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Establishing Reference Intervals for Complete Blood Cell Count in Healthy Korean Elderly Individuals
J Lab Med Qual Assur 2018;40:27-37
Published online March 31, 2018
© 2018 Korean Association of External Quality Assessment Service.

Eun Jin Lee, Miyoung Kim, Eunyup Lee, Kibum Jeon, Jiwon Lee, Han-Sung Kim, Hee Jung Kang, Young Kyung Lee

Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
Correspondence to: Miyoung Kim Department of Laboratory Medicine, Hallym University Sacred Heart Hospital, 22 Gwanpyeong-ro 170beon-gil, Dongan-gu, Anyang 14068, Korea Tel: +82-31-380-1795 Fax: +82-31-380-1798 E-mail: rabbit790622@gmail.com
援먯떊옄: 源誘몄쁺 슦)14068 븞뼇떆 룞븞援 愿룊濡170踰덇만 22, 븳由쇰븰援먯꽦떖蹂묒썝 吏꾨떒寃궗쓽븰怨 Tel: 031)380-1795, Fax: 031)380-1798, E-mail: rabbit790622@gmail.com
Received November 30, 2017; Revised January 15, 2018; Accepted February 1, 2018.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract

Background:

Different age groups may have different reference intervals. However, the currently used reference interval for complete blood count (CBC) in clinical laboratories is based on results from healthy adults between 20 and 50 years of age. In this study, we aimed to establish reference intervals for 16 CBC parameters in Korean healthy elderly individuals.

Methods:

A total of 3,359 healthy adults were selected from 4,253 adults (aged ≥20 years) who underwent regular health check-ups, based on a medical examination by interview. The reference intervals for CBC in two groups (aged <60 and ≥60 years), and the partitioning of reference intervals between the two age groups were established.

Results:

Most CBC parameters showed no significant differences in reference intervals between the two age groups. Among the men, platelet distribution width (PDW) was the only parameter that required a separate reference interval between the two age groups. Among the women, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW), and eosinophil % required separate reference intervals between the two age groups.

Conclusions:

The reference intervals for most CBC parameters were not significantly different between the two age groups. Except for PDW in men and MCV, MCHC, RDW, and eosinophil % in women, reference intervals for CBC parameters in individuals younger than 60 years of age could also be applied to those that are 60 years of age or older.

Keywords : Complete blood cell count, Elderlies, Reference interval
꽌 濡

李멸퀬援ш컙(reference interval) 李멸퀬 몴蹂멸뎔쓽 愿痢↔컪씠굹 紐⑥쭛떒뿉꽌쓽 삁痢≪튂쓽 媛꾧꺽쑝濡 븯븳 李멸퀬移섏 긽븳 李멸퀬移 媛 媛꾩쓽 媛꾧꺽쑝濡 젙쓽릺뼱 엳떎[1]. 삁븸寃궗瑜 넻빐 뼸 痢≪젙寃곌낵뒗 솚옄쓽 吏꾨떒 諛 移섎즺寃곗젙쓣 쐞빐 李멸퀬援ш컙怨쇱쓽 鍮꾧탳怨쇱젙쓣 嫄곗튇떎. 씠 媛숈씠 삁븸寃궗寃곌낵쓽 빐꽍 鍮꾧탳瑜 넻븳 쓽궗寃곗젙怨쇱젙씠誘濡 紐⑤뱺 寃궗빆紐⑹뿉 븯뿬 湲곗씠 릺뒗 李멸퀬援ш컙씠 븘슂븯떎. 留뚯빟 쟻빀븯吏 븡 李멸퀬援ш컙쓣 엫긽寃곌낵쓽 빐꽍뿉 쟻슜븷 寃쎌슦 옒紐삳맂 吏꾨떒 諛 移섎즺寃곗젙쓽 쐞뿕씠 엳떎. 뵲씪꽌 떊猶곗꽦 엳뒗 李멸퀬援ш컙쓣 솗由쏀븯뒗 寃껋 엫긽寃궗떎쓽 以묒슂븳 뾽臾댁씠떎.

쁽궗쉶뒗 湲됱냽븳 씤援ъ쓽 怨좊졊솕媛 吏꾪뻾릺怨 엳쑝硫 룊洹 닔紐낆쓽 뿰옣怨 쓽븰씠 諛쒕떖븿뿉 뵲씪 쓽猷뚭린愿쓣 諛⑸Ц븯뒗 끂씤 씤援ъ쓽 鍮꾩쑉씠 吏냽쟻쑝濡 긽듅븯뒗 異붿꽭씠떎[2]. 븯吏留 쁽옱 엫긽寃궗떎뿉꽌 궗슜븯怨 엳뒗 李멸퀬援ш컙 遺遺 20-50꽭쓽 嫄닿컯븳 꽦씤쓣 긽쑝濡 젙由쏀븳 寃쎌슦媛 留롫떎[3,4]. Alkaline phosphatase 벑 留롮 삁븸寃궗빆紐⑹뿉꽌 뿰졊뿉 뵲瑜 젙긽 李멸퀬援ш컙씠 떖씪吏꾨떎뒗 뿰援ш껐怨쇨 蹂닿퀬릺뼱 엳쑝硫[5], 씠뿉 뵲씪 쑀꺕냼븘쓽 寃쎌슦 꽦蹂, 뿰졊蹂꾨줈 援젣쟻 李멸퀬援ш컙 諛 븳援씤쓽 李멸퀬援ш컙씠 嫄곗쓽 紐⑤뱺 삁븸寃궗빆紐⑹뿉꽌 젙由쎈릺뼱 엳떎[6-9]. 諛섎㈃뿉 60꽭 씠긽 끂씤 씤援щ 긽쑝濡 븳 삁븸寃궗 李멸퀬援ш컙뿉 愿븳 뿰援щ뒗 援궡꺕쇅쟻쑝濡 嫄곗쓽 씠猷⑥뼱졇 엳吏 븡 떎젙씠떎.

