Bleeding Time: Optimal Testing Recommendations
- Nonspecific and insensitive test of platelet function
- This test should no longer be used.
Guidelines for Test Utilization
What does the test tell me?
The bleeding time was the first in vivo platelet function test. The test measures the time taken for bleeding to stop after a standardized incision is made into the skin, usually on the anterior forearm. Normal bleeding times are usually <10 mins, whereas prolongation of >30 mins may result in patients with severe platelet dysfunction. [back to top]
When should I order this test?
This test historically has been ordered to assess the integrity of hemostasis. It has been assumed that bleeding time correlates well with platelet function and can predict the likelihood of bleeding with surgery or invasive procedures. However, this assumption has been poorly documented and test has been discontinued in most institutions. [back to top]
When should I NOT order this test?
Not applicable. [back to top]
How should I interpret the result?
Bleeding time is an indicator of the status of in vivo primary hemostasis. An abnormal bleeding time suggests a platelet disorder and would require additional laboratory evaluation. [back to top]
Is the test result diagnostic/confirmatory of the condition? If not, is there a diagnostic/confirmatory test?
Most laboratories have discontinued bleeding time due to its variability, poor reproducibility, lack of correlation with intraoperative bleeding, and invasiveness. Other assays have taken the place of the bleeding time, including but not limited to von Willebrand evaluation and platelet aggregation studies. [back to top]
Are there factors that can affect the lab result?
Factors that can affect the bleeding time include a low platelet count, low hemoglobin, use of aspirin or other platelet inhibitors, von Willebrand disease or other hereditary platelet disorders such as Glanzmann thrombasthenia and Bernard-Soulier disease. [back to top]
Are there considerations for special populations?
Not applicable.
What other test(s) might be indicated?
Bleeding time has been replaced by other, modern laboratory tests. Specifically, patients with a suspected low platelet count or platelet dysfunction should be evaluated:
- Family history of bleeding disorders
- CBC and specific tests for platelet dysfunction, including the laboratory evaluation of von Willebrand disease (factor VIII levels, ristocetin cofactor activity, and GP-Ib binding assay) and platelet aggregation studies [back to top]
References
Peterson P, Hayes T, et al. The preoperative bleeding time test lacks clinical benefit. College of American Pathologists and American Society of Clinical Pathologists position article. Arch Surg. 1998;132:134-139.
Lind SE. The bleeding time does not predict surgical bleeding. Blood. 1991, 77:2547-52.
Rodgers R, Levin J. A critical reappraisal of the bleeding time. Semin Thromb Hemost. 1990; 16:1-20.21990;16:1-20.
Last reviewed: March 2023. The content for Optimal Testing: the Association for Diagnostics & Laboratory Medicine’s (ADLM) Guide to Lab Test Utilization has been developed and approved by the Academy of Diagnostics & Laboratory Medicine and ADLM’s Science and Practice Core Committee.
As the fields of laboratory medicine and diagnostic testing continue to grow at an incredible rate, the knowledge and expertise of clinical laboratory professionals is essential to ensure that patients receive the highest quality and most useful laboratory tests. ADLM’s Academy and Science and Practice Core Committee have developed a test utilization resource focusing on commonly misused tests in hospitals and clinics. Improper test utilization can result in poor patient outcomes and waste in the healthcare system. This important resource geared toward medical professionals recommends better tests and diagnostic practices. Always consult your laboratory director to make sure these recommendations are appropriate for your patient population.