Reference Ranges for Umbilical Cord Blood Hematological Values

Umbilical cord blood hematological parameters in predicting early onset neonatal sepsis (EOS) - a prospective cohort study

OBJECTIVES

In low and middle income countries, there is a need for affordable and accurate biomarkers to identify neonates at risk of early onset neonatal sepsis (EOS). Cord blood hematological parameters if reliable and accurate for the detection of EOS are cost effective and can reduce the need for repeated venipuncture in the neonate.

METHODS

In this prospective cohort study, the umbilical cord parameters of newborns with gestational age >34 weeks were collected. These neonates were followed up for 72 h and septic screen was employed in those babies who had risk factors or developed clinical features of sepsis. The cord blood parameters of the normal newborn and those who had sepsis were analyzed.

RESULTS

A total of 513 neonates were enrolled for the study, 32 required septic screening of whom 13 neonates were found to meet the criteria for sepsis: either blood culture positive or sepsis screen positive with clinical features. Cord blood parameters were analyzed using independent t test. Red cell distribution width (RDW) and band cells were statistically significant (p 0.007 and 0.009 respectively) between the septic and normal neonates. Increased RDW had a sensitivity of 61.54 %, specificity of 54.60 %. Increased band cells with a cut off of >15 cells had a sensitivity of 7.7 % with specificity of 100 % with higher numbers in septic neonates. Increased RDW and band cells in combination had sensitivity of 61.54 % and specificity of 54.6 %.

CONCLUSIONS

RDW and band cell can be potential markers of EOS in cord blood but require further study in a larger population.

Reference intervals for thyroid hormone, sex hormone, and clinical biochemical tests in cord blood from Taiwanese newborn - TMICS cohort

BACKGROUND/PURPOSE

This study aims to establish reference intervals for important biochemical parameters in cord blood of newborn male and female infants in Taiwan and to investigate their sex difference. We also examined the correlation of the same markers between maternal blood levels and neonatal cord blood levels.

METHODS

2,136 pregnant women receiving regular routine prenatal health assessments in their third trimester (weeks 29-40) were recruited from nine hospitals in Taiwan between 2012 and 2015. After exclusion, we were left with 580 cord blood samples to include in this study.

RESULTS

Cord blood thyroid-stimulating hormone was higher in males than females (p < 0.05). Males also had significantly higher sex hormone levels (estradiol, follicle-stimulating hormone, and sex hormone-binding globulin), while females had higher levels of luteinizing hormone. Male newborns had higher cord blood immunoglobulin E (IgE), while females had higher insulin-like growth factor-1 (IGF-1) levels. We found a slight positive link between maternal blood and cord blood in thyroid hormones and sex hormones.

CONCLUSION

This study found sex differences in cord blood thyroid hormone, sex hormone, IGF-1, and IgE levels and a link between maternal blood levels of thyroid and sex hormones and those in the cord blood of their infants.

The Novel Use of Umbilical Cord Blood to Obtain Complete Blood Counts for Critical Neonatal Assessment

Background: Neonates undergoing clinical evaluations are often subjected to potentially painful phlebotomy for laboratory tests. The use of cord blood laboratory values for admission has been suggested as a means to decrease the risk of painful venipuncture and anemia.

Methods: Peripheral and umbilical cord blood complete blood count (CBC) results were obtained from infants who required a CBC. Results were compared using the Sysmex XN heme analyzer (Sysmex, Kobe, Japan).

Results: White blood cell (WBC) and hemoglobin (HgB) values were significantly higher in peripheral samples than in cord samples. The mean cord WBC count was 14.1 × 10³/mm³ versus 15.6 × 10³/mm³ peripherally (p < 0.001). The mean cord HgB was 15.8 g/dL versus 16.8 g/dL peripherally (p < 0.001). Cord platelet (Plt) counts were, conversely, lower in peripheral samples than in cord samples (264.8 × 10³/mm³ versus 242.3 × 10³/mm³, respectively; p < 0.001). Although statistically different, the mean CBC values from both samples were within the reference ranges. Delayed cord clamping (DCC) increased peripheral versus cord HgB difference nearly threefold (0.6-1.7 g/dL; p = 0.01).

Conclusions: Cord blood is an acceptable source for CBC blood sampling in newborn infants and can be used for clinical decisions. CBC laboratory values for cord blood remained within the peripheral blood reference range, with slight variability between the two samples.

