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Dimauro G, Griseta ME, Camporeale MG, Clemente F, Guarini A, Maglietta R. An intelligent non-invasive system for automated diagnosis of anemia exploiting a novel dataset. Artif Intell Med 2023; 136:102477. [PMID: 36710064 DOI: 10.1016/j.artmed.2022.102477] [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: 08/25/2022] [Revised: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
Anemia is a condition in which the oxygen-carrying capacity of red blood cells is insufficient to meet the body's physiological needs. It affects billions of people worldwide. An early diagnosis of this disease could prevent the advancement of other disorders. Traditional methods used to detect anemia consist of venipuncture, which requires a patient to frequently undergo laboratory tests. Therefore, anemia diagnosis using noninvasive and cost-effective methods is an open challenge. The pallor of the fingertips, palms, nail beds, and eye conjunctiva can be observed to establish whether a patient suffers from anemia. This article addresses the above challenges by presenting a novel intelligent system, based on machine learning, that supports the automated diagnosis of anemia. This system is innovative from different points of view. Specifically, it has been trained on a dataset that contains eye conjunctiva photos of Indian and Italian patients. This dataset, which was created using a very strict experimental set, is now made available to the Scientific Community. Moreover, compared to previous systems in the literature, the proposed system uses a low-cost device, which makes it suitable for widespread use. The performance of the learning algorithms utilizing two different areas of the mucous membrane of the eye is discussed. In particular, the RUSBoost algorithm, when appropriately trained on palpebral conjunctiva images, shows good performance in classifying anemic and nonanemic patients. The results are very robust, even when considering different ethnicities.
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Affiliation(s)
- Giovanni Dimauro
- Department of Computer Science, University of Bari 'Aldo Moro', Bari, Italy.
| | - Maria Elena Griseta
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing, National Research Council of Italy, Bari, Italy.
| | | | - Felice Clemente
- Haematology Dept. of National Cancer Institute 'Giovanni Paolo II', Bari, Italy.
| | - Attilio Guarini
- Haematology Dept. of National Cancer Institute 'Giovanni Paolo II', Bari, Italy.
| | - Rosalia Maglietta
- Institute of Intelligent Industrial Technologies and Systems for Advanced Manufacturing, National Research Council of Italy, Bari, Italy.
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Vyas N, Hendren S, Tushar Sehgal DM, Monga C, Ranjan R, Chaturvedi H, Subramanian A, Vashistha V. The Accuracy of Physical Examination to Diagnose Anemia Among Patients Five Years or Older: A Systematic Review. Indian J Hematol Blood Transfus 2023; 39:90-101. [PMID: 36699436 PMCID: PMC9868202 DOI: 10.1007/s12288-022-01543-z] [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: 12/04/2021] [Accepted: 04/19/2022] [Indexed: 01/28/2023] Open
Abstract
Anemia remains a significant public health challenge, disproportionately impacting lower-income patients residing in areas of lesser healthcare resources. We sought to evaluate the accuracy of physical exam techniques to diagnose anemia among patients 5 years of age or older. A systematic review of 5 databases (MEDLINE via OVID, EMBASE, Scopus, Global Health and Global Health Archives, and WHO Global Index Medicus) was conducted. Studies that (1) compared non-invasive physical exam techniques with anemia diagnoses using standard laboratory measurements and (2) solely assessed or separately reported the diagnostic accuracy of physical exam techniques for patients 5 years or older were considered for inclusion. The diagnostic accuracies of individual and combinatorial physical exam techniques todiagnose anemia were documented. This systematic review was registered with PROSPERO. The systemic literature search yielded 6,457 unique studies after removal of duplicates. Fourteen studies were ultimately selected for inclusion. Eight studies solely assessed pregnant females, 4 solely assessed hospitalized patients, and 2 evaluated the general population. The diagnostic accuracy ranged widely for pallor assessments of conjunctivae (sensitivity: 19-97%, specificity: 65-100%), nailbed (sensitivity: 41-65%, specificity: 58-93%), and palms (sensitivity: 33-91%, specificity: 54-93%). Examining 9 or more sites leads to higher sensitivity (73.8-82.9%) and specificity (76.0-90.9%). No individual examination technique is superior to others for diagnosing anemia. Combinatorial approachs are associated with more acceptable accuracy measures, but improvements need to be balanced with time available for examination. Supplementary Information The online version contains supplementary material available at 10.1007/s12288-022-01543-z.
