Since phlebotomy loss from laboratory testing is the major
cause of anemia in the ﬁrst 2 weeks after birth, a reduction in
these losses should result in a decrease in blood transfusions. The
availability of newer bedside POC devices that require smaller
volumes for blood gas and electrolyte analysis with rapid turn
around times provides the opportunity to decrease blood loss from
phlebotomy and potentially decrease transfusions.
During the ﬁrst 2 weeks of life, we found a statistically and
clinically signiﬁcant reduction in both the number of transfusions
and the volume of blood transfused following the introduction of
the iSTAT in the NICU. Although limited by a lack of direct
measurement of phlebotomy blood loss and no comparison of
severity of illness between two groups, the results of this
retrospective study strongly support the role of laboratory
phlebotomy loss as the primary cause of anemia leading to RBC
transfusion in the early weeks of life. Introduction of the iSTAT in
the post-POC period led to a decrease in the number of tests that
were sent to the laboratory. An estimate of the total phlebotomy
volumes based on the total number of almost all tests in both
groups showed a decrease of approximately 30% in the post-POC
group F a value that is close to the 43% reduction in RBC
transfusions. As shown in a previous study, it is possible that in
order to avoid redrawing a sample because of an insufﬁcient
volume for analysis, the amount of blood drawn by the bedside
nurse or phlebotomist for a test sent to the laboratory was slightly
in excess of that requested.
Other studies have estimated additional
blood losses on to gauze and bedding at the time of drawing to be
It is also possible that extra care was instituted by the
bedside nurse to avoid drawing more than the exact amount of
blood required when performing the test with the iSTAT at the
Other reported causes for a decrease in transfusions include the
use of erythropoietin
and more restrictive transfusion
In the present study, erythropoietin was not used
in the ﬁrst 2 weeks of life. Although transfusion guidelines were
consistent throughout both study periods, transfusion was left to
the discretion of the attending physician and it was possible that
our NICU’s transfusion guidelines were always strictly followed. The
mean pretransfusion hematocrit was similar during both periods.
Thus, the decrease in transfusions seen in the post-POC testing
group was unlikely to be secondary to a higher threshold for
transfusing these infants.
Another possible explanation for the difference between the two
groups would be if there were a larger number of smaller and
sicker infants in the pre-POC testing group.
As shown in Table 1,
although there was a slightly higher percentage of infants with a
birth weight %750 g and a higher percentage of male infants in
the pre-POC testing group, these results were not statistically
In summary, the results of this study suggest that use of newer,
bedside devices can help reduce blood transfusions. Since the use of
the iSTAT unlike other in-line POC devices
does not require
the presence of an arterial catheter, it can potentially contribute
towards reducing phlebotomy losses and blood transfusions
throughout the infant’s hospital stay.
We acknowledge the technical assistance and data collection contributions of
Karen J. Johnson, RN from the University of Iowa and Teresa Newton, Bethany
Ball and the staff in Medical Records and the Blood Bank at Stanford University.
This work was presented in part at the Society for Pediatric Research Meeting in
May 2004 in San Francisco. This study was supported in part by funding provided
by the NIH General Clinical Research Centers Program (Grant RR00059).
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