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A comparison of complete blood count reference intervals in healthy elderly vs. younger Korean adults: a large population study

  • Eun Jin Lee , Miyoung Kim EMAIL logo , Eunyup Lee , Kibum Jeon , Jiwon Lee , Jee-Soo Lee , Han-Sung Kim , Hee Jung Kang and Young Kyung Lee
Published/Copyright: September 18, 2018
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 57 Issue 5

Abstract

Background

The use of laboratory reference intervals based on younger populations is of questionable validity in older populations. We established reference intervals for 16 complete blood count (CBC) parameters in healthy elderly Koreans aged ≥60 years and compared them to those of individuals aged 20–59 years.

Methods

Among 64,532 individuals (39,609 men and 24,923 women) aged ≥20 years who underwent medical checkups, 8151 healthy subjects (12.6%, 5270 men and 2881 women, including 675 and 511, respectively, who were ≥60 years of age) were enrolled based on stringent criteria including laboratory, imaging and endoscopy results; previous medical history; and medication history. CBC parameters were measured using an Advia2120i instrument.

Results

Overall, healthy individuals aged ≥60 years did not require separate reference intervals from those aged <60 years except for red cell distribution width (RDW) and mean corpuscular hemoglobin (MCH) in women. However, subjects aged ≥60 years still required sex-specific reference intervals for red blood cell count, hemoglobin, hematocrit, MCH, monocytes and eosinophils. Separate reference intervals were required for MCH, eosinophils and basophils for certain age subgroups of men aged ≥60 years, and for MCH and RDW in certain age subgroups of women aged ≥60 years, compared to counterparts <60 years of age.

Conclusions

Healthy elderly Koreans can use the same reference intervals as younger populations. Thus, abnormal CBC results may not necessarily be attributable to physiologic changes but possible underlying diseases that should be investigated.

Keywords: complete blood cell count; elderlies; geriatrics; nonparametric method; reference intervals
Corresponding author: Miyoung Kim, MD, PhD, Department of Laboratory Medicine, Hallym University College of Medicine, Hallym University Sacred Heart Hospital, 22, Gwanpyeong-ro 170 beon-gil, Dongan-gu, Anyang, Gyeonggi-do 14068, Republic of Korea, Phone: +82 31 380 1795, Fax: +82 31 380 1798

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: The study was supported by the Hallym University Medical Center CDW Research Fund.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

References

1. Adeli K, Higgins V, Nieuwesteeg M, Raizman JE, Chen Y, Wong SL, et al. Biochemical marker reference values across pediatric, adult, and geriatric ages: establishment of robust pediatric and adult reference intervals on the basis of the Canadian Health Measures Survey. Clin Chem 2015;61:1049–62.10.1373/clinchem.2015.240515Search in Google Scholar PubMed

2. Zierk J, Arzideh F, Rechenauer T, Haeckel R, Rascher W, Metzler M, et al. Age- and sex-specific dynamics in 22 hematologic and biochemical analytes from birth to adolescence. Clin Chem 2015;61:964–73.10.1373/clinchem.2015.239731Search in Google Scholar PubMed

3. Lee HR, Shin S, Yoon JH, Roh EY, Chang JY. Reference intervals of hematology and clinical chemistry analytes for 1-year-old Korean children. Ann Lab Med 2016;36:481–8.10.3343/alm.2016.36.5.481Search in Google Scholar PubMed PubMed Central

4. Tsang CW, Lazarus R, Smith W, Mitchell P, Koutts J, Burnett L. Hematological indices in an older population sample: derivation of healthy reference values. Clin Chem 1998;44:96–101.Search in Google Scholar

5. Ridefelt P, Hellberg D, Aldrimer M, Gustafsson J. Estimating reliable paediatric reference intervals in clinical chemistry and haematology. Acta Paediatr 2014;103:10–5.10.1111/apa.12438Search in Google Scholar PubMed

6. Wu X, Zhao M, Pan B, Zhang J, Peng M, Wang L, et al. Complete blood count reference intervals for healthy Han Chinese adults. PLoS One 2015;10:e0119669.10.1371/journal.pone.0119669Search in Google Scholar PubMed PubMed Central

7. Woo J, Arumanayagam M, Ho SC, Swaminathan R. Hematological indices and the prevalence of anemia in an elderly Chinese population. Pathology 1989;21:31–4.10.3109/00313028909059527Search in Google Scholar PubMed

8. Janu MR, Creasey H, Grayson DA, Cullen JS, Whyte S, Brooks WS, et al. Laboratory results in the elderly: the Sydney Older Persons Study. Ann Clin Biochem 2003;40:274–9.10.1258/000456303321610600Search in Google Scholar PubMed

9. Mugisha JO, Seeley J, Kuper H. Population based haematology reference ranges for old people in rural South-West Uganda. BMC Res Notes 2016;9:433.10.1186/s13104-016-2217-xSearch in Google Scholar PubMed PubMed Central

