PE26.1 | Approach to Anaemia — Summary & Reflection

KEY TAKEAWAYS

Anaemia is defined by age-specific Hb cut-offs (<11 g/dL under 5 years, <11.5 g/dL at 5–11 years, <12 g/dL for adolescent girls). The MCV-based classification (microcytic <80 fL / normocytic 80–100 fL / macrocytic >100 fL) immediately focuses the differential. Microcytic anaemia in Indian children most commonly represents IDA, with thalassaemia trait as the important differential — the Mentzer index (MCV/RBC <13 = thalassaemia; >13 = IDA) and RDW (elevated in IDA, normal in thalassaemia) help distinguish them before electrophoresis. Normocytic anaemia requires the reticulocyte count to split haemolytic (high reticulocytes + indirect bilirubin) from hypoproliferative causes. Macrocytic anaemia requires B12/folate assay and smear for hypersegmented neutrophils. Peripheral blood smear is the single most information-rich investigation beyond the CBC. Transfusion is indicated for Hb <7 g/dL with compromise, at 10–15 mL/kg. Treat underlying cause; monitor reticulocyte response as the earliest sign of effective therapy.

REFLECT

Think back to the opening scenario: a pale, tachycardic 4-year-old with Hb 6.8, MCV 62, and RDW 19%. How has this module changed how you would approach her? Before this module, you might have ordered a battery of tests. Now, you can systematically move from MCV → Mentzer index → ferritin to reach a diagnosis efficiently. Consider: what dietary and social factors in this child's life contributed to her anaemia, and how would you address not just the haemoglobin number but the root cause? How might you counsel her caregiver in a way that is practical and culturally appropriate for a family relying on an anganwadi diet?