Reference Ranges (adult unless otherwise stated) Male g/l. Female g/l. Babies should be over 48 hours old before testing

Transcription

1 Title: Blood Sciences Repertoire - Alphanumeric Version Summary of change 1 New document 2 1. Added in Error 3 2. Added ELF and overnight collection for mets Removed immunology tests 2. Added Lipase Updated to annual review date Added ascorbic acid 2. Updated interference to ALT and salicylate from sulfasalazine and sulfapyridine. 4.4 Removal of ADH/AVP No.of copies : 2 Location of copies : 1. QPulse 2. Insite Sample -1-Antitchymotrypsin g/l -2-Macroglobulin g/l Female g/l -Foetoprotein (AFP) 0-10 ku/l 3 days -Galactosidase Blood Spot Narrative Report -Glutamyl Transferase ( -GT/GGT) Female 0 50 U/L 0 33 U/L, Willink, Manchester -HCG Pregnancy >25 U/L Tumour marker <5 U/L 3 Days Tumour HCG referred to 17 - Hydroxyprogesterone 5- -Dihydrotestosterone Female Babies should be over 48 hours old before testing Female nmol/l < 12 nmol/l nmol/l nmol/l SAS Centre for Steroid Hormones, Leeds SAS Centre for Steroid Hormones, Leeds Version : 4.4 Page 1 of 28

2 Sample 5-Hydroxyindole acetic acid (5-HIAA) 24 hour acid urine (HCl) mol/24 hours 2 Weeks Acetylcholine Receptor Antibodies nmol/l Acyl Carnitine Profile Narrative Report Children s Acute Kidney Injury score (AKI calculation included as part of an U/E profile) Calculated score of 0-3 indicating possible severity <1 day Adrenocorticotrophic hormone (ACTH) EDTA 9 am <46 ng/l Midnight <15 ng/l 2 Weeks, Alanine Aminotransferase (ALT) Albumin 0-40 U/L Patients receiving sulfasalazine may show falsely depressed results by up to 26%. Suggest establishing baseline prior to commencing treatment if possible g/l Mild intoxication 50 mg/dl Alcohol Severe intoxication >300 mg/dl NB. Much inter-individual variation Enzymatic assay used satisfactory for purposes but not for medico legal purposes Aldosterone Li heparin (Orange) Or Following overnight recumbency pmol/l When randomly taken during the day pmol/l 2 Weeks SAS Centre, Leeds Alkaline Phosphatase (ALP) U/L Age related ranges are available. Please contact the Laboratory if required. Version : 4.4 Page 2 of 28

3 Alkaline Phosphatase Isoenzymes Sample Available only after discussion with the Pathologist, Aluminium or Alu free <10 ug/l Northern, Amino Acids - Plasma Li heparin (Orange) Narrative Report Children s Amino Acids Urine Universal ( 5 ml) Narrative Report Children s Amiodarone mg/l, Ammonia Li heparin (Orange) umol/l < 1 Hour Inform laboratory Send sample directly to laboratory. Do not send via POD Amyloid Anabolic Steroids Urine Plain 24hr Urine SAS Steroid Profiling Laboratory, London Version : 4.4 Page 3 of 28

4 Sample Anafranil (Clomipramine) ug/l, Androstendione Pre-pubertal male and female <1.4 nmol/l Provisional adult male nmol/l Provisional adult female without PCO in early follicular phase: nmol/l SAS Centre, Leeds Angiotensin converting enzyme (ACE) U/L 1 Week Anti-Myelin Associated Glycoprotein Antibodies (anti-mag) Immunology Anti-Neuronal (paraneoplastic) Antibodies Immunology Anti-TNF Refer to external report 4 weeks Purine Research Laboratory, London Anti-Thyroglobulin Ascorbic Acid (Vitamin C) Li heparin (Orange) (Protect from light, MPS preserved) umol/l Contact the lab Not routinely available Discuss with Pathologist prior to requesting Version : 4.4 Page 4 of 28

