How to donate blood for a hemostasiogram. Indications for the appointment of a hemostasiogram during pregnancy, interpretation of the results of this analysis, norms of indicators

Throughout pregnancy, the female body must work clearly and harmoniously. Any problems with the mother's health can negatively affect the condition of the child.An analysis such as a hemostasiogram allows you to determine the coherence of the work of the female body and identify all violations.

It is this diagnosis that allows you to determine the presence of any malfunctions in the body of a young mother. A hemostasiogram during pregnancy makes it possible to determine a violation in blood coagulation. There are various factors that affect the correct course of this process, but during pregnancy, the system may fail.

During pregnancy, 2 types of disorders can occur: blood clots or bleeding. Due to various changes taking place in a woman's body, some processes may accelerate or, conversely, slow down. The hormonal background of a young mother changes, which leads to a change in the work of the whole organism. During the appearance of placental circulation, a failure in the homeostasis system is possible.

The body prepares itself to lose a certain amount of blood during childbirth.
The importance of performing a hemostasiogram lies in the fact that such an analysis allows one to predict the subsequent reaction of organs to internal changes. If the blood begins to clot very quickly, then this can lead to the appearance of serious diseases. They are capable of causing significant harm to both mother and child. Slow blood clotting is a significant danger. A similar reaction of the body can provoke profuse bleeding. To avoid such consequences, it is necessary to consult a doctor on time and take an analysis - a hemostasiogram. A woman should undergo this procedure 3 times during pregnancy:

1. 1 time - as soon as the young mother was registered in the consultation.
2. 2 times - from 22 to 24 weeks of pregnancy.
3. 3 times - from 30 to 36 weeks of pregnancy.

The result of the study will be able to show all risk factors and the presence of a malfunction of the homeostasis system. Such a system is responsible for very important functions in the human body. First of all, it helps to keep blood in a liquid state. Secondly, this system provokes the formation of blood clots in case of damage to the walls of blood vessels. There are several factors in blood clotting. And the process itself takes place in several stages. Collapse is external and internal. The blood coagulates inside constantly. This is a normal process. External coagulation occurs only if the integument is damaged.

Blood test

How to get tested? Before donating blood for a hemostasiogram, a woman should refrain from eating, drinking alcohol, tea, coffee, juices, fruit drinks and other liquids except water for 8-12 hours. In case of taking any medication, you need to warn your doctor about it. He will tell you whether to accept them on that day or not. Hemotest will show how correctly the blood clotting process occurs in a pregnant woman. There are certain factors of this phenomenon that can be identified and investigated thanks to the results of the analysis:

1. Bleeding time and frequency.
2. The content of platelets in the blood.
3. Platelet properties.
4. Blood clots.
5. Blood clotting time.
6. PTI (prothrombin index).
7. APTT (activated partial thromboplastin time).

If a pregnant woman has certain deviations from normal indicators, then this means that it is necessary to determine their cause and begin to fight with it. In this case, the woman is advised to stop using any medications that can provoke a similar reaction in the body, refuse certain foods and sometimes change the lifestyle. Having multiple bad habits can cause poor (or excessive) blood clotting during pregnancy. Sometimes a hereditary factor plays a role.

Time of bleeding, blood clotting and adhesion

A hemostasiogram checks the blood clotting time. This is the name of the interval between damage to the skin and the moment the blood begins to coagulate. If the interval does not exceed 3 minutes and is not less than 2, then this indicates normal platelet function. If a pregnant woman has blood clotting for too long, then this may be a signal of the presence of vitamin deficiency or hereditary thrombocytopenia (congenital lack of platelets). A similar symptom manifests itself in women who have taken aspirin or any other medicines that reduce blood clotting for a long time.

A hemostasiogram during pregnancy gives a general idea of \u200b\u200badhesion. This is the property of platelets to remain attached to the surface of the vessels. The norm in this case is 20-50%. If the percentage is lower than it should be, then this indicates the inability of platelets to attach to the injured areas of cells. A similar deviation is possible with renal failure or leukemia. Rarely is a similar factor found in the presence of other ailments.

The platelets must connect with each other. This effect is called aggregation, and its normal index is 0-20%. A decrease in this index is a signal that a woman in labor has a specific disease. If the aggregation is increased, then this is the first sign of thrombosis, atherosclerosis or diabetes mellitus. In certain cases, a decrease in the retraction of blood formation occurs in pregnant women. The process consists in the leakage of fluid from the blood clot. If the average is below 48%, then this indicates a reduced number of platelets in the blood.

The clotting time analyzes the length of time it takes to excrete fibrin in the blood. In venous blood, such formations should begin to appear within 7-10 minutes. Fibrin should appear in capillary blood no later than 2 minutes later. The longer the appearance of fibrin in the patient's blood, the worse the clotting process. This effect can be given by medications that reduce blood clotting, or after using certain contraceptives. A similar effect is possible with liver disease or hemophilia.

PTI and thrombin time

An extended transcript of a blood test should give an overall picture of the protein content - protombin. It is an important element that characterizes blood clotting. It precedes the element that provokes the formation of blood clots. Prothrombin is produced in the liver thanks to vitamin K. Having deciphered the results of the analysis, the doctor will be able to check the work of the gastrointestinal tract and the patient's liver. A similar study is included in the hemotest.

Prothrombin time is the time it takes for the blood to react to the entry of calcium chloride into it and develop a fibrin clot. For an ordinary person, it should take 10-15 seconds to create such a clot. In such a study, they often tend to designate PTI. This is an index that is calculated as the ratio of the time it takes for plasma to clot in a healthy patient and the time it takes to analyze the patient. The analysis decryption should give an index of at least 93%.

If the prothrombin index is significantly lower than the standard indicator, then this indicates a violation of the liver. The very process of the emergence of factors of such a complex occurs in the liver in humans, and the disease of this organ provokes serious disorders. If the PTI is higher than 106%, then this indicates that the patient has increased blood clotting and a predisposition to the appearance of blood clots. Such an excess of the norm may be justified by the frequent use of oral contraceptives or appear in the last weeks of pregnancy. A decrease in blood clotting in a patient and a decrease in PTI indicates that the patient's body lacks vitamin K. This can be triggered by dysbiosis, consumption of large amounts of acetylsalicylic acid or diuretics.

Thrombin time is the period it takes for fibrinogen to convert to fibrin. For an ordinary person, this process takes 15-18 seconds. If the extended interpretation of the analysis showed that the thrombin time is increased, this indicates a serious liver disease. If the result is opposite (if the time is below normal), it can be assumed that the patient has an increased content of paraproteins.

Fibrinogen and APTT

A detailed interpretation of the results implies the determination of the content of fibrinogen in the patient's blood. It is a protein that, as a result of certain processes in the body, turns into fibrin. This part of the analysis enables the patient to find out the pathology of blood coagulation and determine the presence of inflammatory processes. The normal content of fibrinogen in the blood is not less than 2 and not more than 4 g / l.
If the hemotest shows an increased content of fibrinogen, then this indicates increased blood clotting.

Such a process can not only be of an inflammatory nature, but also be noted as a normal phenomenon in the last weeks of pregnancy, in the first few days after a stroke or heart attack, with a malfunction of the thyroid gland, with a burn, with prolonged use of certain contraceptives. A reduced content of such a protein is possible if the patient has cirrhosis of the liver or a serious type of hepatitis, a violation of the blood coagulation process, increased toxicity, a lack of vitamins B and C. Frequent intake of fish oil, hormonal drugs, streptokinases can cause a lack of fibrinogen.

APTT is the time it takes for the body to form a blood clot after the addition of calcium chloride to the plasma. This is the most accurate indicator of blood clotting today. For an ordinary person, this process takes 30-40 seconds.If the patient takes more time to form a clot, then this indicates severe liver disease and a lack of vitamin K.

