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Severe anemia: extremely low rbc... low wbc, but high plateletResolved Question:severe anemia: extremely low rbc... low wbc, but high platelet count..

Female, age 79

Already had one blood transfusion on July 24, and this is the blood test result for today... Doctor had ordered bone marrow aspiration, but we won't be able to get itdone until mid September.... Does this look like some sort of leukemia? Please help ....

(*** : abnormal result)

*** rbc 1.85 (normal range reference: 3.5-5.5)*** wbc 3.75 (4.0-10.0)*** hgb 62 g/L(110-150)*** hct 18.4 %(34-45)

*** mcv 99.2 fL(82-99)*** mch 33.5 pg(27-33)mchc 337 g/L (320-360)

*** rbc-dw 18.8 %(11-16)*** platelet count 361(100-360)pdw 16.3 % (10-20)mpv 12 fL (6.0-12.5)

pct 0.43 %(0.11-0.43)*** NEUT# XXXXX(2.0-7.0)

LYM# XXXXX (0.8-4.0)MONO# XXXXX (0.1-1.0)

EOS# XXXXX (0.0-0.5)BAS# XXXXX (0.0-0.1)*** NEUT% 36.7 (50-70)

*** LYMPH% 45.2 (20-40)*** MONO 10.9 (2.0-10.0)

*** EOS% 5.60 (0.0-5.0)

*** BAS% 1.60 (0.0-1.0)Submitted: 1 year ago.Category: HealthExpert:  Dr. Brims replied 1 year ago.

Dr Brims : Hello, welcome to Justanswer, I will try to assist you with your medical question, and any medical information you seek Dr Brims :

 This does not seem like leukemia at all, it seems like there is some bone marrow failure, although the platelet count is high, so that is a bit odd.I suspect that is the

reason why they want to do a bone marrow biopsy Dr Brims : I'm sorry to hear about this, but try to be patient, the bone marrow biopsy will shed mo re light, and this is not leukemia Customer: Thank you so much for your reply! It is such a big relief for us to hear that this is not leukemia... Before the blood transfusion, her platelet count was even higher than this, and she also had a high iron blood level (35.0 umol/L compare to normal upper limit 30.4),

and she has uncontrolled type II diabetes for many years (around 10 mmol/L compare to normal range<3.6-6.1>), but she's quite healthy other than the diabeticproblem... I understand without seeing the bone marrow biopsy result, it is very hard to guess what is really causing her problem, but based on the the blood test result, could

you give us a little bit hint on what type of bone marrow failure this could be? Could it be aplastic anemia, sideroblastic anemia or myelodysplastic syndromes, orsomething else....? the following is her blood test result before the blood transfusion on July 24th, just in case it might provide some more useful information for you. *** rbc 1.42 (normal range reference: 3.5-5.5) *** wbc 3.91 (4.0-10.0) *** hgb 51 g/L(110-150) *** hct 15.4 %(34-45) *** mcv 108.7 fL(82-99) *** mch 35.9

pg(27-33) mchc 331 g/L (320-360) *** rbc-dw 16.7 %(11-16) *** platelet count 380(100-360) pdw 16.0 % (10-20) mpv 12.2 fL (6.0-12.5) pct 0.46 %(0.11-0.43)*** NEUT# XXXXX(2.0-7.0) LYM# XXXXX (0.8-4.0) MONO# XXXXX (0.1-1.0) EOS# XXXXX (0.0-0.5) BAS# XXXXX (0.0-0.1) *** NEUT% 43.8 (50-70) *** LYMPH%

45.3 (20-40) *** MONO 8.2 (2.0-10.0) *** EOS% 1.30 (0.0-5.0) *** BAS% 1.40 (0.0-1.0) Customer: BTW, the above test was done right before the blood transfusion... Dr Brims : Sorry, please let me read your reply Customer: Hi Doctor, are you there? Dr Brims : I am here now Customer: Thanks for your reply doctor! Customer: I was just wondering if you have got a chance to take a look at her blood test result right before the blood transfusion.. Customer: She had a high iron blood level and even higher blood platelet count.... Dr Brims : I saw it, sorry for the delay Customer: no problem :) Dr Brims : The truth is , these results don't fit into any disease profile exactly, that is why there is no way to classify it, but it may be a type of myelody splastic syndrome Customer: i see...... Customer: Is there anything we could do to help her feel better before we can get the bone marrow biopsy done? The test was scheduled in 3 weeks from now... Dr Brims : Is she taking any iron supplements? Customer: no... I don't think so, she's been taking folic acid and B12 Dr Brims : Okay, then she may want to consider also taking iron supplements as well Customer: Her iron blood level is already higher than the normal range now... is it ok to take more iron supplement? Dr Brims : What are her serum iron levels? Customer: her iron blood level was at 35.0 umol/L (compare to normal upper limit reference 30.4), that was right before the blood transfusion... Dr Brims : Okay, then she should not take iron supplements

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Ions and trace metalsFurther information: Trace metals Included here are also related binding proteins, like  ferritin and transferrin for iron, and ceruloplasmin f or copper.

