Sei sulla pagina 1di 12

Appendix b

Laboratory Values

Adapted by Jennifer E. Cooke

The tables in this appendix list some of the most common tests, their normal values, and the possible etiologies of abnormal values. Laboratory values are expressed in the Système International d’Unités (SI units) that are used in Canada. Conventional units, used in the United States, are presented in parentheses after the SI units. Laboratory values may vary with different techniques or different laborator- ies. Possible etiologies are presented in alphabetical order. Abbreviations appearing in the tables are defined as follows:

<

=

less than

>

=

greater than

=

greater than or equal to

ΑU

=

arbitrary unit

dL

=

decilitre

ΕU

=

ehrlich unit

fL

=

femtolitre

g

=

gram

IU

=

international unit

kPa

=

kilopascal

L

=

litre

mcg

=

microgram (one millionth of a gram) (10 6 )

mckat

=

microkatal

mcL

=

microlitre

mcmol

=

micromole

mcU

=

microunit

mEq

= milliequivalent

mg

=

milligram (10 3 )

mL

=

millilitre

mm

=

millimetre

mm Hg

=

millimetre of mercury

mmol

=

millimole

mOsm

=

milliosmole

ng

=

nanogram (one billionth of a gram) (10 9 )

nmol

=

nanomole

pg

=

picogram (one trillionth of a gram) (10 12 )

pmol

=

picomole

U

=

unit

Table B–1 Serum, Plasma, and Whole Blood Chemistries

 
 

normAl VAlues

possible eTiology

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Acetone

 

Diabetic ketoacidosis, high-fat diet, low- carbohydrate diet, starvation

 

Quantitative

<200 mcmol/L

(<1.16 mg/dL)

 

Qualitative

Negative (Negative)

Albumin

35–50 g/L (3.5– 5.0 g/dL)

Dehydration

Burns, chronic liver disease, malabsorption, malnutrition, nephrotic syndrome, pregnancy

Aldolase

22–59 mU/L (3.0–8.2 Sibley-Lehninger U/dL)

Infection, muscle trauma, skeletal muscle disease

Late muscular dystrophy, renal disease

α 1 -Antitrypsin

0.85–2.13 g/L

Acute and chronic inflammation and infection, arthritis, malignancy, stress syndrome, thyroid infections

Chronic lung disease (early onset of emphysema), malnutrition, nephrotic syndrome

(85–213 mg/dL)

α 1 -Fetoprotein

<40 mcg/L

Cancers of testes and ovaries, carcinoma of liver, neural tube defects or multiple pregnancies in pregnant women

In pregnant women, trisomy 21 or fetal distress/ death

(<40 ng/mL)

Ammonia

6–47 mcmol/L

Gastrointestinal bleeds, hepatic encephalopathy, portal hypertension, severe liver disease

 

(10–80 mcg/dL)

Amylase

30–220 U/L (60–120 Somogyi units/dL)

Acute and chronic pancreatitis, mumps (salivary gland disease), perforated ulcers

Acute alcoholism, cirrhosis of liver, extensive destruction of pancreas

Continued

of liver, extensive destruction of pancreas Continued Copyright © 2010 Elsevier Canada, a division of Reed

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

1972 Appendix B Laboratory Values

Table B–1 Serum, Plasma, and Whole Blood Chemistries continued

 
 

normAl VAlues

possible eTiology

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Ascorbic acid

23–85 mcmol/L

Excessive ingestion of vitamin C

Connective tissue disorders, hepatic disease, renal disease, rheumatic fever, vitamin C deficiency

(0.4–1.5 mg/dL)

B-type naturietic

<100 ng/L

Congestive heart failure, myocardial infarction, hypertension, cor pulmonale

 

peptide

(<100 pg/mL)

Bicarbonate

21–28 mmol/L

Chronic use of loop diuretics, compensated respiratory acidosis, metabolic alkalosis

Acute renal failure, compensated respiratory alkalosis, diarrhea, metabolic acidosis

(21–28 mEq/L)

Bilirubin

 

Biliary obstruction, hemolytic anemia, impaired liver function, pernicious anemia, prolonged fasting

 

Total

5.1–17 mcmol/L

(0.3–1.0 mg/dL)

Indirect

3.4–12 mcmol/L

 

(0.2–0.8 mg/dL)

Direct

1.7–5.1 mcmol/L

(0.1–0.3 mg/dL)

Blood gases*

     

Arterial pH

7.35–7.45

Alkalosis

Acidosis

(same as SI units)

Venous pH

7.31–7.41 (same as SI units)

Alkalosis

Acidosis

Arterial PCO 2

35–45 mm Hg (same as SI units)

Compensated metabolic alkalosis, respiratory acidosis

Compensated metabolic acidosis, respiratory alkalosis

Arterial PO 2

80–100 mm Hg (same as SI units)

Administration of high concentration of oxygen

Chronic lung disease, decreased cardiac output

Venous PO 2

40–50 mm Hg (same as SI units)

