Tropical Medicine and International Health

doi:10.1111/j.1365-3156.2006.01679.x

volume 11 no 8 pp 12951302 august 2006

Relationship between haemoglobin and haematocrit

in the definition of anaemia
Llorenc Quinto1,2, John J. Aponte1,2, Clara Menendez1,2, Jahit Sacarlal2,3, Pedro Aide2,4, Mateu Espasa1,2, Inacio
Mandomando2,4, Caterina Guinovart1,2, Eusebio Macete2,5, Rosmarie Hirt6, Honorathy Urassa6, Margarita
M. Navia1,2, Ricardo Thompson2,4 and Pedro L. Alonso1,2
1
2
3
4
5
6

Centre de Salut Internacional (CSI), Hospital Clinic/IDIBAPS, Universitat de Barcelona, Barcelona, Spain
Centro de Investigacao em Saude da Manhica, Mozambique
Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Mozambique
Instituto Nacional de Saude, Maputo, Mozambique
Direccao Nacional de Saude, Ministerio de Saude, Maputo, Mozambique
Ifakara Health Research and Development Centre, Ifakara, Tanzania

Summary

introduction Anaemia is the most frequent haematological disorder in childhood. The notion that
defines naemia does not change throughout life, although parameters used for its evaluation show
significant variations during childhood. Haematocrit (Hct) (%) is usually defined as three times the value
of haemoglobin (Hgb) (g/dl), while the clinical definition of anaemia is related to either an abnormal Hct
or Hgb value.
objective To evaluate the agreement between Hgb and Hct values in the definition of anaemia, the
relationship between these two parameters and their age-dependence.
methods The Hct and Hgb paired values from children aged 218 months from Ifakara (Tanzania)
and children aged 14 years from Manhica (Mozambique) were analysed. Haematological determinations of the Manhica samples were done using a KX-21N cell counter (Kobe, Japan) and Ifakara samples
were analysed in a semiautomatic cell counter (Sysmex F800 microcell counter, TOA Medical Electronics, Kobe, Japan). The j-statistic was used to calculate the agreement between anaemia definitions in
each group. Crude and multivariate relationship between Hct and Hgb levels were analysed by linear
regression model estimation. The age-dependence of the crude ratio (Hct/Hgb) was analysed using linear
regression models and fractional polynomials.
results The prevalences of mild and moderate anaemia as defined by Hgb levels in the Manhica group
were 61% and 6%, respectively, and 41% and 2% by Hct. In the Ifakara group these were 74% and
10%, respectively, by Hgb and 42% and 3% by Hct, respectively. Agreement between mild and moderate
anaemia definitions made up from Hgb or from Hct levels were from fair to moderate. Hct levels
decreased with age for high Hgb levels, whereas they increased for low Hgb levels. The classification of
cases is improved when higher age-related cut-off values for Hct are used. The crude relationship between
Hct and Hgb levels was significantly different from 3, and this was modified by age. The evaluation of the
age-dependence ratio (Hct/Hgb) showed a non-linear relationship with an asymptotic trend to 3.
conclusions Measurement of haematocrit count is easy and can be performed in most rural health
care centres. However, the corresponding Hgb levels cannot be derived with an acceptable accuracy
using the value 3 as a conversion factor. Furthermore, the commonly assumed equivalent cut-off points
for anaemia definitions need to be re-evaluated.
keywords anaemia, agreement, haemoglobin, haematocrit

Introduction
Anaemia is the most frequent haematological disorder
during childhood. While the absolute number of anaemia
associated deaths during the first years of life is not
sufficiently documented, severe anaemia is unquestionably

2006 Blackwell Publishing Ltd

associated with an increased risk of infant morbidity and

mortality in sub-Saharan Africa (Brabin et al. 2001).
Although the notion that defines anaemia (a decrease of
circulating erythrocitic mass) does not change throughout
life, the parameters used for its evaluation show significant
variations during childhood.
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L. Quinto et al. Relationship between haemoglobin and haematocrit

