Objective: To establish reference haematological values (complete blood count) in healthy full term newborns of Karachi. Methods: This is a cross sectional ...
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September, 2009 >>
Haematological reference values for full term, healthy, newborns of Karachi, Pakistan Danish Hasan Qaiser, Syed Tousif Ahmed ( Department of Physiology, Ziauddin University,Karachi. ) Mohammad Perwaiz Sandila ( Department of Physiology, Liaquat Medical and Dental College,Karachi. ) Tahseen Kazmi ( Department of Community Health Sciences, Liaquat National Medical College,Karachi. )
Abstract
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Objective: To establish reference haematological values (complete blood count) in healthy full term newborns of Karachi. Methods: This is a cross sectional study design based on cord blood sample of 404 newborns and their mothers recruited from Sindh Government Qatar Hospital, Ziauddin University Hospital gole market campus, Sindh Government hospital, Liaquatabad and Chinniot maternity and child hospital. Karachi from July 2006 to April 2008. Both mother's and the new born baby's blood was collected in EDTA containing tubes and analyzed for different haematological parameters. The data entry and analysis was done on computer package SPSS (Statistical Packages of Social Sciences) version 12.0. The results were given in the text as mean, standard deviation and 95% confidence intervals of haematological values (complete blood count). Results: The mean haemoglobin was found to be (14.99±1.47 gm), which is lower than the standard value described in literature. However the total WBCs count and platelet count were found to be (13.61±4.23) and (256. 25±76. 54) respectively, which were similar to the other studies. Conclusion: Our values provide reference range for haematological values in healthy newborns of Karachi, for clinical use by our physicians (JPMA 59:618; 2009). Introduction Health of an individual is known to vary in different countries, in the same country at different times, and in same individuals at different ages. It is thus a relative and not an absolute stage. This means that the condition of individuals must be related to or compared with reference data. On comparing the individuals' data collected through the medical interview, clinical examination and supplementary investigations with the reference data, the condition of individuals can be interpreted.1 Reference value is defined as the value obtained by observation or measurement of a particular type of quality on an individual belonging to the reference group.1 Investigation of an individual should entirely depend on the normal ranges, which have been established to an individuals locality.2 Newborn haematological parameters differ in infants and adults.3 A study was done which revealed that various blood indices vary in the newborns as compared to older children or adults. It depends on the gestational age, day of life, maternal factors, mode of delivery and site of blood collection.4 The first study on the haematology of the newborns was published in 1924 and since then many studies have been conducted that have examined babies at different gestational ages and of varying birth weights.5 Furthermore, determination of reference range of healthy, term neonate is clinically important in terms of various complete blood count parameters for example, haemoglobin concentration which is an important clinical measurement used in decisions regarding clinical diagnosis, treatment and public health interventions for anaemia.6 Haemoglobin and haematocrit have been used routinely in the diagnosis of neonatal anaemia and polycythaemia.7 White blood cells and platelet count have proved helpful in the assessment of neonatal sepsis and haemostatic status of the infant respectively.8 Manroe et al showed that the use of absolute blood neutrophil count has improved the sensitivity in screening for neonatal bacterial diseases.9 Haematological values are also frequently determined in the newborns for diagnostic purposes in suspected infections and in bleeding disorders.10 It is now widely accepted that there are no universal or international standard haematological parameters and all reference values are affected to some extent by factors such as age, race, diet, drug intake, method employed for determination etc. It is thus important that standard reference values of local population should be established.2 However, haematological reference values which are in use in Pakistan are derived from studies done on Caucasoid populations and to the best of our knowledge, there is no reference value of neonatal
haematological parameters available in Pakistan, using umbilical cord blood. The objective of this study was to establish reference hematological values (complete blood count) in healthy full term newborns using umbilical cord blood, either after vaginal delivery or elective caesarean section. Methods This is a cross sectional study design based on cord blood sample of newborns and their mothers. Total 897 mothers and their neonates were recruited initially, from four hospitals (Sindh Government Qatar Hospital, Ziauddin University hospital, gole market campus, Sindh Government hospital, Liaquatabad and Chinniot maternity and child hospital.) of Karachi from July 2006 to April 2008. A total of 404 newborns were included in the study (100 from Sindh Government Qatar Hospital, 85 from Ziauddin University hospital, goal market campus, 92 from Sindh Government hospital, Liaquatabad and 127 from Chinniot maternity and child hospital.). Excluded were 493 patients due to multiple pregnancy (101), maternal anaemia (120), 73 due to the PIH, 59 due to the diabetes, 42 due to antipartum haemorrhage, 61 due to the emergency c/section and 37 due to the birth asphyxia. The inclusion criteria for the mother were, age between 15 to 45 years, booked case, uneventful pregnancy and haemoglobin of 10 grams and above. For Neonates it was full term (37 to 42 weeks) with normal birth weight (2.5 to 4.0 Kg). The exclusion criteria for the mother were, multiple pregnancy, diseases complicating pregnancy (anaemia, antepartum haemorrhage, pregnancy induced hypertension, eclampsia, diabetes (gestational or insulin dependent), heart, kidney or lung disease, malaria, disseminated intravascular coagulation), Thalasemia / Sickle cell disease, drug or alcohol abuse, immediate shock like state after post partum period, and emergency caesarian section. The exclusion criteria for neonates were: Abnormal partogram, perinatal blood loss, hydrops foetalis, birth asphyxia, low Apgar score (
