The Increase in Hemoglobin Concentration With Altitude Differs Between World Regions and Is Less in Children Than in Adults
To compensate for decreased oxygen partial pressure, high-altitude residents increase hemoglobin concentrations [Hb]. The elevation varies between world regions, posing problems in defining cutoff values for anemia or polycythemia. The currently used altitude adjustments (World Health Organization [...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-04-01
|
| Series: | HemaSphere |
| Online Access: | http://journals.lww.com/10.1097/HS9.0000000000000854 |
| _version_ | 1797280580113530880 |
|---|---|
| author | Heimo Mairbäurl Samuel Kilian Svenja Seide Martina U. Muckenthaler Max Gassmann Rukundo K. Benedict |
| author_facet | Heimo Mairbäurl Samuel Kilian Svenja Seide Martina U. Muckenthaler Max Gassmann Rukundo K. Benedict |
| author_sort | Heimo Mairbäurl |
| collection | DOAJ |
| description | To compensate for decreased oxygen partial pressure, high-altitude residents increase hemoglobin concentrations [Hb]. The elevation varies between world regions, posing problems in defining cutoff values for anemia or polycythemia. The currently used altitude adjustments (World Health Organization [WHO]), however, do not account for regional differences. Data from The Demographic and Health Survey (DHS) Program were analyzed from 32 countries harboring >4% of residents at altitudes above 1000 m. [Hb]-increase, (ΔHb/km altitude) was calculated by linear regression analysis. Tables show 95% reference intervals (RIs) for different altitude ranges, world regions, and age groups. The prevalence of anemia and polycythemia was calculated using regressions in comparison to WHO adjustments. The most pronounced Δ[Hb]/km was found in East Africans and South Americans while [Hb] increased least in South/South-East Asia. In African regions and Middle East, [Hb] was decreased in some altitude regions showing inconsistent changes in different age groups. Of note, in all regions, the Δ[Hb]/km was lower in children than in adults, and in the Middle East, it was even negative. Overall, the Δ[Hb]/km from our analysis differed from the region-independent adjustments currently suggested by the WHO resulting in a lower anemia prevalence at very high altitudes. The distinct patterns of Δ[Hb] with altitude in residents from different world regions imply that one single, region-independent correction factor for altitude is not be applicable for diagnosing abnormal [Hb]. Therefore, we provide regression coefficients and reference-tables that are specific for world regions and altitude ranges to improve diagnosing abnormal [Hb]. |
| first_indexed | 2024-03-07T16:42:17Z |
| format | Article |
| id | doaj.art-6c34f2ca847846e8bf88275ec793b672 |
| institution | Directory Open Access Journal |
| issn | 2572-9241 |
| language | English |
| last_indexed | 2024-03-07T16:42:17Z |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | HemaSphere |
| spelling | doaj.art-6c34f2ca847846e8bf88275ec793b6722024-03-03T07:36:58ZengWileyHemaSphere2572-92412023-04-0174e85410.1097/HS9.0000000000000854202304000-00016The Increase in Hemoglobin Concentration With Altitude Differs Between World Regions and Is Less in Children Than in AdultsHeimo Mairbäurl0Samuel Kilian1Svenja Seide2Martina U. Muckenthaler3Max Gassmann4Rukundo K. Benedict51 Translational Pneumology, University Hospital Heidelberg, Germany3 Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany3 Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Germany2 Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research, Heidelberg, Germany5 Institute of Veterinary Physiology, Vetsuisse Faculty, and Zurich Center for Integrative Human Physiology (ZIHP), University of Zürich, Switzerland7 ICF, Demographic and Health Surveys (DHS), Rockville, MD, USATo compensate for decreased oxygen partial pressure, high-altitude residents increase hemoglobin concentrations [Hb]. The elevation varies between world regions, posing problems in defining cutoff values for anemia or polycythemia. The currently used altitude adjustments (World Health Organization [WHO]), however, do not account for regional differences. Data from The Demographic and Health Survey (DHS) Program were analyzed from 32 countries harboring >4% of residents at altitudes above 1000 m. [Hb]-increase, (ΔHb/km altitude) was calculated by linear regression analysis. Tables show 95% reference intervals (RIs) for different altitude ranges, world regions, and age groups. The prevalence of anemia and polycythemia was calculated using regressions in comparison to WHO adjustments. The most pronounced Δ[Hb]/km was found in East Africans and South Americans while [Hb] increased least in South/South-East Asia. In African regions and Middle East, [Hb] was decreased in some altitude regions showing inconsistent changes in different age groups. Of note, in all regions, the Δ[Hb]/km was lower in children than in adults, and in the Middle East, it was even negative. Overall, the Δ[Hb]/km from our analysis differed from the region-independent adjustments currently suggested by the WHO resulting in a lower anemia prevalence at very high altitudes. The distinct patterns of Δ[Hb] with altitude in residents from different world regions imply that one single, region-independent correction factor for altitude is not be applicable for diagnosing abnormal [Hb]. Therefore, we provide regression coefficients and reference-tables that are specific for world regions and altitude ranges to improve diagnosing abnormal [Hb].http://journals.lww.com/10.1097/HS9.0000000000000854 |
| spellingShingle | Heimo Mairbäurl Samuel Kilian Svenja Seide Martina U. Muckenthaler Max Gassmann Rukundo K. Benedict The Increase in Hemoglobin Concentration With Altitude Differs Between World Regions and Is Less in Children Than in Adults HemaSphere |
| title | The Increase in Hemoglobin Concentration With Altitude Differs Between World Regions and Is Less in Children Than in Adults |
| title_full | The Increase in Hemoglobin Concentration With Altitude Differs Between World Regions and Is Less in Children Than in Adults |
| title_fullStr | The Increase in Hemoglobin Concentration With Altitude Differs Between World Regions and Is Less in Children Than in Adults |
| title_full_unstemmed | The Increase in Hemoglobin Concentration With Altitude Differs Between World Regions and Is Less in Children Than in Adults |
| title_short | The Increase in Hemoglobin Concentration With Altitude Differs Between World Regions and Is Less in Children Than in Adults |
| title_sort | increase in hemoglobin concentration with altitude differs between world regions and is less in children than in adults |
| url | http://journals.lww.com/10.1097/HS9.0000000000000854 |
| work_keys_str_mv | AT heimomairbaurl theincreaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT samuelkilian theincreaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT svenjaseide theincreaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT martinaumuckenthaler theincreaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT maxgassmann theincreaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT rukundokbenedict theincreaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT heimomairbaurl increaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT samuelkilian increaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT svenjaseide increaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT martinaumuckenthaler increaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT maxgassmann increaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults AT rukundokbenedict increaseinhemoglobinconcentrationwithaltitudediffersbetweenworldregionsandislessinchildrenthaninadults |