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Sahoo KC, Sinha A, Sahoo RK, Suman SS, Bhattacharya D, Pati S. Diagnostic Validation and Feasibility of a Non-invasive Haemoglobin Screening Device (EzeCheck) for 'Anaemia Mukt Bharat' in India. Cureus 2024; 16:e52877. [PMID: 38406104 PMCID: PMC10894012 DOI: 10.7759/cureus.52877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/27/2024] Open
Abstract
Anaemia remains a major public health issue in India despite several efforts. It is crucial to introduce technology-based innovations for the mass screening and early diagnosis of anaemia. Traditional anaemia screening requires drawing blood and laboratory analysis and can be logistically expensive in resource-constrained settings. A non-invasive haemoglobin test for mass screening in such settings is vital which can quickly and efficiently screen large populations. This study validated the haemoglobin estimation between the invasive haematology analyzer and the non-invasive EzeCheck (EzeRx Health Tech Pvt. Ltd., Bhubaneswar, Odisha, India) in the community setting. We conducted a cross-sectional study among 416 urban slum members in Bhubaneswar, India. We used inter-rater reliability (kappa statistic) of haemoglobin estimation between the haematology analyzer and EzeCheck devices. The finding showed a moderate agreement between both devices (kappa=0.4221). Between both devices, 91.59% of the results were with +/-1.5 difference; 43.51%, no difference; 33.65%, less than one difference; and 14.42%, +/-1 to +/-1.5 difference of haemoglobin estimation. There was no significant difference in overall anaemia status estimates between the devices. Mass screening in schools and communities with non-invasive haemoglobin tests can help identify anaemic people for early diagnosis and bring patients for timely treatment, which can be used in remote areas to support 'Anaemia Mukt Bharat'.
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Affiliation(s)
- Krushna Chandra Sahoo
- Public Health, Health Technology Assessment in India, Indian Council of Medical Research (ICMR) - Regional Medical Research Centre (RMRC), Bhubaneswar, IND
| | - Abhinav Sinha
- Public Health, Health Technology Assessment in India, Indian Council of Medical Research (ICMR) - Regional Medical Research Centre (RMRC), Bhubaneswar, IND
| | - Rakesh Kumar Sahoo
- Public Health, Health Technology Assessment in India, Indian Council of Medical Research (ICMR) - Regional Medical Research Centre (RMRC), Bhubaneswar, IND
| | - S Shradha Suman
- Public Health, Health Technology Assessment in India, Indian Council of Medical Research (ICMR) - Regional Medical Research Centre (RMRC), Bhubaneswar, IND
| | - Debdutta Bhattacharya
- Microbiology, Health Technology Assessment in India, Indian Council of Medical Research (ICMR) - Regional Medical Research Centre (RMRC), Bhubaneswar, IND
| | - Sanghamitra Pati
- Public Health, Health Technology Assessment in India, Indian Council of Medical Research (ICMR) - Regional Medical Research Centre (RMRC), Bhubaneswar, IND
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Arai Y, Shoji H, Awata K, Inage E, Ikuse T, Shimizu T. Evaluation of the use of non-invasive hemoglobin measurement in early childhood. Pediatr Res 2023; 93:1036-1040. [PMID: 35906313 DOI: 10.1038/s41390-022-02204-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/02/2022] [Accepted: 06/07/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Iron deficiency anemia in children affects psychomotor development. We compared the accuracy and trend of a non-invasive transcutaneous spectrophotometric estimation of arterial hemoglobin (Hb) concentration (SpHb) by rainbow pulse CO-oximetry technology to the invasive blood Hb concentration measured by an automated clinical analyzer (Hb-Lab). METHODS We measured the SpHb and Hb-Lab in 109 patients aged 1-5 years. Regression analysis was used to evaluate differences between the two methods. The bias, accuracy, precision, and limits of agreement of SpHb compared with Hb-Lab were calculated using the Bland-Altman method. RESULTS Of the 109 enrolled subjects, 102 pairs of the SpHb and Hb-Lab datasets were collected. The average value of measured Hb was 12.9 ± 1.03 (standard deviation [SD]) g/dL for Hb-Lab. A significant correlation was observed between SpHb and Hb-Lab measurements (SpHb = 7.002 + 0.4722 Hb-Lab, correlation coefficient r = 0.548, 95% confidence interval = 0.329-0.615). Bland-Altman analysis showed good visual agreement, with a mean bias between SpHb and Hb-Lab of 0.188 ± 0.919 g/dL (mean ± SD). CONCLUSIONS We concluded that non-invasive Hb measurement is useful for Hb estimation in children and provides new insights as a screening tool for anemia. IMPACT Our results indicated a good correlation between non-invasive transcutaneous spectrophotometric estimation of arterial hemoglobin (Hb) concentration using a finger probe sensor by rainbow pulse CO-oximetry technology and invasive blood Hb concentration. Although previous studies have indicated that in patients with a worse condition, the bias between the two methods was large, this study, which was conducted on children with stable disease, showed a relatively small bias. Further studies using this non-invasive device might help to understand the current status of anemia in Japan and promote iron intake and nutritional management in children.