According to WHO estimations, nearly 1300 million

people, that is about 30% of the worlds population, were
anaemic in the 1980s (DeMaeyer & Adiels-Tegman 1985).
It is estimated that, at the start of this century, this number
has increased up to two billion, or 40% of the worlds
population (ACC/SCN 2000; Stoltzfus & Dreyfuss 2000).
The geographical distribution of disease shows areas of
high prevalence, so that the burden of anaemia is very
disproportionate, with 42% of pre-school children affected
in non-industrialised countries, compared with 17% in
industrialised ones (ACC/SCN 2000). In sub-Saharan
Africa, between one and two-thirds of the children younger
than 5 years suffer from anaemia (DeMaeyer & AdielsTegman 1985; ACC/SCN 2000). Furthermore, anaemia in
childhood accounts for more than one half of hospital
paediatric mortality in areas with intense malaria transmission (Lackritz et al. 1992; Schellenberg et al. 1999).
The WHO definition of anaemia in children between 6
and 60 months of age is a haemoglobin (Hgb) level lower
than 11 g/dl, which is equivalent to a haematocrit (Hct)
lower than 33% (Stoltzfus & Dreyfuss 2000; Bain & Bates
2001).
The Hgb provides a direct measure of the oxygen
carrying capacity of the blood, whereas the Hct provides
an indirect one. Besides, their calculation depends on the
method used for their determination. Both parameters can
be assessed either with an automated blood-counter or by
manual methods such as microhaematocrit readings for
Hct, or colorimetric methods. The Hgb estimates the
erythrocitic function and is more stable to plasma volume
changes such as dehydration, which makes it somehow
more reliable for the assessment of anaemia. Unfortunately, in many settings automated methods for Hgb
determinations are not available and rough values are
estimated using observed Hct levels, which is a simpler and
cheaper approach (specially in studies carried out away
from western hospitals/centres, where it is often difficult to
have complete haemograms).
To confirm whether the commonly used relationship
between Hgb and Hct is really 3 [Hct (%) Hgb
(g/dl) 3] (Bain & Bates 2001), in this study we have
evaluated the agreement between these two parameters in
the definition of anaemia using a series of samples of
children living in two malaria-endemic areas in subSaharan Africa.

Materials and methods

Subjects and sampling
Blood samples from children from two malaria endemic
areas in sub-Saharan Africa were included in the study. From
1296

a total of 5397 samples, 2474 corresponded to children from

Manhica District (Maputo province) in southern Mozambique who were taking part in the RTS,S/AS02A malaria
candidate vaccine trial (Alonso et al. 2004). The remaining
samples were taken at five cross-sectional surveys, done
during the follow-up of 847 infants at 2, 5, 8, 12 and
18 months of age as part of a study to evaluate the effect of
chemoprophylaxis and iron supplementation on malaria
and anaemia during the first year of life, carried out in
Ifakara town (Tanzania) (Menendez et al. 1997).
The Manhica study was carried out at the Centro de
Investigacao em Saude da Manhica (CISM) between April
2003 and May 2004. The CISM runs a demographic
surveillance system in the study area (Manhica DSS 2002).
Lists of potentially eligible resident children were produced
from this census. All of them were visited at home; parents
or guardians were read information sheets and criteria for
recruitment was checked, including confirmed residency in
the study area and full immunisation with EPI vaccines.
Interested parents or guardians were invited to the Manhica Health Centre or the Ilha Josina Health Post.
Screening included a brief medical history, physical
examination and finger-prick blood sampling for haematology and biochemistry tests. The results of these blood
tests were the ones used in the present study, independently
of the participation of the child in the malaria candidate
vaccine trial.
The Ifakara study was carried out at the St. Francis
Designated District Hospital (SFDDH) between January
1995 and October 1996. Women who gave birth at
SFDDH and who reported being permanent residents of
the Ifakara town were invited to participate in the study.
On admission to the hospital for delivery, an eligible
woman was given a copy of the consent letter (in
Kiswahili), which included detailed information on procedures and the potential risks and benefits of the study.
Laboratory methods
Haematological determinations of the Manhica samples
were done using a KX-21N cell counter (Kobe, Japan),
which allows the determination of blood parameters from
total blood in EDTA, including among others Hgb and
Hct. Blood parameters of the Ifakara samples were
analysed in a semiautomatic cell counter (Sysmex F800
microcell counter, TOA Medical Electronics, Kobe, Japan).
Statistical methods
Mild anaemia was defined as an Hgb level lower than 11 g/
dl, while moderate anaemia was defined as an Hgb level
below 8 g/dl. The cut-off points for Hct levels were 33%

