| Abstract |
Introduction: A complete blood count (CBC), although a routine test, can provide crude but important information about the health status of the examinee. CBC examines in detail the characteristics of red blood cells, quantifies the red cell markers, white blood cells and their subpopulations, and the platelet population with their respective markers. These parameters are variable and are affected by common conditions such as infection, anaemia, pregnancy or by lifestyle changes, chronic diseases and stress. Infection and growth monitoring are the most common causes of referrals for CBC in the pediatric population.The aim of this study was to investigate any differences that may have occurred in hematological parameters related to the timing of blood collection.
Methods: The study included 6,330 participants between 01/01/2016 and 12/31/2022, including infants, children, adolescents and young adults up to 39 years of age. Only pregnant women were excluded from the study due to expected changes in the variables under study. Results were collected using SLIS software. Sex, age, time of blood collection, and CBC data (hematocrit, hemoglobin, erythrocyte markers, white blood cells, neutrophil polymorphonuclear cells, lymphocytes, monocytes, eosinophils, basophils, platelets and platelet markers) were recorded, the sedimentation rate of TCE red cells and biochemical and immunological tests (urea, creatinine, total cholesterol, high-density lipoprotein HDL, 25(OH)vitD3, vitamin B12, folic acid, iron, C-reactive protein CRP, ferritin, thyroid-stimulating hormone TSH and complement C4 fraction). The timing of blood sampling was associated with significant differences in many variables, leading to the subsequent study of two separate periods with a time cut-off of November 2020, coinciding with the first mass case recording of SARS-CoV-2 virus infection that caused the COVID-19 pandemic in Greece. Statistical processing and analysis of the data was performed using the statistical package IBM SPSS Statistics version 29.0.1.0. Results: The females outnumbered the males in the study population (53.5% vs. 46.5%) in agreement with the demographic data of the last census for the Rethymnon area. The mean age was 21.4 years (SD 12) with a distribution: 0.3% infants to 6 months, 5.5% infants and preschoolers from 6 months to 2 years, 9.1% preschoolers and toddlers from 2 to 6 years, 13.4% school-age children 6 to 12 years, 11.8% adolescents 12 to 18 years, and 59.8% young adults 18 to 39 years. Many study variables showed statistically significant differences in the timing of blood collection (before and after November 2020). Notably, the hematocrit value of females was elevated compared to males in the second period. In the latter time period, a decreased basophil value and an increased eosinophil value were also recorded. It is also worth noting the lower mean value of haemoglobin, haematocrit and white blood cells of the participants compared to modern paediatric textbooks with wide recognition and use. The age at which the relative polymorphonuclear population equated to the relative lymphocyte population was determined to be 6.5 years. In addition, for the first time in Greece and especially in the pediatric population, the ratios NLR (neutrophil to lymphocyte), LMR (lymphocyte to monocyte), PLR (platelet to lymphocyte) and the PMI (total platelet mass) and Mentzer (mean red blood cell volume in fL to red blood cell population X106/μL) were recorded. The NLR, LMR and PLR were evaluated for their ability to predict abnormal inflammatory marker values, with NLR predicting with greater sensitivity and specificity (and without gender or age dependence) abnormal TKE, ferritin and CRP values.
Conclusion: The observed differences in haematological parameters, although statistically significant, in many cases cannot be easily interpreted. The attribution of the changes in haematological parameters may coincide with the advent of the COVID-19 pandemic in Greece, but further studies and analyses are needed to evaluate the results of the present longitudinal study (vaccination against SARS-CoV-2, other infections, effects of quarantine and mask use -among others). The main limitations of the study relate to the retrospective nature of the study and the inability to truly correlate the observed differences in the post-COVID era with the virus infection itself.
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