Transient Erythroblastopenia of Childhood

Although the words might seem scary, transient erythroblastopenia of childhood (TEC) is a self-limited anemia of childhood. It is the most common cause of decreased red blood cell production in childhood.

Erythroblasts are the cells that develop into red blood cells and -penia comes from the Greek word for deficiency. Essentially, the anemia results from an inability of the bone marrow to produce red blood cells for some period of time.

Symptoms

The anemia in TEC is a slow process so some children may have no symptoms. These children might be found incidentally with routine blood work or may recover without ever coming to medical attention. In other patients, symptoms are related to anemia. They include:

• Pallor or pale skin
• Fatigue or tiredness
• Poor appetite, anorexia
  
• Rapid heartbeat, known as tachycardia
• Shortness of breath, dizziness

Risk Factors

As the name suggests, TEC occurs in childhood. The majority of children are diagnosed between one and four years of age. Boys appear to have a slightly increased risk compared to girls.

Diagnosis 

There is no single diagnostic test for TEC. Some patients may be identified by routine blood work for well child checks. In other patients, if anemia is suspected, the doctor may start by ordering a complete blood count (CBC).

In general, the CBC will reveal isolated anemia. Occasionally there may be neutropenia (a decreased number of neutrophils, a type of white blood cell). The red blood cells are normal sized but can be enlarged when the patient starts to recover. 

The next part of the workup is a reticulocyte count. Reticulocytes are immature red blood cells just released from the bone marrow. Early in the course, the reticulocyte count is down, called reticulocytopenia. Once the bone marrow suppression resolves, the reticulocyte count goes up (higher than normal) to replenish the red blood cell supply and returns to normal when the anemia resolves. 

During the workup, it is very important to distinguish TEC from Diamond-Blackfan anemia (DBA), an inherited form of anemia. Patients with DBA have severe lifelong anemia. Patients with DBA are generally younger (under the age of 1) at diagnosis and the red blood cells are larger than normal (macrocytosis).

Rarely, if the diagnosis is not clear, a bone marrow aspirate and biopsy may need to be performed. Sometimes the best confirmatory test for TEC is that the patient recovers in 2 to 8 weeks without intervention.

Causes

The short answer is we don’t know. About one-half of patients will report a viral illness 2 - 3 months prior to diagnosis. It is suspected that a virus causes temporary suppression of red blood cell production in the bone marrow. Several viruses have been associated with TEC but none on a consistent basis.

Duration

In most cases, TEC resolves in 1 to 2 months but there are reports of children taking longer to recover. 

Treatments

• Observation: If anemia is mild and your child is asymptomatic, no treatment may be necessary. Your physician may trend your child’s blood count over time until it is resolved.
• Corticosteroids: Sometimes steroids like prednisone have been used but there is no solid evidence that this treatment shortens the time to recovery.  
• Transfusion: If the anemia is severe or your child is symptomatic from the anemia (dizziness, fatigue, shortness of breath, elevated heart rate, etc.) a blood transfusion may be given.