Anemia occurs when there are not enough red blood cells or when the hemoglobin is not working properly to carry oxygen from the lungs to the rest of the body. Red blood cells are made in the bone marrow. They live for about three months in the circulating bloodstream before the spleen clears them away. Hemoglobin is a special protein inside red blood cells that carries oxygen. The number of red blood cells your child requires depends on his or her gender, age and ethnic background.
A reduced number of red blood cells may be caused by:
- Decreased production of red blood cells in the bone marrow. Examples of decreased production of red blood cells in the bone marrow include:
- Underlying bone marrow failures like Diamond-Blackfan anemia (DBA) and aplastic anemia
- Inherited problems, such as thalassemia, that interfere with the normal production of hemoglobin
- Acquired nutritional deficiencies such as iron or folate deficiency
- Early or increased destruction of red blood cells. Examples of early or increased destruction of red blood cells include:
- Sickle cell disease due to the problems with making hemoglobin
- Hereditary spherocytosis due to problems with the red blood cell membrane
- Glucose-6-phosphate dehydrogenase deficiency, which results in a shortened red blood cell lifespan
- A malfunction of the immune system that makes antibodies attack the body’s own red blood cells (autoimmune)
- Sequestration. This means the red blood cells are going into spaces within the body instead of remaining in the circulating bloodstream that goes to the lungs and heart. A common place for sequestration to occur is the spleen.
Other causes of anemia include blood loss, severe inflammation, thyroid problems, kidney disease, recurrent infections, celiac disease and, rarely, cancer.
Anyone can have anemia. There are more than 3 million people with the condition in the U.S. The most common type of anemia is iron-deficiency anemia, which frequently affects women due to menstruation and children (especially toddlers). Anemia is not contagious.
There are many causes of anemia. Some types of anemia are inherited, but most are acquired. Inherited causes of anemia usually imply that an individual will always have anemia unless he or she receives special treatments. This may or may not affect the individual’s lifespan. Acquired types of anemia go away when the underlying problem goes away. For example, if anemia is caused by a poor diet, then diet modification and sometimes supplements will resolve the anemia. If the anemia is caused by excessive bleeding, then evaluation for a bleeding disorder and its correction would be necessary to resolve the anemia. Acquired types of anemia that are treated usually do not affect an individual’s lifespan, and individuals may be able to donate blood in the future without problems.
Symptoms of anemia vary depending on the cause but may include:
- Shortness of breath
- Pale skin
- Yellow skin (jaundice), if there are many red blood cells dying too quickly
- Fast or irregular heartbeat
- Difficulties thinking
- Desire to chew or eat substances such as ice, dirt, clay, sand, metal, paper or chalk (symptoms of pica)
The presence and intensity of symptoms parallel the severity of the anemia.
Diagnosis of Anemia
Doctors at Riley at IU Health diagnose anemia by reviewing your child's medical history, conducting a thorough examination and performing a blood test.
Additional tests may be needed to determine what type of anemia your child has. These additional tests are usually blood tests but could possibly include a bone marrow test because the bone marrow is where red blood cells are made. Additional testing may also include imaging studies.
Treatment for anemia varies greatly and depends on the cause and severity of the condition. Some treatments may be done at home while other treatments require hospital visits. Treatment may include:
- Diet modification. Iron deficiency can be improved by eating iron-rich foods such as red meats, green leafy vegetables, beans and lentils.
- Supplements. Your child’s doctor may recommend an iron supplement.
- Blood transfusions. A blood transfusion can quickly restore low red blood cells or provide normal red blood cell levels.
- Medicines. These include steroids to suppress the immune system and hormonal contraceptives to stop excessive bleeding from monthly periods.
- Stem cell transplant. Stem cell transplant replaces your child’s abnormal bone marrow stem cells with healthy cells to allow increased production of red blood cells. This is most commonly performed in patients who have a severe congenital form of anemia.
The type of anemia dictates the type of treatment. Most of the time, pediatricians and hematologists work together to take care of patients with anemia. Sometimes surgeons are involved because select patients have to undergo splenectomies (surgery to remove part or all of the spleen).
Key Points to Remember
Key Points to Remember
- Anemia occurs when there are not enough red blood cells or when the hemoglobin is not working properly to carry oxygen from the lungs to the rest of the body.
- Some types of anemia are inherited, but most are acquired.
- Symptoms of anemia vary depending on the cause but may include fatigue, shortness of breath and dizziness.
- A blood test can diagnose the condition.
- Treatment may include diet modification, vitamin or mineral supplements, blood transfusions, medicines and stem cell transplantation.
Support Services & Resources
Support Services & Resources
Learn more about anemia by visiting the following recommended websites:
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
The Cancer & Blood Diseases Department at Riley at IU Health participates in ongoing research to improve treatment and outcomes in children with anemia. Speak with your child's doctor for more information about current research studies.