What is the role of primary hemostasis bleeding time testing in the workup of platelet disorders?

Updated: Nov 30, 2019
  • Author: Perumal Thiagarajan, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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This is a valuable test for disorders of primary hemostasis; however, this test is highly operator-dependent and is not recommended as a routine screening test. Primary hemostasis bleeding time is performed by measuring the duration required for bleeding to stop from a fresh superficial cut (1 mm deep, 1 cm long) made on the volar surface of the forearm using a template under standard conditions.

Under these conditions, the cessation of bleeding results from the formation of a primary hemostatic plug. A fairly linear correlation exists between bleeding time and platelet counts of 10,000-100,000/µL. Bleeding time is prolonged with platelet counts below 75,000/µL, although that finding provides no insight into reason the count is low.

Primary hemostasis bleeding time should not be performed on patients with thrombocytopenia. A prolonged bleeding time with a normal platelet count is very significant and indicates a qualitative platelet disorder.

In disorders of secondary hemostasis (eg, hemophilia A and B), bleeding time is almost invariably normal.

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