Abstract
BackgroundSevere anemia is common and frequently fatal for hospitalized patients in limited-resource settings. Lack of access to low-cost, accurate, and rapid diagnosis of anemia impedes the delivery of life-saving care and appropriate use of the limited blood supply. The WHO Haemoglobin Colour Scale (HCS) is a simple low-cost test but frequently inaccurate. AnemoCheck-LRS (limited-resource settings) is a rapid, inexpensive, color-based point-of-care (POC) test optimized to diagnose severe anemia.MethodsDeidentified whole blood samples were diluted with plasma to create variable hemoglobin (Hb) concentrations, with most in the severe (≤ 7 g/dL) or profound (≤ 5 g/dL) anemia range. Each sample was tested with AnemoCheck-LRS and WHO HCS independently by three readers and compared to Hb measured by an electronic POC test (HemoCue 201+) and commercial hematology analyzer.ResultsFor 570 evaluations within the limits of detection of AnemoCheck-LRS (Hb ≤ 8 g/dL), the average difference between AnemoCheck-LRS and measured Hb was 0.5 ± 0.4 g/dL. In contrast, the WHO HCS overestimated Hb with an absolute difference of 4.9 ± 1.3 g/dL for samples within its detection range (Hb 4–14 g/dL, n = 405). AnemoCheck-LRS was much more sensitive (92%) for the diagnosis of profound anemia than WHO HCS (22%).ConclusionsAnemoCheck-LRS is a rapid, inexpensive, and accurate POC test for anemia. AnemoCheck-LRS is more accurate than WHO HCS for detection of low Hb levels, severe anemia that may require blood transfusion. AnemoCheck-LRS should be tested prospectively in limited-resource settings where severe anemia is common, to determine its utility as a screening tool to identify patients who may require transfusion.
Highlights
Severe anemia is common and frequently fatal for hospitalized patients in limited-resource settings
The hemoglobin concentration for most samples (80%) was ≤ 7.0 g/dL, which meets the upper threshold of severe anemia as defined by the World Health Organization (WHO), and half (50%) had Hb ≤ 5 g/dL, defined in this study as profound anemia
POC tests as a screening tool for severe and profound anemia Recognizing that a hemoglobin concentration of 5.0 g/dL is a common threshold to consider blood transfusion, we evaluated 99 samples with a measured (ADVIA) Hb ≤ 5 g/dL and found AnemoCheck-LRS had sensitivity of 91.9% and specificity of 86.1% (81.8–89.6%)
Summary
Severe anemia is common and frequently fatal for hospitalized patients in limited-resource settings. Lack of access to low-cost, accurate, and rapid diagnosis of anemia impedes the delivery of life-saving care and appropriate use of the limited blood supply. Lack of timely transfusions for children with severe anemia has been associated with a significant increase in mortality in several studies within Africa [8, 9]. The accurate diagnosis of severe anemia is critical to appropriately utilize the very limited blood supply and to triage and treat patients in a timely manner to provide life-saving care. The accurate and timely laboratory diagnosis of anemia is often difficult in most limited-resource settings due to lack of equipment, inadequate replenishment of reagents, poor maintenance or calibration of existing equipment, inadequately trained laboratory personnel, or unreliable and inconsistent access to electricity. Two studies examining transfusion practices in Uganda and Tanzania demonstrated that many blood transfusions (as many as half) were administered inappropriately, either without a Hb measurement or with Hb values for which transfusion would not be recommended [13, 14]
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