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Mills K, Vermeer JM, Berry WE, Karreman E, Lett CD. Determining the validity of non-invasive spot-check hemoglobin co-oximetry testing to detect anemia in postpartum women at a tertiary care centre, a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:479. [PMID: 37386388 DOI: 10.1186/s12884-023-05783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/13/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Spot-check hemoglobin co-oximetry analyzers measure hemoglobin transcutaneously and offer the benefit of a hemoglobin measurement without phlebotomy. The objective of this study was to determine the validity of non-invasive spot-check hemoglobin co-oximetry testing for the detection of postpartum anemia (hemoglobin < 10 g/dL). METHODS Five hundred eighty-four women aged 18 and over were recruited on postpartum day one following a singleton delivery. Two non-invasive spot-check hemoglobin co-oximetry monitors, Masimo Pronto Pulse CO-Oximeter (Pronto) and Masimo Rad-67 Pulse CO-Oximeter (Rad-67), were evaluated and compared to the postpartum phlebotomy hemoglobin value. RESULTS Of 584 participants, 31% (181) had postpartum anemia by phlebotomy hemoglobin measurement. Bland-Altman plots determined a bias of + 2.4 (± 1.2) g/dL with the Pronto and + 2.2 (± 1.1) g/dL with the Rad-67. Low sensitivity was observed: 15% for the Pronto and 16% for the Rad-67. Adjusting for the fixed bias, the Pronto demonstrated a sensitivity of 68% and specificity of 84%, while the Rad-67 demonstrated a sensitivity of 78% and specificity of 88%. CONCLUSION A consistent overestimation of hemoglobin by the non-invasive spot-check hemoglobin co-oximetry monitors compared to phlebotomy hemoglobin result was observed. Even after adjusting for the fixed bias, the sensitivity for detecting postpartum anemia was low. Detection of postpartum anemia should not be based on these devices alone.
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Affiliation(s)
- Kienna Mills
- Health Science Building, University of Saskatchewan, 107 Wiggins Rd, Saskatoon, SK, S7N 5E5, Canada
| | - Julie M Vermeer
- Department of Obstetrics and Gynecology, University of Saskatchewan, Reginal General Hospital, 1440 14 Ave, ReginaRegina, Saskatchewan, S4P 0W5, Canada
| | - Warren E Berry
- Saskatchewan Health Authority, 2180 23rd Avenue, Regina, SK, S4S 0A5, Canada
| | - Erwin Karreman
- Saskatchewan Health Authority, 2180 23rd Avenue, Regina, SK, S4S 0A5, Canada
| | - Christine D Lett
- Department of Obstetrics and Gynecology, University of Saskatchewan, Reginal General Hospital, 1440 14 Ave, ReginaRegina, Saskatchewan, S4P 0W5, Canada.
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Czempik PF, Pluta MP, Krzych ŁJ. Hemoglobin Determination Using Pulse Co-Oximetry and Reduced-Volume Blood Gas Analysis in the Critically Ill: A Prospective Cohort Study. Diagnostics (Basel) 2022; 12:diagnostics12122908. [PMID: 36552914 PMCID: PMC9776962 DOI: 10.3390/diagnostics12122908] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/13/2022] [Accepted: 11/19/2022] [Indexed: 11/24/2022] Open
Abstract
Hospital-acquired anemia is common in patients hospitalized in the intensive care unit (ICU). A major source of iatrogenic blood loss in the ICU is the withdrawal of blood for laboratory testing. The aim of our study was to analyze the feasibility and accuracy of non-invasive spot-check pulse co-oximetry (SpHb), and a reduced-volume blood gas analysis (ABG Hb) for the determination of Hb concentration in critically ill patients. Comparisons between Hb determined with test devices and the gold standard—complete blood count (CBC)—were performed using Bland−Altman analysis and concordance correlation coefficient (CCC). The limits of agreement between SpHb and CBC Hb were −2.0 [95%CI −2.3−(−1.7)] to 3.6 (95%CI 3.3−3.9) g/dL. The limits of agreement between ABG Hb and CBC Hb were −0.6 [95%CI −0.7−(−0.4)] to 2.0 (95%CI 1.9−2.2) g/dL. Spearman’s coefficient and CCC between ABG Hb and CBC Hb were 0.96 (95%CI 0.95−0.97, p < 0.001) and 0.91 (95%CI 0.88−0.92), respectively. Non-invasive spot-check Hb co-oximetry is not sufficiently accurate for the monitoring of hemoglobin concentration in critically ill patients. Reduced volume arterial blood gas analysis has acceptable accuracy and could replace complete blood count for the monitoring of Hb concentration in critically ill patients, leading to a significant reduction in blood volume lost for anemia diagnostics.
