Cross-sectional relationship between haemoglobin concentration and measures of physical and cognitive function in an older rural South African population

Relationship between hemoglobin and grip strength in older adults: the ActiFE study

INTRODUCTION

Although anemia is associated with low muscle strength, hemoglobin has been rarely studied considering ferritin.

AIM

To analyze the association between hemoglobin and grip strength in community-dwelling older adults.

METHODS

We used data from a German cohort of adults ≥ 65 years, excluding those with CRP > 10 mg/L or taking iron supplements. Grip strength (kg) was measured using a Jamar dynamometer. Analysis was performed using multiple linear regression, adjusted for established confounders. Due to interaction, age-stratified (< 80, 80 +), further sex-stratified analysis in those < 80 years old and ferritin-stratified in men < 80 years were performed.

RESULTS

In total, 1294 participants were included in this analysis (mean age 75.5 years, 549 (42.3%) women, 910 (70.3%) < 80 years). On average, hemoglobin and grip strength were 14.9 g/dL and 41.3 kg for men, 13.9 g/dL and 25.1 kg for women. Hemoglobin was significantly positively associated with grip strength only among women < 80 years (β 0.923 [95% CI 0.196, 1.650]). For men < 80 years, the association was significant when ferritin was ≥ 300 µg/L (β 2.028 [95% CI 0.910, 3.146]). No association was detected among those participants 80 + .

DISCUSSION AND CONCLUSIONS

Our data show an association between hemoglobin and grip strength only in women < 80 years old. For men < 80 years, the association was only significant with ferritin levels ≥ 300 µg/L. Considering the decreasing levels of hemoglobin and grip strength and the high prevalence of iron deficiency in older adults further analyses investigating this relationship with more iron specific parameters such as transferrin saturation are warranted.

Associations of urinary metal concentrations with anemia: A cross-sectional study of Chinese community-dwelling elderly

BACKGROUND

Anemia seriously affects the health and quality of life of the older adult population and may be influenced by various types of environmental metal exposure. Current studies on metals and anemia are mainly limited to single metals, and the association between polymetals and their mixtures and anemia remains unclear.

METHODS

We determined 11 urinary metal concentrations and hemoglobin levels in 3781 participants. Binary logistic regression and restricted cubic spline (RCS) model were used to estimate the association of individual metals with anemia. We used Bayesian kernel machine regression (BKMR) and Quantile g-computation (Q-g) regression to assess the overall association between metal mixtures and anemia and identify the major contributing elements. Stratified analyses were used to explore the association of different metals with anemia in different populations.

RESULTS

In a single-metal model, nine urinary metals significantly associated with anemia. RCS analysis further showed that the association of arsenic (As) and copper (Cu) with anemia was linear, while cobalt, molybdenum, thallium, and zinc were non-linear. The BKMR model revealed a significant positive association between the concentration of metal mixtures and anemia. Combined Q-g regression analysis suggested that metals such as Cu, As, and tellurium (Te) were positively associated with anemia, with Te as the most significant contributor. Stratified analyses showed that the association of different metals with anemia varied among people of different sexes, obesity levels, lifestyle habits, and blood pressure levels.

CONCLUSIONS

Multiple metals are associated with anemia in the older adult population. A significant positive association was observed between metal mixture concentrations and anemia, with Te being the most important factor. The association between urinary metal concentrations and anemia is more sensitive in the non-hypertensive populations.

Sarcopenia and Anemia in Elderly Koreans: A Nationwide Population-Based Study

Sarcopenia and anemia are common diseases in the elderly and are caused by various factors. In this study, the association between sarcopenia and anemia in an elderly Korean population was examined. The Korea Centers for Disease Control and Prevention's cross-sectional, nationally representative Korea National Health and Nutrition Examination Survey (KNHANES, 2008-2011) served as the source of the data for this study. Of the 2769 participants (1167 men and 1602 women) included in this study, a significant association was found between sarcopenia and anemia in the elderly in Korea. In Model 1, unadjusted for covariates, the prevalence of sarcopenia in all participants was 1.805 (95% CI 1.364-2.388) and 2.746 (95% CI 1.740-4.334) in men, and 1.494 (95% CI 1.045-2.138) in women. In Model 4, adjusted for all covariates, the prevalence of sarcopenia in all participants was 1.455 (95% CI 1.064-1.989) and 2.649 (95% CI 1.475-4.755) in men, but it was insignificant in women. While prior studies failed to consider variables such as exercise status and nutritional intake, this research incorporated these factors as covariates. Despite this comprehensive approach, this study still revealed an independent association between sarcopenia and anemia. Moreover, a significant association was uncovered among elderly men, with no corresponding association identified among women.

