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 Systme International dUnits (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 laboratories. Possible etiologies are presented in alphabetical order. Abbreviations appearing in the tables are defined as follows: < > U dL U fL g IU kPa L = less than = greater than = greater than or equal to = arbitrary unit = decilitre = ehrlich unit = femtolitre = gram = international unit = kilopascal = litre mcg = microgram (one millionth of a gram) (106) mckat mcL mcU mEq mg mL mm = microkatal = microlitre = microunit = milliequivalent = milligram (103) = millilitre = millimetre mmol = millimole

mOsm = milliosmole ng = nanogram (one billionth of a gram) (109) nmol = nanomole pg = picogram (one trillionth of a gram) (1012) pmol U = picomole = unit

mcmol = micromole

mm Hg = millimetre of mercury

Table B1 Serum, Plasma, and Whole Blood Chemistries

Normal Values Test Acetone Quantitative Qualitative Albumin Aldolase 1-Antitrypsin <200 mcmol/L (<1.16 mg/dL) Negative (Negative) 3550 g/L (3.5 5.0 g/dL) 2259 mU/L (3.08.2 Sibley-Lehninger U/dL) 0.852.13 g/L (85213 mg/dL) <40 mcg/L (<40 ng/mL) 647 mcmol/L (1080 mcg/dL) 30220 U/L (60120 Somogyi units/dL) Dehydration Infection, muscle trauma, skeletal muscle disease Acute and chronic inflammation and infection, arthritis, malignancy, stress syndrome, thyroid infections Cancers of testes and ovaries, carcinoma of liver, neural tube defects or multiple pregnancies in pregnant women Gastrointestinal bleeds, hepatic encephalopathy, portal hypertension, severe liver disease Acute and chronic pancreatitis, mumps (salivary gland disease), perforated ulcers Acute alcoholism, cirrhosis of liver, extensive destruction of pancreas
Continued

Possible Etiology Higher Diabetic ketoacidosis, high-fat diet, lowcarbohydrate diet, starvation Lower

SI Units (Conventional Units)

Burns, chronic liver disease, malabsorption, malnutrition, nephrotic syndrome, pregnancy Late muscular dystrophy, renal disease Chronic lung disease (early onset of emphysema), malnutrition, nephrotic syndrome In pregnant women, trisomy 21 or fetal distress/ death

1-Fetoprotein

Ammonia Amylase

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

1972

Appendix B

Laboratory Values

Table B1 Serum, Plasma, and Whole Blood Chemistries continued

Normal Values Test Ascorbic acid B-type naturietic peptide Bicarbonate Bilirubin Total Indirect Direct Blood gases* Arterial pH Venous pH Arterial PCO2 Arterial PO2 Venous PO2 Calcium 7.357.45 (same as SI units) 7.317.41 (same as SI units) 3545 mm Hg (same as SI units) 80100 mm Hg (same as SI units) 4050 mm Hg (same as SI units) 2.252.75 mmol/L (9.010.5 mg/dL) 1.051.30 mmol/L (4.55.6 mg/dL) 2128 mmol/L (2128 mEq/L) 1.44.7 mcmol/L (75253 mcg/dL) 98106 mmol/L (98106 mEq/L) Same as bicarbonate Cystic fibrosis, hypothyroidism, pancreatic insufficiency Corticosteroid therapy, dehydration, excessive infusion of normal saline, metabolic acidosis, respiratory alkalosis, uremia Biliary obstruction, cirrhosis hypothyroidism, hyperlipidemia, idiopathic hypercholesterolemia, renal disease, uncontrolled diabetes Dietary deficiency, malabsorption disorders Addisons disease, congestive heart failure, diarrhea, metabolic alkalosis, overhydration, respiratory acidosis, SIADH (syndrome of inappropriate antidiuretic hormone), vomiting Corticosteroid therapy, extensive liver disease, hyperthyroidism, malnutrition Acute osteoporosis, hyperparathyroidism, multiple myeloma, vitamin D intoxication Acute pancreatitis, hypoparathyroidism, liver disease, malabsorption syndrome, renal failure, vitamin D deficiency Alkalosis Alkalosis Compensated metabolic alkalosis, respiratory acidosis Administration of high concentration of oxygen Acidosis Acidosis Compensated metabolic acidosis, respiratory alkalosis Chronic lung disease, decreased cardiac output 5.117 mcmol/L (0.31.0 mg/dL) 3.412 mcmol/L (0.20.8 mg/dL) 1.75.1 mcmol/L (0.10.3 mg/dL) SI Units (Conventional Units) 2385 mcmol/L (0.41.5 mg/dL) <100 ng/L (<100 pg/mL) 2128 mmol/L (2128 mEq/L) Higher Excessive ingestion of vitamin C Congestive heart failure, myocardial infarction, hypertension, cor pulmonale Chronic use of loop diuretics, compensated respiratory acidosis, metabolic alkalosis Biliary obstruction, hemolytic anemia, impaired liver function, pernicious anemia, prolonged fasting Acute renal failure, compensated respiratory alkalosis, diarrhea, metabolic acidosis Possible Etiology Lower Connective tissue disorders, hepatic disease, renal disease, rheumatic fever, vitamin C deficiency

