Reference intervals for complete blood count parameters in the Longitudinal Study of Adult Health (ELSA-Brasil): a cross-sectional analysis
Keywords:
Complete blood count, Reference intervals, Epidemiology, ELSA-BrasilAbstract
BACKGROUND: Complete blood count (CBC) is the most frequently requested laboratory test worldwide, providing essential clinical information. In Brazil, many laboratories still use reference intervals (RIs) that are inadequately defined or not representative of the local population. Establishing population-specific RIs is crucial for accurate interpretation, diagnosis, and clinical decision making.
OBJECTIVE: To establish RIs for CBC parameters in a sample of Brazilian adults.
METHODS: This cross-sectional study included 2,417 healthy individuals who participated in the baseline (2008–2010) of the Longitudinal Study of Adult Health (ELSA-Brasil). Venous blood collection and storage were performed according to the procedures established by the Clinical and Laboratory Standards Institute (CLSI) in 2018. CBC was performed in laboratories with laboratory proficiency. The RIs were calculated using the nonparametric method proposed by the CLSI.
RESULTS: The RIs were stratified by sex only for the following parameters: Red blood cells (RBC; × 106/mm³): Male (4.4–5.6), Female (3.9–5.1); Hemoglobin (g/dL): Male (13.2–16.7), Female (11.8–14.9); Hematocrit (%): Male (39–49), Female (35.3–44.2); Mean corpuscular hemoglobin concentration (MCHC; g/dL): Male (32.3–35.7), Female (32–35.1); Platelets (× 10³/mm³): Male (146–319), Female: (170–352). The other parameters were as follows: mean corpuscular volume (MCV) (fL): (79.9–96); mean corpuscular hemoglobin (MCH) (pg): (26.4–32.5); White blood cells (WBC; /mm3): (3,700–8,610); Neutrophils (/mm³): (1,666–5,705); Eosinophils (/mm³): (23.8–530); Basophils (/mm³): (0–112); Lymphocytes (/mm³): (1,121–2,824); Monocytes (/mm³): (240–751.7).
CONCLUSION: Our results agree with those of other studies that have proposed RIs for CBC parameters. The differences found in MCV, neutrophil and WBC parameters (total population), and MCHC (both sexes) may be due to differences in the study populations, sample sizes, and pre-analytical and analytical study variables.
Downloads
References
Bennett ST, Lehman CM, Rodgers GM. Laboratory hemostasis: a practical guide for pathologists. 2nd ed. Cham: Springer International Publishing; 2015. xii, 205 p. Available from: https://link.springer.com/10.1007/978-3-319-08924-9.
Loscalzo J, Schafer A, editors. Thrombosis and hemorrhage. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003. 1142 p.
Jakubik LD, Cockerham J, Altmann AR, Grossman MB. The ABCs of pediatric laboratory interpretation: understanding the CBC with differential and LFTs. Pediatr Nurs. 2003;29(2):97–103. PMID: 12723821.
Buttarello M, Plebani M. Automated blood cell counts: state of the art. Am J Clin Pathol. 2008;130(1):104–16. PMID: 18550479; https://doi.org/10.1309/EK3C7CTDKNVPXVTN.
Villela GG, Rodrigues AF. Ferro, hemoglobina e volume globular no sangue humano normal. Hospital (Rio J). 1935;7:791–804.
Karazawa EHI, Jamra M. Parâmetros hematológicos normais. Rev Saúde Públ. 1989;23(1):58–66. Available from: https://revistas.usp.br/rsp/article/view/23552/25589.
Barros NV. Estudos hematológicos em São Paulo. An Fac Med Univ S Paulo. 1944;20:37–43.
Fonseca LC. Subnutrição e anemias na região nordeste do Estado de São Paulo. Hospital (Rio J). 1948;33:559–610.
Gandra YR. Inquérito sobre o estado de nutrição de um grupo de população da cidade de São Paulo. Arq Fac Hig S Paulo. 1956;10:113–216.
Rosenfeld LG, Malta DC, Szwarcwald CL, et al. Reference values for blood count laboratory tests in the Brazilian adult population, National Health Survey. Rev Bras Epidemiol. 2019;22(Suppl 2):E190003.SUPL.2. PMID: 31596374; https://doi.org/10.1590/1980-549720190003.supl.2.
Katayev A, Balciza C, Seccombe DW. Establishing reference intervals for clinical laboratory test results: is there a better way? Am J Clin Pathol. 2010;133(2):180 6. PMID: 20093226; https://doi.org/10.1309/AJCPN5BMTSF1CDYP.
Horowitz GL. Reference intervals: practical aspects. EJIFCC. 2008;19(2):95–105. PMID: 27683304.
Schmidt MI, Duncan BB, Mill JG, et al. Cohort profile: longitudinal study of adult health (ELSA-Brasil). Int J Epidemiol. 2015;44(1):68–75. PMID: 24585730; https://doi.org/10.1093/ije/dyu027.
Aquino EM, Barreto SM, Bensenor IM, et al. Brazilian longitudinal study of adult health (ELSA-Brasil): objectives and design. Am J Epidemiol. 2012;175(4):315–24. PMID: 22234482; https://doi.org/10.1093/aje/kwr294.
Clinical and Laboratory Standards Institute (CLSI). Collection of diagnostic venous blood specimens. CLSI standard GP41. 7th ed. Wayne (PA): CLSI; 2017.
Fedeli LG, Vidigal PG, Leite CM, et al. Logística de coleta e transporte de material biológico e organização do laboratório central no ELSA-Brasil [Logistics of collection and transportation of biological samples and the organization of the central laboratory in the ELSA-Brasil]. Rev Saude Publica. 2013;47(Suppl 2):63–71. PMID: 24346722; https://doi.org/10.1590/s0034-8910.2013047003807.
Clinical and Laboratory Standards Institute (CLSI). Defining, establishing and verifying reference intervals in the clinical laboratory: approved guideline. CLSI document EP28-A3c. 3rd ed. Wayne (PA): CLSI; 2010. 60 p.
Koram K, Addae M, Ocran J, et al. Population based reference intervals for common blood haematological and biochemical parameters in the Akuapem north district. Ghana Med J. 2007;41(4):160–6. PMID: 18464901; http://doi.org/10.4314/gmj.v41i4.55284.
Menard D, Mandeng MJ, Tothy MB, et al. Immunohematological reference ranges for adults from the Central African Republic. Clin Diagn Lab Immunol. 2003;10(3):443–5. PMID: 12738646; https://doi.org/10.1128/cdli.10.3.443-445.2003.
Handin RI, Lux SE, Stossel TP, editors. Blood, principles and practice of hematology. Philadelphia: Lippincott; 1995. 2305 p.
Ghazizadeh H, Kathryn Bohn M, Kardagh Polus R, et al. Comprehensive hematological reference intervals in a healthy adult male population. Cell Mol Biol (Noisy-le-grand). 2020;66(2):99–104. PMID: 32415934.
Ceriotti F, Hinzmann R, Panteghini M. Reference intervals: the way forward. Ann Clin Biochem. 2009;46(Pt1):8–17. PMID: 19103955; https://doi.org/10.1258/acb.2008.008170.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 São Paulo Medical Journal
This work is licensed under a Creative Commons Attribution 4.0 International License.
