A coagulogram is a laboratory blood test aimed at determining its clotting parameters. Another name for the analysis is hemostasiogram.
This test is carried out mainly before surgical interventions, since its results allow to assess the risk of opening bleeding or the formation of blood clots.
Conducting coagulogram is necessary for other indications. For the results to be reliable, you must follow certain rules of preparation for blood collection.
Hemostasis is a system that is responsible for blood clotting. This prevents massive blood loss in various injuries or damage to blood vessels. The nervous and endocrine system is responsible for the activity of hemostasis.
Blood is the main transporter of oxygen and nutrients to all cells of the body. With a decrease in its clotting, intense bleeding can open even with minor injuries or injuries. Such a deviation is called hypocoagulation.
But the opposite scenario is also possible, when blood clotting, on the contrary, increases. In this case we are talking about hypercoagulation. As a result of this process, blood clots are formed in the lumen of blood vessels - blood clots, which clog the artery or vein, thereby preventing normal blood flow. The result is hypoxia, tissue ischemia, and then stroke and heart attack.
During normal operation of hemostasis, the blood circulates freely through the vessels, transporting nutrients and oxygen cells to all internal organs. In parallel, it collapses in such a way as to timely plug gaps in the walls of small and large CS.
Hemostasis is formed from:
- The endothelium is the inner layer lining the vascular wall. If their integrity is compromised, the endothelium begins to produce substances that trigger the blood clot formation process.
- Platelet count. These red bodies are produced when a blood vessel is damaged and, sticking together with one another, plugging the rupture.
- Plasma factors and enzymes (about 15 elements). These structures trigger complex biochemical reactions, under the influence of which fibrin clots are formed. The latter tend to stop bleeding.
What is a coagulogram prescribed for?
Carrying coagulogram shown:
- before planned operations, in which there is a certain risk of opening bleeding;
- during pregnancy (every trimester, but in the presence of preeclampsia or fetoplacental insufficiency, the test can be performed more often);
- with varicose veins or increased thrombosis;
- patients with pathologies of the liver, cardiovascular system;
- patients with autoimmune diseases;
- in violation of blood clotting due to certain factors;
- while taking or before prescribing anticoagulants;
- for the selection of the correct dose of ASA or drugs based on it;
- before the appointment of oral contraceptives (the test is carried out every 3 months);
- during hirudotherapy to prevent the formation of hemorrhages.
How to prepare for the analysis
The blood on the coagulogram is taken from a vein or finger. On the day of the test can not eat, smoke, perform intensive exercise or other loads. The last meal should be done 12 hours before visiting the laboratory.
On the eve of the test it is necessary:
- eliminate fatty and spicy foods;
- refuse cigarettes and liquor;
- limit physical activity;
- avoid stress, overwork, psycho-emotional stress;
- stop taking anticoagulants, NSAIDs and other drugs that can affect blood clotting.
If the use of certain drugs is not possible, it is necessary to inform the attending physician about the treatment.
Interpretation of results and indicators of the normal coagulogram are directly dependent on the method of its implementation. Perform a diagnostic procedure can according to the method of Sukharev or Lee-White.
In the first case, the biomaterial is taken from the finger, that is, capillary blood is examined. It is placed in a special container, which is called the capillary. After that, the laboratory assistant starts rocking the vessel and notes the time. Then the specialist notes in the table the period when the movement of blood slows down, and then completely stops. In healthy people, these figures range from 30 to 120 s (the period of the beginning of coagulation) and from 3 to 5 minutes - the period of completion of the process of coagulation.
A venous biomaterial is taken to conduct a Lee-White sample. In this case, the duration of the period during which a dense blood clot is formed is estimated. In a healthy person, this process takes from 5 to 10 minutes.
Coagulogram: normal values in the table
The analysis requires several complex biochemical reactions. This can take from 24 to 48 hours. The schedule of the medical institution, as well as whether it is a separate laboratory or an intermediary, is also important.
Normal coagulogram values are shown in the table below:
|Blood coagulation time|
|Analysis Index||Its designation||Norm|
|Prothrombin time by Kvik||PV||11-15 seconds|
|INR (International Normalized Attitude)||INR||0,82-1,18|
|Activated Partial (partial) Thromboplastin time||APTTV||22.5-35.5 seconds|
|Activated recalcification time||AVR||81-127 sec|
|Thrombin time||Tv||14-21 seconds|
|Soluble fibrin-monomer complexes||RFMK||0,355-0,479 U|
|Antithrombin III||AT III||75,8-125,6%|
|D-dimer||250.10-500.55 ng / ml|
A coagulogram is an advanced analysis that involves the study of a variety of indicators.
