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APPENDIX B Laboratory Values

Adapted by Jennifer E. Cooke

p0010 The tables in this appendix list some of the most common tests, parentheses. Laboratory values may vary with different tech-
their normal values, and possible etiologies of abnormal values. niques or different laboratories. Possible etiologies are presented
Laboratory values are expressed in the Système International in alphabetical order. Abbreviations appearing in the tables are
d’Unités (SI units) that are used in Canada. Conventional units, defined as follows:
used in the United States, are presented after the SI units in

< = less than mcmol = micromole

> = greater than mcU = microunit
≥ = greater than or equal to mEq = milliequivalent
≤ = less than or equal to mg = milligram (10−3)
AU = arbitrary unit mL = millilitre
dL = decilitre mm = millimetre
EU = Ehrlich unit mm Hg = millimetre of mercury
fL = femtolitre mmol = millimole
g = gram mOsm = milliosmole
IU = international unit nmol = nanomole
kPa = kilopascal ng = nanogram (one billionth of a gram) (10−9)
L = litre pg = picogram (one trillionth of a gram) (10−12)
mcg = microgram (one millionth of a gram) (10-6) pmol = picomole
mckat = microkatal U = unit
t0010 mcL = microlitre

t0015 Table B-1 Serum, Plasma, and Whole Blood Chemistries

NORMAL VALUES POSSIBLE ETIOLOGY

TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Acetone Diabetic ketoacidosis, high-fat diet, —
Quantitative <200 mcmol/L (<1.16 mg/dL) low-carbohydrate diet, starvation
Qualitative Negative (negative)
Alanine aminotransferase (ALT) 4-36 U/L (same as SI units) Liver disease, shock —
(formerly serum glutamate
pyruvate transferase [SGPT])
Albumin 35-50 g/L (3.5-5 g/dL) Dehydration Burns, chronic liver disease,
malabsorption, malnutrition, nephrotic
syndrome, pregnancy
Aldolase 22-59 mU/L (3-8.2 Sibley- Infection, muscle trauma, skeletal Late muscular dystrophy, renal
Lehninger U/dL) muscle disease disease
α1-Antitrypsin 0.85-2.13 g/L (85-213 mg/dL) Acute and chronic inflammation Chronic lung disease (early onset of
and infection, arthritis, malignancy, emphysema), malnutrition, nephrotic
stress syndrome, thyroid infections syndrome
α1-Fetoprotein <40 mcg/L (<40 ng/mL) Cancers of testes and ovaries, In pregnant women, trisomy 21 or
carcinoma of liver, neural tube fetal distress/death
defects or multiple pregnancies in
pregnant women
Ammonia 6-47 mcmol/L (10-80 mcg/dL) GI bleeds, hepatic encephalopathy, —
portal hypertension, severe liver
disease
Continued
I

2061
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2062 APPENDIX B Laboratory Values

Table B-1 Serum, Plasma, and Whole Blood Chemistries—cont’d

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Amylase 30-220 U/L (60-120 Somogyi Acute and chronic pancreatitis, Acute alcoholism, cirrhosis of liver,
units/dL) mumps (salivary gland disease), extensive destruction of pancreas
perforated ulcers
Ascorbic acid 23-85 mcmol/L (0.4-1.5 mg/dL) Excessive ingestion of vitamin C Connective tissue disorders, hepatic
disease, renal disease, rheumatic
fever, vitamin C deficiency
Aspartate aminotransferase (AST) 0-35 U/L(same as SI units) Acute hepatitis, liver disease, —
(formerly serum glutamic myocardial infarction (MI),
oxaloacetic transferase [SGOT]) pulmonary infarction
B-type (or brain) natriuretic <100 ng/L (<100 pg/mL) Congestive heart failure, MI, —
peptide hypertension, cor pulmonale
Bicarbonate 21-28 mmol/L (21-28 mEq/L) Chronic use of loop diuretics, Acute renal failure, compensated
compensated respiratory acidosis, respiratory alkalosis, diarrhea,
metabolic alkalosis metabolic acidosis
Bilirubin Biliary obstruction, hemolytic —
Total 5.1-17 mcmol/L (0.3-1.0 mg/dL) anemia, impaired liver function,
pernicious anemia, prolonged
Indirect 3.4-12 mcmol/L (0.2-0.8 mg/dL)
fasting
Direct 1.7-5.1 mcmol/L (0.1-0.3 mg/dL)
Blood gases*
Arterial pH 7.35-7.45 (same as SI units) Alkalosis Acidosis
Venous pH 7.31-7.41 (same as SI units) Alkalosis Acidosis
PaCO2 35-45 mm Hg (same as SI units) Compensated metabolic alkalosis, Compensated metabolic acidosis,
respiratory acidosis respiratory alkalosis
PaO2 80-100 mm Hg (same as SI units) Administration of high Chronic lung disease, decreased
Venous PO2 40-50 mm Hg (same as SI units) concentration of oxygen cardiac output
Calcium 2.25-2.75 mmol/L (9-10.5 mg/dL) Acute osteoporosis, Acute pancreatitis,
hyperparathyroidism, multiple hypoparathyroidism, liver disease,
myeloma, vitamin D intoxication malabsorption syndrome, renal failure,
vitamin D deficiency
Calcium, ionized 1.05-1.30 mmol/L (4.5-5.6 mg/dL) — —
Carbon dioxide (CO2 content) 21-28 mmol/L (21-28 mEq/L) Same as bicarbonate —
β-Carotene 1.4-4.7 mcmol/L (75-253 mcg/dL) Cystic fibrosis, hypothyroidism, Dietary deficiency, malabsorption
pancreatic insufficiency disorders
Chloride 98-106 mmol/L (98-106 mEq/L) Corticosteroid therapy, dehydration, Addison’s disease, congestive heart
excessive infusion of normal saline, failure, diarrhea, metabolic alkalosis,
metabolic acidosis, respiratory overhydration, respiratory acidosis,
alkalosis, uremia SIADH (syndrome of inappropriate
antidiuretic syndrome), vomiting
Cholesterol <5 mmol/L (<200 mg/dL) age Biliary obstruction, cirrhosis Corticosteroid therapy, extensive liver
dependent hypothyroidism, hyperlipidemia, disease, hyperthyroidism, malnutrition
HDL (high-density lipoproteins) >1.55 mmol/L (>40 mg/dL) idiopathic hypercholesterolemia,
renal disease, uncontrolled
LDL (low-density lipoproteins) <2.59 mmol/L (<100 mg/dL)
diabetes
Cholinesterase (RBC) 5-10 U/L (same as SI units) Exercise, sickle cell disease Acute infections, insecticide
intoxication, liver disease, muscular
dystrophy
Copper 11-22 mcmol/L (70-140 mcg/dL) Cirrhosis, contraceptive use by Wilson’s disease
female patient
*Because arterial blood gases are influenced by altitude, the value for PO2 decreases as altitude increases. The lower value is normal for an altitude of
1 mile.

