AppD BichemistryTestingRefRanges

HMC/QA/GDE/0001-Attach.004 Ver.
3 Effective Date: _21/10/2009

HERMITAGE MEDICAL CLINIC
Appendix D Biochemistry Testing and Reference ranges

Frequency
Routine Biochemistry tests are preformed on a daily basis (see opening hours). Other tests requested will either be sent out or preformed in-house and
the specimen will be assayed at the next available opportunity. The schedule for these assays varies, for information contact the Biochemistry
laboratory. A number of routine tests are not yet available in-house but will be shortly. At the time of print these tests are sent to the Blackrock Clinic
,the information in this booklet are guidelines only - for further information contact the Biochemistry Laboratory.
Reference values
The reference values indicate the nature and the magnitude of variation in Biochemical values and may vary with methodology and between
laboratories.
The reference values and comments were compiled from many sources including:
Clinical Guide to Laboratory tests by Tietz 4th Ed (pub. Saunders Elsevier)
Drug Test Interactions Handbook by Salway (pub. Chapman and Hall Medical. London)
Chemical Pathology and the Sick Child by Clayton & Rounds (pub. Blackwell, London)
Pediatric Clinical Biochemistry by Meitess (pub. MCC, Washington)
Geriatric Clinical Chemistry by Faulkner and Meitess (pub. MCC, Washington)
Different ranges reported in geriatric patients may reflect underlying pathology.
The paediatric ranges listed are derived from the literature and should only be taken as an indication of the changes to be expected with age.
31
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HMC/QA/GDE/0001-Attach.004 Ver. 3 Effective Date: _21/10/2009
Biochemistry
Turn
Sample Special
No. Test Mnemonic Sample Type Around Reference Range Reference
Volumes Precautions
Time
1. ACTH ACTH EDTA 7.5ml Send on ice ASAP 7 days See report for details Send out
Alanine 1hr STAT Adult: 0-55 U/L
2. ALT Lithium Heparin 4.9 ml Haemolysis may invalidate Architect
Aminotransferase 4hr Routine <2 yrs : 0-35 u/L
1hr STAT Adult :3550 g/L
3. Albumin ALB Lithium Heparin 4.9 ml N/A Architect
4hr Routine <14 yrs : 30-50 g/L
4. Aldolase ALD Clotted 4.9ml Spin ASAP and refrigerate 7 days 1-7.6 U/l Send out
5. Aldosterone ALDO Clotted 4.5 ml 7 days See report for details Send out
Adult: 40-150 U/L
Activity in blood is higher <1 yr : 60-580 U/L
Alkaline 1hr STAT
6. ALP Lithium Heparin 4.9 ml in children and in <9 yrs: 45-315 U/L Architect
Phosphatase 4hr Routine
pregnancy. <15 yrs: 50-370 U/L
7. Alpha fetoprotein AFP Clotted 4.9ml N/A 7 days 0-5.8 kU/l Send out
8. Amiodarone AMIO Clotted 4.5 ml NA 3 days See report for details Send out
Activity in plasma lower in 1hr STAT
9. Amylase AMY Lithium Heparin 4.9 ml 25 -125 U/L Architect
infants. 4hr Routine
10. Androstenedione ANDRO Clotted 7.5 ml NA 7 days See report for details Send out
Angiotensin Send out
11. ACE Clotted 4.9ml N/A 7 days 8-50 IU/l
converting enzyme
Asparate 1hr STAT Adult: 0-34 U/L
12. AST Lithium Heparin 4.9 ml Haemolysis may invalidate Architect
Aminotransferase 4hr Routine <1 yr : 0-54 U/L
32
Biochemistry
Turn
Sample Special
Volumes Precautions
Time
Bilirubin (Total) Architect
BILT Lithium Heparin
Protect from light 1hr STAT 3.4 20.5 mol/L
13. 4.9 ml
Bilirubin * Analyse within 2 hours 4hr Routine 0- 3.4 mol/L Architect
BILID Lithium Heparin
(conjugated)
Blood Venous Gas
BGV Specimen analysed in ICU
immediately.
pH
PHV 7.28-7.40
