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Karakochuk CD, Dary O, Flores-Urrutia MC, Garcia-Casal MN, Hayashi C, Jefferds MED, Johnston R, Larson LM, Mapango C, Mazariegos Cordero DI, Moorthy D, Namaste S, Rogers LM, Saha K, Wuehler S. Emerging Evidence and Critical Issues with the Use of Single-Drop Capillary Blood for the Measurement of Hemoglobin Concentration in Population-Level Anemia Surveys. Adv Nutr 2024:100290. [PMID: 39151753 DOI: 10.1016/j.advnut.2024.100290] [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: 05/10/2024] [Revised: 08/01/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024] Open
Abstract
Accurate and precise measurement of hemoglobin concentration is critical for reliable estimations of anemia prevalence at the population level. When systematic and/or random error are introduced in hemoglobin measurement, estimates of anemia prevalence might be significantly erroneous and, hence, limit their usefulness. For decades, single-drop capillary blood has been the most common blood source used for the measurement of hemoglobin concentration in surveys, especially in low-income and middle-income countries. In this study, we highlight historical and emerging evidence that single-drop capillary blood introduces a high degree of random error (variability) to hemoglobin estimates, leading to less reliable estimates of anemia prevalence at the population level. At present, the best practice is to collect and use venous blood for measurement of hemoglobin with an automated hematology analyzer, following standard operating procedures and quality assurance measures. Where use of an automated analyzer is not possible, the analysis of venous blood in a point-of-care hemoglobinometer by trained phlebotomists or specimen collectors should be considered. A forthcoming systematic review will provide additional evidence on the accuracy and precision of single-drop capillary blood for hemoglobin assessment. In the meantime, we raise caution when using single-drop capillary blood for hemoglobin measurement as it can result in inaccurate hemoglobin estimates and less reliable anemia prevalence estimates.
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Affiliation(s)
- Crystal D Karakochuk
- Food, Nutrition and Health, Faculty of Land and Food Systems, The University of British Columbia, Vancouver, Canada
| | - Omar Dary
- USAID, Bureau for Global Health, Maternal and Child Health and Nutrition Office, Washington, DC, United States
| | | | | | - Chika Hayashi
- United Nations Children's Fund, New York, NY, United States
| | | | | | - Leila M Larson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Carine Mapango
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dora I Mazariegos Cordero
- Nutrition and Micronutrient Department, Institute of Nutrition of Central America and Panamá, Guatemala City, Guatemala
| | - Denish Moorthy
- Project USAID Advancing Nutrition, John Snow, Arlington, TX, United States
| | - Sorrel Namaste
- The Demographic and Health Surveys Program, ICF, Rockville, MD, United States
| | - Lisa M Rogers
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Kuntal Saha
- Department of Nutrition and Food Safety, World Health Organization, Geneva, Switzerland
| | - Sara Wuehler
- Nutrition International, Ottawa, Ontario, Canada.
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Das Mahapatra PP, Kumar Mohakud N, Roy C, Rajagopal H, Sharma S. Non-invasive Hemoglobin Screening for Detection of Postpartum Anemia. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:565-571. [PMID: 39206019 PMCID: PMC11347867 DOI: 10.1089/whr.2024.0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 09/04/2024]
Abstract
Introduction Postpartum period is a critical period for a woman, where the body of the woman is in healing stage. In this situation, there arises the risk for developing anemia, if proper diet is not maintained. So, it is necessary to routinely determine the hemoglobin levels during this period to avoid chances of developing anemia and assist in early diagnosis. Methodology A cross-sectional study was carried out at the maternity ward of Kalinga Institute of Medical Sciences Hospital, Bhubaneswar. The study was conducted for a period of 5-6 months by received approval from the concerned institutional committee. The study involved women participants having age above 18 years and who had recently undergone delivery. Written informed consent was taken from all the participants prior to their enrolment for this study. Results A total of 670 women were involved in this study and more than 50% of the women were found to be affected by anemia. A Pearson's correlation of 0.87 was observed with sensitivity of 95.69% and specificity of 67.06% between the hematology analyzer and non-invasive EzeCheck device in determining anemia. Conclusion Women often neglect their health situations and always prioritize their family's wellbeing and health over their own. This avoidance results in the development of a chronic disease which in the long run becomes difficult to be cured. So, in such situations, it is necessary to inculcate certain routine tests for the women during their healing period (such as postpartum stage) to keep an eye on their health status. Use of non-invasive devices can help in achieving this in a painless and much effective manner with instant reporting of the results.
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Affiliation(s)
| | | | - Chaitali Roy
- EzeRx Health Tech Private Limited, Bhubaneswar, India
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Das Mahapatra PP, Roy C, Agarwal K, Banerjee J, Sharma S. Performance of the non-invasive point-of-care device, EzeCheck, for haemoglobin assessment in adults and children in community and institutional care settings. PLOS DIGITAL HEALTH 2024; 3:e0000500. [PMID: 38717987 PMCID: PMC11078411 DOI: 10.1371/journal.pdig.0000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 03/31/2024] [Indexed: 05/12/2024]
Abstract
Anaemia is a major public health problem, especially in resource constrained settings. Dependency on assessment of blood hemoglobin (Hgb) concentration impedes anemia detection, risk stratification and intervention. Thus, valid, frugal and scalable technologies are needed. EzeCheck is a noninvasive portable device developed in India for predicting hemoglobin levels in human beings aged 4 years and above using a finger-tip biosensor. In this assessment, we aimed to: (i) evaluate EzeCheck's performance with an automated whole blood hemato-analyzer (Sysmex XN 1000) as the gold standard, and (ii) estimate EzeCheck's agreement with Sahli's method and HemoCue (Hb-301) in real-world primary and higher care facilities. Paired assessments were done at five sites across India i.e., Bhubaneshwar, Shimla, Solan and Mashobra and Ulhasnagar. Participants across all age groups (4 years and above) were assessed. We used a range of statistical tests to evaluate the performance of EzeCheck. It was found that EzeCheck performed well across age and gender categories with convincing validity, concordance, precision and accuracy, and acceptable bias. While comparing EzeCheck with Hemato-analyzer, no statistically significant systematic bias was found. However, EzeCheck showed significant systematic bias when compared to Sahli's method and HemoCue. We concluded that EzeCheck could detect anemia (as per WHO Hgb cut-offs) in 'real-world settings' and 'across age and gender categories', with high sensitivity, specificity and accuracy, and can serve as a replacement to traditional methods of hemoglobin assessment. Further, for countries with higher prevalence of anemia where universal screening may be mandated, the positive predictive value of EzeCheck will be higher. The likelihood ratios also indicated that the device had moderate-to-good utility. EzeCheck is suitable for embedment into program and out-patient health care settings in resource constrained contexts as a spot-check hemoglobinometer.
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Affiliation(s)
| | - Chaitali Roy
- EzeRx Health Tech Pvt. Ltd, Bhubaneswar, Odisha, India
| | - Komal Agarwal
- EzeRx Health Tech Pvt. Ltd, Bhubaneswar, Odisha, India
| | - Joy Banerjee
- EzeRx Health Tech Pvt. Ltd, Bhubaneswar, Odisha, India
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Williams AM, Brown KH, Allen LH, Dary O, Moorthy D, Suchdev PS. Improving Anemia Assessment in Clinical and Public Health Settings. J Nutr 2023; 153 Suppl 1:S29-S41. [PMID: 37778891 PMCID: PMC11002965 DOI: 10.1016/j.tjnut.2023.05.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/28/2023] [Accepted: 05/10/2023] [Indexed: 10/03/2023] Open
Abstract
We aim to provide a practical approach to assess anemia and its primary causes, both in clinical settings and in the context of public health programs. Anemia remains a global challenge; thus, to achieve goals for anemia reduction and assess progress, standardized approaches are required for the assessment of anemia and its causes. We first provide a brief review of how to assess anemia, based on hemoglobin concentrations and cutoffs that correspond to age, sex, and physiologic status. Next, we discuss how to assess the likely causes of anemia in different settings. The causes of anemia are classified as non-nutritional (for example, because of infection, inflammation, blood loss, or genetic disorders) or nutrition-specific (for example, because of deficiencies of iron, vitamin A, riboflavin, vitamin B12, or folate). There is an important overlap between these 2 categories, such as the increased likelihood of iron deficiency in the context of inflammation. Given the multifaceted nature of anemia etiology, we introduce a framework for anemia assessment based on the "ecology of anemia," which recognizes its many overlapping causes. This conceptual framework is meant to inform what data on anemia causes may need to be collected in population surveys. The framework has a supporting table with information on the diagnostic tests, biomarkers and proposed cutoffs, characteristics, and feasibility of collecting the myriad information that can help elucidate the anemia etiology. We also provide examples of how this framework can be applied to interpret the anemia risk factor data from population-based surveys that can inform decisions about context-specific interventions. Finally, we present research gaps and priorities related to anemia assessment.
