CLINICAL BIOCHEMISTRY REFERENCE RANGES HANDBOOK

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1 CLINICAL GUIDANCE NOTES CLINICAL BIOCHEISTRY REERENCE RANGES HANDBOOK Eastbourne District General Hospital & Conquest Hospital, Hastings Written/Produced By: Title/Directorate Date: Paul Eaton Pathology 07/02/2013 Person Responsible for Paul Eaton onitoring Compliance & Review Lead BS Signature & Date 07/02/2013 ulti-disciplinary Evaluation/Approval Title/Speciality Date: Lead BS 07/02/2013 Principal Biochemist 07/02/2013 Consultant Clinical Biochemist 07/02/2013 Ratification Committee Issue Number (Administrative use only) Date of Issue & Version 10/11/11 V1 07/02/201 3 V2 Next Review Date Date Ratified Name of Committee/Board/Group Nov /11/11 Biochemistry Clinical Team eb /02/2013 Biochemistry Clinical Team Page 1 of 20

2 DEPARTENT O CLINICAL CHEISTRY TESTS KEY Specimen Type: S Serum U Urine Bl - Whole Blood (EDTA) Pl Plasma aeces BS Blood Spot Location: - Daily routine tests * - Batches POCT Point of Care Testing - erral to other hospitals Note turn around time for tests referred to another hospital is 4 weeks or less unless specifically stated. N/A - Not applicable - Not available TEST NAE REERENCE RANGES SOURCE 11 deoxycortisol 8 nmol/l 17 Alpha Hydroxyprogesterone (S) emale adult Neonates ale Neonates 17 Beta Oestradiol (S) Post enopausal ollicular id-cycle Luteal ales 1-10 nmol/l <30.0 nmol/l <30.0 nmol/l EDGH Conquest pmol/l pmol/l pmol/l pmol/l pmol/l 3 methoxy tyramine (U) < 2.5 umol/24h 5HIAA (U) 0 52μmol/24h ACTH (Pl) <46 ng/l (9 am) <10 ng/l (midnight) Albumin (S) Age g/l 0-5d d - 3y y >15y Page 2 of 20

3 Albumin: creatinine ratio (U) None given Alcohol (S) (Ethanol, C 2 H 5 OH) Aldosterone (Pl) The legal limit is 80 mg/dl. Coma ensues at mg/dl. Death may occur at levels over 450 mg/dl. Adults After overnight recumbency: pmol/l After saline suppression : <240 pmol/l Random sample on upright patient: pmol/l In adults, the baseline PRA and the increment in response to changing from a supine to an upright position decline with advancing age. According to some authorities, mean values for both these indices after 60 years of age about half those of young adults. Infants ranges for Pl/S aldosterone are poorly defined in infants, but in the first few weeks of life values of up to 5000 pmol/l have been reported. These high concs. decline rapidly in the first year and then more slowly attaining, by 6 yrs, values similar to those of adults. These ref ranges should be considered with those quoted for Pl. Renin activity. Aldosterone/PRA ratio <800 Conns unlikely >1000 Possible Conns >2000 Conns very likely Alk Phos Isoenzymes (S) Text report Alkaline Phosphatase (S) Age U/L 1-7d d - 1m m m m y y y y y y >15y Alpha 1 Antitrypsin (S) Age related reference range Birth g/l 6 mths yr yr yr Page 3 of 20

