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Barakauskas VE, Bohn MK, Branch E, Boutin A, Albert A, Luke S, Dittrick M, Higgins V, Adeli K, Vallance H, Jung B, Dooley K, Dahlgren-Scott L, Chan WS. Mining the Gap: Deriving Pregnancy Reference Intervals for Hematology Parameters Using Clinical Datasets. Clin Chem 2023; 69:1374-1384. [PMID: 37947280 DOI: 10.1093/clinchem/hvad167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/27/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Physiological changes during pregnancy invalidate use of general population reference intervals (RIs) for pregnant people. The complete blood count (CBC) is commonly ordered during pregnancy, but few studies have established pregnancy RIs suitable for contemporary Canadian mothers. Prospective RI studies are challenging to perform during pregnancy while retrospective techniques fall short as pregnancy and health status are not readily available in the laboratory information system (LIS). This study derived pregnancy RIs retrospectively using LIS data linked to provincial perinatal registry data. METHODS A 5-year healthy pregnancy cohort was defined from the British Columbia Perinatal Data Registry and linked to laboratory data from two laboratories. CBC and differential RIs were calculated using direct and indirect approaches. Impacts of maternal and pregnancy characteristics, such as age, body mass index, and ethnicity, on laboratory values were also assessed. RESULTS The cohort contained 143 106 unique term singleton pregnancies, linked to >972 000 CBC results. RIs were calculated by trimester and gestational week. Result trends throughout gestation aligned with previous reports in the literature, although differences in exact RI limits were seen for many tests. Trimester-specific bins may not be appropriate for several CBC parameters that change rapidly within trimesters, including red blood cells (RBCs), some leukocyte parameters, and platelet counts. CONCLUSIONS Combining information from comprehensive clinical databases with LIS data provides a robust and reliable means for deriving pregnancy RIs. The present analysis also illustrates limitations of using conventional trimester bins during pregnancy, supporting use of gestational age or empirically derived bins for defining CBC normal values during pregnancy.
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Affiliation(s)
- Vilte E Barakauskas
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Mary Kathryn Bohn
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Emma Branch
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
| | - Amelie Boutin
- Department of Pediatrics, Université Laval, and Reproduction, Mother and Youth Health Unit, CHU de Quebec-Université Laval Research Center, Quebec City, QC, Canada
| | - Arianne Albert
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
| | - Sabrina Luke
- Women's Health Research Institute, BC Women's Hospital, Vancouver, BC, Canada
- Research and Surveillance Group, Perinatal Services British Columbia, Vancouver, BC, Canada
| | - Michelle Dittrick
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
| | - Victoria Higgins
- Clinical Biochemistry, DynaLIFE Medical Labs and Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Khosrow Adeli
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Hilary Vallance
- Department of Pathology and Laboratory Medicine, BC Children's and Women's Hospital, Vancouver, BC, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Benjamin Jung
- Clinical Biochemistry, Pediatric Laboratory Medicine, The Hospital for Sick Children and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Kent Dooley
- Clinical Biochemistry, LifeLabs Medical Laboratories, Victoria, BC, Canada
| | - Leanne Dahlgren-Scott
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Wee-Shian Chan
- Department of Medicine, BC Women's Hospital and Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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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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Fiseha M, Mohammed M, Ebrahim E, Demsiss W, Tarekegn M, Angelo A, Negash M, Tamir Z, Tilahun M, Tsegaye A. Common hematological parameters reference intervals for apparently healthy pregnant and non-pregnant women of South Wollo Zone, Amhara Regional State, Northeast Ethiopia. PLoS One 2022; 17:e0270685. [PMID: 35839211 PMCID: PMC9286272 DOI: 10.1371/journal.pone.0270685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/15/2022] [Indexed: 11/19/2022] Open
Abstract
