Download Table of Available Analyses - NHS Greater Glasgow and Clyde

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DIAGNOSTICS DIRECTORATE
DEPARTMENT OF BIOCHEMISTRY, YORKHILL HOSPITAL
NOTES FOR GUIDANCE OF STAFF USING THE
BIOCHEMICAL SERVICES
NON-METABOLIC INVESTIGATIONS
Laboratory Hours
Weekdays _____________ 08.45-17.00 (Specimens received 08.45-17.00)
Saturday _______________ 08.45-12.00 (Specimens received 08.45-12.00)
Routine Collection
(of non-urgent specimens from wards and out-patient clinics)
Mondays to Friday: ______ 08:00, 10:00, 13:30, 15:00
Saturdays: _____________ 09:00, 10:00
Address
Department of Biochemistry,
Royal Hospital for Sick Children,
Dalnair St,
Glasgow G3 8SJ.
Internal Phone Numbers
Enquiries (Reporting Room) incl. Clinical enquires ____________ 80339
(Outwith normal hours contact BMS (Page 8000) and/or Senior Staff via switchboard)
Urgent requests, add-ons and supplies_______________________ 80341
Medical Consultant Biochemist (Dr. Peter Galloway) __________ 80345
Consultant Clinical Scientist (Dr. John Fyffe) _________________ 80335
Principal Biochemist (Dr. G.B. MacPhee) ___________________ 80344
(For direct access, dial 0141 201 and final 4 digits only)
Nov 2007
NOTE:
A separate document “Specialised
Metabolic Investigation”
gives detailed information and clinical guidance on the investigation and diagnosis of
metabolic disease.
Valid until Jan 2009
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
CONTENTS______________________________________________________ PAGE
General Information
Routine determinations _____________________________________________ 3
Specimens
Urgent Requests
Emergency Services
Responsibility for Requesting
Phlebotomy service
Request forms
Patient Details
Clinical Details
Safety Hazards
Small Volume Samples
Age-Related Reference Ranges ______________________________________ 4
Scope of Out of Hours Service
Pneumatic Tube System
HISS Requesting
Computer Downtime
Drugs of Abuse Screening____________________________________________ 5
General Information on Pre-Analytical Problems _______________________ 6
Clinical Advice and Interpretation
Table of Most Common Analyses
Blood _____________________________________________________________ 7
Urine ____________________________________________________________ 10
Amniotic Fluid, Blood Spot, CSF, Faeces, Stone, Saliva and Sweat ________ 11
Appendix A
A guide to reference ranges _________________________________________ 12
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
General Information
The following information is not comprehensive. Any matter not mentioned can be discussed by contacting the
Biochemistry department on ext. 80339. Metabolic investigations are covered in more detail in a separate
handbook.
Routine Requests:
All specimens for routine tests on in-patients should be prepared for the first collection each day. Routine
specimens received after 15:30 on weekdays (11:30 on Saturday) may not be analysed until the following day.
Specimens:
Heparinised blood is usually suitable - but see accompanying table. All specimens must be manually labelled
with surname, forename, and date of birth +/- hospital number. Ideally do not use addressograph labels on
sample tubes; if used ensure ‘window’ for separating still present. All urine samples should be in a plain
universal container unless table indicates preservative required. Ideally all antibodies and RAST should be
performed on serum. Specimens MUST be placed in a sealed plastic bag with a form in the separate wallet.
Urgent Requests:
Requests considered urgent by clinicians should be notified to ext. 80341. These tests will be performed at any
time during normal working hours and a porter will, if necessary be sent by the laboratory to collect the sample
and appropriate request form. Please use the pneumatic tube transport system wherever possible.
Emergency Services:
Outside normal working hours, the services of a Consultant and BMS are always available. When an emergency
biochemical determination is required, the person requesting the analysis should contact (via the telephone
operator) the BMS staff member on call, to whom details of the request should be given. A request form must
accompany the specimen.
Responsibility for Requesting:
Those requesting tests should be in a position to act on the results directly; or be able to tell the reporting room
or on-call BMS who will be acting on the results.
