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Blood over-testing: impact, ethical issues and mitigating actions

  • Federico Pennestrì EMAIL logo , Rossella Tomaiuolo ORCID logo , Giuseppe Banfi and Alberto Dolci
Published/Copyright: January 1, 2024
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 62 Issue 7

Abstract

Plenty of studies demonstrate that hospital-acquired anemia (HAA) can increase transfusion rates, mortality, morbidity and cause unnecessary patient burden, including additional length of hospital stay, sleep disruption and venipuncture harms resulting from blood samples unlikely to change clinical management. Beyond patient costs, community costs should also be considered, such as laboratory time and resources waste, environmental impact, increasing pressure on labs and fewer tests available on time for patients who can benefit from them most. Blood over-testing does not support the principles of non-maleficence, justice and respect for patient autonomy, at the expense dubious beneficence. Reducing the number and frequency of orders is possible, to a certain extent, by adopting nudge strategies and raising awareness among prescribing doctors. However, reducing the orders may appear unsafe to doctors and patients. Therefore, reducing blood volume from each order is a better alternative, which is worth implementing through technological, purchasing and organizational arrangements, possibly combined according to need (smaller tubes, adequate analytic platforms, blind dilution, blood conservative devices, aggregating tests and laboratory units).

Keywords: blood loss; blood management; hospital-acquired anemia; iatrogenic anemia; medical ethics; sampling practices
Corresponding author: Federico Pennestrì, PhD, IRCCS Istituto Ortopedico Galeazzi, Scientific Direction, Via Belgioioso 173, 20157 Milan, Italy, E-mail:

Funding source: Ministero della Salute

Award Identifier / Grant number: Ricerca Corrente

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: The authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: The authors state no conflict of interest.

  5. Research funding: This paper was supported and funded by the Italian Ministry of Health – “Ricerca Corrente”. The APC was funded by Italian Ministry of Health – “Ricerca Corrente”.

  6. Data availability: Not applicable.

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Received: 2023-10-30
Accepted: 2023-12-15
Published Online: 2024-01-01
Published in Print: 2024-06-25

© 2023 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2023-1227
Keywords for this article
blood loss; blood management; hospital-acquired anemia; iatrogenic anemia; medical ethics; sampling practices

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