Childhood Anemia

Definition of childhood anemia

Hb <11 g/dL or Hct <33% in children

Etiology of anemia

Three mechanisms: decreased RBC production, increased RBC destruction (hemolysis), or blood loss

Risk factors for iron deficiency anemia

Excessive cow’s milk intake, picky eating, poor diet, prematurity, menorrhagia, GI bleeding, exclusive breastfeeding beyond 4–6 months without supplementation.

Treatment of iron deficiency anemia

Ferrous sulfate 3–6 mg/kg/day; vitamin C for absorption

Side effects of iron therapy

Constipation, nausea, abdominal pain, irritability, dark stools, temporary tooth staining.

Reasons for poor response to iron therapy

Noncompliance, excessive milk intake, ongoing blood loss, poor absorption, short duration, high gastric pH, incorrect diagnosis (thalassemia, inflammation, malignancy).

Thalassemia trait

Inherited hemoglobinopathy causing microcytosis with normal/high RBC count and normal RDW

Therapy for beta thalassemia major

Chronic transfusions, iron chelation, splenectomy for hypersplenism, curative stem cell transplant, gene therapy (lentiviral addition or CRISPR editing).

Therapy for sickle cell anemia

Supportive care, transfusions, curative stem cell transplant, gene therapy (BCL11A editing to increase fetal Hb).

Hemoglobin E often seen

Common in Southeast Asia

Transient erythroblastopenia of childhood (TEC)

Self-limited pure red cell aplasia

Neonatal alloimmune hemolytic anemia (aka Hemolytic Disease of the Newborn)

Maternal antibodies attack fetal RBCs (Rh, ABO, Kell)

Intrinsic hemolytic anemias

Membrane defects (spherocytosis, elliptocytosis), enzyme defects (G6PD, PK), unstable hemoglobins

Key diagnostic approach

Use MCV + reticulocyte count to categorize anemia and narrow differential.