Point-of-care versus central testing of hemoglobin during large volume blood transfusion.

BACKGROUND: Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions. METHODS: We retrospectively compared the results of our point-of-care hemoglobin test (EPOC®) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000™) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC® and CBC hemoglobin performed within 30 min of each other during the MTP. We assessed the accuracy of EPOC® hemoglobin testing using two variables: interchangeability and clinically significant differences from the CBC. The Clinical Laboratory Improvement Amendments (CLIA) proficiency testing criteria defined interchangeability for measurements. Clinically significant differences between the tests were defined by an expert panel. We examined whether these relationships changed as a function of the hemoglobin measured by the EPOC® and specific patient characteristics. RESULTS: Fifty one percent (86 of 170) of paired samples\u27 hemoglobin results had an absolute difference of ≤7 and 73% (124 of 170) fell within ±1 g/dL of each other. The mean difference between EPOC® and CBC hemoglobin had a bias of - 0.268 g/dL (p = 0.002). When the EPOC® hemoglobin was \u3c 7 g/dL, 30% of the hemoglobin values were within ±7, and 57% were within ±1 g/dL. When the measured EPOC® hemoglobin was ≥7 g/dL, 55% of the EPOC® and CBC hemoglobin values were within ±7, and 76% were within ±1 g/dL. EPOC® and CBC hemoglobin values that were within ±1 g/dL varied by patient population: 77% for cardiac surgery, 58% for general surgery, and 72% for non-surgical patients. CONCLUSIONS: The EPOC® device had minor negative bias, was not interchangeable with the CBC hemoglobin, and was less reliable when the EPOC® value was \u3c 7 g/dL. Clinicians must consider speed versus accuracy, and should check a CBC within 30 min as confirmation when the EPOC® hemoglobin is \u3c 7 g/dL until further prospective trials are performed in this population

Oxidation of Native and Modified Hemoglobin and Myoglobin by Sodium Nitrate. Effect of Inositol Hexaphosphate

Native and modified hemoglobin, myoglobin and a and phemoglobin subunits were oxidized by sodium nitrite at pH 6. The experiments were carried out under oxy and deoxy conditions with and without inositol hexaphosphate (IHP). It is shown (a) that under oxy condition low concentration of IHP inhibits the oxidation of native hemoglobin only. However, high concentration of IHP inhibits the oxidation of both myoglobin and modified hemoglobin (digested or 0-93-SH groups blocked). This inhibition is partially counteracted by high oxygen pressure, (b) Under deoxy condition the oxidation rates of all hemeproteins studied are significantly faster than that of native hemoglobin. IHP inhibits the oxidation of all except the myoglobin and hemoglobin subunits. It is concluded that although the IHP inhibitory effect on hemoglobin oxidation by nitrite can be explained by the shift of the R↔T conformational equilibrium towards T conformation, some other structural changes such as alteration in molecular surface charges must occur to account for the effect of IHP on the oxidation of hemeproteins devoid of heme-heme interaction

Identification of a Hemolysis Threshold That Increases Plasma and Serum Zinc Concentration.

Background: Plasma or serum zinc concentration (PZC or SZC) is the primary measure of zinc status, but accurate sampling requires controlling for hemolysis to prevent leakage of zinc from erythrocytes. It is not established how much hemolysis can occur without changing PZC/SZC concentrations.Objective: This study determines a guideline for the level of hemolysis that can significantly elevate PZC/SZC.Methods: The effect of hemolysis on PZC/SZC was estimated by using standard hematologic variables and mineral content. The calculated hemolysis threshold was then compared with results from an in vitro study and a population survey. Hemolysis was assessed by hemoglobin and iron concentrations, direct spectrophotometry, and visual assessment of the plasma or serum. Zinc and iron concentrations were determined by inductively coupled plasma spectrometry.Results: A 5% increase in PZC/SZC was calculated to result from the lysis of 1.15% of the erythrocytes in whole blood, corresponding to ∼1 g hemoglobin/L added into the plasma or serum. Similarly, the addition of simulated hemolysate to control plasma in vitro caused a 5% increase in PZC when hemoglobin concentrations reached 1.18 ± 0.10 g/L. In addition, serum samples from a population nutritional survey were scored for hemolysis and analyzed for changes in SZC; samples with hemolysis in the range of 1-2.5 g hemoglobin/L showed an estimated increase in SZC of 6% compared with nonhemolyzed samples. Each approach indicated that a 5% increase in PZC/SZC occurs at ∼1 g hemoglobin/L in plasma or serum. This concentration of hemoglobin can be readily identified directly by chemical hemoglobin assays or indirectly by direct spectrophotometry or matching to a color scale.Conclusions: A threshold of 1 g hemoglobin/L is recommended for PZC/SZC measurements to avoid increases in zinc caused by hemolysis. The use of this threshold may improve zinc assessment for monitoring zinc status and nutritional interventions

