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May 2010
Bulletin 44
Table of contents
1. Introduction ............................................................................................................ 2
2. Establishing reference intervals .................................................................................. 4
3. Validating an established reference interval .................................................................. 4
4. Reader's guide to the compendium ............................................................................. 4
5. References .............................................................................................................. 5
6. Parameters included in this compendium ..................................................................... 5
7. Abbreviations ........................................................................................................... 7
8. Conversion factors .................................................................................................... 8
9. Rounding of numbers ................................................................................................ 9
10. Sources used for reference intervals ........................................................................ 11
11. Measured parameters ............................................................................................ 12
pH – Examples of reference intervals ......................................................................... 12
pCO2 – Examples of reference intervals ...................................................................... 13
pO2 – Examples of reference intervals ........................................................................ 14
ctHb – Examples of reference intervals ...................................................................... 15
sO2 – Examples of reference intervals ........................................................................ 16
O2Hb – Examples of reference intervals ...................................................................... 17
COHb – Examples of reference intervals ..................................................................... 17
MetHb – Examples of reference intervals .................................................................... 18
HbF – Examples of reference intervals ....................................................................... 18
cK+ – Examples of reference intervals ........................................................................ 19
cNa+ – Examples of reference intervals ...................................................................... 20
cCl- – Examples of reference intervals ........................................................................ 21
cCa2+ – Examples of reference intervals ..................................................................... 22
cGlu – Examples of reference intervals ....................................................................... 23
cLac – Examples of reference intervals ....................................................................... 24
ctBil – Examples of reference intervals ....................................................................... 25
cCrea – Examples of reference intervals ..................................................................... 26
12. Calculated parameters ........................................................................................... 28
ctHCO3-(P) – Examples of reference intervals .............................................................. 28
cBase(B) or ABE – Examples of reference intervals ...................................................... 28
cBase(Ecf) or SBE – Examples of reference intervals .................................................... 28
cHCO3-(P, st) – Examples of reference intervals ........................................................... 28
ctCO2(P) – Examples of reference intervals ................................................................. 28
ctCO2(B) – Examples of reference intervals ................................................................. 29
Hct – Examples of reference intervals ........................................................................ 29
pO2(A) – Examples of reference intervals ................................................................... 29
p50 – Examples of reference intervals........................................................................ 29
p50(st) – Examples of reference intervals................................................................... 30
pO2(x) – Examples of reference intervals .................................................................... 30
ctO2(B) – Examples of reference intervals................................................................... 30
ctO2(a-v) – Examples of reference intervals ................................................................ 30
ctO2(x) – Examples of reference intervals ................................................................... 30
FShunt – Examples of reference intervals ................................................................... 31
Qx – Examples of reference intervals.......................................................................... 31
Anion gap – Examples of reference intervals ............................................................... 31
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Bulletin 44
1. Introduction
The main part of this compendium is a collection of published reference intervals for clinical
parameters measured by Radiometer blood gas analyzers. The reference intervals have been
extracted from textbooks and journals; each source is referenced. This compendium is
intended to help customers who wish to review the appropriateness of reference intervals in
current use at their healthcare institution for interpretation of patient test results generated by
Radiometer analyzers. The reference intervals contained in the compendium are for
information only. They are not necessarily derived using Radiometer instruments, nor have
they necessarily been derived according to guidelines in this area, e.g. CLSI guidelines. The
compendium thus contains no recommendation for adoption of any particular reference
interval. This brief introduction to the compendium provides a little background information on
how reference intervals are established and validated. For more in-depth treatment of the
theory and practice surrounding reference intervals, users of this compendium are directed to
other published resources [1-4], which include the most authoritative consensus of
international expert opinion in this area from the Clinical and Laboratory Standards Institute
(CLSI) [4].
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Reference intervals are established by measuring the parameter in question (pH, sodium,
glucose, etc.) in samples recovered from "healthy" reference individuals. Validity of a reference
interval relies on patient samples being collected and treated in the same way that samples
from reference individuals are treated. Reference individuals must be carefully selected
according to defined criteria so that they reflect healthy status of the population serviced by
the laboratory. There is recommendation [4] that reference intervals be derived from
measurements made on no less than 120 reference individuals (40 measurements is an
absolute minimum). By convention a reference interval is defined by the limits of the mid 95 %
of reference values obtained from reference individuals; values greater than the 97.5th centile
and values less than the 2.5th centile are thus excluded. So long as reference values conform
to Gaussian (normal) distribution, the 2.5th and 97.5th centiles are equal to –1.96 standard
deviations (–1.96 SD) from the mean and +1.96 standard deviations (+1.96 SD) from the
mean, respectively. So by calculating the mean and standard deviation of 120 reference
values, distributed in Gaussian form, the reference interval can be derived. More complex
statistical tools must be employed for construction of a reference interval if reference values
are not distributed in Gaussian form.
The referenced reference interval is either transcribed directly from the original sources,
or calculated by using the 2.5th and 97.5th centiles.
Where relevant, the reference intervals are given in both SI and conventional units. The
reference intervals are rounded, and the specific number of decimals used is listed with
each parameter.
Conversion between units: the factor used for conversion of units is listed on page 7.
The reference intervals are not evaluated for compliance with CLSI guidelines for
establishing reference intervals as this information is lacking in most of the references.
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Bulletin 44
5. References
1. Solberg HE. Establishment and use of reference values (Chapter 16). In: Burtis CA,
Ashwood E, Bruns D. Tietz textbook of clinical chemistry and molecular diagnostics. 4th ed.
