Coagulogram analysis of stool. Coagulogram results with interpretation of indicators and comparison with the norm. Amount of soluble fibrin-monomer complexes

One of the most important such tests is a coagulogram. It's worth going into more detail about what this research is.

What is a coagulogram

The study checks the functioning of hemostasis - the blood clotting system. In our body it is always liquid. During bleeding, the blood thickens, thereby preventing its excessive loss. This should happen normally. A blood coagulogram allows you to identify whether there are any deviations or disturbances in the functioning of the coagulation system. There is an extensive list of situations in which hemostasiogram analysis is mandatory:

1. Pregnancy. Blood clotting must be checked every trimester. If there are complications, the analysis is done more often.
2. Upcoming surgery.
3. Varicose veins, thrombosis.
4. Autoimmune diseases.
5. Problems with the heart and blood vessels.
6. Liver diseases.
7. Prescription of hormonal contraceptives, anticoagulants, aspirin.
8. Hirudotherapy (treatment with leeches).

Coagulogram indicators

In the laboratory, the collected blood is tested for certain biochemical characteristics. Hemostasis testing can be basic or extensive. What does a standard coagulogram show:

• fibrinogen;
• APTT (activated partial thromboplastin time);
• prothrombin;
• platelets;
• PTI (prothrombin index), PTT (prothrombin time), INR (international normalized ratio);
• thrombin time.

What is included in an extended type coagulogram in addition to the indicators listed above:

• antithrombin;
• protein C;
• D-dimer;
• degree of plasma tolerance to heparin;
• plasma recalcification time;
• RFMC (soluble fibrin-monomer complexes);
• lupus anticoagulant;
• AVR (activated recalcification time).

Coagulogram, interpretation

Probably, listing all the indicators will tell the average person little medical education. To understand what kind of analysis a coagulogram is, you need to explain what each of them means for the body. Without this, the picture will not be complete. Basic blood coagulogram, interpretation:

1. Fibrinogen. An enzyme generated by the liver. When there are inflammatory processes in the body, its level increases greatly.
2. APTT. Shows how quickly a blood clot appears.
3. Prothrombin. A protein that interacts with vitamin K. When they are combined, thrombin is obtained.
4. Platelets. Cells, the number of which indicates the state of the body as a whole.
5. PTI. The rate of plasma coagulation is compared with that of the patient.
6. PTV. Shows how much thrombin (the substance that makes liquid blood clot) is converted from prothrombin (an inactive form of protein).
7. INR. The extrinsic coagulability index is a combination of PTI and PTV.
8. Thrombin time. Shows how quickly fibrin is formed from fibrinogen.

Extended coagulogram

This blood clotting test is prescribed if it is necessary to clarify the results of the basic one. In addition, a detailed coagulogram can be prescribed if a particular pathology is detected. Decoding of indicators:

1. Antithrombin. A substance that prevents blood clotting.
2. D-dimer. An important indicator for women during pregnancy.
3. Plasma recalcification time. General process coagulability is characterized by this indicator.
4. Plasma tolerance to heparin. Based on the results obtained, the presence of heart disease, vascular disease, and oncology is determined.
5. Protein C. If it is deficient, thrombosis may occur.
6. RFMK. An indicator characterizing the process of intravascular coagulation.
7. Lupus anticoagulant. The presence of antibodies during pregnancy indicates gestosis or autoimmune diseases of the child.
8. AVR. Determination of plasma recalcification time using an alternative method.

Find out more about D-dimer - what it is, normal indicators during pregnancy and its planning.

Preparation for coagulogram analysis

The patient must follow certain rules before screening. Preparation for a coagulogram involves:

1. Refusal to eat 8-12 hours before the procedure. If you are going to have dinner the day before, choose a light dish, but it is better to come for the test on an empty stomach.
2. Discontinuation of all medications that are allowed to be taken without a break.
3. Refusal of any drinks other than water, especially alcohol.
4. Decreased physical activity. Try not to overload your body before the test.
5. Avoid stressful situations, nervous.
6. Avoid smoking at least one hour before the test.

The doctor must take blood from a vein without using a tourniquet, so that the body does not start the process of hemostasis, which may distort the results. It is important that the patient is not injured during the puncture, otherwise additional substances will get into the material for analysis that can change its quality. Blood is drawn into two test tubes. The first indicators can be determined instantly.

How long does a coagulogram take?

The period depends on many factors. How long a coagulogram is taken is influenced by the workload of the laboratory and the specific specialist, the availability and serviceability of everything necessary equipment. As a rule, the results are known within a day or two after blood collection. In rare cases, this period increases to 5-10 days. in most laboratories, by paying extra for urgency, you can find out the results of a hemostasiogram right on the day of delivery.

Norms for coagulogram analysis

In the table below you will see what indicators a healthy adult should get. Standards for coagulogram analysis:

thousand cells per µl.

Less than 500 ng/ml

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The analysis is done in each trimester and unscheduled when pathologies and abnormalities are detected. Blood is donated for a coagulogram during pregnancy so often because any changes in the analysis may indicate the appearance of serious problems in the body of both the woman and the baby. Some indicators differ significantly from the norm for an ordinary person, which is caused by hormonal changes. Changes in coagulogram in pregnant women:

1. Fibrinogen levels in the last trimester can reach 6 g/l.
2. PTI increased.
3. Lupus anticoagulant is necessarily absent.
4. The aPTT decreases by
5. D-dimer is significantly greater than 500 ng/ml.
6. Plasma tolerance to heparin is increasing.

Video: coagulological studies

The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.

A coagulogram is a test for blood clotting that will warn of hidden and obvious pathologies

A coagulogram is a complex detailed study aimed at determining the main blood factors that characterize its ability to clot. Blood clotting is one of the basic functions that ensures the normal functioning of the body, and deviations from the normal values ​​of several parameters threaten either increased bleeding or rapid blood clotting into dense clots. By comprehensively assessing the coagulogram data, a competent doctor will diagnose and prescribe treatment in a timely manner, preventing the development of stroke, heart attack, renal-hepatic pathologies and dangerous complications during pregnancy.

Coagulogram - what kind of blood test is it?

Coagulogram is a special laboratory test blood, monitoring the functioning of hemostasis - a complex biosystem aimed at maintaining blood fluidity, maintaining the processes of stopping bleeding, and timely dissolution of dense clots (thrombi).

In other words, an analysis that studies the functioning of hemostasis is called a hemostasiogram.

To maintain basic functions, blood must be:

• liquid enough to carry oxygen and nutrients, remove breakdown products and toxins, support the functioning of the immune system and thermoregulation;
• have a certain degree of viscosity in order to close gaps in large and small vessels when injured.

If blood clotting decreases to critical values, in the case of bleeding this leads to massive blood loss and death of the body.

