Severe Ane
Transcript of Severe Ane
8/13/2019 Severe Ane
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Severe anemia: extremely low rbc... low wbc, but high plateletResolved Question:severe anemia: extremely low rbc... low wbc, but high platelet count..
Female, age 79
Already had one blood transfusion on July 24, and this is the blood test result for today... Doctor had ordered bone marrow aspiration, but we won't be able to get itdone until mid September.... Does this look like some sort of leukemia? Please help ....
(*** : abnormal result)
*** rbc 1.85 (normal range reference: 3.5-5.5)*** wbc 3.75 (4.0-10.0)*** hgb 62 g/L(110-150)*** hct 18.4 %(34-45)
*** mcv 99.2 fL(82-99)*** mch 33.5 pg(27-33)mchc 337 g/L (320-360)
*** rbc-dw 18.8 %(11-16)*** platelet count 361(100-360)pdw 16.3 % (10-20)mpv 12 fL (6.0-12.5)
pct 0.43 %(0.11-0.43)*** NEUT# XXXXX(2.0-7.0)
LYM# XXXXX (0.8-4.0)MONO# XXXXX (0.1-1.0)
EOS# XXXXX (0.0-0.5)BAS# XXXXX (0.0-0.1)*** NEUT% 36.7 (50-70)
*** LYMPH% 45.2 (20-40)*** MONO 10.9 (2.0-10.0)
*** EOS% 5.60 (0.0-5.0)
*** BAS% 1.60 (0.0-1.0)Submitted: 1 year ago.Category: HealthExpert: Dr. Brims replied 1 year ago.
Dr Brims : Hello, welcome to Justanswer, I will try to assist you with your medical question, and any medical information you seek Dr Brims :
This does not seem like leukemia at all, it seems like there is some bone marrow failure, although the platelet count is high, so that is a bit odd.I suspect that is the
reason why they want to do a bone marrow biopsy Dr Brims : I'm sorry to hear about this, but try to be patient, the bone marrow biopsy will shed mo re light, and this is not leukemia Customer: Thank you so much for your reply! It is such a big relief for us to hear that this is not leukemia... Before the blood transfusion, her platelet count was even higher than this, and she also had a high iron blood level (35.0 umol/L compare to normal upper limit 30.4),
and she has uncontrolled type II diabetes for many years (around 10 mmol/L compare to normal range<3.6-6.1>), but she's quite healthy other than the diabeticproblem... I understand without seeing the bone marrow biopsy result, it is very hard to guess what is really causing her problem, but based on the the blood test result, could
you give us a little bit hint on what type of bone marrow failure this could be? Could it be aplastic anemia, sideroblastic anemia or myelodysplastic syndromes, orsomething else....? the following is her blood test result before the blood transfusion on July 24th, just in case it might provide some more useful information for you. *** rbc 1.42 (normal range reference: 3.5-5.5) *** wbc 3.91 (4.0-10.0) *** hgb 51 g/L(110-150) *** hct 15.4 %(34-45) *** mcv 108.7 fL(82-99) *** mch 35.9
pg(27-33) mchc 331 g/L (320-360) *** rbc-dw 16.7 %(11-16) *** platelet count 380(100-360) pdw 16.0 % (10-20) mpv 12.2 fL (6.0-12.5) pct 0.46 %(0.11-0.43)*** NEUT# XXXXX(2.0-7.0) LYM# XXXXX (0.8-4.0) MONO# XXXXX (0.1-1.0) EOS# XXXXX (0.0-0.5) BAS# XXXXX (0.0-0.1) *** NEUT% 43.8 (50-70) *** LYMPH%
45.3 (20-40) *** MONO 8.2 (2.0-10.0) *** EOS% 1.30 (0.0-5.0) *** BAS% 1.40 (0.0-1.0) Customer: BTW, the above test was done right before the blood transfusion... Dr Brims : Sorry, please let me read your reply Customer: Hi Doctor, are you there? Dr Brims : I am here now Customer: Thanks for your reply doctor! Customer: I was just wondering if you have got a chance to take a look at her blood test result right before the blood transfusion.. Customer: She had a high iron blood level and even higher blood platelet count.... Dr Brims : I saw it, sorry for the delay Customer: no problem :) Dr Brims : The truth is , these results don't fit into any disease profile exactly, that is why there is no way to classify it, but it may be a type of myelody splastic syndrome Customer: i see...... Customer: Is there anything we could do to help her feel better before we can get the bone marrow biopsy done? The test was scheduled in 3 weeks from now... Dr Brims : Is she taking any iron supplements? Customer: no... I don't think so, she's been taking folic acid and B12 Dr Brims : Okay, then she may want to consider also taking iron supplements as well Customer: Her iron blood level is already higher than the normal range now... is it ok to take more iron supplement? Dr Brims : What are her serum iron levels? Customer: her iron blood level was at 35.0 umol/L (compare to normal upper limit reference 30.4), that was right before the blood transfusion... Dr Brims : Okay, then she should not take iron supplements
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Ions and trace metalsFurther information: Trace metals Included here are also related binding proteins, like ferritin and transferrin for iron, and ceruloplasmin f or copper.
