given to the patient for whom it was intended Laboratory testing to evaluate for hemolysis, coagulopathy, and renal function should be sent to exclude the possibility of a hemolytic reaction (see Table 93.14 ) Additionally, an aliquot of the unit should be returned to the blood bank for confirmation of the original compatibility testing and labeling For patients with severe acute hemolysis, aggressive fluid resuscitation, sometimes including diuretic therapy is needed to maintain urine output and minimize the toxic effects of free hemoglobin on the renal tubules Suggested Readings and Key References Anemia Bansal D, Oberoi S, Marwaha RK, et al Approach to a child with bleeding in the emergency room Indian J Pediatr 2013;80:411–420 Drucker NA, Wang SK, Newton C Pediatric trauma-related coagulopathy: balanced resuscitation, goal-directed therapy and viscoelastic assays Semin Pediatr Surg 2019; 28:61–66 Hayward CP, Moffat KA Laboratory testing for bleeding disorders: strategic uses of high and low-yield tests Int J Lab Hematol 2013;35:322–333 Jackson J, Carpenter S, Anderst J Challenges in the evaluation for possible abuse: presentations of congenital bleeding disorders in childhood Child Abuse Negl 2012;36:127–134 Blood Loss Janz TG, Johnson RL, Rubenstein SD Anemia in the emergency department: evaluation and treatment Emerg Med Pract 2013;15:1–15; quiz 15–16 Tobian AA, Heddle NM, Wiegmann TL, et al Red blood cell transfusion: 2016 clinical practice guidelines from AABB Transfusion 2016;56(10):2627–2630 Tyrrell CT, Bateman ST Critically ill children: to transfuse or not to transfuse packed red blood cells, that is the question Pediatr Crit Care Med 2012;13:204–209 Villanueva C, Colomo A, Bosch A, et al Transfusion strategies for acute upper gastrointestinal bleeding N Engl J Med 2013;368:11–21 Hemolytic Anemia Dhaliwal G, Cornett PA, Tierney LM Jr Hemolytic anemia Am Fam Physician 2004;69:2599–2606 Ladogana S, Maruzzi M, Samperi P, et al; AIHA Committee of the Italian Association of Paediatric Onco-haematology (AIEOP) Diagnosis and management of newly diagnosed childhood autoimmune haemolytic anaemia Recommendations from the Red Cell Study Group of the Paediatric Haemato-Oncology Italian Association Blood Transfus 2017;15(3):259–267 Petz LD A physician’s guide to transfusion in autoimmune haemolytic anaemia Br J Haematol 2004;124:712–716