Bleeding time

Last updated
Bleeding time
Specialty Haematology
MeSH D001760
MedlinePlus 003656

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 using a stopwatch or other suitable devices.

Contents

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

A newer alternative to the traditional bleeding time test is the platelet function screen performed on the PFA-100 analyzer. [1]

Indications

The template bleeding time test is a method indicated when other more reliable and less invasive tests for determining coagulation are not available. [2] Historically, it was indicated whenever physicians needed information about platelet activation. [3]

Process

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 a template device. [4]

IVY method

The IVY method is the traditional format for this test. While both the IVY and Duke's 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. [5]

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. [6]

A prolonged bleeding time may be a result from decreased number of thrombocytes or impaired blood vessels. However, 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.

A disadvantage of Ivy's method is closure of puncture wound before stoppage of bleeding. [7]

Duke's method

With the Duke's method, the patient is pricked with a special needle or lancet, preferably on the earlobe [8] 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.

This method is not recommended and cannot be standardized because it can cause a large local hematoma. [7]

Interpretation

Bleeding time may be affected by platelet function, certain vascular disorders and von Willebrand Disease—not by other coagulation factors such as haemophilia. Diseases that may cause prolonged bleeding time include thrombocytopenia, disseminated intravascular coagulation (DIC), Bernard-Soulier disease, and Glanzmann's thrombasthenia. [9]

Aspirin and other cyclooxygenase inhibitors can significantly prolong bleeding time. 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. [9]

It is also prolonged in hypofibrinogenemia. [10]

In the British comedy film Doctor in the House (1954), Sir Lancelot Spratt, the intimidating chief of surgery played by James Robertson Justice is asking instructional questions of his medical students. 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."

Related Research Articles

<span class="mw-page-title-main">Bleeding</span> Loss of blood escaping from the circulatory system

Bleeding, hemorrhage, haemorrhage or blood loss is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, vagina or anus, or through a puncture in the skin. Hypovolemia is a massive decrease in blood volume, and death by excessive loss of blood is referred to as exsanguination. Typically, a healthy person can endure a loss of 10–15% of the total blood volume without serious medical difficulties. The stopping or controlling of bleeding is called hemostasis and is an important part of both first aid and surgery.

<span class="mw-page-title-main">Platelet</span> Component of blood aiding in coagulation

Platelets or thrombocytes are a blood component whose function is to react to bleeding from blood vessel injury by clumping, thereby initiating a blood clot. Platelets have no cell nucleus; they are fragments of cytoplasm derived from the megakaryocytes of the bone marrow or lung, which then enter the circulation. Platelets are found only in mammals, whereas in other vertebrates, thrombocytes circulate as intact mononuclear cells.

<span class="mw-page-title-main">Coagulation</span> Process of formation of blood clots

Coagulation, also known as clotting, is the process by which blood changes from a liquid to a gel, forming a blood clot. It results in hemostasis, the cessation of blood loss from a damaged vessel, followed by repair. The process of coagulation involves activation, adhesion and aggregation of platelets, as well as deposition and maturation of fibrin.

<span class="mw-page-title-main">Disseminated intravascular coagulation</span> Medical condition where blood clots block small blood vessels

Disseminated intravascular coagulation (DIC) is a condition in which blood clots form throughout the body, blocking small blood vessels. Symptoms may include chest pain, shortness of breath, leg pain, problems speaking, or problems moving parts of the body. As clotting factors and platelets are used up, bleeding may occur. This may include blood in the urine, blood in the stool, or bleeding into the skin. Complications may include organ failure.

von Willebrand disease Medical condition

Von Willebrand disease (VWD) is the most common hereditary blood-clotting disorder in humans. An acquired form can sometimes result from other medical conditions. It arises from a deficiency in the quality or quantity of von Willebrand factor (VWF), a multimeric protein that is required for platelet adhesion. It is known to affect several breeds of dogs as well as humans. The three forms of VWD are hereditary, acquired, and pseudo or platelet type. The three types of hereditary VWD are VWD type 1, VWD type 2, and VWD type 3. Type 2 contains various subtypes. Platelet type VWD is also an inherited condition.

