Hematological reference values for healthy adults in togo

Region-specific laboratory reference intervals are important: A systematic review of the data from Africa

Region-specific laboratory reference intervals (RIs) are important for clinical trials and these data are often sparse in priority areas for research, including Africa. We reviewed data on RIs from Africa to identify gaps in the literature with a systematic review of PubMed for RI studies from Africa published ≥2010. Search focus included clinical analytic chemistry, hematology, immunological parameters and RIs. Data from adults, adolescents, children, pregnant women, and the elderly were included. We excluded manuscripts reporting data from persons with conditions that might preclude clinical trial participation in studies enrolling healthy volunteers. Of 179 identified manuscripts, 80 were included in this review, covering 20 countries with the largest number of studies in Ethiopia (n = 23, 29%). Most studies considered healthy, nonpregnant adults (n = 55, 69%). Nine (11%) studies included pregnant women, 13 (16%) included adolescents and 22 (28%) included children. Recruitment, screening, enrollment procedures and definition of age strata varied across studies. The most common type of RIs reported were hematology (66, 83%); 14 studies (18%) included flow cytometry and/or T cell counts. Other common tests or panels included liver function assays (32, 40%), renal function assays (30, 38%), lipid chemistries (17, 21%) and serum electrolytes (17, 21%). The number of parameters characterized ranged from only one (three studies characterized either CD4+ counts, D-dimer, or hemoglobin), to as many as 40. Statistical methods for calculating RIs varied. 56 (70%) studies compared their results to international RI databases. Though most presented their data side-by-side with international data with little accompanying analysis, nearly all reported deviation from comparator RI data, sometimes with half or more of otherwise healthy participants having an "out of range" result. We found there is limited local RI data available in sub-Saharan Africa. Studies to fill this gap are warranted, including efforts to standardize statistical methods to derive RIs, methods to compare with other RIs, and improve representative participant selection.

Hematological indices reference intervals for a healthy Arab population in Qatar: Effect of age, gender, and geographic location

Hematologic reference intervals vary with gender, age, ethnicity, and geographic area. Therefore, local or national laboratory reference ranges are essential to enhance the accuracy when diagnosing health conditions. Still, no comprehensive list of reference ranges tailored to the Arab population living in Qatar. Accordingly, this study aims at establishing a hematology reference guide for Arabs in Qatar.This is a retrospective study where 750 healthy volunteers (18-69 years) from 2015 to 2019 were included, analyzed by an automated hematology analyzer. Arab adults were divided into African (Egypt, Libya, Tunisia, Morocco) and Asian (Syria, Lebanon, Jordon, Palestine, Qatar). The Cell-Dyn and Sysmex were used for measuring hematological parameters.The mean +/- 2SD were established for all the study groups. Arab males had significantly higher Hb, Hct, red cell distribution width, absolute neutrophil count, lymphocytes, and monocyte counts than females. Asian-Arab males had significantly higher Hb concentration and higher WBC, lymphocytes, and eosinophils than African Arabs. Asian-Arab young (>18: < 40 years) males had significantly higher Hb and lymphocytes and lower monocytes than older males (>40 years). African-Arab young males had significantly higher lymphocytes and lower monocytes than older males. Asian-Arab young females had higher WBC and absolute neutrophil count than older Asian Arabs.The findings of this study will help in establishing specific reference intervals in the Arab world. The differences in hematology reference intervals considering age, gender, and geographical location highlight the importance of establishing blood reference intervals in each country considering the ethnic diversity of each country.

Hematologic reference intervals for healthy adult Saudis in Riyadh

BACKGROUND

Laboratory hematological tests are widely used in clinical practice to assess health and disease conditions. Reference ranges provided by laboratory reports are considered the most authoritative medical tools to assist in the decision-making phase. International standards institutes recommend that reference ranges be established for each region.

OBJECTIVES

Provide reference values of routine hematological parameters in Saudi adults according to age and gender.

DESIGN

Cross-sectional SETTING: Central province of Saudi Arabia.

PATIENTS AND METHODS

Apparently healthy Saudi adults were subjected to laboratory testing of routine hematological parameters (full blood count, hemostatic profile, and serum hematinics), after completing a detailed health medical questionnaire.

MAIN OUTCOME MEASURES

Hematological reference values based on the local population.

SAMPLE SIZE AND CHARACTERISTICS

637 after screening 827 potentially healthy Saudi adults with ages ranging from 15 to 65 years.

RESULTS

The reference values of routine hematological parameters for the full population and by gender are presented with 90% CI as the lower and upper limits. Reference ranges mostly differed from universal established ranges shown in textbooks.

CONCLUSION

The reference ranges of routine hematologic parameters for accurate assessment and appropriate management will help improve the routine clinical care of the adult Saudi population.

LIMITATIONS

Difficulty in assessing health status of participants, who could have subclinical illnesses not reflected in the evaluated blood measurement. Lack of ability to eliminate individuals who might be carriers for haemoglobinopathies. Studies with larger sample sizes from different areas of the country are required to achieve a more accurate representation of the whole Saudi population.

