Understanding Lab Values
> Anemia: Low Hemoglobin
Anemia: Low Hemoglobin
We screen all of our patients for anemia (low red blood cell count) at 12 months of age. High risk children (such as those who are symptomatic, have a poor diet, or a history of prematurity) will be screened at additional times.
Why we screen for anemia
- The American Academy of Pediatrics recommends screening for anemia between 6 and 12 months.
- Anemia often does not have any symptoms when mild, but can cause fatigue, weakness, pale skin, dizziness, mental slowing, developmental delays, rapid heartbeat, shortness of breath, irritability, poor appetite, numb or cold hands and feet, and headaches as it becomes more severe.
What is anemia and what causes it?
- Anemia means that the number of red blood cells in the body is below normal. It can be caused by not making enough red blood cells, too much breakdown of red blood cells, and loss of red blood cells (such as with heavy bleeding). Some causes are hereditary, such as sickle cell anemia, others can be from illness, poor nutrition, or injury. Treatment of anemia depends on the cause.
- The most common type of anemia is from iron deficiency. Iron is needed for the body to produce red blood cells. Without enough iron, the body cannot make enough red blood cells to bring oxygen to organs and tissues.
- A diet high in iron can help prevent iron deficiency anemia.
- It is recommended that all infants who are exclusively breastfed begin iron supplements by 6 months of age.
- Infant formulas with low iron are not recommended.
- After 1 year of age, your child should not drink more than 24 ounces of cow’s milk a day (about 3 cups) so that he or she has an adequate appetite for solid iron-containing foods. Milk doesn't contain any iron and large amounts of cow’s milk actually causes the gut to leak small amounts of blood.
Foods high in iron are
- Sweet potatoes
- Lima beans
- Kidney beans
- Pinto beans
- Green peas
- Peanut butter
- Enriched cereals and breads
What do we do if my child is anemic?
- If a child’s screening blood count shows a low hemoglobin level or small red blood cells, we will first recommend iron therapy followed by a recheck of the blood count. Iron may need to be taken for 2 to 3 months to get your child's red blood cells back to a normal level.
- Iron should be taken with food to prevent stomach upset.
- Adding the iron drops to a juice containing Vitamin C will improve iron absorption and prevent staining of the teeth.
- Do not give iron with milk or formula because they reduce absorption.
- A common temporary complication of iron therapy is tooth staining. If the teeth become stained, the stain can be brushed off with a small amount of baking soda on a wet cloth.
- The iron may change the color of bowel movements to dark green or black, but this is harmless.
- Too much iron can be dangerous and can cause serious poisoning. Treat iron like any medicine: Keep it out of your child's reach.
In many cases anemia does not have symptoms, but a screening complete blood count (CBC) can show that there are fewer or smaller red blood cells than normal. Any family history of anemia should be discussed. A review of medications should be done because some may cause anemia. After a period on iron therapy follow up tests may include:
- Repeat CBC to see if the anemia has corrected with iron.
- Iron tests: These include total serum iron, iron binding capacity, and ferritin tests, which can help to determine whether anemia is due to iron deficiency. No test is perfect when looking at iron levels, because the liver stores the majority of iron in the body, it is not easily measured in the blood.
- Reticulocyte count: A measure of newer red blood cells, this helps to determine if production of red blood cells is at normal levels. If low when there is an anemia, this indicates too low of production of blood cells. If high but the anemia persists, this indicates a breakdown of red blood cells or a continued loss of red blood cells.
- Hemoglobin electrophoresis: Used to identify various abnormal hemoglobins in the blood and to diagnose sickle cell anemia, the thalassemias, and other inherited forms of anemia. It is done on all newborn screens and can be repeated if indicated.
- Blood smear examination: Blood is smeared on a glass slide for microscopic examination of red blood cells (for size, shape, color, breakage).
- Bone marrow aspiration and biopsy: This test can help determine whether cell production is happening normally in the bone marrow. It is used if there is a concern for certain cancers or a complete shutdown of the bone marrow.