Society for the Advancement of Blood Management

View all recommendations from this society

July 23, 2018

Don’t perform laboratory blood testing unless clinically indicated or necessary for diagnosis or management in order to avoid iatrogenic anemia.

Up to 90% of patients become anemic by day 3 in the intensive care unit. Although laboratory testing can aid in diagnosis, prognosis and treatment of disease, a significant number of tests are inappropriate or unnecessary. Anemia secondary to iatrogenic blood loss causes an increased length of stay and mortality. Increased phlebotomy for laboratory testing also increases the odds for transfusion and its associated risks. Unnecessary laboratory testing adds to the cost of care through laboratory test charges and also by increasing downstream costs due to unnecessary interventions, prescriptions, etc. Thus judicious use of laboratory testing is recommended, and testing should not be performed in the absence of clinical indications.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The Executive Committee and Board of Directors (BOD) of the Society for the Advancement of Blood Management (SABM) had a strong desire to participate in the Choosing Wisely campaign. Participation allows SABM to align with the national Choosing Wisely team and other specialty societies to further the mission of collaborative physician-patient health care delivery and responsible use of resources.

A Task Force was appointed from within the BOD to draft the initial set of recommendations. Evidence-based recommendations were based on our society’s foundational pillars and structured around published SABM Standards. A critical feature was the review of relevant literature for supporting evidence applicable to each statement. Ultimately, the draft recommendations were submitted to the membership for input via an email survey. This resulted in the final five statements for which evidentiary materials and pertinent references were written. The BOD approved the materials prior to submission.

Working with this initiative, our selected recommendations and integrated materials were further honed based on subsequent campaign review. The list and supporting evidence will form the basis of a manuscript for publication in a peer-reviewed journal. SABM will also develop monitors to assess the impact of the initiative for our members and hospital affiliates. We foresee this as a vehicle for outreach to other professional societies, health care providers and patients.

Sources

Gattinoni L and Chiumello P. Anemia in the intensive care unit: how big is the problem? Transfus Altern Transfus Med 2002; 4 (4): 118-120.

Thavendranathan P, Bagai A, Ebidia A et al. Do blood tests cause anemia in hospitalized patients? The effect of diagnostic phlebotomy on hemoglobin and hematocrit levels. J Gen Int Med 2005; 20(6): 520-524.

Chant C, Wilson G, Friedrich JO et al. Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged intensive care unit length of stay: a cohort study. Crit Care 2006; 10 (5): R140.