<span class="mw-page-title-main">Thrombotic thrombocytopenic purpura</span> Medical condition

Thrombotic thrombocytopenic purpura (TTP) is a blood disorder that results in blood clots forming in small blood vessels throughout the body. This results in a low platelet count, low red blood cells due to their breakdown, and often kidney, heart, and brain dysfunction. Symptoms may include large bruises, fever, weakness, shortness of breath, confusion, and headache. Repeated episodes may occur.

In biology, hemostasis or haemostasis is a process to prevent and stop bleeding, meaning to keep blood within a damaged blood vessel. It is the first stage of wound healing. Hemostasis involves three major steps:

<span class="mw-page-title-main">Thrombocytopenia</span> Abnormally low levels of platelets in the blood

In hematology, thrombocytopenia is a condition characterized by abnormally low levels of platelets in the blood. Low levels of platelets in turn may lead to prolonged or excessive bleeding. It is the most common coagulation disorder among intensive care patients and is seen in a fifth of medical patients and a third of surgical patients.

Low-molecular-weight heparin (LMWH) is a class of anticoagulant medications. They are used in the prevention of blood clots and, in the treatment of venous thromboembolism, and the treatment of myocardial infarction.

von Willebrand factor Mammalian protein involved in blood clotting

Von Willebrand factor (VWF) is a blood glycoprotein that promotes hemostasis, specifically, platelet adhesion. It is deficient and/or defective in von Willebrand disease and is involved in many other diseases, including thrombotic thrombocytopenic purpura, Heyde's syndrome, and possibly hemolytic–uremic syndrome. Increased plasma levels in many cardiovascular, neoplastic, metabolic, and connective tissue diseases are presumed to arise from adverse changes to the endothelium, and may predict an increased risk of thrombosis.

Weibel–Palade bodies (WPBs) are the storage granules of endothelial cells, the cells that form the inner lining of the blood vessels and heart. They manufacture, store and release two principal molecules, von Willebrand factor and P-selectin, and thus play a dual role in hemostasis and inflammation.

<span class="mw-page-title-main">Bleeding diathesis</span> Medical condition

In medicine (hematology), bleeding diathesis is an unusual susceptibility to bleed (hemorrhage) mostly due to hypocoagulability, in turn caused by a coagulopathy. Therefore, this may result in the reduction of platelets being produced and leads to excessive bleeding. Several types of coagulopathy are distinguished, ranging from mild to lethal. Coagulopathy can be caused by thinning of the skin, such that the skin is weakened and is bruised easily and frequently without any trauma or injury to the body. Also, coagulopathy can be contributed by impaired wound healing or impaired clot formation.

<span class="mw-page-title-main">Glanzmann's thrombasthenia</span> Medical condition

Glanzmann's thrombasthenia is an abnormality of the platelets. It is an extremely rare coagulopathy, in which the platelets contain defective or low levels of glycoprotein IIb/IIIa (GpIIb/IIIa), which is a receptor for fibrinogen. As a result, no fibrinogen bridging of platelets to other platelets can occur, and the bleeding time is significantly prolonged.

<span class="mw-page-title-main">Thrombophilia</span> Abnormality of blood coagulation increasing the risk of blood clotting (thrombosis)

Thrombophilia is an abnormality of blood coagulation that increases the risk of thrombosis. Such abnormalities can be identified in 50% of people who have an episode of thrombosis that was not provoked by other causes. A significant proportion of the population has a detectable thrombophilic abnormality, but most of these develop thrombosis only in the presence of an additional risk factor.

<span class="mw-page-title-main">Plateletpheresis</span> Method of collecting platelets from blood

Plateletpheresis is the process of collecting thrombocytes, more commonly called platelets, a component of blood involved in blood clotting. The term specifically refers to the method of collecting the platelets, which is performed by a device used in blood donation that separates the platelets and returns other portions of the blood to the donor. Platelet transfusion can be a life-saving procedure in preventing or treating serious complications from bleeding and hemorrhage in patients who have disorders manifesting as thrombocytopenia or platelet dysfunction. This process may also be used therapeutically to treat disorders resulting in extraordinarily high platelet counts such as essential thrombocytosis.

Thromboelastography (TEG) is a method of testing the efficiency of blood coagulation. It is a test mainly used in surgery and anesthesiology, although increasingly used in resuscitations in emergency departments, intensive care units, and labor and delivery suites. More common tests of blood coagulation include prothrombin time (PT) and partial thromboplastin time (aPTT) which measure coagulation factor function, but TEG also can assess platelet function, clot strength, and fibrinolysis which these other tests cannot.

