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Symptoms of acute posthemorrhagic anemia in children
Last reviewed: 04.07.2025
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Minor blood loss in older children does not cause pronounced clinical symptoms and is tolerated relatively well. Significant blood loss is tolerated worse by children than by adults. Newborns tolerate rapid blood loss especially poorly. A loss of 10-15% of the circulating blood volume (CBV) in a newborn causes symptoms of shock, whereas in adults a loss of 10% of the CBV is compensated for independently, without pronounced clinical disorders. In older children, a loss of 30-40% of the CBV leads to shock. A sudden loss of 50 % of the CBV is incompatible with life. At the same time, if the bleeding is relatively slow, a child can tolerate a loss of 50% of the CBV or even more.
Symptoms of acute posthemorrhagic anemia consist of two syndromes - collapse and anemic, caused by a sharp decrease in the BCC. Signs of the collapse syndrome prevail over the anemic one. There are clear relationships between the degree of hypovolemia and the stage of hemodynamic impairment. Centralization of blood circulation occurs with a BCC deficit equal to 25% of the age norm (15 ml/kg), the transitional stage - at 35% (20-25 ml/kg), and decentralization - at 45% (27-30 ml/kg). Signs of hemodynamic decompensation: tachycardia, arterial hypotension, pale skin and mucous membranes, sticky sweat, clouded consciousness.
Symptoms of acute posthemorrhagic anemia in newborns
The clinical picture of acute posthemorrhagic anemia in newborns has its own characteristics. There is pallor of the skin and mucous membranes, adynamia, muscle hypotonia, weak cry, dyspnea, moaning breathing, apnea attacks, tachycardia, often systolic murmur, retraction of the anterior abdominal wall (associated with spasm of the blood vessels of the abdominal organs).
In some newborns, clinical data do not correspond to the severity of anemia. In acute blood loss, there may be signs of hypovolemia (tachycardia, tachypnea, threadlike pulse, arterial hypotension, lethargy, white spot symptom for more than 3 s) with normal skin color. Pallor may appear late - after several hours or on the 2nd-3rd day. If pallor is noted, then an important sign of anemia is the lack of its dynamics against the background of oxygen therapy.
In posthemorrhagic shock, clinical manifestations may develop in the immediate period after blood loss: tachycardia (over 160 beats/min), tachypnea, apnea attacks, severe arterial hypotension (in a full-term newborn, systolic pressure is below 50 mm Hg, and in premature babies less than 45 mm Hg, in children with very low birth weight - below 35-40 mm Hg), signs of which may be the absence of a palpable pulse in the radial and cubital arteries, oliguria or anuria, lethargy or coma. The development of the above-mentioned clinical picture of stage II shock may be delayed from the moment of bleeding by 6-12 hours and even 24-72 hours.
The absence of hepatosplenomegaly, edema, and icterus helps in differential diagnosis with hemolytic disease of the newborn.
Clinical signs of stages of hemodynamic impairment in shock
Stage
- Centralization of blood circulation
- Transitional
- Decentralization of blood circulation
- Terminal
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Clinical characteristics of shock stages
Psychomotor agitation or depression. Systolic blood pressure within the age norm or + 20%. Decreased pulse pressure. The pulse is tense, tachycardia up to 150% of the age norm, sometimes bradycardia. Dyspnea. The skin is pale, cold, "marbling", cyanotic shade of the mucous membranes, nail beds.
The child is inhibited. Systolic blood pressure is reduced, but not more than 60% of the age norm. Pulse is weak, frequency is more than 150% of the age norm. Dyspnea. Skin is markedly pale, acrocyanosis is distinct. Oliguria. The child is inhibited. Systolic blood pressure is below 60% of the age norm, diastolic blood pressure is not determined. Pulse is thready, tachycardia is more than 150% of the age norm. Skin is pale-cyanotic. Breathing is rapid, shallow. Central venous pressure is above or below normal depending on the degree of heart failure. Increased tissue bleeding. Anuria. Clinical picture of agonal state.