NORMAL VALUES – Hematology Determination Bleeding Time Fibrinogen Activated Partial Thromboplastin Time Normal Adult Reference Range Conventional Units SI Units 1.5 – 9.5 min 1.5 – 9.5 min 200 – 400 mg/dL 2 – 4 g/dL Lower limit of normal: 20 – 25 sec Clinical Significance Prolonged in thrombocytopenia, defective plt function and ASA therapy Prolonged in deficiency of fibrinogen, factors II, V, VIII, IX, X, XI, and XII, and in heparin therapy Upper limit of normal: 32 – 39 sec Lower limit of normal: 10 sec Prothrombin Consumption Impaired in deficiency of factors VIII, IX, and X Upper limit of normal: 14 sec Prothrombin Time Prolonged by deficiency in factors I, II, V, VII, and X, fat malabsorption, severe liver dse, Coumadin anticoagulant therapy 9.5 – 12 sec 1.0 INR Erythrocyte Count (Red Blood Cells) 2–3 (for therapy in AFib, DVT and pulmo embolism) 2.5 – 3.5 (for therapy in prosthetic heart valves) Males: 4.6 – 6.2 million/mm3 Females: 4.2 – 5.4 million/ mm3 Used to standardize the prothrombin time and anticoagulation therapy 4.6 – 6.2 x 1012/ L 4.2 – 5.4 x 1012/ L Increased in severe diarrhea and DHN, polycythemia, acute poisoning, pulmonary fibrosis Decreased in all anemias, in leukemia and after hemorrhage when blood volume has been restored ERYTHROCYTE INDICES Mean corpuscular volume (MCV) Mean corpuscular hemoglobin (MCH) Mean corpuscular hemoglobin concentration (MCHC) Erythrocyte Sedimentation Rate (ESR) – Westergren method 84 – 96 cu µm 84 – 96 fL 28 – 33 µµg/cell 28 - 33 pg Males under 50: < 15mm/h Males over 50: < 20 mm/h Concentration fraction: 0.33 – 0.35 < 15 mm/h < 20 mm/h Females under 50: <25 mm/h Females over 50: <30 mm/h < 25 mm/h < 35 mm/h 33 – 35% Increased in macrocytic anemias Decreased in microcytic anemia Increased in macrocytic anemias Decreased in microcytic anemia Decreased in severe hypochromic anemia Increased in tissue destruction (inflammatory or degenerative), during menstruation and pregnancy and in acute febrile disease Erythrocyte Sedimentation Rate – Zeta centrifuge Hematocrit Hemoglobin LEUKOCYTE COUNT < 50 y/o: < 55% 50 – 80 y/o: 40 – 60% Volume fraction: <0.55 Volume fraction: 0.4 – 0.6 Males: 42 – 52% Females: 35 – 47% Volume fraction: 0.42 – 0.52 Volume fraction: 0.35 – 0.47 Males: 13 – 18 g/dL Females: 12 – 16 g/dL 2.02 – 2.79 mmol/L 1.86 – 2.48 mmol/ L 4,500 – 11,000/ mm3 4.5 – 11 x 109/L Significance similar to ESR Decreased in severe anemias, anemia of pregnancy, acute massive blood loss Increased in erythrocytosis of any cause, and in DHN or hemoconcentration associated with shock Decreased in various anemias, pregnancy, severe or prolonged hemorrhage and with excessive fluid intake Increased in polycythemia, COPD, failure of oxygenation because of CHF, and normally in people living at high altitudes Increased with acute infections, trauma or surgery, leukemia, malignant disease, necrosis Neutrophils 45 – 73% Number fraction: 0.45 – 0.73 Decreased with viral infections, bone marrow suppression, primary bone marrow disease Increased in allergy, parasitic disease, collagen disease, subacute infections Eosinophils 0 – 4% Number fraction: 0.00 – 0.004 Decreased with stress, use of some medications (ACTH, epinephrine, thyroxine) Increased with acute leukemia and following surgery or trauma Basophils 0 – 1% Number fraction: 0.00 – 0.01 Decreased with allergic reactions, stress, allergy, parasitic disease, use of corticosteroids Increased with infectious mononucleosis, viral and some bacterial infections, hepatitis Lymphocytes Monocytes Platelet count 20 – 40% 2 – 8% 150,000 – 450,000/ mm3 Number fraction: 0.2 – 0.4 Number fraction: 0.02 – 0.08 0.15 – 0.45 x 1012/L Decreased with aplastic anemia, SLE, immunodeficiency including AIDS Increased with viral infections, parasitic disease, collagen and hemolytic disorders Decreased with use of corticosteroids, RA, HIV infx Increased in malignancy, myeloproliferative disease, RA and post-operatively; about 50% of patient with unexpected increase of platelet count will be found to have a malignancy Decreased in thrombocytopenic purpura, acute leukemia, aplastic anemia and during cancer chemotherapy NORMAL VALUES – Serum, Plasma, and Whole Blood Chemistries Determination Acetone Normal Adult Reference Range Conventional Units SI Units 0.3 – 2.0 mg/dL 51.6 – 344.0/ µmol/L Adenocorticotropic Hormone (ACTH) (Plasma) - RIA < 50 pg/mL <50 ng/L Aldosterone (Plasma) - RIA Supine: 3 – 10 ng/dL Upright: 5 – 30 ng/dL Adrenal vein: 200 – 800 ng/dL 0.08 – 0.30 nmol/L 0.14 – 0.90 nmol/L 5.54 – 22.16 nmol/L Alpha-1-fetoprotein < 15 ng/mL < 15 µg/L Ammonia (Plasma) 15 – 45 µg/dL (varies with method) 11 – 32/ µmol/L 0.4 – 1.5 mg/dL 23 – 85 µmol/L Males: 10 – 40 U/mL Females: 8 – 35 U/mL 0.17 – 0.68 µkat/L 0.14 – 0.60 µkat/L Males: 10 – 40 U/L Females: 15 – 30 U/L 0.34 – 0.68 µkat/L 0.25 – 0.51 µkat/L Total: 0.3 – 1.0 mg/dL Direct: 0.1 – 0.4 mg/dL Indirect: 0.1 – 0.4 mg/dL 5 – 17 µmol/L 1.7 – 3.7 µmol/L 3.4 – 11.2 µmol/L 85 – 95 mm Hg 10.64 – 12.64 kPa 95% - 99% 0.95-0.99 Ascorbic Acid (Vitamin C) ALT (Alanine aminotransferase) Formerly SGPT AST (Aspartate aminotransferase) Formerly SGOT Bilirubin Clinical Significance Increased DKA Toxemia of pregnancy Carbohydrate-free diet High-fat diet Pituitary-dependent Cushing’s syndrome Ectopic ACTH syndrome Primary adrenal atropy Primary aldosteronism Secondary aldosteronism Decreased Adenocortical tunor Adrenal insufficiency secondary to hypopituitarism Addison’s disease Hepatocarcinoma Metastatic Carcinoma of liver Germinal cell carcinoma of the testicle or ovary Fetal neural tube defects – elevation in maternal serum Severe liver disease Hepatic decompensation Large doses of ascorbic acid as a prophylactic against common cold Same conditions as AST (AGOT), but increase is more marked in liver disease than AST (SGOT) Myocardial infarction Skeletal muscle disease Liver disease Hemolytic anemia (indirect) Biliary obstruction and disease Hepatocellular damage (Hepatitis) Pernicious anemia Hemolytic disease of newborn BLOOD GASES Oxygen Partial pressure (PaO2) Saturation (SaO2) Polycythemia Anemia Cardiac or pulmonary disease Cardiac Decompensation Chronic obstructive lung disease Carbon Dioxide Partial Pressure (PaCO2) pH (whole blood, arterial) Calcium Chloride 35 – 45 mm Hg 4.66 – 5.99 kPa 7.35 – 7.45 7.35 – 7.45 8.6 – 10.2 mg/dL 97 – 107 mEq/L 2.15 – 2.55 mmol/L 97 – 107 