Hematological Reference Values




The normal range for most hematologic parameters in infancy and childhood is different from that in adults. Dramatic changes occur during the first few weeks of life. The recognition of variables in the pediatric age group prevents unnecessary medical and laboratory investigations.


Fetal and Cord Blood Hematologic Value




Table A1.1

Hematologic Values a in Normal Fetuses at Different Gestational Ages

















































Week of gestation Hemoglobin (g/dl) RBCs (×10 6 /ml) Hematocrit (%) Mean corpuscular volume (fl) Total WBCs (×10 6 /µl) Corrected WBCs (×10 6 /µl) Platelets (×10 6 /µl)
18–21 ( N =760) 11.69±1.27 2.85±0.36 37.3±4.32 131.1±11.0 4.68±2.96 2.57±0.42 234±57
22–25 ( N =1200) 12.2±1.6 3.09±0.34 38.59±3.94 125.1±7.8 4.72±2.82 3.73±2.17 247±59
26–29 ( N =460) 12.91±1.38 3.46±0.41 40.88±4.4 118.5±8.0 5.16±2.53 4.08±0.84 242±69
>30 ( N =440) 13.64±2.21 3.82±0.64 43.55±7.2 114.4±9.3 7.71±4.99 6.4±2.99 232±87

RBCs, red blood cells; WBCs, white blood cells.

Modified from Forestier, F., Daffos, F., Catherine, N., et al., 1991. Developmental hematopoiesis in normal human fetal blood. Blood 77, 2360.

a Hematologic data obtained with a Coulter S plus II instrument. Total WBC count included nucleated red blood cells. Corrected WBC count included only WBCs, after subtracting the nucleated red cell component, based on a 100-cell manual differential.





Table A1.2

WBC Manual Differential Counts in Normal Fetuses at Different Gestational Ages












































Week of gestation Lymphocytes (%) Neutrophils (%) Eosinophils (%) Basophils (%) Monocytes (%) Nucleated RBCs (% of WBCs)
18–21 ( N =186) 88±7 6±4 2±3 0.5±1 3.5±2 45±86
22–25 ( N =230) 87±6 6.5±3.5 3±3 0.5±1 3.5±2.5 21±23
26–29 ( N =144) 85±6 8.5±4 4±3 0.5±1 3.5±2.5 21±67
>30 ( N =172) 68.5±15 23±15 5±3 0.5±1 3.5±2 17±40

RBCs, red blood cells; WBCs, white blood cells.

From Forestier, F., Daffos, F., Catherine, N., et al. 1991. Developmental hematopoiesis in normal human fetal blood. Blood 77, 2360.




Table A1.3

Hematologic Values for Cord Blood (Vaginal Delivery and Cesarean Section a )





























































































































Characteristic Study sample ( N =167) Vaginal delivery ( N =63) Cesarean section ( N =104) P -value 2
Median Range Median Range Median Range
WBC (×10 9 /l) 15.1 5.54–39.7 18.4 12.0–34.1 13.6 8.54–39.7 <0.0001
RBC (×10 12 /l) 4.7 3.46–6.62 4.78 3.89–6.30 4.62 3.46–6.62 NS
Hb (g/l) 174 130–234 176 140–230 171 130–234 NS
Hct (%) 53.6 40.1–73.1 54.7 41.9–73.1 52.6 40.1–72.2 NS
MCV (fl) 112 97.7–127 114 105–127 112 97.7–125 NS
MCH (pg) 36.5 31.4–41 36.5 31.4–41 36.6 32–39.9 NS
MCHC (g/l) 324 303–359 323 308–359 324 303–344 NS
RDW (%) 17.4 14.2–23.6 17.4 14.9–23.6 17.4 14.2–23.3 NS
PLT (×10 9 /l) 270 161–607 297 169–607 254 161–424 0.0053
MPV (fl) 8.7 7.5–11.5 8.7 7.7–11.4 8.8 7.5–11.5 NS
Plateletcrit (%) 0.24 0.15–0.48 0.26 0.15–0.48 0.23 0.15–0.36 0.0056
CD34+cells (×10 6 /l) 43.9 7.14–253 47.7 15.9–253 39.9 7.14–120 0.007

Hb, hemoglobin; Hct, hematocrit; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; MCV, mean corpuscular volume; MPV, mean platelet volume; NS, not significant; plateletcrit, MPV×PLT; PLT, platelet; RBC, red blood cell; RDW, red blood cell distribution width; WBC, white blood cell.

