AHS Laboratory Services

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1 ECH HCIS Applicability Purpose: Policy: This document applies to all Central Zone ECH HCIS personnel of AHS Laboratory Services and laboratories administered under the Covenant Health Group and the Lamont Health Centre collectively referred to here as Laboratory Services. This policy provides reference intervals for laboratory analytes. This policy states the reference intervals for Chemistry. PATIENT CHEMISTRY All reference intervals adopted from Capital Health or AHS Standardization projects, unless otherwise stated. Acetaminophen (µmol/l) Report Comment: If appropriate Consult Alberta Poison Albumin (g/l) <2 m m-1 y >2 y Alanine Aminotransferase (U/L) Alkaline Phosphatase (U/L) Aspartate Transaminase (U/L) Beta Human Chorionic Gonadotropin (βhcg) (IU/L) Bilirubin Neonatal (umol/l) <50 <2 m m-1 y y y >18 y <7 d <140 8 d 1 y < y <50 > 10 y <40 <5 Age If NBIL Then Append Comment result (μmol/l) is: 24 hours 250 Bilirubin levels of 250 μmol/l in the first 24 hours of life require pediatric consultation and further investigation >24-48 hours >48 hours 9 days 250 Bilirubin levels of 250 μmol/l in the first 48 hours of life require follow-up monitoring < 250 Values < 250, not associated with rising bilirubin values, may Initials: Site: Date Printed: Page 1 of 9

2 Bilirubin Conjugated (Bc) (neonatal testing only) Bilirubin Total (umol/l) Beta- Hydroxybutyrate (BOH) (mmol/l) BNP (ng/l) be considered normal for this age group <300 Bilirubin levels of 250 μmol/l after the first 48 hours of life require follow-up monitoring <350 Bilirubin levels >300 μmol/l require medical reassessment. RE: Possibility of blood group incompatibility, excessive weight loss or inadequate feeding pattern. In presence of blood group incompatibility, the initiation of phototherapy could be considered Bilirubin levels >350 μmol/l, the use of phototherapy would be prudent after appropriate assessment even when no blood group incompatibility exist. Pediatric consultation is recommended. >400 Bilirubin levels > 400 μmol/l require prompt pediatric or neonatal consultation for potential need of exchange transfusion See Provincial Chemistry Document: Guidelines for Biliary Atresia Testing for Meditech Sites > 9 d < BNP <100 ng/l Interpretation/Results BNP < 100 ng/l CHF Unlikely BNP ng/l CHF Possible BNP >500 ng/l CHF Likely Higher BNP concentrations in the first 72 hours after an acute coronary syndrome are associated with an increased risk of death, MI, and CHF Calcium (mmol/l) < 10 d d 12 y > 13 y Initials: Site: Date Printed: Page 2 of 9

3 Carbon Dioxide < 1 y (mmol/l) > 2 y Chloride (mmol/l) C-Reactive Protein 10 (mg/l) Creatinine (µmol/l) < 2m (i-stat) 3m 1y y y Female Male > 18 y Creatinine (µmol/l) Female Male IDMS 0-3 months m 2 yrs yrs yrs yrs Creatine Kinase (U/L) < 1 y y Female Male y > 18 y <200 <250 CSF Glucose (mmol/l) CSF Protein g/l Digoxin (nmol/l) *Suggested Ranges* Heart Failure: Atrial Fibrillation: Not defined Caution: Levels >1.5 are associated with a higher risk of toxicity in heart failure patients. egfr Reporting Algorithms (CKD EPI) IF THEN <18years Report creatinine only >18 years Report creatinine & egfr Ethanol (mmol/l) <3 Report Comment: The method currently used for ETOH testing is not specific for ETOH and may cross react with other alcohols. Please interpret results accordingly. Ferritin (ug/l) F M Report comment for Ferritin >1000 ug/l Ferritin level exceeds the 99 th percentile for Alberta patient. If there is no history of neoplasia, inflammatory or infectious disorder, and no history of transfusion therapy, iron overload associated with hereditary hemochromatosis should be Initials: Site: Date Printed: Page 3 of 9

4 Fetal Fibronectin considered. Genetic testing and or consultation may be indicated. Not applicable Report comment: Negative Fetal Fibronectin results have shown a negative predictive value for pre-term labor of >99%. Free T4 (pmol/l) 0 d 13 d d FSH (U/L) Female < 10 yrs <6.0 > 10 yrs Follicular/Luteal <7.0 Midcycle Postmenopausal Gestational Diabetic Screen (mmol/l) GGT (Gamma Glutamyl Transferase) (U/L) Glucose (mmol/l) (including i-stat) Glucose Tolerance Test (2 Hour, 2 time point) Gestational Glucose Tolerance Test (2 hour, 3 time point) Male <7.0 <7.8 1 hour Normal Gestational Diabetic Screen > hour - Gestational Diabetes Mellitus hour A gestational oral glucose tolerance test should be conducted Male: <70 Female: <55 < 30 d Fasting Random > 30 d Fasting Random Appended comment when random glucose >11.0 mmol/l: A random glucose concentration of greater than or equal to 11.1 mmol/l plus symptoms of disease meets one of the diagnostic criteria for Diabetes Mellitus. Canadian Diabetes Guidelines (2008). IF THEN Fasting glucose mmol/l Normal AND 2 hour < 7.8 mmol/l Fasting glucose mmol/l AND 2 hour mmol/l Impaired Fasting Glucose and Impaired Glucose Tolerance Fasting glucose > 6.9 mmol/l OR 2 Diabetes Mellitus hour > 11.0mmol/L Fasting > 5.3 mmol/l 1hr > 10.6 mmol/l 2 hr > 9.0 mmol/l IF THEN 1 value is met or exceeded Gestational Diabetes Initials: Site: Date Printed: Page 4 of 9

