Mulu Wondemagegn, Abera Bayeh, Mekonnen Zewdie, Adem Yesuf, Yimer Mulat, Zenebe Yohannes, Amuamuta Asmare, Gebeyehu Wondimu
Department of Medical Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Biomedical Research Department, Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia.
PLoS One. 2017 Jul 19;12(7):e0181268. doi: 10.1371/journal.pone.0181268. eCollection 2017.
Establishing national population haematological and immunological reference ranges are essential for clinical management of patients. However, there is scarcity of information on community based haematological reference ranges established from Ethiopian population. Therefore, this study aimed at determining haematological and CD4+ T cells reference ranges in healthy adults from East and West Gojjam zones, Ethiopia.
Community based cross-sectional study was conducted from May 2015 to December 2015 in healthy adult residents of Gojjam zone. A total of 481(246 females and 235 males) healthy adults enrolled in the study. Healthy adults were defined by medical history, physical examination and laboratory screening for HIV, HBV, HCV and intestinal parasitosis. Haematological parameters were measured using haematology analyzer MindrayBC320 (Mindray Biomedical electronic Corporation, China). CD4+Tcells were enumerated using FACS count (Becton Dickinson).
The median age of the participants was 25 years. The overall median and 95th percentile of CD4+ T cells count were 869 cells/mm3 and396-1598 cells/mm3, respectively. Females had a significantly higher CD4+ T cell counts compared to males (P = 0.002). The 95th percentile range for red blood cells (RBCs) was 3.93-6.1 x 106cells/mm3and for hematocrit (Hct) was 40-58% while for hemoglobin (Hb) was 15.69-17.84g/dl. Males had significantly higher values of RBC and Hct than females (P < 0.001). Females (120-379 x 106 cells/mm3) had significantly higher platelet counts than males (106-352 x106 cells/mm3) (P < 0.001). The overall median of WBC was6.78 x103/mm3and its95thpercentile range was3.5-11.5 x103/mm3. The overall 95th percentile range of MCV, MCH and MCHC were 89.5-107.5 fl, 28-34 pg and 30-33.2g/dl, respectively. The higher mean absolute count of RBCs was found in the youngest age groups (P = 0.03). The mean count of RBCs and Hct were significantly higher in highschool completed and above than other participants (P < 0.001). The lower and upper limit of platelet counts was significantly higher in highland (118 -383x106 cells/mm3) compared to lowland residents (107-352 x106 cells/mm3) (P < 0.001). Moreover, it was significantly higher in residents with better monthly income (124-383 x106 cells/mm3) compared to the counters (115-368 x106 cells/mm3) (P = 0.02).
Some of the haematological and CD4+ T cells reference ranges of the healthy adults in this study showed variations with the reference ranges used and reported so far in Ethiopia, Africa and Western countries. We recommend further study considering gender, altitude, and residency in other parts of Ethiopia to establish national reference ranges for Ethiopian population.
建立全国性的血液学和免疫学参考范围对于患者的临床管理至关重要。然而，关于基于埃塞俄比亚人群建立的社区血液学参考范围的信息却很匮乏。因此，本研究旨在确定埃塞俄比亚戈贾姆地区东部和西部健康成年人的血液学和CD4 + T细胞参考范围。
2015年5月至2015年12月，在戈贾姆地区的健康成年居民中进行了基于社区的横断面研究。共有481名（246名女性和235名男性）健康成年人参与了该研究。通过病史、体格检查以及对HIV、HBV、HCV和肠道寄生虫病的实验室筛查来定义健康成年人。使用迈瑞BC320血液分析仪（迈瑞生物医疗电子股份有限公司，中国）测量血液学参数。使用流式细胞仪计数（贝克曼库尔特公司）对CD4 + T细胞进行计数。
参与者的中位年龄为25岁。CD4 + T细胞计数的总体中位数和第95百分位数分别为869个细胞/mm³和396 - 1598个细胞/mm³。女性的CD4 + T细胞计数显著高于男性（P = 0.002）。红细胞（RBC）的第95百分位数范围为3.93 - 6.1×10⁶个细胞/mm³，血细胞比容（Hct）为40 - 58%，血红蛋白（Hb）为15.69 - 17.84g/dl。男性的RBC和Hct值显著高于女性（P < 0.001）。女性（120 - 379×10⁶个细胞/mm³）的血小板计数显著高于男性（106 - 352×10⁶个细胞/mm³）（P < 0.001）。白细胞（WBC）的总体中位数为6.78×10³/mm³，其第95百分位数范围为3.5 - 11.5×10³/mm³。平均红细胞体积（MCV）、平均红细胞血红蛋白含量（MCH）和平均红细胞血红蛋白浓度（MCHC）的总体第95百分位数范围分别为89.5 - 107.5fl、28 - 34pg和30 - 33.2g/dl。在最年轻的年龄组中发现红细胞的平均绝对计数较高（P = 0.03）。完成高中及以上学历的参与者的红细胞计数和血细胞比容平均值显著高于其他参与者（P < 0.001）。与低地居民（107 - 352×10⁶个细胞/mm³）相比，高地居民（118 - 383×10⁶个细胞/mm³）的血小板计数下限和上限显著更高（P < 0.001）。此外，月收入较高的居民（124 - 383×10⁶个细胞/mm³）的血小板计数显著高于收入较低的居民（115 - 368×10⁶个细胞/mm³）（P = 0.02）。
本研究中健康成年人的一些血液学和CD4 + T细胞参考范围与埃塞俄比亚、非洲和西方国家目前使用和报告的参考范围存在差异。我们建议在埃塞俄比亚其他地区进一步开展考虑性别、海拔和居住情况的研究，以建立埃塞俄比亚人群的全国参考范围。
