du Toit Jeanie, Wang Yuqing, Luo Hanqi, Liu Lei, Blau Dianna M, Whitney Cynthia G, Werner Rochelle, Bassat Quique, Storath Kimberleigh, Makekeng Palesa, Dangor Ziyaad, Mahdi Shabir A, Wanga Valentine, Suchdev Parminder S
South African Medical Research Council, Vaccines and Infectious Diseases Analytics Research Unit, University of the Witwatersrand, Johannesburg, South Africa.
Hubert Department of Global Health, Emory University, Atlanta, Georgia, United States of America.
PLOS Glob Public Health. 2025 Feb 13;5(2):e0003997. doi: 10.1371/journal.pgph.0003997. eCollection 2025.
Anemia is an important cause of child morbidity and mortality. Postmortem point-of-care hemoglobin testing is a potential method for assessing anemia at death, but its reliability has not been extensively studied. We aimed to assess the feasibility and validity of postmortem point-of-care hemoglobin assessment using HemoCue in the setting of a child mortality surveillance program in South Africa.In a pilot cohort study, 44 children under five years of age who died in an academic hospital in South Africa were enrolled. Hemoglobin levels were measured from venous blood antemortem using standard hematology analyzers and postmortem using the HemoCue 201 from blood collected within 72 hours of death (either by needle aspiration or from whole blood collected in an EDTA tube). Updated World Health Organization hemoglobin cutoffs to define anemia were used. Wilcoxon signed-rank tests, equivalence tests, and regression models assessed the concordance between antemortem and postmortem hemoglobin concentrations. Postmortem testing showed a significant decrease in hemoglobin concentrations compared to antemortem levels. However, no significant differences were found between hemoglobin measurements from needle aspiration and those from EDTA tubes postmortem. The prevalence of anemia increased from 52% antemortem to 73-77% postmortem, with the most notable rises in moderate and severe anemia. Bland-Altman analysis confirmed a systematic, not random, decrease in postmortem hemoglobin measurements. Upon applying a fixed adjustment of 2.5 g/dL, the sensitivity and specificity of postmortem hemoglobin testing to diagnose anemia were 69.6% and 61.9%, respectively. Postmortem point-of-care hemoglobin testing using HemoCue is feasible and offers a potentially valid reflection of antemortem anemia status in deceased children, despite consistently lower measured values postmortem. These findings support the utility of postmortem hemoglobin assessments in determining the presence and severity of anemia at the time of death.
贫血是儿童发病和死亡的一个重要原因。尸检即时血红蛋白检测是评估死亡时贫血情况的一种潜在方法，但尚未对其可靠性进行广泛研究。我们旨在评估在南非儿童死亡监测项目中使用HemoCue进行尸检即时血红蛋白评估的可行性和有效性。
在一项前瞻性队列研究中，纳入了44名在南非一家学术医院死亡的5岁以下儿童。使用标准血液学分析仪在生前从静脉血中测量血红蛋白水平，死后使用HemoCue 201从死亡72小时内采集的血液（通过针吸或从EDTA管中采集的全血）测量血红蛋白水平。采用世界卫生组织更新的血红蛋白临界值来定义贫血。Wilcoxon符号秩检验、等效性检验和回归模型评估生前和死后血红蛋白浓度之间的一致性。死后检测显示血红蛋白浓度与生前水平相比显著降低。然而，死后针吸法和EDTA管法测量的血红蛋白之间未发现显著差异。贫血患病率从生前的52%升至死后的73%-77%，中度和重度贫血上升最为显著。Bland-Altman分析证实死后血红蛋白测量值存在系统性而非随机性下降。在应用2.5 g/dL的固定校正后，死后血红蛋白检测诊断贫血的敏感性和特异性分别为69.6%和61.9%。使用HemoCue进行尸检即时血红蛋白检测是可行的，并且尽管死后测量值始终较低，但能潜在有效地反映已故儿童生前的贫血状况。这些发现支持了尸检血红蛋白评估在确定死亡时贫血的存在和严重程度方面的实用性。
