Hb estimation at point of care using cyanmethaemoglobin method
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20213559Keywords:
Hb estimation, Direct cyanmethaemoglobin method, Indirect cyanmethaemoglobin method, Accuracy, Anaemia, Point of careAbstract
Background: Accurate estimation of haemoglobin (Hb) is an essential prerequisite for detection of anaemia and for assessing response to treatment. In India the gold standard cyanmethaemoglobin method is used for estimation of Hb in tertiary care institutions but accurate methods for Hb estimation are not being used in primary and secondary healthcare settings. Major national surveys have demonstrated the feasibility and accuracy of Hb estimation by indirect cyanmethaemoglobin method (ICM). However, ICM has not been used for Hb estimation in point of care because of reports that ICM underestimates Hb. A study was taken up to compare the accuracy of Hb estimation by direct (DCM) and indirect cyanmethaemoglobin (ICM) method.
Methods: ANMs and laboratory technicians pipetted out duplicate samples of blood for both direct and indirect Hb estimation. Another trained laboratory technician undertook Hb estimation using colorimeter in all samples. Hb values between duplicates were compared.
Results: There was excellent concordance between means and frequency distribution of Hb values between duplicates when Hb in both were estimated using DCM or ICM and also when Hb estimation was done by DCM in one and ICM in the other. Bland Altman Plots confirmed that across Hb levels there was excellent concordance between direct and indirect method of Hb estimation.
Conclusions: Indirect cyanmethaemoglobin method is accurate. It can be used at point of care for screening for anaemia and assessing improvement in Hb after treatment especially in primary and secondary health care settings.
References
Stevens GA, Finucane MM, De-Regil LM, Paciorek CJ, Flaxman SR, Branca F, et al, Nutrition Impact Model Study Group. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995–2011: a systematic analysis of population-representative data. The Lancet Global Health. 2013;1(1):e16-25.
WHO The global prevalence of anaemia 2011. http://www.who.int/nutrition/publications/micronutrients/global_prevalence_anaemia./en/. 2015 Accessed on 2nd June, 2021.
Nutritional anaemias. Report of a WHO scientific group. Geneva, World Health Organization, (WHO Technical Report Series, No.405). 1968. http://whqlibdoc.who.int/trs/WHO_TRS_405.pdf Accessed on 2nd June, 2021.
Ministry of Health and Family Welfare (MoHFW) Prophylaxis against nutritional anaemia among mothers and children Technical Information, MCH No. 1 New Delhi. 1970.
MoHFW. Policy on control of nutritional anaemia MoHFW, New. Delhi1991.
DeMaeyer EM, Dallman P, Gurney JM, Hallberg L, Sood SK, Srikantia SG, World Health Organization. Preventing and controlling iron deficiency anaemia through primary health care: a guide for health administrators and programme managers. World Health Organization. 1989.
National Nutrition Monitoring Bureau (NNMB) Technical Report No. 22 Prevalence of Micronutrient Deficiencies Hyderabad: National Institute of Nutrition; 2003. http://www.nnmbindia. org/NNMB%20MND%20 REPORT%202004-Web.pdf Accessed on 2nd June, 2021.
NNMB National Nutrition Monitoring bureau repeat survey. 2012. nnmbindia.org/1_NNMB_Third_ Repeat_R ural_Survey_Technicl_Report_26.pdf. Accessed on 2nd June, 2021.
IIPS DLHS- 2 District Level Household and Facility Survey. 2005. http://www.rchiips.org/PRCH-2.html, Accessed on 2nd June, 2021.
IIPS DLHS-4 District Level Household and Facility Survey. 2014. http://www.rchiips.org/DLHS-4.html, Accessed on 2nd June, 2021.
Registrar General of India Annual Health Survey: CAB Component. 2015. http://www.censusindia .gov.in/2011census/hh-series/cab.html. Accessed on 2nd June, 2021.
WHO Technical Report Series, No 182 Iron deficiency anaemia: report of a study group meeting held in Geneva. 1959. https://scholar.google .co.in/scholar?hl=en&as_sdt=0%2C5&q=Iron+deficiency+anaemia%3A+report+of+a+study+group+&btnG=. Accessed on 2nd June, 2021.
WHO Technical Report Series, No. 405,: Nutritional anaemias: report of a WHO Scientific Group. 1968. https://scholar.google.co.in/scholar?hl=en&as_sdt=0%2C5&q=21.%09WHO+Technical+Report+Series%2C+No.+405%2C%3A+Nutritional+anaemias%3A+report+of+a+WHO+Scientific+Group.+1968+&btnG=. Accessed on 2nd June, 2021.
International Committee on standards: expert Panel on haemoglobinometry: Recommendation for reference method for haemoglobinometry in human blood. Journal of Clinical Pathology. 1996;49:271-4.
Sari M, Pee SD, Martini E, Herman S, Bloem MW, Yip R. Estimating the prevalence of anaemia: a comparison of three methods. Bulletin of the World Health Organization. 2001;79:506-11.
Sobhy S, Rogozinska E, Khan KS. Accuracy of on-site tests to detect anemia during prenatal care. International Journal of Gynecology and Obstetrics. 2017;139(2):130-6.
Srivastava T, Negandhi H, Neogi SB, Sharma J, Saxena R. Methods for hemoglobin estimation: a review of “What Works”. J Hematol Transfus. 2014;2(3):1028.
Singh A, Dubey A, Sonker A, Chaudhary R. Evaluation of various methods of point-of-care testing of haemoglobin concentration in blood donors. Blood Transfusion. 2015;13(2):233.
Sumathi S, Tinku T, Beena B, Kurpad AV. Point of care haemoglobin estimation. Indian Journal of Community Health. 2018;30:108-14.
Anand H, Mir R, Saxena R. Hemoglobin color scale a diagnostic dilemma. Indian Journal of Pathology and Microbiology. 2009;52(3):360.
Marn H, Critchley JA. Accuracy of the WHO Haemoglobin Colour Scale for the diagnosis of anaemia in primary health care settings in low-income countries: a systematic review and meta-analysis. The Lancet Global Health. 2016;4(4):e251-65.
Barduagni P, Ahmed AS, Curtale F, Raafat M, Soliman L. Performance of Sahli and colour scale methods in diagnosing anaemia among school children in low prevalence areas. Tropical Medicine & International Health. 2003;8(7):615-8.
Kapoor SK, Kapil U, Dwivedi SN, Anand K, Pathak P, Singh P. Comparison of HemoCue method with cyanmethemoglobin method for estimation of hemoglobin. Indian pediatrics. 2002;39(8):743-6.
Mohanram M, Rao GR, Sastry JG. A comparative study on prevalence of anaemia in women by cyanmethaemoglobin and HemoCue methods. Indian Journal of Community Medicine. 2002;27(2):58.
Ramachandran P, Kalaivani K. Prevalence of anaemia in India and strategies for achieving Sustainable Development Goals (SDG) target. InProc Indian Natn Sci Acad. 2018;84(4):899-912.
Rout D, Sachdev S, Marwaha N. Evaluation of new non-invasive & conventional invasive methods of haemoglobin estimation in blood donors. The Indian journal of medical research. 2019;149(6):755-9.