Strange hgb results

Specialties MICU

Published

Hi everyone, can I pick your brain? Last weekend had a post cardiac arrest patient, 59 y.o.man , hx of HTN, afib, back pain, ETOH abuse, cocaine abuse, who arrested at home. When ambulance arrrived he was asystole. Arrived to ER, asystole, CPR done for 45 minutes. He somehow got a pulse again. He came to our ICU in SR, copious melena q1h, on levo, of course. So I did a CBC. Hgb was 17.8 on first take. After 2 hours and more melena, I repeated and it went up to 19.3. I thought that was strange as his Na was 140, so there was no hyperconcentration and volume depletion. Any thoughts on why his hgb would be so high?

Thank you for any ideas :-)

Up Vote Up Vote ×

All I can think of is some form of bone marrow cancer. I've seen patients with platelet counts of 1.5-2 million and WBC counts of 100K due to cancer, but never an RBC count that high.

Up Vote Up Vote ×

Hmmm, perhaps an undiagnosed Ca. Thanks for thinking!

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

hgb 178g/l is 17.8g/dl for the us people.

occult cancer/liver. copd/ cor pulmonale/polycythemia

high hemoglobin count may occur because:

  • the red blood cell production increases to compensate for low blood oxygen levels due to poor heart or lung function
  • the kidneys release too much of a protein (erythropoietin, or epo) that enhances red blood cell production
  • drugs that stimulate red blood cell production....drugs like epo but cocaine is a potent vasoconstrictor that has been shown to increase hemoglobin levels effect of cocaine use on bone marrow-mediated... [acad emerg med. 2003] - pubmed - ncbi
  • bone marrow dysfunction that results in an increased production of red blood cells
  • red blood cell production increases to compensate for a limited oxygen supply in higher altitudes

if i was a betting woman....i'd say it the cocaine......lot's of cocaine. i don't know how long that efect lasts. i'd have to look it up but my guess is a few days to re-normalize. if it ever does.

Up Vote Up Vote ×

Esme, you're a star! Thanks for the teaching/learning, yet again ;-)

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

You're Welcome. :o Now you made me blush.:lol2:

Up Vote Up Vote ×
+ Add a Comment