THE PROBLEMS OF ASSESSING THE NORMATIVE RANGES OF INDICATORS OF THE MAIN SUBPOPULATIONS OF BLOOD LYMPHOCYTES IN CHILDREN OF DIFFERENT AGES

Abstract

The age-related dynamics of the main subsets of blood lymphocytes in children has been studied quite well, but the question of the limits of the normal ranges, especially at an early age, remains actual and important. The paper analyzes results of a direct study dataset of 624 blood samples of healthy children aged 1 week to 17 years and 11 months, residents of Moscow and the central regions of Russia, who underwent a clinical complete blood count during routine checkups. The main criterion for the inclusion of a child in the study was reliable information about the absence of acute and chronic diseases. The absolute number of lymphocytes was determined in a complex of indicators of automated blood analysis, using 5 Diff technology of flow hemocytometry with fluorescent staining of nucleic acids. The percentage and absolute values of T-lymphocytes, T-helper cells, T-cytotoxic cells, the ratio of helper/cytotoxic lymphocytes, as well as the percentage and absolute numbers of B-lymphocytes and natural killers were determined using the residual blood volume by flow cytometry with 3-4 color staining.  14 age groups were formed with the number of observations in each from 40 to 64. The Kolmogorov-Smirnov method confirmed the normal distribution of the obtained numerical indicators both in the general group and in all separate age groups. The article provides detailed results of processing the data obtained using nonparametric (median, interquartile range, range from 10 to 90 centiles) and parametric (mean and standard deviation) statistics methods. Based on an estimate of the range of 10-90 centiles, the normal limits for the percentage and absolute values of the main subpopulations of lymphocytes were calculated. The well-known dynamics of a gradual decrease in the absolute number of lymphocytes and absolute values for all major subpopulations, as well as relatively higher indicators of the helper/cytotoxic ratio in early age groups, have been confirmed. A higher percentage of B-lymphocytes was detected in children in the age groups from 2 months to 2 years, which, together with a high total number of lymphocytes, determined fairly high absolute B-cell counts in these age groups. The proposed normal ranges were validated on an independent group of 75 children aged 2 to 18 years. The individual indicators of the children in the validation group exceeded the norm in 4 cases (5.3% with an acceptable level of discrepancies up to 10%), which allows us to consider the norms validated. The most debatable results are about the relatively high absolute level В-lymphocytes in young children are in good agreement with the pooled data of the meta-analysis of the world literature. The proposed normal ranges are designed in a form that is convenient for practical use.

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