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Murakami A, Morita A, Watanabe Y, Ishikawa T, Nakaguchi T, Ochi S, Namiki T. Effects of Sitting and Supine Positions on Tongue Color as Measured by Tongue Image Analyzing System and Its Relation to Biometric Information. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2024; 2024:1209853. [PMID: 38560511 PMCID: PMC10981547 DOI: 10.1155/2024/1209853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 10/30/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
Tongue diagnosis is one of the important diagnostic methods in Kampo (traditional Japanese) medicine, in which the color and shape of the tongue are used to determine the patient's constitution and systemic symptoms. Tongue diagnosis is performed with the patient in the sitting or supine positions; however, the differences in tongue color in these two different positions have not been analyzed. We developed tongue image analyzing system (TIAS), which can quantify tongue color by capturing tongue images in the sitting and supine positions. We analyzed the effects on tongue color in two different body positions. Tongue color was quantified as L∗a∗b∗ from tongue images of 18 patients in two different body positions by taking images with TIAS. The CIEDE 2000 color difference equation (ΔE00) was used to assess the difference in tongue color in two different body positions. Correlations were also determined between ΔE00, physical characteristics, and laboratory test values. The mean and median ΔE00 for 18 patients were 2.85 and 2.34, respectively. Of these patients, 77.8% had a ΔE00 < 4.1. A weak positive correlation was obtained between ΔE00 and systolic blood pressure and fasting plasma glucose. Approximately 80% of patients' tongue color did not change between the sitting and supine positions. This indicates that the diagnostic results of tongue color are trustworthy even if medical professionals perform tongue diagnosis in two different body positions.
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Affiliation(s)
- Aya Murakami
- Center for Pharmaceutical Education, Faculty of Pharmacy, Yokohama University of Pharmacy, 601 Matano-Cho, Totsuka-Ku, Yokohama 245-0066, Japan
| | - Akira Morita
- Sumida Kampo Clinic, East Asian Medicine Center, Chiba University Hospital, 1-19-1 Bunka, Sumida-Ku, Tokyo 131-0044, Japan
| | - Yuki Watanabe
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba 260-8670, Japan
| | - Takaya Ishikawa
- Graduate School of Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-Ku, Chiba 263-8522, Japan
| | - Toshiya Nakaguchi
- Center for Frontier Medical Engineering, Chiba University, 1-33 Yayoi-Cho, Inage-Ku, Chiba 263-8522, Japan
| | - Sadayuki Ochi
- Sumida Kampo Clinic, East Asian Medicine Center, Chiba University Hospital, 1-19-1 Bunka, Sumida-Ku, Tokyo 131-0044, Japan
| | - Takao Namiki
- Department of Japanese-Oriental (Kampo) Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba 260-8670, Japan
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Jia S, Wei L, Shi X, Sun D, Shi T, Lv H, Chen W. Reference intervals of biochemical analytes in healthy adults from northern China: A population-based cross-sectional study. Medicine (Baltimore) 2023; 102:e35575. [PMID: 37861546 PMCID: PMC10589515 DOI: 10.1097/md.0000000000035575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Reference intervals (RIs) of laboratory testing play a fundamental role in medical activities. RIs vary greatly for populations in different areas This study aimed to evaluate the age- and sex-specific reference intervals for a healthy population in a typical city of northern China. A cross-sectional study was performed in 4 tertiary care centers of Shijiazhuang of China, biochemical analytes were analyzed using a Beckman Coulter AU5800 (Beckman Coulter Inc., Brea, CA). A total of 42,979 healthy individuals were involved in this study. Grouped by age- and sex-specific, reference intervals of all the measures have been established. We found that different age groups of males and females have significant differences (all P < .001) in levels of various biochemical analytes. We provided a comprehensive age- and sex-specific RIs for biochemical analytes, which showed dynamic changes with both age and sex. For the local population, the reference intervals established here can be adopted in other clinical laboratories after appropriate validation.
