WHAT IS BLOOD TESTING ? A to Z of BLOOD TESTING - PART TWO : ( Source - Wikipedia )

    part - 2 
       
     Acid-base and blood gases[edit]

Further information: Acid-base homeostasis

Further information: Arterial blood gas

If arterial/venous is not specified for an acid-base or blood gas value, then it generally refers to arterial, and not venous which otherwise is standard for other blood tests.

Acid-base and blood gases are among the few blood constituents that exhibit substantial difference between arterial and venous values.^[5] Still, pH, bicarbonate and base excess show a high level of inter-method reliability between arterial and venous tests, so arterial and venous values are roughly equivalent for these.^[38]

Test	Arterial/Venous	Lower limit	Upper limit	Unit
pH	Arterial	7.34,[10] 7.35[9]	7.44,[10] 7.45[9]
	Venous	7.31[39]	7.41[39]
[H+]	Arterial	36[9]	44[9]	nmol/L
		3.6[40]	4.4[40]	ng/dL
Base excess	Arterial & venous[39]	-3[39]	+3[39]	mEq/L
oxygen partial pressure (pO2)	Arterial pO2	10,[9] 11[41]	13,[41] 14[9]	kPa
		75,[9][10] 83[18]	100,[10] 105[9]	mmHg or torr
	Venous	4.0[41]	5.3[41]	kPa
		30[39]	40[39]	mmHg or torr
Oxygen saturation	Arterial	94,[39] 95,[13] 96[18]	100[13][18]	%
	Venous	Approximately 75[13]
Carbon dioxide partial pressure (PCO2)	Arterial PaCO2	4.4,[9] 4.7[41]	5.9,[9] 6.0[41]	kPa
		33,[9] 35[10]	44,[9] 45[10]	mmHg or torr
	Venous		5.5,[41] 6.8[41]	kPa
		41[39]	51[39]	mmHg or torr
Absolute content of carbon dioxide (CO2)	Arterial	23[39]	30[39]	mmol/L
		100[42]	132[42]	mg/dL
Bicarbonate (HCO3-)	Arterial & venous	18[18]	23[18]	mmol/L
		110[43]	140[43]	mg/dL
Standard bicarbonate (SBCe)	Arterial & venous	21, 22[9]	27, 28[9]	mmol/L or mEq/L[9]
		134[43]	170[43]	mg/dL

Liver function[edit]

Further information: Liver function tests

Test	Patient type	Lower limit	Upper limit	Unit	Comments
Total Protein		60,[9] 63[10]	78,[9] 82,[10] 84[18]	g/L	see hypoproteinemia
Albumin		35[9][44]	48,[10] 55[9]	g/L	see hypoalbuminemia
		3.5[10]	4.8,[10] 5.5[9]	U/L
		540[45]	740[45]	μmol/L
Globulins		23[9]	35[9]	g/L
Total Bilirubin		1.7,[46] 2,[9] 3.4,[46] 5[4]	17,[9][46] 22,[46] 25[4]	μmol/L
		0.1,[9] 0.2,[10] 0.29[47]	1.0,[9][18] 1.3,[10] 1.4[47]	mg/dL
Direct/Conjugated Bilirubin		0.0[9] or N/A[4]	5,[9] 7[4][46]	μmol/L
		0[9][10]	0.3,[9][10] 0.4[18]	mg/dL
Alanine transaminase (ALT/ALAT[4])		5,[48] 7,[10] 8[9]	20,[9] 21,[13] 56[10]	U/L	Also called serum glutamic pyruvic transaminase (SGPT)
	Female	0.15[4]	0.75[4]	µkat/L
	Male	0.15[4]	1.1[4]
Aspartate transaminase (AST/ASAT[4])	Female	6[49]	34[49]	IU/L	Also called serum glutamic oxaloacetic transaminase (SGOT)
		0.25[4]	0.60[4]	µkat/L
	Male	8[49]	40[49]	IU/L
		0.25[4]	0.75[4]	µkat/L
Alkaline phosphatase (ALP)	Female	42[48]	98[48]	U/L
	Male	53[48]	128[48]
	(Enzyme activity)	0.6[4]	1.8[4]	µkat/L
Gamma glutamyl transferase (GGT)		5,[48] 8[10]	40,[48] 78[10]	U/L
	Women		0.63[50]	µkat/L
	Men		0.92[50]	µkat/L

Cardiac tests[edit]

Test	Patient type	Lower limit	Upper limit	Unit	Comments
Creatine kinase (CK)	male	24,[51] 38,[10] 60[48]	174,[18] 320[48]	U/L or ng/mL
		0.42[52]	1.5[52]	µkat/L
	female	24,[51] 38,[10] 96[18]	140,[18] 200[48]	U/L or ng/mL
		0.17[52]	1.17[52]	µkat/L
CK-MB		0	3,[10] 3.8,[4] 5[48]	ng/mL or μg/L[4]
Myoglobin	Female	1[53]	66[53]	ng/mL or µg/L
	Male	17[53]	106[53]

Brain natriuretic peptide (BNP) -more detailed ranges in BNP article
Interpretation	Range / Cutoff
Congestive heart failure unlikely	< 100 pg/mL[54][55]
"Gray zone"	100-500 pg/mL[54][55]
Congestive heart failure likely	>500 pg/mL[54][55]

NT-proBNP -more detailed ranges in NT-proBNP article
Interpretation	Age	Cutoff
Congestive heart failure likely	< 75years	> 125 pg/mL[52]
	>75 years	>450pg/mL[52]

