Name: Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management
Uploaded: 2024-01-19T13:20:00
Description: Watch this Scientific Journal Video about Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management at JoVE.com

The team acknowledges Mr. J Suresh, Mr. Medappa, Mrs. Madhu, and the entire Kavintech Corporation, Bangalore team, who successfully developed the decision support tool and the software.&#160;The authors wish to also acknowledge the Indian Council of Medical Research, Government of India for funding and the&#160; Department of public health and family welfare, Telangana for facilitating the study.

The protocol follows the guidelines of the Institutional Review Board of the ICMR-National Institute of Nutrition, Hyderabad, India (IRB. No.08/I/2018).
1. Pooled capillary sample collection for Hb analysis using hematology analyzer10,11
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	<li>Configuring the barcode printer and scanner
	<ol>
		<li>Connect the barcode printer to the laptop system.</li>
		<li>Install the barcode printer driver on ...

POC Method and Integrated Decision Support Tool for Estimating Anemia

<ol>
	<li>Ministry of Women and Child Developmen. Press Information Bureau, Government of India Available from: <a target="_blank" href="https://pib.gov.in/Pressreleaseshare.aspx?PRID=1797687">https://pib.gov.in/Pressreleaseshare.aspx?PRID=1797687</a> (2020)</li><li>. Ministry of Health and Family Welfare Government of India Available from: <a target="_blank" href="https://main.mohfw.gov.in/">https://main.mohfw.gov.in/</a> (2018)</li><li>Neufeld, L. M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hemoglobin+concentration+and+anemia+diagnosis+in+venous+and+capillary+blood:+biological+basis+and+policy+implications.">Hemoglobin concentration and anemia diagnosis in venous and capillary blood: biological basis and policy implications.</a> Annals of New York Academy of Sciences. 1450 (1), 172-189 (2019).</li><li>Haggenm&#252;ller, V., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Smartphone-based+point-of-care+anemia+screening+in+rural+Bihar+in+India.">Smartphone-based point-of-care anemia screening in rural Bihar in India.</a> Community Medicine (Lond). 3 (1), 38 (2023).</li><li>Neogi, S. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+accuracy+of+point-of-care+devices+for+detection+of+anemia+in+community+settings+in+India.">Diagnostic accuracy of point-of-care devices for detection of anemia in community settings in India.</a> BMC Health Service Research. 20 (1), 468 (2020).</li><li>Sharma, S., Zapatero-Rodr&#237;guez, J., Estrela, P., O'Kennedy, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point-of-care+diagnostics+in+low+resource+settings:+Present+status+and+future+role+of+microfluidics.">Point-of-care diagnostics in low resource settings: Present status and future role of microfluidics.</a> Biosensors (Basel). 5 (3), 577-601 (2015).</li><li>Augustine, L. F., Dasi, T., Palika, R., Pullakhandam, R., Kulkarni, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Point+of+care+diagnosis+of+anemia+using+portable+auto+analyzer.">Point of care diagnosis of anemia using portable auto analyzer.</a> Indian Pediatrics. 57 (6), 568-569 (2020).</li><li>Dasi, T., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hemoglobin+measurement+in+capillary+blood+by+a+portable+autoanalyzer+for+population+level+screening+of+anemia:+validation+in+cross-sectional+and+longitudinal+studies.">Hemoglobin measurement in capillary blood by a portable autoanalyzer for population level screening of anemia: validation in cross-sectional and longitudinal studies.</a> British Journal of Nutrition. 128 (6), 1108-1117 (2022).</li><li>Briggs, C., Kimber, S., Green, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Where+are+we+at+with+point-of-care+testing+in+haematology.">Where are we at with point-of-care testing in haematology.</a> British J Haematology. 158 (6), 679-690 (2012).</li><li>Krleza, J. L., Dorotic, A., Grzunov, A., Maradin, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Capillary+blood+sampling:+national+recommendations+on+behalf+of+the+Croatian+Society+of+Medical+Biochemistry+and+Laboratory+Medicine.">Capillary blood sampling: national recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine.</a> Biochemical Medicine (Zagreb). 25 (3), 335-358 (2015).</li><li>World Health Organization. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=WHO+Guidelines+on+Drawing+Blood:+Best+Practices+in+Phlebotomy).">WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy).</a> World Health Organization. , (2010).</li><li>Iron Deficiency Anaemia. Assessment Prevention and Control. A Guide for Programme Managers. World Health Organization Available from: <a target="_blank" href="https://cdn.who.int/media/docs/default-source/2021-dha-docs/ida_assessment_prevention_control.pdf">https://cdn.who.int/media/docs/default-source/2021-dha-docs/ida_assessment_prevention_control.pdf</a> (2001)</li><li>Zaidi, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Operability,+usefulness,+and+task-technology+fit+of+an+mHealth+app+for+delivering+primary+health+care+services+by+community+health+workers+in+underserved+areas+of+Pakistan+and+Afghanistan:+Qualitative+study.">Operability, usefulness, and task-technology fit of an mHealth app for delivering primary health care services by community health workers in underserved areas of Pakistan and Afghanistan: Qualitative study.</a> Journal of Medical Internet Research. 22 (9), e18414 (2020).</li><li>Meena, S., Rathore, M., Kumawat, P., Singh, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Challenges+faced+by+ASHAs+during+their+field+works:+A+cross+sectional+observational+study+in+rural+area+of+Jaipur,+Rajasthan.">Challenges faced by ASHAs during their field works: A cross sectional observational study in rural area of Jaipur, Rajasthan.</a> International Journal of Medicine and Public Health. 10 (3), 97-99 (2020).</li><li>Neogi, S. B., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Cost-effectiveness+of+point-of-care+devices+for+detection+of+anemia+in+community+settings+in+India.">Cost-effectiveness of point-of-care devices for detection of anemia in community settings in India.</a> Clinical Epidemiology and Global Health. 14, 100995 (2022).</li></ol>

The current paper describes a point-of-care method using a pooled capillary blood sample and an auto-analyzer. The method was integrated with custom software, which could upload the results from the analyzer automatically to the server and generate decisions on anemia. Also, it could provide the treatment doses of IFA as per the protocol of the National program2.
The custom software was designed to integrate barcode printing, hematology data export, and visualization of...

