Complete Blood Count Reference Intervals Research Articles

Complete Blood Count Reference Intervals for Children Aged Less Than 1 to 12 Years in the Northern Region of Ghana.

Reliable laboratory diagnostic results are key for evaluating and improving children's health. To interpret these results, child-specific reference intervals (RIs), which account for constant biological changes and physiological development with sex and age, are required, as recommended by the Clinical and Laboratory Standards Institute (CLSI). This study presents age- and sex-specific reference intervals for complete blood count (CBC) parameters in children (<1-12 years old) in the Northern Region of Ghana. In this cross-sectional study, 600 healthy children from randomly sampled schools in Tamale (the Northern Region) were recruited and screened. Data from 388 eligible children were used to nonparametrically determine the reference intervals of CBC parameters at the 2.5th and 97.5th percentiles. The CBC reference intervals were compared for variations in sex and age groups using the Wilcoxon rank-sum test. There were no statistically significant differences in most CBC parameters by sex (RBC, Hb, HCT, MCH, RDW (CV/SD), WBC, LYM#, MON#(%) NEU#(%), EOS#(%), and BAS#(%); p > 0.05) and age group (RBC, MCV, RDW (CV/SD), WBC, LYM#, MON#(%) NEU#(%), EOS#(%), and BAS%; p > 0.05). However, there were observable differences between this locally established CBC reference interval and that used for children at Tamale Teaching Hospital (manufacturer's RIs). This study emphasises the importance of determining reference intervals representative of the local child population and incorporating them into the current reporting system of laboratories in the Northern Region to ensure the provision of effective and efficient healthcare services.

Establishment of reference intervals for hematological parameters of adult population in the western region of Saudi Arabia.

Most of hematology laboratories in Saudi Arabia utilize the reference intervals (RIs) provided by instrument manufacturers. This study aimed to define RIs of hematological parameters for adult population in the western region of Saudi Arabia and to explore their specific features from an international perspective. This study was conducted according to the harmonized protocol of IFCC Committee on RIs and Decision Limits. Blood samples collected from 409 healthy Saudi males and females adults were analyzed for complete blood count (CBC) by using Cell-Dyn Sapphire analyzer and for iron profile by using Architect analyzers. The needs for RIs partitioned by sex and age was based on standard deviation ratio (SDR) and/or bias ratio (BR). RIs were derived parametrically with/without application of the latent abnormal values exclusion method (LAVE). Based on thresholds of SDR≥0.4 and/or BR≥0.57, RIs were partitioned by sex for red-blood cell count, hemoglobin, hematocrit, red cell distribution width, erythrocyte sedimentation rate, iron, transferrin, ferritin, eosinophil, platelet, plateletcrit, etc. Partitioning by age was not necessary for any of the analytes. LAVE procedure caused appreciable changes in RI limits for most erythrocyte and iron parameters but not for leukocyte parameters. Comparable to other non-IFCC studies on CBC RIs, the RBC and hematocrit (Ht) ranges have shifted to a higher side in both genders. After applying the LAVE method, the male and female RIs for Hb were 4.56 to 6.22 ×106/μL and 3.94 to 5.25 ×106/μL respectively while RIs for Ht were 40.2 to 52.0% and 33.6 to 44.5% respectively. LAVE method contributed to reducing the influence of latent anemia in deriving RIs for erythrocyte related parameters. Using the up-to-date methods, the RIs of CBC determined specifically for Saudis will help to improve the interpretation of test results in medical decision making.

Determination of Complete Blood Count Reference Intervals by an Indirect Method for Newborns, Adults, and Geriatric Ages.