Is an analysis that is often prescribed by doctors of various specialties, so it is familiar to most people. Blood for a coagulogram must be taken without fail if there are serious heart and vascular diseases or surgery is planned. Also, a coagulogram is performed for pregnant women every trimester.

Coagulogram is the term that is most often used, but this analysis has another name - hemostasiogram. The study is aimed at assessing the blood clotting ability. The basic coagulogram is prescribed at the first stage of diagnosis. If the doctor sees any deviation from the established norms, he refers the patient to an extended study. It allows you to assess the existing violations not only qualitatively but also quantitatively.

Video: what is a coagulogram? What is its significance in diagnostics?

What is a coagulogram?

In order to answer this question most fully, one should start with the mechanism of blood coagulation. Why is it needed? Let's say a person accidentally cut himself. At the same second, a complex and very important process begins to occur in the focus of tissue damage - the formation of blood clots - thrombi, with the help of which the body "seals" the wound in order to avoid blood loss. We are accustomed to taking a quick stop of bleeding as something natural and self-evident, meanwhile, even the slightest disturbances in the work of the coagulation system threaten us with fatal consequences.

The thing is that during our life our body has to stop bleeding many times: large and small, superficial and internal. The mechanism of hemostasis works not only under extreme conditions (wounds, burns), but also under quite ordinary circumstances - such as menstruation or a local inflammatory process that damages small vessels and capillaries.

If blood did not have the ability to clot, normal life would be simply impossible, let alone cope with serious injury, illness, or undergo surgery. And in order to evaluate the work of the hemostasis system, a coagulogram is just needed - the norms for adults, children and pregnant women in the table will be presented to your attention further.

In addition to the insufficient activity of the blood coagulation system, there is also an excess one, which is no less dangerous to health. Blood clots that form unnecessarily can clog important blood vessels, leading to oxygen starvation or even necrosis of certain organs and areas of the body.

Let's now take a closer look at what the blood coagulation system consists of:

First component - these are flat endothelial cells lining the inner surface of the vascular walls and cardiac cavities. When these cells are irritated as a result of a violation of the integrity of the vessel, they begin to produce biologically active substances: nitric oxide, thrombomodulin, prostacyclin. The blood reacts to these compounds and begins to clot;

Second component - these are platelets called platelets and are one of the most important components of blood. They have a unique ability to stick tightly to each other, forming a primary hemostatic plug at the site of vessel damage, that is, urgently closing the resulting "hole";

Third component Are plasma blood factors. There are fifteen of them, and most of them are enzymes in their biochemical structure. The task of the plasma factors is to form a fibrin clot that stops it completely. Then, at this place, the process of tissue regeneration will begin, but that's another story.

Thus, hemostatic disorders can be caused by a malfunction in any of the above components of the blood coagulation system, and in order to make sure that there are no problems or to establish their exact cause, doctors prescribe a coagulogram during pregnancy, before the upcoming surgery, or in the presence of serious ones.

Types and indicators of coagulogram

A hemostasiogram includes a fairly large number of different blood parameters, not all of which are necessary in a specific diagnostic situation. Therefore, the doctor usually decides which coagulogram indicators need to be determined in the patient. There are several standard tests for different purposes: before a planned operation, during pregnancy, after a stroke or heart attack, following a course of treatment with drugs that affect blood clotting, for preventive purposes, and so on. Each of the typical coagulograms consists of a certain set of indicators, but if the diagnostic result deviates from the norm, the doctor will prescribe an extended analysis to assess the existing hemostasis disorders more objectively.

The study can be conditionally divided into three parts, according to those stages of blood coagulation, in which specific parameters of the coagulogram are involved:

Stage 1 - constriction of damaged blood vessels, which in itself helps to reduce blood loss. This process is called prothrombinase formation by doctors and laboratory technicians;

Stage 2 - platelet aggregation and the formation of a primary plug in the place of violation of the integrity of the vessel walls. Correctly referred to as "thrombin formation";

Stage 3 - "plexus" of an elastic mesh of protein threads called fibrin. It covers the primary plug, clings to the edges of the hole and pulls it together, and then platelets tightly line up in the mesh cells. It turns out a kind of patch that finally stops bleeding. In medicine, this period of blood coagulation is designated by the phrase "fibrin formation".

Now let's name the indicators of the coagulogram related to each of the three stages of hemostasis:

Prothrombinase formation:

• Contact activation index;

  Consumption of prothrombin;

  Factor VIII activity;

  Factor IX activity;

  Factor X activity;

  Factor XI activity;

  Factor XII activity.

Thrombin formation:

• International normalized ratio - INR;

  Prothrombin in percentage according to Quick or prothrombin index (PTI);

  Factor II activity;

  Factor V activity;

  Factor VII activity.

Fibrin formation:

• Thrombin time;

  Fibrinogen concentration;

  Concentration of soluble fibrin-monomeric complexes.

However, in decoding the results of the coagulogram, other indicators may also appear that reflect the work of the opposite function of the blood - fibrinolytic, which plays an equally important role in the human body.

The anticoagulant system of the blood inhibits hemostasis in case of its excess and dissolves unnecessary blood clots so that they do not clog the lumen of the vessels. Thus, a dynamic balance is formed and normal blood circulation in organs and tissues is maintained.

Let's give a specific example: a thrombus formed at the site of the vessel damage, the regeneration process went through, the wall was overgrown, but the thrombus from the inner side remained. Now it is not needed, because the integrity of the vessel is completely restored. Moreover, a blood clot is harmful because it blocks the lumen of the vessel and interferes with the free circulation of blood. It is then that the fibrinolytic system comes into play - its components dissolve an unnecessary thrombus and evacuate it from the bloodstream. In addition, someone has to regulate the process of forming "patches", otherwise they can initially turn out to be so large that they cover the entire lumen of the damaged vessel. One of the components of the fibrinolytic system, antithrombin III, is called upon to cope with this task.

In the interpretation of the results of the extended coagulogram, the following indicators of the anticoagulant function of the blood appear:

Lupus anticoagulant;

• Protein C;

  Protein S;

  Antithrombin III.

Standard (screening) coagulogram

This blood test includes a set of essential blood coagulation parameters:

Prothrombin in percentage according to Quick (in international practice) or PTI prothrombin index (in the post-Soviet space);

Fibrinogen;

Activated partial thromboplastin time (APTT);

Thrombin time (TV).

This includes the following metrics:

Bleeding time;

Blood clotting time according to Lee-White;

Prothrombin as a percentage of Quick or PTI;

Consumption of prothrombin;

Plasma recalcification time (PRP);

Thrombin time;

Platelets;

Activated recalcification time (AVR);

Activated partial thromboplastin time (APTT, APTT, ARTT);

International normalized ratio (INR);

Fibrinogen;

Lupus anticoagulant;

• Protein C;

  Protein S;

  Antithrombin III;

  Factor II and V activity;

  Factor VII activity;

  Factor VIII, IX and IX activity;

• factor XI;

  factor XII.

This list may vary slightly in different laboratories, in addition, as we mentioned above, there are non-standard, specialized hemostasiogram options designed to solve typical diagnostic tasks. Sometimes the doctor, right in the direction of the analysis, indicates those blood parameters that he needs to know in order to correctly assess the state of health of a particular patient.

To whom and why is a coagulogram prescribed?