Lipids[edit]

Further information: Blood lipids

Test	Patient type	Lower limit	Upper limit	Unit	Therapeutic target
Triglycerides	10 – 39 years	54[18]	110[18]	mg/dL	< 100 mg/dL[56] or 1.1[56] mmol/L
		0.61[57]	1.2[57]	mmol/L
	40 – 59 years	70[18]	150[18]	mg/dL
		0.77[57]	1.7[57]	mmol/L
	> 60 years	80[18]	150[18]	mg/dL
		0.9[57]	1.7[57]	mmol/L
Total cholesterol		3.0,[58] 3.6[9][58]	5.0,[4][59] 6.5[9]	mmol/L	< 3.9[56]
		120,[10] 140[9]	200,[10] 250[9]	mg/dL	< 150[56]
HDL cholesterol	female	1.0,[60] 1.2,[4] 1.3[58]	2.2[60]	mmol/L	> 1.0[60] or 1.6[58]  mmol/L > 40[61] or 60[62] mg/dL
		40,[61] 50[63]	86[61]	mg/dL
HDL cholesterol	male	0.9[4][60]	2.0[60]	mmol/L
		35[61]	80[61]	mg/dL
LDL cholesterol(Not valid when triglycerides >5.0 mmol/L)		2.0,[60] 2.4[59]	3.0,[4][59] 3.4[60]	mmol/L	< 2.5[60]
		80,[61] 94[61]	120,[61] 130[61]	mg/dL	< 100[61]
LDL/HDL quotient		n/a	5[4]	(unitless)

Tumour markers[edit]

Further information: Tumour markers

Test	Cutoff	Unit	Comments
Alpha fetoprotein (AFP)	44[10]	ng/mL or µg/L	Hepatocellular carcinoma or testicular cancer
Beta Human chorionic gonadotrophin (bHCG)	5[10]	IU/l or mU/ml	in male and non-pregnant female
CA19-9	40[10]	U/ml	Pancreatic cancer
CA-125	30,[64] 35[65]	kU/L or U/mL
Carcinoembryonic antigen (CEA) non-smokers at 50 years	3.4,[4] 3.6[66]	μg/l
Carcinoembryonic antigen (CEA) non-smokers at 70 years	4.1[66]	μg/l
Carcinoembryonic antigen (CEA) - smokers	5[67]	μg/l
Prostate specific antigen (PSA)	2.5,[4] 4[10]	μg/L[4][10] or ng/mL[18]	below age 45 <2.5 μg/L
PAP	3[18]	units/dL (Bodansky units)
Calcitonin -more detailed cutoffs in Calcitonin article	5,[68] 15[68]	ng/L or pg/mL	Cutoff against medullary thyroid cancer[68]

Endocrinology[edit]

Thyroid hormones[edit]

Further information: Thyroid function tests

Test	Patient type	Lower limit	Upper limit	Unit
Thyroid stimulating hormone (TSH or thyrotropin)	Adults - standard range	0.3,[4] 0.4,[10] 0.5,[18] 0.6[69]	4.0,[4] 4.5,[10] 6.0[18]	mIU/L or μIU/mL
	Adults - optimal range	0.3,[70] 0.5[71]	2.0,[71] 3.0[70]	mIU/L or μIU/mL
	Infants	1.3[72]	19[72]	mIU/L or μIU/mL
Free thyroxine (FT4) -more detailed ranges in Thyroid function tests article	Normal adult	0.7,[73] 0.8[10]	1.4,[73] 1.5,[10] 1.8[74]	ng/dL
		9,[4][75] 10,[76] 12[77]	18,[4][75] 23[77]	pmol/L
	Child/Adolescent 31 d - 18 y	0.8[73]	2.0[73]	ng/dL
		10[75]	26[75]	pmol/L
	Pregnant	0.5[73]	1.0[73]	ng/dL
		6.5[75]	13[75]	pmol/L
Total thyroxine		4,[76] 5.5[10]	11,[76] 12.3[10]	μg/dL
		60[76][77]	140,[76] 160[77]	nmol/L
Free triiodothyronine (FT3)	Normal adult	0.2[76]	0.5[76]	ng/dL
		3.1[78]	7.7[78]	pmol/L
	Children 2-16 y	0.1[79]	0.6[79]	ng/dL
		1.5[78]	9.2[78]	pmol/L
Total triiodothyronine		60,[10] 75[76]	175,[76] 181[10]	ng/dL
		0.9,[4] 1.1[76]	2.5,[4] 2.7[76]	nmol/L
Thyroxine-binding globulin (TBG)		12[10]	30[10]	mg/L
Thyroglobulin (Tg)		1.5[76]	30[76]	pmol/L
		1[76]	20[76]	μg/L

Sex hormones[edit]

Further information: Sex steroid

Levels of estradiol (the main estrogen),progesterone, luteinizing hormone and follicle-stimulating hormoneduring the menstrual cycle.

The diagrams at right take inter-cycle and inter-woman variability into account in displaying reference ranges for estradiol, progesterone, FSH andLH.