The availability of a reliable reference interval is crucial for clinical decision-making. Correctly defined reference intervals for different age groups are currently unavailable for many parameters. Our study aimed to determine the complete blood count reference intervals in our region from newborn to geriatric ages with an indirect method. The study was carried out at Marmara University Pendik E&R Hospital Biochemistry Laboratory between January 2018 and May 2019 using the laboratory information system data. The complete blood count (CBC) measurements were performed by Unicel DxH 800 Coulter Cellular Analysis System (Beckman Coulter, FL, USA). A total of 14,014,912 test results belonging to infants, children, adolescents, adults, and geriatric ages were collected. We analyzed 22 CBC parameters, and an indirect method was used for reference interval determination. Data were analyzed according to the Clinical and Laboratory Standards Institute (CLSI) C28-A3 guideline for defining, establishing, and verifying reference intervals in the clinical laboratory. We have established reference intervals from newborn to geriatric ages for 22 hematology parameters [hemoglobin (Hb), hematocrit (Hct), red blood cell (RBC), mean red cell volume (MCV), mean red cell hemoglobin (MCH), mean red cell hemoglobin concentration (MCHC), red cell distribution width (RDW), white blood cell (WBC) count, WBC differentials, including percentages and absolute counts, platelet count, platelet distribution width (PDW), mean platelet volume (MPV) and plateletcrit (PCT)]. Our study showed that reference intervals established with data obtained from clinical laboratory databases are comparable to those created using direct methods.

Narrowed reference intervals for complete blood count in a multiethnic population.

Background Biological variation studies have shown that the complete blood count (CBC) has narrow within-individual variation and wide group variation, indicating that the use of reference intervals (RIs) is challenging. The aim of this study was to examine differences in CBC RIs according to race/ethnicity in a multiethnic population at a hospital in San Francisco in hopes of improving the medical utility of CBC testing. Methods Subject data were obtained by screening CBC results from the medical records of outpatients meeting certain criteria who visited Zuckerberg San Francisco General Hospital from April 2017 to January 2018. From these records, sex- and race/ethnicity-specific CBC RIs were calculated as the 2.5th to 97.5th percentiles. Results From a total of 552 subjects, 47.9% were male (65 White, 50 Black, 71 Hispanic and 54 Asian) and 52.1% were female (51 White, 39 Black, 122 Hispanic and 72 Asian). The RIs of neutrophil, lymphocyte and eosinophil counts; and hemoglobin, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) showed significant differences (p<0.05) among the four racial/ethnic groups: neutrophil, lymphocyte and eosinophil counts; and MCHC in males, and hemoglobin, MCV, MCH and MCHC in females. Conclusions Race/ethnicity-specific CBC RIs should be taken into consideration in a multiethnic population to better interpret patient status and make progress toward precision medicine.

A Comparison of Complete Blood Count Reference Intervals in Healthy Elderly Versus Younger Korean Adults: A Large Population Study

