Get all the information on anemia documentation
I’m just sticking my foot into a wicked pile of super sticky unknown substance by bringing this topic of ‘acute blood loss anemia’ back up. But there’s been so much back and forth with our own ACDIS Advisory Board to iron out the details published in this week’s CDI Strategies, that I was quite surprised when one of our readers e-mailed shortly after publication to ask another question based on the brief.
Another question? I thought we couldn’t possibly write anything more on the topic! Well, I was wrong. Our friend from Washington, DC, asked: “If ‘precipitous drop in hematocrit’ is documented, must the baseline be known? What are the parameters and is it facility specific?”
So I’m throwing the whole thing out here to blog land. Please help me by posting any (and all) information you might have regarding how you approach physicians with queries for anemia.
About the Author: Melissa Varnavas, CPC, ACDIS associate director, editor for CDI Strategies, CDI Journal. She has several writing awards from various newsletter and newspaper organizations.
Laurie Prescott, RN, MSN | Sep 4, 2009 | Reply
Querying for anemia requires some thought- I do not always depend upon a baseline Hct to precipitate a query. I usually will use a Hgb if available. Post-operative anemia is the easiest as in most cases you will have a baseline pre-op Hgb to compare to the post-operative hgb. You will also have a documented EBL in your operative report or anesthesia record.
When a patient is admitted with a low hgb and there is no baseline to compare I will query for the anemia and etiology by pulling from the fact we are monitoring the hgb/hct, obviously if a transfusion is ordered this helps. I pull from any evidence of blood loss- hematuria, GI, etc. The CBC results offer other clues- if you have a microcytic anemia (low MCV) you are most likely dealing with chronic blood loss.
Looking at the MCH will also offer clues as to the type of anemia you are dealing with. A macrocytic (high MCH)is usually due to a dietary deficiency, possible alcoholism, pernicious anemias. A normocytic and normochromic anemia could tell you it is a an acute anemia. Of course you need to also take into account other complaints of patient.
I guess what I am saying is that you need to not only look at the HCt/Hgb to decide to query. You need to assess the CBC results with consideration as to patient complaints and presentation. A precipitous drop in Hgb does not always lend to blood loss anemia. If the patient was severely dehydrated on admission your numbers will drop (sometimes drastically) with hydration. This does not necessarily mean you have an acute blood loss. The hydration might reveal a chronic state of anemia.
Sorry if this is a long answer. You are right it is complicated and requires thought. I struggle with this one especially with the surgeons- and this should be the easiest to interpret. I appreciate your explanation in the original post related to complication of surgery it is worded well and I plan to use this information to reiterate with my surgeons.