Calcium

2.25–2.75 mmol/L

Acute osteoporosis, hyperparathyroidism, multiple myeloma, vitamin D intoxication

Acute pancreatitis, hypoparathyroidism, liver disease, malabsorption syndrome, renal failure, vitamin D deficiency

(9.0–10.5 mg/dL)

Calcium, ionized

1.05–1.30 mmol/L

   

(4.5–5.6 mg/dL)

Carbon dioxide (CO 2 content)

21–28 mmol/L

Same as bicarbonate

 

(21–28 mEq/L)

β-Carotene

1.4–4.7 mcmol/L

Cystic fibrosis, hypothyroidism, pancreatic insufficiency

Dietary deficiency, malabsorption disorders

(75–253 mcg/dL)

Chloride

98–106 mmol/L

Corticosteroid therapy, dehydration, excessive infusion of normal saline, metabolic acidosis, respiratory alkalosis, uremia

Addison’s disease, congestive heart failure, diarrhea, metabolic alkalosis, overhydration, respiratory acidosis, SIADH (syndrome of inappropriate antidiuretic hormone), vomiting

(98–106 mEq/L)

Cholesterol

<5.2 mmol/L

Biliary obstruction, cirrhosis hypothyroidism, hyperlipidemia, idiopathic hypercholesterolemia, renal disease, uncontrolled diabetes

Corticosteroid therapy, extensive liver disease, hyperthyroidism, malnutrition

(<200 mg/dL)

age dependent

 

HDL (high-density

 

lipoproteins)

Male

>0.75 mmol/L

(>45 mg/dL)

Female

>0.91 mmol/L

(>55 mg/dL)

LDL (low-density

<3.37 mmol/L

   

lipoproteins)

(<60–180 mg/dL)

Cholinesterase (RBC)

5–10 U/L (same as SI units)

Exercise, sickle cell disease

Acute infections, insecticide intoxication, liver disease, muscular dystrophy

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Appendix B Laboratory Values

1973

Table B–1 Serum, Plasma, and Whole Blood Chemistries continued

 
 

normAl VAlues

possible eTiology

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Pseudocholinesterase

8–18 U/mL (same as SI units)

   

(serum)

Copper

11–22 mcmol/L

Cirrhosis, contraceptive use by female client

Wilson’s disease

(70–140 mcg/dL)

Cortisol

a.m.: 138–635 nmol/L (5–23 mcg/dL)

8

Adrenal adenoma, Cushing’s syndrome, hyperthyroidism, pancreatitis, stress

Addison’s disease, adrenal insufficiency,

p.m. : 83–359 nmol/L (3–13 mcg/dL)

8

hypopituitary states, hypothyroidism, liver disease

Creatine

15.3–76.3 mcmol/L

Active rheumatoid arthritis, biliary obstruction, hyperthyroidism, renal disorders, severe muscle disease

Diabetes mellitus

(0.2–1.0 mg/dL)

Creatine kinase (CK)

 

Brain damage, exercise, musculoskeletal injury or disease, myocardial infarction, numerous intramuscular injections, severe myocarditis

 

Male

55–170 U/L (same as SI units)

Female

30–135 U/L (same as SI units)

 

CK-MB (CK-2)

Male: 2–6 mcg/L (2–6 ng /mL)

Acute myocardial infarction

 

Female: 2–5 mcg/L (2–5 ng/mL)

CK mass fraction

<0.05 fraction of total CK

   

Creatinine

 

Severe renal disease

Diseases with decreased muscle mass (e.g., muscular dystrophy, myasthenia gravis)

Male

53–106 mcmol/L

(0.6–1.2 mg/dL)

 

Female

44–97 mcmol/L

(0.5–1.1 mg/dL)

Ferritin (serum)

 

Anemia of chronic disease (infection, inflammation, liver disease), sideroblastic anemia

Iron-deficiency anemia, severe protein deficiency

Male

12–300 mcg/L

(12–300 ng/mL)

Female

10–150 mcg/L

 

(10–150 ng/mL)

Folic acid (folate)

11–57 nmol/L

Hypothyroidism, pernicious anemia

Alcoholism, hemolytic anemia, inadequate diet, malabsorption syndrome, malnutrition, megaloblastic anemia

(5–25 ng/mL)

γ-Glutamyl

8–38 IU/L (same as SI units)

Cholestasis, Cytomegalovirus infection, Epstein- Barr, liver disease, myocardial infarction, pancreatitis

 

transpeptidase (GGT)

Glucose, fasting

4–6 mmol/L

Acute stress, cerebral lesions, Cushing’s syndrome, diabetes mellitus, hyperthyroidism, pancreatic insufficiency

Addison’s disease, hepatic disease, hypothyroidism, insulin overdose, pancreatic tumour, pituitary hypofunction, post dumping syndrome

(70–110 mg/dL)

2-Hour oral glucose tolerance testing (OGTT)

 

Diabetes mellitus

Hyperinsulinism

Fasting

4–6 mmol/L

(70–110 mg/dL)

