Establishing Normal Ranges of Hematological Parameters From an Iranian Healthy Population: A Population-Based Cross-Sectional Study of Hospital Data

  • Leili Koochakzadeh Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
  • Mirgholamreza Mahbod Noor Research Center for Ophthalmic Epidemiology, Noor Eye Hospital, Tehran, Iran.
  • Reza Pakzad Department of Epidemiology, School of Health, Ilam University of Medical Sciences, Ilam, Iran.
  • Davood Jafari Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
  • Fahimeh Khoshhal Department of Nursing, Dezful University of Medical Sciences, Dezful, Iran.
  • Abbasali Yekta Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
  • Mehdi Khabazkhoob Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Keywords: Reference range, Hematological parameters, Iranian population, Adults, Ophthalmology

Abstract

Measurement of hematological parameters and their reference ranges play an important role in the diagnosis and treatment of many infectious diseases and cancers. However, there are marked differences in the reference ranges between developing and developed countries. The aim of this study was to establish reference ranges of hematological parameters. This cross-sectional study was conducted in patients visiting Noor Eye Hospital who had no systemic diseases. In the lying position, blood samples were collected in two test tubes (Becton Dickinson Ltd, UK) using the Venoject method. EDTA-containing blood samples were used for complete blood count and differential leukocyte count using a cell counter (Nihdon Kohden Celltac E, Japan). Descriptive statistics, t-test, and ANOVA were used for data analysis. The data of 46,595 individuals were analyzed of whom 47.3% (n=22,042) were men. The mean (95% confidence interval) of white blood cells (WBC), red blood cells (RBC), platelet, and Hemoglobin (Hb) was 6.68 (6.66-6.69), 4.83 (4.83-4.84), 238.40 (237.87-238.93), and 14.29 (14.27-14.30), respectively. There was no difference in hematological parameters between male and female subjects. Except for the platelet count that was higher in individuals below 18 years than those 18-64 years and ≥65 years, other parameters had no relationship with age. Normal values of hematological parameters in the Iranian population are similar to the Middle East and African countries but below standard reference values. Except for the platelet count that decreased with age, there was no significant difference in hematologic and immunologic parameters between age and sex groups. Considering the difference between our results and standard reference values, we suggest that normal values be determined locally for each country.

References

Zeh C, Amornkul PN, Inzaule S, Ondoa P, Oyaro B, Mwaengo DM, Vandenhoudt H, Gichangi A, Williamson J, Thomas T. Population-based biochemistry, immunologic and hematological reference values for adolescents and young adults in a rural population in Western Kenya. PLOS one 2011,6:e21040.

Adibi P, Faghih Imani E, Talaei M, Ghanei M. Population‐based platelet reference values for an Iranian population. Int J Lab Hematol 2007,29:195-9.

Gräsbeck R. The evolution of the reference value concept. Clin Chem Lab Med 2004,42:692-7.

Kibaya RS, Bautista CT, Sawe FK, Shaffer DN, Sateren WB, Scott PT, Michael NL, Robb ML, Birx DL, de Souza MS. Reference ranges for the clinical laboratory derived from a rural population in Kericho, Kenya. PloS one 2008,3:e3327.

Menard D, Mandeng MJ, Tothy MB, Kelembho EK, Gresenguet G, Talarmin A. Immunohematological reference ranges for adults from the Central African Republic. Clin Diagn Lab Immunol 2003,10:443-5.

Alamooti AA, Ardalan FA, Abdolahi A, Zeidi M, Firouzjaie F. Determination of lymphocyte subsets reference values in healthy Iranian men by a single platform flow cytometric method. Cytometry Part A 2010,77:890-4.

Tugume SB, Piwowar EM, Lutalo T, Mugyenyi PN, Grant RM, Mangeni FW, Pattishall K, Katongole-Mbidde E. Hematological reference ranges among healthy Ugandans. Clin Diagn Lab Immunol 1995,2:233-5.

Aina O, Dadik J, Charurat M, Amangaman P, Gurumdi S, Mang E, Guyit R, Lar N, Datong P, Daniyam C. Reference values of CD4 T lymphocytes in human immunodeficiency virus-negative adult Nigerians. Clin Diagn Lab Immunol 200512:525-30.