Phlebotomy Service:
A limited phlebotomy service - staffed by part-time phlebotomists and managed by Nan MacIntosh Schiehallion
Ward - is available to selected wards on Monday to Saturday mornings.
Completing non-HISS request forms:
Any request forms sent to the Department which are non-HISS orders, should contain the following information
at a minimum: hospital, CHI number, hospital number, patient’s surname, forename, Date of Birth, sex, ward,
date and time of sampling, plus clinical details, specimen type and examination required.
Patient Details:
Full details regarding the patient e.g. (Hospital number, CHI number and date of birth) must be given on the
request form to aid computerised accumulation of results. The initials of the phlebotomist / blood collector and
date / time of withdrawal of specimen should be handwritten. For small volume samples, please state priorities
on the request form in handwriting. CHI NUMBER IS ESSENTIAL FOR ALL NON YORKHILL
SAMPLES.
Clinical Details:
Symptoms, working diagnosis are essential because they enable the Biochemist to check result validation and
interpretation. In some instances the laboratory may initiate further tests on the same specimen(s) to assist
diagnosis. Important points might include (for example): fasting status, height and weight (for clearances), time
of last drug dose, gestation.
General Information (contd.)
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Safety Hazards:
Specimens that present specific safety hazards must be clearly identified and submitted in accordance with
established protocols as per the Trust Health and Safety Policy. All staff are required by the Health and Safety
at Work Act to take reasonable care for their own safety and that of other people who may be affected by their
actions. Laboratory work is hazardous and clinical staff are often in a position to warn staff when extra
precautions are necessary for certain samples.(Appendix A)
Age-Related Reference Ranges:
Reference ranges appear where appropriate on the typed reports and HISS results screen. Help with
interpretation is always available. A guide to commonly required analytes appears in Appendix A.
Scope of Out of Hours Service:
The laboratory is conscious of its requirements as a tertiary referral centre. It routinely offers Electrolytes, Urea
and Creatinine, Liver Function Tests, CRP, Gases, Glucose, Lactate, Ammonia, Iron, Urate, Paracetamol,
Salicylate and CSF Protein and Glucose. It can perform a far wider range of tests following discussion on the
clinical nature of the request with either the BMS or senior staff. The collecting of critical samples is
encouraged, particularly in possible metabolic disorders – though where possible samples should be collected
and delivered during normal hours. If the BMS is concerned about the nature of a request, he/she must refer the
request to the senior staff on-call and until then is not expected to perform the test. The out of hours service is
staffed by one BMS at any given point of time so excessive, inappropriate demands have an adverse effect on
the individual and on the quality of service offered to all other users.
Pneumatic Tube Transfer System:
Specimens may be sent to Biochemistry at any time using this system. All urgent requests must be notified to
80341 (within hours) and outwith hours by paging the on-call staff (Page 8000). Specimens must be placed and
sealed within a specimen bag with a HISS request form in the adjoining pocket and then placed in a pod.
Operating instructions and a list of destination codes are attached to each terminal. Care must be taken to ensure
that the door is properly closed (push at the finger sign). The words “Selection OK” must be displayed in the
LCD status window or the pod will not be dispatched. It should be noted that if the door is opened after a pod
has been loaded, the position of the pod in the waiting list will be lost and will be at the end of the queue when it
is replaced in the terminal. The receiving basket must be kept empty and checked regularly as reports etc. may
be sent to you by this route.
Power Failure: In the event of power failure the pneumatic tube should not be used because it takes an hour to
purge itself after restoration of power.
HISS Requesting:
Due to the complex range of tests performed, the HISS system offers over 500 biochemical tests. The following
tables are a summary of the common tests and their salient pre-analytical features. Most tests are performed on
heparinised plasma. Immunological tests however are best performed on serum samples – and in some cases
serum is essential (e.g. TRAB). The F9 function key will list available tests. Note that different specimen types
for the same analyte may have a unique code. For example, the procedure GLU must only be used for Blood
Glucose – GLU.U for Urine Glucose and GLU.C for CSF Glucose.
