After conception and throughout the gestational period, the female body undergoes many changes. One of the most important indicators is the assessment of hemostasis of a pregnant woman, which can be determined using a laboratory analysis of venous blood - a coagulogram. Otherwise, the analysis is called a coagulation system or a hemostasiogram.

What is this analysis for pregnant women

A coagulogram is included in the list when managing a pregnant woman. Doctors use it to assess the condition of the pregnant woman, determine the presence of pathology and conduct appropriate treatment.

The study of the hemostasis system during the period of bearing a child makes it possible to predict the course of pregnancy. Identify possible in the uteroplacental blood flow.

Based on the indicators of the hemostasiogram, it is possible to prevent the development of bleeding at the time of delivery or in the postpartum period.

Nature conceived that during pregnancy, the blood becomes thicker, due to the main components (in particular fibrinogen).

Its thickening reduces the risk of bleeding during the birth or postpartum period. But for some reason, hemostasis is disturbed, the consistency changes, and there is a tendency to thrombosis.

Importance of research

In the normal course of pregnancy, an analysis for the coagulation system is given:

• at, to the antenatal clinic for pregnancy and childbirth;
• in the period of 22-24 weeks;
• in the period from 30 to 36 weeks of gestation;
• upon admission to the maternity ward.

If during pregnancy there was hospitalization, then the number of analyzes increases.

Indicators of the coagulation system of pregnancy contribute to the identification of:

• the propensity of the mother's body to form blood clots. For example, with thrombophilia. Thrombosis during pregnancy can cause oxygen starvation of the fetus, or to. In the early stages, thrombophilia is one of the factors for spontaneous abortion;
• increased risk of bleeding during pregnancy, or in its logical conclusion. A complication is the development of DIC, in which bleeding is difficult to stop due to the absence or small number of clotting factors. DIC increases the risk of death.

In pregnant women with the following pathologies, a coagulogram is performed to prevent negative consequences and select the correct adequate treatment:

• lower extremities, thrombophlebitis;
• hepatic pathologies;
• primary or secondary infertility in history;
• frequent nosebleeds;
• hematomas caused by a weak blow;
• in history;
• pathologies of the cardiovascular system;
• genetic disorders of blood clotting;
• complication of the current pregnancy: fetopathy, multiple pregnancy);
• pregnancy that occurred with the help of in vitro fertilization (IVF procedure).

Repeat analysis is carried out with unfavorable results of previous studies.

Violation of hemostasis complicates the course of pregnancy, and does not always have clinical signs.

When and how to donate blood for a coagulogram for pregnant women

Pregnant women donate blood for a coagulogram several times during the entire gestation period.

In severe pregnancy and frequent hospitalizations, the number of coagulograms increases along with other laboratory tests.

Pregnant women who have been identified and established the cause of a violation of hemostasis are on special records. For example, the genetic factor.

The attending obstetrician-gynecologist prescribes an analysis, in some cases a hematologist, if there are obvious blood clotting disorders.

Taking a blood test for a hemostasiogram

• blood is given in the morning on an empty stomach;
• in the morning you can drink a glass of water (not tea or coffee);
• when using medications, inform the nurse, who will make a corresponding mark on the analysis form;
• blood is taken from a vein using a vacuum system (not through a needle and syringe). It has been proven that the preanalytical stage (preparatory) has a further influence on the process of sample preparation and analysis. The result obtained depends on these factors;
• venous blood is placed in a test tube with a reagent and must be mixed.

Not subject to analysis:

• hemolyzed blood;
• clots in the sample;
• wrong ratio of reagent and biological material.

Hemostasiogram - decoding of indicators

A blood test for a coagulogram can be of two types:

• basic- allowing to identify the quantitative content of fibrinogen, prothrombin, INR, APTT and thrombin time;
• extended– in addition to the main parameters, D-dimer, lupus AK and antithrombin are subject to research

1. fibrinogen is a coagulation factor derived from fibrin. The higher the amount of fibrinogen, the higher the risk of thrombosis. The decrease in fibrinogen occurs synchronously with the total protein in the biochemical blood test;
2. Prothrombin and INR- indicators of the rate of blood clotting. Prothrombin is the second coagulation factor, and INR (international normalized ratio) is a laboratory indicator of the external pathway of the hemostasis system;
3. APTT(activated partial thromboplastin time) - an indicator of the time of blood clotting from the moment of bleeding to the onset of clot formation against the background of reagents;
4. thrombin time- an indicator of the time (in seconds) during which a clot is formed. With DIC, thrombin time is not determined;
5. D-dimer- an additional indicator for assessing the blood coagulation system. It is a breakdown product of fibrin. A significant increase may have a physiological etiology, since with an increase in the duration of the D-dimer increases;
6. Antithrombin III- a specific protein responsible for blood thinning;
7. Lupus anticoagulant- an indicator of the disease "", in which antibodies to blood enzymes are produced.

The table shows an example of normal values ​​and deviations from the norm.