Test	Patient type	Lower limit	Upper limit	Unit
Dihydrotestosterone	adult male	30[80]	85[80]	ng/dL
Testosterone	Male, overall	8,[81] 10[82]	27,[81] 35[82]	nmol/L
		230,[83] 300[84]	780[83] - 1000[84]	ng/dL
	Male < 50 years	10[4]	45[4]	nmol/L
		290[83]	1300[83]	ng/dL
	Male > 50 years	6.2[4]	26[4]	nmol/L
		180[83]	740[83]	ng/dL
	Female	0.7[82]	2.8[82] - 3.0[4]	nmol/L
		20[84]	80[84] - 85[83]	ng/dL
17-Hydroxyprogesterone	male	0.06[18]	3.0[18]	mg/L
		0.18[85]	9.1[85]	µmol/l
	Female (Follicular phase)	0.2[18]	1.0[18]	mg/L
		0.6[85]	3.0[85]	µmol/l
Follicle-stimulating hormone (FSH) -more detailed menstrual cycle ranges in separate diagram	Prepubertal	<1[86]	3[86]	IU/L
	Adult male	1[86]	8[86]
	Adult female (follicular and luteal phase)	1[86]	11[86]
	Adult female (Ovulation)	6[86] 95% PI (standard)	26[86] 95% PI)
		5[87] 90% PI (used in diagram)	15[87] (90% PI)
	Post-menopausal female	30[86]	118[86]
Luteinizing hormone (LH) -more detailed menstrual cycle ranges in separate diagram	Female, peak	20[87] 90% PI (used in diagram)	75[87] (90% PI)	IU/L
	Female, post-menopausal	15[88]	60[88]
	Male aged 18+	2[89]	9[89]
Estradiol (an estrogen) -more detailed ranges in estradiol article	Adult male	50[90]	200[90]	pmol/L
		14[91]	55[91]	pg/mL
	Adult female (day 5 of follicular phase, and luteal phase)	70[90]	500,[90] 600[90]	pmol/L
		19[91]	140,[91] 160[91]	pg/mL
	Adult female - free (not protein bound)	0.5[92]	9[92]	pg/mL
		1.7[92]	33[92]	pmol/L
	Post-menopausal female	N/A[90]	< 130[90]	pmol/L
		N/A[91]	< 35[91]	pg/mL
Progesterone -more detailed ranges in Progesterone article	Female in mid-luteal phase (day 21-23)	17,[87] 35[93]	92[93]	nmol/L
		6,[87] 11[94]	29[94]	ng/mL
Androstenedione	Adult male and female	60[88]	270[88]	ng/dL
	Post-menopausal female		< 180[88]
	Prepubertal		< 60[88]
Dehydroepiandrosterone sulfate -more detailed ranges in DHEA-S article	Adult male and female	30[95]	400[95]	µg/dL
SHBG -more detailed ranges in SHBG article	Adult female	40[96]	120[96]	nmol/L
	Adult male	20[96]	60[96]
Anti-Müllerian hormone (AMH) -more detailed ranges in AMH article	13–45 years	0.7[97]	20[97]	ng/mL
		5[98]	140[98]	pmol/l

Other hormones[edit]

Further information: Hormones

Test	Patient type	Lower limit	Upper limit	Unit
Adrenocorticotropic hormone (ACTH)		4.4[99]	18,[100] 22[99]	pmol/L
		20[10]	80,[101] 100[10]	pg/mL
Cortisol	09:00 am	140[102]	700[102]	nmol/L
		5[103]	25[103]	μg/dL
	Midnight	80[102]	350[102]	nmol/L
		2.9[103]	13[103]	μg/dL
Growth hormone (fasting)		0	5[9]	ng/mL
Growth hormone (arginine stimulation)		7[9]	n/a	ng/mL
IGF-1 -more detailed ranges in IGF-1 article	Female, 20 yrs	110[104]	420[104]	ng/mL
	Female, 75 yrs	55[104]	220[104]
	Male, 20 yrs	160[104]	390[104]
	Male, 75 yrs	48[104]	200[104]
Prolactin -more detailed ranges in Prolactin article	Female	71,[105] 105[105]	348,[105] 548[105]	mIU/L
		3.4,[105] 3.9[105]	16.4,[105] 20.3[105]	µg/L
	Male	58,[105] 89[105]	277,[105] 365[105]	mIU/L
		2.7,[105] 3.3[105]	13.0,[105] 13.5[105]	µg/L
Parathyroid hormone (PTH)		10,[106] 17[107]	65,[106] 70[107]	pg/mL
		1.1,[4] 1.8[108]	6.9,[4] 7.5[108]	pmol/L
25-hydroxycholecalciferol (a vitamin D) -Standard reference range		8,[18][109] 9[109]	40,[109] 80[18]	ng/mL
		20,[110] 23[111]	95,[111] 150[110]	nmol/L
25-hydroxycholecalciferol -Therapeutic target range		30,[112] 40[113]	65,[113] 100[112]	ng/mL
		85,[56] 100[113]	120,[56] 160[113]	nmol/L
Plasma renin activity		0.29,[114] 1.9[115]	3.7[114][115]	ng/(mL*hour)
		3.3,[116] 21[117]	41[116][117]	mcU/mL
Aldosterone -more detailed ranges in Aldosterone article	Adult		19,[116] 34.0[116]	ng/dL
			530,[118] 940[118]	pmol/L
Aldosterone-to-renin ratio -more detailed ranges in Aldosterone/renin ratio article	Adult		13.1,[119] 35.0[119]	ng/dl per ng/(mL·h)
			360,[119] 970[119]	pmol/liter per µg/(L·h)

Vitamins[edit]

Also including the vitamin B₁₂)-related amino acid homocysteine.

