Reference ranges for blood tests: Difference between revisions

Content deleted Content added
GreenC bot (talk | contribs)
Rescuing 5 sources and tagging 0 as dead.) #IABot (v2.0.9.5
 
(One intermediate revision by one other user not shown)
Line 6:
 
==Interpretation==
A [[reference range]] is usually defined as the set of values 95 percent of the normal population falls within (that is, 95% [[prediction interval]]).<ref>[{{Cite book |url=https://books.google.com/books?id=Je_pJfb2r0cC&pg=PA19 Page 19] in: {{cite book |author=Stephen K. Bangert MA MB BChir MSc MBA FRCPath; William J. Marshall MA MSc MBBS FRCP FRCPath FRCPEdin FIBiol; Marshall, William Leonard |title=Clinical biochemistry: metabolic and clinical aspects |publisher=Churchill Livingstone/Elsevier |___location=Philadelphia |year=2008 |isbn=978-0-443-10186-1 |editor-last=Bangert |editor-first=Stephen K. |edition=2nd |___location=Philadelphia |page=19 |editor-last2=Marshall |editor-first2=William J.}}</ref> It is determined by collecting data from vast numbers of laboratory tests.<ref>{{citeCite journal |last1last=Boyd |first1first=James C. |date=January 2010 |title=Defining laboratory reference values and decision limits: populations, intervals, and interpretations |journal=Asian Journal of Andrology |date=January 2010 |volume=12 |issue=1 |pages=83–90 |doi=10.1038/aja.2009.9 |pmidissn=201110861745-7262 |pmc=3739683 |issnpmid=1745-726220111086}}</ref><ref>{{citeCite web |title=Reference Ranges & What They Mean {{!}} Lab Tests Online-UK |url=https://labtestsonline.org.uk/articles/laboratory-test-reference-ranges |website=labtestsonline.org.ukLab Tests Online-UK}}</ref>
 
===Plasma or whole blood===
In this article, all values (except the ones listed below) denote [[blood plasma]] concentration, which is approximately 60–100% larger than the actual blood concentration if the amount inside [[red blood cells]] (RBCs) is negligible. The precise factor depends on [[hematocrit]] as well as amount inside RBCs. Exceptions are mainly those values that denote total blood concentration, and in this article they are:<ref name="pmid33274357">{{citeCite journal| author|vauthors=Bransky A, Larsson A, Aardal E, Ben-Yosef Y, Christenson RH |year=2021 |title=A Novel Approach to Hematology Testing at the Point of Care. | journal=J Appl Lab Med | year= 2021 | volume= 6 | issue= 2 | pages= 532–542 | pmid=33274357 | doi=10.1093/jalm/jfaa186 | pmc=7798949 |pmid=33274357}} </ref>
* All values in ''Hematology – red blood cells'' (except ''hemoglobin in plasma'')
* All values in ''Hematology – white blood cells''
Line 19:
===Units===
* [[Mass concentration (chemistry)|Mass concentration]] (g/dL or g/L) is the most common measurement unit in the United States. Is usually given with dL (decilitres) as the denominator in the United States, and usually with L (litres) in, for example, Sweden.{{cn|date=February 2024}}
* [[Molar concentration]] (mol/L) is used to a higher degree in most of the rest of the world, including the United Kingdom and other parts of Europe and Australia and New Zealand.<ref>[{{Cite book |last=Dart |first=Richard C. |url=https://books.google.com/books?id=BfdighlyGiwC "Units|title=Medical oftoxicology measurement"]|publisher=Lippincott inWilliams ''Medical& toxicology''Wilkins |year=2004 |isbn=978-0-7817-2845-4 |edition=3, Richardillustrated C.|page=34 Dart|chapter=Units of measurement}}</ref>
Edition: 3, illustrated, Lippincott Williams & Wilkins, 2004, p. 34 {{ISBN|978-0-7817-2845-4}} 1914 pages</ref>
* [[International unit]]s (IU) are based on measured [[biological activity]] or effect, or for some substances, a specified equivalent mass.{{cn|date=February 2024}}
* [[Enzyme activity]] ([[katal|kat]]) is commonly used for e.g. [[liver function test]]s like [[Aspartate transaminase|AST]], [[Alanine transaminase|ALT]], [[lactate dehydrogenase|LD]] and [[Gamma-glutamyl transpeptidase|γ-GT]] in Sweden.<ref name=uppsala/>
* [[Percentage]]s and time-dependent units (mol/s) are used for calculated derived parameters, e.g. for [[beta cell]] function in [[Homeostatic model assessment|homeostasis model assessment]] or [[thyroid's secretory capacity]].<ref>{{citeCite journal |last1last=Hill |first1first=Nathan R. |last2=Levy |first2=Jonathan C. |last3=Matthews |first3=David R. |date=11 July 2013 |title=Expansion of the Homeostasis Model Assessment of β-Cell Function and Insulin Resistance to Enable Clinical Trial Outcome Modeling Through the Interactive Adjustment of Physiology and Treatment Effects: iHOMA2 |journal=Diabetes Care |date=11 July 2013 |volume=36 |issue=8 |pages=2324–2330 |doi=10.2337/dc12-0607 |pmid=23564921 |pmc=3714535 |url=https://diabetesjournals.org/care/article/36/8/2324/33141/Expansion-of-the-Homeostasis-Model-Assessment-of |journal=Diabetes Care |volume=36 |issue=8 |pages=2324–2330 |doi=10.2337/dc12-0607 |issn=0149-5992 |pmc=3714535 |pmid=23564921}}</ref>
 
