What does the prothrombin index show? Treatment of low prothrombin

It was developed in 1935 by American physician and researcher Armand James Quick. Much later, in the 80s of the 20th century, a calculated INR indicator was proposed to take into account the results of PT in patients receiving indirect anticoagulants. The ability to effectively control the action of indirect anticoagulants, primarily warfarin, has led to the demand and widespread this coagulation technique.

Principle of the method

PT is based on determining the coagulation time after adding thromboplastin to BTP. The latter is a procoagulant substance of biological origin, containing phospholipids and tissue factor. Induction of coagulation in the PT occurs due to the activation of proconvertin by tissue factor in the presence of phospholipids and Ca ++ ions.

Reagents and equipment

Thromboplastin-calcium reagent.
Physiological 0.9% sodium chloride solution (used for diluting BTP samples during research prothrombin activity according to Quick).
A sample of a normal FTP.
Coagulometer (if there is no coagulometer, use a water bath and a stopwatch).

Blood samples for research To determine PT, BTP is used. Features of the preparation of BTP samples are discussed in detail in Appendix 3.

Evaluation of the study results

Normal PT values are usually indicated by the manufacturer of the thromboplastin-calcium reagent, but this information should be used only as an approximate estimate of the normal range, since the results of the test depend on the technique of its implementation, the batch of the reagent and many other factors. To more effectively assess the results of PT, it is customary to use calculated indicators (CR, MHO, etc.) based on the results of determining PT in the test and control (normal) samples.

Prothrombin ratio (PR).

To calculate software use the following formula:

PT = PT(b) / PT(k), where PT(b) is the patient’s prothrombin time, PT(k) is the prothrombin time of a normal BTP.

The software does not take into account the ability of thromboplastins to interact differently with decarboxylated coagulation factors (PIVKA), so this indicator is only suitable for screening assessment of the external coagulation mechanism in patients not receiving indirect anticoagulants (with cirrhosis, disseminated intravascular coagulation syndrome, etc.). In contrast to the PT, the inter-run variation of thromboplastin does not have a significant effect on the results of calculating the PT.

Normally, software does not exceed 1.3. A decrease in this indicator to less than 0.8 often indicates defects in the preanalytical stage of the study or an error in measuring the PV of a sample of normal BTP.

International normalized ratio.

It is known that the hypocoagulative effect of indirect anticoagulants is based on the inhibition of vitamin K epoxide reductase (VKOR), which regulates the ability of glutamyl carboxylase to carboxylate factors of the prothrombin complex (II, VII, IX and X) and physiological anticoagulants (proteins C and S).

Prescribing indirect anticoagulants to a patient naturally leads to a violation external path coagulation, however, the degree of prolongation of PT significantly depends on the thromboplastin used. The calculated MHO indicator, adopted in 1983 by the WHO Committee for Standardization in Hematology, is intended to standardize the results of determining PT in patients receiving indirect anticoagulants. To calculate it, information about thromboplastin MIC is required.

MHO = (PO)mich, where PO is the prothrombin ratio, MICH is the international thromboplastin sensitivity index.

It is not customary to indicate the normal range of the MHO indicator, since this indicator is intended primarily for patients taking indirect anticoagulants. The therapeutic MHO interval for most clinical situations related to the need to prevent thrombotic disorders with indirect anticoagulants is in the range of 2-3. However, in some situations this range should be different. A decrease in this indicator to less than 0.8 often indicates defects in the preanalytical stage of the study or an error in measuring the PV of a sample of normal BTP.

Prothrombin activity index according to Quick.

Another test option is the determination of prothrombin activity according to Quick. The technique for determining this indicator does not differ from that when assessing PO and MHO, however, it is additionally necessary to measure PO in diluted samples of normal BTP. The results are obtained using a calibration graph reflecting the dependence of the coagulation time of normal BTP on the degree of its dilution. The prothrombin activity of undiluted normal pooled plasma is assessed as 100%, the clotting time of the same plasma, diluted 2 times, as 50%, 4 times - 25%, 8 times - 12.5%.

Prothrombin activity of plasma according to Quick is not considered a standardized indicator, therefore the results of the determination differ when using different thromboplastins. This indicator is suitable for assessing the external coagulation pathway in patients who do not receive indirect anticoagulants (with cirrhosis, disseminated intravascular coagulation syndrome, etc.).

In healthy individuals, the Quick index of plasma prothrombin activity depends on the type of thromboplastin used, the equipment used and other factors, so for each laboratory it is advisable to clarify the local normal range. An increase in this indicator by more than 120% often indicates defects in the preanalytical stage of the study or an error in measuring the PT of a sample of normal PRP.

Prothrombin index.

The prothrombin index is an outdated way of assessing the results of PT accounting. This indicator should not be used at this time.

Interpretation of research results

PT is one of basic methods studies of coagulation hemostasis. Prolongation of PT (increase in PO, MHO, decrease in prothrombin activity according to Quick) is observed with low activity or functional disability the following coagulation factors: VII, V, X, II and fibrinogen. That is why PT in patients with diseases of the liver and biliary tract often reveals dysfunction of the external coagulation mechanism. In addition, in the presence of inhibitors in the blood, consumption coagulopathy and the use of direct anticoagulants, this test also shows pathological values.

Congenital deficiencies of Stewart-Prower factor and prothrombin, as well as hypoproconvertinemia, vitamin K deficiency, hypo-, dys- and afibrinogenemia in clinical practice are very rare, but their existence should always be remembered when detecting an extended PT in a patient with hemorrhagic syndrome And normal function liver.

When treated with recombinant factor Vila, a significant shortening of PT occurs.

Standardization of PT is currently carried out on the basis of the results of determining PT in plasma samples containing PIVKA factors and calculating the thromboplastin MIC, so more or less reproducible results are obtained only when using the MHO indicator in patients using indirect anticoagulants. Unfortunately, for coagulopathies caused by insufficiency of coagulation factors I, I, V, VII, X, diseases of the liver and biliary tract, PT using thromboplastins different manufacturers(even when calculating MHO) varies significantly.

Causes of errors

Heparin from a venous catheter enters the test blood.
Hemolysis.
The use of the so-called prothrombin index and non-standardized thromboplastins causes gross errors in the interpretation of PT.
Lack or inefficiency of the system internal control quality.
Simultaneous use different indicators assessment of the results of PT (for example, MHO and plasma prothrombin activity according to Quick) in patients receiving indirect anticoagulants naturally leads to confusion when assessing the results. To control treatment indirect anticoagulants A mandatory and non-negotiable requirement is the calculation of the MHO indicator.

