Point‐of‐care haemoglobin testing in African hospitals: a neglected essential diagnostic test

Abstract

Owing to the rapid turnaround time in the assessment of haemoglobin level by point-of-care tests (POC Hb), these have grown in popularity and scope in large parts of the world. However, whilst POC testing for malaria and HIV remains has been integrated into patient management in Africa, the use of POC haemoglobin testing remains neglected by health services. The main users of transfusions (paediatric, maternity and trauma services) present largely as emergencies. Ward-based POC Hb could result in more rapid and accurate diagnosis of anaemia, contributing to saving of lives and at the same time reduce unnecessary transfusions which deplete the limited supplies of donated blood in Africa. Severe anaemia requiring transfusion is a major cause of paediatric admission in Africa. At a dissemination meeting to discuss the results of a large phase III paediatric transfusion trial and steps to implementation of the findings participants strongly recommended that one of the most pressing actions required was to prioritise the use of POC haemoglobin testing. This would facilitate implementation of the new transfusion algorithm, developed at the meeting, which refines patient management including blood transfusions. We present the rationale for the strongly recommended prioritisation of POC Hb, using paediatric transfusion as an exemplar.

Bridging the gaps in newborn screening programmes: Challenges and opportunities to detect haemoglobinopathies in Africa

“…The cost of testing and treating various medical conditions in Africa can be prohibitively expensive for many low-income patients. 48 This financial burden can prevent people from seeking the care they need, leading to delayed diagnoses and life-threatening consequences. Governments in Africa have a role to play in addressing this problem.…”

A predictive algorithm for identifying children with sickle cell anemia among children admitted to hospital with severe anemia in Africa

“…TRACT was an open-label, multicentre, factorial, randomized controlled trial recruiting children aged 2 months to 12 years presenting with severe anemia (Hb < 6.0 g/dl) to four hospitals in Africa, three in Uganda (Mulago, Mbale, and Soroti) and one in Malawi (in Blantyre). Full details of the trial justification and design 7 and the results of previous analyses 5 , 6 , 8 – 10 have been described in detail previously. Briefly, in the complicated stratum, children with an Hb < 6.0 g/dl and one or more severity features (which included known-SCA) were randomized 1:1 to immediate transfusion with 30 versus 20 ml/kg whole blood, or the equivalent volumes as packed cells.…”

“…Full details of the trial justification and design 7 and the results of previous analyses 5,6,[8][9][10] have been described in detail previously. Briefly, in the complicated stratum, children with an Hb < 6.0 g/dl and one or more severity features (which included known-SCA) were randomized 1:1 to immediate transfusion with 30 versus 20 ml/kg whole blood, or the equivalent volumes as packed cells.…”

Severe malaria

“…In patients with acute malaria haemoglobin (Hb) concentrations between 8 g/dL and 11 g/dL are considered as mild anaemia, Hb between 5 g/dl and 8 g/dL is considered moderate, and Hb < 5 g/dL is defined as severe anaemia [ 53 ]. Unfortunately, despite their simplicity, the point of care measurements of haemoglobin concentrations, which are necessary to ensure appropriate use of blood transfusions, are often unavailable [ 54 ]. In sub-Saharan Africa the Hb ≤ 5 g/dL threshold is used widely as an indication for blood transfusion in children with malaria (whereas Hb ≤ 4 g/dL is often used for other causes of anaemia) (Fig.…”