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Chen G, Barlow M, Down L, Mounce LTA, Merriel SWD, Watson J, Martins T, Bailey SER. Exploring ethnic differences in the distribution of blood test results in healthy adult populations to inform earlier cancer detection: a systematic review. Fam Pract 2024:cmae021. [PMID: 38706165 DOI: 10.1093/fampra/cmae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND In primary care, health professionals use blood tests to investigate nonspecific presentations to inform referral decisions. Reference ranges for the commonly used blood tests in western countries were developed in predominately White populations, and so may perform differently when applied to non-White populations. Knowledge of ethnic variation in blood test results in healthy/general populations could help address ethnic inequalities in cancer referral for diagnosis and outcomes. OBJECTIVE This systematic review explored evidence of ethnic differences in the distribution of selected blood test results among healthy/general populations to inform future research aimed at addressing inequalities in cancer diagnosis. METHODS We searched PubMed and EMBASE to identify studies reporting measures of haemoglobin, MCV, calcium, albumin, platelet count, and CRP in nondiseased adults from at least 2 different ethnic groups. Two reviewers independently screened studies, completed data extraction and quality assessment using an adapted Newcastle-Ottawa scale. Participants were stratified into White, Black, Asian, Mixed, and Other groups. Data were synthesised narratively and meta-analyses were conducted where possible. RESULTS A total of 47 papers were included. Black men and women have lower average values of haemoglobin, MCV, and albumin, and higher average values of CRP relative to their White counterparts. Additionally, Black men have lower average haemoglobin than Asian men, whereas Asian women have lower average CRP values when compared with White women. CONCLUSIONS There is evidence of ethnic differences in average values of haemoglobin, MCV, CRP, and albumin in healthy/general populations. Further research is needed to explore the reasons for these differences. Systematic review registration: CRD42021274580.
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Affiliation(s)
- Ge Chen
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
- Bristol Dental School, University of Bristol, Bristol, United Kingdom
| | - Melissa Barlow
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | - Liz Down
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | | | - Samuel William David Merriel
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
- Centre for Primary Care & Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Jessica Watson
- Centre for Academic Primary Care (CAPC), Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tanimola Martins
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
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Kang W, Barad A, Clark AG, Wang Y, Lin X, Gu Z, O'Brien KO. Ethnic Differences in Iron Status. Adv Nutr 2021; 12:1838-1853. [PMID: 34009254 PMCID: PMC8483971 DOI: 10.1093/advances/nmab035] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023] Open
Abstract
Iron is unique among all minerals in that humans have no regulatable excretory pathway to eliminate excess iron after it is absorbed. Iron deficiency anemia occurs when absorbed iron is not sufficient to meet body iron demands, whereas iron overload and subsequent deposition of iron in key organs occur when absorbed iron exceeds body iron demands. Over time, iron accumulation in the body can increase risk of chronic diseases, including cirrhosis, diabetes, and heart failure. To date, only ∼30% of the interindividual variability in iron absorption can be captured by iron status biomarkers or iron regulatory hormones. Much of the regulation of iron absorption may be under genetic control, but these pathways have yet to be fully elucidated. Genome-wide and candidate gene association studies have identified several genetic variants that are associated with variations in iron status, but the majority of these data were generated in European populations. The purpose of this review is to summarize genetic variants that have been associated with alterations in iron status and to highlight the influence of ethnicity on the risk of iron deficiency or overload. Using extant data in the literature, linear mixed-effects models were constructed to explore ethnic differences in iron status biomarkers. This approach found that East Asians had significantly higher concentrations of iron status indicators (serum ferritin, transferrin saturation, and hemoglobin) than Europeans, African Americans, or South Asians. African Americans exhibited significantly lower hemoglobin concentrations compared with other ethnic groups. Further studies of the genetic basis for ethnic differences in iron metabolism and on how it affects disease susceptibility among different ethnic groups are needed to inform population-specific recommendations and personalized nutrition interventions for iron-related disorders.