A coagulogram is carried out. Coagulogram: what is this analysis and what is it for? Minimum set of indicators Our organism protect numerous mechanisms that ensure homeostasis - the constant constancy of the internal environment of our body. One of the most important of them is the system of hemostasis or coagulation, which prevents blood loss when the integrity of the bloodstream is damaged. In the process of blood clotting and clot formation, there are dozens of reactions that can be influenced by hundreds of different chemicals. And in itself, this system includes a number of other regulatory mechanisms, some of which increase blood clotting, while others lower it. Due to the great importance of the system hemostasis For the stable functioning of the body, in clinical medicine, various methods have been developed to study this protective reaction of the body. The most common analysis for the study of blood clotting is the determination of the coagulogram, which includes determining the time required to stop bleeding and the number of various factors of this system. This study provides a lot of information about the state of the body as a whole, because the normal operation of the hemostasis system depends on the proper functioning of various organs and systems, so any disturbances in their work are reflected in the coagulogram. There are a number testimony that warrant this study. Firstly, the determination is mandatory before surgical interventions - during operations, the integrity of the bloodstream is significantly violated, which must be eliminated by the hemostasis system. Otherwise, severe complications may develop in the postoperative period. Secondly, this analysis is often prescribed for pregnant women - due to strong hormonal changes, various blood clotting disorders are possible, both in the direction of its decrease and increase. Thirdly, the determination of the coagulogram is desirable for diseases of various organs that are somehow related to the process of blood clotting - first of all, these are the liver, spleen, bone marrow, and the cardiovascular system. Also, autoimmune diseases have their influence on the formation of blood clots. Finally, determining the activity of the blood coagulation system is useful and, in some cases, necessary before prescribing certain drugs - anticoagulants (for example, heparin), acetylsalicylic acid, hormonal contraceptives. Donating blood for determination activity of the coagulation system requires some preparation. 8-12 hours before the study, you should not take food, alcoholic beverages, coffee or strong tea. Some of the parameters of the coagulogram have a certain instability, especially under stressful conditions for the body, therefore, before and during the test, one should not be nervous or subjected to heavy physical exertion. Immediately before blood sampling, a person is given a glass of clean water to drink - this increases the accuracy of the study. Blood is taken from a vein in the arm and immediately begin to determine the main indicators. Exists basic and detailed blood test to determine the coagulogram. The norm of the basic coagulogram looks something like this: Despite such a large number indicators, usually the basic coagulogram form contains only the main ones - fibrinogen concentration, clotting time, activated recalcification time (AVR), activated partial thromboplastin time (APTT), prothrombin index, thrombin time, the amount of soluble fibrin-monomeric complexes. Based on these values, one can indirectly determine the activity of a particular factor. clotting time- one of the basic indicators, which is determined by one of the first. Its value depends on the type of material of the test tube in which the indicator is determined. In a glass container, the formation of a blood clot normally takes from 5 to 7 minutes, while in a silicone tube, the normal clotting time is 12-25 minutes. Due to such a large difference between the two norms of this indicator, depending on the material of the container, it is necessary to specify in the analysis form whether a silicone or non-silicone tube was used for this. The lengthening of this indicator indicates a decrease in the activity of the hemostasis system or an increase in the thrombolytic ability of the blood, and a more rapid formation of a blood clot indicates the opposite phenomenon - an increase in the activity of blood coagulation, or a decrease in the antithrombin system. The causes of these phenomena are determined by other indicators of the coagulogram. fibrinogen concentration- one of the main proteins of the hemostasis system - is also a key indicator of the coagulogram. It is this soluble protein that, during the formation of a blood clot, turns into strands of insoluble fibrin, which forms a thrombus. The norm of its content is 2-4 g / l of blood plasma, which is a fairly high indicator. It is characteristic that in pregnant women on the eve of childbirth (in the third trimester), there is an increase in the content of fibrinogen up to 6 g / l, which is a normal preparation of the body for bleeding that accompanies the birth of a child. However, you should carefully monitor this indicator - its excessive increase can cause blood clotting right inside the bloodstream, which underlies the onset of DIC, often leading to death. In addition to pregnancy, the level of fibrinogen increases with various inflammatory processes, shocks of various origins, and endocrine disorders. Decrease in this indicator coagulograms causes increased bleeding and an increase in blood clotting time. The cause of this condition may be some liver diseases (hepatitis, cirrhosis), lack of vitamins (K, C, B) and related diseases of the gastrointestinal tract (dysbacteriosis, Crohn's disease, malabsorption syndrome), taking certain drugs, as well as the second stage of DIC. Activated Recalcification Time (ART) in a coagulogram, it characterizes how quickly the level of calcium ions (which are involved in the formation of a blood clot) in the blood plasma is restored. The normal phenomenon is the value of this indicator in the range from 1 to 2 minutes (60-120 seconds). An increase in the duration of recalcification indicates a reduced blood coagulation activity, which is a consequence of an insufficient number of platelets in the blood or their functional inferiority, a lack of the main factors of the hemostasis system, an increased activity of the antithrombin system, and also in the second stage of DIC, when there is an exhaustion of the entire blood coagulation system . Decreasing time recalcification speaks of increased thrombosis - with thrombophlebitis and thrombosis. Activated partial thromboplastin time (APTT)- characterizes the time it takes for the formation of a blood clot. The norm of this parameter of the coagulogram is 35-45 seconds, but when using some types of reagents, 28-35 seconds can also be considered the norm. The shortening of this time is not a characteristic clinical sign of any disorders, but its significant increase occurs with the use of anticoagulants (heparin), an acquired or congenital deficiency of the main blood coagulation factors (for example, hemophilia), with some autoimmune diseases (systemic lupus erythematosus). Prothrombin index- the ratio of human plasma time to the reference value. This indicator of the coagulogram is expressed as a percentage and is normally 78-142%. The prothrombin index is the most accurate value that determines the efficiency of the entire hemostasis system. A decrease in this indicator is a sign of low blood clotting, which occurs as a result of a lack of key factors, vitamin K deficiency, diseases of the liver and gastrointestinal tract. An increase in the protombin index indicates a high risk of thrombosis and related disorders - myocardial infarction, stroke, kidney damage, thromboembolism of various vessels. thrombin time- an indicator closely related to the level of fibrinogen in the blood. Physically, it represents the time during which a certain amount of fibrinogen passes into insoluble fibrin - the norm is from 10 to 20 seconds. With an increase in this time, a decrease in the level of fibrinogen is observed, or this phenomenon is due to the activity of fibrinolytic systems and factors - for example, in liver diseases, pancreatitis. Also, an increase in thrombin time occurs with the use of anticoagulants. A decrease in this indicator of the coagulogram is observed in the last trimester of pregnancy and other factors leading to an increase in the level of fibrinogen in the blood. The amount of soluble fibrin-monomeric complexes- these proteins are a transitional link between fibrinogen and fibrin. The norm of their content in blood plasma is 3.36-4.0 mg per 100 ml of plasma. An increase in the number of these complexes indicates an increased activity of the hemostasis system. A decrease in this indicator is observed with a general decrease in the activity of the blood coagulation system. This indicator is the first to respond to the use of anticoagulants, therefore it is the most accurate and sensitive method for determining the effectiveness of anticoagulant therapy, which is widely used in clinical practice. Typically, after analysis an extended study is performed to compile a basic coagulogram, which is used to confirm problems with blood clotting. The purpose of obtaining an extended coagulogram is to more accurately determine the causes of certain blood clotting disorders. As part of the extended analysis, a number of additional indicators are determined. Protein C is one of the most important anticoagulant factors. Its level is expressed as a percentage of the reference indicator, the norm of determination in the extended coagulogram is 60-140%. With a decrease in this indicator, the blood coagulation system begins to prevail, which leads to increased thrombosis. The reason for the decrease may be liver disease and vitamin K deficiency, which often develops as a result of colon dysbacteriosis. Also, a decrease in the level of protein C may be due to genetic factors. D-dimer is a product of partial disintegration of a fibrin clot (thrombus), therefore, with increased thrombus formation, the level of this indicator also increases. The content norm - its amount should not exceed 500 ng / l. In pregnant women in the last trimester, due to a general increase in the activity of the hemostasis system, the level of D-dimers may slightly exceed the norm. In other cases, a significant increase in this indicator is a symptom of thrombophlebitis, disorders in decompensated diabetes mellitus, and toxicosis. Antithrombin-3, as well as protein C, is an anticoagulant factor, the norm of which is from 75 to 110% of the reference value. A sharp decrease in the content of this factor plays a special role, since in such a situation the risk of thrombosis with the development of an embolism or even DIC increases significantly. Antibodies to phospholipids also called lupus antibodies, are normally completely absent in the blood. Their appearance in plasma is a sign of systemic lupus erythematosus, a severe autoimmune disease. The determination of their content in plasma within the framework of an extended coagulogram is due to the fact that this type of antibody destroys platelets and thereby sharply reduces blood clotting. Level platelets when determining the coagulogram, it is rarely determined, since often this value is already known from the general blood test. However, the role of platelets, the norm of which is 180-320 billion per liter, in the development of a blood clot is enormous, so it makes no sense to start any research without first determining their number. Educational video of decoding the coagulogram in normal and abnormal conditions You can download this video and view it from another video hosting on the page:.