The system allows user-specific order sets to be created. These can be found entering / in the ‘Category’ field followed by F9. Further details are available from ext. 80339.
HISS Failure - “Downtime Procedures”:
‘Downtime’ packs are available, containing request forms which should be used if the HISS goes down. These
should be completed with full patient and request details. Written reports will be sent to the wards for 2pm and
6pm. Where results are required more urgently, please phone the laboratory (80341). Be aware that the loss of
computing facilities impairs the routine flow of samples and that excessive requests for phoned results will
reduce our ability to analyse all samples quickly.
General Information (contd.)
Laboratory Computer Failure:
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
The Biochemistry Laboratory relies heavily on I.T. systems to improve data transfer and failure of the computer
system can have major effects on the flow of information:
 Manual backup systems will be instituted and special written reports will be sent to the wards.
 Tracking and finding samples and results in the system will be complex and laborious.
 Please keep the requests for urgent results to those required only for true clinical emergencies. These
requests must be made by a Registrar or Consultant.
 Do not send “routine” screens, which could be collected the following day.
Only by approaching the problem in a spirit of co-operation can the laboratories hope to cope with the loss of
I.T. services and still offer a reliable service.
Urine Drugs of Abuse Screening:
This term is a misnomer as the assays look for specific drugs or groups of drugs only. The commonly abused
substances screened for at present are amphetamines (but not ecstasy), opiates, benzodiazepines and
methadone.
Where clinical suspicion is raised, specific requests for ecstasy, barbiturates, buprenorphine, tricyclics,
cannabinoids and alcohol can be performed on urine. This range is limited by the costs involved in more
detailed analysis such as that performed by forensic pathology.
When a urine sample is obtained, please put it into a universal container. The sample may be left at room
temperature, or in the refrigerator, and delivery to the laboratory within normal working hours.
 Freezing the sample causes plasticisers in the universal container to enter the urine and interfere with
analysis.
 Note that organic acids are volatile and must be frozen.
Upon receipt of the specimen, a biochemist will contact the Consultant Paediatrician (or his junior doctor)
involved to discuss whether the analysis should be performed and whether drugs, other than amphetamines,
opiates, benzodiazepines, or methadone should be specifically sought.
If an analysis is urgently required out of hours, please discuss the case with the Consultant on call. He or she
may be able to arrange for emergency analysis on a drug by drug basis - with the proviso that the result of the
screening test performed would need confirming during normal working hours.
Sent out Samples:
Due to the vast array of possible tests, the laboratory keeps a list of all referral centres used which is available in
the reporting office. The identification is added to results being reported for all analysis analysed outwith
Yorkhill Biochemistry
Add on Requests:
The department keeps all non “high risk” samples for 10 days minimum. Requests for add-ons within 12 hours
of receipt should be made to extension 80341. Longer term (< 1 month) should be discussed with the duty
biochemist on extension 80339. Some metabolic samples are available for significantly longer and should be
discussed with a biochemistry consultant.
General Information (contd.)
Pre-analytical Problems:
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
In the Biochemistry Department, quality control and assessment samples are used to check and maintain the
accuracy of the analytical service but it must be remembered that errors can arise before specimens reach the
laboratory
Some Common Sources of Pre-Analytical Error

Incorrect patient identification or details – see protocol

Incorrectly preparation (eg not fasted, not rested) or timing (eg interference from administered drugs,
specimen collected at wrong time for eg therapeutic drugs)

Incorrect labelling in ward or wrong tube used

Specimen collection site inappropriate eg. vein near IV infusion site or capillary from area of poor
peripheral circulation

Difficult specimen withdrawal (eg Haemolysis, upper arm occlusion)

Contaminated syringe or container or inappropriate anticoagulant (especially adding EDTA blood to a
heparin tube)

Delay in transport to laboratory. eg. Potassium, Phosphate

Exposure to warmth or cold - some enzymes and potassium

affected

Exposure to light. __e.g. Bilirubin , Porphyrins

Urine collection - wrong bottle, preservative, wrong time on label, failure to empty bladder completely
Complaints:
In the event of difficulties in obtaining the service expected, please discuss this in the first instance with Dr.
