Blood test for hemostasis: meaning, recommendations, interpretation of results. Interpretation of a blood test for hemostasis Coagulogram how many days is done in the clinic

APTT (Activated partial thromboplastin time) is an indicator of measuring the efficiency of the “intrinsic” (contact activation pathway) and the general coagulation pathway. In addition to detecting abnormalities in the blood clotting process, aPTT is also used to monitor the effectiveness of treatment with heparin, the main anticoagulant. Typical range is 25-39 sec (depending on reagents).

This is the time it takes for a blood clot to form after calcium chloride and other substances are added to the plasma. APTT is the most sensitive indicator of blood clotting. The normal APTT is 30-40 seconds on average. An increased aPTT can be observed with liver disease and vitamin K deficiency. Prolongation of APTT may be observed in the following cases:

If heparin is used (or the sample is contaminated);

In the presence of antiphospholipid antibodies (especially lupus anticoagulant, which paradoxically increases the tendency to thrombosis);

In case of shortage clotting factor (For example, hemophilia ).

A shortened aPTT is considered to have little clinical validity, but some studies suggest that this result may correspond to an increased risk thromboembolism

If the level of at least one of the coagulation factors is reduced by 30-40% of normal, then the APTT level also changes.

A slowdown in blood clotting due to an increase in the duration of the aPTT occurs with a decrease in blood clotting, hemophilia and some rarer diseases.

Prothrombin index (PTI) and thrombin time

Prothrombin- a complex protein, one of the most important indicators of a coagulogram, characterizing the state of the blood coagulation system. It is a precursor to thrombin (a protein that stimulates blood clot formation). Prothrombin is synthesized in the liver with the participation of vitamin K.

Based on the analysis of prothrombins, the doctor can evaluate the work and identify diseases of the liver and gastrointestinal tract. To characterize the blood coagulation system, prothrombin analysis is the most important test included in the hemostasiogram.

Prothrombin time (PTT)- this is the time of formation of a fibrin clot in plasma when calcium chloride and thromboplastin are added to it. Prothrombin time is expressed in seconds. Normally it is 11-15 seconds.

However, more often they calculate prothrombin index (PTI) is the ratio of the clotting time of control plasma (plasma of a healthy person) to the clotting time of patient plasma. Expressed in %. Normally, the range of fluctuations in the prothrombin index is 93-107%.

The synthesis of prothrombin complex factors occurs in liver cells; in liver diseases, the number of factors decreases, and the prothrombin index, to a certain extent, can serve as an indicator of the functional state of the liver.

An increase in PTI indicates an increase in coagulability and the risk of thrombosis, but can be observed normally in the last months of pregnancy and when taking oral contraceptives.

A decrease in the prothrombin index indicates a decrease in blood clotting properties.

Vitamin K is necessary for the formation of prothrombin complex factors. With its deficiency, impaired absorption of the vitamin in the intestine due to enterocolitis and dysbacteriosis, the prothrombin index may also decrease.

Large doses of acetylsalicylic acid and diuretics such as hypothiazide cause a decrease in the prothrombin index.

Thrombin time (TV)- the time during which fibrinogen is converted into fibrin. Normally it is 15-18 seconds. An increase in thrombin time occurs with severe liver damage or congenital fibrinogen deficiency.

A shortening of time indicates an excess of fibrinogen or the presence of paraproteins (special proteins from the class of immunoglobulins).

This indicator must be monitored during treatment with heparin and fibrinolytics.

Prothrombin time (PTT) and its derivatives prothrombin index (PTI) And international normalized ratio (INR)- laboratory parameters determined to assess the external pathway of blood coagulation. Used to assess the hemostatic system as a whole and the effectiveness of therapy warfarin, degree of liver dysfunction (synthesis of coagulation factors), degree of saturation with vitamin K.

The normal prothrombin time is 11-16 seconds, for INR it is 0.85-1.35. A higher target level is required for oral anticoagulant therapy (warfarin) INR - usually in the range of 2-3.

With an INR above 5.0, there is a high risk of bleeding; with an INR below 0.5, there is a high risk of thrombus formation.

Fibrinogen

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

Donating blood for fibrin is usually prescribed if you want to:

determine the pathology of blood clotting;

conduct preoperative examination and postoperative period;

conduct a pregnancy examination;

control blood during inflammatory processes.

