Hospitalized patients are often subject to numerous, and sometimes daily, blood draws to obtain complete blood counts (CBC). Frequent phlebotomies can cause discomfort and pain, which adversely affects patient satisfaction. In addition, these laboratory values do not necessarily translate into management changes and are contributing to significant hospital expenses. Blood product transfusions represent a significant management outcome, which are based on concerns related to the changes in the components of the CBC. The aim of this study is to determine the practice and utility of daily CBCs amongst hospitalized patients on an academic hospitalist service.
This was an observational study conducted between March 18th, 2010 and April 22, 2010 on patients admitted to the general medicine wards and followed by the University of Miami’s Hospitalist service. We determined the frequency of complete blood counts ordered during the duration of each patient’s hospitalization. These values were compared to the CBC monitoring recommended by the American College of Chest Physicians (ACCP), which are based on pharmacological anticoagulation regimens and screening for heparin induced thrombocytopenia. In addition, we evaluated if the total number of CBCs ordered per length of hospital stay (CBC frequency) correlated with changes in patient management if that patient had received blood product transfusions. We also sought expert opinion from local and national infectious disease (ID) specialists regarding CBC monitoring for infections.
CBCs were ordered at a high frequency and deviated from recommendations set forth by the ACCP. Patients that received prophylactic anticoagulation had a significantly higher CBC frequency compared to ACCP recommended guidelines (0.76 vs 0.42, P < 0.001). Patients that were on full dose anticoagulation had a significantly higher CBC frequency compared to ACCP recommended guidelines (0.82 vs. 0.50, P < 0.001). There was a significant difference in CBC ordered per day between patients that received blood products and those that did not receive any blood products (1.00 vs 0.75, P < 0.05). However, when comparing sequential quartiles of CBC frequencies there did not appear to be a significant relationship with receiving blood products. The general consensus from our expert panel of ID specialists is that daily CBC monitoring is not necessary for the majority of general ID conditions compared to our clinical assessment of the patient.
In the general internal medicine ward setting, CBCs are ordered at a frequency well above the recommendation guidelines. Increasing the number of CBCs ordered during a patient’s hospital course often does not result in management change. The ability to request daily CBCs should be eliminated from admission order sets and may be contributing to unnecessary hospital costs. This would allow physicians to make cognizant, daybyday decisions regarding the utility of a CBC in patient management.
To cite this abstract:Jaffer A, Li D, Schwartz P, Kalidindi V. The Practice and Utility of Daily Complete Blood Counts (Cbcs) on Hospitalized Patients. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97616. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/the-practice-and-utility-of-daily-complete-blood-counts-cbcs-on-hospitalized-patients/. Accessed April 4, 2020.