2a_Reference_Ranges_2008.pdf

Reference Rangesfor Adults and Children

Pre-Analytical Considerations

2008

W. HeilV. Ehrhardt

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Roche Diagnostics Ltd.ForrenstrasseCH-6343 RotkreuzSwitzerland

Preface, 9th Edition

In order to fulfill increased regulatory stan-dards the contents of this brochure are nowto orientate closer by the information in-cluded in the package inserts of Roche Diag-nostics test kits. As a consequence a numberof changes and modifications concerning theindicated reference ranges as well as the citatedliterature turned out to be necessary. Theresulting number changes compared to the8th edition of this brochure necessitated thepublication of a revised 9th edition.

As a result of differing printing dates, it ispossible that differences may occur betweenthe information given here and that appearsin the package inserts. In such cases the datagiven in the insert, enclosedwith thekit, applies.

The reference ranges listed in this brochure areguide values which may depend on the specificmethod used. Therefore, each laboratoryshould investigate the transferability of the ex-pected values to its own patient populationand if necessary determine its own referenceranges.

PD Dr. W. Heil, WuppertalDr. V. Ehrhardt, Mannheim

Mannheim, March 2008

Hagedorn Kommunikation

68519 ViernheimMax-Planck-Strae 13

Tel. 0 62 04 50 21 Fax: 0 62 04 60 08 66email: [email protected]

Roche / Frau Schutz, Herr Dr. EhrhardtReference RangePraanalytik 2009 (11. Auflage)JANUAR_2010_ENGLISCH SEITE 0

18.2.10 17:44 3. Autorkorrekturhgd / muckel Version: 9.1 M110H:/3B2/Roche/19816_ReferenceRanges/3B2/januar_2010_englisch.3dTiefe Cyan Magenta Yellow

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AuthorsDr. Wolfgang Heil, WuppertalDr. Volker Ehrhardt, Roche Diagnostics GmbH, Mannheim Roche Diagnostics GmbHStatus: July 2008






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Contents

Page

List of abbreviations 4

1 Pre-analytical considerations 71.1 Factors affecting blood collection 81.2 Sample collection 91.3 Transport and storage of sample material 101.4 Assessment of sample material 12

2 Reference ranges 142.1 Clinical chemistry and immunological tests,

serum/plasma 142.2 Hematology 762.3 Coagulation 862.4 Blood gases 1002.5 Therapeutic drug monitoring 1022.6.1 Urinalysis, urinary sediment and status 1082.6.2 Clinical chemical urinalysis 1122.7 Urinary calculi, gallstones 1202.8 CSF 1222.9 Stool 1242.10 Spermiogram 1262.11 Extravascular body fluids 1282.12 Function tests 1372.13 Characteristic analytes for identification of

body fluids 144

3 Decision supports 1453.1 Enzyme patterns 1453.2 Lipids 1463.3 Electrophoretic patterns of plasma proteins 1473.4 Schematic representation of blood coagulation 1493.5 Thrombophilia, risk factors 150

Page

3.6 Age dependence of immunoglobulin synthesis 1523.7 Complement system, classical and

alternative mechanism 1533.8 Tumor markers 1543.9 Serological diagnosis of hepatitis A and B 1553.10 Urinary sediment 1563.11 Nomogram for diagnosing acid-base disorders 158

4 Conversion tables 1594.1 Conversion table from conventional units

to SI units and vice versa (/U refers to urinalysis) 1594.2 Conversion factors for enzyme activities:

U/L mkat/L and nkat/L 171

5 Sample stability 172

6 References 189

7 List of key words 225

COBAS; CARDIAC M; INTEGRA; ELECSYS; REFLOTRON;Roche CARDIAC and TINA-QUANT are trademarks of Roche.






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List of abbreviations

BSA Body surface areaC4bBP C4-binding ProteinCA Tumour-related carbohydrate antigenCO2 Carbon dioxideCSF Cerebrospinal fluidCTAD Citrate, theophylline, adenosine, dipyridamoled DayDGKC German Society of Clinical ChemistryEDTA Ethylene diamine tetraacetic acidEGTA 1,2-bis (2-amino ethoxyethane)tetraacetic acidELISA Enzyme-linked immuno-sorbent assayEq Equivalent

mEq milliequivalentf Femaleg Gram

mg Milligram (103 g)mg Microgram (106 g)ng Nanogram (109 g)pg Picogram (1012 g)

h HourH2 HydrogenHb HemoglobinHct (PCV) Hematocrit (packed cell volume)HPLC High pressure liquid chromatographyIFCC International Federation of Clinical ChemistryINR International Normalized Ratiokat Katal

mkat Millikatal (103 kat)mkat Microkatal (106 kat)nkat Nanokatal (109 kat)pkat Picokatal (1012 kat)

L LiterdL Deciliter (101 L)mL Milliliter (103 L)mL Microliter (106 L)nL Nanoliter (109 L)pL Picoliter (1012 L)fL Femtoliter (1015 L)

m Malem Meter

mm Millimeter (103 m)mm Micrometer (106 m)m2 Square metermm3 Cubic micrometer

MCH Mean corpuscular hemoglobinHb/RBC (hemoglobin content of one red cell)

MCHC Mean corpuscular hemoglobin concentrationMCV Mean corpuscular volumemil Millionmin Minutemol Mole

mmol Millimole (103 mol)mmol Micromole (106 mol)nmol Nanomole (109 mol)pmol Picomole (1012 mol)fmol Femtomole (1015 mol)

mosmol Milliosmole (103 osmole)mth MonthNACB National Academy of Clinical BiochemistryNCEP National Cholesterol Education ProgramNGSP National Glycohemoglobin Standardization ProgramO2 OxygenPa Pascal

kPa (103 pascal)pCO2 Partial pressure of carbon dioxide

1 Pre-analyticalconsiderations

Assay findings in the field of clinical chemistrycan be divided into the following categories:

preanalytical phase analytical phase analytical evaluation postanalytical phase.

The following chart illustrates details of thepreanalytical and analytical phases as well asanalytical and medical evaluation and how theindividual steps are related to one another.The accuracy of a laboratory analysis greatlydepends on the preanalytical phase.






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pH Negative decimal logarithm of the hydrogen ion activitypO2 Partial pressure of oxygenppm Parts per millionpt Particle

Mpt Megaparticle (106 particle)Gpt Gigaparticle (109 particle)Tpt Teraparticle (1012 particle)

s SecondU Unit (international)

kU Kilo unit (103 units)UV Ultravioletw Weekyr Year

PATIENT

Patientpreparation

Influencefactors

Sampletransport

Identitycheck

Sampleevaluation

Samplepreparation

Samplematerial

Samplecollection

Patientdata

Qualitycontrol

Analysis

Method

Medicalevaluation

Analyticalevaluation

Valuemeasured Result

Interferences

Plausibilitycheck

Clinicalquestions

FINDINGS

The following should be taken into accountduring sample collection:

After food intake glucose, cholesterol, tri-glycerides, iron, inorganic phosphate andamino acids are present in elevated concen-trations in blood (103).

If the patient is moved from a recumbent toan upright position, the concentration ofcorpuscular and macromolecular substancessuch as leucocytes, erythrocytes, hemo-globin, hematocrit, total protein, enzymes,lipoproteins and protein-bound ions (e. g.calcium, iron) increase by up to 10%.

Some drugs may affect the test performed. Compress vein for maximum 1 min. Large quantities of alcohol over an extendedperiod of time cause an increase in g-GTactivity, CDT and MCV.

Smokers have elevated CO-Hb- and CEA-concentrations.

Substantial diurnal variations can be ob-served in the case of some analytes, e. g.hormones (epinephrine, aldosterone, corti-cotropin, cortisol, norepinephrine, prolac-tin, somatotropin, testosterone), electrolyteexcretion in urine, serum hemoglobin andiron. Therefore it is recommended to collectsamples between 7 and 9 a.m.

Patients undergoing tolerance tests shouldbe prepared as described in section 2.12Function tests.

If possible, sample collection should alwaystake place under standardized conditions, i. e.when the patient is fasting, always with thepatient in the same position (seated or recum-bent), around the same time of day andfollowing brief venous stasis.

