Ifakara Health Institute, Ifakara, Tanzania, United Republic of Tanzania.
Swiss Tropical & Public Health Institute, Allschwil, Switzerland.
PLoS One. 2023 Oct 19;18(10):e0293084. doi: 10.1371/journal.pone.0293084. eCollection 2023.
In low-resource settings, anaemia is a very common condition. Identification of anaemia aetiologies remains challenging due to the lack of diagnostic tools and expertise. We aimed to improve anaemia diagnostics using peripheral blood smear (PBS) with remote interpretation in people living with HIV (PLHIV) with moderate to severe anaemia.
We conducted a prospective study nested within the Kilombero and Ulanga Antiretroviral Cohort, including non-pregnant PLHIV aged ≥18 years presenting with moderate (haemoglobin 7.0-9.9 g/dl) or severe (<7.0 g/dl) anaemia at any visit from January 2019 to December 2020. For each participant, ten PBS images, full blood count and clinical details were shared with a haematologist for remote interpretation (enhanced care). Identification of anaemia etiologies and potential impact on treatment was compared between enhanced and standard care.
Among 400 PLHIV with moderate to severe anaemia, 349 (87%) were female, median age was 40 years (interquartile range (IQR) 35-46)), 65 (17%) had a body mass index <18.5 kg/m2, 215 (54%) had HIV WHO stage III/IV, 79 (20%) had a CD4 cell count <200 cells/μl and 317 (89%) had HIV viral load <100 copies/ml. Severe anaemia was diagnosed in 84 (21%). Suspected multiple aetiologies were documented more frequently by enhanced care compared to standard care 267 (67%) vs 20 (5%); p<0.001. Suspected iron deficiency was the most frequent aetiology (n = 337; 84%), followed by chronic disease (n = 199; 50%), folate/vitamin B12 deficiency (n = 78; 20%) and haemoglobinopathy (n = 83; 21%). In 272 participants (68%), enhanced care revealed additional clinically relevant findings with impact on the treatment recommendation.
Remote interpretation of PBS combined with clinical information and blood cell count results can provide insights to the suspected aetiological diagnosis of moderate and severe anaemia in rural low-resource settings and impact specific treatment.
在资源匮乏的环境中，贫血是一种非常常见的病症。由于缺乏诊断工具和专业知识，贫血病因的识别仍然具有挑战性。我们旨在通过远程解读外周血涂片（PBS）改善中度至重度贫血的艾滋病毒感染者（PLHIV）的贫血诊断。
我们进行了一项前瞻性研究，该研究嵌套在基洛莫罗和乌兰加抗逆转录病毒队列中，包括 2019 年 1 月至 2020 年 12 月期间在任何就诊时出现中度（血红蛋白 7.0-9.9 g/dl）或重度贫血（<7.0 g/dl）的任何就诊时年龄≥18 岁的非妊娠 PLHIV。对于每个参与者，将 10 张 PBS 图像、全血细胞计数和临床详细信息共享给血液学家进行远程解读（增强护理）。比较增强护理和标准护理下贫血病因的识别和潜在治疗影响。
在 400 名患有中重度贫血的 PLHIV 中，349 名（87%）为女性，中位年龄为 40 岁（四分位距 35-46），65 名（17%）的体重指数<18.5 kg/m2，215 名（54%）患有 HIV WHO 分期 III/IV，79 名（20%）的 CD4 细胞计数<200 个/μl，317 名（89%）的 HIV 病毒载量<100 拷贝/ml。84 名（21%）诊断为严重贫血。与标准护理相比，增强护理更频繁地记录了疑似多种病因 267（67%）与 20（5%）；p<0.001。疑似缺铁性贫血是最常见的病因（n = 337；84%），其次是慢性疾病（n = 199；50%）、叶酸/维生素 B12 缺乏症（n = 78；20%）和血红蛋白病（n = 83；21%）。在 272 名参与者（68%）中，增强护理揭示了对治疗建议有影响的额外临床相关发现。
远程解读 PBS 结合临床信息和血细胞计数结果，可以为资源匮乏的农村地区中度和重度贫血的疑似病因诊断提供深入了解，并影响特定治疗。
