Hematological Indices Reference Intervals for Healthy Arab Population in Qatar: Effect of Age, Gender, Geographic Location and ABO Blood Group

Introduction: The majority of physicians' medical judgments are based on clinical information supported by laboratory reports . The availability of a reference interval for different lab values facilitates the process of interpretation . Complete blood count (CBC), testing is one of the most frequently performed hematology test in any clinical setting. Analysis of CBC by hematology analyzers is an indispensable means in the evaluation of many acute and chronic disorders including traumatic, infectious, immunological, and hematological diseases. Establishment of a normal reference interval is essential for accurate clarification of the disease diagnosis as well as for follow up. CBC techniques have improved significantly, and the accurate automated methods have now substituted manual methods. In addition, various novel blood cell parameters have been developed alongside to aid in diagnosis and management of several blood disorders . However significant differences exist in the reference intervals based on age, gender, ethnicity, genetic differences, environmental factors, and geographical location.. Dietary habits and occupational exposures are factors that have been shown to affect reference interval . Therefore, there is a requirement for each country to establish its own reference intervals. Country-specific reference intervals for CBC of adult peripheral blood have been established in many countries around the world; however, there have been no specific comprehensive studies in Arab population in Qatar based on age, gender, geographic location and ABO blood groups. To the best of our knowledge, this is the first study in Qatar that investigated CBC reference intervals in relation to age, gender, and blood grouping which can now be used as a reference when evaluating patient samples in Qatar. Methods: Venous blood specimens were collected from 720 healthy randomly selected individuals aged 18 to 69 years from 2018 to 2019 and analyzed by Sysmex NX-10 and NX -20 automated hematology analyzers. Results were statistically analyzed and compared by gender, age, and ABO blood group. Arab adults were divided into African Arabs (Egypt, Libya, Tunisia, Morocco) and Asian Arabs (Syria, Lebanon, Jordon, Palestine, Qatar). The lower and upper reference limits of the hematology reference intervals were established at the -2 SD and +2SD respectively. Results: Reference intervals were calculated for all the hematology parameters which included red blood cell, white blood cell and differential count, and platelet parameters. Arab males had significantly higher Hb, Hct, RDW, ANC, lymphocytes and monocyte counts compared to adult females. Asian-Arab males had significantly higher Hb concentration and higher WBC, lymphocytes and eosinophil counts compared to African- Arab males. Asian Arab young males had significantly higher Hb level and lymphocyte count and lower monocytes counts compared old males. African Arab young males had significantly higher lymphocyte and lower monocytes counts compared to old males. Asian- Arab young females had higher WBC, ANC counts compared to old Asian Arab females. No statistical difference in the studied hematological parameters was detected among the three groups with different ABO subgroups Conclusions: Data from this study established specific reference intervals which could be considered for general use in the Arab world. The differences in hematology reference intervals in respect to age, sex and geographical location highlights the necessity to establish reference intervals for venous blood parameters among the healthy population in each country or at least in each region. Disclosures No relevant conflicts of interest to declare.

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EXPRESS: Method dependent variation in TSH and FT4 reference intervals in pregnancy: a systematic review

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1177/00045632211026955 ◽

2021 ◽

pp. 000456322110269

Author(s):

O E Okosieme ◽

Medha Agrawal ◽

Danyal Usman ◽

Carol Evans

Keyword(s):