Clinical chemistry:Clinical chemical assays are almost exclusivelyperformed on serum or plasma. Serum is ob-tained from spontaneously coagulated wholeblood, plasma via the addition of antico-agulants (EDTA, citrate, oxalate or hepari-nate). Differences between serum andplasma are generally observed in the determi-nation of potassium, inorganic phosphate andLDH, and in electrophoresis of fibrinogen(281). In thrombocytosis patients with throm-bocyte values above 500q 103/mL (500 Gpt/L)a potassium determination cannot be per-formed in serum; it is necessary to use hepar-inized plasma instead.

Glucose:Since the rate of glycolysis is around 7% perhour, a glycolysis inhibitor, e.g. sodium fluo-ride, mannose or iodoacetate must be addedto the blood sample prior to determinationof the glucose concentration.

Hematology:In the vast majority of hematological analyses,venous blood treated with EDTA is used.In isolated cases, EDTA-induced pseudo-thrombocytopenia can develop, which is ofno significance clinically. Use of citratedblood returns cell numbers to normal.

Coagulation:In coagulation tests, citrated plasma (onepart 3.2% [0.11 mol/L]* sodium citrate solu-tion and nine parts blood) is used for assaypurposes. It is essential to mix the sodiumcitrate solution and the blood exactly in therelationship 1 + 9. Blood treated with EDTA oroxalate cannot be used for coagulation assays,since these substances may cause more rapid






8 9

* sometimes one part 3.9% [0.129 mol/L] is used

1.1 Influencefactors

1.2 Samplecollection

inactivation of factors Vand VIII, for example.Hemolytic samples or samples which havestarted to coagulate should be discarded.

Urine:In urinalysis it must be noted that there areconsiderable diurnal variations in the excre-tion of some substances, that urine must bepretreated for stabilization of catecholamines,for example, and that it is essential to collectall the urine excreted during the specifiedperiod. For the determination of calcium,the entire amount of urine excreted over 24hours must be acidified and heated.

CSF:CSF collected for the assay of clinical chem-istry analytes should be treated with EDTA topreclude fibrinclot formation since an accuratecell count can otherwise not be obtained.

Centrifugation should generally take place nomore than 1 hour after sample collection. Ifsamples are to be despatched, only serum orplasma should be used unless whole blood isabsolutely necessary for the analysis.With regard to clinical chemical determina-tions, the use of a separator gel in the collec-tion tube has proved advantageous in prevent-ing cellular constituents from entering theserum.

Clinical chemistry (102):Electrolytes, substrates and enzymes in thesample (serum, plasma) are usually stablefor 4 days when stored in the refrigerator at+ 4 C (exceptions: acid phosphatase, ammo-nium, lactate) and are stable for at least oneday at room temperature. If long-term storageis necessary, it is advisable to freeze the sampleat 20 C unless it is to be used for determina-

tion of LDH, Lp[a] or a-HBDH. Repeatedthawing should be avoided.

Plasma glucose determinations:Plasma should be separated from cellular con-stituents (centrifuged) no later than 30minutesafter collection of the blood sample. Avoid he-molysis. Sample material which has been sepa-rated from cellular constituents or in whichglycolysis has been prevented via the additionof a glycolysis inhibitor, e. g. sodium fluoride(NaF), can be refrigerated for up to 7 days.

Hematology (96):When kept in the closed tube, the cellularconstituents and hemoglobin are stable forone day. It should, however, be noted thatthe blood smear must be prepared within3 hours (93).

Coagulation (95, 101):In coagulation analysis, determination of theanalytes should always take place as soon aspossible. If this is not feasible, platelet-poorplasma must be frozen immediately at 20 Cor 40 C. Plasma for Quick, PTT, thrombintime and fibrinogen can be stored for about4 h at room temperature or in a refrigerator.Fibrinogen, protein C and AT III are stablefor 7 days, protein S and factors V and VIIIfor 4 hours only.

Urine:Urine sediment should be evaluated within 2to 3 hours at the latest. Freezing or refrigera-tion of the specimen is not recommended be-cause of salt precipitation.

CSF (214):CSF cells must be counted within the period ofone hour.






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1.3 Transportand storage ofsample material

Blood gases (184):Blood gas determinations should be performedimmediately. If this is not possible, the bloodspecimens collected in glass containers can beplaced in iced water for up to 2 hours.

Hemolysis (102):Determination of potassium, magnesium orLDH is not possible even in slightly hemolyticserum. Considerable hemolysis also affectsother tests.

Bilirubinemia:To avoid interference by icteric samples, thevisual recognition of hyperbilirubinemia isoften not sufficiently sensitive. This is parti-cularly true when samples are simultaneouslycolorized by other pigments (e.g., hemoglo-bin).Spectral bilirubin interferences can be re-moved by blanking, such as with the kineticJaff methods. Chemical bilirubin interferenceof H2O2 - forming enzymatic methods basedon the Trinder reaction can be avoided by se-lection and choice of optimal concentrationsof test components. (84).

Serum Indices:On the Roche/Hitachi, COBAS INTEGRA

and cobas modular platforms Serum Indices(icterus, lipemia, hemolysis) are measured.The package inserts of Roches clinical chem-istry reagents indicate for every test the SerumIndex (I, L, H) limit above which the methodis significantly interfered.On the cobas platforms the Serum Indexlimits are electronically deposed and a SerumIndex flag only appears if the respective test isactually significantly affected by the presentinterferent concentration.

Lipemia:Lipemic sera may interfere with photometricdeterminations. In this case, it is necessary toremove the lipoproteins.






12 13

1.4 Assessmentof samplematerial






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2 Reference ranges2.1 Clinical chemistry and immunological tests, serum/plasma

Analyte Reference Ranges Refe-rences

NotesGroup Conventional SI

Acetoacetate Adults 0.20.4 mg/dL 2040 mmol/L 16

a1-Acid glyco-protein

50120 mg/dL 0.51.2 g/L 237 CRM 470 standardization

Acid phosphatase(ACP), total

f < 6.5 U/L






16 17

2.1 Clinical chemistry and immunological tests, serum/plasma



Alanine amino-transferase,glutamate pyruvatetransaminase(GPT, ALAT, ALT)

Newborn12 mth f






18 19




Alkalinephosphatase (AP),total

Children, 1 d






20 21




Ammonia Adults f






22 23




Anti-thyroideaperoxidase, thyroidperoxidase anti-bodies (Anti-TPO)

Children, adolescentsNewborn






24 25




Aspartate amino-transferase, gluta-mate oxaloacetateaminotransaminase(GOT, ASAT, AST)

Adults f






26 27




Calcium, total Adults 8.610.3 mg/dL 2.152.58 mmol/L 266 Photometric assay8.810.2 mg/dL 2.202.54 mmol/L 266 AAS

Cord blood 8.211.2 mg/dL 2.052.80 mmol/L 299Newborns, premature 6.211.0 mg/dL 1.552.75 mmol/L

Children 90 yr 8.29.6 mg/dL 2.052.40 mmol/L

8.610.2 mg/dL 2.152.55 mmol/L 218 Roche/Hitachi, COBAS INTEGRA,cobas systems.

Calcium, Adults 4.75.2 mg/dL 1.171.29 mmol/L 244free, ionized 4.65.3 mg/dL 1.161.32 mmol/L 266

Carcinoembryonic Non-smokers 2069 yr 3.8 ng/mL 3.8 mg/L 218 CEA Elecsys

antigen (CEA) 40 yr 5.0 ng/mL 5.0 mg/LSmokers 2069 yr 5.5 ng/mL 5.5 mg/L

70 yr 6.5 ng/mL 6.5 mg/L

Carnitin, free 112 mth 0.711.83 mg/dL 1539 mmol/L 3117 yr 0.851.74 mg/dL 1837 mmol/L815 yr 1.462.02 mg/dL 3143 mmol/L

Adults f 0.852.16 mg/dL 17.945.5 mmol/L 242m 1.182.40 mg/dL 24.651.0 mmol/L

Catecholamines Norepinephrine 185275 ng/L 11001600 pmol/L 206 Plasma with addition of glutathione and EGTA Epinephrine 3085 ng/L 170470 pmol/L Dopamine 3085 ng/L 200550 pmol/L

Ceruloplasmin 2060 mg/dL 1.494.40 mmol/L 218, 237 Immunoturbidimetric method, CRM 470standardization

Chloride Children 17 d 97108 mEq/L 97108 mmol/L 247 ISE8 d1 mth 97108 mEq/L 97108 mmol/L26 mth 97108 mEq/L 97108 mmol/L

7 mth1 yr 97106 mEq/L 97106 mmol/L>1 yr 97107 mEq/L 97107 mmol/L

Adults 98107 mEq/L 98107 mmol/L 218, 299 Indirect ISE, coulometry

101110 mEq/L 101110 mmol/L 218 Direct ISE






28 29




Cholesterol, total 130 d f 62155 mg/dL 1.604.01 mmol/L 247 EDTA plasma yields 36% lower valuesm 54151 mg/dL 1.403.90 mmol/L than serum.

