Appendix D Testing and Reference ranges Frequency Routine 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 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 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 4 th Ed (pub. Saunders Elsevier) Drug Test Interactions Handbook by Salway (pub. Chapman and Hall Medical. London) Chemical Pathology and the Sick Child by Clayton & Round s (pub. Blackwell, London) Pediatric Clinical by Meites s (pub. MCC, Washington) Geriatric Clinical Chemistry by Faulkner and Meites s (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
Sample Volumes Special Precautions Around Reference Range Reference 1. ACTH ACTH EDTA 7.5ml Send on ice ASAP 7 days See report for details 2. Alanine Adult: 0-55 U/L ALT Lithium Heparin 4.9 ml Haemolysis may invalidate Aminotransferase <2 yrs : 0-35 u/l 3. Albumin ALB Lithium Heparin 4.9 ml N/A Adult :35 50 g/l <14 yrs : 30-50 g/l 4. Aldolase ALD Clotted 4.9ml Spin ASAP and refrigerate 7 days 1-7.6 U/l 5. Aldosterone ALDO Clotted 4.5 ml 7 days See report for details Adult: 40-150 U/L 6. Activity in blood is higher <1 yr : 60-580 U/L Alkaline ALP Lithium Heparin 4.9 ml in children and in <9 yrs: 45-315 U/L Phosphatase pregnancy. <15 yrs: 50-370 U/L 7. Alpha fetoprotein AFP Clotted 4.9ml N/A 7 days 0-5.8 ku/l 8. Amiodarone AMIO Clotted 4.5 ml NA 3 days See report for details Activity in plasma lower in 9. Amylase AMY Lithium Heparin 4.9 ml 25-125 U/L infants. 10. Androstenedione ANDRO Clotted 7.5 ml NA 7 days See report for details 11. 12. Angiotensin converting enzyme Asparate Aminotransferase ACE Clotted 4.9ml N/A 7 days 8-50 IU/l AST Lithium Heparin 4.9 ml Haemolysis may invalidate Adult: 0-34 U/L <1 yr : 0-54 U/L 32
13. 14. 15. Bilirubin (Total) Bilirubin * (conjugated) Blood Venous Gas ph PCO2 po2 Base Excess Standard Bicarbonate Blood Arterial Gas ph PCO2 po2 Base Excess Standard Bicarbonate BILT BILID BGV PHV PCO2V PO2V BEV HCO3std BGA PH PCO2 PO2 BE HCO3std Lithium Heparin Lithium Heparin Marquest Gaslyte. Blood Gas Syringe Marquest Gaslyte Blood Gas Syringe Sample Volumes 4.9 ml 1 ml 1 ml 33 Special Precautions Protect from light Analyse within 2 hours Specimen analysed in ICU immediately. * To be available routinely by lab when patient numbers increase. Specimen analysed in ICU immediately. * To be available routinely by lab when patient numbers increase. Around 1 hour 1 hour Reference Range 3.4 20.5 µmol/l 0-3.4 µmol/l 7.28-7.40 5.0-7.2 kpa 4.0-8.0 kpa -3.0-2.0 mmol/l 20-27 mmol/l 7.36-7.44 4.5-6.0 kpa 11-14 kpa -2.5-2.5 mmol/l 22-28 mmol/l Reference GEM Premier 3000 GEM Premier 3000 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 18. CA19.9 CA199 Clotted sample 4.5 ml N/A 7 days See report for details 19. CA 125 CA125 Clotted sample 4.5 ml N/A 2 days See report for details
Sample Special Around Reference Range Reference Volumes Precautions 20. C Peptide CPEP Clotted 7.5 ml N/A 7 days See report for details 21. Calcitonin CAL Clotted 7.5 ml N/A 7 days See report for details 22. Calcium Ionized CAI Lithium Heparin 4.9 ml N/A 30 mins See report for details I STAT 23. Calcium Total CA Lithium Heparin 4.9 ml N/A 2.10 2.55 mmol/l 24. Carbamazepine CARB Clotted 7.5 ml N/A 5 days See report for details 25. Catecholamines Blood CATB Clotted 7.5 ml N/A 7 days See report for details 26. Catecholamines Urine CATS Acidified Urine 24 Hr. Acid added 7 days See report for details 27. CEA CEA Clotted 7.5 ml N/A 3 days See report for details 28. Chloride CL Lithium Heparin 4.9 ml N/A 98 107 mmol/l 29. Cholesterol CHOL Lithium Heparin, Adult: <5.18 mmol/l 4.9 ml N/A Clotted <17 yrs : <4.4 mmol/l Muscle damage e.g violent 30. CK CK Lithium Heparin 4.9 ml coughing, exercise, surgery, 29-168 U/L (F) IM injection may elevate 30 200 U/L (M) level. 31. Copper Blood CU Clotted sample 4.5 ml N/A 12 days 11-24 umol/l 32. Copper Urine CUUR Plain 4.5 ml N/A 12 days 0-30 umol/24 hr. 33. Cortisol CORTR Clotted NA 4 days See report for details 34
