Strategies to Reduce Diagnostic Blood Loss and Anemia in Hospitalized Patients: A Scoping Review

Abstract

Blood sampling is a recognized contributor to hospital-acquired anemia. We aimed to bundle all published neonatal, pediatric, and adult data regarding clinical interventions to reduce diagnostic blood loss.DATA SOURCES: Four electronic databases were searched for eligible studies from inception until May 2021.STUDY SELECTION: Two reviewers independently selected studies, using predefined criteria. DATA EXTRACTION:One author extracted data, including study design, population, period, intervention type and comparator, and outcome variables (diagnostic blood volume and frequency, anemia, and transfusion).DATA SYNTHESIS: Of 16,132 articles identified, we included 39 trials; 12 (31%) were randomized controlled trials. Among six types of interventions, 27 (69%) studies were conducted in adult patients, six (15%) in children, and six (15%) in neonates. Overall results were heterogeneous. Most studies targeted a transfusion reduction (n = 28; 72%), followed by reduced blood loss (n = 24; 62%) and test frequency (n = 15; 38%). Small volume blood tubes (n = 7) and blood conservation devices (n = 9) lead to a significant reduction of blood loss in adults (8/9) and less transfusion of adults (5/8) and neonates (1/1). Point-of-care testing (n = 6) effectively reduced blood loss (4/4) and transfusion (4/6) in neonates and adults. Bundles including staff education and protocols reduced blood test frequency and volume in adults (7/7) and children (5/5). CONCLUSIONS:Evidence on interventions to reduce diagnostic blood loss and associated complications is highly heterogeneous. Blood conservation devices and smaller tubes appear effective in adults, whereas point-of-care testing and bundled interventions including protocols and teaching seem promising in adults and children.

Clinical and Analytic Accuracy of Simultaneously Acquired Hemoglobin Measurements: A Multi-Institution Cohort Study to Minimize Redundant Laboratory Usage

“…Repeated laboratory testing can be detrimental to the patient by increasing both the financial and physical burdens associated with repeated blood sampling (8). The Choosing Wisely Campaign has identified reducing laboratory overuse in critically ill patients as its top recommendation (30).…”

“…This may result in providers simultaneously pursuing BG or POC testing to prevent delays in care. Additionally, POC testing requires reduced blood volume which reduces the risk of iatrogenic anemia (8). Reducing duplicative testing while maintaining clinical accuracy and timeliness would improve delivery of effective patient care.…”

“…This very low rate of mismatches is reassuring as within the clinical context for a given patient, BG hemoglobin measurements are very unlikely to be dangerously mismatched from CBC hemoglobin measurements. Repeated laboratory testing can be detrimental to the patient by increasing both the financial and physical burdens associated with repeated blood sampling (8). The Choosing Wisely Campaign has identified reducing laboratory overuse in critically ill patients as its top recommendation (30).…”

Editor’s Choice Articles for January

“…We also know from a prospective, single-center cohort study in Canada (published in PCCM , June 2022) that there remains a major impact of diagnostic blood sampling on anemia during PICU admission (19). The authors of the cohort study currently provide us with a scoping review on strategies to reduce blood loss anemia from blood sampling (20). Once again, take time to refresh your memory on all this content.…”

Incomplete filling of spray-dried K2EDTA evacuated blood tubes: impact on measuring routine hematological parameters on Sysmex XN-10

“…Moreover, smaller blood collection tubes are rarely used for hematological testing, since their use may be impractical (e.g., requiring dedicated devices for collection or needing manual transfer of the whole blood collected through a syringe or with a lancet). Accordingly, collection into standard K2EDTA blood tubes, even if underfilled, is frequently preferred to use of low-volume blood collection tube alternatives (7,8).…”