Comparing Non-Invasive Spectrophotometry to Hematology Analysis for Hemoglobin Measurements in Sickle Cell Disease Patients

Overview

Journal J Clin Med

Specialty General Medicine

Date 2023 Dec 23

PMID 38137588

Authors

Khaled Yassen

Nawal Omer

Fatimah Alsahaf

Fatima Al Amer

Fatimah Alhamad

Imran Alherz

Abdulaziz Bushehab

Fatma Alniniya

Maryam Alwabari

Affiliations

Soon will be listed here.

Abstract

Patients with sickle cell disease (SCD) require repeated blood sampling for hemoglobin (Hb) concentration measurements. The primary aim of this study was to compare non-invasive spectrophotometric hemoglobin (SpHb, g/dL) measurements to those taken via an automated hematology analyzer (Hb, g/dL) in patients with SCD visiting outpatient clinics and to investigate the correlations and agreements between both measurement techniques. Secondarily, we aimed to identify the SpHb cut-off concentration for the diagnosis of anemia and to monitor the effects of the pleth variability index (PVI, %) and perfusion index (PI) on SpHb measurements. The results gained from the examination of one hundred and fifty-eight patients indicated that the SpHb measurements overestimated the lab Hb concentrations, with a mean (SpHb-Hb) bias of 0.82 g/dL (SD 1.29). The SpHb measurements were positively correlated with the Hb measurements (Kendall's tau correlation (τ), = 158, τ = 0.68, < 0.001), with an intra-class correlation (ICC) of 0.67 and a 95% CI from 0.57 to 0.74 ( = 0.000). The SpHb cut-off concentration to diagnose anemia was 11.4 and 11.7 g/dL for males and females, respectively. SpHb sensitivity was low for males and females at 64.4% and 57.1%; however, the specificity was higher at 90.9% and 75%, with positive predictive values (PPVs) of 95.6 and 85.7, respectively. No correlation existed between SpHb measurements and the PVI (%) in contrast with a moderate correlation with the PI (r = 0.049, = 0.54, and r = 0.36, < 0.001, respectively). The mean PI was low at 2.52 ± 1.7. In conclusion, the SpHb measurements were consistently higher than the lab Hb concentrations, with a positive correlation. The sensitivity and precision of the SpHb measurements were lower than expected. However, the SpHb specificity and its positive predictive values (PPVs) indicated that it is less likely for a patient with a positive SpHb test result for anemia to be non-anemic. These results will allow SpHb measurement to play a role in excluding the presence of anemia. In light of the low PI values determined, the SpHb measurements were challenging to take and, thus, require further technological improvements.

References

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. DOI: 10.1097/CCM.0b013e3182227e2d. View

Alabdulaali M . Sickle cell disease patients in eastern province of Saudi Arabia suffer less severe acute chest syndrome than patients with African haplotypes. Ann Thorac Med. 2009; 2(4):158-62. PMC: 2732097. DOI: 10.4103/1817-1737.36550. View

Elwood P, Jacobs A . Haemoglobin estimation: a comparison of different techniques. Br Med J. 1966; 1(5478):20-4. PMC: 1845258. DOI: 10.1136/bmj.1.5478.20. View

Miller R, Ward T, McCulloch C, Cohen N . Does a digital regional nerve block improve the accuracy of noninvasive hemoglobin monitoring?. J Anesth. 2012; 26(6):845-50. DOI: 10.1007/s00540-012-1452-0. View

Czempik P, Pluta M, Krzych L . Hemoglobin Determination Using Pulse Co-Oximetry and Reduced-Volume Blood Gas Analysis in the Critically Ill: A Prospective Cohort Study. Diagnostics (Basel). 2022; 12(12). PMC: 9776962. DOI: 10.3390/diagnostics12122908. View

Mantha S, Roizen M, Fleisher L, Thisted R, Foss J . Comparing methods of clinical measurement: reporting standards for bland and altman analysis. Anesth Analg. 2000; 90(3):593-602. DOI: 10.1097/00000539-200003000-00018. View

