C AS E R EC O R D S O F T H E M AS SAC H U S ET T S G E N E R A L H O S P I TA L

Case Records of the Massachusetts General Hospital

Weekly Clinicopathological Exercises

FOUNDED BY RICHARD C. CABOT

R O B E R T E . S C U L L Y , M . D. , Editor W I L L I A M F . M C N E E L Y , M . D. , Associate Editor

E U G E N E J . M A R K , M . D. , Associate Editor S A L L Y H . E B E L I N G , Assistant Editor

NORMAL REFERENCE LABORATORY VALUES

PREPARED BY ALEXANDER KRATZ, M.D., PH.D., AND KENT B. LEWANDROWSKI, M.D.

The following is a table of reference values, meth-
ods, and conversion factors for tests commonly or-
dered at the Massachusetts General Hospital (MGH)
and recorded in the Case Records. The table revises
the most recently published data (Normal Reference
Laboratory Values. N Engl J Med 1992;327:718-
24). Laboratory values are expressed in the units
used at MGH (MGH units) and the units of the
Système International d’Unités (SI units), with a
factor to convert MGH units to SI units by multi-
plication. This table is not intended to provide a
comprehensive review of reference values, since this
information is widely available in standard text-
books. Detailed information on specific methods
and instruments is not provided, in order to avoid
suggesting an endorsement of commercial products
by the hospital or the Journal. Because reference val-
ues are affected by many variables, the ranges used
at MGH may not be appropriate for other insti-
tutions. Furthermore, the methods and units report-
ed should not be interpreted as a judgment about
the optimal way to perform or report a given labo-
ratory test.
The table was compiled with the aid of Dr. Mi-
chael Laposata, Dr. James Flood, Dr. Neal Smith,
Dr. Kathryn Ruoff, Dr. Mary Jane Ferraro, Dr. Eliz-
abeth Van Cott, William Young, Catherine Tuttle,
Patricia Puopolo, Linda Ardisson, Ela Dhanak, Ed-
ward Masley, Fu-Mei Huang, Stephen Johnson, Lin-
da Jennings, Jeanne Casey, and Debera Grzybek.

CHEMISTRY

FACTOR FOR
CONVERSION
ANALYTE SPECIMEN* MGH UNIT SI UNIT METHOD OR INSTRUMENT TO SI UNIT

Adrenocorticotropin (ACTH) P 6.0–76.0 pg/ml 1.3–16.7 pmol/liter Immunoassay 0.2202

Alanine aminotransferase (ALT, SGPT) S Kinetic method 0.01667
Female 7–30 U/liter 0.12–0.50 mkat/liter
Male 10–55 U/liter 0.17–0.92 mkat/liter
Albumin S 3.1–4.3 g/dl 31–43 g/liter Colorimetry (bromo- 10
cresol purple)
Aldolase S 0–7 U/liter 0–7 U/liter Kinetic method 1
Aldosterone (adult) Immunoassay
Supine, normal-sodium diet S, P 2–9 ng/dl 55–250 pmol/liter 27.74
Upright, normal-sodium diet S, P 2–5 times supine value with
normal-sodium diet
Supine, low-sodium diet S, P 2–5 times supine value with
normal-sodium diet
Urine, normal-sodium diet U 2.3–21.0 mg/24 hr 6.38–58.25 nmol/24 hr 2.774
Alkaline phosphatase (adult) S Kinetic method 0.01667
Female 30–100 U/liter 0.5–1.67 mkat/liter
Male 45–115 U/liter 0.75–1.92 mkat/liter
Alkaline phosphatase, heat fractionated S 20–35% 0.20–0.35 Kinetic method 0.01

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CHEMISTRY (Continued)

