An evaluation of two methods to measure hemoglobin concentration among women with genetic hemoglobin disorders in Cambodia: a method-comparison study

Abstract

<jats:sec><jats:label /><jats:p>Genetic hemoglobin (Hb) E variants are common in Cambodia and result in an altered and unstable Hb molecule. There are no known studies on the accuracy of Hb measurement using these methods in individuals with Hb E variants.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We measured Hb concentration in capillary blood using a hemoglobinometer (HemoCue) and in venous blood using a hematology analyzer (Sysmex XT‐1800i) in 420 Cambodian women (18‐45 y).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Bias and concordance appeared similar between methods among women with no Hb disorders (n=195, bias=2.5, p<jats:sub>c</jats:sub>=0.68), women with Hb E variants (n=133, bias=2.5, p<jats:sub>c</jats:sub>=0.78), and women with other Hb variants (n=92, bias=2.7, p<jats:sub>c</jats:sub>=0.73). The overall bias (difference in Hb means between methods) was 2.6 g/L , resulting in a difference in anemia prevalence of 11.5% (Hemocue 41% vs. Sysmex 29.5%, p &lt;0.001). Based on concordance plots, the HemoCue device appears to underestimate Hb concentrations in capillary blood as compared to Sysmex (venous blood) at lower Hb concentrations, and to overestimate Hb concentrations in capillary blood as compared to Sysmex at higher Hb concentrations.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Bias and concordance were similar among all groups, suggesting the two methods were comparable in measuring Hb among women in all groups. We highlight the bias between the two methods to caution programming staff, researchers, and policy makers in the interpretation of data and the impact that even a small bias can have on anemia prevalence rates.</jats:p></jats:sec>