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Affiliation(s)
- Wanhui Kang
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Alexa Barad
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Andrew G Clark
- Department of Molecular Biology and Genetics, Cornell University, Ithaca, NY, USA,Department of Computational Biology, Cornell University, Ithaca, NY, USA
| | - Yiqin Wang
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
| | - Xu Lin
- Shanghai Institute of Nutrition and Health, Chinese Academy of Sciences, Shanghai, China
| | - Zhenglong Gu
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, USA
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Greene DN, McPherson GW, Rongitsch J, Imborek KL, Schmidt RL, Humble RM, Nisly N, Dole NJ, Dane SK, Frerichs J, Krasowski MD. Hematology reference intervals for transgender adults on stable hormone therapy. Clin Chim Acta 2019; 492:84-90. [PMID: 30771301 DOI: 10.1016/j.cca.2019.02.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The complete blood count (CBC) is a cornerstone of patient care. Several of the normal values for the components of the CBC differ by sex and, therefore, male-specific and female-specific reference intervals are required to interpret these laboratory results. Transgender individuals are often prescribed hormone therapy to affirm their gender, with resulting serum hormone concentrations similar to those of cisgender individuals. Gender-specific reference intervals for transgender men and women have not been established for any laboratory measurements, including hematology. We established clinically relevant hematological reference intervals for transgender individuals receiving stable hormone therapy. METHODS Healthy transgender individuals prescribed testosterone (n = 79) or estrogen (n = 93) for ≥12 months were recruited from internal medicine and primary care clinics that specialize in transgender medical care. Concentrations for hemoglobin, hematocrit, MCV, MCHC, and RDWCV, as well as counts for red cells, white cells, and platelets, were evaluated. Results were interpreted in reference to the overall distribution of values and relative to serum estradiol and total testosterone concentrations. Calculated reference intervals were compared to established cisgender reference intervals. RESULTS Regardless of serum hormone concentration, individuals prescribed testosterone or estrogen had hematology parameters that were not clinically different from cisgender males and females, respectively. CONCLUSION The hematology parameters for transgender men and women receiving stable hormone therapy should be evaluated against the cisgender male and cisgender female reference ranges, respectively and does not require concurrent sex hormone analysis. Care providers can utilize this observation to aid in interpretation of hematology laboratory values for transgender people.
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Affiliation(s)
- Dina N Greene
- Department of Laboratory Medicine, University of Washington, Seattle, WA, United States.
| | | | | | - Katherine L Imborek
- Department of Family Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Robert L Schmidt
- Department of Pathology, University of Utah, Salt Lake City, UT, United States
| | - Robert M Humble
- Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Nicole Nisly
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Nancy J Dole
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa, IA, United States
| | - Susan K Dane
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Janice Frerichs
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, United States
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Tahmasebi H, Trajcevski K, Higgins V, Adeli K. Influence of ethnicity on population reference values for biochemical markers. Crit Rev Clin Lab Sci 2018; 55:359-375. [DOI: 10.1080/10408363.2018.1476455] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Houman Tahmasebi
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Karin Trajcevski
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Victoria Higgins
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Khosrow Adeli
- CALIPER Program, Department of Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
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Datta Mitra A, Gupta A, Jialal I. Folate Insufficiency Due to Celiac Disease in a 49-Year-Old Woman of Southeast Asian-Indian Ethnicity. Lab Med 2016; 47:259-62. [PMID: 27406144 DOI: 10.1093/labmed/lmw036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Indexed: 11/13/2022] Open
Abstract
The clinical presentation of celiac disease has evolved from chronic diarrhea and malnutrition to mild nutrient insufficiencies. Recently diagnosed adults with celiac disease should be assessed for micronutrient deficiencies because early institution of a gluten-free diet (GFD) prevents morbidity and reduces the incidence of gastrointestinal malignant neoplasms and osteoporosis. In this report, we present the case of a 49-year-old woman of Southeast Asian-Indian descent living in the United States who had folate insufficiency, as manifested by low serum and red blood cell (RBC) folate levels. Further investigation, including serologic testing and intestinal biopsy, confirmed a diagnosis of celiac disease and other nutrient deficiencies. Managing the condition of this patient with folate supplements and implementation of a recommended GFD reversed the folate insufficiency. In conclusion, when serum and/or RBC levels are low in a person of Southeast Asian-Indian descent living in a country with folate fortification of the grain supply, such as the United States, the medical team needs to look for an organic cause, as in our patient, to diagnose and manage celiac disease early and, hopefully, forestall complications.
