Control of coagulogram what. Coagulogram - what kind of analysis it is, the correct interpretation of the results. Basic coagulogram parameters

A coagulogram (hemostasiogram) is a blood test that is performed to study its coagulability. Deciphering the blood coagulogram is of great importance in preparing the patient for surgery. It helps prevent serious complications such as bleeding. A study of coagulation must be carried out during, and also if there is a history of liver, heart and vascular diseases. The presence of autoimmune pathologies is also an indication for studying a blood coagulogram. The analysis allows us to determine the cause of bleeding.

The blood clotting system (hemostasis) protects a person from dangerous blood loss when the integrity of the vascular walls is violated due to traumatic injuries and surgical interventions. The nervous and endocrine systems are responsible for adequate hemostasis in the body. In order for blood to adequately perform its basic functions (supplying tissues with oxygen and nutrients and regulating body temperature), it must have normal rheological properties, i.e. fluidity. Hypocoagulation (decreased coagulation) due to various pathologies can lead to life-threatening blood loss. Hypercoagulation causes the formation of blood clots (thrombi) that block the lumen of blood vessels. As a result of thrombosis, tissue ischemia develops, leading, among other things, to and.

The main components of the hemostasis system are:

• endothelial cells of the vascular wall;
• platelets;
• plasma factors.

How to donate blood for a coagulogram

Blood is drawn from a vein in the elbow area. To avoid distortions and misinterpretation of the results, you need to prepare accordingly for the analysis.

Basic rules that are important for the patient to follow:

• 8-12 hours before the test you should not eat;
• the day before you should not overeat at night;
• alcohol, tea, juices and other drinks are excluded - you can only drink clean water;
• people with nicotine addiction should not smoke at least an hour before the test;
• It is important to exclude physical and mental stress 15 minutes before the analysis.

Important:If the patient is taking pharmacological anticoagulants, he must inform the doctor about this! If, during the process of collecting material for a blood coagulogram study, dizziness appears or a fainting state begins to develop, you should immediately notify health care workers about a change in your state of health.

When is a blood coagulation test necessary?

Indications for analysis:

Blood is drawn with a sterile syringe or using a special vacuum system. The tourniquet is not applied to the arm. The puncture must be atraumatic to avoid data distortion due to large amounts of tissue thromboplastin entering the material. Two tubes are filled with blood, but only the second is used for research. The sterile tube contains an anticoagulant - sodium citrate.

Coagulogram indicators: interpretation

In a standard coagulogram analysis, a number of indicators are studied and evaluated together.

Clotting time- this is the time interval between the onset of bleeding and its stopping during the formation of a fibrin clot. Capillary blood clots in 0.5-5 minutes, and venous blood in 5-10. The duration of bleeding increases against the background of thrombocytopenia, hypovitaminosis C, liver pathologies and taking drugs from the group of indirect anticoagulants (including acetylsalicylic acid, Trental and Warfarin). The duration of coagulation is reduced after massive bleeding, and in women, even with the use of .

PTI (prothrombin index) reflects the ratio of the duration of blood coagulation in normal conditions to the coagulation time of the subject. Reference values ​​(variants of the norm) – from 97 to 100%. In pregnant women, the rate increases (up to 150% and above), which is not a pathology. PTI numbers make it possible to identify the presence or absence of liver pathologies. The index increases when taking hormonal contraceptives. An increase in values ​​relative to the norm indicates the risk of developing thrombosis, and a decrease indicates the likelihood of bleeding.

Important:In order for the prothrombin index to be normal, the body requires a constant nutritional intake.

Thrombin time reflects the rate of conversion of fibrinogen to fibrin. The normal interval is 15-18 seconds. A shortening of the time interval most likely indicates an excess of fibrinogen, and its lengthening indicates a low concentration of this protein compound in the serum or severe functional liver failure against the background or with.

Note:Regular monitoring of this blood coagulogram indicator is very important during heparin therapy!

APTT (activated partial thromboplastin time) is an indicator reflecting the duration of clot formation after adding CaCl2 (calcium chloride) to the plasma. Normal values ​​are within 30-40 seconds. Changes are noted when the remaining blood coagulogram parameters deviate within 30%. An extension of this time interval may indicate liver pathology or.

AVR (activated recalcification time) in a healthy person it ranges from 50 to 70 seconds. The indicator allows you to evaluate the course of one of the stages of coagulation. A decrease in AVR is a sign of thrombophilia, and prolongation is observed with thrombocytopenia, taking anticoagulants (heparin), serious injuries, extensive injuries, and the development of a state of shock. A low AVR indicates an increased risk of massive and life-threatening bleeding.

PRP (plasma recalcification time) is a coagulogram indicator that correlates with ABP and reflects the coagulation time of citrate serum after the addition of calcium salts. Normal time is 1 to 2 minutes. Its reduction indicates increased activity of hemostasis.

If a blood coagulogram shows a significant decrease in the indicator, this may be a sign of the following pathologies:

• violation of hemostasis;
• severe liver damage;
• toxicosis during pregnancy;
• hypovitaminosis and deficiency.

The level falls during therapy with anticoagulants and anabolic steroids, as well as against the background of consumption of fish oil.

Fibrinogen B normally not detected.

Fibrinogen concentration in a healthy person – 5.9-11.7 µmol/l. Its decrease is observed with liver problems, and its increase is observed with malignant neoplasms and hypofunction of the thyroid gland.

RFMK indicator (soluble fibrin-monomer complexes) characterizes changes in the structure of the fibrin protein at the molecular level under the influence of coagulation factor II (thrombin) and plasmin. A value not exceeding 4 mg/100 ml is considered normal. The variability of the indicator is due to the same reasons as changes in fibrinogen concentration.

Please note:RFMK is a marker that allows timely measures to be taken to prevent the development of DIC syndrome.

