Laboratory practice of reference intervals modification for children's
blood cell analysis in China
Background: The unreliability of reference intervals (RIs) for
children’s blood cell analysis has led to an unnecessary effort in
interpreting results. The Standard published in 2021 is expected to
solve this problem in China but should be clinically evaluated before
its application. Methods: Compared with the laboratory’s
original RIs, the RIs’ numerical trends were mapped and analyzed, and
the data of the past seven years were retrospectively re-interpreted.
Pediatricians were then consulted to discuss the data analyses.
Results: The new RIs were summarized as follows: 1) The age
stratification is more detailed; 2) The venous blood and peripheral
blood are characterized; 3) The numerical range was relatively more
comprehensive, and some parameters were unilaterally shifted.
Retrospective analysis showed that the revised RIs could correct
previously abnormal results to the normal range in a large proportion.
The recovery ratio of three lineage cells was white blood cells
> red blood cells > platelets, and the ratio
sorted by age is 28 days~1-year-old >
1~13years old > 13~18 years
old. The leukocyte recovery ratio of 28 days~1 year was
the largest, approximately 55% to 83%. Pediatricians recognized the
value of the new RIs. The only exception is that the platelets’ RIs were
too broad, recommending maintaining the original RI. The missing
0~28 days RIs were recommended to be supplemented with
other reference books. Conclusions: The new RIs were optimized
and, combined with clinical feedback, produced new RIs derived from
accumulated experience, evolving a better set of RIs.