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Impact of Blood Sampling on Anemia in the PICU: A Prospective Cohort Study
Tine François1, Michaël Sauthier1, Julien Charlier1
1Department of Pediatrics, Pediatric Intensive Care Unit, Sainte-Justine University Health Centre, Université de Montréal, Montreal, QC, Canada.
Insights
Pediatric intensive care unit (PICU) blood sampling contributes to anemia in children. High blood draw volumes, especially in critically ill patients, are linked to anemia at discharge, with 25% of blood wasted.
Area of Science:
- Pediatric critical care medicine
- Hematology
- Clinical pathology
Background:
- Anemia is common in children post-critical illness, affecting 50% of patients.
- Iatrogenic blood loss from diagnostic testing is a potential contributor to anemia.
- Understanding blood sampling practices is crucial for patient management.
Purpose of the Study:
- To describe blood sampling practices in a pediatric intensive care unit (PICU).
- To identify patient factors associated with increased blood sampling.
- To examine the relationship between blood sampling volume, anemia at PICU discharge, and hemoglobin changes.
Main Methods:
- Prospective observational cohort study conducted in a single PICU.
- Enrolled 423 children consecutively admitted over a 4-month period.
- Collected data on blood volume sampled, patient characteristics, and clinical outcomes.
Main Results:
- Mean blood volume sampled was 3.9 mL/kg/stay, with 26% being discarded.
- Higher sampling volumes were observed in patients with central venous/arterial access, sepsis, shock, cardiac surgery, and mechanical ventilation.
- Blood sample volume was significantly associated with anemia at discharge (adjusted OR, 1.63; p = 0.003).
Conclusions:
- Diagnostic blood sampling in the PICU is associated with anemia at discharge.
- Significant blood loss occurs through sampling, with 25% of drawn blood being wasted.
- Blood draw volumes are highest in critically ill patients requiring advanced support.
Objectives:
Fifty percent of children are anemic after a critical illness. Iatrogenic blood testing may be a contributor to this problem. The objectives of this study were to describe blood sampling practice in a PICU, determine patient factors associated with increased sampling, and examine the association among blood sampling volume, anemia at PICU discharge, and change in hemoglobin from PICU entry to PICU discharge.
Design:
Prospective observational cohort study.
Setting:
PICU of Sainte-Justine University Hospital.
Patients:
All children consecutively admitted during a 4-month period.
Measurements And Main Results:
Four hundred twenty-three children were enrolled. Mean blood volume sampled was 3.9 (±19) mL/kg/stay, of which 26% was discarded volume. Children with central venous or arterial access were sampled more than those without access (p < 0.05). Children with sepsis, shock, or cardiac surgery were most sampled, those with a primary respiratory diagnosis; the least (p < 0.001). We detected a strong association between blood sample volume and mechanical ventilation (H, 81.35; p < 0.0001), but no association with severity of illness (Worst Pediatric Logistic Organ Dysfunction score) (R, -0.044; p = 0.43). Multivariate analysis (n = 314) showed a significant association between the volume of blood sampled (as continuous variable) and anemia at discharge (adjusted OR, 1.63; 95% CI, 1.18-2.45; p = 0.003). We lacked power to detect an association between blood sampling and change in hemoglobin from PICU admission to PICU discharge.
Conclusions:
Diagnostic blood sampling in PICU is associated with anemia at discharge. Twenty-five percent of blood losses from sampling is wasted. Volumes are highest for patients with sepsis, shock, or cardiac surgery, and in patients with vascular access or ventilatory support.
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