localized vs generalized bleeding
Localized Bleeding:
- caused by injury, infection, tumor or an isolated blood vessel defect
Generalized Bleeding:
- due to disorder of pri or sec hemostasis
Mucocutaneous vs Anatomic Generalized bleeding
Mucocutaneous:
occurs on the skin or at body orifices
Petichiae
Purpura
[orfices: openings or holes in body like mouth, nose, anus]
Anatomic:
affects soft tissue, muscles, joints, or deep tissue
components of pri and sec hemostasis
Primary:
- platelets
- vascular system
Secondary:
- coagulation factors
*if there is any problem with any of these components, there would be a blood vessel defects, qualitative plt disorders or coagulation deficiencies that has a tendency of possible bleeding disorders
Acquired vs Congenital bleeding
Acquired:
- begins after childhood
- associated with trauma/drug exposure
Congenital:
- usually diagnosed in infancy or during the first years of life
a screening test for vascular and platelet function
bleeding time test
- in vivo measurement of pri hemostasis
- used to predict the risk of interoperative hemorrhage
[checks plt function and BV integrity]
normal values: 2-9min
≤ 9 minutes → Normal
> 9 minutes → Risk of bleeding (problem with plt or vessels)
history of bleeding time test
1912 – Duke (first method)
1941 – Ivy (modified)
1969 – Mielke (improved)
1976 – Automatic lancet (standardized cut)
- allows loaded incision made simply by pressing lancets against puncture sites
- measures how long it took to stop bleeding
how to write the results of the bleeding time test
’ (single prime) = minutes
“ (double prime) = seconds
briefly explain the causes of prolonged bleeding time
- Quantitative platelet disorder
- thrombocytopenia
- plt decrease = affect pri hemostasis
- prolonged bleeding time
[formation of plt plug is affected] - Qualitative platelet disorders
- excessive bruising and mucocutaneous bleeding in a patient whose platelet count is normal
- plt does not function properly
- disorders of platelet
adhesion
aggregation
secretion - Acquired defect of platelet function
- aspirins/ NSAIDS
blocks cyclooxygenase
↓ Thromboxane A₂ → ↓ platelet activation - Vascular disorders
- scurvy [weak vessels (vitamin C deficiency)]
- vasculitis [inflamed vessels]
what are some of the qualitative platelet disorders
- Disorder of platelet adhesion
Bernard Soulier Syndrome
- defective GPIb receptor [cant bind to collagen]
von Willebrand Disease
- deficiency of vWD factor - Disorders of platelet secretion
Dense Granule Deficiencies
- Hermansky-Pudlak Syndrome
- Chediak-Higashi Syndrome
- Wiskott-Aldrich Syndrome
- TAR Syndrome
Alpha Granule Deficiency
- Gray Platelet Syndrome
- Drug inhibition of prostaglandin pathways
- Disorders of platelet aggregation
- Hereditary Afibrinogenemia
- Glanzmann Thrombasthenia
Most simplest and commonly used method
duke’s method
MATERIALS
Alcohol
Cotton balls
Blood lancet
Filter paper
Timer
PPE
what are the types of lancet
Lancing device
Twist-type lancet
Feather lancet
puncture sites and puncture depth of duke’s method
Puncture Site:
Earlobe (highly vascular)
3rd or 4th finger
*shld be warmed b4 the test
- temp affects bleeding result
too cold: bleeding can stop quickly
too warm/hot: bleeding can prolong
Puncture Depth:
3mm
procedure of Duke’s method
- massage the puncture site
- clean the site for puncture with cotton moistened with 70% isopropyl alcohol. allow it to dry.
- residual alcohol can prolong bleeding time - puncture the lower edge of the finger (3rd or 4th) to a depth of 3mm using a sterile, disposable blood lancet.
- non-dominant hand
- technique: apply pressure sa finger - wipe off the first drop of blood with dry cotton and start the stopwatch as soon as blood appears.
- blot the drop of blood with filter paper every 30 seconds.
- note: make sure that the filter paper does not touch the wound, as this may hasten bleeding time
*clean any excess blood carefully, making sure not to wipe the puncture site itself
- stop the timer asap
these two tests are done together (in tandem) to check bleeding problems
Bleeding Time (BT)
→ checks platelets + BV
👉 Primary hemostasis (platelet plug)
Clotting Time (CT)
→ checks clotting factors
👉 Secondary hemostasis (fibrin clot)
what happens if the bleeding time test exceeds 15 minutes
Report as: “>15 minutes”
Apply pressure to stop bleeding
do’s and dont’s in duke’s method
✅ DO:
- start first blot at 30 seconds
- blot every 30 seconds
- leave space between blots
- include the last blot (no blood) → marks end of bleeding
- apply gentle pressure only if checking bleeding
❌ DON’T:
- do not milk the finger (affects result)
- do not apply too much pressure
- do o not wipe the wound
BLOTTING TIPS
- use filter papers
- blot directly onpuncture site
- avoid overlapping blots
what to write on the filter paper
Name
Age
Date
why is duke’s method not standerdized
uses manual lancet (twist type)
depth of puncture varies
pressure applied varies
👉 Result:
less accurate / inconsistent results
briefly explain the other bleeding time methods
- Ivy’s method
- standardized capillary pressure using a blood pressure cuff
*normal bleeding time: : 2–9 minutes (2’00”–9’00”) - Mielke’s method
- modification of Ivy’s → standardized incision
*ensures more uniform cuts = reduces variability - Simplate/ Surgicutt method
- modern automatic, spring-loaded lancet
- preferred method → precise and reproducible
briefly explain the puncture site and puncture depth of
1. Ivy’s method
2. Mielke’s method
3. Simplate/ Surgicutt method
1.
- Forearm, ~3 finger widths below elbow crease
- 2 mm deep, 2 mm long
2.
- Forearm
- 5 mm deep, 1 mm long
3.
- Forearm
*Capillary Pressure: StandardizedCapillary Pressure: Standardized
materials needed in
1. Ivy’s method
2. Mielke’s method
3. Simplate/ Surgicutt method
- Alcohol, cotton balls, blood lancet, filter paper, timer, blood pressure cuff, PPE
- Bard-Parker disposable blade, alcohol, cotton balls, filter paper, BP cuff, timer, PPE
- Simplate/Surgicutt device, alcohol, cotton balls, filter paper, BP cuff, timer, PPE
procedure of Ivy’s method
- Inflate BP cuff to 40 mmHg
- Disinfect forearm
- Hold skin tightly
- Make 2 small incisions (avoid veins)
- Start timer
- Blot blood every 30 sec (filter paper must not touch wound)
- Stop timer when bleeding stops
- Release cuff
- Record both sites → report average
*Normal Bleeding Time: 2–9 minutes (2’00”–9’00”)
incision device
- depth
- length
- color
- Surgicutt
- 1.0 mm
- 5.0 mm
- White - Surgicutt Junior
- 1.0 mm
- 3.5 mm
- Lavender - Surgicutt Newborn
- 0.5 mm
- 2.5 mm
- Yellow
briefly explain the advantages and disadvantages of the bleeding time test methods
(trans)
