What kind of analysis is this – coagulogram: normal,decoding results, how to pass

Update: December 2018

A coagulogram (otherwise a hemostasiogram) is a special
a study that shows how good or bad
blood coagulation occurs.

itт анализ играет очень важную роль в определении состояния
person His performance helps to predict how the operation will go.
or childbirth, whether the patient will survive, whether it is possible to stop the bleeding
wounded.

True, not all doctors have the ability to read a coagulogram.
However, at times, it is this study that can save lives.
man

Something about blood coagulation

Blood is a special fluid that does not have the property
only circulate through the vessels, but also form dense clots
(blood clots). it качество позволяет ей закрывать бреши в средних и
мелких артериях и венах, порой даже незаметно для person
Liquid retention and blood clotting are regulated
системой hemostasis. Coagulation system or hemostasis system
consists of three components:

  • vascular cells, and specifically the inner layer (endothelium) – with
    damage or rupture of the vessel wall of endothelial cells
    A number of biologically active substances are released (nitrogen oxide,
    prostacyclin, thrombomodulin) that run
    thrombosis;
  • platelets are blood plates that are the first
    rush to the place of damage. They stick together between themselves and
    try to close the wound (forming the primary hemostatic
    cork). If a тромбоциты не могут остановить кровотечение,
    plasma coagulation factors are included;
  • plasma factors – 15 factors enter the hemostasis system
    (many are enzymes) which, due to a number of chemical
    reactions form a dense fibrin clot, finally
    stopping bleeding.

A feature of coagulation factors is that
all of them are formed in the liver with the participation of vitamin K. Hemostasis
human also controlled by anticoagulant and
fibrinolytic systems. Their main function is
prevention of spontaneous thrombosis.

Byказание к назначению гемостазиограммы

  • general assessment of the hemostatic system;
  • planned research before operations;
  • independent childbirth or cesarean section;
  • severe gestosis;
  • control of therapy with indirect anticoagulants (aspirin,
    warfarin, trental), heparin preparations (clexane,
    Fraxiparin);
  • diagnosis of hemorrhagic pathologies (hemophilia,
    thrombocytopathy and thrombocytopenia, von Willebrant disease);
  • varicose veins of the lower extremities (see treatment of varicose veins
    at home);
  • at high risk of thrombosis (atrial fibrillation,
    coronary heart disease);
  • definition of DIC;
  • taking oral contraceptives, glucocorticosteroids,
    anabolic steroids;
  • хронические заболевания печени (cirrhosis);
  • acute inflammatory processes in the body;
  • diagnosis of various thrombosis – vessels of the lower extremities,
    кишечника, ишемического инсульта, тромбоэмболии лhimчной
    arteries.

How to prepare for a coagulogram?

  • the material is taken strictly on an empty stomach, it is desirable that the previous
    food intake was at least 12 hours ago;
  • on the eve it is recommended not to eat spicy, fatty,
    smoked products, alcohol;
  • it is forbidden to smoke before taking the material;
  • It is advisable to stop taking direct and indirect anticoagulants.
    actions, as their presence in the blood can distort the indicators
    coagulogram;
  • if taking these medicines is vital for
    patient, it is necessary to warn the laboratory doctor,
    who will review the analysis.

How is a blood clotting test done?

  • the material is collected with a dry sterile syringe or
    Vacutainer vacuum blood collection system;
  • blood collection should be carried out with a needle with a wide lumen
    without the use of a harness;
  • puncture of the vein must be atraumatic, otherwise the tube
    will get a lot of tissue thromboplastin that will distort
    results;
  • the laboratory assistant fills 2 tubes with material, while
    the survey sends only the second;
  • the test tube must contain a special coagulant (citrate
    sodium).

Where can I take the analysis?

This research can be conducted in any private or
state clinic or laboratory that possesses
necessary reagents. The hemostasiogram is difficult in
performing analysis and requires sufficient qualifications
laboratory doctors. The cost of the examination varies from 1000 to 3000
rubles, the price depends on the number of determinable factors.

How many days is a coagulogram done?

