Laboratory Practice of Reference Intervals Modification for Children’s Blood Cell Analysis in China

Abstract

Background: The unreliability of reference intervals (RIs) for children’s blood cell analysis has led to an unnecessary effort in interpreting results. The Standard published in 2021 is expected to solve this problem in China but should be clinically evaluated before its application. In this study, we aim to analyse the advantages and disadvantages of the new reference intervals (RIs) and realize the optimization based on clinical communication with pediatricians. Methods: Compared with the laboratory’s original reference intervals (RIs), the RIs’ numerical trends were mapped and analysed, and the data of the past seven years were retrospectively re-interpreted. Pediatricians were then consulted to discuss the data analyses. Results: Basically, the new reference intervals (RIs) characterized with more detailed age stratification and two specimen types. The numerical range of some parameters was wider while some were unilaterally shifted. Retrospective analysis showed that the revised reference intervals (RIs) could correct previously abnormal results to the normal range in a large proportion. The recovery ratio of three lineage cells was white blood cells > red blood cells > platelets, and the ratio sorted by age is 28 days~1-year-old > 1~13years old > 13~18 years old. The leukocyte recovery ratio of 28 days~1-year was the largest, approximately 55% to 83%. Pediatricians recognized the value of the new reference intervals (RIs). The only exception is that the platelets’ reference intervals (RIs) were too broad, recommending maintaining the original RI. The missing 0~28-day’s reference intervals (RIs) were recommended to be supplemented with other reference books. Conclusions: The new reference intervals (RIs) were optimized and, combined with clinical feedback, produced new reference intervals (RIs) derived from accumulated experience, evolving a better set of RIs.