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Study of hemostasiograms in miscarriage
Last reviewed: 19.10.2021
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Hemostasiogram studies are the main test for the detection of autoimmune disorders. At present, the spectrum of haemostasis studies is quite wide, but the interpretation of the revealed violations can be complicated. From our point of view, for practical work, it is quite informative to study such parameters as thromboelastogram, platelet aggregation, and the determination of markers of chronic ICE (RCMF, PDF, dimers). Thromboelastography can be whole blood, it can be plasma, so the regulatory parameters depend on the instruments used and must be worked out in each laboratory.
The principle of the method consists in graphically recording the processes of fibrin formation, its retraction and fibrinolysis.
Evaluation of aggregation activity of platelets is carried out by the method of photoelectric registration of the dynamics of the change in light transmission of a plasma sample rich in platelets with agitation with aggregation stimulators: adenosine monophosphate (ADP) solution at a final concentration of 1 × 10 3 M, collagen suspension at a final concentration of 0.04 mg / ml.
Determination of soluble complexes of fibrin monomers is carried out with protamine sulfate and ethanol test. The presence of fibrin monomers indicates the circulation of active thrombin in the blood.
Determination of degradation products of fibrin and fibrinogen (FDP) is performed using a hemagglutination inhibition test using antifibrinogen serum and red blood cells sensitized by human fibrinogen.
According to research and analysis of numerous literature on the diagnosis of thrombophilic disorders in obstetric practice, it is necessary to raise the question that evaluation of the hemostatic system should become routine routine in obstetric practice as a blood and urine test before and during pregnancy. Given the potential for predicting and treating severe obstetrical complications (placental abruption, intrauterine fetal death, loss of pregnancy in all trimesters, severe toxicosis of the second half of pregnancy, intrauterine growth retardation) according to hemostasis evaluation from early pregnancy, makes these studies extremely important for obstetrician work and in the women's consultation and in the maternity hospital. Not to mention the prevention of severe thrombophilic complications in the form of thromboembolism of coagulopathic bleeding. In the presence of a thrombophilic anamnesis, when using heparin, the following studies should also be carried out: the determination of the number of platelets; determination of the activity of antithrombin III, proteins C and S, plasminogen.
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