Wolf Maren E, Elena D Jefferds Maria, Gardner Lisa D, Mei Zuguo, Pfeiffer Christine M, Addo O Yaw
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States; International Micronutrient Malnutrition Prevention and Control Program, Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
International Micronutrient Malnutrition Prevention and Control Program, Nutrition Branch, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
J Nutr. 2025 Mar;155(3):968-974. doi: 10.1016/j.tjnut.2024.12.029. Epub 2024 Dec 30.
Hemoglobin and hematocrit are the 2 most common biomarkers used to identify anemia in clinical settings, but their results do not always agree.
To examine agreement between hemoglobin and hematocrit in identifying anemia among children aged 1 to <5 y and pregnant persons.
Pregnant persons and children aged 1 to <5 y with hemoglobin and hematocrit results from the same whole blood sample in National Health and Nutrition Examination Survey (1999-2020) were included. We used the Centers for Disease Control and Prevention anemia cutoff values for children, pregnancy status, trimester, and smoking adjustments. We examined concordance of anemia, sensitivity, and specificity among those with anemia based on ≥1 test overall and by race/ethnicity, sex, and income level. Cohen's kappa was used to measure concordance.
Analytic samples included 7052 children and 1437 pregnant persons, of whom 1119 had trimester data. Among children, anemia prevalence was 3.7% [95% confidence interval (CI): 3.1, 4.3] based on hemoglobin and 5.5% (95% CI: 4.7, 6.3) based on hematocrit. Among pregnant persons, anemia prevalence was 7.7% (95% CI: 5.9, 9.5) based on hemoglobin and 12.4% (95% CI: 10.1, 14.6) based on hematocrit. Kappa scores overall and by sociodemographic characteristics ranged from 0.64 to 0.75 (moderate concordance) among children and from 0.53 to 0.78 (weak to moderate concordance) among pregnant persons. Among those with anemia on ≥1 test, 53.5% of children and 61.5% of pregnant persons had anemia based on both tests.
We found substantial discordance between the 2 biomarkers; ∼50% of children and 40% of pregnant women were identified by only 1 of the 2 biomarkers. Because hemoglobin and hematocrit may be used interchangeably in the clinical setting, individuals with anemia may be missed, not receive treatment, and therefore be at higher risk of adverse pregnancy, birth, and developmental outcomes.
血红蛋白和血细胞比容是临床环境中用于识别贫血的两种最常见生物标志物，但它们的结果并不总是一致。
研究血红蛋白和血细胞比容在识别1至<5岁儿童和孕妇贫血方面的一致性。
纳入了在国家健康和营养检查调查（1999 - 2020年）中具有来自同一全血样本的血红蛋白和血细胞比容结果的孕妇以及1至<5岁儿童。我们采用了疾病控制和预防中心针对儿童、妊娠状态、孕期和吸烟情况调整后的贫血临界值。我们基于总体≥1项检测以及按种族/族裔、性别和收入水平，检查了贫血患者中贫血的一致性、敏感性和特异性。使用科恩kappa系数来衡量一致性。
分析样本包括7052名儿童和1437名孕妇，其中1119人有孕期数据。在儿童中，基于血红蛋白的贫血患病率为3.7% [95%置信区间（CI）：3.1，4.3]，基于血细胞比容的为5.5%（95% CI：4.7，6.3）。在孕妇中，基于血红蛋白的贫血患病率为7.7%（95% CI：5.9，9.5），基于血细胞比容的为12.4%（95% CI：10.1，14.6）。儿童总体及按社会人口学特征分类的kappa值范围为0.64至0.75（中度一致性），孕妇为0.53至0.78（弱至中度一致性）。在≥1项检测显示贫血的人群中，53.5%的儿童和61.5%的孕妇两项检测均显示贫血。
我们发现这两种生物标志物之间存在显著不一致；约50%的儿童和40%的孕妇仅通过两种生物标志物中的一种被识别出贫血。由于血红蛋白和血细胞比容在临床环境中可能会被交替使用，贫血个体可能会被漏诊，无法接受治疗，因此面临不良妊娠、分娩和发育结局的更高风险。
