Point-of-care haemoglobin measurement in the acute care setting

The Serious Hazards of Transfusion (SHOT) committee has reported the continued occurrence of transfusion incidents related to haemoglobin (Hb) measurement in acute hospital point-of-care testing (POCT) settings, especially in relation to the use of blood gas analysers, and has recommended the use of internal quality control and external quality assessment (EQA), or proficiency testing.1

The UK National External Quality Assessment Scheme for General Haematology (UK NEQAS [H)] established POCT Hb as an option as part of complete blood count EQA in April 2012. Initially open to HemoCue instruments only, blood gas analysers were included on a pilot basis for three distributions between September and November 2012 (distributions 1209HB, 1210HB and 1211HB).
 The present study aims to assess the performance of Hb measurement in acute POCT settings, by HemoCue analysers and blood gas analysers, in the UK NEQAS (H) POCT Hb only EQA (or proficiency testing) surveys.

Methods employed
Survey material was prepared from fresh (<72 hours old) citrate phosphate dextrose (CPD)-anticoagulated human whole blood, with the removal or addition of plasma to manipulate the Hb concentration. Antibiotics were added but the material was not stabilised. Specimens from six pools (two per month for three months) were distributed to the users of approximately 280 HemoCue B and S201 instruments and approximately 170 blood gas analysers (all using CO-oximetric methods) for Hb estimation. The survey specimens were distributed by first-class post and participants were asked to return results within one week of preparation and distribution of the survey material. All participants in the trial were based in the UK.