Test  Lower limit  Upper limit  Unit  Comments 

Sodium (Na)135, 137 145, 147 mmol/L or mEq/L

310, 320 330, 340 mg/dl

Potassium (K)3.5,

[8][4] 3.6

[9]  5.0,

[8][9][4] 5.1 mmol/L or mEq/L

[8] 

See hypokalemia or  hyperkalemia 

14[11]

  20[11]

  mg/dl

Chloride (Cl)95,

[8] 98,

[12] 100

[4]  105,

[8] 106,

[12] 110

[4]  mmol/L or mEq/L

[8] 

340 370 mg/dl

Ionized calcium (Ca)1.03,

[14] 1.10

[4]  1.23,

[14] 1.30

[4]  mmol/L

4.1,[15]

 4.4[15]

  4.9,[15]

 5.2[15]

  mg/dL

Total calcium (Ca)2.1, 2.2 2.5, 2.6, 2.8 mmol/L

8.4, 8.5 10.2, 10.5 mg/dL

Total serum iron (TSI) - male65, 76 176, 198 µg/dL

11.6, 13.6 30, 32, 35 μmol/L 

Total serum iron (TSI) - female26, 50 170 µg/dL

4.6, 8.9 30.4 μmol/L 

Total serum iron (TSI) - newborns 100 250 µg/dL

18 45 µmol/L

Total serum iron (TSI) - children 50 120 µg/dL

9 21 µmol/L

Total iron-binding capacity (TIBC) 240, 262 450, 474 μg/dL 

43, 47 81, 85 µmol/L

Transferrin190, 194, 204 326, 330, 360 mg/dL

25 45 μmol/L 

Transferrin saturation 20[18]

  50[18]

  %

Ferritin - Male12

[23]  300

[23]  ng/mL

27 670 pmol/L

Ferritin - Female12

[23]  150

[23]  ng/mL

27[24]

  330[24]

  pmol/L

 Ammonia 

10,[25]

 20[26]

  35,[25]

 65[26]

  μmol/L 

17,[27]

 34[27]

  60,[27]

 110[27]

  μg/dL 

Copper 70

[17]  150

[17]  µg/dL

11[28]

  24[28]

  μmol/L 

Ceruloplasmin 

15[17]

  60[17]

  mg/dL

1[29]

  4[29]

  μmol/L 

Phosphate (HPO42−

) 0.8 1.5[30]

  mmol/L

Inorganic phosphorus (serum)1.0

[8]  1.5

[8]  mmol/L

3.0[8]

  4.5[8]

  mg/dL

Copper  (Cu) 11[31]

  24 μmol/L 

Zinc (Zn)60,

[32] 72

[33]  110,

[33] 130

[32]  μg/dL 

9.2,[34]

 11[4]

  17,[4]

 20[34]

  µmol/L

Magnesium1.5,

[17] 1.7

[35]  2.0,

[17] 2.3

[35]  mEq/L or mg/dL

0.6,[36]

 0.7[4]

  0.82,[36]

 0.95[4]

  mmol/L

Acid-base and blood gasesFurther 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 tes ts.

 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 baseexcess show a high level of inter-method reliability between arterial and venous tests, so arterial and venous values are roughly equivalent for these.

[37] 

Test  Arterial/Venous  Lower limit  Upper limit  Unit  Comments 

pH Arterial 7.34,

[9] 7.35

[8]  7.44,

[9] 7.45

[8] 

Venous 7.31[38]

  7.41[38]

 

[H+] Arterial

36[8]

  44[8]

  nmol/L

3.6[39]

  4.4[39]

  ng/dL

Base excess   Arterial & venous[38]

  -3[38]

  +3[38]

  mEq/L

oxygen partial pressure (pO2)

 Arterial pO2

10,[8]

 11[40]

  13,[40]

 14[8]

  kPa

75,[8][9]

 83[17]

  100,[9]

 105[8]

  mmHg or  torr  

Venous4.0

[40]  5.3

[40]  kPa

30[38]

  40[38]

  mmHg or torr

Oxygen saturation Arterial 94,

[38] 95,

[12] 96

[17]  100

[12][17] 

%

Venous Approximately 75[12]

 

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Carbon dioxide partial pressure (PCO2)

