Related Experiment Video
Updated: Jan 26, 2026
Methylation Specific Multiplex Droplet PCR using Polymer Droplet Generator Device for Hematological Diagnostics
Published on: June 29, 2020
Next-generation reference intervals for pediatric hematology
Jakob Zierk1, Johannes Hirschmann2, Dennis Toddenroth2
1Department of Pediatrics and Adolescent Medicine, University Hospital Erlangen, Loschgestr. 15, 91054 Erlangen, Germany, Phone: +49 9131/85-33731, Fax: +49 9131/85-35742.
Insights
Creating pediatric reference intervals using percentile charts and z-scores improves the interpretation of blood test results for children. This data-driven approach aids in diagnosing hematological diseases and enhances clinical decision-making.
Area of Science:
- Pediatric Hematology
- Clinical Pathology
- Biostatistics
Background:
- Interpreting pediatric hematology requires accounting for significant sex- and age-specific developmental changes.
- Existing pediatric reference intervals face challenges in creation and clinical application.
- Current laboratory test result displays limit their utility in pediatric clinical decisions.
Purpose of the Study:
- To develop continuous percentile charts for pediatric hematology analytes from birth to adulthood.
- To demonstrate the visualization of hematology test results using percentile charts and z-scores.
- To assess the utility of percentiles and z-scores in diagnosing pediatric hematological diseases.
Main Methods:
- Utilized an improved data-driven approach with a large dataset (9,576,910 samples) from 10 German centers.
- Generated percentile charts for key hematology analytes (hemoglobin, hematocrit, WBC, platelets, etc.) for children aged 0-18 years.
- Developed a website (www.pedref.org/hematology) for visualizing results and assessing diagnostic support.
Main Results:
- Created comprehensive percentile charts for major hematology analytes in boys and girls from birth to 18 years.
- Percentile charts enhanced physician assessment in complex clinical scenarios compared to traditional methods.
- Age-specific percentiles and z-scores improved identification of blood count abnormalities and disease discrimination.
Conclusions:
- The developed reference intervals allow for precise assessment of pediatric hematology test results.
- Using percentiles and z-scores simplifies interpretation and aids clinical decision-making.
- Digital approaches, like percentile charts, show significant potential to improve pediatric healthcare outcomes.
Abstract:
Background Interpreting hematology analytes in children is challenging due to the extensive changes in hematopoiesis that accompany physiological development and lead to pronounced sex- and age-specific dynamics. Continuous percentile charts from birth to adulthood allow accurate consideration of these dynamics. However, the ethical and practical challenges unique to pediatric reference intervals have restricted the creation of such percentile charts, and limitations in current approaches to laboratory test result displays restrict their use when guiding clinical decisions. Methods We employed an improved data-driven approach to create percentile charts from laboratory data collected during patient care in 10 German centers (9,576,910 samples from 358,292 patients, 412,905-1,278,987 samples per analyte). We demonstrate visualization of hematology test results using percentile charts and z-scores (www.pedref.org/hematology) and assess the potential of percentiles and z-scores to support diagnosis of different hematological diseases. Results We created percentile charts for hemoglobin, hematocrit, red cell indices, red cell count, red cell distribution width, white cell count and platelet count in girls and boys from birth to 18 years of age. Comparison of pediatricians evaluating complex clinical scenarios using percentile charts versus conventional/tabular representations shows that percentile charts can enhance physician assessment in selected example cases. Age-specific percentiles and z-scores, compared with absolute test results, improve the identification of children with blood count abnormalities and the discrimination between different hematological diseases. Conclusions The provided reference intervals enable precise assessment of pediatric hematology test results. Representation of test results using percentiles and z-scores facilitates their interpretation and demonstrates the potential of digital approaches to improve clinical decision-making.
Related Concept Videos
01:03Prediction Intervals
However, the point estimate is most likely not the exact value of the population parameter, but close to it. After calculating point estimates, we construct interval estimates, called confidence intervals or prediction intervals. This prediction interval comprises a range of values unlike the point estimate and is a better predictor of the observed sample value, y.
01:21Confidence Intervals
A...
01:03Inertial Frames of Reference
01:27Non-inertial Frames of Reference
00:54Uncertainty: Confidence Intervals
01:19Interpretation of Confidence Intervals
Confidence intervals have confidence coefficients that are crucial for their interpretation. The most common confidence coefficients are 0.90, 0.95, and 0.99, which can be written as percentages–90%, 95%, and 99%, respectively.
Suppose a person calculates a confidence interval with a confidence coefficient of 0.95. In that case, they can...