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Children with anemias often initially present to their pediatricians. Anemia may result from blood loss, a destructive process (ie, hemolysis), nutritional deficiency, or poor production (eg, ineffective erythropoiesis or hypoplastic or aplastic marrow) (Table). Hemolytic and nutritional anemias have been discussed elsewhere and are referenced briefly in this article. (1)(2)(3)(4) This review focuses on the broad differential diagnosis for anemia associated with poor production. These anemias can lead to chronic morbidity and require subspecialty care, whereas others may be managed effectively in primary care. This review offers a framework to guide evaluation and the need for subspecialty investigation.

Aplastic and hypoplastic anemias are characterized by impaired erythropoiesis due to decreased hematopoietic cells in the bone marrow. Impairment of erythropoiesis can result from an acquired condition or an inherited defect in marrow...

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