Philadelphia: WB Saunders, 2005
4. Clinical and Laboratory Standards Institute (CLSI). Defining, establishing and verifying
reference intervals in the clinical laboratory. Approved guideline – 3rd ed. CLSI document C28-
A3. Clinical and Laboratory Standards Institute, Pennsylvania, USA 2008
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Bulletin 44
Symbol Definition
pH Indicates the acidity or alkalinity of the sample.
pCO2 Partial pressure (or tension) of carbon dioxide in blood.
pO2 Partial pressure (or tension) of oxygen in blood.
Concentration of total hemoglobin in blood.
ctHb Total hemoglobin includes all types of hemoglobin: deoxy-, oxy-,
carboxy- and met-.
Oxygen saturation, the ratio between the concentrations of
sO2
oxyhemoglobin and the hemoglobin minus the dyshemoglobins.
FO2Hb Fraction of oxyhemoglobin in total hemoglobin in blood.
FCOHb Fraction of carboxyhemoglobin in total hemoglobin in blood.
FMetHb Fraction of methemoglobin in total hemoglobin in blood.
FHbF (neonates) Fraction of fetal hemoglobin in total hemoglobin in blood.
+
cK Concentration of potassium ions in plasma.
cNa+ Concentration of sodium ions in plasma.
cCa2+ Concentration of calcium ions in plasma.
cCl- Concentration of chloride ions in plasma.
cGlu Concentration of D-glucose in plasma.
cLac Concentration of L-lactate in plasma.
Concentration of total bilirubin in plasma
ctBil Total bilirubin includes its two forms: conjugated and
unconjugated.
cCrea Concentration of creatinine in blood.
Concentration of hydrogen carbonate in plasma (also termed actual
cHCO3–(P)
bicarbonate).
Actual Base Excess, the concentration of titrable base when the
cBase(B) blood is titrated with a strong base or acid to a plasma pH of 7.40,
or ABE at pCO2 of 5.33 kPa (40 mmHg) and 37 °C, at the actual oxygen
saturation.
Standard Base Excess, an in vivo expression of base excess. It
refers to a model of the extracellular fluid (one part of blood is
cBase(Ecf)
diluted by two parts of its own plasma) and is calculated using a
or SBE standard value for the hemoglobin concentration of the total
extracellular fluid.
Standard Bicarbonate, the concentration of hydrogen carbonate in
– the plasma from blood which is equilibrated with a gas mixture with
cHCO3 (P,st)
pCO2 = 5.33 kPa (40 mmHg) and
pO2 = 13.33 kPa (100 mmHg) at 37 °C.
Concentration of total carbon dioxide, (free CO2 + bound CO2) in
ctCO2(P)
plasma.
Concentration of total carbon dioxide in whole blood (also termed
CO2 content).
ctCO2(B)
Calculated based on the total CO2 concentrations in the two phases:
plasma and erythrocyte fluid.
FO2Hb Fraction of oxyhemoglobin in total hemoglobin in blood.
Oxygen saturation, the ratio between the concentrations of
sO2
oxyhemoglobin and the hemoglobin minus the dyshemoglobins.
Hematocrit, the ratio between the volume of erythrocytes and the
Hct
volume of whole blood.
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7. Abbreviations
Abbreviations
WB Whole Blood
A. umb. Arteria umbilicalis
V. umb. Vena umbilicalis
P Plasma
S Serum
N/A Not available
Hep Heparin
8. Conversion factors
Convert to: Multiply by:
Pressure
kPa mmHg × 7.50
mmHg kPa × 0.133
ctHb
g/dL mmol/L × 0.621
mmol/L g/dL × 1.61
Glucose
mg/dL mmol/L × 0.056
mmol/L mg/dL × 18.02
Lactate
mg/dL mmol/L × 0.111
mmol/L mg/dL × 9.01
Bilirubin
μmol/L mg/dL × 0.059
mg/dL μmol/L × 17.10
Creatinine
μmol/L mg/dL × 0.0113
mg/dL μmol/L × 88.4
cCa2+
meq/L mmol/L × 0.5
mg/dL mmol/L × 0.25
mmol/L meq/L ×2
mmol/L mg/dL × 4.00
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9. Rounding of numbers
The reference intervals are rounded regardless of the number of decimals in the original
source.
pCO2: Rounded to 0 decimal place for mmHg and 1 decimal place for kPa.
pO2: Rounded to 0 decimal place for mmHg and 1 decimal place for kPa.
sO2: Rounded to 0 decimal place for percent and 2 decimal places for fraction.
O2Hb: Rounded to 0 decimal place for percent and 2 decimal places for fraction.
MetHb: Rounded to 1 decimal place for percent and 3 decimal places for fraction.
HbF: Rounded to 0 decimal place for percent and 1 decimal place for fraction.
cCa2+: Rounded to 1 decimal place for mg/dL and 2 decimal places for mmol/L.
cGlu: Rounded to 0 decimal place for mg/dL and 1 decimal place for mmol/L.
ctBil: Rounded to 0 decimal place for mmol/L and 0 or 1 decimal place for mg/dL.
cCrea: Rounded to 0 decimal place for µmol/L and 1 decimal place for mg/dL.
Hct: Rounded to 0 decimal place for percent and 2 decimal places for fraction.
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© Radiometer Medical ApS, 2700 Brønshøj, Denmark, 2011. All Rights Reserved. 918-714. 201107C.
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