How many days does a coagulogram analysis take? Blood coagulogram - what kind of analysis is it and what indicators are normal? Reasons for possible deviations

Blood is one of the most important fluids in the human body, sensitively reacting to the slightest changes in the state of its health and allowing existing problems to be quickly identified.

Numerous blood tests can quickly give a specialist a fairly complete picture of the existing changes, which means that in the shortest possible time they can move on to an in-depth study or to direct treatment of the disease, if it can be “calculated” immediately. One of these important ones is a coagulogram.

Coagulogram - study of blood clotting

A coagulogram is a rather complex laboratory test of a blood sample for. This procedure makes it possible to find out whether there are any disturbances in the functioning of the blood coagulation system in the direction of accelerating or slowing down the process. Such a study is very important not only for calculating certain values, but is also simply necessary, for example, before extensive surgery. It will demonstrate how well and quickly the blood can clot during surgery, whether there are problems with accelerated clotting, that is, the formation of blood clots, and whether there will be complications during the intervention if the blood clots with difficulty and slowly.

Disruption of the thrombosis process can lead to internal and external bleeding, and in case of serious problems, lead to large blood loss or death - the patient may simply bleed to death.

Tests for coagulogram norms are necessary not only for planned surgical intervention, but are also a mandatory study during.

Balance in the blood coagulation system is extremely important for the health of the expectant mother and child, because the slightest disturbance can cause miscarriage, premature birth or developmental pathologies.Pregnancy places a serious strain on a woman's circulatory system, so clotting problems can lead to bleeding, placental abruption and be an extremely dangerous factor during childbirth or immediately after it. Uncontrolled severe bleeding can cause severe bleeding, including removal for health reasons.

Coagulogram indicators

What is included in a coagulogram - description of indicators

Any analysis for coagulogram norms can be basic or additional, further expanded.

Basic indicators include the following parameters:

• Fibrinogen. This is the main and most important indicator in a blood clotting test.
• Prothrombin index, international normalized ratio INR, prothrombin time PTT. Under normal conditions, one of these three types of tests is performed, most often this is INR as the most informative and universal analysis. All of these are aimed at the external pathway of blood coagulation.
• Thrombin time.
• Activated partial thromboplastin time aPTT.

Additional coagogram parameters:

• Antithrombin. An important indicator of the normal operation of the anticoagulation system.
• Protein C. A lack of this substance can cause thrombosis.
• Lupus anticoagulant. An indicator of the presence of autoimmune problems.
• D-dimer.
• Activated recalcification time (ATR).
• Soluble fibrin-monomer complexes (SFMC).

Appointment for analysis

A test for coagulogram norms is prescribed in different cases; it is necessary for the patient’s condition and for assessing potential risks during surgery.

It is performed not only on patients - all pregnant women receive a referral for such an analysis once every trimester, and if a woman has previously had miscarriages or there is a threat of pregnancy loss, there is a risk of developing dangerous conditions, then the test can be carried out unscheduled and repeatedly.

The main reasons for prescribing a coagulogram are the following diseases and conditions:

• Planned surgery. Almost any operation, especially an extensive one, is associated with the risk of blood loss, and if there is a clotting disorder, such an invasion threatens with dangerous bleeding.
• Disturbances in the normal functioning of the vascular system, including varicose veins and thrombosis.
• . Throughout the entire period, samples are taken regularly once every trimester.
• Problems with blood clotting.
• Presence of autoimmune diseases.
• Diseases of the cardiovascular system (stroke, heart attack, coronary heart disease).
• Diseases.
• Prescription of oral and other types of hormonal contraceptives. A sample is taken once a quarter.
• Prescription and selection of anticoagulant drugs.
• Prescribing an adequate dose of acetylsalicylic acid (aspirin).

During hirudotherapy (use of leeches for therapeutic purposes). This is necessary to prevent possible blood loss due to a blood clotting disorder, since leeches secrete a special substance that prevents clotting.

A coagulogram, also called a hemostasiogram, can be basic or extended.

During the initial examination, a basic test is first prescribed, and if necessary, to clarify the result or more accurately determine the pathology, an extended test is prescribed.

Preparing for the test and carrying out the procedure

Before performing a coagulogram, the patient must undergo special training. First of all, the sample is taken on an empty stomach, preferably in the morning, so you can have your last dinner no later than 8 hours before the test, and it is best to limit yourself to food for 12 hours. Maximum abolition of medications is recommended, especially those that may affect the blood condition. If this is not possible, you must inform the specialist of the list of medications you are taking.

During preparation for the analysis, the patient must refuse all types of drinks, limiting himself only to clean drinking water. Not only alcoholic drinks are prohibited, but also coffee, cocoa, tea, juices - in short, everything that is not water.

The emotional and physical peace and well-being of the patient is also extremely important for obtaining accurate and correct coagulation results. Doctors recommend avoiding stressful situations in every possible way before the analysis, and also not putting physical strain on the body by postponing training or hard work to another time.

Venous blood is collected for the sample.

The analysis is considered quite complex; it evaluates many different components at once. Correct and accurate interpretation of data can only be provided by an experienced specialist.

Explanation: normal

Since many indicators are taken into account when analyzing coagulogram norms, each of them is an integral part of the overall indicator of the normal functioning of the human circulatory system:

• Fibrinogen. The rate of this, which is synthesized in, is 2-4 g/l. During development, the level of fibrinogen increases, but normally in the last trimester it should not exceed 6 g/l (at this time the maximum increase in this indicator is observed). Fibrinogen level is a sensitive indicator to the state of the body. It clearly demonstrates the presence of various inflammatory processes in the body, since the level of fibrinogen quickly increases with the appearance of necrotic tissue conditions (heart attack, stroke, pneumonia, and so on).
• APTT. This indicator determines the time it takes for a blood clot to form. The usual rate is 20-40 seconds.
• Prothrombin. This interacts with vitamin K, which is very important for the health of the blood and the entire body. In the liver, they combine and form thrombin.
• Thrombin time. This is an indicator of the conversion of fibrinogen to fibrin; normally it should take 11-18 seconds. During this time, the amount of fibrinogen increases, but the thrombin time should be within the normal range. If it lengthens or contracts, we may be talking about a change in the amount of fibrinogen in the blood (increasing or decreasing).
• Prothrombin time. This factor indicates the timing of the conversion of prothrombin to thrombin. Normally, prothrombin time should take 15-17 seconds. Thrombin is an important substance; it is necessary so that the blood can clot and turn into a clot (thrombus), thereby eliminating bleeding. Both too low and too high prothrombin time are equally dangerous.
• Prothrombin index PTI. It is measured as a percentage and refers to the most important indicators of blood clotting. Reflects a comparison of normal plasma coagulation with the same period in the patient (in percentage terms). PTI numbers normally should not go beyond 93 – 107%. During pregnancy this figure increases. It may also be affected by taking birth control medications.
• . This is an important indicator that indicates the general condition of the body, and not just the hematopoietic system. Normally it is 150-400 thousand cells per µl. A low platelet count is called thrombocytopenia and indicates that the expectant mother is not eating well and needs to urgently change her diet so as not to harm the baby.
• Antithrombin. It is a thrombin antagonist, that is, a substance that inhibits blood clotting. Normally, the indicator should be 71 – 115%.
• Lupus anticoagulant. This parameter is very important when conducting tests during pregnancy or assessing the risk of autoimmune diseases. If a woman is diagnosed with gestosis, the risk of miscarriage increases significantly. Autoimmune diseases also pose a serious threat to human health and often cannot be detected by any other tests.
• D-dimer. This is one of the most important indicators for pregnant women. It is formed during incomplete breakdown of fibrin. Normally it is up to 500 ng/ml. In pregnant women, this figure is much higher, even at the very beginning of pregnancy, but by the last trimester it increases several times. Also, an excessive deviation of the indicator from the norm may indicate the presence of gestosis. In the absence of pregnancy, such indicators appear in old age, in case of damage.
• DIC syndrome. This is a very dangerous condition in which the blood clotting and thinning control system fails and DIC develops. It threatens a pregnant woman with endometritis, placental abruption or amniotic fluid embolism.
• Antiphospholipid syndrome, or to phospholipids. An autoimmune disease is detected. Antibodies to phospholipids appear during thrombosis of veins and arteries. A pregnant woman in whom these antibodies are found suffers from fetaplacental insufficiency, which threatens miscarriage or premature birth, and fetal death.
• Plasma tolerance to heparin. Performed simultaneously with the time of recalcification. Heparin is injected into the plasma and the recalcification time is determined. If it deviates from the norm, it may indicate liver disease, heart failure, cancerous tumors and pre-thrombosis conditions. But in pregnant women, the increase in this indicator at the end of pregnancy is normal.
• Plasma recalcification time
• Time period for fibrin clot formation. The normal rate is 60 – 120 seconds.

