H & H Values

[robert.hiester]

Hi, I am a new nurse with a question regarding Hemoglobin and Hematocrit values. I know normal Hemoglobin value is 13-18 for a man and 12-16 for a woman. I also know that normal Hematocrit is 42-52% for a man and 35-47% for a woman.

I also know that often patients are below those normal ranges for a variety of reasons (GI bleed, post surgical, anemic, etc). My question is this: Does anyone have specific low-end thresholds for when they become concerned and/or call the attending MD? I was recently working with a GI bleed patient (female) who was hanging out around 29 and 8. Is that concerning for you? How about a H&H that is dropping over time? How fast of a downward trend sets off alarm bells for you? I realize there are many diverse patient issues which could change your interpretation of H&H, but any advice you could give would be great.

Thanks.

[Lev, MSN, RN, NP]

When looking at H&H, it's important to look at trends and to see if the patient is symptomatic. If the hemoglobin drops from 11 to 7, something is wrong. I currently work on a surgical floor and we will generally only transfuse when the hemoglobin is less than 8 and/or hematocrit less than 25 or so. Keep in mind that many patients come to the hospital very anemic, so those values on your GI bleed patient may be how a elderly patient with many comorbid conditions presents on admission.

[sweetdreame, BSN, RN]

I agree with Lev. If they are symptomatic, dropping fast or are below 8/25, I just make sure the provider is aware.

[Biffbradford]

Agree with above. Additionally, there is probably a cut off number in the orders (call if) and would be MD specific or be different on a case to case basis. If the patient has Sickle Cell Anemia perhaps, or is a Jehovah's Witness. Good question, tough to answer in general.

[ChipNurse]

We typically transfuse for Hgb under 8 (almost all of our patients are anemic), but if the pt drops a couple points say from 10 to 8, then that would warrant a page to the doc and they typically transfuse.

[bsartor]

Great question OP. Im a student nurse and last week during clinical I was very concerned that my patient's platelets were 19,000. When I expressed my concerns, I was pretty much laughed at. I am learning to distinguish between "normal" values, "clinically relevant values", and "when to call the MD" values.

[Esme12, ASN, BSN, RN]

Great question OP. Im a student nurse and last week during clinical I was very concerned that my patient's platelets were 19,000. When I expressed my concerns, I was pretty much laughed at. I am learning to distinguish between "normal" values, "clinically relevant values", and "when to call the MD" values.

Shame on those nurses that laughed. They have forgotten what is is like to be starting from scratch. I apologize for them.

These values are highly variant on the patient. A patient on Chemo or who has cancer who normally has platelets in the single digits are doing just fine with a platelet count of 19,000. If however a "healthy patient" has routine lab work and has a platelet count of 19,000 it is a great concern.

If a patient has a history of renal issues and they live with a HCT of 8 is is not a great concern if however a patient is admitted with a HCT of 11 and the next day is 8 you need to call the MD. The current Red Cross recommendations for transfusion is a symptomatic patient with a HCT of below 8.

[PDF][h=3]2012 Clinical Practice Guide onBlood [/h]

[Lev, MSN, RN, NP]

My patient whose platelet count was 18,000 got transfused 3 units of platelets and 2 units of plasma. So yes, it is concerning and no one should have laughed.

[walkingthecow]

The standard at my facility is to transfuse for hgb

[ghillbert, MSN, NP]

CT surgery - we usually transfuse at