CBC – Hemoglobin Drop

ABCs and Vitals

  • If unstable, call for assistance
  • Repeat urgent CBC and compare with prior
  • Ensure sample is collected in an EDTA tube

HPI

  • Symptoms: Chest tightness, SOB, fatigue
  • Bleeding signs: Melena, hematemesis, PR bleeding, heavy menses, hematuria
  • Appearance: Pale, jaundiced, dark urine, pale stool
  • Bleeding/bruising: Purpura, mucosal bleeding, ecchymoses, joint bleeds
  • Medical history: Known anemia, GI disease, thyroid/liver/renal issues
  • Diet: Veganism, alcohol use
  • Medications: Antiplatelets, anticoagulants, NSAIDs

EXAMINATION

  • Look for pallor, jaundice, ecchymosis, purpura, hematomas
  • Check for hepatosplenomegaly
  • Perform PR exam → inspect for melena or blood
  • If Foley present → check for hematuria

MANAGEMENT

If Hypotensive

  • Administer 1 pint of Normal Saline

If No Active Bleeding

  • Cross-match and reserve 2 PRBCs
    • Maintain Hb >7 g/dL (or >8 g/dL in CVD)

Suspected GI Bleed

  • Start IV PPI (Losec)
    • 80 mg IV stat → then 40 mg IV BID (or infusion 8 mg/hr)

Before Transfusion

  • Send full anemia and hemolysis workup
  • Ask about prior transfusion reactions
CategoryInvestigations
Anemia PanelCBC, blood film, iron profile, vitamin B12, folate
HemolysisReticulocyte count, DAT, LDH, haptoglobin, LFT
Bleeding SourceStool OB (occult blood), PR exam, urine R/M if hematuria unclear

Ongoing Monitoring

  • Monitor stool for melena or occult blood
  • Monitor urine for hematuria if catheterized
  • Repeat CBC after transfusion
  • Treat underlying cause once confirmed (e.g., iron, B12, chronic disease)
MOC