10. Clinical and Laboratory Standards Institute. Defining, establishing, and verifying reference intervals in the clinical laboratory; Approved Guideline-Third Edition. EP EP28-A3. Wayne, PA: Clinical and Laboratory Standards Institute, 2010.Search in Google Scholar

11. Kim YJ, Cribbie RA. ANOVA and the variance homogeneity assumption: exploring a better gatekeeper. Br J Math Stat Psychol 2018;71:1–12.10.1111/bmsp.12103Search in Google Scholar PubMed

12. Reed AH, Henry RJ, Mason WB. Influence of statistical method used on the resulting estimate of normal range. Clin Chem 1971;17:275–84.10.1093/clinchem/17.4.275Search in Google Scholar

13. Harris EK, Boyd JC. On dividing reference data into subgroups to produce separate reference ranges. Clin Chem 1990;36:265–70.10.1093/clinchem/36.2.265Search in Google Scholar

14. Solberg HE. The theory of reference values Part 5. Statistical treatment of collected reference values. Determination of reference limits. J Clin Chem Clin Biochem 1983;21:749–60.10.1016/0009-8981(84)90319-XSearch in Google Scholar

15. Abraham EC, Taylor JF, Lang CA. Influence of mouse age and erythrocyte age on glutathione metabolism. Biochem J 1978;174:819–25.10.1042/bj1740819Search in Google Scholar

16. Ozarda Y, Ichihara K, Bakan E, Polat H, Ozturk N, Baygutalp NK, et al. A nationwide multicentre study in Turkey for establishing reference intervals of haematological parameters with novel use of a panel of whole blood. Biochem Med (Zagreb) 2017;27:350–77.10.11613/BM.2017.038Search in Google Scholar

17. Horn PS, Pesce AJ, Copeland BE. Reference interval computation using robust vs. parametric and nonparametric analyses. Clin Chem 1999;45:2284–5.10.1093/clinchem/45.12.2284Search in Google Scholar

18. Magnani M, Rossi L, Stocchi V, Cucchiarini L, Piacentini G, Fornaini G. Effect of age on some properties of mice erythrocytes. Mech Ageing Dev 1988;42:37–47.10.1016/0047-6374(88)90061-9Search in Google Scholar

19. Glass GA, Gershon H, Gershon D. The effect of donor and cell age on several characteristics of rat erythrocytes. Exp Hematol 1983;11:987–95.Search in Google Scholar

20. Vömel T, Platt D. Lifespan of rabbit erythrocytes and activity of the reticulohistiocyte system. Mech Ageing Dev 1981;17:261–6.10.1016/0047-6374(81)90063-4Search in Google Scholar

21. Gowanlock Z, Sriram S, Martin A, Xenocostas A, Lazo-Langner A. Erythropoietin levels in elderly patients with anemia of unknown etiology. PLoS One 2016;11:e0157279.10.1371/journal.pone.0157279Search in Google Scholar PubMed PubMed Central

22. Makipour S, Kanapuru B, Ershler WB. Unexplained anemia in the elderly. Semin Hematol 2008;45:250–4.10.1053/j.seminhematol.2008.06.003Search in Google Scholar PubMed PubMed Central

23. Ferrucci L, Maggio M, Bandinelli S, Basaria S, Lauretani F, Ble A, et al. Low testosterone levels and the risk of anemia in older men and women. Arch Intern Med 2006;166:1380–8.10.1001/archinte.166.13.1380Search in Google Scholar PubMed PubMed Central

24. Valiathan R, Ashman M, Asthana D. Effects of ageing on the immune system: infants to elderly. Scand J Immunol 2016;83:255–66.10.1111/sji.12413Search in Google Scholar PubMed

25. Bovill EG, Bild DE, Heiss G, Kuller LH, Lee MH, Rock R, et al. White blood cell counts in persons aged 65 years or more from the Cardiovascular Health Study. Correlations with baseline clinical and demographic characteristics. Am J Epidemiol 1996;143:1107–15.10.1093/oxfordjournals.aje.a008687Search in Google Scholar PubMed

Received: 2018-06-22
Accepted: 2018-08-16
Published Online: 2018-09-18
Published in Print: 2019-04-24

©2019 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2018-0649
Keywords for this article
complete blood cell count; elderlies; geriatrics; nonparametric method; reference intervals

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  2. Editorial
  3. Cardiac biomarkers – 2019
  4. Reviews
  5. Current understanding and future directions in the application of TIMP-2 and IGFBP7 in AKI clinical practice
  6. Serum cytokines, adipokines and ferritin for non-invasive assessment of liver fibrosis in chronic liver disease: a systematic review
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  13. Genetics and Molecular Diagnostics
  14. Droplet digital PCR for the simultaneous analysis of minimal residual disease and hematopoietic chimerism after allogeneic cell transplantation
  15. General Clinical Chemistry and Laboratory Medicine
  16. Commutable whole blood reference materials for hemoglobin A1c validated on multiple clinical analyzers
  17. When results matter: reliable creatinine concentrations in hyperbilirubinemia patients
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