It never fails, you’re looking forward to a long weekend and you receive a new low hemoglobin on a patient. Or it’s a Monday morning and the first lab you look at shows a new low hemoglobin. These always make me stop and take notice as something has to be done. The best thing to have in these circumstances is a standardized checklist of questions to ask the patient. I usually use the module on clinicinfo to send the patient a quick note to contact the office. If I’m not using clinicinfo then I’ll as my secretary to give the patient a quick call and ask the following questions. Now, please know that I am initially assuming that the low hemoglobin is due to blood loss as I need to rule this out first.
The questions I typically ask are as follows:
Preamble: On a recent test your hemoglobin was lower than normal or than expected. Hemoglobin is found inside red blood cells and is important in carrying oxygen to your body. A low hemoglobin may make you feel weak, tired, lightheaded or short of breath. There are many causes for a low hemoglobin. The most common cause is blood loss.
I would ask the patient the following questions:
- Recent surgery (this happens more often than you would think)?
- Bleeding from the bowels (blood noticed in toilet or on stool)?
- Black or tarry looking stool?
- Coughing up or vomiting blood?
- Severe nosebleeds?
- Blood in the urine?
- Heavy menstrual periods (women)?
- Any new medications?
- Any other changes to your health?
If you feel chest pain or heaviness, shortness of breath, or lightheadedness please call 911 or go to the closest emergency department.