How Accurate PoC Diagnosis can be a game changer for Anemia Mukt Bharat

1. Dr J L Meena
Joint Director
Hospital Networking & Quality Assurance,
National Health Authority – Govt of India
Dr. J. L. Meena
“ANEMIA”
Prevention & Management

2. Screening/
Estimation
Prophylaxis/
Prevention Treatment
Dr. J. L. Meena

3. Action For Anemia is all
about
1)Screening/
Estimation
2) Prevention/
Prophylaxis
3) Treatment
Action of Anemia control and
management starts and ends
with Screening / Estimation .
Thus
Quality of testing including
accuracy and frequency
matters
Dr. J. L. Meena

4. a) Anemia screening-
Clinical sign
1) Conventionally clinical signs include pallor of
Conjunctive, tongue, lips, nails and palm
2) Screening with clinical signs has turned out to be
subjective specially for Mild and Moderate Anemia
3) Clinical assessment needs to be supported with
Hemoglobin estimation
4) National Anemia control and Prevention program
protocols are based on Hemoglobin level but may
need further investigation for hemoglobinopathy
and other nutritional deficiencies
5) Though value of clinical sign can not be under
estimated it needs blood test support for case
management as per SOPs
Dr. J. L. Meena

5. b) Anemia screening by – Shahli’s
(Community+ OPD laboratory)
1) Though widely in use is not considered Gold standard in
present time
2) Needs Shahli’s set including colour comparator, special tube,
suction tube , stirrer and HCL
3) Prick is important – proper site, prick , time interval between
cleaning of finger with spirit swab and pre prick finger drying
time . But quality of testing suffers due to time constraints and
lack of skill
4) Intact tip of tip of tube to suck blood drop and maintain its
volume is important. But in field situation broken tips, spoiled
plastic tube affects the quality.
5) Solution of HCL is required for test. Exact quantity of HCL and
adequate time given for reaction between it and hemoglobin
affects quality of testing
6) Thus in field situation and even primary to Tertiary level OPD
quality control of HB testing is a major challenge
Dr. J. L. Meena

6. Paper based color
comparison – Talquist
1) This method was in use under National
program at field level
2) Needs colour comparator and specific filter
papers , thus logistics id to be managed
3) Prick quality is important in this technique
also
4) Gives broad estimate cut offs.
5) Ment for operational simplicity to manage
Anemia at community level
6) Befitting for field/ community level
screening activity as a public health tool
Dr. J. L. Meena

7. PHC / CHC OPD level screening -
Hemoque
1) Methods generally recommended for use
in anemia surveys are the
cyanmethemoglobin method (HiCN) in the
laboratory and the HemoCue system.
2) Provides ease of use and enables
workflow efficiency
3) Good support for primary to tertiary care
OPD laboratory
4) Can be used at community level services
if logistics can be efficiently managed
Dr. J. L. Meena

8. Tertiary care Anemia
management
•At tertiary care level Anemia
management needs screening
beyond hemoglobin estimation
•At that level secondary and
tertiary level hospitals Cell
counters are better Anemia
investigation support.
Dr. J. L. Meena

9. What matters for Screening?
• Need of screening for Anemia needs serious consideration as
per protocol In public and private system both
• Quality screening matters and should not be considered
casually
• At field/ community level screening is for broad cutoff for
preventive management
• At PHC onwards screening I for prevention and control to
treatment
• Doable need based Protocol of Hb testing and management
should be a part of SOPs.
Dr. J. L. Meena

10. 10
Anemia packages utilization in
AB PM-JAY till 16th Dec 2020
Anemia packages
utilization by
Admission Amount
Male 41K 21Cr
Female 96K 37 Cr
Total (Male +
Female)
1.37L (0.9% of all
PMJAY admissions
by count)
58Cr (0.3% of all
PMJAY admissions
by amount)
Dr. J. L. Meena
Total No. of Beneficiaries in AB PM-JAY till date – 1.44 Cr

11. THANKS
“Want your support for Improvement”
Dr. J. L. Meena