Abstract
Background: Anemia remains one of the most common comorbidities in intensive care patients worldwide. The cause of anemia is often multifactorial and triggered by underlying disease, comorbidities, and iatrogenic factors, such as diagnostic phlebotomies. As anemia is associated with a worse outcome, especially in intensive care patients, unnecessary iatrogenic blood loss must be avoided. Therefore, this scoping review addresses the amount of blood loss during routine phlebotomies in adult (>17 years) intensive care patients and whether there are factors that need to be improved in terms of patient blood management (PBM). Methods: A systematic search of the Medline Database via PubMed was conducted according to PRISMA guidelines. The reported daily blood volume for diagnostics and other relevant information from eligible studies were charted. Results: A total of 2167 studies were identified in our search, of which 38 studies met the inclusion criteria (9 interventional studies and 29 observational studies). The majority of the studies were conducted in the US (37%) and Canada (13%). An increasing interest to reduce iatrogenic blood loss has been observed since 2015. Phlebotomized blood volume per patient per day was up to 377 mL. All interventional trials showed that the use of pediatric-sized blood collection tubes can significantly reduce the daily amount of blood drawn. Conclusion: Iatrogenic blood loss for diagnostic purposes contributes significantly to the development and exacerbation of hospital-acquired anemia. Therefore, a comprehensive PBM in intensive care is urgently needed to reduce avoidable blood loss, including blood-sparing techniques, regular advanced training, and small-volume blood collection tubes.
Highlights
Anemia is a common comorbidity in intensive care patients with a prevalence of up to 98% [1], of which 40–50% suffer from severe anemia [2]
Overall,we we found studying thethe effects of pediatric size blood blood collection tubes, three intervention trials comparing different blood conservation collection tubes, three intervention trials comparing different blood conservation devices, devices, oneinvestigating study investigating a comprehensive bundle
Intensive care patients show a high prevalence of anemia associated with an increased Intensive patients show a high of anemia associated with an indemand for RBCcare transfusions
Summary
Several studies have repeatedly demonstrated that anemia increases the administration of allogeneic blood products and is associated with an increased complication rate, prolonged hospital stay, and increased mortality rate [3,4]. Revealed that anemia increases the 90 day mortality rate in patients with chronic obstructive pulmonary disease (COPD) from 25% to 57% [6,7]. It is noteworthy to mention that critically ill anemic patients often show a prolonged hospital stay after discharge from ICU [8]. The difference between hemoglobin values at admission to an ICU and at discharge is associated with an increased overall mortality [9]. The mainstay of anemia treatment in critically ill patients is transfusion of allogenic red blood cell (RBC) units. Up to 85% of the patients with an ICU stay >7 days received at least one unit of RBC [10]
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