Abstract
Except in babies, who may become tachypnoeic during feeding, anaemia in children usually presents with pallor and tiredness, rather than breathlessness. The degree of anaemia, therefore, may be much more marked than in adults and it is not uncommon for the haemoglobin concentration (Hb) to fall as low as 4 g/dl before the family becomes aware of any problem. Clinical recognition of pallor due to mild to moderate anaemia is difficult, and in the context of an unwell or lethargic child, should lead to a relatively low threshold for performing a full blood count (FBC) and film. A perfectly adequate specimen can be obtained from an ear or finger prick, which should ideally be performed by experienced personnel. The mean corpuscular volume (MCV), red blood cell count (RBC) and the red cell morphology on the blood film, interpreted against ethnically appropriate norms, provide the critical information the clinician requires to formulate a differential diagnosis of anaemia in the majority of children. Although pregnancy in schoolgirls is distressingly common, the changes in Hb and MCV during pregnancy will not be covered in this article.
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