Pediatric Anemia Causes

1. See Also
   1. Pediatric Anemia
   2. See Anemia Evaluation
2. Causes: Common
   1. Microcytic Anemia
      1. Iron Deficiency Anemia (most common cause)
         1. Rare before age 6 months in term infants
         2. Rare until birth weight doubles in Preterm Infants
      2. Lead Poisoning
      3. Hemoglobinopathy
         1. Sickle Cell Anemia
         2. Thalassemia
   2. Normocytic Anemia
      1. Physiologic Anemia of Infancy
         1. Requires no work-up unless below expected levels
      2. Hemolytic Anemia
         1. Hemolytic Disease of the Newborn
         2. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)
            1. X-Linked Anemia (consider in male children)
         3. Pyruvate Kinase Deficiency
            1. Results in chronic Hemolytic Anemia
   3. Macrocytic Anemia (uncommon in children)
      1. Folate Deficiency
         1. Inadequate intake of human or cow's milk
         2. Inadequate intake of vegetables and fruits
      2. Vitamin B12 Deficiency (rare in U.S.)
         1. Consider in Breast fed infant of vegan mother
3. Causes: Newborn
   1. Blood loss Anemia (e.g. Placental Abruption)
   2. Isoimmunization (Rh incompatability, Fetal hydrops)
   3. Congenital Hemolytic Anemia (e.g. G6PD Deficiency, Spherocytosis)
   4. Congenital infection (Parvovirus B19, HIV Infection, Syphilis, Rubella, Sepsis)
   5. Diamond-Blackfan Syndrome
   6. Fanconi Anemia
   7. Alpha-Thalassemia (three gene deletion)
4. Causes: Infant and Toddler
   1. Iron Deficiency Anemia or blood loss
   2. Concurrent infection
   3. Hemoglobin disorders (e.g. Thalassemia, Sick Cell Disease)
   4. RBC Enzyme deficits (e.g. G6PD Deficiency, Pyruvate Kinase deficiency)
   5. RBC membrane Deficits (e.g. Spherocytosis, elliptocytosis)
   6. Acquired Hemolytic Anemia (e.g. Hemolytic Uremic Syndrome, drug-induced Hemolysis)
   7. Transient Erythroblastopenia of childhood
   8. Hypersplenism
   9. Bone Marrow disorder (Myelofibrosis, Leukemia)
   10. Lead Poisoning
   11. Hypothyroidism
   12. Vitamin B12 Deficiency (or Folate Deficiency)
5. Causes: Child and Teen
   1. Same as Infant and Toddler
   2. Iron Deficiency Anemia (e.g. Menses, growth spurt, other blood loss)
   3. Vitamin B12 Deficiency (or Folate Deficiency)
   4. Chronic disease
      1. Liver disease or Kidney disease
      2. Hypothyroidism
6. References
   1. Janus (2010) Am Fam Physician 81(12): 1462-71 [PubMed]
   2. Wang (2016) Am Fam Physician 93(4): 270-8 [PubMed]