Causes of Moderate and Severe Anaemia in a High-HIV and TB-Prevalent Adult Population in the Eastern Cape Province, South Africa

BACKGROUND

Anaemia affects one in four adults in South Africa, with a higher prevalence in persons with HIV and tuberculosis. The aim of this study is to characterise the causes of anaemia in primary care and a district hospital setting.

METHODS

A cross-sectional study design investigated a purposive sample of adult males and non-pregnant females at two community health centres and a hospital casualty and outpatients. Fingerpick blood haemoglobin was measured with HemoCueHb201+. Those with moderate and severe anaemia underwent clinical examination and laboratory tests.

RESULTS

Of 1327 patients screened, median age was 48 years, and 63.5% were female. Of 471 (35.5%) with moderate and severe anaemia on HemoCue, 55.2% had HIV, 16.6% tuberculosis, 5.9% chronic kidney disease, 2.6% cancer, and 1.3% heart failure. Laboratory testing confirmed 227 (48.2%) with moderate and 111 (23.6%) with severe anaemia, of whom 72.3% had anaemia of inflammation, 26.5% iron-deficiency anaemia, 6.1% folate deficiency, and 2.5% vitamin B12 deficiency. Overall, 57.5% had two or more causes of anaemia. Multivariate modelling showed that patients with severe anaemia were three times more likely to have tuberculosis (OR = 3.1, 95% CI = 1.5-6.5; p-value = 0.002). Microcytosis was present in 40.5% with iron deficiency, macrocytosis in 22.2% with folate deficiency, and 33.3% with vitamin B12 deficiency. The sensitivities of the reticulocyte haemoglobin content and % hypochromic red blood cells in diagnosing iron deficiency were 34.7% and 29.7%, respectively.

CONCLUSIONS

HIV, iron deficiency, and tuberculosis were the most prevalent causes of moderate and severe anaemia. The majority had multiple causes. Iron, folate, and vitamin B12 deficiencies should be identified by biochemical testing rather than by red cell volume.

Relative Handgrip Strength Mediates the Relationship between Hemoglobin and Health-Related Quality of Life in Older Korean Adults

Background: Little is known regarding how anemia and handgrip strength influence the health-related quality of life (HRQoL) of older populations. This population-based study aimed to examine whether handgrip strength mediates the association between anemia and HRQoL in a representative sample of 6892 Korean adults aged ≥ 65 years (3753 females). Methods: HRQoL was assessed with the EuroQol-5 dimension. Anemia was defined according to World Health Organization (WHO) criteria, and handgrip strength was measured with a digital hand dynamometer. Results: Individuals with anemia were at increased risk for a lower HRQoL (odds ratio, OR = 1.285, p = 0.002) even after adjustment for age, sex, body mass index, income, marital status, education, physical activity, and multimorbidity compared with individuals without anemia (OR = 1). Individuals with weak handgrip strength were also at increased risk for a lower HRQoL (OR = 1.429, p < 0.001) even after adjustment for all the covariates compared with individuals with normal handgrip strength (OR = 1). Mediation analysis with a bootstrapping procedure showed that relative handgrip strength mediated the relationship between hemoglobin and HRQoL (95% confidence interval, CI 0.0192 to 0.0289) even after adjustment for all covariates, with 42.0% of the total effect of hemoglobin on HRQoL explained. Conclusions: The current findings suggest that the impact of anemia on HRQoL is partially mediated by weak handgrip strength, implying the clinical importance of having or maintaining adequate hemoglobin and handgrip strength via healthy lifestyle choices to maintain a high HRQoL later in life.

