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Dr. Anil Kumar
Dr. Anil Kumar, General Physician
Category: Health
Satisfied Customers: 6609
Experience:  M.D. with over 30 years of experience in practice.
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My father is 92 and broke his hip a little over two weeks ago.

Resolved Question:

My father is 92 and broke his hip a little over two weeks ago. He is now in a nursing home/rehab facility. His hemoglobin at the time of discharge from the hospital was 9.0. He did not receive any blood during surgery or his hospital stay. The facility called yesterday to tell us his hemoglobin has now dropped to 7.0 and he needs a blood transfusion.
Coincidently he is retaining fluid, is about 15 pounds over his normal weight, and just yesterday also they increased his lasix to help get the fluid off. Could the 2 gram drop in hemoglobin be due to the fluid overload and increased plasma? Is it of sufficient concern to ask for a recheck of his HH before getting the transfusion? Within the past few months he was started on iron and Vit. B12 shots due to some anemia, but nothing as low as 7.0.
Submitted: 1 year ago.
Category: Health
Expert:  Dr. Anil Kumar replied 1 year ago.
Hello,
Is he having severe pain now?
Any blood in stool,urine?
Any other investigations so far?
Any other medical history?
Is he taking any other medications?

Thanks.
Customer: replied 1 year ago.

He is not in pain. No diagnosed blood in stool or urine. He also has had some thrombocytopenia the last 10 years or so. Platelet count runs 110-130 on past CBC's. Got down to 90,000 this last hospital admission. He has an enlarged heart. Has a pacemaker. Is on coumadin post surgery. I do not have his meds list with me as I am at work. Takes a couple of heart pills, lasix. Has NOT been diagnosed with heart or renal failure or CHF. Has been healthy most of his life. Also on some blood pressure medication, very low dose.

Expert:  Dr. Anil Kumar replied 1 year ago.

Hello,

Thanks for providing more information.

Firstly sorry to hear about your father's discomfort.

And as his hemoglobin is going down so possibly it can be caused due to fluid overload as Fluid overload (hypervolemia) causes decreased hemoglobin concentration and apparent anemia.

However this reduction in haemoglobin shouldn't be ignored and it should be treated promptly as it can cause complications like Heart/Renal failure if fluid retention persists.

So either iron supplementation or blood transfusion should be done.

Also his serum electrolytes,repeat CBC should be advised before blood transfusion.

I understand your concern however it's good to see him to his doctor again for a clinical correlation of his blood work findings with his current conditions.




I hope this helps.

If you have any further query then feel free to ask.


Positive feedback and bonus are highly appreciated.

Thank you.



 



 



 

Customer: replied 1 year ago.


Thank you. His regular doctor is also his nursing home/rehab physician so it is good that she knows his history. He is scheduled for transfusion today so I wanted to be certain my concerns about the fluid retention and hemoglobin correlations are valid. The fluid is coming off so I am going to request they recheck his CBC this morning. In your experience do you think the 2.0 grams could be accounted for by an additional 15 pounds of fluid for a man that normally weighs 190 pounds?

Expert:  Dr. Anil Kumar replied 1 year ago.

Hello,

Thanks for the follow-up.

Well it's good to recheck CBC again before blood transfusion.

And it may be possible to have such reduction of hemoglobin with 15 pounds of fluid overload.

Your doctor should also check hematocrit,platelet count as well.

Further a clinical correlation between other blood work findings like MCV,MCHC,MCH help in detecting the type of anemia.

So a proper detailed correlation may be required in his case to rule out the cause of anemia in his case.

I hope this helps.

 

If you have any further query then feel free to ask.
Positive feedback and bonus are highly appreciated.

Thank you.

 

Dr. Anil Kumar, General Physician
Category: Health
Satisfied Customers: 6609
Experience: M.D. with over 30 years of experience in practice.
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