IATROGENIC BLOOD LOSS FOR HEART ATTACK PATIENTS

As I was reading, I find this paper very interesting. After 31years of cardiology, I did not realise that a patient admitted for heart attack, could loss so much blood from medical tests.
Dr Adam Salisbury and colleagues from the Mid America heart and vascular institute, published an interesting paper in the Aug 8th online issue of the Archives of Internal Medicine entitled " Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction" They review the records of 17,676 patients from 57 medical centers across the USA, retrospectively. These patients were admitted with an acute myocardial infraction. They found that on the average, the patients loss about 53-109.6 cc of blood from blood taking for diagnostic tests. About 20% of patients had a Hb of less than 11gm% on discharge. 12% of patients had loss >300 cc of blood ( that is more than half pint ). I never realise that it could be that much, or so bad.
We all know that a low Hb count is associated with higher inpatient and 30 day mortality following an acute myocardial infarction.
I was just thinking, maybe if they take 10 cc of blood each time and run 3 serial samples of cardiac enzymes, like we are all taught, and if we do some renal profiles, that may come to 50-100 cc. If you add blood loss from primary angioplasty, with anticoagulants on board, may mean another 50-100cc blood loss.
I suppose it is something that we cardiologist have to be aware of. Also, the lab people must give us smaller tubes and more efficient diagnostic analytical machines, so that a small amount of blood, maybe 2 cc, can do the whole spectrum of standard clinical chemistry and hematology.
Certainly, we do not wish to take so much blood out of a patient, and then have to replace them with blood transfusion.
I suppose the message is clear. Blood loss from plebotomies can be an issue with acute heart attacks. We must order test that are helpful in decision making. Having smaller blood tbes, and more efficient analytical techniques and machines, may help limit the amount of blood necessary for any given test.
After all, we are healers, not vampires.