Excessive thickness and increased coagulability (hypercoagulation), on the contrary, lead to the formation of blood clots that can block the most important vessels (pulmonary, coronary, cerebral) and lead to thromboembolism, heart attack and stroke.

Analysis of the hemostasiogram is of high importance, since a properly functioning hemostasis system prevents both life threatening blood loss, as well as spontaneous thrombus formation and blockage of the vascular bed with blood clots.

The study is considered complex, since in order to understand the operation of the blood coagulation system, the doctor must be able to evaluate each parameter separately and analyze all indicators together.

Coagulogram contains big number parameters, each of which reflects a specific hemostatic function.

There are two types of hemostasiogram:

• simple (basic, indicative, screening, standard);
• expanded (expanded).

A basic study reveals or excludes the fact of a violation in the functioning of the blood coagulation system. The analysis helps to find out at what level the deviation from the norm is determined, and then, if there is a suspicion of the development of the disease, an extended analysis is prescribed.

The standard coagulogram includes: prothrombin in % according to Quick or PTI, INR, fibrinogen, APTT, TV.

An extensive analysis involves an extended study, during which not only the fact of qualitative changes itself is determined, but also quantitative indicators.

A complete analysis of the coagulogram is carried out taking into account many coagulation factors, deviations of each of which from normal values ​​lead to serious problems. Without this, the study is considered indicative.

A detailed hemostasiogram, in addition to the basic coagulogram indicators, includes TV - Thrombin time, Antithrombin III, D-dimer.

In addition to them, several types of standard coagulograms are performed, including some indicators necessary to assess hemostasis in known conditions (before operations, during pregnancy, anticoagulant therapy).

To whom and under what circumstances can it be assigned?

A hemostasiogram is prescribed to the patient for the following diagnostic studies, diseases, conditions:

• a general understanding of the functioning of the hemostatic system;
• deviations from normal blood clotting parameters;
• planned and emergency operations(to avoid the risk of massive blood loss or, conversely, active thrombus formation);
• vascular disorders in the lower extremities (deep vein thrombosis, varicose veins), pelvic organs, intestines, pulmonary embolism;
• hemorrhagic pathologies (hemophilia, hemorrhagic fever, thrombocytopathy, thrombocytopenia, von Willebrand disease, frequent nosebleeds, subcutaneous hemorrhages);
• stroke, atrial fibrillation, heart attack, coronary heart disease;
• pregnancy, childbirth, caesarean section;
• severe toxicosis;
• suspicion of DIC syndrome (intravascular disseminated coagulation);
• diagnosis of the causes of miscarriage;
• control of treatment with anticoagulants that thin the blood (Warfarin, Dabigatran, Trental, Heparin, Clexane, Fraxiparine, aspirin-based medications);
• taking any contraceptive pills (analysis once every 3 months), since the substances included in oral contraceptives can cause acute thrombosis in young women, often leading to serious conditions;
• chronic liver diseases, including cirrhosis; assessment of the function of synthesis of protein complexes - blood clotting factors;
• autoimmune systemic pathologies (lupus erythematosus, rheumatoid arthritis, scleroderma);
• taking hormonal drugs, anabolic steroids;
• hirudotherapy (treatment with leeches) to prevent hemorrhages (bleeding, subcutaneous hemorrhages).

How to properly prepare for analysis

The cost of an incorrect clotting test is life-threatening bleeding or blocking of blood vessels with blood clots and impaired blood supply. important organs.

For the study to be reliable, basic measures are required, which include the following preparation rules:

• Do not feed infants up to 12 months of age 30–40 minutes before blood sampling;
• do not feed children 1–5 years old 2–3 hours before the test;
• Adults and children over 5 years old should stop eating 12 hours before the test;
• exclude physical activity and psychological stress 30 minutes before donating blood;
• Avoid smoking tobacco 30 minutes before the test;
• Warn your doctor about taking any anticoagulants.

Where can you donate blood for clotting tests? Average price range

A hemostasiogram is carried out by qualified laboratory assistants in a clinic, medical center, or laboratory that has the necessary equipment and reagents.

The cost of the examination is determined by the type of coagulogram (basic or detailed), the number of parameters determined and ranges from 350 to 3000 rubles. Patients expecting the birth of a child undergo a free study if they have a compulsory medical insurance policy, since the study is classified as mandatory during pregnancy.

How is the analysis carried out?

Blood for a hemostasiogram is taken from a vein. The blood collection site is disinfected with an antiseptic and the skin is pierced using a syringe or vacuum system. Injury to the vein and surrounding tissues is not allowed in order to prevent unreliable results due to the possible penetration of thromboplastin fragments from damaged tissues into the biomaterial for research.

For the same purpose, 2 test tubes are filled with blood, the last of which is sent for analysis.

How long does it take to do: how long to wait for results

Coagulogram results are usually obtained within 1–2 days. The turnaround time for the analysis depends on the volume of factors being determined, the workload of the laboratory, and the specifics of the courier service.

Indicators and norms of analysis in adults and children

Considering that the hemostasis process is assessed in several systems of units and by several methods, coagulogram indicators in different laboratories may differ.

Analyzing a coagulogram on your own is impractical and even dangerous, since a specialist, when deciphering indicators, takes into account many factors unknown to the patient and their combination. Sometimes small deviations in certain indicators are dangerous, while at the same time deviations in others may not indicate serious illnesses.

Decoding the indicators - what it is responsible for and what it means

Thanks to the assessment of the obtained parameters in the hemostasiogram, the doctor is able to establish the cause of deviations in values ​​from the norm and understand whether they occurred due to pathology in the coagulation system or due to other diseases that show similar indicators in the coagulogram, that is, to conduct a differentiated diagnosis.

Activated partial thromboplastin time is one of the most important parameters of hemostasis (other abbreviations are APTT, ARTT). Refers to the time required for a blood clot to form after certain reagents are introduced into the blood plasma. The values ​​of this indicator are directly related to changes in other hemostasiogram indicators.

Possible pathologies in case of APTT deviation

• low levels of vitamin K, coagulation factors, fibrinogen;
• taking anticoagulants, streptokinase;
• liver diseases, glomerulonephritis;
• volumetric blood transfusion (blood transfusion);
• presence of lupus anticoagulant;
• hemophilia, antiphospholipid syndrome, systemic lupus erythematosus;
• von Willebrand disease;

• active malignant process;
• acute blood loss.

Fibrinogen level (Fib)

Fibrinogen (factor I) is a special protein produced by liver cells. At the site of vascular rupture, it turns into insoluble fibrin strands, which stabilize the mass of the blood clot that clogs the vessel and remains fixed until the damage heals.

