What is the normal blood coagulogram in children?

Coagulogram

– a procedure aimed at identifying the patient’s blood clotting rate. Since blood clotting is an important protective function of the body and contributes to normal hemostasis (a system in the human body aimed at maintaining blood in a liquid state, stopping blood during bleeding and dissolving “used” platelets), the blood clotting test also has a second name - hemostasiogram or coagulation hemostasis. Although it is worth noting that blood clotting is not the body's only defense mechanism, primary hemostasis is provided by the properties of blood vessels and platelets.

Increased blood clotting rates lead to thrombosis

with bleeding. This phenomenon is called hypercoagulation, and it can lead to a pathological appearance: thrombosis and thromboembolism.

In turn, decreased blood clotting rates or hypocoagulation

observed during bleeding, and can lead not only to fatal consequences, but also be used to treat thrombosis.

When should you take a blood clotting test?

In medicine, there are situations when, in order to make a diagnosis and plan further treatment, it is necessary to conduct a blood clotting test. A coagulogram is prescribed in the following cases:

• When preparing for surgical treatment of a patient
• For various diseases of the liver, heart and blood vessels
• Frequent bleeding in the patient
• The appearance of bruises on the skin at the slightest injury
• To monitor the condition of a pregnant woman
• To study the causes of disruption of the immune defense mechanism

A blood clotting test allows the attending physician to select the correct medications. In some cases, a decrease in blood clotting rates is required to treat vascular thrombosis (stroke, varicose veins, coronary heart disease, and so on).

Indications for the test

In the vast majority of cases, a child’s blood clotting is assessed to confirm the occurrence of a particular disease, since deviations from the norm often have a pathological basis.

Nevertheless, such an analysis should also be carried out for preventive purposes - to monitor the hemostasis system and the general health of the human body.

Other indications for such a diagnostic procedure are:

• control over anticoagulation therapy - in some cases, treatment of a particular disease involves taking anticoagulants, which inhibit the ability of blood to clot;
• routine examination before surgery;
• suspicion of DIC syndrome;
• diseases of the hematopoietic system;
• uncontrolled use of any medications;
• chronic liver diseases;
• frequent bleeding that does not stop for a long time;
• lagging behind peers in growth, mental or physical development.

Preparing for a blood clotting test

A seemingly harmless test, but an error in its readings can lead to thrombosis or severe bleeding, which is why it is important to properly prepare for donating blood.

To ensure the reliability of the result, doctors recommend adhering to the following conditions:

“Coagulogram No. 2 (prothrombin (according to Quick), INR, fibrinogen)”

A coagulogram is a study of the hemostatic system that allows you to evaluate the external and general pathways of blood coagulation and identify the risk of hypercoagulation (excessive clotting) or hypocoagulation (bleeding).

Synonyms Russian

Hemostasiogram: prothrombin index (PI), prothrombin time (PT); international normalized ratio (INR); factor I (first) of the plasma coagulation system.

English synonyms

Coagulation studies (coagulation profile, coag panel, coagulogram): Prothrombin time (Pro Time, PT, Prothrombin time ratio, P/C ratio); International Normalized Ratio (INR); Fibrinogen (FG, Factor I).

Units

% (percent), sec. (second), g/l (grams per liter).

What biomaterial can be used for research?

Venous blood.

How to properly prepare for research?

• Do not eat for 12 hours before the test.
• Avoid physical and emotional stress and do not smoke for 30 minutes before the test.

General information about the study

The hemostasis system consists of many biological substances and biochemical mechanisms that ensure the preservation of the liquid state of the blood and prevent and stop bleeding. It maintains the balance between blood clotting and anti-clotting factors. Significant disturbances in the compensatory mechanisms of hemostasis are manifested by processes of hypercoagulation (excessive thrombus formation) or hypocoagulation (bleeding), which can threaten the patient’s life.

When tissues and blood vessels are damaged, plasma components (clotting factors) participate in a cascade of biochemical reactions, which results in the formation of a fibrin clot. There are internal and external pathways of blood coagulation, which differ in the mechanisms that trigger coagulation. The internal pathway is realized when blood components come into contact with the collagen of the subendothelium of the vessel wall. This process requires coagulation factors XII, XI, IX and VII. The extrinsic pathway is triggered by tissue thromboplastin (factor III) released from damaged tissues and the vascular wall. Both mechanisms are closely interrelated and from the moment of formation of active factor X they have common paths of implementation.

