Chapter 748 ◆ Reference Intervals for Laboratory Tests and Procedures e5

Table 748.1 Prefixes Denoting Decimal Factors in

Table 748.5
PREFIX SYMBOL FACTOR
mega- M 106
kilo- k 103
hecto- h 102
deka- da 101
deci- d 10−1
centi- c 10−2
milli- m 10−3
micro- μ 10−6
nano- n 10−9
pico- p 10−12
femto- f 10−15

Table 748.2 Abbreviations Used in Table 748.5

Ab Absorbance mm3 Cubic millimeter,
microliter (μL)
AU Arbitrary unit
mm Hg Millimeters of mercury
BB Brain isoenzyme of
creatine kinase mmol Millimole
cap Capillary mo Month, months
CH50 Dilution required mol Mole
to lyse 50% of
mOsm Milliosmole
indicator red blood
cells; indicates MW Relative molecular
complement activity weight
Cr Creatinine ND Not detected
CSF Cerebrospinal fluid nm Nanometer
(wavelength)
F Female
Pa Pascal(s)
g Gram, grams
Chapter 748 G6PD Glucose-6-phosphate
pc Postprandial
dehydrogenase RBC Red blood cell(s),
Reference Intervals for Hb Hemoglobin
RT
erythrocyte(s)
Room temperature
Laboratory Tests and HbCO
hpf
Carboxyhemoglobin
High-power field
SD Standard deviation

Procedures hr
IU
Hour, hours
International unit(s) of
sec
Tr
Second, seconds
Trace
Stanley F. Lo hormone activity U International unit(s) of
enzyme activity
L Liter
V Volume
M Male
In Tables 748.1 through 748.5, the reference intervals apply to infants, WBC White blood cell(s)
children, and adolescents when possible. For many analyses, separate MB Heart isoenzyme of
reference intervals for children and adolescents are not well delineated. creatine kinase WHO World Health
When interpreting a test result, the reference interval supplied by the Organization
mEq/L Milliequivalents per
laboratory performing the test should always be used, because these liter wk Week, weeks
intervals are instrument and/or method dependent. Figs. 748.1 and min Minute, minutes yr Year, years
Text continued on p. e14

Downloaded for Med Caduceus (samiauditore75@gmail.com) at MOH Consortium -Tehran University of Medical Sciences from ClinicalKey.com by Elsevier on April 17, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
e6 Part XXXIV ◆ Laboratory Medicine

Table 748.3 Abbreviations for Specimens in Table 748.5

S Serum (C) Citrate
P Plasma (O) Oxalate
(H) Heparin W Whole blood
(LiH) Lithium heparin (NH4H) Ammonium heparinate
(E) Ethylenediaminetetraacetic acid (EDTA)

Table 748.4 Key to Comments Section of Table 748.5

30°C, 37°C Temperature of enzymatic analysis (Celsius) l Fluorometric method
a Values obtained are significantly method dependent m Fluorescence-activated cell sorting (FACS)
b Values in older males are higher than those in older n Fluorescence polarization
females
o Gas chromatography
c Values in older females are higher than those in
p High-performance liquid chromatography (HPLC)
older males
q Indirect fluorescence antibody (IFA) assay
d Atomic absorption
r Ion-selective electrode
e Borate affinity chromatography
s Nephelometry
f Cation-exchange chromatography
t Optical density
g Vitros, a proprietary analytic system of Ortho
Clinical Diagnostics u Radial immunodiffusion (RID)
i Electrophoresis v Radioimmunoassay (RIA)
j Enzymatic assay w Spectrophotometry
k Enzyme-amplified immunoassay

Table 748.5 Reference Intervals*

ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
COMPLETE BLOOD COUNT
Hematocrit (HCT, Hct) W(E) % of packed red Volume fraction (V red
cells (V red cells/V whole blood)
cells/V whole
blood cells × 100)
Calculated from mean 0-30 days 44-70% ×0.01 0.44-0.70
corpuscular volume 1-23 mo 32-42% 0.32-0.42
(MCV) and RBC 2-9 yr 33-43% 0.33-0.43
count (electronic 10-17 yr M 36-47% 0.36-0.47
displacement or laser) F 35-45% 0.35-0.45
>18-99 yr M 42-52% 0.42-0.52
F 37-47% 0.37-0.47
Hemoglobin (Hb) W(E) g/dL mmol/L
0-30 days 15.0-24.0 ×0.155 2.32-3.72 MW Hb =
1-23 mo 10.5-14.0 1.63-2.17 64,500
2-9 yr 11.5-14.5 1.78-2.25
10-17 yr M 12.5-16.1 1.93-2.50
F 12.0-15.0 1.86-2.32
>18-99 yr M 13.5-18.0 2.09-2.79
F 12.5-16.0 1.93-2.48
P(H) See Chemical Elements
Erythrocyte indices
(RBC indices)
Mean corpuscular W(E) pg/cell fmol/cell
hemoglobin (MCH) 0-30 days 33-39 ×0.0155 0.51-0.60
1-23 mo 24-30 0.37-0.46
2-9 yr 25-31 0.39-0.48
10-17 yr M 26-32 0.26-0.32
F 26-32 0.26-0.32
>18-99 yr M 27-31 0.27-0.31
F 27-31 0.27-0.31
Continued

