Appendix

B
● Diagnostic Studies
and Interpretation

TEST VALUE STUDIED

Reference Ranges—Hematology
Reference Ranges—Serum, Plasma, and Whole Blood Chemistries
Reference Ranges—Immunodiagnostic Tests
Reference Ranges—Urine Chemistry
Reference Ranges—Cerebrospinal Fluid (CSF)
Miscellaneous Values

SELECTED ABBREVIATIONS USED IN REFERENCE RANGES

Conventional Units
kg = kilogram mU = milliunit
gm = gram µU = microunit
mg = milligram mEq = milliequivalent
µg = microgram IU = International Unit
µµg = micromicrogram mIU = milliInternational Unit
ng = nanogram
pg = picogram
dL = 100 milliliters
mL = milliliter
SI Units
mm3 = cubic millimeter g = gram
fL = femtoliter L = liter
mM = millimole d = day
nM = nanomole h = hour
mOsm = milliosmole mol = mole
mm = millimeter mmol = millimole
µm = micron or micrometer µmol = micromole
mm Hg = millimeters of mercury nmol = nanomole
U = unit pmol = picomole

2213
2214 Appendix B Diagnostic Studies and Interpretation

Table B-1 • Reference Ranges—Hematology*

REFERENCE RANGE

DETERMINATION Conventional Units SI Units CLINICAL SIGNIFICANCE

A2 hemoglobin 2.0%–3.2% of total hemoglobin Mass fraction: 0.015–0.035 Increased in certain types of thalassemia
of total hemoglobin
Bleeding time 1.5–9.5 min 1.5–9.5 min Prolonged in thrombocytopenia, de-
fective platelet function, and aspirin
therapy
Factor V assay (proac- 60%–140%
celerin factor)
Factor VIII assay (anti- 60%–140% Deficient in classical hemophilia
hemophiliac factor)
Factor IX assay (plasma 60%–140% Deficient in Christmas disease
thromboplastin (pseudohemophilia)
component)
Factor X (Stuart factor) 60%–140% Deficient in Stuart clotting defect
Fibrinogen 200– 400 mg/dL 2–4 g/dL Increased in pregnancy, infections
accompanied by leukocytosis,
nephrosis
Decreased in severe liver disease,
abruptio placentae
Fibrin split (degrada- <5 µg/mL <5 µg/mL Increased in disseminated intravascular
tion) products coagulation
Fibrinolysins (whole No lysis in 24 h Increased activity associated with mas-
blood clot lysis time) sive hemorrhage, extensive surgery,
transfusion reactions
Partial thromboplastin Lower limit of normal: 20–25 sec; Prolonged in deficiency of fibrinogen,
time (activated) Upper limit of normal: 32–39 sec factors II, V, VIII, IX, X, XI, and
XII, and in heparin therapy
Prothrombin con- Lower limit of normal: 10 sec Impaired in deficiency of factors VIII,
sumption Lower limit of normal: 14 sec IX, and X
Prothrombin time 9.5–12 sec Prolonged by deficiency of factors I, II,
INR 1.0 V, VII, and X, fat malabsorption,
severe liver disease, coumarin anti-
coagulant therapy.
2–3 for therapy in atrial fibrillation, INR used to standardize the pro-
deep vein thrombosis, and pulmonary thrombin time and anticoagulation
enbolism therapy
2.5–3.5 for therapy in prosthetic heart
valves
Erythrocyte count Males: 4,600,000–6,200,000/cu mm 4.6–6.2 × 1012/L Increased in severe diarrhea and dehy-
Females: 4,200,000–5,400,000/cu mm 4.2–5.4 × 1012/L dration, polycythemia, acute poison-
ing, pulmonary fibrosis
Decreased in all anemias in leukemia,
and after hemorrhage, when blood
Erythrocyte indices volume has been restored
Mean corpuscular 84–96 cu µm 84–96 fL Increased in macrocytic anemias;
volume (MCV) decreased in microcytic anemia
Mean corpuscular 28–33 µµg/cell 28–33 pg Increased in macrocytic anemias;
hemoglobin decreased in microcytic anemia
(MCH)
Mean corpuscular 33%–35% Concentration fraction: Decreased in severe hypochromic
hemoglobin con- 0.33–0.35 anemia
centration
(MCHC)
Reticulocytes 0.5%–1.5% of red cells Number fraction: Increased with any condition stimulat-
0.005–0.015 ing increase in bone marrow activity
(ie, infection, blood loss [acute and
chronically following iron therapy in
iron deficiency anemia], poly-
cythemia rubra vera)
Decreased with any condition depress-
ing bone marrow activity, acute
leukemia, late stage of severe anemias
(continued)
Table B-1 • Reference Ranges—Hematology* (Continued)
REFERENCE RANGE

