CRNA student with a blood transfusion question

[Jacads]

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I know the formulas for figuring out the Hgb drop to transfuse for a predetermined Hgb drop, and texts also utilize the 20% loss from the EBV. I was talking to my CRNA preceptor the other day and he stated he had a post C-section that lost around 2000cc's of blood and he went ahead and transfused. He stated he was talking to the anesthesiologist and he stated that only time a transfusion is warranted (from a board testing standpoint) is when a patient cannot maintain there O2 saturation with their current hemoglobin level (I am referring to a low hemoglobin level causing the sat drops and not another reason). I cannot find this in any text and all texts will give you different "parameters" and I don't know of any particular hospital policies at any clinical site I have been at. Can someone clarify this for me I know it depends on the patient and what is going on but is a dropping sat really the only true reason to give blood? If so can you give me a reference.


Thanks,

Jacads

 

[Noyac]

I know the formulas for figuring out the Hgb drop to transfuse for a predetermined Hgb drop, and texts also utilize the 20% loss from the EBV. I was talking to my CRNA preceptor the other day and he stated he had a post C-section that lost around 2000cc's of blood and he went ahead and transfused. He stated he was talking to the anesthesiologist and he stated that only time a transfusion is warranted (from a board testing standpoint) is when a patient cannot maintain there O2 saturation with their current hemoglobin level (I am referring to a low hemoglobin level causing the sat drops and not another reason). I cannot find this in any text and all texts will give you different "parameters" and I don't know of any particular hospital policies at any clinical site I have been at. Can someone clarify this for me I know it depends on the patient and what is going on but is a dropping sat really the only true reason to give blood? If so can you give me a reference.


Thanks,

Jacads

I can't (without really stretching things) imagine a person healthy enough to have a child needing a transfusion with a 2000ml blood loss. There are so many physiologic aspects of pregnancy that come into play here that 2000ml is not enough to concern me unless the pt was extremely anemic to start. You better find another reason for the drop in pulse ox. How much did it drop? From 99% to 90%? So what. 90% to 85%? So what. You better find something else, cause that ain't it.

 

[Tenesma]

your CRNA preceptor is full of crap and probably never spoke w/ an attending - that is why SRNAs should spend time w/ physicians who understand physiology.

There is no link between O2 saturation and hemoglobin level.... except of course if your hemoglobin is close to ZERO in which case the pulse Ox won't be able to detect a pulsatile flow 🙂 O2 saturation measures the amount of oxygenated hemoglobin vs deoxygenated hemoglobin and provides a saturation percentage of the hemoglobin. That would be true for a hemoglobin of 6 or a hemoglobin of 18....

Transfusion indications are well documented in the literature (just go look at the most recent NEJM articles (www.nejm.org) or go to pubmed.com).... the primary reason to transfuse blood is evidence of hemodynamic instability (ie: you are on 25 of levophed and the patient just pooped out 3 liters of blood) - the secondary reason is evidence of end-organ damage (ie: cardiac or cerebrovascular ischemia) that could be attributed to anemia.

Now on a different approach there is a link between saturation and oxygen carrying capacity of blood --- but not as it relates to your original question

 

[Amik25]

your CRNA preceptor is full of crap and probably never spoke w/ an attending - that is why SRNAs should spend time w/ physicians who understand physiology.

There is no link between O2 saturation and hemoglobin level.... except of course if your hemoglobin is close to ZERO in which case the pulse Ox won't be able to detect a pulsatile flow 🙂 O2 saturation measures the amount of oxygenated hemoglobin vs deoxygenated hemoglobin and provides a saturation percentage of the hemoglobin. That would be true for a hemoglobin of 6 or a hemoglobin of 18....

Transfusion indications are well documented in the literature (just go look at the most recent NEJM articles (www.nejm.org) or go to pubmed.com).... the primary reason to transfuse blood is evidence of hemodynamic instability (ie: you are on 25 of levophed and the patient just pooped out 3 liters of blood) - the secondary reason is evidence of end-organ damage (ie: cardiac or cerebrovascular ischemia) that could be attributed to anemia.

Now on a different approach there is a link between saturation and oxygen carrying capacity of blood --- but not as it relates to your original question

From what I gathered, it was the attending anesthesiologist who stated that the only indication to transfuse was a drop in your oxygen saturation.

 

[Tenesma]

1) the fact that the CRNA preceptor bought that bs from an "attending" reveals that preceptors limitations when it comes to the basics of physiology...

2) i seriously believe the CRNA preceptor just made up the fact that an "attending" passed this information on...

3) if an "attending" did make that statement he should be disboarded immediatelY!!!

 

[thegasman]

Replace oxygen "saturation" with oxygen delivery or oxygen delivery relative to the patient's oxygen demand and maybe this is what the attending said or meant. Most likely your crna misunderstood the concept (could it have been over his/her head?)

