Blood coagulogram (hemostasiogram) - what kind of analysis is this? Interpretation of coagulogram, indicators are normal, during pregnancy, etc. What kind of analysis is this - a coagulogram: norm, interpretation of the results, how to take it What does a blood test for a coagulogram mean?

All laboratory tests used to study the state of hemocoagulation are divided into several groups, depending on the questions that the doctor poses. The first group combines those laboratory methods that make it possible to answer the question about the state of blood coagulation in a healthy person, in a patient in preparation for surgical interventions, or in cases where there are clinical signs of hemocoagulation disorders. To do this, it is sufficient to carry out so-called assessment or screening tests. These include:

1. Platelet count

2. Bleeding time

3. Prothrombin time

4. Activated partial thromboplastin time

5. Determination of fibrinogen level.

A laboratory indicator of blood clotting is clotting time. The norm is 5-10 minutes if White’s technique is used. They inject the finger and observe how many minutes later a clot forms and the bleeding stops. The shorter the time, the greater the risk of thrombosis.

Reasons for changes in normal clotting time indicators:

prolongation of bleeding time - severe infectious diseases, burns, leukemia, late stages of DIC, hemophilia, alcoholic liver damage, vitamin K deficiency, phosphorus poisoning, systemic connective tissue diseases, incorrectly selected therapy with antiplatelet agents (chimes, etc.) and anticoagulants (heparin, etc.),

shortening of bleeding time - consequences of blood loss, myxedema, anaphylactic shock, early stages of DIC syndrome.

The answer obtained when determining blood clotting is the overall result of a very long cause-and-effect chain of biochemical reactions. And if there are serious coagulation disorders in one direction or another, then a whole complex of biochemical tests is performed - a coagulogram. It allows you to determine which link in the chain of biochemical reactions during blood clotting is disrupted. This is a complex and expensive analysis; unfortunately, not every laboratory can do it.

Anticoagulants reduce blood clotting. This is another group of drugs that reduce the risk of blood clots. Among them, there are drugs of direct and indirect action. They are used orally or by injection only as prescribed by the attending physician, under his regular supervision and laboratory control. Direct local anticoagulants, such as heparin and hirudin ointments (based on leech saliva), can be used independently.

As for aspirin, it also has anticoagulant properties, but to a very small extent, so it is not classified as such a drug.

The second group of studies is represented by sets of additional tests for various clinical manifestations of disorders of the hemocoagulation system and fibrinolysis.

Blood viscosity

A factor influencing thrombus formation is blood viscosity, characterized by its thickening or thinning. The viscosity of blood depends on the ratio of water in it, on the one hand, and blood cells and proteins (including those involved in coagulation), on the other. If the amount of water in the blood vessels decreases or there are more blood cells and proteins, the blood thickens and the risk of thrombosis increases.

The amount of water in the bloodstream may decrease with excessive sweating, urination (for example, when taking diuretics), with excessive diarrhea and vomiting. (By the way, in the heat, due to heavy sweating, the risk of thrombosis increases. To prevent this from happening, you need to drink a lot.)

The number of blood cells in the bloodstream (mainly red blood cells) most often increases compensatoryly when, for some reason, the tissues are not sufficiently supplied with oxygen. Then the body mobilizes a larger number of oxygen carriers - red blood cells, so that they can take the maximum amount from the lungs. This situation is typical for chronic heart and lung diseases.

This is a protective reaction, but due to too high a concentration of cells in the blood, microcirculation deteriorates. Less commonly, an increase in the number of red blood cells occurs with blood diseases (in this case, the reaction is not protective; other mechanisms are at work).

Laboratory indicators indicating blood thickening are an increase in the number of red blood cells per unit volume and a blood test for hematocrit.

The number of red blood cells is calculated during a clinical blood test. The norm is 4.5-5 x 10 (to the 12th power) per 1 liter.

Hematocrit is the ratio of the volumes of blood cells and its liquid part. The principle of analysis is that cells are separated from plasma in a centrifuge and the resulting volumes of cells and plasma are compared. (The volume of cells is divided by the volume of plasma and expressed as a percentage.) Norm: for men - 40-48%, for women - 36-42%.

Prothrombin time is an indicator of the blood coagulation system.

Indications for prescribing prothrombin time analysis: general assessment of the blood coagulation system, DIC syndrome (disseminated intravascular coagulation syndrome), high risk of blood clots, heparin treatment, diagnosis of hemophilia.

Normal prothrombin time:

Normally, the prothrombin time is 11 - 15 s

newborns: longer by 2 - 3 s

premature babies: longer by 3 - 5 s, reaching adult values ​​by 3 or 4 days of life.

INR - 0.8 - 1.15 s

APTT - normally a fibrin clot forms within 21-35 s

Reasons for changes in normal prothrombin time values:

increase in prothrombin time - liver disease, vitamin K deficiency, intravascular coagulation, hereditary deficiency of coagulation factors - 2 (prothrombin), 5, 7, 10, decreased fibrinogen levels (fibrinogen level less than 50 mg (100 ml) or its absence, treatment with coumarin, the presence of anticoagulants in the blood;

decreased prothrombin time - thrombosis, activation of fibrinolysis, increased activity of factor 7;

prolongation of aPTT - hypocoagulation, congenital or acquired deficiency of blood coagulation factors 2, 5, 8, 9, 10, 11, 12 (except for factors 7 and 13), fibrinolysis, 2nd and 3rd phases of DIC syndrome, drug treatment heparin, severe liver disease;

shortening of aPTT - hypercoagulation, phase 1 of DIC syndrome, contamination of the sample with tissue thromboplastin during blood sampling.

Prothrombin index (PTI) is the ratio of standard prothrombin time to prothrombin time in the patient being examined, expressed as a percentage. This indicator is now considered obsolete by many guidelines and the use of INR is recommended instead.

