Hgb level

Tweety, BSN, RN · Aug 13, 2007

We have no policy. The doc takes the patients overall condition and age into consideration. The younger trauma patients don't transfused until they fall below 7.0 as long as there's no active bleeding. Pre-op patients might be transfused for levels just below 10.0 if it's expected they might bleed during surgery. Elderly patients may be transfused 9.0 if their overall condition is poor.

Different docs will do different things.

clee1 · Aug 13, 2007

We have no policy. The doc takes the patients overall condition and age into consideration. The younger trauma patients don't transfused until they fall below 7.0 as long as there's no active bleeding. Pre-op patients might be transfused for levels just below 10.0 if it's expected they might bleed during surgery. Elderly patients may be transfused 9.0 if their overall condition is poor.
Different docs will do different things.

Ditto......

We don't get too excited until

fultzymom · Aug 13, 2007

I am in LTC and we can't get out patients transfused at the local hospital until they are below 8. But our Medical Director does not practice at the hospital so I am not sure if that has anything to do with it or not.

Leslie

CritterLover, BSN, RN · Aug 13, 2007

no set policy anywhere i've worked.

and really, it would be inapproprite to have a set level.

what one patient tolerates, another might not and need blood.

to illustrate: i had two patients last night with a hct of 22 (roughly hgb of a little over 7). one was 65 and having chest pain. the other was 23 and had a history of sickle cell. the first was transfused 2 units and admitted. the second was sent home, no transfusion.

more than age or diagnosis, though, it is important if the patient is symptomatic, and if they are trending down or stable. if they are stable and not too symptomatic, the patient might be able to tolerate iron supplements or epogen and time.

however, even if the hct is 28, if the patient is actively bleeding (say a gi bleed), the docs will probably transfuse anyway.

EmmaG, RN · Aug 13, 2007

It depends on if the anemia is chronic or acute. And if chronic (or a result of their treatment), we consider if the patient is symptomatic, has a consistent downward trend in their H/H, or if they are scheduled for any procedures with a risk of bleeding, etc.

Absent any of the above, we usually don't transfuse until the patient drops below 8.

edit: I've not been able to find the specifics yet, but our hospital requires the blood bank slip (used to order the products) to include the patient's H/H (or plt count, whatever applies) and a code that indicates whether the transfusion is for acute bleeding, surgical prophylaxis, chronic anemia, etc. There are 9 codes to choose from; if the transfusion doesn't fit the guidelines (transfusing someone with stable chronic anemia and a hgb of 9, for example), the blood bank will refuse to set up the blood product and the doc has to file a form with the pathologist for a special allowance. It's all the bottom line, of course, dependent upon what medicare and insurance will cover. I work for HCA, though and this rule probably has to do with their illegal billing activities to the Feds in the past.

MoopleRN · Aug 13, 2007

Ditto the above comments that say each level is up to a doctor's interpretation. I make a note in report if I check labs and the level

RN and Mommy · Aug 13, 2007

So at what number does your hospital hang blood? I am doing an internship this summer and was initally shocked at the patients labs. They will write orders once the low 7's show up.
Maybe it is because it is the ICU? I now find it strange seeing anyone with a 10+. What is your hospital/unit policy?

We generally inform the physician if the Hgb is

ZippyGBR, BSN, RN · Aug 13, 2007

the guidelines we us (not sure ifthey are UK wide) generally transfuse at 7point something if cardiovascualrly well and 9 if cardiovascular comorbidity, we'll make sure that any abnormal bloods are raised with the docs once we find out but as with all things theres a degree of judgement on how quickl you need to raise it with a doc

Altra, BSN, RN · Aug 13, 2007

The magic number in our ER and in our critical care units is around 8.0 for most patients.

Tweety, BSN, RN · Aug 13, 2007

It depends on if the anemia is chronic or acute. And if chronic (or a result of their treatment), we consider if the patient is symptomatic, has a consistent downward trend in their H/H, or if they are scheduled for any procedures with a risk of bleeding, etc.
Absent any of the above, we usually don't transfuse until the patient drops below 8.

Actually, acute conditions such as a trauma our docs still don't transfuse if they think the patients own RBC making faculties will kick in and rebound them naturally, particularly if they are young. Sometimes they supplement with iron p.o.

EmmaG, RN · Aug 13, 2007

Actually, acute conditions such as a trauma our docs still don't transfuse if they think the patients own RBC making faculties will kick in and rebound them naturally, particularly if they are young. Sometimes they supplement with iron p.o.

Point taken. My daughter was sent home with a hgb of just under 7 after childbirth. I wasn't too pleased about that (found out a week later when I took her back to the ER after she tried to pass out on me), but they sent her home on iron and in a little over a month she was nearly back to normal levels. I was thinking more of what I'd seen on our floor, acute bleeds and so on.