Blood makes up a large part of our body. In a person weighing 70 kilograms, there are approximately 5.5 liters of blood! It is thanks to her that our cells receive oxygen and nutrients, and give off carbon dioxide. It is thanks to its movement through the vessels that the shape of our body is maintained. Therefore, it is so important to take care of the he alth of the blood, like any other organ. One of the tests that will help diagnose many pathological processes that affect the blood is an extended coagulogram (hemostasiogram).
A few words about blood clotting
Before we go directly to what the coagulogram shows, let's see why this examination should be done at all. The coagulogram determines the state of the blood clotting system.
What is this systemlike this? The coagulation system consists of two main links: external hemostasis, or platelet, and internal, or coagulation.
Platelet hemostasis works by the adhesion of platelets (the main hemostatic cells in the blood) to the site of damage to the blood vessel. When enough of these platelets accumulate, they firmly stick together, preventing blood from flowing further through the vessel. Such a clot forms quickly, stopping bleeding immediately, but it is short-lived.
At the second stage, coagulation hemostasis is activated. Its mechanism is more complex and is provided by special blood proteins that are synthesized in the liver - clotting factors. With the synchronized and consistent work of these proteins (there are 12 varieties in total), the blood thickens, and fibrin fibers fall into this clot - a connective tissue that stabilizes it and prevents it from disintegrating. Thus, coagulation hemostasis takes longer, but at the same time it permanently stops bleeding.
Extended coagulogram - this is the analysis that allows you to identify violations of the two systems of hemostasis.
Preparation for examination
In order for the indicators of the extended coagulogram to be the most effective and reliably reflect the processes in the body, when taking the analysis, you must adhere to the following rules:
- blood donation only in the morning hours;
- surrender should be carried out on an empty stomach, and you need to refusefood intake 12 hours before the examination. It is allowed to drink water and take medicine;
- at least one day before blood donation should pass without physical activity, alcohol intake, and there should not be significant changes in diet;
- quit smoking at least one hour before donating blood;
- Results may be affected by certain medications. If you are taking acetylsalicylic acid, anticoagulants or other drugs that affect blood viscosity, you need to warn your nurse;
- if you have had adverse reactions during blood sampling (dizziness, nausea) also tell the nurse.
After completing the blood draw, do not exercise the arm for at least one hour, as this may lead to a hematoma.
Main indications
Now it's time to find out what the main conditions and diseases of the body require an extended coagulogram analysis:
- Mandatory examination before surgery.
- Pregnancy screening, both before spontaneous delivery and before caesarean section.
- Severe gestosis of pregnant women.
- Periodic monitoring of treatment with blood thinners ("Heparin", "Warfarin", "Aspirin").
- Diagnostic examination for suspected clotting disorders (hemophilia, thrombocytopenic purpura, hemorrhagic vasculitis).
- Whendiseases of the cardiovascular system that increase the risk of blood clots (ischemic heart disease, arrhythmias, especially atrial fibrillation).
- Varicose disease.
- Suspicion of disseminated intravascular coagulation (DIC).
- Severe liver diseases with the development of cirrhosis, as they have a violation of the synthesis of coagulation factors.
- Suspicion for the development of blood clots and thromboembolism.
As can be seen from the list above, an extended coagulogram is an important study that is necessary for the diagnosis of many pathological conditions of the blood and internal organs.
Time to get results
Anyone who takes this test is probably interested in how much a coagulogram is done. Of course, the results will not be instantaneous, since the laboratory doctor needs time to carry out all the reactions. This usually takes up to two business days. That is, if you passed the tests on Friday, most likely, the results will be ready on Tuesday-Wednesday.
Key indicators
What indicators are determined and what is included in the extended coagulogram? These may vary by lab, but the main ones are listed below:
- fibrinogen;
- prothrombin time and prothrombin index, which together make up the international normalized ratio;
- prothrombin;
- activated partial thromboplastin time;
- antithrombin III.
Some laboratories also test for lupusanticoagulant, D-dimer, protein-C and protein-S.
Fibrinogen
Fibrinogen is one of the coagulation factors mentioned above, proteins synthesized in the liver. It is included in the work at one of the last stages of coagulation hemostasis and is very important for stabilizing the blood clot and completely stopping bleeding. At the last stage, it turns into fibrin - an insoluble connective tissue substance.
Adult norm: 2-4 g/l.
Fibrinogen is the main indicator of all that are included in the extended coagulogram, effective for determining the presence of an acute inflammatory process in the body. Often, along with an increase in the level of fibrinogen, the erythrocyte sedimentation rate increases.
Causes of impaired fibrinogen levels
The following are the main diseases that lead to an increase in fibrinogen in the blood:
- inflammatory and infectious diseases, both viral and caused by other microorganisms: bacteria, fungi, protozoa. That is, this indicator does not indicate a specific infection, but only confirms its presence in the body;
- acute cerebrovascular accident (stroke);
- blockage of the lumen of the coronary vessel with the development of necrosis of the muscle wall (myocardial infarction);
- diseases of the endocrine system, especially hypothyroidism;
- amyloidosis is a specific disease that is characterized by increased production of amyloid protein and its deposition in the internal organs, which leads to impaired function;
- malignant neoplasms can also lead to an increase in fibrinogen;
- stressful events for the body (burns, injuries, surgical interventions);
Decrease in fibrinogen in the blood can be observed in the following cases:
- disseminated intravascular coagulation syndrome (DIC);
- severe liver disease with development of cirrhosis;
- pregnancy with severe toxicosis;
- hypo- and beriberi;
- Bone marrow neoplasms (myeloid leukemia);
- poisoning with snake venom,
- taking anabolics and androgens.
