What indicators are included in the basic coagulogram? Coagulogram results with interpretation of indicators and comparison with the norm. Interpretation of coagulogram results during pregnancy

A coagulogram is a blood test to measure its coagulability. It is important for doctors to know this result when preparing a patient for surgery. It is necessary to have data on blood clotting if a person has a disorder, if there is a history of diseases of the liver, cardiovascular and autoimmune systems, or varicose veins of the lower extremities. Using a coagulogram, the causes of bleeding are determined and the condition of a woman’s blood is monitored during pregnancy.

How to take a blood test for a coagulogram correctly - tips for taking the test

The blood clotting system is called hemostasis and protects the human body from excessive blood loss.

An analysis that tests the operation of this system is called hemostasiogram or coagulogram.

The endocrine and nervous functions of the body are responsible for the proper functioning of hemostasis. So that the blood successfully copes with its basic functions, it should be quite liquid. Thanks to blood circulation through the vessels, tissues are nourished, useful substances are transported to all organs, the immune system is in action, and the body is provided with normal thermoregulation.

Decreased blood clotting leads to to heavy blood loss in case of bleeding of various origins.

Hypercoagulation, on the contrary, to the formation of clots, that is, blood clots.

Since a coagulation test is vitally important, the doctor always wants to get accurate test data.

In order to properly donate blood for a coagulogram, you should properly prepare for the analysis. Exists a number of preparation rules, compliance with which guarantees the accuracy of the results:

• Do not eat food for 8-12 hours before taking the analysis.
• Recommended the day before in the evening, eat only a light dinner.
• You can drink before the test but only ordinary drinking water.
• Do not drink coffee or tea, juices or alcoholic beverages before the test..
• Also recommended refrain from smoking for an hour before donating blood.
• Immediately before blood collection you should take a coagulogram drink a glass of clean water.
• 15 minutes before donating blood, it is not recommended to overexert yourself emotionally or physically.
• Before taking blood, you need to be calm, balanced and relaxed, not tense.
• A patient taking medications that affect clotting should notify physicians about this.

Patients who experience symptoms of dizziness or fainting during blood sampling must warn the specialist who takes the test about this!

All blood coagulogram indicators - what each indicator means, explanation

Standard blood test for coagulogram includes many indicators. Professional decoding of the received data is carried out by qualified specialists, analyzing all parameters together.

Blood coagulation data are especially useful if the patient:

1. There is a tendency to form blood clots.
2. Postoperative, uterine or other bleeding has begun.
3. Treatment with anticoagulants is carried out.
4. History of stroke or heart attack.
5. There are vascular diseases.
6. Liver diseases are present.

The main indicators of the coagulogram are as follows:

• Clotting time means the time interval between the time blood begins to flow from a wound, for example, when a finger is cut, and the moment when the blood stops because a fibrin clot forms in it. This interval normally for capillary blood ranges from 30 seconds to 3-5 minutes. Venous blood takes longer to clot – within 5-10 minutes. This indicator indicates how platelets cope with their work.

The duration of bleeding from the wound may be longer, if the platelet count is low for any reason, if there is a lack of vitamin C or if the person has been taking anticoagulant medications for a long time, such as aspirin, or if hemophilia or liver disease. Blood clots faster after heavy bleeding and when using hormonal contraception.

• Prothrombin index (PTI) measured as the ratio of the clotting time of the blood plasma of a healthy person, the so-called control blood, to the clotting time of the blood of the patient from whom the analysis is taken. The PTI value shows the condition of the human liver. During pregnancy, this indicator increases - this is normal. A pathological upward shift in the value of the prothrombin index occurs when using oral contraceptives, as well as if there is a risk of blood clots. When PTI decreases, there is a danger of bleeding.

When analyzing a blood coagulogram, the norm of the prothrombin index ranges from 93-107%. To maintain the normal state of this indicator, the body needs vitamin K.

• Thrombin time normally equal to 15-18 seconds, measures the interval of conversion of fibrinogen to fibrin. If the thrombin time is less than normal, most likely there is excess fibrinogen in the blood. Prolongation of the thrombin gap is associated with a hereditary deficiency of this protein or with severe liver failure.

When using heparin in the treatment of a patient, this indicator must be strictly monitored!

