Reference intervals for selected haematological and biochemical parameters among apparently healthy adults in different eco-geographical zones in Ghana

Abstract

Background Due to the influence of gender, race/genetics, age, lifestyle habits and geography on the references intervals (RIs), the Clinical and Laboratory Standards Institute (CLSI) recommends the determination of population-specific RIs. Ghana continues to depend on pre-established RIs from other countries which poses the risk of misdiagnoses and wrong treatment. This study presents the haemato-biochemical RIs from four eco-geographical zones in Ghana. Methods In this population-based cross-sectional study, a total of 1227 randomly selected healthy voluntary blood donors from the four eco-geographic zones (Coastal Savannah, Rain Forest, Savannah and Transitional) were enrolled and screened. Based on the CLSI Guidance Document C28A2992, the data of eligible participants were used to non-parametrically determine the RIs for the haemato-biochemical parameters at the 2.5th and 97.5th percentiles. Comparison of analytes by gender was done by Wilcoxon rank sum test and eco-geographic differences were assessed using the Kruskal-Wallis with the Dunn post hoc multiple comparison tests. Results There were statistically significant differences in most of the haematological parameters (RBC, Hb, HCT, MCV, PLT, WBC; p-values <0.0001 and MCH; p-value = 0.007), and biochemical analytes (Urea, Cr, Trig, HDL-C, AST, ALT, ALP, GGT, BID, BIT, Prot-T and Albumin; p-values <0.0001) based on gender. Significant inter eco-geographic (intra-population) variations and substantial differences between the established RI and the RIs accompanying the analyzers used were also observed. Conclusion This study reports significant inter-sex and inter-geographical differences in haemato-biochemical RIs in Ghana as well as differences in RIs with both the RIs accompanying the analyzers and those of other countries. Determining RIs representative of populations and including them in the report systems of laboratories to ensure effective and efficient healthcare service delivery is thus recommended.

Establishment of reference intervals for hematological parameters of adult population in the western region of Saudi Arabia

“…Several studies have been attempted to establish hematological RIs for healthy individuals in many countries, including the Arab gulf [13][14][15][16][17]. There are significant racial and gender differences in almost all studies in calculated RIs for complete blood count parameters demonstrating the necessity to establish population-specific RIs…”

Steering Standardization of Pathology Services Through Centralisation and Consolidation of Laboratory Procurement

“…Reference interval (RI) is an essential component in any laboratory report, and represents the basis of result interpretation (22). Clinical and Laboratory Standards Institute recommends each laboratory establish its own RIs based on the methods used and population served (11,23).…”

Establishing pregnancy-specific haematological reference intervals in Ghana; a three-center cross-sectional study

“…Traditionally, reference intervals used in most clinical laboratories in sub-Saharan African countries are imported from the countries/regions where the respective analysers were procured. The literature however, strongly argues that socio-demographic and geographic variations affect various haemato-biochemical reference ranges [2,18]. Although the WHO has provided haemoglobin cut-off per trimester of pregnancy to guide decision making [8], we tested the hypothesis as to whether context-specific intra-pregnancy reference intervals for haematological parameters was required.…”

“…For example, thrombocytopenia has traditionally been classified as mild (platelet count 100-149 x 10 9 /L), moderate (50-99 x 10 9 /L) and severe (<50 x10 9 /L). Since the present study and other research [2,3,22] from the sub-region are advocating for dropping the lower limit for platelet counts to less than 110 x 10 9 /L, well-controlled longitudinal studies that will correlate pregnancy outcomes with intra-and post-partum platelet counts are warranted to inform context-specific policy formulation. Similarly, anaemia in women have been categorized into mild (10.0 -<11.5 g/dl), moderate (7.0 -<10.0 g/dL) and severe (<7.0 g/dl).…”

“…Since RIs are influenced by age, gender, dietary habits, and race, the Clinical and Laboratory Standard Institute (CLSI) recommends population-specific RIs to situate and contextualize clinical decisions [1]. Previous research in the sub-region have determined that most haematological RIs in sub-Saharan Africa have lower limits lesser than westerncentric RIs [2][3][4][5][6]. For example, in the definition of anaemia in adults, the World Health Organisation (WHO) recommends that haemoglobin cutoff of 12.5 g/dL (females) and 13.5 g/dL (males) be used in Caucasian population compared to 11.5 g/dL (females) and 12.5 g/dL (males) for individuals from sub-Saharan Africa [7].…”