How is a coagulogram analysis done? Interpretation of blood coagulogram. This value increases when

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 intrauterine growth retardation; early or late gestosis; fetoplacental insufficiency);
• varicose veins in 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 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 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, they are appointed additional tests blood test for liver enzymes (ALT and AST), which are most often included in the biochemical blood test “plus”, 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 %). Normal value prothrombin 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 content 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 low level fibrinogen content 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.

The expectant mother's intake of anticoagulants and coumarins, as well as medicines, enhancing 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 should 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, blood plasma is separated, and then reagents (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, when injured, clots quickly form in large blood vessels, and blood clots in small ones;
• 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 is a critical level of fibrinogen in the blood.

An increase in fibrinogen levels may indicate:

• flow acute illness inflammatory and infectious (for example, influenza);
• lack of hormones produced by the thyroid gland;
• protein metabolism disorder;
• recent surgical intervention;
• 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 the initial level. But the increase in D-dimer should be gradual. Rapid growth may indicate pregnancy complications, possible diseases kidneys and diabetes mellitus.

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 a slight increase in the D-dimer value);
• 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;
• the presence of 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 performed during heparin treatment, then you should not pay attention to a positive VA result.

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

Our organism protect numerous mechanisms that ensure homeostasis - constant constancy internal environment 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 other 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 studying blood clotting is the determination of a coagulogram, which includes determining the time required to stop bleeding and the number of various factors of this system. This study provides a lot of information about the state of the body as a whole, because the normal functioning of the hemostatic system depends on the proper functioning of various organs and systems, therefore any disturbances in their work 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, severe complications may develop in postoperative period. Secondly, this analysis is often prescribed to pregnant women - due to strong hormonal changes, various disorders blood clotting, both in the direction of its decrease and increase. 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 - primarily the liver, spleen, bone marrow, and 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. You should not eat food 8-12 hours before the test. alcoholic drinks, 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 undergo heavy physical exertion. 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. For such a reason big difference between 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 a normal preparation of the body for bleeding that accompanies the birth of a child. However, you should carefully monitor this indicator - its excessive increase can cause blood clotting right inside the bloodstream, which underlies the onset of disseminated intravascular coagulation syndrome, which often leads to the death of a person. In addition to pregnancy, the level of fibrinogen increases during various inflammatory processes, shocks of various origins, and 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. Shortening this time is not typical clinical sign any disorders, but a significant increase 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%. The prothrombin index is the most accurate value that determines the efficiency of the entire hemostatic 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 a high risk of thrombosis and related disorders - myocardial infarction, stroke, kidney damage, thromboembolism of various vessels.

Thrombin time- an indicator closely related to the level of fibrinogen in the blood. Physically, it represents the time during which a certain amount of fibrinogen 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 accurately determine the causes of certain blood clotting 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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A coagulogram is a set of tests, information about which makes it possible to determine the state of the blood coagulation system and those of its components, the activity of which affects other systems of the body.

The study requires blood, which is taken from a vein in the bend of the elbow. You must donate blood on an empty stomach. 8-12 hours must pass between eating and taking blood for analysis. Juice, tea, coffee, especially sweetened ones, are strictly prohibited! You are only allowed to drink water.

It is good if fatty, fried and alcoholic foods are excluded from the diet 2 days before blood sampling. An hour before blood sampling, try not to smoke.

It is advisable to eliminate factors that may influence research results: physical activity, emotional swings. Before the fence you need rest for 15 minutes, recover.

Blood is taken for analysis before starting medication or 14 days after stopping it. If you are taking the course drug therapy, be sure to inform your doctor about this.

If you are taking medications that affect blood clotting (aspirin, heparin, contraceptives, etc.), be sure to notify the laboratory technician!

Coagulogram appointed in such cases:

1. liver diseases;
2. examination during pregnancy;
3. problems with the heart and blood vessels;
4. deviations of the coagulation system;
5. control during treatment with anticoagulants;
6. immune system diseases;
7. varicose veins of the lower extremities;
8. period before and after surgery.

How does the blood clotting process occur?

Blood clotting– This is the body’s protection from blood loss. When a cut or other tissue damage occurs, the blood cells are activated and form a plug to stop the bleeding. Such cells are called platelets. Normally, platelets do not manifest themselves in any way, because in order to move through the vessels, blood has a liquid consistency.

A coagulogram study will normally provide information about the ability of the blood to remain liquid and at the same time form clots in case of injury. Increased blood clotting causes consequences such as stroke and thrombosis.

