Hemoglobin Estimation Research Articles

“Comparative evaluation of cytotoxicity of three herbal endodontic irrigants at three intervals of time” – An in vitro study

Aim: The aim of the study was to evaluate and compare the cytotoxicity of 25% of neem leaf extract (Azadirachta indica), 20% of guava leaf extracts (Psidium guajava), and 20% of cinnamon extract (Cinnamomum zeylanicum) irrigants at three intervals of time. Methodology: Four groups were formed (n = 15), Group 1 (control group) – normal saline solution, Group 2 – 25% of neem extract, Group 3 – 20% of guava extract, and Group 4 – 20% of cinnamon extract. Each group was further divided into three subgroups based on intervals (n = 5). Subgroup A – at 10 min, Subgroup B – at 20 min, and Subgroup C – at 30 min. One hundred microliters of each irrigant was added to 2 mL of the diluted red blood cells suspension obtained from a human volunteer. Hemoglobin (Hb) estimation was done with an automated hematology analyzer after incubating the test samples at 10, 20, and 30 min intervals. Results: The reduction in the mean Hb values was not statistically significant in the normal saline, guava, and cinnamon groups. However, in the neem extract group, the mean Hb values reduced significantly at P < 0.001. Among the subgroups, Subgroup A (10 min) showed the least cytotoxicity. Conclusion: In the present study, 20% guava extract had the lowest cytotoxicity and cytotoxicity increased with time. Hence, 20% guava extract can be used as an alternative to conventional irrigants as it has been shown to have the least cytotoxicity.

Hb Co-Pilot: Machine Learning Algorithm for Real-Time Hemoglobin Estimation during Hemodialysis and a Multicenter International Validation Trial

Hb Co-Pilot: Machine Learning Algorithm for Real-Time Hemoglobin Estimation during Hemodialysis and a Multicenter International Validation Trial

Comparison of Copper (II) Sulphate to Hemocue Analyser in the Estimation of Haemoglobin among Voluntary and Replacement Blood Donors at Bugando Medical Centre

Background Pre-donation haemoglobin (Hb) screening is among the foremost test done on blood donors to determine whether an individual is fit to donate with the intention of preventing inadvertent donation from an anaemic donor. The National Blood Transfusion Service (NBTS) in Tanzania uses the Copper II Sulphate (CuSO4) gravimetric method to estimate haemoglobin (Hb) in blood donors. The accuracy of the copper II sulphate method for the rapid screening of prospective blood donors has been questioned because this rapid screening method may lead to false deferral of truly eligible prospective blood donors. However, this and other point-of-care method may provide false results. Methods This was a cross-sectional study conducted among 236 eligible blood donors attending BMC transfusion centre at Mwanza, Tanzania. The blood donors were asked for their consent to participate in this study from 1st May to 1st August 2024. Capillary blood samples were obtained for Hb estimation by CuSO4 and HemoCue methods, and 3mls of venous blood were also collected for Hb quantification by AHA (gold standard). Descriptive statistics were used to analyse the demographic details of the donor. Kappa statistics were used to determine the level of agreement between the two methods of Hb estimation. Results The median age of the study participants was 30 years (IQR: 25-36). The proportion of false eligible donors was 5.5%, and false deferral donors were 2.3% using the CuSO4 gravimetric method. The specificity, sensitivity, positive and negative predictive values, and Kappa agreement for CuSO4 were 53.8%, 94.7%, 93.8%, 58.3%, and 0.51, respectively. In contrast, the specificity, sensitivity, positive and negative predictive values, and Kappa agreement for HemoCue were 63.6%, 97.9%, 96%, 77.7%, and 0.67, respectively. Conclusion. The current study revealed that, the performance of the CuSO4 gravimetric method is relatively poor, with a high proportion of false eligible donors than the HemoCue method. These findings warrant further studies to evaluate the quality control measures for CuSO4 gravimetric method and explore alternative point-of-care methods for Hb estimation among blood donors in similar resource limited-settings.

Clinico-Laboratory Profile of Hypertriglyceridemia Thalassemia Syndrome: A Case Series in a Paediatric Tertiary Care Centre.