Coagulogram values ​​in children are slightly different from those for adults. For example, the level of fibrinogen in a newborn baby is 1.25 - 3 g/l, which is much lower than the standard levels for an adult.

Reasons for possible deviations

Deviation of coagulogram parameters - possible diseases

If, after the analysis, various deviations from the norm of the coagulogram are detected, this may indicate the presence of various pathologies in the hematopoietic system, and may also be signs of the onset of diseases.

For example, a violation of the normal blood clotting time indicates a failure in the thrombosis system: an extension of this period indicates a decrease in active functioning, an increase in the thrombolytic abilities of the body (that is, that the anti-clotting system is overly active). If the blood clots very quickly, this indicates a high activity of the blood coagulation system or poor functioning of the thrombosis resistance system. In order to clarify the specific cause of the disorder, it will be necessary to study other coagulogram indicators. In addition, in this case, you need to pay attention to which tube the blood was drawn into - glass or silicone. When using silicone tubes, the folding time is extended to 25 minutes, while in glass the maximum is 7 minutes.

The concentration of fibrinogen increases during, with various disorders of the body of an endocrine nature and the presence of various inflammatory processes.

A reduced level of fibrinogen indicates disturbances in the blood coagulation system and is the cause of a variety of bleeding.

Most often, this condition is caused by, or other diseases, a lack of vitamins C, K and group B in the body, which provokes the development of diseases such as Crohn's disease, a symptom of malabsorption and dysbiosis. Also, the cause of such a disorder may be the second stage of DIC syndrome or the use of special medications.

The time of recalcification is also an important component of the overall picture of the state of the blood and the health of the body. A reduction in the recalcification period indicates thrombophlebitis or thrombosis, and a lengthening indicates a disruption of the blood coagulation system caused by a lack of platelets or their inferiority, as well as disorders of the hemostatic system, increased activity of the anticoagulation system, or in the second stage of DIC syndrome.

More information about blood clotting can be found in the video.

If the aPTT time is reduced, this does not indicate the presence of serious pathologies, but its prolongation appears when using medications - anticoagulants, with hereditary blood diseases such as hemophilia or with autoimmune problems such as systemic.

Violations of the prothrombin index are the most striking indicators of malfunctions in the hemostasis system. A low prothrombin index indicates bleeding disorders caused by a lack of vitamin K, problems with digestion and liver function. An increase in the prothrombin index indicates an increased level of thrombus formation associated with thromboembolism of various vessels, strokes and heart attacks.

An increase in thrombin time entails a decrease in fibrinogen content, and it is also associated with liver diseases and pancreatitis, when using anticoagulants - substances that prevent rapid blood clotting.

A reduction in thrombin time is characteristic of the third trimester of pregnancy and in conditions that cause an increase in fibrinogen levels.

Decoding coagulogram data is an important and complex task, accessible only to a competent and well-trained specialist. There is no need to try to diagnose yourself, much less begin treatment. The doctor evaluates all sections of the coagulogram as a whole and, if necessary, conducts additional tests and, only after receiving clear data, draws up the necessary treatment regimen.

A coagulogram is a set of tests, information about which makes it possible to determine the state of the blood coagulation system and those of its components, the activity of which affects other systems of the body.

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

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

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

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

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

Coagulogram appointed in such cases:

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

How does the blood clotting process occur?

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

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

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

Such violations are most often observed for diseases:

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

Blood clotting process consists of such stages:

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

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

Coagulation testing in pregnant women

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

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

Analysis procedure:

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

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

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

Interpretation of blood test for coagulogram

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

Fibrinogen

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

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

Increase fibrinogen indicates:

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

Decline fibrinogen level with:

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

Activated partial thromboplastin time

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

Promotion APTT:

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

Slowing blood clotting Due to an increase in the duration of the aPTT, the following occurs:

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

Lupus anticoagulant

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

Excess norms indicate:

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

Prothrombin

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

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

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

Prothrombin time

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

Promotion blood levels:

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

Prothrombin index

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

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

Increase PTI shows:

• increased clotting;
• danger of developing thrombosis.

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

Index decline suggests a decrease in blood clotting rates.

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

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

Thrombin time

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

Increase thrombin time occurs when:

• severe liver pathology;
• congenital fibrinogen deficiency.

Decrease time is an indicator:

• excess fibrinogen;
• available paraproteins - special immunoglobulins.

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

Antithrombin III

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

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

Promotion concentrations at:

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

Decrease:

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

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

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

D-dimer

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

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

Promotion noted when:

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

Platelets

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

When the concentration decreases, the following is diagnosed:

1. thrombocytopenia;
2. maternal malnutrition.

Platelets are produced in the bone marrow.

DIC syndrome

If there are deviations in blood clotting during the period of bearing a child, there is a danger of the so-called DIC syndrome, which is manifested by increased clotting at the initial stage and decreased clotting at the second stage, that is, causing intense bleeding.

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

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

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

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

Off-schedule is carried out if:

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

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

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

Antiphospholipid syndrome

Signs:

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

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

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

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

Coagulogram results

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

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

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

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

The term “coagulogram” comes from the merger of two words: coagulum (coagulation) and gramma (image). It is a graphical expression of the result of a blood clotting test. Another name is hemostasiogram.

Deciphering the coagulogram allows you to determine the presence of abnormalities such as increased blood clotting (hypercoagulation) or decreased blood clotting (hypocoagulation). This test is not standard and is prescribed when it is necessary to evaluate the functioning of the blood coagulation system or hemostasis system.

Hemostasis is a whole complex of reactions occurring in the body when the vascular wall is damaged. This system performs the most important function - it prevents and stops bleeding. It ensures the presence of blood in the vascular bed and prevents death from blood loss.

Along with the coagulation system, the body has an anticoagulant system, thanks to which the blood has a liquid state, certain parameters and composition throughout life. These systems are in balance, which prevents blood clotting inside the vascular bed and at the same time promotes the formation of a clot when the integrity of the wall is violated. Disruption of this balance can lead to consequences such as blood loss and the formation of a blood clot inside the vessel.

With the participation of thrombin, soluble fibrinogen is converted into insoluble fibrin threads

When the vessel wall is damaged, the blood clotting mechanism is triggered. As a result, a blood clot – a thrombus – forms at the site of the vessel defect. This is a very complex process of interaction between the so-called blood clotting factors. The essence of coagulation lies in a cascade of reactions caused by the fact that proenzymes brought into an active state activate other coagulation factors. Plasma-soluble fibrinogen is eventually converted into insoluble fibrin, which appears as threads. Blood cells become entangled in them, thus forming a blood clot.