I
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APPENDIX B Laboratory Values 2063

Table B-1 Serum, Plasma, and Whole Blood Chemistries—cont’d

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Cortisol 8 A.M.: 138-635 nmol/L Adrenal adenoma, Cushing’s Addison’s disease, adrenal
(5-23 mcg/dL) syndrome, hyperthyroidism, insufficiency, hypopituitary states,
8 P.M.: < 83-359 nmol/L pancreatitis, stress hypothyroidism, liver disease
(3-13 mcg/dL)
Creatine 15.3-76.3 mcmol/L Active rheumatoid arthritis, biliary Diabetes mellitus
(0.2-1.0 mg/dL) obstruction, hyperthyroidism, renal
disorders, severe muscle disease
Creatine kinase (CK) Brain damage, exercise, —
Male 55-170 U/L (same as SI units) musculoskeletal injury or disease,
MI, numerous intramuscular
Female 30-135 U/L (same as SI units)
injections, severe myocarditis
CK-MB (CK-2) Male: 2-6 mcg/L (2-6 ng/mL) Acute MI —
Female: 2-5 mcg/L (2-5 ng/mL)
CK mass fraction <0.05 fraction of total CK — —
Creatinine Severe renal disease Diseases with decreased muscle mass
Male 53-106 mcmol/L (0.6-1.2 mg/dL) (e.g. muscular dystrophy, myasthenia
gravis)
Female 44-97 mcmol/L (0.5-1.1 mg/dL)
Ferritin (serum) Anemia of chronic disease Iron-deficiency anemia, severe protein
Male 12-300 ng/L (12-300 ng/mL) (infection, inflammation, liver deficiency
disease), sideroblastic anemia
Female 10-150 ng/L (10-150 ng/mL)
Folic acid (folate) 11-57 mmol/L (5-25 ng/mL) Hypothyroidism, pernicious anemia Alcoholism, hemolytic anemia,
inadequate diet, malabsorption
syndrome, malnutrition, megaloblastic
anemia
γ-Glutamyltranspeptidase (GGT) 8-38 IU/L (same as SI units) Cholestasis, cytomegalovirus —
infection, Epstein-Barr, liver
disease, MI, pancreatitis
Glucose, fasting 4-6 mmol/L (70-110 mg/dL) Acute stress, cerebral lesions, Addison’s disease, hepatic disease,
Cushing’s syndrome, diabetes hypothyroidism, insulin overdosage,
mellitus, hyperthyroidism, pancreatic tumour, pituitary
pancreatic insufficiency hypofunction, postdumping syndrome
2-Hr oral glucose tolerance Diabetes mellitus Hyperinsulinism
testing (OGTT)
Fasting 4-6 mmol/L (70-110 mg/dL)
1 hr <11.1 mmol/L (<200 mg/dL)
2 hr <7.8 mmol/L (<140 mg/dL)
Haptoglobin 0.5-2.2 g/L (50-220 mg/dL) Acute MI, infectious and Chronic liver disease, hemolytic
inflammatory processes, malignant anemia, mononucleosis, systemic
neoplasms lupus erythematosus, toxoplasmosis,
transfusion reactions
Homocysteine 4-14 mcmol/L (0.54-1.9 mg/L) Cardiovascular disease, —
cerebrovascular disease, peripheral
vascular disease, cystinuria,
vitamin B6 or B12 deficiency, folate
deficiency, malnutrition
Insulin 43-186 pmol/L (6-26 mcU/mL) Acromegaly, adenoma of islet cells, Diabetes mellitus, obesity
obesity, untreated mild case of type
2 diabetes
Iron Excessive red blood cell Anemia of chronic disease, iron-
Male 14-32 mcmol/L (80-180 mcg/dL) destruction, hemochromatosis, deficiency anemia
massive transfusion
Female 11-29 mcmol/L (60-160 mcg/dL) I
Continued
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2064 APPENDIX B Laboratory Values

