Point-of-care Hemoglobin Measurement in Comparison with Hematology Analyzer: A Cross-sectional Study in Emergency Department

Abstract

Introduction: Point-of-care hemoglobin testing devices can help emergency physicians to make their clinical decisions in a timelier manner.  They can also improve the patient care process by decreasing the length of stay and costs. Although different devices are available now, their diagnostic accuracy remains still uncertain. 
Objective: This study compares the results of hemoglobin levels measured by a point-of-care hemoglobin testing device and central lab auto-analyzer. 
Methods: Hemoglobin level was measured both by a point-of-care device (Mission® Plus Hb) and the central laboratory auto-analyzer (Sysmex KX-21N™) in medical cases presenting to emergency department (ED) and requiring hemoglobin (Hb)/hematocrit (Hct) level measurement. The agreement of Hb and Hct between the two methods was assessed based on intraclass correlation coefficient (ICC), Bland-Altman analysis and the Mountain plots. Also, time gap between point-of-care testing and preparation of central lab results was measured. 
Results: Hb and Hct were measured in 86 cases mostly presented because of gastrointestinal bleeding. We found a good agreement between the two methods for hemoglobin (ICC=0.985) and hematocrit levels (ICC=0.991). The bias was 0.09 and 95% limits of agreement (LoA) were -0.89 to 1.07 for Hb level. Mean of time delay between point-of-care testing and preparation of central lab results was 207.31 minutes (SD=93.66) and this delay was clinically significant (p=0.001). 
Conclusion: Point-of-care measurement of Hb level provides proper quantitative results in ED patients. It significantly decreases laboratory turnaround time and may be used to improve the patient throughput by decreasing the length of stay in most clinical settings.

1. Howerton D, Anderson N, Bosse D, Granade S, Westbrook G. Survey Findings from Testing Sites Holding a Certificate of Waiver Under the Clinical Laboratory Improvement Amendments of 1988 and Recommendations for Promoting Quality Testing. MMWR, Recommendations and Reports, Nov. 2005;11:54. Available at: www.cdc.gov/mmwr/preview/mmwrhtml/rr5413a1.htm.
2. Giuliano KK, Grant ME. Blood analysis at the point of care: issues in application for use in critically ill patients. AACN Clin Issues.2002;13(2):204-20.
3. Berkow L, Rotolo S, Mirski E. Continuous noninvasive hemoglobin monitoring during complex spine surgery. Anesth Analg. 2011;113(6):1396-402.
4. Frasca D, Dahyot-Fizelier C, Catherine K, Levrat Q, Debaene B, Mimoz O. Accuracy of a continuous noninvasive hemoglobin monitor in intensive care unit patients. Crit Care Med. 2011;39(10):2277-82.
5. Figueiredo S, Taconet C, Harrois A, Hamada S, Gauss T, Raux M, et al. How useful are hemoglobin concentration and its variations to predict significant hemorrhage in the early phase of trauma? A multicentric cohort study. Ann Intensive Care. 2018;8(1):76.
6. Briggs C, Kimber S, Green L. Where are we at with point-of-care testing in haematology? Br J Haematol. 2012;158(6):679-90.
7. Lamhaut L, Apriotesei R, Combes X, Lejay M, Carli P, Vivien B. Comparison of the accuracy of noninvasive hemoglobin monitoring by spectrophotometry (SpHb) and HemoCue® with automated laboratory hemoglobin measurement. Anesthesiology. 2011;115(3):548-54.
8. Begnoche V, O'Reilly M. Hemoglobin Monitoring. In: Ehrenfeld J, Cannesson M, ed. Monitoring Technologies in Acute Care Environments A comprehensive guide to patient monitoring. New York: Springer Science, 2014. pp.299-304.
9. Raikhe M. Accuracy of noninvasive and invasive point-of-care total blood hemoglobin measurement in an outpatient setting. Postgrad Med. 2012;124(4):250-5.
10. Dolscheid-Pommerich RC, Dolscheid S, Grigutsch D, Stoffel-Wagner B, Graeff I. Comparability of point-of-care versus central laboratory hemoglobin determination in emergency patients at a supra-maximal care hospital. PloS One. 2016;11(11):e0166521.
11. Rechner IJ, Twigg A, Davies AF, Imong S. Evaluation of the HemoCue compared with the Coulter STKS for measurement of neonatal haemoglobin. Arch Dis Child Fetal Neonatal Ed. 2002;86(3):F188-9.
12. Nkrumah B, Nguah SB, Sarpong N, Dekker D, Idriss A, May J, et al. Hemoglobin estimation by the HemoCue® portable hemoglobin photometer in a resource poor setting. BMC Clin Pathol. 2011;11(1):5.
13. Radtke H, Polat G, Kalus U, Salama A, Kiesewetter H. Hemoglobin screening in prospective blood donors: comparison of different blood samples and different quantitative methods. Transfus Apher Sci. 2005;33(1):31-5.
14. Adam I, Ahmed S, Mahmoud M, Yassin M. Comparison of HemoCue® hemoglobin-meter and automated hematology analyzer in measurement of hemoglobin levels in pregnant women at Khartoum hospital, Sudan. Diagn Pathol.2012;7:30.
15. Seguin P, Kleiber A, Chanavaz C, Morcet J, Mallédant Y. Determination of capillary hemoglobin levels using the HemoCue system in intensive care patients. J Crit Care. 2011;26(4):423-7.
16. Kim SH, Lilot M, Murphy LS, Sidhu KS, Yu Z, Rinehart J, et al. Accuracy of continuous noninvasive hemoglobin monitoring: a systematic review and meta-analysis. Anesth Analg. 2014;119(2):332-46.
17. Hiscock R, Kumar D, Simmons SW. Systematic review and meta-analysis of method comparison studies of Masimo pulse co-oximeters (Radical-7™ or Pronto-7™) and HemoCue® absorption spectrometers (B-Hemoglobin or 201+) with laboratory haemoglobin estimation. Anaesth Intensive Care. 2015;43(3):341-50.
18. Nichols JH. Quality in point-of-care testing. Expert Rev Mol Diagn. 2003;3(5):563-72.
19. Lewandrowski K, Gregory K, Macmillan D. Assuring quality in point-of-care testing: evolution of technologies, informatics, and program management. Arch Pathol Lab Med. 2011;135(11):1405-14.
20. Briggs C, Kimber S, Green L. Where are we at with point-of-care testing in haematology? Br J Haematol. 2012;158(6):679-90.
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IssueVol 4 No 4 (2020): Autumn (October) QRcode
SectionOriginal article
Keywords
Emergency Service, Hospital Hemoglobin Laboratory Proficiency Testing Point-of-Care Testing

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How to Cite
1.
Arhamidolatabadi A, Hatamabadi H, Amini K. Point-of-care Hemoglobin Measurement in Comparison with Hematology Analyzer: A Cross-sectional Study in Emergency Department. Front Emerg Med. 2019;4(4):e82.

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