Possible conditions and diseases when fibrinogen levels change

• postoperative stage;
• pregnancy;
• Taking birth control pills;
• long-term inflammatory processes;
• atherosclerosis, smoking;
• heart attack;
• injuries with vascular damage, burns;
• rheumatism, nephrosis;
• malignant processes;

• children under 6 months;
• the use of thrombolytics (drugs for breaking blood clots), anticoagulants and antiplatelet agents;
• heart, liver failure;
• poisoning, including poisons;
• gestosis in pregnant women, disseminated intravascular coagulation syndrome;
• complications after childbirth;
• mononucleosis;
• aggressive development of tumors, acute leukemia;
• fibrinogen deficiency.

Prothrombin (factor F II)

It belongs to the basic clotting factors and is an inactive protein fraction, which, under the action of vitamin K, is transformed into active thrombin, which also takes part in the formation of a clot that stops bleeding.

If there is a deviation of factors I - II from the norm, this threatens the development of both bleeding and spontaneous thrombosis without damage and with the formation of pathological blood clots that can break off from the wall of a vein or artery and block blood flow.

To understand changes in hemostasis processes determined by prothrombin concentration, coagulation tests are used:

• PTI (prothrombin index). This is the percentage ratio between the individual time required for blood clotting in a patient to the time required for clotting of control plasma. Normal value is 97 – 107%. Low rate indicates excessive blood fluidity, liver disease, vitamin K deficiency, taking diuretics, anticoagulants. A pathological upward shift (often when using birth control pills) indicates dangerous blood thickening and the threat of blood clots.
• PO (prothrombin ratio) is an indicator inverse to the PTI parameter;
• INR (international normalized ratio). Shows the rate of thrombus formation as a percentage. A typical case requiring an INR assessment is when a patient receives Warfarin, Warfarex, Finilin, or Syncumar.
• PTT or Prothrombin time (PT, PT, RECOMBIPL-PT). Defines the interval (in seconds) required for prothrombin to transform into active thrombin.

Possible pathologies when PTV is deviated

• lack of vitamin K, fibrinogen, coagulation factors;
• taking anticoagulants;
• hemorrhagic diathesis (in infants and small children);
• spasm of the biliary tract;
• disorder of intestinal absorption of lipids;
• Zollinger-Ellison syndrome$

• pregnancy;

abnormalities in hematocrit (volume of red blood cells);

increased antithrombin III.

Prothrombin in % according to Quick

Lee-White clotting time

The parameter reflects the rate of platelet adhesion into a clot, indicating increased activity hemostasis and the risk of thrombosis (if the rate is reduced), or an increased likelihood of bleeding if the time is increased.

Thrombin time (TT, TV)

The indicator expresses the rate of conversion of fibrinogen into fibrin fibers, which fix the platelet clot at the site of injury.

Possible abnormal conditions when TV deviates from the norm

• low fibrinogen content;
• multiple myeloma;
• liver pathologies;
• high levels of urea in the blood (uremia);
• presence of D-dimers in plasma

• Stage 1 of DIC syndrome in pregnant women;
• administration of heparin.

Indicators of coagulation enzymes

Reflects the level of activity of enzymes II, V, VII, VIII, IX, X, XI, XII, the values ​​of which are not associated with physiological reasons, and deviation from the norm always indicates the development of pathologies.

Time and activated time of plasma recalcification (PRP and AVR, respectively)

Both studies determine the overall activity of hemostasis and the rate of fibrin clot formation, and differ only in the way the analysis is performed.

With reduced AVR and VRP, there is a danger of thrombosis. Increased levels signal the threat of bleeding even with minor injuries due to burns, in a state of shock, thrombocytopenia (low platelet levels), therapy with blood thinning drugs.

Lupus anticoagulant

A protein complex, the level of which is determined in autoimmune pathologies, since the lupus enzyme is normally absent in the blood. Its detection in the blood indicates a high risk of antiphospholipid syndrome (APS), which can cause placental insufficiency in premature pregnancy.

D-dimers

Fibrin protein elements remaining after the destruction of blood clots. Their increased number indicates too intense formation of blood clots and the possibility of such conditions as: infections and inflammation, renal and hepatic failure, heart attack, thrombosis, sepsis, large hematomas, malignant tumors.

Sometimes an increase in dimers is observed after operations, in old age, during the use of plasminogen.

Soluble fibrin-monomer complexes (SFMC)

An increased concentration of these molecular protein compounds (transition products between fibrinogen and fibrin) warns of possible thrombosis.

Platelets

The basic cells that support hemostasis processes are normally µl. If the amount decreases, thrombocytopenia is diagnosed.

Protein C

A protein that can reduce the activity of coagulation processes, preventing the formation of large clots.

Antithrombin-III

Protein, which is a physiological anticoagulant, is constantly present in the plasma and most actively (75–80%) inhibits the activity of thrombin, preventing excessive blood thickening and thrombus formation.

Possible pathologies when antithrombin 3 deviates from the norm

• vitamin K deficiency;
• menstruation;
• taking anabolic steroids, agents for thinning and enhancing blood clotting;
• cholestasis, pancreatitis or hepatitis in acute form;
• kidney transplantation;
• high bilirubin levels;

• congenital antithrombin 3 deficiency;
• 26 – 40 weeks of pregnancy;
• use of contraceptive medications;
• liver pathologies (failure, cirrhosis);
• liver transplantation;
• thrombosis, heart attack, pulmonary embolism;
• uncontrolled high-dose use of heparin;
• taking L-asparaginase for gestosis.

Protein S

A protein without which neither antithrombin nor protein C can function. The level can only decrease, which is determined by congenital deficiency of protein S, liver disease, taking Warfarin and other anticoagulants.

analysis standards for adults and children

Normal values ​​of hemostasiogram parameters

Most hemostasis parameters differ only slightly between adult and pediatric patients. A noticeable difference is typical for infants after birth until 2 months of age.

Table of normal coagulogram indicators

up to 10 years 65 – 130%

up to 16 years 80 – 120%

When analyzing a coagulogram, it should be taken into account that reference values, methods and units of measurement in individual laboratories may differ.

Coagulogram during pregnancy

While waiting for a baby, the body experiences high stress and significant changes in hemostasis, which is determined by the development of uteroplacental circulation in a pregnant woman.

During this period, the body tries to protect itself in the event of the probable development of placental abruption, uterine bleeding, formation of intravascular thrombi. A coagulogram helps to timely identify the threat of miscarriage, bleeding, and negative effects on the function of the brain and other organs of the fetus.

With severe gestosis, a life-threatening complication can develop - disseminated intravascular coagulation syndrome, which is first expressed in the appearance of many small blood clots, disruption of blood flow between the mother and the fetus, and then in the failure of blood clotting mechanisms (acoagulation). This pathological condition leads at stage 1 to fetoplacental insufficiency, fetal hypoxia, a high probability of blockage of the arteries of important organs, and later to the risk of massive bleeding and death of the pregnant woman and the fetus.