The study of the hemostatic and fibrinolytic properties of blood is shown in the following situations:

Preparation for planned or emergency surgery, including caesarean section;

Diseases of the heart and blood vessels -, pulmonary embolism, thrombophlebitis and deep vein thrombosis;

Pathologies of the hematopoietic system - hemophilia, thrombocytopenia, anemia, von Willebrand-Diana disease, frequent nosebleeds, unexplained bruising, abnormally heavy menstruation and intermenstrual bleeding;

Chronic liver diseases - fatty or alcoholic hepatosis, cirrhosis, hepatitis;

Pregnancy (for preventive purposes), severe toxicosis, gestosis, threat of miscarriage, miscarriage;

Suspicion of an existing disseminated intravascular coagulation syndrome;

Long-term use of hormonal birth control pills or blood thinners (Warfarin, Aspirin, Heparin, Trental and others);

Treatment with hirudotherapy sessions.

How much does a coagulogram cost, when to expect the result?

Such an analysis can be passed in any private diagnostic center, and the cost will depend on the region and the pricing policy of a particular institution. In Moscow, a screening coagulogram will cost an average of 1,000 rubles, and an extended one - 3,500 rubles. Meanwhile, the study can be taken for free, if there are indications for that: it is enough to consult a doctor at the place of residence, present a compulsory medical insurance policy and receive a referral. A blood coagulogram is performed in any state laboratory at a polyclinic or hospital.

The term for obtaining the analysis results depends on the workload of the institution, but usually is no more than two days. In emergency situations, a hemostasiogram is performed immediately and the conclusion is passed on to the attending physician.

Expectant mothers are entitled to a free blood coagulogram as part of pregnancy management and preparation for childbirth. In the absence of signs of pathology, the analysis is performed three times, that is, in each trimester.

In order for the results of the study to be accurate and reliable, it is necessary to adhere to the following rules of preliminary preparation:

Bring babies for analysis no earlier than 1 hour after feeding;

Children aged 1 to 5 years should be brought in 2-3 hours after eating;

Children over 5 years old and adults should refrain from food for 12 hours;

30 minutes before donating blood for a coagulogram, sit down and calm down;

Do not smoke immediately before the analysis, stop drinking alcoholic beverages 24 hours in advance;

Warn the laboratory assistant about all medications taken the day before.

Blood for this study is taken from a vein in the elbow bend. It is very important that the hand in this place does not have any damage, otherwise platelets, fibrin or clotting factors may get into the sample, and this will distort the results of the coagulogram. For reliability, blood is drawn into two tubes, only the second of which is used for testing.

Coagulogram norms in adults and children

The table below shows the normal indicators of an extended hemostasiogram in adults and children. It should be noted that these numbers vary slightly with age. Significant differences in the work of the hemostatic and fibrinolytic blood systems are inherent only in premature babies and healthy babies in the first two months of life.

Parameter and unit of measure	Norm for adults	Norm for children
Bleeding time, min.
Clotting time according to Lee-White, min.
Prothrombin time, sec.
Prothrombin according to Quick,%
Consumption of prothrombin,%
Time of recalcification of plasma GRP, sec.
Thrombin time, sec.
Platelets, g / l
Activated time for recalcification of AVR, sec.
APTT (APTT, ARTT), sec.
	3.36-4.0 mg / 100 ml
Fibrinogen		5.9-11.7 μmol / L
Lupus anticoagulant	absent	absent
D-dimers, ng / ml
Protein C,%
Protein S, units / ml
Antithrombin III,%
Factor II and V activity,%
Factor VII activity,%
Factor VIII, IX and IX activity,%
Factor X,%
Factor XI,%
Factor XII,%

Now we will consider what the most important indicators from this table mean, and what the deviation of the analysis results from the norm up or down indicates.

Bleeding time

To establish this indicator, the doctor conducts a simple test - he pierces the patient's earlobe and notes how many minutes the bleeding will stop. The sooner this happens, the better, but lengthening the time may indicate hemophilia, thrombocytopenia, hemorrhagic fever, or an overdose of anticoagulants.

Clotting time according to Lee-White

This is the time during which a blood clot forms at the site of damage to the vessel. If this happens too quickly, then there is a risk of thrombosis, and if too slow, then the patient has a tendency to bleed - he can lose a lot of blood as a result of injury or during surgery. There are a number of pathologies that are characterized by a prolonged blood coagulation time: hemophilia, advanced disseminated intravascular coagulation, burn disease, malignant tumors, severe inflammatory lesions of internal organs, systemic autoimmune diseases, and phosphorus poisoning. Shortening of coagulation time according to Lee-White is observed with myxedema, anaphylactic and hemorrhagic shock, disseminated intravascular coagulation syndrome at the initial stages of development.

Activated Recalcification Time (AVR)

This is the period during which a network of fibrin fibers is formed in a plasma saturated with calcium and platelets. There is also an indicator of GRP - the time of plasma recalcification, it also characterizes the general activity of the coagulation system, the differences are only in the method of the test. A greater deviation of both of these parameters from the norm indicates hemophilia, thrombocytopathies, prolonged use of anticoagulants, post-traumatic shock, and to a lesser extent - about the risk of thrombosis.

Activated partial thromboplastin time (APTT, APTT, ARTT)

This is perhaps the most informative diagnostic parameter of the coagulogram. It reflects the effectiveness of hemostasis and characterizes the period during which a fibrin patch is formed at the site of tissue damage. Prolongation of APTT is observed with congenital and acquired deficiency of blood coagulation factors, autoimmune diseases, severe liver pathologies, disseminated intravascular coagulation syndrome, anticoagulant overdose, hemophilia, von Willebrand disease, vitamin deficiency, chronic glomerulonephritis, condition after blood transfusion. A shortened APTT may indicate the onset of disseminated intravascular coagulation, a tendency to thrombosis, acute blood loss, metastasis of a malignant neoplasm, or simply that blood was taken incorrectly for analysis.

Activity of all blood coagulation factors (II, V, VII, VIII, IX, X, XI, XII)

These parameters never change without serious reasons: an increase and decrease in the activity of clotting factors clearly indicates a disease characterized by either excessive thrombus formation or bleeding. When decoding the results of a coagulogram, data on the activity of coagulation factors should be considered in conjunction with other indicators.

Prothrombin time (PT)

This is the period during which a thrombin clot is formed in plasma with calcium and thromboplastin. In premature babies, after birth, a longer prothrombin time is recorded than in full-term babies - 14-19 seconds versus 13-17. And in adults, this parameter varies within 11-15 seconds. Measurement of prothrombin time makes it possible to assess the work of the so-called inner circle of hemostasis, which is responsible for stopping bleeding in organs and tissues, and not on the surface of the body. Prolongation of PT is observed with a deficiency of coagulation factors or fibrinogen, biliary stenosis, liver pathologies, hemorrhagic diathesis, celiac disease. Shortening of PT is characteristic of low hematocrit, elevated antithrombin III levels, activation of fibrinolysis, thromboembolism, and thrombosis.

Quick prothrombin, prothrombin index (PTI) and INR

This is the ratio of the patient's prothrombin time to the ideal value of this parameter, which is expressed as a number or as a percentage. At present, these indicators are considered outdated, since in 1983 the World Health Organization introduced a new term - INR - the international normalized ratio, which means, in fact, the same thing. The deviation of PTI and INR from the norm up or down when decoding the results of the coagulogram is explained by the same reasons as the lengthening and shortening of the prothrombin time, since these parameters are directly related to each other.

Thrombin time (TV)

This indicator characterizes the final stage of hemostasis and is calculated by adding thrombin to the plasma. If the fibrin network is formed for too long, this indicates acute fibrinolysis and fibrinogen deficiency, disseminated intravascular coagulation, autoimmune disease, severe liver pathology, multiple myeloma, uremia, long-term therapy with streptokinase or urokinase. If the “patch” of fibrin is formed too quickly, this indicates the beginning of the development of disseminated intravascular coagulation syndrome, about taking heparin or fibrin polymerization inhibitors.

