Coagulogram normal indicators table. Blood coagulogram (hemostasiogram) - what is this analysis? Deciphering the coagulogram, the indicators are normal, during pregnancy, etc. Patients before surgery and after complex surgical interventions

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

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

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

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

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

This biological system consists of three main components:

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

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

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

Indications for appointment

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

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

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

Preparation for the study

Preparation for this study is of great importance.

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

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

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

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

How is a blood coagulation test performed?

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

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

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

How many days do a coagulogram?

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

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

Norms of the coagulogram

Normally, hemostasis indicators are as follows:

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

Why take a coagulogram, what indicators does it reveal?

Decryption

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

ON

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

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

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

INR

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

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

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

APTT

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

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

AVR

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

PTI

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

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

TV

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

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

fibrinogen

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

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

RFMK

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

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

Antithrombin III

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

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

D-dimer

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

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

Bleeding time

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

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

Is it possible to take a coagulogram during menstruation?

Analysis during menstruation

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

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

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

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

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

On what day of the cycle to take a coagulogram?

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

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

Coagulogram extended

Coagulogram extended- a set of studies of the blood coagulation system, which, in addition to the basic components (APTT, thrombin time, prothrombin time and prothrombin index, fibrinogen, antithrombin III), includes the determination of lupus anticoagulant, protein C, protein S, D-dimer and RFMK. Coagulation tests are performed in combination with a general analysis. The results of an extended coagulogram are used to diagnose and treat conditions associated with bleeding disorders, monitor anticoagulant therapy, determine the causes of miscarriage, in preparation for surgery and other invasive procedures. Blood sampling is performed from a vein, research methods are coagulometric. Each indicator has its own reference values. Terms of complex analysis - from 1 to 2 days.

Extended coagulogram - complex analysis blood, which is aimed at assessing the various links of hemostasis: coagulation, anticoagulation and fibrinolytic systems. The results are used to detect hyper- and hypocoagulation, that is, excessive or insufficient blood clotting.

Hemostasis is a combination of blood factors that, on the one hand, maintain it in a liquid state, and on the other hand, promote clotting in case of damage to blood vessels. Normally, the body maintains a balance between anticoagulant and coagulation factors. If it is violated, there is a tendency to thrombosis or bleeding. An extended coagulogram is used to identify the link whose activity is impaired and to further correct the imbalance.

The first group of extended coagulogram tests is aimed at assessing the coagulation link of hemostasis. In the process of blood coagulation, the external and internal pathways are distinguished. The first is triggered by factor III - tissue thromboplastin, which is released from the walls of blood vessels and tissues when their integrity is violated. Inner path is activated by the interaction of blood components with the subendothelium of the damaged vessel; factors XII, XI, IX and VII participate in it. After the formation of factor X, the coagulation pathway becomes common. In an extended coagulogram, tests for prothrombin (PTT, PTI, INR and Quick prothrombin), thrombin time, fibrinogen, APTT are used to study the blood coagulation system. Antithrombin III, lupus anticoagulant, protein C, protein S are tested to assess anticoagulant mechanisms. Plasma fibrinolytic activity is examined by tests for RFMK and D-dimer.

When performing an extended coagulogram, the research material is plasma isolated from venous blood. Analyzes are performed various methods: photometric, colorimetric, immunological, using orthophenanthroline test. Automatic and semi-automatic coagulometers are used. Extended coagulogram finds wide application in hematology, obstetrics and gynecology, surgery, intensive care, cardiology, phlebology and other areas of clinical practice.

Indications and contraindications

An extended coagulogram is used for overall assessment hemostasis, diagnosis and monitoring of diseases accompanied by a violation of the external, internal and final pathways of blood coagulation, the activity of the anticoagulant and fibrinolytic system. The study is indicated for DIC, venous thrombosis, thromboembolism, hemophilia, antiphospholipid syndrome. Also, the analysis is carried out to evaluate the effectiveness of anticoagulant therapy and identify associated complications. The basis for the appointment of an extended coagulogram may be frequent nosebleeds, bleeding gums, blood in the stool and urine, hemorrhages under the skin and in the joints, anemia, heavy menstruation, pain and heaviness in the legs, the appearance of vascular "mesh" and "stars". The reason for performing an extended study may be the deviation of the basic hemostasiogram tests.

