Bleeding time

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Bleeding time
Intervention
MeSH D001760

Bleeding time is a medical test done on someone to assess their platelets function. It involves making a patient bleed then timing how long it takes for them to stop bleeding.

The term template bleeding time is used when the test is performed to standardized parameters.

Indications[edit]

The bleeding time test is a rather old method and indicated when other more reliable and less invasive tests for determining coagulation are not available.[1] However, it is still to this date the most reliable way of assessing clinical bleeding in patients with uremia.[2] Historically it was indicated whenever the physician needed information about platelet activation.[3]

Process[edit]

It involves cutting the underside of the subject's forearm, in an area where there is no hair or visible veins. The cut is of a standardized width and depth, and is done quickly by an automatic device.

A blood pressure cuff is used above the wound, to maintain venous pressure at a specified value. The time it takes for the bleeding to stop (i.e. the time it takes for a platelet plug to form) is measured. Cessation of bleeding can be determined by blotting away the blood every several seconds until the site looks 'glassy'.

Ivy method[edit]

The Ivy method is the traditional format for this test. While both the Ivy and the Duke method require the use of a sphygmomanometer, or blood pressure cuff, the Ivy method is more invasive than the Duke method, utilizing an incision on the ventral side of the forearm, whereas the Duke method involves puncture with a lancet or special needle. In the Ivy method, the blood pressure cuff is placed on the upper arm and inflated to 40 mmHg. A lancet or scalpel blade is used to make a shallow incision that is 1 millimeter deep on the underside of the forearm.

A standard-sized incision is made around 10 mm long and 1 mm deep. The time from when the incision is made until all bleeding has stopped is measured and is called the bleeding time. Every 30 seconds, filter paper or a paper towel is used to draw off the blood.

The test is finished when bleeding has stopped completely.

A normal value is less than 9 and a half minutes.[4]

A prolonged bleeding time may be a result from decreased number of thrombocytes or impaired blood vessels. However, it should also be noted that the depth of the puncture or incision may be the source of error.

Normal values fall between 3 – 10 minutes depending on the method used.

Duke Method[edit]

With the Duke method, the patient is pricked with a special needle or lancet, preferably on the earlobe[5] or fingertip, after having been swabbed with alcohol. The prick is about 3–4 mm deep. The patient then wipes the blood every 30 seconds with a filter paper. The test ceases when bleeding ceases. The usual time is about 2–5 minutes.

Interpretation[edit]

Bleeding time is affected by platelet function, certain vascular disorders and von Willebrand Disease—not by other coagulation factors such as haemophilia. Diseases that cause prolonged bleeding time include thrombocytopenia, disseminated intravascular coagulation (DIC), Bernard-Soulier disease, and Glanzmann's thrombasthenia.

Aspirin and other cyclooxygenase inhibitors can prolong bleeding time significantly. While warfarin and heparin have their major effects on coagulation factors, an increased bleeding time is sometimes seen with use of these medications as well.

People with von Willebrand disease usually experience increased bleeding time, as von Willebrand factor is a platelet adhesion protein, but this is not considered an effective diagnostic test for this condition.

It is also prolonged in hypofibrinogenemia.[6]

Laboratory findings in various platelet and coagulation disorders (V - T)
Condition Prothrombin time Partial thromboplastin time Bleeding time Platelet count
Vitamin K deficiency or warfarin Prolonged Normal or mildly prolonged Unaffected Unaffected
Disseminated intravascular coagulation Prolonged Prolonged Prolonged Decreased
Von Willebrand disease Unaffected Prolonged or unaffected Prolonged Unaffected
Hemophilia Unaffected Prolonged Unaffected Unaffected
Aspirin Unaffected Unaffected Prolonged Unaffected
Thrombocytopenia Unaffected Unaffected Prolonged Decreased
Liver failure, early Prolonged Unaffected Unaffected Unaffected
Liver failure, end-stage Prolonged Prolonged Prolonged Decreased
Uremia Unaffected Unaffected Prolonged Unaffected
Congenital afibrinogenemia Prolonged Prolonged Prolonged Unaffected
Factor V deficiency Prolonged Prolonged Unaffected Unaffected
Factor X deficiency as seen in amyloid purpura Prolonged Prolonged Unaffected Unaffected
Glanzmann's thrombasthenia Unaffected Unaffected Prolonged Unaffected
Bernard-Soulier syndrome Unaffected Unaffected Prolonged Decreased or unaffected
Factor XII deficiency Unaffected Prolonged Unaffected Unaffected
C1INH deficiency Unaffected Shortened Unaffected Unaffected

The Bleeding Time in Popular Culture[edit]

In the 1954 comedy film Doctor in the House, Sir Lancelot Spratt, the intimidating chief of surgery played by James Robertson Justice is asking instructional questions of his medical student. He asks a young student, who has been distracted by a pretty nurse, what 'the bleeding time' is. The student looks at his watch and answers "ten past ten, sir."

References[edit]

  1. ^ American Society for Clinical Pathology, "Five Things Doctors and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation (American Society for Clinical Pathology), retrieved August 1, 2013 , which cites
      • Lehman, C. M.; Blaylock, R. C.; Alexander, D. P.; Rodgers, G. M. (2001). "Discontinuation of the bleeding time test without detectable adverse clinical impact". Clinical chemistry 47 (7): 1204–1211. PMID 11427450.  edit
      • Peterson, P.; Hayes, T. E.; Arkin, C. F.; Bovill, E. G.; Fairweather, R. B.; Rock Jr, W. A.; Triplett, D. A.; Brandt, J. T. (1998). "The preoperative bleeding time test lacks clinical benefit: College of American Pathologists' and American Society of Clinical Pathologists' position article". Archives of surgery (Chicago, Ill. : 1960) 133 (2): 134–139. doi:10.1001/archsurg.133.2.134. PMID 9484723.  edit
      • Lind, S. E. (1991). "The bleeding time does not predict surgical bleeding". Blood 77 (12): 2547–2552. PMID 2043759.  edit
  2. ^ http://www.slideshare.net/slulabservices/uremic-bleeding
  3. ^ Peterson, P.; Hayes, T. E.; Arkin, C. F.; Bovill, E. G.; Fairweather, R. B.; Rock Jr, W. A.; Triplett, D. A.; Brandt, J. T. (1998). "The preoperative bleeding time test lacks clinical benefit: College of American Pathologists' and American Society of Clinical Pathologists' position article". Archives of surgery (Chicago, Ill. : 1960) 133 (2): 134–139. doi:10.1001/archsurg.133.2.134. PMID 9484723.  edit
  4. ^ "Blood Chemistries". Retrieved 2009-01-02. [dead link]
  5. ^ Schafer, Andrew I.; Loscalzo, Joseph (2003). Thrombosis and hemorrhage. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 397. ISBN 0-7817-3066-X. 
  6. ^ "Bleeding Time". Retrieved 2009-01-02. [dead link]

External links[edit]