 Arterial PaCO2  

4.4,[8]

 4.7[40]

  5.9,[8]

 6.0[40]

  kPa

33,[8]

 35[9]

  44,[8]

 45[9]

  mmHg or torr

Venous5.5 6.8 kPa

41 51 mmHg or torr

 Absolute content of carbon dioxide (CO2) Arterial23

[38]  30

[38]  mmol/L

100 132 mg/dL

Bicarbonate (HCO3-) Arterial & venous

18 23 mmol/L

110 140 mg/dL

Standard bicarbonate (SBCe) Arterial & venous21, 22 27, 28 mmol/L or mEq/L

134 170 mg/dL

Liver functionFurther information: Liver function tests 

Test  Patient type  Lower limit  Upper limit  Unit  Comments 

Total Protein 

60,[8]

 63[9]

  78,[8]

 82,[9]

 84[17]

  g/L see hypoproteinemia 

 Albumin 

35[8][43]

  48,[9]

 55[8]

  g/L see hypoalbuminemia 

3.5[9]

  4.8,[9]

 5.5[8]

  U/L

540[44]

  740[44]

  μmol/L 

Globulins 

23[8]

  35[8]

  g/L

Total Bilirubin 1.7,

[45] 2,

[8]3.4,

[45] 5

[4]  17,

[8][45] 22,

[45]25

[4]  μmol/L 

0.1,[8]

 0.2,[9]

0.29[46]

  1.0,[8][17]

 1.3,[9]

1.4[46]

  mg/dL

Direct/Conjugated Bilirubin0.0

[8] or N/ A

[4]  5,

[8] 7

[45][4]  μmol/L 

0[8][9]

  0.3,[8][9]

 0.4[17]

  mg/dL

 Alanine transaminase( ALT/ALAT[4]

)

5,

[47]

 7,

[9]

 8

[8]

  20,

[8]

 21,

[12]

 56

[9]

  U/L Also called serum glutamic pyruvictransaminase (SGPT)

Female 0.15[4]

  0.75[4]

 µkat/L

Male 0.15[4]

  1.1[4]

 

 Aspartate transaminase( AST/ASAT[4]

)

Female6

[48]  34

[48]  IU/L

 Also calledserum glutamic oxaloacetictransaminase(SGOT)

0.25[4]

  0.60[4]

  µkat/L

Male8

[48]  40

[48]  IU/L

0.25[4]

  0.75[4]

  µkat/L

 Alkaline phosphatase ( ALP)

Female 42 98U/L

Male 53[47]

  128[47]

 

(Enzyme activity)  0.6[4]

  1.8[4]

  µkat/L

Gamma glutamyl transferase(GGT)

5, 8 40, 78 U/L

Women 0.63 µkat/L

Men 0.92[49]

  µkat/L

Cardiac testsTest  Patient type  Lower limit  Upper limit  Unit  Comments 

Creatine kinase (CK)

male24,

[50] 38,

[9] 60

[47]  174,

[17] 320

[47] 

U/Lor ng/mL

0.42[51]

  1.5[51]

  µkat/L

female24,

[50] 38,

[9] 96

[17]  140,

[17] 200

[47] 

U/Lor ng/mL

0.17[51]

  1.17[51]

  µkat/L

CK-MB  0 3,[9]

 3.8,[4]

 5[47]

  ng/mL or μg/L[4]

 

MyoglobinFemale 1

[52]  66

[52] 

ng/mL or µg/LMale 17

[52]  106

[52] 

Cutoffs and ranges for  troponin types, 12 hrs after onset of pain

Test  Lower limit  Upper limit  Unit  Comments 

Troponin-I

 0.2

[53]  ng/mL or μg/L  Upper limit of normal

0.2[53]

  1.0[53]

  ng/mL or μg/L   Acute Coronary Syndrome 

0.4[54]

  2.0[54]

  ng/mL or μg/L  Moderately increased[54]

 

1.0,[53]

 1.5[55]

  n/a[53][55]

  ng/mL or μg/L  Myocardial Infarction likely

Troponin-T

 0.02 ng/mL or μg/L  Upper limit of normal

0.02[53]

  0.10[53]

  ng/mL or μg/L   Acute Coronary Syndrome 

0.10[53]

  n/a[53]

  ng/mL or μg/L  Myocardial Infarction likely

Brain natriuretic peptide (BNP) -more detailed ranges in BNP  article

Interpretation Range / Cutoff  

Congestive heart failure unlikely < 100 pg/mL

"Gray zone" 100-500 pg/mL

Congestive heart failure likely >500 pg/mL

NT-proBNP 

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-more detailed ranges in NT-proBNP  article