31182 d f 62141 mg/dL 1.603.65 mmol/Lm 81147 mg/dL 2.093.80 mmol/L

183365 d f 76216 mg/dL 1.975.59 mmol/Lm 76179 mg/dL 1.974.63 mmol/L

13 yr f 108193 mg/dL 2.794.99 mmol/Lm 85182 mg/dL 2.204.71 mmol/L






No risk 1.45 mmol/L

261 European guidelines

Moderate risk f 4565 mg/dL 1.151.68 mmol/Lm 3555 mg/dL 0.91.45 mmol/L

High risk f






30 31




Cholinesterase(CHE)

m, w >41 yr 5.3212.92 kU/L 89215 mkat/L 29, 218 Pseudocholinesterase, butyrylthiocholineiodide, Roche Diagnostics.

w, 1640 yr,not pregnant, not taking

oral contraceptives

4.2611.25 kU/L 71188 mkat/L Calculated with a temperature conversion factorof 1.52 (25 37 C)

w, 1840 yr, pregnantor taking oral contra-

ceptives

3.659.120 kU/L 61152 mkat/L

Dibucaineinhibition test

Normal individuals Inhibition: >75% Inhibition: >0.75 200

Chromium Fasting volunteers 1.01.5 mg/L 2030 nmol/L 241 Special tubes required

Copper






32 33




Creatine kinase 1 d






34 35




Creatinine Neonates, premature






36 37




Dehydroepiandro-sterone sulfate(DHEA-S)

Children






38 39




a1-Fetoprotein(AFP)

Children, adolescents






40 41




free PSA/total PSA 0.10 0.110.18 0.190.25 > 0.25 218 Free PSA Elecsys, probability of findingratio (fPSA/tPSA) m 5059 yr 49.2% 26.9% 18.3% 9.1% prostate cancer by age in years.

6069 yr 57.5% 33.9% 23.9% 12.2%70 yr 64.5% 40.8% 29.7% 15.8%

Free thyroxine(FT4)

Adults m 1.01.7 ng/dL 13.121.3 pmol/L 219 FT4 Elecsys

f 1.01.6 ng/dL 12.320.2 pmol/L

Pregnants 1st trimester 0.91.5 ng/dL 12.119.6 pmol/L2nd trimester 0.81.3 ng/dL 9.617.0 pmol/L3rd trimester 0.71.2 ng/dL 8.415.6 pmol/L

Children, adolescentsNewborn 0.862.49 ng/dL 11.032.0 pmol/L

6 d3 mth 0.892.20 ng/dL 11.528.3 pmol/L412 mth 0.921.99 ng/dL 11.925.6 pmol/L

16 yr 0.961.77 ng/dL 12.322.8 pmol/L711 yr 0.971.67 ng/dL 12.521.5 pmol/L1220 yr 0.981.63 ng/dL 12.621.0 pmol/L

0.931.7 ng/dL 12.022.0 pmol/L 218 FT4 Elecsys

Adults 1.01.6 ng/dL 12.820.4 pmol/L 146 FT4 Elecsys, healthy blood donors, selected acc.to NACB recommendations

Free triiodo-thyronine(FT3)

Adults m 2.74.3 pg/mL 4.16.7 pmol/L 219 FT3 Elecsys

f On contraceptiva 2.64.5 pg/mL 3.96.9 pmol/LNot on contraceptiva 2.34.2 pg/mL 3.66.4 pmol/L

Pregnants 1st trimester 2.53.9 pg/mL 3.86.0 pmol/L2nd trimester 2.13.6 pg/mL 3.25.5 pmol/L3rd trimester 2.03.3 pg/mL 3.15.0 pmol/L

Children, adolescentsNewborn 1.736.30 pg/mL 2.659.68 pmol/L

6 d3 mth 1.956.04 pg/mL 3.009.28 pmol/L412 mth 2.155.83 pg/mL 3.308.95 pmol/L

16 yr 2.415.50 pg/mL 3.698.46 pmol/L711 yr 2.535.22 pg/mL 3.888.02 pmol/L1220 yr 2.565.01 pg/mL 3.937.70 pmol/L

Adults, euthyroid 2.04.4 pg/mL 3.16.8 pmol/L 218 FT3 Elecsys, routine samples from commerciallaboratory

2.54.3 pg/mL 3.96.7 pmol/L FT3 Elecsys, apparently healthy blood donors

Adults 2.64.4 pg/mL 4.06.8 pmol/L FT3 Elecsys, healthy blood donors, selected acc.to NACB recommendations

Fructosamine Adults 205285 mmol/L 205285 mmol/L 295

Fructose Adults






42 43




FT4I Euthyroid subjectsGermany, Japan

USA4.812.7 mg/dL4.411.4 mg/dL

62164 nmol/L57147 nmol/L

218, 219 T4 Elecsys and T-uptake Elecsys

Adults m 5.610.7 mg/dL 72.2138 nmol/L 219 T4 Elecsys and T-uptake Elecsys

f On contraceptiva 6.212.1 mg/dL 79.7156 nmol/LNot on contraceptiva 5.111.5 mg/dL 66.1148 nmol/L

Children, adolescentsNewborn 5.0820.8 mg/dL 65.3268 nmol/L

6 d3 mth 5.4818.0 mg/dL 70.5232 nmol/L412 mth 5.6816.8 mg/dL 73.1216 nmol/L

16 yr 5.9315.0 mg/dL 76.3193 nmol/L711 yr 5.9713.9 mg/dL 76.1170 nmol/L1220 yr 5.9113.2 mg/dL 74.4162 nmol/L

Galactose Adults 126 mg/dL (7 mmol/L) or2028 h 4681 mg/dL 2.64.5 mmol/L 3. Glucose concentration 2 hours after4052 h 4879 mg/dL 2.74.4 mmol/L oGTT >200 mg/dL (11.1 mmol/L)

Children (fasting) 60100 mg/dL 3.35.6 mmol/L

Adults 74106 mg/dL 4.15.9 mmol/L 299 Plasma is recommended.6090 yr 82115 mg/dL 4.66.4 mmol/L>90 yr 75121 mg/dL 4.26.7 mmol/L

Children 60100 mg/dL 3.35.6 mmol/L

Newborns 1 d 4060 mg/dL 2.223.33 mmol/L 298>1 d 5080 mg/dL 2.784.44 mmol/L






44 45




Glucose Fetal 54103 mg/dL 3.05.7 mmol/L 78 PlasmaInfants 50180 mg/dL 2.810.0 mmol/LAdults 65110 mg/dL 3.66.1 mmol/L

AdultsVenous plasma 74109 mg/dL 4.56.0 mmol/L 218, 265 Following the recommendations of the ADA

reagarding Impaired Fasting Glucose,non-pregnants

Venous whole blood 65100 mg/dL 3.55.5 mmol/LCapillary whole blood 65100 mg/dL 3.55.5 mmol/L

Capillary plasma 74109 mg/dL 4.56.0 mmol/L

PregnantsVenous plasma 7495 mg/dL 4.55.3 mmol/L 265 Following the recommendations of the

Deutsche Diabetesgesellschaft and theDeutsche Gesellschaft fr Gynkologieund Geburtshilfe

Venous whole blood 6585 mg/dL 3.54.7 mmol/LCapillary whole blood 6585 mg/dL 3.54.7 mmol/L

Capillary plasma 74105 mg/dL 4.56.0 mmol/L

Preprandial 70100 mg/dL 3.95.6 mmol/L 265 Plasma (venous, capillary)1 h postprandial






46 47




g-Glutamyltransferase (g-GT)

Newborns, children,adolescents 1 d






48 49




Homocysteic acid f 60 yr 0.91.9 mg/L 714 mmol/L

m 85 yr 2.04.0 mg/L 1530 mmol/L 106

Human chorionicgonadotropin(hCG)

f Premenopause,non-pregnant






50 51




Immunoglobulin G, Neonates 2271378 mg/dL 15.191.9 mmol/L 160 Immunonephelometric method, valuesrecalculated (WHO, CRM 470 stan-dardization)

