RespiteMatch.com Health Blog

Anemia, one of the more common blood disorders, occurs when the number of healthy red blood cells decreases in the body. The disc-shaped red blood cells contain hemoglobin, a unique molecule that carries oxygen to the body’s tissues.

Anemia occurs for different reasons. These include:

increased destruction (break down) of red blood cells (RBCs)
increased blood loss from the body
inadequate production of red blood cells by the bone marrow
In some cases anemia results from an inherited disorder, whereas in other cases the condition is caused by something in a person’s environment, such as a nutritional problem, infection, or exposure to a drug or toxin.

Types of Anemia and Their Causes
Anemia Caused by Destruction of Red Blood Cells
Hemolytic (”hemo” means blood, “lytic” means destroying) anemia occurs when red blood cells are being destroyed prematurely and the bone marrow (the soft, spongy tissue inside bones that produces new blood cells) simply can’t keep up with the body’s demand for new cells. This can happen for a variety of reasons. Sometimes, infections or certain medications - such as antibiotics or antiseizure medicines - are to blame. In a condition known as autoimmune hemolytic anemia, the immune system mistakes red blood cells for foreign invaders and begins destroying them. Other children inherit defects in the red blood cells, which may involve the RBC’s structure or the production of hemoglobin or RBC enzymes. Common forms of inherited hemolytic anemia include sickle cell anemia, thalassemia, and glucose-6-phosphate dehydrogenase deficiency.

Sickle cell anemia is a severe form of anemia found almost exclusively in people of African heritage, although it may also affect those of Caucasian, Saudi Arabian, Indian, and Mediterranean descent. In this condition, the hemoglobin forms long rods when it gives up its oxygen, stretching red blood cells into abnormal sickle shapes. This results in premature destruction of red blood cells, chronically low levels of hemoglobin, and recurring episodes of pain. About one out of every 500 African-American children is born with this form of anemia.

Thalassemia, which usually affects people of Mediterranean, African, and Southeast Asian descent, is marked by abnormal and short-lived red blood cells. Thalassemia major, also called Cooley’s anemia, is a severe form of anemia in which red blood cells are rapidly destroyed and iron is deposited in the skin and vital organs. Thalassemia minor involves only mild anemia and minimal red blood cell changes.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency most commonly affects men of African heritage, although it has been found in many groups of people. The red blood cells of people with this condition either do not make enough of the enzyme G6PD or the enzyme that is produced is abnormal and does not work well. When someone born with the deficiency has an infection, takes certain medicines, or is exposed to specific substances, the body’s red blood cells suffer extra stress. Without adequate G6PD to protect them, many red blood cells are destroyed prematurely.

Anemia Caused by Blood Loss
Blood loss can also cause anemia - whether it’s because of excessive bleeding due to injury, surgery, or a problem with the blood’s clotting mechanism. Slower, long-term blood loss, such as intestinal bleeding due to inflammatory bowel disease, can also cause anemia. Anemia can also result from heavy menstrual periods in teen girls and women. Any of these factors will also increase the body’s need for iron because iron is needed to make new red blood cells.

Anemia Caused by Inadequate RBC Production
Infants are born with high levels of hemoglobin and RBCs in their blood. This occurs in the fetus to help fetal blood carry enough oxygen while the developing baby is in the relatively oxygen-poor environment inside the uterus. After birth, when more oxygen is available, the baby’s hemoglobin level normally drops to a low point at about 2 months of age, a condition known as physiologic anemia of infancy. After this occurs, the infant’s body gets the signal to increase RBC production. This temporary and expected drop in the blood count is considered normal and no treatment is needed.

Anemia also occurs when the body isn’t able to produce enough healthy red blood cells. This can happen because of a deficiency of iron or certain other substances in the body or from inherited defects or diseases that interfere with the production of red blood cells.

Iron is essential for the production of hemoglobin in red blood cells. Poor dietary iron intake (or excessive loss of iron from the body) leads to iron-deficiency anemia, the most common cause of anemia in children. Iron-deficiency anemia can affect children at any age, but it is most commonly seen in children under 2 years of age, and in teens, particularly in adolescent girls who have started menstruating.