When the integrity of the vessel is restored, the dissolution of the fibrin clot begins - fibrinolysis. This process always accompanies coagulation and is an integral part of it.

Coagulogram indicators obtained during a blood test make it possible to evaluate the functioning of all three systems: coagulation, anticoagulation and fibrinolytic.

Only a doctor can decipher a coagulogram. At the same time, he will consider all indicators in aggregate.

Indications for analysis

• Assessment of the state of the coagulation system.
• Planned surgical intervention. Bleeding is possible during surgery, so it is necessary to obtain information about the state of the hemostatic system.
• Bearing the fetus. It is carried out every trimester, as well as for severe gestosis and fetoplacental insufficiency.
• Diseases associated with blood clotting disorders (hemophilia, von Willebrand disease, thrombocytopenia, thrombocytopathy and others).
• Independent childbirth and caesarean section.
• Monitoring treatment with heparin and indirect coagulants.
• Varicose veins.
• Tendency to thrombosis.
• There is a high probability of blood clots due to coronary artery disease, atrial fibrillation, strokes, and heart attacks.
• Acute inflammation.
• Pathologies with an autoimmune development mechanism.
• Chronic liver diseases.
• Taking glucocorticoids and anabolic steroids.
• Continuous use of oral contraceptives (analysis is carried out every 3 months).
• Diagnosis of thrombosis.
• Hirudotherapy.

How is it carried out and how to prepare?

Blood is taken in the morning on an empty stomach. On the eve of the analysis, you should not eat fried, fatty, spicy, smoked or drink alcohol. The last meal should take place at least 10-12 hours before the procedure. Before donating blood, you can only drink plain water and do not smoke. To avoid distorting the test result, you should stop taking blood thinning medications.

Blood for coagulation testing is taken from a vein

For the study, venous blood is used, which is taken using a vacuum method or a sterile syringe with a large-bore needle without applying a tourniquet. It is important that the procedure is not traumatic, otherwise tissue thromboplastin will end up in the test tube, and the results will be distorted. The test tube must contain an anticoagulant. Test results are usually ready in one to two days. After treatment with antibiotics, at least two weeks should pass. Hormonal contraceptives also influence the test result.

Coagulogram parameters

As a rule, a basic analysis is prescribed the first time. If deviations from the norm are found, an extensive study is carried out. The basic parameters include the following.

Fibrinogen. This protein is a valuable indicator of a coagulogram. It is involved in the formation of a blood clot. With its deficiency, the blood does not stop well. The norm is 2-4 g/liter. During pregnancy, its level gradually increases and in the third trimester reaches 6 g/liter. In newborns it is 1.25-3 g/liter.

A decrease in fibrinogen occurs in the following cases:

• in case of disturbances in the hemostasis system;
• toxicosis of pregnant women;
• severe hepatitis;
• liver cirrhosis;
• taking fish oil;
• deficiency of vitamins C and B;
• taking anticoagulants, anabolic steroids.

The fibrinogen content increases in the following cases:

• for acute inflammation and infections;
• during pregnancy;
• for strokes and heart attacks;
• with pneumonia;
• for burns;
• after surgical interventions;
• with hypothyroidism;
• after childbirth.

PTI (prothrombin index)– the ratio of the time it takes for a healthy person’s blood to clot to the time it takes for a particular patient’s blood to clot. It is an indicator of liver function. Normally it ranges from 90 to 110%. If the value is increased, there is a risk of blood clots; if it is decreased, bleeding is possible. During pregnancy, an increase is considered normal. PTI, PTT (prothrombin time) and INR (international normalized ratio) show how long it took for a clot to form at the site of the vessel defect. Using these parameters, the extrinsic pathway of blood coagulation is assessed. Usually one of them is carried out. INR is considered universal.

APTT (activated partial thromboplastin time). Gives an idea of ​​the internal pathway of blood coagulation. An indicator of the time it takes for blood clots to form. Used to monitor treatment with heparin drugs. It is one of the most sensitive indicators. Normally it is about 40 seconds. An increase in time may indicate liver disease or a lack of vitamin K.

Thrombin time. This parameter characterizes the final stage of hemostasis, that is, the period of time during which fibrinogen is converted into insoluble fibrin when exposed to thrombin. This indicator makes it possible to identify the likelihood of developing thrombosis, carry out differential diagnosis of various coagulopathies, and evaluate how effective heparin therapy is. Normally, the indicator should be 11-18 seconds. A value below normal indicates an excess of fibrinogen in the blood. An elevated value indicates liver failure or protein deficiency.

The blood test is interpreted by the attending physician. The interpretation of the result is carried out taking into account all parameters.

Blood coagulation is a very complex process that involves numerous factors.

Additional coagulogram parameters

These include the following:

• Antithrombin - refers to the factors of the anticoagulant system and prevents thrombus formation.
• Soluble fibrin-monomer complexes (SFMC) are an indicator of blood coagulation inside blood vessels. Gives an idea of ​​how fibrin molecules change under the influence of thrombin and plasmin.
• Protein C – deficiency leads to the formation of blood clots.
• Lupus anticoagulant - determined when autoimmune diseases are suspected.
• Plasma tolerance to heparin. This is an indicator of the thrombin level in the blood. During the analysis, heparin is injected into the blood plasma and the time during which a fibrin clot forms is determined. Normally it should be 7-15 minutes. With hypercoagulation during pregnancy, with cancer, after surgery, with cardiovascular pathologies, the time is less than normal. In case of liver diseases, the time period increases and exceeds 15 minutes.
• D-dimer - is formed during the breakdown of blood clots, with its help early diagnosis of thrombosis and prevention of thromboembolism is carried out.
• Duke bleeding time. This is a test for stopping time of capillary blood. Normally it should be about 2 minutes. To do this, a finger prick with a depth of 4 mm is made, then a drop of blood is removed using paper every 15 seconds, without the paper touching the finger. After removing the drops, it is timed to determine how long it will take for the next one to appear.
• Fibrinolytic activity - shows the ability of blood to dissolve clots. If blood clots break down faster than normal, this indicates a tendency to bleed.
• Recalcification time (RCT) is an indicator of the time it takes for a fibrin clot to form. Low values ​​may indicate the development of diseases such as hepatitis, liver cirrhosis, cardiac pathologies, including heart failure.
• Activated recalcification time (ATR). The norm is 50-70 seconds.
• Retraction of a blood clot. Shows how a blood clot shrinks. With anemia, this indicator increases. The decrease occurs when the level of red blood cells increases and platelets decrease.
• Thrombotest - shows how much fibrinogen is in the blood. Normal – grade IV-V test.
• Fibrinogen B is normally negative.
• Blood clotting time, that is, the time from the moment of venous blood collection to the formation of a clot in the test tube. Shows how platelets work. For determination, 1 milliliter of blood is placed in a test tube at a temperature of 37 degrees. The normal average is 5-7 minutes. If it takes longer, this may indicate liver damage, a lack of clotting factors, long-term use of anticoagulants, or low platelet levels. If coagulation occurs faster than normal, this indicates hypercoagulation, the development of disseminated intravascular coagulation syndrome, or is a consequence of taking hormonal contraceptives. For capillary blood this indicator ranges from 30 seconds to 5 minutes, for venous blood – from 5 to 10 minutes.

