Module 2: Normal Values

Hematology, Serum, Plasma, and Urine Chemistry

Learning Objectives
• Understand the different normal values in nursing.
• Answer Board-like Questions using new knowledge in Normal Values.

Hematology
Normal Adult Reference Range

Determination Conventional Units SI Units Clinical Significance

Bleeding Time 1.5 – 9.5 min 1.5 – 9.5 min Prolonged in thrombocytopenia, defective plt function
and ASA therapy

Fibrinogen 200 – 400 mg/dL 2 – 4 g/dL

Lower limit of normal: 20 – 25

sec
Activated Partial Prolonged in deficiency of fibrinogen, factors II, V, VIII,
Thromboplastin IX, X, XI, and XII, and in heparin therapy
Time
Upper limit of normal: 32 – 39
sec

Lower limit of normal: 10 sec

Prothrombin Impaired in deficiency of factors VIII, IX, and X

Consumption
Upper limit of normal: 14 sec
 Prolonged by deficiency in factors I, II, V, VII, and X, fat
malabsorption, severe liver dse, Coumadin
Prothrombin Time 9.5 – 12 sec
anticoagulant therapy

1.0

2–3

(for therapy in AFib, DVT and

pulmo embolism)
INR Used to standardize the prothrombin time and
anticoagulation therapy

2.5 – 3.5

(for therapy in prosthetic heart

valves)

Males: Increased in severe diarrhea and DHN, polycythemia,

acute poisoning, pulmonary fibrosis Decreased in
Erythrocyte Count (Red 4.6 – 6.2 million/mm3 4.6 – 6.2 x 1012/ L
all anemias, in leukemia and after hemorrhage
Blood Cells)
4.2 – 5.4 x 1012/ L when blood volume has been restored

Females:

4.2 – 5.4 million/ mm3

ERYTHROCYTE INDICES

Mean corpuscular 84 – 96 cu µm 84 – 96 fL Increased in macrocytic anemias Decreased in

volume (MCV) microcytic anemia

Mean corpuscular 28 – 33 µµg/cell 28 - 33 pg Increased in macrocytic anemias Decreased in

hemoglobin (MCH) microcytic anemia

Mean corpuscular 33 – 35% Concentration fraction: 0.33 – Decreased in severe hypochromic anemia
hemoglobin 0.35
concentration
(MCHC)
 Males under 50: < 15mm/h < 15 mm/h
Males over 50: < 20
Erythrocyte < 20 mm/h Increased in tissue destruction (inflammatory or
mm/h
Sedimentation Rate degenerative), during menstruation and
(ESR) – Westergren pregnancy and in acute febrile disease
method < 25 mm/h
Females under 50: <25 mm/h
< 35 mm/h
Females over 50: <30 mm/h

Erythrocyte < 50 y/o: < 55% Volume fraction: <0.55 Significance similar to ESR
Sedimentation Rate –
50 – 80 y/o: 40 – 60% Volume fraction: 0.4 – 0.6
Zeta centrifuge

Decreased in severe anemias, anemia of pregnancy,

acute massive blood loss
Hematocrit Males: 42 – 52% Volume fraction: 0.42 – 0.52

Females: 35 – 47% Volume fraction: 0.35 – 0.47

Increased in erythrocytosis of any cause, and in DHN
or hemoconcentration associated with shock

Decreased in various anemias, pregnancy, severe or

prolonged hemorrhage and with excessive fluid
intake
Hemoglobin Males: 13 – 18 g/dL 2.02 – 2.79 mmol/L

Females: 12 – 16 g/dL 1.86 – 2.48 mmol/ L

Increased in polycythemia, COPD, failure of
oxygenation because of CHF, and normally in

people living at high altitudes

LEUKOCYTE COUNT 4,500 – 11,000/ mm3 4.5 – 11 x 109/L

Increased with acute infections, trauma or surgery,

leukemia, malignant disease, necrosis
Neutrophils 45 – 73% Number fraction: 0.45 – 0.73
 Decreased with viral infections, bone marrow
suppression, primary bone marrow disease

Increased in allergy, parasitic disease, collagen

disease, subacute infections
Eosinophils 0 – 4% Number fraction: 0.00 – 0.004

Decreased with stress, use of some medications

(ACTH, epinephrine, thyroxine)

