The ‘cut-off’ values of hemoglobin and hematocrit for defining anemia in pregnant woman were provided with due reference(1). Similar values are also provided by the United States Health & Nutrition Examination Survey II, 1976-80 (N-HANES II)(2), in women 18-44 year of age with no separate mention of criteria of anemia among pregnant women. I agree that various workers have provided different age and sex specific reference standards of hemoglobin and hematocrit to define anemia. However, many individuals with seemingly normal haemoglobin levels likewise respond to iron administration with a rise in hemoglobin which implies that they were actually deficient in iron. Assessing the frequency of anemia in a population by means of hemoglobin measurements thus tends to underestimate the true prevalence(3). 

The hemoglobin estimation as mentioned, was carried out by spectrophotometer using the cyanmethemoglobin method. This is the most accurate and reliable procedure of hemoglobin estimation, hence a small rise of hemoglobin is also significant. To further substantiate the rate of rise in hemoglobin and hematocrit, an intention to treat analysis was also carried out.

Sunil Gomber,
Department of Pediatrics,
University College of Medical Sciences,
and GTB Hospital,
Delhi - 110 095, India.

1. Nicholson JF, Pesce MA. Reference ranges for laboratory tests and procedures. In: Nelson Text Book of Pediatrics. 16th edn. Eds. Behrman RE, Kleigman RM, Jenson HB. Philadelphia, W.B. Saunders, 2000; p 2185.

2. Dallman PR, Yip R, Johnson C. Prevalence and causes of anemia in the United States, 1976-1980. Am J Clin Nutr 1984; 39: 437-445.

3. DeMayer EM, Dallman P, Gurney JM, Hallberg L, Sood SK, SriKantia SG. Prevent-ing and Controlling Iron Deficiency Anemia through Primary Health Care. Geneva: World Health Organization, 1989: 8-9.