Increased hemolysis and repeated blood transfusion trigger oxidative stress resulting in numerous adverse effects in beta-thalassemia patients. Extreme elevation of triglyceride level is a rare clinical entity seen in these patients. It is presumed to be caused due to an increase in oxidative stress and is termed Hypertriglyceridemia Thalassemia Syndrome. To assess the clinical and laboratory characteristics of beta-thalassemia patients presenting with hypertriglyceridemia and its correlation with the pre-transfusion hemoglobin level. Methods: This hospital record-based retrospective study was conducted at the Dr B C Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India. The study comprised 12 pediatric beta-thalassemia patients whose plasma appeared milky or chylous during a complete hemogram. Clinical examination and laboratory investigations were done to describe their clinico-laboratory features. A whole exome sequencing was carried out to assess their genetic background. Blood hemoglobin and serum triglyceride estimation was carried out initially and at follow-up to determine any correlation between the two. Results: Out of 1482 patients, 12 (0.80 %) were diagnosed with Hypertriglyceridemia Thalassemia Syndrome. The median age of presentation was 12.5 months (Q1:10 months, Q3:14 months)., and the pretransfusion hemoglobin was 4.82 ± 1.16 g/dL. The lipid profile showed a triglyceride level of 858.3 ± 198.4 mg/dl and a total cholesterol level of 117.4± 16.15 mg/dl. Analysis revealed that the triglyceride levels were negatively correlated with the pretransfusion hemoglobin level (repeated measures correlation (rmcorr) = -0.65, 95% CI[-0.794, -0.425], p < 0.001). A genetic study highlighted c.92+5G>C as the commonest mutation. Hypertriglyceridemia was a rare presentation in transfusion-dependent beta-thalassemia patients. The serum triglyceride level significantly reduced when blood transfusion at regular intervals restored the patient's hemoglobin level.

Minimizing the error in the hemoglobin estimation of blood donors as an articulate step toward donors’ blood management

Minimizing the error in the hemoglobin estimation of blood donors as an articulate step toward donors’ blood management

First Report on Clinical Feasibility of Dried Blood Spot Technique for Hemoglobin Estimation in Cholistani Cattle

Background: The dried blood spot (DBS) technique using filter papers has revolutionized the conventional blood sampling techniques through ease of blood collection, storage and transport. Various analytes (such as hormones, antigens, antibodies and hematochemical attributes) are being estimated through DBS globally. However, this technique has not yet been implied in Pakistan. This research work is the first of its kind regarding hemoglobin (Hb) estimation in Cholistani cattle (n=63) blood through DBS technique using filter paper.Methods: Three methods of Hb estimation were implied in the present study viz. through veterinary hematology analyzer (HbA), and two indirect cyanmethemoglobin methods (HbIC and HbICX) using measured (20µL) and unmeasured blood drops on the filter paper, respectively.Results: Results revealed that HbA and HbIC were non-significantly (P≥0.05) different from each other, being different from HbICX (P≤0.05). The HbICX gave overestimated values of Hb as compared to HbA and HbIC. The sensitivity, specificity, positive predictive value, and negative predictive value for HbIC were higher being 86.1%, 88.3%, 88.0%, and 86.0%, respectively as compared to the lower values of 45.0%, 12.0%, 12.0% and 45.0%, for HbICX. Bland and Altman test revealed a better level of agreement between HbA and HbIC. Around the mean difference line, there was no proportional bias in data distribution (Mean= -0.16, 95% CI= 0.34 to -0.67). Similarly, measures attained through Cronbach alpha and intraclass correlation coefficient between HbA and HbIC were higher being 0.703 and 0.825 values for single and average, respectively, as compared to the values of 0.200 and 0.333 between HbA and HbICX.Conclusion: It is concluded that the indirect cyanmethemoglobin method for Hb estimation is reliable and accurate for cattle blood, if a measured quantity of blood drop is taken on a filter paper. We recommend this DBS technique for Hb estimation in cattle blood for resource-poor settings and for livestock herds being reared distantly from the laboratories. For future, it is recommended that DBS technique with various other modifications and for other hematochemical biomarkers may be validated for livestock blood.Keywords: Dried blood spot; Hemoglobin; Cholistani cattle

NiADA (Non-invasive Anemia Detection App), a Smartphone-Based Application With Artificial Intelligence to Measure Blood Hemoglobin in Real-Time: A Clinical Validation.

