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      Hemoglobin Concentration in Children at Different Altitudes in Peru: Proposal for [Hb] Correction for Altitude to Diagnose Anemia and Polycythemia

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          Abstract

          The present study was designed to define the hemoglobin [Hb] increase with altitude in Peruvian children. We suggest the normal range of [Hb] as means ±2 standard deviations (SD), with a value less than - 2 SD as a possible threshold to detect anemia. The prevalence of anemia was calculated. These values were compared to the World Health Organization (WHO) altitude correction parameter and the threshold for anemia of 11 g/dL. Likewise, polycythemia is suggested as [Hb] greater than 2 SD. 2,028,701 children aged 6–59 months were analyzed. The quadratic regression analysis shows that [Hb] is constant between sea level and 999 m. Thereafter, [Hb] increases from 11.32 g/dL (1000 m) up to ∼14.54 g/dL at 4000 m. Applying the threshold for anemia defined by WHO (11 g/dL) results in a prevalence of ∼35% for children living at altitudes <1000 m, and prevalence decreases to ∼4.5% at >4000 m. After [Hb] altitude correction, the prevalence was ∼36% (1000 m) and increases to ∼66% above 4000 m. With our proposed threshold for anemia, the prevalence was ∼15% below 1000 m and ∼5% above 4000 m. For polycythemia ([Hb] >14.5 g/dL), increases were from 1.2% at <1000 m to 39.4% at 4000 m. After [Hb] correction for altitude, the prevalence of polycythemia decreases with altitude. Excessive erythrocytosis defined as [Hb] >19 g/dL shows the highest values at 4000 m, while polycythemia defined as [Hb] greater than 2 SD was reduced at high altitude (HA). In conclusion, using WHO thresholds for anemia and [Hb] correction by altitude most likely overestimates the prevalence of anemia and may underestimate polycythemia in Peruvian children living at HA. Therefore, new threshold values for anemia and polycythemia as mean [Hb] less than 2 SD and greater than 2 SD for populations living at a specific altitude are suggested.

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          Author and article information

          Journal
          High Alt Med Biol
          High Alt. Med. Biol
          ham
          High Altitude Medicine & Biology
          Mary Ann Liebert, Inc., publishers (140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA )
          1527-0297
          1557-8682
          01 December 2018
          14 May 2019
          : 19
          : 4
          : 398-403
          Affiliations
          [ 1 ]Laboratories of Investigation and Development (LID) and Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Lima, Peru.
          [ 2 ]Instituto de Investigaciones de Altura, Universidad Peruana Cayetano Heredia, Lima, Peru.
          Author notes
          [*]Address correspondence to: Silvana Ocas-Córdova, Laboratories of Investigation and Development (LID) and Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 31, Perú silvana.ocas@ 123456upch.pe
          Article
          PMC6909695 PMC6909695 6909695 10.1089/ham.2018.0032
          10.1089/ham.2018.0032
          6909695
          30251888
          7c4b4d7b-d628-47ab-ad99-5f0f791499b9
          Copyright 2018, Mary Ann Liebert, Inc., publishers
          History
          : 13 March 2018
          : 14 August 2018
          Page count
          Figures: 1, Tables: 4, Equations: 1, References: 29, Pages: 6
          Categories
          Brief Reports

          erythrocytosis,altitude-corrected hemoglobin,anemia in childhood,polycythemia,hemoglobin,high altitude

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