Assessing Accuracy and Precision of Hemoglobin Determination in Venous, Capillary Pool, and Single-Drop Capillary Blood Specimens Using three Different HemoCue® Hb Models: The Multicountry Hemoglobin Measurement (HEME) Study

Laura S Hackl; Crystal D Karakochuk; Dora Inés Mazariegos; Kidola Jeremiah; Omar Obeid; Nirmal Ravi; Desalegn A Ayana; Veronica Varela; Silvia Alayón; Omar Dary; Denish Moorthy

doi:10.1016/j.tjnut.2024.03.019

Assessing Accuracy and Precision of Hemoglobin Determination in Venous, Capillary Pool, and Single-Drop Capillary Blood Specimens Using three Different HemoCue® Hb Models: The Multicountry Hemoglobin Measurement (HEME) Study

J Nutr. 2024 Apr 3:S0022-3166(24)00168-8. doi: 10.1016/j.tjnut.2024.03.019. Online ahead of print.

Authors

Affiliations

¹ USAID Advancing Nutrition, John Snow Inc., Arlington, VA, USA.
² Food, Nutrition and Health, The University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Nutrition and Micronutrients, Institute of Nutrition of Central America and Panama, Calzada Roosevelt, Guatemala.
⁴ National Institute of Medical Research, Mwanza Research Centre, Mwanza, Tanzania.
⁵ Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Riad El-Solh, Beirut, Lebanon.
⁶ eHealth Africa, Kano, Nigeria.
⁷ School of Medical Laboratory Science, College of Health and Medical Sciences, Haramaya University, Dire Dawa, Ethiopia.
⁸ USAID Advancing Nutrition, Save the Children US, Arlington, VA, United States.
⁹ Bureau for Global Health, United States Agency for International Development, Washington, DC, United States.
¹⁰ USAID Advancing Nutrition, John Snow Inc., Arlington, VA, USA. Electronic address: denishm@gmail.com.

PMID: 38580209
DOI: 10.1016/j.tjnut.2024.03.019

Abstract

Background: Anemia prevalence estimates reported in population surveys can vary based on the blood specimen source (capillary or venous) and analytic device (hematology autoanalyzers or portable hemoglobinometers) used for hemoglobin (Hb) determination.

Objectives: This study aimed to compare accuracy and precision of Hb measurement in three blood specimen types on three models of hemoglobinometers against the results from venous blood from the same individuals measured on automated analyzers (AAs).

Methods: This multisite (Cambodia, Ethiopia, Guatemala, Lebanon, Nigeria, and Tanzania) study assessed Hb measurements in paired venous and capillary blood specimens from apparently healthy women (aged 15-49 y) and children (aged 12-59 mo) using three HemoCue® Hb models (201+, 301, and 801). Measurements were compared against reference values: venous blood in hematology AA and adjusted via regression calibration or mean difference in HemoCue® Hb. Venous, capillary pool, and single-drop capillary blood specimens were assessed for accuracy and precision.

Results: Venous blood measured using HemoCue® Hb 301 exhibited a positive mean error, whereas responses in HemoCue® Hb 201+ and 801 were nondirectional compared with the reference. Adjustment with the reference harmonized mean errors for all devices across study sites to <1.0 g/L using venous blood. Precision was highest for venous blood (±5-16 g/L) in all sites, lowest for single-drop capillary (±9-37 g/L), and intermediate (±9-28 g/L) for capillary pool blood specimen. Imprecision differed across sites, especially with both capillary blood specimens, suggesting different levels of personnel skills.

Conclusions: Findings suggest that venous blood is needed for accurate and precise Hb determination. Single-drop capillary blood use should be discouraged owing to high measurement variability. Further research should evaluate the viability and reliability of capillary pool blood for this purpose. Accuracy of HemoCue® Hb devices can be improved via standardization against results from venous blood assessed using AA.

Keywords: capillary blood pool; hematology autoanalyzer; hemoglobin; single-drop capillary blood; venous.