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Blood Loss from Laboratory Tests

¹ Department of Clinical Chemistry and Laboratory Medicine, Robert-Bosch-Hospital, 70376 Stuttgart, Germany.

² Institute of Anesthesiology and Intensive Care Medicine and

³ Institute of Clinical Chemistry, University Hospital Mannheim, University of Heidelberg, D-68167 Mannheim, Germany.

⁴ Institute of Clinical Chemistry and Laboratory Medicine, Clinic Nuernberg, D-90419 Nuernberg, Germany

^aAddress correspondence to this author at: Clinic Nuernberg, Institute of Clinical Chemistry and Laboratory Medicine, Prof.-Ernst-Nathan-Strasse 1, D-90419 Nuernberg, Germany. Fax 49-911-3985710; e-mail thomas.bertsch{at}klinikum-nuernberg.de.

Background: Laboratory tests can be an important source of blood loss in hospitals, especially for newborns and patients in intensive care. The aim of this study was to quantify blood loss for laboratory diagnostic tests in a large number of patients in a teaching hospital.

Methods: We estimated blood loss by multiplying the number and volumes of sampling tubes collected from 2654 adult inpatients. We compared the number of tests per patient for all inpatients and intensive care unit patients during the first period and again in the same time period 1 year later when cumulative blood-loss volumes were being reported to physicians and educational information had been given to decrease blood loss from laboratory tests.

Results: For 95% of the patients, blood loss during hospitalization was <196 mL. The largest proportion of the blood samples was used for clinical chemical tests (median, 45%), followed by hematologic (median, 26%) and coagulation (median, 17%) tests. In the surgical and cardiovascular surgical intensive care units, however, blood gas analyses accounted for 19–34% (medians) of the use. For 5% of the patients, all undergoing intensive care, blood loss was >200 mL and for 0.7% was >600 mL during their hospital stay. Such high blood losses were observed in patients with long-term ventilation, coagulation disorders, and repeated surgery. The largest median blood loss was in patients undergoing cardiovascular surgery (median, 201 mL). The mean number of tests was 44 per inpatient before cumulative blood loss was being reported and 46 when it was being reported.

Conclusions: Blood loss from laboratory diagnostic testing is not likely to pose a problem for most hospitalized patients. Blood loss is greater in intensive care patients and after cardiovascular surgical procedures. Reporting of the cumulative individual blood loss did not decrease blood loss for laboratory testing.

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