Interpretation Age Cutoff 

Congestive heart failure likely< 75years > 125 pg/mL

>75 years >450pg/mL

LipidsFurther information: Blood lipids 

Test  Patient type  Lower limit  Upper limit  Unit  Therapeutic target 

Triglycerides

10 – 39 years54

[17]  110

[17]  mg/dL

< 100 mg/dL[58]

 

or 1.1[58] mmol/L

0.61[59]

  1.2[59]

  mmol/L

40 – 59 years

70[17]

  150[17]

  mg/dL

0.77[59]

  1.7[59]

  mmol/L

> 60 years80

[17]  150

[17]  mg/dL

0.9[59]

  1.7[59]

  mmol/L

Total cholesterol 3.0,

[60] 3.6

[8][60]  5.0,

[4][61] 6.5

[8]  mmol/L < 3.9

[58] 

120,[9]

 140[8]

  200,[9]

 250[8]

  mg/dL < 150[58]

 

HDL cholesterol  female1.0,

[62] 1.2,

[4] 1.3

[60]  2.2

[62]  mmol/L

> 1.0[62]

 or 1.6[60]

  mmol/L> 40

[63] or 60

[64] mg/dL

40,[63]

 50[65]

  86[63]

  mg/dL

HDL cholesterol male0.9

[62][4]  2.0

[62]  mmol/L

35[63]

  80[63]

  mg/dL

LDL cholesterol (Not valid whentriglycerides >5.0 mmol/L) 

2.0,[62]

 2.4[61]

  3.0,[61][4]

 3.4[62]

  mmol/L < 2.5[62]

 

80,[63]

 94[63]

  120,[63]

 130[63]

  mg/dL < 100[63]

 

LDL/HDL quotient n/a 5[4]

  (unitless)

Tumour markersFurther information: Tumour markers 

Test  Cutoff  Unit  Comments 

 Alpha fetoprotein (AFP) 44[9]

  ng/mL or µg/L Hepatocellular carcinoma or testicular cancer

Beta Human chorionic gonadotrophin (bHCG) 5[9]

  IU/l or mU/ml in male and non-pregnant female

CA19-9  40[9]

  U/ml Pancreatic cancer

CA-125  30,[66]

 35[67]

  kU/L or U/mL

Carcinoembryonic antigen (CEA)non-smokers at 50 years

3.4,[4]

 3.6[68]

  μg/l 

Carcinoembryonic antigen (CEA)non-smokers at 70 years

4.1[68]

  μg/l 

Carcinoembryonic antigen (CEA) - smokers 5 μg/l 

Prostate specific antigen (PSA) 2.5, 4 μg/L  or ng/mL below age 45 <2.5 μg/L 

PAP  3 units/dL (Bodansky units)

Calcitonin -more detailed  cutoffs in Calcitonin article 5,[70] 15[70]  ng/L or pg/mL Cutoff against medullary thyroid cancer [70] 

EndocrinologyThyroid hormonesFurther 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,[9]

 0.5,[17]

 0.6[71]

  4.0,[4]

 4.5,[9]

 6.0[17]

  mIU/L or μIU/mL 

 Adults -optimal range 

0.3,[72]

 0.5[73]

  2.0,[73]

 3.0[72]

  mIU/L or μIU/mL 

Infants 1.3[74]

  19[74]

  mIU/L or μIU/mL 

Free thyroxine (FT4)-more detailed ranges inThyroid function tests article

Normal adult0.7,

[75] 0.8

[9]  1.4,

[75] 1.5,

[9] 1.8

[76]  ng/dL

9,[77][4]

 10,[78]

 12[79]

  18,[4][77]

 23[79]

  pmol/L

Child/Adolescent31 d - 18 y

0.8[75]

  2.0[75]

  ng/dL

10[77]

  26[77]

  pmol/L

Pregnant0.5

[75]

  1.0[75]

  ng/dL

6.5[77]

  13[77]

  pmol/L

Total thyroxine4,

[78] 5.5

[9]  11,

[78] 12.3

[9]  μg/dL 

60[78][79]

  140,[78]

 160[79]

  nmol/L

Free triiodothyronine (FT3)

Normal adult0.2

[78]  0.5

[78]  ng/dL

3.1[80]

  7.7[80]

  pmol/L

Children 2-16 y0.1

[81]  0.6

[81]  ng/dL

1.5[80]

  9.2[80]

  pmol/L

Total triiodothyronine 60,

[9] 75

[78]  175,

[78] 181

[9]  ng/dL

0.9,[4]

 1.1[78]

  2.5,[4]

 2.7[78]

  nmol/L

Thyroxine-binding globulin (TBG) 12[9]

  30[9]

  mg/L

Thyroglobulin (Tg)1.5

[78]  30

[78]  pmol/L

1[78]

  20[78]

  μg/L 

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Sex hormonesLevels of estradiol (the main estrogen), progesterone,luteinizing hormone andfollicle-stimulating hormoneduring the menstrual cycle.

