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Kazma J, Ebner M, Slota J, Berger JS, Farooq F, Smith E, Ahmadzia HK. The correlation of non-invasive hemoglobin testing and lab hemoglobin in surgical patients: A systematic review and meta-analysis. Perfusion 2024:2676591241226465. [PMID: 38231793 DOI: 10.1177/02676591241226465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND The decision regarding intraoperative transfusion has traditionally been based on hemodynamic instability and estimated blood loss. We performed a systematic review to determine the validity of the oximetry method compared to standard of care for hemoglobin measurement. METHODS A systematic literature review was conducted, and several libraries were searched from inception to March 31,2023. The primary outcome was comparing the mean difference between laboratory-derived hemoglobin and non-invasive, point-of-care hemoglobin measurement. Subgroup analysis included comparing the mean difference in the pediatric population and among female patients. RESULTS A total of 276 studies were identified, and 37 were included. We found that the pooled mean difference varied qualitatively between adult and pediatric population (p value for heterogeneity <0.001). In adult populations, lab hemoglobin measurements were on average slightly higher than non-invasive measurements (mean difference = 0.23; 95% CI -0.13, 0.59), though there was greater heterogeneity across studies (I2 = 97%, p value = <0.001). In the pediatric population, most studies showed lab hemoglobin to be slightly lower (mean difference = -0.42; 95% CI -0.87 to 0.03). CONCLUSIONS In general, there was no clinically significant difference in mean hemoglobin among adult and pediatric populations. The percentage of female participants had no effect on the mean difference in hemoglobin.
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Affiliation(s)
- Jamil Kazma
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Megan Ebner
- School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - James Slota
- Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Jeffery S Berger
- Department of Anesthesiology and Critical Care Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Fouzia Farooq
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Emily Smith
- Department of Global Health, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
- Department of Exercise and Nutrition Sciences, The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Homa K Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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Bıcılıoğlu Y, Bal A, Demir Yenigürbüz F, Ergonul E, Geter S, Kazanasmaz H, Bal U. Noninvasive Hemoglobin Measurement Reduce Invasive Procedures in Thalassemia Patients. Hemoglobin 2022; 46:95-99. [PMID: 35686469 DOI: 10.1080/03630269.2022.2078726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This study was conducted to investigate the agreement between laboratory hemoglobin (LabHb) measured in venous blood and noninvasive, spectrophotometric hemoglobin (SpHb) measurement and the usability of SpHb measurement in the transfusion decision-making in patients with thalassemia whose hemoglobin (Hb) was monitored by taking blood samples at frequent intervals and who were transfused. Cardiac pulse, oxygen saturation, Pleth variability index (PVI), and SpHb values were measured in patients who came to the hematology outpatient clinic for a control visit and whose Hb levels were planned to be measured. Venous blood samples were taken for LabHb measurement, which we accept as the gold standard. Cohen's kappa value was calculated for the agreement between SpHb measurements and LabHb values. The relationship and predictability between both measurement methods were evaluated by Pearson correlation analysis, a modified Bland-Altman plot and the linear regression model. In the study conducted with a total of 110 children with thalassemia, a moderate level of agreement between the two measurement methods (kappa = 0.370, p < 0.0001) and a significantly high correlation between the two tests (r = 0.675) were found. The mean bias between the differences was found to be 0.3 g/dL (-1.27 to 1.86 g/dL). The sensitivity and the specificity of SpHb in identifying patients who needed transfusions (Hb <10.0 g/dL) were calculated as 92.2 and 57.1%, respectively. Our results suggest SpHb measurement may be used to screen anemia in hemodynamically stable hemoglobinopathy patients and even for transfusion decision-making with combination clinical findings.
