Rationale and Comments

Excessive fluid administration causing hemodilution and unnecessary phlebotomy reduce hemoglobin levels and may unnecessarily trigger RBC transfusions based on a numeric threshold despite adequate oxygen-carrying capacity. Replacing blood loss with intravenous fluids, which do not contain adequate clotting factors (i.e., crystalloids, colloids, and packed RBCs), may lead to dilutional coagulopathy, causing a bleeding diathesis. Routine blood draws should be avoided, and if necessary, blood laboratory investigations should be consolidated when appropriate, using minimal volume withdrawal and closed loop collecting systems.

Sponsoring Organizations

• Society for the Advancement of Patient Blood Management: Pediatric and Neonatal Medicine

Sources

• Expert consensus

Disciplines

• Hematologic

References

• Spahn DR, Bouillon B, Cerny V, et al. The European guideline on management of major bleeding and coagulopathy following trauma: fifth edition. Crit Care. 2019;23(1):98.
  
• National Blood Authority Australia. Patient blood management guidelines: Module 6 Neonatal And Paediatrics. 2016. https://www.blood.gov.au/pbm-module-6
  
• Valentine SL, Bateman ST. Identifying factors to minimize phlebotomy-induced blood loss in the pediatric intensive care unit. Pediatr Crit Care Med. 2012;13(1):22-7.
  
• Haas T, Mauch J, Weiss M, et al. Management of dilutional coagulopathy during pediatric major surgery. Transfus Med Hemother. 2012;39(2):114-119.