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

[Horseshoe]

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?

[amoLucia]

1 hour ago, Hoosier_RN said:

Or just tired

And very pale.

[Davey Do]

3 hours ago, Horseshoe said:

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?

Interesting subject at this time, for me.

Recently, I was passing meds and Jason Hiney was doing VS and assessments on geriatric psych. Jason noted one elderly female patient had a low BP- something like 94/48. He kept monitoring her and the BP did not change. The patient exhibited no overt symptoms, said she felt fine, but Jason contacted the Hospitalist and got orders for labs. Sure enough, the Hgb was critical at 5.7.

The patient was assessed in ER, found to have a +SOB, was given a transfusion, and shipped to medical.

I asked Jason why he kept on the patient when she exhibited no overt symptoms of distress. He said, "Whenever the DBP is below 50, I keep on them!"

I'm not sure that I would have acted so quickly in consulting the Hospitalist since the patient exhibited no overt s/s of distress, so it's a good thing Jason was on VS/assessments and I was doing meds!

Just as a side note, Jason did get recognition for his prudent nursing care.

[yournurse]

Hgb 3, jehova’s witness. I think sometimes we over transfuse. Our hospital questions transfusion orders if hgb is >7.

[Horseshoe, BSN, RN]

I figured some would have stories of Hgb in the 5s with few symptoms, but wow, in the 4s. Hard to imagine, but the human body does seem to have a remarkable ability to compensate-until it no longer can, of course.

[JKL33]

I've seen my share of low hgb, I just don't know how often I've seen it without any inkling of something being amiss before seeing the lab result.

[K+MgSO4, BSN]

My hb was 8.8, iron 3. I thought I was "fine" working, driving etc. 1g ferrinject infusion, the cognitive fog lifted almost immediately and the fatigue eased after a few days. It is amazing how you adapt to running on fumes.

[Hoosier_RN, MSN]

With dialysis, numbers are all over for any lab. It becomes the norm for those pts

[kp2016]

15 hours ago, 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?

I received a patient with very critical K levels. I was horrified when I received hand over and saw nothing had been done.

I immediately reran the labs. It was 24 hours later with no treatment at all they were text book normal. I was baffled until Pt’s husband a Dr told me they had blown the Vein in the lab draw, not gotten enough blood, hemolized the sample and ran it anyway. So yes. If it’s (my gosh how are you even alive) critical, a stat rerun is a very good idea.

[Jory, MSN, APRN, CNM]

I have chronic anemia and live in the land of 7-8.

[Horseshoe, BSN, RN]

1 hour ago, Jory said:

I have chronic anemia and live in the land of 7-8.

Do you feel ok? Or is it so long since you've had normal blood levels that you honestly can't remember how "normal" actually feels?

[ruby_jane, BSN, RN]

7 hours ago, kp2016 said:

I immediately reran the labs. It was 24 hours later with no treatment at all they were text book normal. I was baffled until Pt’s husband a Dr told me they had blown the Vein in the lab draw, not gotten enough blood, hemolized the sample and ran it anyway.

That's what I was getting at but you said it much more cleanly. ?

[mmc51264, BSN, MSN, RN]

I've seen sickle cell pts as low as in the 4s. When they are in crisis, it is hard to tell exactly if they are symptomatic as their pain is usually very high and they basically feel like crap anyway.

Some of them have terrible transfusion reactions so we will let them live 6-8.

I am primarily an ortho nurse on post-op unit and we don't transfuse until they are under 8. They do labs daily.