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A reference range is a set of values used by a health professional to interpret a set of medical test results. The range is usually defined as the set of values 95% of the normal population falls within.
The reference range will vary, depending on the age, sex and race of a population, and even the instruments the laboratory uses to perform the tests. Furthermore, by definition, 5% of the normal population will fall outside the reference range. The values given below therefore are given as examples only and should not be used to interpret individual test results. Factors other than medical conditions can affect laboratory values, such as male or female sex, diet, use of drugs (prescribed, over-the-counter and herbal remedies), and stress, as well as other more exotic factors like altitude.
Contents |
Clinical biochemistry
- Items marked with a ** are part of "CHEM-7"[1] and CHEM-20
- Items marked with a * are part of "CHEM-20"[2], but not CHEM-7
Electrolytes and Metabolites
Electrolytes and Metabolites:
| Test [3] | Patient type | Lower limit [3] | Upper limit[3] | Unit | Comments |
| ** Sodium (Na) | 135[4]-137[5] | 145[5]-147[4] | mmol/L or mEq/L[4] | ||
| ** Potassium (K) | 3.5[4]-3.6[5] | 5.0[5][4]-5.1 | mmol/L or mEq/L[4] | ||
| Chloride (Cl) | 95[4]-98 | 105[4]-107 | mmol/L or mEg/L[4] | ||
| Osmolality | 275[4] | 295[4] | mOsm/kg | ||
| Urea | 1.2[4]-2.5 | 3.0[4]-6.4 | mmol/L | ** BUN - blood urea nitrogen | |
| 7[4] | 18[4]-21[5] | mg/dL | |||
| * Uric acid[5] | 0.18[4] | 0.48[4] | mmol/L | ||
| 3.0[4]3.5 | 8.2[4]-8.5 | mg/dL | |||
| ** Creatinine | male | 62 | 115 | μmol/L | May be complemented with creatinine clearance |
| 0.7 | 1.3 | mg/dL | |||
| female | 53 | 97 | μmol/L | ||
| 0.6 | 1.1 | mg/dL | |||
| ** Glucose (fasting) | 3.8[4]-3.9 | 5.8-6.1[4] | mmol/L | See also glycosylated hemoglobin (in hematology) | |
| 65[5]-70[4] | 105-110[5][4] | mg/dL | |||
| Total serum iron (TSI) | male | 65[6]-76[5] | 176[6]-198[5] | µg/dL | |
| female | 26[5]-50[6] | 170[6][5] | |||
| newborns[6] | 100 | 250 | |||
| children[6] | 50 | 120 | |||
| Total iron-binding capacity (TIBC) | 240[6]-262[5] | 450[6]-474[5] | |||
| Transferrin[5] | 204 | 360 | mg/dL | ||
| Transferrin saturation[6] | 20 | 50 | % | ||
| Ferritin[5] | Male | 18 | 250 | ng/mL | |
| Female | 12 | 160 |
Acid and base
- Further information: Acid base physiology
- Further information: Arterial blood gas
| Test | Lower limit | Upper limit | Unit | Comments |
| pH | 7.34[5]-7.35[4] | 7.44[5]-7.45[4] | ||
| [H+ | 36[4] | 44[4] | nmol/L | |
| base excess | -3 | +3 | ||
| PO2 | 10[4] | 13-14[4] | kPa | |
| 75[5][4] | 100[5]-105[4] | mmHg | ||
| ** PCO2 | 4.4[4]4.8 | 5.8-5.9[4] | kPa | |
| 33[4]-35[5] | 44[4]-45[5] | mmHg | ||
| Bicarbonate (HCO3-) | 18 | 23 | mmol/L | |
| Standard bicarbonate (SBCe) | 21-22[4] | 27-28[4] | mmol/L or mEq/L[4] |
Liver function
- Further information: Liver function tests
| Test | Lower limit | Upper limit | Unit | Comments |
| * Total Protein | 60[4]-63[5] | 78[4]-82[5] | g/L | |
| * Albumin | 35[7][4] | 48[5]-55[4] | g/L | |
| 3.5[5] | 4.8[5]-5.5[4] | U/L | ||
| Globulins | 23[4] | 35[4] | g/L | |
| * Total Bilirubin | 2[4] | 17[4] | μmol/L | |
