AF anemia study

1. CAUTION: These slides’ data were extracted from the study paper with some
comments/hypotheses added by the presenter. This brief does not represent Federal
Government, DOD, or AF official positions.
AF BMT Iron Anemia Study
Study Period: July 2013-Jan 2014
(UNOFFICIAL SUMMARY)
Conserve the Fighting Strength
1

2. • 18,827 US Air Force Basic Military Training (BMT) trainees tested.
• Total anemic were 12.6 % (2,378).
• Anemic female distribution (1,054)(25.4%) was:
– Borderline - 12.6% (538)
– Moderate - 10.0% (467)
– Severe - 1.9% (79)
• Anemic male distribution (N: 1,294)(8.9%) was:
– Borderline 4.8% (702)
– Moderate 3.8% (551)
– Severe 0.3% (41)
Source: Prevalence and Impact of Anemia on Basic Trainees in the US Air Force, Myhre et al, Sports Med Open. 2016
Dec; 2: 23.
Air Force BMT Iron Anemia Study
2

3. 3
Anemia Definition and Classification
• Hgb measured in grams per deciliter (g/dL): less than 12.0 g/dL
for women and less than 13.5 g/dL for men.
• Female Anemia was defined as
– borderline if Hgb was between 11.5 and 11.9 g/dL,
– moderate if 10.0 to 11.4 g/dL
– severe if <10.0 g/dL.
• Male Anemia was defined as
– borderline if Hgb was between 13.0 and 13.4 g/dL,
– moderate if 11.5 to 12.9 g/dL
– severe if <11.5 g/dL.
Air Force BMT Iron Anemia Study

4. 4
Female (N = 4,270) Male (N = 14,557) Total (N = 18,827)
Non-anemic 3,186 (74.6 %) 13,263 (91.1 %) 16,449 (87.4 %)
Borderline anemia 538 (12.6 %) 702 (4.8 %) 1,240 (6.6 %)
Moderate anemia 467 (10.9 %) 551 (3.8 %) 1,018 (5.4 %)
Severe anemia 79 (1.9 %) 41 (0.3 %) 120 (0.6 %)
Table 2: Prevalence of anemia stratified by sex and anemia status
Air Force BMT Iron Anemia Study

5. 5
• Anemic trainees had longer initial average run times, fewer push-ups,
and fewer sit-ups than non-anemic trainees (p < 0.001).
• Anemic trainees’ discharge and delayed graduation rates were more
common than non-anemic trainees, with risk increasing based on
anemia severity.
• Iron-deficiency anemia is associated with musculoskeletal overuse
injuries, impaired immune function, diminished cognitive performance,
and depressed mood. (Presenter note: And poorer healing)
• Iron supplementation has been shown to improve endurance, work
capacity, and muscle function in both deficient and anemic subjects.
Source: Prevalence and Impact of Anemia on Basic Trainees in the US Air Force, Myhre et al, Sports Med Open. 2016 Dec; 2: 23.
Air Force Iron Anemia Study

6. Air Force BMT Iron Anemia Study
6
• The overall discharge rate = 6.1 %
• 5.8 % for males
• 7.2 % for females.
• The All-Anemic discharge rate was 9.0 %. Non-anemic discharge rate was
5.7%.
• The severely anemic trainees’ discharge rate was 20%.
• The risk of discharge and delayed graduation increased with severity of
anemia, both overall and when stratified by sex.

7. 7
Potential Iron Anemia Screening Tool
https://www.hemocue.us/en-us/solutions/hematology/hemocue-hb-301-system
HemoCue was found to be most sensitive
technique (sensitivity 99.4%; specificity
84.4%).
Comparison of the results obtained by HemoCue, HCS
and CuSO4 methods of Hb estimation against the
reference (n = 1,014)
Result HemoCue HCS CuSO
True positive 842 837 837
True negative 141 45 97
False positive 26 10 70
False negative 05 122 10
Sensitivity (%) 99.4 87.3 98.8
Specificity (%) 84.4 81.8 58.1
Likelihood ratio 630.07 173.69 290.56
Positive predictive 97.0% 98.8% 92.3%
Negative predictive 96.6% 26.9% 90.7%
Linear by linear
association 794.78 238.59 405.68
Quality evaluation of four hemoglobin screening methods in a blood donor setting along with their comparative cost analysis
in an Indian scenario, Tondon et al, Asian J Transfus Sci. 2009 Jul; 3(2): 66–69.