What are normal aPT values ​​in a blood test? Achtv - what is it in a blood test. normal indicators, reasons for increased or decreased aphtv

Activated partial thromboplastin time is considered the basic indicator of a coagulogram, which is aimed at assessing the effectiveness of internal path coagulability. This INR value is considered important for screening the hemostatic system and may be called APTT (activated partial thromboplastin time).

What is APTT in a biochemical blood test?

Medical research for the study of hemostasis is given important APTT in biochemical analysis blood. Using this indicator, you can determine the correctness of coagulation processes, the level of fibrinolysis, assess the severity of the disease, and select the right treatment. If a surgeon performs an abdominal or endoscopic operation, then it almost always has risks of complications - thrombosis, bleeding. To reduce them, the activated partial thromboplastin time is determined.

APTT - not everyone knows what it is, but this value can be found under other names - APTT or cephalin-kaolin time. The study is carried out in conjunction with the determination of PTT (prothrombin time), which differs by determining the external pathway of activation rather than the internal one. According to these indications, the deficiency of blood clotting factors is assessed.

APTT analysis is prescribed in the following cases:

• for diagnosing hemostasis disorders;
• during pregnancy, diagnosis of infertility;
• at risk of bleeding, thromboembolism;
• preoperative examination;
• pathology of coagulation (decrease, increase);
• calculation of the dose of heparins for screening treatment;
• diagnosis of DIC syndrome, hemophilia, APS, when phospholipids are disturbed.

Blood test for APTT

Many specialists prescribe a coagulogram or APTT blood test to check the functioning of coagulation, reverse process and the level of fibrinolysis. The determination is made in the morning on an empty stomach; the day before, you should avoid drinking alcohol. fatty foods, taking medications that affect coagulation. The doctor takes a blood sample from a vein and sends it to be tested for drug interactions. special reagents.

APTT blood test - interpretation

After receiving the taken material, the APTT is deciphered, a time indicator in seconds is obtained, which is compared with the norm. To do this, plasma is obtained from the sample, platelets are removed from it and it is exposed to the activator kaolin, cephalin and calcium chloride. Your doctor will tell you what APTT is in a blood test. If the level is low, then hypercoagulation is observed. With an increased level and hypocoagulation, an extension of the duration of clot formation is observed, which can affect the course of certain diseases and the formation of pathologies.

APTT is normal in the blood

The APTT rate in the blood depends on the content of plasma factors. It shows the time course of blood clot formation in seconds. Various sources and doctors can consider normal readings differently, each of them has its own reference parameters for coagulograms. Most adhere to the normal indicator of 24-35 seconds, it is possible to lower it when the reading is up to 19 seconds, and increase it - over 40.

APTT is higher than normal - what does this mean?

When a coagulation study reveals an increase in aPTT, it is worth studying this in detail. High concentration points to increased sensitivity to the drug and requires dose adjustment. If you increase the activated partial thromboplastin time, you can talk about:

• deficiency of coagulation factors;
• hemophilia;
• treatment with intravenous heparin;
• vitamin K deficiency;
• DIC and antiphospholipid syndromes.

Causes of risk of bleeding may increase the rate. If violations were noticed during the storage of the sample, its contamination or an insufficient amount of material was taken, then the activated partial thromboplastin time is also increased. A technical error that contributes to the increase is the incorrectly selected amount of anticoagulating reagent in the test tube.

APTT below normal - what does this mean?

On increased risk The pathology of thrombosis or thromboembolism is influenced by the factor if the aPTT is reduced according to the results of the study. The activated partial thromboplastin time can be reduced by:

• pregnancy, reception oral contraceptives;
• error during venipuncture – tissue injury;
• first stage of DIC syndrome;
• intestinal infarction, myocardial infarction, renal infarction, thromboembolism pulmonary artery;
• thrombosis in the legs, blood vessels of the placenta.

APTT during pregnancy

APTT is prescribed by doctors every three months during pregnancy to prevent complications from developing. If a woman’s hemostasis system fails while expecting a baby, it represents a threat to the child’s life. Pregnant women have an increased amount of fibrinogen and a shortened time of 14-18 seconds. If the reading is lowered, there is a risk of thrombosis in the placenta, which leads to its abruption. Increased time threatens uterine bleeding, life-threatening fetus and mother.

Video: APTT hemostasis

Every qualified doctor knows that it is best to begin the treatment of any patient by collecting an anamnesis, which is nothing more than a collection of information about the state of a person’s health.

As a rule, any medical examination begins with asking the patient himself about previous diseases or surgical interventions, allergic reactions or hereditary predisposition to certain ailments and so on.

Then the doctor prescribes a series of laboratory tests or simply tests that will help supplement the anamnesis with information about the development of the disease, as well as information necessary for choosing a treatment method or further diagnosis.

(abbreviated coagulogram ) occupy an important place among laboratory blood tests, which are necessarily carried out in preparation for surgical intervention, for example, during planned or during pregnancy .

Coagulogram - what is it?

Many patients needlessly begin to worry when they hear from their attending physician such unusual at first glance words as coagulogram or else hemostasiogram . So what kind of coagulogram analysis is this and why is it taken?

First of all, it is worth noting that this is quite common in modern medicine work study method hemostasis systems human body, which is responsible for such important vital functions as: stopping bleeding in case of injury blood clots or vessels , as well as maintaining the normal fluid state of the blood.

Hence the answer to the question of what it is hemostasiogram – a study that determines how well the body’s hemostasis system functions. A blood test for a coagulogram helps to study such important function blood, as the ability to clot, i.e. formation of a blood clot.

Having received the results coagulology , the attending physician can predict in advance the outcome of surgery or childbirth. Knowledge of blood clotting is vital in emergency situations, for example, when a person is injured, when seconds are counting and you need to stop it as quickly as possible.

Therefore, you hardly need to worry too much about how much it costs. this study. After all, the price of a hemostasiogram cannot be compared with the confidence that the patient will be alive and healthy.

Indications for prescribing such an analysis as a hemostasiogram are the presence of the following diseases in the patient:

• vascular thrombosis And lower extremities;
• cirrhosis chronic form;
• gestosis;
• inflammatory processes in the acute stage;
• hemorrhagic pathologies, for example, thrombocytopenia, hemophilia or von Willebrand disease.

