University Journal of Medicine and Medical Specialities
ISSN 2455- 2852 2021, Vol. 7(5)
Diagnostic Accuracy of Hemoglobin Estimation by Point of Care Devices: A
Comparative Study with the Automated Hematology Analyzer
Akila R, Priya banthavi S and Pramila R
Department of Pathology, Chennai Medical College Hospital and Research Centre, Trichy
ABSTRACT In several situations, these devices might suitably replace
traditional laboratory testing, including several areas of health
Hemoglobin (Hb) estimation for the assessment of care where a very rapid hemoglobin measurement might be
anemia can be done by various methods. Each of these required to make immediate therapeutic decisions. For
methods have their own advantages and limitations. The instance, it could be imperative in patients who require critical
present study was conducted to assess the accuracy of venous access, especially neonates and those undergoing
the commonly used point of care devices - HemoCue chemotherapy due to the low amount of blood required by
301 and Handyspan, a portable hemocalorimeter to these devices, as well as in natural disasters or in sports
assess haemoglobin against the automated hematology medicine.
analyzer Coulter 780. Hb was assessed in fifty blood
samples by utilizing the HemoCue, Handyspan and AIMS AND OBJECTIVES
Automated hematology analyzer Coulter 780. The results
by HemoCue and Handyspan devices were comparable The aims and objectives of the current study are to
with that obtained by the automated hematology analyzer
Coulter 780. Hence it was derived that the Point of care compare the hemoglobin values obtained by automated
devices such as HemoCue and portable hemocalorimetry hematology analyzer Coulter 780 with the point of care
(Handyspan) are as accurate as the Automated devices (POCD) such as Hemocue and portable
hematology analyzer Coulter 780. hemocalorimetry (Handyspan) and to evaluate the
diagnostic accuracy of these Point of care devices.
MATERIALS AND METHODS
Keywords: Hemoglobin, Cyanmethemoglobin, Automated
methods, HemoCue, Handyspan, Point of care devices Hemoglobin was estimated from the venous and
(POCD) capillary blood samples collected from fifty adults using
Hemocue, Handyspan and Automated hematology analyzer
INTRODUCTION Coulter 780 method.
Hemoglobin estimation is the most frequent HEMOCUEHB 301 METHOD
laboratory investigation requested in clinical practice.
Different methods are used to estimate the hemoglobin in The fingertip is pricked with a sterile lance after
the blood. cleaning the finger with 70% alcohol. Wipe away first 2-3
drops of blood. Fill the microcuvette in one continous process
Besides the use of traditional laboratory resources, with 10 microlitres of blood. Place the filled cuvette in the
the diagnosis of anemia can also be accomplished by cuvette holder. After 10 seconds the hemoglobin
assessing hemoglobin (Hb) concentration with measurement is made. This is a photoetric method based on
Point-of-care testing (POCT) devices such as the the determination of azide methemoglobin.
HemoCue, portable hemocalorimetry (Handyspan) test
systems.
An Initiative of The Tamil Nadu Dr. M.G.R. Medical University
University Journal of Medicine and Medical Specialities
The results obtained by the three methods were
HANDYSPAN METHOD
compared using appropriate statistical methods.
The hemoglobin level is estimated using
RESULTS
alkali-haematin method. The blood is diluted using an
alkaline solution containing a non-ionic detergent at pH 13.0.
Frequency Table
This converts all hemoglobin derivatives into a stable end
product, alkali-hematin. The absorbance maxima of
Age
alkali-hematin is at 575nm. Absorbance of alkali hematin is
directly proportional to hemoglobin concentration in blood.
Absorbance of test Particulars No. of respondents Percentage
Hemoglobin concentrat ion (gm/dl) Concentrat ion of standard
Absorbance of standard
21 to 30yrs 9 18.0
31 to 40yrs 5 10.0
41 to 50yrs 12 24.0
51 to 60yrs 15 30.0
61 to 70yrs 9 18.0
Total 50 100.0
One third (30 per cent) of the respondents were in 51
to 60yrs of age group.
Sex
Particulars No. of respondents Percentage
Male 33 66.0
AUTOMATED HEMATOLOGY ANALYZER COULTER 780 Female 17 34.0
The lytic reagent rapidly and simultaneously destroys Total 50 100.0
the erythrocytes and converts a substantial proportion of
the hemoglobin to a stable pigment. The absorbance of the Majority (66 per cent) of the respondents were male.
pigment is directly proportional to the hemoglobin
concentration of the sample. The accuracy of this method
equals that of the hemiglobincyanide method, the reference
method of choice hemoglobinometry recommended by the
International committee for standardization in hematology.
