Yao Y, Hu Y, Chen Y, Wang YP, Li CY. Clinical characteristics of hospitalized children with gastrointestinal bleeding and risk factors for associated anemia. World J Gastrointest Surg 2026; 18(7): 121498 [DOI: 10.4240/wjgs.v18.i7.121498]
Corresponding Author of This Article
Chuan-Ying Li, Academic Fellow, Department of Pediatric Gastroenterology, Anhui Provincial Children’s Hospital, No. 39 Wangjiang East Road, Tong’an Street, Baohe District, Hefei 230051, Anhui Province, China. licy693@163.com
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Yao Y, Hu Y, Chen Y, Wang YP, Li CY. Clinical characteristics of hospitalized children with gastrointestinal bleeding and risk factors for associated anemia. World J Gastrointest Surg 2026; 18(7): 121498 [DOI: 10.4240/wjgs.v18.i7.121498]
Yun Yao, Yan Hu, Yi Chen, Yu-Ping Wang, Chuan-Ying Li, Department of Pediatric Gastroenterology, Anhui Provincial Children’s Hospital, Hefei 230051, Anhui Province, China
Author contributions: Yao Y was responsible for data curation, analysis, as well as manuscript drafting, editing, and review; Wang YP and Chen Y undertook data curation, validation, and formal statistical analysis; Hu Y provided resources and support for the research; Li CY supervised the study and managed the project; all authors jointly agreed to submit the manuscript to this journal, confirmed that the submitted version is the final version, and committed to being responsible for the entire process and the research work content.
Institutional review board statement: This study complies with the Declaration of Helsinki and has been approved by the Ethics Committee of Anhui Provincial Children’s Hospital (Approval No. 2026-19).
Informed consent statement: All study participants or their legal guardians provided written informed consent prior to enrollment in this study.
Conflict-of-interest statement: No conflicts of interest for this article.
Data sharing statement: All experimental data included in this study can be obtained by contacting the corresponding author if needed.
Corresponding author: Chuan-Ying Li, Academic Fellow, Department of Pediatric Gastroenterology, Anhui Provincial Children’s Hospital, No. 39 Wangjiang East Road, Tong’an Street, Baohe District, Hefei 230051, Anhui Province, China. licy693@163.com
Received: April 2, 2026 Revised: April 28, 2026 Accepted: May 9, 2026 Published online: July 27, 2026 Processing time: 118 Days and 23.4 Hours
Abstract
BACKGROUND
Gastrointestinal bleeding (GIB) is common in children and may lead to anemia, yet the risk factors for anemia in pediatric GIB remain poorly understood.
AIM
To characterize hospitalized pediatric patients with GIB and to evaluate GIB incident and independent risk factors for anemia.
METHODS
Pediatric patients hospitalized with GIB between December 2022 and December 2025 at Anhui Provincial Children’s Hospital, were enrolled in this single center retrospective study. Demographic, clinical presentation, laboratory evaluation and final diagnosis were obtained. Based on the presence or absence of anemia, patients were classified into anemic group and non-anemic group. The intergroup comparisons were performed by the non-parametric test and the χ2 test. Independent risk factors for anemia were investigated by performing Logistic regression.
RESULTS
The study included 257 hospitalized children with GIB, 45 of whom showed anemia, the anemic group has older children than 5 year and greater proportion of rural children (P < 0.05). The anemic group has higher rate of melena and the non-anemic group has a higher percentage of children with hematochezia and diarrhea. The results of laboratory tests showed lower white blood cell count, monocyte count, lymphocyte count, albumin level, serum potassium level, as well as higher levels of blood urea nitrogen and prothrombin time, and a shorter activated partial thromboplastin time (APTT) in anemic group (P < 0.05). Multivariate Logistic regression analysis revealed that melena, low albumin levels, low lymphocyte counts, and shortened APTT were independent risk factors for anemia. On the other hand, diarrhea was an independent protective factor (P < 0.05). Additionally, the risk of anemia was significantly lower in children aged 2-5 years than in those aged ≤ 2 years (P < 0.05).