The normal level of fibrinogen in the blood is 2-4 g/l. Fibrinogen levels during pregnancy are slightly higher. During this period, a gradual increase in fibrinogen is observed and in the third trimester of pregnancy the level of fibrinogen reaches 6 g/l.

An increase in fibrinogen indicates an increase in coagulability and the risk of blood clots and is noted: at the end of pregnancy; after childbirth; after surgical interventions; with pneumonia; for acute inflammatory and infectious diseases (influenza, tuberculosis); on the first day of stroke; with myocardial infarction; with decreased thyroid function (hypothyroidism); for burns; when taking estrogens and oral contraceptives; for some specific diseases.

A decrease in fibrinogen is observed in: severe forms of hepatitis or cirrhosis of the liver; serious disorders in the blood coagulation system; toxicosis of pregnancy; lack of vitamin C or B12; taking anabolic hormones, androgens, anticoagulants (streptokinase, urokinase), fish oil.

RKMF or RFMC (soluble complexes of fibrin monomers)- a test to diagnose the activation of blood clotting inside blood vessels. The basis of a blood clot is fibrin, which is formed from fibrinogen. This process goes through the formation of fibrin monomers. Therefore, the determination of RKMF is used to diagnose the activation of blood coagulation inside blood vessels.

RKMP increases with hypercoagulation, increased fibrinolysis, and increased fibrinogen concentrations. During pregnancy, there is a physiological increase in fibrinogen levels, therefore RKMF are also often elevated. For a more accurate and complete diagnosis of intravascular coagulation, determination of the level of D-dimers is used.

Platelet aggregation- ability of platelets to connect. Spontaneous aggregation is normal - 0-20%. A special feature of the platelet is its ability to activate - a rapid and usually irreversible transition to a new state. The activation stimulus can be almost any environmental disturbance, even simple mechanical stress. However, the main physiological activators of platelets are considered collagen(major protein of the extracellular matrix), (the main protein of the plasma coagulation system), ADF(adenosine diphosphate, emerging from destroyed vascular cells or secreted by the platelets themselves) and thromboxane A2 (a secondary activator synthesized and released by platelets; its additional function is to stimulate vasoconstriction).
Activated platelets become able to attach to the site of damage (adhesion) and to each other (aggregation), forming a plug that covers the damage. In addition, they participate in plasma coagulation in two main ways - exposure of the procoagulant membrane and secretion of α-granules.

Increased aggregation occurs with: atherosclerosis; thrombosis; myocardial infarction; diabetes mellitus

Decreased platelet aggregation occurs with a decrease in platelet count or certain specific diseases.

D-dimer- is a breakdown product fibrin, a small protein fragment present in the blood after destruction thrombus(process fibrinolysis). It is called a "dimer" because it contains two D fragments of the fibrinogen protein that join together.

To diagnose thrombosis, you can determine the concentration of D-dimers in the blood - a D-dimer test. Since its introduction in the 1990s, the D-dimer test has become an important test for patients with suspected thrombotic disorders. While a negative result virtually rules out thrombosis, a positive result may be due to either thrombosis or other possible causes. Its main benefit, therefore, is the exclusion of thromboembolism. In addition, it is used in the diagnosis of disorders such as DIC syndrome(intravascular coagulation syndrome).

D-dimers are usually not present in human plasma unless the coagulation system has been activated, such as in the case of advanced thrombosis or disseminated intravascular coagulation. The D-dimer assay depends on the binding of monoclonal antibodies to a specific epitope on the D-dimer fragment.

Normal D-dimer: 250 - 500 ng/ml.

increased content - thrombosis of the great vessels, thromboembolism, wound healing process, disseminated intravascular coagulation syndrome, presence of rheumatoid factor, wound healing process, kuR education;

a decrease in content has no diagnostic value.

Antithrombin- this is the main plasma protein factor, synthesized mainly in the vascular endothelium and cells liver. Has the main inhibitory (anticoagulant) effect on the processes blood clotting.

Consists of two different functional domains - -binding and heparin-inhibiting. It is the main plasma protein in the inactivation mechanism thrombin(up to 75% of the thrombin inhibitory ability of plasma).

