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Thread: Life Threatening Red Blood Cell Count

  1. #1
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    Life Threatening Red Blood Cell Count

    Hi,

    Would appreciate if anyone could tell how low of the red blood cell count is considered life threatening for a 70 year old man suffering from cancer?
    Thank you.

    Regards,
    Fiona

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  3. #2
    For males, the normal range for hemoglobin is 13-17 g/dL. While the World Health Organization classifies a hemoglobin of 8.1 or less in a male as severe anemia, this level may not necessarily be life threatening to a particular individual. Rather then just focusing on the number, symptoms that would represent the need for increased oxygen carrying capacity need to assessed. Is the patient experiencing dyspnea (shortness of breath), chest pain, heart palpatations, dizziness? Individuals with underlying coronary artery disease may require a higher hemoglobin level to prevent such symptoms.

    How low can a hemoglobin go without causing death or permanent damage? There really is no way of knowing. I worked with a 63 y/o patient earlier this year who had a hemoglobin level of 3.8, which is pretty low. She also had coronary artery disease (had had a double bypass 6 weeks earlier) and had end-stage renal disease. Her low hemoglobin level was the result of an acute gastrointestinal bleed. As one of Jehovah's Witnesses, a blood transfusion was out of the question. She was a little short of breath, so she was on continuous oxygen. Her thinking was a bit fuzzy, and she slept quite a bit, but with the help of iron infusions and EPO, plus limiting the amount of bloodwork done, she made a full recovery.

  4. #3
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    An anaesthetist advised me that the actual 'safe' minimum depends on the age and health of the patient, for example a young, healthy person say about 12 years old may sustain a blood count as low as 2.8 and survive AS LONG AS there is ENOUGH FLUID - for short term and with good oxygen supply the chances of survival are dependant more upon the fluid content and the cell trauma than the actual count.
    I know that doesn't directly answer your question, but it gives another facet of view - I'm afraid you question is a little like 'how long is a piece of string' - the cancer will have an effect, but that also depends on how the cancer is affecting oxygen intake and transit.

  5. #4
    Managing Editor Jan B. Wade's Avatar
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    RBC Counts

    Much also depends on how long it takes the RBC count to fall (Acute anemia vs. Chronic anemia). A person who bleeds out from 14 to 8 within hours can be in trouble while a person who looses that amount over a couple of months can go for a nice long walk with friends. There are African people who suffer from blood disorders and live their life at 7-8. By live their life, I mean they hunt, carry water, etc.

    Here's a study about anemic patients ability to accomodate low hemoglobin values. It basically says that a shift in oxygen delivery occurs for patients who become anemic gradually:

    The Oxygen Dissociation Curve in Anemia Of Various Types

    The Oxygen Dissociation Curve in Anemia Of Various Types

    Here's an article found here at NoBlood

    http://noblood.org/prepare-now-medic....html#post2074

    Here is a comprehensive paper on the Physiology of Oxygen Delivery

    http://www.nda.ox.ac.uk/wfsa/html/u10/u1003_01.htm
    Last edited by Jan B. Wade; 10-22-2009 at 06:13 PM.
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    Thumbs up First POst

    Thanks for having me. My dad is 89 and currently in the hospital. He was admitted on 5/9 with a bad foot and leg infection which has subsided. His hemoglobin upon admit was 8.8 (he was recently diagnosed w/double lung cancer) and today, 5/14 it is 7.3. He has had 2 injections of EPO. The hospital wants to discharge him because he does not want a blood transfusion. The insurance company has said it will not pay after 5/12 because he has refused treatment (no blood) which is ridiculous. He is also diabetic. The hospital doctor and the va doctor are saying he should be discharged because he refuses blood. I am at wits end and am ready to call the ACLU in that I believe his rights are being violated. What do you think???

  7. #6
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    Have you asked the elders to get a hold of the local hospital liasion committee?

    Perhaps you could mention to the hospital that the Patient Self Determination Act passed by congress in 1990 says that patients have the right to consent to or to refuse medical treatment. He is not refusing medical care he will accept what is available that doesn't involve blood. I would mention this to the insurance company also. He has the constitutional right under freedom of religion as well as under patient self determination to refuse blood transfusions.

    I don't know how to file grievances or deal with insurance perhaps the liasion would know. What about people who refuse blood for personal reasons?

    The patient's bill of rights which hangs on the walls of hospitals includes the right to informed consent.

    The Consumer Bill of Rights and Responsibilities that was adopted by the US Advisory Commission on Consumer Protection and Quality in the Health Care Industry in 1998. states that: "You have the right to know your treatment options and take part in decisions about your care."

    "You have a right to considerate, respectful care from your doctors, health plan representatives, and other health care providers that does not discriminate against you."

    ACS :: The Patient's Bill of Rights

    http://mhcc.maryland.gov/consumerinf..._of_rights.htm

    I hope this helps.
    Last edited by anonymous2009; 05-16-2010 at 02:07 AM.

  8. #7
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    blood count, cancer

    Thanks for the response annonymous 2009. My dad is not a Witness so don't think the elders come into play here. The information you provided on the patient's bill of rights is very much appreciated. He has had two EPO injections and his hemoglobin has started to rise. Thanks again for taking the time to respond.

  9. #8
    Your experience with your Father is not unusual. I recently worked with a sister who was admitted to my hospital with a hemoglobin of 4. She had been feeling tired, and was experiencing mild shortness of breath. She thought she had an upper respiratory infection, and went to see her PCP. When the lab results came back (the next day), she was told to go to the emergency room ASAP. Further lab tests showed that she was severely iron deficient. She did spend three days in the hospital and was started on iron infusions, but once she was stable, insurance felt that she could continue her treatments on an outpatient basis. She was given specific instructions about any signs/symptoms she might experience that would indicate she needed to be readmitted. She was happy to go home. Treatments like iron infusions and Epo don't work immediately, so to expect insurance to pay for a stable patient to remain in the hospital to receive a once a day infusion is unrealistic in our current healthcare enviroment. Since your post said your Father's foot infection had responded to treatment, I'm sure he would be more comfortable sleeping in his own bed. It might be more of an inconvenience to have to transport him to a doctor's office or infusion center for treatment, but that's not really much of a concern for the insurance company.

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    Update

    Leslie - thank you for taking the time to share your experience. My dad is currently awaiting an MRI to determine whether he will lose one or more toes. Under normal circumstances, I would agree with you. However, the fact that my dad is 89 with COPD, lung cancer, and an insulin dependent diabetic for starters, warranted better care. Thanks again.

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