Screening tests of Haemostatic system

1. Tourniquet Test 2. Bleeding Time 3. Bedside Clotting Time*

1.Tourniquet Test
= Capillary Resistance Test. = Rumple Leede Test = Hesss Test

Principle :
This test measures the ability of the capillaries to resist pressure. In health, the capillaries of the arm will resist a pressure of 100 mmHg. If the capillaries can not resist, they will break or rupture, tiny spot will then appear. These spots are hemorrhages or ptechiae.

Purpose
To evaluate the capillary resistance

Equipments
Sphygmomanometer Stethoscope Stopwatch Markerpen

Procedure :
Draw with marker pen a circle (5 cm in diameter) in the volar surface of the forearm, about 5 cm below the elbow.

Put on a sphygmomanometer cuff in the upper arm, determine a systolic and diastolic pressures.

Procedure (cont.)
Then deflate to a pressure midway between the systolic and diastolic Leave the inflated cuff in place for 5 minutes. Remove the cuff, let for 5 min.

Interpretation
Inspect the circle for ptechiae. Normal : < 10 ptechiae.

Discussion : (Tourniquet test)

- Explain about principle of the test! - Positive results can be found in some diseases, such as. - What are further tests that should be done?

BLEEDING TIME (Dukes Method)

Principle :

When the skin is incised, haemostatic ability of the body (vascular and platelet system) will make platelet plug to stop the bleeding.
The time needed until there's no bleed seen, is Bleeding Time

Purpose :
To evaluate platelet and vascular ability in performing platelet plug.

Equipments
Blood lancet. Cotton ball soaked in alcohol 70%. Circular filter paper. Stop watch

Procedure
The lobe of the ear is cleaned with alcohol 70% and let dry Use a blood lancet to puncture the earlobe with depth of 3 mm. Start the stop watch. At half minute intervals, gently apply edge of small disc of filter paper to absorb the drop of blood do not touch skin. Use a fresh edge of filter paper disc for each half-minute blotting.

Interpretation
Time in minutes equals number of blots divided by 2. Reference value : 1-3 minutes.

Note :
The size of the blood spot about 1 cm in diameter is desirable, but becomes larger in some cases. However bleeding usually stops for several minutes regardless of the size. Dont wipe off the blood. Gently touch. Note so as not to touch the wound.

 When the blood spot becomes 1 mm or smaller, stop the stop watch.

When bleeding is not stop even for 10 min., discontinue the test. Indicate the result as 10 min or longer. Make the patient cover the wound with a sterile gauze for a while, hemostasis should be confirmed, after which the patient may leave.

DISCUSSION : (Bleeding Time Duke`s)

When the result is > 3 min, it is said as.. What is the difference between Duke's method and Ivy's method?

What further tests would you perform when the result is prolonged?

BEDSIDE CLOTTING TIME

PRINCIPLE :

To record time interval since blood contact with glass surface, until fibrin network performed at the room temperature.

 Sample :
Capillary blood

Equipments :
1. 2. 3. 4. 5. Clean, oil free, dry and smooth object glass Stop watch Needle Sterile blood lancet Cotton ball soaked in alcohol 70 %.

PROCEDURE
1. Clean the finger tip with alcohol 70 %, let dry. 2. Puncture with blood lancet, 3 mm in depth. 3. Wipe the blood drop with dry cotton. 4. Drop the next blood drop onto the object glass (4-5 mm in diameter) and start stopwatch immediately as the blood touch glass surface. 5. Put the second drop beside the first one with same size in diameter.

6. Watch the fibrin thread formed in the second

drop of blood by tilt it with a needle every 30 sec 7. When the fibrin was performed, do the same step to the first blood drop and stop the

stopwatch if the fibrin was seen in the first drop

8. Record the time (in minute).

DISCUSSION : (Bedside clotting time)

What are the differences between this method with Lee & White method? Which is better, this method or Lee & White method? Why? In this method, can we assess vascular function?

*** CLOT RETRACTION

Principle
When whole blood is allowed to clot spontaneously, the initial coagulum is composed of all elements of the blood. With time, the coagulum reduces in mass, and fluid serum is expressed from the clot, and its volume stated in %. This is due to an action of platelets on the fibrin network formation.

*** Sample : 5 ml blood obtained from

peripheral vein

Instruments :
1. A set of devices for drawing the blood from peripheral vein

2. Centrifuge glass test tube

3. Wooden stick

4. Centrifuge

***Procedure :
Obtained 5 mL of venous blood Put off the needle and transfer blood into the test tube. Put the tube on the rack. Place the wooden stick vertically on the blood. Leave at room temperature for about 1.5 - 2 hours. After 2 hours, separated blood clot from the test tubes wall carefully, placed the blood clot into another test tube.

***
5. Centrifuge the serum for about 5 min/1000 rpm. 6. Measure the amount (mL) of serum which was performed and compute its percentage