In obstetrics and gynecology, an extended coagulogram is indicated for women who have a history of bleeding disorders, recurrent miscarriage, as well as pregnancy complications: threatened miscarriage, placental abruption, fetal hypoxia. At the stage of pregnancy planning, this study is used to diagnose the causes of infertility. In surgical practice, an extended coagulogram is performed as part of preoperative preparation patient, detection of complications postoperative period. Screening of the blood coagulation system is indicated for hereditary predisposition to thrombosis and hemophilia.

Most extended coagulogram tests are not indicated for inflammatory, including infectious and autoimmune diseases, since in these cases blood clotting temporarily changes, and the indicators become uninformative. The study itself has no contraindications, but blood sampling is impossible when psychomotor agitation the patient, the presence of severe anemia or hypotension, frequent convulsions. An extended coagulogram allows you to most fully assess the hemostasis system and accurately determine which links in it are broken. But for correct setting diagnosis, the interpretation of the results should not be carried out in isolation, but in combination with indicators general analysis blood with ESR and leukocyte formula, as well as data from clinical and instrumental examinations.

Preparation for analysis and collection of material

To determine the parameters of the extended coagulogram, blood plasma is used. Her collection is usually made from 8 to 11 am. The break between the procedure and the last meal should be at least 8-12 hours. Since stress, exercise and smoking affect blood clotting, these factors should be eliminated at least half an hour before sampling. All medications if possible, it is necessary to cancel in advance or discuss the effect of taking them on the results of the analysis with the doctor.

Blood for research is taken from a vein. It is collected in a test tube with sodium citrate and gently mixed - this prevents the formation of clots. Over the next 2-6 hours, the material is delivered to the laboratory, centrifuged to obtain plasma, into which the reagents specific for each test are then injected. Part of the samples is incubated and then applied to the substrate or combined with another reagent. The procedure and calculation of indicators are performed automatically in special analyzers - coagulometers. The timing of the study depends on the set of tests, most often they are 1-2 days, but can take up to 7-14 days (for example, when determining proteins C and S).

Normal values

In adult patients, the following values ​​of extended coagulogram tests are normally determined:

• Prothrombin test: prothrombin time (PTT) - 11-15 sec.; prothrombin index (PTI) - 95-105%; international normalized ratio (INR) - 0.8-1.2; prothrombin according to Quick - 78-142%;
• thrombin time - 16-21 sec.;
• fibrinogen - 2-4 g / l;
• APTT - 21-36.5 sec.;
• Anticoagulant system: antithrombin III - 66-124%; lupus anticoagulant - 0.8-1.2; protein C - 70-140%; protein S for women - 54.7-123.7%, for men - 74.1-146.1%;
• Plasma fibrinolytic activity: RFMK - 3.36-4.0 mg / 100 ml; D-dimer - 0-0.55 µg FEU / ml.

However, the corridor of reference values ​​may differ from laboratory to laboratory, as they use different reagents, analyzers, and sometimes research methods in general. Therefore, it is necessary to determine the norm according to the form with the results (column "reference values"). In addition, blood clotting changes during pregnancy and menopause, during a period of intensive growth and puberty, when smoking, using certain drugs. Temporary physiological deviations in the parameters of the coagulogram are observed during physical exertion, emotional stress.

Diagnostic value of the analysis

In diseases and conditions accompanied by an increase in blood clotting and the risk of thrombosis, the parameters of the extended coagulogram change as follows: INR, PTT, fibrinogen and / or D-dimer exceed the norm, lupus anticoagulant is detected, and PTI, Quick prothrombin, thrombin time, antithrombin III , APTT, protein C, protein S - decrease. Deviations can be detected in one or more tests, depending on which link of hemostasis is broken. In such cases, thrombosis, thromboembolism, stages 1 and 2 of DIC are diagnosed. Also, such changes are typical for the last trimester of pregnancy, the period after injuries, burns, operations.