From Eskola, M., Juutistenaho, S., Aranko, K., et al. 2011. J. Perinatol. 258–262. Data obtained with Sysmex K-1000 analyzer (Sysmex, Kobe Japan).

a P -values of the differences between vaginal delivery and cesarean section. The concentrations were standardized to exclude the varying effect of the anticoagulant.





Table A1.4

Red Cell and Reticulocyte Indices, Serum Iron Status Markers in Cord Blood







































































































Parameter Mean SD Reference range a
BLOOD COUNT AND CELLULAR INDICES
Hb (g/l) 159 15 146–189
HCT (l/l) 0.49 0.05 0.44–0.58
MCV (fl) 109 4 102–118
MCVr (fl) 124 6 115–136
MCH (pg) 35 1 33–38
MCHC (g/l) 325 10 306–342
%Retic (%) 4.0 0.8 2.6–5.4
IRF-H (%) 24.1 7.8 10.2–40.0
CHm (pg) 34.9 1.3 32.5–37.2
CHr (pg) 35.6 1.3 33.1–38.6
%HYPOm (%) 3.0 3.0 0.4–9.9
%HYPOr (%) 42.0 15.6 18.3–76.8
SERUM MEASUREMENTS
TfR (mg/l) 2.0 0.7 1.2–4.0
Ferritin (µg/l) 198 137 45–636
TfR-F index 0.95 0.43 0.49–2.1
Iron (µmol/l) 27.4 7.7 12.2–42.1
Transferrin (g/l) 2.0 0.4 1.2–2.9
TfSat (%) 55 19 21–111

CHm, cellular hemoglobin in red blood cells; CHr, cellular hemoglobin in reticulocytes; Hb, hemoglobin; HCT, hematocrit; %HYPOm, percentage of hypochromic red blood cells; %HYPOr, percentage of hypochromic reticulocytes; IRF-H, high immature reticulocyte fraction; MCH, mean cell hemoglobin; MCHC, mean cell hemoglobin concentration; MCV, mean cell volume of red blood cells; MCVr, mean cell volume of reticulocytes; %Retic, proportion of reticulocytes; TfR, transferrin receptor; TfR-F index, transferrin receptor/log (ferritin); TfSat, transferrin saturation.

From Ervasti, M., Kotisaari, S., Sankilampi, U., et al., 2007. The relationship between red blood cell and reticulocyte indices and serum markers of iron status in the cord blood of newborns. Clin. Chem. Lab. Med. 45, 1000–1003. Hematologic data obtained in 199 full-term newborn infants with an ADVIA 120 analyzer (Siemens Diagnostic Solutions, Terrytown, NY).

a For reference range calculations, only samples in which Hb was greater than 146 g/l were included.





Red Cell Values and Related Serum Values




Table A1.5

Hemoglobin Concentrations (g/dl) for Iron-Sufficient Preterm Infants a
















































Birth weight (g)
Age Number 1000–1500 1501–2000
2 weeks 17,39 16.3 (11.7–18.4) 14.8 (11.8–19.6)
1 month 15,42 10.9 (8.7–15.2) 11.5 (8.2–15.0)
2 months 17,47 8.8 (7.1–11.5) 9.4 (8.0–11.4)
3 months 16,41 9.8 (8.9–11.2) 10.2 (9.3–11.8)
4 months 13,37 11.3 (9.1–13.1) 11.3 (9.1–13.1)
5 months 8,21 11.6 (10.2–14.3) 11.8 (10.4–13.0)
6 months 9,21 12.0 (9.4–13.8) 11.8 (10.7–12.6)

From Lundstrom, U., Siimes, M.A., Dallman, P.R., 1997. At what age does iron supplementation become necessary in low-birth weight infants. J Pediatr. 91, 878, with permission.

a These infants were admitted to the Helsinki Children’s Hospital during a 15-month period. None had a complicated course during the first 2 weeks of life or had undergone an exchange transfusion. All infants were iron sufficient, as indicated by a serum ferritin greater than 10 ng/ml.





