Coagulogram analysis time. Coagulogram during pregnancy, is the study important?

Blood is one of the most important fluids in human body, which is sensitive to the slightest changes in the state of his health and allows one to quickly identify existing problems.

Numerous blood tests can quickly give a specialist a fairly complete picture of the existing changes, which means that in the shortest possible time they can move on to an in-depth study or to direct treatment of the disease, if it can be “calculated” immediately. One of these important ones is a coagulogram.

Coagulogram - study of blood clotting

Coagulogram is quite complicated laboratory test blood samples for . This procedure makes it possible to find out whether there are any disturbances in the functioning of the blood coagulation system in the direction of accelerating or slowing down the process. Such a study is very important not only for calculating certain values, but is also simply necessary, for example, before extensive surgery. It will demonstrate how well and quickly the blood can clot during surgery, whether there are problems with accelerated clotting, that is, the formation of blood clots, and whether there will be complications during the intervention if the blood clots with difficulty and slowly.

Violation of the thrombosis process can lead to internal and external bleeding, and if serious problems lead to large blood loss or fatal outcome– the patient may simply bleed to death.

Tests for coagulogram norms are necessary not only for planned surgical intervention, but are also a mandatory study during.

Balance in the blood coagulation system is extremely important for the health of the expectant mother and child, because the slightest disturbance can cause miscarriage, premature birth or developmental pathologies.Pregnancy places a serious strain on a woman's circulatory system, so clotting problems can lead to bleeding, placental abruption and be extremely dangerous factor during childbirth or immediately after it. Uncontrollable heavy bleeding can cause severe complications, including removal for health reasons.

Coagulogram indicators

What is included in a coagulogram - description of indicators

Any analysis for coagulogram norms can be basic or additional, additionally expanded.

Basic indicators include the following parameters:

• Fibrinogen. This is the main and most important indicator in a blood clotting test.
• Prothrombin index, international normalized ratio INR, prothrombin time PTT. IN normal conditions one of these three types of tests is performed, most often this is INR as the most informative and universal analysis. All of these are aimed at the external pathway of blood coagulation.
• Thrombin time.
• Activated partial thromboplastin time aPTT.

Additional coagogram parameters:

• Antithrombin. An important indicator of the normal operation of the anticoagulation system.
• Protein C. A lack of this substance can cause thrombosis.
• Lupus anticoagulant. An indicator of the presence of autoimmune problems.
• D-dimer.
• Activated recalcification time (ATR).
• Soluble fibrin-monomer complexes (SFMC).

Appointment for analysis

A test for coagulogram norms is prescribed in different cases; it is necessary for the patient’s condition and for assessing potential risks during surgery.

It is performed not only on patients - all pregnant women receive a referral for such an analysis once every trimester, and if a woman has previously had miscarriages or there is a threat of pregnancy loss, there is a risk of developing dangerous conditions, then the test can be carried out unscheduled and repeatedly.

The main reasons for prescribing a coagulogram are the following diseases and states:

• Planned surgery. Almost any operation, especially an extensive one, is associated with the risk of blood loss, and if there is a clotting disorder, such an invasion threatens with dangerous bleeding.
• Disturbances in normal functioning vascular system, including varicose veins and thrombosis.
• . Throughout the entire period, samples are taken regularly once every trimester.
• Problems with blood clotting.
• Availability autoimmune diseases.
• Diseases of the cardiovascular system (stroke, heart attack, ischemic disease hearts).
• Diseases.
• Prescription of oral and other types of hormonal contraceptives. A sample is taken once a quarter.
• Prescription and selection of anticoagulant drugs.
• Prescribing an adequate dose acetylsalicylic acid(aspirin).

During hirudotherapy (use of leeches with therapeutic purpose). This is necessary to prevent possible blood loss due to a blood clotting disorder, since leeches secrete a special substance that prevents clotting.

A coagulogram, also called a hemostasiogram, can be basic or extended.

During the initial examination, a basic test is first prescribed, and if necessary, to clarify the result or more accurately determine the pathology, an extended test is prescribed.

Preparing for the test and carrying out the procedure

Before performing a coagulogram, the patient must undergo special training. First of all, the test is taken on an empty stomach, preferably in the morning, so last time You can have dinner no later than 8 hours before the test, and it is best to limit your diet for 12 hours. Maximum withdrawal recommended medicines, especially those whose intake may affect the condition of the blood. If this is not possible, you must inform the specialist of the list of medications you are taking.

During preparation for the analysis, the patient must refuse all types of drinks, limiting himself only to clean drinking water. Not only alcoholic drinks are prohibited, but also coffee, cocoa, tea, juices - in short, everything that is not water.

The emotional and physical peace and well-being of the patient is also extremely important to obtain accurate correct results coagulograms. Doctors recommend avoiding stressful situations in every possible way before the analysis, and also not putting physical strain on the body by postponing training or hard work to another time.

Venous blood is collected for the sample.

The analysis is considered quite complex; it evaluates many different components at once. Correct and accurate interpretation of data can only be provided by an experienced specialist.

