Indian Journal of Pathology and Microbiology

BRIEF COMMUNICATION
Year
: 2009  |  Volume : 52  |  Issue : 3  |  Page : 360--362

Hemoglobin color scale a diagnostic dilemma


Hema Anand, Rashid Mir, Renu Saxena 
 Department of Haematology, All India Institute of Medical Sciences, New Delhi - 110 029, India

Correspondence Address:
Renu Saxena
Department of Haematology, All India Institute of Medical Sciences, New Delhi - 110 029
India

Abstract

Hemoglobin color scale (HCS) is a commercially available test to screen anaemia in the absence of laboratory based hemoglobinometry. The present study was aimed at to compare the efficacy of HCS with Sahli«SQ»s method (SM) for haemoglobin estimation and to estimate its sensitivity and specificity with respect to auto analyzer as the gold standard. The study was conducted from November 2006 to April 2007 at the department of hematology, All India Institute of Medical Sciences, New Delhi as a project of World Health Organization. The haemoglobin level was measured by all the three methods in 401 patients attending Haematology out patient department. Consent was taken from all the patients. Sensitivity of Sahli«SQ»s method was 98.2% and specificity was 66.2%, whereas the sensitivity of HCS was 30% and specificity was 100%. Sahli«SQ»s method was found to be in good agreement with autoanalyzer (gold standard). It was thus concluded that HCS is not as efficacious, as sahil«SQ»s method for hemoglobin estimations in field.



How to cite this article:
Anand H, Mir R, Saxena R. Hemoglobin color scale a diagnostic dilemma.Indian J Pathol Microbiol 2009;52:360-362


How to cite this URL:
Anand H, Mir R, Saxena R. Hemoglobin color scale a diagnostic dilemma. Indian J Pathol Microbiol [serial online] 2009 [cited 2022 Jan 17 ];52:360-362
Available from: https://www.ijpmonline.org/text.asp?2009/52/3/360/54994


Full Text

 Introduction



Several methods are available for estimation of hemoglobin in field setting, like copper sulphate specific gravity method, the Lovibond comparator and portable hemoglobin meters. [1] The less sophisticated is the device, it is easier for the primary health care worker to perform the test. [2]

Until now, Sahli's hemoglobinometer method of hemoglobin (Hb) estimation is the one which has been recommended by the Government of India for use by the health workers at both the field and at the laboratory facility levels . The Hemoglobin color scale has been proven at the global level to be a very sensitive and specific method for estimating hemoglobin levels and diagnosing anaemia. Recently, the World Health Organization (WHO) developed the hemoglobin color scale (HCS) to screen for anaemia in the absence of laboratory based hemoglobinometry. [3] HCS is a simple and inexpensive device for providing a reliable, indicator of the presence and severity of anaemia. [4]

Since currently in the field, the Sahli's method is being used for the estimation of Hb, it would be interesting to see relative efficiency of HCS with respect to Sahli's method and auto-analyzer for Hb estimation.

The present study was aimed to compare the efficacy of HCS with Sahli's method and auto-analyzer for hemoglobin estimation.

 Materials and Methods



The study was conducted by using samples from patients referred from different out patient departments for hemogram, registered in our institute. Ethical clearance was taken from the institutional ethical committee.

The voluntary participants included were doctors and trained laboratory technicians. For HCS commercial kit was used (COPAC, Germany). After cleaning with 70% alcohol, blood drops were taken after puncturing the ring finger with a sterile lancet. First two drops were discarded and the third drop had been used for hemoglobin estimation. HCS comprises of a small card with six shades of red that represents hemoglobin levels of 4,6,8,10,12 and 14gm/dl respectively. The test strips were kept dry, clean and protected from direct sunlight at all times. A 5cm length of test-strip was torn off for the use.

A single drop of the blood was taken at one end of the test-strip, so that it formed a stain large enough to spread beyond the area of an aperture in the color scale (about 1cm in diameter) and after 30 seconds the blood spot is put against one of the hues on the scale for colour matching as shown in [Figure 1]. Auto-analyzer using 13 parameters including 3 histrogram was used (Sysmex K-4500,Transasia, India). Venous blood was collected in 1.6% ethylene diamine tetra acetic acid (EDTA) vial. Auto-analyzer was calibrated by references of National accreditation board of laboratory (NABL). The results of autoanalyzer, HCS, Sahli's were entered on the reporting forms and then reviewed by the investigator.

It was suggested to analyze the results giving the number of patients showing variability of >±1gm/dl as well as ±>2gm/dl, since HCS is a scale which gives reading in a multiple of 2. The results of HCS, Sahli's and autoanalyzer were analyzed statistically.

Disposal of used lancets and cotton was done according to the WHO guidelines.

 Results



A total of 401 samples were analyzed by HCS, Sahli's hemoglobinometer method and by autoanalyzer. The results of hemoglobin were recorded in g/dl and analyzed by calculating the difference between the hemoglobin determined by HCS, Sahli's and autoanalyzer. The number of samples where this difference was greater than + 1gm /dl or + 2gm/dl is given in [Table 1]. Anemia was graded as mild, moderate (Hb 6-12g/dl) and severe (Hb [5],[6],[7],[8],[9],[10],[11],[12],[13]

 Conclusion



It is concluded that current hemoglobin color scale is not efficacious, as erroneous results were obtained in this study and should not be used for hemoglobin estimation. However there is a need to develop a new hemoglobnin color scale.

 Acknowledgement



Mr Katoch, Mr Keshav, Mr Sukhbir, Mr Rajender, Miss Pooja.[Table 4]

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