Activated partial thromboplastin time
APTT is another indicator of the internal hemostasis system, which displays the time for the formation of a blood clot when calcium chloride is attached to it.
The norm for an adult: 26-45 seconds.
Shortened APTT may be observed:
- with severe hepatic pathologies with the development of cirrhosis;
- insufficient amount of vitamin K, which is synthesized in the liver and is necessary for the full functioning of clotting factors;
- systemic connective tissue diseases (systemic lupus erythematosus);
- DIC in the hypercoagulable phase (1st phase);
- APTT depends on the level of clotting factors: when they decrease, the APTT changes.
The prolongation of activated partial thromboplastin time, and consequently, the slowing down of blood coagulation is determined by:
- for hemophilia- a hereditary disease in which the production of coagulation factor VIII (with hemophilia A) or factor IX (with hemophilia B) is disrupted;
- DIC in the hypocoagulation phase (2nd phase);
- antiphospholipid syndrome - an autoimmune disease in which antibodies to one's own phospholipids are formed; is a common cause of miscarriage.
Prothrombin time
This indicator also characterizes internal hemostasis and shows the time of transition of fibrinogen to fibrin (the last stage of coagulation). Therefore, the prothrombin time directly depends on the amount of fibrinogen in the body: with a decrease in its level, the prothrombin time lengthens.
The norm for an adult: 11-16 seconds.
An increase in the duration of prothrombin time is observed under the following conditions:
- hypofibrinogenemia, which can be either congenital or acquired (often seen in cirrhosis of the liver);
- dysfibrinogenemia is a pathology that is manifested by a violation of the structure of fibrinogen with its normal amount;
- DIC;
- taking drugs that dissolve fibrin (fibrinolytic therapy);
- taking drugs belonging to the group of direct-acting anticoagulants ("Heparin");
- increased blood bilirubin level;
- systemic lupus erythematosus.
Shortening of prothrombin time occurs:
- with DIC in the hypercoagulable phase (1st phase);
- conditions listed as those that level upfibrinogen.
Prothrombin index and INR
Prothrombin index and INR are indicators that are determined together with prothrombin time. And if the prothrombin index and time may differ depending on the laboratory, then the international normalized ratio (INR) is the diagnostic standard that is the same in all laboratories in the world.
Prothrombin index (PI) is an index that is calculated by dividing the patient's prothrombin time by the standard prothrombin time and multiplied by 100%.
When calculating the INR, the patient's blood is compared to standardized plasma.
Norm PI in an adult: 95-105%.
INR norm: 1-1, 25.
Causes of INR violation
Increase in international normalized ratio (INR) occurs:
- with severe liver diseases with the development of cirrhosis;
- reducing the concentration of vitamin K (occurs in inflammatory bowel disease, liver damage);
- amyloidosis;
- kidney disease with the development of nephrotic syndrome, which is manifested by increased permeability of the glomeruli of the capillaries of the kidneys and the loss of protein by the body;
- DIC;
- genetic diseases characterized by deficiency of clotting factors (including hemophilia);
- hypo- and dysfibrinogenemia;
- taking anticoagulants.
The decrease in this indicator is typical:
- for pregnancy in the last trimester (an increase in INR is considered normal for thisperiod);
- thrombosis and thromboembolism;
- taking certain medications (hormonal drugs: oral contraceptives, corticosteroids).
Antithrombin III
This indicator of an extended coagulogram refers to the anticoagulation system of the blood, that is, on the contrary, prevents its clotting.
It can decrease with the following pathologies:
- liver disease;
- genetically inherited antithrombin deficiency;
- DIC;
- septic condition;
- thrombosis and thromboembolism.
The increase in his level is characteristic:
- for acute viral hepatitis;
- diseases of the pancreas;
- reducing the concentration of vitamin K.
Coagulogram during pregnancy
Mandatory diagnostic procedure for pregnancy is a coagulogram. A planned extended coagulogram during pregnancy is carried out at the following dates:
- After registration.
- At 22-24 weeks.
- At 30-36 weeks.
Some indicators of an extended coagulogram may differ in pregnant women. So, they normally have a shortened APTT, an increased level of fibrinogen, and an extended thrombin time.
Where can I get tested?
You can pass an extended coagulogram in "Hemotest", "Invitro".
Deadlines for analysis, prices and indicators that are determined are approximately the same.
So, extended coagulogram in"Hemotest" costs 1720 rubles and is done within one day. Here the following indicators are determined: APTT, antithrombin III, INR, fibrinogen, thrombin time.
In addition to the indicators listed above, the extended coagulogram in "Invitro" also includes the definition of D-dimer. Deadline - also 1 business day, cost - 2360 R.
