Editing Bleeding time

{{Short description|Medical test for assessing blood coagulation function}}
{{Infobox medical intervention
| Name           = Bleeding time
| Image          =
| Caption        =
| Specialty      = [[Haematology]]
| ICD10          =
| ICD9           =
| MeshID         = D001760
| MedlinePlus    = 003656
| OtherCodes     =
}}
'''Bleeding time''' is a [[medical test]] done to assess the function of a person's [[platelets]]. It involves making a patient bleed, then timing how long it takes for them to stop bleeding using a [[stopwatch]] or other suitable devices.

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.<ref name="d583">{{cite journal | last1=Alhaj | first1=Dana | last2=Hagedorn | first2=Nikola | last3=Cuntz | first3=Franziska | last4=Reschke | first4=Madlen | last5=Schuldes | first5=Joerg | last6=Ruthenberg | first6=Juliane | last7=Bakchoul | first7=Tamam | last8=Greinacher | first8=Andreas | last9=Holzhauer | first9=Susanne | title=ISTH bleeding assessment tool and platelet function analyzer in children with mild inherited platelet function disorders | journal=European Journal of Haematology | volume=113 | issue=1 | date=2024 | issn=0902-4441 | doi=10.1111/ejh.14198 | pages=54–65| pmid=38549165 | doi-access=free }}</ref>

==Usage==
The template bleeding time test is a method used when other more reliable and less invasive tests for determining [[coagulation]] are not available.<ref name="ASCPfive">{{Citation |author1 =  American Society for Clinical Pathology |author1-link = American Society for Clinical Pathology |title = Five Things Doctors and Patients Should Question |publisher = American Society for Clinical Pathology |work = [[Choosing Wisely]]: an initiative of the [[ABIM Foundation]] |url=http://www.choosingwisely.org/doctor-patient-lists/american-society-for-clinical-pathology/ |access-date = August 1, 2013}}, which cites
#* {{Cite journal | last1 = Lehman | first1 = C. M. | last2 = Blaylock | first2 = R. C. | last3 = Alexander | first3 = D. P. | last4 = Rodgers | first4 = G. M. | title = Discontinuation of the bleeding time test without detectable adverse clinical impact | journal = Clinical Chemistry | volume = 47 | issue = 7 | pages = 1204–1211 | year = 2001 | pmid = 11427450| doi = 10.1093/clinchem/47.7.1204 | doi-access = free }}
#* {{Cite journal | doi = 10.1001/archsurg.133.2.134 | last1 = Peterson | first1 = P. | last2 = Hayes | first2 = T. E. | last3 = Arkin | first3 = C. F. | last4 = Bovill | first4 = E. G. | last5 = Fairweather | first5 = R. B. | last6 = Rock Jr | first6 = W. A. | last7 = Triplett | first7 = D. A. | last8 = Brandt | first8 = J. T. | title = The preoperative bleeding time test lacks clinical benefit: College of American Pathologists' and American Society of Clinical Pathologists' position article | journal = Archives of Surgery | volume = 133 | issue = 2 | pages = 134–139 | year = 1998 | pmid = 9484723| doi-access =  }}
#* {{Cite journal | last1 = Lind | first1 = S. E. | title = The bleeding time does not predict surgical bleeding | journal = Blood | volume = 77 | issue = 12 | pages = 2547–2552 | year = 1991 | pmid = 2043759| doi = 10.1182/blood.V77.12.2547.2547 | doi-access = free }}</ref> Historically, it was used whenever physicians needed information about platelet activation.<ref>{{Cite journal | doi = 10.1001/archsurg.133.2.134 | last1 = Peterson | first1 = P. | last2 = Hayes | first2 = T. E. | last3 = Arkin | first3 = C. F. | last4 = Bovill | first4 = E. G. | last5 = Fairweather | first5 = R. B. | last6 = Rock Jr | first6 = W. A. | last7 = Triplett | first7 = D. A. | last8 = Brandt | first8 = J. T. | title = The preoperative bleeding time test lacks clinical benefit: College of American Pathologists' and American Society of Clinical Pathologists' position article | journal = Archives of Surgery | volume = 133 | issue = 2 | pages = 134–139 | year = 1998 | pmid = 9484723| doi-access =  }}</ref>

