Point-of-care versus central testing of hemoglobin during large volume blood transfusion

Background Point-of-care (POC) hemoglobin testing has the potential to revolutionize massive transfusion strategies. No prior studies have compared POC and central laboratory testing of hemoglobin in patients undergoing massive transfusions. Methods We retrospectively compared the results of our point-of-care hemoglobin test (EPOC (R)) to our core laboratory complete blood count (CBC) hemoglobin test (Sysmex XE-5000 (TM)) in patients undergoing massive transfusion protocols (MTP) for hemorrhage. One hundred seventy paired samples from 90 patients for whom MTP was activated were collected at a single, tertiary care hospital between 10/2011 and 10/2017. Patients had both an EPOC (R) and CBC hemoglobin performed within 30 min of each other during the MTP. We assessed the accuracy of EPOC (R) hemoglobin testing using two variables: interchangeability and clinically significant differences from the CBC. The Clinical Laboratory Improvement Amendments (CLIA) proficiency testing criteria defined interchangeability for measurements. Clinically significant differences between the tests were defined by an expert panel. We examined whether these relationships changed as a function of the hemoglobin measured by the EPOC (R) and specific patient characteristics. Results Fifty one percent (86 of 170) of paired samples' hemoglobin results had an absolute difference of <= 7 and 73% (124 of 170) fell within +/- 1 g/dL of each other. The mean difference between EPOC (R) and CBC hemoglobin had a bias of - 0.268 g/dL (p = 0.002). When the EPOC (R) hemoglobin was < 7 g/dL, 30% of the hemoglobin values were within +/- 7, and 57% were within +/- 1 g/dL. When the measured EPOC (R) hemoglobin was >= 7 g/dL, 55% of the EPOC (R) and CBC hemoglobin values were within +/- 7, and 76% were within +/- 1 g/dL. EPOC (R) and CBC hemoglobin values that were within +/- 1 g/dL varied by patient population: 77% for cardiac surgery, 58% for general surgery, and 72% for non-surgical patients. Conclusions The EPOC (R) device had minor negative bias, was not interchangeable with the CBC hemoglobin, and was less reliable when the EPOC (R) value was < 7 g/dL. Clinicians must consider speed versus accuracy, and should check a CBC within 30 min as confirmation when the EPOC (R) hemoglobin is < 7 g/dL until further prospective trials are performed in this population.