Guía Técnica: Procedimiento para la determinación de la hemoglobina mediante hemoglobinómetro portátil / Technical Guide: Procedure for determining hemoglobin using a portable hemoglobinometer

Los principales cambios en la presente guía contemplan una mejor distribución en la presentación de los procedimientos priorizando los que involucran a los niños menores de un año, se actualiza los valores de concentración de hemoglobina en cuanto a la severidad. La atención de la salud requiere de una permanente mejora para prestar un servicio de calidad que incluye información confiable a partir de los instrumentos de medición como en este caso la determinación de la hemoglobina, por lo que esperamos esta segunda edición, sea de utilidad

Haematological reference for red-browed parrot (Amazona rhodocorytha, Salvadori, 1890) captive in the Atlantic Forest in Eastern Brazil / Parâmetros hematológicos de papagaios-chauá (Amazona rhodocorytha, Salvatori 1890) em cativeiro

To conduct the survey were used 35 (thirty-five) red-browned parrots (A. rhodocorytha), adults, captive, of both genders and clinically healthy, belonging to the live collection of the Museum of Biology Teacher Mello Leitao, located in Santa Teresa, Espírito Santo, Brazil. Harvests were performed in the morning, by puncture of the brachial vein getting 0.5mL of blood stored in EDTA for a period no longer than 6 hours. Blood smears of fresh material were made at collection, stained using the method of May-Grunwald-Giemsa. Analysis of blood elements was done by cell counting in a mirrored Neubauer chamber using Natt and Herrick solution at a ratio of 2:200 as diluent. For the analysis of the methodology, homoglobinometry cyanide hemoglobin using commercial kits by colorimetry on a semi-automatic biochemical analyzer was used. After completion of the statistical data the following parameters were obtained (mean±standard deviation): Erythrocytes (x106/µl): 2.68±0.56; Hemoglobin (g/dl): 14.27±0.69; Hematocrit (%): 53±3.38; Mean corpuscular volume (fl): 206.7±45.82; Mean corpuscular hemoglobin (pg): 56.4±14.46; Mean corpuscular hemoglobin concentration (%): 27.5±1.19; Thrombocytes (x3/µl): 25.8 ± 10.5; Total plasma protein (g/dl) 5.4±0.5; Leukocytes (x103/dl): 3.1±2; Heterophile (/uL): 1937±1676; Lymphocytes (/uL): 1144±599; Monocytes (/uL): 24.4 ± 28.2; Basophils (/uL): 42.2±46.2; Eosinophils (/uL): 11.7±19.9. In the relation between males and females, no significant differences were found in any hematological parameter evaluated.(AU)

Para a realização da presente pesquisa, foram utilizados 35 (trinta e cinco) papagaios-chauás (A. rhodocorytha), adultos, cativos, de ambos os sexos e clinicamente saudáveis, pertencentes ao acervo vivo do Museu de Biologia Professor Mello Leitão, localizado em Santa Teresa, Espírito Santo, Brasil. As coletas foram realizadas pela manhã, por meio da punção da veia braquial, obtendo-se 0,5mL de sangue, armazenado em EDTA por um período máximo de seis horas. Foram confeccionados esfregaços sanguíneos de material fresco no momento da coleta, posteriormente corados pelo método May-Grunwald-Giensa. A análise dos elementos sanguíneos foi feita por meio de contagem celular em câmara de Neubauer espelhada, utilizando-se como diluente a solução de Natt e Herrick na proporção de 2:200. Para a análise de hemoglobinometria, foi utilizada a metodologia do cianeto de hemoglobina, utilizando-se kits comerciais por colorimetria em um analisador bioquímico semiautomático. Depois de realizada a estatística dos dados, obtiveram-se os seguintes parâmetros (média±desvio-padrão): hemácias (x106/µL): 2,68±0,56; hemoglobina (g/dL): 14,27±0,69; hematócrito (%): 53±3,38; volume corpuscular médio (fL): 206,7±45,82; hemoglobina corpuscular média (pg): 56,4±14,46; concentração hemoglobina corpuscular média (%): 27,5±1,19; trombócitos (x3/µL): 25,8±10,5; proteína plasmática total (g/dL) 5,4±0,5; leucócitos (x103/dL): 3,1±2; heterófilos (/µL): 1937±1676; linfócitos (/µL): 1144±599; monócitos (/µL): 24,4±28,2; basófilos (/µL): 42,2±46,2; eosinófilos (/µL): 11,7±19,9. Na relação entre machos e fêmeas, não foi encontrada diferença estatística relevante em nenhum parâmetro hematológico avaliado.(AU)