CONCLUSION
The incidence of anemia in hospitalized children with GIB was 17.5%, and it was closely related to age, clinical manifestations, and several laboratory indicators. Melena, low albumin, low lymphocyte count, and shortened APTT were closely associated with the occurrence of anemia. High-risk children should be identified and managed in a timely manner to reduce the incidence of anemia.
Core Tip: This single-center retrospective study of 257 hospitalized children found an anemia incidence of 17.5%. Key independent risk factors for anemia included melena, low albumin levels, low lymphocyte count, and shortened activated partial thromboplastin time (APTT). Diarrhea was identified as a protective factor. Notably, shortened APTT, rather than prolonged APTT, emerged as a novel independent risk factor, suggesting a possible compensatory coagulation response to chronic bleeding. These findings highlight the necessity of early identification of high-risk children to enable timely intervention.
Citation: Yao Y, Hu Y, Chen Y, Wang YP, Li CY. Clinical characteristics of hospitalized children with gastrointestinal bleeding and risk factors for associated anemia. World J Gastrointest Surg 2026; 18(7): 121498
Gastrointestinal bleeding (GIB) is a frequent diagnosis in pediatric clinical practice, and has two main categories, upper GIB (UGIB) and lower GIB (LGIB)[1,2]. The etiology of pediatric GIB is multifactorial and variable, and the most typical causes are infection, inflammation, anatomical defects, medication history, and coagulation disorders[2,3]. The incidence of GIB in pediatric populations have been demonstrated to be more than 6%, children with diseases and children with malnutrition, clinical management are relatively urgent[4]. There is currently no systematic description and the unified opinion for the clinical features of children with GIB.
GIB is a pathological manifestation of the digestive system that can lead to secondary anemia[5,6]. Since children are in a critical stage of growth and development, anemia can negatively impact cognitive function, immune competence, and learning ability, and may also be associated with long-term adverse health outcomes[7,8]. Although current studies emphasize the negative impact of anemia on child health, the occurrence of anemia in children with GIB has not received adequate attention. Anemia caused by GIB may result from acute blood loss or develop gradually due to chronic occult bleeding and iron loss[4,5,9]. Some children are significantly anemic when hospitalized for GIB, while others develop anemia during hospitalization[10,11]. Most existing studies focus on the primary etiology of GIB and bleeding control, with limited investigation into the characteristics of anemia in this patient population[9]. Furthermore, few studies have explored which clinical manifestations, laboratory indicators, or underlying diseases in pediatric GIB patients may predict or indicate the risk of anemia, which greatly limits early intervention and the implementation of individualized treatment strategies.
In clinical practice, many children with GIB may present with hematochezia or hematemesis but do not develop anemia, whereas others may have severe anemia without obvious bleeding manifestations[5,12]. These observations suggest that the development of anemia is influenced by factors beyond bleeding alone, potentially including age, nutritional status, underlying disease, inflammatory state, coagulation function, and laboratory indicators. However, there is a lack of studies analyzing these variables[4,12,13]. Therefore, a systematic analysis of anemia in pediatric GIB patients is necessary to clarify its epidemiological characteristics, identify high-risk populations, and provide an evidence-based reference for clinical decision-making.
In summary, this study aims to retrospectively analyze the clinical data of children hospitalized with GIB. The study will summarize the patients' general demographic characteristics, main clinical manifestations, laboratory test results, and diagnoses of underlying diseases. The study will also compare differences between anemic and non-anemic children and screen for independent risk factors that may affect the occurrence of anemia by applying a multifactorial Logistic regression. This study aims to clarify the prevalence of GIB in children and provide precise clinical references for risk assessment. Additionally, the study will provide a theoretical basis and data support for the subsequent development of new intervention strategies and related mechanism research.
