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Review
. 2019 Aug;1450(1):172-189.
doi: 10.1111/nyas.14139. Epub 2019 Jun 23.

Hemoglobin concentration and anemia diagnosis in venous and capillary blood: biological basis and policy implications

Lynnette M Neufeld  1 , Leila M Larson  1   2 , Anura Kurpad  3 , Sheila Mburu  4 , Reynaldo Martorell  5 , Kenneth H Brown  6
Affiliations
Review

Hemoglobin concentration and anemia diagnosis in venous and capillary blood: biological basis and policy implications

Lynnette M Neufeld et al. Ann N Y Acad Sci. 2019 Aug.

Abstract

Anemia is an important public health challenge and accurate prevalence estimates are needed for program planning and tracking progress. While venous blood assessed by automated hematology analyzers is considered gold standard, most population-based surveys use point-of-care diagnostics and capillary blood to estimate population prevalence of anemia. Several factors influence hemoglobin (Hb) concentration, including human and analytic error, analysis method, and type of instrument, but it is unclear whether biological variability exists between venous and capillary blood. The objective of this paper was to systematically review sources of Hb variability and the potential biological basis for venous and capillary differences. We use data from a recent survey in the state of Uttar Pradesh, India, to illustrate the implications on anemia prevalence estimates. Significant differences in Hb concentration between capillary and venous blood samples are common. Most but not all find capillary Hb concentration to be higher than venous. Instrument/method variability and human error play an important role, but cannot fully explain these differences. A normative guide to data collection, analysis, and anemia diagnosis is needed to ensure consistent and appropriate interpretation. Further research is needed to fully understand the biological implications of venous and capillary Hb variability.

Keywords: anemia; capillary; diagnosis; hemoglobin; venous.

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Conflict of interest statement

The authors declare no competing interests. No funding was received by the authors for this work, except for S.M. who worked on a short‐term consultant contract with GAIN.

Figures

Figure 1
Figure 1
Correlation matrix of hemoglobin concentration between capillary and venous blood samples from 997 nonpregnant WRA from Uttar Pradesh, India.
Figure 2
Figure 2
Bland−Altman plot for difference between venous and capillary hemoglobin concentration in 997 nonpregnant WRA. Dark horizontal lines represent 95% confidence intervals around the mean difference between venous and capillary hemoglobin.
Figure 3
Figure 3
Flowchart of the systematic literature review process.
Figure 4
Figure 4
Forest plot of the difference in hemoglobin concentration in venous and capillary blood by analysis method (both by Hemocue, both in laboratory, or mixed) and population group. Estimates are difference (95% CI) in venous minus capillary hemoglobin concentrations. 95% CIs for Ziemann et al.35 in adults are (−0.549 to −0.531); and for Tong et al.27 in men and women are (1.062–1.078) and (0.658–0.682), respectively.
See this image and copyright information in PMC

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