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22 - Reference ranges in neonatal hematology

from Section VIII - Miscellaneous

Published online by Cambridge University Press:  05 February 2013

By
Robert D. Christensen
Edited by
Pedro de Alarcón ,
Eric Werner  and
Robert D. Christensen
Pedro de Alarcón
Affiliation:
University of Illinois College of Medicine
Eric Werner
Affiliation:
Children's Hospital of the King's Daughters
Robert D. Christensen
Affiliation:
McKay-Dee Hospital, Utah
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Summary

The reference range concept

“Normal ranges” for hematologic values of neonates are generally not available. This is because blood is not drawn on healthy normal neonates to establish such ranges, as is done with the consent of healthy adult volunteers. Instead, neonatal hematology generally utilizes “reference ranges.” These ranges consist of 5th to 95th percentile values compiled from laboratory tests that were performed on neonates thought to have minimal pathology relevant to the laboratory test, or with pathology unlikely to significantly affect the test results. The premise on which the reference range concept is based is that these values approximate normal ranges, although they were admittedly obtained for a clinical reason and not from healthy volunteers.

Defining reference ranges in neonatal hematology is complicated by the fact that ranges obtained from term infants generally do not apply to preterm infants, and ranges obtained from low birthweight preterm infants can be very different from ranges obtained from extremely low birthweight infants. As an example, a venous hematocrit of 38% would be within the reference range for a 2-hour-old neonate born at 24 weeks’ gestation, but would be low for a term infant.

Another problem encountered in defining reference ranges in neonatal hematology is that unstable, sick neonates might have values within the reference range, yet those values might not be optimal for patient care. As an example, for a neonate born at 24 weeks’ gestation, now four weeks old, a venous hematocrit of 24% would be within the reference range. However, if such a patient develops a nosocomial infection, becomes hypoxemic and tachycardic, and is placed on a ventilator, the hematocrit of 24% might be too low for optimal patient care. A higher hematocrit might facilitate better tissue oxygenation, diminish the heart rate, and permit better caloric utilization for growth. Therefore, just because a value falls within the reference range does not assure that it is optimal for the clinical circumstance.

Type
Chapter
Information
Neonatal Hematology
Pathogenesis, Diagnosis, and Management of Hematologic Problems
 , pp. 385 - 408
Publisher: Cambridge University Press
Print publication year: 2013

