Determination of aTv in blood using an automatic analyzer. What is an aphtv blood test? what should the indicators be? What are the indications for prescribing an APT blood test?

Indications for analysis

Doctors prescribe an APTT test (as part of a coagulogram) in the following cases:

• hemophilia;
• preparation for operations or postoperative examination;
• pathological course of pregnancy (the mother has an increased risk of blood clots, inability to carry a child to term, spontaneous abortion);
• hereditary diseases of the circulatory system;
• investigation of bleeding of unknown origin;
• suspicion of the development of lupus erythematosus;
• assessment of the effectiveness of heparin therapy;
• DIC syndrome;
• presence in the family of diseases associated with poor blood clotting;
• therapy for pathologies of the heart and blood vessels (heart attack, stroke);
• impaired polymerization of fibrin monomers;
• abnormal structure and function of fibrinogen;
• infertility;
• assessment of the formation of clotting factors;
• selection of an anticoagulant and the dosage of the substance required by the patient;
• blood test when changing a drug (for example, heparin to warfarin);
• vein thrombosis;
• pulmonary embolism.

Scientific editor: M. Merkusheva, PSPbSMU named after. acad. Pavlova, medical practice.
July, 2019

Synonyms: APTT, APTT, activated partial thromboplastin time, cephalin-kaolin time, Activated Partial thromboplastin time, APTT.

APTT (activated partial thromboplastin time) is a screening test that is performed as part of a general coagulogram and allows you to determine the effectiveness of hemostasis (blood clotting). The test is mainly prescribed to patients receiving treatment with indirect anticoagulants (heparin), as well as to expectant mothers with pregnancy pathologies.

General information

APTT is one of the coagulogram indicators that imitates the natural process of blood clotting when a kaolin-kephalin mixture is added to platelet-free plasma. This reagent stimulates the production of clotting factors. After the incubation period, calcium chloride is introduced into the above mixture, which provokes blood clotting through the internal pathway.

Thus, the APTT reflects the period during which a blood clot forms when reagents are added. In this case, the level of deficiency of coagulation factors, prothrombin, or the presence of inhibitors (components that slow down the process) and antibodies in the blood is assessed. TF (tissue factor) is not used in this test, hence the name “partial” or “partial”.

An increase in thromboplastin time indicates hypocoagulation (slow blood clotting), which is observed when:

• liver pathologies;
• deficiency of fibrinogen or coagulation factors, vitamin K;
• the presence in the blood of the drug heparin, fibrin polymerization inhibitors, lupus anticoagulant, autoimmune antibodies to fibrinogen.

Also, APTT may fluctuate when other coagulogram parameters deviate from the norm by more than 30-40%.

A reduction in thromboplastin time occurs against the background of hypercoagulation (increased coagulation).

The APTT test is sensitive and indicative in diagnosing DIC syndrome (thrombosis in small vessels).

Indications

Experts prescribe the determination of activated thromboplastin time as part of a coagulogram in the following cases:

• congenital or acquired pathologies of blood clotting;
• diagnosis of bleeding and bruising of unknown etiology;
• monitoring the state of the hemostasis system;
• general examination of the circulatory system and hematopoietic organs;
• presence of lupus anticoagulant in the blood;
• assessment of the therapeutic effect of taking hirudin, heparin;
• antiphospholipid syndrome (production of antibodies that increase the risk of blood clots);
• DIC syndrome (coagulation disorder due to massive release of thromboplastin substances);
• hemophilia (chronic bleeding due to decreased clotting);
• genetic predisposition to thrombosis;
• a family history of blood clotting pathologies;
• treatment of cardiovascular diseases: heart attack, stroke, varicose veins, thrombophlebitis, etc.;
• violation of the 2nd stage of blood clot formation (polymerization of fibrin monomers);
• dysfibrinogenemia, hypo- and hyperfibrinogenemia (anomalies in the structure and functioning of fibrinogen);
• pathological pregnancy (spontaneous termination, miscarriage, tendency to thrombosis in the mother, etc.);
• infertility;
• assessment of the production of coagulation factors, their concentration;
• assessment of the effect of coagulation inhibitors (components that slow down hemostasis);
• determination of the anticoagulant drug and its dosage;
• transferring the patient from heparin therapy to warfarin;
• diffuse intravascular coagulation;
• venous thromboembolism (combines pathologies: deep vein thrombosis and pulmonary embolism);
• examination and preparation of the patient for surgery, postoperative examination.

Who gives directions

Appointment and decoding of APTT can be carried out

• hematologist,
• anesthetist,
• surgeon,
• cardiologist,
• gynecologist,
• as well as general practitioners.

Norm and interpretation of results

The common unit of measurement for the test is the clotting time in seconds.

In Russia, the standard range of values ​​is considered

• 21.1-36.5 sec

Reference values ​​of the Invitro laboratory
Invitro values ​​are slightly different from the standard ones, since the more modern equipment of this laboratory allows measurements to be taken with greater accuracy.

In Western medicine, more generalized values ​​are considered normal:

An increase in aPTT time indicates a risk of bleeding, and a shortening indicates a risk of thrombus formation.

What can distort the result

Influencing factors (reasons for incorrect results)

• Discrepancy between the volume of anticoagulant and the volume of plasma red blood cells;
• Insufficient filling of the vacuum tube with biomaterial (increases the indicator);
• Contamination of the patient's plasma with heparin (increases the rate);
• Violation of the rules of preparation for venipuncture, the process of blood sampling and storage of a biomaterial sample;
• The entry of tissue thromboplastin into the patient’s blood sample as a result of injury during venipuncture (reduces the indicator);
• Increased levels of lipids in the blood (may be associated with the patient’s diet);
• Therapy with very high doses of anticoagulants reduces the sensitivity of the activated partial thromboplastin time assay.

Important! The interpretation of the results is always carried out comprehensively. It is impossible to make an accurate diagnosis based on only one analysis.