IgG 13 yr 442895 mg/dL 29.559.7 mmol/L46 yr 4921430 mg/dL 32.895.4 mmol/L79 yr 5591439 mg/dL 37.396.0 mmol/L

1011 yr 6811523 mg/dL 45.4101.6 mmol/L1213 yr 7411513 mg/dL 49.4100.9 mmol/L1415 yr 6991671 mg/dL 46.6111.5 mmol/L1619 yr 5361547 mg/dL 35.8103.2 mmol/L

Adults 7001600 mg/dL 7.016 g/L 89, 218 Immunoturbidimetric method,CRM 470 standardization

IgG subclasses IgG1 IgG2 IgG1 IgG25 yr 5601270 40440 mg/dL 5.612.7 0.44.4 g/L 1806 yr 6201130 50400 mg/dL 6.211.3 0.54.0 g/L7 yr 5401050 90350 mg/dL 5.410.5 0.93.5 g/L8 yr 5601050 70450 mg/dL 5.610.5 0.74.5 g/L9 yr 3901140 70470 mg/dL 3.911.4 0.74.7 g/L10 yr 4401080 60400 mg/dL 4.410.8 0.64.0 g/L11 yr 6401090 90430 mg/dL 6.410.9 0.94.3 g/L12 yr 6001150 90480 mg/dL 6.011.5 0.94.8 g/L13 yr 6101150 90790 mg/dL 6.111.5 0.97.9 g/L

Adults 480 950 170690 mg/dL 4.8 9.5 1.76.9 g/L

IgG3 IgG4 IgG3 IgG45 yr 30100 10 80 mg/dL 0.31.0 0.10.8 g/L6 yr 30 80 20 90 mg/dL 0.30.8 0.20.9 g/L7 yr 30110 20110 mg/dL 0.31.1 0.21.1 g/L8 yr 20110 10 80 mg/dL 0.21.1 0.10.8 g/L9 yr 40120 20100 mg/dL 0.41.2 0.21.0 g/L10 yr 30120 10 90 mg/dL 0.31.2 0.10.9 g/L11 yr 30 90 20100 mg/dL 0.30.9 0.21.0 g/L12 yr 40100 20 90 mg/dL 0.41.0 0.20.9 g/L13 yr 20110 10 80 mg/dL 0.21.1 0.10.8 g/L

Adults 30 80 20110 mg/dL 0.30.8 0.21.1 g/L

Immunoglobulin M, Children, adolescentsIgM






52 53




Immunoglobulinlight chains

kappa 138375 mg/dL 1.383.75 g/L 218 Immunoturbidimetric assay,lambda 93242 mg/dL 0.932.42 g/L CRM 470 standardization

kappa/lambda ratio 1.172.93 1.172.93

Insulin Healthy individuals 2.624.9 mU/mL 17.8173 pmol/L 218 Insulin Elecsys, fasting

Iron 130 d f 29127 mg/dL 5.222.7 mmol/L 246m 32112 mg/dL 5.720.0 mmol/L

112 mth f 25126 mg/dL 4.522.6 mmol/Lm 27109 mg/dL 4.819.5 mmol/L







Adults f 37145 mg/dL 6.626 mmol/L 288m 59158 mg/dL 1128 mmol/L

Iron-binding capa-city, total (TIBC) Adults 228428 mg/dL 4177 mmol/L 218 Roche/Hitachi systems

Unsaturated(UIBC)

110370 mg/dL 2066 mmol/L 218 Roche/Hitachi systems112346 mg/dL 2062 mmol/L 218 COBAS INTEGRA, cobas systems

Lactate Adults 4.519.8 mg/dL 0.52.2 mmol/L 299 Venous plasma, fluoride/oxalate tubes4.514.4 mg/dL 0.51.6 mmol/L Arterial plasma, fluoride/oxalate tubes






54 55




Lactatedehydrogenase(LDH)

1 d






56 57




Luteinizinghormone(LH)

f Follicular phase 2.412.6 mU/mL 2.412.6 U/L 218 LH Elecsys

Ovulatory phase 1496 mU/mL 1496 U/LLuteal phase 1.011.4 mU/mL 1.011.4 U/L

Postmenopause 7.759 mU/mL 7.759 U/L

m 1.78.6 mU/mL 1.78.6 IU/L

Lysozyme Adults 3.09.0 mg/L 3.09.0 mg/L 183

a2-Macroglobulin Adults 130300 mg/dL 1.33.0 g/L 237 Consensus values, CRM 470 standardization

Magnesium, total Children, adolescents,newborns

5 mth6 yr712 yr1320 yr

1.52.2 mg/dL1.72.3 mg/dL1.72.1 mg/dL1.72.2 mg/dL

0.620.91 mmol/L0.700.95 mmol/L0.700.86 mmol/L0.700.91 mmol/L

218, 299 AAS

Adults6090 yr>90 yr

1.62.6 mg/dL1.62.4 mg/dL1.72.3 mg/dL

0.661.07 mmol/L0.660.99 mmol/L0.700.95 mmol/L

ionized 1.121.46 mg/dL 0.460.60 mmol/L 118 Ion-selective electrode

erythrocytes 4.016.44 mg/dL 1.652.65 mmol/L 299 AAS

Mannose bindingprotein (MBP)

Adults 0.34.1 mg/L 0.34.1 mg/L 155

Mercury Adults, children






58 59




N-terminal probrain natriureticpeptide(NT-proBNP)

Children 116 yr f






60 61




Parathyrin,Parathyroidhormone (PTH)

24 yr f 3.632 ng/L 0.383.4 pmol/L 45m 5.734 ng/L 0.603.6 pmol/L

56 yr f 1.013 ng/L 0.101.4 pmol/Lm 4.416 ng/L 0.461.7 pmol/L






351 ng/L 0.325.4 pmol/L 250 Chemiluminescence immunoassay

Adults 1250 ng/L 1.265.3 pmol/L 149

1565 ng/L 1.66.9 pmol/L 218 PTH Elecsys

Phosphate,inorganic

Children, adolescents130 d 3.97.7 mg/dL 1.252.50 mmol/L 263

112 mth 3.56.6 mg/dL 1.152.15 mmol/L13 yr 3.16.0 mg/dL 1.001.95 mmol/L46 yr 3.35.6 mg/dL 1.051.80 mmol/L79 yr 3.05.4 mg/dL 0.951.75 mmol/L

1012 yr 3.25.7 mg/dL 1.051.85 mmol/L1315 yr 2.95.1 mg/dL 0.951.75 mmol/L1618 yr 2.74.9 mg/dL 0.951.60 mmol/L

Adults 2.64.5 mg/dL 0.841.45 mmol/L

2.74.5 mg/dL 0.871.45 mmol/L 218

Phosphohexoseisomerase (PHI)

2090 U/L 0.351.50 mkat/L 239

Potassium Adults 3.55.1 mEq/L 3.55.1 mmol/L 218, 299 Roche Diagnostics, indirect ISE, serumflame photometry, plasmaf

m3.44.4 mEq/L3.54.5 mEq/L

3.44.4 mmol/L3.54.5 mmol/L

Children 17 d 3.25.5 mEq/L 3.25.5 mmol/L 247 Plasma, dry slide technology831 d 3.46.0 mEq/L 3.46.0 mmol/L

16 mth 3.55.6 mEq/L 3.55.6 mmol/L7 mth1 yr 3.56.1 mEq/L 3.56.1 mmol/L

>1 yr 3.34.6 mEq/L 3.34.6 mmol/L

Adults 3.75.5 mEq/L 3.75.5 mmol/L 218 COBAS INTEGRA, direct ISE, serum3.64.5 mEq/L 3.64.5 mmol/L COBAS INTEGRA, direct ISE, plasma

3.65.0 mEq/L 3.65.0 mmol/L 218 Reflotron, serum3.54.6 mEq/L 3.54.6 mmol/L Reflotron, plasma






62 63




Prealbumin Children






64 65




Protein, total Children, adolescents1 w 4.47.6 g/dL 4476 g/L 218, 299

7 mth12 mth 5.17.3 g/dL 5173 g/L12 yr 5.67.5 g/dL 5675 g/L>3 yr 6.08.0 g/dL 6080 g/L

Newborns 4.67.0 g/dL 4670 g/LPremature 3.66.0 g/dL 3660 g/L

Umbilical cord 4.88.0 g/dL 4880 g/L

Adults 6.48.3 g/dL 6483 g/L

ElectrophoresisAlbumin 5569% 0.550.69 79 Ponceau Red S

a1-Globulin 1.65.8% 0.020.06a2-Globulin 5.911% 0.060.11b-Globulin 7.914% 0.080.14g-Globulin 1118% 0.110.18

Pyruvate Adults 0.360.59 mg/dL 4167 mmol/L 152 Whole blood, deproteinize immediately usingice-cold perchloric acid.

