Activity 1 BLEEDING TIME Basically bleeding time refers to the length of time required for bleeding to stop. It is a screening test for detecting disorders of Plantae function ad vonWillebrand’s disease, and is directly affected by the platelet count and the ability of the platelet to form plug. The thickness and vascularity of the skin and the ability of the vessels to constrict and retract may also affect test results. Unless there is a severe deficiency of coagulation factors, coagulation mechanism will not affect the test. Prolonged bleeding time is Associated with platelet count lower than 30,000 — 50,000/ul, vonWillebrand’s disease, platelet dysfunction. The most common cause of prolonged bleeding time is drug therapy (aspirin intake and derivatives, antiinflammatory drugs, anticoagulants, some antibiotics and certain other drugs). The following drugs therefore, are not to be taken a week prior to the test) Objectives: The student will be able to: ¥ — Correctly perform the procedure ¥ Apply the theories and principle involved in the test ¥ Enumerate the sources of error when performing bleeding time and the counteractive measures V Differentiate the different methods used in bleeding time Principle: The bleeding time is a measure of vascular and platelet integrity. It is measured by determining the time required for bleeding to stop from small subcutaneous vessels that have been severed by a standardized incision. Three generations of tests have been developed each with increasing standardization of a wound of uniform depth and length. DUKES METHOD A standardized puncture of the ear lobe is made, and the length of time required for bleeding to while the blood is being blotted every 30 seconds is recorded. This test method is the easiest to perform, but is the least standardized and has the worst precision and accuracy. Normal Value: 2-4 minutes Materials: Gloves Filter paper 70% ethyl alcohol Plaster Cotton (wet and dry) Stop watch / Timer Lancet Procedure: a. Massage the finger or the earlobe. . Disinfect the finger or the earlobe. c. A lancet is used to make the puncture. A standardized puncture about 3mm deep of the earlobe or the finger is made. d. Start the time as soon as the first drop of blood appears @. Blot the drop of blood with the filter paper every 30 seconds. Make sure that the filter paper does not touch the wound directly. f. Stop the timer as soon as the bleeding stops. g. Record the patients bleeding time in minutes and seconds. h. After ensuring that the bleeding has stopped, carefully bandage the site. i. Appropriately discard all used materials and wash hands. A Compilation of Hematology 2 - ACTIVITIES‘AgelSex:___—— Requesting Physician; Finger Prick Interpretation of result: Name and Signature of Examiner IVY METHOD ‘A fest of bleeding time in which a blood pressure cuff on the upper arm is inflated to 40 mm Hgand a small wound is made with ascalpel and a template on the volar surface of the arm. Prolongedbleeding times are most often the result of a disorder of plateletproduction or the ingestion of aspirin or other ant-inflammatory medications, Materials: Extraction Kit and Sphygmomanometer Procedure: a. Greet and identify the patient. b. Explain the procedure to the patient, state that the test may leave a small scar. . Obtain a history about aspirin or aspirin containing compounds taken within last 7 - 10 days. d. Select a site on the patient's forearm approximate! ingers widths below the bend in the elbow thats fee of visible subcutaneous vein = ‘A Compilation of Hematology 2 - ACTIVITIESe. Cleanse the outer surface of the patient's fo mae re , circles from the incision site Outward: allow to mye! Moving the alcohol pad in concentric t0 air dry, f. Place a blood pressure cuff on the patient's arm above bulb of the sphygmomanometer unti it stops, ‘Squee ve te oem el be) ‘on the sphygmomanometer. Inflate the Cuff and maintain pressure at 40 rim Hg. 9. Remove safety clip from bleeding time device, place on the skin in a horizontal position with light pressure depress the “trigger”. The puncture must be performed within 30 to 60 seconds of inflation of the blood pressure cuff. Simultaneously start the stopwatch. h. After 30 seconds have passed, blot (do not wipe) the blood with the filter paper. The filter paper must not touch the wound on the arm. Biot the site at regular thirty second intervals. Rotate the filter paper after each 30 seconds. i. When bleeding ceases, stop the watch and release the blood pressure cuff by tuming the knob next to the bulb in the opposite direction used to inflate the cuff. Remove the blood pressure cuff. j, Record the bleeding time. k. If bleeding continues for more than 15 minutes, the procedure should be discontinued, and pressure applied to the wound sites. The bleeding time should be repeated on the other arm. If bleeding has again not ceased within 15 minutes, the results are reported as greater than 15 minutes. |. After ensuring that the bleeding has stopped, carefully bandage the site. m. Appropriately discard all used materials and wash hands. COPLEY LALITCH IMMERSION METHOD Materials: Gloves Stop watch / Timer Cotton (wet and dry) ‘Alcohol Filter paper Puncturing equipment Water bath (set at 37°C) NSS Beaker Plaster Procedure: 1. Prewarm a beaker of NSS in 37 °C. 2. Massage and disinfect the finger and make a very deep puncture (6mm deep) 3, Immediately start the timer after puncturing. 4, Immerse the finger in a prewarmed beaker with NSS at 37°C. 5, Observe the blood flow that comes out of the wound. As soon 2s the blood stops flowing ut of the puncture site, stop the timer. 7. Record the time as the patient's bleeding time in minutes and seconds. 8. After ensuring that the bleeding has stopped, carefully put plaster on the site. 9. Discard all used materials and properly wash hands allName of patient: Age/Sex: Ivy METHOD NORMAL VALUE Interpretation of result: COPLEY LALITCH IMMERSION METHOD NORMAL VALUE Name and Signature of Examiner ‘Template Bleeding Time ‘A modification of the Ivy method by C.H., Mielke, Jr. and colleagues. This procedure uses a standardized template containing a standardized slit in place of disposable lancets. ‘The template has been replaced by several cially made devices such as Si bara commercially SimplateReview Questions: @. What is the bleeding time useful for? . Differentiate Duke's from Ivy Method of bleeding time. ¢. What is the purpose of using the blood pressure cuff during the bleeding time procedure? . Why is it important to find out whether the patient nas been taking aspirin or aspirin containing compounds? ©. Does hemophilia prolongs bleeding time? If so, why? f. What factors of hemostasis are measured by the test? 9. Briefly describe how the Mielke bleeding time method differs from the Ivy method. h. List three sources of esror in the bleeding time procedure which may cause erroneous results. A Compilation of Hematology 2 - ACTIVITIES