Today we are going very briefly discuss some work which was published in the journal Nature Communications titled "Smartphone app for non-invasive detection of anemia using only patient-sourced photos.". In this publication, the authors discuss the development of an application which can be run on a smartphone, take pictures of a person's fingernails, and utilize a correlation between nailbed color and blood hemoglobin levels to quantify those levels with a high degree of accuracy. This technology has the potential to revolutionize diagnosis of anemia, especially in areas where access to the equipment necessary for blood analysis (complete blood count testing, or CBC) is sparse.
Background
This article revolves around detection of anemia, which is a disease revolving around the loss of red blood cells (or loss of red blood cell functionality). Red blood cells are largely responsible for being the carrier of oxygen in our blood via hemoglobin. Hemoglobin is an iron containing protein which binds and shuttles the oxygen we breathe to where ever it is needed in our bodies, it is also the reason why our blood is red!
It is thought that upwards of 80% of people on earth lack sufficient iron with up to 30% of them maintaining that iron deficient state long enough to develop anemia. [2, 3]. Remember iron is needed for hemoglobin, and it is through the iron in hemoglobin's heme that oxygen can be bound.
With numbers like that it means that upwards of 2 billion people live with anemia, which can result in damage to our bodies and organs, resulting in a drastically reduced lifespan. Many forms of anemia can be treated effectively, however for treatment to begin, diagnosis must first occur. Access to blood tests might be prevalent in the US, Europe and other developed areas of the world, however the vast majority of people on our planet may not live in areas where it is. As such the development of an effective, non blood-test diagnostic could truly be lifechanging for many millions of people around the world. Lets very briefly look at the authors work.
Results
Reproduced from [1] Figure 1 The image to the left depicts how the app itself works. People just need to download the app, take photos of their fingernails and allow the app to calculate the hemoglobin levels. The app is equipped with the ability to discriminate things like reflections from the flash of the camera, or leukonychia white lines on a fingernail, and choose regions of the nail which are appropriate for analysis of the color of the bed. The researchers report that the apps analysis can be performed either directly on the user's phone or on a cloud server depending on needs.
Reproduced from [1] Figure 2AHere we can see a figure comparing the hemoglobin levels that were determined from the analysis of the fingernails of 100 different patients. On the Y-axis is the concentration determined by the app, while on the X-axis is the concentration determined by a traditional complete blood count analysis. The authors report that the app is accurate, with an error +/- 2.4 g dL-1 of hemoglobin, which is very good considering the ease of the use of the app! Based upon this data the app has more than sufficient resolution to quantitate whether or not someone has anemia (classified as blood hemoglobin levels < 12 g dL-1 [4]). And this is with out any sort of personalized calibration! Just snap a pic and analyze! Remarkable. The authors report that this margin of error was consistent through out the range of observed blood hemoglobin concentrations.
The authors reported that the app was able to correctly identify a patient with anemia 92% of the time
Reproduced from [1] Figure 5One important point of consideration the authors took was whether or not skin pigmentation and environmental lighting had any affect on the ability of the app's ability to determine the hemoglobin levels. As you can see in the image to the left, in (a) the authors have the error in quantitation by the app (comparison of app vs blood test quant) relative to the skin tone of the patient. There is a correlation reported here, but that result is near negligible (r = 0.13) and should not interfere with accurate identification of anemia. As for lighting (b) you can see that neither light intensity nor indoor vs outdoor light had any effect on the accuracy of quantitaiton. Both of these results are excellent and illustrate the robustness of the app!
Conclusions
The results and quantitation abilities of this app are downright remarkable. The authors of the paper reported that the app was significantly more accurate then even trained hematologists looking at patients during a physical examination, and the app can be provided for a fraction of the cost of even a doctors visit! Given the massive size of the population of the world with anemia, the potential impact of this app is massive. It also goes to show how we are just only scratching at the tip of the iceberg for what the lies in the future with regards to non-invasive, accurate, and cheap medical diagnostics. Ones that could be performed from the comfort of your own home, and allow you to get the treatment you need as soon as it is necessary.
Sources
- https://www.nature.com/articles/s41467-018-07262-2
- https://www.healthline.com/health/iron-deficiency-inadequate-dietary-iron
- prevalence of anemia
- https://dhsprogram.com/pubs/pdf/fr130/12chapter12.pdf
Edit: I need an editor...
I love studies that use smartphones and other common items for medical diagnosis. Good find! One other major benefit is that A smartphone app helps prevent issues from white coat syndrome... patients that get so nervous in a clinic that it affects blood flow.
I wonder if someone could get white phone syndrome.. take out a phone and it affects blood flow.
That name also feels a bit racist...
Technology is growing each and everyday for the better ! Thank you so much for bringing this to my attention
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Yeah its pretty neat. I am always amazed by the new ways in which technology are used for our betterment. I mean, replacing the need for a blood test with a simple picture taken by a phone... is pretty awesome! Nobody wants to have blood drawn, this is just fast, non invasive, and surprisingly accurate.
+/- 2.4 g dL-1 error is great but only for early detection, that 1 g/dL can make a huge difference for special patients,,what about the quality of the photo taken by the camera, not all smartphones have similar resolutions? Is it taken into account or is there minimum requirements? Last but not least, I think it will be pretty cool if they make the app free for everyone 😂 😂😂 but I guess business is business...
Based on the data presented, it seems to have a lesser contribution than you might expect. Perhaps most phone cameras have sufficient resolution that an accurate enough color quantification is able to be achieved. I unfortunately don't have a better answer.
One would hope, but... yeah I doubt it.
Some of the Chinese phones have seriously poor resolution. I guess the app may have to compensate more in such devices given that it has a little marginal differences in detection between various skin tone. I share the same sentiment that the app should be free, let us be their test subjects and run tests for 'em :)
I know that very soon that the phone will be much more than a just a basic device that runs app. Interesting stuff, I hope the app will be free and available on PlayStore for us android folks :)
I have my doubts that it will be free.
Awesome, let's await the app availability then.
This is awesome! It almost sound too good to be true at first glance, but it's great to see that someone has been able to make something like this. I hope this ends up being used on the people who need it, and not just end up as an obscure app that is great in theory, but ends up not being used due to some political/monetarily reason.
I truly see no reason why it wouldn't be used, it opens up so many avenues for cutting costs and improving world wide healthcare. Seems like a true game changer!
I agree with that. It seems like a real game changer. I guess I am just a bit pessimistic about "free" health care diagnosis tools, since cutting costs will mean that someone somewhere ends up making less money, which could potentially lead them to lobbying against this app becoming commonplace.
Always possible, but I don't really see why the end user would care. Charge a couple bucks for the app, word of mouth can sell it alone.
technology growing day by day and life become easy .. now a days we are in technology world....
Indeed we are!
Even in areas of the world where blood tests are "prevalent", access to medical care is not universal. There are people who won't go to the doctors because they have high deductibles, or lack health insurance completely. Then there are people who simply won't go because of fear, of the doctor or a needle. This would open a simple diagnostic/screening tool to them.
Indeed! Truly an eye opener to the future of medicine.
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WOW! This sounds very impressive.
Such low-cost tech to solve real problems seems to be really impressive.