[82] 

The diagrams at right take inter-cycle and inter-woman variability into account in displaying reference ranges for estradiol, progesterone, FSH and LH.[82]

 

Test Patient type Lower limit Upper limit Unit

Dihydrotestosterone adult male 30[83]

  85[83]

  ng/dL

Testosterone

Male, overall8,

[84] 10

[85]  27,

[84] 35

[85]  nmol/L

230,[86]

 300[87]

  780[86]

 - 1000[87]

  ng/dL

Male < 50 years10

[4]  45

[4]  nmol/L

290[86]

  1300[86]

  ng/dL

Male > 50 years6.2

[4]  26

[4]  nmol/L

180[86]

  740[86]

  ng/dL

Female0.7

[85]  2.8

[85] - 3.0

[4]  nmol/L

20[87]

  80[87]

 - 85[86]

  ng/dL

17-Hydroxyprogesterone

male0.06

[17]  3.0

[17]  mg/L

0.18[88]

  9.1[88]

  µmol/l

Female (Follicular phase)0.2

[17]  1.0

[17]  mg/L

0.6[88]

  3.0[88]

  µmol/l

Follicle-stimulatinghormone (FSH)-more detailed menstrual cycleranges in separate diagram 

Prepubertal <1[89]

  3[89]

 

IU/L

 Adult male 1[89]

  8[89]

 

 Adult female (follicular  and luteal phase) 

1[89]

  11[89]

 

 Adult female (Ovulation) 

6[89]

 95% PI (standard) 

26[89]

 95% PI) 

590% PI (used in diagram) 

15(90% PI) 

Post-menopausal female 30[89]

  118[89]

 

Luteinizing hormone (LH)-more detailed menstrual cycleranges in separate diagram 

Female, peak20

[90] 

90% PI (used in diagram) 75

[90] 

(90% PI) 

IU/LFemale, post-menopausal 15 60

Male aged 18+ 2[92]

  9[92]

 

Estradiol (an estrogen) -more detailed ranges inestradiol  article

 Adult male50 200 pmol/L

14 55 pg/mL

 Adult female (day 5 of follicular phase,and luteal phase) 

70[93]

  500,[93]

600[93]

  pmol/L

19[94]

  140,[94]

160[94]

  pg/mL

 Adult female - free (not protein bound)0.5 9 pg/mL

1.7[95]

  33[95]

  pmol/L

Post-menopausal femaleN/ A

[93]  < 130

[93]  pmol/L

N/ A[94]

  < 35[94]

  pg/mL

Progesterone -more detailed rangesin Progesterone article

Female in mid-luteal phase (day 21-23)17,

[90] 35

[96]  92

[96]  nmol/L

6,[90]

 11[97]

  29[97]

  ng/mL

 Androstenedione

 Adult male and female 60 270

ng/dLPost-menopausal female < 180

Prepubertal < 60

Dehydroepiandrosterone sulfate -more detailed rangesin DHEA-S article

 Adult male and female 30[98]

  400[98]

  µg/dL

SHBG -more detailed rangesin SHBG article

 Adult female 40[99]

  120[99]

 nmol/L

 Adult male 20[99]

  60[99]

 

 Anti-Müllerian hormone( AMH)-more detailed ranges in AMH  article

13 –45 years0.7

[100]  20

[100]  ng/mL

5[101]

  140[101]

  pmol/l

Other hormones

Further information: Hormones 

Test  Patient type  Lower limit  Upper limit  Unit 

 Adrenocorticotropic hormone ( ACTH)4.4

[102]  18,

[103] 22

[102]  pmol/L

20[9]

  80,[104]

 100[9]

  pg/mL

Cortisol

09:00 am 140

[105]  700

[105]  nmol/L

5[106]

  25[106]

  μg/dL 

Midnight80

[105]  350

[105]  nmol/L

2.9[106]

  13[106]

  μg/dL 

Growth hormone (fasting) 0 5[8]

  ng/mL

Growth hormone (arginine stimulation) 7[8]

  n/a ng/mL

IGF-1 -more detailed ranges inIGF-1 article

Female, 20 yrs 110[107]

  420[107]

 

ng/mLFemale, 75 yrs 55[107]

  220[107]

 

Male, 20 yrs 160[107]

  390[107]

 

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Male, 75 yrs 48[107]

  200[107]

 