Test	Patient type	Standard range		Unit	Optimal range
		Lower limit	Upper limit		Lower limit	Upper limit
Vitamin A		30[18]	65[18]	µg/dL
Vitamin B9 (Folic acid/Folate) - Serum	Age > 1year	3.0[120]	16[120]	ng/mL or μg/L	5[121]
		6.8[122]	36[122]	nmol/l	11[122]
Vitamin B9 (Folic acid/Folate) - Red blood cells		200[120]	600[120]	ng/mL or μg/L
		450[122]	1400[122]	nmol/L
	Pregnant			ng/mL or μg/L	400[120]
				nmol/L	900[120]
Vitamin B12 (Cobalamin)		130,[123] 160[124]	700,[123] 950[124]	ng/L
		100,[125] 120[4]	520,[125] 700[4]	pmol/L
Homocysteine -more detailed ranges in Homocysteine article		3.3,[126] 5.9[126]	7.2,[126] 15.3[126]	μmol/L		6.3[56]
		45,[127] 80[127]	100,[127] 210[127]	μg/dL		85[56]
Vitamin C (Ascorbic acid)		0.4[18]	1.5[18]	mg/dL	0.9[56]
		23[128]	85[128]	μmol/L	50[56]
25-hydroxycholecalciferol (a vitamin D)		8,[18][109] 9[109]	40,[109] 80[18]	ng/mL	30,[112] 40[113]	65,[113] 100[112]
		20,[110] 23[111]	95,[111] 150[110]	nmol/L	85,[56] 100[113]	120,[56] 160[113]
Vitamin E				μmol/L	28[56]
				mg/dL	1.2[56]

Toxins[edit]

Test	Limit type	Limit	Unit
Lead	Optimal health range	< 20[13] or 40[18]	µg/dL
Blood ethanol content	Limit for drunk driving	0,[129] 0.2,[129] 0.8[129]	‰ or g/L
		17.4[130]	mmol/L

Hematology[edit]

Red blood cells[edit]

These values (except Hemoglobin in plasma) are for total blood and not only blood plasma.

Test	Patient	Lower limit	Upper limit	Unit	Comments
Hemoglobin (Hb)	male	2.0,[131] 2.1[9][132]	2.5,[131] 2.7[9][132]	mmol/L	Higher in neonates, lower in children.
		130,[4] 132,[10] 135[9]	162,[10] 170,[4] 175[9]	g/L
	female	1.8,[131] 1.9[9][132]	2.3,[131] 2.5[9][131][132]	mmol/L	Sex difference negligible until adulthood.
		120[4][9][10]	150,[4] 152,[10] 160[9][18]	g/L
Hemoglobin subunits (sometimes displayed simply as "Hemoglobin")	male	8.0,[133] 8.4[133]	10.0,[133] 10.8[133]	mmol/L	4 per hemoglobin molecule
	female	7.2,[133] 7.6[133]	9.2,[133] 10.0[133]
Hemoglobin in plasma		0.16[9]	0.62[9]	μmol/L	Normally diminutive compared with inside red blood cells
		1	4	mg/dL
Glycosylated hemoglobin (HbA1c)	< 50 years	3.6[4]	5.0[4]	% of Hb
	> 50 years	3.9[4]	5.3[4]
Haptoglobin	< 50 years	0.35[4]	1.9[4]	g/L
	> 50 years	0.47[4]	2.1[4]
Hematocrit (Hct)	male	0.39,[4] 0.4,[10] 0.41,[9]0.45[18]	0.50,[4] 0.52,[10] 0.53,[9]0.62[18]
	female	0.35,[4] 0.36,[9]0.37[10][18]	0.46,[4][9][10] 0.48[18]
	Child	0.31[10]	0.43[10]
Mean cell volume (MCV)	Male	76,[18] 82[10]	100,[18] 102[10]	fL	Cells are larger in neonates, though smaller in other children.
	Female	78[10]	101[10]	fL
Red blood cell distribution width (RDW)		11.5[10]	14.5[10]	%
Mean cell hemoglobin (MCH)		0.39[9]	0.54[9]	fmol/cell
		25,[9] 27[4][18]	32,[18] 33,[4] 35[9]	pg/cell
Mean corpuscular hemoglobin concentration (MCHC)		31,[10] 32[4][18]	35,[10] 36[4][18]	g/dL or %[note 1]
		4.8,[134] 5.0[134]	5.4,[134] 5.6[134]	mmol/L
Erythrocytes/Red blood cells (RBC)	male	4.2,[18] 4.3[4][9][10]	5.7,[4] 5.9,[9] 6.2,[10]6.9[18]	x1012/L or mln/mm3
	Female	3.5,[9] 3.8,[10] 3.9[4]	5.1,[4] 5.5[9][10]
	Infant/Child	3.8[10]	5.5[10]
Reticulocytes	Adult	26[4]	130[4]	x109/L
	Adult	0.5[9][10]	1.5[9][10]	% of RBC
	Newborn	1.1[10]	4.5[10]	% of RBC
	Infant	0.5[10]	3.1[10]	% of RBC

White blood cells[edit]

These values are for total blood and not only blood plasma.