Concordancia de tres métodos para la determinación de la hemoglobina en donantes de un banco de sangre de Medellín, Colombia – 2012 / Concordance between threee methods for the hemoglobin determination in blood donors of a blood bank from Medellin, Colombia – 2012 / Correspondência três métodos para determinação de hemoglobina em doador de um banco de sangue de Medellín, Colômbia - 2012s

Introducción: una medición fundamental en la selección de los donantes de sangre es la concentración de hemoglobina; sin embargo se han reportado resultados variables dependiendo de la metodología utilizada para su cuantificación. Métodos: estudio descriptivo transversal. Se cuantificó la hemoglobina en 70 donantes mediante el Compolab y el Sysmex XE2100. Además se determinó la hemoglobina reticulocitaria y se aplicó una encuesta sobre hábito tabáquico y actividad física. La concordancia entre los parámetros se evaluó mediante elcoeficiente de correlación intraclase. Los datos se analizaron en SPSS.Resultados: la hemoglobina de eritrocitos maduros fue estadísticamente más alta en hombres y en fumadores. No hubo diferencias según grupo etario ni actividad física. Tuvo buena concordancia entre los resultados del Compolab y el Sysmex yun bajo coeficiente de correlación intraclase entre la hemoglobina reticulocitaria y la de eritrocitos maduros. Conclusiones: la selección del donante puede basarse en la hemoglobina dada por el hemoglobinómetro, cuyas cuantificaciones son intercambiables con las del Sysmex XE2100.

Introduction: hemoglobin quantification is fundamental in the selection of blood donors, but has reported varying results depending on the methodology used for its determination.Methods: cross-sectional study. Hemoglobin was quantitated in 70 donors by the Sysmex XE2100 and Compolab. We also determined reticulocyte hemoglobin, We surveyed about smoking and physical activity. The correlation between parameters was assessed using the intraclass correlation coefficient. Data were analyzed in SPSSResults: the mature erythrocyte hemoglobin was statistically higher in men and in smokers. There were no differences by age group and physical activity. There was good agreement between the results of Compolab and Sysmex. There was a low intraclass correlation coefficient between reticulocyte hemoglobin and mature erythrocyte hemoglobin.Conclusions: the donor selection may be based on hemoglobin given by hemoglobinometer whose quantifications are interchangeable with the Sysmex XE2100.

Introdução: a medição fundamental na seleção de doadores de sangue é a hemoglobina, mas relataram resultados variáveis dependendo do método utilizado para a quantificação.Métodos: a hemoglobina foi quantificada em 70 doadores, e pelo Sysmex XE2100 Compolab. Também determinou a hemoglobina de reticulócitos, foram pesquisadossobre o tabagismo e atividade física. A correlação entre os parâmetros foi avaliada pelo coeficiente de correlação intraclasse. Os dados foram analisados no SPSSResultados: a hemoglobina de eritrócitos maduros foi estatisticamente maior em homens e em fumantes. Não houve diferenças por faixa etária e atividade física. Houve boa concordância entre os resultados de Compolab e Sysmex. Houve um baixo coeficiente de correlação entre hemoglobina e reticulócitos eritrócito maduro.Conclusões: a seleção dos doadores pode ser baseada em hemoglobina dada pelo hemoglobinômetro cujas quantificações são permutáveis com a XE2100 Sysmex.

Validity and reliability of haemoglobin colour scale and its comparison with clinical signs in diagnosing anaemia in pregnancy in Ahmedabad, India

This study compared the validity of the haemoglobin colour scale [HCS] and clinical signs in diagnosing anaemia against Sahli's haemoglobinometer method as the gold standard, and assessed the reliability of HCS. The sample comprised 129 pregnant women recruited from 6 urban health centres in Ahmedabad. The prevalence of anaemia was 69.8% by Sahli's method, 78.3% by HCS and 89.9% by clinical signs; there was no statistically significant difference between Sahli's method and HCS whereas there was between Sahli's method and clinical signs. The mean haemoglobin level by Sahli's method and HCS differed significantly. The sensitivity, specificity, positive predictive value and negative predictive value of HCS was 83.3%, 33.3%, 74.3% and 46.4% respectively and that of clinical signs was 91.1%, 12.8%, 70.7% and 38.5% respectively. Interobserver agreement for HCS was moderate [K= 0.43]. Clinical signs are better than HCS for diagnosing anaemia. HCS can be used in the field provided assessors are adequately trained

Development of portable free hemoglobin detector / 中国医疗器械杂志

The paper designed the portable free hemoglobin detector using spectrophotometry, which determines the concentration of free hemoglobin. The device has features of portability, compact and precise. It can evaluate the quality of blood products instantly and effectively.

