What would cause Hgb to plummet? - page 3

I had a patient last week I can't stop thinking about. Med-surg floor, 40 yr old female, admitted with SOB and fevers one week s/p a Thymectomy to treat myasthenia gravis. After the surgery she had... Read More

  1. by   AlphaPig
    Ok, update on the patient. I was not able to look at her chart (because now with electronic charting you can trace everyone who looks at the chart and since I am not her nurse anymore, I could get into trouble) but I was able to glean some information from her doctor and the patient herself (who I visited on the step down room she is now in).

    All of her scans were negative - she is not bleeding anywhere.

    They gave her 2 units of blood and her Hgb went up to 9.0 where it stayed for two days before dropping to 8.2 the day I visited her.

    The doctors have no idea why her Hgb refuses to stay up. Her admitting doctor told me they consulted Hematology but they haven't seen the patient yet. He said they are trying to put all the pieces together - her surgery, her auto-immune disorder, her lung spasms (which has pretty much resolved) - to figure out what is going on.

    The patient appeared much better to me - no cyanosis, no SOB while resting, O2 sat 96% on 2L NC. Pt stated her right flank pain was now being controlled by her pain medicine and the spasms have pretty much stopped. Pt still feels weak.

    So. . .basically they still don't know what is going on. I will continue to try to follow her case and will let you know. I wish I could see her chart.
  2. by   netglow
    hematologic malignancy
  3. by   FranEMTnurse
    I had septicemia once. Would this cause a log hgb count? I was given 2 units of blood.
  4. by   morte
    yeah, maybe she doesn't even have MG...
    Quote from netglow
    hematologic malignancy
  5. by   Grumpy's Girl
    One more tidbit for the truck analogy: Less trucks, though with a full load, must work faster to deliver the goal amount, even faster if they are carrying less load on less trucks. Hence tachycardia. Hence increase RR to fill those less trucks that are running faster with O2.

    As RRT members we encourage - esp new RNs- to call with questions if their senior nurses can't answer. One of the "triggers" to call RRT is the RN is "worried" about how their pt is doing. I guess "worried" is that developing nurse sixth sense that this patient has the potential to crash whether you can get the MD to feel it or not. The RRT will help you put together the pieces to see what has developed and what is probably coming and how to nip it in the bud or d/w MD. Those are good calls - nipping it in the bud. Each call is a learning experience. We teach and think out loud with the RN (and the family). It has been neat, now, to see that many times, by the time we get to the room, the nurses who called us have already started our routine. Talk about nipping it in the bud. We are a team. We have more pts getting over the crisis and staying in the room.
    This is just a RRT aside. So keep in touch with your RRT resources.

    Glad your pt is doing better, hope her mystery is solved soon.
  6. by   alfa-sierra
    Yes, only 5 trucks instead of 20. Yet, 5 trucks may be compensatorily overloaded and the total load still be close to what 20 normally loaded trucks would carry. That may explain why the blood drawn looked so thick and dark- more O2 clinging to fewer cells, fewer hemes, more O2 reacting with the same iron per cell.
  7. by   jacrabbitrn
    still don't get the truck thing
  8. by   psu_213
    Quote from jacrabbitrn
    still don't get the truck thing
    Uh, how so. It was an analogy...and I don't think it was that difficult to understand, although I could be wrong. What about it did you not understand?
  9. by   Anna Flaxis
    Thanks for the update!
  10. by   SarahB84
    Quote from AlphaPig
    It's hard on the floor (when I had 5 other patients) to truly stop and take a good look at the whole clinical picture. I feel like as floor nurses, we tend to focus on the task at hand/main problem and don't have the time to ever put all of the pieces together/get a feel for the whole person.
    the above statement is true and scarey, because of this i no longer wish to work in a hospital.
  11. by   CrunchyMama
    I'm slowly getting the truck analogy, I think it makes sense but I'm going to read over the posts again. Can someone explain to me why her blood was so thick? Dehydrated? But nothing was said if she was.
  12. by   AlphaPig
    "Can someone explain to me why her blood was so thick? Dehydrated? But nothing was said if she was."

    Yes, I was wondering that too! I had to draw labs twice on her, and her blood was very strange - it honestly looked like chocolate pudding. But I don't think she was dehydrated.

    I haven't had time to check in on this patient again - but I work next week so will see if she is still in the hospital and follow up. Will let you all know. I feel like I need closure on this!
  13. by   liveyourlife747
    Wasn't autoimmune mentioned? Couldn't the thickened blood and lowered hbg be something related to an autoimmune disorder? Not sure just guessing.