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Doc: LF_HAND_001 v 1.8 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 D:\841016949.Doc 2 of 16 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.) D:\841016949.Doc 3 of 16 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: D:\841016949.Doc 4 of 16 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: D:\841016949.Doc 5 of 16 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) D:\841016949.Doc 6 of 16 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) D:\841016949.Doc 7 of 16 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 D:\841016949.Doc 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 * * D:\841016949.Doc 9 of 16 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 D:\841016949.Doc 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 10 of 16 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 D:\841016949.Doc 11 of 16 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 D:\841016949.Doc 12 of 16 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 <200mol/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 D:\841016949.Doc 13 of 16 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 D:\841016949.Doc 14 of 16 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 D:\841016949.Doc 15 of 16 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 D:\841016949.Doc _________ <1 month 0.26-1.2 ___ g/l _____ 1-3 months 0.1-0.8 ____ g/l _____ >3months 0.1-0.5 ____ g/l 16 of 16 Chris Hall