Fibrinolytic activity is a coagulogram indicator that reflects the ability of the patient’s blood to dissolve formed blood clots. A component of the body's anticoagulant system, fibrinolysin, is responsible for this function. With its high concentration, the rate of dissolution of blood clots increases, and accordingly, bleeding increases.

Thrombotest allows you to visually determine the volume of fibrinogen in the test material. The norm is thrombotest grade 4-5.

Plasma tolerance to heparin is a characteristic that reflects the time of formation of a fibrin clot after adding heparin to the test material. Reference value – from 7 to 15 minutes. The analysis reveals the level of thrombin in the blood. A decrease in the indicator most likely indicates liver damage. If the interval is less than 7 minutes, cardiovascular pathologies or the presence of malignant neoplasms can be suspected. Hypercoagulation is characteristic of late pregnancy (III trimester) and conditions after surgical interventions.

Blood clot retraction characterizes a decrease in the volume of a blood clot with complete separation from the plasma. Reference values ​​are from 44 to 65%. An increase in values ​​is observed in various forms of anemia (anemia), and a decrease is a consequence of thrombocytopenia and erythrocytosis.

Duke bleeding time- This is a separate analysis, during which capillary rather than venous blood is examined. The fingertip is deeply pierced (4 mm) using a special lancet. The blood that comes out of the puncture is removed with special paper every 15-30 seconds (without contact with the skin). After each blotting, the time until the next drop appears is measured. The normal time for bleeding from small blood vessels to stop is one and a half to two minutes. This indicator is influenced, in particular, by the level of the mediator serotonin.

Blood coagulogram in children

Normal blood coagulogram values ​​in children differ significantly from normal values ​​in adult patients. Thus, in newborn babies, the normal level of fibrinogen ranges from 1.25 to 3.0 g/l.

Indications for studying a child’s coagulogram are:

• suspicion of ;
• diagnosis of pathologies of the hematopoietic system;
• upcoming surgery.

Blood coagulogram during pregnancy

Important:During pregnancy, a blood coagulation test is carried out at least three times (in each trimester).

During pregnancy, hemostasis parameters normally change, which is caused by significant hormonal changes in the female body, an increase in the total volume of circulating blood and the formation of an additional (uteroplacental) circulation.

In the first trimester, the clotting time, as a rule, increases significantly, and in the third, it is significantly shortened, thereby providing the woman with protection from possible blood loss during delivery. A blood coagulogram allows you to identify a threat or premature birth due to the formation of blood clots. Disturbances in the coagulation system of a pregnant woman negatively affect the central nervous system of the unborn child.

Important:Having blood coagulogram data and comparing them with the norm allows obstetricians to take adequate measures to prevent serious bleeding during delivery.

A mandatory blood coagulogram study is necessary if a woman has vascular diseases (in particular -) or is diagnosed. A blood coagulogram is also examined in cases of decreased immunity and negative Rh factor.

Reference values ​​for individual blood coagulation parameters in pregnant women:

• thrombin time – 11-18 seconds;
• APTT – 17-20 sec.;
• fibrinogen – 6 g/l;
• prothrombin – 78-142%.

Important:A deviation of the prothrombin level from normal levels may indicate placental abruption!

Lotin Alexander, medical columnist

A coagulogram or hemostasiogram is a blood test for its coagulability. It is carried out in children (if necessary) and in adults.

There are two types of hemostasiogram:

• basic (assigned at the beginning);
• expanded or expanded (done if a serious pathology is detected during a basic coagulogram).

When is it necessary to take the test?

Usually, a coagulogram is not prescribed to everyone. The following groups of people are subject to mandatory blood clotting testing:

• patients before undergoing planned abdominal surgery;
• pregnant women during the entire period of bearing a baby (blood tests are taken every 3 months);
• people with heart and vascular diseases;
• patients with liver diseases;
• people with autoimmune diseases;
• patients who have disorders in the blood coagulation system;
• those prescribed anticoagulant drugs or aspirin;
• women taking OCs on a regular basis;
• patients who are indicated for a course of hirudotherapy treatment.

Hemostasis in the human body

Blood clots in human vessels are not formed by chance: the hemostasis system is created to prevent the development of severe bleeding and preserve human life. A thrombus is blood particles (mainly platelets) stuck to the inner damaged wall of a vessel, which stick together and prevent blood loss. The body secretes thromboplastin, which forms a protein clot made of fibrin. With high magnification, you can see that it looks like a very thin network, in which platelets from the blood stream get stuck.

In addition to the coagulation system, the human body also has an anticoagulant system, which controls the normal consistency of the blood. The activity of these two systems controls fibrinolysis (resorption of blood clots after healing of the vascular wall). A detailed coagulogram will fully assess the operation of all three systems.

Basic terms and parameters of hemostasiogram

The table shows the most common coagulogram indicators:

Abbreviation	Decoding
Fibrinogen	The most important marker that determines the state of the human blood coagulation system
	Prothrombin index - a study showing external coagulation
	International normalized ratio. The most universal test for the external method of blood coagulation. Coagulogram INR is used most often.
	Prothrombin time is a laboratory test for extrinsic coagulation of a patient's blood.
	Activated partial thromboplastin time
Thrombin time	Time taken to complete the last folding step
Protein C	A substance the lack of which in the blood can lead to the formation of serious blood clots
Antithrombin	Basic protein factor of blood plasma
D-dimer	Particle formed in the blood after a blood clot has been broken
Lupus anticoagulant	Antibodies produced in the blood serum of a person with an autoimmune disease
Plasma tolerance to heparin	Level of plasma heparin resistance
	Activated recalcification time
RFMK	Soluble fibrin monomer complexes
Plasma recalcification time	Time period required for fibrin synthesis

Hemostasiogram indicators. Norms and deviations

The table below shows normal coagulogram values ​​in an adult.