Downloaded for Med Caduceus (samiauditore75@gmail.com) at MOH Consortium -Tehran University of Medical Sciences from ClinicalKey.com by Elsevier on April 17, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
 Chapter 748 ◆ Reference Intervals for Laboratory Tests and Procedures e7

Table 748.5 Reference Intervals—cont’d

ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Mean corpuscular W(E) % Hb/cell or g mmol Hb/L RBC
hemoglobin Hb/dL RBC
concentration (MCHC) 32-36 ×0.155 4.96-5.58
Mean corpuscular W(E) μm 3
fL
volume (MCV) 0-30 days 99-115 ×1 99-115
1-23 mo 72-88 72-88
2-9 yr 76-90 76-90
10-17 yr 78-95 78-95
>18-99 yr 78-100 78-100
Leukocyte count W(E) ×1,000 cells/mm3 (μL) ×109 cells/L
(WBC count) 0-30 days 9.1-34.0 ×1 9.1-34.0
1-23 mo 6.0-14.0 6.0-14.0
2-9 yr 4.0-12.0 45.0-12.0
10-17 yr 4.0-10.5 4.0-10.5
18-99 yr 4.0-10.5 4.0-10.5
Leukocyte differential W(E) % Number fraction
Myelocytes 0% ×0.01 0
Neutrophils (“bands”) 3-5% 0.03-0.05
Neutrophils (“segs”) 54-62% 0.54-0.62
Lymphocytes 25-33% 0.25-0.33
Monocytes 3-7% 0.03-0.07
Eosinophils 1-3% 0.01-0.03
Basophils 0-0.75% 0-0.0075
Cells/mm3 (μL) ×106 cells/L
Myelocytes 0 ×1 0
Neutrophils (“bands”) 150-400 150-400
Neutrophils (“segs”) 3,000-5,800 3,000-5,800
Lymphocytes 1,500-3,000 1,500-3,000
Monocytes 285-500 285-500
Eosinophils 50-250 50-250
Basophils 15-50 15-50
Platelet count W(E) ×103/mm3 (μL) ×109/L
(thrombocyte count) Newborn 84-478 (after 1 wk, same as ×106 84-478 (Buck, 1996)
adult)
Adult 150-400 150-400
Reticulocyte count W(E,H,O) Adults 0.5-1.5% of erythrocytes or ×0.01 0.005-0.015 (number
25,000-75,000/mm3 (μL) ×106 fraction) or 25,000-
75,000 × 106/L
% Number fraction
W(cap) 1 day 0.4-6.0 ×0.01 0.004-0.060
7 days <0.1-1.3 <0.001-0.013
1-4 wk <1.0-1.2 <0.001-0.012
5-6 wk <0.1-2.4 <0.001-0.024
7-8 wk 0.1-2.9 0.001-0.029
9-10 wk <0.1-2.6 <0.001-0.026
11-12 wk 0.1-1.3 0.001-0.013
Alanine transaminase S 0-7 days 6-40 U/L ×1 6-40 U/L 37°C, bgw
(aminotransferase) 8-30 days M 10-40 10-40 (Soldin,
(ALT, SGPT) F 8-32 8-32 Savwoir, Guo,
1-12 mo 12-45 12-45 1997; Lockitch
1-19 yr 5-45 5-45 Halstead,
Albersheim,
Albumin (BCG) P Premature 1 day 1.8-3.0 g/dL ×10 18-30 g/dL
1988)
Full term <6 2.5-3.4 25-34
g (Meites, 1989;
days
Soldin and
8 days-1 yr 1.9-4.9 19-49
Morse, 1998;
1-3 yr 3.4-4.2 34-42
Lockitch
4-19 yr 3.5-5.6 35-56
Halstead,
Albersheim,
1988)
Continued

Downloaded for Med Caduceus (samiauditore75@gmail.com) at MOH Consortium -Tehran University of Medical Sciences from ClinicalKey.com by Elsevier on April 17, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
e8 Part XXXIV ◆ Laboratory Medicine