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Affiliation(s)
- Yüksel Bıcılıoğlu
- Department of Pediatric Emergency Medicine, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Alkan Bal
- Department of Pediatric Emergency Medicine, Manisa Celal Bayar University Medical School, Manisa, Turkey
| | - Fatma Demir Yenigürbüz
- Department of Pediatric Hematology, Acıbadem Mehmet Ali Aydınlar University, Istanbul, Turkey
| | - Esin Ergonul
- Department of Medical Education, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Süleyman Geter
- Department of Pediatrics, Sanlıurfa Training and Research Hospital, Sanlıurfa, Turkey
| | - Halil Kazanasmaz
- Department of Pediactrics, Harran University School of Medicine, Sanlıurfa, Turkey
| | - Ufuk Bal
- Faculty of Engineering, Mugla Sıtkı Kocman University, Mugla, Turkey
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Margulies S, Posa M, Fitzgerald M, Filipp S, Howell D, Tung P, Kelly M. Reliability of transcutaneous hemoglobin measurements in an outpatient pediatric clinic. Postgrad Med 2022; 134:200-204. [PMID: 34895027 PMCID: PMC8983555 DOI: 10.1080/00325481.2021.2018256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/06/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Our study assessed the reliability of a transcutaneous hemoglobin (tcHgb) measurement as compared to a standard capillary hemoglobin (cHgb) measurement in screening for iron deficiency anemia in a single university-based pediatric outpatient clinic. METHODS Study participants included all pediatric patients requiring a hemoglobin (Hgb) assessment from July 2019 to June 2020. A tcHgb measurement was attempted on all children who received a cHgb measurement. Additional variables evaluated were age, visit type, gender, insurance type, weight, BMI percentile and presence of comorbid conditions. RESULTS Of 777 attempts, both cHgb and tcHgb were obtained in 196 children aged 9 months to 21 years. Attempts were most successful in children > 2 years of age due to finger size and ability to remain still for one to two minutes. The mean cHgb was 12.5 ± 1.5 g/dL, mean tcHgb value 13.1 ± 2.1 g/dL, and the mean difference was 0.6 ± 2.1 g/dL (tcHgb-cHgb). An intraclass correlation coefficient was 0.29. There were no differences with regards to age, visit type, gender, insurance type, weight, BMI percentile and presence of comorbid conditions. Bland-Altman analysis displayed a lack of agreement between the tcHgb and cHgb measurements and tcHgb tended to over-estimate Hgb values when the cHgb was low. CONCLUSIONS The measurement of a transcutaneous Hgb is less invasive for pediatric patients but has significant limitations. Smaller children (probe specifications) and movement limited the ability to obtain a tcHgb measurement in ~75% of children tested. Falsely normal tcHgb values occurred due to overestimation of hemoglobin when compared to the traditional cHgb device. The suboptimal sensitivity of the tcHgb device may cause providers to miss a diagnosis of anemia. Future research should compare both methods of Hgb assessment to the gold standard laboratory-analyzed complete blood count and use a smaller probe for children under 2, once available.
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Affiliation(s)
| | - Molly Posa
- Department of Pediatrics, College of Medicine, University of Florida, FL, USA
| | - Melissa Fitzgerald
- Department of Pediatrics, College of Medicine, University of Florida, FL, USA
| | - Stephanie Filipp
- Department of Health Outcomes & Biomedical Informatics, College of Medicine, University of Florida, FL, USA
| | - Diane Howell
- Department of Pediatrics, College of Medicine, University of Florida, FL, USA
| | - Puneet Tung
- Department of Pediatrics, College of Medicine, University of Florida, FL, USA
| | - Maria Kelly
- Department of Pediatrics, College of Medicine, University of Florida, FL, USA
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Kumar Y, Dogra A, Kaushik A, Kumar S. Progressive evaluation in spectroscopic sensors for non-invasive blood haemoglobin analysis - a review. Physiol Meas 2021; 43. [PMID: 34883473 DOI: 10.1088/1361-6579/ac41b7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/09/2021] [Indexed: 11/11/2022]
Abstract
Frequent monitoring of haemoglobin concentration is highly recommended by physicians to diagnose anaemia and polycythemia Vera. Moreover, Some other conditions also demand assessment of haemoglobin, and these conditions are blood loss, before blood donation, during pregnancy, preoperative, perioperative and postoperative conditions. Cyanmethaemoglobin/haemiglobincyanide method, portable haemoglobinometers and haematology analyzers are few standard methods to diagnose mentioned ailments. However, discomfort, delay and risk of infection are typical limitations of traditional measuring solutions. These limitations create the necessity to develop a non-invasive haemoglobin monitoring technique for a better lifestyle. Various methods and products are already developed and popular due to their non-invasiveness; however, invasive solutions are still considered as the reference standard method. Therefore, this review summarizes the attributes of existing non-invasive solutions. These attributes are finalized as brief details, accuracy, optimal benefits, and research challenges for exploring potential gaps, advancements and possibilities to consider as futuristic alternative methodologies. Non-invasive total haemoglobin assessing techniques are mainly based on optical spectroscopy (reflectance/transmittance) or digital photography or spectroscopic imaging in spot check/continuous monitoring mode. In all these techniques, we have noticed that there is a need to consider different light conditions, motion artefacts, melanocytes, other blood constituents, smoking and precise fixing of the sensor from the sensing spot for exact formulation. Moreover, based on careful and critical analysis of outcomes, none of these techniques or products is used independently or intended to replace invasive laboratory testing. Therefore there is a requirement for a more accurate technique that can eliminate the requirement of blood samples and likely end up as a reference standard method.