Normal prothrombin index: 70 - 120%

Reasons for changes in normal prothrombin index values:

increased PTI - deficiency of coagulation factors, liver damage, vitamin K deficiency, treatment with anticoagulants, treatment with heparin.

decrease in PTI - thrombosis, liver disease, increased blood clotting in a woman during childbirth.

Thrombin time is an indicator of the blood coagulation system.

Indications for the analysis: general assessment of the blood coagulation system, assessment of the course of DIC syndrome (disseminated intravascular coagulation syndrome). It is advisable to use the analysis in conjunction with aPTT and prothrombin time.

The normal thrombin time is 14 - 21 s (depending on the method used in a particular laboratory)

Reasons for changes in normal thrombin time values:

prolongation of thrombin time - absence or decrease (less than 0.5 g/l) of fibrinogen content in the blood, acute fibrinolysis, increased fibrinogen levels (more than 4 g/l), DIC syndrome, fibrinolytic therapy (use of urokinase, streptokinase), parenchymal hepatitis , liver cirrhosis, heparin treatment, presence of thrombin antibodies.

shortening of thrombin time - treatment with heparin and fibrin polymerization inhibitors, stage 1 of DIC syndrome - a pronounced increase in fibrinogen in the blood.

Fibrinogen is an indicator of the blood coagulation system and an indicator of inflammation.

Indications for the purpose of the analysis: assessment of the blood coagulation system, inflammatory processes, diseases of the cardiovascular system.

Normal fibrinogen:

adults 2.00 - 4.00 g/l

newborns 1.25 - 3.00 g/l

Reasons for changes in normal fibrinogen levels:

increased content - inflammatory processes in kidney diseases, peritonitis, pneumonia, myocardial infarction, systemic connective tissue diseases (collagenoses), acute stage of infectious diseases, injuries, burns, surgical interventions, amyloidosis, pregnancy, menstruation, malignant tumors (especially lung cancer);

medical factors that increase indicators - heparin, oral contraceptives, estrogens, 3rd trimester of pregnancy, postoperative period.

decreased content - hereditary deficiency, disseminated intravascular coagulation syndrome, use of certain medications (for example, phenobarbital), post-bleeding conditions, leukemia, liver disease, prostate cancer with metastases, bone marrow damage (bone marrow metastases).

medical factors that reduce indicators - anabolics, androgens, asparaginase, fish oil, valproic acid, fibrin polymerization inhibitors, heparin in high concentrations.

Antithrombin 3

Antitrambin is a natural regulator and controller of the blood coagulation system, which prevents thrombus formation in the bloodstream.

Antithrombin 3 norm: in absolute units - 210 - 320 mg/hl, but more often expressed as a percentage:

adults 75 - 125% (antithrombin activity of whole donor blood plasma is taken as 100%)

children up to 1 month 40-80%

children from 1 month to 16 years 80 - 120%

Reasons for changes in normal antithrombin 3 levels:

increased content - inflammatory processes in the body, acute hepatitis, lack of vitamin K, treatment with anabolic hormones;

reduction in content - congenital deficiency, disseminated intravascular coagulation syndrome, severe liver disease, and coronary heart disease, last trimester of pregnancy, thromboembolism, sepsis, heparin treatment.

D-dimer is the most reliable sign of the appearance of blood clots in vessels of different sizes. Using the analysis, the doctor can evaluate how the process of fibrin formation and breakdown occurs, since D-dimer in the blood is formed only if both processes occur.

Indications for the analysis: diagnosis of thromboembolic conditions, deep vein thrombosis, pulmonary embolism, DIC syndrome and pregnancy complications

Normal D-dimer: 250 - 500 ng/ml.

Reasons for changes in normal D-dimer levels:

increased content - thrombosis of the great vessels, thromboembolism, wound healing process, DIC syndrome, the presence of rheumatoid factor, wound healing process, smoking;

a decrease in content has no diagnostic value.

Bleeding time

The main indicator of the state of the coagulation system. It is estimated by the time of bleeding from the earlobe after being pricked with a needle or scarifier.

Normal bleeding time: 2 - 4 minutes

Reasons for changes in normal bleeding time indicators:

prolongation of bleeding time - lack of platelets in the blood, hemophilia, alcoholic liver damage, hemorrhagic fevers, impaired platelet function, incorrectly selected therapy with antiplatelet agents (chimes, etc.) and anticoagulants.

shortening of bleeding time has no diagnostic significance; most often it is a consequence of a technical error during the study.

Barium plasma test.

In clinical practice, it is very important to quickly differentiate hemophilia A (factor VIII deficiency) from hemophilia B (factor IX deficiency). Basically, the study of the activity of the relevant factors is carried out using standard plasmas with a deficiency of this factor (deficient plasmas). In the absence of scarce plasmas, it is possible to use a method such as a barium plasma test. The principle of the method is that when barium sulfate is added to plasma, the proteins of the prothrombin complex, which include factors II, VII, IX and X, are adsorbed on it, while the remaining hemocoagulation factors remain quantitatively unchanged in the “barium” plasma. In this regard, the addition of barium plasma to the plasma of a patient with hemophilia A, i.e. with factor VIII deficiency or defect should lead to normalization of the prolonged aPTT time, but in the presence of hemophilia B, or a factor IX defect, normalization of the aPTT does not occur.

A coagulogram or hemostasiogram is a blood test for its coagulability. It is carried out in children (if necessary) and in adults.

There are two types of hemostasiogram:

• basic (assigned at the beginning);
• expanded or expanded (done if a serious pathology is detected during a basic coagulogram).

When is it necessary to take the test?

Usually, a coagulogram is not prescribed to everyone. The following groups of people are subject to mandatory blood clotting tests:

• patients before undergoing planned abdominal surgery;
• pregnant women during the entire period of bearing a baby (blood tests are taken every 3 months);
• people with heart and vascular diseases;
• patients with liver diseases;
• people with autoimmune diseases;
• patients who have disorders in the blood coagulation system;
• those prescribed anticoagulant drugs or aspirin;
• women taking OCs on a regular basis;
• patients who are indicated for a course of hirudotherapy treatment.