Test Lower limit Upper limit Unit Comments
Sodium (Na)135, 137 145, 147 mmol/L or mEq/L
310, 320 330, 340 mg/dl
Potassium (K)3.5,
[8][4] 3.6
[9] 5.0,
[8][9][4] 5.1 mmol/L or mEq/L
[8]
See hypokalemia or hyperkalemia
14[11]
20[11]
mg/dl
Chloride (Cl)95,
[8] 98,
[12] 100
[4] 105,
[8] 106,
[12] 110
[4] mmol/L or mEq/L
[8]
340 370 mg/dl
Ionized calcium (Ca)1.03,
[14] 1.10
[4] 1.23,
[14] 1.30
[4] mmol/L
4.1,[15]
4.4[15]
4.9,[15]
5.2[15]
mg/dL
Total calcium (Ca)2.1, 2.2 2.5, 2.6, 2.8 mmol/L
8.4, 8.5 10.2, 10.5 mg/dL
Total serum iron (TSI) - male65, 76 176, 198 µg/dL
11.6, 13.6 30, 32, 35 μmol/L
Total serum iron (TSI) - female26, 50 170 µg/dL
4.6, 8.9 30.4 μmol/L
Total serum iron (TSI) - newborns 100 250 µg/dL
18 45 µmol/L
Total serum iron (TSI) - children 50 120 µg/dL
9 21 µmol/L
Total iron-binding capacity (TIBC) 240, 262 450, 474 μg/dL
43, 47 81, 85 µmol/L
Transferrin190, 194, 204 326, 330, 360 mg/dL
25 45 μmol/L
Transferrin saturation 20[18]
50[18]
%
Ferritin - Male12
[23] 300
[23] ng/mL
27 670 pmol/L
Ferritin - Female12
[23] 150
[23] ng/mL
27[24]
330[24]
pmol/L
Ammonia
10,[25]
20[26]
35,[25]
65[26]
μmol/L
17,[27]
34[27]
60,[27]
110[27]
μg/dL
Copper 70
[17] 150
[17] µg/dL
11[28]
24[28]
μmol/L
Ceruloplasmin
15[17]
60[17]
mg/dL
1[29]
4[29]
μmol/L
Phosphate (HPO42−
) 0.8 1.5[30]
mmol/L
Inorganic phosphorus (serum)1.0
[8] 1.5
[8] mmol/L
3.0[8]
4.5[8]
mg/dL
Copper (Cu) 11[31]
24 μmol/L
Zinc (Zn)60,
[32] 72
[33] 110,
[33] 130
[32] μg/dL
9.2,[34]
11[4]
17,[4]
20[34]
µmol/L
Magnesium1.5,
[17] 1.7
[35] 2.0,
[17] 2.3
[35] mEq/L or mg/dL
0.6,[36]
0.7[4]
0.82,[36]
0.95[4]
mmol/L
Acid-base and blood gasesFurther information: Acid-base homeostasis Further information: Arterial blood gas If arterial/venous is not specified for an acid-base or blood gas value, then it generally refers to arterial, and not venous which otherwise is standard for other blood tes ts.
Acid-base and blood gases are among the few blood constituents that exhibit substantial difference between arterial and venous values.[5] Still, pH, bicarbonate and baseexcess show a high level of inter-method reliability between arterial and venous tests, so arterial and venous values are roughly equivalent for these.
