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Haemostasis
Lecture 3:
Coagulation Time of whole blood
Coagulation Time ( Clotting Time) CT.
Clotting Time is the time required for blood to form
a clot in vitro.
The basis for the test is that whole blood will form a
solid clot when exposed to a foreign surface such
as a glass tube.
It is a rough measure of all intrinsic clotting factors
in the absence of tissue factors. Variations are
wide and the test sensitivity is limited.
As the test is the least effective test in the diagnosis
of actual haemostasis failure, it has been replaced
by PTT.
Clotting time was used as a screening test to
measure all stages in the intrinsic coagulation
system and to monitor heparin therapy .
It is however, a time-consuming test, has poor
reproducibility, is sensitive only extreme factor
deficiencies. It is therefore, of limited use in
today’s laboratory .
It is a complex process involving over 30
substances
Conditions accompanied by increased Clotting
Time:
Factors V, VII, VIII, IX, XI, XII Deficiencies.
Hemorrhagic disease of Newborn
Vitamin K deficiency.
Heparin Therapy.
Presence of Circulating antibodies (inhibitors)
Anemia and leukemia.
Afibinogenemia and Pneumonia.
and heparin.
Methods:
Capillary Method.
Slide Method.
Tube Method.
Tube Method (Lee-White method)
Specimen
Fresh whole blood , 4 ml .
Procedure
1. Label 3 glass test tube with patient name and
number them, 1, 2, and 3.
2. Perform a clean, Untraumatic venipucture using a
20-gauge needle and drawn 4 mL of blood.
3. Remove the needle from the syringe, and fill
each of the three tubes with 1 ml blood.
The last 1 ml of blood may be discarded.
Start the stopwatch as soon as the blood
enters the syringe.
4. Place the three test tubes in a 37°C water bath.
5. At exactly 3 min., Remove the first tube form
water bath and tilt gently to a 45° angle to see
whether the blood has clotted.
6. If Blood not clotted return it to the water bath
and examine it at 30 second intervals.
5. After the blood in the first tube has
clotted, examine the second tube
immediately.
6. Then examine the 3rd one.
7. Record the time it took the blood in the 3rd
test tube to clot.
Normal Range:
5 – 12 Minutes***
Discussion
1. Poor venipucture technique, causing hemolysis or
tissue thromboplastin to mix with the blood, shortens
the clotting time.
2. Bubbles entering the syringe when the blood sample is
being obtained increase the rate of coagulation.
3. Always tilt the tube in the same direction and at the
same angle so that the blood is moving in the same
pathway up the side of the tube each time.
4. Excessive agitation of blood (occur during the transfer
of the blood from the syringe to the test tube). The
blood should be allowed to flow gently down the
inside of the test tube and not forcefully squirted into
the test tube.
5. At the completion of the clotting time, one tube
should remain in the 37°C water bath to be checked
for clot retraction. Also, this same tube may be
allowed to remain in the water bath overnight and
checked the next day for clot lysis.
6. Dirty Test Tubes will affect the result.
Controls
Electronic QC
Liquid quality control- normal and abnormal
Reference Ranges
Normal range- healthy donors
RFTCA 510 tubes: 105 – 167 seconds
FTK-ACT tubes: 91 – 151 seconds
Normal range- cardiopulmonary bypass patients
HRFTCA 510 tubes: 86 - 147 seconds
FTK-ACT tubes: 89 - 153 seconds
Clotting Time - Capillary method
Material