A Comparison of the Accuracy of Handheld Hemoglobinometer and Hematocrit Measurements for Detecting Plasma Leakage in Dengue Hemorrhagic Fever

Silvita Fitri Riswari,1,2 Muhammad Fitriandi Budiman,2,3 Dera Darmayanti,2 Ernawati,2 Susantina Prodjosoewojo,2,3 Evan Susandi,2,3 Amaylia Oehadian,3 Bachti Alisjahbana2,3 1Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; 2Research Center for Care and Control of Infectious Diseases, Universitas Padjadjaran, Bandung, Indonesia; 3Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, IndonesiaCorrespondence: Bachti Alisjahbana, Tel +62 823 9841 5612, Fax +62 22 204 4128, Email b.alisjahbana@gmail.comPurpose: Practical methods for detecting plasma leakage should be readily available in all areas where dengue is endemic. We compared the accuracy of measurements obtained with a handheld HemoCue® Hb 201 instrument used for hemoglobin point-of-care testing (Hb-POCT) with that of measurements of hematocrit (Ht) levels for detecting plasma leakage in dengue patients.Patients and Methods: We performed both measurements using the HemoCue® Hb201 system and microhematocrit method on EDTA blood taken from dengue patients at three time points during their hospitalization. Ascites, pleural effusion, or gallbladder thickening determined through ultrasound examinations were considered the gold standard for determining dengue hemorrhagic fever (DHF) versus dengue fever (DF).Results: Close agreement between Hb-POCT and Ht measurements was indicated by an r square value of 0.845 in a linear regression. The sensitivity results for distinguishing between DHF and DF at admission were similar for Hb-POCT (63.6%) and Ht (66.7%) (Kappa = 0.75) using the optimal cutoff point determined via ROC analysis. Delta differences (in percentage) for Hb-POCT and Ht between the highest and lowest values showed lower sensitivity (45.5% and 48.5%, respectively; Kappa 0.60) when the optimal cutoff point was applied. Recommended cutoffs of ≥ 20% to confirm plasma leakage provided a slightly higher sensitivity using Hb-POCT (18.2%) com