Prepared by Date Adopted Supersedes Procedure #/Dated William Pope, PhD & 8-2-13 QM-000 / 6-22-12 Elizabeth Holland, MT (ASCP) GENERAL CHEMISTRY Acetone None detected Albumin, g/dl 3.5 5.0 2.8 4.6 Alk, Phosphatase, u/l 30 112 40 190 50 272 75 275 60-260 14 16 years 12 14 years 2 12 years 0 2 years Ammonia, um/l 18 54 Amylase, u/l 22 132 Serum Bilirubin, Total, mg/dl 0.2 1.3 s Bilirubin, Neonatal, mg/dl 1 7.0 s >18 Bilirubin, Conjugated 0 0.2 BUN, mg/dl 5 22 5 20 0 17 months Calcium, mg/dl 8.5 10.2 7.6 10.4 Chloride meq/l 99-109 Serum Cholesterol, mg/dl 114 200 114 170 53-170 1 19 years 0 1 year < 6.0, > 12.0 Cholesterol, HDL, mg/dl 40 70 40 80 > 60 Low CHD Risk Cholesterol, LDL, mg/dl 60 130 Desirable < 100 Optimal / Low Risk CO2, meq/l 22 32 < 10, > 40 CPK, u/l 39 195 39 162 Creat., mg/dl 0.50 1.37 0.50 1.17 0.50 1.07 10 12 years 0.50 0.97 7 10 years 0.40 0.77 0 7 years QM-000 Page 1 of 17
Normal (95% of population) Low CHD Risk Average CHD Risk High CHD Risk Suspect Acute Inflammation, repeat hscrp for CHD Risk assessment in 2 wks CRP hs, mg/dl 0.02 0.722 < 0.1 0.1 0.3 > 0.30 > 1.0 CSF FI. Prot., mg/dl 15 45 20 80 < 1 month Glucose, mg/dl 70 99 100-125 Impaired fasting glucose GGT, u/l 6 39 > 3 months 12 80 1 3 months 30 150 < 1 month Iron, ug/dl 38 160 34 160 Iron TIBC 245 435 Iron - % Sat. 20 50 K+, meq/l 3.5 5.0 4.0 6.2 0-3 months Lactic Acid mmol/l 0.5 2.2 > 4.0 Lipase, u/l 22 55 LDH, u/l 97 190 140 242 140 279 150 360 HDL Chol 40 80 40 70 > 60 LDL Chol 60 130 6-12 years 1 6 years 0-1 year Low CHD Risk Desirable Optimal / Low Risk < 40 Outpatient, < 1 mth, < 50 Inpatient, > 500 All < 2.5, >6.5 < 100 Magnesium, mg/dl 1.7 2.5 < 1.2, > 4.9 Na+, meq/l 135 145 <120, > 155 Osmolality, mosm/kg 275 295 < 250, > 320 PCHE k u/l 4.9-11.9 Phosphorus, mg/dl 2.5 4.8 3.0 5.6 3.6 6.0 3.5 6.6 > 12 yrs 3 12 yrs 1 3 yrs < 1 yr < 1.0 QM-000 Page 2 of 17
SGOT (AST), u/l 5-38 15-62 0 3 months SGPT (ALT), u/l 5 37 Total Protein, g/dl 6.2 8.0 5.6 7.5 5.1 7.3 Triglycerides, mg/dl 20 149 Uric Acid, mg/dl 2.5 7.7 2.3 6.7 1.8 5.0 > 3 yrs 1 3 yrs 0 1 yr 9 13 yrs 0 9 yrs CALCULATED VALUES BUN/Creatinine Ratio 6 22 Anion Gap (Na-(Cl+CO2)) 3.0 11.0 Albumin/Globulin Ratio 1.2 3.1 TIBC, ug/ml 245 435 % SAT, % 20 50 15 50 LDL, mg/dl 50 129 60 129 70 129 0 19 yrs 19 29 yrs, <100 optimal > 29 yrs, <100 optimal BLOOD GAS ph 7.35 7.45 7.33 7.43 PCO2, mm/hg 36 46 38 48 PO2, mm/hg 85 100 25 47 < 6 mths, < 7.2, > 7.6, 6 mths < 7.3, > 7.6 -arterial- < 20, > 60 < 50 QM-000 Page 3 of 17