FACTOR FOR
CONVERSION
ANALYTE SPECIMEN* MGH UNIT SI UNIT METHOD OR INSTRUMENT TO SI UNIT

Alpha-fetoprotein (nonmaternal) S <12.8 IU/ml <9.92 mg/liter Immunoassay 0.775

Ammonia P 12–48 µmol/liter 12–48 mmol/liter Enzymatic analysis 1
Amylase S 53–123 U/liter 0.88–2.05 nkat/liter Kinetic method 0.01667
P 43–115 U/liter 0.72–1.92 nkat/liter
U 4–400 U/liter 0.07–6.67 nkat/liter
Androstenedione (adult) S 50–250 ng/dl 1.75–8.73 nmol/liter Immunoassay 0.0349
Angiotensin-converting enzyme S Kinetic method 1
Male 19–95 U/liter 19–95 U/liter
Female 19–79 U/liter 19–79 U/liter
Apolipoprotein S Nephelometry
Apolipoprotein A-1 119–240 mg/dl 1.19–2.4 g/liter 0.01
Apolipoprotein B 52–163 mg/dl 0.52–1.63 g/liter 0.01
Apolipoprotein B:apolipoprotein A-1 ratio 0.35–0.98 0.35–0.98 1
Aspartate aminotransferase (AST, SGOT) S Kinetic method 0.01667
Female 9–25 U/liter 0.15–0.42 mkat/liter
Male 10–40 U/liter 0.17–0.67 mkat/liter
Beta2-microglobulin S, P 1.2–2.8 mg/liter 1.2–2.8 mg/liter Immunoassay 1
U <200 µg/liter <200 mg/liter
Bicarbonate (HCO3 ) ¡ WB, S 22–26 meq/liter 22–26 mmol/liter Calculation 1
Bilirubin, direct S 0.0–0.4 mg/dl 0–7 mmol/liter Colorimetry 17.1
Bilirubin, total S 0.0–1.0 mg/dl 0–17 µmol/liter Colorimetry 17.1
C peptide (adult) S, P 0.5–2.0 ng/ml 0.17–0.66 nmol/liter Immunoassay 0.33
C-reactive protein S 0.0–12.0 mg/liter 0–12 mg/liter Nephelometry 1
CA 15-3 S 0–30 U/ml 0–30 kU/liter Immunoassay 1
CA 19-9 S 0–37 U/ml 0–37 kU/liter Immunoassay 1
CA 27,29 S 0–32 U/ml 0–32 kU/liter Immunoassay 1
CA-125 S 0–35 U/ml 0–35 kU/liter Immunoassay 1
Calcitonin S Immunoassay 1
Male 3–26 pg/ml 3–26 ng/liter
Female 2–17 pg/ml 2–17 ng/liter
Calcium S 8.5–10.5 mg/dl 2.1–2.6 mmol/liter Colorimetry 0.25
U 0–300 mg/24 hr 0.0–7.5 mmol/24 hr Colorimetry 0.025
Calcium, ionized WB 1.14–1.30 mmol/liter 1.14–1.30 mmol/liter Ion-selective electrode 1
Carbon dioxide content, total P 24–30 mmol/liter 24–30 mmol/liter Carbon dioxide electrode 1
Carbon dioxide, partial pressure, arterial WB 35–45 mm Hg 4.7–6.0 kPa Carbon dioxide electrode 0.1333
(PaCO2)
Carboxyhemoglobin WB <5% of total hemoglobin <0.05 fraction of total Co-oximetry 0.01
hemoglobin saturation
Carcinoembryonic antigen (CEA) P, S 0.0–3.4 ng/ml 0.0–3.4 mg/liter Immunoassay 1
Catecholamines (adult) U High-pressure liquid
chromatography
Epinephrine 2–24 mg/24 hr 11–131 nmol/24 hr 5.458
Norepinephrine 15–100 mg/24 hr 89–591 nmol/24 hr 5.911
Dopamine 52–480 mg/24 hr 340–3134 nmol/24 hr 6.53
Total (epinephrine + norepinephrine) 26–121 mg/24 hr 142–660 nmol/24 hr 5.458
(as normet-
anephrine)
Cerebrospinal fluid (adult) CSF
Albumin 11–48 mg/dl 0.11–0.48 g/liter Nephelometry 0.01
Cell count 0–5 mononuclear cells/ml 0–5¬106 cells/liter Manual count 1¬106
Chloride 120–130 mmol/liter 120–130 mmol/liter Coulometry 1
Glucose 50–75 mg/dl 2.8–4.2 mmol/liter Enzymatic analysis 0.05551
IgG 8.0–8.6 mg/dl 0.08–0.086 g/liter Nephelometry 0.01
Pressure 70–180 mm of water 70–180 arbitrary units Manual measurement 1
Protein
Lumbar 15–45 mg/dl 0.15–0.45 g/liter Turbidometry 0.01
Cisternal 15–25 mg/dl 0.15–0.25 g/liter
Ventricular 5–15 mg/dl 0.05–0.15 g/liter
Ceruloplasmin S 27–50 mg/dl 270–500 mg/liter Nephelometry 10
Chloride P 100–108 mmol/liter 100–108 mmol/liter Coulometry 1
U Depends on diet Depends on diet
Cholesterol S Colorimetry 0.02586
Desirable <200 mg/dl <5.17 mmol/liter
Borderline high 200–239 mg/dl 5.17–6.18 mmol/liter
High >239 mg/dl >6.18 mmol/liter
Cortisol S Immunoassay 27.59
Fasting, 8 a.m.–noon 5–25 mg/dl 138–690 nmol/liter
Noon–8 p.m. 5–15 mg/dl 138–414 nmol/liter
8 p.m.–8 a.m. 0–10 mg/dl 0–276 nmol/liter
Cortisol, free U 20–70 mg/24 hr 55–193 nmol/24 hr Immunoassay 2.759

