Laboratory Values

Unless noted, all values are for adults
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Arterial blood gases – review;    Anion gap (review);    ANC calculator.
Albumin 3.2 – 5 g/dl
Alkaline phosphatase
(Adults: 25-60)		 33 – 131 IU/L
                Adults > 61 yo: 51 – 153 IU/L
Ammonia 20 – 70 mcg/dl
Bilirubin, direct 0 – 0.3 mg/dl
Bilirubin, total 0.1 – 1.2 mg/dl

Blood Gases
Arterial Venous
pH 7.35 – 7.45 7.32 – 7.42
pCO2 35 – 45 38 – 52
pO2 70 – 100 28 – 48
HCO3 19 – 25 19 – 25
O2 Sat % 90 – 95 40 – 70
BUN 7 – 20 mg/dl

Complete blood count (CBC)  Adults
Male Female
Hemoglobin (g/dl) 13.5 – 16.5 12.0 – 15.0
Hematocrit (%) 41 – 50 36 – 44
RBC’s ( x 106 /ml) 4.5 – 5.5 4.0 – 4.9
RDW (RBC distribution width) < 14.5
MCV 80 – 100
MCH 26 – 34
MCHC % 31 – 37
Platelet count 100,000 to 450,000

Creatine kinase (CK) isoenzymes
CK-BB 0%
CK-MB (cardiac) 0 – 3.9%
CK-MM 96 – 100%
Creatine phosphokinase (CPK) 8 – 150 IU/L
Creatinine (mg/dl) 0.5 – 1.4

Electrolytes
Calcium 8.8 – 10.3 mg/dL
Calcium, ionized 2.24 – 2.46 meq/L
Chloride 95 – 107 mEq/L
Magnesium 1.6 – 2.4 mEq/L
Phosphate 2.5 – 4.5 mg/dL
Potassium 3.5 – 5.2 mEq/L
Sodium 135 – 147 mEq/L

Other
Ferritin  (ng/ml) 13 – 300
Folate  (ng/dl) 3.6 – 20
Glucose, fasting  (mg/dl) 60 – 110
Glucose (2 hours postprandial)  (mg/dl) Up to 140
Hemoglobin A1c <6% of total Hb
AACE Guidelines (2011)
Hemoglobin A1c, % (as a screening test)
≤5.4 – Normal
————————-
5.5-6.4 – High risk/prediabetes; requires screening by glucose criteria
————————-
≥6.5 -Diabetes, confirmed by repeating the test on a different day
=================
In general, therapy should target a A1C level of 6.5% or less for most nonpregnant adults.
Iron  (mcg/dl) 65 – 150
Lactic acid  (meq/L) 0.7 – 2.1
LDH (lactic dehydrogenase) 56 – 194 IU/L

Lipoproteins and triglycerides
Cholesterol, total < 200 mg/dl
HDL cholesterol ≥ 35 mg/dL.  Negative risk factor:  ≥ 60 mg/dL
LDL cholesterol 65 – 180 mg/dl
Triglycerides Normal: < 150 mg/dL.
Borderline-high: 150 to 199 mg/dL
High: 200 to 499 mg/dL
Very High: >499 mg/dL
Osmolality 289 – 308 mOsm/kg
SGOT (AST) < 35 IU/L  (20-48)
SGPT (ALT) <35 IU/L
Testosterone – total (serum) Male: 300 to 1000 ng/dL
Female: < 62 ng/dLALT:
Male:
14-15 yr: 33-585 ng/dL
16-17 yr: 185-886 ng/dL
18-39 yr: 400-1080 ng/dL
40-59 yr: 350-890 ng/dL
> 60 yr: 350-720 ng/dL