Calcium, ionized Carbon dioxide (CO2 content) -Carotene Chloride

Cholesterol

<5.2 mmol/L (<200 mg/dL) age dependent

HDL (high-density lipoproteins) Male Female LDL (low-density lipoproteins) Cholinesterase (RBC) >0.75 mmol/L (>45 mg/dL) >0.91 mmol/L (>55 mg/dL) <3.37 mmol/L (<60180 mg/dL) 510 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 B1 Serum, Plasma, and Whole Blood Chemistries continued

Normal Values Test Pseudocholinesterase (serum) Copper Cortisol SI Units (Conventional Units) 818 U/mL (same as SI units) 1122 mcmol/L (70140 mcg/dL) 8 a.m.: 138635 nmol/L (523 mcg/dL) 8 p.m.: 83359 nmol/L (313 mcg/dL) Creatine 15.376.3 mcmol/L (0.21.0 mg/dL) Active rheumatoid arthritis, biliary obstruction, hyperthyroidism, renal disorders, severe muscle disease Brain damage, exercise, musculoskeletal injury or disease, myocardial infarction, numerous intramuscular injections, severe myocarditis Cirrhosis, contraceptive use by female client Adrenal adenoma, Cushings syndrome, hyperthyroidism, pancreatitis, stress Wilsons disease Addisons disease, adrenal insufficiency, hypopituitary states, hypothyroidism, liver disease Diabetes mellitus Higher Possible Etiology Lower

Creatine kinase (CK) Male Female CK-MB (CK-2) 55170 U/L (same as SI units) 30135 U/L (same as SI units) Male: 26 mcg/L (26 ng /mL) Female: 25 mcg/L (25 ng/mL) CK mass fraction Creatinine Male Female Ferritin (serum) Male Female Folic acid (folate) 12300 mcg/L (12300 ng/mL) 10150 mcg/L (10150 ng/mL) 1157 nmol/L (525 ng/mL) 838 IU/L (same as SI units) 46 mmol/L (70110 mg/dL) 53106 mcmol/L (0.61.2 mg/dL) 4497 mcmol/L (0.51.1 mg/dL) <0.05 fraction of total CK

Acute myocardial infarction

Severe renal disease

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

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

Iron-deficiency anemia, severe protein deficiency

Hypothyroidism, pernicious anemia

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

-Glutamyl transpeptidase (GGT) Glucose, fasting

Cholestasis, Cytomegalovirus infection, EpsteinBarr, liver disease, myocardial infarction, pancreatitis Acute stress, cerebral lesions, Cushings syndrome, diabetes mellitus, hyperthyroidism, pancreatic insufficiency Diabetes mellitus Addisons disease, hepatic disease, hypothyroidism, insulin overdose, pancreatic tumour, pituitary hypofunction, post dumping syndrome Hyperinsulinism

2-Hour oral glucose tolerance testing (OGTT) Fasting 1 hour 2 hours 46 mmol/L (70110 mg/dL) <11.1 mmol/L (<200 mg/dL) <7.8 mmol/L (<140 mg/dL)

