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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