Nigerian Journal of Paediatrics 2011;38(3)125 - 130
ORIGINAL
Ogundeyi MM
Haematological profile of apparently
Olarewaju DM
healthy term babies aged one day, three
Njokanma OF
days and six weeks delivered in Sagamu,
Ogunlesi TA
Nigeria
Abstract
Background:
Normal
10.7 × 10 /L and platelets count of
9
Received: 22nd May 2011
of
haematological
242.5 × 10 /L. In the sixth week of
9
Accepted: 8th September 2011
values
parameters are often required to
life, the mean values of PCV,
Ogunlesi TA ( )
assist with diagnosis and
TWBC and platelets count were as
follows: 32.0%, 8.8 × 10 /L and
9
P.O. Box 652
monitoring.
277.7 × 10 /L respectively. The
9
Sagamu 121001, Ogun State
Objective:
To determine the
Nigerian.
haematological indices of
mean percentage neutrophil counts
Email:
apparently healthy term babies on
and lymphocyte counts were 56.8%
tinuade_ogunlesi@yahoo.co.uk
the first day, third day and sixth
and 38.7% respectively on the first
week of life.
day but were reversed to 34.6% and
Ogundeyi MM
Method: A longitudinal survey of
63.4% respectively on the sixth
Department of Paediatrics Federal
the haematological parameters of
week of life.
Medical Centre Abeokuta Nigeria
apparently healthy Nigerian term
Conclusion: The mean values of
infants was carried out between
the PCV and TWBC were highest
Olarewaju DM
October 2007 and March 2008
on the first day of life and lowest
Department of Paediatrics Olabisi
using electronic devices.
in the sixth week of life whereas
Onabanjo University Sagamu
Results: On the first day of life, the
the mean values of platelets count
Nigeria
mean values were 46.3% for
showed a less consistent pattern
packed cell volume (PCV), 10.8 ×
over the same period.
10 /L for total white blood cell
9
Njokanma OF
(TWBC) and 261.3 × 10 /L for
9
Department of Child Health
Key words: Erythrocytes,
Lagos State University.
platelets. The mean values
Haematological indices,
College of Medicine
obtained on the third day of life
Leucocytes, Newborn, Platelets
Ikeja Lagos, Nigeria
included PCV of 43.3%, TWBC of
Introduction
evaluation of bleeding disorders. The definitive
2
diagnosis of neonatal sepsis for instance, is based on
Haematologic problems are frequently encountered
blood culture. However, it takes about 48 hours to
by paediatricians caring for sick newborn infants.
obtain a preliminary report. On the other hand,
Alterations in the haematopoietic system are most
leukocyte indices could provide a useful guide while
anticipating a definitive result. In addition, severe
3
often reactive, secondary, and sometimes
iatrogenic.
1
However, abnormal haematopoiesis
anaemia and thrombocytopenia may also be found in
may be a useful marker of underlying systemic
infants with neonatal sepsis.
3
diseases, including infections, asphyxia, genetic and
metabolic disorders. Therefore, it is important to
In addition to uniqueness of normal values, different
establish normal ranges of values for various
workers have demonstrated age-related changes in
haematological indices in the newborn. For instance,
various haematologic indices within the first few
weeks of life.
4-8
packed cell volume is particularly important because
Such knowledge is of great value in
anaemia is one of the determinants of both morbidity
interpreting results of tests and in determining limits
and mortality in neonates. Knowledge of the platelet
1
within which to accept the findings in an index patient
count in an index neonate is of immense value in the
as normal.
EDITORIAL
126
Several studies of healthy newborn infants in recent
and written consent of the recruited mothers was also
years have shown, however, that changes in
obtained.
haematological indices in the first few weeks of life
follow a definite pattern and that normal values can
One and half millilitre (1.5ml) of venous blood was
indeed be defined for a given population.