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

Continued

1974

Appendix B

Laboratory Values

Table B1 Serum, Plasma, and Whole Blood Chemistries continued

Normal Values Test Haptoglobin SI Units (Conventional Units) 0.52.2 g/L (50220 mg/dL) 414 mcmol/L (0.541.9 mg/L) Higher Acute myocardial infarction, infectious and inflammatory processes, malignant neoplasms Cardiovascular disease, cerebrovascular disease, peripheral vascular disease, cystinurea, vitamin B6 or B12 deficiency, folate deficiency, malnutrition Acromegaly, adenoma of islet cells, obesity, untreated mild case of type 2 diabetes Excessive red blood cell destruction, hemochromatosis, massive transfusion 1432 mcmol/L (80180 mcg/dL) 1129 mcmol/L (60160 mcg/dL) 4582 mcmol/L (250460 mcg/dL) 0.62.2 mmol/L (520 mg/dL) 100190 U/L (same as SI units) Iron-deficient state, oral contraceptive use, polycythemia Acidosis, congestive heart failure, severe liver disease, shock, tissue ischemia Congestive heart failure, hemolytic disorders, hepatitis, metastatic cancer of liver, myocardial infarction, pernicious anemia, pulmonary embolus and infarction, skeletal muscle damage Cancer, chronic infections, pernicious anemia, uremia Diabetes mellitus, obesity Anemia of chronic disease, iron-deficiency anemia Possible Etiology Lower Chronic liver disease, hemolytic anemia, mononucleosis, systemic lupus erythematosus, toxoplasmosis, transfusion reactions

Homocysteine

Insulin Iron Male Female Total iron-binding capacity (TIBC) Lactic acid Lactic dehydrogenase (LDH)

43186 pmol/L (626 mcU/mL)

Lactic dehydrogenase isoenzymes LDH1 LDH2 LDH3 LDH4 LDH5 0.170.27 (1727%) 0.270.37 (2737%) 0.180.25 (1825%) 0.030.08 (38%) 0.00.05 (05%) Myocardial infarction, pernicious anemia, strenuous exercise Exercise, pulmonary embolus, sickle cell crisis Malignant lymphoma, pulmonary embolus Systemic lupus erythematosus, pancreatitis, pulmonary infarction, renal disease Congestive heart failure, hepatitis, pulmonary embolus and infarction, skeletal muscle damage, strenuous exercise Acute and chronic pancreatitis, hepatic disorders, pancreatic disorder (cancer, pseudocyst), perforated peptic ulcer, salivary gland inflammation or tumour Addisons disease, hypothyroidism, renal failure Chronic alcoholism, hyperparathyroidism, hyperthyroidism, hypoparathyroidism, malnutrition, severe malabsorption Polymyositis

Lipase

0160 U/L (same as SI units)

Magnesium

0.651.05 mmol/L (1.32.1 mEq/L) <90 mcg/L (same as SI units)

Myoglobin

Myocardial infarction, myositis, malignant hyperthermia, muscular dystrophy, skeletal muscle ischemia or trauma, rhabdomyolysis, seizures Chronic renal disease, dehydration, diabetes mellitus, hypernatremia, shock

Osmolality (Adult)

285295 mmol/kg (285295 mOsm/kg) H2O

Addisons disease, diuretic therapy, hyponatremia, overhydration

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

Appendix B

Laboratory Values 1975

Table B1 Serum, Plasma, and Whole Blood Chemistries continued

Normal Values Test Oxygen saturation Arterial Venous pH Phenylalanine Phosphatase, acid 95% (same as SI units) 6080% (same as SI units) See Blood gases 0121 mcmol/L (02 mg/dL) 2.210.5 U/L (0.130.63 U/L Roy, Brower, Hayden 37C) 0.52.0 mckat/L (30120 U/L) 0.971.45 mmol/L (3.04.5 mg/dL) 3.55.0 mmol/L (3.55.0 mEq/L) Phenylketonuria Advanced Pagets disease, cancer of prostate, hyperparathyroidism Bone diseases, cirrhosis, malignancy of liver/ bone, marked hyperparathyroidism, obstruction of biliary system, rickets Bone metastasis, healing fractures, hypoparathyroidism, hypocalcemia, renal disease, vitamin D intoxication Acute or chronic renal failure, Addisons disease, dehydration, diabetic ketosis, excessive dietary or intravenous intake, massive tissue destruction, metabolic acidosis Benign prostatic hypertrophy, prostate cancer, prostatitis Burns, cirrhosis (globulin fraction), dehydration 6483 g/L (6.48.3 g/dL) 3550 g/L (3.55 g/dL) 2334 g/L (2.33.4 g/dL) 1.5:12.5:1 (same as SI units) 0.031.2 ng/L/sec (0.14.3 ng/mL/hr) 135145 mmol/L (135145 mEq/L) Multiple myeloma (globulin fraction), shock, vomiting Renal hypertension, salt-losing gastrointestinal disease (vomiting/diarrhea), volume decrease (e.g., hemorrhage) Corticosteroid therapy, dehydration, impaired renal function, increased sodium in dietary or intravenous intake, primary aldosteronism Malnutrition, nephrotic syndrome, proteinuria, renal disease, severe burns Increased salt intake, primary aldosteronism Congenital agammaglobulinemia, increased capillary permeability, inflammatory disease, liver disease, malabsorption, malnutrition Excessive vitamin D ingestion, hypothyroidism, milk-alkali syndrome Chronic alcoholism, diabetes mellitus, hypercalcemia, hyperparathyroidism, vitamin D deficiency Burns, Cushings syndrome, deficient dietary or intravenous intake, diarrhea (severe), diuretic therapy, gastrointestinal fistula, insulin administration, pyloric obstruction, starvation, vomiting SI Units (Conventional Units) Higher Increased inspired oxygen, polycythemia vera Possible Etiology Lower Anemia, cardiac decompensation, decreased inspired oxygen, respiratory disorders