• Activated partial thromboplastin time (aPTT) - the most sensitive indicator of blood clotting, indicating the time of formation of a blood clot after combining calcium chloride with plasma and a number of other components. Normally, the APT coagulogram shows an interval of 30-40 seconds. The indicator is sensitive to changes in any other component of the coagulogram within 30 or 40 percent. An increase in aPTT is observed with vitamin K deficiency and liver diseases.
• Activated recalcification time (ATR) helps to understand how one of the stages of blood clotting occurs. Normally, the indicator ranges from 50 to 70 seconds. If in the analysis the coagulogram avr is shorter than the normative one, then we can talk about a state of thrombophilia. When the time interval is extended, there is a danger of heavy blood loss in case of bleeding. An increase in recalcification time occurs due to a decrease in the number of platelets in the blood, during heparin therapy, in critical conditions such as burns, trauma, shock.
• Fibrinogen concentration Normally ranges from 5.9 to 11.7 µmol/l. The rate decreases in diseases affecting the liver. It increases with malignant neoplasms, with a lack of thyroid hormones, and with acute infectious diseases.

• Soluble fibrin-monomer complexes (SFMC) show changes in fibrin molecules under the influence of plasmin and thrombin. The upper limit of normal for RFMC per 100 ml is 4 mg. When studying the coagulogram rfmk, the decoding of the indicator serves as a marker of intravascular coagulation. Changing it depends on the same reasons as varying fibrinogen.
• Thrombotest allows you to visually see the amount of fibrinogen contained in the blood. The norm is thrombotest grade 4 or 5.
• Plasma tolerance to heparin shows the amount of thrombin in the blood. The analysis determines the time it takes for a fibrin clot to form in the blood plasma after heparin is administered to it. In normal blood of a healthy person this occurs in 7-15 minutes. A decrease in blood resistance to the action of heparin is indicated by a tolerance interval of more than a quarter of an hour. Heparin resistance decreases in liver diseases. The tolerance time will be less than seven minutes for hypercoagulation, characteristic of pregnancy, cancer, postoperative periods, and diseases of the cardiovascular system.
• Fibrinolytic activity characterizes the ability of blood to independently dissolve blood clots. Fibrinolysin, which is capable of breaking down the structure of a blood clot, is responsible for this indicator in plasma. If blood clots dissolve faster than normal, it means the person has increased bleeding.

• Duke bleeding time characterizes the bleeding time when pricking a finger with a special lancet. The injection is made to a certain depth - 4 mm. Then, every 15-30 seconds, using special paper, one drop of escaping blood is removed from the wound. In this case, the paper does not touch the finger. After removing one drop of blood, the time is noted when the next one comes out of the wound. In this way, the time to stop capillary bleeding is checked. Normally it is approximately 1.5 to 2 minutes. The result of this test is influenced by serotonin and blood platelets.
• Fibrinogen is a protein synthesized by the liver. Under certain factors, it is converted in the hematopoietic system into the high molecular weight protein fibrin. Fibrin fibers serve as the basis for the formation of blood clots. The fibrinogen content in healthy blood should be within 2-4 g/l.

A coagulogram shows a dangerous decrease in fibrinogen levels when:

1. Toxicosis during pregnancy.
2. Malfunctions in hemostasis.
3. Cirrhosis of the liver.
4. Severe form of hepatitis.
5. Lack of B vitamins and ascorbic acid.
6. Taking fish oil.
7. Use of anabolic steroids and anticoagulants.

Fibrinogen content in the blood increases for pneumonia, acute infections and various inflammatory processes, after childbirth, during pregnancy, after surgery, for burn injuries, hypothyroidism, heart attack or stroke, as a consequence of taking hormonal drugs.

• Fibrinogen B – in a healthy blood test, this marker should be negative.
• Blood clot retraction - its normal percentage level ranges from 44 to 65. This is an indicator of a decrease in the volume of a blood clot, its contraction with the release of blood serum. Increased retraction is characteristic of anemia. The decrease occurs due to an increase in the number of red blood cells and a decrease in platelets.
• Plasma recalcification time (PRT) normally ranges from 60 to 120 seconds. This is one of the important indicators of hemostasis, which has something in common with AVR and records the clotting time of oxalate and citrate plasma, which is detected from the moment calcium salts are introduced into it. A reduction in recalcification time indicates hyperactivity of the coagulation system.

Blood coagulogram - table of normal indicators for adults and children

Main indicators of coagulogram - table of standards:

Children's indicators somewhat different. In particular, for newborns the fibrinogen norm is 1.25–3.00 g/l.

A blood coagulogram test is done for the child before any surgical intervention, if you suspect hemophilia or other anomaly of the hematopoietic system, with frequent nosebleeds.

