O3-5083: Add criteria-based reference ranges for Hemoglobin

[VeronicaMuthee]

The CSV contains hemoglobin reference ranges covering the full spectrum from birth to adulthood.

[dkayiwa]

@VeronicaMuthee we do not have the getGestationalAgeInWeeks() function. Do we have a concept which can help us calculate it? Something like when the last menstrual period started?

[dkayiwa]

I have just seen this: https://dev3.openmrs.org/openmrs/dictionary/concept.htm?conceptId=1041
Should we use it in this calculation?

[VeronicaMuthee]

@dkayiwa yes in most clinical systems, LMP is used to calculate GestationalAge(weeks) = (Current date - LMP)/7.

[dkayiwa]

@VeronicaMuthee just go ahead and replace:
$patient.getGestationalAgeInWeeks()
with:
$fn.getObsWeeks('CIEL:1427', $patient)

[VeronicaMuthee]

@dkayiwa i have updated the calculation for gestation, please take a look.

[dkayiwa]

@VeronicaMuthee

1. When checking for gender male, use M instead of Male
2. When checking for gender female use F instead of Female
3. Which concept do you use to tell whether a woman is pregnant or not?
4. What does HB Term (cord) mean?

[VeronicaMuthee]

@dkayiwa

1. When checking for gender male, use M instead of Male ✅
2. When checking for gender female use F instead of Female ✅
3. Which concept do you use to tell whether a woman is pregnant or not?

• Urine pregnancy test: 45AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA = Positive
• Serum pregnancy test: 1945AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA = Positive

4. What does HB Term (cord) mean?

• HB measured from umbilical cord blood sample (at delivery)

[dkayiwa]

HB measured from umbilical cord blood sample (at delivery) does it have a concept?
As for pregnancy, is it determined by both Urine and Serum pregnancy tests? Or any of the two?

[VeronicaMuthee]

@dkayiwa
Pregnancy test is determined by either urine or serum pregnancy test (urine is the most common).

Regarding the HB (cord) concept ..... (and a very good question)..... let me cross-check @gracepotma ???

[dkayiwa]

@VeronicaMuthee for pregnancy, do we use this? https://dev3.openmrs.org/openmrs/dictionary/concept.htm?conceptId=1154

Or this? https://dev3.openmrs.org/openmrs/dictionary/concept.htm?conceptId=399

Or this? https://dev3.openmrs.org/openmrs/dictionary/concept.htm?conceptId=284

Or something else?

[VeronicaMuthee]

@dkayiwa Thanks for pointing this out. The Pregnancy status (Is the patient pregnant Y/N - 5272AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA) is better to use over individual pregnancy tests because it offers more comprehensive coverage. Beyond just test results, pregnancy status can be established through clinical assessment, known pregnancy from previous encounters, or even patient self-reporting.

[dkayiwa]

@VeronicaMuthee in that case, the pregnancy expression becomes:
($fn.isObsValueCodedAnswer("CIEL:45", $patient, "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA") || $fn.isObsValueCodedAnswer("CIEL:1945", $patient, "703AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA") || $fn.isObsValueCodedAnswer("CIEL:5272", $patient, "CIEL:1065"))

[VeronicaMuthee]

@dkayiwa, thanks, i have replaced the pregnancy expression, please check it out. Also, i reached out to Andy regarding HB Term (cord) concept. He is going to create a CIEL concept but it's going to be available in 2 weeks.

[denniskigen]

LGTM. We can improve things in future iterations. Thanks, @VeronicaMuthee!

[VeronicaMuthee]

@dkayiwa kindly take a look. Two areas for future improvements may include

1. There might be some potential overlap between "HB Infants (6 months)" range and "HB Children (6 months - 2 years)" range

2. Currently, newborns and infants without recorded gestational age data may not match any existing reference range.

[dkayiwa]

Do we need to report the overlap and non matching infants to whoever gave us these ranges?

[VeronicaMuthee]

Do we need to report the overlap and non matching infants to whoever gave us these ranges?

Yes, i will have to follow up on that

[VeronicaMuthee]

@dkayiwa @denniskigen, per the expert recommendations, here are the latest changes i have effected:-

1. Removed age overlaps
2. 1-month-old babies: Normal range changed from 10.7-13.9 to 10.0-14.0
3. 2-6 month babies: Now using 9.5-13.5 (reflecting the natural iron dip during this period)
4. 6 months to 2 years: Set at 10.5-13.5

Note: Infants lacking gestational age records are not covered in this iteration but may be addressed later.