Why Check Bloods?
Is is important to understand the rationale for checking bloods and when to repeat them:
1. FBC
- It is vital to be aware of haemoglobin (Hb) level, as well as platelets in any PPH situation
- Clearly, if sent to the lab at the lab at the start of the bleed and the patient then loses a lot more blood, this will not reflect Hb level, but will help guide management based on measured blood loss and that initial FBC. Bloods will need repeated and usually initially a few hours after the patient is staabilised / blood has been given
2. U & Es (urea & electrolytes)
- Having a baseline when PPH occurs is vital as acute renal failure can result due to hypovolaemia
- Increased potassium and decreased sodium may be indicative of renal compromise and urea will proportionately increase to creatinine (Cr) in renal failure, i.e. urea:creatine ratio increases
- Monitoring urine output is vital and the trend in renal function on repeat bloods will also help guide management
Fluid balance requires strict input-output monitoring via indwelling catheter and hourly urometer
Signs of Concern:
- Rising Cr and urea,
- Oliguria (we expect roughly 0.5ml/kg/hr, usually accept around 30ml/hr when averaged out),
- Hyperkalamia and / or hyponatraemia,
- Metabolic acidosis and / or uraemic symptoms which include drowsiness, nausea, hiccoughs and twitching