Background Anemia is a severe public health problem in India affecting more than half of the population. To reduce its burden on the population, the Government of India under the Anemia Mukt Bharat program has adopted a monitoring strategy for the diagnosis and treatment of anemia. Point-of-care testing (POCT) devices play a pivotal role in testing hemoglobin at a community level where sophisticated laboratory instruments are not available. The majority of the currently available POCT devices are invasive in nature which have their own limitations. A non-invasive method of hemoglobin estimation will address many of the limitations of an invasive POCT instrument, which will further improve people's acceptability for hemoglobin testing. The Non-Invasive Anemia Detection App (NiADA) (Monere AI Private Limited, Kolkata, West Bengal, India), a non-invasive POCT application, uses artificial intelligence (AI) to predict the hemoglobin level from lower eyelid images. This real-time, point-of-care, low-cost solution uses a custom computer vision deep-learning algorithm to determine blood hemoglobin value. Method The study validates an AI-based smartphone application NiADAagainst laboratory hemoglobin estimation and a widely used point-of-care hemoglobin estimation instrument (HemoCue Hb 301; HemoCue AB, Angelholm, Skane County, Sweden). The study was conducted in a tertiary care hospital in Eastern India and recruited a total of 556 participants. These included 58 pediatric patients, 51 pregnant women, 214 adult females, and 224 adult males. Statistical analysis was performed using Python (Python Software Foundation, Wilmington, Delaware, United States). A p-value of < 0.05 was taken to be significant. Result The mean difference observed between NiADA and laboratory-estimated hemoglobin values came out to be -0.29 g/dL and -0.89 g/dL for adult females and males respectively, and 0.61 g/dL for pregnant women and -0.69g/dL for the pediatric population. The limits of agreement for NiADA were narrow at 2.77 to -2.18 g/dL for adult females, 3.76 to -1.96 g/dL for adult males, 1.89 to -3.29 g/dL for pregnant women, and 3.28 to -2.08 g/dL for the pediatric population. The sensitivity and specificity of the NiADA application against the laboratory estimation method were 75.8% and 53.8% for adult females, 70.0% and 48.3% for adult males, 23.8% and 90% for pregnant females, and 75% and 57% for the pediatric population. Conclusion As a non-invasive application, NiADA's performance is satisfactory and comparable with minimally invasive tools like HemoCue Hb 301 and otherPOCT devices.

Burden of malaria during pregnancy in perennial transmission settings of two densely forested and remote blocks (Baihar and Birsa) of district Balaghat, Madhya Pradesh, central India.

Background Malaria in pregnancy (MIP) is a major public health problem due to the vulnerability of pregnant women to infections, resulting in adverse maternal/foetal outcomes in endemic areas. Methods We did a field-based study to assess the burden of MIP (prevalence at the time of enrolment and follow-up) and to identify risk factors for MIP in the Birsa and Baihar blocks of district Balaghat in Madhya Pradesh, which have perennial malaria transmission. Malaria screening (during 2015-2017) was done by microscopy and bivalent rapid diagnostic test (SD Bioline RDT, malaria antigen Plasmodium falciparum/Plasmodium vivax Pf/Pv). Dried blood spots were used for haemoglobin estimation. Sociodemographic details with past and present pregnancy status were obtained. A subset of pregnant women were followed up for malaria during pregnancy. Women were also screened for malaria post delivery. Malaria treatment was given as per the National Guidelines of 2013. Multivariate analysis was done to assess independent risk factors for malaria. Results A total of 1728 pregnant women were screened, of which 1651 were included in the final analysis. Malaria prevalence at first screening was 23.4% (Pf 88%). Prevalence and Pf parasitaemia both were significantly higher among primigravid (G1) compared to multigravid (G>2; p value 0.012 and 0.019, respectively). Pregnant women of the Baiga ethnic group were more likely to have malaria compared to those belonging to the Gond group (OR [95% CI]; 2.4 [1.7-3.4]; p<0.00001) and non-indigenous group (OR [95% CI]; 8.3 [3.9-19.7]; p<0.00001). Primigravid status of women, first and second trimester of pregnancy, women belonging to indigenous ethnic tribal group and cash crop insufficiency for whole year (a socioeconomic indicator) in the family were the independent risk factors for malaria. Conclusion MIP is a major public health problem in forested tribal settlements of Birsa and Baihar blocks of Balaghat district in Madhya Pradesh and requires immediate intervention.