John Fyffe or Dr. Peter Galloway.
There is a user questionnaire on the departmental intranet site and users are encouraged to use it to rate their
perception of the service.
Clinical Advice and interpretation:
During normal laboratory hours the reporting room (ext. 80339) should be contacted for advice and results
interpretation. Out of hours, the hospital switchboard (tel 01412010000) will be able to forward any calls
concerning clinical queries to the on-call consultant.
Table of Analyses
(Blood)
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Analysis
HISS
Code
Required Sample
Notes
(Deliver Within 2 Hours unless
stated)
25-OH Cholecalciferol (Vit. D)
17Alpha-OH Progesterone
A.C.T.H.
Aldosterone
Alkaline Phosphatase
Alpha-1-antitrypsin (Phenotype)
Alpha-Fetoprotein
Aluminium
Amino acids
25HCC
17AOHPP
ACTH
ALD
LFT
AAT
AFP
AL
AMA
(* 1ml heparinised
unless stated)
2 ml heparinised
*
2ml heparinised
2ml heparinised
*
*
*
1.5ml heparinised
*
Ammonia
Amylase
Anti-Tissue Transglutaminase
Antibodies
Anti-nuclear Factor
AMMON
AMYL
AB.TTG
*
*
1 ml plain
AB.ANF
Ascorbic Acid (Plasma)
B2-Microglobulin
Bile Acids
Bilirubin (Total and unconjugated)
Biotinidase
Bromide
Caeruloplasmin
Calcium
Carbamazepine
VITC.P
B2M.P
BAC
BIL
BTDASE
BR
CAE
UE
CAR
1 ml plain or
heparinised
*
*
1 ml plain
*
*
*
*
*
*
Carboxyhaemoglobin
Carnitine
Carotene
Cholesterol
Complement levels
COHB
CATN
CAROTN
CHO
COMP
Copper and Zinc
Cortisol
Creatine Kinase
51Cr EDTA Clearance
C.R.P.
COP
COR
CK
CRC
CRP
Cyclosporin
CYCLOSP
*
2ml heparinised
*
*
2 ml plain or
heparinised
*
*
*
2ml heparinised
0.5 ml Heparinised
blood
1ml EDTA
Cystine (Leucocyte)
CYS.LEU
5ml heparinised
Digoxin
Electrolytes
DGXN
UE
*
*
Ethanol
FK506
ALC
FK506
0.5 ml fluoridated
1 ml EDTA
F.S.H.
Galactose-1-Phosphate
Galactose-1-P-U Transferase
Gamma Glutamyl Transferase
Gases (Capillary)
FSH
GAL1P
GAL1PUT
GGT
GAS
*
3ml heparinised
0.5ml heparinised
*
Heparinised capillary
tube (185 ul)
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Deliver within 30 mins.
See appendix A of metabolic
handbook
Deliver within 30 mins.
Turnaround
(Days)
21
10
28
14
0.2
21
7
7
5
0.2
0.2
28
28
Deliver within 30 mins.
Deliver within 30 mins.
Immediately before or 6-8 hrs post
dose.
21
10
7
0.2
10
7
10
0.2
1
0.2
30
15
0.2
14
Protect from light
7
3
0.2
3
0.2
As per protocol.
At least 12 hrs post-dose. Container
should be full.
12 hr post dose. Monday-Thursday
before 1400.
At least 6 hrs post-dose
Sodium, Potassium, Chloride, CO2,
Urea, Creatinine, Calcium and
Phosphate.
12hrs post dose. Container must be
full
3
60
1
0.2
0.2
4
3
60
3
0.2
0.2
To arrive by 14.30 hrs.
Collected by lab staff. Phone to
arrange.
Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Table of Analyses
(Blood)
Analysis
HISS
Code
Required Sample
Gases (Arterial)
GAS
(* 1ml heparinised
unless stated)
Heparinised syringe
Glucose
Glucose Tolerance Test
Glucose 6-P Dehydrogenase
Growth Hormone
Haemoglobin A1c (HBA1c)
H.C.G.
