Comprehensive hematological reference intervals in a healthy adult male population

Hamideh Ghazizadeh; Mary Kathryn Bohn; Ranan Kardagh Polus; Rahim Abdulkarimi; Vahid Mahdavizadeh; Roshanak Ghaffarian Zirak; Atieh Kamel Khodabandeh; Reza Zare-Feyzabadi; Ameneh Timar; Maryam Mohammadi-Bajgiran; Mohammad Reza Oladi; Habibollah Esmaily; Payam Sharifan; Toktam Sahranavard; Elham Kazemi; Mansoureh Sadat Ekhteraee Toosi; Niloofar Taghizadeh; Fatemeh Najar Sedgh Doust; Gordon A. Ferns; Khosrow Adeli; Majid Ghayour-Mobarhan

doi:10.14715/cmb/2020.66.2.16

Issue

Vol. 66 No. 2: Issue 2

Issue Published : May 16, 2020

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Comprehensive hematological reference intervals in a healthy adult male population

https://doi.org/10.14715/cmb/2020.66.2.16

Hamideh Ghazizadeh

Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran

Mary Kathryn Bohn

CALIPER Program, Divisions of Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, ON, Canada

Ranan Kardagh Polus

Department of Basic Science, College of Medicine, Hawler Medical University, Erbil, Kurdistan Region-Iraq

Rahim Abdulkarimi

Independent Scholar, Department of Environment, Boukan Office, Boukan, Iran. Orcid ID: https://orcid.org/0000-0003-1921-5493

Vahid Mahdavizadeh

Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Roshanak Ghaffarian Zirak

Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Atieh Kamel Khodabandeh

Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Reza Zare-Feyzabadi

Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran.

Ameneh Timar

Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Maryam Mohammadi-Bajgiran

Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Mohammad Reza Oladi

International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Habibollah Esmaily

Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Payam Sharifan

International UNESCO Center for Health-Related Basic Sciences and Human Nutrition, Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Toktam Sahranavard

Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Elham Kazemi

Fertility and Infertility Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran

Mansoureh Sadat Ekhteraee Toosi

Department of Biology, Faculty of Sciences, Mashhad Branch, Islamic Azad University, Mashhad, Iran.

Niloofar Taghizadeh

Department of Biology, Faculty of Sciences, Mashhad Branch, Islamic Azad University, Mashhad, Iran.

Fatemeh Najar Sedgh Doust

Department of Biology, Faculty of Sciences, Mashhad Branch, Islamic Azad University, Mashhad, Iran.

Gordon A. Ferns

Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK.

Khosrow Adeli

Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada

Majid Ghayour-Mobarhan

Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.

Corresponding Author(s) : Hamideh Ghazizadeh

Ghazizadehh2@gmail.com

Cellular and Molecular Biology, Vol. 66 No. 2: Issue 2
Article Published : May 15, 2020

Abstract

Reference intervals (RIs) are important tools for improving medical decision-making. Hematology reference values can be influenced by important covariates such as genetic and environmental factors, rendering it essential to define RIs for specific populations. Therefore, we aimed to establish accurate and robust RIs for hematological markers in a healthy adult male Iranian population. This cross-sectional study was conducted in a population of 723 males aged 20-60 years old. Hematological parameters were routinely measured using a Sysmex auto analyser system (KX-21 N). The quality of assays was monitored using commercial quality control samples. The nonparametric rank method, as recommended by the Clinical and Laboratory Standards Institute (CLSI) guidelines, was used to calculate the 2.5th and 97.5th percentiles as the lower and upper reference limits, respectively. Of the 12 hematological parameters assessed, only mean platelet volume (MPV) demonstrated significant age-specific differences, requiring two partitions from 20 to 35 years (8.7-12.2 fL) and 35 to 65 years (8.5-11.5 fL). The remaining hematological parameters (e.g. leukocyte, erythrocyte, and platelet parameters) could be defined by one age range. This study established RIs for 12 routinely used hematological parameters in a healthy male population living in the northeastern region of Iran. Established RIs differed from those previously reported by other cohorts, highlighting the importance of population-specific RIs.