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Affiliation(s)
- Piotr F. Czempik
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
- Transfusion Committee, University Clinical Center of the Medical University of Silesia in Katowice, 40-055 Katowice, Poland
- Correspondence: ; Tel.: +48-327894201
| | - Michał P. Pluta
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
| | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-055 Katowice, Poland
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An R, Huang Y, Man Y, Valentine RW, Kucukal E, Goreke U, Sekyonda Z, Piccone C, Owusu-Ansah A, Ahuja S, Little JA, Gurkan UA. Emerging point-of-care technologies for anemia detection. LAB ON A CHIP 2021; 21:1843-1865. [PMID: 33881041 PMCID: PMC8875318 DOI: 10.1039/d0lc01235a] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Anemia, characterized by low blood hemoglobin level, affects about 25% of the world's population with the heaviest burden borne by women and children. Anemia leads to impaired cognitive development in children, as well as high morbidity and early mortality among sufferers. Anemia can be caused by nutritional deficiencies, oncologic treatments and diseases, and infections such as malaria, as well as inherited hemoglobin or red cell disorders. Effective treatments are available for anemia upon early detection and the treatment method is highly dependent on the cause of anemia. There is a need for point-of-care (POC) screening, early diagnosis, and monitoring of anemia, which is currently not widely accessible due to technical challenges and cost, especially in low- and middle-income countries where anemia is most prevalent. This review first introduces the evolution of anemia detection methods followed by their implementation in current commercially available POC anemia diagnostic devices. Then, emerging POC anemia detection technologies leveraging new methods are reviewed. Finally, we highlight the future trends of integrating anemia detection with the diagnosis of relevant underlying disorders to accurately identify specific root causes and to facilitate personalized treatment and care.
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Affiliation(s)
- Ran An
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Yuning Huang
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Yuncheng Man
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Russell W Valentine
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Erdem Kucukal
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Utku Goreke
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA.
| | - Zoe Sekyonda
- Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA
| | - Connie Piccone
- Department of Pediatric Hematology, Carle Foundation Hospital, Urbana, IL, USA
| | - Amma Owusu-Ansah
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Sanjay Ahuja
- Department of Pediatrics, Division of Hematology and Oncology, University Hospitals Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Jane A Little
- Division of Hematology & UNC Blood Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Umut A Gurkan
- Mechanical and Aerospace Engineering Department, Case Western Reserve University, 10900 Euclid Ave., Glennan Building, Cleveland, OH 44106, USA. and Biomedical Engineering Department, Case Western Reserve University, Cleveland, OH, USA and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, USA
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Robison S, Karur GR, Wald RM, Thavendiranathan P, Crean AM, Hanneman K. Noninvasive hematocrit assessment for cardiovascular magnetic resonance extracellular volume quantification using a point-of-care device and synthetic derivation. J Cardiovasc Magn Reson 2018; 20:19. [PMID: 29544519 PMCID: PMC5856214 DOI: 10.1186/s12968-018-0443-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/05/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Calculation of cardiovascular magnetic resonance (CMR) extracellular volume (ECV) requires input of hematocrit, which may not be readily available. The purpose of this study was to evaluate the diagnostic accuracy of ECV calculated using various noninvasive measures of hematocrit compared to ECV calculated with input of laboratory hematocrit as the reference standard. METHODS One hundred twenty three subjects (47.7 ± 14.1 years; 42% male) were prospectively recruited for CMR T1 mapping between August 2016 and April 2017. Laboratory hematocrit was assessed by venipuncture. Noninvasive hematocrit was assessed with a point-of-care (POC) device (Pronto-7® Pulse CO-Oximeter®, Masimo Personal Health, Irvine, California, USA) and by synthetic derivation based on the relationship with blood pool T1 values. Left ventricular ECV was calculated with input of laboratory hematocrit (Lab-ECV), POC hematocrit (POC-ECV), and synthetic hematocrit (synthetic-ECV), respectively. Statistical analysis included Wilcoxon signed-rank test, Bland-Altman analysis, receiver-operating