Haemoglobin diagnostic cut-offs for anaemia in Indian women of reproductive age

Abstract

BackgroundThe persistent high prevalence of anaemia among Indian women of reproductive age (WRA) despite aggressive long-term iron supplementation, could be related to over-diagnosis from an inappropriately high haemoglobin (Hb) diagnostic cut-off. To develop an appropriate cut-off for Indian WRA, we hypothesized that during iron-folic acid (IFA) supplementation to a mixed (anaemic/non-anaemic) WRA population, the positive slope of the Hb-plasma ferritin (PF) response in anaemic women would in ect into a plateau (zero-response) as a non-anaemic status is reached. The 2•5th percentile of the Hb distribution at this in ection point will be the diagnostic Hb cut-off for iron-responsive anaemia. MethodA hierarchical mixed effects model, with a polynomial mean and variance model to account for intraclass correlation due to repeated measures, was used to estimate the response curve of Hb to PF, or body iron stores (BIS), in anaemic and non-anaemic WRA (without in ammation), who were receiving a 90-day ironfolic acid (IFA) supplementation. ResultsThe Hb response curve at low PF values showed a steep increase, which in ected into a plateau at a PF of 10.1 µg/L. The Hb distribution at the in ection was a normal probability distribution, with mean of 12•3 g/dL. The 2•5th percentile value of this distribution, orthe putative diagnostic Hb cut-off for anaemia, was 10•8 g/dL. ConclusionThe derived Hb cut-off is lower than the current adult values of 12 g/dL and could partly explain the persistently high prevalence of iron de ciency and anaemia.

Anaemia and iron deficiency in India: a venous blood-based survey of adolescents, adults, and the elderly in eight states

“…diagnostic Hb cut-off of 11.0 g/dL (21). This is similar to a statistically derived Hb cut-off value (rounded-off) of 11.0 g/dL suggested for anaemia diagnosis in healthy, normal Indian adolescent girls (22).…”

Consideraciones sobre la anemia en la gestación y el recién nacido en el Perú: revisión narrativa

“…El punto de corte de Hb en mujeres en edad reproductiva también ha sido motivo de dis-crepancia, debido a la baja respuesta de la intervención con hierro. Así, en la India se ha demostrado que el punto de corte de Hb para una mujer no gestante sería 10,8 g/dL y no 12 g/dL como propone OMS y este mayor punto de corte explicaría la persistentemente alta prevalencia de anemia (21) . Si bien la OMS ha definido valores referenciales para los niveles bajos de Hb, no ha hecho lo mismo para los valores altos (14) .…”

Anaemia in India and Its Prevalence and Multifactorial Aetiology: A Narrative Review

“…The World Health Organisation defines anaemia as the condition of having a low blood haemoglobin concentration, i.e., <130, <120 and <110 g/L for men, non-pregnant women and children aged 6–59 months, respectively [ 1 ], although Ghosh et al [ 2 ] have recently suggested that a cut-off value of 110 g/L may be more appropriate for Indian women of childbearing age. WHO [ 3 ] reports that, worldwide, 40% of children aged 6–59 months, 37% of pregnant women and 30% of women aged 15–49 years are affected by anaemia.…”

“… Hb children < 11.0 g/dL, non-pregnant women < 12, pregnant women < 11, men < 13; NFHS 5[11]: 2019-21 Hb children < 11.0 g/dL; non-pregnant women < 12; pregnant women < 11; men < 13 2. Not given.…”

“…For details, see the original paper 2. Odds ratio derived from model including all the listed factors.3 Confidence interval.…”