1 hour

<11.1 mmol/L

(<200 mg/dL)

2 hours

<7.8 mmol/L

(<140 mg/dL)

Continued

2 hours <7.8 mmol/L (<140 mg/dL) Continued Copyright © 2010 Elsevier Canada, a division of Reed

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

1974 Appendix B Laboratory Values

Table B–1 Serum, Plasma, and Whole Blood Chemistries continued

 
   

normAl VAlues

possible eTiology

 

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Haptoglobin

0.5–2.2 g/L

Acute myocardial infarction, infectious and inflammatory processes, malignant neoplasms

Chronic liver disease, hemolytic anemia, mononucleosis, systemic lupus erythematosus, toxoplasmosis, transfusion reactions

(50–220 mg/dL)

Homocysteine

4–14 mcmol/L

Cardiovascular disease, cerebrovascular disease, peripheral vascular disease, cystinurea, vitamin B 6 or B 12 deficiency, folate deficiency, malnutrition

 

(0.54–1.9 mg/L)

Insulin

43–186 pmol/L

Acromegaly, adenoma of islet cells, obesity, untreated mild case of type 2 diabetes

Diabetes mellitus, obesity

(6–26 mcU/mL)

Iron

 

Excessive red blood cell destruction, hemochromatosis, massive transfusion

Anemia of chronic disease, iron-deficiency anemia

Male

14–32 mcmol/L

(80–180 mcg/dL)

Female

11–29 mcmol/L

(60–160 mcg/dL)

Total iron-binding

45–82 mcmol/L

Iron-deficient state, oral contraceptive use, polycythemia

Cancer, chronic infections, pernicious anemia, uremia

capacity (TIBC)

(250–460 mcg/dL)

Lactic acid

0.6–2.2 mmol/L

Acidosis, congestive heart failure, severe liver disease, shock, tissue ischemia

 

(5–20 mg/dL)

Lactic dehydrogenase

100–190 U/L (same as SI units)

Congestive heart failure, hemolytic disorders, hepatitis, metastatic cancer of liver, myocardial infarction, pernicious anemia, pulmonary embolus and infarction, skeletal muscle damage

 

(LDH)

Lactic dehydrogenase

     

isoenzymes

LDH 1

0.17–0.27

Myocardial infarction, pernicious anemia, strenuous exercise

(17–27%)

LDH 2

0.27–0.37

Exercise, pulmonary embolus, sickle cell crisis

(27–37%)

LDH 3

0.18–0.25

Malignant lymphoma, pulmonary embolus

(18–25%)

LDH 4

0.03–0.08 (3–8%)

Systemic lupus erythematosus, pancreatitis, pulmonary infarction, renal disease

LDH 5

0.0–0.05 (0–5%)

Congestive heart failure, hepatitis, pulmonary embolus and infarction, skeletal muscle damage, strenuous exercise

Lipase

0–160 U/L (same as SI units)

Acute and chronic pancreatitis, hepatic disorders, pancreatic disorder (cancer, pseudocyst), perforated peptic ulcer, salivary gland inflammation or tumour

 

Magnesium

0.65–1.05 mmol/L

Addison’s disease, hypothyroidism, renal failure

Chronic alcoholism, hyperparathyroidism, hyperthyroidism, hypoparathyroidism, malnutrition, severe malabsorption

(1.3–2.1 mEq/L)

Myoglobin

<90 mcg/L (same as SI units)

Myocardial infarction, myositis, malignant hyperthermia, muscular dystrophy, skeletal muscle ischemia or trauma, rhabdomyolysis, seizures

Polymyositis

Osmolality

285–295 mmol/kg

Chronic renal disease, dehydration, diabetes mellitus, hypernatremia, shock

Addison’s disease, diuretic therapy, hyponatremia, overhydration

(Adult)

(285–295 mOsm/kg)

H

2 O

   

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Appendix B Laboratory Values

1975

Table B–1 Serum, Plasma, and Whole Blood Chemistries continued

 
 

normAl VAlues

possible eTiology

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Oxygen saturation

 

Increased inspired oxygen, polycythemia vera

 

Arterial

95% (same as SI units)

Anemia, cardiac decompensation, decreased inspired oxygen, respiratory disorders

Venous

60–80% (same as SI units)

pH

See Blood gases

   

Phenylalanine

0–121 mcmol/L

Phenylketonuria

 

(0–2 mg/dL)

Phosphatase, acid

2.2–10.5 U/L (0.13–0.63 U/L – Roy, Brower, Hayden 37ºC)

Advanced Paget’s disease, cancer of prostate, hyperparathyroidism

 

Phosphatase, alkaline

0.5–2.0 mckat/L

Bone diseases, cirrhosis, malignancy of liver/ bone, marked hyperparathyroidism, obstruction of biliary system, rickets

Excessive vitamin D ingestion, hypothyroidism, milk-alkali syndrome

(ALP)

(30–120 U/L)