A Novel Real-Time Non-invasive Hemoglobin Level Detection Using Video Images from Smartphone Camera

Hemoglobin level detection is necessary for evaluating health condition in the human. In the laboratory setting, it is detected by shining light through a small volume of blood and using a colorimetric electronic particle counting algorithm. This invasive process requires time, blood specimens, laboratory equipment, and facilities. There are also many studies on non-invasive hemoglobin level detection. Existing solutions are expensive and require buying additional devices. In this paper, we present a smartphone-based non-invasive hemoglobin detection method. It uses the video images collected from the fingertip of a person. We hypothesized that there is a significant relation between the fingertip mini-video images and the hemoglobin level by laboratory gold standard. We also discussed other non-invasive methods and compared with our model. Finally, we described our findings and discussed future works

Physical and chemical processes and the morphofunctional characteristics of human erythrocytes in hyperglycaemia

Background: This study examines the effect of graduated hyperglycaemia on the state and oxygen-binding ability of hemoglobin, the correlation of phospholipid fractions and their metabolites in the membrane, the activity of proteolytic enzymes and the morphofunctional state of erythrocytes. Methods: Conformational changes in the molecule of hemoglobin were determined by Raman spectroscopy. The structure of the erythrocytes was analyzed using laser interference microscopy (LIM). To determine the activity of NADN-methemoglobinreductase, we used the P.G. Board method. The degree of glycosylation of the erythrocyte membranes was determined using a method previously described by Felkoren et al. Lipid extraction was performed using the Bligh and Dyer method. Detection of the phospholipids was performed using V. E. Vaskovsky method. Results: Conditions of hyperglycaemia are characterized by a low affinity of hemoglobin to oxygen, which is manifested as a parallel decrease in the content of hemoglobin oxyform and the growth of deoxyform, methemoglobin and membrane-bound hemoglobin. The degree of glycosylation of membrane proteins and hemoglobin is high. For example, in the case of hyperglycaemia, erythrocytic membranes reduce the content of all phospholipid fractions with a simultaneous increase in lysoforms, free fatty acids and the diacylglycerol (DAG). Step wise hyperglycaemia in incubation medium and human erythrocytes results in an increased content of peptide components and general trypsin-like activity in the cytosol, with a simultaneous decreased activity of µ-calpain and caspase 3. Conclusions: Metabolic disorders and damage of cell membranes during hyperglycaemia cause an increase in the population of echinocytes and spherocytes. The resulting disorders are accompanied with a high probability of intravascular haemolysis.</p

Incorporation in vitro of labeled amino acids into proteins of rabbit reticuloytes

Continuing our work on the incorporation of labeled amino acids into proteins (1), we have begun a study of the incorporation in vitro of C14-labeled glycine, L-histidine, L-leucine, and L-lysine into the proteins of rabbit reticulocytes. In preliminary experiments the incorporation into the hemoglobin isolated from the reticulocytes was determined. But, after it was found that plasma contains factors accelerating amino acid incorporation, it was decided to proceed as rapidly as possible toward the identification of these factors; we have, therefore, measured incorporation into the total proteins of the reticulocytes, since isolation of the hemoglobin was time-consuming. The results obtained with hemoglobin and with the total proteins are essentially the same, indicating that the other proteins of the reticulocytes incorporate amino acids at approximately the same rate as hemoglobin

SmartHeLP: Smartphone-based Hemoglobin Level Prediction Using an Artificial Neural Network