If the doctor forces you to undergo such a study, then it is definitely worth doing. A violation of the blood clotting process may not have any manifestations for a long period.

Such violations are most often observed for diseases:

1. diabetes;
2. malignant tumors;
3. rheumatism;
4. chronic and acute diseases from the lungs, etc.

Blood clotting process comprises such stages:

1. In the presence of vascular damage, thromboplastin is released - a special substance that is an activator of the coagulation reaction.
2. There is a launch of coagulation factors - proteins that are constantly normally present in the blood and contribute to the formation of a blood clot at the site of a violation of the integrity of the vessel.
3. Thrombin activates the inactive fibrinogen protein, converting it into active fibrin, which is the basis of the clot.
4. Blood components, including platelets, are deposited in fibrin networks.
5. The blood plates compact and compress the clot, creating a thrombus that closes the damaged vessel wall.

Also works to counteract the coagulation system in the body anticoagulation system. Together they create the conditions for maintaining blood in normal condition.

Coagulation testing in pregnant women

It is even more important to correctly decipher a blood test during pregnancy. During pregnancy, a study will certainly show an increase in blood clotting, which is normal V similar condition. This is not a reason not to monitor this indicator and neglect analysis.

Changes in blood clotting can have an impact on the entire pregnancy, as well as on the child’s brain, if these abnormalities are not detected at the right time. Therefore, the expectant mother needs to know what characteristics this analysis has and what the procedure for taking it is.

Analysis procedure:

• On an empty stomach;
• Do not eat 8 hours before blood collection;
• Venous blood is collected.

During pregnancy, the following indicators are checked in a coagulogram:

1. fibrinogen- special protein. It tends to rise throughout the entire pregnancy, right up to the birth itself. The maximum value is 6 g/l.
2. activated partial thromboplastin time- during pregnancy should be below normal. Normally, when testing blood for a coagulogram, this indicator reaches 17-20 seconds.
3. lupus anticoagulant shows antibodies that cause the partial thromboplastin time to increase, so it should not occur during pregnancy. If the test shows lupus anticoagulant, then this indicates serious illness immunity.

Interpretation of blood test for coagulogram

For a standard coagulogram, deciphering the analysis results uses the following indicators:

Fibrinogen

Fibrinogen is a protein synthesized by the liver and, under the influence of a specific blood factor, converted into fibrin.

• determination of blood clotting disorders;
• preoperative examination and postoperative period;
• examination during pregnancy;
• blood control during inflammation in the body.

Increase fibrinogen indicates:

1. increased clotting;
2. risk of blood clots;
3. observed at the end of pregnancy;
4. postpartum condition;
5. postoperative period;
6. pneumonia;
7. acute inflammation and infections;
8. post-stroke condition;
9. myocardial infarction;
10. dysfunction of the thyroid gland;
11. burns;
12. taking contraceptives;
13. some specific diseases.

Decline fibrinogen level with:

1. severe hepatitis, liver cirrhosis;
2. dangerous blood clotting pathologies;
3. pregnancy complications;
4. hypovitaminosis C or B12;
5. taking hormones;
6. androgens;
7. anticoagulants;
8. fish oil.

Activated partial thromboplastin time

Activated partial thromboplastin time is a blood clotting time that depends on the presence of clotting factors, as well as on the concentration of heparin in the blood. The main function is to control the level of heparin during heparin therapy and specify the dosage.

Promotion APTT:

• lack of coagulation factors;
• presence of lupus anticoagulant;
• heparin;
• blood clotting in blood vessels.

Slow blood clotting due to an increase in the duration of aPTT, the following occurs:

• with inhibition of blood clotting;
• for blood diseases;
• for other rare diseases.

Lupus anticoagulant

Lupus anticoagulant is a component of the blood that acts against phospholipids. This enzyme has this name only because it was first discovered in the blood of patients suffering from lupus erythematosus. Normally, the amount of this enzyme reaches 1.2 units.

Excess norms indicate:

• antiphospholipid syndrome;
• risk of blood clots;
• thromboembolism;
• infertility;
• diseases of an immune nature;
• systemic lupus erythematosus;
• pathologies of cerebral circulation.

Prothrombin

Prothrombin is a composite protein, the most significant indicator of a coagulogram, which shows the functioning of the coagulation system. It precedes thrombin. Prothrombin is produced by the liver under the influence of vitamin K.

Based on the analysis of prothrombins, it is possible to obtain status report:

• liver;
• digestive organs;
• blood coagulation system.