In addition, such an analysis is necessarily prescribed to determine the rate of blood clotting in preparation for planned operations, for example, caesarean section, as well as during pregnancy to assess the state of hemostasis and before independent childbirth . Every woman in labor must have a blood test such as a coagulogram in her exchange card.

Human hemostasis system

Having determined what a hemostasis test is, it is worth understanding in more detail such a concept as blood clotting . Perhaps we should start with a definition. So, the hemostasis system of the human body is the most important biological system, the main functions of which can be considered to be the preservation of basic blood parameters, as well as stopping bleeding.

It is not for nothing that the human body is called the whole universe and is compared with complex mechanism. And the hemostasis system can serve just a shining example of how brilliantly people are made. Blood is a unique biological fluid that can literally work miracles in our body.

It not only circulates through the vessels, but also restores veins And arteries throughout his life thanks to his ability to form blood clots or dense clots, i.e. roll.

There are three main components of the human hemostasis system:

• Vascular cells endothelium (inner layer consisting of flat cells lining the lymphatic and blood vessels, as well as the cavities of the heart), which, when ruptured vascular walls or other damage are capable of releasing such biological active ingredients How prostacyclin, thrombomodulin And Nitric oxide . They, in turn, trigger the process of blood clot formation.
• Platelets or blood platelets, having the ability to “stick together” with each other in order to subsequently form a primary hemostatic plug .
• Plasma factors (15 plasma factors in total, most are enzymes ), forming due to chemical reactions fibrin clot , which should finally stop the bleeding.

Summarizing all of the above, we can clearly answer the question of what a blood test for hemostasis shows during pregnancy, in preparation for elective surgery or during diagnostics. This analysis gives an idea of ​​how well or poorly the patient's blood is clotting. In other words, how quickly doctors can stop bleeding when it occurs.

Interpretation of blood coagulogram

The blood test for a coagulogram includes many different indicators that you need to be able to read correctly, i.e. understand and analyze, in other words, decipher. Unfortunately, not every doctor has the skills to decipher hemostasiogram indicators. And only a highly qualified specialist can correctly interpret certain parameters of this analysis.

After conducting laboratory tests of the patient’s blood and receiving the results, the attending physician compares the decoding of the coagulogram with the norm established for adult patients, as well as children. It is important to remember that the normal coagulogram for a child, man or pregnant woman is very different. This is due, first of all, to the peculiarities of the functioning of the body of people of different sexes in different age categories.

Coagulogram indicators

Let's consider the parameters of the blood clotting test, namely normal indicators hemostasiograms. Then we will dwell on each of them in more detail, and also talk about an extended or expanded coagulogram.

It is worth noting that the table below shows several options for normal indicators of such hemostasiogram parameters as bleeding time And blood clotting time . This is due to different interpretations of the norm for these parameters by specialists involved in their study.

Indicator name (abbreviated name)	Standard value of the indicator
Blood clotting time: norm according to Mass and Margot; Lee-White norm.	from 8 to 12 minutes; from 5 to 10 minutes.
Bleeding time: norm according to Shitikova; Duke norm; Ivy norm.	no more than 4 minutes; from 2 to 4 minutes; no more than 8 minutes.
International Normalized Ratio (INR or INR)	0,82-1,18
Thrombin time (TV)	14-21 seconds
Prothrombin index (PTI)	73-122 %
Activated Recalcification Time (ATR)	81-127 seconds
D-dimer	250.10-500.55 ng/ml*
Prothrombin time (PT) according to Quincke	11-15 seconds
Antithrombin III (AT III)	75,8-125,6 %
Activated Partial Thromboplastin Time (APTT)	22.5-35.5 seconds
Fibrinogen	2.7-4.013 grams
Soluble fibrin-monomer complexes (SFMC)	0.355-0.479 units*

*International unit (IU) or Unit of action (AU) , i.e. a measure of measuring the dose of a substance based on its biological activity.

*Nanogram per milliliter Source: Wikipedia

Clotting time

This laboratory test of the patient's blood gives the doctor an idea of ​​the time it takes for the body to form a blood clot. There is no shorthand symbol for this parameter in the analysis. During the research, biological material (blood) taken from a patient’s vein is placed in a sterile and dry tube, and then the time is noted and they wait until a visible blood clot forms.

When the blood clotting time is normal, the doctor can conclude that proper operation hemostasis system, and also exclude some pathological conditions, for example, hemophilia or DIC syndrome , in which a blood clot does not form at all. If the blood clotting time deviates from the norm (increase or decrease in indicators), you should understand the reasons in more detail.

For example, prolongation of bleeding time may occur with hemophilia, red systemic lupus or when rheumatoid arthritis , and also when peritonitis , for chronic liver pathologies , at pneumonia and availability malignant tumor. A shortened bleeding time may be a signal of development or hemorrhagic shock , and myxedema.

In addition, all coagulogram indicators, including this one, may deviate from the norm during pregnancy. Women, as a rule, first learn about the name of a blood clotting test during pregnancy, when they are required to undergo many laboratory tests in order to monitor and promptly influence the health of the mother and unborn child.

The changes that rapidly occur in the body of a pregnant woman do not leave their mark on the properties and characteristics of the blood. It is noteworthy that there is a gradual decrease in blood clotting time starting from the first trimester, and in the third trimester this indicator can differ greatly from the norm. However, do not be afraid, since this is just one of the protective mechanisms that helps prepare the female body for childbirth and reduce possible blood loss.

Bleeding time

In accordance with the standards, the duration of bleeding should not be less than or more than a few minutes from the moment of puncture, the so-called primary hemostasis. To complete the process, i.e. The formation of a blood clot should take an average of 10 minutes maximum. Blood clotting time is a very important indicator that plays a big role when preparing a patient for surgery, for example, during a cesarean section.

The norm of blood clotting in women does not differ from the standards established for adults. The rate of blood clotting in children depends on the age of the child. On average, the duration of bleeding should not exceed 2-4 minutes, and a blood clot should form within 2-5 minutes.

Bleeding time may be increased if:

• hemophilia;
• thrombocytopenia , i.e. with a lack of platelets in the blood;
• hemorrhagic fever , for example, when Ebola or Crimea-Congo;
• liver damage alcohol (intoxication);
• thrombocytopathy;
• drug overdose.

How to take a blood clotting test?

