Medscape is available in 5 Language Editions – Choose your Edition here.


Pediatric Acute Anemia Medication

  • Author: Susumu Inoue, MD; Chief Editor: Robert J Arceci, MD, PhD  more...
Updated: Oct 09, 2015

Medication Summary

Medications for specific forms of anemia may be indicated in addition to blood transfusion (eg, corticosteroids for autoimmune hemolytic anemia, iron therapy for iron deficiency anemia).

Recombinant erythropoietin has been available for the treatment of certain forms of anemia. Its use can allow for avoidance or minimization of the need for blood transfusion. Indications include anemias of chronic disease (eg, renal failure), chemotherapy, acquired immunodeficiency syndrome (AIDS) treatment, preparation for surgery with anticipated significant blood loss, prematurity,[15] and hyporegenerative anemia of erythroblastosis fetalis. It is important to note that erythropoietin is not indicated for the immediate correction of anemia. The correction of anemia with erythropoietin occurs after about 2-8 weeks.


Blood Products

Class Summary

The goal of therapy in acute anemia is to restore the hemodynamics of the vascular system and replace lost red-blood cells. To achieve this, the practitioner may use blood transfusions. Major complications of acute anemia can be prevented by providing timely transfusion to restore hemoglobin to safe levels.

Packed red blood cells


Packed red blood cells (PRBCs) are used preferentially to whole blood since they limit volume, immune, and storage complications. PRBCs have 80% less plasma, are less immunogenic, and can be stored about 40 days (versus 35 days for whole blood). PRBCs are obtained after centrifugation of whole blood. Whole blood is not available in many blood banks.



Class Summary

Corticosteroids have anti-inflammatory properties and cause profound and varied metabolic effects. Corticosteroids modify the body’s immune response to diverse stimuli. They may be used in autoimmune hemolytic anemia.

Prednisolone (Prelone, Millipred)


Prednisolone decreases autoimmune reactions, possibly by suppressing key components of the immune system.

Methylprednisolone (Depo Medrol, Medrol, Solu-Medrol)


This agent is used for initial management of acute hemolytic anemia. Intravenous methylprednisolone is recommended when the most rapid and reliable treatment of hemolytic anemia is required.


Iron Salts

Class Summary

Iron salts are used for treating patients with iron deficiency anemia.

Ferrous Sulfate (Feosol, Fer-Iron, Slow FE)


Iron salts are used as building blocks for hemoglobin synthesis in treating anemia. They allow transportation of oxygen via hemoglobin and are necessary for oxidative processes of living tissue. Treatment should continue for about 2 months after correction of anemia and etiological cause in order to replenish body stores of iron. Ferrous sulfate is the most common and inexpensive form of iron utilized. Tablets contain 50-60 mg of iron salt. Other ferrous salts are used and may cause less intestinal discomfort because they contain smaller doses of iron (25-50 mg). Oral solutions of ferrous iron salts are available for use in pediatric populations.

Contributor Information and Disclosures

Susumu Inoue, MD Professor of Pediatrics and Human Development, Michigan State University College of Human Medicine; Clinical Professor of Pediatrics, Wayne State University School of Medicine; Director of Pediatric Hematology/Oncology, Associate Director of Pediatric Education, Department of Pediatrics, Hurley Medical Center

Susumu Inoue, MD is a member of the following medical societies: American Academy of Pediatrics, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Society for Pediatric Research

Disclosure: Nothing to disclose.


Margaret T Lee, MD Associate Professor, Department of Pediatrics, Division of Pediatric Hematology/Oncology/SCT, Children's Hospital of New York, Columbia University College of Physicians and Surgeons

Margaret T Lee, MD is a member of the following medical societies: American Society of Hematology

Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD Director, Children’s Center for Cancer and Blood Disorders, Department of Hematology/Oncology, Co-Director of the Ron Matricaria Institute of Molecular Medicine, Phoenix Children’s Hospital; Editor-in-Chief, Pediatric Blood and Cancer; Professor, Department of Child Health, University of Arizona College of Medicine

Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for the Advancement of Science, American Association for Cancer Research, American Pediatric Society, American Society of Hematology, American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.


Steven K Bergstrom, MD Department of Pediatrics, Division of Hematology-Oncology, Kaiser Permanente Medical Center of Oakland

Steven K Bergstrom, MD is a member of the following medical societies: Alpha Omega Alpha, American Society of Clinical Oncology, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Children's Oncology Group, and International Society for Experimental Hematology

Disclosure: Nothing to disclose.