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.

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			<td>ABX Miniclean&#160;</td>
			<td>Horiba Ltd, Japan&#160;</td>
			<td>23-450-004</td>
			<td>Enzymatic solution</td>
		</tr>
		<tr>
			<td>ABX Minidil LMG&#160;</td>
			<td>Horiba Ltd, Japan&#160;</td>
			<td>23-450-008</td>
			<td>Buffered isotonic solution for RBC/PLT dilution, sleeving and cleaning</td>
		</tr>
		<tr>
			<td>ABX Minilyse&#160;</td>
			<td>Horiba Ltd, Japan&#160;</td>
			<td>23-450-006</td>
			<td>Hb measurement; lysing solution</td>
		</tr>
		<tr>
			<td>ABX Minocal</td>
			<td>Horiba Ltd, Japan&#160;</td>
			<td>2032002</td>
			<td>Calibrator</td>
		</tr>
		<tr>
			<td>ABX Minoclair&#160;</td>
			<td>Horiba Ltd, Japan&#160;</td>
			<td>23-450-003</td>
			<td>Cleaning reagent</td>
		</tr>
		<tr>
			<td>ABX Minotrol 16 - 2H</td>
			<td>Horiba Ltd, Japan&#160;</td>
			<td>2042209</td>
			<td>Blood control</td>
		</tr>
		<tr>
			<td>ABX Minotrol 16 - 2L</td>
			<td>Horiba Ltd, Japan&#160;</td>
			<td>2042208</td>
			<td>Blood control</td>
		</tr>
		<tr>
			<td>ABX Minotrol 16 - 2N</td>
			<td>Horiba Ltd, Japan&#160;</td>
			<td>2042202</td>
			<td>Blood control</td>
		</tr>
		<tr>
			<td>Autoanalyzer&#160;</td>
			<td>Horiba Ltd, Japan&#160;</td>
			<td>ABX Micros ES 60</td>
			<td>The FTP port should be functional</td>
		</tr>
		<tr>
			<td>Barcode printer</td>
			<td>Technology service corporation, USA</td>
			<td>TSC Model TE 244</td>
			<td>400 Mhz 32 bit RISC processor with 16 MB SDRAM, 8 MB Flash memory</td>
		</tr>
		<tr>
			<td>Barcode Scanner</td>
			<td>Retsol</td>
			<td>LS-450</td>
			<td>Any company which can provide a scanner with the following specifications: 32 bit CPU fast decode ability, IP 54 rated, Light source &#8211; visible laser diode 650 nm, Single scan pattern with scan rate of 100scans/second, Scan width of 200 mm &#38; precision of 4 mil, Scan angle &#8211; YAW 65 Deg, Rotation 30 Deg &#38; Pitch 55 Deg, Scan indication &#8211; buzzer, light indicator, Scan mode both manual &#38; continue scanning</td>
		</tr>
		<tr>
			<td>BD needles holder</td>
			<td>Becton, Dickinson and company Ltd, Dublin, Ireland</td>
			<td>364879</td>
			<td></td>
		</tr>
		<tr>
			<td>Contact activated lancet</td>
			<td>Becton, Dickinson and company Ltd, Dublin, Ireland</td>
			<td>366594, 366593</td>
			<td>For children below 1 year, venous blood sample has been collected.</td>
		</tr>
		<tr>
			<td>Custom software&#160;</td>
			<td>Kavin Corporation, Bangalore</td>
			<td>N/A</td>
			<td></td>
		</tr>
		<tr>
			<td>K2-EDTA Microtainer-5 mL</td>
			<td>Becton, Dickinson and company Ltd, Dublin, Ireland</td>
			<td>363706</td>
			<td>EDTA tube for blood profile analysis with 1.0 mg K2 EDTA, dimensions 13 x 75 mm</td>
		</tr>
		<tr>
			<td>Labels</td>
			<td>G-Technologies, Secunderabad, telangana</td>
			<td>N/A</td>
			<td></td>
		</tr>
		<tr>
			<td>Laptop</td>
			<td>Any</td>
			<td>N/A</td>
			<td>Intel Core I3-1005G1,&#160; 8GB DDR4, 1TB HDD, 15.6 FHD LED, WIN 11 HOME&#160; and MS OFFICE H&#38;S&#160;</td>
		</tr>
	</tbody>
</table>

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.

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.

Testing the validity of the method 
The validity of this method was established by comparing it with the gold standard, which was the venous blood autoanalyzer-based method. The validation study has been described in detail elsewhere8. Briefly, 748 apparently healthy volunteers provided a venous sample and a capillary sample consecutively on the same day. The analyses were conducted at the POC. The participants had a wide range of Hb values and belonged to categories of no-an...

Watch this Scientific Journal Video about Author Spotlight: Developing a Point-of-Care Hemoglobin Estimation Method for Anemia Management at JoVE.com

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 ...

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