KidsMD Health Topics

Pediatric Anemia

  • Anemia is a common blood disorder that occurs when the body has fewer red blood cells than normal. Red blood cells carry oxygen throughout your child’s body using a protein called hemoglobin. If there aren’t enough of these cells or this protein, a condition called anemia results.

    One of the most common pediatric disorders, anemia has many potential causes. In some cases, anemia in children is temporary and caused by a nutritional deficiency or blood loss. In others, it’s the result of a chronic or inherited condition including autoimmune problems, genetic disorders, cancers and other diseases. Severe anemia can be life-threatening.

    How Dana-Farber/Boston Children's approaches pediatric anemia

    Children with anemia and other red blood cell disorders are treated through our Blood Disorders Center within the Dana-Farber/Boston Children's Cancer and Blood Disorders Center.

    Matthew Heeney, MD, an expert in pediatric hematology, who specializes in sickle cell disease and inherited disorders of iron deficiency, sideroblastic anemia and iron overload, leads our program.

    Our program brings together experienced pediatric subspecialists and support staff from across Dana-Farber/Boston Children’s, including:

    • pediatric hematologist oncologists
    • pediatric hematopathologists
    • pediatric hematology nurse practitioners and physician assistants
    • social workers
    • designated hematology patient coordinators

    Reviewed by Colin Sieff, MD
    Boston Children's Hospital, 2012

  • What is anemia?

    Anemia is a common blood disorder that occurs when the body has fewer red blood cells than normal.

    Anemia is often a symptom of a disease rather than a disease itself. Anemia usually develops due to:

    • excessive blood loss
    • deficient production of red blood cells
    • excessive red blood cell destruction
    • both decreased production and excessive destruction of red blood cells

    What are the different types of anemia?

    Symptoms of Anemia

    What are the symptoms of anemia?

    Each child may experience symptoms differently, but the following are the most common symptoms for anemia, although some of those listed below are specific to certain causes of anemia:

    • pale skin, lips, hands or under the eyelids
    • increased heart rate (tachycardia)
    • breathlessness, or difficulty catching a breath (dyspnea)
    • lack of energy, or tiring easily (fatigue)
    • dizziness, or vertigo, especially upon standing
    • headache
    • irritability
    • irregular menstruation cycles
    • absent or delayed menstruation (amenorrhea)
    • sore or swollen tongue (glossitis)
    • jaundice, or yellowing of skin, eyes and mouth
    • enlarged spleen or liver (splenomegaly, hepatomegaly)
    • slow or delayed growth and development
    • impaired wound and tissue healing

    Symptoms may resemble those of other pediatric blood disorders or medical problems. Because anemia is often a symptom associated with another disease, it is important for your child's physician to be aware of any symptoms she may be experiencing. Always consult your child's physician for a diagnosis.

    Anemia Causes

    What causes anemia?

    Anemia may be caused by several problems, including:

    • nutritional deficiencies (iron, folic acid or vitamin B12)
    • inherited diseases (e.g., Fanconi anemia, thalassemia, sickle cell anemia)
    • certain cancerous condition
    • scertain medications
    • infection
    • autoimmune diseases
    • bleeding
  • The first step in treating your child is forming an accurate and complete diagnosis. Anemia is usually discovered during a medical exam through simple blood tests that measure the concentration of hemoglobin and the number of red blood cells.

    In addition to a complete medical history and physical examination, diagnostic procedures to determine the underlying cause of the anemia may include:

    • blood tests—A complete blood count (CBC) can help your child’s doctor to understand the cause of the anemia.
    • hemoglobin electrophoresis—a test to determine the amount and type of hemoglobin in the blood
    • additional blood tests (e.g., iron levels)
    • bone marrow aspiration and biopsy—marrow may be removed by aspiration or a needle biopsy under local anesthesia. With aspiration, a fluid specimen is removed from the bone marrow. In a needle biopsy, a very small core of marrow structure including marrow cells (not fluid) is removed.

    After we complete all necessary tests, our experts meet to review and discuss what they have learned about your child's condition. Then, we will meet with you and your family to discuss the results and outline the best treatment options for your child’s anemia.

  • Children with anemia and other red blood cell disorders are treated through our Blood Disorders Center within the Dana-Farber/Boston Children's Cancer and Blood Disorders Center. For many appointments and certain procedures, your child can also receive care at one of Boston Children's satellite offices.

    How is anemia treated in children?

    Depending on the specific cause of your child’s anemia, your child’s physician may recommend a variety of different treatments. Treatments for various forms of anemia may include:

    • vitamin and mineral supplements
    • change in your child's diet
    • medication and/or discontinuing causative medications
    • treatment of the underlying disorder
    • surgery to remove the spleen (if related to certain hemolytic anemias)
    • blood transfusions, if necessary (to replace significant loss)
    • antibiotics (as appropriate if infection is the cause)
    • stem cell transplant (for aplastic anemia/bone marrow failure) 

    Will my child need long-term care?

    The long-term outlook for children with anemia depends on the specific cause of the anemia. Some forms of anemia, such as a nutritional deficiency, can be treated quickly and don’t require significant long-term follow-up care. In other cases, in which the anemia is caused by a genetic condition or other serious underlying disorder, your child may need regular follow-up by our hematologists. Your child’s physician can discuss your child’s specific care plan.

  • Our research

    Our clinicians are conducting innovative research on anemias and red blood cell disorders. In fact, you can say our faculty 'wrote the book' on pediatric blood disorders. Because of our long track record of innovation, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center is considered a world leader in laboratory and clinical research on blood disorders. Learn more about our research.

    New developments in chronic anemia

    Hemoglobin is a protein in red blood cells that helps them carry oxygen from the lungs to all parts of the body. Without enough hemoglobin, children experience anemia, which causes fatigue, pale skin, an increased heart rate and other symptoms, ranging from mild to life-threatening.

    In children with sickle cell disease, hemoglobin is defective, causing red blood cells to become stiff, sticky and shaped like the letter C. In thalassemia, the body’s ability to produce hemoglobin is also compromised. Both disorders can cause severe anemia.

    Boston Children’s Hospital's Stuart Orkin, MD, and Vijay Sankaran, MD, PhD, identified a way to compensate for this problem: getting red blood cells to make another type of hemoglobin that normally stops being made after birth.

    Legacy of excellence

    Boston Children’s has been a leader in developing new treatments for inherited anemias, such as sickle cell disease and thalassemia.

    David Nathan, MD, pediatrics and president emeritus, recognizes the important role of hypertransfusion in sickle cell disease.

    Richard Proper, MD, and Nathan demonstrated effective iron chelation by subcutaneous pump deferoxamine (Desferal®).

    • Nathan and Orkin develop the first genetic test for prenatal diagnosis of thalassemia.


    • Orah Platt, MD, chief of the Department of Laboratory Medicine, and Nathan use hydroxyurea to induce fetal hemoglobin production in patients with sickle cell disease.


    • Carlo Brugnara, MD, director of the Hematology Lab, and colleagues discover that the common antifungal drug, clotrimazole, prevents dehydration in red blood cells, a factor in sickle cell disease.


    • A recent study tested the effectiveness of a new oral iron chelator, deferasirox.

    • Orkin and Sankaran identify a transcriptional regulator (BCL11A) critical for hemoglobin switching that could serve as a therapeutic target for hemoglobin disorders.

    Clinical Trials

    For many children with rare or hard-to-treat conditions, clinical trials provide new options.

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