Background: The use of laboratory reference intervals based on younger populations is of questionable validity in older populations. We established reference intervals for 16 complete blood count (CBC) parameters in healthy elderly Koreans aged ≥60 years and compared them to those of individuals aged 20-59 years.Methods: Among 64,532 individuals (39,609 men and 24,923 women) aged ≥20 years who underwent medical check-ups, 8,151 healthy subjects (12.6%, 5,270 men and 2,881 women, including 675 and 511, respectively, who were ≥60 years of age) were enrolled based on stringent criteria including laboratory, imaging, and endoscopy results; previous medical history; and medication history. CBC parameters were measured using an Advia2120i instrument. The difference between 2 age groups in subjects of each sex was compared using the Mann-Whitney U-test. P-values <0.05 were considered statistically significant. The reference intervals for measured CBC parameters were established according to a nonparametric method based on the CLSI EP28A-3C in each subgroup. The 90% confidence intervals for the upper and lower limits of each reference interval were calculated; the Reed method was used to remove extreme outliers. The Harris and Boyd method was used to determine the necessity of separating the reference intervals for different age groups within each sex group. To identify reference intervals in different age groups in individuals aged 60 years and over, such individuals of each sex were subdivided into 5 age subgroups with 5-year age interval: since the sizes of 4 of these subgroups were not sufficiently large, we used the Robust method.Results: A statistical difference in the medians of the following parameters were observed between the <60- and ≥60-year age groups: RBC, Hb, hematocrit (Hct), basophils, and platelets in men aged <60 years were higher than those in men aged ≥60 years; furthermore, MCV, MCH, and RDW in men aged ≥60 years were higher than those in men aged <60 years. Neutrophils in women aged <60 years were higher than in those aged ≥60 years. Hb, Hct, MCV, MCH, MCHC, lymphocytes, and basophils in women aged ≥60 years were higher than in those aged <60 years. Separate reference intervals were required only for RDW and MCH in women ≥60 from those < 60 years of age. Men aged ≥60 years versus those <60 years did not require separate reference intervals for any of the 16 measured parameters. In subjects aged ≥60 years, RBC, Hb, Hct, MCV, MCH, MCHC, RDW, WBC, neutrophils, monocytes, eosinophils, MPV, and PDW were higher in men than in women, while the opposite was true for lymphocytes and platelets. Partitioning of reference intervals by sex was required for RBC, Hb, Hct, MCH, monocytes, and eosinophils. In men, median values and the lower limits of the reference intervals for RBC, Hb, and Hct tended to decrease with advancing age. The upper and lower limits of reference intervals for WBC, neutrophils, lymphocytes, and MPV also showed increasing and decreasing tendencies, respectively, widening the reference intervals as the subjects aged (except in the 70-74-year-old group for men). Among women, the lower limits of the reference intervals for RBC, Hb, and Hct showed a tendency to decrease with increasing age for those >70 years of age; however, the median values did not show such a tendency. The reference interval for PDW narrowed as women aged. Separate reference intervals were required among men for MCH and eosinophils in the 70-74-year group, and for basophils in the 65-69-year group. Among women, separate reference intervals were required for MCV in the 65-69-year group; for MCH in the 60-64, 65-69, and ≥75-years groups; and for RDW in all the 4 elderly age subgroups.Conclusion: Healthy elderly Koreans can use the same reference intervals as younger populations. Thus, abnormal CBC results may not necessarily be attributable to physiologic changes but possible underlying diseases that should be investigated. DisclosuresNo relevant conflicts of interest to declare.

A comparison of complete blood count reference intervals in healthy elderly vs. younger Korean adults: a large population study.

Background The use of laboratory reference intervals based on younger populations is of questionable validity in older populations. We established reference intervals for 16 complete blood count (CBC) parameters in healthy elderly Koreans aged ≥60 years and compared them to those of individuals aged 20-59 years. Methods Among 64,532 individuals (39,609 men and 24,923 women) aged ≥20 years who underwent medical checkups, 8151 healthy subjects (12.6%, 5270 men and 2881 women, including 675 and 511, respectively, who were ≥60 years of age) were enrolled based on stringent criteria including laboratory, imaging and endoscopy results; previous medical history; and medication history. CBC parameters were measured using an Advia2120i instrument. Results Overall, healthy individuals aged ≥60 years did not require separate reference intervals from those aged <60 years except for red cell distribution width (RDW) and mean corpuscular hemoglobin (MCH) in women. However, subjects aged ≥60 years still required sex-specific reference intervals for red blood cell count, hemoglobin, hematocrit, MCH, monocytes and eosinophils. Separate reference intervals were required for MCH, eosinophils and basophils for certain age subgroups of men aged ≥60 years, and for MCH and RDW in certain age subgroups of women aged ≥60 years, compared to counterparts <60 years of age. Conclusions Healthy elderly Koreans can use the same reference intervals as younger populations. Thus, abnormal CBC results may not necessarily be attributable to physiologic changes but possible underlying diseases that should be investigated.

Normal complete blood count reference intervals in the Turkish population: a prospective study

This study aim to analyze and report the normal complete blood count CBC reference intervals in the Turkish population healthy people living in Manisa Turkey non pregnant with no known disease with no pathological entity in physical examination and anamnesis with no medicine usage in the last days stating that they and also their first degree relatives do not have any blood diseases were included in the study Vitamin B folic acid ferritin levels were analyzed for each of the participants CBC values of the remaining people of which were women and were men were studied Platelet nbsp PLT Plateletcrit PCT Red cell Distribution Width nbsp RDW levels and the neutrophil ratio were found significantly higher in females On the other hand hemoglobin Hb Total Red Blood Cell count RBC Hematocrit Hct mean cellular volume MCV mean cellular hemoglobin nbsp MCH mean corpuscular hemoglobin concentration MCHC levels together with monocyte count and ratio were found significantly higher in males p lt World Health Organization WHO defines anemia as the level of Hb being less than g dL for men In our study we found this level to be plusmn gr dL WHO defines anemia as the level of Hb less than g dL for women In our study we found this level to be plusmn gr dL We found that anemia borderline of the women in our region was consistent with anemia borderline of WHO

Complete Blood Count Reference Intervals and Patterns of Changes Across Pediatric, Adult, and Geriatric Ages in Korea.