COOX The Medical Central Georgia Quality Management Total Hb, g/dl 14.5 16.5 12.7 14.7 % O2 Hb, % 94 99 94 97 65 85 CO Hb, % 0 1.5 < 5.0 Met Hb, % 0.4 1.5 O2, vol % 15-23,, Non-smokers Smokers > 20 > 20 IONIZED CALCIUM Calcium, mmol/l 1.12 1.32 < 0.8, >1.6 ph 7.33 7.43 TEST THERAPEUTIC RANGE TOXIC (CRITICAL RANGE) TDM & TOXICOLOGY Acetaminophen, mg/dl < 20 > 150 (4 hr, post dose) or > 40 (12 hr. post dose) Amikacin, ug/ml 20 25 1 8 Peak Trough > 30 > 8 4 8 Severe Infections Carbamazepine, ug/ml 8 12 > 20 Digoxin, ug/ml 0.8 2.0 > 2.4 Gentamicin, ug/ml 5 10 Peak > 12.0 1 2 Trough > 2.0 Lithium, meq/l 0.5 1.3 > 1.5 Pentobarbital, ug/ml 1 5 > 10 20 40 Treatment of intracranial pressure with supportive therapy. Phenobarbital, ug/ml 15 30 > 50 Phenytoin, ug/ml (Dilantin) 10 20 > 30 Phenytoin, Free, ug/ml 1.0 2.0 > 2.5 QM-000 Page 4 of 17
TEST THERAPEUTIC RANGE TOXIC (CRITICAL RANGE) Quindine, ug/ml 2 5 > 10 Salicylate, mg/dl 2 29 >34 mg/dl Theophylline, gu/ml 10 20 6 11 s Neonates (< 6 mos. old) > 25 > 20 Tobramycin, ug/ml 4 10 1 2 Peak Trough > 12 > 2 Valproic Acid, ug/ml 50 100 > 200 Vancomycin, ug/ml 30 40 10 20 Peak Trough > 80 > 24 Ethanol, mg/dl None Detected > 300 Ethylene Glycol, mg/dl 0 5 > 20 Isopropanol None Detected > 150 Methanol None Detected > 50 Urine Drug Screening None Detected URINE CHEMISTRIES Acetone None Detected Creatinine, urine, g/24 hrs 1.0 2.0 0.8 1.8 Creatinine Clearance, 70 130 > 3 years mg/min Calcium, urine, mg/24 hrs 50 150 100 300 Avg. calorie diet High Calorie diet Magnesium, urine, mg/ 73 122 24 hrs Microalbumin, urine, mg/dl 0 1.9 <30 mg/24 hr Osmolality, urine, mosm/kg Protein, urine, mg/dl g/24 hrs 390 1090 < 15 0.05 0.15 QM-000 Page 5 of 17
Urea nitrogen, urine, 5 20 g/24 hrs Uric Acid, urine, 250 750 mg/24 hrs Urine Protein/Urine Creatinine Ratio < 0.20 Sodium, urine meq/24 hr 40 220 Potassium (K), urine 25 125 meq/24 hr Chloride (Cl), urine, 110 250 meq/24 hr OTHER FLUID CHEMISTRIES Sweat Chloride, meq/l 45 60 L/S Ratio, Amniotic Fluid > 2.3 Consistent with fetal lung maturity < 1.5 Suggestive of fetal lung immaturity Phosphotidyl Glycerol, Amniotic Fl, ug/ml Lamellar Body Count (LBC), particles/ul > 1.9 < 0.5 1.9 < 0.5 > 50k 50-15 <15 Positive fetal lung maturity Wk Pos suggests fetal lung maturity indeterminate for lung maturity Mature Transitional Immature IMMUNOASSAY / IMMUNOLOGY ACTH, pg/ml 10 60 AFP (tumor, marker), ng/ml < 9 Alpha 1 antitrypsin, mg/dl 75 190 Anti-CCP, U/mL <5.0 Anti-Thyroid Peroxidase <5.61 AB, IU/ml B12, pg/ml 180 914 < 130 > 300 95 percentile Deficiency No Deficiency BNP, pg/ml < 100 C-Peptide, ng/ml 1 5 CA-125, U/ml < 35 CA 19-9, U/ml 0 34 CEA, ng/ml < 3 Non smoker QM-000 Page 6 of 17
