Analysis of the coagulogram rfmk. What does a blood coagulogram show

With the continuous development of medicine, scientists have received many methods.

Analysis indicators contribute to the disclosure of a complete picture of the state of human health, the presence of diseases, infections, pathologies, and the prevention of the development of diseases.

One of the tests is a blood coagulogram.

What is a blood coagulogram?

A blood coagulogram is an analysis that displays blood clotting. In a broad sense, the coagulogram reveals the activity of platelets. Blood clotting is a particularly important indicator.

The blood coagulation system is triggered in two ways: external (outside the vessel, when a damaged area is detected) and internal (when blood cells are destroyed).

When the wall of the blood vessel is destroyed, a protein is released that signals the need to activate the protective mechanism. Nearby platelets quickly change their shape, adhere to each other, forming a mesh.

The site of damage is quickly clogged by the formed plexus, stopping the blood and preventing the penetration of harmful bacteria from the outside.

The medical name for this important process for the body is hemostasis (a process that includes all stages of coagulation up to the dissolution of a protective thrombus).

However, in any, even the most powerful system, failures are possible.

Why is it necessary to do a blood coagulogram?

Disease prevention

Thrombosis is a disease in which, without the need to activate the protective function, the formation of blood clots occurs.

Such blood clots are called emboli, the disease is thromboembolism.

Emboli are able to clog arterial vessels. The formation of an obstruction (obstruction) by more than 90% causes a lack of oxygen (hypoxia), not to mention the accumulation of metabolic products. Hypoxia of the brain, for example, is the most dangerous diagnosis, often leading to coma, resulting in 80% of cases - deaths.

Biochemical screening of the health status of the expectant mother and child

The analysis is especially important for a pregnant woman. A blood coagulogram is recommended for women in the presence of:

• liver diseases;
• blood clotting disorders;
• varicose veins;
• immune diseases.

Bearing a fetus is a natural process associated with the formation of uteroplacental circulation. During gestation, the body prepares for blood loss, which affects the increase in some indicators of the coagulogram.

If the expectant mother has serious deviations in blood clotting, the physician prescribes treatment. Undetermined in time, impaired coagulability can threaten with serious consequences - miscarriage and premature birth.

A blood coagulogram is necessary not only to detect abnormalities in the hemostasis system, but also to diagnose patients in some cases.

How to prepare for the analysis?

Coagulogram does not require special preparation. However, there are points that it is desirable to observe for a good analysis:

• food intake - 8 hours before the moment of blood sampling;
• it is recommended not to eat fatty foods;
• drink only water;
• it is recommended not to smoke for an hour before the analysis;
• before the analysis, it is necessary to try to calm down emotionally and physically;
• if the patient is prescribed a course of medications that is not related to the reasons for donating a blood coagulogram, it is necessary to notify the doctor about this;
• if you feel unwell, dizzy during the sampling, you should immediately inform the specialist taking the tests.

Causes of high and low blood coagulograms

Coagulogram indicators above the norm indicate:

• infectious-toxic and septic disease;
• intoxication of the body;
• atherosclerotic vascular lesions;
• endocrine pathology;
• the occurrence of disseminated intravascular coagulation (DIC), etc.

Coagulogram parameters are below normal:

• leukemia ();
• vein thrombosis;
• various diseases internal organs( , digestive system);
• hereditary clotting defects;
• the final phase of DIC, etc.

The above diagnoses are few. It is important to remember that this is generalized data. To identify the cause that violates the norms of hemostasis, it is necessary to decipher and specifically compare with the norm of each indicator, taking into account the characteristics of the patient's body.

Detailed information about blood coagulation parameters

• Fibrinogen (a protein formed in the liver and is responsible for the final stage of thrombus formation):

Causes of low fibrinogen:

• donation, taking steroids, etc.
• chronically low fibrinogen level, impaired synthesis from birth;
• liver disease;
• unbalanced diet.

Reduced protein concentrations characterize the inability to complete blood clotting, the tendency to spontaneous bleeding.

Increased fibrinogen:

• inflammatory processes, alas, the most diverse - acute, infectious mononucleosis, etc .;
• massive tissue destruction (, lung abscesses, gangrene, abscesses, etc.);
• tumor formation;
• , violation cerebral circulation;
• peripheral vascular disease (atherosclerosis of the arteries, vascular damage in diabetes, thrombophlebitis, chronic venous insufficiency);

Not always an increased or decreased fibrinogen index indicates health problems.

An insignificant effect on the indicator in an adult can also have:

• smoking;
• taking hormonal contraceptives, estrogens;
• loads;
• stress;
• cholesterol;
• obesity.

In adults, the norm ranges from 2-4 g / l, in pregnant women up to 6 g / l, in children the content of fibrinogen in - 1.25-3 g / l.