curve analysis and intra-class correlation (ICC). RESULTS There was no significant difference between Lab-ECV and POC-ECV (27.1 ± 4.7% vs. 27.3 ± 4.8%, p = 0.106), with minimal bias and modest precision (bias - 0.18%, 95%CI [- 2.85, 2.49]). There was no significant difference between Lab-ECV and synthetic-ECV (26.7 ± 4.4% vs. 26.5 ± 4.3%, p = 0.084) in subjects imaged at 1.5 T, although bias was slightly higher and limits of agreement were wider (bias 0.23%, 95%CI [- 2.82, 3.27]). For discrimination of abnormal Lab-ECV ≥30%, POC-ECV had good diagnostic performance (sensitivity 85%, specificity 96%, accuracy 94%, and AUC 0.902) and synthetic-ECV had moderate diagnostic performance (sensitivity 71%, specificity 98%, accuracy 93%, and AUC 0.849). POC-ECV had excellent test-retest (ICC 0.994, 95%CI[0.987, 0.997]) and inter-observer agreement (ICC 0.974, 95%CI[0.929, 0.991]). CONCLUSIONS Myocardial ECV can be accurately and reproducibly calculated with input of hematocrit measured using a noninvasive POC device, potentially overcoming an important barrier to implementation of ECV. Further evaluation of synthetic ECV is required prior to clinical implementation.
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Affiliation(s)
- Sean Robison
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Gauri Rani Karur
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
| | - Rachel M. Wald
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Paaladinesh Thavendiranathan
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Andrew M. Crean
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
- Division of Cardiology, Department of Medicine, Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Kate Hanneman
- Department of Medical Imaging, Toronto General Hospital, University Health Network, University of Toronto, 585 University Ave, 1PMB-298, Toronto, ON M5G 2N2 Canada
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Results of a Prospective Study Evaluating a Noninvasive Method of Hemoglobin Adjustment for Determining the Diffusing Capacity of the Lung. Ann Am Thorac Soc 2016; 14:41-48. [PMID: 27870589 DOI: 10.1513/annalsats.201603-197oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Measurement of the diffusing capacity of the lung for carbon monoxide (DlCO) is significantly influenced by the pulmonary capillary blood volume. Consequently, measurements require adjustment for blood hemoglobin concentration (DlCOadj) to allow meaningful clinical interpretation. Noninvasive point-of-care devices that measure hemoglobin transcutaneously provide immediate values for hemoglobin that may be useful in pulmonary function laboratories for determining DlCOadj. OBJECTIVES To test the hypothesis that DlCOadj determinations obtained with a commercially available device for noninvasive, point-of-care measurement of blood hemoglobin concentrations are not significantly different from determinations obtained using hemoglobin concentrations measured conventionally in venous blood samples. METHODS In a prospective open trial, hemoglobin measurements were obtained with the Pronto-7 spot check pulse CO-oximeter (Massimo, Irvine, CA) and by venipuncture for 205 patients referred for DlCO testing at Cincinnati Children's Hospital. Hemoglobin and DlCOadj measurements were compared between the two methods, using Student paired t tests and Bland-Altman plots. To assess variability, the differences in DlCOadj between the two methods were also compared by a modification of the current standard for acceptable within-session variability for DlCO. Clinical interpretation for individual DlCO tests based on DlCOadj values obtained from the two methods were compared statistically using Kendall's coefficient of concordance to determine whether the Pronto-7 altered the classification of the severity of DlCO defects. MEASUREMENTS AND MAIN RESULTS Measurements of hemoglobin concentration by the Pronto-7 analyzer were significantly lower than those obtained from venipuncture blood samples (13.1 ± 1.8 vs. 13.4 ± 2.0; P = 0.01). However, there were no differences for DlCOadj between both methods (23.6 ± 7.7 vs. 23.7 ± 7.5 ml/min/mm Hg; P = 0.42). There was strong correlation between the Pronto-7 and venipuncture DlCOadj values (r = 0.99, P < 0.0001). Variability between the two methods was low for DlCOadj, with a bias of -0.07. More than 96% of tests met acceptable within-session variability. There was no significant difference in the clinical interpretation of the DlCO test based on DlCOadj values recovered from both methods (Kendall's coefficient, 0.96). CONCLUSIONS Noninvasive measurement of hemoglobin for determination of DlCOadj was accurate and provided acceptable within-session variability. The results obtained noninvasively did not alter clinical interpretation of test results compared with venipuncture. These findings support noninvasive point-of-care devices as an alternative to venipuncture for determining hemoglobin to measure DlCOadj in most patients.
