Valori normale

Börm Bruckmeier Publishing

pocketNormal Values

Michael Jakob

Preface to the First Edition

Everyone involved in medical/clinical work has undoubtedly been faced with the task of assessing lab values, functional parameters, and measurement categories for technical equipment, without having information on normal ranges at hand. As a consequence, it has always been necessary to check with the lab in question and make time-consuming searches through the appropriate literature. This problem mainly affects our younger and less experienced colleagues. However, experienced professionals also know that only a small part of the parameters are relevant to the clinical routine, and many specialized values are forgotten as quickly as they are learned. Careful evaluation of the many measurement parameters that are relevant in differential diagnosis, particularly in internal medicine, should really occupy more of a doctor’s time than a tedious search for normal values and ranges.

With this in mind, this sturdy little pocket-sized book is meant to be a helpful companion in the clinical routine. In the interest of manageability, we have purposely dispensed with detailed evaluation of the parameters given; on the other hand, we have included parameters that are less likely to be defined, and must therefore be looked up that much more frequently. In addition to the "classic" lab values, we have included measurement categories for the most important function tests and routine technological examination procedures, such as electrocardio-graphic, echocardiographic, hemodynamic, and pulmonary function parameters.

We must emphasize that normal values are not absolute values, but are dependent on many factors, e.g. the reagents or equipment used, which can lead to varying definitions of normal ranges, especially in the area of clinical chemistry. This guide is based on the standard works of the medical literature. Thus we recommend a comparison with your in-house laboratory’s normal values.

Advances in medicine, along with the evolution of lab tests and technical diagnostics, will inevitably entail an increase in the number of parameters in use. I hope that this guidebook, with its wide spectrum of normal values, will be of some help in getting to necessary information more quickly, thus leaving more time for the patient.

Michael Jakob, M.D. Hermosa Beach, July [email protected]

normal_values_imprint.fm Page 3 Friday, August 23, 2002 1:41 PM

35Abbreviations

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3. Clinical Chemistry

3.1. Abbreviations(Specimen = S.)

3.2. Clinical Chemical Values

AB arterial (whole-)blood

VB venous (whole-)blood

CB capillary blood

BS blood smear

CiB citrate blood

P Plasma

S Serum

L Liquor

SJ stomach juice

U Urine

Fe Feces

Measurand S. Value (convent.) Value (SI unit) Conv. F

ACE see Angiotensin-Converting Enzyme d p.37

Acetoacetate P < 1.0 mg/dl < 100 µmol/ml 97.95

Acetone S < 2.0 mg/dl < 344 µmol/ml 172

Acetylcholine receptor antibodies

S < 1.0 nmol/l

normal_values.fm Page 35 Monday, August 26, 2002 2:26 PM

36 3. Clinical Chemistry

Adenosine monophosphate, cyclic (cAMP)

P 5.0-25 nmol/l

Alanine aminotransferase (Glutamic-pyruvic transaminase, GPT)

S 0-23 U/l 0-0.38 µkat/l 0.01667

< 1 mo: < 32 U/l< 1 y: < 36 U/l< 16 y: < 21 U/l

< 1 mo: < 0.53 µkat/l< 1 y: < 0.59 µkat/l< 16 y: < 0.34 µkat/l

Albumin S 3.5-5.2 g/dl 33-55 g/l 10

Aldolase S 0-6 U/l 0-100 nkat/l 16.67

< 1 y. < 12.4 U/l 0-200 nkat/l

α1-antitrypsin S 85-200 mg/dl 0.8-2.0 g/l 0.01

α-fetoprotein S < 7 U/ml < 10 µg/l 1.43

Newborns:< 100,000 U/mlPregnant women depending on preg. wk.: < 350 U/ml

< 140,000 µg/l

< 500 µg/l

α1-globulins see Protein fractions d p.54

α2-globulins see Protein fractions d p.54

α1-microglobulin S 19.9-50.3 mg/l

α2-microglobulin S m: 1.5-3.5 g/lf: 1.8-4.2 g/l

Aluminum S < 30 µg/l

toxic: > 100 µg/l



37Clinical Chemical Values

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Ammonia P m: 25-94 µg/lf: 19-82 µg/l

15-55 µmol/l11-48 µmol/l

0.587

vB Newborns (mature):45-109 µg/dlPremature infants:31-211 µg/dl1st-6th month:22-94 µg/dl