Rheumatoid factor(RF)

Adults 90 yr 132146 mEq/L 132146 mmol/L

Adults 146157 mEq/L 146157 mmol/L 218 COBAS INTEGRA, direct ISE

Sorbitol 0.50.9 mg/dL 2749 mmol/L 28 Plasma, deproteinize immediately.

Squamous cellcarcinoma antigen(SCC)






66 67




Testosterone Children, adolescents, m






68 69




Thyroxine-binding 0.81.3 0.81.30 218, 219 T-uptake Elecsys

capacity (as TBI)

Transferrin Adults 2.03.6 g/L 25.245.4 mmol/L 89, 218, Immunoturbidimetric assay,237 CRM 470 standardization

Transferrin, carbo-hydrate deficient(as% CDT)

Adults 3.0% 3.0% 218 Roche Diagnostics, immunoturbidimetric assay,elevated values indicate alcohol misuse.

Transferrin receptor,soluble (sTfR)

624 mth 1.372.85 mg/L 1.372.85 mg/L 144 Enzyme immunoassay26 yr 1.053.05 mg/L 1.053.05 mg/L712 yr 1.162.72 mg/L 1.162.72 mg/L18 yr 0.842.32 mg/L 0.842.32 mg/L

Adultsf 1845 yr 1.94.4 mg/L 2252 nmol/L 141 Roche Diagnostics, immunoturbidimetric assaym 1860 yr 2.25.0 mg/L 2659 nmol/L

Transferrinsaturation (TS)

1645% 1645% 262 TS [%] = Fe [mg/dL]q 70.9/Transferrin [mg/dL]

Triglycerides Premature






70 71




T-uptake Blood donors 24.339.0% 0.2430.390 218 Roche Diagnostics, homogeneous enzyme(free thyroxinebinding capacity)

immunoassay

Urea Children 13 yr 1136 mg/dL 1.86.0 mmol/L 268413 yr 1536 mg/dL 2.56.0 mmol/L1419 yr 1845 mg/dL 2.97.5 mmol/L

Adults 1743 mg/dL 2.87.2 mmol/Lf, 50 yr 2143 mg/dL 3.57.2 mmol/L

m, 50 yr 1855 mg/dL 3.09.2 mmol/L

Adultsf 1849 yr 1638 mg/dL 2.66.4 mmol/L 227 NORIP

50 yr 1947 mg/dL 3.17.9 mmol/Lm 1849 yr 1949 mg/dL 3.28.1 mmol/L

50 yr 2149 mg/dL 3.58.1 mmol/L

Uric acid Childrenf 130 d 1.04.6 mg/dL 59271 mmol/L 267

31365 d 1.15.4 mg/dL 65319 mmol/L13 yr 1.85.0 mg/dL 106295 mmol/L46 yr 2.05.1 mg/dL 118301 mmol/L79 yr 1.85.5 mg/dL 106325 mmol/L

1012 yr 2.55.9 mg/dL 148348 mmol/L1315 yr 2.26.4 mg/dL 130378 mmol/L1618 yr 2.46.6 mg/dL 142389 mmol/L

m 130 d 1.23.9 mg/dL 71230 mmol/L31365 d 1.25.6 mg/dL 71330 mmol/L



Adults f 2.36.1 mg/dL 137363 mmol/L Recommended upper limit of males: 7 mg/dLm 3.68.2 mg/dL 214488 mmol/L (416 mmol/L)

f 2.45.7 mg/dL 142.8339.2 mmol/L 218 Roche/Hitachi, COBAS INTEGRA, cobas,m 3.47.0 mg/dL 202.3416.5 mmol/L Reflotron systems

Adultsf 1849 yr 2.65.8 mg/dL 155350 mmol/L 227 NORIP

50 yr 2.66.7 mg/dL 155400 mmol/Lm 18 yr 3.98.1 mg/dL 230480 mmol/L






72 73




Vitamin A 15 yr f 185841 mg/dL 6.529.4 mmol/L 110 HPLC(Retinol) m 113805 mg/dL 3.928.1 mmol/L



>60 yr f 3801116 mg/dL 13.338.9 mmol/Lm 6001275 mg/dL 20.944.5 mmol/L

Vitamin B1 0.130.75 mg/dL 528 nmol/L 293 HPLC, serum(Thiamine) 1.94.9 mg/dL 71185 nmol/L HPLC, whole blood

Vitamin B2(Riboflavin)

1050 mg/dL 0.271.33 mmol/L 299 HPLC, fluorimetry

Vitamin B6 (Pyri-doxal phosphate)

1.02.4 mg/dL 3998 nmol/L 21 HPLC

Vitamin B12 30 ng/mL >75 nmol/L 280 Health-based reference range






74 75




Vitamin E 60 yr f 0.71.6 mg/dL 1636 mmol/Lm 0.81.6 mg/dL 1938 mmol/L

Vitamin K Adults 0.170.68 mg/L 0.381.51 nmol/L 21 HPLC, fasting

Zinc






76 77

2.2 Hematology


NotesGoup Conventional SI

CO-Hb Non-smokers






78 79

2.2 Hematology



Glucose-6-phos-phate dehydro-genase (G-6-P-DH)

7.916.3 U/g Hb 0.521.04 mU/mol Hb 299 Blood treated with heparinate or EDTA, 37 C

Hematocrit 1 d 4472% 0.440.72 122(Hct, PCV) 26 d 5082% 0.500.82

1423 d 4262% 0.420.622437 d 3159% 0.310.594050 d 3054% 0.300.54

22.5 mth 3046% 0.300.463 -3.5 mth 3143% 0.310.4357 mth 3244% 0.320.44

8 mth3 yr 3543% 0.350.435 yr 3143% 0.310.4310 yr 3345% 0.330.45

Adults f 3547% 0.350.47m 4052% 0.400.52

Hemoglobin (Hb) 1 d 15.223.6 g/dL 9.414.7 mmol/L 122in blood 26 d 15.024.6 g/dL 9.315.3 mmol/L

1423 d 12.718.7 g/dL 7.911.6 mmol/L2437 d 10.317.9 g/dL 6.411.1 mmol/L4050 d 9.016.6 g/dL 5.610.3 mmol/L

22.5 mth 9.213.6 g/dL 5.78.4 mmol/L33.5 mth 9.612.8 g/dL 6.07.9 mmol/L57 mth 10.112.9 g/dL 6.38.0 mmol/L810 mth 10.512.9 g/dL 6.58.0 mmol/L

1113.5 mth 10.713.1 g/dL 6.68.1 mmol/L1.53 yr 10.812.8 g/dL 6.77.9 mmol/L

5 yr 10.714.7 g/dL 6.69.1 mmol/L10 yr 10.815.6 g/dL 6.79.7 mmol/L

Adults f 12.315.3 g/dL 7.69.5 mmol/L 294m 14.017.5 g/dL 8.710.9 mmol/L

>70 yr fm

11.716.2 g/dL12.117.6 g/dL

7.310.1 mmol/L7.510.9 mmol/L

189

>75 yr fm

11.616.1 g/dL11.817.5 g/dL

7.210.0 mmol/L7.310.9 mmol/L

>81 yr fm

10.915.5 g/dL11.616.3 g/dL

6.89.6 mmol/L7.210.1 mmol/L

Hb compositionHbA0 9094% 0.900.94 294HbA1 48% 0.040.08HbA2 1.43.0% 0.0140.03HbF 0.31.0% 0.0030.01






80 81

2.2 Hematology



Leucocytes 12 h 13,00038,000/mL 13.038.0 gpt/L 561 d 9,40034,000/mL 9.434.0 gpt/L1 w 5,00021,000/mL 5.021.0 gpt/L2 w 5,00020,000/mL 5.020.0 gpt/L4 w 5,00019,500/mL 5.019.5 gpt/L

