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((Short description|Medical test for assessing blood coagulation function))
((More citations needed|date=January 2022))((Infobox medical intervention
| Name           = Bleeding time
| Image          =
| Caption        =
| Specialty      = [[Haematology]]
| ICD10          =
| ICD9           =
| MeshID         = D001760
| MedlinePlus    = 003656
| OtherCodes     =
))
'''Bleeding time''' is a [[medical test]] done on someone to assess their [[platelet]]s function. 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.

==Indications==
The bleeding time test is a method indicated 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> However, it remains the most reliable way of assessing clinical bleeding in patients with [[uremia]].<ref>((Cite web | url=http://www.slideshare.net/slulabservices/uremic-bleeding |title = Uremic Bleeding|date = 2011-09-05))</ref> Historically, it was indicated 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==
It 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 an automatic device.((citation needed|date=November 2021))

A blood pressure cuff is used above the wound, to maintain [[Blood pressure|venous pressure]] at a specified value. The time it takes for the bleeding to stop (i.e. the time it takes for a [[platelet plug]] to form) is measured. Cessation of bleeding can be determined by blotting away the blood every several seconds until the site looks "glassy".((citation needed|date=November 2021))

=== 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.((citation needed|date=November 2021))

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 – 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 is affected by platelet function, certain vascular disorders and [[von Willebrand Disease]]—not by other [[coagulation]] factors such as [[haemophilia]].  Diseases that cause prolonged bleeding time include [[thrombocytopenia]], [[disseminated intravascular coagulation]] (DIC), [[Bernard-Soulier disease]], and [[Glanzmann's thrombasthenia]].((citation needed|date=November 2021))

[[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.((citation needed|date=November 2021))

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]

((Myeloid blood tests))
((Authority control))

((DEFAULTSORT:Bleeding Time))
[[Category:Blood tests]]

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