What is the lowest hemoglobin you've observed with no symptoms?

[Horseshoe, BSN, RN]

I often see this question regarding heart rates, but what about H & H? Have you ever gotten lab results on someone who seems normal and then you get a call about a 5 or 6 hemoglobin?

What was your first intervention?

[Rose_Queen, BSN, MSN, RN]

We had one on an appendectomy patient who came in through the ER. Apparently it’s her norm due to extreme periods. We still did her surgery (not much choice unless we wanted to let it rupture and deal with a bigger mess to fix)

[amoLucia]

Ask first "are you Jehovah Witness?"

I may not agree with it, but I respect the pt's decision.

Then repeat bloodwork - like chain of evidence.

[Horseshoe, BSN, RN]

I had a pretty "normal"looking patient in for something unrelated to GI, and his H & H came back at 6 and 23. Doctor was there and ordered immediate transfusion and consult for STAT colonoscopy.

I argued for repeat blood work before taking action. Got big pushback from doc. Patient told me that when lab drew "they barely got any blood at all".

Do you think in a patient with normal vitals a result of that significance should be re-run before taking action?

[ruby_jane, BSN, RN]

On 2/11/2020 at 4:24 PM, Horseshoe said:

I had a pretty "normal"looking patient in for something unrelated to GI, and his H & H came back at 6 and 23. Doctor was there and ordered immediate transfusion and consult for STAT colonoscopy.

I argued for repeat blood work before taking action. Got big pushback from doc. Patient told me that when lab drew "they barely got any blood at all".

Do you think in a patient with normal vitals a result of that significance should be re-run before taking action?

WOW!. Whelp....they always told us in nursing school to treat the patient, not the lab value. So unless something else was going on...I think your gut was right. Transfusion probably wouldn't have hurt....stat colonoscopy? Someone would have rerun the value before that.

[Horseshoe, BSN, RN]

Yeah, so this got me thinking about low lab values and chances of the patient compensating so well as to create doubt about the results. Of course, labs should be repeated if it's not smelling right or before taking serious action. But I was wondering about peoples' experiences with very low H & Hs who turn out to be actually that low while seeming perfectly fine...

[LovingLife123]

My question would be, why would you think the lab was off? Were they a new admit? No other labs to look at? Generally I look at trends and if it’s way off then I will recheck.

Would there be a reason for the physician to suspect a GI bleed? Why not a CT scan?

[amoLucia]

Dialysis pts and those with advanced renal/hematology diseases run chronically low. And I'm talking REALLY low. Yet those pts are freq AAO & walkie/talkies.

Terribly pale & easily fatigued, but seemingly OK.

[Hoosier_RN, MSN]

I've got one now, 4.8. Was driving til I told his wife. Yikes!

[brownbook]

I don't have, remember, any numbers but am very cognizant of the bodies amazing ability to adapt to slow blood loss. People can be functioning normally, some shortness of breath may be the only sign that they're severely anemic.

[Hoosier_RN, MSN]

Just now, brownbook said:

I don't have, remember, any numbers but am very cognizant of the bodies amazing ability to adapt to slow blood loss. People can be functioning normally, some shortness of breath may be the only sign that they're severely anemic.

Or just tired

[KatieMI, BSN, MSN, RN]

Always, always re-check lab values which doesn't look "right". Just for CYA. Just for that one-time in life stuff that happens.

I once saw a grown-up man who walked into urgent care with cut finger. By him, was totally fine otherwise and swore unhappily when it was seen that a ligament was torn and he was sent to ER. Hb 4.1 Ht 19 or 20. Rechecked it - same. Then an Xray was done and everybody literally collapsed. Osteopetrosis - an extremely rare inherited disease (parents were first degree cousins), slow atrophy of bone marrow. Sent to transplant clinic.