Differences in results between pregnant and non-pregnant women

Coagulation system parameters have a significant difference between pregnant and non-pregnant patients:

1. Fibrinogen in non-pregnant women is less than 2 units.
2. APTT is slightly elevated in women who are not in an interesting position.
3. D-dimer is not more than 250 ng/ml.

What to look for when decrypting

When deciphering the hemostasiogram, it is important to pay attention to the units of measurement of indicators. Different laboratories have their own standards.

Reference values ​​depend on reagents and methods of testing samples.

Indications for an additional coagulogram during pregnancy

Additional parameters are aimed at an extended study of hemostasis. The indications are:

• Late preeclampsia;
• Multiple thrombosis;
• Thrombosis of the extremities of the veins;
• Thromboembolism;
• Increased APTT;
• The threat of abortion.

Before an extended analysis, the main parameters are subject to research, and in case of deviations from the norm, an additional study is carried out.

Video: coagulogram during pregnancy

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

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

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

(abbreviated coagulogram ) occupy an important place among the laboratory blood tests that are necessarily carried out in preparation for a surgical intervention, for example, during a planned or during pregnancy .

Coagulogram - what is it?

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

First of all, it is worth noting that this is a fairly common method of studying work in modern medicine. hemostasis systems the human body, which is responsible for such important life functions as: stopping bleeding in case of damage blood clots or vessels , as well as maintaining the normal liquid state of the blood.

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

Having received the results coagulology , the attending physician can predict the outcome of the operation or childbirth in advance. Information about blood clotting is vital in emergency situations, for example, when a person is injured, when seconds count and you need to stop as soon as possible.

Therefore, it is hardly worth worrying too much about how much this study costs. After all, the price of a hemostasiogram cannot be compared with the certainty that the patient will be alive and well.

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

• vascular thrombosis and lower limbs;
• cirrhosis chronic form;
• preeclampsia;
• inflammatory processes in the acute stage;
• hemorrhagic pathologies, for example, thrombocytopenia, hemophilia or von Willebrand disease.

In addition, such an analysis is necessarily prescribed to determine the rate of blood clotting in preparation for elective operations, for example, cesarean section, as well as during pregnancy to assess the state of hemostasis and before independent childbirth . In the exchange card of each woman in labor, such a blood test as a coagulogram is simply required to be present.

Human hemostasis system

Having determined what this analysis for hemostasis is, it is worthwhile to understand in more detail such a concept as blood clotting . Perhaps we should start with a definition. So, the hemostasis system of the human body is the most important biological system, the main functions of which can be considered the preservation of the main parameters of the blood, as well as stopping bleeding.

The human body is not in vain called the whole universe and compared with a complex mechanism. And the hemostasis system can serve as just a vivid example of how ingeniously people are arranged. Blood is a unique biological fluid that can literally work wonders in our body.

It not only circulates through the vessels, but also imperceptibly restores veins and arteries throughout his life thanks to his ability to form blood clots or dense clumps, i.e. roll.

There are three main components of the human hemostasis system:

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

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

Deciphering the coagulogram of blood

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

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

Coagulogram indicators

Consider the parameters of the analysis for blood clotting, namely the normal parameters of the hemostasiogram. Then we will dwell on each of them in more detail, and also talk about an extended or expanded coagulogram.

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

*International unit (IU) or Unit of action (U) , i.e. a measure of the dose of a substance based on its biological activity.

*nanogram per milliliter. Source: Wikipedia

clotting time

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

When the blood clotting time is normal, the doctor can conclude that the hemostasis system is working correctly, as well as exclude some pathological conditions, for example, hemophilia or DIC in which a blood clot does not form at all. If the blood clotting time deviates from the norm (increase or decrease in indicators), it is necessary to understand the reasons in more detail.