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Affiliation(s)
| | - Asha Gupta
- Department of Internal Medicine, Division of Gastroenterology and Hepatology
| | - Ishwarlal Jialal
- Department of Pathology and Laboratory Medicine Division of Endocrinology and Metabolism, University of California Davis Medical Center, Sacramento, CA
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Shin D, Lee S, Lim KS, Park JS, Shin SG, Jang IJ, Yu KS. Pharmacokinetic study of single and multiple oral administrations of 2 mg dienogest in healthy Korean women. Contraception 2013; 87:750-5. [DOI: 10.1016/j.contraception.2012.10.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Revised: 10/21/2012] [Accepted: 10/29/2012] [Indexed: 11/24/2022]
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Oyesanmi O, Kunkel EJ, Monti DA, Field HL. Hematologic side effects of psychotropics. PSYCHOSOMATICS 1999; 40:414-21. [PMID: 10479946 DOI: 10.1016/s0033-3182(99)71206-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Psychiatrists are often unaware of the potential hematologic complications of the psychotropics they prescribe. Although this review is not a hematologic text reference, relevant hematologic syndromes are described so that the consultation-liaison psychiatrist will be familiar with the usual signs, symptoms, and treatments of these syndromes. This article reviews the hematologic side effects of the commonly prescribed psychotropics, including antipsychotics, antidepressants, benzodiazepines, lithium, mood stabilizers (including some of the anticonvulsants), and the acetylcholinesterase inhibitors. Clinical signs and symptoms that should alert the physician to obtain a complete blood count are described.
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Affiliation(s)
- O Oyesanmi
- Department of Psychiatry and Human Behavior, Jefferson Medical College, Philadelphia, Pennsylvania 19107-5004, USA
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Hughes K, Ong CN. Vitamins, selenium, iron, and coronary heart disease risk in Indians, Malays, and Chinese in Singapore. J Epidemiol Community Health 1998; 52:181-5. [PMID: 9616423 PMCID: PMC1756686 DOI: 10.1136/jech.52.3.181] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
STUDY OBJECTIVE To examine the hypothesis that the higher rates of coronary heart disease (CHD) in Indians (South Asians) compared with Malays and Chinese is partly because of differences in antioxidants (vitamins A, C, and E, and selenium) and pro-oxidants (iron). DESIGN Cross sectional study of the general population. SETTING Singapore. PARTICIPANTS Random sample of 941 persons aged 30 to 69 years. MAIN RESULTS There were moderate correlations between vitamin A and vitamin E, and between these vitamins and selenium. Mean plasma vitamins A and E were similar by ethnic group. Vitamin A concentration for Indians were (men 0.66 and women 0.51 mg/l), Malays (men 0.67 and women 0.54 mg/l), and Chinese (men 0.68 and women 0.52 mg/l). Vitamin E concentrations for Indians were (men 12.9 and women 12.8 mg/l), Malays (men 13.6 and women 13.3 mg/l), and Chinese (men 12.6 and women 12.6 mg/l). In contrast, mean plasma vitamin C concentrations were lower in Indians (men 5.7 and women 6.9 mg/l) and Malays (men 5.1 and women 6.4 mg/l) than Chinese (men 6.3 and women 8.4 mg/l). Mean serum selenium was lower in Indians (men 117 and women 115 micrograms/l) than Malays (men 122 and women 122 micrograms/l) and Chinese (men 126 and women 119 micrograms/l). Mean serum ferritin was much lower in Indians (men 132 and women 50 micrograms/l) than Malays (men 175 and women 85 micrograms/l) and Chinese (men 236 and women 92 micrograms/l). MAIN CONCLUSIONS Lower vitamin C and selenium in Indians, particularly in combination, could play a part in their increased risk of CHD. Vitamins A and E, and ferritin (iron) have no such role. Lower vitamin C in Indians and Malays is probably because of its destruction by more prolonged cooking. In Indians, lower selenium is probably because of a lower dietary intake and the much lower ferritin to a lower dietary intake of iron and its binding by phytates.