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Affiliation(s)
- Siming Jia
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People’s Republic of China
- Hebei Orthopedic Clinical Research Center, Shijiazhuang, Hebei, People’s Republic of China
| | - Liu Wei
- Department of Pharmacy, Cangzhou People’s Hospital, Cangzhou, Hebei, People’s Republic of China
| | - Xiaoying Shi
- Department of Neurology, Hebei Hospital, Xuanwu Hospital of Capital Medical University, Shijiazhuang, Hebei, China
| | - Dacheng Sun
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People’s Republic of China
- Hebei Orthopedic Clinical Research Center, Shijiazhuang, Hebei, People’s Republic of China
| | - Tailong Shi
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People’s Republic of China
- Hebei Orthopedic Clinical Research Center, Shijiazhuang, Hebei, People’s Republic of China
| | - Hongzhi Lv
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People’s Republic of China
- Hebei Orthopedic Clinical Research Center, Shijiazhuang, Hebei, People’s Republic of China
| | - Wei Chen
- Trauma Emergency Center, The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, People’s Republic of China
- Orthopaedic Research Institute of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, People’s Republic of China
- NHC Key Laboratory of Intelligent Orthopaedic Equipment, Shijiazhuang, Hebei, People’s Republic of China
- Hebei Orthopedic Clinical Research Center, Shijiazhuang, Hebei, People’s Republic of China
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Borai A, Ichihara K, Bahijri S, Almasoud A, Tamimi W, Abdulhadi W, Lingga J, Bawazeer A, Abdelaal M, Boraie S, Alsofyani A, Elsayid M, Sannan NS, Al-Shareef AS, Khan E, Almohammadi M. Establishment of reference intervals for hematological parameters of adult population in the western region of Saudi Arabia. PLoS One 2023; 18:e0281494. [PMID: 36753498 PMCID: PMC9907849 DOI: 10.1371/journal.pone.0281494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/24/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Most of hematology laboratories in Saudi Arabia utilize the reference intervals (RIs) provided by instrument manufacturers. This study aimed to define RIs of hematological parameters for adult population in the western region of Saudi Arabia and to explore their specific features from an international perspective. METHOD This study was conducted according to the harmonized protocol of IFCC Committee on RIs and Decision Limits. Blood samples collected from 409 healthy Saudi males and females adults were analyzed for complete blood count (CBC) by using Cell-Dyn Sapphire analyzer and for iron profile by using Architect analyzers. The needs for RIs partitioned by sex and age was based on standard deviation ratio (SDR) and/or bias ratio (BR). RIs were derived parametrically with/without application of the latent abnormal values exclusion method (LAVE). RESULTS Based on thresholds of SDR≥0.4 and/or BR≥0.57, RIs were partitioned by sex for red-blood cell count, hemoglobin, hematocrit, red cell distribution width, erythrocyte sedimentation rate, iron, transferrin, ferritin, eosinophil, platelet, plateletcrit, etc. Partitioning by age was not necessary for any of the analytes. LAVE procedure caused appreciable changes in RI limits for most erythrocyte and iron parameters but not for leukocyte parameters. Comparable to other non-IFCC studies on CBC RIs, the RBC and hematocrit (Ht) ranges have shifted to a higher side in both genders. After applying the LAVE method, the male and female RIs for Hb were 4.56 to 6.22 ×106/μL and 3.94 to 5.25 ×106/μL respectively while RIs for Ht were 40.2 to 52.0% and 33.6 to 44.5% respectively. CONCLUSION LAVE method contributed to reducing the influence of latent anemia in deriving RIs for erythrocyte related parameters. Using the up-to-date methods, the RIs of CBC determined specifically for Saudis will help to improve the interpretation of test results in medical decision making.
