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AM24-SN-13-O

AM24-SN-13-O: Diagnostic Blood Loss: An Ignored Component of the Multidisciplinary Pillar of Patient Blood Management (Enduring)

Date
October 23, 2024
Credits
1 General Continuing Education (GEN) | 1 Florida Lab Personnel (FLP) | 1 California Nurse (CN) | 1 California Lab Personnel (CLP) | 1 Physician (PHY)
$30
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Diagnostic-Blood-Loss not only includes MICRO-liters of blood aspirated by an analyzer, or MILLI-liters of blood collected in sample tube, but also the discard-volumes, especially when sampling happens from lines, and also failed draws, unnecessary draws/tests etc. Diagnostic-Blood-Loss, estimated to be ~12 ml/day in medical wards & 40-50 ml/day in Intensive care Unit (ICU) in mid-1980s, increased over the years. A 2021 study shows that estimations of a 2019 study missed the discard-volumes, underestimating loss by 18%. Irrespective of initial Hemoglobin, 90-100% ICU admissions have anemia in 3 days to 3 weeks. Thus ICU-admission itself can be a cause for Hospital-acquired anemia (HAA), aggravating morbidity & mortality. Phlebotomy guidelines of WHO & European federation of Laboratory Medicine (EFLM) don't cover line-draw. CLSI recommends large discard-volumes (2-6 times dead-space) for line draws. Neither guidelines sufficiently sensitize users to large discard-volumes & sampling frequency in ICUs. We will discuss various techniques, gadgets, logistics and practice updates, that help reduce diagnostic blood loss. Large number of lines/catheters make direct phlebotomy challenging in ICUs, leaving drawing from lines as the only choice left. Until recently CLSI guidelines (eg GP41) stress the need for the discard-volume, eg 6 times dead-space when doing coagulation or platelet tests. It is too large when the catheter is long or patient is small, and likely unnecessary. Re-samplings to resolve pre/post-analytic issues, for sake of safety, contribute to anemia, a mortality risk factor. Choosing wisely, Society for Advancement of Patient Blood management (SABM), Test-Utilization (TU) and Minimum-Retesting-Interval (MRI) guidelines explore multipronged collaborative efforts. Minimum Retesting Interval is a very important part of the Test Utilization Tool-Box in practice in the UK for about a decade but not yet covered by Choosing wisely. Accessories like closed-sampling devices, low-volume/pressure tubes, pediatric cups etc, environment-friendly practices, and our practice-survey results, will be discussed with pictures and quizzes. It is high time laboratorians and clinicians join hands to curb this ongoing Diagnostic-Blood-Loss, an often invisible pillar of Patient Blood management (PBM).

Learning Objectives

  • Describe how common and how alarming the preventable harm of Hospital-acquired and Hospital-Aggravated anemia due to Diagnostic Blood Loss is, and how it harms ICU patients.
  • Explain why sampling guidelines mention discarding large volumes of blood and how various techniques and policy enforcements can reduce it from the ICU or Phlebotomy service.
  • Compare the Pillars of PBM, and Explain components of the pillar of interdisciplinary collaborations for minimizing diagnostic blood loss
  • Debate the discard volumes of line sampling guidelines vs infection risks vs coagulopathy/dilution risks of closed system sampling
  • Compare the hazards of the blood wastage and various types of additional plastic-ware wastes associated with line sampling and pediatric testing and their green alternatives

Moderator & Speaker

Speaker Image for Saptarshi Mandal
Saptarshi Mandal, MD, MS, DABPath (CP, BBTM)
AIIMS Jodhpur

Speaker

Speaker Image for Suresh Sharma
Suresh Sharma, RN, PhD, MSc (Medical Surgical Nursing)
AIIMS Jodhpur

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