• (APTT):

Characterizes the period of time required for the reaction of platelets. An increased thromboplastin time characterizes a tendency to uncontrolled bleeding, prolonged blood clotting.

The influence on the concentration can also have a high content of lipids in the blood, the presence of heparin impurities in the blood sample.

- 24-35 seconds, the norm for men is 14-20 s.

• Lupus anticoagulant:

Immunoglobulin that identifies antibodies. Antibodies affect the response time of platelets. Should always be zero. An increased concentration indicates the presence of autoimmune diseases, thromboembolism, Liebman-Sachs disease (), cerebrovascular accident, as well as infertility and AIDS.

• Adhesion, aggregation:

Adhesion - sticking of platelets to the damaged surface. A decrease indicates kidney disease, leukemia; increase - atherosclerosis, thrombosis, heart attack, diabetes mellitus. The norm in women carrying a child is usually higher (see table below).

• Prothrombin and antithrombin:

Proteins involved in the formation and resorption of blood clots. Prothrombin is produced in the liver.

Thrombin time is a special laboratory generally accepted indicator that characterizes the external pathway of hemostasis activation.

Prothrombin index (PTI) - the indicator is measured as a percentage and characterizes the time of the 2nd stage of coagulation - the formation of proteins. PTI norm - 72-123%.

A PTI blood test can indicate diseases of the abdominal organs (liver and gastrointestinal tract). Elevated prothrombin indicates:

• thromboembolism;
• pre-infarction state;
• polycythemia;
• malignant education.

Decreased indicates an acquired deficiency or a deficiency from birth. Often, low prothrombin characterizes vitamin K deficiency. Prothrombin is the main important indicator for diagnosing hemostasis.

• International Normalized Ratio (INR):

Allows you to systematize the data of the coagulogram of blood. Ratio (INR) developed by the International Committee for the Study of Thrombosis and Hemostasis and the International Committee for Standardization in Hematology for ease of prescribing.

According to the INR indicator, doctors evaluate the effect of prescribed drugs.

• D-dimer:

After the destruction of the thrombus (during the breakdown of fibrin), a protein fragment, D-dimer, is observed in the blood. After the restoration of the affected part of the body, the protein plasmin is formed, which destroys and destroys blood clots.

The number of fragments in the blood allows you to identify the work of two processes at once: the formation of blood clots and their dissolution (fibrinolysis). There needs to be a balance between thrombus formation and fibrinolysis. Lack of balance informs about hemostasis.

The norms of indicators in adults and children are presented in the table below. Deciphering the blood coagulogram will reveal the discrepancy of each indicator: what is and how much should be.

Laboratory blood tests help to determine the general condition of the human body, identify abnormalities and diagnose various diseases. One of the most important of these analyzes is the coagulogram. It is worth explaining in more detail what this study is.

What is a coagulogram

During the study, the functioning of hemostasis, the blood coagulation system, is checked. In our body, it is always liquid. When bleeding, the blood thickens, thereby preventing its abundant loss. This is how it should be normally. A blood coagulogram allows you to identify if there are any deviations and disorders during the operation of the coagulation system. There is an extensive list of situations in which the analysis of the hemostasiogram is mandatory:

1. Pregnancy. Blood clotting is certainly 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, blood vessels.
6. Diseases of the liver.
7. The appointment of hormonal contraceptives, anticoagulants, aspirin.
8. Hirudotherapy (treatment with leeches).

Coagulogram indicators

In the laboratory, the collected blood is tested for certain biochemical characteristics. The study of hemostasis can be basic or detailed. 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 the extended type coagulogram in addition to the indicators listed above:

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

Coagulogram, decoding

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

1. fibrinogen. An enzyme produced by the liver. In the presence of inflammatory processes in the body, its level greatly increases.
2. APTT. Indicates 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. Indicates how much it takes for thrombin (a substance that makes liquid blood clot) to be converted from prothrombin (an inactive form of a protein).
7. INR. External coagulation index is a combination of PTI and PTV.
8. thrombin time. Shows how quickly fibrin is formed from fibrinogen.

Extended coagulogram

Such an analysis for blood clotting is prescribed if it is necessary to clarify the results of the baseline. In addition, an expanded coagulogram can be prescribed if one or another pathology is detected. Deciphering indicators:

1. Antithrombin. A substance that prevents blood clotting.
2. D-dimer. Important indicator for women during pregnancy.
3. Plasma recalcification time. The overall process of coagulation is characterized by this indicator.
4. Plasma tolerance to heparin. According to the result, the presence of diseases of the heart, blood vessels, and oncology is determined.
5. Protein C. With its deficiency, thrombosis may occur.
6. RFMK. An indicator characterizing the process of intravascular blood coagulation.
7. Lupus anticoagulant. The presence of antibodies during pregnancy indicates preeclampsia or autoimmune diseases of the child.
8. AVR. Determination of plasma recalcification time by an alternative method.