Phosphorus, inorganic

0.97–1.45 mmol/L

Bone metastasis, healing fractures, hypoparathyroidism, hypocalcemia, renal disease, vitamin D intoxication

Chronic alcoholism, diabetes mellitus, hypercalcemia, hyperparathyroidism, vitamin D deficiency

(3.0–4.5 mg/dL)

Potassium

3.5–5.0 mmol/L

Acute or chronic renal failure, Addison’s disease, dehydration, diabetic ketosis, excessive dietary or intravenous intake, massive tissue destruction, metabolic acidosis

Burns, Cushing’s syndrome, deficient dietary or intravenous intake, diarrhea (severe), diuretic therapy, gastrointestinal fistula, insulin administration, pyloric obstruction, starvation, vomiting

(3.5–5.0 mEq/L)

Prostate-specific

<4 mcg/L

Benign prostatic hypertrophy, prostate cancer, prostatitis

 

antigen (PSA)

(<4 ng/mL)

Proteins

 

Burns, cirrhosis (globulin fraction), dehydration

Congenital agammaglobulinemia, increased capillary permeability, inflammatory disease, liver disease, malabsorption, malnutrition

Total

64–83 g/L

(6.4–8.3 g/dL)

Albumin

35–50 g/L

 

(3.5–5 g/dL)

Globulin

23–34 g/L

(2.3–3.4 g/dL)

Albumin/globulin

1.5:1–2.5:1 (same as SI units)

Multiple myeloma (globulin fraction), shock, vomiting

Malnutrition, nephrotic syndrome, proteinuria, renal disease, severe burns

ratio

Renin

 

Renal hypertension, salt-losing gastrointestinal disease (vomiting/diarrhea), volume decrease (e.g., hemorrhage)

Increased salt intake, primary aldosteronism

Upright position

0.03–1.2 ng/L/sec

(0.1–4.3 ng/mL/hr)

Sodium

135–145 mmol/L

Corticosteroid therapy, dehydration, impaired renal function, increased sodium in dietary or intravenous intake, primary aldosteronism

Addison’s disease, decreased sodium in dietary or intravenous intake, diabetic ketoacidosis, diuretic therapy, excessive loss from gastrointestinal tract, excessive perspiration, water intoxication

(135–145 mEq/L)

Testosterone

     

Male

9.75–38.0 nmol/L

Adrenal hyperplasia, adrenal or pituitary tumours, testicular tumours

Hypofunction of testes

(280–1080 ng/dL)

Female

0.52–2.43 nmol/L

Polycystic ovary, virilizing tumours

(<70 ng/dL)

T 4 (thyroxine), total

64–154 nmol/L

Hyperthyroidism, thyroiditis

Cretinism, hypothyroidism, myxedema

(5–12 mcg/dL)

Continued

hypothyroidism, myxedema (5–12 mcg/dL) Continued Copyright © 2010 Elsevier Canada, a division of Reed

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

1976 Appendix B Laboratory Values

Table B–1 Serum, Plasma, and Whole Blood Chemistries continued

 
 

normAl VAlues

possible eTiology

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

T 4 (thyroxine), free

10–36 pmol/L

Hyperthyroidism, metastatic neoplasms

Hypothyroidism, pregnancy

(0.8–2.8 ng/dL)

T 3 uptake

24–34 AU

   

(24–34%)

T 3 (triiodothyronine)

1.2–3.4 nmol/L

Hyperthyroidism

Hypothyroidism

(70–205 ng/dL)

Thyroid-stimulating

2–10 mU/L

Graves’ disease, myxedema, primary hypothyroidism

Secondary hypothyroidism

hormone (TSH)

(2–10 mcU/L)

Transaminases

     

Serum glutamic oxaloacetic transferase (SGOT) or aspartate amino- transferase (AST)

0–0.58 mckat/L

Acute hepatitis, liver disease, myocardial infarction, pulmonary infarction

(0–35 U/L)

Serum glutamate pyruvate transferase (SGPT) or alanine aminotransferase (ALT)

4–36 U/L (same as SI units)

Liver disease, shock

Triglycerides

 

Diabetes mellitus, hyperlipidemia, hypothyroidism, liver disease

Hyperthyroidism, malabsorption syndrome, malnutrition

Male

0.45–1.81 mmol/L

(40–160 mg/dL)

   

Female

0.40–1.52 mmol/L

(35–135 mg/dL)

Troponin T (cTnT):

<0.2 mcg/L

Cardiac muscle damage (myocardial infarction, myocarditis or pericarditis), chronic renal failure, multiorgan failure, severe heart failure

 

(<0.2 ng/mL)

Troponin I (cTnI)

<0.03 mcg/L

(<0.3 ng/mL)

 

Urea nitrogen (BUN)

3.6–7.1 mmol/L

Burns, dehydration, gastrointestinal bleeds, increase in protein catabolism (fever, stress), renal disease, shock, urinary tract infection

Fluid overload, malnutrition, severe liver damage, SIADH

(10–20 mg/dL)

