Abstract
Anemia is a frequently reported hematological complication of tuberculosis (TB), and its presence may complicate clinical assessment and management in affected children. This study determined the frequency, morphological patterns, and severity of anemia among children with pulmonary tuberculosis treated at a tertiary care hospital in Lahore, Pakistan. A cross-sectional study was conducted in the Department of Pediatric Medicine, Gulab Devi Hospital, from March to July 2026. Using consecutive sampling, 100 children aged 6–12 years with pulmonary TB were enrolled. Demographic and clinical information was recorded, and complete blood counts, peripheral blood smears, iron-related investigations, and selected biochemical tests were performed. Anemia was classified according to the study’s prespecified hemoglobin cutoff of less than 11.2 g/dL; this study-specific cutoff differs from international age-specific recommendations. Of the 100 children, 68 (68.0%) were classified as anemic. Among anemic participants, moderate anemia was the most frequent severity category (36/68; 52.9%), followed by mild (23/68; 33.8%) and severe anemia (9/68; 13.2%). Microcytic hypochromic anemia predominated (47/68; 69.1%), followed by normocytic normochromic anemia (17/68; 25.0%) and macrocytic anemia (4/68; 5.9%). The reported etiological classifications were anemia of chronic disease (48%), iron-deficiency anemia (41%), and mixed or unclassified anemia (11%). Anemia was observed in 35/48 girls (72.9%) and 33/52 boys (63.5%); no statistical significance test for this sex difference was reported. Elevated C-reactive protein and hypoalbuminemia were reported to be associated with anemia (p < 0.05), although detailed estimates were unavailable. Anemia was frequent among children with pulmonary TB in this hospital-based sample. Routine hematological assessment and context-sensitive interpretation of iron studies may support timely recognition of anemia, while larger studies using standardized pediatric diagnostic thresholds are needed to confirm the findings.
Keywords: pulmonary tuberculosis; childhood anemia; iron deficiency; anemia of inflammation; Pakistan; hemoglobin; hematological patterns
Abstract
Anemia is a frequently reported hematological complication of tuberculosis (TB), and its presence may complicate clinical assessment and management in affected children. This study determined the frequency, morphological patterns, and severity of anemia among children with pulmonary tuberculosis treated at a tertiary care hospital in Lahore, Pakistan. A cross-sectional study was conducted in the Department of Pediatric Medicine, Gulab Devi Hospital, from March to July 2026. Using consecutive sampling, 100 children aged 6–12 years with pulmonary TB were enrolled. Demographic and clinical information was recorded, and complete blood counts, peripheral blood smears, iron-related investigations, and selected biochemical tests were performed. Anemia was classified according to the study’s prespecified hemoglobin cutoff of less than 11.2 g/dL; this study-specific cutoff differs from international age-specific recommendations. Of the 100 children, 68 (68.0%) were classified as anemic. Among anemic participants, moderate anemia was the most frequent severity category (36/68; 52.9%), followed by mild (23/68; 33.8%) and severe anemia (9/68; 13.2%). Microcytic hypochromic anemia predominated (47/68; 69.1%), followed by normocytic normochromic anemia (17/68; 25.0%) and macrocytic anemia (4/68; 5.9%). The reported etiological classifications were anemia of chronic disease (48%), iron-deficiency anemia (41%), and mixed or unclassified anemia (11%). Anemia was observed in 35/48 girls (72.9%) and 33/52 boys (63.5%); no statistical significance test for this sex difference was reported. Elevated C-reactive protein and hypoalbuminemia were reported to be associated with anemia (p < 0.05), although detailed estimates were unavailable. Anemia was frequent among children with pulmonary TB in this hospital-based sample. Routine hematological assessment and context-sensitive interpretation of iron studies may support timely recognition of anemia, while larger studies using standardized pediatric diagnostic thresholds are needed to confirm the findings.