Prothrombin time

Prothrombin time is the time of stage 2 of coagulation - the conversion of prothrombin to thrombin.

Promotion blood levels:

• liver diseases;
• hypovitaminosis K;
• lack of prothrombin and other coagulation factors;
• blood clotting in blood vessels.

Prothrombin index

The prothrombin index is the ratio of the coagulation period of a healthy person's plasma to the coagulation period of a patient's plasma. Measured in %. The normal range of fluctuations is from 93 to 107%.

The production of prothrombin complex proteins occurs in the liver; with its pathologies, the number of factors decreases. The prothrombin index is to some extent a characteristic of the state of this organ.

Increase PTI shows:

• increased clotting;
• danger of developing thrombosis.

It can be observed normally at the end of pregnancy and when taking contraceptives.

Index decline suggests a decrease in blood clotting rates.

To produce proteins of the prothrombin complex, vitamin K is needed. With its deficiency, deviation from the absorption of the vitamin in the intestine due to colitis and dysbacteriosis, the indicator may also fall.

Exceeding the dose of acetylsalicylic acid and diuretics also help reduce the prothrombin index.

Thrombin time

Thrombin time is the period during which fibrinogen is converted into fibrin. Normally, this is up to 18 seconds.

Increase thrombin time occurs when:

• severe liver pathology;
• congenital fibrinogen deficiency.

Decrease time is an indicator:

• excess fibrinogen;
• available paraproteins - special immunoglobulins.

The level of this indicator must be monitored during treatment with heparin and fibrin-containing drugs.

Antithrombin III

Antithrombin III is an anti-clotting protein. Produced in the liver.

A drop in its concentration can cause thrombosis and the ineffectiveness of heparin therapy.

Promotion concentrations at:

1. acute hepatitis;
2. obstructive jaundice;
3. inflammation;
4. menses.

Decrease:

1. congenital defect;
2. intravascular coagulation syndrome;
3. liver abnormalities;
4. risk of blood clots.

It is a protein and the opposite of thrombin. Its function is to suppress the action of the coagulation system. This indicator is measured as a percentage. The norm is from 71 to 115 percent.

In case of increased blood clotting, anticoagulants are prescribed. In such a situation, you also need to monitor the level of the indicator.

D-dimer

D-dimer is formed as a result of partial breakdown of fibrin fiber. This is one of the leading characteristics of the coagulogram of pregnant women. The usual rate is less than 500 ng/ml.

Although for pregnant women other parameters are within the normal range. Already at the beginning of pregnancy, the level of the substance begins to increase, and before childbirth it becomes several times higher than normal.

Promotion noted when:

• diabetes mellitus;
• kidney diseases;
• complicated pregnancy;
• in old age.

Platelets

Platelets are blood cells that are directly related to maintaining normal blood composition. The normal level in the blood is from 150,000 to 400,000 per µl.

When the concentration decreases, the following is diagnosed:

1. thrombocytopenia;
2. maternal malnutrition.

Platelets are produced in the bone marrow.

DIC syndrome

If there are deviations in blood clotting during pregnancy, there is a danger of the so-called DIC syndrome, which is manifested by increased clotting in initial stage and a decrease in coagulability - on the second, that is, it causes intense bleeding.

DIC syndrome is the most dangerous complication in gynecology, most often it is uncontrollable and dangerous not only for the life of the child, but also for the life of the mother.

Another situation is also possible. The blood becomes too thin due to changes in the anticoagulant system. As a result, it increases risk of blood loss, especially during childbirth.

In order to establish hemostasis, the coagulogram is analyzed and deciphered. Taking into account the results of the study, treatment is prescribed.

Ideally, this analysis is done every three months of pregnancy.

Off-schedule is carried out if:

1. there were pregnancy failures;
2. hypertension is diagnosed;
3. swelling;
4. protein in urine.
5. increased uterine tone.

Normally, the coagulation and anticoagulation systems are in balance. If any of the indicators of these systems shifts, a failure occurs in the entire hemostasis system. This poses the greatest danger to pregnant women.

The most severe complication is disseminated coagulation within the vessels. Strengthening the action of the coagulation system contributes to development of DIC syndrome. During the development of the disorder, a pregnant woman may experience placental abruption or amniotic fluid embolism.