This is the interval from the onset of bleeding to its completion, accompanied by the formation of a fibrin clot. The clotting period of capillary blood ranges from 0.5 to 5 minutes. Venous blood coagulates in 5 to 10 minutes.
Hypocoagulation may accompany:
- hypovitaminosis C;
- hepatic diseases.
Reduced blood clotting rate is also noted with prolonged use of anticoagulants, massive bleeding. In women, such a deviation often occurs in patients receiving oral contraceptives.
This is the rate of transformation of fibrinogen into fibrin. Normally, the process takes from 15 to 18 seconds. With the shortening of this interval, they say about an excess of fibrinogen, with an elongation - a low content of protein in blood serum. Also, a decrease in thrombin time is observed in liver failure, hepatitis, and cirrhosis.
PTI (prothrombin index)
This is the ratio of the patient's current blood coagulation rate and the generally accepted coagulation rates.
Indicators of the norm - from 97% to 100%. During pregnancy, these figures may increase up to 150%, which is not considered a pathological deviation. According to data PTI can judge the presence of hepatic pathologies. In women, the prothrombin index may increase with oral contraceptives. In other cases, an overestimated rate may indicate a risk of thrombosis, with a decrease in PET, they indicate a tendency to bleeding.
ACHT (activated partial thromboplastin time)
Before the study, calcium chloride is added to the biomaterial, after which the duration of the clot formation is estimated. Normally, this process takes from 30 to 40 seconds. Deviations from such indicators are noted in the case of shifts in other indicators of the coagulogram by 30%. An increase in the AChVT period may indicate liver disease or vitamin A hypovitaminosis.
AVR (activated recalcification time)
In healthy patients, this period lasts from 50 to 70 seconds. A decrease in these indicators may indicate thrombophilia, while an increase often indicates thrombocytopenia or a shock condition. Also, the lengthening of this interval is observed with burns, serious injuries and taking heparin anticoagulants. At low rates, we can talk about the risk of opening life-threatening massive bleeding.
GRP (plasma recalcification time)
This indicator of the coagulogram is compared with AVR. After the addition of calcium salts preparations to the studied biomaterial, citrate serum coagulation is studied. Normally, this process takes 1 - 2 minutes. With its reduction speak of hyperactivity of hemostasis.
It is a thrombin enzyme antagonist that inhibits the action of hemostasis. The rate is 71-115%. With a decrease in double the risk of thrombosis. Overpriced results require the use of anticoagulants.
Norm - 2-4 g / l. This protein structure, which is synthesized by the liver tissues, and then transformed into fibrin. Its threads form the structure of blood clots.
Fibrinogen rises in hypothyroidism, extensive burns, heart attacks and strokes, acute infectious pathologies. High levels of the substance are observed in patients undergoing surgery undergoing a course of hormonal therapy, as well as in pregnant women.
With a significant decrease in the rate we can talk about:
- impaired hemostasis;
- severe hepatic abnormalities;
- toxicosis of pregnant women;
- hypovitaminosis group B;
- vitamin C deficiency
The level decreases when taking anabolic agents, anticoagulants, fish oil.
In healthy people, fibrinogen B is not detected.
In healthy people, the index ranges from 5.9 to 11.7 µmol / L. A decrease in fibrinogen indicates liver pathology, an increase indicates malignant tumors of the thyroid gland or its hypofunction.
This indicator shows the ability of blood to dissolve the formed clots. This functional task is performed by fibrinolysin. Its increase is accompanied by intensive dissolution of blood clots with bleeding accompanying this process.
Indicator RFMK (soluble fibrin-monomeric complexes)
This indicator characterizes the molecular changes of fibrin occurring under the influence of thrombin and plasmin. Norm - 4 mg / 100 ml of blood. The causes of deviations in the level of this element are the same as in violation of the concentration of fibrinogen.
Blood clot retraction
This indicator is used to judge the degree of reduction of a blood clot when it is completely separated from the plasma. Normal values are 44-65%. With exaggerated rates, we can talk about anemia, and if they are too low, we can talk about thrombocytopenia or erythrocytosis.