CONFLICT OF INTEREST

None.

When non-Whiteness becomes a condition

The term "benign ethnic neutropenia" describes the phenotype of having an absolute neutrophil count (ANC) <1500 cells/μL with no increased risk of infection. It is most commonly seen in those of African ancestry. In addition, ANC reference ranges from countries in Africa emphasize that ANC levels <1500 cells/μL are common and harmless. The lower ANC levels are driven by the Duffy null [Fy(a-b-)] phenotype, which is protective against malaria and seen in 80% to 100% of those of sub-Saharan African ancestry and <1% of those of European descent. Benign ethnic neutropenia is clinically insignificant, but the average ANC values differ from what are typically seen in those of European descent. Thus, the predominantly White American medical system has described this as a condition. This labeling implicitly indicates that common phenotypes in non-White populations are abnormal or wrong. We believe that it is important to examine and rectify practices in hematology that contribute to systemic racism.

Haematological reference intervals for healthy adults in Bamenda, Cameroon

BACKGROUND

In the era of evidence-based medicine, haematological reference intervals are essential for the interpretation of data for clinical decision-making, monitoring of treatment and research. It is not uncommon that reference intervals used in most African countries have been obtained from published scientific literature, textbooks, reagent/instrument manuals.

OBJECTIVE

The aim of this study was to determine haematological reference intervals of healthy adults in Bamenda, Cameroon.

METHODS

This was a cross-sectional study conducted between June and November 2015. Participants were voluntary blood donors at the Blood Bank Service of the Regional Hospital Bamenda aged between 18 and 65 years. The mean, median and standard deviation of the mean were calculated for each haematological parameter. The 95th percentile reference intervals were determined using the 2.5th and 97.5th percentile. The differences between gender for all the parameters were evaluated using the Kruskal-Wallis test. Significance was determined at the 95% confidence level.

RESULTS

Out of a total of 340 participants, 202 (59.4%) were men and 138 (40.6%) were women. The median red blood cell, haemoglobin, haematocrit and mean cell haemoglobin concentration were significantly higher in men than women (p < 0.001). The median white blood cell, absolute lymphocytes count, absolute granulocytes and platelet counts for men were significantly lower than those for women (p < 0.011).

CONCLUSION

We propose that the present established haematological reference intervals in this study should be used for clinical management of patients and interpretation of laboratory data for research in Bamenda.

Hematology Reference Intervals for Healthy Adults of the City of Sulaymaniyah, Iraq

Background

Hematology laboratory analyses are essential in the diagnosis of and making decisions on clinical cases. Hematology results are only meaningful when reference made to a normal range of values for a particular population. These values are affected by race, diet, and lifestyle the society.

Objective

To establish the hematological reference values for adult residents of the city of Sulaymaniyah, Iraq.

Methods

Blood samples collected from 1133 healthy males and female volunteers were analyzed for complete blood count, serum iron, and vitamin B12 concentrations. After applying the exclusion criteria, the hematology results from 762 individuals comprising 313 males and 449 males were included in the study.

Results

The mean red blood cell count, hemoglobin concentration, hematocrit, and serum iron concentration were higher in males than females while the neutrophil and platelet counts and plateletcrit were higher in females than males.

Conclusion

This study for the first time recorded hematological reference intervals for residents of the city of Sulaymaniyah.

Determining hematological, biochemical and immunological reference values in healthy adults with high-risk for HIV acquisition in Mozambique

Introduction

In many African countries, laboratory reference values are not established for the local healthy adult population. In Mozambique, reference values are known for young adults (18-24yo) but not yet established for a wider age range. Our study aimed to establish hematological, biochemical and immunological reference values for vaccine trials in Mozambican healthy adults with high-risk for HIV acquisition.

Methods

A longitudinal cohort and site development study in Mozambique between November 2013 and 2014 enrolled 505 participants between 18 to 35 years old. Samples from these healthy participants, were analyzed to determine reference values. All volunteers included in the analysis were clinically healthy and human immunodeficiency virus (HIV), hepatitis B and C virus, and syphilis negative. Median and reference ranges were calculated for the hematological, biochemical and immunological parameters. Ranges were compared with other African countries, the USA and the US National Institute of Health (NIH) Division of AIDS (DAIDS) toxicity tables.

Results

A total of 505 participant samples were analyzed. Of these, 419 participants were HIV, hepatitis B and C virus and syphilis negative including 203 (48.5%) females and 216 (51.5%) males, with a mean age of 21 years. In the hematological parameters, we found significant differences between sex for erythrocytes, hemoglobin, hematocrit, MCV, MCH and MCHC as well as white blood cells, neutrophils and platelets: males had higher values than females. There were also significant differences in CD4⁺T cell values, 803 cells/μL in men versus 926 cells/μL in women. In biochemical parameters, men presented higher values than women for the metabolic, enzymatic and renal parameters: total and direct bilirubin, ALT and creatinine.

