Annals of Hematology

, 88:687 | Cite as

Blood haemoglobin concentrations are higher in smokers and heavy alcohol consumers than in non-smokers and abstainers—should we adjust the reference range?

  • Nils Milman
  • Agnes N. Pedersen
Original Article


The blood haemoglobin concentration is one of the most frequently used laboratory parameters in clinical practice. There is evidence that haemoglobin levels are influenced by tobacco smoking. The objective of this study was to evaluate the impact of smoking and alcohol consumption on haemoglobin concentrations in apparently healthy subjects living at sea level. A retrospective, epidemiological cohort study was performed in 1984. Participants were 1,503 men and 1,437 non-pregnant women evenly distributed in age cohorts of 30, 40, 50, and 60 years. Information of smoking habits and alcohol consumption were obtained by a questionnaire. Haemoglobin was measured in the fasting state on Coulter-S. Men displayed no difference in mean haemoglobin levels in the four age groups. In women, mean haemoglobin increased gradually with age (p = 0.001). Fifty-nine percent of men and 50% of women were daily smokers. Female smokers displayed a significant positive correlation between number of cigarettes/day and haemoglobin concentrations (r = 0.12, p = 0.002). Heavy smokers (more than ten cigarettes/day) had significantly higher mean haemoglobin (1.4% higher in men, on average 3.5% higher in women) than non-smokers (p < 0.01). Smokers demonstrated a significant correlation between cigarettes/day and drinks/week in men (r = 0.24, p < 0.001) and women (r = 0.16, p < 0.001). Non-smokers displayed a significant positive correlation between drinks/week and haemoglobin concentrations in men (r = 0.14, p = 0.001) and women (r = 0.08, p = 0.05). In non-smokers, alcohol consumption >14 drinks/week and more than seven drinks/week for men and women, respectively, increased mean haemoglobin by 1.3% in men and by average 1.9% in women compared with those consuming ≤14 and less than or equal to seven drinks/week. Smokers displayed similar results. Body mass index per se had no direct influence on haemoglobin levels but had indirect positive influence in men through its correlation with tobacco smoking and alcohol consumption. Tobacco smoking has an increasing effect on haemoglobin concentrations in both genders, which is proportional to the amount of tobacco smoked. The effect appears to be more pronounced in women. Likewise, high alcohol consumption has an increasing effect on haemoglobin in both genders, being most pronounced in women. However, in clinical biochemistry, the relatively small changes in haemoglobin do not justify the use of separate reference ranges in smokers and alcohol consumers.


Alcohol Body mass index Epidemiological study Ferritin Hemoglobins Men Reference range Smoking Women 



The study was supported by Sygekassernes Helsefond (grant H 11-23-89), Forskningsfonden for Medicinsk Forskning i København, Færøerne og Grønland (grant 46-83), Bloddonorernes Forskningsfond and Danish National Board of Health. The authors are indebted to the Department of Clinical Biochemistry, Bispebjerg Hospital, Copenhagen, Denmark, for analyses of haemoglobin and serum ferritin.


