high RBC, low H & H

EricJRN, MSN, RN · Oct 4, 2007

The reticulocytes are included but, even when elevated, they make up a pretty negligible percentage (~1-4%) of the RBC count. Can you post the CBC or tell us more about the patient?

danger · Oct 4, 2007

i wish i knew more; i don't have access to her CBC. this was a patient on a med/surg floor one day post-op for a cellulitis (sp?) surgery of her foot. late 80's, maybe early 90 year old female w/ history of diabetes. on my way out in the morning the doctor said that he was troubled by her low H & H. he ordered blood and an erythrocyte count. i believe the H & H was 8.9 and 26.6 and the RBC was 5.5 ish. she also had a K+ of 3.2.

just trying to tie my education to the patients. if i can i'll post her CBC next week.

thanks,

dan

Christie RN2006 · Oct 4, 2007

The only thing I could think of is Hgb E disease (beta thalassemia) Those patients are anemic, but have a high RBC count. It is very common overseas, but not so much in the US.

woody62, RN · Oct 4, 2007

does the RBC count include reticulocytes? and would this explain a high RBC count with a low H & H? or is this, low H & H, more a deficiency of iron?
dan

There are a group of anemias known as microcytic-hypocromic anemia.

Woody:balloons:

MBsGirl · Oct 4, 2007

Hg E and Thalassemia are different. This sounds like it could be a hallmark of Beta Thalassemia minor... high rbc, low to normal hemoglobin, RBC morphology such as shistocytes and poikilocytes, target cells, etc. The rbc count is high, but the cells are microcytic, short lived, and fragile. It's very often mistaken for iron deficiency. Iron studies are necessary to rule out deficiency.

I and 2 of my 3 children have Tminor. Not usually a big deal except when you get sick or take certain antibiotics, then sometimes the hemoglobin will drop..I went down 2 grams in one night after taking Keflex when I had pneumonia. Don't know if it was the med or just being sick.