Attention! The information provided 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 give recommendations for treatment, based on the individual characteristics of a particular patient.

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In the article, we will consider how to pass a coagulogram.

This is special laboratory research, in which the features of blood coagulation are determined. This analysis plays an important role in the study of the patient's condition.

It is important to know how to take an analysis for a coagulogram. Its values ​​help to suggest how successful the delivery or surgery will be, whether the patient will survive, whether it will be possible to stop bleeding in a critical situation. However, not all specialists have the skills to read a coagulogram. But it is precisely such research that often becomes a factor of salvation. human life.

So, let's figure out what a coagulogram is, and why they rent it.

Blood is a biological fluid that has the ability to circulate through the vessels and form clots (blood clots). This quality allows it to close the gap in small and medium-sized veins and arteries, and sometimes this process goes unnoticed by a person. Blood clotting and keeping it in a liquid state is regulated by a body system called hemostasis.

This biological system consists of three main components:

• Vascular cells, namely the inner layer of blood vessels (endothelium) - when the vessel wall is ruptured or damaged, endothelial cells secrete a number of active substances (prostacyclin, nitric oxide, thrombomodulin), which trigger the processes of thrombosis.
• Platelets are special platelets that rush to the site of injury first, after which they stick together and close the wound, forming a hemostatic plug. If these platelets fail to stop the bleeding, the plasma properties of blood clotting come into play.
• Plasma factors - the process of hemostasis includes 15 such factors (many of them are enzymes), which, as a result of a series of chemical reactions, form a fibrin clot of a dense structure, which finally stops bleeding. A feature of these factors of the coagulation system is that almost all of them are produced in the liver with the help of vitamin K.

The processes of human hemostasis are also controlled by fibrinolytic and anticoagulant systems. Their main function is to prevent spontaneous thrombosis.

How to pass a coagulogram, it is important to find out in advance.

Indications for appointment

The list of main indications for the appointment of a hemostasiogram includes the following:

• general assessment of the hemostasis system;
• C-section or independent childbirth;
• planned studies before operations;
• gestoses occurring in severe forms;
• control of exposure treatment (Warfarin, Aspirin, Trental), heparin medications (Fraxiparin, Clexane);
• diagnosis of various hemorrhagic diseases (Villebrant's disease, hemophilia, thrombocytopathy and thrombocytopenia);
• varicose veins lower extremities;
• with a high probability of thrombosis (with atrial fibrillation, coronary disease hearts);
• definition of DIC;
• the use of oral contraceptives, anabolics, glucocorticosteroids;
• liver disease in chronic forms (cirrhosis);
• inflammatory processes of an acute nature in the body;
• in the diagnosis of various thromboses - intestinal vessels, lower extremities, thromboembolism pulmonary artery, ischemic stroke.

How to take a coagulogram correctly, the doctor will tell.

Preparation for the study

Preparation for this study is of great importance.

Many are interested in how to take a coagulogram - on an empty stomach or not.

Biological material is taken on an empty stomach. In this case, it is necessary that the meal was at least 12 hours ago. Before taking the test, it is not recommended to consume spicy, smoked, fatty foods, alcoholic beverages, it is strictly forbidden to smoke.

Everyone should know how to donate blood for a coagulogram correctly.

Another important condition is the cessation of taking indirect and direct anticoagulants, since their presence in the blood can significantly distort laboratory tests. In cases where taking such medications is a vital condition for the patient, it is necessary to warn the specialist who will conduct the study about this. So, how to pass a coagulogram?

How is a blood coagulation test performed?

The sampling of biomaterial is carried out with a sterile dry syringe or a special Vacutainer vacuum blood collection system. This event should be carried out with a needle with a wide lumen without the use of a tourniquet.

The puncture of the vein must be atraumatic, otherwise a large amount of tissue thromboplastin will enter the test tube for research, which also significantly distorts the results of the analysis. The laboratory assistant fills 2 test tubes with blood, while only the second one is sent for analysis. The test tube must contain sodium citrate (special coagulant).

Is it possible to take a coagulogram during menstruation? This is a common question. We will talk about this at the end of the article.

How many days do a coagulogram?

To obtain the correct results of the study, the laboratory assistant conducts certain chemical reactions, which require some time. This process usually takes 1-2 days. However, much depends on the workload of the laboratory, the work of employees, the availability of reagents.

It is not in vain that we tell you how to take a coagulogram correctly. This affects the accuracy of the results.