Relationship between Selected Functional Performance Parameters and the Occurrence of Anaemia in Hospitalized Females and Males Aged 80 and More

Anaemia is considered a factor that significantly increases the risk of disability and mortality in the elderly. Among the hospitalized elderly, the incidence of anaemia is higher than in the general population, which necessitates extensive diagnostics for anaemia in this group. The aim was to assess the relationship between the occurrence of anaemia in hospitalized females and males, aged 80 years and more, and selected determinants of motor fitness. The analysis covered 91 females and 57 males aged 80 and more. The study implemented haemoglobin level, handgrip strength, a lower limb strength, mobility and balance measurement. The analysis used the logistic regression model and the cut-off point was determined by ROC curve. A 1 kg increase in muscle strength reduced the risk of anaemia in a group of males by 12%. The value of handgrip strength from which anaemia can be predicted in a group of males is 24.4 kg. In the female group, no statistically significant correlations were found. There is a need to continue research in this area with the participation of a larger group of respondents to look for potential factors that may be related to anaemia, in order to find non-invasive diagnostic tools useful for elderly people.

Prevalence of Anemia and Factors Associated With Handgrip Strength in Indonesian Elderly Population

Introduction: Anemia is a common blood disorder in the elderly which is associated with numerous poor medical outcomes. However, there is currently no study that assesses anemia prevalence of the Indonesian elderly population aged ≥60 years old in multiple provinces and analyzes its association with handgrip muscle strength using a large sample size.

Aim: We aimed to elucidate the prevalence of anemia and analyze factors associated with handgrip strength in elderly.

Method: This was a cross-sectional study using data from the Indonesian Family Life Survey-5 (IFLS-5). All participants aged ≥60 years old were included in this study. Exclusion criteria were: (1) respondents who refused to take health measurements (hemoglobin (Hb) level, handgrip strength, weight, stature, and waist circumference); (2) respondents with incomplete or missing data; (3) respondents with history of stroke; and (4) respondents with history of pain, swelling, inflammation, injury, and surgery on one or both hands within the last 6 months. The dependent variable for this study was handgrip strength. Subjects were classified as weak if the handgrip strength was <28 kg for men and <18 kg for women based on classification from the Asian Working Group for Sarcopenia (AWGS) 2019. The independent variables were Hb level, gender, age, body mass index (BMI), waist circumference, smoking history, comorbidities, and current use of drug therapies. Based on WHO standard, male and female participants with Hb less than 13 g/dL and 12 g/dL, respectively, are defined as anemic. Statistical analyses used included correlation, bivariate logistic regression, and multivariate logistic regression.

Result: A total of 3192 individuals were selected for analysis. Overall, 38.8% of participants had anemia, and the prevalence of anemia increases with age. A total of 56.30% of participants aged  ≥80 years had anemia. There was a positive correlation between Hb level and handgrip strength in the Indonesian elderly population (r: 0.349; p value: <0.001). Multivariate analysis showed that anemia was significantly associated with weak handgrip strength (OR: 1.557; 95% CI: 1.314-1.846; p value: <0.001).  Age ≥ 80 years (OR: 5.234), age 70-79 years (OR: 3.152), low BMI (OR: 1.827), and hypertension (OR: 1.340) were associated with weak handgrip strength in multivariate analysis.

Conclusion: The prevalence of anemia in the Indonesian elderly was 38.8% and anemia was associated with weak handgrip strength. The association of anemia with weak handgrip strength is more pronounced in males and the elderly aged ≥80 years.

Higher hemoglobin levels are associated with better physical performance among older adults without anemia: a longitudinal analysis

Background

Anemia is the most common hematological abnormality among older adults, and it is associated with decreased physical performance. But the role of hemoglobin in the absence of anemia remains unclear. Thus, this study aimed to assess the impact of hemoglobin levels on physical performance in Brazilian older adults without anemia.

Methods

The study is longitudinal in that it relies on two waves of the Saúde, Bem-Estar e Envelhecimento (SABE; Health, Well-being, and Aging) study: 2010 and 2015-2016. Mixed-effects linear regression was used to determine the effects of the hemoglobin concentrations on the Short Physical Performance Battery-SPPB over time among the 1,023 who had complete data and did not have anemia in 2010. In the follow-up, there were 567 without anemia.

Results

In analyses adjusted for age, education, comorbidities, body mass index, and physical inactivity, we found a differential association between hemoglobin concentration and SBBP by sex, with a positive interaction (β Hb*female= 0.20, 95% CI 0.04,0.37). At lower levels of hemoglobin, women have lower levels of SPPB than men, but at higher levels of hemoglobin concentration, there are no sex differences in physical performance. In addition, higher age was negatively associated with SPPB levels and cardiometabolic diseases, other diseases, and physical inactivity. Education was positively associated with physical performance.

