Coagulogram of blood: transcript, norms, causes of abnormalities
A coagulogram( hemostasiogram) is a blood test that is performed to study its coagulation index.Decoding of the blood coagulogram is of great importance during the preparation of the patient for the operation.It helps prevent serious complications, such as thrombosis and bleeding.The study of coagulation is mandatory during pregnancy, as well as in the case of a history of liver, heart and blood vessels.The presence of autoimmune pathologies is also an indication for studying the blood coagulogram.Analysis allows you to determine the cause of bleeding.Table of contents: How to donate blood to a coagulogram When is a blood coagulogram necessary?Coagulogram parameters: decoding Coagulogram of blood in children Coagulogram in pregnancy
The blood clotting system( hemostasis) protects a person from dangerous blood loss in violation of the integrity of the vascular walls against traumatic injuries and surgical interventions.For adequate hemostasis in the body, the nervous and endocrine systems respond.For blood to adequately perform its basic functions( supplying tissues with oxygen and nutrients and regulating body temperature), it should have normal rheological properties, i.e. fluidity.Hypocoagulation( reduction of coagulability) on the background of various pathologies can lead to life-threatening blood loss.Hypercoagulation is the cause of the formation of blood clots( thrombi), clogging the lumen of blood vessels.As a result of thrombosis, tissue ischemia develops, leading, including infarctions and strokes.
The main components of the hemostatic system are:
- endothelial cells of the vascular wall;
- plasma factors.
How to donate blood to the coagulogram
Blood is drawn from the vein in the area of the elbow fold.To avoid distortions and misinterpretation of the results, analysis must be prepared accordingly.
Basic rules that are important to observe the patient:
- 8-12 hours before analysis can not be eaten;The
- should not be overeaten the night before;
- alcohol, tea, juices and other drinks are excluded - you can drink only pure water;
- people with nicotine addiction should not smoke at least an hour before the analysis;
- it is important to exclude physical and mental stress 15 minutes prior to analysis.
Important: if the patient is taking pharmacological anticoagulants, he must report this to the doctor!If dizziness occurs or a fainting condition develops in the process of taking a material to examine a blood coagulogram, you should immediately notify health workers about the change in your state of health.
When is a blood coagulogram necessary?
Indications for analysis:
- increased susceptibility to thrombus formation;
- previous heart attacks and strokes;
- pathology of blood vessels;
- liver pathology;
- preparation for surgical intervention.
Blood is taken with a sterile syringe or with a special vacuum system.The harness is not superimposed on the arm.The puncture should be atraumatic in order to avoid distortion of the data due to the ingress of a large amount of tissue thromboplastin into the material.Blood is filled with two test tubes, but only the second tube is used for research.The sterile tube contains an anticoagulant - sodium citrate.
Coagulogram indices: decoding
In a standard analysis of a coagulogram, a number of indicators are evaluated that are evaluated in aggregate.
Coagulation time is the time interval between the onset of bleeding and its stopping in the formation of a fibrin clot.Capillary blood is folded in 0,5-5 minutes, and venous blood - for 5-10.The duration of bleeding increases against a background of thrombocytopenia, hypovitaminosis C, hemophilia, liver pathologies and the taking of drugs from a group of indirect anticoagulants( including acetylsalicylic acid, Trental and Warfarin).The duration of coagulation is reduced after massive bleeding, and in women - and against the background of the use of oral contraceptives.
PTI( prothrombin index) reflects the ratio of the duration of blood clotting in the norm to the coagulation time in the subject.The reference values (variants of the norm) are from 97 to 100%.In pregnant women, the indicator increases( up to 150% and higher), which is not a pathology.The figures of PTI allow to reveal the presence or absence of liver pathologies.The index rises on the background of taking hormonal contraceptives.An increase in values relative to the norm indicates a risk of developing thrombosis, and a decrease in the risk of bleeding.
Important: for prothrombin index to be normal, the body needs constant alimentary intake of vitamin K.
The thrombin time of reflects the conversion rate of fibrinogen to fibrin.The normal interval is 15-18 sec.The shortening of the time interval with a high probability indicates an excess of fibrinogen, and its elongation is the low concentration of this protein compound in the serum or severe functional liver failure against hepatitis or cirrhosis.
Note: regular monitoring of this indicator of blood coagulogram is very important for heparin therapy!
APTT( activated partial thromboplastin time) is an indicator reflecting the duration of clot formation after addition of CaCl2( calcium chloride) to the plasma.The normal values are within 30-40 seconds.Changes are noted in the deviation of the remaining indicators of blood coagulogram within 30%.Elongation of this time interval may indicate liver pathology or hypovitaminosis K.
AUS( activated recalcification time) in a healthy person is 50 to 70 seconds.The indicator allows one to evaluate the course of one of the stages of coagulation.Reduction of AVP is a sign of thrombophilia, and lengthening is observed with thrombocytopenia, the use of anticoagulants( heparin), serious injuries, extensive burns and the development of a shock state.A low ATS indicator indicates an increased risk of developing massive and life-threatening bleeding.
