Reference ranges

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Reference ranges are provided for guidance in the interpretation of results for clinical decision making.  They are conventionally set to give the range of values which would be found in approximately 95% of a statistically ‘Normal’ population.

Age-related reference ranges are provided as appropriate but ranges do not take into account normal racial variation or differences between venous and capillary sample type. Please seek advice from the laboratory as necessary.

Unless otherwise stated the haematology reference ranges are selected from:

  • published papers providing ranges established by national and/or international consensus,
  • reference intervals provided by the instrument/assay manufacturer

Where applicable, reference ranges

  • have been verified based on the local adult and paediatric population according to age/gender and detailed age-related reference ranges are available from the Department
  • all ranges have been agreed by the department’s team of Consultant Haematologists

For further details on haematology reference ranges refer to:

  • Dacie and Lewis Practical Haematology, 12th Edition: 2016, ISBN: 9780702066962 and
  • Pediatric Hematology, 3rd Edition: 2006, ISBN: 9781405134002

Age-related reference ranges have been condensed to cover generally recognised stages of development and are generally added to the report automatically by the laboratory IT system when the result is generated. The following terms are used for age-related guidance:

  • Newborn: First 7 days of life for term baby
  • Neonate: First month of life for a term baby. Ranges may not apply to pre-term or small-for-dates babies
  • Infant: Normally from the second month to one year, neonates are included in these ranges if not separately quoted
  • Child: Normally one year to adolescence, neonates and infants are included in these ranges if not separately quoted

Full Blood Count reference ranges

Adult’s ranges were selected from Phase II of the Pathology Harmonisation Project published under pathologyharmony.co.uk and for children the ranges were selected from Pediatric Haematology.

  • Pediatric Hematology, 3rd Edition: 2006

RJ Arceci (Ed), IM Hann (Ed) & OP Smith (Ed). ISBN: 9781405134002

Chapter 37, Reference values (PS Simpkin & RF Hinchliffe).

The selected ranges were verified based on the local adult and paediatric population according to age and gender.

Coagulation reference ranges

Adult’s ranges are taken from Sysmex published ranges and were then verified locally using normal donors and for children the ranges were selected from:

  • Age dependency of coagulation parameters during childhood and puberty

IM Appel , B Grimminck  et al.  Journal of Thrombosis and Haemostasis 2012;10:2254–2263

  • Age dependency for coagulation parameters in paediatric populations

Results of a multicentre study aimed at defining the age-specific reference ranges

P Toulon, M Berruyer et al. Thrombosis and Haemostasis 2016;116:9-16

  • Ranges published by Sysmex Corporation (Sysmex UK Ltd) and provided by Great Ormond Street NHS Foundation Trust

Abnormal Haemoglobin and related reference ranges

Haemoglobin A2 and F reference ranges were verified on the local adult and paediatric population with reference to the leading article:

  • Significant haemoglobinopathies: guidelines for screening and diagnosis

K Ryan, BJ Bain et al. British Journal of Haematology 2010;149:35–49

Glucose 6 Phosphate Dehydrogenase (G6PD) assay reference ranges were selected from those used by Sheffield Teaching Hospitals NHS Foundation Trust and verified on the local adult population.

Zinc Protoporphyrin (ZPP) reference range for children was selected from those used by Sheffield Children’s NHS Foundation Trust in view of 2018 article by Hinchliffe et al the ranges will need revalidating in 2019.

  • Usefulness of Red Cell Zinc Protoporphyrin Concentration in the Investigation of Microcytosis in Children. RF Hinchliffe, JS Lilleyman, GJ Steel & GJ Bellamy. Pediatric Hematology and Oncology 1995;12:455-462
  • Observations on the measurement of zinc protoporphyrin in both whole blood and washed red cells in young children

RF Hinchliffe, VR Waddoups, L Lennard & AJ Vora.  Int J Lab Hem 2018;40:e38–e40

Haematinic assays (Vitamin B12, Folate and Ferritin) reference ranges were selected from the manufacturer Roche Diagnostics Ltd, F. Hoffmann-La Roche Ltd and were verified on the local adult population.

Erythropoietin assays reference ranges were selected from Leeds Teaching Hospital NHS foundation Trust, using the manufacturer Beckman Coulter published ranges as a guide and were verified on the local adult population.

 

(Last reviewed December 2018)