Reducing the volume of blood drawn from neonates has often been a subject of Phlebotomy Today over the years. I've not written about it in a while because there's just not been much new on the topic in the published literature. Along comes an article published in the Annals of Clinical Biochemistry that I think really helps managers comply with CLSI's mandate to monitor blood volumes drawn from patients susceptible to iatrogenic anemia (anemia caused by diagnostic sampling).

CLSI's venipuncture standard not only requires susceptible populations (e.g., neonates, geriatric, oncology, preemies, etc.) to have the volume of blood withdrawn from them to be monitored, but limited. It does no good to merely monitor them if we don't apply triggers at which remedial action is required. Such triggers and their subsequent actions are up to the facility.

The new research led to a spreadsheet managers can implement to facilitate clinical decisions. When a physician places an order, the tool calculates the minimum volume of blood required for the tests. That way, phlebotomists and other healthcare professionals with blood collection responsibilities don't guess at how much is required, but are provided with guidance on what size of tubes are required to prevent overdraws. Calculations are based on the laboratory's instrumentation and test methodologies to ensure adequate volumes of serum or plasma can be extracted from the collection tubes to satisfy test requirements with minimal excess. The patient's hematocrit is also considered as well as dead volumes required for instrument probes, and samples shared between laboratory departments. 

Prior to implementing the tool, researchers analyzed the volumes of blood and number of tubes their hospital's LIS recommended. After the spreadsheet tool was implemented, the recommended volume of blood to be collected dropped 56% (11,222 mL versus 4,915 mL). The number of tubes recommended decreased 18% (18,509 versus 15,549).

The authors concluded the spreadsheet allows for a customized, objective determination of the minimum blood volume required for ordered test combinations. Reductions of up to half the blood volume withdrawn from susceptible populations is a realistic expectation. 

Read the abstract.

Anyone interested in more information on preventing iatrogenic anemia can simply enter "iatrogenic" into the search window in the right panel on this page.

Who is keeping track

Patricia, 08/26/2021 13:27:01

Wig is keeping track

Sounds good,but who is keeping track. Drs order lads all the time they don’t consider the volume. Blood cultures require 3ml and infants are subjected to them along with tubes of blood. Also the pedi tubes no longer are in use and the standard tubes like blue tops require a full tube.

Patricia , 08/26/2021 13:32:57

Where is the tool

Would you able to share that tool with us?

Stephine Samuelson, 09/22/2021 14:35:33

Keeping track

It is the lab's responsibility to keep track of volumes. They can assign this to their phlebotomy staff or collaborate with their nursing staff (optimal). To access the tool, you'll need to access the article mentioned in the blog post. The link provided takes you to the abstract, but access to the article requires registration, perhaps even purchase.

Dennis Ernst, 09/23/2021 07:34:48