Interpreting laboratory values has taken a forefront in many treatment models when deciding on the appropriateness of administering or withholding therapy. A major laboratory value called upon for interpretation is hemoglobin. Several physical therapy (PT) textbooks, articles, and other resources document the standard of therapy being “contraindicated” with a hemoglobin value less than 8 g/dL or use the terminology “no exercise” for patients who classify into this cohort.
This study was designed to objectively look at the number of adverse events that occur within the acute care setting specifically investigating the number of adverse events in patients with a hemoglobin level less than 8 g/dL.
A retrospective chart review was conducted by a single researcher for all PT sessions that took place from the months of March 1, 2011, through June 30, 2011. Adverse events were assessed within each PT treatment session. Adverse events that were analyzed included (1) a systolic blood pressure (BP) that rises to a level greater than 200 mmHg during or after exercise; (2) a pulse oximetry reading that drops less than 90% with activity (with or without baseline oxygen); (3) a systolic BP that drops more than 10 mmHg below resting with activity; (4) a positive orthostatic response (defined as systolic BP dropping ≥20 mmHg, diastolic BP dropping ≥10 mmHg, and heart rate increasing >15 beats per minute); and (5) having a heart rate that increases greater than 120 beats per minute with activity.
A total 3314 PT treatment sessions were reviewed during the retrospective review period. Of that total, 3236 were sessions where hemoglobin levels were 8 g/dl or more. Of the 3236, 448 were identified as having an adverse event giving this group a percentage of 13.8%. The sessions with hemoglobin levels less than 8 g/dL totaled 78. Of the 78, 5 sessions were identified as having an adverse event giving this group a percentage of only 6.4%.
Given the lower percentage of adverse events with hemoglobin levels less than 8 g/dL, the findings of the study fail to support current recommendations of a “no exercise” or “contraindicated” status for this population of patients. It is the recommendation of this pilot investigation to consider low hemoglobin values as a “precautionary” measure and not an absolute contraindication for activity within the acute care setting.