Khaled alzatari

2020

Clotting Time CT.

Coagulation
♥ Coagulation is a complex process by which
blood forms clots.

♥ Coagulation begins almost instantly after an

injury to the blood vessel has damaged the
endothelium (lining of the vessel).

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 Hemostasis
♥ Primary hemostasis:
 platelets immediately form a plug at the site of injury

♥ Secondary hemostasis:
1. proteins in the blood plasma (clotting factors) respond in a
complex cascade
2. to form fibrin strands
3. which strengthen the platelet plug

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2. Secondary hemostasis
The coagulation cascade
♥ The coagulation cascade of secondary hemostasis has
two pathways:

1. The contact activation pathway (formerly known as the

intrinsic pathway)

2. The tissue factor pathway (formerly known as the extrinsic

pathway)

That lead to fibrin formation.

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(Clotting Time) CT.
♥ It is the time required for blood to clot without the
presence of any substance

♥ Used as a screening test to measure all stages in the

intrinsic coagulation system and to monitor heparin
therapy
 A time-consuming test
 Has poor reproducibility
 Is sensitive only in extreme factor deficiencies
 Insensitive to high doses of heparin
 Therefore, of limited use in today’s laboratory

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 Coagulation Tests
1. Tests of the Vascular Platelet Phase of
Haemostasis:
 Platelet count
 Bleeding Time (BT)

2. Tests of the Coagulation Cascade:

 Clotting Time ( CT) or Coagulation time
 Activated Partial Thromboplastin Time (APTT).
 Prothrombin Time (PT).

3. Tests of Fibrinolysis and the Mechanisms That

Control Hemostasis:
 Fibrin Degradation Products (FDP)

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Clotting Time (CT)
♥ Prolonged clotting times are generally found in:
 Severe hemophilia
 A fibrinogenemia
 Sever fibrinolytic states
 Circulating anticoagulants ( inhibitors)

♥ Three procedures are currently in use for

determining the clotting time:
 The Tube Method
 The Capillary Method
 The Slide Method

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Clotting time – Tube method

♥ Specimen
 Fresh whole blood, 4 ml

♥ Principle
 The coagulation time of whole blood is the length
of time required for a measured amount of blood
to clot under certain specified conditions

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Clotting time – Tube method

♥ The normal range

◦ 5 to 15 min.
BUT
◦ Each laboratory should determine its own normal
values

♥ Reagent & equipment

1. Water bath, 37Cₒ
2. Glass test tube
3. Stopwatch
4. Plastic syringe and 20-G needle

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Procedure -Tube method
1. Label 3 glass test tubes with patient name and number
them, #1, #2, and #3

2. Perform a clean venipuncture using a 20-gauge needle

and withdrawn 4 mL of blood

3. Remove the needle from the syringe, and carefully

place 1 mL of blood in test tube #3, 1mL in tube #2,
and 1mL in tube #1.
• The last 1 mL of blood may be discarded.
• Start the stopwatch as soon as the blood is placed in
tube #3.

4. Place the three test tubes in a 37°C water bath

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Procedure – tube method

5. At exactly 5 min. title test tube #1 gently to a 45°

angle. Repeat this procedure every 30 seconds, until
the test tube can be completely inverted without
spilling the contents (that is, until the blood is
completely clotted).

6. Record the time it took the blood in test tube #1 to

clot.

7. 30 sec. after the blood in test tube #1 is clotted.

Proceed with tube #2, and repeat the preceding
procedure, tilting the test tube every 30 seconds, until
a clot is formed. Record the results. Repeat this
procedure for test tube #3

8. Since agitation and handling speed up coagulation, the

clotting time test tube #3 is the reported result.
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Source of errors
1. Poor venipuncture technique, causing hemolysis or
tissue thromboplastin to mix with the blood
 shortens the clotting time.
2. Bubbles entering the syringe when the blood sample
is being obtained
 increase the rate of coagulation.
3. Unnecessary agitation of the blood
 shortens the coagulation time.

Note: Always tilt the tube in the same direction and at

the same angle so that the blood is moving in the
same pathway up the side of the tube each time.

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 Clotting time - capillary method
(Extrinsic)
♥ The normal range
◦ 5 to 10 min

♥ Reagent & equipment

1. Sterile needle or lancet

2. Stop watch
3. Dry glass capillary tube
4. Cotton Swab
5. 70 % ethyl alcohol

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 PROCEDURE – Capillary Method
1. Clean finger with alcoholic 70 % with cotton swab,
allow to dry
2. Pricked the finger by lancet, remove the first drop of
blood.
3. Squeeze the finger to obtain a larger drop of blood
and fill the capillary tube with blood
4. The capillary tubes are sealed plasticine and immersed
in water bath at 37 Cₒ
5. After one minute, start breaking small pieces of the
capillary tube every 30 second until a fibrin thread is
seen between the two broken ends

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PROCEDURE – Capillary Method

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 Clotting Time - Slide Method
(Intrinsic)

♥ The surface of the glass tube

initiates the clotting process.
This test is sensitive to the
factors involved in the
intrinsic pathway
♥ The expected range for
clotting time is 4-10 min.

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