The term "coagulogram" is derived from the confluence of two words: coagulum( coagulation) and gramma( image).It is a graphical expression of the result of the blood coagulation test. Another name is the hemostasiogram.
Hemostasis is a whole complex of reactions occurring in the body, with damage to the vascular wall. This system performs the most important function - it prevents and stops bleeding. It ensures the presence of blood in the vascular bed and prevents death from hemorrhage.
Along with the coagulation system, the anticoagulant function in the body functions, due to which the blood has a liquid state, certain parameters and composition throughout life. These systems are in equilibrium, which prevents the coagulation of blood within the vascular bed and at the same time contributes to the formation of a clot in violation of the integrity of the wall. Violation of this balance can lead to such consequences as loss of blood and the formation of a blood clot inside the vessel.
With the participation of thrombin, soluble fibrinogen is converted to insoluble fibrin strands
When the vessel wall is damaged, the blood coagulation mechanism is triggered. As a result, a blood clot forms on the site of the vessel's defect - a thrombus. This is a very complex process of interaction of the so-called coagulation factors. The essence of coagulation lies in the cascade of reactions caused by the fact that the activated proenzymes activate other coagulation factors. Eventually, the fibrinogen, soluble in plasma, turns into insoluble fibrin, which looks like filaments. They entangle the formed elements of the blood, thus forming a thrombus.
When the integrity of the vessel is restored, the fibrin clot dissolves - fibrinolysis. This process always accompanies coagulation and is its integral part.
The coagulogram values obtained during the blood test make it possible to evaluate the performance of all three systems: coagulation, anticoagulant and fibrinolytic.
Only a doctor can decipher a coagulogram. In this case, he will consider all the indicators in the aggregate.
Indications for analysis of
- Evaluation of the state of the coagulation system.
- Routine surgical intervention. During the operation, bleeding is possible, so it is necessary to obtain information about the state of the hemostasis system. Fruit bearing. Each trimester is held, as well as with severe gestosis and fetoplacental insufficiency.
- Diseases associated with disorders in blood clotting( hemophilia, von Willebrand's disease, thrombocytopenia, thrombocytopathy and others).
- Childbirth and cesarean section.
- Control of treatment with heparin and indirect coagulants.
- Varicose veins.
- Tendency to thrombosis.
- High probability of blood clots in IHD, atrial fibrillation, strokes, heart attacks.
- Acute inflammation.
- Pathologies with an autoimmune mechanism of development.
- Chronic liver disease.
- Admission of glucocorticoids, anabolic steroids.
- Continuous intake of oral contraceptives( analysis is conducted every 3 months).
- Diagnosis of thrombosis.
How is it conducted and how to prepare?
Blood is taken in the morning on an empty stomach. On the eve of the analysis should not eat fried, fatty, spicy, smoked and drink alcohol. The last meal should be at least 10-12 hours before the procedure. Before donating blood you can drink only plain water, you can not smoke. To avoid distortion of the result of the analysis, you must stop taking medications that dilute the blood.
Blood for coagulation studies is taken from the vein
For the study, venous blood is used, which is taken by vacuum or a sterile syringe with a needle with a large lumen without overlapping the tourniquet. It is important that the procedure is not traumatic, otherwise the test tube will contain tissue thromboplastin, and the results will be distorted. An anticoagulant should be in the tube. The results of the analysis are usually ready in one to two days. After treatment with antibiotics should be at least two weeks. Influence on the result of analysis and hormonal contraceptives.
Parameters of the coagulogram
As a rule, the first time you assign a basic analysis. If abnormalities are found, an extended study is performed. The following parameters are related to the basic ones.
Fibrinogen .This protein is a valuable indicator of coagulogram. It is involved in the formation of a blood clot. With its lack, blood stops badly. The norm is 2-4 g / liter. At pregnancy its level gradually rises and in the third trimet reaches 6 g / liter. In newborns it is equal to 1.25-3 g / liter.
Reduction of fibrinogen occurs in such cases:
- in case of abnormalities in the hemostasis system;
- Pregnancy Toxicosis;
- severe hepatitis;
- of cirrhosis;
- reception of fish oil;
- deficiency of vitamins C and B;
- reception of anticoagulants, anabolics.
The content of fibrinogen is increased in the following cases:
- for acute inflammation and infections;
- during pregnancy;
- for strokes and heart attacks;
- with pneumonia;
- for burns;
- after surgery;
- for hypothyroidism;
- after delivery.
