Causes of Anemia Due to Diminished Red Blood Cell Production in Pediatrics

Abstract

The critical feature that distinguishes the anemias discussed in this article is the presence of an inappropriately low reticulocyte count for the degree of anemia. This is consistent with nutritional deficiencies, decreased erythropoietin levels, aplastic anemia, or inherited bone marrow failure syndromes. In addition, bone marrow replacement by a benign or malignant process, including those associated with ineffective erythropoiesis (eg, congenital dyserythropoietic anemias), comprise the differential diagnosis. Anemia causes increased morbidity and mortality in pediatric population; the absolute reticulocyte count (ARC) can be calculated by multiplying the percent reticulocytes by the RBC count/L. In a patient with anemia, ARC values within the “normal range” (generally 50-100 × 109/L) indicate an inappropriate response and suggest that there is an underlying red cell production issue due to intrinsic or extrinsic factors, or a combination of the two. The mean corpuscular volume (MCV) is another valuable red cell index that narrows the differential diagnosis of anemia due to diminished production. It is critical, however, to check age-specific normal values for MCV and to recognize that certain diseases can present with low, normal, and/or high MCVs. Finally, the red cell distribution width (RDW) assists in differentiating whether the anemia is likely due to a mixed process (wide RDW) or from a single cause (normal RDW). However, the management of anemia depends on the etiology. Early diagnosis and prompt treatment improve the quality of life of patients.