Figure for lower end of range of maximal haemoglobin is too low

doi:10.1136/bmj.310.6994.1601c

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Alan F Fleming

Director of laboratory services University Teaching Hospital, P/Bag RW 1X, Ridgeway 15102, Lusaka, Zambia

EDITOR,—The U shaped curves of low birth weight and preterm delivery by maternal haemoglobin concentration described by Philip Steer and colleagues1 were established by Garn et al.2 The two groups agree about the decline in reproductive efficiency when maternal haemoglobin concentration is above about 140 g/l (or packed cell volume 0.41), observations which need to be known by all obstetricians.

The two groups differ importantly, however, over what is the lower end of the range of maximal haemoglobin concentration during pregnancy. The curve of Garn et al showed reducing percentages of favourable pregnancies when lowest maternal packed cell volume was below 0.32 (haemoglobin …