< 5 Smoker Ceruloplasmin, mg/dl 22.9 49.0 CKMB, ng/ml 0.6 6.3 Complement C-3, mg/dl 86 184 Complement C-4, mg/dl 20 59 Cortisol, ug/dl 7 25 AM (collected between 6-8 am) 2 14 PM (collected between 4-6 pm) DHEA Sulphate, ug/dl 108-607 and, 0-6 days 32-431 and, 1-4 weeks 3-124 and, 1-11 mths 0-19 and, 1-4 yrs 3-85 and, 5-9 yrs 34-280, 10-14 yrs 65-368, 15-19 yrs 24-247, 10-14 yrs 70-492, 15-19 yrs 238-539, 20-24 yrs 140-592, 25-44 yrs 136-450, 45-54 yrs 49-362, 55-64 yrs 229-284, >65 yrs 134-407, 20-24 yrs 75-511, 25-44 yrs 56-283, 45-54 yrs 34-182 >55 yrs Estradiol, pg/ml ND 75 < 20 47 27 122 49 291 95 433 3.85 8.78 4.54 22.51 1.79 5.12 6.74 113.59 Haptoglobin, mg/dl 33 200 : Post-menopausal Mid-follicular Mid-luteal Peri-ovulatory Ferritin, ng/ml 23.9 336 11 306 Folate, ng/ml 3.0 20.0 2 4 Suggestive of deficiency FSH, MIU/ml 1.27 19.26 : Mid-follicular Mid-cycle peak Mid-luteal Post-menopausal QM-000 Page 7 of 17
HCG, mlu/ml 0 5, s < 40 yrs 7 > 40 yrs Hemoglobin A1C, % 4.2 5.6 5.7 6.4 Increased risk 6.5 Consistent with Diabetes Homocysteine, umol/l 5.08 15.39 < 7.2 Desirable IgA, mg/dl 90 440 IgG, mg/dl 570 1800 IgM, mg/dl 35 260 Insulin, ulu/ml 1.9 23 Fasting Kappa Free Light Chain, 3.30 19.40 Serum, mg/l Kappa Free Light Chain, 0.39 15.1 Urine, mg/l Lambda Free Light Chain, 5.71 26.30 Serum, mg/l Lambda Free Light Chain, 0.81 10.1 Urine, mg/l K/L Serum Ratio 0.26 1.65 K/L Urine Ratio 0.461 4.00 LH, MIU/ml 1.0 5.8 1.24 8.62 2.12 10.89 19.18 103.03 1.2 12.86 10.97 58.64 Myoglobin, ng/ml 17.4 105.7 14.3 65.8 PTH, pg/ml 11 67 PTH, Intraoperative, pg/ml 12 72 Prealbumin, mg/dl 18 38 Procalcitonin, ng/ml 0.05 0.09 Child : Mid-follicular Mid-cycle peak Mid-luteal Post-menopausal > 2.0 High risk of sepsis Progesterone, ng/ml 0.10 0.84 0.31 1.52 5.16 18 : Mid-follicular Mid-luteal QM-000 Page 8 of 17
