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He F, Xie T, Huang X, Zhang J, Tang T. Retrospective analysis of reference intervals for dried blood spot based ms/ms newborn screening programs in Chinese preterm neonates: a nationwide study. BMC Pediatr 2024; 24:424. [PMID: 38956494 PMCID: PMC11220950 DOI: 10.1186/s12887-024-04865-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 05/30/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES Although recent discoveries regarding the biomarkers of newborn screening (NBS) programs by tandem mass spectrometry (MS/MS) highlight the critical need to establish reference intervals (RIs) specifically for preterm infants, no such RIs has been formally published yet. This study addressed the gap by offering a comprehensive set of reference intervals (RIs) for preterm neonates, and illustrating the dynamic changes of each biomarker with age. DESIGN AND METHODS The NBS data of 199,693 preterm newborns (< 37 weeks of gestation) who met the inclusion and exclusion criteria from the NNSCP database were included in study analysis. The birth weight stratified dynamic trend of each biomarker were captured by their concentrations over age. Reference partitions were determined by the method of Harris and Boyd. RIs, corresponding to the 2.5th and 97.5th percentiles, as well as the 0.5th, 25th, 50th, 75th and 99.5th percentiles were calculated using a non-parametric rank approach. RESULTS Increasing birth weight is associated with an elevation in the levels of arginine, citrulline, glycine, leucine and isobarics, methionine, ornithine, phenylalanine, and valine, whereas the levels of alanine, proline and tyrosine decrease. Additionally, two short-chain acylcarnitines (butyrylcarnitine + isobutyrylcarnitine and isovalerylcarnitine + methylbutyrylcarnitine) and a median-chain acylcarnitine (octenoylcarnitine) decrease, while four long-chain acylcarnitines (tetradecanoylcarnitine, palmitoylcarnitine, palmitoleylcarnitine and oleoylcarnitine) increase with increasing birth weight. Age impacts the levels of all MS/MS NBS biomarkers, while sex only affects the level of malonylcarnitine + 3-hydroxybutyrylcarnitine (C3-DC + C4-OH) in very low birth weight preterm neonates. CONCLUSION The current study developed reference intervals (RIs) specific to birth weight, age, and/or sex for 35 MS/MS biomarkers, which can help in the timely evaluation of the health and disease of preterm neonates.
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Affiliation(s)
- Falin He
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology, Beijing, P. R. China
| | - Tiancheng Xie
- Department of Laboratory Sciences, West China School of Public Health and West China No.4 Hospital, Sichuan University, Chengdu, Sichuan, P. R. China
| | - Xinwen Huang
- Department of Genetics and Metabolism, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, P. R. China
| | - Jinming Zhang
- National Center for Clinical Laboratories, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing Hospital, National Center of Gerontology, Beijing, P. R. China
| | - Tian Tang
- Department of Laboratory Sciences, West China School of Public Health and West China No.4 Hospital, Sichuan University, Chengdu, Sichuan, P. R. China.
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2
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Abbam G, Mensah K, Appiah SK, Nkansah C, Daud S, Aikins CN, Osei-Afoakwa AN, Osei-Boakye F, Derigubah CA, Mohammed S, Tandoh S, Bani SB. Complete Blood Count Reference Intervals for Children Aged Less Than 1 to 12 Years in the Northern Region of Ghana. BIOMED RESEARCH INTERNATIONAL 2024; 2024:6607281. [PMID: 38764534 PMCID: PMC11101252 DOI: 10.1155/2024/6607281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
Reliable laboratory diagnostic results are key for evaluating and improving children's health. To interpret these results, child-specific reference intervals (RIs), which account for constant biological changes and physiological development with sex and age, are required, as recommended by the Clinical and Laboratory Standards Institute (CLSI). This study presents age- and sex-specific reference intervals for complete blood count (CBC) parameters in children (<1-12 years old) in the Northern Region of Ghana. In this cross-sectional study, 600 healthy children from randomly sampled schools in Tamale (the Northern Region) were recruited and screened. Data from 388 eligible children were used to nonparametrically determine the reference intervals of CBC parameters at the 2.5th and 97.5th percentiles. The CBC reference intervals were compared for variations in sex and age groups using the Wilcoxon rank-sum test. There were no statistically significant differences in most CBC parameters by sex (RBC, Hb, HCT, MCH, RDW (CV/SD), WBC, LYM#, MON#(%) NEU#(%), EOS#(%), and BAS#(%); p > 0.05) and age group (RBC, MCV, RDW (CV/SD), WBC, LYM#, MON#(%) NEU#(%), EOS#(%), and BAS%; p > 0.05). However, there were observable differences between this locally established CBC reference interval and that used for children at Tamale Teaching Hospital (manufacturer's RIs). This study emphasises the importance of determining reference intervals representative of the local child population and incorporating them into the current reporting system of laboratories in the Northern Region to ensure the provision of effective and efficient healthcare services.
