Validation of a point-of-care handheld blood total calcium analyzer in postpartum dairy cows

Our objective was to validate a point-of-care handheld blood total calcium analyzer (Ca meter, CM; TD-5220 Vet Ca²⁺, TaiDoc, New Taipei, Taiwan) to estimate circulating Ca concentrations in postpartum dairy cows. Whole blood was collected from 251 multiparous cows between 1 and 4 d in milk from 2 commercial dairy herds in Ontario, Canada. Blood total calcium concentration (tCa) was analyzed in whole blood, fresh plasma, and thawed plasma, and compared with tCa results from thawed serum analyzed in a diagnostic laboratory (using a Cobas Calcium Gen 2 kit, Roche Diagnostics, Indianapolis, IN) as the reference test (RT). Lin's concordance correlation coefficient (βrho;) and Bland-Altman (B-A) plots were assessed to evaluate the agreement between the RT and CM results in each type of sample. Receiver operating characteristic curve analyses were used to describe the accuracy of each test against the categorized RT results (at a cut-point of ≤2.14 mmol/L). Samples where the meter gave a nonquantitative result ("high" or "low"; thawed plasma: 3/247; fresh plasma: 6/100; and whole blood: 20/98) were not included in the βrho; and B-A analyses. Lin's correlation coefficients demonstrated poor agreement between tests (thawed plasma: βrho; = 0.16; fresh plasma: βrho; = 0.21; and whole blood: βrho; = 0.23). Fresh plasma (using a cut-point of 2.55 mmol/L as measured on the CM) had the greatest diagnostic sensitivity (72%), specificity (86%), and accuracy (77%) for determining subclinical hypocalcemia, but that would still misclassify 23% of samples. In addition to substantial variability, the B-A plots revealed bias with changing concentrations of calcium. Because of low sensitivity on whole blood (58%) or thawed plasma (56%), measurement with the CM is not recommended on these types of samples. This rapid and low-cost meter was not sufficiently accurate to quantify blood Ca concentration, but when used with fresh plasma it might be useful as a screening tool for subclinical hypocalcemia.