Increased aPTT period

• Hemophilia A, B or C;
• Antiphospholipid syndrome;
• von Willebrand disease (hereditary bleeding disorder due to insufficient activity of von Willebrand factor);
• Deficiency of clotting factors;
• DIC syndrome (phase 2 and 3);
• Hageman's disease (decreased activity of coagulation factor XII);
• Treatment with anticoagulants: heparin, fraxiparin and other drugs;
• Liver pathologies;
• The presence of inhibitors in plasma (lupus anticoagulant, anticardiolipin antibodies);
• Postpartum hemorrhage;
• Recent injuries with tissue ruptures, massive burns, complex surgery;
• Vitamin K deficiency.

Reduced period

• DIC syndrome (phase 1);
• Tendency to increased thrombosis, associated diseases;
• Thromboembolism;
• Increasing the level of coagulation factor XII;
• Deficiency of coagulation factor (antihemophilic globulin) due to inflammatory processes and damage;
• Taking hormonal drugs.

APTT test during pregnancy

A hematologist and gynecologist can prescribe this test as part of a coagulogram if the expectant mother has a tendency to thrombosis or bleeding.

Pregnancy complications can occur due to natural processes:

• hormonal changes;
• the formation of the third circle of blood circulation (uteroplacental), which delivers oxygen and nutrients to the embryo;
• changes in the hemostatic system before and after childbirth.

Important! In pregnant women, the level of another coagulogram indicator, fibrinogen, increases, which reaches 6 g per 1 liter maximum (2 g more than normal).

At the same time, the APTT begins to decrease and reaches a normal value of 17-20 seconds.

When the thromboplastin time is shortened relative to the specified norm, the risk of developing thrombosis increases (the blood thickens). Thrombosis can affect the vessels of the placenta and cause its premature detachment. Also, APTT does not significantly deviate from the norm while taking iron supplements (prescribed to the expectant mother with low hemoglobin).

Prolongation of APTT in pregnant women (blood thins) can cause uterine bleeding, which threatens the life of the expectant mother and child.

Also, blood clotting disorders during pregnancy increase the risk of developing disseminated intravascular coagulation syndrome. In the 1st phase, blood clots are actively formed, and in the 2nd and 3rd phases the blood practically does not clot, which can cause severe blood loss.

To prevent the development of complications, it is necessary to do a coagulogram with APTT determination

APTT is carried out in order to find out and study the patient’s blood clotting characteristics. This analysis can be carried out in two variations - basic and extended. The first is usually a basic study, which will make it clear if there is a violation in this system. Then an extended one is prescribed, based on the results of which it is possible to determine changes in the body, both qualitative and extended.

When is a test ordered?

The purpose of this analysis is to identify a deficiency of enzymes for blood clotting or an excessive amount of them. It shows how correctly and efficiently the human circulatory system works. It is usually prescribed in cases of:

1. Before carrying out any operation. Any deviations can be fatal if doctors are not aware of deviations from normal values ​​in any direction.
2. Pregnancy. The period of bearing a child greatly changes a woman’s health status and requires constant monitoring to avoid the development of dangerous conditions.
3. Detection of liver diseases;
4. Any pathologies of the heart;
5. Autoimmune diseases and mononucleosis;
6. Disorders of the vascular system - identified thrombosis and varicose veins;
7. Long-term use of contraceptive drugs;
8. Preceding treatment with leeches to prevent the development of dangerous hemorrhages;
9. Possible predispositions and internal bleeding;
10. Postoperative observation.

Normal values

Normal APTT values ​​are the same for men and women and range from 23 to 40 seconds; in newborns, the value can be higher - up to 45 seconds; in premature babies, it is allowed to exceed the norm by 4-6 seconds. Do not forget that each laboratory uses its own methods and equipment, so the final result may differ from the above indicators for aphtv for different categories of people and laboratories.

Typically, laboratories in which the final value differs from generally established norms indicate two columns of results - the first indicates the results obtained by the patient, and the second indicates the results accepted as normal in this laboratory. Important! Obtaining increased results precisely for these reasons may not indicate the presence of violations.

What deviations from the norm can there be?

Women during pregnancy have reduced aPTT values, which is associated with the need for pregnancy. Also during menstruation, this indicator can be greatly underestimated, so it is not recommended to donate blood during menstruation.

Eating fried or salty foods on the eve of donating blood can greatly affect the final reading and reveal an aPTT in the blood that is different from the norm. Attention! You also need to be aware of possible submission violations before taking the test. The clotting rate will be falsely high if blood is drawn from a catheter rather than directly from a vein. And it will be greatly underestimated if the blood had to be squeezed out of the vein for collection or a hematoma appeared during blood collection.

Causes of deviations and identified pathologies

To correctly determine the presence of pathology, the doctor usually prescribes several repeat tests. This way you can observe changes in blood clotting over time. When studying the results, the specialist pays attention to all previously submitted and recent results. This is explained by the presence of a problem if at a given time the value coincides with the norm, but several previously passed indicators were greatly underestimated or overestimated.

As a rule, APTT is not taken separately from other indicators, but together with TV and PTT. Only a specialist can correctly decipher the values, since it is important to take into account all the combinations of indicators at the moment and in dynamics, to take into account the ratio of APTT with TV and with PTT. For example, if the APTT and PTT are too high, but the TV shows a normal value, then this indicates a deficiency of some blood factors, of which there are more than 12.

A normal APTT and TT with an increased PTT may indicate a deficiency of the seventh blood factor, and a sharp decrease in this factor may be a harbinger of irreversible hepatic coma. An aPTT that is too long with other normal values ​​may indicate severe liver dysfunction.

Attention! During pregnancy, this test should be performed at least once every trimester, since circulatory disorders can lead to the death of the fetus and mother. It will be mandatory to follow such recommendations for those women who have already lost a child for similar reasons, who have a history of unclear bleeding and constant uterine tone. If the presence of protein is recorded in a general urine test, a woman has constant high blood pressure and swelling of the extremities, then she urgently needs to donate blood for APTT.

Important! If a blood supply pathology is detected and the APTT time is shortened, it is imperative to take medications prescribed by a specialist, since the formation of blood clots can not only provoke a threat or a miscarriage itself, but also lead to intrauterine death of the baby and mother. Joking with such a diagnosis and refusing prescribed medications is criminal negligence.

What is the reason for the frequent detection of disorders in pregnant women? Their hormonal levels change greatly, the amount of blood in the body doubles, and a second circle of blood circulation appears that nourishes the child. Sometimes this is accompanied by disruption of the normal functioning of the body and the formation of blood clots or bleeding, which is equally dangerous for a pregnant woman.

