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Reference ranges for lymphocyte subsets in pediatric patients
P K Kotylo1, N S Fineberg, K S Freeman
1Department of Pathology/Hematopathology Division, Indiana University School of Medicine, Indianapolis.
Insights
Pediatric lymphocyte subset reference ranges change significantly by age 3. After this age, most ranges approximate adult values, but age-adjusted ranges are crucial for young children.
Area of Science:
- Immunology
- Pediatric Hematology
- Clinical Laboratory Science
Background:
- Establishing accurate reference ranges for lymphocyte subsets is crucial for diagnosing pediatric immune disorders.
- Existing reference ranges may not adequately capture age-specific variations in lymphocyte populations during childhood.
Purpose of the Study:
- To determine age-specific reference ranges for peripheral blood lymphocyte subsets in healthy children.
- To identify the age at which pediatric lymphocyte subset values approximate adult reference ranges.
Main Methods:
- Analysis of peripheral blood samples from 130 healthy pediatric patients (1 month to 17 years).
- Immunophenotyping using monoclonal antibodies and whole blood lysis technique.
- Flow cytometry analysis to quantify lymphocyte subsets (CD2, CD3, CD4, CD8, CD19) and CD4/CD8 ratios.
Main Results:
- Statistically significant changes in most lymphocyte subsets were observed around age 3 years.
- Relative and absolute counts of total lymphocytes, CD2, CD4, CD19, and CD4/CD8 ratios were highest at birth, decreasing by age 3.
- Relative CD8 counts were low in early childhood, increasing to adult levels after age 3; CD3 relative percentage remained stable.
Conclusions:
- Pediatric lymphocyte subset reference ranges exhibit significant age-dependent variations, particularly before age 3.
- Age-adjusted reference ranges are necessary for accurate interpretation of lymphocyte subset data in young children.
- Adult reference ranges may be applicable for children over 3 years, but caution is advised for younger age groups.
Abstract:
Peripheral blood lymphocyte subset reference ranges were examined in a large group (N = 130) of healthy pediatric patients ranging in age from 1 month to 17 years. All samples were stained with monoclonal antibodies, processed with a whole blood lysis technique, and analyzed on a flow cytometer. Data analysis demonstrated statistically significant changes in most lymphocyte subsets at age 3 years. The relative and absolute numbers of total lymphocytes, CD2, CD4, and CD19 cells; absolute numbers of CD3 and CD8 cells; and CD4/CD8 ratios were high at birth, decreased during early childhood, and closely approximated adult reference values after age 3 years. The relative numbers of CD8 lymphocytes were low in early childhood and then rose to adult values after 3 years of age. The relative percentage of CD3 cells remained stable over all ages studied. Although "adult" lymphocyte subset reference ranges may be similar to those in children older than 3 years, age-adjusted reference ranges should be used for the early childhood period.
