Choosing Wisely:

Don’t perform laboratory blood testing unless clinically indicated or necessary for diagnosis or management in order to avoid iatrogenic anemia.

Rationale and Comments: Up to 90% of patients become anemic by day 3 in the intensive care unit. Although laboratory testing can aid in diagnosis, prognosis, and treatment of disease, a significant number of tests are inappropriate or unnecessary. Anemia secondary to iatrogenic blood loss causes an increased length of stay and mortality. Increased phlebotomy for laboratory testing also increases the odds for transfusion and its associated risks. Unnecessary laboratory testing adds to the cost of care through laboratory test charges and also by increasing downstream costs due to unnecessary interventions, prescriptions, etc. Thus judicious use of laboratory testing is recommended, and testing should not be performed in the absence of clinical indications.
Sponsoring Organizations:
  • Society for the Advancement of Blood Management
  • Sources:
  • Expert consensus
  • Disciplines:
  • Hematologic
  • References: • Gattinoni L, Chiumello P. Anemia in the intensive care unit: how big is the problem? Transfus Altern Transfus Med. 2002;4(4):118-120.
    • Thavendranathan P, Bagai A, Ebidia A, et al. Do blood tests cause anemia in hospitalized patients? The effect of diagnostic phlebotomy on hemoglobin and hematocrit levels. J Gen Int Med. 2005;20(6):520-524.
    • Chant C, Wilson G, Friedrich JO, et al. Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged intensive care unit length of stay: a cohort study. Crit Care. 2006;10(5):R140.

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