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Affiliation(s)
- Yogesh Kumar
- Biomedical Instrumentation, CSIR Central Scientific Instruments Organisation, ., Chandigarh, 160030, INDIA
| | | | - Ajeet Kaushik
- Department of Natural Sciences, Florida Polytechnic University, 4700 Research Way, IST#2018, Lakeland, Florida, 33805, UNITED STATES
| | - Sanjeev Kumar
- Biomedical Instrumentation, CSIR Central Scientific Instruments Organisation, ., Chandigarh, 160020, INDIA
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Kazanasmaz H, Demir M. The Comparison of Hemoglobin Values Measured by Blood and Continuous Non-Invasive Monitoring (SpHb) in Newborn Infants. J Trop Pediatr 2021; 67:5881348. [PMID: 32756982 DOI: 10.1093/tropej/fmaa050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Hemoglobin (Hb) measurement is one of the most commonly used laboratory tests in medical practice. Unnecessary blood sampling, especially in neonatal intensive care units (NICUs), contributes to iatrogenic anemia. Continuous non-invasive monitoring of total Hb (SpHb) was compared with invasive venous blood samples (tHb) in NICU patients. METHODS Three hundred and ten patients were identified in NICU. Non-invasive Hb measurement was performed immediately before venous blood sampling and comparison of invasive with non-invasive values was undertaken. RESULTS There was a strongly positive correlation between SpHb and tHb (r = 0.965, p < 0.001). Bland-Altman analysis was performed in 95% limits of agreement for Hb values measured by both methods. The mean bias between tHb and SpHb measurements was 0.05 g/dl (-1.85 to 1.96). In Passing-Bablok regression analysis, the CUSUM test p value was found to be 0.98 for Hb levels measured by SpHb and tHb; and the difference between the methods was not significant. CONCLUSION In newborns, SpHb method offers reliable Hb values, which are comparable with the more traditional tHb method. Continuous non-invasive monitoring of total Hb may help prevent unnecessary blood sampling and iatrogenic anemia. Further clinical studies are required for the effectiveness of the method in critically ill patients with circulatory disorders.
