Introduction Anaemia is the most common problem in children. Majority of the children are managed in the primary care settings. We had a 3 and a half year old girl presenting to children’s emergency department being unwell with profound pallor and lethargy. Her initial haemoglobin was 13 g/L(1.3 g/dl). She was stabilised and managed appropriately. Her most of the haematological investigations were normal apart from iron defiency . This case prompted us to investigate the common causes of severe anaemia in children.
Objectives We aimed to investigate the underlying causes of profound anaemia in children presenting to DGH settings. For the purpose of the study we classified children with haemoglobin < 50 g/L (5 g/dl) as profoundly anaemia.
Methods A retrospective analysis of case notes of children with haemoglobin < 50 g/L over the period from June 2011 to June 2013 was carried out. This data was obtained through the haematology laboratory records.
Results In total 21 cases were identified, 7 cases were excluded as 6 presented on the neonatal unit and were felt to be of differing aetiology to out paediatric population. The other case was excluded as the child had a known diagnosis of sickle cell disease. Of the 14 remaining cases 8 were female, they ranged from ages of 11 days to 13.5 years (Figure 1.) The mean Hb level was 36 g/L(13–47.)
The most frequently occurring presenting symptoms included lethargy, jaundice and pallor (Figure 2) and the most frequently occurring diagnosis was iron deficiency anaemia (50%). The other causes included leukaemia (2 cases), G6PD deficiency, diamond blackfan anaemia, haemolytic anaemia (2 cases) and hereditary spherocytosis with concurrent parvovirus.
Conclusions Iron deficiency anaemia remains the most common cause for profound anaemia in children. Also children with underlying oncological or haematological disorders can present with anaemia as the clinical picture.
This study highlights the common causes of severe anaemia in children and the need for thorough investigation of severe anaemia.
Bootha IW, Aukett MA. Iron deficiency anaemia in infancy and early childhood. Arch Dis Child 1997;76:549–554 doi:10.1136/adc.76.6.549
Oski FA. Iron deficiency in infancy and childhood. N Engl J Med 329:190–193
Galloway, MJ and Smellie, WS. Investigating iron status in microcytic anaemia. BMJ 2006;333:791-793.