mmol/L Nephrosis Nephritis Urinary obstruction Cardiac decompensaton Anemia Lipemia Obstructive jaundice Diabetes Hyperthyroidism Cholesterol 150 – 200 mg/dL 3.9 – 5.2 mmol/L Creatinine 0.7 – 1.4 mg/dL 62 – 124 µmol/L Fasting: 60 – 110 mg/dL 3.3 – 6.05 mmol/L Postprandial (2h): 65 – 140 mg/dL 3.58 – 7.7 mmol/L Glucose Glucose Tolerance (oral) Normal Response: 1. Normal fasting between 60-110 mg/dL 2. No sugar in urine 3. Upper limits of normal: Respiratory Acidosis Metabolic Alkalosis Vomiting Hyperventilation Fever Intestinal Obstruction Tumor or hyperplasia of parathyroid Hypervitaminosis D Multiple myeloma Nephritis with uremia Malignant tumours Sarcoidosis Hypoparathyroidism Skeletal immobilization Excess calcium intake: Milk alkali syndrome 3.3 – 6.05 mmol/L Nephritis Chronic renal disease Diabetes mellitus Nephritis Hypothyroidism Early hyperpituitarism Cerebral lesions Infections Pregnancy Uremia 2-hour value >200 mg/dL (11.1 mmol/L) is diagnostic for Diabetes mellitus Respiratory Alkalosis Metabolic Acidosis Uremia Diabetic ketoacidosis Hemorrhage Nephritis Hyperthyroidism Diarrhea Celiac disease Vitamin D deficiency Acute pancreatitis Nephrosis After paathyroidectomy Diabetes mellitus Diarrhea Vomiting Pneumoia Heavy metal poisoning Cushing’s syndrome Intestinal obstruction Febrile Condition Pernicious aemia Hemolytic anemia Hypothyroidism Severe infection Terminal stages of debilitating disease Hyperinsulinism Hyperthyroidism Late hyperpituitarism Pernicious vomiting Addison’s disease Extensive hepatic damage Decreased 2- and 3-hour values may occur with hypoglycemia in diabetes mellitus Fasting = 125 1 hour = 190 2 hours = 140 3 hours = 125 Hemoglobin (plasma) 6.88 mmol/L 10.45 mmol/L 7.70 mmol/L 6.88 mmol/L 0.5 – 5 mg/dL 5 – 50 mg/L High-density lipoprotein cholesterol (HDL Cholesterol) Males: 35 – 70 mg/dL Females: 35 – 85 mg/dL 0.91 – 1.81 mmol/L 0.91 – 2.20 mmol/L Low-density lipoprotein cholesterol (LDL Cholesterol) mg/dL desirable levels: <160 if no CAD and <2 risk factors <130 if no CAD and 2 or more risk factors <100 if CAD is present Anemia Pregnancy Chronic renal failure HDL cholesterol is lower in patients with risk for coronary heart disease LDL cholesterol is higher in patients with increased risk for coronary heart disease Magnesium 1.3 – 2.3 mg/dL 0.62 – 0.95 mmol/L Phospholipids 125-300 mg/dL 1.25 – 3 g/L Phosphorous, inorganic 2.5 – 4.5 mg/dL 0.8 – 1.45 mmol/L Potassium Transfusion reactions Paroxysmal nocturnal hemoglobinuria Intravascular hemolysis 3.5 – 5 mEq/L 3.5 – 5 mmol/L 6 – 8 gm/dL 60 – 80 g/L Albumin 3.5 – 5.5 g/dL 40 – 55 g/L Globulin 1.7 – 3.3 g/dL 17 – 33 g/L Sodium 135 – 145 mEq/L 135 – 145 mmol/L Excess ingestion of magnesiumcontaining antacids Diabetes mellitus Nephritis Chronic nephritis Hypoparathroidism Renal Failure Acidosis Cell lysis Tissue breakdown or hemolysis Chronic alcoholism Severe renal disease Diarrhea Defective growth Hyperparathyroidism Vitamin D deficiency GI losses Diuretic administration PROTEIN Total Thyroid-stimulating Hormone (TSH) Triglycerides 0.4 – 4.2 mIU/L Hemoconcentration Shock Globulin fraction increased in multiple myeloma, chronic infection, liver disease Hemoconcentraton