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Haematological and biochemical indices in young African children: in search of reference intervals
Llorenç Quintó1, John J Aponte, Jahit Sacarlal
1Centre de Salut Internacional, Hospital Clinic IDIBAPS, Universitat de Barcelona, Barcelona, Spain. lquinto@clinic.ub.es
Insights
Reference intervals for common blood tests in African children differ significantly from Western values. These findings highlight the need for localized reference ranges to accurately assess child health in Africa.
Area of Science:
- Paediatric Haematology and Biochemistry
- Clinical Pathology in Developing Nations
Background:
- Current haematological and biochemical reference intervals used in Africa are derived from Western populations.
- There is a lack of local data to validate these Western-derived values for African children.
- This study addresses the critical need for region-specific paediatric reference ranges.
Purpose of the Study:
- To establish reference intervals for key haematological (haemoglobin, white blood cells, haematocrit, platelets) and biochemical (ALT, creatinine, bilirubin) indices in Mozambican children aged 1-4 years.
- To compare these locally derived intervals with established Western paediatric reference values.
- To assess the clinical implications of using non-local reference ranges for diagnosing normality in African children.
Main Methods:
- Reference intervals were determined using the 2.5th and 97.5th percentiles.
- Age and gender differences were analyzed using partition tests and quantile regression models.
- Agreement between estimated local intervals and Western values for normality classification was assessed using the kappa statistic.
Main Results:
- Significant age-related differences were observed for haemoglobin, white blood cells, haematocrit, platelets, ALT, and creatinine.
- Creatinine values showed gender differences, while bilirubin did not differ significantly by age or gender.
- African children had lower estimated haemoglobin and haematocrit intervals and higher ALT values compared to Western standards.
- The agreement between local and Western classifications of normality was only slight to fair.
Conclusions:
- Established Western reference intervals for haematological and biochemical indices are not suitable for African children.
- The study provides crucial, locally derived reference values for paediatric health assessment in this region.
- These findings underscore the importance of using population-specific data to define normality, especially in regions with prevalent conditions like anaemia and malaria.
Introduction:
The reference intervals of haematological and biochemical indices currently used in Africa are derived from data collected from populations living in industrialized countries. Few studies have been performed in Africa questioning the validity of these values when applied to local African populations.
Objective:
To provide reference intervals of haematological [haemoglobin (Hb), white blood cells (WBC), haematocrit (Htc) and platelets] and biochemical indices (ALT, creatinine and bilirubin) for children aged 1-4 from a rural area of southern Mozambique.
Methods:
Reference intervals were developed using the 2.5 and 97.5 centiles. Partition tests were performed to evaluate age and gender differences. Quantile regression models were estimated for those variables in which age partition was recommended. Deviances from linearity in the estimated models were evaluated using fractional polynomials of first or second degree. Agreement to classify normality, using the estimated reference intervals or values in use in a western paediatric hospital, was made using the kappa statistic.
Results:
Reference intervals for Hb, WBC, Htc, platelets, ALT and creatinine show significant differences by age. Gender differences were observed for creatinine values, while for bilirubin there were no significant differences for age or gender. Estimated Hb and Htc reference intervals in African children were lower than the accepted western ones, while ALT values were higher in the former. Agreement between normal classification, using the estimated intervals or the western values, was from slight to fair.
Conclusions:
Reference intervals of haematological and biochemical indices based on results from western individuals of the same age are not in agreement with the estimated values for African children. These observed values should not be used as a rule to define normality, but are the ones usually found in this population where anaemia, malaria and high mortality rates are also common.