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Affiliation(s)
- Anne M Williams
- Department of Human Nutrition, University of Otago, Dunedin, New Zealand; Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States; Emory University, Atlanta, GA, United States.
| | - Kenneth H Brown
- Department of Nutrition and Institute for Global Nutrition, University of California, Davis, CA, United States
| | - Lindsay H Allen
- United States Department of Agriculture, Agricultural Research Service Western Human Nutrition Research Center, Davis, CA, United States
| | - Omar Dary
- Division of Nutrition and Environmental Health, Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC, United States
| | | | - Parminder S Suchdev
- Nutrition Branch, Centers for Disease Control and Prevention, Atlanta, GA, United States; Emory University, Atlanta, GA, United States
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Nagari SL, Egata G, Mehadi A, Hassen TA, Raru TB, Abdurke M, Yuya M, Abdulkadir S, Berhanu H, Roba KT. Anemia Among Women Using Family Planning at Public Health Facilities in Ambo Town, Central Ethiopia: Multi-Center Cross-Sectional Study. J Blood Med 2023; 14:83-97. [PMID: 36789372 PMCID: PMC9922510 DOI: 10.2147/jbm.s400191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Background Anemia affects more than a quarter of non-pregnant women over the globe, with Sub-Saharan Africa bearing a disproportionate share. Although the use of family planning is beneficial in reducing anemia, lack of scientific study on anemia among family planning users of reproductive-age women is notable, particularly in the study setting. The purpose of this study was to determine the extent of anemia and associated factors in women who used family planning. Methods A cross-sectional multi-centered study was conducted from March 3 to 29, 2019, among 443 non-pregnant reproductive age (15 to 49 years) women receiving family planning services in Ambo town. Sample size was calculated using Epi-info version 7 software. Participants were selected by systematic random sampling technique. Trained data collectors collected data using a structured pretested questionnaire, as well as venous blood and stool samples. Epi-Data and SPSS were used to enter and analyze data. The effect of independent variables on the outcome variable was determined by binary logistic regression analysis with adjusted odds ratio at 95% confidence interval and 5% margin of error. P-value <0.05 was used to declare statistical significance. Results This study revealed 28% (95% CI:23.9%, 32.3%) magnitude of anemia. Age of 25-35 years [AOR:2.84, 95% CI:1.74, 4.64], implantable family planning method [AOR: 0.34, 95% CI: 0.12, 0.96], no previous use of family planning [AOR:2.62, 95% CI: 1.62, 4.24], household food insecurity [AOR: 2.04, 95% CI: 1.06, 3.93], parasite infestations [AOR:2.01, 95% CI: 1.12, 3.63], and regular intake of coffee/tea within 30 minutes post meal [AOR:3.85, 95% CI:1.24, 11.92] were independently associated with anemia. Conclusion Anemia is a moderate public health concern among reproductive-age women receiving family planning services in the study area. There are missed opportunities to address the anemia burden during family planning services. This study emphasizes the importance of nutritional screening for early detection and targeted interventions for healthcare workers in reducing missed opportunities to prevent and control anemia in vulnerable populations.
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Affiliation(s)
| | - Gudina Egata
- College of Health and Medical Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ame Mehadi
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia,Correspondence: Ame Mehadi, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia, Tel +251919118839, Fax +251256668081, Email
| | - Tahir Ahmed Hassen
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Temam Beshir Raru
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mohammed Abdurke
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mohammed Yuya
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Shemsedin Abdulkadir
- College of Health and Medical Sciences, Arsi University, Asella, Oromia, Ethiopia
| | - Hiwot Berhanu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Kedir Teji Roba
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Ghosh A, Mukherjee J, Chakravorty N. A Low-Cost Test for Anemia Using an Artificial Neural Network. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 229:107251. [PMID: 36473420 DOI: 10.1016/j.cmpb.2022.107251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/02/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Anemia during pregnancy can complicate maternal and neonatal health and even lead to fatal consequences if not diagnosed early on. Around 99% of women who face maternal mortality are from middle or low-income countries. Early screening of anemia could facilitate improved health outcomes in pregnant women. Point of care techniques are preferred due to their ability to provide results rapidly and because they can be used by personnel with minimal or no training. Such techniques are especially useful in resource-constrained settings like rural parts of developing countries. OBJECTIVES The aim of the study was to develop a tool using an Artificial Neural Network (ANN) to estimate hemoglobin values using color information recorded from blood sample images. Our method utilizes inexpensive consumables and a simple image acquisition setup that can be assembled easily. METHODS This study explores a neural network model to estimate the hemoglobin content in an individual's blood sample. Blood samples were collected from 86 volunteers and the images of blood drops were obtained using an image acquisition setup designed by the team. The color intensity values calculated from the blood drop images were used as feature descriptors for the samples. The features obtained from our samples were consequently fed to the Artificial Neural Network. RESULTS Our neural network that gives the best result has the architecture of 11 neurons in each of the 5 layers. The best model gave estimated hemoglobin levels by analyzing color of blood samples with an accuracy of ±1.8 g/dl Limits of agreement (LOA) and bias 0.03 g/dl (with mean error of 0.75 g/dl). The model was subsequently tested with a validation set prepared from an additional 65 samples. The estimated hemoglobin levels gave an accuracy of +2 g/dl to -1.9 g/dl Limits of agreement (LOA) and bias 0.06 g/dl (with mean error of 0.78 g/dl). CONCLUSION Optimization of sensitivity and specificity has been able to achieve the sensitivity and specificity values as 95.5% and 52% respectively. These results are at par with the contemporary measurement techniques indicating that our method can be used as a workable screening technique itself.
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Affiliation(s)
- Archita Ghosh
- School of Medical Science & Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, Pin: 721302, INDIA.
| | - Jayanta Mukherjee
- Department of Computer Science & Engineering, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, Pin: 721302, INDIA.
| | - Nishant Chakravorty
- School of Medical Science & Technology, Indian Institute of Technology Kharagpur, Kharagpur, West Bengal, Pin: 721302, INDIA.
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7
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Konate D, Diawara SI, Sogoba N, Shaffer J, Keita B, Cisse A, Sanogo I, Dicko I, Guindo MDA, Balam S, Traore A, Kante S, Dembele A, Kasse F, Denou L, Diakite SA, Traore K, M'Baye Thiam S, Sanogo V, Toure M, Diarra A, Agak GW, Doumbia S, Diakite M. Effect of a fifth round of seasonal malaria chemoprevention in children aged 5-14 years in Dangassa, an area of long transmission in Mali. Parasite Epidemiol Control 2023; 20:e00283. [PMID: 36704118 PMCID: PMC9871299 DOI: 10.1016/j.parepi.2022.e00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/06/2022] [Accepted: 12/22/2022] [Indexed: 01/03/2023] Open
Abstract
Despite a significant reduction in the burden of malaria in children under five years-old, the efficient implementation of seasonal malaria chemoprevention (SMC) at large scale remains a major concern in areas with long malaria transmission. Low coverage rate in the unattainable areas during the rainy season, a shift in the risk of malaria to older children and the rebound in malaria incidence after stopping drug administration are mainly reported in these areas. These gaps represent a major challenge in the efficient implementation of SMC measures. An open randomized study was conducted to assess the effect of a fifth additional round to current regime of SMC in older children living in Dangassa, a rural malaria endemic area. Poisson regression Model was used to estimate the reduction in malaria incidence in the intervention group compared to the control group including age groups (5-9 and 10-14 years) and the use of long-lasting insecticidal nets (LLINs; Yes or No) with a threshold at 5%. Overall, a downward trend in participation rate was observed from August (94.3%) to November (87.2%). In November (round 4), the risk of malaria incidence was similar in both groups (IRR = 0.66, 95%CI [0.35-1.22]). In December (round 5), a decrease of 51% in malaria incidence was observed in intervention group compared to control group adjusted for age groups and the use of LLINs (IRR = 0.49, 95%CI [0.26-0.94]), of which 17% of reduction is attributable to the 5th round in the intervention group. An additional fifth round of SMC resulted in a significant reduction of malaria incidence in the intervention group. The number of SMC rounds could be adapted to the local condition of malaria transmission.