4 15-18yr Adult When Alpha 1 Antitrypsin is <1.2 g/l the performs the Phenotype automatically. Phenotype Text Comment Alpha etoprotein (S) KU/L (EDGH) 0 9 KU/L (Conquest) Alpha galactosidase A (Bl) and (Pl) nmol/hr/ml Aluminium (S) 0 0.6μmol/L Alanine Transaminase (ALT) (S) Age U/L 1-7d d - 1m m y y y y y >15y Amino Acid Chromatography (Pl) Text report Amino Acid Chromatography (U) Text report Amiodarone (S) Desmethylamiodarone Ammonia (Bl) Conquest (Pl) EDGH mg/l mg/l 0-54 μmol/l Conquest 9-30 μmol/l EDGH Amylase (luid) N/A Amylase (S) Age U/L < 1m <30 3-6m < m < y > 19y Amylase (U) U/L Amylobarbitone (S) Anaesthetic Reactions- Tryptase(P) Serum concs of Amylobarbitone in therapy are usually below 5mg/L 2-14 ng/ml Collect samples at 0, 3 and 24 hours after the reaction Androstenedione (S) Age and sex related reference range nmol/l Age/Stage ale emale Premature day full term months Page 4 of 20

5 6-11 months years yrs prepubertal yrs Tanner yrs Tanner see below yrs Tanner see below yrs Tanner see below yrs Tanner see below Adult > 20 years see below yrs Tanner yrs Tanner yrs Tanner yrs Tanner Adult years < 12 Angiotensin Converting Enzyme (ACE) (S) Age-related reference range 18-Adult: 8-52 IU/L Apolipoprotein E Genotype (EDTA) Text report Note: Test result takes minimum2 months to return. Arsenic (Bl) Normal : <0.13 μmol/l Hazardous : >0.60 μmol/l ish, shell-fish and crustacea contain a non-toxic arsenical compound. In suspected chronic exposure sea-food is best excluded from the diet for at least 15 days prior to sample collection. Arsenic (U) Normal : <0.13 μmol/l Hazardous : >1.30μmol/L Aspartate transaminase (AST) (S) Adult IU/L Only available for research studies Bence Jones Protein (U) Text report: Not normally detected * Beta 2 icroglobulin (S) mg/l Beta HCG (S) 0 6 IU/L (EDGH) 0 4 IU/L (CONQ) Beta HCG (Urine Pregnancy Test) By high sensitivity method which detects pregnancy 10 days after conception. (EDGH lab only please refer to microbiolobgy dept at Conquest). Bicarbonate (HCO3) (S) Age mmol/l < 1m m >15y POCT Bile Salts (S) 0 10 μmol/l Bilirubin (S) Age and sex related reference range μmol/l Age < 1d < d < d < 200 7d - 15y < 18 > 15y 3-22 Bilirubin (U) Text report Page 5 of 20

6 Biotinidase Activity (Pl) nmol/l PABA/ml plasma/min Blood Gases ph po 2 pco 2 C-Peptide (S) kpa kpa An interpretation of the results will depend on the glucose result and the clinical details provided. or further clarification please contact the lab. POCT C-Reactive Protein (CRP) <5 mg/l CA 15-3 (S) 0-35 ku/l CA 19-9 (S) 0-30 ku/l CA 125 (S) 0-35 ku/l (EDGH) 0 21 ku/l (CONQ) Cadmium (Bl) Normal (Smoker): <53 nmol/l Normal (Non-smoker): <27nmol/L Hazardous: >180nmol/L Hip replacements:repeat in 3/12 if > 135 nmol/l (DA/2010/033) Calcitonin (Pl) 0 4.6ng/L Calcium (S) Age mmol/l 0-5d d 3y y y > 15y Calcium (U) mmol/24h Calprotectin () 0-50 ug/g and text comment Carbamazepine (S) 4 12mg/L Proprietary Name - Tegretol (ACD/AED) Carbohydrate Def.-Transferrin < 1.6% and Text comment Carcino Embryonic Antigen (CEA) (S) ng/ml (EDGH) ug/l (CONQ) Smokers up to 10ug/L (CONQ) Carotene (S) μmol/l Catecholamines (U) Noradrenaline Adrenaline Dopamine μmol/24h μmol/24h μmol/24h * Chloride (S) Age mmol/l < 1y Page 6 of 20