H.C.G. (tumour marker)
IgF1
Immunoglobulins (IgA,IgG,IgM)
Insulin
Iron / T.I.B.C.
Lactate
GLU
GTT
GPD
HGH
HBA1C
HCG
HCG.T
IGF1
IGS
INS
IRN
LAC
0.5ml fluoridated
0.5ml fluoridated
*
*
0.5ml EDTA
*
*
*
*
2ml heparinised
*
*
Lead
LEAD
Leucocyte Enzymes
CE.W
1ml heparinised or
EDTA
>10ml heparinised
L.H.
Liver Function Tests
LH
LFT
*
*
Magnesium
Methotrexate
Oestradiol
Osmolality
Paracetamol
Parathormone
MAG
MTX
OED
OSM
PARAC
PTH
*
*
2ml heparinised
*
*
2ml
Phenobarbitone
Phenytoin
Phosphate
Porphyrin
PHB
PHY
UE
POR
*
*
*
2ml EDTA
Progesterone
Prolactin
Protein (Total/Albumin)
Pyruvate Kinase
Rapamune / Sirolimus
RAST / Total IgE
PROGST
PRL
LFT
PK
RAPA
RAST
*
*
*
*
1 ml EDTA
2ml plain
Renin
Rheumatoid Factor
Salicylate
Selenium
Sex Hormone Binding Globulin
Testosterone
Theophylline
Thyroid Antibodies
RENIN
AB.RF
SAL
SEL
SHBG
TESTOS
THE
AB.TPO
1.5ml EDTA
*
*
*
*
*
*
1ml plain or
heparinised
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Turnaround
Notes
(Deliver Within 2 Hours unless
stated)
Collected by ward staff. Deliver
within 1/2 hour.
(Days)
0.2
0.2
1
3
3
3
2
7
7
1
10
0.2
0.2
Glucose 45g/m2 in children.
Deliver within 30 mins.
Iron as emergency only
See appendix A of metabolic
handbook
10
Deliver by 14.30hrs. Discuss with
reporting room.
5-28
3
0.2
Bilirubin,Total Protein, Albumin,
Alk Phos, AST,ALT.
8 of 16
0.2
1
10
1
0.2
7
Refer to treatment chart.
Consult HISS for current specimen
requirements
Discuss with Lab. Protect from
light. Full screen requires blood,
urine & faeces.
Record LMP.
State requirements in additional info
field.
100ul per test.
Deliver within 30 mins
0.2
0.2
0.2
21
7
2
0.2
3
4
In House 7
Sent Out 30
For autoimmune Hypothyroidism.
Chris Hall
21
15
0.2
10
7
15
0.2
7
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Table of Analyses
(Blood)
Analysis
HISS
Code
Required Sample
Notes
(Deliver Within 2 Hours unless
stated)
Thyroid Function Tests
(Free T4, TSH)
TRAB
TFT
(* 1ml heparinised
unless stated)
1.5 ml heparinised
AB.TR
1ml PLAIN ONLY
Triglycerides
Urate
Valproate
Vitamin A
Vitamin B screen
Vitamin E
Zinc (with Copper)
TRG
URA
VAL
VITA
VITB
VITE
COP
*
*
*
*
2 ml Lithium Heparin
*
*
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For investigation of Graves’
Disease.
Fasting / pre feed.
Turnaround
(Days)
3
28
0.2
0.2
5
10
Protect from light
10
7
Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Table of Analyses
(Urine)
Analysis
HISS Code
NOTES
Turn-around
(Plain container (10-25mls) suitable unless stated)
(Days)
Albumin
ALB.U
Random/overnight specimen
3
Albumin Excretion Rate
AER
Accurately timed collection.
3
Amino Acids
AMA.U
Random specimen
5
B-2 Microglobulin
B2M.U
Random specimen
21
Catecholamine Screen
FULLC.U
Calcium / Creatinine Ratio
CAL.U
Creatinine Clearance
CCL
Drug Screen
14
2
DRUGS
Random plain specimen; or 24hr collection in acid
containing bottle.
