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Population-Based Biochemistry, Immunologic and Hematological Reference Values for Adolescents and Young Adults in a Rural Population in Western Kenya

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      There is need for locally-derived age-specific clinical laboratory reference ranges of healthy Africans in sub-Saharan Africa. Reference values from North American and European populations are being used for African subjects despite previous studies showing significant differences. Our aim was to establish clinical laboratory reference values for African adolescents and young adults that can be used in clinical trials and for patient management.

      Methods and Findings

      A panel of 298, HIV-seronegative individuals aged 13–34 years was randomly selected from participants in two population-based cross-sectional surveys assessing HIV prevalence and other sexually transmitted infections in western Kenya. The adolescent (<18 years)-to-adults (≥18 years) ratio and the male-to-female ratio was 1∶1. Median and 95% reference ranges were calculated for immunohematological and biochemistry values. Compared with U.S-derived reference ranges, we detected lower hemoglobin (HB), hematocrit (HCT), red blood cells (RBC), mean corpuscular volume (MCV), neutrophil, glucose, and blood urea nitrogen values but elevated eosinophil and total bilirubin values. Significant gender variation was observed in hematological parameters in addition to T-bilirubin and creatinine indices in all age groups, AST in the younger and neutrophil, platelet and CD4 indices among the older age group. Age variation was also observed, mainly in hematological parameters among males. Applying U.S. NIH Division of AIDS (DAIDS) toxicity grading to our results, 40% of otherwise healthy study participants were classified as having an abnormal laboratory parameter (grade 1–4) which would exclude them from participating in clinical trials.


      Hematological and biochemistry reference values from African population differ from those derived from a North American population, showing the need to develop region-specific reference values. Our data also show variations in hematological indices between adolescent and adult males which should be considered when developing reference ranges. This study provides the first locally-derived clinical laboratory reference ranges for adolescents and young adults in western Kenya.

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      Most cited references 49

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            Author and article information

            [1 ]U.S. Centers for Disease Control and Prevention (CDC-Kenya), Kisumu, Kenya
            [2 ]Centre for Global Health Research, Kenya Medical Research Institute/U.S. CDC Research and Public Health, Kisumu, Kenya
            [3 ]Department of Internal Medicine, Center for Infection and Immunity (CINIMA), Center for Poverty-Related Communicable Diseases (CPCD), Academic Medical Center, Amsterdam Institute for Global Health and Development (AIGHD), University of Amsterdam, Amsterdam, The Netherlands
            [4 ]Institute of Tropical Medicine (ITM), Antwerp, Belgium
            [5 ]Global AIDS Program, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
            University of Toronto, Canada
            Author notes

            Conceived and designed the experiments: TT PNA CZ DMM HV KMD JN. Performed the experiments: CZ SI BO. Analyzed the data: CH CZ AG JW PO KL. Contributed reagents/materials/analysis tools: TT KL KMD JN PNA HV. Wrote the paper: CZ JN SI. Read and reviewed the manuscript: CZ PNA SI PO BO DMM HV AG JW TT KMD CH JN KL.


            Current address: International AIDS Vaccine Initiative, San Francisco, California, United States of America


            Current address: Department of Medical Microbiology, College of Health Sciences, University of Nairobi, Nairobi, Kenya


            Current address: Arctic Investigations Program, U.S. Centers for Disease Control and Prevention, Anchorage, Alaska, United States of America


            Current address: Centre for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America

            Role: Editor
            PLoS One
            PLoS ONE
            Public Library of Science (San Francisco, USA )
            21 June 2011
            : 6
            : 6
            This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
            Pages: 10
            Research Article
            Blood Chemistry
            Immune Cells
            Molecular Cell Biology
            Cellular Types
            Blood Cells
            Population Biology
            Diagnostic Medicine
            Clinical Laboratory Sciences
            Red Cells
            Public Health
            Health Screening



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