MATERIALS AND METHODS
Cases
This was a single-center retrospective study that included 257 pediatric patients hospitalized for GIB at Anhui Provincial Children’s Hospital between December 2022 and December 2025. Case information was obtained from the hospital’s electronic medical record system, and all data were anonymized.
Inclusion criteria: (1) A confirmed diagnosis of GIB, including both UGIB and LGIB; (2) Age under 18 years; and (3) Complete laboratory data during hospitalization; comprehensive medical record documentation.
Exclusion criteria: (1) Anemia clearly caused by non-GIB factors; (2) Missing key medical data; (3) Hospitalization due to non-GIB such as postoperative hemorrhage, trauma, or severe coagulopathy; or (4) Presence of malignancy, severe infection, immunodeficiency, or other conditions that could significantly confound the evaluation of anemia and bleeding.
This study was approved by the Ethics Committee of Anhui Provincial Children’s Hospital. All study participants or their legal guardians provided written informed consent prior to enrollment in this study.
Diagnostic criteria
The diagnostic criteria for GIB were based on the guidelines for the diagnosis and treatment of acute non-variceal UGIB in Chinese children and the Guidelines for the diagnosis and treatment of LGIB in Chinese children[14,15]. Specifically, a diagnosis of GIB was established when typical clinical symptoms were present, in combination with any of the following: Positive fecal occult blood test, decreased hemoglobin level, or evidence of active bleeding, ulcers, or other lesions detected through gastrointestinal imaging or endoscopic examination. The diagnosis of anemia referred to the World Health Organization criteria for hemoglobin levels in children of different age groups: < 105 g/L for children aged 6 months to 2 years, < 110 g/L for those aged 2-5 years, < 115 g/L for those aged 5-11 years, and < 120 g/L for those aged 12-14 years[16].
Data
Medical records of all children who met the inclusion criteria were retrieved through the hospital information system. The primary outcome of this study was the presence of anemia at admission or its development during hospitalization. Extracted information included demographic characteristics, clinical manifestations, diagnostic results, and laboratory data. Demographic characteristics included sex, type of residence, age, and whether non-steroidal anti-inflammatory drugs (NSAIDs) were used prior to admission. Regarding clinical manifestations, major symptoms at admission were recorded, including hematemesis, melena, hematochezia, abdominal pain, vomiting, and diarrhea. Final confirmed diagnoses were also documented, such as duodenal bulb ulcer, gastric ulcer, Meckel’s diverticulum, Helicobacter pylori(H. pylori) infection, colitis, and colonic polyps. For laboratory data, the following results at admission were collected: Complete blood count (including hemoglobin level, white blood cell count, and differential), nutritional and inflammatory markers [albumin, C-reactive protein (CRP)], electrolytes (serum potassium and sodium), renal function indicators (creatinine, blood urea nitrogen), and coagulation parameters including prothrombin time (PT) and activated partial thromboplastin time (APTT).
Statistical analysis
All statistical analyses were performed using SPSS (22.0). Continuous variables were tested for normality and found not to follow a normal distribution; therefore, they were presented as medians with interquartile ranges, and group comparisons were conducted using the Mann-Whitney test. Categorical variables were expressed as n (%), and intergroup comparisons were performed using the χ2 test or Fisher’s exact test. To explore factors potentially associated with the occurrence of anemia, univariate Logistic regression analysis was first conducted to identify candidate variables. Variables with P < 0.10 in the univariate analysis were subsequently entered into a multivariate Logistic regression model to calculate adjusted OR and their 95%CIs. To avoid collinearity, hemoglobin, which is directly involved in diagnosing anemia, and specific diagnostic categories that may be highly correlated with clinical symptoms, were excluded from the regression model. Prior to modeling, all independent variables included in the multivariate model were assessed for multicollinearity using variance inflation factors, which showed no notable collinearity among the variables. All statistical tests were two-sided, and a P value < 0.05 was considered statistically significant.
