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Algorithm For Anemia in Children Based On MCV - UpToDate

This document provides an algorithm for classifying and diagnosing anemia in children based on mean corpuscular volume (MCV). The algorithm first categorizes anemia as microcytic, normocytic, or macrocytic based on MCV. It then outlines diagnostic testing and considerations for common causes within each category.

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655 views2 pages

Algorithm For Anemia in Children Based On MCV - UpToDate

This document provides an algorithm for classifying and diagnosing anemia in children based on mean corpuscular volume (MCV). The algorithm first categorizes anemia as microcytic, normocytic, or macrocytic based on MCV. It then outlines diagnostic testing and considerations for common causes within each category.

Uploaded by

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Algorithm for anemia in children based on MCV - UpToDate 03/12/16 19:42

Official reprint from UpToDate


www.uptodate.com 2016 UpToDate

Diagnostic approach to isolated anemia in children: Morphologic classification

HGB: hemoglobin; RBC: red blood cell; MCV: mean corpuscular volume; HU: hydroxyurea; RDW: red cell distribution width; TIBC: total iron binding capacity; TEC: transient
erythroblastopenia of childhood; G6PD: glucose-6-phosphate dehydrogenase; HUS: hemolytic uremic syndrome; TTP: thrombotic thrombocytopenic purpura; DIC: disseminated
intravascular coagulation; DAT: direct antiglobulin test; PMNs: polymorphonuclear cells; LDH: lactate dehydrogenase.
* Hemoglobin levels vary considerably by age, race, and sex; when diagnosing anemia, hemoglobin values should be compared with age-, race-, and sex-adjusted norms. Mild anemia
occurring at six to nine weeks of life is consistent with "physiologic anemia" and is not pathologic. Falsely elevated hemoglobin values may occur when measured using capillary samples (eg,
finger or heel "sticks"), particularly when using microhematocrit measurements. Spurious results may also occur with automated counters in the presence of lipemia, hemolysis,
leukocytosis, or high immunoglobulin levels.
The RDW can be helpful in differentiating thalassemia from iron deficiency. High RDW is typical of iron deficiency whereas the RDW is usually normal in patients with thalassemia (though
elevated RDW can occur).
Anemia of chronic disease typically presents as a normocytic anemia, but can have low MCV.
Selected testing is based upon review of the patient's history and examination of the peripheral blood smear.
In children with mild microcytic anemia and dietary history that is suggestive of iron deficiency, serum iron studies (ie, ferritin, iron, and TIBC levels) are generally not necessary. In these
children, a therapeutic trial of iron can be used to confirm the diagnosis.
Evidence of hemolysis includes jaundice, indirect hyperbilirubinemia, elevated lactate dehydrogenase, and/or elevated haptoglobin.

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Algorithm for anemia in children based on MCV - UpToDate 03/12/16 19:42

Findings on blood smear may suggest an underlying etiology of anemia but they are generally not diagnostic. Further confirmatory testing should be carried out to confirm the diagnosis.

References:
1. Brugnara C, Oski FA, Nathan DG. Diagnostic approach to the anemic patient. In: Nathan and Oski's Hematology and Oncology of Infancy and Childhood, 8th ed, Orkin SH, Fisher DE,
Ginsburg D, et al (Eds), WB Saunders, Philadelphia 2015. p.293.
2. Rapaport SI. Diagnosis of anemia. In: Introduction to hematology, JB Lippincott, Philadelphia 1987. p.15.

Graphic 101548 Version 3.0

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