Name: 빈혈 스크리닝을 위해 통합된 인간 혈액 모세관 샘플을 사용한 헤모글로빈 추정
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

빈혈 추정을 위한 POC 방법 및 통합 의사 결정 지원 도구

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.

저자 스포트라이트: 빈혈 관리를 위한 현장 진료 헤모글로빈 추정 방법 개발

인구 수준에서 빈혈을 추정하기 위한 통합 의사 결정 지원 도구를 사용한 현장 진료 방법

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

빈혈 스크리닝을 위해 통합된 인간 혈액 모세관 샘플을 사용한 헤모글로빈 추정

시작하려면 혈액학 자동 분석기의 용매 수준을 확인하십시오. 기기의 켜기/끄기 스위치를 클릭하여 켭니다. FTP 케이블을 통해 기기를 노트북에 연결합니다.초기화가 완료되면 계측기가 자동 시작 주기를 실행하도록 합니다. 기기 디스플레이에서 참조 공백 계수를 확인하여 계수가 주어진 한계를 초과하지 않는지 확인합니다. 그런 다음 눈금 기호를 눌러 빈 결과를 확인합니다.로그인 페이지에 미리 정의된 사용자 이름과 비밀번호를 입력합니다. 그런 다음 체크 버튼을 누릅니다. 다음으로, 냉간 제어 샘플을 실온으로 해동합니다.사용하기 전에 컨트롤을 여러 번 부드럽게 섞으십시오. 분석기에서 제어 샘플을 실행하여 기기 정밀도를 확인합니다. 샘플 용기의 바코드를 스캔하고 X 아이콘을 누릅니다.참가자의 성별을 입력한 후 체크 버튼을 누릅니다. 참가자의 세부 정보가 코드와 함께 표시됩니다. 그런 다음 혈액 샘플을 부드럽게 혼합하고 샘플 튜브의 캡을 조심스럽게 제거하고 샘플링 바늘 아래에 놓습니다.바늘이 혈액에 잠길 때까지 튜브를 위쪽으로 움직입니다. 시작 버튼을 눌러 10마이크로리터의 혈액을 흡인합니다.amp르. 결과가 기기 화면에 나타나면 프린터 아이콘을 클릭하여 인쇄합니다.뒤로 화살표를 눌러 두 번째 샘플의 분석을 진행합니다. 결과를 서버에 업로드하려면 해당 소프트웨어를 실행하고 로그인 페이지에서 인증된 자격 증명을 입력합니다. 랩 테스트 결과 업로드 단추를 클릭합니다.결과가 서버에 성공적으로 업로드되면 astm 파일이 csv 형식으로 변환되고 변환된 파일이 혈액학 보고서에 나타납니다. astm 파일이 있는 참가자의 경우 빈혈 상태에 대한 결정을 볼 수 있습니다. 개별 결과를 보려면 후속 응용 프로그램에 로그인한 다음 이름 또는 ED로 참가자를 검색하고 EDSS 아이콘을 클릭하여 결과를 확인합니다.평균 헤모글로빈 값의 작은 차이는 모세혈관 혈액 자동 분석기 방법과 골드 스탠다드 정맥혈 자동 분석기 방법에서 나타났습니다. 빈혈이 없다는 유병률 추정치는 두 방법 간에 2.2%포인트 차이가 났다. 의사결정 지원 도구는 현장 의료진이 검증한 참가자의 빈혈 상태와 IFA 투여량을 정확하게 제공했습니다.

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 ...