Anaemia (Severe)

For FFP and platelets see Bleeding protocol, section treatment.

Transfusion Requirement


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

Decreased Production Destruction Loss
  • Malnutrition
  • IRON DEFICIENCY (hookworm)
  • HIV
  • Chronic disease ( TB)
  • Aplastic anemia
  • Leukaemia
  • Parvo B19

Important points in history

Important Points on Examination



Transfusion and monitoring

Not malnurished Malnurished
Volume Either 10 ml/kg of packed cells or
20 ml/kg of whole blood in 3-4 hours
If stable await senior review
If unstable give whole blood (10 ml/kg in 4 hours)
If signs of cardiac failure, infuse 5-7ml/kg of packed cells in 3-4 hours (Malnutrition)
Furosemide iv Only if fluid overload / cardiac failure 1-2 mg/kg, max. 20 mg (give half way through transfusion) Give in all malnourished children 1-2 mg/kg (give half way through transfusion)
Check PCV and/or Hb + MPs Consider after 24 h if still signs of symptomatic severe anaemia
Repeat transfusion Next morning (if necessary) - i.e. Hb 4 g/dL or PCV < 12% and/ or patient still symptomatic NOT unless Hb/PCV less than pre-transfusion or not increasing after 4 days

Discharge and follow-up