EXERCISE 16

Prothrombin time
• PT- measures the length of time required to form a fibrin clot upon the
addition of excess thromboplastin-calcium substrate to plasma

• Uses
- monitoring patients who are undergoing oral anticoagulant therapy
such as warfarin or coumarin ( drugs that inhibits the activity of factor VII,
X,V,and II)
- additional taest for liver profile assessment
- screening test to determine coagulation deficiencies involve in the
extrinsic pathway of coagulation
Prothrombin Time
• Test Procedure: Refer to your manual
• Notes to remember
1. Na citrate (3.2%) is the anticoagulant of choice for the test
2. Anticoagulant should be proper proportion with blood sample
1part anticoagulant + 9 parts of blood (1:10)
3. Minimum tissue trauma and hemolysis is very essential
4. If syringe is used for the collection of sample , two way syringes are used
5. Used siliconized tubes or plastic tubes. Glass tubes activates factor XII
and VII
Prothrombin time (cont)
6. Test should be done immediately maximum of 2 hours. If not done
immediately, store at 4 degree C with the plasma separated from the
red cell

Sources of error
1. Dirty glasswares or scratched glasswares
2. Improper proportion of blood with anticoagulant
3. Inaccurate temperatures of water bath
4. Reagents that are not properly stored
Prolonged PT maybe due to:
1. Vitamin K deficiency
2. Liver disorders
3. Some coagulation factors deficiency

Reference Value 12-14 seconds

% activity = Control result in seconds X 100
patient’s result in seconds
International Normalized Ratio(INR) – used to standardize results of PT no
matter the testing method is. (Patients PT /Control PT)
Exercise 17 Activated Partial
Thromboplastin Time
APTT –used to screen coagulation disorders in the intrinsic pathway
wchich includes Factors XII, XI,IX ,VIII, prekallikrein or Fletcher factor

Other uses:
- detects the presence of circulating anticoagulants or inhibitors
- monitor heparin therapy
• Refer to your manual the Procedure for APTT

• Same precautions should be observed in the collection of blood

sample as in PT

• Reference value :23.4- 36.2 seconds

Exercise 19 Clot Retraction Time
- CRT is a measure of normal blood (in vitro) to clot or to form a fibrin
mesh and expresses serum

- Directly parallel to platelet count

- Tests to determine CRT

- 1. Castor Oil or Hirschboeck
- 2.Stefanini or Test tube
- 3. Mc Farlane
- Note: 2 and 3 are quantitative test for CRT
Conditons that prolongs CRT
- idiopathic thrombocytopenia
- dysfibrogenemia
- Glanzmann thrombasthenia
- DIC
Exercise 20 Capillary Fragility test
- A tourniquet test

- Determines patient’s hemorrhagic tendency

- Assesses capillary walls

- Test to determine thromcytopenia

- Used to diagnose dengue fever ( WHO algorithm)
CRT cont
Methods
1. Tourniquet or Rumpell- Leede or Hess
2. Suction or Petechiometer

Note: Procedures of the test refer to your manual