In this lecture, we’re going
to review anemia in children.
It’s a complicated topic and broad,
but we’re going to try and
cover it in a systematic way.
So anemia is a drop in
hemoglobin or hematocrit
by more than 2 standard deviations.
There are three major categories
that we think of anemia as being in.
One is impaired production.
If you can’t make red blood
cells, you’ll have fewer of them.
Another is increased destruction.
If you’re destroying them,
you’ll have fewer of them.
And the last is just
general blood loss.
So if we’re looking at the area
of impaired production of cells,
there’s a couple of
different ways this can go.
The first is the patient could
have a true red cell aplasia.
They’re simply not
making red blood cells.
Causes of this include the
parvovirus B19 infection.
So the virus comes in, it actually
suppresses bone marrow production.
Patients may have a congenital inability
to actually make red blood cells,
a congenital erythroblastopenia
such as Blackfan-Diamond anemia.
Or children can get a unique disease
usually in the first few years of life
erythroblastopenia of childhood.
In this condition, they transiently
stop making red blood cells
and then recover from
that a few months later.
Very rare, patients could
have aplastic anemia,
Fanconi anemia, leukemia,
there are other causes.
Moving on, patients can have
This can be because of a problem with
actually just making the red cells.
They're having a difficulty at some stage.
One is obviously iron deficiency.
Patients could also be
folate or B12 deficient.
Chronic inflammation such as
juvenile idiopathic arthritis
can cause an ineffective
Chronic renal failure can
decrease EPO production
and thus, there will be
And lead poisoning can interfere
with red cell production
and cause an ineffective
Very rarely, patients may have
a myelodysplastic syndrome.
Okay. What about increased destruction?
Well, there are red cell membrane
disorders like hereditary spherocytosis
or hereditary elliptocytosis
and we’ll go through those.
Patients may have red cell
enzyme disorders like
In that case, they are having
attack of the red blood cells
because of uncontrolled
Patients may have hemoglobinopathy,
something like a thalassemia
or sickle cell disease.
Or there can be an autoimmune
attack on the red blood cell
such as autoimmune hemolytic anemia
or hemolytic anemia of the newborn.
In terms of blood loss situations,
babies at birth can experience blood loss
through a difficult labor and loss of
blood through the umbilical stump.
In GI disease, patients may have
polyps or a Meckel’s diverticulum
that’s causing excessive
bleeding out of the anus
and they’re losing
blood that way.
Or there can be other causes of blood if a
patient especially has a bleeding disorder
like Von Willebrand or hemophilia
or just a really bad trauma.