Evaluation de Perfomances analytiques de l'hémoglobinomètre HEMOCUE® Hb 201+: étude observationnelle analytique monocentrique réalisée aux Cliniques Universitaires de Kinshasa, République Démocratique du Congo / Evaluation of analytical performance of the hemoglobinometer HEMOCUE® Hb 201+: A monocentric study from the Kinshasa University Hospital, Democratic Republic of Congo

Context and objective The dosage of hemoglobin (Hb) is challenging particularly in rural setting. This dosage can be done using "Point of Care" (POC) material within rural areas and emergency situations. The present study aimed to assess the POC HemoCue® Hb 201+. Methods. This was an analytical cross-sectional study comparing the rates of the dosage of Hb carried out on HemoCue® Hb 201+ hemoglobinometer and those obtained with Mindray BC-5150 automaton in Kinshasa University Hospital, Democratic Republic of Congo (DRC). Results. Two hundred subjects were involved in the study. Mean and median Hb rates were 10,438 ± 2,741 g/dl and 10,600 g/dl (IQR: 8,675-12,300 g/dl) by Mindray BC-5150, respectively and mean rate of Hb was 10,5 ± 2,756 g/dl and the median rate was 10,900 g/dl (IQR: 8,775 ­ 12,300 g/dl) by the HemoCue® Hb 201+, respectively. The linear regression revealed a positive relationship between the Hb rates obtained on an automaton Mindray BC- 5150 and those obtained on the HemoCue® Hb 201+. The diagram of Bland Altman showed limits of agreement between automaton Mindray BC- 5150 and HemoCue® Hb 201+. Conclusion. This study showed that the POC HemoCue® Hb 201+ provided similar results to those of the automaton Mindray BC-5150. Thus, HemoCue® Hb 201+ can be used in emergency services or even in medical institutions that do not have or do not meet the conditions for the use of hematology analyzers in the DRC.

Contexte & objectif Le dosage du taux de l'hémoglobine est un véritable défi en milieu rural où les laboratoires sont moins équipés. Et pourtant, cette analyse, réalisée au moyen des équipements plus au moins sophistiqués, permettant de confirmer une anémie, peut être facilitée par l'utilisation des Points of care (POC). Le POC Hemocue® Hb 201+, utilisé dans certains sites pour ce faire, n'a jamais été évalué. L'objectif de la présenté étude était d'évaluer les performances du POC Hemocue® Hb 201+ à Kinshasa /RDC. Méthodes. Il s'agissait d'une étude transversale, analytique comparant les taux d'Hb obtenus sur Hemocue® Hb 201+ et sur Mindray BC-5150 comme référence, aux Cliniques Universitaires de Kinshasa. Résultats. Deux cents sujets ont été inclus. Les taux moyen et médian d'Hb sur l'automate Mindray BC5150 ont été respectivement, de 10,438 ± 2,741 g/dl et de 10,600 g/dl (IQR : 8,675-12,300 g/dl). Le taux moyen d'Hb sur le POC Hemocue® Hb 201 a été de 10,5 ± 2,756 g/dl et le taux médian de 10,900 g/dl (IQR : 8,775 - 12,300 g/dl). La régression linéaire a mis en évidence une relation positive entre les taux d'Hb dosés sur automate Mindray BC- 5150 et ceux dosés sur HemoCue® Hb 201+. Le diagramme de Bland Altman a montré des limites d'accord entre l'automate Mindray BC- 5150 et Hemocue® Hb 201. Conclusion. Cette étude a montré que le POC HemoCue® Hb 201+ fournissait des résultats identiques à ceux de l'automate Mindray BC-5150. Ainsi, l'HemoCue® Hb 201+ peut être utilisé dans les services d'urgence ou dans les institutions médicales ne possédant pas ou ne remplissant pas les conditions d'utilisation des automates d'hématologie en RDC

Progression of anaemia during antenatal period among South African pregnant women