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Tropical Medicine and International Health

volume 11 no 8 pp 12951302 august 2006

L. Quinto et al. Relationship between haemoglobin and haematocrit

for mild and 25% for moderate anaemia, respectively. The

Ifakara and Manhica samples were analysed separately.
Agreement between anaemia definitions was evaluated
using the j-statistic and the results interpreted using the
classification proposed by Landis and Koch (1977).
Linear regression models were estimated in order to
evaluate the relationship between Hgb and the Hct values.
Robust variance estimates were calculated for the Ifakara
samples, to take into account that there was more than one
sample from the same child.
For each group, the appropriate linear regression models
were estimated to evaluate a crude relationship between
Hgb and Hct or a multivariate relationship between these
two parameters, adjusted by age, gender and Hgb per age
interaction. Model estimation was performed without
constant term (intercept), and nested models (multivariate
models vs. crude models) were compared by the decrease in
the residual sum of squares, using an F-test. Differences
between the estimated Hgb coefficients and the theoretical
value of 3 were performed using the Wald test.
The change of the Hct (%)/Hgb (g/dl) ratio with age, was
evaluated by a linear regression model for the Manhica
samples. Deviances from linearity in the estimated models
were evaluated by fractional polynomials of first or second
degree (Royston 1991;Royston & Altman 1994),andthe best
powers for each curve were estimated by maximum likelihood. All analyses were done using Stata Version 8.2 (2003).

Results
The 2474 samples from Manhica came from children
with a mean age of 34.1 months (95% CI: 33.6, 34.7), of
whom 52% were boys. The remaining 2923 blood
samples were from 847 infants from Ifakara, 50% boys,
collected during cross-sectional surveys at 2, 5, 8, 12 and
18 months of age with a median of four samples per
child.
In Manhica, using the Hgb definition, 1497 (61%) of the
children were classified as having mild, and 137 (6%) as
having moderate anaemia, whereas using the Hct definition, 1002 (41%) were classified as having mild and 57
(2%) as having moderate anaemia. For mild anaemia there
were 34% (505/1497) of children classified as anaemic by
Hgb that were not considered anaemic using the Hct level.
For moderate anaemia, the agreement was similar as 59%
(81/137) of the children classified as having moderate
anaemia by Hgb did not classify as anaemic when using the
Hct level (Table 1).
Results from the Ifakara samples were similar,
although the agreement tended to be lower than with the
Manhica ones. Prevalences of mild and moderate
anaemia defined by Hgb levels were 74% and 10%,
respectively, by Hgb and 42% and 3% by Hct,
respectively. In this group, 45% (979/2172) and 72%
(206/287) of samples classified by Hgb levels with mild

Table 1 Agreement between haemoglobin

and haematocrit in the definition of
anaemia

Observed
Agreement
(%)

Expected
Agreement
by chance
(%)

Kappa

Landis & Koch

interpretation

Hgb < 11 g/dL

Hct < 33%
MANHIC
A
No
Yes
IFAKARA
No
Yes

No

Yes

967
10

505
992

79

48

0.60

Moderate

709
42

979
1193

65

46

0.35

Fair

Hgb < 8 g/dL

Hct < 25%
MANHIC
A
No
Yes
IFAKARA
No
Yes

2006 Blackwell Publishing Ltd

No

Yes

2336
1

81
56

97

92

0.56

Moderate

2635
1

206
81

93

88

0.41

Moderate

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L. Quinto et al. Relationship between haemoglobin and haematocrit

