PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE II - LABORATORY
Lesson 11: Bleeding Time and Clotting Time
Introduction
The bleeding time (BT) is the time it takes for a standardized incision to stop bleeding. It tests: (a) the
ability of platelets to form a plug strong enough to stop bleeding from an incision; and, (b) the ability of the
capillary blood vessels to contract and slow blood flow to the area. BT is prolonged in the following
conditions:
1. Thrombocytopenia (particularly <100x109/L)
2. Thrombasthenia (platelet dysfunction, affect the ability of the platelets to stick to each
other to form a plug)
3. Von Willebrand’s disease
4. Intake of aspirin and certain other medications and herbs
Test results may also be affected by the type and condition of the patient’s skin, vascularity, and
temperature, as well as, the phlebotomist’s technique. Therefore, the BT is considered a screening test, and
abnormal results are followed by additional testing. BTs may be ordered as part of a pre-surgical workup or
evaluation of a bleeding disorder; however, the BT has essentially been replaced by other platelet
function tests.
Manual Methods for Bleeding Time:
1. Duke (Slide/Drop Method) (oldest, earlobe/fingertip, CTBT, 3mm deep)
2. Ivy (BP cuff 40mmHg, two standardized punctures on volar surface of forearms 5-10cm
apart)
3. Standardized Template (e.g. Surgicutt®) (modified/improved Ivy method, more accurate,
reproducible results, automated incision-making device, 5mm long, 1mm deep)
Clotting (coagulation) time, on the other hand, is the time it takes for blood to solidify after it has been
removed from the body. It is reflective of the normal function of the coagulation pathway; however, PT and
aPTT has replaced its usefulness for screening coagulopathies.
(Bleeding time: primary hemostasis/platelet-plug formation and blood vessel function; Clotting
time: secondary hemostasis/clotting - coagulation pathway)
Learning Objectives
At the end of this experiment, the learners will be able to:
1. Define bleeding time and clotting time
2. Enumerate the different methods for bleeding time
3. Demonstrate the Duke method properly
Resources
1. PPE 5. Stopwatch
2. Disposable sterile lancet 6. Alcohol wipes
3. Unused/clean glass slide 7. Cotton/gauze pads
4. Filter paper
Principle
The Duke method uses a standardized incision to determine the length of time a patient takes to stop
bleeding. It also uses a drop of blood on a slide to determine the length of time it takes for blood to clot. Both
are indicative of possible bleeding tendencies in the patient.
Procedure: Duke Method
1. Identify the patient following routine protocol.
2. Explain the procedure to the patient, and, verify the collection orders and other necessary information.
(Intake of aspirin and other drugs that may affect results)
3. Prepare necessary materials. Perform hand hygiene and wear gloves prior to patient contact.
PRINCIPLES OF MEDICAL LABORATORY SCIENCE PRACTICE II - LABORATORY
4. Choose puncture site and perform the puncture according to proper capillary puncture procedure.
(3mm depth since this is Duke method)
5. Upon puncture, start the timer for both bleeding time and clotting time.
6. Collect the first drop of blood onto the center of the glass slide.
7. For bleeding time, blot the drop at 30-second intervals without letting the filter paper touch the wound.
(So the platelet plug will not be disturbed) Stop the timer when the blood no longer stains the paper.
(Round off to nearest 30 seconds)
8. For clotting time, pass the tip of the lancet through the drop of blood on the glass slide at 30-second
intervals and note the formation of fibrin strands. (mucus-like strand from the blood to the lancet
tip) Ensure that the glass slide is within eye level when doing this. Stop the timer when fibrin strands
are seen clinging to the tip of the lancet.
9. Dispose all wastes properly.
10. Remove gloves and perform hand hygiene
11. Document the results.
NOTES:
1. The pressure on the lancet affects the bleeding time; thus, pressure must be consistent in every test
performed.
2. Incision may either be parallel or perpendicular to the fingerprints. Results vary depending on the
direction; therefore, direction must be consistent in every test performed.
References:
The Complete Textbook of Phlebotomy 5th Ed.; The Phlebotomy Textbook 3rd Ed., Hematology II
Lecture and Laboratory Guide by M.E.H. Sales 2013