Test	Patient type	Lower limit	Upper limit	Unit
White Blood Cell Count (WBC)	Adult	3.5,[4] 3.9,[135] 4.1,[10] 4.5[9]	9.0,[4] 10.0,[135] 10.9,[10] 11[9]	·                   x109/L ·                   x103/mm3 or ·                   x103/μL
	Newborn	9[136]	30[136]
	1 year old	6[136]	18[136]
Neutrophil granulocytes (A.K.A. grans, polys, PMNs, or segs)	Adult	1.3,[4] 1.8,[135] 2[136]	5.4,[4] 7,[135] 8[136]	x109/L
		45-54[9]	62,[9] 74	% of WBC
	Newborn	6[136]	26[136]	x109/L
Neutrophilic band forms	Adult		0.7[136]	x109/L
		3[9]	5[9]	% of WBC
Lymphocytes	Adult	0.7,[4] 1.0[135][136]	3.5,[135] 3.9,[4] 4.8[136]	x109/L
		16-25[9]	33,[9] 45	% of WBC
	Newborn	2[136]	11[136]	x109/L
Monocytes	Adult	0.1,[4] 0.2[137][123]	0.8[4][123][136]	x109/L
		3,[9] 4.0	7,[9] 10	% of WBC
	Newborn	0.4[136]	3.1[136]	x109/L
Mononuclear leukocytes (Lymphocytes + monocytes)	Adult	1.5	5	x109/L
		20	35	% of WBC
CD4+ T cells	Adult	0.4,[10] 0.5[13]	1.5,[13] 1.8[10]	x109/L
Eosinophil granulocytes	Adult	0.0,[4] 0.04[123]	0.44,[123] 0.45,[136] 0.5[4]	x109/L
		1[9]	3,[9] 7	% of WBC
	Newborn	0.02[136]	0.85[136]	x109/L
Basophil granulocytes	Adult	40[135]	100,[4][123] 200,[136] 900[135]	x106/L
		0.0	0.75,[9] 2	% of WBC
	Newborn		0.64[136]	x109/L

Coagulation[edit]

Test	Lower limit	Upper limit	Unit	Comments
Thrombocyte/Platelet count (Plt)	140,[10] 150[4][9]	350,[4][18] 400,[9] 450[10]	x109/L or x1000/µL
Mean platelet volume (MPV)	7.4[138]	10.4[138]	fL
Prothrombin time (PT)	10,[13] 11,[9][139] 12[10]	13,[13] 13.5,[139] 14,[10] 15[9]	s	PT reference varies between laboratory kits - INR is standardised
INR	0.9[4]	1.2[4]		The INR is a corrected ratio of a patient's PT to normal
Activated partial thromboplastin time (APTT)	18,[10] 30[4][13]	28,[10] 42,[4] 45[13]	s
Thrombin clotting time (TCT)	11	18	s
Fibrinogen	1.7,[10] 2.0[4]	3.6,[4] 4.2[10]	g/L
Antithrombin	0.80[4]	1.2[4]	kIU/L
	0.15,[140] 0.17[141]	0.2,[140] 0.39[141]	mg/mL
Bleeding time	2	9	minutes
Viscosity	1.5[142]	1.72[142]	cP

Immunology[edit]

Acute phase proteins[edit]

Acute phase proteins are markers of inflammation.

Test	Patient	Lower limit	Upper limit	Unit	Comments
Erythrocyte sedimentation rate (ESR)	Male	0	Age÷2[143]	mm/h	ESR increases with age and tends to be higher in females.[144]
	Female		(Age+10)÷2[143]
C-reactive protein (CRP)	n/a		5,[4][145] 6[146]	mg/L
			200,[147] 240[147]	nmol/L
Alpha 1-antitrypsin (AAT)		20,[148] 22[149]	38,[149] 53[148]	μmol/L
		89,[150] 97[4]	170,[4] 230[150]	mg/dL

Isotypes of antibodies[edit]

Further information: Antibody

Test	Patient	Lower limit	Upper limit	Unit	Comments
IgA	Adult	70,[4] 110[151]	360,[4] 560[151]	mg/dL
IgD		0.5[151]	3.0[151]
IgE		0.01[151]	0.04[151]
IgG		800[151]	1800[151]
IgM		54[151]	220[151]

Autoantibodies[edit]

For clinical associations, see Autoantibody.

Autoantibodies are usually absent or very low, so instead of being given in standard reference ranges, the values usually denote where they are said to be present, or whether the test is a positive test. There may also be an equivocal interval, where it is uncertain whether there is a significantly increased level. All included values^[152] are given for theELISA test.

Test	Negative	Equivocal	Positive	Unit
anti-SS-A (Ro)	< 15[153]	15-25[153]	> 25[153]	Units per millilitre (U/mL)
anti-SS-B (La)	< 3[153]	3 – 4[153]	> 4[153]
Anti ds-DNA	< 40[153]	40 – 60[153]	> 60[153]
Anti ss-DNA	< 8[153]	8 - 10[153]	> 10[153]
Anti-histone antibodies	< 25[153]	n/a[153]	> 25[153]
Cytoplasmic/classical anti-neutrophil cytoplasmic antibodies (c-ANCA)	< 20[153]	21 - 30[153]	> 30[153]
Perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA)	< 5[153]	n/a	> 5[153]
Anti-mitochondrial antibodies (AMA)	< 10[153]	n/a[153]	> 10[153]
Rheumatoid factor (RF)	< 20	20 - 30	> 30[10]
Antistreptolysin O titre (ASOT) in preschoolers			> 100
ASOT at school age			> 250[10]
ASOT in adults			> 125[10]

