The effect of cigarette smoking on hemoglobin levels and anemia screening

JAMA. 1990 Sep 26;264(12):1556-9.


The relationships among cigarette smoking, hemoglobin concentration, and carboxyhemoglobin concentration were examined using data from the Second National Health and Nutrition Examination Survey. Among women, smokers had a mean (+/- SE) hemoglobin level of 137 +/- 0.4 g/L, significantly higher than the mean hemoglobin level of 133 +/- 0.5 g/L for never-smokers. Among men, the mean hemoglobin levels for smokers and never-smokers were 156 +/- 0.4 and 152 +/- 0.5 g/L, respectively. No significant difference in mean hemoglobin was noted between ex-smokers and never-smokers. Mean hemoglobin levels and carboxyhemoglobin levels increased progressively with the number of cigarettes consumed per day. Cigarette smoking seems to cause a generalized upward shift of the hemoglobin distribution curve, which reduces the utility of hemoglobin level to detect anemia. Among women of comparable socioeconomic status, the prevalence of anemia was 4.8% +/- 0.6% among smokers, compared with 8.5% +/- 1.2% among never-smokers. This study suggests that minimum hemoglobin cutoff values should be adjusted for smokers to compensate for the masking effect of smoking on the detection of anemia.

MeSH terms

  • Adolescent
  • Adult
  • Anemia / blood
  • Anemia / diagnosis*
  • Anemia, Hypochromic / blood
  • Anemia, Hypochromic / diagnosis
  • Carboxyhemoglobin / analysis
  • Female
  • Hemoglobins / analysis*
  • Humans
  • Male
  • Smoking / adverse effects*
  • Smoking / blood


  • Hemoglobins
  • Carboxyhemoglobin