High postpartum Hct- why??

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Hi! I'm in the middle of writing my MASSIVE OB paper and there is a section asking about what the indications/nsg actions would be if your patient has a significantly different postpartum Hct than she had upon admission.

I pretty much know why she might have a low Hct, but my patient's Hct was actually higher. I can't find anything about the significance of such a finding, and I could really use some help! My pt labored to 9cm before the physician decided to perform a c-section after failure to descend and unreassuring fetal heart tones. That was the only complication, and otherwise everything went fine. She had a slightly higher than avg blood loss of 1300mL.

I appreciate any and all insight! Thank you!

-SLS

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Specializes in Psych.

Hct? or Hgt?

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Hct! I know- I can find things for Hgb, but not crit. :o)

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Did you look up reasons, in general, for high hct? Looking at the causes for it, I can see one that stands out to me that might apply to a postpartum pt and another one that might, but I don't think it would in your case, based on what you've said.

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Thank you, yes- I have looked this up. I'm wondering if there are explanations that are specifically r/t immediate postpartum issues.

Dehydration could certainly be possible, but that's the only thing I can find in the lists of "high hct" that would be applicable to my patient. The other explanations I found (with a general search) wouldn't really apply to an acute episode, as I believe my instructor is suggesting in my paper outline. But I appreciate the suggestion! I could be looking too far into this, but I want to make sure I understand everything :o)

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Specializes in Telemetry.

The only thing I could find in my OB book was about low hct levels...it says "hematocrit should return to normal limits within 4 to 6 weeks unless extensive blood loss has occurred" :/ hmmm Im curious also, so when you find your answer make sure to post it! good luck!

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I usually don't offer to help much on homework, because the questions are typically so easy and if the student just expended a little effort, they would find it themselves.

That said, I don't think this is the case here. It seems you've done your research.

If that were my patient, I would look at a couple of things. Could the draw have been inaccurate? Did she get blood?

And here's something else to consider: is she very edematous? If you fill people full of fluids (as is often the case in L&D), they can leak that fluid out into the tissues. They are fluid overloaded, but at the same time they are actually "dehydrated" in terms of what is flowing through their vascular system. Large amounts of the wrong type of IV fluids can also cause similar issues. Does that make sense?

What was her albumin level? Protein pulls water into the vascular spaces, so if you're low on protein for whatever reason (including a blood loss and a surgical site), you are more likely to leak fluid into the interstitial spaces, leaving your bloodwork to look as if you are dehydrated.

Were her other counts unexpectedly high? WBC? Hgb? What was her kidney function? What were her lytes like? Did they do a redraw later in the day (or the next morning), and did these results corroborate? Or were they significantly different?

I'm not sure if I am able to really answer your question, but I hope I gave you some things to look at, to see if they applied to your patient.

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Specializes in Utilization Management; Case Management.

Well she's postpartum and even with a higher than avg blood loss she still has higher than normal circulating blood volume so I would think high values would be expected. It could be dehydration or a drug...but I doubt she was on epogen unless she was anemic...

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Thank you all very much for your replies!

We actually ended up having a brief hematology lecture the other day, which helped shed a little light on things along with your helpful comments. This is probably pretty basic for those experienced RNs out there, but for my fellow students here's a little breakdown to let you know where to look next:

Hb and Hct are often confused with each other, but Hemoglobin is a part of RBCs- remember those "heme" we learned about in A&P? Well, how I understand it is that the hemoglobin are kinda like strips of velcro on the RBCs. They pick up O2 from the lungs and carry it around on the RBCs. So- while hemoglobin have to do with RBCs, hematocrit have to do with the percentage of RBCs in the total blood volume.

--A low hematocrit reflects a low number of circulating red blood cells. So you have to think about what would actually cause a decrease in circulating RBCs?

1. A decrease in the oxygen-carrying capacity of the RBCs...which would (from what I understand) mean you likely have a decrease in Hgb. Causes of this may include active bleeding, bone marrow disorders, poor diet, or malabsorption of the GI tract.

2. Overhydration. Think about it- if Hct has to do with a percentage of RBCs in the blood, if a patient becomes fluid-overloaded then the blood will become diluted.

--A high hematocrit may reflect just the opposite:

1. An increase in the number of erythrocytes

2. A decrease in plasma volume, such as with dehydration or fluid shifts (third spacing). Consider clients with burns, diarrhea, diuretics, erythrocytosis, polycythemia vera, hemachromotosis, or exogenous erythropoitin (

My patient did have slight edema in her extremities, and from what I understand of post-op patients, fluid does some weird stuff and will shift to the site of injury and then elsewhere, which is why you will sometimes see decreased urine output for a while before the fluid finally gets the picture and the patient will begin to void appropriately (based on her input from IVF's and other fluid replacement measures that were administered to make up for blood loss during surgery).

So with my client, we saw just that scenario- her foley had been d/c earlier that morning and we were waiting for her to void, but she would only be able to produce 50-100mL urine at a time. Later that afternoon (when her fluid finally shifted back), she was able to produce adequate output.

Thanks again for the help! I hope I got this right, but please let me know if I got mixed up on anything!

(Oh- and if anyone is hiring someplace beautiful...apparently there's a hiring freeze going on in FL!) :o)

-S

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Specializes in student; help!.

Isn't physiology cool?

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