HERBAL PLANT CRUDE EXTRACT AND ITS EFFECT TOWARDS BLOOD CLOTTING TIME

MON IVAN D. ARGUELLES ALDEN MAE H. DELLOSA CHARITY MAE D. LAWAS LANIELYN F. REGACHO GERALINE G. SOEJIMA JERIEL B. VELOSO

October 2009

HERBAL PLANT CRUDE EXTRACT AND ITS EFFECT TOWARDS BLOOD CLOTTING TIME

A THESIS PRESENTED TO THE FACULTY OF THE NURSING DEPARTMENT SOUTH PHILIPPINE ADVENTIST COLLEGEADVENTIST UNIVERSITY OF THE PHILIPPINES, CAMANCHILES, MATANAO DAVAO DEL SUR

IN PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE DEGREE BACHELOR OF SCIENCE IN NURSING

MON IVAN D. ARGUELLES ALDEN MAE H. DELLOSA CHARITY MAE D. LAWAS LANIELYN F. REGACHO GERALINE G. SOEJIMA JERIEL B. VELOSO

October 2009

APPROVAL SHEET This thesis attached hereto, entitled, Herbal Plant Crude Extract and its Effect towards Blood Clotting Time, prepared and submitted by Mon Ivan D. Arguelles, Alden Mae H. Dellosa, Charity Mae D. Lawas, Lanielyn F. Regacho, Geraline G. Soejima, Jeriel B. Veloso, in partial fulfillment of the requirements for the degree Bachelor of Science in Nursing is hereby accepted. Ranzolin G. Bayeta, MA Adviser PANEL OF EXAMINERS JEE ANN M. MARATAS, RN, MAN, Ph. D Chair JARED R. MARATAS, Ph. D Member BERNARD A. CORDITA, MAT Member ________________ Date Signed ________________ Date Signed

Accepted as partial fulfillment of the requirements for the degree of Bachelor of Science in Nursing. JIMMY F. FADEROGAYA, Ph. D Dean, Academic Affairs ________________ Date Signed JEE ANN M. MARATAS, RN, MAN, Ph. D Chairperson, Nursing Department ________________ Date Signed

ACKNOWLEDGEMENT The researchers are so much grateful for all the abounding grace, love, and wisdom of the Almighty God, the Heavenly Master Teacher. It continues to bean inspiration for the researchers who completed this research with the contributions of different knowledgeable persons. Therefore, the researchers would like to acknowledge the following persons, who, in one way or another, extended their help for the accomplishment of this research work: To Jee Ann M. Maratas, RN, MAN, Ph.D, Chairperson of the Nursing Department, for letting them explore and experience the world of research and sparing her time in correcting this study which inspired them to finish their work; To Dr. Jared R. Maratas, research and community extension officer, for his untiring support, suggestions, and motivation to the group; To Bernard A. Cordita, MA; one of the members of the panel, for his support and modifications to make this piece of work a successful one; To their adviser, Ranzolin G. Bayeta, MA, for the expertise he shared in statistics and for being supportive; To Karel Mei G. Navora, MALE, and Moises R. Perral, MALE, for the corrections of the grammar of this manuscript; To Dionosio V. Tuapin, the school librarian, for linking and accessing the books for them to fill the parts in the review of related studies; To the beloved parents of the researchers, who care and give their financial and moral support; To their classmates and friends for the support. Thank you all.

DEDICATION Our heartfelt dedication to all the people who were part of our success their unlimited love, understanding and encouragement that made this research study possible. To our beloved parents who were always there to support us in obtaining better education.

TABLE OF CONTENTS PAGE APPROVAL SHEET ACKNOWLEDGEMENT DEDICATION TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES ABSTRACT CHAPTER I INTRODUCTION Background of the Study Statement of the Problem Objectives of the Study Significance of the Study Scope of limitation of the Study II THEORETICAL FRAMEWORK Review of Related Literature and Studies Blood Clotting The Blood Clotting Mechanism Guava Malunggay Mayana Betadine Conceptual Framework Research Paradigm Hypotheses Definition of Terms III RESEARCH METHODOLOGY Research Design Locale of the Study Respondents of the Study Sampling Procedure Data gathering Procedure Statistical Treatment 1 1 3 3 4 4 6 6 6 8 10 11 13 15 15 17 18 18 20 20 20 20 22 22 23 ii iii iv v vii viii x

IV PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA Clotting Time of Different Herbs, Natural (- Control), and Betadine (+Control) Computation of the F value Mean Difference of Clotting Time of the Blood with Extracts to the Positive and Negative Control Variables Different Subsets of Blood Clotting Time V SUMMARY, CONCLUSION AND RECOMMENDATION Summary of Findings Conclusion Recommendation BIBLIOGRAPHY APPENDICES

24 25 26 27 28 29 30 31 32 33 35

LIST OF TABLES TABLE 1. Clotting Time of Different Herbs, Natural (- Control), and Betadine (+ Control) 2. Computation of the F value 3. Mean Difference of Clotting Time of the Blood with Extracts to the Positive and Negative Control Variables 4. Different Subsets of Blood Clotting Time Pages 25 26 27 28

LIST OF FIGURES FIGURES 1. Research Paradigm Used in this Study 2. Map of St. Michael Hospital, Kabacan, North Cotabato Page 17 21

LIST OF APPENDICES APPENDIX 1 2 3 4 Appendix A Communication Letter Appendix B Response Letter Curriculum Vitae Pictures PAGE 35 36

