Reference Value Profile for Healthy Individuals From the Aljouf region of Saudi Arabia

Establishment of reference intervals for hematological parameters of adult population in the western region of Saudi Arabia

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.

Single-center experience of LVAD implantation in patients with sickle-cell trait: A retrospective analysis

BACKGROUND

The most worrisome complications in patients supported by left ventricular assist device (LVAD) are pump thrombosis, embolism, and bleeding. The actual rate of these events in patients with sickle-cell disease (SCD) has not well investigated. The aim of our study is to evaluate the outcomes of LVAD implantation in patients with sickle-cell hemoglobinopathy at our institution.

METHODS

This retrospective, observational, single-center study was conducted on patients with sickle-cell trait (SCT), who underwent LVAD implantation using the HeartMate3 LVAD.

RESULTS

LVAD devices were implanted in four patients with SCT. All procedures were performed successfully. All patients had uneventful post-implant course. Overall, the mean follow-up time was 25 months (range 21-28 months) and showed an unremarkable post-implant course. There was a significant improvement in hematological markers over the follow-up period.

CONCLUSIONS

Despite the limited numbers of patients enrolled in this study, our findings indicate that LVAD surgery is safe in SCD patients and offers remarkable clinical improvement. Further studies are needed to provide more evidence regarding this type of patients undergoing LVAD implantation.

Hematological indices in the adult saudi population: Reference intervals by gender, age, and region

Introduction

Hematological parameters are critical in disease diagnosis, management, and monitoring; however, complete blood count (CBC) reference intervals vary across populations. The aim of the current study was to provide the reference ranges of hematological parameters/indices in the healthy adult Saudi population.

Methods

A multicenter retrospective cross-sectional study was conducted with a sample of employees who were screened pre-employment from January 2015 to December 2019, at tertiary care hospitals in three regions. Demographic and CBC data were extracted from the electronic health system. The 2.5^th and 97.5^th percentiles were used to determine the reference intervals.

Results

Of a total of 1,388 participants, 53.82% were male. The majority 96% was less than 40 years old, and 85% were from the Central region. Gender-related differences were observed for the RBC count, Hb, HCT, MCV, MCH, MCHC, and the platelet count. Age-related differences were observed for the RBC, Hb, HCT, and eosinophils. The WBC parameters did not differ by gender or age categories. Region-related differences were observed for the RBC, hemoglobin, HCT, MCV, WBC, and basophils. The platelet count was higher in the female group, the age group 40 years and above, and in the Western region. The prevalence of anemia was high in the female group and the Eastern region. The overall neutropenia rate was 12.8%.

Conclusion

The data from this study provide hematological parameter reference ranges for the adult Saudi population by gender, age, and region. Gender and age-related differences were observed for the hematological parameters. Anemia was more frequent in the female group and the Eastern region. Caution must be taken when comparing or interpreting results from different age groups, gender, region of origin, and ethnicity.

Hematologic reference intervals for healthy adult Saudis in Riyadh

BACKGROUND

Laboratory hematological tests are widely used in clinical practice to assess health and disease conditions. Reference ranges provided by laboratory reports are considered the most authoritative medical tools to assist in the decision-making phase. International standards institutes recommend that reference ranges be established for each region.

OBJECTIVES

Provide reference values of routine hematological parameters in Saudi adults according to age and gender.

DESIGN

Cross-sectional SETTING: Central province of Saudi Arabia.

PATIENTS AND METHODS

Apparently healthy Saudi adults were subjected to laboratory testing of routine hematological parameters (full blood count, hemostatic profile, and serum hematinics), after completing a detailed health medical questionnaire.

MAIN OUTCOME MEASURES

Hematological reference values based on the local population.

SAMPLE SIZE AND CHARACTERISTICS

637 after screening 827 potentially healthy Saudi adults with ages ranging from 15 to 65 years.

RESULTS

The reference values of routine hematological parameters for the full population and by gender are presented with 90% CI as the lower and upper limits. Reference ranges mostly differed from universal established ranges shown in textbooks.

