Haematological Reference Intervals in a Multiethnic Population

Introduction: Similar to other populations, full blood count reference (FBC) intervals in Malaysia are generally derived from non-Malaysian subjects. However, numerous studies have shown significant differences between and within populations supporting the need for population specific intervals. Methods: Two thousand seven hundred twenty five apparently healthy adults comprising all ages, both genders and three principal races were recruited through voluntary participation. FBC was performed on two analysers, Sysmex XE-5000 and Unicel DxH 800, in addition to blood smears and haemoglobin analysis. Serum ferritin, soluble transferrin receptor and Creactive protein assays were performed in selected subjects. All parameters of qualified subjects were tested for normality followed by determination of reference intervals, measures of central tendency and dispersion along with point estimates for each subgroup. Results: Complete data was available in 2440 subjects of whom 56% (907 women and 469 men) were included in reference interval calculation. Compared to other populations there were significant differences for haemoglobin, red blood cell count, platelet count and haematocrit in Malaysians. There were differences between men and women, and between younger and older men; unlike in other populations, haemoglobin was similar in younger and older women. However ethnicity and smoking had little impact. 70% of anemia in premenopausal women, 24% in postmenopausal women and 20% of males is attributable to iron deficiency. There was excellent correlation between Sysmex XE-5000 and Unicel DxH 800. Conclusion: Our data confirms the importance of population specific haematological parameters and supports the need for local guidelines rather than adoption of generalised reference intervals and cut-offs

Comparison of Reference Intervals of various populations.

<p>Gaza Strip (N = 50,127)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0091968#pone.0091968-Sirdah1" target="_blank">[1]</a>.</p><p>Germany(N = 2967)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0091968#pone.0091968-Ittermann1" target="_blank">[6]</a>.</p><p>US (N = 7664) <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0091968#pone.0091968-Beutler1" target="_blank">[4]</a>, (N = not available)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0091968#pone.0091968-NHANES1" target="_blank">[5]</a>, (N = not available)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0091968#pone.0091968-Hsieh1" target="_blank">[8]</a>.</p><p>UK (N = 700)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0091968#pone.0091968-OseiBimpong1" target="_blank">[2]</a>.</p><p>South India(N = 500)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0091968#pone.0091968-Subhashree1" target="_blank">[3]</a>.</p><p>Ghana (N = 691)<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0091968#pone.0091968-Dosoo1" target="_blank">[7]</a>.</p>a<p>19–45 years old.</p>b<p>>45 years old.</p>c<p>20–81 years old.</p>d<p>50–59 years old.</p>e<p>60–69 years old.</p>f<p>19–65 years old.</p>g<p>66 years and above.</p>h<p>16–91 years.</p>i<p>18–70 years.</p>j<p>18–59 years.</p><p>W = White B = Black.</p

Incidence of anaemia, iron deficiency and iron deficiency anaemia.

<p>Incidence of anaemia, iron deficiency and iron deficiency anaemia.</p

Reference intervals from this study compared with previous study.

<p>M =  male, F =  female.</p><p>* Median, range 2.5-97.5 centiles.</p><p>** Ferritin ng/mL<13 excluded.</p>§<p>Reference interval  =  mean±SD.</p