ABSTRACT Arguelles, M.I.D., Dellosa, A.M.H., Lawas, C.M.D., Regacho, L.F., Soejima, G.G., Veloso, J.B., South Philippine Adventist College-Adventist University of the Philippines. October 2009. Herbal Plants Extract and its Effect to Blood Clotting Time. The study was conducted at St. Michael Hospital Kabacan, North Cotabato. An experimental type of research and convenience sampling were used in this study. Result shows that guava extracts have the lesser blood clotting time of 142 seconds, then the Betadine (+control) with 234.4 s. Mayana has a clotting time of 283.4 s, natural clotting time is 288.4 s (- control) and last is the malunggay with 375.4s. One way ANOVA was employed to test for the significant difference among the means. The computed F value is 1074.442 which is much higher than the critical F value of 7.27 at degrees of freedom 4 and 20 ( equal to 0.01). This means that there is significant difference among the means of the blood clotting time using the different crude extracts of common herbs. Scheffe post hoc test was employed. Guava crude extract was found significantly higher than the betadine in hastening the blood clotting. It was found out that guava is the most effective herbal plant extract to stop bleeding and the best herb to be used in emergency cases. Based on the findings of the study, the following are recommended. The public health nurse and other health care personnel must conduct community teachings about the effectiveness of malunggay, guava, and mayana leaves extract to the blood clotting time. It is also recommended that the public health nurse and other health care personnel must emphasize that in their in health lectures the guava extract has the fastest blood clotting time than malunggay and mayana. Also, doctors must recommend the guava extract in

treating a wound in case of emergency for fast clotting. And lastly, further study will be conducted on the variables which are not included in the study such as having respondents of blood type A, AB, and B.

CHAPTER I INTRODUCTION Background of the Study In the past years many herbal plants are believed to be effective in treating wounds specifically in minimizing its bleeding however, people in the communities are using herbal plants to treat wounds. Some people use herbal perching for the leaves to produce extract and put the leaves on the wound. Examples of those are the guava and malunggay. Other people use guava leaves; they chew the leaves and put it into their wounds. Most people believed that these herbals are used only in treating wounds. Not knowing that these herbal plants are also effective in minimizing the bleeds on wounds which can be used as an immediate treatment for the wounds that excessively bleed. In rural areas where there is no clinic to ask for the treatment of wounds that excessively bleed, people resorted to use herbal plants instead of seeking consultations from the clinics or hospitals. They can just get herbal plants to treat the bleeding wounds. Nowadays, people are educated about the usefulness of herbal plants. One of the commonly used herbal plants in treating the bleeding wounds are guava leaves, mayana leaves, and malunggay leaves. Guava leaf contains Vitamin C which often aligned with wound healing because of its role in collagen formation. Vitamin C is a co-factor in proline and lysine hydroxylation, a necessary step in the formation of collagen (Collins, 2003). Batugal (2005), pointed out that Malunggay is indeed considered a Miracle Tree because of the healing and nutritional benefits that it can give. Most notable would be its possible

contribution to the prevention or healing of the three most dreaded illnesses such as cancer, diabetes and hypertension. The folkloric used of Mayana are for carminatives, bruises and sprains, headaches, mild bleeding of wounds, sinusitis, dyspepsia, and eyedrops for eye irritations. The use of mayana is reported as an Asian traditional medicine for asthma, angina, bronchitis, epilepsy, insomnia, skin rashes (http://www.stuartxchange.com/ index.html). However, the use of locally available medical plants has been advocated by the Department of Health. Many local plants and herbs in the Philippine backyard and field have been found to be effective in the treatment of common ailments as attested to by the National Science Development Board (Cuevas, 2007). This study looked into the field of emergency care for wounds, especially, those that need immediate management to prevent blood loss.. The researchers would like to determine the effectiveness of the guava leaves, the mayana leaves and the malungay leaves extract crude to blood clotting time. Furthermore, this study was conducted to provide additional option aside from the betadine or any other management for wound in cases of emergency situations.

Statement of the Problem The study is designed to find out the herbal plant extract and its effect to blood clotting time. Specifically, it answers the following questions: 1. What is the blood clotting time when the following herbal plants crude extract are used: 1.1 1.2 1.3 2. 3. Malunggay Guava Mayana

What is the most effective herbal plant which hastens blood clotting time? Is there a significant difference in the blood clotting time using the following herbal plants: 2.1 2.2 2.3 Malunggay Guava Mayana Objectives of the Study Generally, this determines the effectiveness of malunggay, guava, and mayana leaves extract to the blood clotting time. Specifically, it intends to: 1. Identify the blood clotting time when the Malunggay, guava, and mayana extracts are used. 2. Identify which herbal plant is effective to hasten the blood clotting time. 3. Distinguish the significant difference in the blood clotting time using the malunggay, guava and mayana herbal plants.

Significance of the Study The study was conducted to determine the effectiveness of malunggay, guava, and mayana leaves extract to the blood clotting time. The result of the study gives benefits to the following: Public Health Nurse. The result of the study would give additional knowledge regarding health information given or taught by public health nurse about the effectiveness of malunggay, guava, and mayana leaves extract to the blood clotting time. Doctors. The study would help the doctors to recommend what kind of herbal plant is effective in treating a wound in cases of emergency Community. The study would help the people informed which herbal plant crude extract is better to hasten the blood clot of the wounds. Future Researchers. This would serve as a reference and a guide to the future researchers on what variables they would include or focus as they conduct another study related to this topic. Scope and Limitation of the Study The scope of the study is on the effectiveness of malunggay, guava, and mayana leaves extract to the blood clotting time. The study was conducted at the St. Michael Hospital, Kabacan, North Cotabato. The respondents are the students of South Philippine Adventist College whose blood type is O. It was decided to use persons with blood type O because it is the universal blood type. Five drops of blood samples were placed

on the slides with a malunggay, guava, and mayana extract. Each herbal extract was done in five (5) replications.

