Current Status of Measurement Accuracy for Total Hemoglobin Concentration in the Clinical Context
Abstract
:1. Background
2. Material and Methods
2.1. Measurement Systems and Application
2.2. Blood Gas Analyzer (BGA)
2.3. HemoCue 201+
2.4. Sysmex XN 9000
2.5. AHD Method
2.6. Preparation of Basic Blood Units
2.7. Data Acquisition
2.8. Definition of References
2.9. Bland and Altman Method (B and A) and Prediction Interval
2.10. Tolerance Level Analysis (TLA)
3. Results
4. Discussion
4.1. Limitations
4.1.1. Definition of the References
4.1.2. Manual Procedures from the Laboratory
4.1.3. Automatic Procedures
4.1.4. Causes of Variability in tHb Measurement
4.2. Representation According to B and A
4.3. Overlapping of B and A Definitions with the 95% Prediction Interval
4.4. Presentation as TLA
4.5. Clinical Consequences from the Results
4.5.1. For Patient Blood Management (PBM)
4.5.2. For the Identification of a Critical Threshold for Lowest tHb
4.5.3. For the Decision-Making Concerning Treatment
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AHA | Automatic hematology analyzer |
AHD | Alkaline hematin detergent |
B and A | Bland and Altman |
BGA | Blood gas analyzer |
DIN | German Institute for Standardization |
HiCN | Cyanmethemoglobin method |
PB | Passing–Bablok |
PBM | Patient blood management |
POCM | Point-of-care monitoring |
POCT | Point-of-care testing |
RBC | Red blood cell |
REF | Reference |
RMSE | Root mean square error |
RSQ | R squared |
SD | Standard deviation |
SLS | Sodium lauryl sulfate |
THb | Total hemoglobin concentration |
TLA | Tolerance level analysis |
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Device | Manufacturer | n | Serial Number | N | System | Method | Measurement |
---|---|---|---|---|---|---|---|
GEM 4000 | Instrumentation Laboratory * | 2 | 10033403 | 3 | BGA | CO-oximeter | optical |
10043637 | 3 | BGA | CO-oximeter | optical | |||
GEM 5000 | Instrumentation Laboratory * | 2 | 16080371 | 3 | BGA | CO-oximeter | optical |
18122404 | 3 | BGA | CO-oximeter | optical | |||
ABL 80 COOX | Radiometer | 1 | 305040 | 3 | Stand-alone | CO-oximeter | optical |
OSM 3 | Radiometer | 1 | 89R62N03 | 3 | Stand-alone | CO-oximeter | optical |
Sysmex XN 9000 | Sysmex Europe GmbH | 1 | 12784 + 15591 | 3 | Analyzer | SLS reagent | optical |
HemoCue 201+ | HemoCue AB, Sweden | 3 | 945013284 | 3 | POCT | Microcuvette | optical |
619012266 | 3 | POCT | Microcuvette | optical | |||
619012265 | 3 | POCT | Microcuvette | optical | |||
Norm | DIN 58931:2010-08 | 1 | 3 | Laboratory | AHD reagent | optical |
All Data | Mean of the Identical Devices | ||||
---|---|---|---|---|---|
Devices & Method | Device Nr. | n = | Assigned to | n = | Assigned to |
GEM 4000 | 01 | 54 | REF I | 54 | REF II |
02 | 54 | REF I | |||
GEM 5000 | 01 | 54 | REF I | 54 | REF II |
02 | 54 | REF I | |||
ABL 80 CO-OX | 01 | 54 | REF I | 54 | REF II |
OSM 3 | 01 | 54 | REF I | ||
XN 9000 | 01 | 54 | REF I | 54 | REF II |
HemCue 201+ | 01 | 54 | REF I | ||
02 | 54 | REF I | |||
