Determining an Individual's Anemia Status based on Hemoglobin Levels

Version 4.03.16

 

Observed hemoglobin value (g/dL)   

 Must be between 4 and 18 g/dL

Age in Years

  Must be at least 0.5 years (i.e., 6 mos of age)

Sex of respondent (required if 15 years of age or older)

 1 = Male

 2 = Female

If adult female, pregnancy status

 1 = First trimester OR pregnant, trimester unknown

 2 = Second trimester

 3 = Third trimester

 Leave blank if not pregnant or not applicable

Altitude in meters

  Meters (must be between -400 and 6000 meters)

Smoking status (cigarettes per day)

 1 = 10-19 cigs/day OR a smoker, amount unknown

 2 = 20-39 cigs/day

 3 = 40 or more cigs/day

 Leave blank if not a smoker or not applicable


Adjusted hemoglobin value (g/dL)

 Observed hemoglobin value adjusted, as appropriate, for pregnancy status, altitude, and smoking status

Cutoff value for anemia (g/dL)

 Cutoff value taking into account age and sex

Anemic?

Anemia defined as an adjusted hemoglobin   less than the cutoff value

 

By Kevin Sullivan (cdckms@sph.emory.edu).  Details on the adjustment process is shown below.

 

This program takes an individual's observed hemoglobin (Hb) and adjusts the Hb, when appropriate, to take into account pregnancy status, altitude, and smoking status.  The individual's adjusted Hb is then compared to cutoff values to determine whether the individual is anemic.  If the adjusted Hb is below the age and sex specific cutoff value (see Table 1), the individual is considered to be anemic.  If their hemoglobin is equal to or greater than the cutoff value, then they are considered to be not anemic.  The adjustments for pregnancy, altitude, and smoking are presented in Tables 2-4.

 

This approach to determining anemia status may be useful with computerized data, such as from a cross-sectional survey or from routinely collected clinic data entered onto computer, but less useful at a clinic level where the anemia status of an individual needs to be determined.

 

Table 1.  Hemoglobin cutoffs to define anemia in people living at sea level

Age in Years and Sex group

Hemoglobin  below (g/dL)

Children (both sexes)

 

    0.5 < age in years <   5

11.0

    5    < age in years < 12

11.5

   12   < age in years < 15

12.0

 

 

Nonpregnant females > 15 years

12.0

 

 

Men > 15  years

13.0

UNICEF/UNU/WHO (2001) and INACG (2002) documents

 

Table 2.  Hemoglobin adjustment for pregnancy in women living at sea level

Stage of pregnancy

Hemoglobin

(trimester)

(g/dL)

First

+1.0

Second

+1.5

Third

+1.0

 

 

Trimester unknown

+1.0

Note: the adjustment is added to each woman’s observed

hemoglobin level to calculate an adjusted hemoglobin.  The

INACG document has adjustments by trimester; The UNICEF/UNU/WHO

and INACG documents provide adjustments for pregnant vs. not

pregnant.

 

Table 3.  Hemoglobin adjustments for altitude

Altitude (m)

Range

Hemoglobin adjustment (g/dL)

            m < 1000

No adjustment

1000< m <1250

-0.2

1250< m <1750

-0.5

1750< m <2250

-0.8

2250< m <2750

-1.3

2750< m <3250

-1.9

3250< m <3750

-2.7

3750< m <4250

-3.5

4250< m <4750

-4.5

4750< m <5250*

-5.5

              5250< m*

-6.7

Note: the adjustment is subtracted from each individual’s

observed hemoglobin level to calculate an adjusted hemoglobin.

*Hemoglobin adjustments are based on the UNICEF/UNU/WHO

document except for the highest two altitude values which are

based on the INACG document.

 

Table 4.  Hemoglobin adjustment for smokers

Amount smoked

Hemoglobin (g/dL)

Adjustment

Fewer than 10 cigarettes/day

No adjustment

10 < cigarettes/day < 20

-0.3

20 < cigarettes/day < 40

-0.5

40 < cigarettes/day

-0.7

 

 

Smoker, amount unknown

-0.3

Note: the adjustment is subtracted from each individual’s

observed hemoglobin level to calculate an adjusted hemoglobin.

Based on both UNICEF/UNU/WHO and INACG documents

 

References

Iron deficiency anaemia assessment, prevention, and control – A guide for programme managers.  UNICEF, UNU, WHO, 2001 (WHO/NHD/01.2) (http://www.who.int/reproductive-health/docs/anaemia.pdf)

Adjusting hemoglobin values in program surveys.  Penelope Nestel and the INACG Steering Committee, June 2002. (http://inacg.ilsi.org/file/Hemoglobin.pdf)