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Normal values for hematologic parameters in children

Normal values for hematologic parameters in children
Age Hemoglobin (g/dL) Hematocrit (%) MCV (fL) RDW (%)
Lower limit Upper limit Lower limit Upper limit Lower limit Upper limit Lower limit Upper limit
6 months to <2 years* 11.0 13.5 31 42 73 85 12.3 15.6
2 to 6 years 11.0 13.7 34 44 75 86 12.0 14.6
6 to 12 years 11.2 14.5 35 44 78 90 11.9 13.8
12 to <18 years
Female 11.4 14.7 36 46 80 96 11.9 14.6
Male 12.4 16.4 40 51 80 96 11.9 13.7
This table summarizes lower and upper limits (defined as the 2.5th and 97.5th percentile, respectively) for hematologic parameters in children according to age and sex, based upon normative data from healthy populations in the United States. Previous reports have described lower values for hemoglobin in Black Americans compared with White Americans (approximately 0.5 to 1 g/dL lower for Black Americans). However, those differences likely reflect health disparities related to social determinants of health. We recommend using the same hemoglobin and hematocrit thresholds for evaluating anemia in all racial and ethnic groups (ie, we do not assume that a slightly lower value in a Black individual is normal). Reference ranges may differ slightly from one laboratory to another. For more specific guidance, clinicians should refer to the reference ranges at the laboratory performing the testing.
MCV: mean corpuscular volume; RDW: red cell distribution width.
* Normal values for hemoglobin, hematocrit, and MCV change dramatically during the first 6 months after birth. Refer to UpToDate topic on the approach to the child with anemia for a discussion of normal values in young infants.
¶ The lower limit of normal (ie, 2.5th percentile) for hemoglobin at these ages is slightly less than 11 g/dL. However, for the purposes of screening for iron deficiency anemia in infants and young children, many experts use a cutoff of hemoglobin <11 g/dL to define an abnormal screen.
References:
  1. Brugnara C, Oski FA, Nathan DG. Diagnostic approach to the anemic patient. In: Nathan and Oski's Hematology and Oncology of Infancy and Childhood, 8th ed, Orkin S, Nathan D, Ginsburg D, et al (Eds), Elsevier 2015. p.293.
  2. Cembrowski GS, Chan J, Cheng C. NHANES 1999-2000 data used to create comprehensive health-associated race-, sex- and age-stratified pediatric reference intervals for the Coulter MAXM. Laboratory Hematol 2004; 10:245.
  3. Baker RD, Greer FR, Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency andiron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics 2010; 126:1040.
  4. Staffa SJ, Joerger JD, Henry E, et al. Pediatric hematology normal ranges derived from pediatric primary care patients. Am J Hematol 2020.
  5. Higgins V, Tahmasebi H, Bohn MK, et al. CALIPER Hematology Reference Standards (II). Am J Clin Pathol 2020; 154:342.
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