Accurately timed collection and plasma sample.
Height and weight for surface area
Discuss with lab. in morning. See note above
10
Electrolyte
ELECT.U
Random specimen
1
Glucose
GLU.U
Random specimen
2
HMMA (VMA)
PHE
4
HVA
PHE
5-Hydroxy Indole Acetic Acid
5HIAA
24hr Acid container. Deliver promptly. Within 1/2
hour. OR fresh Random sample, deliver
immediately, acidified in lab on receipt
24hr Acid container. Deliver promptly. Within 1/2
hour. OR fresh Random sample, deliver
immediately, acidified in lab on receipt
Acid container. Deliver promptly. Within 1/2 hour.
Laxative Screen
LXSCRN
Metabolic Bone Screen
MBS
Osmolality
OSM.U
Phosphate
PHOS.U
Acid container or acidified on receipt.
1
Porphyrin
POR
Discuss with Lab. Protect from light. Full screen requires
blood, urine & faeces.
21
Protein / Creatinine Ratio
PRO.U
Sugar Chromatography
SUG.U
Random specimen
14
Urate
URA.U
24hr collection or random specimen.
1
Performed on all urine specimens received.
1
Random specimen
1
Urea + Creatinine
Urobilinogen
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UROBIL
3
4
21
21
(+/- Liquid faeces for Osmolality/ Magnesium). (20
mls urine).
Calcium, Phosphate, Creatinine, PEI and TRP.
Concurrent plasma required.
2
1
2
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Table of Analyses
(Miscellaneous fluids)
Analysis
Hiss Code
Required Sample
Turnaround
Notes
(Days)
Bloodspot
17-OH Progesterone
17AOHPB
Bloodspot card
Immunoreactive Trypsin
IRT
Bloodspot card
90
4
Sent to Medical Genetics
CSF
Glucose
GLU.C
0.5ml fluoridated
0.2
Protein
PRO.C
0.5ml plain
0.2
Lactate
LAC.C
0.5ml plain
0.2
Faeces
Alpha-1-antitrypsin
AAT.F
plain universal
Random specimen
10
Chymotrypsin
CHYM
plain universal
Random specimen
7
Fat
FAT
5
Fat Microscopy
FATMIC
plain universal
Container from lab. 3-5 day
collection.
Random specimen
Occult Blood
FOB
Random specimen
3
pH Reducing Substances
REDS
Smeared on Hemascreen cards
plain universal
5
Porphyrin
POR
plain universal
Random specimen Ensure
liquid portion is submitted.
Random specimen. Discuss
7
21
with Lab. Protect from light.
Full screen requires blood,
urine & faeces.
Saliva
Cortisol
COR.F
60
2ml in plain universal
Stone
Stone
STONE
28
plain universal
Sweat
Sweat Test
SWT
1
Arranged via Respiratory
Lab.
Prepared by Peter Galloway
Medical Consultant
November, 2007
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Appendix A:
A GUIDE TO CLINICAL CHEMISTRY VALUES
The values given are a guide to the normal range. For simplicity, exact data for tight age ranges are not given
although are produced on reports. When interpreting an analyte, the pathophysiological processes need to be
considered; in particular inflammation and acute phase response, such that analytes increase (e.g. copper, -1antitrypsin) or decrease (e.g. iron, zinc). Those where large differences occur when compared to adult
reference ranges are highlighted.