Fibrinogen

It is a protein made by the liver. When bleeding begins, fibrinogen is converted to fibrin by the Hageman factor, and from it, in turn, a "patch" is formed. Therefore, fibrinogen is referred to as an acute phase protein - an increase in its concentration in the blood indicates trauma, burns, myocardial infarction, growth, inflammation of internal organs, and autoimmune pathology. A decrease in the level of fibrinogen in the blood indicates its congenital deficiency, disseminated intravascular coagulation syndrome, liver disease, leukemia, momonucleosis, food poisoning, intake of heparin, androgenic hormones, anabolic steroids, barbiturates, valproic acid.

Soluble fibrin-monomeric complexes (RFMK)

These substances are fibrin breakdown products and are recorded in the blood during fibrinolysis. Accordingly, RFMK is of primary importance for the early diagnosis of disseminated intravascular coagulation. If, when decoding the results of a coagulogram, an increase in the level of RFMK is found in the blood, this may also indicate thrombosis, thromboembolism, autoimmune pathology of connective tissues, shock, postoperative complications, preeclampsia, preeclampsia in pregnant women.

Antithrombin III

It is on this protein that the effectiveness of the entire fibrinolytic system, which is necessary to control blood coagulation and dissolve unnecessary blood clots, depends on three quarters. The level of antithrombin of the third type increases with, and other inflammatory diseases, as well as after kidney transplantation and long-term use of anabolic steroids. Lack of antithrombin III is characteristic of liver failure, cirrhosis of the liver and the period after its transplant, disseminated intravascular coagulation syndrome, thrombosis, pulmonary embolism, myocardial infarction, and the use of oral contraceptives.

Lupus anticoagulant

It is a protein that indicates the presence of antiphospholipid syndrome or antiphospholipid antibody syndrome (SAFA). It leads to the formation of multiple blood clots and pathologies of the course of pregnancy. Deciphering the results of a coagulogram of a healthy person should not contain data on the presence of a lupus anticoagulant.

D-dimers

These substances are constantly present in the blood, but especially a lot of them appear as a result of the breakdown of large amounts of fibrin. And this process indicates too active blood coagulation and dissolution of unclaimed blood clots. Accordingly, an excess of the D-dimer norm in the coagulogram indicates the onset of disseminated intravascular coagulation, blood poisoning, acute infarction, thromboembolism, kidney or liver failure, postoperative complications, the growth of a malignant neoplasm, large hematoma, preeclampsia.

Protein C

This protein is needed to control the process of hemostasis and prevent the formation of too large clots inside damaged vessels. When decoding the results of a coagulogram, the doctor's concerns arise if the level of protein C in the blood is too low. This may indicate the development of DIC, liver disease, or simply a congenital deficiency of the corresponding protein.

Protein S

And this is an activator of protein C and antithrombin III - without it, the anticoagulant function of the blood would be impossible. The lack of protein S can also be hereditary, or it can develop against the background of prolonged use of blood thinners (Heparin, Warfarin, Aspirin).

During the period of bearing a child, the total volume of circulating blood in a woman increases by an average of 25%. This is necessary in order to serve both the organisms of the expectant mother and the fetus. In addition, you need to insure against extensive blood loss in case of miscarriage, premature placental abruption, as well as before the decisive natural event - childbirth. Consequently, the activity of the blood coagulation and anticoagulation systems also increases during pregnancy: in the second trimester - by 15-20%, in the third - sometimes by 30% compared to a healthy woman who is not expecting a child.

It is very important to donate blood for a coagulogram three times during pregnancy. Deviations from the norm in time will indicate to the doctor the risk of spontaneous abortion, uterine bleeding, placental insufficiency, gestosis, disseminated intravascular coagulation, preeclampsia and eclampsia, as well as extensive blood loss during childbirth or during cesarean section.

Of course, expectant mothers are worried about this and want to know the decoding of the results of a coagulogram during pregnancy. To begin with, we bring to your attention a table of norms for trimesters, and then we will tell you what the deviations in the indicators mean.

Indicator, unit	I trimester	II trimester	III trimester
Thrombin time, sec.
Prothrombin,%
APTT, sec.
D-dimers, mg / l	no more than 1.1	no more than 2.1	no more than 2.81
Platelets, * 109 / l
Prothrombin index,%
Antithrombin III, g / l
Fibrinogen, g / l

Deciphering the results of a coagulogram during pregnancy

Normally, the first trimester is characterized by some inhibition of both the coagulation and anticoagulant functions of the blood, and then, as labor approaches, the indicators increase. The table below shows the probable causes of deviations from the norms.

Indicator	Decline	Enhancement
	Stage 1 DIC syndrome, thrombosis	2-3 stage of DIC syndrome
Prothrombin time and INR	Stage 1 disseminated intravascular coagulation, approaching labor	2-3 stage of DIC syndrome
Prothrombin	less than 70% - 1 stage of DIC syndrome	the threat of placental abruption
Thrombin time	less than 10 seconds - 1 stage of DIC syndrome	more than 26 seconds - 2-3 stage of DIC syndrome
Antithrombin III	less than 50% of the norm - fetoplacental insufficiency, threat of placental abruption	threatened miscarriage, uterine bleeding, hepatitis
		gestosis, diabetes mellitus, kidney failure
Fibrinogen	less than 3 g / l - severe toxicosis, gestosis, stages 2-3 of DIC syndrome, vitamin deficiency	1 stage of DIC syndrome, acute infection, heart attack, stroke, malignant process
Lupus anticoagulant	appearance indicates gestosis, preeclampsia, threat of miscarriage, placental abruption, premature birth
	almost never occurs and does not matter	an increase of more than 4 times - 1 stage of disseminated intravascular coagulation, the threat of placental abruption

If several indicators deviate from the norm in decoding a coagulogram during pregnancy, this does not mean that the expectant mother and baby are in serious danger. Only if almost all the parameters of the study are abnormal should the alarm sound.

In conclusion, I would like to emphasize that only a qualified gynecologist can draw the correct conclusions by looking at the results of a hemostasiogram of a pregnant woman. Each organism is individual, and while carrying a child, everyone adapts in different ways to changing conditions. Do not jump to conclusions and panic ahead of time - this in itself is very harmful in such a period. Take care of yourself and be healthy!

Video: Dr. Evdokimenko - simple advice on blood thinning, prevention of atherosclerosis and thrombophlebitis.

Education: In 2013 he graduated from the Kursk State Medical University and received a diploma "General Medicine". After 2 years, completed residency in the specialty "Oncology". In 2016, completed postgraduate studies at the Pirogov National Medical and Surgical Center.

Coagulogram - a comprehensive analysis of blood clotting indicators. Studies of venous blood by the method of coagulometry help to assess the state and efficiency of the functioning of various parts of such blood systems as coagulation, anticoagulation and fibrinolytic.

Coagulogram indicators, or hemostasiograms, are studied to assess the possible risk of hyper- and hypocoagulation, respectively, increased and decreased blood clotting ability, the likelihood of blood clots or bleeding.

How to prepare for a blood clotting test

This study is carried out strictly on an empty stomach, with a break after the last meal for at least 12 hours. At the last meal, it is recommended to exclude spicy, fatty, canned foods with an abundance of spices from the diet. Only pure, non-mineral water is allowed from drinks, juices, compotes, drinks and alcohol are excluded.

Immediately before the analysis, it is recommended to avoid physical, emotional and mental stress (brisk walking, excitement), as well as smoking for 30 minutes.
With the current or recently completed course of treatment with anticoagulant drugs, it is necessary to inform the specialist of the name, dosage and duration of administration.
If during blood sampling there is a feeling of nausea, dizziness, deterioration of health, you must immediately inform the medical staff.

