Complete Blood Count Hemoglobin Research Articles

Screening Characteristics of Hemoglobin and Mean Corpuscular Volume for Detection of Iron Deficiency in Pregnancy.

Iron deficiency in pregnancy remains underdiagnosed despite professional society recommendations for first-trimester complete blood count (CBC) screening. To determine the effectiveness of the CBC hemoglobin and mean corpuscular volume (MCV) to identify iron deficiency in pregnancy, we conducted a retrospective analysis of 20,550 pregnancies from 2009 to 2022 at the University of California, San Francisco, obstetrics clinics. A total of 16,547 (80.5%) pregnant individuals had first-trimester screening CBC; 345 (2.1%) had a coincident ferritin test. Hemoglobin level less than 11 g/dL and MCV level less than 80 fL each had sensitivity of only 30% (95% CI, 20-41%) to detect first-trimester iron deficiency (ferritin level less than 30), corresponding to a negative likelihood ratio of 0.90 (95% CI, 0.77-1.05) and 0.85 (95% CI, 0.73-0.99), respectively. More than 50% of the 1,749 women with documented iron deficiency anytime during pregnancy were neither anemic nor microcytic at the time of diagnosis.

Clinical and Analytic Accuracy of Simultaneously Acquired Hemoglobin Measurements: A Multi-Institution Cohort Study to Minimize Redundant Laboratory Usage.

Frequent diagnostic blood sampling contributes to anemia among critically ill children. Reducing duplicative hemoglobin testing while maintaining clinical accuracy can improve patient care efficacy. The objective of this study was to determine the analytical and clinical accuracy of simultaneously acquired hemoglobin measurements with different methods. Retrospective cohort study. Two U.S. children's hospitals. Children (< 18 yr old) admitted to the PICU. None. We identified hemoglobin results from complete blood count (CBC) panels paired with blood gas (BG) panels and point-of-care (POC) devices. We estimated analytic accuracy by comparing hemoglobin distributions, correlation coefficients, and Bland-Altman bias. We measured clinical accuracy with error grid analysis and defined mismatch zones as low, medium, or high risk-based on deviance from unity and risk of therapeutic error. We calculated pairwise agreement to a binary decision to transfuse based on a hemoglobin value. Our cohort includes 49,004 ICU admissions from 29,926 patients, resulting in 85,757 CBC-BG hemoglobin pairs. BG hemoglobin was significantly higher (mean bias, 0.43-0.58 g/dL) than CBC hemoglobin with similar Pearson correlation ( R2 ) (0.90-0.91). POC hemoglobin was also significantly higher, but of lower magnitude (mean bias, 0.14 g/dL). Error grid analysis revealed only 78 (< 0.1%) CBC-BG hemoglobin pairs in the high-risk zone. For CBC-BG hemoglobin pairs, at a BG hemoglobin cutoff of greater than 8.0 g/dL, the "number needed to miss" a CBC hemoglobin less than 7 g/dL was 275 and 474 at each institution, respectively. In this pragmatic two-institution cohort of greater than 29,000 patients, we show similar clinical and analytic accuracy of CBC and BG hemoglobin. Although BG hemoglobin values are higher than CBC hemoglobin values, the small magnitude is unlikely to be clinically significant. Application of these findings may reduce duplicative testing and decrease anemia among critically ill children.

Point-of-care versus central testing of hemoglobin during large volume blood transfusion

