Introduction
Anaemia is a haemoglobin below the normal range for age: WHO cut-offs are 110 g/L at 6 months–5 years, 115 g/L at 5–11 years and 120 g/L at 12–14 years. A healthy term baby's haemoglobin falls to its lowest at 8–12 weeks (about 100–110 g/L, the physiological nadir), earlier and lower in preterm babies. Haemorrhagic diseases are disorders of the vessels, platelets or clotting factors that cause abnormal bleeding.
Iron deficiency anaemia
- Who: infants and toddlers (too much cow's milk, late weaning, preterm birth), adolescent girls (periods), blood loss (coeliac disease, inflammatory bowel disease, Meckel diverticulum).
- Signs: pallor, tiredness, irritability, poor concentration and development, pica, angular cheilitis, spoon nails.
- Tests: low MCV and MCH, low ferritin (under 12–15 µg/L; ferritin rises in inflammation), high red cell distribution width. Mentzer index (MCV ÷ red cell count) over 13 suggests iron deficiency, under 13 thalassaemia trait.
- Treatment: oral elemental iron 3 mg/kg a day, between meals, with vitamin C; limit cow's milk to about 500 mL a day. Reticulocytes rise in 5–10 days; continue for 3 months after haemoglobin is normal. Iron stains teeth temporarily.