03 | 54 | REF I | |||
AHD | 01 | 54 | REF I | ||
Total n = | 594 | 216 |
Devices | Deming Slope | Deming Intercept | PB Slope | PB Intercept | RMSE | RSQ |
---|---|---|---|---|---|---|
Hemocue 1 | 1.002 | −0.321 | 1 | −0.295 | 0.327 | 0.999 |
Hemocue 2 | 0.983 | −0.232 | 0.983 | −0.196 | 0.434 | 0.999 |
Hemocue 3 | 0.997 | −0.246 | 0.996 | −0.2 | 0.3 | 0.999 |
ABL 80 | 0.987 | −0.109 | 0.986 | −0.104 | 0.266 | 1 |
XN 9000 | 0.992 | −0.149 | 0.993 | −0.123 | 0.264 | 0.999 |
GEM 5000 1 | 1.018 | 0.066 | 1.011 | 0.082 | 0.357 | 0.998 |
GEM 5000 2 | 1 | 0.151 | 0.999 | 0.115 | 0.193 | 0.999 |
GEM 4000 1 | 1 | 0.162 | 0.996 | 0.157 | 0.23 | 0.999 |
GEM 4000 2 | 1.001 | 0.139 | 0.998 | 0.151 | 0.231 | 0.999 |
AHD | 1.002 | 0.423 | 1.004 | 0.408 | 0.46 | 0.999 |
OSM 3 | 1.023 | 0.064 | 1.027 | 0.023 | 0.357 | 0.999 |
Absolute Differences in [g/dl] | Relative Differences in [%] | |||||
---|---|---|---|---|---|---|
All Device in Test | Mean | SD | 1.96 SD | Mean | SD | 1.96 SD |
Hemocue—REF I | −0.33 | 0.14 | 0.28 | −3.93 | 2.21 | 4.43 |
GEM 4000—REF I | 0.16 | 0.18 | 0.35 | 2.07 | 2.29 | 4.59 |
GEM 5000—REF I | 0.20 | 0.18 | 0.36 | 2.22 | 1.69 | 3.38 |
ABL 80—REF I | −0.24 | 0.14 | 0.28 | −2.69 | 1.38 | 2.77 |
XN 9000—REF I | −0.23 | 0.15 | 0.30 | −2.52 | 1.67 | 3.34 |
OSM 3—REF I | 0.30 | 0.21 | 0.42 | 2.88 | 1.97 | 3.93 |
AHD—REF I | 0.44 | 0.16 | 0.33 | 5.50 | 3.17 | 6.35 |
Clinically relevant devices | ||||||
GEM 4000—REF II | 0.12 | 0.11 | 0.21 | 1.48 | 1.37 | 2.74 |
GEM 5000—REF II | 0.16 | 0.11 | 0.23 | 1.66 | 0.99 | 1.98 |
ABL 80—REF II | −0.28 | 0.18 | 0.36 | −3.22 | 1.98 | 3.97 |
XN 9000—REF II | −0.27 | 0.20 | 0.40 | −3.06 | 1.99 | 3.98 |
References | ||
---|---|---|
Origin of the blood sample | ||
Capillary vs. arterial vs. venous | [15,41,42,43] | |
Population dependent | [3,20,41,42] | |
Blood collection technique | ||
Preanalytical failure | [9,23,42,44] | |
Choice of anticoagulants | [23] | |
Methods of Measurements | ||
Standard and reference methods | [36,43,45,46,47] | |
Invasive and non-invasive measurements (POCT, POCM) | [1,11,20,46,48,49,50] |
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Stawschenko, E.; Schaller, T.; Kern, B.; Bode, B.; Dörries, F.; Kusche-Vihrog, K.; Gehring, H.; Wegerich, P. Current Status of Measurement Accuracy for Total Hemoglobin Concentration in the Clinical Context. Biosensors 2022, 12, 1147. https://doi.org/10.3390/bios12121147
Stawschenko E, Schaller T, Kern B, Bode B, Dörries F, Kusche-Vihrog K, Gehring H, Wegerich P. Current Status of Measurement Accuracy for Total Hemoglobin Concentration in the Clinical Context. Biosensors. 2022; 12(12):1147. https://doi.org/10.3390/bios12121147
Chicago/Turabian StyleStawschenko, Elena, Tim Schaller, Benjamin Kern, Berit Bode, Frank Dörries, Kristina Kusche-Vihrog, Hartmut Gehring, and Philipp Wegerich. 2022. "Current Status of Measurement Accuracy for Total Hemoglobin Concentration in the Clinical Context" Biosensors 12, no. 12: 1147. https://doi.org/10.3390/bios12121147