Other analytical technologies

To determine PT, various thromboplastins are used. These reagents differ significantly in their preparation technology, source of raw materials (rabbit brain, placenta, etc.), as well as in their ability to detect various defects in the external coagulation mechanism.

Another option for PT is the study of plasma according to Ouren. To implement this option for assessing the external coagulation pathway, coagulation factor V and fibrinogen are additionally added to the reagent, which eliminates the influence of these two components of the coagulation cascade on the results of PT.

Some special coagulometers implement technologies for determining the MHO indicator, based on the use of dry chemistry methods (INR detectors).

To detect the effects of lupus-type inhibitors, it is advisable to use diluted thromboplastin, which can coagulate normal PTP in 40-45 s.

A blood test for the prothrombin index (abbreviated as PTI) is very important indicator necessary for the initial diagnosis of bleeding disorders. It makes it possible to timely determine the patient’s predisposition to thrombosis and hemorrhage of different nature origin.

Any coagulation disorders (from the Latin coagulatio - thickening, coagulation) inevitably lead to the emergence and development of very life-threatening diseases. To determine the cause of the disease, confirm or exclude the diagnosis, the patient is prescribed a blood test for PTI. Norm of prothrombin index healthy person is its fairly stable indicator.

General information about prothrombin

Prothrombin called a special protein that is responsible for blood clotting. This substance, when damaged and wounded during the coagulation chain, is transformed into the most important component of this system - serine protease (thrombin). The wound is clogged with the resulting blood clot, which prevents large blood loss in the person.

A blood test, during which the prothrombin index is detected, determines the ratio of the blood clotting time of the patient and a healthy person. Based on the level of this index, experts estimate the concentration of prothrombin in the blood plasma. The analysis results are displayed as percentages.

Deviations of PTI from the norm in blood tests

With an increase in the prothrombin index, the risk of blood clots in blood vessels, veins and arteries increases, and with its deficiency, significant hemorrhages can occur.

Every person is obliged to be interested in the question of whether a blood test for PTI corresponds to the norm, especially after the age of forty. This helps to detect damage early and prevent the progression of deadly diseases. Lesions are the cause of thrombosis, strokes, heart attacks and other extremely serious diseases.

Deviations of the PTI indicator from the norm are most often associated with liver pathologies, since this is where the synthesis of this protein occurs. From which we can conclude that the analysis makes it possible not only to recognize blood disease, but also to diagnose liver disease. Before surgical intervention Patients are required to undergo a blood test for PTI.

Normal values

Specialists involved in decoding blood tests consider the norm for PTI in an adult to be from 78 to 142%. However, during therapy with some drugs, noticeable deviations may occur, but in such cases they can be considered normal.

The PTI rate in the blood test of women during pregnancy may also change, which will also not be a sign of the disease, but correction will be necessary.

Today, qualified doctors use the PTI table according to Quick to more accurately determine the blood clotting index. This graph is based on indicators of prothrombin activity in the blood of healthy people who were tested in different medical institutions, so it is considered a very reliable source.

In conclusion, it should be noted that the PTI norm in a blood test is approximately the same in men and women.

Why might the index be downgraded?

The coagulability index directly depends on the activity of prothrombin in the blood. If, when deciphering a biochemical blood test, the PTI norm is not maintained, and, say, its level is reduced, then there is a threat of severe hemorrhages. In particular, bleeding in the brain and abdominal cavity. A reduced prothrombin index is observed due to the following reasons:

Elevated prothrombin levels

Deviation from the norm of PTI in biochemical analysis blood in the upward direction indicates that the blood is clotting too quickly, which can lead to the formation of blood clots, which can disrupt blood flow and lead to serious consequences. An increase in PTI is observed due to the following reasons:

genetic factor in pathogenesis;
increased concentration of red blood cells;
malignant tumors and neoplasms;
heparin deficiency;
third trimester of pregnancy;
use of certain medications containing hormones.

Decoding the results

Today, there are several methods for determining deviations or norms of PTI when deciphering a blood test. For this reason, there is a risk of setting misdiagnosis, since indicators may vary depending on the laboratory.

An analysis to determine the activity of prothrombins in the blood must be deciphered by the attending physician, since only he can fully take into account everything possible factors, affecting the index.

Abroad, the PTI blood test has not been carried out for quite a long time; in countries with developed civilization, the international normalized ratio (INR) is used - a study of blood clotting. The data from this analysis is more accurate and has more standard forms of calculation. In this regard, in modern Russian clinics, instead of IPT, an INR study is carried out.

Be that as it may, determining the deviation of the prothrombin level from the norm using a PTI or INR blood test and making the correct diagnosis is the task of the attending physician.

Distinctive features of female analysis

Experts pay attention special attention on the concentration of prothrombin in the blood of pregnant women. A study on the prothrombin index should be carried out for every pregnant woman, since this way doctors will be able to timely detect any possible deviations. If suddenly expectant mother If deviations of the PTI indicator from the norm are detected in the blood test, the doctor will prescribe corrective drug therapy for her.

But, unfortunately, many pregnant women do not take into account the doctor’s order to undergo an IPT test. They believe that this indicator is completely unimportant for health, since they feel great. But as a rule, statistics most often show the opposite. According to its results, about 10% of pregnant women who did not test for prothrombin activity in the blood, unfortunately, died during childbirth from sudden onset of severe hemorrhages or due to a blood clot.

In what cases is it necessary to take the test regularly?

A blood test for the prothrombin index is most often prescribed before surgery and during pregnancy. But there are patients who need to be tested regularly in order to monitor the effectiveness of therapy. These include:

People with diseases of the cardiovascular system.
Patients with a cardiac implant.
Patients who have been diagnosed with atherosclerosis.
People who suffer from varicose veins.

The prothrombin index must be monitored for women and men over 50 years of age, since they belong to a special risk group for the occurrence of cardiovascular diseases. Timely diagnosis of these diseases can save the life of an elderly person. Today in our country, about 70% of older people die from stroke and heart attack.