When exposed independently, thrombin inactivation proceeds slowly and incrementally. In the presence of heparin, the inactivation process unfolds very quickly. Therefore, antithrombin III is called plasma antithrombin cofactor heparin. But in the case of a significant decrease in the level of antithrombin III, heparin has almost no anticoagulant effect.

The mechanism of inactivation by antithrombin III consists of the formation of a complex in which an irreversible connection of the thrombin molecule and the antithrombin III molecule occurs. A decrease in antithrombin III levels indicates a risk of thrombosis.

Antithrombin is a natural regulator and controller of the blood coagulation system, which prevents thrombus formation in the bloodstream.

Antithrombin 3 norm: in absolute units - 210 - 320 mg/hl, but more often expressed as a percentage: adults 75 - 125% (antithrombin activity of whole donor blood plasma is taken as 100%)

The value of antithrombin III is increased in the following cases:

Inflammatory processes.

Spicy hepatitis .

Cholestasis .

Shortage vitamin K .

Reception anticoagulants .

Heavy spicy pancreatitis .

Cancer pancreas .

Menstruation .

Treatment with anabolic drugs.

The antithrombin III value is reduced in the following cases:
Congenital deficiency.

Atherosclerosis .

Last trimester of pregnancy.

After surgery.

For liver diseases (chronic hepatitis, cirrhosis).

Spicy DIC syndrome .

Chronic liver failure .

Thromboembolism .

Sepsis .

Long-term administration of heparin.

Taking oral contraceptives.

Protein C- basic physiological anticoagulant. Protein C belongs to vitamin K-dependent proteolytic enzymes(serine protease), which is activated by thrombin. At the same time, it turns into activated protein C, which is able to communicate with protein S.

Protein C is synthesized in the liver and is a vitamin K-dependent protein, so its activity also depends on vitamin K deficiency and oral anticoagulant therapy.

Determination of protein C is an additional test to assess the state of the anticoagulant system. Protein C deficiency is associated with a high risk of thrombosis, especially venous thrombosis and pulmonary embolism in young people.

Lupus anticoagulant (LA)

Belongs to immunoglobulins of the IgG class. This is a group of antibodies against negatively charged phospholipids. It suppresses the reaction in the blood from converting prothrombin to thrombin. It is assumed that lupus anticoagulants are formed in the body mainly as a result of the development of autoimmune processes after infectious exposure. When the presence of these antibodies in the blood is detected by lengthening coagulation tests, they are defined as “lupus anticoagulant”. They received this name due to the fact that they were first identified in patients with SLE (systemic lupus erythematosus). The presence of lupus anticoagulant is often observed in antiphospholipid syndrome. In conditions of a whole organism, the chronic presence of a lupus anticoagulant in the blood, in contrast to antibodies to individual coagulation factors, is associated with a tendency to thrombosis. VA is an important indicator of the risk of thrombosis, especially in systemic, autoimmune diseases, antiphospholipid syndrome, and in patients with AIDS. The presence of this type of antibody is associated with the risk of miscarriage. Lupus anticoagulants, increasing in human blood, attach to the walls of blood vessels, platelets, and enter into blood clotting reactions, thereby provoking the development of thrombosis. Depending on the size of the blood clot, the degree of damage to the vessel, the location, and the rate of blockage of the vessel, antiphospholipid syndrome can manifest itself differently. The most common symptom of antiphospholipid syndrome is livedo reticularis, a thin network of blood vessels on the surface of the skin that is better visible in the cold. A slight vascular lesion in APS will cause various organ dysfunctions, chronic organ diseases (liver cirrhosis, Alzheimer's disease), and pulmonary thromboembolism.

Anticoagulants - chemical substances And medicines, inhibiting the activity of the blood coagulation system and preventing the formation blood clots.

Anticoagulants affect various parts of the blood coagulation process. There are direct acting anticoagulants ( heparin, hirudin etc.), reducing activity thrombin V blood, and indirect anticoagulants ( dicoumarin, , neodicoumarin, or swaddle, , etc.), disrupting education prothrombin V liver involved in blood clotting.

Anticoagulants mainly inhibit the formation of fibrin filaments; they prevent thrombus formation, help stop the growth of existing blood clots, and enhance the effect of endogenous fibrinolytic enzymes on blood clots.