To obtain the results of the study, the laboratory doctor usually
conducts a series of chemical reactions that require a certain
of time. It usually takes 1-2 business days. One thing depends
also from the workload of the laboratory, the availability of reagents, work
courier

Coagulogram norm

Blood coagulation time
  • By Ли-Уайту
  • By Масс и Магро
  • 5-10 minutes;
  • 8-12 minutes.
Bleeding time
  • By Дюку
  • By Айви
  • By Шитиковой
  • 2-4 minutes;
  • Up to 8 minutes;
  • Up to 4 minutes;
Byказатель анализа Its designation Norm
Протромбиновое time по Kwiku PV 11-15 seconds
INR (International Normalized Attitude) INR 0.82-1.18
Activated Partial (partial) Thromboplastin
time
APTTV 22.5-35.5 seconds
Activated recalcification time AVR� 81-127 sec
Prothrombin index PTI 73-122%
Тромбиновое time  Tv 14-21 seconds
Soluble fibrin-monomer complexes RFMK 0,355-0,479 U
Antithrombin III AT III 75.8-125.6%
D-dimer 250.10-500.55 ng / ml
Fibrinogen 2.7-4.013 g

 Coagulogram transcript

Протромбиновое time (PV)

PV – это time формирования тромбинового сгустка, если добавить
plasma calcium and thromboplastin. Byказатель отражает 1 и 2 фазу
plasma coagulation and activity work 2,5,7 and 10 factors.
Нормы протромбинового времени (PV) в разном возрасте:

  • Newborn premature babies – 14-19 seconds;
  • Newborn full-term babies – 13-17 seconds;
  • Younger children – 13-16 seconds;
  • Older children – 12-16 seconds;
  • Взрослые – 11-15 seconds.

Терапия антикоагулянтами считается действенной, если PV
increases at least 1.5-2 times.

INR

INR или протромбиновый коэффициент – это отношение PV больного в
PV контрольной пробирки. The показатель ввела Всемирная
health organization in 1983 to streamline work
laboratories, as each lab uses different
thromboplastin reagents. Главная цель определения INR – контроль
receiving patients with indirect anticoagulants.

Причины изменения показателей PV и INR:

Увеличение протромбинового времени и INR Снижение протромбинового времени и INR
  • liver diseases (cirrhosis, chronic hepatitis);
  • vitamin K deficiency in enteropathy, intestinal
    dysbacteriosis;
  • amyloidosis;
  • nephrotic syndrome;
  • DIC syndrome;
  • hereditary deficiency of coagulation factors (2,5,7,10);
  • снижение уровня фибриногена или him absence;
  • treatment with coumarin derivatives (warfarin, merevan);
  • the presence of anticoagulants in the blood.
  • thrombosis and vascular thromboembolism;
  • activation of fibrinolysis;
  • increased activity of 7 factors.

 APTTV (активированное частичное тромбиновое time,
кефалинкаолиновое time)

APTTV – это показатель эффективности остановки кровотечения
plasma factors. Фактически APTTV отражает внутренний путь
hemostasis, how fast the fibrin clot forms. it
The most sensitive and accurate hemostasiogram indicator.
Значение APTTV, в первую очередь, зависит от используемых врачом
reagents-activators, and in different laboratories indicator can
vary. Укорочение APTTV говорит о повышенной свертываемости,
the possibility of the formation of blood clots. And its elongation indicates
decrease in hemostasis.

Byчему меняется величина APTTV?

Causes of lengthening Causes of shortening
  • reduced blood clotting;
  • congenital or acquired insufficiency of factors
    blood coagulation (2,5,8,9,10,11,12);
  • fibrinolysis;
  • 2nd and 3rd stages of DIC;
  • treatment with heparin and its low-molecular analogs (clexane,
    Cybor, Fraxiparin);
  • autoimmune pathologies (systemic lupus erythematosus);
  • severe liver disease (cirrhosis, fatty infiltration
    liver).
  • increased blood clotting;
  • 1st phase DIC;
  • improper blood sampling technique (material contamination
    tissue thromboplastin).

 Активированное time рекальцификации

AVR� – time, необходимое для образования фибрина в плазме,
rich in calcium and platelets. Byказатель отражает, насколько
plasma and cell links interact
hemostasis. Its value may vary depending on
reagents used in the laboratory. Удлиняется AVR� при
decrease in the number of platelets (thrombocytopenia) and change them
quality (thrombocytopathy), hemophilia. Укорочении AVR� говорит о
propensity to form blood clots.

Prothrombin index

Prothrombin index или PTI – это соотношение идеального
prothrombin time to patient’s prothrombin time,
multiplied by 100%. В настоящее time этот показатель считается
устаревшим, вместо нhim врачи рекомендуют определять INR.
Byказатель, как и INR, нивелирует те отличия результатов PV,
which occur due to the different activity of thromboplastin in
different laboratories.