Systematic Review ◽

Reference Interval ◽

First Trimester ◽

Reference Intervals ◽

Assay Method ◽

Specific Reference ◽

Upper Limits ◽

Wide Range ◽

Assay Methods ◽

In Pregnancy

Background: Gestational TSH and FT4 reference intervals may differ according to assay method but the extent of variation is unclear and has not been systematically evaluated. We conducted a systematic review of published studies on TSH and FT4 reference intervals in pregnancy. Our aim was to quantify method-related differences in gestation reference intervals, across four commonly used assay methods, Abbott, Beckman, Roche, and Siemens. Methods: We searched the literature for relevant studies, published between January 2000 and December 2020, in healthy pregnant women without thyroid antibodies or disease. For each study, we extracted trimester-specific reference intervals (2.5â97.5 percentiles) for TSH and FT4 as well as the manufacturer provided reference interval for the corresponding non-pregnant population. Results: TSH reference intervals showed a wide range of study-to-study differences with upper limits ranging from 2.33 to 8.30 mU/L. FT4 lower limits ranged from 4.40â13.93 pmol/L, with consistently lower reference intervals observed with the Beckman method. Differences between non-pregnant and first trimester reference intervals were highly variable, and for most studies the TSH upper limit in the first trimester could not be predicted or extrapolated from non-pregnant values. Conclusions: Our study confirms significant intra and inter-method disparities in gestational thyroid hormone reference intervals. The relationship between pregnant and non-pregnant values is inconsistent and does not support the existing practice in some laboratories of extrapolating gestation references from non-pregnant values. Laboratories should invest in deriving method-specific gestation reference intervals for their population.

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Evaluation of Thyroid Function in Pregnant Women Using Automated Immunoassays

Clinical Chemistry ◽

10.1093/clinchem/hvab009 ◽

2021 ◽

Author(s):

K Aaron Geno ◽

Matthew S Reed ◽

Mark A Cervinski ◽

Robert D Nerenz

Keyword(s):

Pregnant Women ◽

Equilibrium Dialysis ◽

Reference Interval ◽

First Trimester ◽

Reference Intervals ◽

Free Thyroxine ◽

Specific Reference ◽

Childbearing Age ◽

Thyroid Autoantibody ◽

The Impact

Abstract Introduction Automated free thyroxine (FT4) immunoassays are widely available, but professional guidelines discourage their use in pregnant women due to theoretical under-recoveries attributed to increased thyroid hormone binding capacity and instead advocate the use of total T4 (TT4) or free thyroxine index (FTI). The impact of this recommendation on the classification of thyroid status in apparently euthyroid pregnant patients was evaluated. Methods After excluding specimens with thyroid autoantibody concentrations above reference limits, thyroid-stimulating hormone (TSH), FT4, TT4, and T-uptake were measured on the Roche Cobas® platform in remnant clinical specimens from at least 147 nonpregnant women of childbearing age and pregnant women at each trimester. Split-sample comparisons of FT4 as measured by the Cobas and equilibrium dialysis were performed. Results FT4 decreased with advancing gestational age by both immunoassay and equilibrium dialysis. TSH declined during the first trimester, remained constant in the second, and increased throughout the third, peaking just before delivery. Interpretation of TT4 concentrations using 1.5-times the nonpregnant reference interval classified 13.6% of first trimester specimens below the lower reference limit despite TSH concentrations within trimester-specific reference intervals. Five FTI results from 480 pregnant individuals (about 1.0%) fell outside the manufacturer’s reference interval. Conclusions Indirect FT4 immunoassay results interpreted in the context of trimester-specific reference intervals provide a practical and viable alternative to TT4 or FTI. Declining FT4 and increasing TSH concentrations near term suggest that declining FT4 is not an analytical artifact but represents a true physiological change in preparation for labor and delivery.

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Reference intervals for venous blood gas measurement in adults

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-1224 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Kirsty L. Ress ◽

Gus Koerbin ◽

Ling Li ◽

Douglas Chesher ◽

Phillip Bwititi ◽

...

