By Nursing Home Law Center
When a loved one has a pressure sore, many families find themselves at loss for interpreting blood lab work and how it relates to the treatment and progression of the wound. Below is a explanation of the interplay between lab studies and pressure sores patients authored by John Baeke M.D.
There is no lab study which is absolutely predictive of a pressure ulcer occurring in a patient. As malnutrition indeed is a pressure ulcer risk factor, monitoring a patient’s protein status is of value. There are several serological markers which clinicians historically have used to help asses a patient’s nutritional status. These have included total protein, albumin, transferritin levels.
However, the standard of care is now a blood study called a pre-albumin level. Pre-albumin is a protein which has a much shorter % life than the other mentioned molecules. Thus its level gives a more accurate picture of current conditions. An albumin level (by virtue of its long % life) gives data which is already out of date the moment the results are reported to the clinician. It gives an indication of what was happening nutritionally a week or two ago, but is not reflective of current conditions. Pre-albumin levels (again because oftheir short % life) need to be rechecked often.
The reason accurate knowledge of a patient’s protein status is important is when a patient has a large pressure ulcer, these ulcers tend to drain serous fluid like a sieve. That fluid is highly proteinaceous, meaning the wound drainage is sapping the body badly needed protein. The body of a patient suffering from hypoproteinemia (low protein) will prioritize which physiological systems must utilize the limited supply of protein; and which systems will be shut down.
Unfortunately, one of the earliest systems to be shut down is wound healing. What this means clinically is: a) patients with pressure ulcers whose protein needs are not being met with aggressive nutritional supplementation will NEVER heal; and b) pressure ulcer patients taken to surgery for expensive reconstructive surgery are doomed to fail if their pre-op protein levels are low.
Otherwise, the only other laboratory studies which too often are ignored is wound cultures. Culture reports will direct the medical staff as to what topical dressings to employ; what antibiotics to employ; and identify the source of infection in cases of sepsis (i.e. blood poisoning).
By John Baeke, M.D.
Chicago Attorney Nursing Home Law Center LLC Home