In an apparently healthy person, this indicator may also be impaired. A deviation of more than 30% from normal coagulation values ​​indicates dangerous conditions, among which we can note the presence of acute leukemia in the initial stage. Treatment of this disease can be successful if detected early. Bleeding disorders also include hereditary circulatory disorders, critical vitamin K deficiency, disseminated intravascular coagulation syndrome, and bleeding as a result of accidents or childbirth.

How to donate blood for APTT correctly

Blood is donated from a vein and on an empty stomach. There are no special preparatory procedures for donating blood or restrictions on sexual activity. You just can’t eat 8-10 hours before donating blood and drink anything other than clean, non-carbonated water in the morning. It is strictly forbidden to consume alcohol, toxic or narcotic substances on the eve of blood donation, as this will directly affect the test results. Alcohol will increase the time it takes for your blood to clot.

You should avoid eating fried, salty or spicy foods the day before so as not to distort the results. When taking medications that may affect the circulatory system, you should consult your doctor and, if possible, stop taking them 2-3 days before the test to see the true picture. If the drug you are taking is vital, then in no case should you stop it yourself without consulting the specialist who prescribed the APTT.

You should not be nervous on the day of the test, experience strong moral anxiety or perform heavy physical labor, as this may affect the results of the study. In addition, overstrained muscles can negatively affect the results of the study. Immediately before entering the laboratory, you should drink a glass of cold water.

Particular attention should be paid to this indicator in elderly people and children. It is important to understand what it is, what role it plays, why deviations from the norm are possible and what this can mean, how normalization is carried out.

Description and importance

The abbreviation APTT stands for “activated partial thromboplastin time.” This is one of the main indicators of a coagulogram, necessary to simulate the coagulation of blood fluid along the internal route. This study is necessary to determine the ability to stop bleeding.

The analysis allows you to evaluate the efficiency of the internal coagulation system.

Despite the fact that the technique does not take much time, is quite simple to perform and is relatively inexpensive, it provides a lot of useful information.

In some cases, APTT can be used as a stand-alone procedure, for example, when screening for hemostasis.

At the same time, during surgery, injury or after childbirth, the bleeding time is not prolonged. In addition, the patient should not be afraid of accelerated clotting, which can provoke the formation of blood clots.

Determination of APTT - the test is not mandatory. It is prescribed only in certain situations:

• for diagnosing hemophilia;
• if there is a hereditary predisposition to the formation of blood clots;
• when carrying out therapeutic measures to eliminate a heart attack;
• if there are bruises of unknown nature;
• for the diagnosis of hypofibrinogenemia, DIC syndrome and its treatment;
• in the process of bearing a child;
• with infertility and numerous miscarriages;
• in order to determine the tendency to bleeding when the patient is being prepared for surgery;
• with antiphospholipid syndrome;
• in case of impaired polymerization of fibrin monomers.

An increased APTT value indicates an increase in the rate of blood clotting. This means that there is a high probability of bleeding even with minor damage to tissues and organs. If the value is lower, there is a risk of blood clots forming.

Standards for adults and children

Normally, indicators for women and men range from 24 to 40 seconds. It is worth noting that the values ​​​​may differ slightly in different sources. In newborns, the aPTT ranges from 25 to 43 seconds. If the baby is premature, the indicator will be increased by 3-5 seconds.

It is also worth taking into account that all laboratories use different research instruments, which may lead to slight deviations from the classical value.

An increased result may not in all cases indicate the development of a pathological process.

Normal values ​​during pregnancy

During the period of bearing a child, intravascular coagulation indicators are especially important, since they allow monitoring the condition of not only the expectant mother, but also the child.

Minor deviations from the norm are considered quite acceptable during pregnancy. However, a large decrease or increase in value can pose a serious threat. Therefore, women in an interesting position need to have the test done every trimester.

In case of development of a pathological process, the frequency of procedures increases. A PTT value higher than normal may indicate a sudden onset of bleeding before, during or after childbirth.

In addition, the risk of placental abruption increases significantly, which can cause miscarriage or premature birth at a later date.

How is the analysis carried out?

A procedure that evaluates the clotting of blood fluid is called a coagulogram. APTT should be assessed simultaneously with:

• thrombosed index;
• fibrinogen;
• prothrombin according to Quick;
• thrombosed time.

All these indicators most effectively evaluate the work of not only internal, but also external coagulation processes.

It is important to understand that these values ​​are only indicative and do not serve as a basis for making a final diagnosis. This requires a full medical examination.

Preparation

To get the most accurate results of activated partial thromboplastin time, experts recommend following some simple tips for preparing for the analysis:

• a couple of days before the procedure, avoid drinking alcohol and quit smoking;
• a few days before blood sampling, do not eat fatty foods, as well as spicy and salty foods;
• Do not eat 10 hours before the test.

In addition, increased physical and emotional stress should be excluded.

Change

To determine APTT, a biochemical blood test is done. The essence of the procedure is based on several sequential actions:

1. In order to study the indicators, venous blood is taken, which is subsequently placed in a sterile tube. It already contains a special reagent that is capable of binding calcium ions.
2. After this, the blood is mixed with kaolin or cephalin. These are special substances that help induce blood coagulation.
3. In the next step, calcium chloride is added to the test tube. Thanks to this manipulation, the clotting properties of sodium citrate are eliminated. As a result, blood clotting ability is restored. Based on the data obtained, the rate of clot formation is estimated.

On the day of the test, it is prohibited to take medications with anticoagulant properties.

Interpretation

The interpretation of the results is carried out exclusively by a specialist.

If there is a decrease in the indicator (up to 20 seconds), this may indicate pathological processes such as:

• oncological neoplasms;
• pathologies of the vascular system;
• amyloidosis;
• liver diseases.

If the aPTT is too high, there may be speculation about the development of hypercoagulability. Most often this is associated with a reduced number of procoagulants or their reduced activity. In this case, we can talk about the following diseases:

The level of the value may be increased as a result of the use of drugs (heparin or warfarin).