CHAPTER II THEORETICAL FRAMEWORK This chapter discusses the review of related literature and studies, conceptual framework, research paradigm, hypothesis of the study, and definition of terms. Review of Related Literature and Studies Blood Clotting Theories on the coagulation of blood have existed since antiquity. Physiologist Johannes Mller (1801-1858) described fibrin, the substance of a thrombus. Its soluble precursor, fibrinogen, was thus named by Rudolf Virchow (1821-1902), and isolated chemically by Prosper Sylvain Denis (1799-1863). Alexander Schmidt suggested that the conversion from fibrinogen to fibrin is the result of an enzymatic process, and labeled the hypothetical enzyme "thrombin" and its precursor "prothrombin". Arthus discovered in 1890 that calcium was essential in coagulation. Platelets were identified in 1865, and their function was elucidated by Giulio Bizzozero in 1882(Fogoros,2003). The theory that thrombin is generated by the presence of tissue factor was consolidated by Paul Morawitz in 1905. At this stage, it was known that thrombokinase/thromboplastin (factor III) is released by damaged tissues, reacting with prothrombin (II), which, together with calcium (IV), forms thrombin, which converts fibrinogen into fibrin (I). Coagulation factors the remainder of the biochemical factors in the process of coagulation were largely discovered in the 20th century. A first clue as to the actual

complexity of the system of coagulation was the discovery of proaccelerin (initially and later called Factor V) by Paul Owren (1905-1990) in 1947. He also postulated its function to be the generation of accelerin (Factor VI), which later turned out to be the activated form of V (or Va); hence, VI is not now in active use. Factor VII (also known as serum prothrombin conversion accelerator or proconvertin, precipitated by barium sulfate) was discovered in a young female patient in 1949 and 1951 by different groups. Factor VIII turned out to be deficient in the clinically recognised but etiologically elusive hemophilia A; it was identified in the 1950s and is alternatively called antihemophilic globulin due to its capability to correct hemophilia A. Factor IX was discovered in 1952 in a young patient with hemophilia B named Stephen Christmas (1947-1993). His deficiency was described by Dr. Rosemary Biggs and Professor R.G. MacFarlane in Oxford, UK. The factor is, hence, called Christmas Factor or Christmas Eve Factor. Christmas lived in Canada, and campaigned for blood transfusion safety until succumbing to transfusion-related AIDS at age 46. An alternative name for the factor is plasma thromboplastin component, given by an independent group in California. Hageman factor, now known as factor XII, was identified in 1955 in an asymptomatic patient with a prolonged bleeding time named of John Hageman. Factor X, or Stuart-Prower factor, followed, in 1956. This protein was identified in a Ms. Audrey Prower of London, who had a lifelong bleeding tendency. In 1957, an American group identified the same factor in a Mr. Rufus Stuart. Factors XI and XIII were identified in 1953 and 1961, respectively. The view that the coagulation process is a "cascade" or "waterfall" was enunciated almost simultaneously

by MacFarlane in the UK and by Davie and Ratnoff in the USA, respectively (Hara, 2005). The Blood Clotting Mechanism Blood Clotting is one of the three mechanisms that reduce the loss of blood from broken blood vessels. These three mechanisms are Vascular Spasm, platelet plug formation and blood clotting. In vascular spasm the smooth muscle in blood vessel walls contracts immediately the blood vessel is broken. This response reduces blood loss for some time, while the other haemostatic mechanisms become active. The clotting

mechanism is one of the most important and complex of physiologic systems. Blood must flow freely through the blood vessels in order to sustain life. But if a blood vessel is traumatized, the blood must clot to prevent life from flowing away. Thus, the blood must provide a system that can be activated instantaneously and that can be contained locally to stop the flow of blood. This system is called the clotting mechanism (Fogoros,2003). When blood platelets encounter a damaged blood vessel, platelet plug formation will occur to help close the gap in the broken blood vessel. The key stages of this process are called platelet adhesion, platelet release reaction, and platelet aggregation. Following damage to a blood vessel, vascular spasm occurs to reduce blood loss while other mechanisms also take effect. Blood platelets congregate at the site of damage and a mass to form a platelet plug. This is the beginning of the process of the blood "breaking down" from its usual liquid form in such a way that its constituents play their own parts in processes to minimize blood loss. Blood normally remains in its liquid state while it is within the blood vessels but when it leaves them the blood may thicken

and form a gel (coagulation). Blood clotting technically "blood coagulation" is the process by which (liquid) blood is transformed into a solid state. This blood clotting is a complex process involving many clotting factors (incl. calcium ions, enzymes, platelets, damaged tissues) activating each other. (Kozier,2006) The three stages of this process are Formation of Prothrombinase, prothrombin converted into the enzyme thrombin, and fibrinogen (soluble) converted to fibrin (insoluble). Prothrombinase which is the stage one can be formed in two ways, depending of which of two "systems" or "pathways" apply. These are Intrinsic System and extrinsic System. Intrinsic System is initiated by liquid blood making contact with a foreign surface, i.e. something that is not part of the body. The Extrinsic System is initiated by liquid blood making contact with damaged tissue. Both the intrinsic and the extrinsic systems involve interactions between coagulation factors. These coagulation factors have individual names but are often referred to by a standardised set of Roman Numerals, e.g. Factor VIII (antihaemophilic factor), Factor IX (Christmas factor). In stage two, Prothrombin converted into the enzyme Thrombin; Prothrombinase formed in stage one converts prothrombin, which is a plasma protein that is formed in the liver, into the enzyme thrombin; And in stage tree Fibrinogen (soluble) will be converted to Fibrin (insoluble). In turn, thrombin converts fibrinogen (which is also a plasma protein synthesized in the liver) into fibrin. Fibrin is insoluble and forms the threads that bind the clot (Hara, 2005).

Guava Guava is a great snack and a healthy fruit. The whole fruit can be eaten, including the rind and the seeds. It is high in fiber, low in cholesterol, sodium, fat and calories. In addition, the rind of the guava is said to contain five times more vitamin C than an orange. Other nutrients found in the guava fruit include: vitamin A, folate, calcium, iron, and potassium. Check out the benefits of such nutrients below. Vitamin A is beneficial for eyes, assists with night vision and healthy immune system functioning. It promotes repair and growth of body tissue. Vitamin C helps protect the bodys cells from free radical damage that can lead to a host of health complications including heart disease and cancer. Vitamin C also promotes wound healing, strengthens blood vessels and helps build connective tissue, boosts immunity and aids the skin, bones, gums and teeth. Calcium strengthens the bones, protects against osteoporosis, high blood pressure, heart disease and kidney stones. Iron supplies oxygen to the blood, which is vital to the entire body. Potassium aids muscle contractions, helps the body maintain healthy blood pressure levels, promotes healthy electrical activity in the heart, and rapid transmission of the bodys nerve impulses (Lewis, 2009). The leaves of the guava tree are also medicinal in nature. They yield an essential oil that has a pleasant odor. This is the reason for the guava oils being used in perfumery and confectionery industries. Guava leaves and the bark of the guava tree are powdered and used for their medicinal properties. The powdered form of the bark and leaves has been found to be beneficial in treating wounds and sores. A decoction of guava leaves has been found to be good in increasing the digestion of foods.

