Diagnosis, management and prevention of Pediatric Acute Hemolytic Anemia: Egyptian adapted evidence-based clinical practice guidelines

Abstract

Abstract Background Acute hemolytic anemia (AHA) is a common emergency in pediatric emergency departments, hence the need to adapt pre-existing high-quality practice guidelines for the diagnosis, management, and prevention of AHA to be available for national use. Methods The guideline panel used the adapted ADAPTE methodology. The panel prioritized the health questions and recommendations according to their importance for clinicians and patients. The procedure included searching for existing guidelines, quality appraisal, and adaptation of the recommendations to be used in low-resource countries. Results The guideline provided approach to a child with AHA: laboratory diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency, autoimmune hemolytic anemia (AIHA), and hemolytic uremic syndrome (HUS); treatment of AHA including indications for red cell transfusion, medical treatment, plasma exchange, and indications of antibiotic in HUS; how to avoid further episodes of hemolysis; and when to refer to a hematologist. Implementation tools included a checklist for history and examination, lists of differential diagnoses, flow charts for the diagnosis of AHA, and a list of medications and food to be avoided in patients with G6PD deficiency. Conclusion This adapted guideline will aid decision-making related to the diagnosis, management, and prevention of AHA.

Keywords

• Guideline adaptation
• Acute hemolytic anemia
• Autoimmune hemolytic anemia
• Glucose-6-phosphate dehydrogenase deficiency
• Hemolytic uremic syndrome