HEMOSTATIC TEST

Rahajuningsih D. Setiabudy
Conditions that need hemostatic test
 Bleeding symptoms
 Bleeding history
 Prior to surgery
 Monitoring of anticoagulant therapy
 Hemostatic screening tests
Bleeding time
Tourniquet test
Platelet count
Prothrombin time (PT)
Activated partial thromboplastin
time (APTT)
Thrombin time (TT)
Screening for F XIII
 Bleeding time
To evaluate vascular and platelet
(number and function)
Sphygmomanometer at 40 mm Hg
Make an incision using lancet at volar
Every 30 seconds blot the blood by
filter paper
 Tourniquet test
To evaluate integrity of vascular wall
Sphygmomanometer at pressure
between systolic and diastolic for 10
min.
Release the pressure and observe
the appearance of petechiae
Positive : > 10 petechiae
 Platelet count
Manual method: EDTA blood, Rees
Ecker or ammonium oxalate
Indirect method: blood smear,
compared with RBC count
Automatic cell counter: should be
rechecked on blood smear
Platelet is fragile, tend to aggregate
and to adhere to glass surface
 Prothrombin time
To evaluate extrinsic and common
pathway (VII, X, V, II, I)
To monitor oral anticoagulant
therapy, reported in INR
(international normalized ratio)
Prolonged PT : deficiency or inhibitor
in the extrinsic or common pathway
FXII
PK HMWK
F XI F VII

F IX
F VIII
PT
FX
FV
F II
FI

clot
Activated partial thromboplastin
time
To evaluate intrinsic and common
pathway
To monitor heparin therapy, the
result shoud be 1,5 – 2,5 x control
Prolonged APTT : deficiency or
inhibitor in the intrinsic or common
pathway
 FXII
PK HMWK
F XI F VII

F IX
F VIII
APTT
FX
FV
F II
FI

clot
 Thrombin time
To evaluate the changes of
fibrinogen to fibrin
To monitor heparin therapy
Prolongation of TT:
– Hypofibrinogenemia
– Dysfibrinogenemia
– Inhibitor of thrombin (FDP, heparin)
 FXII
PK HMWK
F XI F VII

F IX
F VIII
APTT PT
FX
FV
F II
FI TT

clot
 Screening for F XIII
Deficiency of F XIII cannot be detected by
PT, APTT, TT
F XIII deficiency : clot is not stable in urea
5M
 Test for fibrinolytic system
Whole blood clot lysis
Euglobulin clot lysis time
Serial thrombin time
FDP, D dimer
Plasminogen activity
Antiplasmin
PAI
Plasmin-antiplasmin complex
 Hemostatic special test
Platelet Anti Xa
aggregation Antithrombin
FDP, D dimer Protein C
Coagulation factor Protein S
Von Willebrand’s Fibrinopeptide A
factor Prothrombin
TGT fragment F 1.2.
Prothrombin Fibrin monomer
consumption test complex
Lupus Thrombin-
anticoagulant antithrombin
Thrombotest complex
 Pre analytical factors
Patient preparation:
– Fasting/non fasting
– Medicine: aspirin, NSAID, oral
anticoagulant
– Exercise
Sampling:
– Method of blood collection
– Anticoagulant: sodium citrate 0.109 M
– Syringe and needle
– Container: plastic or siliconized glass