Table 748.5 Reference Intervals—cont’d

ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Ammonia P 11-35 μmol/L ×1 11-35 μmol/L g
Amylase S,P 1-19 yr 30-100 U/L ×1 30-100 U/L (Lockitch
% pancreatic % pancreatic fraction Halstead,
fraction Albersheim,
1988; Gillard
et al, 1983)
Amylase isoenzymes S,P(H) Cord-8 mo 0-34% ×0.01 0-0.34%
9 mo-4 yr 5-56% 0.05-0.56%
5-19 yr 23-59% 0.23-0.59%
Anion gap (sodium P(H) 7-16 mEq/L ×1 7-16 mEq/L
− [chloride +
bicarbonate])
Antideoxyribonuclease S Age Upper limit of Upper limit of normal
B titer (anti-DNase B normal
titer) 4-6 yr 240-480 U ×1 240-480 U (Kaplan et al,
7-12 yr 480-800 U 480-800 U 1998)
Antidiuretic hormone P(E) Plasma Plasma ADH Plasma ADH ng/L
(hADH, vasopressin) osmolarity (pg/mL)
(mOsm/kg)
270-280 <1.5 ×1 <1.5
280-285 <2.5 <2.5
285-290 1-5 1-5
290-295 2-7 2-7
295-300 4-12 4-12
Antistreptolysin-O titer S Age Upper limit of Upper limit of normal
(ASO titer) normal
2-5 yr 120-160 Todd units ×1 120-160 Todd units (Kaplan et al,
6-9 yr 240 Todd units 240 Todd units 1998)
10-12 yr 320 Todd units 320 Todd units
Aspartate transaminase S U/L U/L
(aminotransferase) 0-7 days M 30-100 ×1 35-100 37°C, g (Soldin,
(AST, SGOT) F 24-95 24-95 Savwoir, Guo,
8-30 days 22-71 22-71 1997; Lockitch
1-12 mo 22-63 22-63 Halstead,
1-3 yr 20-60 20-60 Albersheim,
3-9 yr 15-50 15-50 1988)
10-15 yr 10-40 10-40
16-19 yr M 15-45 15-45
F 5-30 5-30
Base excess W(H) mmol/L mmol/L
Newborn (−10)-(−2) ×1 (−10)-(−2)
Infant (−7)-(−1) (−7)-(−1)
Child (−4)-(+2) (−4)-(+2)
Thereafter (−3)-(+3) (−3)-(−3)
Bicarbonate S,P mmol/L mmol/L
Arterial 21-28 ×1 21-28
Venous 22-29 22-29
Bilirubin, total S mg/dL μmol/L
Newborn See Bhutani ×17.1 (Bhutani et al,
nomogram 1999)
(Fig. 748.3)
1 mo-adult <1.0 <17
C-reactive protein (high S (Soldin et al,
sensitivity) M (mg/dL) F (mg/dL) M (mg/L) F (mg/L) 2004)
0-90 days 0.08-1.58 0.09-1.58 ×10 0.8-15.8 0.9-15.8
91 days-12 mo 0.08-1.12 0.05-0.79 0.8-11.2 0.5-7.9
13 mo-3 yr 0.08-1.12 0.08-0.79 0.8-11.2 0.8-7.9
4-10 yr 0.06-0.79 0.5-1.0 0.6-7.9 0.5-10.0
11-14 yr 0.08-0.76 0.06-0.81 0.8-7.6 0.6-8.1
15-18 yr 0.04-0.79 0.06-0.79 0.4-7.9 0.6-7.9
Continued

Downloaded for Med Caduceus (samiauditore75@gmail.com) at MOH Consortium -Tehran University of Medical Sciences from ClinicalKey.com by Elsevier on April 17, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
 Chapter 748 ◆ Reference Intervals for Laboratory Tests and Procedures e9

