A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level
January 19th, 2024
An accurate hemoglobin estimation method is lacking at the point of care and may hinder population-based programs for treating anemia. Therefore, we developed a point-of-care method based on pooled capillary blood and an auto-analyzer integrated into a custom software application to categorize the hemoglobin values into different grades of anemia.
Anemia is a major public health problem in India. Screen and trained approach is considered to be a promising strategy for tackling anemia. However, there are no methods established so far, which could make this possible at the point of care.
We tried to establish a point of care method for hemoglobin estimation. This we also tried to integrate this method into a custom software which decides whether a participant is anemic or not, and based on the hemoglobin levels, the inbuilt algorithm in the software also guides the treatment, and all this happens within a few seconds. Using this protocol, we can obtain accurate results on hemoglobin estimation while reducing turnaround time of test results.
This will enable rapid decision-making on the initiation of treatment. Moreover, it would result in improved intervention delivery. This integrated method can be used as a job aid for the medical staff to decide on IFA treatment at the healthcare facility.
It can also be adopted for any field-level surveys or intervention programs that involve Hb testing. Going forward, we would like to compare our method with other invasive and non-invasive methods of hemoglobin estimation, which are available at point of care. We would also like to investigate the cost-effectiveness of our method in the field setting.
To begin, launch the application software on the desktop. Click on the Barcode printing tab to generate barcodes. A list of the participants will appear in the tab with geographic details.
Click on the Display Selection option, then press Print Barcode. Next, position a participant in a comfortable position allowing for easy access to any of the three middle fingers on the left hand. Clean the finger with an alcohol wipe.
Label the participant Microtainers with the corresponding participant's barcode immediately after identification and before skin puncture. After the finger is dried, use a single-use safety lancet to puncture the skin approximately one centimeter from the tip. Wipe away the first drop of blood.
Then place a Microtainer vertically beneath the puncture site so that the blood flows freely into the tube without pressure. Once a desired volume of blood has been collected, cap the tube. Gently swirl and invert its contents to mix well, wrapping the Microtainer, including the barcode with the remaining identification tag.
Next, press a cotton swab onto the puncture site and apply pressure to stop the bleeding. Immediately dispose of the lancet as per the disposal guidelines. To begin, check the solvent levels of a hematology auto analyzer.
Click the on/off switch on the instrument to turn it on. Connect the instrument to a laptop via an FTP cable. Once the initialization is complete, allow the instrument to run an automatic startup cycle.
Check the instrument display for reference blank counting, ensuring the counts do not exceed the given limits. Then press the tick symbol to validate the blank results. Enter the predefined username and password into the login page, then press the tick button.
Next, thaw the cold control samples to room temperature. Gently mix the controls several times before use. Run the control samples in the analyzer to check the instrument precision.
Scan the barcode on the sample container and press the X icon. Input the gender of the participant, then press the tick button. The details of the participant will be displayed with a code.
Next, mix the blood samples gently, carefully remove the cap of the sample tube and place it beneath the sampling needle. Move the tube upwards until the needle is immersed in the blood. Press the Start button to aspirate 10 microliters of the blood sample.
Once the results appear on the instrument screen, click on the printer icon to print them out. Press the back arrow to proceed with the analysis of the second sample. To upload the results to the server, launch the corresponding software and enter the authorized credentials on the login page.
Click on the Lab test results upload button. Once the results are uploaded successfully to the server, the ASTM files are converted into CSV format and the converted files appear in the hematology report. For participants with ASTM files, a decision on the anemia status can be viewed.
To view individual results, log in on the follow-up application, then search for the participant with their name or ID, and click on the EDSS icon to view results. A small difference in the mean hemoglobin values was seen for the capillary blood auto analyzer method and the gold standard venous blood auto analyzer method. The prevalence estimates of no anemia differed by 2.2%points between the two methods.
The decision support tool accurately provided the anemia status and IFA doses of the participants as verified by field medical officers.
Overview
Anemia is a significant public health issue in India, and current methods for estimating hemoglobin at the point of care are inadequate. This study presents a developed point-of-care method using pooled capillary blood and an integrated auto-analyzer with custom software for rapid hemoglobin estimation and anemia classification.
Key Study Components
Research Area
- Public health and anemia management
- Point-of-care diagnostics
- Technology integration in healthcare
Background
- Anemia is prevalent in India, affecting health interventions
- Existing hemoglobin estimation methods are not suitable for immediate application
- The need for rapid analysis to improve treatment outcomes
Methods Used
- Development of an auto-analyzer integrated with custom software
- Pooled capillary blood sampling techniques
- Rapid decision-making support via algorithmic treatment recommendations
Main Results
- Effective categorization of hemoglobin levels into anemia grades
- Reduction in turnaround time for test results
- Comparison of capillary blood analysis with the gold standard venous method yields consistent results
Conclusions
- The study demonstrates a rapid and accurate method for hemoglobin estimation at the point of care.
- This method has significant implications for population-based anemia treatments and intervention programs.