Background: Anaemia in pregnancy is a known public health problem in South Africa. Maternal, perinatal morbidity and mortality are known to be associated with anaemia in pregnancy. Very little is known from literature with regards to the progression of anaemia during the antenatal period of pregnancy. Objectives: To estimate haemoglobin levels, the prevalence and determinants of anaemia at different gestational ages and to show the trend. Method: A retrospective cohort (follow-up) study was conducted using the antenatal clinic register. Prevalence rates of anaemia (haemoglobin < 11 g/dl) at different gestational ages were measured. Factors associated with anaemia were assessed using chisquare test and stepwise multivariate logistic regression analysis. Results: A total of 801 pregnant women were enrolled at the booking visit and followed-up during their antenatal period. The prevalence of anaemia at the booking visit was 37%. The prevalence of anaemia at 20, 26, 32 and 36 weeks of gestation were 36.6%, 39.6%, 39.8% and 29.2% respectively. Binary logistic regression at the booking visit showed that teenage women were 2.5 times more likely to have anaemia (OR=2.5, p=0.005) than older women. Women who booked during the first trimester were 60% less likely to have anaemia (OR= 0.40, P=0.005) at the booking visit and 62% less likely to be anaemic at 36 weeks of gestation (OR=0.38, p=0.013) compared to those who booked late for antenatal care. Conclusion: Prevalence of anaemia during pregnancy was high. Early booking for antenatal care was a predictor for lower rate of anaemia. Thus, health education strategy should be encouraged for early antenatal booking

Family-integrated diabetes education for individuals with diabetes in South-west Nigeria

Objectives: This study aimed to determine the effects of family-integrated diabetes education on diabetes knowthe ledge of patients and family members, as well as its impact on patients' glycosylated haemoglobin (A1C). Design: The design was a two-group Pretest Posttest quasi-experimental. Setting: The study took place at the diabetes clinics of two tertiary hospitals in southwestern Nigeria. Participants: People Living with Diabetes (PLWD) and family members aged 18 years and over and without cognitive impairment were placed, as clusters, into either a control group (CG) or an intervention group (IG) The CG comprised 88 patients and 88 family members while IG comprised 82 patients and 82 family members. Of these, 78 and 74 patients completed the study in CG and IG, respectively. Interventions: PLWD in IG along with their family members were given an educational intervention on diabetes management and collaborative support with an information booklet provided. This was followed by three (3) complimentary Short Messaging Service (SMS). Main outcome measures: A1C and diabetes knowledge. Results: Over half (52.4%) and about a fifth (18.2%) of family members and patients, respectively, had never had diabetes education. There was a statistically significant increase in the knowledge of patients and family members in IG. Unlike CG, the A1C of patients in IG improved significantly at three and six-month post-intervention, (p<0.01). Regression showed an independent effect of family members' knowledge on IG's A1C. Conclusions: Improved family members' diabetes knowledge positively impacted patients' glucose level. There is a need to integrate family members into diabetes care better

Transfusion, mortality and hemoglobin level: associations among emergency department patients in Kigali, Rwanda

Background: Studies from high-income countries (HIC) support restrictive blood transfusion thresholds in medical patients. In low- and middle-income countries (LMIC), the etiologies of anemia and baseline health states differ greatly; optimal transfusion thresholds are unknown. This study evaluated the association of packed red blood cell (PRBC) transfusion with mortality outcomes across hemoglobin levels amongst emergency center (EC) patients presenting with medical pathology in Kigali, Rwanda. Methods: This retrospective cohort study was performed using a random sample of patients presenting to the EC at the University Teaching Hospital of Kigali. Patients ≥15 years of age, treated for medical emergencies during 2013­16, with EC hemoglobin measurements were included. The relationship between EC PRBC transfusion and patient mortality was evaluated using logistic regression, with stratified analyses performed at hemoglobin levels of 7 mg/dL and 5 mg/dL. Results: Of 3609 cases sampled, 1116 met inclusion. The median age was 42 years (IQR 29, 60) and 45.2% were female. Transfusion occurred in 12.1% of patients. Hematologic (24.4%) and gastrointestinal pathologies (20.7%) were the primary diagnoses of those transfused. Proportional mortality was higher amongst those receiving transfusions, although not statistically significant (23.7% vs 17.0%, p=0.06). No significant difference in adjusted odds of overall mortality by PRBC transfusion was found. In stratified analysis, patients receiving EC transfusions with a hemoglobin >5.0 mg/dL, had 2.21 times the odds of mortality (95% CI 1.51­3.21) as compared to those ≤5.0 mg/dL. Conclusions: No association between PRBC transfusion and odds of mortality was observed amongst EC patients in this LMIC setting. An increased mortality association was found for patients receiving PRBC transfusions with an initial hemoglobin >5 mg/dL. Results suggest benefits from PRBC transfusion are limited as compared to HIC. Further research evaluating emergent transfusion thresholds for medical pathologies should be performed in LMICs to guide practice