Table 748.5 Reference Intervals—cont’d

ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Calcium, ionized (Ca) S,P(H),W(H) mg/dL mmol/L
Cord blood 5.0-6.0 ×0.25 1.25-1.50
Newborn, 4.3-5.1 1.07-1.27
3-24 hr
24-48 hr 4.0-4.7 1.00-1.17
Thereafter 4.8-4.92 1.12-1.23
or 2.24-2.46 Eq/L ×0.5 1.12-1.23
Calcium, total S mg/dL mmol/L
Cord blood 9.0-11.5 ×0.25 2.25-2.88
Newborn, 9.0-10.6 2.3-2.65
3-24 hr
24-48 hr 7.0-12.0 1.75-3.00
4-7 days 9.0-10.9 2.25-2.73
Child 8.8-10.8 2.20-2.70
Thereafter 8.4-10.2 2.10-2.55
Carbon dioxide, partial W(H) mm Hg kPa
pressure (PCO2) Newborn 27-40 ×0.1333 3.6-5.3
Infant 27-41 3.6-5.5
Thereafter M 35-48 4.7-6.4
F 32-45 4.3-6.0
Carbon monoxide W(E) Nonsmoker <2% HbCO ×0.01 HbCO fraction <0.02
(carboxyhemoglobin) Smoker <10% <0.10
Lethal >50% >0.5
Chloride S,P(H) Cord blood 96-104 mmol/L ×1 96-104 mmol/L
Newborn 97-110 97-110
Thereafter 98-106 98-106
Chloride, sweat Sweat mmol/L (Farrell et al,
0-5 mo ≤29 CF unlikely 2008)
30-59 Intermediate
≥60 Indicative of
CF
≥6 mo ≤39 CF unlikely
40-60 Intermediate
≥60 Indicative of
CF
Cortisol S,P(H) μg/dL nmol/L
Newborn 1-24 ×27.59 28-662
Adults, 8 AM 5-23 138-635
4 PM 3-15 82-413
8 PM <50% of 8 AM ×0.01 Fraction of 8 AM
≤0.50
Creatine kinase S Cord blood 70-380 U/L ×1 70-380 U/L 30°C, b
5-8 hr 214-1,175 214-1,175 (Jedeikin et al,
24-33 hr 130-1,200 130-1,200 1982)
72-100 hr 87-725 87-725
Adult 5-130 5-130
Creatine kinase S % MB % BB
isoenzymes Cord blood 0.3-3.1 0.3-10.5
5-8 hr 1.7-7.9 3.6-13.4
24-33 hr 1.8-5.0 2.3-8.6
72-100 hr 1.4-5.4 5.1-13.3
Adult 0-2 0
Creatinine (IDMS)
Enzymatic S,P mg/dL μmol/L g
0-4 yr 0.03-0.50 ×88.4 2.65-44.2
4-7 yr 0.03-0.59 2.65-52.2
7-10 yr 0.22-0.59 19.4-52.2
10-14 yr 0.31-0.88 27.4-77.8
>14 yr 0.50-1.06 44.2-93.7
Creatinine clearance S,P,U Newborn 40-65 mL/min/1.73 m2
(endogenous) <40 yr, M 97-137
F 88-128
Decreases <6.5 mL/min/decade
Continued

Downloaded for Med Caduceus (samiauditore75@gmail.com) at MOH Consortium -Tehran University of Medical Sciences from ClinicalKey.com by Elsevier on April 17, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
e10 Part XXXIV ◆ Laboratory Medicine

Table 748.5 Reference Intervals—cont’d

ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Ferritin S ng/mL μg/L
0-6 wk 0-400 ×1 0-400
7 wk-365 days 10-95 10-95
1-9 yr 10-60 10-60
10-18 yr M 10-300 10-300
F 10-70 10-70
Folate S Newborn 7.0-32 ng/mL ×2.265 15.9-72.4 nmol/L
Thereafter 1.8-9.0 4.1-20.4
W(E) 150-450 ng/mL RBCs 340-1,020 nmol/L cells
Glucose S mg/dL mmol/L
Cord blood 45-96 ×0.0555 2.5-5.3
Premature 20-60 1.1-3.3
Neonate 30-60 1.7-3.3
Newborn
1 day 40-60 2.2-3.3
>1 day 50-90 2.8-5.0
Child 60-100 3.3-5.5
Adult 70-105 3.9-5.8
W(H) Adult 65-95 3.6-5.3
Glucose, 2 hr post S <120 <6.7
Glucose tolerance test S mg/dL mmol/L
(GTT) (Chapter 607)
Oral dose
Adult: 75 g Normal Diabetic Normal Diabetic
Child: 1.75 g/kg of Fasting 70-105 ≥126 ×0.0555 3.9-5.8 ≥7.0 (Diabetes Care,
ideal weight, up 120 min 70-120 ≥200 3.9-6.7 ≥11 2010)
to a maximum of
75 g
G6PD in erythrocytes W(E,H,C)
Bishop, modified Adult Adult
3.4-8.0 U/g Hb ×0.0645 0.22-0.52 mU/mol Hb
98.6-232 U/1012 RBCs ×10−3 0.10-0.23 nU/106 RBCs
1.16-2.72 U/mL RBC ×1 1.16-2.72 kU/L RBC
Newborn: 50% higher Newborn: 50% higher
γ-Glutamyl S U/L U/L
transpeptidase Cord blood 37-193 ×1 37-193 37°C, b (Knight
(GGT, GGTP) 0-1 mo 13-147 13-147 and Haymond,
1-2 mo 12-123 12-123 1981)
2-4 mo 8-90 8-90
4 mo-10 yr 5-32 5-32
10-15 yr 5-24 5-24
Immunoglobulin A (IgA) S mg/dL mg/L
Cord blood 1.4-3.6 ×10 14-36 s (Meites, 1989)
1-3 mo 1.3-53 13-530
4-6 mo 4.4-84 44-840
7 mo-1 yr 11-106 110-1,060
2-5 yr 14-159 140-1,590
6-10 yr 33-236 330-2,360
Adult 70-312 700-3,120
Immunoglobulin D (IgD) S Newborn: none detected None detected
Thereafter: 0-8 mg/dL ×10 0-80 mg/L
Immunoglobulin E (IgE) S M 0-230 IU/mL ×1 0-230 kIU/L
F 0-170 0-170
Immunoglobulin G (IgG) S mg/dL g/L
Cord blood 636-1,606 ×0.01 6.36-16.06 s (Meites, 1989)
1 mo 251-906 2.51-9.06
2-4 mo 176-601 1.76-6.01
5-12 mo 172-1,069 1.72-10.69
1-5 yr 345-1,236 3.45-12.36
6-10 yr 608-1,572 6.08-15.72
Adult 639-1,349 6.39-13.49
Continued