PTI( prothrombin index) is the ratio of the time during which the blood of a healthy person is folded to the time of blood coagulation in a particular patient. It is an indicator of liver function. Normally it ranges from 90 to 110%.If the value is increased, there is a risk of blood clots, if lowered, bleeding may occur. In pregnancy, raising is considered the norm. PTI, PTB( prothrombin time) and INR( international normalized ratio) show for what time interval in the place of the defect of the vessel formed a clot. With the help of these parameters, the external blood clotting pathway is evaluated. Usually one of them is held. Universal is an INE.
APTT( activated partial thromboplastin time) .Gives an idea about the internal way of blood clotting. Blood clotting time index. Used to control the treatment with heparin. It is one of the most sensitive indicators. Normally it is about 40 seconds. An increase in time may indicate liver disease or a lack of vitamin K.
Thrombin time. This parameter characterizes the final stage of hemostasis, that is, the time interval for which fibrinogen is converted to insoluble fibrin when exposed to thrombin. This indicator provides an opportunity to identify the likelihood of thrombosis, to conduct differential diagnosis of various coagulopathies, to assess how effectively heparin therapy is. Normally, the indicator should be 11-18 seconds. The parameter below the norm indicates an excess of fibrinogen in the blood. An increased value indicates a liver failure or lack of protein.
The transcript of the blood test is performed by the attending physician. Interpretation of the result is carried out taking into account all parameters.
Blood coagulation is a very complex process involving numerous factors
Additional coagulogram parameters
These include the following:
- Antithrombin - refers to the factors of the anticoagulant system and prevents thrombosis.
- Soluble fibrin-monomer complexes( RFMC) - the index of blood coagulation inside the vessels. Gives an idea of how the molecules of fibrin change under the action of thrombin and plasmin.
- Protein C - a deficiency leads to the formation of blood clots.
- Lupus anticoagulant - determined when suspected of autoimmune diseases.
- Plasma tolerance to heparin. This is an indicator of the content of thrombin in the blood. During the analysis, heparin is injected into the blood plasma and the time during which the fibrin clot is formed is determined. Normally, it should be 7-15 minutes. When hypercoagulable during pregnancy, with cancer, after surgery, with cardiovascular pathologies, time is less than normal. With liver diseases, the time interval increases and exceeds 15 minutes.
- D-dimer - formed during the decay of blood clots, with the help of early diagnosis of thrombosis and prevention of thromboembolism.
- Duration of bleeding by Duke. This is a test of the stoppage time of capillary blood. Normally should be about 2 minutes. To do this, make a finger prick 4 mm deep, then using a paper, a droplet of blood is removed every 15 seconds, while the finger paper does not touch. After the drop is removed, the next time the next one appears.
- Fibrinolytic activity - shows the ability of blood to dissolve clots. If thrombi split more quickly than normal, this indicates a tendency to bleeding.
- Recalcification time( GRP) is a measure of the formation time of a fibrin clot. Low values can talk about the development of diseases such as hepatitis, cirrhosis, heart pathologies, including heart failure.
- Activated recalcification time( ATS).The rate is 50-70 seconds.
- Retraction of the blood clot. Shows how the blood clot decreases. With anemia, this indicator increases. Decrease occurs when the level of erythrocytes rises and the platelets decrease.
- Thrombotest - shows how much fibrinogen is in the blood. In norm - test of IV-V degree.
- Fibrinogen B - normally negative.
- Blood clotting time, that is, the time from the moment of venous blood sampling to the formation of a clot in the test tube. Shows how the platelets work. To determine in the tube, place blood in the amount of 1 milliliter at a temperature of 37 degrees. The average is 5-7 minutes on average. If more time is required, this may indicate liver damage, lack of coagulation factors, prolonged administration of anticoagulants, and low platelet count. If coagulation occurs faster than normal, this indicates hypercoagulation, development of DIC syndrome, or is a consequence of hormonal contraceptive use. For capillary blood, this indicator is from 30 seconds to 5 minutes, for venous blood - from 5 to 10 minutes.
The process of formation of the thrombus
The table will help to more clearly present the norms of the basic indicators of the coagulogram:
|Fibrinogen( concentration)||2-4 g / l|
|Thrombin time||11-18 seconds|
|Plasma tolerance to heparin||3-11 minutes|
|RFMC||4 mg/ 100 ml|
|Blood clot retraction||44-65%|
|Duke bleeding time||no more than 4 minutes|
|Fibrinogen||from 5.9 to 11.7 μmol|
|Fibrinolytic activity of||From 183 to 263 minutes|
|BClotting time||5-10 minutes|
Coagulogram is not included in the standard examination, but it may be necessary for the doctor to prepare the patient for surgery, in the presence of autoimmune diseases, liver pathology, tendency to bleeding, with varicose veins.