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American Academy of Pediatrics
Article

Microcytic Anemia

Matthew Richardson
Pediatrics in Review January 2007, 28 (1) 5-14; DOI: https://doi.org/10.1542/pir.28-1-5
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This article has corrections. Please see:

  • Clarification - April 01, 2007
  • Clarification - July 01, 2007
  • Corrections and Clarifications in Response to Reader Comments, 2007 - May 01, 2009

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  1. Matthew Richardson, MD*
  1. *Section of Pediatric Hematology/Oncology, Baystate Children’s Hospital, Springfield, Mass

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.

Common
  • Iron deficiency

  • Thalassemia trait (alpha or beta)

Less Common
  • Hemoglobinopathy (with or without thalassemia)

  • Inflammation

  • Thalassemia major

  • Lead toxicity

  • Sideroblastic anemia

Table 1.

Causes of Microcytic 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.

AgeMean Hemogobin (g/dL) (g/L)“−2SD”Mean Hematocrit (%) (Proportion of 1.0)“−2SD”Mean Cell Volume (mcm3)“−2SD”
Birth16.5 (165)13.5 (135)51 (0.51)42 (0.42)10898
1 to 3 d18.5 (185)14.5 (145)56 (0.56)45 (0.45)10895
1 mo14.0 (140)10.0 (100)43 (0.43)31 (0.31)10485
2 mo11.5 (115)9.0 (90)35 (0.35)28 (0.28)9677
3 to 6 mo11.5 (115)9.5 (95)35 (0.35)29 (0.29)9174
6 mo to 2 y12.0 (120)10.5 (105)36 (0.36)33 (0.33)7870
2 to 6 y12.5 (125)11.5 (115)37 (0.37)34 (0.34)8175
6 to 12 y13.5 (135)11.5 (115)40 (0.40)35 (0.35)8677
12 to 18 y
    Female14.0 (140)12.0 (120)41 (0.41)36 (0.36)9078
    Male14.5 (145)13.0 (130)43 (0.43)37 (0.37)8878
18 to 49 y
    Female14.0 (140)12.0 (120)41 (0.41)36 (0.36)9080
    Male15.5 (155)13.5 (135)47 (0.47)41 (0.41)9080
  • ↵* 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.

  • Table 2.

    Hemoglobin and Mean Cell Volume Throughout Childhood*

    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 …

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    In this issue

    Pediatrics in Review: 28 (1)
    Pediatrics in Review
    Vol. 28, Issue 1
    January 2007
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    Microcytic Anemia
    Matthew Richardson
    Pediatrics in Review Jan 2007, 28 (1) 5-14; DOI: 10.1542/pir.28-1-5

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    Microcytic Anemia
    Matthew Richardson
    Pediatrics in Review Jan 2007, 28 (1) 5-14; DOI: 10.1542/pir.28-1-5
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    • Article
      • Objectives
      • Microcytic Anemia
      • Is It Anemia? Is It Microcytic?
      • Hemoglobin Overview
      • History and Physical Examination
      • Iron Deficiency
      • Thalassemias
      • Hemoglobinopathies With and Without Thalassemia
      • Lead Poisoning
      • Anemia of Inflammation
      • Sideroblastic Anemia
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