Norms of the coagulogram

Normally, hemostasis indicators are as follows:

• the blood clotting interval is 5-12 minutes;
• bleeding period - from 2 to 8 minutes;
• prothrombin time - 11-15 sec;
• 22.6-35.8 sec;
• activated recalcification period ABP 82-126 seconds;
• prothrombin index - 72-123%;
• thrombin time - 14-21 seconds;
• fibrin-monomeric complexes - 0.356-0.478 units;
• antithrombin III - 75.9-124.6%;
• D-dimer - 250.09-500.48 ng/ml;
• fibrinogen 2.6-4.023 g.

Why take a coagulogram, what indicators does it reveal?

Decryption

In order to correctly understand the significance of this analysis, it is necessary to familiarize yourself in more detail with each of its indicators, since they reflect the most important properties of the blood of a particular patient. When decoding, normative values ​​​​for a certain age are taken into account.

ON

Prothrombin time is the period of formation of a blood clot if thromboplastin and calcium are added to the plasma. This indicator reflects two phases of plasma coagulation and the functionality of 10, 7, 5 and 2 factors. The norms of prothrombin time at different ages are:

• premature babies - 13-18 seconds;
• full-term babies - 12-16 sec;
• young children - 14-17 sec;
• older children - 12-16 seconds;
• in adults - 11-16 sec.

Treatment with anticoagulants is considered effective if this indicator rises at least 2 times.

INR

INR (prothrombin ratio) is the ratio of the patient's PV to the PT of the control tube. The main goal of the INR assessment is to control the intake of indirect anticoagulants. The reasons for the change in INR indicators are:

• prolongation of prothrombin time;
• liver diseases (hepatitis, cirrhosis of the liver);
• lack of vitamin K in enteropathy, dysbacteriosis;
• nephrotic syndrome;
• amyloidosis;
• DIC; hereditary deficiency of coagulation factors (10, 7, 5, 2);
• absence or decrease in the concentration of fibrinogen;
• therapy with coumarin derivatives ("Merevan", "Warfarin");
• treatment with anticoagulant medications;
• thromboembolism and vascular thrombosis;
• increase in the activity of factor 7;
• activation of fibrinolysis.

It is interesting for many women to take a coagulogram on which day of the cycle.

APTT

This indicator indicates the partial activated thrombin time, the effectiveness of plasma factors in stopping bleeding. APTT reflects the path of hemostasis, and how quickly a fibrin clot forms. This is the most accurate and sensitive indicator of the hemostasiogram. APTT depends on the reagents-activators used by specialists. A shortened APTT indicates a high coagulability, the likelihood of thrombus formation, and an elongation indicates a decrease in the level of hemostasis. Reasons for changing this value:

• acquired or congenital factor deficiency (12,10,9,8,5,2);
• fibrinolysis;
• DIC;
• therapy with heparin and its analogues ("Cibor", "Clexane", "Fraksiparin");
• autoimmune diseases (lupus erythematosus);
• pathology of the liver of severe forms (fatty infiltration, cirrhosis);
• high blood clotting;
• improper blood sampling (tissue thromboplastin contamination).

AVR

Activated recalcification time - the period required for the formation of fibrin in blood saturated with platelets and calcium. This value reflects how effectively the cellular and plasma parts of hemostasis interact. The indicator may depend on the reagents. AVR lengthens with a decrease in the number of platelets (thrombocytopenia) and a violation of their quality (thrombocytopathy), as well as with hemophilia. AVR is shortened in the presence of a tendency to thrombosis.

PTI

The prothrombin index is the ratio of the normal prothrombin time to that observed in the patient, and is multiplied by 100%. This indicator increases with:

• deficiency of hemostasis factors;
• vitamin K deficiency (enterocolitis, colitis);
• therapy with indirect anticoagulants ("Neocoumarin", "Warfarin", "Sinkumar");
• treatment with drugs "Heparin", "Clexane", "Flenox";
• liver damage;
• vascular thrombosis;
• increased clotting during pregnancy or childbirth.

TV

Thrombin time reflects the final stage of hemostasis. It characterizes the time period required for the formation of a fibrin clot if thrombin is added to the plasma. This indicator is determined together with PT and APTT to control heparin therapy and fibrinolytic diagnosis of congenital fibrinogen pathologies. Factors that prolong thrombin time are:

• acute fibrinolysis;
• treatment with fibrinolytic drugs ("Urokinase", "Streptokinase");
• DIC;
• autoimmune diseases (presence of antibodies to thrombin);
• liver disease;
• therapy with fibrin inhibitors and heparin.

fibrinogen

This is one of the blood. This protein is formed in the liver and under the influence of the Hageman factor and is converted into insoluble fibrin. Fibrinogen is classified as an acute phase protein; its plasma level increases with stress, infection, and trauma. This indicator may change in the following cases:

• inflammatory pathologies severe course(peritonitis, pyelonephritis, pneumonia);
• systemic connective tissue pathologies (SLE, rheumatoid arthritis, scleroderma);
• myocardial infarction;
• oncological tumors;
• pregnancy;
• burn disease;
• amyloidosis;
• after surgical interventions;
• period of menstruation;
• therapy with heparin and its analogues, as well as estrogens (use of hormonal contraceptives);
• DIC;
• leukemia, aplastic lesions of the bone marrow;
• liver pathology;
• oncology of the prostate with metastases;
• conditions after bleeding;
• treatment with androgens, anabolics, barbiturates, valproic acid, fish oil, fibrin polymerization inhibitors;
• heparin poisoning

RFMC

This indicator - which are intermediate products of the breakdown of a fibrin clot as a result of fibrinolysis. They are very quickly removed from the plasma, the indicator is extremely difficult to determine. RFMC increases with:

• thrombosis of various localization;
• in the postoperative period;
• complications of pregnancy (preeclampsia, preeclampsia);
• kidney failure;
• shocks;
• sepsis;
• systemic connective tissue pathologies.

Antithrombin III

It is a physiological anticoagulant substance. Structurally, it is a glycoprotein that inhibits thrombin and some coagulation factors. The main site of its production is the liver cells. A change in the level of a given substance occurs when:

• heavy inflammatory diseases(pyelonephritis, peritonitis, pneumonia);
• acute liver damage (hepatitis);
• lack of vitamin K;
• anabolic therapy, glucocorticosteroids;
• hereditary and congenital deficiency;
• liver disease (cirrhosis, alcoholic disease);
• DIC;
• late pregnancy;
• thrombosis and thromboembolism;
• sepsis;
• treatment with heparin and inhibitors of fibrin polymerization.

D-dimer

This value characterizes the remains of split fibrin strands and the work of hemostasis. If the D-dimer is elevated, it means that too much fibrin has been broken down. It is contained in the blood for about 7 hours after its formation, so the biomaterial must be examined immediately. Diagnostic value has a promotion this indicator, which is observed at:

• thrombosis and thromboembolism;
• liver diseases;
• ischemic heart disease and heart attack;
• extensive hematomas;
• in the postoperative period;
• prolonged smoking;
• rheumatoid seropositive arthritis;
• DIC syndrome.

Bleeding time

The clotting time indicates the interval required for the formation of a blood clot. In practice, only an increase in this indicator is estimated, since this indicates:

• lack of platelets;
• hemophilia;
• liver damage from alcohol;
• hemorrhagic fever;
• thrombocytopathy and thrombocytopenia;
• overdose of anticoagulants and anticoagulants.

Is it possible to take a coagulogram during menstruation?

Analysis during menstruation

This laboratory test during menstruation, as a rule, cannot give a clear result. This is due to the fact that during this period the blood is the most liquefied, and it is not possible to check its coagulation properties.

That is why it is so important to find out how to pass a coagulogram. Especially when it comes to women.

Therefore, for the implementation of this procedure, it is best to wait until the end of menstruation, however, do not analyze immediately after it. The body in this period is interested in removing blood from the uterus, so clotting is somehow impaired. After graduation critical days all processes of this nature return to normal, and the patient may well go for tests.

There were cases when women passed a coagulogram during menstruation. Their results were inaccurate.

Before the start of menstruation, it is also not recommended to carry out such a procedure, since the body is preparing to withdraw blood, which is already gradually thinning during this period. The analysis will be incorrect and will have to be repeated.

On what day of the cycle to take a coagulogram?

The most optimal time for conducting this laboratory analysis in women is 5 days before the onset of menstruation and the same after its completion, that is, 10-20 days of the cycle. In this period of time, the result will be the most reliable.

We examined what a coagulogram is and why it is taken.

A coagulogram or hemostasiogram is prescribed when it is necessary to determine the parameters of blood coagulation.

Most often, such a need arises before surgical interventions in order to prevent blood loss. Pregnant women, people with disorders of the heart, liver, kidneys are also tested.

As a result, a number of indicators are obtained. Each parameter is important individually and their combination. What kind of analysis is this, where is the blood taken from, how to prepare for the delivery of a coagulogram, how many days is an extended study done and what are the rules for deciphering the results?

Blood circulates through the vessels in a liquid form, but when they are damaged, it thickens, forms blood clots to close the wound and allow the damaged tissue to recover. This ability is controlled by the hemostasis system. Coagulation takes place in three stages:

1. The inner surface of the vessels in case of damage triggers the processes of thrombosis. The walls of the vessels spasm to reduce blood loss.
2. Platelets are produced in the bone marrow. Which are plates that rush to the damaged area and stick together to close the wound.
3. The liver produces 15 clotting factors (mostly enzymes). Reacting with each other, they form a fibrin clot, which finally stops bleeding.