Antiphospholipid syndrome

Signs:

1. Thrombophlebitis of the arms and legs;
2. Parts of the skin over the affected vessel turn red, become denser, and swelling appears;
3. Poorly healing wounds appear on the skin;
4. There is a pattern in the form of a grid on the skin - bluish spots of a strange shape, with branches, light in the center;
5. With pressure, the spots disappear;
6. The spots become paler when the woman is hot, and less bright if she is cold;
7. On the tips of the fingers and on the feet there may be spots with a star-shaped or linear pattern of small vessels.

This is a violation of the immune system. There is an increase in the number of antibodies to phospholipids in the body. This is a list of signs that are related to thrombosis of veins and arteries. Pregnant women diagnosed with APS may experience miscarriage due to fetaplacental insufficiency.

Using coagulogram indicators you can control the most minor changes in organism.
In fact, all characteristics depend both on the disorder and on the age of the patient, the day of the menstrual cycle, the amount and duration of treatment with a particular drug, etc.

Thus, when decoding, doctors do not always have the opportunity to compare the available data with normal values. In this case, it is necessary to take into account the smallest features of the human body.

Coagulogram results

The listed analysis indicators are not complete. The choice of the necessary parameters for diagnostics is determined by for various reasons. The results of the study can be obtained the next day after blood collection.

A surgeon, gynecologist, infectious disease specialist, therapist, ENT specialist, and endocrinologist refer for such an analysis.

In addition to pregnant women, Doctors advise getting tested those who suspect the presence of immune damage, disorders of the heart and blood vessels, or those who suffer from varicose veins of the legs. If a patient has abnormal liver function, then he needs a coagulogram.

Only a professional can accurately interpret the analysis indicators. It is he who will carefully examine the available results and draw conclusions about the degree of their deviation from the norm.

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What it is? A coagulogram is a blood test to identify indicators of the hemostatic system, determining the ability of coagulation and possible deviations.

Disturbances in the hemostatic process, either increasing or decreasing, lead to serious illnesses such as a heart attack or stroke.

An increased level of hemostatic activity causes the formation of blood clots, and a decreased level leads to bleeding. The analysis is usually carried out together with the general laboratory examination blood on nine points - deviations in each indicator indicate a deterioration in the hemostatic functions of the body.

Coagulogram - basic concepts and definition

Hemostasis is a biological system whose work is aimed at maintaining the state of the blood and preventing damage vascular walls and dissolution of blood clots that have performed their own functions. It includes three actions:

• First, when the endothelium is damaged or ruptured, a number of active substances. This is thrombomodulin, nitric oxide, prostacyclin, which triggers the primary defense mechanism.
• Second, platelet membranes rush to the area of ​​damage to unite and close the gap.
• Third, due to 15 plasma elements and enzymes (the so-called coagulation factors), a dense fibrin layer is formed that stops bleeding.

Along with clotting properties, the body has an anticoagulating mechanism. Both systems are related in constant equilibrium. This circumstance determines the liquid form of blood, its necessary parameters and composition throughout the life of the body, creating optimal conditions for it.

Violation of this balance often does not manifest itself externally. To identify it, two types of research are performed (extended and regular). If the basic analysis reveals a pathology, an extended coagulogram is performed.

This is due to the fact that all indicators are indicative. For a full assessment, a diagnosis of thirteen main points is required, and a deviation from the norm in at least one column indicates the development of pathology.

Indications - why do they take a coagulogram?

When prescribing a test, patients have a question: why do they take a coagulogram? The main reasons for conducting the analysis are the following factors:

• During elective surgical interventions, the risk of bleeding is taken into account. Before performing the operation, the doctor receives information about the state of blood clotting ability.
• When using hirudotherapy (application of leeches), it is necessary to monitor hemostasis in order to avoid the risk of developing hemorrhagic syndrome (damage to the vascular walls, impaired coagulation, changes in the number of platelets).
• When prescribing contraceptives, the analysis is carried out once every three months.
• During pregnancy, examinations are done every trimester due to hormonal changes.
• For autoimmune diseases.
• For liver pathologies.
• To select the optimal dosage of drugs based on acetylsalicylic acid.
• For diseases of the heart and blood vessels.
• For thrombophlebitis, embolism, varicose veins.
• In case of previously identified disorders in hemostasis.

Coagulogram during pregnancy

The normal state of hematopoiesis is the primary indicator of a healthy body of the expectant mother. Women undergo changes during this period as they prepare for an additional circulatory cycle and loss of extravasation during childbirth.

The slightest disturbances in coagulogram parameters during pregnancy are recognized as a threat to the health of the mother and child. If the level of hemostasis is low, there is a risk of placental abruption and bleeding of other origins and localization.