J Martin Johnston, MD Associate Professor of Pediatrics, Mercer University School of Medicine; Director of Pediatric Hematology/Oncology, Backus Children's Hospital; Consulting Oncologist/Hematologist, St Damien's Pediatric Hospital

J Martin Johnston, MD is a member of the following medical societies: American Academy of Pediatrics and American Society of Pediatric Hematology/Oncology

Disclosure: Nothing to disclose.

John T Truman, MD, MPH Professor Emeritus of Clinical Pediatrics, Columbia University College of Physicians and Surgeons

John T Truman, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American Association for the History of Medicine, American Society of Pediatric Nephrology, and New York Academy of Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

  1. Dowling MM, Quinn CT, Plumb P, et al. Acute silent cerebral ischemia and infarction during acute anemia in children with and without sickle cell disease. Blood. 2012 Nov 8. 120(19):3891-7. [Medline]. [Full Text].

  2. Parkin PC, DeGroot J, Maguire JL, Birken CS, Zlotkin S. Severe iron-deficiency anaemia and feeding practices in young children. Public Health Nutr. 2015 Jun 1. 1-7. [Medline].

  3. Niemeyer CM, Baumann I. Myelodysplastic syndrome in children and adolescents. Semin Hematol. 2008 Jan. 45(1):60-70. [Medline].

  4. Ballin A, Hussein A, Vaknine H, Senecky Y, Avni Y, Schreiber L. Anemia associated with acute infection in children: an animal model. J Pediatr Hematol Oncol. 2013 Jan. 35(1):14-7. [Medline].

  5. Sherry B, Mei Z, Yip R. Continuation of the decline in prevalence of anemia in low-income infants and children in five states. Pediatrics. 2001 Apr. 107(4):677-82. [Medline].

  6. Cusick SE, Mei Z, Freedman DS, et al. Unexplained decline in the prevalence of anemia among US children and women between 1988-1994 and 1999-2002. Am J Clin Nutr. 2008 Dec. 88 (6):1611-7. [Medline].

  7. Mujica-Coopman MF, Brito A, Lopez de Romana D, Ríos-Castillo I, Coris H, Olivares M. Prevalence of Anemia in Latin America and the Caribbean. Food Nutr Bull. 2015 Jun. 36 Suppl 2:S119-28. [Medline].

  8. Cusick SE, Mei Z, Cogswell ME. Continuing anemia prevention strategies are needed throughout early childhood in low-income preschool children. J Pediatr. 2007 Apr. 150(4):422-8, 428.e1-2. [Medline].

  9. Hare GM, Tsui AK, McLaren AT, Ragoonanan TE, Yu J, Mazer CD. Anemia and cerebral outcomes: many questions, fewer answers. Anesth Analg. 2008 Oct. 107(4):1356-70. [Medline].

  10. Gibson BE, Todd A, Roberts I, Pamphilon D, Rodeck C, Bolton-Maggs P. Transfusion guidelines for neonates and older children. Br J Haematol. 2004 Feb. 124(4):433-53. [Medline].

  11. Amendments and corrections to the 'Transfusion Guidelines for neonates and older children' (BCSH, 2004a); and to the 'Guidelines for the use of fresh frozen plasma, cryoprecipitate and cryosupernatant' (BCSH, 2004b). Br J Haematol. 2007 Feb. 136(3):514-6. [Medline].

  12. Bateman ST, Lacroix J, Boven K, et al. Anemia, blood loss, and blood transfusions in North American children in the intensive care unit. Am J Respir Crit Care Med. 2008 Jul 1. 178(1):26-33. [Medline].

  13. Carson JL, Carless PA, Hebert PC. Outcomes using lower vs higher hemoglobin thresholds for red blood cell transfusion. JAMA. 2013 Jan 2. 309(1):83-4. [Medline].

  14. Villanueva C, Colomo A, Bosch A, Concepcion M, Hernandez-Gea V, Aracil C. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013 Jan 3. 368(1):11-21. [Medline].

  15. Ohlsson A, Aher SM. Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2006 Jul 19. CD004863. [Medline].

Algorithm for diagnostic approach and workup of anemia in children. Hb=hemoglobin; Hct=hematocrit; HS=hereditary spherocytosis; HE=hereditary elliptocytosis; G-6-PD=glucose-6-phosphate dehydrogenase; PK=pyruvate kinase; HUS=hemolytic uremic syndrome; TTP=thrombotic thrombocytopenic purpura; DIC=disseminated intravascular coagulation; DBA=Diamond-Blackfan anemia.
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.