Therefore, a woman expecting a baby must undergo a hemostasiogram once a trimester (and more often in case of complications).

Indicators of hemostasis in pregnant women

Important! All specified standards are indicative and not unified. Competent decoding Coagulograms can only be performed by an obstetrician-gynecologist. It is strictly not recommended to use information from the Internet and advice from forums on the Internet.

Interpretation of hemostasiogram during pregnancy

Normally, in the first three months, blood clotting parameters may be reduced, but by the end of pregnancy, on the contrary, they increase, as preparation for blood loss during childbirth occurs.

Possible abnormal conditions when hemostatic parameters deviate from the norm

kidney diseases, diabetes, thrombosis, oncology

If 1 or 2 indicators in the hemostasiogram have values ​​deviating from the norm, this does not mean that the patient is immediately at risk severe complication. As a rule, this only indicates an adaptation of the mechanisms of hemostasis, which operates in the mode required for this moment for a pregnant woman.

Really threatening pathologies are reflected in the coagulogram by a significant deviation from the norm of many indicators

A correctly and timely hemostasiogram is the key to successful treatment of acquired and congenital diseases in the developmental stage and in the early stages, preventing bleeding or, conversely, abnormal formation of blood clots. An analysis of blood clotting in women carrying a child will allow the doctor to prevent placental abruption, fetal underdevelopment due to vascular thrombosis, miscarriage, the development of preeclampsia, disseminated intravascular coagulation syndrome, dangerous bleeding and death. But due to the complexity of the study, it is unacceptable to independently draw conclusions about the presence or absence of pathologies. Only a qualified specialist is able to conduct an accurate analysis and make a correct forecast.

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The material is published for informational purposes only and under no circumstances can it be considered a substitute for medical consultation with a specialist in a medical institution. The site administration is not responsible for the results of using the posted information. For questions regarding diagnosis and treatment, as well as prescription medical supplies and determining the regimen for taking them, we recommend that you consult a doctor.

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

Indicators of a coagulogram, or hemostasiogram, are studied to assess the possible risk of hyper- and hypocoagulation, respectively, increased and decreased blood clotting ability, the likelihood of blood clots or bleeding.

How to prepare for a blood clotting test

This study is carried out strictly on an empty stomach, with a break after the last meal of at least 12 hours. At the last meal, it is recommended to exclude spicy, fatty, canned foods with a lot of spices from the diet. Only pure drinks are allowed, not mineral water, juices, compotes, drinks and alcohol are excluded.

Immediately before the analysis, it is recommended to avoid physical, emotional and mental stress (fast walking, excitement), as well as smoking, for 30 minutes.
If you are currently or have recently completed a course of treatment with anticoagulant drugs, you must inform the specialist of the name, dosage and duration of use.
If during blood sampling you experience nausea, dizziness, or deterioration in health, you must immediately inform medical personnel.

How is the analysis carried out?

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

Where do you donate blood for a hemocoualogram?

A blood test for a hemostasiogram is carried out in public and private clinics and laboratories; this analysis is one of the basic ones. All certified laboratories with the necessary set of reagents and equipment can conduct analysis for hemostasis indicators.
The cost of tests depends on the laboratory and the set of blood factors assessed.

How many days does a coagulogram take?

The blood test itself takes from 24 to 48 hours, which is due to the need to evaluate various indicators when interacting with reagents at certain intervals. If laboratory technicians are very busy and there is a need to transport biomaterial, the study time may increase.

In what cases is a blood test for coagulogram prescribed?

Regardless of the presence of any symptoms and signs of blood coagulation pathologies, a hemostasis test is prescribed in preparation for surgery and during the gestational period. In this way, the likelihood of life-threatening risks of bleeding and thrombosis during surgery or delivery is assessed ( in a natural way or caesarean section).
Other indications for this analysis include:

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

Components of the hemostasis system

The hemostasis system includes biological substances and biochemical mechanisms that maintain blood in a liquid state, as well as prevent and stop bleeding. The main function of the hemostatic system is to maintain a balance between coagulating and anticoagulant factors. An imbalance is realized by hypercoagulation (increased blood clotting, leading to the formation of blood clots) and hypocoagulation (decreased coagulation, threatening prolonged bleeding).

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

Indicators and norms of hemostasis

When studying indicators, different laboratories can use various techniques. Thus, the speed rate of the coagulation process varies from 5-10 to 8-12 minutes depending on the chosen technique (according to Lee-White or Mass and Margot). The assessment of compliance of results with the norm must be carried out in accordance with the standards of the specific laboratory.

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

Interpretation of hemostasis indicators

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

Blood clotting time indicator

This indicator assesses the rate of formation of a fibrin clot at the site of injury and is assessed by the time interval between the onset of bleeding and its cessation. For venous blood, the reference rate of thrombus formation is 5 to 10 minutes.

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

PTI indicator

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

Thrombin time indicator

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

APTT as a factor in monitoring anticoagulant intake

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

AVR

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

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

VLOOKUP

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

Estimation of fibrinogen amount

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

Thrombotest

Thrombotest is a method for visually assessing the amount of fibrinogen in a biomaterial. Normally, this indicator corresponds to level 4-5.

RFMK

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

Antithrombin III

A glycoprotein related to natural anticoagulants. Its norms vary significantly depending on the age of the patient. The level of antithrombin 3 in women also changes during pregnancy, which is not a pathological condition.
Causes of excess and deficiency of antithrombin III

D-dimer as an indicator of hemostasis

D-dimer is a fibrin breakdown product; the fibrinolytic activity of plasma is assessed by its amount. An increase indicates the presence of intravascular thrombosis, liver disease, ischemia or myocardial infarction, and can also develop with prolonged smoking.
Indicator deficit clinical significance does not have.

Estimation of bleeding time

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

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

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

Hemostasis of the gestational period

Normal indicators change with increasing gestational age.

	Normal 1st trimester	Normal 2 trimesters	Normal 3 trimesters
Fibrinogen	2,9-3,1	3,0-3,5	4,4-5,1
APTT	36-41	33,6-37,4	37-40
AVR	60-72	56,7-67,8	48,2-55,3
PI	85,4-90,1	91,2-100,4	105,8-110,6
RFMK	78-130	85-135	90-140
Antithrombin III	0,222	0,176	0,155
Platelets	301-317	273-298	242-263

A blood coagulogram, or hemostasiogram, is the result of a set of blood parameters that can be used to determine the degree of its coagulation. Blood clotting is performed protective function, since if the integrity of a blood vessel is violated, it helps stop bleeding and prevent large blood losses. The analysis also has a different name - blood hemostasiogram or coagulation hemostasis.

