Bleeding Time

Test Description


Bleeding time measures the duration of bleeding after a standardized skin incision
has been made. Commercially manufactured bleeding template devices predominate
in the performance of bleeding times because of the standardization of testing that
only they can provide. In addition, they are cost effective, sterile, and disposable,
and reduce scarring. With the template method, one or two standardized incisions
are made on the volar surface of the forearm and the time required for bleeding to
stop is determined—this is the “bleeding time.” The Ivy method requires three
small punctures.
Bleeding time is a screening test for detecting disorders involving platelet function
and for vascular (i.e., capillary) defects that interfere with the clotting process
Prolonged bleeding time in the absence of a low platelet count indicates that a
qualitative platelet disorder exists. The test is indicated when there is a personal or
family history of bleeding tendencies and as a screening test for preoperative
patients when a hemostatic defect is suspected.

Normal Values
1–9 minutes (Ivy method)

Possible Meanings of Abnormal Values

Increased (Prolonged)                           

Anemia due to folic acid deficiency
Aplastic anemia
Aspirin ingestion
Bone marrow disorder
Collagen vascular disease
Cushing’s disease
Disseminated intravascular coagulation (DIC)
Factor VI, VII, XI deficiencies
Fibrinogen defects
Heat stroke
Hypocalcemia
Leukemia
Pernicious anemia
Renal failure
Severe liver disease
Thrombocytopenia
Uremia
Vascular abnormalities
Von Willebrand’s disease

Contributing Factors to Abnormal Values

• Many variables influence the result, including skin thickness, temperature, location
 of incision, and presence of edema.
• Platelet counts <100,000 mm3 and low hematocrit can alter the test result.
• Drugs that may prolong the bleeding time: alcohol, antibiotics, anticoagulants, antineoplastics,
  nitroglycerin, nonsteroidal anti-inflammatory drugs (NSAIDs), salicylates,
  thiazides, thrombolytics.

Interventions/Implications

Pretest

• Obtain medication history. Aspirin, anticoagulants, NSAIDs, and over-the-counter cold
   medications should be avoided for 7 days before the test.
• Explain the procedure to the patient.
• No fasting is required before the test.
• Advise the patient to abstain from drinking alcoholic beverages for 24 hours before the
test.
• Inform the patient that scar formation may occur, especially in those patients with a history
of keloid formation.

Procedure

• The volar surface of the patient’s forearm should be extended and inspected for superficial
veins, scarring, bruises, and swelling. The muscular portion below the elbow fold is
the site of choice. If visually satisfactory, the site is cleansed with an antiseptic and
allowed to air dry completely.
• A blood pressure cuff is placed on the patient’s arm and inflated to 40 mm Hg.This pressure
should be maintained throughout the procedure.
• The commercially manufactured bleeding template device is placed in the prepared area
on the forearm.Only enough pressure is applied to ensure that the entire device is touching
the skin. Too much pressure will result in an incision that is too deep.
• Activate the device and start a stopwatch.
• As drops of blood form, they (not the wound) are blotted every 30 seconds with filter
paper. Care must be taken not to touch the wound at any time during testing.
• When bleeding ceases, the watch is stopped and the blood pressure cuff is released.
• If two incisions are made, they must be in the same orientation, either parallel or perpendicular
to the elbow, and the individual times obtained are averaged.
• If bleeding does not stop within 15 minutes, the test should be discontinued.
• Gloves are worn throughout the procedure.

Posttest

• Butterfly bandages are placed over each cut. These should remain in place for 48 hours
to minimize scarring. Assess periodically for continued bleeding.
• If the patient has bleeding tendencies, apply a pressure dressing over the butterfly bandages.
The pressure dressing can be removed after 12 hours, leaving the butterfly bandages
in place.
• Teach the patient to monitor the site. If the site begins to bleed, the patient should apply
direct pressure and, if unable to control the bleeding, return to the laboratory or notify
the primary care provider.
• Teach the patient to report if signs or symptoms of infection occur, such as drainage, redness,
warmth, edema, pain at the site, or fever.
• Report abnormal findings to the primary care provider.

Clinical alert               
• Possible complications include bleeding, scar formation, and skin infection at

site of testing.

CONTRAINDICATIONS!

• Patients with platelet counts <75,000/mm3
• Patients with edematous arms, such as postmastectomy

• Patients who are unable to cooperate during the test