In order for the doctor to receive undistorted information after laboratory tests, one should take the correct approach to taking any tests, including blood clotting tests. Biological material taken in the morning, always on an empty stomach. It should be remembered that at least 8, and preferably 12, hours must have passed since the last meal.

In addition, you should refrain from taking alcoholic beverages and medications on the eve of the study, as this may affect the test result. If the patient is forced to take any medications, he must remember to inform the medical professional about this.

Prothrombin time

What is prothrombin time? This is one of the main laboratory indicators of a coagulogram used by doctors to assess the hemostatic system of the human body as a whole, as well as to determine the effectiveness medicines, preventing blood clotting.

PT reflects phases 1 and 2 of plasma coagulation. In other words, the time of formation of a thrombin clot in the blood when thromboplastin and calcium are added. For this parameter, the abbreviated designation PV is accepted; sometimes PVT is also used. Blood clotting test parameters such as: international normalized ratio (INR) And prothrombin index(PTI) are derived from prothrombin time, the norm of which varies depending on the age and gender of the patient.

For example, the normal thrombin time in women and men is 11-15 seconds. Standards are established for children depending on their age. For example, for newborns - 13-17 seconds or 14-19 seconds for premature babies. For an older child (from 10 years old) the norm is 12-16 seconds, and for a younger child – 13-16 seconds.

Thrombin time is higher than normal - what does this mean? Deviation from standard indicators, set for this coagulogram parameter, can mean the following:

• flaw vitamin K in organism;
• low concentration or lack of clotting factors 1,2,5,7, and also 10;
• violation in normal functioning liver, liver failure or other diseases of this organ;
• Availability DIC syndrome .

Prothrombin time is increased, what does this mean? As a rule, exceeding the PT indicator is associated with the patient taking medications belonging to the group of anticoagulants, i.e. drugs with anticoagulant properties, for example , Kumadinilin or .

International Normalized Ratio

Prothrombin ratio (abbreviated PTI) or INR in a blood test, what is it? Let's start with a little background. Such a parameter as INR in a hemostasiogram appeared in 1983, when the World Health Organization (hereinafter referred to as WHO) decided to streamline the work of research laboratories and bring all indicators of blood clotting tests to a single standard understandable to doctors all over the world.

Previously, each laboratory could use different thromboplastin reagents , which could distort the final research results. This coagulogram parameter is abbreviated as INR or INR. In domestic medicine, you can currently still find instead of INR such an indicator as the prothrombin index, which reflects how well the patient’s blood clots.

However, due to various techniques When determining this parameter, it is considered unstable and therefore it is customary to use INR abroad. In a blood test for PTI and INR, the norm is set at the level:

• PTI - 70-100, and for patients taking Warfarin – 24,0-42,6;
• INR – 0.82-1.18.

So what is INR in a blood test? This is an indicator that is nothing more than the ratio of the PT of the patient’s analysis and the PT of the control sample. INR norm in human blood analysis according to international standards can range from 0.82 to 1.18.

If there is a deviation from the above values, the patient may be diagnosed with the following diseases:

• with elevated PT and INR levels: chronic , deficit vitamin K, , amyloidosis, DIC syndrome, reduced level fibrinogen, nephrotic syndrome, clotting factor deficiency (2.5, 7 and 10);
• at reduced rates PT and INR: vascular thromboembolism , increased activity of factor 7, thrombosis or activation fibrinolysis.

In addition, an increase in INR and PT may indicate the presence of anticoagulant drugs in the patient’s blood. Therefore, the INR norm when taking Warfarin differs from established standards. For patients taking this drug and drugs similar in action to it, use the following range of normal INR values ​​- 2.0-3.0.

The INR norm in the blood of women usually does not differ from the general values. But during pregnancy, the female body changes so much that the INR norm during pregnancy may not coincide with the above numbers.

Activated partial thrombin time

Blood test for APTT - what it is? This is another analysis indicator that provides information about the effectiveness of plasma factors designed to quickly stop bleeding. This parameter is abbreviated as APTT.

APTT blood test - What is this? The parameter is often called activated partial thromboplastin time. APTT, like APTT, provides information about the rate of formation of a fibrin clot and best characterizes the internal process of hemostasis. It is believed that the APTT indicator is the most accurate, but at the same time the most sensitive, because may vary depending on the reagents used in laboratory tests.

The general norm of aPTT in human blood is set at 22.5-35.5 seconds. The APTT rate in women also corresponds to the above values. However, as is the case with other coagulogram parameters, the APTT rate during pregnancy does not always correspond to the general rules. Let us consider the reasons for the deviation of this indicator from the norm.

When the above reasons are excluded, and the aPTT is higher than normal, this means that the patient may have diseases such as:

• fibrinolysis;
• acquired or possibly congenital clotting factor deficiency (8, 9, 11, 10, 12, 2 and 5);
• DIC syndrome (2 or 3 stages);
• autoimmune pathologies (usually systemic lupus erythematosus );
• liver diseases.

When APTT is low, what does it mean? If the value is below normal, this indicates that the blood's ability to clot is reduced. The main reasons for this condition may be:

• DIC syndrome 1st degree;
• increased coagulability;
• an error during laboratory testing, for example, incorrect blood sampling.

Soluble fibrin-monomer complexes

Abbreviated in a coagulogram as RFMK. RFMK analysis, what is it? Let's start with a definition fibrin-monomer complexes - these are products of the breakdown of a blood clot in the process fibrinolysis . According to researchers, this indicator is quite difficult to reliably determine, since soluble fibrin-monomer complexes are very quickly removed from the blood.

Such a parameter as RFMC plays an important role in diagnosis DIC syndrome (full name: disseminated intravascular coagulation syndrome). The norm of RFMK in human blood is 0.355-0.479 units. However, during pregnancy, RFMC norms may differ significantly from the above indicated level. Because the female body is actively preparing for upcoming birth, along with it, the main parameters of the blood change, including its ability to clot.

This is a kind of defense mechanism that helps minimize the risk of bleeding. Counts normal deviations RFMK level during pregnancy is up to 5.1 ml. per 100 ml. blood. If RFMK is elevated, what do these analysis results mean?

When RFMK is increased in a patient’s coagulogram, the reasons may be as follows:

• thromboembolism deep veins of the extremities or pulmonary artery;
• sepsis;
• or preeclampsia during pregnancy;
• connective tissue pathologies;
• renal failure in the chronic or acute stage.