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Affiliation(s)
- Drissa Konate
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- Corresponding author.
| | - Sory I. Diawara
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Nafomon Sogoba
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Jeff Shaffer
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Bourama Keita
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Abdourhamane Cisse
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Ibrahim Sanogo
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ilo Dicko
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Merepen dite Agnes Guindo
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Saidou Balam
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Abdouramane Traore
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Salimata Kante
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Assitan Dembele
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Fatoumata Kasse
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Larissa Denou
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Seidina A.S. Diakite
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Karim Traore
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Sidibe M'Baye Thiam
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
| | - Vincent Sanogo
- National Malaria Control Program, Ministry of Health, Bamako, Mali
| | - Mahamoudou Toure
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Ayouba Diarra
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - George W. Agak
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Seydou Doumbia
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Mahamadou Diakite
- International Center for Excellence in Research, Faculty of Medicine and Odontostomatology, University of Sciences, Techniques and Technologies of Bamako, Mali
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Aynalem M, Shiferaw E, Adane T, Gelaw Y, Enawgaw B. Anemia in African malnourished pre-school children: A systematic review and meta-analysis. SAGE Open Med 2022; 10:20503121221088433. [PMID: 35371481 PMCID: PMC8968978 DOI: 10.1177/20503121221088433] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 03/02/2022] [Indexed: 11/29/2022] Open
Abstract
Generating accurate epidemiological data on the magnitude of anemia in malnourished children is a vital step for health policymakers. Therefore, this study is aimed to synthesize the overall magnitude of anemia in African malnourished pre-school children. We have searched the databases PubMed/MEDLINE, Embase, Scopus, Web of Science, Google Scholar, and Google to identify relevant articles. Joana Brigg’s Institute critical appraisal tool was used to assess the quality of articles. A random-effects model was applied to estimate the pooled prevalence of anemia in malnourished children. The I2 statistics were used to examine heterogeneity among the included studies. In the presence of heterogeneity, a subgroup analysis has been used. The funnel plot analysis and Egger’s tests were used to investigate the presence of publication bias. A total of 15 articles with 12,211 study participants were included in this study. Anemia was observed in 57.53% (95% CI: 47.05, 68.01) of African malnourished pre-school children. Moreover, the prevalence of anemia was 58.52% (95% CI: 43.04, 73.81) and 56.18% (95% CI: 40.24, 72.13) in HemoCue and auto-machine diagnosis method of anemia, respectively. This review showed that the magnitude of anemia was high among African malnourished pre-school children. Therefore, planning preventive measures to decrease anemia and its complications in malnourished children in Africa is an important step.
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Affiliation(s)
| | | | - Tiruneh Adane
- Tiruneh Adane, Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
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9
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Addo OY, Yu EX, Williams AM, Young MF, Sharma AJ, Mei Z, Kassebaum NJ, Jefferds MED, Suchdev PS. Evaluation of Hemoglobin Cutoff Levels to Define Anemia Among Healthy Individuals. JAMA Netw Open 2021; 4:e2119123. [PMID: 34357395 PMCID: PMC8346941 DOI: 10.1001/jamanetworkopen.2021.19123] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/27/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Anemia, defined as low hemoglobin (Hb) concentration insufficient to meet an individual's physiological needs, is the most common blood condition worldwide. Objective To evaluate the current World Health Organization (WHO) Hb cutoffs for defining anemia among persons who are apparently healthy and to assess threshold validity with a biomarker of tissue iron deficiency and physiological indicator of erythropoiesis (soluble transferrin receptor [sTfR]) using multinational data. Design, Setting, and Participants In this cross-sectional study, data were collected and evaluated from 30 household, population-based nutrition surveys of preschool children aged 6 to 59 months and nonpregnant women aged 15 to 49 years during 2005 to 2016 across 25 countries. Data analysis was performed from March 2020 to April 2021. Exposure Anemia defined according to WHO Hb cutoffs. Main Outcomes and Measures To define the healthy population, persons with iron deficiency (ferritin <12 ng/mL for children or <15 ng/mL for women), vitamin A deficiency (retinol-binding protein or retinol <20.1 μg/dL), inflammation (C-reactive protein >0.5 mg/dL or α-1-acid glycoprotein >1 g/L), or known malaria were excluded. Survey-specific, pooled Hb fifth percentile cutoffs were estimated. Among individuals with Hb and sTfR data, Hb-for-sTfR curve analysis was conducted to identify Hb inflection points that reflect tissue iron deficiency and increased erythropoiesis induced by anemia. Results A total of 79 950 individuals were included in the original surveys. The final healthy sample was 13 445 children (39.9% of the original sample of 33 699 children; 6750 boys [50.2%]; mean [SD] age 32.9 [16.0] months) and 25 880 women (56.0% of the original sample of 46 251 women; mean [SD] age, 31.0 [9.5] years). Survey-specific Hb fifth percentile among children ranged from 7.90 g/dL (95% CI, 7.54-8.26 g/dL in Pakistan) to 11.23 g/dL (95% CI, 11.14-11.33 g/dL in the US), and among women from 8.83 g/dL (95% CI, 7.77-9.88 g/dL in Gujarat, India) to 12.09 g/dL (95% CI, 12.00-12.17 g/dL in the US). Intersurvey variance around the Hb fifth percentile was low (3.5% for women and 3.6% for children). Pooled fifth percentile estimates were 9.65 g/dL (95% CI, 9.26-10.04 g/dL) for children and 10.81 g/dL (95% CI, 10.35-11.27 g/dL) for women. The Hb-for-sTfR curve demonstrated curvilinear associations with sTfR inflection points occurring at Hb of 9.61 g/dL (95% CI, 9.55-9.67 g/dL) among children and 11.01 g/dL (95% CI, 10.95-11.09 g/dL) among women. Conclusions and Relevance Current WHO cutoffs to define anemia are higher than the pooled fifth percentile of Hb among persons who are outwardly healthy and from nearly all survey-specific estimates. The lower proposed Hb cutoffs are statistically significant but also reflect compensatory increased erythropoiesis. More studies based on clinical outcomes could further confirm the validity of these Hb cutoffs for anemia.
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Affiliation(s)
- O. Yaw Addo
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Emma X. Yu
- Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anne M. Williams
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
- McKing Consulting Corporation, Atlanta, Georgia
| | | | - Andrea J. Sharma
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- USPHS Commissioned Corps, Atlanta, Georgia
| | - Zuguo Mei
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Maria Elena D. Jefferds
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Parminder S. Suchdev
- Nutrition Branch, International Micronutrient Malnutrition Prevention and Control Program Unit, Centers for Disease Control and Prevention, Atlanta, Georgia
- Emory University Rollins School of Public Health, Atlanta, Georgia
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10
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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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11
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Rappaport AI, Karakochuk CD, Hess SY, Whitehead RD, Namaste SML, Dary O, Parker ME, Neufeld LM, Larson LM, Newton S, Wegmuller R, Moorthy D. Variability in haemoglobin concentration by measurement tool and blood source: an analysis from seven countries. J Clin Pathol 2020; 74:657-663. [PMID: 33023940 DOI: 10.1136/jclinpath-2020-206717] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE We explore factors such as the blood sampling site (capillary vs venous), the equipment (HemoCue vs automated haematology analyser) and the model of the HemoCue device (201+ vs 301) that may impact haemoglobin measurements in capillary and venous blood. METHODS Eleven studies were identified, and bias, concordance and measures of diagnostic performance were assessed within each study. FINDINGS Our analysis included 11 studies from seven countries (Cambodia, India, The Gambia, Ghana, Laos, Rwanda and USA). Samples came from children, men, non-pregnant women and pregnant women. Mean bias ranged from -8.7 to 2.5 g/L in Cambodian women, 6.2 g/L in Laotian children, 2.4 g/L in Ghanaian women, 0.8 g/L in Gambian children 6-23 months and 1.4 g/L in Rwandan children 6-59 months when comparing capillary blood on a HemoCue to venous blood on a haematology analyser. Bias was 8.3 g/L in Indian non-pregnant women and 2.6 g/L in Laotian children and women and 1.5 g/L in the US population when comparing capillary to venous blood using a HemoCue. For venous blood measured on the HemoCue compared with the automated haematology analyser, bias was 5.3 g/L in Gambian pregnant women 18-45 years and 11.3 g/L in Laotian children 6-59 months. CONCLUSION Our analysis found large variability in haemoglobin concentration measured on capillary or venous blood and using HemoCue Hb 201+ or Hb 301 or automated haematology analyser. We cannot ascertain whether the variation is due to differences in the equipment, differences in capillary and venous blood, or factors affecting blood collection techniques.
