Why low Hg, Hct, and RBC postop?

[AlmostNurseJ]

I have had multiple patients that have low Hg, Hct, and RBC counts after surgery, but when putting my reason for the patient's abnormal finding, I can't seem to think of anything except for the fact that they are postop. It makes sense that someone who just had surgery would have a low CBC, but why does it happen exactly?

My patient just had a resection of her colon due to diverticulitis.

Her values are as follows:

First number indicates the day after surgery, second value indicates 7 days later

Hg 9.4, 9.3

Hct 28.1, 28.1

RBC 2.93, 2.92

[Rose_Queen, BSN, MSN, RN]

First of all, you need to look at the patient's labs preoperatively as well. Not everyone goes to surgery with normal labs. As a result of the condition leading to surgery, lab results may have been affected for quite some time. Additionally, not every type of surgery is going to cause abnormal labs. You haven't really given us enough to assess your patient for you. These are questions that should be answered by looking at the patient's history, what happened during the surgery (was there higher than expected blood loss? transfusion?), and lab trends. Your instructor, the patient's primary nurse, and other members of the team providing care for the patient would be better equipped to help you with your question.

[Compassion_x]

Imagine what occurs during surgery. After everything is all prepped and everyone's prepared, the surgeon cuts into the skin, and.... Think about what physiologically occurs.

Of course there are other reasons as well that the CBC would be affected.

[TU RN, DNP, CRNA]

Even though textbooks might disagree with me, in real practice a 9.3 hemoglobin on a female postoperative patient is not concerning at all. I don't think I've ever seen a female hemoglobin above 11

[psu_213, BSN, RN]

The changes between POD 0 and POD 7 are almost nonexistent so I don't think there is really any issue there.

What was the preop H/H? What was the estimated blood loss for the surgery? Otherwise, nothing particularly stands out with those values.

[KelRN215, BSN, RN]

Even though textbooks might disagree with me, in real practice a 9.3 hemoglobin on a female postoperative patient is not concerning at all. I don't think I've ever seen a female hemoglobin above 11

You know, I often wonder what schools are teaching these days when I see these posts about "low" hemoglobins in the 11s. Most of the time the "low" hemoglobin the poster is worried about is better than MY hemoglobin. :)

Maybe it's because I work oncology but any hemoglobin above 7 is good in my book.

[Lev, MSN, RN, NP]

KelRN - It's all about the NCLEX...

OP, many many patients are chronically anemic. Anemia of Chronic Disease is an actually diagnosis. In real life, patients are many times not transfused until hemoglobin drops below 8 and hematocrit below 25. A surgical patient with low H&H (hemoglobin and hematocrit) may be tranfused before surgery or during surgery if there is significant blood loss. Sometimes patients with higher H&H's will be transfused to prepare them for procedures that have a risk of bleeding, such as EGD (Esophagogastroduodenoscopy - when scope GI system), or if they have a large stage 4 pressure ulcer to help them heal better.

Blood can be lost during surgery in a number of ways. Blood can "pool" or seep into tissues outside of veins and arteries. Blood is lost when veins or arteries are nicked, accidentally or on purpose. Some blood loss and hence lower H&H may be expected after surgery.

[Lev, MSN, RN, NP]

Even though textbooks might disagree with me, in real practice a 9.3 hemoglobin on a female postoperative patient is not concerning at all. I don't think I've ever seen a female hemoglobin above 11

My Hgb was 12 when I went to donate plasma (too low for apheresis).

[KelRN215, BSN, RN]

In real life patients are many times not transfused until hemoglobin drops below 8 and hematocrit below 25. [/quote']

We don't transfuse until hemoglobin is less than 7 and/or hematocrit is less than 20. We used to do 8/25 but that changed several years ago.

[Lev, MSN, RN, NP]

I guess it depends on institutional policy. Also depends on the patient. The sickle cell patients are not always transfused even though their H&Hs are lower than 8/25.

[nurseprnRN, BSN, RN]

Agree with all of the above. In addition, there are 2 things going on here, possibly 3.

One, many people who have surgery often lose blood. If they are not transfused for replacement, their blood counts will be low for a while until their bone marrow gets a chance to fix that.

Two, it's not just a matter of their having lost blood. It's a matter of having received non-blood-cell-containing fluids. Therefore their hematocrit is what's called "dilutional." That means the red cells are floating in fluid, and if you remember that hematocrit is the percentage of blood volume that is red cells, you can see why the administration of a lot of normal saline will decrease hematocrit, even if there is no blood loss to begin with.

Three, someone who's having a colon resection may very well have malignancy. Even if they don't, they have probably been pretty sick. You might want to look up the concept of "anemia of chronic disease."

[Do-over, ASN, RN]

GrnTea beat me to it - dilution. Consider how much fluid they got in OR, and how many boluses they needed after.