Heparin Plasma Tolerance
During the study, heparin is added to the blood, after which the formation time of the blood clot is evaluated. Indicators of the norm - from 7 to 15 minutes.
Such a test helps to determine the level of thrombin in the biomaterial under study. When it decreases, there is a high probability that the patient has liver disease. If the clotting time is less than 7 minutes, then it is possible to suspect the development of CVD diseases, or the formation of malignant tumors.
Hypercoagulation occurs in late pregnancy and the postoperative period.
Based on the visual determination of the amount of fibrinogen in the blood. The standard is thrombotest 4-5 degrees.
This analysis helps to determine the rate of blood clotting, and the period of time necessary to dissolve the clot. Thanks to the test for this marker, it is possible to notice the imbalance between the indicators in time, and determine its cause (varicose veins, thrombophilia, pulmonary embolism, etc.).
In healthy people, the indicator of this marker is 243 ng / ml of blood. In future mothers, it grows as the gestational period increases.
With the coordinated work of the organism, the coagulation and anticoagulation systems have a clear balance. But if the indicators of one of the processes are violated, the whole hemostasis is disturbed. This is especially dangerous for the body of a pregnant woman.
A complication of this disorder is ICE, or disseminated intravascular coagulation. When the coagulation system and fibrinolysis are activated, the development of DIC occurs. During pregnancy, this condition is fraught with detachment of the placenta, endometrium, and emboli of the OPV.
Duke bleeding duration
During this analysis, capillary blood is examined. To do this, the cushion of the ring finger is punctured with a scarifier, and with a special litmus paper that has appeared with blood. Such a manipulation is carried out every 15 - 30 seconds, while direct contact with the skin does not occur. After each promakivaniya laboratory technician notes the time until a new drop of blood. Bleeding stops after about 1.5 - 2 minutes.
A serotonin mediator has a direct effect on this process.
Coagulogram during pregnancy
The gestation period is accompanied by numerous and significant changes in the woman’s body. And the hemostatic system does not stand aside. During the first days, a new circulation is created - the uteroplacental - which is responsible for the delivery of nutrients and oxygen to the fetus. Thus, the volume of circulating blood increases, its composition changes.
We can not take into account the hormonal changes. They also make major adjustments, because throughout the gestation progesterone will dominate estrogen.
During pregnancy, the activity of coagulation factors increases in women. In particular, this applies to 7, 8, 10 factors and fibrinogen. Fibrin fragments begin to gradually be deposited on the walls of the uteroplacental system. Due to this, the process of fibrinolysis is suppressed.
Such actions of the female body is trying, as it were, to hedge against the opening of uterine bleeding, or the risk of a spontaneous abortion - miscarriage. This, in turn, prevents placental abruption, and prevents the formation of intravascular clots.
Normal hemostasis in women during pregnancy are as follows:
|Indicator||1 term||2 trimester||3 term|
|Fibrinogen, g / l||2,91-3,11||3,03-3,46||4,42-5,12|
|Antithrombin III, g / l||0,222||0,176||0,155|
|Platelets, * 109/ l||301-317||273-298||242-263|
If the pregnancy proceeds with complications (early toxicosis, preeclampsia), the regulation of blood coagulation is significantly impaired. There is an increase in fibrinolytic activity, and the life span of platelets is shortened. In such situations, it is extremely important to consult a doctor. If such a violation is not eliminated, it can lead to DIC.
Syndrome of intravascular disseminated coagulation develops in 3 stages:
- Hypercoagulation, which is accompanied by the formation of small blood clots. Such a violation leads to circulatory disorders between the maternal organism and the fetus.
- Hypocoagulation is a condition in which blood clotting factors begin to deplete. This process is accompanied by the collapse of blood clots.
- Coagulation is a pathological disorder of hemostasis, in which the blood stops clotting.This is a terrible condition that can lead to unpredictable consequences for the body of a pregnant woman, and provoke serious complications. Often the fetus in this situation dies.
Where to get tested and how much does it cost?
In the presence of reagents and the necessary equipment, any laboratory - private or public - can perform such a study. The cost of manipulation depends on what kind of indicators need to be studied, what methods and apparatus are used for this.
If we talk on average, the usual coagulogram costs from 700 to 1300 rubles. For the advanced analysis, the patient will have to pay about 3,500 rubles. Although it should be borne in mind that pregnant women such an analysis is carried out necessarily, so for them it is usually free, as in the OMS system.