5 Sample Aspartate aminotransferase (AST) 0 40 U/L Bicarbonate mmol/l < 1 Hour Bile Acids <14 umol/l Bilirubin - Conjugated 0-10 umol/l < 3 Hours Bilirubin - Total < 21 umol/l < 3 Hours Biotinidase Li heparin (Orange) U/L Children s Blood Gases Arterial blood ph pco kpa po kpa Bicarbonate mmol/l < 1 Hour Contact the lab Please send directly to the laboratory Bone Alkaline Phosphatase Northern, Brain Natriuretic Peptide (BNP) EDTA (Separate EDTA required from FBC/ESR/HbA1c) Heart failure (HF) very unprobable <100 pg/ml If suspicion of HF then HF probable pg/ml HF very probable >500 pg/ml 3 Days, Version : 4.4 Page 5 of 28

6 Sample Bromide mmol/l, C-Peptide (Sep immed) Fasting adults pmol/l Referred, Or The Clinical Laboratory, Guildford Caffeine Li heparin (Orange) On high dose regime mg/l Assayed on Tuesday Children s Calcitonin Li heparin (Orange on ice) With report 2 Weeks Discuss with Pathologist before requesting SAS Laboratories, London Calcium Urine 24 hour acid urine (HCl) mmol/24 hours Calcium Profile Albumin g/l Alkaline Phosphatase (ALP) IU/L Adult range. Please contact the Laboratory if age related ranges required. Version : 4.4 Page 6 of 28

7 Sample Corrected Calcium mmol/l Phosphate mmol/l Adult range. Please contact the Laboratory if age related ranges required. Calculi renal Calculus Narrative report Calculi Assay Laboratory, Leicester Calprotectin Faeces 2 Weeks Carbamazepine Therapeutic 4-12 mg/l Carbohydrate Antigen 125 (CA 125) 0-35 ku/l 3 Days, Carbohydrate Antigen 153 (CA 153) 0-30 ku/l 2 Weeks Carbohydrate Antigen 199 (CA 199) 0-35 ku/l 3 Days, Carbohydrate Deficient Transferrin With report Carboxyhaemoglobin Arterial blood Non-smokers up to 1.5% Smokers up to 6.0% Heavy smokers up to 9.0% When required (Inform the lab) Version : 4.4 Page 7 of 28

8 Sample Carcinoembryonic Antigen (CEA) ug/l 3 Days, Carnitine Li heparin Total umol/l Free umol/l Children s Carotene (Vitamin A) (delievered in dark) umol/l Adult range. Please contact the Laboratory if age related ranges required., Rotherham Adrenaline nmol/24 hours Catecholamines Urine Overnight acidified urine (HCl) Noradrenaline nmol/24 hours Dopamine nmol/24 hours 2 Weeks Metanephrine mol/24 hours Normetanephrine mol/24 hours Chloride Serum mmol/l if requested Chloride Urine 24 hour mmol/24 hours Cholesterol (Random) See fasting lipid profile Cholinesterase (see Pseudocholinesterase) With report Details of anaesthetic sensitivity required Cholinesterase Investigation Unit, Bristol Version : 4.4 Page 8 of 28

9 Sample Chromogranin A 0 6 nmol/l Chromogranin B Trasylol (From Lab) SAS Laboratories, London Cholinesterase Acetyl (pesticide exposure) 2x EDTA Health Sciences Group, Buxton Cholinesterase Pseudo (scoline sensitivity) EDTA Cholinesterase Investigation Unit, Bristol Chromium EDTA Trace Elements Laboratory, Birmingham Chymotrypsin Faecal Faeces With report Referred Department of Clinical Biochemistry, Leeds CKMB Northern, Clomipramine ug/l Referred Version : 4.4 Page 9 of 28,