Test	Negative	Low/weak positive	Moderate positive	High/strong positive	Unit
Anti-phospholipid IgG	< 20[153]	20 –30[153]	31 – 50[153]	> 51[153]	GPLU/ml[153]
Anti-phospholipid IgM	< 1.5[153]	1.5 –2.5[153]	2 – 9.9[153]	> 10[153]	MPL /ml[153]
Anti-phospholipid IgA	< 10[153]	10 -20[153]	21 – 30[153]	> 31[153]	arb U/ml[153]
Anti-citrullinated protein antibodies	< 20[153]	20 – 39[153]	40 - 59[153]	> 60[153]	EU[153]

Other enzymes and proteins[edit]

Test	Lower limit	Upper limit	Unit	Comments
Lactate dehydrogenase (LDH)	50[18]	150[18]	U/L
	0.4[48]	1.7[48]	μmol/L
	1.8[4]	3.4[4]	µkat/L	< 70 years old[4]
Amylase	25,[9] 30,[10] 53[18]	110,[10] 120,[154] 123,[18] 125,[9] 190[48]	U/L
	0.15[4]	1.1[4]	µkat/L
	200[147]	240[147]	nmol/L
D-dimer -more detailed ranges in D-dimer article	n/a	500[155]	ng/mL	Higher in pregnant women[156]
		0.5[4]	mg/L
Lipase	7,[10] 10,[18] 23[48]	60,[10] 150,[18] 208[48]	U/L
Angiotensin-converting enzyme (ACE)	23[48]	57[48]	U/L
Acid phosphatase		3.0[48]	ng/mL
Eosinophil cationic protein (ECP)	2.3[4]	16[4]	µg/L

Other electrolytes and metabolites[edit]

Electrolytes and Metabolites: For iron and copper, some related proteins are also included.

Test	Patient type	Lower limit	Upper limit	Unit	Comments
Osmolality		275,[9] 280,[18] 281[4]	295,[9] 296,[18] 297[4]	mOsm/kg	Plasma weight excludes solutes
Osmolarity		Slightly less than osmolality		mOsm/l	Plasma volume includes solutes
Urea		3.0[157]	7.0[157]	mmol/L	BUN - blood urea nitrogen
		7[9]	18,[9] 21[10]	mg/dL
* Uric acid[10]		0.18[9]	0.48[9]	mmol/L
	Female	2.0[18]	7.0[18]	mg/dL
	Male	2.1[18]	8.5[18]	mg/dL
Creatinine	male	60,[4] 68[158]	90,[4] 118[158]	μmol/L	May be complemented with creatinine clearance
		0.7,[159] 0.8[159]	1.0,[159] 1.3[159]	mg/dL
	female	50,[4] 68[158]	90,[4] 98[158]	μmol/L
		0.6,[159] 0.8[159]	1.0,[159] 1.1[159]	mg/dL
BUN/Creatinine Ratio		5[18]	35[18]	-
Plasma glucose (fasting)		3.8,[9] 4.0[4]	6.0,[4] 6.1[160]	mmol/L	See also glycosylated hemoglobin (in hematology)
		65,[10] 70,[9] 72[161]	100,[160] 110[18]	mg/dL
Full blood glucose (fasting)		3.3[4]	5.6[4]	mmol/L
		60[161]	100[161]	mg/dL
Lactate (Venous)		4.5[18]	19.8[18]	mg/dL
		0.5[162]	2.2[162]	mmol/L
Lactate (Arterial)		4.5[18]	14.4[18]	mg/dL
		0.5[162]	1.6[162]	mmol/L
Pyruvate		300[18]	900[18]	μg/dL

   

Schumm test

From Wikipedia,

The Schumm test (shoom) is a blood test [1] that uses spectroscopy to determine significant levels of methemalbumin in the blood. A positive result could indicate intravascular hemolysis. The Schumm test was named for Otto Schumm, a German chemist who lived in the early 20th century.[2]

A positive test result occurs when the haptoglobin binding capacity of the blood is saturated, leading to heme released from cell free hemoglobin to bind to albumin. Urinalysis

From Wikipedia, the free encyclopedia

Urinalysis
Intervention
White blood cells seen under a microscope from a urine sample.
MeSH	D016482
Othercodes:	LOINC Codes for Urinalysis panels
MedlinePlus	003579

A urinalysis (UA), also known as routine and microscopy (R&M), is an array of tests performed on urine, and one of the most common methods of medical diagnosis.^[1] The word is a portmanteau of the words urine and analysis.^[2]

The target parameters that can be measured or quantified in urinalysis include many substances and cells, as well as other properties, such as specific gravity.

A part of a urinalysis can be performed by using urine test strips, in which the test results can be read as color changes. Another method is light microscopy of urine samples.

Contents

  [hide] 

·                                 1 Target parameters

o                                        1.1 Ions and trace metals

o                                        1.2 Proteins and enzymes

o                                        1.3 Blood cells

o                                        1.4 Other molecules

o                                        1.5 Other urine parameters

o                                        1.6 Illicit substances

·                                 2 Methods

o                                        2.1 Urine test strip

o                                        2.2 Microscopic examination

o                                        2.3 Other methods of urinalysis

·                                 3 See also

·                                 4 References

·                                 5 External links

Target parameters[edit]

Urine test results should always be interpreted using the reference range provided by the laboratory that performed the test, or using information provided by the test strip/device manufacturer.^[3]

In addition to the substances mentioned in tables below, other tests include a description of color and appearance.