An increase in this indicator is often found in patients who have recently undergone surgical interventions. Therefore, in postoperative period analysis for RFMC may deviate from the norm.

Activated recalcification time

Abbreviated as ABP in the analysis, it denotes the time required for the formation of fibrin in blood plasma saturated with platelets and calcium. This parameter is also used to evaluate the blood coagulation system as a whole. AVR reflects the interaction of cellular and plasma components of hemostasis.

It is noteworthy that the value of this parameter may vary depending on the reagents used in laboratory studies. As a rule, a shortened recalcification time indicates the patient’s body’s tendency to form blood clots, and an extended one indicates hemophilia, as well as a decrease in the number of platelets and a change in their basic characteristics.

Prothrombin index. Norm for women

The abbreviated name for this parameter in the analysis is PTI. Blood test for PTI - what is it? Prothrombin index – this is the ratio of the established ideal prothrombin time value to the prothrombin time indicator in the patient’s analysis multiplied by 100%.

It is noteworthy that this indicator is currently almost never used, since WHO recommends the use of such a parameter, which is more resistant to laboratory tests, such as INR. The normal level of PTI in the blood for a healthy person is set at 73-122%.

By general rule the rate of IPT in women should not differ from the above values, with the exception of the period of pregnancy, when blood clotting increases. Therefore, if a woman’s coagulogram deviates from the norm, she should consult a doctor for advice. This parameter increases, as a rule, if the human body lacks vitamin K, and there is also a deficiency of blood clotting factors.

In addition, an increase in PTI is due to treatment with anticoagulants such as , Warfarin or Neodicoumarin , as well as when receiving Heparin and its analogues. PTI decreases with liver damage, for example, with cirrhosis and hepatitis, with vascular thrombosis and during pregnancy.

Norm of prothrombin for women in the blood

In the hemostasis system, 15 coagulation factors play a fundamental role, i.e. substances that characterize the correctness of its operation. One of the most important factors counts prothrombin or factor II, also known as thrombogen . This is a protein that is a precursor to thrombin, which in turn is responsible for the coagulation function of the blood - it stimulates the formation of a thrombus (blood clot).

The level of prothrombin in the blood is determined using the following tests:

• PV according to Kwik – the norm for women is 78-142%;
• INR or INR – the norm for women is 0.85-1.15.

If the level of factor II is higher than normal, then blood circulation is hampered due to the fact that the blood becomes viscous, as a result, the blood vessels become clogged. In this condition, the patient’s body is more at risk than ever before. strokes and heart attacks , and also significantly increases the risk of developing malignant tumors or thromboembolism .

In case the level thrombogen is reduced, the formation of a blood clot occurs abnormally slowly, which is fraught with significant blood loss if bleeding develops. As a rule, the causes of such a failure in the hemostatic system are: lack of vitamin K in the body or other congenital and acquired factors.

Thrombin time

Abbreviated name – TV. This parameter characterizes the final stage of hemostasis and determines the length of time required for clot formation fibrin when added to blood plasma thrombin . TV control is always carried out in combination with PT and APTT for the most effective diagnosis congenital fibrinogen pathologies, as well as to assess the effectiveness of fibrinolytic and heparin therapy.

Fibrinogen

What is a fibrinogen blood test? The first clotting factor or fibrinogen - this is nothing more than a protein formed under the influence Hageman factor in the liver, and subsequently under its influence transforms into insoluble fibrin . The presence of fibrinogen is determined by performing a thrombotest.

Thrombotest grades 4 and 5 are considered normal. It is worth noting that since fibrinogen (protein acute phase), its level increases in the blood during stress, injury or infection. As a general rule, the level of fibrinogen in the blood should be between 2.7 and 4.013 grams. The level of fibrinogen in women's blood should not be lower or higher than the specified values, except during pregnancy.

The blood parameters of a pregnant woman undergo changes, as does her entire body as a whole. Many protective systems are launched, including the hemostasis system in preparation for the upcoming delivery. Often, already in the first trimester, fibrinogen levels may be slightly higher or lower than normal. For this period of pregnancy, indicators are set from 2.3 to 5 g/l.

When the level of this protein increases, the blood becomes denser and thicker. Because of this, the process of thrombus formation begins, which harms the child, because he will suffer from an acute lack of oxygen and, as a result, from a deficiency of important micro- and macroelements, as well as vitamins. During pregnancy in the second trimester, the fibrinogen level should be within the normal range of 2.4-5.1 g/l, and in the third trimester – up to 6.2 g/l.

Elevated levels of fibrinogen are also observed with:

• burn disease;
• menses;
• rheumatoid;
• amyloidosis;
• pneumonia;
• pyelonephritis;
• systemic scleroderma;
• peritonitis.

In addition, protein levels are affected by drugs such as Heparin and oral contraceptives.

A low level of fibrinogen indicates that the patient has diseases such as:

• DIC syndrome;
• prostate cancer;
• cirrhosis of the liver and other organ pathologies;

Fibrinogen levels may decrease during poisoning Heparin , as well as when the patient receives anabolic steroids, androgens, And barbiturates .

Antithrombin III

This physiological anticoagulant in its structure belongs to glycoproteins , i.e. substances capable of inhibiting coagulation factors 9, 10 and 12 and thrombin. It is synthesized in liver cells. Standard indicators for this coagulogram parameter vary depending on the patient’s age.

For adults, the normal rate will be 75-125%, for newborn children - 40-80%, for children from 10 to 16 years old - 80-120%, and under 10 years old - 60-100%. If antithrombin 3 is low, what does this mean? A decrease in the level of this anticoagulant may be associated with the presence of such diseases in the patient as DIC syndrome, sepsis, ischemia, liver cirrhosis, thromboembolism or thrombosis.

In addition, antithrombin III may decrease in the last trimester of pregnancy and when the patient takes Heparin or fibrin inhibitors. When antithrombin 3 is elevated, inflammatory pathologies may be the cause, e.g. peritonitis, pyelonephritis And pneumonia, as well as hepatitis and deficiency vitamin K.

D-dimer

Another indicator of an extended coagulogram, with the help of which the doctor analyzes not only blood clotting, but also the anticoagulant system of the human body. D-dimer - these are split fibrin strands. Only an increased result of this parameter is significant, which indicates the development of liver diseases in the patient’s body, DIC syndrome, thrombosis, ischemia, arthritis, myocardial infarction.

