Duke Method for Bleeding Time: A Clinically Obsolete Test
The Duke bleeding time should not be performed in modern clinical practice, as it has been superseded by more reliable methods and is no longer recommended by any major guideline or professional society. 1, 2, 3
Why the Duke Method Is No Longer Used
The Duke method has been abandoned for several critical reasons:
Poor reproducibility: Even when performed by experienced investigators, duplicate measurements frequently deviate by more than 20%, making results unreliable for clinical decision-making. 4
Inferior performance: Direct comparative studies demonstrate that the Duke method produces markedly inferior results compared to the Ivy technique, with greater variability and less clinical correlation. 4
Minimal clinical adoption: By 1984, only 13.6% of UK hospitals were still using the Duke method, while 88.5% had already transitioned to the Ivy technique or abandoned bleeding time testing altogether. 5
No predictive value: The bleeding time test in general—including both Duke and Ivy methods—lacks clinical benefit as a preoperative screening tool and cannot predict surgical hemorrhage risk in patients without a known bleeding disorder. 6
Historical Duke Method Technique (For Reference Only)
If you encounter this in historical literature, the Duke method involved:
- Site: Earlobe puncture
- Incision: Superficial puncture of the earlobe using a lancet
- Blood collection: Blotting blood drops every 30 seconds with filter paper without touching the wound
- Endpoint: Time from puncture until bleeding stops (normal range historically cited as 1-3 minutes)
However, this technique is not standardized, not reproducible, and should never be performed clinically. 4, 5
Current Evidence-Based Approach to Platelet Function Assessment
Modern guidelines explicitly recommend against using any bleeding time test (Duke, Ivy, or template methods) for routine clinical assessment. 1, 2, 3
What to Do Instead
First-line screening: The International Society on Thrombosis and Haemostasis recommends light transmission aggregometry (LTA) with standard agonists (ADP, collagen, epinephrine, ristocetin) as the gold standard for platelet function assessment. 1
Flow cytometry: Use antibodies against GPIIb/IIIa (CD41), GPIIIa (CD61), GPIb (CD42b), and GPIb/IX (CD42a) to identify specific platelet glycoprotein defects with 90% sensitivity and 95% specificity. 1, 2
Clinical history: The best preoperative screen remains a carefully conducted bleeding history including family history, previous dental/surgical bleeding, trauma, and medication use (especially aspirin, NSAIDs, antiplatelet agents). 6
Tests to Avoid
The American Society of Hematology explicitly recommends against routinely ordering:
- Bleeding time (any method)
- Platelet-associated IgG assay
- Platelet survival studies
- PFA-100 as a standalone screening tool (sensitivity only 87-88% for VWD, with 6% false-negative rate) 2, 3
Critical Clinical Pitfall
A normal bleeding time does not exclude the possibility of excessive hemorrhage with invasive procedures, and an abnormal result does not reliably predict surgical bleeding risk. 6 Relying on bleeding time testing may provide false reassurance or lead to unnecessary procedure delays.