Anemia in pregnant women
Anemia in pregnant women Edgar Sejas 08.07.99
RE: Anemia in pregnant women Ibrahim Parvanta 09.07.99
RE: Anemia in pregnant women Penelope Nestel 09.07.99
RE: Anemia in pregnant women Fernando Viteri 12.07.99
RE: Anemia in pregnant women Mona Shaikh 13.07.99
Anemia in pregnant women Ray Yip 13.07.99
high altitude haemoglobin level Michael H.N.Golden 15.07.99
Thanks Edgar Sejas 15.07.99


Date: Thu, 08 Jul 1999 17:08:03 -0400

From: "Dr. Edgar Sejas" <jnconatcomteco.entelnet.bo>

Subject: Anemia in pregnant women

 

Dears friends,

I'm working on aenemia in pregnant women in Bolivia.

I'm looking for a article reference which talk about definition of aenemia in altitud.

I know that for the pregnant women is 11.0g/dl more 0.4 g/dl for 1000 m but I don't have reference.

 

Thanks you for help me.


Date: Fri, 09 Jul 1999 11:02:14 +0100

From: "Parvanta, Ibrahim" <ixp1atcdc.gov>

Subject: RE: Anemia in pregnant women

 

Please see Centers for Disease Control and Prevention. Recommendations to Prevent and Control Iron Deficiency in the United States. MMWR 1998;47 (No. RR-3). On the web, you should find it at ftp://ftp.cdc.gov/pub/Publications/mmwr/rr/rr4703.pdf.

 

Ibrahim Parvanta

Centers for Disease Control and Prevention Atlanta, Georgia, USA

Tel: 770-488-5865, e-mail: ixp1atcdc.gov

 

(The table for correction of cut off values for anaemia at high altitude is given on Page 13 of this report - MG)


Date: Fri, 09 Jul 1999 10:52:05 +0100

From: Penelope Nestel <pnestelaterols.com>

Subject: Re: Anemia in pregnant women.

 

Ray Yip when at CDC developed a formula based on CDC pediatric nutrition surveillance data (Altitude and hemoglobin elevation: implication for anemia screening and health risk of polycythemia. 8th Intl Hypoxia Symp, McMaster U, 1993; CDC criteria for anemia in children and childbearing-aged women. MMWR 1989;38):

Hb=-0.32*(alt)+0.022*(alt)(alt)

Alt=elevation in 1000 feet units or in 1000 meter*3.3

 

For example, the Hb increase at 1500 meters will have an (Alt) value of 1.5*3.3=4.95

Hb=-0.032*(4.95)+0.022*(4.95)(4.95)=0.38 g/dL

 

Ray also developed tables

Alt

Hb

ft*1000

g/dL

0

0.0

1

0.0

2

0.0

3

0.1

4

0.2

5

0.4

6

0.6

7

0.9

8

1.2

9

1.5

10

1.9

11

2.3

12

2.8

13

3.3

14

3.9

15

4.5

16

5.1

17

5.8

 

Alt

Hb

m*1000

g/dL

0

0

0.5

0.0

1

0.1

1.5

0.4

2

0.7

2.5

1.2

3

1.8

3.5

2.5

4

3.4

4.5

4.3

5

5.4

5.5

6.6

Correction factors were also developed by: Dirrin H, Logman MH, Barclay DV, and Freire WB. Altitude correction for hemoglobin. Eur J Clin Nutr 1994;48:625-632.

Note also:

Berger J, Aguayo V, Miguel L, Lujan C, Tellez W, Traissac P. Definition and prevalence of anemia in Bolivian women of childbearing age living at high altitudes: the effect of iron-folate supplementation. Nutr. Rev. 1997;55(6):247-56.

I think people tend to use Ray's tables or formula.


Date: Mon, 12 Jul 1999 10:06:40 +0100

From: viteriatnature.berkeley.edu

Subject: Re: Anemia in pregnant women.

 

Dear Dr. Cejas:

As you may know, there is an ongoing debate about what constitutes mild anemia in pregnancy and what should be "the " cut-off point or the various "cut-off points" at different gestational ages. Ray Yip's cut-off points are derived from USA and European iron-folate supplemented population at sea level. This unclear area is, in my opinion, complicated by corrections for altitude above sea level. As far as I know, there is no data to show that the correction of hemoglobin concentration for altitude that has been derived for non-pregnant populations applies to the pregnant state.

I am sorry to be so skeptical about "a cut-off" point and even more if this is simply "corrected" for altitude. I suggest reading many papers and reviews on this matter by Hytten and also suggest that hemoglobin distributions be analyzed for getting a feeling of the problem.

