Zierk, Jakob, Hirschmann, Johannes, Toddenroth, Dennis, Arzideh, Farhad, Haeckel, Rainer, Bertram, Alexander, Cario, Holger ORCID: 0000-0002-6923-488X, Fruehwald, Michael C., Gross, Hans-Juergen, Groening, Arndt, Gruetzner, Stefanie, Gscheidmeier, Thomas, Hoff, Torsten, Hoffmann, Reinhard, Klauke, Rainer, Krebs, Alexander, Lichtinghagen, Ralf, Muehlenbrock-Lenter, Sabine, Neumann, Michael, Noellke, Peter, Niemeyer, Charlotte M., Razum, Oliver, Ruf, Hans-Georg, Steigerwald, Udo, Streichert, Thomas, Torge, Antje, Rascher, Wolfgang, Prokosch, Hans-Ulrich, Rauh, Manfred and Metzler, Markus (2019). Next-generation reference intervals for pediatric hematology. Clin. Chem. Lab. Med., 57 (10). S. 1595 - 1608. BERLIN: WALTER DE GRUYTER GMBH. ISSN 1437-4331

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Abstract

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.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Zierk, JakobUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hirschmann, JohannesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Toddenroth, DennisUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Arzideh, FarhadUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Haeckel, RainerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bertram, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Cario, HolgerUNSPECIFIEDorcid.org/0000-0002-6923-488XUNSPECIFIED
Fruehwald, Michael C.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gross, Hans-JuergenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Groening, ArndtUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gruetzner, StefanieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Gscheidmeier, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hoff, TorstenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Hoffmann, ReinhardUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Klauke, RainerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Krebs, AlexanderUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lichtinghagen, RalfUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Muehlenbrock-Lenter, SabineUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neumann, MichaelUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Noellke, PeterUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Niemeyer, Charlotte M.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Razum, OliverUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ruf, Hans-GeorgUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Steigerwald, UdoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Streichert, ThomasUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Torge, AntjeUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rascher, WolfgangUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Prokosch, Hans-UlrichUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rauh, ManfredUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Metzler, MarkusUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-133193
DOI: 10.1515/cclm-2018-1236
Journal or Publication Title: Clin. Chem. Lab. Med.
Volume: 57
Number: 10
Page Range: S. 1595 - 1608
Date: 2019
Publisher: WALTER DE GRUYTER GMBH
Place of Publication: BERLIN
ISSN: 1437-4331
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
MYELOMONOCYTIC LEUKEMIA; CHILDHOOD; MARKERS; ESTABLISHMENT; ALGORITHM; CHILDREN; GERMANMultiple languages
Medical Laboratory TechnologyMultiple languages
Refereed: Yes
URI: http://kups.ub.uni-koeln.de/id/eprint/13319

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