Bleeding time

Bleeding time is a medical test done on someone to assess their platelet function.
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 standardised 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 special
value. The time it takes for bleeding to stop (as thus 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'.
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 and disseminated intravascular
coagulation (DIC).
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 agglutination protein, but this is not considered an effective
diagnostic test for this condition.
Normal values fall between 2 - 9 minutes depending on the method used.

Ivy method
The Ivy method is the traditional format for this test. In the Ivy method, a blood pressure
cuff is placed on the upper arm and inflated to 40 mmHg. A lancet or scalpel blade is used
to make a stab wound on the underside of the forearm.
A standard-sized cut is made (usually using an automatic blade.) The time from when the
stab wound 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.
Bleeding time

Definition
Bleeding time is a crude test of hemostasis (the arrest or stopping of bleeding). It
indicates how well platelets interact with blood vessel walls to form blood clots.
Purpose
Bleeding time is used most often to detect qualitative defects of platelets, such as Von
Willebrand's disease. The test helps identify people who have defects in their platelet
function. This is the ability of blood to clot following a wound or trauma. Normally,
platelets interact with the walls of blood vessels to cause a blood clot. There are many
factors in the clotting mechanism, and they are initiated by platelets. The bleeding time
test is usually used on patients who have a history of prolonged bleeding after cuts, or
who have a family history of bleeding disorders. Also, the bleeding time test is
sometimes performed as a preoperative test to determine a patient's likely bleeding
response during and after surgery. However, in patients with no history of bleeding
problems, or who are not taking anti-inflammatory drugs, the bleeding time test is not
usually necessary.
Precautions
Before administering the test, patients should be questioned about what medications
they may be taking. Some medications will adversely affect the results of the bleeding
time test. These medications include anticoagulants, diuretics, anticancer drugs,
sulfonamides, thiazide, aspirin and aspirin-containing preparations, and nonsteroidal
anti-inflammatory drugs. The test may also be affected by anemia (a deficiency in red
blood cells). Since the taking of aspirin or related drugs are the most common cause of
prolonged bleeding time, no aspirin should be taken two weeks prior to the test.
Description
There are four methods to perform the bleeding test. The Ivy method is the traditional
format for this test. In the Ivy method, a blood pressure cuff is placed on the upper arm
and inflated to 40 mM Hg. A lancet or scalpel blade is used to make a stab wound on
the underside of the forearm. An automatic, spring-loaded blade device is most
commonly used to make a standard-sized cut. The area stabbed is selected so that no
superficial or visible veins are cut. These veins, because of their size, may have longer
bleeding times, especially in people with bleeding defects. The time from when the stab
wound 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.
The three other methods of performing the bleeding test are the template, modified

template, and Duke methods. The template and modified template methods are
variations of the Ivy method. A blood pressure cuff is used and the skin on the forearm
prepared as in the Ivy method. A template is placed over the area to be stabbed and two
incisions are made in the forearm using the template as a location guide. The main
difference between the template and the modified method is the length of the cut made.
For the Duke method, a nick is made in an ear lobe or a fingertip is pricked to cause
bleeding. As in the Ivy method, the test is timed from the start of bleeding until
bleeding is completely stopped. The disadvantage to the Duke method is that the
pressure on the blood veins in the stab area is not constant and the results achieved are
less reliable. The advantage to the Duke method is that no scar remains after the test.
The other methods may result in a tiny, hairline scar where the wound was made.
However, this is largely a cosmetic concern.
Preparation
There is no special preparation required of the patient for this test. The area to be
stabbed should be wiped clean with an alcohol pad. The alcohol should be left on the
skin long enough for it to kill bacteria at the wound site. The alcohol must be removed
before stabbing the arm because alcohol will adversely affect the tests results by
inhibiting clotting.
Aftercare
If a prolonged bleeding time is caused by unknown factors or diseases, further testing is
required to identify the exact cause of the bleeding problem.
Normal results
A normal bleeding time for the Ivy method is less than five minutes from the time of
the stab until all bleeding from the wound stops. Some texts extend the normal range to
eight minutes. Normal values for the template method range up to eight minutes, while
for the modified template methods, up to 10 minutes is considered normal. Normal for
the Duke method is three minutes.
Abnormal results
A bleeding time that is longer than normal is an abnormal result. The test should be
stopped if the patient hasn't stopped bleeding by 20-30 minutes. Bleeding time is longer
when the normal function of platelets is impaired, or there are a lower-than-normal
number of platelets in the blood.
A longer-than-normal bleeding time can indicate that one of several defects in
hemostasis is present, including severe thrombocytopenia, platelet dysfunction,
vascular defects, Von Willebrand's disease, or other abnormalities.

