Determination of Bleeding Time

Mr. Topesh Patle

AIM: Determination of Bleeding Time

Duke Method

Principle:

  • The Duke method is a simple test to measure the time taken for a small puncture to stop bleeding.
  • It involves making a standardised puncture on the earlobe (or fingertip) and measuring the time it takes for the bleeding to cease.
  • The test primarily evaluates platelet function and small blood vessel integrity.

 

Requirements

  1. Sterile Lancet or Needle 

  2. Stopwatch/Timer 

  3. Filter Paper 

  4. Alcohol Swabs 

  5. Cotton or Antiseptic 

  6. Gloves 

  7. Sterile Gauze 

Sample

  • Blood Sample: A small amount of blood is drawn from the earlobe (or fingertip) using a sterile lancet.

Procedure

  1. Clean the earlobe or fingertip with an alcohol swab and allow it to air dry.

  2. Using a sterile lancet or needle, make a small puncture of approximately 3-4 mm deep on the earlobe (or fingertip).

  3. Start timing immediately after the puncture is made.

  4. Gently blot the site with a clean piece of filter paper or gauze every 30 seconds to remove any blood that is oozing from the puncture. Be careful not to disturb the clot formation.

  5. Continue blotting until the bleeding stops completely. The bleeding time is considered complete when no blood is visible on the filter paper after blotting.

  6. The time it takes for the bleeding to stop is recorded as the bleeding time.

Normal Range

  • Normal Bleeding Time (Duke Method): 1 to 3 minutes.

IVY Method

Principle

  • The Ivy method is a standardised test used to measure bleeding time, which assesses platelet function and small blood vessel integrity.
  • The principle involves making a standardised incision on the forearm and observing the time it takes for bleeding to stop.
  • This method measures the vascular and platelet response to injury.

Requirements

    1. Sterile Lancet or Needle 

    2. Stopwatch/Timer 

    3. Filter Paper 

    4. Alcohol Swabs 

    5. Cotton or Antiseptic 

    6. Gloves 

    7. Sterile Gauze 

Sample

  • Blood Sample: No direct blood sample is required, as the test involves making an incision on the forearm to observe bleeding time.

Procedure

  1. Clean the forearm (usually the inner side of the forearm) with an alcohol swab and allow it to air dry.

  2. Inflate a blood pressure cuff on the upper arm to a pressure of around 40 mmHg, ensuring that the capillaries in the forearm are dilated and blood flow is maintained.

  3. Using a sterile scalpel or lancet, make a small, standardised incision (1-2 cm long) on the forearm. This incision should be superficial and not too deep.

  4. Start the timer immediately after making the incision.

  5. Blot the site gently with filter paper or gauze at regular intervals (usually every 30 seconds) without disturbing the clot formation.

  6. Continue blotting until bleeding stops. The time it takes for bleeding to cease is recorded as the bleeding time.

  7. The bleeding time is recorded as the time from the incision until bleeding stops completely.

Normal Range

  • Normal Bleeding Time (IVY Method): 2 to 9 minutes.

Clinical Significance

Prolonged Bleeding Time:

A prolonged bleeding time indicates a problem with platelet function, vascular integrity, or both. Conditions that can cause prolonged bleeding time include:

  1. Platelet Disorders:

    • Thrombocytopathies: These are disorders where platelets are dysfunctional despite a normal platelet count, e.g., von Willebrand disease, Aspirin therapy, or Bernard-Soulier syndrome.

    • Platelet Aggregation Issues: In some cases, platelets fail to aggregate properly in response to injury.

  2. Clotting Factor Deficiency:

    • While the Ivy method specifically tests platelet function, it can indicate problems in coagulation pathways if bleeding times are prolonged due to deficiencies in clotting factors (e.g., Hemophilia, Vitamin K deficiency).

  3. Vascular Disorders:

    • Vascular Abnormalities can impair the ability of blood vessels to constrict and form a clot. This may include conditions like Ehlers-Danlos syndrome or Scurvy (Vitamin C deficiency).

    • Weak Vessel Walls: Conditions that weaken blood vessel walls can lead to prolonged bleeding times.

  4. Leukemia and Bone Marrow Disorders:

    • In conditions like leukemia, myeloproliferative disorders, or other bone marrow conditions, platelet function may be compromised, leading to prolonged bleeding times.

  5. Medications:

    • Aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) can impair platelet function, leading to prolonged bleeding time, even though these drugs do not directly impact the clotting cascade.

  6. Other Conditions:

    • Liver Disease: Severe liver dysfunction may lead to a decreased production of clotting factors, affecting the clotting process.

    • Renal Failure: Chronic kidney disease can sometimes affect platelet function and bleeding time.

Normal or Short Bleeding Time:

  1. Healthy Platelets and Vessels:

    • Normal bleeding time indicates that platelets are functioning properly and blood vessels constrict well to control bleeding.

  2. Normal Function After Medications:

    • A short bleeding time after discontinuation of medications like Aspirin or NSAIDs suggests the platelets have returned to normal function.

  3. Absence of Platelet Dysfunction:

    • A normal bleeding time confirms that there are no apparent platelet dysfunctions, such as those found in Bernard-Soulier syndrome or Glanzmann’s thrombasthenia.