estimation of hemoglobin using pooled human blood capillary samples for the screening of anemia

POC Method and Integrated Decision Support Tool for Estimating Anemia

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.

Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management

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

Anemia is a major public health problem in India. Screen and treat 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 service 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.

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Estimation of Hemoglobin Using Pooled Human Blood Capillary Samples for the Screening of Anemia

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JoVE Journal

Biology

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