An Initiative of The Tamil Nadu Dr. M.G.R. Medical University
University Journal of Medicine and Medical Specialities
One way ANOVA difference between age of the respondents and their method of Auto, Hemocue and Handy Span
Statistical
Age n Mean S.D SS Df MS
inference
Auto
Between Groups 80.102 4 20.026
21 to 30yrs 9 12.6778 2.23594
31 to 40yrs 5 14.7800 .95760
F=2.593
41 to 50yrs 12 11.5250 2.86773 .049>0.05
Not Significant
51 to 60yrs 15 10.6733 2.97453
61 to 70yrs 9 12.9667 3.34664
Within Groups 347.595 45 7.724
Hemocue
Between Groups 88.477 4 22.119
21 to 30yrs 9 13.3444 2.23725
31 to 40yrs 5 15.3600 1.04547
F=2.887
41 to 50yrs 12 12.1500 2.83148 .033<0.05
Significant
51 to 60yrs 15 11.1200 2.99647
61 to 70yrs 9 13.6667 3.28748
Within Groups 344.768 45 7.662
Span
Between Groups 63.072 4 15.768
21 to 30yrs 9 12.0889 2.29970
31 to 40yrs 5 14.5400 1.07378
F=1.956
41 to 50yrs 12 11.7750 2.88164 .118>0.05
Not Significant
51 to 60yrs 15 10.8267 2.74447
61 to 70yrs 9 13.0333 3.85681
Within Groups 362.713 45 8.060
Statistical test: One way ANOVA ‘f’ test was used the T-Test
above table
Statistical
n Mean S.D
inference
The above table auto methods of mean ± S.D values Auto
from 21 to 30yrs age group (n=9) 12.6778 ± 2.23594, 31 to t=3.987
Male 33 13.1091 2.78336 df=48
40yrs age group (n=5) 14.7800 ± 0.95760, 41 to 50yrs age
0.000<0.05
group (n=12) 11.52.50 ± 2.86773, 51 to 60yrs age group Female 17 10.0294 2.14148 Significant
(n=15) 10.6733 ± 2.97453 and remaining 61 to 70yrs age Hemocue
group (n=9) 12.9667 ± 3.34664. Therefore, there is no t=3.998
Male 33 13.7061 2.79586
significant difference between age of the respondents and df=48
their auto methods. Hence, the calculated value greater than 0.000<0.05
Female 17 10.6000 2.16304 Significant
table value (0.049>0.05)
Span
Male 33 13.0939 2.77409 t=3.983
df=48
Female 17 10.0235 2.14695 0.000<0.05
Significant
An Initiative of The Tamil Nadu Dr. M.G.R. Medical University
University Journal of Medicine and Medical Specialities
Paired Sample ‘t’ test
Statistical Statistical
n Mean S.D Correlation Mean S.D t df
inference inference
Auto 50 12.0620 2.95441
0.000<0.05 - 0.000<0.05
.997 -.5880 .24714 49
Significant 16.824 Significant
Hemocue 50 12.6500 2.97351
Statistical Statistical
n Mean S.D Correlation Mean S.D t df
inference inference
Auto 50 12.0620 2.95441 .899>0.05
0.000<0.05
.975 .0120 .66567 .127 49 Not
Significant
Span 50 12.0500 2.94779 Significant
Statistical Statistical
n Mean S.D Correlation Mean S.D t df
inference inference
Hemocue 50 12.6500 2.97351 0.000<0.05
0.000<0.05
.973 .6000 .69429 6.111 49 Significant
Significant
Span 50 12.0500 2.94779 0
Descriptive Statistics
n Min. Max. Mean S.D
Age 50 21 70 47.36 14.659
Auto 50 6.00 19.10 12.0620 2.95441
Hemocue 50 6.40 19.90 12.6500 2.97351
Span 50 6.20 19.70 12.0500 2.94779
Karl Pearson coefficient correlation relationship between auto, haemacu and their span
Mean S.D Auto Haemacu Span
Auto 12.0620 2.95441 1 .997(**) .975(**)
Hemocue 12.6500 2.97351 .997(**) 1 .973(**)
Span 12.0500 2.94779 .975(**) .973(**) 1
n 50 50 50
** Correlation is significant at the 0.01 level
Statistical test: Karl Pearson coefficient correlation test was used the above hypothesis table
The above table indicates that there is a significant This might happen in any health care context where
relationship between automated, Hemocue and Handyspan. the clinical laboratory is too far, making turnaround time
Hence, the calculated value is less than table value incompatible with a fast triage (e.g., in decentralized health
(p**<0.05). So the research hypothesis is accepted. care facilities with no support of a clinical laboratory unit
within a network or those organized according to a
DISCUSSION hub-and-spoke model), or in hospital units where the fastest
possible turnaround time from shipping a sample for Hb
There are several reasons supporting the use of assessment to the core laboratory might still be insufficient
POCD devices, including those for Hb assessment, in clinical (e.g., critical hemorrhages in the operating room, intensive
and laboratory practice. First, saving time is critical in several care patients)9.10.
areas of health care, where a very rapid Hb measurement
The availability of POCD for Hb assessment is also
might be required to make immediate therapeutic decisions.
valuable due to the low amount of blood required by these
devices in patients requiring critical venous access,
especially neonates and those undergoing chemotherapy.
