Anaemia

For FFP and platelets see Bleeding protocol, section treatment.

Transfusion Requirement

• Hb < 4 g/dL ~ PCV < 12%
• Hb < 6 g/dL ~ PCV < 18% AND:
• Dehydration
• Shock
• Significant respiratory distress or acidosis
• Prostration (inability to sit up)
• Heart Failure
• MPS 4+
• BCS less than or equal to 3

Causes

(most common causes written in CAPITALS - always check and treat those in Malawi as their presence significantly increases post-discharge mortality)

Important points in history

• Bleeding (tendency) (nose/ gums/ stool/ urine)
• Jaundice
• Colour of urine
• Fever
• Previous transfusions
• History of painful crises (SCD)
• Drug history (G6PD)
• Family, social and geographic history

Important Points on Examination

• Respiratory
• Rate/Pattern
• Heart rate/ Cardiac failure
• BCS
• Jaundice
• Malnourished
• Dehydrated
• Septic/ Shocked
• Enlarged Nodes/ Spleen/ Swellings
• Bleeding/ haematoma/ trauma
• Bone deformities/ frontal bossing

Investigations

• In all children check:
• MPs + PCV + HIV status
• Grouping and Cross-match if transfusion is being considered
• If the MPS are negative or if other disease suspected:
• Full Blood Count (look at MCV) + Diff. - take BEFORE transfusion
• Blood Culture if septicaemia considered
• If signs of other disease present consider:
• Urinalysis
• Sickle Cell test
• Chest X-Ray
• Stool for parasites and/or occult blood
• Peripheral blood film (to exclude malignancy) - send to department lab
• Consider Bone Marrow Biopsy after FBC results discussed

Management

• Blood transfusion (Indicate volume and PCV result on the requesting form), deliver the sample to blood bank, follow up to obtain the crossmatched blood
• Oxygen - even with good saturations (will improve O2 delivery to tissues)
• Treat cause (e.g. Artesunate, antibiotics, antihelminths etc)
• Persistent fever after 48 hrs of Artesunate: consider Salmonella infection

Transfusion and monitoring Discharge and follow-up

• Discharge when child is pink (Hb > 4 g/dL or PCV > 12% and asymptomatic), not vomiting, no oedema
• Albendazole treatment to ALL anaemic children > 1 year
• Ferrous sulfate and folic acid to all anaemic children except those with sickle cell disease (DO NOT GIVE IRON SUPPLEMENTS TO A CHILD WITH ACUTE MALARIA/ SEPTICAEMIA. WAIT UNTILL THEY ARE DISCHARGED.) FeFol will be needed for 3 months
• Check that children have a bed net at home. If not, give one from A&E
• Arrange a health centre follow-up 2 weeks after discharge for PCV/ Hb (there is a high risk of recurrence/ death in the first month after transfusion)