Table A1.6

Red Cell Values on First Postnatal Day













































































Gestational age (weeks)
24–25 (7) a 26–27 (11) 28–29 (7) 30–31 (25) 32–33 (23) 34–35 (23) 36–37 (20) Term (19)
RBC×10 6 4.65 b ±0.43 4.73±0.45 4.62±0.75 4.79±0.74 5.0±0.76 5.09±0.5 5.27±0.68 5.14±0.7
Hb (g/dl) 19.4±1.5 19.0±2.5 19.3±1.8 19.1±2.2 18.5±2.0 19.6±2.1 19.2±1.7 19.3±2.2
Hematocrit (%) 63±4 62±8 60±7 60±8 60±8 61±7 64±7 61±7.4
MCV (fl) 135±0.2 132±14.4 131±13.5 127±12.7 123±15.7 122±10.0 121±12.5 119±9.4
Reticulocytes (%) 6.0±0.5 9.6±3.2 7.5±2.5 5.8±2.0 5.0±1.9 3.9±1.6 4.2±1.8 3.2±1.4
Weight (g) 725±185 993±194 1174±128 1450±232 1816±192 1957±291 2245±213

From Zaizov, R., Matoth, Y., 1976. Red cell values on the first postnatal day during the last 16 weeks of gestation. Am. J. Hematol. 1, 276, with permission.

a Number of infants.


b Mean values±SD.





Table A1.7

Mean Hematological Values in the First 2 Weeks of Life in the Term Infant










































































Hematological value Cord blood Day 1 Day 3 Day 7 Day 14
Hb (g/dl) 16.8 18.4 17.8 17.0 16.8
Hematocrit 0.53 0.58 0.55 0.54 0.52
Red cells (310 12 /l) 5.25 5.8 5.6 5.2 5.1
MCV (fl) 107 108 99.0 98.0 96.0
MCH (pg) 34 35 33 32.5 31.5
MCHC (%) 31.7 32.5 33 33 33
Reticulocytes (%) 3–7 3–7 1–3 0–1 0–1
Nucleated RBC (mm 3 ) 500 200 0–5 0 0
Platelets (310 9 /l) 290 192 213 248 252

From Oski, F.A., Naiman, J.L., 1982. Hematologic Problems in the Newborn, third ed. Saunders, Philadelphia, PA, with permission.




Table A1.8

Red Cell Values at Various Ages: Mean and Lower Limit of Normal (22 SD) a

































































































































































































































































Hemoglobin (g/dl) Hematocrit (%) Red cell count (10 12 /l) MCV (fl) MCH (pg) MCHC (g/dl) Reticulocytes
Age Mean 22 SD Mean 22 SD Mean 22 SD Mean 22 SD Mean 22 SD Mean 22 SD Mean 22 SD
Birth (cord blood) 16.5 13.5 51 42 4.7 3.9 108 98 34 31 33 30 3.2 1.8
1–3 days (capillary) 18.5 14.5 56 45 5.3 4.0 108 95 34 31 33 29 3.0 1.5
1 week 17.5 13.5 54 42 5.1 3.9 107 88 34 28 33 28 0.5 0.1
2 weeks 16.5 12.5 51 39 4.9 3.6 105 86 34 28 33 28 0.5 0.2
1 month 14.0 10.0 43 31 4.2 3.0 104 85 34 28 33 29 0.8 0.4
2 months 11.5 9.0 35 28 3.8 2.7 96 77 30 26 33 29 1.6 0.9
3–6 months 11.5 9.5 35 29 3.8 3.1 91 74 30 25 33 30 0.7 0.4
0.5–2 years 12.0 10.5 36 33 4.5 3.7 78 70 27 23 33 30 1.0 0.2
2–6 years 12.5 11.5 37 34 4.6 3.9 81 75 27 24 34 31 1.0 0.2
6–12 years 13.5 11.5 40 35 4.6 4.0 86 77 29 25 34 31 1.0 0.2
12–18 Years
Female 14.0 12.0 41 36 4.6 4.1 90 78 30 25 34 31 1.0 0.2
Male 14.5 13.0 43 37 4.9 4.5 88 78 30 25 34 31 1.0 0.2
18–49 Years
Female 14.0 12.0 41 36 4.6 4.0 90 80 30 26 34 31 1.0 0.2
Male 15.5 13.5 47 41 5.2 4.5 90 80 30 26 34 31 1.0 0.2

From Dallman, P.R., 1997. Blood and blood-forming tissue. In: Rudolph, A. (Ed.), Pediatrics, sixteenth ed. Appleton-Cernuary-Croles, Norwalk, CT, with permission.

a These data have been compiled from several sources. Emphasis is given to studies employing electronic counters and to the selection of populations that are likely to exclude individuals with iron deficiency. The mean ±2 SD can be expected to include 95% of the observations in a normal population.