It has been found that increased secretion of digestive enzymes is possible with guava leaves. The decoction of guava leaves has been effective in arresting vomiting and also diarrhea. The decoction can also be gargled to relieve tooth ache and boils on the gums. A paste formed from the powdering of leaves added to water can be applied on the skin of joints where there is pain due to rheumatoid arthritis. This will help to relieve the pain from the area affected (Deena, 2009). Malunggay Malunggay (Sajina or Moringa) plant grows in the Philippines, Malaysia, Thailand and other regions of the Far East. The plant is sometimes referred to as nature's medicine cabinet and a miracle vegetable or horseradish tree for its root taste. Moringa has sprouts of flowers, appear eight months during the year. These flowers are edible when cooked (taste like mushrooms) or used to make tea, containing calcium and potassium. The bark of the tree sometimes used to make mats and rope. The leaves taste like spinach (contains three times the iron of spinach. Also, a Moringa dried leaf has over ten times more nutrients than a fresh Moringa leaf, confirmed by universities and independent research laboratory analyses.), and its fruit produces a vegetable, like asparagus. Both contain Vitamin C (seven times more than found in oranges) and other minerals. Sajina contains seven times the amount of Vitamin C found in oranges, four times as much calcium as milk (a substitute for whole milk powder.) and three times the potassium of bananas. Moringa has quadruple amount of beta Carotene found in carrots, which is good for eyesight, and effective against treating cancer.

The Moringa plant provides nutrition for healthy skin (provide healing benefits for cuts, scrapes, rashes, and cracking signs of aging), bone, muscle development, medicinal properties, enriches anemic blood (an extract from Moringa leaf has been shown to be effective in lowering blood sugar levels within three hours of ingestion). The effects increased with larger doses, in Africa nursing mothers have been shown to produce more milk when Moringa leaves have been added to their diet, and natural source of energy supplement. Also, University laboratories around the world have shown Moringa ability to purify water. The process by which, it attaches itself to harmful material and bacteria. Afterwards, waste is expelled. Doctors use it to treat diabetes in West Africa and high blood pressure in India. Other known health benefits include: Strengthening immune system, blood pressure controlled, reducing arthritis pains and inflammations, restricting the growth of tumors, managing diabetes sugar level, and treating headaches and migraines (Travels, 2006). Malunggay contains the phytochemical niaziminn, found to have molecular components that can prevent the development of cancer cells. The edible parts of Malunggay (leaves, pods, and flowers) are served with meals or converted to a powder, used as a food supplement. Moringa provides excellent source of fuel and fertilizer. The plant contains for human consumption very low fat and carbohydrates. Roots of Moringa are used to treat sore throat and effective treating gingivitis (inflammation of the gums around the teeth) (Janzen, 2005). Many organizations around the world and researchers study

Malunggay.Researchers at the Britain University of Leichester is studying the coagulating properties of the seeds, found in the Moringa pods, believe to work better

than known water purifier aluminum sulfate, which can be toxic. International Eye Foundation based in Bethesda Maryland, is using Moringa to treat childhood blindness, attributed to seventy percent lacking vitamin A. The National Science Foundation, National Geographic Society and Ander Mellon Foundations is financing, the collection of thirteen known species of Moringa. Published studies in the journal Phytotherapy Research and HortScience discovered different Moringa parts to be effective in lowering blood sugar, reducing swelling, lowering blood pressure, healing gastric ulcers and calming the nervous system. Moringa contains nutrients attributed that are lacking, causing diseases such as Beri beri, rickets, and scurvy. Three spoonfuls of Moringa leaf powder contain these nutrients: Vitamin 'A' - 272%, protein - 42%, calcium - 125%, iron - 71% and Vitamin 'C' - 22%. Reported in September 2006, Japanese businessman Mitsuo Shoji has

developed a tea made from Malunggay plant contains antioxidants, amino acids vitamins and minerals for healthy nutritional supplement. In a Bible passage: "tree that cures all diseases." The tea distributed by Yumeshoji Trading Corporation. According to Shoji, people suffering from chronic diseases should consume at least 3.5 grams of the powdered tea. Also, he mentioned those who take Moringa Condensed Powder may experience a "slight to moderate discomfort" depending on their health status (Travel, 2006). Mayana According to Janzen (2005), Vachellia mayana probably represents a "wet-forest edition" of V. cornigera. Undoubtedly, the two taxa are very closely related, having

many vegetative and floral characteristics in common. However, the large leaflets (more than 10 mm long), the rachis glands between each pinna pair, and the inflorescence, which narrows toward the elongated and pointed apex separate this species from the closely related V. cornigera and V. sphaerocephala. Also, the pair of blade-like longitudinal flanges extending from the spine base to apex separates V. mayana from all other species of ant-acacia. As is typical of most ant-acacias, none of the individuals of V. mayana tested positive for cyanide production. Vachellia mayana is one of the rarer of the ant-acacias. Collecting data from the few collections observed indicate that it has pinkish flowers and varies in size from a shrub to a small tree to 10 m tall. Most collections indicate that Vachellia mayana occurs as scattered individuals in moist lowland forests. Janzen (2005) reported an individual from old second growth cornfield regeneration where the forest was about 15 m tall. Unlike most wet forest ant-acacias, Beltian body production in Vachellia mayana is extremely high. On developing leaves, nearly all of the leaflets contain Beltian bodies, and these bodies are usually about 2 mm long and up to 0.8 mm wide. Mayana grows well in open areas with moist, well-drained and friable soil. Occasionally cultivated throughout the Philippines. Common garden plant. It flowers all year round.The plant is deeply rooted. Prefers warm and moist habitat, sensitive to dryness. Soil should be well-drained, and rich in humus to produce higher yields. Use seeds for propagation. The mature fresh leaves of Mayana are harvested 2 to 3 months after planting. Leaves are picked leaving the branches on the plant to allow it to flower and produce

