This document discusses various methods for measuring bleeding time and clotting time. The Ivy method, Duke method, and Template method are described for measuring bleeding time. The Ivy method involves making small punctures on the forearm and timing how long it takes for bleeding to stop. Prolonged bleeding time can indicate platelet or coagulation disorders. Clotting time is measured by timing how long it takes blood to form a clot after a finger prick. Prolonged clotting time suggests a deficiency in intrinsic coagulation factors. Normal ranges for bleeding time and clotting time are provided.

1. DR.SAMIYAH SYEED

2. BLEEDING TIME
 The time in minutes which is taken for a standardized
skin wound to stop bleeding.
 Test of platelet function.
 Used as a screening test of haemostasis.
 It assesses Platelet integrity & Vessel Wall Integrity

3. METHODS
1) IVY METHOD
2) DUKE METHOD
3) TEMPLATE METHOD

4. IVY`S METHOD
 Principle- 3 standard punctures made by a lancet on
volar aspect of forearm.
- Average time required for bleeding to stop is
recorded.
 Equipments- Sphygmomanometer.
- Sterile disposable lancets
-Stop watch
- Filter Paper

5. IVY METHOD
1. Sphygmomanometer cuff is applied to the upper arm & inflated to
40 mmHg.
2. Volar aspect of forearm is cleansed with spirit & dried
3. 3 punctures are made with a lancet
4. Wounds should be 3mm in depth and 2-3 mm in length.
5. Stopwatch started as soon as puncture is made. One stopwatch for
each puncture
6. Blood oozing from each puncture is gently blotted with filter paper at
30 s interval.
7. Continue till blood no longer stains filter paper.
8. Time required for bleeding to stop noted & average time reported.
9. Sterile adhesive tape is applied over puncture.

8. DUKE METHOD
 Difficult to get a standardized wound
 Can be used in infants in whom it is very difficult to fit
a BP cuff.
 It can cause a large hematoma
SITE OF PUNCTURE:
- Ear lobe in adult or older child
- Heel of foot in infant

9.  Clean the area
 Make a wound 3mm deep as in Ivy method
 Time is begun soon after this
 Blot drop of blood with filter paper every 30 seconds
and report the time when blood no longer stains the
filter paper.

10. TEMPLATE METHOD
 Newer method
 Use a glass or plastic template with a transverse slit,
which allows a lancet to make a cut on the volar aspect
of forearm – Exactly 11 mm long and 1 mm deep
 Very sensitive and reproducible test

11. REFERENCE RANGES
 Normal Bleeding Time- 2-7 minutes
 Usually, BT <4 mins
 When bleeding continues beyond 20 minutes- report
at >20 minutes
- Test discontinued.

12. PROLONGED BT
 1. Disorders of Platelets
- Thrombocytopenia
- Increased Destruction of platelets
- ITP
- Infection- malaria, dengue, septicemia
- Drugs- Quinine, Heparin
- DIC
- Increased Pooling of platelets
- Hypersplenism
- Decreased production of platelets in bone marrow
- Aplastic anemia
- Bone marrow infiltration- leukemia, lymphomas
- Megaloblastic anemia
- Drugs, radiation, infections

13. PROLONGED BT
- Disorders of platelet function
- Acquired- Drugs- Aspirin, NSAID
- Myeloproliferative disorders
- Hereditary- Bernard Soulier Syndrome
- Glanzmanns Thrombasthenia
2. Disorders of coagulation
- Hereditary- Von Willebrands Disease
- Hemophilia A, B
- Acquired – DIC, Liver disease, Vit. K Deficiency,
Heparin therapy.

14. PROLONGED BT
3. Disorders of Blood Vessels
Acquired- Allergic Purpura
Infections- Viral Septicemia
Scurvy, Senile Purpura
Inherited- Hereditary hemorrhagic telangiectasia

15. CLOTTING TIME
 Time required for blood to form a clot
 It is a rough measure to assess clotting factors in blood
 It is a crude test, has been replaced by aPTT
 PROCEDURE- Clean finger with spirit
- Prick with lancet, note the time of prick
- Take a capillary tube & hold
horizontally over the blood
- Place in water bath after sealing tube.
 After 2 minutes of prick, take the capillary tube &
break it , separate the 2 ends slowly.

16.  Repeat the process at 30 seconds interval
 When a thin thread-like clot is formed, note the time.
 Time from finger prick to appearance of clot is
Clotting Time.
 Normal Referance Range- 5-15 mins
 Prolonged in deficiency of intrinsic coagulation
Pathway. Eg- Hemophila due to Factor VIII deficiency