Sincerely,

 

Fernando


Date: Tue, 13 Jul 1999 10:51:44 +0100

From: "Mona Shaikh" <Mona.Shaikhatwfp.org>

Subject: Re: Anemia in pregnant women

 

A paper on altitude correction for hemoglobin cut off points has been published by Dirren H, MHGM Logman, DV Barclay, WB Freire (1994). Altitude correction for hemoglobin. European Journal of Clinical Nuitrition. 48:625-632. The following table is from that paper.

Altitude

Cutoff Hb

(m)

(g/dl)

0

<11.0

200

<11.0

300

<11.0

400

<11.0

500

<11.2

600

<11.2

700

<11.3

800

<11.3

900

<11.3

1000

<11.4

1100

<11.4

1200

<11.5

1300

<11.5

1400

<11.6

1500

<11.7

1600

<11.7

1700

<11.8

1800

<11.8

1900

<11.9

2000

<12.0

2100

<12.1

2200

<12.1

2300

<12.2

2400

<12.3

2500

<12.4

2600

<12.5

2700

<12.6

2800

<12.7

2900

<12.8

3000

<12.9

3100

<13.0

3200

<13.2

3300

<13.3

3400

<13.4

3500

<13.6

A review of literature on Iron supplementation, screening methods, cutoffs, etc. is covered in "Mothercare Matters" newsletter Vol 6:1, Dec 1996. Contact is mothercare_projectatjsi.com, or 1616 N ft Myer Dr., 11th Floor, Arlington VA 22209, USA.

Mona Shaikh


Date: Tue, 13 Jul 1999 12:52:15 +0100

From: ryipatunicef.org

Subject: Anemia in pregnant women

 

Dr. Viteri pointed out a valid concern - do altitude adjustment based on non-pregant women and men can be applied to pregnant women?

To my knowledge, finding realted to this has not been published.

I do wish to share one unpublished information from an OB practice (Dr. Oaks) in Colorado Springs, US (elevation 2300 meters). The average Hb across all three trimesters were higher than the mean Hb data from sea level locations. The interesting part is that the difference is the same difference observed for non-pregant women or men between Colorado Springs and sea level. Based on this, I am welling to conclude that altitude adjustment likely applies to pregnant women also.

The issue on what is appropriate definition of anemia during pregnancy is another matter. The same reference pointed out by Mr. Parvanta has some detail on that also. For clincal purpose, it would be useful to consider the stiking difference in Hb level across pregancy when defining anemia.

Ray Yip


Date: Thu, 15 Jul 1999 19:09:18 +0100

From: Michael Golden <refugeesatabdn.ac.uk>

Subject: high altitude haemoglobin level

 

Dr S M Lewis smlenlatintonet.co.uk writes:

In response to your enquiry, the value which you quote for 1000 m is about right, and at higher altitudes the generally accepted values for normal people are as follows: 2000 m above sea level: increase of about 1 g/dl 3000 m above sea level: increase of about 2 g/l

There have been a number of studies on altitude effects, though fewer in recent years. Here are a few which may be relevant for you

Hurtado A, Merino C, Delgado E (1945) Influence of anoxia on the hemopietic activity Archives of Internal Medicine 75: 284 - this was the classic study which is generally quoted in publications.

Levin NW, Metz J, Hart D, van Heerden DR et al (1960). The blood volume of healthy adult males resident in Johannesburg (altitude 5740 feet). South African Journal of Medical Sciences 28:132

Myhre LD, Dill DB, HallFG, BrownDK (1970). Blood volume changes during three-week residence at high altitude. Clinical Chemistry 16:7

Richalet J-P, Souherbie J-C et al (1994). Control of erythropoiesis in humans during prolonged exposure to the altitude of 6542 m. American Journal of Physiology 266(R): 756

Piedras Ros J et al (1991). Erythrocyte reference values in healthy adults living at 2240 m above sea level. Revue Investigation Clinica 43: 174

Pugh LGCE (1964). Blood volume and haemoglobin concentration at altitudes above 18000 feet (5600 m). Journal of Physiology 170:344

And there is one excellent book:

Ward MP, Milledge JS & West JB: High altitude medicine and physiology. Chapman & Hall, London, 1989.

 

--------------

Prof. Michael H.N.Golden


Date: Thu, 15 Jul 1999 15:03:37 -0400

From: "Dr. Edgar Sejas" <jnconatcomteco.entelnet.bo>

Subject: Thanks

 

I want to say thanks very much at all the persons which have answer to my question of hemoglobin altitud correction.

You have really helped me.

 

Edgar Sejas