collection of pooled human blood capillary samples for the screening of anemia

貧血推定のためのPOC法と統合意思決定支援ツール

Anemia is a major public health problem globally, particularly in India. It is well known that anemia has a detrimental impact on the work productivity of the population and the economic growth of the country1. To leverage the national-level efforts to reduce anemia, the latest public health program initiated in 2018 is the Anemia Mukt Bharat program (AMB). AMB identifies &#39;testing&#39; followed by tailored &#39;treatment&#39; as one of the most promising approaches to reducing anemia prevalence in vulnerable age groups2. However, accurate point of care (POC) estimation of hemoglobin (Hb) for diagnosing anemia is needed to implement the &#39;test and treat&#39; strategy of AMB. Moreover, robust methods are useful for accurately estimating anemia in large-scale community surveys. The current POC methods include non-invasive and minimally invasive devices, and they use capillary blood samples for Hb estimation3. However, several pre-analytical factors, such as variation in finger prick dimensions, the thickness of skin, and the stability of POC devices under environmental conditions, lead to imprecise measurements and result in large differences in prevalence estimates3,4,5. Therefore, there is a need to establish a method of Hb estimation that is mobile, has a short&#160;turnaround time (TAT), and is suited for resource-poor settings6. In order to address these needs, a pooled capillary blood collection method was developed using a touch-activated lancet (to ensure uniform prick depth and dimension) to facilitate 6-8 drops of the free-flowing blood sample into potassium ethylenediaminetetraacetic acid (EDTA) microtainer tubes. The Hb in these samples was then measured using a portable auto-analyzer placed in a vehicle at the POC equipped with an uninterrupted power supply or at a nearby center with electricity (Anganwadi, Health clinic, Panchayath, or household). A validation study comparing this method against two gold standard methods (paired venous blood samples and cyanomethamoglobin method) showed high accuracy and precision7,8.
In addition to setting up a valid and reliable POC method, there is a need for rapid decision-making to facilitate the screening and treatment of anemia at the population level. This is not currently feasible where the Hb estimation is done at the health facility, and a medical officer directly supervises the delivery of iron and folic acid (IFA) supplements. Due to the large population catered to by the medical officers at the primary health centers, there is a significant time delay in initiating the intervention. There is a need for technology that can reduce the job burden on the medical officer and empower the front-line health workers to carry out the intervention delivery without the direct involvement of medical personnel. Therefore, the study aimed to develop a custom application (eSTAR app) that can automatically transmit the data from the machine and an in-built algorithm that provides decision support to the front-line workers on the dosage of IFA based on Hb values, age, and gender groups. The software was designed using open source tools such as PHP: hypertext preprocessor (PHP) scripting language and PHP desktop chrome with Visual Studio Code as an integrated development environment. A detailed treatment protocol based on the Anemia Mukt Bharat guidelines has been integrated into the Android application2.
This integrated method addresses the ever-increasing demand to reduce the turnaround time of test results while maintaining accuracy and precision. Further, the ability to provide results within minutes enables rapid decision-making on the initiation of treatment and results in improved intervention delivery9. This integrated method can be adapted for any field-level surveys or intervention programs that include Hb testing. Additionally, it can be used at the health care facility as a job aid for the medical staff to decide on IFA treatment.

著者スポットライト:貧血管理のためのポイントオブケアヘモグロビン推定法の開発

集団レベルで貧血を推定するための統合意思決定支援ツールを備えたポイントオブケア法

Watch this Scientific Journal Video about Collection of Pooled Human Blood Capillary Samples for the Screening of Anemia at JoVE.com

貧血スクリーニングのためのプールされたヒト毛細血管サンプルの収集

まず、デスクトップでアプリケーションソフトウェアを起動します。バーコード印刷タブをクリックして、バーコードを生成します。参加者のリストが地理的な詳細とともにタブに表示されます。表示選択オプションをクリックし、バーコードの印刷を押します。次に、参加者を楽な位置に配置し、左手の3本の中指のどれかに簡単にアクセスできるようにします。アルコールワイプで指をきれいにします。識別直後、皮膚穿刺前に、対応する参加者のバーコードを参加者にマイクロテナーのラベル付けします。指を乾かした後、使い捨ての安全ランセットを使用して、先端から約1センチメートルの皮膚に穴を開けます。最初の一滴の血液を拭き取り、マイクロテナーを穿刺部位の下に垂直に置き、血液が圧力なしでチューブ内に自由に流れるようにします。必要な量の血液が採取されたら、チューブに蓋をします。内容物を静かに渦巻かせたり、反転させたりしてよく混ぜます。マイクロテナーを包み、バーコードと残りの識別タグを添えます。次に、綿棒を穿刺部位に押し付け、圧力をかけて出血を止めます。ランセットは、廃棄ガイドラインに従って直ちに廃棄してください。

collection-pooled-human-blood-capillary-samples-for-screening

Research

JoVE Journal

Biology

Collection of Pooled Human Blood Capillary Samples for the Screening of Anemia

122 ビュー. まず、デスクトップでアプリケーションソフトウェアを起動します。バーコード印刷タブをクリックして、バーコードを生成します。参加者のリストが地理的な詳細とともにタブに表示されます。表示選択オプションをクリックし、バーコードの印刷を押します。次に、参加者を楽な位置に配置し、左手の3本の中指のどれかに簡単にアクセスできるようにします。...

ビデオ: 貧血スクリーニングのためのプールされたヒト毛細血管サンプルの収集

A Point-of-Care Method with Integrated Decision Support Tool to Estimate Anemia at Population Level

Robust point-of-care methods are required to estimate anemia at the population level. The accurate methods are lab-based and cannot be used at the point of care. To address this caveat, a novel method based on pooled capillary blood and a portable autoanalyzer was developed for the estimation of Hb. Additionally, custom software was developed for near-real-time integration of the Hb values from the auto analyzer to the server. Moreover, a decision support tool that can immediately categorize the participants into different stages of anemia was developed. The decision support tool was designed based on the World Health Organization (WHO) cut-off for anemia at the population level and was available for all age and gender groups. This simple and user-friendly tool could&#160;easily be used by front-line health workers who have limited technical skills. Overall, the method developed could&#160;be used at the point of care and is accurate. This high-throughput method could&#160;be used for screening anemia at the population level for all age and gender groups.

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.

Robust point-of-care methods are required to estimate anemia at the population level. The accurate methods are lab-based and cannot be used at the point ...