Explanation: normal

Since when analyzing coagulogram norms, many indicators are taken into account, each of them is integral part general indicator of the normal functioning of the human circulatory system:

• Fibrinogen. The rate of this, which is synthesized in, is 2-4 g/l. During development, the level of fibrinogen increases, but normally in the last trimester it should not exceed 6 g/l (at this time the maximum increase in this indicator is observed). Fibrinogen level is a sensitive indicator to the state of the body. It clearly demonstrates the presence of various inflammatory processes in the body, since the level of fibrinogen quickly increases with the appearance of necrotic tissue conditions (heart attack, stroke, pneumonia, and so on).
• APTT. This indicator determines the time it takes for a blood clot to form. The usual rate is 20-40 seconds.
• Prothrombin. This interacts with vitamin K, which is very important for the health of the blood and the entire body. In the liver, they combine and form thrombin.
• Thrombin time. This is an indicator of the conversion of fibrinogen to fibrin; normally it should take 11-18 seconds. During this time, the amount of fibrinogen increases, but the thrombin time should be within the normal range. If it lengthens or contracts, we may be talking about a change in the amount of fibrinogen in the blood (increasing or decreasing).
• Prothrombin time. This factor indicates the timing of the conversion of prothrombin to thrombin. Normally, prothrombin time should take 15-17 seconds. Thrombin is an important substance; it is necessary so that the blood can clot and turn into a clot (thrombus), thereby eliminating bleeding. Both too low and too high prothrombin time are equally dangerous.
• Prothrombin index PTI. It is measured as a percentage and refers to the most important indicators of blood clotting. Reflects a comparison of normal plasma coagulation with the same period in the patient (in percentage terms). PTI numbers normally should not go beyond 93 – 107%. During pregnancy this figure increases. It may also be affected by taking birth control medications.
• . This is an important indicator that indicates general state body, and not just the hematopoietic system. Normally it is 150-400 thousand cells per µl. A low platelet count is called thrombocytopenia and indicates that the expectant mother is not eating well and needs to urgently change her diet so as not to harm the baby.
• Antithrombin. It is a thrombin antagonist, that is, a substance that inhibits blood clotting. Normally, the indicator should be 71 – 115%.
• Lupus anticoagulant. This parameter is very important when conducting tests during pregnancy or assessing the risk of autoimmune diseases. If a woman is diagnosed with gestosis, the risk of miscarriage increases significantly. Autoimmune diseases also pose a serious threat to human health and often cannot be detected by any other tests.
• D-dimer. This is one of the most important indicators for pregnant women. It is formed during incomplete breakdown of fibrin. Normally it is up to 500 ng/ml. In pregnant women, this figure is much higher, even at the very beginning of pregnancy, but by the last trimester it increases several times. Also, an excessive deviation of the indicator from the norm may indicate the presence of gestosis. In the absence of pregnancy, such indicators appear in old age, in case of damage.
• DIC syndrome. This is a very dangerous condition in which the blood clotting and thinning control system fails and DIC develops. It threatens a pregnant woman with endometritis, placental abruption or amniotic fluid embolism.
• Antiphospholipid syndrome, or to phospholipids. An autoimmune disease is detected. Antibodies to phospholipids appear during thrombosis of veins and arteries. A pregnant woman in whom these antibodies are found suffers from fetaplacental insufficiency, which threatens miscarriage or premature birth, and fetal death.
• Plasma tolerance to heparin. Performed simultaneously with the time of recalcification. Heparin is injected into the plasma and the recalcification time is determined. If it deviates from the norm, it may indicate liver disease, heart failure, cancerous tumors and pre-thrombosis conditions. But in pregnant women, the increase in this indicator at the end of pregnancy is normal.
• Plasma recalcification time
• Time period for fibrin clot formation. Normal indicator– 60 – 120 seconds.

Coagulogram values ​​in children are slightly different from those for adults. For example, the level of fibrinogen in a newborn baby is 1.25 - 3 g/l, which is much lower than the standard levels for an adult.

Reasons for possible deviations

Deviation of coagulogram indicators - possible diseases

If, after the analysis, various deviations from the norm of the coagulogram are detected, this may indicate the presence of various pathologies in the hematopoietic system, and may also be signs of the onset of diseases.

For example, a violation of the normal blood clotting time indicates a failure in the thrombosis system: an extension of this period indicates a decrease in active functioning, an increase in the thrombolytic abilities of the body (that is, that the anti-clotting system is overly active). If the blood clots very quickly, this indicates a high activity of the blood coagulation system or poor functioning of the thrombosis resistance system. In order to clarify the specific cause of the disorder, it will be necessary to study other coagulogram indicators. In addition, in this case, you need to pay attention to which tube the blood was drawn into - glass or silicone. When using silicone tubes, the folding time is extended to 25 minutes, while in glass the maximum is 7 minutes.

The concentration of fibrinogen increases during, with various disorders of the body of an endocrine nature and the presence of various inflammatory processes.

A reduced level of fibrinogen indicates disturbances in the blood coagulation system and is the cause of a variety of bleeding.

Most often, this condition is caused by, or other diseases, a lack of vitamins C, K and group B in the body, which provokes the development of diseases such as Crohn's disease, a symptom of malabsorption and dysbiosis. Also, the cause of such a violation may be the second stage of DIC syndrome or the use of special medicines.

The time of recalcification is also an important component of the overall picture of the state of the blood and the health of the body. A reduction in the period of recalcification indicates thrombophlebitis or thrombosis, and a lengthening indicates a disruption of the blood coagulation system caused by a lack of platelets or their inferiority, as well as disorders of the hemostasis system, increased activity of the anticoagulation system, or in the second stage of DIC syndrome.

More information about blood clotting can be found in the video.

