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Pregnancy-specific continuous reference intervals for haematology parameters from an Australian dataset: A step
Corey Markus1, Cindy Flores2, Ben Saxon3,4
1SA Pathology, Women's and Children's Hospital Site, Adelaide, South Australia, Australia.
The Australian & New Zealand Journal of Obstetrics & Gynaecology
|October 24, 2020
Summary
This study introduces gestational age-specific centile curves for key hematological parameters in pregnancy. These new curves aid in monitoring maternal health and identifying potential complications like anemia during gestation.
Area of Science:
- Obstetrics and Gynecology
- Hematology
- Biostatistics
Background:
- Pregnancy involves significant physiological changes.
- Standard centile curves are used for measurements by age.
- Centile charts have not been applied to hematological parameters during pregnancy.
Purpose of the Study:
- To create gestational age-specific centile curves for six hematological parameters.
- To compare these derived curves with existing published reference intervals.
Main Methods:
- Utilized the LMS (Lambda-Mu-Sigma) approach with a large dataset of obstetric hematology results.
- Applied exclusion criteria to refine the data.
- Employed a two-step modeling process involving Bayesian information criteria and test-dataset global deviance to select the best distribution model.
Main Results:
- Analyzed data from 11,255 deliveries (10,813 patients).
- The Box-Cox power exponential distribution was selected as the overall best fit.
- Observed distinct trends: red cell parameters decreased then increased, leukocyte and neutrophil counts rose and plateaued, and platelet counts gradually decreased with advancing gestation.
Conclusions:
- This is the first study to model gestational age-dependent hematological variations using the LMS approach.
- The derived hemoglobin reference intervals are lower than previous ones, reflecting the specific patient population.
- These centile charts can enhance serial monitoring of antenatal patients, aiding early detection of adverse outcomes and anemia.