Phosphatase, alkaline (ALP) Phosphorus, inorganic

Potassium

Prostate-specific antigen (PSA) Proteins Total Albumin Globulin Albumin/globulin ratio Renin Upright position Sodium

<4 mcg/L (<4 ng/mL)

Addisons disease, decreased sodium in dietary or intravenous intake, diabetic ketoacidosis, diuretic therapy, excessive loss from gastrointestinal tract, excessive perspiration, water intoxication Hypofunction of testes

Testosterone Male Female T4 (thyroxine), total 9.7538.0 nmol/L (2801080 ng/dL) 0.522.43 nmol/L (<70 ng/dL) 64154 nmol/L (512 mcg/dL) Adrenal hyperplasia, adrenal or pituitary tumours, testicular tumours Polycystic ovary, virilizing tumours Hyperthyroidism, thyroiditis Cretinism, hypothyroidism, myxedema
Continued

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

1976

Appendix B

Laboratory Values

Table B1 Serum, Plasma, and Whole Blood Chemistries continued

Normal Values Test T4 (thyroxine), free T3 uptake T3 (triiodothyronine) Thyroid-stimulating hormone (TSH) Transaminases Serum glutamic oxaloacetic transferase (SGOT) or aspartate aminotransferase (AST) Serum glutamate pyruvate transferase (SGPT) or alanine aminotransferase (ALT) Triglycerides Male Female Troponin T (cTnT): Troponin I (cTnI) Urea nitrogen (BUN) 0.451.81 mmol/L (40160 mg/dL) 0.401.52 mmol/L (35135 mg/dL) <0.2 mcg/L (<0.2 ng/mL) <0.03 mcg/L (<0.3 ng/mL) 3.67.1 mmol/L (1020 mg/dL) Cardiac muscle damage (myocardial infarction, myocarditis or pericarditis), chronic renal failure, multiorgan failure, severe heart failure Burns, dehydration, gastrointestinal bleeds, increase in protein catabolism (fever, stress), renal disease, shock, urinary tract infection Alcoholism, eclampsia, gout, gross tissue destruction, high-protein weight reduction diet, leukemia, multiple myeloma, renal failure Fluid overload, malnutrition, severe liver damage, SIADH Administration of uricosuric drugs 00.58 mckat/L (035 U/L) Acute hepatitis, liver disease, myocardial infarction, pulmonary infarction SI Units (Conventional Units) 1036 pmol/L (0.82.8 ng/dL) 2434 AU (2434%) 1.23.4 nmol/L (70205 ng/dL) 210 mU/L (210 mcU/L) Hyperthyroidism Graves disease, myxedema, primary hypothyroidism Hypothyroidism Secondary hypothyroidism Higher Hyperthyroidism, metastatic neoplasms Possible Etiology Lower Hypothyroidism, pregnancy