Hemostasis in the human body

Blood clots in human vessels are not formed by chance: the hemostasis system is created to prevent the development of severe bleeding and preserve human life. A thrombus is blood particles (mainly platelets) stuck to the inner damaged wall of a vessel, which stick together and prevent blood loss. The body secretes thromboplastin, which forms a protein clot made of fibrin. With a strong magnification, you can see that it looks like a very thin network in which platelets from the blood stream get stuck.

In addition to the coagulation system, the human body also has an anticoagulant system, which controls the normal consistency of the blood. The activity of these two systems controls fibrinolysis (resorption of blood clots after healing of the vascular wall). A detailed coagulogram will fully assess the operation of all three systems.

Basic terms and parameters of hemostasiogram

The table shows the most common coagulogram indicators:

Abbreviation	Decoding
Fibrinogen	The most important marker that determines the state of the human blood coagulation system
	Prothrombin index - a study showing external coagulation
	International normalized ratio. The most universal test for the external method of blood coagulation. Coagulogram INR is used most often.
	Prothrombin time is a laboratory test for extrinsic coagulation of a patient's blood.
	Activated partial thromboplastin time
Thrombin time	Time taken to complete the last folding step
Protein C	A substance the lack of which in the blood can lead to the formation of serious blood clots
Antithrombin	Basic protein factor of blood plasma
D-dimer	Particle formed in the blood after a blood clot has been broken
Lupus anticoagulant	Antibodies formed in the blood serum of a person who has an autoimmune disease
Plasma tolerance to heparin	Level of plasma heparin resistance
	Activated recalcification time
RFMK	Soluble fibrin monomer complexes
Plasma recalcification time	Time period required for fibrin synthesis

Hemostasiogram indicators. Norms and deviations

The table below shows normal coagulogram values ​​in an adult.

Below is a description of the most important coagulogram indicators, the norms and values ​​of the indicators are indicated.

How to take the test correctly?

After receiving a referral from a doctor to take a hemostasiogram, the patient is interested in how to take the test: on an empty stomach or not? A coagulogram is taken on an empty stomach early in the morning. You cannot eat at night, you are only allowed to drink water. If the patient is taking any medications, this must be indicated at the time of examination.

Today's report discusses the coagulogram: what kind of analysis it is, the norm, interpretation. For convenience, we have placed the data in tables.

Coagulation blood testing is a comprehensive laboratory assessment of the state of hemostasis. The main function of hemostasis is to participate in the process of stopping bleeding and disposing of blood clots. The analysis allows you to diagnose malfunctions in the mechanisms of blood clotting, and is also required before any surgical intervention and when determining the causes of miscarriage.

Violation of the integrity of tissues and blood vessels activates the launch of a sequence of biochemical reactions of protein factors that ensure coagulation during bleeding. The final result is the formation of a blood clot from fibrin strands. There are 2 main pathways leading to blood clotting:

• internal - for its implementation, direct contact of blood cells and the subendothelial membrane of blood vessels is required;
• external - activated by the protein antithrombin III, secreted by damaged tissues and blood vessels.

Each of the mechanisms individually is ineffective, however, forming a close relationship, they ultimately help stop bleeding. Violation of the compensatory mechanisms of the hemostatic system is one of the reasons for the development of thrombosis or bleeding, which poses a threat to human life and health. This is what emphasizes the importance of timely diagnosis of the state of the hemostatic system.

Coagulogram - what kind of analysis is this?

Patients often wonder what a blood coagulogram is, for example, before surgery or during pregnancy, and why is it so important to take it?

A coagulogram is a medical analysis to assess the state of the system that starts and stops the blood clotting mechanism.

The obligatory examination before surgery is due to the possible risk of bleeding during surgery. If failures in the hemostatic system are detected, the patient may be denied surgical intervention if the risk of bleeding is too great. In addition, the inability to carry out one of the coagulation mechanisms can be the cause of miscarriage.

The effectiveness of therapy for any pathology affecting the hemostatic system requires strict control and is implemented through the examination in question. Positive dynamics indicate the correctness of the chosen tactics and a favorable outcome. Lack of improvement requires immediate correction of the treatment regimen by a specialist.

What is included in a blood coagulogram?

Coagulogram parameters: prothrombin index (PTI), international normalized ratio (INR), fibrinogen protein, antithrombin (AT III), activated partial thromboplastin time (APTT) and protein fragment (D-dimer).

PTI and INR

Using two parameters - PTI and INR, it is possible to assess the normal functioning of the external and general pathway for blood coagulation. In the case of a decrease in the concentration of protein factors in the serum of the subject, a deviation of the criteria under consideration is observed to be greater than the norm.

It has been established that prothrombin is produced by liver cells (hepatocytes) and requires vitamin K for its normal functioning. In case of its hypofunction (deficiency), a failure occurs in the formation of a blood clot. This fact underlies the treatment of people with a predisposition to thrombosis and cardiovascular pathologies. The essence of treatment is to prescribe drugs that interfere with the normal synthesis of the vitamin. Both criteria under consideration are used to determine the degree of effectiveness of these tactics.

Formula for calculating prothrombin index:

PTI std. – the amount of time it takes for plasma to clot in the control sample after adding clotting factor III.

The INR coagulogram is calculated using the following formula:

ISI (International Sensitivity Index) is a standard coefficient.

It is known that the values ​​under consideration are characterized by an inverse correlation, that is, the higher the prothrombin time index, the lower the INR. The statement is also true for the inverse relationship.

Fibrinogen

Fibrinogen protein synthesis occurs in hepatotocytes. Under the influence of biochemical reactions and degrading enzymes, it takes an active form in the form of fibrin monomer, which is part of the blood clot. Protein deficiency can be due to two reasons: congenital genetic mutations and its excessive depletion for biochemical reactions. This condition is characterized by excessive bleeding and poor blood clotting.