DETERMINATION Conventional Units SI Units CLINICAL SIGNIFICANCE

Erythrocyte sedimenta- Males under 50 yr: <15 mm/h <15 mm/h Increased in tissue destruction, whether
tion rate (ESR)— Males over 50 yr: <20 mm/h <20 mm/h inflammatory or degenerative; during
Westergren method Females under 50 yr: <25 mm/h <25 mm/h menstruation and pregnancy; and in
Females over 50 yr: <30 mm/h <30 mm/h acute febrile diseases
Erythrocyte sedimenta- <50 years: <55% Volume fraction: <0.55 Significance similar to ESR
tion ratio—Zeta 50–80 years: 40%–60% 0.40–0.60
centrifuge
Hematocrit Males: 42%–52% Volume fraction: 0.42–0.52 Decreased in severe anemias, anemia of
Females: 35%–47% Volume fraction: 0.35–0.47 pregnancy, acute massive blood loss
Increased in erythrocytosis of any
cause, and in dehydration or hemo-
concentration associated with shock
Hemoglobin Males: 13–18 gm/dL 2.02–2.79 mmol/L Decreased in various anemias, preg-
Females: 12–16 gm/dL 1.86–2.48 mmol/L nancy, severe or prolonged hemor-
rhage, and with excessive fluid intake
Increased in polycythemia, chronic ob-
structive pulmonary disease, failure
of oxygenation because of congestive
heart failure, and normally in people
living at high altitudes
Hemoglobin F Less than 2% of total hemoglobin Mass fraction: <0.02 Increased in infants and children, and
in thalassemia and many anemias
Leukocyte alkaline Score of 15–130 (varies among labs) Increased in polycythemia vera,
phosphatase myelofibrosis, and infections
Decreased in chronic granulocytic
leukemia, paroxysmal nocturnal he-
moglobinuria, hypoplastic marrow,
and viral infections, particularly
infectious mononucleosis
Leukocyte count Total: 4,500–11,000/cu mm 4.5–11 × 10 9/L Neutrophils increased with acure infec-
Neutrophils 45%–73% Number fraction: 0.45–0.73 tions, trauma or surgery, leukemia,
Eosinophils 0%–4% Number fraction: malignant disease, necrosis; decreased
0.00–0.04 with viral infections, bone marrow
Basophils 0%–1% Number fraction: suppression, primary bone marrow
0.00–0.01 disease
Lymphocytes 20%–40% Number fraction: 0.2–0.4 Eosinophils increased in allergy, para-
Monocytes 2%–8% Number fraction: sitic disease, collagen disease, sub-
0.02–0.08 acute infections; decreased with
stress, use of some medications
(ACTH, epinephrine, thyroxine)
Basophils increased with acute
leukemia and following surgery or
trauma; decreased with allergic reac-
tions, stress, allergy, parasitic disease,
use of corticosteroids
Lymphocytes increased with infectious
mononucleosis, viral and some bacte-
rial infections, hepatitis; decreased
with aplastic anemia, SLE, immuno-
deficiency including AIDS
Monocytes increased with viral infec-
tions, parasitic disease, collagen and
hemolytic disorders; decreased with
use of corticosteroids, RA, HIV
infection
Platelet count 150,000– 450,000/cu mm 0.15–0.45 × 1012/L Increased in malignancy, myeloprolif-
erative disease, rheumatoid arthritis,
and postoperatively; about 50% of
patients with unexpected increase of
platelet count will be found to have a
malignancy
Decreased in thrombocytopenic pur-
pura, acute leukemia, aplastic anemia,
and during cancer chemotherapy.

