Bleeding Time (BT)

Clotting Time (CT)

-Dr Abdul Khader
What happens 1st

• Bleeding Stops (Haemostasis)

• Later clot formation
Recap Haemostasis and Coagulation
 Haemostasis
• Spontaneous arrest of Bleed (3 Steps)
• 1)Vasoconstriction: Initial vasoconstriction due to 5HT receptors nd other
vasoconstrictors
• 2)Platelet plug Formation
Adhesion (Damage collagen nd endothelial cell>platelet swell,
irregular pseudopodia formation, >release of many factors >
become sticky ,adhere to the damaged collagen nd endothelium)
Activation (Platelet release ADP nd Thromboxane A2, activates the
adj platelet which causes their adhesion to the originally activated
platelet > leads to activation and adherence of large no of Platelets)
Aggregation (Large no of activated platelet stick to form aggregation)
Formation of Hemostatic Plug
Inhibition of further Plug Formation (by Prostacyclin)
Clot Formation
• Intrinsic(Damaged endothelium)
• Extrinsic (External Injury)
Determination of BT (Duke Method)
• Principle (Deep skin puncture in made, and the time for bleeding to
stop is recorded, it determines fn of platelet and integrity of capillary)
• Requirements (lancet , Blotting paper, stop watch)
 Procedure
• Clean the finger tip or Ear lobe (Good site) with
alc and allow it to dry
• Deep puncture by lancet
• Immediately start the stopwatch
• Blot the drop of blood every 30 sec on the
blotting paper
• Stop the stop watch as soon as bleeding stops
• Count the number of drops and calculate the
bleeding time
• NORMAL RANGE : 1 to 5 mins
Precautions
• Do not rub the skin too much b4 the prick
• Skin to dry completely b4 the prick
• Puncture min 4mm
• Do not squeeze
• Exactly 30sec blotting
• Do not press the filter paper on the bleeding spot
• If >10mins apply pressure and stop
Significance
• Thrombocytopenia
• DIC
• Von willibrand disease
• Aplastic anaemia
• Vascular Abnormalities like Ehler danlos syndrome or Osteogenesis
imerfecta

• Other Method : IVY METHODE (More Reliable but Painful)

Determination of CT (Capillary tube
methode)
• Principle (Standard incision is made on skin and blood is taken into a
capillary tube , the time taken for clot to form by appearance of fibrin
string , is reported as CT)
• Requirements (Lancet ,capillary tube{10to 15 cm and 1.5mm dia} stop
watch)
 Procedure
• Sterile finger puncture atleast 3mm depth
• As soon as blood is visible start stopwatch
• Wipe of the 1st drop and allow the next drop to
flow in the capillary tube by introducing one end
into the drop and other end at a lower level
• Hold the capillary tube between the palm to
maintain body temp
• After 2 mins ,break off the capillary tube 1-2cm
from one end every 30 secs and look for
appearance of fibrin thread
• When u c a thin string of fibrin, note the time
• Normal value: 2-8mins
Precautions
• Finger tip to b cleaned
• Deep puncture
• Once capillary tube filled to b held between the palms ASAP coz temp
affects the clotting
• With each break the fibrin sting has to b noted
Clinical significance
• CT is prolonged in diseases where Clotting factor is deficint
• Haemophilia A : 8
• Haemophilia B or Christmas disease : 9
• Stuart factor deficiency : 10
• Von Willebrand disease :VWB factor
• Fibrinogenopenia : 1
• Hypoprothrombinaemia : 2

• Other methode (Lee white method , reliable but difficult)

Antihaemostatic Mech
• Preventing platelet aggregation (Prostacyclin)
• Circulatory anticoagulants (Heparin , Antithrombin 3, Protein C)
• Fibrinolytic mech (Plasmin)
Thankyou
Reference : GK Pal Practical Physio
Indu Khurana Physio Text book