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Reliability of transcutaneous hemoglobin measurements in an outpatient pediatric clinic
Shae Margulies1, Molly Posa2, Melissa Fitzgerald2
1College of Medicine, University of Florida, FL, USA.
Insights
Transcutaneous hemoglobin (tcHgb) measurements show limitations in accurately screening pediatric patients for iron deficiency anemia compared to standard capillary hemoglobin (cHgb) tests. The tcHgb device may overestimate low hemoglobin levels, potentially leading to missed anemia diagnoses in children.
Area of Science:
- Pediatrics
- Hematology
- Medical Devices
Background:
- Iron deficiency anemia is a common pediatric concern.
- Accurate hemoglobin screening is crucial for early diagnosis and treatment.
- Transcutaneous hemoglobin (tcHgb) measurement offers a less invasive alternative to traditional methods.
Purpose of the Study:
- To evaluate the reliability of transcutaneous hemoglobin (tcHgb) measurements against standard capillary hemoglobin (cHgb) for anemia screening in pediatric patients.
- To identify factors influencing the accuracy and success rate of tcHgb measurements in a pediatric outpatient setting.
Main Methods:
- A comparative study was conducted on pediatric patients requiring hemoglobin assessment.
- Transcutaneous hemoglobin (tcHgb) and capillary hemoglobin (cHgb) measurements were performed concurrently.
- Data analysis included intraclass correlation and Bland-Altman analysis to assess agreement.
Main Results:
- Transcutaneous hemoglobin (tcHgb) measurements showed poor agreement with capillary hemoglobin (cHgb) (ICC=0.29).
- tcHgb tended to overestimate hemoglobin values when cHgb was low, potentially masking anemia.
- Measurement success was limited in younger children (<2 years) due to probe size and patient movement.
Conclusions:
- Transcutaneous hemoglobin (tcHgb) measurement has significant limitations for pediatric anemia screening.
- The device's suboptimal sensitivity and tendency to overestimate low values pose a risk of missed diagnoses.
- Further research is needed, including comparison to gold-standard complete blood counts and development of smaller probes for infants.
Objective:
Our study assessed the reliability of a transcutaneous hemoglobin (tcHgb) measurement as compared to a standard capillary hemoglobin (cHgb) measurement in screening for iron deficiency anemia in a single university-based pediatric outpatient clinic.
Methods:
Study participants included all pediatric patients requiring a hemoglobin (Hgb) assessment from July 2019 to June 2020. A tcHgb measurement was attempted on all children who received a cHgb measurement. Additional variables evaluated were age, visit type, gender, insurance type, weight, BMI percentile and presence of comorbid conditions.
Results:
Of 777 attempts, both cHgb and tcHgb were obtained in 196 children aged 9 months to 21 years. Attempts were most successful in children > 2 years of age due to finger size and ability to remain still for one to two minutes. The mean cHgb was 12.5 ± 1.5 g/dL, mean tcHgb value 13.1 ± 2.1 g/dL, and the mean difference was 0.6 ± 2.1 g/dL (tcHgb-cHgb). An intraclass correlation coefficient was 0.29. There were no differences with regards to age, visit type, gender, insurance type, weight, BMI percentile and presence of comorbid conditions. Bland-Altman analysis displayed a lack of agreement between the tcHgb and cHgb measurements and tcHgb tended to over-estimate Hgb values when the cHgb was low.
Conclusions:
The measurement of a transcutaneous Hgb is less invasive for pediatric patients but has significant limitations. Smaller children (probe specifications) and movement limited the ability to obtain a tcHgb measurement in ~75% of children tested. Falsely normal tcHgb values occurred due to overestimation of hemoglobin when compared to the traditional cHgb device. The suboptimal sensitivity of the tcHgb device may cause providers to miss a diagnosis of anemia. Future research should compare both methods of Hgb assessment to the gold standard laboratory-analyzed complete blood count and use a smaller probe for children under 2, once available.
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