Hospital-acquired anemia is a highly prevalent and often preventable complication of hospitalization. The authors report that anemia affects up to 40–74% of inpatients and may occur in up to 90% of patients in intensive care units. A key, modifiable contributor to this problem is cumulative blood loss from routine diagnostic phlebotomy. The narrative review frames sample volume management (SVM) as a laboratory-led, system-level strategy embedded within patient blood management to reduce diagnostic blood loss and its downstream harms.
Evidence summarized in the review links cumulative diagnostic blood collection volumes with higher risk of moderate to severe anemia and increased transfusion requirements. Diagnostic sampling often exceeds the minimal analytical volumes required by assays, which amplifies total blood loss over an admission. Beyond direct patient harm from anemia and transfusion, excessive sampling generates economic costs and environmental burden associated with consumables and waste.
The review identifies multiple system-level drivers that result in sampling volumes greater than necessary. These include ordering practices that are not demand-managed, legacy workflows and tube sizes that were not optimized for current assay requirements, fragmented preanalytical processes that increase recollection rates, and limited deployment of devices or methods that enable low-volume sampling. The authors note that these drivers are modifiable and that targeting them is central to SVM.
SVM is presented as a structured framework encompassing four interrelated domains:
The review emphasizes that SVM is laboratory-led but requires collaboration across clinical teams, nursing, and hospital leadership to be effective.
Several interventions are described as consistently effective in reducing phlebotomy-related blood loss and transfusion requirements without compromising analytical quality or patient safety. Noted approaches include:
The review indicates that these strategies have been demonstrated in the literature to lower diagnostic blood loss and associated transfusion utilization when implemented appropriately.
Strengthening preanalytical processes is highlighted as a mechanism to reduce errors and unnecessary recollection. The authors advocate for standardized protocols for specimen collection, handling, labeling, and transport, as well as leveraging automation where feasible to reduce human error. Workflow changes that reduce duplicate orders and unnecessary timing of tests are also recommended as part of SVM.
Despite robust evidence supporting SVM measures and alignment with international standards, the review reports that implementation remains inconsistent across institutions. Barriers include lack of standardized protocols, limited multidisciplinary coordination, variable availability or adoption of reduced-volume devices and closed systems, and insufficient monitoring of sampling volumes. The authors call for immediate, coordinated action involving laboratory leadership, clinicians, nursing, and hospital administration, supported by continuous monitoring and structured change management.
Integrating SVM into routine clinical workflows is presented as a high-value strategy that advances patient safety by reducing hospital-acquired anemia and transfusion needs, enhances sustainability by lowering consumable waste and environmental impact, and supports value-based laboratory medicine. The review concludes that system-level adoption of SVM—through standardized protocols, multidisciplinary collaboration, and sustained monitoring—can deliver measurable clinical, economic, and environmental benefits.
(Details such as specific study outcomes, numerical effect sizes, or implementation case studies were not reported in the abstract and thus are not available from the provided source.)