Estado actual de la medida de hemoglobina A1c y objetivos para su mejora: del caos al orden para mejorar la atención de la diabetes / Status of Hemoglobin A1c measurement and goals for improvement: from chaos to order for improving diabetes care

El Estudio de Control y Complicaciones de la Diabetes (DCCT) y el Estudio Prospectivo de Diabetes en el Reino Unido (UKPDS) establecieron la importancia de la hemoglobina A1c (Hb A1c) como un predictor de consecuencias en pacientes con diabetes mellitus. En 1994, la Asociación Americana de Diabetes comenzó a recomendar metas específicas para Hb A1c, pero la falta de comparación entre los ensayos limitó la capacidad de los médicos para usar estos objetivos. El Programa de Estandarización Nacional de Hemoglobina Glicosilada (NGSP) fue implementado en 1996 para estandarizar los resultados de la Hb A1c según los estudios DCCT / UKPDS. El NGSP certifica a los fabricantes de métodos de Hb A1c como trazables al DCCT. Los criterios de certificación se han reforzado con el tiempo y el NGSP ha trabajado con el Colegio Americano de Patólogos en establecer requisitos estrictos para la aptitud de los ensayos. Como resultado, la variabilidad de los valores de la Hb A1c entre los laboratorios clínicos se ha reducido considerablemente. La Federación Internacional de Química Clínica (IFCC) ha desarrollado un sistema de referencia para la Hb A1c , que facilita la trazabilidad de la metrología a un orden superior. El NGSP mantiene la trazabilidad a la red de la IFCC a través de continuas comparaciones de muestras. Ha habido controversias en relación a si el informe de los resultados de Hb A1c debe ser en unidades IFCC o NGSP, o una estimación promedio de glucosa. Los diferentes países se encuentran tomando esta decisión. La variabilidad entre los resultados de Hb A1c se ha reducido considerablemente. No todos los países informarán Hb A1c en las mismas unidades, pero se han establecido ecuaciones que permiten la conversión entre diferentes unidades. Ahora se recomienda Hb A1c para el diagnóstico de la diabetes, acentuando aún más la necesidad de un ensayo de óptimo rendimiento. El NGSP proseguirá sus esfuerzos para mejorar los tests de Hb A1c asegurando que se cumplan las necesidades clínicas.

BACKGROUND: The Diabetes Control and Complications Trial (DCCT) and United Kingdom Prospective Diabetes Study (UKPDS) established the importance of hemoglobin A1c (Hb A1c) as a predictor of outcome in patients with diabetes mellitus. In 1994, the American Diabetes Association began recommending specific Hb A1c targets, but lack of comparability among assays limited the ability of clinicians to use these targets. The National Glycohemoglobin Standardization Program(NGSP) was implemented in 1996 to standardize Hb A1c results to those of the DCCT/UKPDS. CONTENT: The NGSP certifies manufacturers of Hb A1c methods as traceable to the DCCT. The certification criteria have been tightened over time and the NGSP has worked with the College of American Pathologists in tightening proficiency-testing requirements. As a result, variability of Hb A1c results among clinical laboratories has been considerably reduced. The IFCC has developed a reference system for Hb A1c that facilitates metrological traceability to a higher order. The NGSP maintains traceability to the IFCC network via ongoing sample comparisons. There has been controversy over whether to report Hb A1c results in IFCC or NGSP units, or as estimated average glucose. Individual countries are making this decision. SUMMARY: Variability among Hb A1c results has been greatly reduced. Not all countries will report Hb A1c in the same units, but there are established equations that enable conversion between different units. Hb A1c is now recommended for diagnosing diabetes, further accentuating the need for optimal assay performance. The NGSPwill continue efforts to improve Hb A1c testing to ensure that clinical needs are met.

