Deny Morlino Posted December 20, 2011 Share Posted December 20, 2011 We had an extreme case roll in yesterday. A patient with a history of Chronic Mylogenous Leukemia (in remission I guess) had a bowel resection performed at the end of November. She presented yesterday with a hemoglobin of 2.6 g/dL!! Was feeling a bit run down, but was still holding a conversation with the ED staff. Today she is up to a 9.8 and feeling better (I would imagine so!!). The hematology supervisor said it was the lowest he had seen in his 35 year career. We checked and the draw site was not anywhere near an IV. How low have you seen and the patient pulled through the situation? Mostly a curiosity question. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 20, 2011 Share Posted December 20, 2011 Had a JW patient once with a PPH who went down to about the same level as your patient. Had a TAH with no blood cover and pulled through. Made me wonder why the heck I was ever employed!!!!!!!!!! Link to comment Share on other sites More sharing options...
David Saikin Posted December 20, 2011 Share Posted December 20, 2011 Had an old lady one time who was "just a little tired walking up the hill." Hgb 2.2. Got 4 rbcs over 3 days and went home rejuvenated. Link to comment Share on other sites More sharing options...
John C. Staley Posted December 20, 2011 Share Posted December 20, 2011 Mine was the same as David's. I wonder if she was the same lady?? Said she was a little dizzy when she climbed a flight a stairs. The real question is, how long did it take her to get to that level. Obviously it was not a sudden drop! Link to comment Share on other sites More sharing options...
Dr. Pepper Posted December 21, 2011 Share Posted December 21, 2011 Back in the days when med techs actually drew blood, we were called to the ER to help with a combative patient. She was an old lady (old to the 23 year-old Phil), but pretty big and strong as a bull. It took four of us, one on each thrashing extremity, to hold her down and get the blood drawn. Her hemoglobin was 2.0. I'd have hated to tangle with her when it got back up to double figures. Link to comment Share on other sites More sharing options...
AngiB Posted December 21, 2011 Share Posted December 21, 2011 Must be the season. We had one that low a couple of days ago. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 21, 2011 Share Posted December 21, 2011 I'd have hated to tangle with her when it got back up to double figures.Coward!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!:rofl::rofl:P.S. So would I!!!!!!!! Link to comment Share on other sites More sharing options...
AMcCord Posted December 21, 2011 Share Posted December 21, 2011 I think our all time record is 2.4 Hgb. We've seen a fair number of 2-4 range Hgbs over the last few years - all did well with a little top off. Makes a big difference whether they are a slow leak or a trauma with sudden dramatic loss. The slow leakers usually do pretty well. It's amazing that most of them are still functional, though complaining of feeling a little off (Ya think?!). I have read that it is not uncommon in some African countries to NOT transfuse malaria patients until the Hgb is 2-3, because the transfusion itself is so risky due to inability to test donors for HIV. Link to comment Share on other sites More sharing options...
Dr. Pepper Posted December 21, 2011 Share Posted December 21, 2011 Coward!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!My sister-in-law had been trained as a cytotechnologist but her employer apparently wanted to expand her horizons and trained her to do phlebotomy as well. On her first solo trip up on the floors, her first patient died while she had the needle in his arm. She got some help, and reassurance, took a deep breath and went into the next room. As she was putting on the tournequet, the patient rolled over and punched her in the jaw. She flew backwards and smacked her head on a radiator, knocking her out. That was it for her phlebotomy career! Link to comment Share on other sites More sharing options...
tbostock Posted December 21, 2011 Share Posted December 21, 2011 We had a 1.6 that survived. JW patient that had a femoral bleed and refused all blood products, including cell saver during his vascular surgery, and subsequent amputation. He was discharged with a 10 Hgb a couple weeks later with no blood transfusions. It was quite awesome and taught us a lot on how to treat traumas that refuse blood. He was a young healthy 30 year old, so he had that going for him. They kept him vented and paralyzed, gave him tons of IV iron and Procrit, and did no blood draws for an entire week. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 21, 2011 Share Posted December 21, 2011 Coward!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!My sister-in-law had been trained as a cytotechnologist but her employer apparently wanted to expand her horizons and trained her to do phlebotomy as well. On her first solo trip up on the floors, her first patient died while she had the needle in his arm. She got some help, and reassurance, took a deep breath and went into the next room. As she was putting on the tournequet, the patient rolled over and punched her in the jaw. She flew backwards and smacked her head on a radiator, knocking her out. That was it for her phlebotomy career!The first one would have done for me Phil - FOREVER!!!!!!!!!!!!! Link to comment Share on other sites More sharing options...
Dr. Pepper Posted December 21, 2011 Share Posted December 21, 2011 I think my first patient only wished he had died. I never had one actually do so, although I did try to wake up, with great lack of success, a few of them who had expired. Link to comment Share on other sites More sharing options...
lgabbert Posted December 21, 2011 Share Posted December 21, 2011 We had a woman who was 2.6 g/dl. She drove her husband to the doctor's office for his appointment, but she was the one who ended up in the hospital. Can you believe she was driving? Link to comment Share on other sites More sharing options...
