Case 9 (9/29/2013): Case Management Commentary

Click this link to download the case file from box.net:https://app.box.com/s/nspnar642z408d7nline
…Case 9 is a 30 year-old obstetrical patient admitted for labor at 38 4/7 weeks with twin pregnancy.

You must download the file after opening the link in box.com, or you will not be able to easily see all of the information in the file. This case management commentary follows the initial patient presentation posted (9/29/2013) and includes commentary about blood management in this patient. If you encounter a problem with the box download, notify me at djadwin@columbia-analytics.com. This material is Copyright © 2013 by Columbia Healthcare Analytics, Inc. and may not be used for other purpose without written permission.

You may assume that information not listed in the patient case sheet is either not recorded or not significant.

Objective data includes:

R 13 (0:50 hours post-admission): Hemoglobin 10.0 gm/dL and microcytic (iron deficiency) indices (77 fL). Ninety days prior to admission the patient’s hematocrit was 32%, indicating anemia with MCV 84 fL. Note that the MCV dropped 7 units in 3 months.

R 17 (3:44 hours): Twin infants delivered with placental abruption and EBL 1,500 mL (anesthesia) v 1,900 mL (obstetrical report). The vital recordings on the anesthesia record (not listed in the case sheet) are sparse, but BPs is between 90 and 80, pulse 80 to 95 and BPd generally 60.

R 18 (4:50 hours): Post-delivery hemoglobin 6.3 gm/dL and MCV 79 fL.

R 20 (5:15 hours): Blood pressure 173/84, pulse 84/minute.

R 27 (6:02 hours): Transfusion start, PRBC #1

R 30 (6:11 hours): Transfusion stop, PRBC #1

R 32 (6:13 hours): Transfusion start, PRBC #2

R 34 (6:20 hours): Transfusion stop, PRBC #2

R 36 (10:28 hours): Post-transfusion hemoglobin 7.3 gm/dL, MCV 78 fL

R 38 (16:57 hours): Patient received IV iron 200 mg (solitary dose)

R 39 (22:35 hours): Hemoglobin 6.3 gm/dL

R 40 (34:08 hours): Hemoglobin 6.2 gm/dL

R 41 (48:40 hours): Oral iron 325 mg initial dose

R 42, 44, 45: Oral iron 325 mg (61:58, 74:39 and 85:08 hours post-admission)

R 46: Patient discharged (Length of stay 3.9 days)

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