Uric acid

 

Alcoholism, eclampsia, gout, gross tissue destruction, high-protein weight reduction diet, leukemia, multiple myeloma, renal failure

Administration of uricosuric drugs

Male

0.24–0.51 mmol/L

(4.0–8.5 mg/dL)

Female

0.16–0.43 mmol/L

 

(2.7–7.3 mg/dL)

Vitamin A

0.52–2.09 mcmol/L

Excess ingestion of vitamin A

Vitamin A deficiency

(15–60 mcg/dL)

Vitamin B 12

118–701 pmol/L

Chronic myeloid leukemia

Malabsorption syndrome, pernicious anemia, strict vegetarianism, total or partial gastrectomy

(160–950 pg/mL)

Zinc

11.5–18.5 mcmol/L

 

Alcoholic cirrhosis

(75–120 mcg/dL)

*Because arterial blood gases are influenced by altitude, the value for PO 2 decreases as altitude increases. The lower value is normal for an altitude of 1.6 km (1.0 mile).

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Appendix B Laboratory Values

1977

Table B–2 Hematology

 
   

normAl VAlues

possible eTiology

 

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Bleeding time (IVY)

1–9 min

Aspirin ingestion, clotting factor deficiency, defective platelet function, thrombocytopenia, vascular disease, von Willebrand’s disease

 

Activated partial thromboplastin time (APTT)

30–40 sec* (same as SI units)

Deficiency of factors I, II, V, VIII, IX, X, XI, and XII; hemophilia; heparin therapy; liver disease

 

Partial thromboplastin time (PTT)

60–70 sec (same as SI units)

Same etiology as for APTT

 

Automated coagulation time or activated clotting time (ACT)

70–120 sec (same as SI units)

Same etiology as for APTT

 

Prothrombin time (protime, PT)

11–12.5 sec* (same as SI units)

Deficiency of factors I, II, V, VII, and X; liver disease; vitamin K deficiency; warfarin therapy

 

International normalized

0.81–1.2 (same as SI units)

Same etiology as for PT

 

ratio (INR)

Thrombin time

8–12 sec (same as SI units)

Disseminated intravascular coagulation (DIC), increased tendency to bleed

 

Fibrinogen

2–4 g/L (200–400 mg/dL)

Burns (after first 36 hours), inflammatory disease

Burns (during first 36 hours), DIC, severe liver disease

Fibrin split (degradation) products

<10 mg/L (<10 mcg/mL)

Acute DIC, massive hemorrhage, massive trauma, primary fibrinolysis

 

D-Dimer

<250 mcg/L (<250 ng/mL)

Deep vein thrombosis, DIC, myocardial infarction, unstable angina

 

Erythrocyte count (altitude dependent)

 

Dehydration, high altitudes, polycythemia vera, severe diarrhea

Anemia, leukemia, post hemorrhage

Male

4.7–6.1 × 10 12 /L (4.7–6.1 ×

10

6 /mcL)

Female

4.2–5.4 × 10 12 /L (4.2–5.4 ×

10

6 /mcL)

Mean corpuscular volume (MCV)

80–95 mm 3 (same as SI units)

Folic acid and vitamin B 12 deficiency, liver disease, macrocytic anemia

Microcytic anemia

Mean corpuscular hemoglobin (MCH)

27–31 pg (same as SI units)

Macrocytic anemia

Microcytic anemia

Mean corpuscular hemoglobin concentration (MCHC)

320–360 g/L (32–36 g/dL)

Intravascular hemolysis, spherocytosis

Hypochromic anemia

(32–36%)

Erythrocyte sedimentation rate (ESR), Westergren

 

Moderate increase: acute hepatitis, myocardial infarction, rheumatoid arthritis

Malaria, severe liver disease, sickle cell anemia

Male

<50 yr

<15 mm/hr (same as SI units) <20 mm/hr (same as SI units)

>50 yr

Marked increase: acute and severe bacterial infections, malignancies, pelvic inflammatory disease

Female

<50 yr

<20 mm/hr (same as SI units) <30 mm/hr (same as SI units)

>50 yr

Continued

<30 mm/hr (same as SI units) >50 yr Continued Copyright © 2010 Elsevier Canada, a division

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

1978 Appendix B Laboratory Values

Table B–2 Hematology continued

 
 

normAl VAlues

possible eTiology

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Hematocrit (altitude

 

Dehydration, high altitudes, polycythemia

Anemia, bone marrow failure, hemorrhage, leukemia, overhydration

dependent)

Male

0.42–0.52 volume fraction

 

(42–52%)

Female

0.37–0.47 volume fraction

(37–47%)

Hemoglobin (altitude

 

Chronic obstructive pulmonary disease (COPD), high altitudes, polycythemia

Anemia, hemorrhage

dependent)

Male

8.7–11.2 mmol/L (14–18 g/dL)

 

Female

7.4–9.9 mmol/L (12–16 g/dL)

Hemoglobin, glycosylated or glycated (HbA 1C [A 1C ])

