A PROSPECTIVE REVIEW OF BOOKING HAEMATOLOGICAL PARAMETERS IN A MULTIRACIAL DEVELOPING COUNTRY

1. A PROSPECTIVE REVIEW OF BOOKING HAEMATOLOGICAL PARAMETERS IN A MULTIRACIAL DEVELOPING COUNTRY Albert C C Tan, Eugene W K Leong, F M Moy, A C ChuaUniversity Malaya Medical Centre Objective Methods • RBC between the Chinese (4.03±0.09E12/L) and the Malays (4.20±0.04E12/L) p-value 0.002; the Chinese and the Indians (4.27±0.08E12/L) p-value 0.000 • MCV between the Chinese (90.12±1.42fl) and the Malays (85.60±0.72fl) p-value 0.000; the Chinese and the Indians (83.46±1.43fl) p-value 0.000; between the Indians and the Malays and Indians p-value 0.033 • MCH between the Chinese (30.10±0.53pg) and the Malays (28.53±0.28pg) p-value 0.000; the Chinese and the Indians (27.41±0.60pg) p-value 0.000; the Malays and the Indians p-value 0.001 • RDW between the Indians (15.64±0.56%) and the Malays (14.31±0.18%) p-value 0.000; the Indians and the Chinese (13.79±0.24%) p-value 0.000. • MCHC between the Chinese (333.76±2.25g/L) and the Indians (327.74±2.55g/L) p-value 0.001; the Malays (333.51±1.19g/L) and the Indians p-value 0.000. Conclusions There was no statistically significant difference in the booking Hb of the three major races in Malaysia found in this prospective review. Hence, we can firmly infer that is no racial preponderance for anaemia at first booking. However, this study did reveal that there were statistically significant variations in the RBC, MCV, MCH, MCHC and RDW amongst the races in Malaysia. Therefore, further studies should be attempted in establishing their significance in relation to pregnancy outcome. This is a prospective study of primigravidae booked at the Antenatal Clinic of University Malaya Medical Centre, a tertiary hospital located in Kuala Lumpur, Malaysia. It serves as a referral centre and an urban obstetrics centre for a population of about eight million. This population consists of 47.2% Malays, 40.2% Chinese, 10.3% Indians and 1.8% other ethnic groups which consist of Eurasians, and other indigenous races from East Malaysia.12 Race was determined by the name and racial identification documents on the marriage certificate. There were a total of 900-1000 primigravidae booked in University Malaya Medical Centre (UMMC) annually. Primigravidae booked in UMMC from February 2010 to October 2010 were recruited into the study. Their race identification, date of birth, gestational age, and previous medical conditions were taken down. Then booking FBC samples were taken. All primigravidae who were found to be anaemic were then screened for thalassaemia, and other common haematological conditions. Primigravidae who had been diagnosed with sickle cell trait/disease, thalassemia trait/disease, or any myelodysplastic disorders were excluded from the study. Booking primigravidae from foreign countries were also excluded from the study. University Malaya Medical Centre Ethics Committee approved the proposal for this study and consent was obtained from all subjects. A total of 3- 4mL of venous blood sample were taken from the antecubital vein of each woman by venepuncture. The sample was then put into a dipotassium EDTA specimen bottle for determination of haematological parameters using the standard methods. They were analysed using a spectrophotometer (Sysmex XE 5000, Japan). The full blood count parameters from the venous blood sample that were compared are the Haemoglobin (Hb), Haematocrit (Hct), Red Blood Cell (RBC), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin Concentration (MCHC), Mean Corpuscular Haemoglobin (MCH), Red Blood Cell Distribution Width (RDW), White Blood Cell (WBC), and the Platelet count. The data were then analysed with the Oneway ANOVA comparative mean test. The statistical package SPSS version 17 was used for the data analysis. The level of significance was set at p-value ≤0.05. In this study, anemia was defined as having a hemoglobin of less than 11.0g/dL. 537 primigravidae without any known history of haematological disorders were recruited into the study. There were statistically significant differences (p-value ≤0.05) in the following booking hematological parameters (mean ± 95%CI): • To quantify any differences in booking haematological parameters of primigravidae among the major races in Malaysia Background The booking health status in primigravidae of a country provides an important description of maternal health. One of the most common health problem found in primigravidae is anaemia.2, 3 Anaemia in pregnancy has been associated with potentially delivering of low