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

In addition, all indicators of the coagulogram, including this one, may deviate from the norm during pregnancy. Women, as a rule, first learn about the name of the blood coagulation test during pregnancy, when they are prescribed a lot of laboratory tests without fail in order to monitor and promptly influence the health of the mother and the unborn child.

The changes that are rapidly occurring in the body of a pregnant woman do not go unnoticed for the properties and characteristics of the blood. It is noteworthy that there is a gradual decrease in blood clotting time starting from the first trimester, and in the third trimester this figure can be very different from the norm. However, do not be afraid, because this is just one of the protective mechanisms that help prepare the female body for childbirth and reduce possible blood loss.

Bleeding time

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

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

Bleeding time may be increased with:

• hemophilia;
• thrombocytopenia , i.e. with a lack of platelets in the blood;
• hemorrhagic fever , for example, when ebole or Crimea-Congo;
• liver damage alcohol (intoxication);
• thrombocytopathy;
• drug overdose.

How to take a blood test for clotting?

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

In addition, it is worth refraining from taking alcoholic beverages and medicines on the eve of the study, as this may affect the result of the analysis. If the patient is forced to take any medication, he must not forget to inform the health worker about this.

prothrombin time

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

PV reflects the 1st and 2nd phase of plasma coagulation. In other words, the time of formation of a thrombin clot in the blood with the addition of thromboplastin and calcium. For this parameter, the abbreviated designation PV is adopted; sometimes HTP is found. Blood clotting parameters such as international normalized ratio (INR) and prothrombin index (PTI) are derived from prothrombin time, the norm of which varies depending on the age and sex of the patient.

For example, the norm of thrombin time in women and men is 11-15 seconds. For children, standards are set depending on their age. For example, for newborns - 13-17 seconds or 14-19 seconds for premature babies. For an older child (from 10 years old), the norm is 12-16 seconds, and for a younger child - 13-16 seconds.

Thrombin time above normal - what does it mean? Deviation from the normative indicators established for this coagulogram parameter may mean the following:

• flaw vitamin K in the body;
• low concentration or lack of clotting factors 1,2,5,7 as well as 10;
• disturbance in the normal functioning of the liver, liver failure or other diseases of this organ;
• Availability DIC .

Prothrombin time is increased, what does it mean? As a rule, the excess of the PV indicator is associated with the patient taking medical devices belonging to the group of anticoagulants, i.e. drugs with anticoagulant properties, such as , Coumadinin or .

International Normalized Ratio

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

Previously, each laboratory could use different thromboplate reagents , which could distort the final results of the study. This parameter of the coagulogram is abbreviated as INR or INR. In domestic medicine, at present, instead of INR, one can still find such an indicator as the prothrombin index, which displays how well the patient's blood coagulates.

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

• PTI - 70-100, and for patients taking warfarin – 24,0-42,6;
• INR - 0.82-1.18.

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

With a deviation from the above values, the patient can be diagnosed with the following diseases:

• with elevated PV and INR: chronic , deficit vitamin K, , amyloidosis, DIC, reduced level fibrinogen, nephrotic syndrome, coagulation factor deficiency (2.5, 7 and 10);
• with reduced PV and INR: vascular thromboembolism , increased activity of 7 factors, thrombosis or activation fibrinolysis.

In addition, an increase in the INR and PT may indicate the presence of anticoagulant drugs in the patient's blood. Therefore, the INR norm at admission warfarin different from established standards. For patients taking this drug and drugs similar to it, the following range of normal INR values ​​\u200b\u200bis used - 2.0-3.0.

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

Activated partial thrombin time

Blood test for APTT - what it is? This is another indicator of the analysis, which provides information on the effectiveness of plasma factors designed to quickly stop bleeding. This parameter is abbreviated as APTT.

APTT blood test - what is this? Often there is such a parameter name as activated partial thromboplastin time. APTT, as well as APTT, provide information about the rate of formation of a fibrin clot and best characterize the internal process of hemostasis. It is believed that the APTT indicator is the most accurate, but at the same time the most sensitive, because. may vary depending on the reagents used in laboratory studies.

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

When the above causes are excluded, and the APTT is above normal, this means that the patient may experience such diseases as:

• fibrinolysis;
• acquired or possibly congenital coagulation factor deficiency (8, 9, 11, 10, 12, 2 and 5);
• DIC (2 or 3 stages);
• autoimmune diseases (often systemic lupus erythematosus );
• liver disease.

When the APTT is lowered what does it mean? If the value of the indicator is below the norm, then this indicates that the ability of the blood to clot is reduced. The main reasons for this condition may be:

• DIC 1 degree;
• increased clotting;
• an error in the production of laboratory tests, for example, incorrect blood sampling.

Soluble fibrin-monomeric complexes

In the coagulogram, it is abbreviated as RFMK. RFMK analysis, what is it? Let's start with a definition fibrin-monomeric complexes are the breakdown products of a blood clot during fibrinolysis . According to the researchers, this indicator is rather difficult to reliably determine, since soluble fibrin-monomer complexes are very quickly removed from the blood.

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

This is a kind of defense mechanism that helps to minimize the risk of bleeding. It is considered normal deviations in the level of RFMK during pregnancy up to 5.1 ml. per 100 ml. blood. If MFMC is elevated, what do these test results mean?

When in the patient's coagulogram FMMC increased, the reasons may be as follows:

• thromboembolism deep veins of the extremities or pulmonary artery;
• sepsis;
• or preeclampsia during pregnancy;
• connective tissue pathology;
• renal failure in the chronic or acute stage.

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

Activated recalcification time

It is abbreviated in the analysis as ABP and denotes the time required for the formation of fibrin in blood plasma saturated with platelets and calcium. This parameter is also used to assess the blood coagulation system as a whole. AVR reflects the interaction of cellular and plasma links of hemostasis.

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

prothrombin index. Norm for women

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

It is noteworthy that this indicator is now almost never used, since WHO recommends using a more laboratory-resistant parameter, the INR. The rate of PTI in the blood for a healthy person is set at 73-122%.