ND 0.78 Post-menopausal 4.73 50.74 Preg. 1 st Trimester 19.41 45.3 Preg. 2 nd Trimester Prolactin, ng/ml 2.64 13.13 3.34 26.72 2.74 19.64 Prostate Specific Antigen, (PSA), ng/ml 0 4 0 2.5 0 3.5 0-4.5 0 6.5 Rheumatoid Factor, u/ml 0 25 RBC Folate, ng/ml 164 867 Testosterone, ng/dl 1 10 3 50 10 570 160 781 175-781 2 25 10 75 : Pre-menopausal Post-menopausal 40 49 years 50 59 years 60 69 years > 69 years 0 5 years, 5 11 years, 11 14 years, 14 16, 17, 5 11 years, 11-17 years T3, Free, pg/ml 2.5 3.9 T3, Total, ng/dl 87 178 15-200 0 30 days T4, ug/dl 4.87 11.72 T4, Free (measured), ng/dl 0.58 1.60 FTI, ug/ml 5.05 9.42 T-Uptake, T-Uptake Units 0.69 1.41 TSH, UlU/ml 0.34 5.6 Thyroglobulin, ng/ml < 33 (tumor marker) <5 Thyroglobulin Antibodies, IU/ml <4.11 Transferrin, mg/dl 181 340 Troponin, ng/ml 0.09 0.10 Vitamin D, gn/ml <12 <20 >60 >80 > 16 yrs Athyrotic Cardiac Injury Severe Deficiency Deficiency Potential for Adverse Effects Toxicity > 0.50, first incident only within 24 hrs QM-000 Page 9 of 17
ELECTROPHORESIS Hemoglobin Elect. Fetal Hemoglobin AA Pattern 55 85% 2.1% Protein Elect Total protein, g/dl 5.1 7.3 5.6 7.5 6.2 8.0 Albumin, g/dl 3.2 4.8 3.7 5.7 3.3 5.8 3.5 5.0 Alpha 1, g/dl 0.1 0.3 0.2 0.4 Alpha 2, g/dl 0.2 0.6 0.3 0.7 0.5 1.1 0.4 1.0 Beta, g/dl 0.3 0.6 0.3 0.7 0.4 1.0 0.3 1.2 0.5 1.2 Gamma, g/dl 0.6 1.2 0.2 0.7 0.2 0.9 0.4 1.4 0.7 1.6 At birth > 2 years 3 12 months > 3 years 0 3 months 3 12 months 12 24 months > 2 years 0 2 months > 2 months 1 3 months 3 12 months >12 months 1 3 months 3 12 months 12 24 month > 2 years 1 3 months 3 12 months 12 24 months > 2 years HEPATITIS & HIV MARKERS Hepatitis B Surface Ag Positive Hepatitis B Surface Ab Positive = Immune = Non-immune HIV 1/2 Positive Hepatitis C Virus Ab Hepatitis B Core Ab Hepatitis B Core IgM Ab Hepatitis A Virus IgM QM-000 Page 10 of 17
SEROLOGY Rubella Positive = Immune = Non-immune Infectious Mononucleosis Mycoplasma pneumoniae ASO <200 IU/mL Cryptococcal Antigen Positive ANA Screen Sm Antibody RNP Jo1 SSA SSB SCL70 dsdna Centromere Histone HEp2NA HSV IgM Type 1/2 HSV IgG Type 1 HSV IgG Type 2 PF4 (Platelet Factor 4) Positive RPR TP-PA Non-Reactive VDRL Non-Reactive H. pylori Breath Test H. pylori IgG Fetal Fibronectin QM-000 Page 11 of 17
HEMATOLOGY WBC, K/mm 3 5.00 38.00 6.00 17.50 4.50 15.50 4.50 13.50 3.07 11.77 RBC, M/mm 3 3.00 6.60 2.70 5.30 3.90 5.30 4.50 5.30 4.10 5.10 4.28 5.48 3.76 5.20 Hemoglobin, gm/dl 10.0 22.5 9.0 13.5 11.5 15.5 13.0 16.0 12.0 16.0 12.9 16.9 11.6 15.6 Hematocrit, % 39.0 67.0 28.0 42.0 34.0 45.0 37.0 49.0 36.0 46.0 38.7 49.1 33.9 45.9 MCV, fl 85.0 126.0 70.0 115.0 75.0 95.0 78.0 98.0 78.0 98.0 81.1 98.4 MCH, pg 28.0 40.0 23.0 35.0 24.0 33.0 25.0 35.0 