At increased factor– blood clots and placental insufficiency. The latter causes impaired fetal growth and hypoxia. Doctors also note cases of vascular blockage pulmonary artery and the occurrence of clots in the pelvic area and lower limbs if there is a hypercoagulable state.

Bleeding disorders lead to premature birth or miscarriage.

A coagulogram is carried out as planned at the first visit to the gynecologist, in the second trimester (22-24 weeks) and third (30-36). The frequency of testing increases in the following cases:

• Rh conflict with the father of the unborn baby.
• Predisposition to thromboembolism.
• Varicose veins
• Vascular, endocrine, urogenital pathologies.
• Predisposition to increased coagulability.
• Problems with previous pregnancies (arbitrary termination, miscarriage).
• Changes in the condition of the placenta.
• Liver diseases.
• Anemia.
• Development of several fruits simultaneously.
• Autoimmune pathologies.
• Preeclampsia (manifests increased performance pressure in the arterial system, protein in the urine and sometimes edema).

Each index is limited by a scope. For children, women and men, a standard test is traditionally prescribed.

Pregnant women and patients with a need to clarify the diagnosis are offered an extended examination.

Coagulogram interpretation and norms for adults (Table 1)

Options	Indicator name	Normal for adults	Norm for children
Clotting period	According to Lee-White	12-15 min.	3-10 min
Activated thromboplastin period	APTT	25-35 sec.	25-35 sec.
Prothrombin time	PTV	11-18 sec.	Premature newborns -14-19 sec. The first 6 months of life – 13-17 seconds. Up to 5 years – 13-16 seconds. Up to 15 years – 12-16 seconds.
Prothrombin index	PI	80-120%	75-100%
D-dimer		Up to 0.78 mg/l Pregnant women – 1st trimester – 1.1 mg/l 2nd trimester – 2.1 mg/l 3rd trimester – 2.8 mg/l	0.8 mg/l
Fibrinogen		2-4 g/l	2.70-3.60 g/l
Antithrombin		70-120%	70-120%
Concentration of soluble complexes	RFMK	3.35-4.0 mg/100 ml plasma	3.0-3.5 mg/100 ml plasma
Lupus anticoagulant		0	0

Decoding coagulogram (standard and extended)

The coagulogram includes a fixed number of indicators. Each of them displays blood clotting functions. In practice, a standard study is required. The doctor selects the parameters necessary to confirm the diagnosis.

These are typical mechanisms for ordinary situations. If during such an analysis (coagulogram) the transcript shows deviations, additional extended studies are prescribed.

Each indicator provides the following information.

1. Fibrinogen.

This is an enzyme produced by the liver. It reacts to inflammatory and necrotic processes, infections occurring in the body. When reagents are added, the substance turns into fibrin. The fibers are placed on a filter device, dyed and weighed, so the unit of measurement is g/l.

During pregnancy, the indicator increases, reaching a value of 6 g/l, which is not considered a deviation. In other cases, an increase in enzyme levels may indicate the development of the following pathologies:

• Heart attack.
• Injuries and burns.
• Rheumatism.
• Atherosclerosis.
• Malignant formations.
• Postoperative conditions.
• Nephrotic manifestations.
• Myelomas.

Indicates the following diseases:

• Heart failure.
• Genetic enzyme deficiency.
• Cirrhosis.
• Taking medications that eliminate blood clots.
• Mononucleosis of infectious etiology.
• Food or chemical poisoning.
• Development of the metastatic process in cancer.
• Complications after childbirth.
• Late toxicosis.
• Leukemia (group oncological diseases blood system).

2. APTT

Partially activated thromboplastin time is a parameter showing the interval during which one clot is formed. The value reflects the speed of the first phase of coagulation.

This is a sensitive and accurate indicator that, using a coagulogram, determines the normal blood level in women. The values ​​depend on the reagents and may vary from laboratory to laboratory.

Therefore, the analysis form always contains reference values ​​developed in a particular laboratory. An increased parameter shows the following problems in the body:

• Insufficiency of clotting factors.
• Disseminated intravascular syndrome in the second and third phases.
• Taking heparin drugs.
• Autoimmune pathologies.
• Hemophilia.
• Antiphospholipid deficiency (a syndrome in which damage to phospholipids on the cell membrane occurs).
• Thrombophilia.
• Parenteral administration of hydroxyethyl starches.

The short index identifies the following pathologies:

• Thromboembolism.
• Pregnancy.

3. PTV

Characterizes hemostasis and coagulation abilities. The index determines the period of creation of clots with calcium and plate.

