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- Title
Comparison between blood hemoglobin concentration determined by point-of-care device and complete blood count in adult patients with dengue.
- Authors
Wisanuvej, Kantasit; Boonyawat, Kochawan; Savetamornkul, Chutchaiwat; Virapongsiri, Sirapong; Krongvorakul, Jatupon; Sungkanuparph, Somnuek; Phuphuakrat, Angsana
- Abstract
Background: Hematocrit measurement has been an indispensable tool for monitoring plasma leakage and bleeding in dengue patients. However, hematocrit measurement by automated methods is hampered by frequent venipunctures. Utility of point-of-care hemoglobin (POC-Hb) test for monitoring dengue patients has not been established. We evaluated the relationship between hemoglobin measured by POC-Hb testing and hematocrit measured by the automated method in adult dengue patients. Methodology and principal findings: Adult dengue patients were recruited at two university hospitals in Thailand from October 2019 to December 2020. POC-Hb test was performed using capillary blood simultaneously with venipuncture to obtain whole blood for an automated complete blood count (CBC) analysis. The correlation of hemoglobin and hematocrit measurement was evaluated. A total of 44 dengue patients were enrolled. Twenty-nine patients (65.9%) were female, with a median age of 31 years (interquartile range 22–41). Of the enrolled patients, 30 (68.2%), 11 (25.0%), and 3 (6.8%) were classified as dengue without warning signs, with warning signs, and severe dengue, respectively. Seven patients (15.9%) had hemoconcentration, and five patients (11.3%) had bleeding. A total of 216 pairs of POC-Hb and CBC were evaluated. A significant positive correlation was observed between hemoglobin measured by POC-Hb testing and hematocrit measured by an automated CBC (r = 0.869, p <0.001). Bland-Altman analysis between hemoglobin measured by POC-Hb testing and an automated CBC showed a bias of -0.43 (95% limit of agreement of -1.81 and 0.95). Using the cutoff of POC-Hb ≥20% as a criteria for hemoconcentration, the sensitivity and specificity of hemoconcentration detected by POC-Hb device were 71.4% and 100.0%, respectively. Conclusions: Hemoglobin measurement by POC-Hb testing has a strong correlation with hematocrit in adult patients with dengue fever. However, the sensitivity in detecting hemoconcentration is fair. The adjunct use of capillary POC-Hb testing can decrease the frequency of venipuncture. Further study in children is encouraged. Author summary: The natural history of dengue has the unique characteristic of plasma leakage that results in hemoconcentration as well as vasculopathy and thrombocytopenia that result in bleeding. Therefore, hematocrit monitoring is a crucial tool to guide management in dengue patients. Microhematocrit adjunct with a complete blood count (CBC) to monitor dengue patients were traditionally performed to decrease the frequency of venipuncture. However, microhematocrit is currently less preferred to the point-of-care hemoglobin monitoring tools to measure red cells in other diseases. There has been no study investigating the feasibility of using point-of-care hemoglobin (POC-Hb) to monitor dengue patients. We studied the correlation of hemoglobin measured by POC-Hb testing and hematocrit measured by an automated CBC in adult dengue patients. We were able to show a strong positive correlation between the two measurements (r = 0.869, p <0.001). Using the rise of POC-Hb value of ≥20% above the convalescent value as the criteria for detecting hemoconcentration by POC-Hb testing, measurement of hemoglobin using POC-Hb has a sensitivity of 71.4% for detecting hemoconcentration compared to the traditional hematocrit criteria. Our findings support the use of POC-Hb testing adjunct with a complete blood count to guide fluid management in dengue patients.
- Subjects
THAILAND; BLOOD cell count; ADULTS; ERYTHROCYTES; DENGUE; HEMOGLOBINS; HEMATOCRIT
- Publication
PLoS Neglected Tropical Diseases, 2021, Vol 15, Issue 8, p1
- ISSN
1935-2727
- Publication type
Article
- DOI
10.1371/journal.pntd.0009692