436 U/L (same as SI units)

Liver disease, shock

Diabetes mellitus, hyperlipidemia, hypothyroidism, liver disease

Hyperthyroidism, malabsorption syndrome, malnutrition

Uric acid Male Female Vitamin A Vitamin B12 Zinc 0.240.51 mmol/L (4.08.5 mg/dL) 0.160.43 mmol/L (2.77.3 mg/dL) 0.522.09 mcmol/L (1560 mcg/dL) 118701 pmol/L (160950 pg/mL) 11.518.5 mcmol/L (75120 mcg/dL)

Excess ingestion of vitamin A Chronic myeloid leukemia

Vitamin A deficiency Malabsorption syndrome, pernicious anemia, strict vegetarianism, total or partial gastrectomy Alcoholic cirrhosis

*Because arterial blood gases are influenced by altitude, the value for PO2 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 B2 Hematology
Normal Values Test Bleeding time (IVY) SI Units (Conventional Units) 19 min Higher Aspirin ingestion, clotting factor deficiency, defective platelet function, thrombocytopenia, vascular disease, von Willebrands disease Deficiency of factors I, II, V, VIII, IX, X, XI, and XII; hemophilia; heparin therapy; liver disease Same etiology as for APTT Same etiology as for APTT Deficiency of factors I, II, V, VII, and X; liver disease; vitamin K deficiency; warfarin therapy Same etiology as for PT Disseminated intravascular coagulation (DIC), increased tendency to bleed Burns (after first 36 hours), inflammatory disease Acute DIC, massive hemorrhage, massive trauma, primary fibrinolysis Deep vein thrombosis, DIC, myocardial infarction, unstable angina Dehydration, high altitudes, polycythemia vera, severe diarrhea 4.76.1 1012/L (4.76.1 106/mcL) 4.25.4 1012/L (4.25.4 106/mcL) 8095 mm3 (same as SI units) 2731 pg (same as SI units) 320360 g/L (3236 g/dL) (3236%) Folic acid and vitamin B12 deficiency, liver disease, macrocytic anemia Macrocytic anemia Intravascular hemolysis, spherocytosis Moderate increase: acute hepatitis, myocardial infarction, rheumatoid arthritis Marked increase: acute and severe bacterial infections, malignancies, pelvic inflammatory disease
Continued

Possible Etiology Lower

Activated partial thromboplastin time (APTT) Partial thromboplastin time (PTT) Automated coagulation time or activated clotting time (ACT) Prothrombin time (protime, PT)

3040 sec* (same as SI units)

6070 sec (same as SI units) 70120 sec (same as SI units) 1112.5 sec* (same as SI units) 0.811.2 (same as SI units) 812 sec (same as SI units) 24 g/L (200400 mg/dL) <10 mg/L (<10 mcg/mL) <250 mcg/L (<250 ng/mL)

International normalized ratio (INR) Thrombin time Fibrinogen Fibrin split (degradation) products D-Dimer Erythrocyte count (altitude dependent) Male Female Mean corpuscular volume (MCV) Mean corpuscular hemoglobin (MCH) Mean corpuscular hemoglobin concentration (MCHC) Erythrocyte sedimentation rate (ESR), Westergren Male Female <50 yr >50 yr <50 yr >50 yr

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

Anemia, leukemia, post hemorrhage

Microcytic anemia Microcytic anemia Hypochromic anemia Malaria, severe liver disease, sickle cell anemia

<15 mm/hr (same as SI units) <20 mm/hr (same as SI units) <20 mm/hr (same as SI units) <30 mm/hr (same as SI units)

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

1978

Appendix B

Laboratory Values

Table B2 Hematology continued

Normal Values Test Hematocrit (altitude dependent) Male Female Hemoglobin (altitude dependent) Male Female Hemoglobin, glycosylated or glycated (HbA1C [A1C]) Red cell distribution width (RDW) Platelet count (thrombocytes) 8.711.2 mmol/L (1418 g/dL) 7.49.9 mmol/L (1216 g/dL) Less than 6% (adult without diabetes) 1114.5% (same as SI units) 150400 109/L (150,000 400,000/mm3) Acute infections, chronic granulocytic leukemia, chronic pancreatitis, cirrhosis, collagen disorders, polycythemia, post splenectomy Hemolytic anemia, polycythemia vera Inflammatory and infectious processes, leukemia Nondiabetic hyperglycemia, poorly controlled diabetes mellitus Chronic blood loss, chronic renal failure, pregnancy, sickle cell anemia Anisocytosis, macrocytic anemia, microcytic anemia Acute leukemia, cancer chemotherapy, DIC, hemorrhage, infection, systemic lupus erythematosus, thrombocytopenic purpura Hypoproliferative anemia, macrocytic anemia, microcytic anemia Aplastic anemia, autoimmune diseases, overwhelming infection, side effects of chemotherapy and irradiation Aplastic anemia, viral infections 0.420.52 volume fraction (4252%) 0.370.47 volume fraction (3747%) Chronic obstructive pulmonary disease (COPD), high altitudes, polycythemia Anemia, hemorrhage SI Units (Conventional Units) Higher Dehydration, high altitudes, polycythemia Possible Etiology Lower Anemia, bone marrow failure, hemorrhage, leukemia, overhydration

