Establishing Hematological Reference Values of Venous Blood for Healthy Egyptian Adults Measured by Automated Hematology Analyzers
Mennat-Allah Raafat Ahmed Asker;
Abstract
Complete Blood Picture is an integral part of the diagnosis, treatment and prognosis. Reference intervals are the health associated reference values which help in distinguishing healthy from the diseased state.
National reference intervals are not readily available and the used values are usually based on results of measurements in advanced countries. The few small studies with African populations that have been reported indicate differences in normal values compared with those for populations in industrialized countries. These differences suggest the need for the development of locally derived reference intervals for Egyptian population.
In the light of this, the current work aimed to establish the hematological reference ranges for adult (18-60 years) Egyptian population and to compare the calculated reference ranges with the currently used reference values.To set the Egyptian reference intereval of complete blood count a total of 200 apparently healthy Egyptian adults were enrolled in this study. They were recruited from the check up clinic at Ain Shams specialized University hospitals. 100 of these were males and 100 were females with male to female ratio 1: 1.
All participants were chosen after thorough clinical history and the absence to all exclusion criteria.
CBC samples were done using LH-750 analyzer and were examined for the following parameters: total WBC count and 5-part automated differential count, RBC count, Hb, Hct, MCV, MCHC, RDW, PLT count and MPV.
Results were analyzed using the MedCalc software for assessment of reference interval according to the CLSI Guidelines.
Concerning the WBCs, the current study revealed that females had higher RI compared to that of males. Higher total WBC count in females could be due to the effect of sex hormones, it also revealed lower RI for both male and female compared to the standard values. Possibly due to that Africans have WBC and neutrophil counts that are below the range for people of European descent, a condition called “benign ethnic neutropenia”.
In the current study, results of RBCs, hemoglobin and hematocrit were highly significantly higher in males than females.
The lower Hgb RI of females (11.7 g/dl) is lower than that of Dacie refrence interval (12g/dl). Upper limit of Hct RI male (49%) are slightly lower than those mentioned in standard RI (50%). While, female Hct RI (36 - 45%) is lower than the standard RI (36-46%). The mentioned differences observed in the RBC components between African and Caucasian populations may be attributed to lower dietary iron intake, thalassemia and sickle cell trait or chronic exposure to endemic parasites including helminths, malaria and schistosomiasis.
Regarding the red cell indices, MCV, MCH values were none significantly higher in males than females. It also can be explained with the same explanation for the difference of Hgb and Hct values.
Male and female MCV RIs were found to be lower than the global reference interval. Upper limit of MCHC of both sexes is lower than the standard RI.
As for the RDW, males tended to have higher RI than females but it wasn’t statistically proven. RDW RI of both sexes was higher than the Dacie RI. Zeh et al. (2011) stated that RDW may give high results when there's early iron defiency but still not clinically detected.
In the present work, platelet counts were significantly higher in female than male possibly due to estrogen effect on megakaryocytes.Besides, male RI was lower than Dacie some studies showed that people of African descent have lower platelet counts than Caucasians due to the polymorphism in the thrombopoietin receptor gene.
Regarding, MPV values were found to be similar in both males and females with no statistical difference.
Besides, MPV values for both males and females were lower than that of U.S. based values.
Regarding neutrophil RIs, it was found that male relative and absolute RIs were higher than that of female but, it was statistically non significant. Both sexes RIs were lower than dacie RI this was explained by Reich et al. (2009) as a condition called “benign ethnic neutropenia” affecting Africans.
National reference intervals are not readily available and the used values are usually based on results of measurements in advanced countries. The few small studies with African populations that have been reported indicate differences in normal values compared with those for populations in industrialized countries. These differences suggest the need for the development of locally derived reference intervals for Egyptian population.
In the light of this, the current work aimed to establish the hematological reference ranges for adult (18-60 years) Egyptian population and to compare the calculated reference ranges with the currently used reference values.To set the Egyptian reference intereval of complete blood count a total of 200 apparently healthy Egyptian adults were enrolled in this study. They were recruited from the check up clinic at Ain Shams specialized University hospitals. 100 of these were males and 100 were females with male to female ratio 1: 1.
All participants were chosen after thorough clinical history and the absence to all exclusion criteria.
CBC samples were done using LH-750 analyzer and were examined for the following parameters: total WBC count and 5-part automated differential count, RBC count, Hb, Hct, MCV, MCHC, RDW, PLT count and MPV.
Results were analyzed using the MedCalc software for assessment of reference interval according to the CLSI Guidelines.
Concerning the WBCs, the current study revealed that females had higher RI compared to that of males. Higher total WBC count in females could be due to the effect of sex hormones, it also revealed lower RI for both male and female compared to the standard values. Possibly due to that Africans have WBC and neutrophil counts that are below the range for people of European descent, a condition called “benign ethnic neutropenia”.
In the current study, results of RBCs, hemoglobin and hematocrit were highly significantly higher in males than females.
The lower Hgb RI of females (11.7 g/dl) is lower than that of Dacie refrence interval (12g/dl). Upper limit of Hct RI male (49%) are slightly lower than those mentioned in standard RI (50%). While, female Hct RI (36 - 45%) is lower than the standard RI (36-46%). The mentioned differences observed in the RBC components between African and Caucasian populations may be attributed to lower dietary iron intake, thalassemia and sickle cell trait or chronic exposure to endemic parasites including helminths, malaria and schistosomiasis.
Regarding the red cell indices, MCV, MCH values were none significantly higher in males than females. It also can be explained with the same explanation for the difference of Hgb and Hct values.
Male and female MCV RIs were found to be lower than the global reference interval. Upper limit of MCHC of both sexes is lower than the standard RI.
As for the RDW, males tended to have higher RI than females but it wasn’t statistically proven. RDW RI of both sexes was higher than the Dacie RI. Zeh et al. (2011) stated that RDW may give high results when there's early iron defiency but still not clinically detected.
In the present work, platelet counts were significantly higher in female than male possibly due to estrogen effect on megakaryocytes.Besides, male RI was lower than Dacie some studies showed that people of African descent have lower platelet counts than Caucasians due to the polymorphism in the thrombopoietin receptor gene.
Regarding, MPV values were found to be similar in both males and females with no statistical difference.
Besides, MPV values for both males and females were lower than that of U.S. based values.
Regarding neutrophil RIs, it was found that male relative and absolute RIs were higher than that of female but, it was statistically non significant. Both sexes RIs were lower than dacie RI this was explained by Reich et al. (2009) as a condition called “benign ethnic neutropenia” affecting Africans.
Other data
| Title | Establishing Hematological Reference Values of Venous Blood for Healthy Egyptian Adults Measured by Automated Hematology Analyzers | Authors | Mennat-Allah Raafat Ahmed Asker | Issue Date | 2014 |
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