Anticoagulants are divided into 2 groups: a) direct anticoagulants - fast-acting (sodium heparin, calcium nadroparin, sodium enoxaparin, etc.), effective in vitro And in vivo; b) indirect anticoagulants (vitamin K antagonists) - long-acting (warfarin, phenindione, acenocoumarol, etc.), act only in vivo and after the latent period.

The anticoagulation effect of heparin is associated with a direct effect on the blood coagulation system due to the formation of complexes with many hemocoagulation factors and is manifested in the inhibition of coagulation phases I, II and III. Heparin itself is activated only in the presence of antithrombin III.

Indirect anticoagulants - derivatives of oxycoumarin, indanedione, competitively inhibit vitamin K reductase, thereby inhibiting the activation of the latter in the body and stopping the synthesis of vitamin K-dependent plasma hemostasis factors - II, VII, IX, X.

Antiplatelet agents- inhibit the aggregation of platelets and erythrocytes, reduce their ability to bond and adhere (adhesion) to the endothelium of blood vessels. By reducing the surface tension of red blood cell membranes, they facilitate their deformation when passing through capillaries and improve blood fluidity. Antiplatelet agents can not only prevent aggregation, but also cause disaggregation of already aggregated blood platelets.

They are used to prevent the formation of postoperative blood clots, for thrombophlebitis, thrombosis of retinal vessels, cerebrovascular accidents, etc., as well as to prevent thromboembolic complications in coronary heart disease and myocardial infarction.

Drugs of different pharmacological groups (organic nitrates, calcium channel blockers, purine derivatives, antihistamines, etc.) have an inhibitory effect on the adhesion (aggregation) of platelets (and erythrocytes) to varying degrees. NSAIDs have a pronounced antiplatelet effect, of which NSAIDs are widely used for the prevention of thrombosis.

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

There are two types of hemostasiogram:

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

When is it necessary to take the test?

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

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

Hemostasis in the human body

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

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

Basic terms and parameters of hemostasiogram

The table shows the most common coagulogram indicators:

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

Hemostasiogram indicators. Norms and deviations

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

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

How to take the test correctly?

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

Hemostasis is the most important biological process, which consists in maintaining the liquid state of blood plasma when the walls of blood vessels are injured, and removing blood clots that have completed their task. Thus, hemostasis in human blood performs the vital tasks of constancy of the state of internal fluids and some other physiological processes: for example, blood circulation and oxygen supply to organs and tissues.

Operation

So, what is the function of hemostasis?

• Maintaining a fluid state of blood;
• Preservation of coagulability if large veins and arteries are injured, as well as the formation of a so-called platelet plug for minor vascular injuries;
• Also, the dissolution of blood clots after restoration of the walls, when it occurs;

In essence, it is protection against extensive blood loss. depends on the interaction of thirteen enzymes. They are proteins and are called “clotting factors.”

The whole procedure consists of several stages and its essence is the processing of an inactive factor into an active one. Next, the active enzyme provokes the next processing of the inactive enzyme, and this happens countless times. This process is called the “coagulation cascade.” It is divided into external and internal cascades.

For the functioning of the internal type of coagulation cascade, all the necessary substances are already in the blood. To ensure the external cascade, an enzyme such as tissue thromboplastin is required. The appearance of this enzyme in the blood is always associated with injury to blood vessels.

Kinds

There are two types of hemostasis.

Vascular-platelet:

• platelets;
• vessel walls;
• bioactive enzymes;
• extravascular tissue;

Also in this type of hemostasis, a platelet plug is formed.

Coagulation. The following blood clotting factors play a role here:

• fabric;
• blood plasma;
• vessel wall;
• blood cells;

Its essence is the transformation of fibrinogen (a specific protein that has no color) and the formation of insoluble fibrin from it.

Coagulation hemostasis stops bleeding in those vessels where vascular-platelet homeostasis fails. The blood pressure is too high for the platelet plug and more powerful protective clots are required. Thus, homeostasis is a complex process that includes various components.

This blood test for hemostasis is carried out in order to find the causes of disruption of the homeostasis process. This is a complex multi-level one that allows you to give accurate information about coagulation in general. A blood test allows you to establish the interaction of the coagulating and anticoagulant functions of the blood.

These may be problems with the activation of the coagulation system, as well as in the activation of the anticoagulation system. In the first option, thrombosis appears, and in the latter, a predisposition to bleeding.

