Anemia in Children | Boston Children’s Hospital

How is anemia diagnosed?

The first step in treating your child is forming an accurate and complete diagnosis. Anemia is usually discovered during a medical exam through simple blood tests that measure the concentration of hemoglobin and the number of red blood cells. Diagnostic procedures to determine the underlying cause of the anemia may include:

• complete medical history and physical examination
• measurement of hematocrit — the percent of red blood cells found in a specific volume of blood
• hemoglobin electrophoresis to determine the amount and type of hemoglobin in the blood
• additional blood tests
• bone marrow aspiration and biopsy

There may be other diagnostic tests that your doctor will discuss with you depending on your child’s individual situation. After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child’s condition. Then we will meet with you and your family to discuss the results and outline the best possible treatment options.

What are the treatments for anemia?

Depending on the specific cause of your child’s anemia, your child’s physician may recommend a variety of different treatments. Treatments for various forms of anemia may include:

• vitamin and mineral supplements
• change in your child’s diet
• medication and/or discontinuing causative medications
• treatment of the underlying disorder
• surgery to remove the spleen (if related to certain hemolytic anemias)
• blood transfusions, if necessary (to replace significant loss)
• antibiotics (as appropriate if infection is the cause)
• stem cell transplant (for bone marrow failure, such as aplastic anemia, Fanconi anemia, or Diamond-Blackfan anemia)

Our multidisciplinary team of doctors will help determine the best approach for your child’s unique situation, based on a number of factors including age and overall health, severity of the disease, and tolerance for certain medications or therapies.

What is the long-term outlook for children with anemia?

The long-term outlook for children with anemia depends on the specific cause. Some forms of anemia, such as a nutritional deficiency, can be treated quickly and don’t require significant long-term follow-up care.

In other cases, in which the anemia is caused by a genetic condition or other serious underlying disorder, your child may need regular follow-up by our hematologists. Your child’s physician can discuss your child’s specific care plan.

We have a number of resources at Dana-Farber/Boston Children’s to help you and your family through this time. From the first visit through follow-up care, our nurses will be on hand to walk you through your child’s treatment and help answer any questions you may have. If you’d like to talk with someone whose child has been treated for anemia, we can put you in touch with other families who have been through the same experience that you and your child are facing.

How we care for anemia

Children and young adults with iron deficiency anemia receive treatment through Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, an integrated pediatric hematology and oncology partnership between Dana-Farber Cancer Institute and Boston Children’s Hospital.

Our Blood Disorders Center brings together world-renowned pediatric hematology specialists and support staff from across Dana-Farber/Boston Children’s, including pediatric hematologists/oncologists, hematopathologists, hematology nurse practitioners, social workers, and designated hematology patient coordinators. For many appointments and certain procedures, your child can also receive care at one of the Boston Children’s Hospital satellite offices.

Anaemia – Better Health Channel

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Summary

Read the full fact sheet

• Anaemia refers to a haemoglobin concentration or number of red blood cells below a specified cut-off point. This cut off point is influenced by factors such as age, gender or even geological locations.
• Haemoglobin is an important protein contained in red blood cells that function to transport oxygen to organs. A lack of this results in decreased oxygen supply to organs.
• Anaemia itself is not a disease, but an abnormal state that can be caused by a wide spectrum of medical conditions, diseases or medications.
• Low iron levels (iron deficiency) is the most common cause of anaemia.

In our circulation red blood cells carry oxygen throughout our body, transporting oxygen in specialized proteins called haemoglobin. A decreased level of haemoglobin compared to normal is referred to as anaemia. This results in a reduced capacity for blood to provide organs with oxygen. In turn, the body needs to compensate for this by working harder in order to keep up with the same requirements such as increasing the breathing rate or heart rate.

At even lower levels of haemoglobin or when there is increased demand such as heavy exercise, normal function of organs cannot be achieved and injury to organs can develop.

The onset of the symptoms can vary in speed, depending on factors such as age, fitness and presence of other health problems, if any.

Red blood cells explained

Red blood cells are produced in the bone marrow. Once mature and released into circulation they have a life span of about 120 days. The bone marrow is always making new red blood cells to replace old ones which are cleared naturally. Millions of new red blood cells enter the blood stream each day in a healthy person.

Red blood cells contain proteins called haemoglobin. These proteins incorporate iron to bind oxygen. Red blood cells are transported through our circulation to our lungs where they receive oxygen, which in turn is released when they reach our organs in different parts of our body in order to supply them with oxygen for normal function.