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Affiliation(s)
- Anwar Borai
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
- * E-mail:
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Suhad Bahijri
- Department of Clinical Biochemistry–Faculty of Medicine- King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulaziz Almasoud
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Waleed Tamimi
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Wail Abdulhadi
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Jamil Lingga
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Ali Bawazeer
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Mohammed Abdelaal
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Sultanah Boraie
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Abeer Alsofyani
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Mohieldin Elsayid
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Naif S. Sannan
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Ali S. Al-Shareef
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Eman Khan
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
| | - Mohammed Almohammadi
- King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Ministry of National Guard Health Affairs, King Saud bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, Saudi Arabia
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Bawua SA, Ichihara K, Keatley R, Arko-Mensah J, Ayeh-Kumi PF, Erasmus R, Fobil J. Derivation of sex and age-specific reference intervals for clinical chemistry analytes in healthy Ghanaian adults. Clin Chem Lab Med 2022; 60:1426-1439. [PMID: 35786502 DOI: 10.1515/cclm-2022-0293] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 06/13/2022] [Indexed: 11/15/2022]
Abstract
OBJECTVIES This study is aimed at establishing reference intervals (RIs) of 40 chemistry and immunochemistry analytes for Ghanaian adults based on internationally harmonized protocol by IFCC Committee on Reference Intervals and Decision Limits (C-RIDL). METHODS A total of 501 healthy volunteers aged ≥18 years were recruited from the northern and southern regions of Ghana. Blood samples were analyzed with Beckman-Coulter AU480 and Centaur-XP/Siemen auto-analyzers. Sources of variations of reference values (RVs) were evaluated by multiple regression analysis (MRA). The need for partitioning RVs by sex and age was guided by the SD ratio (SDR). The RI for each analyte was derived using parametric method with application of the latent abnormal values exclusion (LAVE) method. RESULTS Using SDR≥0.4 as threshold, RVs were partitioned by sex for most enzymes, creatinine, uric acid (UA), bilirubin, immunoglobulin-M. MRA revealed age and body mass index (BMI) as major source of variations of many analytes. LAVE lowered the upper limits of RIs for alanine/aspartate aminotransferase, γ-glutamyl transaminase and lipids. Exclusion of individuals with BMI≥30 further lowered the RIs for lipids and CRP. After standardization based on value-assigned serum panel provided by C-RIDL, Ghanaian RIs were found higher for creatine kinase, amylase, and lower for albumin and urea compared to other collaborating countries. CONCLUSIONS The LAVE effect on many clinical chemistry RIs supports the need for the secondary exclusion for reliable derivation of RIs. The differences in Ghanaian RIs compared to other countries underscore the importance of country specific-RIs for improved clinical decision making.
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Key Words
- AG, anion gap
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- AMY, amylase
- AST, aspartate aminotransferase
- Alb, albumin
- BD, Becton Dickinson
- BMI, body mass index
- BR, bias ratio
- C-RIDL, Committee on Reference Intervals and Decision Limits
- C3, complement component 3
- C4, complement component 4
- CDL, clinical decision limit
- CI, confidence interval
- CK, creatine kinase
- CRP, C-reactive protein
- CV(b), CV of the regression slope b
- Ca, calcium
- Cl, chloride
- Cre, creatinine
- DBil, direct bilirubin
- F, female
- GGT, gamma-glutamyl transferase
- Glb, globulin
- Glu, glucose
- HDL-CHDL-C, high-density lipoprotein cholesterol
- HbA1c, hemoglobin A1c
- IFCC, International Federation of Clinical Chemistry and Laboratory Medicine
- IP, inorganic phosphate
- IgA, immunoglobulin A
- IgG, immunoglobulin G
- IgM, immunoglobulin M
- K, potassium
- LAVE, latent abnormal values exclusion
- LDH, lactate dehydrogenase
- LDL-C, low-density lipoprotein cholesterol
- LL, lower limit
- M, male
- MF, male + female
- MRA, multiple regression analysis
- Mg, magnesium
- NP, non-parametric
- Na, sodium
- P, parametric
- RI, reference interval
- RV, reference values