Less than 6% (adult without diabetes)

Nondiabetic hyperglycemia, poorly controlled diabetes mellitus

Chronic blood loss, chronic renal failure, pregnancy, sickle cell anemia

Red cell distribution width (RDW)

11–14.5% (same as SI units)

 

Anisocytosis, macrocytic anemia, microcytic anemia

Platelet count (thrombocytes)

150–400 × 10 9 /L (150,000– 400,000/mm 3 )

Acute infections, chronic granulocytic leukemia, chronic pancreatitis, cirrhosis, collagen disorders, polycythemia, post splenectomy

Acute leukemia, cancer chemotherapy, DIC, hemorrhage, infection, systemic lupus erythematosus, thrombocytopenic purpura

Reticulocyte count (manual)

0.5–2% of red blood cells (same as SI units)

Hemolytic anemia, polycythemia vera

Hypoproliferative anemia, macrocytic anemia, microcytic anemia

White blood cell (WBC) count

5–10 × 10 9 /L (5000– 10,000/mm 3 )

Inflammatory and infectious processes, leukemia

Aplastic anemia, autoimmune diseases, overwhelming infection, side effects of chemotherapy and irradiation

WBC differential

     

Segmented neutrophils

2.5–7.5 × 10 9 /L (62–68%)

Bacterial infections, collagen diseases, Hodgkin’s disease

Aplastic anemia, viral infections

Band neutrophils

0–1 × 10 9 /L (0–9%)

Acute infections

Lymphocytes

0.1–0.4 × 10 9 /L (1000– 4000/mm 3 ) (20–40%)

Chronic infections, lymphocytic leukemia, mononucleosis, viral infections

Corticosteroid therapy, whole body irradiation

Monocytes

0.02–0.07 × 10 9 /L (100– 700/mm 3 ) (2–8%)

Acute infections, chronic inflammatory disorders, Hodgkin’s disease, malaria, monocytic leukemia

Eosinophils

0.01–0.04 × 10 9 /L (50– 100/mm 3 ) (1–4%)

Allergic reactions, eosinophilic and chronic granulocytic leukemia, Hodgkin’s disease, parasitic disorders

Corticosteroid therapy

Basophils

0.0–0.01 × 10 9 /L (25– 100/mm 3 ) (0.5–1%)

Hypothyroidism, myeloproliferative diseases, ulcerative colitis

Hyperthyroidism, stress

Sickle cell solubility test

Negative (Negative)

Sickle cell anemia

 

*Clients receiving anticoagulant therapy:

APTT: 1.5–2.5 times control value in seconds PT: 1.5–2.0 times control value in seconds Components of complete blood count (CBC).

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Appendix B Laboratory Values

1979

Table B–3 Serology–Immunology

 
 

normAl VAlues

possible eTiology

 

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Antinuclear antibody

Negative at 1:40 dilution (same as SI units)

Chronic hepatitis, rheumatoid arthritis, scleroderma, systemic lupus erythematosus (SLE)

 

(ANA)

Anti-DNA antibody

Negative <70 U/mL (same as SI units)

SLE

 

Anti-RNP

Negative (Negative)

Mixed connective tissue disease, scleroderma, rheumatoid arthritis, Sjögren's syndrome, SLE

 

(ribonucleoprotein)

Anti-Sm (Smith)

Negative (Negative)

SLE

 

Antistreptolysin-O (ASO)

160 Todd units/mL (same as SI units)

Acute glomerulonephritis, rheumatic fever, streptococcal infection

 

Cross-reactive protein

<10 mg/L (<1.0 mg/dL)

Acute infections, any inflammatory condition (e.g., acute rheumatic fever/arthritis), widespread malignancy

 

(CRP)

Carcinoembryonic

5 mcg/L (5 ng/mL)

Carcinomas of colon, liver, pancreas; chronic cigarette smoking; inflammatory bowel disease; other cancers

 

antigen (CEA)

Complement assay

   

Acute glomerulonephritis, rheumatoid arthritis, serum sickness, subacute bacterial endocarditis, SLE

components

Total

75–160 k/units/L

(75–160 U/mL)

 

C3

0.55–1.2 g/L

(55–120 mg/dL)

C4

0.2–0.5 g/L (20–50 mg/dL)

Direct antihuman globulin test (DAT) or direct Coombs’ test

Negative (Negative)

Acquired hemolytic anemia, drug reactions, hemolytic disease of the newborn, transfusion reactions

 

(No agglutination)

Fluorescent treponemal

Negative (Nonreactive)

Syphilis

 

antibody absorption

(FTAAbs)

Hepatitis A antibody

Negative (Negative)

Hepatitis A

 

Hepatitis B surface antigen (HBsAg)

Negative (Negative)

Hepatitis B

 

Hepatitis C antibody

Negative (Negative)

Hepatitis C

 

Immunoglobulins (Igs)

     

IgA

0.85–3.85 g/L

Autoimmune disorders, chronic infection, chronic liver disease, IgA myeloma, rheumatoid arthritis