Valeurs de référence de l'hémogramme chez les donneurs de sang du Centre National de Transfusion Sanguine de Libreville

Introduction : les valeurs de référence peuvent être obtenues à partir des bases de données. Nous nous proposons de produire ces valeurs à partir d'une base de données hématologiques et de souligner les contraintes inhérentes à cette méthodologie. Matériel et méthodes: Il s'agit d'une étude rétrospective, réalisée du 1er janvier 2015 au 30 mars 2017, au Centre National de Transfusion Sanguine de Libreville. Les dossiers des donneurs, dont les sérologies (HIV, AgHBs, Ac HVC, VDRL et TPHA) étaient négatives ont été retenus. Les paramètres de l'hémogramme ont été notés pour chaque dossier. L'identification des valeurs aberrantes a été réalisée à l'aide de la méthode de Cook, la nature de la distribution a été étudiée grâce au test de normalité de Shapiro-Wilk. Les limites de référence à 95% et leurs intervalles de confiance à 90% ont été calculés. La recherche des partitions a été effectuée à l'aide du z-test. Les différences étaient considérées comme statistiquement significatives, pour une valeur de p inférieure à 0,05. Résultats: ce protocole a concerné 27022 dossiers, dont 2013 (7,4%) ont été exploités. L'intervalle de référence à 95% des leucocytes allait de 2,8.103 à 6,1.103/mm3, alors que celui des hématies allait de 4,3.106 à 5,3.106/mm3et celui des plaquettes de 129,7.103 à 258,0.103/mm3. De plus, les hématies allaient de 4,4.106 à 5,3.106/mm3chez les hommes contre 4,4.106 à 5,1.106/mm3pour les femmes de même tranche d'âge.Conclusion: la réalisation d'une telle étude nécessite une collaboration interdisciplinaire, une bonne tenue des bases de données et nous rappelle la primauté d'une différence biologique, par rapport à une différence statistique

Rheological variations among Nigerians with different hemoglobin genotypes

A total of one hundred and Forty-five (145) subjects comprising of 50 homozygous Hemoglobin A subjects (HbAA); 50 heterozygous hemoglobin AS (HbAS) subjects and 45 homozygous hemoglobin S (HbSS) subjects were recruited for this study with a view to ascertain variations in the Hemorheological values possibly associated with the inherited hemoglobin genotype. Some Hemorheological determinants such as whole blood viscosity (WBV) and plasma viscosity (PV) and Plasma Fibrinogen Concentration (PFC) were measured with standard methods. We recorded a relatively unchanged whole blood viscosities in subjects with various hemoglobin genotypes (AA; AS and SS; P0.05; respectively). Also; there were no significant differences in PV values of HbAA and HbAS while there were significant increases in PV and PFC of HbSS compared with others (P0.05; respectively). However; relative erythrocyte viscosity (REV) of HbSS became significantly reduced when repeated with saline after replacing plasma with saline (P0.05; respectively); to ascertain the erythrocytic cellular viscosity. We conclude that increased plasma viscosity coupled with that of PFC in HBSS could be due to plasmatic components and that cellular rheologic properties of the erythrocytes may be dependent on its content of hemoglobin while whole blood viscosities are stable in native blood irrespective of haemoglobin genotypes

Evaluating the Knowledge of Sickle Cell Disease and Hemoglobin Electrophoretic Pattern among People Living in Sekondi-Takoradi Metropolis; Ghana