Conclusion

This study has established reference values for healthy adults with high-risk for HIV acquisition in Mozambique. These data are helpful in the context of future clinical research and patient care and treatment for the general adult population in the Mozambique and underline the importance of region-specific clinical reference ranges.

Haematological values in a healthy adult population in Yaoundé, Cameroon

Background

Haematological values derived from local populations are useful in laboratories to improve diagnoses for local patients. In Cameroon, these data are not yet available. Moreover, there is great variation in baseline parameters pertaining to full blood cell count among medical laboratories.

Objectives

This study aimed to determine values for the complete blood cell count of a healthy adult Cameroonian population for use in locally derived ranges in our medical laboratories.

Methods

A cross-sectional study was conducted among blood donors attending three blood banks in Yaoundé from November 2015 to September 2016. We expected to obtain at least 120 venous blood samples from both men and women. Tests were performed for (1) HIV, (2) complete blood cell count, (3) hepatitis B virus, (4) malaria, (5) syphilis, (6) C-reactive protein and (7) hepatitis C virus.

Results

We enrolled 294 healthy participants (161 men, 133 women) aged 18 to 55 years. The median haemoglobin concentration was 135 g/L in men and 114 g/L in women (p < 0.001). The median reticulocyte count was 60 × 10⁹/L in men and 40 × 10⁹/L in women (p < 0.001). Significant variation by sex was observed for the platelet count. The median white blood cell count was 4.1 × 10⁹/L in men and 4.6 × 10⁹/L in women (p = 0.008).

Conclusion

This study provides locally derived ranges for complete blood cell and reticulocyte counts for a healthy adult population in Yaoundé, Cameroon. These results can be used pending larger studies.

Reference values for blood count laboratory tests in the Brazilian adult population, National Health Survey

OBJECTIVE

To describe reference values for blood counts obtained from laboratory tests in the Brazilian adult population according to laboratory results from the National Health Survey (Pesquisa Nacional de Saúde - PNS), by gender, age group and skin color.

METHODS

The initial sample consisted of 8,952 adults. To determine the reference values, individuals with prior diseases and outliers were excluded. Mean values, standard deviation and limits were stratified by gender, age group and skin color.

RESULTS

For red blood cells, men presented a mean value of 5.0 million per mm3 (limits: 4.3-5.8) and women, 4.5 million per mm3 (limits: 3.9-5.1). Hemoglobin levels were higher among men with a mean of 14.9 g/dL (13.0-16.9), and in women, 13.2 g/dL (11.5-14.9). The mean number of white blood cells among men was 6.142/mm3 (2.843-9.440) and 6.426/mm3 (2.883-9.969) for women. Other parameters showed close values between the genders. Regarding age groups and skin color, mean values, standard deviation and limits of the exams presented small variations.

CONCLUSION

Hematological reference values based on the national survey allow for the establishment of specific reference limits for gender, age and skin color. The results presented here may contribute to the establishment of better evidence and criteria for the care, diagnosis and treatment of diseases.

Hypertensive disorders of pregnancy are associated with an inflammatory state: evidence from hematological findings and cytokine levels

Background

Abnormalities of blood cell counts and of cytokine profiles in women with hypertensive disorders of pregnancy (HDP) have been reported in several studies. Although their cause-effect relationships to HDP are not yet clear, detecting and monitoring these alterations can be of use for prognosis and management of HDP. This study aimed to determine hematological, coagulation and cytokine profiles in hypertensive as compared to normotensive pregnancy and to identify correlations between these profiles.

Methods

This was a hospital-based comparative cross-sectional study conducted from September 2017 to February 2018. There were two groups: the comparison group consisted of 77 normotensive pregnant women attending the antenatal clinic of Muhimbili National Hospital (MNH); the index group consisted of 76 hypertensive pregnant women admitted to the maternity block of the same hospital. Hematological and cytokine parameters were compared between the hypertensive and the normotensive group. We analyzed the data using Student’s independent t-test when the data were normally distributed; and the Mann–Whitney U-test when the data were not normally distributed. Kruskal Wallis with Dunn’s multiple comparison tests was run for subgroup analysis and correlation studies were done using Spearman ranking.

Results

Hemoglobin levels were slightly but significantly lower, (P < 0.01) in women with HDP compared to normotensive (N) women; the same was true for platelet counts (P < 0.001). The red cell distribution width (RDW) was slightly but significantly higher in HDP than in N. Neutrophil counts and Interleukin 6 (IL-6) levels were significantly (P < 0.001) higher in HDP than in N; and within HDP IL-6 levels increased with increasing severity of HDP. A novel remarkable finding was that eosinophil counts, normal in N, were lower and lower with increasing severity of HDP, to the point that they were nearly absent in women with eclampsia.