Table B-1 Serum, Plasma, and Whole Blood Chemistries—cont’d

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Total iron-binding capacity (TIBC) 45-82 mcmol/L (250-460 mcg/dL) Iron deficient state, oral Cancer, chronic infections, pernicious
contraceptive use, polycythemia anemia, uremia
Lactic acid 0.6-2.2 mmol/L (5-20 mg/dL) Acidosis, congestive heart failure, —
severe liver disease, shock, tissue
ischemia
Lactic dehydrogenase (LDH) 100-190 U/L (same as SI units) Congestive heart failure, hemolytic —
disorders, hepatitis, metastatic
cancer of liver, MI, pernicious
anemia, pulmonary embolus and
infarction, skeletal muscle damage
Lactic dehydrogenase isoenzymes
LDH1 0.17-0.27 (17-27%) MI, pernicious anemia, strenuous —
exercise
LDH2 0.27-0.37 (27-37%) Exercise, pulmonary embolus, sickle —
cell crisis
LDH3 0.18-0.25 (18-25%) Malignant lymphoma, pulmonary —
embolus
LDH4 0.03-0.08 (3-8%) Systemic lupus erythematosus, —
pancreatitis, pulmonary infarction,
renal disease
LDH5 0.0-0.05 (0-5%) Congestive heart failure, hepatitis, —
pulmonary embolus and infarction,
skeletal muscle damage, strenuous
exercise
Lipase 0-160 U/L (same as SI units) Acute and chronic pancreatitis, —
hepatic disorders, pancreatic
disorder (cancer, pseudocyst),
perforated peptic ulcer, salivary
gland inflammation or tumour
Magnesium 0.65-1.05 mmol/L (1.3-2.1 mEq/L) Addison’s disease, hypothyroidism, Chronic alcoholism,
renal failure hyperparathyroidism, hyperthyroidism,
hypoparathyroidism, malnutrition,
severe malabsorption
Myoglobin <90 mcg/L (same as SI units) MI, myositis, malignant Polymyositis
hyperthermia, muscular dystrophy,
skeletal muscle ischemia or
trauma, rhabdomyolysis, seizures
Osmolality 285-295 mmol/kg (285- Chronic renal disease, dehydration, Addison’s disease, diuretic therapy,
295 mOsm/kg) H20 diabetes mellitus, hypernatremia, hyponatremia, overhydration
shock
Oxygen saturation Increased inspired oxygen, Anemia, cardiac decompensation,
Arterial ≥95% (same as SI units) polycythemia vera decreased inspired oxygen, respiratory
disorders
Venous 60-80% (same as SI units)
pH See Blood gases
Phenylalanine 0-121 mcmol/L (0-2 mg/dL) Phenylketonuria —
Phosphatase, acid 2.2-10.5 U/L (0.13-0.63 U/L–Roy, Advanced Paget’s disease, cancer —
Brower, Hayden 37°C) of prostate, hyperparathyroidism

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APPENDIX B Laboratory Values 2065

