Bleeding Time & Coagulation Time

Presentation by : Dr. Mohammed Abdul Aleem (1st year PG)

Upgraded department of Pathology
Osmania Medical College, Hyderabad

Objectives
To learn the principle, technique and interpretation
of screening tests for haemostasis bleeding time
(BT) and clotting time (CT)
To know the normal range of BT and CT and
abnormal values in diseases.

 Haemostasis is the process by which the bleeding

from an injured site is arrested by formation of
haemostatic plug, followed by removal of that plug
spontaneously in due course of time.
Components of Haemostasis:

1. Integrity of vascular wall

2. Plateletsabnormalities in count and function
3. Coagulation systemvarious plasma coagulation
factors
4. Fibrinolytic mechanism
5. Inhibitors of coagulation

 Normally, a balance is maintained in these

factors.
Anything that interferes with any of these
components results in abnormal bleeding.
For investigation, following scheme is
followed:
A. Clinical evaluation that includes patients history
including intake of drugs, family history, details of
sites of bleeding, frequency, and character of
haemostatic defect.
B. Screening tests for assessment of abnormalities
of various components of haemostasis.

Screening tests for Haemostasis:

1. Disorders of vascular haemostasis:
Bleeding time (BT), Hess capillary test
(tourniquest test)
2. Disorders of platelets:
Platelet count, Bleeding time (BT)
3. Coagulation system:
Whole Blood clotting (coagulation) time (CT),
Activated Partial Thromboplastin Time with
kaolin (APTTK),
one-stage Prothrombin time (PT), Thrombin time
(TT)
4. Fibrinolytic system:

 Blood for coagulation studies is collected by

venepuncture in Trisodium citrate in the ratio of 1:9
Care must be taken that the sample is neither
haemolysed nor clotted.

Bleeding Time
The bleeding time test assesses primary hemostasis.
Bleeding time is duration of bleeding from a standard
puncture wound on the skin which is a measure of the
function of the platelets as well as integrity of the
vessel wall.
One of the most important preliminary indicators for
detection of bleeding disorders.
Most commonly done preoperative investigation in
patients scheduled for surgery.

METHODS FOR BLEEDING TIME

1. Dukes method
2. Ivys method
Principle: A small puncture is made on the skin and
the time for which it bleeds is noted. Bleeding stops
when platelet plug forms and breach in the vessel
wall has sealed.

Dukes Method:
Procedure:
Clean the tip of finger with spirit.
Puncture deeply so that blood flows drop by drop
without squeezing the finger.
Start the stop-watch immediately.
At every 30 seconds intervals remove the drops of
blood on filter paper without touching the skin.
Stop the watch when no more blood spot comes on
the filter paper and note the time.
Normal Bleeding time: 1- 4 minutes

Ivys Method
Tie the BP apparatus cuff around the arm and inflate
it.
Clean an area with spirit over the forearm and allow
it dry.
Make 2 clean punctures avoiding the superficial
veins.
Start the stop-watch immediately.
Remove the drops of blood on filter paper without
touching the skin every 15 seconds.
Stop the watch when no more blood spot comes on
the filter paper and note the time.

Clinical Application of Bleeding Time:

The bleeding time is prolonged in following conditions:
i. Thrombocytopenia ITP, Infections, Heparin Induced
(HIT)
ii. Disorders of platelet functions - Bernard-Soulier
syndrome,
Glanzmans Thrombosthenia
iii. Acute leukaemias
iv. Aplastic anaemias
v. Liver disease
vi. von Willebrands disease
vii. DIC
viii. Abnormality in the wall of blood vessels Allergic
Purpura

Coagulation Time
Clotting Time is also known as whole blood clotting
time and is a measure of the plasma clotting factors.
It is a screening test for coagulation disorders.
Various other tests for coagulation disorders include:
Prothrombin time (PT)
Partial thromboplastin time with kaolin (PTTK) or
Activated partial thromboplastin time with kaolin
(APTTK),
Measurement of fibrinogen.

METHODS FOR CLOTTING TIME

1. Capillary tube method
2. Lee and White method
3. Slide Method

1. Capillary Tube Method

Procedure:
Clean the tip of a finger with spirit.
Puncture it deeply with a disposable needle.
Start the stopwatch.
Fill two capillary tubes (4 inch size tube, fill upto 3 inch
continuous) with free flowing blood from the puncture
after wiping the first drop of blood.
After 2 minutes and then every 30 seconds interval, break
the capillary tube at 1 cm distance to see whether a thin
fibrin strand is formed between the two broken ends.
Stop the watch and calculate the time from average of
the two capillary tubes

Capillary Tube method:

Advantages:
It can be performed when venous blood cannot be
obtained.
Disadvantages:
i. Method is insensitive.
ii. Method is unreliable.
Normal clotting time 4-7 minutes.

2. Lee and White Method:

Procedure:
After cleaning the forearm, make a venepuncture and
draw 5 ml of blood in a siliconised glass syringe.
Start the stopwatch.
Transfer 1 ml of blood each into 3 glass tubes which
are kept at 37C in a water bath.
Third tube is gently tilted every 30 seconds until the
blood in it clots. Second tube is then tilted in same
manner. Lastly, the first tube is tilted in the same
manner.
The clotting time is taken when the tubes can be tilted
without spilling of their contents.

Lee and White Method:

Advantages:
i. More accurate and standard method.
ii. Test can be run with control.
Disadvantages:
There can be contamination of syringe or tubes.
Normal clotting time 6-9 minutes.

3. Slide Method:
Place several drops of blood on a clean slide from a
deep finger puncture.
At 30 second intervals, draw a needle through one of
the drops.
As soon as the needle picks up fibrin threads and
drags them along, coagulation has taken place.
The time interval between the placing of the drops on
the slide and the formation of fibrin threads is the
coagulation time.
Normal time : 2- 8 Minutes.

Clinical Applications of Clotting Time

Clotting time is prolonged in following conditions:
i. Deficiency of coagulation factors Haemophilia A (F VIII),
Von Willebrands Disease, Haemophilia B (F IX
Christmas Disease)
ii. Afibrinogenaemia.
iii. Disseminated intravascular coagulation (DIC).
iv. Liver Disease or Renal Disease
v. Vitamin K Deficiency
vi. Administration of drugs such as anticoagulants - Heparin

Thank you