Prolactin -more detailed ranges inProlactin article

Female71,

[108] 105

[108]  348,

[108] 548

[108]  mIU/L

3.4, 3.9 16.4, 20.3 µg/L

Male58, 89 277, 365 mIU/L

2.7,[108]

 3.3[108]

  13.0,[108]

 13.5[108]

  µg/L

Parathyroid hormone (PTH)10, 17 65, 70 pg/mL

1.1, 1.8 6.9, 7.5 pmol/L

25-hydroxycholecalciferol (a vitamin D) -Standard reference range 

8, 9 40, 80 ng/mL

20, 23 95, 150 nmol/L

25-hydroxycholecalciferol -Therapeutic target range 

30, 40 65, 100 ng/mL

85, 100 120, 160 nmol/L

Plasma renin activity  0.29, 1.9 3.7 ng/(mL*hour)

3.3, 21 41 mcU/mL

 Aldosterone -more detailed ranges in Aldosterone article

 Adult19, 34.0 ng/dL

530,[121]

 940[121]

  pmol/L

 Aldosterone-to-renin ratio -more detailed ranges in Aldosterone/renin ratio article

 Adult13.1,

[122] 35.0

[122]  ng/dl per ng/(mL·h)

360,[122]

 970[122]

  pmol/liter per µg/(L·h)

Vitamins 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 65 µg/dL

Vitamin B9 (Folic acid/Folate) - Serum 

 Age > 1year3.0 16 ng/mL or μg/L  5

6.8 36 nmol/l 11

Vitamin B9 (Folic acid/Folate) - Red blood cells 

200 600 ng/mL or μg/L 

450 1400 nmol/L

Pregnantng/mL or μg/L  400

nmol/L 900

Vitamin B12 (Cobalamin)130, 160 700, 950   ng/L

100, 120 520, 700   pmol/L

Homocysteine -more detailed ranges inHomocysteine article

3.3, 5.9 7.2, 15.3 μmol/L  6.3

45,[130]

 80[130]

  100,[130]

 210[130]

  μg/dL  85[58]

 

Vitamin C ( Ascorbic acid)0.4

[17]  1.5

[17]  mg/dL 0.9

[58] 

23[131]

  85[131]

  μmol/L  50[58]

 

25-hydroxycholecalciferol (a vitamin D) 8,

[17][112] 9

[112]  40,

[112] 80

[17]  ng/mL 30,

[115] 40

[116]  65,

[116] 100

[115] 

20, 23 95, 150 nmol/L 85, 100 120, 160

Vitamin E 

μmol/L  28[58]

 

mg/dL 1.2[58]

 

Toxins

Test  Limit type  Limit  Unit 

Lead Optimal health range < 20[12]

 or 40[17]

  µg/dL

Blood ethanol content Limit for drunk driving 0,

[132] 0.2,

[132] 0.8

[132]  ‰ or g/L

17.4[133]

  mmol/L

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

Test  Patient  Lower limit  Upper limit  Unit  Comments 

Hemoglobin (Hb)

male2.0,

[134]2.1

[135][8]  2.5,

[134]2.7

[135][8]  mmol/L

Higher in neonates, lower in children.

130,[4]

 132,[9]

135[8]

  162,[9]

 170,[4]

175[8]

  g/L

female1.8,

[134]1.9

[135][8]  2.3,

[134]2.5

[8][135][134]  mmol/L Sex difference negligible until

adulthood.120[4][8][9]

  150,[4]

 152,[9]

160[8][17]

  g/L

Hemoglobin subunits (sometimes displayedsimply as "Hemoglobin")

male 8.0,[136]

 8.4[136]

  10.0,[136]

10.8[136]

 mmol/L 4 per hemoglobin molecule

female 7.2,[136]

 7.6[136]

  9.2,[136]

 10.0[136]

 

Hemoglobin in plasma0.16

[8]  0.62

[8]  μmol/L  Normally diminutive compared with

inside red blood cells1 4 mg/dL

Glycosylated hemoglobin (Hb A1c)< 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,

[9]0.41,

[8] 0.45

[17]  0.50,

[4] 0.52,

[9]0.53,

[8] 0.62

[17] 

female 0.35,[4]

 0.36,[8]

0.37[9][17]

  0.46,[8][9][4]

0.48[17]

 

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Child 0.31[9]

  0.43[9]

 

Mean cell volume (MCV)Male 76,

[17] 82

[9]  100,

[17] 102

[9]  fL Cells are larger in neonates, though

smaller in other children.Female 78 101 fL

Red blood cell distribution width (RDW) 11.5 14.5 %

Mean cell hemoglobin (MCH)0.39

[8]  0.54

[8]  fmol/cell

25, 27 32, 33, 35 pg/cell

Mean corpuscular hemoglobinconcentration (MCHC)