Prevalence of Anemia in Children Three to 12 Months Old in a Health Service in Ribeirão Preto, SP, Brazil / Prevalência de anemia em crianças de 3 a 12 meses de vida em um serviço de saúde de Ribeirão Preto, SP, Brasil / La prevalencia de anemia en niños de 3 a 12 meses de vida en un servicio de salud de Ribeirão Preto, SP, Brasil

Iron deficiency anemia is the most common nutritional deficiency among children. This cross-sectional, descriptive and quantitative study is part of a multicenter project, which verified the prevalence of anemia in children aged three to 12 months, treated by a health service unit in Ribeirão Preto, SP, Brazil. Interviews with mothers and determining hemoglobin dosage were carried out with 121 children who participated in the study. Two international criteria were adopted as parameters of anemia according to the children's age. Descriptive statistics, measures of central tendency and associations were used for data analysis. The prevalence of anemia among 69 children aged three to 5 months was 20.2 percent and 48.0 percent among 52 children aged six to 12 months. The total prevalence of anemia was 32.2 percent. There was significant association between anemia and children's age, and anemia and the consumption of liquid cow's milk.

Das carências nutricionais entre crianças, a anemia ferropriva constitui-se no evento mais frequente. Este é um estudo transversal, descritivo, quantitativo, recorte de um projeto multicêntrico, que verificou a prevalência de anemia em crianças de 3 a 12 meses, em um serviço de saúde em Ribeirão Preto, SP. Foram realizadas entrevistas e dosagem de hemoglobina de 121 crianças que participaram do estudo. Adotaram-se dois critérios internacionais como parâmetros de anemia, de acordo com a idade da criança. Para a análise dos dados foram utilizadas estatística descritiva, medidas de tendência central e associações. A prevalência de anemia nas 69 crianças de 3 a 5 meses foi de 20,2 por cento e naquelas 52, de 6 a 12 meses, foi de 48 por cento. A prevalência total de anemia foi de 32,2 por cento. Encontrou-se associação significativa entre anemia e idade da criança e anemia e uso de leite de vaca fluido.

Entre las carencias nutricionales de niños, la anemia ferropénica es la más frecuente. Estudio transversal, descriptivo, cuantitativo es un extracto de un proyecto multicéntrico que verificó la prevalencia de anemia en niños de 3 a 12 meses de edad, en un servicio de salud de Ribeirão Preto, SP, Brasil. Fueron realizadas entrevistas y dosificación de hemoglobina en los 121 niños. Dos criterios internacionales fueron adoptados como parámetro de anemia, de acuerdo con la edad del niño. Estadística descriptiva, medidas de tendencia central y testes de asociación fueron usados para el análisis de datos. La prevalencia de anemia en los 69 niños de 3 a 5 meses fue del 20,2 por ciento, y en los 52 niños de 6 a 12 meses fue del 48,0 por ciento. En total, la prevalencia de anemia fue del 32,2 por ciento. Encontró asociación significativa entre anemia y edad del niño y anemia y el consumo de leche de vaca liquido.

Non-invasive Hemoglobin Measurement in Emergency Patients

PURPOSE: At present, the hemoglobin count is one of the most commonly performed clinical laboratory tests in the emergency department. However, the conventional method is invasive and permits only intermittent assessments. The aim of this study was to determine whether non-invasive hemoglobin measurements (SpHb) produce comparably accurate results to laboratory hemoglobin tests (tHb) in patients presented to the emergency department. METHODS: From May to July 2009, 217 patients who required hemoglobin tests after presenting to the emergency department of a hospital were enrolled. We measured hemoglobin values using the conventional method (tHb), and the non-invasive method (SpHb). The study population was classified into two groups: 'non-bleeding' and 'bleeding'. The concordance between tHb and SpHb was analyzed by the Pearson's correlation coefficient. RESULTS: A total of 217 data pairs were collected from 217 subjects, 193(88.9%) non-bleeding patients, 24(11.1%) bleeding patients. A total of 114 subjects were male (52.5%). The Pearson's correlation coefficient between tHb and SpHb was 0.814(p=0.000). In the 'non-bleeding' and 'bleeding' groups, the Pearson's correlation coefficients between tHb and SpHb were 0.779(p=0.000) and 0.788(p=0.000) respectively. CONCLUSION: Non-invasive SpHb measurement provides clinically acceptable accuracy compared to the conventional laboratory method (tHb) in the setting of the emergency department.

Design of portable HGB measurement system / 中国医疗器械杂志

This paper proposes a portable dual-wavelength HGB measurement system to avoid the defect that the single-wavelength HGB (Hemoglobin) admeasuring apparatus needs to measure the blank solution for comparison and correction, The system consists of constant light sources, residual, core controller based on ARM, data processing unit, LCD part and so on. Compared with the methods of single-wavelength measurement, the system is proved to be high-efficiency and can work at a high speed, and well meet the need of clinical medicine, The technology and methods adopted in the system are practical and can be extensively used.

