Use of Pediatric Size Phlebotomy Tubes in Adult Critically Ill Patients to Reduce Red Blood Cell Transfusions

Inclusion Criteria:

- New admission to the medical or transplant ICU at Memorial Hermann Hospital in Houston

- ICU admission hemoglobin level of at least 7 g/dL. The ICU admission hemoglobin will
be the most recent hemoglobin value available at the time of screening for inclusion
in the study.

- Randomization is expected within 12 hour of admission to the ICU

Exclusion Criteria:

- Clinical bleeding. Defined as menstrual bleeding, bleeding leading to a change in the
frequency of hemoglobin monitoring or to an order for a medication, transfusion,
procedure, or consultation intended to prevent or treat bleeding.

- Known hemolytic disorder (e.g. sickle cell disease, hereditary spherocytosis,
autoimmune hemolytic anemia)

- Bone marrow disorder (e.g. aplastic anemia, marrow infiltration disorder, chemotherapy
within the last 8 weeks)

- Jehovah's Witnesses

- Patient is comfort care measures only

- Refractory shock: mean arterial blood pressure below 60 mmHg despite maximal doses of
3 vasopressors. Maximal dose of vasopressors are as follows: Norepinephrine 70
mcg/min; vasopressin 0.04 units/min; epinephrine 35 mcg/min; dopamine 20 mcg/kg/min;
phenylephrine 350 mcg/min

- Severe acidosis: pH below 7 in more than one arterial blood gas within 24 hours of ICU
admission in the absence of diabetic ketoacidosis Surgical admission diagnosis

- Pregnancy

- Current prisoner