HEMOSTATIC TEST

Rahajuningsih D. Setiabudy

Conditions that need hemostatic test

Bleeding symptoms Bleeding history Prior to surgery Monitoring of anticoagulant therapy

Hemostatic screening tests

Bleeding time Tourniquet test Platelet count Prothrombin time (PT) Activated partial thromboplastin time (APTT) Thrombin time (TT) Screening for F XIII

Bleeding time

To evaluate vascular and platelet (number and function) Sphygmomanometer at 40 mm Hg

Make an incision using lancet at volar

Every 30 seconds blot the blood by filter paper

Tourniquet test
To evaluate integrity of vascular wall Sphygmomanometer at pressure between systolic and diastolic for 10 min. Release the pressure and observe the appearance of petechiae Positive : > 10 petechiae

Platelet count

Manual method: EDTA blood, Rees Ecker or ammonium oxalate Indirect method: blood smear, compared with RBC count Automatic cell counter: should be rechecked on blood smear Platelet is fragile, tend to aggregate and to adhere to glass surface

Prothrombin time

To evaluate extrinsic and common pathway

(VII, X, V, II, I)

To monitor oral anticoagulant therapy, reported in INR (international normalized ratio) Prolonged PT : deficiency or inhibitor in the extrinsic or common pathway (VII, X, V, II, I)

FXII PK HMWK F XI F IX F VII

F VIII
FX FV F II FI

PT

clot

Activated partial thromboplastin time

To evaluate intrinsic and common pathway (XII, PK, HMWK, XI, IX, VIII, X, V, II, I) To monitor heparin therapy, the result shoud be 1,5 2,5 x control Prolonged APTT : deficiency or inhibitor in the intrinsic or common pathway (XII, PK, HMWK, XI, IX, VIII, X, V, II, I)

FXII PK HMWK F XI F IX APTT F VII

F VIII
FX FV F II FI

clot

Thrombin time
To evaluate the changes of fibrinogen to fibrin To monitor heparin therapy Prolongation of TT:

Hypofibrinogenemia Dysfibrinogenemia Inhibitor of thrombin (FDP, heparin)

FXII PK HMWK F XI F IX APTT F VII

F VIII
FX FV F II FI TT

PT

clot

Screening for F XIII

Deficiency of F XIII cannot be detected by PT, APTT, TT F XIII deficiency : clot is not stable in urea

5M

Test for fibrinolytic system

Whole blood clot lysis Euglobulin clot lysis time Serial thrombin time FDP, D dimer Plasminogen activity Antiplasmin PAI Plasmin-antiplasmin complex

Hemostatic special test

Platelet aggregation FDP, D dimer Coagulation factor Von Willebrands factor TGT Prothrombin consumption test Lupus anticoagulant Thrombotest

Anti Xa Antithrombin Protein C Protein S Fibrinopeptide A Prothrombin fragment F 1.2. Fibrin monomer complex Thrombin-antithrombin complex

Pre analytical factors

Patient preparation: Fasting/non fasting Medicine: aspirin, NSAID, oral anticoagulant Exercise ( t-PA release) Sampling: Method of blood collection (two syringes method) Anticoagulant: sodium citrate 0.109 M ( 1: 9) Plastic syringe and needle (no 20) Container: plastic or siliconized glass