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Affiliation(s)
- Yoshiteru Arai
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiromichi Shoji
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Kentaro Awata
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Eisuke Inage
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Tamaki Ikuse
- Department of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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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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Mahapatra S, Parker ME, Dave N, Zobrist SC, Shajie Arul D, King A, Betigeri A, Sachdeva R. Micronutrient-fortified rice improves haemoglobin, anaemia prevalence and cognitive performance among schoolchildren in Gujarat, India: a case-control study. Int J Food Sci Nutr 2021; 72:690-703. [PMID: 33427528 DOI: 10.1080/09637486.2020.1855126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Anaemia is a public health problem in India. A case-control, quasi-experimental study was conducted to evaluate the effect of a multiple micronutrient fortified rice intervention among school children (6-12 years) through the midday meal programme in Gujarat, India, over 8 months. The fortified rice provided approximately 10% Recommended Dietary Allowance of iron; 25-33% of vitamin A, thiamine, niacin and vitamin B6; and 100% of folic acid and vitamin B12. Outcomes of interest included haemoglobin concentration, anaemia prevalence, and cognitive performance. Cognitive performance was evaluated using J-PAL-validated Pratham reading and mathematics testing tools. 973 children completed the study (cases n = 484; controls n = 489). The intervention significantly increased mean haemoglobin by 0.4 g/dL (p = 0.001), reduced anaemia prevalence by 10% (p < 0.00001), and improved average cognitive scores by 11.3 points (p < 0.001). Rice fortification can help address anaemia in settings where rice is a staple food.
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Affiliation(s)
- Sudip Mahapatra
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Megan E Parker
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Niraj Dave
- Nielsen India Pvt. Ltd., Gurugram, India
| | - Stephanie C Zobrist
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Danie Shajie Arul
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Allie King
- Maternal, Newborn, Child Health and Nutrition Division, PATH, Seattle, WA, USA
| | - Arvind Betigeri
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
| | - Ruchika Sachdeva
- Maternal, Newborn, Child Health and Nutrition Division, PATH, New Delhi, India
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5
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John B, Jamal A. Efficacy of noninvasive hemoglobin measurement by pulse co-oximetry in neonates. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_89_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Whitehead RD, Mei Z, Mapango C, Jefferds MED. Methods and analyzers for hemoglobin measurement in clinical laboratories and field settings. Ann N Y Acad Sci 2019; 1450:147-171. [PMID: 31162693 DOI: 10.1111/nyas.14124] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/22/2019] [Accepted: 05/02/2019] [Indexed: 01/17/2023]
Abstract
This paper describes and compares methods and analyzers used to measure hemoglobin (Hb) in clinical laboratories and field settings. We conducted a literature review for methods used to measure Hb in clinical laboratories and field settings. We described methods to measure Hb and factors influencing results. Automated hematology analyzer (AHA) was reference for all Hb comparisons using evaluation criteria of ±7% set by College of American Pathologists (CAP) and Clinical Laboratory Improvement Amendments (CLIA). Capillary fingerprick blood usually produces higher Hb concentrations compared with venous blood. Individual drops produced lower concentrations than pooled capillary blood. Compared with the AHA: (1) overall cyanmethemoglobin (1.0-8.0 g/L), WHO Colour Scale (0.5-10.0 g/L), paper-based devices (5.0-7.0 g/L), HemoCue® Hb-201 (1.0-16.0 g/L) and Hb-301 (0.5-6.0 g/L), and Masimo Pronto® (0.3-14.0 g/L) overestimated concentrations; (2) Masimo Radical®-7 both under- and overestimated concentrations (0.3-104.0 g/L); and (3) other methods underestimated concentrations (2.0-16.0 g/L). Most mean concentration comparisons varied less than ±7% of the reference. Hb measurements are influenced by several analytical factors. With few exceptions, mean concentration bias was within ±7%, suggesting acceptable performance. Appropriate, high-quality methods in all settings are necessary to ensure the accuracy of Hb measurements.This paper describes and compares methods and analyzers used to measure hemoglobin (Hb) in clinical laboratories and field settings. With few exceptions, mean concentration bias was within ±7%, suggesting acceptable performance. Appropriate, high-quality methods in all settings are necessary to ensure the accuracy of Hb measurements.