Keywords

Reference interval Hematological parameters CLSI guidelines

Ghazizadeh, H., Kathryn Bohn, M., Kardagh Polus, R., Abdulkarimi, R., Mahdavizadeh, V., Ghaffarian Zirak, R., Kamel Khodabandeh, A., Zare-Feyzabadi, R., Timar, A., Mohammadi-Bajgiran, M., Oladi, M. R., Esmaily, H., Sharifan, P., Sahranavard, T., Kazemi, E., Ekhteraee Toosi, M. S., Taghizadeh, N., Najar Sedgh Doust, F., Ferns, G. A., Adeli, K., & Ghayour-Mobarhan, M. (2020). Comprehensive hematological reference intervals in a healthy adult male population. Cellular and Molecular Biology, 66(2), 99–104. https://doi.org/10.14715/cmb/2020.66.2.16

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References

Koerbin G, Potter J, Andriolo K, West NP, Glasgow N, Hawkins C, et al. ‘Aussie Normals': an a priori study to develop reference intervals in a healthy Australian population using the Beckman Coulter LH 750 Haematology Analyser as candidates for harmonised values. Pathol. 2017;49(5):518-25.
McFarlane A, Aslan B, Raby A, Bourner G, Padmore R. Critical values in hematology. Int J Lab Hematol. 2015;37(1):36-43.
Bakrim S, Motiaa Y, Benajiba M, Ouarour A, Masrar A. Establishment of the hematology reference intervals in a healthy population of adults in the Northwest of Morocco (Tangier-Tetouan region). Pan Afr. Med. J. Conf. Proc. 2018;29:169.
Adibi P, Faghih Imani E, Talaei M, Ghanei M. Population-based platelet reference values for an Iranian population. Int. J. Lab. Hematol. 2007 Jun;29(3):195-9.
McFarlane A, Aslan B, Raby A, Bourner G, Padmore R. Critical values in hematology. Int. J. Lab. Hematol. 2015 Feb;37(1):36-43.
Mugisha JO, Seeley J, Kuper H. Population based haematology reference ranges for old people in rural South-West Uganda. BMC Res. Notes. 2016 2016/09/07;9(1):433.
Gu Y, Hu K, Huang Y, Zhang Q, Liu L, Meng G, et al. White blood cells count as an indicator to identify whether obesity leads to increased risk of type 2 diabetes. Diabetes Res Clin Pract, 2018 2018/07/01/;141:140-7.
Okba AM, Amin MM, Abdelmoaty AS, Ebada HE, kamel AH, Allam AS, et al. Neutrophil/lymphocyte ratio and lymphocyte/monocyte ratio in ulcerative colitis as non-invasive biomarkers of disease activity and severity. Autoimmunity Highlights. 2019 2019/05/15;10(1):4.
Yüksel M, Yıldız A, Oylumlu M, Akyüz A, Aydın M, Kaya H, et al. The association between platelet/lymphocyte ratio and coronary artery disease severity. ANATOL J CARDIOL. 2016 Aug;15(8):640-7.
Kucera M, Balaz D, Kruzliak P, Ciccocioppo R, Oravec S, Rodrigo L, et al. The effects of atorvastatin treatment on the mean platelet volume and red cell distribution width in patients with dyslipoproteinemia and comparison with plasma atherogenicity indicators”A pilot study. Clin. Biochem. 2015/06/01/;48(9):557-61.
Seringec Akkececi N, Yildirim Cetin G, Gogebakan H, Acipayam C. The C-Reactive Protein/Albumin Ratio and Complete Blood Count Parameters as Indicators of Disease Activity in Patients with Takayasu Arteritis. Med Sci Mon Int Med J Exp Clin Res.
Cross T. Hematocrit Evaluation for Identifying Risk of Cyanotic Nephropathy in Patients with Congenital Cyanotic Heart Disease. 2017.
Hsueh C-Y, Lau H-C, Li S, Tao L, Zhang M, Gong H, et al. Pretreatment Level of Red Cell Distribution Width as a Prognostic Indicator for Survival in a Large Cohort Study of Male Laryngeal Squamous Carcinoma. Front. Oncol. 2019 2019-April-16;9(271).
Sertoglu E, Kayadibi H, Uyanik M. Biochemical view: "red blood cell distribution width as a useful indicator to predict systemic vasculitis in patients with cutaneous vasculitis". RHEUMATOL INT. 2015 Apr;35(4):765-6.
Jung B, Adeli K. Clinical laboratory reference intervals in pediatrics: the CALIPER initiative. Clin. Biochem. 2009 Nov;42(16-17):1589-95.
Szecsi PB, Jorgensen M, Klajnbard A, Andersen MR, Colov NP, Stender S. Haemostatic reference intervals in pregnancy. J Thromb Haemost. 2010 Apr;103(4):718-27.
Solberg HE. International Federation of Clinical Chemistry (IFCC), Scientific Committee, Clinical Section, Expert Panel on Theory of Reference Values, and International Committee for Standardization in Haematology (ICSH), Standing Committee on Reference Values. Approved Recommendation (1986) on the theory of reference values. Part 1. The concept of reference values. Journal of clinical chemistry and clinical biochemistry Zeitschrift fur klinische Chemie und klinische Biochemie. 1987 May;25(5):337-42.