Reticulocyte count (manual) White blood cell (WBC) count

0.52% of red blood cells (same as SI units) 510 109/L (5000 10,000/mm3)

WBC differential Segmented neutrophils Band neutrophils Lymphocytes Monocytes 2.57.5 109/L (6268%) 01 109/L (09%) 0.10.4 109/L (1000 4000/mm3) (2040%) 0.020.07 109/L (100 700/mm3) (28%) 0.010.04 109/L (50 100/mm3) (14%) 0.00.01 109/L (25 100/mm3) (0.51%) Negative (Negative) Bacterial infections, collagen diseases, Hodgkins disease Acute infections Chronic infections, lymphocytic leukemia, mononucleosis, viral infections Acute infections, chronic inflammatory disorders, Hodgkins disease, malaria, monocytic leukemia Allergic reactions, eosinophilic and chronic granulocytic leukemia, Hodgkins disease, parasitic disorders Hypothyroidism, myeloproliferative diseases, ulcerative colitis Sickle cell anemia Corticosteroid therapy Corticosteroid therapy, whole body irradiation

Eosinophils

Basophils Sickle cell solubility test

Hyperthyroidism, stress

*Clients receiving anticoagulant therapy: APTT: 1.52.5 times control value in seconds PT: 1.52.0 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 B3 SerologyImmunology
Normal Values Test Antinuclear antibody (ANA) Anti-DNA antibody Anti-RNP (ribonucleoprotein) Anti-Sm (Smith) Antistreptolysin-O (ASO) Cross-reactive protein (CRP) Carcinoembryonic antigen (CEA) Complement assay components Total C3 C4 Direct antihuman globulin test (DAT) or direct Coombs test Fluorescent treponemal antibody absorption (FTAAbs) Hepatitis A antibody Hepatitis B surface antigen (HBsAg) Hepatitis C antibody Immunoglobulins (Igs) IgA IgD IgE IgG 0.853.85 g/L (85385 mg/dL) Minimal Minimal 5.6517.65 g/L (5651765 mg/dL) 0.553.75 g/L (55375 mg/dL) Autoimmune disorders, chronic infection, chronic liver disease, IgA myeloma, rheumatoid arthritis Chronic infection, connective tissue disease Anaphylactic shock, atopic disease (allergies), parasitic infections Hepatitis, IgG monoclonal gammopathy, infectionsacute and chronic, SLE Acute infections, liver disease, rheumatoid arthritis Acquired deficiencies, burns, congenital deficiencies, immunosuppression, nephrotic syndromes Congenital and acquired antibody deficiencies, lymphocytic leukemia, protein-losing enteropathies
Continued

Possible Etiology Higher Chronic hepatitis, rheumatoid arthritis, scleroderma, systemic lupus erythematosus (SLE) SLE Mixed connective tissue disease, scleroderma, rheumatoid arthritis, Sjgren's syndrome, SLE SLE Acute glomerulonephritis, rheumatic fever, streptococcal infection Acute infections, any inflammatory condition (e.g., acute rheumatic fever/arthritis), widespread malignancy Carcinomas of colon, liver, pancreas; chronic cigarette smoking; inflammatory bowel disease; other cancers Acute glomerulonephritis, rheumatoid arthritis, serum sickness, subacute bacterial endocarditis, SLE Lower

SI Units (Conventional Units) Negative at 1:40 dilution (same as SI units) Negative <70 U/mL (same as SI units) Negative (Negative) Negative (Negative) 160 Todd units/mL (same as SI units) <10 mg/L (<1.0 mg/dL)

5 mcg/L (5 ng/mL)

