How Much Blood is too Much Guideline

How Much Blood is too Much Guideline

Often blood from children is drawn in the same big tubes used for adults. I applaud parents, nurses, or phlebotomists acting as advocates for children when large-volume blood draws are ordered, to be sure that the amount of blood requested is carefully considered. In general it is preferable to withdraw the smallest amount of blood that will still allow the best medical care for the child. One way to do this is to ask that the blood be drawn in pediatric (not adult) tubes where possible, using something we call micro-sampling techniques – equipment designed to use the least amount of blood necessary for each test.

To parents, I suggest asking to be sure it is truly necessary if someone suggests taking more than 1 ml of blood per pound of your child’s weight (or a maximum of 30 ml for larger children). Thirty ml is equivalent to 1 ounce.

GUIDELINES FOR PEDIATRIC BLOOD DRAWS

I gave a general rule of thumb I use as an outside limit for blood draws, because at these levels of blood loss there can be measurable health consequences. Blood draws in infants and children should not exceed 5% of their total blood volume in any 24 hour period, unless medically necessary. This is a generous upper limit. Ideally it should be less than 3% of the total blood volume, and where possible, micro-sampling techniques to reduce the amount further are preferred. Blood draws in infants and children should not exceed 10% of the total blood volume in any one-month period, unless medically necessary.

The total blood volume can be estimated from the age and weight of the child. As a rough estimate, for pre-term babies, the amount of blood is about 90 ml per kilogram of body weight. For term newborns, it is about 80 ml per kg. For older babies, 1 to 12 months of age, estimate 75 ml per kg. For toddlers, up to age 3 estimate 70 ml per kg. And for older children and teens, 65 ml per kg is a reasonable estimate.

These are general guidelines, and the individual medical situation should be taken into account. But think twice whenever adult techniques or equipment are suggested for children.

To put these numbers in perspective, I have attached the guidelines from several different hospitals and labs. As you will see, there is not universal agreement on the precise numbers, but there is a general awareness that it is best to minimize blood loss, and the numbers used at different centers fall within a narrow range.

Alliance Laboratory Services uses the following table:

Maximum Amounts of Blood to be Drawn From Patients Younger than 14 Years

Patient’s Weight Pounds Patient’s Weight Kilograms (approx.) Maximum Amount to be drawn at any one time (mL) Maximum Amount of blood –cumulative to be drawn during a given hospital stay (1 month or less-mL)
6-8 2.7-3.6 2.5 23
8-10 3.6-4.5 3.5 30
10-15 4.5-6.8 5 40
16-20 7.3-9.1 10 60
21-25 9.5-11.4 10 70
26-30 11.8-13.6 10 80
31-35 14.1-15.9 10 100
36-40 16.4-18.2 10 130
41-45 18.6-20.5 20 140
46-50 20.9-22.7 20 160
51-55 23.2-25.0 20 180
56-60 25.5-27.3 20 200
61-65 27.7-29.5 25 220
66-70 30.0-31.8 30 240
71-75 32.3-34.1 30 250
76-80 34.5-36.4 30 270
81-85 36.8-38.6 30 290
86-90 39.1-40.9 30 310
91-95 41.4-43.2 30 330
96-100 43.6-45.5 30 350

 

At Harvard’s Mass General they use the following guidelines when the blood is taken solely for research purposes:

  • Blood volume taken from children must be less than 3 cc/kg body weight per 8 week period. In studies where the direct benefit far outweighs this volume restriction, a full protocol must be submitted for review of the full committee, and the following guidelines will apply:
    • If more than 3 cc/kg body weight per 8 week period is required and justified by the potential benefits, up to 9 cc venous blood/kg body weight/8 week period may be considered in older children (e.g., not neonates, toddlers, etc.), with the latter figure being the absolute upper limit.
    • Any child involved in a study involving removal of venous blood in the range of 3-9 cc/kg body weight per 8 week period should be placed on iron supplementation therapy. It is recommended that a dose of 30 mg ferrous sulfate/kg/day in 3 divided doses be given. Such therapy should continue for at least 8 weeks and should be monitored by hemoglobin measurements.

The Guidelines of the NIH Clinical Center, for blood drawn for research purposes are:

For pediatric patients, no more than 3 ml/kg. may be drawn for research purposes in a single blood withdrawal, and no more than 7 ml./kg. may be drawn over any six-week period. Investigators should consider further limiting blood drawing in patients with anemia or low cardiac output.

In instances of clinical needs, phlebotomy in excess of the above limits may be permitted.

At UCLA they use:

  1. No more than 2.5% of total blood volume may be drawn solely for research purposes (no benefit to the subject) within a 24-hour period. This is generally 2 ml/kg.
  2. No more than 5% of total blood volume may be drawn solely for research purposes (no benefit to the subject) within a 30-day period. This is generally 4 ml/kg.
  3. If the investigator requests blood in excess of this amount, he/she must provide a detailed justification for this, and describe what safeguards are in place to protect the subject from undue risk.

