Next-generation reference intervals for pediatric hematology

被引：45

作者：

Zierk, Jakob ^{[1
]}

Hirschmann, Johannes ^{[2
]}

Toddenroth, Dennis ^{[2
]}

Arzideh, Farhad ^{[3
]}

Haeckel, Rainer ^{[4
]}

Bertram, Alexander ^{[5
]}

Cario, Holger ^{[6
]}

Fruehwald, Michael C. ^{[7
]}

Gross, Hans-Juergen ^{[8
]}

Groening, Arndt ^{[5
]}

Gruetzner, Stefanie ^{[9
]}

Gscheidmeier, Thomas ^{[8
]}

Hoff, Torsten ^{[10
]}

Hoffmann, Reinhard ^{[11
]}

Klauke, Rainer ^{[12
]}

Krebs, Alexander ^{[13
]}

Lichtinghagen, Ralf ^{[12
]}

Muehlenbrock-Lenter, Sabine ^{[10
]}

Neumann, Michael ^{[14
]}

Noellke, Peter ^{[15
]}

Niemeyer, Charlotte M. ^{[15
]}

Razum, Oliver ^{[16
]}

Ruf, Hans-Georg ^{[11
]}

Steigerwald, Udo ^{[14
]}

Streichert, Thomas ^{[17
]}

Torge, Antje ^{[18
]}

Rascher, Wolfgang ^{[1
]}

Prokosch, Hans-Ulrich ^{[2
]}

Rauh, Manfred ^{[1
]}

Metzler, Markus ^{[1
]}

机构：

[1] Univ Hosp Erlangen, Dept Pediat & Adolescent Med, Loschgestr 15, D-91054 Erlangen, Germany

[2] Friedrich Alexander Univ Erlangen Nuremberg, Chair Med Informat, Erlangen, Germany

[3] Univ Bremen, Dept Stat, Bremen, Germany

[4] Klinikum Bremen Mitte, Bremer Zentrum Lab Med, Bremen, Germany

[5] MVZ Wagnerstibbe, Amedes Grp, Hannover, Germany

[6] Univ Med Ctr Ulm, Dept Pediat & Adolescent Med, Ulm, Germany

[7] Klinikum Augsburg, Dept Pediat Oncol Hematol, Augsburg, Germany

[8] Univ Med Ctr Ulm, Core Facil Clin Chem, Ulm, Germany

[9] Klinikum Augsburg, Dept Transfus Med & Haemostasis, Augsburg, Germany

[10] Gesundheit Nord Bremen Hosp Grp, Cent Lab, Bremen, Germany

[11] Klinikum Augsburg, Inst Lab Med & Microbiol, Augsburg, Germany

[12] Hannover Med Sch, Inst Clin Chem, Hannover, Germany

[13] MVZ Lab PD Dr Volkmann & Kollegen, Karlsruhe, Germany

[14] Univ Hosp Wurzburg, Div Lab Med, Wurzburg, Germany

[15] Univ Freiburg, Dept Pediat & Adolescent Med, Div Pediat Hematol & Oncol, Freiburg, Germany

[16] Bielefeld Univ, Sch Publ Hlth, Dept Epidemiol & Int Publ Hlth, Bielefeld, Germany

[17] Univ Hosp Cologne, Dept Clin Chem, Cologne, Germany

[18] Univ Hosp Schleswig Holstein, Inst Clin Chem, Campus Kiel, Kiel, Germany

来源：

CLINICAL CHEMISTRY AND LABORATORY MEDICINE | 2019年 / 57卷 / 10期

关键词：

hematology; laboratory test result display; pediatric reference intervals; MYELOMONOCYTIC LEUKEMIA; CHILDHOOD; MARKERS; ESTABLISHMENT; ALGORITHM; CHILDREN; GERMAN;

D O I：

10.1515/cclm-2018-1236

中图分类号：

R446 [实验室诊断]; R-33 [实验医学、医学实验];

学科分类号：

1001 ;

摘要：

Background: 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. Methods: 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, 412,9051,278,987 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. Results: 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. Conclusions: 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.

引用

页码：1595 / 1607

页数：13

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