Hemostasiogram shows the state of hemostasis. Appointed in the following cases:

• Before any operations to determine the clotting time;
• before any kind of delivery;
• pathologies of hematopoietic organs and control of their treatment;
• liver disease;
• at cardiovascular diseases with a high risk of blood clots;
• when taking certain medications;
• blood loss of various nature;
• chronic foci of inflammation in the body.

If the activity of the hemostasis system is reduced, an increased tendency to bleeding develops, and with excessive activity, the risk of blockage of blood vessels by blood clots increases.

Before surgery, the clotting time is determined to avoid blood loss. And for heart disease it is important to avoid thickening to warn , or .

Watch an informative video animation about the human hemostasis system:

Preparation for such a procedure, how to take it correctly

To get reliable results, it is important to correctly hand over the material for examination.

For this you need to remember:

1. Blood sampling is carried out in the morning on an empty stomach. The last meal should be at least 8 hours before the study (preferably 12). On the eve, you can not use spicy, smoked, fatty and alcoholic drinks.
2. Do not smoke before taking the test.
3. You can drink. But only clean water.
4. Some medications affect clotting and can make the results unreliable. Be sure to provide the doctor with a list of medications taken. If possible, 2 days before the examination, you should stop taking medications.

It is advisable to drink a glass of water before the study. Also, you can not take an analysis immediately after physical exertion or with strong nervous tension. The results may be distorted.

The fence is made from a vein without the use of a tourniquet. It is important that the test material is sterile. The result is ready in 1-2 days.

Hemostasiogram is one of the most complex studies. To make a correct diagnosis It is also desirable to perform a general blood test(). Then the picture will be complete.

Violations of the rules for taking material for analysis, recent blood transfusions, or ingress of tissues from capillary blood into the sampled sample can affect the result.

What does a blood test for clotting show?

The hemostasiogram may include a different set of indicators. It all depends on the purpose of the study. The doctor indicates the necessary parameters in each case.

Usually, as a result of a hemostasiogram, the following is determined:

During the examination, the indicators of all three stages of blood coagulation are checked.

More useful information about taking this test for women's health in childbearing age, you can learn from the video:

Indicators are normal and deviations in children and adults in the table

We bring to your attention a table with normal indicators blood test for coagulogram and possible reasons changes in hemostasis.

Coagulogram index	The norm in children 3-14 years old	The norm in adults	Indicators below the norm	Indicators above the norm
Coagulation time according to Lee-White, min.	5–10		Hemorrhagic or anaphylactic shock.	Inflammation, burns, pregnancy, intoxication, kidney and liver diseases.
Bleeding time (according to Duke), min.	2–4		–	Platelet deficiency, alcohol intoxication, blood diseases.
Prothrombin time (PT) according to Quick, sec.	13–16	11–15	–	Risk of blood clots
Prothrombin index (PTI), %	70–100	73–122	Liver disease, thrombosis, pregnancy and childbirth.	Vitamin K deficiency, exposure to certain medications.
INR	0,82–1,12		Thrombosis.	Pathological processes of the liver and kidneys, lack of vitamin K, taking certain drugs.
APTT, sec.	24–35	22,5–32,5	Increased coagulability, improper sampling of material for analysis.	Reduced coagulability, pathology of the liver and kidneys, lack of vitamin K.
Thrombin time, sec.	10–16	14–21	Taking certain medications.	Decreased fibrinogen, autoimmune disorders, liver disease
Fibrinogen, g/l	1,7–3,5	2,7–4,013	Diseases of the liver, consequences of bleeding, blood diseases.	Inflammatory processes, malignant tumors, menstruation, pregnancy, heart disease, burns.
Antithrombin III, %	80–120	75–125	Ischemia, thrombosis, sepsis, congenital pathologies, last trimester of pregnancy.	Strong inflammatory processes, lack of vitamin K, hepatitis.
Lupus anticoagulant	negative		–	autoimmune processes.
D-dimer, ng/ml	250–500		–	Thrombosis, multiple hematomas, long-term smoking, postoperative period, liver disease.

Interpretation of possible disorders and diagnosis

The final diagnosis is made by the doctor. Based on the hemostasiogram, general analysis blood, medical history, examination of the patient. Additional examinations may be ordered.

In general, an increase in indicators indicates a thickening of the blood. A decrease in parameters indicates an insufficient number of platelets, as a result - the risk of blood loss.

Causes of violations of hemostasis:

A coagulogram is prescribed by cardiologists, hematologists, surgeons, therapists, hepatologists, gynecologists.

Diagnosis of cardiovascular diseases

For problems with the cardiovascular system it is important to exclude blood clots. Since there is a risk of blood clots and blockage of blood vessels. There may be a heart attack, stroke, thrombosis. With increased viscosity, drugs are prescribed for thinning.

Also, the analysis is important for monitoring the effectiveness of certain cardiac drugs. During heart surgery, a hemostasiogram is performed to assess the risk of blood loss.