Ions and trace metals[edit]

Target	Lower limit	Upper limit	Unit	Comments	LOINCCodes
Nitrite	n/a	0 / negative[4]		The presence of nitrites in urine, termed nitrituria, indicates the presence of coliform bacteria. Further information: Nitrite test	5802-4
Sodium(Na) – per day	150[5]	300[5]	mmol / 24 h	A urinalysis is frequently ordered during the workup of acute renal failure. Full kidney function can be detected through the simple dipstick method.	2956-1
Potassium(K) – per day	40[5]	90[5]	mmol / 24 h	Urine K may be ordered in the workup of hypokalemia. In case of gastrointestinal loss of K, the urine K will be low. In case of renal loss of K, the urine K levels will be high. Decreased levels of urine K are also seen in hypoaldosteronism and adrenal insufficiency.	2829-0
Urinary calcium(Ca) – per day	15[6]	20[6]	mmol / 24 h	An abnormally high level is called hypercalciuria and an abnormally low rate is called hypocalciuria. Further information: Urinary calcium	14637-3
	100[6]	250[6]	mg / 24 hours		6874-2
Phosphate(P) – per day	n/a[5]	38[5]	mmol / 24 h	Phosphaturia is the hyperexcretion of phosphate in the urine. This condition is divided into primary and secondary types. Primary hypophosphaturia is characterized by direct excess excretion of phosphate by the kidneys, as from primary renal dysfunction, and also the direct action of many classes of diuretics on the kidneys. Additionally, secondary causes, including both types ofhyperparathyroidism, cause hyperexcretion of phosphate in the urine.	14881-7

A sodium-related parameter is fractional sodium excretion, which is the percentage of the sodium filtered by the kidney which is excreted in the urine. It is a useful parameter inacute renal failure and oliguria, with a value below 1% indicating a prerenal disease and a value above 3%^[7] indicating acute tubular necrosis or other kidney damage.

Proteins and enzymes[edit]

Target	Lower limit	Upper limit	Unit	Comments
Protein	0	trace amounts[4] / 20	mg/dl	Proteins may be measured with the Albustix test. Since proteins are very large molecules (macromolecules), they are not normally present in measurable amounts in the glomerular filtrate or in the urine. The detection of protein in urine, called proteinuria, may indicate the permeability of the glomerulus is increased. This may be caused by renal infections or by other diseases that have secondarily affected the kidneys, such as hypertension, diabetes mellitus, jaundice, or hyperthyroidism. Further information: Proteinuria
Human chorionic gonadotropin|hCG	–	50[8]	U/l	This hormone appears in the urine of pregnant women. Home pregnancy tests commonly detect this substance.

Blood cells[edit]

Target	Lower limit	Upper limit	Unit	Comments
Red blood cells (RBCs) / erythrocytes	0[4][9]	2[4] – 3[9]	per High Power Field (HPF)	May be present as intact RBCs, which indicate bleeding. Even trace amount of blood is enough to give the entire urine sample a red/pink hue, and it is difficult to judge the amount of bleeding from a gross examination. Hematuria may be due to a generalized bleeding diathesis or a urinary tract-specific problem (trauma, stone, infection, malignancy, etc.) or artefact of catheterization in case the sample is taken from a collection bag, in which case a fresh urine sample should be sent for a repeat test. If the RBCs are of renal or glomerular origin (due to glomerulonephritis), the RBCs incur mechanical damage during the glomerular passage, and then osmotic damage along the tubules, so get dysmorphic features. The dysmorphic RBCs in urine which are most characteristic of glomerular origin are called "G1 cells", which are doughnut-shaped rings with protruding round blebs sometimes looking like Mickey Mouse's head (with ears). Painless hematuria of nonglomerular origin may be a sign of urinary tract malignancy, which may warrant a more thorough cytological investigation. Further information: Hematuria
RBC casts	n/a	0 / negative[4]
White blood cells(WBCs) / leukocytes / (pus cells)	0[4]	2[4] / negative[4]		Further information: Pyuria
	–	10	per µl or mm3	"Significant pyuria" at greater than or equal to 10 leucocytes per microlitre (µl) or cubic millimeter (mm3)
"Blood" / (actuallyhemoglobin)	n/a	0 / negative[4]	dip-stick qualitative scale of 0 to 4+	Hemoglobinuria is suggestive of in vivo hemolysis, but must be distinguished from hematuria. In case of hemoglobinuria, a urine dipstick shows presence of blood, but no RBCs are seen on microscopic examination. If hematuria is followed by artefactual ex vivoor in vitro hemolysis in the collected urine, then the dipstick test also will be positive for hemoglobin and will be difficult to interpret. The urine color may also be red due to excretion of reddish pigments or drugs.

