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Anemia in Children -- American Family Physician

Source: www.aafp.org
Topic: Anemia
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Sort Desciption: OCTOBER 15, 2001 / VOLUME 64, NUMBER 8 www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1379 in developing humans: the embryonic, Gower-I, Gower-II, Portland, fetal hemoglobin (HbF) and normal adult hemoglobin (HbA and HbA 2 ). ...

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Anemia in Children - American Family Physician OCTOBER 15, 2001 / VOLUME 64, NUMBER 8 www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1379 in developing humans: the embryonic, Gower-I, Gower-II, Portland, fetal hemoglobin (HbF) and normal adult hemoglobin (HbA and HbA 2 ). HbF is the primary hemoglobin found in the fetus. It has a higher affinity for oxygen than adult hemoglobin, thus increasing the efficiency of oxygen transfer to the fetus. The relative quantities of HbF rapidly decrease to trace levels by the age of six to 12 months and are ultimately replaced by the adult forms, HbA and HbA 2 . General Approach to Management Most children with anemia are asymptomatic and have an abnormal hemoglobin or hematocrit level on routine screening (Table 1). 2 Infrequently, a child with anemia may have pallor, fatigue and jaundice but may or may not be critically ill. Key historical points and findings on physical examination can reveal the underlying cause of the anemia. The newborns body reclaims and stores iron as the hematocrit levels decrease during the first few months of life. Therefore, in fullterm infants, iron deficiency is rarely the cause of anemia until after six months of age. In premature infants, iron deficiency can occur only after the birth weight has been doubled. X-linked causes of anemia, such as glucose-6phosphate dehydrogenase (G6PD) deficiency, should be considered in males. Pyruvate kinase deficiency is autosomal recessive and associated with chronic hemolytic anemia of A nemia is a frequent laboratory abnormality in children. As many as 20 percent of children in the United States and 80 percent of children in developing countries will be anemic at some point by the age of 18 years. 1 Physiology of Hemoglobin Production Erythropoietin is the primary hormone regulator of red blood cell (RBC) production. In the fetus, erythropoietin comes from the monocyte/macrophage system of the liver. Postnatally, erythropoietin is produced in the peritubular c ...

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