The process of blood clot formation

The table will help to more clearly present the norms of the main coagulogram indicators:

Fibrinogen (concentration)	2-4 g/l
Thrombin time	11-18 seconds
Prothrombin index	80-120%
APTT	24-35 seconds
Plasma tolerance to heparin	3-11 minutes
RFMK	4 mg/100 ml
GRP	60-120 seconds
Blood clot retraction	44-65%
Duke bleeding time	no more than 4 minutes
AVR	50-70 seconds
Fibrinogen	from 5.9 to 11.7 µmol
Fibrinogen B	negative
Fibrinolytic activity	From 183 to 263 minutes
Clotting time	5-10 minutes

In conclusion

A coagulogram is not included in the standard examination, but the doctor may need it when preparing a patient for surgery, in the presence of autoimmune diseases, liver pathology, a tendency to bleeding, or varicose veins.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Coagulogram is also called hemostasiogram, and is a laboratory clinical analysis to determine various indicators of the blood coagulation system. That is, a coagulogram is an analogue of a biochemical blood test. Only a coagulogram determines indicators that reflect the functioning of the blood coagulation system, and a biochemical analysis determines the functioning of various internal organs.

What is a coagulogram?

The blood coagulation system is a combination of various active substances that ensure the formation of a clot and stop bleeding in case of various violations of the integrity of blood vessels. That is, when a person injures, for example, a finger, his coagulation system is activated, thanks to which the bleeding stops and a blood clot is formed, closing the damage in the wall of the blood vessel. That is, in essence, the coagulation system is activated when the vascular wall is damaged and as a result of its work, a blood clot is formed, which, like a patch, closes the hole in the blood vessel. Thanks to the application of such a “patch” from the blood clot, the bleeding stops, and the body is able to function as usual.

However, it is necessary to understand that the coagulation system stops bleeding and ensures the formation of a blood clot not only in case of skin wounds, but also in case of any damage to blood vessels. For example, if a vessel bursts due to overstrain or active inflammatory process in any organ or tissue. Also, the coagulation system stops bleeding after separation of the mucous membrane during menstruation or the placenta after childbirth in women.

Disturbances in the functioning of the coagulation system can occur not only by the type of its insufficient activity, but also by its excessive activity. If the coagulation system is insufficiently active, a person develops bleeding, a tendency to bruise, long-term unstoppable bleeding from a small wound on the skin, etc. And with excessive activity of the coagulation system, on the contrary, a large number of blood clots are formed, which clog blood vessels and can cause heart attacks, strokes, thrombosis, etc.

Returning to the coagulogram, this analysis can be briefly described as a determination of blood coagulation parameters. Based on the results of the coagulogram, it is possible to identify certain disorders in the blood coagulation system and begin their timely treatment, aimed at achieving compensation and preventing bleeding or, on the contrary, excessive formation of blood clots.

Coagulogram indicators

A coagulogram, like a biochemical blood test, includes a large number of indicators, each of which reflects a function of the blood coagulation system. However, in practice, just as in a biochemical blood test, determination of not all, but only some coagulogram parameters is usually prescribed. Moreover, the coagulogram indicators necessary to determine in a given situation are selected by the doctor based on what kind of blood clotting disorder he suspects.

In addition, there are several varieties of so-called standard coagulograms, which include only some specific parameters necessary for analyzing coagulation in typical situations. Such coagulograms are done under certain conditions, for example, during pregnancy, before surgery, after using medications that affect blood clotting. If any indicators of such standard coagulograms turn out to be abnormal, then to find out at what stage of blood coagulation the disorder occurred, other necessary parameters are determined.

Each coagulogram indicator reflects the course of the first, second or third stage of blood clotting. At the first stage, the blood vessel spasms, that is, it narrows as much as possible, which minimizes the amount of damage. At the second stage, blood platelets “stick together” (aggregate) and form a loose and large clot that seals the hole in the blood vessel. At the third stage, a kind of mesh is formed from threads of the dense fibrin protein, which cover the loose mass of sticky platelets and tightly fix it to the edges of the hole on the vessel wall. Then the mass of sticky platelets compacts and fills the cells between the fibrin fibers, forming a single elastic and very strong “patch” (thrombus), which completely closes the hole in the wall of the blood vessel. This is where blood clotting ends.

Let's consider all the indicators that are part of the coagulogram and reflect all three stages of blood coagulation, and also give examples of standard hemostasiograms for various typical conditions.

So, the coagulogram indicators, reflecting the three different stages of blood coagulation, are the following:

1. First stage indicators formation of prothrombinase):

• Lee-White blood clotting time;
• Contact activation index;
• Plasma recalcification time (PRT);
• Activated recalcification time (AVR);
• Activated partial thromboplastin time (APTT, APTT, ARTT);
• Prothrombin consumption;
• Factor VIII activity;
• Factor IX activity;
• Factor X activity;
• Factor XI activity;
• Factor XII activity.

2. Second stage indicators blood clotting (this stage is correctly called - thrombin formation):

• Prothrombin time;
• International normalized ratio - INR;
• Prothrombin in % according to Duke;
• Prothrombin index (PTI);
• Factor II activity;
• Factor V activity;
• Factor VII activity.

3. Third stage indicators blood clotting (this stage is correctly called - fibrin formation):

• Thrombin time;
• Fibrinogen concentration;
• Concentration of soluble fibrin-monomer complexes.

In addition to these indicators, in an analysis called a “coagulogram”, laboratories and doctors often include other indicators that reflect the functioning of another system, which is called anticoagulant (fibrinolytic). Anticoagulant system has the opposite effect of coagulation, that is, it dissolves blood clots and inhibits the blood clotting process. Normally, these systems are in dynamic equilibrium, neutralizing each other’s effects and ensuring blood clotting when needed and dissolution of the clot if it is formed accidentally.

The most typical example of the operation of the anticoagulant system is the following: after damage to the vessel, the coagulation system formed a blood clot, which closed the hole and stopped the flow of blood. Then the wall of the vessel was restored, its tissues grew and completely closed the existing hole, as a result of which the blood clot was simply glued to the already intact wall of the blood vessel. In this condition, a blood clot is not needed; moreover, it has a negative effect, since it narrows the lumen of the vessel and slows down the flow of blood. This means that such a clot must be removed. It is at such moments that the anticoagulant system plays a huge role, since it is activated when unnecessary blood clots are detected and must be removed. As a result of the work of the anticoagulant system, the blood clot is disassembled into parts, which are then removed from the body. That is, the anticoagulant system dismantles blood clots that have already become unnecessary, cleaning the walls of blood vessels and freeing their lumens from a useless cluttering clot that has fulfilled its function.

In addition, it is the anticoagulation system (specifically antithrombin III) that stops the active work of the coagulation system when a blood clot has already been created. That is, when a blood clot closes a hole in the wall of a vessel, the anticoagulation system is activated, which inhibits the activity of the coagulation system so that it, in turn, does not create too large “patches” that can completely block the lumen of the vessel and stop the movement of blood in it.

The work of the fibrinolytic system is assessed by the following indicators which are included in the coagulogram:

• Lupus anticoagulant;
• D-dimers;
• Protein C;
• Protein S;
• Antithrombin III.

These parameters of the anticoagulation system are also often included in the coagulogram.

Depending on which parameters are included in the analysis, there are currently two main types of coagulograms that are used in everyday clinical practice: extended and screening (standard). The standard coagulogram includes the following indicators:

• Fibrinogen;
• Thrombin time (TV).

The first indicator of a standard coagulogram is the prothrombin complex, the result of which can be expressed in two ways - in the form of the amount of prothrombin in % according to Duke or in the form of the prothrombin index (PTI). Prothrombin in % according to Duke is the international version of the designation of the activity of the prothrombin complex, and PTI is accepted in the countries of the former USSR. PTI and % according to Duke reflect the same thing, therefore they are two options for designating one parameter. Exactly how the prothrombin complex is reflected depends on the laboratory, whose employees can calculate both the Duke % and the PTI.