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Affiliation(s)
- K Hughes
- Department of Community, Occupational, and Family Medicine, National University of Singapore, Faculty of Medicine, Singapore
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Weiss G, Reibnegger G, Murr C, Wachter H, Fuchs D. Iron and coronary heart disease. Iron linked to immune activation. BMJ (CLINICAL RESEARCH ED.) 1993; 307:1067. [PMID: 8251795 PMCID: PMC1679270 DOI: 10.1136/bmj.307.6911.1067-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Sullivan JL. Iron and coronary heart disease. Iron makes myocardium vulnerable to ischemia. BMJ (CLINICAL RESEARCH ED.) 1993; 307:1066-7. [PMID: 8251793 PMCID: PMC1679257 DOI: 10.1136/bmj.307.6911.1066-b] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Godsland IF, Bruce R, Worthington M, Stevenson JC. Iron and coronary heart disease. Control for haematological variables. BMJ (CLINICAL RESEARCH ED.) 1993; 307:1067. [PMID: 8251794 PMCID: PMC1679231 DOI: 10.1136/bmj.307.6911.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Parr JH, Seed M, Godsland I, Wynn V. The effects of reverse sequential anti-androgen therapy (cyproterone acetate and ethinyl estradiol) on hematological parameters. J Endocrinol Invest 1987; 10:237-9. [PMID: 2957418 DOI: 10.1007/bf03348120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Hematological parameters were studied in female patients receiving reverse-sequential anti-androgen therapy for hirsutism and acne. A significant fall in hemoglobin, total red cell count and packed cell volume occurred after 3-month treatment in 30 patients during the 10-day cyproterone acetate and ethinyl estradiol phase; this change was sustained in 14 patients studied to 12 months. A fall in hemoglobin and packed cell volume alone occurred after 3 months in 31 patients in the ethinyl estradiol phase. Reverse-sequential therapy may influence hemopoiesis by its anti-androgenic action on erythropoiesis, although we found no relationship between changes in hematological parameters and total testosterone levels.
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Bain B, Seed M, Godsland I. Normal values for peripheral blood white cell counts in women of four different ethnic origins. J Clin Pathol 1984; 37:188-93. [PMID: 6693578 PMCID: PMC498676 DOI: 10.1136/jcp.37.2.188] [Citation(s) in RCA: 87] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Total and differential white cell counts were studied in 399 women living in the same community in Britain but drawn from four different ethnic groups. The groups were white (northern European), Indian, black (African and West Indian), and Oriental. The total white cell count and absolute neutrophil count were significantly lower in the black group than in each of the other groups. The absolute monocyte count was higher in whites than in each of the other groups. Contrary to earlier reports, the absolute eosinophil count in blacks was no higher than in whites, suggesting that the high eosinophil counts previously found had an environmental rather than a genetic cause. The eosinophil count of Indians was only marginally higher than that of whites and the difference was not significant, again suggesting that high eosinophil counts previously reported had an environmental cause. No ethnic variation was found in the absolute lymphocyte count. The lower white cell count and neutrophil count found in blacks is of considerable practical importance, and blacks should not be assessed in relation to reference ranges derived for whites. Nevertheless, the eosinophil count in healthy blacks is no higher than that of whites and counts above reference ranges for whites should be considered clinically important. The differences between white cell counts of Indians and Orientals and those of whites are minor and for practical purposes they can be assessed in relation to reference ranges derived for whites.
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