Lab Results that Screech Something is Not Kosher

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Know your labs before you’re in crisis—because once you’re in the system, it might be too late to ask questions.

If I hadn’t seen these labs myself… I still wouldn’t know the truth!

Not once—not once—in all the pages of medical records did I find a note suggesting the sudden drop in H&H might be related to trauma.

No mention of an actual trauma that may have occurred. No exploration of internal bleeding. Just a diagnosis of anemia.

But when blood values plummet out of nowhere, shouldn’t someone ask why?

Shouldn’t we be looking for what caused the numbers to crash—before labeling someone with a lifelong condition they never had?

A CT angiogram was performed—but not to look for trauma or internal bleeding.

It was ordered to rule out a pulmonary embolism. No PE was found.

But the scan revealed something unexpected: fresh compression fractures in the mid-back.

Despite this clear sign of trauma, I found no clue that anyone had investigated whether the drop in blood values was related.

Still, the official diagnosis? Anemia.

And yet, buried at the very end of the discharge summary—almost camouflaged in its placement—was this one line.

“The patient will be transferred to a SNF for recovery from the fall.”

No details. No mention of trauma. No acknowledgment of what that fall really meant.

I found Heparin was administered—a powerful blood thinner. Even without a clot. Even with active blood loss. No explanation, no documentation of need.

I would have never known if I hadn’t combed through the medical records myself. On paper, it all looked routine and per protocol.

But when you step back and read between the lines… an ambiguous story begins to take shape.

That’s why I believe so strongly in this:

👉 If you don’t understand your lab values—or at least know what to look for—you may never know what really happened.

🧪 What Are Hemoglobin and Hematocrit—And Why Do They Matter?

Hemoglobin (Hgb) is the protein in red blood cells that carries oxygen throughout your body. When it drops too low, your organs and tissues are essentially starved of oxygen.

Hematocrit (Hct) tells you the percentage of your blood made up of red blood cells. It shows how concentrated your blood is—and how well your body can carry oxygen.

📉 A sudden drop in these two values isn’t just a number—it’s often a red flag for internal bleeding, hemolysis, or another serious event. And if no one investigates why they dropped, the real story can go completely unnoticed.

And just like hematocrit, the hemoglobin levels painted a troubling picture…

So, what could cause a sudden, unexplained drop in hemoglobin and hematocrit? Let’s look at what clinical sources say.

🧾 Still feeling unsure about how to interpret your lab results?
There’s a great book written for non-doctors that breaks it all down.
📘 Check it out here.

📌 What Could Really Cause a Sudden Drop in H&H?

🔻 1. Acute Internal Bleeding

A traumatic fall—especially one that results in spinal compression fractures—can cause internal bleeding in areas not immediately visible, like the abdomen, retroperitoneum, or even surrounding soft tissue. This kind of bleeding doesn’t always present with obvious signs but can still result in a rapid drop in red blood cell levels.

💉 2. Heparin Administration

Heparin, a powerful blood thinner, was administered even in the presence of very low H&H levels and without any evidence of a blood clot. This is highly concerning. When someone has active or suspected internal bleeding, anticoagulants like Heparin can prevent the body from stopping that bleed—potentially making the situation worse.

🩸 3. Hemolysis

Trauma can sometimes trigger a process called hemolysis, where red blood cells break down faster than the body can replace them. This, too, can lead to an abrupt drop in H&H. Labs such as LDH, bilirubin, and reticulocyte count can help identify this, but they aren’t always ordered unless someone is actively looking for the cause.

💧 4. Dilution from IV Fluids

If a large volume of intravenous fluids is given rapidly, it can dilute the blood and make H&H appear lower—even without significant blood loss. However, this drop is often temporary and doesn’t fully explain a prolonged or progressive anemia pattern.

So what was the real cause?
A fall? Fractures? A hidden bleed? Or a combination of events missed entirely because no one asked?

🛑 Why This Matters
If no one questions a sudden change, this could simply be labeled “anemia”—with no search for a cause, no accountability, and possibly the wrong treatment.

❗️This is why you must know your lab values—or at the very least, know when something doesn’t add up. Because when no one asks questions, the system doesn’t stop to ask either. It just runs the protocol.

🔍 The Danger of Treating a Protocol, Not a Person

D-dimer.

It’s not a lab most people even recognize—yet it can launch a person down a path of serious interventions fast.

👉 So what is it, exactly?

D-dimer is a protein fragment that shows up in your blood when your body breaks down a blood clot. Normally, you shouldn’t have much of it—if any.

So when levels are high, it could mean your body is forming and breaking down clots—possibly pointing to a serious condition like a pulmonary embolism (PE) or deep vein thrombosis (DVT).

