UNRECOGNIZED SEVERE ANEMIA IN CHILDREN PRESENTING WITH RESPIRATORY-DISTRESS

The cases of four children who presented with respiratory distress unr esponsive to bronchodilator treatment and who were subsequently diagno sed with severe anemia were retrospectively reviewed from charts at a children's hospital with 110 beds and an emergency department census o f 32,000 per year, The four children, age range 11 months to 2 years, each initially presented with tachypnea. Three had wheezing, three wer e pale, and each received outpatient bronchodilator treatment. Three t o 4 days later, each patient was hospitalized for continued respirator y distress. Each child was pale, and hemoglobin levels ranged from 2.5 to 5.2 g/dL. In three children, respiratory distress resolved with bl ood transfusions. Final diagnoses were transient erythroblastopenia of childhood in 2, acute lymphoblastic leukemia in 1, and iron deficienc y anemia in 1. Severe anemia is a known cause of respiratory distress, These cases remind the clinician to consider severe anemia in childre n who are tachypneic, pale, and unresponsive to treatment of respirato ry disorders. (Am J Emerg Med 1998;16:386-389. Copyright (C) 1998 by W .B. Saunders Company).