birth weight infants, pre-term birth, and maternal mortality.4- 6, The prevalence of anaemia is higher in teenage group, non-urban areas, more prevalent in lower socioeconomic status groups, and in higher parity (five or more pregnancies).1- 3, 5, 7 Race as an independent risk factor for anaemia has been described in multiple studies.1, 2, 7, 11 In addition, race- specific criteria in screening for iron deficiency anaemia had once been considered.1 Malaysia consists of a very unique combination of races; our society comprises of citizens who are direct descendants from China, and India; both of which form a significant minority in Malaysia. There have been several studies done to describe the racial distribution of anaemia in Malaysia 2, 5, 8 but, none of these studies had focused on the well-being of primigravidae alone nor had they described the variation in other parameters of a full blood count analysis. In a recent Malaysian cross-sectional survey study done by Haniff J et al2 in a multicentre analysis of all booking mothers’ venous and capillary blood, it was found that the overall prevalence of anaemia in pregnancy is 35%, and that there was a significant association of anaemia with the ethnic group and the gestational age. 2 In their study, the average haemoglobin level of the Chinese race in Malaysia was found to be significantly higher than the haemoglobin level of the Malays.2 White blood cells (WBC) and platelets are both inflammatory markers and components found in a full blood count (FBC). In addition, platelets function mainly in activating the coagulation mechanism whilst, WBCs are function as defence against invading organisms in the immune system. These two parameters have been shown to have a racial variation in certain ethnic population. 9,10 Therefore, there is a need to clearly establish the above differences in a prospective study of booking mothers in a controlled setting. This study aims to quantify any haematological differences in the booking full blood count sample of primigravidae among the Malays, Chinese and Indian population of an urban obstetrics centre. References Johnson-Spear MA, Ray Y. Hemoglobin difference between black and white women with comparable iron status: justification for race-specific anemia criteria. Am J Clin Nutr;1994; 60: 117-21. Haniff J, Das A, Onn LT et al. Anemia in Pregnancy in Malaysia: a cross-sectional survey. Asia Pac J ClinNutr. 2007; 16 (3): 527-536. School TO. Iron status during pregnancy: setting the stage for mother and infant. Am J ClinNutr2005;81(suppl):1218S-22S Ronnergberg AG, Wood RJ, Wang X et al. Proconception haemoglobin and ferritin concentrations are associated with pregnancy outcome in a prospective cohort of Chinese women. J Nutr. 2004;134(10):2586-2591. Zulkifli Ahmad, RogayahJaafar et al. Anemia during pregnancy in rural Kelantan. Mal J Nutr. 1997; 3:83-90. Rasmussen KM. Is there a causal relationship between iron deficiency or iron deficiency anemia and weight birth, length of gestation and perinatal mortality. J Nutr. 2001;131 (2S-2):590S-603S. Adebisi OY, Strayhorn G. Anemia in pregnancy and race in the United States: blacks at risk. Fam Med. 2005 Oct; 37(9):655-62. Siong TE, Kandiah M et al. Nutritional anemia in pregnancy: a study at the maternity hospital, Kuala Lumpur. Malays J. Reprod Health. 1984; 2(1):32-50. Lim EM, Cembrowski G et al. Race- specific WBC and neutrophil count reference intervals. Int J Lab Hematol 2010 Dec; 32(6 Pt2): 590-7. Bain BJ. Ethnic and sex differences in the total and differential white cell count and platelet count. J ClinPathol 1996 Aug;49(8):664-6 Singh K, Fong YF, ArulkumaranS. Anaemia in pregnancy- a cross-sectional study in Singapore. Eur J ClinNutr. 1998 Jan; 52 (1):65-70. Population Distribution and Basic Demographic Characteristics 2010. Population and Housing Census of Malaysia. Department of Statistics, Malaysia. Pg 11. Mean: 85.60±0.72fl (95%CI) Mean: 11.92±0.12g/dL (95%CI) Mean: 90.12±1.42fl (95%CI) Mean: 12.07±0.23g/dL (95%CI) Mean: 83.46±1.43fl (95%CI) Mean: 11.66±0.26g/dL (95%CI) Mean: 12.38±0.61g/dL (95%CI) Mean: 86.75±5.63fl (95%CI) Mean: 4.20±0.04E12/L (95%CI) Mean: 28.53±0.28pg (95%CI) Mean: 4.03±0.09E12/L (95%CI) Mean: 30.10±0.53pg (95%CI) Mean: 4.27±0.08E12/L (95%CI) Mean: 27.41±0.60pg (95%CI) Mean: 4.26±0.33E12/L (95%CI) Mean: 29.24±2.32pg (95%CI) Mean: 14.31±0.18% (95%CI) Mean: 333.51±1.19g/L (95%CI) Mean: 13.79±0.24% (95%CI) Mean: 333.76±2.25g/L (95%CI) Results Mean: 15.64±0.56% (95%CI) Mean: 327.74±2.55g/L (95%CI) Mean: 336.88±8.89g/L (95%CI) Mean: 14.16±1.13% (95%CI)