Below is a description of the most important coagulogram indicators, the norms and values ​​of the indicators are indicated.

How to take the test correctly?

After receiving a referral from a doctor to take a hemostasiogram, the patient is interested in how to take the test: on an empty stomach or not? A coagulogram is taken on an empty stomach early in the morning. You cannot eat at night, you are only allowed to drink water. If the patient is taking any medications, this must be indicated at the time of examination.

Blood is the main liquid medium of the body, and the quality of life and human health directly depend on its properties. One of the important properties of blood is fluidity, which ensures the ability to deliver nutrients to cells and participate in the process of removing metabolic products.

Hemostasis, the coagulation system, is responsible for the normal state of the blood—its fluid. Hemostasis maintains the necessary state, preventing both life-threatening bleeding and the formation of blood clots. To evaluate the operation of this system, the blood is examined for a coagulogram or, as it is also called, a hemostasiogram.

What is a coagulogram?

A coagulogram is a comprehensive diagnostic that studies individual indicators of blood clotting. The name itself is derived from two words - Latin coagulum, which means coagulation, and Greek - gramma, which translates as line or image. That is, based on this phrase, the study implies a digital expression or graphical representation of the results obtained when assessing coagulation indicators.

And if we consider diagnostics in a broader sense, then it turns out that the entire hemostatic system. The study of venous blood using coagulometry (which means measuring coagulability) allows us to draw a conclusion about the state and quality of functioning of the components of hemostasis. This includes anticoagulation, coagulation and fibrinolytic functions.

A blood test for a coagulogram is carried out to assess the potential risks of hypo- and hypercoagulation, which is expressed in a decrease or increase in coagulability, and, consequently, the likelihood of bleeding or thrombosis. Correct and timely interpretation of the study data allows the doctor to assess the patient’s current condition, make a prediction of the outcome of the operation and prescribed therapy, and also be prepared for childbirth with possible complications.

In some cases, this analysis is almost the only guarantee for the patient. All parameters included in a comprehensive blood test for a coagulogram are considered to be indicative. There are 13 of them in total, but deviations from the normal values ​​of any of them can lead to serious consequences for a person.

Table of parameters determined during a hemostasiogram

When is analysis necessary?

There are quite a few indications for prescribing a hemostasiogram, since deviations in the functioning of the coagulation system lead to a large number of diseases. Therefore, examination will be recommended in the following situations:

• assessing the activity of the hemostatic system;
• routine diagnostics before surgery;
• preparation for self-delivery or cesarean section;
• monitoring of severe gestosis that occurs with complications;
• observation when taking oral contraceptives, anabolic steroids, glucocorticoid hormones;
• control of anticoagulation therapy carried out with indirect-acting drugs (Warfarin, Aspirin, Trental) and heparin therapy (Clexane, Fraxiparine).

Also, the technique is necessarily prescribed for identifying diseases, as primary screening and as a regular check. A hemostasiogram is used to determine or confirm:

• varicose veins of the venous vessels of the lower extremities;
• DIC (disseminated intravascular coagulation) syndrome;
• chronic liver pathologies – cirrhosis and inflammatory processes;
• hemorrhagic diseases - hemophilia, thrombocytopenia and thrombocytopathy, von Willebrandt disease);
• thrombosis of various organs - vessels of the lower and upper extremities, intestines, brain (stroke), pulmonary thromboembolism (TE).

A blood coagulogram examination is always carried out if there is a high risk of thrombosis. Such diseases include coronary heart disease (CHD) and atrial fibrillation.

Sequence of the coagulation process

What is the preparation?

To donate blood for clotting, the patient does not have to perform any complex actions; it is enough to just meet a few simple conditions, such as:

• come to the procedure with an empty stomach, since the biomaterial is taken strictly on an empty stomach, and it would be correct to refrain from eating for at least 12 hours;
• at least one day before the test, exclude spicy, fried, fatty foods, as well as smoked foods, marinades and alcohol from the diet;
• You should stop smoking at least an hour before donating blood.

In addition, it is recommended to stop taking direct and indirect anticoagulants, since their effect will affect the hemostasiogram parameters. Of course, such permission to cancel must be agreed upon with the attending physician. Indeed, in some cases, independent withdrawal of drugs of this effect can lead to recurrent thrombosis.

If the attending physician does not allow you to stop taking the drug for a day or two before the procedure, then before taking blood you should notify the laboratory technician in the diagnostic room. All necessary information can be obtained in advance by contacting the clinic chosen for the examination. The receptionist will tell you in detail where the blood is taken from, how long the analysis takes, and will answer all the patient’s questions.

Blood collection procedure

The algorithm for donating biomaterial to determine coagulation parameters is in many ways similar to a typical blood draw, but in some ways it differs from standard procedures. Basic rules that must be followed when taking blood for a hemostasiogram:

• Blood collection is performed using a dry sterile syringe or a Vacutainer vacuum sampling system;
• For the procedure, a needle with a wide bore is used, which makes it possible not to use a tourniquet;
• the puncture of the vein must be clear - without damaging nearby tissues, otherwise the test tube will have an increased content of tissue prothrombin, which will affect the reliability of the results;
• a laboratory technician or nurse collects 2 test tubes, but sends only the second one, which contains a special coagulant - sodium nitrate, for testing.

Where can I donate blood and when will the results be ready?

You can undergo blood coagulogram diagnostics in any medical diagnostic institution, both public and private, which has specialized equipment and the necessary reagents. This procedure is a rather complex study in terms of interpretation, so interpretation of the blood clotting test should be carried out by qualified doctors.

The cost of diagnostics depends on the number of indicators determined. The analysis time can also be lengthened, since studying each parameter requires a series of chemical reactions. In most cases, results are ready in 1-2 business days. In addition, the speed may be affected by the presence or absence of reagents, workload of the laboratory or courier.