Many women are prescribed a biological fluid test called a coagulogram. It helps the attending physician determine the state of hemostasis and identify the presence of hyper- or hypocoagulation. In addition, it becomes easier for the patients themselves to understand the various symptoms if they know what kind of analysis it is - a coagulogram, what it is intended for, and how to decipher it correctly.

What is included in the coagulogram analysis?

Hemostasis is a system that is responsible for the normal consistency of blood, as well as its ability to clot. Any violation leads either to the formation of blood clots, which is typical for varicose veins, cardiovascular pathologies, and hepatological diseases, or to a decrease in the density of biological fluid (hemophilia, frequent bleeding due to minor vascular damage).

Thus, a coagulogram differs from a general and biochemical blood test in terms of indicators. It includes in the basic version:

1. PTI (prothrombin index), PTT (prothrombin time) or INR (international normalized ratio). The last test is considered the most informative and universal. These indicators allow you to calculate the period of time during which a blood clot forms at the site of injury.
2. Fibrinogen is a protein that is responsible for the appearance of blood clots as the final stage of the coagulation of biological fluid and is converted into fibrin.
3. Thrombin time. Shows the period during which fibrin is produced from fibrinogen.
4. APTT (activated partial thromboplastin time). The indicator allows you to record the time of formation of blood clots.

Additional information for a coagulogram is obtained from a blood test for the following parameters:

• plasma tolerance to heparin;
• protein C;
• D-dimer;
• plasma recalcification time (PRP), the activated parameter (APRP) is also taken into account;
• antithrombin;
• RFMC (soluble fibrin monomer complexes);
• lupus anticoagulant.

The listed additional indicators are required for a more accurate diagnosis if a specific disease is suspected, especially during pregnancy.

Preparation for coagulogram analysis

The only requirement for the patient before the study is to refuse to eat 8 hours before the collection of biological fluid. It is recommended to donate blood in the morning, but this is not a strict rule.

How long does a coagulogram analysis take?

The time required to calculate the quantitative indicators of the study is 1 working day. It may exceed the specified period depending on the equipment installed in the laboratory, as well as the need to transport the material (no more than 3-4 days).

Norms for coagulogram analysis

Decoding the study consists of comparing the obtained parameters with reference values.

They are:

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

As a rule, any medical examination begins with asking the patient himself about previous diseases or surgical interventions, 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 information necessary for choosing a treatment method or further diagnosis.

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

Coagulogram - what is it?

Many patients needlessly begin to worry when they hear from their attending physician such unusual at first glance words as coagulogram or else hemostasiogram . So what kind of coagulogram analysis is this 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 human body, which is responsible for such important vital functions as: stopping bleeding when damaged blood clots or vessels , as well as maintaining the normal fluid 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 coagulogram test helps to study such an important blood function as the ability to clot, i.e. formation of a blood clot.

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

Therefore, you hardly need to worry too much about how much this research costs. After all, the price of a hemostasiogram cannot be compared with the confidence that the patient will be alive and healthy.

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

• vascular thrombosis And lower extremities;
• cirrhosis chronic form;
• gestosis;
• 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 planned operations, for example, cesarean section, as well as during pregnancy to assess the state of hemostasis and before independent childbirth . Every woman in labor must have a blood test such as a coagulogram in her exchange card.

Human hemostasis system

Having determined what a hemostasis test is, it is worth understanding 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 to be the preservation of basic blood parameters, as well as stopping bleeding.

It is not for nothing that the human body is called the whole universe and is compared to a complex mechanism. And the hemostasis system can serve as a striking example of how ingeniously people are designed. Blood is a unique biological fluid that can literally work miracles in our body.

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

There are three main components of the human hemostasis system:

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

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

Interpretation of blood coagulogram

The 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 indicators. 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 decoding of the coagulogram with the norm established for adult patients, as well as children. It is important to remember that the normal coagulogram for a child, man or 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

Let's consider the parameters of the blood clotting test, namely the normal hemostasiogram values. 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 different interpretations of the norm for these parameters by specialists involved in their study.

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

*Nanogram per milliliter Source: Wikipedia

Clotting time

This laboratory test of the patient's blood gives the doctor an idea of ​​the time it takes for the body to form a blood clot. There is no shorthand symbol for this parameter in the analysis. During the research, biological material (blood) taken from a patient’s vein is placed in a sterile and dry tube, and then the time is noted 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, and also exclude some pathological conditions, for example, hemophilia or DIC syndrome , in which a blood clot does not form at all. If the blood clotting time deviates from the norm (increase or decrease in indicators), you should understand the reasons in more detail.