Sample Special Around Reference Range Reference Volumes Precautions 34. Cortisol urine CORTU Plain urine 24 hour collection 4 days See report for details 35. C-Reactive Protein CRP Lithium Heparin, Clotted 36. Creatinine CREA Lithium Heparin 4.9 ml 37. Calcium/Creatinine Ratio CACR Spot/24 hour urine 4.9 ml N/A 1.3 ml/ 24 hour collection Plasma concentrations lower in pregnancy. Results influenced by muscle mass. 38. CO2 (Bicarbonate) CO2 Lithium Heparin 4.9 ml N/A N/A 0-10 mg/l Adults : 53-97µmol/L (F) 62 115 µmol/l (M) < 2yrs : 20-35 µmol/l < 14yrs : 25-60 µmol/l 0.06-0.74 Adults : 22-32 mmol/l <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 Filtration Rate (GFR) collection Lithium Heparin collection 40. Cyclosporin CYC Clotted sample 7.5 ml NA 7 days See report for details 41. DHEA Sulfate DHEAS Clotted sample 7.5 ml NA 7 days See report for details 42. Digoxin DIG Clotted sample 7.5 ml NA 2 days 1-2.0 ng/ml 43. Drug screen, blood DRUG Clotted sample 7.5 ml NA 3 days See report for details 35
Sample Special Around Reference Range Reference Volumes Precautions 44. Drug screen, urine DRUGU Urine Spot NA 3 days See report for details 45. Ferritin FERR Clotted 7.5ml NA 2 days See report for details 46. Folate FOL Clotted 7.5ml NA 3 days See report for details 47. Folate, RBC RCF EDTA 7.5ml NA 5 days See report for details 48. Free T4 FT4 Clotted 7.5ml NA 2 days 9.0-19.1 pmol/l 49. FSH FSH Clotted 7.5ml NA 2 days See report for details 50. Gamma Glutamyl Transferase (GGT) GGT Lithium Heparin 4.9 ml N/A 51. Gentamicin GENT Lithium Heparin 4.9 ml Sample drawn just prior to a dose (trough level). Peak specimen should be drawn 30 mins after IV infusion. 9-36 IU/L (f) 12-64 IU/L (m) Daily regimen trough < 1mg/L For patients on BD or TDS regimens: trough <2 mg/l and peak 4-7 mg/l. In patients with a gram negative pneumonia peak is > 7mg/L 52. Glucagon GLUC Clotted 7.5 ml NA 7 days GLUR 2.8-7.8 mmol/l Fluoride Heparin 53. Glucose GLUF 4.9 ml N/A 2.78-4.44 mmol/l plasma GLU2 2.8-7.8 mmol/l 54. Glucose Tolerance Test GTT Fluoride Heparin plasma 4.9 ml Collect blood at fasting, +30,+60,+90,+120 mins. N/A mmol/l 36
Sample Volumes 37 Special Precautions Around Reference Range Reference 55. Haemoglobin A1c HBA1C EDTA 7.5ml N/A 5 days See report form for details. % (HbA1c) 5Hydroxy 56. indolacetic acid (5 HIAA) 5HIAA Urine 24 hr Acid 7 days 2.5-50 mmol/24hr HMMA also VMA See report for details 57. Vanilylmandelic acid VMA Urine 24 hr Acid 7 days 58. Homocysteine HOM Clotted 4.5 ml Fasting serum sample on See report for details 5 days ice to laboratory 59. Insulin INSULIN Clotted 4.5 ml Fasting sample, sent to lab 7 days 0.0-12.0 Mu/L ASAP 60. Lactate LACT Lithium heparin 4.9 ml NA Stat < 1Hr. I Stat 61. Lactate LDH Lithium Heparin 4.9 ml N/A dehydrogenase 125-243 U/l (m/f) 62. Lithium Clotted 7.5 ml NA Daily 0.2-1.2 mmol/l 63. Magnesium MG Lithium Heparin 4.9 ml N/A 0.85-1.15 mmol/l 64. Methotrexate METH Clotted 7.5 ml N/A 2 days See report for details 65. Microalbumin MICROALBUMIN urine spot N/A 4 days See report for details 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 68. Osmolality OSMO1 Lithium Heparin Calculated result 4-5 hours 280-295 mmol/kg (blood)
Sample Volumes OSMOU1 Urine container 4.9ml 5ml Special Precautions Around Reference Range 50-1400 mmol/kg (urine) Reference 69. Phenytoin PHENY Clotted sample 7.5 ml N/A 2 days See report for details 70. Phosphate PHOS Lithium Heparin 4.9 ml N/A Adult : 0.74-1.52 mmol/l <14 yrs : 1.2-2.0 mmol/l 71. Potassium K Lithium Heparin 4.9 ml Avoid haemolysis 3.5 5.1 mmol/l 72. Progesterone PROG Clotted sample 7.5 ml NA 7 days See report for details 73. Prolactin PRL Clotted 7.5 ml NA 7 days See report for details 74. Protein, 24 hour PRU24 urine 24 hour See report for details 75. Protein, CSF CSFP CSF 400uL NA Daily See report for details 1.3 ml/ Protein/Creatinine 76. PRCR Spot/24 hour urine 24 hour N/A 4-5 hours 0-200 mg/mmol Ratio collection 77. PSA Profile PSAP Clotted 7.5 ml Separate from cells ASAP 2 days See report for details 78. PSA Total PSA Clotted 7.5 ml Separate from cells ASAP 2 days See report for details 79. PTH hormone PTH Clotted 7.5 ml Store at 4C immediately 7 days See report for details 80. Renin REN Clotted 7.5 ml * See report for details 81. SHBG BHCG EDTA 7.5 ml NA 5 days See report for details 38
