heamoglobin of 6 and pt got iron only

[PRETTYODD]

There is a scenario where pt had hgb of 6 , age 75 male with hx of diabetes and heart bypass surgery done 4 yrs ago. He was just given iron by doctors but after 4 days he still had hgb as 6. His egd and colonoscopy results came negative. Diabetes is managed. I am wondering why iron was hung before blood. Should not he be getting 2 units of blood if he had anemia. Will this kind of anemia treated by diet and meds at home or rehab and we will see difference later.

I am confused because in all nursing books, low hgb increases chance of stroke or heart failure.

Any input is appreciated

[Annaiya, NP]

I don't think this is ever as easy as saying Hgb of X = Y. There are many risks associated with giving blood. Is he Jehovah's Witness? What type of anemia is it? It is only iron deficiency anemia, or is there more going on? Does he also have CRF from the DM and something like Epogen would be more effective? I just think there is a lot more that goes into making this type of treatment decision than just looking at the Hgb number. Hope that helps.

[RNstokes]

It is possible that he may be a bloodless pt.. For example, Jehovah's Witness who don't accept blood products and they are maybe using iron as an alternative to try an raise hgb level.

[PRETTYODD]

pt is not jehovah witness and is 77 yrs old asian guy practicing religion which does not restricts blood.

[ErinS, BSN, RN]

Maybe he has decided to limit medical interventions. I have pt's on hospice who get blood, and some who choose not to get blood because they feel it is not worth the risks. Also, I once had a patient who had so many past blood transfusions that he chose not to have anymore. By the time I met him it took several DAYS to find a matching donor because of all of the markers in his blood.

[P_RN, ADN, RN]

My spouse keeps a hgb of under 9 most of the time. His doc has tried Fe tabs etc, and last year he got an iron infusion on outpatient basis. His hgb rose to about 11 but is now creeping downward. No GI problems noted, bone marrow & labs are OK. HemeOnc is puzzled, renal, internist and GI are puzzled and hubb is fine with it. His whole family runs subnormal Hgb. I wish I knew why.

[coogabooga]

He must be chronically anemic and lives in a low Hgb state. What is his admitting dx? I guess if they can find no active bleed, the patient is sufficiently oxygenated, and perfusing then there is no need. Sometimes I think doctors jump to blood transfusions too soon because there are so many risks involved. I'd be interested to know more about this patient's history and status since yes, that is a very low Hgb.

[ckh23, BSN, RN]

Was he symptomatic at all? Where I work, as blood shortage grows, they have changed the policy to how low the hgb will go before they transfuse.

[Lylesmom]

Our ortho doctors have started being more selective with ordering blood. They must be symptomatic and have a hemoglobin around 6. With the concern for a reaction from the blood products they want to be as careful as possible.

[neuroms]

Sounds like thalassemia which can be benign or symptomatic, or some other enzymatic defect. You would need more labs and history to offer an evaluation. What is the patient's cc for presentation?

[caliotter3]

Personal experience. Was actively hemorrhaging with a Hgb of 6, was given iron in conjunction with 3 units of blood, don't quite remember. Was supposed to get 4 units but never got the 4th unit. I couldn't give a reason why this fellow had a different course of action, other than there must have been something about his situation that called for it.

[mama_d, BSN, RN]

I've also noticed a trend towards a three-day course of Venofer instead of transfusions depending on the cause of the anemia and whether or not the pt is symptomatic. Over the last ten years I've also seen the threshold for when a pt fets transfused go down as well...when I first started nursing, we'd consider transfusing once they hit a hgb of less than nine...now it's less than seven unless pt is actively bleeding. We're much more likely now, it seems to me at least, to seek out what's causing the drop, treat that, and wait for the numbers to stabilize instead of hitting them with PRBCs right off the bat.

I've also had pts who have so many antibodies that it takes FOREVER to get blood for them. Most recent was an active GIB who came in with hgb of 6, had it drop to below 4 before we could find mostly compatible blood. Which meant it was not 100% compatible...I did vitals on her q 15 min the whole transfusion just waiting for something to happen! Thank goodness for benadryl and Tylenol.