When blood clotting is insufficient (hypocoagulation), there is a risk of bleeding. In this case, the parameters of the extended coagulogram change as follows: the values ​​of PTI, Quick prothrombin, thrombin time, antithrombin III, APTT, protein C, protein S increase. Lupus anticoagulant is absent, and the values ​​of INR, PTT, fibrinogen and D-dimer decrease. As in the previous case, the deviation can be detected in one or more analyzes. Hypocoagulation is determined by congenital or acquired deficiency of coagulation factors, including hemophilia, von Willebrand factor deficiency, hypo- and afibrinogenemia, vitamin K deficiency, stages 2 and 3 of DIC.

Treatment of deviations from the norm

An extended coagulogram allows you to comprehensively explore the hemostasis system, identify deviations in various parts of the coagulation, anticoagulation and fibrinolytic systems. Its results are most in demand in hematology, surgery, obstetrics and gynecology. If deviations from the norm are detected, it is necessary to seek advice and treatment from the doctor who issued the referral for analysis. If blood clotting is increased or decreased slightly, then you can correct it yourself. To do this, avoid stressful situations, select physical activity in accordance with the level of preparedness of the body, give up uncontrolled medication and smoking, timely detect and treat inflammatory diseases.

Synonyms: coagulogram, hemostasiogram

Coagulogram is a complex hematological analysis, which allows you to evaluate the coagulation ability of the blood. The study is prescribed after a serious injury and before surgery in order to prevent the development of bleeding or blood clots.

Also, the study of coagulogram parameters is necessary in the diagnosis of hereditary and acquired diseases of internal organs (kidneys and liver, blood vessels, heart). It is mandatory to monitor blood clotting during pregnancy and with diagnosed autoimmune disorders.

General information

Hemostasis is a system of blood coagulation that protects the human body from excessive blood loss as a result of injuries, ruptures of the vascular walls and tissues of internal organs, and surgery.

Hemostasis is regulated by the endocrine and nervous systems. Blood transports oxygen and energy components to cells, regulates body temperature precisely due to its “fluidity”. In the case of hypocoagulation (decrease in clotting), a person rapidly loses blood even with a small wound or cut. Hypercoagulation ( increased clotting) leads to the accumulation of blood clots (thrombi), which clog the lumen of the arteries and veins, preventing free movement biological fluid on bloodstream. As a result, ischemia and tissue necrosis develop, dangerous complications which is cerebral stroke and myocardial infarction.

If hemostasis is functioning normally, then the blood coagulates just enough to plug the gaps in the arteries and veins (this process is not always noticeable to a person).

Hemostasis is provided by the following components:

• endothelium (inner layer lining the vessels) - if the integrity of the vascular walls is violated, its cells produce bioactive substances that trigger thrombus formation;
• platelets (red blood cells) - are the first to go to the rupture site, stick together and, thereby, clog the wound, that is, create a hemostatic plug;
• plasma factors and enzymes (up to 15 components) - trigger chemical reactions, as a result of which a dense fibrin clot is formed, which stops bleeding.

Indications for analysis

A coagulogram is prescribed by a therapist or hematologist when diagnosing the following conditions:

• pathology of the structure or inflammatory processes of internal organs;
• tendency to form blood clots;
• thromboembolism (blockage by blood clots) of the pulmonary artery;
• a history of stroke or heart attack;
• anomalies in the structure and functioning of blood vessels (small and medium veins, arteries);
• hemorrhagic disorders:
  • von Willebrand's disease (spontaneous bleeding);
  • thrombocytopenia (platelet deficiency);
  • thrombocytopathy (increased secretion of platelets);
  • hemophilia (deficiency of clotting factors), etc.
• atrial fibrillation (chaotic (erratic) heart contractions);
• ischemic heart disease (damage to the heart muscle due to insufficient blood supply);
• DIC (thrombus formation in small vessels);
• cirrhosis of the liver (pathological change in structure) in a chronic form;
• abnormal pregnancy, history of miscarriage;
• preparation for natural childbirth or caesarean section;
• preeclampsia (a complication of toxicosis of the 3rd trimester of pregnancy).

Also, the study is carried out in the following cases:

• general and comprehensive assessment of the state of hemostasis;
• planned analysis before surgery;
• drug treatment control
  • anticoagulants;
  • heparin;
  • oral contraceptives;
  • hormones;
  • glucocorticosteroids;
  • anabolics.