[37]
Test Arterial/Venous Lower limit Upper limit Unit Comments
pH Arterial 7.34,
[9] 7.35
[8] 7.44,
[9] 7.45
[8]
Venous 7.31[38]
7.41[38]
[H+] Arterial
36[8]
44[8]
nmol/L
3.6[39]
4.4[39]
ng/dL
Base excess Arterial & venous[38]
-3[38]
+3[38]
mEq/L
oxygen partial pressure (pO2)
Arterial pO2
10,[8]
11[40]
13,[40]
14[8]
kPa
75,[8][9]
83[17]
100,[9]
105[8]
mmHg or torr
Venous4.0
[40] 5.3
[40] kPa
30[38]
40[38]
mmHg or torr
Oxygen saturation Arterial 94,
[38] 95,
[12] 96
[17] 100
[12][17]
%
Venous Approximately 75[12]
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Carbon dioxide partial pressure (PCO2)
Arterial PaCO2
4.4,[8]
4.7[40]
5.9,[8]
6.0[40]
kPa
33,[8]
35[9]
44,[8]
45[9]
mmHg or torr
Venous5.5 6.8 kPa
41 51 mmHg or torr
Absolute content of carbon dioxide (CO2) Arterial23
[38] 30
[38] mmol/L
100 132 mg/dL
Bicarbonate (HCO3-) Arterial & venous
18 23 mmol/L
110 140 mg/dL
Standard bicarbonate (SBCe) Arterial & venous21, 22 27, 28 mmol/L or mEq/L
134 170 mg/dL
Liver functionFurther information: Liver function tests
Test Patient type Lower limit Upper limit Unit Comments
Total Protein
60,[8]
63[9]
78,[8]
82,[9]
84[17]
g/L see hypoproteinemia
Albumin
35[8][43]
48,[9]
55[8]
g/L see hypoalbuminemia
3.5[9]
4.8,[9]
5.5[8]
U/L
540[44]
740[44]
μmol/L
Globulins
23[8]
35[8]
g/L
Total Bilirubin 1.7,
[45] 2,
[8]3.4,
[45] 5
[4] 17,
[8][45] 22,
[45]25
[4] μmol/L
0.1,[8]
0.2,[9]
0.29[46]
1.0,[8][17]
1.3,[9]
1.4[46]
mg/dL
Direct/Conjugated Bilirubin0.0
[8] or N/ A
[4] 5,
[8] 7
[45][4] μmol/L
0[8][9]
0.3,[8][9]
0.4[17]
mg/dL
Alanine transaminase( ALT/ALAT[4]
)
5,
[47]
7,
[9]
8
[8]
20,
[8]
21,
[12]
56
[9]
U/L Also called serum glutamic pyruvictransaminase (SGPT)
Female 0.15[4]
0.75[4]
µkat/L
Male 0.15[4]
1.1[4]
Aspartate transaminase( AST/ASAT[4]
)
Female6
[48] 34
[48] IU/L
Also calledserum glutamic oxaloacetictransaminase(SGOT)
0.25[4]
0.60[4]
µkat/L
Male8
[48] 40
[48] IU/L
0.25[4]
0.75[4]
µkat/L
Alkaline phosphatase ( ALP)
Female 42 98U/L
Male 53[47]
128[47]
(Enzyme activity) 0.6[4]
1.8[4]
µkat/L
Gamma glutamyl transferase(GGT)
5, 8 40, 78 U/L
Women 0.63 µkat/L
Men 0.92[49]
µkat/L
Cardiac testsTest Patient type Lower limit Upper limit Unit Comments
Creatine kinase (CK)
male24,
[50] 38,
[9] 60
[47] 174,
[17] 320
[47]
U/Lor ng/mL
0.42[51]
1.5[51]
µkat/L
female24,
[50] 38,
[9] 96
[17] 140,
[17] 200
[47]
U/Lor ng/mL
0.17[51]
1.17[51]
µkat/L
CK-MB 0 3,[9]
3.8,[4]
5[47]
ng/mL or μg/L[4]
MyoglobinFemale 1
[52] 66
[52]
ng/mL or µg/LMale 17
[52] 106
[52]
Cutoffs and ranges for troponin types, 12 hrs after onset of pain
Test Lower limit Upper limit Unit Comments
Troponin-I
0.2
[53] ng/mL or μg/L Upper limit of normal
0.2[53]
1.0[53]
ng/mL or μg/L Acute Coronary Syndrome
0.4[54]
2.0[54]
ng/mL or μg/L Moderately increased[54]
1.0,[53]
1.5[55]
n/a[53][55]
ng/mL or μg/L Myocardial Infarction likely
Troponin-T
0.02 ng/mL or μg/L Upper limit of normal
0.02[53]
0.10[53]
ng/mL or μg/L Acute Coronary Syndrome
0.10[53]
n/a[53]
ng/mL or μg/L Myocardial Infarction likely
Brain natriuretic peptide (BNP) -more detailed ranges in BNP article
Interpretation Range / Cutoff
Congestive heart failure unlikely < 100 pg/mL
"Gray zone" 100-500 pg/mL
Congestive heart failure likely >500 pg/mL
