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 draws are ordered, to be sure that the amount requested is carefully considered. In general it is preferable to withdraw the smallest amount 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 smallest amount 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 –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 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 research purposes are:
For pediatric patients, no more than 3 ml/kg. may be taken for research purposes in a single draw, 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:
- 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.
- 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.
- 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.
Alan Greene MD
Our goal is to improve children's health by inspiring parents to become knowledgable partners who can work with their children's physicians in new and rich ways.
Recent Comments
Hello everyone,
I came to know that about six month pre-mature baby can need 15 ml packed red blood cell. A healthy new born baby has 118 ml blood i.e. a small cup of coffee. I donated blood so far 172 times. This much blood can save as many as 516 lives. I feel proud.
how much blood required for 4 month old child
I’ve had a lot of blood tests. If I’m dehydrated the nurse often has trouble getting enough blood. Maybe that was your problem?
The nurse was taking from me blood.she didnt take enouph blood because she got something sharp and she put it in my finger and there wasnt enouph blood coming out .Is that normal?
I’ve had a lot of blood tests. If I’m dehydrated the nurse often has trouble getting enough blood. Maybe that was your problem?
hi sir my baby girl is 15 days old and weighted around 3 kg . last day i admitted my girl in a naval hospital for treatment of suppuration of the navel but during this time period i saw that nurse come to my baby and she inspect the navel and she take two blood sample for test. i think it was normal but after 12 hour he come again and she take three sample and one half injection . when i saw this i afraid thinking that she taking to much blood so i want to know
that is this normal to take blood of an infant in every 12 hours please reply me sir
As an ER nurse, I am glad you let her comment stay. Some of the comments had a negative tone to it, but she is right in her comments. Sometimes we need to be blunt to make a point. As a well educated individual, I think you understand that to create behavior changes, facts alone never work, it requires an emotional connection. That is exactly what she delivered.
But yeah it can be done in a less offensive way
Thanks for the article.
I had a stroke on the right side of brain on March 13th…I had 14 vials of blood drawn from me at one time. After being released from Hospital, I had to get two pints of bloods. Is 14 vials normal?
I’ve had a lot of blood drawn in the past two years plus a blood transfusion in the hospital. I needed 3 units of blood but my body rejected the end of the second one. I was sent home anemic. Every month my dr sent me to the lab for blood work. When my level was almost normal another dr ordered more blood work to keep a check on my one kidney. Blood pressure meds were causing me problems. My question is how much blood can be drawn in a month in all? I am now on a 3 mo. scheduling for blood work. I’m still anemic and always tired. I think I would feel better if not so much blood was drawn from me.
Michelle,
The amount of blood that is taken is determined by what tests need to be run.
Be sure and drink a lot of water in the days leading up to and after a blood test. Always tell the person drawing your blood that you get light headed after a blood draw. They may have you lie down for the draw and will be sure to take the smallest amount they can get by with.
Best,
@MsGreene
I have low blood, is it necessary to take more than 10tubes,makes me dizzy
Michelle,
The amount of blood that is taken is determined by what tests need to be run.
Be sure and drink a lot of water in the days leading up to and after a blood test. Always tell the person drawing your blood that you get light headed after a blood draw. They may have you lie down for the draw and will be sure to take the smallest amount they can get by with.
Best,
@MsGreene
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.
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.
As an ER nurse, I am glad you let her comment stay. Some of the comments had a negative tone to it, but she is right in her comments. Sometimes we need to be blunt to make a point. As a well educated individual, I think you understand that to create behavior changes, facts alone never work, it requires an emotional connection. That is exactly what she delivered.
But yeah it can be done in a less offensive way
Thanks for the article.
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.
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.
How much blood Can be taken at on in testing
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.
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)
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.
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)
did you get a reply on this safe amount for about an 8 lb baby to have taken? I was wondering as well
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.
Great, no answers from anybody!
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
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
I have low blood, is it necessary to take more than 10tubes,makes me dizzy
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
did you get a reply on this safe amount for about an 8 lb baby to have taken? I was wondering as well