In addition, an increase in D-dimer is a sign of heavy smokers.

What is a coagulogram during pregnancy? This is the same coagulogram that is necessarily prescribed to women during pregnancy, as well as immediately before preparing for childbirth.

During pregnancy, the norm for all indicators of the blood clotting test does not correspond generally accepted meanings for the body of a healthy adult.

This is due, first of all, to the fact that the hemostasis system of a pregnant woman undergoes serious changes, as does her entire body as a whole due to the appearance of another circle of blood circulation - uteroplacental. An important role is also played by the hormonal background, which is dominated by .

It is noteworthy that during pregnancy the activity of blood clotting factors such as 7,8 and 10, as well as fibrinogen, increases significantly. This is a kind of natural protective mechanism designed to help increase the chances of a favorable birth outcome.

Fibrin fragments are deposited on the walls of blood vessels and thus the fibrinolysis system is suppressed. This allows the female body to be safe in case of placental abruption or miscarriage, with uterine bleeding and during the formation of intravascular thrombi.

Decoding coagulogram indicators during pregnancy

We talked about what a coagulogram is and why this test is taken. Now let’s figure out how to properly undergo a hemostasiogram so that, based on the results obtained, the doctor can make the right conclusion and choose an effective treatment plan.

So, if you need to do a blood clotting test, then remember the following rules:

A standard hemostasiogram can be done in most public clinics, and an expanded or detailed analysis is more often available in paid medical institutions. For example, in the Invitro laboratory, a coagulogram can be done quite quickly. As a rule, the test result can be collected within a couple of days. This is due to the need for a number of chemical reactions that require a certain amount of time, which simply cannot be avoided.

However, in any case, the result paid analysis you will receive it in your hands much faster than in government agency, where the laboratory is heavily loaded due to the influx of patients or may not have available certain reagents necessary for research. The cost of the analysis depends on the number of parameters that need to be studied and varies from 1000 to 3000 rubles.

APTT is a test that shows blood clotting inside blood vessels. When the blood stops due to trauma skin, this is one coagulation system. And when the blood forms clots inside the vessels, this is a different coagulation system in which platelets practically do not participate.

Normally, the APTT result should range from 25 to 39 seconds, but the result is assessed individually for each patient.

What to consider when interpreting the APTT result:

2. Age.

3. Concomitant diagnoses and the degree of their development, stage.

4. Medicines used, their compatibility and duration of use.

5. In some cases, race is taken into account, since in last years There have been many studies showing that even the most common diseases among people occur differently in patients of different races.

Mechanism for performing APTT analysis

The test is based on the availability of reagents and the patient’s blood. Executing the test itself is simple:

1. 5-10 ml of blood is taken from a patient’s vein using a syringe.

2. The blood is poured into a test tube with sodium citrate, which binds calcium ions. The absence of calcium ions contributes to blood incoagulability and preparation of the sample for the test itself.

3. The blood is sent for centrifugation, resulting in plasma, which contains a small number of platelets.

4. To activate the mechanism of internal blood coagulation, kaolin or another reagent is added to the resulting plasma.

6. A calcium chloride solution is added to enrich the blood with calcium ions and neutralize the effect of sodium citrate.

7. After carrying out all the manipulations, we note the time of formation of a blood clot.

Indications for prescribing analysis

Activated partial thromboplastin time analysis is prescribed in the following cases:

1. The presence of bleeding, hematomas and other changes in the integrity of blood vessels for no apparent reason (impact, cut, autoimmune and hereditary diseases).

2. Constant reception medicines that affect blood clotting mechanisms (Heparin, Warfarin, etc.).

3. Comprehensive assessment of blood clotting in preparation for planned surgery.

4. Assessment of the degree of manifestation of hereditary and other diseases that affect the blood system (pathology bone marrow, B12 deficiency anemia, vitamin K deficiency and others).

5. Detection of pathology in the gastrointestinal tract.

Evaluation of APTT results

In children and adults, the clot formation time during aPTT analysis normally ranges from 25 to 39 seconds.

An analysis result that is higher than normal (more than 39 seconds) only indicates that the blood is clotting too slowly. This may lead to internal bleeding, prolonged external bleeding, a large number of hematomas, etc.

If the APTT result is higher than normal in adults:

1. It is necessary to check which medications a person takes constantly or rarely, since the combined effects of most medications can affect the homeostasis of the blood system.

2. Analyze availability chronic diseases and the degree of their expression.

3. If the patient uses anticoagulants (Heparin, Warfarin, etc.), the dosage must be reduced or the drug discontinued.

If the APTT result is higher than normal for children:

2. Make sure there are no genetic abnormalities, hereditary diseases and others pathological conditions.

3. Take other tests that can help evaluate the blood coagulation system.

How to prepare for the APTT test

Blood samples from a vein are taken on an empty stomach. You need to understand that eating any food 5-6 hours before the test can affect the quantitative composition of cells in the body, so to get a clear result you need to take tests on an empty stomach. Drinking water in moderation is not prohibited.

Treatment

When receiving any test result, you must wait for the final diagnosis, because tests do not cure. Only comprehensive assessment state of health can contribute to the correct interpretation of the clinical analysis of aPTT, the formulation of accurate and correct diagnosis, prescribing the necessary treatment.

If the examination does not reveal any pathological conditions, and the APTT result is higher than normal, even after a repeat test, you need to:

1. Make sure the doctor is competent.

2. Eliminate the effects of toxins (alcohol, smoking).

3. For 1-2 months, follow the correct healthy image life and retake the analysis.

Important! The activated partial thromboplastin time test can only be evaluated in conjunction with other blood clotting tests, since this test does not take into account the important tissue clotting factor.

This indicator relates to the study of the blood coagulation system and reflects the internal and general path of coagulation, i.e. this is the time required for the formation of a blood clot. This test is part of a study called a coagulogram, which studies the coagulation system in more detail.

This test determines the time required for clot formation. When testing blood for aPTT, the norm for a healthy person is from 25 to 40 seconds. If other coagulation parameters change (prothrombin, INR, fibrinogen, etc.), then the APTT parameter reacts sharply to this. The normal APTT in the blood of pregnant women is 17-20 s.

Why are pregnant women prescribed an APTT test?

