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Semin Thromb Hemost 2024; 50(03): 499-516
DOI: 10.1055/s-0043-1777307
Historical Paper

A Critical Reappraisal of the Bleeding Time[*]

R. P. Channing Rodgers
1   Department of Laboratory Medicine, School of Medicine, University of California, San Francisco, California
2   The Veterans Administration Medical Center, San Francisco, California
,
Jack Levin
1   Department of Laboratory Medicine, School of Medicine, University of California, San Francisco, California
2   The Veterans Administration Medical Center, San Francisco, California
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Funding This work was supported in part by the Veterans Administration; grants from the Research Evaluation and Allocation Committee (School of Medicine) and the Academic Senate of the University of California at San Francisco; a grant from the Research Corporation of Tucson, Arizona; and Research Grant HL 31035 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD.
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Abstract

Seminars in Thrombosis and Hemostasis (STH) celebrates 50 years of publishing in 2024. To celebrate this landmark event, STH is republishing some archival material. This manuscript represents the second most highly cited paper ever published in STH. The manuscript published without an abstract, and essentially represented a State of the Art Review on the bleeding time, a relatively invasive procedure that required an incision on the skin or earlobe of a patient, and timing how long it took for the incision to stop bleeding. The bleeding time test was first described in 1901 by the French physician Milian, who presented three studies of bleeding from stab wounds made in the fingertips of healthy and diseased subjects. In 1910, Duke observed the duration of bleeding from small incisions of the ear lobe, and pointed out that the duration of bleeding was increased in instances of reduced platelet counts. The test was subsequently repeatedly modified, and numerous variants of the test, including semiautomated methods, were described by several workers. The most frequently utilised test reflected one described by Ivy and coworkers, who shifted the location of the incision to the volar aspect of the forearm and applied a blood pressure cuff to the arm to maintain a standard venous pressure. The bleeding time has been proposed for use as a diagnostic test for platelet-related bleeding disorders, a measure of efficacy in various forms of therapy, and as a prognosticator of abnormal bleeding. The authors to the current review reevaluated the bleeding time literature using methods to assess the performance of the test in 1990, locating 862 printed documents that discussed the bleeding time, the majority in peer-reviewed professional journals. As this is a republication of archival material, transformed into a modern format, we apologise in advance for any errors introduced during this transformation.

Keywords

skin bleeding time - clinical utility - surgical bleeding risk - platelet count and function - predictor of therapy efficacy

Note

The literature survey on which this study was based was closed at the end of 1986 (although several more recent publications which came to our attention were included). A recent review (Burns ER, Lawrence C: Bleeding time: a guide to its diagnostic and clinical utility. Arch Pathol Laboratory Med 1989;113:1219–1224) contains 26 more recent publications not included in our bibliography. None of the conclusions drawn in the present study are modified by consideration of the data provided by these publications. Although the aforementioned review concludes that there is no evidence to support the use of the bleeding time as a preoperative screening test, it recommends using the test to monitor bleeding in the settings of uremia, von Willebrand's disease, congenital platelet function abnormalities, chronic liver disease, acute alcoholism, aspirin ingestion, anemia, and antibiotic usage. An accompanying editorial (Triplett DA: The bleeding time: neither pariah or panacea. Arch Pathol Laboratory Med 1989;113:1207–1208) further recommends that the test be used in the settings of plastic surgery and major surgery where there is a history of the use of antiplatelet medications. Neither the review nor the editorial makes specific recommendations as to how or when to perform the test or how to interpret its results in any of the recommended clinical settings. Furthermore, none of the cited studies provides such instructions or evidence supporting the recommended uses of the test.


* This article is a republished version of: Rodgers RPC, Levin J. A critical reappraisal of the bleeding time. Semin Thromb Hemost 1990;16(01):1–20.




Publication History

Article published online:
12 December 2023

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Comment to this article:

The Bleeding Time Test in 2024: A Glorious Past and Current ChallengesSemin Thromb Hemost 2024; 50(03): 517-519
DOI: 10.1055/s-0043-1776877