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Understanding Laboratory Reference Ranges

The document discusses reference ranges and normal values for biochemical test results. It explains that reference ranges are chosen to represent values found in 95% of healthy volunteers and may differ based on factors like gender, age, diet, exercise, medical history, and pregnancy. False positives and negatives can occur when a patient's value overlaps the normal range but does not accurately reflect their disease state. Direct sampling of healthy individuals is preferred for establishing reference ranges over indirect medical database methods. The document concludes by listing reference ranges for several common laboratory tests according to the American Board of Internal Medicine.

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94 views13 pages

Understanding Laboratory Reference Ranges

The document discusses reference ranges and normal values for biochemical test results. It explains that reference ranges are chosen to represent values found in 95% of healthy volunteers and may differ based on factors like gender, age, diet, exercise, medical history, and pregnancy. False positives and negatives can occur when a patient's value overlaps the normal range but does not accurately reflect their disease state. Direct sampling of healthy individuals is preferred for establishing reference ranges over indirect medical database methods. The document concludes by listing reference ranges for several common laboratory tests according to the American Board of Internal Medicine.

Uploaded by

Ms Tahniat Rehman
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© All Rights Reserved
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Reference range and Normal

values
LECTURE BY TAHNIAT REHMAN
Reference range

 Biochemical test results are usually compared to a reference range


considered to represent the normal healthy state
 Most reference range are chosen arbitrarily to include 95% of the values
found in healthy volunteers
 5% of the population will have a result out with the reference range.
 Reference range can be used to separate normal from abnormal values
False positive and false negative

 There is often a degree of overlap between the disease state and the
'normal value'
 A patient with an abnormal result who is found not to have the disease is
a false positive.
 A patient who has the disease but has a 'normal' result is a false negative
Factors That Influence Reference
Ranges

 Gender of the patient: Reference ranges for some analytes such as Hb or


iron are different for men and women.
 Age of the patient: There may be different reference range for neonates,
children, adults and the elderly.
 Effect of diet: The sample may be inappropriate if taken when the patient is
fasting or after a meal.
Factors That Influence Reference Ranges

 Time when sample was taken: There may be variations during the day and
night
 Stress and anxiety: They may affect the analyte of interest
 Posture of the patient: Redistribution of fluid may affect the result
 Effects of exercise: Strenuous exercise can release enzymes from tissues
 Medical history: Infection and/or tissue injury can affect biochemical values
Factors That Influence Reference Ranges

 Pregnancy: The alters some reference ranges


 Menstrual cycle: Hormone measurements will vary through the menstrual
cycle
 Drug history: Drugs may have specific effects on the plasma concentration
of some analytes
Selection of Reference individuals

 Reference individuals may be selected by either direct or indirect methods


 Direct methods involve selection of known healthy individuals from a
general population using specific criteria
 Indirect sampling methods use medical databases containing results from
both healthy and non-healthy individuals
 Direct sampling methods are strongly recommended, and indirect sampling
methods only should be used when other options are not unavailable
ABIM Laboratory Test Reference Ranges ̶
January 2023

LABORATORY TEST REFERENCE RANGES


Albumin, serum 3.5–5.5 g/dL
Bilirubin, serum
Total 0.3–1.0 mg/dL
Direct (conjugated) 0.1–0.3 mg/dL
Indirect (unconjugated) 0.2–0.7 mg/dL
Erythrocyte count 4.2–5.9 million/μL
Erythrocyte sedimentation rate (Westergren) Female: 0–20 mm/hr; male: 0–15 mm/hr
ABIM Laboratory Test Reference Ranges ̶
January 2023
ABIM Laboratory Test Reference Ranges ̶
January 2023

Laboratory test Normal values


Leukocyte count 4000–11,000/μL
Platelet count 150,000–450,000/μL of blood
pH, urine 4.5–8.0
Thrombin time 17–23 seconds
Mean corpuscular volume 80–98 fL
Mean corpuscular hemoglobin 28–32 picogram
Mean corpuscular hemoglobin concentration 33–36 g/dL
REFERENCES

 Techniques In Biochemistry Lab: CHAPTER 3


 American Board of Internal Medicine : Laboratory Test Reference Ranges ̶ January 2023

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