31,[9]

 32[17][4]

  35,[9]

 36[17][4]

 g/dLor %

[note 1] 

4.8,[137]

 5.0[137]

  5.4,[137]

 5.6[137]

  mmol/L

Erythrocytes/Red blood cells (RBC)

male 4.2,[17]

4.3[8][9][4]

  5.7,[4]

 5.9,[8]

6.2,[9]

 6.9[17]

 

x1012

/Lormln/mm

3 

Female 3.5,[8]

 3.8,[9]

3.9[4]

  5.1,[4]

 5.5[8][9]

 

Infant/Child 3.8 5.5

Reticulocytes

 Adult 26[4]

  130[4]

  x109/L

 Adult 0.5[8][9]

  1.5[8][9]

  % of RBC

Newborn 1.1 4.5 % of RBC

Infant 0.5 3.1 % of RBC

White blood cellsThese 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, 3.9, 4.1, 4.5 9.0, 10.0, 10.9, 11  x10

9/L

  x103/mm

3 or

  x103/μL 

Newborn 9 30

1 year old 6[139]

  18[139]

 

Neutrophil granulocytes (A.K.A. grans, polys, PMNs, or segs)

 Adult

1.3,[4]

 1.8,[138]

 2[139]

  5.4,[4]

 7,[138]

 8[139]

  x109/L

45-54[8]

  62,[8]

 74 % of WBC

Newborn 6[139]

  26[139]

  x109/L

Neutrophilic band forms   Adult0.7

[139]  x10

9/L

3[8]

  5[8]

  % of WBC

Lymphocytes 

 Adult0.7,

[4] 1.0

[138][139]  3.5,

[138] 3.9,

[4] 4.8

[139]  x10

9/L

16-25[8]

  33,[8]

 45 % of WBC

Newborn 2[139]

  11[139]

  x109/L

Monocytes 

 Adult0.1,

[4] 0.2

[140][126]  0.8

[126][139][4]  x10

9/L

3,[8]

 4.0 7,[8]

 10 % of WBC

Newborn 0.4[139]

  3.1[139]

  x109/L

Mononuclear leukocytes (Lymphocytes + monocytes)

 Adult1.5 5 x10

9/L

20 35 % of WBC

CD4+ cells  Adult 0.4,[9]

 0.5[12]

  1.5,[12]

 1.8[9]

  x109

/L

Eosinophil granulocytes Adult

0.0,[4]

 0.04[126]

  0.44,[126]

 0.45,[139]

 0.5[4]

  x109/L

1[8]

  3,[8]

 7 % of WBC

Newborn 0.02[139]

  0.85[139]

  x109/L

Basophil granulocytes Adult

40[138]

  100,[126][4]

 200,[139]

 900[138]

  x106/L

0.0 0.75,[8]

 2 % of WBC

Newborn 0.64[139]

  x109/L

Coagulation

Test  Lower limit  Upper limit  Unit  Comments 

Thrombocyte/Platelet count (Plt) 140,[9]

 150[8][4]

  350,[17][4]

 400,[8]

450[9]

 x10 /L orx1000/µL

Mean platelet volume (MPV) 7.4[141]

  10.4[141]

  fL 

Prothrombin time (PT) 10, 11, 12 13, 13.5, 14, 15 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,[9]

 30[12][4]

  28,[9]

 42,[4]

 45[12]

  s

Thrombin clotting time (TCT) 11 18 s

Fibrinogen 1.7, 2.0 3.6, 4.2 g/L

 Antithrombin  0.80 1.2 kIU/L

Bleeding time  2 9 minutes

Viscosity 1.5 1.72 cP 

ImmunologyAcute phase proteins Acute phase proteins are markers of  inflammation. 

Test  Patient  Lower limit  Upper limit  Unit  Comments 

Erythrocyte sedimentation rate (ESR)

Male0

 Age÷2[144]

 mm/hr ESR increases with age and tends to be higher in females.

[145] 

Female (Age+10)÷2[144]

 

C-reactive protein (CRP) n/a 5,[146][4]

 6[147]

  mg/L

8/13/2019 Severe Ane

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 200,

[148]240

[148]  nmol/L

 Alpha 1-antitrypsin (AAT)20,

[149]22

[150]  38,

[150] 53

[149]  μmol/L 

89, 97 170, 230 mg/dL

Isotypes of antibodiesFurther information:  Antibody  

Test  Patient  Lower limit  Upper limit  Unit  Comments 

IgA

 Adult

70, 110 360, 560

mg/dL

IgD 0.5 3.0

IgE 0.01 0.04

IgG  800 1800

IgM 54[152]  220[152] 

AutoantibodiesFor 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 whetherthe 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

[153] are given for

the ELISA test.

