{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T19:49:03Z","timestamp":1793303343867,"version":"4.5.0"},"reference-count":21,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T00:00:00Z","timestamp":1627603200000},"content-version":"unspecified","delay-in-days":29,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2021,7,7]]},"published-print":{"date-parts":[[2021,7]]},"abstract":"<jats:p>The accuracy of haemoglobin concentration measurements is crucial for deriving global anaemia prevalence estimates and monitoring anaemia reduction strategies. In this analysis, we examined and quantified the factors affecting preanalytic and analytic variation in haemoglobin concentrations. Using cross-sectional data from three field studies (in children, pregnant and nonpregnant women), we examined the difference in haemoglobin concentration between venous-drawn and capillary-drawn blood measured by HemoCue (ie, preanalytic) and modelled how the bias observed may affect anaemia prevalence estimates in population surveys and anaemia public health severity classification across countries. Using data from an international quality assurance programme, we examined differences due to instrumentation from 16 different haematology analyzers (ie, analytic). Results indicated that capillary and venous haemoglobin concentrations are not in agreement (bias +5.7 g\/L (limits of agreement (LoA) \u221211.2, 22.6) in preschool age children; range from \u221228 g\/L to +20 g\/L in pregnant women; bias +8.8 g\/L (LoA \u22125.2, 22.9) in non-pregnant women). The bias observed could introduce changes in population survey estimates of anaemia of up to \u221220.7 percentage points in children and \u221228.2 percentage points in non-pregnant women after venous adjustment. Analytic variation was minimal and unlikely to influence the diagnosis of anaemia. These findings suggest that global estimates of anaemia prevalence derived from capillary haemoglobin, as they often are, may be inaccurate and lead to erroneous public health severity classification, but that point-of-care, or other, instruments should not introduce variation if properly used.<\/jats:p>","DOI":"10.1136\/bmjgh-2021-005756","type":"journal-article","created":{"date-parts":[[2021,7,30]],"date-time":"2021-07-30T10:30:32Z","timestamp":1627641032000},"page":"e005756","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":32,"title":["Preanalytic and analytic factors affecting the measurement of haemoglobin concentration: impact on global estimates of anaemia prevalence"],"prefix":"10.1136","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2570-7323","authenticated-orcid":false,"given":"Leila M","family":"Larson","sequence":"first","affiliation":[{"name":"Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Braat","sequence":"additional","affiliation":[{"name":"Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia"},{"name":"Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed Imrul","family":"Hasan","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin N","family":"Mwangi","sequence":"additional","affiliation":[{"name":"School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando","family":"Estepa","sequence":"additional","affiliation":[{"name":"The Royal College of Pathologists of Australasia Quality Assurance Program, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheikh Jamal","family":"Hossain","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Clucas","sequence":"additional","affiliation":[{"name":"Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia"},{"name":"Diagnostic Haematology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"},{"name":"Clinical Haematology, The Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beverley-Ann","family":"Biggs","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, Australia"},{"name":"The Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kamija S","family":"Phiri","sequence":"additional","affiliation":[{"name":"School of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jena Derakhshani","family":"Hamadani","sequence":"additional","affiliation":[{"name":"Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sant-Rayn","family":"Pasricha","sequence":"additional","affiliation":[{"name":"Population Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, Australia"},{"name":"Diagnostic Haematology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia"},{"name":"Clinical Haematology, The Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, Melbourne, VIC, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,7,30]]},"reference":[{"key":"2025073014121668000_6.7.e005756.1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32335-3"},{"key":"2025073014121668000_6.7.e005756.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2015.11.002"},{"key":"2025073014121668000_6.7.e005756.3","first-page":"163","volume-title":"Comparative quantification of health risks: global and regional 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