The study of indicators such as PTI (prothrombin index) and INR (international normalized ratio) allows us to assess the state of the external coagulation pathway. PTI is calculated as the ratio of the standard prothrombin time (the clotting time of control plasma after the addition of tissue thromboplastin) to the plasma clotting time, expressed as a percentage. INR is a prothrombin test standardized in accordance with international recommendations. It is calculated by the formula: INR = (patient prothrombin time / control prothrombin time) x MICH, where MICH (international sensitivity index) is the sensitivity coefficient of thromboplastin relative to the international standard. INR and PI are inversely proportional indicators, that is, an increase in INR corresponds to a decrease in the patient’s PTI and vice versa.

Reference PTI values ​​depend on the set and characteristics of the reagents and differ in the activity of thromboplastin used in the test. The results of INR determination, thanks to standardization, make it possible to compare the results of different laboratories.

Tests for PTI (or a similar indicator - prothrombin according to Quick) and INR in a coagulogram help to identify disorders in the external and internal blood coagulation pathways associated with a deficiency or defect of fibrinogen (factor I), prothrombin (factor II), factors V (proaccelerin) , VII (proconvertin), X (Stewart-Prower factor). With a decrease in the concentration of these coagulation factors in the blood, the prothrombin time increases in relation to control laboratory parameters.

Plasma factors of the extrinsic coagulation pathway are synthesized in the liver. For the formation of prothrombin and some other coagulation factors, vitamin K is required, the deficiency of which leads to disturbances in the cascade of reactions and prevents the formation of a blood clot. This fact is used in the treatment of patients with an increased risk of thromboembolism and cardiovascular complications. Thanks to the prescription of the indirect anticoagulant warfarin, vitamin K-dependent protein synthesis is suppressed. PTI (or Quick prothrombin) and INR coagulation are used to monitor warfarin therapy in patients with factors that promote thrombosis (eg, deep vein thrombosis, presence of prosthetic valves, antiphospholipid syndrome).

Normally, a coagulogram in a healthy person has an INR in the range of 0.8-1.2; in patients being treated with indirect anticoagulants to prevent thromboembolic complications - 2.0-3.0, in patients with prosthetic valves and antiphospholipid syndrome - 2.5-3.5.

Simultaneous determination of fibrinogen in a coagulogram allows a comprehensive assessment of the state of the plasma hemostasis system.

Fibrinogen is blood clotting factor I, which is produced in the liver. Thanks to the action of the coagulation cascade and active plasma enzymes, it is converted into fibrin, which is involved in the formation of a blood clot and thrombus. Fibrinogen deficiency can be primary (due to genetic disorders) or secondary (due to excessive consumption in biochemical reactions), which is manifested by impaired formation of a stable blood clot and increased bleeding.

Fibrinogen is also an acute phase protein. Its concentration increases in the blood during diseases accompanied by tissue damage and inflammation. Determining the level of fibrinogen is important in the diagnosis of diseases with increased bleeding or thrombosis, as well as for assessing the synthetic function of the liver and the risk of cardiovascular diseases with complications.

What is the research used for?

• For a general assessment of the blood coagulation system.
• For the diagnosis of disorders of the external and general pathways of blood coagulation.
• To study the activity of coagulation factors I, II, V, VII, X.
• To monitor the patient's condition when prescribing anticoagulants.
• To assess the risk of cardiovascular complications.
• To assess the protein-synthesizing function of the liver (synthesis of blood clotting factors).

When is the study scheduled?

• With a comprehensive examination.
• When planning surgical interventions.
• When examining patients with nosebleeds, bleeding gums, blood in the stool or urine, hemorrhages under the skin and in large joints, chronic anemia, heavy menstrual flow, sudden loss of vision.
• When examining a patient with a history of episodes of thrombosis.
• With a hereditary predisposition to disorders of the hemostatic system.
• With a high risk of cardiovascular complications and thromboembolism.
• Before prescribing anticoagulants.
• When monitoring the hemostatic system while taking anticoagulants.
• For liver diseases.

What do the results mean?

Reference values ​​(table of normal coagulogram indicators)

• Prothrombin according to Quick: 70 - 120%.
• INR

• Fibrinogen: 1.8 - 3.5 g/l.

Reasons for an increase in INR and a decrease in the level of prothrombin according to Quick (indicates a possible deficiency of factors in the external hemostasis pathway and a tendency to increased bleeding):

• DIC syndrome (disseminated intravascular coagulation) during the period of hypocoagulation;
• hypofibrinogenemia (factor I deficiency);
• dysfibrinogenemia (synthesis of a defective protein that is unable to participate in the cascade of biochemical reactions);
• hereditary or acquired deficiency of factors II, V, VII;
• Factor X deficiency (eg, purpura due to amyloidosis);
• vitamin K deficiency;
• hemorrhagic disease of newborns;
• malabsorption with impaired fat absorption (due to celiac disease, chronic diarrhea);
• acute leukemia;
• antiphospholipid syndrome;
• congestive heart failure;
• liver pathology (hepatitis, cirrhosis, alcoholic liver disease);
• obstruction of the biliary tract, obstructive jaundice;
• pancreas cancer;
• Zollinger-Ellison syndrome (pancreatic adenoma);
• toxic shock syndrome;
• nephrotic syndrome (excessive urinary excretion of factors V and VII);
• oral anticoagulants (warfarin).