10 Sample Conjugated Bilirubin (? Gilberts syndrome) Copper mol/l Female mol/l 2 Weeks Children s Northern, Cortisol Serum Morning = nmol/l Cortisol Urine 24 hour <250 nmol/24 hours Referred SAS Centre for Steroid Hormones, Leeds C-Reactive (CRP) 0-10 mg/l Creatine Kinase (CK) U/L Female U/L Creatinine mol/l Female mol/l Creatinine Clearance + 24 h urine ml/min CSF Oligoclonal Bands CSF in Universal blood sample Immunology CSF Xanthochromia screen CSF in Universal (Min 0.5ml) 3 Days Sample must be protected from natural light Version : 4.4 Page 10 of 28

11 Sample Sample in Dark Cyclosporin EDTA Depends on indication Northern, (under normal circumstances) Or, Or Department of Transplant Immunology, Leeds Cysteine White Cell/Leucocyte Heparin Department of, Leeds Cytogenetics (including basic chromosome analysis, karyotyping and FISH) EDTA Heparin Refer to external report 8-12 weeks Pre adrenarche (1 5yr) <1 mol/l Female Post puberty 24yr Dehydroepiandrosterone Sulphate (DHEAS) 25 34yr yr yr Referred SAS Centre for Steroid Hormones, Leeds 60 69yr <6.0 <7.0 >70yr <5.0 <6.0 Version : 4.4 Page 11 of 28

12 Sample Therapeutic = g/l Digoxin Daily Dopamine - Urine 24 Hr collection containing HCL 2 Weeks Downs Screening (Double ) Request to be ordered only on specific Downs Screening stationary. Department of Immunology, Contact Immunology directly. Drugs of Abuse Confirmation Identification of Opiates - Urine Drugs of Abuse Screen - Urine Elastase Universal Container Universal Container Faeces Referred only when specifically requested following positive identification of opiates within urine drug screen. Negative Positive < 1 Week 2 Weeks Toxicology Department, Northern, Electrophoresis - Narrative report 1 Week Immunology Version : 4.4 Page 12 of 28

13 Sample Enhanced Liver Fiborsis (ELF) <7.7 can be considered normal and suggest no fibrosis corresponds to moderate fibrosis is advanced fibrosis >11.3 is indicative of cirrhosis and above this level the risk of serious complications increases iqur, Free, London Biochemistry Endomysial Antibodies (IgA) Endomysial Antibodies (IgG) Ethylene Glycol Negative Negative usually laboratory initiated test 2 Weeks < 2 Days Toxicology Department, Northern Immunology Immunology Ethosuximide Fabry s (α galactosidase) Blood Spot Narrative report Willink, Manchester Faecal Calprotectin Faeces 2 Weeks Faecal Elastase Faeces small sample ug/g Ferritin ug/l Haematology Fish Odour Syndrome (Trimethylaminuria) 24 Hour collection containing HCl Children s Flecainide ug/l, Folate (Serum) ug/l Haematology Follicle Stimulating Hormone (FSH) Follicular Peak Luteal Post-menopausal U/L U/L U/L U/L U/L 3 Days Version : 4.4 Page 13 of 28

14 Free Androgen Index (Calculated from testosterone and SHBG) Sample Yr Yr Yr , Female > 20 Yr Free Fatty Acids Fluoride See Hypoglycaemia Screen Free Light Chains (serum) Free Light Chains (urine) Random Urine Free Kappa mg/l Free Lambda mg/l Kappa /lambda ratio Immunology Immunology Free Thyroxine (ft4) pmol/l Adult range. Please contact laboratory if age related ranges required. Free Tri-iodothyronine (ft3) Fructosamine pmol/l Adult range. Please contact laboratory if age related ranges required. Department of Clinical Biochemistry, Middlesex Galactosaemia Screen Li heparin (Orange) Negative Children s Gastrin BDGastrin Vacutainer (from lab) 0 40 pmol/l (Part of gut hormone screen) SAS Laboratories, London Glucagon BDGastrin Vacutainer (from lab) 0 50 pmol/l (Part of gut hormone screen) Referred SAS Laboratories, London Normal fasting <7.0 mmol/l Glucose Fasting indicative of Diabetes Mellitus 7.0 mmol/l Random indicative of Diabetes Mellitus 11.1 mmol/l Version : 4.4 Page 14 of 28

