Possible causes of low H&H?

[miniangel729]

last week i had a patient with wound infection from laparoscopic bilateral salpingo-oophorectomy on her llq (post-op 17 days). her lab value was..(patient have htn and diabetes)

wbc

4500 - 11,000/µl

11.8 (h)

hgb

12-17 g/dl

10.5 (l)

hct

35-52%

31.2 (l)

platelets

150,000-400,000 /µl

457 (h)

we had to give rationale of each abnormal lab value,

for the h&h i put " patient is on antibiotic, which could cause ↓in hemoglobin count. also, patient have sob, which could also ↓ h&h."

my instructor made a big deal saying how come i didn't mention her h&h are low due to post-op. i didn't understand why.. (cuz its already post-op 17 days, it shouldn't be due to blood loss?)

she also asked me how long does it take for body to replenish h&h.

can anyone tell me where i can look up for causes for abnormal lab values? and why should h&h be low after post-op and how long does it take to get back to normal level?

oh.. another thing, why does diabetic have slow wound healing?

(first semester nursing student and feeling very lost.. =/)

[2jen]

Well, I will give it a shot! The body needs a few days to reproduce RBC, and if there are not enough of those then the Hct and Hgb will both be low causing anemia. The patient may have had a bleed before the surgery which would have also decreased the number and there is always blood loss during surgery which would also cause those numbers to be low. 17 days post op does seem like a long time but that would probably be what I would have put on my labs as a possible cause.

With diabetes, there can be impaired circulation and altered carbohydrate metabolism slowing the healing of wounds.

Is this what you were asking? A lot of times I just google exactly what I am looking for to try to understand whatever it is I am looking up.

[Daytonite, BSN, RN]

can anyone tell me where i can look up for causes for abnormal lab values?

• medicine net procedures & tests a to z index http://www.medicinenet.com/procedures_and_tests/article.htm
  
• web md index list of tests http://www.webmd.com/a_to_z_guide/medical_tests.htm
  
• lab tests online http://www.labtestsonline.org/
  

why should h&h be low after post-op and how long does it take to get back to normal level?

http://www.biosbcc.net/doohan/sample/htm/blood%20cells.htm

- blood cells (nice explanation of erythropoetin and rbc cycle)

http://www.anemia.org/professionals/monograph/surgery/

-

• one-third to one-half of surgical patients may be anemic preoperatively because of conditions for which they require surgery.
  
  
• post operative anemia may occur in up to 90% of patients, probably due to a blunted erythropoietic response. (surgery induced erythropesis)

why does diabetic have slow wound healing?

• http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/wounds_how_to_care_for_them?opendocument - wounds, causes of chronic wounds, the healing process - "factors that can slow the wound healing process include. . . medical conditions - such as diabetes, anaemia and some vascular diseases that restrict blood flow to the area, or any disorder that hinders the immune system."
  
• http://diabetes.niddk.nih.gov/dm/pubs/america/pdf/chapter22.pdf - "macrovascular disease and microvascular dysfunction may result in compromised local circulation leading to delayed response to infection and impaired wound healing."

[RNKel, ASN, RN]

I always used my Pagana and Pagana Lab Manual by Mosby's.

[trepinCT]

low H and H can also be due to extra fluids, such as an IV...