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

In addition, all coagulogram indicators, including this one, may deviate from the norm during pregnancy. Women, as a rule, first learn about the name of a blood clotting test during pregnancy, when they are required to undergo many laboratory tests in order to monitor and promptly influence the health of the mother and unborn child.

The changes that rapidly occur in the body of a pregnant woman do not leave their mark on 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 indicator can differ greatly from the norm. However, do not be afraid, since 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 standards, the duration of bleeding should not be less than or more than a few minutes from the moment of puncture, the so-called primary hemostasis. To complete the process, i.e. The formation of a blood clot should take an average of 10 minutes maximum. Blood clotting time is a very important indicator that plays a big role in preparing the patient for surgery, for example, during a cesarean 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 if:

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

How to take a blood clotting test?

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

In addition, you should refrain from taking alcoholic beverages and medications on the eve of the study, as this may affect the test result. If the patient is forced to take any medications, he must remember to inform the medical professional about this.

Prothrombin time

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

PT reflects phases 1 and 2 of plasma coagulation. In other words, the time of formation of a thrombin clot in the blood when thromboplastin and calcium are added. For this parameter, the abbreviated designation PV is accepted; sometimes PVT is also used. Blood clotting test 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 gender of the patient.

For example, the normal thrombin time in women and men is 11-15 seconds. Standards are established for children 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 is higher than normal - what does this mean? Deviation from the standard indicators established for a given coagulogram parameter may mean the following:

• flaw vitamin K in organism;
• low concentration or lack of clotting factors 1,2,5,7, and also 10;
• disruption of the normal functioning of the liver, liver failure or other diseases of this organ;
• Availability DIC syndrome .

Prothrombin time is increased, what does this mean? As a rule, exceeding the PT indicator is associated with the patient taking medications belonging to the group of anticoagulants, i.e. drugs with anticoagulant properties, for example , Kumadinilin or .

International Normalized Ratio

Prothrombin ratio (abbreviated PTI) or INR in a blood test, what is it? Let's start with a little background. Such a parameter as INR in a 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 clotting tests to a single standard understandable to doctors all over the world.

Previously, each laboratory could use different thromboplastin reagents , which could distort the final research results. This coagulogram parameter is abbreviated as INR or INR. In domestic medicine, you can currently still find instead of INR such an indicator as the prothrombin index, which reflects how well the patient’s blood clots.

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

• 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 PT of the patient’s analysis and the PT of the control sample. The INR norm in a human blood test according to international standards can range from 0.82 to 1.18.

If there is a deviation from the above values, the patient may be diagnosed with the following diseases:

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

In addition, an increase in INR and PT may indicate the presence of anticoagulant drugs in the patient’s blood. Therefore, the INR norm when taking Warfarin differs from established standards. For patients taking this drug and drugs similar to it in action, the following range of normal INR values ​​is used - 2.0-3.0.

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

Activated partial thrombin time

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

APTT blood test - What is this? The parameter is often called activated partial thromboplastin time. APTT, like APTT, provides information about the rate of formation of a fibrin clot and best characterizes 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 tests.

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

When the above reasons are excluded, and the aPTT is higher than normal, this means that the patient may have diseases such as:

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

When APTT is low, what does it mean? If the value is below normal, this indicates that the blood's ability to clot is reduced. The main reasons for this condition may be:

• DIC syndrome 1st degree;
• increased coagulability;
• an error during laboratory testing, for example, incorrect blood sampling.

Soluble fibrin-monomer complexes

Abbreviated in a coagulogram as RFMK. RFMK analysis, what is it? Let's start with a definition fibrin-monomer complexes - these are products of the breakdown of a blood clot in the process fibrinolysis . According to researchers, this indicator is quite 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 diagnosis DIC syndrome (full name: disseminated intravascular coagulation syndrome). The norm of RFMK in human blood is 0.355-0.479 units. However, during pregnancy, RFMC norms may differ significantly from the above indicated level. Since the female body is actively preparing for the upcoming birth, the basic parameters of the blood change along with it, including its ability to clot.

This is a kind of defense mechanism that helps minimize the risk of bleeding. Deviations of RFMC levels during pregnancy of up to 5.1 ml are considered normal. per 100 ml. blood. If RFMK is elevated, what do these analysis results mean?

When RFMK is increased in a patient’s coagulogram, the reasons may be as follows:

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

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

Activated recalcification time

Abbreviated as ABP in the analysis, it denotes the time required for the formation of fibrin in blood plasma saturated with platelets and calcium. This parameter is also used to evaluate the blood coagulation system as a whole. AVR reflects the interaction of cellular and plasma components of hemostasis.