Hemostasis is a special system in the body, the main task of which is to maintain blood in a liquid state in the vessels, stop bleeding in damaged vessel walls and prevent the formation of blood clots. Blood clotting is not the only mechanism aimed at maintaining the body and reducing blood loss. The primary functions of hemostasis are provided by platelets and special properties vessels. That is why it is important to understand what a coagulogram is and why it is prescribed.

Detailed blood coagulogram

The indicators included in the blood test for a coagulogram are relative. To complete the study, it is important to evaluate each blood clotting factor in a detailed coagulogram. There are 13 of them, and omission when analyzing at least one of them can lead to serious consequences.

An extended coagulogram is a combination of many indicators; such a study is carried out mainly in the diagnosis of specific hereditary diseases. Not every laboratory can conduct such a study, because it requires special, expensive equipment.

In this regard, in practice, a set of basic indicators is often studied, the level of which, in combination with other analyzes of primary hemostasis, will allow one to judge the general coagulation properties. To do this, it is also necessary to know the total number of platelets in the blood, bleeding time, platelet aggregation and clot retraction.

For a more accurate diagnosis of certain diseases and in the treatment of low or excessively high blood clotting, it is necessary to obtain the results of all indicators and determine the components of the blood.

A detailed coagulogram includes obtaining data on:

Blood clot retraction;

Thrombotest;

Plasma tolerance to heparin;

Fibrinolytic activity.

Abbreviated coagulogram - what kind of analysis is it?

A shortened set of indicators includes:

Coagulogram indicators

Calculated by adding an active thrombin solution to the plasma. The indicator is measured in seconds and indicates the ability to clot in the presence of a solution. Normally, this indicator is 15-18 seconds. An increased indicator may be due to hereditary pathologies, indicating an increased value of blood coagulation inside the vessels and significant liver damage. This method is often used when drug treatment with the use of fibrinolytics and heparin.

The method for determining blood clot retraction is similar to the method for determining thrombin time; it allows one to determine both the coagulability of a blood clot and the degree of its compression; the norm of the indicator is expressed in qualitative and quantitative values. The qualitative indicator can be 0 or 1, indicating the absence or presence of clot coagulation. The norm of quantitative value is 40-95%. A decreased reading may be caused by thrombocytopenia; an elevated reading may indicate anemia.

Thrombotest - assessment of the presence in the blood. Normal thrombotest - grade 4-5. Fibrinogen levels should be between 2.7 and 4.013 grams. If the level of this protein increases, the blood becomes thicker, and this can lead to the onset of blood clots. For pregnant women, this norm may vary slightly.

The process of determining plasma heparin tolerance examines how quickly a fibrin clot can form when heparin is added to the blood. Ideally, this process should last 7-15 minutes. Reduced tolerance to heparin is an increased period of time for clot formation, which may indicate liver disease. If the coagulogram of this indicator is less than normal, then this may indicate hypercoagulation.

The indicator of fibrinolytic activity allows us to identify the ability of the blood to independently dissolve formed blood clots over a certain period of time. The value is significantly influenced by the presence of fibrinolysin in plasma. The norm is 183-263 minutes. Indicators below normal indicate an increased degree of bleeding.

In what cases is a coagulogram indicated?

There are many situations in life in which it is extremely important to know clotting indicators, therefore such a study is of significant importance and is indicated for:

Presence of signs of bleeding, frequent occurrence of hematomas under the skin from minor bruises;

Preparation for various types of operations;

Various diseases of blood vessels;

after heart attacks and strokes;

After implantation of artificial heart valves, to assess the risk of emboli;

Identifying the reasons for the decrease in the immune functions of the body’s defenses;

Monitoring the condition of women during pregnancy and before childbirth. During this period, indicators may fluctuate slightly, but this can be explained by hormonal changes in the body. The analysis allows you to determine whether there is a likelihood of complications occurring during childbirth, because some deviations from the norm can cause miscarriage, premature placental abruption, or lead to heavy bleeding. To monitor a woman’s condition during pregnancy, the test must be taken every trimester, and when the results are received, an increase in clotting is often noted - this is how the body reduces the risk of possible blood loss.

A blood clotting test is also necessary for the correct prescription of drug treatment when using drugs that stabilize various parameters of the body. For cardiac arrhythmia, varicose veins, stroke and coronary disease cardiac hemostasiogram analysis is carried out to monitor the effect of medications and timely diagnosis of possible abnormalities.

How to take a blood coagulogram test?

It is important to follow some recommendations when taking the test to obtain reliable data. So, how to take a coagulogram?

It is necessary to donate blood on an empty stomach, that is, you do not need to eat 8-12 hours before the test.

Alcohol consumption is prohibited, including low-alcohol drinks and beer.

Physical stress on the body should be avoided 2-3 days before the test.

When taking any medications (especially anticoagulants), you should notify your doctor about this; you may need to wait 1-2 weeks for their effect to cease and be removed from the body.

You should not do the test during menstruation, since the blood in women during this period is diluted, so it will be almost impossible to determine the exact time of its clotting. Best time To take this analysis - the middle of the cycle.

You should not take a coagulogram test against the background of strong emotions and general fatigue. In this case, it is better to wait a while, as this may affect the results of the coagulogram and its interpretation. It is necessary to donate blood for a coagulogram in the morning before breakfast, after sleep and proper rest.

At severe dizziness at sight own blood or injections, you should definitely notify the nurse about this.

Interpretation of coagulogram results

Clotting time

To determine it, take 2 ml of blood from the cubital vein. After this, without adding any substances, the blood is divided equally into 2 test tubes, which are placed in water, the temperature of which corresponds to the temperature of the human body, and a stopwatch is turned on. The tubes should be tilted slightly and monitor the moment a clot appears. A reliable result is considered to be the average value obtained from 2 test tubes, while the norm is considered to be 5-10 minutes.

If the result obtained exceeds 10-15 minutes, this may indicate:

Prothrombinase deficiency;

Fibrinogen deficiency;

Vitamin C deficiency.

An indicator above the norm of blood clotting indicates hypercoagulation and leads to greater platelet formation, which, in the absence of bleeding, can lead to blockage of blood vessels - thrombosis or thromboembolism.

If in a detailed coagulogram the blood clotting value is reduced, then this condition is called hypocoagulation. In this case, the blood clots poorly or does not clot at all, which can lead to large blood losses even with minor vascular damage. Hidden ones are especially dangerous internal bleeding, since it is not always possible to recognize them in a timely manner.

