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 the body using a protein called hemoglobin. If there aren’t enough of these cells or this protein, anemia results.

Anemia is often a symptom of a disease rather than a disease itself. In some cases, anemia is temporary and caused by a nutritional deficiency or blood loss. In others, it’s the result of a chronic or inherited condition, including genetic disorders, autoimmune problems, cancers, and other diseases. While many types of anemia can be mild and easily corrected, certain types of anemia can be severe, chronic, and/or life-threatening.

Types of anemia include:

• Iron deficiency anemia
• Iron-refractory iron deficiency anemia (IRIDA)
• Congenital sideroblastic anemia
• Megaloblastic anemia
• Hemolytic anemia
• Sickle cell anemia
• Thalassemia
• Aplastic anemia
• Fanconi anemia
• Diamond-Blackfan anemia

Each child may experience anemia symptoms differently. Some of the symptoms included are specific to certain causes of anemia but most are non-specific. Anemia can also be a symptom associated with other diseases. The most frequently noted anemia symptoms include:

• 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

It is important to understand that some symptoms of anemia may resemble those of other more common medical problems or other blood disorders. Because some of these symptoms can also point to other conditions, and because anemia itself can be a symptom of another medical problem, it’s important to have your child evaluated by a qualified medical professional for an accurate diagnosis and prompt treatment.

Anemia's causes are largely dependent on the type of anemia your child suffers from. The most common causes include:

• Nutritional deficiencies (iron, folic acid, or vitamin B12)
• Inherited diseases (e.g., Fanconi anemia, thalassemia, sickle cell anemia)
• Autoimmune diseases
• Bleeding
• Certain cancerous conditions
• Certain medications
• Infections

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. Diagnostic procedures to determine the underlying cause of the anemia may include:

• Complete medical history and physical examination
• Measurement of hematocrit — the percent of red blood cells found in a specific volume of blood
• Hemoglobin electrophoresis to determine the amount and type of hemoglobin in the blood
• Additional blood tests
• Bone marrow aspiration and biopsy

There may be other diagnostic tests that your doctor will discuss with you depending on your child's individual situation. 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 possible treatment options.

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 bone marrow failure, such as aplastic anemia, Fanconi anemia or Diamond-Blackfan anemia)

Our multidisciplinary team of doctors will help determine the best approach for your child's unique situation, based on a number of factors including age and overall health, severity of the disease, and tolerance for certain medications or therapies.

The long-term outlook for children with anemia depends on the specific cause. 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.

We have a number of resources at Dana-Farber/Boston Children’s to help you and your family through this time. From the first visit through follow-up care, our nurses will be on hand to walk you through your child’s treatment and help answer any questions you may have. If you’d like to talk with someone whose child has been treated for anemia, we can put you in touch with other families who have been through the same experience that you and your child are facing.

Children and young adults with iron deficiency anemia receive treatment through Dana-Farber/Boston Children's Cancer and Blood Disorders Center, an integrated pediatric hematology and oncology partnership between Dana-Farber Cancer Institute and Boston Children's Hospital.

Our Blood Disorders Center brings together world-renowned pediatric hematology specialists and support staff from across Dana-Farber/Boston Children's, including pediatric hematologists/oncologists, hematopathologists, hematology nurse practitioners, social workers, and designated hematology patient coordinators. For many appointments and certain procedures, your child can also receive care at one of the Boston Children's Hospital satellite offices.