From: Elizabeth M. Van Cott, M.D., and Michael Laposata, M.D., Ph.D., “Coagulation.” In: Jacobs DS et al, ed. The Laboratory Test Handbook, 5th Edition. Lexi-Comp, Cleveland, 2001; 327-358.
Related Information
Platelet Aggregation
von Willebrand Factor
Applies to Bleeding Time, Duke; Bleeding Time, Ivy; Bleeding Time, Mielke
Abstract The bleeding time is intended to measure platelet function, but it is neither a sensitive nor a specific test. For this reason, its use is declining and at some institutions this test has been eliminated.
Patient Preparation Aspirin prolongs the bleeding time, and therefore, patients should not have taken aspirin or related compounds for at least 1 week prior to testing.
Clinicians may wish to inform the patient that a scar might form as a result of a bleeding time test, particularly if the patient has a history of keloids.
Aftercare A butterfly bandage is placed over the incision and kept in place for 24 hours.
Specimen None – performed at bedside by a coagulation technologist or other trained healthcare professional.
Turnaround Time 30 minutes or less after the coagulation technologist arrives at the bedside
Reference Interval Approximately 1.5-9.5 minutes (shorter in newborns)1
Use Its intended use is as a measure of platelet function, but due to its inaccuracies, it is generally not useful.
Limitations Lacks sensitivity and specificity. Platelet counts <100,000/microL, low hematocrit, aspirin, other platelet inhibitory drugs, and certain other medications can prolong the bleeding time. Many variables influence the result, including skin thickness, temperature, blood vessel characteristics, the blade, orientation of the incision (horizontal vs vertical), location of the incision, handedness, and other features.
Methodology A trained healthcare professional makes a small incision on the patient’s arm, and every 30 seconds gently blots the blood with filter paper to see if the bleeding has stopped. The filter paper must not touch the wound. Prior to making the cut, a blood pressure cuff is placed on the patient’s arm at 40 mm Hg.
Additional Information The bleeding time can be prolonged in von Willebrand disease and other hereditary platelet function disorders, uremia, macroglobulinemia, and a variety of other conditions. However, it is not a reliable test for diagnosis or for predicting bleeding risk. In 1990, an analysis of 862 publications on the bleeding time concluded that the bleeding time is not a useful test, particularly as a preoperative screening test in a patient with a negative bleeding history.2 More recent publications continue to support this concept.3,4,5,6,7
Historically, the Duke bleeding time was used, in which the earlobe or fingertip was pierced with a lancet. This was later replaced with the Ivy bleeding time, in which a blood pressure cuff was placed on the arm at 40 mm Hg and the forearm was cut with a lancet. This approach was later modified into the template bleeding time (Mielke bleeding time), which attempted to standardize the size and depth of the cut by placing a template on the skin. A spring-loaded blade within the template device creates a cut through a slit in the template. Two such template devices are Surgicutt® (International Technidyne Corp) and Simplate® (Organon Teknika Corp).
Footnotes
1. Andrew M, Paes B, Bowker J, et al, “Evaluation of an Automated Bleeding Time Device in the Newborn,”Am J Hematol, 1990, 35(4):275-7.
2. Rodgers RP and Levin J, “A Critical Reappraisal of the Bleeding Time,”Semin Thromb Hemost, 1990, 16(1):1-20.
3. Basili S, Ferro D, Leo R, et al, “Bleeding Time Does Not Predict Gastrointestinal Bleeding in Patients With Cirrhosis,”J Hepatol, 1996, 24(5):574-80.
4. de Rossi SS and Glick MG, “Bleeding Time: An Unreliable Predictor of Clinical Hemostasis,”J Oral Maxillofac Surg, 1996, 54(9):1119-20.
5. Gewirtz AS, Miller ML, and Keys TF, “The Clinical Usefulness of the Preoperative Bleeding Time,”Arch Pathol Lab Med, 1996, 120(4):353-6.
6. Munro J, Booth A, and Nicholl J, “Routine Preoperative Testing: A Systematic Review of the Evidence,”Health Technol Assess, 1997, 1(12):1-62.
7. Peterson P, Hayes TE, Arkin CF, et al, “The Preoperative Bleeding Time Test Lacks Clinical Benefit,”Arch Surg, 1998, 133(2):134-9.
References
Brown BA, Hematology: Principles and Procedures, 6th ed, Philadelphia, PA: Lea and Febiger, 1993, 267-70.