27-63 µmol/l

19-123 µmol/l

13-55 µmol/l

Amylase S 60-180 U/l 0.8-3.2 mkat/l 0.01667

total amylase vB m: 102-358 U/lf: 150-468 U/l

(Note: different methods + different norm. values)

pancreatic amylase vB m: 19-161 U/lf: 55-219 U/l

salivary amylase vB m: 38-257 U/lf: 44-235 U/l

ratio pancreatic / salivary

vB m: 0.11-2.5f: 0.24-3.5

ANA see Antinuclear antibodies d p.37

Angiotensin-con-verting enzyme (ACE)

S 8-52 U/l 0.13-0.87 µkat/l 0.163

Anions S 155 mmol/l

Anion gap S 8-16 mmol/l

Antihyaluronidase titer

S < 128 U/l

Antimitochondrial antibodies

S neg.: titer <1:20pos.: titer > 1:20

Antinuclear antibodies (ANA)

S neg.: titer <1:20pos.: titer ≥ 1:160




Antistaphylolysin titer

S < 2.0 IU/l

Antistreptolysin titer S < 200 IU/l

Apolipoprotein, A-IApolipoprotein, B

S > 95 mg/dl< 111 mg/dl

Ascorbic acid (Vit. C) SvB

0.4-1.0 mg/dl0.7-2.0 mg/dl

56,78

Aspartate aminotransferase (Glutamic-oxalo-acetic transaminase, GOT)

S 0-19 U/l 0-0.31 µkat/l 0.01667

< 1 mo.: < 38 U/l< 1 y: < 27 U/l< 16 y: < 22 U/l

< 1 mo.: < 0.63 µkat/l< 1 y: < 0.45 µkat/l< 16 y: < 0.37 µkat/l

Base (total) S 145-155 mval/l 145-155 mmol/l 1

Base excess aB -3.4-2.3 mval/l -3.4-2.3 mmol/l 1

β-carotene S 90-350 µg/l

β-hydroxybutyric acid

P < 3 mg/dl < 300 µmol/l 96.05

β-globulins see Protein fractions d p.54

β2-microglobulin S 1.1-2.4 mg/l

Bicarbonate, actualBicarb., standard-

aB 20-26 mval/l21-27 mval/l

20-26 mmol/l21-17 mmol/l

1

Bile acids S < 6 µmol/l




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Bilirubin, total S 0.3-1.0 mg/dl 5.1-17 µmol/l 17.10

Newborns:24 h: < 4.0 mg/dl24-48 h: < 9.0 mg/dlUp to 5th day: < 13.5 mg/dl

< 68.4 µmol/l< 153.9 µmol/l

< 230.85 µmol/l

Bilirubin, direct S 0.1-0.3 mg/dl 1.7-5.1 µmol/l 17.10

Bilirubin, indirect S 0.2-0.7 mg/dl 3.4-12 µmol/l 17.10

Blood gases, arterial aB

pCO2 aB 35-45 mmHg 4.7-6.0 kPa 0.13333

pO2 aB 70-100 mmHg 9.3-13-3 kPa 0.13333

pH-value aB 7.35-7.45

actual bicarbonate aB 20-26 mval/l 20-26 mmol/l 1

standard bicarbonate aB 21-27 mval/l 21-27 mmol/l 1

base excess aB -3.4-2.3 mval/l -3.4-2.3 mmol/l 1

O2 saturation aB > 95%

O2 content (Ca, O2) aB 19-21 ml/dl 8.43-9.43 mmol/l 0.44

CO2 content (Ca, CO2) aB 49-54 ml/dl 22-24 mmol/l 0.44

Blood gases, pCO2(child. and newborns)

aB Umbilical artery:35-80 mmHgUmbilical vein:30-57 mmHgNewborns 1st day:29-61 mmHg

4.7-10-7 kPa

4.0-7.6 kPa

4.0-8.0 kPa

0.13333




Blood gases, pO2 (child. and newborns)

Umbilical artery:0-22 mmHgUmbilical vein:16-35 mmHgNewborns 1st day:70-85 mmHg

0-2.9 kPa

2.2-4.7 kPa

9.3-11.4 kPa

0.13333

Blood gases,pH-value (child. and newborns)

Umbilical artery:7.09-7.40Umbilical vein:7.15-7.45Newborns 1st day:7.20-7.41

standard bicarbonate (child. and newborns)