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Affiliation(s)
- Ralph D Whitehead
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zuguo Mei
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carine Mapango
- Division of Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maria Elena D Jefferds
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Amano I, Murakami A. Prevalence of infant and maternal anemia during the lactation period in Japan. Pediatr Int 2019; 61:495-503. [PMID: 30895654 DOI: 10.1111/ped.13833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 01/22/2019] [Accepted: 03/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND The perinatal period is associated with a high risk of infant anemia. The aim of the present study was to determine the prevalence of infant and maternal anemia during the late lactation period and the risk factors for anemia in Japan. METHODS This retrospective cohort study was based on data from health checkups of healthy infants at 6-7 and 9-10 months of age and their mothers who visited Akitsu Children's Clinic between September 2013 and August 2015. Complete blood count data from infant blood samples obtained at 6-7 months and 9-10 months and from maternal blood samples obtained at 6-7 months, information on feeding methods, and other related parameters were analyzed. RESULTS Data from 388 mother-infant pairs were analyzed. The prevalence of infant anemia was 21.1% at 6-7 months and 29.1% at 9-10 months. The prevalence of anemia in exclusively breast-fed infants was 28.4% at 6-7 months and 40.0% at 9-10 months. The risk factors for infant anemia at 9-10 months were exclusive breast-feeding, lower gestational age at birth, male sex, and high weight gain. The prevalence of maternal anemia was 10.5%. There was no correlation between infant and maternal hemoglobin in exclusively breast-fed infants. CONCLUSIONS Japanese infants who were breast-fed exclusively had a high prevalence of anemia. A nationwide strategy to prevent anemia is required to prevent infant anemia, even in a nutrition-rich country such as Japan.
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Affiliation(s)
- Izuki Amano
- Akitsu Children's Clinic, Higashimurayama, Tokyo, Japan
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8
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Zeng R, Svensen CH, Li H, Xu X, Skoog Svanberg A, Liu H, Li Y, Shangguan W, Lian Q. Can noninvasive hemoglobin measurement reduce the need for preoperative venipuncture in pediatric outpatient surgery? Paediatr Anaesth 2017; 27:1131-1135. [PMID: 28940988 DOI: 10.1111/pan.13229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Noninvasive measurements of hemoglobin in the pediatric perioperative setting could be helpful to avoid venipunctures in children. The present study aims to evaluate this by using a noninvasive device for hemoglobin determination. We compared noninvasively obtained hemoglobin with laboratory hemoglobin concentrations in children during their preoperative assessment. METHODS In an observational study, 122 nonanemic children (age 4.2 ± 1.6 years) who were scheduled to undergo different surgical procedures under general anesthesia were included. In their preoperative preparations, single invasive blood samples for laboratory hemoglobin concentrations were routinely taken following hospital policy and compared to simultaneous noninvasive determinations of hemoglobin. A preoperative invasive value ≤9 g/dL would have caused cancelation of surgery and implied further investigations. RESULTS A Bland-Altman plot showed that the average difference between noninvasively obtained hemoglobin and laboratory hemoglobin concentration was -0.44 g/dL (bias) with a standard deviation of the mean bias of 1.04 g/dL. A hemoglobin error grid showed that the noninvasive device could identify almost all invasive hemoglobin values >9 g/dL. In total, there were 4 false-positive values where noninvasively obtained hemoglobin observations were below while the paired invasive values were above 9 g/dL. CONCLUSION The data in this pediatric setting suggest that the device may eliminate the need for venipuncture in nonanemic children.
