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TABLE 93.5 TREATMENT OF ANEMIA Cause Treatment Iron deficiency Iron supplementation and increase dietary intake Vitamin B12 and folic acid deficiency Lead poisoning Cobalamin and folate supplements Hemolytic anemia Supportive care with iron and folate supplementation and cessation of possible causative medications; autoimmune: steroids or intravenous immunoglobulin (IVIG), plasmapheresis; transfusion if clinically unstable Treat underlying disease process Anemia of chronic disease Aplastic anemia Remove child from site of exposure; intestinal irrigation if radiographs demonstrate retained lead particles; chelation therapy if severe; iron and folate supplementation Bone marrow transplant; supportive care with transfusion Thalassemia Chronic transfusions, iron chelation for prevention of iron overload and close monitoring for end-organ effects of iron toxicity; bone marrow transplant Transient erythroblastopenia of childhood Diamond–Blackfan anemia Supportive, self-resolving; transfusion only in the case of clinical decompensation Gastrointestinal losses Supportive, acid blocker; endoscopy to identify source of bleeding; octreotide infusion and transfusion if severe Menstrual losses Supportive, hormonal (e.g., estrogen) therapy, tranexamic acid, and transfusion if severe Steroids; if unresponsive, bone marrow transplant; supportive care with transfusions CLINICAL PEARLS AND PITFALLS Sickle cell patients require aggressive pain control when they present with a vasoocclusive episode Management includes IV fluids to improve vascular flow, nonsteroidal anti-inflammatory drugs (NSAIDs), and administration of narcotics as well as other analgesics Acute chest syndrome presents as fever, respiratory symptoms (increased work of breathing, hypoxia, or chest pain), and a new infiltrate on CXR Acute chest syndrome can evolve rapidly to become life threatening Patients with sickle cell disease have a 300-fold higher risk of stroke compared with other children New neurologic findings should prompt emergent hematology consultation, plans for exchange transfusion, and head imaging Patients with sickle cell disease are functionally asplenic and at increased risk of severe bacterial infections Fever >101.5°F/38.5°C necessitates blood culture, other cultures as clinically indicated, and empiric coverage with a broad-spectrum antibiotic such as ceftriaxone Splenic sequestration results from pooling of blood within the spleen and can lead to hypovolemic shock necessitating transfusion Most presentations are in children