Reference values ​​for coagulogram

The coagulogram is a comprehensive test that involves the study of several components in the aggregate. Each of them has its own time for research, as well as a unit of measurement.

Clotting time

The time interval between the start of bleeding and its stop. The rate of fibrin clot formation is estimated.

• Venous blood should clot in 5-10 minutes, and capillary blood faster (in 30 seconds - 5 minutes).

The ratio of blood clotting time (norm) to the patient's blood clotting time.

• The obtained relative indicators range from 97-100%, and in pregnant women they can reach 150% or more.

Prothrombin is also measured according to Quick, where the range of 78-142% is considered the norm (including in expectant mothers). Reference values ​​allow you to determine liver dysfunction.

The rate of transformation of blood fibrinogen into fibrin.

• The normal range for this test is 10.3-16.6 seconds, and for pregnant women it is 11-18.

When the interval is lengthened, fibrinogen is contained in excess, and when the interval is shortened, there is a deficiency of this protein component. It also allows you to evaluate the performance of the liver.

The test results reflect the rate of blood clotting, and also make it possible to predict the risk of bleeding or thrombosis.

Most often, lupus anticoagulant is determined in patients with a prolonged aPTT and a tendency to thrombosis, which is typical for antiphospholipid syndrome(AFS).

• Normal time is less than 1.2 sec.

An analysis for D-dimer allows you to evaluate 2 factors in a complex at once: coagulation (blood clotting) and fibrinolysis (dissolution of clots). The marker makes it possible to timely detect the imbalance between them in case of diseases circulatory system(varicose veins, thrombophilia, pulmonary embolism etc.).

• Normally, the indicator should be below 243 ng / ml. In pregnant women, an increase in values ​​\u200b\u200bdepending on the trimester is allowed.

The study allows you to timely diagnose thrombotic conditions and predict the risk of developing diseases associated with blockage of veins and arteries. Plasminogen is also evaluated during the preparation and management of pregnancy in order to prevent possible complications.

Normally, the amount of plasminogen in the blood varies within

• 80-132%

In newborns and children under 6 months, 60% of the adult rate is considered the norm.

Activated Recalcification Time (ART)

The rate of restoration of the concentration of calcium ions in the blood plasma to a normal level.

• In healthy people, the indicator is 50-70 seconds.

Plasma recalcification time (PRT)

This coefficient correlates with ABP and allows you to set the clotting time of citrate (obtained according to the previous principle) serum when adding a preparation of calcium salts.

• The time should be at least 1-2 minutes.

It is produced in the liver, where it is converted to fibrin under the influence of clotting factors. The threads of the latter, in turn, form blood clots. To start hemostasis, a person needs at least 0.5 g of fibrinogen. At the same time, fibrinogen B should not be detected in plasma.

• The level of this component is normally 2-4 g / l (5.9-11.7 μmol / l),
• in pregnant women can reach 6 g / l.

Soluble fibrin-monomeric complexes (SFMK)

Directly affect the molecular structure of fibrin with the participation of plasmin and thrombin (coagulation factors).

• Normally, the indicator is up to 4 mg per 100 ml.

This test is specific and sensitive for preventing DIC.

fibrinolytic activity

It is an important indicator of the coagulogram, which indicates the ability of the blood to independently dissolve emerging blood clots. This process provides fibrinolysin.

Thrombotest

The study is carried out to visually calculate the volume of fibrinogen in the studied plasma.

• The norm is the result of 4-5 degrees.

The norm is 83-128%.

Antithrombin refers to the proteins of the anticoagulant system and inhibits thrombin (inhibits blood clotting). With a decrease in the rate, the development of thrombosis is possible. The control of the indicator is important when taking anticoagulants (heparin).

Plasma tolerance to heparin

The time of formation of a fibrin clot after the addition of heparin to the plasma.

• The normal range is 7 to 15 minutes.

By using this study thrombin concentration is determined.

Retraction of a blood clot

The analysis evaluates the gradual reduction of the blood clot with its separation from the plasma.

• Measured in relative terms: 44-65%.