AMcCord Posted December 22, 2011 Share Posted December 22, 2011 I think my first patient only wished he had died. I never had one actually do so, although I did try to wake up, with great lack of success, a few of them who had expired.I've done that, too. Actually drew one poor soul who had expired already (he was still warm, though) when I was young and new. I came out of the room with sample in hand and a nurse passing in the hall asked me why I had drawn the dead guy. Nice of them to let us know! Link to comment Share on other sites More sharing options...
Dr. Pepper Posted December 22, 2011 Share Posted December 22, 2011 Nice of them to let us know!They never do. You open the curtain, see the patient peacefully sleeping, say a cheery "Good morning, hon, I have to get a little blood from your arm", then give them a gentle wake-up shake and realize they're cold and stiff. And you hurry to find a nurse to let them know they've lost one and they tell you, "Oh, she's dead." No kidding. Maybe they need to reinstate the pennies on the eyes........... Link to comment Share on other sites More sharing options...
AMcCord Posted December 22, 2011 Share Posted December 22, 2011 Maybe they need to reinstate the pennies on the eyes...........Oh my, there's a picture! Would be pretty effective, though. Link to comment Share on other sites More sharing options...
Auntie-D Posted December 22, 2011 Share Posted December 22, 2011 (edited) We had a vegan with a walk-in haemaglobin of 2.4, the lowest I have seen, with recovery, in massive blood loss is 2.8.TBOstock - that is an amazing story!Edit - I forgot to add that this lady wasn't transfused either. She was given iron infusions and folate and within 3 months her hb was 12.5! Yes she was symptomatic, but her body had adapted so transfusion was deemed unnecessary Edited December 22, 2011 by Auntie-D Link to comment Share on other sites More sharing options...
Steven Jeff Posted December 22, 2011 Share Posted December 22, 2011 I had a patient with a Hb of 2.4 in the early hours a couple of years ago, post myomectomy the previous day. The lady survived following a hysterectomy with platelet, FFP and red cell support. Blood and platelets arrived by blue light courtesy of Malcolms blood centre. Like others have said survival is often dependent on acute or chronic loss, age of patient, fitness of patient etc. In my case acute loss but patient was young.Steve:) Link to comment Share on other sites More sharing options...
EDibble Posted December 25, 2011 Share Posted December 25, 2011 We have had a few between 2 an 3, usually iron deficiency patients. The body is quite good at adapting to chronic anemia. Link to comment Share on other sites More sharing options...
LCoronado Posted December 26, 2011 Share Posted December 26, 2011 Since I never win any contests I have to jump in here - this may be my day. A few months ago we had a patient in the ED with a migraine headache. This 45 kg (99 lb.) female had a hgb of 0.3, RBC 0.23. We called for a redraw of course, with the same results (and chemistry results from the same draw were relatively normal). The patient was not actively bleeding, was walking and talking. She said she had had chronic anemia all her life and had the red cell indices to support this. Five units of packed cells later, she left with a 10.4 hemoglobin. Link to comment Share on other sites More sharing options...
Deny Morlino Posted December 26, 2011 Author Share Posted December 26, 2011 OK that is truely incredible!! The human body is amazing. Link to comment Share on other sites More sharing options...
Malcolm Needs ☆ Posted December 26, 2011 Share Posted December 26, 2011 How old was she, and how was her cardiac function after the shock of her Hb going up 10.1g/dL in such a short space of time????? Link to comment Share on other sites More sharing options...
Deny Morlino Posted December 26, 2011 Author Share Posted December 26, 2011 Cardiac function was part of my concern with our recent case. She has had no negative outcome to my knowledge and the units were all administered within a 24 hour period. Link to comment Share on other sites More sharing options...
AMcCord Posted December 26, 2011 Share Posted December 26, 2011 Since I never win any contests I have to jump in here - this may be my day. A few months ago we had a patient in the ED with a migraine headache. This 45 kg (99 lb.) female had a hgb of 0.3, RBC 0.23. You are definitely the hands-down winner here - Wow! Must not have been much of a cell button when you spun down the chemistry tubes. Link to comment Share on other sites More sharing options...
Auntie-D Posted December 27, 2011 Share Posted December 27, 2011 Here's a question for all... Chronic anaemia in a walking well patient - why transfuse? Their bodies have adapted... If there is no medical reason a Hb can be returned to 'normal' in about 3 months with iron infusions and/or folate/b12. Our lady with the Hb of 2.4 wasn't transfused and recovered perfectly well with just iron infusions and folate supplements. How can donor exposure be justified, based on numbers alone, if the patient is clinically well? Link to comment Share on other sites More sharing options...
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