{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T18:17:09Z","timestamp":1759342629134,"version":"3.37.3"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T00:00:00Z","timestamp":1635206400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100018935","name":"Universit\u00e4tsklinikum Erlangen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100018935","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Reference intervals for laboratory test results have to be appropriate for the population in which they are used to be clinically useful. While sex and age are established partitioning criteria, patients\u2019 origin also influences laboratory test results, but is not commonly considered when creating or applying reference intervals. In the German population, stratification for ethnicity is rarely performed, and no ethnicity-specific hematology reference intervals have been reported yet. In this retrospective study, we investigated whether specific reference intervals are warranted for the numerically largest group of non-German descent, individuals originating from Turkey. To this end, we analyzed 1,314,754 test results from 167,294 patients from six German centers. Using a name-based algorithm, 1.9% of patients were identified as originating from Turkey, in line with census data and the algorithm\u2019s sensitivity. Reference intervals and their confidence intervals were calculated using an indirect data mining approach, and Turkish and non-Turkish reference limits overlapped completely or partially in nearly all analytes, regardless of age and sex, and only 5\/144 (3.5%) subgroups\u2019 reference limits showed no overlap. We therefore conclude that the current practice of using common reference intervals is appropriate and allows correct clinical decision-making in patients originating from Turkey.<\/jats:p>","DOI":"10.1038\/s41598-021-00566-2","type":"journal-article","created":{"date-parts":[[2021,10,26]],"date-time":"2021-10-26T10:02:49Z","timestamp":1635242569000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Influence of Turkish origin on hematology reference intervals in the German population"],"prefix":"10.1038","volume":"11","author":[{"given":"Franz X.","family":"Mayr","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Bertram","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Holger","family":"Cario","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael C.","family":"Fr\u00fchwald","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-J\u00fcrgen","family":"Gro\u00df","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arndt","family":"Groening","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefanie","family":"Gr\u00fctzner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Gscheidmeier","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinhard","family":"Hoffmann","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Krebs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hans-Georg","family":"Ruf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antje","family":"Torge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Woelfle","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Razum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manfred","family":"Rauh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Markus","family":"Metzler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jakob","family":"Zierk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,10,26]]},"reference":[{"key":"566_CR1","volume-title":"Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Guideline-Third Edition, CLSI Document","author":"Clinical and Laboratory Standards Institute (CLSI)","year":"2008","unstructured":"Clinical and Laboratory Standards Institute (CLSI). Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Guideline-Third Edition, CLSI Document (Clinical and Laboratory Standards Institute, 2008)."},{"key":"566_CR2","doi-asserted-by":"publisher","first-page":"5","DOI":"10.11613\/BM.2016.001","volume":"26","author":"Y Ozarda","year":"2016","unstructured":"Ozarda, Y. Reference intervals: Current status, recent developments and future considerations. Biochem. Med. 26, 5\u201311 (2016).","journal-title":"Biochem. Med."},{"key":"566_CR3","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1080\/10408363.2018.1476455","volume":"55","author":"H Tahmasebi","year":"2018","unstructured":"Tahmasebi, H., Trajcevski, K., Higgins, V. & Adeli, K. Influence of ethnicity on population reference values for biochemical markers. Crit. Rev. Clin. Lab. Sci. 55, 359\u2013375 (2018).","journal-title":"Crit. Rev. Clin. Lab. Sci."