Umbilical vein:11.8-21.4 mval/lNewborns 1st day:18.6-22-6 mval/l

11.8-21.4 mmol/l

18.6-22-6 mmol/l

1

Blood gases, venous

pCO2 38-54 mmHg 5.0-7.2 kPa 0.13333

pO2 36-44 mmHg 4.8-5.9 kPa 0.13333

pH-value 7.26-7.46

actual bicarbonate 22-28 mval/l 22-28 mmol/l 1

standard bicarbonate 19-24 mval/l 19-24 mmol/l 1

base excess -2-5 mval/l -2-5 mmol/l 1

O2 saturation 60-85%

Brucella antibodies S < 1:50

Calciferol (Vit. D3)25(OH)D (calcifediol)1,25(OH)2D (calcitriol)

P8-80 ng/ml16-65 pg/ml

20-200 nmol/l40-160 pmol/l

2.4692.469

Calcium, ionizedCalcium, total

S 2.2-2.8 mval/l4.5-6.5 mval/l

1.1-1.4 mmol/l1.25-2.75 mmol/l

0.50.5




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cAMP see Adenosine monophosphate, cyclic d p.36

Candida antibodies S < 1:320

Carbohydrate deficient transferrin (CDT)

S "cut off"m: < 20 U/lf: < 26 U/L

Carotenoids S 50-300 µg/dl 0.9-5.6 µmol/l 0.0186

Cations S 155 mmol/l

CDT see Carbohydrate deficient transferrind p.41

Ceruloplasmin S 20-60 mg/dl 0.2-0.6 g/l 0.01

Chloride S 98-106 mval/l 98-106 mmol/l 1

Cholesterol, total S No risk of atherosclerosis: < 200 mg/dlQuestionable risk:200-239 mg/dlHigh risk: > 240 mg/dlWith coronary heart disease: < 180 mg/dl

< 5.2 mmol/l

5.2-6.2 mmol/l

> 6.2 mmol/l

< 4.6 mmol/l

0.02586

Cholesterol, fract. S

LDL-cholesterol No risk of atherosclerosis: < 130 mg/dlQuestionable risk:130-159 mg/dlHigh risk:> 160 mg/dlSecondary prophylaxis in coronary heart disease: < 100 mg/dl

< 3.36 mmol/l

3.4-4.1 mmol/l

> 4.1 mmol/l

< 2.6 mmol/l

0.02586




Cholesterol, fract. (cont.)

HDL-cholesterol No risk ofatherosclerosis: > 55 mg/dlquestionable risk:55-35 mg/dlhigh risk: < 35 mg/dl

> 1.4 mmol/l

1.4-0.9 mmol/l

< 0.9 mmol/l

0.02586

LDL/HDL Quotient No risk of atherosclerosis: < 3Increased risk: > 4Secondary prophylaxis in coronary heart disease: < 2.5

Cholinesterase S 3000-8000 U/l

Chrome S 0.5-9.0 µg/l

Circulating immune complexes (Ag-unspecific)

S < 0.01 g/l

Citrate S 1.7-3.0 mg/dl 88-156 µmol/l 52

CK see Creatine(phospho)kinase d p.44

Cobalt S < 0.5 µg/l 8,5 nmol/l 16,968

Cold agglutinins vB titer < 1:16




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Complement S

total hemolytic complement (CH50)

19.5-60.0 U/ml

C1q 13-32 mg/dl

C1r 2.5-3.8 mg/dl

C1s 2.5-3.8 mg/dl

C2 2.2-3.4 mg/dl

C3 90-180 mg/dl 0.9-1.8 g/l 0.01

C4 10-40 mg/dl 0.1-0.4 g/l 0.01

C5 5.1-7-7 mg/dl

C6 4.8-6.4 mg/dl

C7 4.9-7.0 mg/dl

C8 4.3-6.3 mg/dl

C9 4.7-6.9 mg/dl

C1 esterase inhibitor 16-33 mg/dl

CO2 content aB 49-54 ml/dl 22-24 mmol/l 0.44

CO2 partial pressure aB 35-45 mmHg 4.7-6.0 kPa 0.13333

Copper S 70-140 µg/dl 11-22 µmol/l 0.1574

C-reactive protein (CRP)

S < 5 mg/l

Newborns: < 15 mg/lInfants: < 10 mg/lSmall child.: < 8 mg/l




Creatine S 0.1-0.7 mg/dl 7.6-53 µmol/l 76.3

Creatinine S Total: < 1.36 mg/dlm: 0.84-1.36 mg/dlf: 0.66-1.17 mg/dl

< 120 µmol/l 88.4

< 1 y: 0.3-1.1 mg/dl1-6 y: 0.2-0.5 mg/dl7-14 y: 0.3-0.8 mg/dl15-16 y: 0.5-1.1 mg/dl

