Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review

Karakochuk, Crystal D; Hess, Sonja Y.; Moorthy, Denish; Namasté, Sorrel; Parker, Megan; Rappaport, Aviva I; Wegmüller, Rita; Dary, Omar

doi:10.1111/nyas.14003

Cited by 74 publications

(89 citation statements)

References 115 publications

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“…Anemia prevalence was found to be close to half in children in the GMS (35.6%) compared to the DHS in 2014 (65.7%) and half in women (21.7% vs. 42.4%, respectively). Some explanation might be the use of a different HemoCue machine (301 in GMS vs. 201+ in DHS) with the 301-model having a tendency to underestimate anemia while 201+ rather overestimates the anemia prevalence [32], venous blood samples vs. capillary blood samples (in women) which have also shown to lead to different results [32] and finally the seasonality which might have had the biggest influence as the DHS was conducted after the rainy season with a malaria prevalence of 36% vs. 20% in the GMS that was conducted just prior to the start of the rainy season and has likely resulted in lower hemoglobin values in those affected with malaria and thus a higher anemia prevalence in the DHS.…”

Section: Discussionmentioning

confidence: 99%

Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: Findings from a national survey

Wegmüller¹,

Bentil

Wirth³

et al. 2020

PLoS ONE

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Nationally representative data on the micronutrient status of Ghanaian women and children are very scarce. We aimed to document the current national prevalence of micronutrient deficiencies, anemia, malaria, inflammation, α-thalassemia, sickle cell disease and trait, and under-and over-nutrition in Ghana. In 2017, a two-stage cross-sectional design was applied to enroll preschool children (6-59 months) and non-pregnant women (15-49 years) from three strata in Ghana: Northern, Middle and Southern Belt. Household and individual questionnaire data were collected along with blood samples. In total, 2123 households completed the household interviews, 1165 children and 973 women provided blood samples. Nationally, 35.6% (95%CI: 31.7,39.6) of children had anemia, 21.5% (18.4,25.0) had iron deficiency, 12.2% (10.1,14.7) had iron deficiency anemia, and 20.8% (18.1,23.9) had vitamin A deficiency; 20.3%(15.2,26.6) tested positive for malaria, 13.9% (11.1,17.3) for sickle trait plus disease, and 30.7% (27.5,34.2) for α-thalassemia. Anemia and micronutrient deficiencies were more prevalent in rural areas, poor households and in the Northern Belt. Stunting and wasting affected 21.4% (18.0,25.2) and 7.0% (5.1,9.5) of children, respectively. Stunting was more common in rural areas and in poor households. Among non-pregnant women, 21.7% (18.7,25.1) were anemic, 13.7% (11.2,16.6) iron deficient, 8.9% (6.7,11.7) had iron deficiency anemia, and 1.5% (0.8,2.9) were vitamin A deficient, 53.8% (47.6,60.0) were folate deficient, and 6.9% (4.8,9.8) were vitamin B12 deficient. Malaria parasitemia in women [8.4% (5.7,12.2)] was lower than in children, but the prevalence of sickle cell disease or trait and α-thalassemia were similar. Overweight [24.7% (21.0,28.8)] and obesity [14.3% (11.5,17.7)] were more common in wealthier, older, and urban women. Our findings demonstrate that anemia and several micronutrient deficiencies are highly present in Ghana calling for the strengthening of Ghana's food fortification program while overweight and obesity in

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Section: Discussionmentioning

confidence: 99%

Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: Findings from a national survey

Wegmüller¹,

Bentil

Wirth³

et al. 2020

PLoS ONE

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“…Hypoxic environment influences not only physical growth but also physiological states like respiration, metabolism and blood circulation rates (13,21) . A good example is the rise of Hb concentration in highlands, a phenomenon considered as a normal adaptive response to the decrease in O 2 tension at high altitude areas (14,15,(28)(29)(30) . Likewise, the slow growth rate in highlands might be in part due to the hypoxic environment, acting on its own or most probably interacting with other highland-specific ecological, socio-cultural and genetic characters.…”

Section: Discussionmentioning

confidence: 99%

“…Further studies are also warranted to know the mechanism(s) through which high altitude influences growth negatively. We are also of the opinion that the slow growth, and consequently the short stature, of children living in highlands needs to be viewed as an adaptive response to the hypoxic environment like the case of Hb, which is considered normal (13)(14)(15)(28)(29)(30) . Recently, the WHO has established a task force to investigate the validity of the existing Hb cut-off points for highland communities (15,16) .…”