In addition, when tissue integrity is damaged as a result of mechanical damage or inflammatory processes, the production of fibrinogen increases significantly. Measuring protein concentration allows you to diagnose pathologies of the cardiovascular system (CVS) and liver, as well as assess the risk of possible complications.

AT III

AT III is one of the most important factors, the main producers of which are hepatocytes and endothelium, which lines the internal cavity of blood vessels. The main function is to suppress coagulation processes by inhibiting the functioning of thrombin. Thanks to the normal ratio of these two proteins, stable hemostasis is achieved. Insufficient synthesis of antithrombin leads to increased coagulation processes and a critical level of thrombosis.

APTT

APTT in a coagulogram is a criterion that allows one to evaluate the normal implementation of the internal pathway. Its duration is directly dependent on the concentration of kininogen (precursor of polypeptides) and various protein coagulation factors.

The APTT value is determined by measuring the time it takes to form a full-fledged blood clot when reagents are added to the test sample. Deviation of the criterion to a greater extent than the norm leads to an increase in the frequency of bleeding, and to a lesser extent – ​​to excessive formation of blood clots. In addition, isolated use of aPTT is acceptable in order to reliably monitor the effectiveness of the use of anticoagulant drugs.

D-dimer

Normally, a blood clot should undergo destruction (destruction) over time. By measuring the D-dimer value it is possible to determine the efficiency and completeness of this process. In case of incomplete dissolution of the thrombus, an increase in the criterion is noted. In addition, the use of D-dimer to monitor the effectiveness of anticoagulant treatment is acceptable.

Norm and interpretation of blood coagulogram in adults in the table

All coagulogram indicators (which means each criterion and interpretation) are presented in the table.

Age	Normal values	Reasons for the increase	Reasons for the downgrade
PTI, %
Any	From 70 to 125	· Disseminated intravascular coagulation syndrome (DIC syndrome); · Thrombosis; · Increased functional activity of proconvertin.	· Lack of clotting factors; · Production of mutant proteins that cannot take part in biochemical processes; · Hypofunction of vitamin K; · Leukemia in the acute stage; · Pathologies of the heart muscle; · Liver diseases (chronic hepatitis, cirrhosis, cancer); · Disturbances in the functioning of the bile ducts; · Malignant tumor of the pancreas; · Taking anti-clotting medications.
Up to 3 days	1,1-1,37	Similar to PTI	Similar to PTI
Up to 1 month	1-1,4
Up to 1 year	0,9-1,25
1-6 years	0,95-1,1
6-12 years	0,85-1,25
12-16 years old	1-1,35
Over 16 years old	0,85-1,3
Fibrinogen, g/l
Any	1,75 — 3,6	· Acute stage of the infectious process; · Violations in the body's natural defenses; · Heart pathologies; · Oncopathology; · Malignant lesion of lymphatic tissue; · Kidney diseases; · Chronic viral hepatitis; · Violation of tissue integrity of unknown etiology.	· Congenital absence of fibrinogen protein; · DIC syndrome; · Hereditary hemophilia; · Liver diseases; · Severe degree of malignant oncopathology; · Anemia; · Extensive infection of the body with bacteria; · Lack of macro- and microelements as a result of disruption of the digestive process; · Reaction to blood transfusion.
AT III, %
Up to 3 days	57-90	· Disturbances in the process of production and outflow of bile; · Hypofunction of vitamin K; · Period of menstruation; · Taking anticoagulant drugs; · Chronic excess globulin content as a result of liver pathology.	· Hereditary defect; · DIC syndrome; · Formation of blood clots in deep veins; · Liver diseases; · Heart attack; · Inflammatory damage to intestinal tissues; · Malignant tumors; · Organ sepsis.
Up to 1 month	60-85
Up to 1 year	70-135
1-6 years	100-135
6-12 years	95-135
12-16 years old	95-125
Over 16 years old	65-127
APTT, sec
Any	20,8 – 37	· Hereditary defect; · Low concentrations of vitamin K; · Genetic mutations; DIC syndrome; · Kidney or liver failure; · Anemia; · Taking anticoagulant medications.	· Bleeding before biomaterial collection; · Oncological disease.
D-dimer, µg FEU/ml
Any	0 – 0,55	· Thrombosis; · DIC syndrome; · Infection of the body; · Mechanical injuries; · Cancer.	—

Important: when selecting reference (normal) values, the age of the subject must be taken into account.

Peculiarities

A referral for a blood test for a coagulogram can be prescribed by a physician, surgeon, gynecologist or hepatologist. Moreover, in each specific case a certain set of criteria is selected. The determined coagulogram indicators can vary from two to a full complex, including all 6 criteria. Advanced analysis indicators are significant for a comprehensive comprehensive assessment of the functioning of the mechanisms that ensure blood clotting.

It should be noted that deciphering a blood coagulogram in adults should be carried out strictly by a specialist. Independent interpretation for the purpose of selecting treatment is unacceptable; this can lead to complications of the disease and death. In addition, the analysis in question is not enough to make a final diagnosis. It should be used in combination with additional laboratory and instrumental methods.

Deviation from the norm

It should be noted that a slight deviation from the norm by tenths or hundredths of units does not have diagnostic significance. This is explained by daily fluctuations in all laboratory readings of a person, as well as individual characteristics.

Significant deviations from reference values—by several units or more—acquire diagnostic value. A tenfold increase in the criterion indicates a severe stage of the pathology and requires immediate treatment.

Coagulogram during pregnancy

During pregnancy, a detailed coagulogram analysis is mandatory for all women. This fact is explained by the fact that a violation of the mechanisms that ensure blood clotting can occur for a long time without clinical signs.

The standard frequency of examination is once every trimester, however, if a woman has varicose veins, renal or liver failure, or chronic autoimmune pathologies, then the frequency increases at the discretion of the doctor.

