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What can be given a patient whose blood count has dropped from 5.4 to 4.8?

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Patient is a 57yr old female. Doctor has performed an upper GI and CT scan of the abdomen today. No evidence of blood loss was encountered.
asked Aug 30, 2012 in Conditions and Treatments by anonymous

2 Answers

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Hi,

I recently (11 months ago) was in hospital, with major complications during my pregnancy. They knew when the time came for delivery (via c-section) I was going to lose a lot of blood.

my iron levels were below normal, so I was given an iron infusion to boost my iron levels. Over a six hour period, an iron solution was given thru my iv.

also, the plan was, if I lost too much blood, to give me EPO (erythropoietin) which stimulates the bone marrow into producing red blood cells (this is what the numerous doctors who I saw told me). On top of the EPO, I would be given saline, to replace the volume, while my body took care of the red cells, so my blood didn't get too thick. Because, basically, when you lose blood (with or without EPO) your body goes into red cell production over time. So all that needs to be replaced is the volume, so your circulatory system can keep pumping.

This is what I have learned, through the doctors I spoke with, and my own research. I hope this helps.
answered Aug 30, 2012 by anonymous
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You must find the focus and stop bleeding. In the differential diagnose we must consider acute massive or chronic occult bleeding. The reasons of chronically occult bleeding can be for example: anal fissure or hemorrhoid, GI ulcers, cancer, intestinal helminthes,  urinary calculus, postmenopausal vaginal bleeding due uterine fibroids, cancer or uncontrolled hypertension; hemolysis after artificial cardiac valve etc. Diagnose must individualized. 

What to do: Stop bleeding, maintain vital function (hydration, oxygenation etc.) and increase blood production (iv iron, EPO, vitamin B 12, C, folic acid). You can find further readings in this site.

A case: A 46 year old JW woman had massive dysfunctional vaginal bleeding due to myoma uteri. Operation was planned, but her hemoglobin level was 8 mg/dl. She had to wait. Her hemoglobin dropped to 5,6. She was hospitalized; was hydrated (saline, dextrose, dextran etc. ); given Oxygen, IV iron, vitamin B12, folic acid, progesterone, tranexamic acid. Vital sings maintained and discharged. Continued with oral progesterone, iron and vitamins. In spite of vaginal bleeding, her hemoglobin raised to 12,6 after three weeks; operated and discharged in three days. Four weeks after operation, her hemoglobin raised to 14 mg/dl.

answered Aug 30, 2012 by Hatice Simsek MD (3,070 points)
Thank you for a great answer, hopefully I never have to "use" this information. Unfortunable I have an appointment for Oncology and preparing to hear some news from my blood tests. My father and aunt died for leukemia, so leukemia is as a curse word for me. Happily I have a non -blood hospital nearby.

I greatly appreciate the work you do for us all, showing that you are REAL professionals!                                                                                                                                                       I don't have too much appreciation for those doctor's who are still being ignorant and pushing for blood transfusions. How would we push THEM to open their minds for a new effective ways to take care of the patients without ? It's so frustrating when I feel like knowing more than the doctors (of course I'm NOT a doctor but learning about alternatives).

Again, thank you for your outstanding work!!

Inge Guzman
Thank you Inge for your encouraging comment. Unfortunately most physicians in my area doesn't know Patient Blood Management or they think it is very expensive, complicated and requires many sophisticated devices. The studies show patient blood management is safe, simple and effective. In my opinion, sometimes we need to think simple; not focus on one part of the body, such as heart, stomach, uterus, hip, laboratory etc but should see the whole person with his or her history, background and environment. What can WE do? It is wise, let checked annually hemoglobin, iron and ferritin, if possible vitamin b12. We should be sure, not being anemic. In my daily practice, chronic anemia can be without any symptoms. Some patients take over months iron without success. In iron deficiency I add vitamin b12, folic acid and vitamin c. Even in one month hemoglobin levels rises above 12. In one case, a woman came complaining about chronic anemia, was some months a year on iron. No acute or chronic bleeding history. Checking blood hemoglobin; hemoglobin, iron and ferritin; ferritin was above 1000 ng/ml. Referred to hematologist; she had hereditary hemolytic anemia. This is it, what I meant to see the whole person. Thank you again. Hatice

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