CONCLUSION

The reference ranges of routine hematologic parameters for accurate assessment and appropriate management will help improve the routine clinical care of the adult Saudi population.

LIMITATIONS

Difficulty in assessing health status of participants, who could have subclinical illnesses not reflected in the evaluated blood measurement. Lack of ability to eliminate individuals who might be carriers for haemoglobinopathies. Studies with larger sample sizes from different areas of the country are required to achieve a more accurate representation of the whole Saudi population.

CONFLICT OF INTEREST

None.

Molecular Analysis of Xmn1-Polymorphic Site ´5 to Gγ of the β-Globin Gene Cluster in a Saudi Population of Jazan Region in Correlation with Hb F Expression

The southern part of Saudi Arabia has an ethnically diverse population where sickle-cell anemia (sickle cell disease) is common, but little is known about its βs haplotypes. The goal of the current study is to ascertain the prevalence of the Hb S gene with analysis of Xmn1 ′5 to Gγ haplotype among the Saudi population in the Jazan area. Initially recorded findings of (1) Hb S gene and (2) hematological parameters with Hb F levels were collected from 5990 participants. Then, the second series of 70 different patients with established sickling disease and 30 healthy individuals as a control group was recruited, in which the genotype of Xmn1 ′5 to Gγ-SNP was performed by PCR-RFLP. In the first series, the prevalence of Hb types was AA at 86.8% (N = 5198), AS at 12.4% (N = 745), and SS at 0.8% (N = 47). Of the second series, three patients (4.3%) were (±) Xmn1 ′5 to Gγ and 67 (95.7%) were (−/−) in Xmn1 ′5 to Gγ. In the controls, the (±) Xmn1 ′5 to Gγ was observed in only one individual (3.3%), aged 30. These findings possibly represent a new Saudi haplotype, [±] Xmn1 ′5 to Gγ. Our results demonstrate that most patients with SCD in Jazan have [−/−] Xmn1 with higher levels of Hb F and positive Xmn1 ′5 to Gγ normally associated with a low level of Hb F.

The population characteristics of the main leukocyte subsets and their association with chronic diseases in a community-dwelling population: a cross-sectional study

Aim:

To analyse the characteristics of the main leukocyte subsets and elucidate their distributions amongst the natural population. We wanted to determine whether leukocyte subsets are potential biomarkers to evaluate the risk of common chronic diseases.

Background:

The peripheral blood leukocyte count is a routine exam performed to detect pathogen infections. Recently, subsets of white blood cells and their homeostasis have shown strong associations with some chronic diseases. Therefore, studies aiming to discover whether the distribution of leukocyte counts and its subsets are useful for predicting health conditions are worthwhile.

Methods:

This cross-sectional study analysed 10 564 residents from the basic public health service project of the Health Checkup Program performed by the BaiYun Community Health Service Center. Data on demographic information, physical measurements, medical history, and routine blood examination parameters were collected using questionnaires and health check-ups. Restricted cubic spline incorporated into logistic regression analysis was performed to evaluate the association between subsets of leukocytes and common chronic diseases.

Findings:

The counts of leukocytes and their subsets in males were higher than those in females amongst all age groups, yet the percentages of lymphocytes and neutrophils did not present sex-specific differences. A low lymphocyte count and percentage were associated with old age. The neutrophil-to-lymphocyte ratio (NLR) in patients with hypertension was higher than that in the non-hypertensive population. The risk of NLR in the top quartiles was 1.17-fold higher than that in people in the lowest quartiles.

Conclusions:

The distributions of the white blood cell count and percentage were associated with age, sex, and body mass index (BMI). In addition to the immune barrier for pathogens, the NLR or monocyte-to-lymphocyte ratio (MLR) may be potentially used to indicate the risk of some chronic non-communicable diseases. Homeostasis of subsets of leukocytes may be an important biomarker for body health conditions.