- SDR, standard deviation ratio
- SV, sources of variation
- TBil, total bilirubin
- TC, total cholesterol
- TCO2, total carbon dioxide
- TG, triglycerides
- TP, total protein
- UA, uric acid
- UL, upper limit
- between-country differences
- bias ratio
- eGFR, estimated glomerular filtration rate
- ethnicity
- latent abnormal values exclusion method
- multiple regression analysis
- nonparametric method
- parametric method
- rp, standardized partial correlation coefficient
- standard deviation ratio
- standardization
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Affiliation(s)
- Serwaa Akoto Bawua
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | | | - John Arko-Mensah
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Accra, Ghana
| | - Patrick F Ayeh-Kumi
- Department of Microbiology, University of Ghana Medical School, College of Health Sciences, University of Ghana, Korle-Bu, Ghana
| | - Rajiv Erasmus
- University of Stellenbosch, Division of Chemical Pathology, Tygerberg, Cape Town, South Africa
| | - Julius Fobil
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Accra, Ghana
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Baz H, Ichihara K, Selim M, Awad A, Aglan S, Ramadan D, Hassab A, Mansour L, Elgaddar O. Establishment of reference intervals of clinical chemistry analytes for the adult population in Egypt. PLoS One 2021; 16:e0236772. [PMID: 33740794 PMCID: PMC7979267 DOI: 10.1371/journal.pone.0236772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND This is the first Egyptian nationwide study for derivation of reference intervals (RIs) for 34 major chemistry analytes. It was conducted as a part of the global initiative by the IFCC Committee on Reference Intervals and Decision Limits (C-RIDL) for establishing country-specific RIs based on a harmonized protocol. METHODS 691 apparently healthy volunteers aged ≥18 years were recruited from multiple regions in Egypt. Serum specimens were analyzed in two centers. The harmonization and standardization of test results were achieved by measuring value-assigned serum panel provided by C-RIDL. The RIs were calculated by parametric method. Sources of variation of reference values (RVs) were evaluated by multiple regression analysis. The need for partitioning by sex, age, and region was judged primarily by standard deviation ratio (SDR). RESULTS Gender-specific RIs were required for six analytes including total bilirubin (TBil), aspartate and alanine aminotransferase (AST, ALT). Seven analytes required age-partitioning including glucose and low-density lipoprotein cholesterol (LDL-C). Regional differences were observed between northern and southern Egypt for direct bilirubin, glucose, and high-density-lipoprotein cholesterol (HDL-C) with all their RVs lower in southern Egypt. Compared with other collaborating countries, the features of Egyptian RVs were lower HDL-C and TBil and higher TG and C-reactive protein. In addition, BMI showed weak association with most of nutritional markers. These features were shared with two other Middle Eastern countries: Saudi Arabia and Turkey. CONCLUSION The standardized RIs established by this study can be used as common Egyptian RI, except for a few analytes that showed regional differences. Despite high prevalence of obesity among Egyptians, their RVs of nutritional markers are less sensitive to increased BMI, compared to other collaborating countries.
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Affiliation(s)
- Heba Baz
- Chemical Pathology Department, Cairo University, Cairo, Egypt
| | - Kiyoshi Ichihara
- Faculty of Health Sciences, Department of Clinical Laboratory Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
- * E-mail:
| | - May Selim
- Chemical Pathology Department, Cairo University, Cairo, Egypt
| | - Ahmed Awad
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Sarah Aglan
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Dalia Ramadan
- Chemical Pathology Department, Cairo University, Cairo, Egypt
| | - Amina Hassab
- Clinical Pathology Department, Alexandria University, Alexandria, Egypt
| | - Lamia Mansour
- Chemical Pathology Department, Cairo University, Cairo, Egypt
| | - Ola Elgaddar
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Bawua ASA, Ichihara K, Keatley R, Arko-Mensah J, Dei-Adomakoh Y, Ayeh-Kumi PF, Erasmus R, Fobil J. Establishing Ghanaian adult reference intervals for hematological parameters controlling for latent anemia and inflammation. Int J Lab Hematol 2020; 42:705-717. [PMID: 32881316 PMCID: PMC7754426 DOI: 10.1111/ijlh.13296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/12/2020] [Accepted: 06/30/2020] [Indexed: 12/18/2022]
Abstract