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

In addition, the increase in PTI is due to treatment with such anticoagulants as , warfarin or neodicumarin , as well as when receiving Heparin and its analogues. PTI decreases with liver damage, for example, with cirrhosis and hepatitis, with vascular thrombosis and during pregnancy.

The norm of prothrombin for women in the blood

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

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

• PV according to Quick - the norm for women is 78-142%;
• INR or INR - the norm for women is 0.85-1.15.

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

In case the level thrombogen reduced, the formation of a blood clot occurs abnormally slowly, which is fraught with significant blood loss in the event of bleeding. As a rule, the causes of such a failure in the hemostasis system are: lack of vitamin K in the body or other congenital and acquired factors.

thrombin time

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

fibrinogen

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

It is believed that thrombotest grades 4 and 5 are normal. It is worth noting that since fibrinogen (an acute phase protein), its level rises in the blood during stress, injury or infection. As a general rule, the level of fibrinogen in the blood should be between 2.7 and 4.013 grams. The norm of fibrinogen in women in the blood should not be lower or higher than the indicated values, with the exception of the period of pregnancy.

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

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

An increased level of fibrinogen is also observed with:

• burn disease;
• menses;
• rheumatoid;
• amyloidosis;
• pneumonia;
• pyelonephritis;
• systemic scleroderma;
• peritonitis.

In addition, protein levels are affected by drugs such as Heparin and oral contraceptives.

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

• DIC;
• prostate cancer;
• cirrhosis of the liver and other organ pathologies;

Fibrinogen levels may decrease with poisoning Heparin , as well as when taken by the patient anabolics, androgens, and barbiturates .

Antithrombin III

This physiological anticoagulant in its structure refers to glycoproteins , i.e. substances capable of inhibiting coagulation factors 9,10 and 12 and thrombin. It is synthesized in liver cells. Normative indicators of this parameter of the coagulogram varies depending on the age of the patient.

For adults, the normal rate will be 75-125%, for newborns - 40-80%, for children from 10 to 16 years old - 80-120%, and up to 10 years old - 60-100%. If antithrombin 3 is lowered, what does this mean? A decrease in the level of this anticoagulant may be associated with the presence of diseases such as DIC, sepsis, ischemia, liver cirrhosis, thromboembolism or thrombosis.

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

D-dimer

Another indicator of an extended coagulogram, with which the doctor analyzes not only blood clotting, but also the anti-coagulation system of the human body. D-dimer are split strands of fibrin. Only the increased result of this parameter is important, which indicates the development of liver diseases in the patient's body, DIC, thrombosis, ischemia, arthritis, myocardial infarction.

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

What is a coagulogram during pregnancy? This is still the same coagulogram, which is necessarily prescribed to women during the period of bearing a child, as well as immediately before preparing for childbirth.

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

This is due, first of all, to the fact that the hemostatic system of a pregnant woman undergoes serious changes, as well as her whole body as a whole due to the appearance of another circle of blood circulation - uteroplacental. An important role is also played by the hormonal background, in which .

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

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

Interpretation of coagulogram indicators during pregnancy

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

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

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

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

With the continuous development of medicine, scientists have received many methods.

Analysis indicators contribute to the disclosure of a complete picture of the state of human health, the presence of diseases, infections, pathologies, and the prevention of the development of diseases.

One of the tests is a blood coagulogram.

What is a blood coagulogram?

A blood coagulogram is an analysis that displays blood clotting. In a broad sense, the coagulogram reveals the activity of platelets. Blood clotting is a particularly important indicator.

The blood coagulation system is triggered in two ways: external (outside the vessel, when a damaged area is detected) and internal (when blood cells are destroyed).

When the wall of the blood vessel is destroyed, a protein is released that signals the need to activate the protective mechanism. Nearby platelets quickly change their shape, adhere to each other, forming a mesh.

The site of damage is quickly clogged by the formed plexus, stopping the blood and preventing the penetration of harmful bacteria from the outside.

The medical name for this important process for the body is hemostasis (a process that includes all stages of coagulation up to the dissolution of a protective thrombus).

However, in any, even the most powerful system, failures are possible.

Why is it necessary to do a blood coagulogram?

Disease prevention

Thrombosis is a disease in which, without the need to activate the protective function, the formation of blood clots occurs.

Such blood clots are called emboli, the disease is thromboembolism.

Emboli are able to clog arterial vessels. The formation of an obstruction (obstruction) by more than 90% causes a lack of oxygen (hypoxia), not to mention the accumulation of metabolic products. Hypoxia of the brain, for example, is the most dangerous diagnosis, often leading to coma, resulting in 80% of cases - deaths.

Biochemical screening of the health status of the expectant mother and child

The analysis is especially important for a pregnant woman. A blood coagulogram is recommended for women in the presence of:

• liver diseases;
• blood clotting disorders;
• varicose veins;
• immune diseases.

Bearing a fetus is a natural process associated with the formation of uteroplacental circulation. During gestation, the body prepares for blood loss, which affects the increase in some indicators of the coagulogram.

If the expectant mother has serious deviations in blood clotting, the physician prescribes treatment. Undetermined in time, impaired coagulability can threaten with serious consequences - miscarriage and premature birth.

A blood coagulogram is necessary not only to detect abnormalities in the hemostasis system, but also to diagnose patients in some cases.

How to prepare for the analysis?

Coagulogram does not require special preparation. However, there are points that it is desirable to observe for a good analysis:

• food intake - 8 hours before the moment of blood sampling;
• it is recommended not to eat fatty foods;
• drink only water;
• it is recommended not to smoke for an hour before the analysis;
• before the analysis, it is necessary to try to calm down emotionally and physically;
• if the patient is prescribed a course of medications that is not related to the reasons for donating a blood coagulogram, it is necessary to notify the doctor about this;
• if you feel unwell, dizzy during the sampling, you should immediately inform the specialist taking the tests.

