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American Academy of Pediatrics
Index of Suspicion

Microcytic Anemia

Richard Zanetti, Brian Feldman and Timothy Porea
Pediatrics in Review January 2021, 42 (1) 41-43; DOI: https://doi.org/10.1542/pir.2019-0295
Richard Zanetti
*Walter Reed National Military Medical Center, Bethesda, MD
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Brian Feldman
†Naval Medical Center Portsmouth, Portsmouth, VA
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Timothy Porea
‡Texas Children’s Hospital and Baylor College of Medicine, Houston, TX
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  1. Richard Zanetti, MD, MPH*
  2. Brian Feldman, MD, MPH†
  3. Timothy Porea, MD, MPH‡
  1. *Walter Reed National Military Medical Center, Bethesda, MD
  2. †Naval Medical Center Portsmouth, Portsmouth, VA
  3. ‡Texas Children’s Hospital and Baylor College of Medicine, Houston, TX
  • AUTHOR DISCLOSURE

    Dr Porea holds stock in Walgreens and Merck. Drs Zanetti and Feldman have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Presentations

Herein we present 3 different patient presentations with a common diagnosis.

  • Case 1: A 9-year-old boy with a normal diet presents for evaluation of fatigue. During review of systems, intermittent loose stools without hematochezia are reported. Screening laboratory values are obtained and reveal microcytic anemia (red blood cell [RBC] count, 4.6×106/μL [4.6×1012/L]; hemoglobin level, 9.6 g/dL [96 g/L]; mean cell volume [MCV], 66 fL; and RBC distribution width [RDW], 14.7%) and a low serum iron level (<9 μg/dL [1.61 μmol/L]). He is given a presumptive diagnosis of iron deficiency and is started on replacement therapy. Four weeks later, repeated laboratory tests show only mild improvement (RBC count, 4.91×106/μL [4.91×1012/L]; hemoglobin level, 10.3 g/dL [103 g/L]; MCV, 66 fL; RDW, 15.6%; ferritin level, 19 ng/mL). Additional laboratory values at this time reveal an elevated erythrocyte sedimentation rate (ESR) (32 mm/hr) and a decreased albumin level (2.6 g/dL [26 g/L]).

  • Case 2: A 14-year-old boy with a regular diet is found to have microcytic anemia (RBC count, 4.5×106/μL [4.5×1012/L]; hemoglobin level, 8.7 g/dL [87 g/L]; MCV, 60 fL; RDW, 15.6%) during evaluation for an acute febrile respiratory illness. At presentation he also reports a history of fatigue and 4 to 8 bowel movements per day with occasional episodes of hematochezia that predated his febrile illness. Further evaluation demonstrates occult blood in his stool on 3 separate samples, as well as a low albumin level (2.2 g/dL [22 g/L]) and an elevated ESR (55 mm/hr). …

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Pediatrics in Review: 42 (1)
Pediatrics in Review
Vol. 42, Issue 1
1 Jan 2021
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Microcytic Anemia
Richard Zanetti, Brian Feldman, Timothy Porea
Pediatrics in Review Jan 2021, 42 (1) 41-43; DOI: 10.1542/pir.2019-0295

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Microcytic Anemia
Richard Zanetti, Brian Feldman, Timothy Porea
Pediatrics in Review Jan 2021, 42 (1) 41-43; DOI: 10.1542/pir.2019-0295
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