*Laboratory values may vary according to the techniques used in different laboratories.
2216 Appendix B Diagnostic Studies and Interpretation

Table B-2 • Reference Ranges—Serum, Plasma, and Whole Blood Chemistries

NORMAL ADULT REFERENCE RANGE CLINICAL SIGNIFICANCE

DETERMINATION Conventional Units SI Units Increased Decreased

Acetoacetate 0.2–1.0 mg/dL 19.6–98 µmol/L Diabetic acidosis
Fasting
Acetone 0.3–2.0 mg/dL 51.6–344.0/µmol/L Diabetic ketoacidosis
Toxemia of pregnancy
Carbohydrate-free diet
High-fat diet
Acid, total phos- Males: 2–12 UL Males: 2–12 UL Carcinoma of prostate
phatase Females: 0.3–9.2 UL Females: 0.3–9.2 UL Advanced Paget’s disease
Hyperparathyroidism
Gaucher’s disease
Acid, phosphatase, 2.5–3.37 ng/mL 2.5–3.37 µg/L Carcinoma of prostate
prostatic—RIA
Alkaline phosphatase Adults: 50–120 UL 50–120 UL Conditions reflecting increased
osteoblastic activity of bone
Rickets
Hyperparathyroidism
Hepatic disease
Bone disease
Alkaline phos- Hepatic: >25%
phatase, ther- Combined: 10%–25%
mostable fraction Skeletal: <10%
Adrenocorticotropic <50 pg/mL <50 ng/L Pituitary-dependent Adrenocortical tumor
hormone (ACTH) Cushing’s syndrome Adrenal insufficiency
(plasma)—RIA* Ectopic ACTH syndrome secondary to hypo-
Primary adrenal atrophy pituitarism
Aldolase 3–8 Sibley-Lehninger 22–59 mU/L at 37°C Hepatic necrosis
U/dL at 37°C Granulocytic leukemia
Myocardial infarction
Skeletal muscle disease
Aldosterone Supine: 3–10 ng/dL 0.08–0.30 nmol/L Primary aldosteronism Addison’s disease
(plasma)—RIA Upright: 5–30 ng/dL 0.14–0.90 nmol/L Secondary aldosteronism
Adrenal vein: 200–800 5.54–22.16 nmol/L
ng/dL
Alpha-1-antitrypsin 110–140 mg/dL 1.1–1.4 g/L Certain forms of
chronic lung and liver
disease in young
adults
Alpha-1-fetoprotein <15 ng/mL <15 µg/L Hepatocarcinoma
Metastatic carcinoma of liver
Germinal cell carcinoma of the
testicle or ovary
Fetal neural tube defects—
elevation in maternal serum
Alpha-hydroxy- <140 U/L <140 U/L Myocardial infarction
butyric dehydroge- Granulocytic leukemia
nase Hemolytic anemias
Muscular dystrophy
Ammonia (plasma) 15–45, µg/dL (varies with 11–32/µmol/L Severe liver disease
method Hepatic decompensation
Amylase 60–160 Somogyi U/dL 111–296U/L Acute pancreatitis Chronic pancreatitis
Mumps Pancreatic fibrosis and
Duodenal ulcer atrophy
Carcinoma of head of pancreas Cirrhosis of liver
Prolonged elevation with pseudo- Pregnancy (2nd and
cyst of pancreas 3rd trimesters)
Increased by medications that
constrict pancreatic duct
sphincters: morphine, codeine,
cholinergics
(continued)
 Appendix B Diagnostic Studies and Interpretation 2217

Table B-2 • Reference Ranges—Serum, Plasma, and Whole Blood Chemistries (Continued)
NORMAL ADULT REFERENCE RANGE CLINICAL SIGNIFICANCE

