HEMOSTATIC TESTHEMOSTATIC TEST

Rahajuningsih D. SetiabudyRahajuningsih D. Setiabudy

Conditions that need hemostatic testConditions that need hemostatic test

Bleeding symptomsBleeding symptoms

Bleeding historyBleeding history

Prior to surgeryPrior to surgery

Monitoring of anticoagulant therapyMonitoring of anticoagulant therapy

Hemostatic screening testsHemostatic screening tests

Bleeding timeBleeding timeTourniquet testTourniquet testPlatelet countPlatelet countProthrombin time (PT)Prothrombin time (PT)Activated partial thromboplastin time Activated partial thromboplastin time

(APTT)(APTT)Thrombin time (TT)Thrombin time (TT)Screening for F XIIIScreening for F XIII

Bleeding timeBleeding time

To evaluate vascular and platelet (number To evaluate vascular and platelet (number

and function)and function)

Sphygmomanometer at 40 mm HgSphygmomanometer at 40 mm Hg

Make an incision using lancet at volarMake an incision using lancet at volar

Every 30 seconds blot the blood by filter Every 30 seconds blot the blood by filter

paperpaper

Tourniquet testTourniquet test

To evaluate integrity of vascular wallTo evaluate integrity of vascular wallSphygmomanometer at pressure Sphygmomanometer at pressure

between systolic and diastolic for 10 min.between systolic and diastolic for 10 min.Release the pressure and observe the Release the pressure and observe the

appearance of petechiaeappearance of petechiaePositive : > 10 petechiaePositive : > 10 petechiae

Platelet countPlatelet count

Manual method: EDTA blood, Rees Ecker or Manual method: EDTA blood, Rees Ecker or ammonium oxalate ammonium oxalate

Indirect method: blood smear, compared with Indirect method: blood smear, compared with RBC countRBC count

Automatic cell counter: should be rechecked Automatic cell counter: should be rechecked on blood smearon blood smear

Platelet is fragile, tend to aggregate and to Platelet is fragile, tend to aggregate and to adhere to glass surface adhere to glass surface

Prothrombin timeProthrombin time

To evaluate extrinsic and common pathway To evaluate extrinsic and common pathway

(VII, X, V, II, I)(VII, X, V, II, I) To monitor oral anticoagulant therapy, To monitor oral anticoagulant therapy,

reported in INR (international normalized reported in INR (international normalized ratio)ratio)

Prolonged PT : deficiency or inhibitor in the Prolonged PT : deficiency or inhibitor in the extrinsic or common pathway (VII, X, V, II, I)extrinsic or common pathway (VII, X, V, II, I)

F VII

FXII

PK

HMWK

F XI

F IX

F VIII

F X

F V

F II

F I

PT

clot

Activated partial thromboplastin Activated partial thromboplastin timetime

To evaluate intrinsic and common pathway (XII, To evaluate intrinsic and common pathway (XII,

PK, HMWK, XI, IX, VIII, X, V, II, I)PK, HMWK, XI, IX, VIII, X, V, II, I)

To monitor heparin therapy, the result shoud be To monitor heparin therapy, the result shoud be

1,5 – 2,5 x control1,5 – 2,5 x control

Prolonged APTT : deficiency or inhibitor in the Prolonged APTT : deficiency or inhibitor in the

intrinsic or common pathway (XII, PK, HMWK, intrinsic or common pathway (XII, PK, HMWK,

XI, IX, VIII, X, V, II, I)XI, IX, VIII, X, V, II, I)

F VII

FXII

PK

HMWK

F XI

F IX

F VIII

F X

F V

F II

F I

APTT

clot

Thrombin timeThrombin time

To evaluate the changes of fibrinogen to To evaluate the changes of fibrinogen to fibrinfibrin

To monitor heparin therapyTo monitor heparin therapyProlongation of TT: Prolongation of TT:

HypofibrinogenemiaHypofibrinogenemiaDysfibrinogenemiaDysfibrinogenemia Inhibitor of thrombin (FDP, heparin)Inhibitor of thrombin (FDP, heparin)

F VII

FXII

PK

HMWK

F XI

F IX

F VIII

F X

F V

F II

F I

PTAPTT

TT

clot

Screening for F XIIIScreening for F XIII

Deficiency of F XIII cannot be detected by PT, Deficiency of F XIII cannot be detected by PT,

APTT, TTAPTT, TT

F XIII deficiency : clot is not stable in urea F XIII deficiency : clot is not stable in urea

5 M5 M

Test for fibrinolytic systemTest for fibrinolytic system

Whole blood clot lysisWhole blood clot lysis Euglobulin clot lysis timeEuglobulin clot lysis time Serial thrombin timeSerial thrombin time FDP, D dimerFDP, D dimer Plasminogen activityPlasminogen activity AntiplasminAntiplasmin PAIPAI Plasmin-antiplasmin complexPlasmin-antiplasmin complex

Hemostatic special testHemostatic special test Platelet aggregationPlatelet aggregation FDP, D dimerFDP, D dimer Coagulation factorCoagulation factor Von Willebrand’s Von Willebrand’s

factorfactor TGTTGT Prothrombin Prothrombin

consumption testconsumption test Lupus anticoagulantLupus anticoagulant ThrombotestThrombotest

Anti XaAnti Xa AntithrombinAntithrombin Protein CProtein C Protein SProtein S Fibrinopeptide AFibrinopeptide A Prothrombin fragment Prothrombin fragment

F 1.2.F 1.2. Fibrin monomer Fibrin monomer

complexcomplex Thrombin-antithrombin Thrombin-antithrombin

complexcomplex

Pre analytical factorsPre analytical factors Patient preparation:Patient preparation:

Fasting/non fastingFasting/non fastingMedicine: aspirin, NSAID, oral anticoagulantMedicine: aspirin, NSAID, oral anticoagulantExercise ( t-PA release)Exercise ( t-PA release)

Sampling: Sampling: Method of blood collection (two syringes method)Method of blood collection (two syringes method)Anticoagulant: sodium citrate 0.109 M Anticoagulant: sodium citrate 0.109 M ( 1: 9)( 1: 9)Plastic syringe and needle (no 20)Plastic syringe and needle (no 20)Container: plastic or siliconized glassContainer: plastic or siliconized glass