Creatine(phospho)kinase (CK)

S m: 25-90 U/lf: 10-70 U/l

0.42-1.50 µkat/l0.17-1.17 µkat/l

0.1574

Isoenzymes

CK-BB (brain) 0%

CK-MB (myocard) < 10 U/l (3-6% of the total CK) Suspected myocardial infarction:> 6% of the total CK

CK-MM (skeletal muscle)

97-100%

CRP see C-reactive protein d p.43

Cryofibrinogen vB < 60 mg/l

Cryoglobulins vB < 80 mg/l or < 1% of immunoglobulins

δ-aminolaevulic acid S 15-23 µg/dl 1.1-1.7 µmol/l 0.073

DNA, double-stranded DNA antibodies (ds-DNA-Ab)

S < 5 mg/l

DNA, single-stranded DNA antibodies (ss-DNA-Ab)

S 0-20% bonding




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Elastase P 60-110 ng/ml

Electrophoresis S see Protein fractions d p.54

Fatty acids, totalFatty acids, free

S 190-420 mg/dl< 18 mg/dl

7.0-15.5 mmol/l< 0.67 mmol/l

0.037

Ferritin S m: 15-400 ng/mlf: 10-200 ng/ml

15-400 µg/l10-200 µg/l

< 1 mo.: 150-600 ng/ml2-3 mo.: 37-223 mg/ml4-5 mo.: 19-142 ng/ml0.5-15 y.: 7-140 ng/ml

Fluoride vB < 0.05 mg/dl 0.027 mmol/l 0.53

Folic acid S 3.6-15 ng/ml 8.2-24 nmol/l 2.266

Fructosamine S 205-285 µmol/l

< 1 y.: 92-292 mmol/l2-3 y.: 69-345 mmol/l

4-6 y.: 102-285 mmol/l

Fructose S 1-6 mg/dl 55.5-333 µmol/l 55.5

Galactose vB Adults: 0 < 1.1 mmol/l 0.055

Children: < 20 mg/dl

γ-glutamyl transferase(γ-GT)

S m: < 28 U/lf: < 18 U/l

< 1 mo.: < 163 U/l1-12 mo.: < 91 U/l

1-16 y.: < 17 U/l

γ-globulins see Protein fractions d p.54

Gastrin S 40-200 pg/ml 40-200 ng/l 1

Globulins, total S 2.0-3.0 g/dl (40-50%)




Glucose (fasting) cB Adults: 70-100 mg/dlPath. OGTT:100-120 mg/dlDiab.: > 120 mg/dl

3.9-5.5 mmol/l

5.5-6.7 mmol/l> 6.7 mmol/l

0.05551

Newborns: 38-64 mg/dlInfants < 1 wk.:44-76 mg/dl

2.1-3.6 mmol/l

2.4-4.2 mmol/l

1 h. value after OGTT (75 g glucose)

Adults: 70-160 mg/dlPath. oGTT:160-220 mg/dlDiab.: > 220 mg/dl

3.9-8.9 mmol/l

8.9-12.2 mmol/l> 12.2 mmol/l

2 h. value after OGTT (75 g glucose)

Adults: < 140 mg/dlPath. OGTT:140-200 mg/dlDiab.: > 200 mg/dl

< 7.8 mmol/l

7.8-11.1 mmol/l> 11.1 mmol/l

Glucose-6-phosphate dehydrogenase

ciB 120-240 mU/billion erythrocytes

5-15 U/g Hb

Glutamate dehydrogenase (GLDH)

S m: < 4 U/lf: < 3 U/l

< 1 mo.: < 6.6 U/l1-6 mo.: < 4.3 U/l7-12 mo.: < 3.5 U/l1-16 y.: < 3.2 U/l

Glutamic-oxaloacetic transaminase (GOT)

see Aspartate aminotransferase d p.38

Glutamic-pyruvic transaminase (GPT)

see Alanine aminotransferase d p.36




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Glutathione vB 24-37 mg/dl 0.77-1.18 mmol/l 0.032

Glycerol (free) P 0.29-1.27 mg/dl 0.032-0.187 mmol/l 0.12

Gold S < 10 µg/dl < 0.51 µmol/l 0.051

GOT see Aspartate aminotransferase d p.38

GPT see Alanine aminotransferase d p.36

Haptoglobin S 50-220 mg/dl 0.5-2.2 g/l 0.01

HBDH see Hydroxybutyric dehydrogenase d p.47

Hemoglobin (Hb) vB m: 14-18 g/dlf: 12-16 g/dl

m: 140-180 g/lf: 120-160 g/l

10

Hemoglobin Fractions

HbA Adults: 97%Newborns: 20%

HbA0 Adults: 90%

HbA1 5-8%

HbA2 Adults: 1.3-3.5%Newborns: 0.5%

HbF Adults: < 2%Newborns: 80%

Hemopexin S 50-115 mg/dl

Hydroxybutyric dehydrogenase (HBDH)