Downloaded for Med Caduceus (samiauditore75@gmail.com) at MOH Consortium -Tehran University of Medical Sciences from ClinicalKey.com by Elsevier on April 17, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
 Chapter 748 ◆ Reference Intervals for Laboratory Tests and Procedures e11

Table 748.5 Reference Intervals—cont’d

ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Immunoglobulin M S mg/dL mg/L
(IgM) Cord blood 6.3-25 ×10 63-250 s (Meites, 1989)
1-4 mo 17-105 170-1,050
5-9 mo 33-126 330-1,260
10 mo-1 yr 41-173 410-1,730
2-8 yr 43-207 430-2,070
9-10 yr 52-242 520-2,420
Adult 56-352 560-3,520
Iron P All ages 22-184 μg/dL ×0.1791 4-33 μmol/L (Lockitch
Halstead,
Iron-binding capacity, S Infant 100-400 μg/dL ×0.179 17.90-71.60 μmol/L
Wadsworth,
total (TIBC) Thereafter 250-400 44.75-71.60
1988)
L-lactate (perchloric W mg/dL mmol/L
acid) 1-12 mo 10-21 ×1 1.1-2.3 (Bonnefont
1-7 yr 7-14 0.8-1.5 et al, 1990)
7-15 yr 5-8 0.6-0.9
D-lactate P(H) j (Rosenthal and
6 mo-3 yr 0.0-0.3 ×1 0.0-0.3 Pesce, 1985)
Lactate dehydrogenase S U/L U/L
(LDH) <1 yr 170-580 ×1 170-580 37°C, a (Meites,
1-9 yr 150-500 150-500 1989)
10-19 yr 120-330 120-330
Isoenzymes S % of total activity
1-6 yr 7-19 yr
LD1 20-38 20-35
LD2 27-38 31-38
LD3 16-26 19-28
LD4 5-16 7-13
LD5 3-13 5-12
Lead W(H) μg/dL mmol/L
Child <5 ×0.0483 <0.0024
Toxic ≥70 ≥3.38
Lipase P,S 1-18 yr 145-216 U/L ×1 145-216 U/L (Ghoshal and
Soldin, 2003)
Magnesium P(H) mg/dL mmol/L
0-6 days 1.2-2.6 ×0.411 0.48-1.05 gw (Meites,
7 days-2 yr 1.6-2.6 0.65-1.05 1989)
2-14 yr 1.5-2.3 0.60-0.95
0.78 ± 0.37% of total Hb ×0.01 0.0078 ± 0.0037 (mass
fraction)
Osmolality S Child, adult
275-295 mOsm/kg H2O
Phosphatase, alkaline S U/L U/L
1-9 yr 145-420 ×1 145-420 37°C, aw
10-11 yr 140-560 140-560
M F M F
12-13 yr 200-495 105-420 200-495 105-420
14-15 yr 130-525 70-230 130-525 70-230
16-19 yr 65-260 50-130 65-260 50-130
Phosphorus, inorganic S,P(H) mg/dL mmol/L
0-5 days 4.8-8.2 ×0.3229 1.55-2.65 w (Meites, 1989)
1-3 yr 3.8-6.5 1.25-2.10
4-11 yr 3.7-5.6 1.20-1.80
12-15 yr 2.9-5.4 0.95-1.75
16-19 yr 2.7-4.7 0.90-1.50
Continued

Downloaded for Med Caduceus (samiauditore75@gmail.com) at MOH Consortium -Tehran University of Medical Sciences from ClinicalKey.com by Elsevier on April 17, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
e12 Part XXXIV ◆ Laboratory Medicine

