Why are my pt.'s RBC, Hgb, Hct low?

Editorial Team / Admin · Jun 22, 2012

Depends on how low we're talking here. We've seen many women of childbearing age come in for surgery with slightly low H&H due to heavy menstruation. Some people also just seem to run lower than the "normal" range and feel no affect from it.

What about having the abscess drained? Did she have surgery? Another type of intervention such as ultrasound guided drainage?

ilearntoo · Jun 22, 2012

Depends on how low we're talking here. We've seen many women of childbearing age come in for surgery with slightly low H&H due to heavy menstruation. Some people also just seem to run lower than the "normal" range and feel no affect from it.
What about having the abscess drained? Did she have surgery? Another type of intervention such as ultrasound guided drainage?

Rbc 3.43, Hgb 10, Hct 32. Pt. is elderly lady. She has a JP drainage tube in place. No blood being drained just green fluids. This may be a very dumb question, but would drainage of fluids (of any kind) esp. high volumes cause oxygen levels to drop leading to low hgb, etc? Pt. is not dehydrated, but she was upon admin.

MN-Nurse, ASN, RN · Jun 22, 2012

Rbc 3.43, Hgb 10, Hct 32. Pt. is elderly lady. She has a JP drainage tube in place. No blood being drained just green fluids. This may be a very dumb question, but would drainage of fluids (of any kind) esp. high volumes cause oxygen levels to drop leading to low hgb, etc? Pt. is not dehydrated, but she was upon admin.

Shoot, depending on many other factors that might be baseline. I've had shifts where a Hgb of 10 is a world champion.

One set of labs doesn't tell you a thing. What are the trends?

Esme12, ASN, BSN, RN · Jun 22, 2012

Pt may just be anemic all the time and is undiagnosed. The seeming drop is because she is now hydrated. Patients can develop ulcers/GI bleeds due to stress. Where would you look for occult blood in the GI system?

What other meds is she on? What other comorbidities are there? What meds does she take? What surgical procedure was done to place the JP? What is he baseline/trending labs? How old is this person? Does she menstruate?

While the blood have the products that carry oxygen to the cells a drop in O2 doesn't cause a low Hct/HgB/RBC but...... a severe lack of Hct/HgB/RBCs will cause a lack of O2. The drainage of copious amounts of purulent fluid from the abdominal cavity has no effect on oxygenation unless it is blood that is drained due to hemorrhage. It would be the loss of blood causing a loss of HgB (the oxygen carrying blood product) that would cause a loss of O2 carrying capacity to the cells even if there is enough O2 to breath.....it doesn't have a ride to get there.

metal_m0nk, BSN, RN · Jun 22, 2012

Is she receiving IV fluids? What's her fluid intake/output ratio? If she's taking in more than she's putting out, I would suspect fluid overload.

ilearntoo · Jun 22, 2012

Thanks for all the comments guys. Esme12, I actually ended up thinking about her dx. Dx pelvic abscess secondary to diverticulitis. Perhaps she was GI bleeding before being dx with abscess. That's the only thought that made sense to me due to her diverticulitis. Either that, or she is undiagnosed anemic. I looked at the labs and although hgb, hct are still low they actually increased a bit throughout my shifts. She also has high glucose levels and she is not diabetic and no hx of diabetes. I'm looking into meds and the fact that she didn't eat for a week before ending up at the E.R. due to her abdominal pain. (hence diverticulitis, me thinking GI bleeding, x-ray to identify she had an abscess)

Anyhow, I spoke with my prof. and she told me simply to include my thoughts and what could possibly be the cause backed up with evidence and I should be good for my careplan. Thanks for the help guys! :)

KelRN215, BSN, RN · Jun 22, 2012

Thanks for all the comments guys. Esme12, I actually ended up thinking about her dx. Dx pelvic abscess secondary to diverticulitis. Perhaps she was GI bleeding before being dx with abscess. That's the only thought that made sense to me due to her diverticulitis. Either that, or she is undiagnosed anemic. I looked at the labs and although hgb, hct are still low they actually increased a bit throughout my shifts. She also has high glucose levels and she is not diabetic and no hx of diabetes. I'm looking into meds and the fact that she didn't eat for a week before ending up at the E.R. due to her abdominal pain. (hence diverticulitis, me thinking GI bleeding, x-ray to identify she had an abscess)
Anyhow, I spoke with my prof. and she told me simply to include my thoughts and what could possibly be the cause backed up with evidence and I should be good for my careplan. Thanks for the help guys! :)

If she truly didn't eat for a week prior to admission, you could have your answer right there. One of the most common causes of anemia in women is low intake of iron.

In my world, a hemoglobin of 10 and a hematocrit of 32 would hardly be noticed on the labs... in oncology anything above 20 is a good hematocrit and anything above 7 is a good hemoglobin!

metal_m0nk, BSN, RN · Jun 23, 2012

Keep it simple. If she's receiving fluids, check her I&O. If it's on target, THEN you should consider other possibilities. One of the biggest mistakes I've seen in nursing school and in clinicals is students overthinking and missing the obvious.

ilearntoo · Jun 23, 2012

Gotcha! Yes her I&O's are good. She did not eat for a week prior to admin, but that was two weeks ago. She's been eating well during my shifts. No dehydration. No IV. Is it possible that lab values take long to be stable again? & I know she's on one blood thinner med (possible contribution?) all other meds are antibiotics.

Esme12, ASN, BSN, RN · Jun 23, 2012

dischagrge instructions for someone on "blood thinners" anticoagulants.

Blood Thinner Pills: Your Guide to Using Them Safely

When taking a blood thinner it is important to be aware of its possible side effects. Bleeding is the most common side effect.

Call your doctor immediately if you have any of the following signs of serious bleeding:

Menstrual bleeding that is much heavier than normal.
Red or brown urine.
Bowel movements that are red or look like tar.
Bleeding from the gums or nose that does not stop quickly.
Vomit that is brown or bright red.
Anything red in color that you cough up.
Severe pain, such as a headache or stomachache.
Unusual bruising.
A cut that does not stop bleeding.
A serious fall or bump on the head.
Dizziness or weakness.

cardiacrocks, BSN, RN · Jun 23, 2012

Someone could have good saturation of their O2 and not be hypoxic but have hypoxemia. Basically they have some damage going on in their tissues. It's complicated. However, there are pt.'s that with H&H of 10 and 32 that is excellent! We don't even give blood unless the hemoglobin falls below 8 and sometimes it's 7 depending on their condition. Good question though.