Decreased RBC in Children: Anemia Concerns and Testing

Decreased RBC (Red Blood Cell) count in blood test?

Hello, doctor.
My son is eight years old.
From 2019 to 2021, he had three routine blood tests, and his RBC count decreased from 4.67 to 4.53 to 4.34, Hb from 13 to 12.9, and Hct from 39.7 to 38.7 to 37.
All these values are consistently below the reference range.
Is this anemia? Could it be caused by easy bruising leading to anemia? Are the normal blood test values for children the same as for adults? Should we be concerned about this decrease in values? Thank you, doctor!

Kelvin, 0~9 year old female. Ask Date: 2021/04/12

Dr. Xiao Kaiwen reply Pediatrics

An 8-year-old's complete blood count (CBC) values are similar to those of adults.
Easy bruising should be evaluated in terms of coagulation function, such as platelet count, and is not related to anemia.
Such values show only a very slight decrease; if other parameters in the CBC, such as white blood cell count and platelet count, are normal, then ongoing monitoring should suffice.

Reply Date: 2021/04/12

More Info

When evaluating the blood test results of your eight-year-old son, it is important to understand the implications of decreasing red blood cell (RBC) counts, hemoglobin (Hb), and hematocrit (Hct) levels over time. The values you provided indicate a gradual decline in these parameters, which can indeed suggest the presence of anemia. Anemia in children is defined as a decrease in the number of red blood cells or the amount of hemoglobin in the blood, leading to insufficient oxygen delivery to tissues.

In children, the normal reference ranges for RBC, Hb, and Hct can differ from those in adults. For an eight-year-old boy, typical reference ranges are approximately:
- RBC: 4.1 to 5.5 million cells per microliter
- Hb: 11.5 to 15.5 grams per deciliter
- Hct: 34% to 45%
Given that your son's RBC count has decreased from 4.67 to 4.34 million cells per microliter, and his Hb has dropped from 13 to 12.9 grams per deciliter, these values are indeed approaching the lower limits of normal. The Hct also shows a downward trend, which is concerning.
The causes of anemia in children can vary widely, including nutritional deficiencies (such as iron, vitamin B12, or folate), chronic diseases, bone marrow disorders, or hemolytic conditions. The fact that your son is experiencing easy bruising could suggest a bleeding disorder or a problem with platelet function, which may or may not be related to the anemia. Easy bruising can occur due to low platelet counts (thrombocytopenia) or issues with blood vessel integrity, and it is essential to investigate this further.

To determine the cause of the anemia, additional tests may be warranted. These could include:
1. Complete Blood Count (CBC): To assess other components of the blood, including white blood cells and platelets.

2. Reticulocyte Count: To evaluate bone marrow response to anemia.

3. Iron Studies: To check for iron deficiency, which is a common cause of anemia in children.

4. Vitamin B12 and Folate Levels: To rule out deficiencies that can contribute to anemia.

5. Peripheral Blood Smear: To examine the shape and size of red blood cells and identify any abnormalities.

If the anemia is confirmed, it is crucial to identify the underlying cause to guide appropriate treatment. For instance, if iron deficiency is diagnosed, iron supplementation and dietary changes may be recommended. If there are concerns about bleeding disorders, a referral to a hematologist may be necessary.

In summary, the decreasing RBC, Hb, and Hct levels in your son indicate a potential anemia that should be evaluated further. While the easy bruising could be related, it is essential to conduct a thorough assessment to determine the exact cause and appropriate management. Regular follow-up with your pediatrician and possibly a specialist will be important to monitor his condition and ensure he receives the necessary care.

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