COAGULATION TEST

Introduction
Clotting is what stops excessive bleeding when you cut yourself.
But the blood flowing through your vessels should not clot. If clots
form, they can move through your bloodstream to your heart,
lungs, or brain. And can induce a stroke, heart attack, or even
death[1].
Coagulation tests measure blood’s capability to clot and how much
time it takes to clot. Testing can help your doctor evaluate your
risk of excessive bleeding or thrombosis someplace in your blood
vessels[1].
Coagulation tests are the same as most blood tests. Unwanted
effects and risks are the least. A medical professional will collect a
blood sample and send it to a laboratory for examining and
analysis[1].
The link between cancer and coagulation is characterized by
various mechanisms showing that tumor biology and coagulation
are closely connected processes. It is now confirmed that clotting
activation is often encountered in cancer, typically displaying as a
low-grade disseminated intravascular coagulation or venous
thromboembolism either due to cancer itself or agents used for
treatment. Patients with lung tumors, pancreatic tumors, and
gastrointestinal tract tumors are thought to be more inclined
towards a hypercoagulable state[2]. Therefore, clinical
consequences of thrombosis can be significant with a negative
impact on the course of disease-causing mortality and
morbidity[3].

PURPOSE OF COAGULATION TEST

The process of hemostasis happens in three phases: the vascular
platelet stage, which confirms primary hemostasis; activation of
the coagulation cascade, which guaranteed the formation of the
clot; and activation of a series of mechanisms, which stop the
propagation of the clot and restrict activation of the coagulation
cascade to the area of endothelial rupture[4]. So, clotting disorders
can cause a significant amount of bleeding or clotting. If your
doctor speculates that you have a clotting disorder, they may
suggest one or more coagulation tests. These tests measure
various proteins and how they function[1].
Coagulation tests are beneficial in monitoring people who use
medications that affect clotting ability[1]. Coagulation tests are
also sometimes suggested before surgery[1].
Activation of coagulation and fibrinolysis is commonly observed
among cancer patients. Such tumors are thought to be associated
with a higher risk of invasion, metastasis, and ultimately more
critical outcomes [2].

TYPES OF COAGULATION TEST
(A) Factor V assay:- This test measures Factor V, a substance
required in clotting. An abnormally low level may be a sign of liver
disease, primary fibrinolysis i.e breakdown of clots, or
disseminated intravascular clots (DIC)[1].
(B) Complete blood count:- A complete blood count or CBC test is
a simple and frequently used test for various conditions which
might influence your health[4].
A CBC decides if your blood cell counts are increased or
decreased. Normal values vary with your age and sex. The typical

value range for your age and gender will be mentioned in your lab
result[4].
CBCs can assist in the diagnosis of a wide variety of diseases from
anemia to cancer infection[4].
(C) Fibrinogen level:- Fibrinogen is a liver-built protein. This test
measures your blood’s level of fibrinogen. Abnormal findings might
indicate an extensive hemorrhage, bleeding, fibrinolysis, or
placental abruption i.e., placenta detachment from the uterine
wall[1].
The factor I and hypofibrinogenemia tests are other names for this
test[1].
(D) Prothrombin time test:- The other protein that your liver
produces is prothrombin. The test of prothrombin time evaluates
how well and how long your blood takes to coagulate. It usually
takes between 25 and 30 seconds. If you take blood thinners, it
might take longer. Hemophilia, liver illness, and malabsorption are
some reasons for abnormal findings[1].
It is also beneficial in the surveillance of people using drugs that
alter coagulation, such as warfarin (Coumadin)[1].
Results are given in the number of seconds it takes the blood to
coagulate. Sometimes the PT test utilizes a calculation called the
international normalized ratio (INR) to analyze results of different
laboratories[1].
(E) Platelet count:- Platelets are blood cells that aid your
coagulation. If you are on chemotherapy, use certain drugs, or
have a huge blood transfusion, you may have a low count of the
platelet. Low platelet count is also caused by celiac disease,
vitamin K insufficiency, and leukemia [1].

The unusually large number of platelets can be caused by anemia,
primary thrombocythemia, or chronic myelogenous leukemia
(CML)[1].
(F) Thrombin time:- Thrombin time assesses the functioning
properties of fibrinogen. Inherited fibrinogen diseases, liver illness,
some cancers, and clotting-influencing medicines may have
abnormal outcomes[1].
(G) Bleeding time:- This test looks at how fast tiny blood vessels
shut and stop bleeding in your skin. It is done differently from
other blood tests[1].

COAGULATION AND CANCER
Importantly, rather than being only a trigger of improved
thromboembolic events, cancer-induced hemostatic activity has
been proved to support tumor growth and cancer cell
dissemination. Current studies have proposed that hemostatic
abnormalities seen in cancer patients may lead to recruitment of
inflammatory cells, generation of tumor stroma, and angiogenesis.
For instance, tumors activating the coagulation system are
thought to act more aggressively with a greater risk of invasion
and metastasis[2].
Raised levels of circulating biomarkers resembling activated
coagulation and fibrinolytic systems such as fibrinogen, fibrinogen
split products, and D-dimer have been linked with reduced
survival for various tumor types in studies[2].
Research activities among patients of lung cancer examining the
relationship between the activated hemostatic system and
prognosis have exhibited similar results. These findings have
emerged from studies estimating the effect of anticoagulants in

adjunct with chemotherapy mainly in Small Cell Lung Cancer
patients[5]. Although a survival advantage was recognized in that
study, enough proof of such an advantage was not given for cancer
patients in general. But, knowing the potential pathways
responsible for activated hemostatic/fibrinolytic activity may
assist to identify surrogate markers for new therapeutic targets in
the coming future[2].
It has recently been stated that a number of coagulation factors
(e.g. prothrombin time, fibrinogen, and d-dimer) are critical
autonomous predictors of survival[6].

HOW COAGULATION TESTS PERFORMED?
Coagulation tests are performed in the same way as most blood
tests. You may need to stop taking certain medicines prior to the
test. No other preparation is required[1].
Your healthcare provider will disinfect a spot on the back of your
hand or inside your elbow. They will inject a needle into a vein[1]
Your healthcare provider will draw and collect your blood. After
collecting blood, a healthcare professional will put a bandage on
the puncture site[1].
The unwanted effects of a coagulation test are usually minor. You
may have small soreness or bruises at the site. The risks include
pain, lightheadedness, and infection[1].
If you have experienced profuse bleeding, the method will be
carefully monitored[1].
This sample will be sent to a laboratory for testing and analysis of a
disease (cancer etc.)[1].