How should I treat a severely malnourished child with severe anaemia?

If Hb is less than 4 g/dl then give whole blood 10ml/kg body weight slowly over 3 hours. Give furosemide 1mg/kg IV at the start of the transfusion to make space for the blood. It is particularly important that the volume of 10ml/kg is not exceeded in severely malnourished children. If the child has signs of cardiac failure, transfuse packed cells (5-7ml/kg) rather than whole blood. A fall in Hb can be expected during treatment due to haemodilution, so do not transfuse if the Hb becomes <4 g/dl after Day 1.

Monitor for signs of transfusion reactions. Also monitor the respiratory rate and pulse rate every 15 minutes. If respiratory rate and/or pulse rate rise, transfuse more slowly.

Following the transfusion, if the Hb remains less than 4g/dl do not repeat the transfusion within 4 days.

What do I do if a severely anaemic child reacts to a blood transfusion?

During blood transfusion, monitor for signs of transfusion reactions. If any of the following signs develop during the transfusion, stop the transfusion:

  • Fever
  • Itchy rash
  • Dark red urine
  • Confusion
  • Shock