To diagnose diseases that can affect any indicator of blood clotting, sometimes a blood test is not enough, and even an extended hemostasiogram cannot fully clarify the situation. Deciphering the blood coagulogram should be carried out exclusively by the attending physician, and when assessing the indicators, it is necessary to compare other groups of tests, take into account the biochemical blood test and have knowledge of specific changes during drug treatment. Therefore, having received blood tests for coagulation, you should not independently evaluate the results, much less take any measures aimed at stabilizing them.

Prothrombin time

The determination of prothrombin time is almost the same as that of coagulation, with the exception of the addition of calcium chloride solution and thromboplastin solution to the blood. The blood clotting rate is 12-20 seconds. An upward deviation of the indicator when using this technique may indicate problems in the synthesis of the prothrombinase enzyme. This can lead to chronic liver diseases, a lack of vitamins in the body, and dysbacteriosis.

High coagulogram values ​​may indicate the use of indirect coagulants; such treatment requires constant monitoring. The dosage is selected in such a way that the indicator increases no more than 2 times. Hormonal contraceptives are also able to increase the prothrombin index.

ATCHV

APT is the plasma response to the addition of erythrophosphatide and cephalin, which helps identify clotting failure and is considered the most sensitive indicator. Normal APTT is 38-55 seconds. If the value is less than the minimum threshold, then blood clots may form.

Plasma fibrinogen

The determination method is based on the property of plasma to transform into fibrin after adding special substances to it. After conversion, the fibrin strands are weighed. This allows you to get quantitative indicator. The norm is a value ranging from 5.9 to 11.7 µmol per 1 liter of blood.

A low rate may indicate congenital diseases- fibrinogenemia or significant liver damage. A reading above the upper limit of normal coagulogram may indicate:

The presence of an infectious disease;

Development of malignant tumors;

Development of acute or chronic inflammatory processes;

Thromboembolism, taking into account the totality of data obtained from other studies;

Disorders of the thyroid gland.

In newborns, this indicator is significantly lower than in adults; the coagulogram rate ranges from 1.25-3.0 g/l.

Coagulogram (hemostasiogram, blood clotting test, blood clotting assessment)- this is an analysis that allows you to judge the main indicators of the coagulation and anticoagulation systems of the blood.

The mechanism of blood clotting is very complex and depends on many factors. On the one hand, with any injury, the blood at the site of the injury must quickly clot, forming a thrombus (blood clot), which prevents blood loss and protects the wound from mechanical particles and infection, “gluing” the edges of the wound. On the other hand, even with massive injuries, blood must retain its liquid properties inside the vessels, penetrating into the smallest capillaries and without clogging them. To maintain the complex mechanism of hemostasis (stopping bleeding), two opposing systems function simultaneously in the body: one system thins the blood, the other clots it. Normally, a balance between these two processes must be constantly maintained. A coagulogram allows you to reflect the state of these processes using graphs or numbers.

For analysis, blood is taken from a vein, placed in a test tube with a special additive that prevents the blood from clotting, and a number of basic and auxiliary parameters are determined.

Basic coagulogram parameters

• Prothrombin time (PTT), prothrombin index (PTI) or international normalized ratio (INR). These indicators characterize the external pathway of blood coagulation. Depending on the equipment of the laboratory, one of the tests is performed. The INR indicator is considered the most universal. Data from this test can be compared with each other regardless of the laboratory where it was performed.
• Activated partial thrombin time (aPTT)- characterizes the internal path of hemostasis.
• Thrombin time (TV)- a test characterizing the last stage of blood clot formation, indicating the amount of fibrin in the blood.
• Fibrinogen- a soluble protein that, when activated by thrombin, is converted into insoluble fibrin and forms a blood clot. Fibrin is also an indicator of inflammation.

Additional coagulation tests

• Antithrombin III- factor of the anticoagulant system. With its deficiency, thrombosis of internal organs, varicose veins, etc. is observed.
• D-dimer- a product of the natural destruction of a blood clot. Determination of D-dimer is necessary for early diagnosis thrombosis and prevention of thromboembolism of the pulmonary artery and other vessels.
• Protein C- factor of the anticoagulant system. With its deficiency, the risk of internal thrombosis increases after operations, during pregnancy, etc.
• Lupus anticoagulant (LA) determined when the development of antiphospholipid syndrome is suspected.

Coagulogram: reasons for prescribing

• identifying the causes of thrombosis or bleeding;
• DIC syndrome;
• diagnosis of thromboembolism;
• diagnosis of hemophilia;
• auxiliary diagnosis of autoimmune diseases (antiphospholipid syndrome);
• monitoring the effectiveness of treatment with heparin and other drugs that affect hemostasis;
• before and after surgery, some diagnostic and therapeutic procedures (for example, thrombolysis, coronary angiography).

Preparing for a blood coagulation assessment

The test is taken in the morning on an empty stomach (the fasting period should be 8-12 hours), you can drink clean water. It is advisable to quit smoking a few hours before the examination. When conducting the analysis, you must indicate which medications you have been taking recently.

Normal values ​​of the main coagulogram indicators

• PTV 11-16 sec.;
• PTI 80-120%;
• INR 0.8-1.2 UNITS;
• APTT 21-35 sec.;
• TV 14-21 sec.;
• fibrinogen in adults 2-4 g/l;
• fibrinogen in newborns 1.25-3.00 g/l.

Interpretation of coagulogram results

Evaluating a coagulogram is a complex diagnostic process. Often, for this purpose, they resort to the help of hematologists. Not each indicator is assessed separately, but their complex, their mutual influence on each other and the effect of the therapy.

While taking medications that affect blood clotting (heparin, warfarin and others), the coagulogram parameters change significantly, which is the target direction of treatment. Thus, while taking warfarin, the INR level for many diseases should be at the level of 2-3 units, and sometimes increase to 4.5 units, which indicates a reduced risk of thrombosis.

Coagulogram values ​​can vary significantly depending on the properties of the reagents used by diagnostic laboratories. Therefore, it is advisable to take control tests within one institution.

Features of coagulogram in pregnant women

At various pathologies During pregnancy, as well as during a normal pregnancy, before giving birth, a woman is advised to have a coagulogram. Blood counts change significantly throughout pregnancy. In the first trimester of pregnancy, blood clotting time may be slightly longer than normal, and closer to childbirth, on the contrary, the balance shifts in favor of the coagulation system. This is necessary for timely hemostasis after childbirth: this is how the body has adapted to fight blood loss.

Today's report discusses the coagulogram: what kind of analysis it is, the norm, interpretation. For convenience, we have placed the data in tables.

Coagulation blood testing is a comprehensive laboratory assessment of the state of hemostasis. The main function of hemostasis is to participate in the process of stopping bleeding and disposing of blood clots. The analysis allows you to diagnose malfunctions in the mechanisms of blood clotting, and is also mandatory before any surgical intervention and when determining the causes of miscarriage.

