When I was a resident I saw a really low hemoglobin. I don't remember what the number was but I remember the circumstances. I was working the ER at Riley Children's hospital and EMS pulled up with a infant who was short of breath. The family had been feeding him cows milk instead of formula and as a result he had
severe iron deficiency anemia. Great case and after a few transfusions and some parental education, everyone lived happily ever after.
Last week I saw another lowest hemoglobin. Since I wasn't blogging when I was a resident I don't know if this hemoglobin is lower than that poor kid but here it is:
Hemoglobin of 3.6 g/dL. The hematocrit is still a double digit number, but still that's a really low hemoglobin.
This is a dialysis patient who started having some vomiting that looked a little "dark" but didn't really bother him. A day or so later he developed some dark colored diarrhea. Still didn't bother him. Then he found himself short of breath, like he missed a treatment and got volume overloaded. This kept getting worse so he finally decided to get in his car and drive to the ER. The admitting hemoglobin was 3.7 followed by a repeat by I'm sure a disbelieving ER doc.
Diagnosis duodenal ulcer and after a half dozen transfusions and a prescription for BID omeprazole he was discharged home to lived happily ever after.