| 0.1[4]-0.2[5] | 1.0[4]-1.3[5] | mg/dL | ||
| * Direct Bilirubin | 0.0[4] | 5[4] | μmol/L | |
| 0[5][4] | 0.3[5][4] | mg/dL | ||
| * Alanine transaminase (ALT) | 7[5]-8 [4] | 20[4], 40, 56[5] | U/L | Also called serum glutamic pyruvic transaminase (SGPT) |
| * Alkaline phosphatase (ALP) | 20[4]-38[5] | 70[4]-126[5] | U/L | p-NPP at 30 degrees C[4] Higher in children and pregnant women. |
| * Gamma glutamyl transferase (GGT) | 8[5] | 50-78[5] | U/L |
Cardiac tests
| Test | Lower limit | Upper limit | Unit | Comments |
| Creatine kinase (CK) - male | 24[8]-38[5] | 195 | U/L or ng/mL |
|
| Creatine kinase (CK) - female | 24[9]-38[5] | 170 | U/L | |
| CK-MB[5] | 0 | 3 | ng/mL | |
| Troponin[5] | 0 | 0.4 | ng/mL |
Other enzymes and proteins
| Test | Lower limit | Upper limit | Unit | Comments |
| * Aspartate transaminase (AST) | 5[5]-8[4] | 20[4]-35[5] | U/L | Also called serum glutamic oxatoacetic transaminase (SGOT) |
| * Lactate dehydrogenase (LDH) | 85 | 285 | U/L | |
| Amylase | 25[4]-30[5] | 110[5], 120[10], 125[4] | U/L | |
| C-reactive protein (CRP) | n/a | 5[11] | mg/L | |
| D-dimer | n/a | 500 | ng/mL | |
| Lipase[5] | 7 | 60 | U/L |
Other ions and trace metals
- Further information: Trace metals
| Test | Lower limit | Upper limit | Unit | Comments |
| Ionised calcium (Ca) | 1.15 | 1.29 | mmol/L | Some calcium is bound to albumin, thus not measured by certain techniques. |
| * Total calcium (Ca) | 2.1[4] | 2.8[4] | mmol/L | |
| 8.4[4] | 10.2[4] | mg/dL | ||
| Phosphate (HPO42−) | 0.8 | 1.5 [12] | mM | |
| Inorganic phosphorus (serum) | 1.0[4] | 1.5[4] | mmol/L | |
| 3.0[4] | 4.5[4] | mg/dL | ||
| Copper (Cu) | 11[13] | 24 | μmol/L | |
| Zinc (Zn) | 10 | 17 | μmol/L |
Lipids
- Further information: Blood lipids
| Test | Lower limit | Upper limit | Unit | Comments |
| Triglycerides | 0.4 | 2 | mmol/L | |
| 50[5] | 250[5] | mg/dL | ||
| * Total cholesterol | 3.6[4] | 5.0[14]-6.5[4] | mmol/L | |
| 120[5]-140[4] | 200[5]-250[4] | mg/dL | ||
| HDL cholesterol (male) | 0.7 | 1.9 | mmol/L | |
| HDL cholesterol (female) | 0.9 | 2.4 | mmol/L | |
| LDL cholesterol | 2.4 | 3[14] | mmol/L | Not valid when triglycerides >5.0 mmol/L. |
Tumour markers
- Further information: Tumour markers
| Test | Lower limit | Upper limit | Unit | Comments |
| Alpha fetoprotein (AFP) | n/a | 10 | kU/l | |
| 0 | 44[5] | ng/mL | ||
| Alpha 1-antitrypsin (AAT) | 20 | 53 | mmol/L | |
| 150 | 350 | mg/dL | ||
| Beta Human chorionic gonadotrophin (bHCG) | n/a | 5[5] | IU/l | in male and non-pregnant female |
| CA-125 (also CA12.5) | n/a | 35 | U/ml | |
| CA15.3 | n/a | 28 | U/ml | |
| CA19.9 | n/a | 40[5] | U/ml | |
| Carcinoembryonic antigen (CEA) - non-smokers | n/a | 3 | μg/l | |
| Carcinoembryonic antigen (CEA) - smokers | n/a | 5 | μg/l | |
| Prostate specific antigen (PSA) | n/a | 4[5] | μg/L |
Hormones
- Further information: Hormones
| Test | Lower limit | Upper limit | Unit | Comments |
| Thyroid stimulating hormone (TSH) | 0.3 | 3.0 | mIU/L | Also called: Thyrotropin |
| Free thyroxine (FT4) | 9 | 24 | pmol/L | |
| 0.8[5] | 1.5[5] | ng/dL | ||
| Total thyroxine | 60[15] | 140[15] | nmol/L | |
| 5.5[5] | 12.3[5] | ng/mL | ||
| Free triiodothyronine (FT3) | 2.5 | 5.3 | pmol/L | |
| 0.2[15] | 0.5[15] | ng/dL | ||
