Observed full blood count and lymphocyte subset values in a cohort of clinically healthy South African children from a semi-informal settlement in Cape Town

Abstract

Background. The paediatric full blood count and lymphocyte subset reference intervals used by the National Health Laboratory Service (NHLS), South Africa (SA), are taken from two international reference interval publications. Differences in reference intervals suggest that international data sets may not be appropriate for use in SA. Objective. To study immunohaematological values of a group of clinically healthy children from an informal settlement in Cape Town, SA, to assess whether international paediatric reference intervals used by the NHLS are appropriate. Methods. A cross-sectional study of 207 female and 174 male HIV-uninfected children living in an informal settlement in Cape Town was performed. Full blood counts, automated differential counts and lymphocyte subset analysis were done using internationally accepted technologies. Data were categorised by age and reference intervals compiled using medians and 95% confidence intervals (CIs). Gender comparisons were calculated by non-parametric tests. Results. Although median and 95% CI values differed slightly, physiological trends for red cell, platelet, white blood cell differential and lymphocyte subsets were similar to international reference intervals currently in use at the NHLS. Benign ethnic neutropenia was not a significant finding, and gender-specific intervals were not necessary until 12 years of age. Lower overall median values for haemoglobin and haematocrit, and higher median values for mean cell volume and red cell distribution width, were noted. Assessment of haemoglobin, red cell distribution width and calculated Mentzer ratios suggested underlying iron deficiency in 14.2% of participants. Conclusion. Paediatric immunohaematological reference intervals observed in this study are similar to, and support continued use of, international paediatric reference intervals. Underlying iron and related nutritional deficiencies may be contributing to lower haemoglobin levels noted in local children. A larger nationwide study, including all ethnic groups, is recommended.

Thymic Output and CD4 T-Cell Reconstitution in HIV-Infected Children on Early and Interrupted Antiretroviral Treatment: Evidence from the Children with HIV Early Antiretroviral Therapy Trial

“…Importantly, Figure 3 C also shows that even though these children started ART early, aged between 6 and 12 weeks, the stable average CD4 z -score was significantly below 0. For comparison, CD4 z -scores in >400 HIV-uninfected South African children from the CWC ( 19 ) had mean ± SEM −0.06 ± 0.05, significantly higher than the HIV-infected children on early ART. When early ART was initiated, CD4 z -scores were comparable to infants randomized to defer treatment (−0.82 ± 0.07 versus −0.64 ± 0.09).…”

“…To compare reference values between the European children used to calculate z -scores and Black African children living in Africa, immunophenotypic data were obtained from the Child Wellness Clinic (CWC) for children from birth up to 12 years of age, established at a community health clinic in Wesbank, a suburb in the Eastern subdistrict of Cape Town. The primary aim of the CWC was to acquire HIV-uninfected blood specimens comparable to CHER participants in terms of intercurrent infection, nutrition, vaccination, and socio-economic status to establish hematological and immunological reference ranges ( 19 ) and measure thymic output in healthy children. The z -scores calculated for this population as described above were comparable to the European z -scores and were also compared with HIV-infected children (see Results ).…”

Complete blood count reference intervals from a healthy adult urban population in Kenya

“…Menstruating women returned in 2 weeks. CBC analyser : Beckman Coulter LH 750 (Beckman Coulter, Fullerton, CA, USA) [ 25 ].…”

Neutrophil Counts in Healthy South African Infants: Implications for Enrollment and Adverse Event Grading in Clinical Trials in an African Setting

“…In that study, the median ANC in infants 0-3 months of age was 2360 cells/mm 3 (95% CI, 1260-5200 cells/mm 3 ). 16 This difference may be due to the proportion of participants of mixed ethnic ancestry in their study, whereas our study population almost exclusively comprised black Africans. Although attempts have been made to establish hematology reference ranges for healthy African adults, 17 we are not aware of a similar study among children <5 years of age.…”