DETERMINATION Conventional Units SI Units Increased Decreased

Arsenic <70 µg/dL; poisoning: <0.93–2.6 µmol/L; Intentional or unintentional
100–150 µg/dL poisoning: poisoning
133–6.65 µmol/L Excessive occupational exposure
Ascorbic acid 0.4–1.5 mg/dL 23–85 µmol/L Large doses of ascorbic acid as a
(vitamin C) prophylactic against the com-
mon cold
ALT (alanine Males: 10–40 U/mL Males: Same conditions as AST (SGOT),
aminotransferase), 0.17–0.68 µkat/L but increase is more marked in
formerly SGPT Females: 8–35 U/mL Females: liver disease than AST (SGOT)
0.14–0.60 µkat/L
AST (aspartate Males: 10–40 U/L Males: Myocardial infarction
aminotransferase), 0.34–0.68 µkat/L Skeletal muscle disease
formerly SGOT Females: 15–30 U/L Females: Liver disease
0.25–0.51 µkat/L
Bilirubin Total: 0.3–1.0 mg/dL 5–17µmol/L Hemolytic anemia (indirect)
Direct: 0.1–0.4 mg/dL 1.7–3.7/µmol/L Biliary obstruction and disease
Indirect: 0.1–0.4 mg/dL 3.4–11.2 µmol/L Hepatocellular damage (hepatitis)
Pernicious anemia
Hemolytic disease of newborn
Blood gases
Oxygen, arterial
(whole blood):
Partial pressure 85–95 mm Hg 10.64–12.64kPa Polycythemia Anemia
(PaO2) Cardiac or pulmonary
disease
Saturation (SaO2) 95%–99% Volume fraction: Cardiac decompensation
0.95–0.99 Chronic obstructive
lung disease
Carbon dioxide, 35–45 mm Hg 4.66–5.99 kPa Respiratory acidosis Respiratory alkalosis
arterial (whole Metabolic alkalosis Metabolic acidosis
blood) partial
pressure (PaCO2)
pH (whole blood, 7.35–7.45 7.35–7.45 Vomiting Uremia
arterial) Hyperventilation Diabetic acidosis
Fever Hemorrhage
Intestinal obstruction Nephritis
Calcitonin Basal: <19 pg/mL 19 ng/L Medullary carcinoma of the
Stimulation test thyroid
Males: <350 pg/mL <350 ng/L Some nonthyroid tumors
Females: <100 pg/mL <100 ng/L Zollinger-Ellison syndrome
Calcium 8.6–10.2 mg/dL 2.15–2.55 mmol/L Tumor or hyperplasia of para- Hypoparathyroidism
thyroid Diarrhea
Hypervitaminosis D Celiac disease
Multiple myeloma Vitamin D deficiency
Nephritis with uremia Acute pancreatitis
Malignant tumors Nephrosis
Sarcoidosis After parathyroidectomy
Hyperthyroidism
Skeletal immobilization
Excess calcium intake:milk
alkali syndrome
CO2, venous Adults 24–32 mEq/L 24–32 mmol/L Tetany Acidosis
Infants: 18–24 mEq/L 18–24 mmol/L Respiratory disease Nephritis
Intestinal obstruction Eclampsia
Vomiting Diarrhea
Anesthesia

(continued)
2218 Appendix B Diagnostic Studies and Interpretation

Table B-2 • Reference Ranges—Serum, Plasma, and Whole Blood Chemistries (Continued)
NORMAL ADULT REFERENCE RANGE CLINICAL SIGNIFICANCE

DETERMINATION Conventional Units SI Units Increased Decreased

Catecholamines Epinephrine: <540 pmol/L Pheochromocytoma
(plasma)—RIA <100 pg/mL
Norepinephrine: <2360 pmol/L
<400 pg/mL
Dopamine: <143 pg/mL <935 pmol/L
Ceruloplasmin 20–40 mg/dL 1.26–2.52 µmol/L Wilson’s disease
(hepatolenticular
degeneration)
Chloride 97–107 mEq/L 97–107 mmol/L Nephrosis Diabetes mellitus
Nephritis Diarrhea
Urinary obstruction Vomiting
Cardiac decompensation Pneumonia
Anemia Heavy metal poisoning
Cushing’s syndrome
Intestinal obstruction
Febrile conditions
Cholesterol 150–200 mg/dL 3.9–5.2 mmol/L Lipemia Pernicious anemia
Obstructive jaundice Hemolytic anemia
Diabetes Hyperthyroidism
Hypothyroidism Severe infection
Terminal states of de-
bilitating disease
Cholesterol esters 60%–70% of total Fraction of total cho- The esterified fraction
lesterol 0.6–0.7 decreases in liver
diseases
Cholinesterase Serum: 0.6–1.6 delta pH 0.6–1.6 U Nephrosis Nerve gas exposure
Red cells-0.6–1 delta pH 0.6–1 U Exercise (greater effect on red
cell activity)
Insecticide poisoning
Chorionic 0–5 IU/L 0–5 IU/L Pregnancy Threatened abortion
gonadotropin, Hydatidiform mole Ectopic pregnancy
beta subunit Choriocarcinoma
Complement, C3 80–170 mg/dL 0.8–1.7 g/L Some inflammatory diseases, Acute glomerulo-
acute myocardial infarction, nephritis
cancer Disseminated lupus ery-
thematosus with renal
involvement
Complement C4 18–51 mg/dL 180–510 mg/L Some inflammatory diseases, Often decreased in im-
acute myocardial infarction, munologic disease,
cancer especially with active
systemic lupus erythe-
matosus
Hereditary angio-
neurotic edema
Complement, total 90%–94% complement 25–70 U/mL Some inflammatory diseases Acute glomerulo-
(hemolytic) nephritis
Epidemic meningitis
Subacute bacterial endo-
carditis
Copper 70–150 µg/dL 11–24 µmol/L Cirrhosis of liver Wilson’s disease
Pregnancy
Cortisol-RIA 8 AM: 5–25/µg/dL 138–690 nmol/L Stress: infectious disease, surgery, Addison’s disease
4 PM: 3–16 µg/dL 83–442 nmol/L burns, etc. Anterior pituitary hypo-
Pregnancy function
Cushing’s syndrome
Pancreatitis
Eclampsia
C-peptide reactivity 0.9–4.0 ng/mL 0.9–4.0 µg/L Insulinoma Diabetes mellitus

