TEST FOR VASCULAR INTEGRITY • Example: Menstruation  bleeding  pressure

 extravasation of RBC or hematoma 

Capillary Fragility/ Resistance Test
petechiae
- Test ability of our blood vessel to retain
 Test the stability of blood vessels once
RBC under stress or trauma
exposed to pressure to retain
If RBC exposed to trauma
(pressure) what we test here is Methods:
the ability of vessel to resist the
red cell inside and the pressure Tourniquet or Rumpel-Leede or Hess Test
u applied positive pressure technique.
If vessels fragile/ lack collagen  Principle: by partially obstructing the
the moment u applied pressure venous blood, the capillary pressure is
on the vessel these red cells increased. This will give rise to
leave the vessels and goes to extravasation of blood which will be
tissue and on skin manifested manifested in the form of small
as PETECHIAE hemorrhage called petechiae

Procedure:
 Test for checking the integrity of blood vessels
 Healthy and Intact blood vessel: 1.
Remember na in hemostasis if u want  I here get blood pressure of patient and
to have normal mechanism u must have get midpoint patient BP
intact blood vessels because it give us a  Apply blood pressure cuff and maintain
lot of things to ensure normal 100mmHg for 5 minutes
hemostasis Ex: 110/90= midpoint is 100
Provide vitamin C to aid the formation Pressure served as stress
of collagen
Collagen –makes vessels intact 3. Apply BP cuff on patient’s arm and set at 100
Intact blood vessel ensure in cases of mmHg for 5 minutes
Injury we can form clot and lyse clot 4. Remove BP cuff and wait for 2-5 minutes
Absence of injury having intact blood
vessel we can prevent formation of clot 5. Check and count the presence of any
possible petechiae on the forearm of the
o Apply pressure on blood vessels o If the patient.
vessels are intact, blood vessel can resist the
pressure o If vessels are fragile, cells inside Tourniquet Test: alternative for blood pressure
particularly RBCs will come out which would count and stethoscope
lead to extravasation of RBCs  Disadvantage: amount of
o Once RBCs start to leave blood vessel, they pressure is not measured
will then go to tissues and manifest in skin in  Not too tight nor too loose;
same procedure
the form of petechiae
 Not a confirmatory of dengue
• Indicates that blood vessels are fragile  Aside from vitamin C and
collagen they will also need
platelets because it can contain
granules makes the vessel
 intact (platelet derived growth  Patients arms and nail may turn dark and feel
factor Pdgf) and beta heavy because u will blocking the flow of blood
thromboglobulin)  Tell him who will perform the procedure and
o abnormal result on tourniquet test is when.
Indirectly related to platelet count but having  Inform him that food or fluids need not be
an abnormal tourniquet test is not only limited restricted.
to platelets  Explain that he may feel discomfort from the
pressure of the blood pressure cuff.
On dengue cases there is
bleeding so it consume platelet
so platelet count is low so there
is deficiency on these granules
So performing this test there
are lot of petechiae  Before proceeding with the test, check first
the patients arm (allergy, skin asthma, pimple
marks) = falsely identified
Confirmatory for dengue: NS1 antigen
PROCEDURE:
1. Examine the forearm, hand and fingers to
 Dengue: make certain that no petechiae are present.
2. Apply a blood pressure cuff on the upper arm
 platelet count is low above the elbow, and take blood pressure
 PDGF and BTG are low reading.
 Blood vessel intactness are affected 3. Inflate the blood pressure cuff to a point
causing formation of petechiae midway between the systolic and diastolic
b. Quick’s Method blood pressures for five minutes.
c. Gothlin’s Method 4. After deflating the cuff, wait for the skin to
return to its normal color (usually about five to
Suction Cup/ Petechiometer Method/ ten minutes).
Negative Pressure Technique: 5. Count the number of petechiae visible in a
 Principle: employs the use of a modified da one inch square area on the ventral surface of
Silva Melle Instrument. the forearm. Disregard any petechiae within 1.2
 The cup is applied to the outer surface of inch if the blood pressure cuff because this may
the arm for a period of one minute at 200 be due to pinching of the skin by the cuff
