Anemia is a condition in which the blood has a lower-than-normal level of hemoglobin or fewer red blood cells than expected.
Red blood cells carry oxygen from the lungs to the rest of the body through a protein called hemoglobin. When there are not enough red blood cells, the body does not get the oxygen it needs to work properly. Red blood cells develop in the bone marrow, the soft, spongy tissue at the center of the bones.
Signs and symptoms of anemia include:
- Feeling weak and tired (fatigue)
- Dizziness or fainting
- Shortness of breath
- Fast heartbeat
- Pale skin, lips, gums, or nail beds
- Headache
- Cold hands or feet
Some children, especially those with iron-deficiency anemia, may develop pica - a craving to eat nonfood items such as ice, dirt, clay, paper, or starch. It is important to monitor your child for these symptoms.
Anemia develops when:
- Your child’s body does not make enough healthy red blood cells
- Red blood cells are destroyed or break down too quickly
- Blood is lost faster than it can be replaced
The reasons this happens may include:
- Not having enough of certain nutrients, such as iron, folate, or vitamin B12
- Disorders of the blood or bone marrow, such as aplastic anemia
- Inherited blood disorders, such as sickle cell disease or thalassemia.
- Cancers that involve or spread to the bone marrow, such as leukemia and lymphoma
- Chemotherapy that damages the bone marrow
- Radiation therapy to areas of the body that affect bone marrow (this can decrease how many healthy red blood cells are made)
- Blood loss from an injury, surgery, heavy menstrual periods, or blood disorders
- Certain medical conditions, such as kidney disease, liver disease, digestive disorders, infections, and autoimmune diseases
- Premature birth, which can increase the risk of anemia in infancy
- Chronic inflammation or chronic disease
Anemia is diagnosed based on your child’s medical history, physical exam, and lab tests. Lab tests may include:
- Complete blood count (CBC) to look for signs of anemia and help identify the cause. A CBC test measures:
- The number of red blood cells, white blood cells, and platelets
- Hematocrit, which shows how much of the blood is made up of red blood cells
- Hemoglobin, the protein inside red blood cells that carries oxygen
- Red blood cell characteristics, such as their size and variation in size, to help identify the type of anemia
- Peripheral blood smear to look at blood cells under a microscope
- Reticulocyte count to measure how well your child’s bone marrow is making new red blood cells. A high reticulocyte count means your child’s body is replacing red blood cells that were lost (such as from bleeding) or destroyed. A low reticulocyte count may mean your child’s bone marrow is not making enough new red blood cells.
Your care team may order more tests to determine the type of anemia and its cause. These tests may measure:
- Iron (ferritin, transferrin saturation)
- Vitamin B12
- Folate
- Kidney function
- Hemoglobin electrophoresis (when indicated)
Your child’s treatment will depend on the cause of anemia. If anemia is caused by an underlying condition, treating that condition may help improve the anemia. In some cases, your child’s health care provider may refer your child to a hematologist, a doctor who specializes in diagnosing and treating blood disorders.
Treatments for anemia may include:
- Vitamin and mineral supplements such as iron, folic acid, or vitamin B12
- Changes to your child’s diet to increase iron and other nutrients, when appropriate
- Red blood cell transfusion to give red blood cells through a vein
- Medicines to stimulate red blood cell production
- Treating the underlying cause of anemia
- Medicines that help calm your child’s immune system if it is attacking their red blood cells (in certain types of anemia)
A stem cell (bone marrow) transplant may be needed for certain severe blood disorders or bone marrow failure disorders. These disorders may include aplastic anemia and some inherited blood diseases.
To help manage anemia, make sure your child:
- Eats a balanced diet with enough iron, vitamins, and other nutrients.
- Gets enough sleep each day to support overall health and help manage symptoms of anemia:
- Infants: 12–16 hours
- Ages 1–2 years: 11–14 hours
- Ages 3–5 years: 10–13 hours
- Ages 6–12 years: 9–12 hours
- Ages 13–18 years: 8–10 hours
- Balances rest with physical activity. Light to moderate activity is usually encouraged. Your child may need to limit strenuous exercise or sports if they have severe anemia or symptoms such as dizziness, shortness of breath, or chest pain.
Always follow your care team’s recommendations and contact your child’s health care provider if symptoms do not improve or get worse.
The prognosis for anemia depends on the type of anemia and its cause. With the right treatment, many types of anemia improve. But untreated or severe anemia can be serious and sometimes life threatening.
Questions to ask your care team
