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567?g/dL, median 0.9?g/dL; standard deviation 1.38?g/dL). The Bland-Altman plot (Figure?1) showed this systematic bias to be equal in width across the whole Hb range. Deviation of SpHb from HbRef was similar in both sexes (men: 0.5?g/dL Hb, interquartile range (IQR) 1.85?g/dL Hb; women: 0.8?g/dL Hb, IQR 1.3?g/dL http://www.selleckchem.com/products/CP-690550.html Hb). Analysis of the distribution of deviation showed that approximately 25% of values were located around 1?g/dL Hb. As a consequence of the systematically higher SpHb measurements, anemia prevalence was lower when anemia was defined using the noninvasive method than using the reference method. Using HbRef, according to World Health Organization criteria,[7] anemia was detected in 52 individuals (29 men (45.3%), 23 women (63.9%)), 21 of whom were severely anemic (Hb? http://www.selleck.cn/products/MLN8237.html http://www.selleckchem.com/products/XL184.html These findings are consistent with previous reports that found significant correlations between SpHb and HbRef,[4, 5] with deviations tending toward higher SpHb values.[4-6] With this systematic bias, the method is likely to produce some false negatives. According to the PPV and NPV found, the noninvasive method appears to be useful for the detection of anemia but lacks sensitivity, although in certain settings (e.g., anemia awareness programs at senior fairs), it is of clinical value to know Hb to within 1 to 2?g/dL immediately. Suppressed SpHb levels should be verified using a reference method, and individuals should undergo a standard evaluation for anemia. In addition, the noninvasive method has some practical limitations that are important in older adults. Because the technology uses oximetric sensors, all states influencing translucence and oxygen flow, such as calloused skin, nail polish, poor peripheral blood flow, and blood viscosity, limit its use. Especially in elderly adults, dehydration and overhydration are common, and the effect of blood viscosity on SpHb has not been clearly established.[8, 9] In summary, initiatives for anemia screening are increasingly gaining interest.