BackgroundPoint-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions.MethodsWe retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min of each other during the MTP. We assessed the accuracy of EPOC® hemoglobin testing using two variables: interchangeability and clinically significant differences from the CBC. The Clinical Laboratory Improvement Amendments (CLIA) proficiency testing criteria defined interchangeability for measurements. Clinically significant differences between the tests were defined by an expert panel. We examined whether these relationships changed as a function of the hemoglobin measured by the EPOC® and specific patient characteristics.ResultsFifty one percent (86 of 170) of paired samples’ hemoglobin results had an absolute difference of ≤7 and 73% (124 of 170) fell within ±1 g/dL of each other. The mean difference between EPOC® and CBC hemoglobin had a bias of − 0.268 g/dL (p = 0.002). When the EPOC® hemoglobin was < 7 g/dL, 30% of the hemoglobin values were within ±7, and 57% were within ±1 g/dL. When the measured EPOC® hemoglobin was ≥7 g/dL, 55% of the EPOC® and CBC hemoglobin values were within ±7, and 76% were within ±1 g/dL. EPOC® and CBC hemoglobin values that were within ±1 g/dL varied by patient population: 77% for cardiac surgery, 58% for general surgery, and 72% for non-surgical patients.ConclusionsThe EPOC® device had minor negative bias, was not interchangeable with the CBC hemoglobin, and was less reliable when the EPOC® value was < 7 g/dL. Clinicians must consider speed versus accuracy, and should check a CBC within 30 min as confirmation when the EPOC® hemoglobin is < 7 g/dL until further prospective trials are performed in this population.

Time advantage of HemoCue versus traditional complete blood count during cordocentesis

Objectives During cordocentesis, a significant risk factor for adverse outcome is procedure length. One of the greatest contributors to total procedure length is the time that elapses between obtaining a fetal sample and receiving the results of the complete blood count (CBC) from the hospital laboratory. We aimed to evaluate whether there is an advantage to using a point of care hemoglobinometer (HemoCue) compared with traditional CBC during cordocentesis, measured in time elapsing between obtaining fetal sample, and available result. Secondarily we aimed to compare accuracy of HemoCue in relation to traditional CBC. Methods A prospective cohort study was conducted on women undergoing cordocentesis and fetal transfusion for suspected fetal anemia from July 2016 to July 2018 at an urban academic medical center. Fetal blood samples were obtained during cordocentesis, and concurrently sent for traditional CBC, as well as immediately analyzed at bedside using a HemoCue machine. The time elapsing between the obtained fetal sample and availability of results with HemoCue versus traditional CBC were recorded. Primary outcome was time elapsed between obtaining fetal sample and result available for HemoCue versus traditional CBC. Secondary outcome was comparison of HemoCue and CBC hemoglobin values for accuracy. Results Forty-five fetal samples were compared using CBC and HemoCue. Sixteen cordocentesis procedures were performed on 10 patients during the study period. Use of HemoCue was associated with a significantly shorter time to yield a fetal hemoglobin result, compared to traditional CBC (1.5 versus 5.5 min, p = .0001). Results yielded by the HemoCue highly correlated to those yielded by traditional CBC (R = 0.96). Conclusions Use of HemoCue during cordocentesis is associated with a 4-min time advantage over traditional CBC. Hemoglobin results yielded by HemoCue and traditional CBC are highly correlated. KEY MESSAGE Use of a point-of-care hemoglobinometer is associated with a time advantage of 4 min over traditional complete blood count during cordocentesis. This represents a potentially modifiable risk factor for procedure length, and thus procedure complications.

171: Time advantage of HemoCue versus traditional complete blood count during cordocentesis

