an optimal set is isolated, according to which one can judge the coagulation properties of blood.
- Coagulogram PTI or prothrombin index. As well as PTT (prothrombin time), this value shows how long it takes for a blood clot to form at the site of injury.
- Coagulogram APTT (activated partial thrombin time) is an indicator that determines how quickly a fibrin clot appears. This is one of the most accurate and sensitive indicators that allows you to judge how effectively the blood plasma factors are working. At the same time, a shortening of the APTT value will indicate an increase in coagulability and the risk of thrombosis, and an elongation will indicate hypocoagulation and the likelihood of bleeding.
- Plasma fibrinogen. This is a special protein that, at the final stage of blood plasma coagulation, is converted into fibrin and provokes the formation of blood clots.
- Thrombin time (TV) - This indicator indicates how long fibrin is formed from fibrinogen.
In addition, there are a number of advanced coagulogram indicators that help determine exactly where in the blood coagulation system a failure has occurred. These include factors such as prothrombin time, bleeding time, antithrombin, plasma recalcification time, RFMK and other values.
In medical practice, two types of coagulograms are used - basic and expanded. In the first, basic version, the study allows you to determine violations in hemostasis, while advanced analysis gives an idea of the causes of such deviations, helps to make an accurate diagnosis and differentiate the disease from other pathologies with similar ones.
Deciphering the coagulogram of blood
A blood test for a coagulogram must be able to read and analyze correctly. Not every doctor has the skills to decipher the indicators, only a highly qualified specialist can correctly evaluate and interpret certain hemostasiogram parameters. The interpretation of the analysis consists in comparing the obtained values \u200b\u200bwith the norm of the blood coagulogram.
So, when determining the time of blood clotting, the normal indicator is up to 15 minutes. Exceeding this value indicates a deficiency of prothrombin and fibrinogen and is an expected consequence of the administration of anticoagulants.
The norm of the prothrombin index (PTI) is from 12 to 20 seconds. The lengthening of this time indicates failures in the synthesis of prothrombinase, prothrombin and fibrinogen. Such changes are accompanied by beriberi, chronic liver pathologies, absorption disorders in the intestines, or are the result of taking indirect anticoagulants. The indicator is expressed as a percentage. In a healthy person, it is at the level of 97-107%
When determining the APTT, the normal value is from 38 to 55 seconds. A decrease in this value indicates the risk of developing thrombosis, and an elongation indicates a congenital deficiency of clotting factors (hemophilia) or is observed during heparin therapy.
Fibrinogen - this enzyme is synthesized in the liver. A decrease in this indicator indicates the presence of such pathologies as beriberi, toxicosis of pregnant women, liver damage (hepatitis, cirrhosis). An increase in the value is observed at the initial stage of myocardial infarction, during inflammatory and infectious processes in the body, hypothyroidism or tissue necrosis.
This is what a table with blood coagulation parameters looks like:
| Name of indicator | Norm |
| Blood clotting time: norm according to Mass and Margot; Norm according to Lee-White. |
from 8 to 12 minutes; 5 to 10 min. |
| Bleeding time: Norm according to Shitikova; The norm according to Duke; Ivy norm. |
no more than 4 minutes; · from 2 to 4 minutes; no more than 8 min. |
| International Normalized Ratio (INR or INR) | 0,82-1,18 |
| Thrombin Time (TV) | 14-21 sec. |
| Prothrombin index (PTI) | 73-122 % |
| D-dimer | 250.10-500.55 ng/ml* |
| Prothrombin time (PT) | 11-15 sec. |
| APTT | 22.5-35.5 sec. |
| fibrinogen | 2.7- 4.013 g/l |
In this case, the doctor must take into account that the coagulogram parameters in children and adults are different. Thus, the value of prothrombin time for premature newborns is from 14 to 19 seconds, for full-term infants - from 13 to 17 seconds, and for healthy older children - from 12 to 16 seconds.
Indicators of antithrombin III (physiological anticoagulant) also depend on age. So, if in newborns a value of 40-80% is considered normal, then in adolescents this figure should be in the range of 80-120%, and in adults - from 75 to 125%.
For a full assessment of blood coagulation factors, a specialist needs to study at least 13 indicators, including taking into account the extended components of the coagulogram. Additional indicators allow you to more accurately see the picture of the disease, make the correct diagnosis and prescribe treatment.
Coagulogram during pregnancy
During pregnancy, a woman's body is rebuilt, preparing for the upcoming motherhood. Changes also concern the hemostasis system, which is due to hormonal changes and the appearance of an additional, uteroplacental circulation.
During this period, the results of the coagulogram usually show an increase in the activity of coagulation factors and an increase in fibrinogen. In this case, fibrin fragments are deposited on the walls of the vessels of the additional circulation, and fibrinolysis processes are suppressed, which prevents the formation of blood clots and placental abruption. Due to these changes, the woman's body insures against the risk of uterine bleeding and miscarriage.
With the pathological course of pregnancy and manifestations of preeclampsia, there is a violation of the regulation of blood coagulability. If timely treatment is not started, a dangerous complication, DIC, may develop. Its development is accompanied by the formation of many small blood clots and impaired blood supply to the fetus. In severe cases, uterine bleeding occurs, which leads to the death of the fetus and endangers the woman's life.
Good to know
Therefore, in the process of carrying a child, a blood coagulogram is made in each trimester of pregnancy, which helps prevent possible thrombotic complications, avoid miscarriage and prepare for the upcoming birth.
Rules for preparing for a coagulogram
It is necessary to prepare correctly for the delivery of an important analysis. The main rules of preparation should be explained by the attending physician. They are as follows:
- on the eve of the delivery, it is necessary to refuse to take heavy, fatty foods, exclude any alcoholic beverages;
- in the evening, a light dinner is allowed, for example, stewed vegetables with a piece of boiled dietary meat;
- blood for analysis is taken in the morning, on an empty stomach;
- do not smoke, drink tea or coffee before taking the material;
- 20 minutes before entering the treatment room, you can drink 200 ml of ordinary drinking water;
If the patient is being treated with anticoagulants, they should be stopped before taking the test to avoid distorting the results of the hemostasiogram. In cases where taking such drugs is a vital necessity, the laboratory assistant who will perform the analysis should be warned about this.
H should donate blood against the background of overwork, stressful situations. A few days before the sampling of the material, it is necessary to stop taking any medications. In case of intolerance to the type of blood, severe dizziness, fainting, you need to warn the laboratory assistant about this. In this case, when taking blood, the patient is placed on the couch.
How is blood drawn?
The sampling of material for analysis is carried out from a vein, with a dry sterile syringe without the use of a tourniquet. The syringe must be equipped with a wide bore needle. A vein puncture should be as less traumatic as possible, otherwise a lot of tissue thromboplastin will get into a pre-prepared test tube with a special coagulant, which can ultimately distort the result of the coagulogram. After blood sampling, the laboratory assistant fills 2 test tubes with material and sends one of them for research.
Where can the analysis be done?
A standard analysis can be done at any state clinic whose laboratory has the necessary reagents for. In most cases, an extended coagulogram can be done only in paid medical centers. This is a rather complex study that requires highly qualified laboratory technicians. As a rule, the results of the analysis will be ready in two days.
The price that needs to be paid for the study largely depends on the number of parameters that need to be determined during the hemostasiogram, and varies from 2000 to 3500 rubles.