Pediatric Anemia (Fanconi)

Fanconi anemia is a blood disorder. With this condition, the bone marrow doesn't make enough blood cells. Or it makes defective blood cells.

Bone marrow is the spongy material inside bones. It makes white and red blood cells, and platelets.

• Red blood cells carry oxygen through the body.
• White blood cells help fight infection.
• Platelets help with clotting.

All these cells die after a certain amount of time. They constantly need to be replaced.

Fanconi anemia is a very rare genetic condition. That means it runs in families. It is passed from parents to children. The condition can affect your child's whole body. It can cause physical problems, failure of the bone marrow and organ defects. It also increases the chance of getting some cancers, especially of the blood (leukemia). 

Defects in at least 15 genes have been linked to the disease.

People that have higher risk for Fanconi anemia include:

• Ashkenazi or Eastern European Jews
• Afrikaners or Black South Africans
• Romanis from Spain

You know your child better than anyone else. If you are in doubt or if you have questions or concerns, contact your child’s provider.

Also, work closely with your child's healthcare provider to know what to report. It depends on your child's age, treatment and other factors. For example, your child's provider will tell you what to watch for if your child has had a stem cell transplant. Or if your child is taking a certain medicine, the provider will tell you what side effects may occur. 

Diagnosing Fanconi anemia is difficult. There is no specific test for it. And, the signs may be found in other conditions. More testing is done on babies with physical signs (for example, abnormally developed thumbs). But about one in four babies don’t have physical signs. More tests may be done on a child with other health problems. Your child's health care provider will refer you to a blood specialist called a hematologist, or a geneticist. These experts will have experience in diagnosing Fanconi anemia. A diagnosis includes:

• Medical history including previous health problems and growth and development progress
• Physical exam
• Family history, including others with symptoms of Fanconi anemia and whether or not the family is part of one of the high-risk groups

Your child may have tests such as:

• Hemoglobin and hematocrit. This is a blood test that measures the amount of hemoglobin (the part of red blood cells that carries oxygen) and red blood cells in the blood.
• Complete blood count (CBC). A complete blood count checks the red and white blood cells, blood clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells.
• Peripheral smear. A small sample of blood is examined under a microscope. Blood cells are checked to see if they look normal or not.
• Blood tests of genes and chromosomes. Blood samples are taken and checked for abnormal genes and chromosomes. This is a test called a chromosomal breakage assay.
• Bone marrow tests. Samples of bone marrow are taken and checked for decreased and abnormal blood cells.

Your child's symptoms may include:

• Bone marrow related symptoms.These may include tiredness or fatigue, frequent infections and bleeding problems.
• Physical abnormalities.These may involve the skin, bones, kidneys, gastrointestinal system, brain, spinal cord, eyes, ears and the reproductive systems.

As an infant, your child may have many signs including:

• Irregular skin coloring
• Shorter than usual
• Abnormal thumbs or forearms
• Increased fluid in the brain (hydrocephaly)
• A small head 
• Abnormally shaped eyes or ears
• Kidney problems
• Heart problems that are present at birth (congenital heart defects)

Treatment of Fanconi anemia may require many different medical specialists. Your child will get treatment based on his or her signs and symptoms. Stem cell transplants offer the only cure for Fanconi anemia. Treatment may also include:

• Blood transfusions. This is done for low blood counts.
• Medicines. This is done for low blood counts, infections and other problems.
• Surgery.This may be done to correct malformed bones, for example. 

Fanconi anemia may lead to:

• Delayed growth or development
• Certain cancers, such as leukemia, cancers of the head and neck, and cancers of the female reproductive system
• Trouble getting pregnant (female and male infertility)
• Hearing loss
• Anemias, low red blood cell counts
• Infections
• Bleeding problems
• Gastrointestinal system and nutrition problems
• Blood sugar (glucose) and insulin problems
• Death

Your child will be watched very closely. He or she will have:

• Frequent physical exams and lab and other diagnostic tests
• More frequent screenings for cancer
• Genetic counseling, for you, your child and other brothers and sisters. This is very important before any pregnancy.
• Special precautions with medicines and diagnostic tests or treatments with X-ray or radiation

Fanconi anemia is a life-long disease that can be life threatening. Work with your child’s health care provider to develop a treatment plan for your child that can help him or her live as normal a life as possible. To do this:

• Work closely with your child’s school so that he or she gets what is needed. Your child may qualify for special programs under Section 504 of the Rehabilitation Act of 1973. 
• You and your family may get counseling or attend support groups. This can help you deal with a life-threatening disease. 
• Think about working with a social worker to get support, including financial support.  
• Remember to also pay attention to other children in the family.