PCO2 Marquest Gaslyte. GEM Premier
14. PCO2V 1 ml 1 hour 5.0-7.2 kPa
pO2 Blood Gas Syringe 3000
PO2V * To be available routinely 4.0-8.0 kPa
Base Excess
BEV by lab when patient -3.0-2.0 mmol/L
Standard
HCO3std numbers increase. 20-27 mmol/L
Bicarbonate
Blood Arterial Gas
BGA Specimen analysed in ICU
immediately.
pH
PH 7.36-7.44
PCO2 Marquest Gaslyte GEM Premier
15. PCO2 1 ml 1 hour 4.5-6.0 kPa
pO2 Blood Gas Syringe 3000
PO2 * To be available routinely 11-14 kPa
Base Excess
BE by lab when patient -2.5-2.5 mmol/L
Standard
HCO3std numbers increase. 22-28 mmol/L
Bicarbonate
16. Pro-BNP BNP Lithium Heparin 4.9 ml N/A 1hr Stat 0-125 pm/mL Pathfast
17. CA15.3 CA153 Clotted sample 4.5 ml N/A 2 days See report for details Send out
18. CA19.9 CA199 Clotted sample 4.5 ml N/A 7 days See report for details Send out
19. CA 125 CA125 Clotted sample 4.5 ml N/A 2 days See report for details Send out
33
Biochemistry
Turn
Sample Special
Volumes Precautions
Time
20. C Peptide CPEP Clotted 7.5 ml N/A 7 days See report for details Send out
21. Calcitonin CAL Clotted 7.5 ml N/A 7 days See report for details Send out
22. Calcium Ionized CAI Lithium Heparin 4.9 ml N/A 30 mins See report for details I STAT
1hr STAT
23. Calcium Total CA Lithium Heparin 4.9 ml N/A 2.10 2.55 mmol/L Architect
4hr Routine
24. Carbamazepine CARB Clotted 7.5 ml N/A 5 days See report for details Send out
25. Catecholamines Blood CATB Clotted 7.5 ml N/A 7 days See report for details Send out
26. Catecholamines Urine CATS Acidified Urine 24 Hr. Acid added 7 days See report for details Send out
27. CEA CEA Clotted 7.5 ml N/A 3 days See report for details Send out
1hr STAT
28. Chloride CL Lithium Heparin 4.9 ml N/A 98 107 mmol/L Architect
4hr Routine
Lithium Heparin, 1hr STAT Adult: <5.18 mmol/L
29. Cholesterol CHOL 4.9 ml N/A Architect
Clotted 4hr Routine <17 yrs : <4.4 mmol/L
Muscle damage e.g violent
coughing, exercise, surgery, 1hr STAT 29-168 U/L (F)
30. CK CK Lithium Heparin 4.9 ml Architect
IM injection may elevate 4hr Routine 30 200 U/L (M)
level.
31. Copper Blood CU Clotted sample 4.5 ml N/A 12 days 11-24 umol/l Send out
32. Copper Urine CUUR Plain 4.5 ml N/A 12 days 0-30 umol/24 hr. Send out
33. Cortisol CORTR Clotted NA 4 days See report for details Send out
34
Biochemistry
Turn
Sample Special
Volumes Precautions
Time
34. Cortisol urine CORTU Plain urine 24 hour collection 4 days See report for details Send out
Lithium Heparin, 1hr STAT
35. C-Reactive Protein CRP 4.9 ml N/A 0-10 mg/L Architect
Clotted 4hr Routine
Adults :
Plasma concentrations
53 - 97mol/L (F)
lower in pregnancy. 1hr STAT
36. Creatinine CREA Lithium Heparin 4.9 ml 62 115 mol/L (M) Architect
Results influenced by 4hr Routine
< 2yrs : 20-35 mol/L
muscle mass.
< 14yrs : 25-60 mol/L
1.3 ml/
Calcium/Creatinine 1hr STAT
37. CACR Spot/24 hour urine 24 hour N/A 0.06-0.74 Architect
Ratio 4hr Routine
collection
1hr STAT Adults : 22-32 mmol/L
38. CO2 (Bicarbonate) CO2 Lithium Heparin 4.9 ml N/A Architect
4hr Routine <14 hrs : 20-28 mmol/L
Creatinine 24 hour
Clearance 24 hour urine and collection Send to lab upon
90-140 ml/min
39. Glomerular GFR blood sample mid / 1.3 ml completion of 24 hour 4-5 hours Architect
Filtration Rate collection Lithium collection
(GFR) Heparin
40. Cyclosporin CYC Clotted sample 7.5 ml NA 7 days See report for details Send out
41. DHEA Sulfate DHEAS Clotted sample 7.5 ml NA 7 days See report for details Send out
42. Digoxin DIG Clotted sample 7.5 ml NA 2 days 1-2.0 ng/ml Send out