Normal values ​​for pregnant women

When deciphering the results, you should take into account the exact week of pregnancy, since the indicators differ for each of them.

Week of pregnancy	Reference values
PTI, %
Similar to values ​​for non-pregnant women: from 70 to 125
INR
13-20	0,55-1,15
20-30	0,49-1,14
30-35	0,55-1,2
35-42	0,15-1,15
Fibrinogen, g/l
Up to 13	2,0-4,3
13-20	3-5,4
20-30	3-5,68
30-35	3-5,5
35-42	3,1-5,8
42-	3,5-6,55
AT III, %
13-20	75-110
20-30	70-115
30-35	75-115
35-42	70-117
APTT, sec
Similar to values ​​for non-pregnant women: 20.8 – 37
D-dimer, µg FEU/ml
Up to 13	0-0,5
13-20	0,2-1,43
20-30	0,3-1,68
30-35	0,3-2,9
35-42	0,4-3,15

Who needs a coagulogram?

The main indications for conducting an extended examination for a person:

• suspicion of DIC syndrome;
• carrying out an operation;
• frequent nosebleeds or bleeding gums;
• hematomas of unknown etiology;
• chronic anemia;
• heavy and prolonged menstruation;
• a sharp unexplained decrease in visual acuity;
• thrombosis;
• presence of a family history of hemostasis disorders;
• detection of lupus antibodies;
• CVD diseases with concomitant pathologies;
• intrauterine growth retardation;
• recurrent miscarriages (permanent miscarriage).

Hemostasiogram and coagulogram - what is the difference?

People are often concerned about the question: what kind of tests are a coagulogram and a hemostasiogram, and are there any differences between them?

A coagulogram is part of a hemostasiogram; it allows you to evaluate the correct implementation of the coagulation mechanisms themselves. In turn, a hemostasiogram is an advanced diagnosis that takes into account the entire cellular composition of the blood (erythrocytes, neutrophils) and indicators included in hemostasis (hematocrit, thrombocrit).

How to take a coagulogram test?

The most reliable results are achieved with accurate implementation of the analysis methodology. And proper preparation for a blood coagulogram is also important.

The most common question is whether it is necessary to take a coagulogram test on an empty stomach or not? Yes, you should take biomaterial strictly on an empty stomach. The minimum interval after the last meal should be 12 hours. The process of digesting food is a complex multi-stage process in which all human biological fluids are involved. Failure to comply with this rule may result in false results.

Preparation for the examination also means eliminating physical and emotional stress for the person at least 1 hour before collecting the material. Severe stress changes the condition of human tissues, as well as the biochemical composition of fluids. And before going to the treatment room, it is recommended to sit in the laboratory for at least 15 minutes in a free position and try to calm down as much as possible.

Taking anticoagulant medications significantly distorts the results, up to complete unreliability. Therefore, they, like any other medications (including oral contraceptives), must be excluded within 3 days. If this is not possible, inform the laboratory employee about all medications you are taking.

Smoking is prohibited 30 minutes before, and drinking alcohol is prohibited 24 hours before. At least 1 month must pass from the moment of blood transfusion, since this can significantly distort the value of fibrinogen and APTT.

What influences the result?

If even one of the following conditions of damage to the biomaterial occurs, the analysis must be canceled and the result is considered invalid:

• violation of the temperature regime for storing or taking biomaterial;
• hemolysis - destruction of red blood cells;
• the presence of fatty inclusions in the serum;
• the volume of red blood cells critically deviates from the norm;
• the presence of anticoagulant molecules in the biomaterial as a result of taking drugs.

The biomaterial should be re-sampled in compliance with all rules.

How many days does a coagulogram take?

The state clinic provides the opportunity to take a test with a minimum set of indicators, as a rule, this is a coagulogram of PTI and INR. The execution time does not exceed 1 day, not counting the day of collection of the biomaterial.

Private clinics offer both a limited version of the analysis (price starts from 200 rubles) and an extended full version (from 1,500 rubles). The duration is similar to state laboratories.

Thus, to summarize, it must be emphasized that:

• timely detection of hemostasis disorders can significantly reduce the risk of possible bleeding or excessive coagulation that threatens the formation of a blood clot;
• before submitting the biomaterial, it is important to prepare properly;
• These laboratory indicators are not enough to make a final diagnosis, because deviations from the norm can be caused by a number of pathological conditions. Determining the final diagnosis involves the use of additional laboratory and instrumental diagnostic methods.

Why do they take a blood clotting test? What are the indications for a coagulogram? What will deciphering a blood coagulogram tell you? What pathological processes and diseases can be indicated by deviations of certain blood clotting markers from reference values? We will try to answer these questions in as much detail as possible in this article, covering all indicators of blood clotting.

So, coagulogram with interpretation.

Fibrinogen

This is the so-called factor I blood clotting. Converted into fibrin - the insoluble basis of a blood clot - it plays a key role in the formation of a blood clot and, thus, in stopping bleeding.

When is a plasma fibrinogen test indicated:

• As one of the examinations before surgical interventions.
• In the presence of inflammatory processes.
• For cardiovascular diseases.
• During pregnancy for prenatal diagnosis.

Table of reference values, hemostasiogram indicators:

What could an increase in fibrinogen levels in the blood mean? Fibrinogen is increased during the development of heart attack, stroke, pneumonia, cancer, as well as acute inflammation, thyroid dysfunction, and amyloidosis. In addition, exceeding the norm may occur while taking estrogens and oral contraceptives, in the case of burns and surgical interventions. The interpretation of the analysis must be carried out by a doctor.

In the case of a low level of fibrinogen in the blood, a coagulogram may indicate:

• lack of vitamins B12 and C;
• serious liver pathologies such as hepatitis or cirrhosis;
• DIC syndrome;
• embolism of newborns (in this case we are talking about embolism with amniotic fluid);
• toxicosis of pregnant women;
• myeloid leukemia;
• polycythemia.