Violation of the integrity of tissues and blood vessels activates the launch of a sequence of biochemical reactions of protein factors that ensure coagulation during bleeding. The final result is the formation of a blood clot from fibrin strands. There are 2 main pathways leading to blood clotting:

• internal - for its implementation, direct contact of blood cells and the subendothelial membrane of blood vessels is required;
• external - activated by the protein antithrombin III, secreted by damaged tissues and blood vessels.

Each of the mechanisms individually is ineffective, however, forming a close relationship, they ultimately help stop bleeding. Violation of the compensatory mechanisms of the hemostatic system is one of the reasons for the development of thrombosis or bleeding, which poses a threat to human life and health. This is what emphasizes the importance of timely diagnosis of the state of the hemostatic system.

Coagulogram - what kind of analysis is this?

Patients often wonder what a blood coagulogram is, for example, before surgery or during pregnancy, and why is it so important to take it?

Coagulogram is medical analysis by assessing the state of the system that starts and stops the blood clotting mechanism.

The obligatory examination before surgery is due to the possible risk of bleeding during surgery. If failures in the hemostatic system are detected, the patient may be denied surgical intervention if the risk of bleeding is too great. In addition, the inability to carry out one of the coagulation mechanisms can be the cause of miscarriage.

The effectiveness of therapy for any pathology affecting the hemostatic system requires strict control and is implemented through the examination in question. Positive dynamics indicate the correctness of the chosen tactics and a favorable outcome. Lack of improvement requires immediate correction of the treatment regimen by a specialist.

What is included in a blood coagulogram?

Coagulogram parameters: prothrombin index (PTI), international normalized ratio (INR), fibrinogen protein, antithrombin (AT III), activated partial thromboplastin time (APTT) and protein fragment (D-dimer).

PTI and INR

Using two parameters - PTI and INR, it is possible to assess the normal functioning of the external and general pathway for blood coagulation. In the case of a decrease in the concentration of protein factors in the serum of the subject, a deviation of the considered criteria is observed to be greater than the norm.

It has been established that prothrombin is produced by liver cells (hepatocytes) and requires vitamin K for its normal functioning. In case of its hypofunction (deficiency), a failure occurs in the formation of a blood clot. This fact underlies the treatment of people with a predisposition to thrombosis and cardiovascular pathologies. The essence of treatment is to prescribe drugs that interfere with the normal synthesis of the vitamin. Both criteria under consideration are used to determine the degree of effectiveness of these tactics.

Formula for calculating prothrombin index:

PTI std. – the amount of time it takes for plasma to clot in the control sample after adding clotting factor III.

The INR coagulogram is calculated using the following formula:

ISI (International Sensitivity Index) is a standard coefficient.

It is known that the values ​​under consideration are characterized by an inverse correlation, that is, the higher the prothrombin time index, the lower the INR. The statement is also true for the inverse relationship.

Fibrinogen

Fibrinogen protein synthesis occurs in hepatotocytes. Under the influence of biochemical reactions and degrading enzymes, it takes an active form in the form of fibrin monomer, which is part of the blood clot. Protein deficiency can be due to two reasons: congenital genetic mutations and excessive depletion for biochemical reactions. Similar condition characterized by excessive bleeding and poor blood clotting.

In addition, if tissue integrity is compromised as a result of mechanical damage or inflammatory processes, fibrinogen production increases significantly. Measuring protein concentration allows you to diagnose pathologies of cardio-vascular system(CVS) and liver, and also assess the risk of possible complications.

AT III

AT III is one of the most important factors, the main producers of which are hepatocytes and endothelium, which lines the internal cavity of blood vessels. The main function is to suppress coagulation processes by inhibiting the functioning of thrombin. Thanks to the normal ratio of these two proteins, stable hemostasis is achieved. Insufficient synthesis of antithrombin leads to increased coagulation processes and a critical level of thrombosis.

APTT

APTT in a coagulogram is a criterion that allows one to evaluate the normal implementation of internal path. Its duration is directly dependent on the concentration of kininogen (precursor of polypeptides) and various protein coagulation factors.

The APTT value is determined by measuring the time it takes to form a full-fledged blood clot when reagents are added to the test sample. Deviation of the criterion to a greater extent than the norm leads to an increase in the frequency of bleeding, and to a lesser extent – ​​to excessive formation of blood clots. In addition, isolated use of aPTT is acceptable in order to reliably monitor the effectiveness of the use of anticoagulant drugs.

D-dimer

Normally, a blood clot should undergo destruction (destruction) over time. By measuring the D-dimer value it is possible to determine the efficiency and completeness of this process. In case of incomplete dissolution of the thrombus, an increase in the criterion is noted. In addition, the use of D-dimer to monitor the effectiveness of anticoagulant treatment is acceptable.

Norm and interpretation of blood coagulogram in adults in the table

All coagulogram indicators (which means each criterion and interpretation) are presented in the table.

Age	Normal values	Reasons for the increase	Reasons for the downgrade
PTI, %
Any	From 70 to 125	· Disseminated intravascular coagulation syndrome (DIC syndrome); · Thrombosis; · Increased functional activity of proconvertin.	· Lack of clotting factors; · Production of mutant proteins that cannot participate in biochemical processes; · Hypofunction of vitamin K; · Leukemia in the acute stage; · Pathologies of the heart muscle; Liver diseases ( chronic hepatitis, cirrhosis, cancer); · Disturbances in the functioning of the bile ducts; · Malignant tumor of the pancreas; · Taking anti-clotting medications.
Up to 3 days	1,1-1,37	Similar to PTI	Similar to PTI
Up to 1 month	1-1,4
Up to 1 year	0,9-1,25
1-6 years	0,95-1,1
6-12 years	0,85-1,25
12-16 years old	1-1,35
Over 16 years old	0,85-1,3
Fibrinogen, g/l
Any	1,75 — 3,6	· Acute stage of the infectious process; · Violations in the body's natural defenses; · Heart pathologies; · Oncopathology; · Malignant lesion of lymphatic tissue; · Kidney diseases; Chronic viral hepatitis; · Violation of tissue integrity of unknown etiology.	· Congenital absence of fibrinogen protein; DIC syndrome; · Hereditary hemophilia; · Liver diseases; · Severe degree of malignant oncopathology; · Anemia; · Extensive infection of the body with bacteria; · Lack of macro- and microelements as a result of disruption of the digestive process; · Reaction to blood transfusion.
AT III, %
Up to 3 days	57-90	· Disturbances in the process of production and outflow of bile; · Hypofunction of vitamin K; · Menstruation period; · Taking anticoagulant drugs; · Chronic excess globulin content as a result of liver pathology.	· Hereditary defect; DIC syndrome; · Formation of blood clots in deep veins; · Liver diseases; · Heart attack; · Inflammatory damage to intestinal tissues; · Malignant tumors; · Organ sepsis.
Up to 1 month	60-85
Up to 1 year	70-135
1-6 years	100-135
6-12 years	95-135
12-16 years old	95-125
Over 16 years old	65-127
APTT, sec
Any	20,8 – 37	· Hereditary defect; · Low concentrations of vitamin K; · Genetic mutations; DIC syndrome; · Kidney or liver failure; · Anemia; · Taking anticoagulant medications.	· Bleeding before biomaterial collection; · Oncological disease.
D-dimer, µg FEU/ml
Any	0 – 0,55	· Thrombosis; DIC syndrome; · Infection of the body; · Mechanical injuries; · Cancer.	—

Important: when selecting reference (normal) values, the age of the subject must be taken into account.

