The findings of this study may also apply to select the suitable POCT for Hb measurement in other contexts and settings. This study, therefore, aimed to systematically compare the accuracy, precision, and practicality of four POCT, including HctCap, iSTAT, HemoCue, and SpHb, against the reference LHb in the surgical ICU setting. Also, the practicality of POCT, including the workload, turnaround time, and unit cost, should be taken into account. To select a suitable POCT for Hb measurement during the perioperative period, the method accuracy and precision have to be compared with the reference Hb measurement from the central laboratory. Radical-7 Pulse CO-Oximeter can be applied for SpHb measurement based on spectrophotometry using multi-wavelength light absorption. This method needs a few drops of the blood sample to fill into a cartridge, which is then inserted into the iSTAT handheld to measure Hb concentration. iSTAT is another POCT which measures Hct (and then calculate for Hb level) based on microfluidic conductometry. HemoCue uses a minimal blood volume (10 μL) for an analysis. HemoCue is POCT that provides immediate hemoglobin values base upon a modified azide methemoglobin reaction and dual wavelengths (570 nm and 880 nm) detection for compensation of turbidity. Hb is then estimated from Hct divided by three. HctCap is the conventional method to measure hematocrit (Hct) level by using a centrifugal force to sediment red blood cells (RBC) expressed as the percentage of the sediment RBC to the whole blood volume measured. POCT for Hb measurement can be classified as invasive hemoglobin measurement, i.e., hematocrit capillary tube centrifugation (HctCap), HemoCue, and iSTAT), and non-invasive hemoglobin monitoring (SpHb) such as Radical-7 Pulse CO-Oximeter. Thus, transfusion decision during the perioperative period mostly relies on point-of-care testing (POCT) for Hb measurement. Although Hb measurement by the central laboratory (LHb) is the gold standard method, its official report is usually delayed due to time-consuming processes such as specimen transport and report generation. Hemoglobin (Hb) concentration is the mainstay parameter to evaluate acute anemia in both operating room and intensive care unit (ICU). The decision to treat anemia rely on both clinical signs of inadequate oxygen delivery and laboratory parameter. Severe anemia leads to inadequate oxygen delivery to the tissues. This study identified HemoCue as the suitable point-of-care method for the sole purpose of Hb measurement in the surgical ICU setting, while iSTAT should be considered when additional data is needed.Īcute anemia due to bleeding is a significant complication that causes morbidity and mortality in patients during the perioperative period. Considering the practicality, all point-of-care methods had less workload and turnaround time than LHb, but only HemoCue and HctCap had lower unit cost. Thirty-five patients were enrolled, corresponding to 48 blood specimens for analyses, resulting in the measured hemoglobin of 11.2 ± 1.9 g/dL by LHb. Pearson correlation and Bland-Altman analyses were performed to assess the accuracy and precision, while the workload, turnaround time, and the unit cost were evaluated for the method practicality. Four point-of-care methods, i.e., capillary hematocrit (HctCap), HemoCue Hb201+, iSTAT with CG8+ cartridge, and SpHb from Radical-7 pulse co-oximeter were carried out when LHb was ordered. This cross-sectional method comparison study was conducted in the surgical intensive care unit at Ramathibodi Hospital, Thailand, from September 2015 to July 2016. This study aimed systematically compared four point-of-care methods with the central laboratory measurement of hemoglobin (LHb) regarding the accuracy, precision, and assay practicality to identify the preferred point-of-care method during the perioperative period. Transfusion decision during the perioperative period mostly relies on the point-of-care testing for Hb measurement.
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