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 to 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 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 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