(PO15-25-22) Comparison of Anemia Screening Methods Using Paired Venous Samples in Women of Reproductive Age in Southern India

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Presenting Author(s)

AF

Amy Fothergill, PhD, MPH
– Postdoctoral Associate, Cornell University, Ithaca, New York, United States

Co-Author(s)

KC

Krista S. Crider, PhD
– Geneticist, Centers for Disease Control and Prevention, Chamblee, Georgia, United States
CJ

Christina B. Johnson, MS
– Arogyavaram Medical Centre, Madanapalle, Andhra Pradesh, India
MR

Mical P. Raj
– Arogyavaram Medical Centre
HG

Heather M. Guetterman, MS
– Doctoral Student, Cornell University, Ithaca, New York, United States
BB

Beena Bose, BS
– Biochemist, St. John's Research Institute, Bangalore, Karnataka, India
CR

Charles E. Rose, PhD
– Centers for Disease Control and Prevention, Atlanta, Georgia, United States
YQ

Yan Ping Qi, MPH
– Centers for Disease Control and Prevention, Chamblee, Georgia, United States
JW

Jennifer L. Williams, MSN, MPH, FNP-BC
– Centers for Disease Control and Prevention, Atlanta, Georgia, United States
RK

Rebecca Kuriyan
– St. John's Research Institute
BW

Bonam Wesley, BSc, MBBS, FAIMS, MRSH
– Director, Arogyavaram Medical Centre, Madanapalle, Andhra Pradesh, India
JF

Julia L. Finkelstein, MPH, SM, ScD
– Assistant Professor, Cornell University, Ithaca, New York, United States

Disclosure(s):

Amy Fothergill, PhD, MPH: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: To evaluate anemia screening via portable hemoglobinometer (HemoCue 301) compared to automated hematology analyzer (AHA) reference, using paired venous samples from a population-based biomarker survey in Southern India.

Methods: Participants were women of reproductive age (WRA; 15-40 y) who were not pregnant or lactating. Paired venous whole blood samples (n=896) were analyzed for hemoglobin (Hb) via HemoCue 301 and Coulter Counter AHA, as the gold standard. Serum ferritin (SF) was measured by electrochemiluminescence. Anemia and severe anemia were defined as Hb < 12.0 and < 8.0 g/dL, respectively. SF was adjusted for inflammation using BRINDA methods; iron deficiency (ID) was defined as SF < 15.0 μg/L. Bland-Altman methods were used to assess level of agreement between Hb results (i.e., mean difference, standard deviation of differences, limits of agreement). Diagnostic accuracy parameters (i.e., sensitivity, specificity, positive predictive value, negative predictive value, accuracy) were calculated to evaluate HemoCue performance compared to the AHA reference, overall and by sociodemographic (e.g., age, parity), nutritional (e.g., iron, vitamin B12, folate status), and metabolic (e.g., HbA1c, body mass index (BMI)) characteristics.

Results: The estimated prevalence of anemia (36.3% vs. 41.6%, p< 0.0001) was significantly lower via HemoCue compared to the AHA reference. A total of 84.4% of anemia and 98.8% of severe anemia screening results were concordant. HemoCue had 74.8% sensitivity and 91.2% specificity, compared to AHA. HemoCue sensitivity was higher in women with iron deficiency (SF < 15.0 μg/L: 81.6% vs. ≥15.0 μg/L: 41.3%; p< 0.0001), and lower in WRA who were overweight (BMI≥25.0 kg/m²: 63.9% vs. < 25.0 kg/m²: 78.8%; p=0.004) or had elevated C-reactive protein (CRP) (CRP >1.0 mg/L: 67.2% vs. ≤1.0 mg/L: 82.9%; p=0.001; CRP >3.0 mg/L: 62.2% vs. ≤3.0 mg/L: 79.3%; p=0.001).

Conclusions: Findings suggest the estimated prevalence of anemia evaluated via portable hemoglobinometer (HemoCue) was lower compared to the AHA reference. HemoCue sensitivity varied by iron status and metabolic risk factors in this population.

Funding Sources: Centers for Disease Control and Prevention (5U01DD001007), University of South Carolina Disability Research and Dissemination Center; NIH 5T32HD087137 (AF); NIH T32DK007158 (HMG); Cornell DNS