4-6, 9
drawn from the recruited infants between the second
and sixth hour of life and on the third day of life while
The last study of haematological profile in term
they were with the mothers in the postnatal ward of
neonates from Western Nigeria was done three
the hospital. Prior to discharge from the hospital, the
decades ago. Thus, the study was aimed at
mothers were counselled to breastfeed the babies
establishing the current pattern of haematological
exclusively and avoid nutritional supplements. They
profile of babies delivered at Sagamu, South-West
were also encouraged to reach the principal
Nigeria.
investigator on phone at the slightest indication of an
illness in their babies. During the postnatal clinic
visit, only babies who had remained healthy and
exclusively breastfed since discharge from the
Materials and Methods
hospital were re-included in the study. Thus, a third
sample of venous blood was obtained at the age of six
A longitudinal study of the haematological
weeks during the postnatal visit.
parameters of apparently healthy term infants was
carried out over a six month period (October 2007 to
These blood samples were preserved in Ethylene
March 2008) at Olabisi Onabanjo University
Diamine Tetra aceticAcid (EDTA) bottles. The blood
Teaching Hospital (O.O.U.T.H.), Sagamu. This
samples were mixed gently to achieve good
hospital provides general and specialized paediatric
anticoagulation and were processed immediately
and haematologic care for children delivered within
after collection. The haematological parameters
Ogun State or referred from parts of Lagos and
studied included the packed cell volume (PCV),
Ondo States.
erythrocytes count, haemoglobin concentration,
mean corpuscular volume (MCV), mean corpuscular
The inclusion criteria included term, singleton
haemoglobin (MCH), mean corpuscular
deliveries while antepartum haemorrhage,
haemoglobin concentration (MCHC), nucleated red
caesarean delivery, overt bleeding, significant
blood cells (nRBC), reticulocytes count, total white
mechanical birth trauma, severe birth asphyxia,
blood cells count (TWBC), differential white blood
large cephalohaematoma, gross congenital
cells count and platelets count.
malformations, features of intra-uterine infections
and perinatal exposure to HIV were the exclusion
The haematological parameters were determined
criteria. Babies previously included in the study but
using the ADVIA 60 Closed Tube (CT) Automated
®
who subsequently developed significant jaundice
Haematology System while the reticulocyte count
10
(defined as total serum bilirubin > 12mg/dl) or
required blood transfusion were also excluded.
was manually performed using newly prepared
methylene blue as described by Dacie and Lewis.
11
This is because ADVIA
®
The sample size was derived from the formula (n =
60 closed tube (CT)
Automated Haematology System does not have this
10
(Z x S )/ B where Z represented the standard
2
2
2
normal coefficient at 95% confidence interval
function.
(1.96), S represented the standard deviation and B
represented the desired precision level expressed as
Descriptive information like means, ranges, ratios,
half the maximum acceptable confidence interval
and standard deviation of continuous variables were
width about the mean (0.05 or 5%). Using mean
derived as necessary.
values for each haematologic parameter previously
reported from other parts of Nigeria,
4,
5
the
calculated total sample size was 144 but additional
36 babies were studied to allow for attrition.
Result
Overall, one hundred and eighty term singleton
babies were recruited into the study. All the babies
One hundred and eighty singleton term babies were
were delivered in the teaching hospital after an
recruited into the study at birth. However, owing to
uneventful antenatal period. The babies were
attrition, 173 and 142 babies were studied on the third
positioned at the level of the introitus during
day of life and the sixth week of life respectively.
delivery and cord was clamped witin 30seconds of
Seven babies could not be studied on the third day of
delivery.
life because they were prematurely discharged from
the hospital against medical discharge. Of the 38
Prior to the commencement of the study, ethical
babies who defaulted at the sixth week of life, 4
clearance was obtained from the Scientific and
(10.5%) declined further participation, 20 (52.6%)
Ethics review Committee of the O.O.U.T.H.
did not attend the clinic and could not be traced while
127
The remaining 14 (36.8%) had various medical
Table 2 describes the distribution of babies according
problems such as haemorrhagic disease of the
to the PCV on the days of study. The PCV-1 of most
newborn, severe neonatal jaundice requiring
babies (81.6%) ranged between 35% and 54% while
exchange blood transfusion and severe sepsis.
only 3.9% had PCV-1 less than 35%. Similarly, most
babies (80.3%) had PCV-3 ranging between 35% and
The birth weight of the 180 babies ranged from 2.5kg
54% while a higher proportion (11.3%) had PCV-3
to 4.0kg with a mean of 3.18 ± 0.42kg. Eighty-four
less than 35%. On the contrary, 73.2% of the babies
(46.7%) of the babies were males while 96 (53.3%)
had PCV-6 less than 35% and only 26.8% had PCV-6
were females with male-to-female ratio of
ranging between 35% and 54%.
approximately 0.9:1.
