Bleeding time and clotting time

AIM : To determine bleeding time

Bleeding time is a test of platelet function. The time elapse between skin prick and for the
bleeding to arrest (time for a platelet plug to form).

Objectives: (Student should be able to)

1. Perform these tests

2. Tell the principle underlying

3. Tell the clinical significance of the tests.

Reagents and apparatus:

a) Blotting paper
b) A stop-watch
c) A sterile lancet
d) Alcohol swabs

Procedure : (Duke’s method); the simplest is the Duke’s method.

a) After following sterile precautions, prick the fingertip deep enough (2 3 mm) to result in
bleeding. Note the time of onset of bleeding.
b) Apply a piece of filter paper to the blood-drop every 30 seconds until the bleeding stops.
Note the time when no trace of blood on the filter paper
c) Count the spots of blood on filter paper and express bleeding time in minutes and
seconds.
d) The bleeding time estimated by this method of a normal subject is within the range of 2-5
minutes.
e) The upper limb should be held vertical and pressure applied on the forearm to increase
pressure in the finger veins
f) Though the test is popular, its drawback is the lack of reproducibility because the amount
of pressure applied on the forearm is not constant.
Ivy method: standard method
a) following sterile precautions, a standard wound 1 mm wide and 3 mm deep is inflicted on
the ventral surface of the forearm about 2 inches below the elbow.
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 b) A blood pressure cuff is applied on the arm on that side and kept inflated at 40 mm Hg to
occlude venous outflow from the forearm.
c) The test is timed using a stopwatch.
d) The puncture is blotted with a filter paper every 30 seconds.
e) Caution must be exercised not to cut subcutaneous veins. When bleeding ceases, the BP
cuff can be released.
Normally, bleeding time by this method ranges from 1-7 minutes. A value exceeding 10 minutes
is clearly abnormal.
Observation and Results:

1. The individual’s Bleeding time is :……………………

AIM: To determine Clotting time by capillary method

The time from pricking the finger to the appearance of the clot is the clotting time

Reagents and apparatus:

1. Glass capillary tubes of uniform size( Non heparnised )

2. A Petri dish
3. Alcohol swabs
4. Cotton wool
5. Sterile lancet

Procedure:

a) Clean finger with aseptic alcohol swap.

b) Prick the finger with lancet resulting bleeding and note the time of onset of bleeding.
c) Wipe away the first drop of blood, Fill freely flowing blood is taken into a capillary tube
about 8 cm long with out air bubble, holding the tube horizontally let it fill by capillary
action.
d) Roll the capillary gently between the palms, Fill more than one tube.
e) At the end of two minutes after making the puncture, break off 0.5cm of capillary tube
(blood containing end) and separate the two halves slowly.
f) Repeat the procedure at 30 second intervals with the remaining tubes.
g) When the blood forms a continuous thread-like clot between the broken ends of the tube,
the end-point has been reached, Note the time.
h) Clotting time by this method is 2-6 minutes.

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Precautions:
1. There should not be any air bubbles in the blood column in the capillary
2. Hold the capillary horizontally between the palms to maintain body temperature.

Observation and Results:

1. The individual’s Clotting time is :……………………

Student assignment:

Please answer the following questions briefly:

1. What does bleeding time reflect?

2. What does clotting time reflect?

3. Why is bleeding time prolonged in thrombocytopenia?

4. Why is bleeding time prolonged in von Willebrand’s disease?

5. What happens to clotting time in von Willebrand’s disease? Why?

6. What further tests would you perform when clotting time is increased?

7. Why is clotting time prolonged in patients with chronic liver disease?