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Affiliation(s)
- Aviva I Rappaport
- Strengthening Partnerships, Results, and Innovations in Nutrition Globally (SPRING), Arlington, Virginia, USA.,School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Crystal D Karakochuk
- Food, Nutrition, and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonja Y Hess
- Institute for Global Nutrition, Department of Nutrition, University of California Davis, Davis, California, USA
| | - Ralph D Whitehead
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia, USA
| | - Sorrel M L Namaste
- The Demographic and Health Survey (DHS) Program, ICF, Rockville, Maryland, USA
| | - Omar Dary
- US Agency for International Development (USAID), Bureau of Global Health, Office of Maternal Child Health and Nutrition, Washington, DC, USA
| | - Megan E Parker
- Maternal, Newborn, Child Health and Nutrition, PATH, Seattle, Washington, USA
| | - Lynnette M Neufeld
- Knowledge Leadership, Global Alliance for Improved Nutrition, Geneva, Switzerland
| | - Leila M Larson
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Sam Newton
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Rita Wegmuller
- GroundWork, Fläsch, Switzerland.,Medical Research Council Unit The Gambia, Keneba, The Gambia
| | - Denish Moorthy
- USAID Advancing Nutrition, John Snow Inc. Research and Training Institute, Arlington, Virginia, USA
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12
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Nass SA, Hossain I, Sanyang C, Baldeh B, Pereira DIA. Hemoglobin point-of-care testing in rural Gambia: Comparing accuracy of HemoCue and Aptus with an automated hematology analyzer. PLoS One 2020; 15:e0239931. [PMID: 33002049 PMCID: PMC7529235 DOI: 10.1371/journal.pone.0239931] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 09/15/2020] [Indexed: 11/18/2022] Open
Abstract
Background Anemia is one of the most impactful nutrient deficiencies in the world and disproportionately affects children in low-resource settings. Point-of-care devices (PoCDs) measuring blood hemoglobin (Hb) are widely used in such settings to screen for anemia due to their low cost, speed, and convenience. Here we present the first iteration of Aptus, a new PoCD which measures Hb and hematocrit (HCT). Aim To evaluate the accuracy of Aptus and HemoCue® Hb 301 against an automated hematology analyzer (Medonic®) in Gambian children aged 6–35 months and the Aptus’ usage in the field. Methods Aptus, HemoCue® and Medonic® were compared using venous blood (n = 180), and Aptus and HemoCue® additionally using capillary blood (n = 506). Agreement was estimated using Bland-Altman analysis and Lin’s concordance. Usage was assessed by error occurrence and user experience. Results Mean Hb values in venous blood did not significantly differ between Aptus and HemoCue® (10.44±1.05 vs 10.56±0.93g/dl, p>0.05), but both measured higher Hb concentrations than Medonic® (9.75±0.99g/dl, p<0.0001). Lin’s coefficient between Aptus and Medonic® was rc = 0.548, between HemoCue® and Medonic® rc = 0.636. Mean bias between the PoCDs venous measurements was -0.11g/dl with limits of agreement (LoA) -1.63 and 1.40g/dl. The bias was larger for the comparisons between the Medonic® and both Aptus (0.69g/dl, LoA 0.92 and 2.31g/dl) and HemoCue® (0.81g/dl, LoA 0.17 and 1.78g/dl). ROC curves showed an AUC of 0.933 in HemoCue® and 0.799 in Aptus. Capillary Hb was higher with Aptus than HemoCue® (10.33±1.11g/dl vs 10.01±1.07g/dl, p<0.0001). Mean bias was 0.32g/dl with LoA of -1.91 and 2.54g/dl. Aptus‘ usage proved intuitive, yet time-to-results and cuvettes could be improved. Conclusion Both PoCDs showed a relatively limited bias but large LoA. Aptus and HemoCue® showed similar accuracy, while both overestimated Hb levels. Aptus showed promise, with its operation unimpaired by field conditions as well as being able to show HCT values.
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Affiliation(s)
- Stefan A. Nass
- Medical Humanities, Amsterdam-UMC—VUmc Location, Vrije Universiteit, Amsterdam, The Netherlands
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- * E-mail:
| | - Ilias Hossain
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Chilel Sanyang
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Bakary Baldeh
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
| | - Dora I. A. Pereira
- Medical Research Council Unit, The Gambia at the London School of Hygiene & Tropical Medicine, Banjul, The Gambia
- Department of Pathology, University of Cambridge, Cambridge, United Kingdom
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13
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Neogi SB, Sharma J, Pandey S, Zaidi N, Bhattacharya M, Kar R, Kar SS, Purohit A, Bandyopadhyay S, Saxena R. Diagnostic accuracy of point-of-care devices for detection of anemia in community settings in India. BMC Health Serv Res 2020; 20:468. [PMID: 32456639 PMCID: PMC7249358 DOI: 10.1186/s12913-020-05329-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 05/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background Accurate diagnosis of anemia by community workers using a point-of-care device is a challenge. The objective of the study was to establish the diagnostic accuracy of point-of-care devices for detecting anemia in community settings. Methods It was diagnostic accuracy study with cross-sectional design on adult patients attending the outpatient department of rural/ urban health centres of Medical colleges from India. The index tests were HemoCue, TrueHb, Massimo’s device and spectroscopic device, compared against autoanalyzer (gold standard). Accuracy was expressed by sensitivity, specificity, likelihood ratios, predictive values, area under the curve (AUC) and levels of agreement. For the diagnostic accuracy component, 1407 participants were recruited with a minimum of 600 for each device. An additional 200 participants were considered to elucidate the performance of devices in different weather conditions. Results HemoCue and TrueHb performed better than Massimo and spectroscopic devices. Detection of anemia by technicians was similar between TrueHb and HemoCue (AUC 0.92 v/s 0.90, p > 0.05). Community workers performed better with Hemocue for detecting anemia compared to TrueHb (AUC 0.92 v/s 0.90, p < 0.05). For detection of severe anemia, accuracy of TrueHb was significantly better with technicians (AUC 0.91 v/s 0.70; p < 0.05) and community workers (AUC 0.91 v/s 0.73; p < 0.05). HemoCue showed a bias or mean difference (95%CI) of 0.47 g/dl (0.42, 0.52) for all values, and 0.92 g/dl (0.82, 1.03) for severe anemia. For TrueHb, it was − 0.28 g/dl (− 0.37, − 0.20) for all readings, and 0.06 g/dl (− 0.52, 0.63) for severe anemia. TrueHb appeared to be more consistent across different weather conditions, although it overestimated Hb in extreme cold weather conditions. Conclusion For detection of anemia, True Hb and HemoCue were comparable. For severe anemia, True Hb seemed to be a better and feasible point-of-care device for detecting anemia in the community settings.
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Affiliation(s)
| | - Jyoti Sharma
- Indian Institute of Public Health- Delhi, Delhi NCR, India
| | - Shivam Pandey
- Indian Institute of Public Health- Delhi, Delhi NCR, India
| | - Nausheen Zaidi
- Indian Institute of Public Health- Delhi, Delhi NCR, India
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14
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Parker M, Barrett K, Kahn M, Saul D, Bansil P, Tawiah C, Advani N, Zobrist S, de Los Santos T, Gerth-Guyette E. Potential new tool for anemia screening: An evaluation of the performance and usability of the TrueHb Hemometer. PLoS One 2020; 15:e0230333. [PMID: 32163502 PMCID: PMC7067473 DOI: 10.1371/journal.pone.0230333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 02/26/2020] [Indexed: 11/17/2022] Open
Abstract
In low- and middle-income countries, many women experience anemia during pregnancy due to insufficient dietary intake of key micronutrients, parasitic infections, hemoglobinopathies, and chronic infections. Maternal anemia increases perinatal risks for both mothers and infants, and slow progress to reduce the prevalence may be due in part to the lack of affordable tools to quantify hemoglobin levels in antenatal care (ANC) clinics. A simple, inexpensive, accurate, and robust diagnostic is needed to measure hemoglobin in ANC. This study evaluated the performance and usability of the TrueHb Hemometer. A cross-sectional diagnostic accuracy study was conducted to compare the accuracy of the TrueHb and the HemoCue® 201+ using capillary samples. Next, analytical performance (precision, coefficient of variation, R2) of the TrueHb was evaluated in varying environmental conditions using linearity panels with serial dilutions of venous blood samples. Lastly, the usability of the TrueHb Hemometer was assessed across three domains (effectiveness, efficiency, and satisfaction) by 20 ANC providers in Ghana. Capillary blood test results were not well correlated (R2 = 0.35) between the TrueHB and HemoCue201+, but 80% of TrueHb measurements were within +/-1.0 g/dl of the HemoCue® 201+ hemoglobin values. Precision tests indicated similar mean values across the three environmental conditions (CV<6%). At 21°C, the TrueHb follows a linear relationship (R2≥0.96) but does not generate accurate readings below 4.0 g/dl. At 30°C and 37°C, the TrueHb follows a linear relationship (R2 > 0.90) but begins to underestimate the hemoglobin concentration below 7.0 g/dl. The usability study identified potential failure modes due to inadequate instructions and device feedback. With some modifications, both to the product and to the instructions for use, the TrueHb may be suitable for use in ANC settings to help fill the diagnostic gap for anemia screening during pregnancy. Further testing is required with anemic populations in LMIC settings.