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References

International Committee for Standardization in Haematology: recommendations for reference method for haemoglobinometry in human blood. J Clin Pathol 1978;31:139–43.
Jopling, J, Henry, E, Wiedmeier, SE, Christensen, RD. Reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period: data from a multihospital healthcare system. Pediatrics 2009;123;e333–77.Google Scholar
Wintrobe, MM. A simple and accurate hematocrit. J Lab Clin Med 1929;15:287–94.Google Scholar
Waugh, TF, Merchant, FT, Maugham, GB. Blood studies on newborn; determination of hemoglobin, volume of packed red cells, reticulocytes and fragility of erythrocytes over 9 day period. Am J Med Sci 1939;198:646–9.CrossRefGoogle Scholar
Perkins, SL. Principles of hematologic examination. In Wintrobe’s Clinical Hematology. Greer, JP, Foerster, J, Rodgers, GM, et al. eds. Philadelphia: Lippincott, Williams & Wilkins, 2009;3.
Gairdner, D, Marks, J, Bosco, JD. Blood formation in infancy: the normal bone marrow. Arch Dis Child 1952;27:124–32.Google ScholarPubMed
Christensen, RD, Jopling, J, Henry, E, et al. The erythrocyte indices of neonates, defined using data from over 12,000 patients in a multihospital healthcare system. J Perinatol 2008;28:24–8.CrossRefGoogle Scholar
Scott-Emuakpor, AB, Okolo, M, Omene, JA, Ukpe, SI. Normal hematological values of the African neonate. Blut 1985;51:11–18.CrossRefGoogle ScholarPubMed
Michaels, LA, Cohen, AR, Zhao, H, et al. Screening for hereditary spherocytosis by use of automated erythrocyte indexes. J Pediatr 1997;130:57–61.CrossRefGoogle ScholarPubMed
Dessypris, EN, Sawyer, ST. Erythropoiesis. In Wintrobe’s Clinical Hematology. Greer, JP, Foerster, J, Rodgers, GM, et al. eds. Philadelphia: Lippincott, Williams & Wilkins, 2009;108,109.
Killman, SA. On the size of normal human reticulocytes. Acta Med Scand 1964;176:529–31.CrossRefGoogle Scholar
Warwood, TL, Ohls, RK, Lambert, DK, et al. Urinary excretion of darbepoetin after intravenous vs. subcutaneous administration to preterm neonates. J Perinatol 2006;26:636–9.CrossRefGoogle ScholarPubMed
Wegelius, R. On changes in peripheral blood picture of newborn infant immediately after birth. Acta Paediatr 1948;35:1–6.Google Scholar
Humbert, JR, Abelson, H, Hathaway, WE, et al. Polycythemia in small for gestational age infants. J Pediatr 1969;75:812–18.CrossRefGoogle ScholarPubMed
Christensen, RD, Henry, E, Andres, RL, Bennett, ST. Neonatal reference ranges for blood concentrations of nucleated red blood cells. Neonatology 2010;99:289–94.CrossRefGoogle ScholarPubMed
Perrone, S, Vezzosi, P, Longini, M, et al. Nucleated red blood cell count in term and preterm newborns: reference values at birth. Arch Dis Child Fetal Neonatal Ed 2005;90:F174–5.CrossRefGoogle ScholarPubMed
Buonocore, G, Perrone, S, Gioia, D, et al. Nucleated red blood cell count at birth as an index of perinatal brain damage. Am J Obstet Gynecol 1999;181:1500–5.CrossRefGoogle ScholarPubMed
Green, DW, Hendon, B, Mimouni, FB. Nucleated erythrocytes and intraventricular hemorrhage in preterm neonates. Pediatrics 1995;96:475–8.Google ScholarPubMed
Zipursky, A. Erythrocyte morphology in newborn infants: a new look. Pediatr Res 1977;11:843–8.CrossRefGoogle Scholar
Pearson, EA, McIntosh, S, Rooks, Y, et al. Interference phase microscopic enumeration of pitted RBC and splenic hypofunction in sickle cell anemia. Pediatr Res 1978;12:471–5.Google Scholar
Vahlquist, B. Das Serumeisen. Eine padiatrischklinische und experimentelle Studie. Acta Paediatr 1941;28:1–9.Google Scholar
Oettinger, L Jr, Mills, WE. Simultaneous capillary and venous hemoglobin determinations in the newborn infant. J Pediatr 1949;35:362–70.CrossRefGoogle ScholarPubMed
