It might not have helped Iron Man survive use of the Infinity gauntlet, but for individuals with chronically iron-poor blood, Sanguina Inc.’s new mobile app could be a lifesaver.

Atlanta-based Sanguina released Anemocheck Mobile, an app that measures hemoglobin levels, for the Google Play Store and will shortly add the app for iOS. Anemocheck analyzes a photo of the user's fingernail beds and provides the hemoglobin level on the screen. Hemoglobin levels provide the most common measure of anemia.

Anemia, a shortage of iron in the blood, plagues more than 2 billion people around the globe and is the most common blood disorder in the U.S., where it affects more than 3 million, according to the National Heart, Lung, and Blood Institute. Caused by inadequate or dysfunctional red blood cells, anemia impairs the circulation of oxygen throughout the body, leading to symptoms such as chronic fatigue, dizziness, irregular or fast heartbeat, headache, cold extremities, pale skin and chest pain.

Pregnant women and women with heavy menstrual flows, children, high-performance athletes and the elderly are at particularly high risk. Poor diet, intestinal disorders, internal bleeding, significant wounds, infections and certain chronic diseases also can lead to anemia. In severe cases, complications include preterm birth and other pregnancy complications and cardiac arrest.

Given the prevalence of anemia, the team at Sanguina hope that hemoglobin levels become the next vital sign – right up there with heart rate and blood pressure as a major indicator of health (and just as easy to measure). The app’s beauty derives in large part from the freedom from blood draws – and lab visits and costs – it offers to people with anemia.

The desire for ubiquity has propelled the company’s strategy, driving it to develop a wellness app rather than pursuing U.S. FDA clearance first. Literally, they want the app in (and measuring) everyone’s hands quickly.

“As hemoglobin levels can vary due to a variety of issues, hemoglobin level is being positioned as a general wellness and illness indicator,” like a step counter or Fitbit, said Erika Tyburski, Sanguina’s CEO and co-founder. “This app can be used for the general population for spot checking and trending to have overall more awareness about their health and wellness, for maintaining a healthy lifestyle, to maintain quality of life.”

The company is working on a clinical version of the app for which it hopes to receive FDA clearance Tyburski told BioWorld. Both the wellness app and the clinical version will give individuals immediate information on their hemoglobin levels to see if anemia is responsible for nonspecific symptoms, such as fatigue or dizziness, and provide data they can share with their physicians.

New meaning for thumbnail image

While a thumbnail image usually means a small version of graphic, for Sanguina, the fingernail image is the basis of their technology. Users take a “fingernail selfie,” and Anemocheck Mobile calculates the hemoglobin level based on the color of the nail bed.

The technology does not face the challenge of adjusting for skin tone that many photo-based apps do. “Interestingly, most nailbeds do not contain melanin, which is the major contributor to skin tone. Nailbeds are varying shades of pink and red, which is almost entirely due to the capillary blood underneath, which is red due to hemoglobin,” said Tyburski. “Hemoglobin is what makes your blood red, so paler nailbeds typically have less hemoglobin.”

The app was trained on thousands of images and data points from a diverse set of people. The artificial intelligence underlying the system will continue to improve as more people use the app. The clinical version will likely enable calibration for the individual user, Tyburski noted. The company also is working with blood banks to see whether the clinical version of the app could replace current hemoglobin testing practices.

“Smart-device technologies can enhance awareness of our individual health status,” said Tiffani Bailey Lash, director of the program in point of care technologies at the National Institute of Biomedical Imaging and Bioengineering, part of the National Institutes of Health. “Putting effective and easy-to-use tools in the hands of people with chronic anemias has the potential to improve regular monitoring of hemoglobin levels that, in turn, leads to daily wellbeing and maintenance of better health in the long term.”

Tyburski and co-founder Rob Mannino understand the value of such tools. Both suffer from chronic anemia.

The company got its start while both worked with Wilbur Lam – Tyburski as an undergraduate at the Georgia Institute of Technology and Mannino as a postdoctoral scientist. Sanguina is a spinout from Lam's lab at the Georgia Institute of Technology and Emory University in Atlanta and took shape through a collaborative effort of the Georgia Research Alliance, Georgia Tech, Emory, Children’s Hospital of Atlanta and the U.S. Centers for Disease Control and Prevention.

In addition to Anemocheck Mobile, the company has developed Anemocheck, a point-of-care test that uses an oxidation-reduction chemical reaction to accurately determine hemoglobin levels from a drop of blood. The inexpensive, disposable test is specifically designed for use in limited resource settings.