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Price MA, Fast PE, Mshai M, Lambrick M, Machira YW, Gieber L, Chetty P, Muturi-Kioi V. Region-specific laboratory reference intervals are important: A systematic review of the data from Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000783. [PMID: 36962599 PMCID: PMC10021479 DOI: 10.1371/journal.pgph.0000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022]
Abstract
Region-specific laboratory reference intervals (RIs) are important for clinical trials and these data are often sparse in priority areas for research, including Africa. We reviewed data on RIs from Africa to identify gaps in the literature with a systematic review of PubMed for RI studies from Africa published ≥2010. Search focus included clinical analytic chemistry, hematology, immunological parameters and RIs. Data from adults, adolescents, children, pregnant women, and the elderly were included. We excluded manuscripts reporting data from persons with conditions that might preclude clinical trial participation in studies enrolling healthy volunteers. Of 179 identified manuscripts, 80 were included in this review, covering 20 countries with the largest number of studies in Ethiopia (n = 23, 29%). Most studies considered healthy, nonpregnant adults (n = 55, 69%). Nine (11%) studies included pregnant women, 13 (16%) included adolescents and 22 (28%) included children. Recruitment, screening, enrollment procedures and definition of age strata varied across studies. The most common type of RIs reported were hematology (66, 83%); 14 studies (18%) included flow cytometry and/or T cell counts. Other common tests or panels included liver function assays (32, 40%), renal function assays (30, 38%), lipid chemistries (17, 21%) and serum electrolytes (17, 21%). The number of parameters characterized ranged from only one (three studies characterized either CD4+ counts, D-dimer, or hemoglobin), to as many as 40. Statistical methods for calculating RIs varied. 56 (70%) studies compared their results to international RI databases. Though most presented their data side-by-side with international data with little accompanying analysis, nearly all reported deviation from comparator RI data, sometimes with half or more of otherwise healthy participants having an "out of range" result. We found there is limited local RI data available in sub-Saharan Africa. Studies to fill this gap are warranted, including efforts to standardize statistical methods to derive RIs, methods to compare with other RIs, and improve representative participant selection.
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Affiliation(s)
- Matt A. Price
- IAVI, New York City, New York, United States of America
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Patricia E. Fast
- IAVI, New York City, New York, United States of America
- Division of Infectious Diseases, Stanford University School of Medicine, Palo Alto, California, United States of America
| | | | | | | | - Lisa Gieber
- IAVI, New York City, New York, United States of America
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Kosiyo P, Otieno W, Gitaka J, Munde EO, Ouma C. Haematological abnormalities in children with sickle cell disease and non-severe malaria infection in western Kenya. BMC Infect Dis 2021; 21:329. [PMID: 33827455 PMCID: PMC8028187 DOI: 10.1186/s12879-021-06025-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 03/30/2021] [Indexed: 12/29/2022] Open
Abstract
Background In Plasmodium falciparum infection, clinical conditions such as anaemia, thrombocytopenia and leukocytosis are common. Mutation in haemoglobin sub-unit beta gene (HBB) may be a genetic factor responsible for these haematological changes during infection. However, the contributions of the carriage of different HBB genotypes on these changes remain largely unknown. Methodology In this cross-sectional study, we evaluated haematological abnormalities in P. falciparum-infected children (n = 217, aged 1–192 months) with different haemoglobin sub-unit beta (HBB) genotypes (HbAA, HbAS and HbSS). Children with acute febrile conditions were recruited at Jaramogi Oginga Odinga Teaching and Referral Hospital at the outpatient clinic. Haematological parameters were determined using Beckman Coulter counter ACTdiff2™ while HBB genotyping was done using TaqMan® SNP genotyping assay. Chi-square (χ2) was used to determine differences between proportions. Differences in haematological parameters were compared across groups using Kruskal Wallis test and between groups using Mann Whitney U test. Partial correlation test was used to determine correlation between haematological parameters and sickle cell genotypes while controlling for age and sex. Results Haemoglobin (Hb), [median (IQR); 7.3 (1.3), P = 0.001], haematocrit (HCT), [median (IQR); 26.4 (4.4), P = 0.009], red blood cells (RBC), [median (IQR); 3.2 (1.7), P = 0.048] were markedly reduced in HbSS, however, red cell distribution with (RDW) [median (IQR); 14.9 (3.3), P = 0.030] was increased in malaria infected children with HbSS. Severe anaemia was highest in HbSS (23.1%) followed by HbAA (8.6%) and HbAS (7.1%). There were no differences in platelet count (P = 0.399) hence no severe thrombocytopeania across the genotypes. Leukocytosis was highest in HbSS (69.2%), 42% in HbAS and 31% in HbAA. The RBC, HCT and Hb had negative correlation with RDW in HbSS in malarial-infected children (r = − 0.725, P = 0.008), (r = − 0.718, P = 0.009) and (r = − 0.792, P = 0.002), respectively. Conclusion Our study reveals that anaemia is the most common abnormality in malaria-infected children with carriage of HbSS. The RBC, HCT and Hb concentration decrease with increase in RDW levels in infected children with carriage of HbSS compared to other HBB genotypes. Therefore, carriage of HbSS genotype is correlated with severity of haematological abnormalities. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06025-7.
