Coagulogram: what is it, interpretation of hemostasis indicators

Coagulogram: what kind of analysis it is, interpretation of hemostasis indicators

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

Coagulogram, or hemostasiogram, is studied to assess the possible risk of hyper- and hypocoagulation, respectively, increased and decreased blood coagulation, 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 from the diet spicy, fatty, canned dishes with an abundance of spices. Only pure, non-mineral water, juices, compotes, drinks and alcohol are excluded from drinks.

Immediately before analyzing for 30 minutes, it is recommended to avoid physical, emotional and mental stress (walking, agitation), and also smoking.
With the current or recently completed course of treatment with anticoagulants, the name, dosage and duration of treatment should be communicated to the specialist.
If in the process of blood sampling there is a feeling of nausea, dizziness, deterioration of health, you must immediately inform the medical staff.

Coagulogram: what kind of analysis it is, interpretation of hemostasis indicators
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How to analyze?

Venous blood is collected from the cubital vein without applying a tourniquet. In order to comply with the rules of coagulation, two test tubes are filled, the biomaterial from the second in order of filling the tank containing the coagulant is to be studied.

Where do they give blood for hemocuogram?

A blood test for hemostasiogram is carried out in public and private clinics and laboratories, this analysis is among the base. All certified laboratories with the necessary set of reagents and equipment can perform analysis for hemostasis indicators.
The cost of tests depends on the laboratory and the set of blood factors to be evaluated.

How many days is a coagulogram done?

Directly a blood test takes from 24 to 48 hours, which is caused by the need to evaluate various indicators when interacting with reagents at certain intervals. With a high workload of laboratory doctors and the need to transport the biomaterial, the study time may increase.

In which cases a blood test is prescribed for a coagulogram

Regardless of the presence of any symptoms and signs of blood coagulation abnormalities, hemostasis is prescribed for preparation for surgery and during the gestational period. Thus, the likelihood of life-threatening risks of bleeding and thrombosis during surgery or delivery (naturally or during caesarean section) is assessed.
Other indications for this analysis are:

  • gestosis of pregnancy, as well as repeated miscarriages;
  • injuries with internal and / or external bleeding;
  • a tendency to thrombosis, thrombosis varicose blood vessels; tendency to thromboembolism;
  • heart attack, history of stroke, pre-infarction conditions, ischemia, arrhythmia;
  • pathology of the circulatory system;
  • Liver dysfunction;
  • control of the state during anticoagulant therapy;
  • hemorrhagic pathologies, chronic anemia, frequent nosebleeds, heavy menstruation, inclusions of blood in the discharge (urine, feces), sudden loss of vision, etc.
  • long-term therapy with anabolic drugs, glucocorticosteroids, taking oral contraceptives;
  • scheduled medical examination.

Components of the hemostatic system

The hemostasis system includes biological substances and biochemical mechanisms that maintain blood in a liquid state, as well as preventing and stopping bleeding. The main function of the hemostasis system is to maintain a balance between coagulating and anti-clotting factors. The imbalance is realized by hypercoagulation (increased blood clotting, leading to the formation of blood clots) and hypocoagulation (low clotting, threatening with prolonged bleeding).

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

Indicators and hemostasis rates

When researching indicators, different laboratories may use different techniques. Thus, the rate of the coagulation process varies from 5-10 to 8-12 minutes depending on the chosen method (according to Lee-White or according to Mass and Margo). Evaluation of compliance with the norm should be carried out in accordance with the regulations of the specific laboratory.

Indicator Name Accepted Designation Norms, units
Prothrombin time Fri 11-15 s.
INR INR 0.82-1.18
Prothrombin Index PTI 72-123%
Activated Partial Thromboplastin Time APTT 23-36 seconds.
Thrombin Time tv 14-21 p.
Activated Recalculation Time ATS 81-127 p.
Antithrombin III ATIII 76-126%
D-dimer 250-500 ng / ml
Soluble fibrin-monomer complexes RFMK 0.36-0.48 units
fibrinogen 2.7-4.0 grams

Each rate of coagulogram and its components in the table is shown without regard to gender and age indicators and individual characteristics. To decipher hemostasis, you need to contact a specialist.

