AnemoCheck-LRS: an optimized, color-based point-of-care test to identify severe anemia in limited-resource settings

• Authors: Marina S. Perez-Plazola, Washington University St. Louis; Erika A. Tyburski, Georgia Institute of Technology; Luke R. Smart, Cincinnati Children's Hospital Medical Center; Thad A. Howard, Cincinnati Children's Hospital Medical Center; Amanda Pfeiffer, Cincinnati Children's Hospital Medical Center; Russell E. Ware, Cincinnati Children's Hospital Medical Center; Wilbur Lam, Emory University; Patrick T. McGann, Cincinnati Children's Hospital Medical Center
• Journal Title: BMC Medicine
• Volume: Volume 18, Number 1
• Publisher: BioMedical Central | 2020-12-01, Pages 337-337
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s12916-020-01793-6
• Subjects: Health Sciences, Public Health
• Keywords: Anemia; Global health; Hematology; Point-of-care diagnostics

Abstract

Background: Severe anemia is common and frequently fatal for hospitalized patients in limited-resource settings. Lack of access to low-cost, accurate, and rapid diagnosis of anemia impedes the delivery of life-saving care and appropriate use of the limited blood supply. The WHO Haemoglobin Colour Scale (HCS) is a simple low-cost test but frequently inaccurate. AnemoCheck-LRS (limited-resource settings) is a rapid, inexpensive, color-based point-of-care (POC) test optimized to diagnose severe anemia. Methods: Deidentified whole blood samples were diluted with plasma to create variable hemoglobin (Hb) concentrations, with most in the severe (≤ 7 g/dL) or profound (≤ 5 g/dL) anemia range. Each sample was tested with AnemoCheck-LRS and WHO HCS independently by three readers and compared to Hb measured by an electronic POC test (HemoCue 201+) and commercial hematology analyzer. Results: For 570 evaluations within the limits of detection of AnemoCheck-LRS (Hb ≤ 8 g/dL), the average difference between AnemoCheck-LRS and measured Hb was 0.5 ± 0.4 g/dL. In contrast, the WHO HCS overestimated Hb with an absolute difference of 4.9 ± 1.3 g/dL for samples within its detection range (Hb 4–14 g/dL, n = 405). AnemoCheck-LRS was much more sensitive (92%) for the diagnosis of profound anemia than WHO HCS (22%). Conclusions: AnemoCheck-LRS is a rapid, inexpensive, and accurate POC test for anemia. AnemoCheck-LRS is more accurate than WHO HCS for detection of low Hb levels, severe anemia that may require blood transfusion. AnemoCheck-LRS should be tested prospectively in limited-resource settings where severe anemia is common, to determine its utility as a screening tool to identify patients who may require transfusion.