If the aPTT time is reduced, this does not indicate the presence of serious pathologies, but its prolongation appears when using medications - anticoagulants, with such hereditary diseases blood, such as hemophilia or for autoimmune problems such as systemic.

Violations of the prothrombin index are the most striking indicators of malfunctions in the hemostatic system. A low prothrombin index indicates bleeding disorders caused by a lack of vitamin K, problems with digestion and liver function. An increase in the prothrombin index indicates increased level thrombus formation associated with thromboembolism of various vessels, strokes and heart attacks.

An increase in thrombin time entails a decrease in fibrinogen content, and it is also associated with liver diseases and pancreatitis, when using anticoagulants - substances that prevent rapid blood clotting.

A reduction in thrombin time is typical for the third trimester of pregnancy and in conditions causing growth fibrinogen level.

Decoding coagulogram data is an important and complex task, accessible only to a competent and well-trained specialist. There is no need to try to diagnose yourself, much less begin treatment. The doctor evaluates all sections of the coagulogram as a whole and, if necessary, carries out additional tests and, only after receiving clear data, drawing up the necessary treatment regimen.

Coagulogram (or hemostasiogram)- a test necessary to assess the ability of blood to clot. It can indicate a pregnant woman’s tendency to form blood clots or bleeding, which helps prevent the development of pathologies of fetal formation, placental abruption and complications during childbirth.

Indications and preparation for donating blood for a coagulogram

During pregnancy, there are three scheduled blood donations for a coagulogram:

1. Immediately after registration for pregnancy.
2. Between 22-24 weeks.
3. Between 30-36 weeks.

Unscheduled blood donation for hemostasiogram is performed according to the following indications:

• long-term previous infertility;
• complications (multiple pregnancy; pregnancy resulting from IVF; as well as fetal growth intrauterine development; early or late gestosis; fetoplacental insufficiency);
• varicose veins veins expectant mother;
• formation of hematomas (bruises) after minor bruises, nose bleed, bleeding gums when brushing teeth;
• smoking and other bad habits of a pregnant woman;
• the need to assess liver function. IN in this case a hemostasiogram allows you to assess the functioning of the liver by monitoring the formation of prothrombin complex factors in it;
• monitoring the state of the blood coagulation system in women who have been treated for a long time with direct anticoagulants (for example, Heparin);
• suspected blood clotting disorder.

To obtain reliable indicators of blood clotting, you need to do a hemostasiogram on an empty stomach. It is not recommended to eat food 8 hours before the test, including drinking juices, tea, coffee. Avoid eating sweets (including chewing gum with sugar). You can only drink clean water without gas.

Half an hour before donating blood, you should refrain from smoking if the expectant mother has such bad habit. It is also not recommended to overexert yourself physically 30-40 minutes before the test. Emotionally, a woman should be calm, only slight excitement is acceptable.

Blood for analysis is taken from a vein in the crook of the arm.

Decoding coagulogram indicators

A simple hemostasiogram necessarily reveals:

• Prothrombin + INR
• Fibrinogen
• Thrombin time

An extended coagulogram is prescribed if there are deviations in a simple coagulogram or is performed immediately instead of it. Then additionally indicate:

• Antithrombin III (AT3)
• D-dimer
• Lupus anticoagulant

A referral for an extended hemostasiogram is issued according to indications. These include:

• recurrent miscarriage;
• previous long-term infertility;
• fetal death in the past;
• multiple pregnancy;
• hereditary blood diseases;
• severe forms of toxicosis (preeclampsia).

The analysis is deciphered by the attending physician in the antenatal clinic.

Norms of coagulogram indicators necessary for deciphering the analysis results

Prothrombin + INR

Prothrombin(factor II) is one of the main blood clotting factors. If a deviation of this indicator from the norm is detected in a timely manner, the doctor is able to promptly prevent the development of thrombosis, placental abruption, or the occurrence of bleeding during delivery. That is why it is advisable to conduct a coagulogram in each trimester of pregnancy.

In addition, the level of prothrombin allows the doctor to assume the presence of malfunctions in the liver and digestive system women. How is prothrombin connected to these organs? - you ask.

The answer is: prothrombin is produced in the liver with the participation of vitamin K. One part of this vitamin is produced by the intestinal microflora, and the other enters the body with food, which must be digested in order to obtain the coveted vitamin K.

The gastrointestinal tract and liver are involved in the digestion process, because it produces bile for gastric juice. And if the prothrombin level is reduced, it means:

1) the liver cannot cope with its duties;

2) absorption of vitamin K from the gastrointestinal tract is difficult (for example, due to diseases such as enterocolitis or ulcerative colitis);

3) the production of vitamin K does not occur completely due to disturbed intestinal microflora.

In this case, additional blood tests are prescribed for liver enzymes (ALT and AST), which are most often included in biochemical analysis“plus” blood, referrals are issued for a repeat general blood and urine test (possibly stool). If necessary, ultrasound of these organs or other diagnostic studies may be prescribed.

Modern laboratories measure prothrombin according to Quick (in %). The normal prothrombin value is in the range of 78-142%.

Some laboratories calculate only the thrombosed index (PTI). Its norm differs in different laboratories; it must be found out from the laboratory assistant.

An increased level of prothrombin (more than 142%) can be detected when:

• tendency to form blood clots. These include pre-infarction conditions and myocardial infarction, thromboembolic conditions, increased levels of globulins in the blood and hypohydration, which arose due to increased blood viscosity;
• taking medications that inhibit the effect of coumarin (for example, vitamin K) or can reduce it (meprobamate and corticosteroids).