씠뿉 蹂 뿰援ъ뿉꽌뒗 援궡 理쒖큹濡 嫄닿컯븳 븳援 끂씤쓣 긽쑝濡 븯뿬 媛옣 湲곕낯씠 릺뒗 16媛吏 씪諛섑삁븸寃궗빆紐⑹뿉 븳 李멸퀬移섎 Clinical and Laboratory Standards Institute (CLSI) EP28-A3뿉꽌 젣떆븯뒗 鍮꾨え닔諛⑸쾿(nonparametric method)뿉 뵲씪 젙由쏀븯怨좎옄 븯떎.

옱猷 諛 諛⑸쾿

1. 뿰援щ긽

嫄닿컯利앹쭊꽱꽣뿉꽌 2010뀈 1썡遺꽣 2016뀈 3썡源뚯 嫄닿컯寃吏꾩쓣 諛쏆 닔吏꾩옄 以 20꽭 씠긽 꽦씤 궓瑜 긽쑝濡 븯떎. 嫄닿컯븳 긽옄瑜 꽑蹂꾪븯湲 쐞븯뿬 怨쇨굅 蹂묐젰, 蹂듭슜빟臾, 寃궗냼寃 벑쓽 湲곕줉쓣 李몄“븯뿬 젣쇅湲곗쓣 떎쓬怨 媛숈씠 꽕젙븯떎.

1) 理쒓렐(6媛쒖썡 씠궡) 媛먯뿼吏덊솚

(1) 뿼利앸컲쓳씠 씪뼱궇 닔 엳뒗 쟾떊吏덊솚(룓졃 벑)쓣 吏꾨떒諛쏆븯嫄곕굹 移섎즺빟臾쇱쓣 蹂듭슜븳 寃쎌슦

(2) 닔닠젰씠 엳뒗 寃쎌슦

2) 媛꾩쭏솚

A삎媛꾩뿼, 솢룞꽦 B삎媛꾩뿼, C삎媛꾩뿼 諛 媛꾩븫, 븣肄붿삱꽦 媛꾩쭏솚, 媛꾧꼍솕 벑쓣 吏꾨떒諛쏆븯嫄곕굹 쁽옱 移섎즺 以묒씤 媛꾩닔移 긽듅씠 엳뒗 寃쎌슦

3) 留뚯꽦吏덊솚

怨좏삁븬, 떦눊, 떖옣蹂(삊떖利, 떖洹쇨꼍깋, 遺젙留), 떊利앺썑援곗쓣 吏꾨떒諛쏆븯嫄곕굹 移섎즺 以묒씤 寃쎌슦

4) 븙꽦醫낆뼇

삁븸醫낆뼇(諛깊삁蹂 벑), 鍮덊삁, 留먮씪由ъ븘 吏꾨떒쓣 諛쏆 寃쎌슦

5) 빟臾쇰났슜

뵾遺怨 吏덊솚, 젙떊怨 吏덊솚, 븣肄붿삱以묐룆, 媛묒긽꽑吏덊솚, 瑜섎쭏떚뒪吏덊솚, 留뚯꽦룓뇙꽦룓吏덊솚 벑쓽 移섎즺빟臾쇱쓣 蹂듭슜 以묒씠嫄곕굹 硫댁뿭뼲젣젣, 븳빟 벑쓣 蹂듭슜븯뒗 寃쎌슦

6) 寃궗寃곌낵 씠긽냼寃

(1) 떖쟾룄寃궗: ST 遺꾩젅쓽 긽듅, 떖洹쇨꼍깋, pacemaker 궫엯, 뿀삁꽦 떖吏덊솚 쓽떖냼寃ъ쓣 蹂댁씤 寃쎌슦

(2) 쓨遺諛⑹궗꽑: 媛묒긽꽑, 醫낃꺽룞 醫낆뼇, 솢룞꽦 寃고빑, 룓졃, 룓븫 쓽떖냼寃ъ쓣 蹂댁씤 寃쎌슦

(3) 蹂듬珥덉쓬뙆: 媛꾧꼍솕, 留뚯꽦媛꾩뿼, 痍뚯옣뿼, 븣肄붿삱꽦 媛꾩쭏솚 냼寃ъ쓣 蹂댁씤 寃쎌슦

(4) 궡떆寃쎄궗: 쐞븫, 옣븫, 異쒗삁꽦 쐞뿼 냼寃ъ쓣 蹂댁씤 寃쎌슦

7) 엫떊 以묒씤 寃쎌슦

2. 痢≪젙諛⑸쾿

吏꾨떒寃궗쓽븰怨쇱뿉꽌 씪諛섑삁븸寃궗뿉 씠슜븯怨 엳뒗 옄룞솕寃궗湲곌린씤 Coulter LH 750 (Beckman Coulter, Brea, CA, USA)쑝濡 痢≪젙븳 씪諛섑삁븸寃궗寃곌낵瑜 씠슜븯떎. 쟻삁援(red blood cells), 삁깋냼(hemoglobin), 뿤留덊넗겕由ы듃(hematocrit), 룊洹 쟻삁援ъ슜쟻(mean corpuscular volume, MCV), 룊洹 쟻삁援ы삁깋냼웾(mean corpuscular hemoglobin, MCH), 룊洹 쟻삁援ы삁깋냼냽룄(mean corpuscular hemo異뇄obin concentration, MCHC), 쟻삁援 겕湲곕텇룷(red cell distribution width, RDW), 諛깊삁援(white blood cells), 샇以묎뎄(neutrophil %), 샇궛援(eosinophil %), 由쇳봽援(lymphocyte %), 샇뿼湲곌뎄(basophil %), 떒援(monocyte %), 삁냼뙋(platelet), 룊洹 삁냼뙋슜쟻(mean platelet volume, MPV), 삁냼뙋 겕湲곕텇룷(platelet distribution width, PDW)쓽 16媛吏 빆紐⑹뿉 븯뿬 痢≪젙븯떎.

