Around one-third of children with normocytic anemia have iron deficiency anemia, according to findings of a study published in the Journal of Pediatrics.¹ But the causes are diverse and also include statistical anemia (24%), transient marrow suppression (13%) and transient erythroblastopenia of childhood (7%).

This retrospective cohort analysis included 271 children with normocytic anemia in the age group 0–21 years (median age 5.4 years). Nearly half of the study group was female (48%). According to the referring laboratory reference range used by the referring centers, normocytic anemia was defined as a low hemoglobin level along with a normal mean corpuscular volume (MCV). The goal was to describe the assessment and outcomes of children with normocytic anemia who had been referred to pediatric hematology between 2019 and 2021.

The most common diagnosis was iron deficiency in 33% participants followed by statistical anemia (24%), transient marrow suppression (13%) and transient erythroblastopenia of childhood (7%). Seventeen patients (6%) had their anemia deemed secondary to a nonhematologic condition such as chronic diseases, infections, or endocrine disorder; as a result, they were sent to a different pediatric specialty.

Anemia in 16 patients (6%) did not have an identifiable cause; the anemia resolved on its own in these patients. In addition to those with iron deficiency, 35 patients (13%) had diagnoses such as hemolytic anemia, Diamond Blackfan anemia, transitory erythroblastopenia of childhood and aberrant beta globin characteristics that required ongoing hematologic care.

After receiving hematological care for a median duration of 25 days (range 0-2124 days), 271 patients (93%) were discharged.

The authors have revisited normocytic anemia in children in this study. They show that iron deficiency is the most common underlying cause of normocytic anemia in this age group. However, there are a multitude of etiologies and a proper workup of the patient is essential. Serum ferritin, iron panel and reticulocyte count are useful as initial tests. Only a small percentage of patients need continued specialist treatment as iron deficiency anemia can be effectively managed in primary care. Hence, primary care physicians should refer these patients for specialist care only after excluding iron deficiency as the cause of anemia. Individualized treatment plans must be developed based on the specific needs and diagnoses of each patient.

Reference

1.   Emily Equitz, et al. Etiologies and outcomes of normocytic anemia in children. J Pediatr. 2024 Mar 28:271:114041. doi: 10.1016/j.jpeds.2024.114041.