Coagulogram - the most important study to determine the parameters of blood coagulation, which is performed for the safe operation, with heart disease, during pregnancy. The results can be used to judge the risk of bleeding or thrombosis.

In today's report, a coagulogram is considered: what kind of analysis, norm, decoding. For convenience, we have placed the data in tables.

A coagulation blood test 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 required before any surgical intervention and in 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 clotting during bleeding. The end result is the formation of a thrombus from fibrin strands. There are 2 main ways 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 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 to stop bleeding. Violation of the compensatory mechanisms of the hemostasis system is one of the causes of thrombosis or bleeding, which poses a threat to human life and health. This emphasizes the importance of timely diagnosis of the state of the hemostasis system.

Coagulogram - what is this analysis?

Patients often ask themselves the question - what is a blood coagulogram, for example, before surgery or during pregnancy, and why is it so important to donate it?

The coagulogram is medical analysis by assessing the state of the system that starts and stops the blood coagulation mechanism.

The obligatory examination before the operation is due to the possible risk of bleeding during the operation. If failures in the hemostasis system are detected, the patient may be denied surgical intervention if the risk of bleeding is too great. In addition, the impossibility of implementing one of the coagulation mechanisms may be the cause of miscarriage.

The effectiveness of therapy for any pathology affecting the hemostasis system requires strict control and is realized by means of the survey in question. Positive dynamics indicates 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

With the help of two parameters - PTI and INR, it is possible to assess the normal functioning of the external and common pathways for blood coagulation. In the case of a decrease in the concentration of protein factors in the serum, a deviation of the criteria under consideration is observed in a larger direction from the norm.

It has been established that prothrombin is produced by liver cells (hepatocytes) and vitamin K is required for its normal functioning. In case of its hypofunction (deficiency), a failure occurs in the formation of a thrombus clot. This fact underlies the therapy of people with a predisposition to thrombosis and CVS pathologies. The essence of the treatment is the appointment of drugs that interfere with the normal synthesis of the vitamin. Both considered criteria are used to determine the degree of effectiveness of this tactic.

The formula for calculating the prothrombin index:

PTI std. is the amount of time taken for plasma to clot in the control sample after the addition of clotting factor III.

The INR coagulogram is calculated using the following formula:

IHI (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

Synthesis of fibrinogen protein is carried out in hepatotocytes. Under the influence of biochemical reactions and degrading enzymes, it takes an active form in the form of a fibrin monomer, which is part of a blood clot. The lack of protein can be due to two reasons: congenital genetic mutations and its excessive depletion for biochemical reactions. This condition is characterized by excessive bleeding and poor blood clotting.

In addition, when the integrity of tissues is violated as a result of mechanical damage or inflammatory processes, the production of fibrinogen is significantly increased. Measurement of protein concentration allows diagnosing pathologies of the cardiovascular system (CVS) and liver, as well as assessing 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 the vessels. The main function is to suppress clotting processes by inhibiting the functioning of thrombin. Due to the normal ratio of these two proteins, hemostasis stability 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 you to evaluate the normal implementation of the internal pathway. Its duration is directly dependent on the concentration of kininogen (the precursor of polypeptides) and various protein clotting factors.

The APTT value is set by measuring the time it takes to form a full-fledged blood clot when reagents are added to the test sample. The deviation of the criterion to a greater side from the norm leads to an increase in the frequency of bleeding, and to a smaller one - to excessive formation of blood clots. In addition, the isolated use of APTT is acceptable in order to reliably monitor the effectiveness of the use of anticoagulant drugs.

D-dimer

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

The norm and interpretation of the blood coagulogram in adults in the table

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

Age	Normal values	Reasons for the increase	Reasons for the downgrade
PTI, %
Any	70 to 125	Syndrome of disseminated intravascular coagulation (DIC); Thrombosis; · Increased functional activity of proconvertin.	Lack of clotting factors; · Production of mutant proteins that cannot take part in biochemical processes; Hypofunction of vitamin K; Leukemia in the acute stage; Pathology of the heart muscle; Liver diseases (chronic hepatitis, cirrhosis, cancer); Disorders in the work of the bile ducts; · Malignant tumor of the pancreas; Reception of the drugs interfering coagulability.
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 old	0,95-1,1
6-12 years old	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; Disturbances in the body's natural defenses; Pathology of the heart; oncopathology; · Malignant lesion of lymphatic tissue; · Diseases of the kidneys; · Chronic viral hepatitis; Violation of the integrity of tissues of unknown etiology.	Congenital absence of fibrinogen protein; · DIC-syndrome; · Hereditary hemophilia; · Diseases of the liver; Severe degree of malignant oncopathology; · Anemia; Extensive infection of the body with bacteria; Lack of macro- and microelements as a result of a violation 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; The period of menstruation; taking anticoagulant drugs; Chronic excess of globulins as a result of liver pathology.	· Hereditary defect; · DIC-syndrome; Formation of blood clots in deep veins; · Diseases of the liver; · 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 old	100-135
6-12 years old	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; Renal or liver failure; · Anemia; Taking anticoagulant medications.	Bleeding before biomaterial sampling; Oncological disease.
D-dimer, μg FEU / ml
Any	0 – 0,55	Thrombosis; · DIC-syndrome; · Infection of the body; · Mechanical injuries; · Crayfish.	—