===Arterial or venous===
If not otherwise specified, a reference range for a blood test is generally the [[vein|venous]] range, as the standard process of obtaining a sample is by [[venipuncture]]. An exception is for acid–base and [[blood gas]]es, which are generally given for arterial blood.<ref>{{citeCite bookweb |title=Reference Interval and Critical Results Table |url=https://pathology.vcu.edu/media/pathology/catalog/LAB.GEN.0022CPathologyBloodGasTestingandWholeBloodChemistryRefIntervalsCritValues05.17.2024.pdf |website=VCU Health Pathology |department=Blood Gas Laboratory}}</ref>
 
Still, the blood values are approximately equal between the arterial and venous sides for most substances, with the exception of acid–base, blood gases and drugs (used in [[therapeutic drug monitoring]] (TDM) assays).<ref name="Dufour">[{{Cite magazine |last=Dufour |first=D. Robert |date=April 2000 |title=Arterial versus venous reference ranges |url=http://findarticles.com/p/articles/mi_m3230/is_4_32/ai_61893437/ "Arterial|url-status=dead versus|archive-url=https://web.archive.org/web/20050421011421/http://findarticles.com/p/articles/mi_m3230/is_4_32/ai_61893437/ venous|archive-date=2005-04-21 reference ranges"], ''|magazine=Medical Laboratory Observer'', April, 2000 by D. Robert Dufour}}</ref> Arterial levels for drugs are generally higher than venous levels because of extraction while passing through tissues.<ref name=Dufour/>
 
===Usual or optimal===
Line 35 ⟶ 34:
===Variability===
{{Further|Reference range}}
References range may vary with age, sex, race, pregnancy,<ref>{{Cite journal |last=Abbassi-Ghanavati doi|first=M. |last2=Greer 10|first2=L.1097/AOG G.0b013e3181c2bde8| pmid |last3=Cunningham 19935037|first3=F. titleG. |year=2009 |title=Pregnancy and Laboratory Studies| |journal = Obstetrics & Gynecology| |volume =114 114| issue =6 6| pages = 1326–31| year = 2009| last1 doi= Abbassi-Ghanavati | first1 = M10. | last2 = Greer | first2 = L. G1097/AOG.0b013e3181c2bde8 | last3 pmid= Cunningham19935037 | first3 = F. G. | s2cid = 24249021}}</ref> diet, use of prescribed or herbal drugs and stress. Reference ranges often depend on the analytical method used, for reasons such as [[Accuracy and precision|inaccuracy]], lack of [[standardisation]], lack of [[certified reference materials|certified reference material]] and differing [[epitope|antibody reactivity]].<ref>{{citeCite journal |last=Armbruster |first=David |author2last2=Miller |first2=Richard R. |date=August 2007 |title=The Joint Committee for Traceability in Laboratory Medicine (JCTLM): A Global Approach to Promote the Standardisation of Clinical Laboratory Test Results |journal=The Clinical Biochemist Reviews|date=August 2007|volume=28 |issue=3 |pages=105–14 |pmc=1994110 |pmid=17909615}}</ref> Also, reference ranges may be inaccurate when the reference groups used to establish the ranges are small.<ref>{{citeCite journal |titlelast=SampleMeeker Sizes for Prediction Intervals|authorfirst=William Q. Meeker &|last2=Hahn |first2=Gerald J. Hahn|doiyear=10.1080/00224065.1982.11978821 |title=Sample Sizes for Prediction Intervals |journal=Journal of Quality Technology |volume=14|year=1982 |issue=4 |pages=201–206 |doi=10.1080/00224065.1982.11978821}}</ref>
 