},{"key":"566_CR4","unstructured":"Statistisches Bundesamt. Bev\u00f6lkerung und Erwerbst\u00e4tigkeit Bev\u00f6lkerung mit Migrationshintergrund\u2014Ergebnisse des Mikrozensus 2018 Fachserie 1 Reihe 2.2, Destatis, Wiesbaden (2019)."},{"key":"566_CR5","first-page":"302","volume":"74","author":"E Lim","year":"2015","unstructured":"Lim, E., Miyamura, J. & Chen, J. J. Racial\/ethnic-specific reference intervals for common laboratory tests: A comparison among Asians, blacks, hispanics, and white. Hawaii J. Med. Public Health 74, 302\u2013310 (2015).","journal-title":"Hawaii J. Med. Public Health"},{"key":"566_CR6","doi-asserted-by":"publisher","first-page":"590","DOI":"10.1111\/j.1751-553X.2010.01223.x","volume":"32","author":"EM Lim","year":"2010","unstructured":"Lim, E. M., Cembrowski, G., Cembrowski, M. & Clarke, G. Race-specific WBC and neutrophil count reference intervals. Int. J. Lab. Hematol. 32, 590\u2013597 (2010).","journal-title":"Int. J. Lab. Hematol."},{"key":"566_CR7","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1111\/j.1469-1809.2011.00701.x","volume":"76","author":"U Hodo\u011flugil","year":"2012","unstructured":"Hodo\u011flugil, U. & Mahley, R. W. Turkish population structure and genetic ancestry reveal relatedness among Eurasian populations. Ann. Hum. Genet. 76, 128\u2013141 (2012).","journal-title":"Ann. Hum. Genet."},{"key":"566_CR8","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.1007\/s00103-019-03012-x","volume":"62","author":"C Santos-H\u00f6vener","year":"2019","unstructured":"Santos-H\u00f6vener, C. et al. Zur gesundheitlichen Lage von Kindern und Jugendlichen mit Migrationshintergrund in Deutschland. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 62, 1253\u20131262 (2019).","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"566_CR9","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1007\/s00103-015-2145-2","volume":"58","author":"A Rommel","year":"2015","unstructured":"Rommel, A., Sa\u00df, A. C., Born, S. & Ellert, U. Health status of people with a migrant background and impact of socio-economic factors; Die gesundheitliche Lage von Menschen mit Migrationshintergrund und die Bedeutung des sozio\u00f6konomischen Status. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 58, 543\u2013552 (2015).","journal-title":"Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz"},{"key":"566_CR10","doi-asserted-by":"publisher","unstructured":"Schenk, L. et al. Kinder-und Jugendgesundheitssurvey (KiGGS 2003\u20132006): Kinder und Jugendliche mit Migrationshintergrund in Deutschland. https:\/\/doi.org\/10.25646\/3140 (2008).","DOI":"10.25646\/3140"},{"key":"566_CR11","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1017\/S1368980009991030","volume":"13","author":"C Kleiser","year":"2010","unstructured":"Kleiser, C., Mensink, G. B., Neuhauser, H., Schenk, L. & Kurth, B.-M. Food intake of young people with a migration background living in Germany. Public Health Nutr. 13, 324\u2013330 (2010).","journal-title":"Public Health Nutr."},{"key":"566_CR12","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1515\/pubhef-2016-0065","volume":"24","author":"L Schenk","year":"2016","unstructured":"Schenk, L., Anton, V., Baer, N.-R. & Schmitz, R. Food patterns of children and adolescents with migration background: Findings of the KiGGS study. Public Health Forum 24, 205\u2013208 (2016).","journal-title":"Public Health Forum"},{"key":"566_CR13","first-page":"532","volume":"108","author":"E Kohne","year":"2011","unstructured":"Kohne, E. Hemoglobinopathies: Clinical manifestations, diagnosis, and treatment. Dtsch. Arzteblatt Int. 108, 532\u2013540 (2011).","journal-title":"Dtsch. Arzteblatt Int."},{"issue":"139","key":"566_CR14","first-page":"434","volume":"1946","author":"S Eber","year":"2014","unstructured":"Eber, S. & Dickerhoff, R. Anemia and hemoglobin diseases in patients with migration background; An\u00e4mien und H\u00e4moglobinkrankheiten bei Patienten mit Migrationshintergrund. Dtsch. Med. Wochenschr. 1946(139), 434\u2013440 (2014).","journal-title":"Dtsch. Med. Wochenschr."},{"key":"566_CR15","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1007\/s00108-016-0030-1","volume":"57","author":"B Zur","year":"2016","unstructured":"Zur, B. Increase in genetically determined anemia as a result of migration in Germany; Zunahme genetisch determinierter An\u00e4mien durch Migration in Deutschland. Internist 57, 444\u2013451 (2016).","journal-title":"Internist"},{"key":"566_CR16","doi-asserted-by":"publisher","first-page":"85","DOI":"10.3109\/08880018.2014.940074","volume":"32","author":"C Albayrak","year":"2015","unstructured":"Albayrak, C. & Albayrak, D. Red cell glucose 6-phosphate dehydrogenase deficiency in the northern region of Turkey: Is G6PD deficiency exclusively a male disease?. Pediatr. Hematol. Oncol. 