Keyword(s):

Partial Pressure ◽

Meta Analysis ◽

Venous Blood ◽

Reference Interval ◽

Reference Intervals ◽

Published Data ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Venous Blood Gas

AbstractObjectivesVenous blood gas (VBG) analysis is becoming a popular alternative to arterial blood gas (ABG) analysis due to reduced risk of complications at phlebotomy and ease of draw. In lack of published data, this study aimed to establish reference intervals (RI) for correct interpretation of VBG results.MethodsOne hundred and 51 adult volunteers (101 females, 50 males 18–70 y), were enrolled after completion of a health questionnaire. Venous blood was drawn into safePICO syringes and analysed on ABL827 blood gas analyser (Radiometer Pacific Pty. Ltd.). A non-parametric approach was used to directly establish the VBG RI which was compared to a calculated VBG RI based on a meta-analysis of differences between ABG and VBGResultsAfter exclusions, 134 results were used to derive VBG RI: pH 7.30–7.43, partial pressure of carbon dioxide (pCO2) 38–58 mmHg, partial pressure of oxygen (pO2) 19–65 mmHg, bicarbonate (HCO3−) 22–30 mmol/L, sodium 135–143 mmol/L, potassium 3.6–4.5 mmol/L, chloride 101–110 mmol/L, ionised calcium 1.14–1.29 mmol/L, lactate 0.4–2.2 mmol/L, base excess (BE) −1.9–4.5 mmol/L, saturated oxygen (sO2) 23–93%, carboxyhaemoglobin 0.4–1.4% and methaemoglobin 0.3–0.9%. The meta-analysis revealed differences between ABG and VBG for pH, HCO3−, pCO2 and pO2 of 0.032, −1.0 mmol/L, −4.2 and 39.9 mmHg, respectively. Using this data along with established ABG RI, calculated VBG RI of pH 7.32–7.42, HCO3− 23 – 27 mmol/L, pCO2 36–49 mmHg (Female), pCO2 39–52 mmHg (Male) and pO2 43–68 mmHg were formulated and compared to the VBG RI of this study.ConclusionsAn adult reference interval has been established to assist interpretation of VBG results.

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Reference intervals for hematology test parameters from apparently healthy individuals in southwest Ethiopia

SAGE Open Medicine ◽

10.1177/2050312118807626 ◽

2018 ◽

Vol 6 ◽

pp. 205031211880762 ◽

Cited By ~ 6

Author(s):

Lealem Gedefaw Bimerew ◽

Tesfaye Demie ◽

Kaleab Eskinder ◽

Aklilu Getachew ◽

Shiferaw Bekele ◽

...

Keyword(s):

Platelet Count ◽

Blood Cell ◽

White Blood Cell ◽

Red Blood Cell ◽

Hematological Parameters ◽

Age Groups ◽

Reference Interval ◽

Reference Intervals ◽

Southwest Ethiopia ◽

Apparently Healthy

Background: Clinical laboratory reference intervals are an important tool to identify abnormal laboratory test results. The generating of hematological parameters reference intervals for local population is very crucial to improve quality of health care, which otherwise may lead to unnecessary expenditure or denying care for the needy. There are no well-established reference intervals for hematological parameters in southwest Ethiopia. Objective: To generate hematological parameters reference intervals for apparently healthy individuals in southwest Ethiopia. Methods: A community-based cross-sectional study was conducted involving 883 individuals from March to May 2017. Four milliliter of blood sample was collected and transported to Jimma University Medical Center Laboratory for hematological analysis and screening tests. A hematological parameters were measured by Sysmex XS-500i hematology analyzer (Sysmex Corporation Kobe, Japan). The data were analyzed by SPSS version 20 statistical software. The non-parametric independent Kruskal–Wallis test and Wilcoxon rank-sum test (Mann–Whitney U test) were used to compare the parameters between age groups and genders. The 97.5 percentile and 2.5 percentile were the upper and lower reference limit for the population. Results: The reference interval of red blood cell, white blood cell, and platelet count in children were 4.99 × 1012/L (4.26–5.99 × 1012/L), 7.04 × 109/L (4.00–11.67 × 109/L), and 324.00 × 109/L (188.00–463.50 × 109/L), respectively. The reference interval of red blood cell, white blood cell, and platelet count in adults was 5.19 × 1012/L (4.08–6.33 × 1012/L), 6.35 × 109/L (3.28–11.22 × 109/L), and 282.00 × 109/L (172.50–415.25 × 109/L), respectively. The reference interval of red blood cell, white blood cell, and platelet count in geriatrics were 5.02 × 1012/L (4.21–5.87 × 1012/L), 6.21 × 109/L (3.33–10.03 × 109/L), and 265.50 × 109/L (165.53–418.80 × 109/L), respectively. Most of the hematological parameters showed significant differences across all age groups. Conclusion: Most of the hematological parameters in this study showed differences from similar studies done in the country. This study provided population-specific hematological reference interval for southwest Ethiopians. Reference intervals should also be established in the other regions of the country.

