• There is a lack of good quality evidence from the systematic reviews in haemoglobin cutoffs to define anaemia and its severity at individual and public health level.

• The GDG agreed on the value and on the positive effects of reviewing haemoglobin concentrations to diagnose anaemia, and other possible adjustments by other determinants, but recognized that there may be costs associated with having to revise and implement new adjustments.
• The group considered that the haemoglobin adjustments are acceptable to stakeholders, cost-effective, and have a positive impact in equity.
• Correct diagnosis at the individual and population levels is important in order to accurately report anaemia prevalence rates and efficiently apply health interventions.

• Benefits of reviewing haemoglobin cutoffs to define anaemia clearly outweigh harms.
• The GDG considered that there is a high value and a clear benefit from reviewing cutoffs to define anaemia and its severity because such a review would improve decisions about implementation of public health interventions and decision-making on whether to treat anaemia at the individual level.
• Considerations of the balance of effects and cost-effectiveness favour no adjustments of haemoglobin concentrations by genetic ancestry, since the complexity of genetic testing makes adjustments to cutoffs based on genetic background unfeasible.
• The GDG found that there was positive value in using the gold-standard practice for haemoglobin determination (using venous blood, automated haematology analysers, and high-quality control standards), and that the positive effects of a clear knowledge of comparable methodologies to measure haemoglobin and the correct diagnosis of anaemia at individual and at population levels were clear.

• The differences between urban and rural areas, different levels of educational attainment, and the decision-making level at which community groups operate were considered.
• The group concluded that effective interventions to improve nutrition in disadvantaged populations could help to reduce health inequalities.
• In general, effective nutrition interventions would be more likely to decrease health inequities only if they are accompanied by concurrent interventions that address the root cause of the anaemia.
• In contexts of extended poverty and lack of opportunities, guaranteeing access to anaemia diagnosis and treatment requires addressing the factors that allow for the continuation of exclusion and poverty, which are socially determined and thus modifiable.
• Research is needed to set haemoglobin cutoffs adjusted by race/ethnicity/genetic ancestry, especially recognizing how underrepresented some genetic backgrounds have been in the genetic literature thus far.

Costs

• The presumed benefits are worth the cost.

Feasibility

• No studies were available to address cost, acceptability, or feasibility implications, but the group considered that reviewing haemoglobin concentration cutoffs to define anaemia in individuals and populations was acceptable and feasible to key stakeholders, since in general, improved anaemia cutoffs would benefit patients across the world, including a broad range of clinical, laboratory, public health, and research settings.