Rasouli M, Pourmokhtar M, Sarkardeh S. Hematological Reference Intervals for Healthy Iranian Blood Donors. Int J Hematol Oncol Stem Cell Res. 2017 Oct 1;11(4):305-12.
Ramezani A, Shams M, Zarinfar N, Banifazl M, Aghakhani A, Eslamifar A, et al. Hematological Reference Values for Healthy Males in the Central Part of Iran. Iran J Pathol. 2014;9(1):50-5.
Samaneka WP, Mandozana G, Tinago W, Nhando N, Mgodi NM, Bwakura-Dangarembizi MF, et al. Adult Hematology and Clinical Chemistry Laboratory Reference Ranges in a Zimbabwean Population. PloS one. 2016;11(11):e0165821.
Horowitz GL, Altaie S, Boyd JC. Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline: CLSI; 2010.
Harris EK, Boyd JC. On dividing reference data into subgroups to produce separate reference ranges. Clin Chem. 1990;36(2):265-70.
Friedman LA, Morrison JA, Daniels SR, McCarthy WF, Sprecher DL. Sensitivity and specificity of pediatric lipid determinations for adult lipid status: findings from the Princeton Lipid Research Clinics Prevalence Program Follow-up Study. J. Pediatr. 2006 Jul;118(1):165-72. PubMed PMID: 16818562. Epub 2006/07/05. eng.
Karita E, Ketter N, Price MA, Kayitenkore K, Kaleebu P, Nanvubya A, et al. CLSI-Derived Hematology and Biochemistry Reference Intervals for Healthy Adults in Eastern and Southern Africa. PLOS ONE. 2009;4(2):e4401.
Zeh C, Amornkul PN, Inzaule S, Ondoa P, Oyaro B, Mwaengo DM, et al. Population-based biochemistry, immunologic and hematological reference values for adolescents and young adults in a rural population in Western Kenya. PLoS One. 2011;6(6):e21040.
M Pekelharing J, Hauss O, De R, Lokhoff J, Sodikromo J, Spaans M, et al. Haematology Reference Intervals for Established and Novel Parameters in Healthy Adults2010.
Wayne P. Defining, establishing and verifying reference intervals in the clinical laboratory; approved guideline. Clinical and laboratory Standards Institute. 2008.
Eller LA, Eller MA, Ouma B, Kataaha P, Kyabaggu D, Tumusiime R, et al. Reference Intervals in Healthy Adult Ugandan Blood Donors and Their Impact on Conducting International Vaccine Trials. PLOS ONE. 2008;3(12):e3919.
Subhashree RS, Parameaswari PJ, Shanthi B, Revathy C, Parijatham BO. The reference intervals for the haematological parameters in healthy adult population of chennai, southern India. Journal of clinical and diagnostic research : JCDR. 2012 Dec;6(10):1675-80.
Adeli K, Raizman JE, Chen Y, Higgins V, Nieuwesteeg M, Abdelhaleem M, et al. Complex biological profile of hematologic markers across pediatric, adult, and geriatric ages: establishment of robust pediatric and adult reference intervals on the basis of the Canadian Health Measures Survey. CLIN CHEM. 2015 Aug;61(8):1075-86.
Kratz A, Ferraro M, Sluss PM, Lewandrowski KB. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Laboratory reference values. N Engl J Med. 2004 Oct 7;351(15):1548-63.
Miri-Dashe T, Osawe S, Tokdung M, Daniel N, Choji RP, Mamman I, et al. Comprehensive reference ranges for hematology and clinical chemistry laboratory parameters derived from normal Nigerian adults. PLoS One. 2014;9(5):e93919.
Sundaram M, Mohanakrishnan J, Murugavel KG, Shankar EM, Solomon S, Srinivas CN, et al. Ethnic variation in certain hematological and biochemical reference intervals in a south Indian healthy adult population. EUR J INTERN MED. 2008 Jan;19(1):46-50.
Hong J, Min Z, Bai-shen P, Jie Z, Ming-ting P, Xian-zhang H, et al. Investigation on reference intervals and regional differences of platelet indices in healthy Chinese Han adults. J Clin Lab Anal. 2015 Jan;29(1):21-7.
Pekelharing J, Hauss O, De Jonge R, Lokhoff J, Sodikromo J, Spaans M, et al. Haematology reference intervals for established and novel parameters in healthy adults. Sysmex Journal International. 2010;20(1):1-9.
Maluf CB, Barreto SM, Vidigal PG. Standardization and reference intervals of platelet volume indices: Insight from the Brazilian longitudinal study of adult health (ELSA-BRASIL). Platelets. 2015;26(5):413-20.