The manufacture of red cells requires raw materials derived from our food, such as iron and vitamin B12. Our body is also able to recycle materials when cells are naturally broken down, to a certain extent. Iron is a major component in haemoglobin, critical for its oxygen binding ability.

Red cell production is regulated through the hormone erythropoietin, produced by kidneys, which stimulates bone marrow cells in manufacturing red cells.

Since the number of red cells and concentration of haemoglobin reflects the result of production and clearance or loss, anaemia itself is an abnormal state that can be caused by a variety of conditions. Loss or destruction of red cells overwhelming the capacity to replace them or decreased red cell production can both result in anaemia, but are distinct problems represented by a wide variety of conditions.

The discovery of anaemia should prompt further investigations as to the underlying causes. The treatment options depend on the reason causing anaemia.

Causes of anaemia

Anaemia can have many causes. Examples of these include:

• Dietary deficiency – Lack of iron, vitamin B12 or folic acid in the diet
• Malabsorption – Abnormalities reducing the body’s ability to absorb nutrients in diet, such as coeliac disease
• Inherited disorders– Genetic abnormalities involving abnormal haemoglobin production, such as thalassemia or sickle cell disease; or abnormalities in the enzymes involved in haemoglobin production, such as porphyria.
• Autoimmune disorders – Red cell life span decreased due to increased clearance by immune system such as autoimmune haemolytic anaemia or thyroid disease
• Kidney disease – Decreased erythropoietin production
• Chronic inflammatory diseases – Chronic inflammation such as seen in arthritis can result in reduced ability to utilize iron in the body
• Bone marrow disorders – Decrease production of red cells resulting from a malfunctioning bone marrow, such as in blood cancer
• Blood loss – Direct loss of blood such as in trauma, surgery, blood donation, menstrual periods, gastric ulcers, intestinal polyps
• Toxins or medications – Toxins such as alcohol can directly damage bone marrow; some medications can reduce bone marrow function
• Periods of increased need – Pregnancy
• Mechanical destruction – Mechanical heart valves can damage red cells reducing their natural life span
• Infections – Anaemia in infections are often due to several different mechanisms such as in malaria

Symptoms of anaemia

Depending on the severity, the symptoms of anaemia may include:

• Pale skin
• Fatigue
• Tiring easily
• Breathlessness
• Drop in blood pressure when standing from a sitting or lying position (orthostatic hypotension) – this may happen after acute blood loss, like a heavy period
• Frequent headaches
• Racing heart or palpitations
• Becoming irritated easily
• Concentration difficulties
• Cracked or reddened tongue
• Loss of appetite
• Strange food cravings.

Groups at high risk of anaemia

Certain people are at increased risk of anaemia, including:

• Menstruating women
• Pregnant and breastfeeding women
• Babies, especially if premature
• Children going through puberty
• People following a vegetarian or vegan diet
• People with cancer, stomach ulcers and some chronic diseases (particularly kidney disease & those on dialysis)
• People on fad diets
• Athletes.

Investigations in anaemia

Anaemia itself is demonstrated by doing a blood test measuring Full Blood Count (FBC) which will include Haemoglobin levels and red cell indices.

As the potential causes of anaemia are extremely varied, several other investigations are also needed. A thorough medical history and examination is required to elicit clues as to the underlying cause. Further specialized blood tests such as iron studies, hormone levels, kidney function might be required. More invasive tests such as endoscopy or bone marrow biopsy may need to be utilized in appropriate situations.

Treatment for anaemia

The treatment for anaemia is dependent on and should target the underlying problem. Causes of anaemia range from simple and mild to extremely severe and even life threatening.

If anaemia is due to more complex causes, other specialists such as haematologist or gastroenterologist may be involved in the management.

Treatment choice can also depend on the severity of anaemia or other factors influencing the health of someone with anaemia, such as age or the speed of development of anaemia.

Long-term outlook for people with anaemia

As the causes of anaemia a wide-ranging, prognosis of people with anaemia depends on the cause of their anaemia. For example, if the anaemia is caused by dietary deficiencies, correcting the cause and the use of appropriate supplements for some weeks or months will resolve the condition. Relapses may occur, so changes to diet and, perhaps, regular supplements may be necessary.

In other cases, the anaemia may be permanent and lifelong treatment is needed. No matter what the cause, it is important to have a doctor regularly monitor your blood to make sure your red blood cell and haemoglobin levels are adequate and to adjust treatment if required.

Prevention of anaemia

Some forms of anaemia can’t be prevented because they are caused by a breakdown in the cell-making process. Anaemia caused by dietary deficiency can be prevented by making sure that you eat food from certain food groups on a regular basis, including dairy foods, lean meats, nuts and legumes, fresh fruits and vegetables.

