Ayuen DS
Olupot-Olupot P
Muhindo R
Onyamboko MA
Ajayi S
Chimjinda N
Taya C
Uyoga S
Williams TN
Maitland K
Fanello C
Day NPJ
Taylor WR
Mukaka M
Malar J. 2025;2477
BACKGROUND: Anaemia is a deleterious consequence of malaria, and its accurate diagnosis is crucial for effective management. However, laboratory methods for measuring haemoglobin (Hb) concentration, like the Coulter Counter and the Quantitative Buffy Coat(R) (QBC(R)), are costly and not widely accessible in resource-limited settings. The point-of-care HemoCue(R) test is a cheaper alternative and suitable in rural areas. The study aimed to determine the level of agreement between Coulter Counter/QBC(R) vs. HemoCue(R)-measured Hb concentrations by Bland-Altman analysis. METHODS: As part of a randomized, placebo-controlled trial of single low-dose primaquine in Ugandan and Congolese children with acute uncomplicated Plasmodium falciparum malaria, Hb concentrations were measured on days 0, 3, 7, and 28 using Coulter Counter (Uganda, n = 1880 paired values), QBC(R) (DR Congo, n = 1984 paired values) and HemoCue(R) Hb-301. The predefined clinically acceptable limits were set at +/- 0.5 g/dL. RESULTS: The Bland-Altman analysis showed that the HemoCue(R) minus Coulter Counter mean Hb difference was - 0.15 g/dL with lower and upper limits of agreement of - 3.68 g/dL and 3.39 g/dL, respectively. Corresponding HemoCue(R) minus QBC(R) values were - 0.23 g/dL, - 1.66 g/dL and 1.22 g/dL. Linear regression of Hb concentration differences vs. mean Hb concentrations showed negative correlations: r = - 0.43 and r = - 0.34 for HemoCue(R) vs. Coulter Counter and HemoCue(R) vs. QBC(R), respectively. CONCLUSIONS: Compared to Coulter and QBC(R), mean HemoCue(R) measured Hb concentrations were lower and, compared to the Coulter or QBC(R) methods, had an overall tendency to measure lower Hb concentrations with increasing Hb concentrations. Upper and lower limits of agreement were wider than the predefined clinically acceptable limits of +/- 0.5 g/dL. HemoCue(R) should be used with caution in settings where decisions about blood transfusions are made.