References

Koerbin G, Potter J, Andriolo K, West NP, Glasgow N, Hawkins C, et al. ‘Aussie Normals': an a priori study to develop reference intervals in a healthy Australian population using the Beckman Coulter LH 750 Haematology Analyser as candidates for harmonised values. Pathol. 2017;49(5):518-25.

McFarlane A, Aslan B, Raby A, Bourner G, Padmore R. Critical values in hematology. Int J Lab Hematol. 2015;37(1):36-43.

Bakrim S, Motiaa Y, Benajiba M, Ouarour A, Masrar A. Establishment of the hematology reference intervals in a healthy population of adults in the Northwest of Morocco (Tangier-Tetouan region). Pan Afr. Med. J. Conf. Proc. 2018;29:169.

Adibi P, Faghih Imani E, Talaei M, Ghanei M. Population-based platelet reference values for an Iranian population. Int. J. Lab. Hematol. 2007 Jun;29(3):195-9.

McFarlane A, Aslan B, Raby A, Bourner G, Padmore R. Critical values in hematology. Int. J. Lab. Hematol. 2015 Feb;37(1):36-43.

Mugisha JO, Seeley J, Kuper H. Population based haematology reference ranges for old people in rural South-West Uganda. BMC Res. Notes. 2016 2016/09/07;9(1):433.

Gu Y, Hu K, Huang Y, Zhang Q, Liu L, Meng G, et al. White blood cells count as an indicator to identify whether obesity leads to increased risk of type 2 diabetes. Diabetes Res Clin Pract, 2018 2018/07/01/;141:140-7.

