No bleeding required: Anemia detection via smartphone

December 4, 2018, Emory University
No bleeding required: Anemia detection via smartphone
Fingernail beds are ideal for detection of anemia because they don't contain melanin. Credit: From Mannino et al Nature Communications 2018

Biomedical engineers have developed a smartphone app for the non-invasive detection of anemia. Instead of a blood test, the app uses photos of someone's fingernails taken on a smartphone to accurately measure how much hemoglobin is in their blood.

The results are scheduled for publication in Nature Communications.

"All other 'point-of-care' anemia detection tools require external equipment, and represent trade-offs between invasiveness, cost, and accuracy," says principal investigator Wilbur Lam, MD, Ph.D. "This is a standalone app whose accuracy is on par with currently available point-of-care tests without the need to draw blood."

Lam is associate professor of pediatrics at Emory University School of Medicine, a faculty member in the Wallace H. Coulter Department of Biomedical Engineering at Georgia Tech and Emory, and a clinical hematologist at the Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta.

The app is part of the Ph.D. work of former biomedical engineering graduate student Rob Mannino, Ph.D., who was motivated to conduct the research by his own experience living with beta-thalassemia, an inherited blood disorder caused by a mutation in the beta-globin gene.

"Treatment for my disease requires monthly blood transfusions," Mannino says. "My doctors would test my hemoglobin levels more if they could, but it's a hassle for me to get to the hospital in between transfusions to receive this . Instead, my doctors currently have to just estimate when I'm going to need a transfusion, based on my hemoglobin level trends."

"This whole project couldn't have been done by anyone but Rob," Lam says. "He took pictures of himself before and after transfusions as his hemoglobin levels were changing, which enabled him to constantly refine and tweak his technology on himself in a very efficient manner. So essentially, he was his own perfect initial test subject with each iteration of the app."

Mannino and Lam say that their app could facilitate self-management by patients with chronic anemia, allowing them to monitor their disease and to identify the times when they need to adjust their therapies or receive transfusions, possibly reducing side effects or complications of having transfusions too early or too late.

The researchers say that the app should be used for screening, not clinical diagnosis. The technology could be used by anyone at any time, and could be especially appropriate for pregnant women, women with abnormal menstrual bleeding, or runners/athletes. Its simplicity means it could be useful in developing countries. Clinical diagnostic tools have strict accuracy requirements, but Mannino and Lam think that with additional research, they can eventually achieve the accuracy needed to replace blood-based anemia testing for clinical diagnosis.

Anemia is a blood condition that affects two billion people worldwide and can lead to fatigue, paleness and cardiac distress if left untreated. The current gold standard for anemia diagnosis is known as a complete blood count (CBC).

The researchers studied fingernail photos and correlated the color of the fingernail beds with measured by CBC in 337 people: some healthy, and others with a variety of anemia diagnoses. The algorithm for converting fingernail color to blood hemoglobin level was developed with 237 of these subjects and then tested on 100.

A single smartphone image, without personalized calibration, can measure hemoglobin level with an accuracy of 2.4 grams/deciliter with a sensitivity of up to 97 percent. Personalized calibration, tested on four patients over the course of several weeks, can improve the accuracy to 0.92 grams/deciliter, a degree of accuracy on par with point-of-care -based hemoglobin tests. Normal values are 13.5-17.5 grams/deciliter for males and 12.0-15.5 grams/deciliter for females.

In the app, the use of fingernail beds, which do not contain melanin, means the test can be valid for people with a variety of skin tones. The accuracy is consistent for dark or light skin tones, Mannino says. The app uses image metadata to correct for background brightness, and can be adapted to phones from multiple manufacturers.

Mannino and Lam say they are working with a variety of doctors at Emory and Children's—geriatric, internal medicine, neonatologists, transfusion medicine, global health—to obtain additional data and better calibrate their system.

"This is just a snap shot of the accuracy right now," Lam says. "The algorithm gets smarter with every patient enrolled."

