Abstract Background The complete blood count (CBC) is an important screening tool for healthy adults, commonly ordered at periodic physical exams. However, test results are typically interpreted using one-size-fits-all reference intervals (RIs), which don’t account for the low index-of-individuality of most CBC markers. This undermines the goal of precision medicine - to tailor patient care based on individual characteristics. Methods Here we utilize a database of >50,000 healthy outpatients with yearly CBCs, to investigate the value of patient-specific reference intervals (PRIs) for 9 CBC markers. We use Gaussian mixture modelling to calculate each patient’s setpoints, and to construct associated PRIs. Mechanistic drivers of setpoints were investigated through GWAS and via analysis of excess clinical specimens. Clinical outcomes were analyzed by comparing sensitivity of RIs and PRIs for detection of future cytopenia/cythemia and mortality. Results We found healthy adults had patient-specific setpoints that were stable over decades, and distinctly identifiable from 98% of other patients. Setpoints reflected a deep physiologic phenotype, enabling improved detection of genetic determinants of hematologic regulation (Fig1A), including discovery of multiple novel loci via GWAS analysis. Deviation from PRIs was associated with greater risk of cytopenia/cythemia and mortality (Fig1B) than deviation from the RI for all setpoints except MCHC. Setpoints were significantly correlated with long-term all-cause mortality, even when limited to those within the RI (Fig1C). Conclusions We show that hematologic setpoints reflect a deep, patient-specific phenotype. This phenotype can enhance mechanistic studies, and allow for increased diagnostic sensitivity, through calculation of a personalized reference interval. Setpoints are sufficiently stable and patient-specific to help realize the promise of precision medicine for healthy adults.Fig1A.Significance of GWAS hits using setpoints versus single CBCs. Fig1B. 10yr mortality hazard ratio for tests outside the RI and PRI. Fig1C. Association of WBC setpoint with mortality (limited to WBC setpoints inside the RI).
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