Blood
Acid-base [H+] __________ 38-45 nmol/l
pH 7.35-7.42
(Neonates especially premature
pH 7.2 – 7.5)
pCO2 _________________ 4.5-6.0 kPa
(32-45 mmHg)
pO2 __________________ 11-14 kPa
(78-105 mmHg)
-
Bicarbonate [HCO3 ]_____ 22-27 mmol/l
(Preterm/<1 month ______ 17-25 mmol/l)
Base excess ____________ -4 to +3 mmol/l
Plasma: electrolytes and minerals
Sodium________________
135-145 ____ mmol/l
Potassium______________ Newborns
4.3-7.0 _____ mmol/l
______________________ Older Children
3.5-5.0 _____ mmol/l
Chloride _______________
95-105 _____ mmol/l
Calcium _______________ Preterm
1.5-2.5 _____ mmol/l
______________________ First year
2.25-2.75 ___ mmol/l
______________________ Children
2.25-2.70 ___ mmol/l
Phosphate (lower in breast fed) Preterm
1.4-3.0 ____ mmol/l
______________________ First year
1.2-2.5 _____ mmol/l
______________________ Children
0.9-1.8 ____ mmol/l
Magnesium ____________ Children
0.7-1.0 ____ mmol/l
Copper ________________ Birth to 4 weeks
5.0-12.0 ____ mol/l
______________________ 17-24 weeks
5.0-17.0 ____ mol/l
______________________ 25-52 weeks
8.0-21.0 ____ mol/l
______________________ >1 year
12.0-24.0 ___ mol/l
Zinc __________________
9.0-18.0 ____ mol/l
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Iron __________________ < 3 years
5.0-30.0 ____ mol/l
______________________ >3 years
15.0-45.0 ___ mol/l
Ceruloplasmin __________ Newborn
0.05-0.26 ___ g/l
______________________ Children
0.25-0.45 ___ g/l
Plasma: other analytes
Acetoacetate (incl. acetone)
<30 _______ mg/l
AFP __________________ < 6 months
(Very high levels especially if premature – rapid fall over a week expected)
______________________ > 6 months
< 10 _______ U/ml
Alkaline phosphatase _____ Newborn
<800 ______ U/l
______________________ Children
100-500 ____ U/l
Alanine aminotransferase (ALT) Infants
10-60 ______ U/l
______________________ Children
10-40 ______ U/l
Ammonia ______________ 1 – 4 months
<60 _______ mol/l
______________________ > 4 months
20-45 ______ mol/l
______________________ Term neonate
<100 ______ mol/l
______________________ Preterm neonate
<180 ______ mol/l
Amylase _______________
<200 ______ U/l
Ascorbic acid ___________
15-90 ______ mol/l
Aspartate aminotransferase (AST) <4 weeks
40-120 _____ U/l
______________________ >4 weeks
10-50 ______ U/l
Bilirubin total___________ Cord blood
<50 _______ mol/l
______________________ Term Day1
<100 ______ mol/l
______________________ (pre-term greater)
______________________ Term days 2 -5
<200mol/l
______________________ >1 month
<20 _______ mol/l
Cholesterol_____________ Cord blood
1.0-3.0 _____ mmol/l
______________________ Newborn
2.0-4.8 _____ mmol/l
______________________ Infants and children 2.8-5.7 _____ mmol.l
Cortisol _______________ Neonates use synacthen test
______________________ Diurnal variation after 10 weeks post-term
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Creatine kinase (CK) _____ Newborn
<600 ______ U/l
______________________ Infants
<300 ______ U/l
______________________ Children
<200 ______ U/l
Creatinine
40-100 _____ mol/l
_______ Newborn
_______ Reflects Maternal level and declines over first month
______________________ 1-2 years
20-45 ______ mol/l
______________________ 7-9 years
30-65 ______ mol/l
Creatinine clearance _____ 0-3 months
30-70 ______ ml/min/m2
______________________ 12-24 months
50-100 _____ ml/min/m2
__________________________________
90-120 _____ ml/min/m2
Older children
C-reactive protein (CRP) __
<7 ________ mg/l
Follicle-stimulating hormone (FSH)
<3 ________ U/l
Gammaglutamyltransferase (GT) Newborn