| Total triiodothyronine | 1.1[15] | 2.7[15] | nmol/L | Values in children may be higher [15] |
| 60[5]-75[15] | 175[15]-181[5] | ng/dL[15] | ||
| Adrenocorticotropic hormone (ACTH) | 1.3 | 15 | pmol/L | |
| 20[5] | 100[5] | pg/mL | ||
| Cortisol (0830 h) | 250 | 850 | nmol/L | Cortisol levels are higher in the morning than at night. |
| Cortisol (1630 h) | 110 | 390 | nmol/L | |
| Growth hormone (fasting) | 0 | 5[4] | ng/mL | |
| Growth hormone (arginine stimulation) | 7[4] | n/a | ng/mL | |
| Prolactin (male) | n/a | 450 | mIU/L | |
| Prolactin (female) | n/a | 580 | mIU/L | |
| Testosterone (male) | 8 | 38 | nmol/L | |
| Testosterone (male prepuberty) | 0.1 | 0.5 | nmol/L | |
| Testosterone (female) | 0.3 | 2.5 | nmol/L |
Hematology
Red blood cells
| Test | Patient | Lower limit | Upper limit | Unit | Comments |
| Haemoglobin (Hb) | male | 2.1[4] | 2.7[4] | mmol/L | Higher in neonates, lower in children. |
| 132[5]-135[4] | 162[5]-175[4] | g/L | |||
| female | 1.9[4] | 2.5[4] | mmol/L | Sex difference negligible until adulthood. | |
| 115-120[4][5] | 152[5]-160[4] | g/L | |||
| Glycosylated hemoglobin (HbA1c) | 4[16] | 5.9[16] | % of Hb | ||
| Haematocrit (Hct) | male | 0.38, 0.4[5], 0.41[4] | 0.52-0.53[4] | ||
| female | 0.36[4]-0.37[5] | 0.46[5][4]-0.47 | |||
| Child | 0.31[5] | 0.43[5] | |||
| Hemoglobin in plasma | 0.16[4] | 0.62[4] | μmol/L | ||
| 1 | 4 | mg/dL | |||
| Mean cell volume (MCV) | Male | 82[5] | 102[5] | fL | Cells are larger in neonates, though smaller in other children. |
| Female | 78[5] | 101[5] | fL | ||
| MCV standard deviation | 35[5] | 47[5] | fL | ||
| Mean cell haemoglobin (MCH) | 0.39[4] | 0.54[4] | fmol/cell | ||
| 25[4]-26 | 34-35[4] | pg/cell | |||
| Mean cell haemoglobin concentration (MCHC) | 31[5] | 35[5] | g/dL | ||
| Red cell count (RBC) | male | 4.3[5][4]-4.5 | 5.9[4]-6.2[5] | x1012/L | |
| Female | 3.5[4]-3.8[5] | 5.5[5][4]-5.8 | x1012/L | ||
| Infant/Child | 3.8[5] | 5.5[5] | x1012/L | ||
| Reticulocytes | 10 | 100 | x109/L | ||
| Adult | 0.5[5][4] | 1.5[5] [4] | % of RBC | ||
| Newborn | 1.1[5] | 4.5[5] | % of RBC | ||
| Infant | 0.5[5] | 3.1[5] | % of RBC | ||
| Red blood cell distribution width (RDW) | 11.5[5] | 14.5[5] | % | Coefficient of variation |
White blood cells
| Test | Lower limit | Upper limit | Unit | Comments |
| White Blood Cell Count (WBC.) | 4.1[5]-4.5[4] | 10.9[5]-11[4] |
|
Higher in neonates and infants. |
| Neutrophil granulocytes | 2 | 7.5 | x109/L | Also known as granulocytes (grans), polys, PMNs, or segs. |
| 45-54[4] | 62[4]-74 | % of WBC | ||
| Neutrophilic band forms | 3[4] | 5[4] | % of WBC | |
| Lymphocytes | 1.3 | 4 | x109/L | |
| 16-25[4] | 33[4]-45 | % of WBC | ||
| Monocytes | 0.2 | 0.8 | x109/L | |
| 3[4]-4.0 | 7[4]-10 | % of WBC | ||
| Mononuclear leukocytes | 1.5 | 5 | x109/L | Lymphocytes + monocytes. Mean: 35% of WBC. |
| 20 | 35 | % of WBC | ||
| CD4+ cells | 0.4 [5] | 1.8[5] | x109/L | |
| Eosinophil granulocytes | 0.04 | 0.4 | x109/L | |
| 1[4] | 3[4]-7 | % of WBC | ||
| Basophil granulocytes | 0.01 | 0.1 | x109/L | |
| 0.0 | 0.75[4]-2 | % of WBC |
Coagulation
| Test | Lower limit | Upper limit | Unit | Comments |
| Platelet count (Plt) | 140[5]-150[4] | 400[4]-450[5] | x109/L | |