An incidental finding of a hemoglobin E variant in a diabetic patient with an abnormal glycated hemoglobin level: a case report

BackgroundGlycated hemoglobin is a well-known marker for evaluating long-term glycemic control. However, the accuracy of glycated hemoglobin measurement can be affected by the presence of hemoglobin variants, which makes the determination and interpretation of glycated hemoglobin values in terms of glycemic control not only difficult but also misleading. Here we present the first ever case of a patient with type 2 diabetes with hemoglobin E from Nepal, diagnosed incidentally because of spurious glycated hemoglobin levels.Case presentationA 45-year-old Hindu Mongolian female with a history of type 2 diabetes for around 9 years but not very compliant with follow-ups was referred to our facility for plasma fasting and postprandial blood glucose levels and glycated hemoglobin. Fasting and postprandial blood sugars were found to be high. A consistent very low glycated hemoglobin by two different high-performance liquid chromatography (HPLC) methods compelled us to call the patient for a detailed clinical history and for the records of investigations done in the past. The patient has been a known case of type 2 diabetes for around 9 years and presented irregularly for follow-up visits. Around 4 years ago, she presented to a healthcare facility with fatigue, severe headaches, pain in the abdomen, discomfort, and dizziness for a couple of months, where she was shown to have high blood glucose. She was referred to a tertiary-level hospital in Kathmandu, where she was prescribed metformin 500 mg once daily (OD). Due to her abnormal hemoglobin A1c reports, she was then sent to the National Public Health Laboratory for repeat investigations. Her blood and urine investigations were sent. Complete blood count findings revealed high red blood cell and white blood cell counts, a low mean corpuscular volume, and a high red cell distribution width-coefficient of variation. Other parameters, including serum electrolytes, renal function tests, liver function tests, and urine routine examinations, were within normal limits. A peripheral blood smear revealed microcytic hypochromic red cells with some target cells. Hemoglobin electrophoresis showed a very high percentage of hemoglobin E, a very low percentage of hemoglobin A2, and normal proportions of hemoglobin A and hemoglobin F. A diagnosis of homozygous hemoglobin E was made, and family screening was advised.ConclusionsClinicians should be aware of the limitations of glycated hemoglobin estimation by ion exchange high-performance liquid chromatography in patients with hemoglobin E and other hemoglobin variants. If the clinical impression and glycated hemoglobin test results do not match, glycated hemoglobin values should be determined with a second method based on a different principle, and glycemic status should be confirmed through alternative investigations, preferably those that are not influenced by the presence of hemoglobin variants (for example, boronate affinity chromatography, fructosamine test, glycated albumin test, the oral glucose tolerance test, continuous glucose monitoring, etc.). Consistent or even doubtful results should also raise the suspicion of a hemoglobin variant, which should be confirmed through further evaluation and investigations.

Comparison of indirect cyanmethaemoglobin method and TrueHb haemometer point of care test with direct cyanmethaemoglobin (gold standard) method for strengthening anaemia detection at primary health care level

ABSTRACT Introduction: The most reliable indicator for anaemia diagnosis at the population level is haemoglobin (Hb) estimation. The direct cyanmethaemoglobin method is considered the gold standard method for haemoglobin estimation. However, for resource constraint areas like primary health care (PHC) level, either blood samples are transported on filter paper for Hb testing (indirect cyanmethaemoglobin method) in laboratory or point of care testing is commonly used. Therefore, a comparative analysis of haemoglobin estimation of direct with indirect cyanmethaemoglobin method and also with TrueHb (Wrig Nanosystems Pvt. Ltd.) haemometer was done to strengthen anaemia diagnosis at the PHC level. Materials and Methods: This was a cross-sectional study. A total of 90 participants above 9 years of age, who visited the outpatient department (OPD) of health centre, Kheri and gave consent were included. Comparative analysis was done between Hb concentration assessed by indirect cyanmethaemoglobin method and TrueHb haemometer device against the gold standard method. Results: The mean Hb value estimated by direct method, TrueHb haemometer and indirect methods (filter paper A, B and C) was 11.42 ± 1.59 g/dl, 11.52 ± 1.54 g/dl, 10.66 ± 1.52 g/dl, 9.84 ± 1.50 g/dl and 10.19 ± 1.62 g/dl, respectively. There was no significant difference found between the mean Hb concentration estimated by the direct method and the TrueHb haemometer device. However, there was a significant difference in mean Hb values between the direct method and the indirect method. Therefore, regression analysis was done to estimate the correction factor for the indirect method. Conclusion: TrueHb metre device gave promising results in comparison to the gold standard method and can be used if resource permits in PHC centres. Indirect methods of haemoglobin estimation can be an alternative in resource-constraint settings, specifically for surveys. However, further studies are required for the validation of the indirect method.

