Data (N = 11251) from National Health and Nutrition Examination Survey (NHANES) for 2003-2016 for US adults aged ≥20 years were stratified by gender and anemia and analyzed to evaluate the associations between the concentrations of whole blood hemoglobin (WBHGB) and selected perfluoroalkyl acids (PFAAs) in serum by stages of glomerular filtration (GF). Investigated PFAAs were perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorodecanoic acid (PFDA), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA). Females with whole blood hemoglobin concentrations <12 g/dL and males with whole blood hemoglobin concentrations <13 g/dL were classified as being anemic. Regression models with log10 transformed concentrations of whole blood hemoglobin as dependent variable and age, poverty income ratio, body mass index, serum cotinine, daily alcohol intake, survey year, and log10 concentrations of one of the PFAA as independent variables were fitted. For anemic females, association between WBHGB and PFAA concentrations were uniformly positive across worsening stages of renal failure and percent increases for 10% increases in PFAAs varied between 0.03% and 0.39%. For anemic males, association between WBHGB and PFAA concentrations were positive except at GF-3A (45 ≤ eGFR<60 mL/min/1.73 m2) and percent increases for 10% increases in PFAAs varied between 0.02% and 0.53%. Thus, more often than not, presence of positive associations between WBHGB and PFAA among anemics imply elevated levels of PFAA are associated with higher levels of WBHGB. Similar results were observed for non-anemic males and females, however strengths of associations between whole blood hemoglobin and PFAAs were several fold higher among anemic compared to non-anemic participants. Hemoglobin is consistently associated with serum PFAAs.
