Decoding of a coagulogram in pregnancy
These coagulograms give an idea to the doctor about the woman's blood condition. So, with the help of this analysis, you can find out about the level of fibrinogen content, which, with the course of pregnancy, constantly rises, up to the birth. It can reach a normal 6 g / l.
The indices of activated partial thromboplastin time during pregnancy differ slightly and amount to 20 seconds, which is 10-15 seconds less than before pregnancy.
Decoding the coagulogram in pregnancy also has indicators of lupous anticoagulant, which indicates a group of antibodies that contribute to the increase in the level of APTT. In normal pregnancy, they should not be in the blood. In case of their appearance, a systemic disease of autoimmune nature, including gestosis, should be suspected.
Thrombin time is often slightly elevated in pregnant women, but should not be much higher than normal values - up to 18 seconds.
Analysis of evaluation of the hemostatic system has a rather important indicator - prothrombin, indicating a threat of premature placental detachment. It should normally fluctuate within 80-140%.
An expanded coagulogram in pregnancy
The study of blood coagulability can be ordinary and detailed. Most often, doctors resort to the usual coagulogram, which consists of four indicators: prothrombin index, APTT (the value of activated partial thromboplastin time), the amount of fibrinogen and platelets. If the doctor suspects any disturbance of the coagulation system, then he can prescribe a developed coagulogram that will demonstrate the entire picture of blood coagulation in the body. In this case, it will be possible to evaluate not only the state of the coagulation system proper, but also to predict its functionality in the future.
The detailed analysis is recommended for those who have family heredity (for example, there are patients with thromboembolism, strokes, heart attacks), as well as women with varicose veins or thrombophlebitis, or after prolonged intake of hormonal contraceptives.
RFMC in pregnancy
Indicators of hemostasis (soluble fibrin-monomer complexes - RFMK) - allow to assess the level and percentage of elements of blood clots, the number of which can increase with massive thrombogenesis in the circulatory system. For example, this condition can be observed with thrombosis of large main vessels, with thromboembolism of the pulmonary artery.
Elevated levels of RFMC can be observed in the blood of patients with disseminated intravascular coagulation syndrome, in which a sudden and increasing disorder of all stages of coagulation occurs. This happens, for example, with a shock state, with severe injuries, extensive burns, systemic thrombosis, etc.
Coagulogram RMPC is characterized by increased sensitivity, in contrast to, for example, ethanol test.
An increase in the RFMC indices indicates an increasing risk of formation of intravascular thrombi.
Coagulogram in pregnancy decoding RFMC looks like this:
- in a healthy person, a normal RFMC score is 3.38-4.0 mg / 100 ml;
- during pregnancy it is allowed to increase this value by about 3 times.
As we mentioned above, D-dimer is a product of fibrinolysis-the decomposition of a thrombus. Evaluation of this indicator should be carried out both before pregnancy and during the gestation process.
Before pregnancy, the level of fibrinolysis product should be 248 ng / ml, and should not be more than 500 ng / ml.
Normal indicators during the period of gestation fluctuate depending on the term.
- I trimester - the level can increase by 1.5 times (not more than 750 ng / ml);
- II trimester - not more than 1000 ng / ml;
- III trimester - no more than 1500 ng / ml.
Thus, for physiological reasons, the level of D-dimer in pregnant women increases. However, exceeding this value above the allowable limits may indicate development:
- diabetes mellitus;
- kidney pathology;
- late toxicosis;
- pathology of the liver;
- premature detachment of the placenta.
Lowering the level of the D-dimer is observed much less frequently. Such a decrease is not an indicator of any pathology, but in most cases it serves as a reason for more thorough studies of the functional coagulation capacity of the blood. In such cases, a consultation of the hematologist is mandatory.
INR - indicators according to the norms of the international normalized ratio - represent the estimated value of the coagulogram, which shows the ratio of prothrombin time of a specific person and normal averaged prothrombin time. Assessment of INR is necessary to observe the state of the coagulation system during the treatment with anticoagulant drugs - anticoagulants of indirect action (eg, Phenylin, Valfarin). If such treatment is carried out, INR should be monitored at least once every three months.
Excessive excess of INR may indicate the risk of bleeding, including internal bleeding.
A decrease in the indices demonstrates the insufficient effectiveness of anticoagulant treatment, which confirms the continuing danger of formation of thrombi.
The normal indices of INR are 0.8-1.2. In the period of treatment with anticoagulants, the permissible norm is about 2.5.