Dialysis and H&H

[JonSnowedSRNA]

Hi everyone. I had a patient recently in ICU GI bleed attempted fix in OR, 2 years post liver transplant, hep C, ESRD. Patient came back from exp lap surgery 3 am(stitched a bleeding area). Had dialysis 4L off during day shift, along with many loose dark stools. H&H 11/33 appx at 3pm. 11pm that night H&H 8/24. Only IV fluids are Levo and prograf. Some MDs were concerned with another active bleed. Surgeon in AM was not impressed and though H&H drop was due to fluid shifts. I admit fluids and renal are a weak point, but can someone explain this or post an article that addresses dialysis affecting H&H like this? Thanks in advance.

[Chisca, RN]

Hemodialysis is only able to remove fluid from the blood. As that fluid is removed it is replaced by fluid from the tissue, where the majority of the fluid in the body resides. If the HCT is drawn after removal of 4 liters of water from the blood the HCT will be higher than after fluid moves from the tissue back into the blood. I wouldn't draw any lab sooner than two hours after the end of a dialysis treatment.

[AlabamaBelle]

We like to ask if any labs are needed prior to treatment, just after we have accessed the patient. After that, if labs are needed, we tell the staff and lab personnel who may be trying to obtain blood, that any labs drawn during dialysis will not be accurate and a minimum of 2 hours post treatment is necessary to obtain accurate results.

I'd be more concerned about a slow, active bleed, especially with dark (blackish) stools.