Ampofo W, Torpey K, Mukadi Y, Koram K, Nolan K, Amenyah R, Kaitoo E, Antwi P, Ofori-Adjei D, Lamptey P. Normal CD4+ T lymphocyte levels in HIV seronegative individuals in the Manya/Yilo Krobo communities in the Eastern region of Ghana. Viral Immunol 2006,19:260-6.

Lee BW, Yap HK, Chew FT, Quah TC, Prabhakaran K, Chan GS, Wong SC, Seah CC. Age‐and sex‐related changes in lymphocyte subpopulations of healthy Asian subjects: From birth to adulthood. Cytometry 1996,26:8-15.

Rakoto Alson O, Ratsitorahina M, Pfister P, Laganier R, Dromigny J. Estimation des valeurs normales de l’hémogramme à Madagascar. Arch Inst Pasteur Madagascar 2000,66:68-71.

Shahabuddin S. Quantitative differences in CD8+ lymphocytes, CD4/CD8 ratio, NK cells, and HLA-DR+-activated T cells of racially different male populations. Clin Immunol Immunopathol 1995,75:168-70.

Sarraf-Zadegan N, Atashi M, Naderi GA, Baghai AM, Asgary S, Fatehifar MR, Samarian H, Zarei M. The effect of fasting in Ramadan on the values and interrelations between biochemical, coagulation and hematological factors. Ann Saudi Med 2000,20:377-81.

Lugada ES, Mermin J, Kaharuza F, Ulvestad E, Were W, Langeland N, Asjo B, Malamba S, Downing R. Population-based hematologic and immunologic reference values for a healthy Ugandan population. Clin Diagn Lab Immunol 2004,11:29-34.

Badenhorst CJ, Fourie J, Steyn K, Jooste PL, Lombard CJ, Bourne L, Slazus W. The haematological profile of urban black Africans aged 15-64 years in the Cape Peninsula. East Afr Med J 1995,72:19-24.

Biino G, Santimone I, Minelli C, Sorice R, Frongia B, Traglia M, Ulivi S, Di Castelnuovo A, Gögele M, Nutile T. Age-and sex-related variations in platelet count in Italy: a proposal of reference ranges based on 40987 subjects' data. PloS one 2013,8:e54289.

El-Hazmi MA, Warsy AS. Normal reference values for hematological parameters, red cell indices, HB A2 and HB F from early childhood through adolescence in Saudis. Ann Saudi Med 2001,21:165-9.

Kelly A, Munan L. Haematologic profile of natural populations: red cell parameters. Br J Haematol 1977,35:153-60.

Tsegaye A, Messele T, Tilahun T, Hailu E, Sahlu T, Doorly R, Fontanet AL, de Wit TFR. Immunohematological reference ranges for adult Ethiopians. Clin Diagn Lab Immunol 1999,6:410-4.

Wintrobe MM, Greer JP. Wintrobe's clinical hematology: Lippincott Williams & Wilkins; 2009.

Dewanti L, Watanabe C, Ohtsuka R. Unexpected changes in blood pressure and hematological parameters among fasting and nonfasting workers during Ramadan in Indonesia. Eur J Clin Nutr 2006,60:877-81.

DeMaeyer E, Adiels-Tegman M. The prevalence of anaemia in the world= la prévalence de l'anémie dans le monde 1985.

Sahr F, Hazra P, Grillo T. White blood cell count in healthy Sierra Leoneans. West Afr J Med 1994,14:105-7.

Shaper A, Lewis P. Genetic neutropenia in people of African origin. Lancet 1971,298:1021-3.

Ishiguro A, Nakahata T, Matsubara K, Hayashi Y, Kato T, Suzuki Y, Shimbo T. Age‐related changes in thrombopoietin in children: reference interval for serum thrombopoietin levels. Br J Haematol 1999,106:884-8.

Liu Z, Huang AJ, Pflugfelder SC. Evaluation of corneal thickness and topography in normal eyes using the Orbscan corneal topography system. Br J Ophthalmol 1999,83:774-8.

Published
2018-12-25
How to Cite
1.
Koochakzadeh L, Mahbod M, Pakzad R, Jafari D, Khoshhal F, Yekta A, Khabazkhoob M. Establishing Normal Ranges of Hematological Parameters From an Iranian Healthy Population: A Population-Based Cross-Sectional Study of Hospital Data. Acta Med Iran. 56(9):571-6.
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