Keywords: pulmonary tuberculosis; childhood anemia; iron deficiency; anemia of inflammation; Pakistan; hemoglobin; hematological patterns
References
- World Health Organization. Global Tuberculosis Report 2025: TB
Disease Burden, Incidence. World Health Organization, 2025. https://www.who.int/teams/global-programme-on-tuberculosis-and-lung-health/tb-reports/global-tuberculosis-report-2025/tb-disease-burden/1-1-tb-incidence.
- Nortey, Abraham Norman, et al. “Adherence Patterns, Risk Factors and
Complications among Patients with Tuberculosis: A Cross-Sectional Study
at Nsawam Government Hospital.” BMJ Public Health, vol. 2, no.
1, 2024, article e000618. https://doi.org/10.1136/bmjph-2023-000618.
- Tahseen, Sabira, et al. “Extrapulmonary Tuberculosis in Pakistan—A
Nation-Wide Multicenter Retrospective Study.” PLOS ONE, vol.
15, no. 4, 2020, article e0232134.
- McAllister, Susan M., et al. “High Tuberculosis Incidence among
People Living with Diabetes in Indonesia.” Transactions of the Royal
Society of Tropical Medicine and Hygiene, vol. 114, no. 2, 2020,
pp. 79–85.
- Kanji, Samina Iqbal. “Tuberculosis: Moving from Cure to Prevention in
Pakistan.” International Journal of Endorsing Health Science
Research, vol. 3, no. 3, 2015, pp. 27–30.
- Walzl, Gerhard, et al. “Tuberculosis: Advances and Challenges in
Development of New Diagnostics and Biomarkers.” The Lancet
Infectious Diseases, vol. 18, no. 7, 2018, pp. e199–e210.
- Gao, Zhongmin, et al. “Growth and Anemia among Children with
Tuberculosis Infection at Different Sites in Southwest China.”
Frontiers in Pediatrics, vol. 11, 2023, article 1188704. https://doi.org/10.3389/fped.2023.1188704.
- Tellez-Navarrete, Norma A., et al. “Malnutrition and Tuberculosis:
The Gap between Basic Research and Clinical Trials.” The Journal of
Infection in Developing Countries, vol. 15, no. 3, 2021, pp.
310–19.
- World Health Organization. Guideline on Haemoglobin Cutoffs to
Define Anaemia in Individuals and Populations. World Health
Organization, 2024. https://www.ncbi.nlm.nih.gov/books/NBK602185/table/ch5.tab2/.
- Auerbach, Michael, and John W. Adamson. “How We Diagnose and Treat
Iron Deficiency Anemia.” American Journal of Hematology, vol.
91, no. 1, 2016, pp. 31–38.
- Cercamondi, Colin I., et al. “Iron Homeostasis during Anemia of
Inflammation: A Prospective Study of Patients with Tuberculosis.”
Blood, vol. 138, no. 15, 2021, pp. 1293–1303. https://doi.org/10.1182/blood.2020010562.
- Minchella, Peter A., et al. “Complex Anemia in Tuberculosis: The Need
to Consider Causes and Timing When Designing Interventions.”
Clinical Infectious Diseases, vol. 60, no. 5, 2015, pp.
764–772. https://doi.org/10.1093/cid/ciu945.
- Banerjee, Molay, et al. “Hematological Profile among Pulmonary
Tuberculosis Patients in Tertiary Care Hospital.” International
Journal of Bioassays, vol. 4, no. 5, 2015, pp. 3900–02.
- Mukherjee, Anirudh, et al. “Prevalence, Characteristics, and
Predictors of Tuberculosis Associated Anemia.” Journal of Family
Medicine and Primary Care, vol. 8, no. 7, 2019, pp. 2445–2449. https://doi.org/10.4103/jfmpc.jfmpc_311_19.
- Barzegari, Saeed, et al. “Prevalence of Anemia among Patients with
Tuberculosis: A Systematic Review and Meta-Analysis.” Indian Journal
of Tuberculosis, vol. 66, no. 2, 2019, pp. 299–307. https://doi.org/10.1016/j.ijtb.2019.04.002.