In this case, it was part of the standard protocol for someone presenting with COPD exacerbation and shortness of breath: order a D-dimer to rule out a pulmonary embolism (PE). If it’s elevated, order a CT angiogram.

Here’s the thing—D-dimer can be elevated for many reasons that have nothing to do with a blood clot:

• A COPD flare

• Infection or inflammation

• Trauma (like a fall that causes spinal fractures)

• Recent surgery

• Even just being hospitalized

And in this case, all of the above apply. The D-dimer was high. But no PE was found on the scan.

So why was Heparin still ordered—a powerful blood thinner that increases bleeding risk—when this same person had dangerously low hemoglobin and hematocrit levels and a positive test for occult blood in the stool, clearly suggesting internal bleeding?

A nurse even said—rather curtly over the phone—“There’s bleeding from somewhere.”

Somewhere? That’s not good enough. They knew there was bleeding. But no one found the source. No one paused to ask why, or whether administering a blood thinner was wise in someone already losing blood.

And strangely—once discharged and out of that hospital—stool returned to normal color. The bleeding stopped. Just like that.

Was it trauma from a fall? A temporary internal bleed that resolved on its own? We’ll never know.

Because in that hospital, no one looked deeper. They saw a number, followed a protocol, and moved on.

No explanation in the notes. No confirmed clot. No immobility before admission. Nothing that clearly justified anticoagulation. Just a protocol that ran on autopilot.

Here’s what got missed:

• D-dimer isn’t a diagnosis. It’s a clue. A red flag that should be interpreted in context.

• And in this context, it was a mismatch.

You don’t treat a lab result in isolation—you treat the person.

But, when the system prioritizes protocol over personalized care, risky decisions happen.

And if no one questions it?

The patient pays the price.

When you’re bleeding from “somewhere,” and no one tries to find out where—that’s not care. That’s negligence disguised as routine.

🧬 The Lactic Acid Clue: What Was the Body Trying to Say?

Just seven days before everything spiraled, a full panel of labs was drawn.

Not every result was perfect—but the key indicators were stable:

🩸 Hemoglobin and hematocrit were completely normal.
🚫 No signs of internal bleeding.
📋 No diagnosis of anemia. No indication of sepsis.

There was even a documented risk assessment for pulmonary embolism (PE), which concluded:

No recent trauma or surgery. No signs of DVT or PE. The patient is low risk with less than a 2% chance of having a pulmonary embolism.

But then came the fall.

And everything changed.

Within days, new compression fractures were found on imaging—injuries that hadn’t been there before.

Lactic acid level, which had been 2.3 on labs before hospitalization and rose to 2.6 after hospital admission. That may not sound like much—but in a clinical context, it matters.

🧪 What Is Lactic Acid—and Why Should You Care?

Lactic acid is a substance your body produces when cells break down glucose for energy in low-oxygen conditions.

When it builds up in the blood, it often means one thing: the body is under stress—either from infection, trauma, or poor tissue perfusion (oxygen delivery).

Elevated lactic acid levels can point to:

• 🚑 Sepsis

• 💥 Trauma or shock

• 🫁 Respiratory failure (as in COPD exacerbation)

• 🔄 Poor circulation or oxygenation

• ❗Internal bleeding or hidden infection

It’s a silent warning—your body telling the medical team that something deeper is going wrong at the cellular level.

In this case, there was no evidence of PE, and sepsis had been ruled out just one week prior. So what changed?

A fall? New fractures? Possible internal bleeding?
And soon after—sepsis was diagnosed.

That’s why lab values like lactic acid matter.
They don’t always scream.
But they whisper the truth—if someone’s listening.

📚 Want to Learn More About Lab Values?

If you’re curious about what these numbers mean and want a simple, reliable guide, this bestselling book is a great place to start:

👉 Lab Values: Everything You Need to Know about Laboratory Medicine and its Importance in the Diagnosis of Diseases (2nd Edition). By: M. Mastenbjörk, M.D., S. Meloni, M.D., and David Andersson
⭐️ Rating: 4.4 stars from 1,200+ reviews. Check it out here.

Before You Go…

🩺 We’re not numbers. We’re not kabobs on a stick.
Protocols don’t catch everything—and they sure don’t tell your whole story.

Know your labs. Ask the questions. Demand better.
Because once the system starts treating you like a chart, it’s up to you to remind them, You still count!

PS…. Check out my blog post on monitoring your oxygen levels at home here.

Disclaimer: The information on this blog is for general informational purposes only and is not intended to provide medical advice, diagnosis, or treatment. Always consult your qualified health professional before changing your health or wellness routine. Do not disregard professional medical advice or delay seeking it because of something you have read on this blog.