7 1-15y > 15y Chloride (U) N/A Cholesterol (S) Cholinesterase & Dibucaine No. (S) Sensitivity to Scoline (Suxamethonium) Cholinest. Activity Dibucaine No. luoride No. R02 Genotype Phenotype mmol/l IU/L Text report Text report Chromium (Bl) < 40 nmol/l Hip replacements:repeat in 3/12 if > 120 nmol/l (DA/2010/033) Citrate (U) mmol/24h Clobazam (S) Desmethylclobazam μg/l μg/l Clonazepam (S) μg/l Copper Caeruloplasmin (S) μmol/l g/l Copper (U) 0-0.9μmol/24h Cortisol (S) nmol/l (9 am) Creatinine (S) Age mol/l 0-7d d d d - 1y y y y y y y y y >18y Creatinine Clearance (U) A. ale ml/min A. emale ml/min Creatine Kinase (S) Age U/L 0-1y y y y Page 7 of 20

8 9-11y y y y >19y Crosslinks NTX (U) for Hydroxyproline Premenopausal women n BCE/m Post menopausal women n BCE/m ales Up to 51 nm BCE/m Creatinine - μmol/l Cryoglobulins (Bl) No significant amount should be detected. Cyclosporin (S), To King's (EDTA) No specific reference range available. erence ranges vary from Hospital to Hospital. Please state transplant hospital. Cystine (U) <500 μmol/24h * Dehydroepiandrosterone SO4 (S) Age and sex related reference range umol/l Diazepam (Pl) Desmethyl Diazepam Age/Stage ale emale Prem w day months months months years years yrs prepubertal yrs Tanner yrs Tanner see below yrs Tanner see below yrs Tanner see below yrs Tanner see below Adult years see below yrs Tanner yrs Tanner yrs Tanner yrs Tanner Adult years Post menopausal mg/l mg/l Digoxin (S) μg/L Dihydrotestosterone Age and sex related reference range pmol/l Age/Stage ale emale Cord blood days <1890 s to undetectable 2weeks -6 mths undetectable 6 mths Tanner 1 <100 <100 <9.8yrs Tanner 1 <100 < Tanner Tanner Tanner Tanner Adult Post menopausal Diuretic Screen Text report Page 8 of 20

9 Dothiepin (S) Desmethyldothiepin Total μg/l μg/l μg/l (60-200) Drug Screen (S) Text report. Drug Screen (U) Text report. Elastase (faecal) >200μg/g and Text Comment Ethosuximide (S) (ACD/AED) mg/l erritin (S) emale ng/ml ale ng/ml Roche olate (S) ng/ml Roche ree T4 (S) pmol/l (EDGH) pmol/l (CONQ) ree T3 (S) pmol/l (EDGH and Conquest) SH (S) Post enopausal iu/ml (EDGH) ollicular iu/ml id-cycle iu/ml Luteal iu/ml ales iu/ml Post enopausal iu/ml (CONQ) ollicular iu/ml id-cycle iu/ml Luteal iu/ml ales iu/ml G-1-P Uridyl Transferase (Bl) μmol/h/g Hb Galactose-1-Phosphate (Bl) Normal - Non Galactosemic - <0.1 μmol/g/hb Untreated Galactosemic - Up to 10.8 μmol/g/hb Patient on diet when levels dropping and levels stabilized μmol/g/hb Gamma GT (S) Age U/L 1-7d d - 1m m m m y y y y y y y >20y Glucose (CS) mmol/l Page 9 of 20