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

Peculiarities

A referral for a blood test for a coagulogram can be issued by a therapist, surgeon, gynecologist or hepatologist. Moreover, in each case, a certain set of criteria is selected. The determined indicators of the coagulogram can vary from two to a complete complex, including all 6 criteria. Extended analysis indicators are significant for a comprehensive comprehensive assessment of the functioning of the mechanisms that ensure blood clotting.

It should be noted that the decoding of blood coagulograms in adults should be carried out strictly by a specialist. Self-interpretation for the purpose of selecting treatment is unacceptable; this can lead to a complication of the disease and lethal outcome. In addition, the analysis under consideration 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 by tenths or hundredths of units has no diagnostic significance. This is due to daily fluctuations in all human laboratory readings, as well as individual characteristics.

Diagnostic value is acquired by significant deviations from the reference values ​​- by several units or more. A tenfold increase in the criterion indicates a severe stage of the pathology and requires immediate treatment.

Coagulogram during pregnancy

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

The standard frequency of examination is once a trimester, however, if a woman has varicose veins veins, renal or hepatic insufficiency, or chronic autoimmune pathologies, then the frequency increases at the discretion of the physician.

Normal values ​​for pregnant women

When deciphering the results, the exact week of pregnancy should be taken into account, since the indicators are different for each of them.

week of pregnancy	Reference values
PTI, %
Similar to non-pregnant women: 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 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 an extended examination for a person:

• suspected DIC;
• carrying out the operation;
• frequent nosebleeds or bleeding gums;
• hematomas of unknown etiology;
• chronic anemia;
• heavy and prolonged menstruation;
• a sharp unexplained decrease in visual acuity;
• thrombosis;
• the presence in the anamnesis of relatives of violations of hemostasis;
• detection of lupus antibodies;
• CCC diseases with concomitant pathologies;
• intrauterine growth retardation;
• habitual miscarriages (permanent miscarriage of a child).

Hemostasiogram and coagulogram - what's the difference?

Often people are concerned about the question - what kind of tests are the coagulogram and hemostasiogram, and are there any differences between them?

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

How to take an analysis for a coagulogram?

The most reliable results are achieved with the exact implementation of the analysis methodology. Proper preparation for a blood coagulogram is also important.

The most common question is whether it is necessary to take a test for a coagulogram on an empty stomach or not? Yes, biomaterial should be taken strictly on an empty stomach. The minimum interval after the last meal should be 12 hours. The process of digestion of food is a complex multi-stage process, which involves all human biological fluids. Failure to follow this rule may result in false results.

Preparation for the examination also implies the exclusion of physical and emotional stress for a person at least 1 hour before the material is taken. Severe stress changes the state of human tissues, as well as the biochemical composition of fluids. And before going to the 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 drugs significantly distorts the results, up to complete unreliability. Therefore, they, like any other medications (including oral contraceptives), must be excluded for 3 days. If not possible, notify the laboratory staff of all medications taken.

For 30 minutes it is forbidden to smoke, and for a day - to drink alcohol. A minimum of 1 month should elapse from the moment of blood transfusion, as this can significantly distort the value of fibrinogen and APTT.

What influences the result?

In the event of even one of the following conditions of damage to the biomaterial, the analysis must be canceled, the result is considered invalid:

• violation of the temperature regime of storage or taking of 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.

It is necessary to re-sample the biomaterial in compliance with all the rules.

How many days is a coagulogram done?

In the state clinic, it is possible to take an analysis with a minimum set of indicators, as a rule, this is a coagulogram of PTI and INR. The term of execution does not exceed 1 day, not counting the day of taking the biomaterial.

Private clinics offer both a limited analysis option (the price starts from 200 rubles) and an extended full one (from 1500 rubles). The duration is similar to state laboratories.

Thus, summing up, it must be emphasized that:

• timely detection of hemostasis disorders can significantly reduce the risk of possible bleeding or excessive clotting, threatening the formation of a blood clot;
• before handing over the biomaterial, it is important to properly prepare;
• these laboratory parameters are not enough to make a definitive diagnosis, because a deviation from the norm can be caused by a number of pathological conditions. Determining the final diagnosis involves the use of additional laboratory and instrumental diagnostic methods.