Duke bleeding time

It is included in the complex coagulogram, but in this test, not venous, but capillary blood is evaluated.

The doctor pierces the finger with a special lancet at least 4 mm. The blood that oozes from the wound is removed with a special napkin every 15-30 seconds (contact with the skin is unacceptable). After each subsequent blotting, the time until a new drop is released is recorded. The time of complete cessation is also estimated. capillary bleeding, which is normally 1.5-2 minutes.

A doctor can issue a referral for a coagulogram general practice, therapist, functional diagnostician, pediatrician, etc. But comprehensive assessment indicators and their interpretation should be performed by an experienced hematologist.

Preparation for analysis

Biomaterial for research: venous blood.

Biomaterial sampling method: standard venipuncture.

Manipulation time: from 8.00 to 11.00.

Mandatory conditions: strictly on an empty stomach! Before venipuncture, fasting for 10-12 hours is indicated, while dinner on the eve of the test should be light. In the morning before the analysis, you can drink plain water, exclude soda, tea, coffee drinks, juices.

Basic training requirements

• For 3 days - to exclude the use of alcohol;
• For 1 day - to limit physical and emotional stress(weight lifting, stressful situations);
• On the eve - remove fatty, spicy, smoked, salty foods from the diet;
• For 2-3 hours - it is forbidden to smoke.

Additionally

About current treatments medications you must inform your doctor in advance. In this case, it is desirable to indicate their name, duration of therapy, dosage, etc.

Important! Study results may be affected by hormonal drugs(including contraceptives), aspirin, anticoagulants, so it is advisable to do a coagulogram 2 weeks after treatment.

Learn more about blood clotting

A coagulogram (hemostasiogram) is a blood test that is performed to study the indicator of its coagulability. Deciphering the coagulogram of blood is of great importance in the course of preparing the patient for surgery. It prevents such serious complications like bleeding. The study of coagulability is necessarily carried out during, as well as if there is a history of diseases of the liver, heart and blood vessels. Availability autoimmune pathologies is also an indication for the study of blood coagulation. The analysis allows you to determine the cause of bleeding.

The blood coagulation system (hemostasis) protects a person from dangerous blood loss in case of violation of the integrity of the vascular walls against the background of traumatic injuries and surgical interventions. For adequate hemostasis in the body, the nervous and endocrine system. In order for the blood to adequately perform its basic functions (supplying tissues with oxygen and nutrients and regulation of body temperature), she should have normal rheological properties, i.e. fluidity. Hypocoagulation (decrease in clotting) against the background various pathologies can lead to life-threatening blood loss. Hypercoagulability is the cause of the formation of blood clots (thrombi), clogging the lumen of blood vessels. As a result of thrombosis, tissue ischemia develops, leading, including 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 sampling is carried out from a vein in the elbow area. To avoid distortion and misinterpretation of the results, the analysis should be prepared accordingly.

Basic rules that are important for the patient to follow:

• 8-12 hours before the analysis, you can not eat;
• on the eve should not overeat at night;
• alcohol, tea, juices and other drinks are excluded - you can only drink clean water;
• people with nicotine addiction do not smoke at least an hour before the analysis;
• 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 in the process of taking material for the study of blood coagulation, dizziness appears or begins to develop fainting, you should immediately notify health workers about a change in well-being.

When is a blood coagulogram needed?

Indications for analysis:

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

Coagulogram indicators: decoding

At standard analysis a number of indicators are studied on the coagulogram, which are evaluated in the aggregate.

Clotting time- this is the time interval between the onset of bleeding and its stop during the formation of a fibrin clot. Capillary blood coagulates 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 - and against the background of application.

PTI (prothrombin index) reflects the ratio of the duration of blood clotting in the norm to the time of clotting in the subject. Reference values ​​(variants of the norm) - from 97 to 100%. In pregnant women, the indicator increases (up to 150% and above), which is not a pathology. PTI numbers allow you to identify the presence or absence of liver pathologies. The index rises while taking hormonal contraceptives. An increase in values ​​relative to the norm indicates the risk of developing thrombosis, and a decrease indicates the likelihood of bleeding.