Conclusion

Our study demonstrates that higher hemoglobin levels were associated with better physical performance among older adults without anemia in Brazil. However, there were sex differences in this association. This finding is important because, in clinical practice, most health professionals focus on the World Health Organization definition of anemia. Our study suggests the importance of hemoglobin levels among older adults, even those without anemia, and highlights sex differences.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02937-4.

Socioeconomic differences in handgrip strength and its association with measures of intrinsic capacity among older adults in six middle-income countries

Handgrip strength, a measure of muscular strength is a powerful predictor of declines in intrinsic capacity, functional abilities, the onset of morbidity and mortality among older adults. This study documents socioeconomic (SES) differences in handgrip strength among older adults aged 50 years and over in six middle-income countries and investigates the association of handgrip strength with measures of intrinsic capacity-a composite of all the physical and mental capacities of an individual. Secondary data analysis of cross-sectional population-based data from six countries from the WHO's Study on global AGEing and adult health (SAGE) Wave 1 were conducted. Three-level linear hierarchical models examine the association of demographic, socioeconomic status and multimorbidity variables with handgrip strength. Regression-based Relative Index of Inequality (RII) examines socioeconomic inequalities in handgrip strength; and multilevel linear and logistic hierarchical regression models document the association between handgrip strength and five domains of intrinsic capacity: locomotion, psychological, cognitive capacity, vitality and sensory. Wealth quintiles are positively associated with handgrip strength among men across all countries except South Africa while the differences by education were notable for China and India. Work and nutritional status are positively associated with handgrip strength. Our findings provide new evidence of robust association between handgrip strength and other measures of intrinsic capacity and confirms that handgrip strength is a single most important measure of capacity among older persons.

Association between anemia, physical performance and cognitive function in Iranian elderly people: evidence from Bushehr Elderly Health (BEH) program

Background and objectives

The present study aimed to investigate the relation between anemia and hemoglobin (Hgb) concentration, physical performance, and cognitive function in a large sample of Iranian elderly population.

Methods

Data were collected from Bushehr elderly health (BEH) program. A total of 3000 persons aged ≥60 years were selected through multistage random sampling. Hemoglobin values lower than 12 and 13 g/dL were considered as anemia for women and men, respectively. The cognitive function was measured using the Mini-cog test and Category fluency test (CFT), and the physical function was measured using handgrip strength (muscle strength), Relative handgrip strength (RHGS), and 4.57-m usual gait speed. Univariate and adjusted multivariate logistic regression and linear regression with Stata MP (version 15) were run, and a p-value of < 0.05 was used as statistically significant for all analyses.

Results

Among participants, 7.43% were anemic, and 115 (51.57%) simultaneously had anemia and cognitive disorder. There were significant associations between red blood cell count (RBC), hemoglobin (Hgb), platelet count (PLT), and hematocrit percentage (HCT) with cognitive impairment. Additionally, Hgb concentration was significantly associated with all physical measures (Mean handgrip, Relative handgrip, and usual gait speed) and late recall (mini-cog) among the whole participants. This association remained statistically significant after considering multi-cofounders. In contrast, after stratifying the participants by gender, the association between Hgb concentration and usual gait speed was decreased in both men and women; moreover, Hgb association with cognitive measures (category fluency test and late recall) was no longer significant (all p-values > 0.05).

Conclusion

There was a cross-sectional and significant association between anemia and functional variables (e.g., Relative and mean handgrip) in Iranian elderly population, whereas Semantic memory, Late recall, and walking were more affected by gender.

Global cognition modifies the relationship between anemia and depression in old age: A longitudinal analysis of the IMIAS Study

OBJECTIVES

To examine the relationship between anemia and depression and whether sex and global cognition modify this relationship over a 4-year follow-up.

DESIGN

Longitudinal analysis of an international cohort study SETTINGS AND PARTICIPANTS: Older adults from the International Mobility in Aging Study (IMIAS) aged between 65 and 74 years at baseline.

METHODS

Participants were recruited in Natal (Brazil), Manizales (Colombia), Kingston (Ontario, Canada), and Saint-Hyacinthe (Quebec, Canada). The study outcome was depression, defined by a score of ≥16 in the Center for Epidemiologic Studies Depression Scale. Longitudinal associations over a 4-year follow-up were examined using generalized estimating equations. Cognition was ascertained with the Leganes Cognitive Test with scores ≤ 22 indicating poor cognition. Models were also adjusted for research sites, marital status, alcohol drinking status, body mass index, chronic conditions, activities of daily life disabilities, and polypharmacy.