  1. 1.
    Skjelbakken T, Wilsgaard T, Førde OH, Arnesen E, Løchen ML (2006) Haemoglobin predicts total mortality in a general young and middle-aged male population. The Tromsø Study. Scand J Clin Lab Invest 66:567–576 doi: 10.1080/00365510600863895 PubMedCrossRefGoogle Scholar
  2. 2.
    Milman N, Pedersen AN, Ovesen L, Schroll M (2008) Haemoglobin concentrations in 358 apparently healthy 80-year-old Danish men and women. Should the reference interval be adjusted for age? Aging Clin Exp Res 20:8–14PubMedGoogle Scholar
  3. 3.
    Nordin G, Mårtensson A, Swolin B et al (2004) A multicentre study of reference intervals for haemoglobin, basic blood cell counts and erythrocyte indices in the adult population of the Nordic countries. Scand J Clin Lab 64:385–398 doi: 10.1080/00365510410002797 CrossRefGoogle Scholar
  4. 4.
    Milman N, Kirchhoff M (1991) Iron stores in 1433, 30- to 60-year-old Danish males. Evaluation by serum ferritin and haemoglobin. Scand J Clin Lab 51:635–641 doi: 10.3109/00365519109104574 CrossRefGoogle Scholar
  5. 5.
    Milman N, Kirchhoff M (1992) Iron stores in 1359, 30- to 60-year-old Danish women: evaluation by serum ferritin and hemoglobin. Ann Hematol 64:22–27 doi: 10.1007/BF01811467 PubMedCrossRefGoogle Scholar
  6. 6.
    Tsang CW, Lazarus R, Smith W, Mitchell P, Koutts J, Burnett L (1998) Hematological indices in an older population sample: derivation of healthy reference values. Clin Chem 44:96–101PubMedGoogle Scholar
  7. 7.
    Skjelbakken T, Dahl IM, Wilsgaard T, Langbakk B, Løchen ML (2006) Changes in haemoglobin levels according to changes in body mass index and smoking habits, a 20-year follow-up of a male cohort: the Tromsø Study 1974–1995. Eur J Epidemiol 21:493–499 doi: 10.1007/s10654-006-9032-y PubMedCrossRefGoogle Scholar
  8. 8.
    Van Tiel E, Peeters PH, Smit HA et al (2002) Quitting smoking may restore hematological characteristics within five years. Ann Epidemiol 12:378–388 doi: 10.1016/S1047-2797(01)00282-4 PubMedCrossRefGoogle Scholar
  9. 9.
    Nordic Council of Ministers Nordic Nutrition Recommendations (2004) Copenhagen 2004Google Scholar
  10. 10.
    Milman N, Pedersen NS, Visfeldt J (1983) Serum ferritin in healthy Danes: relation to bone marrow haemosiderin iron. Dan Med Bull 30:115–120PubMedGoogle Scholar
  11. 11.
    World Health Organization (2001) Iron deficiency anaemia. Assessment, prevention and control. WHO/NHD/01.3, GenevaGoogle Scholar
  12. 12.
    Charlton RW, Jacobs P, Seftel H, Bothwell TH (1964) The effect of alcohol on iron absorption. BMJ 5422:1427–1429CrossRefGoogle Scholar
  13. 13.
    Tavill AS, Quadri AM (2004) Alcohol and iron. Semin Liver Dis 24:317–325 doi: 10.1055/s-2004-832943 PubMedCrossRefGoogle Scholar
  14. 14.
    Scherer G (2006) Carboxyhemoglobin and thiocyanate as biomarkers of exposure to carbon monoxide and hydrogen cyanide in tobacco smoke. Exp Toxicol Pathol 58:101–124 doi: 10.1016/j.etp.2006.07.001 PubMedCrossRefGoogle Scholar
  15. 15.
    McDonough P, Moffatt RJ (1999) Smoking-induced elevations in blood carboxyhaemoglobin levels. Effect on maximal oxygen uptake. Sports Med 27:275–283 doi: 10.2165/00007256-199927050-00001 PubMedCrossRefGoogle Scholar
  16. 16.
    Ramsey JM (1975) The hematological effects of chronic, low level exposures to carbon monoxide in rats. Bull Environ Contam Toxicol 13:537–542 doi: 10.1007/BF01685176 PubMedCrossRefGoogle Scholar
  17. 17.
    Cronenberger C, Mould DR, Roethig H-J, Sarkar M (2008) Population pharmacokinetic analysis of carboxyhaemoglobin concentrations in adult cigarette smokers. Br J Clin Pharmacol 65:30–39 doi: 10.1111/j.1365-2125.2007.02974.x PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.Department of Clinical BiochemistryNæstved HospitalNæstvedDenmark
  2. 2.Research Centre for Prevention and HealthCopenhagen RegionDenmark
  3. 3.Department of Nutrition, National Food InstituteTechnical University of DenmarkCopenhagenDenmark
  4. 4.VirumDenmark

Personalised recommendations