Interpretation of indicators

As mentioned above, a hemostasiogram is a very complex and informative analysis, and it is interpreted exclusively by specialized specialists. Sometimes the attending physician may prescribe several indicators for the study, which will be indicated in the referral, and in some cases, all parameters of the coagulogram are studied. These include the following.

Prothrombin time (PT)

The value shows the time period during which, when thromboplastin and calcium are added to the plasma, a thrombin clot has time to form. The parameter determines the 1st and 2nd phases of plasma coagulation and the activity of the factors listed in generally accepted tables under numbers 2, 5, 7, 10.

PV standards for adults and children of different age categories

Important! Treatment with anticoagulants is considered effective if the PT increases by at least 1.5–2 times.

International normalized ratio (INR)

The indicator is the prothrombin coefficient, that is, the ratio of the PT of the subject to the PT of the control tube. This parameter was introduced by WHO - the World Health Organization to streamline the activities of laboratories in 1983, since each uses different thromboplastin reagents. The main task of INR is to monitor the condition of patients taking indirect anticoagulants.

The main reasons for the increase in PT and INR include:

• intestinal enteropathies, dysbiosis, accompanied by a lack of vitamin K;
• amyloidosis is a systemic disease characterized by impaired protein metabolism;
• genetically determined deficiency of 2, 5, 7, 10 coagulation factors;
• therapy with coumarin-based medications (Merevan, Warfarin);
• liver diseases – cirrhosis, chronic hepatitis;
• decrease in concentration or absence of fibrinogen;
• DIC syndrome and nephrotic syndrome;
• the presence of anticoagulants in the blood.

The following factors lead to a decrease in these coefficients:

• activation of fibrinolysis function (dissolution of blood clots);
• thrombus formation in vessels and TE;
• increase in the work of 7 factors.

Activated partial thrombin time (aPTT)

This value is also called cephalinkaolin time, and it determines the effectiveness of the functioning of plasma factors in stopping bleeding. In other words, APTT reflects the internal work of hemostasis, that is, the rate of creation of a fibrin clot. This is the most accurate and sensitive coagulogram value.

Its parameters, first of all, may vary depending on the activator reagents used in a particular clinic. A reduction in the coefficient indicates an increase in coagulability and a tendency to thrombosis, and a lengthening indicates a decrease in hemostatic function and the possibility of bleeding.

The reasons leading to an increase in APTT are:

• liver pathologies that occur in severe form - fatty infiltration, cirrhosis;
• congenital coagulation deficiency 2, 5, 8, 9, 10, 11, 12 factors;
• therapy with heparin and its derivatives (Clexane, etc.);
• autoimmune systemic connective tissue diseases (SCTDs) – systemic lupus erythematosus (SLE);
• excess fibrinolysis activity;
• 2 and 3 degrees of DIC syndrome.

And, conversely, a decrease in APTT is caused by:

• increased coagulation capacity;
• Stage 1 of DIC syndrome;
• ingress of tissue thromboplastin into a blood sample due to incorrect technique for taking biomaterial.

INR parameters that determine the required dose for a patient during warfarin therapy

Activated recalcification time (ATR)

The value reflects the time taken for fibrin to appear in plasma containing calcium and platelets, which indicates the quality of contact between plasma and hemostasis components. The AVR coefficient may vary depending on the reagents used.

Attention! An increase in the indicator is directly related to a decrease in the number of platelets, a change in quality characteristics, as well as hemophilia. A decline in AVR signals the possibility of thrombosis formation.

Prothrombin index (PTI)

The parameter displays the ratio of the ideal PTT to the identical value of a specific subject, multiplied by 100%. Recently, as a rule, experts refuse to determine this value and replace it with INR. PTI, like INR, smooths out differences in test responses that arise due to differences in reagents in laboratories. Changes in this parameter are in many ways similar to INR, that is, they are caused by almost the same aspects.

Thrombin time (TV)

The value is demonstrated by the final stage of hemostasis - the rate of fibrin clot formation in plasma when thrombin is added. The indicator is one of the three mandatory factors for study, along with aPTT and PT, and is used to monitor heparin therapy and congenital fibrinogenic anomalies.

Among the conditions that increase TV are:

• absence of fibrinogen or its drop to less than 0.5 g/l;
• taking fibrinolytic medications;
• autoimmune pathologies (with the production of antibodies to thrombin);
• chronic liver diseases – hepatitis, cirrhosis;
• acute fibrinolysis, DIC syndrome.

A decrease in the indicator is observed with heparin therapy or the use of ICE (fibrin polymerization inhibitors), as well as at the 1st stage of development of DIC syndrome.

Table of factors by numbers and their main brief characteristics

Fibrinogen

This indicator, which is a protein compound, refers to 1 coagulation factor. It is synthesized in the liver, and when exposed to factor 7 (contact or Hageman) it is transformed into insoluble fibrin. The appearance of fibrinogen is characteristic of the acute phase, when its level increases during injuries, inflammation, infections and stressful situations.

An increase in fibrinogen concentration is caused by:

• inflammatory processes occurring in severe form - peritonitis, pneumonia, pyelonephritis;
• myocardial infarction, oncological tumors, especially those localized in the lungs, amyloidosis;
• gestation and complications during pregnancy, menstruation;
• surgical operations performed, burn disease;
• therapy with heparin and its derivatives, as well as estrogens;
• CTD – scleroderma, SLE, rheumatoid arthritis;
• use of oral contraceptives.

A decrease in fibrinogen values ​​is associated with the following conditions:

• congenital and acquired deficiency;
• DIC syndrome, status after severe bleeding;
• liver disease due to alcoholism, cirrhosis;
• red bone marrow aplasia, leukemia;
• malignant neoplasm of the prostate gland;
• excess heparin – refers to acute conditions, and protamine, which is an antidote to fibrin, is used for its treatment;
• taking anabolic steroids, barbiturates, valproic acid, androgens, fish oil, (IPF).