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Pediatric reference intervals for 1,25-dihydroxyvitamin D using the DiaSorin LIAISON XL assay in the healthy CALIPER cohort

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2017-0767 ◽

2018 ◽

Vol 56 (6) ◽

pp. 964-972 ◽

Cited By ~ 7

Author(s):

Victoria Higgins ◽

Dorothy Truong ◽

Nicole M.A. White-Al Habeeb ◽

Angela W.S. Fung ◽

Barry Hoffman ◽

...

Keyword(s):

Children And Adolescents ◽

Critical Role ◽

Reference Interval ◽

Reference Intervals ◽

Biologically Active ◽

Specific Reference ◽

Healthy Children ◽

Serum Samples ◽

Dihydroxyvitamin D ◽

1,25 Dihydroxyvitamin D

Abstract Background: 1,25-dihydroxyvitamin D (1,25(OH)2D), the biologically active vitamin D metabolite, plays a critical role in calcium and phosphate homeostasis. 1,25(OH)2D is measured to assess calcium and phosphate metabolism, particularly during periods of profound growth and development. Despite its importance, no reliable pediatric reference interval exists, with those available developed using adult populations or out-dated methodologies. Using the fully automated chemiluminescence immunoassay by DiaSorin, we established 1,25(OH)2D pediatric reference intervals using healthy children and adolescents from the CALIPER cohort. Methods: Serum samples from healthy subjects (0 to <19 years) were analyzed for 1,25(OH)2D using the DiaSorin LIAISON XL assay and age-specific reference intervals were established. The Mann-Whitney U-test was used to determine seasonal differences. Pooled neonatal and infantile samples were quantified using liquid chromatography tandem mass spectrometry (LC-MS/MS) to determine if elevated concentrations during the first year of life may be attributed to cross-reacting moieties. Results: Three reference interval age partitions were required with highest levels in subjects 0 to <1 year (77–471 pmol/L), which declined and narrowed after 1 year (113–363 pmol/L) and plateaued at 3 years (108–246 pmol/L). 1,25(OH)2D concentration was not significantly affected by seasonal variation or sex. Elevated 1,25(OH)2D concentrations in neonatal and infantile samples may be the result of an interfering substance. The absence of 3-epi-1,25-dihydroxyvitamin D in the pooled samples makes it unlikely to be the interfering moiety. Conclusions: Pediatric reference intervals for 1,25(OH)2D were established to improve test result interpretation in children and adolescents. 1,25(OH)2D is elevated in a proportion of neonates and infants, which may be the result of a cross-reacting moiety.

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Distribution of HOMA-IR in a population-based cohort and proposal for reference intervals

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2021-0643 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Bassel Matli ◽

Andreas Schulz ◽

Thomas Koeck ◽

Tanja Falter ◽

Johannes Lotz ◽

...

Keyword(s):