<200 ______ U/l
______________________ 1-6 months
<120 ______ U/l
______________________ >6 months
<40 _______ U/l
Glucose _______________ Newborn (<48h)
2.2-5.0 _____ mmol/l
______________________ Infants and children 3.0-5.0 _____ mmol/l
Glycosated haemoglobin __
4.1-6.1 _____ %
______________________
(DCCT aligned)
17 OH Progesterone ____ >4 days
<13 nmol/l
______________________
>60 confirms CAH
Insulin ________________ Fasting
<13 _______ mU/l
______________________ (Always measure glucose)
Lactate (blood) _________ Newborn
<3.0 _______ mmol/l
______________________ Infants and Children 1.0-1.8 _____ mmol/l
______________________ Adult
0.7-2.1
Lactate dehydrogenase (LDH) <1 month
550-2100 ___ U/L
______________________ 1-12 months
400-1200 ___ U/l
______________________ 1-6 years
470-920 ____ U/l
______________________ 6-9 years
420-750 ____ U/l
______________________ >9 years
300-500 ____ U/l
Lipids – Triglycerides ____ Fasting
0.3-1.5 ____ mmol/l
Luteinising hormone (LH) _
<1.9 _______ U/l
Osmolality _____________
275-295 ____ mmol/kg
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Protein – Total __________ Newborn
45-70 ______ g/l
______________________ Infants
50-70 ______ g/l
______________________ Children
60-80 ______ g/l
- Albumin______________ Newborn
25-35 ______ g/l
______________________ Infants and Children 35-50 ______ g/l
Immunoglobulins (g/l)
IgG
IgA
IgM
Newborn
2.8-6.8
0-0.5
0-0.7
Infants
3.0-10.0
0.2-1.3
0.3-1.5
Children >3 years
5.0-15.0
0.4-2.5
0.4-1.8
Pyruvate (blood) ________
50-80 ______ mol/l
______________________ (Ratio Lactate/Pyruvate > 20 abnormal)
Free Thyroxine (T4) ______ <1 month
6-30 _______ pmol/l
______________________ >1 month
9-26 _______ pmol/l
Thyroid-stimulating hormone (TSH) 1-30 days
0.5-16 _____ mU/l
______________________ 1 month – 5 years
0.5-8 ______ mU/l
______________________ 5 years -
0.4-6 ______ mU/l
Tri-iodthyronine(T3) _____ Newborn
0.5-6.0 _____ nmol/l
______________________ Infants and children 0.9-2.8 _____ nmol/l
Urea __________________
2.5-6.0 _____ mmol/l
______________________ (Neonates often 1.0-5.0 mmol/l)
Uric acid ______________ <9 years
0.11-0.3 ____ mmol/l
Vitamin A _____________ Preterm
0.09.1.7 ____ mol/l
______________________ <1year
0.5-1.5 _____ mol/l
______________________ 1 year-6 years
0.7-1.7 _____ mol/l
______________________ Older
0.9-2.5 _____ mol/l
25 Hydroxyvitamin D ____
>15 _______ nmol/l
______________________ Ideally > 25 + <100 nmol/l
Vitamin E (-tocopherol) _ <2month
2-8 ________ mol/l
______________________ 1-6 months
5-14 _______ mol/l
______________________ 2 years
13-24 ______ mol/l
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Chris Hall
Royal Hospital for Children, Glasgow
Department of Biochemistry
Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations
Urine
The kidney develops rapidly over the first year of life. Its handling of many filtered compounds is substantially
different,
e.g.
Urine calcium
Urine Phosphate
Birth – 6 months
< 2.4 mmol/mmol Creatinine
6-12 months
0.09 – 2.2 mmol/mmol Creatinine,
1-3 years
0.06 – 1.4 mmol/mmol Creatinine,
3-5 years
0.05-1.1 mmol/mmol Creatinine,
7 years to adult
0.04-0.7 mmol/mmol Creatinine
7-12 months
1.2-19 mmol/mmol Creatinine
1-3 years
1.2-12 mmol/mmol Creatinine
3-6 years
1.2-8 mmol/mmol Creatinine
Adult_
0.8-2.7 mmol/mmol Creatinine
CSF
Protein
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_________ <1 month
0.26-1.2 ___ g/l
_____ 1-3 months
0.1-0.8 ____ g/l
_____ >3months
0.1-0.5 ____ g/l
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Chris Hall