Improving anemia assessment in clinical and public health settings

Authors: WILLIAMS, ANNE - University Of Otago; BROWN, KENNETH - University Of California, Davis; Allen, Lindsay - A; DARY, OMAR - Us Agency For International Development (USAID); MOORTHY, DENISH - Us Agency For International Development (USAID); SUCHDEV, PARMINDER - Emory University

Submitted to: Journal of Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 5/10/2023
Publication Date: 9/29/2023
Citation: Williams, A.M., Brown, K.H., Allen, L.H., Dary, O., Moorthy, D., Suchdev, P.S. 2023. Improving anemia assessment in clinical and public health settings. Journal of Nutrition. 153:S29-S41. https://doi.org/10.1016/j.tjnut.2023.05.032.
DOI: https://doi.org/10.1016/j.tjnut.2023.05.032

Interpretive Summary: The aim of this article is to provide a practical approach to assess anemia and its primary causes, both in clinical settings and in the context of public health programs. Anemia remains a global challenge, and to achieve goals for anemia reduction and assess progress, standard approaches are required for assessment of anemia and its causes. We first provide a brief review of how to assess anemia, based on low hemoglobin or hematocrit concentrations. Next, we discuss how to assess the likely causes of anemia in different settings. The causes of anemia can be classified as non-nutritional (e.g., due to infection, inflammation, blood loss, or genetic disorders) or nutrition-specific (e.g., due to deficiencies in iron, vitamin A, riboflavin, vitamin B12, or folate). Anemia can actually be caused by several factors, so a new framework is proposed here to assess potential overlapping causes using an "ecological" approach. We present a decision tree to inform what data on anemia causes may need to be collected and a supporting table with information on how to collect them. We also describe an approach to interpret anemia risk factor data from population-based surveys that can inform decisions about context-specific interventions. Finally, we present research gaps and priorities related to anemia assessment.

Technical Abstract: We aim to provide a practical approach to assess anemia and its primary causes, both in clinical settings and in the context of public health programs. Anemia remains a global challenge; thus, to achieve goals for anemia reduction and assess progress, standard approaches are required for assessment of anemia and its causes. We first provide a brief review of how to assess anemia, based on low hemoglobin or hematocrit concentrations. Next, we discuss how to assess the likely causes of anemia in different settings. The causes of anemia are broadly classified as non-nutritional (e.g., due to infection, inflammation, blood loss, or genetic disorders) or nutrition-specific (e.g., due to deficiencies in iron, vitamin A, riboflavin, vitamin B12, or folate). Anemia etiology is multifaceted, so we introduce a framework for anemia assessment based on the ‘ecology of anemia’, which recognizes its many overlapping causes. We present a decision tree to inform what data on anemia causes may need to be collected and a supporting table with information on how to collect them. We also describe an approach to interpret anemia risk factor data from population-based surveys that can inform decisions about context-specific interventions. Finally, we present research gaps and priorities related to anemia assessment.