specificity, positive predictive and negative predictive

values, using the Hgb test as a Gold Standard, are shown
in Table 3. Percentages of cases classified as anaemic by
Hgb but not by Hct were lower than those described
before. Thus, when Hct levels were used with the
estimated age-related cut-off, 8% (118/1497) and 21%
(29/137) of the samples identified as anaemia cases (mild
and moderate, respectively) by Hgb were not in the
Manhica group and 8% (182/2172) and 36% (104/287) in
the Ifakara group.
The crude ratio age-dependency, Hct (%)/Hgb (g/dl),
showed a non-linear relationship with an asymptotic trend
to 3. This ratio ranged from 3.34 at 10 months and
decreased with age until it became stable at around 3.13
(see Figure 3). The best fit for this ratio was a grade two
model with powers equal to 2 and 3.

70

and moderate anaemia, respectively, were not detected

using Hct levels (Table 1).
Figure 1 shows the relationship between Hgb and Hct
levels for the Manhica and Ifakara samples, respectively,
using different regression models. In both cases, the model
including an interaction between the age and Hgb was the
one with the best fit. Table 2 shows the estimated
parameters and 95% CI for these models. The Wald test
showed that the coefficient for Hgb was significantly
different from 3, P < 0.0001 both for Manhica and
Ifakara.
According to the estimated models, Hct decreased with
age for high Hgb levels, whereas it increased for low levels
(Figure 1). Figure 2 shows the Hct for Hgb equal to 11 and
8 g/dl (mild and moderate anaemia using Hgb test) in the
Manhica group. The Hct values at 2, 5, 8, 12 and
18 months for the Ifakara group were 36.7, 36.6, 36.6,
36.5 and 36.4%, respectively, when Hgb was 11 g/dl and
27.1, 27.8, 28.4, 29.3 and 30.6% when Hgb was 8 g/dl.
Using these Hct values as an age-related cut-off, we
obtained a new classification of cases whose sensitivity,

Discussion
Both Hct and Hgb levels could be affected by factors
such as the method and equipment used for its

MANHIA

10

20

Haematocrit (%)
30 40 50 60

1 year
2 years
3 years
4 years

70

10
12
14
Haemoglobin (g/dL)

16

18

20

IFAKARA

50
40
30
10

20

Haematocrit (%)

60

2 months
5 months
8 months
12 months
18 months

10
12
14
Haemoglobin (g/dL)

Observed values
Crude Model

1298

16

18

Hct = 3 x Hgb
Multivariate Model

20

Figure 1 Relationship between the Hgb

and Hct levels.

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L. Quinto et al. Relationship between haemoglobin and haematocrit

Table 2 Coefficients and 95% confidence intervals (CI) of the linear regression models estimated from each group
MANHIC
A
Coefficients

95% CI

3.27
0.22
)0.02

<0.001
<0.001
<0.001

3.26 to 3.29
0.20 to 0.23
)0.02 to )0.02

Coefficients

95% CI

3.34
0.83
)0.08

<0.001
<0.001
<0.001

3.31, 3.36
0.73, 0.93
)0.09, )0.07

40

Haemoglobin (g/dl)
Age (months)
Haemoglobin Age

IFAKARA

Hct cut-off (mild anaemia) = 36.0

Haematocrit (%)
30
35

0 - 0.03 *Age (months)

e (months)

emia) = 26.18 + 0.03 *Ag

20

25

Hct cut-off (moderate ana

12

18

Figure 2 The Hct values equivalent to Hgb

levels of 8 and 11 g/dl by age.

24

30

36
42
Age (months)

Haemoglobin = 8 g/dL

Table 3 Classification of cases by

age-related cut-off for Hct using Hgb tests
as gold standard

48

54

60

Haemoglobin = 11 g/dL

Sensitivity Specificity
(%)
(%)
PPV (%) NPV (%)
Hct < age-related
cut-off (mild)
MANHIC
A
No
Yes
IFAKARA
No
Yes

Hgb < 11 g/dL

No

Yes

794
183

118
1379

92

81

88

87

493
258

182
1990

92

66

89

73

Hgb < 8 g/dL

Hct < age-related
cut-off (moderate) No
Yes
MANHIC
A
No
Yes
IFAKARA
No
Yes

2300
37

29
108

79

98

74

99

2500
136

104
183

64

95

57

96

PPV: Positive Predictive Value NPV: Negative Predictive Value.