The extended coagulogram includes the following indicators:

• Prothrombin in % according to Quick or prothrombin index;
• International normalized ratio (INR);
• Fibrinogen;
• Activated partial thromboplastin time (aPTT);
• Thrombin time (TV);
• Antithrombin III;
• D-dimer.

The above configurations of standard and extended coagulogram indicators are international. However, in Russia and other CIS countries there are a huge number of other options for “standard” and “extended” coagulograms, which include other indicators.

As a rule, the arrangement of indicators in such coagulograms is arbitrary, depending on what parameters the doctor considers necessary for his work. In many cases, such “standard” and “extended” coagulograms include parameters C-protein, S-protein and others, which need to be determined only in rare cases when a person has coagulation disorders and it is necessary to determine exactly what is not working. In other cases, coagulation tests include indicators such as the ethyl test and clot retraction, which are outdated and not currently used to diagnose the coagulation system. These indicators are included in coagulograms simply because the laboratory performs them.

In fact, such independently compiled “standard” and “extended” coagulograms are very free variations on generally accepted world standards, and therefore are always associated with excessive testing and waste of reagents.

What coagulogram parameters are needed for children and pregnant women?

To save money and nerves, we recommend that when prescribing a coagulogram test for all children, as well as adult men and non-pregnant women, only the parameters included in the standard combination are determined. And pregnant women are recommended to determine only the parameters included in the extended coagulogram. Additional parameters should be determined separately and only if necessary, if any abnormalities are detected in the extended or standard coagulograms, combined with clinical symptoms of blood coagulation pathology.

Coagulogram parameters and their values ​​are normal

All coagulogram indicators, including parameters of the anticoagulant system, as well as their normal values ​​and abbreviations used for short designation, are reflected in the table.

Coagulogram parameter	Abbreviation of coagulogram parameter	Parameter norm
Lee-White blood clotting time	Lee-White	In a silicone tube 12 - 15 minutes, and in a regular glass tube - 5 - 7 minutes
Contact activation index	No abbreviation	1,7 – 3
Plasma recalcification time	GRP	60 – 120 seconds
Activated recalcification time	AVR	50 – 70 seconds
Activated partial thromboplastin time	APTT, APTT, ARTT	24 – 35 seconds for the Renam reagent kit and 30 – 45 seconds for the “Technology Standard” reagent kit
Prothrombin consumption	No abbreviation	75 – 125%
Factor VIII activity	Factor VIII or simply VIII	50 – 200%
Factor IX activity	IX	50 – 200%
Factor X activity	X	60 – 130%
Factor XI activity	XI	65 – 135%
Factor XII activity	XII	65 – 150%
International normalized ratio	INR, INR	0,8 – 1,2
Prothrombin time	RECOMBIPL-PT, PT, PV	15 – 17 seconds, or 11 – 14 seconds, or 9 – 12 seconds, depending on the set of reagents
Prothrombin in % according to Duke	Duke	70 – 120%
Prothrombin index	PTI, R	0,7 – 1,3
Factor II activity	II	60 – 150%
Factor V activity	V	60 – 150%
Factor VII activity	VII	65 – 135%
Thrombin time	TV, TT-5, TT	10 – 20 seconds
Fibrinogen concentration	FIB, RECOMBIPL-FIB, FIB.CLAUSS	2 – 5 g/l
Concentration of soluble fibrin-monomer complexes	RFMK	3.36 – 4.0 mg/100 ml plasma
Lupus anticoagulant	No abbreviation	Absent
D-dimers	No abbreviation	Non-pregnant women and men – less than 0.79 mg/l I trimester of pregnancy – up to 1.1 mg/l II trimester of pregnancy – up to 2.1 mg/l III trimester of pregnancy – up to 2.81 mg/l
Protein C	No abbreviation	70-140% or 2.82 – 5.65 mg/l
Protein S	No abbreviation	67 – 140 U/ml
Antithrombin III	No abbreviation	70 – 120%

The table shows the average norms for each coagulogram indicator. However, each laboratory may have its own standards, taking into account the reagents used and the characteristics of the blood coagulation system of people living in the area. Therefore, it is recommended to take normal values ​​from the laboratory that performed the analysis to evaluate each coagulogram parameter.

Decoding the coagulogram

Let's look at what each coagulogram indicator means, and also indicate what an increase or decrease in parameter values ​​relative to the norm may indicate.

Lee-White clotting time

Lee-White clotting time reflects the rate at which a blood clot forms. If the Lee-White time is less than normal, then this indicates increased activity of the coagulation system and a high risk of thrombosis, and if it is higher than normal, then, on the contrary, it indicates bleeding and a tendency to bleed.

Plasma recalcification time (PRT)

Plasma recalcification time (PRT) reflects the rate of fibrin clot formation when calcium is added to the blood plasma. This indicator reflects the overall activity of the entire coagulation system.

Activated recalcification time (ATR)

Activated recalcification time (AVR) reflects the same thing as the “plasma recalcification time” indicator, and differs from it only in the method of conducting the study.

If AVR or GRP is below normal, this indicates a tendency to thrombosis. If the AVR or GRP is higher than normal, then this indicates the danger of severe bleeding even with minor damage to the integrity of the tissues. Typically, prolongation of AVR or VRP occurs due to a low number of platelets in the blood, administration of heparin, as well as against the background of burns, trauma and shock.

Activated partial thromboplastin time (APTT, APTT, ARTT)

Activated partial thromboplastin time (APTT, APTT, ARTT) reflects the rate of the entire first phase of blood coagulation.

Prolongation of APTT is typical for the following diseases:

• von Willebrand's disease;
• Deficiency of coagulation factors (II, V, VII, VIII, IX, X, XI, XII);
• Congenital deficiency of prekalykrein and kinin;
• Administration of heparin or streptokinase;
• Taking anticoagulants (Warfarin, Sincumarin, etc.);
• Vitamin K deficiency;
• Low levels of fibrinogen in the blood;
• Liver diseases;
• II and III phases of DIC syndrome;
• Condition after a large volume of blood transfusion;
• Presence of lupus anticoagulant in the blood;
• Antiphospholipid syndrome;
• Chronic glomerulonephritis;
• Systemic lupus erythematosus;
• Connective tissue diseases.

A shortened APTT occurs in the following diseases and conditions:

• Acute blood loss;
• Initial stage of DIC syndrome.

Activity of all coagulation factors (II, V, VII, VIII, IX, X, XI, XII)

The activity of all coagulation factors (II, V, VII, VIII, IX, X, XI, XII) in the blood reflects the intensity of the work of these enzymes. Accordingly, a decrease or increase in the activity of coagulation factors relative to the norm indicates a disease that needs to be treated. The activity of coagulation factors never changes under the influence of physiological reasons, therefore, its decrease or increase relative to the norm clearly indicates a disease in which either a lot of blood clots form or frequent and heavy bleeding occurs.

Prothrombin time (PT, RT, recombipl RT)

Prothrombin time (PT, RT, recombipl RT) reflects the rate of activation of the internal pathway of the coagulation system. The fact is that the blood clotting process can be started along the internal or external pathway. The extrinsic activation pathway is triggered when there is damage to the blood vessels externally due to trauma, such as a cut, scrape, bite, etc. The internal pathway of activation of the blood coagulation system works when damage to the wall of the blood vessel occurs from the inside, for example, by any microbes, antibodies or toxic substances circulating in the blood.

