Hematology and blood serum chemistry reference intervals for children in Iganga district of Uganda


In this study, normal ranges for hematology and serum biochemistry in children aged 1 to 5 years inUgandawere determined. By a cross-sectional study, 1168 children from Iganga, a prospective site for clinical trials in Uganda, were screened. From 1168 households, 460 children were selected for enrollment, while 600 (58%) were excluded because of either a history of fever in the previous 24 hours, presence of asexual malaria parasites in the peripheral blood or presence of fever. Accordingly, 460 children (39.4%) of median age = 3 years were enrolled in the baseline study. While the lower limits of hemoglobin, hematocrit levels, mean corpuscular volume and platelet counts for the Ugandan children were found to be less than conventional reference values of Caucasisan children, the white blood cell count reference values were higher than the international intervals. On the other hand, the upper limits of the reference intervals for serum transaminases, bilirubin, creatinine, urea, total protein and albumin in sera of the Ugandan children were higher than the corresponding values for a Caucasian pediatric population. This study showed that, if hematology test results of the Ugandan children were assessed against “imported” international reference values, up to 44.6% of the study participants would have been excluded from clinical trials or would have been reported as adverse events in such trials. The present study was not only the first report of serum biochemistry reference ranges for children aged one to five years in Uganda but also one of very few such studies in Africa.