The study is conducted to evaluate the extrinsic clotting pathway. Decoding the results implies disorders or complications in the body with a shortened indicator:

• Taking oral contraceptives.
• Disseminated intravascular syndrome.
• Last weeks of pregnancy (the body “prepares” to stop blood loss during childbirth).

The extended factor is interpreted as follows:

• Diseases of the liver and biliary tract.
• Therapy with indirect anticoagulants.

Thrombin time determines the final stage of blood clotting. During this interval, fibrinogen is converted into fibrin under the action of enzymes.

Determined simultaneously with APTT and PTT for diagnosis congenital pathologies and assessment of anticoagulant functionality. An underestimated indicator indicates heparin and antifibrin therapy.

Deviations to the long side (reduced foldability) indicate the following diseases:

• Lack of fibrinogen.
• Increased amount of bilirubin.
• The presence of structurally abnormal protein elements in the blood.
• Chronic liver pathologies.
• Myeloma.

The parameters discussed above are detected with a standard coagulogram. When indicators change in one direction or another, additional research(included in the extended coagulogram):

• Antithrombin is a factor that prevents pathological clot formation.
• Prothrombin coefficient denotes the ratio of the PTT of a particular patient to the corresponding standardized indicator in the international susceptibility index. This is a correction value necessary to compare results obtained in independent study centers. The main purpose of the analysis is to monitor patients’ intake of indirect-acting coagulants.
• RFMC – intravascular coagulation index.
• The D-dimer coagulogram shows the amount of products formed during the breakdown of fibrin after the destruction of a blood clot. The analysis is required to diagnose early thrombosis. It is often prescribed in obstetric practice, especially for repeated pregnancy losses.
• Lupus anticoagulant is aimed at diagnosing antiphospholipid syndrome. Normally, the amount of enzymes is minimized or not detected at all. Increased index indicates a threat of miscarriage and a predisposition to the development of blood clots in the arteries and veins.

How to take a coagulogram?

The results of the study largely depend on preparatory stage. Blood is taken from a vein. The procedure is carried out several hours after eating. Last appointment food – eight hours before the start of manipulations. During prohibited times, you are allowed to drink water.

If a person is undergoing treatment that involves taking medications that can affect clotting, the doctor is warned in advance. Otherwise, the diagnostics will show an unreliable result.

It is prohibited to drink alcohol, drink tea, coffee and juices. The day before the test, you must stop smoking.

Muscle strain, anxiety, and stressful conditions affect the indicators and interpretation. The procedure is painless, short-term, it is recommended to remain calm during the collection.

• The results of standard studies are ready within 24 hours.
• It takes 3-4 days to decipher an extended coagulogram.

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 death - 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 an 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. Important indicator normal operation anticoagulation systems.
• 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(RFMK).

Appointment for analysis

A test for coagulogram norms is prescribed in different cases, it is necessary for the patient’s condition and for assessing the potential risks of 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 conditions:

• 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.
• Presence of autoimmune diseases.
• Diseases and of cardio-vascular system(stroke, heart attack, coronary heart disease).
• Diseases.
• Prescription of oral and other types hormonal contraceptives. A sample is taken once a quarter.
• Prescription and selection of anticoagulant drugs.
• Prescribing an adequate dose of acetylsalicylic acid (aspirin).

During hirudotherapy (use of leeches with therapeutic purpose). This is necessary to prevent possible losses blood in case of 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 sample is taken on an empty stomach, preferably in the morning, so you can have your last dinner no later than 8 hours before the test, and it is best to limit yourself to food for 12 hours. Maximum abolition of medications is recommended, especially those that may affect the blood condition. 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 at all costs stressful situations before analysis, and also not to put physical strain on the body by postponing training or hard work for 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 many indicators are taken into account when analyzing coagulogram norms, each of them is an integral part of the overall indicator of normal functioning circulatory system person:

• 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 in the body of various inflammatory processes, 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. It is equally dangerous to be too low or too low. high rate prothrombin time.
• 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 when, in old age, in case of defeat.
• 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 prethrombosis 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 parameters - 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 disorder may be the second stage of DIC syndrome or the use of special medications.

Recalcification time is also an important component big picture blood condition and body health. 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 decreases, this does not indicate the presence of serious pathologies, but its lengthening 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 characteristic of the third trimester of pregnancy and in conditions that cause an increase in fibrinogen levels.

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, conducts additional tests and, only after receiving clear data, draws up the necessary treatment regimen.