Intraoperative blood loss and silent ischemia

My wife is 45 and recently underwent elective total abdominal hysterectomy for endometriosis. She is in otherwise good health and has no significant personal cardiac risk factors. The surgery was unexpectedly complicated and long (5.5 hours) and resulted in an estimated blood loss of 6 units. Immediately postop her hemoglobin/hematocrit were 3.9/10.8, her pulse was 90, and blood pressure about 100/50. It was about 3 hours before transfusion was initiated in Recovery. In view of the blood loss and extremely low hematocrit (possible exaggerated due to hemodilution) I asked for an ECG to be performed to rule out occult ischemia, noting that studies show 90% of such perioperative episodes are without overt clinical manifestations; and experimental studies show that a hematocrit of 10 represents the limit of the body's ability to maximize oxygen carrying capacity in the face of severe anemia. The surgeon refused, citing her lack of risk factors, absence of hypotensive episodes intraoperatively, and lack of significant tachycardia. Am I justified in my concern and in my demand to screen her for silent ischemia/MI?

[ireneo]

You said she had the surgery recently. How long has it been? I would think you could find another doctor to run an EKG on her. It's not difficult or terribly expensive compared to say an angiogram or even stress test. From what I've read if she had an MI and there was damage to the heart the EKG will probably show some changes. With ischemia? I'm not so sure if things are back to normal. Plus, has she had an EKG before, kind of a baseline for comparison? I'm just thinking out loud here.

[M_A_Schuster]

Her surgery was 1 week ago. Prior ECG was normal. When she feels strong enough to go to a physician's office I'm going to push for a repeat study.