Table B-1 Serum, Plasma, and Whole Blood Chemistries—cont’d

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Phosphatase, alkaline (ALP) 35-120 U/L (0.5-2.0 mckat/L) Bone diseases, cirrhosis, Excessive vitamin D ingestion,
malignancy of liver/bone, marked hypothyroidism, milk-alkali syndrome
hyperparathyroidism, obstruction of
biliary system, rickets
Phosphorus, phosphate 0.97-1.45 mmol/L (3.0-4.5 mg/dL) Bone metastasis, healing fractures, Chronic alcoholism, diabetes mellitus,
hypoparathyroidism, hypocalcemia, hypercalcemia, hyperparathyroidism,
renal disease, vitamin D vitamin D deficiency
intoxication
Potassium 3.5-5.0 mmol/L (3.5-5.0 mEq/L) Acute or chronic renal failure, Burns, Cushing’s syndrome, deficient
Addison’s disease, dehydration, dietary or IV intake, diarrhea (severe),
diabetic ketosis, excessive dietary/ diuretic therapy, GI fistula, insulin
IV intake, massive tissue administration, pyloric obstruction,
destruction, metabolic acidosis starvation, vomiting
Prostate-specific antigen (PSA) <4 mcg/L (<4 ng/mL) Benign prostatic hypertrophy, —
prostate cancer, prostatitis
Proteins Burns, cirrhosis (globulin fraction), Congenital agammaglobulinemia,
Total 64-83 g/L (6.4-8.3 g/dL) dehydration increased capillary permeability,
inflammatory disease, liver disease,
Albumin 35-50 g/L (3.5-5 g/dL)
malabsorption, malnutrition
Globulin 23-34 g/L (2.3-3.4 g/dL)
Albumin/globulin ratio 1.5 : 1-2.5 : 1 (same as SI units) Multiple myeloma (globulin Malnutrition, nephrotic syndrome,
fraction), shock, vomiting proteinuria, renal disease, severe
burns
Pseudocholinesterase (serum) 8-18 U/mL (same as SI units) — —
Renin Renal hypertension, salt-losing GI Increased salt intake, primary
Upright position 0.03-1.2 ng/L/sec (0.1-4.3 mg/ disease (vomiting/diarrhea), aldosteronism
mL/hr) volume decrease (e.g., hemorrhage)
Sodium 135-145 mmol/L (135-145 mEq/L) Corticosteroid therapy, dehydration, Addison’s disease, decreased sodium
impaired renal function, increased intake in dietary or IV intake, diabetic
sodium intake in diet/IV, primary ketoacidosis, diuretic therapy,
aldosteronism excessive loss from GI tract, excessive
perspiration, water intoxication
Testosterone Adrenal hyperplasia, adrenal or Hypofunction of testes
Male 9.75-38 nmol/L (280-1080 ng/dL) pituitary tumours, testicular
tumours
Female 0.52-2.43 nmol/L (<70 ng/dL) Polycystic ovary, virilizing tumours —
T4 (thyroxine), total 64-154 nmol/L (5-12 mcg/dL) Hyperthyroidism, thyroiditis Cretinism, hypothyroidism, myxedema
T4 (thyroxine), free 10-36 pmol/L (0.8-2.8 ng/dL) Hyperthyroidism, metastatic Hypothyroidism, pregnancy
neoplasms
T3 uptake 24-34 AU (24-34%) — —
T3 (triiodothyronine) 1.2-3.4 nmol/L (70-205 ng/dL) Hyperthyroidism Hypothyroidism
Thyroid-stimulating hormone 2-10 mU/L (2-10 mcU/L) Graves’ disease, myxedema, Secondary hypothyroidism
(TSH) primary hypothyroidism
Triglycerides Diabetes mellitus, hyperlipidemia, Hyperthyroidism, malabsorption
Male 0.45-1.81 mmol/L (40-160 mg/dL) hypothyroidism, liver disease syndrome, malnutrition
Female 0.40-1.52 mmol/L (35-135 mg/dL)
Troponin T (cTnT) <0.2 mcg/L (<0.2 ng/mL) Cardiac muscle damage, (MI, —
Troponin I (cTnI) <0.03 mcg/L (<0.3 ng/mL) myocarditis or pericarditis), chronic —
renal failure, multiorgan failure,
severe heart failure
Continued

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Dirksen; 00086

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2066 APPENDIX B Laboratory Values

Table B-1 Serum, Plasma, and Whole Blood Chemistries—cont’d

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Urea nitrogen, blood (blood urea 3.6-7.1 mmol/L (10-20 mg/dL) Burns, dehydration, GI bleeds, Fluid overload, malnutrition, severe
nitrogen [BUN], serum urea increase in protein catabolism liver damage, SIADH
nitrogen) (fever, stress), renal disease,
shock, urinary tract infection
Uric acid Alcoholism, eclampsia, gout, gross Administration of uricosuric drugs
Male 0.24-0.51 mmol/L (4.0-8.5 mg/dL) tissue destruction, high-protein
weight reduction diet, leukemia,
Female 0.16-0.43 mmol/L (2.7-7.3 mg/dL)
multiple myeloma, renal failure
Vitamin A 0.52-2.09 mcmol/L (15-60 mcg/ Excess ingestion of vitamin A Vitamin A deficiency
dL)
Vitamin B12 118-701 pmol/L (160-950 pg/mL) Chronic myeloid leukemia Malabsorption syndrome, pernicious
anemia, strict vegetarianism, total or
partial gastrectomy
Zinc 11.5-18.5 mcmol/L (75-120 mcg/ — Alcoholic cirrhosis
dL)

