Evaluation of Hemoglobin Cutoff Levels to Define Anemia Among Healthy Individuals

作者：O. Yaw Addo, Xinchun Yu, Anne M Williams, Melissa Young, Andrea J. Sharma, Zuguo Mei, Nicholas J Kassebaum, Maria Elena Jefferds, Parminder S. Suchdev · 发表于：JAMA Network Open · 年份：2021 · DOI：10.1001/jamanetworkopen.2021.19123 · 被引用次数：117 · 研究领域：Iron Metabolism and Disorders、Erythropoietin and Anemia Treatment、Hemoglobinopathies and Related Disorders

Importance: Anemia, defined as low hemoglobin (Hb) concentration insufficient to meet an individual's physiological needs, is the most common blood condition worldwide. Objective: To evaluate the current World Health Organization (WHO) Hb cutoffs for defining anemia among persons who are apparently healthy and to assess threshold validity with a biomarker of tissue iron deficiency and physiological indicator of erythropoiesis (soluble transferrin receptor [sTfR]) using multinational data. Design, Setting, and Participants: In this cross-sectional study, data were collected and evaluated from 30 household, population-based nutrition surveys of preschool children aged 6 to 59 months and nonpregnant women aged 15 to 49 years during 2005 to 2016 across 25 countries. Data analysis was performed from March 2020 to April 2021. Exposure: Anemia defined according to WHO Hb cutoffs. Main Outcomes and Measures: To define the healthy population, persons with iron deficiency (ferritin <12 ng/mL for children or <15 ng/mL for women), vitamin A deficiency (retinol-binding protein or retinol <20.1 μg/dL), inflammation (C-reactive protein >0.5 mg/dL or α-1-acid glycoprotein >1 g/L), or known malaria were excluded. Survey-specific, pooled Hb fifth percentile cutoffs were estimated. Among individuals with Hb and sTfR data, Hb-for-sTfR curve analysis was conducted to identify Hb inflection points that reflect tissue iron deficiency and increased erythropoiesis induced by anemia. Results: A total ...