Conclusion

There are significant changes in hematological, cytokine and coagulation parameters in pregnant women with hypertensive disorders compared to normotensive pregnant women. The picture that emerges is that of an inflammatory state associated with hypertensive disorders of pregnancy.

Establishment of reference values for selected haematological parameters in young adult Nigerians

BACKGROUND

Haematological reference values are necessary for accurate diagnosis of diseases, clinical decision-making, treatment monitoring and clinical research. Due to unavailability of pan-Nigerian reference values, local results interpretation is based on the use of Western values.

OBJECTIVE

This study aims to establish national reference values for some haematological parameters in apparently healthy young adult Nigerians.

METHODS

Seven Thousand, Seven Hundred and Ninety-Seven (7,797) volunteers aged 18 to 26 years participated in the study. Participants' interviewer-administered questionnaires and blood samples were collected, analyzed and those with confounding factors (HIV infection, Hepatitis B sero-positivity, Malaria and Pregnancy) were excluded from statistical analysis. The 95-percentile reference range was determined for each haematological parameter using SPSS Version 16®. The result obtained was reviewed with reference to already established reference values in two West African and Western countries.

RESULTS

Blood specimens from 6153 (78.9%) participants [comprising 5915 (96.1%) males and 238 (3.9%) females] were analyzed after exclusion of 1,644 (21.1%) participants with confounding variables. Reference ranges among males and females varied and these were consistent with findings from two other West African countries. The median platelets count in this study was 218 x 109/l while commonly used Western value is 280 x 109/l. Other haematological parameters in the study were similar to Western values.

CONCLUSION

The findings of this study will improve clinical and research decision-making. Considering that this study is limited to young adult participants, there is a need to conduct future pan-Nigerian studies that will include all age groups.

Baseline haematological and biochemical reference values for healthy male adults from Mali

INTRODUCTION

Haematological reference values are very important for diagnostic orientation and treatment decision. The aim of this study was to establish haematological reference values for Malian healthy adults.

METHODS

A cross-sectional study including 161 male Malians aged between 19 and 54 years old was performed. Median and reference ranges were calculated for haematological and biochemical parameters. Parametric student's t-test was used to determine any statistically significant differences by age, smoker status, body mass index (BMI) and occupation. Ranges were further compared with those reported for other African, Afro-American and Caucasian populations.

RESULTS

Increased levels of MCV, MCH, PLT and EOS were found in younger Malians who had abnormal BMI and altered platelets parameters. Notably, significantly lower eosinophil and monocyte counts were observed in Malians compared to Europeans The smoking status did not seem to directly affect RIs.

CONCLUSION

This is the first study to determine normal laboratory parameters in Malian adult males. Our results underscore the necessity of establishing region-specific clinical reference ranges that would allow clinicians and practitioners to manage laboratory tests, diagnosis and therapies. These data are useful not only for the management of patients in Mali, but also to support European and American clinicians in the health management of asylum seekers and migrants from Mali.

Valores de referência para exames laboratoriais de colesterol, hemoglobina glicosilada e creatinina da população adulta brasileira

RESUMO: Introdução: Este artigo teve o objetivo de estimar valores de referência de exames laboratoriais de colesterol, hemoglobina glicosilada e creatinina para a população adulta brasileira. Métodos: Estudo descritivo realizado com os dados laboratoriais da Pesquisa Nacional de Saúde (PNS). Foram coletadas amostras de sangue e urina em subamostra da PNS constituída de 8.952 indivíduos de 18 anos ou mais. Para determinar os valores de referência, aplicaram-se critérios de exclusão, como a presença de doenças prévias e dos outliers, definidos pelos valores fora do intervalo estimado pela média ± 1,96 × desvio padrão. Posteriormente, foram calculados os valores de referência segundo sexo, faixa etária e raça/cor. Resultados: Observaram-se diferenças nos valores de referência de acordo com o sexo. O colesterol total, a lipoproteína de baixa densidade colesterol (LDL-c) e a lipoproteína de alta densidade colesterol (HDL-c) apresentaram valores mais elevados entre as mulheres. A hemoglobina glicosilada alcançou valores semelhantes segundo sexo, e a creatinina foi mais elevada entre os homens. Os valores médios de referência foram mais altos na população idosa, de 60 anos ou mais. A média e os limites inferiores e superiores do colesterol total e frações dos indivíduos não brancos foram ligeiramente mais baixos. Não houve diferença segundo raça/cor para hemoglobina glicosilada nem para creatinina. Conclusão: O estabelecimento de parâmetros nacionais de referência de exames laboratoriais, adaptados às características sociodemográficas e geográficas, fornece subsídios relevantes para a avaliação do diagnóstico e tratamento de doenças crônicas no Brasil.