Deciphering of hemostasis

What is included in coagulogram research? A basic hemostasis study includes several indicators evaluated in aggregate.

Blood Coagulation Time

This indicator measures the rate of formation of a fibrin clot at the site of injury and is estimated by the time interval between the onset of bleeding and termination. For venous blood, the reference thrombus formation rate ranges from 5 to 10 minutes.

Excess of the indicator often indicates the presence of such diseases and conditions as thrombocytopenia, hemophilia, vitamin C deficiency, liver disease, and also occurs during therapy with indirect anticoagulants (Trental, Warfarin, Aspirin, etc.). The indicator below the norm indicates an accelerated ability to form clots, and may also decrease after extensive bleeding. In women, a reduction in clotting time is noted during the reception of contraceptive preparations .

PTI Indicator

The prothrombin index shows the ratio of the clotting time of the test and the accepted standard. The most favorable indicator is considered to be 97-100%, corresponding to the general rate. However, deviations do not unequivocally indicate a deviation in the functioning of the body: in women with gestation, during pregnancy, PTI can reach 150%, which is the physiological feature of the gestational period. On average, exceeding the limits of the norm indicates the likelihood of blood clots, a decrease indicates the risk of bleeding.

Thrombin Time Index

Thrombin time is the period needed to convert fibrin from fibrinogen. Thrombin time above normal indicates a reduced amount of fibrinogen in the blood, and also accompanies pronounced pathologies and liver diseases (hepatitis , cirrhosis).
The rate below the norm is most often associated with an increased amount of fibrinogen.

APTTV as a factor in controlling the administration of anticoagulants

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

ATS

The ABP indicator allows you to assess the likelihood of pathologies such as thrombophilia, thrombocytopenia, and also changes with anticoagulant therapy, with significant internal injuries, burns.

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

CDF

The CDF score is estimated in correlation with activated recalcification time. Low values ​​indicate increased hemostasis.

Estimation of the amount of fibrinogen

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

Trombotest

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

RFMK

Estimation 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

Glycoprotein, a natural anticoagulant. Its rates 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.
Causes of antithrombin III excess and deficiency

Excess Causes of Deficiency
Diseases of inflammatory etiology Congenital or hereditary failure
Vitamin K deficiency Chronic liver function
Acute Liver Dysfunction Thrombosis of various localization, thromboembolism
Drug therapy (drugs-glucocorticosteroids, anabolic) Direct coagulant therapy (Heparin)
Oral contraceptive use Ischemia

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D-dimer as an indicator of hemostasis

D-dimer is a product of the breakdown of fibrin, according to its quantity plasma fibrinolytic activity is estimated. An increase indicates the presence of intravascular thrombosis, liver disease, ischemia, or myocardial infarction, and can also be formed with prolonged smoking.
A deficiency in the indicator has no clinical significance.

Estimation of bleeding time

In the study of this indicator study the period from the onset of bleeding to the formation of a clot in the capillary. Method of treatment: using a sharp sterile needle, apply superficial damage to the ear lobe and estimate the time from the onset to stopping the bleeding. The diagnostic value is greater than normal.

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

Changes in the gestational period are reflected in all body systems, including the process of blood formation. During pregnancy, hemostasis rates change, and the assessment should be carried out on the basis of matching the gestation period with the reference values.
The main factor in the change in blood clotting is associated with increased risks of bleeding during termination of pregnancy, placental abruption and in the process of childbirth, and therefore fibrinolysis is suppressed.

Hemostasis of the gestational period

Rates change with increasing gestation.

Norm 1 trimester Norm 2 trimester Norm 3 trimester
fibrinogen 2.9-3.1 3.0-3.5 4.4-5.1
APTT 36-41 33.6-37.4 37-40
ATS 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
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