 

[jetproppilot]

your CRNA preceptor is full of crap and probably never spoke w/ an attending - that is why SRNAs should spend time w/ physicians who understand physiology.

There is no link between O2 saturation and hemoglobin level.... except of course if your hemoglobin is close to ZERO in which case the pulse Ox won't be able to detect a pulsatile flow 🙂 O2 saturation measures the amount of oxygenated hemoglobin vs deoxygenated hemoglobin and provides a saturation percentage of the hemoglobin. That would be true for a hemoglobin of 6 or a hemoglobin of 18....

Transfusion indications are well documented in the literature (just go look at the most recent NEJM articles (www.nejm.org) or go to pubmed.com).... the primary reason to transfuse blood is evidence of hemodynamic instability (ie: you are on 25 of levophed and the patient just pooped out 3 liters of blood) - the secondary reason is evidence of end-organ damage (ie: cardiac or cerebrovascular ischemia) that could be attributed to anemia.

Now on a different approach there is a link between saturation and oxygen carrying capacity of blood --- but not as it relates to your original question

Nice, nice explanation.

 

[militarymd]

Just read this

 

[stephend7799]

I know the formulas for figuring out the Hgb drop to transfuse for a predetermined Hgb drop, and texts also utilize the 20% loss from the EBV. I was talking to my CRNA preceptor the other day and he stated he had a post C-section that lost around 2000cc's of blood and he went ahead and transfused. He stated he was talking to the anesthesiologist and he stated that only time a transfusion is warranted (from a board testing standpoint) is when a patient cannot maintain there O2 saturation with their current hemoglobin level (I am referring to a low hemoglobin level causing the sat drops and not another reason). I cannot find this in any text and all texts will give you different "parameters" and I don't know of any particular hospital policies at any clinical site I have been at. Can someone clarify this for me I know it depends on the patient and what is going on but is a dropping sat really the only true reason to give blood? If so can you give me a reference.


Thanks,

Jacads

go to all nursing and ask the nurses there.. they know just as much as we do.. so go ask them ... this thread will be detrioratioing soon im sure

 

[Dr. J?]

go to all nursing and ask the nurses there.. they know just as much as we do.. so go ask them ... this thread will be detrioratioing soon im sure

Only b/c of insecure posts like this....

Look the s hit storm doesn't need any help. Jacads asked a pretty straight forward question w/o any pretension and he was receiving pretty straight forward responses. The guy was doing what he should be doing - looking to deepen his understanding of physiology for the future benefit of his pts. So, cut with the BS.

 

[stephend7799]

Only b/c of insecure posts like this....

Look the s hit storm doesn't need any help. Jacads asked a pretty straight forward question w/o any pretension and he was receiving pretty straight forward responses. The guy was doing what he should be doing - looking to deepen his understanding of physiology for the future benefit of his pts. So, cut with the BS.

well he needs to obtain his knowledge from crnas at allnursing.com

 

[Noyac]

well he needs to obtain his knowledge from crnas at allnursing.com

Well then you need to obtain your knowledge from pricks at allpricks.com 😴

 

[BIS]

well he needs to obtain his knowledge from crnas at allnursing.com

Got Millitant?

 

[underdog27]

Well then you need to obtain your knowledge from pricks at allpricks.com 😴

LMAO!!!!!!!!

 

[Idiopathic]

Well then you need to obtain your knowledge from pricks at allpricks.com 😴

Post of the year.

 

[canjosh]

go to all nursing and ask the nurses there.. they know just as much as we do.. so go ask them ... this thread will be detrioratioing soon im sure

Not sure what d e t r i o r a t o i n g means, but yes, I'm sure this thread will do just that...starting with your post.

 

[Jacads]

I am going to clarify this question with hime when he gets back off of vacation he might have stated oxygen delivery it was about a week ago that he told me this and I havn't been able to find it in any references. It was just something I had never heard mentioned before and the way it was told to me was that it's not a real life reason but a "board question/rationale" thanks for the advice I have received so far. I have to comment that all the anesthesiologists I have run into in practice are not as anti CRNA as I have some on this board they are very helpful and really assist in guiding my clinical education and asking clinical questions but in a relevant capacity not because they know I don't know the answer and they want to be a dick. I believe the CRNA makes the anesthesiologist job easier in a lot of aspects and I would hope more profitable.

Thanks,

Jacads

Replace oxygen "saturation" with oxygen delivery or oxygen delivery relative to the patient's oxygen demand and maybe this is what the attending said or meant. Most likely your crna misunderstood the concept (could it have been over his/her head?)

 

[florida]

The attending was probably referring to the mixed venous oxygen saturation (SvO2).

 

[Tenesma]

florida (while you are factually correct) i doubt it... do we measure SVO2 on everybody?? absolutely not...