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Affiliation(s)
- Neha Vyas
- Trinity College of Arts and Sciences, Duke University, Durham, NC USA
| | | | | | - Charu Monga
- Indian Institute of Technology, Delhi, India
| | - Rajeev Ranjan
- All India Institute of Medical Sciences, Delhi, India
| | | | | | - Vishal Vashistha
- Section of Hematology and Oncology, Raymond G. Murphy New Mexico Veterans Affairs Medical Center, Albuquerque, USA
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Ullah A, Sohaib M, Saeed F, Iqbal S. Prevalence of anemia and associated risk factors among pregnant women in Lahore, Pakistan. Women Health 2018; 59:660-671. [PMID: 30462581 DOI: 10.1080/03630242.2018.1544966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Maternal anemia is a frequent problem during pregnancy, especially in developing countries, such as Pakistan. In this context, the present study was conducted to determine factors associated with maternal anemia prevalent among women of different age groups visiting different hospitals in Lahore from February to April 2017. The current study used a cross-sectional design involving 390 pregnant women. Data related to demographic area, maternal age, gestational age/period, educational and income level, as well as socioeconomic status of all the participants were collected. Also, hemoglobin levels of the participants were obtained for assessment of maternal anemia. A total of 57.7% of participants were anemic (34.4 % mild and 23.3% moderate anemia). Bivariate analysis showed that less education (p = 0.01), occupation as housewife (p = 0.03), lower income (p = 0.001), rural residence (p = 0.028), and greater number of house members (p = 0.04) were significantly associated with maternal anemia. Results of multivariable logistic regression showed that low income was the only significant factor independently associated with maternal anemia. These results suggest that interventions, such as the Nutrition Support Program, to improve nutritional status of pregnant women by providing free food supplements with focus on the poor and marginalized communities are recommended to prevent anemia.
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Affiliation(s)
- Azmat Ullah
- a Department of Food Science and Human Nutrition , University of Veterinary and Animal Sciences , Lahore , Pakistan
| | - Muhammad Sohaib
- a Department of Food Science and Human Nutrition , University of Veterinary and Animal Sciences , Lahore , Pakistan
| | - Farhan Saeed
- b Institute of Home and Food Science , Government College University , Faisalabad , Pakistan
| | - Sanaullah Iqbal
- a Department of Food Science and Human Nutrition , University of Veterinary and Animal Sciences , Lahore , Pakistan
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Low Hemoglobin among Pregnant Women in Midwives Practice of Primary Health Care, Jatinangor, Indonesia: Iron Deficiency Anemia or β-Thalassemia Trait? Anemia 2017. [PMID: 28634546 PMCID: PMC5467296 DOI: 10.1155/2017/6935648] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Low hemoglobin (Hb) or anemia is common among pregnant women in developing countries which may cause adverse pregnancy outcomes and maternal deaths. Our study aimed to assess Hb level measured by midwives in primary health care facility at rural area of Jatinangor, Indonesia, and to explore whether the anemia was due to iron deficiency (IDA) or β-thalassemia trait (β-TT). Pregnant women (n = 105) had finger prick test for Hb level during a regular antenatal care examination from October to November 2016. Hb level by finger prick test was compared with venous blood, measured by complete blood count (CBC). Indices including MCV and MCH and indices of Shine & Lal, Mentzer, Srivastava, Engels & Frase, Ehsani, and Sirdah were analyzed to differentiate anemia due to IDA and anemia due to suspect β-TT. HbA2 was measured to confirm β-TT. Anemic pregnant women were found in 86.7% by finger prick test compared to 21.9% (n = 23) by CBC. The prevalence of β-TT in our study was 5.7%. Hb measurement among pregnant women in low resource area is highly important; however, finger prick test in this study showed a high frequency of anemia which may lead to iron oversupplementation. A standard CBC is encouraged; MCV and MCH would help midwives to identify β-TT.