During pregnancy, a number of things happen in a woman’s body: physiological changes. This also applies to a pregnant woman, who often becomes thicker. The reason to prescribe a coagulogram test is changes in the general blood test, which a woman takes regularly after registering for pregnancy.

If general analysis blood showed an increase shaped elements, this may mean blood thickening, and there is a reason to prescribe a coagulogram, which includes an APTT analysis. The norm for this indicator for pregnant women is slightly different and is 17-20 s. It's connected with gradual increase fibrinogen during pregnancy, which by the time of birth reaches a value of 6 g/l, whereas in healthy people it normally ranges from 2.0 to 4.0 g/l.

In the body of a pregnant woman, some processes are not active, this also applies to hemostasis. This is normal, but deviations from the norm still happen. To avoid possible negative consequences for the child and mother, a coagulogram is prescribed.

What studies are included in a coagulogram?

The coagulogram study can be basic and advanced. The basic study includes the following parameters:

1. Prothrombin (PTI - prothrombin index).
2. i.e. standard for determining blood coagulation).
3. APTT.
4. Fibrinogen.

If necessary, additional parameters can be assigned:

• Protein C - with its deficiency, the likelihood of thrombosis is high.
• Antithrombin - belongs to the anticoagulation system, and its deficiency can also lead to thrombosis.
• D-dimer - released when a blood clot breaks down. His increased amount indicates the formation of blood clots in the bloodstream.
• AVR (activated calcification time).
• Plasma recalcification time.
• Plasma tolerance to heparin.

What do the coagulogram indicators indicate?

APTT during pregnancy (normal 17-20 sec.), fibrinogen and other parameters, especially in latest dates, have great importance to prevent complications. Thus, an increase in PTI (prothrombin) above 150% may indicate placental abruption. This is very dangerous for life itself expectant mother and her child.

D-dimer should normally be no more than 248 ng/ml. This is in healthy people. During pregnancy, its levels increase. By the end of pregnancy, they can be 3-4 times higher than the initial value. This is the norm. An increase in D-dimer by more than 4 times the initial value may indicate a serious pathology - gestosis, and also occurs in pregnant women with diabetes mellitus or severe kidney disease.

One of the many causes of miscarriage and miscarriages of various periods is APS ( antiphospholipid syndrome), which is characterized by the formation of arterial and venous thrombosis. To make such a diagnosis, antibodies to outer shell membranes (phospholipids), as well as indicators of fibrinogen, D-dimer, prothrombin, APTT. During pregnancy, their norm differs from the normal indicators of healthy people.

Why is the homeostasis system activated during pregnancy?

The main reasons for this activation are as follows:

• During pregnancy, the body's hormonal levels change.
• An additional circle of blood circulation appears - the uteroplacental one.
• A woman’s body prepares for inevitable blood loss during labor.

Thick blood - what to do?

If during pregnancy studies show that the blood is thick, there is no need to panic right away. Most likely, the doctor will prescribe a corrective diet. First of all, salt and all salty foods (sausages, smoked meats, pickles, etc.) should be excluded from the diet. It is also better to avoid fatty foods. Instead, eat more vegetables, berries and fruits of red and orange color. They are richer than others in vitamin C, which can thin the blood.

It is useful to include the following foods in your diet:

• berries (raspberries, black and red currants, mulberries, plums, strawberries, cranberries, sea buckthorn, viburnum), but you should be careful with eating raspberries and viburnum - these berries are large quantities Pregnant women should not use;
• citrus fruits (tangerines, oranges, lime, lemon, grapefruit);
• pomegranate;
• dried apricots;
• a pineapple;
• beets;
• tomatoes;
• onion and garlic;
• Birch juice;
• chocolate and cocoa;
• vegetable oils (rapeseed, olive, flaxseed);
• spices instead of salt (turmeric, curry, oregano, paprika, dill, cayenne pepper, ginger, thyme, cinnamon).

Products that can thicken the blood should be completely avoided. These include: bananas, potatoes, buckwheat, all carbonated drinks and alcohol.

You need to drink at least 1.5 liters of water per day. But the water must be potable and without gas.

DIC syndrome

One of the most dangerous complications in obstetric practice it is considered DIC syndrome (desseminated intravascular coagulation). On initial stage this occurs, which is then replaced by hypocoagulation (decreased coagulation ability), which leads to massive blood loss and is life-threatening. DIC syndrome often takes on an uncontrollable course, and then this can lead to the death of the woman herself and her baby.

To avoid such a situation, a coagulogram study is prescribed with the obligatory determination of fibrinogen, PTI, APTT, the norm of which during pregnancy is 17-20 s. Typically, such an examination, if there is no history of complications from previous pregnancies, is prescribed in each trimester. Such studies are carried out unscheduled in cases where:

• At least one of my previous pregnancies ended in miscarriage.
• There are symptoms of gestosis - the presence of protein in the urine, swelling of the extremities, arterial hypertension.
• It is placed, for example, in cases of uterine hypertonicity.

How to take a blood test for a coagulogram?

Blood for such a study is donated from a vein in the treatment room in the morning on an empty stomach. Pregnant women do this at the antenatal clinic. For reliable indicators, several simple conditions must be met:

• The last meal should be no later than 10-12 hours before the test.
• It is not recommended to take any medications before donating blood. If the patient is taking medications that affect the coagulation system, this must be indicated in the referral.
• It is not recommended to drink coffee, tea, carbonated drinks, and especially alcohol before donating blood. You are allowed to drink only a glass of clean drinking water.
• Your emotional state can also affect the result, so it’s better to sit in front of the office for a few minutes and calm down.
• Muscle strain can distort the test results, so it is not recommended to visit immediately before donating blood and the day before. GYM's and engage in heavy physical labor.

For the APTT indicator, the norm for women and men is from 25 to 40 s. It does not differ by gender, only during pregnancy it decreases slightly. Interpretation of the research results is carried out only by specialists.

What is the price?

Pregnant women at the antenatal clinic usually do this test free of charge, provided they have a stamped referral from a doctor. All other citizens, if desired, can undergo such a study for a fee. costs about 3500 rubles. Basic parameters will cost less - from 700 to 1300 rubles.

What does aPTT below normal indicate?