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Affiliation(s)
- Paul Kosiyo
- Department of Biomedical Science and Technology, School of Public Health and Community Development, Maseno University, Private Bag, Maseno, Kenya.,Department of Medical Laboratory Sciences, School of Medicine, Maseno University, Private Bag, Maseno, Kenya
| | - Walter Otieno
- Department of Paediatrics and Child Health, School of Medicine, Maseno University, Private Bag, Maseno, Kenya
| | - Jesse Gitaka
- Directorate of Research and Innovation, Mount Kenya University, General Kago Road, P.O. Box 342-01000, Thika, Kenya
| | - Elly O Munde
- Department of Clinical Medicine, School of Health Sciences, Kirinyaga University, P.O. Box 143-10300, Kerugoya, Kenya
| | - Collins Ouma
- Department of Biomedical Science and Technology, School of Public Health and Community Development, Maseno University, Private Bag, Maseno, Kenya.
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Ouma JO, Mulama DH, Otieno L, Owuoth J, Ogutu B, Oyieko J, Korir JC, Sifuna P, Singoei V, Owira V, Gondii SMO, Andagalu B, Otieno W. Clinical laboratory hematology reference values among infants aged 1month to 17 months in Kombewa Sub-County, Kisumu: A cross sectional study of rural population in Western Kenya. PLoS One 2021; 16:e0244786. [PMID: 33730016 PMCID: PMC7968642 DOI: 10.1371/journal.pone.0244786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 12/15/2020] [Indexed: 11/29/2022] Open
Abstract
There is an urgent need for reliable region-specific hematological reference values for clinical monitoring. Laboratory reference ranges are important for assessing study participant eligibility, toxicity grading and management of adverse events in clinical trials and clinical diagnosis. Most clinical laboratories in Kenya rely on hematological reference values provided by instrument manufacturers and/or textbooks, which are based on population from Europe or North America. The use of such values in medical practice could result in improper patient management, selection bias in selection of appropriate participants for clinical trials and flawed classification of the clinical adverse events when applied to African populations. The aim of this study was to establish local laboratory hematological reference values in infants aged 1 month to 17 months from Kombewa Sub-county that could be true representative of the existing rural population. The study participants in the current study were those who had previously been recruited from GSK-sponsored study. This study was a phase III, Double Blind, Randomized, GSK-sponsored, Malaria Vaccine Clinical Trial that was conducted in infants aged 1month to 17months. 1,509 participants were included in the study analysis. Data were partitioned into 3 different age groups (1-6 months[m], 6-12 m and 12-17 m) and differences between gender were compared within each group. Data were analyzed using Graphpad prism V5 to generate 95% reference ranges (2.5th-97.5th percentile). There was evidence of gender differences in hemoglobin values (p = 0.0189) and platelet counts (p = 0.0005) in the 1 to 6m group. For the 12-17m group, there were differences in MCV (p<0.0001) and MCH (p = 0.0003). Comparing gender differences for all age groups, differences were noted in percent lymphocytes (p = 0.0396), percent monocytes (p = 0.0479), percent granulocytes (p = 0.0044), hemoglobin (p = 0.0204), hematocrit (p = 0.0448), MCV (p = 0.0092), MCH (p = 0.0089), MCHC (p = 0.0336) and absolute granulocytes (p = 0.0237). In 1 to 6m age group and all age groups assessed, for WBCs, hemoglobin, hematocrit, MCV and lymphocytes absolute counts, both 2.5th and 97.5th percentiles for Kisumu infants were higher than those from Kilifi. Platelet ranges for Kisumu children were narrower compared to Kilifi ranges. Kisumu hematology reference ranges were observed to be higher than the ranges of Tanzanian children for the WBCs, absolute lymphocyte and monocyte counts, hemoglobin, hematocrit and MCV. Higher ranges of WBCs, absolute lymphocyte and monocyte counts were observed compared to the values in US/Europe. Wider ranges were observed in hemoglobin, hematocrit, and MCV. Wider ranges were observed in platelet counts in Kisumu infants compared to the US/Europe ranges. Compared to Harriet Lane Handbook reference values that are used in the area, higher counts were observed in WBC counts, both absolute and percent lymphocyte counts, as well as monocyte counts for current study. Wider ranges were observed in RBC, platelets and RDW, while lower ranges noted in the current study for hemoglobin, hematocrit and granulocyte counts. This study underscores the importance of using locally established hematology reference ranges of different age groups in support of proper patient management and for clinical trials.
