7.3 Hgb

[Jolly]

We are currently experiencing a nationwide blood shortage...Not quite as bad as a few months ago, but still bad. I'm going to do a 2 unit match this morning on a patient that's A) Greater than 80 years old, and B) has metastatic cancer.

As our convened Medical Ethics board, what say you?

[George K]

@jolly not enough info.

Metastatic cancer of what kind? Is the patient end-of-life, or not?
Functional status? GOMER'ed out lying in bed, or feeling punk after a 3 mile walk?
Comorbidities?
Cause of the anemia? Sudden or chronic?
Do you expect the transfusion to be therapeutic, or are you just treating a number?

[Jolly]

@george-k said in 7.3 Hgb:

@jolly not enough info.

Metastatic cancer of what kind? Is the patient end-of-life, or not?
Functional status? GOMER'ed out lying in bed, or feeling punk after a 3 mile walk?
Comorbidities?
Cause of the anemia? Sudden or chronic?
Do you expect the transfusion to be therapeutic, or are you just treating a number?

1. Don't know. All I have is the Admit DX, not the chart.
2. Mentally alert. Don't know if they could walk a quarter mile. Or even 100 yards.
3. Again, no clue.
4. I'm guessing chronic. MCV of 71 (microcytic) with marked hypochromia.
5. Knowing the doc, magic number.

[bachophile]

The country with the best medical infrastructure in the world has to rationalize giving some poor old guy with cancer two units of blood.

That’s very sad. Give him the fucking blood. And make a local blood donation drive.

I have to tell you that in all my years, I’ve certainly considered varied indications for giving blood. I don’t ever remember a blood bank shortage being a reason to deny someone who could benefit from it.

[Jolly]

@bachophile said in 7.3 Hgb:

The country with the best medical infrastructure in the world has to rationalize giving some poor old guy with cancer two units of blood.

That’s very sad. Give him the fucking blood. And make a local blood donation drive.

I have to tell you that in all my years, I’ve certainly considered varied indications for giving blood. I don’t ever remember a blood bank shortage being a reason to deny someone who could benefit from it.

First unit is hanging, but we have recently sat on some patients, simply because we have extremely low supplies. A couple of weeks ago, I walked down the hallway to tell a doc that the next step was for me to hang an incompatible unit, on his signature, because I didn't have a damn thing that would work, and couldn't get anything that day that would. So my best choice was to hang a Rh positive unit on a Rh negative patient, knowing I was going to sensitize him.