Society for the Advancement of Patient Blood Management: Pediatric and Neonatal Medicine

View all recommendations from this society

September 21, 2021

Avoid hemodilution and unnecessary blood draws to avoid dilutional coagulopathy and iatrogenic anemia.

Excessive fluid administration causing hemodilution and unnecessary phlebotomy reduce hemoglobin levels and may unnecessarily trigger red blood cell transfusions based on a numeric threshold despite adequate oxygen carrying capacity. Replacing blood loss with intravenous fluids which do not contain adequate clotting factors (i.e. crystalloids, colloids and packed red blood cells) may lead to dilutional coagulopathy causing a bleeding diathesis. Routine blood draws should be avoided, and if necessary, blood laboratory investigations should be consolidated when appropriate, using minimal volume withdrawal and closed loop collecting systems.

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 Patient 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 healthcare delivery and responsible use of resources.

A Task Force composed of specialists in neonatal and pediatric medicine and surgery was appointed at the suggestion of the SABM Educational Oversight Committee. With SABM BOD approval, this Task Force drafted an initial set of statements. Evidence-based recommendations were based on our Society’s foundational pillars and structured around published SABM Standards. For this particular list, the SABM Standards, Section 13, 5th edition for neonatal and pediatric patients were critical for statement development. An essential element was the review of relevant literature for supporting evidence applicable to each statement. Ultimately, the draft recommendations were vetted by the Task Force. This resulted in the final five statements for which evidentiary materials and pertinent references were written. The Educational Oversight Committee and the BOD approved the materials prior to submission to the Choosing Wisely® national team.

Working with this initiative, our selected recommendations and integrated materials will be further honed based on subsequent Campaign review. The list and supporting evidence, once approved, will form the basis of a manuscript for publication in a peer-reviewed journal. We foresee this as a vehicle for outreach to other professional societies, healthcare providers and patients.


Spahn DR, Bouillon B, Cerny V, Duranteau J, Filipescu D, Hunt BJ, Komadina R, Maegele M, Nardi G, Riddez L, Samama CM, Vincent JL, Rossaint R. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019 Mar 27;23(1):98

National Blood Authority Australia: Patient Blood Management Guidelines Module 6: Neonatal and Paediatrics, April 2016.

Valentine SL, Bateman ST. Identifying factors to minimize phlebotomy-induced blood loss in the pediatric intensive care unit. Pediatr Crit Care Med. 2012 Jan;13(1):22-7

Haas T, Mauch J, Weiss M, Schmugge M. Management of Dilutional Coagulopathy during Pediatric Major Surgery. Transfus Med Hemother. 2012 Apr; 39(2):114-119