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L. Quinto et al. Relationship between haemoglobin and haematocrit

4.0
3.5
3.0
2.5
2.0

Haematocrit (%) / Haemoglobin (g/dL)

Fractional Polynomial of 2nd degree and powers 2 and 3

12

18

24

30

36
42
Age (months)

Observed values
95% Confidence Interval

determination, environment or subjects differences that

may cause a spurious change in the measured value and
lead to inaccuracies (Keen 1998). In this study, we have
evaluated this relationship in two groups of samples,
from different countries and measured with different
equipments (although both automated). Results obtained
in both are quite similar. Differences observed between
the two studies might be due to several causes, mainly
to in the age of the children studied (in Ifakara,
children were younger than in Manhica), the laboratory
equipments, malaria endemicity and aetiologies of
anaemia.
In accordance with what has been previously shown, in
our study Hgb and Hct tests at commonly used cut-offs,
detected different prevalences of anaemia in the same
population (Graitcer et al. 1981). In a previous study, with
more than 13.000 samples, it was reported that in general,
anaemia prevalence is higher when calculated using Hgb
levels than when using Hct levels (Graitcer et al. 1981).
Our results are in accordance with these findings, specially
with respect to mild anaemia, for which differences were
around 20% in the Manhica group (61% vs. 41%) and
32% in the Ifakara group (74% vs. 42%).
Determining Hgb seems to be a more sensitive way to
determine mild and moderate anaemia, bearing in mind
that there is not a gold standard. The significant number
of anaemic children diagnosed using Hgb levels, not
detected using Hct levels, might be due to the spurious
elevation of Hct caused by poorly packed iron deficient
cells (Graitcer et al. 1981). Nevertheless, as shown in
Figure 1, Hgb and Hct are closely related, although the
1300

48

54

Fitted values

60

Figure 3 Evolution of the Hct (%)/Hgb

(g/dl) ratio.

usual transformation three times the Hgb (g/dl) equals

the haematocrit (%) is not accurate. Thus, the correspondence between the cut-off points is not adequate,
requiring higher values for the Hct cut-off point to obtain
the same sensitivity than for Hgb.
Regression models show that the association between the
cut-offs of Hgb and Hct not only depends on the age but
also on the Hgb level. In the Manhica group, the 11 g/dl
cut-off for Hgb in relation to Hct decreases with age (from
around 36% before 12 months of age to 34%
at 60 months of age). Whereas, as shown in Figure 2, the
8 g/dl Hgb cut-off in relation to the Hct increases with age
from 26% to 28% for the same ages. For both Manhica
and Ifakara, the predicted Hct levels for 8 and 11 g/dl of
Hgb are far from the commonly used equivalent Hct levels
of 24% and 33%, respectively.
The decrease in the percentage of undetected cases is
notorious when using the estimated Hct values according
to age. In both groups we observed an 8% in mild anaemia
with the estimated values (Table 3) vs. a 34% and 45%
observed when using the standard cut-off values (Table 1).
With moderate anaemia, a 59% in the Manhica group is
reduced to 21%, while in the Ifakara group it goes down
from 72% to 36%.
The reason why Hct values are commonly used within
the clinical practice in rural African settings has to do with
the fact that they are easy and cheap to do using manual
techniques. In this study we obtained all values using a
Sysmex, which is an expensive system. In general, in a rural
setting, the running costs for Hct are very low (around
0.07 USD) compared to what a hemocue would cost

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L. Quinto et al. Relationship between haemoglobin and haematocrit