How is the analysis done?

The collection of venous blood is performed from the cubital vein without the application of a tourniquet. To comply with the rules of coagulology, two test tubes are filled, the biomaterial from the second in order of filling the container containing the coagulant must be examined.

Where is blood donated for hemoculogram?

A blood test for a hemostasiogram is carried out in public and private clinics and laboratories, this analysis is one of the basic ones. All certified laboratories with the necessary set of reagents and equipment can analyze hemostasis indicators.
The cost of tests depends on the laboratory and the set of blood factors assessed.

How many days is the coagulogram done?

The blood test itself takes from 24 to 48 hours, which is due to the need to assess various indicators when interacting with reagents at regular intervals. With a high workload of laboratory assistants, the need to transport biomaterial, the study time may increase.

In what cases is a blood test prescribed for a coagulogram

Regardless of the presence of any symptoms and signs of blood coagulation pathologies, a hemostasis test is prescribed in preparation for surgery and during the gestational period. Thus, the likelihood of life-threatening risks of bleeding and thrombus formation during surgery or delivery (by natural means or by cesarean section) is assessed.
Other indications for this analysis are:

• gestosis of pregnancy, as well as repeated miscarriages;
• injuries accompanied by internal and / or external bleeding;
• the presence of a tendency to thrombosis, varicose veins of blood vessels, a tendency to thromboembolism;
• heart attack, stroke in history, preinfarction conditions, ischemia, arrhythmia;
• pathology of the circulatory system;
• liver dysfunctions;
• condition control during anticoagulant therapy;
• hemorrhagic pathologies, chronic anemia, frequent nosebleeds, profuse menstruation, inclusion of blood in the secretions (urine, feces), sudden loss of vision, etc.;
• long-term therapy with anabolic drugs, glucocorticosteroids, taking oral contraceptives;
• routine medical examination.

Components of the hemostasis system

The hemostasis system includes biological substances and biochemical mechanisms that maintain blood in a liquid state, as well as prevent and stop bleeding. The main function of the hemostatic system is to maintain a balance between coagulating and anticoagulant factors. Imbalance is realized by hypercoagulation (increased blood coagulability, leading to the formation of blood clots) and hypocoagulation (decreased coagulation, threatening prolonged bleeding).

Blood clotting is provided by two mechanisms: external and internal. With tissue injuries and violations of the walls of blood vessels, tissue thromboplastin (factor III) is released, which triggers the external process of blood coagulation. The internal mechanism requires the contact of collagen endothelium of the vascular walls and blood components.

Indicators and norms of hemostasis

Different laboratories may use different methods to study indicators. So, the rate of speed of the coagulation process varies from 5-10 to 8-12 minutes, depending on the chosen technique (according to Lee-White or Mass and Margot). Evaluation of the conformity of the results with the norm should be carried out in accordance with the norms of the particular laboratory.

Each norm of the coagulogram and its components in the table is given without taking into account gender and age indicators and individual characteristics. To decipher the indicators of hemostasis, you must contact a specialist.

Decoding of indicators of hemostasis

What is included in the study of a coagulogram? The baseline study of hemostasis includes several indicators, assessed in the aggregate.

Clotting time index

This indicator evaluates the rate of formation of a fibrin clot at the site of injury and is assessed by the time interval between the onset of bleeding and cessation. For venous blood, the reference thrombus rate is 5 to 10 minutes.

An excess of the indicator often indicates the presence of such diseases and conditions as thrombocytopenia, hemophilia, vitamin C deficiency, liver pathology, and also occurs during therapy with indirect anticoagulants (Trental, Warfarin, Aspirin, etc.). A reading below normal indicates an accelerated ability to form clots, and may also decrease after extensive bleeding. In women, a decrease in clotting time is noted during administration.

PTI indicator

The prothrombin index shows the ratio of the blood coagulation time of the studied and the accepted standard. The most favorable indicator is 97-100%, corresponding to the general rate. However, deviations do not unequivocally indicate a deviation in the functioning of the body: in women, when carrying a fetus, during pregnancy, PTI can reach 150%, which is a physiological feature of the gestational period. On average, exceeding the normal range indicates the likelihood of thrombus formation, and a decrease indicates the risk of bleeding.

Thrombin time index

Thrombin time is the period required for the conversion of fibrin from fibrinogen. Thrombin time above normal indicates a reduced amount of fibrinogen in the blood, and also accompanies severe pathologies and liver diseases (cirrhosis).
An indicator below normal is most often associated with an increased amount of fibrinogen.

APTT as a factor in the control of anticoagulant intake

APTT is measured based on the duration of clot formation when the biomaterial reacts with calcium. This indicator is especially relevant for control and correction of therapy with direct coagulants (Heparin). It may also indicate DIC, the presence of autoimmune diseases, liver pathologies.

ABP

The AVR index allows one to assess the likelihood of such pathologies as thrombophilia, thrombocytopenia, and also changes during anticoagulant therapy, with significant internal injuries, burns.

A pronounced non-compliance with the norm is especially dangerous with an extremely low rate and indicates the development of a life-threatening condition - extensive and prolonged bleeding.

VLOOKUP

The VLR indicator is assessed in correlation with the activated recalcification time. Low values \u200b\u200bindicate increased hemostatic activity.

Estimation of the amount of fibrinogen

Protein fibrinogen belongs to blood coagulation factors I. It is produced in the liver and a change in its amount may indicate the pathology of this organ. Exceeding the norm of this indicator can accompany inflammatory diseases and tissue trauma, the deficiency is assessed as primary (genetic etiology) or secondary, provoked by excessive consumption during hemostasis.

Thrombotest

Thrombotest is a method of visual assessment of the amount of fibrinogen in a biomaterial. Normally, this indicator corresponds to level 4-5.

RFMK

Evaluation of the concentration of soluble febrin-monomeric complexes is important in the diagnosis of DIC. Interpretation of indicators is also important for thrombosis, complicated pregnancy, impaired renal function, during the recovery period after invasive procedures, etc.

Antithrombin III

A glycoprotein related to natural anticoagulants. Its norms vary considerably depending on the age of the patient. The rate of antithrombin 3 in women also changes during pregnancy, which is not a pathological condition.
Reasons for excess and deficiency of antithrombin III

D-dimer as an indicator of hemostasis

D-dimer is a fibrin breakdown product; its amount is used to estimate the fibrinolytic activity of plasma. An increase indicates the presence of intravascular thrombosis, liver disease, ischemia or myocardial infarction, and can also form with prolonged smoking.
The deficit of the indicator has no clinical significance.

Estimation of bleeding time

When studying this indicator, the period from the onset of bleeding to the formation of a clot in the capillary is studied. Methodology: with a sharp sterile needle, a superficial injury is applied to the ear lobe and the time from the beginning to the stop of bleeding is estimated. An indicator exceeding the norm has a diagnostic value.

Features of hemostasis in pregnant women: research and interpretation of results

Changes that occur during the gestational period are reflected in all body systems, including the process of hematopoiesis. During pregnancy, the rates of hemostasis change, and the assessment should be carried out on the basis of the compliance of the gestation period with the reference values.
The main factor in the change in blood clotting is associated with an increased risk of bleeding during termination of pregnancy, placental abruption and during childbirth, in connection with which suppression of fibrinolysis occurs.

Gestational hemostasis

Normal indicators change with an increase in gestation.