Prevalence of Low Platelet Count and Identification of Associating Determinants and Genetic Polymorphism in Healthy Individuals of Upper Assam, India

The purpose of the study was to assess the prevalence of low platelet count among the healthy population of upper Assam, India. The impact of socio-demographic features was moreover pointed to evaluate. Additionally, Mean platelet volume (MPV) and Interleukin-6 gene polymorphism (-174 G > C) were also determined to speculate their effect on the basal platelet count. For determination of hematological indices, CBC was done and genetic polymorphism was identified by ARMS-PCR technique. Out of 510 study subjects, 25.3% (n = 129) had low platelet count, and females were recorded with significantly higher mean platelet count as compared to their male counterpart (p < 0.001). A progressive decline in platelet count was observed with ageing and more significantly noticed in females across the various age groups (p < 0.001). The mean MPV was significantly higher in low platelet count group as compared to the normal group (p < 0.001). Both platelet count and MPV differed significantly among the individuals with varied ethnicity. An inverse correlation between platelet count and its volume was reported, and such observation was continued to persist in every age-group under the study. However, no significant differences were observed for other hematological indices between the studied groups except for platelet indices and RBC count. Moreover, the peripheral blood smear examined for cellular morphology and in vitro platelet clumping did not report any significant aberrancy. No significant penetrance of the risk allele was revealed in the studied groups. However, ARMS-PCR confirmed 6% (n = 8/129) of the low platelet count subjects with heterozygous for G allele. This happens to be the first description of low platelet count among the healthy population of upper Assam, where age, gender, ethnicity, and MPV are significantly associated with platelet count variation. Heterozygosity of the risk allele does not contribute to the low platelet count condition.

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

BACKGROUND

There 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.

METHOD

By 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.

RESULTS

Haemoglobin (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 x10(3) per μL respectively.

CONCLUSION

Consistent 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.

Haematological and immunological reference intervals for adult population in the state of Amhara, Ethiopia

OBJECTIVE

Reference intervals (RIs) currently being used in Ethiopia are derived from western populations. Thus, this study aimed to establish locally derived haematological and immunological RIs.

METHOD

The study was conducted in Amhara State, Ethiopia with a total of 967 (55.2% males) participants. 56.9% of males and 43.1% of females were eligible for haematological and immunological RI determination. A non-parametric test was used for the determination of upper (97.5th percentile) and lower (2.5th percentile) reference interval limits with 95% CI. The Harris and Boyd Rule was used to determine the need of partitioning of reference intervals based on gender.

RESULT

The established 95% reference intervals (2.5th-97.5th percentile) were: for WBC: 3-11.2 × 10⁹ /l; for platelet: 90-399 × 10⁹ /l; for RBC: 4-6 × 10¹² /l for males and 3.5-5.6 × 10¹² /l for females; for haemoglobin: (Hgb) 12-18.9 g/dl for males and 10.7-17.5 g/dl for females; for PCV: 35.7-55.3% for males and 32.2-50.1% for females; for CD4: 400-1430 × 10⁹ /l for males and 466-1523 × 10⁹ /l for females; for CD4 percentage: 18-49.1% for males and 21.3-52.9% for females; for MCV: 81-100 fl; for MCH: 25.3-34.6 pg; MCHC: 28.8-36.9%; for RDW: 11.6-15.4% and for MPV: 8-12.3 fl. Males had significantly higher RBC, Hgb and PCV than females. CD4 counts and CD4 percentage were significantly higher in females.

CONCLUSION

The reference intervals established in this study differ from others and thus should be used for the interpretation of laboratory results in diagnosis and safety monitoring in clinical trials in Amhara.

Establishment of the hematology reference intervals in a healthy population of adults in the Northwest of Morocco (Tangier-Tetouan region)

Introduction

Among the most useful biological examinations in common medical practice, blood count is the most prescribed. The reference intervals of the hematological parameters of this examination are of major importance for clinical orientations and therapeutic decisions. In Morocco, the reference values used by the laboratories of medical biology and used by doctors are ones collected from Caucasian and European individuals. These values could be different in the Moroccan population. Besides, reference intervals of the blood count specific to the various Moroccan regions are missing. We decided to determine the reference intervals from a population of healthy adults of the Tangier-Tetouan region by following the procedures recommended by the IFCC-CLSI guidelines in 2008 and comparing them to those of the literature.

Methods

Blood samples were taken from 15840 adult volunteers (8402 men from 18 to 55 years old and 7438 women from 18 to 50 years old) from the regional transfusion center of Tangier and Tetouan during a period between November 2014 and May 2016. The complete blood count was measured by the Sysmex KX21N^® analyzer. For each sample a systematic blood smear was done to determine the leukocyte differential. The data analysis was made by the software SPSS 20.0 by using percentiles 2.5^th and 97.5^th.

Results

A significant difference between both sexes was noted (p<0,001) for all the hematological parameters (red blood cells, hematocrit, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, leukocytes, neutrophils, basophils, eosinophils, monocytes, platelets and mean platelet volume) except for the numeration of lymphocytes (p = 0.552). The values of this study were compared with those reported in Arabic, Caucasian and African populations. Said comparisons showed the existence of significant differences.

