The Clinical Outcomes, Blood Transfusions, And Modern Mitigation Strategies

Abstract

Background:

Blood sampling causes significant blood loss in intensive care unit (ICU) patients. It is partially responsible for the development of anaemia in critically ill patients, which is strongly associated with poorer patient outcomes. Blood sampling also increases the demand for blood transfusions. Fortunately, methods to reduce blood loss have been developed, such as closed-circuit arterial lines and blood sampling optimisation. However, these practices are not widely implemented within ICU settings. Their introduction could significantly reduce iatrogenic blood loss and consequently improve patient outcomes.

Objectives:

To identify whether significant blood loss due to sampling is experienced by ICU patients.

Methods:

A retrospective, observational study was performed on non-bleeding, level 3 ICU patients with a length of stay ≥14 days. The volumes of blood lost due to blood sampling were collected and correlated against blood transfusion requirements, patient outcomes, and the maximum haemoglobin decline patients experienced after ICU admission.

Results:

32 patients were included in the study. The mean (± standard deviation) total volume of blood loss due to sampling for individual patients was 578.0mL (±242.3) with an average of 24.5mL/day (±5.0) per patient. Discarded blood volumes represented 46.3% (±3.5) of all blood lost by patients. Within the patient population, 37.5% of patients received a blood transfusion. Higher volumes of blood sampling were also strongly associated with higher mortality rates when compared with patients who survived to hospital discharge (p= 0.0269). All patients admitted to the ICU developed anaemia during their admission.

Conclusions: Patients experience significant blood loss during their ICU admission. Higher volumes of blood sampling may contribute towards increased mortality for patients. Therefore, patients could benefit from the introduction of blood conservation methods.