Dr. Alan Greene

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.

  1. Elle

    Monica, Sandra, Imran, and anyone else asking about their baby and if they took too much blood.. If you look up, there is a handy little chart where you can figure it out yourself, you don’t need someone to do it for you but if you do, you probably shouldn’t be having kids.

    Eva, Chill out, 10 tubes is not a lot, do you realize how much blood you have in you? When people go to donate blood, approx 1 pint is taken, 10 tubes is nowhere near a pint of blood. Do you really think a doctor is going to put themselves in a deliberate position of being liable because they hurt you because they took too much blood? No. I have personally drawn over 30 tubes on a single patient, I have friends who have done close to 50 tubes. 10 tubes will not kill or harm you.

    zmm912714- That is absolutely disgusting. Call your doctor. I promise no one, ever wants to hear that story. Plus, no one here is a doctor and cannot give you legal advice.

    This is why people need to stay off medical websites (and everything below is what this page has created).. You find out some piece of information that was always there but now that you know about it, you’re going to lose your mind and flip out every time you or your child get your blood drawn. You’re going to be those rude people who plop down in my chair, you don’t even bother to say hi you just get straight to the un-pleasantries: “Do you know what you’re doing?”, “How long have you been doing this?”, “Did you go to school for this?”, “My veins roll, you won’t be able to get me”, “Why do you keep touching my arm, no one has ever touched my arm before, they just stick the needle in. You’re new aren’t you.”, “Is this ALL you do all day is stick people with needles, seriously?”. So unbelievably rude. I like my job, and it’s helping me pay for a better education but why you think it’s justifiable to treat us in such a manner is inexcusable, especially when you go to an outpatient lab. I’d love to go to your jobs and treat you in that manner and even if I did want into your place of employment, I’m not that rude. But just a piece of advice.. You really shouldn’t e nasty to someone about to shove a very, very sharp object into your body. But you just created a bunch of fear mongers. If for whatever reason they had to take that much blood out of your body it would cause you harm, they would give you a transfusion. Common sense.

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    • Hi Elle,

      I have to be honest with you, I really considered deleting your comment instead of approving it because your tone is pretty negative. My concern is that you come off as rude to people who have previously posted here and we don’t want to foster that tone. The internet has enough negativity. As a result, we don’t usually let those comments through, but in the end I decided to post yours because you really have some great points.

      When I go to a lab (which is pretty often) I’m happy to see trained phlebotomists who do this all day, every day. They are typically very skilled and make giving blood as pleasant an experience as possible.

      Years ago I had a very bad experience while having a blood draw (long story, but I don’t think the phlebotomists was at fault, I was an extremely hard draw at the time) and after that I was pretty scared for a while. I hope my fear wasn’t translated into rude behavior, but I’ll certainly take your words of advice and be extra aware in the future.

      Best,
      @MsGreene

      BTW — If you’d like to rewrite your comment to have as much punch, but be less negative, I’d be happy to replace this one. I think people would be better able to hear what you really want to get across.

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  2. Nichole

    How much blood Can be taken at on in testing

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    • It depends on the weight of the person. See the chart above and look for your weight on the far left, then the amount of blood that can be drawn on the right.

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  3. zmm912714

    Help! It’s horrific! My period is every 15-20 days sometimes 2 times a month. I lose a cup of blood every 2-3 hours and everytime I use the restroom in a day of my menstral cycle. I use the restroom 7-9 times a day.

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    • Oh, my. What does your doctor say? This seems like it’s way out of the norm.

      @MsGreene
      (Note: I’m not a doctor, just a woman, mom, and caring person)

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  4. sandra olson

    a 4 month old child, born 5 weeks premature, weighing 4 11 at birth and 4 1 when left hospital, would be I am guessing no more then 7 or 8 lbs at 4 months of age,, in 1994, how much blood would have been required, to have run both hla testing and dna testing, and would such an amount have been safe to take from such a small infant.

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  5. PHIL

    Great, no answers from anybody!

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  6. imran khan

    My child is 2 years old today.he had 6 pont of blood taken 11 kg weaght only. And he does not take food. So he is very week. Please explan this to me i feel like bad now

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  7. Eva

    Hi,I went for GYN docter today,they drawm me 10 blood samples at one time,10 big tubes…is this normal and necessary..usually only takes 1 tube

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  8. Monica Owen

    My baby is four months old today she had 13 mls of blood taken she is 6.9kg or 15lb.6oz ,dr delatorie at cooks childrens in ft worth tx ordered for CAH testing this is the second time he has ordered this exact amount last time she was only 8 lbs is this safe for her she is realy sluggish and thats not normal for she is usualy a verry bubbly baby please explain this to me i feel like i just keep getting the run around has anyone else had this experience

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    • sandra olson

      did you get a reply on this safe amount for about an 8 lb baby to have taken? I was wondering as well

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