#2654 Erythropoietin hypo-responsiveness in haemodialysis patients, contributing factors and outcome

Abstract Background and Aims Erythropoietin (ESA) resistance or hypo-responsiveness (HR) is a condition when patients do not achieve the desired haemoglobin concentration or require incremental ESA doses to maintain stable Hb concentration. Contributing factors include iron deficiency, inflammation, infection, mineral bone disease (CKD-MBD), insufficient dialysis, malnutrition, and hematologic abnormalities. This study aimed to determine the prevalence of HR in maintenance haemodialysis (HD) population and its contributing factors. The outcome in terms of all-cause mortality and need for hospitalization over 6 months follow-up was studied. Method We prospectively studied 100 maintenance HD patients above 18 years age over one and a half years. Those with a known haematological disorder, malignancy or active infection were excluded. Enrolled patients were classified into 2 groups: 1) Initial ESA Group: Initiated on ESA therapy and had Hb less than 10 gm/dl. These were also incident HD patients. Initial ESA HR for the study was defined as any Hb increase less than 0.8 gm/dl over 1 month after initiating ESA. The ESA dose and modification remained as per current existing practice in the dialysis unit. 2) Subsequent ESA Group: Already receiving ESA therapy and on HD for at least 3 months. Patients on previously stable doses of ESA who required two increments in ESA doses up to 50% beyond the previous dose to maintain Hb were taken as HR. Patients who required Epoetin or equivalent ESA dose of more than 300 IU/kg/week were also included in HR. All underwent anaemia workup at start and monthly haemoglobin estimation. They were also tested for CRP and CKD-MBD. All were followed for 6 months; hospitalization (excluding vascular access) and mortality was noted. The Charlson comorbidity index was used to ensure equitability. Results Seventeen cases were in Initial ESA group and 83 cases were in subsequent ESA group. ESA type was not associated with responsiveness in either group. In the ‘initial’ group, 8/17 were HR. Iron deficiency was noted in 75 and 33 percent of HR vs R patients (p =0.15). Median CRP in HR group was significantly higher at 10 mg/dL (7.4-20.4) as compared to R 2.8mg/dl (1.5-4), p=0.034. Distribution of other bio-chemical parameters was comparable. HR patients had more hospitalizations (62.5% vs 22.2%; p =0.153). In subsequent ESA group 10/83 (12%) cases were HR. Mean average weekly ESA dose (IU/Kg/week) in HR (286 ± 28) was significantly higher than R group (137 ± 44, p &amp;lt;0.0001). Median CRP (mg/dL) in HR was 20.2 (8.8-27.6) and was significantly higher than R 2.6 (1.2-5.4, p=0.0001). Median iPTH (pg/mL) in HR group was 899 (801-1053) significantly higher than R 418 (242-632; p =&amp;lt;0.0001). Mean serum phosphorus (mg/dL) in HR was 6.4 ± 1.7 which was significantly higher as compared to R (5.3 ± 1.6, p value=0.038). Median ALP of 366 (276-408) IU/L in HR was significantly higher than in R 126 (93-196, p=0.0007). Both groups were equitable in adequacy. Hospitalization rate was not (60 vs 30%, p=0.09) different. Mortality rate was significantly higher in HR as compared to R (40% vs 1.4%, p=0.0005). Conclusion The study revealed a substantial occurrence of ESA hypo-responsiveness in HD population. High CRP, signifying inflammation and CKD-MBD turned out to be significant contributors to development of hypo-responsiveness. ESA hypo-responsiveness is associated with higher mortality over short term.

Low Serum Ferritin Level: A Risk Factor of Simple Febrile Seizures– A Hospital-Based Case-Control Study

Background: Febrile seizure (FS) is the single most common seizure type in children younger than 5 years. The age for peak incidence of febrile seizure is 14 to 18 months, which overlaps with that of iron deficiency anemia. Objectives: The purpose of this study was to explore the association of serum ferritin and iron deficiency anaemia with simple febrile seizures. Methods: In this case-control study 50 patients with febrile seizure were evaluated for iron deficiency anaemia by estimation of Hemoglobin%, MCV, MCH, RDW, and serum ferritin. The control group consisted of 50 febrile children of the same age group without convulsion. Data were recorded in case record form and all the outcomes were recorded. Results: In this study, the mean age of the patients was 20.48 ± 13.79 (range: 6-60) months. In the case group, the mean (± SD) Serum Ferritin level was 52.54 ± 52.64 µg/L and in the control group, the mean (± SD) S. Ferritin level was 87.40 ± 75.74 µg/L. In the case group, 46% of patients had low ferritin level and in the control group, 24% of patients had low ferritin level. Iron Deficiency Anaemia (IDA) was found among 26% of children in the case group and 14% in the control group. A statistically significant difference was found regarding mean S. Ferritin level and ferritin status between the case and control group. (Odds ratio 0.002 and 2.698) But, in the case of IDA, there was no statistically significant difference observed between the groups. Conclusion: A low ferritin level was associated with an increased risk of febrile seizures. Therefore, in children with febrile seizures, clinicians should be concerned about ferritin status even at normal hemoglobin levels. J Bangladesh Coll Phys Surg 2024; 42: 139-143

