Journal of Thrombosis and Haemostasis, 12: 1591
DOI: 10.1111/jth.12642
FORUM
Iatrogenic anemia (can it be prevented?)
M. STEFANINI
Department of Medicine, Clinch Valley Medical Center, Richlands, VA, USA
To cite this article: Stefanini M. Iatrogenic anemia (can it be prevented?). J Thromb Haemost 2014; 12: 1591.
See also Levi M. Twenty-five million liters of blood into the sewer. This issue, pp 1592.
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coagulometers, chemical analyzers, and immunologic procedures based on mAbs. Most of these procedures require
a minimal volume of serum or plasma. However, blood
needs to be collected in a variety of test tubes containing
different anticoagulants, leading to the need for multiple
separate samples. Both newly hospitalized patients and
old patients seen in physicians’ offices may donate
30–40 mL of blood for testing. This may be repeated
within a short period of time, especially in patients with
chronic disease or receiving repeated treatments, and
could amount to 50–60 mL of blood loss with each
venisection. I know from experience that this occurs during chemotherapy and radiation therapy to patients
already suffering from bone marrow depression. Loss of
blood through diagnostic venisections may become a
comorbidity.
Providers of test tubes for blood collection are able to
supply smaller tubes (2–5 mL) to help reduce the volume
of blood collected. I understand that large volumes of
blood are requested by local and reference laboratories.
However, I directed clinical laboratories for many years.
My experience and that of the technologists with whom I
worked indicate that a volume of 3 mL is sufficient if
repeat of most tests is necessary. The large volume of
blood generally removed from patients is not required in
most cases.
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Summary. ‘Iatrogenic anemia’ is a condition of lowered
hematocrit and hemoglobin count resulting from large or
frequent removal of blood samples, usually for laboratory
testing. It is frequently seen in patients who are already
suffering from bone marrow depression, and thus may
become a comorbidity. Because several different types of
chemical agents may be required for test procedures, a
large volume of blood could be removed for each set of
testing, perhaps 50–60 mL. Often local and reference laboratories request larger samples than are really necessary
to perform a given test and still have some left to perform
any required repeat testing. My experience shows that a
volume of about 3 mL of each type of sample should be
sufficient for this purpose.
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Keywords: anemia; clinical laboratory techniques; iatrogenic
disease; medical laboratory science; phlebotomy.
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In the mid-1940s, evaluation of hematologic, biomedical
and immune parameters relied on instrumentation that
was primitive by today’s standards. It required the availability of relatively large samples of blood. We had noted
that some patients would leave the hospital with a significantly lower hemoglobin and hematocrit than on admission. Inquiry showed that these patients had been
venisected frequently, with the loss of 3–4 points in their
hematocrit. We labeled this occurrence ‘iatrogenic anemia’.
Sixty-five years later, technology has changed dramatically, with the availability of automated hemocytometers,
Disclosure of Conflict of Interest
The author states that he has no conflict of interest.
Correspondence: Mario Stefanini, 2582 Nichols Road, Hamilton,
OH 45013, USA.
Tel.: +1 513 524-2152
E-mail: devescogm@gmail.com
Received 4 June 2014
Manuscript handled by: F. R. Rosendaal
Final decision: F. R. Rosendaal, 13 June 2014
© 2014 International Society on Thrombosis and Haemostasis
15/12/2014