Hemoglobin concentration in white, black, and Oriental children: is there a need for separate criteria in screening for anemia?

Abstract

The concentration of hemoglobin in blacks was found to be 0.5 to 1.0 g/dl lower than that of income-matched whites in several large surveys. This difference could be a racial characteristic of blacks, or it might be due to a higher frequency of genetic traits such as thalassemia minor and hemoglobinopathies, or to environmental factors such as iron deficiency. To help in making this distinction, we analyzed the data from multiphasic examinations (1973 to 1975) on 1718 white, 741 black, and 315 Oriental healthy, nonindigent children between 5 and 14 years of age. In the entire population, the median hemoglobin concentration averaged 0.5 g/dl lower in blacks than in whites of both sexes (t test, P less than 0.001). The differences still averaged 0.5 g/dl (P less than 0.001) after exclusion of all those with abnormal hemoglobin by electrophoresis (Hgb S and C) and those whose mean corpuscular volume was more than 5% below the normal mean for age (to exclude iron deficiency or thalassemia minor). The data strengthen the impression that blacks normally have a concentration of hemoglobin averaging about 0.5 g/dl less than in whites. If this is the case, about 10% of normal blacks will be mistakenly designated anemic, if the same norms are applied.

Racial variability in the UDP-glucuronosyltransferase 1 ( UGT1A1 ) promoter: A balanced polymorphism for regulation of bilirubin metabolism?

“…It is therefore very likely that there are genetic differences between Africans and Europeans with respect to the metabolism of bilirubin other than the UGT1A1 promoter polymorphisms. One of these is that Africans have lower hemoglobin levels and therefore presumably a smaller red cell mass than do Europeans (29)(30)(31)(32). Given the same red cell lifespan, they would produce less bilirubin.…”

Proporção de anemia de acordo com o estadiamento puberal, segundo dois critérios diagnósticos

“…Portanto, novos estudos são necessários para estabelecer padrões de referência de valores de hemoglobina em populações com muita miscigenação [32][33][34] . A Tabela 5 mostra que, efetivamente, classificação da anemia encontrada neste trabalho é a do tipo hipocrômica e microcíticas, corroborando a idéia de anemia carencial.…”

Iron status of inner‐city African‐American infants

“…The following strategy was employed: the percentage of infants with values indicative of iron deficiency was calculated for each parameter based on the cutoffs for a given source; the number of abnormal iron measures was determined for each infant for each set of cutoffs; and the proportion of the sample with two or more abnormal iron measures (our criterion for iron deficiency) was calculated. A lower cutoff for defining anemia among blacks is sometimes recommended [14,41]. Therefore, we calculated the prevalence of anemia and iron deficiency anemia at both Hb < 110 g/l and lower concentrations (<105 g/l or < 100 g/l).…”

“…One interpretation is that the anemia was not due to iron deficiency. Another is that the definition of ''anemia'' was inappropriate, since Hb concentrations are somewhat lower, on average, among blacks than whites, [13][14][15][16] which could result in ''nonresponders'' who were really not anemic to begin with. However, the study noted serious limitations (e.g., administration of iron therapy was unmonitored, only 36% were reassessed within 3 months, etc.).…”