Thus, prothrombin time reflects a very important physiological phenomenon - the rate of activation of the internal blood coagulation pathway, which is responsible for the formation of blood clots and “patching” holes in the vessels formed due to the negative effects of substances circulating in the blood.

Prolongation of prothrombin time more than normal indicates the following diseases:

• Taking anticoagulants (Warfarin, Thromboass, etc.);
• Administration of heparin;
• Congenital or acquired deficiency of coagulation factors II, V, VII, X;
• Vitamin K deficiency;
• DIC syndrome in the initial phase;
• Hemorrhagic diathesis in newborns;
• Liver diseases;
• Narrowing of the bile ducts;
• Impaired absorption and digestion of fats in the intestines (sprue, celiac disease, diarrhea);
• Zollinger-Ellison syndrome;
• Fibrinogen deficiency in the blood.

A shortening of prothrombin time below normal indicates the following diseases:

• Incorrect blood sampling through the central catheter;
• High or low hematocrit;
• Long-term storage of blood plasma in the refrigerator at + 4 o C;
• Increased concentration of antithrombin III;
• Pregnancy;
• DIC syndrome;
• Activation of the anticoagulant system.

Prothrombin index (PTI)

Prothrombin index (PTI) is an indicator calculated on the basis of prothrombin time and, accordingly, reflects the rate of activation of the internal blood coagulation pathway. An increase in PTI above normal occurs under the same conditions as prolongation of prothrombin time. A decrease in PTI below normal occurs under the same conditions as a shortening of prothrombin time.

International normalized ratio (INR)

The international normalized ratio (INR), like PTI, is an indicator calculated based on prothrombin time and also reflects the rate of activation of the internal coagulation pathway.

An increase in INR above normal occurs under the same conditions as an increase in prothrombin time. A decrease in INR below normal occurs under the same conditions as a shortening of prothrombin time.

Prothrombin according to Duke

Duke prothrombin is, like PTI and INR, an indicator calculated on the basis of prothrombin time and also reflects the rate of activation of the internal blood coagulation pathway.

An increase in the Duke prothrombin percentage above normal occurs under the same conditions as a shortening of prothrombin time. A decrease in the Duke prothrombin percentage below normal occurs under the same conditions as an increase in prothrombin time.

Thus, prothrombin time, prothrombin index, international normalized ratio and Duke prothrombin are parameters that reflect the same physiological effect, namely, the rate of activation of the intrinsic coagulation pathway. These parameters differ from each other only in the way they are expressed and calculated, and therefore are completely interchangeable.

However, it has traditionally developed that in some situations it is customary to assess the rate of activation of the internal pathway of blood coagulation by PTI, in others by INR, and in others by Duke, in fourths by prothrombin time. Moreover, PTI and Duke’s prothrombin in % are almost always mutually exclusive, that is, the laboratory determines either the first or the second parameter. And if the analysis results contain PTI, then prothrombin according to Duke can be omitted and, accordingly, vice versa.

PTI and Duke prothrombin are calculated in diagnostic coagulograms, which people take before operations, during preventive examinations, or examinations for any symptoms. INR is calculated when monitoring and selecting the dosage of anticoagulants (Aspirin, Warfarin, Thrombostop, etc.). Prothrombin time is usually indicated in coagulograms, which are necessary to identify diseases of the blood coagulation system.

Thrombin time (TV, TT)

Thrombin time (TT, TT) reflects the rate of transition of fibrinogen into fibrin threads, which hold the platelets stuck together in the area of ​​the hole in the vessel wall. Accordingly, thrombin time reflects the speed of the last, third phase of blood coagulation.

An increase in thrombin time reflects a decrease in blood clotting and is observed in the following conditions:

• Fibrinogen deficiency of varying severity;
• DIC syndrome;
• Multiple myeloma;
• Severe liver diseases;
• Uremia (increased concentration of urea in the blood);
• The presence of fibrin or fibrinogen breakdown products in the blood (D-dimers, RFMC).

A shortening of thrombin time reflects excessive blood clotting and is recorded in the following diseases:

• Use of heparin;
• The first stage of DIC syndrome.

Fibrinogen concentration (fibrinogen, Fib)

Fibrinogen is a protein produced in the liver that circulates in the blood and is used as needed. It is from fibrinogen that fibrin threads are formed, which hold the mass of sticky platelets attached to the wall of the vessel in the area of ​​the hole. Accordingly, the concentration of fibrinogen reflects the amount of reserves of this protein that can be used to repair damage in the walls of blood vessels if necessary.
An increase in fibrinogen concentration is observed in the following diseases:

• Myocardial infarction;
• Injuries;
• Burns;
• Nephrotic syndrome;
• Multiple myeloma;
• Inflammatory diseases that last a long time;
• Pregnancy;
• Taking estrogen-containing oral contraceptives (Marvelon, Mercilon, Qlaira, etc.);
• Condition after surgery.

A decrease in fibrinogen concentration below normal is observed in the following conditions:

• DIC syndrome;
• Metastasis of malignant tumors;
• Acute promyelocytic leukemia;
• Postpartum complications;
• Hepatocellular failure;
• Infectious mononucleosis;
• Toxicosis of pregnancy;
• Poisoning by poisons;
• Taking thrombolytic drugs that dissolve blood clots;
• Anchord therapy;
• Congenital fibrinogen deficiency;
• Age less than 6 months.

Soluble fibrin-monomer complexes (SFMC)

Soluble fibrin monomer complexes (SFMCs) are a transitional form between fibrinogen and fibrin filaments. A small amount of these complexes is always present in the blood and reflects the normal functioning of the coagulation system. If the amount of RFMK becomes higher than normal, this indicates excessive activity of the coagulation system and, accordingly, the formation of blood clots in the vessels in large quantities. That is, an increase in the amount of RFMC above normal indicates the development of thrombosis of veins and arteries or disseminated intravascular coagulation syndrome.

Lupus anticoagulant

Lupus anticoagulant is a protein whose presence indicates that a person has antiphospholipid syndrome (APS). Normally, this protein should not be in the blood, and its appearance means that the development of APS has begun.

D-dimers

D-dimers are small proteins that are particles of broken fibrin strands. Normally, D-dimers are always present in the blood in small quantities, since they are formed after the destruction of already unnecessary blood clots. An increase in the number of D-dimers indicates that blood clotting is too intense, resulting in the formation of a large number of unnecessary blood clots in the vessels, causing thrombosis, thromboembolism and their complications.

An increase in the level of D-dimers in the blood develops in the following diseases:

• DIC syndrome (first phase);
• Myocardial infarction;
• Thrombosis of arteries or veins;
• Infectious diseases;
• Acute or chronic inflammatory diseases;
• Gestosis during pregnancy;
• Large hematomas;
• The presence of rheumatoid factor in the blood;
• Condition after surgery;
• Age over 80 years;
• Malignant tumors of any location;
• Use of tissue plasminogen activator.

Protein C

Protein C is a protein that inactivates the blood clotting process. This protein is necessary for the timely cessation of the coagulation system so that it does not form too large blood clots that clog not only the damaged wall, but also the entire lumen of the vessels. The concentration of protein C can only fall below normal, and such a disorder develops in the following conditions:

• Congenital protein C deficiency;
• Liver diseases;
• The first stage of development of DIC syndrome.

Antithrombin III

Antithrombin III is a protein that has the same functions as protein C. However, antithrombin III accounts for about 75% of the total activity of the anticoagulant system. That is, 2/3 of the functioning of the anticoagulant system is ensured by this protein.

