Case 9 (9/29/2013): Subsequent Patient Management

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… This 30 year-old obstetrical patient was admitted for labor at 38 4/7 weeks. The admission hemoglobin is 10.0 gm/dL (MCV 77 Fl). Three months prior to admission the hematocrit was 32% with MCV 84 fL. Twins were delivered 3 hours 44 minutes post-admission, with 1,500 mL v 1,900 mL estimated blood loss. The post-delivery hemoglobin, 4 hours 50 minutes post-admission, is 6.3 gm/dL.

The patient received back-to-back PRBC transfusions 6:02 and 6:13 hours post-admission, 47 and 58 minutes post-op. Both units were transfused within 18 minutes. The post-transfusion hemoglobin levels are 7.3, 6.3, 6.2 and 7.0 gm/dL at 10:28, 22:35, 34:08 and 63:54 hours post-admission. The patient received Venofer 200 mg IV x1, 16:57 hours post-admission. The patient was discharged 93:42 hours post admission (length of stay 3.9 days).

Could this patient have been differently managed?