BT CT Hess Test Clot Retraction Time

BLEEDINF TIME and CLOTTING TIME
DEPT- M.Sc MLT( Haematology &

Blood Transfusion)
Introduction
• Disorder of hemostastis are broadly divided into
bleeding disorders and thrombotic disorders.
• Most bleeding disorders are caused by one of the
three defects-
I. A defect in platelet number or function
II. A defect in platelet-vessel wall interaction
III. A defect or deficiency in coagulation factor
There are the certain laboratory tests which helps to
diagnose the bleeding disorders
BLEEDING TIME
• Test assesses primary haemostasis
• Used as a screening test for disorders of
platelet-vessel wall interaction
• Introduce by Duke in 1900.
• It measures the time required for bleeding to
stop after a standardized superficial cut of the
skin
• Normal bleeding time is between 2-6 minutes
METHOD
The three method is commonly used:
• Duke’s method
• Ivy’s method
• Template methods
• Duke’s method- measures bleeding time
following ear lob puncture.
Is not advocated since it cannot be standardized
and can cause a large local hematoma.
REQUIREMENTS
- Stopwatch
- Lancet
- Filter paper
- Glass slide
- Alcohol sponges
METHODS
- Clean the ear lobe with alcohol and let it dry
- Hold the glass slide behind the ear lobe
- Pierce the ear lobe by a lancet against the glass slide
- Start the stop watch when the stab was made
- Bleeding of the wound should be allowed to proceed without
pressure and blood is allowed to drop on the filter paper
- The paper should be moved so that each drop will
fall on fresh area
- When bleeding slows, the wound is touched
gently with fresh area of the filter paper at 30 sec
intervals.
- When blood no longer stains the filter paper, the
watch is stopped and the time recorded.
Normal value-
- The normal range is up to 6 mins
- Between 6-10 mins, the result are borderline
- Over 10 mins is definitely abnormal
• Ivy’s method- Three standard puncture are made
with a lancet on the volar surface of the forearm
under standard pressure and the average time
required for bleeding to cease from the puncture
sites is measured.
EQUIPMENTS-
- Sphygmomanometer
- Lancet
- stopwatch
- Filter paper
METHOD
- A sphygmomanometer cuff is wrapped around
thee upper arm and inflated to 40 mm of Hg.
- The dorsal surface of the forearm is cleaned with
70% ethanol and allowed to dry
- Three puncture are made about 1mm deep and
start a stopwatch soon after the puncture
- Blood oozing from the puncture wound is gently
blotted with filter paper at 15 sec intervals
- The timer is stopped when blood no longer
stains the filter paper
- The time required for bleeding to cease from all
the three puncture wounds is noted. The
average time is reported as the bleeding time.
- Sterile adhesive strip is applied over the
puncture.
Normal range-
- Normal values are 1-6 mins
- More than 6 mins should be taken as abnormal
• Template methods-
- it is a disposable blade fitted on to a holder made of
plastic and is used for the test.
- the blade projects through the bottom so that the
incision made through the slit is 9mm long and
1mmdeep
Principle- a small skin cut of a standard size and depth is
made and the oozing blood is wiped with a filter paper.
Bleeding stops when the capillaries contract and platelet
plug seals the vessel.
• Aantages;
- Test is very sensitive and reproducible
- Detect even minor alterations in platelet function.
Procedure –
- Patient is made sit on a chair with an arm rest, so that
the forearm is steady and exposed
- The skin of the forearm is cleaned with alcohol and
allowed to dry
- Sphygmomanometer cuff is tied to the upper arm and
the cuff is inflated to 40 mm Hg
- A site on the forearm is selected away from the
superficial veins
- Place the template 5cm distal to anticubital crease
- One cut is made using a smooth rapid movement with
the template
- Immediately after the incision, a stop watch is started
- Another cut is made 1.5-2 cm away from the first one
and another stop watch is started
- The blood oozing from the sides of the cut is blotted
with filter paper, every 30 sec until bleeding stops
- Time at which bleeding stops is noted for both cuts
- Place a butterfly adhesive bandage over the site of
puncture to avid scarring
- Average of the two readings is the bleeding time for the
patient.
NORMAL RANGE: 2-9minutes

