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Updated: Jun 30, 2026

A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
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Published on: January 19, 2024

Pediatric Reference and Optimal Curves for Hemoglobin.

Vid Bijelic1,2, Franco Momoli1, Mira Liebman3

  • 1School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

JAMA Network Open
|June 29, 2026
PubMed
Summary
This summary is machine-generated.

This study developed new hemoglobin reference curves (RCs) and optimal curves (OCs) for children, improving accuracy over traditional methods. These curves offer better clinical context and highlight potential differences with current World Health Organization (WHO) thresholds.

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Measuring Deformability and Red Cell Heterogeneity in Blood by Ektacytometry
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Published on: January 12, 2018

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Last Updated: Jun 30, 2026

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Measuring Deformability and Red Cell Heterogeneity in Blood by Ektacytometry
09:12

Measuring Deformability and Red Cell Heterogeneity in Blood by Ektacytometry

Published on: January 12, 2018

Area of Science:

  • Pediatric Hematology
  • Clinical Biochemistry
  • Biostatistics

Background:

  • Reference intervals (RIs) are crucial for interpreting pediatric laboratory results.
  • Traditional RIs require age and sex partitioning, leading to limited sample sizes and imprecise estimates.
  • Hemoglobin level modeling as a continuous function of age addresses these limitations.

Purpose of the Study:

  • To establish sex-specific hemoglobin reference curves (RCs) for children.
  • To estimate hemoglobin optimal curves (OCs) using health-based criteria.
  • To complement World Health Organization (WHO) hemoglobin thresholds and inform reporting standards.

Main Methods:

  • Cross-sectional study of healthy Canadian children aged 2 weeks to 10 years.
  • Nonparametric quantile regression with restricted cubic splines to estimate RCs and OCs.
  • Development of a web-based platform for visualizing curves and calculating limits.

Main Results:

  • Hemoglobin RCs and OCs were estimated for 4597 and 3426 children, respectively.
  • Optimal curves (OCs) showed sex-specific differences compared to reference curves (RCs), particularly in younger children.
  • World Health Organization (WHO) thresholds were often higher than the lower limits of the OCs, especially in younger age groups.

Conclusions:

  • Modeled hemoglobin RCs overcome limitations of traditional pediatric RIs.
  • Optimal curves (OCs) provide additional clinical context beyond RIs.
  • Findings suggest potential misalignments between new curves and existing WHO thresholds, particularly for younger children.