Beckman Coulter Inc., Moscow, Russia.
Faculty of Health Sciences, Yamaguchi University Graduate School of Medicine, Ube, Japan.
PLoS One. 2024 Sep 30;19(9):e0304020. doi: 10.1371/journal.pone.0304020. eCollection 2024.
This study aimed to establish reference intervals (RIs) for Russian adults for hematological parameters including related iron markers and vitamins. Sources of variation of reference values (RVs) and needs for secondary exclusion were explored for proper derivations of RIs.
Following the harmonized protocol of the IFCC Committee on Reference Intervals and Decision Limits (C-RIDL), 506 healthy Russians (age 18-80; 46% male) were recruited. Complete blood counts (CBC) and leukocyte differentials, iron markers, vitamin B12, and folate were measured by Beckman Coulter's analyzers. Sources of variation were analyzed by multiple regression analysis, and ANOVAs, and the need for partitioning RVs was decided accordingly. Two schemes of excluding latent anemia were compared: (1) latent abnormal values exclusion method (LAVE) based on associations among CBC parameters, or (2) explicit exclusion of individuals with either ferritin or iron below the respective lower limit of the manufacturer. RIs were determined by the parametric method using two-parameter Box-Cox formula.
Gender-specific RIs were required for most analytes, while age-specific RIs were set only for ferritin in females. A BMI-related increase in RVs was prominently observed for reticulocyte parameters, hence we chose to exclude individuals with BMI>28 kg/m2 when establishing the RIs. The LAVE method was more effective in excluding individuals with latent anemia, than exclusion based on low ferritin and/or iron values. International comparison revealed that Russian RIs featured a lower side shift of platelet counts. Similar to African countries, Russian RIs for total leukocyte and neutrophil counts were lower compared to most of other countries.
RIs for the Russian population for 34 hematological and related parameters were established using up-to-date methods proposed by C-RIDL. Reducing the influences of latent anemia and obesity on RIs was crucial for erythrocyte parameters. Low levels of Russian RIs observed for platelet and neutrophil counts need further investigation.
本研究旨在为俄罗斯成年人建立血液学参数的参考区间（RI），包括相关的铁标志物和维生素。本研究探索了参考值（RV）的变化来源和二次排除的需求，以正确推导 RI。
根据 IFCC 参考区间和决策限委员会（C-RIDL）的协调方案，招募了 506 名健康的俄罗斯人（年龄 18-80 岁；46%为男性）。使用贝克曼库尔特分析仪测量全血细胞计数（CBC）和白细胞分类、铁标志物、维生素 B12 和叶酸。通过多元回归分析和方差分析来分析变异来源，并相应决定 RV 分区的必要性。比较了两种排除潜在贫血的方案：（1）基于 CBC 参数之间关联的潜在异常值排除法（LAVE），或（2）根据制造商提供的铁蛋白或铁值低于各自下限，明确排除个体。使用双参数 Box-Cox 公式通过参数方法确定 RI。
大多数分析物需要性别特异性 RI，而女性的铁蛋白仅设定年龄特异性 RI。观察到 RV 与体重指数（BMI）呈正相关，因此在建立 RI 时，我们选择排除 BMI>28 kg/m2 的个体。与基于低铁蛋白和/或铁值的排除相比，LAVE 方法更有效地排除潜在贫血个体。国际比较显示，俄罗斯的血小板计数 RI 偏低。与非洲国家一样，俄罗斯的总白细胞和中性粒细胞计数 RI 低于大多数其他国家。
使用 C-RIDL 提出的最新方法，为俄罗斯人群建立了 34 种血液学和相关参数的 RI。对于红细胞参数，降低潜在贫血和肥胖对 RI 的影响至关重要。观察到俄罗斯血小板和中性粒细胞计数 RI 较低，需要进一步研究。