Background In Ghana, diagnostic laboratories rely on reference intervals (RIs) provided by manufacturers of laboratory analyzers which may not be appropriate. This study aimed to establish RIs for hematological parameters in adult Ghanaian population. Methods This cross‐sectional study recruited 501 apparently healthy adults from two major urban areas in Ghana based on the protocol by IFCC Committee for Reference Intervals and Decision Limits. Whole blood was tested for complete blood count (CBC) by Sysmex XN‐1000 analyzer, sera were tested for iron and ferritin by Beckman‐Coulter/AU480, for transferrin, vitamin‐B12, and folate was measured by Centaur‐XP/Siemen. Partitioning of reference values by sex and age was guided by “effect size” of between‐subgroup differences defined as standard deviation ratio (SDR) based on ANOVA. RIs were derived using parametric method with application of latent abnormal values exclusion method (LAVE), a multifaceted method of detecting subjects with abnormal results in related parameters. Results Using SDR ≥ 0.4 as a threshold, RIs were partitioned by sex for platelet, erythrocyte parameters except mean corpuscular constants, and iron markers. Application of LAVE had prominent effect on RIs for majority of erythrocyte and iron parameters. Global comparison of Ghanaian RIs revealed lower‐side shift of RIs for leukocyte and neutrophil counts, female hemoglobin and male platelet count, especially compared to non‐African countries. Conclusion The LAVE effect on many hematological RIs indicates the need for deliberate secondary exclusion for proper derivation of RIs. Obvious differences in Ghanaian RIs compared to other countries underscore the importance of country‐specific RIs for improved clinical decision‐making.
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Affiliation(s)
- Abigail S A Bawua
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Legon, Ghana
| | - Kiyoshi Ichihara
- Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | | | - John Arko-Mensah
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Legon, Ghana
| | - Yvonne Dei-Adomakoh
- Medlab Ghana Ltd. (A Member of Synlab), Accra, Ghana.,Department of Hematology, University of Ghana Medical School, College of Health Sciences, Korle-Bu, University of Ghana, Legon, Ghana
| | - Patrick F Ayeh-Kumi
- Department of Microbiology, University of Ghana Medical School, College of Health Sciences, Korle-Bu, University of Ghana, Legon, Ghana
| | - Rajiv Erasmus
- Division of Chemical Pathology, University of Stellenbosch, Cape Town, South Africa
| | - Julius Fobil
- Department of Biological, Environmental & Occupational Health Sciences, University of Ghana School of Public Health, Legon, Ghana
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Jassam N, Luvai A, Narayanan D, Turnock D, Lee G, Earp K, West J, Day A, Jeffery J, Zouwail S, El-Farhan N, Dearman R, Hayden K, Willett S, Osborne J, Barth JH. Albumin and calcium reference interval using healthy individuals and a data-mining approach. Ann Clin Biochem 2020; 57:373-381. [PMID: 32646226 DOI: 10.1177/0004563220944204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Harmonization of reference intervals for analytes that have a sound calibration and metrological traceability is a widely recommended practice. The UK Pathology Harmony has recently harmonized reference intervals for calcium and albumin. In this study, we have determined the reference intervals for calcium and albumin on the UK's most commonly used analytical platforms. METHOD A prospective reference population of healthy individuals was recruited according to the IFCC CRIDL criteria. A second indirect population was collected from 14 primary care setting and measured in laboratories using various analytical platforms and methods (Roche, Abbott, Beckman and Siemens analytical platforms). RESULTS In total, 299 subjects were recruited; the central 95th centile values for calcium for three out of four analytical platforms were in a close agreement with UK Pathology Harmony reference intervals of 2.2-2.6 mmol/L. Reference intervals of BCG methods from both cohorts and irrespective of analytical platforms were higher for both lower and upper reference limits than those for BCP. In comparison, the indirect study showed an age-related variation. The younger population reference intervals varied by up to 5.7% at the lower reference limit and up to 12% at the upper reference limit compared with Pathology Harmony reference intervals, and the older population showed a variation of up to 14% at both limits. CONCLUSION While calcium reference intervals can be a subject for harmonization, albumin reference intervals studied showed large variation which is unsupportive of embracing a common reference interval for albumin.