Immunohematology testing using umbilical cord blood: review of the literature, survey of practice and guidance development

BACKGROUND

Following delivery, blood tests are performed on umbilical cord blood (CB) to avoid neonatal venipuncture. Despite widespread and longstanding CB testing, no guidelines exist to suggest which immunohematology tests should be performed on CB.

STUDY DESIGN AND METHODS

We performed a scoping review, surveyed national practice, and developed guidance statements concerning CB testing. Database searches identified relevant articles. A survey was sent to all Canadian hospitals and transfusion laboratories that perform perinatal testing. A national panel of experts was convened to develop guidance statements.

RESULTS

A total of 116 articles met the inclusion criteria and were summarized. Literature on CB testing is limited; few studies have investigated laboratory testing methodologies or validated CB test results with peripheral samples. The survey was completed by 580/597 institutions (97%); 85% were community hospitals and 16% had a neonatal intensive care unit. There is diversity in the types of CB tests performed and variability in practice. While most centers order appropriately, some laboratories routinely perform CB tests that are not clinically indicated (e.g., direct antiglobulin testing for all neonates) and other do not perform CB tests when results would be beneficial (e.g., phenotype on CB when mother has a clinically significant antibody). Fifteen guidance statements were developed.

DISCUSSION

This study highlights variability in CB testing, likely reflecting evidence gaps, methodology differences between studies, and lack of guidelines. CB tests should only be performed when indicated and validated on this sample type. The presented guidance statements aim to standardize practice and encourage judicious CB sampling.

Umbilical cord blood hematological parameters reference interval for newborns from Addis Ababa, Ethiopia

BACKGROUND

Several factors like altitude, age, sex, pregnancy, socioeconomic status, life style and race influence hematological reference interval (RIs), which are critical to support clinical decisions and to interpret laboratory data in research. Currently there are no well-established RIs for cord blood hematological parameters of newborns in Ethiopia. This study aims to generate RIs for umbilical cord blood hematological parameters of newborns from Addis Ababa, Ethiopia.

METHOD

A cross-sectional study was conducted from January 1 to March 31, 2019 on healthy, term newborns (37-42 weeks) with normal birth weight born to apparently healthy pregnant mothers who had met the eligibility criteria. From 139 newborns, 2-3ml cord blood was immediately collected from the clumped cord using EDTA tube. The samples were analyzed using Sysmex KX 21 hematology analyzer. Data was entered and the 2.5th and 97.5th percentiles (upper and lower reference limit) were determined using non parametric method by SPSS version 23. The non-parametric independent Mann-Whitney U test (Wilcoxon rank-sum test) was used to compare the distribution of the parameters between genders, modes of deliveries and gestational age. P value less than 0.05 was considered to declare statistical significance.

RESULT

The median values and 95 % reference interval for umbilical cord blood hematological parameters of newborns were as follows: WBC = 12.4 [6.6-19.4] x109/L, RBC = 4.51 [3.55-5.52] x1012/L, HGB = 15.8 [12.4-19.7] g/dL, HCT = 45.9[37.9-56.3]%, MCV = 102.1[83.9-111.6] fL, MCH = 35.3 [29.4-39.1] pg, MCHC = 34.3 [32.3-37.4] %, PLT = 236 [146-438] x109/L, LYM = 37.5 [16.6-63.0] %, MXD = 7.9[1.7-15.8] %, NEU = 53.7[30.3-78.4] %, RDW = 15.6[12.0-19.0]%, PDW = 11.0[9.1-15.7]% and MPV = 9.4[8.1-11.8] fL. The current study found no significant difference between genders, except RDW (P = 0.01), and gestational age group, but there was significant difference for WBC (p = 0.007), RBC (p = 0.018) and Absolute NEU (p = 0.001) by delivery type where newborns delivered through caesarean section had lower values for these three parameters compared to those with spontaneous delivery.

CONCLUSIONS

hematological reference intervals in cord blood were established for the first time from healthy newborns of Addis Ababa and its surrounding. The values are applicable for newborns from this area. Larger study throughout the country is warranted.

Hematological reference intervals among full-term newborns in Ethiopia: a cross-sectional study

BACKGROUND

Hematological reference intervals are used for medical decision tools for interpretation of numerical test results. Establishing of hematological interval among newborn babies is very important for the diagnosis of malignancy, anemia, bleeding disorders, and various infections. There are no locally established hematological reference intervals in Ethiopia. Thus, the aim of this study is to establish locally determined hematological reference interval among full-term newborns.