If prothrombin is reduced (less than 78%), then the following is detected:

• hypofibrinogenemia, characterized by low levels of fibrinogen in the blood;
• vitamin K deficiency female body (hemorrhagic diathesis in a baby);
• insufficiency of the coagulation factor prothrombin, as a result of which the pregnant woman has a tendency to bleed.

Taking anticoagulants and coumarins by the expectant mother, as well as medications that enhance their effect, also leads to a decrease in prothrombin in the blood.

INR (International Normalized Ratio) shows the rate of formation of a blood clot. An analysis to determine the level of prothrombin + INR is regularly prescribed to people who take anticoagulants - drugs that prevent thrombosis.

If the expectant mother is treated with direct anticoagulants, then the results of the coagulogram must also indicate the value of the International Normalized Ratio, which the woman must inform in advance so that an additional calculation and INR (in English INR - International Normalized Ratio) can be performed for her.

If a woman is not treated with blood thinning drugs, then the INR value is usually not indicated in the test results (it is simply not calculated, because this is not necessary).

INR healthy person falls within the range of 0.8-1.2. But depending on the disease and its treatment tactics, the normative range may be different. Therefore, for each patient, the norm of this indicator is determined by the attending physician and is called the “target INR range”.

If INR is below normal, then the dose of the anticoagulant is insufficient and the risk of thrombosis is still high.

If INR is higher than normal, then the selected dose of the anticoagulant is excessive and now the risk of bleeding increases.

Therefore, calculating the INR is necessary to adjust the dosage of a drug prescribed to reduce the risk of blood clots.

APTT

APTT (activated partial thromboplastin time)– the period of time during which a blood clot forms.

In the laboratory, this time is determined using the following experiment. First, the blood plasma is separated, and then reagents are added to it (calcium salt of hydrochloric acid, kaolin-kephalin mixture and others). This simulates the beginning of the natural process of blood clotting in the human body.

As a result of the experiment, the presence of factors involved in coagulation or their deficiency is established. The presence of components in the blood that slow down the coagulation process is also determined. And, of course, the very time during which a blood clot forms is recorded.

The normal APTT value for expectant mothers is in the range of 17-20 seconds.

For a non-pregnant woman, the normal APTT falls within the following time frame: 24.0 – 38.2 seconds.

APTT = 21 seconds or more. If, after adding reagents to the blood plasma, a clot has formed in more than 20 seconds, then this indicates a tendency to bleeding due to the presence of:

• second or third phase of disseminated intravascular coagulation (DIC syndrome);
• hemophilia A, B, C;
• increased production of antibodies to phospholipids.

APTT may be increased when the expectant mother is treated with heparin, therefore, in order to get a reliable result, it is necessary to stop heparin 2 days before the test or donate additional blood for lupus anticoagulant and for antibodies to cardiolipin.

APTT = 16 seconds or less. And if a clot has formed in less than 17 seconds, then this indicates:

• the initial phase of DIC syndrome, characterized by increased blood clotting, when, after receiving injuries in large blood vessels clots form quickly, and in small ones - blood clots;
• thromboembolism or thrombosis;
• increased content of activated coagulation factors;
• getting injured while taking blood for analysis (the analysis must be retaken; it is better to take blood from a vein in the second arm).

Fibrinogen

Another blood clotting factor is fibrinogen. Fibrinogen(factor I) is a special protein that is supposed to be considered the main component of a blood clot. In healthy people, it is produced by the liver and distributed throughout the circulatory system. At the site of damage to the vessel wall, fibrinogen is converted into insoluble fibrin, which becomes the basis of a blood clot. Such a blood clot clogs the damaged vessel, thereby stopping the bleeding.

Only with a sufficient number of components of the blood clot, the thrombus is stable and remains at the site of the vessel injury until healing. If there is a deficiency of factors I and II, a person is prone to increased bleeding, and if there is an excess of it, thrombosis is observed without damage (that is, pathological blood clots are formed that can break off from the walls of blood vessels and block blood flow).

Fibrinogen is measured in mg/dL or g/L. To obtain the component value in g/l, it is necessary to calculate using the formula:

mg/dl 0.01 0.555 = g/l.

Fibrinogen norm:

• until approximately 12 weeks of pregnancy – this is 2.00-4.00 g/l;
• from 3 months until the end of pregnancy, an increase in fibrin to 6.5 g/l is permissible;

The fibrinogen level should not fall below 0.5 g/l. This critical level fibrinogen in the blood.

An increase in fibrinogen levels may indicate:

• flow acute illness inflammatory and infectious nature(eg influenza);
• lack of hormones produced by the thyroid gland;
• protein metabolism disorder;
• recent surgery;
• increased estrogen content;
• extensive burn.

Low fibrinogen (less than 2.0 g/l) may result from:

• DIC syndrome;
• lack of vitamins B12 and C;
• toxicosis;
• heart failure;
• acute promyelocytic leukemia;
• complications after childbirth;
• severe liver damage;
• thrombolytic therapy.

Thrombin time

Thrombin time (TV) is the time it takes for a clot to form after mixing blood plasma with thrombin. During pregnancy, the normal TV time ranges from 10.3 to 25 seconds.

