Lauryl sulphate haemoglobin: a non-hazardous substitute for HiCN in haemoglobinometry

HemoCue Hb-801 Provides More Accurate Hemoglobin Assessment in Blood Donors Than OrSense NBM-200

Hemoglobin levels are commonly assessed to prevent causing or worsening of anemia in prospective blood donors. We compared head-to-head the accuracy of different technologies for measuring hemoglobin suitable for use in mobile donation units. We included 144 persons donating platelets at the Central Institute for Blood Transfusion and Immunology in Innsbruck, Austria. Hemoglobin levels were measured in venous blood using the portable hemoglobinometer HemoCue Hb-801 and noninvasively using OrSense NBM-200, and compared to values obtained with the Sysmex XN-430, an automated hematology analyzer employing the sodium lauryl sulphate method, which is broadly used as reference method in everyday clinical practice. Mean age of participants was 34.2 years (SD 13.0); 34.0% were female. Hemoglobin values measured with HemoCue were more strongly correlated with the Sysmex XN-430 (r = 0.90 [95% CI: 0.87-0.93]) than measured with OrSense (r = 0.49 [0.35-0.60]). On average, HemoCue overestimated hemoglobin by 0.40 g/dL (0.31-0.48) and OrSense by 0.75 g/dL (95% CI: 0.54-0.96). When using OrSense, we found evidence for higher overestimation at higher hemoglobin levels (proportional bias) specifically in females but not in males (Pdifference = .003). Sensitivity and specificity for classifying donors according to the hemoglobin donation thresholds were 99.2% (95% CI: 95.3%-100.0%) and 43.8% (23.1%-66.8%) for HemoCue vs 95.3% (89.9%-98.0%) and 12.5% (2.2%-37.3%) for OrSense. Areas under the receiver operating characteristic curves were higher using HemoCue vs OrSense both in females (0.933 vs 0.547; P = .044) and males (0.948 vs 0.628; P < .001). HemoCue Hb-801 measures hemoglobin more accurately than OrSense NBM-200 in the setting of mobile blood donation units. Our findings are particularly relevant for females, having in mind that anemia is more prevalent in females than in males.

Reliability of a spot check non-invasive hemoglobin monitoring (SpHb) of the Masimo RAD-67™ and the HemoCue® for anemia screening

Background : To test the reliability of the spot check Masimo Rad-67 (Masimo Corp., Irvine, CA, USA) as part of a preoperative anemia screening, hemoglobin measurements were compared to those of the HemoCue® Hb 201+ System (HemoCue AB, Ängelholm, Sweden) and the standard laboratory measurement. Methods : During preoperative evaluation of patients scheduled for elective orthopedic surgery hemoglobin concentration was simultaneously determined by standard laboratory analysis (HbLab), the HemoCue® Hb 201+ System (HbHemocue) and by Pulse Co-Oximetry using the Masimo Rad-67 (SpHb) with the rainbow® DCI®-mini Sensor (Masimo Corp., Irvine, CA, USA). Linear correlation, agreement (Bland-Altman analysis), sensitivity/specificity and positive/negative prediction values (PPV/NPV) for anemic hemoglobin values were determined. P-values less than 0.05 were considered statistically significant. Results : 303 patients were analyzed. Twenty-one patients (12 male and 9 female) had mild or moderate anemia, detected by HbLab. In 20 patients, the HbHemocue, and in 34 patients, the SpHb detected anemia. Linear correlation and mean bias (limits of agreement, LOA) for HbHemocue and HbLab were r = 0.969 and -1.08 (+6.44/-8.60) g/L, and for SpHb and HbLab r = 0.61 and +1.76 (+26.92/-23.4) g/L. Sensitivity/specificity of the HbHemocue to detect anemia in all, male and female patients were 85.0/99.3%, 75.0/100/% and 88.9/98.9/% with a PPV/NPV of 89.5/98.9%, 100/98.0% and 80.0/99.3%, respectively. Sensitivity/specificity of SpHb to detect anemia for all, male and female patients were 71.4%, 93.3%, 75.0/95.2/% and 66.7/91.1%, with a PPV/NPV for all, male and female patients of 44.1/97.8%, 56.3/97.9% and 33.3/97.7%, respectively. Conclusions : HbHemocue and HbLab show a strong linear correlation and a good agreement, while linear correlation of SpHb and HbLab is moderate and agreement poor. For both devices, anemia detection is moderate, but the positive prediction value for anemia is much better with the HbHemocue. Both devices reliably detected non-anemic patients. Glossary : CO = carbon monoxide ; PPV = positive predicted value ; NPV = negative predicted value ; HbLab = hemoglobin determined by the laboratory ; HbHemocue = hemoglobin determined by the HemoCue device ; SpHb = hemoglobin determined by the Masimo-RAD67 device ; LOA = limits of agreement ; LOS = length of stay ; POC = point of care ; SpO2 = arterial hemoglobin ; PR = pulse rate ; PI = perfusion index ; PVI = plethysmography variability index ; SpCO = carboxyhemoglobin ; SpMet = methemoglobin ; LED = Light Emitting Diodes ; HiCN = hemiglobincyanide ; SLS = Sodium Lauryl Sulphate ; BMI = body mass index ; BT = body temperature ; WHO = World Health Organization ; IQR = interquartile range ; MAP = mean arterial pressure ; HF = heart frequency ; SD = standard deviation Key point Summary : – Question : Is Hb measurement of the Masimo Rad-67 and of the HemoCue reliable? – Findings : Non-anemic patients are reliably detected with the Masimo Rad-67. Of the 303 patients examined, HbLab detected twenty-one patients (12 male and 9 female) with mild or moderate anemia. The Hbhemocue showed anemia in 20 patients, while the SpHb identified 34 patients as anemic. HbHemocue and HbLab showed a strong linear correlation and a good agreement, while linear correlation of SpHb and HbLab was moderate and agreement poor. For both devices, anemia detection is moderate, but the positive prediction value for anemia is much better with the HbHemocue. Both devices reliably detected non-anemic patients. – Meaning : With both devices, non-anemic patients are reliably recognized, while anemia detection is moderate. However, the prediction for the presence of anemia is much better with the Hbhemocue.

