Blood makes up most of our body. In a person weighing 70 kilograms, about 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 blood health, as well as any other organ. One of the tests that will help diagnose many pathological processes that affect the blood is an expanded coagulogram (hemostasiogram).
A few words about blood coagulation
Before going 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 coagulation system.
What kind of system is this? The coagulation system consists of two main links: external hemostasis, or platelet, and internal, or coagulation.
Platelet hemostasis works due to the adhesion of platelets (the main hemostatic blood cells) to the site of damage to the blood vessel. When enough of these platelets accumulate, they firmly adhere to each other, preventing the blood from flowing further through the vessel. Such a clot forms quickly, immediately stopping the bleeding, but it is short-lived.
At the second stage, coagulation hemostasis is included in the work. Its mechanism is more complex and is provided by special blood proteins that are synthesized in the liver - coagulation factors. With the synchronized and sequential operation of these proteins (there are 12 varieties in total), the blood coagulates, and fibers of fibrin, the connective tissue, which stabilize it and prevent it from breaking down, fall into this clot. Thus, coagulation hemostasis takes longer, but at the same time it stops the bleeding irrevocably.
Expanded coagulogram - this is the analysis that allows you to identify violations of the two systems of hemostasis.
Examination preparation
In order for the indicators of the expanded coagulogram to be the most effective and reliably display the processes in the body, the following rules must be followed when passing the analysis:
- blood donates only in the morning;
- delivery should be carried out on an empty stomach, and you need to refuse food intake 12 hours before the examination. It is allowed to drink water and take medication;
- at least one day before blood donation should pass without physical exertion, alcohol intake, there should also be no significant changes in the diet;
- quit smoking at least an hour before blood donation;
- some drugs may affect your results. If you are taking acetylsalicylic acid, anticoagulants, or other drugs that affect blood viscosity, you should notify your nurse;
- if you previously had an undesirable reaction when taking blood (dizziness, nausea), also warn the nurse.
After completing the blood sampling, do not load your arm for at least one hour, as this can lead to a hematoma.
Main indications
Now it's time to find out what basic conditions and diseases of the body require the analysis of an expanded coagulogram:
- Be sure to check before surgery.
- Screening during pregnancy, both before independent births and before cesarean section.
- Severe gestosis of pregnant women.
- Periodic monitoring of treatment with blood thinners (Heparin, Warfarin, Aspirin).
- Diagnostic examination for suspected diseases with blood clotting disorders (hemophilia, thrombocytopenic purpura, hemorrhagic vasculitis).
- With diseases of the cardiovascular system that increase the risk of blood clots (coronary heart disease, rhythm disturbances, especially atrial fibrillation).
- Varicose disease.
- Suspicion of the development of disseminated intravascular coagulation (DIC).
- Severe liver disease with the development of cirrhosis, since they have a violation of the synthesis of coagulation factors.
- Suspected development of blood clots and thromboembolism.
As can be seen from the list above, an expanded coagulogram is an important study that is necessary for the diagnosis of many pathological conditions of the blood and internal organs.
Results Time
Anyone who passes this analysis is probably interested in how much a coagulogram is made. Of course, the results will not be instantaneous, since the laboratory doctor needs time to carry out all the reactions. It 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.
Main characteristics
What indicators are determined and what is included in the expanded coagulogram? They may vary depending on the laboratory, but the main ones are presented 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 determine lupus anticoagulant, 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 a blood clot and stopping bleeding completely. 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 expanded coagulogram, effective for determining the presence of an acute inflammatory process in the body. Often, along with an increase in fibrinogen levels, the erythrocyte sedimentation rate increases.
Causes of Fibrinogen Disorders
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);
- endocrine system diseases, especially hypothyroidism;
- amyloidosis is a specific disease that is characterized by increased formation of amyloid protein and its deposition in internal organs, which leads to a violation of their function;
- malignant neoplasms can also lead to an increase in fibrinogen;
- stressful events for the body (burns, injuries, surgical interventions);
A decrease in blood fibrinogen can be observed in the following cases:
- disseminated intravascular coagulation syndrome (DIC);
- severe liver disease with the development of cirrhosis;
- pregnancy accompanied by severe toxicosis;
- hypo - and vitamin deficiencies;
- bone marrow neoplasms (myelogenous leukemia);
- snake venom poisoning
- taking anabolics and androgens.
