title: Non-invasive haemoglobin estimation in patients with thalassaemia major.
abstract: OBJECTIVE
  This study aimed to validate pulse CO-oximetry-based haemoglobin (Hb) estimation in children and adults with thalassaemia major (TM) and to determine the impact of different baseline variables on the accuracy of the estimation.
  
  
  METHODS
  This observational study was conducted over a five-week period from March to April 2012. A total of 108 patients with TM attending the daycare thalassaemia centre of a tertiary care hospital in Muscat, Oman, were enrolled. Spot (Sp) Hb measurements were estimated using a Pronto-7(®) pulse CO-oximetry device (Masimo Corp., Irvine, California, USA). These were compared to venous samples of Hb using the CELL-DYN Sapphire Hematology Analyzer (Abbott Diagnostics, Abbott Park, Illinois, USA) to determine the reference (Ref) Hb levels. A multivariable linear regression model was used to assess the impact of baseline variables such as age, gender, weight, height, Ref Hb and blood pressure on the Hb estimations.
  
  
  RESULTS
  Of the 108 enrolled patients, there were 54 males and 54 females with a mean age of 21.6 years (standard deviation [SD] = 7.3 years; range: 2.5-38 years). The mean Ref Hb and Sp Hb were 9.4 g/dL (SD = 0.9 g/dL; range: 7.5-12.3 g/dL) and 11.1 g/dL (SD = 1.2 g/dL; range: 7.5-14.7 g/dL), respectively. The coefficient of determination (R(2)) was 21% with a mean difference of 1.7 g/dL (SD = 1.1 g/dL; range: -0.9-4.3 g/dL). In the multivariable model, the Ref Hb level (P = 0.001) was the only statistically significant predictor.
  
  
  CONCLUSIONS
  The Pronto-7(®) pulse CO-oximetry device was found to overestimate Hb levels in patients with TM and therefore cannot be recommended. Further larger studies are needed to confirm these results.
authors.affiliation: Departments of Haematology, Sultan Qaboos University Hospital;
authors.forename: Murtadha K
authors.initials: MK
authors.lastname: Al Khabori
authors.affiliation: Departments of Haematology, Sultan Qaboos University Hospital;
authors.forename: Arwa Z
authors.initials: AZ
authors.lastname: Al-Riyami
authors.affiliation: Departments of Haematology, Sultan Qaboos University Hospital;
authors.forename: Khalil
authors.initials: K
authors.lastname: Al-Farsi
authors.affiliation: Departments of Haematology, Sultan Qaboos University Hospital;
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Huneini
authors.affiliation: Medicine, Sultan Qaboos University Hospital;
authors.forename: Abdulhakeem
authors.initials: A
authors.lastname: Al-Hashim
authors.affiliation: Anaesthesia & Intensive Care, Sultan Qaboos University Hospital;
authors.forename: Nasser
authors.initials: N
authors.lastname: Al-Kemyani
authors.affiliation: Medicine, Sultan Qaboos University Hospital;
authors.forename: Issa
authors.initials: I
authors.lastname: Al-Qarshoubi
authors.affiliation: Department of Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.
authors.forename: Hammad
authors.initials: H
authors.lastname: Khan
authors.affiliation: Emergency Medicine, Sultan Qaboos University Hospital;
authors.forename: Khalfan
authors.initials: K
authors.lastname: Al-Amrani
authors.affiliation: Department of Haematology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman.
authors.forename: Shahina
authors.initials: S
authors.lastname: Daar
keywords: Hemoglobin; Pulse Oximetry; Validation Studies; beta Thalassemia