Soluble fibrin-monomer complexes (SFMC)

RFMK are intermediate results of the dissolution of a fibrin clot, formed during fibrinolysis. They are quickly eliminated from plasma, so this parameter is quite difficult to study. Its main significance in terms of diagnosis is the early detection of DIC syndrome. The indicator increases:

• in case of thrombus formations of different localization - deep veins of the arms or legs, pulmonary artery thrombosis;
• acute and chronic forms of renal failure;
• complications of pregnancy - preeclampsia, gestosis;
• CTD, shock, sepsis, etc.

Important! An increase in RFMC may also be observed in the postoperative period, which will indicate the development of abnormalities in hemostasis.

Antithrombin III

This blood component is an anticoagulant of physiological origin. This is a glycoprotein that inhibits thrombin and 9, 10, 12 coagulation factors. It is formed in hepatocytes (liver cells). This coefficient may increase in severe inflammatory pathologies - pyelonephritis, pneumonia, peritonitis, therapy with glucocorticoids or anabolic steroids, acute damage to the liver parenchyma (for example, hepatitis), vitamin K deficiency.

Antithrombin III norm values ​​for different age categories

A decrease in values ​​is noted due to:

• chronic pathological processes of the liver that have developed in connection with alcoholism (cirrhosis, etc.);
• DIC syndrome, ischemic heart disease, thrombosis and TE, sepsis;
• congenital or acquired deficiency;
• heparin and ICE therapy.

Also, a decrease in this parameter is observed in pregnant women in the 3rd trimester.

Features of coagulogram during pregnancy

During the period of gestation, multiple changes occur in the female body, affecting all systems, not excluding hemostasis. Such changes are caused by a hormonal surge and the formation of a second circulation. When a woman becomes pregnant, then her activity of coagulation factors 7, 8, 10, and especially fibrinogen, sharply increases.

Fibrin elements are deposited on the vascular walls of the uterus and placenta. Fibrinolysis is suppressed. Thus, the female body is insured in case uterine bleeding occurs and there is a threat of spontaneous abortion. These changes are aimed at preventing placental abruption and the formation of blood clots in the vessels feeding the uterus, and, in particular, the fetus.

With pathological gestation - gestosis of the early and late periods, disturbances in the functioning of hemostasis may develop. This manifests itself in an increase in fibrinolysis activity or a decrease in platelet life expectancy. If a woman did not undergo examinations on time, such as a general (clinical), biochemical blood test, coagulogram, and, therefore, did not receive qualified help, then the risk of developing DIC syndrome is very high.

Hemostasiogram indicators during pregnancy

This pathology occurs in three phases, which pose a serious threat to both mother and child. Hypercoagulation is the formation of many small clots in a woman’s blood, causing disruption of the blood circulation between mother and fetus. Hypocoagulation - at this stage, clotting factors are depleted and clots disintegrate. Acoagulation is a lack of coagulation function, which causes uterine bleeding, creating risks for the life of the mother, and the child in such a situation most often dies.

Coagulogram is a comprehensive analysis of blood clotting indicators. Studies of venous blood using the coagulometry method help assess the condition and efficiency of functioning of various parts of such blood systems as coagulation, anticoagulation and fibrinolytic.

Indicators of a coagulogram, or hemostasiogram, are studied to assess the possible risk of hyper- and hypocoagulation, 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 a lot of spices from the diet. As for 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.
If you are currently or have recently completed a course of treatment with anticoagulant drugs, you must inform the specialist of the name, dosage and duration of use.
If during blood sampling you experience nausea, dizziness, or deterioration in health, you must immediately inform medical personnel.

How is the analysis carried out?

Venous blood is collected from the ulnar vein without applying a tourniquet. To comply with the rules of coagulation, two test tubes are filled; the biomaterial from the second container containing the coagulant is subject to examination.

Where do you donate blood for a hemocoualogram?

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 conduct analysis for hemostasis indicators.
The cost of tests depends on the laboratory and the set of blood factors assessed.

How many days does a coagulogram take?

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. If laboratory technicians are very busy and there is a need to transport biomaterial, the study time may increase.

In what cases is a blood test for coagulogram prescribed?

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 by caesarean section) is assessed.
Other indications for this analysis include:

• gestosis of pregnancy, as well as repeated miscarriages;
• injuries accompanied by internal and/or external bleeding;
• the presence of a tendency to thrombus formation, varicose veins of blood vessels, a tendency to thromboembolism;
• heart attack, history of stroke, pre-infarction conditions, ischemia, arrhythmia;
• pathologies of the circulatory system;
• liver dysfunction;
• monitoring the condition during anticoagulant therapy;
• hemorrhagic pathologies, chronic anemia, frequent nosebleeds, heavy menstruation, inclusions of blood in discharge (urine, feces), sudden loss of vision, etc.;
• long-term therapy with anabolic drugs, glucocorticosteroids, oral contraceptives;
• routine medical examination.

Components of the hemostasis system

The hemostatic 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 hemostatic system is to maintain a balance between coagulating and anticoagulant factors. An imbalance is realized by hypercoagulation (increased blood clotting, leading to the formation of blood clots) and hypocoagulation (decreased coagulation, threatening prolonged bleeding).

Blood clotting is ensured by two mechanisms: external and internal. When tissue injuries and violations of the vascular walls occur, tissue thromboplastin (factor III) is released, which triggers the external process of blood clotting. The internal mechanism requires contact between the collagen of the endothelium of the vascular walls and blood components.

Indicators and norms of hemostasis

When studying indicators, different laboratories may use different techniques. Thus, the speed 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 compliance of results with the norm must be carried out in accordance with the standards of the specific laboratory.