Also, PTI levels should be regularly checked in patients suffering from the following diseases:

Hepatitis.
Post-stroke and post-infarction condition.
Gynecological diseases.
Oncological diseases.
Hereditary coagulation disorders.
Cirrhosis.
Thromboembolism.

In addition, the level of PTI must be monitored during the course of hormonal and heparin treatment. Drugs of these groups can have a strong effect on blood clotting. Uncontrolled use of these medications can lead to life-threatening consequences. Do not forget that any medication must be taken strictly as prescribed by the attending physician, even if we are talking about traditional medicine.

Rules for taking a blood test for IPT

As with any blood test, the material for this study must be submitted to morning time days and on an empty stomach. During the week before blood sampling, you should exclude alcoholic beverages and fatty foods from your diet.

Immediately before the pick-up, you should not drink coffee or tea, and it is also strongly recommended not to smoke. You also need to be in a balanced state and not be nervous. The listed factors can influence the results of the analysis. The use of any medications, and even herbal teas, must be reported to your doctor.

If any deviations from the norm are detected, the specialist will prescribe additional research, which should help determine the cause of the bleeding disorder.

It is worth remembering that deviations in the prothrombin index are not independent diseases; they are just the body’s reaction to pathogenic process. Determining the root cause of the deviation is very important for prescribing appropriate treatment. The results of the analysis should only be deciphered by the attending physician.

Laboratory testing is an important area of diagnostic medicine. Various tests make it possible to determine whether everything in the body is functioning normally, make it possible to promptly recognize any disturbances in the functioning of organs and systems, and even understand the cause of their occurrence. Today there are many varieties laboratory research, and understanding their diversity can be difficult for an ordinary person. And today we will look at what the Quick test for prothrombin is, what it is, we will answer the question, what is the norm for this study, and what does it mean if this indicator decreased or increased.

A blood test for prothrombin is one way to determine the ability of blood to clot. Comprehensive analysis Doctors call this indicator a coagulogram.

What is the Quick prothrombin test??

In order to understand what such a study is, you first need to determine what prothrombin is. So, this term refers to a special protein compound that takes part in the processes of blood clotting. Prothrombin is produced in our body by the liver with the participation of a number of substances, among which is vitamin K.

The prothrombin test allows you to determine the level of blood clotting, and the Quick test is considered the most accurate and at the same time universal diagnostic method. When executing this test Laboratory technicians evaluate the activity of prothrombin in a blood sample taken from the patient, comparing it with the activity of this compound in a control sample.

Carrying out such a study allows you to determine not only the level of blood clotting, but also allows you to study the activity digestive tract, as well as the liver. The result of the Quick analysis is expressed as a percentage.

When might such a study be needed??

A blood test for prothrombin according to Quick is performed when:

Blood clotting disorders;
- liver diseases;
- antiphospholipid syndrome(for diagnosing increased thrombus formation caused by autoimmune disorders);
- blood oncology;
- disorders of vitamin K synthesis.

Sometimes a Kwik blood test is performed to monitor the coagulation system during the period when the patient is taking anticoagulant drugs, for example, Warfarin or Heparin, etc.

Norm of prothrombin according to Quick

Doctors claim that the extreme values of this study should be considered minimum indicator at 78% and the maximum at 142%. There is also a gradation of norms for different ages.

So, in childhood up to six years, the norm is considered to be 80–100%.

For children from 6 to 12 years old – from 79 to 102%.
For teenagers from 12 to 18 years old – 78 – 110%.
For adults from 18 to 25 years old – 82 – 115%.
For adults from 25 to 45 years old – 78 – 135%.
For adults from 45 to 65 years old – from 78 to 142%.

Decreased prothrombin

A decrease in prothrombin level according to the results of the Quick study may indicate excessively rapid formation of blood clots. This phenomenon can be explained:

Pregnancy and the period after childbirth;
- vein thrombosis;
- penetration of thromboplastin into blood vessels against the background of tissue damage;
- high blood viscosity (this condition is also classified as polycythemia);
- taking certain medications that increase blood thickness.

With a decrease in prothrombin according to Quick, the patient's blood clots faster than the control plasma sample.

What does an increase in prothrombin level according to Quick mean??

This phenomenon can be observed in a number of pathological conditions, namely when:

Congenital deficiency of certain coagulation factors;
- deficiency of coagulation factors resulting from liver diseases, as well as amyloidosis or nephrotic syndrome;
- deficiency of coagulation factors due to the presence of antibodies to such factors;
- decreased activity of vitamin K;
- DIC syndrome, which stands for disseminated intravascular coagulation;
- consumption of a number of medications, including anticoagulants, coagulation inhibitors, anabolic steroids, antibiotics, acetylsalicylic acid, laxatives, methotrexate, nicotinic acid, diuretics;
- ailments of fibrin functioning.

When prothrombin increases above normal, the patient's blood clotting occurs more slowly than in the control sample.

Features of prothrombin level according to Quick during pregnancy

When carrying a child, the level of prothrombin according to Quick naturally decreases somewhat, in other words, the coagulation system works more actively. This is explained by the emergence in female body a new circle of blood circulation and gradual preparation of the body for childbirth and possible blood loss.

But at the same time, an excessive decrease in the level of prothrombin poses a threat of thrombosis, and a significant increase in this indicator increases the likelihood of severe bleeding during childbirth (even internal). Therefore, the coagulogram as a whole and the prothrombin level are important diagnostic studies during pregnancy.

In order for the study on prothrombin levels to be truly informative, it is important to adhere to basic rules: avoid consuming fatty and fried foods the day before donating blood and do not eat for at least six hours before the test.

What is it? Prothrombin is a protein involved in the blood clotting mechanism; its synthesis occurs in the liver with the participation of vitamin K. Clotting involves the transition of blood from a liquid to a thick state.

To function comfortably in the body, blood must have a liquid consistency. When blood vessels are damaged, a process of coagulation—thickening—must occur. The body cannot lose a large volume of blood and clog the vessels with numerous blood clots.

Laboratory analysis for prothrombin allows you to assess the quality of the coagulation mechanism.

Like any analysis, a prothrombin test is taken on an empty stomach. Patient who cannot perform this condition for health reasons, eats 4-5 hours before the procedure.

Drugs that affect blood clotting cannot be taken before the test - the results will be far from the truth.

If you refuse medicine If it doesn’t work, notify your doctor about taking it.