An increase in TV (more than 25 seconds) indicates:

• low fibrinogen (up to 0.5 g/l);
• liver pathologies due to the presence of fibrinogen defects at the molecular level;
• fibrinolytic therapy;
• high levels of bilirubin in the blood serum;
• the presence of direct anticoagulants in the blood during treatment with heparin or other similar drugs.

Low TV (less than 10.3 sec.) is observed when:

• high level of fibrinogen in the blood;
• the initial stage of development of DIC syndrome.

Antithrombin III

Antithrombin III (AT3)- a complex protein produced by vascular and liver cells that inhibits the process of blood clotting. It is necessary to prevent increased formation of blood clots (thrombi).

Normally, AT3 is 70-120%.

High AT3 (more than 120%) is observed with:

• acute hepatitis;
• presence of inflammation;
• cholestasis;
• severe acute pancreatitis;
• treatment with anticoagulants;
• vitamin K deficiency.

Reduced AT3 (less than 70%) may be a consequence of:

• congenital deficiency of antithrombin III;
• acute DIC syndrome;
• atherosclerosis;
• chronic liver failure;
• heparin treatment;
• blockage of a vessel by a thrombus.

D-dimer

D-dimer is an indicator that characterizes the process of thrombus formation and fibrin dissolution. Normally, by the end of pregnancy it increases 3-4 times from baseline. But the increase in D-dimer should be gradual. Rapid growth may indicate pregnancy complications, possible kidney disease and diabetes.

D-dimer levels vary by laboratory.

For the independent laboratory "Invitro" and the clinic "Euromed" the standard values ​​for pregnant women are:

• I trimester – less than 286 ng/ml;
• II trimester – less than 457 ng/ml;
• III trimester – less than 644 ng/ml.

The D-dimer value should not fall below 33 ng/ml.

For the AltraVita clinic, the D-dimer norm during pregnancy is different:

• I trimester – from 0 to 525 ng/ml;
• II trimester – from 438 to 1200 ng/ml;
• III trimester – from 888 to 2085 ng/ml.

The Helix laboratory service has its own D-dimer standards for pregnant women:

• up to 13 weeks – 0-0.55 mcg/ml;
• 13-21 weeks – 0.2-1.4 mcg/ml;
• 21-29 weeks – 0.3-1.7 mcg/ml;
• 29-35 weeks – 0.3-3 mcg/ml;
• 35-42 weeks – 0.4-3.1 mcg/ml.

Conversion of values:

µg/ml 1000 = ng/ml

ng/ml 0.001 = µg/ml

For example, 500 ng/ml = 0.5 μg/ml.

An increase in level is observed in the presence of:

• deep vein thrombosis, pulmonary embolism;
• DIC syndrome;
• infections, sepsis;
• inflammation (with slight increase D-dimer values);
• liver diseases;
• extensive hematomas.

After thrombolic therapy or surgery (even after tooth extraction), the D-dimer value may increase. Late toxicosis also contributes to an increase in this indicator.

Lupus anticoagulant

Lupus anticoagulant (LA)– antibodies that prevent the conversion of prothrombin to thrombin. Normally, during pregnancy there is no VA. The appearance of antibodies indicates autoimmune diseases (for example, systemic lupus erythematosus, antiphospholipid syndrome), when the body accepts its own cells as foreign and begins to fight them. As a rule, in the presence of VA in the blood, an increase in APTT is observed.

The standard result in seconds is 31-44 seconds.

Identification of VA occurs when:

• blockage of a vessel by a blood clot (thrombosis, thromboembolism);
• with persistent miscarriage due to antiphospholipid syndrome (APS);
• ulcerative colitis;
• rheumatoid arthritis or other autoimmune diseases;
• availability infectious diseases(HIV, EBV, parvovirus B19, hepatitis).

VA can be detected in human blood, but in small quantities up to 1.2 conventional units (in some laboratories up to 9 conventional units). If the lupus anticoagulant is conditionally absent, then the test results are written “negative”, if it is present in the blood - “positive”.

Treatment with anticoagulants may lead to false positive result Therefore, lupus anticoagulant testing should be performed before heparin or heparin replacement therapy.

If an extended coalogram is carried out during heparin treatment, then positive result VA is not worth paying attention to.

Depending on the amount of antibodies in the sample, a comment is assigned: “weak”, “moderate” or “significant”.

Doctors prescribe many different tests for every sick person. However, not everyone knows what they are all intended for. In this article we'll talk about what a blood coagulogram is.

Designation of concepts

Let's understand the basic concept that will be actively used in this article. So, a blood coagulogram is an analysis of its homeostasis. In other words, the blood clotting system itself will be examined.

Blood clotting is the process of its thickening from a liquid consistency to the state of a so-called clot. This is a natural phenomenon, a certain protective reaction of the body to blood loss. The coagulation process itself is regulated by such important systems, both endocrine and nervous.

Preparing for tests

How to donate blood for a coagulogram, what do you need to know for this? First of all, it is worth saying that it is necessary to prepare for this procedure in advance. Only in this way will the results obtained be correct and will be able to indicate either the presence of problems or their absence.