What may affect the results

Like any blood test, the APTT test can be either false positive or false negative. Distortion of the results depends on several factors. These include:

• presence of fatty foods in the diet;
• menstrual cycle in the fair sex;
• smoking;
• pregnancy period;
• treatment with hormonal drugs;
• failure by the laboratory assistant to comply with the rules for conducting the analysis (non-sterile test tube, incorrect ratio of reagents and blood fluid, etc.).

To obtain the most reliable data, you must strictly adhere to all prescribed recommendations.

Increased APTT

The reasons for the increase in the indicator are:

• von Willebrand disease;
• the presence of a lupus-type anticoagulant in the blood;
• lupus erythematosus (systemic);
• chronic glomerulonephritis;
• lack of vitamin K;
• liver pathologies;
• hemophilia A and B types;
• congenital deficiency of kinin and prekallikrein;
• antiphospholipid syndrome;
• decreased fibrinogen levels;
• treatment with anticoagulants (Sincumar, Warfarin, etc.);
• 2 and 3 degrees of DIC syndrome;
• pathological processes in connective tissues.

Reasons that provoke increased blood clotting during pregnancy:

• therapy with antibiotics, aspirin, thrombolytic drugs;
• coagulopathy;
• leukemia;
• disruption of the production of vitamin K by the gastrointestinal tract.

As a rule, with increased values, the risk of bleeding increases.

Demotion

It happens that the indicators are below normal. The following factors may contribute to this:

• hereditary blood disease;
• genetic predisposition to the formation of blood clots;
• first phase of DIC syndrome;
• taking oral contraceptives;
• thromboembolism;
• increased concentration of clotting factor 12.

The following factors may influence the decrease in indicators during pregnancy:

• development of malignant oncological processes;
• active formation of blood clots;
• inflammation of the vascular walls.

If there is a suspicion of the formation of gestosis, then an APTT analysis is mandatory.

How to normalize values

To lower the aPTT in the blood, the doctor prescribes medications such as:

• Vikasol is a synthetic analogue of vitamin K;
• Tranexam, which contains tranexamic acid, which has anti-inflammatory, hemostatic and antifibrinolytic effects.

To increase clotting time, prescribe:

Therapeutic measures aimed at restoring APTT deviations from the norm should only be selected by a specialist in each case individually. Under no circumstances should you self-medicate. This can only worsen the situation and lead to the development of more serious complications.

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APTT is increased - causes, signs and normalization of the indicator

A blood test is a very effective way to obtain a lot of important information about the condition of the whole organism and the functioning of the circulatory and hematopoietic systems in particular. The issue of blood clotting is very important for assessing health, as it indicates the operation of specific internal factors. Such information is especially needed when preparing for and during various surgical interventions.

In the latter case, normal coagulogram values ​​are a very important moment, since they are important for the normal course of labor and will prevent large blood loss in the event of bleeding.

What is APTT

APTT is an important indicator that reflects one of the stages of blood coagulation

The abbreviation APTT means activated partial thromboplastin time and is one of the important indicators of a coagulogram - a study of the ability of blood to clot and stop bleeding.

The analysis evaluates how efficiently the internal blood coagulation system works, takes little time, is quite simple and inexpensive, but carries a large amount of important and useful information. Sometimes APTT analysis is used as an independent procedure for screening the hemostatic system.

Normal values ​​of activated partial thromboplastin time indicate a healthy coagulation system.

However, one should not expect a catch in the form of prolongation of bleeding time during surgery, injury or after childbirth. Also, the patient’s circulatory system is not threatened by accelerated clotting, which can lead to the formation of thick blood and blood clots. And this is a direct path to problems such as thrombosis and its consequences - heart attacks and strokes, high rates of arterial hypertension.

If the aPTT is elevated, this means an increase in the rate of blood clotting, that is, a high risk of bleeding with the slightest damage to tissues and organs. Decreased rates indicate accelerated coagulation, that is, the risk of blood clots.

Diagnostics: preparation and procedure

To diagnose APTT, it is necessary to donate venous blood in the morning on an empty stomach, having previously properly prepared for the analysis

The APTT blood test is performed in laboratories or clinics by medical personnel from blood collected from a patient's vein. To obtain accurate data, it must be taken into account that certain types of food and/or medications may have a negative effect and distort the test results.

Therefore, before a blood test, the patient should not eat for at least 8 hours, and not eat very fatty or heavy foods the day before, since the abundance of fats (lipids) can affect the blood picture and the functioning of the hemostatic system. These indicators are also affected by taking iron supplements or multivitamins containing iron. Ideally, it is recommended to stop all medications long before taking a blood test, sometimes 2 weeks before, for others 3 days is enough.

Naturally, before the test you should not drink alcohol or drugs, you should avoid significant physical effort and emotional stress. Coffee, tea, cocoa and all other drinks, including sweet and carbonated waters, are prohibited - they can affect not only the composition of the blood, but also significantly affect the process and speed of its coagulation. You should not smoke for at least half an hour before blood collection. Also, before the analysis, doctors recommend sitting quietly to normalize all indicators in the body.

Any physical or psychological stress or strong anxiety can be reflected in the results of this important analysis.

Activated partial thromboplastin time allows assessment of the intrinsic coagulation pathway. The analysis process itself consists of the following stages:

• Adding the patient's blood to a tube containing an anticoagulant (usually sodium citrate). This substance binds calcium ions, which interferes with the coagulation process.
• Since blood platelets are designed to cause coagulation through the internal pathway, they also need to be eliminated. This is done using centrifugation.
• Then three substances are introduced into the test tube: phospholipids, which activate the extrinsic coagulation pathway. They are contained in cell membranes and, when damaged, “trigger” the blood coagulation mechanism. Then the activator and calcium chloride are added. After all additions, the time for the appearance of a blood clot is recorded. This is the APTT indicator.

Normal for age and pregnancy

Normally, APTT values ​​for a healthy person fall between 28 and 40 seconds. Such data demonstrate the normal functioning of the blood coagulation system along the general and internal pathways.

However, normal indicators do not always indicate complete well-being in this area, since to obtain pronounced changes, a shift of at least 35 - 40% of various blood factors is necessary. For example, there may be a slight deficiency of one of the coagulation factors or the presence of a small amount of lupus anticoagulant.

