What is the expected blood loss in Intensive Care Unit (ICU) patients?

From the Guidelines

The expected blood loss in ICU patients is approximately 340–660 mL of blood per week due to diagnostic testing, with an average of 77.8 mL/day 1. This amount of blood loss can significantly contribute to the development of anemia, with an 18% increase in the risk of anemia for each 50 mL of blood lost 1. Some key factors to consider when assessing expected blood loss in ICU patients include:

• The frequency and volume of diagnostic blood sampling
• The use of standard versus small-volume tubes for blood collection
• The patient's underlying condition, such as severe illness or impaired erythropoiesis
• The presence of other risk factors, such as low body weight or pre-existing anemia To minimize iatrogenic blood loss and prevent anemia, clinicians should consider implementing blood conservation strategies, including:
• Using small-volume collection tubes
• Utilizing point-of-care testing devices
• Implementing blood conservation sampling systems that return discard volumes
• Consolidating laboratory tests when possible
• Regularly assessing the necessity of each blood draw and considering less invasive monitoring alternatives when appropriate 1.

From the Research

Expected Blood Loss in ICU

• The expected blood loss in Intensive Care Unit (ICU) patients can vary depending on several factors, including the underlying disease, comorbidities, and iatrogenic factors such as diagnostic phlebotomies 2.
• A study found that phlebotomized blood volume per patient per day can be up to 377 mL, highlighting the need for patient blood management (PBM) to reduce avoidable blood loss 2.
• Another study reported that 57% of ICU patients with haematological malignancies experienced at least one bleeding episode, with a median duration of 3 days, and most often from lower and upper airways and upper GI tract 3.
• The use of pediatric-sized blood collection tubes can significantly reduce the daily amount of blood drawn, as shown in interventional trials 2.

Factors Contributing to Blood Loss

• Iatrogenic blood loss for diagnostic purposes contributes significantly to the development and exacerbation of hospital-acquired anemia 2.
• Platelet count on admission was associated with subsequent bleeding in ICU patients with haematological malignancies, with a lower platelet count increasing the risk of bleeding 3.
• The type of hematological malignancy, neutropenia, thrombocytopenia, bacteremia, prior administration of chemotherapy, age, or gender was not significantly associated with outcome in ICU patients with hematological diseases 4.

Management of Blood Loss

• A comprehensive PBM in intensive care is urgently needed to reduce avoidable blood loss, including blood-sparing techniques, regular advanced training, and small-volume blood collection tubes 2.
• Expeditious control of bleeding should be accomplished, either operatively or angiographically, in patients with acute blood loss 5.
• Care must be individualized, but adherence to general guidelines will improve outcome in patients with acute blood loss 5.