Preanalytic and analytic factors affecting the measurement of haemoglobin concentration: impact on global estimates of anaemia prevalence
The accuracy of haemoglobin concentration measurements is crucial for deriving global anaemia prevalence estimates and monitoring anaemia reduction strategies. In this analysis, we examined and quantified the factors affecting preanalytic and analytic variation in haemoglobin concentrations. Using c...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2021-07-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/6/7/e005756.full |
| _version_ | 1819035440806625280 |
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| author | Sabine Braat Beverley-Ann Biggs Jena Derakhshani Hamadani Leila M Larson Mohammed Imrul Hasan Sheikh Jamal Hossain Sant-Rayn Pasricha Kamija S Phiri Martin N Mwangi Fernando Estepa Danielle Clucas |
| author_facet | Sabine Braat Beverley-Ann Biggs Jena Derakhshani Hamadani Leila M Larson Mohammed Imrul Hasan Sheikh Jamal Hossain Sant-Rayn Pasricha Kamija S Phiri Martin N Mwangi Fernando Estepa Danielle Clucas |
| author_sort | Sabine Braat |
| collection | DOAJ |
| description | The accuracy of haemoglobin concentration measurements is crucial for deriving global anaemia prevalence estimates and monitoring anaemia reduction strategies. In this analysis, we examined and quantified the factors affecting preanalytic and analytic variation in haemoglobin concentrations. Using cross-sectional data from three field studies (in children, pregnant and nonpregnant women), we examined the difference in haemoglobin concentration between venous-drawn and capillary-drawn blood measured by HemoCue (ie, preanalytic) and modelled how the bias observed may affect anaemia prevalence estimates in population surveys and anaemia public health severity classification across countries. Using data from an international quality assurance programme, we examined differences due to instrumentation from 16 different haematology analyzers (ie, analytic). Results indicated that capillary and venous haemoglobin concentrations are not in agreement (bias +5.7 g/L (limits of agreement (LoA) −11.2, 22.6) in preschool age children; range from −28 g/L to +20 g/L in pregnant women; bias +8.8 g/L (LoA −5.2, 22.9) in non-pregnant women). The bias observed could introduce changes in population survey estimates of anaemia of up to −20.7 percentage points in children and −28.2 percentage points in non-pregnant women after venous adjustment. Analytic variation was minimal and unlikely to influence the diagnosis of anaemia. These findings suggest that global estimates of anaemia prevalence derived from capillary haemoglobin, as they often are, may be inaccurate and lead to erroneous public health severity classification, but that point-of-care, or other, instruments should not introduce variation if properly used. |
| first_indexed | 2024-12-21T07:49:40Z |
| format | Article |
| id | doaj.art-1d15261aaf3645f6bd7554b72720caf0 |
| institution | Directory Open Access Journal |
| issn | 2059-7908 |
| language | English |
| last_indexed | 2024-12-21T07:49:40Z |
| publishDate | 2021-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj.art-1d15261aaf3645f6bd7554b72720caf02022-12-21T19:11:07ZengBMJ Publishing GroupBMJ Global Health2059-79082021-07-016710.1136/bmjgh-2021-005756Preanalytic and analytic factors affecting the measurement of haemoglobin concentration: impact on global estimates of anaemia prevalenceSabine Braat0Beverley-Ann Biggs1Jena Derakhshani Hamadani2Leila M Larson3Mohammed Imrul Hasan4Sheikh Jamal Hossain5Sant-Rayn Pasricha6Kamija S Phiri7Martin N Mwangi8Fernando Estepa9Danielle Clucas10Centre for Epidemiology and Biostatistics, The University of Melbourne, Melbourne, Victoria, AustraliaDepartment of Infectious Diseases at the Peter Doherty Institute, The University of Melbourne, Melbourne, Victoria, AustraliaMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshDepartment of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USAMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshMaternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, BangladeshPopulation Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, AustraliaSchool of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, MalawiSchool of Public Health and Family Medicine, University of Malawi College of Medicine, Blantyre, MalawiThe Royal College of Pathologists of Australasia Quality Assurance Program, Melbourne, Victoria, AustraliaPopulation Health and Immunity Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Victoria, AustraliaThe accuracy of haemoglobin concentration measurements is crucial for deriving global anaemia prevalence estimates and monitoring anaemia reduction strategies. In this analysis, we examined and quantified the factors affecting preanalytic and analytic variation in haemoglobin concentrations. Using cross-sectional data from three field studies (in children, pregnant and nonpregnant women), we examined the difference in haemoglobin concentration between venous-drawn and capillary-drawn blood measured by HemoCue (ie, preanalytic) and modelled how the bias observed may affect anaemia prevalence estimates in population surveys and anaemia public health severity classification across countries. Using data from an international quality assurance programme, we examined differences due to instrumentation from 16 different haematology analyzers (ie, analytic). Results indicated that capillary and venous haemoglobin concentrations are not in agreement (bias +5.7 g/L (limits of agreement (LoA) −11.2, 22.6) in preschool age children; range from −28 g/L to +20 g/L in pregnant women; bias +8.8 g/L (LoA −5.2, 22.9) in non-pregnant women). The bias observed could introduce changes in population survey estimates of anaemia of up to −20.7 percentage points in children and −28.2 percentage points in non-pregnant women after venous adjustment. Analytic variation was minimal and unlikely to influence the diagnosis of anaemia. These findings suggest that global estimates of anaemia prevalence derived from capillary haemoglobin, as they often are, may be inaccurate and lead to erroneous public health severity classification, but that point-of-care, or other, instruments should not introduce variation if properly used.https://gh.bmj.com/content/6/7/e005756.full |
| spellingShingle | Sabine Braat Beverley-Ann Biggs Jena Derakhshani Hamadani Leila M Larson Mohammed Imrul Hasan Sheikh Jamal Hossain Sant-Rayn Pasricha Kamija S Phiri Martin N Mwangi Fernando Estepa Danielle Clucas Preanalytic and analytic factors affecting the measurement of haemoglobin concentration: impact on global estimates of anaemia prevalence BMJ Global Health |
| title | Preanalytic and analytic factors affecting the measurement of haemoglobin concentration: impact on global estimates of anaemia prevalence |
| title_full | Preanalytic and analytic factors affecting the measurement of haemoglobin concentration: impact on global estimates of anaemia prevalence |
| title_fullStr | Preanalytic and analytic factors affecting the measurement of haemoglobin concentration: impact on global estimates of anaemia prevalence |
| title_full_unstemmed | Preanalytic and analytic factors affecting the measurement of haemoglobin concentration: impact on global estimates of anaemia prevalence |
| title_short | Preanalytic and analytic factors affecting the measurement of haemoglobin concentration: impact on global estimates of anaemia prevalence |
| title_sort | preanalytic and analytic factors affecting the measurement of haemoglobin concentration impact on global estimates of anaemia prevalence |
| url | https://gh.bmj.com/content/6/7/e005756.full |
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