3. 李멸퀬援ш컙쓽 꽕젙 諛 룊洹 鍮꾧탳

60꽭 誘몃쭔怨 60꽭 씠긽 몢 뿰졊援곗쓽 꽦蹂, 빆紐⑸퀎 寃궗寃곌낵 遺꾪룷瑜 궡렣蹂닿퀬 뿰졊援곌낵 꽦蹂꾩뿉 뵲씪 빆紐⑸퀎 寃곌낵뿉 李⑥씠媛 엳뒗吏 뿬遺瑜 Mann六럋itney U-test independent samples t-test瑜 넻빐 룊洹 鍮꾧탳븯떎. 媛 솚옄援곗쓽 룊洹 鍮꾧탳 떆뿉뒗 P竊0.05씪 븣 넻怨꾩쟻 쓽쓽媛 엳뒗 寃껋쑝濡 룊媛븯떎.

李멸퀬援ш컙 CLSI EP28A-3C뿉꽌 젣떆븯뒗 鍮꾨え닔諛⑸쾿뿉 뵲씪 60꽭 誘몃쭔怨 60꽭 씠긽援곗쑝濡 굹늻뼱 꽕젙븯떎[1,10]. 鍮꾨え닔諛⑸쾿뿉꽌뒗 븯븳 李멸퀬븳怨꾩튂(r1)瑜 2.5踰덉㎏ 諛깅텇쐞 닔{r1=0.025*(n+1)}뿉 빐떦븯뒗 愿痢≪튂濡 궛異쒗븯怨, 긽븳 李멸퀬븳怨꾩튂(r2)瑜 97.5踰덉㎏ 諛깅텇쐞닔{r2=0.975*(n+1)}뿉 빐떦븯뒗 愿痢≪튂濡 궛異쒗븳떎. 鍮꾨え닔諛⑸쾿뿉꽌 90% 떊猶곕룄瑜 媛吏뒗 李멸퀬移섎 꽕젙븯湲 쐞븳 理쒖냼 愿痢 닔瑜 120紐낆쑝濡 꽕젙븯怨 엳쑝誘濡 꽦蹂꾧낵 뿰졊뿉 뵲씪 遺꾨쪟븳 媛 븘援곗쓣 120紐 씠긽쑝濡 援ъ꽦븯떎. 씠긽移(outlier) 寃異쒖뿉뒗 Reed 벑[11]씠 젣븞븳 諛⑸쾿쓣 궗슜븯떎.

삉븳 CLSI EP28A-3C뿉꽌 젣떆븯뒗 李멸퀬移 遺꾪븷諛⑸쾿씤 Harris Boyd 諛⑸쾿뿉 뵲씪 몢 뿰졊援곗쓽 李멸퀬移 遺꾪븷뿉 넻怨꾩쟻 쑀쓽꽦씠 엳뒗吏 룊媛븯떎[12]. 씠 諛⑸쾿뿉꽌뒗 떎쓬쓽 꽭 媛吏濡 븘援곗쓽 李멸퀬移 遺꾪븷쓣 沅뚯옣븯怨 엳떎.

1) Standard normal deviation (z) 媛믪씠 쑀쓽移(z*=3 (naverage/120)1/2)瑜 꽆뼱꽌뒗 寃쎌슦

naverage=媛곴컖쓽 吏묐떒쓽 닔(n1怨 n2)쓽 룊洹

2) 겙 몴以렪李(s2)媛 옉 몴以렪李(s1)쓽 1.5諛곕낫떎 겕嫄곕굹 媛숈 寃쎌슦

3) s2/(s2竊뛱1)씠 3蹂대떎 옉 寃쎌슦

궗슜맂 넻怨꾪봽濡쒓렇옩 MedCalc ver. 17.9.7 (MedCalc Software, Ostend, Belgium), Excel 2016 (Microsoft, Redmond, WA, USA), 諛 PASW SPSS ver. 18.0 (SPSS Inc., Chicago, IL, USA)떎.

寃 怨

1. 뿰援щ긽援곗쓽 꽑젙

嫄닿컯利앹쭊꽱꽣뿉꽌 2010뀈 1썡遺꽣 2016뀈 3썡源뚯 嫄닿컯寃吏꾩쓣 諛쏆 20꽭 씠긽 닔吏꾩옄 以 Coulter LH 750쑝濡 痢≪젙븳 씪諛섑삁븸寃궗寃곌낵媛 엳뒗 닔吏꾩옄뒗 珥 4,253紐낆씠뿀떎. 씠 以묒뿉꽌 젣쇅湲곗뿉 쓽빐 894紐낆씠 젣쇅릺뿀쑝硫 珥 3,359紐낆쓽 닔吏꾩옄媛 嫄닿컯븳 긽옄뿉 룷븿릺뿀떎. 씠 以 60꽭 씠긽 374紐낆씠뿀쑝硫 룊洹 뿰졊 65.9±5.88꽭떎. 궓꽦쓽 寃쎌슦 226紐낆쑝濡 룊洹 뿰졊 65.0±5.31꽭쑝硫, 뿬꽦 148紐낆쑝濡 룊洹 뿰졊 67.2±6.42떎. 60꽭 誘몃쭔 긽옄뒗 2,985紐낆씠뿀쑝硫 룊洹 뿰졊 46.4±7.11꽭떎. 궓꽦 1,861紐낆씠뿀쑝硫 룊洹 뿰졊 47.3±6.77꽭怨, 뿬꽦 1,124紐낆쑝濡 룊洹 뿰졊 45.1±7.32꽭떎.