Oh, W, Lind, J. Venous and capillary hematocrit in newborn infants and placental transfusion. Acta Paediatr Scand 1966;55:38–42.CrossRefGoogle ScholarPubMed
Moe, PJ. Umbilical cord blood and capillary blood in the evaluation of anemia in erythroblastosis fetalis. Acta Paediatr Scand 1967;56:391–400.CrossRefGoogle Scholar
Linderkamp, O, Versmold, HT, Strohhacker, I, et al. Capillary–venous hematocrit differences in newborn infants.1. Relationship to blood volume, peripheral blood flow and acid-base parameters. Eur J Pediatr 1977;127:9–14.CrossRefGoogle Scholar
Turner, CW, Luzins, J, Hutcheson, C. A modified harvest technique for cord blood hematopoietic stem cells. Bone Marrow Transpl 1992;10:89–92.Google ScholarPubMed
Yao, AC, Lind, J. Placental transfusion. Am J Dis Child 1974;127:128–34.Google ScholarPubMed
Yao, AC, Lind, J. Blood flow in the umbilical vessels during the third stage of labor. Biol, Neonate 1974;25:186–91.CrossRefGoogle ScholarPubMed
Barnett, HL, Einhorn, AH. Pediatrics, 15th edn. New York: Appleton-Century-Crofts, 1972;597.Google Scholar
Xanthou, M. Leukocyte blood picture in healthy full term and premature babies during the neonatal period. Arch Dis Child 1970;45:242–7.CrossRefGoogle ScholarPubMed
Zipursky, A, Palko, J, Milner, R, et al. The hematology of bacterial infections in premature infants. Pediatrics 1976;57:829–33.Google ScholarPubMed
Akenzua, GI, Hui, IT, Milner, R, et al. Neutrophil and band counts in the diagnosis of neonatal infection. Pediatrics 1974;54:38–43.Google Scholar
Manroe, BL, Weinberg, AG, Rosenfeld, CR, et al. The neonatal blood count in health and disease. 1. Reference values for neutrophilic cells. J Pediatr 1979;95:89–93.CrossRefGoogle ScholarPubMed
Christensen, RD, Rothstein, G. Pitfalls in the interpretation of leukocyte counts of newborn infants. Am J Clin Pathol 1979;72:608–12.CrossRefGoogle ScholarPubMed
Chervenick, PA, Boggs, DR, Marsh, JC, et al. Quantitative studies of blood and bone marrow neutrophils in normal mice. Am J Physiol 1968;215:353–9.Google ScholarPubMed
Mouzinho, A, Rosenfeld, CR, Sanchez, PJ, Risser, R. Revised reference ranges for circulating neutrophils in very-low-birth-weight neonates. Pediatrics 1994;94:76–81.Google ScholarPubMed
Maynard, EC, Reed, C, Kircher, T.Neutrophil counts in newborn infants at high altitude. J Pediatr 1993;122:990–1.CrossRefGoogle ScholarPubMed
Schmutz, N, Henry, E, Jopling, J, Christensen, RD. Expected ranges for blood neutrophil concentrations of neonates: the Manroe and Mouzinho charts revisited. J Perinatol 2008:28;275–81.CrossRefGoogle ScholarPubMed
Carballo, C, Foucar, K, Swanson, P et al. Effect of high altitude on neutrophil counts in newborn infants. J Pediatr 1991;119:464–6.CrossRefGoogle ScholarPubMed
Coulombel, L, Dehan, M, Tehernia, G, et al. The number of polymorphonuclear leukocytes in relation to gestational age in the newborn. Acta Paediatr Scand 1979;68:709–12.CrossRefGoogle ScholarPubMed
Lloyd, BW, Oto, A. Normal values for mature and immature neutrophils in very preterm babies. Arch Dis Child 1982;57:233–6.CrossRefGoogle ScholarPubMed
Calhoun, DA, Sullivan, SE, Lunøe, M, et al. Granulocyte-macrophage colony-stimulating factor and interleukin-5 concentrations in premature neonates with eosinophilia. J Perinatol 2000;20:166–71.CrossRefGoogle ScholarPubMed
Sullivan, SE, Calhoun, DA. Eosinophilia in the neonatal intensive care unit. Clin Perinatol 2000;27:603–9.CrossRefGoogle ScholarPubMed
Medoff, HS, Barbero, GJ. Total blood eosinophil counts in the newborn period. Pediatrics 1950;6:737–50.Google ScholarPubMed
Xanthou, M. Leucocyte blood picture in ill newborn babies. Arch Dis Child 1972;47:741–7.CrossRefGoogle ScholarPubMed
Burell, JM. A comparative study of the circulating eosinophil levels in babies. Arch Dis Child 1952;27:337–40.CrossRefGoogle Scholar