t0020 Table B-2 Hematology

NORMAL VALUES POSSIBLE ETIOLOGY

TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Bleeding time (IVY) 1-9 min Aspirin ingestion, clotting factor —
deficiency, defective platelet
function, thrombocytopenia,
vascular disease, von
Willebrand’s disease
Activated partial thromboplastin 30-40 sec* (same as SI units) Deficiency of Factors I, II, V, VIII, —
time (aPTT) IX and X, XI, XII; hemophilia;
heparin therapy; liver disease
Partial thromboplastin time 28-35 sec (same as SI units) Same etiology as for aPTT —
(PTT)
Activated coagulation time or 70-120 sec (same as SI units) Same etiology as for aPTT —
automated clotting time (ACT)
Prothrombin time (Protime, PT) 11-12.5 sec* (same as SI units) Deficiency of Factors I, II, V, VII, —
and X; liver disease; vitamin K
deficiency; warfarin therapy
International normalized ratio 0.81-1.2 (same as SI units) Same etiology as for PT —
(INR)
Thrombin time 8-12 sec (same as SI units) Disseminated intravascular —
coagulation (DIC), increased
tendency to bleed
Fibrinogen 2-4 g/L (200-400 mg/dL) Burns (after first 36 hr), Burns (during first 36 hr), DIC, severe
inflammatory disease liver disease
Fibrin split (degradation) <10 mg/L (<10 mcg/mL) Acute DIC, massive hemorrhage, —
products massive trauma, primary
fibrinolysis
D-Dimer <250 mcg/L (<250 ng/mL) Deep vein thrombosis, DIC, —
myocardial infarction, unstable
angina
*Patients receiving anticoagulant therapy:
u0010 aPTT: 1.5-2.5 times control value in seconds.
I u0015 PT: 1.5-2.0 times control value in seconds.
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APPENDIX B Laboratory Values 2067

Table B-2 Hematology—cont’d

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Erythrocyte count† Red blood Dehydration, high altitudes, Anemia, leukemia, post hemorrhage
cell count [RBC count] (altitude polycythemia vera, severe
dependent) diarrhea
Male 4.7-6.1 × 1012/L (4.7-6.1 × 106/
mcL)
Female 4.2-5.4 × 1012/L (4.2-5.4 × 106/
mcL)
Mean corpuscular volume (MCV) 80-95 fL (80-95 mm3) Folic acid and vitamin B12 Microcytic anemia
[Hct/RBC] deficiency, liver disease,
macrocytic anemia
Mean corpuscular hemoglobin 27-31 pg (same as SI units) Macrocytic anemia Microcytic anemia
(MCH)
[Hb/RBC]
Mean corpuscular hemoglobin 32-36 g/dL or 32-36% Intravascular hemolysis, Hypochromic anemia
concentration (MCHC) spherocytosis
Erythrocyte sedimentation rate Moderate increase: acute Malaria, severe liver disease, sickle
(ESR), Westergren hepatitis, myocardial infarction, cell anemia
Male ≤15 mm/hr (same as SI units) rheumatoid arthritis
Female ≤20 mm/hr (same as SI units) Marked increase: acute and
severe bacterial infections,
malignancies, pelvic inflammatory
disease
Hematocrit (altitude Dehydration, high altitudes, Anemia, bone marrow failure,
dependent)† polycythemia hemorrhage, leukemia, overhydration
Male 0.42-0.52 volume fraction
(42-52%)
Female 0.37-0.47 volume fraction
(37-47%)
Hemoglobin (altitude Chronic obstructive pulmonary Anemia, hemorrhage
dependent)† disease, high altitudes,
Male 140-180 mmol/L (14-18 g/dL) polycythemia
Female 120-160 mmol/L (12-16 g/dL)
Hemoglobin, glycosylated or <6% (adult without diabetes) Nondiabetic hyperglycemia, poorly Chronic blood loss, chronic renal
glycated (HbA1c [A1c]) controlled diabetes mellitus failure, pregnancy, sickle cell anemia
Red cell distribution width 11-14.5% (same as SI units) — Anisocytosis, macrocytic anemia,
(RDW) microcytic anemia
Platelet count (thrombocytes) 150-400 × 109/L (150,000- Acute infections, chronic Acute leukemia, cancer chemotherapy,
400,000 mm3) granulocytic leukemia, chronic DIC, hemorrhage, infection, systemic
pancreatitis, cirrhosis, collagen lupus erythematosus,
disorders, polycythemia, post thrombocytopenic purpura
splenectomy
Reticulocyte count(manual) 0.5-2% of RBC (same as SI Hemolytic anemia, polycythemia Hypoproliferative anemia, macrocytic
units) vera anemia, microcytic anemia
White blood cell (WBC) count† 5-10 × 109/L (5000-10,000 Inflammatory and infectious Aplastic anemia, autoimmune
mm3) processes, leukemia diseases, overwhelming infection, side
effects of chemotherapy and
irradiation
†Components of complete blood count (CBC). Continued

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2068 APPENDIX B Laboratory Values

