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The following points highlight the three main methods which should be adopted during bleeding time. The methods are: 1. Finger Tip Method 2. Duke’s Method 3. Ivy’s Method.
Bleeding time is duration of bleeding form a standard puncture wound on the skin which is a measure of the function of the platelets as well as integrity of the vessel wall. This is one of the most important preliminary indicators for detection of bleeding disorders. This is also the most commonly done preparative investigation in patients scheduled for surgery.
A small puncture is made on the skin and the time for which it bleeds is noted. Bleeding stops when platelet plug forms and breach in the vessel wall has scaled.
Methods for Bleeding Time:
1. Finger tip method
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2. Duke’s method
3. Ivy’s method
1. Finger Tip Method:
Procedure:
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i. Clean the tip of a finger with spirit.
ii. Prick with a disposable needle or lancet.
iii. Start the stop-watch immediately.
iv. Start gently touching the pricked finger with filter paper till blood spots continue to be made on the filter paper.
v. Stop the watch when no more blood spot comes on the filter paper and note the time.
Disadvantages:
(i) It is crude method
(ii) Bleeding time is low by this method
Normal bleeding time 1-3 minutes.
2. Duke’s Method:
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Procedure:
i. Clean the lobe of a ear with a spirit swab.
ii. Using a disposable lancet/needle, puncture the lower edge of the earlobe to a depth of approximately 3 min.
iii. Start the stop-watch immediately.
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iv. Allow the drops of blood to fall on a filter paper without touching the earlobe and then slowly touching the blood drop gently on a new area on the filter paper.
v. Stop the watch when no more blood comes over the filter paper and note the time.
Advantages of the Methods:
(i) The ear lobule has abundant subcutaneous tissue and it vascular.
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(ii) Flow of blood is quite good.
Normal Bleeding Time 3-5 Minutes:
3. Ivy’s Method:
Procedure:
i. Tie the BP apparatus cuff around the patient’s upper arm and inflate it upto 40 mmHg which is maintained throughout the test.
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ii. Clean an area with spirit over the flexor surface of forearm and allow it dry.
iii. Using a disposable lancet or surgical blade, make 2 punctures 3 mm deep 5-10 cm form each other taking care not to puncture the superficial veins.
iv. Start the stop-watch immediately.
v. Go on blotting each puncture with a filter paper as in Duke’s method.
vi. Stop the watch, note the time in each puncture and calculate average bleeding time.
Advantages of the Method:
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(i) This is the method of choice.
(ii) It is a standardised method.
(iii) Bleeding time is more accurate.
Normal Bleeding Time 3-8 Minutes:
The bleeding time is prolonged in following conditions:
(i) Thrombocytopenia
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(ii) Disorders of platelet functions
(iii) Acute leukaemias
(iv) Aplastic anaemias
(v) Liver disease
(vi) Von Willebrand’s disease
(vii) DIC
(viii) Abnormality in the wall of blood vessels
(ix) Administration of drugs prior to test, e.g. aspirin