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CHEMISTRY (Continued)

FACTOR FOR
CONVERSION
ANALYTE SPECIMEN* MGH UNIT SI UNIT METHOD OR INSTRUMENT TO SI UNIT

Creatine kinase (CK) S Kinetic method 0.01667

Male 60–400 U/liter 1.00–6.67 mkat/liter
Female 40–150 U/liter 0.67–2.50 mkat/liter
Creatine kinase isoenzyme index S 0–2.5% relative index None ng/ml None
Total CK(U/liter) ¬100
Creatine kinase isoenzymes, MB fraction S 0–5 ng/ml 0–5 µg/liter Immunoassay 1
Creatinine P 0.6–1.5 mg/dl 53–133 mmol/liter Colorimetry 88.4
U 15–25 mg/kg/day 0.13–0.22 mmol/kg/day 0.0884
Dehydroepiandrosterone (DHEA) (adult) S Immunoassay 0.03467
Male 180–1250 ng/dl 6.24–43.3 nmol/liter
Female 130–980 ng/dl 4.5–34.0 nmol/liter
Dehydroepiandrosterone (DHEA) S Immunoassay 10
sulfate (adult)
Male 10–619 mg/dl 100–6190 mg/liter
Female
Premenopausal 12–535 mg/dl 120–5350 mg/liter
Postmenopausal 30–260 mg/dl 300–2600 mg/liter
Deoxycorticosterone (DOC) (adult) S 2–19 ng/dl 61–576 nmol/liter Immunoassay 30.3
11-Deoxycortisol (adult) (8 a.m. sample) S 12–158 ng/dl 0.35–4.56 nmol/liter Immunoassay 0.02886
1,25-Dihydroxyvitamin D S 18–62 pg/ml 43.2–148.8 pmol/liter Immunoassay 2.4
Estradiol S, P Immunoassay 3.671
Female
Menstruating
Follicular phase 50–145 pg/ml 184–532 pmol/liter
Midcycle peak 112–443 pg/ml 411–1626 pmol/liter
Luteal phase 50–241 pg/ml 184–885 pmol/liter
Postmenopausal <59 pg/ml <217 pmol/liter
Male <50 pg/ml <184 pmol/liter
Fatty acids, free (adult) S 0.17–0.95 mmol/liter 0.17–0.95 mmol/liter Spectrophotometry 1
Follicle-stimulating hormone (FSH) S, P Immunoassay 1
Female
Menstruating
Follicular phase 3.0–20.0 U/liter 3.0–20.0 U/liter
Ovulatory phase 9.0–26.0 U/liter 9.0–26.0 U/liter
Luteal phase 1.0–12.0 U/liter 1.0–12.0 U/liter
Postmenopausal 18.0–153.0 U/liter 18.0–153.0 U/liter
Male 1.0–12.0 U/liter 1.0–12.0 U/liter
Gastrin S <100 ng/liter <100 ng/liter Immunoassay 1
Globulin S 2.6–4.1 g/dl 26–41 g/liter Calculation: total pro- 10
tein¡albumin
Glucagon P 20–100 pg/ml 20–100 ng/liter Immunoassay 1