Congenital afibrinogenemia is a rare, genetically inherited blood fibrinogen disorder in which the blood does not clot normally due to the lack of fibrinogen, a blood protein necessary for coagulation. This disorder is autosomal recessive, meaning that two unaffected parents can have a child with the disorder. The lack of fibrinogen expresses itself with excessive and, at times, uncontrollable bleeding.

<span class="mw-page-title-main">Bernard–Soulier syndrome</span> Medical condition

Bernard–Soulier syndrome (BSS) is a rare autosomal recessive bleeding disorder that is caused by a deficiency of the glycoprotein Ib-IX-V complex (GPIb-IX-V), the receptor for von Willebrand factor. The incidence of BSS is estimated to be less than 1 case per million persons, based on cases reported from Europe, North America, and Japan. BSS is a giant platelet disorder, meaning that it is characterized by abnormally large platelets.

<span class="mw-page-title-main">Ristocetin</span> Chemical compound

Ristocetin is a glycopeptide antibiotic, obtained from Amycolatopsis lurida, previously used to treat staphylococcal infections. It is no longer used clinically because it caused thrombocytopenia and platelet agglutination. It is now used solely to assay those functions in vitro in the diagnosis of conditions such as von Willebrand disease (vWD) and Bernard–Soulier syndrome. Platelet agglutination caused by ristocetin can occur only in the presence of von Willebrand factor multimers, so if ristocetin is added to blood lacking the factor, the platelets will not clump.

Thromboelastometry (TEM), previously named rotational thromboelastography (ROTEG) or rotational thromboelastometry (ROTEM), is an established viscoelastic method for hemostasis testing in whole blood. It is a modification of traditional thromboelastography (TEG).

References

  1. ↑ Alhaj, Dana; Hagedorn, Nikola; Cuntz, Franziska; Reschke, Madlen; Schuldes, Joerg; Ruthenberg, Juliane; Bakchoul, Tamam; Greinacher, Andreas; Holzhauer, Susanne (2024). "ISTH bleeding assessment tool and platelet function analyzer in children with mild inherited platelet function disorders". European Journal of Haematology. 113 (1): 54–65. doi:10.1111/ejh.14198. ISSN   0902-4441. PMID   38549165.
  2. ↑ 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
  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. 133 (2): 134–139. doi:10.1001/archsurg.133.2.134. PMID   9484723.
  4. ↑ Quiroga, T.; Goycoolea, M.; Muñoz, B.; Morales, M.; Aranda, E.; Panes, O.; Pereira, J.; Mezzano, D. (2004). "Template bleeding time and PFA-100® have low sensitivity to screen patients with hereditary mucocutaneous hemorrhages: comparative study in 148 patients". Journal of Thrombosis and Haemostasis. 2 (6): 892–898. doi:10.1111/j.1538-7836.2004.00693.x. PMID   15140124.
  5. ↑ Burns, E. R.; Lawrence, C. (1989). "Bleeding time. A guide to its diagnostic and clinical utility". Archives of Pathology & Laboratory Medicine. 113 (11): 1219–1224. ISSN   0003-9985. PMID   2535679.
  6. ↑ "Blood Chemistries". Archived from the original on August 14, 2007. Retrieved 2009-01-02.
  7. 1 2 Dg, Dayyal (2016). "BLEEDING TIME (BT) AND CLOTTING TIME (CT)". BioScience. ISSN   2521-5760.
  8. ↑ Schafer, Andrew I.; Loscalzo, Joseph (2003). Thrombosis and hemorrhage. Hagerstwon, MD: Lippincott Williams & Wilkins. p. 397. ISBN   978-0-7817-3066-2.
  9. 1 2 Mehic, Dino; Assinger, Alice; Gebhart, Johanna (2024-07-01). "Utility of Global Hemostatic Assays in Patients with Bleeding Disorders of Unknown Cause". Hämostaseologie (in German). doi:10.1055/a-2330-9112. ISSN   0720-9355. PMID   38950624.
  10. ↑ "Bleeding Time". Archived from the original on September 14, 2006. Retrieved 2009-01-02.
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