Figure A1.1


Physiologic nadir for term and preterm infants. The mean and range of normal hemoglobin and reticulocyte values for term and preterm infants are shown. Premature infants reach a nadir of erythrocyte production sooner and require longer to recover than their term infant counterparts.

Source: From Dallman, P.R., 1981. Anemia of prematurity. Ann. Rev. Med. 32, 143.





Figure A1.2


(A) Hemoglobin and MCV percentile curves for girls. (B) Hemoglobin and MCV percentile curves for boys.

Source: From Dallman, P.R., Siimes, M.A., 1979. Percentile curves for hemoglobin and red cell volume in infancy and childhood. J. Pediatr. 94, 28, with permission.




Table A1.9

Serum Ferritin Values



























Age ng/ml
Newborn 25–200
1 month 200–600
2–5 months 50–200
6 months–15 years 7–140
Adult
Male 15–200
Female 12–150





Figure A1.3


Normal values for serum iron and transferrin saturation.

From Koerper, M.A., Dallman, P., 1977. Serum iron concentration and transferrin saturation in the diagnosis of iron deficiency in children: normal developmental changes. J. Pediatr. 91, 870, with permission.




Table A1.10

Values of Serum Iron (SI), Total Iron-Binding Capacity (TIBC), and Transferrin Saturation (S%) from Infants During the First Year of Life



































































































Age (months)
0.5 1 2 4 6 9 12
SI
Median μmol/l 22 22 16 15 14 15 14
11–36 10–31 3–29 3–29 5–24 6–24 6–28
95% range μg/dl 120 125 87 84 77 84 78
63–201 58–172 15–159 18–164 28–135 34–135 35–155
TIBC
Mean±SD μmol/l 34±8 36±8 44±10 54±7 58±9 61±7 64±7
μg/dl 191±43 199±43 246±55 300±39 321±51 341±42 358±38
S%
Median 68 63 34 27 23 25 23
95% range 30–99 35–94 21–63 7–53 10–43 10–39 10–47

Note: These data were obtained from a group of healthy, full-term infants who were born at the Helsinki University Central Hospital. Infants received iron supplementation in formula and cereal throughout the 12-month period. Infants with hemoglobin below 10 g/dl, mean corpuscular volume of red blood cells below 71 fl, or serum ferritin below 10 ng/ml were excluded from the study. The 95% range of the transferrin saturation values indicates that the lower limit of normal is about 10% after 4 months of age.

From Saarinen, U.M., Siimes, M.A., 1977. Serum iron and transferrin in iron deficiency. J. Pediatr. 91, 876, with permission.




Table A1.11

Mean Serum Iron and Iron Saturation Percentage
























Age (years) Serum iron (mg/dl) Saturation (%)
0.5–2 68±3.6 (16–120) 22±1.1 (6–38)
2–6 72±3.4 (20–124) 25±1.2 (7–43)
6–12 73±3.4 (23–123) 25±1.2 (7–43)
181 92±3.8 (48–136) 30±1.1 (18–46)

From Koerper, M.A., Dallman, P.R., 1977. Serum iron concentration and transferrin saturation are lower in normal children than in adults. J. Pediatr. Res. 11, 473, with permission.




Table A1.12

Normal Serum Folic Acid Levels (ng/ml)



























































































Folate Age Range Mean ± SD
Serum folate Normal premature infants
1–4 days 7.17–52.00 29.54±0.98
2–3 weeks 4.12–15.62 8.61±0.55
1–2 months 2.81–11.25 5.84±0.35
2–3 months 3.56–11.82 6.95±0.50
3–5 months 3.85–16.50 8.92±0.86
5–7 months 6.00–12.25 9.02±0.74
Normal children
1 year 3.0–35 9.3
1–6 years 4.12–21.15 11.37±0.82
1–10 years 6.5–16.5 10.3
Normal adults
20–45 years 4.50–28.00 10.29±1.14
Red cell folate Infants, 1 year 74–995 277
Children, 1–11 years 96–364 215
Adults 160–640 316
Whole blood folate Infants, 1 year 20–160 87
Infants, 1 year 31–400 86
Infants, 2–24 months 34–160 96
Children, 1–11 years 52–164 97
Adults 50–400 195

From Shojania, A., Gross, S., 1964. Folic acid deficiency and prematurity. J. Pediatr. 64, 323, with permission.




