Jump to content

How long before you transfuse in PP?

Posted

Specializes in LDRP.

OK, so I am a new OB nurse and have noticed a trend in my unit to hold off ordering transfusion until the Pt's HGB drops really low and they become symptomatic. (Like a recent pt I had w/ a hgb of 6 and a hct of 17 who was tachy in the 120's and dizzy-not actively bleeding, though. They FINALLY decided to transfuse her after much discussion.) Just wondering what the rationale is behind this and if this is a common practice in post partum?

Thanks!:specs:

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

I think it depends on the pt - some people (sickle cell trait, example) live with an h/h of 8 and 25 and pp will be slightly lower and they can be asx. However, with someone whose h/h is that low and she is symptomatic, (that's usually the key no matter what the lab results say) they would be transfusing without too much discussion. I don't know what the story is.

bagladyrn, RN

Specializes in OB.

In many cases I think it is because most postpartum moms are basically healthy young women whose body can "bounce back" pretty easily. I've seen young women up and walking around with an H&H which would have laid me out. I also wonder if some of the dramatic drop we see is partially a result of hemodilution from the amount of fluid we dump into some of these patients.

Now when a patient is symptomatic this is different unless the patient herself has some objections to transfusion and prefers to wait and see what happens.

RNmommy

Specializes in Postpartum, Lactation. Has 5 years experience.

IME, transfusion is a last resort and only IF a mom is symptomatic. I have discharged women with a Hgb of 6 just on oral iron. I agree with the above poster in that the rationale seems to be that these healthy women can bounce back pretty quickly.

crysobrn

Specializes in OB L&D Mother/Baby. Has 7 years experience.

IME, transfusion is a last resort and only IF a mom is symptomatic. I have discharged women with a Hgb of 6 just on oral iron. I agree with the above poster in that the rationale seems to be that these healthy women can bounce back pretty quickly.

:yeahthat:

I think our docs often look at what the mom is going home too as well. For example the only girl I remember transfusing recently was going home to twins that were breastfeeding. I think the doc thought that she needed that little extra boost because of the extra work involved. I've seen plenty of moms go home with hgb's of 6 and have it not be an issue.

RNmommy

Specializes in Postpartum, Lactation. Has 5 years experience.

I forgot to add that those of whom I have transfused felt a million times better post transfusion and I do think that many more women could use a transfusion.

HazeKomp, BSN, RN

Specializes in L&D.

those of whom I have transfused felt a million times better post transfusion and I do think that many more women could use a transfusion.[/quote]

having received 8 units post-hemorrage from "blown" fallopian tube ectopic, I felt like night and day before and after! I agree that transfusions are often withheld due to fear of bloodborne problems vs what the patient could really benefit from!

Guest
This topic is now closed to further replies.