Haematological, biochemical and bone density parameters in vegetarians and non-vegetarians / Parámetros de densidad ósea, hematológica, y bioquímica en vegetarianos y no vegetarianos

OBJECTIVE: The objective is to determine any possible differences between haematological, biochemical and bone mineral density in vegetarians (vegans and lacto-ovovegetarians) and non-vegeterians. METHODS: The examined group consisted of 100 individuals: 50 non-vegetarians and 50 vegetarians. The vegetarian group was further divided in 2 subgroups: 20 vegans and 30 lacto-ovovegetarians. In all participants, plasma levels of erythrocytes, haemoglobin, haematocrit, iron, low density lipoprotein, (LDL), high density lipoprotein (HDL) total cholesterol, triglycerides and glucose were measured. Quantitative ultrasound parameters of the right calcaneus were determined in all participants. RESULTS: The results showed that lacto-ovovegetarians had statistically significantly higher red blood cell counts and haematocrit values than non-vegetarians. Vegans also had higher haematocrit values than non-vegetarians. Statistically significant differences were found between iron plasma levels in the examined groups. Iron levels were lower in non-vegetarians than in vegans and lacto-ovovegetarians. Non-vegetarians had much higher levels of cholesterol, triglycerides and LDL than the other two groups, but there were no differences found between same values in vegans and lacto-ovovegetarians. CONCLUSION: A well planned and balanced vegetarian diet, with avoidance of risk factors, does not result in abnormalities in laboratory tests and bone status parameters.

OBJETIVO: El objetivo es determinar las diferencias entre la densidad hematológica, bioquímica y mineral ósea en vegetarianos (veganos y ovolactovegetarianos) y no vegetarianos. MÉTODOS: El grupo examinado consistía en 100 individuos: 50 no vegetarianos y 50 vegetarianos. El grupo vegetariano estaba a su vez dividido en 2 subgrupos: 20 veganos y 30 ovolactovegetarianos. A todos los participantes se les midieron los niveles plasmáticos de eritrocitos, hemoglobina, hematocrito, hierro, lipoproteína de baja densidad (LDL), lipoproteína de alta densidad (HDL), colesterol total, triglicéridos, y glucosa. Se determinaron los parámetros cuantitativos de ultrasonidos del calcáneo derecho en todos los participantes. RESULTADOS: Los resultados mostraron que los ovolactovegetarianos tuvieron conteos de glóbulos rojos y valores de hematocrito significativamente más altos en términos estadísticos, que los no vegetarianos. Los veganos también tuvieron valores de hematocrito más altos que los no vegetarianos. Se halló diferencia estadísticamente significativa entre los niveles séricos de hierro en los grupos examinados. Los niveles de hierro fueron más bajos en los no vegetarianos que en los veganos y los ovolacto-vegetarianos. Los no vegetarianos tuvieron niveles de colesterol, triglicéridos y LDL mucho más altos que los otros dos grupos, pero no se encontraron diferencias entre los mismos valores en los veganos y los ovolactovegetarianos. CONCLUSIÓN: Podemos concluir que una dieta vegetariana bien planeada y equilibrada, que evite factores de riesgo, no trae consigo anormalidades en las pruebas de laboratorio y los parámetros del estado óseo.

Blood zinc levels and clinical severity of dengue hemorrhagic fever in children.

The aims of the study were to investigate the relationship between blood zinc levels and the severity of DHF. A cross-sectional study was conducted involving 51 children at Budhi Asih Hospital, Jakarta, from March to May, 2005. Blood zinc levels were measured with a colorimeter using 5-BR-PAPS. The diagnosis and grading of DHF was determined according to WHO criteria. On analyzing the data, z test, ANNOVA, chi-square, linear regression and coefficient of correlation, were applied appropriately with p < or = 0.05. Forty-five samples were obtained consisting of 15 boys and 30 girls, age 75 +/- 35 months, body mass index of 15.1 +/- 3.2, pre-admission fever for 4.4 +/- 1.6 days, a hematocrit of 38.4 +/- 5.1%, a thrombocyte count of 77,200 +/- 32,100/dl, and a zinc level of 6.4 +/- 6.3 micromol/l, of with 34 had low and 11 were high zinc level cases (cutoff point: 9.18 micromol/l). The clinical severity in the low and high zinc groups were not significantly different. The blood zinc level in DHF grade 4 was not significantly lower than in the other three grades (p>0.05). The numbers of lymphocytes in the four grades were significantly different (p<0.01), between the low and high zinc groups (p<0.05). The association between lymphocytes and zinc levels showed a linear regression of Yc: 42.04+1.30X, p<0.05 and a coefficient correlation of r: 0.47. Therefore, no association was found between zinc levels and clinical severity of DHF in children.

