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ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 19-22

Hematological reference values for full-term, healthy newborns of Jeddah, Saudi Arabia


Department of Paediatrics, Umm Al-Qura University, Mecca; Department of Pediatric, Dr. Soliman Fakeeh Hospital, Jeddah, Saudi Arabia

Date of Web Publication8-Feb-2017

Correspondence Address:
Dr. Saleh Alharbi
Dr. Soliman Fakeeh Hospital, Jeddah
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4847.199758

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  Abstract 

Objective: To establish hematological values (complete blood count) in healthy full-term newborns born at Dr. Soliman Fakeeh Hospital, as a reference value for healthy newborns in Jeddah, KSA. Methods: This is a cross-sectional study. Two thousand one hundred and sixty-three newborns were enrolled between January 1, 2013, and April 30, 2013, from Dr. Soliman Fakeeh Hospital in Jeddah - KSA. Newborn babies' blood was collected in ethylenediaminetetraacetic acid containing tubes in the 1st day of life and analyzed for three different parameters: hematological, leukocytic, and thrombocytic. Red blood corpuscles analysis included cell count, hemoglobin (Hb) concentration, hematocrit, mean corpuscular volume (MCV), mean corpuscular Hb, and mean corpuscular Hb concentration. White blood corpuscles (WBCs) assessment included total leukocytic count (TLC) and monocytes, lymphocytes, neutrophils, eosinophils, and basophils percentages. Platelet count was assessed. Results: There were no significant differences between males' and females' hematological parameters. Leukocytic parameters showed significant difference between males and females in TLC (P = 0.017) and a statistically significant difference between the monocytes in both genders (P = 0.037). The differential WBCs parameters were similar between both genders. Conclusion: We established the reference range of hematological parameters from cord blood in healthy full-term newborns in Jeddah, KSA. Our results can be used as a reference range to support clinical diagnosis, treatment, and public health interventions in healthy full-term newborns in Jeddah.

Keywords: Hematological reference, Jeddah, newborns


How to cite this article:
Alharbi S, Alkhotani A. Hematological reference values for full-term, healthy newborns of Jeddah, Saudi Arabia. J Clin Neonatol 2017;6:19-22

How to cite this URL:
Alharbi S, Alkhotani A. Hematological reference values for full-term, healthy newborns of Jeddah, Saudi Arabia. J Clin Neonatol [serial online] 2017 [cited 2019 Dec 8];6:19-22. Available from: http://www.jcnonweb.com/text.asp?2017/6/1/19/199758


  Introduction Top


Several factors influence the health of individuals. These variables include demographic aspects such as place of residence or country, race, timing of the year, and the age of the individuals. Personal factors such as diet and drug intake also have to be taken into consideration. Methods employed for assessment, as well, could variably influence the accuracy of the assessment. Therefore, there is a necessity to reference data when thoroughly focusing on individuals' health status and particularly when discussing infants, in regards of blood picture parameters.[1] Because variables such as hematological parameters differ between infants, neonates, and adults and differ as per location. Investigation of an individual should entirely depend on the normal ranges, which have been established to an individual's locality.[2],[3] Reference value is defined as a set of laboratory test values obtained from an individual or group in a defined state of health. This term replaces normal values because it is based on a defined state of health rather than on apparent health.[4]

A previous study, published in 2001, was conducted to determine the values in apparently healthy Saudi children screened during a household screening program.[4] The study attempted to establish the normal reference values for hematological parameters in Saudi children and adolescents with ages ranging from 1 to 15 years. However, no particular emphasis was made on the very rapidly changing parameters, in the 1st weeks of newborn's life.

Blood indices in infants and neonates vary depending on gestational age, maternal factors, mode of delivery, and site of blood collection. Determination of reference ranges for healthy and full-term neonates is clinically important, also for clinical diagnosis, treatment, and public health interventions.[1] Hemoglobin (Hb) and hematocrit are routine investigations on normal newborns to determine anemia, and more commonly, polycythemia. Some disorders in the pregnant mother, such as preeclampsia, can lead to neutropenia in infants.[5] The use of absolute blood neutrophil count has improved the sensitivity in screening for neonatal bacterial diseases.[6] Platelet count is essential in the assessment of newborn's hemostatic status. Hematological values are also frequently determined in the newborns for diagnostic purposes in suspected infections and bleeding disorders.