	1 trimester rate	2 trimester rate	3 trimester rate
Fibrinogen	2,9-3,1	3,0-3,5	4,4-5,1
APTT	36-41	33,6-37,4	37-40
ABP	60-72	56,7-67,8	48,2-55,3
PI	85,4-90,1	91,2-100,4	105,8-110,6
RFMK	78-130	85-135	90-140
Antithrombin III	0,222	0,176	0,155
Platelets	301-317	273-298	242-263

The need for various tests during pregnancy often becomes a cause of discontent among women. But it is extremely dangerous to ignore medical appointments at this time, since a woman "in position" is responsible for two lives: her own and the baby's. In addition to other studies, expectant mothers must be assigned a blood clotting test - a hemostasiogram.

Why is this study important and remarkable, is it necessary to do this analysis during pregnancy, and what can a hemostasiogram tell about in such an important period?

The blood picture is vital to the human body. The complex process of coagulation is called hemostasis or coagulation, and the analysis for determining the ability of blood to coagulate is called a hemostasiogram (coagulogram). Normally, the human body works harmoniously and has its own reserves to quickly stop bleeding in case of damage to blood vessels. This feature protects a person from blood loss due to illness or injury. In case of any, even the smallest damage to the capillary, the protective mechanism is automatically activated and the blood clots.

In the body, the coagulation and anticoagulation systems are in balance. If these systems fail in one direction, there may be a tendency to either bleeding or thrombosis, which is equally dangerous.

The coagulation system consists of three parts:

• blood clotting system in the form of clot formation;
• anticoagulant system, which prevents thrombus formation and maintains a liquid state of the blood;
• fibrinolytic system that breaks down blood clots.

A decrease in the amount of blood during bleeding during childbirth is especially dangerous.

Even with normal childbirth, a woman loses at least 300 ml of blood. Loss of blood in 1000 ml is considered dangerous, in 1500 ml - threatening, and if the volume of blood lost in childbirth is more than 3000 ml, then such blood loss in most cases leads to death.

Pregnancy changes the hormonal background of a woman and enormously loads her blood vessels, forming an additional uteroplacental circle of blood circulation. Thus, the body is prepared for physiological blood loss during childbirth, which is reflected in a change in hemostasis.

It is especially important that blood clotting during gestation is normal, since a significant increase or decrease in this indicator is equally undesirable for a pregnant woman.

With high blood clotting, DIC syndrome (a state of disseminated intravascular coagulation) often develops, which can lead to disruption of placental blood flow, and then to a frozen pregnancy and fetal death. But not only thick blood is dangerous for a pregnant woman: its increased dilution can lead to fatal blood loss during childbirth.

What the hemostasiogram method shows

A hemostasiogram is prescribed before any operations - planned and urgent. The study includes a number of indicators of the blood picture, which allows the doctor to analyze the work of the entire blood-clotting system.

To avoid serious complications during pregnancy, an analysis for its coagulation ability (hemostasiogram) is required during the period of gestation. This study is done several times during pregnancy in order to timely identify and correct interruptions in blood clotting.

A hemostasiogram is especially important in cases of:

• violations in previous analyzes;
• threats of interruption (increased uterine tone);
• complications of pregnancy (intrauterine growth retardation, fetoplacental insufficiency, pregnancy after IVF, multiple or multiple pregnancies, etc.);
• aged pregnant woman;
• past infections or oncology;
• unsuccessful completion of previous pregnancies (miscarriages, missed pregnancies) or prolonged infertility;
• (high blood pressure, edema, protein in urine).

Also, a coagulogram is extremely important for pregnant women with pathologies:

• liver;
• autoimmune;
• varicose veins;
• with manifestations of excessive bleeding (nosebleeds or gums, unreasonable bruising);
• with the presence of blood clots, thromboembolism in question or a genetic predisposition to such ailments;
• dangerous disorders in the body (circulatory, cardiovascular, endocrine, urinary systems, etc.);
• after intoxication, with sepsis or shock;
• with prolonged immobilization;
• in mothers with bad habits (alcoholism, drug addiction).

The increased risk of blood clotting failure during pregnancy requires monitoring of hemostasis in women during this period.

Why is a hemostasiogram important during pregnancy

A hemostasiogram (coagulogram or clotting test) is a mandatory screening test for pregnant women. It is performed at least 3 times (1 time in each trimester). For any violations, a pregnant woman may be prescribed to take such an analysis more often.

During pregnancy, clotting (coagulation) and clot dissolution (fibrinolysis) disorders are typical due to the too strong activity of the anticoagulant and fibrinolytic systems. Together, these phenomena often lead to a state of hypercoagulability (increased blood clotting).

Hypercoagulation in pregnant women is an adaptive mechanism that protects a woman from blood loss during childbirth.

However, the phenomenon of hypercoagulation also has a second side. It lies in the increased risk of blood clots. Thick blood impairs blood circulation in the placenta and interferes with the supply of oxygen and nutrients to the fetus. And venous thromboembolism (usually deep veins of the lower extremities or pelvis) during pregnancy can cause maternal death.

Preparation for the procedure

A hemostasiogram in combination with other tests allows you to get not only a complete picture of the state of blood clotting in the body of a pregnant woman, but also information about the work of the most important internal organs.

For this analysis, the pregnant woman donates blood from a vein (from the elbow). There is nothing painful for a woman in this process.

It is not necessary to prepare especially for a hemostasiogram. The only condition for a qualitative analysis is an empty stomach.

This sample is usually taken in the morning, and the night before the last meal is allowed no later than 8 hours before the test. It is also forbidden to use any liquid before the analysis, except for pure water.

On the eve of a coagulogram, you need to adhere to a diet: exclude fatty, fried foods and alcohol. If the pregnant woman takes any medications, then the doctor should be informed about this. It is especially important to know about medicines taken less than a day before the analysis.

This is reported to the laboratory assistant and is additionally indicated on the referral form.

What is the time frame for the analysis

If the doctor does not consider it necessary to do the analysis additionally, then the hemostasiogram is submitted on time:

• registration;
• 22-24 weeks of the second trimester;
• 30-36 weeks of the third trimester.

Types of hemostasiogram

The hemostasiogram can be basic or extended. The main hemostasiogram includes the determination of the necessary indicators:

• prothrombin;
• fibrinogen;
• APTT;
• RFMK.

An extended hemostasiogram includes the determination of a much larger number of indicators: for example, antithrombin III, D-dimer, lupus anticoagulant, etc. An extended study is prescribed according to indications: for example, pregnant women or people with clotting pathology.

What the results say

Let us consider what results can be obtained in the study of blood coagulation and what can be judged from them.

The norm of hemostasiogram indicators during pregnancy

Indicators	What do they mean	The norm during pregnancy
Fibrinogen	Leading factor of blood coagulation, preceding fibrin.	1st trimester: 2.4-5.1 g / l, 2nd trimester: 2.9-5.4 g / l, 3rd trimester: 3.7-6.2 g / l.
APTT	Time of blood clot formation.	1 trimester: 24.3-38.9 s. 2nd trimester: 24.2-38.1, 3rd trimester: 24.7 -35.0.
Prothrombin	Protein, the second important factor in blood clotting.	78-142%
Platelet count	Non-nuclear blood cells that play an important role in hemostasis.	1st trimester: 174-391 thousand / μl, 2nd trimester: 155-409 thousand / μl, 3rd trimester: 146-429 thousand / μl.
Prothrombin time (PTT)	Time for plasma clot formation (fibrin). Warns of a tendency to bleeding.	1st trimester: 9.7-13.5 s, 2nd trimester: 9.5-13.4 s., 3rd trimester: 9.6-12.9 s.
Prothrombin index	Determination of plasma clotting time after calcium removal.	85-115% (or 0.8-1.2 according to international standards).
Antithrombin 3	Protein in the anticoagulant system. Responsible for counteracting coagulation in the formation of blood clots.	1st trimester: 89-114%, 2nd trimester: 88-112%, 3rd trimester: 82-116%.
D -dimer	The main marker of thrombus formation. Appears when fibrin breaks down in a blood clot.	Increased during pregnancy: in the 1st trimester - 0.05-0.95 μg / ml, in the 2nd trimester - 0.32-1.29 μg / ml, in 3 tr. - 0.13-1.7 μg / ml ( with a lower limit of at least 33 mg / ml).
INR (International Normalized Ratio)	Indicators of prothrombin time in various laboratories. Shows the effectiveness of anticoagulant treatment.	In the 1st trimester: 0.89-1.05 s, in the 2nd trimester: 0.85-0.97 s, in the 3rd trimester: 0.80-0.94 s.
Lupus anticoagulant (in two versions)	Antibodies that increase blood clotting.	During pregnancy from 0.8 to 1.2 g / l
Antiphospholipid bodies	A special group of proteins is determined. It is prescribed for thrombosis or after several interruptions of pregnancy. Their excess leads to cell damage and thrombosis.	Calculation of immunoglobulins G and M.
Cuff test	To assess the anti-thrombotic capacity of blood vessels (squeeze the arm with a cuff).	About 40-50%.
Clotting time	It is recorded until a drop of blood is completely coagulated (in a test tube or on a glass).	Within 2-4 minutes.

