Reference intervals for hemoglobin and mean corpuscular volume in an ethnically diverse community sample of Canadian children 2 to 36 months

Jemila S Hamid, Eshetu G Atenafu, Cornelia M Borkhoff, Catherine S Birken, Jonathon L Maguire, Mary Kathryn Bohn, Khosrow Adeli, Mohamed Abdelhaleem, Patricia C Parkin, Jemila S Hamid, Eshetu G Atenafu, Cornelia M Borkhoff, Catherine S Birken, Jonathon L Maguire, Mary Kathryn Bohn, Khosrow Adeli, Mohamed Abdelhaleem, Patricia C Parkin

Abstract

Objective: To establish reference intervals for hemoglobin and mean corpuscular volume (MCV) in an ethnically diverse community sample of Canadian children 36 months and younger.

Methods: We collected blood samples from young children at scheduled primary care health supervision visits at 2 weeks, 2, 4, 6, 9, 12, 15, 18, 24, and 36 months of age. Samples were analyzed on the Sysmex XN-9000 Hematology Analyzer. We followed the Clinical and Laboratory Standards Institute guidelines in our analysis. Data were partitioned by sex and also combined. We considered large age partitions (3 and 6 months) as well as monthly partitions. Reference intervals (lower and upper limits) and 90% confidence intervals were calculated.

Results: Data from 2106 children were included. The age range was 2 weeks to 36 months, 46% were female, 48% were European and 23% were of mixed ethnicity. For hemoglobin, from 2 to 36 months of age, we found a wide reference interval and the 90% confidence intervals indicated little difference across age groups or according to sex. For MCV, from 2 to 7 months of age there was considerable decrease in the reference interval, which was lowest during the second year of life, followed by a slight increase in the last months of the third year of life.

Conclusion: These findings suggest adoption of a single hemoglobin reference interval for children 2-36 months of age. Further studies in children under 4 months of age are needed.

Trial registration: TARGet Kids! cohort is registered at ClinicalTrials.gov. www.clinicaltrials.gov . Identifier: NCT01869530 .

Keywords: Hemoglobin; Mean corpuscular volume; Reference intervals.

Conflict of interest statement

CMB received the following unrelated to this study: an unrestricted research grant for a completed investigator-initiated study from the Sickkids Center for Healthy Active Kids (2015–2016).

CSB received the following unrelated to this study: a research grant from the Center for Addiction and Mental Health Foundation (2017–2020).

JLM received the following unrelated to this study: an unrestricted research grant for a completed investigator-initiated study from the Dairy Farmers of Canada (2011–2012), and Ddrops provided nonfinancial support (vitamin D supplements) for an investigator-initiated study on vitamin D and respiratory tract infections (2011–2015).

KA received the following unrelated to this study: a foundation grant from the Canadian Institutes of Health Research (Funding Reference Number: 353989).

PCP received the following related to this study: a grant from the Hospital for Sick Children Foundation, a grant from Canadian Institutes of Health Research (Funding Reference Number 115059); and the following unrelated to this study: nonfinancial support from Mead Johnson Nutrition (Fer-In-Sol liquid iron supplement; 2011–2017) for a completed investigator-initiated trial of iron deficiency in young children; unrestricted research grants for completed investigator-initiated studies from Danone Institute of Canada (2002–2004 and 2006–2009) and Dairy Farmers of Ontario (2008–2010).

These agencies had no role in the design, collection, analyses, or interpretation of the results of this work or in the preparation, review, or approval of this article; the other authors have indicated they have no financial relationships relevant to this article to disclose.

Figures

Fig. 1
Fig. 1
a and b Age-specific scatter plots by sex for hemoglobin (a) and MCV (b) for children from 2 weeks to 36 months of age

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