Severe Anaemia

Clinical Description

Severe anemia in children is dependent on age

Signs and Symptoms

• Pallor
• Tachycardia
• Fatigue
• Respiratory distress

Investigations

• To confirm anaemia
• Full blood count/ PCV/ Hb
• To Identify cause of anaemia:
• Peripheral blood film
• Sickling test/ Hb electrophoresis
• Malaria parasites (MPs or Rapid diagnostic test (MRDT)

Treatment

Blood transfusion

• Transfusion threshold for severe anemia in children is dependent on age

Neonates

Assisted Ventilation CPAP/HFNC Low flow oxygen (<3L/min)

Room air <28 days ≥ 28 days < 28 days ≥ 28 days

FiO2 ≥ 0.21 Well in room air

FiO2 ≥ 0.21

FiO2 < 0.21

Hb < 10g/dL

Hb < 10g/dL Hb < 8g/dL Hb < 7g/dL

Hb < 12g/dL

Hb < 11g/dL

RBC Transfusion maybe considered at higher thresholds than the above for neonates requiring acute resuscitation

• In neonates give 20ml/Kg packed cells over 4 hours
• Frusemide should not be routinely given
• Withhold feeds for the duration of transfusion due to the possible risk of transfusion associated NEC
• Additional IV fluids are not required

Children and infants

• If Hb < 4 g/dl or PCV <12
• If Hb < 6 g/dl or PCV <18 with any of the following:
• Shock or clinically detectable dehydration
• Impaired consciousness
• Respiratory acidosis (deep labored breathing)
• Heart Failure
• Requiring oxygen for any reason
• Transfuse 20ml/kg of whole blood or 10ml/kg of packed red blood cells over 4 hours.
• In severely malnourished children give 10mls/kg of packed cells over 4 hours. Give

Frusemide 1mg/Kg at the beginning of the transfusion.

• A diuretic is usually not indicated because many of these children are usually hypovolemic with a low blood volume.
• Check the respiratory rate and pulse rate every 15 minutes and if one of them rises, transfuse more slowly.
• If there is evidence of fluid overload due to the blood transfusion, give extra Frusemide (1-2mg/kg)
• If severe respiratory distress, consider oxygen therapy with or without

CPAP as appropriate

• If the Hb remains low following a blood transfusion, repeat the transfusion.

Complications

• Fluid overload, Transfusion reactions and Infections

Complications and Referral Criteria

• If no transfusion services are available at health facility
• Recurrent anaemia requiring repeated transfusions
• If anaemia is accompanied by thrombocytopenia, leucopenia, and/or leukocytosis
• Anaemia with bleeding tendencies