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Affiliation(s)
- Ruifeng Zeng
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Christer H Svensen
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.,Department of Clinical Science and Education, Section of Anesthesiology and Intensive Care, Karolinska Institutet, Stockholm, Sweden.,Department of Anesthesiology, University of Texas Medical Branch, UTMB Health, Galveston, TX, USA
| | - Husong Li
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China.,Department of Anesthesiology, University of Texas Medical Branch, UTMB Health, Galveston, TX, USA
| | - Ximou Xu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | | | - Huacheng Liu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yanrong Li
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Wangning Shangguan
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qingquan Lian
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
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9
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Modesto i Alapont V. Buena ciencia. Med Intensiva 2017; 41:327-329. [DOI: 10.1016/j.medin.2016.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 10/24/2016] [Accepted: 10/26/2016] [Indexed: 11/28/2022]
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10
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A System for Non-invasive Assessment of Blood Hemoglobin Level in Screening Tests. BIOMEDICAL ENGINEERING 2017. [DOI: 10.1007/s10527-017-9691-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Shamah Levy T, Méndez-Gómez-Humarán I, Morales Ruán MDC, Martinez Tapia B, Villalpando Hernández S, Hernández Ávila M. Validation of Masimo Pronto 7 and HemoCue 201 for hemoglobin determination in children from 1 to 5 years of age. PLoS One 2017; 12:e0170990. [PMID: 28170445 PMCID: PMC5295714 DOI: 10.1371/journal.pone.0170990] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 01/14/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the accuracy and precision of HemoCue 201 (HemoCue) and Masimo Pronto 7 (Masimo) devices for measuring hemoglobin (Hb) in epidemiological studies, having venous blood samples as a gold standard. MATERIAL AND METHODS We measured Hb concentrations in a field sample of 148 children from one to five years of age. Masimo and HemoCue were used for capillary blood samples and an automatic analyzer for venous blood samples. Regression models with no intercept were constructed to measure precision and predictability, concordance correlations to measure accuracy and precision, and Bland-Altman limits of agreement as well as hierarchical linear models to estimate variance. RESULTS Both HemoCue and Masimo underestimated Hb concentrations compared to the gold standard. They respectively yielded the following results: regression coefficients of 0.887 and 0.876 with 98.7% and 98.6% predictability; concordance correlation coefficients of 0.183 (p<0.001) and 0.166 (p<0.001); and Bland-Altman variances of -1.51 and -1.62. With regard to Masimo specifically, the three-level Hierarchical Linear Model showed that 57.9% of total variance stemmed from random errors in repeated measures from the same subject. CONCLUSIONS HemoCue and Masimo measure lower Hb concentrations than the gold standard. Their accuracy and precision levels are comparable. It is essential to ensure proper use of devices through enhanced training of field workers.
