Torabian, KianLezzar, DaliaPiety, Nathaniel Z.George, AlexShevkoplyas, Sergey S.2020-03-102020-03-109/20/2017Copyright 2017 Biosensors. Recommended citation: Torabian, Kian, Dalia Lezzar, Nathaniel Piety, Alex George, and Sergey Shevkoplyas. "Substituting sodium hydrosulfite with sodium metabisulfite improves long-term stability of a distributable paper-based test kit for point-of-care screening for sickle cell anemia." Biosensors 7, no. 3 (2017): 39. DOI: 10.3390/bios7030039 URL: file:///C:/Users/drsstudent/Downloads/biosensors-07-00039.pdf Reproduced in accordance with the original publisher’s licensing terms and with permission from the author(s).https://hdl.handle.net/10657/6186Sickle cell anemia (SCA) is a genetic blood disorder that is particularly lethal in early childhood. Universal newborn screening programs and subsequent early treatment are known to drastically reduce under-five SCA mortality. However, in resource-limited settings, cost and infrastructure constraints limit the effectiveness of laboratory-based SCA screening programs. To address this limitation our laboratory previously developed a low-cost, equipment-free, point-of-care, paper-based SCA test. Here, we improved the stability and performance of the test by replacing sodium hydrosulfite (HS), a key reducing agent in the hemoglobin solubility buffer which is not stable in aqueous solutions, with sodium metabisulfite (MS). The MS formulation of the test was compared to the HS formulation in a laboratory setting by inexperienced users (n = 3), to determine visual limit of detection (LOD), readout time, diagnostic accuracy, intra- and inter-observer agreement, and shelf life. The MS test was found to have a 10% sickle hemoglobin LOD, 21-min readout time, 97.3% sensitivity and 99.5% specificity for SCA, almost perfect intra- and inter-observer agreement, at least 24 weeks of shelf stability at room temperature, and could be packaged into a self-contained, distributable test kits comprised of off-the-shelf disposable components and food-grade reagents with a total cost of only $0.21 (USD).en-USsickle cell anemiapaper-based diagnosticspoint-of-care screeningarticle