Comparing Non-Invasive Spectrophotometry to Hematology Analysis for Hemoglobin Measurements in Sickle Cell Disease Patients.

Patients with sickle cell disease (SCD) require repeated blood sampling for hemoglobin (Hb) concentration measurements. The primary aim of this study was to compare non-invasive spectrophotometric hemoglobin (SpHb, g/dL) measurements to those taken via an automated hematology analyzer (Hb, g/dL) in patients with SCD visiting outpatient clinics and to investigate the correlations and agreements between both measurement techniques. Secondarily, we aimed to identify the SpHb cut-off concentration for the diagnosis of anemia and to monitor the effects of the pleth variability index (PVI, %) and perfusion index (PI) on SpHb measurements. The results gained from the examination of one hundred and fifty-eight patients indicated that the SpHb measurements overestimated the lab Hb concentrations, with a mean (SpHb-Hb) bias of 0.82 g/dL (SD 1.29). The SpHb measurements were positively correlated with the Hb measurements (Kendall's tau correlation (τ), n = 158, τ = 0.68, p < 0.001), with an intra-class correlation (ICC) of 0.67 and a 95% CI from 0.57 to 0.74 (p = 0.000). The SpHb cut-off concentration to diagnose anemia was 11.4 and 11.7 g/dL for males and females, respectively. SpHb sensitivity was low for males and females at 64.4% and 57.1%; however, the specificity was higher at 90.9% and 75%, with positive predictive values (PPVs) of 95.6 and 85.7, respectively. No correlation existed between SpHb measurements and the PVI (%) in contrast with a moderate correlation with the PI (r = 0.049, p = 0.54, and r = 0.36, p < 0.001, respectively). The mean PI was low at 2.52 ± 1.7. In conclusion, the SpHb measurements were consistently higher than the lab Hb concentrations, with a positive correlation. The sensitivity and precision of the SpHb measurements were lower than expected. However, the SpHb specificity and its positive predictive values (PPVs) indicated that it is less likely for a patient with a positive SpHb test result for anemia to be non-anemic. These results will allow SpHb measurement to play a role in excluding the presence of anemia. In light of the low PI values determined, the SpHb measurements were challenging to take and, thus, require further technological improvements.

Can Non-Invasive Spectrophotometric Hemoglobin Replace Laboratory Hemoglobin Concentrations for Preoperative Anemia Screening? A Diagnostic Test Accuracy Study.

Preoperative assessment of hemoglobin concentration in blood is important to diagnose anemia. The primary aim of this prospective diagnostic test accuracy study was to monitor non-invasive spectrophotometric hemoglobin (SpHb, g/dL) concentrations among adults prior to elective surgery and to investigate the correlation and agreement of SpHb with laboratory hemoglobin (Hb, g/dl). A secondary aim was to identify the anemia cut-off values for SpHb based on the World Health Organization (WHO) definitions for anemia. This study included 151 consecutive patients (age ≥ 18 year) presenting for preoperative evaluation prior to scheduled elective general or orthopedic surgery. Results identified the mean ± SD of SpHb at 11.43 ± 2.01 g/dL, which underestimated the mean laboratory Hb (12.64 ± 2.29 g/dL, p < 0.001). A bias mean difference (SpHb-Hb) of -1.21 g/dL, with a SD of 1.76, was reported. This bias (SpHb-Hb) was inversely correlated with the mean Hb concentrations. A positive correlation existed between SpHb and Hb, with a good degree of reliability and a significant Intra Class Correlation (ICC). SpHb diagnosed anemia in 32.3% and 60.3% of males and females, respectively. The SpHb cut-off values to identify anemia were 11.3 and 10.2 g/dL for males and females, respectively, with a sensitivity of 83.3% for males and only 62.9% for females. The specificity for males and females were 81% and 91.3%, respectively. SpHb sensitivity allows for anemia diagnosis among males, but not females. However, the specificity allows SpHb to rule out anemia for both.