RESULTS
Baseline demographic characteristics of patients
First, we performed statistical analyses of the baseline characteristics of all the children. As shown in Table 1, this study included a total of 257 hospitalized children with GIB. Among them, boys accounted for 64.2% of the cases, and the age distribution was concentrated among children aged ≤ 2 years (28.02%) and 5-12 years (36.58%). In terms of demographics, 186 children lived in urban areas, and 71 lived in rural areas. The past medication history showed that 43 cases (16.7%) had used NSAIDs within two weeks prior to admission.
Table 1 Baseline demographic characteristics of all patients.
Patient symptoms and diagnoses and symptom differences across age groups
We analyzed the clinical symptoms and diagnoses of the included children. As shown in Table 2, the most common clinical manifestations were hematochezia (56.03%), abdominal pain (32.68%), vomiting (31.91%), and hematemesis (24.12%), while the proportions of melena and diarrhea were relatively low. Regarding diagnostic results, colitis (14.01%), colonic polyps (12.45%), H. pylori infection (10.12%), and duodenal bulb ulcer (7.00%) were relatively common, whereas the proportions of Meckel’s diverticulum, gastric ulcer, Crohn’s disease, acute gastroenteritis, superficial gastritis, anal fissure, and acute gastritis were lower. Further analysis by age group (Table 3) showed significant differences in the distribution of hematochezia (P = 0.019), abdominal pain (P < 0.001), melena (P < 0.001), and diarrhea (P < 0.001) among children of different ages, while vomiting and hematemesis did not differ significantly. Specifically, children aged ≤ 2 years had the highest proportions of hematochezia and diarrhea, whereas those aged > 12 years had the highest proportions of abdominal pain and melena.
Table 2 Clinical presentations and confirmed diagnoses of all patients.
We also analyzed the laboratory test results of the patients. As shown in Table 4, for complete blood count parameters, the median hemoglobin level among the 257 children was 116 g/L, the white blood cell count was 8.11 × 109/L, the monocyte count was 5 × 108/L, and the lymphocyte count was 2.79 × 109/L. The median albumin level was 42.6 g/L. Regarding serum electrolytes, the median serum potassium level was 4.17 mmol/L, and the median sodium level was 138 mmol/L. For renal function indicators, the median blood urea nitrogen was 4 mmol/L, and the median serum creatinine was 31.7 μM. In terms of key coagulation-related markers, the median APTT was 29.1 seconds, and the median PT was 12 seconds. Lastly, the median CRP level was 0.8 mg/L.
Demographic, symptomatic and diagnoses differences between anemic and non-anemic patients
Next, the children were divided into anemic (n = 45) and non-anemic (n = 212) groups based on anemia status. As shown in Table 5, significant differences were observed between the two groups in terms of age (P < 0.001) and place of residence (P = 0.041). Specifically, children with anemia were more prevalent in the 5-12 years and > 12 years groups, and a higher proportion lived in rural areas. As shown in Table 6, regarding clinical manifestations, the incidence of melena was significantly higher in the anemic group (P < 0.001), while the incidences of hematochezia (P = 0.017) and diarrhea (P = 0.003) were significantly lower compared to the non-anemic group. In terms of final clinical diagnoses, the proportions of duodenal bulb ulcer (P < 0.001), gastric ulcer (P = 0.008), H. pylori infection (P < 0.001), and Meckel’s diverticulum (P < 0.001) were significantly higher in the anemic group. In contrast, children diagnosed with colitis (P = 0.042), colonic polyps (P = 0.005), and acute enteritis (P = 0.02) were significantly more common in the non-anemic group.
Table 5 Demographic differences between anemic and non-anemic patients, n (%).
Laboratory parameters differences between anemic and non-anemic patients
Similarly, we compared the laboratory test results between the two groups. As shown in Table 7, in terms of complete blood count, hemoglobin (P < 0.001), white blood cell count (P < 0.001), monocyte count (P = 0.001), and lymphocyte count (P < 0.001) were all significantly lower in the anemic group compared to the non-anemic group. For nutritional status, the anemic group had a significantly lower albumin level than the non-anemic group (P < 0.001). In terms of electrolytes, serum potassium levels were significantly lower in the anemic group (P = 0.003). Finally, regarding coagulation function, the anemic group had a significantly shorter APTT and a significantly longer PT compared to the non-anemic group.