USES-
- Test is prone to problems of reproducibility,
sensitivity and specificity
- This test evaluates the defects of primary
haemostasis
CLOTTING TIME
Clotting time measures the time required for the
blood to clot.
It measures all stages of intrinsic coagulation
Normal range is between 8-15 minutes
Method-
- Lee and white method (venepuncture method)
- Capillary method
• Lee and White method- It measures the time
taken for the fresh blood to clot
NORMAL VALUE : 4-11 minutes
Equipments-
- Cotton wool, surgical gauze, syringe
- Test tubes
- Water bath-37 degree Celsius
- Stop watch
PROEDURE:
• 2ml of venous blood is collected with aseptic precaution
• Label 2 test tubes as no. 1 and 2 and keep in a water bath
at 37 Degree celsius
• After 3mins tilt the first tube at an angle 45 Degree
• If not clotted return to water bath
• Examine at an interval of 30 sec
• When the blood is clotted it can be tilted at an angle of
90 Degree without spilling the contents.
• As soon as the blood is clotted, immediately examine the
second tube
• Stop the stop watch and note the time
• Coagulation time is the clotting time of the second tube.
• CAPILLARY METHOD
NORMAL VALUE: 1-5 minutes
Equipments-
- Disposable lancet
- Capillary tubing
• Procedure
- Clean the finger tip with a cotton spirit and wait for a sec to
dry.
- Warm up the finger for skin puncture
- Make an incision with a sterile disposable lancet to depth of
30mm.
- As soon as the blood is visible start the stop watch
- Wipe off the first drop of blood
- Allow 2nd drop of blood to flow to capillary tube
- After 2 mins break off the capillary tubing 1-2cm from the
end.
- When a thin string of fibrin can be seen in between the
broken end of the capillary tube, stop the watch and note
the time.
HESS TEST
• Also know as tourniquet test or Rumpel-Leede
test or capillary fragility test.
• This test measures the ability of capillaries to
withstands the increased stress
Normal: 0-5
METHOD
• Inflate the blood pressure cuff on the upper to a
point midway between the systolic and diastolic
pressure for 5mins
• Release and make an imaginary 2.5cm square or
1 inch square just below the cuff at the
antecubital fossa
• Count the number of petechia inside the box.
• Presence of more than 10 petechia is considered
a positive test.
Positive test
CLOT RETRACTION TIME
DEFINITION- The time required following for
withdrawal of a blood clot to completely
contrast and express the serum entrapped
within the fibrin net.
usually completed in 18-24 hours.
Clot retraction depends on the number of
platelets in the specimen.
PRINCIPLE
After the coagulation of blood, the clot under the
action of thrombasthenin undergoes contraction and
starts retracting within one hours. The clot shows
50% retraction in 2 to 4 hours. This process is
completed in 18-24 hours with separation of serum.
Subsequently, the fibrin clot dissolves due to
fibrinolysis and the RBCs sink to the bottom. Clot
retraction is dependent on normal platelet number,
platelet function, concentration of fibrinogen and the
activity of the fibrinolytic pathway.
PROCEDURE
• Place a tube containing blood in a water-bath
at 37 Degree Celsius.
• Examine the clot after 1 hour and after 24
hours.
• Note the size, consistency of the colt and the
nature of retraction.
• Continue observation of clot for 72 hours to
assess the clot lysis.
NORMAL VALUE
• Normal clot retraction shows more than 50%
of serum separated at the end of 24hours.
• A normal clot is firm, rubbery, elastic and not
easily broken
INTERPRETATION
Absent or reduced clot retraction is seen in-
• Fibrinogen deficiency
• Thrombocytopenia
• thrombasthenia
REFERECES
• Daice and lewis Practical Hematology
• Essential of Hematology by Shirish M
Kawthalkar.
• Essentials in HEMATOLOGY and CLINICAL
PATHOLOGY- Nayak Rai Gupta
• HEMATOLOGY for Students and Practitioners-
Ramnik Sood
THANK YOU

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BLEEDINF TIME and CLOTTING TIME

DEPT- M.Sc MLT( Haematology &

NORMAL RANGE: 2-9minutes

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