Hematologic reference values for African American children and adolescents

Abstract

Anemia is prevalent among African American children. When evaluating pediatric patients for anemia, clinicians refer to the normative hematological reference values in reference textbooks. These reference values are used in spite of evidence that healthy African American people of all ages have average hemoglobin concentrations from 0.5 to 0.73 g/dl below those of Whites. In an earlier study, using samples from 2,161 healthy African American children from 2 to 18 years old, we found a statistically significant difference (P < 0.0001) in the mean hemoglobin value for each age group as compared to reference normative mean hemoglobin values. Here we present the results of a comparative analysis of the data set from our previous study and the data set from the National Health and Nutrition Examination Surveys III (NHANES III) 1988–1994. We found no statistically significant difference between these data sets with respect to the hemoglobin values for any age or sex group, confirming that African American children and adolescents have lower mean hemoglobin values than do Whites. Use of the reference hemoglobin values presented here will help prevent the misdiagnosis of anemia in African American children and thereby minimize unnecessary hematological workups and treatment. Am. J. Hematol. 82: 2007. © 2006 Wiley‐Liss, Inc.

Insights from the Chronic Kidney Disease in Children (CKiD) Study

“…Generalized gamma modeling confirmed that differences in hemoglobin levels become more pronounced when moving from high to low in the overall hemoglobin distribution level. Noteworthy, however, is the finding that the average racial differences in hemoglobin levels in children with early-stage CKD parallel observed differences in otherwise healthy children (22), whereas the racial disparity widens as the children become more anemic in the context of CKD. Recently, a retrospective review of the NAPRTCS CKD registry identified the prevalence of anemia among children with stage 3 CKD (23).…”

Determinants of Anemia and Hemoglobin Concentration in Haitian School-Aged Children

“…Estimates for lower Hb threshold for African-Americans in the United States range from 0.5 to 1.0 g/dL. [13][14][15] Given the limited evidence supporting adjustment by race in global research contexts, WHO does not recommend adjustment; we thus applied the WHO thresholds for all analyses. No adjustment for altitude was necessary because Cap Haitien is less than 1,000 m above sea level.…”

Hematological and Biochemical Data Obtained in Rural Northern Uganda

“…Ranges for RBC count, hematocrit and hemoglobin values were generally broad when compared to Western reference intervals obtained from Pathology Associates Medical Laboratories [22]. The low hemoglobin; hematocrit; white blood cell, erythrocyte and platelet counts in Africans compared to northern European population or whites have been shown to be related to ethnicity and/or genetic factors [23,24,25]. Significant age differences for red cell indices were obtained when reference intervals were partitioned to two broad age groups (6–15 and 16–32 years-old).…”