The purpose of this study is to establish hematological values (complete blood count) in healthy full-term newborns in Dr. Soliman Fakeeh Hospital, as a reference value for healthy newborns in Jeddah, Saudi Arabia


  Methods Top


Study design

This study is a cross-sectional study, carried out between January 2013 and April 2013. All newborns at 1st day of life that underwent blood sampling in Dr. Soliman Fakeeh Hospital in Jeddah were enrolled in the study. Dr. Soliman Fakeeh Hospital is a private (tertiary care) hospital uniquely located to serve a wide catch population from South and North Districts of Jeddah. The number of deliveries per year is 7500. Newborns' blood were collected in ethylenediaminetetraacetic acid containing tubes and analyzed for different hematological parameters. Hematological reference values were obtained from Al-Marzoki et al.[1]

Statistical analysis

The data entry and analysis was done using computer package Statistical Packages of Social Sciences (SPSS) version Released 2011. IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corp.. Descriptive statistics included frequency tables (n, mean, median, standard deviation, minimum and maximum for continuous variables and n, frequency and percentage for categorical values).

Population of Jeddah is approximately 3.58 million and its birth rate is 18.78 births/1000 people. Assuming that birth rates are uniform throughout the year, the total number of newborns in Jeddah between January and April is 22,398, which could be considered as a universe population. The sample size of 2161 children allowed a margin of error of 9.78 at confidence interval of 95% and response distribution of 50%.


  Results Top


From the 2161 newborns enrolled in the study, 1055 were males (48.8%) and 1106 were females (51.2%). The 2161 participants were born between January 1, 2013, and April 30, 2013.

Full blood count parameters are summarized in [Table 1], which shows a mean Hb level of 17.7 ± 2 g/dL (range 5.1–23.6) and a mean red blood corpuscle (RBC) count of 5.6% ±5.1% (range 2.8–25.5). The mean total white cell count was 16.7 ± 9.3 × 103/µL, (range 3.9–365) and the mean platelet count was 238.4 ± 6.6 × 103/µL (range 30.6–787).
Table 1: Descriptive statistics of red blood corpuscle, white blood corpuscle, and platelet parameters (n=2162)

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Red blood cell parameters (Hb, hematocrit, MCV, mean corpuscular hemoglobin [MCH], and mean corpuscular hemoglobin concentration [MCHC]) in cord blood for males and females showed no statistical significant gender differences (P > 0.05) in red cell count, hematocrit, MCH, and MCHC. The Hb Level was 17.7 ± 1.9 g/dL in males and 17.8 ± 2 g/dL in females (P = 0.465), and mean corpuscular volume (MCV) was 105.1 ± 7.1 fl in males compared with 105.1 ± 7.3 fl in females (P = 0.828).

As seen in [Table 2], despite the high statistically significant difference between total white blood corpuscle (WBC) count between males and females, the differential count of the lymphocytes, neutrophils, basophils, and eosinophils showed no statistically significant difference between males and females except that there was a statistically significant difference between the monocytes in both genders. Total WBC was 16.2 ± 5.3 × 109/L in males compared with 17.2 ± 12 × 109/L in females (P = 0.017), mean monocyte percentage was 1.2 ± 0.2 × 109/L in males and 1.3 ± 0.4 × 109/L in females (P = 0.037), and mean platelet count was 237.8 ± 59.2 × 109/L in males and 239 ± 62.2 × 109/L in females (P = 0.635).
Table 2: Differential white blood corpuscles and platelets in males versus females