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Abstract
Anaemia affects roughly a third of the world's population; half the cases are due to iron deficiency. It is a major and global public health problem that affects maternal and child mortality, physical performance, and referral to health-care professionals. Children aged 0-5 years, women of childbearing age, and pregnant women are particularly at risk. Several chronic diseases are frequently associated with iron deficiency anaemia--notably chronic kidney disease, chronic heart failure, cancer, and inflammatory bowel disease. Measurement of serum ferritin, transferrin saturation, serum soluble transferrin receptors, and the serum soluble transferrin receptors-ferritin index are more accurate than classic red cell indices in the diagnosis of iron deficiency anaemia. In addition to the search for and treatment of the cause of iron deficiency, treatment strategies encompass prevention, including food fortification and iron supplementation. Oral iron is usually recommended as first-line therapy, but the most recent intravenous iron formulations, which have been available for nearly a decade, seem to replenish iron stores safely and effectively. Hepcidin has a key role in iron homoeostasis and could be a future diagnostic and therapeutic target. In this Seminar, we discuss the clinical presentation, epidemiology, pathophysiology, diagnosis, and acute management of iron deficiency anaemia, and outstanding research questions for treatment.
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Affiliation(s)
- Anthony Lopez
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, Paris, France; Inflammation-Immunopathology-Biotherapy Department, F-75005, Paris, France; AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
| | | | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France.
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Khan AA, Fatmi Z, Kadir MM. Accuracy and Use of WHO Hemoglobin Color Scale for Diagnosis of Anemia Among Pregnant Women by Health Care Providers in Periurban Settings in Karachi, Pakistan. Asia Pac J Public Health 2015; 27:610-9. [DOI: 10.1177/1010539515588777] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The study assessed the diagnostic accuracy of the Hemoglobin Color Scale (HCS), comparing clinical signs assessment technique (CSAT) of health care providers against the gold standard of laboratory hemoglobinometry. A cross-sectional validation study was conducted among 194 pregnant women located in 2 towns of periurban settings in Karachi, from June 2012 to February 2013. Anemia was assessed by HCS and CSAT by health care providers and compared with laboratory hemoglobinometry. The sensitivity and specificity of HCS were 70.9% (95% CI = 62.7-78.3) and 49.1% (95% CI = 35.1-63.2); for CSAT they were 95.7% (95% CI = 91.0-98.4) and 5.7% (95% CI = 1.2-15.7), respectively. The area under the curve for HCS for diagnosis of anemia was 0.60 (95% CI = 0.52-0.66), compared with 0.50 (95% CI = 0.43-0.57) for CSAT ( P = .01). The accuracy of HCS is better than CSAT for assessing anemia by health care providers among pregnant women.
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Goonewardene M, Shehata M, Hamad A. Anaemia in pregnancy. Best Pract Res Clin Obstet Gynaecol 2011; 26:3-24. [PMID: 22138002 DOI: 10.1016/j.bpobgyn.2011.10.010] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 10/19/2011] [Accepted: 10/19/2011] [Indexed: 11/16/2022]
Abstract
Anaemia in pregnancy, defined as a haemoglobin concentration (Hb) < 110 g/L, affects more than 56 million women globally, two thirds of them being from Asia. Multiple factors lead to anaemia in pregnancy, nutritional iron deficiency anaemia (IDA) being the commonest. Underlying inflammatory conditions, physiological haemodilution and several factors affecting Hb and iron status in pregnancy lead to difficulties in establishing a definitive diagnosis. IDA is associated with increased maternal and perinatal morbidity and mortality, and long-term adverse effects in the new born. Strategies to prevent anaemia in pregnancy and its adverse effects include treatment of underlying conditions, iron and folate supplementation given weekly for all menstruating women including adolescents and daily for women during pregnancy and the post partum period, and delayed clamping of the umbilical cord at delivery. Oral iron is preferable to intravenous therapy for treatment of IDA. B12 and folate deficiencies in pregnancy are rare and may be due to inadequate dietary intake with the latter being more common. These vitamins play an important role in embryo genesis and hence any relative deficiencies may result in congenital abnormalities. Finding the underlying cause are crucial to the management of these deficiencies. Haemolytic anaemias rare also rare in pregnancy, but may have life-threatening complications if the diagnosis is not made in good time and acted upon appropriately.
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Affiliation(s)
- Malik Goonewardene
- Department of Obstetrics and Gynaecology, University of Ruhuna, Faculty of Medicine, Galle, Sri Lanka.
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