2 week post-op: Hemoglobin, hematocrit, RBC remain depressed

tjay · Aug 6, 2024

I had never had any issue with Hemoglobin, Hematocrit and RBC before surgery in my the entire life. Normal range all along. Even 5 days before surgery these numbers were normal. But they remain very depressed since surgery. Anyone else experienced this post op?

I got mechanical (On-X) valve 2 weeks ago for your reference.

Surgery team looked for any internal bleeding but to no avail. Now I’m referred to a Hematologist..

Let me know if anyone has any leads or experience to this regard. I can also send exact numbers if necessary.

Thanks

pellicle · Aug 6, 2024

I understood that this takes a while to balance out ... IIRC I had lower red count at first after surgery, however nothing so substantial as to warrant a haematologist ...

I hope the bumpy landing smooths out in the coming months.

Best Wishes

tjay · Aug 6, 2024

Essentially that's what the Hematologist also said. But perhaps my numbers were far too low to prompt a consultation:

Hemoglobin: 7.9 g/dL (Standard Range: 13.5 - 17.7 )
RBC: 2.79 MIL/uL (Standard Range: 4.40 - 5.90)
Hematocrit: 25.1% (Standard Range: 40 - 52%)

I wonder how low others had been right after the surgery (and were stuck there for days)

Hematologist is going to give me a boost of Iron thru IV. She thinks that's the culprit.

Good thing is that she looked at my RBC under the microscope to rule out the possibility that my new valve itself may be causing this damage

Any pertaining experience, please share.
thanks

3mm · Aug 6, 2024

I'm sorry about your issues, but you will overcome them! Be patient, keep walking, etc.

When I had endocarditis 18 months ago my hemoglobin got down to 8.1 so they gave me an IV of iron. It took several hours, so it is worth using the bathroom just before starting that iron IV. Fortunately, my hemoglobin recovered before my surgery (installation of an On-X aortic valve) and has been fine since then.

pellicle · Aug 6, 2024

tjay said:
Hematologist is going to give me a boost of Iron thru IV. She thinks that's the culprit.

sounds good

Consider a Guinness at the earliest opportunity (half joking)

tjay · Aug 7, 2024

3mm said:
I'm sorry about your issues, but you will overcome them! Be patient, keep walking, etc.

When I had endocarditis 18 months ago my hemoglobin got down to 8.1 so they gave me an IV of iron. It took several hours, so it is worth using the bathroom just before starting that iron IV. Fortunately, my hemoglobin recovered before my surgery (installation of an On-X aortic valve) and has been fine since then.

Yes I feel great and just about everything is fine. I don’t feel I had an open heart procedure just 2 weeks back. Yes, I’ve been walking a LOT too

If it’s not for them telling me this or that is low, I would not have known

I appreciate that they’re being so thorough and conservative.

Thank you

V__ · Aug 7, 2024

tjay said:
I had never had any issue with Hemoglobin, Hematocrit and RBC before surgery in my the entire life. Normal range all along. Even 5 days before surgery these numbers were normal. But they remain very depressed since surgery. Anyone else experienced this post op?

I only remember RBCs - they were depressed for a while. Apparently, if you have blood loss (can easily happen) and get transfusion, usually you don't receive the red blood cells. There are some kind of complications with them. So these cells are stripped from the donor blood you get. I was told it would take 1-2 months for them to get to the normal range. That was accurate - 5 weeks post-op I was at the bottom part of the normal range.

vitdoc · Aug 7, 2024

It is expected that the red blood cell count will go down after surgery. Blood is lost during the procedure. Generally if the body has iron stores or is given iron if the stores are low the blood count will gradually return close to the previous values. It varies from place to place when they decide to transfuse. At your levels some places would transfuse others not. If you have other comorbidities say ischemic heart disease or early kidney failure etc.. transfusion would be used sooner than not. One feels sort of crummy with a low red count but that will usually change within a few weeks. Not sure that IV iron is needed, oral may be adequate.

ncw3642 · Aug 7, 2024

tjay said:
I had never had any issue with Hemoglobin, Hematocrit and RBC before surgery in my the entire life. Normal range all along. Even 5 days before surgery these numbers were normal. But they remain very depressed since surgery. Anyone else experienced this post op?

I got mechanical (On-X) valve 2 weeks ago for your reference.

Surgery team looked for any internal bleeding but to no avail. Now I’m referred to a Hematologist..

Let me know if anyone has any leads or experience to this regard. I can also send exact numbers if necessary.

Thanks

When my wife gave birth, her Hgb dropped from 11 (slightly anemic) to 6. While my levels dipped slightly after my OHS, they did quickly return to normal. My wife's did not-- they actually sent her home after giving her IV Iron (Venofer) while saying "it will take 2-3 weeks to return to normal.

This resulted in her going back to the hospital 2 days later due to some general malaise, dizziness and nausea. They gave her a transfusion (our hospital has a cutoff of under 7.0 to transfuse. Instantly felt better.

I will second the oral iron mentioned above. She used these (https://www.slowfe.com/) during pregnancy and after birth which helped stabilize the levels. They are available OTC or you can get a prescription for them from your doctor as well.

