Appropriateness of Hemoglobin Cut Off’s for Defining Anemia
The use of the hemoglobin cut-off points permits the identification of populations at greatest risk of anemia. The reference cut off’s of Hb also facilitates the monitoring and assessment of progress towards preventing and controlling iron deficiency. These cut off’s also provides the scientific basis for advocacy for the prevention of anemia. There has been continued discussion about the appropriateness of the Cut Off’s used to define anaemia and their applicability to different populations, which has implications for epidemiological surveillance, monitoring, and targeting (1,2).
Haemoglobin concentration is affected by physiological characteristics such as age, sex, and pregnancy status, as well as environmental factors such as smoking and altitude. Several studies have shown that the population distribution of haemoglobin is lower in black people than in white people (1,3,4). Only a few studies from low-income and middle-income countries have, however, examined the applicability of the WHO cut off’s to other populations (4,5).
The haemoglobin cut-offs presented in Table-1 are used to diagnose anaemia in individuals in a screening or clinical setting.
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10. WHO. 1968. “Nutritional Anaemias. Report of a WHO Scientific Group.” WHO Technical Report Series, No. 405. Geneva: WHO. http://whqlibdoc.who.int/trs/WHO_TRS_405.pdf.
11. Preventing and controlling anaemia through primary health care: a guide for health administrators and programme managers. Geneva, World Health Organization, 1989. Available at http://www.who.int/nutrition/publications/micronutrients/anaemia iron deficiency/9241 542497. pdf
12. WHO 2001 “Preventing and Controlling Anaemia through Primary Health Care: A Guide for Health Administrators and Programme Managers.” http://www.who.int/ nutrition/publications/micronutrients/anaemia_iron_deficiency/9241542497.pdf
13. WHO 2011. “Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity.” WHO/NMH/NHD/MNM/11.1. Vitamin and Mineral Nutrition Information System. Geneva, Switzerland: World Health Organization. http://www.who.int/vmnis/ indicators/ haemoglobin. pdf.
14. Beutler E1, Waalen J.The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood. 2006 Mar 1;107(5):1747-50. Epub 2005 Sep 27.
15. Perry GS, Byers T, Yip R, Margen S. Iron nutrition does not account for the hemoglobin differences between blacks and whites. J Nutr. 1992 Jul;122(7):1417-24. PubMed PMID: 1619469.[PubMed].
16. Hurtado A , Merino C, Delgado E. Influence of anoxemia on haematopoietic activities. Archives of Internal Medicine, 1945, 75:284-323. Centers for Disease Control. CDC Criteria for anemia in children and childbearing age women. MMWR, 1989, 38:400-404.
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18. Hurtado A, Merino C, Delgado E. Influence of anoxemia on haematopoietic activities. Archives of Internal Medicine, 1945, 75:284-323.
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20. Moon, Ji-Hyun, Mi-Hee Kong, and Hyeon-Ju Kim. 2015. “Relationship between Low Muscle Mass and Anemia in Korean Elderly Men: Using the Korea National Health and Nutrition Examination Survey (KNHANES IV–V).” Journal of Clinical Gerontology and Geriatrics 6 (4): 115–19. doi:doi:10.1016/j.jcgg.2015.03.007.
21. Ray Yip Significance of an abnormally low or high hemoglobin concentration during pregnancy: special consideration of iron nutrition Am J Clin Nutr July 2000 vol. 72 no. 1 272s-279s
22. The Encyclopaedia of Sports Medicine: An IOC Medical Commission Publication, 2nd Edition, Volume II, Endurance in Sport R. J. Shephard (Editor), P.O. Astrand (Editor)ISBN: 978-0-470-69482-4 1008 pages April 2008, Wiley-Blackwell http://as.wiley.com/WileyCDA/WileyTitle/productCd-0470694823.html Website accessed on 20.1.2016