10 Glucose (luid) N/A Glucose (asting) (Pl) mmol/l Gonadotrophins (SH&LH) SH Post enopausal ollicular id-cycle Luteal ales LH Post enopausal ollicular id-cycle Luteal ales EDGH CONQ iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml iu/ml Gut Hormone (Pl) Glucagon Gastrin Vasointestinal Peptide Somatostatin Pancreatic polypeptide Chromogranin A Chromogranin B CART HbA 1c (P) 0 50 pmol/l 0-40 pmol/l 0-30 pmol/l pmol/l 0 300pmol/L 0-42 pmol/l pmol/l 0 85 pmol/l Non-diabetic mmol/mol Good control mmol/mol Diabetes 48 mmol/mol HDLC (S) mmol/l Diabetes UK HBS (Washed RBC & Pl) nmol uroporphoyrin/ml/red cells/h Homocysteine (S) μmol/l Human Growth Hormone (S) Random < 0.3 ug/l excludes acromegaly Random > 6.7 ug/l excludes GH deficiency Hydroxyproline (U) See Crosslinks NTX IgA (S) See Immunoglobulins IgD (S) Text Comment IG-1 (S) Age related reference range Age Range (nmol/l) Page 10 of 20

11 IGBP3 (S) > Age-related reference range Age (years) Range (mg/l) > IgG (S) See Immunoglobulins IgG Albumin Ratio / Oligoclonal Bands (S & CS) CS Age related reference range Age Alb g/l IgG g/l < IgG - See Immunoglobuins reference ranges SERU IgG Sub-Classes (S) IgG1 IgG2 IgG3 IgG4 Ignore the Albumin reference ranges from the erral lab and use our albumin reference ranges in its place. Adult ref. ranges (Guildford s own adult ranges) g/l g/l g/l g/l In adults IgG3 concs. are higher in females than in males and IgG4 higher in males than females. No sex difference is seen before the age of 15 years. Age IgG1 g/l IgG2 g/l IgG3 g/l IgG4 Cord Bl <0.5 6 mths: <0.5 2 yrs: <0.5 5 yrs: < yrs < yrs <1.1 Note: There might be a slight difference in Page 11 of 20

12 children ranges due to the computer calculations of the age. Ig (S) See Immunoglobulins Immunofixation (S) Text report Immunofixation (U) Text report Immunoglobulins (S) Age IgG g/l IgA g/l Ig g/l Cord < * Wks: ths: Yrs: Over Immunoreactive Trypsin (S) 0-60 μg/l Inhibin B (S) pg/mL and Text comment. Insulin (Pl) Iron studies (S) Iron Transferrin TIBC An interpretation of the results will depend on the glucose result and the clinical details provided. or further clarification please contact the lab μmol/l g/l μmol/l Ketones (U) Text report POCT Lactate (Bl) mmol/L Lamotrigine (S) 1 15mg/L Laxative Screen (U) Text report Levetiracetim (S) mg/l LDH (S) Age U/L 1d - 1m m m m y y Page 12 of 20

13 7-10y y y y y > Lead (Bl) Normal : 0 0.5μmol/L LH (S) Post enopausal iu/ml (EDGH) ollicular iu/ml id-cycle iu/ml Luteal iu/ml ales iu/ml Post enopausal iu/ml (CONQ) ollicular id - Cycle Luteal ales iu/ml iu/ml iu/ml iu/ml Lipid profile (S) Cholesterol Triglycerides HDL mmol/l mmol/l mmo/ll Lithium (S) mmol/l Lipase (S) 22 51U/L Lp(a) (S) > 300 mg/l Increased CVD risk acro CK (S) Text report anganese μg/l agnesium (S) Age mmol/l < 9y y > 15y ercury (U) (Long term exposure or exposure to Inorganic ercury Compounds) ercury (Bl) (Recent exposure -few days or exposure to Organic ercury Compounds e.g. Ethyl or ethyl ercury) etadrenaline (P) Collect through indwelling catheter after 30 minutes recumbency Normal: <5 μmol/mol creat Normal: <5 nmol/l <0.7 nmol/l low probability of phaeo nmol/l medium probability of phaeo > 1.2 nmol/l high probability of phaeo Page 13 of 20

