A multicentre study of reference intervals for haemoglobin, basic blood cell counts and erythrocyte indices in the adult population of the Nordic countries

Abstract

Eight haematological quantities were measured in EDTA anticoagulated venous blood specimens collected from 1826 healthy male and female individuals between 18 and 90 years of age in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden). The samples, collected between November 1999 and November 2001 as part of the Nordic Reference Interval Project (NORIP), were analysed on 12 different types of modern automated haematology instruments currently in use among the 60 laboratories participating in the study. Non-parametric reference intervals (between 2.5 and 97.5 percentiles) have been calculated for B-Haemoglobin (females 117-153 g/L, males 134-170 g/L), B-Erythrocytes (females 3.94-5.16 x 10(12)/L, males 4.25-5.71 x 10(12)/L), B-EVF (females 0.348-0.459, males 0.395-0.500), B-MCV (82-98 fL), Erc-MCH (27.1-33.3 pg), Erc-MCHC (317-357 g/L), B-Trc (females 165-387 x 10(9)/L, males 145 x 348 x 10(9)/L) and B-Lkc (3.5-8.8 x 10(9)/L). Partitioning of data according to age and gender was done according to a standardized procedure. For most variables the calculated reference intervals corresponded well with older and less well-defined reference intervals. The mean concentration of B-Haemoglobin increased by 0.08 g/L per year of age in women, and decreased by 0.1 g/L per year of age in men. B-Haemoglobin increased with body mass index in both men and women. Smoking increased the mean of B-Lkc by 1.1 x 10(9)/L and regular use of alcohol increased the mean of B-MCV by 0.8 fL. The influence of these factors was small overall and did not promote specific reference intervals.

Blood haemoglobin concentrations are higher in smokers and heavy alcohol consumers than in non-smokers and abstainers—should we adjust the reference range?

“…Serum ferritin was measured by an immunoradiometric assay (Phadebas Ferritin PRIST ® , Pharmacia Diagnostics, Uppsala, Sweden) [10]. According to the results obtained in our previous studies [2,3] we considered serum ferritin values >20 μg/l to be consistent with the absence of iron deficiency anaemia.…”

“…Furthermore, among consistent smokers, there was a positive dose-response relationship between change in cigarettes smoked per day and change in haemoglobin. Nordin et al [3] established haematological reference intervals in the Nordic Reference Interval Project comprising 1,826 subjects (866 men) 18-90 years of age, of whom 14% were regular smokers. Haemoglobin decreased with age in men; this was probably due to the large age variation with inclusion of elderly men.…”

“…In epidemiological studies, low and high haemoglobin levels, even within the reference range, are predictors of mortality [1,2]. The establishment of appropriate reference ranges in healthy populations is therefore of paramount importance [3].…”

“…smokers displayed higher levels than non-smokers. Search of the literature disclosed several papers reporting an association between smoking and haemoglobin [2,3,[6][7][8], although the studies were not specifically designed to evaluate this topic. The widespread and variable habit of smoking makes it a potential confounder in the establishment of normal reference ranges for haemoglobin.…”

Whether western normative laboratory values used for clinical diagnosis are applicable to Indian population? An overview on reference interval

“…A total of 124744 reference values were obtained. Apart from the main project, the reference interval common hematology analytes were also determined by laboratories in Finland and Sweden (71). A central bio bank was also created by depositing reference sample aliquots for further analysis.…”