Bass, DA. Behavior of eosinophil leukocytes in acute inflammation. II Eosinophil dynamics during acute inflammation. J Clin Invest 1975;56:870–6.CrossRefGoogle ScholarPubMed
Gibson, JG Jr, Vaucher, Y, Corrigan, JJ. Eosinophilia in premature infants: relationship to weight gain. J Pediatr 1979;95:99–104.CrossRefGoogle ScholarPubMed
Portuguez-Molavasi, A, Cote-Boileau, T, Aranda, JV. Eosinophilia in the newborn, possible role in adverse drug reactions. Pediatr Res 1980;14:537–41.Google Scholar
Craver, RD. The cytology of cerebrospinal fluid associated with neonatal intraventricular hemorrhage. Pediatr Pathol Lab Med 1996;16:713–19.CrossRefGoogle ScholarPubMed
Christensen, RD, Jensen, J, Maheshwari, A, Henry, E. Reference ranges for blood concentrations of eosinophils and monocytes during the neonatal period defined from over 63 000 records in a multihospital health-care system. J Perinatol 2010;30(8):540–5.CrossRefGoogle Scholar
Thurlbeck, SM, McIntosh, N. Preterm blood counts vary with sampling site. Arch Dis Child 1987;62:74–9.CrossRefGoogle ScholarPubMed
Rogers, GM. In Wintrobe’s Clinical Hematology. Greer, JP, Foerster, J, Rodgers, GM, et al. eds. Philadelphia: Lippincott, Williams & Wilkins, 2009;1277.Google Scholar
Wiedmeier, SE, Henry, E, Sola-Visner, MC, Christensen, RD. Platelet reference ranges for neonates, defined using data from over 47,000 patients in a multihospital healthcare system. J Perinatol 2009:29;130–6.CrossRefGoogle Scholar
Peterec, SM, Brennan, SA, Tinder, EM, et al. Reticulated platelet values in normal and thrombocytopenic neonates. J Pediatr 1996;12:269–73.CrossRefGoogle Scholar
Joseph, MA, Adams, D, Maragos, J, Saving, KL. Flow cytometry of neonatal platelet RNA. J Pediatr Hematol Oncol 1966;18:277–81.CrossRefGoogle Scholar
Andrew, M, Castle, V, Mitchell, L, Paes, B. Modified bleeding time in the infant. Am J Hematol 1989;30:190–1.CrossRefGoogle ScholarPubMed
Del Vecchio, A, Latini, G, Henry, E, Christensen, RD. Template bleeding times of 240 neonates born at 24–41 weeks gestation. J Perinatol 2008;28:427–31.CrossRefGoogle Scholar
Boudewijns, M, Raes, M, Peeters, V, et al. Evaluation of platelet function on cord blood in 80 healthy term neonates using the Platelet Function Analyser (PFA-100); shorter in vitro bleeding times in neonates than adults. Eur J Pediatr 2003;162:212–13.CrossRefGoogle ScholarPubMed
Saxonhouse, MA, Garner, R, Mammel, L, et al. Closure times measured by the platelet function analyzer PFA-100 are longer in neonatal blood compared to cord blood samples. Neonatology 2010;97:242–9.CrossRefGoogle ScholarPubMed
Sheffield, MS, Schmutz, N, Lambert, DK, Henry, E, Christensen, RD. Ibuprofen lysine administration to neonates with a patent ductus arteriosus: effect on platelet plug formation assessed by in vivo and in vitro measurements. J Perinatol 2009;29: 39–43.CrossRefGoogle ScholarPubMed
Sheffield, MJ, Lambert, DK, Henry, E, Christensen, RD. Effect of ampicillin on the bleeding time of neonatal intensive care unit patients. J Perinatol 2010;30:527–30.CrossRefGoogle ScholarPubMed
Sheffield, MJ, Lambert, DK, Henry, E, Christensen, RD. Effect of ampicillin on bleeding time in very low birth weight neonates during the first week after birth. J Perinatol 2011 (in press).CrossRefGoogle ScholarPubMed
Sola, MC, Rimsza, LM, Christensen, RD. A bone marrow biopsy technique suitable for use in neonates. Br J Haematol 1999;107:458–60.CrossRefGoogle ScholarPubMed
Rosse, C, Kraemer, MJ, Dillon, TL, et al. Bone marrow cell populations of normal infants: the predominance of lymphocytes. J Lab Clin Med 1977;89:1228–32.Google ScholarPubMed
Shapiro, LM, Bassen, FA. Sternal marrow changes during first week of life. Am J Med Sci 1941;202:341–54.CrossRefGoogle Scholar

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