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Martin JR, Camp CL, Stitz A, Young EY, Abdel MP, Taunton MJ, Trousdale RT. Noninvasive Hemoglobin Monitoring: A Rapid, Reliable, and Cost-Effective Method Following Total Joint Replacement. J Bone Joint Surg Am 2016; 98:349-55. [PMID: 26935456 DOI: 10.2106/jbjs.o.00820] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Noninvasive hemoglobin (nHgb) monitoring was initially introduced in the intensive care setting as a means of rapidly assessing Hgb values without performing a blood draw. We conducted a prospective analysis to compare reliability, cost, and patient preference between nHgb monitoring and invasive Hgb (iHgb) monitoring performed via a traditional blood draw. METHODS We enrolled 100 consecutive patients undergoing primary or revision total hip or total knee arthroplasty. On postoperative day 1, nHgb and iHgb values were obtained within thirty minutes of one another. iHgb and nHgb values, cost, patient satisfaction, and the duration of time required to obtain each reading were recorded. The concordance correlation coefficient (CCC) was utilized to evaluate the agreement of the two Hgb measurement methods. Paired t tests and Wilcoxon signed-rank tests were utilized to compare mean Hgb values, time, and pain for all readings. RESULTS The mean Hgb values did not differ significantly between the two measurement methods: the mean iHgb value (and standard deviation) was 11.3 ± 1.4 g/dL (range, 8.2 to 14.3 g/dL), and the mean nHgb value was 11.5 ± 1.8 g/dL (range, 7.0 to 16.0 g/dL) (p = 0.11). The CCC between the two Hgb methods was 0.69. One hundred percent of the patients with an nHgb value of ≥ 10.5 g/dL had an iHgb value of >8.0 g/dL. The mean time to obtain an Hgb value was 0.9 minute for the nHgb method and 51.1 minutes for the iHgb method (p < 0.001). At our institution, the cost of iHgb monitoring is approximately $28 per blood draw compared with $2 for each nHgb measurement, resulting in a savings of $26 per Hgb assessment when the noninvasive method is used. CONCLUSIONS Noninvasive Hgb monitoring was found to be more efficient, less expensive, and preferred by patients compared with iHgb monitoring. Providers could consider screening total joint arthroplasty patients with nHgb monitoring and only order iHgb measurement if the nHgb value is <10.5 g/dL. If this protocol had been applied to the first blood draw in our 100 patients, approximately $2000 would have been saved. Extrapolated to the U.S. total joint arthroplasty practice, approximately $20 million could be saved annually.
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Affiliation(s)
- J Ryan Martin
- Departments of Orthopedic Surgery (J.R.M., C.L.C., A.S., E.Y.Y., M.P.A., M.J.T., and R.T.T.) and Nursing (A.S.), Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Christopher L Camp
- Departments of Orthopedic Surgery (J.R.M., C.L.C., A.S., E.Y.Y., M.P.A., M.J.T., and R.T.T.) and Nursing (A.S.), Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Amber Stitz
- Departments of Orthopedic Surgery (J.R.M., C.L.C., A.S., E.Y.Y., M.P.A., M.J.T., and R.T.T.) and Nursing (A.S.), Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Ernest Y Young
- Departments of Orthopedic Surgery (J.R.M., C.L.C., A.S., E.Y.Y., M.P.A., M.J.T., and R.T.T.) and Nursing (A.S.), Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Matthew P Abdel
- Departments of Orthopedic Surgery (J.R.M., C.L.C., A.S., E.Y.Y., M.P.A., M.J.T., and R.T.T.) and Nursing (A.S.), Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Michael J Taunton
- Departments of Orthopedic Surgery (J.R.M., C.L.C., A.S., E.Y.Y., M.P.A., M.J.T., and R.T.T.) and Nursing (A.S.), Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | - Robert T Trousdale
- Departments of Orthopedic Surgery (J.R.M., C.L.C., A.S., E.Y.Y., M.P.A., M.J.T., and R.T.T.) and Nursing (A.S.), Mayo Clinic and Mayo Foundation, Rochester, Minnesota
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