Anemia in Children: Even your aunt can tell when you are anemic – Part 1


Within one week of private medical practice I encountered three children with anemia.
One was a seventeen-year-old girl who came to my office for a sports clearance medical examination. She enjoyed playing tennis a lot. When her blood test result came back, her hemoglobin level was 7.8. On speaking to mother, the teen did not have any signs of anemia. ‘Nothing,’ Mom said, ‘except that my daughter loves to sleep,’ which most teenage girls do.

The second child was a toddler of fifteen months, who came in for a regular visit to assess height and weight, and behavioral developmental progress. Her blood test showed a hemoglobin level of 7.7 gm/dl.
The third child was an energetic two-year-old girl. Her mother said she was diagnosed with anemia while in New York City, but now they had moved to Connecticut and the patient was attending my practice for the first time. She had a hemoglobin level of 9.5 gm/dl.

A normal hemoglobin level is anywhere between 11.3 gm/dl and 14.5 gm/dl. My three patients had anemia caused by lack of iron in their blood, most likely from eating food low in iron.

General introduction: childhood anemia due to lack of iron
If you are unlucky and have one of those intrusive aunties who stop unsuspecting children and use their index fingers to expose the inside of your lower eyelids, don’t panic – they are just checking you out for lack of blood, also known as anemia.

‘Does anybody feed this child?’ your auntie might ask the rest of the family. ‘His eyelids look pale, like egg white. Please make him eat more vegetables, eggs, cereals, beans and red meat.’
Your aunt probably got her way and made your mother promise she would take you to the doctor.
Your aunt might be right in noticing that you are anemic, but what she is not able to tell is the severity of the anemia and the specific reasons why you are anemic. Your anemia may or may not be due to your hatred for vegetables, beans, and red meat.

Having said that, since the lack of iron in the food we eat is a common reason why people become anemic, your aunt is not totally wrong in suggesting that your mother gives you more beans, and vegetables, eggs, and red meat, which are foods that contains plenty of iron.

Even though taking iron medication would not fix all types of anemia, trying it out for a few days may be a sensible option in a child suspected of lacking iron, as long as a hemoglobin recheck to determine improvement is possible.

Blood and hemoglobin
Varieties of cells swim in our blood. Each cell type has its individual function. Inside one particular type of cell, called the red blood cells, resides a herculean molecule –hemoglobin – whose job it is to pick up oxygen [body fuel] from blood vessels near the lungs and transport it to all the living tissues of the body. If red blood cells were hens’ eggs, hemoglobin would be the yolk inside the eggs.

Anemia and hemoglobin
A person’s degree of anemia is measured by the quantity of hemoglobin in their blood. The normal hemoglobin level is between 11.3 gm/dl and 14.5 gm/dl.

Iron and protein in hemoglobin
Irons [hemo] and proteins [globin] are the main raw materials needed for hemoglobin. Production of the red blood cells and their hemoglobin content takes place primarily in the bone marrow. For our body and blood to have plentiful hemoglobin, it must have an abundant supply of iron, provided through the food we eat.

The protein portion of hemoglobin is as important as the iron part. Anemia resulting from the protein part of hemoglobin has to do with the quality or the quantity of protein the body provides for hemoglobin production – issues which are mostly inherited and originate at the gene level.

Sickle cell disease is an example of a condition which frequently leads to anemia, not because of lack of iron but because of a problem with the protein [globin] part of hemoglobin. As a result the red blood cells are easily destroyed, and with that the degradation of hemoglobin and anemia.

Part 11 and Part 111 of this Article is on


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