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Affiliation(s)
- Megan Parker
- PATH, Seattle, Washington, United States of America
| | | | - Maria Kahn
- PATH, Seattle, Washington, United States of America
| | | | - Pooja Bansil
- PATH, Seattle, Washington, United States of America
| | - Charlotte Tawiah
- Kintampo Health Research Centre, Kintampo, Brong-Ahafo Region, Ghana
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15
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Braune S, Latour RA, Reinthaler M, Landmesser U, Lendlein A, Jung F. In Vitro Thrombogenicity Testing of Biomaterials. Adv Healthc Mater 2019; 8:e1900527. [PMID: 31612646 DOI: 10.1002/adhm.201900527] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/15/2019] [Indexed: 12/29/2022]
Abstract
The short- and long-term thrombogenicity of implant materials is still unpredictable, which is a significant challenge for the treatment of cardiovascular diseases. A knowledge-based approach for implementing biofunctions in materials requires a detailed understanding of the medical device in the biological system. In particular, the interplay between material and blood components/cells as well as standardized and commonly acknowledged in vitro test methods allowing a reproducible categorization of the material thrombogenicity requires further attention. Here, the status of in vitro thrombogenicity testing methods for biomaterials is reviewed, particularly taking in view the preparation of test materials and references, the selection and characterization of donors and blood samples, the prerequisites for reproducible approaches and applied test systems. Recent joint approaches in finding common standards for a reproducible testing are summarized and perspectives for a more disease oriented in vitro thrombogenicity testing are discussed.
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Affiliation(s)
- Steffen Braune
- Institute of Biomaterial Science and Berlin‐Brandenburg Centre for Regenerative Therapies (BCRT)Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
| | - Robert A. Latour
- Rhodes Engineering Research CenterDepartment of BioengineeringClemson University Clemson SC 29634 USA
| | - Markus Reinthaler
- Institute of Biomaterial Science and Berlin‐Brandenburg Centre for Regenerative Therapies (BCRT)Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
- Department for CardiologyCharité UniversitätsmedizinCampus Benjamin Franklin Hindenburgdamm 30 12203 Berlin Germany
| | - Ulf Landmesser
- Department for CardiologyCharité UniversitätsmedizinCampus Benjamin Franklin Hindenburgdamm 30 12203 Berlin Germany
| | - Andreas Lendlein
- Institute of Biomaterial Science and Berlin‐Brandenburg Centre for Regenerative Therapies (BCRT)Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
- Institute of ChemistryUniversity of Potsdam Karl‐Liebknecht‐Strasse 24‐25 14476 Potsdam Germany
- Helmholtz Virtual Institute “Multifunctional Biomaterials for Medicine”Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
| | - Friedrich Jung
- Institute of Biomaterial Science and Berlin‐Brandenburg Centre for Regenerative Therapies (BCRT)Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
- Helmholtz Virtual Institute “Multifunctional Biomaterials for Medicine”Helmholtz‐Zentrum Geesthacht Kantstrasse 55 14513 Teltow Germany
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16
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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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17
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Karakochuk CD, Hess SY, Moorthy D, Namaste S, Parker ME, Rappaport AI, Wegmüller R, Dary O. Measurement and interpretation of hemoglobin concentration in clinical and field settings: a narrative review. Ann N Y Acad Sci 2019; 1450:126-146. [PMID: 30652320 DOI: 10.1111/nyas.14003] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/16/2018] [Accepted: 12/26/2018] [Indexed: 12/26/2022]
Abstract
Anemia affects over 800 million women and children globally. Defined as a limited or insufficient functional red blood cell supply in peripheral blood, anemia causes a reduced oxygen supply to tissues and can have serious health consequences for women and children. Hemoglobin (Hb) concentration is most commonly measured for anemia diagnosis. Methods to measure Hb are usually invasive (requiring a blood sample); however, advances in diagnostic and clinical chemistry over the past decade have led to the development of new noninvasive methods. Accurate diagnosis at the individual level is important to identify individuals who require treatment. At the population level, anemia prevalence estimates are often the impetus for national nutrition policies or programs. Thus, it is essential that methods for Hb measurement are sensitive, specific, accurate, and reproducible. The objective of our narrative review is to describe the basic principles, advantages, limitations, and quality control issues related to methods of Hb measurement in clinical and field settings. We also discuss other biomarkers and tests that can help to determine the severity and underlying causes of anemia. In conclusion, there are many established and emerging methods to measure Hb concentration, each with their own advantages, limitations, and factors to consider before use.
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Affiliation(s)
- Crystal D Karakochuk
- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sonja Y Hess
- Department of Nutrition, University of California Davis, Davis, California
| | - Denish Moorthy
- USAID-funded Strengthening Partnerships, Results, and Innovation in Nutrition Globally Project, John Snow Inc., Arlington, Virginia
| | | | - Megan E Parker
- Nutrition Innovation, Maternal Newborn and Child Health and Nutrition, PATH, Seattle, Washington
| | - Aviva I Rappaport
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rita Wegmüller
- GroundWork, Fläsch, Switzerland.,Medical Research Council Unit the Gambia, Keneba, the Gambia
| | - Omar Dary
- Nutrition Division, Office of Maternal and Child Health and Nutrition, Bureau for Global Health, United States Agency for International Development, Washington, DC
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- Food, Nutrition and Health, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Adam I, Ibrahim Y, Elhardello O. Prevalence, types and determinants of anemia among pregnant women in Sudan: a systematic review and meta-analysis. BMC HEMATOLOGY 2018; 18:31. [PMID: 30455961 PMCID: PMC6225563 DOI: 10.1186/s12878-018-0124-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023]
Abstract
Background Anemia during pregnancy is a public health problem especially in developing countries and it is associated with maternal and perinatal adverse outcomes. There is no meta-analysis on anemia during pregnancy in Sudan. The current systemic review and meta-analysis was conducted to assess the prevalence, types and determinant of anemia during pregnancy in Sudan. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed. The databases (PubMed, Cochrane Library, Google Scholar, CINAHL, and African Journals Online) were searched using; anemia, pregnancy related anemia and Sudan. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) and Modified Newcastle – Ottawa quality assessment scale were used for critical appraisal of studies. The pooled Meta logistic regression was computed using OpenMeta Analyst software. Results Sixteen cross-sectional studies included a total of 15, 688 pregnant women were analyzed. The pooled prevalence of anemia among pregnant women in Sudan was 53.0% (95%, CI = 45.9–60.1). The meta-analysis showed no statistical significant between the age (mean difference = 0.143, 95 CI = − 0.033 − 0.319, P = 0.112), parity (mean difference = 0.021, 95% CI = − 0.035 − 0.077, P = 0.465) between the anemic and no anemic women. Malaria was investigated in six studies. Pregnant women who had malaria infection during pregnancy were 1.94 times more likely to develop anemia than women who had no malaria infection (OR = 1.94, 95% CI =1.33–2.82). Six (37.5%) studies investigated type of anemia. The pooled prevalence of iron deficiency anemia (IDA) among pregnant women in Sudan was 13.6% (95% CI = 8.9–18.2). Conclusion There is a high prevalence of anemia among pregnant in the different region of Sudan. While age and parity have no association with anemia, malaria infection was associated with anemia. Interventions to promote the strengthening of antenatal care, and access and adherence to nutrition, and malaria preventive measures are needed to reduce the high level of anemia among pregnant women in Sudan. Electronic supplementary material The online version of this article (10.1186/s12878-018-0124-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ishag Adam
- 1Faculty of Medicine, University of Khartoum, P.O. Box 102, Khartoum, Sudan
| | - Yassin Ibrahim
- 2Faculty of Medicine, University of Tabuk, P.O. Box 741, Tabuk, Saudi Arabia
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Hinnouho GM, Barffour MA, Wessells KR, Brown KH, Kounnavong S, Chanhthavong B, Ratsavong K, Kewcharoenwong C, Hess SY. Comparison of haemoglobin assessments by HemoCue and two automated haematology analysers in young Laotian children. J Clin Pathol 2017; 71:532-538. [PMID: 29197856 PMCID: PMC5969348 DOI: 10.1136/jclinpath-2017-204786] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/14/2017] [Indexed: 11/30/2022]
Abstract
Background Haemoglobin (Hb) assessment by Hemocue is used widely for anaemia screening in both adults and children. However, few studies have compared the diagnostic accuracy of Hemocue with an automated haematology analyser in young children. Aim To compare Hb concentrations by Hemocue Hb301 and two automated haematology analysers in young children in rural communities of Lao PDR. Methods Capillary blood was collected from 6-month-old to 23-month-old children (n=1487) for determination of Hb concentration by Hemocue Hb301. On the same day, venous blood was collected for complete blood count using one of two haematology analysers (XT-1800i, Sysmex, and BC-3000Plus, Mindray Medical International). In a subsample of children (n=129), venous Hb was also measured by HemoCue Hb301. Agreement between the two methods was estimated using Bland-Altman plots. Results Mean capillary Hb by Hemocue was significantly higher than mean venous Hb by haematology analysers combined (108.4±10.3 g/L vs 102.3±13.1 g/L; P<0.001), resulting in a significantly lower anaemia prevalence (Hb <110 g/L) by Hemocue (53.7% vs 73.9%; P<0.001). The Bland-Altman assessment of agreement showed a bias of 6.1 g/L and limits of agreement were −11.5 g/L to 23.7 g/L. Mean venous Hb concentration by Hemocue Hb301 (113.6±14.0 g/L) was significantly higher than mean capillary Hb concentration by Hemocue Hb301 (110.0±10.7; P=0.03 g/L), which in turn was significantly higher than mean venous Hb concentration by the Mindray BC-3000Plus (102.3±17.4 g/L). Conclusion Capillary and venous Hb concentrations assessed by Hemocue Hb301 showed poor agreement compared with venous Hb by automated haematology analysers, resulting in significantly different anaemia prevalences.