Table B-2 Hematology—cont’d

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
WBC differential
Segmented neutrophils 2.5-7.5 × 109/L (62-68%) Bacterial infections, collagen Aplastic anemia, viral infections
diseases, Hodgkin’s disease
Band neutrophils 0-1 × 109/L (0-9%) Acute infections —
Lymphocytes 0.1-0.4 × 10 /L (1000-4000
9
Chronic infections, lymphocytic Corticosteroid therapy, whole body
mm3) (20-40%) leukemia, mononucleosis, viral irradiation
infections
Monocytes 0.02-0.07 × 109/L (100-700 Acute infections, chronic —
mm3) (2-8%) inflammatory disorders, Hodgkin’s
disease, malaria, monocytic
leukemia
Eosinophils 0.01-0.04 × 109/L (50-100 mm3) Allergic reactions, eosinophilic Corticosteroid therapy
(1-4%) and chronic granulocytic
leukemia, Hodgkin’s disease,
parasitic disorders
Basophils 0-0.01 × 109/L (25-100 mm3) Hypothyroidism, myeloproliferative Hyperthyroidism, stress
(0.5-1%) diseases, ulcerative colitis
Sickle cell solubility Negative (negative) Sickle cell anemia —

t0025 Table B-3 Serology-Immunology

NORMAL VALUES POSSIBLE ETIOLOGY

TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Antinuclear antibody (ANA) Negative at 1 : 40 dilution (same Chronic hepatitis, rheumatoid —
as SI units) arthritis, scleroderma, systemic
lupus erythematosus (SLE)
Anti-DNA antibody Negative <70 U/mL (same as SI SLE —
units)
Anti-RNP (ribonucleoprotein) Negative (negative) Mixed connective tissue disease, —
scleroderma, rheumatoid arthritis,
Sjögren’s syndrome, SLE
Anti-Sm (Smith) Negative (Negative) SLE —
Antistreptolysin-O (ASO) ≤160 Todd units/mL (same as SI Acute glomerulonephritis, —
units) rheumatic fever, streptococcal
infection
C-reactive protein(CRP) <10 mg/L (<1.0 mg/dL) Acute infections, any inflammatory —
condition (e.g., acute rheumatic
fever/arthritis), widespread
malignancy
Carcinoembryonic antigen (CEA) 5 mcg/L (5 ng/mL) Carcinomas of colon, liver, —
pancreas; chronic cigarette
smoking; inflammatory bowel
disease; other cancers
Complement assay components — Acute glomerulonephritis, rheumatoid
Total 75-160 k/units/L (75-160 U/mL) arthritis, serum sickness, subacute
bacterial endocarditis, SLE
C3 0.55-1.2 g/L (55-120 mg/dL)
C4 0.2-0.5 g/L (20-50 mg/dL)
Direct antihuman globulin test Negative (negative) Acquired hemolytic anemia, drug —
(DAT) or direct Coombs’ test (no agglutination) reactions, hemolytic disease of the
newborn, transfusion reactions
I

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APPENDIX B Laboratory Values 2069

Table B-3 Serology-Immunology—cont’d

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Fluorescent treponemal antibody Negative (nonreactive) Syphilis —
absorption (FTAAbs)
Hepatitis A antibody Negative (negative) Hepatitis A —
Hepatitis B surface antigen Negative (negative) Hepatitis B —
(HBsAg)
Hepatitis C antibody Negative (negative) Hepatitis C —
Immunoglobulins
IgA 0.85-3.85 g/L (85-385 mg/dL) Autoimmune disorders, chronic Burns, hereditary telangiectasia,
infection, chronic liver disease, IgA malabsorption syndromes
myeloma, rheumatoid arthritis
IgD Minimal Chronic infection, connective tissue —
disease
IgE Minimal Anaphylactic shock, atopic disease —
(allergies), parasite infections
IgG 5.65-17.65 g/L (565-1765 mg/dL) Hepatitis, IgG monoclonal Acquired deficiencies, burns,
gammopathy, infections—acute congenital deficiencies,
and chronic, SLE immunosuppression, nephrotic
syndromes
IgM 0.55-3.75 g/L (55-375 mg/dL) Acute infections, liver disease, Congenital and acquired antibody
rheumatoid arthritis deficiencies, lymphocytic leukemia,
protein-losing enteropathies
Monospot or Mono-Test Negative (<1 : 28 titre) Infectious mononucleosis —
Rheumatoid factor (RA factor) Negative or <60 units/mL by Rheumatoid arthritis, Sjögren’s —
nephelometric method syndrome, SLE
RPR (rapid plasma reagin) test Negative or nonreactive (same as Febrile diseases, IV drug abuse, —
SI units) leprosy, malaria, rheumatoid
arthritis, syphilis, SLE
VDRL (Venereal Disease Research Negative or nonreactive (same as Syphilis —
Laboratory) test SI units)
Thyroid antibodies Titre <1 : 100 (same as SI units) Early hypothyroidism, Graves’ —
disease, Hashimoto’s thyroiditis,
pernicious anemia, SLE, thyroid
carcinoma

t0030 Table B-4 Urine Chemistry

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SPECIMEN SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Acetone (ketones) Random Negative (negative) Diabetes mellitus, high-fat and —
low-carbohydrate diets, starvation states
Aldosterone 24 hr 6-72 nmol/24 hr Primary aldosteronism: Adrenocortical Adrenocorticotropic hormone
(2-26 mcg/24 hr) (depends on tumours (ACTH) deficiency, Addison’s
urinary sodium) Secondary aldosteronism: Cardiac disease, corticosteroid
failure, cirrhosis, large dose of ACTH, therapy
salt depletion
Amylase 24 hr ≤5000 Somogyi units/24 hr OR Acute pancreatitis —
6.5-48.1 units/hr
Continued
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2070 APPENDIX B Laboratory Values

