A practical approach to the child with anemia.

Anemia can be defined as a reduction in the hemoglobin concentration and red blood cell mass compared with age-matched normal values. Anemia is caused by poor production of red blood cells, destruction of red blood cells, or loss of red blood cells. Pediatric nurse practitioners will encounter patients in their practice who have anemia resulting from each of these causes. Common clinical presentations include the child who is feeling well but is found to have a low hemoglobin concentration on a routine screening test, the child who is "tired" and does not eat well, the infant or child who is being evaluated for other chronic problems and is found to have a low hemoglobin concentration, and last, the child who is obviously pale, lethargic, and requires immediate assessment and evaluation.