Anemia: Questions & Cases

By: Nikki Timko, MD

Learning Objectives:

1. Understand the process of diagnostic evaluation of children with anemia.

2. Describe common reasons for iron deficiency

3. Describe the treatment plan for a child with iron deficiency

4. Understand steps for management if the child does not respond to a trial of iron supplementation.
Contents


Questions and Cases

1. An eight week old is brought to your office with a temperature of 102. A CBC is drawn as part of your work-up for fever. The results show: 10.1> 9.6/29 < 256 MCV 90 RDW 16

Is this patient anemic? Does this patient require treatment for the low hemoglobin?

2. A one year old child with no significant past medical history comes in for a routine visit. You draw a CBC and lead as per routine. The results show: 8.5 > 10.2/30 < 256 MCV 76.9 MCH 27.8 RDW 13.2 Lead of 2

• What is your next step?
• What type of anemia does this child have based on indices?
• You obtain a dietary history that explains your findings.
• What have you heard?
• What changes do you suggest?
• Why do we choose to treat?

3. A grandparent brings in her 3 year old grandchild of whom she has recently gained custody. She brings in a vaccine card which shows the child had a Hg of 8 for a WIC visit 2 days ago.

Results of your screening CBC and lead show: 8.5 > 8.2/26 < 256 MCV 69.1 Lead 3 RDW 20 Reticulocyte count 1

• You obtain a dietary history that explains your findings. What have you heard?
• What changes do you suggest?
• What do you advise next?
• What if the hemoglobin does not improve with iron therapy?

4. A teenage girl comes in for a routine annual visit. She has regular menses monthly lasting 7 days. She reports she eats fruits, vegetables and meats and drinks juice and soda.

You order a CBC with these results: 6.5 > 10.6/ 34 < 256 MCV 69.1 RDW 16

• What advice do you give her?


References:

Required: Richardson M. Microcytic Anemia. Pediatrics in Review. 2007:28:5-15.

WBC Discussion Group on Iron Deficiency and Microcytic Anemia

Oski, Iron Deficiency in Infancy and Childhood. NEJM. July15, 1993 (link)

Suggested:

1. Wu AC, et al. Screening for iron deficiency. Pediatrics in Review. 2002;23:171-7.

2. Hermiston M, Mentzer W. A practical approach to the evaluation of the anemic child. The Pediatric Clinics of North America. 2002;49: 877-91.

3. White K. Anemia is a poor predictor of iron deficiency among toddlers in the United States: for heme the bell tolls. Pediatrics. 2005;115: 315-20.

4. Segel G, et al. Managing anemia in pediatric office practice: part 1. Pediatrics in Review. 2002;23: 75-84.

5. Segel G, et al. Managing anemia in a pediatric office practice: part 2. Pediatrics in Review. 2002;23: 111-22.