Under what pathologies does the index change?

Byвышается Declining
  • deficiency of coagulation factors;
  • vitamin K deficiency (colitis, enterocolitis);
  • treatment with indirect anticoagulants (warfarin,
    neodikumarin, syncumar);
  • treatment with heparin and its low molecular weight analogues (flenox,
    clexane).
  • liver damage (cirrhosis, chronic hepatitis);
  • vascular thrombosis;
  • повышенная свертываемость у женщин во time беременности и в
    period of birth.

 Тромбиновое time

Тромбиновое time показывает конечный этап hemostasis. Tv
characterizes the length of time required to form a clot
fibrin in plasma, if you add to it thrombin. Always determined
вместе с APTTV и PV для контроля фибринолитической и
heparin therapy, diagnosis of congenital abnormalities of fibrinogen.

Какие болезни влияют на тромбиновое time?

Заболевания, удлиняющие тромбиновое time Заболевания, укорачивающие тромбиновое time
  • decrease in fibrinogen concentration (below 0.5 g / l) or full
    him absence;
  • acute fibrinolysis;
  • DIC syndrome;
  • therapy with fibrinolytic drugs (streptokinase,
    urokinase);
  • autoimmune pathologies (formation of antibodies to thrombin);
  • chronic liver disease (cirrhosis, hepatitis).
  • treatment with heparin and fibrin polymerization inhibitors;
  • Stage 1 of DIC.

 Fibrinogen

Fibrinogen – это первый фактор свертывания крови. This protein
formed in the liver and under the action of Hageman factor turns into
insoluble fibrin. Fibrinogen относится к белкам острой фазы,
its concentration increases in plasma with infections, injuries,
stresses.

Why does fibrinogen levels change in the blood?

Increase content Content reduction
  • severe inflammatory pathologies (pyelonephritis, peritonitis,
    pneumonia);
  • myocardial infarction;
  • systemic connective tissue diseases (rheumatoid
    arthritis, SLE, systemic scleroderma);
  • malignant tumors (especially in the lungs);
  • pregnancy;
  • burns, burn disease;
  • after surgery;
  • amyloidosis;
  • menstruation;
  • treatment with heparin and its low-molecular analogs,
    estrogen, oral contraceptive use.
  • congenital and hereditary deficiency;
  • DIC syndrome;
  • liver pathologies (alcoholic liver disease, cirrhosis);
  • leukemia, aplastic lesion of the red bone marrow;
  • prostate cancer with metastases;
  • condition after bleeding;
  • Anabolic, androgenic, barbiturate, fish oil,
    valproic acid, fibrin polymerization inhibitors;
  • heparin poisoning (this acute condition is treated with an antidote
    fibrin – protamine).

 RFMK

RFMK (растворимые фибрин-мономерные комплексы) являются
intermediate breakdown products of the fibrin clot due to
fibrinolysis. RFMK очень быстро выводится из плазмы крови,
The indicator is very difficult to determine. Diagnostic value of it
consists in the early diagnosis of DIC. Также RFMK увеличивается
with:

  • thrombosis of various localization (pulmonary thromboembolism
    arteries, deep veins of the extremities);
  • in the postoperative period;
  • pregnancy complications (preeclampsia, gestosis);
  • acute and chronic renal failure;
  • sepsis;
  • shocks;
  • systemic pathologies of connective tissue and others.

Antithrombin III

Antithrombin III – это физиологический антикоагулянт. By
structure, it is a glycoprotein that inhibits thrombin and
a number of coagulation factors (9,10,12). The main place of its synthesis is
liver cells. Byказатели антитромбина III в разном возрасте:

  • Newborns – 40-80%
  • Children under 10 years old – 60-100%
  • Children from 10 to 16 years old – 80-120%
  • Adults – 75-125%.

Byчему изменяется him содержание в крови?

