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Re: Post-operative H/H From: Glen Elrod MD (glen.elrod@elmendorf.af.mil) Sun Jul 13 02:04:54 2003 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Bernard Cristalli: "Re: Uterine Closure Post C/S" Previous message: Cheri Van Hoover: "Re: Experts on Shoulder Dystocia" In reply to: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Post-operative H/H" Next in thread: Joanne Bulley, MD: "Re: Post-operative H/H" There have been two good articles recently in the Green Journal out of Good Samaritan in Cincinnati and the Journal of Reproductive Medicine out of the Air Force Academy that looked at the utility of postop H/H. The green journal also projected potential health care dollar savings from not doing them "routinely." The gist of both articles is that routine H/H's don't give you much useful information. In all cases of women after major surgery that needed transfusion, there were physical signs or symptoms of blood loss that would have triggered the clinician to check an H/H and treat with blood (ie hypotension, tachycardia, light headedness, SOB) Based on these two studies, I don't routinely check H/Hs for major cases unless I lost a good amount of blood, or am concerned for oozing. To date, I haven't missed anyone that ultimately needed to be transfused in the immediate postop period. To extend this a little farther, I don't check H/Hs after uncomplicated vaginal deliveries either, for the same reasons. If there is an issue for the need for transfusion, the patient will be symptomatic. Besides, most pregnant women are already anemic so pretty much all of them could benefit from iron, do whether their hemoglobin goes from 10.2 to 9.0 after delivery doesn't change my management at all. Glen At Fri, 11 Jul 2003, Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. wrote: > >At Fri, 11 Jul 2003, Garry E. Siegel, M.D. wrote: >> >>After various surgeries, many of us may or may not get routine CBCs, or >>H/H's, etc. >> >>For instance, after a C/Section, Hysterectomy (any type), pretty much >>any laparotomy, and myomectomy, I'll check a H/H later in the day. >>However, I've seen some other docs who don't routinely do that. >> >>What do you guys do? >> >>Garry >> >>-- >>Garry E. Siegel, M.D. >>Private Practice >>Roswell, GA >> >Garry we have routine post-op orders for all our cases, majors get CBC >the >next day. But if I do a difficult Hyst, section etc , and I am concerned >about hemotoma or further blood loss I will order a separate CBC for >about >6 hrs post-op. > >-- > Take care, John > -- D. Glen Elrod, Maj, USAF, MC Medical Director Women's Health Center Elmendorf AFB, AK 99506 Next message: Bernard Cristalli: "Re: Uterine Closure Post C/S" Previous message: Cheri Van Hoover: "Re: Experts on Shoulder Dystocia" In reply to: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C.: "Re: Post-operative H/H" Next in thread: Joanne Bulley, MD: "Re: Post-operative H/H"

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