Haemoglobin Cutoffs to Define Anaemia in Individuals and Populations

Publication Date: March 4, 2024
Last Updated: March 7, 2024

Summary of Recommendations

Analysis of the evidence suggested modification of the current haemoglobin cutoffs for defining anaemia for one population group (children 6–23 months of age) and use of the existing cutoff for pregnant women in the second trimester.
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Changes to current methodology for establishing cutoffs to indicate the severity of anaemia based on haemoglobin concentrations in individuals are not recommended, due to insufficient evidence.
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Adjustments of haemoglobin concentrations are recommended to diagnose anaemia in individuals and populations to account for the effect of elevation of place of residency on haemoglobin concentrations.
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Haemoglobin concentrations should be adjusted to diagnose anaemia in individuals and populations to account for the effect of smoking on haemoglobin concentrations.
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Haemoglobin concentrations should not be adjusted to diagnose anaemia in individuals and populations to account for the effect of infection and inflammation on haemoglobin concentrations.
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Haemoglobin concentrations should not be adjusted to diagnose anaemia in populations to account for the effect of genetic ancestry/ethnicity/race due to insufficient evidence to change current adjustments and the complexity of operationalization.
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Use of venous blood, automated haematology analysers and high-quality control measures are recommended to measure haemoglobin concentration in individuals and populations.
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Haemoglobin concentrations should be used as one of the markers to assess the impact of iron interventions (e.g. iron supplementation and staple food fortification with iron and other vitamins and minerals) for preventing and treating iron deficiency anaemia throughout the life cycle.
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The current classification of public health significance of anaemia prevalence in populations should be maintained (Table 6). There is a lack of evidence showing a clear association between the severity of the public health burden of anaemia with clinical and/or demographic outcomes. The current expert-based classification has been in use since 2000 and this should be maintained until new evidence becomes available.
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Haemoglobin cutoffs to define anaemia in individuals and populations

Having trouble viewing table?
Population Haemoglobin concentration (g/L)*
Children, 6–23 months <105
Children, 24–59 months <110
Children, 5–11 years <115
Children, 12–14 years, nonpregnant girls <120
Children, 12–14 years, boys <120
Adults, 15–65 years, nonpregnant women <120
Adults, 15–65 years, men <130
Pregnancy - 1st trimester <110
Pregnancy - 2nd trimester <105
Pregnancy - 3rd trimester <110
*Based on 5th percentile.

Haemoglobin cutoffs to define anaemia severity in individuals

Having trouble viewing table?
Population No anaemia Mild anaemia Moderate anaemia Severe anaemia
Children, 6–23 months ≥105 95–104 70–94 <70
Children, 24–59 months ≥110 100–109 70–99 <70
Children, 5–11 years ≥115 110–114 80–109 <80
Children, 12–14 years, nonpregnant girls ≥120 110–119 80–109 <80
Children, 12–14 years, boys ≥120 110–119 80–109 <80
Adults, 15–65 years, nonpregnant women ≥120 110–119 80–109 <80
Adults, 15–65 years, men ≥130 110–129 80–109 <80
Pregnancy - 1st trimester ≥110 100–109 80–109 <70
Pregnancy - 2nd trimester ≥105 95–104 70–99 <70
Pregnancy - 3rd trimester ≥110 100–109 70–99 <70

Adjustments to haemoglobin concentration (g/L) in 500 m increments in elevation

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Elevation range (metres above sea level) Adjustments in haemoglobin concentration (g/L)
1–499 0
500–999 4
1000–1499 8
1500–1999 11
2000–2499 14
2500–2999 18
3000–3499 21
3500–3999 25
4000–4499 29
4500–4999 33

Adjustments to haemoglobin for smoking status and cigarettes per day

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Cigarettes per day Haemoglobin adjustment (g/L)
Smoker, quantity unknown 3
<10 3
10–19 5
>20 6

Classification of public health significance of anaemia in populations based on prevalence estimated from blood levels of haemoglobin

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Category of public health significance Prevalence of anaemia (%)
Severe 40 or higher
Moderate 20.0–39.9
Mild 5.0–19.9
Normal 4.9 or lower

Recommendation Grading

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.

Overview

Title

Haemoglobin Cutoffs to Define Anaemia in Individuals and Populations

Authoring Organization

World Health Organization

Publication Month/Year

March 4, 2024

Last Updated Month/Year

April 1, 2024

Document Type

Guideline

Country of Publication

Global

Document Objectives

This guideline aims to help Member States and their partners in their efforts to make informed decisions on the appropriate tools to support assessing and reducing the global burden of anaemia as an important public health priority.

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Infant, Older adult

Health Care Settings

Ambulatory

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Assessment and screening, Management

Diseases/Conditions (MeSH)

D000740 - Anemia, D006454 - Hemoglobins

Keywords

anemia, Haemoglobin, Hemoglobin

Source Citation

Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. Geneva: World Health Organization; 2024. Licence: CC BY-NC-SA 3.0 IGO.