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Kironde, F. , Sekikubo, M. , Naiwumbwe, H. , Namusoke, F. , Buwembo, W. , Kiwuwa, S. , Oketch, B. , Noor, R. , Chilengi, R. , Mworozi, E. and Kaddumukasa, M. (2013) Hematology and blood serum chemistry reference intervals for children in Iganga district of Uganda. Health, 5, 1261-1267. doi: 10.4236/health.2013.58171.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Tefferi, A., Hanson, C.A. and Inwards, D.J. (2005) How to interpret and pursue an abnormal complete blood cell count in adults. Mayo Clinic Proceedings, 80, 923-936. doi:10.4065/80.7.923
[2] Mold, J.W., Aspy, C.B., Blick, K.E. and Lawler, F.H. (1998) The determination and interpretation of reference intervals for multichannel serum chemistry tests. Journal of Family Practice, 46, 233-241.
[3] Terry, F.W., Gillespy, W.G., Indovina, M. and Benson, S.J. (1976) Diagnostic value of a chemistry test profile. Southern Medical Journal, 69, 1425-1428. doi:10.1097/00007611-197611000-00009
[4] Schwartz, L., Brown, G.V., Genton, B. and Moorthy, V.S. (2012) A review of malaria vaccine clinical projects based on the WHO rainbow table. Malaria Journal, 11, 11. doi:10.1186/1475-2875-11-11
[5] Garcia-Basteiro, A.L., Bassat, Q. and Alonso, P.L. (2012) Approaching the target: The path towards an effective malaria vaccine. Mediterranean Journal of Hematology and Infectious Diseases, 4, e2012015. doi:10.4084/mjhid.2012.015
[6] Agnandji, S.T., Lell, B., Fernandes, J.F., Abossolo, B.P., Methogo, B.G., Kabwende, A.L., Adegnika, A.A., Mordmuller, B., Issifou, S., Kremsner, P.G., et al. (2012) A phase 3 trial of RTS, S/AS01 malaria vaccine in African infants. New England Journal of Medicine, 367, 2284-2295. doi:10.1056/NEJMoa1208394
[7] Abrams, A.L., Opiyo, N., Cotton, M., Crowley, S., Okebe, J. and Wiysonge, C.S. (2011) Supporting registration of child-focused clinical trials in Africa: The Child Strategy Project. South African Medical Journal, 101, 804.
[8] Miiro, G.M., Oukem-Boyer, O.O., Sarr, O., Rahmani, M., Ntoumi, F., Dheda, K., Pym, A., Mboup, S. and Kaleebu, P. (2013) EDCTP regional networks of excellence: Initial merits for planned clinical trials in Africa. BMC Public Health, 13, 258. doi:10.1186/1471-2458-13-258
[9] Eller, L.A., Eller, M.A., Ouma, B., Kataaha, P., Kyabaggu, D., Tumusiime, R., Wandege, J., Sanya, R., Sateren, W.B., Wabwire-Mangen, F., et al. (2008) Reference intervals in healthy adult Ugandan blood donors and their impact on conducting international vaccine trials. PLoS One, 3, e3919. doi:10.1371/journal.pone.0003919
[10] Lugada, E.S.M.J., Kaharuza, F., Ulvestad, E., Were, W., Langeland, N., Asjo, B., Malamba, S. and Downing, R. (2004) Population-based hematologic and immunologic reference values for a healthy Ugandan population. Clinical and Diagnostic Laboratory Immunology, 11, 29-34.
[11] Kibaya, R.S., Bautista, C.T., Sawe, F.K., Shaffer, D.N., Sateren, W.B., Scott, P.T., Michael, N.L., Robb, M.L., Birx, D.L. and de Souza, M.S. (2008) Reference ranges for the clinical laboratory derived from a rural population in Kericho, Kenya. PLoS One, 3, e3327. doi:10.1371/journal.pone.0003327
[12] Tugume, S.B., Piwowar, E.M., Lutalo, T., Mugyenyi, P.N., Grant, R.M., Mangeni, F.W., Pattishall, K. and Katongole-Mbidde, E. (1995) Hematological reference ranges among healthy Ugandans. Clinical and Diagnostic Laboratory Immunology, 2, 233-235.
[13] Quinto, L., Aponte, J.J., Sacarlal, J., Espasa, M., Aide, P., Mandomando, I., Guinovart, C., Macete, E., Navia, M.M., Thompson, R., et al. (2006) Haematological and biochemical indices in young African children: In search of reference intervals. Tropical Medicine & International Health, 11, 1741-1748. doi:10.1111/j.1365-3156.2006.01764.x
[14] Karita, E., Ketter, N., Price, M.A., Kayitenkore, K., Kaleebu, P., Nanvubya, A., Anzala, O., Jaoko, W., Mutua, G., Ruzagira, E., et al. (2009) CLSI-derived hematology and biochemistry reference intervals for healthy adults in eastern and southern Africa. PLoS One, 4, e4401. doi:10.1371/journal.pone.0004401
[15] Gomez, P., Coca, C., Vargas, C., Acebillo, J. and Martinez, A. (1984) Normal reference-intervals for 20 biochemical variables in healthy infants, children, and adolescents. Clinical Chemistry, 30, 407-412.
[16] Humberg, A., Kammer, J., Mordmuller, B., Kremsner, P.G. and Lell, B. (2011) Haematological and biochemical reference intervals for infants and children in Gabon. Tropical Medicine & International Health, 16, 343-348. doi:10.1111/j.1365-3156.2010.02705.x
[17] Mordmuller, B., Szywon, K., Greutelaers, B., Esen, M., Mewono, L., Treut, C., Murbeth, R.E., Chilengi, R., Noor, R., Kilama, W.L., et al. (2010) Safety and immunogenicity of the malaria vaccine candidate GMZ2 in malaria-exposed, adult individuals from Lambarene, Gabon. Vaccine, 28, 6698-6703. doi:10.1016/j.vaccine.2010.07.085
[18] Rutebemberwa, E., Kallander, K., Tomson, G., Peterson, S. and Pariyo, G. (2009) Determinants of delay in careseeking for febrile children in eastern Uganda. Tropical Medicine & International Health, 14, 472-479. doi:10.1111/j.1365-3156.2009.02237.x
[19] Rutebemberwa, E., Pariyo, G., Peterson, S., Tomson, G. and Kallander, K. (2009) Utilization of public or private health care providers by febrile children after user fee removal in Uganda. Malaria Journal, 8, 45. doi:10.1186/1475-2875-8-45
[20] Kallander, K., Kadobera, D., Williams, T.N., Nielsen, R.T., Yevoo, L., Mutebi, A., Akpakli, J., Narh, C., Gyapong, M., Amu, A. and Waiswa, P. (2011) Social autopsy: INDEP TH Network experiences of utility, process, practices, and challenges in investigating causes and contributors to mortality. Population Health Metrics, 9, 44. doi:10.1186/1478-7954-9-44
[21] Uganda Bureau of Statistics (2002) The 2002 Uganda population and housing census, Population composition, October 2006. Uganda Bureau of Statistics, Kampala.
[22] Stover, K.R., King, S.T. and Robinson, J. (2012) Artemether-lumefantrine: An option for malaria. Annals of Pharmacotherapy, 46, 567-577. doi:10.1345/aph.1Q539
[23] NCCLS (2000) NCoCLS: How to define and determine reference intervals in the clinical laboratory. C28-A2, 20, Wayne.
[24] Wintrobe, M.M. and Lee, G.R. (1999) Wintrobe’s clinical hematology. 10th Edition, The Williams & Wilkins Co., Baltimore.
[25] Colantonio, D.A., Kyriakopoulou, L., Chan, M.K., Daly, C.H., Brinc, D., Venner, A.A., Pasic, M.D., Armbruster, D. and Adeli, K. (2012) Closing the gaps in pediatric laboratory reference intervals: A CALIPER database of 40 biochemical markers in a healthy and multiethnic population of children. Clinical Chemistry, 58, 854-868. doi:10.1373/clinchem.2011.177741
[26] Eller, L.A.E.M., Ouma, B., Kataaha, P., Kyabaggu, D., Tumusiime, R., Wandege, J., Sanya, R., Sateren, W.B., Wabwire-Mangen, F., Kibuuka, H., Robb, M.L., Michael, N.L. and de Souza, M.S. (2008) Reference intervals in healthy adult Ugandan blood donors and their impact on conducting international vaccine trials. PLoS One, 3, e39 19. doi:10.1371/journal.pone.0003919
[27] Menard, D., Mandeng, M.J., Tothy, M.B., Kelembho, E.K., Gresenguet, G. and Talarmin, A. (2003) Immunohematological reference ranges for adults from the Central African Republic. Clinical and Diagnostic Laboratory Immunology, 10, 443-445.
[28] Waiswa, P., Peterson, S.S., Namazzi, G., Ekirapa, E.K., Naikoba, S., Byaruhanga, R., Kiguli, J., Kallander, K., Tagoola, A., Nakakeeto, M. and Pariyo, G. (2012) The Uganda Newborn Study (UNEST): An effectiveness study on improving newborn health and survival in rural Uganda through a community-based intervention linked to health facilities: Study protocol for a cluster randomized controlled trial. Trials, 13, 213. doi:10.1186/1745-6215-13-213
[29] Adetifa, I.M., Hill, P.C., Jeffries, D.J., Jackson-Sillah, D., Ibanga, H.B., Bah, G., Donkor, S., Corrah, T. and Adegbola, R.A. (2009) Haematological values from a Gambian cohort—Possible reference range for a West African population. Clinical and Diagnostic Laboratory Immunology, 31,615-622. doi:10.1111/j.1751-553X.2008.01087.x

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