NT-proBNP
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-more detailed ranges in NT-proBNP article
Interpretation Age Cutoff
Congestive heart failure likely< 75years > 125 pg/mL
>75 years >450pg/mL
LipidsFurther information: Blood lipids
Test Patient type Lower limit Upper limit Unit Therapeutic target
Triglycerides
10 – 39 years54
[17] 110
[17] mg/dL
< 100 mg/dL[58]
or 1.1[58] mmol/L
0.61[59]
1.2[59]
mmol/L
40 – 59 years
70[17]
150[17]
mg/dL
0.77[59]
1.7[59]
mmol/L
> 60 years80
[17] 150
[17] mg/dL
0.9[59]
1.7[59]
mmol/L
Total cholesterol 3.0,
[60] 3.6
[8][60] 5.0,
[4][61] 6.5
[8] mmol/L < 3.9
[58]
120,[9]
140[8]
200,[9]
250[8]
mg/dL < 150[58]
HDL cholesterol female1.0,
[62] 1.2,
[4] 1.3
[60] 2.2
[62] mmol/L
> 1.0[62]
or 1.6[60]
mmol/L> 40
[63] or 60
[64] mg/dL
40,[63]
50[65]
86[63]
mg/dL
HDL cholesterol male0.9
[62][4] 2.0
[62] mmol/L
35[63]
80[63]
mg/dL
LDL cholesterol (Not valid whentriglycerides >5.0 mmol/L)
2.0,[62]
2.4[61]
3.0,[61][4]
3.4[62]
mmol/L < 2.5[62]
80,[63]
94[63]
120,[63]
130[63]
mg/dL < 100[63]
LDL/HDL quotient n/a 5[4]
(unitless)
Tumour markersFurther information: Tumour markers
Test Cutoff Unit Comments
Alpha fetoprotein (AFP) 44[9]
ng/mL or µg/L Hepatocellular carcinoma or testicular cancer
Beta Human chorionic gonadotrophin (bHCG) 5[9]
IU/l or mU/ml in male and non-pregnant female
CA19-9 40[9]
U/ml Pancreatic cancer
CA-125 30,[66]
35[67]
kU/L or U/mL
Carcinoembryonic antigen (CEA)non-smokers at 50 years
3.4,[4]
3.6[68]
μg/l
Carcinoembryonic antigen (CEA)non-smokers at 70 years
4.1[68]
μg/l
Carcinoembryonic antigen (CEA) - smokers 5 μg/l
Prostate specific antigen (PSA) 2.5, 4 μg/L or ng/mL below age 45 <2.5 μg/L
PAP 3 units/dL (Bodansky units)
Calcitonin -more detailed cutoffs in Calcitonin article 5,[70] 15[70] ng/L or pg/mL Cutoff against medullary thyroid cancer [70]
EndocrinologyThyroid hormonesFurther information: Thyroid function tests
Test Patient type Lower limit Upper limit Unit
Thyroid stimulating hormone (TSH or thyrotropin)
Adults -standard range
0.3,[4]
0.4,[9]
0.5,[17]
0.6[71]
4.0,[4]
4.5,[9]
6.0[17]
mIU/L or μIU/mL
Adults -optimal range
0.3,[72]
0.5[73]
2.0,[73]
3.0[72]
mIU/L or μIU/mL
Infants 1.3[74]
19[74]
mIU/L or μIU/mL
Free thyroxine (FT4)-more detailed ranges inThyroid function tests article
Normal adult0.7,
[75] 0.8
[9] 1.4,
[75] 1.5,
[9] 1.8
[76] ng/dL
9,[77][4]
10,[78]
12[79]
18,[4][77]
23[79]
pmol/L
Child/Adolescent31 d - 18 y
0.8[75]
2.0[75]
ng/dL
10[77]
26[77]
pmol/L
Pregnant0.5
[75]
1.0[75]
ng/dL
6.5[77]
13[77]
pmol/L
Total thyroxine4,
[78] 5.5
[9] 11,
[78] 12.3
[9] μg/dL
60[78][79]
140,[78]
160[79]
nmol/L
Free triiodothyronine (FT3)
Normal adult0.2
[78] 0.5
[78] ng/dL
3.1[80]
7.7[80]
pmol/L
Children 2-16 y0.1
[81] 0.6
[81] ng/dL
1.5[80]
9.2[80]
pmol/L
Total triiodothyronine 60,
[9] 75
[78] 175,
[78] 181
[9] ng/dL
0.9,[4]
1.1[78]
2.5,[4]
2.7[78]
nmol/L
Thyroxine-binding globulin (TBG) 12[9]
30[9]
mg/L
Thyroglobulin (Tg)1.5
[78] 30
[78] pmol/L
1[78]
20[78]
μg/L
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Sex hormonesLevels of estradiol (the main estrogen), progesterone,luteinizing hormone andfollicle-stimulating hormoneduring the menstrual cycle.
