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(Pediatrics in Review. 2007;28:5-14.)
© 2007 American Academy of Pediatrics

Microcytic Anemia

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Discuss the common causes of microcytic anemia in children.
   
2. Define the most common cause of microcytic anemia in children.
   
3. Distinguish iron deficiency anemia from beta thalassemia trait.
   
4. Recognize when disorders of beta-globin may present in infants.
   

	Microcytic Anemia

 
Anemia is the most common hematologic abnormality that pediatricians encounter. The differential diagnosis for anemia in children includes congenital, acquired, benign, malignant, common, and extraordinarily rare disorders. Thankfully, most conditions cause consistent changes in the mean cell volume (MCV) of red blood cells (RBCs) and can be grouped by using this parameter. In children, anemia is caused most often by disorders that result in smaller-than-normal RBCs (microcytosis) (Table 1). With a thorough history, a good physical examination, and perhaps some additional blood work, the correct cause of a child’s microcytic anemia can be discovered.

Table 1. Causes of Microcytic Anemia

Common Iron deficiency Thalassemia trait (alpha or beta) Less Common Hemoglobinopathy (with or without thalassemia) Inflammation Thalassemia major Lead toxicity Sideroblastic anemia

	Is It Anemia? Is It Microcytic?

 
Automated blood counters may not take into account the normal variations in hemoglobin/hematocrit and MCV that are seen throughout childhood. Results reported as abnormal must be compared with age-specific values (Table 2). Values that are 2 standard deviations below the age-appropriate mean can be considered abnormal.

Table 2. Hemoglobin and Mean Cell Volume Throughout Childhood^*

Age Mean Hemogobin (g/dL) (g/L) "–2SD" Mean Hematocrit (%) (Proportion of 1.0) "–2SD" Mean Cell Volume (mcm3) "–2SD" Birth 16.5 (165) 13.5 (135) 51 (0.51) 42 (0.42) 108 98 1 to 3 d 18.5 (185) 14.5 (145) 56 (0.56) 45 (0.45) 108 95 1 mo 14.0 (140) 10.0 (100) 43 (0.43) 31 (0.31) 104 85 2 mo 11.5 (115) 9.0 (90) 35 (0.35) 28 (0.28) 96 77 3 to 6 mo 11.5 (115) 9.5 (95) 35 (0.35) 29 (0.29) 91 74 6 mo to 2 y 12.0 (120) 10.5 (105) 36 (0.36) 33 (0.33) 78 70 2 to 6 y 12.5 (125) 11.5 (115) 37 (0.37) 34 (0.34) 81 75 6 to 12 y 13.5 (135) 11.5 (115) 40 (0.40) 35 (0.35) 86 77 12 to 18 y     Female 14.0 (140) 12.0 (120) 41 (0.41) 36 (0.36) 90 78     Male 14.5 (145) 13.0 (130) 43 (0.43) 37 (0.37) 88 78 18 to 49 y     Female 14.0 (140) 12.0 (120) 41 (0.41) 36 (0.36) 90 80     Male 15.5 (155) 13.5 (135) 47 (0.47) 41 (0.41) 90 80

^* Adapted from Nathan DG, Orkin SH, Look AT, Ginsburg D, eds. Nathan and Oski’s Hematology of Infancy and Childhood. 6th ed. Philadelphia, Pa: Saunders; 2003, with permission from Elsevier.

	Hemoglobin Overview

 
Because disorders of heme metabolism or globin synthesis can lead to microcytic anemia, an appreciation of hemoglobin structure and how it changes over the first few months after birth is important. Hemoglobin is produced by a multistep process involving several enzymes in mitochondria and the cytosol. Hemoglobin consists of an iron-containing heme ring associated with four globin chains (Fig. 1). Except for the first few weeks after conception, the dominant hemoglobin . . . [Full Text of this Article]

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