Our objective was to assess the prevalence of and association between anemia, including hypochromic microcytic anemia, and active tuberculosis (TB) in a rural community in South India.
Study participants (n=372) were enrolled at a former TB sanatorium in South India. Active TB was assessed by acid-fast bacilli sputum smear microscopy. An automated hematology analyzer assayed serological indicators, including hemoglobin, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH). Anemia was defined by hemoglobin cutoffs, per World Health Organization (WHO) recommendations. Hypochromic microcytic anemia was defined by hemoglobin (per WHO cutoffs), MCV (<80 femtoliters/cell), and MCH (<27.5 picograms/cell).
Median hemoglobin was 100 g/L (IQR 88-107) among women, and 116 g/L (IQR 99-128) among men. Men had a lower prevalence of anemia (55.8%) and hypochromic microcytic anemia (21.4%), compared to women (96.2%; 39.7%; both p<0.05). A greater prevalence of anemia was observed among patients with TB (82.2%), compared to those without TB (58.5%; p<0.05). Anemia and hypochromic microcytic anemia were both associated with presence active TB, adjusting for age and sex (all p<0.05).
Even though the link between anemia and increased morbidity and mortality in general and specifically in patients with TB is well-recognized, nearly all the women in this cohort had anemia regardless of TB status.These results underscore the need for bolstering surveillance efforts to detect anemia in both the community and clinical settings as well as to improve our understanding of the links between anemias and TB disease progression, co-infections, and treatment outcomes.