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Dr. Andrew Rynne

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Total knee replacement surgery done and have low haemoglobin. What should be done?

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Dr. Anantharamakrishnan

Cardiologist

Practicing since :1966

Answered : 4506 Questions

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Posted on Wed, 12 Dec 2012 in Bones, Muscles and Joints
Question: My Dad underwent a total knee replacement surgery last saturday on 17th. He is still in Hospital but now out of ICU. Over last few days of his recovery, his haemoglobin is coming down regularly . His haemoglobin reading on 18th was 9.5gm/DL, on 19th it was 8.0,on 21st it was 7.8 and on today (22nd) it is 7.6 . With Haemoglobin going down on a daily basis, doctor told me he will transfuse one bottle of blood today and that it will move haemoglobin up by 1 gm/DL which will make it around 9mg/DL while as per my understanding it should be somewhere around 12 and then he says rest of the moving up of Haemoglobin can be taken care in natural way with proper food and recovery process.. He is 73 years old male. Should i be ok with this or should i be concerned enough not to take discharge from the hospital till he gets his haemoglobin level proper?
doctor
Answered by Dr. Anantharamakrishnan 2 hours later
Hi friend,
Welcome to Health Care Magic

     Yes, you should go ahead and give Packed Cell Transfusion (whole blood is occasionally given).

     No, it is not good to get him discharged as of now – lowering haemoglobin means blood loss. He needs more investigations to see why this is happening. He should stay in the hospital, until 2 or more consecutive values are steady – confirming there is no further fall. It is risky to go home.

     His haemoglobin is now around 50% only / he need more than one unit – probably 3 or more units, to elevate to a comfortable level.

Take care
Wishing speedy recovery
God bless
Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anantharamakrishnan 1 hour later
Just now, got stool test result of My Father and it seems blood is coming out of Stool and that may be the reason of low count of Haemoglobin.
Doctor says he will give some tablets which will stop this blood flow from Stool but now he says there is no need of Blood transfusion .

My questions are:-

1) Stopping blood flow through stool will only prevent further drop of Haemoglobin but will Haemoglobin automatically shoot up without further blood transfusion?

2) Should we still demand blood transfusion or just wait for 2 or more days of steady Haemoglobin reports ?

3) If haemoglobin has to shoot up, how much time it would take provided we take care of iron XXXXXXX food and nutrition level?
doctor
Answered by Dr. Anantharamakrishnan 29 minutes later
Hi Mr XXXXXXX

The commonest cause in such situations is bleeding from the gut – mostly from anti-inflammatory drugs given for pain relief.

It may take some time for the oozing to stop. Haemoglobin will not fall further, if the bleeding stops.

     It is better to have transfusion – especially in view of his age. If he has any further fall, it may not be safe and may cause breathlessness, failure and so on.
The condition may become critical, if there is a sudden and severe bout of bleeding.

Haemoglobin will slowly and steadily rise - but it will take time to come up – not more than approximately 1% daily – in spite of the best treatment and diet.

Regards
All the best

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Anantharamakrishnan 2 hours later
They are against blood,don't know the reason but they have prescribed zentel 400mg and fefol-2 cap. Is this medication enough? Do I need to protest for blood transfusion?
doctor
Answered by Dr. Anantharamakrishnan 8 hours later
Hi

They only advised blood initially and subsequently they are not inclined...They should have a reason – source of bleeding stopped, very stable state, danger of allergy or antibodies and so on The treating physician facing the situation is best suited to advise. Keep regular follow up.

Zentel is to de-worm / Fefol is Iron and Folic acid
This medication is enough.

Good luck

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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