Test  Negative  Equivocal  Positive  Unit 

anti-SS-A (Ro) < 15 15-25 > 25

Unitsper

millilitre(U/mL)

anti-SS-B (La) < 3 3 – 4 > 4

 Anti ds-DNA < 40 40 – 60 > 60

 Anti ss-DNA < 8 8 - 10 > 10

 Anti-histone antibodies < 25 n/a > 25

Cytoplasmic/classicalanti-neutrophil cytoplasmicantibodies (c-ANCA)

< 20[154]

  21 - 30[154]

  > 30[154]

 

Perinuclearanti-neutrophil cytoplasmicantibodies (p-ANCA)

< 5[154]

  n/a > 5[154]

 

 Anti-mitochondrial antibodies ( AMA) < 10[154]

  n/a[154]

  > 10[154]

 

Rheumatoid factor  (RF) < 20 20 - 30 > 30[9]

 

 Antistreptolysin O titre (ASOT) inpreschoolers

> 100

 ASOT at school age > 250

 ASOT in adults > 125

Test  Negative  Low/weak positive  Moderate positive  High/strong positive  Unit 

 Anti-phospholipid IgG < 20[154]

  20 –30[154]

  31 – 50[154]

  > 51[154]

  GPLU/ml[154]

 

 Anti-phospholipid IgM < 1.5[154]

  1.5 –2.5[154]

  2 – 9.9[154]

  > 10[154]

  MPL /ml[154]

 

 Anti-phospholipid IgA < 10[154]

  10 -20[154]

  21 – 30[154]

  > 31[154]

  arb U/ml[154]

 

 Anti-citrullinated protein antibodies < 20[154]

  20 – 39[154]

  40 - 59[154]

  > 60[154]

  EU[154]

 

Other enzymes and proteins

Test  Lower limit  Upper limit  Unit  Comments 

Lactate dehydrogenase (LDH)

50 150 U/L

0.4[47]

  1.7[47]

  μmol/L 

1.8[4]

  3.4[4]

  µkat/L < 70 years old[4]

 

 Amylase 

25,[8]

 30,[9]

 53[17]

  110,[9]

 120,[155]

 123,[17]

 125,[8]

190[47]

  U/L

0.15[4]

  1.1[4]

  µkat/L

200[148]

  240[148]

  nmol/L

D-dimer   n/a500

[156]  ng/mL

Higher in pregnant women[157]

 0.5

[4]  mg/L

Lipase 7,[9]

 10,[17]

 23[47]

  60,[9]

 150,[17]

 208[47]

  U/L

 Angiotensin-converting enzyme( ACE) 23[47]

  57[47]

  U/L

 Acid phosphatase   3.0

[47]

  ng/mL

Eosinophil cationic protein (ECP) 2.3[4]

  16[4]

  µg/L

Other electrolytes and metabolitesElectrolytes and Metabolites: For iron and copper, some related proteins are also included.

Test  Patient type  Lower limit  Upper limit  Unit  Comments 

Osmolality 

275, 280, 281 295, 296, 297 mOsm/kg Plasma weight excludes solutes

Osmolarity 

Slightly less than osmolality mOsm/l Plasma volume includes solutes

Urea 

3.0 7.0 mmol/LBUN - blood urea nitrogen 

7 18, 21 mg/dL

* Uric acid[9]

 

0.18 0.48 mmol/L

Female 2.0 7.0 mg/dL

Male 2.1 8.5 mg/dL

Creatinine male60, 68 90, 118 μmol/L 

May be complemented with creatinine clearance 0.7, 0.8 1.0, 1.3 mg/dL

8/13/2019 Severe Ane

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female50,

[4] 68

[159]  90,

[4] 98

[159]  μmol/L 

0.6,[160]

 0.8[160]

  1.0,[160]

 1.1[160]

  mg/dL

BUN/Creatinine Ratio 5 35 -

Plasma glucose(fasting)3.8, 4.0 6.0, 6.1 mmol/L

See also glycosylated hemoglobin (in hematology)65,

[9] 70,

[8] 72

[162]  100,

[161] 110

[17]  mg/dL

Full blood glucose (fasting)3.3 5.6 mmol/L

60 100 mg/dL

Lactate (Venous)4.5 19.8 mg/dL

0.5 2.2 mmol/L

Lactate (Arterial)4.5 14.4 mg/dL

0.5 1.6 mmol/L

Pyruvate 

300 900 μg/dL 

34 102 μmol/L