Conclusion

This study tries to accentuate the necessity of proceeding with the establishment of reference intervals specific to the blood count of the Moroccan population to avoid errors of diagnosis, allow clinicians to interpret with greater specificity the hematological examinations and to improve the quality of medical care distributed to patients.

Hematological Reference Intervals for Healthy Iranian Blood Donors

Background: Development of locally-derived hematological reference intervals is necessary for improving the quality of health care and clinical trials. However hematological reference intervals are affected by several variables including age, gender and environmental factors. Therefore this study was conducted to determine the gender and age-specific hematological reference intervals of healthy Iranian blood donors. Materials and Methods: Selected hematological indices of 394 healthy blood donor volunteers, donating blood at Tehran Blood Transfusion Center were analyzed. Hematological reference intervals, stratified by age and gender were compared. The results of current study were also compared with those of US population. Results: There were significant gender-related differences for mean values of hematological indices, with males having higher mean values of RBC, HCG, HCT and MCV than females. While the mean of PLT and MCH were higher in women. Age-related differences for mean values of RBC and MCH were also significant. The comparison of reference intervals, stratified by both gender and age showed that RBC, HGB and HCT values were higher in males than females in all age groups. But MCH values of females in all age groups and WBC and PLT counts in females older than 30 years were higher compared to the males in the same age group. The results of this study showed some similarity with US population, with narrower intervals. Conclusion: This study suggests that gender and age-specific, locally derived hematological reference intervals should be referred to, before interpretation of any laboratory test result.

Age- and sex-related changes in hematological parameters in healthy Malawians

Aim

The aim of the study was to determine how values for white blood cell (WBC) counts, hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (mcv), and platelet counts vary with age and sex in healthy Malawians.

Methods

We recruited 660 (316 male and 344 female) participants in 12 different age groups. An ethylenediaminetetraacetic acid-anticoagulated blood sample collected from each participant was analyzed using a hematological analyzer.

Results

WBC counts decreased with age with the lowest counts observed in the 20 to <60 years old group. Median WBC counts for 20 to <60 year old females (5.9×10⁹/L) were significantly higher than those for men (4.7×10⁹/L; p=0.015) of the same age. Hb and Hct increased between 5 and 10 years in males and 10 and 15 years in females to adult levels. Males aged 5 to <10 years had significantly higher Hb (13.05 g/dL) and Hct (42.50%) compared to females of the same age (10.40 g/dL and 32.55%, respectively; p<0.0001 for both parameters). Platelet counts in males, which were highest between 3 and 5 years (376×10⁹/L), decreased to lowest counts among 5 to <10 year olds (238×10⁹/L), while in females these decreased from 402×10⁹/L in 6 to <10 years olds to 226×10⁹/L in 10 to <15 year olds. mcv median values were high in neonates reaching a nadir at 13–18 months and then increased throughout life. Females aged 0 to <6 months had significantly higher mcv values (81.85 fL) than males of the same age (69.3 fL; p<0.0001).

Conclusion

This study provides hematological values according to age and sex that are suitable for reference use in studies among Malawian subjects.

Establishing Reference Ranges of Hematological Parameters from Malian Healthy Adults

INTRODUCTION

Measurement of immuno-hematological parameters has been historically helpful in the diagnosis and treatment monitoring of many infectious diseases and cancers. However, these parameters have not yet been established in many developing countries where patient care strongly relies on such low-cost tests. This study describes the immuno-hematological parameter ranges for Malian healthy adults.

METHODS

A cross sectional study was conducted from August 2004 to May 2013. We included 213 healthy volunteers (173 male and 40 female), aged between 18-59 years. Median, 2.5 and 97.5 percentile ranges for each immuno-hematological parameter are presented.

RESULTS

In our study population, the hematological parameters' ranges were mostly different to the universal established ranges. We found in our population a Median white blood cell (WBC) count of 5200 cells/μL [3237.5-11900], Red Blood Cell (RBC) count of 4.94 10^6 [3.56-6.17], hemoglobin (Hb) of 14.2 g/dL [12.2-17.38], platelet count (Plt) of 275 10^3/μL [145.4-614.4], lymphocytes 2050/μL [1200-3800], neutrophils 2200/μL [1040-6220]; monocytes 200/μL [100-660]; eosinophils 131/μL [0-1026]; CD4 902 cells/μL [444-1669] and CD8 485 cells/μL [0-1272]. We found significant gender differences in RBC, Hb level and MPV. However, RBC and Hb were higher in males median values compared to females (median values) (p<0.001), whereas the Mean platelet volume lower values (MPV) in males than females (P<0.047). The hemoglobin level for some West African countries (Mali, Burkina Faso, Togo, and Nigeria) ranged from 13.5 to 15.1 g/dL for males and 12 to 13 g/dL for females. However in East and Southern Africa, the values were anywhere from 14.1 to 16.1 for males and 11.2 to 14.4 for females.