Thrombophilia is a condition caused by increased clotting. the occurrence of a heart attack, the development of thrombosis, and stroke.

With reduced coagulability, frequent bleeding occurs. As a result, the wounds do not heal for a long time; complications after surgical interventions, internal bleeding, and the occurrence of hemorrhagic syndromes are also possible.

Women and men have the same level of blood clotting. However, pregnant women have some differences in indicators.

You should take a blood test for hemostasis during pregnancy and not only for:

• Identifying the causes of increased blood loss and various types of hemorrhages;
• When diagnosing and treating thrombosis;
• When carrying out treatment and prevention, as well as strokes;
• Prevention of bleeding after surgical interventions;
• During pregnancy and prevention of gynecological diseases;

Hemostasis analysis includes the following studies:

• prothrombin time with international normalized ratio - clotting time.
• activated partial thromboplastin time - assessment of the internal type of blood clotting (consists of three stages).
• thrombin time - the period of transformation of the fibrinogen enzyme into fibrin due to the activation of thrombin.

Next, it is necessary to decipher the coagulogram. The most important parts of this analysis are the prothrombin time and APTT. They demonstrate activation along the intrinsic pathway as well as the extrinsic coagulation pathway. If the indicators of all of the listed parts of the analysis are normal, then there are no violations in the main part of the elements of the coagulation system.

During the analysis, the activation of reactions at all stages of hemostasis is studied.

If the diagnostic results are positive, a conclusion can be made about the normal functioning of the entire blood coagulation system. If, after completing the clotting test process, unfavorable findings are identified, then the cause of the problem must be identified.

Indications

This hemostasis study is carried out when volumetric blood loss is possible in certain specific diseases.

The main reasons when a coagulogram is required:

• before planned surgery;
• in the postoperative period;
• various problems with veins;
• Problems with the liver, which is a hematopoietic organ.
• After the transferred and brain;
• For various gynecological diseases and pathological conditions of the reproductive function of the female body;
• To control hemostasis during the period of taking various medications that affect blood clotting;
• With a disease such as hemorrhagic vasculitis (destruction of skin vessels).
• During pregnancy;
• Severe autoimmune diseases;
• After a heart attack;

Violation

Disorders of blood hemostasis have various causes. Basically, these dysfunctions can be reduced to a reduced level and to an increased level of coagulation.

Among them:

• Cogualopathy– this is one of the most common dysfunctions of the coagulation and anticoagulation systems, which leads to a low level of coagulation. very difficult.
• Thrombohemorrhagic syndrome(the second name for DIC is syndrome) – coagulation is impaired due to the massive formation of blood clots in the tissues. It is a generalized disorder, that is, the entire circulatory system is impaired. In organs and in the system as a whole, blood circulation fails, which leads to dystrophic changes. Sometimes it goes away without any symptoms.

• Hypocoagulative-hemorrhagic condition– a pathological condition of reduced blood clotting, fraught with frequent bleeding.
• Thrombophlibia– a state of excessive inadequate coagulation (clotting). Leads to the formation of blood clots, and subsequently to a decrease in blood circulation in tissues or organs.

All of the listed pathologies can be local and generalized (that is, affecting the entire system)

Gene research

A blood test for mutations in hemostasis genes is carried out when the hemostasis test does not give all the answers regarding various pathologies of blood clotting in a patient.

Gene mutation analysis is carried out for the following categories of patients:

• Females taking hormonal contraceptives;
• Persons who smoke under the age of fifty.
• Persons under the age of fifty suffering from thrombosis.
• Before surgical interventions related to organ transplantation;
• Women who have problems with pregnancy;
• Persons undergoing chemotherapy;
• Before surgical interventions related to gynecology;
• Persons who need hormone replacement therapy;
• Before joint replacement surgery;
• Persons whose relatives have suffered heart attacks and strokes;

Hemostasis is the most important part of the body's vital system. Early research will help provide adequate treatment.

Normal coagulogram indicators in the table include optimal indicators. So, when conducting an analysis, a person receives several numbers as a result. These include APTT, Fibrinogen, Lupus coagulant, Platelets, Prothrombin, TV, D-Dimer and Antithrombin III.

If we are talking about an advanced analysis, then these indicators include the following: Prothrombin time, Protein S, Protein C and von Willebrandt factor.