43. Drug screen, blood DRUG Clotted sample 7.5 ml NA 3 days See report for details Send out
35
Biochemistry
Turn
Sample Special
Volumes Precautions
Time
44. Drug screen, urine DRUGU Urine Spot NA 3 days See report for details Send out
45. Ferritin FERR Clotted 7.5ml NA 2 days See report for details Send out
46. Folate FOL Clotted 7.5ml NA 3 days See report for details Send out
47. Folate, RBC RCF EDTA 7.5ml NA 5 days See report for details Send out
48. Free T4 FT4 Clotted 7.5ml NA 2 days 9.0-19.1 pmol/l Send out
49. FSH FSH Clotted 7.5ml NA 2 days See report for details Send out
Gamma Glutamyl 1hr STAT 9-36 IU/L (f)
50. GGT Lithium Heparin 4.9 ml N/A Architect
Transferase (GGT) 4hr Routine 12-64 IU/L (m)
Daily regimen trough < 1mg/L
For patients on BD or TDS
Sample drawn just prior to
regimens: trough <2 mg/L and
a dose (trough level). Peak 1hr STAT
51. Gentamicin GENT Lithium Heparin 4.9 ml peak 4-7 mg/L. Architect
specimen should be drawn 4hr Routine
In patients with a gram
30 mins after IV infusion.
negative pneumonia peak is >
7mg/L
52. Glucagon GLUC Clotted 7.5 ml NA 7 days Send out
GLUR 2.8-7.8 mmol/L
Fluoride Heparin 1hr STAT
53. Glucose GLUF 4.9 ml N/A 2.78-4.44 mmol/L Architect
plasma 4hr Routine
GLU2 2.8-7.8 mmol/L
Glucose Tolerance Fluoride Heparin Collect blood at fasting, 1hr STAT
54. GTT 4.9 ml N/A mmol/L Architect
Test plasma +30,+60,+90,+120 mins. 4hr Routine
36
Biochemistry
Turn
Sample Special
Volumes Precautions
Time
Haemoglobin A1c Send out
55. HBA1C EDTA 7.5ml N/A 5 days See report form for details. %
(HbA1c)
5Hydroxy Send out
56. indolacetic acid (5 5HIAA Urine 24 hr Acid 7 days 2.5-50 mmol/24hr
HIAA)
HMMA also VMA See report for details Send out
57. Vanilylmandelic VMA Urine 24 hr Acid 7 days
acid
Fasting serum sample on See report for details Send out
58. Homocysteine HOM Clotted 4.5 ml 5 days
ice to laboratory
Fasting sample, sent to lab Send out
59. Insulin INSULIN Clotted 4.5 ml 7 days 0.0-12.0 Mu/L
ASAP
60. Lactate LACT Lithium heparin 4.9 ml NA Stat < 1Hr. I Stat
Lactate 1hr STAT
61. LDH Lithium Heparin 4.9 ml N/A 125-243 U/l (m/f) Architect
dehydrogenase 4hr Routine
62. Lithium Clotted 7.5 ml NA Daily 0.2-1.2 mmol/L Send out
1hr STAT
63. Magnesium MG Lithium Heparin 4.9 ml N/A 0.85-1.15 mmol/L Architect
4hr Routine
64. Methotrexate METH Clotted 7.5 ml N/A 2 days See report for details Send out
65. Microalbumin MICROALBUMIN urine spot N/A 4 days See report for details Send out
66. NT PRO BNP BNP Lithium Heparin 4.9 ml N/A Stat < 1 hour <125 pg/ml Pathfast
67. Oestradiol OEST Clotted 7.5 ml N/A See report for details Send out
68. Osmolality OSMO1 Lithium Heparin Calculated result 4-5 hours 280-295 mmol/Kg (blood) Architect
37
Biochemistry
Turn
Sample Special
Volumes Precautions
Time
OSMOU1 Urine container 4.9ml 50-1400 mmol/Kg (urine)
5ml
69. Phenytoin PHENY Clotted sample 7.5 ml N/A 2 days See report for details Send out
1hr STAT Adult : 0.74 -1.52 mmol/L
70. Phosphate PHOS Lithium Heparin 4.9 ml N/A Architect
4hr Routine <14 yrs : 1.2-2.0 mmol/L
1hr STAT
71. Potassium K Lithium Heparin 4.9 ml Avoid haemolysis 3.5 5.1 mmol/L Architect
4hr Routine
72. Progesterone PROG Clotted sample 7.5 ml NA 7 days See report for details Send out
73. Prolactin PRL Clotted 7.5 ml NA 7 days See report for details Send out
74. Protein, 24 hour PRU24 urine 24 hour See report for details Architect
75. Protein, CSF CSFP CSF 400uL NA Daily See report for details Architect
1.3 ml/
Protein/Creatinine