2 mth 5,50018,000/mL 5.518.0 gpt/L412 mth 6,00017,500/mL 6.017.5 gpt/L

2 yr 6,00017,000/mL 6.017.0 gpt/L4 yr 5,50015,500/mL 5.515.5 gpt/L6 yr 5,00014,500/mL 5.014.5 gpt/L

812 yr 4,50013,500/mL 4.513.5 gpt/L1416 yr 4,50013,000/mL 4.513.0 gpt/L

18 yr 4,50012,500/mL 4.512.5 gpt/L20 yr 4,50011,500/mL 4.511.5 gpt/L

Adults 4,40011,300/mL 4.411.3 gpt/L 294

MCH (Hb/RBC) 1 d 3341 pg/cell 2.02.5 fmol/cell 12226 d 2945 pg/cell 1.82.8 fmol/cell

1437 d 2638 pg/cell 1.62.4 fmol/cell4050 d 2537 pg/cell 1.62.3 fmol/cell

22.5 mth 2436 pg/cell 1.52.2 fmol/cell33.5 mth 2336 pg/cell 1.42.2 fmol/cell510 mth 2133 pg/cell 1.32.0 fmol/cell

11 mth5 yr 2331 pg/cell 1.41.9 fmol/cell10 yr 2234 pg/cell 1.42.1 fmol/cell

Adults 2833 pg/cell 1.72.0 fmol/cell 294

MCHC 1 d 3135 g/dL 1922 mmol/L 12226 d 2436 g/dL 1522 mmol/L

1423 d 2634 g/dL 1621 mmol/L2437 d 2537 g/dL 1623 mmol/L

40 d7 mth 2634 g/dL 1621 mmol/L813.5 mth 2832 g/dL 1720 mmol/L

1.53 yr 2634 g/dL 1621 mmol/L510 yr 3236 g/dL 2022 mmol/L

Adults 3336 g/dL 2022 mmol/L 294






82 83

2.2 Hematology



MCV 1 d 98122 mm3 98122 fL 12226 d 94150 mm3 94150 fL

1423 d 84128 mm3 84128 fL2437 d 82126 mm3 82126 fL

22.5 mth 81121 mm3 81121 fL33.5 mth 77113 mm3 77113 fL57 mth 73109 mm3 73109 fL810 mth 74106 mm3 74106 fL

1113.5 mth 74102 mm3 74102 fL1.53 yr 73101 mm3 73101 fL

5 yr 7288 mm3 7288 fL10 yr 6993 mm3 6993 fL

Adults 8096 mm3 8096 fL 294

Methemoglobin Non-smokers/smokers 0.005 NaCl 56 Heparinized bloodof erythrocytes Complete hemolysis






84 85

2.2 Hematology



Thrombocytes 15 yr f 229553 q 103/mL 229553 Gpt/L 80m 217497 q 103/mL 217497 Gpt/L

610 yr f 184488 q 103/mL 184488 Gpt/Lm 181521 q 103/mL 181521 Gpt/L








>70 yr f 149409 q 103/mL 149409 Gpt/Lm 139335 q 103/mL 139335 Gpt/L

Volume Blood f 4969 mL/kg 0.0490.069 L/kg 56

m 4479 mL/kg 0.0440.079 L/kg Erythrocytes f 1929 mL/kg 0.0190.029 L/kg

m 2037 mL/kg 0.0200.037 L/kg Plasma f 2841 mL/kg 0.0280.041 L/kg

m 2344 mL/kg 0.0230.044 L/kg






86 87

2.3 Coagulation



Antiphospholipidantibodies (APA)

No antibodies No antibodies 273 ELISA, Asserachrom* APA

a2-Antiplasmin 210 yr 108155% 1.081.55 1911118 yr 79161% 0.791.61

Adults 80120% 0.801.2 218 Photometric assay

Full-term infants 1 d 0.551.15 U/mL 0.551.15 U/mL 45 d 0.701.30 U/mL 0.701.30 U/mL30 d 0.761.24 U/mL 0.761.24 U/mL90 d 0.761.40 U/mL 0.761.40 U/mL180 d 0.831.39 U/mL 0.831.39 U/mLAdults 0.681.36 U/mL 0.681.36 U/mL

Antithrombin III Infants, premature 1 d 2051% 0.200.51 1994 d 2151% 0.210.517 d 4054% 0.400.54

Infants, full-term 1 d 4484% 0.440.847 d 3470% 0.340.70

Children 210 yr >67% >0.67 1911118 yr >81% >0.81

Adults >80% >0.80 108 Activity test, chromogenic substrate

Bleeding time 15 yr






88 89

2.3 Coagulation



Factor II Neonates 3159% 0.310.59 202

Adults >70% >0.70 20

Factor V Neonates 42182% 0.421.82 202

Adults >70% > 0.70 20

Factor VII Neonates 3495% 0.340.95 22810 yr f 60122% 0.601.22

m 56140% 0.561.4013 yr f 69131% 0.691.31

m 68125% 0.681.25

Adults >70% >0.70 20

55170% 0.551.70 218

Factor VIII 210 yr 52300% 0.523.00 1921118 yr 54170% 0.541.70

Adults >70% >0.70 20

Adults 60150% 0.601.50 218

Factor IX Neonates 1155% 0.110.55 192

210 yr 6098% 0.600.98 283Adults >60% >0.60

Factor X Neonates 2445% 0.240.45 191

Adults >70% >0.70 20, 218

Factor XI 116 yr 56156% 0.561.56 72

Adults >70% >0.70 20

Adults 60150% 0.601.50 218

Factor XII 116 yr 52192% 0.521.92 72 Newborns have approx. 50% of the adult value

Adults >60% >0.60 20, 218

Factor XIII Adults >60% >0.60 20

Fibrin monomers Adults






90 91

2.3 Coagulation



Fibrinogen Infants, premature 1 d 150370 mg/dL 1.53.7 g/L 125 d 160420 mg/dL 1.64.2 g/L

1 mth 150410 mg/dL 1.54.1 g/L3 mth 150350 mg/dL 1.53.5 g/L6 mth 150360 mg/dL 1.53.6 g/L

Infants, full-term 1 d 160400 mg/dL 1.64.0 g/L 115 d 160460 mg/dL 1.64.6 g/L

1 mth 160380 mg/dL 1.63.8 g/L3 mth 150380 mg/dL 1.53.8 g/L6 mth 160390 mg/dL 1.63.9 g/L

210 yr 140360 mg/dL 1.43.6 g/L 1911118 yr 160390 mg/dL 1.63.9 g/L

Adults 200400 mg/dL 2.04.0 g/L 218 Fibrinogen levels increase during pregnancy

Fibrin(ogen)degradationproducts (FDP)

Adults 0.70

High molecular 116 yr 47123% 0.471.23 72weight kininogen(HMWKG)

Adults >70% >0.70 20

Internationalnormalizedratio (INR)

Atrial fibrillation/flutter INR 2.03.0 182 When determining the INR the bleedingand thrombosis risk has to be consideredindividually for each patient.

Valvular defects INR 2.03.0

Valve replacementsa) Mechanical valvesBileaflet valves/tilting disc valves in aortic position

INR 2.03.0

in mitral position INR 2.53.5

Caged Ball valves INR 2.53.5Mechanical valve + embolism INR 2.53.5b) Bioprosthetic valves INR 2.03.0 For 3 months

Deep vein thrombosis/pulmonary embolism INR 2.03.0






92 93

2.3 Coagulation



a2-Macroglobulin Full-term infants 1 d 0.951.83 U/mL 0.951.83 U/mL 45 d 0.981.98 U/mL 0.981.98 U/mL

1 mth 1.061.94 U/mL 1.061.94 U/mL3 mth 1.262.26 U/mL 1.262.26 U/mL6 mth 1.492.33 U/mL 1.492.33 U/mLAdults 0.521.20 U/mL 0.521.20 U/mL

(Activated) Partial Premature infants 1 d






94 95

2.3 Coagulation



Plasminogen activa-tor inhibitor (PAI)






96 97

2.3 Coagulation



Prothrombin 16 yr 0.351.20 nmol/L 0.351.20 nmol/L 215 Enzyme immunoassayfragments 1+2 712 yr 0.361.28 nmol/L 0.361.28 nmol/L

1318 yr 0.281.40 nmol/L 0.281.40 nmol/LAdults 0.381.14 nmol/L 0.381.14 nmol/L

Prothrombin time(PT)

6 mth5 yr6 yr7 yr816 yr

53100%65100%77100%

0.531.000.651.000.771.00

191 Therapeutic range in percent is methoddependent and corresponds to INR: 2.04.5.Values >100% are of no clinical significance.

