Tourniquet Test (Capillary Fragility)

Normal Findings
<2 petechiae

Indications
This test evaluates capillary integrity. It is used to aid in the clinical diagnosis of hemorrhagic fever (Dengue fever).

Test Explanation
Petechiae occur as a result of increased capillary fragility (microvessels easily rupture and a small amount of bleeding occurs in
the skin) or thrombocytopenia (causing spontaneous bleeding in the skin). There are more accurate tests to indicate platelet
count and function. Petechiae are small, round nonraised red spots in the skin.

Production of petechiae can be induced in patients who have increased capillary fragility or thrombocytopenia. There
are two methods of inducing petechiae. The most common is with positive pressure. A blood pressure cuff is applied to an
extremity and inflated above venous pressure. The second way is with negative pressure. A suction cup is applied to an area of
skin for a particular period of time. Patients with thrombocytopenia, poor platelet function, or purpura will develop more than 10
petechiae per square inch of skin. The number of petechiae can be graded from few to confluent (1 to 4).

Interfering Factors
• Premenstrual women experience transient episodes of increased capillary fragility.

• Postmenopausal women who do not use hormones experience increased capillary fragility.

• Women, especially those with sun-damaged skin, can have increased capillary fragility.

*Prolonged use of steroids increases capillary fragility.

Procedure and Patient Care

Before

☑Explain the procedure to the patient.

• Obtain an informed consent if required by the institution.

☑Tell the patient that no fasting is required.

• Examine the extremity for preexisting petechiae or ecchymoses.

During
Positive Pressure Test

• Place a blood pressure cuff on the upper arm and inflate it to a level above venous pressure (around 70 mm Hg) for 5 minutes.

• Release the cuff pressure.

• Inspect the distal extremity for petechiae.

Negative Pressure Test

• Place a lubricated suction cup (2 cm in diameter) on the upper arm skin.

• Remove the suction after 1 minute.

• Examine the site for petechiae.

After

☑Explain the results to the patient.

☑If the test is positive, explain to the patient that appropriate precautions should be taken to avoid soft-tissue injury.

Test Results and Clinical Significance

Positive: Greater Than 2 Petechiae

Immunologic thrombocytopenia (e.g., idiopathic thrombocytopenic purpura),

Drug-induced thrombocytopenia,

Thromboasthenia (poor platelet function):

Reduced platelets cause spontaneous microbleeding. Nonimmunologic thrombocytopenia is rarely associated with a positive
tourniquet test.

Hereditary telangiectasia,

Vascular purpura (autoimmune diseases),

Senile purpura,

Allergic purpura,

Scurvy: Increased capillary permeability causes petechiae.

Hemophilia: Spontaneous bleeding causes petechiae.