2. 빆紐⑸퀎 씪諛섑삁븸寃궗寃곌낵쓽 遺꾪룷

60꽭 씠긽 뿰졊援곗쓽 씪諛섑삁븸寃궗빆紐⑸퀎 遺꾪룷뒗 Figs. 1, 2 媛숈븯떎. 留롮 寃궗빆紐⑹뿉꽌 뿰졊利앷뿉 뵲瑜 슌졆븳 諛⑺뼢꽦쓣 愿李고븷 닔뒗 뾾뿀떎. 60꽭 씠긽 뿰졊援곗쓽 룊洹좎쓣 Mann六럋itney U-test 瑜 넻빐 60꽭 誘몃쭔援곌낵 鍮꾧탳븯쓣 븣 떎닔쓽 빆紐⑹뿉꽌 뿰졊援곕퀎 룊洹좎뿉 쑀쓽븳 李⑥씠瑜 蹂댁떎(Table 1). 쑀쓽븳 李⑥씠瑜 蹂댁씠吏 븡 빆紐⑹ 궓꽦쓽 諛깊삁援, 샇궛援, 샇뿼湲곌뎄, 떒援ъ 뿬꽦쓽 諛깊삁援, 쟻삁援, PDW, 샇뿼湲곌뎄, 떒援ъ떎. 60꽭 씠긽 뿰졊援곗뿉꽌 궓꽦怨 뿬꽦쓽 븘援곗쑝濡 굹늻뼱 independent samples t-test濡 룊洹좎쓣 鍮꾧탳븯쓣 븣 뿭떆 꽦蹂꾩뿉 뵲瑜 룊洹좎뿉 쑀쓽븳 李⑥씠瑜 蹂댁떎. 쑀쓽븳 李⑥씠瑜 蹂댁씠吏 븡 빆紐⑹ 삁냼뙋, MCHC, MPV, 샇뿼湲곌뎄떎(Fig. 3).

Figure 1.

Distributions for complete blood cell count in male healthy geriatric population (≥60 years old). The solid lines represent the median values, and the dotted lines denote lower and upper reference limit, respectively. (A) WBC, (B) RBC, (C) hemoglobin, (D) hematocrit, (E) RDW, (F) platelet, (G) MCV, (H) MCH, (I) MCHC, (J) PDW, (K) MPV, (L) neutrophil, (M) eosinophil (N) basophil, (O) lymphocyte, and (P) monocyte. Abbreviations: WBC, white blood cells; RBC, red blood cells; RDW, red cell distribution width; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; PDW, platelet distribution width; MPV, mean platelet volume.


Figure 2.

Distributions for complete blood cell count in female healthy geriatric population (≥60 years old). The solid lines represent the median values, and the dotted lines denote lower and upper reference limit, respectively. (A) WBC, (B) RBC, (C) hemoglobin, (D) hematocrit, (E) RDW, (F) platelet, (G) MCV, (H) MCH, (I) MCHC, (J) PDW, (K) MPV, (L) neutrophil, (M) eosinophil (N) basophil, (O) lymphocyte, and (P) monocyte. Abbreviations: WBC, white blood cells; RBC, red blood cells; RDW, red cell distribution width; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; PDW, platelet distribution width; MPV, mean platelet volume.


Table 1 . The comparison of the median between age groups ≥60 and <60 years using Mann–Whitney U-test.

   VariableAge (yr)MaleFemale


NumberMedian (range)P-value*NumberMedian (range)P-value*
White blood cells (×109/L)≥602266.1 (3.3–14.0)0.051485.5 (2.8–12.2)0.17
<601,8615.9 (2.7–16.1)1,1245.3 (2.6–17.5)
Red blood cell (×1012/L)≥602264.66 (3.51–5.6)<0.0011484.16 (3.4–5.3)0.33
<601,8614.85 (3.1–6.9)1,1244.21 (2.9–5.4)
Hemoglobin (g/dL)≥6022615.0 (10.0–18.0)<0.00114813.2 (11.3–16.0)<0.001
<601,86115.3 (8.0–19.0)1,12413.0 (8.2–16.5)
Hematocrit (%)≥6022644.7 (32.2–53.2)<0.00114839.3 (33.5–50.2)0.001
<601,86145.2 (27.6–56.7)1,12438.8 (24.8–48.9)
Red cell distribution width (%)≥6022613.1 (11.9–19.6)<0.00114812.9 (11.7–14.9)0.14
<601,86112.9 (11.4–20.7)1,12413.0 (11.1–22.4)
Platelet (×109/L)≥60226212.5 (96.0–441.0)<0.001148223.0 (105.0–376.0)0.06
<601861228.0 (68.0–450.0)1,124233.0 (85.0–591.0)
Mean corpuscular volume (fL)≥6022595.7 (65.5–111.8)<0.00114894.2 (85.6–101.6)<0.001
<601,86193.4 (55.8–113.3)1,12492.2 (62.0–105.8)
MCH (pg)≥6022532.1 (20.1–37.5)<0.00114831.6 (28.9–34.5)<0.001
<601,86131.5 (17.3–39.0)1,12431.0 (18.7–36.0)
MCH concentration (g/dL)≥6022633.6 (30.7–35.2)<0.00114833.7 (31.9–35.3)0.03
<601,86033.7 (26.8–36.1)1,12433.5 (29.9–36.2)
Platelet distribution width (fL)≥6022616.4 (10.1–18.1)0.00314816.1 (8.9–17.8)0.79
<601,86116.3 (9.0–18.9)1,12416.2 (8.4–19.0)
Mean platelet volume (fL)≥602268.4 (6.3–11.7)0.131488.4 (6.2–11.9)0.003
<601,8618.4 (5.7–13.1)1,1248.7 (6.3–13.2)
Neutrophil (%)≥6022656.1 (34.3–86.4)0.0114853.4 (29.2–77.6)<0.001
<601,86154.1 (26.2–87.5)1,12456.8 (27.7–89.4)
Eosinophil (%)≥602262.5 (0–18.5)0.671481.8 (0.3–7.2)0.18
<601,8612.6 (0–21.8)1,1241.8 (0–18.4)
Basophil (%)≥602260.5 (0–1.9)0.941480.5 (0.1–2.8)0.01
<601,8610.6 (0–2.6)1,1240.6 (0–2.9)
Lymphocyte (%)≥6022632.4 (4.0–57.1)0.00314836.9 (15.7–61.8)<0.001
<601,86134.7 (8.4–60.3)1,12433.6 (5.9–57.0)
Monocyte (%)≥602267.2 (3.0–12.6)0.051486.7 (4.0–13.5)0.19
<601,8617.0 (2.1–19.1)1,1246.6 (2.6–15.0)

Values are presented as number or median (range)..

Abbreviation: MCH, mean corpuscular hemoglobin..

*For each variable, two age groups were compared using the Mann–Whitney U-test. P-values ≤0.05 were considered statistically significant.


Figure 3.