An analysis of the quality of blood clotting is necessary when the following diseases and suspicion of their presence:

Antiphospholipid syndrome in pregnant women (it manifests itself as miscarriages, frozen pregnancies, placental insufficiency and other obstetric complications);
Liver pathologies;
Atherosclerosis, varicose veins;
Imbalance of vitamin K in the body;
Presence of autoimmune diseases;
Long-term use of indirect anticoagulants.

The prothrommin test may also be prescribed for other diseases to screen for coagulation. Under a microscope, the natural mechanism of blood clotting is recreated.

Potassium ions and thromboplastin are added to recalcified plasma. Prothrombin complex has several coagulation factors - analysis allows us to identify a deficiency or surplus of such factors.

Prothrombin time - what is it? (norm)

Prothrombin time is the period of blood clotting from the moment a mixture of potassium and thromboplastin is added to the plasma. Thromboplastin, used in laboratories, has a certain level of sensitivity to factors II, V, VII and X.

The normal prothrombin time is from 11 to 16 seconds, but the activity of the substance may vary depending on the sample. Accordingly, draw conclusions by comparing general meaning The result in seconds is incorrect. A relative assessment is required.

Prothrombin index - what is it? (norm)

The prothrombin index is the ratio of the fixed normal blood clotting time to the patient’s individual indicator. The prothrombin index can be determined more accurately using the INR (international normalized ratio) analysis.

The prothrombin index mathematically corrects the prothrombin time. The individual result in seconds is divided by the fixed norm of a healthy person and multiplied by the sensitivity coefficient of the taken thromboplastin. The number of the latter is from 1 to 3; it can be found in the universal international classification.

Remember, when determining the prothrombin index: the norm for women and men is the same - from 0.8 to 1.3. But the rate may vary depending on age and health status.

The results of the preoperative study should not go beyond 0.85 - 1.25. An indicator of 3.0 - 4.0 is observed in a patient who has suffered a myocardial infarction or suffers from serious cardiovascular diseases.

The normal prothrombin index is 2.0 – 3.0 in the case of:

Heart valve defects;
Chronic atrial fibrillation and taking Warfarin against its background;
Treatment of venous thrombosis and prevention of deep vessel thrombosis after surgery;
Implantation of mitral and aortic valve prosthesis;
Treatment of thromboembolism in the pulmonary artery area.

A prothrombin index according to INR above 6.0 requires urgent hospitalization of the patient. This coefficient indicates high risk internal bleeding in various locations.

The situation becomes more complicated if the person has already had ulcerative lesions gastrointestinal tract, renal failure, hypertension and blood flow disorders in the brain. In this case, the potential risk of hemorrhagic (bleeding-related) infarctions in organs increases.

If unsatisfactory results of the analysis using the INR system are obtained, a repeat study is not required (the result is very sensitive and reliable). The index values do not differ depending on the type of laboratory material taken (capillary, venous blood).

The prothrombin index is calculated taking into account the sensitivity of thromboplastin to blood clotting factors.

Prothrombin according to Quick - what is it? (decreased, increased and normal)

For several decades now laboratory conditions prothrombin is calculated according to Quick. What is it? This is the percentage expression of prothrombin activity. The scientist proposed to compare the patient’s prothrombin time with the indicator of the dependence of this period of time on the number of prothrombin complex factors in the taken plasma. The result is a percentage.

The construction of the dependence allows you to very accurately estimate the coagulation index, but the sensitivity coefficient of thromboplastin is not taken into account.

This feature of the test affects the quality of the result in the area of critical values below and above the norm. In standard results and minor deviations from them, the INR and Quick index are directly proportional.

The test results card in any laboratory will contain prothrombin according to Quick. The norm is in the range of 78% - 142%. The indicator may be slightly higher than the average, but it should be within normal percentages.

In a healthy body, blood clotting is often increased - hypercoagulation is observed. This process is considered normal until a person develops any vascular diseases or chronic tissue damage. Their presence becomes a risk of blood clots.

Regular screening is necessary after blood thinning medications are prescribed. In some cases, a depot (the stage of accumulation of a substance) can form in the body from these drugs, which will lead to a state of hypocoagulation with increased bleeding.

In addition, the analysis results may also show the opposite process - hypercoagulation (increased coagulation activity). Indicators of insufficient blood thickness are observed much less frequently than excess blood density.

However, any pathology of prothrombin factors requires control or even treatment.

Increased prothrombin in men and women

Prothrombin in men and women over 45-50 years of age is often increased - more than 142% according to Quick. Hypercoagulation can be caused both by the presence of vascular diseases and by temporary factors. The latter include:

Imbalance of vitamin K, which interferes with the proper synthesis of prothrombin in the liver, where it is normally formed;
Chronic liver diseases and disorders of its functioning, which also interfere with the normal synthesis of prothrombin;
Congenital anomalies: deficiency of blood coagulation factors II, V, VII, X;
The presence of a heparin inhibitor in the coagulation mechanism;
Nephrotic syndrome, amyloidosis (deposition of a special pathological protein in organs);
Taking antiseptic, laxatives, anabolic drugs, hormonal drugs, nicotine and acetylsalicylic acid, quinine, quinidine.

Increased prothrombin not due to the above factors indicates the presence of serious illnesses. So, diagnostic search is based on the following nosologies:

Thromboembolism (blockage of blood vessels with blood clots);
Polycythemia (increased number of red blood cells in the blood, including in connection with oncological processes);
Oncological diseases: leukemia, cancerous tumors various localizations;
Pre-infarction state of the body;
Myocardial infarction.

Prothrombin in women may be increased due to long-term use hormonal contraceptives, especially with an increased dosage of the estrogen component (from 30 to 50 mcg in 1 tablet).

If the patient has serious vascular disease, birth control pills should be discontinued. Possible transition to hormonal drugs local impact(suppositories, vaginal ring).

Diet does not significantly affect blood clotting. You can reduce the Kwik score by several percent by adding daily menu"oxidizing" products. Improved results causes dietary deficiency fermented milk products, red and black berries, citrus fruits, fatty fish and the volume of water drunk.

Low prothrombin - what does it mean?

Low prothrombin is observed during hypocoagulation. This result indicates the body’s tendency to internal bleeding. A deficiency of coagulation factors occurs in the following situations:

Vitamin K deficiency is a violation of prothrombin synthesis;
Congenital deficiency of certain factors regulating processes in the blood;
Pathologies of the liver that interfere with the normal synthesis of coagulation factors;
Lack of fibrinogen in the blood (congenital and acquired);
Taking medications that reduce the blood's ability to clot.