Adults >70% >0.70 218

Reptilase time Adults






98 99

2.3 Coagulation



Tissue plasminogenactivator (t-PA)






100 101

2.4 Blood gases



Base excess Adults 2 to + 3 mmol/L 2 to + 3 mmol/L 184 Blood, arterial, venous

O2-saturation Adults 9498% 0.940.98 184 Blood, arterialBlood, venous7080% 0.700.80

pCO2 Children A. umb. 3580 mm Hg 4.710.7 kPa 184 BloodV. umb. 3057 mm Hg 4.07.6 kPa

Children 1 d 2961 mm Hg 4.08.0 kPa10 d3 mth 2743 mm Hg 3.55.7 kPa412 mth 2740 mm Hg 3.65.3 kPa

Adults w 3243 mm Hg 4.35.7 kPam 3546 mm Hg 4.76.1 kPa

pH Children A. umb. 7.097.40 7.097.40 184 BloodV. umb. 7.157.45 7.157.45

Children 1 d 7.207.41 7.207.4110 d3 mth 7.347.45 7.347.45412 mth 7.387.45 7.387.45

Adults 7.377.45 7.377.45 Blood, arterial7.357.43 7.357.43 Blood, mixed venous

pO2 Children A. umb. < 22 mm Hg < 2.9 kPa 184 BloodV. umb. 1635 mm Hg 2.24.7 kPa

10 d3 mth 7085 mm Hg 9.311.4 kPaAdults 71104 mm Hg 9.513.9 kPa Blood, arterial

3644 mm Hg 4.85.9 kPa Blood, mixed venous

Standardbicarbonate

Children V. umb. 1221 mmol/L 1221 mmol/L 184 Blood

Children 1 d 1923 mmol/L 1923 mmol/L10 d3 mth 1925 mmol/L 1925 mmol/L412 mth 2024 mmol/L 2024 mmol/L

Adults 2126 mmol/L 2126 mmol/L

2229 mmol/L 2229 mmol/L Serum, plasma






102 103

* The therapeutic range given is a general recommendation which can only be clinically interpreted in conjunction with the toxicity and the therapeutic efficacy of the drug monitored.

2.5 Therapeutic drug monitoring

Analyte Therapeutic Range* Refe-rence


Acetaminophene 1030 mg/mL 66199 mmol/L 218 Immunoturbidimetric assay, Roche Diagnostics

Acetylsalicylic acid 50300 mg/mL 0.831.66 mmol/L 193 Blood collection: 13 h after oral dose.

Amikacin Peak: 2025 mg/mLTrough: 510 mg/mL

3443 mmol/L917 mmol/L

218 Fluorescence polarization immunoassay,immunoturbidimetric immunoassay,Roche Diagnostics

Benzodiazepine






104 105


Analyte Therapeutic Range* Refe-rences


Methotrexate A generally applicable therapeuticrange is not available.

Therapeutic concentrationsdepend on the treatment

protocol.

299 Collect specimen at 0.5 or 2 h after i.v. or p.o.low dose, respectively. Collect specimen at 24,48, and 72 h after high-dose infusion.

Mycophenolic acid,total (MPA)

Therapeutic range not yet fullyestablished and dependent

on transplant type andco-administered drugs.

218

N-Acetytylprocain-amide (NAPA)

530 mg/mL 18.1108.3 mmol/L 218 Immunoturbidimetric assay, homogeneousimmunoassay, fluorescence polarizationimmunoassay, Roche Diagnostics; commonlyaccepted therapeutic range for the sum of NAPAand procainamide. For effective treatment,some patients may require serum/plasma levelsoutside thise range.

Phenobarbital 1540 mg/mL 65172 mmol/L 218 Immunoturbidimetric assay, homogeneousimmunoassay, fluorescence polarizationimmunoassay, Roche Diagnostics; some pa-tients may require serum/plasma levels outsidethise range to obtain effective seizure control.

Phenytoin Premature infantsAdults

614 mg/mLapprox. 1020 mg/mL

2456 mmol/Lapprox. 4080 mmol/L

218 Immunoturbidimetric assay, homogeneousimmunoassay, fluorescence polarizationimmunoassay, Roche Diagnostics.

Primidone 512 mg/mL 22.950 mmol/L 218 Fluorescence polarization immunoassay,Roche Diagnostics.

Procainamide 410 mg/mL 16.942.3 mmol/L 218 Immunoturbidimetric assay, homogeneousimmunoassay, fluorescence polarizationimmunoassay, Roche Diagnostics.

Quinidine 1.55 mg/mL 4.615 mmol/L 218 Thrapeutic ranges established with unspecificmethods that measure quinidine as well asquinidine metabolites.

Salicylic acid 30100 mg/mL150300 mg/mL

0.220.72 mmol/L1.092.17 mmol/L

218 Antipyretic/analgetic conditions.Anti-inflammatory/rheumatic fever conditions.Colorimetric assay, enzymatic UV test;Roche Diagnostics.

Tacrolimus 520 ng/mL (trough) 416 mmol/L (trough) 299







106 107


Analyte Therapeutic Range* Refe-rences


Theophylline approx. 1020 mg/mL approx. 56111 mmol/L 218 Homogeneous immunoassay, fluorescenceimmunoassay, immunoturbidimetric assay,Roche Diagnostics.

Tobramycin Peak: 610 mg/mLTrough: 0.52.0 mg/mL

Peak: 12.821.4 mmol/LTrough: 1.14.3 mmol/L

218 Homogeneous immunoassay, fluorescenceimmunoassay, Roche Diagnostics

Valproic acid 50100 mg/mL 347693 mmol/L 218 Homogeneous immunoassay, fluorescenceimmunoassay, Roche DiagnosticsFluorescence immunoassay, Roche Diagnostics

free fraction 515% of the plasma value 0.050.15 of the plasma value

Vancomycin Peak: 2040 mg/mLTrough: 510 mg/mL

Peak: 1428 mmol/LTrough: 3.57.0 mmol/L

218 Homogeneous immunoassay, fluorescenceimmunoassay, Roche Diagnostics







108 109

2.6.1 Urinalysis, urinary sediment and status



Bacteria Children






110 111

2.6.1 Urinalysis, urinary sediment and status



Urinary statusBilirubin






112 113

2.6.2 Clinical chemical urinalysis



a1-Acid glycoprotein(Orosomucoid)

1 mth15 yr






114 115




C-Peptide Adults 17.2181 mg/24 h 5.7460.3 nmol/d 218 24 h-urine, C-Peptide Elecsys

Creatinine Adults f 28217 mg/dL 2.4719.2 mmol/L 172 Roche Diagnostics, kinetic Jaff method,m 39259 mg/dL 3.4622.9 mmol/L rate-blanked, compensated, 1st morning

urine.

f 0.74- 1.57 g/24 h 6.613.9 mmol/d 126 Roche Diagnostics, kinetic Jaff method,m 1.042.35 g/24 h 9.220.7 mmol/d rate-blanked, compensated, 24 h-urine.

f 29226 mg/dL 2.5520.0 mmol/L 172 Roche Diagnostics, enzymatic method,m 40278 mg/dL 3.5424.6 mmol/L 1st morning urine.

f 0.721.51 g/24 h 6.313.4 mmol/d 126 Roche Diagnostics, enzymatic method,24 h-urine.m 0.982.20 g/24 h 8.6- 19.4 mmol/d

Creatinineclearance

Adults 71.2151 mL/min 71.2151 mL/min 126 Roche Diagnostics, Jaff kin., rate-blanked, compensated, measured.

82.5120 mL/min 82.5120 mL/min Calculated acc. to Cockroft-Gault.77132.2 mL/min 77132.2 mL/min Calculated using MDRD study formula.

52.1110 mL/min 52.1110 mL/min Roche Diagnostics, Jaff kin., rate-blanked, non-compensated, measured.

67.5141 mL/min 67.5141 mL/min Calculated acc. to Cockroft-Gault.64.397.7 mL/min 64.397.7 mL/min Calculated using MDRD study formula.

66.3143 mL/min 66.3143 mL/min Roche Diagnostics, enzym. method,measured.