RESULTS

Anemia and poor cognition at baseline were associated with an increased risk of depression at follow-up (OR = 5.73, 95% CI: 1.58-20.78). Global cognition was also an effect modifier of the longitudinal association between the severity of anemia and depression.

CONCLUSIONS

In international samples of older adults, anemia, as well as the severity of anemia, were independent risk factors for depression, and the effect of these associations was modified by global cognition. The findings highlight an important issue as to whether depression in old age may be at least partially preventable through public health interventions to correct low Hb levels.

Red Cell Distribution Width and Dementia Among Rural-Dwelling Older Adults: The MIND-China Study

BACKGROUND

Evidence has emerged that anemia is associated with dementia, but data on the relationships of red blood cell distribution width (RDW) with dementia and cognitive function in older adults are sparse.

OBJECTIVE

We sought to investigate the associations of RDW with dementia and global cognitive performance among rural-dwelling Chinese older adults and further to examine their associations by anemia status.

METHODS

This population-based cross-sectional study included 5,115 participants (age≥65 years, 57.0%women) in the baseline examination (March-September 2018) of the Multimodal Interventions to Delay Dementia and Disability in rural China (MIND-CHINA). We collected data through face-to-face interviews, clinical examinations, and laboratory tests. Global cognitive function was evaluated using the Mini-Mental State Examination (MMSE). We defined dementia, Alzheimer's disease (AD), and vascular dementia (VaD) following the respective international criteria. Data were analyzed using multinomial logistic and general linear regression models.

RESULTS

Of all participants, 300 were diagnosed with dementia, including 195 with AD and 95 VaD. The multiple-adjusted odds ratio of dementia associated with quartiles of RDW were 1.45 (95%CI: 0.87-2.44), 1.00 (reference), 1.77 (1.07-2.93), and 2.28 (1.40-3.72). Similar J-shaped patterns existed for the association of RDW with odds ratio of AD and VaD. Anemia was not significantly associated with dementia. The J-shaped associations of RDW with dementia and subtypes were statistically evident only among participants without anemia. There was an inverted J-shaped relationship between RDW quartiles and β-coefficients of MMSE score.

CONCLUSION

There is a J-shaped association between RDW level and likelihood of dementias among rural-dwelling Chinese older adults, especially among people without anemia.

Low handgrip strength is closely associated with anemia among adults: A cross-sectional study using Korea National Health and Nutrition Examination Survey (KNHANES)

Background

Anemia, which is a major public health problem worldwide, represents a decline in the oxygenation function, and can therefore be related to low strength. However, hemoglobin cannot repair muscles directly, but is beneficial only in a supportive role. Previous studies on the relationship between handgrip strength and anemia have been controversial. Thus, we aimed to analyze the association between handgrip strength and anemia in Korean adults.

Methods

This cross-sectional study used the 2013–2017 data from the 6th and 7^th Korean National Health and Nutrition Examination Survey (KNHANES) that included 16,638 Korean adults, aged ≥19 years, who met the inclusion or exclusion criteria. Differences in sociodemographic factors (sex, age, education, income, and employment), lifestyle factors (alcohol consumption, smoking, and physical activity), and illness and health factors [body mass index (BMI), vitamin intake, iron intake, comorbid illnesses, and handgrip strength] by existence of anemia, were analyzed using the Chi square test. Binary logistic regression analysis was used to measure the association between handgrip strength and anemia, while adjusting for other possible confounders. Subgroup analysis, stratified by sex and age, was performed.

Results

Among Korean adults aged ≥19 years, 745,296 (7.7%) had anemia. A higher odds ratio, adjusted for other covariates/factors (OR) of anemia occurred in the weak handgrip strength group than in the strong handgrip strength group (OR = 1.92, 95% CI: 1.58–2.33). The subgroup analysis showed a higher OR adjusted for other covariates/factors of anemia in the weak handgrip strength group than in the strong handgrip strength group, regardless of sex or age. However, the association was greater for males (OR = 2.13, 95% CI: 1.35–3.34) and for those aged ≥65 years (OR = 1.92, 95% CI: 1.42–2.58).

Conclusion

This study showed a strong association between handgrip strength and anemia that was particularly strong for males and those aged ≥65 years.

