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Capillary Fragility Test

CPT Synonyms Tourniquet Test The capillary fragility test is a crude assay to assess plateletvessel wall interactions. Theoretically, increasing the intravascular pressure in the arm (by inflating a blood pressure cuff between systolic and diastolic) causes "gaps" to appear between endothelial cells. However, the extravasation of red blood cells does not normally occur, since these gaps are normally occluded by platelets. However, petechiae form if platelets are decreased or dysfunctional. The capillary fragility test is rarely performed at the present time.


Test Description

Patient Preparation


Specimen C Requirements The capillary fragility test is performed by placing a blood pressure cuff on the upper arm. The cuff is inflated to the midpoint between the systolic and diastolic blood pressure (< 100 mm Hg), and the arm is observed for the development of petechiae over a period of five minutes. A blood pressure cuff is applied to the upper arm and the intravascular pressure in the arm is increased by adjusting the pressure midway between systolic and diastolic. The pressure is maintained for five minutes. Normally vascular integrity is maintained by this partial obstruction of the venous return but occasionally petechiae may occur. Most of these are micro Test aneurysms and do not rupture but return to normal a few hours Methodology after the cuff is removed. If these micro aneurysms do rupture, the blood is readily absorbed but may leave a minute deposit of hemosiderin with a faint yellow discoloration. In this test the petechiae formed by the venous obstruction are counted and serve as the basis for a negative or a positive test. 1. Examine the forearm for the presence of petechiae or any skin blemishes which might be mistaken for petechiae. 2. Have the patient lie down before performing this test. 3. Take a blood pressure reading and inflate the cuff to a

pressure midway between systolic and diastolic. Maintain this pressure for five minutes. 4. Remove the cuff and raise the arm into the air for 1-2 minutes. 5. Observe for petechiae over the entire arm and grade as follows: a. 1+ = a few petechiae on the anterior part of the forearm b. 2+ = many petechiae on the anterior part of the forearm c. 3+ = multiple petechiae over the whole arm and back of hand d. 4+ = confluent petechiae over the arm and hand

Normal Values and Critical Limits The arm is examined and the test is interpreted by a pathologist. Results are reported as normal, 1+, 2+, 3+, and 4+. Results are recorded on the hemostasis profile sheet, and/or requisition as needed. Disregard any petechiae formed within 1/2 inch of the cuff, since these may be due to pinching. Do not repeat this procedure on the same arm within seven Interferences days. Sometimes the petechiae may not appear for several minutes, therefore the arm should be observed for several minutes following the test. Observation of the arm during the performance of the bleeding time obviates the need for the capillary fragility test. Although nonspecific, the capillary fragility test provides information regarding in vivo platelet function that cannot be obtained by other assays. The capillary fragility test is usually positive in severe thrombocytopenia, von Willebrands disease, and other platelet diseases. Because platelets function to maintain capillary integrity, this test

Petechiae do not develop in individuals with normal plateletvessel wall interaction. The development of petechiae indicates a positive assay. Normal values: normally less than 10 petechiae are seen in a 5 cm in. diameter circular area on the anterior part of the forearm. If more are seen the test is considered positive.

Clinical Utilization

measures platelet function. It also measures vascular function. This test is positive in a number of healthy individuals and interpretation must be made only after careful consideration of all facts of the hemostasis evaluation. The presence of many petechiae may be helpful in the diagnosis of telangiectasia. A strongly positive test is also frequently seen in thrombocytopenia, thrombasthenia, thrombopathies, von Willebrand's disease, purpura fulminans, dysproteinemias, hypertension, rheumatoid arthritis, and diabetes mellitus. Women have a tendency to develop petechiae more easily than men (especially if over 40 years of age), possibly due to hormonal changes. Healthy elderly individuals have a tendency to develop increased numbers of petechiae. Gimbrone, M.A. et al. Preservation of vascular integrity in organs perfused in vitro with a platelet-rich medium. Nature 221:33, 1969. Literature References Tranzer, J.P. and Baumgartner, H.R. Filling gaps in the vascular endothelium with blood platelets. Nature 216:1126, 1967. Wojcik, J.D. Mechanism whereby platelets support the endothelium. Transfusion. 9:324, 1969.

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