Name: 使用合并的人毛细血管样本估计血红蛋白以筛查贫血
Uploaded: 2024-01-19T13:20:00
Description: Watch this Scientific Journal Video about Estimation of Hemoglobin Using Pooled Human Blood Capillary Samples for the Screening of Anemia at JoVE.com

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

用于估计贫血的 POC 方法和综合决策支持工具

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.

作者聚焦：开发用于贫血管理的床旁血红蛋白估计方法

一种具有集成决策支持工具的即时护理方法，用于估计人群水平的贫血

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.

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

使用合并的人毛细血管样本估计血红蛋白以筛查贫血

首先，检查血液学自动分析仪的溶剂水平。单击仪器上的开关将其打开。通过 FTP 电缆将仪器连接到笔记本电脑。初始化完成后，允许仪器运行自动启动周期。检查仪器显示屏上的参考空白计数，确保计数不超过给定的限值。然后按刻号验证空白结果。在登录页面中输入预定义的用户名和密码。然后按下勾选按钮。接下来，将冷对照样品解冻至室温。使用前轻轻混合对照物数次。在分析仪中运行对照样品以检查仪器精度。扫描样品容器上的条形码，然后按 X 图标。输入参与者的性别，然后按勾选按钮。参与者的详细信息将显示与代码一起显示。接下来，轻轻混合血液样本，小心地取下样本管的盖子，并将其放在采样针下方。向上移动管子，直到针头浸入血液中。按下开始按钮吸出 10 微升血样。一旦结果出现在仪器屏幕上，单击打印机图标将其打印出来。按后退箭头继续分析第二个样品。要将结果上传到服务器，请启动相应的软件并在登录页面上输入授权凭据。单击实验室测试结果上传按钮。一旦结果成功上传到服务器，astm文件就会被转换为csv格式，并且转换后的文件会出现在血液学报告中。对于有 astm 文件的参与者，可以查看有关贫血状态的决定。要查看单个结果，请登录后续应用程序，然后使用其姓名或 ED 搜索参与者，然后单击 EDSS 图标以查看结果。毛细血管血液自动分析仪方法和金标准静脉血液自动分析仪方法的平均血红蛋白值略有不同。两种方法之间无贫血的患病率估计值相差2.2个百分点。决策支持工具准确地提供了经现场医务人员核实的参与者的贫血状况和IFA剂量。

Research

JoVE Journal

Biology

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

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 ...