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García-Soler P, Camacho Alonso JM, González-Gómez JM, Milano-Manso G. Noninvasive hemoglobin monitoring in critically ill pediatric patients at risk of bleeding. Med Intensiva 2016; 41:209-215. [PMID: 28034464 DOI: 10.1016/j.medin.2016.06.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/10/2016] [Accepted: 06/28/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the accuracy and usefulness of noninvasive continuous hemoglobin (Hb) monitoring in critically ill patients at risk of bleeding. DESIGN An observational prospective study was made, comparing core laboratory Hb measurement (LabHb) as the gold standard versus transcutaneous hemoglobin monitoring (SpHb). SETTING Pediatric Intensive Care Unit of a tertiary University Hospital. PATIENTS Patients weighing >3kg at risk of bleeding. INTERVENTIONS SpHb was measured using the Radical7 pulse co-oximeter (Masimo Corp., Irvine, CA, USA) each time a blood sample was drawn for core laboratory analysis (Siemens ADVIA 2120i). VARIABLES Sociodemographic characteristics, perfusion index (PI), pleth variability index, heart rate, SaO2, rectal temperature, low signal quality and other events that can interfere with measurement. RESULTS A total of 284 measurements were made (80 patients). Mean LabHb was 11.7±2.05g/dl. Mean SpHb was 12.32±2g/dl (Pearson 0.72, R2 0.52). The intra-class correlation coefficient was 0.69 (95%CI 0.55-0.78)(p<0.001). Bland-Altman analysis showed a mean difference of 0.07 ±1.46g/dl. A lower PI and higher temperature independently increased the risk of low signal quality (OR 0.531 [95%CI 0.32-0.88] and 0.529 [95%CI 0.33-0.85], respectively). CONCLUSIONS SpHb shows a good overall correlation to LabHb, though with wide limits of agreement. Its main advantage is continuous monitoring of patients at risk of bleeding. The reliability of the method is limited in cases with poor peripheral perfusion.
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Affiliation(s)
- P García-Soler
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario, Málaga, España.
| | - J M Camacho Alonso
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario, Málaga, España
| | - J M González-Gómez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario, Málaga, España
| | - G Milano-Manso
- Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Universitario, Málaga, España
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Paksu S, Paksu MS, Ozdemir S, Karli A, Acikgoz M, Sezgin U, Murat N. Reliability of spot-check transcutaneous hemoglobin measurement in children. Pediatr Int 2016; 58:1136-1139. [PMID: 27031285 DOI: 10.1111/ped.12994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/10/2016] [Accepted: 03/22/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study investigated the correlation between spot-check transcutaneous hemoglobin (Hb) and simultaneously measured venous Hb in children. METHODS Two hundred and seventeen children weighing 10-30 kg in whom complete blood count had been obtained for any reason were enrolled in this study. Demographic characteristics and vital signs were recorded. Prior to taking blood samples, transcutaneous Hb, heart rate, oxygen saturation, and perfusion index were measured using a probe connected to the subject's thumb. To determine the reliability of the transcutaneous measurement versus venous blood measurement performed via an autoanalyzer device, interclass correlation coefficient (ICC) was calculated. The correlation between the two measurements was evaluated on Bland-Altman analysis. RESULTS A total of 59.4% of the patients were boys. The average age was 53 months (range, 6-132 months). Average bodyweight was 16 kg (range, 10-25 kg). Mean venous Hb, hematocrit, and transcutaneous Hb were 11.94 ± 1.15 g/dL, 35.8 ± 3.2%, and 12.42 ± 1.24 g/dL, respectively. The ICC for the reliability of the transcutaneous measurements versus venous blood measurements was r = 0.67 (95%CI: 0.5776-0.7526). The correlation between the two sets of measurements was good, as evaluated by the Bland-Altman analysis. CONCLUSION There is good correlation between transcutaneous and venous blood measurements of Hb. In the future, transcutaneous measurement, as a non-invasive method, may be an alternative for the measurement of Hb in childhood.