Okba AM, Amin MM, Abdelmoaty AS, Ebada HE, kamel AH, Allam AS, et al. Neutrophil/lymphocyte ratio and lymphocyte/monocyte ratio in ulcerative colitis as non-invasive biomarkers of disease activity and severity. Autoimmunity Highlights. 2019 2019/05/15;10(1):4.

Yüksel M, Yıldız A, Oylumlu M, Akyüz A, Aydın M, Kaya H, et al. The association between platelet/lymphocyte ratio and coronary artery disease severity. ANATOL J CARDIOL. 2016 Aug;15(8):640-7.

Kucera M, Balaz D, Kruzliak P, Ciccocioppo R, Oravec S, Rodrigo L, et al. The effects of atorvastatin treatment on the mean platelet volume and red cell distribution width in patients with dyslipoproteinemia and comparison with plasma atherogenicity indicators”A pilot study. Clin. Biochem. 2015/06/01/;48(9):557-61.

Seringec Akkececi N, Yildirim Cetin G, Gogebakan H, Acipayam C. The C-Reactive Protein/Albumin Ratio and Complete Blood Count Parameters as Indicators of Disease Activity in Patients with Takayasu Arteritis. Med Sci Mon Int Med J Exp Clin Res.

Cross T. Hematocrit Evaluation for Identifying Risk of Cyanotic Nephropathy in Patients with Congenital Cyanotic Heart Disease. 2017.

Hsueh C-Y, Lau H-C, Li S, Tao L, Zhang M, Gong H, et al. Pretreatment Level of Red Cell Distribution Width as a Prognostic Indicator for Survival in a Large Cohort Study of Male Laryngeal Squamous Carcinoma. Front. Oncol. 2019 2019-April-16;9(271).

Sertoglu E, Kayadibi H, Uyanik M. Biochemical view: "red blood cell distribution width as a useful indicator to predict systemic vasculitis in patients with cutaneous vasculitis". RHEUMATOL INT. 2015 Apr;35(4):765-6.

Jung B, Adeli K. Clinical laboratory reference intervals in pediatrics: the CALIPER initiative. Clin. Biochem. 2009 Nov;42(16-17):1589-95.

Szecsi PB, Jorgensen M, Klajnbard A, Andersen MR, Colov NP, Stender S. Haemostatic reference intervals in pregnancy. J Thromb Haemost. 2010 Apr;103(4):718-27.

Solberg HE. International Federation of Clinical Chemistry (IFCC), Scientific Committee, Clinical Section, Expert Panel on Theory of Reference Values, and International Committee for Standardization in Haematology (ICSH), Standing Committee on Reference Values. Approved Recommendation (1986) on the theory of reference values. Part 1. The concept of reference values. Journal of clinical chemistry and clinical biochemistry Zeitschrift fur klinische Chemie und klinische Biochemie. 1987 May;25(5):337-42.

Rasouli M, Pourmokhtar M, Sarkardeh S. Hematological Reference Intervals for Healthy Iranian Blood Donors. Int J Hematol Oncol Stem Cell Res. 2017 Oct 1;11(4):305-12.

Ramezani A, Shams M, Zarinfar N, Banifazl M, Aghakhani A, Eslamifar A, et al. Hematological Reference Values for Healthy Males in the Central Part of Iran. Iran J Pathol. 2014;9(1):50-5.

Samaneka WP, Mandozana G, Tinago W, Nhando N, Mgodi NM, Bwakura-Dangarembizi MF, et al. Adult Hematology and Clinical Chemistry Laboratory Reference Ranges in a Zimbabwean Population. PloS one. 2016;11(11):e0165821.

Horowitz GL, Altaie S, Boyd JC. Defining, establishing, and verifying reference intervals in the clinical laboratory; approved guideline: CLSI; 2010.