The role of rotational thromboelastometry during the COVID-19 pandemic: a narrative review.

The coronavirus disease 2019 (COVID-19) pandemic is currently recognized as a global health crisis. This viral infection is frequently associated with hypercoagulability, with a high incidence of thromboembolic complications that can be fatal. In many situations, the standard coagulation tests (SCT) fail to detect this state of hypercoagulability in patients with COVID-19 since clotting times are either not or only mildly affected. The role of viscoelastic tests such as rotational thromboelastometry (ROTEM®) during this pandemic is explored in this review. COVID-19-associated coagulopathy, as measured using the rotational thromboelastometry parameters, can vary from hypercoagulability due to increased fibrin polymerization and decreased fibrinolysis to bleeding from hypocoagulability. The use of a multimodal diagnostic and monitoring approach, including both rotational thromboelastometry and SCT, such as plasma fibrinogen and D-dimer concentrations, is recommended. Rotational thromboelastometry provides comprehensive information about the full coagulation status of each patient and detects individual variations. Since COVID-19-associated coagulopathy is a very dynamic process, the phenotype can change during the course of infection and in response to anticoagulation therapy. Data from published literature provide evidence that the combination of rotational thromboelastometry and SCT analysis is helpful in detecting hemostasis issues, guiding anticoagulant therapy, and improving outcomes in COVID-19 patients. However, more research is needed to develop evidence-based guidelines and protocols.

Preimplantation Genetic Testing: A Perceptual Study From the Eastern Province, Saudi Arabia.

BACKGROUND: Chromosomal abnormalities affect many children which lead to high rates of morbidity and mortality among them. So, preimplantation genetic testing (PGT) is an evolving technology used to detect a specific genetic disorder in embryos of a couple known to be carriers or affected by a specific mutation. Similarly, it could be used in advanced maternal age which is a high risk of chromosomal abnormalities. Although PGT is a solution for many inherited chromosomal disorders, many ethical dilemmas surround its application. Thus, the aim of this study is to evaluate the community awareness and acceptance of PGT which will eventually lead to a healthier society through disease-free babies in Eastern Province, Kingdom of Saudi Arabia (KSA). METHODOLOGY: A qualitative cross-sectional questionnaire-based study was conducted within the population of the Eastern Province of Saudi Arabia. The questionnaire was designed in Arabic and distributed electronically through social media platforms. RESULTS: The study included 837 participants, whose ages ranged from 18 to 65 years with the mean age 33.5 ± 11.9 years. Good awareness and acceptance were detected among 53.7% of the old aged group (50 years or more) compared to 39.5% of the young age group. Also, 44.9% of female participants had good awareness in comparison to 34.2% of males (p=.033). Participants with a higher number of children had significantly higher awareness and acceptance of PGT. Also, 44.3% of participants who knew someone in need of assisted reproductive technology, had good awareness and acceptance levels compared to 36.9% of those who did not (p=.033). CONCLUSION: The perception of Eastern Province's Saudi citizens toward PGT is found to be low. Increasing their perception toward such technology is needed as it is known that many chromosomal abnormalities are prevalent among this population, particularly sickle cell disease. Achieving this goal will eventually lead to decrease the burden of prevalent inherited diseases. Since Saudis' opinions are almost influenced by cultural and religious points of view, care should be given to these aspects.

Congenital Nephrotic Syndrome With a Novel Presentation in Saudi Arabia.

Congenital nephrotic syndrome (CNS) is a rare and serious entity of renal diseases diagnosed in infants younger than three months. The triad of this syndrome is proteinuria, hypoalbuminemia, and edema. Without renal transplantation, these patients rarely live beyond the age of three years. Infections and sepsis are the most common causes of this condition among children. The majority of patients progress to end-stage renal disease early in life, even with aggressive supportive therapy. In this study, we present a case of a 10-year-old Saudi boy who had been diagnosed with CNS since he was two months old and has improved without renal transplantation.