Causes of high and low blood coagulograms

Coagulogram indicators above the norm indicate:

• infectious-toxic and septic disease;
• intoxication of the body;
• atherosclerotic vascular lesions;
• endocrine pathology;
• the occurrence of disseminated intravascular coagulation (DIC), etc.

Coagulogram parameters are below normal:

• leukemia ();
• vein thrombosis;
• various diseases of internal organs (, digestive system);
• hereditary clotting defects;
• the final phase of DIC, etc.

The above diagnoses are few. It is important to remember that this is generalized data. To identify the cause that violates the norms of hemostasis, it is necessary to decipher and specifically compare with the norm of each indicator, taking into account the characteristics of the patient's body.

Detailed information about blood coagulation parameters

• Fibrinogen (a protein formed in the liver and is responsible for the final stage of thrombus formation):

Causes of low fibrinogen:

• donation, taking steroids, etc.
• chronically low fibrinogen level, impaired synthesis from birth;
• liver disease;
• unbalanced diet.

Reduced protein concentrations characterize the inability to complete blood clotting, the tendency to spontaneous bleeding.

Increased fibrinogen:

• inflammatory processes, alas, the most diverse - acute, infectious mononucleosis, etc .;
• massive tissue destruction (, lung abscesses, gangrene, abscesses, etc.);
• tumor formation;
• , violation of cerebral circulation;
• peripheral vascular disease (atherosclerosis of the arteries, vascular damage in diabetes mellitus, thrombophlebitis, chronic venous insufficiency);

Not always an increased or decreased fibrinogen index indicates health problems.

An insignificant effect on the indicator in an adult can also have:

• smoking;
• taking hormonal contraceptives, estrogens;
• loads;
• stress;
• cholesterol;
• obesity.

In adults, the norm ranges from 2-4 g / l, in pregnant women up to 6 g / l, in children the content of fibrinogen in - 1.25-3 g / l.

• (APTT):

Characterizes the period of time required for the reaction of platelets. An increased thromboplastin time characterizes a tendency to uncontrolled bleeding, prolonged blood clotting.

According to the INR indicator, doctors evaluate the effect of prescribed drugs.

• D-dimer:

After the destruction of the thrombus (during the breakdown of fibrin), a protein fragment, D-dimer, is observed in the blood. After the restoration of the affected part of the body, the protein plasmin is formed, which destroys and destroys blood clots.

The number of fragments in the blood allows you to identify the work of two processes at once: the formation of blood clots and their dissolution (fibrinolysis). There needs to be a balance between thrombus formation and fibrinolysis. Lack of balance informs about hemostasis.

The norms of indicators in adults and children are presented in the table below. Deciphering the blood coagulogram will reveal the discrepancy of each indicator: what is and how much should be.

• Soluble fibrin-monomeric complexes (SFMK):

Few have heard of the RFMK blood test. The RFMC blood test is an additional indicator included in the coagulogram and is considered an important laboratory analysis that characterizes the hemostasis system. Many experts consider RFMK blood test as an indicator of thrombinemia (the formation of small blood clots), the onset of DIC.

Blood coagulogram indicators: norms in adults and children Table

Summing up, I would like to note: an accurate blood coagulogram can be interpreted by a good specialist - a doctor.

Only he will be able to identify deviations from the norm for each patient with high accuracy.

The medical history of each patient is a separate situation that requires detailed consideration.

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Interesting

A coagulogram is a complex detailed study aimed at determining the main blood factors that characterize its ability to coagulate. Blood clotting is one of the basic functions that ensure the normal functioning of the body, and a deviation from the normal indicators of several parameters threatens either increased bleeding or rapid blood clotting into dense clots. Comprehensively evaluating the data of the coagulogram, a competent doctor will diagnose and prescribe treatment in time, preventing the development of stroke, heart attack, renal and hepatic pathologies and dangerous complications during pregnancy.

Coagulogram - what is this blood test

A coagulogram is a special laboratory blood test that monitors the functioning of hemostasis - a complex biosystem aimed at maintaining blood fluidity, maintaining the processes of stopping bleeding, and timely dissolution of dense clots (thrombi).

In another way, an analysis that examines the work of hemostasis is called a hemostasiogram.

To maintain basic functions, the blood must be:

• liquid enough to carry oxygen and nutrients through the vessels to tissues and organs, remove decay products and toxins, support the immune system and thermoregulation;
• have a certain degree of viscosity in order to close gaps in large and small vessels in case of injury.

If blood clotting is reduced to critical values, in case of bleeding, this leads to massive blood loss and death of the body.

Excessive density and increased clotting (hypercoagulation), on the contrary, leads to the formation of blood clots that can block the most important vessels (pulmonary, coronary, cerebral) and lead to thromboembolism, heart attack and stroke.

An analysis of the hemostasiogram is of high importance, since a properly functioning hemostasis system prevents both life-threatening blood loss and spontaneous thrombosis and blockage of the vascular bed with blood clots.

The study is considered complex, since in order to understand the work of the blood coagulation system, the doctor must be able to evaluate each parameter individually and analyze all indicators in the aggregate.

Kinds

The coagulogram contains a large number of parameters, each of which reflects a specific function of hemostasis.

There are two types of hemostasiogram:

• simple (basic, indicative, screening, standard);
• expanded (expanded).

The basic study reveals or excludes the fact of a violation in the functioning of the blood coagulation system. The analysis helps to find out in which link the deviation from the norm is determined, and then - if there is a suspicion of the development of the disease, an extended analysis is prescribed.

The standard coagulogram includes: prothrombin in% according to Quick or PTI, INR, fibrinogen, APTT, TV.
A detailed analysis provides for an extended study, during which not only the very fact of qualitative changes is determined, but also quantitative indicators.

A complete analysis of the coagulogram is carried out taking into account many clotting factors, the deviation of each of which from normal values ​​leads to serious problems. Without this, the study is considered indicative.

