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Regarding your question i want to share with you that as you mentioned your child have low level of hemoglobin and rest of the cell count and retic count are normal some time iron deficency in childrens can present with low level of hemoglobin as iron is necessary for the foramtion of hemoglobin so ge check iron level and total iron binding capacity and if levels are low then replace your child iron accoringly .
I would like to add that he suffers from nose bleeds. In June he had a severe nose bleed which caused him to almost pass out. Could this recent episode be the cause of the 6.9 reading?If his body is lacking hemoglobin and his red blood cells are 'small' according to a recent blood test, why isn't his retic counts higher indicating that his body is trying to make it up?
What methods of iron replacement do you suggest?
As you mentioned that he had nose bleed and recent blood test showed small red blood cells mean microcytic cells are these cells are seen usually in iron defeciency anemia commonly called microcytic ,hypochromic anemia,i will suggest him fresh apple juice that is rich in iron twice a day , along with iron syrup three times a day one teaspoonful and continue this treatment for 2 -3 months he will improve.
Well retic can be normal in different types of anemia such as in vitamin B12 defeciency and other type of anemia so dont worry for that and start his treatment.
There was also a mention of broken fragments in the redblood cells.... what does that mean?
I will finally suggest you to please get once consultation from hematologist and discuss all the report parameters with him that will also helpful for you.
Well broken fragments in the red blood cells or such fragmented RBC's are known as schistocytes and they are indicative of a hemolysis or breakdown of red blood cells.