The level of fibrinogen in the blood plasma will be lower than normal during the period of taking anabolic steroids and androgens, as well as fish oil, as a result of poisoning with snake venom.

Thrombin time (TV)

This time is called thrombin time because it characterizes the time period during which the fibrin we have already mentioned under the influence of calcium ions turns into a blood clot.

When a blood test is prescribed to determine thrombin time:

• when it is necessary to determine how sufficient the level of fibrinogen in the blood is and what its effectiveness is, that is, whether the fibrinogen present in the blood copes with its functions;
• to monitor the effectiveness of treatment with fibrinolytics;
• to monitor the condition of patients with DIC syndrome;
• for severe liver diseases;
• to confirm miscarriages;
• to identify fibringen and (or) fibrin breakdown products in blood plasma.

Reference values ​​of the blood coagulogram indicator:

If TV on the coagulogram is reduced, this means that blood clots form very quickly, which is fraught with blockage of blood vessels and thrombosis, often leading to death.

Among the reasons for the increase in TV:

• congenital fibrinogen deficiency;
• autoimmune diseases;
• liver failure, hepatitis;
• presence of DIC syndrome;
• general hypovitaminosis against the background of hypervitaminosis with vitamin K;
• therapy with direct anticoagulants;
• development of infectious processes in the body;
• impaired blood circulation.

Prothrombin time

This blood clotting rate will tell us how quickly coagulation occurs and a blood clot is formed. Indications for referral for PTV test:

• general examination;
• preoperative examination;
• the likelihood of internal bleeding and hemorrhage;
• probability of thrombosis;
• assumption of hemostasis disorders;
• diagnosis of pathological processes in the liver;
• cardiovascular diseases;
• thromboembolism;
• therapy with direct and indirect anticoagulants;
• suspicion of chronic anemia;
• nosebleeds.

What are the normal values ​​for the coagulogram indicator Prothrombin time? Typically this is 11–16 seconds. During pregnancy, the upper limit is a couple of seconds higher. However, different brands of laboratory equipment may have their own regulatory indicators depending on the testing methods and conditions. Interpretation of indicators should be carried out by a doctor. When PTV is reduced:

• in the last three months of pregnancy;
• during therapy with aspirin in small doses;
• when using oral contraceptives;
• in the presence of polycythemia (increased number of red blood cells in the blood);
• in case of deep vein thrombosis of the legs.

An increase in PTV compared to the standard value may mean:

• congenital or acquired deficiency of certain blood clotting factors;
• DIC syndrome;
• treatment with warfarin;
• progressive hypovitaminosis of vitamin K (against the background of pathologies of the pancreas and gall bladder, imbalance of microflora);
• increase in antithrombin in the blood.

Deviation of PTT from the norm towards an increase can also be caused by taking certain antibiotics, laxatives, hormonal drugs and aspirin).

Prothrombic index

Normally, this blood test indicator is 95–105%; when analyzing a blood sample according to Quick, it is 78–142%. If the indicator is below the reference value this may indicate:

• insufficient amount of vitamin K, which affects blood clotting;
• treatment with coagulants;
• pathologies in the liver;
• congenital or acquired fibrinogen deficiency;
• congenital deficiency of certain blood clotting factors.

If the PTI on the coagulogram is higher than normal, then this may indicate a deficiency:

• congenital - prothrombin, plasma Ac-globulin, proaccelerin (labile factor), proconvertin (stable factor), Stewart-Prower factor;
• acquired - coagulation factors caused by nephrotic syndrome, amyloidosis, liver dysfunction;
• vitamin K.

And also occur during therapy with direct anticoagulants, the presence of heparin in the blood, leukemic disseminated intravascular coagulation syndrome, antibiotic treatment, taking anabolic steroids, laxatives, aspirin, nicotinic acid, etc., taking hormonal contraceptives.

Activated partial thromboplastin time

A study of this indicator can be prescribed to the patient along with the tests described above. The reasons for this are usually the following:

• bleeding;
• heart attack;
• intestinal necrosis;
• control of therapy in the presence of DIC syndrome;
• infertility, miscarriages, abortions;
• examination before surgery;
• diagnosis of hemophilia;
• thromboembolism;
• deep vein thrombosis;
• damage to great vessels.

Normal APTT values:

An increase in APTT value warns of the risk of bleeding due to:

• hemophilia;
• insufficient amount of vitamin K;
• presence of lupus anticoagulant in the blood;
• genetic abnormalities;
• acute leukemia;
• DIC syndrome;
• postpartum hemorrhage.

An APVT in the coagulogram below normal indicates a predisposition to hemophilia, bleeding and thromboembolism as a result of a deficiency of antihemophilic globulin, thromboembolism, and the initial stage of disseminated intravascular coagulation syndrome in a child.

When assessing the APVT indicator in combination with PTT, the decoding of the blood coagulogram can be as follows:

• a normal APVT with an increased PTT means the likelihood of liver pathologies, vitamin K deficiency and weak function of blood coagulation factor VII;
• the APVT norm + the PTT norm in the presence of a lupus anticoagulant in the sample is evidence of von Willebrand disease;
• APVT and PTT are increased, which means we can talk about serious problems with the liver, fibrinogen and prothrombin deficiency;
• a normal PTT + a slight decrease in aPTT indicates normal blood coagulation or a slight deficiency of coagulation factor.

D-dimer test These coagulogram indicators are valuable due to their high negative predictive value. The accuracy in this case is up to 98%.

How to evaluate the interpretation of the coagulogram in this case? If the D-dimer coagulation parameters are normal, then thrombosis is practically excluded with the indicated probability.

Increased values ​​will indicate that blood clotting is more active and the risk of thrombosis is high.

