WHO guidelines recommend measuring haemoglobin concentration to diagnose anaemia.
The World Health Organization (WHO) recently released new guidelines for defining anaemia based on haemoglobin concentration levels in individuals and populations. Anaemia is a condition characterized by low haemoglobin levels and is a significant public health concern globally. In 2019, WHO estimated that around 30% of women aged 15–49 and 40% of children aged 6–59 months were affected by anaemia. It is considered one of the leading causes of years lived with disability worldwide.
Historically, there have been discrepancies in defining haemoglobin concentration thresholds for anaemia, leading to variations in diagnostic criteria between different laboratories and expert groups. There have been debates about whether the different thresholds for males and females are based on physiological differences or variations in iron stores, especially in menstruating individuals. Additionally, there has been uncertainty about adjusting thresholds based on genetic ancestry and concerns about overestimating anaemia prevalence in specific age groups.
The new WHO guideline, released in March 2024, aims to provide clarity and consistency in defining anaemia based on haemoglobin concentrations. The guideline recommends specific haemoglobin concentration thresholds for different age groups, including children, adolescents, adults, and pregnant individuals. Notably, the guideline suggests lower thresholds for young children aged 6–23 months compared to previous recommendations.
One key aspect of the guideline is the adjustment of haemoglobin concentrations for populations living at higher altitudes or individuals who smoke. The guideline provides a table outlining adjustments based on elevation above sea level, with larger adjustments for individuals living at higher altitudes. This adjustment accounts for the increase in haemoglobin due to long-term hypoxia at higher altitudes.
The guideline emphasizes the importance of using venous blood samples and automated haematology analysers in laboratories with quality control measures for accurate anaemia detection. However, challenges exist in low-resource settings where capillary blood samples are commonly used. Efforts are underway to explore alternative sampling techniques to reduce variability in haemoglobin measurements.
Despite the comprehensive nature of the guideline, there are still research gaps that need to be addressed. These include the lack of data from certain populations, such as older individuals and neonates, as well as the need for functional outcome-based thresholds to enhance clinical relevance. Additionally, the implications of the new recommendations on national and global estimates of anaemia prevalence need to be carefully considered.
Overall, the WHO guideline represents a significant step towards harmonizing haemoglobin thresholds for anaemia diagnosis globally. It provides a framework for consistent diagnoses across different settings and regions, ultimately aiming to improve patient care and monitor progress towards reducing anaemia prevalence worldwide.
**Source:** https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00502-6/fulltext
Historically, there have been discrepancies in defining haemoglobin concentration thresholds for anaemia, leading to variations in diagnostic criteria between different laboratories and expert groups. There have been debates about whether the different thresholds for males and females are based on physiological differences or variations in iron stores, especially in menstruating individuals. Additionally, there has been uncertainty about adjusting thresholds based on genetic ancestry and concerns about overestimating anaemia prevalence in specific age groups.
The new WHO guideline, released in March 2024, aims to provide clarity and consistency in defining anaemia based on haemoglobin concentrations. The guideline recommends specific haemoglobin concentration thresholds for different age groups, including children, adolescents, adults, and pregnant individuals. Notably, the guideline suggests lower thresholds for young children aged 6–23 months compared to previous recommendations.
One key aspect of the guideline is the adjustment of haemoglobin concentrations for populations living at higher altitudes or individuals who smoke. The guideline provides a table outlining adjustments based on elevation above sea level, with larger adjustments for individuals living at higher altitudes. This adjustment accounts for the increase in haemoglobin due to long-term hypoxia at higher altitudes.
The guideline emphasizes the importance of using venous blood samples and automated haematology analysers in laboratories with quality control measures for accurate anaemia detection. However, challenges exist in low-resource settings where capillary blood samples are commonly used. Efforts are underway to explore alternative sampling techniques to reduce variability in haemoglobin measurements.
Despite the comprehensive nature of the guideline, there are still research gaps that need to be addressed. These include the lack of data from certain populations, such as older individuals and neonates, as well as the need for functional outcome-based thresholds to enhance clinical relevance. Additionally, the implications of the new recommendations on national and global estimates of anaemia prevalence need to be carefully considered.
Overall, the WHO guideline represents a significant step towards harmonizing haemoglobin thresholds for anaemia diagnosis globally. It provides a framework for consistent diagnoses across different settings and regions, ultimately aiming to improve patient care and monitor progress towards reducing anaemia prevalence worldwide.
**Source:** https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00502-6/fulltext
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