Activated partial thromboplastin time
APTT is another indicator of the internal system of hemostasis, which displays the time of formation of a blood clot when calcium chloride is attached to it.
Norm in an adult: 26-45 seconds.
Shortening of APTT can 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 coagulation factors;
- systemic diseases of the connective tissue (systemic lupus erythematosus);
- DIC-syndrome in the phase of hypercoagulation (1st phase);
- APTT depends on the level of coagulation factors: when they decrease, APTT changes.
The lengthening of the activated partial thromboplastin time, and therefore the slowing down of blood coagulation, is determined by:
- with hemophilia - a hereditary disease in which the production of coagulation factor VIII (with hemophilia A) or factor IX (with hemophilia B) is disrupted;
- DIC-syndrome in the phase of hypocoagulation (2nd phase);
- antiphospholipid syndrome - an autoimmune disease in which antibodies to its own phospholipids are formed; is a common cause of preterm pregnancy.
Prothrombin time
This indicator also characterizes internal hemostasis and shows the time of transition of fibrinogen to fibrin (the last stage of coagulation). Therefore, prothrombin time directly depends on the amount of fibrinogen in the body: when its level decreases, prothrombin time is lengthened.
Norm in an adult: 11-16 seconds.
An increase in the duration of prothrombin time is observed in the following conditions:
- hypofibrinogenemia, which can be either congenital or acquired (often observed with cirrhosis);
- dysfibrinogenemia - 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");
- elevated levels of bilirubin in the blood;
- systemic lupus erythematosus.
Shortening of prothrombin time occurs:
- with DIC-syndrome in the phase of hypercoagulation (1st phase);
- the conditions listed as those that increase fibrinogen levels.
Prothrombin index and INR
The 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.
The prothrombin index (PI) is an index that is calculated by dividing the patient's prothrombin time by standard prothrombin time and is multiplied by 100%.
When calculating INR, the patient’s blood is compared with standardized plasma.
The norm of PI in an adult: 95-105%.
INR norm: 1-1.25.
Reasons for violation of INR
An increase in the international normalized ratio (INR) is found:
- in severe hepatic diseases with the development of cirrhosis;
- a decrease in the concentration of vitamin K (found in inflammatory bowel diseases, 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 loss of protein by the body;
- DIC;
- genetic diseases characterized by a deficiency of coagulation factors (including hemophilia);
- hypo- and dysfibrinogenemia;
- taking anticoagulants.
A decrease in this indicator is characteristic of:
- for pregnancy in the last trimester (an increase in INR is considered normal for this period);
- thrombosis and thromboembolism;
- taking certain medications (hormonal drugs: oral contraceptives, corticosteroids).
Antithrombin III
This indicator of an expanded coagulogram refers to the anticoagulant system of blood, that is, on the contrary, prevents its coagulation.
It can decrease with the following pathologies:
- liver diseases;
- genetically inherited antithrombin deficiency;
- DIC;
- septic condition;
- thrombosis and thromboembolism.
An increase in its level is characteristic:
- for acute viral hepatitis;
- pancreatic diseases;
- decrease in concentration of vitamin K.
Coagulogram during pregnancy
A mandatory diagnostic procedure for pregnancy is a coagulogram. The planned expanded coagulogram during pregnancy is carried out on the following dates:
- After registration.
- At 22-24 weeks.
- In 30-36 weeks.
Some indicators of extended coagulogram may differ in pregnant women. So, they normally have shortened APTT, increased fibrinogen levels, and thrombin time has been lengthened.
Where can I get an analysis?
You can pass an extended coauglogram in the "Hemotest", "Invitro".
The availability of analyzes, prices and indicators that are determined are approximately the same.
So, an expanded coagulogram in the Hemotest costs 1720 rubles and is done within one day. Here, such indicators are determined: APTT, antithrombin III, INR, fibrinogen, thrombin time.
In addition to the indicators listed above, the Invitro expanded coagulogram also includes the definition of a D-dimer. The deadline is also 1 business day, the cost is 2360 rubles