Table 2: Frequency of PCV ranges on the first and
Red Cell Indices
third days and the sixth week of life
The mean PCV on the first day of life (PCV-1) was
PCV range
46.3 ± 7.2% while the mean PCV on the third day of
(%)
Day 1
Day 3
Week 6
life (PCV-3) and in the sixth week of life (PCV-6)
(n = 180) (n = 173) (n = 142)
were 43.3 ± 7.7% and 32.0 ± 4.8% respectively.
(Table)
< 35
7 (3.9)
20 (11.6)
104 (73.2)
35 – 44 66 (36.6)
77 (44.5)
36 (25.4)
The mean haemoglobin on the first day was 0.9g/dl
45 – 54
81 (45.0)
62 (35.8)
2 (1.4)
higher than the value obtained on the third day and it
55 – 64 25 (13.9)
14 (18.1)
0 (0.0)
dropped further by 3.9g/dl in the sixth week. While
> 65
1 (0.6)
0 (0.0)
0 (0.0)
The mean values of MCV, MCH and nRBC were
Total
180 (100)
173 (100)
142 (100)
highest on the first day, decreased slightly on the
Key: PCV Packed Cell Volume
third day and were lowest in the sixth week. Table 1.
The mean reticulocytes count was 3.5% on the first
White Cell Indices
day, 2.6% on the third day and 2.7% in the sixth
week.
The mean values of TWBC on the first day, third day
and in the sixth week were 10.8 × 10 /L, 10.7× 10 /L
9
9
Table 1 : Red cell indices of the babies on the first
and 8.8 × 10 /Lrespectively as shown in Table 3.
9
day, third day and sixth week of life
The mean percentage neutrophil count decreased
from 56.8% on the first day, through 46.9% on the
third day to 34.6% in the sixth week .
Parameter
Day 1(n=180)
Day 3(n=173)
Week 6(n=142)
Mean ± SD
Mean ± SD
Mean ± SD
(Range) (Range)
(Range)
Table 3: Total and differential white cell count on
Days 1, 3 and Week 6
PCV (%)
46.3 ± 7.2
43.3 ± 7.7
32.0 ± 4.8
Parameter
Day 1 (n=180)
Day 3(n=173)
Week 6 (n=142)
(30 – 68)
(30 – 64)
(23 – 48)
Mean ± SD
Mean ± SD
Mean ± SD
Hb (g/dl)
15.4 ± 2.4
14.5 ± 2.6
10.6 ± 1.7
(Range)
(Range)
(Range)
(9.4 – 22.7)
(8.0 – 22.1)
(7.7 – 15.9)
1 2
RBC (x 10 /l)
5.1 ± 0.8 4.8 ± 0.9
3.9 ± 0.6
TWBC (x 10 /L)
9
10.8 ± 15.0
10.7 ± 3.8
8.8 ± 2.8
(3.2 – 7.6)
(2.7 – 7.5)
(1.3 – 5.9)
(3.5 – 25.0)
(3.5 – 24.3)
(3.9 – 17.4)
MCV (fL)
91.6 ± 7.2
89.9 ± 6.8
80.4 ± 8.3
Neutr (% TWBC)
56.8 ± 10.9
46.9 ± 12.9
34.6 ± 11.5
(73.0 – 110.0)
(74.0 – 104.0)
(62.0 – 99.0)
(22.0 – 76.0)
(11.0 – 90.0)
(14.0 – 78.0)
MCH (pg)
30.5 ± 2.6
29.9 ± 2.5
26.6 ± 2.8
Lymph (% TWBC)
38.7 ± 10.9
50.7 ± 12.9
63.4 ± 11.3
(24.0 – 36.0)
(23.5 – 35.9)
(20.8 – 34.1)
(16.0 – 70.0)
(10.0 – 89.0)
(22.0 – 86.0)
MCHC (g/dl)
33.1 ± 1.4
33.0 ± 1.3
32.7 ± 1.3
Baso (% TWBC)
0.0 ± 0.0
0.0 ± 0.0
0.0 ± 0.0
(25.9 – 36.1)
(23.5 – 35.9)
(25.9 – 36.7)
(0.0)
(0.0)
(0.0)
nRBC (%)
4.3 ± 8.8 1.5 ± 4.5
0.6 ± 2.2
(0.0 – 48.0)
(0.0 – 30.0)
(0.0 – 20.0)
Mono (% TWBC)
4.3 ± 3.2
2.2 ± 2.7
1.9 ± 2.6
Retic (%)
3.5 ± 1.4
2.6 ± 1.5
2.7 ± 1.7
(0.0 – 12.0)
(0.0 – 11.0)
(0.0 – 12.0)
(0.0 – 7.1)
(0.0 – 6.0)
(0.0 – 8.4)
Eosin (% TWBC)
0.2 ± 0.6
0.3 ± 0.9
0.4 ± 0.8
(0.0 – 4.0)
(0.0 – 6.0)
