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Jan B. Wade · #5 (**permalink**) 03-07-2005, 04:51 AM

When asking for a protocol the doctor probably wants a series of 'what to do next' steps. These will need to go through committee and then adopted by the medical staff.

Also - The protocol should include pre-delivery patients with "low" hgb levels.

When opening this issue the hospital will need to examine current post partum protocols. In other words, your MD's or mid-wives are already treating anemia orally. They are also using RBC's. The oral treatment may fit in some cases. You are replacing the use of RBC's so - what is the current trigger for using those? etc.

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The protocol should spring from a policy stating the hospitals intent to treat anemic pre-delivery and post partum patients.

ie - XYZ medical center recognizes the benefits of treating anemia in pre-delivery and post partum patients. XYZ recognizes the benefits of avoiding banked blood whenever possible. (If your hospital is in the mood to mention JW patients this is a good place to insert appropriate language - Realizing JW patients refuse blood a protocol is needed to use appropriate non-blood management etc)

(next identify the condition or hgb level that will trigger the protocol)

Any patient with a pre-delivery hgb of X (10?) will be treated pre-delivery using the protocol

Any patient with a post-delivery hgb of X (9? 8?) will be treated using the protocol

(then outline the protocol)

For cases of "moderate" anemia (X hgb)

-xxx mg of po iron daily
- x mg of folic acid po daily
- xxx mg vit C deep Sub Q daily
- xxxx micrograms Vit B12 deep sub Q 1 time

For severe (hgb of x or below)

- xxx ferros gluconate IV
- xxxxx units of EPO
- x mg of folic acid po daily
- xxx mg vit C deep Sub Q daily
- xxxx micrograms Vit B12 deep sub Q 1 time

Until target hgb acheived

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The discovery process of your anemia protocol committee is vital. It will raise the bar in the hospital. The process creates advocates for alternatives to blood.

Hope this helps you.