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

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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?

3 hours ago, Horseshoe said:

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?

I have chronic fatigue, but just learned to live with it. Only the iron infusions helped and I didn't want to get a port. So...you just learned to live with it, take oral iron and do the best you can.

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Specializes in Surgical, quality,management.
9 hours ago, Jory said:

I have chronic fatigue, but just learned to live with it. Only the iron infusions helped and I didn't want to get a port. So...you just learned to live with it, take oral iron and do the best you can.

Why can't you get iron peripherally? I consented to the infusion knowing the risk of staining.

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We had a 90+-year-old come in for knee pain. Labs came back with hgb in low 4. No symptoms, she only came in for the knee pain because she couldn’t walk out to get her mail or something, which was very off for her as she was incredibly active!

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Specializes in ICU, LTACH, Internal Medicine.

Just yesterday. Classic little old lady caught in malignant circle of "ER >> ICU >>acute >> rehab >> ER" and everything-but-the-kitchen-sink list of comorbidities for several months. Before she broke her hip while chasing a runaway calf she was living on a farm, ate whatever was available there, still did some work caring for cattle and house and did not know about any meds or doctors except for incidental aspurin and a glass of homemade dangelion wine for cold.

Sent to ER yet another time for "weakness". Cachectic, confused, not walking for months, not sitting for weeks, eating almost nothing, daily blood draws for the last 2 months(!!!), Hb 4.5. Vitamin D, iron, copper, folic acid, B6 all "extremely low" to "nondetectable".

Took report from another NP covering that rehab, asked her why they did daily labs for weeks in a row. Answer: nurses were constantly calling because they were concerned about patient's deterioration and suggested doing labs and practice secretary, who triages the calls just made them ordered.

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I started at a FQHC and had a patient with epigastric pain with nausea who ended up coming back with a hemoglobin between 4-5 but was hemodynamically stable at the time of the appointment. I got the results on a Saturday night and called the patient and sent them to the ER. ER confirmed the level but discharged.... No insurance. America is a very tiered health system.

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11 hours ago, KatieMI said:

Just yesterday. Classic little old lady caught in malignant circle of "ER >> ICU >>acute >> rehab >> ER" and everything-but-the-kitchen-sink list of comorbidities for several months. Before she broke her hip while chasing a runaway calf she was living on a farm, ate whatever was available there, still did some work caring for cattle and house and did not know about any meds or doctors except for incidental aspurin and a glass of homemade dangelion wine for cold.

Sent to ER yet another time for "weakness". Cachectic, confused, not walking for months, not sitting for weeks, eating almost nothing, daily blood draws for the last 2 months(!!!), Hb 4.5. Vitamin D, iron, copper, folic acid, B6 all "extremely low" to "nondetectable".

Took report from another NP covering that rehab, asked her why they did daily labs for weeks in a row. Answer: nurses were constantly calling because they were concerned about patient's deterioration and suggested doing labs and practice secretary, who triages the calls just made them ordered.

That's really unfortunate.

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Specializes in ICU, Home Health and Hospice.

Hemoglobin of 3.6 when I worked in the ICU. Could not understand how this kid was just slightly pale with no other symptoms. Cannot even tell you how many times we rechecked because everyone was baffled. Still to this day I wonder if we were in the twilight zone that shift.

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20 hours ago, Emm_RN said:

Hemoglobin of 3.6 when I worked in the ICU. Could not understand how this kid was just slightly pale with no other symptoms. Cannot even tell you how many times we rechecked because everyone was baffled. Still to this day I wonder if we were in the twilight zone that shift.

Wow!

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On 2/13/2020 at 3:54 AM, K+MgSO4 said:

Why can't you get iron peripherally? I consented to the infusion knowing the risk of staining.

You absolutely can...but after a couple of months or so with multiple IV sticks with multiple attempts for each one...you start running out of sites.

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Specializes in Surgical, quality,management.
24 minutes ago, Jory said:

You absolutely can...but after a couple of months or so with multiple IV sticks with multiple attempts for each one...you start running out of sites.

Ahh, OK. It is just some places are coming down on peripheral IV iron after patients had tattooing from stains. As a very pale Irish person I got a very long lecture on the risks by my GP and practice nurse. The nurse was also super reluctant to give the high dose in the clinic. On reflection I should of popped into my hospital infusion centre because there was some dodgy practice in the administration....5 x 20ml syringes administered as no IV pump.

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Specializes in Intensive Care/AG-ACNP Student.

I had a 70-something year old man come for an elective Cath which was postponed due to Hgb 3.2.. He was just pale. Eventually found he had a tiny chronic GIB that was found by the third radiologist on a nuclear scan after dozens of other tests to find the bleed.

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it was my biggest nightmare,i work in general medical,He is 45yo male,nkmi,admitted because of heart rate was low 45-56,ecg shown sinus brady,vitals normal,gcs 15,complaint of unable to pass motion for 4/7,we were expecting IO or just some impacted stool,axray done,nothing shown IO,just impacted stool,during admission no signs of any bleeding tendencies,we gave him bolus 5cc/kg/hr then another 10cc/kg/hr the heart rate was improving bit by bit,pr was done it was impacted brownish stool,we gave him enema,all of sudden its like the battle of blood,bleeding from rectal,fbc,rp,and coag was taken before out urgently,shown hb dropping,we transfused him with safe o,patient become tachypnoeic,and gcs drop,intubate him,brought him for scope,within 2 hours admited from ER,condition worsening,lucky enough ive had good team at that time,at the end of the day,dx forest 2 ulcer,pt was discharged from our ward,,,not even icu admissions,,,i was so glad he is well now,,,

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