How can a pt experience both anemia (with a low hematocrit) and volume overload?

MunoRN, RN · Jul 1, 2014

What does hematocrit measure? If someone's hematocrit is 45%, what happens to that % if you add volume to their blood that aren't red blood cells?

westieluv · Jul 1, 2014

Renal patients are chronically anemic and most of them are chronically fluid overloaded. Healthy kidneys produce erythropoietin, which stimulates the body to make red blood cells, so when you lose kidney function, you lose erythropoietin production and your body is not stimulated to make red blood cells. Increased fluid volume in the intravascular space combined with low red blood cell production = low hematocrit with fluid overload. This is the norm in dialysis patients.

jadelpn, LPN, EMT-B · Jul 1, 2014

Think about fluid being a dilutant.

Hemoglobin and Hematocrit - Clinical Methods - NCBI Bookshelf

Tarabara · Jul 1, 2014

Thanks for your responses, sorry I should have included more info. The patient does not have kidney disease, his low hgb and hct are suspected result of GI bleed. Therefore if he has a GI bleed I would think he'd be volume down?

meanmaryjean, DNP, RN · Jul 1, 2014

Unless he's gotten volume replacement in the form of IV fluids which do not contain cells.

HouTx, BSN, MSN, EdD · Jul 1, 2014

It's not unusual for severely anemic patients to be fluid over-loaded & 3rd spacing due to compensatory mechanisms... chemical and baro-receptors kick in trying to increase volume by any means possible. 3rd spacing due to osmotic pressures as intravascular fluid becomes more diluted.

So - low H&H is due to acute bleeding - volumes will be low also. But as homeostatic compensatory mechanisms kick in & enthusiastic fluid resuscitation gets underway, things can easily go awry.

Cobweb · Jul 1, 2014

I'll tell you something that goes along with that kind of deal too--you can be fluid overloaded and dehydrated at the same time!

Here.I.Stand, BSN, RN · Jul 1, 2014

Thanks for your responses, sorry I should have included more info. The patient does not have kidney disease, his low hgb and hct are suspected result of GI bleed. Therefore if he has a GI bleed I would think he'd be volume down?

He could have been volume depleted from the blood loss, but then what happens to the BP? BP and CVP's down, let's fill up the tank! Give a liter NS, another liter NS, another liter NS... what has then happened to the fluid:blood cell ratio?

Here.I.Stand, BSN, RN · Jul 1, 2014

Also, keep in mind that we tolerate lower hgb's than we used to before transfusing. So just because someone has low BP because of hypovolemia, they're not necessarily going to replace that volume w/ PRBCs. A hgb of 8 while yes anemic, is not low enough to warrant a blood transfusion in most cases. So then they would treat the hypovolemia w/ fluids like I mentioned ^^^