Causes of increased fibrinogen levels (indicates an increased risk of blood clots and cardiovascular complications):

• acute infection (eg pneumonia, tuberculosis);
• autoimmune diseases (rheumatoid arthritis, reactive arthritis);
• acute coronary syndrome, myocardial infarction;
• burns;
• cancer (breast, kidney, stomach);
• multiple myeloma;
• Hodgkin's disease (lymphogranulomatosis);
• glomerulonephritis, nephrotic syndrome, nephrosis;
• pregnancy;
• eclampsia;
• cerebrovascular disease, stroke;
• hepatitis;
• postoperative period;
• rheumatic fever;
• tissue damage.

Reasons for a decrease in INR and an increase in prothrombin according to Quick (indicates a tendency to form blood clots):

• DIC syndrome (period of hypercoagulation);
• deep vein thrombosis (initial stages);
• polycythemia;
• pregnancy (last months);
• increased activity of factor VII.

Reasons for decreased fibrinogen levels (may indicate an increased risk of bleeding):

• dysfibrinogenemia;
• hereditary afibrinogenemia;
• DIC syndrome;
• fibrinolysis;
• hemophilia A and B;
• liver pathology (hepatitis, cirrhosis);
• abortion;
• premature placental abruption;
• late stage of cancer;
• embolism (amniotic fluid, meconium, fat, tissue);
• anemia;
• eclampsia;
• leukemia;
• malabsorption;
• shock;
• sepsis;
• post-transfusion reactions.

What can influence the result?

• Factors that distort the result of the analysis: the presence of lupus anticoagulant in the blood (directly inhibits coagulation factors);
• transfusion of donor blood components in the last month (distorts the fibrinogen indicator).


Important Notes

• Before prescribing anticoagulants, it is necessary to determine the initial PI and INR values. A PTI of less than 25% and an INR of more than 3.5 in patients taking anticoagulants are critical and require immediate medical attention. With an INR above 5.0 there is a high risk of bleeding, and with an INR below 0.5 there is a risk of blood clots.
• If fibrinogen decreases to a level of less than 1 g/l, urgent consultation with a specialist is necessary due to the high risk of bleeding.

Also recommended

• D-dimer
• Activated partial thromboplastin time (aPTT)
• Antithrombin III
• Thrombin time
• Vitamin K (phylloquinone)
• Complete blood count (without leukocyte formula and ESR)
• Erythrocyte sedimentation rate (ESR)
• Predisposition to increased blood clotting
• Genetic risk of thromboembolism
• Genetic risk of thromboembolism (advanced)

Who orders the study?

Cardiologist, surgeon, hematologist, hepatologist, therapist, obstetrician-gynecologist.

Literature

• Nazarenko G.I., Kishkun A. Clinical assessment of laboratory research results. – M.: Medicine, 2000. – 249-262.
• Fischbach FT, Dunning MB A Manual of Laboratory and Diagnostic Tests, 8th Ed. Lippincott Williams & Wilkins, 2008: 1344 p.
• Wilson D. McGraw-Hill Manual of Laboratory and Diagnostic Tests 1st Ed. Normal, Illinois, 2007: 666 p.

The importance of a blood test for clotting during pregnancy

During pregnancy, a restructuring of a woman's blood circulation occurs, which requires additional blood volume for the pregnant child. To monitor the proper development of pregnancy, women are prescribed a coagulogram every trimester. A blood clotting test helps prevent the following complications during pregnancy:

Sign up for a coagulogram

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Fibrinogen

This specific protein produced by the human liver is considered the first plasma coagulation factor. A fibrin clot, formed as a result of a series of chemical reactions, is the main component of a blood clot.

Normally, the protein concentration should be in the range of 5.9-11.7 µmol/l, which corresponds to 2-3.5 g/l. However, with liver diseases, its production decreases. Low protein levels can be caused by hereditary factors.

Protein concentration increases sharply during acute infectious diseases or inflammatory processes (pneumonia, pyelonephritis, peritonitis), with a deficiency of thyroid hormones and in the presence of malignant neoplasms. Against the background of increased coagulability, there is a risk of developing complications in the cardiovascular system.