5 Lactate (mmol/l) Lactate Dehydrogenase (U/L) Lactose Tolerance (Adult) Mellitus IF THEN in glucose by >1.7 mmol/l Normal Lactose Tolerance in glucose by mmol/l Inconclusive may result from GI pathology in glucose by <1.1 mmol/l Impaired Lactose Tolerance Peak rise in glucose >1.1 mmol/l Normal Lactase Activity ( mmol/l) Peak rise in glucose of <1.0 mmol/l Deficient or significantly reduced lactase activity LH (U/L) Female < 10 yrs < 10.0 > 10 yrs Follicle/Luteal <15.0 Midcycle Postmenopausal Male < 10 yrs < 10.0 > 10 years < 12.0 Lipase (U/L) Lipid (mmol/l) The table below provides treatment target values for LDLcholesterol, Cholesterol/HDL-cholesterol Ratio, and triglyceride. These target values vary according to the patient s cardiovascular risk (low, medium, high), which is determined by the method described in the paper written by the Canadian working group on Hypercholesterolemia and other Dyslipidemias CMAJ Oct 28/03; Lithium (mmol/l) 168 (9): Risk Category LDL-C Target value Chol/HDLC ratio Target value Trig- Target value HIGH <2.5 <4.0 <1.7 MEDIUM <3.5 <5.0 <1.7 LOW <4.5 <6.0 <1.7 Not Applicable Report Comment: Therapeutic: (acute mania therapy) (Bipolar maintenance therapy) Magnesium (mmol/l) Initials: Site: Date Printed: Page 5 of 9

6 Urine Albumin / <3.4 Creatinine Ratio Semi- Quantitative (mg/mmol) Mononucleosis Negative Screen Occult blood screen Negative fecal Phosphate (mmol/l) < 10 d d -1 y y > 13 y Potassium (mmol/l) < 28 d > 29 d Potassium (mmol/l) 0 mo 1 mo (i-stat) 1 mo 1 yr Total Protein (g/l) Rheumatoid Factor Screen Salicylate (mmol/l) > 1 yr y > 18y Not Applicable Not Applicable Seminal Fluid Analysis Post Vasectomy Sodium (mmol/l) Sodium (mmol/l) (i- Stat) Troponin I (ug/l) (Triage meter) Report Comment: Therapeutic Range: Two consecutive specimens with no spermatozoa seen. 0 mo 1 mo mo 1 yr > 1 yr Negative > 0.02 Indicates myocardial injury in a clinical setting consistent with Acute Coronary Syndrome. Report comment: In a clinical setting consistent with Acute Coronary Syndrome, TnI > 0.02 ug/l is consistent with myocardial injury, whereas peak TnI 0.02 ug/l is consistent with myocardial ischemia without injury. TnI > 0.02 ug/l may also be observed in several other cardiac and systemic diseases (most commonly - acute PE, acute pericarditis, acute or severe HF, myocarditis, sepsis and/or shock). Initials: Site: Date Printed: Page 6 of 9

7 Troponin I (ug/l) (ECi) <0.034 Normal >0.034 Report comment: In a clinical setting consistent with Acute Coronary Syndrome, Tnl >0.034 ug/l is consistent with myocardial injury whereas peak Tnl <0.034 ug/l is consistent with myocardial ischemia without injury. Tnl >0.034 ug/l may also be observed in several cardiac and systemic diseases (most commonly acute PE, acute pericarditis, acute or severe HF, myocarditis, sepsis and/or shock. This result is generated by Ortho Clinical Diagnostics ECi methodology. Test results and cutoffs vary between different methodologies. TSH (mu/l) 0-2 weeks weeks weeks 1 year years years >14 years Urea (mmol/l) < 3 m m - <2 yrs yrs - < 18 yrs >18 yrs Urate (umol/l) < 9 y Female Male y > 18 y Vitamin B12 (pmol/l) >150 Initials: Site: Date Printed: Page 7 of 9

8 ADULT/PEDIATRIC ARTERIAL VENOUS Blood Gases i-stat Reference Interval Reference Interval ph pco 2 (mmhg) po 2 (mmhg) HCO 3 (mmol/l) Base Excess (mmol/l) - 2 to +2-2 to +2 TCO 2 (mmol/l) O 2 Saturation (%) ADULT/PEDIATRIC ARTERIAL VENOUS CAPILLARY Blood Gases Reference Interval Reference Interval Reference Interval IL GEM Premier 4000 ph pco 2 (mmhg) po 2 (mmhg) HCO 3 (mmol/l) Base Excess (mmol/l) - 2 to +2-2 to +2-2 to +2 TCO 2 (mmol/l) O 2 Saturation (%) Hb (g/l) O 2 Hb (%) COHb (%) MHb (%) Ionized Calcium (mmol/l) (0-14days) (14days) Lactate (mmol/l) Initials: Site: Date Printed: Page 8 of 9

9 Blood Gases IL GEM Premier 4000 and i- STAT CORD/UMBILICAL ARTERIAL Reference Interval VENOUS Reference Interval ph Physiologically, the arterial cord blood ph is always expected to be lower than the venous cord blood ph. When the arterial ph >venous ph, this likely indicates a sampling error or specimen mislabeling. A ph < 7 for an arterial cord blood sample may indicate a severe hypoxic event intrapartum or prepartum. References: Referenced CH Laboratory Services web site, 2005 Provincial Chemistry Document Guidelines for Biliary Atresia Testing for Meditech Sites Initials: Site: Date Printed: Page 9 of 9