The Anemia of Childhood

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Abstract
Minor increases in plasma inorganic phosphate concentration produce major alterations in red-cell metabolism in vitro and lead to raised levels of red-cell adenosine triphosphate and 2,3-diphosphoglycerate in vivo, with a resultant shift in the hemoglobin-oxygen dissociation curve to the right. Normal children have plasma phosphates 50 per cent above the normal adult range. Studies were performed to determine whether this hyperphosphatemia might alter levels of red-cell adenosine triphosphate and 2,3-diphosphoglycerate, as well as oxygen affinity, in childhood. In 62 normal children aged one to 12 years the levels of the red-cell organic phosphates were significantly higher than in 48 normal adults. In nine normal children the hemoglobin-oxygen dissociation curve was shifted 1.6 mm Hg to the right of that in 17 normal adults. It is postulated that the physiologic "hyperphosphatemia" of childhood leads to raised levels of red-cell organic phosphates and decreased oxygen affinity and may thus explain the physiologic "anemia" of childhood.