Increased with acute leukemia and following surgery

or trauma
Basophils 0 – 1% Number fraction: 0.00 – 0.01

Decreased with allergic reactions, stress, allergy,

parasitic disease, use of corticosteroids

Increased with infectious mononucleosis, viral and

some bacterial infections, hepatitis
Lymphocytes 20 – 40% Number fraction: 0.2 – 0.4

Decreased with aplastic anemia, SLE,

immunodeficiency including AIDS

Increased with viral infections, parasitic disease,

collagen and hemolytic disorders
Monocytes 2 – 8% Number fraction: 0.02 – 0.08

Decreased with use of corticosteroids, RA, HIV infx

Increased in malignancy, myeloproliferative disease,

RA and post-operatively; about 50% of patient
with unexpected increase of platelet count will be
found to have a malignancy

Platelet count 150,000 – 450,000/ mm3 0.15 – 0.45 x 1012/L

 Decreased in thrombocytopenic purpura, acute
leukemia, aplastic anemia and during cancer
chemotherapy

Serum, Plasma, and Whole Blood Chemistries

Normal Adult Reference Range Clinical Significance

Determination Conventional Units SI Units Increased Decreased

DKA

Acetone 0.3 – 2.0 mg/dL 51.6 – 344.0/ µmol/L Toxemia of pregnancy

Carbohydrate-free diet
High-fat diet

Adenocorticotropic Pituitary-dependent Adenocortical tunor

Hormone (ACTH)
< 50 pg/mL <50 ng/L Cushing’s syndrome Ectopic Adrenal insufficiency secondary to
(Plasma)
ACTH syndrome Primary hypopituitarism
- RIA adrenal atropy

Supine: 3 – 10 ng/dL 0.08 – 0.30 nmol/L Primary aldosteronism

Secondary aldosteronism
Aldosterone (Plasma) - Upright: 5 – 30 ng/dL 0.14 – 0.90 nmol/L Addison’s disease
RIA
Adrenal vein: 200 – 800 5.54 – 22.16 nmol/L
ng/dL

Hepatocarcinoma

Metastatic Carcinoma of liver

Germinal cell carcinoma
Alpha-1-fetoprotein < 15 ng/mL < 15 µg/L
of the testicle or ovary
 Fetal neural tube defects –
elevation in maternal
serum

Ammonia (Plasma) 15 – 45 µg/dL 11 – 32/ µmol/L Severe liver disease

(varies with method) Hepatic decompensation

Ascorbic Acid (Vitamin Large doses of ascorbic acid

C) as a
0.4 – 1.5 mg/dL 23 – 85 µmol/L
prophylactic against common
cold

ALT (Alanine Males: 10 – 40 U/mL 0.17 – 0.68 µkat/L Same conditions as AST
(AGOT),
aminotransferase) Females: 8 – 35 U/mL 0.14 – 0.60 µkat/L
but increase is more marked
Formerly SGPT
in liver disease than AST
(SGOT)

AST (Aspartate Males: 10 – 40 U/L 0.34 – 0.68 µkat/L Myocardial infarction

aminotransferase) Females: 15 – 30 U/L 0.25 – 0.51 µkat/L Skeletal muscle disease Liver
disease
Formerly SGOT

Hemolytic anemia (indirect)

Total: 0.3 – 1.0 mg/dL 5 – 17 µmol/L Biliary obstruction and disease

Hepatocellular damage
Bilirubin Direct: 0.1 – 0.4 mg/dL 1.7 – 3.7 µmol/L
(Hepatitis)
Indirect: 0.1 – 0.4 mg/dL 3.4 – 11.2 µmol/L
Pernicious anemia

Hemolytic disease of newborn

BLOOD GASES

Oxygen

Partial pressure (PaO2) 85 – 95 mm Hg 10.64 – 12.64 kPa Polycythemia Anemia

 Cardiac or pulmonary disease

Saturation (SaO2) 95% - 99% 0.95-0.99 Cardiac Decompensation

Chronic obstructive lung disease

Carbon Dioxide

Partial Pressure 35 – 45 mm Hg 4.66 – 5.99 kPa Respiratory Acidosis Respiratory Alkalosis Metabolic
(PaCO2) Metabolic Alkalosis Acidosis

Vomiting Hyperventilation Uremia

Fever
pH (whole blood, 7.35 – 7.45 7.35 – 7.45 Diabetic ketoacidosis Hemorrhage
arterial) Intestinal Obstruction Nephritis