seeds for the next season. The leaves are air-dried until they crumble when crushed with the fingers. Store in amber colored bottles in a cool, dry place. Betadine Povidone- iodine, it is virtually non stinging and nonirritating to skin and mucous membrane and non stinging to skin and clothing. Used for prevention and treatment of surface infections, as antiseptic for burns, lacerations, abrasions, and other minor wounds, and in management of vaginitis.( Govoni & Hayes, 2002) According to Gutierez and Queener (2005), povidone-iodine is used in the prevention and treatment of infections of the skin, scalp, and mucous membrane of the mouth and vagina. It is effective against most bacteria, fungi, and viruses, but antiseptic activity depends on the concentration of iodine. When applied to the skin, a1% solution kills approximately 90% of bacteria within 90 seconds. Conceptual Framework This study is based on the theory of the blood coagulation that described fibrin, the substance of a thrombus. The theory discuss that thrombin is generated by the presence of tissue factor. At this stage, it was known that thrombokinase/thromboplastin (factor III) is released by damaged tissues, reacting with prothrombin (II), which, together with calcium (IV), forms thrombin, which converts fibrinogen into fibrin (I). Blood Clotting is one of three mechanisms that reduce the loss of blood from broken blood vessels. These three mechanisms are Vascular Spasm, platelet plug formation and blood clotting. In vascular spasm the smooth muscle in blood vessel walls

contracts immediately the blood vessel is broken. This response reduces blood loss for some time, while the other haemostatic mechanisms become active. The clotting

mechanism is one of the most important and complex of physiologic systems. Blood must flow freely through the blood vessels in order to sustain life. But if a blood vessel is traumatized, the blood must clot to prevent life from flowing away. Thus, the blood must provide a system that can be activated instantaneously and that can be contained locally to stop the flow of blood (Forgoros, 2003).

Research Paradigm

Independent Variables

Dependent Variables

Herbal Plants: - Malunggay - Guava - Mayana Blood Clotting Time

(Positive control) Povidone Iodine

Figure 1. Research Paradigm showing the Independent and Dependent variables of the Study

Hypotheses The following hypotheses of the study are stated in the null and alternative forms: Ho1: There is no significant difference in the clotting time of blood with extracts of malunggay, guava and mayana leaves. Ha1: There is a significant difference on the blood clotting time using the different herbal plants extract. Definition of Terms The following are the operational terms used in the study: Blood clotting. This refers to the conversion of fluid blood into a coagulum that involves shedding of blood, release of thromboplastin, inactivation of heparin, conversion of prothrombin to thrombin, interaction of thrombin with fibrinogen to form an insoluble fibrin network, and contraction of the network to squeeze excess fluid. Betadine. This word pertains to the antiseptic that is used topically to destroy microbes. In comparison to iodine, it is less to sensitize or sting the affected area. Crude Extracts. This word refers to the liquid form of the mayana, guava, and malunggay made by purging of the leaves. Effectiveness. This defines as the fulfilling result of the herbal plants used in the clotting time. Fibrinogen. This pertains to a plasma protein that is produced in the liver and is converted into fibrin during blood clot formation.

Guava. This refers to the herbal plant with a scientific name of 'psidium guajava'. Guava leaves are used in folk medicine as a remedy for diarrhea and, as well as the bark, for their supposed antimicrobial properties and as an astringent. Guava leaves or bark are used in traditional treatments against diabetes. Malunggay. This pertains to the herbal plant with a scientific name of Sajina or Moringa, the plant is sometimes referred to as natures medicine cabinet and a miracle vegetable or horseradish tree for its root taste. It has sprouts of flowers, appear eight months during the year. Mayana. This word defines as the herbal plant with a scientific name of Coleus scutellarioides. This herbal plant has the large leaflets (more than 10 mm long), with rachis glands between each pinna pair, and the inflorescence, which narrows towards the elongated and pointed, with an apex pair of blade-like longitudinal flanges extending from the spine. Time. This word refers to the duration of time the blood will clot if the herbal plants are used during bleeding.

CHAPTER III RESEARCH METHODOLOGY The chapter presents the research methodology of the study. It also includes the research design, locale of the study, respondents of the study, sampling procedure, data gathering procedures, research instruments and validation, and statistical treatment. Research Design An experimental type of research is used in this study to determine the accurate blood clotting time when the different herbal plants extract are used. Experimental research controls the condition of the study (Venzon, 2004). Locale of the Study The study was conducted at St. Michael Hospital, Kabacan, North Cotabato with the supervision of a registered medical technologist. This was intended to be done at St. Michael Hospital because this institution is equipped with facilities and laboratory equipment needed in the research study. In addition, the management of this institution give the researchers an opportunity to use their laboratory for free. Respondents of the Study The respondents of the study are the students of South Philippine Adventist College. Specifically, the researchers conveniently chose students with blood type O since it is the most common among the blood types. Five respondents were chosen to

offer blood samples. Four of them are females and one is male. They are 20 to 26 years old. All of them are singles. Participation in the study is voluntary. The analysis of blood samples was done at St. Michael Hospital, Kabacan, North Cotabato. Sampling Procedure Convenience sampling was employed in this study. The respondents are those students whose blood type is O. They were readily available at the time when the study was conducted. Data Gathering Procedure A letter from the researchers was sent to the medical technologist of St. Michael Hospital in Kabacan, North Cotabato asking permission to assist the researchers in analyzing the data gathered. After securing the approval of the request, the researchers together with the respondents went to St. Michael Hospital to submit the data for analysis. After conducting the test all data were tabulated and analyzed. The following is the step by step process of getting the data. (1) Find persons with type O blood. (2) Clean the end of the finger to be pricked using a cotton ball with alcohol in a circular motion. (3) Press the end of the finger and prick it. (4) Get a slide and let the blood drop into the slide; then get another cotton ball and press it on the pricked area to stop bleeding. (5) Get 10 uL of guava extract and mix it on the slide with blood. (6) Using a stopwatch, get the exact blood clotting time.(7) Using a toothpick, about every 15 seconds, observe if there is a