METHODS

A cross-sectional study was conducted from May 15 to July 30 2019 among 151 apparently healthy full-term newborns at Gondar University Hospital. About 3 ml of cord blood was obtained for analysis of Hematological parameters and determined by using Sysmex KX-21N (Sysmex Corporation Kobe, Japan) automated analyzer. Median, 2.5th and 97.5th percentile were computed.

RESULT

Male to female ratio was almost equal. All hematological parameter had no statistically significant difference between males and females. The delivery types were not influenced its hematological values. The reference interval of white blood cells, red blood cells, platelets, hemoglobin, hematocrit, mean cell volume, and mean cell hemoglobin were (7.64-22.16) x109/l, (3.69-5.47)x1012/l, (132.74-413.4) x109/l, (13.32-19.64) g/dl and (39.42-58.06)%, (91.6-113.22)fl, and (30.48-38.02 pg), respectively.

CONCLUSIONS

All hematological reference intervals were established from full-term newborns at University of Gondar hospital was different from other studies in Nigeria, Iraq, Pakistan, Nepal, Saudi Arabia and Iran. Therefore, own determined reference value is very important for the clinicians to correctly diagnosis the patients at health facility levels.

Umbilical Cord Blood Screening for the Detection of Common Deletional Mutations of α-Thalassemia in Bangladesh

α-Thalassemia (α-thal) is assumed to be very prevalent in Bangladesh. We aimed to assess the prevalence of the disease in the country and provide a model for α-thal newborn screening in Bangladesh. We collected umbilical cord blood (UCB) samples from 413 unrelated newborns in Bangladesh. Demographic information, blood indices, osmotic fragility, serum iron (Fe), and zinc (Zn) levels were evaluated for all the subjects. All subjects underwent a polymerase chain reaction (PCR)-based diagnosis for α-thal status, followed by a multiplex gap-PCR-based identification of the deletion type present. Sixty-seven subjects had at least one α-thal deletion (16.22%). We observed that -α^3.7 (rightward), - -^SEA (Southeast Asian), -α^4.2 (leftward), - -^MED (Mediterranean) and - -^THAI (Thailand) deletions were the most common α-globin deletions present in the country, with the -α^3.7 (n = 37) and - -^SEA (n = 18) being most prevalent. The osmotic fragility test (OFT) could predict the presence of α-thal deletions with over 98.0% sensitivity. Complete UCB count analysis revealed significant differences between healthy subjects and subjects with α-thal deletions. Although the iron level was almost the same (108.0 vs. 105.7 µg/dL), a reduced level of Zn (98.6 vs. 71.8 µg/dL, p < 0.01) was observed in the cord blood-derived serum of the subjects with α-thal deletions. Moreover, parental age at the time of delivery, gestational period, and birth weight was lower in the subjects with α-thal deletions. This study provides partial information on the epidemiology of α-thal in Bangladesh and describes a model for α-thal newborn screening in the country.

A comprehensive study of umbilical cord blood cell developmental changes and reference ranges by gestation, gender and mode of delivery

OBJECTIVE

The purpose of this study was to determine the normal hematological values in cord blood during gestation, the impact of the type of delivery and differences in gender.

STUDY DESIGN

The database included 10 287 live births of 30-44 weeks gestation from cesarean or vaginal deliveries. Cord blood was collected into bags containing lyophilized heparin. Specimens were stored for 24 h or less and analyzed using the SysmexXE-2100. Data from cesarean births were used to evaluate developmental hematopoietic changes.

RESULT

Increases during maturation occurred in hemoglobin, hematocrit, red blood cell count, and decreases in mean corpuscular volume and mean corpuscular hemoglobin. The number of nucleated red blood cells per 100 white blood cells decreased but absolute counts remained constant. Quantitative counts of white blood cells, neutrophils, monocytes (MON), eosinophils and lymphocytes (LYMP) increased, but percentages of lymphocytes and monocytes decreased. Platelets increased from 30-35 weeks.

CONCLUSION

Reference ranges were established for cord blood. Erythroid and myeloid cells show developmental changes. Mode of delivery has a significant effect on hematologic values. Only a rare parameter showed differences based on gender. The cord blood complete blood cell count has the potential for providing relevant clinical information for managing neonatal patients.