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Affiliation(s)
- Jew Ochola Ouma
- KEMRI/USAMRD-K, Walter Reed Project, Kisumu, Kenya
- Department of Biological Sciences, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - David H. Mulama
- Department of Biological Sciences, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Lucas Otieno
- KEMRI/USAMRD-K, Walter Reed Project, Kisumu, Kenya
| | - John Owuoth
- KEMRI/USAMRD-K, Walter Reed Project, Kisumu, Kenya
| | | | - Janet Oyieko
- KEMRI/USAMRD-K, Walter Reed Project, Kisumu, Kenya
| | - Jackson C. Korir
- Department of Biological Sciences, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Peter Sifuna
- KEMRI/USAMRD-K, Walter Reed Project, Kisumu, Kenya
| | | | | | | | - Ben Andagalu
- KEMRI/USAMRD-K, Walter Reed Project, Kisumu, Kenya
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Kosiyo P, Otieno W, Gitaka J, Munde EO, Ouma C. Association between haematological parameters and sickle cell genotypes in children with Plasmodium falciparum malaria resident in Kisumu County in Western Kenya. BMC Infect Dis 2020; 20:887. [PMID: 33238928 PMCID: PMC7690073 DOI: 10.1186/s12879-020-05625-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Sickle cell disease (SCD) is a monogenic disorder due to point mutation in the β-globin gene resulting in substitution of Valine for Glutamic acid. The SCD is prevalent in P. falciparum endemic regions such as western Kenya. Carriage of different sickle cell genotypes may influence haematological parameter during malaria. Children resident in malaria holoendemic regions suffer more from malaria-related complications and this is moderated by the presence of the SCD. In the current study, we determined the association between sickle cell genotypes and haematological parameters in children with P. falciparum malaria resident in Kisumu County in Western Kenya. Methodology Children (n = 217, aged 1–192 months) with acute febrile condition were recruited at Jaramogi Oginga Odinga Teaching and Referral Hospital. Chi-square (χ2) analysis was used to determine differences between proportions. Differences in haematological parameters were compared across groups using Kruskal Wallis test and between groups using Mann Whitney U test. Multivariate logistic regression analysis controlling for infection status was used to determine the association between sickle cell genotypes and haematological parameters. Results Using HbAA as the reference group, multivariate logistic regression analysis revealed that carriage of HbSS was associated with reduced haemoglobin [OR = 0.310, 95% CI = 0.101–0.956, P = 0.041], reduced haematocrit [OR = 0.318, 95% CI = 0.128–0.793, P = 0.014], reduced RBC count [OR = 0.124, 95% CI = 0.045–0.337, P = 0.001], reduced MCHC [OR = 0.325, 95% CI = 0.118–0.892, P = 0.029], increased leucocytosis [OR = 9.283, 95% CI = 3.167–27.210, P = 0.001] and reduced monocytosis [OR = 0.319, 95% CI = 0.123–0.830, P = 0.019]. However, carriage of HbAS was only associated with increased micro-platelets [OR = 3.629, 95% CI = 1.291–8.276, P = 0.012]. Conclusion Results show that carriage of HbSS in children influence the levels of haemoglobin, haematocrit, RBC, MCHC, WBC and Monocytes. Therefore prior knowledge of HbSS should be considered to improve clinical management of haematological alterations during malaria in children. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-020-05625-z.
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Affiliation(s)
- Paul Kosiyo
- Department of Biomedical Science and Technology, School of Pub;ic Health and Community Development, Maseno University, Maseno, Kenya.,Department of Medical Laboratory Sciences, School of Medicine, Kisii University, P.O. Box 408-40200, Kisii, Kenya
| | - Walter Otieno
- Department of Paediatrics and Child Health, School of Medicine, Maseno University, Private Bag, Maseno, Kenya
| | - Jesse Gitaka
- School of Clinical Medicine, Mount Kenya University, Gen Kago Rd, P.O. Box 342 01000, Thika, Kenya
| | - Elly O Munde
- Department of Clinical Medicine, School of Health Sciences, Kirinyaga University, P.O Box 143-10300, Kerugoya, Kenya
| | - Collins Ouma
- Department of Biomedical Science and Technology, School of Pub;ic Health and Community Development, Maseno University, Maseno, Kenya.