Tanner Stage IV: 165-854 ng/dL
Tanner Stage V: 194-783 ng/dL

Thyroid Function tests
Thyroid Function Testing

Thyroid Function Test
Measurement
Normal Range
Total T4 (TT4) bound and free T4 4.5 -11.5 ug/dL
Free T4 (FT4) free T4 0.8 – 1.7 ng/dL (up to 2.7 ng/dL depending on the reference).
Free T4 Index (FT4I) estimate of free T4
FT4I = TT4 x RT3U		 1.0 -4.3 U
Total T3 (TT3) bound and free T3 75 -200 ng/dL
Resin T3 Uptake (RT3U) binding capacity of TBG 25 -35%
TRH TRH 5 -25 mIu/mL
TSH TSH 0.5 – 4.70 µIU/mL

American Association of Clinical Endocrinologists guidelines changed their normal range for TSH to
0.3 – 3.04 mIU/L.
Thyroglobulin Thyroglobulin 5-25 ng/mL
Radioactive Iodine Uptake (RAIU) Distribution of radiolabeled iodine in the thyroid 5 hr – 5 to 15%
24 hr – 15 to 35%

Notes:
Free T4 – much more useful then total T4 (e.g. interested in unbound or active form).  Total T4 not commonly measured. Greatly affected by TBG. 
Free T4 index: indirect measure of free T4. Corrects for high/low values of TBG.
Total T3: not as useful as free T3, however, may be useful in locating problems with TBG, or if looking for problems with peripheral conversion of T4 to T3. 
Resin T3 Uptake: if low, then TBG binding capacity is high. Opposite if high.
TSH: best measure to determine thyroid function. 
Thyroglobulin: nonspecific test that is elevated when the thyroid gland is inflamed or enlarged.
Free T3 2.3-4.2 pg/ml
Total iron binding capacity (TIBC) 250 – 420  mcg/dl
Transferrin > 200 mg/dl
Uric acid    (male) 2.0 – 8.0 mg/dl
                 (female) 2.0 – 7.5 mg/dl

WBC + differential
WBC (cells/ml) 4,500 – 10,000
Segmented neutrophils 54 – 62%
Band forms 3 – 5%  (above 8% indicates left shift)
Basophils 0 – 1   (0 – 0.75%)
Eosinophils 0 – 3   (1 – 3%)
lymphocytes 24 – 44  (25 – 33%)
Monocytes 3 – 6   (3 – 7%)

Absolute Neutrophil Count  (ANC) – Oncology
Equations:
(1) Segs and bands reported as a percentage:
WBC * ((segs / 100) + (bands / 100))(2) Segs and bands reported in total numbers:
WBC * (segs + bands)

Neutrophils (aka polymorphonuclear cells, PMNs, granulocytes, segmented neutrophils,  or segs) fight against infection and represent a subset of the white blood count. Neutropenia by definition is an ANC below 1800/mm3 (some sources use a lower value).

Absolute neutrophil count (ANC) of 1000-1800:
Most patients will be given chemotherapy in this range.
Risk of infection is considered low.

Mild neutropenia – Absolute neutrophil count (ANC) of 500-1000:
Carries with it a moderate risk of infection.

Absolute neutrophil count (ANC) of less than 500:
Severe neutropenia – high risk of infection. Remember that a reduced WBC is known as leukopenia.

The WBC consists of the following (differential):
Lymphocytes: 20-40%
Neutrophils: 50-60%
Basophils: 0.5-2%
Eosinophils: 1-4%
Monocytes: 2-9% (average: 4%).
ANC = Total WBC x (% “Segs” + % “Bands”)
Equivalent to: WBC x ((Segs/100) + (Bands/100))

The ANC refers to the total number of neutrophil granulocytes present in the blood.

Normal value: ≥ 1500 cells/mm3.
Mild neutropenia: ≥1000 – <1500/mm3.
Moderate neutropenia: ≥500 – <1000/mm3.
Severe neutropenia: < 500/mm3.

Reference:
Ayalew Tefferi, MD, ed. Primary Hematology. Totowa, NJ: Humana Press, 2001
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