The stabilization of the severely anemic child is guided by the clinical presentation more than by laboratory values In chronic blood loss, low hemoglobin levels may be relatively well tolerated due to compensatory mechanisms and should not be the sole indication for transfusion The acuity or chronicity of a clinical condition will impact the clinical status and thereby affect management Prompt transfusions and isotonic fluid resuscitation needed for acute blood loss may be detrimental in chronically anemic patients Transfusion risks versus benefits must be considered based on the clinical situation Current Evidence Anemia in the pediatric patient ranges from an incidental finding in an asymptomatic patient to acute or chronic processes presenting in a critically ill patient The classification of causes of anemia according to (i) blood loss, (ii) increased RBC destruction, and (iii) decreased RBC production provides a framework for the evaluation of the anemic child