[82]
The diagrams at right take inter-cycle and inter-woman variability into account in displaying reference ranges for estradiol, progesterone, FSH and LH.[82]
Test Patient type Lower limit Upper limit Unit
Dihydrotestosterone adult male 30[83]
85[83]
ng/dL
Testosterone
Male, overall8,
[84] 10
[85] 27,
[84] 35
[85] nmol/L
230,[86]
300[87]
780[86]
- 1000[87]
ng/dL
Male < 50 years10
[4] 45
[4] nmol/L
290[86]
1300[86]
ng/dL
Male > 50 years6.2
[4] 26
[4] nmol/L
180[86]
740[86]
ng/dL
Female0.7
[85] 2.8
[85] - 3.0
[4] nmol/L
20[87]
80[87]
- 85[86]
ng/dL
17-Hydroxyprogesterone
male0.06
[17] 3.0
[17] mg/L
0.18[88]
9.1[88]
µmol/l
Female (Follicular phase)0.2
[17] 1.0
[17] mg/L
0.6[88]
3.0[88]
µmol/l
Follicle-stimulatinghormone (FSH)-more detailed menstrual cycleranges in separate diagram
Prepubertal <1[89]
3[89]
IU/L
Adult male 1[89]
8[89]
Adult female (follicular and luteal phase)
1[89]
11[89]
Adult female (Ovulation)
6[89]
95% PI (standard)
26[89]
95% PI)
590% PI (used in diagram)
15(90% PI)
Post-menopausal female 30[89]
118[89]
Luteinizing hormone (LH)-more detailed menstrual cycleranges in separate diagram
Female, peak20
[90]
90% PI (used in diagram) 75
[90]
(90% PI)
IU/LFemale, post-menopausal 15 60
Male aged 18+ 2[92]
9[92]
Estradiol (an estrogen) -more detailed ranges inestradiol article
Adult male50 200 pmol/L
14 55 pg/mL
Adult female (day 5 of follicular phase,and luteal phase)
70[93]
500,[93]
600[93]
pmol/L
19[94]
140,[94]
160[94]
pg/mL
Adult female - free (not protein bound)0.5 9 pg/mL
1.7[95]
33[95]
pmol/L
Post-menopausal femaleN/ A
[93] < 130
[93] pmol/L
N/ A[94]
< 35[94]
pg/mL
Progesterone -more detailed rangesin Progesterone article
Female in mid-luteal phase (day 21-23)17,
[90] 35
[96] 92
[96] nmol/L
6,[90]
11[97]
29[97]
ng/mL
Androstenedione
Adult male and female 60 270
ng/dLPost-menopausal female < 180
Prepubertal < 60
Dehydroepiandrosterone sulfate -more detailed rangesin DHEA-S article
Adult male and female 30[98]
400[98]
µg/dL
SHBG -more detailed rangesin SHBG article
Adult female 40[99]
120[99]
nmol/L
Adult male 20[99]
60[99]
Anti-Müllerian hormone( AMH)-more detailed ranges in AMH article
13 –45 years0.7
[100] 20
[100] ng/mL
5[101]
140[101]
pmol/l
Other hormones
Further information: Hormones
Test Patient type Lower limit Upper limit Unit
Adrenocorticotropic hormone ( ACTH)4.4
[102] 18,
[103] 22
[102] pmol/L
20[9]
80,[104]
100[9]
pg/mL
Cortisol
09:00 am 140
[105] 700
[105] nmol/L
5[106]
25[106]
μg/dL
Midnight80
[105] 350
[105] nmol/L
2.9[106]
13[106]
μg/dL
Growth hormone (fasting) 0 5[8]
ng/mL
Growth hormone (arginine stimulation) 7[8]
n/a ng/mL
IGF-1 -more detailed ranges inIGF-1 article
Female, 20 yrs 110[107]
420[107]
ng/mLFemale, 75 yrs 55[107]
220[107]
Male, 20 yrs 160[107]
390[107]
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Male, 75 yrs 48[107]
200[107]
Prolactin -more detailed ranges inProlactin article
Female71,
[108] 105
[108] 348,
[108] 548
[108] mIU/L
3.4, 3.9 16.4, 20.3 µg/L
Male58, 89 277, 365 mIU/L
2.7,[108]
3.3[108]
13.0,[108]
13.5[108]
µg/L
Parathyroid hormone (PTH)10, 17 65, 70 pg/mL
1.1, 1.8 6.9, 7.5 pmol/L
25-hydroxycholecalciferol (a vitamin D) -Standard reference range
8, 9 40, 80 ng/mL
20, 23 95, 150 nmol/L
25-hydroxycholecalciferol -Therapeutic target range
30, 40 65, 100 ng/mL
85, 100 120, 160 nmol/L
Plasma renin activity 0.29, 1.9 3.7 ng/(mL*hour)
3.3, 21 41 mcU/mL
Aldosterone -more detailed ranges in Aldosterone article
Adult19, 34.0 ng/dL
530,[121]
940[121]
pmol/L
Aldosterone-to-renin ratio -more detailed ranges in Aldosterone/renin ratio article
Adult13.1,
[122] 35.0
[122] ng/dl per ng/(mL·h)
360,[122]
970[122]
pmol/liter per µg/(L·h)
Vitamins Also including the vitamin B12)-related amino acid homocysteine.