Each norm of a coagulogram and its components in the table is given without taking into account gender and age indicators and individual characteristics. To decipher hemostasis indicators, you must contact a specialist.

Interpretation of hemostasis indicators

What is included in a coagulogram study? A basic hemostasis study includes several indicators assessed together.

Blood clotting time indicator

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 its cessation. For venous blood, the reference rate of thrombus formation is 5 to 10 minutes.

Exceeding the indicator often indicates the presence of diseases and conditions such as thrombocytopenia, hemophilia, vitamin C deficiency, liver pathologies, and also occurs during therapy with indirect anticoagulants (Trental, Warfarin, Aspirin, etc.). A reading below normal indicates an accelerated ability to form clots, and may also decrease after extensive bleeding. In women, a decrease in clotting time is observed while taking it.

PTI indicator

The prothrombin index shows the ratio of the blood clotting time of the test and the accepted standard. The most favorable indicator is considered to be 97-100%, corresponding to the general norm. However, deviations do not clearly indicate a deviation in the functioning of the body: in women during pregnancy, PTI can reach 150%, which is a physiological feature of the gestational period. On average, exceeding normal limits indicates the likelihood of thrombosis, while a decrease indicates the risk of bleeding.

Thrombin time indicator

Thrombin time is the period required for the conversion of fibrin from fibrinogen. A thrombin time higher than normal indicates a reduced amount of fibrinogen in the blood, and also accompanies severe pathologies and liver diseases (cirrhosis).
A reading below normal is most often associated with an increased amount of fibrinogen.

APTT as a factor in monitoring anticoagulant intake

APTT is measured based on the duration of clot formation when the biomaterial reacts with calcium. This indicator is especially relevant for monitoring and correction of therapy with direct coagulants (Heparin). It may also indicate DIC syndrome, the presence of autoimmune diseases, and liver pathologies.

AVR

The AVR indicator allows you to assess the likelihood of such pathologies as thrombophilia, thrombocytopenia, and also changes during anticoagulant therapy, with significant internal injuries, burns.

A pronounced discrepancy with the norm is especially dangerous when the indicator is extremely low and indicates the development of a life-threatening condition - extensive and prolonged bleeding.

VLOOKUP

The VPR indicator is assessed in correlation with the activated recalcification time. Low values ​​indicate increased hemostatic activity.

Estimation of fibrinogen amount

The fibrinogen protein belongs to blood clotting factors I. It is produced in the liver and a change in its quantity may indicate pathologies of this organ. Exceeding the norm of this indicator can accompany inflammatory diseases and tissue injuries; the deficiency is assessed as primary (genetic etiology) or secondary, provoked by excessive consumption during 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.

RFMK

Assessment of the concentration of soluble febrin-monomer complexes is important in the diagnosis of DIC syndrome. Interpretation of indicators is also important in case of thrombus formation, complicated pregnancy, renal dysfunction, during the recovery period after invasive procedures, etc.

Antithrombin III

A glycoprotein related to natural anticoagulants. Its norms vary significantly depending on the age of the patient. The level 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 fibrin breakdown product; the fibrinolytic activity of plasma is assessed by its amount. An increase indicates the presence of intravascular thrombosis, liver disease, ischemia or myocardial infarction, and can also develop with prolonged smoking.
The deficiency of the indicator has no clinical significance.

Estimation of bleeding time

When studying this indicator, the period from the onset of bleeding to the formation of a clot in the capillary is studied. Methodology: with a sharp sterile needle, a superficial injury is made on the earlobe and the time from the onset to the cessation of bleeding is assessed. An indicator that exceeds the norm has diagnostic value.

Features of hemostasis in pregnant women: research and interpretation of results

Changes that occur during the gestational period affect all body systems, including the process of hematopoiesis. During pregnancy, hemostasis norms change, and assessment should be based on compliance of gestational age with reference values.
The main factor in changes in blood clotting is associated with increased risks of bleeding during termination of pregnancy, placental abruption and during childbirth, and therefore fibrinolysis is suppressed.

Hemostasis of the gestational period

Normal indicators change with increasing gestational age.

	Normal 1st trimester	Normal 2 trimesters	Normal 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
RFMK	78-130	85-135	90-140
Antithrombin III	0,222	0,176	0,155
Platelets	301-317	273-298	242-263

Coagulogram is a laboratory test of blood aimed at determining its coagulability. Another name for the analysis is hemostasiogram.

This test is performed primarily before surgical interventions, since its results allow one to assess the risk of bleeding or blood clots.

A coagulogram is also necessary for other indications. In order for the results to be reliable, you must follow certain rules for preparing for blood collection.

General information

Hemostasis is a system that is responsible for blood clotting. This prevents massive blood loss due to various injuries or damage to blood vessels. The nervous and endocrine systems are responsible for the activity of hemostasis.

Blood is the main transporter of oxygen and nutrients to all cells of the body. When its coagulability decreases, intense bleeding may occur even with minor wounds or damage. This deviation is called hypocoagulation.

But the opposite scenario is also possible, when blood clotting, on the contrary, increases. In this case we are talking about hypercoagulation. As a result of this process, blood clots are formed in the lumen of the blood vessels - thrombi, which clog an artery or vein, thereby preventing normal blood flow. The result of this is hypoxia, tissue ischemia, and then stroke and heart attack.

During normal hemostasis, blood circulates freely through the vessels, transporting useful substances and oxygen cells to all internal organs. At the same time, it is folded in such a way as to promptly plug gaps in the walls of small and large CS.

Hemostasis is formed from:

1. Endothelium is the inner layer lining the wall of blood vessels. If their integrity is violated, the endothelium begins to produce substances that provoke the process of thrombosis.
2. Platelets. These red cells are produced when a blood vessel is damaged and, sticking to each other, clog the rupture site.
3. Plasma factors and enzymes (about 15 elements). These structures trigger complex biochemical reactions, under the influence of which fibrin clots are formed. The latter tend to stop bleeding.

