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A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
Published on: January 19, 2024
A Dynamic, Continuous Model for Age-Specific Anemia Classification in Children and Non-Pregnant Women
Charles P Wakim1, Carla A El-Mallah2, James P Wirth2
1Department of Nutrition and Food Sciences, Faculty of Agricultural Sciences, American University of Beirut, Beirut, Lebanon.
Insights
A new dynamic model for anemia detection improves classification accuracy, especially in young children, by accounting for age-related hemoglobin variations. This approach offers a more precise understanding of anemia prevalence compared to fixed cutoffs.
Area of Science:
- Hematology
- Pediatrics
- Public Health
Background:
- Fixed hemoglobin cutoffs for anemia diagnosis overlook physiological age-related variations.
- This can lead to misclassification, particularly in early childhood.
- A dynamic, continuous model based on hemoglobin-age relationships is proposed to address these limitations.
Purpose of the Study:
- To develop and evaluate a dynamic, continuous model for anemia classification using age-specific hemoglobin thresholds.
- To compare anemia prevalence estimates from the dynamic model with current WHO fixed cutoffs.
- To assess the impact of the dynamic model on reducing misclassification, especially in vulnerable age groups.
Main Methods:
- Secondary data analysis of the Lebanon Integrated Micronutrient, Anthropometry and Child Development Survey 2023 (LIMA-2023).
- Polynomial regression applied to hemoglobin distributions in a healthy reference population to derive continuous, age-specific anemia thresholds.
- Comparison of anemia prevalence and misclassification patterns between the dynamic model and WHO 2024 fixed criteria in children (6-59 months) and women (10-50 years).
Main Results:
- The dynamic model indicated a higher prevalence of anemia in children aged 6-59 months compared to WHO 2024 criteria, especially for mild and severe cases.
- Anemia estimates for older children and women were comparable between the two models.
- The continuous model effectively captured age-dependent physiological trends and reduced misclassification associated with fixed thresholds.
Conclusions:
- Fixed hemoglobin cutoffs are insufficient for accurately reflecting age-related physiological changes in anemia assessment.
- A dynamic, continuous model provides a more refined approach to anemia classification, particularly beneficial for early childhood.
- This improved classification can lead to more accurate epidemiological data and public health interventions.
Background:
Fixed hemoglobin cutoffs are commonly used to define anemia, yet hemoglobin concentration varies physiologically with age. Rigid thresholds may therefore misclassify individuals, particularly in early childhood. This study proposes a dynamic, continuous model based on empirical hemoglobin-age relationships to address limitations of fixed anemia cutoffs.
Methods:
This secondary data analysis used nationally representative data from the Lebanon Integrated Micronutrient, Anthropometry and Child Development Survey 2023 (LIMA-2023) survey conducted in Lebanon. Venous blood samples were collected, and complete blood counts were analyzed on the same day in a centralized laboratory. The analysis included 1448 children, 6 to 59 months of age and 4353 girls and non-pregnant women, 10 to 50 years of age. Polynomial regression was applied to hemoglobin distributions within a healthy reference population to derive continuous, age-specific thresholds for anemia severity (mild, moderate, or severe). Anemia prevalence under the dynamic model was compared with WHO 2024 fixed cutoffs. Misclassification patterns and age-related trends in hematological parameters (red blood cell count [RBC], mean corpuscular volume [MCV], mean corpuscular hemoglobin [MCH], mean corpuscular hemoglobin concentration [MCHC], soluble transferrin receptor [sTfR]) were explored.
Results:
The dynamic model identified a higher prevalence of anemia among children, 6 to 59 months of age, than WHO 2024 criteria, particularly for mild and severe anemia. Estimates in older children and women were largely comparable. The continuous model captured age-dependent physiological trends and reduced misclassification linked to fixed thresholds.
Conclusion:
Fixed hemoglobin cutoffs may not adequately reflect age-related physiology. A dynamic, continuous model offers a refined alternative that improves anemia classification, especially in early childhood, and may inform more accurate epidemiological and public health responses.
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