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Affiliation(s)
- Guy-Marino Hinnouho
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, California, USA
| | - Maxwell A Barffour
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, California, USA
| | - K Ryan Wessells
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, California, USA
| | - Kenneth H Brown
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, California, USA.,Nutrition and Global Development, Bill & Melinda Gates Foundation, Seattle, Washington, USA
| | | | | | | | - Chidchamai Kewcharoenwong
- Faculty of Associated Medical Sciences, Centre for Research and Development of Medical Diagnostic Laboratories, Khon Kaen University, Khon Kaen, Thailand
| | - Sonja Y Hess
- Department of Nutrition, Program in International and Community Nutrition, University of California, Davis, California, USA
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20
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Karakochuk CD, Rappaport AI, Barr SI, Green TJ. Mean hemoglobin concentrations in fasting venous and non-fasting capillary blood of Cambodian women using a hemoglobinometer and an automated hematology analyzer. Clin Chem Lab Med 2017; 55:e247-e250. [PMID: 28412720 DOI: 10.1515/cclm-2017-0118] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/15/2017] [Indexed: 11/15/2022]
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21
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Accuracy of on-site tests to detect anemia during prenatal care. Int J Gynaecol Obstet 2017; 139:130-136. [DOI: 10.1002/ijgo.12289] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 06/11/2017] [Accepted: 07/27/2017] [Indexed: 11/07/2022]
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High level of hemoglobin, white blood cells and obesity among Sudanese women in early pregnancy: a cross-sectional study. Future Sci OA 2017; 3:FSO182. [PMID: 28670473 PMCID: PMC5481852 DOI: 10.4155/fsoa-2016-0096] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/02/2017] [Indexed: 12/21/2022] Open
Abstract
Aim: To investigate the association between obesity and anemia/hemoglobin levels. Material & methods: A cross-sectional study was conducted at Khartoum, Sudan. Obstetric data were collected from 388 pregnant women at mean (standard deviation) of 10.5 (3.1) weeks of gestation using questionnaires. Weight and height were determined, and BMI was calculated. Results: There were 15 (4.4%), 95 (28.1%), 127 (37.6) and 101 (29.9%) women who were underweight, normal weight, (18.5–24.9 kg/m2), overweight (25–29.9 kg/m2) and obese (≥30 kg/m2), respectively. Hemoglobin levels and white blood cell counts were significantly higher in obese than nonobese groups. Compared with normal BMI, overweight and obesity were associated with higher hemoglobin level. Conclusion: Obese women had higher white blood cell count and hemoglobin level. Obesity during pregnancy has many maternal and perinatal adverse effects. The current study was conducted to investigate the association between obesity, hemoglobin level and white blood cell count among pregnant Sudanese women in their early pregnancy. Around a third of the 388 women were obese. Hemoglobin level and white blood cells count were significantly higher in obese than nonobese women. Further studies are needed to fully understand the implications of this relationship.
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Accuracy of Capillary Hemoglobin Measurements for the Detection of Anemia among U.S. Low-Income Toddlers and Pregnant Women. Nutrients 2017; 9:nu9030253. [PMID: 28282926 PMCID: PMC5372916 DOI: 10.3390/nu9030253] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 12/01/2022] Open
Abstract
The aim of this study is to evaluate the accuracy of capillary hemoglobin (Hb) measurements in detecting anemia among low-income toddlers (aged 12–35 months) and pregnant women. In analyses of data among toddlers from Kansas City (n = 402) and St. Louis, Missouri (n = 236), and pregnant women at <20 weeks gestation from Cleveland, Ohio (n = 397), we compared subjects’ anemia status based on capillary Hb concentrations in finger puncture samples as measured by the HemoCue system with their anemia status based on venous Hb concentrations as measured by the HemoCue and Coulter Counter. The sensitivity of capillary blood analyses in identifying cases of anemia was 32.8% (95% Confidence Intervals (CI): 21.0%–46.3%), among Kansas City toddlers, 59.7% (95% CI: 45.8%–72.4%) among St. Louis toddlers, and 66.7% (95% CI: 46.0%–83.5%) among pregnant women in Cleveland; the corresponding specificities were 97.7%, 86.6%, and 96.7%, respectively. The correlation between HemoCue and Coulter Counter measurements of venous Hb (0.9) was higher than that between HemoCue measurements of capillary and venous blood (0.8). The results show that Hb measurements of capillary blood with HemoCue were not optimal for determining the anemia status of toddlers and pregnant women.
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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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Zatloukal J, Pouska J, Kletecka J, Pradl R, Benes J. Comparison of the accuracy of hemoglobin point of care testing using HemoCue and GEM Premier 3000 with automated hematology analyzer in emergency room. J Clin Monit Comput 2016; 30:949-956. [PMID: 26507548 DOI: 10.1007/s10877-015-9799-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/22/2015] [Indexed: 11/30/2022]
Abstract
The laboratory analysis provides accurate, but time consuming hemoglobin level estimation especially in the emergency setting. The reliability of time-sparing point of care devices (POCT) remains uncertain. We tested two POCT devices accuracy (HemoCue®201+ and Gem®Premier™3000) in routine emergency department workflow. Blood samples taken from patients admitted to the emergency department were analyzed for hemoglobin concentration using a laboratory reference Beckman Coulter LH 750 (HBLAB), the HemoCue (HBHC) and the Gem Premier 3000 (HBGEM). Pairwise comparison for each device and HbLAB was performed using correlation and the Bland-Altman methods. The reliability of transfusion decision was assessed using three-zone error grid. A total of 292 measurements were performed in 99 patients. Mean hemoglobin level were 115 ± 33, 110 ± 28 and 111 ± 30 g/l for HbHC, HbGEM and HbLAB respectively. A significant correlation was observed for both devices: HbHC versus HbLAB (r2 = 0.93, p < 0.001) and HBGEM versus HBLAB (r2 = 0.86, p < 0.001). The Bland-Altman method revealed bias of -3.7 g/l (limits of agreement -20.9 to 13.5) for HBHC and HBLAB and 2.5 g/l (-18.6 to 23.5) for HBGEM and HBLAB, which significantly differed between POCT devices (p < 0.001). Using the error grid methodology: 94 or 91 % of values (HbHC and HbGEM) fell in the zone of acceptable difference (A), whereas 0 and 1 % (HbHC and HbGEM) were unacceptable (zone C). The absolute accuracy of tested POCT devices was low though reaching a high level of correlation with laboratory measurement. The results of the Morey´s error grid were unfavorable for both POCT devices.