Table 748.5 Reference Intervals—cont’d

ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Potassium S mmol/L mmol/L
0-1 wk 3.2-5.5 ×1 3.3-5.5 (Greeley et al,
1 wk-1 mo 3.4-6.0 3.4-6.0 1993)
1-6 mo 3.5-5.6 3.5-5.6 Increased by
6 mo-1 yr 3.5-6.1 3.5-6.1 hemolysis;
>1 yr 3.3-4.6 3.3-4.6 serum values
systematically
higher than
plasma values
P(H) 3.5-4.5 mmol/L 3.5-4.5 mmol/L
Prealbumin S mg/dL mg/L
(transthyretin) 0-5 days 6.0-21.0 ×10 60-210 s (Lockitch,
1-5 yr 14.0-30.0 140-300 Halstead,
6-9 yr 15.0-30.0 150-300 Quigley, 1988)
10-13 yr 20.0-36.0 200-360
14-19 22.0-45.0 220-450
Protein, total S g/dL g/L
Premature 4.3-7.6 ×10 43-76 (Meites, 1989)
Newborn 4.6-7.4 46-74
1-7 yr 6.1-7.9 61-79
8-12 yr 6.4-8.1 64-81
13-19 yr 6.6-8.2 66-82
Pyruvate (perchloric W 7-17 yr 0.076 ± ×1 0.076 ± 0.026 mmol/L (Pianosi et al,
acid) 0.026 mmol/L 1995)
Sodium S,P (LiH, mmol/L mmol/L
NH4H) Newborn 133-146 ×1 133-146 g (Greeley et al,
Infant 134-144 134-144 1993)
Child 134-143 134-143
Thereafter 135-145 135-145
Thyroid-stimulating S μIU/L μIU/L
hormone (TSH) 0-3 days 1.00-20.00 ×1 1.0-20.00 g (Dugaw et al,
3-30 days 0.5-6.5 0.50-6.50 2001)
1-5 mo 0.5-6.0 0.5-6.0
6 mo-18 yr 0.5-4.5 0.5-4.5
Thyroid uptake of Activity over 2 hr <6% ×0.01 2 hr <0.06
radioactive iodine thyroid 6 hr 3-20% 6 hr 0.03-0.20
gland 24 hr 8-30% 24 hr 0.08-0.30
Thyroid uptake of Activity over After 24 hr 0.4-3.0% ×0.01 Fractional uptake
technetium-99m thyroid 0.004-0.030
gland
Thyrotropin-releasing P 5-60 pg/mL ×2.759 14-165 pmol/L
hormone (TRH)
Thyroxine-binding S mg/dL mg/L
globulin (TBG) Cord blood 1.4-9.4 ×10 14-94
1-4 wk 1.0-9.0 10-90
1-12 mo 2.0-7.6 20-76
1-5 yr 2.9-5.4 29-54
5-10 yr 2.5-5.0 25-50
10-15 yr 2.1-4.6 21-46
Adult 1.5-3.4 15-34
Thyroxine (T4), total S μg/dL nmol/L
0-3 days 8.0-20.0 ×12.9 103-258 g (Dugaw et al,
3-30 days 5.0-15.0 64-193 2001)
31-365 days 6.0-14.0 77-180
1-5 yr 4.5-11.0 58-142
6-18 yr 4.5-10.0 58-129
Thyroxine (T4), free S ng/dL pmol/L
0-3 days 2.00-5.00 ×12.9 25.7-64.3 g (Dugaw et al,
3-30 days 0.90-2.20 11.6-28.3 2001)
31 days-18 yr 0.7-2.00 9.0-25.7
Thyroxine (T4), total W Newborn screen ×12.9 80-283 nmol/L
(filter paper)
6.2-22.0 μg/dL
Continued

Downloaded for Med Caduceus (samiauditore75@gmail.com) at MOH Consortium -Tehran University of Medical Sciences from ClinicalKey.com by Elsevier on April 17, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
 Chapter 748 ◆ Reference Intervals for Laboratory Tests and Procedures e13

Table 748.5 Reference Intervals—cont’d

ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Triiodothyronine (T3), S pg/dL pmol/L
free Cord blood 20-240 ×0.01536 0.3-3.7
1-3 days 200-610 3.1-9.4
6 wk 240-560 3.7-8.6
Adult (20-50 yr) 230-660 3.5-10.0
Triiodothyronine (T3), S ng/dL nmol/L
total 0-3 days 60-300 ×0.0154 0.9-4.7
4-365 days 90-260 1.4-4.0
1-6 yr 90-240 1.4-3.7
7-11 yr 90-230 1.4-3.6
12-18 yr 100-210 1.5-3.3 g (Dugaw et al,
2001)
Urea nitrogen S,P mg/dL mmol/L
Cord blood 21-40 ×0.357 7.5-14.3
Premature 3-25 1.1-9.0
(1 wk)
Newborn 3-12 1.1-4.3
infant or child 5-18 1.8-6.4
Thereafter 7-18 2.5-6.4
Uric acid S mg/dL μmol/L
1-3 yr 1.8-5.0 ×59.48 100-300
4-6 yr 2.2-4.7 130-280
7-9 yr 2.0-5.0 120-295
10-11 yr M 2.3-5.4 135-320 (Lockitch
10-11 yr F 3.0-4.7 180-280 Halstead,
12-13 yr M 2.7-6.7 160-400 Albersheim,
14-15 yr M 2.4-7.8 140-465 1988)
12-15 yr F 3.0-5.8 180-345
16-19 yr M 4.0-8.6 235-510
16-19 yr F 3.0-5.9 180-350
*In preparing the reference range listings, a number of abbreviations, symbols, and codes were used (see Table 748.2).
†
Reference values are shown in SI units (International System of Units) and U.S. units (Traditional Units).]

