HELP! I am a surgical RN, with no recent OB-GYN experience. My sister had a c-section for twin girls, her hematocrit is only 6 and they are not insisting on transfusion for her. Needless to say her heart rae is over 110 constantly, and crit only went up to 7 24 hrs postop. This is a VERY small rural hospital.....and I am worried. Can anyone remember not transfusing a mom with crits that low?? I am hesitant to speak up not knowing what other parts of the country is accepting as OK to not transfuse. I have always transfused crits of 12-17 in the surgical areas unless religious objections. Is OB that much different?
Mar 16, '01
With a crit that low she should be transfused. Some OB's prefer to do the wait and see routine, but I can tell you she will not feel very well for a long time. A nurse friend of mine had a crit of 7.5 on return home after bleeding and ended up having to come back to get blood outpatient and not enjoying her baby (literally cuz she did not have an ounce of energy). Have her get a second opinion! There are always the inherent risks of transfusion reaction and a little greater risk of problems post delivery. Be an advocate for her
Mar 16, '01
ok, I am no OB rn, but maybe the hospital is thinking that the low crit is dilutional? And as she diuresis (SP??) the crit will rise. but I do agree a transfusion may be in order. I work a surgery trauma ICU and we often do not transfuse until crit is way way low- 7-8 but thats just the way we do it here and I am not even saying the way we do it is right, I'm open for info.
Mar 17, '01
OBs are bound by some ACOG standards and the Bloodbank criteria to transfuse at 7 IF symptomatic. If not dizzy or hypotensive, Fe is prescribed. Theory is that most pregnant people are young, healthy and if not feeling symptomatic, can recover on their own.
Mar 17, '01
Thanks everyone!! I feel better knowing that they are not being letting her get too low. She has been unable to get out of bed and walk, but she was able to sit up in a bedside chair for a short while but was too weak to hold the babies for more than a min. They are going to send her home with my mom who is also a nurse who went there to help. So the plan is to just deliver babies to her in bed while mom and dad change and bath babies till she is able to be less symptomatic.
********Current motto: It's even worse than it appears.
Mar 20, '01
How low is too low a 'crit? How does it affect the patient. I had a C-section with my last child. My hgb droped to 6 and 'crit was 20! If my doctor "rushed" to give me a transfusion when all I was feeling is tiredness and mild exertional shortness of breath, I would have ran the risk of a blood-related disease such as Hepatitis!! There are alternatives to blood transfusions and as nurses we should educate ourselves about these safer, better alternatives. Check into the "Bloodless Medicine and Surgery" programs that are in place at many progressive institutions. There are many things that the body can cope with and adapt to without resorting to treating the patient with the most "comfortable" treatment for us. For every treatment there are options, alternatives, and hazards. Currently when it comes to blood products, the Jehovah's Witnesses are best educated patient population. (They know more than we nurses do about blood alternatives and treatment of anemias!) We should all learn a little about alternatives to blood and NOT just for the sake of JW patients but for ALL of our patients. I am glad that I did not have to run the risk of a transfusion.
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