Insulin Resistance ◽

Fasting Glucose ◽

Reference Group ◽

Reference Interval ◽

Population Based ◽

Reference Intervals ◽

Health Study ◽

Specific Reference ◽

Model Assessment ◽

Significant Difference

Abstract Objectives Insulin resistance (IR) is a hallmark of type 2 diabetes mellitus (DM). The homeostatic model assessment of insulin resistance (HOMA-IR) provides an estimate for IR from fasting glucose and insulin serum concentrations. The aim of this study was to obtain a reference interval for HOMA-IR for a specific insulin immunoassay. Methods The Gutenberg Health Study (GHS) is a population-based, prospective, single-center cohort study in Germany with 15,030 participants aged 35–74 years. Fasting glucose, insulin, and C-peptide were available in 10,340 participants. HOMA-IR was calculated in this group and three reference subgroups with increasingly more stringent inclusion criteria. Age- and sex-dependent distributions of HOMA-IR and reference intervals were obtained. In a substudy three insulin assays were compared and HOMA-IR estimated for each assay. Results Among the 10,340 participants analyzed there were 6,590 non-diabetic, 2,901 prediabetic, and 849 diabetic individuals. Median (interquartile range [IQR]) HOMA-IR was 1.54 (1.13/2.19), 2.00 (1.39/2.99), and 4.00 (2.52/6.51), respectively. The most stringently selected reference group consisted of 1,065 persons. Median (IQR) HOMA-IR was 1.09 (0.85/1.42) with no significant difference between men and women. The 97.5th percentile was 2.35. There was a non-significant trend towards higher values with older age. Comparison of three immunoassays for insulin showed an unsatisfactory correlation among the assays and systematic differences in calculated HOMA-IR. Conclusions We present HOMA-IR reference intervals for adults derived by more or less stringent selection criteria for the reference cohort. In addition we show that assay specific reference intervals for HOMA-IR are required.

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Optimized procedures for diagnostic testing for pheochromocytoma and paraganglioma in patients on hemodialysis

10.21203/rs.3.rs-452821/v1 ◽

2021 ◽

Author(s):

Christina Pamporaki ◽

Aleksander Prejbisz ◽

Robert Małecki ◽

Frank Pistrosch ◽

Mirko Peitzsch ◽

...

Keyword(s):

Venous Blood ◽

Diagnostic Testing ◽

Reference Intervals ◽

Mass Spectrometric ◽

Specific Reference ◽

Optimal Sampling ◽

Optimal Conditions ◽

Sampling Conditions ◽

Spectrometric Measurements ◽

Plasma Metanephrines

Abstract Background Diagnosis of pheochromocytomas and paragangliomas in patients receiving hemodialysis is troublesome. Aim To establish optimal conditions for blood sampling for mass spectrometric measurements of normetanephrine, metanephrine and 3-methoxytyramine in patients on hemodialysis and specific reference intervals for plasma metanephrines under the most optimal sampling conditions. Methods Blood was sampled before and near the end of dialysis, including different sampling sites in 170 patients on hemodialysis. Results Plasma normetanephrine concentrations were lower (P < 0.0001) and metanephrine concentrations higher (P < 0.0001) in shunt than in venous blood, with no differences for 3-methyxytyramine. Normetanephrine, metanephrine and 3-methoxytyramine concentrations in shunt and venous blood were lower (P < 0.0001) near the end than before hemodialysis. Upper cut-offs for normetanephrine were 34% lower when the blood was drawn from the shunt and near the end of hemodialysis compared to blood drawn before hemodialysis. Conclusion This study establishes optimal sampling conditions using blood from the dialysis shunt near the end of hemodialysis with optimal reference intervals for plasma metanephrines for the diagnosis of pheochromocytomas/paragangliomas among patients on hemodialysis.

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Reference intervals for 21 clinical chemistry analytes in arterial and venous umbilical cord blood

Clinical Chemistry ◽

10.1093/clinchem/39.6.1041 ◽

1993 ◽

Vol 39 (6) ◽

pp. 1041-1044 ◽

Cited By ~ 16

Author(s):

S L Perkins ◽

J F Livesey ◽

J Belcher

Keyword(s):

Alkaline Phosphatase ◽

Umbilical Cord ◽

Clinical Chemistry ◽

Venous Blood ◽

Reference Interval ◽

Reference Intervals ◽

Nonparametric Analysis ◽

Term Infants ◽

Male And Female ◽

Gamma Glutamyltransferase

Abstract Reference intervals were determined for 21 clinical chemistry analytes in umbilical cord arterial and venous blood from healthy term infants. Nonparametric analysis (rank number) was used to determine the central 95% reference interval. No significant differences were observed between male and female infants. Reference intervals for glucose, urea, creatinine, urate, phosphate, calcium, albumin, total protein, cholesterol, triglycerides, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, creatine kinase, lactate dehydrogenase, gamma-glutamyltransferase, and magnesium all were significantly different from adult values.

