Surgery and anemia

Two points I'd like to make here:

When you say "a couple of days" after surgery - they may still be retaining fluid, and the "anemia" you see, may be hemodilution. Are you looking at hematocrit or hemoglobin? How low is low? Anesthesia doesn't even begin to get worried about blood loss until the hgb approaches 10, and only then if the patient has an underlying disease process that would mean they wouldn't withstand it well.

Secondly, it takes at least 21 days for reticulocytes to begin to show up as differentiation into mature erythrocytes. The best thing that can be done for these patients is to monitor iron, folate, B12 and inflammation levels - all things that can contribute to protracted anemia.

You technically *can* monitor reticulocyte counts, but it's not so much the number itself as it is the trends, so it's not always helpful.

Look at your MCV, and see if its rising - not big, but around 100 or so, give or take...it's usually a sign of increased reticulocyte activity.

Nursekitten:

Thanks!! That was helpful. I also wasn't considering the possibity of hemodilution and these are mostly urology patients so maybe that is why.

If they're urology patients, consider that they may have some underlying renal issues to begin with, so it may take them a little longer, as the erythropoetin levels may not be exactly optimal.

Fluid dumps from surgery (and yes, anesthesia does give a LOT of fluid - has to do with the nature of the drugs we give causing BP to drop like a stone if we don't) generally occur 48-72 hours after surgery.

The first thing I thought of was hemodilution....that coupled with minor blood loss could make the crit 'low'.

Another thought I had on this subject the other day:

If these are post-op TURP patients, they are 1) loosing more blood than you think and 2) have absorbed TONS of fluid via the prostate during surgery. Something like 120cc/hour of extremely HYPOTONIC solution, so you also want to be alert for their electrolyte levels as the "auto-correction" continues over the course of their first few post op days.

I had no idea! I didn't have much info in my book about TURP and what do you know, these were TURP pt's. Thanks!