These patients can benefit from ED hemoglobin test

Here are three scenarios in which noninvasive hemoglobin measurements could affect an ED patient's care:

• Acute trauma situations, such as motor vehicle accidents, gunshot wounds, and knife wounds.

When internal bleeding isn't obvious, having an immediate noninvasive hemoglobin measurement available can be life-saving, according to John Viljoen, MD, clinical professor of anesthesiology at Loma Linda (CA) University School of Medicine. "Drawing a blood sample, sending it off to the lab, and receiving the result takes time, which is precious in these situations," he says.

Also, on-the-spot hemoglobin levels can help you determine whether a blood transfusion is needed. "If the level is not critically low, all that may be needed is an infusion of crystalloids/colloids. This can eliminate the need to transfuse blood, which is costly and always carries a risk," Viljoen says.

Also, the ED nurse can track the patient's response to the treatment without the need for repeated drawing of blood samples, he adds.

• When a patient presents with a previous history of chronic bleeding that is not apparent, due to a peptic ulcer, or a genitourinary or colon problem.

"Having an immediate measurement saves the time and expense associated with lab testing to confirm the diagnosis," Viljoen says.

• When anemia has to be ruled out.

Because the signs and symptoms of anemia can mimic other conditions such as the flu or the common cold, hemoglobin levels can be measured quickly and easily to readily rule out anemia, he says.

• When you need to determine if a chemotherapy patient has developed anemia.

When cancer patients present to the ED, hemoglobin levels can be measured within seconds to rapidly determine their anemic status without drawing blood, Viljoen says.

Learning a patient's hemoglobin level in the ED can lead to discovering a potentially life-threatening condition that would otherwise go undiscovered. He says his own esophageal cancer was caught early as a result of a random hemoglobin measurement. At the time, he exhibited none of the signs or symptoms of cancer and had no outward appearance of anemia.

"Nonetheless, I received a low measurement of 10.6 g/dl, which was confirmed by lab blood testing. This signaled anemia and prompted additional medical testing, which revealed esophageal cancer as the cause," says Viljoen. "It has been 18 months since I underwent surgery to remove the cancer, and I've had no evidence of recurrence."