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Affiliation(s)
- Gabriel Abbam
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Kofi Mensah
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
| | - Samuel Kwasi Appiah
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
| | - Charles Nkansah
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
| | - Samira Daud
- Department of Haematology, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Cheryl Namusoke Aikins
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Akua Nyarko Osei-Afoakwa
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Felix Osei-Boakye
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
- Department of Medical Laboratory Technology, Faculty of Applied Science and Technology, Sunyani Technical University, Sunyani, Ghana
| | - Charles Angnataa Derigubah
- Department of Medical Laboratory Science, Faculty of Health Science and Technology, Ebonyi State University, Abakaliki, Nigeria
- Department of Medical Laboratory Technology, School of Applied Science and Arts, Bolgatanga Technical University, Bolgatanga, Ghana
| | - Sanda Mohammed
- Systems Solutions Geospatial Research Services, Accra, Ghana
- Research Department, SSNIT, Accra, Ghana
| | - Samuel Tandoh
- University Clinic Laboratory, University of Education, Winneba, Ghana
| | - Simon Bannison Bani
- Department of Biomedical Laboratory Sciences, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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3
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Ammer T, Schützenmeister A, Prokosch HU, Rauh M, Rank CM, Zierk J. A pipeline for the fully automated estimation of continuous reference intervals using real-world data. Sci Rep 2023; 13:13440. [PMID: 37596314 PMCID: PMC10439150 DOI: 10.1038/s41598-023-40561-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 08/12/2023] [Indexed: 08/20/2023] Open
Abstract
Reference intervals are essential for interpreting laboratory test results. Continuous reference intervals precisely capture physiological age-specific dynamics that occur throughout life, and thus have the potential to improve clinical decision-making. However, established approaches for estimating continuous reference intervals require samples from healthy individuals, and are therefore substantially restricted. Indirect methods operating on routine measurements enable the estimation of one-dimensional reference intervals, however, no automated approach exists that integrates the dependency on a continuous covariate like age. We propose an integrated pipeline for the fully automated estimation of continuous reference intervals expressed as a generalized additive model for location, scale and shape based on discrete model estimates using an indirect method (refineR). The results are free of subjective user-input, enable conversion of test results into z-scores and can be integrated into laboratory information systems. Comparison of our results to established and validated reference intervals from the CALIPER and PEDREF studies and manufacturers' package inserts shows good agreement of reference limits, indicating that the proposed pipeline generates high-quality results. In conclusion, the developed pipeline enables the generation of high-precision percentile charts and continuous reference intervals. It represents the first parameter-less and fully automated solution for the indirect estimation of continuous reference intervals.
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Affiliation(s)
- Tatjana Ammer
- Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
- Roche Diagnostics GmbH, Penzberg, Germany
| | | | - Hans-Ulrich Prokosch
- Chair of Medical Informatics, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Manfred Rauh
- Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Erlangen, Loschgestr. 15, 91054, Erlangen, Germany
| | | | - Jakob Zierk
- Department of Pediatrics and Adolescent Medicine, Universitätsklinikum Erlangen, Loschgestr. 15, 91054, Erlangen, Germany.
- Center of Medical Information and Communication Technology, Universitätsklinikum Erlangen, Erlangen, Germany.