==Sorted by concentration==
Line 435 ⟶ 434:
| [[CA19-9]] || || 40<ref name=southwest/> || U/mL || Pancreatic cancer
|-
| [[CA-125]] || || 30,<ref name=gp-ca125>[http://www.gpnotebook.co.uk/simplepage.cfm?ID=-100270014 GP Notebook > range (reference, ca-125)] Retrieved on Jan 5, 2009</ref> 35<ref>[http://www.clinlabnavigator.com/Test-Interpretations/ca-125.html ClinLab Navigator > Test Interpretations > CA-125] {{Webarchive|url=https://web.archive.org/web/20120626000109/http://www.clinlabnavigator.com/Test-Interpretations/ca-125.html |date=2012-06-26 }} Retrieved on March 8, 2011</ref> || kU/L or U/mL ||
|-
|rowspan=3| [[Carcinoembryonic antigen]] (CEA) || Non-smokers, 50 years || 3.4,<ref name=uppsala/> 3.6<ref name=bjerner>{{cite journal |vauthors=Bjerner J, Høgetveit A, Wold Akselberg K, etal |s2cid=12545738 |title=Reference intervals for carcinoembryonic antigen (CEA), CA125, MUC1, Alfa-foeto-protein (AFP), neuron-specific enolase (NSE) and CA19.9 from the NORIP study |journal=Scandinavian Journal of Clinical and Laboratory Investigation |volume= 68|issue= 8|pages=703–13 |date=June 2008 |pmid=18609108 |doi=10.1080/00365510802126836 |url=https://figshare.com/articles/journal_contribution/11808120 }}</ref> ||rowspan=3| μg/L ||
Line 584 ⟶ 583:
|rowspan=2| [[Progesterone]]<br />{{hatnote|-more detailed ranges<br /> in [[Progesterone#Levels|Progesterone]] article}} ||rowspan=2| Female in mid-[[luteal phase]] (day 21–23) || 17,<ref name=Stricker/> 35<ref name=progesterone-mass>Derived from mass values using molar mass of 314.46 g/mol</ref> || 92<ref name="progesterone-mass"/> || nmol/L
|-
| 6,<ref name=Stricker/> 11<ref name=Bhattacharya>Bhattacharya Sudhindra Mohan (July/August 2005) [http://medind.nic.in/jaq/t05/i4/jaqt05i4p350.pdf Mid-luteal phase plasma progesterone levels in spontaneous and clomiphene citrate induced conception cycles] {{Webarchive|url=https://web.archive.org/web/20100602092012/http://medind.nic.in/jaq/t05/i4/jaqt05i4p350.pdf |date=2010-06-02 }} J Obstet Gynecol India Vol. 55, No. 4 : July/August 2005 pp. 350–52</ref> || 29<ref name=Bhattacharya/> || ng/mL
|-
|rowspan=3| [[Androstenedione]] || Adult male and female || 60<ref name=nyhq/> || 270<ref name=nyhq/> ||rowspan=3| ng/dL
Line 614 ⟶ 613:
! Unit
|-
|rowspan=2| [[Adrenocorticotropic hormone]] (ACTH) ||rowspan=2| || 2.2<ref name="Nieman">{{cite web |last1=Nieman |first1=Lynnette K |title=Measurement of ACTH, CRH, and other hypothalamic and pituitary peptides |url=https://www.uptodate.com/contents/measurement-of-acth-crh-and-other-hypothalamic-and-pituitary-peptides |website=www.uptodate.com |publisher=UpToDate |access-date=25 June 2021 |date=29 September 2019 |archive-date=25 June 2021 |archive-url=https://web.archive.org/web/20210625125528/https://www.uptodate.com/contents/measurement-of-acth-crh-and-other-hypothalamic-and-pituitary-peptides |url-status=dead }}</ref> || 13.3<ref name="Nieman"/> || pmol/L
|-
| 20<ref name=southwest/> || 100<ref name=southwest/> || pg/mL
|-
|rowspan=4| [[Cortisol]] ||rowspan=2| 09:00 [[ante meridiem|am]] || 140<ref name=goodhope>[http://www.goodhope.org.uk/departments/pathweb/refranges.htm Biochemistry Reference Ranges at Good Hope Hospital] {{Webarchive|url=https://web.archive.org/web/20100720014644/http://www.goodhope.org.uk/Departments/pathweb/refranges.htm |date=2010-07-20 }} Retrieved on Nov 8, 2009</ref> || 700<ref name=goodhope/> || nmol/L
|-
| 5<ref name=cortisol-derived>Derived from molar values using molar mass of 362 g/mol</ref> || 25<ref name=cortisol-derived/> || μg/dL
Line 903 ⟶ 902:
|rowspan=2| [[Antithrombin]] || 0.80<ref name=uppsala/> || 1.2<ref name=uppsala/> || kIU/L || rowspan=2 |
|-
| 0.15,<ref name=teruya2014>{{EMedicine|article|2084978|Antithrombin III}}</ref> 0.17<ref name=mgh>[http://mghlabtest.partners.org/coagbook/co000300.htm Antithrombin CO000300] {{Webarchive|url=https://web.archive.org/web/20170909215510/http://mghlabtest.partners.org/coagbook/co000300.htm |date=2017-09-09 }} in ''Coagulation Test Handbook'' at [[Massachusetts General Hospital]]. In turn citing:
* Elizabeth M. Van Cott, M.D., and Michael Laposata, M.D., Ph.D., "Coagulation." In: Jacobs DS et al, ed. The Laboratory Test Handbook, 5th Edition. Lexi-Comp, Cleveland, 2001; 327–58.</ref> || 0.2,<ref name=teruya2014/> 0.39<ref name=mgh/> || mg/mL
|-