76. PRCR Spot/24 hour urine 24 hour N/A 4-5 hours 0-200 mg/mmol Architect
Ratio
collection
77. PSA Profile PSAP Clotted 7.5 ml Separate from cells ASAP 2 days See report for details Send out
78. PSA Total PSA Clotted 7.5 ml Separate from cells ASAP 2 days See report for details Send out
79. PTH hormone PTH Clotted 7.5 ml Store at 4C immediately 7 days See report for details Send out
80. Renin REN Clotted 7.5 ml * See report for details Send out
81. SHBG BHCG EDTA 7.5 ml NA 5 days See report for details Send out
38
Biochemistry
Turn
Sample Special
Volumes Precautions
Time
Special perchloric Send out
82. Pyruvate PYR 4.5 ml Frozen <1 hour 6 days See report form for details
acid tube
83. Sodium Na Lithium Heparin 4.9 ml N/A 2 hours 136 145 mmol/L Architect
84. Spot Calcium CALCUR Spot urine,Plain 5ml N/A 2 hours N/A (mmol//L) Architect
85. Spot Chloride CLUR Spot urine,Plain 5ml N/A 2 hours N/A (mmol//L) Architect
86. Spot Creatinine CREAU Spot urine,Plain 5ml N/A 2 hours N/A (mmol//L) Architect
87. Spot Phosphorus PHOSU Spot urine,Plain 5ml N/A 2 hours N/A (mmol//L) Architect
88. Spot Potassium KU Spot urine,Plain 5ml N/A 2 hours N/A (mmol//L) Architect
89. Spot Protein PRRU Spot urine,Plain 5ml N/A 2 hours N/A (mmol//L) Architect
90. Spot Sodium NAU Spot urine,Plain 5ml N/A 2 hours N/A (mmol//L) Architect
91. Spot Urea UREAU Spot urine,Plain 5ml N/A 2 hours N/A (mmol//L) Architect
92. Spot Uric Acid UAU Spot urine,Plain 5ml N/A 2 hours N/A (mmol//L) Architect
Plain container. Send out
Collect in plain container
for urate assay.
Collect in acid container for
93. Stone screen STONE urine 24 hr 7 days See report for details
Ca,In. phosphate & oxalate
assays. Refridgerate urine
during collection 7 prior to
assay.
94. T3 T3 Clotted 7.5 ml NA 2 days See report for details Send out
95. T3,free FT3 Clotted 7.5 ml NA 4 days See report for details Send out
96. T4 T4 Clotted 7.5 ml NA 2 days See report for details Send out
39
Biochemistry
Turn
Sample Special
Volumes Precautions
Time
97. T4,free FT4 Clotted 7.5 ml NA 2 days See report for details Send out
98. Teicoplanin TEIC Clotted 7.5 ml NA 3 days See report for details Send out
99. Testosterone TEST Clotted 7.5 ml NA 6 days See report for details Send out
100. Theophylline THEO Clotted 7.5 ml NA 3 days See report for details Send out
101. Thyroglobulin THYRO Clotted 7.5 ml NA 3 days See report for details Send out
102. Total Protein TP Lithium Heparin 4.9 ml N/A 2 hours 64-83 g/L Architect
103. Transferrin TRANS Clotted 4.5 ml N/A 7 days 1.31-2.57 g/l Send out
104. Triglyceride TRIG Lithium Heparin 4.9 ml Fasting 2 hours <1.7 mmol/L Architect
105. Tropinin TROP Lithium Heparin 4.9 ml N/A 1hr Stat 0.0-0.06 (ng/mL) Unitech i-stat
106. TSH TSH Clotted 7.5 ml N/A 2 days
1hr STAT 150 350 uMOL/L (F)
107. Urate Uric Lithium Heparin 4.9 ml N/A Architect
4hr Routine 210 420 uMOL/L (M)
1hr STAT Adult 3.0-7.2 mmol/L
108. Urea UREA Lithium Heparin 4.9 ml N/A Architect
4hr Routine <14 yrs 2.0-6.5 mmol/L
40
Biochemistry
Turn
Sample Special
Volumes Precautions
Time
24 hour Urine Tests
Calcium CA24 2.5-10.0 mmol/L
Chloride CL24 20-110 mmol/L
Creatinine CRCL 80-125 ml/min
24 hour urine collection
Phosphate PHOS24 24 hour urine 13-42 mmol/L
109. 4-5 hours Architect
Potassium UK24 collection 8-58 mmol/L
Protein PROT24 <150 mmol/L
Sodium UNAT 80-250 mmol/L
Urate URU24 1.48-4.43 mmol/day
Urea UREAUD 430-710 mmol/day
110. Valproic acid VAL Clotted 7.5 ml NA 3 days See report for details Send out
The recommended trough