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4
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Nielsen ST, Lytsen RM, Strandkjær N, Hansen MK, Sillesen AS, Vøgg ROB, Raja AA, Rasmussen IJ, Kamstrup PR, Benn M, Iversen K, Bundgaard H, Frikke-Schmidt R. Red blood cell parameters in early childhood: a prospective cohort study. Clin Chem Lab Med 2023; 61:275-284. [PMID: 36377310 DOI: 10.1515/cclm-2022-0826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Red blood cell parameters are frequently used biomarkers when assessing clinical status in newborns and in early childhood. Cell counts, amounts, and concentrations of these parameters change through gestation and after birth. Robust age-specific reference intervals are needed to optimize clinical decision making. METHODS The Copenhagen Baby Heart Study (CBHS) and the COMPARE study are prospective cohort studies including red blood cell parameters from 7,938 umbilical cord blood samples and 295 parallel venous blood samples from newborns with follow-up at two and at 14-16 months after birth. RESULTS For venous blood at birth, reference intervals for hemoglobin, erythrocytes, and hematocrit were 145-224 g/L, 4.1-6.4 × 1012/L, and 0.44-0.64, respectively. Hemoglobin, erythrocytes, and hematocrit were lower at birth in children delivered by prelabor cesarean section compared to vaginal delivery. Conversion algorithms based on term newborns were: venous hemoglobin=(umbilical cord hemoglobin-86.4)/0.39; venous erythrocytes=(umbilical cord erythrocytes-2.20)/0.44; and venous hematocrit=(umbilical cord hematocrit-0.24)/0.45. CONCLUSIONS This study presents new reference intervals for red blood cell parameters in early childhood, describes the impact of delivery mode, and provide exact functions for converting umbilical cord to venous blood measurements for term newborns. These findings may improve clinical decision making within neonatology and infancy and enhance our clinical understanding of red blood cell parameters for health and diseases in early life.
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Affiliation(s)
- Sofie Taageby Nielsen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Rikke Mohr Lytsen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nina Strandkjær
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Malene Kongsgaard Hansen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Anne-Sophie Sillesen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - R Ottilia B Vøgg
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Anna Axelsson Raja
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ida Juul Rasmussen
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pia R Kamstrup
- Department of Clinical Biochemistry, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
| | - Marianne Benn
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Frikke-Schmidt
- Department of Clinical Biochemistry, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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5
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Mrosewski I, Dähn T, Hehde J, Kalinowski E, Lindner I, Meyer TM, Olschinsky-Szermer M, Pahl J, Puls M, Sachse K, Switkowski R. Indirectly determined reference intervals for automated white blood cell differentials of pediatric patients in Berlin and Brandenburg. Clin Chem Lab Med 2023; 61:1116-1122. [PMID: 36669090 DOI: 10.1515/cclm-2022-1265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/12/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Establishing direct reference intervals for pediatric patients is a costly, challenging, and time-consuming enterprise. Indirectly established reference intervals can help to ameliorate this situation. It was our objective to establish population-specific reference intervals for automated white blood cell differentials via data mining and non-parametric percentile method. METHODS Blood counts and automated white blood cell differentials of patients aged 0 days to 18 years, performed from the 1st of January 2018 until the 30th of June 2022, were identified in our laboratory information system. Reference intervals were established in accordance with IFCC and CLSI recommendations as well as the propositions by Haeckel et al. RESULTS Initially, 47,173 blood counts on our SYSMEX XN-9000 were identified. 11,707 data sets were excluded, leaving 35,466 sample sets for analysis. Of these, 17,616 contained automated white blood cell differentials. Due to insufficient patient numbers, no reference intervals for automated white blood cell differentials could be established for children aged <7 months. In comparison to the corresponding reference intervals published by Herklotz et al., reference intervals determined by us showed relevant differences throughout all age groups. CONCLUSIONS The combination of non-parametric percentile method and the propositions by Haeckel et al. utilizing conscientious data mining appears to be potent alternative to direct reference interval determination.