Bleeding time

Blood clot test

Definition

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Bleeding time is a blood test that looks at how fast small blood vessels close to stop you from bleeding.
How the Test is Performed

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A blood pressure cuff inflates around your upper arm. While on the cuff is on your arm, the health care
provider makes two small cuts on the lower arm. They are just just deep enough to cause a tiny amount of
bleeding.
The blood pressure cuff is immediately deflated. Blotting paper is touched to the cuts every 30 seconds
until the bleeding stops. The health care provider records the time it takes for the cuts to stop bleeding.
How to Prepare for the Test

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Certain medications may change the test results. Always tell your doctor what medications you are taking,
even over-the-counter drugs. Drugs that may increase bleeding times include dextran, indomethacin, and
salicylates (including aspirin).
Your doctor may tell you to stop taking certain medicines a few days before the test. Never stop taking
medicine without first talking to your doctor.
How the Test Will Feel

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The tiny cuts are very shallow. Most people say it feels like a skin scratch.
Why the Test is Performed

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This test helps diagnose bleeding problems.

Normal Results

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Bleeding normally stops within 1 to 9 minutes. However, values may vary from lab to lab.
What Abnormal Results Mean

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Longer-than-normal bleeding time may be due to:

Blood vessel defect

Platelet aggregation
Thrombocytopenia

Additional conditions under which the test may be performed:

Risks

Acquired platelet function defect

Congenital platelet function defects
Primary thrombocythemia
Von Willebrand's disease
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There is a very slight risk of infection where the skin is broken. Excessive bleeding is rare.

Blood clot test

The bleeding time test is used to evaluate how well a person's blood is clotting. The test
evaluates how long it takes the vessels cut to constrict and how long it takes for platelets in the
blood to seal off the hole. Blood vessel defects, platelet function defects, along with many other
conditions can result in prolonged bleeding time.

Bleeding time
Images

Blood clot test

Definition
This is a test that measures the speed at which small blood vessels close off to stop bleeding (the condition
of the blood vessels) and platelet function.
How the test is performed
A blood pressure cuff is placed on the upper arm and inflated. Two incisions are made on the lower arm.
These are about 10 mm (less than 1/2 inch) long and 1 mm deep (just deep enough to cause minimal
bleeding).
The blood pressure cuff is immediately deflated. Blotting paper is touched to the cuts every 30 seconds until
the bleeding stops. The length of time it takes for the cuts to stop bleeding is recorded.
How to prepare for the test
Certain medications can interfere with platelet function and therefore may alter test results. Always make
sure to tell your doctor what medications you are taking, even over-the-counter preparations.
Your health care provider may ask you to discontinue these medications several days prior to the test. Never
discontinue medication without consulting your health care provider.
How the test will feel
The incisions are very shallow and should feel like scratches.
Why the test is performed
This test is useful for detecting bleeding problems.
Normal Values
The bleeding stops within 1 to 9 minutes (what is considered normal varies from lab to lab, depending on
how the test is measured).
What abnormal results mean
Prolonged bleeding time may indicate:

A vascular (blood vessel) defect

A platelet function defect (see platelet aggregation)
Thrombocytopenia (low platelets)
Drugs that may increase bleeding times include dextran, indomethacin, and salicylates (including aspirin).
Additional conditions under which the test may be performed:

Acquired platelet function defect

Congenital platelet function defects
Primary thrombocythemia
Von Willebrand's disease
What the risks are

There is a very slight risk of infection where the skin is broken. Excessive bleeding is rare.
Special considerations
The bleeding time test is used to evaluate the vascular (blood vessel) and platelet factors associated with
hemostasis (blood clot formation). When vascular injury occurs, the first hemostatic response is a spastic
contraction of the lacerated vessels. Next, platelets adhere to the wall of the vessel at the area of laceration
in an attempt to plug the hole. The failure of either process results in a prolonged bleeding time.
Review Date: 2/3/2005
Reviewed by: Rita Nanda, M.D., Department of Hematology/Oncology, University of Chicago Medical
Center, Chicago, IL. Review provided by VeriMed Healthcare Network.

Bleeding time test