All these “elements” must have certain numbers. They indicate that everything is normal or has a slight deviation. In normal form, the indicators should be as follows:

In case of any deviations, the coagulogram norm is not similar to the given data. This phenomenon requires finding out the cause and eliminating the problem itself.

Coagulogram indicators are normal if there are no negative processes in the human body. Moreover, if the patient does not take indirect coagulants, then changing the basic “elements” is simply impossible.

If there are still deviations, then it is imperative to find out the reason. The fact is that a decrease in certain indicators can lead to blood clots, which is especially dangerous for humans. If we are talking about a pregnant girl, then any deviations can provoke not only the formation of blood clots, but also premature detachment of the placenta. Therefore, the normal coagulogram should always be reviewed, this will avoid serious complications.

Normal coagulogram INR

The normal coagulogram depends on many indicators. Thus, this “element” represents calculated data, thanks to which you can find out the ratio of the patient’s prothrombin time to the average prothrombin time. This indicator is necessary during therapy with indirect coagulants.

The fact is that these medications can impair blood clotting and lead to serious problems. Patients on such therapy should monitor their INR.

Normally, this “element” is less than 1.25. If the figure is underestimated or overestimated, it is necessary to look for the cause of this phenomenon. Basically, a sharp decrease in INR indicates an insufficient effect provided by anticoagulants, which requires some intervention. This process can lead to a significant risk of blood clots. The norm of the coagulogram of the INR indicator should not fluctuate, because otherwise it will harm the body and most likely the negative process has already begun.

Fibrinogen norm

If the normal fibrinogen coagulogram is violated, it can lead to increased bleeding. This indicator hides a specific protein. It refers to the main component of a blood clot that can form during blood clotting. Fibrinogen, due to its properties, is responsible for many functions regarding the coagulation process.

This indicator fluctuates the most during pregnancy, and there is nothing to worry about. But still, a woman should be under the supervision of a doctor. Indeed, in some cases, this may indicate the presence of an inflammatory process or the risk of developing cardiovascular complications. All this can occur against the background of increased blood clotting, which is not the norm. In general, this figure should not exceed 6.5 g/l.

With a significant decrease in it, severe bleeding may develop, which can be congenital. It is worth observing the “element” during pregnancy, and paying special attention to this moment. After all, the coagulogram norm of this indicator must be observed.

Normal coagulogram PTI

The PTI coagulogram norm is the ratio of the clotting time of normal plasma to the clotting time of the patient's plasma. This number should be expressed as a percentage and not exceed 78-142%.

This indicator can increase, but only if there is a risk of developing blood clots. The set number is reduced if there is a tendency to bleed. That is why you need to pay special attention to it.

It should be noted that in pregnant women this indicator can vary slightly and this is the norm. True, this may be due to premature placental abruption.

An increase in the index indicates the presence of increased blood clotting. This is not entirely good, because it can lead to the development of cardiovascular diseases. In some cases, the rate varies due to long-term use of oral contraceptives. In any case, the true cause of such a phenomenon must be determined. The normal prothrombin index coagulogram must be observed.

Normal coagulogram RFMK

The normal coagulogram rfmk depends on many things. Basically, this indicator is necessary to determine the amount of soluble complexes in the blood.

These “elements” are markers of thrombinemia during intravascular coagulation. This indicator can only be determined manually. Naturally, the procedure is not complicated and is carried out quite quickly. Ideally, there should be no complexes in a person’s blood at all.

RFMC is not at all mandatory. Rather, it is done before a major surgical intervention. This indicator is taken from the blood that was donated for analysis. The higher the concentration of complexes in it, the higher the risk of intravascular thrombus formation. Therefore, RFMK plays a significant role.

Its decrease indicates treatment with heparin. This is quite effective when it is necessary to prescribe heparin prophylaxis or heparin therapy. The RFMK coagulogram norm should not go beyond 0-0.4.

Normal coagulogram D dimer

The normal coagulogram d dimer plays a significant role. Thus, this indicator is a fibrin breakdown product. It shows disturbances in the blood clotting process. This element is especially important in the diagnosis of thrombosis, pregnancy and cancer.

The dimer has always been considered a specific degradation product that is part of the thrombus. Using these data, you can monitor the intensity of the processes of formation and destruction of fibrin clots.