If it turns out that the aPTT is increased or decreased, it is necessary to take adequate measures, taking into account the level of indicators and the general condition of the patient.

For a pregnant woman, normal APTT readings are especially important, as they indicate the well-being of both herself and her unborn child. An increase or decrease in data is ominous as the numbers change, so the pregnant woman is tested every trimester. If pathology is present, the doctor may prescribe such tests more often. Elevated numbers of this indicator can threaten the sudden onset of bleeding or its development during childbirth, after which, cause placental abruption, which can lead to loss of pregnancy in the early stages and premature birth in the later stages. All this suggests that the analysis is of very high importance, so it must be performed within the time frame specified by the doctor.

When assessing the results obtained, do not forget that different laboratories have different normal criteria, so it is recommended to take all tests in the same laboratory to obtain accurate comparable data. For pregnant women, the normal aPTT is 17 - 20 seconds.

Causes and signs of increased APTT

An increase in aPTT is an alarming sign that may indicate a more dangerous disease

The fact that the aPTT is elevated means that the time it takes for the blood clot to form is prolonged. The reason for this may be the following conditions and diseases:

• Deficiency or inhibition of factors VI, IX, XI, XII (hemophilia in forms A and B, lack of von Willebrand factor).
• Deficiency of factors II, V and X, as well as exposure to indirect anticoagulants.
• Factor VII deficiency.
• Hypofibrinogenemia, afibrinogenemia (congenital or caused by severe liver damage), treatment by activating fibrinolysis - resorption of a blood clot.
• Treatment with anticoagulants, especially heparin.
• The presence of lupus anticoagulant in the patient's blood.
• Liver diseases.
• Vitamin K deficiency.

Sometimes there is a combination of several reasons that cause an increase in indicators. Treatment requires identification of the specific cause and individual selection of the necessary drugs and treatments for the disease.

Useful video - Blood test for INR:

You can suspect a change in the blood picture in the direction of lengthening its clotting time based on external signs. The most obvious sign may be how long it takes to bleed from the slightest cut, such as when shaving. If blood does not clot for a long time and constantly flows even from a very small wound or scratch, then there are serious problems in the blood coagulation system.

In women, a clear sign of problems with blood may be too heavy and prolonged menstruation. If the blood constantly has a bright scarlet color, is liquid, and menstruation is almost twice as long as the usual indicator of 3 - 4 days, then this is a reason to visit a doctor and get a referral for a blood test and other examinations.

Methods for normalizing an indicator

In the event that the aPTT is elevated, and especially for pregnant women, measures should be taken as early as possible to normalize the values. Although it is believed that pregnant women should not take any medications, blood problems can threaten the health of the mother and baby or even lead to fetal loss.

In the early stages of pregnancy, the development of DIC syndrome is threatening, in which in the first stage the blood clots too quickly, and in the second - extremely slowly, which can lead to miscarriage or heavy bleeding during childbirth.

The treatment method in each specific case is selected individually and depends on the general health of the patient, the presence of chronic and severe diseases, age and many other factors.

With constant monitoring of blood coagulation, doctors use drugs that help normalize the process and enhance coagulation.

This is a very responsible process, since it is necessary to accurately calculate the dosage so as not to lead to an excessive increase in coagulation. Treatment is carried out under the close supervision of medical personnel.

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Coagulogram

General information

Every qualified doctor knows that it is best to begin treatment of any patient by collecting an anamnesis, which is nothing more than a collection of information about the state of a person’s health.

As a rule, any medical examination begins with asking the patient himself about previous diseases or surgical interventions, allergic reactions or hereditary predisposition to certain ailments, and so on.

Then the doctor prescribes a series of laboratory tests or simply tests that will help supplement the anamnesis with information about the development of the disease, as well as information necessary for choosing a treatment method or further diagnosis.

Coagulological studies (abbreviated coagulogram) occupy an important place among laboratory blood tests that are necessarily carried out in preparation for surgery, for example, during a planned cesarean section or during pregnancy.

Coagulogram - what is it?

Many patients needlessly begin to worry when they hear from their attending physician such unusual at first glance words as coagulogram or otherwise hemostasiogram. So what kind of coagulogram analysis is this and why is it taken?

First of all, it is worth noting that this is a fairly common method in modern medicine for studying the functioning of the hemostatic system of the human body, which is responsible for such important vital functions as stopping bleeding when blood clots or blood vessels are damaged, as well as maintaining the normal fluid state of the blood.

Hence the answer to the question of what a hemostasiogram is - a study that determines how well the body’s hemostasis system functions. A blood coagulogram test helps to study such an important blood function as the ability to clot, i.e. formation of a blood clot.

Having received the results of coagulation, the attending physician can predict in advance the outcome of surgery or childbirth. Information about blood clotting is vital in emergency situations, for example, when a person is injured, when seconds are counting and the bleeding needs to be stopped as quickly as possible.

Therefore, you hardly need to worry too much about how much this research costs. After all, the price of a hemostasiogram cannot be compared with the confidence that the patient will be alive and healthy.

Indications for prescribing such an analysis as a hemostasiogram are the presence of the following diseases in the patient:

In addition, such an analysis is necessarily prescribed to determine the rate of blood clotting in preparation for planned operations, for example, cesarean section, as well as during pregnancy to assess the state of hemostasis and before spontaneous childbirth. Every woman in labor must have a blood test such as a coagulogram in her exchange card.

Human hemostasis system

Having determined what a hemostasis test is, it is worth understanding in more detail the concept of blood clotting. Perhaps we should start with a definition. So, the hemostatic system of the human body is the most important biological system, the main functions of which can be considered to be the preservation of basic blood parameters, as well as stopping bleeding.

It is not for nothing that the human body is called the whole universe and is compared to a complex mechanism. And the hemostasis system can serve as a striking example of how ingeniously people are designed. Blood is a unique biological fluid that can literally work miracles in our body.

It not only circulates through the vessels, but also, unnoticed by a person, restores veins and arteries throughout his life due to its ability to form blood clots or dense clots, i.e. roll.