Background: Sickle cell disease (SCD) is an inherited lifelong hemolytic disorder affecting many children in sub-Saharan Africa; especially in West and Central Africa. There is a limited public health education on SCD in Ghana with only two information centers in Accra and Kumasi; respectively.Methodology: This cross-sectional study evaluated the knowledge of SCD among people living in Sekondi-Takoradi metropolis. Churches; saloons; internet cafes and bus stations were randomly selected in the center of the city with proximity to the central market.Results: A total of 621 individuals were recruited; 52.5 (326) had knowledge of their hemoglobin (Hb) electrophoretic pattern while 47.5 (295) had none. In addition; 93.4 individuals had knowledge of SCD while 6.6 had no knowledge of SCD. Older individuals exhibited better knowledge of their Hb electrophoretic pattern than the younger ones (P = 0.019). Individuals with tertiary education and married couples exhibited higher knowledge of SCD when compared to their counterparts (P 0.001).Conclusion: Despite the relatively high knowledge of SCD and Hb electrophoretic pattern observed in this study; it is very important to increase neonatal screenings and health care services to the region. In addition; more emphasis is needed to increase public awareness of SCD especially in schools; churches; hospitals and the media

Point-of-Care Estimation of Haemoglobin Concentration in all Age Groups in Clinical Practice

Background: The measurement of haemoglobin (Hb) concentration provides a reliable; primary screening test for the presence and severity of anaemia. The HemoCuer is a point-of-care test for Hb measurement. The introduction of pointof- care testing in hospitals and general practice has improved patient care and accessibility. This study was performed to evaluate the utility of point-of-care Hb measurement with the HemoCuer device for the diagnosis of anaemia. Method: In this prospective study; we compared the analytical performance of the HemoCuer to the Coulterr LH 750 automated haematology analyser with regard to accuracy; precision and linearity in the measurement of Hb in adult and paediatric patient samples; referred for routine laboratory testing. Results: Samples from 100 patients were analysed with both instruments; and the results were compared using standard scatter and difference plots. The mean Hb value of the HemoCuer (11.3 g/dl; range 4.6-16.7) was comparable to the Coulterr LH 750 (11.3 g/dl; range 4.7-17.2). The Bland-Altman difference plot revealed good correlation. Bias between the two methods was small; and the imprecision was within acceptable limits. Hb measurement was linear in the range of 4.8-20 g/dl. Conclusion: In all age groups; the HemoCuer point-of-care device can be used to provide accurate and reliable Hb measurements with a smaller sample volume; improved turnaround time; and long-term cost saving

The influence of socioeconomic status on the hemoglobin level and anthropometry of sickle cell anemia patients in steady state at the Lagos University Teaching Hospital

Background: Sickle cell anemia (SCA) has multisystemic manifestations and is associated with severe morbidity and high mortality. It commonly affects growth leading to wasting and stunting. Aims and Objectives: This study aimed to determine the influence of socioeconomic status on the nutritional status using anthropometric measurements and steady-state hemoglobin; of children with homozygous SCA; aged 1 year to 10 years in steady state at the Lagos University Teaching Hospital. Materials and Methods: This is a cross-sectional study involving 100 children with SCA and 100 age-; sex-; and social class-matched controls that fulfilled the inclusion criteria. Social class was assessed using educational attainment and occupation of parents. Hemoglobin concentration was determined using the oxy-hemoglobin method. Results: This study demonstrated a significantly lower mean weight and weight-for-height in the SCA patients than those of controls (P 0.001). By contrast; this study did not demonstrate any statistical significant difference in the mean height and mean body mass index of SCA patients and controls (P 0.1). However; SCA patients had significantly lower values than controls in each of the social classes. Conclusion: Poor socioeconomic status has an adverse effect on the nutritional status and hemoglobin of SCA patients

The Prevalence of Sickle Cell Anaemia in Northern Areas of Algadaref State; Sudan

Sickle cell anaemia is one of the major types of anaemia found in Sudan; especially in western Sudan in which the sickle cell gene is frequent. This study estimates the prevalence of sickle cell anaemia in other areas rather than western Sudan where it is more prevalent (Algadaref state). 100 blood samples of blood were taken from differenttribes (eleven tribes) living in the northern area of Algadaref state. 24 samples were collected from urban area; 76 from rural area; all tribes originated from Afro-Asiatic speaking regions. All samples were tested for complete blood count (CBC); and haemoglobin electrophoresis. The study revealed that the majority of sickle cell anaemia cases was found among the Masaleet tribe. 20 samples were (Hb-SS); 55 samples were (Hb- AS) and 25 samples were (Hb -AA)