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Partitioning biochemical reference data intosubgroups: comparison of existing methods

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm.2004.123 ◽

2004 ◽

Vol 42 (7) ◽

Cited By ~ 14

Author(s):

Ari Lahti

Keyword(s):

Reference Data ◽

Reference Interval ◽

Reference Intervals ◽

New Method ◽

Poor Correlation ◽

Specific Reference ◽

Common Reference ◽

Reference Limits ◽

The Common ◽

The Ideal

AbstractFour existing methods for partitioning biochemical reference data into subgroups are compared. Two of these, the method of Sinton et al. and that of Ichihara and Kawai, are based on a quotient of a difference between the subgroups and the reference interval for the combined distribution. The criterion of Sinton et al. appears rather stringent and could lead to recommendations to apply a common reference interval in many cases where establishment of group-specific reference intervals would be more useful. The method of Ichihara and Kawai is similar to that of Sinton et al., but their criterion, based on a quantity derived from between-group and within-group variances, seems to lead to inconsistent results when applied to some model cases. These two methods have the common weakness of using gross differences between subgroup distributions as an indicator of differences between their reference limits, while distributions with different means can actually have equal reference limits and those with equal means can have different reference limits. The idea of Harris and Boyd to require that the proportions of the subgroup distributions outside the common reference limits be kept reasonably close to the ideal value of 2.5% as a prerequisite for using common reference limits seems to have been a major improvement. The other two methods considered, that of Harris and Boyd and the “new method” follow this idea. The partitioning criteria of Harris and Boyd have previously been shown to provide a poor correlation to those proportions, however, and the weaknesses of their method are summarized in a list of five drawbacks. Different versions of the new method offer improvements to these drawbacks.

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Screening of Undiagnosed Hypothyroidism in Elderly Persons with Diabetes according to Age-Specific Reference Intervals for Serum Thyroid Stimulating Hormone and the Impact of Antidiabetes Drugs

Journal of Diabetes Research ◽

10.1155/2016/1417408 ◽

2016 ◽

Vol 2016 ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

Rosita Fontes ◽

Patricia de Fatima dos Santos Teixeira ◽

Mario Vaisman

Keyword(s):

Fasting Glucose ◽

Reference Interval ◽

The Elderly ◽

Reference Intervals ◽

Thyroid Stimulating Hormone ◽

Specific Reference ◽

Elderly Persons ◽

Patients With Diabetes ◽

The Impact ◽

Tsh Levels

Background. Studies have suggested that hypothyroidism is more frequent in the elderly with diabetes mellitus. However, an adaptation of TSH levels to age should be considered in this assessment. Some antidiabetes drugs reportedly interfere with TSH levels. The objectives of this study were to evaluate the prevalence of undiagnosed hypothyroidism in patients with diabetes and the influence of antidiabetes drugs.Material and Methods. 1160 subjects, 60 years and older (751 with diabetes), were studied; results were compared according to diabetes treatment and with persons without diabetes. TSH, FT4, antithyroperoxidase, fasting glucose, and HbA1c were measured.Results and Discussion. 6.4% of patients with diabetes had hypothyroidism, a higher prevalence compared with persons without diabetes (5.1%), but lower than observed in many studies. The use of age-specific TSH reference interval (RI) could explain this difference. Patients taking metformin (MTF) had TSH (showed in medians) slightly lower (2.8 mU/L) than those not on MTF (3.3 mU/L),p<0.05. MTF doses influenced TSH levels.Conclusions. The use of specific TSH RI could avoid the misdiagnosis of hypothyroidism in elderly with diabetes. Patients in use of MTF as single drug had lower TSH than those using other medications and persons without diabetes.

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