Low rate prothrombin indicates diseases:

Dysbacteriosis;
Pathologies of the gastrointestinal tract;
Prothrombin deficiency;
Hypovitaminosis.

You can correct a slightly reduced prothrombin level with the help of foods containing vitamin K. Cabbage, carrots, bananas, apples, pears, spinach and lettuce will be useful.

The reason for poor results in diet concerns men more often than women. It is the male gender that prefers meat products vegetables. As a result of such addictions, a deficiency of vitamins appears in the body.

Prothrombin during pregnancy

For pregnant women, a test for prothrombin index is done in mandatory. During childbirth, a low reading can lead to heavy bleeding, and a high reading can lead to premature contractions and even late miscarriage.

Therefore, it is very important to evaluate this indicator during gestation, especially if there are various complications both during this pregnancy and during the previous one.

During gestation, a blood test for the prothrombin index is taken at least 3 times (once per trimester). If the expectant mother is diagnosed with significant abnormalities, it is necessary to do a clotting test more often. The rate of prothrombin in the blood of women during pregnancy is lower than usual - from 70% to 120%.

Disturbances in the blood clotting mechanism of pregnant women are indicated by:

Varicose veins on the limbs;
Bleeding and appearance noticeable bruises after minor damage;
Improper liver function;
A long period of lack of results when trying to conceive;
Conception through the IVF procedure;
Multiple pregnancy;
Fetal development lags behind norms;
Drinking alcohol, smoking by the expectant mother;
Long-term treatment with anticoagulants;
Multiple miscarriages.

Since prothrombin according to Quick decreases during pregnancy, the INR index also decreases. Changes are especially noticeable in the second trimester of gestation. Until the 13th week, the coefficient should correspond to the norm: from 0.8 to 1.3. Then the indicator decreases:

From the 14th to the 20th week, the prothrombin index according to INR ranges from 0.55 to 1.1;
From the 21st to the 28th week, the indicator can decrease to 0.5, but cannot exceed 1.15;
From the 29th to the 35th week the result is 0.6 – 1.17;
From the 36th to the 42nd week the index is from 0.55 to 1.15.

In the case of pregnant women, the INR indexing method is preferred. The indicators are quite low, and the Quick method produces errors at critical values.

Source: https://zdrav-lab.com/prothrombin-norma/

Prothrombin: normal

IN human body There is a constant movement of blood - a life-giving fluid that provides nutrition to all cells of the body and metabolism. The length of the vessels is thousands of kilometers, and their area is more than half a hectare. It is impossible to imagine how all this fits in the body of an adult.

But the amount of life-giving fluid is small: for men - a little more than five liters, and for women - about four.

Therefore, when injuries or cuts disrupt the integrity of the circulatory system, its contents can quickly spill out, threatening the person with death.

If blood loss is not prevented, the main transport link that nourishes the entire body will cease to exist.

To prevent this from happening, nature has created a system responsible for blood clotting. She is the one who can launch defense mechanisms, closing the wound and preventing blood from leaving the vessels.

The value of prothrombin in the body

Part of this system are special plasma proteins called blood clotting factors. They are designated by Roman numerals from I to XIII. Prothrombin is one of the main components. This protein is blood clotting factor II.

The name “prothrombin” suggests that it is a precursor to thrombin, an active enzyme. With its assistance, a clot (thrombus) is formed, closing the wound and stopping blood loss.

A normal level of prothrombin indicates that the blood clotting process is working efficiently and the body will be able to stop the loss of this life-giving fluid in time.

Protein testing is not performed as often as clinical blood testing. This procedure is not simple and is prescribed only in cases of extreme necessity, for example in case of blood diseases or problems with blood clotting.

Determination of prothrombin level – the most important test as part of a hemostasiogram.

Norm of prothrombin

Prothrombin molecules disintegrate very easily and quickly. It is difficult to separate them from other proteins, which makes determining its level much more difficult. For qualitative analysis Several methods are used.

Prothrombin according to Quick. Today this method is generally accepted and widespread. This technique involves calculating the level of a substance as a percentage of permissible quantity. The following values (%) are considered optimal:
- minimum – 70;
- maximum – 120.
The indicator allows you to determine the activity of the thrombosed plasma complex in comparison with various dilutions of the patient’s plasma. A graph of changes in prothrombin is drawn up, which is based on data on blood clotting time.

Experts consider the Quick analysis to be the most accurate when low prothrombin levels are recorded.
Prothrombin index– also determined as a percentage. Normal indicator is within the following limits (%):
- minimum – 95;
- maximum – 105.
The results of the two tests above may be the same if prothrombin is normal. But when its value is lower than optimal, they diverge significantly. The index is highly dependent on the sensitivity of the chemical reagents used in testing.
Prothrombin time– shows how many seconds it takes the plasma to coagulate after adding a special mixture to it.
The final test data depends on age. In newborn babies, blood clotting time can range from 14 to 18 seconds. And these indicators are normal. In adults, a period of 10 to 15 seconds is considered optimal.
International normalized ratio - INR. This method is additional and is used to monitor the results of the prothrombin test.
The results of such a test allow the doctor to monitor the effectiveness of treatment with anticoagulants - synthetic substances that reduce the level of prothrombin in the blood and slow down its clotting.

These drugs are used in the treatment of thrombophlebitis, thrombosis, that is, diseases that form dangerous blood clots in the venous vessels.

The normal INR is 0.85–1.15.

When treating diseases such as pulmonary embolism, venous thrombosis, or there are pathologies of the heart valves, the permissible limits increase to 3.0.

Indications for prothrombin test

A blood test for prothrombin may be prescribed by a doctor in the following cases:

the patient has bleeding that does not stop for too long (this clearly indicates that blood clotting is below normal levels);
the performance of liver enzymes and the liver in general decreases;
to monitor clotting during long-term use anticoagulants;
for antiphospholipid syndrome in order to clarify the cause of the disease;
if there are diseases that are accompanied by a lack of vitamin K in the body.

Some indirect reasons requiring a prothrombin test are exclusively individual character. Most often, the study is prescribed to representatives of the fair sex between the ages of 50 and 60. It is at this time that hormonal changes occur, causing change in the composition and structure of blood.