Peculiarities

A referral for a blood test for a coagulogram can be prescribed by a physician, surgeon, gynecologist or hepatologist. Moreover, in each specific case a certain set of criteria is selected. Determined coagulogram parameters can vary from two to full complex, including all 6 criteria. Advanced analysis indicators are significant for a comprehensive comprehensive assessment of the functioning of the mechanisms that ensure blood clotting.

It should be noted that deciphering a blood coagulogram in adults should be carried out strictly by a specialist. Independent interpretation for the purpose of selecting treatment is unacceptable; this can lead to complications of the disease and fatal outcome. In addition, the analysis in question is not enough to make a final diagnosis. It should be used in combination with additional laboratory and instrumental methods.

Deviation from the norm

It should be noted that a slight deviation from the norm of tenths or hundredths of units does not have diagnostic significance. This is explained by daily fluctuations in all laboratory readings of a person, as well as individual characteristics.

Significant deviations from reference values—by several units or more—acquire diagnostic value. A tenfold increase in the criterion indicates a severe stage of the pathology and requires immediate treatment.

Coagulogram during pregnancy

During pregnancy, a detailed coagulogram analysis is mandatory for all women. This fact is explained by the fact that a violation of the mechanisms that ensure blood clotting long time may occur without clinical signs.

The standard frequency of examination is once every trimester, however, if a woman has varicose veins veins, renal or liver failure or chronic autoimmune pathologies, then the frequency increases at the discretion of the doctor.

Normal values ​​for pregnant women

When deciphering the results, you should take into account the exact week of pregnancy, since the indicators differ for each of them.

Week of pregnancy	Reference values
PTI, %
Similar to values ​​for non-pregnant women: from 70 to 125
INR
13-20	0,55-1,15
20-30	0,49-1,14
30-35	0,55-1,2
35-42	0,15-1,15
Fibrinogen, g/l
Up to 13	2,0-4,3
13-20	3-5,4
20-30	3-5,68
30-35	3-5,5
35-42	3,1-5,8
42-	3,5-6,55
AT III, %
13-20	75-110
20-30	70-115
30-35	75-115
35-42	70-117
APTT, sec
Similar to values ​​for non-pregnant women: 20.8 – 37
D-dimer, µg FEU/ml
Up to 13	0-0,5
13-20	0,2-1,43
20-30	0,3-1,68
30-35	0,3-2,9
35-42	0,4-3,15

Who needs a coagulogram?

The main indications for conducting an extended examination for a person:

• suspicion of DIC syndrome;
• carrying out an operation;
• frequent nose bleed or bleeding gums;
• hematomas of unknown etiology;
• chronic anemia;
• heavy and prolonged menstruation;
• a sharp unexplained decrease in visual acuity;
• thrombosis;
• presence of a family history of hemostasis disorders;
• detection of lupus antibodies;
• CVD diseases with concomitant pathologies;
• intrauterine growth retardation;
• recurrent miscarriages (permanent miscarriage).

Hemostasiogram and coagulogram - what is the difference?

People are often concerned about the question: what kind of tests are a coagulogram and a hemostasiogram, and are there any differences between them?

A coagulogram is part of a hemostasiogram; it allows you to evaluate the correct implementation of the coagulation mechanisms themselves. In turn, a hemostasiogram is an advanced diagnosis that takes into account the entire cellular composition of the blood (erythrocytes, neutrophils) and indicators included in hemostasis (hematocrit, thrombocrit).

How to take a coagulogram test?

The most reliable results are achieved with accurate implementation of the analysis methodology. And just as important proper preparation to a blood coagulogram.

The most common question is whether it is necessary to take a coagulogram test on an empty stomach or not? Yes, you should take biomaterial strictly on an empty stomach. The minimum interval after the last meal should be 12 hours. The process of digesting food is a complex multi-stage process in which all human biological fluids are involved. Non-compliance of this rule may lead to false results.

Preparation for the examination also means eliminating physical and emotional stress for the person at least 1 hour before collecting the material. Severe stress changes the condition of human tissues, as well as biochemical composition liquids. And before you go to treatment room, it is recommended to sit in the laboratory for at least 15 minutes in a free position and try to calm down as much as possible.

Taking anticoagulant medications significantly distorts the results, up to complete unreliability. Therefore, they are like any other medications(including oral contraceptives), must be eliminated 3 days in advance. If this is not possible, inform the laboratory employee about all medications you are taking.

Smoking is prohibited 30 minutes before, and drinking alcohol is prohibited 24 hours before. At least 1 month must pass from the moment of blood transfusion, since this can significantly distort the value of fibrinogen and APTT.

What influences the result?

If even one of the following conditions of damage to the biomaterial occurs, the analysis must be canceled and the result is considered invalid:

• violation of the temperature regime for storing or taking biomaterial;
• hemolysis - destruction of red blood cells;
• the presence of fatty inclusions in the serum;
• the volume of red blood cells critically deviates from the norm;
• the presence of anticoagulant molecules in the biomaterial as a result of taking drugs.

The biomaterial should be re-sampled in compliance with all rules.

How many days does a coagulogram take?

The state clinic provides the opportunity to take an analysis with a minimum set of indicators, as a rule, this is a coagulogram of PTI and INR. The execution time does not exceed 1 day, not counting the day of collection of the biomaterial.

Private clinics offer both a limited analysis option (price starts from 200 rubles) and an extended full one (from 1,500 rubles). The duration is similar to state laboratories.

Thus, to summarize, it must be emphasized that:

• timely detection of hemostasis disorders can significantly reduce the risk of possible bleeding or excessive coagulation that threatens the formation of a blood clot;
• before submitting the biomaterial, it is important to prepare properly;
• laboratory data are not sufficient to make a final diagnosis, because deviations from the norm can be caused by a number of pathological conditions. Determining the final diagnosis involves the use of additional laboratory and instrumental methods diagnostics