Macknet M, Allard M, Applegate 2nd R, Rook J . The accuracy of noninvasive and continuous total hemoglobin measurement by pulse CO-Oximetry in human subjects undergoing hemodilution. Anesth Analg. 2010; 111(6):1424-6. DOI: 10.1213/ANE.0b013e3181fc74b9. View

Barker S, Badal J . The measurement of dyshemoglobins and total hemoglobin by pulse oximetry. Curr Opin Anaesthesiol. 2008; 21(6):805-10. DOI: 10.1097/ACO.0b013e328316bb6f. View

Hiscock R, Kumar D, Simmons S . 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. DOI: 10.1177/0310057X1504300310. View

10.

Kavanagh P, Fasipe T, Wun T . Sickle Cell Disease: A Review. JAMA. 2022; 328(1):57-68. DOI: 10.1001/jama.2022.10233. View

11.

Chaudhary R, Dubey A, Sonker A . Techniques used for the screening of hemoglobin levels in blood donors: current insights and future directions. J Blood Med. 2017; 8:75-88. PMC: 5503668. DOI: 10.2147/JBM.S103788. View

12.

Gomaa D, Rodriquez Jr D, Petro M, Blakeman T, Branson R . Impact of Oxygenation Status on the Noninvasive Measurement of Hemoglobin. Mil Med. 2017; 182(S1):87-91. DOI: 10.7205/MILMED-D-16-00137. View

13.

Khalafallah A, Chilvers C, Thomas M, Chilvers C, Sexton M, Vialle M . Usefulness of non-invasive spectrophotometric haemoglobin estimation for detecting low haemoglobin levels when compared with a standard laboratory assay for preoperative assessment. Br J Anaesth. 2014; 114(4):669-76. DOI: 10.1093/bja/aeu403. View

14.

Jastaniah W . Epidemiology of sickle cell disease in Saudi Arabia. Ann Saudi Med. 2011; 31(3):289-93. PMC: 3119971. DOI: 10.4103/0256-4947.81540. View

15.

Young M, Raines K, Jameel F, Sidi M, Oliveira-Streiff S, Nwajei P . Non-invasive hemoglobin measurement devices require refinement to match diagnostic performance with their high level of usability and acceptability. PLoS One. 2021; 16(7):e0254629. PMC: 8284642. DOI: 10.1371/journal.pone.0254629. View

16.

Vos J, Kalmar A, Struys M, Porte R, Wietasch J, Scheeren T . Accuracy of non-invasive measurement of haemoglobin concentration by pulse co-oximetry during steady-state and dynamic conditions in liver surgery. Br J Anaesth. 2012; 109(4):522-8. DOI: 10.1093/bja/aes234. View

17.

Neumayr L, Hoppe C, Brown C . Sickle cell disease: current treatment and emerging therapies. Am J Manag Care. 2019; 25(18 Suppl):S335-S343. View

18.

Honnef G, Auinger D, Eichinger M, Eichlseder M, Metnitz P, Rief M . Evaluation of the usefulness of non-invasive serum haemoglobin measurement in a perioperative setting in a prospective observational study. Sci Rep. 2022; 12(1):9065. PMC: 9153232. DOI: 10.1038/s41598-022-13285-z. View

19.

Gayat E, Aulagnier J, Matthieu E, Boisson M, Fischler M . Non-invasive measurement of hemoglobin: assessment of two different point-of-care technologies. PLoS One. 2012; 7(1):e30065. PMC: 3253126. DOI: 10.1371/journal.pone.0030065. View

20.

Park S, Lee O, Park Y, Shin H, Kang H, Baek C . The changes of non-invasive hemoglobin and perfusion index of Pulse CO-Oximetry during induction of general anesthesia. Korean J Anesthesiol. 2015; 68(4):352-7. PMC: 4524933. DOI: 10.4097/kjae.2015.68.4.352. View