Appropriateness of Hemoglobin Cut Off’s for Defining Anemia

  • Radhika Kapil Jawaharlal Nehru Medical College, Belgaum, Karnataka


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).


1. Dallman P, Barr G, Allen C, Shinefi eld H. Hemoglobin concentration in white, black, and Oriental children: is there a need for separate criteria in screening for anemia? Am J Clin Nutr 1978; 31: 377–80.
2. Beutler E, Waalen J. The definition of anemia: what is the lower limit of normal of the blood hemoglobin concentration? Blood 2006; 107: 1747–50.
3. Johnson-Spear M, Yip R. Hemoglobin difference between black and white women with comparable iron status: justification for race-specific anemia criteria. Am J Clin Nutr 1994; 60: 117.
4. Himes J, Walker S, Williams S, Bennett F, Grantham-McGregor S. A method to estimate prevalence of iron defi ciency and iron deficiency anemia in adolescent Jamaican girls. Am J Clin Nutr 1997; 65: 831–36.
5. Khusun H, Yip R, Schultink W, Dillon DHS. World Health Organization hemoglobin cut-off points for the detection of anemia are valid for an Indonesian population. J Nutr 1999; 129: 1669–74.
6. Natvig, K. 1966. “Studies on Hemoglobin Values in Norway. V. Hemoglobin Concentration and Hematocrit in Men Aged 15–21 Years.” Acta Medica Scandinavica 180: 613–20.
7. Kilpatrick, GS, and RM Hardisty. 1961. “The Prevalence of Anaemia in the Community. A Survey of a Random Sample of the Population.” British Medical Journal 5228: 778–82.
8. de Leeuw, NK, L Lowenstein, and YS Hsieh. 1966. “Iron Deficiency and Hydremia in Normal Pregnancy.” Medicine (Baltimore) 45: 291–315.
9. Sturgeon, P. 1959. “Studies of Iron Requirements in Infants. III. Influence of Supplemental Iron during Normal Pregnancy on Mother and Infant. A. The Mother.” British Journal of Haematology 5: 31–44.
10. WHO. 1968. “Nutritional Anaemias. Report of a WHO Scientific Group.” WHO Technical Report Series, No. 405. Geneva: WHO.
11. Preventing and controlling anaemia through primary health care: a guide for health administrators and programme managers. Geneva, World Health Organization, 1989. Available at iron deficiency/9241 542497. pdf
12. WHO 2001 “Preventing and Controlling Anaemia through Primary Health Care: A Guide for Health Administrators and Programme Managers.” 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. 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 et al. Iron nutrition does not account for the haemoglobin differences between blacks and whites. Journal of Nutrition, 1992, 122:1417-1424.
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.
17. Chanarin I, Rotman D. Further observations on the relation between iron and folate status in pregnancy. British Medical Journal, 1971, 2:81-84.\
18. Hurtado A, Merino C, Delgado E. Influence of anoxemia on haematopoietic activities. Archives of Internal Medicine, 1945, 75:284-323.
19. Cesari, Matteo, Brenda Penninx, Fulvio Lauretani, Cosimo R. Russo, Christy Carter, Stefania Bandinelli, Hal Atkinson, Graziano Onder, Marco Pahor, and Luigi Ferrucci. 2004. “Hemoglobin Levels and Skeletal Muscle: Results From the InCHIANTI Study.” J Gerontol A Biol Sci Med Sci, M249–54.
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 Website accessed on 20.1.2016
How to Cite
KAPIL, Radhika. Appropriateness of Hemoglobin Cut Off’s for Defining Anemia. Indian Journal of Community Health, [S.l.], v. 29, n. 3, sep. 2017. ISSN 2248-9509. Available at: <>. Date accessed: 16 jan. 2018.