A 3-year-old child has hypochromic, microcytic anemia. Which condition should be included in the differential diagnosis?

A 3-year-old child has hypochromic, microcytic anemia. Which condition should be included in the differential diagnosis?

• A. Pernicious anemia
• B. Lead poisoning
• C. Hemophilia
• D. Folic acid deficiency

Answer: (B)

In a young child, hypochromic, microcytic anemia points to disorders that impair hemoglobin synthesis. Lead poisoning is a classic consideration because lead blocks key enzymes in heme production (ferrochelatase and ALA dehydratase), leading to smaller red cells with less hemoglobin and often basophilic stippling on the smear. It’s particularly important to consider in toddlers due to environmental exposure risks (pica, contaminated dust or paint). Pernicious anemia and folic acid deficiency produce macrocytic (not microcytic) anemia, since they disrupt DNA synthesis in red cell precursors. Hemophilia is a bleeding disorder; it can cause anemia if there’s significant chronic blood loss, but it does not characteristically cause microcytosis with hypochromia. Thus, lead poisoning best fits the described cell morphology and age-related exposure risk.

In a young child, hypochromic, microcytic anemia points to disorders that impair hemoglobin synthesis. Lead poisoning is a classic consideration because lead blocks key enzymes in heme production (ferrochelatase and ALA dehydratase), leading to smaller red cells with less hemoglobin and often basophilic stippling on the smear. It’s particularly important to consider in toddlers due to environmental exposure risks (pica, contaminated dust or paint).

Pernicious anemia and folic acid deficiency produce macrocytic (not microcytic) anemia, since they disrupt DNA synthesis in red cell precursors. Hemophilia is a bleeding disorder; it can cause anemia if there’s significant chronic blood loss, but it does not characteristically cause microcytosis with hypochromia. Thus, lead poisoning best fits the described cell morphology and age-related exposure risk.