Red Cell Distribution Width Is Directly Associated with Poor Cognitive Performance among Nonanemic, Middle-Aged, Urban Adults

BACKGROUND

Epidemiological evidence suggests that both anemia and elevated red cell distribution width (RDW) are associated with cognitive impairment. However, the interplay between these 2 predictors has been understudied.

OBJECTIVES

We examined sex- and anemia-specific associations between RDW and cognitive performance among urban adults in the United States.

METHODS

Data from the Healthy Aging in Neighborhoods of Diversity Across the Life Span Study (Baltimore, MD; participants aged 30-65 y at baseline, ∼59% African-American, 45% men) were used. Participants were selected based on the completion of 11 cognitive tasks at baseline (2004-2009) and follow-up (2009-2013) visits (mean time between visits: 4.64 ± 0.93 y) and availability of exposure and covariate data, yielding a sample of between 1526 and 1646 adults out of the initial 3720 adults recruited at baseline. Multiple linear mixed-effects regression models were conducted with RDW as the main exposure of interest and anemia/sex as the key effect modifiers.

RESULTS

Overall, high RDWs were linked to poorer baseline performance on the California Verbal Learning Test (CVLT) List A (per 1 unit increase in RDW %, main effect: γ01 = -0.369 ± 0.114; P = 0.001) and to slower rates of decline on the CVLT Delayed Free Recall (per 1 unit increase in RDW %, RDW × time: γ11 = +0.036 ± 0.013; P = 0.007). Among nonanemic participants, RDWs were consistently associated with poorer baseline performance on the Trailmaking Test, Part A (γ01 = +3.11 ± 0.89; P < 0.001) and on the CVLT List A (γ01 = -0.560 ± 0.158; P < 0.001). Moreover, RDWs were associated with poorer baseline performance on the Brief Test of Attention in the total population (γ01 = -0.123 ± 0.039; P = 0.001) and among men (γ01 = -0.221 ± 0.068; P = 0.001). We did not detect an association between hemoglobin (Hb) and baseline cognitive performance or changes over time.

CONCLUSIONS

Elevated RDW had a consistent cross-sectional association with poor cognitive performance in the domains of verbal memory and attention among the nonanemic group in a sample of middle-aged, urban adults. Anemia and Hb concentrations were not associated with cognition. More longitudinal studies are needed to replicate our findings.

Association between Anemia and Cognitive Impairment among Elderly Patients with Heart Failure

Cognitive impairment is more prevalent in heart failure (HF) patients. Anemia can influence cognitive ability and is likely more prevalent in elderly patients with HF. However, there are limited data on the association of anemia with cognitive impairment in elderly HF patients. This study aimed to identify the association between anemia and cognitive impairment in elderly HF patients. This secondary data analysis included 181 patients aged 60 years or older with HF. Patients were categorized into an anemic or non-anemic group based on World Health Organization (WHO) criteria. We assessed the cognitive function using the Modified Mini-Mental State (3MS) at the time of enrollment. The prevalence of anemia and cognitive impairment in older patients with HF was the same at 35.4%. The main finding of the multiple logistic regression indicated that compared to a non-anemic status, anemia increased the risk of cognitive impairment (odds ratio (OR) = 4.268, 95% confidence interval (CI) = 1.898–9.593, p < 0.001). Healthcare providers should recognize the value of the significance of early assessment of anemic status and cognitive function following HF. A prospective cohort study should identify the pathway of the association between anemia and incidence of cognitive impairment.

Patient blood management: A solution for South Africa

For more than 70 years the default therapy for anaemia and blood loss was mostly transfusion. Accumulating evidence demonstrates a significant dose-dependent relationship between transfusion and adverse outcomes. This and other transfusion-related challenges led the way to a new paradigm. Patient blood management (PBM) is the application of evidence-based practices to optimise patient outcomes by managing and preserving the patient's own blood. 'Real-world' studies have shown that PBM improves patient outcomes and saves money. The prevalence of anaemia in adult South Africans is 31% in females and 17% in males. Improving the management of anaemia will firstly improve public health, secondly relieve the pressure on the blood supply, and thirdly improve the productivity of the nation's workforce. While high-income countries are increasingly implementing PBM, many middle- and low-income countries are still trying to upscale their transfusion services. The implementation of PBM will improve South Africa's health status while saving costs.