Table 7 Laboratory differences between anemic and non-anemic patients.
Univariate logistic regression for risk factors of anemia
Next, logistic regression analysis was performed to explore factors associated with the occurrence of anemia in children with GIB. As shown in Table 8, univariate logistic regression revealed that age > 12 years (OR = 6.19, P = 0.002), age > 5-12 years (OR = 3.77, P = 0.006), rural residence (OR = 2.00, P = 0.043), and melena (OR = 15.94, P < 0.001) were significantly positively associated with anemia. In contrast, the presence of hematochezia (OR = 0.46, P = 0.019) and diarrhea (OR = 0.14, P = 0.009) were associated with a lower risk of anemia. Among laboratory indicators, lower albumin (OR = 0.83, P < 0.001), decreased white blood cell count (OR = 0.89, P = 0.029), reduced lymphocyte count (OR = 0.61, P < 0.001), lower serum potassium (OR = 0.29, P = 0.004), and shorter APTT (OR = 0.87, P = 0.002) were all significantly associated with a higher likelihood of anemia. In addition, increased blood urea nitrogen (OR = 1.22, P = 0.019) and prolonged PT (OR = 1.61, P < 0.001) were also positively associated with the risk of anemia. The multivariate model did not include diagnoses such as H. pylori infection and duodenal ulcer, as these are highly correlated with the symptom of melena and are likely to introduce multicollinearity, thereby confounding the results.
Table 8 Univariate logistic regression for risk of anemia.
Multivariate logistic regression for independent predictors of anemia
As shown in Table 9, after incorporating variables with P < 0.1 from the univariate Logistic regression into the multivariate Logistic regression model, several independent factors associated with the occurrence of anemia in children with GIB were identified. Among them, melena was the strongest independent risk factor (OR = 26.85, P < 0.001). Other significant independent risk factors included lower albumin level (OR = 0.78, P < 0.001), decreased lymphocyte count (OR = 0.58, P = 0.042), and shortened APTT (OR = 0.87, P = 0.031). Meanwhile, diarrhea was identified as an independent protective factor (OR = 0.08, P = 0.005), suggesting that its presence may be associated with a reduced risk of anemia. In addition, children aged 2-5 years had a significantly lower risk of anemia compared to those aged ≤ 2 years (OR = 0.16, P = 0.042), while the risk reduction observed in the 5-12 years and > 12 years groups did not reach statistical significance. Furthermore, although white blood cell count, serum potassium level, and prolonged PT were significant in the univariate analysis, they were no longer significant after adjustment for other variables.
Table 9 Multivariate Logistic regression for risk of anemia.
This study analyzed the clinical characteristics of 257 hospitalized children with GIB and investigated anemia as the primary outcome, exploring its potential influencing factors. The results showed that approximately 17.5% of children with GIB developed anemia either at admission or during hospitalization, indicating that anemia is a clinically significant issue in pediatric GIB. Multivariate Logistic regression analysis identified several independent factors significantly associated with the occurrence of anemia, including melena, low albumin, decreased lymphocyte count, and shortened APTT, while diarrhea appeared to be a significant protective factor. These findings not only offer new insights into the possible mechanisms underlying anemia in children with GIB but also provide a basis for the early identification of high-risk patients in clinical practice.
