Population-based hematologic and immunologic reference values for a healthy Ugandan population

Abstract

To assess the validity of the reference values for hematologic and immunologic indices currently used in Africa, we evaluated blood samples from 3,311 human immunodeficiency virus (HIV)-negative Ugandans aged 1 week to 92 years. Erythrocyte, hemoglobin, and hematocrit levels and mean corpuscular volume all significantly increased with age (P < 0.001) and were independent of gender until the age of 13 years, after which the levels were higher in males than in females (P < 0.001). White blood cell, neutrophil, lymphocyte, basophil, and monocyte counts significantly declined with age until the age of 13 years (P < 0.001), with no differences by gender, while platelet counts declined with age (P < 0.001) and showed differences by gender only among adults older than age 24 years. CD4+- and CD8+-cell counts declined with age until the age of 18 years; thereafter, females had higher counts than males. The absolute values for many of these parameters differed from those reported for populations outside Africa, suggesting that it may be necessary to develop tables of reference values for hematologic and immunologic indices specific for the African population. This may be particularly important with regard to CD4+-cell counts among children because significant differences in absolute and percent CD4+-cell counts exist between the values for Western populations and the values for the population evaluated in our study. These differences could influence the decision to initiate antiretroviral therapy among children infected with HIV.

FIG. 1.

Box and whisker plot showing the median, interquartile, and range CD4⁺- and CD8⁺-cell counts (10³ cells per milliliter), lymphocyte counts (10⁹ cells per liter), and proportions by age group. The heights of the boxes in the box plots indicate the interquartile lengths. The central bar in each box is the median. Whiskers extend to the most extreme values to 1.5 box lengths from the edge of the box. Circles indicate outliers beyond 1.5 box lengths from the edge of the box. (a) CD4⁺-cell count by age group; (b) CD4⁺-cell proportion by age group; (c) CD8⁺-cell count by age group; (d) CD8⁺-cell proportion by age group; (e) WBC count by age group; (f) CD4/CD8 ratio by age group.