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Affiliation(s)
- Sule Paksu
- Department of Pediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Muhammet Sukru Paksu
- Department of Pediatric Intensive Care Unit, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Sadriye Ozdemir
- Department of Pediatrics, Dr Vefa Tanir Ilgin State Hospital, Konya, Turkey
| | - Arzu Karli
- Department of Pediatric Infection Disease, Mehmet Aydin Training and Research Hospital, Samsun, Turkey
| | - Mehmet Acikgoz
- Department of Pediatric Emergency, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Ugur Sezgin
- Department of Pediatrics, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Naci Murat
- Department of Industrial Engineering, Faculty of Engineering, Ondokuz Mayis University, Samsun, Turkey
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14
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Riess ML, Pagel PS. Noninvasively Measured Hemoglobin Concentration Reflects Arterial Hemoglobin Concentration Before but Not After Cardiopulmonary Bypass in Patients Undergoing Coronary Artery or Valve Surgery. J Cardiothorac Vasc Anesth 2016; 30:1167-71. [PMID: 27475734 DOI: 10.1053/j.jvca.2016.03.148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study compared noninvasively measured hemoglobin and arterial hemoglobin before and after cardiopulmonary bypass in patients undergoing coronary artery or valve surgery. DESIGN Observational study with retrospective data analysis. SETTING Veterans Affairs hospital. PARTICIPANTS Thirty-five men. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Hemoglobin values were measured noninvasively by co-oximetry to corresponding arterial hemoglobin concentrations taken at clinically relevant time points chosen at the discretion of the cardiac anesthesiologist. Thirty-five and 27 pooled pairs of data were obtained before and after cardiopulmonary bypass, respectively. Arterial hemoglobin concentration was analyzed using i-STAT CG8+test cartridges routinely used in the authors' operating rooms and those of other institutions. Linear regression and Bland-Altman analysis revealed a significant positive bias, wide limits of agreement, and low correlation coefficients between the noninvasive and arterial hemoglobin measurements. These findings were especially notable after compared with before cardiopulmonary bypass. CONCLUSIONS The results suggested that noninvasive measurement of hemoglobin overestimates arterial hemoglobin by almost 1 g/dL when compared to iSTAT. A lack of precision also was observed with noninvasive measurement of hemoglobin, especially after cardiopulmonary bypass. These findings supported the contention that sole reliance on noninvasive measurement of hemoglobin for transfusion decisions in cardiac surgery patients may be inappropriate.
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Affiliation(s)
- Matthias L Riess
- Departments of Anesthesiology and Pharmacology, Vanderbilt University Medical Center, Nashville, TN; TVHS VA Medical Center, Nashville, TN.
| | - Paul S Pagel
- Clement J. Zablocki VA Medical Center, Milwaukee, WI
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Bhat A, Upadhyay A, Jaiswal V, Chawla D, Singh D, Kumar M, Yadav CP. Validity of non-invasive point-of-care hemoglobin estimation in healthy and sick children-a method comparison study. Eur J Pediatr 2016; 175:171-9. [PMID: 26286814 DOI: 10.1007/s00431-015-2602-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 07/15/2015] [Accepted: 07/20/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED This study was conducted at a tertiary care center in northern India to evaluate the validity of non-invasive transcutaneous hemoglobin estimation in healthy and sick children in comparison to hemoglobin estimation by traditional lab method. A method comparison study was conducted including 150 subjects. Enrolled patients included 80 neonates with average age of 3.9 ± 2.1 days, and 70 children with average age of 5.8 ± 2 years. Each population (newborn and children) comprised of almost equal numbers of healthy and critically ill patients with shock. Hemoglobin (Hb) was estimated on enrolment by transcutaneous spectrophotometry (SpHb) and traditional automated lab analyzer (Hb-Lab). Difference between Hb levels by the two methods (called bias) was measured and analyzed using Bland-Altman method. Out of 148 data pairs analyzed, bias between SpHb and Hb-Lab was -1.52 ± 1.91 g/dl (mean ± SD). SpHb showed excellent positive correlation with Hb-Lab (r = 0.94 (p < 0.001)) and good visual agreement on Bland-Altman plots. Bias was higher in sick subjects with shock as compared to healthy ones in both neonatal and pediatric population (-2.31 ± 2.21 g/dl versus -0.77 ± 1.2 g/dl, respectively). CONCLUSIONS SpHb showed good accuracy and correlated well with lab estimated Hb levels in healthy children. However, in children with impaired peripheral perfusion, its diagnostic accuracy was inadequate to justify routine use for quantification of severity of anemia and making transfusion decisions solely on non-invasive estimation of hemoglobin. WHAT IS KNOWN Non-invasive hemoglobin estimation is a relatively new and novel method which has given mixed results regarding its potential efficacy in adults. There is limited data regarding usefulness and accuracy of non-invasive Hb estimation by SpHb in sick neonates and children. WHAT IS NEW Non-invasive Hb estimation by SpHb monitor is reasonably accurate in healthy neonates and children. It can be used in critically ill children and neonates, but in conjunction with lab confirmation of Hb values.