Section: Discussionmentioning

confidence: 99%

“…We are also of the opinion that the slow growth, and consequently the short stature, of children living in highlands needs to be viewed as an adaptive response to the hypoxic environment like the case of Hb, which is considered normal (13)(14)(15)(28)(29)(30) . Recently, the WHO has established a task force to investigate the validity of the existing Hb cut-off points for highland communities (15,16) . Likewise, it would be timely and important to investigate the suitability and validity of the WHO growth standards for highland populations and develop a mechanism to adjust for the effect of altitude during growth assessment and stunting classification.…”

Section: Discussionmentioning

confidence: 99%

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The relationship between residential altitude and stunting: evidence from >26 000 children living in highlands and lowlands of Ethiopia

et al. 2020

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Little information is known about the influence of altitude on child growth in Ethiopia, where most people live in highlands. We investigated the relation of residential altitude with growth faltering (stunting) of infants and young children in Ethiopia. We also examined whether the altitude–growth relationship was independent of the influence of the dietary and non-dietary determinants of growth. We used the data of 26 976 under-5-year-old children included in the Ethiopian Demographic and Health Surveys, conducted from 2005 to 2016. The samples were recruited following a two-stage cluster sampling strategy. Stunting was defined by height-for-age <−2 z-scores. The relationship between residential altitude and stunting was examined by running multiple logistic regression analysis, controlling the effect of covariate dietary and non-dietary variables. The residential altitude of the study participants ranged from −116 to 4500 m above sea level (masl). There was a significant and progressive increase in the prevalence and odds of stunting with increasing altitude (P < 0·001), irrespective of the dietary and non-dietary predictors of stunting. The prevalence of stunting was lowest in lowlands (39 %) and highest in highlands (47 %). Compared with altitude <1000 masl, the odds of stunting was 1·41 times higher at altitude ≥2500 masl (OR 1·41, 95 % CI 1·16, 1·71) and 1·29 times higher at altitude 2000–2499 masl (OR 1·29, 95 % CI 1·11, 1·49). Children living in highlands might be at a higher risk of poor growth. Further studies are warranted to understand the mechanism behind the observed altitude–stunting link and identify strategies to compensate for the growth-faltering effect of living in highlands.

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“…[20] In addition to the HemoCue, several other portable hemoglobinometers have been developed and released in recent years. [21] The TrueHb Hemometer System (Wrig Nanosystems, New Delhi, India), a new hemoglobinometer, represents one product that may fill the diagnostic gap for hemoglobin measurement in ANC.…”

Section: Introductionmentioning

confidence: 99%

Potential new tool for anemia screening: An evaluation of the performance and usability of the TrueHb Hemometer

et al. 2020

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In low-and middle-income countries, many women experience anemia during pregnancy due to insufficient dietary intake of key micronutrients, parasitic infections, hemoglobinopathies, and chronic infections. Maternal anemia increases perinatal risks for both mothers and infants, and slow progress to reduce the prevalence may be due in part to the lack of affordable tools to quantify hemoglobin levels in antenatal care (ANC) clinics. A simple, inexpensive, accurate, and robust diagnostic is needed to measure hemoglobin in ANC. This study evaluated the performance and usability of the TrueHb Hemometer. A crosssectional diagnostic accuracy study was conducted to compare the accuracy of the TrueHb and the HemoCue® 201+ using capillary samples. Next, analytical performance (precision, coefficient of variation, R 2) of the TrueHb was evaluated in varying environmental conditions using linearity panels with serial dilutions of venous blood samples. Lastly, the usability of the TrueHb Hemometer was assessed across three domains (effectiveness, efficiency, and satisfaction) by 20 ANC providers in Ghana. Capillary blood test results were not well correlated (R 2 = 0.35) between the TrueHB and HemoCue201+, but 80% of TrueHb measurements were within +/-1.0 g/dl of the HemoCue® 201+ hemoglobin values. Precision tests indicated similar mean values across the three environmental conditions (CV<6%). At 21˚C, the TrueHb follows a linear relationship (R 2 �0.96) but does not generate accurate readings below 4.0 g/dl. At 30˚C and 37˚C, the TrueHb follows a linear relationship (R 2 > 0.90) but begins to underestimate the hemoglobin concentration below 7.0 g/dl. The usability study identified potential failure modes due to inadequate instructions and device feedback. With some modifications, both to the product and to the instructions for use, the TrueHb may be suitable for use in ANC settings to help fill the diagnostic gap for anemia screening during pregnancy. Further testing is required with anemic populations in LMIC settings.

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Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review

Cited by 74 publications

References 115 publications

Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: Findings from a national survey

Anemia, micronutrient deficiencies, malaria, hemoglobinopathies and malnutrition in young children and non-pregnant women in Ghana: Findings from a national survey

The relationship between residential altitude and stunting: evidence from >26 000 children living in highlands and lowlands of Ethiopia

Potential new tool for anemia screening: An evaluation of the performance and usability of the TrueHb Hemometer

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