UPH –DJGTMU

Bleeding Time DUKE METHOD

Duke method
BLEEDING TIME materials :
●​ Sterile Blood Lancet
Bleeding Time is used to measure the duration of ●​ Stopwatch
bleeding after a measured skin incision. ●​ Sterile Filter Paper
●​ depends on the elasticity of the blood ●​ Gauze Pads or Cotton Balls
vessel wall and on the number and ●​ 70% alcohol or povidone iodine solution
functional capacity of platelets. procedure :
●​ usually performed on patients with a ➔​ Prepare all materials needed.
personal or family history of bleeding ➔​ Obtain a piece of filter paper and
disorders stopwatch.
○​ useful along with a platelet ➔​ Clean the middle or ring finger then allow
count for preoperative the skin to air dry.
screening ➔​ Make a puncture 2-4 mm deep in the
●​ not recommended for patients with earlobe or finger using a lancet
platelet count of less than 75,000 uL ➔​ Start stopwatch immediately.
➔​ Blot the filter paper every 30 seconds
3 methods: until bleeding stops
1.​ Template ➔​ Record bleeding time​
most common and most accurate because the incision
size is the standardized
reference range :
2.​ Duke Method
●​ 1-3 minutes
3.​ Ivy Method
notes
should be the blood flow mire than 15 minutes,
PRINCIPLE discontinue the test and report as “greater than 15
minutes”

●​ The test is performed by using a sterile

blood lancet to make a measured skin
puncture in the earlobe or forearm.
●​ The time is started immediately after the
puncture.
●​ Touching a piece of filter paper to the cut
every 30 seconds until bleeding ceases
and record the time and reported as
bleeding time.

Ask the patient’s history for recent use of drugs

that prolong bleeding time, including
-​ sulphonamides
-​ thiazide diuretics
-​ antineoplastic
-​ anticoagulants
-​ non steroidal inflammatory drugs
-​ aspirin and aspirin compounds
-​ some non narcotic analgesics
 IVY METHOD

Ivy method
materials :
●​ Sterile Blood Lancet
●​ Stopwatch
●​ Sterile Filter Paper
●​ Sphygmomanometer
●​ Gauze Pads or Cotton Balls
●​ 70% alcohol or povidone iodine solution​

procedure :
➔​ Prepare all materials needed.
➔​ Obtain a piece of filter paper and
stopwatch.
➔​ Position patient’s arm with the volar
surface exposed.
➔​ Place the sphygmomanometer on the
upper arm.
➔​ Clean the puncture site then allow the
skin to air dry.
➔​ Apply the cuff and inflate to 40 mmHg,
and hold the exact pressure during the
duration of the test. (time on incision and
inflation should be 30-60 seconds only)
➔​ Make 3 same puncture. Avoid
subcutaneous veins.
➔​ Start stopwatch immediately.
➔​ Blot the filter paper every 30 seconds
➔​ Stop the timer when no bleeding is seen,
or only clear fluid is absorbed by the filter
paper. The nearest 30 seconds is the
bleeding time.
➔​ Release the pressure from
sphygmomanometer Bleeding Time
➔​ Record the result and get the average
bleeding time in minutes and seconds​

reference range :
●​ 3-6 minutes
●​ borderline: 6-11 minutes

Note/ Sources of error:

-​ If body hair will interfere, lightly shave
the area.
-​ Patient should be advised of a potential
to produce scar.
-​ aspirin may prolong result up to 2 weeks
-​ A standardized cut is necessary.
-​ Low skin temperature may reduce blood
flow.
-​ If bleeding still continues after 15
minutes, discontinue the test and report
as "greater than 15 minutes".
Clotting Time
➔​ Disinfect site of puncture with 70% ethyl
alcohol, air dry.
➔​ Puncture to a depth of 3mm using a
blood lancet.
CLOTTING TIME ➔​ Start timer as soon as the first drop of
blood appears.
Clotting Time is the measured time between when ➔​ Transfer the three drops of blood onto a
bleeding starts and when the fibrin clot thread is clean glass slide.
first seen on the whole blood. ➔​ Careful not to touch the skin.
●​ checks if the patient has a deficiency in ➔​ Pass the tip of the lancet through the first
the coagulation factors. drop of blood every 30 seconds. Repeat
●​ is rarely used nowadays in laboratory with drop number 2 and 3.
practice and is obsolete as it may be ➔​ Stop the timer once fibrin strand appears
affected by different interfering factors. on the third drop.
➔​ Record the result.
Instead of clotting time, physicians will opt to ➔​ Clean area.​
choose more sensitive markers such as
➔​ prothrombin time reference range :
➔​ activated partial thromboplastin time ●​ Slide method : 2-4 minutes
➔​ thromboplastin time
➔​ fibrinogen in checking for patient
hemostasis WRIGHT’S METHOD

Methods: Wright’s method (Glass capillary)

