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Anemia is the most common hematologic abnormality that pediatricians encounter. The differential diagnosis for anemia in children includes congenital, acquired, benign, malignant, common, and extraordinarily rare disorders. Thankfully, most conditions cause consistent changes in the mean cell volume (MCV) of red blood cells (RBCs) and can be grouped by using this parameter. In children, anemia is caused most often by disorders that result in smaller-than-normal RBCs (microcytosis) (Table 1). With a thorough history, a good physical examination, and perhaps some additional blood work, the correct cause of a child’s microcytic anemia can be discovered.

Automated blood counters may not take into account the normal variations in hemoglobin/hematocrit and MCV that are seen throughout childhood. Results reported as abnormal must be compared with age-specific values (Table 2). Values that are 2 standard deviations below the age-appropriate mean can be considered...

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