Investigating the importance of haemoglobin measurement for selection of blood donors in Libya

In Libya, haemoglobin estimation is not used routinely to assess the fitness of blood donors. We examined the importance of including this parameter in donor selection. Venous blood samples were collected from the bleed line at the end of the donation process from 1339 healthy adult male blood donors, aged 18­60 years, in Al-Jala Women Hospital in Tripoli, Libya. Haemoglobin concentration was measured using an automated haematology analyzer. The main donor age categories were 21-30 and 31-40 years (49.5% and 37%, respectively). Blood donation was mainly a replacement donation. The mean ±2SD range for haemoglobin was 10.8­17.0 g/dl. 27.2% of the donors had haemoglobin concentration of less than 13 g/dl, 16.9% of them had less than 12.5 g/dl and 1.9% had less than 10.8.5 g/dl.Our results suggest that it is important to include haemoglobin estimation as a routine procedure in selection of blood donors

Comparative evaluation of haemoglobin estimation amongst pregnant women in Ibadan: Hemocue ­ B Haemoglobin analyzer versus haemiglobincyanide (Standard) method as the gold standard

This was a comparative crossectional study that was conducted among 557 antenatal women at the University College Hospital, Ibadan, Nigeria between 1st April and 30th May 2006. The study compared the accuracy of haemoglobin estimation using an automated HemoCue B analyzer kit with a standard laboratory method(haemogloincyanide) as the gold standard. The result showed a positive correlation of HaemoCue haemoglobin results when compared with the standard methods (Pearson's correlation coefficient = 0.892; p value = 0.000). We concluded that the use of the automated HemoCue kit for haemoglobin estimation gives an objective assessment which overcomes the challenge of extra skilled manpower or power outages in rural areas thereby enhancing access to quality of care in resource poor countries. (Afr J Reprod Health 2008; 12[2]:153-159)

Prevalence of Glucose-6-phosphate Dehydrogenase Deficiency and Haemoglobin S in High and Moderate Malaria Transmission Areas of Muheza; North-Eastern Tanzania

Glucose-6-phosphate dehydrogenase (G6PD) deficiency and haemoglobin S (HbS) are very common genetic disorders in sub Saharan Africa; where malaria is endemic. These genetic disorders have been associated with protection against malaria and are therefore under strong selection pressure by the disease. In November-December 2003; we conducted a cross-sectional survey to determine the prevalence of G6PD deficiency and HbS in the population and relate these to malaria infection and haemoglobin levels in lowland and highland areas of differing malaria transmission patterns of Muheza; Tanzania. Blood samples from 1959 individuals aged 6 months to 45 years were collected. A total of 415 (21) and 1181 (60) samples were analysed for G6PD deficiency and HbS; respectively. Malarial parasite prevalence was 17.2(114/1959) in the highlands and 39.6(49/1959) in the lowlands. Lowlands had higher prevalence of G6PD deficiency and HbS than highlands (G6PD deficiency = 11.32(24/212) versus 4.43(9/203); P = 0.01; and HbS = 16.04(98/611) versus 6.32(36/570); P = 0.0001). Logistic regression model showed an association between G6PD deficiency and altitude [lowlands] (Odds ratio [OR] 3.4; 95CI=1.49; 7.90; P=0.004). In the lowlands; G6PD deficient individuals had lower mean haemoglobin (10.9g/dl) than normal ones (12.8g/dl); P = 0.01. These findings show that high malaria transmission in the lowlands might have selected for G6PD deficiency and HbS

Haematological Parameters and Haemoglobin Genotype in Maternal and Cord Blood Pairs in Port Harcourt; Nigeria