==Process==
The test involves cutting the underside of the subject's forearm, in an area where there is no hair or visible [[vein]]s. The cut is of a standardized width and depth, and is done quickly by a template device.<ref name="v636">{{cite journal | last1=Quiroga | first1=T. | last2=Goycoolea | first2=M. | last3=Muñoz | first3=B. | last4=Morales | first4=M. | last5=Aranda | first5=E. | last6=Panes | first6=O. | last7=Pereira | first7=J. | last8=Mezzano | first8=D. | title=Template bleeding time and PFA-100® have low sensitivity to screen patients with hereditary mucocutaneous hemorrhages: comparative study in 148 patients | journal=Journal of Thrombosis and Haemostasis | volume=2 | issue=6 | date=2004 | doi=10.1111/j.1538-7836.2004.00693.x | pages=892–898| pmid=15140124 }}</ref>

===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 and drainage|incision]] on the ventral side of the forearm, whereas the Duke method involves puncture with a [[Blood lancet|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.<ref name="o137">{{cite journal | last1=Burns | first1=E. R. | last2=Lawrence | first2=C. | title=Bleeding time. A guide to its diagnostic and clinical utility | journal=Archives of Pathology & Laboratory Medicine | volume=113 | issue=11 | date=1989 | issn=0003-9985 | pmid=2535679 | pages=1219–1224}}</ref>

A standard-sized incision is made around 10&nbsp;mm long and 1&nbsp;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.<ref name="urlBlood Chemistries">{{cite web|url=http://www.obgyn.ufl.edu/obgyn101/Lab/Blood%20Chemistries.htm |title=Blood Chemistries |access-date=2009-01-02 |url-status=dead |archive-url=https://web.archive.org/web/20070814013421/http://www.obgyn.ufl.edu/obgyn101/Lab/Blood%20Chemistries.htm#Liver%20Function%20Tests |archive-date=August 14, 2007 }}</ref>

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.

[[Reference ranges for common blood tests|Normal values]] fall between 3&nbsp;– 10 minutes depending on the method used.

A disadvantage of Ivy's method is closure of puncture wound before stoppage of bleeding.<ref name=":0">{{Cite journal|url=https://www.bioscience.com.pk/topics/microbiology/item/151-bleeding-time-and-clotting-time|title=BLEEDING TIME (BT) AND CLOTTING TIME (CT)|last=Dg|first=Dayyal|year=2016|journal=BioScience|issn=2521-5760}}</ref>

===Duke's method===

With the Duke's method, the patient is pricked with a special needle or lancet, preferably on the [[earlobe]]<ref name="isbn0-7817-3066-X">{{cite book |author1=Schafer, Andrew I. |author2=Loscalzo, Joseph |title=Thrombosis and hemorrhage |publisher=Lippincott Williams & Wilkins |location=Hagerstwon, MD |year=2003 |pages=397  |isbn=978-0-7817-3066-2 }}</ref> or [[fingertip]], after having been swabbed with alcohol. The prick is about 3–4&nbsp;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.<ref name=":0" />

==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]].<ref name="y378">{{cite journal | last1=Mehic | first1=Dino | last2=Assinger | first2=Alice | last3=Gebhart | first3=Johanna | title=Utility of Global Hemostatic Assays in Patients with Bleeding Disorders of Unknown Cause | journal=Hämostaseologie | date=2024-07-01 | issn=0720-9355 | doi=10.1055/a-2330-9112 | language=de | page=| pmid=38950624 }}</ref>

[[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.<ref name="y378"/>

It is also prolonged in [[hypofibrinogenemia]].<ref name="urlBleeding Time">{{cite web|url=http://www.obgyn.ufl.edu/obgyn101/Lab/Bleeding%20Time.htm |title=Bleeding Time |access-date=2009-01-02 |url-status=dead |archive-url=https://web.archive.org/web/20060914061228/http://www.obgyn.ufl.edu/obgyn101/Lab/Bleeding%20Time.htm |archive-date=September 14, 2006 }}</ref>

==In popular culture==
<!-- This section includes humor, should be modified as per [[WP:HUMOR]] and relevant source(s) of the specific ''joke'' -->In the British comedy film ''[[Doctor in the House (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."

==References==
{{Reflist}}

==External links==
* [https://www.nlm.nih.gov/medlineplus/ency/article/003656.htm MedlinePlus Medical Encyclopedia]

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[[Category:Blood tests]]