Latest News on Blood Hemoglobin : April 21
 Reference Ranges for Hematocrit and Blood Hemoglobin Concentration During the Neonatal Period: Data From a Multihospital Health Care System
OBJECTIVE. “Reference ranges” are developed when it is impossible or inappropriate to establish “normal ranges” by drawing blood on healthy normal volunteers. Reference ranges for the hematocrit and the blood hemoglobin concentration of newborn infants have previously been reported from relatively small sample sizes by using measurement methods that now are considered outmoded.
METHODS. We sought to develop reference ranges for hematocrit and hemoglobin during the neonatal period (28 days) by using very large sample sizes and modern hematology analyzers, accounting for gestational and postnatal age and gender. Data were assembled from a multihospital health care system after exclusion of patients with a high likelihood of an abnormal value and those who were receiving blood transfusions.
RESULTS. During the interval from 22 to 40 weeks’ gestation, the hematocrit and blood hemoglobin concentration increased approximately linearly. For every week advance in gestational age, the hematocrit increased by 0.64% and the hemoglobin concentration increased by 0.21 g/dL. No difference was seen on the basis of gender. During the 4-hour interval after birth, hematocrit/hemoglobin values of late preterm and term neonates (35–42 weeks’ gestation) increased by 3.6% ± 0.5% (mean ± SD), those of neonates of 29 to 34 weeks’ gestation remained unchanged, and those of <29 weeks’ gestation decreased by 6.0% ± 0.3%. During the first 28 days after birth, an approximately linear decrease in hematocrit/hemoglobin occurred.
CONCLUSIONS. The figures presented herein describe reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period, accounting for gestational and postnatal age.
 IFCC Reference System for Measurement of Hemoglobin A1c in Human Blood and the National Standardization Schemes in the United States, Japan, and Sweden: A Method-Comparison Study
Background: The national programs for the harmonization of hemoglobin (Hb)A1c measurements in the US [National Glycohemoglobin Standardization Program (NGSP)], Japan [Japanese Diabetes Society (JDS)/Japanese Society of Clinical Chemistry (JSCC)], and Sweden are based on different designated comparison methods (DCMs). The future basis for international standardization will be the reference system developed by the IFCC Working Group on HbA1c Standardization. The aim of the present study was to determine the relationships between the IFCC Reference Method (RM) and the DCMs.
Methods: Four method-comparison studies were performed in 2001–2003. In each study five to eight pooled blood samples were measured by 11 reference laboratories of the IFCC Network of Reference Laboratories, 9 Secondary Reference Laboratories of the NGSP, 3 reference laboratories of the JDS/JSCC program, and a Swedish reference laboratory. Regression equations were determined for the relationship between the IFCC RM and each of the DCMs.
Results: Significant differences were observed between the HbA1c results of the IFCC RM and those of the DCMs. Significant differences were also demonstrated between the three DCMs. However, in all cases the relationship of the DCMs with the RM were linear. There were no statistically significant differences between the regression equations calculated for each of the four studies; therefore, the results could be combined. The relationship is described by the following regression equations: NGSP-HbA1c = 0.915(IFCC-HbA1c) + 2.15% (r2 = 0.998); JDS/JSCC-HbA1c = 0.927(IFCC-HbA1c) + 1.73% (r2 = 0.997); Swedish-HbA1c = 0.989(IFCC-HbA1c) + 0.88% (r2 = 0.996).
Conclusion: There is a firm and reproducible link between the IFCC RM and DCM HbA1c values.
 Hemoglobin function in stored blood
Serial oxygen dissociation curves were performed on blood units preserved in acid-citrate-dextrose (ACD), ACD-adenine, and ACD-adenine-inosine. Dividing blood from a single donor into two or more bags allowed direct comparison between preservatives. During the 1st wk of storage in ACD, a progressive increase in oxygen affinity was observed. Thereafter, little further change was noted. Oxygen affinity increased even more rapidly during initial storage in ACD-adenine. However, with the inclusion of inosine as a preservative, oxygen affinity remained unaltered during the first 2 wk. Increases in oxygen affinity correlated well with falling levels of red cell 2,3-diphosphoglycerate (2,3-DPG) during storage. No significant changes in glutathione, reduced form (GSH), or A3 (AI) hemoglobin levels were noted during the first 3 wk of storage. No significant accumulation of ferrihemoglobin was detected. When blood stored 20 days in ACD or ACD-adenine was incubated with inosine for 60 min at 37°C, 2,3-DPG and adenosine triphosphate (ATP) were resynthesized, and oxygen affinity was decreased. The distribution of 2,3-DPG in fresh and stored red cells appeared to influence experimental values for Hill’s n, a measure of heme-heme interaction.