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Affiliation(s)
- N Jassam
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - A Luvai
- Department of Clinical Biochemistry, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - D Narayanan
- Department of Blood Sciences, Hull Royal Infirmary, Hull, UK
| | - D Turnock
- Department of Clinical Biochemistry, York Teaching Hospital NHS Foundation Trust, York, UK
| | - G Lee
- Department of Clinical Biochemistry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - K Earp
- Department of Clinical Chemistry, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - J West
- Department of Clinical Biochemistry and Immunology, Peterborough City Hospital, Peterborough, UK
| | - A Day
- Department of Clinical Biochemistry, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Jeffery
- Derriford Combined Laboratory, Derriford Hospital, Plymouth, UK
| | - S Zouwail
- Department of Biochemistry & Immunology, University Hospital of Wales, Cardiff, UK
| | - N El-Farhan
- Department of Biochemistry, Aneurin Bevan University Health Board, Newport, UK
| | - R Dearman
- Faculty of Biology, Medicine and Health, Manchester University, Manchester, UK
| | - K Hayden
- Department of Clinical Biochemistry, Manchester University Hospital, Manchester, UK
| | - S Willett
- Department of Clinical Biochemistry, North Cumbria University Hospitals, Carlisle, UK
| | - J Osborne
- Department of Clinical Biochemistry, Manchester University Hospital, Manchester, UK
| | - J H Barth
- Department of Clinical Biochemistry, Leeds Teaching Hospitals Trust, Leeds, UK
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8
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Jassam N, Hayden K, Dearman R, Allgar V, Barth JH. Prospective study comparing the outcome of a population-specific adjusted calcium equation to ionized calcium. Ann Clin Biochem 2020; 57:316-324. [DOI: 10.1177/0004563220926542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Calcium circulates bound to albumin and changes in albumin concentration will therefore affect total calcium measurements. In order to mitigate this, correction factors are frequently used. The most widely used correction equation was described by Payne and colleagues in 1973. This equation was derived from well-defined hospitalized patients’ data. Current clinical practice is consistent with the general application of the adjusted calcium equation irrespective of clinical setting. This study aims to assess the validity of this approach by the derivation of a community care-specific adjusted calcium equation (‘community equation’) and the comparison of its performance to a hospitalized patient equation and ionized calcium. Method Retrospective data were collected according to Payne’s criteria from an inpatient and community care setting. Data were used to derive the two equations: the in-patient equation and community equation. The outcome of these equations was compared with ionized calcium obtained from 123 healthy participants. Results The community equation correctly identified the calcium status of 92% of the 123 healthy participants, while the inpatient equation identified 46% only. Regression analysis against ionized calcium showed a higher R2 for the community equation than for the inpatient equation. Furthermore, we have shown that mean albumin and calcium concentrations are significantly different between these two populations. Conclusion In this study, we found that the diagnostic accuracy of the adjusted calcium equation in ambulant patients was improved by the derivation of a population-specific equation for the community care setting.
