BLEEDING TIME
blood
– Time required for a standardized skin
wound to stop bleeding
– In-vivo measurement of a platelet
function (adhesiveness)
– Provides an estimate of the integrity of
the platelet plug and thereby measures
the interaction between the capillaries
and platelets
– First original test for platelet function
before aggregation test
– Single platelet function test although
there are certain factors affecting the
test
– If platelet count of patient is normal or
quantitatively count which is normal
but there is still bleeding so assess
function of platelets
– Can detect congenital and acquired
– TIME IT TAKES FOR BLEEDING TO STOP
– Measure how long bleeding stop
– Depend on the size and site of injury
– platelet plug not always relying on
platelet adhesion but somehow
bleeding time can give rough estimate
how capable platelet to form plug
– 2-9 mins
Nowadays more on aggregation test for
assessing platelet function
In-vitro measurement of platelet
adhesiveness- PLATELET RETENTION TEST
Bleeding on vital parts the more severe
bleeding
Bleeding time involve skin puncture with
standard depth 2-4mm to hit capillary bead
METHODS FOR BLEEDING TIME
A. Duke’s Method
 1912 first described by dukes and
modified by Ivy’s
 Puncture site: finger
 Simple and quite easy to do
 Standard procedure for collecting
 Use non-dominant hand because it
was less callous
 When blood start to appear start to
count
 Do not wipe the first blood drop
 Every 30 seconds-blot the blood
using filter paper
 Note: as u blot blood do not apply
pressure on patient finger
 After blot apply pressure
 Every blot is equivalent to 30
seconds
 Blot becomes smaller and smaller
coz nagkakaroon na ng plug
 Possible mistakes: too much apply
pressure
 Make sure there is ample space on
blood in blotting paper to avoid
mixing
 2-6 mins
METHOD:
1. Sterile Blood Lancet
2. Stopwatch
3. Sterile Filter Paper or clean tissue paper
4. Gauze pads or cotton balls
5. 70% Alcohol or Povidone Iodine Solution
PROCEDURE
1. Obtain a piece of filter paper and stopwatch.
2. Moisten a piece of cotton with 70% alcohol or
Povidone iodine and thoroughly cleanse the ball
of the patient’s middle or ring finger.
3. Allow the skin to air dry
4. Make a puncture wound 2-4mm deep in the
earlobe or finger with a disposable blood lancet.
5. Start the stopwatch immediately.
6. Being careful not touch the puncture site.
Blot the filter paper every 30 seconds, until the
bleeding stops (no more blood adhere on
paper)
 Make sure to make spaces between blots
7. Record the bleeding time.
 Recording: 2 mins and 30 secs
o Add 30 seconds – 5 th blot (no more blood
attaches to filter paper)
Increments of 30 seconds
NOTE: Should be the blood flow more than 15
minutes. Discontinue the test and report and
test as “greater than 15 minutes”
B. Modified Ivy’s Method – best method to
assess platelet adhesiveness
 Puncture site: forearm
 Apply constant amount of pressure
on arm (40mmHg)
 Better than DUKE’s METHOD
because of constant pressure
 More accurate
 Single puncture will do
 As blood appear start timing
 No need to apply pressure
 Viscous, core muscle so blood not
total comes out easily
 Make sure not to puncture any
portion with veins because of veins
were puncture more blood come-
falsely elevated
 If u hit veins sign is purge of blood
and dark blood
 9 mins
 Best procedure: constant pressure is applied
on the arm with use of blood pressure cuff – 40
mmHg
Ballar surface of the forearm – forearm
o Careful to not hit the vein to not cause
falsely elevated result
o Constant pressure is applied
o 2 – 3 punctures: Average is computed
PROCEDURE
1. Obtain a piece of filter paper, stopwatch and
sphygmomanometer.
2. Position the patient’s arm with the volar
surface exposed.
3. Place the sphygmomanometer on the upper
arm.