threadlike form to be noticed on the blood with guava extract, and if this will be noticed it would indicates that the blood is already clot. (8) Stop the timer when a threadlike formation is noticed and record the time. Same procedure is used in Mayana, malunggay, natural (- control), and betadine (+ control). Statistical Treatment To determine the significant difference of the clotting time among the different herb extracts, different statistical tools were employed. First, the measure of central tendency and variability which include the mean were computed. Standard deviation of the different blood clotting time were also calculated for every herb extracts. Finally, Analysis of variance (ANOVA) was employed to test if there is significant difference on the means of the blood clotting time. Furthermore, ANOVA was used since this study involves interval level variables with equal number of cases in each of the categories. Scheffe post hoc test was computed after determining the F value.

Chapter IV PRESENTATION, ANALYSIS, AND INTERPRETATION OF DATA This chapter discusses the presentation, analysis, and interpretation of the study. The significant effect of herbal plant crude extract towards blood clotting time is discussed in this chapter. Table 1 shows the different clotting times of the different herbs, natural clotting (control), and Betadine (+ control) and the overall mean of each variables used. There are five replications in each variable. In malunggay, the result in replication one is 375 seconds, replication two is 375 seconds, replication three is 375 seconds, replication four is 376 seconds, and replication five is 376 seconds. It has an overall mean clotting time of 375.4 seconds. These are the clotting time of Mayana: replication one result is 280 seconds, replication two is 285 seconds, replication three is 283 seconds, replication four is 283 seconds, and replication five is 287 seconds. It has an overall mean clotting time of 283.4 seconds. For the clotting time of Guava: replication one result is 140 seconds, replication two is 145 seconds, replication three is 140 seconds, replication four is 140 seconds and replication five is 145 seconds. It has an overall mean clotting time of 142 seconds. The next variable is natural blood (- control). The first replication is 285 seconds, replication two is 290 seconds, replication three is 290 seconds, replication four is 287 seconds, and replication five is 290 seconds. It has the overall mean clotting time of 288.4 seconds.

The last variable is betadine (+control). The clotting time in replication one is 239 seconds, replication two is 236 seconds, replication three is 220 seconds, replication four is 237 seconds, and replication five is 240 seconds. This variable has the overall mean clotting time of 234.4 seconds. Table 1. Clotting Time of Different Herbs, Natural (- Control), and Betadine (+ Control) Clotting Time (s) Herbs Malunggay Mayana Guava Natural(-control) Betadine (+ control) To test for the significant difference among the blood clotting time using the different crude extracts of common herbs, one way ANOVA was used. One Way ANOVA was utilized since there are more than three variables considered. Table 2 presents the computed F value. The computed F value is 1074.442 which is much higher than the critical F value of 7.27 at degrees of freedom 4 and 20 ( equal to 0.01). This means that there is a significant difference among the means of the blood clotting time using the different crude extracts of common herbs. Table 2. Computation of the F value Average Seconds 375.4 283.4 142 288.4 234.4 Average Minutes 6:26 5:12 2:37 5:21 4:31

R1 375 280 140 285 239

R2 375 285 145 290 236

R3 375 282 140 290 220

R4 376 283 140 287 237

R5 376 287 145 290 240

Between Groups Within Groups Total

Sum of Squares 79680.640 370.800 80051.440

df 4 20 24

Mean Square F 19920.160 1074.442 18.540

Sig. .000

To determine the most effective herbal plant that hastens blood clotting time, betadine was used as the positive control since it is the most common medicine used to stop bleeding. Natural blood clotting without the aid of medicines nor herb extracts serves as the negative control. Scheffe post hoc test was used to test for the homogeneity of the different blood clotting time. Table 3 shows its result. The table 3 shows that there is no significant difference between malunggay and the natural clotting time. Mayana has the higher blood clotting time as to compare it with the natural clotting time but there is still no significant difference. Only guava and betadine (positive control) are found significant at 0.05 level of significance in clotting time as to compare with the natural clotting. As to compare with the blood clotting time of the positive control, Betadine, only the blood clotting time with guava extracts come up with positive mean difference. The difference was found significant at 0.05 level of significance. Malunggay and mayana clotting time is also significant at 0.05 level of significance but of negative values. It means that the clotting time of both malunggay and mayana is higher than the blood clotting time of the batadine. It is guava crude extract that is found significantly higher than that of the betadine in hastening the blood clotting. Therefore, it is the most effective crude extract to stop

bleeding and the best herb to use in emergency cases. This finding supports the study of Janzen (2005) that the guava extract hasten the blood clotting time of a wounded person. Table 3. Mean Difference of Clotting Time of the Blood with Extracts to the Positive and Negative Control Variables Independent Herbal plants Variables Malunggay Natural Clotting (negative control) Mayana Guava Betadine Betadine (positive control) Malunggay Mayana Guava Natural -54.00000* Clotting *. The mean difference is significant at the 0.05 level. Furthermore, test of homogeneity among the clotting time was also done. The table 4 below shows the result. In terms of different means, blood clotting time of guava has the shortest. Second is the blood clotting time of betadine. It further reveals that the clotting time of mayana, malunggay and the natural clotting is statistically equal. Therefore, it further proves that guava crude extract is the best and it is much better than the commercially available betadine. This finding corroborates the study of Deena (2009) that it is better used guava extract to hasten the blood clotting time of the person than the commercial products. Table 4. Different Subsets of Blood Clotting Time -63.2206 -44.7794 Difference 0 5 146.40000* 54.00000* -54.00000* -49.00000* 92.40000* Mean 95% Confidence Interval Lower Bound -9.2206 -4.2206 137.1794 44.7794 -63.2206 -58.2206 83.1794 Upper Bound 9.2206 14.2206 155.6206 63.2206 -44.7794 -39.7794 101.6206

Subset for alpha = 0.05 Herbal Plants N 1 2 Guava 5 142.0000 Betadine 5 234.4000 Mayana 5 Malunggay 5 Natural Clotting 5 Sig. 1.000 1.000 Means for groups in homogeneous subsets are displayed. a. Uses Harmonic Mean Sample Size = 5.000.

