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1. Poor reproducibility and unreliable test results due to variability of earlobe thickness and variability of
puncture depth
2. Outdated and rarely used site for puncture as new methods use the forearm for an improved
sensitivity and reproducibility
Use of the earlobe to determine bleeding time was developed by Dr. William W. Duke in 1910. It was
replaced by the Ivy Bleeding Time with the following advantages:
"Surgical" incision more closely approximated patient's
hemostatic response to surgery
Large surface area of template (longer incision) minimized
skin displacement
Depth of incision was controlled
Clotting Time
In order for blood to clot, the enzyme thrombin must be generated from the plasma precursor prothrombin.
Thrombin then converts soluble fibrinogen into insoluble fibrin. Generation of thrombin involves the sequential
activation of a number of other plasma clotting factor, this process is also being assisted by Ca++ and by
factors released by platelets and damaged tissues . The time taken for blood to clot mainly reflects the time
required for the generation of thrombin in this manner. If the plasma concentration of prothrombin or of some
of the other factors is low (or if the factor is absent, or functionally inactive), clotting time will be prolonged.
The expected range for clotting time is 4-10 mins.
Bleeding Time
This test measures the time taken for blood vessel constriction and platelet plug formation to occur. No clot is
allowed to form, so that the arrest of bleeding depends exclusively on blood vessel constriction and platelet
action.
Expt 29
Expt 29
1. What are the signs of hyperemia?
2. After differentiating active from passive hyperemia, what type of hyperemia is produced by 70%
isopropyl alcohol? Explain.
Expt 30
1. Explain the importance of the capillary resistance test.
The capillary resistance test is important in measuring the ability of the capillary walls to resist
pressure which is needed to facilitate capillary exchange. It is through capillary exchange that
nutrients diffuse across the capillary walls into the interstitial spaces, whereas waste products diffuse
in the opposite direction. This happens as fluid at the arterial end from the capillaries flow out due to
the higher osmotic pressure present in blood outside (water moves towards inside of capillaries
pushing solutes outside), afterwhich 9/10 of its volume will reenter at the venous end due to osmosis
(as water now moves towards the outside of capillaries pushing solutes inside).
2. Enumerate the conditions characterized by fragile capillaries
Weak capillaries lead to small spots of bleeding in the skin and easy bruising. Bruises look like
areas of blue to purple-colored skin that can turn yellow to dark brown over the course of a few
days.
Capillaritis is the name given to a harmless skin condition in which there are reddish-brown
patches caused by leaky capillaries. It is also known as pigmented purpura.
Purpura is a skin discoloration caused by bleeding (hemorrhage) under the skin. A small
hemorrhage is called a petechia and a large one, as in a bruise, is called an ecchymosis. Purpura
may result from trauma, from fragility of the blood vessels, or from clotting disorders.
Fragility of the blood vessels usually is inherited, although it seldom is serious. In a more serious
inherited form of the disorder, a condition known as telangiectasia, there are obvious abnormalities
of the blood vessels in the lips, mouth, and fingers.
Expt. 31
1. What are the functions of the following heart structures?
a. Chordae tendineae
The chordae tendineae are strong, fibrous strings attached to the leaflets (or cusps) of
the heart on the ventricular side; i.e., the lower chamber. These strings originate from
small mounds of muscle tissue, the papillary muscles, which project inward from the
walls of the ventricle. When the cusps close, the chordae tendineae prevent them from
swinging back into the atrium cavity (the upper chamber).
When the ventricles of the heart contract in ventricular systole, the increased blood pressuresin
both chambers push the AV valves to close simultaneously, preventing backflow of blood into
the atria. Since the blood pressure in atria is much lower than that in the ventricles, the flaps
attempt to evert to the low pressure regions. The chordae tendineae prevent the
eversion, prolapse, by becoming tense thus pulling the flaps, holding them in closed position. [1]
b. Tricuspid valve
Prevent the back flow of blood into the right atrium
c. Interventricular septum
d. Bicuspid valve
To calculate a mean arterial pressure, double the diastolic blood pressure and add the sum to the
systolic blood pressure. Then divide by 3. For example, if a patients blood pressure is 83 mm Hg/50
mm Hg, his MAP would be 61 mm Hg. Here are the steps for this calculation:
MAP = SBP + 2 (DBP)
3
MAP = 83 +2 (50)
3
MAP = 83 +100
3
MAP = 183
3
MAP = 61 mm HG
Another way to calculate the MAP is to first calculate the pulse pressure (subtract the DBP from the
SBP) and divide that by 3, then add the DBP:
MAP = 1/3 (SBP DBP) + DBP
MAP = 1/3 (83-50) + 50
MAP = 1/3 (33) + 50
MAP = 11 + 50
MAP = 61 mm Hg
There are several clinical situations in which it is especially important to monitor mean arterial
pressure. In patients with sepsis, vasopressors are often titrated based on the MAP. In the guidelines
of the Surviving Sepsis Campaign, it is recommended that mean arterial pressure (MAP) be
maintained 65 mm Hg. Also, in patients with head injury or stroke, treatment may be dependent
on the patients MAP.