Background Hematological reference intervals (RIs) are affected by inherent variables like age, sex, genetic background, environment, diet and certain circumstances such as pregnancy signifying the need for population specific values. This study was designed to establish RIs for common hematological parameters of apparently healthy pregnant and non-pregnant women from Northeast Ethiopia. Method This community based cross-sectional study recruited 600 pregnant and non-pregnant women in South Wollo Zone, Northeast Ethiopia from June to August 2019. Complete blood count was performed for eligible participants using Mindary BC-3000 plus hematology analyzer. The mean, median, and 2.5th and 97.5th percentile reference limits with 90% CI were determined using SPSS version 23. Result The established selected 2.5th–97.5th percentiles RIs for pregnant women were: WBC: 4.0–13.2x109/L; RBC: 3.45–4.67x1012/L; Hgb: 10.1–13.7g/dL; HCT: 33.5–46.5%; MCV: 85-104fL; MCH: 27.5–33.0pg; MCHC: 30.3–33.7g/dL and Platelet count: 132-373x109/L. The respective values for non-pregnant women were 3.6–10.3; 4.44–5.01; 12.4–14.3; 38.4–50.1; 86–102; 27.1–32.4, 30.4–34.1, 173–456. A statistically significant difference between pregnant and non-pregnant women was noted in all hematological parameters except MCHC. The mean and median value of WBC count, MCV, MPV and PDW increased, whereas mean values of HCT and Platelet count decreased as gestational period advances. Conclusion The observed difference from other studies signify the necessity for using trimester specific RIs and separate RI for pregnant and non-pregnant women. Thus, we recommend the health facilities in the study area to utilize the currently established RIs for pregnant and non-pregnant women for better care.
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Affiliation(s)
- Mesfin Fiseha
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
- * E-mail:
| | - Miftah Mohammed
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Endris Ebrahim
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Wondmagegn Demsiss
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Mohammed Tarekegn
- Kombolcha 03 Health Center, Kombolcha, South Wollo, Amhara Regional State, Ethiopia
| | - Amanuel Angelo
- Medical Laboratory Department, Saint Peter Specialized Hospital, Addis Ababa, Ethiopia
| | - Mikias Negash
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Zemenu Tamir
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mihret Tilahun
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Aster Tsegaye
- Department of Medical Laboratory Sciences, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Perazzio SF, Palmeira P, Moraes-Vasconcelos D, Rangel-Santos A, de Oliveira JB, Andrade LEC, Carneiro-Sampaio M. A Critical Review on the Standardization and Quality Assessment of Nonfunctional Laboratory Tests Frequently Used to Identify Inborn Errors of Immunity. Front Immunol 2021; 12:721289. [PMID: 34858394 PMCID: PMC8630704 DOI: 10.3389/fimmu.2021.721289] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
Inborn errors of immunity (IEI), which were previously termed primary immunodeficiency diseases, represent a large and growing heterogeneous group of diseases that are mostly monogenic. In addition to increased susceptibility to infections, other clinical phenotypes have recently been associated with IEI, such as autoimmune disorders, severe allergies, autoinflammatory disorders, benign lymphoproliferative diseases, and malignant manifestations. The IUIS 2019 classification comprises 430 distinct defects that, although rare individually, represent a group affecting a significant number of patients, with an overall prevalence of 1:1,200-2,000 in the general population. Early IEI diagnosis is critical for appropriate therapy and genetic counseling, however, this process is deeply dependent on accurate laboratory tests. Despite the striking importance of laboratory data for clinical immunologists, several IEI-relevant immunoassays still lack standardization, including standardized protocols, reference materials, and external quality assessment programs. Moreover, well-established reference values mostly remain to be determined, especially for early ages, when the most severe conditions manifest and diagnosis is critical for patient survival. In this article, we intend to approach the issue of standardization and quality control of the nonfunctional diagnostic tests used for IEI, focusing on those frequently utilized in clinical practice. Herein, we will focus on discussing the issues of nonfunctional immunoassays (flow cytometry, enzyme-linked immunosorbent assays, and turbidimetry/nephelometry, among others), as defined by the pure quantification of proteins or cell subsets without cell activation or cell culture-based methods.