Assessment of iron deficiency anaemia by observing the correlation between serum ferritin and haemoglobin levels

In order to observe the correlation between the serum ferritin and blood haemolgobin in anemic patients determination of haemoglobin levels was carried out in uncoagulated blood using Sysmex K1000. The remaining 2 ml blood was used to separate serum by centrifugation, which was then analyzed for determination of ferritin by Elecsys 2010, through electrochemilluminescence technique. Data were compared using correlation analysis and significant correlations were observed in case of male patients, as well as the patients when studied collectively, before distribution into genders. Female patients did not exhibit any significant correlations, when studied separately. The results of the present study show that elevation or decrease in serum ferritin level is a very significant factor in causing anaemia

Comparison between Coulter LH-750 and URIT-12 for measuring hemoglobin concentration / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the feasibility of URIT-12 hemoglobin analyzer for fast measurement of hemoglobin concentration.</p><p><b>METHODS</b>Hemoglobin concentration was detected in 100 random blood samples using URIT-12 hemoglobin analyzer and Coulter LH-750 hematology analyzer.</p><p><b>RESULTS</b>The two analyzers showed good correlation of the results (r=0.994) without significant difference between them (P>0.05). The linear range of URIT-12 hemoglobin analyzer was 46-240 g/L, and in the repeated measurements (20 times) of 3 batches of blood samples with low, moderate and high hemoglobin concentrations, the within-batch coefficient of variation of URIT-12 hemoglobin analyzer, from low to high concentrations, were 2.13%, 2.17%, and 2.33%, respectively. In the measurement of 4 batches of high-fat, high-bilirubin, high-globin and high-white-blood-cell blood samples, the interference rate of the former 3 samples were all less than 4% by the two devices, but that of the fourth sample was 10% by URIT-12 hemoglobin analyzer and 7% by Coulter LH-750 analyzer.</p><p><b>CONCLUSION</b>The results detected by URIT-12 hemoglobin analyzer have high accuracy and precision and is easy to operate, fast-testing and portable.</p>

Population Based Reference Intervals for Common Blood Haematological and Biochemical Parameters in the Akuapen North District

Objectives : To estimate the reference intervals for commonly used blood haematology and biochemical parameters in an adult (18-55yrs) population of residents of Mampong Akuapem. Design: This was a population based cross sectional study of a randomly selected sample of the adult population of Mampong. The sample was selected from an updated census list of the Mampong area. Results: Median values (95 range) for measured parameters were established as follows: Haemoglobin; (males) 14.2 g/dl (females) 12.0 g/dl Alanine aminotransferase (ALT); (female) 19.6 U/L (males) 26.1 U/L and Creatinine; (males) 108 mmol/L (females) 93 mmol/L. Conclusion: In comparison to reference values that are commonly used in Ghana; the haemoglobulin levels from this study were lower; and liver function parameters higher. This could be a result of genetic or environmental differences and calls for the need to establish site specific reference values applicable to our population

Diagnostic accuracy comparison between clinical signs and hemoglobin color scale as screening methods in the diagnosis of anemia in children

OBJECTIVES: to compare the validity and reproducibility of clinical signs with the World Health Organization hemoglobin color scale. METHODS: Two hundred six children in the age range of 6-23 months, at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP, were assessed. Two examiners evaluated the clinical signs and the hemoglobin color scale of each child at the different times. The hemoglobin value was used as a standard for validation. RESULTS: in more than 90 percent of cases the agreement between the values of the color scale and the laboratorial hemoglobin was <2 g/dL. Between the clinical signs the highest sensitivity level for diagnosing Hb<11 g/dL was presented by the hemoglobin color scale (75.7 percent). For moderate/severe anemia Hb<9g/dL the highest sensitivity was shown by combined palmar or conjunctival pallor (74.3 percent) and by the color scale (52.5 percent), according to the first and second observer, respectively. The highest specificity level for Hb<11 g/dL was presented by palmar pallor in comparison with the mother's palm and conjunctival pallor (100 percent). For Hb<9 g/dL the highest specificity was presented by the hemoglobin color scale (91.9 percent). CONCLUSIONS: this study suggests that moderate/severe anemia can be diagnosed either by clinical signs or by the color scale, while, in cases of mild anemia, the better diagnosis tool appears to be the color scale.