75160 k/units/L (75160 U/mL) 0.551.2 g/L (55120 mg/dL) 0.20.5 g/L (2050 mg/dL) Negative (Negative) (No agglutination) Negative (Nonreactive) Acquired hemolytic anemia, drug reactions, hemolytic disease of the newborn, transfusion reactions Syphilis

Negative (Negative) Negative (Negative) Negative (Negative)

Hepatitis A Hepatitis B Hepatitis C Burns, hereditary telangiectasia, malabsorption syndromes

IgM

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

1980

Appendix B

Laboratory Values

Table B3 SerologyImmunology continued

Normal Values Test Monospot or monotest Rheumatoid factor (RA factor) SI Units (Conventional Units) Negative (<1:28 titre) 0.2 kU/L (0.2 U/mL) nephelometric method <1:20 titre agglutination method RPR (rapid plasma reagin) test VDRL (Venereal Disease Research Laboratory) test Thyroid antibodies Negative or nonreactive (same as SI units) Negative or nonreactive (same as SI units) Titre <1:100 (same as SI units) Febrile diseases, intravenous drug abuse, leprosy, malaria, rheumatoid arthritis, syphilis, SLE Syphilis Early hypothyroidism, Graves disease, Hashimotos thyroiditis, pernicious anemia, SLE, thyroid carcinoma Higher Infectious mononucleosis Rheumatoid arthritis, Sjgren's syndrome, SLE Possible Etiology Lower

Table B4 Urine Chemistry

Normal Values Specimen Test Acetone (ketones) Aldosterone Random 24 hr SI Units (Conventional Units) Negative (Negative) 672 nmol/24 hr (226 mcg/24 hr) (depends on urinary sodium) Higher Diabetes mellitus, high-fat and lowcarbohydrate diets, starvation states Primary aldosteronism: adrenocortical tumours Secondary aldosteronism: cardiac failure, cirrhosis, large dose of ACTH, salt depletion Amylase Bence Jones protein Bilirubin Calcium 24 hr Random Random 24 hr Up to 5000 Somogyi units/24 hr OR 6.548.1 units/hr Negative (Negative) Negative (Negative) 6.2 mmol/d (<250 mg/d) Acute pancreatitis Biliary duct obstruction, multiple myeloma Hepatitis Bone tumour, hyperparathyroidism, milk-alkali syndrome Heart failure, pheochromocytoma, progressive muscular dystrophy Addisons disease Burns, diarrhea, excessive perspiration, menstruation, vomiting Hypoparathyroidism, malabsorption of calcium and vitamin D Adrenocorticotropic hormone (ACTH) deficiency, Addisons disease, corticosteroid therapy Lower Possible Etiology

Catecholamines Epinephrine Norepinephrine Chloride

24 hr <109 nmol/d (<20 mcg/d) <590 nmol/d (<100 mcg/d) 24 hr 110250 mmol/d (110250 mEq/d) <0.5 mcmol/d (<30 mcg/d)

Copper Coproporphyrin Creatine Male Female

24 hr 24 hr 24 hr

0.6 mcmol/d (<40 mcg/d) <300 nmol/d (<200 mcg/d)

Cirrhosis, Wilsons disease Lead poisoning, oral contraceptive use, poliomyelitis Addisons disease, burns, carcinoma of liver, diabetes, hyperthyroidism, infections, muscular dystrophy, skeletal muscle atrophy Hypothyroidism

<300 mcmol/d (<60 mg/d) <600 mcmol/d (<80 mg/d)

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

Appendix B

Laboratory Values 1981

Table B4 Urine Chemistry continued

Normal Values Specimen Test Creatinine Creatinine clearance Male Female Estriol Female Ovulation peak Luteal peak Pregnancy Menopause Male Glucose Random 104370 nmol/d (28100 mcg/d) 81296 nmol/d (2280 mcg/d) Up to 166,455 nmol/d (Up to 45,000 mcg/d) 5.272.5 nmol/d (1.419.6 mcg/d) 1867 nmol/d (518 mcg/d) Negative (Negative) Diabetes mellitus, low renal threshold for glucose resorption, physiological stress, pituitary disorders Extensive burns, glomerulonephritis, hemolytic anemias, hemolytic transfusion reaction Malignant carcinoid syndrome Alcoholism, fasting, high-protein diets, marked ketonuria, poorly controlled diabetes mellitus, starvation Lead poisoning Pheochromocytoma Crushing injuries, electric injuries, extreme physical exertion Chronic renal failure, compensatory phase of alkalosis, salicylate intoxication, vegetarian diet Phenylketonuria Fever, hypoparathyroidism, nervous exhaustion, rickets, tuberculosis Acute intermittent porphyria, liver disorders Chronic renal failure, starvation, Cushings syndrome, hyperaldosteronism, alkalosis, diuretic therapy Congestive heart failure, nephritis, nephrosis, physiological stress
Continued

