Expert: JM Starkman, MD - 9/29/2010

Question
Dear Dr Starkman
Thanks in advance for taking the time to read my question. I thought you might be able to help me with a question not related specifically to anesthesiology however I though you best qualified to answer.

Late last year I had a D&C procedure for a missed miscarriage (my third). Later that evening I developed severe abdominal and shoulder tip pain which I knew wasn't normal. Then I fainted at home...that also was not normal for me so I returned to the hospital.  I waited for 16 hours before I begged them to please perform a hemoglobin test because my instinct told me I was bleeding internally. Lucky I did that because my hemoglobin result came back at 77 and it normally sits at around 140 (a little high for a small female). My blood pressure was dropping slowly (from 137/85 when first admitted to 112/47 when the test was done (the nurses said this was normal but I felt it wasn't). My heart rate was 62 where it normally sits around 88 (fast i know).

Anyway, specifically my questions are these:  Is it possible to estimate from this how much actual blood I lost from the hemoglobin results? I don't know why but i really want to know exactly how much of my life blood was swishing around in my tummy. None of it was coming 'out', it was all going into my peritoneal cavity.  I ended up with a blood transfusion, peritonitis and now am infertile as a result.  
Should this type of blood loss been diagnosed sooner?  

Thanks again, Anne

Answer
Certainly, it would have been preferable to diagnose the problem sooner, but I don't have at hand the many variables that may have prolonged your diagnosis and treatment.  The values of 77 and 140 are unusual for hemoglobin levels which are normally expressed as grams per deciliter--which puts a normal woman's hemoglobin in the 12-16 range.  It is possible to estimate blood loss from hemoglobin values, but, again the proper values for hemoglobin must be used.  This site may be helpful in explaining or simplifying the process:  http://manuelsweb.com/blood_loss.htm