It is noteworthy that the value of this parameter may vary depending on the reagents used in laboratory tests. As a rule, a shortened recalcification time indicates the patient’s body’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 basic characteristics.

Prothrombin index. Norm for women

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

It is noteworthy that this indicator is currently almost never used, since WHO recommends the use of such a parameter, which is more resistant to laboratory tests, such as INR. The normal level of PTI in the blood for a healthy person is set at 73-122%.

As a general rule, the rate of IPT in women should not differ from the above values, with the exception of the period of pregnancy, when blood clotting increases. Therefore, if a woman’s coagulogram deviates from the norm, she 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, an increase in PTI is due to treatment with anticoagulants such as , Warfarin or Neodicoumarin , 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.

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 operation. One of the most important factors is considered prothrombin or factor II, also known as thrombogen . This is a protein that is a precursor to thrombin, which in turn is responsible for the coagulation function of the blood - 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 Kwik – 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 is hampered 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 before. strokes and heart attacks , and also significantly increases the risk of developing malignant tumors or thromboembolism .

In case the level thrombogen is reduced, the formation of a blood clot occurs abnormally slowly, which is fraught with significant blood loss if bleeding develops. As a rule, the causes of such a failure in the hemostatic 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 clot formation fibrin when added to blood plasma thrombin . Monitoring of TV is always carried out in combination with PT and APTT for the most effective diagnosis of congenital fibrinogen pathologies, as well as to assess the effectiveness of fibrinolytic and heparin therapy.

Fibrinogen

What is a fibrinogen blood test? First blood clotting factor or fibrinogen - this is nothing more than a protein formed under the influence Hageman factor in the liver, and subsequently under its influence transforms into insoluble fibrin . The presence of fibrinogen is determined by performing a thrombotest.

Thrombotest grades 4 and 5 are considered normal. It is worth noting that since fibrinogen (an acute phase protein), its level increases 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 level of fibrinogen in women's blood should not be lower or higher than the specified values, except during pregnancy.

A pregnant woman's blood parameters undergo changes, as does her entire body. Many protective systems are launched, including the hemostasis system in preparation for the upcoming delivery. Often, already in the first trimester, fibrinogen levels 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 increases, 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 consequence, from a deficiency of important micro- and macroelements, as well as vitamins. During pregnancy in the second trimester, the fibrinogen level should be within the normal range of 2.4-5.1 g/l, and in the third trimester - up to 6.2 g/l.

Elevated levels of fibrinogen are 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 diseases such as:

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

Fibrinogen levels may decrease during poisoning Heparin , as well as when the patient receives anabolic steroids, androgens, And barbiturates .

Antithrombin III

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

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

In addition, antithrombin III may decrease in the last trimester of pregnancy and when the patient takes Heparin or fibrin inhibitors. When antithrombin 3 is elevated, inflammatory pathologies may be the cause, e.g. peritonitis, pyelonephritis And pneumonia, as well as hepatitis and deficiency vitamin K.

D-dimer

Another indicator of an extended coagulogram, with the help of which the doctor analyzes not only blood clotting, but also the anticoagulant system of the human body. D-dimer - these are split fibrin strands. Only an increased result of this parameter is significant, which indicates the development of liver diseases in the patient’s body, DIC syndrome, 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 the same coagulogram that is necessarily prescribed to women during pregnancy, as well as immediately before preparing for childbirth.

During pregnancy, the norm for all blood clotting test indicators 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 hemostasis system of a pregnant woman undergoes serious changes, as does her entire 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, which is dominated by .

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

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

Decoding coagulogram indicators during pregnancy

We talked about what a coagulogram is and why this test is taken. Now let’s figure out how to properly undergo 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 expanded or detailed analysis is more often available in paid medical institutions. For example, in the Invitro laboratory, a coagulogram can be done quite quickly. As a rule, the test result can be collected within a couple of days. This is due to the need for a number of chemical reactions that require a certain amount of time, which simply cannot be avoided.

However, in any case, you will receive the result of a paid analysis much faster than in a government 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.

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

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

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

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

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

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

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

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

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

Indications for analysis

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

How is it carried out and how to prepare?