Sample Volumes 39 Special Precautions Around Reference Range Reference 82. Pyruvate PYR Special perchloric 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 84. Spot Calcium CALCUR Spot urine,plain 5ml N/A 2 hours N/A (mmol//l) 85. Spot Chloride CLUR Spot urine,plain 5ml N/A 2 hours N/A (mmol//l) 86. Spot Creatinine CREAU Spot urine,plain 5ml N/A 2 hours N/A (mmol//l) 87. Spot Phosphorus PHOSU Spot urine,plain 5ml N/A 2 hours N/A (mmol//l) 88. Spot Potassium KU Spot urine,plain 5ml N/A 2 hours N/A (mmol//l) 89. Spot Protein PRRU Spot urine,plain 5ml N/A 2 hours N/A (mmol//l) 90. Spot Sodium NAU Spot urine,plain 5ml N/A 2 hours N/A (mmol//l) 91. Spot Urea UREAU Spot urine,plain 5ml N/A 2 hours N/A (mmol//l) 92. Spot Uric Acid UAU Spot urine,plain 5ml N/A 2 hours N/A (mmol//l) Plain container. 93. Stone screen STONE urine 24 hr Collect in plain container for urate assay. Collect in acid container for Ca,In. phosphate & oxalate assays. Refridgerate urine during collection 7 prior to assay. 7 days See report for details 94. T3 T3 Clotted 7.5 ml NA 2 days See report for details 95. T3,free FT3 Clotted 7.5 ml NA 4 days See report for details 96. T4 T4 Clotted 7.5 ml NA 2 days See report for details
Sample Special Around Reference Range Reference Volumes Precautions 97. T4,free FT4 Clotted 7.5 ml NA 2 days See report for details 98. Teicoplanin TEIC Clotted 7.5 ml NA 3 days See report for details 99. Testosterone TEST Clotted 7.5 ml NA 6 days See report for details 100. Theophylline THEO Clotted 7.5 ml NA 3 days See report for details 101. Thyroglobulin THYRO Clotted 7.5 ml NA 3 days See report for details 102. Total Protein TP Lithium Heparin 4.9 ml N/A 2 hours 64-83 g/l 103. Transferrin TRANS Clotted 4.5 ml N/A 7 days 1.31-2.57 g/l 104. Triglyceride TRIG Lithium Heparin 4.9 ml Fasting 2 hours <1.7 mmol/l 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 107. Urate Uric Lithium Heparin 4.9 ml N/A 108. Urea UREA Lithium Heparin 4.9 ml N/A 150 350 umol/l (F) 210 420 umol/l (M) Adult 3.0-7.2 mmol/l <14 yrs 2.0-6.5 mmol/l 40
109. 24 hour Urine Tests Calcium Chloride Creatinine Phosphate Potassium Protein Sodium Urate Urea CA24 CL24 CRCL PHOS24 UK24 PROT24 UNAT URU24 UREAUD 24 hour urine collection Sample Volumes Special Precautions 24 hour urine collection Around 4-5 hours Reference Range 2.5-10.0 mmol/l 20-110 mmol/l 80-125 ml/min 13-42 mmol/l 8-58 mmol/l <150 mmol/l 80-250 mmol/l 1.48-4.43 mmol/day 430-710 mmol/day Reference 110. Valproic acid VAL Clotted 7.5 ml NA 3 days See report for details 111. Vancomycin Vanc Lithium Heparin 4.9 ml Sample should be drawn just prior to a dose (trough level). Peak samples should be taken 30 minutes after infusion. The recommended trough concentration of Vancomycin is 10 15mg/L. for serious systemic or Staph Aureus infection the recommended optimal trough concentration is 15-20mg/L. 112. VMA (see HMMA) VMA Urine 24 Hour. Acid added. See report for details 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 nurse s 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 Myoglobulin Osmolality Oxalate Phosphate Porphyrins Protein Urate (uric acid) VMA 24 hour collection or random. Plain bottle 24 hour collection or random. Plain bottle Random. Plain bottle 24 hour collection. Acid bottle required** 24 hour collection. Acid bottle required** Very fresh random sample sent straight to lab. Protected from light. Plain bottle. 24 hour collection. Plain bottle 24 hour collection. Plain bottle 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