Blood hemoglobin level (Hgb) measurement has a vital role in the diagnosis, evaluation, and management of numerous diseases. We describe the use of smartphone video imaging and an artificial neural network (ANN) system to estimate Hgb levels non-invasively. We recorded 10 second-300 frame fingertip videos using a smartphone in 75 adults. Red, green, and blue pixel intensities were estimated for each of 100 area blocks in each frame and the patterns across the 300 frames were described. ANN was then used to develop a model using the extracted video features to predict hemoglobin levels. In our study sample, with patients 20-56 years of age, and gold standard hemoglobin levels of 7.6 to 13.5 g/dL., we observed a 0.93 rank order of correlation between model and gold standard hemoglobin levels. Moreover, we identified specific regions of interest in the video images which reduced the required feature space

MR imaging–derived oxygen-hemoglobin dissociation curves and fetal-placental oxygen-hemoglobin affinities

PURPOSE: To generate magnetic resonance (MR) imaging–derived, oxygen-hemoglobin dissociation curves and to map fetal-placental oxygen-hemoglobin affinity in pregnant mice noninvasively by combining blood oxygen level–dependent (BOLD) T2* and oxygen-weighted T1 contrast mechanisms under different respiration challenges. MATERIALS AND METHODS: All procedures were approved by the Weizmann Institutional Animal Care and Use Committee. Pregnant mice were analyzed with MR imaging at 9.4 T on embryonic days 14.5 (eight dams and 58 fetuses; imprinting control region ICR strain) and 17.5 (21 dams and 158 fetuses) under respiration challenges ranging from hyperoxia to hypoxia (10 levels of oxygenation, 100%–10%; total imaging time, 100 minutes). A shorter protocol with normoxia to hyperoxia was also performed (five levels of oxygenation, 20%–100%; total imaging time, 60 minutes). Fast spin-echo anatomic images were obtained, followed by sequential acquisition of three-dimensional gradient-echo T2*- and T1-weighted images. Automated registration was applied to align regions of interest of the entire placenta, fetal liver, and maternal liver. Results were compared by using a two-tailed unpaired Student t test. R1 and R2* values were derived for each tissue. MR imaging–based oxygen-hemoglobin dissociation curves were constructed by nonlinear least square fitting of 1 minus the change in R2*divided by R2*at baseline as a function of R1 to a sigmoid-shaped curve. The apparent P50 (oxygen tension at which hemoglobin is 50% saturated) value was derived from the curves, calculated as the R1 scaled value (x) at which the change in R2* divided by R2*at baseline scaled (y) equals 0.5. RESULTS: The apparent P50 values were significantly lower in fetal liver than in maternal liver for both gestation stages (day 14.5: 21% ± 5 [P = .04] and day 17.5: 41% ± 7 [P < .0001]). The placenta showed a reduction of 18% ± 4 in mean apparent P50 values from day 14.5 to day 17.5 (P = .003). Reproduction of the MR imaging–based oxygen-hemoglobin dissociation curves with a shorter protocol that excluded the hypoxic periods was demonstrated. CONCLUSION: MR imaging–based oxygen-hemoglobin dissociation curves and oxygen-hemoglobin affinity information were derived for pregnant mice by using 9.4-T MR imaging, which suggests a potential to overcome the need for direct sampling of fetal or maternal blood. Online supplemental material is available for this article

Studies on the Hemoglobin of Cooley's Anemia and Cooley's Trait

The diseases sickle cell anemia and Cooley's anemia (also known as thalassemia or Mediterranean anemia) have associated with them "minor" or "trait" forms of the disease in which the symptomatology is minimal, and the abnormalities in the red cells are correspondingly less. Extensive genetic studies carried out on these diseases [1-4] have led to the conclusion that in each case the trait is inherited as a Mendalian dominant, the person being heterozygous in the sickle cell gene or Cooley's gene. Homozygosity in either of these genes leads to the corresponding anemia. Our understanding of sickle cell anemia has improved considerably with the discovery of an abnormal hemoglobin and a molecular interpretation of the pathological behavior of the red cell. [5] In that disease it was possible to demonstrate heterozygosity and homozygosity directly, by observing varying amounts of the abnormal hemoglobin. Liquori [6] has recently reported the pr'esence of fetal hemoglobin in cases of Cooley's anemia. We have carried out a number of experiments which support his findings, and have extended the investigation to include cases of Cooley's trait, for which no fetal hemoglobin was found. A hypothesis is advanced to explain these facts