If you follow a vegan diet (one that does not include any animal products) talk to your health professional about recommended vitamin and mineral supplements.

If you have kidney disease, you should be tested for anaemia, 1 in 2 people with kidney disease will develop anaemia.

Where to get help

• Your GP (doctor)
• Dietitians AustraliaExternal Link Tel. 1800 812 942
• Kidney HelplineExternal Link Tel. 1800 454 363

• Allali, S., Brousse, V., Sacri, A.-S., Chalumeau, M., & de Montalembert, M. (2017). Anemia in children: prevalence, causes, diagnostic work-up, and long-term consequences. Expert Review of Hematology, 10(11), 1023-1028. doi:10.1080/17474086.2017.1354696
• Cappellini, M. D., Russo, R., Andolfo, I., & Iolascon, A. (2020). Inherited microcytic anemias. Hematology, 2020(1), 465-470. doi:10.1182/hematology.2020000158
• Halawi, R., Moukhadder, H., & Taher, A. (2017). Anemia in the elderly: a consequence of aging? Expert Review of Hematology, 10(4), 327-335. doi:10.1080/17474086.2017.1285695
• Liu, K., & Kaffes, A. J. (2012). Iron deficiency anaemia: a review of diagnosis, investigation and management. European Journal of Gastroenterology & Hepatology, 24(2).
• Newhall, D. A., Oliver, R., & Lugthart, S. (2020). Anaemia: A disease or symptom. Neth J Med, 78(3), 104-110.
• Partridge, J. , Harari, D., Gossage, J., & Dhesi, J. (2013). Anaemia in the older surgical patient: a review of prevalence, causes, implications and management. J R Soc Med, 106(7), 269-277. doi:10.1177/0141076813479580.
• World Health OrganizationExternal Link. (n.d.). Anaemia. Retrieved September 13, 2022.

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Reviewed on: 26-09-2022

Anemia – symptoms, treatment, diagnosis

Anemia – symptoms, treatment, diagnosis

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Anemia is a condition in which there is a decrease in the content of red blood cells and hemoglobin protein in the blood, which deliver oxygen to the organs. Patients most often experience weakness, fatigue, often freeze. There are several types of anemia. The most common is the iron deficiency form.

Every year, anemia of varying degrees is diagnosed in two billion people. It is more common in developing countries, but also affects people in industrialized countries.

Forms

There are several forms of anemia, each of which causes a decrease in the amount of red blood cells in the body in the bloodstream. The level drops for one of the following reasons:

• Reduced hemoglobin production
• Synthesis of deformed hemoglobin unable to transport oxygen
• Reduced red cell synthesis
• Premature destruction of red blood cells in the body

Symptoms

Fatigue, shallow short breathing, a feeling of coldness in the legs and hands are characteristic signs. The following symptoms occur:

• Dizziness, weakness
• Headaches
• Pale, dry skin, bruising
• Restless legs syndrome – discomfort in the lower leg, unintentional motor activity of the lower extremities more often during sleep
• Cold hands and feet
• Palpitations
• Shortness of breath

Causes

Each form has its own reason:

• Iron deficiency anemia. It develops against the background of a lack of iron in the body. It is required for the production of hemoglobin in the bone marrow. Iron deficiency anemia is caused by blood loss, such as during heavy menstruation, stomach or small intestine ulcers, colon cancer; with regular use of painkillers, an inflammatory lesion of the gastric mucosa with bleeding can occur. It is important to determine the source of blood loss in order to prevent recurrence.
• Vitamin deficiency anemia. Sufficient amounts of vitamin B-12 and folic acid are required for synthesis. A diet low in key nutrients and vitamins leads to anemia.
• Anemia of chronic inflammation. HIV/AIDS, cancer, rheumatoid arthritis, chronic kidney disease, Crohn’s disease and a number of other chronic diseases interfere with red blood cell synthesis.
• Anemia associated with diseases of the bone marrow. Leukemia, myelofibrosis can disrupt the construction of red blood cells.
• Hemolytic anemia. Associated with premature destruction and inappropriate disposal with the formation of new red cells.
• Sickle cell anemia. Hereditary pathology, characterized by defective red cells that are not able to tolerate hemoglobin and are destroyed prematurely.

Diagnostics

If anemia is suspected, the attending physician – the therapist prescribes a blood test. The main laboratory test is a complete blood count, which shows the content of red blood cells, their shape, size, and hemoglobin level. The purpose of additional tests depends on the type of suspected anemia:

• Vitamin B test for suspected vitamin deficiency anemia
• Urinalysis for suspected hemolytic anemia
• Colonoscopy, esophagogastroduodenoscopy for suspected gastrointestinal bleeding
• Puncture with bone marrow biopsy in rare cases with suspected leukemia, myelofibrosis.

