HGB, Blood Loss and Hypotension Relationship

[AcuteHD]

Some time ago we had an incident where a pt lost some blood, maybe 50-100 mL. He became very hypotensive and was sent to the ICU and put on levophed. But there was no significant change in H&H. With that little amount of blood loss and no change in H&H I don't see how the blood loss could cause the hypotensive episode, but I don't like coincidences. Thoughts?

[Rose_Queen, BSN, MSN, RN]

There are many other things that can cause hypotension besides just blood loss. Yes, 50-100mL doesn't seem like much, but if the patient had another underlying cause, that could have been the straw that broke the camel's back or completely unrelated. The other thing to remember with H&H is that when a patient bleeds, he/she is losing whole blood volume. So, the concentration of hemoglobin in the blood may be the same, but there's less of it to go around. You'll see the decrease in H&H with volume replacement with crystalloids or colloids where the blood volume expands but the number of red cells doesn't increase.

Other things that can cause hypotension:

Cardiac conditions such as bradycardia, heart failure, MI, valve issues

Endocrine abnormalities

Dehydration

Infection

Anaphylaxis

Medications

It's not always just about the H&H and blood pressure- there are so many other parts of the picture to look at.

[AcuteHD]

Thanks for the thorough reply. I don't remember the pts history, but being HD I'm sure more than one of the mentioned conditions apply.