Test Patient type Standard range
Unit Optimal range
Lower limit Upper limit Lower limit Upper limit
Vitamin A
30 65 µg/dL
Vitamin B9 (Folic acid/Folate) - Serum
Age > 1year3.0 16 ng/mL or μg/L 5
6.8 36 nmol/l 11
Vitamin B9 (Folic acid/Folate) - Red blood cells
200 600 ng/mL or μg/L
450 1400 nmol/L
Pregnantng/mL or μg/L 400
nmol/L 900
Vitamin B12 (Cobalamin)130, 160 700, 950 ng/L
100, 120 520, 700 pmol/L
Homocysteine -more detailed ranges inHomocysteine article
3.3, 5.9 7.2, 15.3 μmol/L 6.3
45,[130]
80[130]
100,[130]
210[130]
μg/dL 85[58]
Vitamin C ( Ascorbic acid)0.4
[17] 1.5
[17] mg/dL 0.9
[58]
23[131]
85[131]
μmol/L 50[58]
25-hydroxycholecalciferol (a vitamin D) 8,
[17][112] 9
[112] 40,
[112] 80
[17] ng/mL 30,
[115] 40
[116] 65,
[116] 100
[115]
20, 23 95, 150 nmol/L 85, 100 120, 160
Vitamin E
μmol/L 28[58]
mg/dL 1.2[58]
Toxins
Test Limit type Limit Unit
Lead Optimal health range < 20[12]
or 40[17]
µg/dL
Blood ethanol content Limit for drunk driving 0,
[132] 0.2,
[132] 0.8
[132] ‰ or g/L
17.4[133]
mmol/L
HematologyRed blood cellsThese values (except Hemoglobin in plasma) are for total blood and not only blood plasma.
Test Patient Lower limit Upper limit Unit Comments
Hemoglobin (Hb)
male2.0,
[134]2.1
[135][8] 2.5,
[134]2.7
[135][8] mmol/L
Higher in neonates, lower in children.
130,[4]
132,[9]
135[8]
162,[9]
170,[4]
175[8]
g/L
female1.8,
[134]1.9
[135][8] 2.3,
[134]2.5
[8][135][134] mmol/L Sex difference negligible until
adulthood.120[4][8][9]
150,[4]
152,[9]
160[8][17]
g/L
Hemoglobin subunits (sometimes displayedsimply as "Hemoglobin")
male 8.0,[136]
8.4[136]
10.0,[136]
10.8[136]
mmol/L 4 per hemoglobin molecule
female 7.2,[136]
7.6[136]
9.2,[136]
10.0[136]
Hemoglobin in plasma0.16
[8] 0.62
[8] μmol/L Normally diminutive compared with
inside red blood cells1 4 mg/dL
Glycosylated hemoglobin (Hb A1c)< 50 years 3.6
[4] 5.0
[4]
% of Hb> 50 years 3.9
[4] 5.3
[4]
Haptoglobin< 50 years 0.35
[4] 1.9
[4]
g/L> 50 years 0.47
[4] 2.1
[4]
Hematocrit (Hct)male 0.39,
[4] 0.4,
[9]0.41,
[8] 0.45
[17] 0.50,
[4] 0.52,
[9]0.53,
[8] 0.62
[17]
female 0.35,[4]
0.36,[8]
0.37[9][17]
0.46,[8][9][4]
0.48[17]
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Child 0.31[9]
0.43[9]
Mean cell volume (MCV)Male 76,
[17] 82
[9] 100,
[17] 102
[9] fL Cells are larger in neonates, though
smaller in other children.Female 78 101 fL
Red blood cell distribution width (RDW) 11.5 14.5 %
Mean cell hemoglobin (MCH)0.39
[8] 0.54
[8] fmol/cell
25, 27 32, 33, 35 pg/cell
Mean corpuscular hemoglobinconcentration (MCHC)
31,[9]
32[17][4]
35,[9]
36[17][4]
g/dLor %
[note 1]
4.8,[137]
5.0[137]
5.4,[137]
5.6[137]
mmol/L
Erythrocytes/Red blood cells (RBC)
male 4.2,[17]
4.3[8][9][4]
5.7,[4]
5.9,[8]
6.2,[9]
6.9[17]
x1012
/Lormln/mm
3
Female 3.5,[8]
3.8,[9]
3.9[4]
5.1,[4]
5.5[8][9]
Infant/Child 3.8 5.5
Reticulocytes
Adult 26[4]
130[4]
x109/L
Adult 0.5[8][9]
1.5[8][9]
% of RBC
Newborn 1.1 4.5 % of RBC
Infant 0.5 3.1 % of RBC
White blood cellsThese values are for total blood and not only blood plasma.
