Population-Based Hematologic and Immunologic Reference Values for a Healthy Ugandan Population

Abstract

To assess the validity of the reference values for hematologic and immunologic indices currently used in Africa, we evaluated blood samples from 3,311 human immunodeficiency virus (HIV)-negative Ugandans aged 1 week to 92 years. Erythrocyte, hemoglobin, and hematocrit levels and mean corpuscular volume all significantly increased with age (P < 0.001) and were independent of gender until the age of 13 years, after which the levels were higher in males than in females (P < 0.001). White blood cell, neutrophil, lymphocyte, basophil, and monocyte counts significantly declined with age until the age of 13 years (P < 0.001), with no differences by gender, while platelet counts declined with age (P < 0.001) and showed differences by gender only among adults older than age 24 years. CD4؉ -and CD8 ؉ -cell counts declined with age until the age of 18 years; thereafter, females had higher counts than males. The absolute values for many of these parameters differed from those reported for populations outside Africa, suggesting that it may be necessary to develop tables of reference values for hematologic and immunologic indices specific for the African population. This may be particularly important with regard to CD4 ؉ -cell counts among children because significant differences in absolute and percent CD4 ؉ -cell counts exist between the values for Western populations and the values for the population evaluated in our study. These differences could influence the decision to initiate antiretroviral therapy among children infected with HIV.The reference values of hematologic and immunologic indices currently used in Africa are derived from data collected for populations living in industrialized countries (27). The few small studies with African populations that have been reported indicate differences in normal values compared with those for populations in industrialized countries (2,3,5,8,10,23,25,26). Ethnic origin, genetics, gender, altitude, and environmental factors, especially pathogens, may influence some values of

Evaluation of treatment outcomes for patients on first‐line regimens in US President's Emergency Plan for AIDS Relief (PEPFAR) clinics in Uganda: predictors of virological and immunological response from RV288 analyses

“…In HIV-negative Ugandan populations, women have higher absolute CD4 cell counts and percentages than men [27,28], as is seen in some other African populations (South Rift Valley, Kenya; Southern Highlands, Tanzania) [29,30], but not in all [31]. This pattern could also be the result of men having lower absolute CD4 cell counts and percentages at baseline than women.…”

Lymphocyte subset reference intervals in blood donors from northeastern Brazil

“…In contrast to previous studies, which have primarily focused on isolated T cell subsets, the present study represents the first attempt to establish lymphocyte subset reference intervals from peripheral blood populations of other countries, such as Uganda (Lugada et al 2004) and the UK (Wakeman et al 2007). By contrast, the eosinophil counts herein were found to be higher than those obtained by two laboratories in São Paulo and Rio de Janeiro, the two largest and most affluent cities in Brazil (data not shown).…”

“…In these regions, it is possible that the eosinophil levels may vary in accordance with rates of helminth infection. However, these authors found no correlation between eosinophil counts and elevated total anti-helminth IgE (Lugada et al 2004). In addition, a previous study involving the same individuals included in the present study found a high prevalence of seropositivity to Toxocara spp., whose infection is known to be highly associated with eosinophilia and total IgE (Dattoli et al 2011).…”

“…By contrast, the eosinophil counts herein were found to be higher than those obtained by two laboratories in São Paulo and Rio de Janeiro, the two largest and most affluent cities in Brazil (data not shown). Lugada et al (2004) reported an increased number of eosinophils in Uganda when compared to Western populations, as well as in relation to other African populations residing in Europe. In these regions, it is possible that the eosinophil levels may vary in accordance with rates of helminth infection.…”

The platelet count in EDTA‐anticoagulated blood from patients with thrombocytopenia may be underestimated when measured in routine laboratories

“…The accuracy of PC measurement is important for the diagnosis [1][2][3][4][5] and management [6][7][8][9][10][11] of patients with thrombocytopenia. Spuriously low PC is observed in 0.07-0.27% of blood samples [12][13][14] owing to the presence of antibodies that cause a time-dependent in vitro platelet agglutination.…”