Authors' objectives: The National Salaried Workers' Health Insurance Fund (CNAMTS) asked HAS to assess the value of the different laboratory tests for haemostasis abnormalities with a view to updating the section in the Nomenclature of Procedures in Laboratory Medicine (NABM) containing the procedures in laboratory medicine for measuring haemostasis disorders (subsection 5-02). One of these tests is the bleeding time (Duke's test, Ivy's incision test or Ivy's 3-point test). The bleeding time (BT), an NABM procedure, is a global test to investigate primary haemostasis in vivo. BT consists in measuring the time needed for bleeding to stop after a superficial incision is made in the patient's skin. Historically, the BT was used for preoperative assessment of haemostasis or to investigate haemorrhagic syndrome.

Authors' recommendations: According to the different documents analysed, the BT has little or no reproducibility, poor sensitivity and specificity, and lacks predictive value. The BT is an invasive procedure which may leave scars. The BT is not considered suitable for the investigation of primary haemostasis. There are alternative techniques: - "preoperative investigation of haemostasis" for the preoperative assessment of the risk of haemorrhage, which is already an NABM procedure; - "measurement of von Willebrand's factor", "determination of ristocetin activity" and "measurement of factor VIII" for the diagnosis of von Willebrand's disease, which are already NABM procedures; - "photometric platelet aggregation test" for the assessment of platelet function disorders, which is not at present an NABM procedure but is the subject of a HAS assessment report. In conclusion, on the basis of the literature identified and analysed, BT is not recommended either for preoperative assessment of the risk of haemorrhage or for the diagnosis of von Willebrand's disease, nor does it have any place in the diagnostic strategy. There are alternatives which are already NABM procedures.

Project Status: Completed

URL for project: http://www.has-sante.fr/portail/jcms/c_1009982/en/biology-of-haemostasis-disorders?xtmc=&xtcr=42

Year Published: 2011

URL for published report: http://www.has-sante.fr/portail/upload/docs/application/pdf/2011-08/biologie_anomalie_hemostase_t1_temps_de_saignement_-_rapport_devaluation_2011-08-10_14-55-5_340.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: Haute Autorité de Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: has.seap.secretariat@has-sante.fr

Contact Email: has.seap.secretariat@has-sante.fr