Total haemoglobin – a reference measuring system for improvement of standardisation

Background

Total haemoglobin (Hb) concentration in blood belongs to the most requested measurands, and the HiCN method (hemiglobincyanide) is accepted as a reference. Although the reaction principle is clearly characterised, measurement conditions and settings are not consistently defined, some of them influencing the results. An improvement of standardisation is the object.

Methods

After method optimization, measurement results between different calibration laboratories (CL) were compared with each other and also with results of the National Metrology Institute of Germany (PTB), with target values of certified reference material, within the RELA scheme, and to >1500 results from routine laboratories.

Results

Overall deviations between three CLs were ≤0.5% (n = 24 samples) in a measurement range of 20 g/L to 300 g/L. A CV of 0.4% was determined in pooled blood (1 year long-term imprecision, 99.0%–101.1% recovery of the mean). For selected measurements (n = 4 samples) the PTB participated without significant differences to three CLs, and no significant differences were observed comparing CLs to certified values of reference materials. The expanded measurement uncertainty (probability 95%) was estimated as 1.1%.

Conclusions

A reference measuring system, comprising measuring instruments and other devices, including reagents and supply, to generate reference measurement values for total Hb concentration of high accuracy and low measurement uncertainty is presented. Measurement parameters are investigated and defined. The reference measuring system is ready to offer service to EQA providers and to the IVD industry for certifying control materials or calibrators.

Short-term mercury exposure in tilapia (Oreochromis niloticus) at different salinities: impact on serum osmoregulation, hematological parameters, and Na+/K+-ATPase level

The objectives of this study were to analyze and compare the effects of mercury (Hg) exposure on osmoregulation and hematological responses in East Java strain tilapia (Oreochromis niloticus). Fish were exposed to 0, 0.1, and 1 mg L-1 Hg at 0, 5, 10, and 15 g L-1 salinities, and serum osmolality (SO), ion level, hematological parameters, and sodium (Na+)/potassium (K+)-ATPase (NKA) levels in the gills and kidney were assessed after 96 h of exposure. SO significantly increased in fish exposed to Hg at 15 g L-1 salinity compared with those exposed at 0, 5, 10, and 15 g L-1 salinities, but SO did not significantly increase in fish exposed to Hg at 5 and 10 g L-1 salinities compared with those exposed at 0 g L-1 salinity. At 15 g L-1 salinity, the Na+ level was significantly different from that at 0, 5, and 10 g L-1 salinities. The chloride ion level significantly increased only at 15 g L-1 salinity. Furthermore, the K+ level was significantly different at 10 and 15 g L-1 salinities from that at 0 and 5 g L-1 salinities. Hematocrit and hemoglobin levels and red blood cell and white blood cell (WBC) counts were not significantly different among all salinities. At 15 g L-1 salinity, the NKA level in the gills was significantly different from that at 0 g L-1 salinity, but in the kidney, there was no difference among all salinities. These data provide useful information for future reference and aquaculture practices to reduce Hg effects on tilapia. In conclusion, higher salinity reduced the effect of Hg on the K+ level and WBC count in tilapia.

