Hemoglobin no anemia

WHO's 2024 guideline sets this line at the 5th percentile of hemoglobin in "apparently healthy, ethnically diverse populations," which means it is a statistical floor, not a verdict. The guideline says so: "The 5th percentile implies that 95% of healthy individuals would have a higher haemoglobin value, and 5% of healthy individuals would still have a lower haemoglobin value than the cutoff and be falsely diagnosed as anaemic." The cutoffs are 130 g/L (13.0 g/dL) for men and 120 g/L (12.0 g/dL) for non-pregnant women, ages 15 to 65. WHO considered raising the men's line to 135 and kept 130, citing "the limited evidence" and the risk of triggering iron supplementation in men.

Two adjustments before you compare. WHO recommends adjusting for elevation of residence: subtract 4 g/L from your reading at 500 to 999 m, 8 at 1,000 to 1,499 m, 11 at 1,500 to 1,999 m, 14 at 2,000 to 2,499 m. Smokers subtract 3 g/L (under 10 cigarettes a day), 5 (10 to 19) or 6 (more than 20), though WHO notes it is "unclear whether the difference ... is physiologically relevant" for an individual. WHO does not adjust for inflammation, infection or ancestry, while noting a reported 10 g/L lower mean in Black individuals. A separate trap: the NHLBI prints a laboratory reference range of 14 to 17 g/dL for men and 12 to 15 for women. That is a lab's normal range, not the WHO anemia cutoff, and the two should not be mixed.

What a normal hemoglobin does not rule out. Iron stores empty before hemoglobin falls. The British Society of Gastroenterology's 2021 guideline calls this "non-anaemic iron deficiency" and gives the example of young women with heavy periods: "over half had reduced iron stores but only 25% were actually anaemic." Its position is that the cancer risk in that state is low, that invasive investigation is not supported "unless there are additional indications," and that "periodic blood count monitoring is suggested." It adds that the threshold for looking further "should however be low in men, postmenopausal women, and those with GI symptoms or a family history of GI pathology." No body we checked says a normal hemoglobin with symptoms warrants a ferritin test, so we do not say it either.

Over 65. WHO's tables stop at 65 and the guideline names men and women over 65 as a research gap. The BSG notes anemia affects more than 20 percent of people over 85, that iron deficiency contributes in about half of cases, and that older patients "are more likely than younger ones to have more than one contributing cause."