Related Experiment Video
Updated: Jun 9, 2025
Evaluation of a Point-of-Care Testing Analyzer for Measuring Peripheral Blood Leukocytes
Published on: March 22, 2022
Establishment and verification of reference intervals for blood cell analysis in extremely high altitude
Zhimin Yuan1,2, Jian Zhuang3,4
1Department of Clinical Laboratory, Shaanxi Provincial Cancer Hospital, Xi'an Jiaotong University, Xi'an, China.
Insights
This study established new reference intervals for complete blood counts (CBC) in healthy adults living at high altitudes. These new high-altitude reference ranges differ significantly from national standards, improving diagnostic accuracy for this population.
Area of Science:
- High-altitude physiology
- Clinical laboratory science
- Hematology
Background:
- Complete blood count (CBC) reference intervals are typically established at sea level.
- High-altitude environments present unique physiological challenges that may alter hematological parameters.
- Existing national reference intervals may not accurately reflect the health status of populations residing at very high altitudes.
Purpose of the Study:
- To establish reference intervals for CBC parameters in healthy adults residing at very high altitudes.
- To compare these new reference intervals with existing national clinical reference ranges.
- To evaluate the diagnostic utility of the newly established high-altitude reference intervals.
Main Methods:
- Recruited 4,863 healthy adults from Ali District People's Hospital (2019-2021).
- Utilized XT-4000i automatic cell analyzer for CBC detection.
- Employed SPSS 23.0 for statistical analysis, including between-groups and diagnostic concordance comparisons.
- Validated intervals with 20 independent samples from 2022.
Main Results:
- CBC counts exhibited non-normal distributions.
- Significant differences (p < 0.05) were observed for most CBC parameters compared to national ranges.
- Sex-based differences in red blood cell (RBC), hemoglobin (HGB), and hematocrit (HCT) were significant (p < 0.05).
- The newly established reference intervals showed higher diagnostic value.
Conclusions:
- Preliminary reference intervals for CBC in high-altitude adults in the Ali region were established.
- These findings highlight the need for altitude-specific laboratory reference intervals.
- Regularly updating laboratory reference intervals is crucial for accurate health assessments in diverse environments.
Objective:
This study aimed to establish the reference intervals for complete blood count (CBC) in healthy adults at very high altitudes.
Methods:
This study recruited 4,863 healthy adults (3,598 males and 1,265 females) who received routine health check-ups at Ali District People's Hospital from January 2019 to December 2021 through the LIS system. CBC was detected by the XT-4000i automatic cell analyzer and statistically analyzed by SPSS 23.0 software (between-groups comparison, diagnostic concordance comparison). In addition, 20 health check samples were collected in 2022 to validate the established reference intervals.
Results:
The CBC count showed a non-normal distribution in each item separately. The white blood cell (WBC), neutrophil (NEUT), lymphocyte (LYMPH), monocyte (MONO), eosinophil (EO), basophil (BASO), red blood cell (RBC), hemoglobin (HGB), hematocrit (HCT), mean corpuscular volume (MCV), mean hemoglobin content (MCH), and mean erythrocyte hemoglobin concentration (MCHC) levels of healthy adults were significantly different from the national clinical reference range (p < 0.05). There were significant differences between males and females in RBC, HGB, and HCT levels (p < 0.05). The new reference intervals were less consistent with the expert consensus CBC reference intervals (p < 0.05). Compared with the other reference intervals, the diagnostic value of the reference screening interval established was significantly higher in this study (p < 0.05). The reference range established is verified by 20 independent samples from 2022, and the results are acceptable.
Conclusion:
This study preliminarily established reference intervals for complete blood counts of healthy adults at high altitudes in the Ali region of Tibet to provide a reference point for understanding routine blood markers in permanent residents of high-altitude environments and illustrate the need for regular establishment of laboratory reference intervals on a regular basis.