During the first 6 months of life, babies are usually protected against developing iron deficiency due to the stores of iron built up in their bodies while they are in the uterus. However, by the second half of the first year of life, as infants continue to undergo significant growth, often they do not take in enough iron through breast milk alone or regular cow’s milk (which contains less iron than fortified infant formula) to meet their iron needs. Regular cow’s milk can also cause some infants to lose iron from their intestines, and drinking lots of it can make an infant less interested in eating other foods that are better sources of iron. For these reasons, regular cow’s milk is not recommended for children until they reach 1 year of age and are eating an iron-rich diet.

The growth spurt that occurs during puberty is also associated with an increased risk of iron-deficiency anemia. Girls are at particularly high risk because of the onset of menstruation; the monthly blood loss increases the need for dietary iron. In a recent report on iron deficiency in the United States, the Centers for Disease Control and Prevention (CDC) noted that, according to a 1996 survey, less than half of 1- to 2-year-olds and just over one fourth of teen girls were meeting the recommended daily intake of iron.

Anemia can be caused by deficiency in the nutrients folic acid and vitamin B12, both of which are necessary for normal blood production. Pernicious anemia is a type of anemia that occurs when a person lacks a substance that is necessary to absorb and process vitamin B12. However, these forms anemia are rarely found in babies and young children.
Aplastic anemia occurs when the bone marrow is unable to produce sufficient numbers of blood cells. More often, aplastic anemia is caused by a virus infection or exposure to certain toxic chemicals, radiation, or medications, such as antibiotics, antiseizure medications, or cancer medications. Some childhood cancers can cause anemia of this type, such as with certain types of leukemia in which abnormal cells crowd out the bone marrow cells needed to produce blood cells. Chronic diseases of other organs can result in anemia. For example, the kidneys and thyroid gland make hormones that are needed by the bone marrow to produce blood cells.

Signs and Symptoms of Anemia
The most common sign of iron deficiency and other types of nutritional anemia is mild paleness of the skin, along with decreased pinkness of the lips, the lining of the eyelids, and the nail beds. A friend or relative who sees your child only occasionally may be more likely to notice this than you because the changes usually happen so gradually.

Other common signs of anemia may include:

irritability
fatigue
dizziness, lightheadedness, and a rapid heartbeat
Depending on the condition causing the anemia, other signs and symptoms may occur, such as jaundice (yellow-tinged skin), dark tea-colored urine, easy bruising or bleeding, and enlargement of the spleen or liver.

In infants and preschool children, iron-deficiency anemia can result in developmental delays and behavioral disturbances, such as decreased motor activity and problems with social interaction and attention to tasks. Recent research studies indicate that behavioral problems may persist into and beyond school age if the iron deficiency is not properly treated.

Diagnosing Anemia
In many cases, doctors don’t discover anemia until they run blood tests as part of a routine physical examination. A complete blood count (CBC) may indicate that there are fewer red blood cells than normal. Other diagnostic tests may include:

Blood smear examination: Microscopic examination of red blood cells after blood is smeared on a glass slide can sometimes indicate the cause of the anemia.
Iron tests: These include total serum iron and ferritin tests, which can help to determine whether anemia is due to iron deficiency.
Hemoglobin electrophoresis: This test identifies various abnormal hemoglobins in the blood and is used to diagnose sickle cell anemia and the thalassemias.
Bone marrow aspiration and biopsy: This test can help determine whether cell production is happening normally in the bone marrow. It’s the only way to diagnose aplastic anemia definitively and is also used if it is suspected that a disease affecting the bone marrow (such as leukemia) could be the cause for the anemia.
In addition to running these tests, your child’s doctor may ask about a family history of anemia and your child’s symptoms and medications. This may lead the doctor to perform other tests to look for specific diseases that might be the underlying cause of the anemia.