The expanded hemostasiogram, in addition to the indicators of the basic coagulogram, includes TV - Thrombin time, Antithrombin III, D-dimer.
In addition to them, several types of standard coalgulograms are carried out, including some indicators necessary to assess hemostasis in known conditions (before surgery, during pregnancy, anticoagulant therapy).

Important! What is a coagulogram? When and in what cases is the appointment of an analysis recommended:

To whom and under what circumstances it can be assigned

A hemostasiogram is prescribed to a patient for the following diagnostic studies, diseases, conditions:

• a general idea of ​​the functioning of the hemostasis system;
• deviations from normal blood coagulation;
• planned and emergency operations (to avoid the risk of massive blood loss or, conversely, active thrombosis);
• vascular disorders in the lower extremities (deep vein thrombosis, varicose veins), pelvic organs, intestines, pulmonary embolism;
• hemorrhagic pathologies (hemophilia, hemorrhagic fever, thrombocytopathy, thrombocytopenia, frequent nosebleeds, subcutaneous hemorrhages);
• stroke, atrial fibrillation, heart attack, coronary heart disease;
• pregnancy, childbirth, caesarean section;
• severe toxicosis;
• suspicion of DIC (intravascular disseminated coagulation);
• diagnosis of the causes of miscarriage;
• control of treatment with anticoagulants that thin the blood (Warfarin, Dabigatran, Trental, Heparin, Clexane, Fraxiparine, aspirin-based drugs);
• taking any contraceptive pills (analysis once every 3 months), since the substances that make up oral contraceptives can cause acute thrombosis in young women, often leading to serious conditions;
• chronic liver disease, including cirrhosis; assessment of the function of the synthesis of protein complexes - blood coagulation factors;
• autoimmune systemic pathologies (, rheumatoid arthritis, scleroderma);
• taking hormonal drugs, anabolics;
• hirudotherapy (treatment with leeches) to prevent hemorrhages (bleeding, subcutaneous hemorrhages).

Methods for studying hemostasis during pregnancy:

How to properly prepare for an analysis

The price of an incorrect coagulation analysis is life-threatening bleeding or blockage of blood vessels with blood clots with a violation of the blood supply to important organs.

For the study to be reliable, elementary measures are necessary, which include the following preparation rules:

• infants up to 12 months of age do not feed in the interval of 30-40 minutes before blood sampling;
• children 1 - 5 years old do not feed in the interval of 2 - 3 hours before the study;
• for adults and young patients older than 5 years, stop eating 12 hours before the analysis;
• exclude physical activity and psychological stress 30 minutes before blood donation;
• stop smoking tobacco 30 minutes before the study;
• tell your doctor if you are taking any anticoagulants.

Where can I donate blood for clotting. Average price range

A hemostasiogram is carried out by qualified laboratory assistants in a polyclinic, a medical center, a laboratory that has the necessary equipment and reagents.

The cost of the examination is determined by the type of coagulogram (basic or expanded), the number of parameters to be determined and ranges from 350 to 3000 rubles. Patients who are expecting the birth of a child undergo a free examination if they have a compulsory medical insurance policy, since the examination belongs to the category of mandatory during pregnancy.

How is the analysis carried out

Blood is taken from a vein for a hemostasiogram. The blood sampling site is disinfected with an antiseptic and the skin is pierced using a syringe or a vacuum system. Injury to the vein and surrounding tissues is not allowed in order to prevent unreliable results due to the possible ingress of thromboplastin fragments from damaged tissues into the biomaterial for research.

For the same purpose, 2 test tubes are filled with blood, the last of which is sent for analysis.

How long it takes: how long to wait for results

The results of the coagulogram, as a rule, are obtained after 1 to 2 days. The turnaround time for the analysis is related to the volume of determined factors, the workload of the laboratory, and the specifics of the courier service.

Indicators and norms of analysis in adults and children

Considering that the process of hemostasis is evaluated in several systems of units and by several methods, the coagulogram parameters in different laboratories may differ.

It is impractical and even dangerous to independently analyze the coagulogram, since the specialist, when deciphering the indicators, takes into account many factors unknown to the patient, and their totality. Sometimes small deviations in certain indicators are dangerous, while deviations in others may not indicate serious diseases.

Deciphering indicators - what it is responsible for and what it means

By evaluating the parameters obtained in the hemostasiogram, the doctor is able to establish the cause of deviations from the norm and understand whether they occurred due to pathology in the coagulation system or due to other diseases that show similar indicators in the coagulogram, that is, to conduct a differentiated diagnosis.

APTT

Activated partial (partial) thromboplastin time is one of the most important parameters of hemostasis (other abbreviations APTT, ARTT). Denotes the time required for the formation of a blood clot after the introduction of certain reagents into the blood plasma. The values ​​of this indicator are directly related to changes in other hemostasiogram parameters.

Possible pathologies with APTT deviation

Fibrinogen level (Fib)

Fibrinogen (factor I) is a special protein produced by liver cells. At the site of vascular rupture, it turns into insoluble fibrin strands, which stabilize the mass of the thrombus that clogs the vessel and remains fixed until the injury heals.

Probable conditions and diseases with a change in the level of fibrinogen

Prothrombin (factor F II)

It belongs to the basic coagulation factors and is an inactive protein fraction, which, under the action of vitamin K, is transformed into active thrombin, which also takes part in the formation of a clot that stops bleeding.

If there is a deviation of factors I-II from the norm, this threatens to develop both bleeding and spontaneous thrombosis without damage and with the formation of pathological blood clots that can break away from the wall of a vein or artery and block the blood flow.

To understand the changes in the processes of hemostasis, determined by the concentration of prothrombin, coagulation tests are used:

• PTI (prothrombin index). This is the ratio, expressed as a percentage, between the individual time needed for blood clotting in a patient to the clotting time of the control plasma. The normal value is 97 - 107%. A low indicator indicates excessive blood fluidity, liver disease, vitamin K deficiency, diuretics, anticoagulants. An upward pathological shift (often when using birth control pills) indicates a dangerous thickening of the blood and the threat of thrombosis.
• PO (prothrombin ratio) - an indicator inverse of the PTI parameter;
• INR (international normalized ratio). Shows the rate of thrombus formation in percent. A typical case requiring an assessment of the INR is the patient receiving Warfarin, Warfarex, Finilin, Sincumar.
• PTT or Prothrombin Time (PT, PT, RECOMBIPL-PT). Specifies the interval (in seconds) required for prothrombin to transform into active thrombin.