Important:in order for the prothrombin index to be normal, the body needs a constant alimentary intake.

thrombin time reflects the rate at which fibrinogen is converted to fibrin. The normal interval is 15-18 seconds. A shortening of the time interval with a high degree of probability 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 or with.

Note:regular monitoring of this indicator of the blood coagulogram is very important during heparin therapy!

APTT (activated partial thromboplastin time) is an indicator that reflects 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 other indicators of the blood coagulogram deviate within 30%. The lengthening of this time interval may indicate a pathology of the liver or.

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

GRP (plasma recalcification time) is a coagulogram indicator that correlates with AVR and reflects the coagulation time of citrate serum after the addition of calcium salt preparations. Normal time is 1 to 2 minutes. Its abbreviation speaks of increased activity hemostasis.

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

• violation of hemostasis;
• severe liver damage;
• toxicosis during the period of bearing a child;
• hypovitaminosis and deficiency.

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

Fibrinogen B normally not detected.

fibrinogen concentration in a healthy person - 5.9-11.7 µmol / l. Its decrease is noted in case of problems with the liver, and an increase in malignant neoplasms and hypofunction of the thyroid gland.

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

Notice:RFMC is a marker that allows timely measures to be taken to prevent the development of DIC.

fibrinolytic activity- This is an indicator of the coagulogram, reflecting the ability of the patient's blood to dissolve the formed blood clots. Responsible for this function is the component of the anticoagulant system of the body - fibrinolysin. When it high concentration the rate of dissolution of blood clots increases, respectively, bleeding increases.

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

Plasma tolerance to heparin is a characteristic that reflects the time of formation of a fibrin clot after the addition of 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 with a high degree of probability indicates liver damage. If the interval is less than 7 minutes, cardiovascular pathologies or the presence of malignant neoplasms. Hypercoagulability is characteristic of late dates pregnancy ( III trimester) and conditions after surgical interventions.

Retraction of a blood clot 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 noted at various forms anemia (anemia), and the decrease is a consequence of thrombocytopenia and erythrocytosis.

Duke bleeding time- This is a separate analysis, during which not venous, but capillary blood is examined. The pad of the finger is deeply pierced (by 4 mm) with a special lancet. The blood that has come 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. Time to stop bleeding from small blood vessels normally ranges from one and a half to two minutes. This indicator is affected, in particular, by the level of the mediator serotonin.

Blood coagulogram in children

The indicators of the norm of the blood coagulogram in children differ significantly from the normal values ​​in adult patients. Yes, in newborns normal level fibrinogen is from 1.25 to 3.0 g/l.

Indications for the study of the child's coagulogram are:

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

Blood coagulogram during pregnancy

Important:during the bearing of a child, a blood coagulation study is carried out at least three times (in each of the trimesters).

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

In the first trimester, the clotting time, as a rule, increases significantly, and in the third trimester 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 thrombus formation. Violations of the coagulation system of a pregnant woman negatively affects the central nervous system future child.

Important:the availability of blood coagulation data and their comparison with the norm allows obstetricians to take adequate measures to prevent serious bleeding during delivery.

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

Reference values ​​of individual indicators of blood coagulation in pregnant women:

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

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

Lotin Alexander, medical columnist

Coagulogram - important analysis, which determines the parameters of blood clotting. It is prescribed during pregnancy, before surgery and with a tendency to thrombosis.

Coagulogram - what is this analysis?

Coagulology or coagulation is a branch of hematology that studies the process of blood clotting, its biochemistry and physiology. An analysis that determines coagulability indicators is called a coagulogram. With its help, the activity of platelets in the human body is established.

If it is reduced, there is high risk the appearance of bleeding and the appearance of difficult-to-heal wounds. When elevated, blood clots can form, leading to serious illness.

Coagulation study is indicated in the following cases:

A coagulological study is carried out with severe bleeding in order to establish their cause or before surgery.

Tests help doctors prescribe correct dosage anticoagulants and monitor health conditions when taking oral contraceptives, which can cause blood clots.

It is worth thinking about passing a coagulogram in case of bruising even after minor bruises and in the presence of frequent bleeding.

Why they are tested depends on the state of human health and the presence of chronic diseases. The indicators of the coagulogram make it possible to assess not only the state of the blood, but also to identify some chronic pathologies of the internal organs. The analysis is included in full examination organism.