79.9167 mL/min 79.9167 mL/min Calculated acc. to Cockroft-Gault.76.6127.3 mL/min 76.6127.3 mL/min Calculated using MDRD study formula.

Cystine Clinical patients 5.537 mg/24 h 46306 pmol/d 157 24 h-urine, pH 23

Deoxypyridinolintotal 1964 mg/g crea 517 mmol/mol crea 23free 635 mg/g crea 1.69.3 mmol/mol crea

Fructose Adults






116 117




Immunoglobulinlight chains k/l ratio

Adults 0.704.50 0.704.50 218 Roche Diagnostics, immunoturbidi-metric method

Immunoglobulin G(IgG)

Children






118 119




PorphyrinsTotal porphyrin Adults






120 121

2.7 Urinary calculi, gallstones

Concrement Major components Refe-rences

Gallstones Bilirubin 99

Calcium carbonate

Cholesterol

Urinary calculi Calcium hydrogen phosphate dihydrate 99

Calcium oxalate dihydrate

Calcium oxalate monohydrate

Carbonate apatite

Cystine

2,8-Dihydroxyadenine

Magnesium ammonium phosphate hexahydrate

Magnesium ammonium phosphate monohydrate

Mono-ammonium urate

Mono-sodium urate monohydrate

Protein

Uric acid

Uric acid dihydrate

Xanthine






122 123

2.8 CSF

Analyte Reference Range Refe-rences


Albumin Adults 110350 mg/L 110350 mg/L 211

Albumin, CSF/serum ratio

Children 15 yr 5.0 q 103 5.0 q 103 210, 218

Adults 40 yr 6.5 q 103 6.5 q 103 60 yr 8.0 q 103 8.0 q 103

Cells NeonatesAdults






124 125

2.9 Stool


NotesConventional SI

Albumin 220 nkat/g 218

Composition Dry substance 1060 g/24 h 1060 g/d 214Volume of water 100180 mL/24 h 100180 mL/dNeutral fats






126 127

2.10 Spermiogram


a-Glucosidase > 20 mU/ejaculate 291

Acid phosphatase > 200 mmol/ejaculate

Citrate > 52 mmol/ejaculate

Fructose > 13 mmol/ejaculate

Leucocytes < 1 mil/mL

MAR test < 10% of spermatozoa with adhesive particlesor erythrocytes

Morphology > 30% normally formed spermatozoa

Motility > 50% spermatozoa with progressive motility(categories a and b)or> 25% spermatozoa with rapid progressivemotility (category a)

pH 7.2 7.8

Sperm concentration > 20 mil spermatozoa/mL

Total sperm count > 40 mil spermatozoa/ejaculate

Vitality > 75% vital spermatozoa, i.e. cells not absorbingeosin dye

Volume > 2 mL

Zinc > 2.4 mmol/ejaculate


Normozoosperms Normal ejaculate findings 291

Oligozoosperms < 20 mil spermatozoa/mL

Cryptozoosperms < 1 mil spermatozoa/mL

Polyzoosperms > 250 mil spermatozoa/mL

Asthenozoosperms < 50% of spermatozoa with progressive motility(categories a and b) and< 25% of spermatozoa with motility of category a

Teratozoosperms < 30% of spermatozoa with normal morphology

Oligoasthenoterato-zoosperms

Combination of oligo-, astheno- and teratozoo-sperms

Azoosperms No spermatozoa in the ejaculate

Parvisemia Ejaculate volume < 2 mL

Hypersemia Ejaculate volume > 6 mL

Aspermia No ejaculate

Hemosperms Erythrocytes in ejaculate






128 129

2.11 Extravascular body fluids

Amniotic fluid

Analyte Reference Ranges Ref.

Albumin < 3.0 g/LBicarbonate 11 45 mmol/L

39Bilirubin < 0.1 mg/dLCalcium 0.86 2.57 mmol/L

9>>=>>;

CEA < 107 mg/L 61Chloride 83 111 mmol/L 39Creatinine 0.2 0.7 mg/dL 39Erythropoietin 1.2 6.5 U/L 37Glucose 45 76 mg/dL 39hCG < 4300 IU/L 61Lysozyme 6 12 mg/L 91Osmolality 268 280 mosmol/kg 39Phosphate, inorg. 0.5 2.8 mmol/L 39Potassium 3.7 4.4 mmol/L 39Prolactin < 70 nmol/L 61Protein < 4.0 g/LSodium 139 144 mmol/L 39Urea 12 32 mg/dL

9=;

Ascites


Nonmalignant Malignant

CEA < 2.5 mg/L > 2.5 mg/LCholesterol < 45 mg/dL > 45 mg/dL 76LDH 60% of theserum LDH

9=;

Phospholipids 0.15 0.84 mmol/L 0.14 1.34 mmol/L 75Protein < 30 g/L > 30 g/L 76Triglycerides 14 164 mg/dL 17 849 mg/dL 75

Bile, clear colorless fluid


Bilirubin < 1.3 mg/dLCalcium 0.6 4.6 mmol/LChloride 94 152 mmol/L 274Cholesterol 6 20 mg/dLGlucose < 5 mg/dL

9>>>>=>>>>;

Lysozyme < 0.8 mg/L 91Magnesium < 0.2 mmol/LOsmolality 1006 1019 mosmol/kgpH 6.64 8.46Phosphate, inorg. < 1.0 mmol/LPhospholipids < 50 mg/dL

274

Potassium 3.0 6.6 mmol/LProtein < 9 g/LSodium 138 162 mmol/L

9>>>>>>>>>>=>>>>>>>>>>;

Bile, yellow bile


Bicarbonate 7 42 mmol/LBilirubin 9 77 mg/dLCalcium 2.3 4.9 mmol/L 274Chloride 80 144 mmol/LCholesterol 123 209 mg/dL

9>>>>=>>>>;

Color yellowGlucose < 8 mg/dL 274Iron excretion 0.14 0.50 mmol/h 204Magnesium 0.7 1.3 mmol/LOsmolality 1016 1018 mosmol/kgpH 5.78 8.22Phosphate, inorg. < 0.6 mmol/LPhospholipids 113 381 mg/dL

274

Protein 2 6 g/LPotassium 3.8 5.4 mmol/LSodium 144 170 mmol/L

9>>>>>>>>>>=>>>>>>>>>>;

Volume 0.5 1 L/24 h






130 131

Coelomic fluid


Albumin 2.0 11 g/LBicarbonate 16 29 mmol/LBilirubin < 0.5 mg/dLCalcium 1.8 3.0 mmol/LChloride 100 115 mmol/LCreatinine 0.4 3.0 mg/dL

39Glucose 50 88 mg/dLOsmolality 264 275 mosmol/kgPhosphate, inorg. 1.2 12 mmol/LPotassium 3.5 4.2 mmol/LSodium 135 141 mmol/LUrea 16 41 mg/dL

9>>>>>>>>>>>>>>>>>>=>>>>>>>>>>>>>>>>>>;

Duodenal fluid


Calcium 0.7 4.2 mmol/LPotassium 4.2 11.0 mmol/L 77Sodium 97 153 mmol/L

9=;

Amylase 130 3400 U/minBicarbonate 8 73 mmol/hChymotrypsin after secretin stimulation 16 150 U/min 225Lipase 950 7200 U/minTrypsin 1 42 mg/minVolume 120 800 mL/h

9>>>>>>=>>>>>>;

8>>>>>>>>>>>:

Gastric juice


Ammonium 0.6 1.9 mmol/L 136Ascorbic acid 17 31 mg/L 207Calcium 0.6 7.0 mmol/L 178CEA < 0.5 mg/L 32Chloride 6 48 mth 84 119 mmol/L 3

Adults 57 137 mmol/L 178Citrate 3.3 6.5 mg/dL 201Free acid < 78 mmol/L 178b-Glucosidase < 5.0 mg/L 221Lactate 1.9 3.7 mg/dL 201LDH >>>>>>>>>>>>>>>>>>>>>>>>>=>>>>>>>>>>>>>>>>>>>>>>>>>>;

Differentiation between chyle and pseudochyle is possible with the detection ofchylomicrons (only in chyle) and triglycerides 2 to 8 times higher in chyle than inpseudochyle (45).





18.2.10 17:46 3. Autorkorrekturhgd / muckel Version: 9.1 M110H:/3B2/Roche/19816_ReferenceRanges/3B

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