Anemia in the pediatric patient

Abstract

The World Health Organization estimates that approximately a quarter of the world's population suffers from anemia, including almost half of preschool age children. Globally, iron deficiency anemia is the most common cause of anemia. Other important causes of anemia in children are the hemoglobinopathies, infection, and other chronic diseases. Anemia is associated with increased morbidity, including neurologic complications, increased risk of low birth weight, infection, and heart failure, as well as increased mortality. When approaching a child with anemia, detailed historical information, particularly diet and environmental exposures, and family history often yield important clues to the diagnosis. Dysmorphic features on physical examination may indicate syndromic causes of anemia. Diagnostic testing involves a stepwise approach utilizing various laboratory techniques. The increasing availability of genetic testing is providing new mechanistic insights into inherited anemias and allowing diagnosis in many previously undiagnosed cases. Population-based approaches are being taken to address nutritional anemias. Novel pharmacologic agents and advances in gene therapy-based therapeutics have the potential to ameliorate anemia-associated disease and providing treatment strategies even in the most difficult and complex cases.

Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy

“…Multiple micronutrients play a role in the development of anemia: in particular iron, but also folate, vitamin B12, copper ( 51 ), and vitamin E ( 52 ). Mild or moderate chronic anemia may present with fatigue, pallor, exercise intolerance, tachycardia, and/or syncope, or may be asymptomatic due to compensatory mechanisms.…”

“…Severe chronic anemia can cause growth failure and neurodevelopmental impairment. Patients with severe anemia are at increased risk of heart failure ( 51 ) and adverse outcomes related to pre existing heart conditions.…”

Severe Hemolytic Anemia: Atypical Presentation of Cobalamin Deficiency

“…Pediatric nonimmune hemolysis is mainly associated with intrinsic disorders of the erythrocyte, such as defects of RBC membrane, enzymatic defects or of hemoglobin synthesis, or acquired disorders, such as paroxysmal nocturnal hemoglobinuria or microangiopathic phenomena, mostly hemolytic uremic syndrome (HUS), TTP, or disseminated intravascular coagulation. 1 A peripheral blood smear can inform on the presence of schistocytes, which may be found in microangiopathic anemia. Case 1 presented with microangiopathic anemia (normocytic nonimmune anemia with evidence of hemolysis and schistocytes on a peripheral blood smear).…”

“…A less frequent cause of anemia is cobalamin deficiency, which may result from either acquired (decreased intake or reduced absorption) or inherited abnormalities (absorption, transport, or metabolism of vitamin B12). 1 Although uncommon in developed countries, its prevalence is rising in African and Asian countries (up to 80% in Indian preschool children), 2 related to poverty and cultural vegetarian diets. Since cobalamin is an essential cofactor in methylation processes in reactions involving DNA and cell metabolism, its deficit manifests not only as ineffective hematopoiesis but also as faltering growth, developmental delay, or neurological symptoms.…”

“…Since cobalamin is an essential cofactor in methylation processes in reactions involving DNA and cell metabolism, its deficit manifests not only as ineffective hematopoiesis but also as faltering growth, developmental delay, or neurological symptoms. 1,2 Hematological manifestations typically include macrocytic anemia, which may be transfusion-dependent. The other blood cell lineages may be affected, simulating acute leukemia or aplastic anemia.…”