Background and aim: The relative importance of the different causes of severe anemia varies with the regions of the world. Most studies have been confined to the severe anemia associated with malaria, HIV or with other individual factors. We conducted this cross sectional study to assess the causative factors and management of severe anemia in a large tertiary center.
Study design: Records of all children (≤16 years) with severe anemia (hemoglobin < 7.0 g/dl) admitted between 2008 and 2013 to pediatric departments were reviewed. Data including demographic characteristics, presenting signs and symptoms, laboratory findings, causal factors and management were analyzed.
Results: A total of 227 children (123 female, 54%) at a median (range) age at of 4.4 years (1 day-15.5 years) were included. The median (range) hemoglobin at presentation was 6.3 (2.66.9) g/dl. The main causes for severe anemia were iron deficiency anemia (IDA) (37%), acute blood loss (14%), neonatal causes (10%). Red blood cells (RBCs) transfusion was used as a sole or part of treatment in 144 (63%) children. Of all children with IDA, 25 (30%) received RBCs transfusion. In this subgroup, the use of RBCs transfusion was associated with the presence of underlying diseases (p=0.02) and higher mean capsular volume (MCV) levels (p<0.001).
Conclusion: Iron deficiency, a potentially preventable medical problem, is the leading cause for severe anemia in children presenting to the hospital. The use of RBCs transfusion in almost third of these cases may result in unnecessary transfusion related complications. Improved attempts for prevention of IDA in children and guidelines for RBCs transfusion in children with severe anemia are needed.