Burns, hereditary telangiectasia, malabsorption syndromes

(85–385 mg/dL)

IgD

Minimal

Chronic infection, connective tissue disease

 

IgE

Minimal

Anaphylactic shock, atopic disease (allergies), parasitic infections

IgG

5.65–17.65 g/L

Hepatitis, IgG monoclonal gammopathy, infections—acute and chronic, SLE

Acquired deficiencies, burns, congenital deficiencies, immunosuppression, nephrotic syndromes

(565–1765 mg/dL)

IgM

0.55–3.75 g/L

Acute infections, liver disease, rheumatoid arthritis

Congenital and acquired antibody deficiencies, lymphocytic leukemia, protein-losing enteropathies

(55–375 mg/dL)

Continued

protein-losing enteropathies (55–375 mg/dL) Continued Copyright © 2010 Elsevier Canada, a division of Reed

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

1980 Appendix B Laboratory Values

Table B–3 Serology–Immunology continued

 
 

normAl VAlues

possible eTiology

 

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Monospot or monotest

Negative (<1:28 titre)

Infectious mononucleosis

 

Rheumatoid factor (RA factor)

0.2 kU/L (0.2 U/mL) nephelometric method

Rheumatoid arthritis, Sjögren's syndrome, SLE

 

<1:20 titre agglutination method

RPR (rapid plasma reagin) test

Negative or nonreactive (same as SI units)

Febrile diseases, intravenous drug abuse, leprosy, malaria, rheumatoid arthritis, syphilis, SLE

 

VDRL (Venereal Disease Research Laboratory) test

Negative or nonreactive (same as SI units)

Syphilis

 

Thyroid antibodies

Titre <1:100 (same as SI units)

Early hypothyroidism, Graves’ disease, Hashimoto’s thyroiditis, pernicious anemia, SLE, thyroid carcinoma

 

Table B–4 Urine Chemistry

 
   

normAl VAlues

possible eTiology

speCimen

 

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Acetone (ketones)

Random

Negative (Negative)

Diabetes mellitus, high-fat and low- carbohydrate diets, starvation states

 

Aldosterone

24

hr

6–72 nmol/24 hr (2–26 mcg/24 hr) (depends on urinary sodium)

Primary aldosteronism:

Adrenocorticotropic hormone (ACTH) deficiency, Addison’s disease, corticosteroid therapy

 

adrenocortical tumours

 

Secondary aldosteronism: cardiac failure, cirrhosis, large dose of ACTH, salt depletion

Amylase

24

hr

Up to 5000 Somogyi units/24 hr OR 6.5–48.1 units/hr

Acute pancreatitis

 

Bence Jones protein

Random

Negative (Negative)

Biliary duct obstruction, multiple myeloma

 

Bilirubin

Random

Negative (Negative)

Hepatitis

 

Calcium

24

hr

6.2

mmol/d (<250 mg/d)

Bone tumour, hyperparathyroidism, milk-alkali syndrome

Hypoparathyroidism, malabsorption of calcium and vitamin D

Catecholamines

24

hr

 

Heart failure, pheochromocytoma, progressive muscular dystrophy

 

Epinephrine

 

<109 nmol/d (<20 mcg/d)

Norepinephrine

<590 nmol/d (<100 mcg/d)

 

Chloride

24

hr

110–250 mmol/d (110–250 mEq/d)

Addison’s disease

Burns, diarrhea, excessive perspiration, menstruation, vomiting

 

<0.5 mcmol/d (<30 mcg/d)

Copper

24

hr

0.6

mcmol/d (<40 mcg/d)

Cirrhosis, Wilson’s disease

 

Coproporphyrin

24

hr

<300 nmol/d (<200 mcg/d)

Lead poisoning, oral contraceptive use, poliomyelitis

 

Creatine

24

hr

 

Addison’s disease, burns, carcinoma of liver, diabetes, hyperthyroidism, infections, muscular dystrophy, skeletal muscle atrophy

Hypothyroidism

Male

 

<300 mcmol/d (<60 mg/d)

Female

<600 mcmol/d (<80 mg/d)

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

Appendix B Laboratory Values

1981

Table B–4 Urine Chemistry continued

 
   

normAl VAlues

possible eTiology

speCimen

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Creatinine

24

hr

7.1–17.7 mmol/d (0.8–2 g/d)

Anemia, leukemia, muscular atrophy, salmonellosis

Renal disease

Creatinine clearance

24

hr

1.42–2.25 mL/sec (85–135 mL/min)

 

Renal disease

Male

 

1.78–2.32 mL/sec (107–139 mL/min)

Female

1.45–1.78 mL/sec (87–107 mL/min)

Estriol

24

hr

 

Gonadal or adrenal tumour

Agenesis of ovaries, endocrine disturbance, menopause, ovarian dysfunction

Female

 

Ovulation peak

104–370 nmol/d (28–100 mcg/d)

Luteal peak

81–296 nmol/d (22–80 mcg/d)

