Unrecognized severe anemia in children presenting with respiratory distress

The cases of four children who presented with respiratory distress unresponsive to bronchodilator treatment and who were subsequently diagnosed with severe anemia were retrospectively reviewed from charts at a childrenʹs hospital with 110 beds and an emergency department census of 32,000 per year. The four children, age range 11 months to 2 years, each initially presented with tachypnea. Three had wheezing, three were pale, and each received outpatient bronchodilator treatment. Three to 4 days later, each patient was hospitalized for continued respiratory distress. Each child was pale, and hemoglobin levels ranged from 2.5 to 5.2 g/dL. In three children, respiratory distress resolved with blood transfusions. Final diagnoses were transient erythroblastopenia of childhood in 2, acute lymphoblastic leukemia in 1, and iron deficiency anemia in 1. Severe anemia is a known cause of respiratory distress. These cases remind the clinician to consider severe anemia in children who are tachypneic, pale, and unresponsive to treatment of respiratory disorders.