Many factors can affect this indicator. Determination of Dimer level is considered specific. Its level depends on the presence of pathological conditions that can be accompanied by increased fibrinolysis. These include various types of infections, wound healing, hemorrhagic complications and similar processes. Normally, Dimer does not exceed 33-726 ng/ml. If there are any violations, they must be neutralized. Because the coagulogram norm of this indicator must be fully observed.

Normal coagulogram PV

The norm of the PV coagulogram is another important indicator. Prothrombin time is an “element” that reflects the rate of blood clotting. It is used to diagnose diseases of the blood coagulation system. In addition, it allows you to evaluate the effect of drugs that are aimed at impairing coagulation ability.

Normally, this indicator should not exceed 10-13 seconds. Any deviations indicate the presence of pathological processes in the body. A reading above normal indicates that there is a low concentration of coagulation factors, a lack of vitamin K, as well as liver disease or dysfunction.

It is likely that we are talking about the presence of disseminated intravascular coagulation syndrome. This condition can be life-threatening because it does not allow blood to clot quickly, which can lead to complete failure to stop bleeding. An increase in prothrombin time is not a good process. If surgical intervention is necessary, the coagulogram norm for this indicator must be observed.

Normal coagulogram during pregnancy

The norm of a coagulogram during pregnancy must be observed without fail. The fact is that any deviations may indicate serious problems in the body, including early placental abruption, which is extremely unacceptable.

In some cases, decrypting the received data is not so easy. It is advisable to leave this to the doctors. Although readings may fluctuate significantly during pregnancy, they should not exceed acceptable limits. So, they have the following form: APTT – 17-20 s; Fibrinogen – up to 6.5 g/l; Lupus anticoagulant – must be absent; Platelets – 131-402 thousand/µl; Prothrombin – 78-142%; Thrombin time – 18-25 s; D-dimer – 33-726 ng/ml; Antithrombin III – 70-115%.

If the data obtained differs from these figures, appropriate measures must be taken. After all, all this can negatively affect the development of the fetus. Childbirth involves the loss of a small amount of blood. If coagulation is poor, this is simply unacceptable. Therefore, the coagulogram norm must be observed.

Normal coagulogram in children

The normal coagulogram in children is practically no different from adult indicators. Thanks to this analysis, it becomes possible to determine the ability of blood to rapidly clot. The procedure is not performed so often in children, mainly only before surgery.

In some cases, analysis is done even for minor procedures. This will avoid all sorts of complications and make sure that the properties of platelets are working to their full potential. Any deviations can lead to blockage of blood vessels. Often a coagulogram is performed if blood pathologies are suspected.

Normally, the indicators should not go beyond the following limits: APTT – 17-20 s; Fibrinogen – up to 6.5 g/l; Lupus anticoagulant – must be absent; Platelets – 131-402 thousand/µl; Prothrombin – 78-142%; Thrombin time – 18-25 s; D-dimer – 33-726 ng/ml; Antithrombin III – 70-115%. Such data is considered standard. The coagulogram norm must fully correspond to the declared indicators.

Quick page navigation

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

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

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

Coagulogram - basic concepts and definition

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

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

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

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

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

Indications - why do they take a coagulogram?

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

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

Coagulogram during pregnancy

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

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

With an increased factor, blood clots form and placental insufficiency occurs. The latter causes impaired fetal growth and hypoxia. Doctors also note cases of blockage of pulmonary artery vessels and the occurrence of clots in the pelvic area and lower extremities if there is a hypercoagulable state.

Bleeding disorders lead to premature birth or miscarriage.

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

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

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

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

Coagulogram interpretation and norms for adults (Table 1)

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

Decoding coagulogram (standard and extended)

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

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

Each indicator provides the following information.

1. Fibrinogen.

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

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

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

Indicates the following diseases:

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

2. APTT

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

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

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

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

The short index identifies the following pathologies:

• Thromboembolism.
• Pregnancy.

3. PTV

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

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

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

The extended factor is interpreted as follows:

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

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

Determined simultaneously with APTT and PTT to diagnose congenital pathologies and assess anticoagulant functionality. An underestimated indicator indicates heparin and antifibrin therapy.

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

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

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

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

How to take a coagulogram?

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

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

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

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

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