3

283.4000 288.4000 288.4000 .514

Chapter V SUMMARY, CONCLUSION, AND RECOMMENDATION This chapter presents the summary of findings, the pertinent conclusions and recommendations drawn by the researchers from the result obtained. Summary This study entitled Herbal Plant Crude Extract and its Effect towards Blood Clotting Time was conducted at St. Michael Hospital, Kabacan, North Cotabato.. The objective of the study is to identify the blood clotting time when the malunggay, guava, and mayana extracts are used. This also identify what is the most effective herbal plant that hastens the blood clotting time and distinguish the significant difference in the blood clotting time using the malunggay, guava and mayana herbal plants. An experimental type of research with convenience sampling is used in this study to determine the accurate blood clotting time when the different herbal plant extracts are used. The respondents of the study are the students of South Philippine Adventist College. Specifically, the researchers conveniently chose students with blood type O since it is the most common among the blood types. To determine the significant difference of the clotting time among the different herb extracts, different statistical tools were employed. First, the measure of central tendency and variability which includes the mean were computed. Standard deviation of the different blood clotting time was also calculated for every herb extracts.

Finally, the Analysis of variance (ANOVA) was employed to test if there is a significant difference on the means of the blood clotting time. Furthermore, ANOVA was used since this study involves interval level variables with equal number of cases in each of the categories. Scheffe post hoc test was computed after determining the F value. Summary of Findings The study is to determine the blood clotting time when the different common herbs extracts are used. The result has shown that the guava extracts have the lesser blood clotting time of 142 seconds, next is the Betadine (+control) with 234.4 s. Mayana has a clotting time of 283.4 s, natural clotting time has 288.4 s (- control) and last is the malunggay with 375.4s. The computed F value is 1074.442 which is much higher than the critical F value of 7.27 at degrees of freedom 4 and 20 ( equal to 0.01). This means that there is significant difference among the means of the blood clotting time using the different crude extracts of the common herbs. There is no significant difference between the malunggay and the natural clotting time. Mayana has a higher blood clotting time compared with the natural clotting time but still there is no significant difference. Only guava and betadine (positive control) are significant at 0.05 level of significance in clotting time compared with the natural clotting. Only the blood clotting time of Betadine with guava extracts come up with a positive mean difference. The difference is found significant at 0.05 level of significance.

Malunggay and mayana clotting time is also significant at 0.05 level of significance but of negative values. It means that the clotting time of both malunggay and mayana is higher than the blood clotting time of betadine. It is the guava crude extract that is found significantly higher than that of the betadine in hastening the blood clotting. Therefore, it is the most effective crude extract to stop bleeding and the best herb to use in emergency cases. In terms of different means, the blood clotting time of guava has the shortest. The blood clotting time of betadine comes in second. It was also found out that the clotting time of mayana, malunggay and the natural clotting is statistically equal. Therefore, it further proves that the guava crude extract is the best and it is much better than the commercially available betadine. Conclusion In the light of the findings of the study, the researchers come up with the following conclusions. 1. There is a significant difference among the means of the blood clotting time using the different crude extracts of common herbs. 2. Guava crude extract is found significantly higher than the betadine in hastening the blood clotting. 3. Guava is the most effective crude-extract to stop bleeding and the best herb to use in emergency cases.

4. Mayana and malunggay are not the best options in applying open wounds to stop bleeding. Both herbs have a blood clotting time statistically equal with the natural clotting. Recommendation Relative to the findings and conclusions the researchers come up with the following recommendations: 1. The public health nurse and other health care personnel must conduct community teachings about the effectiveness of malunggay, guava, and mayana leaves extract to the blood clotting time. 2. The public health nurse and other health care personnel must emphasize in their in health lectures that the guava extract has the fastest blood clotting time than malunggay and mayana. 3. Doctors must recommend the guava extract in treating a wound in case of emergency for fast clotting. 4. Further study will be conducted on the variables which are not included in the study such as having respondents of blood type A, AB, and B.

BIBLIOGRAPHY Books Cuevas, Frances Prescilla L., Editor in chief (2007). Public Health Nursing in the Philippines; Publication Committee, National League of Philippine Government Nurses, Incorporated 11th Ed. @ Govoni, Laura E. & Janice E. Hayes (2002). Drugs and Nursing Implications;Meredith Publishing Company. Gutierez, Kathleen & Sherry F. Queener (2005). Pharmacology for Nursing; Mosby Inc. Kozier, Barbara, et. Al.(2006). Fundamentals of Nursing: Concepts, Process, and Practice 8th ed. Pearson Education Inc. Ramont, Robeta Pavy, Maldonado, Dolores and Towle, Mary Ann. (2006). Comprehensive Nursing Care. United States of America. Pearson Education, Inc.. Venzon, Lydia M. (2004). Introduction to Nursing Research; Quest for Quality Nursing. Quezon Avenue.

