MLSP112 Lab Week 10 CTBT28129

CT / BT
Clotting Time / Bleeding Time
Ruth Ellen T. Alonzo, RMT

General Overview
● Bleeding time and clotting time are
procedures performed used to assess
both quantitative and qualitative
properties of thrombocytes to help in
the screening of possibly underlying
conditions
● It is often requested for patients
undergoing surgery, with bleeding
tendencies
BLEEDING TIME
● Test performed to evaluate platelet function by allowing the incision or
bleeding to stop within a given time reference
● Involves making a puncture wound in a superficial skin
Methods of Bleeding Time
A. Duke’s Method
○ Most used procedure, easy to perform
○ Materials: lancet, filter paper
○ Reference: 3 to 5 minutes
○ Procedure:
1. Make a single incision on either earlobes or finger
2. Timer starts as soon as bleeding begins and blot to filter paper
immediately
3. Check evidence of bleeding every 30 seconds until no blood is seen
4. Report the bleeding time that is closest minute
B. Ivy’s Method
○ Most recommended procedure
○ Requires standardized pressure of 40mmHg and incision of
1mm deep and 3mm wide
○ Materials: lancet, filter paper, sphygmomanometer
○ Procedure:
1. Three incisions are made on the volar surface of the arm with pressure
2. Timer starts as soon as bleeding begins and blot to filter paper
immediately
3. Check evidence of bleeding every 30 seconds until no blood is seen
4. Remove the blood pressure cuff
5. Report the average bleeding time
C. Standard Template Method
○ Similar procedure with Ivy’s method
○ Requires single incision of 11mm deep and 11mm wide
○ Materials: filter paper, glass, or plastic template (lancet),
sphygmomanometer
Variables Affecting Bleeding Time
ü Prolonged bleeding time
o Physiologic errors: aspirin intake, cephalothin intake
o Pathologic cause: anemia, thrombocytopenia, Bernard Soulier syndrome,
fibrinogen deficiencies, vascular disorders, von Willebrand disease,
disseminated intravascular coagulation, Glanzmann’s thrombasthenia
ü Shortened bleeding time

o Physiologic errors: smaller incision, low pressure
CLOTTING TIME
● Clotting time is a test performed to determine the time required for clot to
form
● Involves the activity of coagulation factor and presence of a negative charge
surface for its activation
● The formation of clot or fibrin demands the presence of thrombin who is
responsible for the conversion fibrinogen to become fibrin then stabilized by
transglutaminase
Methods of Clotting Time
A. Slide Method
○ Most used procedure, easy to perform
○ Materials: lancet, glass slides
○ Procedure:
1. Perform capillary puncture. Make sure that the finger is warmed prior to
puncture. Incision should be 3mm deep. Start the timer as soon as the
blood appears and don’t forget to wipe to first drop of blood to prevent
contamination of tissue juices.
2. Place a drop of blood on slide for the determination of clotting time.
3. Check the drop of blood every 30 seconds until the presence of clot or
fibrin clot is first observed and seen.
4. Report the time where fibrin is first seen.
B. Capillary Method
○ Formation of fibrin is observed in non-anticoagulated capillary tubes by breaking it
○ Materials: capillary puncture kit, whole blood sample
○ Procedure:
1. Perform capillary puncture and fill up the capillary tube up to ¾ amount.
Make sure that the finger is warmed prior to puncture. Incision should be
3mm deep.
2. Start the timer as soon as the blood appears and don’t forget to wipe to first
drop of blood to prevent contamination of tissue juices. Wait for 2 minutes
for blood to clot.
3. After 2 minutes, break off the capillary tube from 1-2cm from end.
4. In the absence of clot, wait for another 30 seconds and break the tube again.
Repeat the step until a fibrin strand appears.
5. Report the time where fibrin is first seen.
C. Tube Method
○ Also known as the whole blood clotting time; measures all stages of intrinsic
coagulation
○ Materials: venipuncture kit, tube, water bath, whole blood sample
C. Tube Method
○ Procedure:
1. Perform venipuncture and extract 4ml of blood and label 3 test tubes from
#1 to #3.
2. Dispense 1ml of blood in tube #3, then in #2 and lastly in tube #1. Discard
the remaining blood in the syringe. Do not discard the blood in sink.
3. Timer should start as soon the blood interacts with glass tube and place them
in a water bath and incubate at 37C for 5 minutes.
4. After incubation, check any presence of clot in the tube #1 by tilting at 45°
angle. If no presence of clot, return the tube the water bath.
5. Check the presence of clot every 30 seconds. Start checking from tube #1, if
clot is present, move to tube #2 and until to tube #3. You cannot move to
another test tube in the absence of clot of the preliminary tube.
6. Once all tubes have clotted, report the time where clot is seen in tube #3.
Variables Affecting Clotting Time
ü Prolonged clotting time
o Physiologic errors: insufficient blood, intake of heparin, intake of thrombin
inhibitors
o Pathologic cause: coagulation factor deficiencies, presence of circulating
anticoagulants
ü Shortened clotting time

o Physiologic errors: hemolysis, vigorous agitation, pre-exposure to clot
activators

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CT / BT

Clotting Time / Bleeding Time

Ruth Ellen T. Alonzo, RMT

ü Shortened bleeding time

ü Shortened clotting time

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