title: Complex biological profile of hematologic markers across pediatric, adult, and geriatric ages: establishment of robust pediatric and adult reference intervals on the basis of the Canadian Health Measures Survey.
abstract: BACKGROUND
  In a collaboration between the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) and the Canadian Health Measures Survey (CHMS), we determined reference value distributions using an a priori approach and created a comprehensive database of age- and sex-stratified reference intervals for clinically relevant hematologic parameters in a large household population of children and adults.
  
  
  METHODS
  The CHMS collected data and blood samples from 11 999 respondents aged 3-79 years. Hematology markers were measured with either the Beckman Coulter HmX or Siemens Sysmex CA-500 Series analyzers. After applying exclusion criteria and removing outliers, we determined statistically relevant age and sex partitions and calculated reference intervals, including 90% CIs, according to CSLI C28-A3 guidelines.
  
  
  RESULTS
  Hematology marker values showed dynamic changes from childhood into adulthood as well as between sexes, necessitating distinct partitions throughout life. Most age partitions were necessary during childhood, reflecting the hematologic changes that occur during growth and development. Hemoglobin, red blood cell count, hematocrit, and indices (mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration) increased with age, but females had lower hemoglobin and hematocrit starting at puberty. Platelet count gradually decreased with age and required multiple sex partitions during adolescence and adulthood. White blood cell count remained relatively constant over life, whereas fibrinogen increased slightly, requiring distinct age and sex partitions.
  
  
  CONCLUSIONS
  The robust dataset generated in this study has allowed observation of dynamic biological profiles of several hematology markers and the establishment of comprehensive age- and sex-specific reference intervals that may contribute to accurate monitoring of pediatric, adult, and geriatric patients.
authors.affiliation: CALIPER Program, Divisions of Clinical Biochemistry and Hematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; khosrow.adeli@sickkids.ca.
authors.forename: Khosrow
authors.initials: K
authors.lastname: Adeli
authors.affiliation: CALIPER Program, Divisions of Clinical Biochemistry and Hematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada;
authors.forename: Joshua E
authors.initials: JE
authors.lastname: Raizman
authors.affiliation: CALIPER Program, Divisions of Clinical Biochemistry and Hematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada;
authors.forename: Yunqi
authors.initials: Y
authors.lastname: Chen
authors.affiliation: CALIPER Program, Divisions of Clinical Biochemistry and Hematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada;
authors.forename: Victoria
authors.initials: V
authors.lastname: Higgins
authors.affiliation: CALIPER Program, Divisions of Clinical Biochemistry and Hematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada;
authors.forename: Michelle
authors.initials: M
authors.lastname: Nieuwesteeg
authors.affiliation: CALIPER Program, Divisions of Clinical Biochemistry and Hematopathology, Pediatric Laboratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada;
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdelhaleem
authors.affiliation: Health Analysis Division, Statistics Canada, Ottawa, ON;
authors.forename: Suzy L
authors.initials: SL
authors.lastname: Wong
authors.affiliation: Health Statistics Division, Statistics Canada, Ottawa, ON; Current affiliation: Section Head, Laboratory Services, Health Canada, Ottawa, ON, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Blais
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D001772:Blood Cell Count / Q000592:standards*; D001774:Blood Chemical Analysis / Q000592:standards*; D002170:Canada; D002648:Child; D002675:Child, Preschool; D006306:Health Surveys; D006400:Hematocrit / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count / Q000592:standards; D012015:Reference Standards; D012016:Reference Values; D055815:Young Adult
chemical_list: D015415:Biomarkers