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 if there is abnormal result
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) with target
value 2-3
Normal range: around 11-14 seconds Prolonged PT
: deficiency or inhibitor in the 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 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
Normal range : around 27 37 seconds
Prolonged APTT : deficiency or inhibitor in the
intrinsic or common pathway (XII, PK, HMWK, 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 time
To evaluate the changes of fibrinogen to fibrin
To monitor heparin therapy
Normal range : 16 20 seconds
Prolonged TT:
Hypofibrinogenemia
Dysfibrinogenemia
Inhibitor of thrombin (FDP, heparin)
F VII
FXII
PK

HMWK
F XI
F IX
F VIII
F X
F V
F II
F I
PT
APTT
TT
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
5 M
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