A negative result of this test is extremely rare, only in 2% of cases. First of all, when such a result is obtained, possible errors are eliminated even at the stage of collecting material, and a repeat analysis is performed. And even then, the obtained value below the normative threshold may indicate a small thrombus size, a decrease in FAP (plasma fibrinolytic activity or the ability to spontaneously dissolve blood clots) or a high level of the plasmogen inhibitor activator PAI-I. However, this is where the complex topic of genetics begins and to understand it, a separate article will be needed.

Lupus anticoagulant

The specificity of this indicator is that as such it is of little significance for diagnosis on its own and is considered by specialists as one of the factors in a series of tests. So, with a positive test result, the presence of blood clots, oncology, an inflammatory process or AIDS can be assumed. However, a correct diagnosis can only be made by assessing a set of indicators.

Coagulogram indicators proteins C

The deficiency of this protein argues for the risk of thrombosis and is inherited. The likelihood of developing this pathology depends on the form of inheritance, which is determined during the process of genetic analysis. Depending on its result, DIC syndrome and neonatal purpura (with a homozygous form of gene carriage) may be detected at an early age, or the risk of thrombosis and low sensitivity to anticoagulant therapy in adolescence increases.

When is a protein C test ordered?

• for thrombosis;
• if direct relatives have a congenital deficiency of this protein;
• according to the results of other blood clotting tests.

Reference values ​​of protein C in a coagulogram:

• activity - 70–130%;
• amount - > 3 mg/ml or 60 nmol/l.

Proteins S

The normal values ​​for these hemostasiogram indicators in blood plasma are 140%, in free form - 65–144%. However, you need to know that women have slightly less of this protein than men.

Protein S deficiency is a cause of venous thrombosis, especially at a young age.

Plasma heparin tolerance

Normally, this coagulogram indicator is 7–15 minutes. If the upper threshold of the reference value is exceeded, this indicates a decrease in resistance to heparin, which often happens in cases of liver disease. If a blood coagulogram shows that the test result did not reach the lower value of the norm, this may indicate oncology, diseases of the cardiovascular system, during pregnancy and in the postoperative period.

RFMC or soluble fibrin-monomer complex

The normal test value is 3.36–4 mg/100 ml of plasma. If rfmk is increased, this may indicate disturbances in the hemostasis system, thrombinemia (excessive number of microthrombi in the vessels).

RFMC may be below normal while taking anticoagulants, usually when the recommended doses are violated, causing the blood to begin to clot poorly.

Duke bleeding time

Normally, bleeding in this test completely stops within 1.5–2 minutes. This coagulogram indicator is diagnostically significant only with a comprehensive assessment of blood tests.

Coagulability according to Lee White

The reference values ​​of the indicator fall within a time period of 4–7 minutes for a glass test tube and 15–25 for a silicone one.

If this coagulation rate exceeds the norm, this may indicate a malfunction of the thyroid gland, anaphylactic shock, or blood loss.

This phenomenon can also occur as a result of vascular manipulation.

A slower clotting time in this test often indicates liver disease, severe infections, hemophilia and oncological heparin therapy and treatment with other anticoagulants.

Antithrombin III

This blood test for coagulogram is indicated for:

• suspicion of venous thrombosis;
• after surgery to remove a blood clot;
• with low sensitivity to heparin,
• and also in combination with tests for proteins C, S and lupus anticoagulants.

The indicator values ​​are normal:

There is also a separate scale of normative values ​​for pregnant women.

If this oagulogram indicator is elevated, this may mean:

• long-term therapy with warfarin, phenylin;
• lack of vitamin K in the body;
• the presence of acute viral hepatitis and other liver diseases;
• the course of the inflammatory process;
• period of menstruation in women.

Low values ​​indicate:

• predisposition to thrombotic processes;
• last weeks of pregnancy;
• mid-menstrual cycle.

Coagulation is a complex and very important process in the human body; a coagulogram blood test allows you to control it. The hemostasiogram in adults and children must be deciphered by a doctor. Yes, indeed, this is the lot of a specialist, and a fairly experienced and qualified one at that. Without having a sufficient amount of knowledge, it is simply impossible to interpret the coagulogram indicators correctly. Therefore, your own interpretation of the coagulogram results is not a reason to adjust the treatment prescribed by the doctor, otherwise the results may be unpredictable.

Before surgical interventions and when diagnosing various diseases, doctors refer patients for a blood test for clotting. This indicator is very important for the normal functioning of the entire body as a whole, because deviations in one direction or another pose a risk of developing serious diseases. The results of the study will tell the doctor about the abnormalities existing in the body. Let’s figure out what the normal coagulogram should be and what its main indicators tell the doctor.

Description of the analysis

A blood coagulogram is a study that shows how quickly a clot forms. It should be noted that in most cases the patient undergoes a regular coagulogram. It reports on the state of the hemostatic system, in particular the number of platelets and their aggregation, capillary resistance and bleeding time, as well as some other blood parameters. However, sometimes, to make a diagnosis, a doctor may need a detailed coagulogram, which analyzes and deciphers a number of other factors.

Each of the decoding indicators correlates with certain functions of the human body. Therefore, a deviation from the norm of the coagulogram in one direction or another will tell you which organ or system is not working correctly, and what should be given special attention. Deciphering the analysis is subject to only a specialist.

There is no need to try to diagnose yourself, because the result of treatment directly depends on the accuracy of the diagnosis.

For the convenience of analyzing the research results, a single table is created in which the obtained indicators and norms for each of them are entered. It is worth noting that the diagnosis should be made taking into account the level of all indicators entered in the table. Carrying out a blood clotting test, the norm of which depends on age, is possible only in laboratory conditions.

So, let’s take a closer look at what this analysis is and its main indicators.

Clotting time

This indicator is determined by the time interval between the moment of damage to the wall of a blood vessel (for example, a cut) and the moment the bleeding stops, which occurs due to the formation of a fibrin clot. It characterizes the efficiency of platelet function. For capillary blood, the clotting time is 0.5-3 minutes, sometimes it can extend up to 5 minutes. For venous blood, this figure is normally 5-10 minutes.