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Affiliation(s)
- Aditya Bhat
- Department of Paediatrics, LLRM Medical College, Meerut, Uttar, Pradesh, 250002, India.
| | - Amit Upadhyay
- Department of Paediatrics, LLRM Medical College, Meerut, Uttar, Pradesh, 250002, India.
| | - Vijay Jaiswal
- Department of Paediatrics, LLRM Medical College, Meerut, Uttar, Pradesh, 250002, India.
| | - Deepak Chawla
- Department of Paediatrics, Government Medical College, Chandigarh, India.
| | - Dharamveer Singh
- Department of Paediatrics, LLRM Medical College, Meerut, Uttar, Pradesh, 250002, India.
| | - Mithilesh Kumar
- Department of Paediatrics, LLRM Medical College, Meerut, Uttar, Pradesh, 250002, India.
| | - C P Yadav
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
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Evaluation of a Noninvasive Hemoglobin Measurement Device to Screen for Anemia in Infancy. Matern Child Health J 2015; 20:827-32. [DOI: 10.1007/s10995-015-1913-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
PURPOSE OF REVIEW Determination of hemoglobin (Hb) concentration is essential for the detection of anemia and hemorrhage and is widely used to evaluate a patient for a possible blood transfusion. Although commonly accepted as intrinsic to the process, traditional laboratory measurements of Hb are invasive, intermittent, and time-consuming. Noninvasive Hb (NIHb)-monitoring devices have recently become available and promise the potential for detecting sudden changes in a patient's Hb level. In addition to reduced delays in clinical intervention, these devices also allow for a reduction in patient discomfort, infection risk, required personnel, and long-term costs. Unfortunately, it has been shown that many clinical factors can influence their accuracy. RECENT FINDINGS Many studies have been published on the accuracy and precision of NIHb-monitoring devices in various clinical settings. A recent meta-analysis has shown a small mean difference but wide limits of agreement between NIHb and laboratory measurements, indicating that caution should be used by physicians when making clinical decisions based on this device. SUMMARY NIHb measurements may currently be considered to be a supplemental tool for monitoring trends in Hb concentration, but are not currently developed enough to replace an invasive approach. Moreover, further studies are still required before implementing NIHb in the clinical decision-making process. Specifically, no studies have demonstrated that this technology improves clinical outcomes or patient safety.
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Wittenmeier E, Bellosevich S, Mauff S, Schmidtmann I, Eli M, Pestel G, Noppens RR. Comparison of the gold standard of hemoglobin measurement with the clinical standard (BGA) and noninvasive hemoglobin measurement (SpHb) in small children: a prospective diagnostic observational study. Paediatr Anaesth 2015; 25:1046-53. [PMID: 26179143 DOI: 10.1111/pan.12683] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/10/2015] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Collecting a blood sample is usually necessary to measure hemoglobin levels in children. Especially in small children, noninvasively measuring the hemoglobin level could be extraordinarily helpful, but its precision and accuracy in the clinical environment remain unclear. In this study, noninvasive hemoglobin measurement and blood gas analysis were compared to hemoglobin measurement in a clinical laboratory. METHODS In 60 healthy preoperative children (0.2-7.6 years old), hemoglobin was measured using a noninvasive method (SpHb; Radical-7 Pulse Co-Oximeter), a blood gas analyzer (clinical standard, BGAHb; ABL 800 Flex), and a laboratory hematology analyzer (reference method, labHb; Siemens Advia). Agreement between the results was assessed by Bland-Altman analysis and by determining the percentage of outliers. RESULTS Sixty SpHb measurements, 60 labHb measurements, and 59 BGAHb measurements were evaluated. In 38% of the children, the location of the SpHb sensor had to be changed more than twice for the signal quality to be sufficient. The bias/limits of agreement between SpHb and labHb were -0.65/-3.4 to 2.1 g·dl(-1) . Forty-four percent of the SpHb values differed from the reference value by more than 1 g·dl(-1) . Age, difficulty of measurement, and the perfusion index (PI) had no influence on the accuracy of SpHb. The bias/limits of agreement between BGAHb and labHb were 1.14/-1.6 to 3.9 g·dl(-1) . Furthermore, 66% of the BGAHb values differed from the reference values by more than 1 g·dl(-1) . The absolute mean difference between SpHb and labHb (1.1 g·dl(-1) ) was smaller than the absolute mean difference between BGAHb and labHb (1.5 g·dl(-1) /P = 0.024). CONCLUSION Noninvasive measurement of hemoglobin agrees more with the reference method than the measurement of hemoglobin using a blood gas analyzer. However, both methods can show clinically relevant differences from the reference method (ClinicalTrials.gov: NCT01693016).
