Cost and effectiveness comparison of two methods for screening potential blood donors for anaemia in Vietnam

Aim/Objective: To compare the cost and effectiveness of Copper Sulphate (CS) and HemoCue (HC) methods for screening blood donors for anaemia. Background: Robust information from developing countries about cost and effectiveness of anaemia screening methods for blood donors is scarce. In such countries there are widespread shortages of blood, so the most cost‐effective method should maximise blood supply without compromising donor safety. Methods: Economic data (e.g. staff time, equipment and buildings) were collected from direct observation of procedures and purchase data from Hanoi's Central Blood Bank administrative department. A framework for comparing the cost and effectiveness of anaemia screening methods was developed and a cost per effective (i.e. usable and accurate) test was generated for each method. Results: Samples from 100 potential donors from the Hanoi Central Blood Bank (static) and 198 from two mobile units were tested. The mean probability of an ineffective anaemia test was 0·1 (0·05–0·2). The average cost of an HC test was $0·75 (static $0·61 and mobile $0·89) and a CS test was $0·31 (static $0·17 and mobile $0·45). The difference between static and mobile units was predominantly due to transport costs; the difference between the two methods was predominantly due to the HC microcuvettes. Conclusion: In this setting the CS yields greater value for money than the HC method for screening blood donors. The relative cost and effectiveness of CS and HC may be different in places with higher staff turnover, lower test accuracy, higher anaemia prevalence or lower workload than in Vietnam.     

Evaluation of the utility of the HemoCue 301 haemoglobinometer for blood donor screening

BACKGROUND AND OBJECTIVES: Reliable blood donor screening requires more accurate measure of haemoglobin (Hb) than by either copper sulphate or the haemoglobin colour scale. The HemoCue haemoglobinometer has established a method for this, but it is considerably more expensive; a modified version (HemoCue 301) has now been developed with a cheaper reagent-free cuvette for use in budget-restricted situations. This report describes evaluation of the performance, the assessment of reproducibility and accuracy of this modified analyser against the reference technique for Hb measurement. MATERIALS AND METHODS: Over 300 routine blood samples from specimens received routinely in a hospital laboratory were tested in accordance with the International Committee for Standardization in Haematology (ICSH) protocol. Accuracy and linearity were confirmed by the reference method with the WHO international haemoglobincyanide reference standard. Tests were also performed on selected samples for checking interference by biochemical abnormalities and leucocytosis. The effects of various sample storage conditions prior to testing were also tested. RESULTS: Ninety per cent of results were within 4% of true values, 96% within 6% and in only three cases was the deviation > 10%, due to interference by bilirubinaemia and/or C-reactive protein. At an Hb value of 120 g/l for donor selection, there were no cases where the method would have been misleading. CONCLUSION: HemoCue 301 provides a simple and reliable anaemia screen method, conforming to the requirements of CLIA'88 regulations; it is reliable for discriminating Hb values for donor acceptance. The main advantage is that the cuvettes are significantly cheaper than the previous models, and will not deteriorate in adverse climatic conditions.     

Drops of Capillary Blood Are Not Appropriate for Hemoglobin Measurement with Point-of-Care Devices: A Comparative Study Using Drop Capillary,Pooled Capillary,and Venous Blood Samples

Population-based surveys matched by time but using different methodologies for determining hemoglobin (Hb) concentration have shown inconsistencies in estimating anemia prevalence. This study aimed to estimate measurement errors in Hb quantification in HemoCue 201+ using venous blood (VB) and capillary blood both drops (DCB) and pools (PCB), and compare the results against those of a reference method (VB analyzed in hematology analyzers based on the cyanmethemoglobin method). Children (n = 49), adult females (n = 50), and older adults (n = 50) were randomly allocated to donate VB (4 mL) and either DCB (three drops) or PCB (350 µL). Results in HemoCue were analyzed through Bland Altman and Lyn’s concordance against Hb concentration by the reference method. A positive average bias (systematic error) was found for the HemoCue (0.31 g/dL) using the same VB samples. This value was then subtracted from all readings carried out in the device. After this adjustment, DCB still produced a positive bias (0.42 ± 0.81 g/dL), and the variation of single results was ±1.6 g/dL (95% CI). PCB and VB performed similarly; the average bias was negligible (−0.02 ± 0.36 and 0.00 ± 0.33 g/dL, respectively) and the variation of the results (95% CI) was ±0.7 g/dL or lower. Lyn’s concordance values were 0.86, 0.96, and 0.98 for DCB, PCB, and VB, respectively. Random variation using DCB is too large to approximate the true Hb values, and therefore DCB should be discontinued for diagnosing anemia both in individuals and in populations.     

Determination of capillary hemoglobin levels using the HemoCue system in intensive care patients

Purpose

The study aimed to compare hemoglobin (Hb) values determined using the portable HemoCue system (HemoCue Hb 201+; HemoCue AB, Ängelholm, Sweden) with laboratory Hb level determination.

Materials and Methods

Adult patients hospitalized in our surgical intensive care unit who required an Hb level determination were included. To determine Hb level, one drop of arterial (A) or venous (V) blood was analyzed using HemoCue (HemoCue_[A/V]), and also with an automated analyzer in the laboratory (Hb reference method, or Hb Lab_[A/V]). Capillary blood (Cap) sample obtained simultaneously by fingerstick was analyzed using HemoCue (HemoCue_[Cap]). Factors that could interfere with the accuracy of fingerstick measurements were also studied. Paired Hb level measurements were compared by Bland and Altman analysis (Hb Lab_[A/V] vs HemoCue_[A/V] and HemoCue_[Cap]).

Results

One hundred fifty blood samples were obtained from 79 patients. The mean absolute differences between Hb Lab [A] and HemoCue [A], Hb Lab [V] and HemoCue [V] and Hb Lab [A/V] and HemoCue [Cap] were 0.1 g/dl (95% confidence interval, −1.9 to + 2.2 g/dl), 0.1 g/dl (95%CI, −2.5 to +2.6 g/dl) and 1.1 g/dl (95%CI, −3.6 to + 5.8 g/dl, respectively. Edema was the sole independent risk factor for discordance between HemoCue_[Cap] and Hb Lab_[A/V] (odds ratio, 6.65; 95% CI, 1.99-22.21; P < .001].

Conclusions

Hemoglobin level determination using HemoCue should not be used in critically patients, especially when capillary blood samples are used and/or in presence of edema.     

测定血红蛋白含量的两种方法比较

为了解氰化高铁法和HemoCue法测定血红蛋白含量的可比性 ,应用两种方法测定了 2 80名 3～ 5岁儿童的末稍血和 71名 12～ 13岁儿童的静脉血血红蛋白含量 ,并测定了质控血样的血红蛋白含量。结果显示 ,两种方法测定末稍血和静脉血血红蛋白含量结果具有较好的相关关系 ,HemoCue法较氰化高铁法结果偏高 ,末稍血高 (18 4± 6 1)g L ,静脉血高 (3 4± 4 4 )g L。结果提示在研究人群血红蛋白含量时 ,氰化高铁法较为可靠 ;由于HemoCue法具有操作简便、易于携带、不需复杂的培训等优点 ,在应用氰化高铁法有困难时可以使用 ,但其结果应考虑加以校正