Comparison of potential higher order reference methods for total haemoglobin quantification-an interlaboratory study

The total haemoglobin (Hb) concentration in blood is one of the most frequently measured analytes in clinical medicine because of its significance for evaluating the health state of a human. The spectrophotometric cyanmethaemoglobin (HiCN) method is the internationally accepted conventional reference method to determine this biomarker. It is frequently used in clinical routine diagnostics but is not traceable to the International System of Units and thus does not meet highest metrological demands. A further critical issue is the toxicity of the necessary potassium cyanide. Different methods to solve these problems are reported here. They all were validated against the HiCN method in an interlaboratory comparison by measuring the total Hb concentration present in the certified reference material JCCRM 912-2M. Methods considered were the spectrophotometric alkaline haematin detergent (AHD) method as well as several isotope dilution (ID)-based approaches. The latter include inductively coupled plasma mass spectrometry (ICP-MS), species-specific (SS) ICP-MS, organic MS and Raman spectrometry. Graphical abstract ᅟ.

Adaptive use of bubble wrap for storing liquid samples and performing analytical assays

This paper demonstrates that the gas-filled compartments in the packing material commonly called "bubble wrap" can be repurposed in resource-limited regions as containers to store liquid samples, and to perform bioanalyses. The bubbles of bubble wrap are easily filled by injecting the samples into them using a syringe with a needle or a pipet tip, and then sealing the hole with nail hardener. The bubbles are transparent in the visible range of the spectrum, and can be used as "cuvettes" for absorbance and fluorescence measurements. The interiors of these bubbles are sterile and allow storage of samples without the need for expensive sterilization equipment. The bubbles are also permeable to gases, and can be used to culture and store micro-organisms. By incorporating carbon electrodes, these bubbles can be used as electrochemical cells. This paper demonstrates the capabilities of the bubbles by culturing E. coli, growing C. elegans, measuring glucose and hemoglobin spectrophotometrically, and measuring ferrocyanide electrochemically, all within the bubbles.

Technology and new fluorescence flow cytometry parameters in hematological analyzers

BACKGROUND

Modern hematological analyzers offer a series of new tests in addition to the differential blood cell count. Here, we provide a short overview of the technique and the new tests included in the hematological analyzers manufactured by the company Sysmex (Kobe, Japan). As introduced here, the resulting new extended blood cell count allows for the quantification of DNA- and RNA-rich, activated and/or precursor leukocyte subpopulations.

METHODS

To compare the different methods of blood cell counting, repetitive cell counting is carried out by hematological experts using microscopy and using the XE-5000 hematological analyzer.

RESULTS

The hematological analyzer delivers more-accurate results with respect to normal cells but microscopy is suited better to recognize and count pathological cells.

CONCLUSION

With the new hematological analyzers, several new hematological tests are made available as screening tools that were not possible previously using standard cell-counting procedures.

Hemoglobin determination with paired emitter detector diode

Two ordinary green light-emitting diodes used as light emitter and detector coupled with simple voltmeter form a complete, cost-effective prototype of a photometric hemoglobinometer. The device has been optimized for cuvette assays of total hemoglobin (Hb) in diluted blood using three different chemical methods recommended for the needs of clinical analysis (namely Drabkin, lauryl sulfate, and dithionite methods). The utility of developed device for real analytics has been validated by the assays of total Hb content in human blood. The results of analysis are fully compatible with those obtained using clinically recommended method and clinical analyzer.

Setting up and statistical evaluation of a new haemoglobin assay

A new method for the determination of haemoglobin concentration in human whole blood has been devised. The assay takes advantage of the lysis of erythrocytes that occurs when blood penetrates the pores of a microporous membrane by a strong capillary effect. The released haemoglobin reacts with the reagents previously dried on the membrane, diffuses through the pores of the membrane and produces a uniform coloured spot whose reflectance at 556 nm can be evaluated at the side to that of application of the sample. In the experimental conditions used by authors, a linear relationship was obtained when the reciprocal reflectance was plotted against the haemoglobin concentration. Data obtained by the reflectometric method were compared with reference values on the same samples from centralized laboratories. Statistical analysis gave a correlation coefficient of 0.985 and only 4% of all haemoglobin determinations were outside the 95% confidence interval. No interference was observed by haematocrit, erythrocyte count, mean corpuscular volume or mean corpuscular haemoglobin concentration and leukocyte count. This method proved to be useful for rapid, accurate and precise assay of total haemoglobin on both capillary and venous blood.