Abstract
The laboratory analysis provides accurate, but time consuming hemoglobin level estimation especially in the emergency setting. The reliability of time-sparing point of care devices (POCT) remains uncertain. We tested two POCT devices accuracy (HemoCue®201+ and Gem®Premier™3000) in routine emergency department workflow. Blood samples taken from patients admitted to the emergency department were analyzed for hemoglobin concentration using a laboratory reference Beckman Coulter LH 750 (HBLAB), the HemoCue (HBHC) and the Gem Premier 3000 (HBGEM). Pairwise comparison for each device and HbLAB was performed using correlation and the Bland–Altman methods. The reliability of transfusion decision was assessed using three-zone error grid. A total of 292 measurements were performed in 99 patients. Mean hemoglobin level were 115 ± 33, 110 ± 28 and 111 ± 30 g/l for HbHC, HbGEM and HbLAB respectively. A significant correlation was observed for both devices: HbHC versus HbLAB (r2 = 0.93, p < 0.001) and HBGEM versus HBLAB (r2 = 0.86, p < 0.001). The Bland–Altman method revealed bias of −3.7 g/l (limits of agreement −20.9 to 13.5) for HBHC and HBLAB and 2.5 g/l (−18.6 to 23.5) for HBGEM and HBLAB, which significantly differed between POCT devices (p < 0.001). Using the error grid methodology: 94 or 91 % of values (HbHC and HbGEM) fell in the zone of acceptable difference (A), whereas 0 and 1 % (HbHC and HbGEM) were unacceptable (zone C). The absolute accuracy of tested POCT devices was low though reaching a high level of correlation with laboratory measurement. The results of the Morey´s error grid were unfavorable for both POCT devices.
Similar content being viewed by others
References
Valeri CR, Cassidy G, Pivacek LE, Ragno G, Lieberthal W, Crowley JP, Khuri SF, Loscalzo J. Anemia-induced increase in the bleeding time: implications for treatment of nonsurgical blood loss. Transfusion. 2001;41(8):977–83.
Patel AJ, Wesley R, Leitman SF, Bryant BJ. Capillary versus venous haemoglobin determination in the assessment of healthy blood donors. Vox Sang. 2013;104(4):317–23.
Skelton VA, Wijayasinghe N, Sharafudeen S, Sange A, Parry NS, Junghans C. Evaluation of point-of-care haemoglobin measuring devices: a comparison of Radical-7™ pulse co-oximetry, HemoCue(®) and laboratory haemoglobin measurements in obstetric patients*. Anaesthesia. 2013;68(1):40–5.
Mimoz O, Frasca D, Médard A, Soubiron L, Debaene B, Dahyot-Fizelier C. Reliability of the HemoCue® hemoglobinometer in critically ill patients: a prospective observational study. Min Anestesiol. 2011;77(10):979–85.
Adam I, Ahmed S, Mahmoud MH, Yassin MI. Comparison of HemoCue® hemoglobin-meter and automated hematology analyzer in measurement of hemoglobin levels in pregnant women at Khartoum hospital, Sudan. Diagn Pathol. 2012;7:30.
Paiva ADA, Rondó PHC, Silva SSDB, Latorre MDRDO. Comparison between the HemoCue and an automated counter for measuring hemoglobin. Rev Saude Publica. 2004;38(4):585–7.
Giraud B, Frasca D, Debaene B, Mimoz O. Comparison of haemoglobin measurement methods in the operating theatre. Br J Anaesth. 2013;111(6):946–54.
Seguin P, Kleiber A, Chanavaz C, Morcet J, Mallédant Y. Determination of capillary hemoglobin levels using the HemoCue system in intensive care patients. J Crit Care. 2011;26(4):423–7.
Ray JG, Post JR, Hamielec C. Use of a rapid arterial blood gas analyzer to estimate blood hemoglobin concentration among critically ill adults. Crit Care. 2002;6(1):72–5.
Shah N, Osea EA, Martinez GJ. Accuracy of noninvasive hemoglobin and invasive point-of-care hemoglobin testing compared with a laboratory analyzer. Int J Lab Hematol. 2014;36(1):56–61.
Richards N, Boyce H, Yentis S. Estimation of blood haemoglobin concentration using the HemoCue during caesarean section: the effect of sampling site. Int J Obstet Anesth. 2010;19(1):67–70.