(0.0 – 5.0)
Key: PCV Packed Cell Volume; Hb - Haemoglobin
Concentration; RBC Red Blood Cells;
Key: TWBC Total White Blood Cells Count; Neutr
MCV - Mean Corpuscular Volume; MCH Mean
Neutrophils; Lymph Lymphocytes; Baso Basophils;
Corpuscular Haemoglobin; MCHC -
Mean
Mono Monocytes; Eosin - Esoinophils
Corpuscular Haemoglobin Concentration; nRBC
nucleated Red Blood Cells; Retic
Reticulocyte
Counts
128
Majority of the babies had TWBC ranging from 8.0 to
Electronically and this difference in methodology
13.9 × 10 /L on the first day (49.4%), third day
9
might be responsible for the difference in values
(58.4%) and in the sixth week (52.1%) as shown in
obtained from both studies.
Table 4. The proportion of babies with TWBC
ranging from 3.5 to 7.9 × 10 /L increased from 13.3%
9
The lowest value of PCV obtained on the first day of
through 23.7% to 41.5% on the first day, third day and
life in the present study was 30%. Ordinarily, babies
sixth week respectively. Similarly, the proportion of
with PCV less than 40% on the first day of life would
babies with TWBC ranging from 14.0 to 19.9 × 10 /L
9
have been described as severely anaemic according
decreased from 30.6% through 16.2% to 6.4% on the
to the Caucasian reference values being used
presently.
9,15
first day, third day and sixth week respectively.
Interestingly, none of these babies with
PCV less than 40% on the first day of life had clinical
Platelets
features referable to severe anaemia such as lethargy,
breathlessness or cardiac strain.
The platelets count ranged from 120 × 10 /L to 649 ×
9
10 /Lon the first day, 129 × 10 /Lto 607 × 10 /Lon the
9
9
9
The mean PCV was highest on the first day in the
third day and from 124 × 10 /L to 619 × 10 /L in the
9
9
present study and thereafter declined consistently
sixth week. The mean values were 261.3 × 10 /L,
9
through day-3 to week-6. This is consistent with
findings in other Nigerian studies.
4-8, 12
242.5 × 10 /L and 277.7 × 10 /L on the first day, third
9
9
The mean PCV
day and sixth week respectively.
values at the sixth week of life in this study were
Most of the babies (90.6%, 94.8% and 88.0%) had
similar to values obtained from Northern Nigeria in
1984 at about the sixth week of life. Caucasian
6
platelets count varying between 150 × 10 /Land 450 ×
9
10 /L on the first day, third day and sixth week
9
infants also showed the same pattern of steady
decline in the haemoglobin concentration.
1, 9, 15, 16
respectively.
Table 4: Ranges of Platelet Counts on Days 1 and 3
There was relative reticulocytosis and high nucleated
and Week 6
red blood cells count at birth and these showed a
steady decline throughout the period of the study.
Platelet count
This pattern was similar to that reported for neonates
Day 1
Day 3
Week 6
from other parts of Nigeria
4, 5, 6
Zimbabwe
13
range (× 10 /L)
9
and
Malawi.
