Hemoglobin estimation by the HemoCue® portable hemoglobin photometer in a resource poor setting

Abstract

BackgroundIn resource poor settings where automated hematology analyzers are not available, the Cyanmethemoglobin method is often used. This method though cheaper, takes more time. In blood donations, the semi-quantitative gravimetric copper sulfate method which is very easy and inexpensive may be used but does not provide an acceptable degree of accuracy. The HemoCue® hemoglobin photometer has been used for these purposes. This study was conducted to generate data to support or refute its use as a point-of-care device for hemoglobin estimation in mobile blood donations and critical care areas in health facilities.MethodEDTA blood was collected from study participants drawn from five groups: pre-school children, school children, pregnant women, non-pregnant women and men. Blood collected was immediately processed to estimate the hemoglobin concentration using three different methods (HemoCue®, Sysmex KX21N and Cyanmethemoglobin). Agreement between the test methods was assessed by the method of Bland and Altman. The Intraclass correlation coefficient (ICC) was used to determine the within subject variability of measured hemoglobin.ResultsOf 398 subjects, 42% were males with the overall mean age being 19.4 years. The overall mean hemoglobin as estimated by each method was 10.4 g/dl for HemoCue, 10.3 g/dl for Sysmex KX21N and 10.3 g/dl for Cyanmethemoglobin. Pairwise analysis revealed that the hemoglobin determined by the HemoCue method was higher than that measured by the KX21N and Cyanmethemoglobin. Comparing the hemoglobin determined by the HemoCue to Cyanmethemoglobin, the concordance correlation coefficient was 0.995 (95% CI: 0.994-0.996, p < 0.001). The Bland and Altman's limit of agreement was -0.389 - 0.644 g/dl with the mean difference being 0.127 (95% CI: 0.102-0.153) and a non-significant difference in variability between the two measurements (p = 0.843). After adjusting to assess the effect of other possible confounders such as sex, age and category of person, there was no significant difference in the hemoglobin determined by the HemoCue compared to Cyanmethemoglobin (coef = -0.127, 95% CI: -0.379 - 0.634).ConclusionHemoglobin determined by the HemoCue method is comparable to that determined by the other methods. The HemoCue photometer is therefore recommended for use as on-the-spot device for determining hemoglobin in resource poor setting.

Poor Validity of Noninvasive Hemoglobin Measurements by Pulse Oximetry Compared with Conventional Absorptiometry in Children in Côte d'Ivoire

“…18 Regardless, the finger-prick technique is an extremely common and well-validated mode of Hb measurement in clinical, public health, and research settings in low-and middle-income countries, often used as a diagnostic 'gold' standard in these settings. 19 Another limitation is our use of only a single noninvasive pulse oximetry device for measurement for all comparisons.…”

Podoconiosis and Soil-Transmitted Helminths (STHs): Double burden of Neglected Tropical Diseases in Wolaita zone, Rural Southern Ethiopia.

“…The 5 ml sample was taken for more detailed hematology and immunology measurements, which will be reported separately. Both HemoCue and automated hematology analyzer are acceptable methods for measuring hemoglobin level and produce comparable results [18,19].…”

Point-of-Care Testing for Anaemia in Children Using Portable Haematocrit Meter: A Pilot Study from Southwest Nigeria and Implications for Developing Countries

“…The Haematocrit centrifuge requires electricity to power which may make it unsuitable for analysis when there is power outage, a situation that may delay diagnosis or appropriate intervention and lead to increased morbidity and mortality. Both gravimetric copper sulphate and colour code haemoglobin estimation methods are fraught with high observer errors that impinge their accuracy (8)(9).…”

“…Several methods are routinely used to monitor an individual`s haematocrit (PCV) or Hb levels. These include the use of haematology analyzers, haematocrit centrifuge, cyanmethemoglobin method, gravimetric copper sulphate method and colour code haemoglobin estimation (8)(9)(10). Although the haematology analyzers are the gold standards and very accurate, they are electricitydependent, expensive, and may be out of reach of many health facilities in resource-poor settings of most developing countries (8).The cyanmethemoglobin method is cheaper compared to the haematology analyzers but more laborious and time consuming (10).…”

“…These include the use of haematology analyzers, haematocrit centrifuge, cyanmethemoglobin method, gravimetric copper sulphate method and colour code haemoglobin estimation (8)(9)(10). Although the haematology analyzers are the gold standards and very accurate, they are electricitydependent, expensive, and may be out of reach of many health facilities in resource-poor settings of most developing countries (8).The cyanmethemoglobin method is cheaper compared to the haematology analyzers but more laborious and time consuming (10). The Haematocrit centrifuge requires electricity to power which may make it unsuitable for analysis when there is power outage, a situation that may delay diagnosis or appropriate intervention and lead to increased morbidity and mortality.…”