Anemia and plaquetopenia: attention and care what the pediatric must have during the service

Thrombotic microangiopathies (TMA), defined by microangiopathic hemolytic anemia (MAHA), associated with thrombocytopenia and ischemic lesion in microtrombic target organs, are hematological emergencies that require urgent intervention1. In MAHA, a non-immune anemia occurs due to intravascular hemolysis, secondary to endothelial cell aggression, platelet thrombi and fibrin, with consequent vascular lesion2, resulting in increased LDH (lactic dehydrogenase), presence of schizocytes,3 indirect hyperbilirubinemia, low haptoglobin, reticulocytosis and negative Coombs Double test.1‒8 Due to the severity and the underdiagnosis of TMA, requiring early treatment, patients with anemia and thrombocytopenia without definite cause should be investigated early. The study aims to propose a flowchart for management and / or referral to a reference center, in cases of anemia with thrombocytopenia.