An Initiative of The Tamil Nadu Dr. M.G.R. Medical University
University Journal of Medicine and Medical Specialities
The use of POCD devices also represents the best 5. Gomez-Simon, A., Navarro-Nunez, L., Perez-Ceballos, E.,
option in the unfortunate circumstance of natural disasters, Lozano, M. L., Candela, M. J., Cascales, A., Martinez, C.,
where there is a compelling need to convey laboratory Corral, J., Vicente, V., Rivera, J. Evaluation of Four Rapid
technologies that can be easily transported, installed, and Methods for Hemoglobin Screening of Whole Blood Donors
appropriately used outside the traditional laboratory in Mobile Collection Settings. Transfus. Apher. Sci. 2007, 36
environment. (3), 235–242.
Sports medicine is another ideal context for POCD, 6. Bahadur, S., Jain, S., Jain, M. Estimation of Hemoglobin in
where rapid test results might guide the application of Blood Donors: A Comparative Study Using HemoCue and
specific training regimens and testing when carried out with Cell Counter. Transfus. Apher. Sci. 2010, 43(2), 155–157.
rigorous preanalytical and analytical requirements8.
7. Nkrumah, B., Nguah, S. B., Sarpong, N., Dekker, D.,
In all these situations, POCD devices such as the Idriss, A., May, J., Adu-Sarkodie, Y. Hemoglobin Estimation
HemoCue and Handyspan might yield accurate Hb results by the HemoCue® Portable Hemoglobin Photometer in a
within seconds, with a small amount of sample required and Resource Poor Setting. BMC Clin. Pathol. 2011, 11, 5.
thereby less discomfort9,11.
8. Banfi, G., Drago, L., Lippi, G. Analytical Variability in
Our study reveals that there is no significant Athletes Haematological Testing. Int. J. Sports Med. 2010, 31
difference in the results obtained on statistical analysis of (3), 218.
hemoglobin estimation by the above three
methods-HemoCue, Handyspan and automated hematology 9. Mimoz, O., Frasca, D., Medard, A., Soubiron, L., Debaene,
analyzer coulter 780 . B., Dahyot-Fizelier, C. Reliability of the HemoCue®
Hemoglobinometer in Critically Ill Patients: A Prospective
Diagnostic accuracy of Hemoglobin estimation by Observational Study. Minerva Anestesiol. 2011, 77
point of care devices with Automated Hematology Analyzer
(10), 979–985.
Method has been proved in our study. Therefore anyone of
these methods can be used depending upon the 10. Seguin, P., Kleiber, A., Chanavaz, C., Morcet, J.,
accessibility and cost affectivity. Malledant, Y. Determination of Capillary Hemoglobin Levels
Using the HemoCue System in Intensive Care Patients. J.
CONCLUSION
Crit. Care 2011, 26(4), 423–427.
It was concluded that the Hemoglobin (Hb)
11. Lamhaut, L., Apriotesei, R., Combes, X., Lejay, M., Carli,
estimation done using point of care devices - Hemocue Hb
P., Vivien, B. Comparison of the Accuracy of Noninvasive
301 and Handyspan inspite of the different working
Hemoglobin Monitoring by Spectrophotometry (SpHb) and
principles were found to correlate with the standard
HemoCue® with Automated Laboratory Hemoglobin
Automated hematology analyzer coulter 780 method.
Measurement. Anesthesiology 2011, 115(3), 548–554.
It is therefore recommended that for small samples
and preliminary parameters like hemoglobin POCD methods 12. Spielmann, N., Mauch, J., Madjdpour, C., Schmugge, M.,
can be employed since these are cost effective, easy in Weiss, M., Haas, T. Accuracy and Precision of Hemoglobin
operation, requires less training and feasible to be used in Point-of-Care Testing during Major Pediatric Surgery. Int. J.
field work. Moreover these PCOD methods have also been Lab. Hematol. 2012, 34(1), 86–90.
proven to have good diagnostic accuracy. 13.valuation of alkaline hematin D-575method for hemoglobin
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University Journal of Medicine and Medical Specialities