CONCLUSION

Our data may help physicians to better define hematological abnormalities in patients. They may also be used to define new "normal hematological values" in Malian population or in the whole West African population.

Human cells involved in atherosclerosis have a sex

The influence of sex has been largely described in cardiovascular diseases. Atherosclerosis is a complex process that involves many cell types such as vessel cells, immune cells and endothelial progenitor cells; however, many, if not all, studies do not report the sex of the cells. This review focuses on sex differences in human cells involved in the atherosclerotic process, emphasizing the role of sex hormones. Furthermore, we report sex differences and issues related to the processes that determine the fate of the cells such as apoptotic and autophagic mechanisms. The analysis of the data reveals that there are still many gaps in our knowledge regarding sex influences in atherosclerosis, largely for the cell types that have not been well studied, stressing the urgent need for a clear definition of experimental conditions and the inclusion of both sexes in preclinical studies.

Hematological reference intervals determination in adults at Gondar university hospital, Northwest Ethiopia

Background

Hematological reference values are important for the clinical decisions in laboratory diagnosis and monitoring of patients. The correct interpretation of laboratory results depends entirely on the reference intervals that have been established for the locality. But, in sub-Saharan African countries particularly in Ethiopia, locally derived reference intervals were not established and they are forced to use intervals established from western population. Thus this study aimed to establish locally derived hematological reference values that could be used in Northwest Ethiopia.

Methods

A cross sectional study was conducted from April to May 2014 with 120 male and 120 female apparently health adult blood donors at Gondar University Hospital. A structured pretested questionnaire was used for socio demographic and clinical data collection. About 4 ml of blood was collected with EDTA test tube and analyzed using Cell-Dyn 1800 to enumerate the hematological parameters. The data were collected and entered into SPSS version 20 for analysis. Mann–Whitney U test was used to determine reference intervals and Harris and Boyd test was used to determine the reference intervals that need partition. The 95th percentile of measurements was taken as a reference interval.

Results

Median and 95th percentile of WBC for general population were lower than Caucasian population, Addis Ababa, Burkina Faso and Kenya of similar studies. The RBC, Hgb and PCV lower 95% limit values of both sex were lower than studies in Addis Ababa, Kenya, Burkina Faso and text book. While PCV upper limit values higher than the above countries. MCV values of the current study were higher than those countries while MCHC values were lower. Similarly, the absolute values of neutrophils in the current study were lower than Caucasian and Afro Caribbean but higher than African countries and Jamaica but lymphocyte count was higher.

Conclusions

The hematological reference intervals established in this study was different from those reported in other part of Ethiopia or African countries as well as Caucasian population. The RBC, PCV, Hgb and MCHC reference intervals were different in gender. Thus, using of locally determined reference range is advisable.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-016-2288-8) contains supplementary material, which is available to authorized users.

Seasonal variation in haematological and biochemical reference values for healthy young children in The Gambia

Background

Haematological and biochemistry reference values for children are important for interpreting clinical and research results however, differences in demography and environment poses a challenge when comparing results. The study defines reference intervals for haematological and biochemistry parameters and examines the effect of seasonality in malaria transmission.

Methods

Blood samples collected from clinically healthy children, aged 12–59 months, in two surveys during the dry and wet season in the Upper River region of The Gambia were processed and the data analysed to generate reference intervals based on the 2.5^th and 97.5^th percentiles of the data.

Results

Analysis was based on data from 1141 children with median age of 32 months. The mean values for the total white cell count and differentials; lymphocyte, monocyte and neutrophil decreased with increasing age, were lower in males and higher in the wet season survey. However, platelet values declined with age (p < 0.0001). There was no evidence of effect of gender on mean values of AST, ALT, lymphocytes, monocytes, platelets and haemoglobin.

Conclusion

Mean estimates for haematological and biochemistry reference intervals are affected by age and seasonality in the first five years of life. This consistency is important for harmonisation of reference values for clinical care and interpretation of trial results.

Electronic supplementary material

The online version of this article (doi:10.1186/s12887-016-0545-6) contains supplementary material, which is available to authorized users.

Evaluation of locally established reference intervals for hematology and biochemistry parameters in Western Kenya

Background

Important differences have been demonstrated in laboratory parameters from healthy persons in different geographical regions and populations, mostly driven by a combination of genetic, demographic, nutritional, and environmental factors. Despite this, European and North American derived laboratory reference intervals are used in African countries for patient management, clinical trial eligibility, and toxicity determination; which can result in misclassification of healthy persons as having laboratory abnormalities.

Methods

An observational prospective cohort study known as the Kisumu Incidence Cohort Study (KICoS) was conducted to estimate the incidence of HIV seroconversion and identify determinants of successful recruitment and retention in preparation for an HIV vaccine/prevention trial among young adults and adolescents in western Kenya. Laboratory values generated from the KICoS were compared to published region-specific reference intervals and the 2004 NIH DAIDS toxicity tables used for the trial.