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Affiliation(s)
- Ingo Mrosewski
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Berlin, Germany
| | - Tobias Dähn
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Berlin, Germany
| | - Jörg Hehde
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Berlin, Germany
| | - Elena Kalinowski
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Berlin, Germany
| | - Ilona Lindner
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Berlin, Germany
| | - Thea Maria Meyer
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Berlin, Germany
| | | | - Jana Pahl
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Berlin, Germany
| | - Monika Puls
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Berlin, Germany
| | - Kristin Sachse
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Berlin, Germany
| | - Rafael Switkowski
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Berlin, Germany
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6
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Mrosewski I, Dähn T, Hehde J, Kalinowski E, Lindner I, Meyer TM, Olschinsky-Szermer M, Pahl J, Puls M, Sachse K, Switkowski R. Indirectly determined hematology reference intervals for pediatric patients in Berlin and Brandenburg. Clin Chem Lab Med 2021; 60:408-432. [PMID: 34904427 DOI: 10.1515/cclm-2021-0853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/02/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Establishing direct reference intervals (RIs) for pediatric patients is a very challenging endeavor. Indirectly determined RIs can address this problem by utilization of existing clinical laboratory databases. In order to provide better laboratory services to the local pediatric population, we established population-specific hematology RIs via data mining. METHODS Our laboratory information system (LIS) was searched for pediatric blood counts of patients aged from 0 days to 18 years, performed from 1st of January 2018 until 31st of March 2021. In total, 27,554 blood counts on our SYSMEX XN-9000 were initially identified. After application of pre-defined exclusion criteria, 18,531 sample sets remained. Age- and sex-specific RIs were established in accordance with International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) and Clinical & Laboratory Standards Institute (CLSI) recommendations. RESULTS When compared to pediatric RIs supplied by other authors, the RIs determined specifically for pediatric patients from Berlin and Brandenburg showed several relevant differences, especially with regard to white blood cell counts (WBCs), red blood cell counts (RBCs), red cell distribution widths (RDW) and platelet counts (PLTs) within the distinct age groups. Additionally, alterations to several published age-specific partitions had to be made, while new sex-specific partitions were introduced for WBCs and PLTs. CONCLUSIONS Generic RIs from textbooks, manufacturer information and medical publications - even from nationwide or multicenter studies - commonly used in many laboratories might not reflect the specifics of local patient populations properly. RIs should be tailored to the serviced patient population whenever possible. Careful data mining appears to be suitable for this task.
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Affiliation(s)
- Ingo Mrosewski
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Tobias Dähn
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Jörg Hehde
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Elena Kalinowski
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Ilona Lindner
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Thea Marie Meyer
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | | | - Jana Pahl
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Monika Puls
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Kristin Sachse
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
| | - Rafael Switkowski
- Department of Laboratory Medicine, MDI Limbach Berlin GmbH, Berlin, Germany
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7
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Jokic A, Rimac V, Vlasic Tanaskovic J, Podolar S, Honovic L, Lenicek Krleza J. The concurrence of the current postanalytical phase management with the national recommendations: a survey of the Working Group for Postanalytics of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochem Med (Zagreb) 2021; 31:030704. [PMID: 34658645 PMCID: PMC8495617 DOI: 10.11613/bm.2021.030704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 08/01/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction The detection and prevention of errors in the postanalytical phase can be done through the harmonization and standardization of constituent parts of this phase of laboratory work. The aim was to investigate how well the ongoing management of the postanalytical phase corresponds to the document “Post-analytical laboratory work: national recommendations” in Croatian medical biochemistry laboratories (MBLs). Materials and methods All 195 MBLs participating in the national external quality assessment scheme, were invited to undertake a part in a survey. Through 23 questions the participants were asked about management of the reference intervals (RI), delta check, reflex/reflective testing, postanalytical quality indicators and other parts of the postanalytical phase recommended in the national recommendations. The results are presented in numbers and percentages. Results Out of 195 MBLs, 119 participated in the survey, giving a response rate of 61%. Not all of the respondents provided answers to all the questions. Delta check has not been used in 59% (70/118) of the laboratories. Only 22/113 (20%) laboratories use reflex and/or reflective testing. In 53% of the laboratories, critical results were reported within 30 minutes of the confirmation of the results. In 34% (40/118) of the laboratories, turnaround time and reporting of critical results are two most often monitored postanalytical quality indicators. Conclusion The results showed the critical results reporting and monitoring of postanalytical quality indicators are in the line with the recommendations. However, the management of RI verification, the use of delta check and reflex/reflective testing still must be harmonized among Croatian MBLs.