27.2 34.0 MCHC, % 28.0 38.0 29.0 37.0 32.2 35.9 32.2 35.9 1 month < 2 years 2 < 9 years 9 < 18 years 18 years 1 month < 2 years 2 < 9 years, 9 < 18 years, 9 < 18 years, 18 years, 18 years 1 month < 2 years 2 < 9 years, 9 < 18 years, 9 < 18 years, 18 years, 18 years 1 month < 2 years 2 < 9 years, 9 < 18 years, 9 < 18 years, 18 years, 18 years 1 month < 2 years 2 < 9 years, 9 < 18 years, 9 < 18 years 18 years 1 month < 2 years 2 < 9 years 9 < 18 years 18 years 1 month < 2 years 2 < 18 years 18 years < 2.00, > 7.00 < 6.9, > 25.0 < 6.0, > 20.0 < 20.0, > 75.0 < 19.0, > 60.0 QM-000 Page 12 of 17
RDW, % 13.0 18.0 11.5 16.0 11.5 15.0 11.5 14.0 10.4 13.9 The Medical Central Georgia Quality Management 1 month < 2 years 2 < 9 years 9 < 18 years 18 years Platelet, K/mm 129 355 < 20, > 1,000 MPV, fl 7.4 11.4 NRBC, % 0 Differential Neutrophils, % 40 80 Bands, % 0 10 Lymphocytes, % 15 40 Monocytes, % 0 10 Eosinophils, % 0 7 Basophils, % 0 2 Automated Reticulocyte Absolute Retic, M/mm 3 0.0226 0.1206 0.0200 0.1168 % Retic, % 0.40 2.54 0.49 2.65 Immature Retic Fraction 0.137 0.369 (IRF), M/mm 3 0.155 0.383 OTHER HEMATOLOGY Manual Reticulocyte Retic % Manual 0.5 1.5 Absolute Retic, M/mm 3 0.0135 0.0795 Retic Index, % 0.4 1.8 Sedimentation Rate (ESR), mm/hr 0 15 0 20 0 20 0 30 Eosinophil Blood, mm 0 850 0 600 Leukocyte Alkaline 32 182 Phosphatase (LAP score) Kleihauer-Betke, % fetal 0.00 cells Malaria Smear No parasites seen, 0 < 50 years, 0 < 50 years, 50 years, 50 years 0 < 1 year 1 year Positive for malaria or other parasite QM-000 Page 13 of 17
Myeloperoxidase Normal peroxidase activity COAGULATION Antithrombin III Activity, % 80 120 D-Dimer, µg/ml FEU < 0.46 Factor VIII, % 51 173 Factor IX, % 53 194 Fibrinogen, mg/dl 267 484 Heparin, IU/ml 0.5 1.0 LMW, Therapeutic 0.10 0.30 LMW, Prophylactic 0.3 0.7 Unfractionated, Therapeutic P2Y12, PRU 194 418 PT, sec 11.8 15.1 48.2 INR 0.80 1.20 5.0 PTT, sec 23.7 37.2 150 PFA, sec 92 174 Epinephrine 54 104 ADP Protein C Activity, % 70 130 Protein S Activity, % 77 143 60 123 Thrombin Time, sec 13.9 19.9 Thromboelastograph (TEG) R, min K, min AA, Deg MA, mm 5.6 10.0 1.0 3.0 55 78 51 69 URINALYSIS Specific Gravity 1.001 1.035 ph 5.0 8.0 Protein Glucose Ketones Bilirubin Nitrite Leukocyte Esterase Blood Urobilinogen 0.0 1.0 RBC, hpf 0 4 WBC, hpf 0 4 Hyaline cast, lpf 0 7 Squamous Epithelial, hpf 0 3 QM-000 Page 14 of 17