1.​ Slide Method materials :
2.​ Wright's Method (Glass Capillary) ●​ Blood lancet
3.​ Lee and White Method ●​ Capillary tube, non-heparinized
●​ Timer/stopwatch
●​ Cotton
●​ 70% Ethyl Alcohol​

procedure :
➔​ Prepare all materials needed.
➔​ Apply 70% alcohol to the clean finger with
cotton swab. Allow it to dry naturally.
➔​ Prick the finger with usual aseptic
precautions. Immediately start the
stopwatch.
➔​ Dip one end of the capillary into blood
drop gently without pressure.
➔​ Allow to fill the capillary with blood by
lowering the end of fitted capillary. (Do
not stuck the blood around 3/4 of its
SLIDE METHOD length undipped)
➔​ After about two minutes start snapping
off small lengths of the tube at intervals
Slide method
of 15 seconds. Repeat until fibrin threads
materials :
are formed.
●​ Blood lancet
➔​ Record the time interval between pricking
●​ Glass slide
of finger and appearance of fibrin thread.
●​ Timer/stopwatch
➔​ Clean area.​
●​ Cotton
●​ 70% Ethyl Alcohol​
reference range :
●​ Wright’s method : 4-9 minutes
procedure :
➔​ Prepare all materials needed.
 procedure :
LEE AND WHITE METHOD
➔​ Prepare all materials needed
➔​ Label 3 tubes with patient's name and
Lee and white method number (1, 2, 3)
The coagulation of blood is the length of time ➔​ Perform venipuncture using 20g needle
required for a measured amount of blood to clot and draw 4mL of blood.
under certain conditions. ➔​ After drawing blood, remove needle, and
​ The test is based on the fact that when add imL of blood from each tube in
venous blood is put into glass tube chronological order.
-​ it will form a solid clot. ➔​ Place 3 tubes in water bath.
​ The time required for this response is a ➔​ Gently tilt test tube after 5 minutes (tube
measure of the number 1).
a.​ overall intrinsic ➔​ Once tube number 1 starts to clot, check
b.​ common pathways of for the clot formation in tube 2 and 3
coagulation every after 30 seconds.
materials : ➔​ Record the time blood on tube number 3
●​ Glass test tubes, 3 pieces clotted
●​ Syringe ➔​ Clean area.​
●​ Water Bath 37C
●​ Timer/ Stopwatch reference range :
●​ Modified lee and white method : 7-15
minutes
Clot Retraction Time MCFARLANE METHOD

Mcfarlane method
CLOT RETRACTION TIME materials :
●​ Venipuncture materials
Clot Retraction Time measures the amount of time ●​ Test tubes (plain)
it takes for a blood clot to pull away from the walls ●​ Cork
of a test tube. procedure :
➔​ is used to evaluate and manage blood ➔​ Prepare all materials needed.
platelet disorders ➔​ Proceed with whole blood collection via
◆​ including Glanzmann's venepuncture.
thrombasthenia. ➔​ Fill a 5mL, non-anticoagulated test tube
with venous blood.
Fibrin : a fibrous protein involved in the clotting of ➔​ Fuse a coiled wire into blood with cork
blood fitted on the neck of tube.
➔​ which forms a mesh in hemostatic plug ➔​ Incubate blood at 37 C, checking for clot
over a wound site. every 5 to 10 minutes interval.
➔​ Remove tube in incubator after 1 hour.
When whole blood is allowed to clot ➔​ Observe for retraction. (blood retracted
spontaneously are attached to coiled wire)
​ the initial coagulum is composed of all ➔​ Record the clot retraction time and
elements of blood. volume.
➔​ Clean area.
​ With time, coagulum reduces in mass and
normal value :
the serum is expressed from the clot.
●​ Clot Retraction : 44-67%
-​ This is due to action of the
●​ Clot Retraction Time : 0-2 hours
platelets on the fibrin network.

Serum : Clear yellowish fluid obtained upon

separating whole blood into its liquid and solid
components after it has been allowed to clot.

Importantly, clot retraction time reflects the

completion of the overall platelet function,
●​ from platelet adhesion to aggregation
until it reaches the retraction phase.
 HIRSCHBOEK METHOD

Hirschboek method
materials :
●​ Venipuncture materials
●​ Test tubes (plain) and rack
●​ Sahli pipette
●​ Incubator/water bath
●​ Castor oil
procedure :
➔​ Prepare all materials needed.
➔​ Proceed with whole blood collection via
capillary puncture.
➔​ Place about 10 mL of Castor oil in a test
tube
➔​ Wipe first drop of blood from capillary
puncture. Create a large drop of blood
from the capillary and drop in the test
tube with castor oil. Avoid presence of
clot or introduction of blood on the sides
of tube.
➔​ Observe for the dimpling phenomenon
extrusion of the blood to clot.
➔​ Record the time from collection to
presence dimpling/extrusion of serum.
➔​ Clean area.

STEFANINI- DAMESHEK METHOD

Stefanini-dameshek method
materials :
●​ Venipuncture materials
●​ Test tubes (plain) and rack
●​ Incubator/water bath
●​ timer
procedure :
➔​ Prepare all materials to be needed.
➔​ Proceed with whole blood collection via
venepuncture.
➔​ Place 3 mL of blood in a test tube without
anticoagulant.
➔​ Incubate for 37 C.
➔​ Clot retraction will start after 1 hour.
➔​ Observe clot retraction until completed
within 18-24 hours
➔​ Record the time from collection to
presence of dimpling/extrusion of serum.
➔​ Clean area.
Reporting of Result :
●​ Normal of complete rectractility
2-4 hours
●​ Poor
4-24 hours
●​ None
no retraction after 24 hours