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

Blood for coagulation testing is taken from a vein

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

Coagulogram parameters

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

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

A decrease in fibrinogen occurs in the following cases:

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

The fibrinogen content increases in the following cases:

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

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

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

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

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

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

Additional coagulogram parameters

These include the following:

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

The process of blood clot formation

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

Finally

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

A coagulogram or hemostasiogram is prescribed when it is necessary to determine blood clotting parameters.

Most often, this need arises before surgical interventions to prevent blood loss. Pregnant women and people with disorders of the heart, liver, and kidneys are also tested.

As a result, a number of indicators are obtained. Each parameter individually and their combination is important. What kind of analysis is this, where is the blood taken from, how to prepare for a coagulogram, how many days does the extended study take and what are the rules for deciphering the results?

Blood circulates through the vessels in liquid form, but when they are damaged, it thickens and forms blood clots to close the wound and allow the damaged tissue to recover. This ability is controlled by the hemostasis system. Coagulation occurs in three stages:

1. When damaged, the inner surface of blood vessels triggers thrombus formation processes. The walls of the blood vessels spasm to reduce blood loss.
2. Platelets are produced in the bone marrow. Which are plates that rush to the damaged area and stick together to close the wound.
3. The liver produces 15 clotting factors (mostly enzymes). Reacting with each other, they form a fibrin clot, which finally stops bleeding.

A hemostasiogram shows the state of hemostasis. Prescribed in the following cases:

• Before any operations to determine clotting time;
• before any type of delivery;
• pathologies of the hematopoietic organs and control of their treatment;
• liver diseases;
• for cardiovascular diseases with a high risk of blood clots;
• when taking certain medications;
• blood loss of various nature;
• chronic foci of inflammation in the body.

If the activity of the hemostatic system is reduced, an increased tendency to bleeding develops, and with excessive activity, the risk of blocking blood vessels with blood clots increases.

Before surgery, the clotting time is determined to avoid blood loss. And for heart disease it is important to prevent thickening to warn, or.

Watch an educational video animation about the human hemostasis system:

Preparing for such a procedure, how to take it correctly

To obtain reliable results, it is important to submit the examination material correctly.

To do this you need to remember:

1. Blood sampling is carried out in the morning on an empty stomach. The last meal should be at least 8 hours before the test (preferably 12). The day before you should not drink spicy, smoked, fatty or alcoholic drinks.
2. You should not smoke before taking the test.
3. You can drink. But only clean water.
4. Some medications affect clotting and may make the results unreliable. You must provide your doctor with a list of medications you are taking. If possible, you should stop taking medications 2 days before the examination.

It is advisable to drink a glass of water before the test. Also, you should not take the test immediately after physical activity or during severe nervous tension. Results may be distorted.

The collection is made from a vein without using a tourniquet. It is important that the material being tested is sterile. The result is ready in 1–2 days.

Hemostasiogram is one of the most difficult studies. To make a correct diagnosis It is advisable to also perform a general blood test(). Then the picture will be complete.

Violations of the rules for collecting material for analysis, recent blood transfusions, and tissue from capillary blood entering the collected sample can affect the result.

What does a blood clotting test show?

A hemostasiogram may include a different set of indicators. It all depends on the purpose of the research. The doctor indicates the necessary parameters in each specific case.

Typically, as a result of a hemostasiogram, the following is determined:

During the examination, indicators of all three stages of blood clotting are checked.

You can learn more useful information about taking this test for women’s health during childbearing years from the video:

Normal indicators and deviations in children and adults in the table

We present to your attention a table with normal blood test results for a coagulogram and possible causes of changes in hemostasis.

Interpretation of possible disorders and diagnosis

The final diagnosis is made by a doctor. Based on a hemostasiogram, general blood test, medical history, and examination of the patient. Additional examinations may be ordered.

In general, an increase in indicators indicates blood thickening. A decrease in parameters indicates an insufficient number of platelets, resulting in a risk of blood loss.

Causes of hemostasis disorders:

A coagulogram is prescribed by cardiologists, hematologists, surgeons, therapists, hepatologists, and gynecologists.

Diagnosis of cardiovascular diseases

For problems of the cardiovascular system it is important to avoid blood clots. Since there is a risk of blood clots forming and blocking blood vessels. A heart attack, stroke, or thrombosis may occur. In case of increased viscosity, thinning agents are prescribed.

The analysis is also important for monitoring the effectiveness of certain heart medications. During cardiac surgery, a hemostasiogram is performed to assess the risk of blood loss.

Coagulogram – the most important study to determine blood clotting parameters, which is performed for safe surgery, for heart disease, and during pregnancy. Based on the results, you can judge the risk of bleeding or thrombosis.