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Approach to the child with anemia

INTRODUCTION

The approach to anemia in the pediatric patient is reviewed here. Included are pertinent issues related to the history and physical examination, the initial laboratory workup, methods for classifying anemia, and algorithms designed to help guide diagnosis.

A systematic approach to the examination of the peripheral blood smear and bone marrow is discussed separately. (See "Evaluation of the peripheral blood smear" and "Evaluation of bone marrow aspirate smears".)

DEFINITION OF ANEMIA

Anemia may be defined as a reduction in red blood cell (RBC) mass or blood hemoglobin concentration. In practice, anemia most commonly is defined by reductions in one or both of the following:

Hematocrit (HCT) — The hematocrit is the fractional volume of a whole blood sample occupied by red blood cells (RBCs), expressed as a percentage. As an example, the normal HCT in a child age 6 to 12 years is approximately 40 percent.

Hemoglobin (HGB) — This is a measure of the concentration of the RBC pigment hemoglobin in whole blood, expressed as grams per 100 mL (dL) of whole blood. The normal value for HGB in a child age 6 to 12 years is approximately 13.5 g/dL (135 g/L).

                

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Literature review current through: Jul 2014. | This topic last updated: Sep 25, 2013.
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References
Top
  1. Robins EB, Blum S. Hematologic reference values for African American children and adolescents. Am J Hematol 2007; 82:611.
  2. Brugnara C, Platt OS. The neonatal erythrocyte and its disorders. In: Hematology of Infancy and Childhood, 7th, Nathan DG, Orkin SH (Eds), WB Saunders, Philadelphia 2009. p.21.
  3. Kling PJ, Schmidt RL, Roberts RA, Widness JA. Serum erythropoietin levels during infancy: associations with erythropoiesis. J Pediatr 1996; 128:791.
  4. Holland BM, Jones JG, Wardrop CA. Lessons from the anemia of prematurity. Hematol Oncol Clin North Am 1987; 1:355.
  5. Matoth Y, Zaizov R, Varsano I. Postnatal changes in some red cell parameters. Acta Paediatr Scand 1971; 60:317.
  6. Delhommeau F, Cynober T, Schischmanoff PO, et al. Natural history of hereditary spherocytosis during the first year of life. Blood 2000; 95:393.
  7. Means RT, Glader B. Anemia: General Considerations. In: Wintrobe's Clinical Hematology, 12 Ed, Greer JP, Foerster J, Rodgers GM, et al. (Eds), Lippincott Williams and Wilkins, Philadelphia 2009. Vol 1, p.784.
  8. Kalter HD, Burnham G, Kolstad PR, et al. Evaluation of clinical signs to diagnose anaemia in Uganda and Bangladesh, in areas with and without malaria. Bull World Health Organ 1997; 75 Suppl 1:103.
  9. Christensen RD, Jopling J, Henry E, Wiedmeier SE. The erythrocyte indices of neonates, defined using data from over 12,000 patients in a multihospital health care system. J Perinatol 2008; 28:24.
  10. Pappo AS, Fields BW, Buchanan GR. Etiology of red blood cell macrocytosis during childhood: impact of new diseases and therapies. Pediatrics 1992; 89:1063.
  11. d'Onofrio G, Chirillo R, Zini G, et al. Simultaneous measurement of reticulocyte and red blood cell indices in healthy subjects and patients with microcytic and macrocytic anemia. Blood 1995; 85:818.
  12. Walters MC, Abelson HT. Interpretation of the complete blood count. Pediatr Clin North Am 1996; 43:599.
  13. Thomas WJ, Collins TM. Comparison of venipuncture blood counts with microcapillary measurements in screening for anemia in one-year-old infants. J Pediatr 1982; 101:32.
  14. Novak RW. Red blood cell distribution width in pediatric microcytic anemias. Pediatrics 1987; 80:251.
  15. Sandoval C, Dong S, Visintainer P, et al. Clinical and laboratory features of 178 children with recurrent epistaxis. J Pediatr Hematol Oncol 2002; 24:47.
  16. Geller J, Kronn D, Jayabose S, Sandoval C. Hereditary folate malabsorption: family report and review of the literature. Medicine (Baltimore) 2002; 81:51.
  17. Stoltzfus RJ, Edward-Raj A, Dreyfuss ML, et al. Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe. J Nutr 1999; 129:1675.
  18. Montresor A, Albonico M, Khalfan N, et al. Field trial of a haemoglobin colour scale: an effective tool to detect anaemia in preschool children. Trop Med Int Health 2000; 5:129.
  19. Hung OL, Kwon NS, Cole AE, et al. Evaluation of the physician's ability to recognize the presence or absence of anemia, fever, and jaundice. Acad Emerg Med 2000; 7:146.
  20. Sinaki B, Jayabose S, Sandoval C. Iron-deficiency anemia associated with hiatal hernia: case reports and literature review. Clin Pediatr (Phila) 2010; 49:984.
  21. Rapaport SI. Diagnosis of anemia. In: Introduction to hematology, JB Lippincott, Philadelphia 1987. p.15.
  22. Daae LN, Hallerud M, Halvorsen S. A comparison between haematological parameters in 'capillary' and venous blood samples from hospitalized children aged 3 months to 14 years. Scand J Clin Lab Invest 1991; 51:651.
  23. Bellamy GJ, Hinchliffe RF. Venous and skin puncture blood counts compared. Clin Lab Haematol 1988; 10:329.
  24. Sandoval C. Thrombocytosis in children with iron deficiency anemia: series of 42 children. J Pediatr Hematol Oncol 2002; 24:593.
  25. Perlman MK, Schwab JG, Nachman JB, Rubin CM. Thrombocytopenia in children with severe iron deficiency. J Pediatr Hematol Oncol 2002; 24:380.