 Frequency Distribution of Hemoglobin Variants, ABO and Rhesus Blood Groups among Students of African Descent
Background: Hemoglobin variants, ABO and Rhesus blood groups are known to vary from one population to another. This study therefore sought to study the frequency of these indices among a cohort of Nigerian University students of African descent. The result will serve as a platform for instituting genetic counseling services with a view to reducing hemoglobinopathies.
Methods: Two hundred consenting students were recruited and screened for hemoglobin variants by standard alkaline cellulose acetate electrophoresis. ABO and Rhesus blood groups were determined by the hemagglutination technique.
Results: Of the 200 students aged 18 – 25 years that were screened, 123 (61.5%) were males and 77(38.5%) were females. Those with blood group O were the most prevalent (45%) followed by groups A (25.5%), B (25%) and AB (3.5%). Only 2 genotypes HbAA (78.5%) and HbAS (21.5%) were reported in this study. Rhesus D antigen was positive for 94.0% and negative for 6.0% of the study population.
Conclusions: The frequency of ABO and Rhesus blood groups appeared to be stable and consistent with reports from previous studies in Nigeria. Blood group O was the most prevalent. This also means there is a large pool of ‘’apparently’’ universal blood donors in this population. There was only one genotype variant reported (HbAS). This could imply a decline in hemoglobinopathies among Africans. Therefore the culture of genetic counseling must be encouraged and sustained.
 Association of Delta-Aminolevulinic Acid Dehydratase Polymorphism with Blood Lead and Hemoglobin Level in Lead Exposed Workers
Introduction: Despite decades of intensive research, lead toxicity still remains one of the most health concerns. Hence, risks posed by lead are more likely to be determined by individual susceptibility as delta-aminolevulinic acid dehydratase (ALAD) gene can modify lead toxicokinetics.
Method: The present study was aimed to evaluate the association of ALAD gene polymorphism (rs1800435 C/G) (ALAD 1-1, ALAD 1-2, ALAD 2-2) with blood lead level (BLL) and hemoglobin (Hb) content from 200 lead-exposed workers of Gujarat, India against 200 controls.
Results: ALAD genotype frequency was found to be 90%, 8% and 2% in control whereas 80%, 14.5% and 5.5% in workers for ALAD 1-1, 1-2 and 2-2 genotypes, respectively. ALAD 1-1 genotype was attributed to higher BLL and lower Hb content as compared to ALAD 1-2/2-2 genotype in workers. Whereas, inverse association had been observed between BLL and Hb content in workers having ALAD 1-1 genotype. On the other hand, ALAD 1-2/2-2 genotype might play an important role in lead toxicity by decreasing free lead in blood and by transporting into tissues due to more binding affinity. So, it may protect Hb against free lead by decreasing lead availability in blood.
Conclusion: To deal with lead toxicity more effectively, attention should be given to the workers having the ALAD 1-1 genotype.
 Jopling, J., Henry, E., Wiedmeier, S.E. and Christensen, R.D., 2009. Reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period: data from a multihospital health care system. Pediatrics, 123(2), pp.e333-e337.
 Hoelzel, W., Weykamp, C., Jeppsson, J.O., Miedema, K., Barr, J.R., Goodall, I., Hoshino, T., John, W.G., Kobold, U., Little, R. and Mosca, A., 2004. IFCC reference system for measurement of hemoglobin A1c in human blood and the national standardization schemes in the United States, Japan, and Sweden: a method-comparison study. Clinical chemistry, 50(1), pp.166-174.
 Bunn, H.F., May, M.H., Kocholaty, W.F. and Shields, C.E., 1969. Hemoglobin function in stored blood. The Journal of clinical investigation, 48(2), pp.311-321.
 Pennap, G.R., Envoh, E. and Igbawua, I., 2011. Frequency distribution of hemoglobin variants, ABO and rhesus blood groups among students of African descent. Microbiology Research Journal International, pp.33-40.
 Nariya, A., Pathan, A., Shah, N., Patel, A., Chettiar, S., Vyas, J., Shaikh, I. and Jhala, D., 2017. Association of delta-aminolevulinic acid dehydratase polymorphism with blood lead and hemoglobin level in lead exposed workers. Annual Research & Review in Biology, pp.1-7.