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Nolasco DM, Fortes ICP, Valadares ER. Quantitative analysis of amino acids by HPLC in dried blood and urine in the neonatal period: Establishment of reference values. Biomed Chromatogr 2020; 34:e4931. [DOI: 10.1002/bmc.4931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022]
Affiliation(s)
- Daniela M. Nolasco
- Programa de Pós‐Graduação Saúde da Criança e do adolescente Faculdade de Medicina da Universidade Federal de Minas Gerais Brazil
| | | | - Eugênia R. Valadares
- Programa de Pós‐Graduação Saúde da Criança e do adolescente Faculdade de Medicina da Universidade Federal de Minas Gerais Brazil
- Laboratório de Erros Inatos do Metabolismo do Hospital das Clínicas da da Universidade Federal de Minas Gerais Brazil
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Haileslasie H, Tsegaye A, Teklehaymanot G, Belay G, Gebremariam G, Gebremichail G, Tesfanchal B, Kaleaye K, Legesse L, Adhanom G, Mardu F, Gebrewahd A, Tesfay G, Gebertsadik A. Community based hematological reference intervals among apparently healthy adolescents aged 12-17 years in Mekelle city, Tigrai, northern Ethiopia: A cross sectional study. PLoS One 2020; 15:e0234106. [PMID: 32925920 PMCID: PMC7489559 DOI: 10.1371/journal.pone.0234106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 05/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hematological reference intervals are important in clinical and diagnostic management for the assessment of health and disease conditions. Hematological reference intervals are better to be established based on gender and age differences as these are among the main affecting factors. OBJECTIVE The aim of this study was to establish hematological reference intervals among apparently healthy adolescents aged 12-17 years in Mekelle City, Tigrai, Northern Ethiopia, 2019. METHOD A community-based cross-sectional study was conducted in 249 adolescents aged 12-17 years from December 2018 to May 2019. About 4ml of blood sample was collected from each study participant using vacutainer tube containing K2EDTA. Hematological parameters were analyzed using Sysmex KX-21N hematology analyzer (Sysmex Corporation Kobe, Japan). Data were entered and analyzed using SPSS version 23. Both parametric and non-parametric analyses were used to calculate the median and 95% of reference intervals. The 97.5th and 2.5th percentiles were calculated using descriptive statistics for the upper and lower reference limits of the study participants. Differences in reference intervals between male and female participants were evaluated using the Mann-Whitney U test. RESULT Among the 249 participants 122 (49%) were males and 127 (51%) were females with the median age of 14.5 (range 12 to 17) years were recruited in this study. The median and the 95% reference intervals of hematological parameters were determined. The 95% RIs were: Red blood cells (1012/Liter) 4.6-5.9 (Males) and 4.3-5.6 (Females), White blood cells (109/Liter) 2.9-9.6 (Males) and 3.4-10.2 (Females), Hemoglobin (g/dl) 12.6-17.1 (Males) and 12-15.4 (Females), Platelets (109/Liter) 138-364 (Males) and 151-462 (Females). Almost all of the hematological parameters showed significant differences (p<0.05) across gender. CONCLUSION The hematological reference intervals established in this study showed a difference based on gender. We suggest preparing and using distinct local reference intervals for males and females separately.
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Affiliation(s)
- Hagos Haileslasie
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigrai, Ethiopia
- * E-mail:
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Gebreyohanes Teklehaymanot
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Mekelle University, Mekelle, Tigrai, Ethiopia
| | - Getachew Belay
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigrai, Ethiopia
| | - Gebreslassie Gebremariam
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Mekelle University, Mekelle, Tigrai, Ethiopia
| | - Gebremedhin Gebremichail
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigrai, Ethiopia
| | - Brhane Tesfanchal
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigrai, Ethiopia
| | - Kelali Kaleaye
- Laboratory Diagnostic, Research and Quality Assurance Directorate, Tigrai Health Research Institute, Mekelle, Tigrai, Ethiopia
| | - Lemlem Legesse
- Laboratory Diagnostic, Research and Quality Assurance Directorate, Tigrai Health Research Institute, Mekelle, Tigrai, Ethiopia
| | - Gebre Adhanom
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigrai, Ethiopia
| | - Fitsum Mardu
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigrai, Ethiopia
| | - Aderajew Gebrewahd
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigrai, Ethiopia
| | - Gebrehiwet Tesfay
- Department of Medical Laboratory Sciences, College of Medicine and Health Sciences, Adigrat University, Adigrat, Tigrai, Ethiopia
| | - Ataklti Gebertsadik
- Laboratory Diagnostic, Research and Quality Assurance Directorate, Tigrai Health Research Institute, Mekelle, Tigrai, Ethiopia
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