Tumor or hyperplasia of
parathyroid
Hyperthyroidism Diarrhea
Hypervitaminosis D
Multiple myeloma Celiac disease Vitamin D deficiency
Nephritis with uremia Acute pancreatitis Nephrosis
Malignant tumours
Sarcoidosis After paathyroidectomy
Calcium 8.6 – 10.2 mg/dL 2.15 – 2.55 mmol/L
Hypoparathyroidism
Skeletal immobilization

Excess calcium intake: Milk

alkali syndrome

Diabetes mellitus Diarrhea Vomiting

Pneumoia
Nephrosis Nephritis
Heavy metal poisoning Cushing’s
Urinary obstruction Cardiac
syndrome Intestinal obstruction
decompensaton Anemia
Chloride 97 – 107 mEq/L 97 – 107 mmol/L
Febrile Condition
 Pernicious aemia Hemolytic anemia
Hypothyroidism Severe infection
Lipemia
Terminal stages of debilitating
Cholesterol 150 – 200 mg/dL 3.9 – 5.2 mmol/L Obstructive jaundice Diabetes
disease
Hyperthyroidism

Creatinine 0.7 – 1.4 mg/dL 62 – 124 µmol/L Nephritis

Chronic renal disease

Diabetes mellitus Nephritis

Hypothyroidism
Fasting: Hyperinsulinism Hyperthyroidism Late
Early hyperpituitarism hyperpituitarism Pernicious
60 – 110 mg/dL 3.3 – 6.05 mmol/L
Cerebral lesions vomiting Addison’s disease
Glucose Infections Pregnancy
Extensive hepatic damage
Postprandial (2h): 65 – 140 3.58 – 7.7 mmol/L Uremia
mg/dL

Normal Response:

Glucose Tolerance Normal fasting between 60- 2-hour value >200 mg/dL Decreased 2- and 3-hour values may
(oral) 110 mg/dL (11.1 mmol/L) is occur with hypoglycemia in
3.3 – 6.05 mmol/L
diagnostic for Diabetes diabetes mellitus
No sugar in urine
mellitus
Upper limits of normal:

Fasting = 125 6.88 mmol/L

hour = 190 10.45 mmol/L

hours = 140 7.70 mmol/L

hours = 125 6.88 mmol/L

Transfusion reactions Anemia Pregnancy

Paroxysmal nocturnal
Hemoglobin (plasma) 0.5 – 5 mg/dL 5 – 50 mg/L Chronic renal failure
hemoglobinuria
Intravascular hemolysis
High-density Males: 35 – 70 mg/dL 0.91 – 1.81 mmol/L HDL cholesterol is lower in patients
lipoprotein with risk for coronary heart
Females: 35 – 85 mg/dL 0.91 – 2.20 mmol/L
cholesterol (HDL disease
Cholesterol)

mg/dL desirable levels:

Low-density <160 if no CAD and <2 LDL cholesterol is higher in

lipoprotein risk factors patients with increased
cholesterol (LDL risk for coronary heart
<130 if no CAD and 2 or
Cholesterol) disease
more risk factors

<100 if CAD is present

Chronic alcoholism Severe renal

disease Diarrhea
Magnesium 1.3 – 2.3 mg/dL 0.62 – 0.95 mmol/L Excess ingestion of
magnesium- containing Defective growth
antacids

Phospholipids 125-300 mg/dL 1.25 – 3 g/L Diabetes mellitus Nephritis

Phosphorous, 2.5 – 4.5 mg/dL 0.8 – 1.45 mmol/L Chronic nephritis

inorganic Hypoparathroidism

Renal Failure Acidosis Hyperparathyroidism Vitamin D

deficiency GI losses
Potassium 3.5 – 5 mEq/L 3.5 – 5 mmol/L Cell lysis
Diuretic administration
Tissue breakdown or
hemolysis

PROTEIN

Total 6 – 8 gm/dL 60 – 80 g/L Hemoconcentration Shock Malnutrition Hemorrhage

Albumin 3.5 – 5.5 g/dL 40 – 55 g/L Globulin fraction increased in Loss of plasma from burns Proteinuria
multiple myeloma,
Globulin 1.7 – 3.3 g/dL 17 – 33 g/L
chronic infection, liver
disease
 Hemoconcentraton Nephritis Alkali deficit Addison’s disease
Myxedema
Sodium 135 – 145 mEq/L 135 – 145 mmol/L Pyloric obstruction

