Hgb 7.2 from 13.3 after delivery

Specialties Ob/Gyn

Published

Sister just delivered a baby lady partslly. Hgb was 13.3 to start. After bleeding in the bed for 5 hours dr finally came in. Ended up doing a d&c. Pulled lots of stuff out. Was this drs fault for not checking placenta after it came out?. I didn't find out she was bleeding until the 5th hour and got someone in there plus I'm in a different state. Next am I call for a Hgb and it was 7.2?? Nobody seemed concerned to add iron to her meds nor give her 2 units. Finally that night she got 2 units? Is this because she was on an OB floor?. Was dr at fault for not checking placenta? Any floor I have ever worked we gave 2 units under 8. Any insight would be appreciated :-)

Up Vote Up Vote ×

Well I'm not OB expert, but when it comes to blood products the team I work with has a definite less is more view. We typically don't transfuse unless Hct is less than 19, unstable, and actively bleeding. Otherwise the surgical team supports the patient medically to promote their own RBC production (IV iron infusions, procrit, fluids to maintain BP, and an adequate diet). In fact if the procedure is planned and the patient is anemic preop IV iron infusions are administered. The rational being each transfusing poses a lot of risk of complication (highest of any IV administered medication), each additional transfusion builds antibodies making additional transfusions riskier. Also if a patient is stable transfusing blood will make them feel better in the short term, however studies (sorry can't find citations right now) have shown that it does not increase positive outcomes.

Up Vote Up Vote ×

Just from personal experience, I have had a Hgb of 6.0-7.2 after all 3 kids and a D&C and have never been transfused. It was always explained that the body would replenish in healthy people over a period of a week or so, and I always did. Sometimes there is no need to transfuse, just rest and a little time:)

Up Vote Up Vote ×

Just as a heads up I am not an OB nurse but found my teacher fascinating and she drilled a bunch in to my head. But you have to realize that while 7.2 is very low in the next day or two postpartum women diaeresis a couple litters and that will bring it back up into the 8-9 range. And I work cardiac and unless the patient is dramatically symptomatic we try to find the cause and support them more than transfuse (especially with our transplant listers).

Up Vote Up Vote ×

Thank each of you for your insight. They decided to transfuse because her lips were white, she was dizzy and trying to pass out. They had to get a wheel chair for her. Do you think after being symptomatic do you it was a good call to transfuse two units? Also what Hgb/hema #'s would you most def transfuse?

Up Vote Up Vote ×
Just as a heads up I am not an OB nurse but found my teacher fascinating and she drilled a bunch in to my head. But you have to realize that while 7.2 is very low in the next day or two postpartum women diaeresis a couple litters and that will bring it back up into the 8-9 range. And I work cardiac and unless the patient is dramatically symptomatic we try to find the cause and support them more than transfuse (especially with our transplant listers).
What is your take of the reply I posted below?
Up Vote Up Vote ×
Specializes in Medical and general practice now LTC.

As this is personal and as per the Terms of Service of the site we can not offer medical advice. Your sister really needs to speak to her medical provider

Up Vote Up Vote ×
+ Add a Comment