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Anaemia and cigarette smoking
Open accessAbstract
Summary: Cigarette smoking causes numerous diseases that are associated with anaemia but the resulting low haemoglobin levels may be counterbalanced by increased red blood cell production caused by chronic exposure to carbon monoxide from cigarette smoke. Diverse mechanisms are involved in influencing the development or the course of anaemic disease in smokers. This article presents an evaluation of the current literature on the impact of cigarette smoking on various forms of anaemia.
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TL;DR
This narrative review evaluates literature on how cigarette smoking affects anaemia, noting that smoking often raises haemoglobin and can mask anaemia while also influencing iron, folate, haemolytic, and aplastic anaemia pathways. It concludes that effects vary by anaemia type and that further studies are needed.
Key findings
- Smoking-associated Hb elevation may mask anaemia: among women of comparable socio-economic status, anaemia prevalence was 4.8% in smokers vs 8.5% in never-smokers (Nordenberg et al., 1990). Hb increases are generally reversible; healthy ex-smokers show no Hb difference vs nonsmokers, though long-term smokers with COLD or emphysema may have persistently elevated Hb/polycythaemia.
- Folate levels in serum or RBCs are reduced in smokers, in both nonpregnant and pregnant individuals, and the risk of reduced RBC folate relates to cigarettes smoked per day; vitamin B12 findings remain inconsistent. Smoking is well documented as correlated with myeloid leukaemia, with relative risk correlated with quantity smoked; benzene is linked to aplastic anaemia, but AA-smoking data are rare (Linet et al., 1989 found no significant correlation in 59 patients), and average smoker benzene uptake of approximately 1.8 mg/day may be too low to show AA effects.
- In sickle cell disease, smoking-related reduced oxygenation may precipitate crisis, acute chest syndrome is more frequent in smokers, and children exposed to environmental tobacco smoke had more inpatient sickle cell crises (West et al., 2003). HbCO is elevated in smokers but no correlation with vaso-occlusive severity was detected (Sears et al., 2001); CO may stabilize Hb Zurich and reduce haemolysis.
- In pregnancy, most studies show no significant Hb difference between smoking and nonsmoking women, but fetuses of mothers who continued smoking had elevated HbF and higher haematocrit levels.
Methods
- Narrative review/evaluation of the current literature on the impact of cigarette smoking on various forms of anaemia; no primary data are collected.
- The text does not describe a systematic search strategy, inclusion criteria, or quantitative meta-analysis; it synthesizes cited studies across iron homeostasis, haemolytic anaemia, megaloblastic anaemias, and aplastic anaemia/haematotoxicity.
Limitations
- Stated: human data on cigarette smoke-induced haemolysis are inconclusive; specific data on thalassaemia and cigarette smoking are not available; AA-smoking data are rare; it is unclear whether reduced folate correlates with higher megaloblastic anaemia incidence; vitamin B12 data are inconsistent; further studies are needed.
- Evident: as a narrative review, it relies on previously published studies and does not report a systematic search or formal quality assessment; conclusions may be constrained by heterogeneity and small study sizes noted in the text.
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0 Valid · 1 Not valid · 58 Not checked · 33 Own results and interpretations
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Cigarette smoking causes numerous diseases that are associated with anaemia but the resulting low haemoglobin levels may be counterbalanced by increased red blood cell production caused by chronic exposure to carbon monoxide from cigarette smoke.”
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
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- Rests on an assumption not shown here.
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In the paper
“Iron homeostasis appears to be affected mainly by changing of Hb concentrations.”
hedgedstates a cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Diverse mechanisms are involved in influencing the development or the course of anaemic disease in smokers.”
plainstates an association- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Most authors see no significant difference in Vitamin B12 levels in smokers compared with nonsmokers, either in nonpregnant or pregnant individuals (Wadia et al., 1972;Mansoor et al., 1997;Ozerol et al., 2004), although some studies show reduced (Pagan et al., 2001;van Wersch, Janssens & Zandvoort, 2002) or even raised levels of vitamin B 12 in smokers (Tungtrongchitr et al., 2003).”
What the sources say
plain- Asserted: passes — The authors put it forward as true.
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- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“In addition, the slightly reduced plasma volume may also contribute to the increase in Hb levels detected in smokers (Siggaard-Andersen et al., 1969;Smith & Landaw, 1978;Stonesifer, 1978).”
What the sources say
hedgedstates a possible cause- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
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Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ A P L A S T I C A N A E M I A A N D H A E M A T O X I C I T Y
“In contrast, increased levels of erythropoietin were observed in newborns of mothers who constantly smoked through pregnancy (Varvarigou et al., 1994;Bili et al., 1996;Yin et al., 1996;Gruslin et al., 2000).”
§ References
“Yin S.N., Hayes R.B., Linet M.S., Li G.L., Dosemeci M., Travis L.B. et al. (1996) An expanded cohort study of cancer among benzene-exposed workers in China.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ A P L A S T I C A N A E M I A A N D H A E M A T O X I C I T Y
“However, the correlation between cigarette smoke and development of myeloid leukaemia is well documented (Kinlen & Rogot, 1988;McLaughlin et al., 1989;Severson et al., 1990;Sears, Udden & Thomas, 2001).”
§ References
“Sears D.A., Udden M.M. & Thomas L.J. (2001) Carboxyhemoglobin levels in patients with sickle-cell anemia: rela- tionship to hemolytic and vasoocclusive severity.”
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Metadata
- Authors
- LEIFERT, J. A.
- Affiliations
- University of Freiburg (DE)
- Corresponding author
- LEIFERT, J. A.
- ORCID
- LEIFERT, J. A.
- Venue
- International Journal of Laboratory Hematology
- Publisher
- Wiley
- Published
- 2008-06
- Volume
- 30
- Issue
- 3
- Pages
- 177-184
- ISSN
- 1751-5521 (ISSN-L)
- 1751-553X
- OpenAlex
- W2147291454
- Cited by
- 83
- References
- 91
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 6 · 2023: 7 · 2022: 7 · 2021: 10 · 2020: 5 · 2019: 4 · 2018: 5 · 2017: 4 · 2016: 8 · 2015: 4 · 2014: 2 · 2013: 4
- FWCI
- 0.18
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Laboratory Hematology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Hematology › Iron Metabolism and Disorders
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Smoking Behavior and Cessation
- Health Sciences › Medicine › Hematology › Erythropoietin and Anemia Treatment
- Keywords
- anemia, cigarette smoking, carbon monoxide, hemoglobin, erythropoiesis, smoking and disease
- MeSH terms
- Anemia, Carbon Monoxide, Carboxyhemoglobin, Humans, Smoking
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-11-13, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-11-13 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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Data sources
Bibliographic data: Semantic Scholar, OpenAlex, Crossref.
Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).
Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.