15 Glycated Haemoglobin (HbA1c) Sample EDTA In diabetes aim for <53 mmol/mol 3 Days, Growth Hormone ug/l, Gastrin <40 pmol/l Glucagon <50 pmol/l Gut Hormones BDGastrin Vacutainer (from lab) Neurotensin (specific request) Pancreatic Polypeptide Somatostatin <100 pmol/l <300 pmol/l <150 pmol/l Referred SAS Laboratories, London VIP <30 pmol/l Chromogranin A <60 pmol/l Chromogranin B <150 pmol/l Female g/l g/l Haptoglobin Female 14yr L/L L/L 16yr L/L L/L >=18yr L/L L/L 1 Week Immunology Homocysteine EDTA Separate within 1 hour Female 0 18 umol/l 0 16 umol/l 1 Week Children s Immunoreactive Trypsin Blood spot With report Children s Version : 4.4 Page 15 of 28

16 Sample Insulin pmol/l, Insulin Antibodies (IgG) Negative Equivocal Positive <5 mg/l 5 10 mg/l >10 mg/l Insulin-like Growth Factor (IGF-1) Age and sex related ranges. Contact laboratory or see report., Intermediary Metabolites (Part of hypoglycaemia screen) Yellow Includes: Glucose Lactate Free fatty acids 3-Hydroxybutyrate Comment issued with report 2 Weeks Children s Iron Profile Iron Iron Transferrin mol/l Female 9-30 mol/l g/l Transferrin saturation 20 50% Female 15 50% Lactate Yellow Fluoride mmol/l Lactate Dehydrogenase (LDH) U/L Lamotrigine 2 5 mg/l Some patients may tolerate >10 mg/l without toxicity, Version : 4.4 Page 16 of 28

17 Sample Lead EDTA (Pink) Whole blood ug/dl In the absence of lead exposure, blood lead levels rarely exceed 10 ug/dl. Values greater than this require investigation to identify and remove the source of the lead. Northern, Lipase U/L Lipid Profile (Fasting - 12hours) Total Cholesterol HDL Cholesterol Total:HDL Cholesterol Ratio LDL Cholesterol (calculated) Triglycerides Desirable <4.0 mmol/l Desirable >0.90 mmol/l Desirable <2.0 mmol/l mmol/l NB. Consider non-lipid factors in cardio- vascular risk assessment i.e. family history of CHD, hypertension, smoking, diabetes mellitus and male gender. Lithium Therapeutic mmol/l Magnesium mmol/l Microalbumin Urine (Albumin:creatinine ratio) Myelin Associated Glycoprotein Antibodies <2.5 mg/mmol creatinine Universal random 3 Days Female <3.5 mg/mmol creatinine With report, Immunology Neurone Specific Enolase (NSE) <12.5 ug/l Immunology Version : 4.4 Page 17 of 28

18 Sample Neurotensin BD Gastrin Bottle (from lab) See Gut Hormones SAS Laboratories, London Oestradiol Follicular Mid-cycle Luteal Post-menopausal pmol/l pmol/l pmol/l <136 pmol/l pmol/l 3 Days, Oligoclonal bands (CSF) CSF + Narrative report NB. Blood and CSF required for full interpretation Immunology Organic Acids Urine Universal 5mL (Freeze immediately) Narrative report Children s Osmolality Serum mmol/kg Osmolality Urine Universal random mmol/kg P1NP g/l Northern, Pancreatic Elastase Faeces See Elastase/Faecal Elastase 2 Weeks Pancreatic Polypeptide BDGastrin Vacutainer (from lab) See Gut Hormones SAS Laboratories, London Version : 4.4 Page 18 of 28