Validation of new invasive digital hemoglobinometer for hemoglobin estimation as point-of-care device among pregnant women in a facility setting India

Background: Anemia poses a significant health challenge for pregnant women (PW), and accurate and timely diagnosis is essential for effective management. Objective: The objective was to assess the diagnostic validity of the new digital hemoglobinometer for hemoglobin against laboratory-based hematology autoanalyzer among PW. Methodology: The study was conducted at a secondary-level healthcare facility among 204 pregnant women to be sampled conveniently, their sociodemographic and iron intake data collected, and hemoglobin levels assessed using a digital hemoglobinometer (Device A) and a hematology analyzer. Specificity, sensitivity, PPV, NPV, diagnostic accuracy, and method agreement were evaluated via Bland-Altman analysis and Lin's concordance correlation coefficient. Results: The proportion of anemia using the Device A was 64.7% while the hematology analyzer reported a proportion of 52.9%. Device A showed a sensitivity of 97.22%, specificity of 80.30%, and diagnostic accuracy of 86.3%, with substantial agreement indicated by Cohen's kappa coefficient (kappa = 0.72) and the weighted kappa coefficient for different grades of anemia was 0.67. Bland-Altman analysis revealed a mean difference (bias) of -0.28 (± 0.5) between the two methods, with limits of agreement at -1.24 and 0.68. Lin's concordance correlation coefficient of absolute agreement was 0.91. Conclusion: The DH showed high sensitivity and diagnostic accuracy for anemia detection in PW, with substantial agreement with the hematology analyzer. It offers a convenient and rapid alternative for POC hemoglobin estimation in resource-constrained settings.

Effect of Hemolysis on Serum Markers of Liver Function

Introduction Samples received in the laboratory are often rejected because of visible hemolysis. Every laboratory has protocols on whether to accept or reject hemolyzed samples based on tests ordered. The objective of the study was to observe and analyze the variations seen in association with hemolyzed samples in liver function test parameters and electrolytes measurement. MethodsThis cross-sectional observational study was carried out in 88 laboratory samples in the Clinical Biochemistry Laboratory. Hemolysis was induced by mechanical mixing. This study compared reported values of bilirubin, protein, albumin, aminotransferases (ALT and AST), alkaline phosphatase (ALP), gamma glutamyl transpeptidase (GGT), sodium and potassium between hemolyzed and non-hemolyzed samples. ResultsMean values of total bilirubin (TB) and direct bilirubin (TB), ALT, ALP, GGT and sodium (Na) were found to be significantly decreased post hemolysis (p&lt;=0.001) with mean variances (σ2) at 0.30 (TB), 0.38 (DB), 0.56 (ALT), 0.18 (ALP), 0.01 (GGT) and 0.001 (Na). In contrast, mean values of AST (σ2= -0.9, p&lt;0.001) and potassium (σ2 = -0.3, p&lt;0.001) were found to be significantly elevated post hemolysis. Total protein and albumin were also found to be elevated in hemolyzed samples but the average variance was not statistically significant. Degree of hemolysis had highly varying effects in some parameters like AST and total protein, but less varying and more consistent effects on other measured parameters. ConclusionFree hemoglobin estimation should be considered before rejecting a clinical sample because of hemolysis. Mathematical equations cannot be expected to reproduce corrected values of the analytes in question because of the large variances, so these tests need to be repeated on non-hemolyzed samples for the analytes that are affected.Keywords

Supportive supervision of village, health, sanitation and nutrition day (VHSND) during post-pandemic period in Assam