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Affiliation(s)
- Jan Zatloukal
- Department of Anesthesiology and Intensive Care, The Faculty of Medicine, The University Hospital, Plzen - Charles University Prague, alej Svobody 80, 304 60, Plzeň, Czech Republic.
| | - Jiri Pouska
- Department of Anesthesiology and Intensive Care, The Faculty of Medicine, The University Hospital, Plzen - Charles University Prague, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Jakub Kletecka
- Department of Anesthesiology and Intensive Care, The Faculty of Medicine, The University Hospital, Plzen - Charles University Prague, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Richard Pradl
- Department of Anesthesiology and Intensive Care, The Faculty of Medicine, The University Hospital, Plzen - Charles University Prague, alej Svobody 80, 304 60, Plzeň, Czech Republic
| | - Jan Benes
- Department of Anesthesiology and Intensive Care, The Faculty of Medicine, The University Hospital, Plzen - Charles University Prague, alej Svobody 80, 304 60, Plzeň, Czech Republic
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26
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Ghatpande NS, Apte PP, Joshi BN, Naik SS, Bodas D, Sande V, Uttarwar P, Kulkarni PP. Development of a novel smartphone-based application for accurate and sensitive on-field hemoglobin measurement. RSC Adv 2016. [DOI: 10.1039/c6ra24366e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A smartphone-based app for the accurate and sensitive measurement of hemoglobin was developed.
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Affiliation(s)
| | - Priti P. Apte
- Bioprospecting Group
- Agharkar Research Institute
- Pune-411004
- India
| | - Bimba N. Joshi
- Bioprospecting Group
- Agharkar Research Institute
- Pune-411004
- India
| | | | - Dhananjay Bodas
- Nanobioscience Group
- Agharkar Research Institute
- Pune-411004
- India
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27
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Pawlowski M, Latute F, Bardou-Jacquet E, Latournerie M, Zerrouki S, Bendavid C, Brissot P, Ropert M. Portable hemoglobinometer is a reliable technology for the follow-up of venesections tolerance in hemochromatosis. Clin Res Hepatol Gastroenterol 2015; 39:570-5. [PMID: 25776452 DOI: 10.1016/j.clinre.2014.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 08/01/2014] [Accepted: 09/01/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of HFE-related hemochromatosis, one of the most common genetic diseases, is based on phlebotomies whose tolerance is evaluated by regular monitoring of hemoglobin. Using a portable hemoglobinometer (PH) could provide an easy and fast determination of hemoglobin. Therefore, the aim of the present study was to compare, in hemochromatosis patients treated by bloodletting, the hemoglobin concentrations as assayed, on capillary blood, by a PH device and, on venous blood, by a cell counter (CC) device. METHODS For a total period of 12 weeks duration, all patients undergoing phlebotomies in the same hospital outpatient unit had hemoglobin determinations both by the HemoCue and by the laboratory's DxH 800 Coulter. To evaluate the sensitivity and specificity of the HemoCue, patients were classified as presenting or not anemia as defined by hemoglobin level below 11 g/dl. RESULTS Measurements of hemoglobin were performed in 122 patients. The sensitivity and specificity of PH compared to CC were 100 and 98.1%, respectively. Capillary hemoglobin by PH slightly underestimated venous hemoglobin by CC. The Pearson's correlation coefficient between PH and CC was 0.80 (P<0.0001). CONCLUSION PH is a reliable, quick and easy technology, which can be proposed to follow-up the tolerance of venesections in hemochromatosis patients.
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Affiliation(s)
- Maxime Pawlowski
- Laboratory of Biochemistry, University Hospital Pontchaillou, 35033 Rennes, France
| | - Fanny Latute
- Laboratory of Biochemistry, University Hospital Pontchaillou, 35033 Rennes, France.
| | - Edouard Bardou-Jacquet
- Inserm UMR991, University of Rennes 1, 35033 Rennes France; Liver Disease Department, University Hospital Pontchaillou, 35033 Rennes, France
| | - Marianne Latournerie
- Liver Disease Department, University Hospital Pontchaillou, 35033 Rennes, France
| | - Selim Zerrouki
- Liver Disease Department, University Hospital Pontchaillou, 35033 Rennes, France
| | - Claude Bendavid
- Laboratory of Biochemistry, University Hospital Pontchaillou, 35033 Rennes, France
| | - Pierre Brissot
- Inserm UMR991, University of Rennes 1, 35033 Rennes France; Liver Disease Department, University Hospital Pontchaillou, 35033 Rennes, France
| | - Martine Ropert
- Laboratory of Biochemistry, University Hospital Pontchaillou, 35033 Rennes, France; Liver Disease Department, University Hospital Pontchaillou, 35033 Rennes, France
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Vyas KJ, Danz D, Gilman RH, Wise RA, León-Velarde F, Miranda JJ, Checkley W. Noninvasive Assessment of Excessive Erythrocytosis as a Screening Method for Chronic Mountain Sickness at High Altitude. High Alt Med Biol 2015; 16:162-8. [PMID: 25973777 DOI: 10.1089/ham.2015.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Vyas, Kaetan J., David Danz, Robert H. Gilman, Robert A. Wise, Fabiola León-Velarde, J. Jaime Miranda, and William Checkley. Noninvasive assessment of excessive erythrocytosis as a screening method for chronic mountain sickness at high altitude. High Alt Med Biol 16:162-168, 2015.--Globally, over 140 million people are at risk of developing chronic mountain sickness, a common maladaptation to life at high altitude (>2500 meters above sea level). The diagnosis is contingent upon the identification of excessive erythrocytosis (EE). Current best practices to identify EE require a venous blood draw, which is cumbersome for large-scale surveillance. We evaluated two point-of-care biomarkers to screen for EE: noninvasive spot-check tests of total hemoglobin and oxyhemoglobin saturation (Pronto-7, Masimo Corporation). We conducted paired evaluations of total serum hemoglobin from a venous blood draw and noninvasive, spot-check testing of total hemoglobin and oxyhemoglobin saturation with the Pronto-7 in 382 adults aged ≥35 years living in Puno, Peru (3825 meters above sea level). We used the Bland-Altman method to measure agreement between the noninvasive hemoglobin assessment and the gold standard lab hemoglobin analyzer. Mean age was 58.8 years and 47% were male. The Pronto-7 test was unsuccessful in 21 (5%) participants. Limits of agreement between total hemoglobin measured via venous blood draw and the noninvasive, spot-check test ranged from -2.8 g/dL (95% CI -3.0 to -2.5) to 2.5 g/dL (95% CI 2.2 to 2.7), with a bias of -0.2 g/dL (95% CI -0.3 to -0.02) for the difference between total hemoglobin and noninvasive hemoglobin concentrations. Overall, the noninvasive spot-check test of total hemoglobin had a better area under the receiver operating characteristic curve compared to oxyhemoglobin saturation for the identification of EE as measured by a gold standard laboratory hemoglobin analyzer (0.96 vs. 0.82; p<0.001). Best cut-off values to screen for EE with the Pronto 7 were ≥19.9 g/dL in males and ≥17.5 g/dL in females. At these cut-points, sensitivity and specificity were both 92% and 89% for males and females, respectively. A noninvasive, spot-check test of total hemoglobin had low bias and high discrimination for the detection of EE in high altitude Peru, and may be a useful point-of-care tool for large-scale surveillance in high-altitude settings.
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Affiliation(s)
- Kaetan J Vyas
- 1 Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University , Baltimore, Maryland
| | - David Danz
- 2 Biomedical Research Unit, A.B. PRISMA , Lima, Peru
| | - Robert H Gilman
- 3 Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University , Baltimore, Maryland
| | - Robert A Wise
- 1 Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University , Baltimore, Maryland
| | - Fabiola León-Velarde
- 4 Departamento de Ciencias Biológicas y Fisiológicas, Laboratorio de Adaptación a la Altura, Laboratorios de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia , Lima, Peru
| | - J Jaime Miranda
- 5 CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia , Lima, Peru .,6 Departamento de Medicina, Escuela de Medicina, Universidad Peruana Cayetano Heredia , Lima, Peru
| | - William Checkley
- 1 Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University , Baltimore, Maryland
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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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Kim H, Song S, Yim J, Kim HO, Joo C. Hemoglobin assay in anemic patients with a photothermal spectral-domain optical coherence reflectometric sensor. Clin Chim Acta 2015; 439:71-6. [DOI: 10.1016/j.cca.2014.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 09/27/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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Evaluation of two methods to measure hemoglobin concentration among women with genetic hemoglobin disorders in Cambodia: a method-comparison study. Clin Chim Acta 2014; 441:148-55. [PMID: 25542983 DOI: 10.1016/j.cca.2014.12.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 12/11/2014] [Accepted: 12/16/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Genetic hemoglobin (Hb) E variants are common in Cambodia and result in an altered and unstable Hb molecule. We evaluated two methods to measure Hb concentration among individuals with and without Hb variants using a hemoglobinometer (HemoCue) and a hematology analyzer (Sysmex XT-1800i). METHODS We determined the bias and concordance between the methods among 420 Cambodian women (18-45 y). RESULTS Bias and concordance appeared similar between methods among women with no Hb disorders (n=195, bias=2.5, ρc=0.68), women with Hb E variants (n=133, bias=2.5, ρc=0.78), and women with other Hb variants (n=92, bias=2.7, ρc=0.73). The overall bias was 2.6g/l, resulting in a difference in anemia prevalence of 11.5% (41% using HemoCue and 29.5% using Sysmex, p<0.001). Based on visual interpretation of the concordance plots, the HemoCue device appears to underestimate Hb concentrations at lower Hb concentrations and to overestimate Hb concentrations at higher Hb concentrations (in comparison to the Sysmex analyzer). CONCLUSIONS Bias and concordance were similar across groups, suggesting the two methods of Hb measurement were comparable. We caution field staff, researchers and policy makers in the interpretation of data and the impact that bias between methods can have on anemia prevalence rates.
