Bleeding problems, also known as a coagulogram, are a group of blood tests requested by your doctor to evaluate the blood clotting process, so your doctor can identify changes to indicate treatment and avoid complications.
These tests are mainly requested before surgeries to assess the patient’s risk of bleeding during the procedure; Over time, it is possible to estimate bleeding time, prothrombin time, activated partial thromboplastin time, thrombin time and platelet count.
- Bleeding problems should not be reported until before surgery.
- However.
- Your doctor may also ask you to look for the cause of haematological diseases and check for the risk of thrombosis.
- Especially in women who use hormonal contraceptives.
In addition, the coagulogram may also be indicated after a person has suffered the bite of a poisonous animal, so it may contain toxins that interfere with the clotting process; You may also order people who are being treated with blood thinners, such as Heparin and Warfarin, for example. Know other blood thinners and as directed.
The coagulogram should be done with the person within 2 to 4 hours, and involves removing a blood sample, which is sent to the lab for testing, with the exception of the bleeding time (TS) currently being performed and its goal is to determine the time it takes to stop the bleeding.
It is important that prior to the scan the bioanalysis is being reported if any anticoagulant medicinal products are being used, as it may interfere with the result and should be considered at the time of the analysis, in this way, medical advice on the suspension of the drug is essential before the end of the coagulogram.
The coagulogram consists of tests showing the presence of all the factors that affect blood clotting and, therefore, hemostasis, which corresponds to the processes that occur in the blood vessels, which aim to keep the blood fluid to prevent the formation of clots. bleeding.
The main abnormalities of the coagulogram are
This test is usually requested as a means to perform other tests and is useful for detecting any platelet alteration, it is done by performing a small puncture in the ore, corresponding to Duke’s technique, making an incision in the forearm, corresponding to Ivy’s technique, so that you can know how long it takes to stop the bleeding.
To perform the Ivy technique, pressure is applied to the patient’s arm and a small incision is made in the area, in the case of Duke’s technique the air puncture is performed by lancet or disposable stylus, in both cases bleeding is valued every 30 seconds using a filter paper, which absorbs blood from the area. The problem ends when the filter paper does not absorb more blood.
Thanks to the result of TS, it is possible to evaluate hemostase and the absence of von Willebrand factor, which is a factor present in platelets and plays a key role in the blood clotting process, although this test is useful for detecting changes in hemostase, can cause discomfort, especially in children, but I need to perform a puncture.
How to interpret the result: After punctuation, the doctor or technician in charge counts the time it takes to clot the blood and controls it using a filter paper that absorbs blood from the area, when the filter paper does not absorb more blood, the problem is solved. In the case of the Ivy technique, the normal bleeding time is between 6 and 9 minutes. In the case of Duke’s technique, the normal bleeding time is between 1 and 3 minutes.
When the time is longer than the reference time, the TS test is said to be prolonged, indicating that the clotting process took longer than normal, and could suggest Von Willebrand disease, the use of anticoagulant drugs or thrombocytopenia, for example. the main causes of thrombocytopenia.
Prothrombin, also known as coagulation factor II, is a protein that is activated during the coagulation process and has the function of promoting the conversion of fibrinogen into fibrin, forming the definitive secondary platelet cap.
The purpose of this test is to evaluate the extrinsic pathway of clotting, which determines how long it takes for the blood to form after exposure to calcium thromboplastin, if this reactive element is used in the blood.
How to interpret the result: under normal conditions, in blood contact with calcium thromboplastin, the extrinsic pathway is activated, producing coagulation factors VII and X, and therefore factor II, which is prothrombin, favoring the conversion of fibrinogen into fibrin, stopping This process normally takes between 10 and 14 seconds.
However, in some situations, the coagulogram detects a prolonged TP, which means that activation of prothrombin takes longer than normal Increased TP values are usually due to the use of anticoagulants, vitamin K deficiency, factor VII deficiency and liver problems, for example, because prothrombin occurs in the liver.
In common cases, TP may be reduced, such as the use of vitamin K supplements or estrogen birth control pills, for example. Learn more about the prothrombin time test result.
This test also evaluates hemostase, however, it can be used to verify the presence of the absence of clotting factors present in the intrinsic route of the coagulation cascade.
It is important to request APTT when the patient is taking heparin, which is an anticoagulant, has blood clotting problems, and is helpful in identifying changes related to clotting factors.
In this test, a sample of extracted blood is exposed to the reagents and the time needed to calculate the time required for blood clotting.
How to interpret the result: Under normal conditions, the TTPA is 21 to 32 seconds. However, when the person uses anticoagulants, such as heparin, there is a deficiency of specific intrinsic factors of the pathway, such as factors XII, XI, VIII, and IX, which indicate hemophilia, usually greater than the initial time. . , indicating the revision that the APTT is expanded.
The thrombin time corresponds to the time required for clot formation after the addition of thrombin, which is a clotting factor that has the function of converting fibrinogen into fibrin, which ensures the stability of the clot.
This high-sensitivity examination is performed from the addition of thrombin at low concentrations in the blood plasma, being influenced by coagulation time by the amount of fibrinogen present in the plasma.
How to interpret the result: Normally, after adding thrombin to the plasma, the clot forms between 14 and 21 seconds, which is considered the reference value, and may vary depending on the lab in which the test is performed.
TT is considered prolonged when the person uses anticoagulants, has fibrin breakdown products, for example, due to a deficiency of factor XIII or fibrinogen.
Platelets are fragments of cells that circulate in the blood because they play a key role in hemostase, which can be important factors in the clotting process, such as the von Willebrand factor, for example.
When there is a tissue injury, the nameplate moves quickly to the site of the injury to aid in the bleeding process. Activated platelets adhere to the injured endothelium using the von Willenbrand factor, modifying its shape and releasing substances into the blood plasma to recruit more platelets around the injured area and thus form the primary platelet cap.
In this way, the determination of platelet count in the coagulogram is important, as it allows the doctor to assess whether there is a change in the primary hemostase process, thus indicating a more specific treatment.
How to interpret the result: the normal blood platelet count is between 150,000 and 450,000 / mm3. Values lower than the reference to Indian thrombocytopenia, indicating fewer circulating platelets, which can lead to clotting problems, favoring bleeding, in addition to being able to suggest nutritional deficiencies, bone marrow modifications or infections, for example.
Higher reference values are called thrombocytosis, which can cause excessive clotting and occur due to lifestyle habits, such as smoking, alcoholism, due to pathological conditions, such as iron deficiency anemia, myelodoliferative syndrome, and leukemia, and recognizes other causes of platelet enlargement.