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What hemoglobin level is safe for a release of an elderly patient from the hospital?

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Before being admitted to the hospital for a UTI my 85 year old grandmother had been living with a hemoglobin level of about 8, now she has been in for 7 days and we cannot keep it up above 7.5 because she has two ulcers.  She is weak now from not getting out of bed. What can we do for her besides giving blood.  They gave her epo only once and her hemo shot up to 8.2. But then went back down the next day.
asked May 31, 2012 in Conditions and Treatments by anonymous
retagged Jun 4, 2012 by LarryEitel

4 Answers

2 like 0 dislike
I think it is a very different question.

We should consider a variety of factors : current health status of the person, acute or a chronic anaemia, presence of geriatric syndromes for example any form of dementia, chronic illnesses just as diabetes, hypertension, heart failure, coronary heart disease, lung disease, cancer, malnutrition etc.

W e should also consider the questions: Are there any signs of hypoxia? How are the vital functions during daily physical activity?

In this special case, we must apply the alternatives to blood transfusion.  You will find them in this site.
answered Jun 3, 2012 by Hatice Simsek MD (3,070 points)
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I would like to focus on one part of Doctor Simsek's answer - "We should also consider the questions: Are there any signs of hypoxia? How are the vital functions during daily physical activity?"

 

If your grandmother has been living with a hemoglobin of 8 her body has learned to deliver oxygen more 'efficiently'.  Notice this comment from an article authored by Dr. P Van der Linden of Belgium.  I have taken the liberty of underlining key phrases.

 

"ACUTE NORMOVOLEMIC ANEMIA:PHYSIOLOGICAL AND PRACTICAL CONCERNS (Abstract): The adequacy of a hemoglobin concentration in a given clinical situation depends on whether a sufficient amount of oxygen is carried to the tissues to meet metabolic requirements. Therefore, the decision to transfuse a given patient cannot be based only on the hemoglobin level. Rather, rigid adherence to an arbitrarily predefined transfusion threshold will result in the over-transfusion of some patients, but also in the under-transfusion of
others. A better knowledge of the physiologic responses developed during acute isovolemic anemia and the clinical factors that can limit the ability of the organism to maintain adequate tissue oxygenation in these situations, will allow the clinician to better define the transfusion trigger for each patient."

 

Notice the article recommends NOT to transfuse due to some number i.e. hemoglobin count.  He recommends treatment guided by how well the patient is doing. 

This article is discussing Acute Anemia (very serious), your grandmother has Chronic Anemia (long term) but the issue of whether she can live well enough with a lower than normal hemoglobin is the same.  In your grandmothers case physicians would want to do as Doctor Simsek says.  Assess how well she is doing physiologiclly (how well her body is functioning) and determine treatment and where to place her at discharge based on the whole picture.

 

A comment based on research and personal experience:  The fall in your grandmother’s hemoglobin is very likely hospital caused.  When she was admitted did they begin taking blood for testing and infusing water?  If your grandmother is a small person and if she is frail it doesn't take too many days and her hemoglobin will fall.  Take away the cause (hospital) and her blood counts should come back up, especially if they continue treating her with EPO and nutritional support.

 


 

 

answered Jun 3, 2012 by Jan B. Wade (4,930 points)
edited Jun 3, 2012 by Jan B. Wade
Thank you for yor replies. Yes, they did draw blood upon admittance. She does not have any of the diseases you mentioned. Only edema, ulcers, bi polar disorder, depression, anemia from ulcers. Since posting my question. Her uti cleared up and she was sent to a rehab facility because she lost her mobility being in bed for so long. She is returning to herself, but I still believe she is a little confused and has some scattered thinking.  Hopefully she will get on her feet again.
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Free full text article about anaemia in elderly for further reading:

 

Anemia in the Elderly

Am Fam Physician. 2000 Oct 1;62(7):1565-1572.

Anemia should not be accepted as an inevitable consequence of aging. A cause is found in approximately 80 percent of elderly patients. The most common causes of anemia in the elderly are chronic disease and iron deficiency. Vitamin B12 deficiency, folate deficiency, gastrointestinal bleeding and myelodysplastic syndrome are among other causes of anemia in the elderly. Serum ferritin is the most useful test to differentiate iron deficiency anemia from anemia of chronic disease. Not all cases of vitamin B12 deficiency can be identified by low serum levels. The serum methylmalonic acid level may be useful for diagnosis of vitamin B12 deficiency. Vitamin B12deficiency is effectively treated with oral vitamin B12 supplementation. Folate deficiency is treated with 1 mg of folic acid daily.

Full text: http://www.aafp.org/afp/2000/1001/p1565.html

answered Jun 7, 2012 by Hatice Simsek MD (3,070 points)
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How many units of epo(procrit)was she given?
answered Mar 27, 2013 by 21stCentury (630 points)

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