Hemoglobin Plummets Within Minutes of Injury

Researchers at the University of Texas Southwestern Medical School (Dallas, TX, USA) conducted a retrospective study of 404 consecutive patients at an urban level I trauma center, which included 39 patients who required emergent surgical or radiologic intervention to control bleeding. All 404 patients underwent point-of-care (POC) hemoglobin (Hgb) measurements within 30 minutes of emergency department arrival. Hgb levels were correlated with physiologic signs of hemorrhage (blood pressure, heart rate, base deficit, pH, and resuscitation volume), and the need for emergent interventions to stop hemorrhage.

The results showed that early Hgb levels were significantly lower in patients who required emergent interventions to stop hemorrhage. Lower Hgb levels were associated with increasing heart rate, decreasing blood pressure, decreasing pH, worsening base deficit, and increasing transfusion requirements. Hgb equal to or less than 10 g/dl was associated with a greater than three-fold increase in the need for emergent interventions to stop bleeding, and correctly identified the need for intervention in 87% of patients. The study was published in the August 2007 issue of the Journal of Trauma-Injury Infection & Critical Care.

"Hemoglobin levels obtained shortly after injury may not detect occult bleeding in trauma patients because of the time needed for plasma levels to equilibrate, or may be confounded by crystalloid-related hemodilution,” said Dr. Brandon Bruns M.D., and colleagues of the department of surgery. "We hypothesized that Hgb levels measured within minutes of arrival can identify trauma patients who are actively bleeding.”


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University of Texas Southwestern Medical School