Table B-4 Urine Chemistry—cont’d

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SPECIMEN SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Bence Jones protein Random Negative (negative) Biliary duct obstruction, multiple —
myeloma
Bilirubin Random Negative (negative) Hepatitis —
Calcium 24 hr 6.2 mmol/day (<250 mg/day) Bone tumour, hyperparathyroidism, Hypoparathyroidism,
milk-alkali syndrome malabsorption of calcium
and vitamin D
Catecholamines 24 hr Heart failure, pheochromocytoma,
Epinephrine <109 nmol/day (<20 mcg/day) progressive muscular dystrophy
Norepinephrine <590 nmol/day (<100 mcg/day)
Chloride 24 hr 110-250 mmol/day (110- Addison’s disease Burns, diarrhea, excess
250 mEq/day) perspiration, menstruation,
<0.5 mcmol/day (<30 mcg/day) vomiting
Copper 24 hr 0.6 mcmol/day (<40 mcg/day) Cirrhosis, Wilson’s disease —
Coproporphyrin 24 hr <300 nmol/day (<200 mcg/day) Lead poisoning, oral contraceptive use, —
poliomyelitis
Creatine 24 hr Addison’s disease, burns, carcinoma of Hypothyroidism
Male <300 mcmol/day (<60 mg/day) liver, diabetes, hyperthyroidism,
infections, muscular dystrophy, skeletal
Female <600 mcmol/day (<80 mg/day)
muscle atrophy
Creatinine 24 hr 7.1-17.7 mmol/day (0.8-2 g/day) Anemia, leukemia, muscular atrophy, Renal disease
salmonellosis
Creatinine clearance 24 hr 1.42-2.25 mL/sec (85-135 mL/ — Renal disease
min)
Male 1.78-2.32 mL/sec (107-139 mL/
min)
Female 1.45-1.78 mL/sec (87-107 mL/
min)
Estriol 24 hr Gonadal or adrenal tumour
Female Agenesis of ovaries,
   • Ovulation peak 104-370 nmol/day (28-100 mcg/ endocrine disturbance,
day) menopause, ovarian
dysfunction
   • Luteal peak 81-296 nmol/day (22-80 mcg/
day)
   • Pregnancy ≤166,455 nmol/day
(≤45,000 mcg/day)
   • Menopause 5.2-72.5 nmol/day (1.4-
19.6 mcg/day)
Male 18-67 nmol/day (5-18 mcg/day) — —
Glucose Random Negative (negative) Diabetes mellitus, low renal threshold for —
glucose resorption, physiological stress,
pituitary disorders
Hemoglobin Random Negative (negative) Extensive burns, glomerulonephritis, —
hemolytic anemias, hemolytic transfusion
reaction
5-Hydroxyindole-acetic 24 hr 10-40 mcmol/day Malignant carcinoid syndrome —
acid (5-HIAA) (2-8 mg/24 hr)

I
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typesetter Toppan Best-set. It is not allowed to publish this proof online or in print. This proof copy is the copyright property of the publisher and is confidential until formal publication.

APPENDIX B Laboratory Values 2071

Table B-4 Urine Chemistry—cont’d

NORMAL VALUES POSSIBLE ETIOLOGY
TEST SPECIMEN SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Ketone bodies Random Negative (negative) Alcoholism, fasting, high-protein diets, —
marked ketonuria, poorly controlled
diabetes mellitus, starvation
Lead 24 hr <0.40 mcmol/day (<80 mcg/ Lead poisoning —
day)
Metanephrine 24 hr <7 mcmol/day (<1.3 mg/day) Pheochromocytoma —
Myoglobin Random Negative (negative) Crushing injuries, electric injuries, —
extreme physical exertion
pH Random 4.6-8 (same as SI units) Chronic renal failure, compensatory Compensatory phase of
Average: 6 phase of alkalosis, salicylate acidosis, dehydration,
intoxication, vegetarian diet emphysema
Phenylpyruvic acid Random Negative (negative) Phenylketonuria —
Phosphorus, inorganic 24 hr 29-42 mmol/day (0.9-1.3 g/day) Fever, hypoparathyroidism, nervous Acute infections, nephritis
exhaustion, rickets, tuberculosis
Porphobilinogen Random Negative (negative) Acute intermittent porphyria, liver —
24 hr <8.8 mcmol/day (<2 mcg/day) disorders
Potassium 24 hr 25-100 mmol/day (25-100 mEq/ Chronic renal failure, starvation, Reduced intake, dehydration,
day) Cushing’s syndrome, hyperaldosteronism, Addison’s disease,
alkalosis, diuretic therapy malnutrition, vomiting,
diarrhea, acute renal failure
Protein (dipstick) Random Negative (negative) Congestive heart failure, nephritis, —
nephrosis, physiological stress
Protein (quantitative) 24 hr <0.15 g/day (<150 mg/day) Cardiac failure, inflammatory processes —
At rest 0.05-0.08 g/day (<50-80 mg/ of urinary tract, nephritis, nephrosis,
day) toxemia of pregnancy
During exercise <0.25 g/day (<250 mg/day)
Sodium 24 hr 40-250 mmol/day (40-250 mEq/ Acute tubular necrosis Hyponatremia
day)
Specific gravity Random 1.005-1.030 (same as SI units) Albuminuria, dehydration, fever, GI Diabetes insipidus, diuresis,
losses (vomiting/diarrhea), glycosuria, overhydration
syndrome of inappropriate antidiuretic
hormone (SIADH)
Titratable acidity 24 hr 20-50 mEq/day (same as SI Metabolic acidosis Metabolic alkalosis
units)
Uric acid 24 hr 1.48-4.43 mmol/day (250- Gout, leukemia Nephritis
750 mg/24 hr)
Urobilinogen 24 hr 0.0-6.8 mcmol/day (0.0- Hemolytic disease, hepatic parenchymal Complete obstruction of bile
4.0 mg/24 hr) cell damage, liver disease duct
Random <0.01-1 EU (same as SI units)
Uroporphyrins 24 hr Lead poisoning, liver disease, porphyria —
Male 4-46 mcg/day (same as SI
units)
Female 3-22 mcg/day (same as SI
units)
Vanillylmandelic acid 24 hr <35 mcmol/day (<6.8 mg/day) Pheochromocytoma, neuroblastomas —