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Affiliation(s)
- Eva Wittenmeier
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Sophia Bellosevich
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Susanne Mauff
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Irene Schmidtmann
- Biostatistician Institute of Medical Biostatistics, Epidemiology and Informatics, Medical Centre of the Johannes Gutenberg-University, Mainz, Germany
| | - Michael Eli
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Gunther Pestel
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
| | - Ruediger R Noppens
- Department of Anesthesiology, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany
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Hiscock R, Kumar D, Simmons SW. Systematic Review and Meta-Analysis of Method Comparison Studies of Masimo Pulse Co-Oximeters (Radical-7™ or Pronto-7™) and HemoCue® Absorption Spectrometers (B-Hemoglobin or 201+) with Laboratory Haemoglobin Estimation. Anaesth Intensive Care 2015; 43:341-50. [DOI: 10.1177/0310057x1504300310] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed agreement in haemoglobin measurement between Masimo pulse co-oximeters (Rad-7™ and Pronto-7™) and HemoCue® photometers (201+ or B-Hemoglobin) with laboratory-based determination and identified 39 relevant studies (2915 patients in Masimo group and 3084 patients in HemoCue group). In the Masimo group, the overall mean difference was -0.03 g/dl (95% prediction interval -0.30 to 0.23) and 95% limits of agreement -3.0 to 2.9 g/dl compared to 0.08 g/dl (95% prediction interval -0.04 to 0.20) and 95% limits of agreement -1.3 to 1.4 g/dl in the HemoCue group. Only B-Hemoglobin exhibited bias (0.53, 95% prediction interval 0.27 to 0.78). The overall standard deviation of difference was larger (1.42 g/dl versus 0.64 g/dl) for Masimo pulse co-oximeters compared to HemoCue photometers. Masimo devices and HemoCue 201+ both provide an unbiased, pooled estimate of laboratory haemoglobin. However, Masimo devices have lower precision and wider 95% limits of agreement than HemoCue devices. Clinicians should carefully consider these limits of agreement before basing transfusion or other clinical decisions on these point-of-care measurements alone.
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Affiliation(s)
- R. Hiscock
- Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Victoria
| | - D. Kumar
- Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Victoria
| | - S. W. Simmons
- Department of Anaesthesia, Mercy Hospital for Women, Heidelberg, Department of Pharmacology, University of Melbourne, Victoria
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Amano I, Murakami A. Reply to "Screening for anemia: is this ready for prime time?". Pediatr Int 2014; 56:655. [PMID: 25252063 DOI: 10.1111/ped.12388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 05/14/2014] [Indexed: 11/30/2022]
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Rice MJ, Gravenstein N, Morey TE. Screening for anemia: is this ready for prime time? Pediatr Int 2014; 56:438. [PMID: 24894936 DOI: 10.1111/ped.12358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 03/26/2014] [Indexed: 11/27/2022]
Affiliation(s)
- Mark J Rice
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, Florida, USA
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