The research was supported by the National Science Foundation (Graduate Research Fellowship DGE-1650044 and Southeastern Nanotechnology Infrastructure Corridor 1542174), the 2017 Massachusetts General Hospital Primary Care Technology Prize, and National Institutes of Health (R21 EB025646).

The smartphone anemia app is projected to be available commercially for public download as soon as Spring of 2019.

A has been filed for the anemia app, and Wilbur Lam and Rob Mannino have a financial interest in the success of this product.

Explore further: Blood management program safely reduces transfusions in orthopedic patients

More information: Robert G. Mannino et al, Smartphone app for non-invasive detection of anemia using only patient-sourced photos, Nature Communications (2018). DOI: 10.1038/s41467-018-07262-2

Related Stories

Blood management program safely reduces transfusions in orthopedic patients

August 20, 2018
A patient blood management program designed to limit the amount of transfused blood orthopedic patients undergoing common surgeries such as hip and knee replacement receive was associated with fewer transfusions, reduced ...

New portable blood analyzer could improve anemia detection worldwide

October 3, 2017
About one quarter of the world's population suffers from anemia, a disease caused by a concentration deficiency of hemoglobin in red blood cells. To reduce the burden of anemia, health officials need a better picture of the ...

Blueprint to reduce wasteful blood transfusions

November 20, 2017
By analyzing data from randomized clinical trials comparing blood transfusion approaches, Johns Hopkins experts, along with colleagues at Cleveland Clinic and NYU Langone Medical Center, endorse recommendations for blood ...

Restricting post-surgery blood transfusion is safe for some hip patients

December 14, 2011
More than half of the older, anemic patients in a New England Journal of Medicine study did not need blood transfusions as they recovered from hip surgery, according to new research co-authored by University of Maryland School ...

Anemia negatively affects recovery from traumatic brain injuries

May 25, 2016
Approximately half of patients hospitalized with traumatic brain injuries are anemic, according to recent studies, but anemia's effects on the recovery of these patients is not clear. Now, researchers from the University ...

World's largest transfusion study in cardiac surgery changes transfusion practices

August 27, 2018
Lower thresholds for blood transfusions for cardiac surgery patients compared to traditional thresholds provide positive patient outcomes and safety at six months after surgery, according to the world's largest research study ...

Recommended for you

Study examines disruption of circadian rhythm as risk factor for diseases

December 11, 2018
USC scientists report that a novel time-keeping mechanism within liver cells that helps sustain key organ tasks can contribute to diseases when its natural rhythm is disrupted.

New light-based technology reveals how cells communicate in human disease

December 11, 2018
Scientists at the University of York have developed a new technique that uses light to understand how cells communicate in human disease.

Study may offer doctors a more effective way to treat neuroblastoma

December 7, 2018
A very large team of researchers, mostly from multiple institutions across Germany, has found what might be a better way to treat patients with neuroblastoma, a type of cancer. In their paper published in the journal Science, ...

Progress made in transplanting pig hearts into baboons

December 6, 2018
A large team of researchers from several institutions in Germany, Sweden, Switzerland and the U.S. has transplanted pig hearts into baboons and kept them alive for an extended period of time. In their paper published in the ...

'Chemo brain' caused by malfunction in three types of brain cells, study finds

December 6, 2018
More than half of cancer survivors suffer from cognitive impairment from chemotherapy that lingers for months or years after the cancer is gone. In a new study explaining the cellular mechanisms behind this condition, scientists ...

Hybrid prevalence estimation: Method to improve intervention coverage estimations

December 6, 2018
LSTM's Professor Joseph Valadez is senior author on a new study published today in the Proceedings of the National Academy of Sciences, which outlines proposals for a more accurate estimator of health data.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

RichManJoe
not rated yet Dec 04, 2018
Have a friend who really needs this. She gets frequent hemoglobin testing. How does one enroll in the trial?

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.