Comparison of complete blood cell count between males and females in healthy geriatric population (≥60 years old). For each variable, the two gender groups were compared using Student t-test. P-values ≤0.05 were considered statistically significant. (A) WBC, (B) RBC, (C) hemoglobin, (D) hematocrit, (E) RDW, (F) platelet, (G) MCV, (H) MCH, (I) MCHC, (J) PDW, (K) MPV, (L) neutrophil, (M) eosinophil (N) basophil, (O) lymphocyte, and (P) monocyte. Abbreviations: WBC, white blood cells; RBC, red blood cells; RDW, red cell distribution width; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; PDW, platelet distribution width; MPV, mean platelet volume.


3. 李멸퀬援ш컙쓽 꽕젙

鍮꾨え닔諛⑸쾿뿉 뵲씪 꽦蹂, 뿰졊蹂꾨줈 꽕젙맂 李멸퀬援ш컙 Tables 2, 3뿉 굹궡뿀떎. 궓꽦쓽 씪諛섑삁븸寃궗쓽 寃쎌슦 嫄곗쓽 紐⑤뱺 씪諛섑삁븸寃궗빆紐⑹뿉꽌 60꽭 씠긽 嫄닿컯 끂씤怨 60꽭 誘몃쭔援곌낵쓽 李멸퀬援ш컙쓣 遺꾪븷븯뒗 寃껋 넻怨꾩쟻 쓽쓽媛 뾾뿀떎(Table 4). PDW뿉꽌留 겙 몴以렪李(s2)媛 옉 몴以렪李(s1)쓽 1.5諛곕낫떎 而ㅼ꽌 李멸퀬援ш컙쓽 넻怨꾩쟻 李⑥씠瑜 蹂댁떎. 뿬꽦뿉꽌 z竊엧*쓽 寃곌낵瑜 蹂댁嫄곕굹, s2/(s2竊뛱1)씠 3蹂대떎 옉 寃곌낵瑜 蹂댁뿬 李멸퀬援ш컙쓽 넻怨꾩쟻 李⑥씠媛 愿李곕맂 빆紐⑹ MCV MCH, RDW 諛 샇궛援ъ떎. 씠쇅쓽 씪諛섑삁븸寃궗빆紐⑹뿉꽌 60꽭 씠긽 嫄닿컯 끂씤怨 60꽭 誘몃쭔援곌낵쓽 李멸퀬援ш컙 넻怨꾩쟻 李⑥씠媛 뾾뿀떎.

Table 2 . The RIs in healthy geriatric population (≥60 years old).

   VariableMaleFemale


RILower 90% CIHigher 90% CIRILower 90% CIHigher 90% CI
White blood cells (×109/L)3.6–9.83.5–4.09.3–12.73.3–8.62.8–3.77.9–12.2
Red blood cells (×1012/L)3.91–5.463.68–3.995.30–5.613.64–4.83.42–3.754.72–5.34
Hemoglobin (g/dL)12.9–17.210.8–13.116.9–17.611.8–15.111.3–12.114.8–16.0
Hematocrit (%)38.2–51.232.6–39.250.1–52.235–45.233.5–35.944.1–50.2
Red cell distribution width (%)12.1–15.611.9–12.214.5–17.311.9–14.511.7–12.114.1–14.9
Platelet (×109/L)125.4–325.8110–151.0305.0–391.0127.6–322.6105–159310–376
Mean corpuscular volume (fL)86.2–103.783.8–88.8102.3–107.887.8–100.585.6–88.799–101.6
MCH (pg)28.1–3527.1–29.734.5–36.929.2–34.328.9–29.633.8–34.5
MCH concentration (g/dL)32.5–34.732–32.834.6–35.132.6–3531.9–32.734.7–35.3
Platelet distribution width (fL)13–17.610.2–15.717.3–18.011.7–178.9–13.716.9–17.8
Mean platelet volume (fL)6.8–10.76.6–7.110.2–11.36.8–11.36.2–7.110.6–11.9
Neutrophil (%)36.9–74.735.8–40.372.6–85.134.6–73.429.2–37.867.6–77.6
Eosinophil (%)0.4–10.30–0.79.0–14.00.4–6.50.3–0.54.9–7.2
Basophil (%)0.2–1.40–0.31.1–1.60.2–1.40.1–0.31.3–2.8
Lymphocyte (%)16.5–50.611.9–18.947.6–53.519.1–53.515.7–23.050.3–61.8
Monocyte (%)4.2–10.53.1–5.09.9–11.94.2–10.54.0–4.59.8–13.5

All RIs were established according to the Clinical and Laboratory Standards Institute guideline EP28-A3c and 2.5th–97.5th percentile. The 90% CI was calculated according to the following formula: mean±1.645×standard deviation÷√number..

Abbreviations: RI, reference interval; CI, confidence interval; MCH, mean corpuscular hemoglobin..


Table 3 . The RIs in healthy adult population (≥20 and <60 years old).

   VariableMaleFemale


RILower 90% CIHigher 90% CIRILower 90% CIHigher 90% CI
White blood cells (×109/L)3.8–10.23.7–3.99.9–10.63.3–8.83.1–3.38.5–9.2
Red blood cells (×1012/L)4.2–5.64.15–4.235.53–5.613.7–4.93.66–3.734.77–4.88
Hemoglobin (g/dL)13.4–17.213.3–13.617.1–17.310–14.69.6–10.314.5–14.7
Hematocrit (%)39.9–5139.3–40.250.6–51.331.3–43.430.1–31.943.1–43.9
Red cell distribution width (%)11.9–14.111.8–14.114.1–14.311.8–17.911.8–11.917.2–18.7
Platelet (×109/L)149–346.5145–153333–357146.1–366.4140.0–150.0352.0–383.0
Mean corpuscular volume (fL)86.6–10185.8–86.9100.4–101.775.6–99.873.1–77.299.1–100.2
MCH (pg)29–34.328.8–29.234.1–34.424–3423.4–24.833.7–34.1
MCH concentration (g/dL)32.7–3532.6–32.834.9–35.131.6–34.831.3–31.834.7–34.9
Platelet distribution width (fL)10.7–17.410.6–11.017.3–17.510.6–17.310.3–10.917.1–17.4
Mean platelet volume (fL)6.8–116.8–6.910.8–11.17–11.26.9–7.111.0–11.3
Neutrophil (%)39.1–71.737.8–40.190.6–73.239.8–72.238.2–41.270.9–73.7
Eosinophil (%)0.6–9.40.5–0.68.5–10.20.3–8.80.3–0.48.0–9.9
Basophil (%)0.2–1.30.2–0.21.2–1.30.2–1.50.2–0.21.4–1.6
Lymphocyte (%)19.1–49.218.3–20.448.6–50.220–48.119.0–20.847.4–49.4
Monocyte (%)4.4–10.94.3–4.510.7–11.24.1–10.63.8–4.210.2–11.0

All reference ranges were established according to Clinical and Laboratory Standards Institute guideline EP28-A3c and 2.5th–97.5th percentile. The 90% CI was calculated according to the following formula: mean±1.645×standard deviation÷√number..