32, 85\u201391 (2015).","journal-title":"Pediatr. Hematol. Oncol."},{"key":"566_CR17","doi-asserted-by":"publisher","first-page":"337","DOI":"10.1080\/00365513.2018.1471617","volume":"78","author":"MK \u00d6z\u00e7\u00fcr\u00fcmez","year":"2018","unstructured":"\u00d6z\u00e7\u00fcr\u00fcmez, M. K. & Haeckel, R. Biological variables influencing the estimation of reference limits. Scand. J. Clin. Lab. Investig. 78, 337\u2013345 (2018).","journal-title":"Scand. J. Clin. Lab. Investig."},{"key":"566_CR18","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1515\/cclm-2018-0073","volume":"57","author":"GRD Jones","year":"2018","unstructured":"Jones, G. R. D. et al. Indirect methods for reference interval determination\u2014Review and recommendations. Clin. Chem. Lab. Med. 57, 20\u201329 (2018).","journal-title":"Clin. Chem. Lab. Med."},{"key":"566_CR19","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1515\/cclm-2016-1112","volume":"55","author":"R Haeckel","year":"2017","unstructured":"Haeckel, R. et al. Critical comments to a recent EFLM recommendation for the review of reference intervals. Clin. Chem. Lab. Med. 55, 341\u2013347 (2017).","journal-title":"Clin. Chem. Lab. Med."},{"key":"566_CR20","doi-asserted-by":"publisher","first-page":"1595","DOI":"10.1515\/cclm-2018-1236","volume":"57","author":"J Zierk","year":"2019","unstructured":"Zierk, J. et al. Next-generation reference intervals for pediatric hematology. Clin. Chem. Lab. Med. CCLM 57, 1595\u20131607 (2019).","journal-title":"Clin. Chem. Lab. Med. CCLM"},{"key":"566_CR21","doi-asserted-by":"crossref","unstructured":"Revision of the \u201cGuideline of the German medical association on quality assurance in medical laboratory examinations\u2014Rili-BAEK\u201d (unauthorized translation). LaboratoriumsMedizin 39, 26 (2015).","DOI":"10.1515\/labmed-2014-0046"},{"key":"566_CR22","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1046\/j.1365-3156.2001.00760.x","volume":"6","author":"O Razum","year":"2001","unstructured":"Razum, O., Zeeb, H. & Akgun, S. How useful is a name-based algorithm in health research among Turkish migrants in Germany?. Trop. Med. Int. Health 6, 654\u2013661 (2001).","journal-title":"Trop. Med. Int. Health"},{"key":"566_CR23","doi-asserted-by":"publisher","first-page":"2380","DOI":"10.1016\/S0959-8049(00)00333-6","volume":"36","author":"O Razum","year":"2000","unstructured":"Razum, O. et al. Combining a name algorithm with a capture-recapture method to retrieve cases of Turkish descent from a German population-based cancer registry. Eur. J. Cancer 36, 2380\u20132384 (2000).","journal-title":"Eur. J. Cancer"},{"key":"566_CR24","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1055\/s-2006-927166","volume":"68","author":"J Spallek","year":"2006","unstructured":"Spallek, J. et al. Name-based identification of cases of Turkish origin in the childhood cancer registry in Mainz. Gesundheitsw 68, 643\u2013649 (2006).","journal-title":"Gesundheitsw"},{"key":"566_CR25","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1186\/1471-2458-8-152","volume":"8","author":"J Spallek","year":"2008","unstructured":"Spallek, J., Spix, C., Zeeb, H., Kaatsch, P. & Razum, O. Cancer patterns among children of Turkish descent in Germany: A study at the German Childhood Cancer Registry. BMC Public Health 8, 152 (2008).","journal-title":"BMC Public Health"},{"key":"566_CR26","doi-asserted-by":"publisher","first-page":"526","DOI":"10.1186\/s12885-021-08141-8","volume":"21","author":"R R\u00fcdiger","year":"2021","unstructured":"R\u00fcdiger, R. et al. No evidence to support the impact of migration background on treatment response rates and cancer survival: A retrospective matched-pair analysis in Germany. BMC Cancer 21, 526 (2021).","journal-title":"BMC Cancer"},{"key":"566_CR27","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/1472-6874-14-24","volume":"14","author":"E-M Berens","year":"2014","unstructured":"Berens, E.-M. et al. Participation in breast cancer screening among women of Turkish origin in Germany\u2014A register-based study. BMC Womens Health 14, 24 (2014).","journal-title":"BMC Womens Health"},{"key":"566_CR28","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1016\/j.canep.2009.10.006","volume":"33","author":"J Spallek","year":"2009","unstructured":"Spallek, J., Arnold, M., Hentschel, S. & Razum, O. Cancer incidence rate ratios of Turkish immigrants in Hamburg, Germany: A registry based study. Cancer Epidemiol. 33, 413\u2013418 (2009).","journal-title":"Cancer Epidemiol."