The following doctors can prescribe an analysis:

therapist;
traumatologist;
surgeon;
cardiologist;
anesthesiologist-resuscitator;
pulmonologist;
pediatrician.

Blood from a vein is used for the study. To ensure that the results are as correct as possible, you must follow the standard rules before the study:

dinner no later than eight o'clock in the evening, at least 12 hours before testing;
Before the study, be sure to get your nerves in order and not overexert yourself physically;
Do not smoke on the day of the test and do not drink strong drinks.

As usual, blood is donated in the morning on an empty stomach. Need to inform medical staff about all medications taken in the last 24 hours.

Prothrombin is increased

An increased level of prothrombin in the blood indicates that blood clotting is greater than normal. This means that it becomes too viscous, which impedes blood circulation and leads to blockage of blood vessels.

The following ailments can provoke an increase in prothrombin levels, and therefore blood clotting:

malignant neoplasms;
liver pathologies;
thromboembolism;
polycythemia;
progressive angina.

An increase in the amount of protein can also be caused by the following factors:

an excess of vitamin K in the body, with the help of which prothrombin is produced;
use of anticoagulants, antibiotics in therapy, nicotinic acid, hormonal contraception. Excessive use aspirin, anabolic steroids, laxatives can also affect the growth of prothrombin.

Quite often, the protein content increases during pregnancy. Most often it appears in the last trimester and does not require treatment.

Prothrombin is reduced: reasons

A reduced level of prothrombin is dangerous because even a minor injury that damages a blood vessel can result in significant blood loss. After all, the formation of a blood clot occurs more slowly than it should.

A decrease in prothrombin levels is provoked by the following reasons:

Certain liver pathologies, although most of them are accompanied by an increase in protein. The prothrombin content decreases during acute and chronic forms hepatitis. Liver cirrhosis has a similar effect.
Insufficient synthesis of vitamin K by the body. This process develops most often due to gastrointestinal ailments and dysbiosis.
Deficiency of fibrinogen, a protein that is produced in the liver and then converted into fibrin, which is the basis of the clot during blood clotting. Such a deficiency can be either congenital or acquired.
Admission to medicinal purposes drugs that promote blood clotting.

It is possible to bring the prothrombin level back to normal, but anything should be done only after consulting a specialist.

Therapy is aimed at eliminating the ailments that caused the problem. Quite often, the basis of treatment is a special diet.

Source: http://OnWomen.ru/prothrombin.html

Prothrombin (according to Quick) and prothrombin index, normal

The prothrombin test is part of the blood clotting test - coagulogram.

In addition to the activity of this protein, indicators such as PI (prothrombin index, or PTI) and PT (prothrombin time) are also determined, allowing one to evaluate the rate of coagulation.

The normal values of prothrombin in women, men and children, as well as the reasons for their deviation from the norm, are described in detail below.

Prothrombin - what is it?

Prothrombin is a high molecular weight protein compound involved in blood clotting. Its production occurs in the liver in the presence of many substances. In particular, vitamin K, deficiency of which leads to the synthesis of incorrect prothrombin molecules - they form blood clots that disrupt blood flow and can be fatal.

A prothrombin test is needed to assess blood clotting, and the most accurate and universal test method is PC - prothrombin according to Quick. What is it? This test detects the activity of prothrombin in the patient's blood compared to that in a control portion of plasma. This is the ratio of the patient's plasma clotting time to the time of this process in the sample.

The analysis is named after the scientist A. Quick, who proposed this method. In the results of the Quick prothrombin test, it is expressed as a percentage. In international nomenclature it is given the number II, since it was discovered second after fibrinogen.

The Quick analysis is used not only to assess the activity of blood clotting elements, but also to study the functioning of the gastrointestinal tract and liver. The PC test is more universal compared to the prothrombin time and prothrombin index tests.

List of indications to carry out the prothrombin analysis according to Quick:

impaired blood clotting;
liver diseases;
antiphospholipid syndrome - increased thrombus formation due to autoimmune causes;
blood cancer;
pathologies in which the production of vitamin K is impaired (blockage of the bile ducts, poor digestibility of food in the intestines, etc.).

Help: Vitamin K is produced by bacteria in the intestines and is actively involved in the formation of prothrombin. Both its deficiency and its excess negatively affect the rate of blood clotting.

A PC test is necessary to monitor the hemocoagulation system during the use of anticoagulants - Heparin, Warfarin and others. The structure of the blood and its composition also change with the onset of menopause in women (after 45 years), which is a risk factor for the development cancer diseases. Therefore, at this age it is especially important to regularly get tested for prothrombin.

Prothrombin time - what is it?

Depending on the causes of bleeding, blood can begin to clot along two routes - internal or external. The first is activated if the vessels are damaged externally - as a result of a bruise, cut, scratch, bite, or abrasion. The internal path works when the integrity of the wall blood vessel was damaged from the inside - under the influence of toxins, pathogenic microorganisms, antibodies.

Prothrombin time is an indicator reflecting the work of the internal pathway in the hemocoagulation system.

It reflects the effectiveness of “repairing” vessels that have been damaged by compounds circulating through the bloodstream. In test results, prothrombin time may be referred to as PT, ecombipl RT or RT.

Prothrombin time is increased, compared to the norm, in the following conditions:

lack of vitamin K;
initial stage of DIC syndrome;
liver pathologies;
taking drugs from the group of anticoagulants - Thromboassa, Aggregal, Warfarin, Heparin and others;
hemorrhagic diathesis of newborns;
inflammation and blockage of the biliary tract;
Zollinger-Ellison syndrome;
impaired absorption of fats in the intestines;
deficiency of coagulation factors - fibrinogen, prothrombin, AC globulin, proconvertin and Stewart-Prower factor.

The lower the concentration of prothrombin in the blood, the higher the prothrombin time, because the blood clotting process occurs more slowly.

Prothrombin time is decreased, if the following conditions occur:

pregnancy;
DIC syndrome;
high levels of antithrombin-III and other anticoagulants produced by the body;
deviation from the norm of hematocrit - the ratio of the volume of blood cells to the volume of plasma.

Low prothrombin time during the test may be due to long storage plasma before the study and irregularities during blood collection.

Prothrombin index

The prothrombin index is an indicator that reflects the rate at which blood clotting starts. inner path. It is calculated on the basis of prothrombin time, so its increase is observed with the same disorders in the body as an increase in PT, as well as a decrease.