Regarding clinical features, in this study, boys were mostly affected in the children with GIB, age distribution of GIB primarily distributed in the group of ≤ 2 years and 5-12 years of age. The most common symptom was hematochezia, followed by abdominal pain and vomiting, which is consistent with previous reports[4,12,17,18]. Significant age-related differences in symptom presentation were demonstrated in this study. For instance, younger children tended to present with hematochezia and diarrhea, older children with more often abdominal pain and melena. Interestingly, upper gastrointestinal diseases, including duodenal bulb ulcer and H. pylori infection were more frequent among the anemic group, and lower gastrointestinal diseases including colitis and colonic polyps were more prevalent in the non-anemic group, which is similar to findings from previous studies[17,19]. This may be attributed to the fact that UGIB is often more insidious and difficult to detect promptly, which may lead to ongoing chronic blood loss and eventually result in anemia[18,20]. For instance, H. pylori infection can cause chronic gastric mucosal injury and occult bleeding, while also interfering with iron absorption, thereby increasing the risk of anemia[21]. In contrast, LGIB is typically characterized by visible bleeding, making it easier to recognize and intervene in a timely manner. The volume of bleeding is relatively small, and the risk of anemia severe enough to endanger life is low. This may also explain why, in our study, the proportion of hematochezia was actually higher in the non-anemic group. Because LGIB often presents as overt bleeding, it is more likely to prompt rapid clinical intervention before the bleeding progresses to a level that causes anemia.
The effect of age on the occurrence of anemia in this study appeared to be somewhat contradictory. In the group comparison and univariate Logistic regression analysis, children older than 5 years showed a significantly higher risk of anemia. However, in the multivariate logistic regression model, only children aged 2-5 years had a significantly lower risk of anemia compared to those aged ≤ 2 years, while the 5-12 years and > 12 years groups did not show statistically significant differences. Previous studies have indicated that younger children are more prone to iron-deficiency anemia due to limited iron stores and rapid growth, whereas older children with chronic gastrointestinal diseases are more likely to develop anemia from chronic occult bleeding[22]. Therefore, combining our findings with previous research, it can be inferred that the role of age in the development of anemia is not simply linear, but is likely influenced by multiple factors such as nutritional status and comorbid conditions, and should be interpreted in the context of underlying causes.
Melena typically indicates UGIB, especially when the bleeding occurs in proximal sites such as the stomach or duodenum. In such cases, blood undergoes oxidation under the action of digestive fluids, resulting in black-colored stool. It also often reflects a longer duration of bleeding[2,23]. In this study, we found that although the overall proportion of melena was low among all patients and within the non-anemic group, it accounted for as high as 48.89% in the anemic group, clearly demonstrating a strong association between melena and anemia. Furthermore, among all clinical manifestations, melena was identified as the strongest independent risk factor for anemia. Conversely, diarrhoea was identified in this study as an independent protective factor against anaemia, although the OR was low; this may be attributed to the small sample size and uneven distribution of variables. The aetiologies suggested by diarrhoea are predominantly related to the lower gastrointestinal tract; these conditions are characterised by either a short duration or limited blood loss, and are therefore unlikely to have a substantial impact on blood volume or iron stores[24]. Furthermore, diarrhoea typically presents acutely and with pronounced symptoms, making it more likely to alert family members and prompt timely medical consultation. Consequently, diagnosis and intervention are achieved at an early stage of the disease, thereby reducing the risk of anaemia caused by persistent blood loss or impaired iron absorption[4]. Therefore, the protective effect observed with diarrhoea does not indicate that the symptom itself has a protective role, but rather reflects a combination of factors, including the relatively mild nature of the child’s illness, limited bleeding, high clinical recognition, and timely intervention.