BackgroundSampling a healthy reference population to generate reference intervals (RIs) for complete blood count (CBC) parameters is not common for pediatric and geriatric ages. We established age- and sex-specific RIs for CBC parameters across pediatric, adult, and geriatric ages using secondary data, evaluating patterns of changes in CBC parameters.MethodsThe reference population comprised 804,623 health examinees (66,611 aged 3–17 years; 564,280 aged 18–59 years; 173,732 aged 60–99 years), and, we excluded 22,766 examinees after outlier testing. The CBC parameters (red blood cell [RBC], white blood cell [WBC], and platelet parameters) from 781,857 examinees were studied. We determined statistically significant partitions of age and sex, and calculated RIs according to the CLSI C28-A3 guidelines.ResultsRBC parameters increased with age until adulthood and decreased with age in males, but increased before puberty and then decreased with age in females. WBC and platelet counts were the highest in early childhood and decreased with age. Sex differences in each age group were noted: WBC count was higher in males than in females during adulthood, but platelet count was higher in females than in males from puberty onwards (P<0.001). Neutrophil count was the lowest in early childhood and increased with age. Lymphocyte count decreased with age after peaking in early childhood. Eosinophil count was the highest in childhood and higher in males than in females. Monocyte count was higher in males than in females (P<0.001).ConclusionsWe provide comprehensive age- and sex-specific RIs for CBC parameters, which show dynamic changes with both age and sex.

Complete blood count reference intervals from a healthy adult urban population in Kenya.

BackgroundThere are racial, ethnic and geographical differences in complete blood count (CBC) reference intervals (RIs) and therefore it is necessary to establish RIs that are population specific. Several studies have been carried out in Africa to derive CBC RIs but many were not conducted with the rigor recommended for RI studies hence limiting the adoption and generalizability of the results.MethodBy use of a Beckman Coulter ACT 5 DIFF CP analyser, we measured CBC parameters in samples collected from 528 healthy black African volunteers in a largely urban population. The latent abnormal values exclusion (LAVE) method was used for secondary exclusion of individuals who may have had sub-clinical diseases. The RIs were derived by both parametric and non-parametric methods with and without LAVE for comparative purposes.ResultsHaemoglobin (Hb) levels were lower while platelet counts were higher in females across the 4 age stratifications. The lower limits for Hb and red blood cell parameters significantly increased after applying the LAVE method which eliminated individuals with latent anemia and inflammation. We adopted RIs by parametric method because 90% confidence intervals of the RI limits were invariably narrower than those by the non-parametric method. The male and female RIs for Hb after applying the LAVE method were 14.5–18.7 g/dL and 12.0–16.5 g/dL respectively while the platelet count RIs were 133–356 and 152–443 x103 per μL respectively.ConclusionConsistent with other studies from Sub-Saharan Africa, Hb and neutrophil counts were lower than Caucasian values. Our finding of higher Hb and lower eosinophil counts compared to other studies conducted in rural Kenya most likely reflects the strict recruitment criteria and healthier reference population after secondary exclusion of individuals with possible sub-clinical diseases.

Establishment of complete blood count reference intervals for Chinese preschoolers.