1. Before taking the test, you should not eat for 10-12 hours. That is why this analysis take it in the morning. The patient is told not to have breakfast. That is, the analysis is taken on an empty stomach.
2. In the evening, on the day before donating blood, the patient is recommended to have a light dinner without fatty foods, smoked foods, or fried foods.
3. You can drink it in the morning before the test. However, only clean water without gas. Coffee, tea, juices are prohibited.
4. If the patient smokes, you should abstain from cigarettes for an hour before taking the test.
5. Doctors recommend: before taking a blood test for a coagulogram, you need to drink a glass clean water(200-250 ml).
6. On the day of the test, it is not recommended to overexert yourself both physically and emotionally.
7. Immediately before blood sampling, the patient should be calm and balanced. The pulse should return to normal.
8. If a person is taking medications that affect blood clotting, be sure to tell doctors about this.
9. If the patient does not tolerate the blood sampling process well, specialists should also be warned about this.

How and from where?

If a patient is prescribed a coagulogram, where is the blood taken from in this case? The sample will be taken from a vein. The resulting liquid is placed in test tubes (up to a certain mark), into which a preservative was added the day before.

1. The puncture site is pre-treated with alcohol (but not ether!).
2. The puncture is made only after the alcohol has completely dried.
3. It is best not to apply a tourniquet before drawing blood. The thing is that constriction of a human limb activates blood clotting, in which case the results may be distorted.
4. The first 5-6 drops of blood are not allowed into the test tube (they are blotted with a swab), as they may contain tissue thromboplastin.

Important: if the patient is prescribed several tests, blood is taken at the very beginning for a coagulogram, fibrinogen and prothrombin index.

Indications

When can a blood coagulogram be prescribed?

1. If the patient has problems with blood clotting.
2. This analysis is mandatory for patients undergoing surgery.
3. If the patient has uterine or other bleeding.
4. This analysis is needed for those patients who are being treated with anticoagulants.
5. If the patient has a history of heart attack or stroke.
6. This analysis is needed for people who have problems with the liver or vascular function.
7. In case of autoimmune diseases, it is also necessary to donate blood for a coagulogram.
8. The test is often prescribed for pregnant women.
9. The indication for its examination is varicose veins of the lower extremities.

Clotting time

Among the main indicators of a coagulogram, blood clotting time is distinguished. So, doctors determine how long the blood will flow, for example, from the moment of the cut until it stops completely. Normal interval:

• from 30 seconds to 5 minutes, if we are talking about capillary blood;
• about 10-15 minutes if it is venous blood.

This indicator allows you to judge how well platelets cope with their task. When the duration of bleeding from a wound may be increased:

1. If there is a lack of vitamin C in the body.
2. If for a certain reason the platelet count is reduced.
3. If the patient long time takes anticoagulants - for example, Aspirin.
4. For hemophilia or liver disease.

Blood may clot faster than the presented indicators if the patient is taking hormonal contraceptives or has previously had heavy bleeding.

PTI

This is the prothrombin index. This indicator is very important, as it allows you to monitor the condition of the liver. Its normal value: 80-120%. PTI may increase in the following cases:

1. If a woman is pregnant (this is normal).
2. If the patient takes contraceptives orally.
3. If there is a risk of blood clots that are dangerous to the body.

If the PTI is below normal, this is fraught with bleeding for the patient. And in order for this indicator to be within standard limits, the patient must take vitamin K.

Thrombin time

What other indicators are important if a patient is prescribed a blood coagulogram? This is thrombin time. Normally it is 15-20 seconds. During this period, the process of converting fibrinogen into fibrin is measured. If this indicator can be obtained over a longer period of time, this may indicate the following problems:

• there is an excess of fibrinogen in the patient’s blood;
• there is a lack of protein in the body;
• severe renal failure developed.

If the patient is treated with a drug such as Heparin, this indicator must be strictly monitored. How is it designated in medicine? Blood coagulogram - INR, i.e. international normalized treatment.

APTT

This abbreviation stands for “active partial thromboplastin time.” It is worth saying that this is the most sensitive indicator of blood clotting. It demonstrates how quickly a blood clot forms after calcium chloride or other components are added to the plasma. The normal rate is 30-40 seconds. If the blood coagulogram (APTT) is higher than normal, this may indicate that the patient has a diseased liver or a lack of vitamin K in his body.

AVR

This is the activated recalcification time. This indicator allows you to find out how one of the stages of blood clotting occurs. Normal data: 50 to 70 seconds. If the readings are lower, this may indicate that the patient has a thrombophilia condition. If the time period is significantly longer, the reason may be the following:

• a significant decrease in the number of platelets in the blood;
• heparin therapy;
• one of the critical conditions: trauma, burn, shock.

Fibrinogen concentration

Normal value: from 5.9 to 11.7 µmol/l. It may decrease when various diseases liver. Increases in the following situations:

1. If the patient has malignant tumors.
2. For acute infectious diseases.
3. With a lack of thyroid hormones.

RFMK

This indicator stands for “soluble fibrin-monomer complexes.” This is a marker of intravascular coagulation. It demonstrates changes in fibrin under the influence of thrombin and plasmin. Upper limit of normal: 4 mg/100 ml. It can change depending on the same reasons as fibrinogen.

Thrombotest

What does a blood coagulogram show if an indicator such as thrombotest is considered? It allows you to detect the amount of fibrinogen contained in the patient’s blood. Normal indicators: thrombotest grade 4 or 5.

Tolerance to plasma heparin

This indicator indicates the amount of thrombin in the blood. In this case, it will be possible to see how long it takes for a fibrin clot to form in the blood plasma (this should happen after heparin is introduced into the blood). Normal values: 7-15 minutes. Blood resistance to heparin decreases if the patient has liver problems (15 minutes or more). Hypercoagulation (which is typical for pregnant women), the presence cancerous tumors, diseases of the cardiovascular system, as well as the postoperative period - these problems can cause indicators in which blood tolerance is less than 7 minutes.