(around 2 USD). However, it does require more infrastructure including a centrifuge (around 3000 USD), a
Hawskley Micro-Hct reader (around 200 USD) and
electrical power supply. A hemocue only requires the
apparatus in itself (around 1000 USD) as it can be powered
with a battery. These are approximate numbers and can
vary within countries, but in general in studies involving
large populations it is cheaper to measure Hct.
The relationship between Hct and Hgb is expressed with
the Mean Corpuscular Hgb Concentration (MCHC). The
MCHC varies depending on the type of anaemia. An
increased MCHC is seen in spherocytosis but not in
pernicious anaemia, whereas decreased levels may indicate
iron deficiency, blood loss, B6 deficiency or thalassemia. It
could be the case that obtaining a single conversion factor
is not feasible, as the relationship depends on the prevalence of anaemia in each population and on the type of
anaemia pre-dominating within it.
These data show that Hgb levels cannot be derived from
the Hct values with an acceptable accuracy using the
general rule of dividing by 3. The relationship between
Hgb and Hct is not exactly 3 and it changes with age
during the first years of life. Due to the lack of agreement,
the commonly assumed equivalent cutoff points for
anaemia definitions need to be re-evaluated. More information is needed for other age groups (adults) and different
aetiologies of anaemia.
This information is of relevance for both clinical
diagnosis and management of anaemia cases, as well as for
descriptive and intervention studies on anaemia. It will also
help to plan more efficiently anaemia control measures in
the community.
References
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RTS,S/AS02A vaccine against Plasmodium falciparum infection
and disease in young African children: randomised controlled
trial. Lancet 364, 14111420.

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Brabin BJ, Premji Z & Verhoeff F (2001) An analysis of anemia
and child mortality. The Journal of Nutrition 131, 636S645S.
DeMaeyer E & Adiels-Tegman M (1985) The prevalence of
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and hematocrits: are they equally sensitive in detecting anemias?
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clinical accuracy. Case study of the anemic patient. American
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blood transfusion on survival among children in a Kenyan
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Landis JR & Koch GG (1977) The measurement of observer
agreement for categorical data. Biometrics 33, 159174.
Manhica DSS (2002) Mozambique. In: Population and Health in
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at INDEPTH Sites. International Development Research
Centre, Canada, pp. 189195.
Menendez C, Kahigwa E, Hirt R et al. (1997) Randomised
placebo-controlled trial of iron supplementation and malaria
chemoprophylaxis for prevention of severe anaemia and malaria
in Tanzanian infants. Lancet 350, 844850.
Royston P (1991) Constructing time-specific reference ranges.
Statistics in Medicine 10, 675690.
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children with malaria in an area of intense Plasmodium falciparum transmission: features on admission to the hospital and
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Stata Corporation (2003) Stata Statistical Software: Release 8.0.
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Corresponding Author Llorenc Quinto, CSI, Hospital Clnic de Barcelona, C/Rossello 132 2n 2a. 08036 Barcelona, Spain. Tel.: +34
93 227 5706; Fax: +34 93 227 9853; E-mail: lquinto@clinic.ub.es

2006 Blackwell Publishing Ltd

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L. Quinto et al. Relationship between haemoglobin and haematocrit