Bacteria None seen - Occasional HCG Qualitative, Urine Eosinophils, Urine None seen BODY FLUIDS CSF Cell Count / Diff Color Clear Turbidity Colorless Xanthochromia WBC, /mm 3 0 5 RBC, /mm 3 0 5 Neutrophils, % 0 6 Lymphocytes, % 40 80 Monocytes, % 15 45 Eosinophils, % 0 Basophils, % 0 Fluid Cell Count / Diff Color Clear Turbidity Colorless WBC, /mm 3 0 5 RBC, /mm 3 0 5 Neutrophils, % 0 6 Lymphocytes, % 40 80 Monocytes, % 15 45 Eosinophils, % 0 Mesothelials, % 0 Group A Strep Wet Prep, Vaginal Epithelial Cells None seen White Blood Cells None seen Yeast None seen Trichomonas None seen Clue Cells None seen POINT OF CARE i-stat SYSTEM Sodium, meq/l Capillary 135 145 135 145 135 145 Children 0 1 month Potassium, mmol/l *(0-3 mos) *(0-6 mos) 3.5 5.0 4.0 6.2 3.5 5.0 4.0 6.2 QM-000 Page 15 of 17 <120, >155 <120, >158 <120, >158
Capillary 3.5 5.0 *for all, <2.5, >6.5 Chloride, mmol/l 65 140 Ionized Calcium, mmol/l 1.07 1.27 1.07 1.27 Capillary 1.07 1.27 *for all, <0.8, >1.6 ph pco2, mm/hg po2, mm/hg BE, mmoi/l Hematocrit, % PCV Capillary Capillary Capillary 7.33 7.43 7.31 7.41 7.33 7.43 36 46 38 48 38 46 85 100 25 47 85 100 (-2) (+2) (-2) (+2) 38 51 (1 mo-adult) & 39-67 (0-1 ms) & ACT (k), Seconds Troponin I, ng/ml 0.00 0.08 Creatinine, mg/dl 0.6 1.3 Capillary 0.6 1.3 Lactate, mmol/l PT, INR Capillary 0.8 1.2 TCO2 on the i-stat 23 27 Cartridge (measured) 24 29, Children, 0 1 Month QM-000 Page 16 of 17 <7.30, >7.60 <7.20, >7.60 <7.20, >7.60, < 20, > 60, Children, Children 0 1 Month 74 137 74 137 > 180 Children 0.36 1.25 0.90 1.70 > 4.0 Children < 50 < 50 < 20, > 60 < 20, > 60 < 20, > 75 > 7.4 > 3.8 < 11, > 40 < 11, >39 MICROBIOLOGY APT ADULT Hgb Chlamydia DNA Probe Clostridium difficile toxin Cryptosporodium Antigen Fecal Fat (Qualitative) Normal Fecal ph 7.0-7.5 Flu A/B Antigen Giardia Antigen Gonorrhoeae DNA probe Herpes viral culture
Ova and Parasite Exam, Comprehensive Fecal Reducing Substance Rotavirus Antigen Respiratory Syncytial Virus Antigen Fecal Trypsin No amoeba, ova, or parasite seen Positive Positive Semen Volume 2.0-5.0 ml Viscosity Normal Motility 60-100% Normal Forms >60% Count 20-250 sperm/million/ml NOTE: The lab s policy for reporting critical values can be found in the Lab Policy Manual III.309 Critical Values. This is a restatement of those values. A copy of this procedure is also located in the Central Georgia Cancer Care Manual. Approved Reviewed Reviewed Reviewed Reviewed Reviewed Date Signature QM-000 Page 17 of 17