PRINCIPLES OF MEDICAL

LABORATORY SCIENCE
PRACTICE II-
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LABORATORY
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Clotting time and Bleeding Time

( CTBT)
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Define Enumerate
ll the
Demonstrate
bleeding time different
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the Duke
and clotting methods of
Method
time bleeding time
e De
properly
 Introduction
The bleeding time (BT) is the time it
takes for a standardized incision to
stop bleeding. It tests:
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(a) the ability of platelets to form a plug strong

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enough to stop bleeding from an incision;

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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)

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2. Thrombasthenia (platelet dysfunction, affect
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the ability of the platelets to stick to each other to

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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.
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and abnormal results are followed by

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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however, the BT has essentially been replaced
by other platelet function tests.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
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punctures on volar surface of forearms 5-10cm

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apart)
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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
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coagulation pathway; however, PT and APTT
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has replaced its usefulness for screening

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coagulopathies.
Bleeding time: primary hemostasis/platelet-plug
formation and blood vessel function
Clotting time: secondary hemostasis/clotting -
coagulation pathway
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PPE Stopwatch
Disposable Sterile Alcohol wipes
Lancet Cotton / Gauze
Unused clean glass slide pads
Filter Paper
  The Duke method uses a standardized

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incision to determine the length of time
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a patient takes to stop bleeding.

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 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.
 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

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may affect results)
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3. Prepare necessary materials. Perform hand

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hygiene and wear gloves prior to patient contact.
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

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blood no longer stains the paper. (Round off to nearest 30

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seconds)
8. For clotting time, pass the tip of the lancet through the drop

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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.
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Bleeding Time

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Clotting Time

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Clotting Time

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NOTES:
 The pressure on the lancet affects the
bleeding time; thus, pressure must be
consistent in every test performed.

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 Incision may either be parallel or

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perpendicular to the fingerprints.

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Results vary depending on the
direction; therefore, direction must
be consistent in every test
performed.