Relation entre hemoglobine et hematocrite dans la definition de lanemie

objectifs Evaluer la concordance entre les valeurs dhemoglobine et dhematocrite dans la definition de lanemie, la relation entre ces deux parame`tres
et leur association avec lage.
methodes Des valeurs paires dhemoglobine et dhematocrite denfants de 2 a` 18 mois dIfakara en Tanzanie et denfants de 1 a` 4 ans de Manhica au
Mozambique ont ete analysees. Les determinations hematologiques des echantillons de Manhica ont ete realisees en utilisant un compteur de cellules
KX-21N (Kobe, Japon) et ceux de Ifakara par un compteur semi automatique (Sysmex F800 microcell counter, TOA Medical Electronics, Kobe, Japon).
La valeur statistique Kappa a ete utilisee pour calculer les concordances entre les definitions danemie dans les deux groupes. Les associations brutes et
multivariees entre les taux dhematocrite et dhemoglobine ont ete analysees en utilisant un mode`le destimation par regression lineaire et des polynomiales fractionnelles.
resultats Les prevalences danemie faible et moderee etaient de 61%et 6%respectivement definies par les taux dhemoglobine dans le groupe de
Manhica et de 42%et 3%respectivement par definition basee sur lhematocrite. Dans le groupe dIfakara, elles etaient de 74%et 10%respectivement par
definition basee sur lhemoglobine et 42%et 3%respectivement par definition basee sur lhematocrite. Les concordances entre les definitions basees sur
les taux dhemoglobine ou dhematocrite pour lanemie faible et moderee etaient de faibles a` moderees. Les taux dhematocrite diminuaient avec lage
pour les taux eleves dhemoglobine, mais ils augmentaient pour des taux eleves dhemoglobine. La classification des cas est amelioree lorsque des valeurs
limites, plus elevees et liees a` lage etaient utilisees. La relation brute entre taux dhematocrite et dhemoglobine etait significativement differente de 3 et
cela etait modifie par lage. Levaluation du rapport hematocrite/hemoglobine en fonction de lage a revele une relation non lineaire avec une tendance
asymptotique vers 3.
conclusions La mesure du taux dhematocrite est facile et peut etre realisee dans la plupart des centres de soin de sante ruraux. Cependant, les
niveaux correspondants dhemoglobine ne peuvent pas etre deduits avec une precision acceptable en utilisant la valeur 3 comme facteur de conversion.
De plus, les valeurs limites generalement assumees comme equivalents pour la definition de lanemie devraient etre reevaluees.
mots cles anemie, concordance, hemoglobine, hematocrite

Relacion entre hemoglobina y hematocrito en la definicion de anemia

objetivo Evaluar la concordancia entre los valores de hemoglobina y hematocrito en la definicion de anemia, la relacion entre estos dos parametros y
su dependencia de la edad.
metodos Se analizaron los valores pareados de hematocrito y hemoglobina de ninos de 2 a 18 meses provenientes de Ifakara (Tanzania) y ninos entre
1 y 4 anos provenientes de Manhica (Mozambique). Las determinaciones hematologicas de las muestras de Manhica se hicieron utilizando un contador
hematologico KX-21N y las muestras de Ifakara se analizaron en un contador semiautomatico Sysmex F800 microcell counter. Se utilizo el ndice
Kappa para calcular la concordancia entre las definiciones de anemia en cada grupo. La relacion cruda y multivariada entre niveles de hematocrito y
hemoglobina se analizo mediante estimacion del modelo de regresion linear. La dependencia por edad de la proporcion cruda (hematocrito/hemoglobina) se calculo mediante modelos de regresion linear y polinomios fraccionados.
resultados La prevalencia de anemia leve y moderada definida por los niveles de hemoglobina en el grupo de Manhica fue del 61% y 6%,
respectivamente y 41% y 2% por hematocrito. En el grupo de Ifakara estas fueron respectivamente de 74% y 10% por hemoglobina y 42% y 3% por
hematocrito. La concordancia entre las definiciones de anemia leve y moderada construidas a partir de los niveles de hemoglobina o hematocrito fueron
de aceptable a moderada. Los niveles de Hct disminuyeron con la edad para niveles altos de Hgb, mientras que aumentaron para niveles bajos de Hgb.
La clasificacion de los casos mejora cuando se utilizan valores de corte relacionados con la edad mas altos. La relacion cruda entre niveles de
hematocrito y hemoglobina fue significativamente diferente a 3 y esto fue modificado por edad. La evaluacion de la proporcion dependiente de edad
(hematocrito/hemoglobina) mostro una relacion no linear con una tendencia asintotica a 3.
conclusiones Medir el hematocrito es facil y puede hacerse en la mayora de centros sanitarios rurales. Sin embargo los niveles de hemoglobina
correspondientes no pueden derivarse con una precision aceptable utilizando el valor de 3 como factor de conversion. Mas aun, los puntos de corte para
anemia, comunmente asumidos como equivalentes, necesitan ser reevaluados.
palabras clave anemia, concordancia, hemoglobina, hematocrito

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2006 Blackwell Publishing Ltd