In examining the coagulation system, one of the main parameters is the APTT indicator. Its norm is from 25 to 40 seconds. Let us remind you that this parameter shows the time it takes for the blood to completely coagulate and form a blood clot. If this indicator is below 25 seconds, then this fact may indicate blood thickening and the risk of thrombosis. In pregnant women, the norm for APTT is from 17 to 20 seconds. Typically, this condition does not require treatment during pregnancy and goes away on its own after childbirth. In addition, iron supplements, which are often prescribed to pregnant women with low hemoglobin levels, can thicken the blood somewhat.

What does an increase in APTT indicate?

An aPTT reading higher than normal may indicate that a person has a disease such as hemophilia, serious liver disease such as cirrhosis, or a lack of vitamin K. In addition, an increase in this parameter is observed in the following cases:

• With a lack of blood.
• If the patient is treated with anticoagulants, for example, Heparin or Warfarin.
• At hereditary pathologies blood, such as von Willebrand disease.
• With DIC syndrome.

A study of the coagulation system such as a coagulogram is useful not only for pregnant women, but for all people. In case of any deviations from the norm, you should consult a doctor.

Activated partial thromboplastin time (aPTT) is an indicator that is the basis of a coagulogram.

This index evaluates the efficiency of the blood coagulation system (hemostasis system).

The indicator was discovered by medical scientists in 1953 of the last century and this moment, is a very convenient and fast screening test for the blood coagulation system (hemostasis).

What is APTT?

Activated partial thromboplastin time (APTT), when checking the hemostatic system, is combined with two more valuable indicators:

• prothrombin time (PTT);
• thrombin time (TT).

These indicators examine the entire path of blood clotting from the beginning of the process to its very end.

To conduct a biochemical analysis for APTT, calcium chloride is introduced into the blood, which is a provocateur of blood clotting.

In many clinical laboratories, aPTT goes by another test name, APTT (activated partial thromboplastin time).

But the essence of this analysis does not change - examination of the coagulation process in the composition of blood plasma.

Indications for APTT testing

An APTT test is prescribed for the following suspected pathologies:

Preparing the body for analysis

A correct and accurate interpretation of a coagulogram can only be done if the body has been prepared for this analysis.

Exceptions are made only in in case of emergency, during pregnancy for unscheduled testing, with pronounced symptoms of a disorder in vascular system.

A biochemical analysis to determine the APTT coagulation index of blood plasma cannot be performed without proper preparation of the body for it.

For aPTT examination, only the following is taken:

• It is recommended to take blood for the APTT index in the morning on an empty stomach;
• The last meal should be light and minimal (do not overeat), and it should not contain fatty, salty or spicy foods. Also do not use large quantity sweet products;
• You can drink a small amount of purified water before the analysis - no more than 100 milliliters;
• do not drink alcohol;
• do not take coffee;
• stop smoking;
• avoid the day before the test stressful situations;
• exclude for a day physical exercise and active recreation;
• Stop taking medications two weeks before blood sampling.

APTT rate and interpretation

Coagulogram with baseline APTT. The concentration of this index depends on the factors of the coagulation process of blood plasma:

The APTT value is determined in blood plasma. The result of the analysis occurs through the action of the following components:

• blood clotting activator - kaolin;
• phospholipid - cephalin;
• calcium chloride;
• anticoagulant effect of sodium citrate.

Each clinical laboratory issues its regulatory indices APTT.

TF (tissue factor) is not used in this test, which is why the analysis is called partial, or partial thrombotic time.

The essence of this testing is that the composition of the blood plasma, which is taken with an anticoagulant, is cleared of platelet molecules, a reagent (mixture) of cephalin with kaolin, as well as calcium chloride, is added.

But there are reference values ​​that most clinical laboratories adhere to - this index is normalized in men and women outside pregnancy, as well as in children during blood clotting, from 24.0 seconds to 35.0 seconds.

Increased coagulation time by 5.0 sec. - this means hypocoagulation, and a decrease in coagulation over time is hypercoagulation. 38.0 seconds is the borderline value of hypocoagulation, so such patients should be under constant monitoring of hemostasis using tests.

Risk factors for hypocoagulation

An extended coagulation time of blood plasma means that in the plasma there is a decrease in the concentration of blood coagulation factors, or factor No. 1 - fibrinogen.

Reasons for decreased coagulation factors:

• damage to liver parenchyma cells. The liver is the site of synthesis of all factors of the coagulation process in the hemostasis system;
• a small amount of vitamin K in the body, which affects the coagulation of blood plasma;
• the presence of heparin in the blood plasma;
• the presence of a lupus-type anticoagulant in the plasma;
• the presence in the blood of pathological biosubstances that delay the process of fibrin polymerization - these are myeloma cell proteins (FDP - fibrin products of their degradation);
• hemophilia disease - insufficient number of globulin molecules (antihemophilic factor F№VIII), lack of factor №IX (Christmas factor) in the body, absence or a small number of molecules of factor XI;
• inhibitory type hemophilia - presence in blood plasma higher level anticoagulant factors;
• deficiency of coagulation factor No. XII - Hageman's disease;
• von Willebrand disease;
• DIC syndrome of the second and third stages of pathology;
• treatment of the hemostatic system with drugs from the heparin group.

Analysis values ​​for the body

The APTT index is increased or decreased - this means:

• prolongation of coagulation time is an increased APTT index (the time required for a blood plasma clot to form is longer than normal);
• the APTT index is reduced - this is when factors coagulate blood plasma a little more actively.

APTT is of great importance in biochemical analysis - coagulogram.

The importance of this indicator in the body is very high.

The APTT index is higher than normal, which means that there may be severe bleeding in the bloodstream, which leads to a large volume of lost blood and causes anemia, and also leads to more serious consequences blood loss is a state of coma.

A low APTT index leads to thrombosis of arteries of various diameters with blood clots and leads to the pathologies of Thrombosis, as well as the disease Thromboembolism.

These pathologies can become the causes of such serious illnesses in organism:

• spicy coronary syndrome(clogging of coronary vessels);
• stroke;
• myocardial infarction;
• PE disease.

Reasons for decreased APTT

A decrease in the APTT index means increased thrombus formation in the body’s vascular system. The lower the index, the greater the risk of developing pathologies associated with high blood clotting.

Pathologies that provoke a low APTT index:

• pathology arterial thrombosis;
• thromboembolism disease;
• DIC syndrome of the first degree of disease development;
• high level of F№VIII;
• use of oral contraceptives;
• an inflammatory process in the body caused by infection or viruses;
• in a blood sample increased content tissue thromboplastin.

