Even during pregnancy, expectant mothers often hear about the reduced hemoglobin and anemia in their address, and after the birth of the child pediatricians almost put a similar diagnosis and baby. However, if you look closely at the lab forms that do the blood test, you will notice that in most of them in the "Reference Values" graph (i.e. set norm for a specific indicator) are the standards for the average adult non-pregnant person.

In particular, my "pregnant" card for haemoglobin 110 g/l in the second trimester of pregnancy was diagnosed with "mild anemia." In the daughter's card a similar diagnosis appeared in 3 months of life with haemoglobin 100 g/l. In both cases, the form forms as the norm indicated the interval from 120 to 145 g/l, respectively, were prescribed horse doses of the drug iron.

During pregnancy, I was not particularly bothered by this issue and trusted the doctor. But when it came to the daughter, whose iron reception caused terrible problems with the tummy and exacerbation of atopic dermatitis, I decided to understand: how much really all this is necessary? Or is it not as critical as the form from an unknown laboratory is broadcasting to us?

The almighty Internet offered a lot of variations of hemoglobin norms, so I decided to get to the official sources, which can really be trusted. One such source, I consider the World Health Organization (WHO), on the official website of which I found the following norms:

Population groups Not anemia Anemia
Easy Moderate Acute
Children aged 6-59 months 110 or higher 100 – 109 70 – 99 less than 70
Children aged 5-11 115 or higher 110 – 114 80 – 109 less than 80
Children aged 12-14 120 or higher 110 – 119 80 – 109 less than 80
Non-pregnant women (15 years and older) 120 or higher 110 – 119 80 – 109 less than 80
Pregnant women 110 or higher 100 – 109 70 – 99 less than 70
Men (15 years and older) 130 or higher 110 – 129 80 – 109 less than 80

At the same time, the norms of haemoglobin in the table are given in grams per liter.  Overall, the limits have remained unchanged since 1968 (except for the breakdown of the age group of children ages 5-14 and the lower limit for children 5-11 years old, reflecting the results of studies among children in the United States who did not have iron deficiency).

Pregnant women were also singled out as far back as 1968, as it was found that healthy, iron-free women have drastically altered hemoglobin concentrations during pregnancy to adjust to the increase in maternal blood and to the needs of the fetus in the gland.

This is as follows: hemoglobin concentrations begin to decrease during the first trimester of pregnancy, reaching the lowest limit in the second trimester, after which they begin to rise again in the third trimester.

There are currently no WHO recommendations for the use of different term hemoglobin limits, but it is recognized that hemoglobin concentrations decrease by approximately another 5 g/l during the second trimester.

WHO also notes that living above sea level and smoking increases haemoglobin concentrations, so the prevalence of anaemia in smokers as well as those living at high altitudes may be underestimated when applying standard limits for anaemia. Accordingly, appropriate amendments have been developed for such populations to apply to the measured actual limits of haemoglobin concentration for anaemia shown in the table above.

Amendments to measured hemoglobin concentrations above sea level (height):

Height (metres above sea level) Correction to the measured value of hemoglobin (g/l)
<1000 0
1000 -2
1500 -5
2000 -8
2500 -13
3000 -19
3500 -27
4000 -35
4500 -45

Amendments to measured hemoglobin concentrations for smokers:

Smoking status Correction to the measured value of hemoglobin (g/l)
Non-smoker 0
Smoker (all kinds) -0.3
1/2 – 1 pack/day -0.3
1 – 2 packs/day -0.5
≥ 2 packs/day -0.7

And for smokers living in places above sea level, two amendments should be made.

There were also small differences in the distribution of hemoglobin values among different ethnic groups, but the data are not yet sufficient, and it is recommended that standard limits be used.

In addition, the measured concentration of hemoglobin may be influenced by the method of measuring hemoglobin (measurement of cyanmeghemoglobin or HemoCue®), as well as the method of taking blood for analysis (taking capillary or venous blood).

Thus, hemoglobin 110 g/l in the second trimester of pregnancy for a non-smoking resident of the city. St. Petersburg (where the altitude for the central areas is 1-5 m) is the norm and does not require the appointment of iron preparations, especially in therapeutic doses.

However, the question of children under 6 months of age remained unresolved. I didn't find any information on the WHO website, but I found a lot of research on "non-Nashen" sites. The rules are slightly different, but not significantly. This is due more to the fact that the study involved children from different age groups (someone considered by week, someone by month, someone took into account at once a couple of months). On average, the following normal indicators of haemoglobin levels are called (the data are set for capillary blood, as in pediatrics with venous blood practically do not work):

Age Hemoglobin, g/l
Day 1 145-225
Week 1 135-195
2 weeks 125-205
1 month 100-180
2 months 90-140
3-6 months 95-141

It is also noted that the reduction of hemoglobin at the age of 2-4 months is a physiological norm and is associated with the replacement of fetal hemoglobin (formed in the red blood cells of the fetus) with the so-called "adult" hemoglobin.  However, most studies show that iron deficiency is virtually non-existing in pre-term children without risk factors for anaemia, and hemoglobin does not decrease below 97 g/l even at this age. In the case of children born to women with iron deficiency anaemia, haemoglobin may decline to 90-92 g/l during this period.

Thus, if a child has a 2-3.5 month reduction in haemoglobin to 90-97 g/l, this should not be considered a clear iron deficiency, but it is likely that the child is at risk for future anaemia. In this regard, it makes sense to trace – what indicators will take place in 4-6 months. If hemoglobin returns to the figures of 100-110 g/l – there is nothing to worry about. Otherwise, you should discuss with the pediatrician the intake of iron from the age of 3.5-4 months or the introduction of "iron" bait until the age of 6 months (but not earlier than 4 months).

Thus, the diagnosis of "anemia" in my daughter's map with a haemoglobin rate of 100 g/l in 3 months also turned out to be hyperdiagnosis. We canceled the iron intake, and hemoglobin "grew" itself (without problems with the abdomen and dermatitis from "iron" drugs) to 118 g/l by 8 months, 125 g/l – by 11 months and 139 g/l – by 13 months.