Thrombophilia test

A study for thrombophilia can be offered to pregnant women in a complex hemostasiogram. It is prescribed according to indications (with a tendency to thrombosis or thromboembolism in a woman or her relatives). This is a paid analysis of a number of commercial laboratories, based on the determination of the composition of genes. The study reveals up to 15 different forms of thrombophilia.

As a result of the assessment of the hemostasiogram, two main disorders can be identified:

1. 1. Hypercoagulation. This condition is typical for:
      • increased D-dimer, platelets and fibrinogen;
      • decrease in PTT, APHT, INR and antithrombin III.
   2. Hypocoagulation. Such a conclusion is made with the following changes in the coagulogram:
      • an increased level of PTT, APTCH, INR and antithrombin III concentration;
      • reduced platelet and fibrinogen counts.

Hypercoagulation is dangerous due to the formation of blood clots in the venous system (more often in the veins of the lower extremities).
The state of hypocoagulation is dangerous with bleeding, which seriously threatens the life of the mother and baby.

The analysis of the hemostasiogram is complex, and for its correct interpretation, even an experienced doctor often needs additional research.

"Pros" and "cons" of hemostasiogram

Analysis of the coagulogram allows you to correct the hemostasis of the pregnant woman, avoiding the risk to the health of the woman and her baby. This research is available and does not require large material investments.

The disadvantage of a hemostasiogram is that this analysis "sees" the pathology, but does not determine its exact cause. This requires more research. Also, it takes time to conduct a coagulogram, which is impossible if you need to quickly assess the state of hemostasis.

A pregnant woman should not panic when she sees any irregularities in the analysis of the hemostasiogram. For some indicators of this analysis, it is impossible to correctly diagnose. After all, pregnancy changes the results of many studies. For a complete assessment of hemostasis, the results of this analysis are considered in aggregate, which only an experienced doctor can do. Health to you and your children!

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Analysis such as coagulogram quite widely known, but with a standard medical examination, it is not prescribed. Therefore, patients are sometimes surprised by the doctor's proposal to conduct this study. More often, a blood coagulogram is performed for patients with cardiovascular pathology, as well as before a planned operation or pregnant women. In the latter case, it is done in every trimester without fail.

What is hidden under this mysterious term? Coagulogram (another name for the study is hemostasiogram) is carried out to study the patient's blood clotting... Analysis happens basic and expanded... Usually, a baseline study is assigned first. It helps to understand where the deviation from the norm occurred in the system. And if a pathology is detected, a detailed study is carried out, as a result of which not only qualitative changes, but also quantitative ones are determined.

The main indications for the analysis

• Planned operations. There is always some risk of bleeding during surgery. Therefore, knowledge about the state of the blood coagulation system is important.
• Pregnancy. During this period, changes can occur in the female body, both positive and negative. It is usually performed once every trimester. If fetoplacental insufficiency is diagnosed or - more often.
• Vascular disorders (increased thrombus formation,).
• Liver disease.
• Autoimmune pathologies.
• Violation.
• Cardiovascular pathology (,).
• When prescribing anticoagulants.
• For the correct selection of the dose of acetylsalicylic acid and preparations based on it.
• The appointment of contraceptive drugs. In this case, the analysis is done every 3 months.
• ... A coagulogram is performed to prevent hemorrhages.

Natural hemostatic system

In a healthy body, a normally functioning system hemostasis - natural protection against excessive blood loss in violation of the integrity of the vascular wall. Many people know about the danger to human health and life, but nature does not create anything in vain: thrombus formation is the very same protection against blood loss. Let's try to figure out how the natural hemostasis system works.

Blood is constantly in a liquid state. Moreover, this liquid has a certain composition and physical parameters. The body's systems tirelessly maintain this state throughout life. However, various situations occur: for example, as a result of damage to the vessel wall, it opens. The first substance that is released in the blood is thromboplastin... It starts the work of the coagulation system: it activates proteins that are normally present in the blood. These proteins form a clot at the site of the violation of the integrity of the vessel. A chain leading to thrombus formation is carried out: from prothrombin thrombin is synthesized, which activates fibrinogen, from which, in turn, is formed fibrin. It is in the fibrin, like insects in a spider's web, that platelets get stuck, forming a blood clot. The fibrin clot "patches" the wound in the vessel, the bleeding stops.

In a healthy body, both systems - coagulation and anti-coagulation - are in balance. But there is also a third system - absorbable (). It is she who ensures the dissolution of the blood clot after the restoration of the integrity of the vessel. Coagulogram indicators allow making a conclusion about the state of all systems.

Basic parameters of a hemostasiogram

1. ... The most important test of the state of the coagulation system.
2. , INR (international normalized ratio), PTT (prothrombin time). Usually one of these tests is performed based on the equipment available in the laboratory. The most versatile test is. All of these studies show an extrinsic coagulation pathway.
3. . In the test, you can find the abbreviation - APTT.

Additional parameters of hemostasiogram

• Protein C... An insufficient amount of this parameter leads to thrombosis.
• ... Like protein C, it belongs to the anticoagulation system factors.
• ... Formed as a result of the destruction of a blood clot.
• Plasma Tolerance to Heparin.
• AVR (Activated Recalcification Time).
• (soluble fibrin-monomeric complexes).
• Plasma recalcification time.

Conducting a coagulogram during pregnancy

Who gets the most research when they are perfectly healthy? Undoubtedly, these are pregnant women. Numerous ultrasounds, tests, analyzes, examinations - all these tests must be passed by the expectant mother for the birth of a healthy child. The list of necessary studies of pregnant women includes a coagulogram. Analysis data characterize hemostasis and allow early detection of violations in this system. In the body of the expectant mother, many processes do not go the same way as before pregnancy. In particular, hemostasis activity increases, which is normal.

However, there are also deviations from the norm. And this is already becoming dangerous for both the mother and the child. Disruption of the blood systems can lead to irreparable consequences. In order to detect and neutralize all kinds of problems in time, a hemostasiogram is performed.

What is the activation of the hemostasis system associated with during pregnancy?

1. First, the hormonal background of a woman changes.
2. Secondly, a new (uteroplacental) circle of blood circulation appears.
3. Thirdly, the body of a pregnant woman prepares for the inevitable blood loss during the birth of a child.

With a violation of blood clotting during pregnancy, there is always a danger of the development of the so-called (disseminated intravascular coagulation), which is characterized at the first stage and hypocoagulation - at the second, that is, leads to. DIC syndrome is considered one of the most serious complications in obstetrics, it is often uncontrollable and poses a danger not only to the life of the fetus, but also to the life of the woman.