- Abaynew, Yeshewas, et al. “Prevalence and Types of Anemia among
People with Tuberculosis in Africa: A Systematic Review and
Meta-Analysis.” Scientific Reports, vol. 13, 2023, article
5385. https://doi.org/10.1038/s41598-023-32609-1.
- Farhadian, Maryam, et al. “Hematological Parameters in Newly
Diagnosed TB Patients: A Systematic Review and Meta-Analysis.”
Tuberculosis, vol. 144, 2024, article 102430. https://doi.org/10.1016/j.tube.2023.102430.
- Lee, Sei Won, et al. “The Prevalence and Evolution of Anemia
Associated with Tuberculosis.” Journal of Korean Medical
Science, vol. 21, no. 6, 2006, pp. 1028–1032. https://doi.org/10.3346/jkms.2006.21.6.1028.
- Kwon, Yong-Soo, et al. “Risk Factors for Death during Pulmonary
Tuberculosis Treatment in Korea: A Multicenter Retrospective Cohort
Study.” Journal of Korean Medical Science, vol. 29, no. 9,
2014, pp. 1226–31.
- Araújo-Pereira, Mariana, et al. “Anemia and Anti-Tuberculosis
Treatment Outcome in Persons with Pulmonary Tuberculosis: A Multi-Center
Prospective Cohort Study.” Journal of Infection and Public
Health, vol. 16, no. 6, 2023, pp. 974–980. https://doi.org/10.1016/j.jiph.2023.04.009.
- Brooks, Meredith B., et al. “Predictors of Unsuccessful Tuberculosis
Treatment Outcomes in Children from a Prospective Cohort Study in
Pakistan.” Journal of Global Health, vol. 11, 2021, article
04011.
- Hasan, Zahra, et al. “Evaluation of Xpert MTB/RIF Testing for Rapid
Diagnosis of Childhood Pulmonary Tuberculosis in Children by Xpert
MTB/RIF Testing of Stool Samples in a Low Resource Setting.” BMC
Research Notes, vol. 10, 2017, article 473. Supplementary Table S1
presents the modified Kenneth Jones/Pakistan Paediatrics Association
scoring chart. https://doi.org/10.1186/s13104-017-2806-3.
- Powers, Jacquelyn M., and Donald H. Mahoney. “Iron Deficiency in
Infants and Children <12 Years: Screening, Prevention, Clinical
Manifestations, and Diagnosis.” UpToDate, 2020.
- de Mendonça, Edson Beyker, et al. “Anemia in Tuberculosis Cases: A
Biomarker of Severity?” PLOS ONE, vol. 16, no. 2, 2021, article
e0245458. https://doi.org/10.1371/journal.pone.0245458.
- Ashenafi, Senait, et al. “Anemia Is a Strong Predictor of Wasting,
Disease Severity, and Progression, in Clinical Tuberculosis (TB).”
Nutrients, vol. 14, no. 16, 2022, article 3318.
- Luo, Mengxing, et al. “Impact of Anemia on Prognosis in Tuberculosis
Patients.” Annals of Translational Medicine, vol. 10, no. 6,
2022, article 329.
How to cite:
Hafsa Aftab, Muhammad Naeem, Sumbal Inam, Maha Ijaz, Hamna Sohail, Zainab Sultan. Frequency of Anemia in Children With Pulmonary Tuberculosis Presenting at a Tertiary Care Hospital. Revista Cultura Científica, 2026 Issue 24. pg. 1779-1787.
Publication History
-
Received: 03/07/2026
-
Accepted: 26/09/2026
-
Published: 13/10/2026
Copyright © 2026, Hafsa Aftab, Muhammad Naeem, Sumbal Inam, Maha Ijaz, Hamna Sohail, Zainab Sultan. Published by Revista Cultura Científica. This article is published as open access under the Creative Commons Attribution 4.0 International (CC BY 4.0) license (
http://creativecommons.org/licenses/by/4.0/).