Abbreviations: RI, reference interval; CI, confidence interval; MCH, mean corpuscular hemoglobin..


Table 4 . Partitioning of RI for age groups (≥60 and <60 years old) according to Harris and Boyd method.

   VariableMaleFemale


zz*s1s21.5s1s2/(s2-s1)zz*s1s21.5s1s2/(s2-s1)
White blood cells (×109/L)1.598.841.611.652.4241.251.146.911.41.462.124.33
Red blood cells (×1012/L)6.768.850.360.380.54190.656.910.290.30.4430
Hemoglobin (g/dL)4.238.850.981.121.4785.276.910.851.091.284.48
Hematocrit (%)3.348.852.913.364.367.424.616.912.592.893.899.63
Red cell distribution width (%)5.078.850.660.860.994.35.426.910.611.460.921.72
Platelet (×109/L)3.938.8548.9649.573.4491.672.436.9148.5456.4572.817.14
Mean corpuscular volume (fL)6.038.853.874.575.816.539.496.913.125.694.682.21
MCH (pg)4.208.851.441.742.165.88.056.911.262.291.892.22
MCH concentration (g/dL)3.728.840.570.590.8629.53.146.910.60.770.94.53
Platelet distribution width (fL)5.038.850.911.481.372.61.946.911.11.591.653.24
Mean platelet volume (fL)2.078.850.921.041.388.672.716.911.051.061.58129.27
Neutrophil (%)2.238.858.329.6112.487.453.946.918.389.1412.5712.03
Eosinophil(%)0.148.852.382.623.5710.733.226.911.442.252.162.78
Basophil (%)0.108.850.280.290.4236.441.146.910.310.360.477.26
Lymphocyte (%)2.778.857.588.711.377.774.766.917.48.2911.19.31
Monocyte (%)1.428.851.541.652.31151.296.911.661.692.4956.33

Abbreviations: RI, reference interval; MCH, mean corpuscular hemoglobin..

*We used the method of Harris and Boyd to decide whether it was necessary to separate the RIs for age groups. The standard normal deviation (z) and critical value {z*=3(naverage/120)1/2 } were calculated.

If the calculated z exceeds z*, or the larger standard deviation (s2) exceeds 1.5 smaller standard deviation (s1), or s2/(s2-s1) is less than 3, it is recommended partitioning the RIs for age groups.


怨 李

룊洹 닔紐낆쓽 利앷뿉 뵲瑜 끂씤 씤援щ뒗 怨꾩냽 利앷異붿꽭뿉 엳쑝硫 2016뀈 넻怨꾩껌쓽 議곗궗뿉 뵲瑜대㈃ 븳援쓽 60꽭 씠긽 끂씤 씤援щ뒗 빟 1,013留 紐낆쑝濡 쟾泥 씤援ъ쓽 빟 20%뿉 떖븳떎[13]. 쓽猷뚭린愿쓣 諛⑸Ц븯뒗 끂씤쓽 鍮꾩쨷 씤援 援ъ꽦鍮꾩쑉蹂대떎 뜑 넂븘꽌, 嫄닿컯蹂댄뿕떖궗룊媛썝쓽 2016뀈 議곗궗뿉 뵲瑜대㈃ 끂씤 씤援(65꽭 씠긽)쓽 吏꾨즺鍮꾧 嫄닿컯蹂댄뿕 쟾泥 吏꾨즺鍮꾩쓽 37.5%瑜 李⑥뻽떎[2]. 씠泥섎읆 蹂묒썝뿉꽌 끂씤쓽 李멸퀬援ш컙뿉 븳 엫긽쟻 븘슂꽦 利앷븯怨 엳吏留 쁽옱 엫긽寃궗떎뿉꽌 궗슜븯怨 엳뒗 李멸퀬援ш컙 遺遺 20-50꽭쓽 嫄닿컯븳 꽦씤쓣 긽쑝濡 젙由쏀븳 寃쎌슦媛 留롫떎[3,4]. 쟾 꽭怨꾩쟻쑝濡쒕룄 끂씤 씤援ъ쓽 李멸퀬援ш컙뿉 愿븳 뿰援щ뒗 誘몃명븳 긽깭濡, 蹂 뿰援ъ뿉꽌 젙由쏀븳 嫄닿컯븳 븳援 끂씤 씤援ъ쓽 씪諛섑삁븸寃궗 李멸퀬援ш컙 떎젣 엫긽寃궗떎뿉꽌 쑀슜븯寃 씠슜맆 닔 엳쓣 寃껋쑝濡 蹂댁씤떎.

