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Gazzetta Medica Italiana Archivio per le Scienze Mediche 2005 June;164(3):195-213


language: Italian

Diagnostic approach to hypochromic micro-cytic anemia in childhood

Vecchi V., Pericoli R.

Dipartimento di Fisiopatologia dell’Apparato Riproduttivo Femminile, Maternità, Neonatologia ed Età Evolutiva, Ospedale Infermi, Rimini


When a patient is suffering from anemia, it is very important to establish whether the problem is due to a single cell line (e.g. red blood cells) or to a multiple cell line (i.e. red cell, white cells and platelets). The etiologic classification of anemia is based on the following investigation: 1) detailed history and physical examination; 2) clinical evaluation of symptoms and signs; 3) analysis of complete blood count. According to the main pathophysiology mechanism, it is possible to identify 4 groups of anemias due to: decreased erythroid cell line, decreased red cell production, decreased hemoglobin synthesis, reduction in the normal red cell survival. Hypoch-romic microcytic anemias are the most common forms of anemia in chilhood, characterized by normal production of erythroid cell line and normal red cell life, but impaired hemoglobin synthesis. The lower mean erytroblastic hemoglobin concentration determines a supplemental mitotic division which causes the little size red cells production and hypochromic condition. Disorders associated with hypochromic and microcytic anemias are: congenital sideroblastic anemia, lead poisoning, protein deficiency, vitamin B6 deficiency, chronic infections, thalassemia, iron deficiency. In order to establish the nature of anemia, it is necessary to perform various laboratory studies including complete blood count (red cell indices, morphologic characteristics), determination of serum iron level, total iron binding capacity, serum ferritin level, and serum transferrin receptor level, free erytrocyte protoporphyrin, hemoglobin electrophoresis and bone marrow examination. Iron deficiency and heterozygotes β-thalassemia are the most prevalent anemias in childhood which require differential diagnosis.

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