GRP( plasma recalcification time) is a coagulogram score that correlates with the ABP and reflects the coagulation time of citrated serum after the addition of calcium salt preparations.Normal time is from 1 to 2 minutes.Its reduction indicates an increased activity of hemostasis.
The content of fibrinogen in the absence of pathology varies from 2 to 4 g / l.This protein compound is synthesized in the liver, and under the influence of clotting factors it is transformed into fibrin, the filaments of which are the structural basis of thrombi.
If the blood coagulogram shows a significant decrease in the index, this may be a sign of the following pathologies:
- hemostasis disorder;
- severe liver damage;
- toxicosis during the period of bearing of the child;
- hypovitaminosis in group B and deficiency of ascorbic acid.
The level falls with anticoagulant and anabolic therapy, as well as the consumption of fish oil.
The increase in fibrinogen content is recorded with hypothyroidism, significant burns, acute circulatory disorders( strokes and heart attacks), acute infections, after surgeries, hormone replacement therapy, and in women during the period of gestation.
Fibrinogen In is normally not detected.
The concentration of fibrinogen in a healthy person is 5.9-11.7 μmol / l.Its decrease is noted for problems with the liver, and an increase in malignant tumors and hypothyroidism of the thyroid gland.
The RFMK index( soluble fibrin-monomer complexes) characterizes the change in the structure of the fibrin protein at the molecular level under the influence of coagulation factor II( thrombin) and plasmin.The normal value is not more than 4 mg / 100 ml.The variability of the indicator is due to the same reasons as the change in the concentration of fibrinogen.
Note: RFMK is a marker that allows timely action to prevent the development of DIC syndrome.
Fibrinolytic activity of is a measure of coagulogram reflecting the patient's blood ability to dissolve the formed thrombi.Responsible for this function component of the anticoagulant system of the body - fibrinolysin.With its high concentration, the rate of dissolution of blood clots increases, respectively, the bleeding rises.
The thrombotest allows to visually determine the volume of fibrinogen in the test material.The norm is a thrombote test of 4-5 degree.
Plasma tolerance to heparin is a characteristic that reflects the formation time of a fibrin clot after addition of heparin to the test material.The reference value is from 7 to 15 minutes.The analysis reveals the level of thrombin in the blood.Decrease in the index with a high probability indicates liver damage.If the interval is less than 7 minutes, you can suspect cardiovascular pathologies or the presence of malignant neoplasms.Hypercoagulation is characteristic of late pregnancy( III trimester) and post-surgical conditions.
The clotting of the blood clot characterizes the decrease in the volume of the blood clot with complete separation from the plasma.The reference values are from 44 to 65%.An increase in values is noted with various forms of anemia( anemia), and a decrease is a consequence of thrombocytopenia and erythrocytosis.
The duration of Duke bleeding is a separate analysis, during which non-venous and capillary blood is examined.The finger pad is deeply pierced( by 4 mm) by means of a special lancet.Proceeded from the puncture blood is removed with special paper every 15-30 seconds( without contact with the skin).After each blotting, the time until the next drop appears.The time of cessation of bleeding from small blood vessels is normally from one and a half to two minutes.This indicator is influenced, in particular, by the serotonin mediator level.
Coagulogram of blood in children
Blood coagulogram in children is significantly different from normal values in adult patients.So, in newborn babies the normal level of fibrinogen is from 1.25 to 3.0 g / l.The indications for the study of the child's coagulogram are:
- Suspected hemophilia;
- diagnosis of hematopoietic system pathologies;
- upcoming surgical intervention.
Blood coagulation during pregnancy
Important: during the gestation of a child, a blood coagulogram is carried out at least three times( in each of the trimesters).
During pregnancy, the parameters of hemostasis change normally, which is caused by a significant hormonal restructuring of the female body, an increase in the total volume of circulating blood and the formation of an additional( uteroplacental) circle of blood circulation.
In the first trimester, clotting time is usually significantly increased, and in III, it is significantly shortened, thereby providing a woman with protection against possible blood loss during delivery.A coagulogram of the blood can reveal the threat of spontaneous abortion or premature birth due to the formation of thrombi.Violations from the coagulation system of a pregnant woman adversely affect the central nervous system of the unborn child.
Important: availability of blood coagulogram data and comparison with the norm allows obstetricians to take adequate measures to prevent serious bleeding during delivery.
Mandatory blood coagulogram examination is necessary if a woman has vascular disease( in particular - varicose veins) or liver failure is diagnosed.A coagulogram of the blood is also examined with a decrease in immunity and a negative Rh factor.
Reference values of individual blood coagulation indicators in pregnant women:
- thrombin time - 11-18 sec.;
- APTTV - 17-20 seconds;
- fibrinogen - 6 g / l;
- prothrombin - 78-142%.
Important: , a drop in the level of prothrombin from normal indices can indicate a placental abruption!
Alexander Lotin, medical reviewer