Internet Sources Batugal, Pons, 2009. http://malungaimiracleoil.multiply.com/ Collins, Nancy, 2003. http://www.cc.gatech.edu/classes/cs6751_97_winter/Topics/ questdesign/ Deena, David, 2009 http://www.saching.com/Article/Guava-trees--Health-benefits-ofguava-trees--leaves--fruits-and-bark/3574 Fogoros,Richard N., clotting.htm M.D., 2003. http://heartdisease.about.com/cs/-heartattacks/a/

Hara, Hari C., 2005. http://www.shvoong.com/exact-sciences/biology/1757270-bloodclotting-mechanism/ Janzen, 2005. http://www.filipinoherbshealingwonders.filipinovegetarian-recipe.com/ balanoy.htm

Nazia, Hussain. http://www.psychicsahar.com/artman/publish/article_376.shtml Rica Lewis, 2009. http://www.brighthub.com/health/diet-nutrition/articles/46313.aspx Travels, 2006. http://www.associatedcontent.-com/article/64998/utilizing_malunggay_ for_ nutrition_ and_pg2.html Travels, 2006. http://pinoyentrepreneurs.multiply.-com/market/item/27/Moringa_ Plus_Multivitamin_CapsMalunggay_extract

APPENDIX A - Communication Letter October 16, 2009 St. Michael Hospital Rizal Avenue, Kabacan North Cotabato Through: Aisha B. Kalipapa Medical Technologist Dear Madam: Greetings! We would like to ask permission from your office that we will be conducting a laboratory test on October 18, 2009 for our thesis writing in partial fulfillment of our subject Introduction to Research as part of our Bachelor of Science in Nursing Curriculum. The title of the study is Herbal Plant Crude Extract and its effect towards blood clotting time. The respondents of our study are the residents of South Philippine Adventist College, Camanchiles, Matanao, Davao del Sur with a blood type O. Rest assured that the data will be kept confidential. Hoping for your approval. Thank you and God Bless. Sincerely yours,

Alden Mae H. Dellosa Group Leader Noted By:

Jee Ann M. Maratas, RN, MAN, Ph.D Chairperson, Nursing Department

APPENDIX B - Response Letter October 16, 2009 Ms. Alden Mae H.Dellosa BSN 4th year, Group Leader, Introduction to Reasearch SPAC Km.68, Matanao, Davao del Sur Dear Ms. Dellosa, I have read your letter regarding your intention to conduct a study on HERBAL PLANT CRUDE EXTRACT AND ITS EFFECT TOWARDS BLOOD CLOTTING TIME at St. Michael Hospital. I found out that your study is beneficial to the people in the community by using herbal plant to hasten blood clotting time. I assure you to lend my expertise in the laboratory to conduct your study by getting the blood clotting time. Thank you for informing me of your intention to undergo this kind of research study. God bless you and also your group. Sincerely yours, Aisha B. Kalipapa_ Medical Technologist

Name : Mon Ivan Dela Cruz Arguelles Age: 21 years old Birthdate: September 16, 1988 Birthplace: Caloocan City Address: Tienda Aplaya, Digos City Parents: Father: Nehemias Dionson Arguelles Mother: Ofelia Dela Cruz Aeguelles Educational Backgropund: Primary: Digos Center SDA Elementary School School-Year: 2000 - 2001 Honor: Honor List Secondary: School-Year: South Philippine Adventist College Academy Honor: Deans Lister Tertiary: Adventist University of the Philippines South Philippine Adventist College Enrolled in Bachelor of Science in Nursing

Name : Alden Mae Hemoroz Dellosa Age: 20 years old Birthdate: April 30, 1989 Birthplace: Magkiangkang, Bayugan City Address: : Magkiangkang, Bayugan City Parents: Father: Marcial Galanido Dellosa Mother: Eden Hemoroz Dellosa Educational Backgropund: Primary: Forest Hills Academy Elementary Department School-Year: 2001 - 2002 Honor: First Secondary: Forest Hills Academy School-Year: 2005 - 2006 Honor: Valedictorian Tertiary: Adventist University of the Philippines South Philippine Adventist College Enrolled in Bachelor of Science in Nursing

Name : Charity Mae Dacanay Lawas Age: 19 years old Birthdate: May 14, 1990 Birthplace: Tokawal, Alabel, Saranggani Province Address: Sunrise Village, Padada, Davao del Sur Parents: Father: Jemilito Momo Lawas Mother: Meriam Dacanay Lawas Educational Backgropund: Primary: Tala-o Elementary School School-Year: 2001 - 2002 Honor: Valedictorian Secondary: Sulop National High School School-Year: 2005 2006 Honor: Honor List Tertiary: Adventist University of the Philippines South Philippine Adventist College Enrolled in Bachelor of Science in Nursing

Name : Lanielyn Fudolin Regacho Age: 22 years old Birthdate: April 24, 1987 Birthplace: Capayuran, Pigcawayan, Cotabato Address: 22 Talisay Street, Kidapawan City Parents: Father: Rolando Echalar Regacho Mother: Jocelyn Sancho Regacho Educational Backgropund: Primary: Capayuran Elementary School School-Year: 2000 - 2001 Honor: Honor List Secondary: Presbitero National High School School-Year: 2004 - 2005 Honor: None Tertiary: Adventist University of the Philippines South Philippine Adventist College Enrolled in Bachelor of Science in Nursing

Name : Geraline Gonzales Soejima Age: 21 years old Birthdate: November 13, 1988 Birthplace: Purok Poblacion, Bitaugan West, Cagwait, Surigao del Sur Address: Purik Mandalo, Unidad, Cagwait, Surigao del Sur Parents: Father: Gerardo Corvera Soejima Mother: Elena Gonzales Soejima Educational Backgropund: Primary: Bitaugan East, Elementary School School-Year: 2000 - 2001 Honor: Consistent third honor student from grade 1 to grade 6 Secondary: Northeastern Minsanao Academy School-Year: 2004 - 2005 Honor: Deans Lister Tertiary: Adventist University of the Philippines South Philippine Adventist College Enrolled in Bachelor of Science in Nursing

Name : Jeriel Bedolido Veloso Age: 20 years old Birthdate: July 8, 1989 Birthplace: Maniki, Kapalong, Davao del Norte Address: Block 1, Lot 18, Villa Clementa, Maniki, Kapalong, Davao del Norte Parents: Father: Gennethon Abacial Veloso Mother: Elsa Astronomo Veloso Educational Backgropund: Primary: Maniki Central Elementary School School-Year: 2005 - 2006 Honor: Honor List Secondary: South Philippine Adventist College Academy School-Year: 2005 - 2006 Honor: None Tertiary: Adventist University of the Philippines South Philippine Adventist College Enrolled in Bachelor of Science in Nursing