Fibrinolytic activity

This indicator allows you to determine how much blood can independently dissolve blood clots. Fibrinolysin, which is found in the plasma and can break down the structure of the blood clot, is responsible for this. If a patient’s blood clots dissolve faster than normal, then he or she is at risk of bleeding.

Duke indicators

If the patient needs to undergo a blood test for a coagulogram, the duration of bleeding according to Duke can also be examined. In this case, the patient's finger will be pricked. The penetration depth of the lancet (special instrument) is 4 mm. Then, approximately every 20-30 seconds, drops of blood will be removed from the patient using special paper. After removing one drop, the doctor times the time during which the next one appears from the wound. In this way, the patient's capillary blood clotting is checked. Ideally, this indicator should fluctuate between one and a half to two minutes.

Fibrinogen

I would like to remind you once again what a coagulogram examines - blood clotting. It is very important to study a protein synthesized by the liver called fibrinogen. At special conditions he is in hematopoietic system synthesized into such an important substance as fibrin. Normal content fibrinogen in the blood of a healthy person: 2-4 g/l. When indicators can be reduced:

1. If a woman has toxicosis while carrying a baby.
2. If the patient has cirrhosis of the liver.
3. At very severe forms a disease such as hepatitis.
4. In case of failures in homeostasis.
5. If there is a lack of B vitamins or ascorbic acid in the body.
6. These indicators may decrease if the patient takes fish fat, anabolics or anticoagulants.

Fibrinogen levels exceed the norm in the following cases:

1. For acute infections.
2. For pneumonia.
3. In inflammatory processes.
4. While carrying a baby.
5. After childbirth.
6. After operations.
7. In case of heart attack or stroke.
8. After receiving burns.
9. As a consequence of taking hormonal contraceptives.

Important: fibrinogen B must be negative.

Blood clot retraction

When taking a blood coagulogram, the norm of this indicator should be from 45 to 65%. In this case, the decrease in the volume of the blood clot is studied, its reduction along with the release of blood serum. Indicators increase as a result of anemia. They decrease if the patient’s platelet count decreases or red blood cell count increases.

GRP

This indicator provides information about the time of plasma recalcification. Normal: from 60 to 120 seconds. This is one of the most important indicators homeostasis. If the time is less than specified, we can say that the patient has hyperactive blood clotting.

A few words about children

It is important to say that in young patients some indicators will differ slightly from the norms presented above, while others will differ significantly. So, for example, the optimal amount of fibrinogen in a child’s blood is about 1.25-3.00 g/l. At the same time, in an adult it is 2-4 g/l. This test can be prescribed for children in the following situations:

1. Before surgery.
2. With frequent bleeding.
3. If there is a suspicion of hemophilia or other diseases that affect the circulatory system.

A few words about pregnant women

For women who are pregnant, this test is done three times in 9 months (once in each trimester). This is very important, since the hormonal system of a pregnant woman changes, which affects homeostasis (the changes are not pathological, but physiological, i.e. normal). Also, this study will help identify the threat of miscarriage or premature birth (which often occurs as a result of blood clots). In the first trimester, blood clotting rates may increase, but closer to childbirth they may decrease. All this is normal, because in this way the body tries to protect itself from possible bleeding and large blood loss. If the doctor is not satisfied with the results obtained, the woman will have to take this test again. If a pregnant woman is prescribed a coagulogram (blood test), the norm will be slightly different than that of a healthy person:

1. Thrombin time: 11-18 seconds.
2. Fibrinogen: 6 g/l.
3. Prothrombin: 78-142%.
4. APTT: 17-20 seconds.

If a woman is pregnant, it is very important for her to study an indicator such as prothrombin. Its deviation from the norm may indicate that the patient is at risk of pathological

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 hemostasis or coagulation system, which prevents blood loss when the integrity of the bloodstream is damaged. In the process of blood coagulation and thrombus formation, there are dozens of reactions that can be influenced by hundreds of different chemical substances. And this system itself includes a number of others regulatory mechanisms, some of which increase blood clotting, while others reduce it.

Due to the enormous importance of the system hemostasis for stable functioning of the body, in clinical medicine developed various methods research into this protective reaction of the body. The most common test for blood clotting is the coagulation test, which involves determining the time required to stop bleeding and the amount of bleeding. various factors this system. This study provides a lot of information about the state of the body as a whole, because the normal functioning of the hemostatic system depends on the proper functioning various organs and systems, therefore any disturbances in their operation are reflected in the coagulogram.

There are a number testimony, which require mandatory conduct of this study. Firstly, the determination must be made before surgical interventions- during operations, the integrity of the bloodstream is significantly compromised, which must be eliminated by the hemostasis system. Otherwise it may develop severe complications V postoperative period. Secondly, this analysis is often prescribed to pregnant women - due to strong hormonal changes, various blood clotting disorders are possible, both in the direction of decreasing it and increasing it. Thirdly, determining a coagulogram is desirable for diseases of various organs that are related in one way or another to the process of blood clotting - first of all, the liver, spleen, Bone marrow, the cardiovascular system. Autoimmune diseases also have an 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 medications - anticoagulants (for example, heparin), acetylsalicylic acid, hormonal contraceptives.