There are three main components of the human hemostasis system:

• Vascular endothelial cells (the inner layer consisting of flat cells lining lymphatic and blood vessels, as well as the cavities of the heart), which, when vascular walls rupture or other damage, are capable of releasing biologically active components such as prostacyclin, thrombomodulin and nitric oxide. They, in turn, trigger the process of blood clot formation.
• Platelets or blood platelets that have the ability to “stick together” with each other in order to subsequently form a primary hemostatic plug.
• Plasma factors (15 plasma factors in total, most are enzymes), which, due to chemical reactions, form a fibrin clot, which should finally stop the bleeding.

Summarizing all of the above, we can clearly answer the question of what a blood test for hemostasis shows during pregnancy, in preparation for a planned operation, or during diagnostics. This test gives an idea of ​​how well or poorly a patient's blood is clotting. In other words, how quickly doctors can stop bleeding when it occurs.

Interpretation of blood coagulogram

The blood test for a coagulogram includes many different indicators that you need to be able to read correctly, i.e. understand and analyze, in other words, decipher. Unfortunately, not every doctor has the skills to decipher hemostasiogram indicators. And only a highly qualified specialist can correctly interpret certain parameters of this analysis.

After conducting laboratory tests of the patient’s blood and receiving the results, the attending physician compares the decoding of the coagulogram with the norm established for adult patients, as well as children. It is important to remember that the normal coagulogram for a child, man or pregnant woman is very different. This is due, first of all, to the peculiarities of the functioning of the body of people of different sexes in different age categories.

Coagulogram indicators

Let's consider the parameters of the blood clotting test, namely the normal hemostasiogram values. Then we will dwell on each of them in more detail, and also talk about an extended or expanded coagulogram.

It is worth noting that the table below shows several options for normal indicators of such hemostasiogram parameters as bleeding time and blood clotting time. This is due to different interpretations of the norm for these parameters by specialists involved in their study.

*International Unit (IU) or Action Unit (AU), i.e. a measure of measuring the dose of a substance based on its biological activity.

*Nanograms per milliliter. Source: Wikipedia

Clotting time

This laboratory test of the patient's blood gives the doctor an idea of ​​the time it takes for the body to form a blood clot. There is no shorthand symbol for this parameter in the analysis. During the research, biological material (blood) taken from a patient’s vein is placed in a sterile and dry tube, and then the time is noted and they wait until a visible blood clot forms.

When the blood clotting time is normal, the doctor can conclude that the hemostasis system is working correctly, and also exclude some pathological conditions, for example, hemophilia or disseminated intravascular coagulation syndrome, in which a blood clot does not form at all. If the blood clotting time deviates from the norm (increase or decrease in indicators), you should understand the reasons in more detail.

For example, prolongation of bleeding time can be observed in hemophilia, systemic lupus erythematosus or rheumatoid arthritis, as well as in peritonitis, chronic liver pathologies, pneumonia and the presence of a malignant tumor. A shortened bleeding time may be a signal of the development of anaphylactic or hemorrhagic shock, as well as myxedema.

In addition, all coagulogram indicators, including this one, may deviate from the norm during pregnancy. Women, as a rule, first learn about the name of a blood clotting test during pregnancy, when they are required to undergo many laboratory tests in order to monitor and promptly influence the health of the mother and unborn child.

The changes that rapidly occur in the body of a pregnant woman do not leave their mark on the properties and characteristics of the blood. It is noteworthy that there is a gradual decrease in blood clotting time starting from the first trimester, and in the third trimester this indicator can differ greatly from the norm. However, do not be afraid, since this is just one of the protective mechanisms that helps prepare the female body for childbirth and reduce possible blood loss.

Bleeding time

In accordance with the standards, the duration of bleeding should not be less than or more than a few minutes from the moment of puncture, the so-called primary hemostasis. To complete the process, i.e. The formation of a blood clot should take an average of 10 minutes maximum. Blood clotting time is a very important indicator that plays a big role in preparing the patient for surgery, for example, during a cesarean section.

The norm of blood clotting in women does not differ from the standards established for adults. The rate of blood clotting in children depends on the age of the child. On average, the duration of bleeding should not exceed 2-4 minutes, and a blood clot should form within 2-5 minutes.

Bleeding time may be increased if:

How to take a blood clotting test?

In order for the doctor to receive undistorted information after laboratory tests, one should take the correct approach to taking any tests, including blood clotting tests. Biological material is taken in the morning, always on an empty stomach. It should be remembered that at least 8, and preferably 12, hours must have passed since the last meal.

In addition, you should refrain from taking alcoholic beverages and medications on the eve of the study, as this may affect the test result. If the patient is forced to take any medications, he must remember to inform the medical professional about this.

Prothrombin time

What is prothrombin time? This is one of the main laboratory indicators of a coagulogram used by doctors to assess the hemostasis system of the human body as a whole, as well as to determine the effectiveness of drugs that prevent blood clotting.

PT reflects phases 1 and 2 of plasma coagulation. In other words, the time of formation of a thrombin clot in the blood when thromboplastin and calcium are added. For this parameter, the abbreviated designation PV is accepted; sometimes PVT is also used. Blood coagulation test parameters such as international normalized ratio (INR) and prothrombin index (PTI) are derived from prothrombin time, the norm of which varies depending on the age and gender of the patient.

For example, the norm of thrombin time in women and men is equal to seconds. Standards are established for children depending on their age. For example, for newborn children – seconds or seconds for premature babies. For an older child (from 10 years old) the norm is seconds, and for a younger child – seconds.

Thrombin time is higher than normal - what does this mean? Deviation from the standard indicators established for a given coagulogram parameter may mean the following:

• lack of vitamin K in the body;
• low concentration or deficiency of blood clotting factors 1,2,5,7, and 10;
• disruption of the normal functioning of the liver, liver failure or other diseases of this organ;
• presence of DIC syndrome.

Prothrombin time is increased, what does this mean? As a rule, exceeding the PT indicator is associated with the patient taking medications belonging to the group of anticoagulants, i.e. drugs that have anti-clotting properties, such as Heparin, Coumadiline or Warfarin.

International Normalized Ratio

Prothrombin ratio (abbreviated PTI) or INR in a blood test, what is it? Let's start with a little background. Such a parameter as INR in a hemostasiogram appeared in 1983, when the World Health Organization (hereinafter referred to as WHO) decided to streamline the work of research laboratories and bring all blood clotting test indicators to a single standard understandable to physicians all over the world.

