Pediatric emergency medicine trisk 2189 2189

creatinine >1.4)
Formulation: 650
mg tabs or IV
solution

lead to intrarenal
obstruction

Patients with atraumatic acute blood loss are resuscitated based on the presence of
uncompensated shock, on the ability to achieve hemostasis, and the anticipated need for
procedural intervention. In the stable patient with chronic blood loss, IV fluids should be
used with caution, if at all, due to the potential for hemodilution. The decision to
transfuse in these cases is based on symptoms, the trajectory of the blood loss, and
ability to reverse the inciting cause. Pediatric data are limited, but transfusion in adult
patients with a hemoglobin level >7 g/dL has not improved outcomes. Patients with a
hemoglobin below 5 to 6 g/dL frequently require transfusion. In patients with chronic
blood loss, evidence of insufficient end-organ perfusion is an indication for transfusion;
however, overly rapid or voluminous transfusion can lead to circulatory overload and
collapse. For severe anemia with a tenuous hemodynamic status, exchange transfusion
may be necessary to safely and efficiently correct the anemia. Specific treatment
strategies may be available for some conditions, such as use of estrogen for
menorrhagia.
The need for transfusion in a patient with anemia should be carefully considered,
given the low but real associated risks of transmission of infectious agents and
transfusion reaction. As a practical guide to rapid decision making, a volume of 10- to
15-mL packed red blood cells (pRBCs) per kg may be given for acute blood loss, with
the infusion rate varying from rapid to over 4 hours, depending on the degree of patient
instability and rate of ongoing blood loss. In contrast, for severe, chronic anemia, 5-mL
pRBCs per kg over 4 hours may be necessary to avoid circulatory overload.
Clinical Indications for Discharge or Admission
In stable patients with anemia, without physiologic compromise, discharge may be

considered if the etiology of the condition is known, not expected to progress or
accelerate, and close and reliable follow-up is available.

HEMOLYTIC ANEMIA
CLINICAL PEARLS AND PITFALLS