Donating blood for testing activity of the coagulation system requires some preparation. 8-12 hours before the test you should not eat food, alcoholic beverages, coffee or strong tea. Some of the coagulogram parameters have a certain instability, especially under stressful conditions for the body, so before and during the test you should not be nervous or subject to severe physical activity. Immediately before blood sampling, the 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 the determination of the main indicators immediately begins.

Exists basic and detailed blood test to determine the coagulogram. The norm of a basic coagulogram looks something like this:

Despite such a large number indicators, usually the basic coagulogram form contains only the main ones - fibrinogen concentration, coagulation time, activated recalcification time (AVR), activated partial thromboplastin time (APTT), prothrombin index, thrombin time, the number of soluble fibrin-monomer complexes. Based on these values, the activity of a particular factor can be indirectly determined.

Clotting time- one of the basic indicators, which is one of the first to be determined. 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 standards of this indicator, depending on the material of the container, the analysis form must specify whether a silicone or non-silicone tube was used for this. An increase in this indicator indicates a decrease in the activity of the hemostatic 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 blood coagulation activity, or a decrease in the functioning of the antithrombin system. The causes of these phenomena are determined by other coagulogram indicators.

Fibrinogen concentration- one of the main proteins of the hemostatic system - is also a key indicator of the coagulogram. It is this soluble protein that, during the formation of a blood clot, turns into threads of insoluble fibrin, which forms a blood clot. The normal level of its content is 2-4 g/l of blood plasma, which is a fairly high indicator. It is typical that in pregnant women on the eve of childbirth (in the third trimester), there is an increase in fibrinogen content to 6 g/l, which is normal training body to bleeding accompanying 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 disseminated intravascular coagulation syndrome, which often leads to the death of a person. In addition to pregnancy, fibrinogen levels increase during various inflammatory processes, shocks of various origins, endocrine disorders.

Decrease in this indicator coagulograms causes increased bleeding and increased blood clotting time. The cause of this condition may be some liver diseases (hepatitis, cirrhosis), lack of vitamins (K, C, B) and related diseases gastrointestinal tract(dysbacteriosis, Crohn's disease, malabsorption syndrome), taking certain medicinal substances, as well as the second stage of DIC syndrome.

Activated recalcification time (ATR) in a coagulogram characterizes how quickly the level of calcium ions (which are involved in the process of blood clot formation) in the blood plasma is restored. Normal occurrence The value of this indicator is considered to range from 1 to 2 minutes (60-120 seconds). An increase in the duration of recalcification indicates reduced blood coagulation activity, which is a consequence of an insufficient number of platelets in the blood or their functional inferiority, a lack of basic factors of the hemostatic system, increased activity antithrombin system, as well as in the second stage of DIC syndrome, when depletion of the entire blood coagulation system is observed.
Reducing time recalcification speaks of increased thrombus formation - with thrombophlebitis and thrombosis.

Activated partial thromboplastin time (aPTT)- characterizes the time required for the formation of a blood clot. The norm for this coagulogram parameter is 35-45 seconds, but when using some types of reagents, 28-35 seconds can be considered the norm. A shortening of this time is not a characteristic clinical sign of any disorder, but a significant increase in it occurs with the use of anticoagulants (heparin), acquired or congenital deficiency of the main blood clotting factors (for example, hemophilia), and with some autoimmune diseases (systemic lupus erythematosus).

Prothrombin index- the ratio of human plasma time to the reference value. This coagulogram indicator is expressed as a percentage and is normally 78-142%. Prothrombin index is the most exact value, which 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 basic factors, vitamin K deficiency, liver and gastrointestinal tract diseases. An increase in the prothombin index indicates high risk thrombus formation 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 turns 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. An increase in thrombin time also occurs with the use of anticoagulants. A decrease in this coagulogram indicator is observed during the last trimester of pregnancy and other factors leading to an increase in the level of fibrinogen in the blood.

Quantity of soluble fibrin-monomer complexes- these proteins are a transition link between fibrinogen and fibrin. The normal level 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 increased activity of the hemostatic 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.

As a rule, after analysis An extensive 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 precise definition causes of certain bleeding disorders. As part of the advanced 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 value; the norm of determination in an extended coagulogram is 60-140%. When this indicator decreases, the blood coagulation system begins to prevail, which leads to increased thrombus formation. The reason for the decrease may be liver disease and vitamin K deficiency, which often develops as a result of colon dysbiosis. Also, a decrease in protein C levels 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. 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 hemostatic 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, for toxicosis.

Antithrombin-3, like protein C, is an anticoagulant factor, the norm of which ranges from 75 to 110% of the reference value. Plays a special role a sharp decline content of this factor, since in such a situation the risk of thrombus formation with the development of embolism or even disseminated intravascular coagulation syndrome increases significantly.

Antibodies to phospholipids also called lupus antibodies, are normally completely absent from the blood. Their appearance in plasma is a sign of systemic lupus erythematosus, a severe autoimmune disease. Determining 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 a coagulogram, it is rarely determined, since this value is often already known from general analysis blood. However, the role of platelets, the normal content 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.

Training video for deciphering a coagulogram in normal conditions and with deviations

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

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

Hemostasis system

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

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

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

Indications

Indications for a coagulogram study:

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

Preparation

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

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

Decoding

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

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

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

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

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

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

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

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

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

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

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

Decrease in fibrinogen level:

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

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

Additional coagulogram indicators include:

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

An increase in the coagulogram level is observed when:

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

Downgrade:

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

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

This value increases when:

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

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

Increase value:

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

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