Background: VHSND, a community platform bringing health, early childhood development, nutrition, and sanitation services by community engagement was affected by COVID-19 pandemic. Aims &amp; Objectives: To assess the process of VHSND implementation during post-pandemic period in Assam. Methodology: This cross-sectional study was conducted as operational research in five districts of Assam, selected based on zonal representation; between Sept’2021- Aug’2022. Standard format (GOI) was used for VHSND monitoring. Descriptive analysis was done along with quarter-wise comparison of observations and knowledge of Auxiliary Nurse and Midwife (ANM). Results: A total of 370 VHSND sessions were observed. VHSND micro plan availability increased from 87.5% to 98.4% over four quarters. Displaying banners varied between 56.3% and 79.5%, and functional toilets increased from 41.3% to 77%. Height measurement improved from 58.8% to 88.5%. Haemoglobin estimation varied between 46.3% and 75.4%. Recognition of high-risk pregnancies due to severe anaemia increased from 60% to 91.8%. Regarding danger signs like bleeding from vagina increased from 50.0% to 95.1%. Conclusion: Notable progress could be documented in logistical readiness and ANM knowledge in different quarters in post-pandemic period. While service delivery and ANM counselling efforts have seen improvement, targeted interventions remain crucial for optimizing maternal and child health outcomes in the region.

Diagnostic Accuracy of Fetal Middle Cerebral Artery Peak Systolic Velocity in the Detection of Fetal Anaemia Keeping Neonatal Hae Moglobin Estimation at Birth as the Gold Standard

Objective: To assess whether monitoring the peak systolic velocity (PSV) in the middle cerebral artery (MCA) was a useful, non-invasive method for predicting anaemia in fetuses. Study Design: Cross-sectional study Place and Duration of Study: Armed Forces Institute of Radiology, Rawalpindi Pakistan, from Feb and Aug 2022. Methodology: Fifty pregnant women who did not have hydropic babies were included. The peak systolic velocity (PSV) was measured in the middle cerebral artery (MCA). A positive result was determined when the MCA-PSV value exceeded 1.5multiples of the median (MoM). The blood samples obtained from neonates were forwarded to the hospital laboratory to estimate haemoglobin levels shortly after birth. The outcome of the method (MoM) was observed and subsequently compared with neonatal haemoglobin levels. Results: 60% of neonates were anaemic according to middle MCA-PSV while the haematology laboratory reported 74% of neonates as anaemic according to cut-off haemoglobin of less than 13.5gm/dl. Sensitivity, specificity, positive predictive value(PPV), negative predictive value (NPV), and accuracy of the MCA-PSV in detecting the anaemia were 93.75%, 61.1%, 81.08%, 84.62%, and 82%, respectively. Conclusion: MCA-PSV Doppler is deemed valuable as a diagnostic technique for fetal anaemia, albeit secondary to the primary approach of neonatal haemoglobin estimation upon birth.

Estimation of haemoglobin using non-invasive portable device with spectroscopic signal application

An estimated 52% of non-pregnant women of reproductive age in India are estimated to be affected by anaemia, which is categorised as a chronic condition. In 2019–2021, the National Family Health Survey–5 (NFHS–5) which was undertaken revealed the following statistics about the prevalence of anaemia in the state of Karnataka. To estimate haemoglobin levels using non-invasive portable device among nursing students. A cross sectional study was done among students of Nursing college in central Karnataka for a period of 3 months. Total of 140 students were included in the study. EzeCheck haemoglobin estimation was done twice and was recorded in the same Google form. The frequency and percentage of variation of results between Haematology Analyzer and EzeCheck devices was presented with a range of difference such as 0, less than 1, 1.0 to 1.9, 2.0 to 2.9, 3.0 to 3.9, and 4.0 and above. The total prevalence of anaemia among nursing students was 57.8% and most of the students had moderate degree of anaemia (28.6%). Two readings of haemoglobin were taken and difference of readings were calculated and majority of the students had difference of < 0.5 gm/dl (61.4%) and only 1.4% of the students had difference of > 2 gm/dl. The mean difference of haemoglobin of two readings was 0.5 ± 0.5 gm/dl. The technology employed in this study bridges the gap between patients and anaemia diagnosis by providing screening services. The device provides the diagnosis via a non-invasive, IoT-enabled service at a low cost.