Nomogram
Height For children of S.A. Weight
cm in M2 lb kg
normal height
for weight 180 80
90 160 70
1.30
80 2.0 140
1.20 1.9 130 60
240 70 1.10 1.8 120
90 1.7 110 50
220 85 60 1.00 1.6 100
1.5 90
200 80 1.4 40
50 .90 80
190 75 1.3
180 70 .80 1.2 70
30
170 40 1.1 60
Surface area in square meters

65 .70
160 1.0 25
150 60 50
0.9 45
140 55 30 .60 20
.55 0.8 40
Weight in pounds

130 50 .50 35 15
120 0.7
30
45 20 .45
110 0.6 25
.40
100 40 10
15 .35 0.5 20 9.0
90 35 18 8.0
16 7.0
.30 0.4
80 14
30 10 6.0
12
28 9 .25 5.0
70 10
26 8 0.3
9 4.0
24 7 8
60
22 6 .20 7 3.0
6
50 20 5 0.2 2.5
19 5
18 4 .15 2.0
17 4
40 16
15 3 1.5
3
14
13
.10 1.0
30 12 2 0.1

Alternative (Mosteller’s formula):

Surface area (m2) ! Height (cm) " Weight (kg)
3600
Fig. 748.1 Nomogram for the estimation of surface area. The surface area is indicated where a straight line that connects the height and weight
levels intersects the surface area column, or if the patient is roughly of average size, from the weight alone (enclosed area). (Nomogram modified
from the data of E. Boyd by C.D. West. See also Briars GL, Bailey BJ: Surface area estimation: pocket calculator v nomogram, Arch Dis Child
70:246–247, 1994.)

Downloaded for Med Caduceus (samiauditore75@gmail.com) at MOH Consortium -Tehran University of Medical Sciences from ClinicalKey.com by Elsevier on April 17, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.
 e14 Part XXXIV ◆ Laboratory Medicine

2.0 Bhutani VK, Johnson L, Sivieri EM: Predictive ability of a predischarge hour-specific
Pounds to square meter (m2) serum bilirubin for subsequent significant hyperbilirubinemia in healthy term and
1.8 105 near-term newborns, Pediatrics 103:6–14, 1999.
Bonnefont JP, Specola NB, Vassault A, et al: The fasting test in children: application to
100
the diagnosis of pathological hypo- and hyperketotic state, Eur J Pediatr 150:80–85,
1.6 94 1990.
88 Buck ML: Anticoagulation with warfarin in infants and children, Ann Pharmacother
1.4 82 30:1316–1322, 1996.
76 Diaz J, Tornel PL, Martinez P: Reference intervals for blood ammonia in healthy

Percent adult dose

Surface area m2

1.2 71 subjects, determined by microdiffusion, Clin Chem 41:1048, 1995.

65 Dugaw KA, Jack RM, Rutledge J: Pediatric reference ranges for TSH, free T4,
1.0 59 total T4, total T3 and T3 uptake on the VitrosECi analyzer, Clin Chem 47:A108,
53 2001.
Esoterix Endocrinology, Calabasas Hills, CA 91301.
0.8 47
Farrell PM, Rosenstein BJ, White TB, et al: Guidelines for diagnosis of cystic fibrosis
41 in newborns through older adults: Cystic Fibrosis Foundation Consensus Report,
0.6 35 J Pediatr 153:S4–S14, 2008.
30 Ghoshal A, Soldin S: Evaluation of the Dade Behring dimension R × L: integrated
0.4 24 chemistry system, pediatric reference ranges, Clin Chim Acta 331:135–146,
18 2003.
0.2 12 Gillard BK, Simbala JA, Goodglick L: Reference intervals for amylase isoen-
6 zymes in serum and plasma of infants and children, Clin Chem 29:1119–1123,
1983.
0 20 40 60 80 100 120 140 160 Greeley C, Snell J, Colaco A, et al: Pediatric reference ranges for electrolytes and
creatinine, Clin Chem 39:1172, 1993.
Body weight—pounds Jedeikin R, Makela SK, Shennan AT, et al: Creatine kinase isoenzymes in serum
Fig. 748.2 Relationships among body weight (lb), body surface area, from cord blood and the blood of healthy full-term infants during the first three
and adult dosage. The surface area values correspond with those set postnatal days, Clin Chem 28:317–322, 1982.
forth by Crawford JD, Terry ME, Rourke GM: Simplification of drug Kaplan EL, Rothermel CD, Johnson DR: Antistreptolysin O and anti-deoxyribonuclease
dosage calculation by application of the surface area principle, Pediatrics B titers: normal values for children ages 2 to 12 in the United States, Pediatrics
5:783–790, 1950. Note that the 100% adult dose is for a patient weighing 101:86–88, 1998.
approximately 140 lb and having a surface area of approximately 1.7 m2. Knight JA, Haymond RE: γ-Glutamyltransferase and alkaline phosphatase activities
(From Talbot NB, Richie RH, Crawford JH: Metabolic homeostasis: a compared in serum of normal children and children with liver disease, Clin Chem
syllabus for those concerned with the care of patients, Cambridge, MA, 27:48–51, 1981.
1959, Harvard University Press.) Lockitch G, Halstead AC, Albersheim S, et al: Age- and sex-specific pediatric reference
intervals for biochemistry analytes as measured with the Ektachem-700 analyzer,
Clin Chem 34:1622–1625, 1988.
Lockitch G, Halstead AC, Quigley G, et al: Age- and sex-specific pediatric
25
reference intervals: study design and methods illustrated by measurement of
serum proteins with the behring LN nephelometer, Clin Chem 34:1618–1621,
1988.
20 Lockitch G, Halstead AC, Wadsworth L, et al: Age- and sex-specific pediatric reference
High-risk zone
Total serum bilirubin (mg/dL)