mmHg (constant) and the resistance of the
capillaries is expressed as the negative Results:
pressure required to produce a The test result may be graded roughly as
macroscopic petechiae follows: (Semi-quantitative)
PRESSURE IS CONSTANT AT 200
mmHg
Apply for 1 minute
 > 1 min = blood vessel will be damage
Normal Value: 4 petechiae
Qualitative:
Patient preparation:  Normal value: 0-10 petechiae
 Explain to the patient that this test is used to  Equivocal: 10-20 petechiae
identify abnormal bleeding tendencies.  Abnormal: >20 petechiae (possible vessel
problem)
 - Contractile ability of platelets because
Precautions platelets are flexible contains
• Do not repeat this test on the same arm microfilaments to contract them with
within 1 week. the help thrombostenin
• This test is contraindicated in patients with
disseminated intra vascular coagulation (DIC) or Clot retraction reflects platelets and
other bleeding disorders, and in those with number and function, and also reflect
significant petechiae already present fibrinogen concentration of patient blood
and patient hematocrit
Abnormal findings Connection: when forming clot it form a
• A positive finding (more than 10 petechiae or mesh of entire elements of blood
a Score of 2+ to 4+) indicates weakness of the CLOT: contain platelets and rbc
capillary walls (vascular purpura) or a platelet Clotting factors- stabilize the clot especially
defect. red cells
• It may occur in such conditions as Degree of clot factor to the extent of fibrin
thrombocytopenia, thrombasthenia, purpura contraction
senilis, scurvy, DIC, von Willebrand's disease, After converted fibrinogen to fibrin there is
vitamin K deficiency, dysproteinemia, and contraction. there’s contraction because of
polycythemia vera and in severe deficiencies of the red cell component inside
factor VII, fibrinogen, or prothrombin.  Clotting factors are activated when blood have
• Conditions unrelated to bleeding defects, such contact to glass tube (negative charge) that
as scarlet fever, measles, influenza, chronic allows it to form a clot  attached on the wall of
renal disease, hypertension, and diabetes with the tube
coexistent vascular disease, may also increase  Retraction: whenever the clot pulls away from
capillary fragility. the walls of test tube
• An abnormal number of petechiae sometimes  Directly proportional to the function and
appear before menstruation and at other times number of platelets due to its contractility
in some healthy persons, especially in women properties
over age 40  Increase hematocrit/decrease platelets =
decrease clot retraction
Interfering factors  decrease hematocrit/ increase platelets=
• Decreasing estrogen levels in postmenopausal increase clot retraction
women (possible increase)  Detects: problem with coagulation
Brown spots and marks on skin because
vessels are now fragile to those old Degree of clot retraction is directly proportional
women to number of platelets and inversely
• Glucocorticoids (possible decrease) proportional to hematocrit/fibrinogen
• Repeating the test on the same arm within 1 concentration
week, causing errors in counting the number of
petechiae. Methods:
• Overinflation or underinflation of the cuff 1. QUALITATIVE TEST
a. Hirshboeck or Castor Oil Method
CLOT RETRACTION TEST  Add drop of blood on castor oil
- Measures the entire platelet function  Presence of “dimpling phenomenon” for
- Indirectly detect problems on clotting 15-45 minutes
factors for secondary hemostasis  Blood is starting to pull away from the
because there is clot castor oil or negative charge
b. Single Tube Method

2. QUANTITATIVE TEST
a. Stefanini Method – similar with single tube
method.
 Place applicator stick on the tube 
incubate at 37°C  wait for 18-24 hours
 check if there is still blood attached on
tube
 Qualitative reporting:
o Complete retraction – entire clot is
attached on stick
o Partial retraction – there still clot
attached on test tube

b. Macfarlane Method
 Place applicator stick on the tube
 37°C water or dry bath  clot  check for
retraction
 Clot will be attached on applicator stick
 Measure the amount of serum
 Reporting: percent of serum
 𝑣𝑜𝑙𝑢𝑚𝑒 𝑜𝑓 𝑠𝑒𝑟𝑢𝑚 𝑡𝑜𝑡𝑎𝑙 𝑏𝑙𝑜𝑜𝑑 𝑣𝑜𝑙𝑢𝑚𝑒 𝑥 100
 Example: 2.5 𝑚𝐿 5 𝑚𝐿 𝑥 100 = 50%
 Normal value: atleast 50%
Use wireloop or straight wire to
completely collect clot