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Affiliation(s)
- N Jassam
- Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK
| | - K Hayden
- Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Dearman
- Faculty of Biology, Medicine and Health, Manchester University, Manchester, UK
| | - V Allgar
- Department of Health Sciences, Hull York Medical School, University of York, York, UK
| | - JH Barth
- Department of Clinical Biochemistry, Leeds Teaching Hospitals Trust, Leeds, UK
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Shah SAV, Ichihara K, Dherai AJ, Ashavaid TF. Reference intervals for 33 biochemical analytes in healthy Indian population: C-RIDL IFCC initiative. Clin Chem Lab Med 2019; 56:2093-2103. [PMID: 30074895 DOI: 10.1515/cclm-2018-0152] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 05/23/2018] [Indexed: 11/15/2022]
Abstract
Background In 2011, the IFCC Committee on Reference Intervals and Decision Limits (C-RIDL) initiated a worldwide multicenter study on references values facilitating the implementation of country-specific reference intervals (RIs). There has been no well-designed RI study in India. This study aims to derive RIs for 33 major biochemical analytes in carefully selected healthy Indians as defined in C-RIDL protocol. Methods A total of 512 healthy Indians were recruited. Sera collected from overnight fasting blood samples were measured collectively for the analytes. Multiple regression analysis (MRA) and nested analysis of variance (ANOVA) were used to identify the potential sources of variation (SV) of test results. RI were derived by both parametric and non-parametric methods for comparison. The need for secondary exclusion by latent abnormal values exclusion (LAVE) method was examined. Results MRA results indicated that both age and BMI were apparent SV for many analytes in both sexes. ANOVA revealed that partition of RIs by gender and age was required for 17 analytes (TC, HDL-C, TG, hsCRP, ALB, AST, ALT, ALP, GGT, TBil, Urea, CRE, UA, Fe, TTR, CK and IgM) and 5 (Glu, ALB, TC, ALP and Urea), respectively. RIs by parametric method were generally narrower than by non-parametric method, reflecting distorted peripheral distributions of test results. The LAVE method had no appreciable effect on RIs possibly due to inconsistency among abnormal values of related analytes. Conclusions This study has for the first time provided comprehensive RIs information in healthy Indians. The final RIs adopted were those derived by parametric method without LAVE procedure.
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Affiliation(s)
- Swarup A V Shah
- Department of Biochemistry, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Kiyoshi Ichihara
- Department of Clinical Laboratory Science, Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Alpa J Dherai
- Department of Biochemistry, P. D. Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - Tester F Ashavaid
- Consultant Biochemist, Head - Department of Laboratory Medicine, Director - Lab Research, Department of Biochemistry, P. D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400 016, India
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Wang D, Yu S, Cheng X, Cao L, Zhang H, Liu L, Tang Y, Cai Q, Li P, Ma C, Hou L, Sun D, Zou Y, Li H, Xia L, Yin Y, Li D, Qiu L, Ichihara K. Nationwide Chinese study for establishing reference intervals for thyroid hormones and related tests. Clin Chim Acta 2019; 496:62-67. [PMID: 31238040 DOI: 10.1016/j.cca.2019.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/08/2019] [Accepted: 06/10/2019] [Indexed: 12/12/2022]
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Xu YJ, Su MM, Li HL, Liu QX, Xu C, Yang YS, Zhu HL. A fluorescent sensor for discrimination of HSA from BSA through selectivity evolution. Anal Chim Acta 2018; 1043:123-131. [DOI: 10.1016/j.aca.2018.09.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/03/2018] [Accepted: 09/05/2018] [Indexed: 01/20/2023]
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Özçürümez MK, Haeckel R. Biological variables influencing the estimation of reference limits. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:337-345. [PMID: 29764232 DOI: 10.1080/00365513.2018.1471617] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Reference limits (RLs) are required to evaluate laboratory results for medical decisions. The establishment of RL depends on the pre-analytical and the analytical conditions. Furthermore, biological characteristics of the sub-population chosen to provide the reference samples may influence the RL. The most important biological preconditions are gender, age, chronobiological influences, posture, regional and ethnic effects. The influence of these components varies and is often neglected. Therefore, a list of biological variables is collected from the literature and their influence on the estimation of RL is discussed. Biological preconditions must be specified if RL are reported as well for directly as for indirectly estimated RL. The influence of biological variables is especially important if RL established by direct methods are compared with those derived from indirect techniques. Even if these factors are not incorporated into the estimation of RL, their understanding can assist the interpretation of laboratory results of an individual.
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Affiliation(s)
- Mustafa K Özçürümez
- a IMD-Oderland GmbH , Frankfurt (Oder) , Germany.,b Institut für Klinische Chemie Medizinische Fakultät Mannheim der Universität Heidelberg , Mannheim , Germany
| | - Rainer Haeckel
- c Bremer Zentrum für Laboratoriumsmedizin Klinikum Bremen Mitte , Bremen , Germany
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