Test Patient type Lower limit Upper limit Unit
White Blood Cell Count (WBC)
Adult 3.5, 3.9, 4.1, 4.5 9.0, 10.0, 10.9, 11 x10
9/L
x103/mm
3 or
x103/μL
Newborn 9 30
1 year old 6[139]
18[139]
Neutrophil granulocytes (A.K.A. grans, polys, PMNs, or segs)
Adult
1.3,[4]
1.8,[138]
2[139]
5.4,[4]
7,[138]
8[139]
x109/L
45-54[8]
62,[8]
74 % of WBC
Newborn 6[139]
26[139]
x109/L
Neutrophilic band forms Adult0.7
[139] x10
9/L
3[8]
5[8]
% of WBC
Lymphocytes
Adult0.7,
[4] 1.0
[138][139] 3.5,
[138] 3.9,
[4] 4.8
[139] x10
9/L
16-25[8]
33,[8]
45 % of WBC
Newborn 2[139]
11[139]
x109/L
Monocytes
Adult0.1,
[4] 0.2
[140][126] 0.8
[126][139][4] x10
9/L
3,[8]
4.0 7,[8]
10 % of WBC
Newborn 0.4[139]
3.1[139]
x109/L
Mononuclear leukocytes (Lymphocytes + monocytes)
Adult1.5 5 x10
9/L
20 35 % of WBC
CD4+ cells Adult 0.4,[9]
0.5[12]
1.5,[12]
1.8[9]
x109
/L
Eosinophil granulocytes Adult
0.0,[4]
0.04[126]
0.44,[126]
0.45,[139]
0.5[4]
x109/L
1[8]
3,[8]
7 % of WBC
Newborn 0.02[139]
0.85[139]
x109/L
Basophil granulocytes Adult
40[138]
100,[126][4]
200,[139]
900[138]
x106/L
0.0 0.75,[8]
2 % of WBC
Newborn 0.64[139]
x109/L
Coagulation
Test Lower limit Upper limit Unit Comments
Thrombocyte/Platelet count (Plt) 140,[9]
150[8][4]
350,[17][4]
400,[8]
450[9]
x10 /L orx1000/µL
Mean platelet volume (MPV) 7.4[141]
10.4[141]
fL
Prothrombin time (PT) 10, 11, 12 13, 13.5, 14, 15 s PT reference varies between laboratory kits - INR is standardised
INR 0.9[4]
1.2[4]
The INR is a corrected ratio of a patient's PT to normal
Activated partial thromboplastin time (APTT) 18,[9]
30[12][4]
28,[9]
42,[4]
45[12]
s
Thrombin clotting time (TCT) 11 18 s
Fibrinogen 1.7, 2.0 3.6, 4.2 g/L
Antithrombin 0.80 1.2 kIU/L
Bleeding time 2 9 minutes
Viscosity 1.5 1.72 cP
ImmunologyAcute phase proteins Acute phase proteins are markers of inflammation.
Test Patient Lower limit Upper limit Unit Comments
Erythrocyte sedimentation rate (ESR)
Male0
Age÷2[144]
mm/hr ESR increases with age and tends to be higher in females.
