Hematology Reference Values in Indonesian Children
Hematology Reference Values in Indonesian Children
in Indonesian Children
Author:
DR. Dr. Ina S. Timan, Sp.PK(K)
Prof. DR. Dr. Aryati, MS, Sp.PK(K)
Abstract
Every clinical laboratory have to established its reference ranges for every
parameter analyzed. This reference values are intervals that is considered
normal in physiological condition of a healthy person. It will be used by the
clinician or other health professionals to interpred the laboratory test resutls
of the patient for making diagnostic decision, monitoring patient therapy,
predicting the prognosisand its also used in epidemiology studies. A
reference range is defined as an interval in which 95% of values of a reference
population fall into it. It is very crucial to establish reference interval for local
population as it is sometimes affected by ethnicity, nutrition and food habits,
economic and other local conditions.
Introduction
Hematology parameters are the most common test asked by the clinician
especially pediatrician for the making the clinical decisions. Hematology
parameters are mostly performed using automated blood cell counters, in
Indonesia based of reports the most parameters analyzed are for the
hemoglobin, hematocrit, red blood cell count, red blood cell indices, white
blood cell count, white blood cell differential count, and platelet. This is the
most basic hematology test performed in a basic small blood cell counter.
Many larger instruments can perform more than 30 hematology parameters
simultaneously using only around 150-300 L whole blood. It is a very
efficient test, using small amount of blood, generating many useful
parameters especially in babies and small children.1,2
Results were calculated as mean+ 2SD except those marked with * were
calculated as 5th to 95th percentile.
The WHO cut off points for determining anemia in babies and children
differed. The lower hemoglobin reference values for babies, children and
teenagers in Indonesia were slightly lower from 13.6%, 3.5% and 6.7%
respectively in each age group. This should be considered when hemoglobin
levels is used for determining anemia in epidemiological studies or in clinical
practice. The reference values for hemoglobin, hematocrite and red blood cell
indices (MCV and MCH) showed slight increase by age group. 7-9 The value
of RDW can also be applied for screening of iron deficiecy anemia and
differentiate it with thalassemia.13
Summary
Hematology is the most common test performed in a clinical laboratory, and
the most used parameter by the clinician especially pediatricians. An
established reference interval for hematological parameters in babies and
children in Indonesia would be very useful in the epideiological or clinical
setting. Some of the pediatric hematology reference value reported slightly
differed compared those used by the WHO or reported in other countries, a
specific age and ethnic reference value will be beneficial in managing
pediatric patients.
References
1. Bates I. Reference ranges and normal values. In Bain BJ, Bates I, Laffan MA,
Lewis SM(Eds). Dacie and Lewis Practical hematology. 12th ed International
China Elsevier, 2107:8-17.
2. Khusun H, Yip R, Schultink W, Dillon HS. World Health Organization Hemoglobin
Cut-Off Points for the Detection of Anemia Are Valid for an Indonesian
Population. J Nutrition, 1999;129:1669–74
3. Yalew A, Terefe B, Alem B, Enawgaw B. Hematological reference intervals
determination in adults at Gondar university hospital, Northwest Ethiopia. BMC
Res Notes (2016) 9:483. DOI 10.1186/s13104-016-2288-8
4. World Health Organization. Haemoglobin concentrations for the diagnosis of
anaemia and assessment of severity. VMNIS WHO/NMH/NHD/MNM/11.1.
Downloaded 5 September 2022. Available from
https://apps.who.int/iris/bitstream/handle/10665/85839/WHO _NMH
_NHD_MNM_11.1_eng.pdf
5. Khusun H, Yip R, Schultink W, Dillon HS. World Health Organization Hemoglobin
Cut-Off Points for the Detection of Anemia Are Valid for an Indonesian
Population. J Nutrition, 1999;129:1669–74.
6. Timan, I.S., Aulia, D., Atmakusuma, D. et al. Some hematological problems in
Indonesia. Int J Hematol 76 (Suppl 1), 286–290 (2002).
https://doi.org/10.1007/BF03165264
7. Funahara Y. Reports field evaluation for anemia Indonesia. Japan Society for the
Promotion of Science.Kobe 2000.
8. Firmansyah A. Reports field survey for children in South Jakarta. Faculty of
medicine University of Indonesia. Jakarta 2007.
9. Timan IS, Tatsumi N, Funahara Y, Aulia D, Margono S, Sayogo S, et all. Anemia
in Indonesian SchoolChildren. ICMR Annals. 2000;20:223–230.
10. El Nageh MM, Heuck CC, Appel W, Vandepitte J, Engbaek K, Gibbs WN. Pre
analytical control. In Basic of quality assurance for intermediate and peripheral
laboratory. WHO publication 1992;pp.1-7.
11. Cho SM, Lee SG, Kim HS, Kim JH. Establishing pediatric reference intervals for
13 biochemical analytes derived from normal subjects in a pediatric
endocrinology clinic in Korea. Clinical Biochemistry 2014;47:268–71.
12. Nurazizah R, Handika RS, Sahiratmadja E, Ismiarto YD, Prihatni D. Concordance
test of various erythrocyte indices for screening of beta thalassemia carrier.
Indones J Clinical Pathol Med Laboratory 2022;28(2):137-42
13. Mataos JF, Borges KBG, Fernandes APS, Faria JR, Carvalho MG. RDW as a
differential parameter between microcytic anemias in pure and concomitant
forms. J Bras Patol Med Lab 2015;51:22-7.
14. Benson VS, Hartl S, Barnes N, et al. Blood eosinophil counts in the general
population and airways disease: a comprehensive review and meta-analysis. Eur
Respir J 2022; 59:2004590 [DOI: 10.1183/13993003.04590-2020].
Providing Total
Healthcare Solutions
To Optimise Patient Care
Haematology | Haemostasis | Urinalysis | Clinical Chemistry | Immunology | Flowcytometry | Digital Healthcare Solution
CDAKB
FK.01.01/2/062/2021
www.sysmex.co.id
Haematology Solution
XP-Series PocH-100i
Haematology Systemisation
Digital Morphology