Byвышение уровня Level reduction
  • severe inflammatory pathologies (pyelonephritis, peritonitis,
    pneumonia);
  • acute liver damage (hepatitis);
  • lack of vitamin K;
  • treatment with glucocorticosteroids, anabolic steroids.
  • congenital and hereditary deficiency;
  • chronic liver disease (alcoholic liver disease,
    cirrhosis);
  • DIC syndrome;
  • coronary heart disease;
  • last trimester of pregnancy;
  • thrombosis and thromboembolism;
  • sepsis;
  • treatment with heparin and fibrin polymerization inhibitors;

 D-dimer

D-dimer – это остаток расщепленных нитей фибрина. The
the indicator reflects the work of the coagulation system (if the blood
много D-dimerа, значит, расщепилось много фибрина), так и функцию
anticoagulation system. The blood index contains about 6
hours after the formation, so the material must be immediately investigated in
laboratories.

Diagnostic value is only increasing
показателя, которое встречается with:

  • thrombosis and thromboembolism of arteries and veins;
  • liver disease;
  • extensive hematomas;
  • coronary heart disease and myocardial infarction;
  • in the postoperative period;
  • long smoking;
  • DIC syndrome;
  • seropositive rheumatoid arthritis.

Bleeding time

Method of determination: medical needle or scarifier
pierces the earlobe. Byсле чhim засекаем time, пока кровь не
will stop. Doctors estimate only the elongation of the index, since
his shortening speaks of a wrong study.
Bleeding time удлиняется из-за:

  • lack of platelets in the blood (thrombocytopenia);
  • hemophilia A, B and C;
  • alcohol damage to the liver;
  • hemorrhagic fevers (Crimea-Congo, Ebola, with
    renal syndrome);
  • thrombocytopenia and thrombocytopathy;
  • overdose of indirect anticoagulants and
    anticoagulants.

Coagulation time by Lee-White and Mass and Magro

This study shows the time required for
blood clot formation. The method is very simple to perform:
blood is taken from a vein. The material is poured into a dry,
sterile tube. Catch time until visible
eye blood clot. In case of violation of the hemostatic system time
coagulation may shorten and lengthen. With some
pathological conditions (DIC, hemophilia) clot can
do not form at all.

Lengthening bleeding time Shortening bleeding time
  • severe inflammatory pathologies (pyelonephritis, peritonitis,
    pneumonia);
  • late stages of DIC;
  • systemic connective tissue diseases (rheumatoid
    arthritis, systemic scleroderma, systemic lupus erythematosus);
  • hemophilia;
  • malignant tumors;
  • poisoning with phosphorus and its compounds;
  • pregnancy;
  • burns, burn disease;
  • overdose of indirect anticoagulants and
    anticoagulants;
  • chronic liver disease (alcoholic liver disease,
    cirrhosis);
  • anaphylactic shock;
  • myxedema;
  • early stages of DIC;
  • hemorrhagic shock.

Coagulogram during pregnancy

During pregnancy in the body of a woman occur
tremendous changes that affect all systems, including
hemostasis system. These changes are due to
additional circle of blood circulation (uteroplacental) and
changes in the hormonal status (the prevalence of progesterone over
estrogen).

In the period of carrying a child increases the activity of factors
coagulation, especially 7,8,10 and fibrinogen. Procrastination
fibrin fragments on the vessel walls of the placental-uterine system.
Byдавляется система fibrinolysis. Thus, the body of a woman
trying to hedge in case of uterine
bleeding and miscarriage, prevents placental abruption and
the formation of intravascular thrombus.

Byказатели гемостаза в период беременности

Byказатель 1 term 2 trimester 3 term
Fibrinogen, г/л 2.91-3.11 3.03-3.46 4.42-5.12
APTTV, with 35.7-41.2 33.6-37.4 36.9-39.6
AVR, with 60.1-72.6 56.7-67.8 48.2-55.3
Prothrombin Index,% 85,4-90,1 91.2-100.4 105.8-110.6
RFMK, ЕД 78-130 85-135 90-140
Antithrombin III, г/л 0,222 0.176 0.155
Тромбоциты, *109 301-317 273-298 242-263

With a pathological pregnancy (early and late gestosis)
violations in the regulation of blood coagulation. Shortens
platelet life, increased fibrinolytic activity. If a
a woman does not consult a doctor and does not treat gestosis,
there is a very terrible complication – DIC.

DIC or intravascular disseminated syndrome
coagulation consists of 3 stages:

  • hypercoagulation – the formation of many small blood clots,
    impaired blood circulation between the mother and the fetus;
  • hypocoagulation – over time, coagulation factors are depleted in
    blood clots disintegrate;
  • acoagulation – the absence of blood coagulation, there are uterine
    bleeding that threatens the life of the mother, the fetus is in most
    cases perish.

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