Prevalence of Anemia in Pregnant Women and Its Associated Socioeconomic Factors

Background: Anemia during pregnancy is an important public health problem, in developing countries. This community based study was conducted in Northeast India to study the prevalence of anemia along with the associated socioeconomic factors.&#x0D; Methods: The present one-year cross sectional study was carried out in the selected villages under Lahowal Block of Dibrugarh District and the relevant data was collected in a pre-designed and pre-tested proforma by house to house interviews. The sample size was calculated 310. Clinical examination was done and haemoglobin estimation was performed using Sahli’s acid hematin method. Data were analyzed in Microsoft Excel using percentage, range, t-test and ANOVA; wherever applicable. A significance level of 5% was taken with 95% confidence interval&#x0D; Results: Anemia was seen in 89.68% of the subjects. The highest mean hemoglobin (Hb) level was observed in the 1st trimester subjects (9.14 gm/dl), while the lowest mean Hb-level was observed in the 3rd trimester subjects (8.90 gm/dl). A significant difference was observed between the mean Hb-levels of the study subjects belonging to nuclear families and joint families, subjects belonging to different socio-economic status, different levels of education, different professions, those consuming tobacco and those not consuming tobacco, and those consuming betel nut and not consuming betel nut.&#x0D; Conclusion: There was a high prevalence of anemia in pregnancy which was related to the socioeconomic status, occupational status, level of education, type of family, and personal habits in these women.

Evaluation of new haematology analyser, XN-31, for malaria detection in blood donors: A single-centre study from India.

Malaria continues to be a significant public health concern in India, with several regions experiencing endemicity and sporadic outbreaks. The prevalence of malaria in blood donors, in India, varies between 0.02% and 0.07%. Common techniques to screen for malaria, in blood donors and patients, include microscopic smear examination and rapid diagnostic tests (RDTs) based on antigen detection. The aim of this study was to evaluate a new fully automated analyser, XN-31, for malaria detection, as compared with current practice of using RDT. Cross-sectional analytical study was conducted to evaluate clinical sensitivity and specificity of new automated analyser XN-31 among blood donors' samples and clinical samples (patients with suspicion of malaria) from outpatient clinic collected over between July 2021 and October 2022. No additional sample was drawn from blood donor or patient. All blood donors and patients' samples were processed by malaria rapid diagnostic test, thick-smear microscopy (MIC) and the haematology analyser XN-31. Any donor blood unit incriminated for malaria was discarded. Laboratory diagnosis using MIC was considered the 'gold standard' in the present study. Clinical sensitivity and specificity of XN-31 were compared with the gold standard. Fife thousand and five donor samples and 82 diagnostic samples were evaluated. While the clinical sensitivity and specificity for donor samples were 100%, they were 96.3% and 100% for diagnostic samples. Automated haematology analysers represent a promising solution, as they can deliver speedy and sensitive donor malaria screening assessments. This method also has the potential to be used for pre-transfusion malaria screening along with haemoglobin estimation.

Validation of ToucHb, a non-invasive haemoglobin estimation: Effective for normal ranges, needs improvement for anaemia detection.

Non-invasive methods for haemoglobin estimation hold enormous potential for early detection and treatment of anaemia, especially in limited resource settings. We sought to validate the diagnostic accuracy of ToucHb, a non-invasive haemoglobin estimation device available in the Indian market. We prospectively evaluated the diagnostic performance of the ToucHb device using the Automated complete blood count (CBC) method as the gold standard. Persons referred for haemoglobin estimation to the central laboratory of the government medical college hospital in Mysore, southern India were included in the study. Out Of 140 people approached, 127 gave consent; 65% (n = 82) were female with median age of 37 (IQR 28-45). ToucHB reported median haemoglobin value of 14 g/dL compared to 13.3 g/dL for CBC. Within 1 g/dL and 2 g/dL of CBC, 55.2% (70/127) and 74% (94/127) of ToucHb haemoglobin observations fell, respectively. The Bland-Altman plot showed a mean difference of 3 g/dL in haemoglobin between ToucHb and CBC among those with anaemia. The ToucHb device showed 22.2% sensitivity and 94.5% specificity for anaemia detection. In rural resource-limited settings, point of care non-invasive devices such as ToucHb can improve access and acceptance for anaemia screening. However, ToucHb has showed low sensitivity for anaemia detection and low accuracy at lower haemoglobin values. The utility of the instrument is especially limited in detecting anaemia, while it can estimate haemoglobin accurately among those with haemoglobin is in the normal range. Based on these findings, ToucHb and devices that work on the core technology deployed in ToucHb may be better suited to monitor known haemoglobin level rather than in anaemia screening or detection in primary/ secondary care and community settings.