Blood is thicker than water

When I started my shift yesterday, the first patient I examined was a 12 hour-old infant with low blood sugars, irritability and a hematocrit of 71 (normal is around 50 for a newborn). My immediate thought was that the child needed to have a procedure to thin his blood so he does not have a stroke (among other complications).

When I spoke with the staff, I was told that the protocol was to thin blood for greater than 75 and that he was not a candidate. I was trained that a symptomatic infant with a level greater than 65 needs intervention, but I did not rock the boat and just observed the baby.

Throughout the day, he did not improve either clinically or with his laboratory values. Finally, at 8PM, I made the executive decision that he needed his blood thinned.

As I was filling out the consent form, I wrote that there were potential complications of bleeding, infection, thrombosis or vein rupture. A nurse looked over my shoulder and said, “Oh no, you can’t tell the parents that, they will never want to do it. Just tell them what you are going to do.”

I just said, “If I am going to get informed consent, they should be informed before they consent. I will not hide the potential complications.”

The nurse smiled and said “good luck”.

After a 30 minute conversation with the parents, they hesitantly agreed. The nurse was correct that I would scare them, but I was willing to take the chance.

I placed a large IV in the umbilical vein and over an hour we slowly took 65ml of blood out and replaced it with fluid.

The moment we finished, the patient had a hematocrit of 56 and was completely better.

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