An increase in the indicator above the specified norms indicates a decrease in the number of platelets, a lack of vitamin C or liver disease. It can also grow while taking contraceptives and anticoagulants.

Prothrombin index

This indicator correlates with prothrombin time (PT). PTI, like the previous indicator, is determined by the duration of blood clotting, but this process occurs when calcium and thromboplastin are added to the test sample. Thus, the ability of blood to clot with sufficient levels of thromboplastin is examined.

The norms of the indicator depend on the age of the patient. For newborns, PTI is 13-18 seconds, for school-age children - 12-16 seconds, for adults 11-15 seconds.

Deviation of PTI from these norms indicates chronic liver diseases, poor intestinal absorption, and the presence of dysbacteriosis. An increase in PTI in pregnant women is considered natural and normal.

This index is directly related to the level of vitamin K in the body.

PTI evaluates the effectiveness of indirect anticoagulant therapy. If, while taking drugs, the PV increases by 1.5-2 times, then the dosage is considered sufficient.

If clotting time increases beyond normal, the risk of blood clots increases. Taking oral contraceptives can cause the same result. A very low PT indicates a risk of bleeding.

The index value is determined by the ratio of the PV of the blood plasma of a healthy person to the PV of the blood plasma of the test sample. Normally, the coagulogram PI should be 93-107%. If there is any deviation in the indicator, the patient is prescribed an additional examination.

INR

The name of this indicator is an abbreviation for International Normalized Ratio, but it is also called prothrombin ratio. It was introduced by WHO in 1983 with the aim of unifying the work of laboratories around the world, since each of them used different thromboplastins as reagents for research.

This indicator is calculated as the ratio of the patient's PT to the average prothrombin time.

It is used to monitor patients' treatment with indirect anticoagulants, such as phenylin or warfarin, which are drugs that impair blood clotting. People who are indicated for therapy with these drugs should monitor their INR at least once every three months. A decrease in INR indicates the low effectiveness of the medications taken and a possible risk of vascular thromboembolism.

An increase in this indicator can be caused by liver disease, nephrotic syndrome, hereditary disorders of clotting factors and can cause frequent bleeding.

The INR coagulogram is included in an extended study, which the doctor prescribes in addition to the main one.

APTT

This indicator is determined by the time required for the formation of a blood clot after adding special reagents to the plasma - activated partial thromboplastin time. APTT is the most accurate and sensitive element of a blood test, as it characterizes its ability to clot under the influence of plasma factors.

For a coagulogram, the normal aPTT value is 30-50 seconds. Its value changes sharply when any of the components of the coagulogram deviates from the hole by more than 30-40%. A result that is too low indicates that the blood has increased clotting, which increases the risk of blood clots. This APTT result can be obtained if the sampling technique for a blood test is violated. Indicators above normal may be signs of hemophilia, phases 2 and 3 of disseminated intravascular coagulation syndrome (DIC), autoimmune disease, and severe liver pathology.

The APTT value increases during treatment with heparin or its analogues.

APTT is a mandatory component of a standard coagulogram.

Fibrinogen

This specific protein produced by the human liver is considered the first plasma coagulation factor. A fibrin clot, formed through a series of chemical reactions, is the main component of a blood clot.

Normally, the protein concentration should be in the range of 5.9-11.7 µmol/l, which corresponds to 2-3.5 g/l. However, with liver diseases, its production decreases. Low protein levels can be caused by hereditary factors.

Protein concentration increases sharply during acute infectious diseases or inflammatory processes (pneumonia, pyelonephritis, peritonitis), with a deficiency of thyroid hormones and in the presence of malignant neoplasms. Against the background of increased coagulability, there is a risk of developing complications in the functioning of the cardiovascular system.

The value of the coagulogram increases significantly during pregnancy, but this is normal, since in this way the body prepares for future blood loss. However, this indicator must be monitored once every three months throughout the entire period of gestation. Fluctuations in the direction of increasing fibrinogen concentrations in women during menstruation have been noted. In young children, normal protein coagulogram values ​​are significantly lower than in adults and amount to 1.25-3 g/l.

Dimer

The dimer is a breakdown product of fibrin, which forms a blood clot. Its quantity allows one to judge the intensity of the processes of formation and disintegration of fibrin clots.

The dimer concentration is affected not only by blood clotting, but also by the size of the clot.

Exceeding the norm indicates the presence of hematomas, venous thrombosis, vascular thromboembolism, coronary heart disease, vascular problems caused by long-term smoking, and rheumatoid arthritis.

RFMK

The amount of soluble fibrin-monomer complexes in blood plasma allows us to estimate the rate of fibrin clot breakdown under the influence of plasmin and thrombin.

To diagnose diseases, the doctor pays attention to the upper threshold of the RFMC level. Normally per 100 ml. should be 4 mg. RFMK. A higher content of complexes is fraught with the risk of intravascular thrombus formation.

An increase in the concentration of RFMK indicates the presence of:

• various thromboses,
• complications of pregnancy,
• states of shock,
• sepsis,
• renal failure,
• connective tissue pathologies.

A decrease in the concentration of RFMC is recorded during heparin administration, which makes it possible to identify patients in need of heparin therapy.

This indicator is not included in the factors of a standard examination, but is determined using a detailed coagulogram. Most often it is examined before surgery.

AVR

The activated recalcification time reflects one of the stages of blood coagulation, indicating how long it takes for fibrin to form in calcium- and platelet-rich plasma. A period of 50-70 seconds is considered a normal indicator. Exceeding the norm may indicate hemophilia, and too short a time may indicate an increased likelihood of blood clots.

Fibrinolytic activity

We got acquainted only with the most basic coagulogram indicators, which characterize the general state of the hemostatic system and allow the doctor to diagnose a number of serious internal diseases. The transcript of the analysis may contain a much larger number of parameters being studied, on the basis of which a decision will be made about the effectiveness of the therapy or the possibility of surgical intervention.