eMedicine Specialties > Pediatrics: General Medicine > Hematology

Anemia, Acute: Treatment & Medication

Author: Margaret T Lee, MD,, Associate Professor, Department of Pediatrics, Division of Pediatric Hematology, Children's Hospital of New York, Columbia University
Contributor Information and Disclosures

Updated: Apr 17, 2009

Treatment

Medical Care

Acute anemia usually warrants immediate medical attention. Treatment depends on the severity and underlying cause of the anemia.

  • Initial treatment begins with careful assessment of the signs and symptoms of the anemia that indicate therapy. Guidelines for the treatment of patients with critical illness apply to children with severe anemia who are in acute distress and unstable. Supportive measures, such as supplemental oxygen for decreased oxygen-carrying capacity, fluid resuscitation for hypovolemia, and bed rest or activity restriction for fatigue, may be required.
  • Transfusion with packed RBCs (PRBC) is the universal treatment for most individuals with severe acute anemia. The British Committee for Standards in Hematology Transfusion Task Force has established guidelines for transfusions in neonates and older children.4 The indication to transfuse should not be based solely on the hemoglobin or hematocrit levels; more importantly, one must consider the clinical effects or signs and symptoms of the individual with anemia.
    • Packed RBC (PRBC) dose is 10-15 mL/kg over 3-4 hours. The rate of transfusion can be modified according to the clinical situation. Transfusion can be administered faster in individuals with acute blood loss or slower or in smaller aliquots in persons with congestive heart failure (CHF).
    • In individuals with autoimmune hemolytic anemia, blood must be given with extreme caution, using the blood unit that is least reactive on crossmatch.
  • 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, and hyporegenerative anemia of erythroblastosis fetalis. It is important to note that erythropoietin is not indicated for the immediate correction of anemia. Correction of anemia with erythropoietin occurs after about 2-8 weeks.

Surgical Care

  • Except in cases of uncontrolled hemorrhage, surgery is very rarely indicated in acute anemia.
  • Splenectomy is occasionally considered in persons with autoimmune hemolytic anemia that is refractory to medical treatment.

Consultations

Except for patients who have acute anemia secondary to blood loss from obvious trauma or injury, a hematology consultation is ideal for most patients with acute anemia to determine the underlying RBC disorder and provide the appropriate therapy.

  • In particular, the following features in an individual with acute anemia indicate the need for a hematology consultation:
    • Concomitant abnormality in WBC and/or platelet counts (eg, neutropenia, thrombocytopenia, presence of immature WBCs)
    • Positive Coombs test result
    • Hepatosplenomegaly
    • History of underlying hematologic disorder
    • Excessive blood loss relative to the degree of injury in individuals who may have an underlying bleeding disorder
  • Consider consultation with a gastroenterologist in cases of GI blood loss.

Diet

Activity

  • Activity restriction or bed rest may be indicated in symptomatic individuals with severe anemia.

Medication

More on Anemia, Acute

Overview: Anemia, Acute
Differential Diagnoses & Workup: Anemia, Acute
Treatment & Medication: Anemia, Acute
Follow-up: Anemia, Acute
Multimedia: Anemia, Acute
References
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References

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

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

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

  4. Transfusion Task Force. 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. Feb 2007;136(3):514-6. [Medline].

  5. 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. Jul 1 2008;178(1):26-33. [Medline].

  6. Abshire TC. The anemia of inflammation. A common cause of childhood anemia. Pediatr Clin North Am. Jun 1996;43(3):623-37. [Medline].

  7. Armano R, Gauvin F, Ducruet T, Lacroix J. Determinants of red blood cell transfusions in a pediatric critical care unit: a prospective, descriptive epidemiological study. Crit Care Med. Nov 2005;33(11):2637-44. [Medline].

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

  9. Graham EA. The changing face of anemia in infancy. Pediatr Rev. May 1994;15(5):175-83; quiz 184. [Medline].

  10. [Best Evidence] Lacroix J, Hebert PC, Hutchison JS, et al. Transfusion strategies for patients in pediatric intensive care units. N Engl J Med. Apr 19 2007;356(16):1609-19. [Medline].

  11. Liet JM, Paranon S, Baraton L, Dejode JM, Roze JC. Is a prophylactic treatment by erythropoietin relevant to reduce red blood cell transfusion in the pediatric intensive care unit?. Pediatr Crit Care Med. Nov 2006;7(6):541-4. [Medline].

  12. Ohls RK. Evaluation and treatment of anemia in the neonate. In: Christensen RD, Fletcher J, eds. Hematologic Problems in the Neonate. WB Saunders Co; 2000:137-69.

  13. [Best Evidence] Ohlsson A, Aher SM. Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. Jul 19 2006;3:CD004863. [Medline].

  14. Oski FA, Brugnara C, Nathan DG. A diagnostic approach to the anemic patient. In: Nathan and Oski's Hematology of Infancy and Childhood. 5th ed. Harcourt Health Sciences; 1998:375-84.

  15. Walters MC, Abelson HT. Interpretation of the complete blood count. Pediatr Clin North Am. Jun 1996;43(3):599-622. [Medline].

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Further Reading

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Keywords

anemia, low hemoglobin, low hematocrit, anemic, reduced red cell mass, diminished oxygen-carrying capacity, hematologic abnormality, decreased or ineffective red cell production, increased red cell destruction, blood loss, acute anemia, congestive heart failure, CHF, hemolysis, hemorrhage, thalassemia, splenectomy, Fanconi anemia, aplastic anemia, treatment, diagnosis, myelofibrosis, leukemia, sickle cell disease, systemic lupus erythematosus, chronic renal failure, iron deficiency anemia, X-linked disorders, tachycardia, gallop rhythm, tachypnea, cardiomegaly, hepatomegaly, Diamond-Blackfan anemia, transient erythroblastopenia of childhood, hypothyroidism, pyruvate kinase deficiency

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Contributor Information and Disclosures

Author

Margaret T Lee, MD,, Associate Professor, Department of Pediatrics, Division of Pediatric Hematology, Children's Hospital of New York, Columbia University
Margaret T Lee, MD, is a member of the following medical societies: American Society of Hematology
Disclosure: Nothing to disclose.

Medical Editor

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 Society of Pediatric Hematology/Oncology
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Steven K Bergstrom, MD, Assistant to the Chairman, 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.

CME Editor

Samuel Gross, MD, Professor Emeritus, Department of Pediatrics, University of Florida; Clinical Professor, Department of Pediatrics, University of North Carolina; Adjunct Professor, Department of Pediatrics, Duke University
Samuel Gross, MD is a member of the following medical societies: American Association for Cancer Research, American Society for Blood and Marrow Transplantation, American Society of Clinical Oncology, American Society of Hematology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Robert J Arceci, MD, PhD, King Fahd Professor of Pediatric Oncology, Professor of Pediatrics, Oncology and the Cellular and Molecular Medicine Graduate Program, Kimmel Comprehensive Cancer Center at Johns Hopkins University School of Medicine
Robert J Arceci, MD, PhD is a member of the following medical societies: American Association for Cancer Research, American Association for the Advancement of Science, American Pediatric Society, American Society of Hematology, and American Society of Pediatric Hematology/Oncology
Disclosure: Nothing to disclose.

 
 
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