Patel KP, Hay GW, Cheteri MK, Holt DW. Hemoglobin test result variability and cost analysis of eight different analyzers during open heart surgery. J Extra Corpor Technol. 2007;39(1):10–7.
Spielmann N, Mauch J, Madjdpour C, Schmugge M, Weiss M, Haas T. Accuracy and precision of hemoglobin point-of-care testing during major pediatric surgery. Int J Lab Hematol. 2012;34(1):86–90.
Lardi AM, Hirst C, Mortimer AJ, McCollum CN. Evaluation of the HemoCue for measuring intra-operative haemoglobin concentrations: a comparison with the Coulter Max-M. Anaesthesia. 1998;53(4):349–52.
Neville RG. Evaluation of portable haemoglobinometer in general practice. Br Med J (Clin Res Ed). 1987;294(6582):1263–5.
Louw A, Lasserre N, Drouhin F, Thierry S, Lecuyer L, Caen D, Tenaillon A. Reliability of HemoCue in patients with gastrointestinal bleeding. Intensive Care Med. 2007;33(2):355–8.
McNulty SE, Torjman M, Grodecki W, Marr A, Schieren H. A comparison of four bedside methods of hemoglobin assessment during cardiac surgery. Anesth Analg. 1995;81(6):1197–202.
Lamhaut L, Apriotesei R, Combes X, Lejay M, Carli P, Vivien B. Comparison of the accuracy of noninvasive hemoglobin monitoring by spectrophotometry (SpHb) and HemoCue® with automated laboratory hemoglobin measurement. Anesthesiology. 2011;115(3):548–54.
Gehring H, Hornberger C, Dibbelt L, Rothsigkeit A, Gerlach K, Schumacher J, Schmucker P. Accuracy of point-of-care-testing (POCT) for determining hemoglobin concentrations. Acta Anaesthesiol Scand. 2002;46(8):980–6.
Muñoz Gómez M, Naveira Abeigón E, Romero Ruiz A, Ramírez Ramírez G. Precision and accuracy of the immediate determination of hemoglobin using HemoCueB Hemoglobin in urgent, surgical, and critical patients. Rev Esp Anestesiol Reanim. 2003;50(7):332–9.
Morey TE, Gravenstein N, Rice MJ. Let’s think clinically instead of mathematically about device accuracy. Anesth Analg. 2011;113(1):89–91.
American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Practice guidelines for perioperative blood transfusion and adjuvant therapies: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Transfusion and Adjuvant Therapies. Anesthesiology. 2006;105(1):198–208.
Spahn DR, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Filipescu D, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Vincent JL, Rossaint R. Management of bleeding and coagulopathy following major trauma: an updated European guideline. Crit Care. 2013;17(2):R76.
Muñoz M, Romero A, Gómez JF, Manteca A, Naveira E, Ramírez G. Utility of point-of-care haemoglobin measurement in the HemoCue-B haemoglobin for the initial diagnosis of anaemia. Clin Lab Haematol. 2005;27(2):99–104.
Gayat E, Bodin A, Sportiello C, Boisson M, Dreyfus JF, Mathieu E, Fischler M. Performance evaluation of a noninvasive hemoglobin monitoring device. Ann Emerg Med. 2011;57(4):330–3.
Conway AM, Hinchliffe RF, Earland J, Anderson LM. Measurement of haemoglobin using single drops of skin puncture blood: is precision acceptable? J Clin Pathol. 1998;51(3):248–50.
Jaeger M, Ashbury T, Adams M, Duncan P. Perioperative on-site haemoglobin determination: as accurate as laboratory values? Can J Anaesth. 1996;43(8):795–8.
Acknowledgments
The authors wish to thank to the staff of department of Anesthesia and Intensive Care Medicine, Charles University Teaching Hospital in Plzeň.
Funding
Study was supported by the P36 PRVOUK research project of Charles University Prague.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Authors declare no conflict of interest regarding this study.
Ethical standards
All procedures performed in study involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinky declaration and its later amendments of comparable ethical standards. Given its observational nature, anonymity and because all procedures which were done were standard procedures in our institution, no informed consent was required for this study.
Rights and permissions
About this article
Cite this article
Zatloukal, J., Pouska, J., Kletecka, J. et al. Comparison of the accuracy of hemoglobin point of care testing using HemoCue and GEM Premier 3000 with automated hematology analyzer in emergency room. J Clin Monit Comput 30, 949–956 (2016). https://doi.org/10.1007/s10877-015-9799-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10877-015-9799-z