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Hello,
This post is in regards to a recent case that I had flown with. Im a flight medic and figured this would be the best place to get these questions answered, I appreciate the replies in advance. My question is how much a paediatrics Hgb and HCT can be raised with 1 unit 272ml O NEG? I know an adult Hgb can be raised 1, 2 and even 3 grams per deca litre in cases post one unit infusion. Id like to find out the limit for a paediatric. Ill lay the case out below and what I had toggled around with.
24 kg Pt sustained penetrating trauma 7 hrs prior. Had received maintenance fluid at a clinic 500ml total over 7 hrs. Hgb trend on hema Q heel stick at clinic was 107 115 95
Istat portable lab = Venous draw @ 7 hrs by flight team. Hgb 5.1g/dL HCT 15 %
Estimated blood volume 75mg/kg = 1800ml
Estimated blood loss 850ml
Estimated circulatory volume 950ml
A transfusion at 4ml/kg should bring a paediatrics value up 1g/dL.
272ml of O Neg was given which would amount to 11.3 ml/kg. Roughly bringing up the value to a minimum of 3g/dL at the minimum, and the HCT up a minimum of 9%.
Upon arrival to the ER 4 hrs post O Neg administration, a venous draw was done via hospital lab with a value of 11.3g/dL and HCT 35%.
A comparison was done with the hospital lab and the istat on a volunteer resident in the ER to check values, with a hospital value of 16.1g/dL and the Istat value of 15.3g/dL.
During the flight down the Pt had received additional fluids of Nacl total 1250ml. Dilutional values should be a decrease in Hgb of 1.57g/dl and 3.6% HCT for that amount of fluid given.
With the differential in the lab values of the hospital and the Istat being 0.8g/dL (16.1g/dL to the Istats 15.3)
The end result should match up to 11.8g/dL value with account for fluid dilution which would be a close match to their 11.3g/dL value? Correct?
Also following a formula of PRBC's to be infused of:
Desired HCT - Current HCT x Estimated Blood Volume, divided by the HCT in PRBC's which is 60% to 70%
35 % (The hospitals HCT value upon arrival) - 15% (IStat value pre O Neg administration) x EBV 950ml
divided by 70% (HCT in the unit of O Neg)
The outcome is 271.42 ml which is what was given, to obtain a desired HCT of 35% which is what the value was on arrival with the hospital venous draw.
Is this possible and does this make sense?
Thank you I look forward to your response.
This post is in regards to a recent case that I had flown with. Im a flight medic and figured this would be the best place to get these questions answered, I appreciate the replies in advance. My question is how much a paediatrics Hgb and HCT can be raised with 1 unit 272ml O NEG? I know an adult Hgb can be raised 1, 2 and even 3 grams per deca litre in cases post one unit infusion. Id like to find out the limit for a paediatric. Ill lay the case out below and what I had toggled around with.
24 kg Pt sustained penetrating trauma 7 hrs prior. Had received maintenance fluid at a clinic 500ml total over 7 hrs. Hgb trend on hema Q heel stick at clinic was 107 115 95
Istat portable lab = Venous draw @ 7 hrs by flight team. Hgb 5.1g/dL HCT 15 %
Estimated blood volume 75mg/kg = 1800ml
Estimated blood loss 850ml
Estimated circulatory volume 950ml
A transfusion at 4ml/kg should bring a paediatrics value up 1g/dL.
272ml of O Neg was given which would amount to 11.3 ml/kg. Roughly bringing up the value to a minimum of 3g/dL at the minimum, and the HCT up a minimum of 9%.
Upon arrival to the ER 4 hrs post O Neg administration, a venous draw was done via hospital lab with a value of 11.3g/dL and HCT 35%.
A comparison was done with the hospital lab and the istat on a volunteer resident in the ER to check values, with a hospital value of 16.1g/dL and the Istat value of 15.3g/dL.
During the flight down the Pt had received additional fluids of Nacl total 1250ml. Dilutional values should be a decrease in Hgb of 1.57g/dl and 3.6% HCT for that amount of fluid given.
With the differential in the lab values of the hospital and the Istat being 0.8g/dL (16.1g/dL to the Istats 15.3)
The end result should match up to 11.8g/dL value with account for fluid dilution which would be a close match to their 11.3g/dL value? Correct?
Also following a formula of PRBC's to be infused of:
Desired HCT - Current HCT x Estimated Blood Volume, divided by the HCT in PRBC's which is 60% to 70%
35 % (The hospitals HCT value upon arrival) - 15% (IStat value pre O Neg administration) x EBV 950ml
divided by 70% (HCT in the unit of O Neg)
The outcome is 271.42 ml which is what was given, to obtain a desired HCT of 35% which is what the value was on arrival with the hospital venous draw.
Is this possible and does this make sense?
Thank you I look forward to your response.
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