Table A1.13

Percentage of Hemoglobin F (HbF) in the First Year of Life a


















































































Age Number tested Mean 2 SD Range
1–7 days 10 74.7 5.4 61–79.6
2 weeks 13 74.9 5.7 66–88.5
1 month 11 60.2 6.3 45.7–67.3
2 months 10 45.6 10.1 29.4–60.8
3 months 10 26.6 14.5 14.8–55.9
4 months 10 17.7 6.1 9.4–28.5
5 months 10 10.4 6.7 2.3–22.4
6 months 15 6.5 3.0 2.7–13.0
8 months 11 5.1 3.6 2.3–11.9
10 months 10 2.1 0.7 1.5–3.5
12 months 10 2.6 1.5 1.3–5.0
1–14 years and adults 100 0.6 0.4 –

From Schröter, W., Nafz, C., 1981. Diagnostic significance of hemoglobin F and A 2 levels in homo- and heterozygous beta-thalassemia during infancy. Helv. Paediatr. Acta. 36, 519.

a HbF measured by alkali denaturation.





Table A1.14

Percentage of Hemoglobin F and A 2 in Newborn and Adult
















Hemoglobin F (%) Hemoglobin A 2 (%)
Newborn 60–90 1.0
Adult 1.0 1.6–3.5





Figure A1.4


Relative concentration of hemoglobin F in infants and variation with age.

Modified from Garby, L., Sjolin, S., Vuille, J.C., 1962. Studies on erythro-kinetics in infancy. II The relative rate of synthesis of haemoglobin F and haemoglobin A during the first months of life. Acta Paediatr. 51, 245, with permission.




Table A1.15

Estimated Blood Volumes








































































Age Plasma volume (PV) (ml/kg) Red cell mass (RCM) (ml/kg) Total blood volume (ml/kg)
(From PV) (From RCM)
Newborn 43.6 43.1 80.0 85.4
1–7 days 51–54 37.9 82.9 77.8
1–12 months 46.1 25.5 78.1 72.8
1–3 years 45.8 24.9 77.8 69.1
4–6 years 49.6 25.5 82.8 67.5
7–9 years 50.6 24.3 88.6 67.5
10–12 years 49.0 26.3 85.4 67.5
13–15 years 51.2 88.3
16–18 years 50.1 90.2
Adult 39–44 25–30 68–88 55–75

Modified from Price, D.C., Ries, C. In: Handmaker, H., Lowenstein, J.M. (Eds.), Nuclear Medicine in Clinical Pediatrics. Society of Nuclear Medicine, New York, p. 279.




Table A1.16

Methemoglobin Levels in Normal Children a



















































































































Number of cases Number of determinations Methemoglobin (g/dl) Number of cases Number det. Methemoglobin as percentage of total hemoglobin
Mean Range SD Mean Range SD
Prematures (birth–7 days) 29 34 0.43 (0.02–0.83) ±0.07 24 28 2.3 (0.08–4.4) ±1.26
Prematures (7–72 days) 21 29 0.31 (0.02–0.78) ±0.19 18 23 2.2 (0.02–4.7) ±1.07
Prematures (total) 50 63 0.38 (0.02–0.83) ±0.10 42 51 2.2 (0.08–4.7) ±1.10
Cook Country Hospital prematures (1–14 days) 8 8 0.52 (0.18–0.83) ±0.08 – – – – –
Newborns (1–10 days) 39 39 0.22 (0.00–0.58) ±0.17 25 30 1.5 (0.00–2.8) ±0.81
Infants (1 month–1 year) 8 8 0.14 (0.02–0.29) ±0.09 8 8 1.2 (0.17–2.4) ±0.78
Children (1–14 years) 35 35 0.11 (0.00–0.33) ±0.09 35 35 0.79 (0.00–2.4) ±0.62
Adults (14–78 years) 30 30 0.11 (0.00–0.28) ±0.09 27 27 0.82 (0.00–1.9) ±0.63

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