H & H

cassie77775 · Dec 29, 2013

I had a patient hemorrhage and got 2 units. The next day it went down to 6.6 and wasn't symptomatic so we didn't give more blood however later in the day she became symptomatic and we did end up with 2 more units(she had tachycardia and dizziness). Our hospital says under 8 we have to treat unless not symptomatic.

sandseaandstone · Dec 29, 2013

I had a patient hemorrhage and got 2 units. The next day it went down to 6.6 and wasn't symptomatic so we didn't give more blood however later in the day she became symptomatic and we did end up with 2 more units(she had tachycardia and dizziness). Our hospital says under 8 we have to treat unless not symptomatic.

Did she have any clotting? Or any obvious sign of blood loss?

amoLucia · Dec 29, 2013

I may be totally out of place, but my first thought was could she have REFUSED blood r/t being Jehovah Witness? Or some other personal reason?

Just a thought. Or was this NOT an issue?

sandseaandstone · Dec 29, 2013

I may be totally out of place but my first thought was could she have REFUSED blood r/t being Jehovah Witness? Or some other personal reason? Just a thought. Or was this NOT an issue?[/quote']
I had her as a patient for delivery, and she was not a Jehovah's Witness. She was not offered transfusion....but a bedside ultrasound was not done and an MD had not come back to evaluate.

klone, MSN, RN · Dec 29, 2013

Yes, of course. That happens often. I assume the OP would have known if she was JW, though.

ReneeRN0521 · Dec 31, 2013

The thing about OB patients is our bodies expect to lose blood during delivery. I had a doctor tell her patient once who had a mild-moderate hemorrhage "Our bodies are still designed to give birth in the woods with no assistance and they make extra blood during pregnancy to combat blood loss during delivery." Now there are hemorrhages that do require blood transfusions and are way more than the body can handle, but most of the time if you can stop the hemorrhage before too much is lost then the patient shouldn't require more invasive interventions.

In relation to the clot.. had she been lying down a long time and then stood up and just the clot came out or was there a lot of blood with the clot. If it was just a clot and she had no other bleeding I would wonder if it was related to lady partsl pooling and then clotting while she was lying down. If this were an every time she stood up thing that would be different, but just once wouldn't concern me too much if there was not more blood accompanying the clot.

PinkNBlue, BSN, RN · Jan 3, 2014

[h=1]Guidelines Define Hemoglobin Levels for Transfusion[/h] Free Medscape registration required to read article--excellent professional site. Karen I am truly grateful for all of this discussion- it's really helping me to get a good idea about these kinds of situations....has anyone ever had to transfuse for hemorrhage? What was the situation?

I have had a few. One was a PC/S who, in report, I was told had bled a bit in recovery. She had just passed a 200ml clot prior to transfer, yet the OB did not want to transfer the patient to us on Pitocin. I had a gut feeling it wasn't going to be good and sure enough, 30 minutes after her arrival we began the rapid response. She had vomited, gushed and went downhill fast. Pale as snow, cold and when all was said and done, she lost approximately 3L of blood; 2L in the room and 1L in the OR before coming to me. We gave methergine and I began a bag of Pitocin 40 units. Her stat hemoglobin was only down from 13 to 10. She didn't get blood immediately but became symptomatic and dropped to 6 a few days later so she received 2 units.

For us, it usually depends on the OB. Some are super conservative and don't transfuse unless the hemoglobin is close to 5, others transfuse if the patient is 8. It also depends on the patient and whether they're symptomatic; SOB, tachy, etc. :)

sandseaandstone · Jan 3, 2014

I have had a few. One was a PC/S who in report, I was told had bled a bit in recovery. She had just passed a 200ml clot prior to transfer, yet the OB did not want to transfer the patient to us on Pitocin. I had a gut feeling it wasn't going to be good and sure enough, 30 minutes after her arrival we began the rapid response. She had vomited, gushed and went downhill fast. Pale as snow, cold and when all was said and done, she lost approximately 3L of blood; 2L in the room and 1L in the OR before coming to me. We gave methergine and I began a bag of Pitocin 40 units. Her stat hemoglobin was only down from 13 to 10. She didn't get blood immediately but became symptomatic and dropped to 6 a few days later so she received 2 units. For us, it usually depends on the OB. Some are super conservative and don't transfuse unless the hemoglobin is close to 5, others transfuse if the patient is 8. It also depends on the patient and whether they're symptomatic; SOB, tachy, etc. :)[/quote']
Thank you for sharing theses stories. The hard part for me is to sit on my haunches and ***wait*** for things to happen before being able to **do** anything.

PinkNBlue, BSN, RN · Jan 4, 2014

Thank you for sharing theses stories. The hard part for me is to sit on my haunches and ***wait*** for things to happen before being able to **do** anything.

It is hard. :)

lovemyjoblandd · Mar 23, 2014

At our hospital we wont transfuse unless below 7 except for certain situations. The other day we had a r c/s patient come in in eatly labor. Her h and h came back at like 7.6/ 26. The doc wanted her to have rbcs prior to surgery. I understood that.

Some things not mentioned- what was her BPs? Did yall do pad counts after the clot? Was her fundus firm and involuting as expected?

nocturnalnurse · Mar 28, 2014

We have mom's up and running around the unit at 4-5hgb and are juststarted on iron and others who are super symptomatic and getting transfused at 8... it's really individualized. We do, however, give blood before counts drop on severe postpartum bleeds (1000+ ebls). Worse one I saw was a 2.5 hgb with 7% crit and she was in dic post abruption and got tons and tons of blood products.