From Andrea Harper:
We continue to offer bleeding time testing. I would like to offer our pathologists an alternative to replace this ancient testing. In a lecture that you gave in October, 2007 in Portland, Maine, you spoke of the PFA-100. We are a 25 bed critical access facility. I’m not sure if it would be cost effective to purchase this device. We only perform 10 BT’s per year. Is this a tests that can be sent out to a reference lab? I would appreciate any assistance you would give. Thank you, Andrea
Thank you, Andrea. First, here are two reference that discredit the use of the bleeding time in general, and in particular as a pre-operative screen for potential bleeding.
Gewirtz AS, Miller ML, Keys TF. The clinical usefulness of the preoperative bleeding time. Arch Pathol Lab Med 1996;120:353-6.
Rodgers RPC, Levin J. A critical reappraisal of the bleeding time. Semin Thrombos Hemostas 1990;16:1-19.
There are lots more such references, mostly from the 1990s, but these will help your pathologists counsel surgeons and internists on the poor predictive qualities of the test.
Besides the PFA-100, the Accumetrics Ultegra may substitute for the bleeding time. I’ve not seen data that support either as a pre-operative screen, however they will turn up the occasional undiagnosed von Willebrand patient. Perhaps their greatest value is to provide your surgeons with an alternative to the bleeding time when they insist. The Ultegra is also used to identify anti-platelet drug resistance, which could keep it busy.
I’m not certain what testing volume makes either instrument cost-effective, however the distributors tend to keep the instrument cost low as their profits come from sales of the test cartridges. Both require fresh whole blood, so the patient must be on site. I hope this helps. Geo