Journal of Thrombosis and Haemostasis, 12: 1591
Iatrogenic anemia (can it be prevented?) M. STEFANINI Department of Medicine, Clinch Valley Medical Center, Richlands, VA, USA
To cite this article: Stefanini M. Iatrogenic anemia (can it be prevented?). J Thromb Haemost 2014; 12: 1591. See also Levi M. Twenty-five million liters of blood into the sewer. This issue, pp 1592.
Summary. ‘Iatrogenic anemia’ is a condition of lowered hematocrit and hemoglobin count resulting from large or frequent removal of blood samples, usually for laboratory testing. It is frequently seen in patients who are already suffering from bone marrow depression, and thus may become a comorbidity. Because several different types of chemical agents may be required for test procedures, a large volume of blood could be removed for each set of testing, perhaps 50–60 mL. Often local and reference laboratories request larger samples than are really necessary to perform a given test and still have some left to perform any required repeat testing. My experience shows that a volume of about 3 mL of each type of sample should be sufficient for this purpose. Keywords: anemia; clinical laboratory techniques; iatrogenic disease; medical laboratory science; phlebotomy. In the mid-1940s, evaluation of hematologic, biomedical and immune parameters relied on instrumentation that was primitive by today’s standards. It required the availability of relatively large samples of blood. We had noted that some patients would leave the hospital with a significantly lower hemoglobin and hematocrit than on admission. Inquiry showed that these patients had been venisected frequently, with the loss of 3–4 points in their hematocrit. We labeled this occurrence ‘iatrogenic anemia’. Sixty-five years later, technology has changed dramatically, with the availability of automated hemocytometers,
Correspondence: Mario Stefanini, 2582 Nichols Road, Hamilton, OH 45013, USA. Tel.: +1 513 524-2152 E-mail: [email protected]
Received 4 June 2014 Manuscript handled by: F. R. Rosendaal Final decision: F. R. Rosendaal, 13 June 2014 © 2014 International Society on Thrombosis and Haemostasis
coagulometers, chemical analyzers, and immunologic procedures based on mAbs. Most of these procedures require a minimal volume of serum or plasma. However, blood needs to be collected in a variety of test tubes containing different anticoagulants, leading to the need for multiple separate samples. Both newly hospitalized patients and old patients seen in physicians’ offices may donate 30–40 mL of blood for testing. This may be repeated within a short period of time, especially in patients with chronic disease or receiving repeated treatments, and could amount to 50–60 mL of blood loss with each venisection. I know from experience that this occurs during chemotherapy and radiation therapy to patients already suffering from bone marrow depression. Loss of blood through diagnostic venisections may become a comorbidity. Providers of test tubes for blood collection are able to supply smaller tubes (2–5 mL) to help reduce the volume of blood collected. I understand that large volumes of blood are requested by local and reference laboratories. However, I directed clinical laboratories for many years. My experience and that of the technologists with whom I worked indicate that a volume of 3 mL is sufficient if repeat of most tests is necessary. The large volume of blood generally removed from patients is not required in most cases. Disclosure of Conflict of Interest The author states that he has no conflict of interest.