Wishing you all the best! Sometimes it just takes a bit for your body to recalibrate. 7.9 really isn't that much to worry about- get it redrawn in a couple weeks to see if any improvements happen!

pellicle · Aug 7, 2024

serious stuff, thanks for sharing

ncw3642 said:
This resulted in her going back to the hospital 2 days later due to some general malaise, dizziness and nausea. They gave her a transfusion (our hospital has a cutoff of under 7.0 to transfuse. Instantly felt better.

glad to hear that bit

Windfinder · Aug 29, 2024

When I got discharged from my AVR my hemoglobin was at 8.3 and they told me that was actually pretty good as it always drops significantly. They put me on iron supplements for a month and said in a few weeks more I should be back at normal range. They seemed so sure and see it all the time so they said running blood test to see progress was not even needed if you don’t have fever, extremely fatigued, pale or a combination of it…

tjay · Aug 29, 2024

Windfinder said:
When I got discharged from my AVR my hemoglobin was at 8.3 and they told me that was actually pretty good as it always drops significantly. They put me on iron supplements for a month and said in a few weeks more I should be back at normal range. They seemed so sure and see it all the time so they said running blood test to see progress was not even needed if you don’t have fever, extremely fatigued, pale or a combination of it…

Thanks

I don’t know why they freaked out so much in my case if it was so common.
Couple more weeks later, my numbers are already in normal range.

Thanks all for your insights.

SatoriFound · Oct 24, 2024

tjay said:
I had never had any issue with Hemoglobin, Hematocrit and RBC before surgery in my the entire life. Normal range all along. Even 5 days before surgery these numbers were normal. But they remain very depressed since surgery. Anyone else experienced this post op?

I got mechanical (On-X) valve 2 weeks ago for your reference.

Surgery team looked for any internal bleeding but to no avail. Now I’m referred to a Hematologist..

Let me know if anyone has any leads or experience to this regard. I can also send exact numbers if necessary.

Thanks

My husband is day 11 post-surgery today, still in the hospital. They almost did a transfusion on him yesterday, but then the numbers had gone up by a couple. He is still VERY anemic, and even after adding iron into his many meds the number is moving up very slowly. He has a long way to go to normal level.

tjay · Oct 24, 2024

As others noted on this thread and I also experienced, Hemoglobin/hematocrit/RBC comes back up eventually. It's one of those things that can be depressed for a while. There could be blood loss during surgery among various other factors. Mine gradually got better, and was in normal range after just a few weeks (I think 3-4 weeks).
They also gave me 1 unit of blood on day 12-13 or so, which I think was unnecessary. My Hemoglobin/hematocrit/RBC numbers are posted in one of the responses above for your reference. Hematologist was called and she wasn't concerned at all. Gave me iron pill to take come and I was discharged a day later.
But then follow their direction, they know best. Once again, not something to get too concerned about.

SatoriFound · Oct 25, 2024

tjay said:
As others noted on this thread and I also experienced, Hemoglobin/hematocrit/RBC comes back up eventually. It's one of those things that can be depressed for a while. There could be blood loss during surgery among various other factors. Mine gradually got better, and was in normal range after just a few weeks (I think 3-4 weeks).
They also gave me 1 unit of blood on day 12-13 or so, which I think was unnecessary. My Hemoglobin/hematocrit/RBC numbers are posted in one of the responses above for your reference. Hematologist was called and she wasn't concerned at all. Gave me iron pill to take come and I was discharged a day later.
But then follow their direction, they know best. Once again, not something to get too concerned about.

My husband's numbers are very close to what yours were, some were initially lower, but then came up just enough for them to not do a transfusion.
RBC 2.82
HGB 8
HCT 25.2

Right now he has a high WBC and platelet count to go with it.

LondonAndy · Oct 27, 2024

Not sure if this is relevant to your situation, but my iron count remained low and tests showed that I had "normocytic normochromic anaemia", and I was told that this is because in SOME mechanical valve patients, the opening/closing action of the valve damages red blood cells. I am on an iron tablet twice a day for life now, to compensate.

3mm · Oct 27, 2024

I am going to make a JOKE, so people who are sensitive about their brand of heart valve may want to stop reading now!

LondonAndy said:
in SOME mechanical valve patients, the opening/closing action of the valve damages red blood cells

I see you have one of those St Jude aortic valves. my On-X aortic valve doesn't have that problem!

Lisa from LJ · Oct 27, 2024

If RBC is low, H&H will also be low as they're all measurements of essentially the same thing. Hematocrit will be about 3 times Hemoglobin, which is 3 times the RBC. I had a blood transfusion during surgery and my Hemoglobin was still around 6 after surgery. I did have some Iron while in the hospital, but they don't like to administer a lot because it can cause constipation. I was instructed to treat with diet - spinach, red meat, beans, salmon, whole grains, etc. By the time I went back to the doctor 2 weeks later, it was better, still slightly low, and by a month it was fine.

SatoriFound · Oct 29, 2024

tjay said:
Thanks

I don’t know why they freaked out so much in my case if it was so common.
Couple more weeks later, my numbers are already in normal range.

Thanks all for your insights.

They freaked out on my husband too. The doctor wasn't going to let him go, but she called his main surgeon and he said he could go home.

2 week post-op: Hemoglobin, hematocrit, RBC remain depressed

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