Previously, each laboratory could use different thromboplastin reagents, which could distort the final research results. This coagulogram parameter is abbreviated as INR or INR. In domestic medicine, you can currently still find instead of INR such an indicator as the prothrombin index, which reflects how well the patient’s blood clots.

However, due to different methods for determining this parameter, it is considered unstable and therefore it is customary to use INR abroad. In a blood test for PTI and INR, the norm is set at the level:

So what is INR in a blood test? This is an indicator that is nothing more than the ratio of the PT of the patient’s analysis and the PT of the control sample. The INR norm in a human blood test according to international standards can range from 0.82 to 1.18.

If there is a deviation from the above values, the patient may be diagnosed with the following diseases:

In addition, an increase in INR and PT may indicate the presence of anticoagulant drugs in the patient’s blood. Therefore, the INR norm when taking Warfarin differs from the established standards. For patients taking this drug and drugs similar to it in action, the following range of normal INR values ​​is used - 2.0-3.0.

The INR norm in the blood of women usually does not differ from the general values. But during pregnancy, the female body changes so much that the INR norm during pregnancy may not coincide with the numbers indicated above.

Activated partial thrombin time

APTT blood test - what is it? This is another analysis indicator that provides information about the effectiveness of plasma factors designed to quickly stop bleeding. This parameter is abbreviated as APTT.

APTT blood test - what is it? The parameter is often called activated partial thromboplastin time. APTT, like APTT, provides information about the rate of formation of a fibrin clot and best characterizes the internal process of hemostasis. It is believed that the APTT indicator is the most accurate, but at the same time the most sensitive, because may vary depending on the reagents used in laboratory tests.

The general norm of aPTT in human blood is set at 22.5-35.5 seconds. The APTT rate in women also corresponds to the above values. However, as is the case with other coagulogram parameters, the APTT rate during pregnancy does not always correspond to the general rules. Let us consider the reasons for the deviation of this indicator from the norm.

As a general rule, if the APTT is elevated, this means that the hemostatic system is unstable or the patient is taking Heparin and its analogues, for example Fraxiparine, Clexane, and Cibor.

When the above reasons are excluded, and the aPTT is higher than normal, this means that the patient may have diseases such as:

• fibrinolysis;
• acquired or possibly congenital deficiency of coagulation factors (8, 9, 11, 10, 12, 2 and 5);
• DIC syndrome (stage 2 or 3);
• autoimmune pathologies (usually systemic lupus erythematosus);
• liver diseases.

When APTT is low, what does it mean? If the value is below normal, this indicates that the blood's ability to clot is reduced. The main reasons for this condition may be:

• DIC syndrome 1st degree;
• increased coagulability;
• an error during laboratory testing, for example, incorrect blood sampling.

Soluble fibrin-monomer complexes

Abbreviated in a coagulogram as RFMK. RFMK analysis, what is it? It’s worth starting with the definition of fibrin-monomer complexes - these are the products of the breakdown of a blood clot during the process of fibrinolysis. According to researchers, this indicator is quite difficult to reliably determine, since soluble fibrin-monomer complexes are very quickly removed from the blood.

Such a parameter as RFMC plays a big role in the diagnosis of DIC syndrome (full name - disseminated intravascular coagulation syndrome). The norm of RFMK in human blood is 0.355-0.479 units. However, during pregnancy, RFMC norms may differ significantly from the above indicated level. Since the female body is actively preparing for the upcoming birth, the basic parameters of the blood change along with it, including its ability to clot.

This is a kind of defense mechanism that helps minimize the risk of bleeding. Deviations of RFMC levels during pregnancy of up to 5.1 ml are considered normal. per 100 ml. blood. If RFMK is elevated, what do these analysis results mean?

When RFMK is increased in a patient’s coagulogram, the reasons may be as follows:

An increase in this indicator is often found in patients who have recently undergone surgery. Therefore, in the postoperative period, the analysis for RFMC may deviate from the norm.

Activated recalcification time

Abbreviated as ABP in the analysis, it denotes the time required for the formation of fibrin in blood plasma saturated with platelets and calcium. This parameter is also used to evaluate the blood coagulation system as a whole. AVR reflects the interaction of cellular and plasma components of hemostasis.

It is noteworthy that the value of this parameter may vary depending on the reagents used in laboratory tests. As a rule, a shortened recalcification time indicates the patient’s body’s tendency to form blood clots, and an extended one indicates hemophilia, as well as a decrease in the number of platelets and a change in their basic characteristics.

Prothrombin index. Norm for women

The abbreviated name for this parameter in the analysis is PTI. Blood test for PTI - what is it? The prothrombin index is the ratio of the established ideal value of prothrombin time to the prothrombin time in the patient’s analysis, multiplied by 100%.

It is noteworthy that this indicator is currently almost never used, since WHO recommends the use of a parameter that is more resistant to laboratory tests, such as INR. The norm of PTI in the blood for a healthy person is set at the level of %.

As a general rule, the rate of IPT in women should not differ from the above values, with the exception of the period of pregnancy, when blood clotting increases. Therefore, if a woman’s coagulogram deviates from the norm, she should consult a doctor for advice. This parameter increases, as a rule, if the human body lacks vitamin K, and there is also a deficiency of blood clotting factors.

In addition, an increase in PTI is caused by treatment with anticoagulants such as Sincumar, Warfarin or Neodicoumarin, as well as when taking Heparin and its analogues. PTI decreases with liver damage, for example, with cirrhosis and hepatitis, with vascular thrombosis and during pregnancy.

Norm of prothrombin for women in the blood

In the hemostasis system, 15 coagulation factors play a fundamental role, i.e. substances that characterize the correctness of its operation. One of the most important factors is prothrombin or factor II, also known as thrombogen. This is a protein that is a precursor to thrombin, which in turn is responsible for the coagulation function of the blood - it stimulates the formation of a thrombus (blood clot).

