Evaluating the Diagnostic Performance of Hemoglobin in the Diagnosis of Iron Deficiency Anemia in High-Altitude Populations: A Scoping Review

Cinthya Vásquez-Velásquez (), Daniel Fernandez-Guzman (), Carlos Quispe-Vicuña, Brenda Caira-Chuquineyra, Fabricio Ccami-Bernal, Piero Castillo-Gutierrez, Miriam Arredondo-Nontol and Gustavo F. Gonzales
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Cinthya Vásquez-Velásquez: Laboratorio de Endocrinología y Reproducción, Laboratorios de Investigación y Desarrollo (LID), Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía Alberto Cazorla Tálleri, Universidad Peruana Cayetano Heredia, Lima 15102, Peru
Daniel Fernandez-Guzman: Carrera de Medicina Humana, Universidad Científica del Sur, Lima 15067, Peru
Carlos Quispe-Vicuña: Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru
Brenda Caira-Chuquineyra: Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa 04001, Peru
Fabricio Ccami-Bernal: Facultad de Medicina, Universidad Nacional de San Agustín de Arequipa, Arequipa 04001, Peru
Piero Castillo-Gutierrez: Sociedad Científica San Fernando, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru
Miriam Arredondo-Nontol: Escuela Profesional de Medicina Humana, Universidad Nacional de Tumbes, Tumbes 24001, Peru
Gustavo F. Gonzales: Laboratorio de Endocrinología y Reproducción, Laboratorios de Investigación y Desarrollo (LID), Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía Alberto Cazorla Tálleri, Universidad Peruana Cayetano Heredia, Lima 15102, Peru

IJERPH, 2023, vol. 20, issue 12, 1-17

Abstract: We evaluated the available literature on the diagnostic performance of hemoglobin (Hb) in the diagnosis of iron deficiency anemia (IDA) in high-altitude populations. We searched PubMed, Web of Science, Scopus, Embase, Medline by Ovid, the Cochrane Library, and LILCAS until 3 May 2022. We included studies that evaluated the diagnostic performance (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curves, and accuracy) of Hb (with and without an altitude correction factor) compared to any iron deficiency (ID) marker (e.g., ferritin, soluble transferrin receptor (sTFR), transferrin saturation, or total body iron (TBI)) in populations residing at altitudes (≥1000 m above sea level). We identified a total of 14 studies (with 4522 participants). We found disagreement in diagnostic performance test values between the studies, both in those comparing hemoglobin with and in those comparing hemoglobin without a correction factor for altitude. Sensitivity ranged from 7% to 100%, whereas specificity ranged from 30% to 100%. Three studies reported higher accuracy of uncorrected versus altitude-corrected hemoglobin. Similarly, two studies found that not correcting hemoglobin for altitude improved the receiver operating characteristic (ROC) curves for the diagnosis of iron deficiency anemia. Available studies on high-altitude populations suggest that the diagnostic accuracy of Hb is higher when altitude correction is not used. In addition, the high prevalence of anemia in altitude regions could be due to diagnostic misclassification.

Keywords: altitude; hemoglobin; iron deficiency anemia; scoping review; accuracy; ROC curves (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2023
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