How to take a coagulogram?

In order to prepare for the delivery of a coagulogram, you must follow simple rules:

• Blood for a coagulogram is taken strictly on an empty stomach. For 8 hours before taking the analysis, it is forbidden to eat.
• The use of alcoholic beverages is contraindicated.
• An hour before you donate blood, you can not take tea, coffee and juices.
• You can drink a glass of water about 20 minutes before the procedure.
• Do not take the test when stressful situations and fatigue, as the results may be distorted.

Preparation for analysis is no different from that which is carried out in other studies. The best way to donate blood early morning before breakfast. In the treatment room, a person is located in the supine position on the couch.

During the analysis, it is necessary to inform the doctor about taking any medications, as this may affect the result.

Where is blood taken for coagulogram?

The material is taken from a vein or a finger, after which the area from which the analysis is taken is clamped cotton swab until the blood stops completely. The resulting material is placed in a test tube, and the study is carried out by a device - a coagulometer.

How many days is the analysis done and what is the price of a coagulogram?

Depends on the laboratory, but usually the results are ready the next day. The price varies within small limits and does not exceed 1500 rubles. An extended coagulogram costs about 3,200 rubles. At the direction of the doctor, analysis in public clinics are carried out free of charge.

Main characteristics

Coagulation analysis allows you to identify a list of indicators that together give a complete assessment of the state of human blood.

The main ones are presented in the table:

The main indicators of the coagulogram are the clotting time and the interval during which the formation of a dense clot occurs, which helps to stop the bleeding. You can get other coagulability indicators during an extended coagulogram .

An extended coagulogram allows you to identify a number of hereditary diseases, however, it is not performed in all laboratories due to lack of equipment.

The indicators that allow you to identify a detailed coagulogram include:

Decoding of coagulometry should be carried out exclusively by the attending physician. The specialist evaluates the result individually in each case.

The rate can be affected by:

• Pregnancy.
• lactation period.
• The presence of chronic diseases.
• Past injuries and burns.

Coagulogram during pregnancy

The period of pregnancy is characterized by global changes in organs and systems, and especially in hemostasis. This can be explained by the appearance of an additional circle of blood circulation and changes in the hormonal background, which contributes to an increase in the activity of coagulation factors.

During pregnancy, fibrin fragments are deposited on the walls of the vessels of the placenta. This is how the body protects itself from uterine bleeding and miscarriages.

In each trimester, the indicators of the norm of hemostasis differ mainly upwards. The table shows the norms for women in the 1st-3rd trimester.

In case of violation during pregnancy, there are changes in the coagulogram parameters up or down.

Women who do not see a doctor and do not get tested can get DIC syndrome, which develops in 3 stages:

Coagulogram when planning pregnancy

During pregnancy planning, the further course of fetal development depends on the coagulogram data. Most indicators can deviate slightly during gestation, and this is a normal process. But a significant deviation from the norm indicates the presence of deviations that can cause a miscarriage and threaten the life of a woman.

Increased blood clotting can cause placental abruption, severe bleeding and fetal hypoxia.

It is important to conduct blood tests both during pregnancy planning and during gestation. The smallest deviations from the norm should alert the specialist. If necessary, assign additional research allowing to make the correct diagnosis and prescribe the correct treatment.

The norms of the coagulogram in children practically do not differ from those found in adults.

All data is entered into a table and analyzed. Only in rare cases It is difficult for doctors themselves to determine the presence of certain deviations.

Most often this occurs with chronic liver diseases and problems of the immune system.

The norms of the coagulogram in children 3-14 years old are presented in the table:

The analysis should be carried out in the following cases:

The interpretation of the analysis is carried out exclusively by the doctor. The specialist not only compares the indicators with the norm, but also takes into account other factors that may affect the distortion of the result.

As a result, the coagulogram allows you to identify the presence of vascular, inflammatory and autoimmune diseases.

A coagulogram is an important analysis that allows you to identify the first changes in blood coagulation. You can conduct a study in almost any laboratory, however, a detailed analysis requires additional equipment. During pregnancy, the delivery of a coagulogram is free of charge.

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