ArticleBMJ global health2021
Preanalytic and analytic factors affecting the measurement of haemoglobin concentration: impact on global estimates of anaemia prevalence.
Article in BMJ global health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
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16 citing papers in PubMed, 1 synthesis or guideline pooled it, 31 citations in OpenAlex.
- Associations between type of blood collection, analytical approach, mean haemoglobin and anaemia prevalence in population-based surveys: A systematic review and meta-analysis.Journal of global health · 2022Pooled it
- Ferric carboxymaltose versus standard-of-care oral iron to treat second-trimester anaemia in Malawian pregnant women: a randomised controlled trial.Lancet (London, England) · 2023Trial
- Haemoglobin concentration thresholds that discriminate functional outcomes among children aged 6-30 months in eight countries: a pooled analysis of individual participant data.BMJ global health · 2026Article
- Emerging Evidence and Critical Issues with the Use of Single-Drop Capillary Blood for the Measurement of Hemoglobin Concentration in Population-Level Anemia Surveys.Advances in nutrition (Bethesda, Md.) · 2024Article
- Time for Paradigm Shift in Anemia Assessment?Advances in nutrition (Bethesda, Md.) · 2024Article
- Hemoglobin Determination: How Good is Good Enough?The Journal of nutrition · 2024Article
- Article
- Characteristics of hemoglobin distributions in preschool children and non-pregnant women of reproductive age and their implications for establishing quality control criteria for hemoglobin data in field surveys: evidence from 483 surveys conducted in refugee settings worldwide.Population health metrics · 2023Article
- Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990-2021: findings from the Global Burden of Disease Study 2021.The Lancet. Haematology · 2023Article
- Diagnosing anemia: Challenges selecting methods, addressing underlying causes, and implementing actions at the public health level.Annals of the New York Academy of Sciences · 2023Review
- Design, Methods, and Select Baseline Results from a School Nutrition Project for Adolescents in Bangladesh.Current developments in nutrition · 2023Article
- Impact of market-based home fortification with micronutrient powder on childhood anemia in Bangladesh: a modified stepped wedge design.Frontiers in nutrition · 2023Article
- Article
- Iron Deficiency in the United States: Limitations in Guidelines, Data, and Monitoring of Disparities.American journal of public health · 2022Article
- Article
- Prevalence of anemia and years lived with disability in eastern Sub-Saharan Africa, 1990 to 2023.The journal of medicine accessArticle
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Authors and funding
11 authors at 6 institutions in 4 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
The accuracy of haemoglobin concentration measurements is crucial for deriving global anaemia prevalence estimates and monitoring anaemia reduction strategies. In this analysis, we examined and quantified the factors affecting preanalytic and analytic variation in haemoglobin concentrations. Using cross-sectional data from three field studies (in children, pregnant and nonpregnant women), we examined the difference in haemoglobin concentration between venous-drawn and capillary-drawn blood measured by HemoCue (ie, preanalytic) and modelled how the bias observed may affect anaemia prevalence estimates in population surveys and anaemia public health severity classification across countries. Using data from an international quality assurance programme, we examined differences due to instrumentation from 16 different haematology analyzers (ie, analytic). Results indicated that capillary and venous haemoglobin concentrations are not in agreement (bias +5.7 g/L (limits of agreement (LoA) -11.2, 22.6) in preschool age children; range from -28 g/L to +20 g/L in pregnant women; bias +8.8 g/L (LoA -5.2, 22.9) in non-pregnant women). The bias observed could introduce changes in population survey estimates of anaemia of up to -20.7 percentage points in children and -28.2 percentage points in non-pregnant women after venous adjustment. Analytic variation was minimal and unlikely to influence the diagnosis of anaemia. These findings suggest that global estimates of anaemia prevalence derived from capillary haemoglobin, as they often are, may be inaccurate and lead to erroneous public health severity classification, but that point-of-care, or other, instruments should not introduce variation if properly used.
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