19 Sample Paracetamol Significant toxicity likely: >200 mg/l at 4h >50 mg/l at 12h Treatment indicated if above treatment line. See BNF. Parathyroid Hormone EDTA ng/l 3 Days Phenobarbitone Therapeutic mg/l 3 Days Phenytoin Therapeutic 5-20 mg/l, Phosphate Serum mmo/l Adult range stated. Please contact lab for age related ranges. Phosphate Urine 24 hour acid (HCl) mmol/24 hours Placental Alkaline Phosphatase (PLAP) Non-smokers Cigarette smokers <500 mu/l <1500 mu/l Porphyrins/Porphyria full screen Blood: 2 x EDTA Urine: fresh random sample Faeces: small portion* *Protect all samples from light Reference ranges and comment with report Department of Medical Biochemistry, Cardiff Potassium mmol/l Pregnancy Urine Universal container early morning collection Negative Positive (3 7 days after first missed menstrual period) Progesterone Follicular Luteal Mid-luteal Post-menopausal Pre-pubertal children nmol/l nmol/l nmol/l < nmol/l < nmol/l Version : 4.4 Page 19 of 28

20 Sample < nmol/l Proinsulin (On ice and separated promptly) With report Discuss with Pathologist The Clinical Laboratory, Guildford Prolactin Female miu/l miu/l Prostate Specific Antigen (PSA) yr <3.0 ug/l yr <4.0 ug/l >70 yr <5.0 ug/l PSA is raised in Ca. prostate and in 25 30% of patients with BPH. Version : 4.4 Page 20 of 28

21 Sample Ranges quoted from National Prostate Cancer Risk Management Programme (2002) PSA samples should not be taken from men who have: - an active UTI - ejaculated in the previous 48 hours - exercised vigorously in the previous 48 hours - had a prostate biopsy in the previous 6 weeks. - had a DRE in the previous week. N.B PSA is not tumour specific and is elevated in benign prostatic hypertrophy, prostatis etc. Samples referred to, Urine EMU is now preferred or 24 hour :creatinine ratio (PCR) Albumin:creatinine ratio (ACR) 24hr urine protein <50 mg/mmol creatinine <30mg/mmol creatinine <0.1 g/24 hours (Total) Serum g/l Electrophoresis Narrative report 1 Week Immunology Version : 4.4 Page 21 of 28

22 Sample Pseudocholinesterase (for scoline apnoea) EDTA With report Details of anaesthetic sensitivity required Cholinesterase Investigation Unit, Bristol Quinine Therapeutic 3 7 mg/l, Renal Calculi Calculi Narrative report Calculi Assay Laboratory, Leicester Renin (PRA - plasma renin activity) Li heparin (Orange) After overnight recumbency After 30 min upright When taken at random during the day nmol/l/h nmol/l/h nmol/l h 2 Weeks SAS Centre for Steroid Hormones, Leeds Therapeutic <250 mg/l Salicylate Toxicity likely if >500 mg/l Patients receiving sulfasalazine may show falsely elevated results by up to 25% and patients receiving sulfapyridine may show falsely depressed results by up to 25%. Suggest establishing baseline prior to commencing treatment if possible. Selenium umol/l Northern, Version : 4.4 Page 22 of 28

23 Sample Sex Hormone Binding Globulin (SHBG) Female nmol/l nmol/l Pre-pubertal child nmol/l 3 Days, Sodium mmol/l Tacrolimus EDTA trough level Dependent on indication. Please specify transplant type and Unit Northern, Or to appropriate Transplant Unit (where possible) Temazepam g/l Female nmol/l osterone 3 Days nmol/l Therapeutic mg/l Theophylline < 1Day Neonatal Apnoea 6 11 mg/l Thiamine (Vitamin B1) EDTA (Protect from light) nmol/l 2 weeks,, Version : 4.4 Page 23 of 28

