Red cell parameters in infant and children from the Arabian Peninsula

α+-Thalassemia trait and iron deficiency anemia are frequent causes of microcytosis and a common diagnostic challenge in Arabian children. In this study, their prevalences and effects on the red cell parameters were evaluated in 28,457 children aged one day to 6 years. α+-Thalassemia trait was considered to be present when mean cell volume (MCV) was <94 fL at birth and iron deficiency anemia when red cell distribution width (RDW) was >14.5%. The prevalence of α+-thalassemia trait was 15.7% (502/3,191), which was similar to previously reported values for adults (9-14%). Iron deficiency anemia peaked at 7 months (53%) and then declined at a rate of 8% per year. The nadirs of red blood cell count (RBC) and hemoglobin concentration (Hb) occurred at two months of age (physiological anemia). Subsequently, Hb increased at a rate similar to that of MCV, demonstrating the two processes are coupled. The third percentile MCV in children older than 3 months was ≤64 fL, which was significantly lower than that in European children. The third percentile Hb, on the other hand, was similar to that in European children. Thus, α+-thalassemia trait and iron deficiency anemia are exceptionally frequent in Arabian children and their red cell indices are considerably different from European-based norms. Careful interpretation of red cell parameters is required for the evaluation of microcytic anemia in Arabian children.