Hemoglobin standards in children and pregnant women

Even during pregnancy, expectant mothers often hear about reduced hemoglobin and anemia in their address, and after the birth of the child pediatricians are almost the same diagnosis and baby. However, if you look closely at the laboratory forms that make the blood test, you may notice that most of them are in the "Reference values" column (i.e. Established norm for a specific indicator) the norms for the average adult not pregnant person are specified.

In particular, in my "pregnant" map with hemoglobin 110 g/L in the second trimester of pregnancy was diagnosed "mild anemia". In the map of the daughter of a similar diagnosis appeared in 3 months of life with hemoglobin 100 g/L. In both cases, in the form of a norm was specified interval from 120 to 145 g/L, respectively, were appointed horse doses of iron.

During the pregnancy I still somehow did not fulfilling this question and trusted the doctor. But when it came to the daughter, whose reception iron caused terrible problems with the tummy and aggravation of atopic dermatitis, I decided to understand: how really all this is necessary? Or is it not as critical as the letterhead of an unknown laboratory is broadcasting to us?

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

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 Years 115 or higher 110 – 114 80 – 109 Less than 80
Children aged 12-14 Years 120 or higher 110 – 119 80 – 109 Less than 80
Not 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

 

In this case the norms of hemoglobin in the table are given in grams per liter.  In general, the limit values have remained unchanged since 1968 (except for the breakdown of the age group of children aged 5-14 years and the setting of a lower limit for children 5-11 years, reflecting the results of studies among children in the United States, Iron deficiency).

Pregnant women were also separated into a separate group as early as 1968, as it was found that healthy, non-iron-deficient women's hemoglobin concentrations are drastically changed during pregnancy to adjust to the increase in the volume Maternal blood and the needs of the fetus in the gland.

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

There are currently no who recommendations for the use of the various term hemoglobin limits, but it is recognized that during the second trimester, hemoglobin concentrations are reduced by approximately another 5 G/L.

who also notes that living above sea level and smoking increases hemoglobin concentrations, and therefore, the prevalence of anaemia in smokers as well as those living at high altitudes may be underestimated by the use of standard Limit values for anemia. Accordingly, appropriate amendments have been developed for such population groups to apply to the measured actual limits of hemoglobin concentration for anemia shown in the table above.

Corrections to the measured concentrations of hemoglobin according to the level of living above sea level (height):

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

 

Amendments to the measured hemoglobin concentrations for smokers:

Smoking status Amendment to the measured value of hemoglobin (g/L)
Smoker 0
Smoker (All kinds) -0.3
½-1 pack/day -0.3
1-2 packs/day -0.5
≥ 2 packs/day -0.7

 

And for smokers living in places above sea level, it is necessary to make two corrections.

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

In addition, the measured hemoglobin concentration may be affected by the method of measuring haemoglobin (Cianmetgemoglobina measurement or Hemocue ® system), 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 non-smokers g. St. Petersburg (where the altitude above sea level for central areas is 1-5 m) is the norm and does not require the appointment of iron preparations, especially in therapeutic doses.

However, the issue 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 "nenashenskih" sites. The rules are a little different, but not significant. This is due to the fact that the study was attended by children from different age groups (someone considered for weeks, someone for months, someone took into account at once a couple of months). On average, the following normal levels of hemoglobin are called (data are set for capillary blood, because in pediatrics with venous blood practically do not work):

Age Hemoglobin, G/l
1 day 145-225
1 week 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 decrease in hemoglobin at the age of 2-4 months is a physiological norm and is associated with the replacement of fetal hemoglobin (formed in erythrocytes fetus) on the so-called "adult" hemoglobin.  However, the results of most studies show that in term children without risk factors of anemia, iron deficiency is practically not found, and hemoglobin even at this age does not decrease below 97 g/L. With regard to children born to women with iron deficiency anaemia, hemoglobin in this period may be reduced to 90-92 g/L.

Thus, if the child is aged 2-3.5 months lowering hemoglobin to 90-97 g/L, should not be considered a clear iron deficiency, but it is likely that this child is at risk in terms of future anaemia. Therefore, it makes sense to trace-what indicators will take place in 4-6 months. If the hemoglobin returns to the numbers 100-110 G/L – there is nothing to worry about. Otherwise, it is necessary to discuss with the pediatrician the reception of iron from the age of 3, 5-4 months or the introduction of "iron" food before reaching the age of 6 months (but not earlier than 4 months).

Thus, the diagnosis of "anemia" in my daughter's map with an indicator of hemoglobin 100 g/L in 3 months was also giperdiagnostikoj. We canceled reception of iron, and hemoglobin "grew" itself (without problems with stomach and dermatitis from "iron" preparations) to 118 G/L to 8 months, 125 g/L-to 11 months and 139 g/L-to 13 months.

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