The level of prothrombin in the blood is determined using the following tests:

If the level of factor II is higher than normal, then blood circulation is hampered due to the fact that the blood becomes viscous, as a result, the blood vessels become clogged. With this condition, the patient’s body is more at risk than ever of strokes and heart attacks, and the risk of developing malignant tumors or thromboembolism also increases significantly.

When thrombogen levels are low, blood clot formation occurs abnormally slowly, which can lead to significant blood loss if bleeding occurs. As a rule, the causes of such a failure in the hemostatic system are: lack of vitamin K in the body or other congenital and acquired factors.

Thrombin time

Abbreviated name – TV. This parameter characterizes the final stage of hemostasis and determines the length of time required for the formation of a fibrin clot when thrombin is added to the blood plasma. Monitoring of TV is always carried out in combination with PT and APTT for the most effective diagnosis of congenital fibrinogen pathologies, as well as for assessing the effectiveness of fibrinolytic and heparin therapy.

Fibrinogen

What is a fibrinogen blood test? The first coagulation factor or fibrinogen is nothing more than a protein formed under the influence of the Hageman factor in the liver, and subsequently, under its influence, converted into insoluble fibrin. The presence of fibrinogen is determined by performing a thrombotest.

Thrombotest grades 4 and 5 are considered normal. It is worth noting that since fibrinogen (an acute phase protein), its level increases in the blood during stress, injury or infection. As a general rule, the level of fibrinogen in the blood should be between 2.7 and 4.013 grams. The level of fibrinogen in women's blood should not be lower or higher than the specified values, except during pregnancy.

A pregnant woman's blood parameters undergo changes, as does her entire body. Many protective systems are launched, including the hemostasis system in preparation for the upcoming delivery. Often, already in the first trimester, fibrinogen levels may be slightly higher or lower than normal. For this period of pregnancy, indicators are set from 2.3 to 5 g/l.

When the level of this protein increases, the blood becomes denser and thicker. Because of this, the process of thrombus formation begins, which harms the child, because he will suffer from an acute lack of oxygen and, as a result, from a deficiency of important micro- and macroelements, as well as vitamins. During pregnancy in the second trimester, the fibrinogen level should be within the normal range of 2.4-5.1 g/l, and in the third trimester - up to 6.2 g/l.

Elevated levels of fibrinogen are also observed with:

In addition, medications such as Heparin and oral contraceptives affect protein levels.

A low level of fibrinogen indicates that the patient has diseases such as:

Fibrinogen levels may decrease with Heparin poisoning, as well as when the patient takes anabolic steroids, valeric acid, androgens, fish oil and barbiturates.

Antithrombin III

This physiological anticoagulant is classified as a glycoprotein in its structure, i.e. substances capable of inhibiting coagulation factors 9, 10 and 12 and thrombin. It is synthesized in liver cells. Standard indicators for this coagulogram parameter vary depending on the patient’s age.

For adults, the normal indicator will be %, for newborn children - 40-80%, for children from 10 to 16 years old -%, and under 10 years old -%. If antithrombin 3 is low, what does this mean? A decrease in the level of this anticoagulant may be associated with the presence of diseases in the patient such as disseminated intravascular coagulation syndrome, sepsis, ischemia, liver cirrhosis, thromboembolism or thrombosis.

In addition, antithrombin III may decrease in the last trimester of pregnancy and when the patient takes Heparin or fibrin inhibitors. When antithrombin 3 is elevated, the causes may be inflammatory pathologies, for example, peritonitis, pyelonephritis and pneumonia, as well as hepatitis and vitamin K deficiency.

D-dimer

Another indicator of an extended coagulogram, with the help of which the doctor analyzes not only blood clotting, but also the anticoagulant system of the human body. D-dimer is split fibrin strands. Only an increased result of this parameter is significant, which indicates the development of liver diseases, disseminated intravascular coagulation syndrome, thrombosis, ischemia, arthritis, and myocardial infarction in the patient’s body.

In addition, an increase in D-dimer is a sign of heavy smokers.

Coagulogram during pregnancy

What is a coagulogram during pregnancy? This is the same coagulogram that is necessarily prescribed to women during pregnancy, as well as immediately before preparing for childbirth.

During pregnancy, the norm for all blood clotting test indicators does not correspond to generally accepted values ​​for the body of a healthy adult.

This is due, first of all, to the fact that the hemostasis system of a pregnant woman undergoes serious changes, as does her entire body as a whole due to the appearance of another blood circulation - the uteroplacental. Hormonal levels, in which progesterone predominates, also play an important role.

It is noteworthy that during pregnancy the activity of blood clotting factors such as 7,8 and 10, as well as fibrinogen, increases significantly. This is a kind of natural protective mechanism designed to help increase the chances of a favorable birth outcome.

Fibrin fragments are deposited on the walls of blood vessels and thus the fibrinolysis system is suppressed. This allows the female body to be safe in case of placental abruption or miscarriage, uterine bleeding and the formation of intravascular blood clots.

Decoding coagulogram indicators during pregnancy

How to take a coagulogram?

We talked about what a coagulogram is and why this test is taken. Now let’s figure out how to properly undergo a hemostasiogram so that, based on the results obtained, the doctor can make the right conclusion and choose an effective treatment plan.

So, if you need to do a blood clotting test, then remember the following rules:

• blood is donated exclusively on an empty stomach, it is better that more than 12 hours have passed since your last meal;
• on the eve of the analysis, you should not eat too spicy food, you should also refrain from smoked meats and overly fatty foods;
• It is strictly prohibited to drink any alcohol, even if the drink contains a small percentage of it;
• don't smoke;
• It is recommended not to take medications before the analysis, and if medications are vital, you should definitely notify the laboratory technician about this and indicate which medications are prescribed to you.

A standard hemostasiogram can be done in most public clinics, and an expanded or detailed analysis is more often available in paid medical institutions. For example, in the Invitro laboratory, a coagulogram can be done quite quickly. As a rule, the test result can be collected within a couple of days. This is due to the need for a number of chemical reactions that require a certain amount of time, which simply cannot be avoided.

However, in any case, you will receive the result of a paid analysis much faster than in a government institution, where the laboratory is heavily loaded due to the influx of patients or may not have certain reagents necessary for the study. The cost of the analysis depends on the number of parameters that need to be studied and varies from 1000 to 3000 rubles.

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