On this page
Care priority and warning signs
Care priority
Refer URGENTLY
Red flags
- Signs of heart failure (difficulty breathing, fast breathing, enlarged liver)
- Signs of shock (lethargy, cold extremities)
- Any general danger sign
- Jaundice (suggests hemolysis)
Assessment
- Look/Feel: Look at the child's palms. Are they very pale? (Severe Palmar Pallor). Compare with your own palm or another healthy person's palm if unsure.
Classification
- Severe palmar pallor -> SEVERE ANAEMIA
Key features
- Presence of Severe Palmar Pallor is the key sign.
- Indicates a critically low level of haemoglobin.
- Requires urgent assessment for cause and likely referral for transfusion/further management.
Management
Non-pharmacological management
- Handle child gently.
- Keep child warm.
- Minimize exertion.
Pre-referral treatment
- Assess for and manage any associated severe conditions requiring pre-referral treatment (e.g., give pre-referral antimalarial if also Very Severe Febrile Disease, antibiotic if severe infection, manage shock/hypoglycemia).
- Do NOT give iron pre-referral.
- If Sickle Cell Disease (SCD) is suspected or known, manage appropriately (hydration, pain relief - specific pre-referral protocols may apply).
Follow-up
- To be managed at referral hospital facility (investigation of cause, blood transfusion if needed, specific treatment).
Counselling points
- Explain that the child is very pale, which is serious and needs urgent hospital care.
- Explain any pre-referral treatments given.
- Advise on keeping child warm and calm during transport.
- If SCD is suspected, explain the need for specific tests/care.
- Write a detailed referral note indicating severe palmar pallor and any associated findings/treatments.
Differential diagnosis
- Anaemia (non-severe)
- Causes of severe anaemia: Severe malaria, Iron deficiency (usually chronic, severe is less common acutely), Hookworm infestation, Sickle Cell Disease crisis (vaso-occlusive or sequestration), Other haemoglobinopathies, Hemolysis (G6PD deficiency, autoimmune), Bleeding (chronic or acute), Malignancy (leukemia), Aplastic anaemia, Chronic kidney disease, Severe malnutrition.
Complications
- Heart failure
- Shock
- Impaired consciousness
- Organ damage due to hypoxia
- Death
Prevention
- Malaria prevention (ITNs).
- Iron supplementation where indicated/routine.
- Deworming.
- Good nutrition.
- Early diagnosis and management of Sickle Cell Disease.
- Prompt treatment of conditions causing anaemia.
References
IMCI Chart Booklet - Page 7