OBJETIVOS: comparar a validade e reprodutibilidade dos sinais clínicos (palidez palmar e conjuntival) com a escala de cores da hemoglobina da Organização Mundial de Saúde. MÉTODOS: pesquisa realizada em 206 crianças de 6-23 meses, atendidas nos ambulatórios de puericultura e pediatria do Instituto Materno Infantil Prof. Fernando Figueira, IMIP. Os sinais clínicos e a escala de cores da hemoglobina foram avaliados por dois observadores em diferentes momentos. A validação foi realizada utilizando-se a hemoglobina como padrão. RESULTADOS: em mais de 90 por cento dos casos, a concordância entre os valores da escala de cores e da hemoglobina laboratorial encontravam-se em <2 g/dL. Entre os sinais clínicos e a escala de cores, a maior sensibilidade para diagnosticar anemia (Hb<11 g/dL) foi apresentada pela escala de cores da hemoglobina (75,7 por cento) e na anemia moderada/grave (Hb<9 g/dL), pela palidez palmar ou de conjuntiva ocular combinadas (74,3 por cento) e pela escala de cores (52,5 por cento), para o primeiro e segundo examinadores, respectivamente. A maior especificidade foi apresentada na palidez palmar comparada à palma da mãe e palidez de conjuntiva (100 por cento) para Hb<11 g/dL e a escala de cores da hemoglobina (91,9 por cento) para a Hb<9 g/dL. CONCLUSÕES: o presente estudo sugere que o diagnóstico da anemia moderada/grave seja possível através dos sinais clínicos e da escala de cores e, no caso da anemia leve, o melhor instrumento parece ser a escala de cores.

Dor óssea e sua relação na apresentação inicial da leucemia linfóide aguda / Bone pain and its relation to the initial presentation of acute lymphoblastic leukemia

A leucemia linfóide aguda é uma neoplasia maligna do sistema hematopoiético caracterizada pela alteração do crescimento e da proliferação das células linfóides na medula óssea, com conseqüente acúmulo de células jovens indiferenciadas, denominadas blastos. É a neoplasia maligna mais freqüente (70 por cento) entre as crianças menores de 15 anos de idade. As manifestações clínicas mais comuns incluem febre, equimose e palidez, porém a dor óssea pode ser encontrada como sintoma inicial em 25 por cento dos casos. Assim, com o objetivo de determinar a freqüência da dor óssea e sua relação com dados clínico-laboratoriais em crianças portadoras de leucemia linfóide aguda atendidas na unidade de Oncologia Pediátrica do Hospital de Base de São José do Rio Preto-SP, foram avaliadas cinqüenta crianças portadoras de leucemia linfóide aguda com idade até 15 anos, no período de dezembro de 1991 a dezembro de 2001. Entre as crianças estudadas, 18 apresentaram dor óssea como queixa principal e, destas, 14 apresentaram tempo de evolução (período entre primeiro sintoma e o diagnóstico) superior a 15 dias (p=0.018). Além disso, 13 crianças com dor óssea e tempo de evolução superior a 15 dias apresentaram níveis de hemoglobina inferiores a 8g/dl (p=0,008).

Acute lymphoblastic leukemia is a hematopoietic malignancy characterized by alterations in the growth and proliferation of lymphoblastic cells in bone marrow, with consequent accumulation of immature white blood cells called blasts. It is the most common malignant neoplasm seen in under fifteen-year-olds. Acute lymphoblastic leukemia frequently presents with fever, ecchymosis and paleness, however bone pain is the initial symptom found in 25 percent of the cases. The objective of this work is to determine the frequency of bone pain and its relation with clinical and laboratory data in children with acute lymphoblastic leukemia admitted in the Pediatric Oncology Unit of Hospital de Base de São José do Rio Preto, São Paulo, Brazil. Fifty children with acute lympho­blastic leukemia, aged under fifteen years old, in the period from December 1991 to December 2001 were assessed. Among the children studied, 18 presented bone pain as the main complain and of these, 14 presented a time of evolution (period between first symptom and diagnosis) of over 15 days (p=0.01). Moreover, 13 children with bone pain and time of evolution greater than 15 days had hemoglobinometry below 8 g/dL (p=0.008).