An increase in the concentration of antithrombin III in the blood develops under the following conditions:

• Acute hepatitis;
• Cholestasis;
• Vitamin K deficiency;
• Acute pancreatitis;
• Period of menstruation;
• Taking Warfarin;
• Taking anabolic steroids;
• Long-term or severe inflammatory processes;
• Condition after kidney transplantation;
• Increased levels of bilirubin in the blood (hyperbilirubinemia);
• Taking drugs that increase blood clotting.

A decrease in the concentration of antithrombin III is observed in the following diseases:

• Congenital antithrombin III deficiency;
• Condition after liver transplant;
• Cirrhosis;
• Liver failure;
• Deep vein thrombosis;
• DIC syndrome;
• Myocardial infarction;
• Pulmonary embolism;
• Severe inflammatory diseases of any organs and systems;
• Use of heparin in high dosages without monitoring blood clotting parameters;
• The use of L-asparaginase for the treatment of gestosis of pregnancy;
• Third trimester of pregnancy (27 – 40 weeks of gestation inclusive);
• Taking oral contraceptives.

Protein S

Protein S is a protein that is required for the activation of protein C and antithrombin III. That is, without protein S, the two most important enzymes of the anticoagulant system, protein C and antithrombin III, will not work. The concentration of protein S can only fall below normal, which is observed with congenital deficiency of this protein, liver disease, or when taking anticoagulants (Aspirin, Warfarin, etc.).

Decoding the coagulogram during pregnancy

During pregnancy, a woman's circulating blood volume increases by 20–30%. This is necessary in order to form blood circulation in the fetus and placenta. That is, in fact, during pregnancy it is necessary to carry out the function of blood supply to two different organisms simultaneously - the mother and the fetus, allocating a certain volume of blood to each of them. It is precisely because of the need to allocate the volume of blood it needs for the fetus that its total amount in a woman’s body increases.

Due to this increase in the volume of circulating blood, the content of various substances of the coagulation and anticoagulation system increases in a pregnant woman. After all, a woman’s body must provide both itself and the fetus with the substances necessary for the functioning of the coagulation and anticoagulation systems. And that is why during pregnancy there is always an increase in the content of all components of the coagulation and anticoagulation systems, and at the same time an increase in their activity. This, in turn, means that the activity and content of all coagulogram parameters are increased by 15 - 30%, which is the norm for pregnancy.

In practice, this means that the coagulogram norms of a pregnant woman differ significantly from those for other adults. So, normal values ​​of the following parameters during pregnancy are 15–30% less or more than usual:

• Blood clotting time according to Lee-White is 8 - 10 seconds in a silicone tube and 3.5 - 5 seconds in a glass tube;
• Plasma recalcification time – 45 – 90 seconds;
• Activated recalcification time – 35 – 60 seconds;
• Activated partial thromboplastin time is 17 – 21 seconds for Renam reagents and 22 – 36 seconds for “Technology-standard” kits;
• International normalized ratio (INR) – 0.65 – 1.1;
• Prothrombin time – 9 – 12 seconds;
• Prothrombin in % according to Duke – 80 – 150%;
• Prothrombin index – 0.7 – 1.1;
• Thrombin time – 12 – 25 seconds;
• Fibrinogen concentration – 3 – 6 g/l;
• Soluble fibrin-monomer complexes – up to 10 mg/100 ml;
• Lupus anticoagulant – absent;
• D-dimers – first trimester of pregnancy – up to 1.1 mg/l; II trimester of pregnancy – up to 2.1 mg/l; III trimester of pregnancy – up to 2.81 mg/l;
• Protein C – 85 – 170% or 3.1 – 7.1 mg/l;
• Protein S-80 – 165;
• Antithrombin III – 85 – 150%.

Prothrombin consumption and clotting factor activity may also increase by 15 to 30% above normal for adult men and non-pregnant women. If the results of coagulogram analyzes fall within the above limits, then this indicates the normal functioning of the coagulation and anticoagulation systems in a pregnant woman. That is, the expectant mother does not need to worry about anything, since the blood flow through the vessels of both herself and the fetus is normal.

However, the analysis indicators do not always fit into the norm, and in this case, women want to understand what this means, that is, to decipher the coagulogram. In general, in order to decipher a coagulogram during pregnancy, you need to know why this analysis is needed and what processes in a woman’s body it reflects. After all, a coagulogram during pregnancy is not done to identify diseases of any organs and systems, but to assess the risk of thrombosis or, on the contrary, bleeding, which can become fatal for the fetus and the woman herself, causing placental abruption or infarction, miscarriages, intrauterine fetal death, gestosis etc.

Therefore, in essence, a coagulogram during pregnancy is prescribed for early detection of the threat of placental abruption, gestosis, antiphospholipid syndrome, latent DIC and thrombosis. The coagulogram does not have any other functions. These pathologies need to be identified at an early stage and the necessary therapy carried out, since in the absence of it they can lead, at best, to loss of pregnancy, and at worst, to the death of the woman herself.

So, if a pregnant woman has a hidden threat of placental abruption, gestosis, DIC or thrombosis, then the coagulogram indicators will vary within the following limits:

• Reduction of antithrombin III to 65% or lower due to excess consumption;
• An increase in the concentration of D-dimers above the norm for pregnancy;
• An increase in the concentration of RFMK by more than 4 times relative to the norm (above 15 mg/l);
• Shortening of thrombin time to less than 11 seconds (first phase of DIC syndrome);
• Prolongation of thrombin time by more than 26 seconds (advanced phase of DIC syndrome, which requires urgent medical intervention);
• Decrease in the amount of fibrinogen below 3 g/l;
• Prolongation of prothrombin time, increase in PTI and INR (initial stage of DIC syndrome);
• Reduction in the amount of prothrombin according to Duke is less than 70% (initial stage of DIC syndrome);
• Prolongation of aPTT more than normal;
• Presence of lupus anticoagulant.

If in the coagulogram of a pregnant woman any one or two indicators have values ​​that fit into the above pathological framework, this does not mean that she is at risk of placental abruption, DIC syndrome, etc. This only indicates that the woman’s coagulation system is currently working in a certain mode that she needs. Remember that in truly severe conditions, for the early detection of which a coagulogram is performed, literally all of its indicators turn out to be abnormal. That is, if 1–2 indicators in the coagulogram are abnormal, then this indicates the normal course of compensatory adaptive mechanisms and the absence of severe pathology. And only if all indicators are abnormal in some way, this indicates a severe pathology that needs to be treated. Actually, this is the main decoding of the coagulogram of a pregnant woman. Before use, you should consult a specialist.

A coagulogram (hemostasiogram) is a blood test that is performed to study its coagulability. Deciphering the blood coagulogram is of great importance in preparing the patient for surgery. It helps prevent serious complications such as bleeding. A study of coagulation must be carried out during, and also if there is a history of liver, heart and vascular diseases. The presence of autoimmune pathologies is also an indication for studying a blood coagulogram. The analysis allows us to determine the cause of bleeding.

The blood clotting system (hemostasis) protects a person from dangerous blood loss when the integrity of the vascular walls is violated due to traumatic injuries and surgical interventions. The nervous and endocrine systems are responsible for adequate hemostasis in the body. In order for blood to adequately perform its basic functions (supplying tissues with oxygen and nutrients and regulating body temperature), it must have normal rheological properties, i.e. fluidity. Hypocoagulation (decreased coagulation) due to various pathologies can lead to life-threatening blood loss. Hypercoagulation causes the formation of blood clots (thrombi) that block the lumen of blood vessels. As a result of thrombosis, tissue ischemia develops, leading, among other things, to and.

The main components of the hemostasis system are:

• endothelial cells of the vascular wall;
• platelets;
• plasma factors.