Reference intervals are critical for interpreting test results of a clinical laboratory. The aim of this study was to establish local reference intervals of complete blood count for healthy preschoolers in China. Three thousand eight hundred and twenty-one blood specimens from children aged 4months to 6years were collected and analyzed. Complete blood counts were determined by Sysmex XT-4000i Automated Hematology Analyzer. The nonparametric 2.5th to 97.5th percentile reference ranges were calculated according to CLSI EP28-A3c guideline. Reference intervals for each blood cell parameter are determinded as follows: total WBC 4.86-12.1×109 /L for males and 4.73-12.3×109 /L for females; RBC 4.13-5.32×1012 /L for males and 4.08-5.24×1012 /L for females; HGB 109-145g/L for males and 111-143g/L for females; HCT 33.1-41.2% for males and 33.3-41.1% for females; MCH 23.5-29.7pg for males and 24.6-30.0pg for females; MCHC 320-365g/L for males and 321-362g/L for females; MCV 71.4-85.1fL for males and 73.8-86.9fL for females; RDW-SD 33.5-41.9fL for males and 33.5-41.0fL for females; RDW-CV 12.0-15.2% for males and 11.8-14.5% for females; PLT 181-475×109 /L for males and 179-456×109 /L for females; PCT 0.18-0.44% for males and 0.18-0.43% for females; MPV 8.20-11.6fL for males and 8.20-11.5fL for females; PDW 8.40-14.4fL for males and 8.40-14.0fL for females; P-LCR 12.0-36.6% for males and 11.8-35.6% for females. We established local complete blood count reference intervals for apparent healthy preschoolers in China. It is necessary to establishing region-specific reference intervals of complete blood count for preschoolers.

Complete blood count reference intervals for healthy Han Chinese adults.

BackgroundComplete blood count (CBC) reference intervals are important to diagnose diseases, screen blood donors, and assess overall health. However, current reference intervals established by older instruments and technologies and those from American and European populations are not suitable for Chinese samples due to ethnic, dietary, and lifestyle differences. The aim of this multicenter collaborative study was to establish CBC reference intervals for healthy Han Chinese adults.MethodsA total of 4,642 healthy individuals (2,136 males and 2,506 females) were recruited from six clinical centers in China (Shenyang, Beijing, Shanghai, Guangzhou, Chengdu, and Xi’an). Blood samples collected in K2EDTA anticoagulant tubes were analyzed. Analysis of variance was performed to determine differences in consensus intervals according to the use of data from the combined sample and selected samples.ResultsMedian and mean platelet counts from the Chengdu center were significantly lower than those from other centers. Red blood cell count (RBC), hemoglobin (HGB), and hematocrit (HCT) values were higher in males than in females at all ages. Other CBC parameters showed no significant instrument-, region-, age-, or sex-dependent difference. Thalassemia carriers were found to affect the lower or upper limit of different RBC profiles.ConclusionWe were able to establish consensus intervals for CBC parameters in healthy Han Chinese adults. RBC, HGB, and HCT intervals were established for each sex. The reference interval for platelets for the Chengdu center should be established independently.

Complete blood count reference intervals and age- and sex-related trends of North China Han population

Defining common reference intervals (RIs) are encouraging. The aim of this study is to establish RIs for complete blood count (CBC) in a Chinese Han population and probe their age- and sex-related CBC trends. Additionally, we will compare the CBC RIs of Han with those of other races. In total 1259 Han individuals (584 male and 675 female) were recruited in North China. CBC was processed on Sysmex XE-2100, Coulter LH750 and Mindray BC5800 whose traceability was well verified. The non-parametric 2.5th-97.5th percentiles RIs were calculated. The RIs for CBC parameters did not show apparent analyzer-specificity, apart from mean cellular volume (MCV), mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW). Red blood cell (RBC), hemoglobin (HBG), hematocrit (HCT), mean cellular hemoglobin (MCH), and mean cellular hemoglobin concentration (MGHC) are higher in males; and their male mean values tend to drop after 40 years; conversely, the female mean values tend to rise. Platelet (PLT) is higher in females and tends to drop after 40 years in both sexes. White blood cell (WBC) and absolute count of neutrophils (NE) and monocytes (MO) are higher in males, but there is no apparent change with age. Lymphocytes (LY) absolute count declines with age in males, but the same change in females is not obvious. RIs for HBG and HCT are similar among Han, Nordic, US European and US Mexican populations and are lower in US Africans. WBC RIs for Han and US African populations are lower than that for US Europeans and US Mexicans. RIs for major blood cell parameters are not method-dependent; variations obviously exist in age, sex and race. Consequently, common RIs for most CBC parameters appear inapplicable.