2025 – PAGE 285 – HEMATOLOGY & ONCOLOGY
TRANSIENT ERYTHROBLASTOPENIA OF CHILDHOOD
Look for a healthy child with slow onset of pallor, erythropenia. The typical age of onset for transient erythroblastopenia of childhood is around 18-24 months, but can happen earlier or later. The etiology is unknown.
PEARLS: Even if the hemoglobin is 4.2, the treatment is to OBSERVE unless there is hemodynamic compromise due to high output cardiac failure. This condition can look similar to Diamond-Blackfan (as just the red cell is affected), but the age of presentation is different. Diamond-Blackfan occurs around 3-12 months of age and is associated with dysmorphic features. Also, for DB the anemia is MACROCYTIC.
ACUTE BLOOD LOSS ANEMIA
In cases of acute blood loss anemia, there can be a normal MCV because there has been no time for the MCV to change.
(DOUBLE TAKE) ANEMIA OF CHRONIC DISEASE
Anemia of a chronic disease is a chronic inflammation that leads to a defect in the production of RBCs. There are plenty of building blocks, so the MCV is usually NORMAL, but it can be LOW NORMAL or only BORDERLINE LOW. This can be a normocytic or a slightly microcytic anemia. Also look for a low TIBC (Total Iron Binding Capacity). The TIBC measures the ability of transferrin to take on more iron. If the value is low, there’s plenty of iron around.
END STAGE RENAL DISEASE (AKA ESRD or RENAL FAILURE)
In end-stage renal disease (AKA ESRD or renal failure), the kidneys fail to produce erythropoietin. Again, it’s a defect in the production of RBCs. There are plenty of building blocks, so the MCV is normal.
PEARLY REMINDERS
- The combination of ANEMIA + JAUNDICE = HEMOLYSIS! This may last for WEEKS in ABO incompatibilities and Rh disease as the maternal antibodies slowly clear. Treat with phototherapy, transfusions, and exchange transfusions (if severe). Remember, an MCV of 70 – 90 is NORMAL up to 2 years of age.