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The total WBC count of the newborns in this study was within the normal reference range values yet higher than the values in the other 3 studies in comparison. Similarly, the neutrophils were within the normal range, yet higher than in the three other studies as seen in [Table 3] after the below paragraph. In this study, all RBC parameters (Hb, Hematocrit, MCV, MCH, and MCHC) were all within normal ranges, except the red cell count (5.6), which was higher than both the reference values (4.62) and the three other studies (4.29, 4.35, and 4.45). Hb and hematocrit concentration were also higher than the three comparison studies, yet still within the reference range. The basophils and eosinophils were within the normal reference range. Only the monocytes (7.6%) were slightly higher than the maximum normal range (7%). The platelet count was within the normal reference range.
Table 3: Comparison of red blood corpuscles values, differential white blood corpuscles, and platelets between current study, reference values, and similar studies

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In this study, all RBC parameters (Hb, Hematocrit, MCV, MCH, and MCHC) were all within normal ranges, except the red cell count (5.6), which was higher than both the reference values (4.62) and the three other studies (4.29, 4.35, and 4.45). Hb and hematocrit concentration were also higher than the three comparison studies, yet still within the reference range.


  Discussion Top


Since reference values are not always derived from “healthy” people, the term “Normal Range” is frowned upon and preferably replaced with “Reference Range.”[1] A reference range is usually defined as the set of values, 95% of the normal population falls within and is determined through collecting data from large numbers of laboratory tests.[7] The interpretation of test results and particularly blood test results rely on reference values since there is always a need to compare obtained results with these reference values for the locality.[8] Several studies show that hematological parameters vary according to the stage in life. Neonates' red blood cells, packed cell volume, and total Hb are higher than any other point in life.[9],[10] Various studies have been conducted in different population groups to work out the hematological references for children and adults,[11],[12],[13],[14],[15],[16],[17],[18],[19],[20] which also varied according to the ethnic groups.[12],[14],[18],[21] Most studies convey that the sex and ethnicity create a significant difference in hematological values, where Africans and Afro-Caribbean's values are less than Caucasian values.[15],[18],[21]

A previous study was carried out in the Central Province of Saudi Arabia, comprising 1526 patients, to assess normal reference values for hematological parameters, red cell indices, HbA2, and fetal Hb from early childhood through adolescence. However, that study included patients between 0 and 15 years old and was not intended for establishing hematological reference values in newborns.[4] Hence, a study was conducted in Jeddah, Saudi Arabia, to define reference ranges for full blood count parameters in neonatal cord blood. As previously mentioned, most of the parameters were within reference values.

Regarding the red cell parameters, no statistically significant differences were evident between males and females. From WBC parameters, there was a significant difference only between total leukocytic counts and monocytes in both genders. Comparison of red blood cell parameters in neonatal cord plasma for the current study with reference values cited by other studies shows that only the red cell counts were higher than both the reference values (4.62 × 106/µL) and the three other studies (4.29, 4.35, and 4.45 × 106/µL). This may be due to varying numbers of newborns in the studies, varying time intervals between birth and clamping of the cord, ethnic differences, severity of anemia in the mothers, or the mothers having received different hematinic doses during pregnancy.[22] This also might have possibly been due to postmaturity, diabetes in the mother, or a low oxygen level in the fetal blood.[23]

From the WBC parameters, only the monocytes were higher than the established reference ranges. According to a study investigating sick preterm neonates receiving intensive care, a spectacular rise in monocyte count has frequently been observed in sequential full blood examinations.[23] The size of the sample and racial factors, in addition, might have played a role in this increase.


  Conclusion Top


This study established the reference range of hematological parameters in healthy full-term newborns in Jeddah, Saudi Arabia. Our results can be used as a reference range to support clinical diagnosis, treatment, and public health interventions in healthy full-term newborns in Jeddah.