Harris EK, Boyd JC. On dividing reference data into subgroups to produce separate reference ranges. Clin Chem. 1990;36(2):265-70.

Friedman LA, Morrison JA, Daniels SR, McCarthy WF, Sprecher DL. Sensitivity and specificity of pediatric lipid determinations for adult lipid status: findings from the Princeton Lipid Research Clinics Prevalence Program Follow-up Study. J. Pediatr. 2006 Jul;118(1):165-72. PubMed PMID: 16818562. Epub 2006/07/05. eng.

Karita E, Ketter N, Price MA, Kayitenkore K, Kaleebu P, Nanvubya A, et al. CLSI-Derived Hematology and Biochemistry Reference Intervals for Healthy Adults in Eastern and Southern Africa. PLOS ONE. 2009;4(2):e4401.

Zeh C, Amornkul PN, Inzaule S, Ondoa P, Oyaro B, Mwaengo DM, et al. Population-based biochemistry, immunologic and hematological reference values for adolescents and young adults in a rural population in Western Kenya. PLoS One. 2011;6(6):e21040.

M Pekelharing J, Hauss O, De R, Lokhoff J, Sodikromo J, Spaans M, et al. Haematology Reference Intervals for Established and Novel Parameters in Healthy Adults2010.

Wayne P. Defining, establishing and verifying reference intervals in the clinical laboratory; approved guideline. Clinical and laboratory Standards Institute. 2008.

Eller LA, Eller MA, Ouma B, Kataaha P, Kyabaggu D, Tumusiime R, et al. Reference Intervals in Healthy Adult Ugandan Blood Donors and Their Impact on Conducting International Vaccine Trials. PLOS ONE. 2008;3(12):e3919.

Subhashree RS, Parameaswari PJ, Shanthi B, Revathy C, Parijatham BO. The reference intervals for the haematological parameters in healthy adult population of chennai, southern India. Journal of clinical and diagnostic research : JCDR. 2012 Dec;6(10):1675-80.

Adeli K, Raizman JE, Chen Y, Higgins V, Nieuwesteeg M, Abdelhaleem M, et al. Complex biological profile of hematologic markers across pediatric, adult, and geriatric ages: establishment of robust pediatric and adult reference intervals on the basis of the Canadian Health Measures Survey. CLIN CHEM. 2015 Aug;61(8):1075-86.

Kratz A, Ferraro M, Sluss PM, Lewandrowski KB. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Laboratory reference values. N Engl J Med. 2004 Oct 7;351(15):1548-63.

Miri-Dashe T, Osawe S, Tokdung M, Daniel N, Choji RP, Mamman I, et al. Comprehensive reference ranges for hematology and clinical chemistry laboratory parameters derived from normal Nigerian adults. PLoS One. 2014;9(5):e93919.

Sundaram M, Mohanakrishnan J, Murugavel KG, Shankar EM, Solomon S, Srinivas CN, et al. Ethnic variation in certain hematological and biochemical reference intervals in a south Indian healthy adult population. EUR J INTERN MED. 2008 Jan;19(1):46-50.

Hong J, Min Z, Bai-shen P, Jie Z, Ming-ting P, Xian-zhang H, et al. Investigation on reference intervals and regional differences of platelet indices in healthy Chinese Han adults. J Clin Lab Anal. 2015 Jan;29(1):21-7.

Pekelharing J, Hauss O, De Jonge R, Lokhoff J, Sodikromo J, Spaans M, et al. Haematology reference intervals for established and novel parameters in healthy adults. Sysmex Journal International. 2010;20(1):1-9.

Maluf CB, Barreto SM, Vidigal PG. Standardization and reference intervals of platelet volume indices: Insight from the Brazilian longitudinal study of adult health (ELSA-BRASIL). Platelets. 2015;26(5):413-20.

Author biographies is not available.