Bleeding times in the elderly.

Q Do you have any experiences, references, or suggestions with regard to bleeding times in elderly patients? Some of our surgeons have begun to order these tests on their patients as a preoperative screen. Is this test a valid indicator of possible intra- or postoperative bleeding?

A We seem to be fielding more and more questions concerning the bleeding time test each year. One set of questions relates to the technique itself, while the other group questions the clinical usefulness of this labor-intensive procedure.

A few years ago, a study compared bleeding times in a group of 48 men and women under age 50 with a group of 95 men and women over 50 years of age. While there were no significant male/female differences in any age group, there was a significant reduction with increasing age in the bleeding time in both men and women.

The authors concluded that contrary to a number of statements in the literature, finding a prolonged bleeding time in an older person should be given the same consideration and significance it would merit in a younger person. It cannot be considered a normal manifestation of aging.[1]

There has been a growing debate over the usefulness of routine preoperative screening bleeding time tests. For instance, consider letters to the editor of Archives of Pathology and Laboratory Medicine that were published in November 1991 (115: 1088-1089, 1991). One letter recounts experiences in a 1,180-bed general hospital, including their method of education as well as policy promulgation that succeeded in controlling this problem. The second letter relates an institution's similar experiences, summarizes its educational efforts, and includes an extensive review of published data on the bleeding time test.

Even though it is quite useful to assess platelet function in patients with hemorrhagic disorders, in many opinion the bleeding time test is only minimally useful for routine preoperative screening. Burns and Lawrence have published a practical review of the use and abuse of the bleeding time test.[2] Their paper includes a helpful table of the conditions where the bleeding time is useful in patient management. But routine preoperative screening is not found in the table. [1] Macpherson. C.R., and Jacobs, P. Bleeding time decreases with age. Arch. Pathol. Lab. Med. 111:328-329, 1987. [2.] Burns, E.R., and Lawrence, C. Bleeding time: A guide to its diagnostic and clinical utility. Arch. Pathol. Lab. med 113: 1219 1224, 1989.

John A. Koepke, M.D., professor of pathology and director, laboratory quality improvement program, Duke University Medical Center, Durham, N.C.