14 etadrenaline (24h urine) < 1.2 umol/24h icroalb/creatinine Ratio (U) See Albumin/Creatinine Ratio (U) ucopolysaccharides (U) Text report Neurone Specific Enolase (S) μg/L Nitrazepam (S) μg/l Normetadrenaline (P) Collect through indwelling catheter after 30 minutes recumbency <1.3 nmol/l low probability of phaeo nmol/l medium probability of phaeo > 2.18 nmol/l high probability of phaeo Normetadrenaline (24h urine) < 3.3 umol/24h Occult Blood () Text report - Positive or Negative Organic Acid Studies (U) Text report Osmolality (S) mmol/kg Osmolality (U) Normal early morning urine >600 mmol/kg Overdose Screen (S) See paracetamol and salicylate Oxalate (U) μmol/24h Paracetamol (S) Not normally detected. Paraproteins (S) Text report * Paraproteins (U) Text report * Paraquat (U) Text report - Positive or Negative Parathyroid Hormone (PTH) (S) ng/l but needs to be interpreted with serum calcium. (EDGH) ng/l again requires calcium for interpretation (CONQ) Perhexiline mg/l ph (Bl) Phenobarbitone (S) (ACD/AED) mg/l POCT Phenylalanine (Phenylketonuria) μmol/l Phenytoin (S) Proprietary Name - Epanutin 10 20mg/L * Page 14 of 20

15 (ACD/AED) Phosphate (S) Age mmol/l < 5d d - 3y y y > 15y Phosphate (U) N/A Pigments (U) Text report. Porphobilinogen (U) μmol/mmol creatinine * Porphyrins (Bl) RBC free protoporphyrin: nmol/l cells RBC zinc protoporphyrin: nmol/l cells Porphyrins () 0 50 mmol/g faeces Porphyrins (U) 0 35 nmol/mmol creatinine Potassium (S) Age mmol/l < 1y y >15y Primidone (S) Proprietary Name - ysoline (ACD/AED) Procollagen Peptide Type III Less than 13 mg/l Age and sex-related (ug/l) Age ale emale 0 2 years years years years years Adult Progesterone (S) Normal mid luteal peak: nmol/l (EDGH) id Luteal peak: nmol/l (CONQ) ollicular: 2 8 nmol/l (Conq) Proinsulin (S) Less than 10 pmol/l Prolactin (S) ale: mU/L (EDGH) emale: mU/L (EDGH) ale: mu/l (CONQ) emale: mu/l (CONQ) Protein (CS) g/l Protein (luid) N/A Page 15 of 20

16 Protein (U) g/l * Protein:creatinine ratio (U) 0 45 mg/mmol * Protein Electrophoresis (S) Text report * Protein-24 hour (U) g/24h * PSA (S) 0-4 ng/ml Quinine 10 15mg/L Reducing Substances () Text report * Reducing Substances (U) Text report Renin (Pl) Adult After overnight recumbency: pmol/ml/hr Ambulant (30min): pmol/mL/Hr Random sample: pmol/ml/hr In adults, the baseline PRA and the increment in response to changing from a supine to an upright position decline with advancing age. According to some authorities, mean values for both these indices after 60 years of age about half those of young adults. Infant The ref ranges for PRA are poorly defined in infants, but, in the first few weeks of life, values of up to 50 pmol/ml/h have been reported. There is an initial rapid fall, followed by a slower decrease until normal adult levels are reached at about the age of 6 years. These ref ranges should be considered with those quoted for Pl Aldosterone activity. Rheumatoid actor (S) <12 IU/ml Salicylate (S) mg/l. Not normally detected. Selenium (S) μmol/L Sex Hormone Binding Globulin (S) emale nmol/l ale nmol/l Serum free light chains (slcs) (S) Kappa mg/l Lambda mg/l Ratio ( in patients on dialysis) Sodium (S) < 15y mmol/l > 15y Page 16 of 20

