The changing face of anemia in infancy

Clinicolaboratory findings and treatment of iron-deficiency anemia in childhood

One of the major causes of anemia in childhood worldwide is iron deficiency. Its prevalence depends mainly on age, being higher in infancy and adolescence. Its etiology varies, but poor iron diet is considered the commonest causative factor. Better tactics may be needed, like the targeted screening of children who belong to high-risk groups, to eradicate childhood iron deficiency. The amount of the body iron regulates its absorption from the gut through mechanisms that are still poorly understood. Early identification of iron deficiency is essential for the prevention not only of anemia but also the numerous and long-term consequences caused by the lack of iron. Many tests are available for the diagnosis of the disease. Some of them seem very promising for the early detection of iron deficiency, but further research is needed before they become widely acceptable in clinical practice. Treatment is based on oral iron salts, which do not have any serious side effects.

The anemia of inflammation. A common cause of childhood anemia

Pediatricians should understand that the anemia of inflammation is second only to iron deficiency in overall incidence. When evaluating a child for mild to moderate anemia, one should always consider hemolytic anemia, both immune and congenital, and blood loss. Careful scrutiny of the peripheral blood smear is always helpful and can assist in minimizing expensive and unnecessary evaluations. When the anemia of inflammation is suggested by history or physical examination and the CBC reveals a normocytic, or possibly microcytic, mild to moderate anemia with a normal peripheral blood smear, it is prudent to not embark on an extensive evaluation for the anemia but instead wait for the inflammation to resolve. This may take as many as 3 months, depending on the degree of inflammation. Because the anemia resolves with subsiding inflammation, it is best to avoid treatment with iron or RBC transfusions. More studies need to be performed concerning the pathogenesis of the anemia of acute inflammation in children and the best course of treatment, if needed. The role of erythropoietin in the treatment of this form of anemia, though promising in some adult models of inflammation, awaits exploration in pediatric patients.