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Affiliation(s)
- Halil Kazanasmaz
- Department of Pediatrics, Faculty of Medicine, Harran University, Sanliurfa, Turkey
| | - Mahmut Demir
- Department of Pediatrics, Faculty of Medicine, Harran University, Sanliurfa, Turkey
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Kamel MM, Hasanin A, Nawar B, Mostafa M, Jacob VF, Elhadi H, Alsadek W, Elmetwally SA. Evaluation of noninvasive hemoglobin monitoring in children with congenital heart diseases. Paediatr Anaesth 2020; 30:571-576. [PMID: 32160358 DOI: 10.1111/pan.13851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/19/2020] [Accepted: 03/09/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Noninvasive measurement of blood hemoglobin could save time and decrease the risk of anemia and infection. The accuracy of CO-oximetry-derived noninvasive hemoglobin (Sp-Hb) had been evaluated in pediatric population; however, its accuracy in children with congenital heart disease has not been studied till date. We evaluated the accuracy of Sp-Hb in relation to laboratory-measured hemoglobin (Lab-Hb) in children with congenital heart disease. METHODS This prospective observational study included children with congenital heart disease undergoing procedural intervention. Sp-Hb measurements were obtained using Radical-7 Masimo pulse CO-oximeter and were compared against simultaneous Lab-Hb measurements obtained from the arterial line. Children were divided in cyanotic and acyanotic, and separate analysis was performed for each group. The values of both measurements were analyzed using Spearman's correlation coefficient and Bland-Altman analysis. Correlation was performed between Sp-Hb and Lab-Hb bias and each of arterial oxygen saturation and perfusion index. RESULTS One-hundred and eleven pairs of readings were obtained from 65 children. The median (quartiles) age and weight of the children were 1 (1.2-4) years and 11 (8-17) kg, respectively. There was moderate correlation between Lab-Hb and Sp-Hb with a correlation coefficient (95% confidence interval [CI]) of 0.75 (0.63-0.83) in acyanotic children and 0.62 (0.37-0.79) in cyanotic children. The mean bias (95% limits of agreements) was -0.4 g/dL (-2.4 to 1.6 g/dL) and 1 g/dL (-2.7 to 4.6 g/dL) in acyanotic and cyanotic children, respectively. The mean bias between Sp-Hb and Lab-Hb showed a weak negative correlation with oxygen saturation (r [95% CI]): (-0.36 [-0.51--0.18]), and a weak positive correlation with the perfusion index (r [95% CI]): (0.19 [0.01-0.37]). CONCLUSION The large bias and the wide limits of agreement between Sp-Hb and Lab-Hb denote that Masimo-derived Sp-Hb is not accurate in children with congenital heart disease especially in the cyanotic group; the error in Sp-Hb increases when oxygen saturation decreases.
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Affiliation(s)
- Mohamed Maher Kamel
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Hasanin
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Beshoy Nawar
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Maha Mostafa
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Victor F Jacob
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Hany Elhadi
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Wafaa Alsadek
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
| | - Sarah A Elmetwally
- Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt
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Invasive and non-invasive point-of-care testing and point-of-care monitoring of the hemoglobin concentration in human blood – how accurate are the data? BIOMED ENG-BIOMED TE 2019; 64:495-506. [DOI: 10.1515/bmt-2018-0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/11/2018] [Indexed: 11/15/2022]
Abstract
Abstract
In this review, scientific investigations of point-of-care testing (POCT) and point-of-care monitoring (POCM) devices are summarized with regard to the measurement accuracy of the hemoglobin concentration. As a common basis, information according to the Bland and Altman principle [bias, limits of agreement (LOA)] as well as the measurement accuracy and precision are considered, so that the comparability can be mapped. These collected data are subdivided according to the manufacturers, devices and procedures (invasive and non-invasive). A total of 31 devices were identified. A comparability of the scientific investigations in particular was given for 23 devices (18 invasive and five non-invasive measuring devices). In terms of measurement accuracy, there is a clear leap between invasive and non-invasive procedures, while no discernible improvement can be derived in the considered time frame from 2010 to 2018. According to the intended use, strict specifications result from the clinical standards, which are insufficiently met by the systems. More stringent requirements can be derived both in the area of blood donation and in the treatment of patients.
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Accuracy and trending ability of hemoglobin measurement by the Pulse CO-Oximeter during vascular surgery. J Clin Monit Comput 2019; 34:501-508. [DOI: 10.1007/s10877-019-00337-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/06/2019] [Indexed: 12/19/2022]
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Morrison C, Liversedge T, Moss R, Sibson K. Correspondence to: Can noninvasive hemoglobin measurements reduce the need for preoperative venipuncture in pediatric outpatient surgery? Paediatr Anaesth 2018; 28:675. [PMID: 30133921 DOI: 10.1111/pan.13409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Christa Morrison
- Department of Anesthesia, Great Ormond Street Hospital, London, UK
| | - Tim Liversedge
- Department of Anesthesia, Great Ormond Street Hospital, London, UK
| | - Rachel Moss
- Department of Haematology, Great Ormond Street Hospital, London, UK
| | - Keith Sibson
- Department of Haematology, Great Ormond Street Hospital, London, UK
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