Pregnancy

Up to 166,455 nmol/d (Up to 45,000 mcg/d)

 

Menopause

5.2–72.5 nmol/d (1.4–19.6 mcg/d)

Male

18–67 nmol/d (5–18 mcg/d)

Glucose

Random

Negative (Negative)

Diabetes mellitus, low renal threshold for glucose resorption, physiological stress, pituitary disorders

 

Hemoglobin

Random

Negative (Negative)

Extensive burns, glomerulonephritis, hemolytic anemias, hemolytic transfusion reaction

 

5-Hydroxyindole-

24

hr

10–40 mcmol/d (2–8 mg/24 hr)

Malignant carcinoid syndrome

 

acetic acid (5-HIAA)

 

Ketone bodies

Random

Negative (Negative)

Alcoholism, fasting, high-protein diets, marked ketonuria, poorly controlled diabetes mellitus, starvation

 

Lead

24

hr

<0.40 mcmol/d (<80 mcg/d)

Lead poisoning

 

Metanephrine

24

hr

<7 mcmol/d (<1.3 mg/d)

Pheochromocytoma

 

Myoglobin

Random

Negative (Negative)

Crushing injuries, electric injuries, extreme physical exertion

 

pH

Random

4.6–8 (same as SI units)

Chronic renal failure, compensatory phase of alkalosis, salicylate intoxication, vegetarian diet

Compensatory phase of acidosis, dehydration, emphysema

Average: 6

Phenylpyruvic acid

Random

Negative (Negative)

Phenylketonuria

 

Phosphorus,

24

hr

29–42 mmol/d (0.9–1.3 g/d)

Fever, hypoparathyroidism, nervous exhaustion, rickets, tuberculosis

Acute infections, nephritis

inorganic

 

Porphobilinogen

Random

Negative (Negative)

Acute intermittent porphyria, liver disorders

 

24

hr

< 8.8 mcmol/d (<2 mcg/d)

Potassium

24

hr

25–100 mmol/d (25–100 mEq/d)

Chronic renal failure, starvation, Cushing’s syndrome, hyperaldosteronism, alkalosis, diuretic therapy

Reduced intake, dehydration, Addison’s disease, malnutrition, vomiting, diarrhea, acute renal failure

Protein (dipstick)

Random

Negative (Negative)

Congestive heart failure, nephritis, nephrosis, physiological stress

 

Continued

nephrosis, physiological stress   Continued Copyright © 2010 Elsevier Canada, a division of Reed

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.

1982 Appendix B Laboratory Values

Table B–4 Urine Chemistry continued

 
   

normAl VAlues

possible eTiology

speCimen

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Protein

24

hr

<0.15 g/d (<150 mg/d)

Cardiac failure, inflammatory processes of urinary tract, nephritis, nephrosis, toxemia of pregnancy

 

(quantitative)

 

At rest

0.05–0.08 g/d (<50–80 mg/d)

During exercise

<0.25 g/d (<250 mg/d)

 

Sodium

24

hr

40–250 mmol/d (40–250 mEq/d)

Acute tubular necrosis

Hyponatremia

Specific gravity

Random

1.005–1.030 (same as SI units)

Albuminuria, dehydration, fever, gastrointestinal losses (vomiting/ diarrhea), glycosuria, syndrome of inappropriate antidiuretic hormone (SIADH)

Diabetes insipidus, diuresis, overhydration

Titratable acidity

24

hr

20–50 mEq/d (same as SI units)

Metabolic acidosis

Metabolic alkalosis

Uric acid

24

hr

1.48–4.43 mmol/d (250–750 mg/24 hr)

Gout, leukemia

Nephritis

Urobilinogen

24

hr

0.0–6.8 mcmol/d (0.0–4.0 mg/24 hr)

Hemolytic disease, hepatic parenchymal cell damage, liver disease

Complete obstruction of bile duct

Random

<0.01–1 EU (same as SI units)

Uroporphyrins

24

hr

 

Lead poisoning, liver disease, porphyria

 

Male

 

4–46 mcg/d (same as SI units)

Female

3–22 mcg/d (same as SI units)

 

Vanillylmandelic

24

hr

<35 mcmol/d (<6.8 mg/d)

Pheochromocytoma,

 

acid

 

neuroblastomas

Table B–5 Gastric Analysis

 
 

normAl VAlues

possible eTiology

si uniTs

   

TesT

(ConVenTionAl uniTs)

HigHer

lower

Basal

     

Free hydrochloric acid

0.3 mmol/L (0.3 mEq/L)

Hypermotility of stomach

Pernicious anemia

Total acidity

15–45 mmol/L (15–45 mEq/L)

Gastric and duodenal ulcers, Zollinger-Ellison syndrome

Gastric carcinoma, severe gastritis

Poststimulation

     

Free hydrochloric acid

10–130 mmol/L (10–130 mEq/L)

Total acidity

20–150 mmol/L (20–150 mEq/L)

Copyright © 2010 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.