Diagnosing Anemia in Children
Anemia is a common condition in children. About 20% of children in the U.S. will be
diagnosed with anemia at some point. A child who is anemic does not have enough red
blood cells or enough hemoglobin. Hemoglobin is a special type of protein that allows
red blood cells to carry oxygen to other cells in the body.
Anemia has three main causes. They are a loss of red blood cells from bleeding, inability
to make enough red blood cells, and a medical condition that causes the destruction
of red blood cells.
In most cases, anemia can be diagnosed with a few simple blood tests. The American
Academy of Pediatrics currently recommends universal screening for anemia with a hemoglobin
test at one year of age. It should include an assessment for any risk factors for
iron deficiency anemia. In addition, if the hemoglobin level is low, more evaluation
is needed to determine the type of anemia present. If any risk factors are known to
be present at any age, a test for anemia should be performed. For older children,
a blood test for anemia may be done during a child's routine physical exam.
Symptoms of anemia in children
Many children with anemia have no symptoms. That's why it's important for children
to have routine blood tests to check for the condition. Some of the signs and symptoms
that might make a healthcare provider suspect anemia in a child include:
Yellow skin color
Blood tests for diagnosing anemia
To get a blood sample, a healthcare provider will insert a needle into a vein, usually
in the child's arm or hand. A tourniquet may be wrapped around the child's arm to
help the healthcare worker locate a vein. Blood may be drawn up into a syringe or
a test tube. In some cases, blood can be taken using a needle prick.
Blood tests may cause a little discomfort while the needle is inserted, and the needle
may cause some bruising or swelling. After the blood is removed, the healthcare provider
will remove the tourniquet, put pressure on the area, and apply an adhesive bandage.
It's possible to have persistent bleeding, nerve damage, or infections from a blood
test, but these risks are small. In most cases, a child will not need any special
preparation or care after a blood test.
Most anemias in children can be diagnosed with these blood tests:
Hemoglobin and hematocrit. This is often the first screening test for anemia in children. It measures the amount
of hemoglobin in the blood and the amount of red blood cells in the blood sample.
Complete blood count, or CBC. If hemoglobin or hematocrit is abnormal, a complete blood count may be done. This
test adds important information about the blood, including the size of red blood cells
(called the mean corpuscular volume, or MCV).
Peripheral smear. This test involves a smear of blood on a slide that is examined under a microscope.
By looking at a child's blood cells under a microscope, a lab specialist may be able
to diagnose a type of anemia that causes red cells to grow or develop abnormally.
Reticulocyte count. Reticulocytes are immature blood cells. A reticulocyte count measures the percentage
of newly formed red blood cells in the child's blood sample. Anemia caused by not
enough red blood cells being made results in a low reticulocyte count. Anemia caused
by too many red blood cells being lost causes a high reticulocyte count.
Types of anemia in children
Once a healthcare provider has evaluated the child's blood tests, the type of anemia
can usually be determined and treatment can be started. Children's anemia can be classified
by the size of their red blood cells:
Microcytic anemia. This means the child's red blood cells are smaller than normal. The most common cause
of microcytic anemia is iron deficiency.
Normocytic anemia. This means the child's red blood cells are normal in size. Normocytic anemia has many causes
and may require other special types of blood tests.
Macrocytic anemia. This means the child's red blood cells are larger than normal. This is the rarest
type of anemia in children. It may be caused by vitamin B12 deficiency.
Treating anemia in children depends on the type of anemia and its cause. In some cases,
treatment may need simply a change in diet or the use of diet supplements. In other
cases, a blood transfusion or long-term treatment may be needed. Screening for anemia
is an important part of caring for a child. Many problems caused by anemia can be
prevented when anemia in children is diagnosed at an early stage.