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Kim SH, Lilot M, Murphy LSL, Sidhu KS, Yu Z, Rinehart J, Cannesson M. Accuracy of Continuous Noninvasive Hemoglobin Monitoring. Anesth Analg 2014; 119:332-346. [DOI: 10.1213/ane.0000000000000272] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Saleh AM, Abdalla HS, Satti AB, Babiker SM, Gasim GI, Adam I. Diagnosis of Trichomonous vaginalis by microscopy, latex agglutination, diamond's media, and PCR in symptomatic women, Khartoum, Sudan. Diagn Pathol 2014; 9:49. [PMID: 24602349 PMCID: PMC3975644 DOI: 10.1186/1746-1596-9-49] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 03/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trichomoniasis is the most common sexually transmitted disease. However, limited data are available on an effective technique for the diagnosis of Trichomonas vaginalis. METHODS A cross-sectional study was conducted to evaluate the accuracy of wet mount microscopy, latex agglutination, Diamond's media, and polymerase chain reaction (PCR) for detection of T. vaginalis among symptomatic women who attended the gynecological clinic at Khartoum, Sudan. RESULTS Of the 297 women studied, 252 (84.8%) were positive for T. vaginalis by wet mount microscopy, 257 (86.5%) by latex agglutination, 253 (85.2%) by Diamond's media, and 253 (85.2%) by PCR. The sensitivity and specificity of wet mount microscopy were 99.2% and 97.7%, respectively, compared with PCR. The sensitivity and specificity of latex agglutination and Diamond's media were 99.6% and 88.6%, and 100.0% and 86.4%, respectively, compared with PCR. CONCLUSIONS In this study, wet mount microscopy, latex agglutination, and Diamond's media were found to be highly sensitive and specific. However, the availability and cost effectiveness might limit the use of Diamond's media and PCR in routine practice. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/7859723851211496.
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Affiliation(s)
| | | | | | | | | | - Ishag Adam
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
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Abdullahi H, Osman A, Rayis DA, Gasim GI, Imam AM, Adam I. Red blood cell distribution width is not correlated with preeclampsia among pregnant Sudanese women. Diagn Pathol 2014; 9:29. [PMID: 24499498 PMCID: PMC3916796 DOI: 10.1186/1746-1596-9-29] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 12/18/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Preeclampsia is a leading cause of maternal and perinatal mortality worldwide. The exact etiology of preeclampsia is unknown, but the inflammatory process is postulated as one of the etiologies. Red blood cell distribution width (RDW) is a measure of anisocytosis (variation of red cell size) and is associated with hypertension and diabetic ketoacidosis. There are few data on the association between RDW and preeclampsia. This study aimed to investigate the association between RDW and preeclampsia. METHODS A case-control study was conducted at Khartoum Hospital, Sudan, during June to August 2012. Cases were women with preeclampsia and healthy women were controls. Sociodemographic characteristics, obstetrics, and clinical data were recorded. The complete blood count, including RDW, was measured using an automated hematology analyzer. RESULTS The cases and controls (65 women in each arm) were matched in their basic characteristics. There was no difference in the mean (SD) RDW between women with preeclampsia and controls (14.5 ± 1.8% vs. 14.4 ± 1.4%, P = 0.710). There was also no difference in the mean RDW between women with mild and severe preeclampsia (14.7 ± 1.9% vs. 13.9 ± 1.4%, P = 0.144. In logistic regression, there was no association between RDW and preeclampsia (OR = 0.9, CI = 0.7-1.1, P = 0.952). CONCLUSIONS RDW levels are not associated with the presence or severity of preeclampsia. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1206247718115175.
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Affiliation(s)
| | | | | | | | | | - Ishag Adam
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Khartoum, Khartoum, Sudan.
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Kashif AH, Adam GK, Mohmmed AA, Elzaki SE, AbdelHalim AM, Adam I. Reliability of rapid diagnostic test for diagnosing peripheral and placental malaria in an area of unstable malaria transmission in Eastern Sudan. Diagn Pathol 2013; 8:59. [PMID: 23587371 PMCID: PMC3640898 DOI: 10.1186/1746-1596-8-59] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 04/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diagnosing Plasmodium falciparum malaria during pregnancy is a great challenge for clinicians because of the low density of parasites in the peripheral blood and parasite sequestration in the placenta. Nevertheless, few data on the use of malaria rapid diagnostic test (RDT) during pregnancy have been published. METHODS P. falciparum infections were assessed in 156 febrile pregnant women by microscopic examination of their blood smears and by RDT and polymerase chain reactions (PCR). In addition, 150 women were assessed at the time of delivery by microscopy, RDT, PCR and placental histology investigations. The study was conducted at the Gadarif Hospital, Eastern Sudan. The SD Bioline P. f / P. v (Bio Standard Diagnostics, Gurgaon, Korea) RDT kit was evaluated in this study. RESULTS Among the febrile pregnant women, 17 (11.0%), 26 (16.7%) and 18 (11.5%) positive cases of P. falciparum were detected by microscopy, RDT, and PCR, respectively. The sensitivity and specificity of the microscopy was 94.4% and 100%, respectively. The corresponding values for RDT evaluation were 83.3% and 92.0%, as compared with PCR as the gold standard.While there were no detected cases of malaria by microscopic examination of blood smears, 27 (18.0%), 21(14.0%) and 46 (30.7%) out of the 150 placentae investigated had P. falciparum as determined by RDT, PCR, and histology, respectively. The sensitivity and specificity for RDT was 17.4% and 81.7%, respectively. The corresponding values for PCR were 6.5% and 82.7%, where histology was used as the gold standard. CONCLUSIONS The RDT kit used in this study has poor performance for peripheral and placental P. falciparum malaria detection in this setting. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1092363465928479.
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Affiliation(s)
- Awadalla H Kashif
- Faculty of Medical Laboratory Sciences, University of Khartoum, Khartoum, Sudan
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Abdelrahman EG, Gasim GI, Musa IR, Elbashir LM, Adam I. Red blood cell distribution width and iron deficiency anemia among pregnant Sudanese women. Diagn Pathol 2012. [PMID: 23206545 PMCID: PMC3538607 DOI: 10.1186/1746-1596-7-168] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Iron deficiency anemia (IDA) is a major health problem during pregnancy and it has adverse effects on the mother and the newborn. Red cell distribution width (RDW), which is a quantitative measure for red cell size variation (anisocytosis), is a predictor of IDA. Little is known regarding RDW and IDA during pregnancy. METHODS A cross sectional study was conducted at the antenatal clinic of Khartoum Hospital, Sudan, to determine the performance of RDW in the diagnosis of IDA using serum ferritin as a gold standard. RESULTS Among 194 pregnant women with a gestational period of 21.4 ± 6.5 weeks, 57 (29.4%) had IDA according to serum ferritin levels (<15 μg/l) and 61 (31.4%) had IDA according to RDW (>14.5). The sensitivity, specificity, positive predictive value, and negative predictive value of RDW where serum ferritin was the gold standard were 43.8% (95% CI: 31.4-57.0%), 73.7% (95% CI: 65.8-80.5%), 41.0% (95% CI: 29.2-53.6%), and 76.0% (95% CI: 68.1-82.6%), respectively. CONCLUSIONS In this study, we found that RDW has a poor performance in diagnosing IDA among pregnant women compared with serum ferritin as the gold standard.
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