蹂 뿰援ъ뿉꽌 젙由쏀븳 븳援 끂씤쓽 씪諛섑삁븸寃궗 李멸퀬援ш컙 遺遺꾩쓽 씪諛섑삁븸寃궗빆紐⑹뿉꽌 60꽭 씠긽 嫄닿컯 끂씤怨 60꽭 誘몃쭔援 媛꾩뿉 넻怨꾩쟻 李⑥씠媛 愿李곕릺吏 븡븯떎. 궓꽦쓽 寃쎌슦 PDW瑜 젣쇅븳 寃궗빆紐⑹뿉꽌 李멸퀬援ш컙쓽 넻怨꾩쟻 李⑥씠媛 蹂댁씠吏 븡븘 湲곗〈뿉 젙由쎈맂 꽦씤쓽 삁븸寃궗 李멸퀬移섎 遺遺 洹몃濡 씠슜븷 닔 엳쓣 寃껋쑝濡 깮媛곷맂떎. 뿬꽦뿉꽌룄 留롮 寃궗빆紐⑹뿉꽌 李멸퀬援ш컙씠 넻怨꾩쟻 李⑥씠瑜 蹂댁씠吏 븡븘 湲곗〈쓽 젙由쎈맂 꽦씤쓽 삁븸寃궗 李멸퀬移섎 씠슜븷 닔 엳쓣 寃껋쑝濡 깮媛곷맂떎. 떎留 뿬꽦쓽 寃쎌슦 60꽭 誘몃쭔援곗뿉 鍮꾪빐 60꽭 씠긽援곗뿉꽌 MCV MCH媛 利앷븯뒗 寃쏀뼢쓣 蹂댁떎. 삉븳 RDW쓽 李멸퀬援ш컙 醫곸븘吏怨 샇궛援щ뒗 媛먯냼븯뒗 寃쏀뼢쓣 蹂댁떎. 끂씤 씤援ъ뿉꽌 MCV 利앷쓽 寃쎌슦 湲곗〈쓽 臾명뿄뿉꽌 蹂닿퀬븳 寃곌낵뱾怨 씪移섑븯뒗 寃곌낵瑜 蹂댁쑝硫[14,15], 씠뒗 뿰졊쓽 利앷뿉 뵲瑜 쟻삁援ъ쓽 닔紐 蹂솕媛 썝씤씤 寃껋쑝濡 異붿륫릺怨 엳떎[14]. 洹 諛뽰뿉 넻怨꾩쟻 쓽쓽媛 엳뒗 李⑥씠媛 愿李곕맂 빆紐⑹쓽 寃쎌슦 쁽옱源뚯 洹 쓽쓽媛 뿰援щ맂 寃쎌슦뒗 嫄곗쓽 뾾쑝硫 끂씤 씤援ъ쓽 떎瑜 듅吏뺤쟻씤 슂냼쓽 愿젴꽦 諛 엫긽쟻씤 쑀슜꽦 벑쓽 遺꾩꽍씠 異붽쟻쑝濡 븘슂븷 寃껋쑝濡 깮媛곷맂떎.

끂씤쓽 씪諛섑삁븸寃궗 李멸퀬援ш컙뿉 빐 湲곗〈뿉 蹂닿퀬맂 뿰援щ뒗 誘멸뎅怨 以묎뎅 벑 紐뉖챺 냼닔쓽 援媛뿉꽌留 議댁옱븯쑝硫[16-18], 씠 寃곌낵뱾 遺遺꾩쓽 빆紐⑹뿉꽌 蹂 뿰援ъ뿉꽌 젙由쏀븳 寃곌낵 겙 李⑥씠瑜 蹂댁씠吏 븡븯떎. 삁깋냼瑜 삁떆濡 궡렣蹂대㈃, 蹂 뿰援ъ뿉꽌뒗 60꽭 씠긽援곗뿉꽌 궓꽦 12.9-17.2, 뿬꽦 11.8-15.1쓽 李멸퀬援ш컙쓣 蹂댁뒗뜲, 誘멸뎅쓽 65꽭 씠긽 씤援щ 긽쑝濡 뿰援ы븳 寃곌낵뿉 쓽븯硫 궓꽦쓽 寃쎌슦 12.6-17.4, 뿬꽦쓽 寃쎌슦 11.7-16.1쓽 李멸퀬援ш컙쓣 蹂댁떎[16]. 諛섎㈃ 蹂 뿰援ш껐怨쇰낫떎 떎냼 궙 삁깋냼 李멸퀬援ш컙쓣 蹂댁씠뒗 寃쎌슦룄 엳뿀뒗뜲, 以묎뎅쓽 60꽭 씠긽 씤援щ 긽쑝濡 뿰援ы븳 寃곌낵뿉 쓽븯硫 궓꽦 12.1-16.5, 뿬꽦 10.7-15.0쓽 李멸퀬援ш컙쓣 蹂댁떎[17]. 씠泥섎읆 떎瑜 援媛쓽 援ъ꽦썝 媛꾩쓽 씪諛섑삁븸寃궗 李멸퀬援ш컙 씤醫낆씠굹 寃쎌젣닔以 벑뿉 뵲씪 떎瑜 닔 엳쑝誘濡 븳援씤쓣 긽쑝濡 븳 끂씤 씤援ъ쓽 李멸퀬援ш컙쓣 젙由쏀븯뿬 씠슜븯뒗 寃껋씠 븘슂븯硫, 蹂 뿰援ш껐怨쇰뒗 떎젣 븳援씤쓣 긽쑝濡 븳 吏꾨즺뿉 쑀슜븯寃 씠슜맆 닔 엳쓣 寃껋쑝濡 蹂댁씤떎.

李멸퀬援ш컙쓽 꽕젙뿉꽌 媛옣 以묒슂븳 遺遺꾩 嫄닿컯援곗쓽 李멸퀬移섎 꽕젙븯뒗 寃껋씠떎. 嫄닿컯 蹂댄렪쟻 젙쓽媛 뾾뒗 긽쟻씤 긽깭濡, 嫄닿컯븯떎뒗 寃껋쓣 뼱뼸寃 젙쓽븯뒗吏媛 李멸퀬移 꽕젙쓽 湲곕낯씠 맂떎[1]. 洹몃윭굹 끂씤쓽 寃쎌슦 젇 꽦씤뿉 鍮꾪빐 湲곗 吏덈퀝쓣 媛吏怨 엳뒗 寃쎌슦媛 留롮쑝硫, 빟臾쇱쓣 蹂듭슜븯怨 엳뒗 寃쎌슦媛 留롮븘 洹 븘슂꽦뿉 鍮꾪빐 李멸퀬援ш컙 꽕젙뿉 愿븳 뿰援ъ뿉 뼱젮씠 엳뿀떎. 蹂 뿰援ъ뿉꽌뒗 옣湲곌컙쓽 嫄닿컯寃吏 솚옄 뜲씠꽣瑜 諛뷀깢쑝濡 嫄닿컯寃吏 떆 옉꽦븳 臾몄쭊寃곌낵뿉 뵲씪 젣쇅湲곗쓣 꽕젙븯뿬 李멸퀬移 꽕젙뿉 븘슂븳 鍮꾧탳쟻 留롮 닔쓽 嫄닿컯 끂씤쓽 뜲씠꽣瑜 닔吏묓븷 닔 엳뿀떎.