To determine the PTI, the patient's plasma clotting time is divided by this value in the control sample. Normally, the result should be 95-105%.

The accuracy of the prothrombin index test depends on the sensitivity of the drugs used in the laboratory. Therefore, it cannot be called universal, unlike the Quick prothrombin test.

Increased prothrombin

If the Quick prothrombin test is elevated and shows high values (up to 150% or more), the reason for this may be:

DIC syndrome;
cholestasis and other diseases that reduce the activity of vitamin K;
diseases that impair the functioning of fibrin;
hereditary and acquired pathologies leading to a deficiency of coagulation factors (amyloidosis, liver disease, nephrotic syndrome).

Increased prothrombin also appears with long-term use drugs:

antibiotics;
diuretics;
Aspirin;
indirect anticoagulants;
anabolic steroids;
Methotrexate;
laxatives;
nicotinic acid;
Heparin and other clotting inhibitors.

Prothrombin norm, table

The extreme values of PC are figures below 78 and above 142%. Prothrombin standards according to Quick are presented in the table.

Norms of prothrombin in men and women of the same age group do not differ. Normal prothrombin time values for both sexes are 9-12 seconds. The rate of prothrombin in the blood of women expecting a child is slightly higher than normal values.

Low prothrombin

Low prothrombin according to Quick always indicates excessive rapid education blood clots and can be triggered by conditions such as:

pregnancy and postpartum period;
vein thrombosis;
penetration of thromboplastin into blood vessels due to tissue damage;
high blood viscosity (polycythemia).

The decrease in PC can be explained by this dependence - the activity of the prothrombin protein is high, the blood clots faster compared to the control plasma sample, therefore the Quick test for prothrombin is lower than normal.

Low prothrombin according to Quick can also be caused by taking Mercaptopurine, hormonal contraceptives and other drugs that increase blood density.

Prothrombin during pregnancy

A coagulogram is a mandatory part of the tests for pregnant women. Evaluation of this study, including prothrombin tests, allows for the timely identification of conditions dangerous to the health of the child and the expectant mother.

Prothrombin according to Quick during pregnancy is normally slightly reduced, that is, the activity of the coagulation system increases. This is due to the emergence of a new circle of blood circulation and the preparation of the body for upcoming birth and possible blood loss.

A very low PC can provoke the development of thrombosis, and its increase in pregnant women can cause heavy bleeding during childbirth, including internal labor.

Severe bleeding due to incompatibility of the Rh factor of the woman and the fetus can cause hemolytic shock due to the mixing of the blood of mother and child. This is one of common reasons postpartum mortality.

To avoid this, in this situation, not only monitor and control the state of the coagulation system, but also introduce immunoglobulins at 28 weeks of pregnancy, which destroy potentially dangerous antibodies.

The normal prothrombin index for women carrying a child is 80-100%. When its values are high, in order to avoid thrombosis and other complications, drugs that reduce increased activity coagulability.
Low PI, on the contrary, carries a risk of bleeding. The normal value of prothrombin time for pregnant women is 11-18 seconds. During pregnancy, any deviation from the norm in the coagulogram is a reason for thorough examination and in most cases - hospitalization.

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Prothrombin is normal

It is very difficult for a person far from medicine to assess what a blood test that is completely incomprehensible at first glance can tell a specialist. In fact, each indicator allows you to obtain a fairly large amount of useful information.

For example, prothrombin is vital important protein. Checking whether prothrombin is normal is not carried out as often as, for example, a general blood test.

This is a rather complex study, which is why it is prescribed in special cases: for screening tests, blood diseases, clotting problems.

What is the normal level of prothrombin in the blood?

There are several different tests for prothrombin:

Prothrombin according to Quick allows you to determine the level of protein activity.
Knowing the prothrombin time, you can determine how many seconds it takes the patient’s blood to clot.
The prothrombin index, or abbreviated as PTI, is the ratio of normal prothrombin time to the parameters of the patient being examined.
INR - international normalized ratio - is the opposite of PTI. It shows the ratio of the patient's prothrombin time to normal value prothrombin.

The most informative and effective studies are those that determine the prothrombin index and prothrombin according to Quick:

The normal value of prothrombin in the blood according to Quick ranges from 78 to 142 percent.
The PTI value may vary depending on the sensitivity of the reagents used for the study, but ideally it should be 95-105%.

For both men and women, the prothrombin rate remains the same. Any deviations from the norm are a cause for concern. Can contribute to an increase or decrease in prothrombin levels various diseases, some of which represent serious threat for health.

What causes the level of prothrombin in the blood to be higher than normal?

Too much large number prothrombin in the blood is a symptom of increased blood clotting. The following factors can provoke this:

The production of prothrombin is associated with vitamin K. Increased quantity This protein in the blood indicates an excess of the vitamin.
A large amount of prothrombin can be observed in malignant tumors.
An excess of the norm in the blood test for prothrombin is observed in patients in a pre-infarction state.
It is very common for protein levels to jump during pregnancy. Especially in the later stages.
Prothrombin may also increase in patients suffering from liver problems.
Sometimes excess protein norm occurs due to the use of Aspirin, hormonal contraceptives, diuretics, corticosteroids, anabolic steroids, and laxatives.
Thromboembolism and polycythemia cause an increase in prothrombin.

Why is prothrombin below normal?

A decrease in prothrombin does not have a very good effect on health either. It is caused by the following reasons:

Some liver diseases contribute to an increase in prothrombin, but in acute and chronic forms of hepatitis or cirrhosis, the protein decreases.
A prothrombin test will show a value below normal if the patient is taking drugs that increase clotting.
The level of prothrombin decreases with vitamin K deficiency. Most often, the problem develops against the background of dysbiosis and diseases of the gastrointestinal tract.
A lack of fibrinogen negatively affects test results. Moreover, deficiency can be congenital or acquired.

It is possible to normalize prothrombin levels, but it is better to discuss treatment methods with a specialist. Treatment course depends on the cause of the problem. In most cases, the patient is offered special diet. Often, special medications are required for recovery.

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Prothrombin is found in blood plasma and has a decisive influence in the process of blood clotting (another name is coagulation). Therefore, deviations of prothrombin from the norm cause increased bleeding or, conversely, indicate a risk of thrombosis. It is very important for doctors to know about this possibility if surgery is necessary, as well as when prescribing medications that affect blood clotting. Doctors also use this indicator to judge the state of the liver and gastrointestinal tract.