(continued)
 Appendix B Diagnostic Studies and Interpretation 2219

Table B-2 • Reference Ranges—Serum, Plasma, and Whole Blood Chemistries (Continued)
NORMAL ADULT REFERENCE RANGE CLINICAL SIGNIFICANCE

DETERMINATION Conventional Units SI Units Increased Decreased

Creatine 0.2–0.8 mg/mL 15.3–61 µmol/L Pregnancy
Skeletal muscle necrosis or atrophy
Starvation
Hyperthyroidism
Creatine phosphoki- Males: 50–325 mU/mL 50–325 U/L Myocardial infarction
nase (CPK) Females: 50–250 mU/mL 50–250 U/L Skeletal muscle diseases
Intramuscular injections
Crush syndrome
Hypothyroidism
Alcohol withdrawal delirium
Alcoholic myopathy
Cerebrovascular disease
Creatine phosphoki- MM band present (skele- MB band increased in myocardial
nase isoenzymes tal muscle)-MB band infarction, ischemia
absent (heart muscle)
Creatinine 0.7–1.4 mg/dL 62–124 µmol/L Nephritis
Chronic renal disease
Creatinine clearance Males: 85–125 mL/min 1.42–2.08 mL/s Kidney diseases
Females: 75–115 1.25–1.92 mL/s
mL/min
Cryoglobulins, qual- Negative Multiple myeloma
itative Chronic lymphocytic leukemia
Lymphosarcoma
Systemic lupus erythematosus
Rheumatoid arthritis
Infective subacute endocarditis
Some malignancies
Scleroderma
11-Deoxycortisol 1/µg/dL <0.029 µmol/L Hypertensive form of virilizing
adrenal hyperplasia due to an
11-β-hydroxylase defect
Dibucaine number Normal: 70%–85% Important in detecting
inhibition carriers of abnormal
Heterozygote: cholinesterase activity
50%–65% inhibition who are susceptible to
Homozygote: 16%–25% succinylcholine
inhibition anesthetic shock
Dihydrotestosterone Males: 50–210 ng/dL 1.72–7.22 nmol/L Testicular feminization
Females: none detectable syndrome
Estradiol—RIA Females: Pregnancy Depressed or failure to
Follicular: 10–90 pg/mL 37–370 pmol/L peak—ovarian failure
Midcycle: 100–500 367–1835 pmol/L
pg/mL
Luteal: 50–240 pg/mL 184–881 pmol/L
Follicular phase: 2–20
ng/dL
Midcycle: 12–40 ng/dL
Luteal phase: 10-30
ng/dL
Postmenopausal: 1–5
ng/dL
Males: 0.5–5 ng/dL
Estriol—RIA Nonpregnant females: <1.75 nmol/L Pregnancy Depressed or failure to
<0.5 ng/mL peak—ovarian failure
Pregnant females:
1st trimester: up to Up to 3.5 nmol/L
1 ng/mL
2nd trimester: 2.8–24.3 nmol/L
0.8–7 ng/mL
3rd trimester: 17.4–86.8 nmol/L
5–25 ng/mL (continued)