Nephritis Pyloric obstruction Hypothyroidism 100 – 200 mg/dL 1.13 – 3.8 mmol/L Increased risk for atherosclerosis Troponin I < 0.35 ng/mL < 0.35 µg/L Myocardial infarction Troponin T < 0.2 ng/mL < 0.2 µg/L Rhabdomyolysis TROPONIN Malnutrition Hemorrhage Loss of plasma from burns Proteinuria Alkali deficit Addison’s disease Myxedema Hyperthyroidism Severe crushing injuries Urea Nitrogen (BUN) 10 – 20 mg/dL 3.6 – 7.2 mmol/L Uric Acid 2.5 – 8 mg/dL 0.15 – 0.5 mmol/L Zinc 55 – 150 µg/dL 7.65 – 22.95 µmol/L Obstructive uropathy Mercury poisoning Neprotic syndrome Gouty arthritis Acute leukemia Lymphomas treated by chemotherapy Toxemia of pregnancy Coronary artery disease Arteriosclerosis Industrial exposure Pregnancy Defective tubular reabsorption Metastatic liver disease Tuberculosis Sprue NORMAL VALUES – Urine Chemistry Determination Creatinine Normal Adult Reference Range Conventional Units 0 – 270 mg/ 24 h Glucose Negative Hemoglobin and Myoglobin Negative SI Units 0 – 2.05 mmol/ 24 h Osmolality 250 – 900 mOsm/kg 250 – 900 mmol/kg Potassium 26 – 123 mEq/24 h 26 – 123 mmol/ 24 h Protein < 150 mg/ 24 h < 150 mg/ 24 h Sodium 75 – 200 mEq/ 24 h 75 – 200 mmol/ 24h Clinical Significance Increased Typhoid fever Salmonella infections Tetanus Diabetes mellitus Pituitary disorders Increased ICP Lesion in floor of 4th ventricle Extensive burns Transfusion of incompatible blood Myoglobin increased in severe crushing injuries to muscles Useful in the study of electrolyte and water balance Hemolysis Chronic renal failure Acidosis Cushing’s disease Corpus luteum cysts Nephritis Cardiac failure Mercury poisoning Bence-Jones protein in multiple myeloma Febrile states Hematuria Useful in detecting gross changes in water and salt balance Decreased Muscular atrophy Anemia Advanced degeneration of kidneys Leukemia Renal disease Diarrhea Adrenocortical insufficiency Urea Nitrogen Uric Acid Urobilinogen 9 – 16 gm/24 h 0.32 – 0.57 mol/L Excessive protein catabolism Impaired kidney function 250 – 750 mg/ 24 h 1.48 – 4.43 mmol/24 h Gout Nephritis Random urine: <0.25 mg/dL 24-hr urine: up to 4 mg/ 24 h <0.42 mol/ 24 h Up to 6.67 µmol/ 24 h Liver and biliary tract disease Hemolytic anemia Complete or nearly complete biliary obstruction Diarrhea NORMAL VALUES – Miscellaneous Values Determination Normal Values Clinical Significance Conventional Units SI Units Acetaminophen Zero Therapeutic level = 10 – 30 µg/mL 10 – 30 mg/L Carbamazepine Zero Therapeutic level = 4 – 12 µg/mL 34 – 51 µmol/L Carbon monoxide 0 – 2% Symptoms with 10 – 30% saturation Diazepam Zero Therapeutic level = 0.2 – 1.0 µg/mL Digoxin Zero Therapeutic level = 0.8 – 2 ng/mL Ethanol 0 – 0.1% Lithium Zero Therapeutic level = 0.6 – 1.2 mEq/L Lidocaine Zero Toxic (48 h after high dose) 454 mg/mL Propanolol Zero Therapeutic level = 50 – 100 ng/mL Additional Values: HCO3 Urine pH Urine Specific Gravity Cardiac Enzymes Creatinine Kinase Myoglobin 22 – 26 mEq/L 4.6 – 8.0 1.005 – 1.030 Males: 55 – 160 µ/L Females: 30 – 135 µ/L < 90 mcg/L 0.2 – 1.0 mg/L 0.8 – 2/µg/L Legal intoxication level = 0.1% or above 0.3 – 0.4% = marked intoxication 0.4 – 0.5% - alcoholic stupor 0.6 – 1.2 mmol/L 1000 mmol/L 347 – 693 µmol/L