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Affiliation(s)
- Anja Jokic
- Department of Medical Biochemistry, Hematology and Coagulation with Cytology, University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia.,Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Vladimira Rimac
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Jelena Vlasic Tanaskovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia
| | - Sonja Podolar
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Medical Biochemistry Laboratory, General Hospital "Dr. Tomislav Bardek", Koprivnica, Croatia
| | - Lorena Honovic
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, General Hospital Pula, Pula, Croatia
| | - Jasna Lenicek Krleza
- Working Group for Post-analytics, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Croatian Centre for Quality Assessment in Laboratory Medicine, Croatian Society of Medical Biochemistry and Laboratory Medicine, Zagreb, Croatia.,Department of Laboratory Diagnostics, Children's Hospital Zagreb, Zagreb, Croatia
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8
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Fleming JK, Katayev A, Moorer CM, Ward-Jeffries DA, Terrell CL. Development of nation-wide reference intervals using an indirect method and harmonized assays. Clin Biochem 2021; 99:20-59. [PMID: 34626611 DOI: 10.1016/j.clinbiochem.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/20/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES For many years, clinical laboratories have either verified or estimated reference intervals (RI) for laboratory tests. Those calculations have largely been performed by direct sampling analysis of ostensibly healthy individuals or by post-analysis biochemical screening. Recently however, indirect calculations have come to the forefront as an IFCC endorsed method by using normal and abnormal patient data. DESIGN AND METHODS Using a large database of patient test results from Laboratory Corporation of America, age and gender based RIs, inclusive of neonatal, pediatric, and geriatric populations, were determined using a modified indirect method of Hoffmann, and represent a diverse population distributed across the United States from a nation-wide system of laboratories and is unbiased with respect to age, gender, race or geography. RESULTS The tabulation of RIs using big data by an indirect method represent 72 M patient test results. The table includes 266 individual analytes consisting of approximately 2,700 age categories, including tests across multiple medical disciplines. CONCLUSIONS To our knowledge, this is the largest collection of RIs that were calculated by an indirect method representing clinical chemistry, endocrinology, coagulation, and hematology analytes that have been derived with very powerful "Ns" for each age bracket. This process provides more robust RIs and allows for the determination of pediatric and geriatric RIs that would otherwise be difficult to obtain using traditional direct RI determinations.
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Affiliation(s)
- James K Fleming
- Laboratory Corporation of America,® Holdings (retired), USA.
| | - Alex Katayev
- Laboratory Corporation of America,® Holdings, USA
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9
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Hamid JS, Atenafu EG, Borkhoff CM, Birken CS, Maguire JL, Bohn MK, Adeli K, Abdelhaleem M, Parkin PC. Reference intervals for hemoglobin and mean corpuscular volume in an ethnically diverse community sample of Canadian children 2 to 36 months. BMC Pediatr 2021; 21:241. [PMID: 34011305 PMCID: PMC8132375 DOI: 10.1186/s12887-021-02709-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022] Open
Abstract
Objective To establish reference intervals for hemoglobin and mean corpuscular volume (MCV) in an ethnically diverse community sample of Canadian children 36 months and younger. Methods We collected blood samples from young children at scheduled primary care health supervision visits at 2 weeks, 2, 4, 6, 9, 12, 15, 18, 24, and 36 months of age. Samples were analyzed on the Sysmex XN-9000 Hematology Analyzer. We followed the Clinical and Laboratory Standards Institute guidelines in our analysis. Data were partitioned by sex and also combined. We considered large age partitions (3 and 6 months) as well as monthly partitions. Reference intervals (lower and upper limits) and 90% confidence intervals were calculated. Results Data from 2106 children were included. The age range was 2 weeks to 36 months, 46% were female, 48% were European and 23% were of mixed ethnicity. For hemoglobin, from 2 to 36 months of age, we found a wide reference interval and the 90% confidence intervals indicated little difference across age groups or according to sex. For MCV, from 2 to 7 months of age there was considerable decrease in the reference interval, which was lowest during the second year of life, followed by a slight increase in the last months of the third year of life. Conclusion These findings suggest adoption of a single hemoglobin reference interval for children 2–36 months of age. Further studies in children under 4 months of age are needed. Trial registration TARGet Kids! cohort is registered at ClinicalTrials.gov. www.clinicaltrials.gov. Identifier: NCT01869530. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02709-w.
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Affiliation(s)
- Jemila S Hamid
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, Canada
| | - Eshetu G Atenafu
- Biostatistics Department, Princess Margaret Cancer Center, University Health Network, Toronto, Canada
| | - Cornelia M Borkhoff
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Catherine S Birken
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Pediatrics, and Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Mary Kathryn Bohn
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Khosrow Adeli
- CALIPER Program, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada.,Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Mohamed Abdelhaleem
- Department of Laboratory Medicine & Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Canada.,Haematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Patricia C Parkin
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and Sick Kids Research Institute, Hospital for Sick Children, Toronto, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. .,The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay St, Toronto, ON, M5G 0A4, Canada.
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