Skip to main content
Caring for kids new to Canada

A guide for health professionals working with immigrant and refugee children and youth

Hereditary Anemias: An Overview

Key points

  • All children and youth new to Canada should be screened for anemia upon arrival.

  • Children and youth should be screened for hemoglobinopathies using high-performance liquid chromatography (HPLC), or hemoglobin electrophoresis, especially if microcytic anemia is present or if they are from high-risk ethnic backgrounds.

  • Early recognition of sickle cell disease and significant thalassemia, as well as management by a multidisciplinary team, can reduce significant complications.

  • All children and youth of Asian, African and Mediterranean descent should be screened for glucose-6-phosphate dehydrogenase (G6PD) deficiency upon arrival, especially if they are male, if newborn jaundice was prolonged or severe, or if treatment for malaria is required.

An approach to anemia

All children and youth new to Canada should be screened for anemia upon arrival. Those who may have experienced extreme poverty, such as refugees, are at particularly high risk of iron deficiency anemia. Iron deficiency anemia is often due to the complex interaction of malnutrition and chronic or recurrent gastrointestinal parasitic infestations.

Iron deficiency anemia and thalassemia are the most common causes of microcytic anemia in children. Less common causes are anemia of chronic disease/inflammation, lead toxicity and, rarely, sideroblastic anemia.

Children and youth with microcytic anemia should be screened or treated for iron deficiency empirically (unless there is concern for thalassemia major and potential iron overload). Further testing for hemoglobinopathies (using HPLC or hemoglobin electrophoresis), including sickle cell disease and thalassemia, is recommended when microcytic or normocytic anemia exists in the presence of normal iron studies, and:

  • there is a clinical history consistent with these diseases, or
  • the patient is at risk because of ethnicity or family history.

Iron deficiency and iron deficiency anemia are further discussed in the Malnutrition section of this website.

Children and youth of certain ethnicities are at increased risk of hereditary anemias, including:

Hemoglobinopathies such as thalassemia and sickle cell disease affect the quantity and quality, respectively, of hemoglobin molecules within red blood cells. Poor diet and weight loss due to parasites or chronic illness can compound the adverse effects of these hereditary anemias.

Health care providers should be aware that hemoglobinopathies are more common among newly arrived women from high-risk regions, and these conditions may lead to serious maternal and neonatal complications. Carrier screening is not standard practice in most parts of the world. The Society of Obstetricians and Gynaecologists of Canada recommends that women in at-risk ethnic populations be screened prior to conception or as early as possible in pregnancy.

Sources

Reviewer(s)

Meghna Dua, MD

Last updated: July, 2026