Results

About 1106 participants were screened for the KICoS between January 2007 and June 2010. Nine hundred and fifty-three participants aged 16 to 34 years, HIV-seronegative, clinically healthy, and non-pregnant were selected for this analysis. Median and 95% reference intervals were calculated for hematological and biochemistry parameters. When compared with both published region-specific reference values and the 2004 NIH DAIDS toxicity table, it was shown that the use of locally established reference intervals would have resulted in fewer participants classified as having abnormal hematological or biochemistry values compared to US derived reference intervals from DAIDS (10% classified as abnormal by local parameters vs. >40% by US DAIDS). Blood urea nitrogen was most often out of range if US based intervals were used: <10% abnormal by local intervals compared to >83% by US based reference intervals.

Conclusion

Differences in reference intervals for hematological and biochemical parameters between western and African populations highlight importance of developing local reference intervals for clinical care and trials in Africa.

Establishment of Normal Reference Intervals for CD3(+), CD4(+), CD8(+), and CD4(+) to CD8(+) Ratio of T Lymphocytes in HIV Negative Adults from University of Gondar Hospital, North West Ethiopia

Background. Reference values for the CD3⁺, CD4⁺, CD8⁺, and CD4⁺ to CD8⁺ ratio T lymphocyte subsets are adopted from textbooks. But for appropriate diagnosis, treatment, and follow-up of patients, correct interpretations of the laboratory results from normal reference interval are mandatory. This study was, therefore, planned to establish normal reference interval for T lymphocytes subset count and CD4⁺ to CD8⁺ ratio. Methods. A cross-sectional study was conducted on apparently healthy adult individuals who visited voluntary counseling and HIV testing clinic Gondar University Hospital from April to May, 2013. Whole blood was analyzed using fluorescence-activated cell sorting (BD FACS, San Jose, CA) machine to enumerate the T-cell subpopulations. Results. Out of the total 320 study participants, 161 (50.3%) were men and 159 (49.7%) were women. The normal reference intervals were (655–2,823 cells/μL), (321–1,389 cells/μL), and (220–1,664 cells/μL) for CD3⁺, CD4⁺, and CD8⁺ T lymphocyte subsets, respectively, and CD4⁺ to CD8⁺ ratio was 0.5–2.5. Conclusion. The overall CD3⁺ T lymphocytes reference interval in the current study was wide; low CD4⁺ T lymphocytes, CD4 to CD8 ratio, and high CD8⁺ T lymphocytes values were observed.

Hematological and biochemical data obtained in rural northern Uganda

Reference intervals for common hematological and clinical chemistry parameters constitute an important basis for health care. Moreover, with increasing priority in drug and vaccine development for infectious diseases in Africa, the first priority is the safety evaluation and tolerability of the candidate interventions in healthy populations. To accurately assess health status and address adverse events, clinical reference intervals in the target population are necessary. We report on hematological and biochemical indices from healthy volunteers who participated in a clinical trial in Lira, northern Uganda. Median and nonparametric 95% percentiles on five hematology and 15 biochemistry analytes are shown. Although most hematological analytes conformed to reported reference intervals and trends in Africa, literature review from different African countries highlight the need for a region-specific children reference interval that can be appropriate for the population.

Investigation on reference intervals and regional differences of platelet indices in healthy Chinese Han adults

BACKGROUND

Reference intervals are important for interpretation of clinical laboratory tests. The platelet (PLT) indices such as the mean platelet volume (MPV) and platelet distribution width (PDW) are newer hematological parameters, which have been recently reported as clinically valuable biomarkers. However, there are not many studies that have estimated the reference intervals for these parameters in healthy Chinese Han adults.

OBJECTIVE

The objectives of this study were to establish reference values of PLT indices [including PLT count, MPV, PDW, platelet-large cell ratio (P-LCR), and plateletcrit (Pct)] for healthy Chinese Han adults. We also aimed to determine the region-based differences of PLT indices in China.

METHODS

A total of 4,642 volunteers with a mean age of 43 were recruited from six regions of China. PLT indices were performed on Sysmex XE-2100 hematology analyzers, whose traceability was well verified.

RESULTS

There were significant region-based differences for all PLT indices. Reference people in Chengdu had the lowest mean PLT count and Pct, but the highest MPV, PDW, and P-LCR among the six regions. Therefore, we derived the reference intervals in Chinese Han population excluding Chengdu reference people for PLT indices as PLT count: (127-341) × 10(9)/l; MPV: (9.20-13.30) fl; PDW: 9.90-19.00%; P-LCR: 18.10-52.00%; Pct: 16.00-41.00%.

CONCLUSIONS

Region-specific reference intervals are essential as there were statistically significant region-related differences in the PLT parameters. The reference intervals established in this study differed from the existing reference values. Chengdu region may need proper specific reference ranges, which apply to their people, for all PLT parameters.