The value of the coagulogram increases significantly during pregnancy, but this is normal, since in this way the body prepares for future blood loss. However, this indicator must be monitored once every three months throughout the entire period of gestation. Fluctuations in the direction of increasing fibrinogen concentrations in women during menstruation have been noted. In young children, normal protein coagulogram values ​​are significantly lower than in adults and amount to 1.25-3 g/l.

Where can I get tested for blood clotting speed in Moscow?

At a multidisciplinary medical center, you can always undergo a blood clotting rate test (Coagulogram)

. Our medical center is located between the Konkovo ​​and Belyaevo metro stations (South-Western Administrative District of Moscow in the area of ​​the Belyaevo, Konkovo, Teply Stan, Chertanovo, Yasenevo, Sevastopolskaya, New Cheryomushki metro stations " and "Trade Union"). Here you will find highly qualified personnel and the most modern diagnostic equipment. Our clients will be pleasantly surprised by our quite affordable prices.

What is the normal blood coagulogram in children?

In order to understand what a coagulogram is and why it is necessary to undergo it, you should study several concepts:

1. Blood clotting is the ability of blood, when damaged and the integrity of blood vessels is damaged, to form a clot to close the site of damage and stop bleeding.
2. Hemostasis is a system of the child’s body, the main function of which is to ensure blood clotting.
3. Coagulogram is a blood test showing the functioning of hemostasis in a child.

This test must be taken for children before any surgical intervention, even the most minor one. A coagulogram performed before surgery will help avoid possible severe bleeding.

There are cases when surgical intervention is impossible due to increased blood clotting, which increases the risk of blood clot formation.

A coagulogram is often used to determine the diagnosis of suspected hemophilia in children.

Additional research

Coagulogram tests are taken:

1. Lupus anticoagulant is a very important indicator. Determines the amount of enzyme involved in hemostasis. Designed to neutralize the work of phospholipids. It cannot be in the blood of a healthy child. The presence of this enzyme may indicate diseases such as ulcerative colitis, cancer, etc. Taking any medications can also affect a positive test result.
2. Prothrombin shows the time it takes for thrombin to be formed from prothrombin in the second stage of blood coagulation. It is expressed as a percentage of this time in the blood of a sick child to the clotting time of control plasma.

Norms of coagulogram results in children

Key figures:

1. The clotting time for a child in full health is 4-9 minutes.
2. Thrombin time. The result should be equal to 30 minutes with an error of 3 minutes.
3. Prothrombin index - the norm is 70-100%.
4. Fibrinolytic activity. The result should be 180-260 seconds for a healthy child.
5. Activated partial thromboplastin time. The number can vary from 24 to 35 seconds.
6. Fibrinogen concentration in blood plasma. The test result for a healthy child should be 1.25-4 g/l.
7. Thrombotest - IV-V stage.
8. AVR or Activated recalcification time - the time indicator should correspond to 50 -70 seconds.
9. Soluble fibrin-monomer complexes - the level of this substance in the blood of a healthy child should not be 4 mg\100 ml.
10. Plasma tolerance to heparin should normally be 3-11 minutes.
11. Fibrinogen - 5.9-11.7 µmol/l.
12. Duke bleeding time. The indicator in healthy children is up to 4 minutes.
13. The normal time for plasma recalcification is 90-120 seconds.
14. Blood clot retraction - 30-40%.
15. Prothrombin - the norm is 78-142%.
16. Lupus anticoagulant - negative.

Cost of blood coagulation analysis in children

Currently, a very large number of clinics provide coagulogram testing services. Such an analysis is carried out in any hospital located near your home, which has the necessary equipment and reagents for the analysis.

The cost of a basic coagulogram package varies in Moscow from 700 to 1300 rubles. It is possible to conduct an advanced analysis, which examines additional indicators of the blood coagulation system.

In this case, the cost of a coagulogram will increase to 3,500 rubles.

Donating blood for a coagulogram in children is most often prescribed in the following cases:

1. Before surgery. Timely identified pathologies in the blood clotting system can eliminate problems with bleeding and blood loss and even save the life of a small patient.
2. If your child bleeds frequently. This could be nosebleeds or bleeding from wounds that cannot be stopped for a long time.
3. If you suspect hemophilia or other similar diseases associated with blood clotting disorders.

Do not forget that only a doctor should decipher the analysis. When deciphering the result, the specialist not only checks the obtained indicators with the norm, but also takes into account a number of associated factors. The results obtained as a result of a coagulogram will help identify autoimmune, inflammatory and vascular diseases.