| Patient characteristics |
Age: - In neonates and young infants, immune hemolytic disease, infection, and hereditary disorders are most common
- Anemia detected at 3 to 6 months of age suggests a hemoglobinopathy
- Nutritional iron deficiency is an unlikely cause of anemia before the age of 6 months in term infants
- In older children, acquired causes of anemia are more likely, particularly iron deficiency anemia (dietary or due to blood loss)
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Sex: - Some inherited causes of anemia are X-linked (eg, G6PD deficiency and X-linked sideroblastic anemia) and occur most commonly in males
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Ethnicity/ancestry: - Hemoglobin S and C are most commonly seen in individuals of African or Hispanic descent and Middle Eastern populations
- Thalassemia syndromes are more common in individuals of Mediterranean and Southeast Asian descent
- G6PD deficiency is more common among Sephardic Jewish individuals; Black individuals from sub-Saharan Africa or Brazil; African Americans; and people from Thailand, Sardinia, Greece, South China, and India
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| Symptoms |
- Changes in urine color, scleral icterus, or jaundice suggest a hemolytic disorder
- Bloody stools, hematemesis, severe epistaxis, or severe menstrual bleeding suggest anemia from blood loss and/or iron deficiency
- Infectious symptoms (eg, fevers, cough) suggest an infectious etiology of anemia
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| History of anemia |
- Prior episodes of anemia suggest an inherited disorder
- Anemia in a patient with previously documented normal CBC suggests an acquired etiology
- Hyperbilirubinemia in the newborn period suggests a hemolytic etiology; microcytosis at birth suggests chronic intrauterine blood loss or thalassemia
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| Underlying medical conditions |
- Underlying renal disease, malignancy, or inflammatory/autoimmune disorders may be associated with anemia
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| Drugs and toxin exposure |
- Anemia following exposure to oxidant drugs or fava beans suggests G6PD deficiency
- Exposure to paint, home renovations, or use of imported or glazed ceramics suggest lead toxicity
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| Family history |
- Family members with jaundice, gallstones, or splenomegaly suggests an inherited hemolytic anemia
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| Dietary history |
In infants and young children, iron deficiency is suggested by the following: - Use of low iron formula
- Introduction of unmodified cow's milk before the age of 1 year
- Excessive milk intake (>24 ounces per day)
- Poor intake of iron-rich foods (meats or fortified infant cereal)
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| Travel history |
- Travel to/from areas of endemic infection suggests infectious etiology such as malaria or tuberculosis
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| Developmental history |
- Developmental delay is associated with iron deficiency, vitamin B12/folic acid deficiency, and Fanconi anemia
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