Next-generation reference intervals for pediatric hematology

Zierk J, Hirschmann J, Toddenroth D, Arzideh F, Haeckel R, Bertram A, Cario H, Frühwald MC, Groß HJ, Groening A, Grützner S, Gscheidmeier T, Hoff T, Hoffmann R, Klauke R, Krebs A, Lichtinghagen R, Mühlenbrock-Lenter S, Neumann M, Nöllke P, Niemeyer CM, Razum O, Ruf HG, Steigerwald U, Streichert T, Torge A, Rascher W, Prokosch HU, Rauh M, Metzler M (2019)

Publication Type: Journal article

Publication year: 2019

Journal

DOI: 10.1515/cclm-2018-1236

Abstract

Interpreting hematology analytes in children is challenging due to the extensive changes in hematopoiesis that accompany physiological development and lead to pronounced sex- and age-specific dynamics. Continuous percentile charts from birth to adulthood allow accurate consideration of these dynamics. However, the ethical and practical challenges unique to pediatric reference intervals have restricted the creation of such percentile charts, and limitations in current approaches to laboratory test result displays restrict their use when guiding clinical decisions. We employed an improved data-driven approach to create percentile charts from laboratory data collected during patient care in 10 German centers (9,576,910 samples from 358,292 patients, 412,905-1,278,987 samples per analyte). We demonstrate visualization of hematology test results using percentile charts and z-scores (www.pedref.org/hematology) and assess the potential of percentiles and z-scores to support diagnosis of different hematological diseases. We created percentile charts for hemoglobin, hematocrit, red cell indices, red cell count, red cell distribution width, white cell count and platelet count in girls and boys from birth to 18 years of age. Comparison of pediatricians evaluating complex clinical scenarios using percentile charts versus conventional/tabular representations shows that percentile charts can enhance physician assessment in selected example cases. Age-specific percentiles and z-scores, compared with absolute test results, improve the identification of children with blood count abnormalities and the discrimination between different hematological diseases. The provided reference intervals enable precise assessment of pediatric hematology test results. Representation of test results using percentiles and z-scores facilitates their interpretation and demonstrates the potential of digital approaches to improve clinical decision-making.

Authors with CRIS profile

Involved external institutions

Inselspital, Universitätsspital Bern Switzerland (CH) Universität Bremen Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Universitätsklinikum Würzburg Germany (DE) Universitätsklinikum Köln Germany (DE) Albert-Ludwigs-Universität Freiburg Germany (DE) Klinikum Augsburg Germany (DE) Klinikverbund Bremen (Gesundheit Nord) Germany (DE) amedes Medizinische Dienstleistungen GmbH Germany (DE) Universität Bielefeld Germany (DE) MVZ Labor PD Dr. Volkmann und Kollegen Germany (DE)

How to cite

APA:

Zierk, J., Hirschmann, J., Toddenroth, D., Arzideh, F., Haeckel, R., Bertram, A.,... Metzler, M. (2019). Next-generation reference intervals for pediatric hematology. Clinical Chemistry and Laboratory Medicine. https://dx.doi.org/10.1515/cclm-2018-1236

MLA:

Zierk, Jakob, et al. "Next-generation reference intervals for pediatric hematology." Clinical Chemistry and Laboratory Medicine (2019).

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