| Prothrombin time (PT) | 11[4][17]-12[5] | 13.5[17], 14[5], 15[4] | s | PT reference varies between laboratory kits - INR is standardised |
| INR | 0.9 | 1.2 | The INR is a corrected ratio of a patients PT to normal | |
| Activated partial thromboplastin time (APTT) | 18[5]-29 | 28[5]-41 | s | |
| Thrombin clotting time (TCT) | 11 | 18 | s | |
| Fibrinogen | 1.7[5]-1.8 | 4.2[5] | g/L | |
| Bleeding time | 2 | 9 | minutes |
Immunology
| Category | Test | Patient | Lower limit | Upper limit | Unit | Comments |
| Acute phase protein markers of Inflammation |
Erythrocyte sedimentation rate (ESR) |
Male | 0 | Age÷2[18] | mm/hr | ESR increases with age and tends to be higher in females.[19] |
| Female | (Age+10)÷2 [18] | |||||
| C-reactive protein (CRP) | 0 | 6 | mg/L | |||
| Autoantibodies | Antinuclear antibodies (ANA) | |||||
| Extractable nuclear antigen (ENA) | ||||||
| Rheumatoid factor (RF) | 0 | 20-30[5] | IU/mL | High levels not specific for Rheumatoid Arthritis alone. | ||
| Serology | Antistreptolysin O titre (ASOT) |
Preschoolers | n/a | 100 | units/mL | |
| School age | 250[5] | |||||
| Adult | 125[5] |
See also
- Blood test
- Comprehensive metabolic panel
- Medical technologist
- Cardiology diagnostic tests and procedures
References
- ^ MedlinePlus Encyclopedia 003462
- ^ MedlinePlus Encyclopedia 003468
- ^ a b c Unless else specified in boxes, then ref is: Ashwood, Edward R.; Tietz, Norbert W.; Burtis, Carl A. (1994). Tietz textbook of clinical chemistry, 2nd edition, Philadelphia: Saunders. ISBN 0-7216-4472-4.
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi bj bk bl bm bn bo bp bq br bs bt bu bv bw bx by bz ca cb cc cd ce cf cg ch ci cj ck cl cm cn co cp cq cr cs ct cu cv cw cx cy cz da db dc dd de df dg dh di dj dk dl dm Last page of Deepak A. Rao; Le, Tao; Bhushan, Vikas (2007). First Aid for the USMLE Step 1 2008 (First Aid for the Usmle Step 1). McGraw-Hill Medical. ISBN 0-07-149868-0.
- ^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac ad ae af ag ah ai aj ak al am an ao ap aq ar as at au av aw ax ay az ba bb bc bd be bf bg bh bi bj bk bl bm bn bo bp bq br bs bt bu bv bw bx by bz ca cb cc cd ce cf cg ch ci cj ck cl cm cn co cp cq cr cs ct cu cv cw cx cy cz da db dc dd Normal Reference Range Table from The University of Texas Southwestern Medical Center at Dallas. Used in Interactive Case Study Companion to PATHOLOGIC BASIS of DISEASE.
- ^ a b c d e f g h i Slon S (2006-09-22). "Serum Iron". University of Illinois Medical Center. Retrieved on 2006-07-06.
- ^
- ^
- ^
- ^
- ^
- ^ Walter F., PhD. Boron. Medical Physiology: A Cellular And Molecular Approaoch. Elsevier/Saunders. ISBN 1-4160-2328-3. Page 849
- ^
- ^ a b
- ^ a b c d e f g h i j Table 4: Typical reference ranges for serum assays - Thyroid Disease Manager
- ^ a b "Hemoglobin A1c Test". MedicineNet.com. Retrieved on 2007-12-26.
- ^ a b MedlinePlus Encyclopedia 003652
- ^ a b Miller A, Green M, Robinson D (1983). "Simple rule for calculating normal erythrocyte sedimentation rate". Br Med J (Clin Res Ed) 286 (6361): 266. PMID 6402065. Full text at PMC: 6402065.
- ^ Böttiger LE, Svedberg CA (1967). "Normal erythrocyte sedimentation rate and age". Br Med J 2 (5544): 85–7. PMID 6020854. Full text at PMC: 6020854.
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