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Age and sex specific reference intervals of 13 hematological analytes in Chinese children and adolescents aged from 28 days up to 20 years: the PRINCE study

  • Wenqi Song , Ruohua Yan , Mingting Peng , Hong Jiang , Guixia Li , Sancheng Cao , Yongmei Jiang , Zhenxin Guo , Dapeng Chen , Hongling Yang , Jin Xu , Yong Chang , Yun Xiang , Min Zhao , Chenbin Li ORCID logo , Ying Shen , Fang Jin , Qiliang Li , Yan Wang , Yaguang Peng , Lixin Hu , Ying Liu , Xiaofei Zhang , Wenxiang Chen EMAIL logo , Xiaoxia Peng ORCID logo EMAIL logo and Xin Ni EMAIL logo
Published/Copyright: May 24, 2022
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 60 Issue 8

Abstract

Objectives

Pediatric Reference Intervals in China (PRINCE) is a nationwide initiative that aims to establish and validate harmonized reference intervals (RIs) for Chinese children and adolescents, in which 15,150 healthy volunteers aged up to 20 years were recruited from 11 centers to establish RIs and 7,557 children and adolescents were enrolled from 21 centers to validate RIs.

Methods

The complete blood cell counts (CBC) of venous whole blood were measured by hematology analyzers through Sysmex systems in different centers. Age- and sex-specific RIs were calculated according to the guidelines.

Results

Unlike adults with certain levels of analyte concentrations, hematological parameters of children changed through growth and development. Red blood cell counts, hemoglobin, and hematocrit increased with age, and revealed higher concentrations in boys than girls after puberty. White blood cell counts and platelet counts showed significant higher levels than adults before 2 years of age, and then gradually decreased without distinct sex differences. In addition, lymphocyte counts decreased with age while neutrophil counts showed an opposite trend. The lower and upper limits of pediatric RIs of CBC were different from those of adults.

Conclusions

The validation of RIs indicated that the PRINCE study provided a version of RIs suitable for most of regions in China. This first harmonized pediatric RIs of CBC across China provided a robust database to understand the dynamic changes of hematologic parameters from birth to adolescence, and will contribute to clinical diagnosis and prognosis evaluation for pediatric patients as well.

Keywords: China; complete blood cell count; hematology; pediatric; reference interval
Corresponding authors: Wenxiang Chen, National Center for Clinical Laboratories (NCCL), No. 1 Dahua Road, Beijing, 100730, P.R. China, Phone: 86-010-58115060, E-mail: ; and Xiaoxia Peng and Xin Ni, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, No. 56 Nanlishi Road, Beijing, 100045, P.R. China, Phone: 86-010-59617132 (X. Peng), 86-010-59616688 (X. Ni), E-mail: (X. Peng), (X. Ni)
Wenqi Song, Ruohua Yan, Mingting Peng, Hong Jiang, Guixia Li, Sancheng Cao, Yongmei Jiang, Zhenxin Guo, Dapeng Chen, Hongling Yang, Jin Xu, Yong Chang and Yun Xiang contributed equally to this work.

Funding source: The Medical Hospital Authority, National Health Commission of the People's Republic of China

Award Identifier / Grant number: No. 2017374

Acknowledgments

We thank Dr. Ali Abbas for his help in language polishing. We thank all of the members of workgroups in 11 medical centers for their hard work in participant recruitment and sample collection. At last, we specially thank all of the healthy children volunteers and their family.

  1. Research funding: This study was supported by the grant from the Medical Hospital Authority, National Health Commission of the People’s Republic of China (No. 2017374).

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

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from each participant’s legally authorized representative (parent or guardian) in the case of the child aged less than 8 years. Otherwise, the informed consent was obtained from both the child and his/her legally authorized representative.

  5. Ethical approval: The PRINCE study was approved by The Institutional Review Board of Beijing Children’s Hospital (2016-53). At the same time, the protocol was approved by the institutional review boards of other 10 collaborating centers.

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Supplementary Material

The online version of this article offers supplementary material (https://doi.org/10.1515/cclm-2022-0304).

Received: 2022-03-28
Accepted: 2022-05-10
Published Online: 2022-05-24
Published in Print: 2022-07-26

© 2022 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/cclm-2022-0304
Keywords for this article
China; complete blood cell count; hematology; pediatric; reference interval

Articles in the same Issue

  1. Frontmatter
  2. Editorial
  3. Transdermal measurement of cardiac troponins: the future is now
  4. Reviews
  5. Perinatal presepsin assessment: a new sepsis diagnostic tool?
  6. Hypertriglyceridemia, a causal risk factor for atherosclerosis, and its laboratory assessment
  7. Opinion Paper
  8. The novelties of the regulation on health technology assessment, a key achievement for the European union health policies
  9. General Clinical Chemistry and Laboratory Medicine
  10. Performance of four regression frameworks with varying precision profiles in simulated reference material commutability assessment
  11. Comparison of six regression-based lot-to-lot verification approaches
  12. Failure Mode and Effects Analysis (FMEA) at the preanalytical phase for POCT blood gas analysis: proposal for a shared proactive risk analysis model
  13. Evaluation of a pneumatic tube system carrier prototype with fixing mechanism allowing for automated unloading
  14. Analytical performance of eight enzymatic assays for ethanol in serum evaluated by data from the Belgian external quality assessment scheme
  15. Vitamin D metabolism in living kidney donors before and after organ donation
  16. Validation of steroid ratios for random urine by mass spectrometry to detect 5α-reductase deficiency in Vietnamese children
  17. Evaluation of serum neurofilament light in the early management of mTBI patients
  18. Assessment of urine sample quality by the simultaneous measurement of urinary γ-glutamyltransferase and lactate dehydrogenase enzyme activities: possible application to unravel cheating in drugs of abuse testing
  19. Reference Values and Biological Variations
  20. Age and sex specific reference intervals of 13 hematological analytes in Chinese children and adolescents aged from 28 days up to 20 years: the PRINCE study
  21. Cancer Diagnostics
  22. Prostate health index (PHI) as a reliable biomarker for prostate cancer: a systematic review and meta-analysis
  23. A comparison of the faecal haemoglobin concentrations and diagnostic accuracy in patients suspected with colorectal cancer and serious bowel disease as reported on four different faecal immunochemical test systems
  24. Circulating cell-free DNA undergoes significant decline in yield after prolonged storage time in both plasma and purified form
  25. Cardiovascular Diseases
  26. Analytical and clinical performance evaluation of a new high-sensitivity cardiac troponin I assay
  27. Infectious Diseases
  28. Results of a SARS-CoV-2 virus genome detection external quality assessment round focusing on sensitivity of assays and pooling of samples
  29. Letters to the Editors
  30. Improving D-dimer testing appropriateness by controlling periodicity of retesting: prevention is better than cure
  31. Biological variation of serum cholinesterase catalytic concentrations
  32. Three-month ad interim analysis of total anti-SARS-CoV-2 antibodies in healthy recipient of a single BNT162b2 vaccine booster
  33. Fibrin strands in peripheral blood smear: the COVID-19 era
  34. Fragments of alpha-1-antitrypsin in patients with severe COVID-19 and bacterial pulmonary sepsis
  35. Comparison of thyroid stimulating hormone, free thyroxine, total triiodothyronine, thyroglobulin and peroxidase antibodies measurements by two different platforms
  36. Effect of different incubation times on the detection of factor VIII inhibitor in acquired hemophilia A
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