Acta Haematologica

bu. 35434

Editors-in-Chief: E.A. Beck. Bern: R.S. Hillman, Portland. Me.; H.R. Mami, Aarau

Publisher: S. Karger AG, Basel

5303 f Printed in Switzerland


Acta haemat. 77: 95-100 (1987)

Normal Hematologic Values and Prevalence of Anemia in Children Living on
Selected Pacific Atolls

Claibourne I. Dungy, Beverly C. Morgan, Peter M. Heotis, Herman E. Branson, William H. Adams
Departments of Pediatrics and Pathology, University of California, Irvine Medical Center, Orange, Calif., and
Medical Department, Brookhaven National Laboratory, Upton, Long Island, N.Y., USA

Key Words. Anemia - Iron deficiency - Mean corpuscular volume - Normal hematologic values - Oceania Pacific islanders

Abstract. The hematologic status of infants and children living on the small islands of the Pacific basin has
been poorly documented. This report determines the normal ranges for hemoglobin (Hb) and mean corpuscular volume (MCY)for children residing on four of the small atolls of the Republic of the Marshall Islands in
the archipelago of Micronesia. The difficulty in establishing normal hematologic values in pediatric populations is discussed and a methodology suggested that does not exclude any Hb value above the mean in determining the normal range for Hb. The study population was comprised of 563 Marshallese children representing approximately 3.4%of all children less than 16 years of age living in the Marshall Islands. The local prevalence of anemia and iron deficiency wasalso established.


Anemia is the most commonly described hemato. logic problem of infants and children. However, the
prevalence of anemia may vary depending on the
method used to determine normal hematologic values. Published information regarding the hematologic
status of the pediatric populations of the Pacific Islandsis limited [1] and specific reference to the archipelago of Micronesia is virtually unavailable. Micronesia is comprised of the Republic of the Marshall
Islands and the Caroline, Kiribati and Mariana Is-

lands. This article reports the hematologic status of
children residing on the small atolls of the Republic
of the Marshall Islands where the median age is 14.8
years and 52.2% of the inhabitants are less than 16
years of age [2]. Normal ranges of hemoglobin (Hb)
and mean corpuscular volume (MCV) were established for ages 1-11 years, and the prevalenceof iron
deficiency anemia determined. Thestatistical methodology used to determine the normal range for Hb did
not exclude any Hb value above the mean. Thedifficulties in determining normal values for Hb and
MCYVin large populations of infants and children are

discussed and the rationale supporting the proposed
methodology presented.
The Population of the Marshall Islands
The Republic of the Marshall Islands is located
north of the equator in the central Pacific, approximately 6,700 km (4,200 miles) southwest of San Francisco, California. The 30,000 inhabitants are dis-

tributed throughout 30 atolls and 5 mountain-top

islands with a land masstotalling 110 km? (69 square

miles) scattered across an ocean area of 480,000 km?
(300,000 square miles). Almost half of the population
lives in isolated island communities which typically
contain fewer than 1,000 persons. The remainder of
the inhabitants live on one of the two major population centers, Majuro atoll or Kwajalein atoll, the formerbeing the capital of the Republic. The ethnic origin of the Marshallese, as inferred from archeological
studies, is eastern Melanesian, with the original inhabitation of the Marshall Islands occurring perhaps
2,000 years ago [3]. It is clear that the remote island
populations enjoyed extremeisolation for many cen-

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