Other molecules[edit]

Target	Lower limit	Upper limit	Unit	Comments
Glucose	n/a	0 / negative[4]		Glucose can be measured with Benedict's test. Although glucose is easily filtered in the glomerulus, it is not present in the urine because all of the glucose filtered is normally reabsorbed from the renal tubules back into the blood. Presence of glucose in the urine is called glucosuria. Further information: Glucosuria
Ketone bodies	n/a	0 / negative[4]		With carbohydrate deprivation, such as starvation or high-protein diets, the body relies increasingly on the metabolism of fats for energy. This pattern is also seen in people with diabetes mellitus, when a lack of the hormone insulin prevents the body cells from using the large amounts of glucose available in the blood. This happens because insulin is necessary for the transport of glucose from the blood into the body cells. The metabolism of fat proceeds in a series of steps. First, triglycerides are hydrolyzed to fatty acids and glycerol. Second, the fatty acids are hydrolyzed into smaller intermediate compounds (acetoacetic acid, betahydroxybutyric acid, and acetone). Thirdly, the intermediate products are used in aerobic cellular respiration. When the production of the intermediate products of fatty acid metabolism (collectively known as ketone bodies) exceeds the ability of the body to metabolize these compounds, they accumulate in the blood and some end up in the urine (ketonuria). Further information: Ketonuria
Bilirubin	n/a	0 / negative[4]		The fixed phagocytic cells of the spleen and bone marrow destroy old red blood cells and convert the heme groups of hemoglobin to the pigment bilirubin. The bilirubin is secreted into the blood and carried to the liver, where it is bonded to (conjugated with) glucuronic acid, a derivative of glucose. Some of the conjugated bilirubin is secreted into the blood and the rest is excreted in the bile as bile pigment that passes into the small intestine. The blood normally contains a small amount of free and conjugated bilirubin. An abnormally high level of blood bilirubin may result from an increased rate of red blood cell destruction, liver damage (as in hepatitis and cirrhosis), and obstruction of the common bile duct as with gallstones. An increase in blood bilirubin results in jaundice, a condition characterized by a brownish-yellow pigmentation of the skin and of the sclera of the eyes. Further information: Bilirubinuria
Urobilinogen	0.2[4]	1.0 [4]	Ehrlich units or mg/dL
Creatinine – per day	4.8[5]	19[5]	mmol / 24 h
Freecatecholamines, dopamine – per day	90 [10]	420 [10]	μg / 24 hours
Free cortisol	28[11]or 30[12]	280[11] or 490[12]	nmol/24 h	Values below threshold indicate Addison's disease, while values above indicate Cushing's syndrome. A value smaller than 200 nmol/24 h (72 µg/24 h[13]) strongly indicates absence of Cushing's syndrome.[12]
	10[14]or 11[13]	100[14] or 176[13]	µg/24 h
Phenylalanine		30.0	mg/L[15]	In neonatal screening, a value above the upper limit defines phenylketonuria.[15]

Other urine parameters[edit]

Test		Lower limit	Upper limit	Unit	Comments
Urine specific gravity		1.003[1][4]	1.030[1][4]	no unit	This test detects the ion concentration of urine. Small amounts of protein or ketoacidosis tend to elevate the urine'sspecific gravity (SG). This value is measured using a urinometer and indicates hydration or dehydration. If the SG is under 1.010, the patient is hydrated; an SG value above 1.020 indicates dehydration.
Osmolality		400[5]	n/a[5]	mOsm/kg
pH		5[4]	7[4]	(unitless)
Bacterial cultures	by urination	–	100,000	colony forming units per millilitre (CFU/mL)	Bacteriuria can be confirmed if a single bacterial species is isolated in a concentration greater than 100,000 CFU/ml of urine in clean-catch midstream urine specimens (one for men, two consecutive specimens with the same bacterium for women). Further information: Bacteriuria
	by bladder catheterisation	–	100		For urine collected via bladder catheterisation, the threshold is 100 CFU/ml of a single species. Further information: Bacteriuria

Illicit substances[edit]

Main article: Drug test

Urine may be tested to determine whether an individual has engaged in recreational drug use. In this case, the urinalysis would be designed to detect whatever marker indicates drug use.

Methods[edit]

When doctors order a urinalysis, they will request either a routine urinalysis or a routine and microscopy (R&M) urinalysis, with the difference being a routine urinalysis does not include microscopy or culture.

Urine test strip[edit]

A urine test strip can quantify:

·                    Leukocytes – with presence in urine known as leukocyturia

·                    Nitrite – with presence in urine known as nitrituria

·                    Protein – with presence in urine known as proteinuria, albuminuria, or microalbuminuria

·                    Blood – with presence in urine known as hematuria

·                    specific gravity

Microscopic examination[

A urine sample is about to be examined under a phase-contrast microscope using a Neubauer counting chamber. The urine is under the cover slide, in the upper segment formed by the H-shaped grooves.

The numbers and types of cells and/or material such as urinary casts can yield a great detail of information and may suggest a specific diagnosis.

·                    Hematuria – associated with kidney stones, infections, tumors and other conditions

·                    Pyuria – associated with urinary infections

·                    Eosinophiluria – associated with allergic interstitial nephritis, atheroembolic disease

·                    Red blood cell casts – associated with glomerulonephritis, vasculitis, or malignant hypertension

·                    White blood cell casts – associated with acute interstitial nephritis, exudative glomerulonephritis, or severe pyelonephritis

·                    (Heme) granular casts – associated with acute tubular necrosis

·                    Crystalluria – associated with acute urate nephropathy (or acute uric acid nephropathy, AUAN)

·                    Calcium oxalatin – associated with ethylene glycol

·                    Waxy casts – associated with chronic renal disease

Other methods of urinalysis[edit]

·                    Urine culture – a microbiological culture of urine samples, detecting bacteriuria, is indicated when a urinary tract infection is suspected.

·                    Ictotest – this test is used to detect the destruction of old red blood cells in the urine.

·                    Hemoglobin test – this tests for hemolysis in the blood vessels, a rupture in the capillaries of the glomerulus, or hemorrhage in the urinary system, which cause hemoglobinto appear in the urine.