4. Moisten a piece of cotton with 70% alcohol
or Povidone iodine solution and thoroughly
cleanse the puncture site.
5. Apply the cuff and inflate to 40 mmHg, and
hold at this exact pressure for the duration of
the test NOTE: The time between inflation and
incision should be 30 to 60 seconds
6. After applying the pressure cuff and
preparing the tessiet. Make 3 same punctures
with a disposable lancet (1mm wide and 3 mm
deep) NOTE: Avoid subcutaneous veins
7. Start the stopwatch immediately.
8. After 30 seconds, wipe the flow of blood with
the filter paper. (Bring the paper close to the
incision, but do not touch the paper directly to
the incision, so as not to disturb the formation
of the platelet plug.)
9. Blot each site with filter paper every 30
seconds thereafter, until no blood stains the
paper.
10. Stop the timer when only clear fluid is
absorbed onto the filter paper. The bleeding
time is determine to the nearest 30 seconds.
11. Release the pressure of the
sphygmomamoter.
12. Record the bleeding time for each of the
puncture.
13. Get the average of the bleeding time in
minutes and seconds
SOURCES OF ERROR
1. If body hair will interfere, lightly shave the
area.
2. Patients should be advised of a potential to
produce a scar. This can usually be avoided by
the use of a butterfly bandage for 24 hours
3. Aspirin and aspirin containing products may
cause a prolonged bleeding time for up to 2
weeks
4. A standardized cut is necessary for valid
results. Too little pressure on the device and the
wound will be shallow or non-existent. Too
much pressure and the wound will be too deep.
This is the one area where standardization has
not been completely controlled.
5. Low skin temperature produces constriction
of the capillary vessels, resulting decreased
blood flow.
!!Precaution: Be sure to maintain a cuff
pressure of 40 mmHg throughout the test. If
bleeding does not diminish after 15 minutes,
discontinue the test. Report the test as “greater
than 15 minutes”
C. Coply-Lalitch Method - Both involve
immersion of the wounded finger in a
sterile NSS warmed at 37oC until bleeding
stops
Immerse puncture site at 37’C
water bath and check if there still
had bleeding
D. Adelson-Crosby Method
E. Mac-farlanes method – same principle with
Adelson Crosby method by it only uses earlobe
as the site of puncture.
F. Aspirin tolerance test – assess the effect of a
standard dose of aspirin on the Duke’s Bleeding
Time
 Aspirin inhibits cyclooxygenase
 Do not take aspirin for 24 hours prior to test
FACTORS AFFECTING BLEEDING TIME
1. Elasticity of the cut tissue –surrounding blood
vessels
2. Ability of the blood vessel to constrict and
retract: bleeding time is indirect test to assess
Integrity of vessels
If there Injury then blood vessels
constrict so if vessel is intact, have
enough collagen and healthy expect
that your bleeding will be controlled
3. Mechanical and chemical action of platelets
in the formation of hemostatic plug
 Skin thickness: callous, scars, hairs
 Size and depth of wound- 2-4mm
required
 < 100 x 109 /L – bleeding time will be
prolonged
Quantitatively and qualitatively
problem on platelets affect the bleeding
time
Time not to take aspirin- 24 hours
because it has anti-platelet activity;
cyclooxygenase-inhibit the formation of
txa2 which essential in forming clot
Aspirin makes bleeding time falsely
elevated
ABNORMAL BLEEDING TIME:
 Thrombocytopenia
 Hypofibrinogenemia
 vWF disorder – VWF essential for adhesion
and problem affecting fibrinogen
 Connective tissue disorder – such as Marfan’s
 If bleeding stop immediately – puncture is not
deep enough
Blood vessel problem
BLEEDING
 If platelet count is normal, and bleeding time
is prolonged. Possible problem on:
o Vessel disorder
o Qualitative platelet disorder o Drugs: platelets
and NSAIDS REFERENCE VALUE
 2 – 9 minutes

Earlobe- mas maraming nerve ending and

cannot facilitate flow of blood