Anemia in children with acute infections seen in a primary care pediatric outpatient clinic

Anemia is a recognized feature of chronic disease and severe acute infection in hospitalized children. The purpose of this study was to determine the association of anemia with manifestations of infection in an unselected group of children seen as outpatients. The group consisted of 1347 children between the ages of 0.5 and 12 years that were seen over a 3-month period. Anemia was detected in 17% of the children ages 6 to 47 months (hemoglobin (Hgb) less than 11.0 g/dl) and in 5% of the children between 4 and 12 years of age (Hgb less than 11.5 g/dl). The prevalence of anemia was strongly associated with the degree of inflammation as indicated by the erythrocyte sedimentation rate (ESR). Of those children ages 6 to 47 months with an ESR greater than or equal to 50 mm/hour, 91% had Hgb less than 11.0 g/dl and 52% had Hgb less than 10.0 mg/dl. In contrast anemia (Hgb less than 11.0 g/dl) was rare (9%) in the group with ESRs of 0 to 19 mm. The corresponding prevalences of anemia in other ESR categories were 49% with ESR 40 to 49 mm/hour, 28% with ESR 30 to 39 mm/hour and 16% with ESR 20 to 29 mm/hour. There was also a significant association of anemia with the duration of fever in the children ages 6 to 47 months with ESR greater than or equal to 40 mm. The results show that anemia was commonly associated with the usually mild infections that are typically seen in a pediatric primary care setting. The anemia could be inferred to be reversible and unrelated to iron deficiency in most cases.