How to donate blood for a coagulogram

Blood is drawn from a vein in the elbow area. To avoid distortions and misinterpretation of the results, you need to prepare accordingly for the analysis.

Basic rules that are important for the patient to follow:

• 8-12 hours before the test you should not eat;
• the day before you should not overeat at night;
• alcohol, tea, juices and other drinks are excluded - you can only drink clean water;
• people with nicotine addiction should not smoke at least an hour before the test;
• It is important to exclude physical and mental stress 15 minutes before the analysis.

Important:If the patient is taking pharmacological anticoagulants, he must inform the doctor about this! If, during the process of collecting material for a blood coagulogram study, dizziness appears or a fainting state begins to develop, you should immediately notify health care workers about a change in your state of health.

When is a blood coagulation test necessary?

Indications for analysis:

Blood is drawn with a sterile syringe or using a special vacuum system. The tourniquet is not applied to the arm. The puncture must be atraumatic to avoid data distortion due to the entry of a large amount of tissue thromboplastin into the material. Two tubes are filled with blood, but only the second is used for research. The sterile tube contains an anticoagulant - sodium citrate.

Coagulogram indicators: interpretation

In a standard coagulogram analysis, a number of indicators are studied and evaluated together.

Clotting time- this is the time interval between the onset of bleeding and its stopping during the formation of a fibrin clot. Capillary blood clots in 0.5-5 minutes, and venous blood in 5-10. The duration of bleeding increases against the background of thrombocytopenia, hypovitaminosis C, liver pathologies and taking drugs from the group of indirect anticoagulants (including acetylsalicylic acid, Trental and Warfarin). The duration of coagulation is reduced after massive bleeding, and in women, even with the use of .

PTI (prothrombin index) reflects the ratio of the duration of blood coagulation in normal conditions to the coagulation time of the subject. Reference values ​​(variants of the norm) – from 97 to 100%. In pregnant women, the rate increases (up to 150% and above), which is not a pathology. PTI numbers make it possible to identify the presence or absence of liver pathologies. The index increases when taking hormonal contraceptives. An increase in values ​​relative to the norm indicates the risk of thrombosis, and a decrease indicates the likelihood of bleeding.

Important:In order for the prothrombin index to be normal, the body requires a constant nutritional intake.

Thrombin time reflects the rate of conversion of fibrinogen to fibrin. The normal interval is 15-18 seconds. A shortening of the time interval most likely indicates an excess of fibrinogen, and its lengthening indicates a low concentration of this protein compound in the serum or severe functional liver failure against the background or with.

Please note:Regular monitoring of this blood coagulogram indicator is very important during heparin therapy!

APTT (activated partial thromboplastin time) is an indicator reflecting the duration of clot formation after adding CaCl2 (calcium chloride) to the plasma. Normal values ​​are within 30-40 seconds. Changes are noted when the remaining blood coagulogram parameters deviate within 30%. An extension of this time interval may indicate liver pathology or.

AVR (activated recalcification time) in a healthy person it ranges from 50 to 70 seconds. The indicator allows you to evaluate the course of one of the stages of coagulation. A decrease in AVR is a sign of thrombophilia, and prolongation is observed with thrombocytopenia, taking anticoagulants (heparin), serious injuries, extensive injuries, and the development of a state of shock. A low AVR indicates an increased risk of massive and life-threatening bleeding.

PRP (plasma recalcification time) is a coagulogram indicator that correlates with ABP and reflects the time of coagulation of citrate serum after the addition of calcium salts. Normal time is 1 to 2 minutes. Its reduction indicates increased activity of hemostasis.

If a blood coagulogram shows a significant decrease in the indicator, this may be a sign of the following pathologies:

• violation of hemostasis;
• severe liver damage;
• toxicosis during pregnancy;
• hypovitaminosis and deficiency.

The level falls during therapy with anticoagulants and anabolic steroids, as well as against the background of consumption of fish oil.

Fibrinogen B normally not detected.

Fibrinogen concentration in a healthy person – 5.9-11.7 µmol/l. Its decrease is observed with liver problems, and its increase is observed with malignant neoplasms and hypofunction of the thyroid gland.

RFMK indicator (soluble fibrin-monomer complexes) characterizes changes in the structure of the fibrin protein at the molecular level under the influence of coagulation factor II (thrombin) and plasmin. A value not exceeding 4 mg/100 ml is considered normal. The variability of the indicator is due to the same reasons as changes in fibrinogen concentration.

Please note:RFMK is a marker that allows timely measures to be taken to prevent the development of DIC syndrome.

Fibrinolytic activity- this is an indicator of a coagulogram, reflecting the ability of the patient’s blood to dissolve formed blood clots. A component of the body's anticoagulant system, fibrinolysin, is responsible for this function. With its high concentration, the rate of dissolution of blood clots increases, and accordingly, bleeding increases.

Thrombotest allows you to visually determine the volume of fibrinogen in the test material. The norm is thrombotest grade 4-5.

Plasma tolerance to heparin is a characteristic that reflects the time of formation of a fibrin clot after adding heparin to the test material. Reference value – from 7 to 15 minutes. The analysis reveals the level of thrombin in the blood. A decrease in the indicator most likely indicates liver damage. If the interval is less than 7 minutes, cardiovascular pathologies or the presence of malignant neoplasms can be suspected. Hypercoagulation is characteristic of late pregnancy (III trimester) and conditions after surgical interventions.

Blood clot retraction characterizes a decrease in the volume of a blood clot with complete separation from the plasma. Reference values ​​are from 44 to 65%. An increase in values ​​is observed in various forms of anemia (anemia), and a decrease is a consequence of thrombocytopenia and erythrocytosis.

Duke bleeding time- This is a separate analysis, during which capillary rather than venous blood is examined. The fingertip is deeply pierced (4 mm) using a special lancet. The blood that comes out of the puncture is removed with special paper every 15-30 seconds (without contact with the skin). After each blotting, the time until the next drop appears is measured. The normal time for bleeding from small blood vessels to stop is one and a half to two minutes. This indicator is influenced, in particular, by the level of the mediator serotonin.

Blood coagulogram in children

Normal blood coagulogram values ​​in children differ significantly from normal values ​​in adult patients. Thus, in newborn babies, the normal level of fibrinogen ranges from 1.25 to 3.0 g/l.

Indications for studying a child’s coagulogram are:

• suspicion of ;
• diagnosis of pathologies of the hematopoietic system;
• upcoming surgery.

Blood coagulogram during pregnancy

Important:During pregnancy, a blood coagulation test is carried out at least three times (in each trimester).

During pregnancy, hemostasis parameters normally change, which is caused by significant hormonal changes in the female body, an increase in the total volume of circulating blood and the formation of an additional (uteroplacental) circulation.

In the first trimester, clotting time, as a rule, increases significantly, and in the third, it is significantly shortened, thereby providing the woman with protection from possible blood loss during delivery. A blood coagulogram allows you to identify a threat or premature birth due to the formation of blood clots. Disturbances in the coagulation system of a pregnant woman negatively affect the central nervous system of the unborn child.

Important:Having blood coagulogram data and comparing them with the norm allows obstetricians to take adequate measures to prevent serious bleeding during delivery.

A mandatory blood coagulogram study is necessary if a woman has vascular diseases (in particular -) or is diagnosed. A blood coagulogram is also examined in cases of decreased immunity and negative Rh factor.

Reference values ​​for individual blood coagulation parameters in pregnant women:

• thrombin time – 11-18 seconds;
• APTT – 17-20 sec.;
• fibrinogen – 6 g/l;
• prothrombin – 78-142%.

Important:A deviation of the prothrombin level from normal levels may indicate placental abruption!

Lotin Alexander, medical columnist