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Elora Thorpe RN · #3 (**permalink**) 08-30-2004, 11:26 AM

Gail:
We always have dilutional anemia unless the physician uses colloids and not crystalloids which usually does not happen. We just know that as long as it is not a large amount that it doesn't change what the hemoglobin really is. In other words if it is 9.0, it is 9.0 even though there is a large amount of fluid in it that is telling you the hgb is 8.0 or 7.0. The fluid does not change the red cell (RBC)count even when the RBC's have much fluid around them. The oxygenation of the patient also does not change unless there is just a large amount of fluid and the patient is fluid overloaded. Remember during anemia in the normal person, when the hgb drops the body automatically compensates by dumping more fluid into the vascular system thus changing the viscosity of the blood by making it less thick and that causes your RBC's to go to the microcirculation even faster thus oxygenating your patient even thought the hemoglobin is low. This is a good thing as long as it is not too much. Our cardiac surgeons are the ones most concerned about fluid overload and they are also the best when it comes to not having a large dilutional anemia post surgery. We wait until after the patient starts to diurese and as long as there is no cardiac problems or renal problems to prevent the diuiresis then we let it go.