Low albumin levels were identified as a risk factor for anemia in pediatric patients with GIB in this study. Albumin is a key indicator of the body’s nutritional reserves, protein synthesis and chronic inflammatory burden; reduced levels typically suggest inadequate protein intake, impaired intestinal absorption or a persistent state of low-grade inflammation. These factors may influence iron metabolism and the haematopoietic process via multiple pathways, thereby contributing to the development of anaemia[25,26]. On the one hand, inadequate protein intake or malabsorption directly leads to a shortage of raw materials for haematopoiesis; on the other hand, chronic inflammation can inhibit intestinal iron absorption and promote iron sequestration by upregulating inflammatory factors, thereby reducing haemoglobin synthesis. We therefore hypothesise that low albumin levels may increase the risk of anaemia through both nutritional deficiency and inflammation-mediated iron metabolism disorders[27]. Regarding the association between reduced lymphocyte counts and anaemia, the findings of this study are inconsistent with some previous literature. Some studies have reported elevated lymphocyte counts in children with iron-deficiency anaemia, whilst others have observed lymphocytopenia in specific subgroups; no consensus has yet been reached[28,29]. Based on the findings of this study, we propose the following hypothesis: Chronic blood loss associated with gastrointestinal haemorrhage, occult inflammation, or damage to the intestinal mucosal barrier may mildly suppress the production and circulation of immune cells, leading to a decrease in peripheral blood lymphocyte counts; conversely, a persistent state of immunosuppression may further exacerbate intestinal inflammation and the tendency to bleed, forming a mutually reinforcing pathway with anaemia. However, due to the limitations of the retrospective design and the absence of measurements for inflammatory markers and lymphocyte subsets, this study is unable to confirm this causal chain; this association requires further validation through prospective studies. Elevated blood urea nitrogen was associated with an increased risk of anaemia in univariate analysis, a finding consistent with previous studies[20]. In cases of UGIB, blood absorbed through the intestinal tract can lead to a transient elevation in blood urea nitrogen. Such elevated levels typically indicate a substantial volume of blood loss, a prolonged duration of bleeding, or a haemorrhage occurring in the upper gastrointestinal tract, thereby indirectly increasing the likelihood of anaemia[4,30]. Consequently, blood urea nitrogen is more likely to serve as a marker of the severity of bleeding rather than a direct aetiological factor for anaemia.
In general, prolonged APTT or PT often indicates coagulation factor deficiency or an anticoagulant state, and such abnormalities in coagulation function are typically considered to increase the risk of bleeding[31]. Notably, contrary to conventional understanding, this study found that shortened rather than prolonged APTT was an independent risk factor for anemia. This may provide a preliminary explanation for why, in cases of chronic inflammation or upper gastrointestinal disorders leading to prolonged bleeding, the body may experience sustained activation of coagulation factors, thereby resulting in a shortened APTT[32]. Consequently, the shortened APTT may represent a potential pathological adaptive phenomenon in paediatric patients with anaemia, reflecting the body’s compensatory enhancement of coagulation function in the context of persistent blood loss. However, the evidence supporting this explanation remains limited at present; this finding should be regarded as an exploratory observation, and further basic research is required to validate its underlying mechanisms.
However, this study has the following limitations: Firstly, as this was a single-centre retrospective study with a limited sample size—particularly the anaemia group, which comprised only 45 cases—this may have affected the stability of the multivariate model; furthermore, the lack of data on certain variables, such as duration of illness and previous nutritional status, may have introduced some bias into the conclusions and limited their generalisability. Secondly, this study did not directly distinguish between UGIB and LGIB, relying instead on indirect inferences based on symptoms and diagnosis; this weakens the directness of the argument to some extent. Furthermore, due to the lack of uniform endoscopic or imaging localisation criteria in the raw data, it was not possible to conduct subgroup analyses for UGIB and LGIB. Thirdly, although known confounders were controlled for through multivariate adjustment, the influence of potential unknown factors cannot be entirely ruled out. Furthermore, this study did not distinguish between different types of anaemia in detail, nor did it track changes in haemoglobin levels during the children’s hospital stay, making it impossible to assess the dynamic progression of GIB-related anaemia. Therefore, future multicentre, prospective studies are required to further validate the findings of this study.
CONCLUSION
By systematically analyzing the clinical data of pediatric patients with GIB, this study identified a set of independent risk factors associated with anemia, including melena, low albumin, decreased lymphocyte count, and shortened APTT. In addition, diarrhea was found to be potentially protective. These findings provide clinicians with more accurate tools for risk identification and offer a theoretical basis for future mechanistic research.
ACKNOWLEDGEMENTS
The authors thank all patients and their families for participation in this study.
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