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 To protect the rights of the author(s) and publisher we inform you that this PDF is an uncorrected proof for internal business use only by the author(s), editor(s), reviewer(s), Elsevier and
typesetter Toppan Best-set. It is not allowed to publish this proof online or in print. This proof copy is the copyright property of the publisher and is confidential until formal publication.

2072 APPENDIX B Laboratory Values

t0035 Table B-5 Gastric Analysis

NORMAL VALUES POSSIBLE ETIOLOGY

TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Basal
Free hydrochloric acid 0.3 mmol/L (0.3 mEq/L) Hypermotility of stomach Pernicious anemia
Total acidity 15-45 mmol/L (15-45 mEq/L) Gastric and duodenal ulcers, Zollinger-Ellison Gastric carcinoma, severe
syndrome gastritis
Poststimulation
Free hydrochloric acid 10-130 mmol/L (10-130 mEq/L) — —
Total acidity 20-150 mmol/L (20-150 mEq/L) — —

t0040 Table B-6 Fecal Analysis

NORMAL VALUES POSSIBLE ETIOLOGY

TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Fecal fat 7.21 mmol/day (2-6 g/day) Chronic pancreatic disease, cystic fibrosis, —
malabsorption syndrome, obstruction of common
bile duct, short gut syndrome
Urobilinogen 51-372 mcmol/100 g of stool Hemolytic anemias Complete biliary obstruction
(30-220 mg/100 g of stool)
Mucus Negative (negative) Mucous colitis, spastic constipation —
Pus Negative (negative) Chronic bacillary dysentery, chronic ulcerative —
colitis, localized abscesses
Blood* Negative (negative) Anal fissures, hemorrhoids, inflammatory bowel —
disease, malignant tumour, peptic ulcer
Colour
Brown Various colours depending on diet —
Clay Biliary obstruction or presence of barium sulphate —
Tarry More than 100 mL of blood in GI tract —
Red Blood in large intestine —
Black Blood in upper GI tract or iron medication —
*Ingestion of meat may produce false-positive results. Patient may be placed on a meat-free diet for 3 days before the test.

t0045 Table B-7 Cerebrospinal Fluid Analysis

NORMAL VALUES POSSIBLE ETIOLOGY

TEST SI UNITS (CONVENTIONAL UNITS) HIGHER LOWER
Pressure <20 cm H2O (same as SI units) Hemorrhage, intracranial tumour, meningitis Head injury, spinal tumour,
subdural hematoma
Blood Negative (negative) Intracranial hemorrhage —
Cell count (age dependent)
WBCs (white blood cells) 0-5 × 106/L (0-5 cells/mcL) Inflammation or infections of central nervous —
system (CNS)
RBCs (red blood cells) Negative (negative) —
Chloride 115-130 mmol/L (115-130 mEq/L) Uremia Bacterial infections of CNS
(meningitis, encephalitis)
Glucose 2.8-4.2 mmol/L (50-75 mg/dL) Diabetes mellitus, viral infections of CNS Bacterial infections and
tuberculosis of CNS
Protein
Lumbar 0.15-0.45 g/L (15-45 mg/dL) Guillain-Barré syndrome, poliomyelitis, traumatic —
tap
Cisternal 0.15-0.25 g/L (15-25 mg/dL) Syphilis of CNS —
I Ventricular 0.05-0.15 g/L (5-15 mg/dL) Acute meningitis, brain tumour, chronic CNS —
infections, multiple sclerosis

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