Why is a coagulogram prescribed?

A coagulogram is indicated:

• before planned operations in which there is a certain risk of bleeding;
• during pregnancy (every trimester, but in the presence of gestosis or fetoplacental insufficiency, the test can be performed more often);
• with varicose veins or increased thrombosis;
• patients with pathologies of the liver and cardiovascular system;
• patients with autoimmune diseases;
• in case of a blood clotting disorder caused by certain factors;
• while taking or before prescribing anticoagulants;
• to select the correct dose of ASA or drugs based on it;
• before prescribing oral contraceptives (the test is carried out once every 3 months);
• during hirudotherapy to prevent the formation of hemorrhages.

How to properly prepare for analysis

Blood for a coagulogram is donated from a vein or finger. On the day of the test, you should not eat, smoke, or do intense exercise or other activities. The last meal should be taken 12 hours before visiting the laboratory.

On the eve of the test you must:

• exclude fatty and spicy foods;
• give up cigarettes and alcohol;
• limit physical activity;
• avoid stress, overwork, psycho-emotional stress;
• stop taking anticoagulants, NSAIDs and other drugs that can affect blood clotting.

If the use of certain medications is not possible, then it is necessary to notify the attending physician about the treatment.

Research methods

Interpretation of the results and indicators of the normal coagulogram directly depend on the method of its implementation. The diagnostic procedure can be performed using the Sukharev or Lee-White method.

In the first case, the biomaterial is taken from a finger, that is, capillary blood is examined. It is placed in a special container called a capillary. After this, the laboratory assistant begins to shake the vessel and records the time. Then the specialist notes in the table the period when the blood flow slows down and then stops completely. In healthy people, these indicators range from 30 to 120 s (the period of the beginning of coagulation) and from 3 to 5 minutes – the period of completion of the coagulation process.

To perform the Lee-White test, venous biomaterial is taken. In this case, the duration of the period during which a dense blood clot forms is estimated. In a healthy person, this process takes from 5 to 10 minutes.

Coagulogram: normal indicators in the table

The analysis requires several complex biochemical reactions. This may take 24 to 48 hours. The work schedule of the medical institution, as well as whether it is a separate laboratory or an intermediary, is also important.

Normal coagulogram values ​​are shown in the table below:

Clotting time
According to Lee-White By Mass and Magro	5-10 minutes; 8-12 minutes.
Bleeding time
According to Duke By Ivy According to Shitikova	2-4 minutes; Up to 8 minutes; Up to 4 minutes;
Analysis indicator	Its designation	Norm
Prothrombin time according to Quick	PV	11-15 sec
INR (International Normalized Ratio)	INR	0,82-1,18
Activated Partial Thromboplastin Time	APTT	22.5-35.5 sec
Activated Recalcification Time	AVR	81-127 sec
Prothrombin index	PTI	73-122%
Thrombin time	TV	14-21 sec
Soluble fibrin-monomer complexes	RFMK	0.355-0.479 units
Antithrombin III	AT III	75,8-125,6%
D-dimer		250.10-500.55 ng/ml
Fibrinogen		2.7-4.013 g

Decoding the coagulogram

A coagulogram is an advanced analysis that involves studying a number of indicators.

Clotting time

This is the interval from the onset of bleeding to its completion, accompanied by the formation of a fibrin clot. The coagulation period of capillary blood ranges from 0.5 to 5 minutes. Venous blood coagulates in 5–10 minutes.

Hypocoagulation may accompany:

• thrombocytopenia;
• hypovitaminosis C;
• hemophilia;
• liver diseases.

A reduced rate of blood clotting is also observed with long-term use of anticoagulants and massive bleeding. In women, this deviation often occurs while taking oral contraceptives.

Thrombin time

This is the rate of transformation of fibrinogen into fibrin. Normally, the process takes from 15 to 18 seconds. When this interval is shortened, they speak of an excess of fibrinogen, and when it lengthens, it indicates a low content of protein in the blood serum. Also, a decrease in thrombin time is observed in liver failure, hepatitis, and cirrhosis.

PTI (prothrombin index)

This is the ratio of the patient's current blood clotting rate and generally accepted coagulation standards.

Normal indicators are from 97% to 100%. During pregnancy, these figures can increase up to 150%, which is not considered a pathological deviation. Based on IPT data, one can judge the presence of liver pathologies. In women, the level of prothrombin index may increase when taking oral contraceptives. In other cases, an overestimated indicator may indicate a risk of thrombosis; with a decrease in PTI, a tendency to bleeding is indicated.

APTT (activated partial thromboplastin time)

Before the study, calcium chloride is added to the biomaterial, after which the duration of clot formation is assessed. Normally, this process takes from 30 to 40 seconds. Deviations from such indicators are noted in the case of shifts in other coagulogram indicators by 30%. An increase in the APVT period may indicate liver disease or hypovitaminosis K.

AVR (activated recalcification time)

In healthy patients, this period lasts from 50 to 70 seconds. A decrease in these indicators may indicate thrombophilia, while an increase often indicates thrombocytopenia or a state of shock. Also, an extension of this interval is observed with burns, serious injuries and taking heparin anticoagulants. If the indicators are too low, we may be talking about the risk of life-threatening massive bleeding.

PRP (plasma recalcification time)

This coagulogram indicator is compared with AVR. After adding calcium salts to the biomaterial being studied, the coagulation of citrate serum is studied. Normally, this process takes 1 – 2 minutes. When it decreases, they speak of hyperactivity of hemostasis.

Antithrombin-III

It is an antagonist of the thrombin enzyme, which inhibits the effect of hemostasis. The norm is 71-115%. When the rate decreases by half, there is a risk of blood clots. Inflated results require the use of anticoagulants.