The opposite situation is possible. The blood, due to a violation in the anticoagulant system, is highly thinned. As a result, the risk of bleeding increases, especially during childbirth. In order to restore hemostasis, the analysis and further decoding of the coagulogram are carried out. Based on the results of the study, treatment is prescribed.

Normally, this test is performed in each trimester of pregnancy. Unscheduled if:

• The woman had miscarriages.
• Symptoms are observed gestosis:, swelling of the limbs, protein in the urine.
• Diagnosed with hypertonicity of the uterus (threat of miscarriage).

There are many reasons for hemostasis disorders, but special attention should be paid to their condition to women whose relatives had a heart attack, stroke, varicose veins, diseases of the blood system.

Important! Among pregnant women, there is a widespread opinion about the harm of any medication for the unborn child. But you can't joke with the hemostasis system. A timely study and taking the necessary drugs will help a woman to bear and give birth to a healthy child.

Study of hemostasiogram

After a blood test, the coagulogram is deciphered. What indicators can be seen in the laboratory report, and what do they mean?

1. Fibrinogen

This enzyme is synthesized in the liver. Normally, this figure ranges from 2 g / l to 4 g / l. For pregnant women, its increase is considered normal, however, the content of fibrinogen, even in the third trimester, should not exceed 6 g / l. This is a very sensitive factor. Its reaction to inflammation and tissue necrosis was established. Also, an increase may indicate infections, acute inflammatory processes (pneumonia), the onset of a heart attack or brain, hypothyroidism, burns, contraception. If the amount of fibrinogen decreases, one may suspect a lack of vitamins (C, B 12), hepatitis, toxicosis, taking certain medications, cirrhosis of the liver. And, of course, the infamous DIC.

2. APTT

The time taken for the formation of a blood clot is examined. This indicator reacts sharply to changes in other coagulation factors. The norm of APTT is from 30 to 40 seconds. An increase in the parameter may indicate a lack of vitamin K, liver disease.

3. Prothrombin

Thrombin is synthesized from this protein in the liver when exposed to vitamin K. By changing the value of this factor, the state of the gastrointestinal tract and liver is judged.

4. Lupus anticoagulant

This indicator is assessed mainly when carrying out a hemostasiogram in case of suspicion of antiphospholipid syndrome, or another autoimmune disease. In the blood, IgM and IgG antibodies to phospholipids are produced (they are normally absent), which increase the APTT index. Their appearance indicates gestosis or autoimmune diseases. Usually, this situation ends in failure: a woman loses a child.

table: normal values \u200b\u200bof the base coagulogram

5. Thrombin time

Shows the time of conversion of fibrinogen protein to fibrin. The normal setting is 11 to 18 seconds. Since the amount of fibrinogen increases during pregnancy, it is logical to assume that thrombin time is also lengthened. However, the indicator does not go beyond the norm. If the data are deviated from the norm, then this may indicate a lack or excess of fibrinogen in the blood.

6. Prothrombin time

This indicator means the time of thrombin formation from its inactive form (prothrombin protein). Thrombin is needed to form a blood clot, which helps stop bleeding. If this indicator is increased, it is possible to diagnose hypovitaminosis K, lack of coagulation factors, liver disease.

7. Prothrombin index

One of the most important indicators. The normal clotting time of plasma is compared to the same time in the patient. It is expressed as a percentage of PTI. The normal indicator should be in the range of 93-107%. A change in PTI can signal liver disease, risk. An increase in the indicator can be observed during pregnancy, taking contraceptives. If the blood clotting properties deteriorate, PTI will be lowered. Since the prothrombin index is directly related to vitamin K, a decrease indicates a lack of this vitamin or poor absorption in the intestine (for example, with intestinal ailments). Taking aspirin or also lowers IPT values.

8. Platelets

Blood cells that are most directly involved in maintaining hemostasis. The norm in the blood of these cells is from 150,000 to 400,000 per microliter. When the indicator decreases, they are diagnosed. This may indicate that the mother is undernourished. Platelets are synthesized in the bone marrow.

9. Antithrombin-III

It is of a proteinaceous nature and is an antagonist of the thrombin enzyme. Its role is to suppress the action of the coagulation system. This parameter is expressed as a percentage. The norm is from 71 to 115 percent. If the parameter is halved, the risk of thrombus formation increases. With increased blood clotting, anticoagulants are prescribed. In this case, control of the indicator is also necessary.

10. DIC syndrome

Normally, the coagulation and anticoagulation systems are in balance. If any of the factors of these systems is disturbed, an imbalance of the entire hemostasis occurs. This is especially dangerous in pregnant women. The most formidable complication is disseminated intravascular coagulation. Activation of the coagulation system and fibrinolysis stimulates the development of DIC. As a result of the development of pathology in a pregnant woman, placental abruption, endometritis, can occur.

11.D-dimer

As a result of incomplete disintegration of fibrin fibers, rather large "fragments" - D-dimers appear. This is one of the main indicators of a coagulogram for pregnant women. The general rate is less than 500 ng / ml. However, other parameters are considered normal in pregnant women. Already at the beginning of pregnancy, the indicator begins to grow, and before childbirth it exceeds the norm by several times. Also, an increase can be observed in patients with diabetes mellitus, with kidney disease, with complicated pregnancy (gestosis), in old age.

12. Antibodies to phospholipids (Antiphospholipid syndrome)

The disease is autoimmune. The body begins to increase the amount of antibodies to phospholipids. This is a series of symptoms that characterize arterial and venous thrombosis. Pregnant women who have APS are at risk of losing their baby due to fetapplacental insufficiency.

13. Time of plasma recalcification

An indicator of fibrin protein clot formation. This parameter reflects the clotting process as a whole.

14. Tolerance of plasma to heparin

This test is carried out simultaneously with the previous one. Heparin is added to the plasma and the time of plasma recalcification is noted. If this indicator is less than normal, changes in other factors of the coagulation system are possible. Liver cirrhosis and hepatitis are suspected. With an increase in the parameter, one can assume the presence in the body of such diseases as the state of prethrombosis, malignant tumors. However, normally, an increase in the indicator can occur in the last stages of pregnancy.

Important! It should be noted that only a specialist can decipher the coagulogram during pregnancy (as, indeed, for all other patients). It is unacceptable for one or another data to diagnose and prescribe treatment.

Where to get tested and how much does it cost?

Anyone can take a blood test such as a hemostasiogram at one of the nearest medical centers, if he has the necessary equipment and reagents at his disposal. The cost of a coagulogram depends on the range of services and equipment of the center. Basically, the price of the basic package varies from 700 to 1,300 rubles (in Moscow). Extended coagulogramma costs about 3,500 rubles.

However, for pregnant women, a coagulogram is included in a number of mandatory studies and is carried out free of charge. Under the compulsory medical insurance system, you can also do an analysis completely free of charge, having previously received a referral from your doctor.

How to take?

The question "how to take" in the case of analysis for a coagulogram is not at all superfluous. The results of the study depend on the correct preparation of the patient. This analysis is carried out in vitro(in vitro - outside the body). Blood is taken from a vein.

Blood is donated on an empty stomach. The last meal should be no later than 8-12 hours before the analysis. You can not drink any drinks (coffee, tea, and even more so alcohol). Only clean water is allowed. Medications taken - especially those that affect the blood clotting process - must be indicated at the time of the test. The emotional state of the patient is very important. You need to try not to be nervous, to be calm, balanced. Muscle overstrain also negatively affects the study results. It is useful to drink an additional glass of cold water right before taking the test. The interpretation of the results is carried out only (!) By a specialist.