Treating Anemia
Treatment for anemia depends on the cause of the condition. It’s important not to assume that any symptoms your child may be having are due to iron deficiency. Be sure to have her checked by a doctor, and don’t attempt to treat her yourself before doing so.

If your child does have iron-deficiency anemia, the doctor may prescribe medication in the form of drops (for infants) or a liquid or tablet form (for older children). The doctor also may recommend adding certain iron-rich foods to your child’s diet.

If your teenage daughter is anemic and has heavy or irregular menstrual periods, in some cases her doctor may prescribe a birth control pill to help regulate the bleeding.

Folic acid and vitamin B12 supplements may be prescribed if the anemia is traced back to a deficiency of these nutrients.

If a certain medication appears to be the cause, your child’s doctor may discontinue it or replace it with something else - unless the benefit of the drug outweighs this side effect.

If an infection is the cause, the anemia will usually get better when the infection passes on its own or it is cured by treatment.

Treatment for more severe or chronic forms of anemia may include (depending on the cause):

transfusions of normal red blood cells taken from a donor
removal of the spleen or treatment with medications to prevent blood cells from being removed from the circulation or destroyed too rapidly
medications to fight infection or stimulate the bone marrow to make more blood cells
Bone marrow transplantation may be considered in some cases of sickle cell anemia, thalassemia, and aplastic anemia. This procedure involves taking bone marrow cells from a donor and injecting them into the child’s vein; the donated cells then travel through the bloodstream to the child’s bone marrow, where they begin producing new blood cells.

Caring for a Child With Anemia
The type, cause, and severity of your child’s anemia will determine what kind of care she needs. In general, though, if your child has significant anemia, she may tire more easily than other children and therefore need to limit her activity. Make sure that her teachers and other caregivers are aware of her condition. If iron deficiency is the cause, follow her doctor’s directions about dietary changes and iron supplementation.

If the spleen is enlarged, your child may be prohibited from playing contact sports because of the risk of rupture and hemorrhage.

Children who have sickle cell anemia need to stay well hydrated, so make sure that your child drinks plenty of water and carries a water bottle during activities. Also, exposure to extremes in temperature can make the condition worse, so make sure your child dresses appropriately for the environmental temperature.

Can Anemia Be Prevented?
Whether anemia can be prevented depends on the cause of the condition. Presently, there is no way to prevent anemia that is caused by genetic defects affecting the production of red blood cell or hemoglobin.

However, there are steps you can take to help prevent iron deficiency - the most common form of anemia. Before following any of these suggestions, be sure to talk them over with your child’s doctor.

Cow’s milk consumption: Cow’s milk given before 1 year of age or in too large an amount at any age has been associated with anemia. Parents also tend to associate milk with good nutrition and may not realize that the child needs better sources of iron. It’s best not to introduce cow’s milk into your child’s diet until your child reaches her first birthday. In addition, your child should not drink more than 24 to 32 ounces of milk each day. If you still can’t get her to eat more iron-rich foods, speak with your child’s doctor about adding an iron supplement to her diet.
Iron-fortified cereal and formula: These products can help ensure that your baby is getting enough iron, especially as she makes the transition from breast milk or formula to solid foods.
Well-balanced diet: Make sure that your child or teen regularly eats foods that contain iron. Good choices include iron-fortified grains and cereals, red meat, egg yolks, leafy green and yellow vegetables, yellow fruits, potato skins, tomatoes, molasses, and raisins. If your child is a vegetarian, you’ll need to make an extra effort to ensure that she gets sufficient iron. That’s because iron found in meat, poultry, and fish is more easily absorbed than iron found in plant-based and iron-fortified foods. Also, be aware that certain food combinations can inhibit or promote absorption of iron. For example, drinking coffee or tea (including iced tea) with a meal can significantly lower the amount of iron absorbed. On the other hand, vitamin C helps the body absorb iron.
Side effects of medications: Some medications can cause anemia. In most cases, the benefit of the drug your child’s doctor prescribes outweighs the risk, but your child may need to be monitored for signs of anemia.
Reviewed by: Robin Miller, MD
Date reviewed: October 2002