During cordocentesis, a significant risk factor for adverse outcome is procedure length. One of the greatest contributors to total procedure length is the time that elapses between obtaining a fetal sample, and receiving the results of the Complete Blood Count from the hospital laboratory. We therefore aimed to evaluate whether there is an advantage to using apoint of care hemoglobinometer (HemoCue) compared with traditional Complete Blood Count (CBC) during cordocentesis, in terms of time between obtaining sample, and available result. Secondarily we aimed to compare accuracy of HemoCue in relation to traditional CBC. A prospective cohort study was conducted on women undergoing cordocentesis and fetal transfusion for suspected fetal anemia between 07/2016 to 07/2018 at an urban academic medical center. Fetal blood samples were obtained during cordocentesis, and simultaneously sent for traditional CBC, as well as immediately analyzed at bedside using a HemoCue machine. The time elapsing between the obtained fetal sample and availability of results with HemoCue versus traditional CBC were recorded. Primary outcome was time elapsed between obtaining fetal sample and result available for HemoCue versus traditional CBC. Secondary outcome was comparison of Hemocue and CBC Hemoglobin values for accuracy. Forty-five fetal samples were compared using CBC and HemoCue. Fifteen cordocentesis procedures were performed on 10 patients during the study period. The mean gestational age for the cordocentesis was 27.7 (range 19-36 weeks). Use of HemoCue was associated with a significantly shorter time to yield a fetal hemoglobin result, compared to traditional CBC (1.6 vs 5.6 minutes, p=.0001), as seen in Figure 1. The hemoglobin/hematocrit results yielded by the HemoCue highly correlated to those yielded by traditional CBC (R=0.96). Use of HemoCue during cordocentesis is associated with a 4-minute advantage time over traditional CBC. Hemoglobin results yielded by HemoCue and traditional CBC are highly correlated.

332: Can a point-of-care hemoglobin device replace complete blood count for fetal blood sampling during intrauterine transfusion?

Our objective was to prospectively validate a Point-of-Care (POC) hemoglobin device (Hemocue 201 DM system) as an alternative to a laboratory based complete blood count (CBC) in the setting of hemoglobin evaluation during cordocentesis and intrauterine fetal transfusion. This prospective study was performed in a tertiary level maternity hospital. Fifteen consecutive cases of fetal anemia attending the hospital for cordocentesis and intrauterine fetal transfusion over an 18 month period were included. At the time of cordocentesis all participants had at least two episodes of dual fetal blood sampling with both a POC Test and a laboratory-based CBC. Statistical analysis was performed via Pearson’s test. Fifteen cordocentesis procedures were performed during the 18 month period yielding a total of 35 paired samples. There was strong correlation between the POC hemoglobin and a CBC hemoglobin with r=0.976 (95% CI 0.952-0.988) and a p value <0.0001. This study demonstrated a linear fit between both methods of hemoglobin quantification enabling the prediction of the anticipated CBC hemoglobin from CBC hemoglobin via the equation Hemocue Hemoglobin = 2.902 + 0.9617 Laboratory Hemoglobin. Overall there is good agreement between the POC fetal hemoglobin and the CBC fetal hemoglobin. This suggests that the Hemocue 201 DM system is a viable and reproducible alternative form of measurement of fetal hemoglobin, with the important advantage of providing expedited results at the bedside. This ultimately may reduce fetal morbidity associated with cordocentesis and intrauterine transfusion, minimizing the time required to complete the procedure.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Cervical Tuberculosis Mimicking Cervical Malignancy

A 36 years old patient presented to us with a history of primary infertility and secondary amenorrhea since 2 years and postcoital spotting per vaginum since 3 months. There was no history of any foul smelling discharge per vaginum, or any urinary problems. Her past menstrual cycles were regular, moderate and painless and she had amenorrhea since 2 years. There was no past history of tuberculosis and no history of contact. On examination, general condition was good. Systemic examination, did not reveal any respiratory pathology and cardiac status was normal. Per abdomen examination was normal. Per speculum examination (Fig. 1), cervical erosion on the anterior lip of the cervix was noticed, and a growth on the posterior cervical lip which bled on touch. On per vaginal examination, the uterus was bulky, fornices were clear. On per rectal examination both parametria were free. Investigations done as follows: Complete blood count Hemoglobin 10.9 gm/dl, total WBC count 8560 × 103 platelet count 3.24 lacs, ESR was normal. Her chest X-ray was normal and HIV status was negative. Total proteins were normal and liver and renal functions were normal. A pelvic ultrasound (Fig. 2) was done which was suggestive of bulky uterus and a collection within the uterine cavity. A dilatation and curettage with cervical biopsy was done for this patient. On D and C, a liquefied cheesy material was CASE REPORT