15
<149
10 (5.6)
3 (1.7)
7 (5.0)
In healthy term newborns, virtually no
150 – 299
122 (67.8) 129 (74.6) 79 (55.6)
nRBCs are foundafter the third or fourth day of life,
1,9
300 – 449
39 (21.7)
34 (19.6) 54 (38.0)
which was the pattern observed in this study. The
1
450 - 599
7 (3.8)
6 (3.5)
1 (0.7)
measured red cell indices MCV, MCH and MCHC
>600
2 (1.1)
1 (0.6)
1 (0.7)
did not show significant differences between this
study and previous studies
1, 4-7, 9, 13,14
Total
180 (100)
173 (100)
142 (100)
The mean white blood cell count at birth in the
present study was lower than those previously
reported among babies in other parts of Africa,
4-6, 13, 14
Discussion
1,
and much lower than those for Caucasian newborns.
9, 15
The mean PCV of 46.3 ± 7.2% reported on the first
day of life in this study was similar to 45% and 46%
Nevertheless, the mean value fell within the range of
previously reported values from Benin and Lagos
5
12
9
9
3.5 × 10 /L to 25.0 × 10 /L as previously reported
among other African and Caucasian babies.
4,6, 13-15
respectively, both in the Southern part of Nigeria, but
was lower than
some other previously reported
Although, bacteriologic screening was not routinely
values of 49 to 51% in the Middle belt and Northern
done for all the babies to exclude infections,
parts of Nigeria
4, 6
The differences do not appear to be
particularly among the babies with extreme values,
purely due to regional factors as our mean value was
there was no report of any possible indicator of sepsis
higher than a figure of 42% previously obtained
by the mothers or when the babies were examined.
among Northern Nigerian neonates. The mean PCV
8
Neutrophils were the predominant white cells on the
value obtained in the present study were similar to the
first day of life, but the proportion decreased
mean values previously reported from other African
gradually afterwards while the proportion of
countries (47% from Zimbabwe and 47% from
lymphocytes increased. By the sixth week of life,
Malawi).
13,14
The only study that recorded a mean
there was a reversal in the proportions of neutrophils
PCV of 60.8 ± 7.2% at birth which was similar to
and lymphocytes. The pattern of change between
theCaucasian values of 61.0 ± 7.4%,
1, 9, 15
was done at
neutrophils and lymphocytes obtained in this study
Ibadan, Nigeria
7
in 1976. The latter was done
agrees with previous reports among Caucasian and
African neonates,
1, 4, 9, 13
manually while the present study was done
But differed from the finding
in the Benin City study of 1984 in which a
6
129
Relatively higher proportion of lymphocytes was
count obtained at the third day and sixth week of life
recorded at birth. With respect to other leucocytes,
in the present study were also similar to those of
Caucasian neonates of same ages.
1, 9, 15
the concentrations of monocytes, eosinophils and
None of the
basophils were similar to values cited for different
infants studied had platelets count less than 100 x
ethnic groups in Nigeria overtime,
5, 6, 13, 14
and to those
10 /L.
9
given in standard haematology textbooks for
Caucasian newborns.
1, 9, 15
The reason for the disparity
between the mean TWBC, neutrophil and eosinophil
inAfrican and Caucasian infant is not clear.
Conclusion
The mean platelet count on the first day of life (261.3
× 10 ± 99.6 × 10 /L) in the present study was
9
9
the values of most of the haematological parameters
studied were highest on the first day of life and
7, 13
Essentially similar to many previous reports,
but
thereafter declined over the third day and the sixth
slightly higher than others from Jos and Kaduna in
4
6
week of life. Although, their mean values were not
Northern Nigeria. The platelet count in this study has
remarkably different from values previously
a wide range (120× 10 /L to 649 × 10 /L), which was
9
9
obtained in Nigeria, they were lower than known
the experience of previous researchers within and
Caucasian values. Further large scale multi-centre
outside the country.
4, 6, 13, 14
Although, there was a
studies are required to generate data that could be
marginal drop in the mean platelets count on the third
used to evaluate and possibly redefine important
day of life, this rose again by the sixth week of life,
conditions like severe anaemia, polycythaemia,
which is in agreement with the findings from Jos,
4
leucocytosis, leucopaenia and thrombocytopaenia
Nigeria. It is noteworthy that the values of platelet
among Nigerian babies
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