Treatment at the Federal Scientific and Practical Center

Therapy depends on the cause of the anemia. Iron deficiency anemia is treated with:

• Prescription of iron tablets
• Intravenous iron preparations
• Surgery with blood transfusion for established internal bleeding

Hereditary diseases (sickle cell anemia) in some cases require bone marrow transplantation. Attention is paid to anemia, which is a symptom of oncological pathology and can be aggravated after chemotherapy. Between chemotherapy sessions, blood counts are always monitored, if necessary, drugs are prescribed for correction in order to carry out a further course of treatment.

An important recommendation is to enrich the diet with foods high in iron and vitamin C, which improves iron absorption.

At the first suspicion of this disease, you should consult a general practitioner. He will prescribe a diagnosis, based on the results of which he will draw up a treatment plan. Physicians – therapists of the Federal Scientific and Practical Center have extensive experience in diagnosing and treating diseases. An integrated approach to patient management and modern methods of treatment are the key to a quick recovery.

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What is anemia and how to deal with it? – article on the site Aptechestvo, Nizhny Novgorod

What is anemia?

Anemia is a clinical and hematological syndrome that occurs due to various reasons. It is a pathological condition of the body caused by a low content of hemoglobin in the blood. Its main danger is that it complicates the transfer of oxygen to tissues and develops hypoxia or oxygen starvation. This is due to the fact that hemoglobin is part of the red blood cells and is involved in its transportation. This protein also promotes the utilization of carbon dioxide and helps deliver it to the lungs.

Anemia can be an independent disease, or it can accompany oncological and infectious diseases, ulcers, polyps, and helminthic invasions. The basis for diagnosis is a clinical blood test and patient complaints. To identify the causes of pathology, instrumental research methods are necessarily assigned. This helps to establish the presence of tumors and disorders of the internal organs.

Symptoms and degrees of anemia

The diagnosis is established when the hemoglobin content is below 130 g/l in men and less than 120 g/l in women. This is the main symptom of the disease. In children, the acceptable level of hemoglobin depends on age. The lower this indicator, the more severe the anemia of the degree, which is presented below:

• Light, Hb 120-95 g/l;

• Average, Hb 94-80 g/l;

• Severe, Hb 79-65 g/l;

• Life-threatening, Hb < 65 g/l.

Externally, anemia, the symptoms of which will be described below, manifests itself depending on the severity of the condition. The lower the hemoglobin values, the more pronounced the clinical picture. There are general signs of the disease that make up the anemic syndrome, and symptoms that characterize only specific types of the disease. Common include weakness, pallor, dizziness, fainting, shortness of breath, palpitations. In iron-deficient forms of the disease, fragility of nails, hair loss, burning of the tongue, changes in taste are added to them. The picture may be blurry with mild to moderate degrees.

Species

Depending on the causes, blood anemia is divided into the following types:

Iron deficiency anemia (IDA) is the most common. It is caused by a lack of iron in the body in violation of the intake or absorption of this element.

Posthemorrhagic appearance occurs as a result of excessive blood loss. At the same time, hemoglobin sharply decreases, oxygen starvation and circulatory disorders occur.

With intensive destruction of red blood cells, when the bone marrow does not have time to replenish their number, hemolytic anemia develops.

The aplastic form of the disease is the result of a violation of hematopoiesis. This reduces the production of all blood cells, including red blood cells.

The pernicious variety occurs with disorders caused by a lack of vitamin B12.

Causes

Usually anemia, the causes of which are different, is provoked by the following factors:

• the nature of the diet;

• violation of hematopoiesis;

• chronic blood loss;

• violation of absorption processes.

Chronic blood loss occurs due to small but prolonged bleeding. They are observed with hemorrhoids, heavy menstruation, gastric ulcers, oncological diseases. This causes the depletion of iron stores, which is not replenished with the intake of food. The result is impaired hemoglobin production.

The occurrence of this pathology during pregnancy is caused by an increase in the need for trace elements and vitamins. Deficiency anemia usually develops in women. This is due to insufficient initial iron content in the body of the expectant mother.

The risk of developing the disease is exacerbated by demographic and social factors, which include low income, poor nutrition.

Treatment

Each anemia, the treatment of which is carried out in a complex, is treated depending on its type. The algorithm includes the following steps:

To find out the causes of chronic blood loss, consultations of narrow specialists are prescribed.