49 - Pallor and Anemia

Abstract

Pallor, a perceptible reduction in skin color and tone, is a nonspecific physical exam finding often associated with anemia, a condition in which the hemoglobin level is lower than established thresholds for age. Anemia occurs in a broad number of diagnoses. It results from one of, or a combination of, three pathophysiologic mechanisms: acute blood loss, impaired bone marrow production of erythrocytes, and/or increased peripheral red blood cell destruction (hemolysis). Important aspects of the clinical history, including neonatal, dietary, and family history, as well as signs and symptoms of blood loss or hemolysis, can narrow the evaluation of a patient presenting with anemia. Physical exam findings, including the evaluation for red flags concerning for an underlying malignancy, are vital. Finally, laboratory evaluation including hematologic indices (hemoglobin, mean corpuscular volume, red cell distribution width, reticulocyte count), peripheral smear review for morphology, and adjunctive laboratory assessments aid in identifying the underlying mechanism of anemia and often confirm the suspected hematologic condition. A review of the presenting signs, symptoms, and laboratory findings in children with nutritional deficiencies (iron deficiency, vitamin B12, and folate), hemoglobinopathies (thalassemia syndromes, sickle cell disease), other hereditary hemolytic anemias, anemia of inflammation, and bone marrow failure conditions is provided.