슂빟븯硫, 蹂 뿰援ъ뿉꽌 젙由쏀븳 嫄닿컯븳 븳援 끂씤쓽 씪諛섑삁븸寃궗 李멸퀬援ш컙 궓꽦쓽 寃쎌슦 遺遺꾩쓽 씪諛섑삁븸寃궗빆紐⑹뿉꽌 60꽭 씠긽 嫄닿컯 끂씤怨 誘몃쭔援 궗씠뿉 넻怨꾩쟻 李⑥씠瑜 蹂댁씠吏 븡븯떎. 떎留 뿬꽦뿉꽌뒗 60꽭 씠긽 嫄닿컯 끂씤怨 誘몃쭔援 궗씠뿉 넻怨꾩쟻 李⑥씠瑜 蹂댁씠뒗 援ш컙씠 떎냼 議댁옱븯떎. 뵲씪꽌 엫긽寃궗떎뿉꽌뒗 듅엳 뿬꽦 끂씤쓽 삁븸寃궗 빐꽍 떆 湲곗씠 릺뒗 李멸퀬移섎 寃궗떎쓽 궗젙뿉 留욎텛뼱 옱꽕젙븯뒗 怨쇱젙씠 븘슂븷 寃껋쑝濡 깮媛곷맂떎.

References
  1. Clinical and Laboratory Standards Institute. Defining, establishing, and verifying reference intervals in the clinical laboratory: approved guideline: EP28-A3c. 3rd ed. Wayne (PA): Clinical and Laboratory Standards Institute, 2010.
  2. National Health Insurance Service, Health Insurance Review and Assessment Service. 2016 Korea health insurance statistics. http://www.nhis.or.kr/menu/retriveMenuSet.xx?menuId=F3323 (Accessed November 18 2017).
  3. Wu X, Zhao M, Pan B, Zhang J, Peng M, Wang L, et al. Complete blood count reference intervals for healthy Han Chinese adults. PLoS One 2015;10:e0119669.
    Pubmed KoreaMed CrossRef
  4. Park SH, Park CJ, Lee BR, Kim MJ, Han MY, Cho YU, et al. Establishment of age- and gender-specific reference ranges for 36 routine and 57 cell population data items in a new automated blood cell analyzer, Sysmex XN-2000. Ann Lab Med 2016;36:244-9.
    Pubmed KoreaMed CrossRef
  5. Turan S, Topcu B, Gokce I, Guran T, Atay Z, Omar A, et al. Serum alkaline phosphatase levels in healthy children and evaluation of alkaline phosphatase z-scores in different types of rickets. J Clin Res Pediatr Endocrinol 2011;3:7-11.
    Pubmed KoreaMed CrossRef
  6. Colantonio DA, Kyriakopoulou L, Chan MK, Daly CH, Brinc D, Venner AA, et al. Closing the gaps in pediatric laboratory reference intervals: a CALIPER database of 40 biochemical markers in a healthy and multiethnic population of children. Clin Chem 2012;58:854-68.
    Pubmed CrossRef
  7. Ridefelt P, Hellberg D, Aldrimer M, Gustafsson J. Estimating reliable paediatric reference intervals in clinical chemistry and haematology. Acta Paediatr 2014;103:10-5.
    Pubmed CrossRef
  8. Lee HR, Shin S, Yoon JH, Roh EY, Chang JY. Reference intervals of hematology and clinical chemistry analytes for 1-year-old Korean children. Ann Lab Med 2016;36:481-8.
    Pubmed KoreaMed CrossRef
  9. Zierk J, Arzideh F, Rechenauer T, Haeckel R, Rascher W, Metzler M, et al. Age- and sex-specific dynamics in 22 hematologic and biochemical analytes from birth to adolescence. Clin Chem 2015;61:964-73.
    Pubmed CrossRef
  10. Solberg HE. Approved recommendations (1987) on the theory of reference values: part 5. statistical treatment of collected reference values: determination of reference limits. J Clin Chem Clin Biochem 1987;25:645-56.
    CrossRef
  11. Reed AH, Henry RJ, Mason WB. Influence of statistical method used on the resulting estimate of normal range. Clin Chem 1971;17:275-84.
    Pubmed
  12. Harris EK, Boyd JC. On dividing reference data into subgroups to produce separate reference ranges. Clin Chem 1990;36:265-70.
    Pubmed
  13. Korean Statistical Information Service. http://kostat.go.kr/portal/korea/kor_nw/2/1/index.board?bmode=read&aSeq=362609 (Accessed November 18 2017).
  14. Gamaldo AA, Ferrucci L, Rifkind JM, Zonderman AB. Age-related changes in mean corpuscular volume in adult whites and African Americans. J Am Geriatr Soc 2011;59:1763-4.
    Pubmed KoreaMed CrossRef
  15. Danon D, Bologna NB, Gavendo S. Memory performance of young and old subjects related to their erythrocyte characteristics. Exp Gerontol 1992;27:275-85.
    CrossRef
  16. Yip R, Johnson C, Dallman PR. Age-related changes in laboratory values used in the diagnosis of anemia and iron deficiency. Am J Clin Nutr 1984;39:427-36.
    Pubmed CrossRef
  17. Woo J, Arumanayagam M, Ho SC, Swaminathan R. Hematological indices and the prevalence of anemia in an elderly Chinese population. Pathology 1989;21:31-4.
    Pubmed CrossRef
  18. Tsang CW, Lazarus R, Smith W, Mitchell P, Koutts J, Burnett L. Hematological indices in an older population sample: derivation of healthy reference values. Clin Chem 1998;44:96-101.