Indirect determination of hemoglobin A2 reference intervals in Pakistani infants using data mining.

Area of Science:

• Clinical Chemistry
• Hematology
• Pediatric Diagnostics

Background:

• Reference intervals (RIs) are essential for disease diagnosis and vary by age.
• Hemoglobinopathies are prevalent in Pakistan, necessitating accurate hemoglobin variant quantification.
• Establishing local RIs for infants is challenging, particularly for Hemoglobin A2.

Purpose of the Study:

• To establish Hemoglobin A2 reference intervals for infants in Pakistan.
• To address the lack of local RIs for pediatric hemoglobinopathies.
• To improve diagnostic accuracy for hemoglobinopathies using an indirect data mining approach.

Main Methods:

• Retrospective observational study analyzing 88,690 Hemoglobin A2 measurements from infants (birth to 1 year).
• Utilized an indirect KOSMIC algorithm on routine laboratory data from Aga Khan University Hospital.
• Hemoglobin A2 was measured using the Bio-Rad Variant™ II analyzer.

Main Results:

• Calculated RIs for 22,713 infants across five age sub-groups.
• The derived RIs demonstrated good agreement with established international RIs (Mayo Clinic Laboratories).
• Identified age-specific fluctuations in Hemoglobin A2 synthesis.

Conclusions:

• Data mining is a viable method for establishing RIs in resource-limited settings.
• The new Hemoglobin A2 RIs enhance clinical decision-making for Pakistani infants.
• Results are specific to the population, instrument, and reagents used.