Pediatric Acute Anemia Differential Diagnoses

Updated: Sep 22, 2021
  • Author: Susumu Inoue, MD; Chief Editor: Robert J Arceci, MD, PhD  more...
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Diagnostic Considerations

Conditions to consider, aside from those in the next section, in the differential diagnosis of acute anemia include the following:

  • Acute hemorrhage - Eg, trauma, gastrointestinal (GI) tract hemorrhage (gastritis, ulcers, diverticulum, polyps, varices, hemangioma), intracranial hemorrhage in neonates, pulmonary hemosiderosis, heavy menstrual bleeding in adolescents, congenital or acquired bleeding disorder

  • Anemia of inflammation/infection

  • Aplastic anemia, due to blood loss

  • Autoimmune hemolytic anemia with acute hemolysis

  • Erythrophagocytosis (hemophagocytic lymphohistiocytosis [HLH])

  • G-6-PD deficiency and other red cell enzyme deficiencies, such as pyruvate kinase and glutathione synthetase deficiency, causing a hemolytic episode [15]

  • Hereditary spherocytosis and other red blood cell membrane abnormalities, including band 3 nullVIENNA, [16] resulting in splenic sequestration, or acute hemolytic episode

  • Aplastic crisis - In a patient with chronic hemolytic anemia (sickle cell anemia, hereditary spherocytosis)

  • Microangiopathic hemolytic anemia (DIC, Kasabach-Merritt phenomenon)

  • Paroxysmal cold hemoglobinuria

  • Paroxysmal nocturnal hemoglobinuria (PNH)

  • Hemolytic disease of newborn

  • Hemolytic-uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP)

  • Acute porphyria

Conditions to consider, aside from those in the next section, in the differential diagnosis of chronic anemia include the following:

  • Acute leukemia
  • Chronic renal failure

  • Congenital dyserythropoietic anemia

  • Fanconi anemia

  • Iron deficiency anemia

  • Diamond-Blackfan anemia

  • Osteopetrosis

  • Sideroblastic anemia

  • Unstable hemoglobinopathy

  • Thymoma

  • Transient erythroblastopenia of childhood

  • Evans syndrome (ITP and autoimmune hemolytic anemia)

  • Hemoglobin H disease

  • Hypothyroidism

  • Myelofibrosis

  • Aplastic or hypoplastic anemia

  • Autoimmune hemolytic anemia

  • Pure red cell aplasia

  • PNH

Many anemias may be due to a combination of several mechanisms. For example, anemia due to acute infection is due to temporal suppression of erythropoiesis and some degree of hemolysis.

Differential Diagnoses