Screening Test of Haemostatic System
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Transcript of Screening Test of Haemostatic System
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Screening tests of
Haemostatic system
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1. Tourniquet Test
2. Bleeding Time
3. Bedside Clotting Time*
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1.Tourniquet Test
= Capillary Resistance Test.
= Rumple Leede Test = Hesss Test
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Principle :
This test measures the ability of the
capillaries to resist pressure.
In health, the capillaries of the arm will
resist a pressure of 100 mmHg.
If the capillaries can not resist, they will
break or rupture, tiny spot will then appear.
These spots are hemorrhages orptechiae.
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Purpose
To evaluate the capillary resistance
Equipments Sphygmomanometer
Stethoscope
Stopwatch Markerpen
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Procedure :
Draw with marker pen a circle (5 cm in
diameter) in the volar surface of the
forearm, about 5 cm below the elbow.
Put on a sphygmomanometer cuff in the
upper arm, determine a systolic and
diastolic pressures.
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Procedure (cont.)
Then deflate to a pressure midway
between the systolic and diastolic
Leave the inflated cuff in place for 5
minutes.
Remove the cuff, let for 5 min.
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Interpretation
Inspect the circle for ptechiae. Normal : < 10 ptechiae.
Discussion : (Tourniquet test)
- Explain about principle of the test!
- Positive results can be found in some
diseases, such as.
- What are further tests that should be
done?
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BLEEDING TIME (Dukes Method)
Principle :
When the skin is incised, haemostatic
ability of the body (vascular and plateletsystem) will make platelet plug to stop the
bleeding.
The time needed until there's no bleed
seen, is Bleeding Time
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Purpose :
To evaluate platelet and vascular ability inperforming platelet plug.
Equipments Blood lancet.
Cotton ball soaked in alcohol 70%.
Circular filter paper.
Stop watch
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Procedure
The lobe of the ear is cleaned with alcohol 70%
and let dry
Use a blood lancet to puncture the earlobe with
depth of 3 mm. Start the stop watch.
At half minute intervals, gently apply edge of
small disc of filter paper to absorb the drop of
blood do not touch skin. Use a fresh edge of
filter paper disc for each half-minute blotting.
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Interpretation
Time in minutes equals number of blots
divided by 2.
Reference value : 1-3 minutes.
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Note :
The size of the blood spot about 1 cm in
diameter is desirable, but becomes larger in
some cases. However bleeding usually
stops for several minutes regardless of thesize.
Dont wipe off the blood. Gently touch. Note
so as not to touch the wound.
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When the blood spot becomes 1 mm or smaller,
stop the stop watch.
When bleeding is not stop even for 10 min.,
discontinue the test. Indicate the result as 10
min or longer.
Make the patient cover the wound with a sterile
gauze for a while, hemostasis should be
confirmed, after which the patient may leave.
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DISCUSSION : (Bleeding Time Duke`s)
When the result is > 3 min, it is said as..
What is the difference between Duke's
method and Ivy's method?
What further tests would you perform
when the result is prolonged?
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BEDSIDE CLOTTING TIME
PRINCIPLE :
To record time interval since blood contact
with glass surface, until fibrin networkperformed at the room temperature.
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Sample : Capillary blood
Equipments :
1. Clean, oil free, dry and smooth object glass2. Stop watch
3. Needle
4. Sterile blood lancet
5. Cotton ball soaked in alcohol 70 %.
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PROCEDURE
1. Clean the finger tip with alcohol 70 %, let dry.2. Puncture with blood lancet, 3 mm in depth.
3. Wipe the blood drop with dry cotton.
4. Drop the next blood drop onto the object glass(4-5 mm in diameter) and start stopwatch
immediately as the blood touch glass surface.
5. Put the second drop beside the first one withsame size in diameter.
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6. Watch the fibrin thread formed in the second
drop of blood by tilt it with a needle every 30sec
7. When the fibrin was performed, do the same
step to the first blood drop and stop thestopwatch if the fibrin was seen in the first drop
8. Record the time (in minute).
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DISCUSSION : (Bedside clotting time)
What are the differences between this
method with Lee & White method?
Which is better, this method or Lee &
White method? Why?
In this method, can we assess vascular
function?
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*** CLOT RETRACTION
Principle When whole blood is allowed to clot
spontaneously, the initial coagulum is
composed of all elements of the blood.With time, the coagulum reduces in mass,
and fluid serum is expressed from the clot,
and its volume stated in %. This is due toan action of platelets on the fibrin network
formation.
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*** Sample : 5 ml blood obtained fromperipheral vein
Instruments :
1. A set of devices for drawing the blood
from peripheral vein
2. Centrifuge glass test tube
3. Wooden stick4. Centrifuge
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***Procedure :
Obtained 5 mL of venous blood
Put off the needle and transfer blood intothe test tube. Put the tube on the rack.Place the wooden stick vertically on the
blood. Leave at room temperature for about 1.5
- 2 hours.
After 2 hours, separated blood clot fromthe test tubes wall carefully, placed theblood clot into another test tube.
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***
5. Centrifuge the serum for about 5
min/1000 rpm.
6. Measure the amount (mL) of serum
which was performed and compute its
percentage