Fibrinogen

The norm is 2-4 g/l. This is a protein structure that is synthesized by liver tissues, after which it is transformed into fibrin. Its threads form the structure of blood clots.

Fibrinogen increases with hypothyroidism, extensive burns, heart attacks and strokes, and acute infectious pathologies. High levels of the substance are observed in patients who have undergone surgery, undergoing hormone therapy, as well as in pregnant women.

With a significant decrease in the indicator, we can talk about:

• impaired hemostasis;
• severe liver pathologies;
• toxicosis of pregnant women;
• hypovitaminosis group B;
• vitamin C deficiency.

The level decreases when taking anabolic agents, anticoagulants, and fish oil.

In healthy people, fibrinogen B is not detected.

Fibrinogen concentration

In healthy people, the indicator ranges from 5.9 to 11.7 µmol/l. A decrease in fibrinogen indicates liver pathologies, an increase indicates malignant neoplasms of the thyroid gland or its hypofunction.

Fibrinolytic activity

This indicator reflects the ability of blood to dissolve formed clots. This functional task is performed by fibrinolysin. Its increase is accompanied by intensive dissolution of blood clots with accompanying bleeding.

RFMK indicator (soluble fibrin-monomer complexes)

This indicator characterizes the molecular changes in fibrin that occur under the influence of thrombin and plasmin. The norm is 4 mg/100 ml of blood. The reasons for deviations in the level of this element are the same as for the violation of fibrinogen concentration.

Blood clot retraction

This indicator is used to judge the degree of reduction of the blood clot when it is completely separated from the plasma. Normal values ​​are 44-65%. If the indicators are too high, we can talk about anemia, and if the indicators are too low, we can talk about thrombocytopenia or erythrocytosis.

Plasma tolerance to heparin

During the study, heparin is added to the blood, after which the time of blood clot formation is assessed. Normal indicators are from 7 to 15 minutes.

This test helps determine the level of thrombin in the biomaterial being studied. When it decreases, there is a high probability that the patient has liver diseases. If the clotting time is less than 7 minutes, then the development of cardiovascular diseases or the formation of malignant tumors can be suspected.

Hypercoagulation is observed in late pregnancy and the postoperative period.

Thrombotest

Based on visual determination of the amount of fibrinogen in the blood. The norm is thrombotest grade 4-5.

D-dimer

This test helps determine the rate of blood clotting and the length of time it takes for the clot to dissolve. Thanks to a test for this marker, you can promptly notice an imbalance between indicators and determine its cause (varicose veins, thrombophilia, pulmonary embolism, etc.).

In healthy people, the level of this marker is 243 ng/ml of blood. In expectant mothers, it increases as the gestational period increases.

DIC syndrome

When the body works well, the coagulation and anticoagulation systems have a clear balance. But if the indicators of one of the processes are disrupted, the entire hemostasis is disrupted. This is especially dangerous for the body of a pregnant woman.

A complication of this disorder is DIC, or disseminated intravascular coagulation. When the coagulation and fibrinolysis system is activated, DIC syndrome develops. During pregnancy, this condition is fraught with abruption of the placenta, endometrium, and OPV embolism.

Duke bleeding time

During this analysis, capillary blood is examined. To do this, the pad of the ring finger is pierced with a scarifier and the blood that appears with special litmus paper. This manipulation is carried out every 15 - 30 seconds, without direct contact with the skin. After each blotting, the laboratory assistant records the time until a new drop of blood appears. Bleeding stops after about 1.5 - 2 minutes.

The mediator serotonin directly influences this process.

Coagulogram during pregnancy

The pregnancy period is accompanied by numerous and significant changes in a woman’s body. And the hemostasis system does not stand aside. During the first days, a new circle of blood circulation is created - the uteroplacental - which is responsible for the delivery of nutrients and oxygen to the fetus. Thus, the volume of circulating blood increases and its composition changes.

Hormonal changes cannot be ignored. They also make serious adjustments, because throughout the entire gestation, progesterone will dominate over estrogens.

During pregnancy, women experience increased activity of coagulation factors. This is especially true for factors 7, 8, 10 and fibrinogen. Fibrin fragments begin to gradually be deposited on the walls of the uteroplacental system. Due to this, the process of fibrinolysis is suppressed.

With such actions, the female body tries, as it were, to insure itself in case of uterine bleeding, or the risk of spontaneous termination of pregnancy - miscarriage. This, in turn, prevents placental abruption and prevents the formation of intravascular blood clots.

Normal indicators of hemostasis in women during pregnancy are as follows:

If pregnancy occurs with complications (early toxicosis, gestosis), then the regulation of blood clotting is significantly disrupted. There is an increase in fibrinolytic activity, and the life span of platelets is shortened. In such situations, it is extremely important to consult a doctor. If such a violation is not corrected, it can lead to DIC syndrome.

Disseminated intravascular coagulation syndrome develops in 3 stages:

1. Hypercoagulation, which is accompanied by the formation of small blood clots. Such a violation leads to circulatory disorders between the maternal body and the fetus.
2. Hypocoagulation is a condition in which blood clotting factors begin to become depleted. This process is accompanied by the disintegration of blood clots.
3. Acoagulation is a pathological disorder of hemostasis in which the blood stops clotting. This is a dangerous condition that can lead to unpredictable consequences for the body of a pregnant woman and provoke serious complications. Often the fetus dies in such a situation.

Where can I get tested and how much does it cost?

If reagents and necessary equipment are available, any laboratory - private or public - can perform such a study. The cost of manipulation depends on what indicators need to be studied, what methodology and equipment is used for this.

Speaking on average, a regular coagulogram costs from 700 to 1300 rubles. To conduct an extended analysis, the patient will have to pay about 3,500 rubles. Although it is worth considering that such an analysis is mandatory for pregnant women, so for them it is usually free, just like under the compulsory medical insurance system.