24 Sample Thiopurine Methyltransferase EDTA Normal pmol/h/mghb Deficiency <10 pmol/h/mghb Carrier pmol/h/mghb With comment on report 4 weeks Purine Research Laboratory, London Thyroglobulin <60mg/L Thyroid Profile See TSH ft4 and ft3 Total Iron Binding Capacity (TIBC) umol/l Part of Iron Profile Total g/l Transferrin g/l Samples should not be taken on Fridays. Transferrin Receptor Refer to the original report. Biochemistry Department of Clinical Biochemistry, London. Transferrin Saturation 20 50% Female 15 50% Part of Iron Profile pathology Version : 4.4 Page 24 of 28

25 Sample Triglycerides (patient should be fasting) mmol/l Minimum fast 14 hours Tri-iodothyronine (Free T3) Troponin I pmol/l Adult range. Age related ranges available, please contact the laboratory if required ng/l No detectable myocardial damage >40.0 ng/l Detectable myocardial damage, the aetiology of which depends on the scenario and ECG findings TSH mu/l Urea mmol/l Adult range. Age related ranges available if required. Please contact the laboratory. Urea Electrolytes (UEs) Creatinine Potassium Sodium Urea mol/l Female mol/l mmol/l mmol/l mmol/l Adult range. Age related ranges available if required. Please contact the laboratory if required. Uric acid Female mol/l mol/l Urine Calcium 24 hour acid urine (HCl) mmol/24 hours Urine Drugs of Abuse Screen Universal Negative Positive Confirmation or drug identification available on specific request Twice Weekly Urine Urea Electrolytes Creatinine Random = very variable interpret in conjunction with serum UEs 9 17 mmol/24 hours Potassium Sodium Universal Random mmol/24hr mmol/24hr Very variable dependant on dietary intake and should be interpreted with the serum UEs Version : 4.4 Page 25 of 28

26 Urea Sample or 24 hour (Plain) mmol/ 24hr Urine Free Cortisol 24 hour urine (Plain) nmol/24hr Referred SAS Centre for Steroid Hormones, Leeds Urine Magnesium 24 hour urine (Plain) mmol/24hr As required Urine NTX Second morning void Pre-menopausal Post-menopausal nm BCE/mmol creatinine nm BCE/mmol creatinine nm BCE/mmol creatinine Referred Northern, Urine Oxalate 24 hour acid urine (HCl) mmol/24hr Referred Birmingham (C) Urine Phosphate 24 hour acid urine (HCl) mmol/24hr Urine Urate 24hour urine (plain) mmol/24hr Valproate Therapeutic = mg/l s Vasoactive Intestinal Peptide (VIP) BD Gastrin Tube. Please contact the laboratory See Gut Hormones Referred Clinical Biochemistry Medical Oncology Charing Cross, London Very Long Chain Fatty Acids Li heparin (Orange) With report Referred Children s Version : 4.4 Page 26 of 28

27 Sample Vitamin A (Protect from light) mol/l Adult range given. Please contact laboratory for age related ranges 2 Weeks Vitamin B1 (Thiamine) EDTA (Protect from light) nmol/l 2 Weeks Vitamin B12 Clotted Gel (brown) 4.9ml ng/l Vitamin B2 EDTA nmol/l 2 Weeks Vitamin B6 EDTA (Protect from light) nmol/l 2 Weeks <25 nmol/l Vitamin D deficiency. Give supplementation. Vitamin D nmol/l Vitamin D insufficiency, increase safe sun exposure and give supplementation. >50 nmol/l Vitamin D level may be sufficient >75 nmol/l Vitamin D level may be optimal 3 Days, >150 nmol/l Vitamin D excess. Potential adverse effects. Suggest review Vitamin E (Protect from light) mol/l Adult range given. Please contact laboratory for age related ranges 2 Weeks Voltage Gated K Channel Antibodies Clotted Gel (brown) 4.9ml 0-69 pm Referred the Department of Immunology, White Cell Enzymes (other than Fabry s and Pope s) Xanthochromia Zinc 2x EDTA With report Referred CSF (protect from light) Narrative report 3 Days mol/l Willink, Manchester Northern, Version : 4.4 Page 27 of 28

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