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Affiliation(s)
- Sandro Félix Perazzio
- Division of Rheumatology, Universidade Federal de São Paulo, Sao Paulo, Brazil
- Immunology Division, Fleury Medicine and Health Laboratory, Sao Paulo, Brazil
| | - Patricia Palmeira
- Laboratório de Investigação Médica (LIM-36), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Dewton Moraes-Vasconcelos
- Laboratório de Investigação Médica (LIM-56), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | - Andréia Rangel-Santos
- Laboratório de Investigação Médica (LIM-36), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
| | | | - Luis Eduardo Coelho Andrade
- Division of Rheumatology, Universidade Federal de São Paulo, Sao Paulo, Brazil
- Immunology Division, Fleury Medicine and Health Laboratory, Sao Paulo, Brazil
| | - Magda Carneiro-Sampaio
- Laboratório de Investigação Médica (LIM-36), Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
- Department of Pediatrics, Faculdade de Medicina da Universidade de São Paulo (FMUSP), Sao Paulo, Brazil
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Gebere YF, Bimerew LG, Malko WA, Fenta DA. Hematological and CD4+ T- cell count reference interval for pregnant women attending antenatal care at Hawassa University Comprehensive Specialized Hospital, Hawassa Southern Ethiopia. PLoS One 2021; 16:e0249185. [PMID: 33831053 PMCID: PMC8031454 DOI: 10.1371/journal.pone.0249185] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 03/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Pregnancy is a state characterized by physiological, hematological, and immunological changes. However, the reference intervals (RI) being used in clinical practice in Ethiopia are derived from non-local general populations. Therefore; this study was aimed to determine the reference interval of hematological and immunological profiles among healthy pregnant mothers attending Hawassa University Hospital. METHODS A cross-sectional study in a total of 360 healthy pregnant women was enrolled from January to April 2019, at Hawassa University hospital. Sociodemographic and obstetric data were collected using a structured questionnaire. Blood samples collected from each participant were used to define the hematological parameters. The median and 95% intervals were calculated for the immunological and hematological profiles. P-value 0.05 was considered statistically significant. RESULT A total of 360 healthy pregnant women were enrolled in this study. The age range of the participants was 18-45 years. 342(95%) were married and 270 (75%) of the participants were multigravida. The overall median CD4+ T-cell and total WBC counts (cells/mm3) were 602 and 7.58 respectively. The overall median value for lymphocytes, neutrophils, monocytes, eosinophils, and basophil count was (cells/mm3) was 2.21, 6.74, .63, .53, and 0.09 respectively. Whereas the median RBC and platelet count was 4.48×106/μLand 212×106/μL. The median value of hematological profiles in the first, second, and third trimesters was TWBC (103/μL) (7.90, 8.30, 8.65), RBC (106/μL) (4.5, 4.6, 4.62), and PLT (103/μL) (210, 209,161) respectively. The CD4 T cell count median value was (600, 598, and 591) in the first, second, and third trimesters. Significant changes were observed in hematological and immunological parameters between trimesters (P < 0.05). CONCLUSION Significant changes were observed in hematological and immunological parameters between trimesters (P < 0.05). Considerable differences were also seen between the values in this study and other studies from Ethiopia and other countries, indicated the need for the development of local reference intervals for pregnant women.
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Affiliation(s)
- Yidnekachew Fiseha Gebere
- Department of Medical Laboratory, College of Medicine and Health Science, Hawassa University, Comprehensive Specialized Hospital, Hawassa, Sidama Region, Ethiopia
| | - Lealem Gedefaw Bimerew
- School of Medical Laboratory Sciences, Institute of Health Faculty of Health, Jimma University, Jimma, Oromiya Region, Ethiopia
| | - Wondimagegn Adissu Malko
- School of Medical Laboratory Sciences, Institute of Health Faculty of Health, Jimma University, Jimma, Oromiya Region, Ethiopia
| | - Demissie Assegu Fenta
- School of Medical Laboratory Science, College of Medicine and Health Science, Hawassa University, Hawassa, Sidama Region, Ethiopia
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