Thyroid-stimulating 0.4 – 4.2 mIU/L Hypothyroidism Hyperthyroidism

Hormone (TSH)

Triglycerides 100 – 200 mg/dL 1.13 – 3.8 mmol/L Increased risk for
atherosclerosis

TROPONIN

Troponin I < 0.35 ng/mL < 0.35 µg/L Myocardial infarction

Troponin T < 0.2 ng/mL < 0.2 µg/L Rhabdomyolysis

Severe crushing injuries

Obstructive uropathy Mercury

poisoning Neprotic
Urea Nitrogen (BUN) 10 – 20 mg/dL 3.6 – 7.2 mmol/L Pregnancy
syndrome

Gouty arthritis Acute leukemia

Uric Acid 2.5 – 8 mg/dL 0.15 – 0.5 mmol/L Lymphomas treated by Defective tubular reabsorption
chemotherapy Toxemia
of pregnancy

Coronary artery disease Metastatic liver disease Tuberculosis

Arteriosclerosis
Zinc 55 – 150 µg/dL 7.65 – 22.95 µmol/L Sprue
Industrial exposure

Urine Chemistry
Normal Adult Reference Range Clinical Significance

Determination Conventional Units SI Units Increased Decreased

 Muscular atrophy

Typhoid fever Salmonella infections Anemia

Tetanus
Creatinine 0 – 270 mg/ 24 h 0 – 2.05 mmol/ 24 h Advanced degeneration of
kidneys

Leukemia Renal disease

Diabetes mellitus

Glucose Negative Pituitary disorders Increased ICP

Lesion in floor of 4th ventricle

Extensive burns

Hemoglobin and Negative Transfusion of incompatible blood

Myoglobin Myoglobin increased in severe
crushing injuries to muscles

Osmolality 250 – 900 mOsm/kg 250 – 900 mmol/kg Useful in the study of electrolyte and

water balance

Hemolysis

Potassium 26 – 123 mEq/24 h 26 – 123 mmol/ 24 h Chronic renal failure Acidosis Diarrhea Adrenocortical
insufficiency
Cushing’s disease Corpus luteum
cysts

Nephritis

Cardiac failure Mercury poisoning

Protein < 150 mg/ 24 h < 150 mg/ 24 h Bence-Jones protein in multiple
myeloma Febrile states

Hematuria

Sodium 75 – 200 mEq/ 24 h 75 – 200 mmol/ 24h Useful in detecting gross changes in

water and salt balance

 Advanced Nursing Competency Appraisal Program

Urea Nitrogen 9 – 16 gm/24 h 0.32 – 0.57 mol/L Excessive protein catabolism Impaired kidney
function

Uric Acid 250 – 750 mg/ 24 h 1.48 – 4.43 mmol/24 h Gout Nephritis

Complete or nearly
complete biliary
Urobilinogen Random urine: <0.25 <0.42 mol/ 24 h Liver and biliary tract disease
obstruction
mg/dL 24-hr urine: Hemolytic anemia
Up to 6.67 µmol/ 24 h
up to 4 mg/ 24 h Diarrhea

Miscellaneous Values
Clinical Significance

Determination Normal Values Conventional Units SI Units

Acetaminophen Zero Therapeutic level = 10 – 30 µg/mL 10 – 30 mg/L

Carbamazepine Zero Therapeutic level = 4 – 12 µg/mL 34 – 51 µmol/L

Carbon monoxide 0 – 2% Symptoms with 10 – 30% saturation

Diazepam Zero Therapeutic level = 0.2 – 1.0 µg/mL 0.2 – 1.0 mg/L

Digoxin Zero Therapeutic level = 0.8 – 2 ng/mL 0.8 – 2/µg/L

Legal intoxication level = 0.1% or above

Ethanol 0 – 0.1% – 0.4% = marked intoxication

– 0.5% - alcoholic stupor

Lithium Zero Therapeutic level = 0.6 – 1.2 mEq/L 0.6 – 1.2 mmol/L

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 Advanced Nursing Competency Appraisal Program

Lidocaine Zero Toxic (48 h after high dose) 454 mg/mL 1000 mmol/L

Propanolol Zero Therapeutic level = 50 – 100 ng/mL 347 – 693 µmol/L

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