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How would you answer this question?
Your patient had abdominal surgery with a large blood loss. She was transfused to a hemoglobin level of 10g/dL. If she was previously healthy before this operation, then how long will it take her to restore her hemoglobin level to her previous level of 14g/dL?
a. Four days.
b. Two weeks.
c. Six weeks.
d. Two years.
The correct answer is "c" six weeks.
One of the goals for a patient who has a large blood loss is the restoration of normal hemoglobin levels. This is partially done by blood transfusions, usually to a hemoglobin level of about 10g/dL. A hemoglobin level that low will leave the patient feeling fatigued, but should be high enough to protect the heart from anemic ischemia.
Blood transfusions are generally administered when the hemoglobin reaches 8g/dL or lower. At that point the hemoglobin level is low enough to cause decreased tissue perfusion and cardiac dysfunction. Transfusions are not indicated at higher hemoglobin levels due to inflammation caused by the transfusion that can lead to complications and a higher mortality rate. Each unit of transfused blood increases the hemoglobin level by 1g/dL.
When your patient goes home it will take six weeks or longer for the hemoglobin to recover to pre-surgery levels, assuming that the patient is healthy and that she maintains a healthy diet. If your patient has chronic health conditions it might take considerably longer to restore the hemoglobin level and iron and erythropoietin supplementation may be necessary.
From: Karkouti, K., McCluskey, S.A., Ghannam, M., et al. (2006). Intravenous iron and recombinant erythropoietin for the treatment of postoperative anemia. Can J. Anaesth., 53(1): 11-19.
Congratulations to Mallika Patel who won an autographed copy of my 101 Tips to Improve Your Nursing Care book for answering this week's question correctly. Congratulations Mallika!
Best wishes,
David W. Woodruff, MSN, RN-BC, CNS, CEN
President, Ed4Nurses, Inc.
PS. 10 Goals by 10/10/10! Find out how a professional coach can help.
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