Name: Estimación de la hemoglobina utilizando muestras capilares de sangre humana agrupadas para el cribado de la anemia
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

Método POC y herramienta integrada de apoyo a la toma de decisiones para la estimación de la 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.

Autor destacado: Desarrollo de un método de estimación de la hemoglobina en el punto de atención para el tratamiento de la anemia

Un método en el punto de atención con una herramienta integrada de apoyo a la toma de decisiones para estimar la anemia a nivel poblacional

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

Estimación de la hemoglobina utilizando muestras capilares de sangre humana agrupadas para el cribado de la anemia

Para empezar, compruebe los niveles de disolventes de un autoanalizador de hematología. Haga clic en el interruptor de encendido y apagado del instrumento para encenderlo. Conecte el instrumento a una computadora portátil a través de un cable FTP.Una vez completada la inicialización, permita que el instrumento ejecute un ciclo de inicio automático. Verifique la pantalla del instrumento para ver el conteo de referencia en blanco, asegurándose de que los recuentos no excedan los límites dados. A continuación, pulse el símbolo de marca para validar los resultados en blanco.Introduzca el nombre de usuario y la contraseña predefinidos en la página de inicio de sesión. A continuación, pulse el botón de marca. A continuación, descongele las muestras de control en frío a temperatura ambiente.Mezcle suavemente los controles varias veces antes de usarlos. Ejecute las muestras de control en el analizador para comprobar la precisión del instrumento. Escanee el código de barras en el recipiente de la muestra y presione el icono X.Ingrese el género del participante, luego presione el botón de verificación. Los datos del participante se mostrarán con un código. A continuación, mezcle las muestras de sangre suavemente, retire con cuidado la tapa del tubo de muestra y colóquelo debajo de la aguja de muestreo.Mueva el tubo hacia arriba hasta que la aguja se sumerja en la sangre. Presione el botón de inicio para aspirar 10 microlitros de la muestra de sangre. Una vez que los resultados aparezcan en la pantalla del instrumento, haga clic en el icono de la impresora para imprimirlos.Presione la flecha hacia atrás para continuar con el análisis de la segunda muestra. Para cargar los resultados en el servidor, inicie el software correspondiente e ingrese las credenciales autorizadas en la página de inicio de sesión. Haga clic en el botón de carga de resultados de pruebas de laboratorio.Una vez que los resultados se cargan correctamente en el servidor, los archivos astm se convierten al formato csv y los archivos convertidos aparecen en el informe de hematología. En el caso de los participantes con archivos ASTM, se puede ver una decisión sobre el estado de anemia. Para ver los resultados individuales, inicie sesión en la aplicación de seguimiento, luego busque al participante con su nombre o ED, y haga clic en el icono EDSS para ver los resultados.Se observó una pequeña diferencia en los valores medios de hemoglobina para el método de autoanálisis de sangre capilar y el método de autoanálisis de sangre venosa de referencia. Las estimaciones de prevalencia de ausencia de anemia difirieron en 2,2 puntos porcentuales entre los dos métodos. La herramienta de apoyo a la toma de decisiones proporcionó con precisión el estado de anemia y las dosis de IFA de los participantes, según lo verificado por los funcionarios médicos de campo.

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 ...