APTT index in women during pregnancy

Women are prescribed blood donation for APTT analysis every trimester of pregnancy. On at this stage female body Coagulogram indicators are very important, because during the intrauterine formation of the baby, the numbers of the hemostasis system should be normal.

Changes in the body of a pregnant woman that can cause deviations in the blood coagulation of the hemostasis system:

• changes and restructuring of the hormonal background of the female body occur;
• an additional circle of blood flow appears between the body of the mother and the unborn child (blood supply to the fetus through the uteroplacental blood flow);
• changes in the body force it to adapt to new conditions, and the hemostatic system begins to prepare for the planned loss of blood volume.

During the period of intrauterine gestation, the fibrinogen index begins to increase, but an increase above 6.0 grams per liter should not be allowed.

A fibrinogen index higher than the standard value is dangerous, since this concentration indicates a danger due to increased blood plasma clotting.

Indesk APTT above the norm poses a threat to the mother and unborn child.

This condition poses a threat to the mother and unborn child.

APTT is also shortened during pregnancy. Reference values ​​for normal aPTT at the time of pregnancy range from 17.0 seconds to 20.0 seconds.

The normative indicators of the upper limit of blood plasma thrombosis and the lower value are at a short distance from each other, so it is very important not to go beyond these limits throughout the entire intrauterine formation of the fetus.

Reduced aPTT index during pregnancy

A low aPTT in the coagulogram is an indicator of thick blood, which can lead to such pathologies during pregnancy that can threaten the mother and the unborn baby:

• freezing of the fetus early stages intrauterine development and miscarriage;
• disorders during pregnancy;
• premature birth;
• placental abruption and separation;
• thrombosis of umbilical cord vessels;
• pathology of gestosis;
• fetal hypoxia;
• arterial thrombosis in a woman in labor;
• pulmonary artery thrombosis.

Thrombosis can occur in various arteries of the body.

An extended blood plasma clotting time is just as dangerous during pregnancy as a shortened one.

With an increased APTT index liquid blood can cause uterine bleeding, which is dangerous for the development and life of the baby, and also threatens the life of the mother in labor.

Diagnosis during pregnancy

During pregnancy, from the first trimester, it is necessary to take hemostasiogram tests in each subsequent trimester.

If the indicators of this analysis do not satisfy the requests of the attending physician and more precise clarification is needed, additional diagnostic tests are prescribed:

• index D-dimer;
• indicators of plasma coagulability factors;
• clotting time period;
• plasma concentration of antibodies.

A pregnant woman with a high APTT index will remain in the hospital from the third trimester until the time of birth, which should normalize this indicator by the time of birth.

With disseminated intravascular coagulation of blood plasma, increased coagulation of the blood composition and formation of blood clots

Deviations from the normative APTT in the coagulation system may develop disseminated intravascular coagulation syndrome.

At the second stage of development of DIC syndrome, and at its third stage, hypocoagulation occurs with increased danger bleeding.

Low blood plasma coagulability in the second and third stages of disseminated intravascular coagulation results in heavy bleeding that can be fatal.

DIC syndrome is a pathological process that is difficult to diagnose and treat.

This syndrome is one of the most dangerous diseases in obstetrics and gynecology.

A hemostasiogram can be prescribed unscheduled, based on the severe pathological symptoms of the pregnant woman:

• high blood pressure index;
• increased heart rate;
• painful sensations in the veins;
• tense arteries that appear through the skin;
• pathology proteinuria;
• state of swelling.

Biochemical analysis for aPTT in children

In childhood, it is very important not only to diagnose the pathology in a timely manner, but also to prevent its further development.

Children are tested to determine the coagulation abilities of the blood composition.

As a result of this testing, pathologies of a genetic hereditary nature can be identified in a growing baby, which can manifest themselves during the period of growth of the body.

Intensive maturation can provoke a number of congenital diseases.

At the time of blood collection laboratory diagnostics It is very important that the child does not experience emotional overstrain, because a stressful situation can give false result in testing.

How to increase the APTT index?

To increase blood clotting time (APTT index), the following methods are used:

• therapy with drugs from the anticoagulant group - these are drugs: Heparin, Pradaxa, Clexane;
• taking drugs from the fibrinogen group - the drug Warfarin;
• use of antiplatelet agents. These are drugs based acetylsalicylic acid and are used to dilute blood plasma. Medicines in this group - Aspecard, Aspirin;
• anti-cholesterol diet because education cholesterol plaques interferes with the correct flow of blood in the system, and slow movement leads to increased plasma coagulability, and, accordingly, to a low APTT;
• the use of vitamin-mineral complexes in therapy makes it possible to correct immune system and the hematopoietic system. Long-term use vitamins E, C, A and omega 3, reduce blood clotting factors;
• it is necessary to correctly adjust the load on the body to avoid stagnation of blood in the bloodstream system.

How to lower the APTT index?

To lower the index of increased blood clotting time (for treatment), the following methods are used:

• taking drugs from the coagulant group - the drug Tranexam, the drug Docinon;
• use of vitamin K analogues in therapy - injection solution Vikasol;
• treatment of liver pathology - hepatitis, as well as cirrhosis;
• Blood transfusions with a high plasma coagulability index are also used in treatment.

In the treatment of low blood clotting, a diet high in animal products is also used:

Prevention in case of deviations

Systematic monitoring of the activated partial thromboplastin time aPTT using the coagulogram technique:

• Stick to proper nutrition.
• Promptly correct deviations in thromboplastin time in different directions.
• Accept vitamin complex- vitamin K, vitamin A, and C.
• Use for prevention healing herbs and medicinal plants.
• Refuse bad habits- alcohol and nicotine addiction.
• Avoid stressful situations and apply adequate physical activity to the body.

Prognosis for life with APTT

With timely diagnosis, as well as timely treatment pathologies that cause deviations from the normative values, the APTT index has a favorable prognosis.

In case of disturbances in the hemostatic system during pregnancy, with strict adherence all doctor's orders and under the strict supervision of medical staff, especially in the third trimester of pregnancy - the prognosis for mother and child is favorable.

If the coagulation process is disturbed and adequate actions are not taken to correct it, then this is fraught with complications: thrombosis large arteries and myocardial infarction.

And with low blood clotting - heavy bleeding. In these cases, the prognosis is not favorable.