Hematological reference values

The normal range for most hematologic parameters in infancy and childhood is different from that in adults. Dramatic changes occur during the first few weeks of life. The recognition of these differences in the pediatric age-group prevents unnecessary medical and laboratory investigations.

Fetal and cord blood hematologic value

Table A1.1

Hematologic values in normal fetuses at different gestational ages.

Modified from Forestier, F., Daffos, F., Catherine, N., et al., 1991. Developmental hematopoiesis in normal human fetal blood. Blood 77, 2360.

Week of gestation	Hemoglobin (g/dL)	RBCs (×10 ⁶ /mL)	Hematocrit (%)	Mean corpuscular volume (fL)	Total WBCs (×10 ⁶ /µL)	Corrected WBCs (×10 ⁶ /µL)	Platelets (×10 ⁶ /µL)
18–21 ( N =760)	11.69±1.27	2.85±0.36	37.3±4.32	131.1±11.0	4.68±2.96	2.57±0.42	234±57
22–25 ( N =1200)	12.2±1.6	3.09±0.34	38.59±3.94	125.1±7.8	4.72±2.82	3.73±2.17	247±59
26–29 ( N =460)	12.91±1.38	3.46±0.41	40.88±4.4	118.5±8.0	5.16±2.53	4.08±0.84	242±69
>30 ( N =440)	13.64±2.21	3.82±0.64	43.55±7.2	114.4±9.3	7.71±4.99	6.4±2.99	232±87

RBCs , Red blood cells; WBCs , white blood cells.

Hematologic data obtained with a Coulter S Plus II instrument. Total WBC count included nucleated red blood cells. Corrected WBC count included only WBCs, after subtracting the nucleated red cell component, based on a 100-cell manual differential.

Table A1.2

White blood cell (WBC) manual differential counts in normal fetuses at different gestational ages.

Modified from Forestier, F., Daffos, F., Catherine, N., et al., 1991. Developmental hematopoiesis in normal human fetal blood. Blood 77, 2360.

Week of gestation	Lymphocytes (%)	Neutrophils (%)	Eosinophils (%)	Basophils (%)	Monocytes (%)	Nucleated RBCs (% of WBCs)
18–21 ( N =186)	88±7	6±4	2±3	0.5±1	3.5±2	45±86
22–25 ( N =230)	87±6	6.5±3.5	3±3	0.5±1	3.5±2.5	21±23
26–29 ( N =144)	85±6	8.5±4	4±3	0.5±1	3.5±2.5	21±67
>30 ( N =172)	68.5±15	23±15	5±3	0.5±1	3.5±2	17±40

RBCs , Red blood cells.

Table A1.3

Hematologic values for cord blood (vaginal delivery and cesarean section).

Modified from Eskola, M., Juutistenaho, S., Aranko, K., Sainio, S., Kekomäki, R., 2011. Association of cord blood platelet count and volume with hemoglobin in healthy term infants. J. Perinatol. 31, 258-262. doi:10.1038/jp.2010.95; PMID: 20689516. Data obtained with Sysmex K-1000 analyzer (Sysmex, Kobe, Japan).

	Study sample ( N =167)		Vaginal delivery ( N =63)		Cesarean section ( N =104)
Characteristic	Median	Range	Median	Range	Median	Range	P value ^a
WBC (×10 ⁹ /L)	15.1	5.54–39.7	18.4	12.0–34.1	13.6	8.54–39.7	<0.0001
RBC (×10 ¹² /L)	4.7	3.46–6.62	4.78	3.89–6.30	4.62	3.46–6.62	NS
Hb (g/L)	174	130–234	176	140–230	171	130–234	NS
Hct (%)	53.6	40.1–73.1	54.7	41.9–73.1	52.6	40.1–72.2	NS
MCV (fL)	112	97.7–127	114	105–127	112	97.7–125	NS
MCH (pg)	36.5	31.4–41	36.5	31.4–41	36.6	32–39.9	NS
MCHC (g/L)	324	303–359	323	308–359	324	303–344	NS
RDW (%)	17.4	14.2–23.6	17.4	14.9–23.6	17.4	14.2–23.3	NS
PLT (×10 ⁹ /L)	270	161–607	297	169–607	254	161–424	0.0053
MPV (fL)	8.7	7.5–11.5	8.7	7.7–11.4	8.8	7.5–11.5	NS
CD34+ cells (×10 ⁶ /L)	43.9	7.14–253	47.7	15.9–253	39.9	7.14–120	0.007

Hb , Hemoglobin; Hct , hematocrit; MCH , mean corpuscular hemoglobin; MCHC , mean corpuscular hemoglobin concentration; MCV , mean corpuscular volume; MPV , mean platelet volume; NS , not significant; PLT , platelet; RBC , red blood cell; RDW , red blood cell distribution width; WBC , white blood cell.

a P values of the differences between vaginal delivery and cesarean section. The concentrations were standardized to exclude the varying effect of the anticoagulant.

Table A1.4

Red cell and reticulocyte indices, serum iron status markers in cord blood.

Modified from Ervasti, M., Kotisaari, S., Sankilampi, U., et al., 2007. The relationship between red blood cell and reticulocyte indices and serum markers of iron status in the cord blood of newborns. Clin. Chem. Lab. Med. 45, 1000–1003. Hematologic data obtained in 199 full-term newborn infants with an ADVIA 120 analyzer (Siemens Diagnostic Solutions, Terrytown, NY).

Parameter	Mean	SD	Reference range ^a
Blood count and cellular indices
Hb (g/L)	159	15	146–189
HCT (L/L)	0.49	0.05	0.44–0.58
MCV (fL)	109	4	102–118
MCVr (fL)	124	6	115–136
MCH (pg)	35	1	33–38
MCHC (g/L)	325	10	306–342
%Retic (%)	4.0	0.8	2.6–5.4
IRF-H (%)	24.1	7.8	10.2–40.0
CHm (pg)	34.9	1.3	32.5–37.2
CHr (pg)	35.6	1.3	33.1–38.6
%HYPOm (%)	3.0	3.0	0.4–9.9
%HYPOr (%)	42.0	15.6	18.3–76.8
Serum measurements
TfR (mg/L)	2.0	0.7	1.2–4.0
Ferritin (µg/L)	198	137	45–636
TfR-F index	0.95	0.43	0.49–2.1
Iron (µmol/L)	27.4	7.7	12.2–42.1
Transferrin (g/L)	2.0	0.4	1.2–2.9
TfSat (%)	55	19	21–111

%HYPOm , Percentage of hypochromic red blood cells; %HYPOr , percentage of hypochromic reticulocytes; %Retic , proportion of reticulocytes; CHm , cellular hemoglobin in red blood cells; CHr , cellular hemoglobin in reticulocytes; Hb , hemoglobin; HCT , hematocrit; IRF-H , high immature reticulocyte fraction; MCH , mean cell hemoglobin; MCHC , mean cell hemoglobin concentration; MCV , mean cell volume of red blood cells; MCVr , mean cell volume of reticulocytes; TfR , transferrin receptor; TfR-F index , transferrin receptor/log (ferritin); TfSat , transferrin saturation.

a For reference range calculations, only samples in which Hb was greater than 146 g/L were included.

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