Possible pathologies in case of PTV deviation

Prothrombin in% according to Quick

This is one of the most significant and sensitive ways to determine prothrombin when compared with the PTI and PTT profile. The Quick index is obtained by comparing the percentage of the activity of the patient's plasma coagulation factors with the established norm.

Clotting time according to Lee-White

The parameter reflects the rate of platelet aggregation into a clot, indicating an increased activity of hemostasis and the risk of thrombosis (with a reduced rate), or an increase in the likelihood of bleeding if the time is increased.

Thrombin time (TT, TV)

The indicator expresses the rate of conversion of fibrinogen into fibrin fibers that fix the platelet clot at the site of injury.

Possible anomalous conditions in case of TV deviations from the norm

Coagulation enzymes

It reflects the level of activity of enzymes II, V, VII, VIII, IX, X, XI, XII, the values ​​of which are not associated with physiological causes, and a deviation from the norm always indicates the development of pathologies.

Plasma recalcification time and activated time (VRP and AVR, respectively)

Both studies measure the overall activity of hemostasis and the rate of fibrin clot formation, and differ only in the way the analysis is performed.

With reduced AVR, VRP, there is a risk of thrombosis. Elevated levels signal the threat of bleeding even with minor injuries from burns, shock, thrombocytopenia (low platelet count), and therapy with blood thinners.

Lupus anticoagulant

A protein complex, the level of which is determined in autoimmune pathologies, since normally there is no lupus enzyme in the blood. Its detection in the blood indicates a high risk of antiphospholipid syndrome (APS), which can cause placental insufficiency in preterm pregnancy.

D-dimers

Protein elements of fibrin remaining after the destruction of blood clots. Their increased number indicates too intensive formation of blood clots and the possibility of such conditions as: infections and inflammations, renal and hepatic failure, heart attack, thrombosis, sepsis, large hematomas, malignant tumors.

Sometimes an increase in dimers is observed after operations, in old age, against the background of the use of plasminogen.

Soluble fibrin-monomeric complexes (SFMK)

An increased concentration of these molecular-protein compounds (transitional products between fibrinogen and fibrin) warns of possible thrombosis.

platelets

Basic cells that support the processes of hemostasis, normally constituting 150,000–400,000 µl. With a decrease in the number, thrombocytopenia is diagnosed.

Protein C

A protein that can reduce the activity of coagulation processes, preventing the formation of large clots.

Antithrombin-III

A protein that is a physiological anticoagulant that is constantly present in plasma and most actively (by 75 - 80%) inhibits the activity of thrombin, preventing excessive blood clotting and thrombosis.

Probable pathologies in case of deviations of antithrombin 3 from the norm

Protein S

A protein without which neither antithrombin nor protein C can work. The level can only decrease, which is determined with congenital protein S deficiency, liver disease, taking Warfarin and other anticoagulants.
norms of analysis in adults and children

Normal values ​​of hemostasiogram parameters

Most parameters of hemostasis differ only slightly between adults and young patients. A noticeable difference is typical for infants after childbirth up to 2 months of life.

Table of normal coagulogram indicators

When analyzing a coagulogram, it should be taken into account that reference values, methods and units of measurement may differ in individual laboratories.

Coagulogram during pregnancy

While waiting for the baby, the body experiences high loads and significant changes in hemostasis, which is determined by the development of the uteroplacental circulation in a pregnant woman.

The body during this period tries to protect itself with the likely development of placental abruption, uterine bleeding, and the formation of intravascular blood clots. A coagulogram helps to timely identify the threat of miscarriage, bleeding, negative effects on the function of the brain and other organs of the fetus.

With severe gestosis, a life-threatening complication can develop - DIC, which is first expressed in the occurrence of many small blood clots, impaired blood flow between the mother and fetus, and then in the failure of blood coagulation mechanisms (acoagulation). Such a pathological condition leads at the 1st stage to placental insufficiency, fetal hypoxia, to a high probability of blockage of the arteries of important organs, and later to the risk of massive bleeding and death of the pregnant woman and fetus.

Therefore, a woman, in anticipation of a baby, once a trimester (and in case of complications, more often) must undergo a hemostasiogram.

Indicators of hemostasis in pregnant women

Important! All of these standards are indicative, not unified. A competent interpretation of the coagulogram can only be performed by an obstetrician-gynecologist. It is strictly not recommended to use information from the Internet and advice from forums on the Internet.

Deciphering the hemostasiogram during pregnancy

Normally, in the first three months, blood coagulation parameters can be reduced, but by the end of pregnancy, on the contrary, they increase, as preparation for blood loss during childbirth takes place.

Probable anomalous conditions in case of deviation of hemostasis indicators from the norm

If in the hemostasiogram 1 or 2 indicators have values ​​that deviate from the norm, this does not mean that the patient is immediately threatened with a serious complication. As a rule, this only indicates the adaptation of the mechanisms of hemostasis, which works in the mode that is currently necessary for the pregnant woman.

Really threatening pathologies are reflected in the coagulogram by a significant deviation from the norm of many indicators

Correctly and timely made hemostasiogram is the key to successful treatment of acquired and congenital diseases in the developmental stage and in the early stages, prevention of bleeding or, conversely, abnormal formation of blood clots. An analysis of blood clotting in women carrying a child will allow the doctor to prevent placental abruption, fetal underdevelopment due to vascular thrombosis, miscarriage, the development of preeclampsia, DIC, dangerous bleeding and death. But due to the complexity of the study, it is unacceptable to independently draw conclusions about the presence or absence of pathologies. Only a qualified specialist is able to conduct an accurate analysis and make a correct prediction.