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

Bernard Nkrumah,Samuel Blay Nguah,Nimako Sarpong,Juergen May,Yaw Adu-Sarkodie,Ali Idriss,Denise Dekker

doi:10.1186/1472-6890-11-5

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.

Highlights

In resource poor settings where automated hematology analyzers are not available, the Cyanmethemoglobin method is often used
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

Summary

Introduction

In resource poor settings where automated hematology analyzers are not available, the Cyanmethemoglobin method is often used This method though cheaper, takes more time. 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. Hb concentration is measured routinely using automated hematology analyzers, such as those produced by the Sysmex Corporation (Kobe, Japan) These counters are very accurate and reliable, they are expensive and transport of the samples to the laboratory delays the process which may delay treatment, resulting in preventable deaths [3]. This study was conducted to generate data to support or refute its use as a point-ofcare device for Hb estimation, mobile blood donations and critical care areas in health facilities

Results

Discussion

Conclusion