Background: The study was conducted to ascertain the pattern of haematological parameters and haemoglobin genotype in maternal and cord blood pairs in the Port Harcourt area of the South-South geopolitical zone of Nigeria. Methods: One hundred and three (103) postpartum women and their newborns were randomly recruited into the study. Five millilitres (5ml) of blood was taken from the mothers and their respective babies and analyzed for haematological parameters and haemoglobin genotype. Results: Haemoglobin concentration (Hb) in mothers was 10.90-14.45 g/dl (PCV; 32.42-43.92Hb in cord blood was 12.50-17.68 g/dl (PCV; 37.5-52.90). Average total white blood cell count (WBC) in mothers was 3.32-10.70 X 109/l and in cord blood; 4.10-13.10X109/l. Haemoglobin genotype revealed that AS was higher in maternal blood (17.5vs 4.8) while AA was higher in cord blood (94.2vs 82.5). Conclusion: The study adds to the data base of reference haematological values in Nigeria; especially the South-South zone and suggests that the frequency of the AS genotype may be undergoing a gradual reduction in subsequent generations as malaria is being controlled makings its relative advantage less important. Testing of prospective couples and counselling of AS individuals is still very important

The effect of insecticide-treated bed net on malarial parasitaemia and haemoglobin level of under-five children in a semi-urban community in south-south Nigeria

Background: Imperfect control measures like insecticide-treated bed net that merely reduces transmission; appear unlikely to have any significant effect on malarial morbidity in an area of intense perennial malaria transmission. Also; some field studies have indicated that the efficacy achieved might be due to the high coverage rate achieved during the trial that produced a mass killing of mosquitoes in the communities.Aim: To assess the impact of the use of the insecticide-treated bed net in a programme situation; on malarial parasitaemia; haemoglobin levels and spleen sizes in under-five children; in an area of intense perennial malaria transmission in South-South Nigeria.Methods: The study was carried out over a six-month period in two communities in the Ogba/ Egbema/ Ndoni Local Government Area of Rivers State; South-South Nigeria. A non-randomized control group pre-intervention-post-intervention study design was used. Fifty five children under five years systematically chosen from buyers of the nets sold by a social marketing project were used as the intervention group. Fifty eight children were recruited as controls; from a neighbouring community about ten kilometers away; and matched for age and socio-economic status of their parents with those in the intervention group.Results: The baseline data of the study groups were broadly the same (p 0.1). However; in the post-intervention study; there was a 0.75g/dl (p0.05) difference in the haemoglobin level of the children; with a concomitant difference of 24.05(p-value 0.05) in the proportion with moderate anaemia (8g/dl). There was also a 2.03cm (p-value 0.001) difference in spleen size; and a 34.42(p-value 0.05) difference in the prevalence of splenomegaly. The 21.35difference in the proportion with parasitaemia between the two groups was also found to be significant (p-value 0.05). Conclusions: The study shows that insecticide-treated bed net can be an effective tool for malaria control in an area of intense perennial malaria transmission

Haematological reference values for healthy adults in Port Harcourt; Nigeria

Background: Published reports of the basic haematological parameters of apparently healthy subjects in Port Harcourt; Nigeria are relatively scanty. This has resulted in an apparent unavailability of laboratory reference values for haematological parameters for the population. Aim: To determine the reference values of some basic haematological parameters in apparently healthy adult subjects in Port Harcourt; Nigeria. Methods: Two hundred and fifty apparently healthy adults consisting of 150 males and 100 females; aged between 15 and 55 years; residing in Port Harcourt were randomly selected via a cross sectional prospective study. The following haematological parameters were determined by the indicated methods: haematocrit (Hct) was determined using Hawksley micro-capillary centrifugation; haemoglobin concentration (Hbc) was determined using the cyanmethaemoglobin method; red blood cell count and white blood cell count were both determined manually using the improved Neubauer counting chamber; mean corpuscular volume (MCV); mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) were calculated from the appropriate haematological parameters; erythrocyte sedimentation rate (ESR) was determined using the Westergren method. Results: The reference values; modes and ranges of all haematological parameters determined are presented. The mean values of haematocrit; haemoglobin concentration; red blood cell count; white blood cell count; mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) were found to be significantly higher in male subjects; while the mean values of mean corpuscular haemoglobin concentration (MCHC) and ESR were found to be significantly higher in female subjects (p 0.05). Conclusion: The present study reports reference values of basic haematological parameters for healthy adult residents of Port Harcourt; Nigeria. Significant gender variations possibly exist in the basic haematological parameters of the population under investigation