Sample should be drawn concentration of Vancomycin
just prior to a dose (trough is 10 15mg/L. for serious
1hr STAT
111. Vancomycin Vanc Lithium Heparin 4.9 ml level). Peak samples should systemic or Staph Aureus Send out
4hr Routine
be taken 30 minutes after infection the recommended
infusion. optimal trough concentration is
15-20mg/L.
Send out
112. VMA (see HMMA) VMA Urine 24 Hour. Acid added. See report for details
Send out
113. Zinc ZINC Clotted 7.5 ml NA 6 days
41
Urine tests
Please ensure that start and end dates and times are noted on the bottle label with nurses signature.
Analyte Specimen Requirements

5 HIAA 24 hour collection. Acid bottle required**
18 Hydroxy cortisol Plain bottle
Albumin Plain bottle: Random sample-preferred first sample on waking
Amylase 24 hour urine container. Plain bottle
Calcium 24 hour collection. Acid bottle required**
Catecholamines 24 hour collection. Acid bottle required**
Copper 24 hour urine container. Plain bottle
Cortisol Plain bottle
Creatinine 24 hour collection/random. Plain bottle
Creatinine clearance* 24 hour collection. Plain bottle.
Electrolytes (Sodium, 24 hour collection or random. Plain bottle
Potassium,urea,chloride)
Homocysteine Early morning urine (fasting) frozen <1 hour. Plain bottle
Lead 24 hour collection or random. Plain bottle
42
Mercury 24 hour collection or random. Plain bottle

Myoglobulin 24 hour collection or random. Plain bottle
Osmolality Random. Plain bottle
Oxalate 24 hour collection. Acid bottle required**
Phosphate 24 hour collection. Acid bottle required**
Porphyrins Very fresh random sample sent straight to lab. Protected from light. Plain
bottle.
Protein 24 hour collection. Plain bottle
Urate (uric acid) 24 hour collection. Plain bottle
VMA 24 hour collection. Acid bottle required**
* Creatinine clearances can only be calculated if the blood creatinine is measured within 24 hours of the 24 hour urine.
** Acid must be added to the bottle BEFORE the collection begins. Please go to lab for an aliquot of HCL. The bottle will be labelled with an
acid added sticker.
Health and Safety Notice for containers with acid added.

These containers contain concentrated acid.
Keep the bottles out of the reach of children.
In case of contact with eyes or skin rinse immediately with plenty of water and seek medical advice.
DO NOT breathe any fumes from the bottles.
43
Patients MUST be advised NOT TO URINATE DIRECTLY in the bottle.
Definitions
Random collection: urine can be collected at any time.
Early morning specimen: Specimen of choice for urinalysis, since the urine is normally more concentrated (due to length of time the urine is allowed
to remain in the bladder) and contains higher levels of cellular elements and analytes such as protein.
24 hour collection: measure analytes that are affected by diurnal variations. In this collection method, the bladder is emptied before beginning the
timed collection in the morning. Then for the duration of the 24 hours, all urine is collected and pooled in the urine container, with the final collection
taking place at the very end of that period. i.e. the early morning urine is collected at the end of the 24 hours.
The urine container is amber coloured for specimens being assayed for light sensitive analytes, such as urobilinogen and porphrins.
44

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HMC/QA/GDE/0001-Attach.004 Ver.

3 Effective Date: _21/10/2009

Appendix D Biochemistry Testing and Reference ranges

Clinical Guide to Laboratory tests by Tietz 4th Ed (pub. Saunders Elsevier)

Pediatric Clinical Biochemistry by Meitess (pub. MCC, Washington)

Geriatric Clinical Chemistry by Faulkner and Meitess (pub. MCC, Washington)

Different ranges reported in geriatric patients may reflect underlying pathology.

The recommended trough

Analyte Specimen Requirements

Mercury 24 hour collection or random. Plain bottle

Health and Safety Notice for containers with acid added.

Patients MUST be advised NOT TO URINATE DIRECTLY in the bottle.

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