S Adults: < 140 U/l

< 1 mo.: < 515 U/l1-6 mo.: < 310 U/l7-12 mo.: < 276 U/l1-2 y.: < 222 U/l3-16 y.: < 175 U/l

quotient LDH/HBDH 1.38-1.64




Immunoglobulins S

IgA 90-325 mg/dl 0.9-3.2 g/l 0.01

< 1 mo.: 0-2 mg/dl1-6 mo.: 3-82 mg/dl7-24 mo.: 14-108 mg/dl3-12 y.: 23-270 mg/dl13-16 y.: 81-232 mg/dl

IgD 0-8 mg/dl 0-0.08 g/l 0.01

IgE < 0.025 mg/dl(< 150 U/l)

< 0.00025 g/l 0.01

IgG 800-1500 mg/dl 8-15 g/l 0.01

< 1 mo.: 700-1480 mg/dl1-6 mo.: 300-1000 mg/dl0.5-2 y.: 500-1200 mg/dl3-12y.: 500-1650 mg/dl13-16 y.: 700-1550 mg/dl

IgM 45-150 mg/dl 0.45-1.5 g/l 0.01

< 1 mo.: 5-30 mg/dl1-6 mo.: 15-109 mg/dl7-24 mo.: 43-239 mg/dl3-12 y.: 50-260 mg/dl13-16 y.: 45-240 mg/dl

IgG/albumin quotient S 0.3-0.6




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Iodine (protein bound) P 3.0-7.6 µg/dl 236-598 nmol/l 0.0127

Iron m: 50-150 µg/dlf: 40-140 µg/dl

9-27 µmol/l7-25 µmol/l

0.1791

2 wk.: 63-201 mg/dl6 mo.: 28-135 mg/dl12 mo.: 35-155 mg/dl2-12 y.: 22-135 mg/dl

Iron-binding capacity S 250-370 µg/dl 45-66 µmol/l 0.1791

Ketone bodies (total) S 0.5-1.5 mg/dl 5-15 g/l 10

Lactate P 5-15 mg/dl 0.6-1.7 mmol/l 0.111

Lactate dehydrogenase (LDH)

S Adults: 120-240 U/l

< 1 mo.: 150-7855 U/l1-6 mo.: 160-437 U/l7-12 mo.: 145-365 U/l1-2 y.: 86-305 U/l3-16 y.: 100-290 U/l

LDH isoenzymes fraction 1 (HBDH) fraction 2 fraction 3 fraction 4 fraction 5

Aagarose electrophoresis:15-23% (~68-135 U/l; mostly myocard, erythrocytes)30-39% (mostly myocard, erythrocytes)20-25%8-15%9-14% (liver, skeletal muscle)

Lead vB < 20 µg/dl < 1.0 µmol/l 0.04826

Leucine vB Newborns: < 4.0 mg/dl

Leucine aminopeptidase

S 6-35 U/l




Leukocyte phosphatase, alkaline

see Alkaline leukocyte phosphatase d p.50

Lipase (turbidimetric) S < 190 U/l

Lipids S

Cholesterol, total S No risk of atherosclerosis: < 200 mg/dlQuestionable risk:200-239 mg/dlHigh risk:> 240 mg/dlSecondary prophylaxis in coronary heart disease:< 180 mg/dl

< 5.2 mmol/l

5.2-6.2 mmol/l

> 6.2 mmol/l

< 4.5 mmol/l

0.0259

Cholesterol, fract. HDL cholesterol

S No risk of atherosclerosis: > 55 mg/dlQuestionable risk:55-35 mg/dlHigh risk:< 35 mg/dl

> 1.40 mmol/l

1.4-0.9 mmol/l

< 0.9 mmol/l

0.0259

LDL cholesterol S No risk of atherosclerosis: < 130 mg/dlQuestionable risk:130-159 mg/dlHigh risk:> 160 mg/dlSecondary prophylaxis in coronary heart disease: < 100 mg/dl

< 3.4 mmol/l

3.4-4.1 mmol/l

> 4.1 mmol/l

< 2.6 mmol/l



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Valori normale