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Original research
Haemoglobin and red blood cell reference intervals during infancy
  1. Sara Marie Larsson1,2,
  2. Lena Hellström-Westas3,
  3. Andreas Hillarp4,
  4. Pia Karlsland Åkeson5,
  5. Magnus Domellöf6,
  6. Ulrica Askelöf7,
  7. Cecilia Götherström7,
  8. Ola Andersson2
  1. 1 Department of Clinical Chemistry, Halland Hospital, Halmstad/Varberg, Sweden
  2. 2 Department of Clinical Sciences Lund, Paediatrics, Lund University, Lund, Sweden
  3. 3 Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
  4. 4 Department of Translational Medicine, Lund University, Lund, Sweden
  5. 5 Department of Clinical Sciences Malmö, Preventive Paediatrics, Lund University, Lund, Sweden
  6. 6 Department of Clinical Sciences, Paediatrics, Umeå University, Umeå, Sweden
  7. 7 Department of Clinical Science, Intervention and Technology, Division of Obstetrics and Gynecology, Karolinska Institute, Stockholm, Sweden
  1. Correspondence to Sara Marie Larsson, Department of Clinical Chemistry, Halland Hospital, 301 85 Halmstad, Sweden; marie.larsson{at}med.lu.se

Abstract

Objectives There is a need for updated haematological reference data in infancy. This study aimed to define intervals for haemoglobin and red blood cell biomarkers based on data from a large cohort of longitudinally followed Swedish infants.

Design Longitudinal cohort study.

Setting Two Swedish study centres.

Participants Three community-based populations including 442 presumably healthy infants born at term and with umbilical cord clamping delayed to 30 s or more after birth.

Methods Blood samples were collected from umbilical cord blood (a), at 48–118 hours (b), at 4 months (c) and at 12 months (d). Reference intervals as the 2.5th and 97.5th percentiles were calculated in coherence with Clinical and Laboratory Standards Institute guidelines.

Results Reference intervals for haemoglobin (g/L) were: (a) 116–189, (b) 147–218, (c) 99–130, (d) 104–134, and for mean cell volume (fL): (a) 97–118, (b) 91–107, (c) 71–85, (d) 70–83. Reference intervals for erythrocyte counts, reticulocyte counts, reticulocyte haemoglobin, mean cell haemoglobin and mean cell haemoglobin concentration were also estimated. According to the WHO definition of anaemia, a haemoglobin value less than 110 g/L, 16% of this presumably healthy cohort could be classified as anaemic at 12 months.

Conclusion We found mainly narrower reference intervals compared with previously published studies. The reference intervals for each parameter varied according to the infants’ age, demonstrating the necessity of age definitions when presenting infant reference intervals. The discrepancy with the WHO classification for anaemia at 12 months, despite favourable conditions in infancy, needs future investigation.

  • biochemistry
  • statistics
  • growth
  • health services research
  • technology

Data availability statement

Data are available upon reasonable request. The data are not publicly available due to privacy or ethical reasons.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/archdischild-2021-321672

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    Data availability statement

    Data are available upon reasonable request. The data are not publicly available due to privacy or ethical reasons.

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    Footnotes

    • Contributors LH-W, MD, UA, CG and OA designed the original cord clamping studies. SML, AH and OA conceptualised this reference interval study. LH-W, MD, UA, CG and OA collected and curated the data. SML carried out the analyses and drafted the initial manuscript. LH-W, AH, OA, PKÅ, MD, UA and CG revised and reviewed the manuscript for important intellectual content. OA is the guarantor of the study.

    • Funding This study was supported by grants from the Regional Scientific Council of Halland and funds for development and research from the Swedish Southern Healthcare Region.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.