Prothrombin is a complex glycoprotein molecule. The decoding of this term is simple - glucose plus protein, in other words: a complex that combines carbohydrates and proteins. Prothrombin is a component that is activated on one of the initial stages after damage to body tissues that causes bleeding. The stages of blood clotting are as follows:

After vascular damage, platelets are activated and adhere to damaged tissues, stick to each other, forming a platelet plug.
At the same time, platelets begin to secrete substances that make the plug more dense.
At the same time, prothrombin is activated.
Thrombin is formed from prothrombin, which is synthesized under the action of a specific enzyme called prothrombinase.
Thrombin then produces fibrin from fibrinogen.
Fibrin, together with platelets contained in the blood, forms a blood clot.

Based on this, it is obvious that prothrombin deficiency increases bleeding time. The lack of this component is caused mainly by a deficiency of vitamin K, which plays important role in the process of prothrombin synthesis by liver cells. Vitamin K deficiency can be caused by various circumstances, and is often accompanied by impaired bile production, which signals problems in the liver. Among the main causes of vitamin K deficiency is impaired absorption or impaired synthesis by intestinal microflora.

It is worth noting that the lack of prothrombin can be explained by other reasons. For example, substances that counteract blood clotting, treatment with indirect anticoagulants, insufficient bile supply.

How the analysis is carried out

If we talk about such a thing as prothrombin time (PTT), then you should know that this is the name of a blood test that measures the time it takes for plasma (the liquid part of the blood) to coagulate, that is, to coagulate or thicken.

Prothrombin time is measured to measure the blood's ability to form clots. Knowledge about it is directly related to the prescription of the dose of anticoagulants, the degree of liver damage and the amount of vitamin K in the body.

The essence of the analysis is as follows: when a blood vessel is damaged, the body activates the blood clotting mechanism, which stops the bleeding. The coagulation process involves special proteins called coagulation factors, whose task is to promote coagulation. The PTT test accurately measures the ability of these substances to affect blood clotting.

A PTT blood test is carried out like a regular blood test: the material is collected in a tube and analyzed. The technician then adds various chemicals to the blood sample. The time that passes from the start of adding reagents to the thickening of the blood is called prothrombin time.

The American biochemist Armand James Quick is related to the existence of this type of research. At the beginning of the last century, Quick studied the biochemistry of processes in the liver, in particular, what effect vitamin K and anticoagulants have on its work. As a result, he determined the norms of hemostasis (the process of stopping bleeding). In 1935, Quick published the prothrombin time (PTT) technique that later bore his name (the test is now known as the Quick test).

Features of the analysis

The interpretation of the prothrombin test largely depends on the laboratory in which it was performed. prothrombin test. Prothrombin time is usually related to the international normalized ratio (INR), which is 0.8-1.2. INR is calculated as the ratio of direct proportionality of the prothrombin time obtained in the test to the normal prothrombin time in a healthy person (INR = PTT test / PTT norms).

For men and women, the prothrombin rate is the same and ranges from 12.7 to 15.4 seconds. In pregnant women, the PTV transcript shows a faster rate of blood clotting:

First trimester – 9.7-13.5 seconds.
Second trimester – 9.5-13.4 seconds.
Third trimester – 9.6-12.9 seconds.

The increase in clotting rate during pregnancy is explained by the fact that by this method the body reduces blood loss, which is always observed during childbirth. But on the other hand, this leads to the formation of blood clots in the veins of the legs and pelvis. Fortunately, statistics show that blood clots are rarely a concern during pregnancy: there are only 1-2 cases per 1000 women giving birth, which means there is no need to panic, unless, of course, the woman is at risk.

The formation of a blood clot in women during pregnancy is most likely in the following situations:

During the first trimester of pregnancy or first three months after birth.
If you have close relatives with thrombosis.
Mutations of the prothrombin gene.
The woman smokes or is constantly exposed to tobacco smoke.
Age over 35 years.
Overweight.
Frequent trips to other cities during pregnancy.
Expecting twins or triplets.
Sedentary lifestyle.
The previous birth was a cesarean section.

The appearance of blood clots in the veins during pregnancy is indicated by symptoms such as a feeling of swelling and distension in one or both legs, increased pain while walking. It may also be observed varicose veins veins in the legs (that is, they become enlarged).

The presence of such symptoms during pregnancy means that the woman must follow all the doctor’s instructions. Otherwise, complications are possible: blood thickening and a blood clot in the placenta, miscarriage, pulmonary embolism, heart attack.

Considering dire consequences, women are often interested in how to avoid blood clots during pregnancy. Doctors recommend paying special attention healthy image life, follow the recommendations for pregnant women physical activity and exercises. It is also important to comply healthy diet, and of course, be regularly examined by a doctor.

Preparing for analysis

If your doctor has prescribed a Quick test, you need to properly prepare for the test. The time between the last meal and the procedure should be more than eight hours. Before donating blood for prothrombin, you must inform the doctor about all the products, medications, herbs, and supplements that the patient uses.

This is very important because many substances thin the blood and, in fact, increase the prothrombin time. The doctor will tell you which foods you need to stop eating and how long it should take after that to donate blood from a vein and get correct results. You can only drink still water in the morning.

The day before the procedure, it is necessary to limit physical activity, since it greatly affects the composition of the blood. Before donating blood, you need to rest well and be less nervous. You must not smoke for an hour before donating blood.

As a rule, the results obtained as a result of a PTV test need to be understood relatively, since they largely depend on the laboratory where they are carried out, equipment, and personnel. The doctor conducting the decoding usually takes into account the error, since the indicators may deviate from the norm under the influence various factors even if the patient has properly prepared for the analysis.

If the result shows a deviation of the PTT from the norm, you should not be alarmed right away, since this does not always indicate a disease. Perhaps the patient made a mistake and ate food from the list of non-recommended foods. For example, the day before the analysis I drank a can of beer: you should stop drinking any alcoholic beverages three days before the analysis.

Therefore, if the results are negative, the doctor prescribes a repeat test. If in this case the transcript shows a deviation from the norm, he refers the patient for further examination to determine the reasons for too slow or rapid coagulation and prescribe the correct treatment.