95th percentile intervals and correlations for zinc, copper, selenium, iron, vitamins A and E, and
related proteins, Clin Chem 34:1625–1628, 1988.
ne rcentile
zo 75th pe Meites S, editor: Pediatric clinical chemistry, reference (normal) values, ed 3, Washington,
15 isk
e-r DC, 1989, American Association for Clinical Chemistry.
iat e ntile
ed zon 40th perce
er m risk Muntau A, Streiter M, Kappler M, et al: Age-related reference values for serum selenium
int ia te-
Hig
h ed concentrations in infants and children, Clin Chem 48:555–560, 2002.
rm
10 inte Nichols Institute Diagnostics, San Juan Capistrano, CA 92675.
Low
Nir A, Bar-Oz B, Perles Z, et al: N-terminal pro-B-type natriuretic peptide: reference
plasma levels from birth to adolescence: elevated levels at birth and in infants and
Low-risk zone children with heart diseases, Acta Paediatr 93:603–607, 2004.
5
Pianosi P, Seargeant L, Haworth JC: Blood lactate and pyruvate concentrations, and
their ratio during exercise in healthy children: developmental perspective, Eur J
Appl Physiol Occup Physiol 71:518–522, 1995.
0 Rosenthal P, Pesce MA: Long-term monitoring of D-lactic acidosis in a child, J Pediatr
0 12 24 36 48 60 72 84 96 108 120 132 144 156 168 Gastroenterol Nutr 4:674–676, 1985.
Age (hr) Sherry B, Jack RM, Weber A, et al: Reference interval for prealbumin for children 2
Fig. 748.3 Nomogram for risk assessment of hyperbilirubinemia. to 36 months old, Clin Chem 34:1878–1880, 1988.
(From Bhutani VK, Johnson L, Sivieri EM: Predictive ability of a predis- Soldin SJ, Morse AS: Pediatric reference ranges for albumin and total protein in children
charge hour-specific serum bilirubin for subsequent significant hyper- <1 year old using the Vitros 500 analyzer, Clin Chem 44:A15, 1998.
bilirubinemia in healthy term and near-term newborns, Pediatrics Soldin SJ, Savwoir TV, Guo Y: Pediatric reference ranges for alkaline phosphatase,
103:6−14, 1999, Fig 2.) aspartate aminotransferase, and alanine aminotransferase in children less than 1
year old on the Vitros 500, Clin Chem 43:S199, 1997.
Soldin SJ, Brugnara C, Wong ED, editors: Pediatric reference intervals, ed 5, Washington,
DC, 2005, American Association for Clinical Chemistry.
748.2 provide estimations related to dosages. Fig. 748.3 is a nomogram Soldin O, Bierbower L, Choi J, et al: Serum iron, ferritin, transferrin, total iron binding
for risk assessment of hyperbilirubinemia. capacity, hs-CRP, LDL cholesterol and magnesium in children: new reference
intervals using the Dade Dimension Clinical Chemistry System, Clin Chim Acta
Bibliography (for Table 748.5) 342:211–217, 2004.
American Diabetes Association: Diagnosis and classification of diabetes mellitus, Soldin SJ, Hicks JM, Bailey J, et al: Pediatric reference ranges for 25-hydroxy vitamin
Diabetes Care 33:562–569, 2010. D during the summer and winter, Clin Chem 43:S200, 1997.

Downloaded for Med Caduceus (samiauditore75@gmail.com) at MOH Consortium -Tehran University of Medical Sciences from ClinicalKey.com by Elsevier on April 17, 2019.
For personal use only. No other uses without permission. Copyright ©2019. Elsevier Inc. All rights reserved.