Possible Etiology Higher Anemia, leukemia, muscular atrophy, salmonellosis Lower Renal disease Renal disease

SI Units (Conventional Units) 7.117.7 mmol/d (0.82 g/d) 1.422.25 mL/sec (85135 mL/min) 1.782.32 mL/sec (107139 mL/min) 1.451.78 mL/sec (87107 mL/min)

24 hr 24 hr

24 hr

Gonadal or adrenal tumour

Agenesis of ovaries, endocrine disturbance, menopause, ovarian dysfunction

Hemoglobin

Random

Negative (Negative)

5-Hydroxyindoleacetic acid (5-HIAA) Ketone bodies

24 hr Random

1040 mcmol/d (28 mg/24 hr) Negative (Negative)

Lead Metanephrine Myoglobin pH

24 hr 24 hr Random Random

<0.40 mcmol/d (<80 mcg/d) <7 mcmol/d (<1.3 mg/d) Negative (Negative) 4.68 (same as SI units) Average: 6

Compensatory phase of acidosis, dehydration, emphysema Acute infections, nephritis

Phenylpyruvic acid Phosphorus, inorganic Porphobilinogen Potassium

Random 24 hr Random 24 hr 24 hr

Negative (Negative) 2942 mmol/d (0.91.3 g/d) Negative (Negative) < 8.8 mcmol/d (<2 mcg/d) 25100 mmol/d (25100 mEq/d)

Reduced intake, dehydration, Addisons disease, malnutrition, vomiting, diarrhea, acute renal failure

Protein (dipstick)

Random

Negative (Negative)

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

1982

Appendix B

Laboratory Values

Table B4 Urine Chemistry continued

Normal Values Specimen Test Protein (quantitative) At rest During exercise Sodium Specific gravity 24 hr Random 24 hr SI Units (Conventional Units) <0.15 g/d (<150 mg/d) 0.050.08 g/d (<5080 mg/d) <0.25 g/d (<250 mg/d) 40250 mmol/d (40250 mEq/d) 1.0051.030 (same as SI units) Higher Cardiac failure, inflammatory processes of urinary tract, nephritis, nephrosis, toxemia of pregnancy Acute tubular necrosis Albuminuria, dehydration, fever, gastrointestinal losses (vomiting/ diarrhea), glycosuria, syndrome of inappropriate antidiuretic hormone (SIADH) Metabolic acidosis Gout, leukemia Hemolytic disease, hepatic parenchymal cell damage, liver disease Lead poisoning, liver disease, porphyria Pheochromocytoma, neuroblastomas Hyponatremia Diabetes insipidus, diuresis, overhydration Lower Possible Etiology

Titratable acidity Uric acid Urobilinogen

24 hr 24 hr 24 hr Random

2050 mEq/d (same as SI units) 1.484.43 mmol/d (250750 mg/24 hr) 0.06.8 mcmol/d (0.04.0 mg/24 hr) <0.011 EU (same as SI units)

Metabolic alkalosis Nephritis Complete obstruction of bile duct

Uroporphyrins Male Female Vanillylmandelic acid

24 hr 446 mcg/d (same as SI units) 322 mcg/d (same as SI units) 24 hr <35 mcmol/d (<6.8 mg/d)

Table B5 Gastric Analysis

Normal Values Test Basal Free hydrochloric acid Total acidity Poststimulation Free hydrochloric acid Total acidity 10130 mmol/L (10130 mEq/L) 20150 mmol/L (20150 mEq/L) 0.3 mmol/L (0.3 mEq/L) 1545 mmol/L (1545 mEq/L) Hypermotility of stomach Gastric and duodenal ulcers, Zollinger-Ellison syndrome Pernicious anemia Gastric carcinoma, severe gastritis SI Units (Conventional Units) Higher Possible Etiology Lower

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