• Deborah M Siegal, Emilie P Belley-Côté, Shun Fu Lee, Stephen Hill, Frédérick D'Aragon, Ryan Zarychanski, Bram Rochwerg, Michaël Chassé, Alexandra Binnie, Kimia Honarmand, François Lauzier, Ian Ball, Waleed Al-Hazzani, Patrick Archambault, Erick Duan, Kosar Khwaja, François Lellouche, Paul Lysecki, François Marquis, Jean-François Naud, Jason Shahin, Jennifer Shea, TsangJennifer L YJLYDepartment of Medicine, McMaster University, Hamilton, Ontario, Canada.Niagara Health - St. Catharine's General Hospital, St. Catharine's, Ontario, Canada., Han Ting Wang, Mark Crowther, Donald M Arnold, Emily Di Sante, Gladys Marfo, Tanya Kovalova, Sylvanus Fonguh, Jessica Vincent, and Stuart J Connolly.
• Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
• JAMA. 2023 Nov 21; 330 (19): 187218811872-1881.

ImportanceBlood collection for laboratory testing in intensive care unit (ICU) patients is a modifiable contributor to anemia and red blood cell (RBC) transfusion. Most blood withdrawn is not required for analysis and is discarded.ObjectiveTo determine whether transitioning from standard-volume to small-volume vacuum tubes for blood collection in ICUs reduces RBC transfusion without compromising laboratory testing procedures.Design, Setting, And ParticipantsStepped-wedge cluster randomized trial in 25 adult medical-surgical ICUs in Canada (February 5, 2019 to January 21, 2021).InterventionsICUs were randomized to transition from standard-volume (n = 10 940) to small-volume tubes (n = 10 261) for laboratory testing.Main Outcomes And MeasuresThe primary outcome was RBC transfusion (units per patient per ICU stay). Secondary outcomes were patients receiving at least 1 RBC transfusion, hemoglobin decrease during ICU stay (adjusted for RBC transfusion), specimens with insufficient volume for testing, length of stay in the ICU and hospital, and mortality in the ICU and hospital. The primary analysis included patients admitted for 48 hours or more, excluding those admitted during a 5.5-month COVID-19-related trial hiatus.ResultsIn the primary analysis of 21 201 patients (mean age, 63.5 years; 39.9% female), which excluded 6210 patients admitted during the early COVID-19 pandemic, there was no significant difference in RBC units per patient per ICU stay (relative risk [RR], 0.91 [95% CI, 0.79 to 1.05]; P = .19; absolute reduction of 7.24 RBC units/100 patients per ICU stay [95% CI, -3.28 to 19.44]). In a prespecified secondary analysis (n = 27 411 patients), RBC units per patient per ICU stay decreased after transition from standard-volume to small-volume tubes (RR, 0.88 [95% CI, 0.77 to 1.00]; P = .04; absolute reduction of 9.84 RBC units/100 patients per ICU stay [95% CI, 0.24 to 20.76]). Median decrease in transfusion-adjusted hemoglobin was not statistically different in the primary population (mean difference, 0.10 g/dL [95% CI, -0.04 to 0.23]) and lower in the secondary population (mean difference, 0.17 g/dL [95% CI, 0.05 to 0.29]). Specimens with insufficient quantity for analysis were rare (≤0.03%) before and after transition.Conclusions And RelevanceUse of small-volume blood collection tubes in the ICU may decrease RBC transfusions without affecting laboratory analysis.Trial RegistrationClinicalTrials.gov Identifier: NCT03578419.

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