17 Sodium (U) mmol/l Sodium Valproate mg/l Proprietary Name - Epilim (ACD/AED) Solvent Screen (U) (EDTA) Text report Squamous Cell Carcinoma (SCC) (S) 0 150ng/dLI Steroid Profile (U) Stone Analysis (Stone) Sugar Chromatography () Text report - based on relevant biochemical and clinical information provided. Weight in mg Composition in % All sugars <1.0 mmol/kg faeces. interval variable: not usually > 1.0 mmol/kg Sugar Chromatography (U) Text report - Less than 1 month of age up to 3 mmol/l lactose or galactose, if receiving high carbohydrate diet. The sugars must be present in the diet to be detected i.e., to exclude galactosaemia the infant must be having feeds containing lactose. Sugars (U) Text report Sweat Test Sweat Chloride Conductivity Testing Normal: <40 mmol/l Borderline: 40 60mmol/L ibrocystic: >60mmol/L Normal: 0-60 mmol/l Borderline: mmol/l ibrocystic: >90 mmol/l Tacrolimus (K506) μg/l TCO2 (S) Renamed as bicarbonate Temazepam (S) Text report Testosterone (S) ale nmol/l (EDGH) emale nmol/l (EDGH) ale - 15D (CONQ) Y Y Y Y emale 15D (CONQ) Y Y Y - - Page 17 of 20

18 50Y Y Theophylline (S) mg/l Thiamine (EDTA) (Vitamin B1) Thyroglobulin (Tg)(S) Thyroid unction Tests (S) T3 T4 TSH T4 TSH nmol/l NO COENT ON OUR REPORT Endogenous antibodies to Tg may interfere in its measurement. Interpret Tg results in Tg-Ab positive sera with caution pmol/L (EDGH and CONQ) pmol/l (EDGH) mu/l (EDGH) pmol/l (CONQ) mu/l (CONQ) TPT (thiopurine methyl transferase (E) pmol/h/mg Hb normal pmol/h/mg Hb carrier <10 pmol/h/mg Hb deficiency Plus text interpretation and advice Total Protein (S) 63 82g/L Transketolase (Red Cell) Red Cell Transketolase U/G Hb Transketolase activation - <27 % Triglyceride (asting) (S) mmol/l Troponin T (S) TSH (S) Troponin T should be measured at presentation and 6-9 hours later: Both levels <14ng/L: I can be ruled out(unless further chest pain or ECG changes suggest further investigation is required). If at LEAST ONE Troponon T is 14ng/L or above AND <20% change: not consistent with an acute event % change: significant rise, suggest further evaluation to distinguish between other causes and chronic elevation in Troponin T. >100% change (a doubling): consistent with myocardial necrosis mu/l (EDGH) mu/l (CONQ) TSH Binding Inhibiting Ig < 1.0 U/L negative U/L borderline > 1.5 U/L positive Urate (S) Age mol/l 0-1m Page 18 of 20

19 1-3m m m y y y y y y y y y y y >17y > 44y Results greater than 0.35 umol/l are above target for gout prevention Urate (U) Depends on intake Urea (S) Age mmol/l <1y y >13y Urobilin (U) Text report Urobilinogen (U) Text report Valproate (S) Proprietary Name Epilim (ACD/AED) mg/l q Very Long Chain atty Acids (VLCA) / Phytanic (Pl) Vitamin A (S) Text report Age and sex related reference range Age (years) Range (μmol/l) Adult female Adult male Vitamin B12 (S) pg/ml Roche Vitamin D (S) <12.5 nmol/l deficiency nmol/l insufficiency nmol/l adequate Vitamin E (S) Age-related reference range Age (years) Range (μmol/l) < Adult Vitamin E/cholesterol Warfarin >/= 2.22 umol/mmol Therapeutic range: mg/l (mean 1.6 mg/l) in 56 well controlled patients. Page 19 of 20

20 White Cell Enzyme Text report Xanthochromia (CS) Text report Zinc (S) μmol/l NOTE: erence ranges are liable to change due to updates in equipment, methods, reagents and change in erral s. erence ranges are updated on our computer system as they are received. Please contact us if you need further information on tests or reference ranges. Tel no.: ext / 4296 or ext 8585 / 8019 Page 20 of 20