Phlebotomy is a cause of blood loss in critically ill patients. We prospectively studied the effect of phlebotomy on blood use and outcome in chronic critically ill patients.
All patients admitted to our medical intensive care unit (MICU) between May 1, 2001 and December 31, 2002 for more than 6 days were enrolled. The patients were randomly assigned to routine care with phlebotomy for CBC and electrolytes twice daily or phlebotomy once daily (OD). Additional blood tests for both groups were obtained as clinically necessary. Patients with GI bleeding or severe metabolic disorders were excluded. The total amount of blood phlebotomized including blood discard from lines was obtained. The number of blood transfusions was recorded. ICU outcomes including mortality were studied.
60 patients were enrolled; 31 females (52%) and 29 males (48%). The mean age of the patients was 75 (∀8). Demographically the two groups were similar. Patients in the standard care (SC) group had an average of 798 mL of blood loss from phlebotomy during their ICU stay, versus 383 mL in patients with OD phlebotomy (P=0.001). 21 patients in the SC group required blood transfusions as compared to 13 in the study group (P=0.03). There was a 63% reduction in blood use in the study group as compared to the SC patients; 26 units of PRBC vs. 69 units (P=0.01). ICU mortality was similar in both groups; 4 in the SC group and 6 in the OD group. ICU length of stay was reduced in the OD group 10.4 days vs. 14.6 days in the SC group (P=0.08).CONCLUSIONS: Phlebotomy causes significant blood loss in critically ill patients and is responsible for a majority of blood transfusions required. Once daily blood drawing of CBC and electrolytes does not worsen patient care and may decrease ICU length of stay.
Decreasing the amount of blood drawings results in improved patient care by reducing the need for blood transfusions.
S. Pathmanathan, None.