},{"key":"566_CR29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-020-58749-2","volume":"10","author":"J Zierk","year":"2020","unstructured":"Zierk, J. et al. Reference Interval estimation from mixed distributions using truncation points and the Kolmogorov\u2013Smirnov distance (kosmic). Sci. Rep. 10, 1\u20138 (2020).","journal-title":"Sci. Rep."},{"key":"566_CR30","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1373\/clinchem.2015.239731","volume":"61","author":"J Zierk","year":"2015","unstructured":"Zierk, J. et al. Age- and sex-specific dynamics in 22 hematologic and biochemical analytes from birth to adolescence. Clin. Chem. 61, 964\u2013973 (2015).","journal-title":"Clin. Chem."},{"key":"566_CR31","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1093\/clinchem\/36.2.265","volume":"36","author":"EK Harris","year":"1990","unstructured":"Harris, E. K. & Boyd, J. C. On dividing reference data into subgroups to produce separate reference ranges. Clin. Chem. 36, 265\u2013270 (1990).","journal-title":"Clin. Chem."},{"key":"566_CR32","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1373\/clinchem.2003.027953","volume":"50","author":"A Lahti","year":"2004","unstructured":"Lahti, A. et al. Partitioning of nongaussian-distributed biochemical reference data into subgroups. Clin. Chem. 50, 891\u2013900 (2004).","journal-title":"Clin. Chem."},{"key":"566_CR33","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1515\/CCLM.2010.319","volume":"48","author":"K Ichihara","year":"2010","unstructured":"Ichihara, K., Boyd, J. C. & IFCC Committee on Reference Intervals and Decision Limits (C-RIDL). An appraisal of statistical procedures used in derivation of reference intervals. Clin. Chem. Lab. Med. 48, 1537\u20131551 (2010).","journal-title":"Clin. Chem. Lab. Med."},{"key":"566_CR34","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1002\/psp.457","volume":"13","author":"P Mateos","year":"2007","unstructured":"Mateos, P. A review of name-based ethnicity classification methods and their potential in population studies. Popul. Space Place 13, 243\u2013263 (2007).","journal-title":"Popul. Space Place"},{"key":"566_CR35","doi-asserted-by":"publisher","first-page":"e22943","DOI":"10.1371\/journal.pone.0022943","volume":"6","author":"P Mateos","year":"2011","unstructured":"Mateos, P., Longley, P. A. & O\u2019Sullivan, D. Ethnicity and population structure in personal naming networks. PLoS ONE 6, e22943 (2011).","journal-title":"PLoS ONE"},{"key":"566_CR36","doi-asserted-by":"publisher","first-page":"e0201774","DOI":"10.1371\/journal.pone.0201774","volume":"13","author":"J Kandt","year":"2018","unstructured":"Kandt, J. & Longley, P. A. Ethnicity estimation using family naming practices. PLoS ONE 13, e0201774 (2018).","journal-title":"PLoS ONE"},{"key":"566_CR37","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1056\/NEJMsb025007","volume":"348","author":"EG Burchard","year":"2003","unstructured":"Burchard, E. G. et al. The importance of race and ethnic background in biomedical research and clinical practice. N. Engl. J. Med. 348, 1170\u20131175 (2003).","journal-title":"N. Engl. J. Med."},{"key":"566_CR38","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1093\/eurpub\/ckaa198","volume":"31","author":"Y Namer","year":"2021","unstructured":"Namer, Y. & Razum, O. \u2018Race\u2019 causes discomfort? Worse: It misleads. Eur. J. Public Health 31, 4\u20135 (2021).","journal-title":"Eur. J. Public Health"},{"key":"566_CR39","first-page":"272","volume":"69","author":"L Feller","year":"2014","unstructured":"Feller, L., Ballyram, R., Meyerov, R., Lemmer, J. & Ayo-Yusuf, O. A. Race\/ethnicity in biomedical research and clinical practice. SADJ J. S. Afr. Dent. Assoc. Tydskr. Van Suid-Afr. Tandheelkd. Ver. 69, 272\u2013274 (2014).","journal-title":"SADJ J. S. Afr. Dent. Assoc. Tydskr. Van Suid-Afr. Tandheelkd. Ver."}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-00566-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-00566-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-00566-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,3]],"date-time":"2022-12-03T16:52:39Z","timestamp":1670086359000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-021-00566-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,26]]},"references-count":39,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,12]]}},"alternative-id":["566"],"URL":"https:\/\/doi.org\/10.1038\/s41598-021-00566-2","relation":{},"ISSN":["2045-2322"],"issn-type":[{"type":"electronic","value":"2045-2322"}],"subject":[],"published":{"date-parts":[[2021,10,26]]},"assertion":[{"value":"20 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 October 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 October 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"21074"}}