[145]
Female (Age+10)÷2[144]
C-reactive protein (CRP) n/a 5,[146][4]
6[147]
mg/L
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200,
[148]240
[148] nmol/L
Alpha 1-antitrypsin (AAT)20,
[149]22
[150] 38,
[150] 53
[149] μmol/L
89, 97 170, 230 mg/dL
Isotypes of antibodiesFurther information: Antibody
Test Patient Lower limit Upper limit Unit Comments
IgA
Adult
70, 110 360, 560
mg/dL
IgD 0.5 3.0
IgE 0.01 0.04
IgG 800 1800
IgM 54[152] 220[152]
AutoantibodiesFor clinical associations, see Autoantibody . Autoantibodies are usually absent or very low, so instead of being given in standard reference ranges, the values usually denote where they are said to be present, or whetherthe test is a positive test. There may also be an equivocal interval, where it is uncertain whether there is a significantly increased level. All included values
[153] are given for
the ELISA test.
Test Negative Equivocal Positive Unit
anti-SS-A (Ro) < 15 15-25 > 25
Unitsper
millilitre(U/mL)
anti-SS-B (La) < 3 3 – 4 > 4
Anti ds-DNA < 40 40 – 60 > 60
Anti ss-DNA < 8 8 - 10 > 10
Anti-histone antibodies < 25 n/a > 25
Cytoplasmic/classicalanti-neutrophil cytoplasmicantibodies (c-ANCA)
< 20[154]
21 - 30[154]
> 30[154]
Perinuclearanti-neutrophil cytoplasmicantibodies (p-ANCA)
< 5[154]
n/a > 5[154]
Anti-mitochondrial antibodies ( AMA) < 10[154]
n/a[154]
> 10[154]
Rheumatoid factor (RF) < 20 20 - 30 > 30[9]
Antistreptolysin O titre (ASOT) inpreschoolers
> 100
ASOT at school age > 250
ASOT in adults > 125
Test Negative Low/weak positive Moderate positive High/strong positive Unit
Anti-phospholipid IgG < 20[154]
20 –30[154]
31 – 50[154]
> 51[154]
GPLU/ml[154]
Anti-phospholipid IgM < 1.5[154]
1.5 –2.5[154]
2 – 9.9[154]
> 10[154]
MPL /ml[154]
Anti-phospholipid IgA < 10[154]
10 -20[154]
21 – 30[154]
> 31[154]
arb U/ml[154]
Anti-citrullinated protein antibodies < 20[154]
20 – 39[154]
40 - 59[154]
> 60[154]
EU[154]
Other enzymes and proteins
Test Lower limit Upper limit Unit Comments
Lactate dehydrogenase (LDH)
50 150 U/L
0.4[47]
1.7[47]
μmol/L
1.8[4]
3.4[4]
µkat/L < 70 years old[4]
Amylase
25,[8]
30,[9]
53[17]
110,[9]
120,[155]
123,[17]
125,[8]
190[47]
U/L
0.15[4]
1.1[4]
µkat/L
200[148]
240[148]
nmol/L
D-dimer n/a500
[156] ng/mL
Higher in pregnant women[157]
0.5
[4] mg/L
Lipase 7,[9]
10,[17]
23[47]
60,[9]
150,[17]
208[47]
U/L
Angiotensin-converting enzyme( ACE) 23[47]
57[47]
U/L
Acid phosphatase 3.0
[47]
ng/mL
Eosinophil cationic protein (ECP) 2.3[4]
16[4]
µg/L
Other electrolytes and metabolitesElectrolytes and Metabolites: For iron and copper, some related proteins are also included.
Test Patient type Lower limit Upper limit Unit Comments
Osmolality
275, 280, 281 295, 296, 297 mOsm/kg Plasma weight excludes solutes
Osmolarity
Slightly less than osmolality mOsm/l Plasma volume includes solutes
Urea
3.0 7.0 mmol/LBUN - blood urea nitrogen
7 18, 21 mg/dL
* Uric acid[9]
0.18 0.48 mmol/L
Female 2.0 7.0 mg/dL
Male 2.1 8.5 mg/dL
Creatinine male60, 68 90, 118 μmol/L
May be complemented with creatinine clearance 0.7, 0.8 1.0, 1.3 mg/dL
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female50,
[4] 68
[159] 90,
[4] 98
[159] μmol/L
0.6,[160]
0.8[160]
1.0,[160]
1.1[160]
mg/dL
BUN/Creatinine Ratio 5 35 -
Plasma glucose(fasting)3.8, 4.0 6.0, 6.1 mmol/L
See also glycosylated hemoglobin (in hematology)65,
[9] 70,
[8] 72
[162] 100,
[161] 110
[17] mg/dL
Full blood glucose (fasting)3.3 5.6 mmol/L
60 100 mg/dL
Lactate (Venous)4.5 19.8 mg/dL
0.5 2.2 mmol/L
Lactate (Arterial)4.5 14.4 mg/dL
0.5 1.6 mmol/L
Pyruvate
300 900 μg/dL
34 102 μmol/L