The treatment of anemia depends on the etiology of the anemia and the symptoms and clinical status of the patient. In the ED setting, one is faced most commonly with the management of anemia resulting from acute blood loss. All patients who have ongoing blood loss and anemia should have blood typed and crossmatched so that it is available for transfusion if needed. The decision to transfuse PRBCs has to be individualized for each patient with consideration of clinical symptoms, objective signs, age of the patient, presence of comorbid disease, and the likelihood of further blood loss. In general, patients who are symptomatic and hemodynamically unstable and have evidence of tissue hypoxia and/or limited cardiopulmonary reserve should have PRBCs transfused. In most settings, patients with anemia resulting from acute blood loss are transfused at hemoglobin levels of 7g/dL, if not at higher levels, as dictated by patient considerations discussed earlier.
ED patients with chronic anemia or a newly diagnosed anemia of uncertain etiology not caused by acute blood loss may not require immediate transfusion unless they are hemodynamically unstable, hypoxic, or have acidosis or ongoing cardiac ischemia. In a patient with newly diagnosed anemia of uncertain etiology, it is important that laboratory studies that may be required for hematologic evaluation are obtained prior to transfusion. Consultation with a hematologist may be beneficial to guide this evaluation. The condition of some patients with chronic anemias or anemias of uncertain etiology can be made worse by transfusion, so transfusion should not be undertaken unless specifically indicated.
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