Recommendation

It is recommended to do similar studies, considering focusing on mothers' variables (such as age or medical history), newborn variables (such as weight or term of birth), or procedural factors (such as mode of delivery).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Al-Marzoki JM, Al-Maaroof ZW, Kadhum AH. Determination of reference ranges for full blood count parameters in neonatal cord plasma in Hilla, Babil, Iraq. J Blood Med 2012;3:113.   Back to cited text no. 1
    
2.
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Mohson A, Hazmi E, Warsy A. Normal reference values for hematological parameters, red cell indices, HBA2 and HbF from early childhood through adolescence in Saudis. Ann Saudi Med 2011;21:165-9.  Back to cited text no. 3
    
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Manroe BL, Weinberg AG, Rosenfeld CR, Browne R. The neonatal blood count in health and disease. I. Reference values for neutrophilic cells. J Pediatr 1979;95:89-98.  Back to cited text no. 6
    
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Bangert SK, Marshall WJ, Leonard MW. Clinical Biochemistry: Metabolic and Clinical Aspects. Philadelphia: Churchill Livingstone/Elsevier; 2008. p. 19.  Back to cited text no. 7
    
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Matoth Y, Zaizov R, Varsano I. Postnatal changes in some red cell parameters. Acta Paediatr Scand 1971;60:317-23.  Back to cited text no. 8
    
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Burman D. Haemoglobin levels in normal infants aged 3 to 24 months, and the effect of iron. Arch Dis Child 1972;47:261-71.  Back to cited text no. 9
    
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Armstrong P. Full blood count values in adolescents. Ir Med J 1989;82:68-9.  Back to cited text no. 10
    
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Onwukeme KE, Olomu IN. Haematologic indices in African children. Trop Geogr Med 1991;43:171-3.  Back to cited text no. 11
    
12.
Kabata J, Raszeja-Specht A, Steffek I, Angielski S. Reference values for peripheral blood morphology in countryside population of Northern Poland. Pol Tyg Lek 1995;50:62-5.  Back to cited text no. 12
    
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Akdag R, Energin VM, Kalayci AG, Karakelleoglu C. Reference limits for routine haematological measurements in 7-14-year-old children living at an intermediate altitude (1869 m, Erzurum, Turkey). Scand J Clin Lab Invest 1996;56:103-9.  Back to cited text no. 13
    
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Bain BJ. Ethnic and sex differences in the total and differential white cell count and platelet count. J Clin Pathol 1996;49:664-6.  Back to cited text no. 14
    
15.
Bao W, Dalferes ER Jr., Srinivasan SR, Webber LS, Berenson GS. Normative distribution of complete blood count from early childhood through adolescence: The Bogalusa Heart Study. Prev Med 1993;22:825-37.  Back to cited text no. 15
    
16.
Khraisha S. Comparative study of hematological values of school children of both sexes at Dead Sea level and at Amman. Aviat Space Environ Med 1983;54:250-2.  Back to cited text no. 16
    
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Santiago Borrero PJ. Hemoglobin concentration, hematocrit and red cell index values in metropolitan San Juan children and adolescents. Bol Asoc Med P R 1981;73:538-47.  Back to cited text no. 17
    
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Castro OL, Haddy TB, Rana SR. Age- and sex-related blood cell values in healthy black Americans. Public Health Rep 1987;102:232-7.  Back to cited text no. 18
    
19.
Taylor MR, Holland CV, Spencer R, Jackson JF, O'Connor GI, O'Donnell JR. Haematological reference ranges for schoolchildren. Clin Lab Haematol 1997;19:1-15.  Back to cited text no. 19
    
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Saxena S, Wong ET. Heterogeneity of common hematologic parameters among racial, ethnic, and gender subgroups. Arch Pathol Lab Med 1990;114:715-9.  Back to cited text no. 20
    
21.
Jopling J, Henry E, Weidmeier SE. Reference ranges for hematocrit and blood hemoglobin concentration during the YH neonatal period: Data from a multi hospital healthcare system. Pediatrics 2009;123:e333-7.  Back to cited text no. 21
    
22.
Mukiibi JM, Nkrumah FK, Kaur M, Pollard R, Akino V, Nhembe M. Neonatal haematology in Zimbabwe. II: The red cell and white cell parameters. Cent Afr J Med 1995;41:76-82.  Back to cited text no. 22
    
23.



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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