Precisión y exactitud de un oxímetro de pulso "de bolsillo" en la ciudad de México / Precision and accuracy of "a pocket"pulse oximeter in Mexico City

Background. Pulse oximeters are frequently used in the clinical practice and we must known their precision and accuracy. The objective was to evaluate the precision and accuracy of a "pocket" pulse oximeter at an altitude of 2,240 m above sea level. Methods. We tested miniature pulse oximeters (Onyx 9,500, Nonin Finger Pulse Oximeter) in 96 patients sent to the pulmonary laboratory for an arterial blood sample. Patients were tested with 5 pulse oximeters placed in each of the fingers of the hand oposite to that used for the arterial puncture. The gold standard was the oxygen saturation of the arterial blood sample. Results. Blood samples had SaO2 of 87.2 ± 11.0 (between 42.2 and 97.9%). Pulse oximeters had a mean error of 0.28 ± 3.1%. SaO2 - (1.204 x SpO2) - 17.45966 (r = 0.92, p < 0.0001). Intraclass correlation coefficient between each of five pulse oximeters against the arterial blood standard ranged between 0.87 and 0.99. HbCO (2.4 ± 0.6) did not affect the accuracy. Conclusions. The miniature oximeter Nonin is precise and accurate at 2,240 m of altitude. The observed levels of HbCO did not affect the performance of the equipment. The oximeter good performance, small size and low cost enhances its clinical usefulness.

Introducción. Los oxímetros de pulso son ampliamente utilizados en la práctica clínica y su precisión y exactitud deben conocerse especialmente en altitudes moderadas como en la ciudad de México. El objetivo principal fue evaluar la precisión y exactitud de un oxímetro de pulso "de bolsillo" (Onyx 9500 de Nonin®) en la ciudad de México. Métodos. Se realizaron mediciones de la saturación de oxígeno estimada por el oxímetro de pulso (SpO2) y se compararon contra la medida espectrofotométricamente en sangre arterial (SaO2) en 96 pacientes que acudieron al laboratorio de fisiología pulmonar del Instituto Nacional de Enfermedades Respiratorias. A cada paciente se le colocaron cinco oxímetros de pulso en los dedos de una mano obteniéndose un promedio de SpO2 para cada uno de los oxímetros y para los cinco oxímetros a la vez, mediciones que se compararon de manera simultánea contra el estándar. Resultados. Las muestras sanguíneas de los 96 pacientes que participaron tuvieron una SaO2 de 87.2 ± 11.0 (entre 42.2-97.9%). Los oxímetros (promedio de los cinco) tuvieron un error de medición promedio de 0.28 ± 3.1%. SaO2 = (1.204 x SpO2) - 17.45966 (r = 0.92, p < 0.0001). Los coeficientes de correlación intraclase que se obtuvieron al comparar los oxímetros entre sí y contra el estándar (SaO2) estuvieron entre 0.87 y 0.99. El nivel de carboxihemoglobina (HbCO) fue de 2.4 ± 0.6% y no afectó significativamente la exactitud del oxímetro. Conclusiones. El oxímetro digital de pulso "de bolsillo" es preciso y exacto en la estimación de la SaO2 a 2,240 metros de altitud. Los niveles observados de HbCO (2.4%) no afectaron su exactitud. Se observó un adecuado desempeño del oxímetro digital de pulso en la ciudad de México.

Use of the WHO hemoglobin color scale in family welfare clinics in India.

A situation is reported for the use of the WHO color scale for the measurement of hemoglobin, which was introduced into India in 1996. Charity family welfare clinics held at a medical college hospital in North India offer free sterilization by tubal ligation under local anesthetic to women following a preliminary screening. An obligatory test of the hemoglobin level is required and must be above 7.0 g/dl for the operation. Some clinics attract large numbers, and the card gives a cheap, rapid and reasonably accurate test, adding to the smooth running and reduction of waiting time. It has proved satisfactory over a 2-year period; 2.3% of participants were shown to have a hemoglobin level of 7 g/dl or less.

Intrauterine fetal transfusion

The incidence of perinatal death resulting from rhesus Rh isoimmunization has dropped dramatically since the introduction of Rh immunoglobulin. However, Rh sensitization continues to be one of the leading causes of fetal anemia. Our patient is a 38-year-old woman; she gives a history of 2 uneventful pregnancies followed by 5 consecutive stillbirths. Investigations revealed an anti-D titre of 1/2048 and anti-C titre of 1/256. Ultrasound examination revealed fetal ascites at 18 weeks gestation. The fetus had a total of 9 successful intrauterine transfusions. She was delivered by an elective cesarean section at 34 weeks gestation; outcome was a healthy female baby weighing 2060g. Examination at 9 month of age showed normal growth and neurodevelopment