Glucose U <0.05 g/dl <0.003 mmol/liter Enzymatic analysis 0.05551
Glucose, fasting P 70–110 mg/dl 3.9–6.1 mmol/liter Enzymatic analysis 0.05551
g-Glutamyltransferase (GGT) S Spectrophotometry 1
Male 1–94 U/liter 1–94 U/liter
Female 1–70 U/liter 1–70 U/liter
Growth hormone (resting) S 2–5 ng/ml 2–5 µg/liter Immunoassay 1
Hemoglobin A1C WB 3.8–6.4% 0.038–0.064 Liquid chromatography 0.01
High-density lipoprotein cholesterol, as S <35 mg/dl <0.91 mmol/liter Colorimetry 0.02586
major risk factor
Human chorionic gonadotropin (hCG) S <5 mIU/ml <5 IU/liter Immunoassay 1
(nonpregnant women)
5-Hydroxyindoleacetic acid (5-HIAA) U «6 mg/24 hr «31.4 µmol/day High-pressure liquid 5.23
chromatography
17-Hydroxyprogesterone (adult) S Immunoassay 0.03
Male 5–250 ng/dl 0.15–7.5 nmol/liter
Female
Follicular phase 20–100 ng/dl 0.6–3.0 nmol/liter
Midcycle peak 100–250 ng/dl 3–7.5 nmol/liter
Luteal phase 100–500 ng/dl 3–15 nmol/liter
Postmenopausal «70 ng/dl «2.1 nmol/liter
25-Hydroxyvitamin D S 8–42 ng/ml 20–105 nmol/liter Immunoassay 2.496
Insulin S, P 2–20 µU/ml 14.35–143.5 pmol/liter Immunoassay 7.175
Ketone (acetone) S, U Negative Negative Colorimetry (nitro-
prusside)
17-Ketosteroids U Modified Zimmerman 3.467
Male 7–20 mg/24 hr 24.3–69.3 µmol/24 hr reaction
Female 5–15 mg/24 hr 17.3–52.0 µmol/24 hr
Lactic acid P 0.5–2.2 mmol/liter 0.5–2.2 mmol/liter Enzymatic analysis 1
Lactate dehydrogenase (LDH) S 110–210 U/liter 1.83–3.50 µkat/liter Kinetic method 0.01667

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 The Ne w E n g l a nd Jo u r n a l o f Me d ic i ne

CHEMISTRY (Continued)

FACTOR FOR
CONVERSION
ANALYTE SPECIMEN* MGH UNIT SI UNIT METHOD OR INSTRUMENT TO SI UNIT

Lactate dehydrogenase isoenzymes S

LD1 16–29% 0.16–0.29 Electrophoresis 0.01
LD2 30–41% 0.30–0.41 Electrophoresis 0.01
LD3 15–24% 0.15–0.24 Electrophoresis 0.01
LD4 6–13% 0.06–0.13 Electrophoresis 0.01
LD5 5–29% 0.05–0.29 Electrophoresis 0.01
Total LDH (when isoenzymes deter- 90–250 U/liter 1.5–4.17 µkat/liter Kinetic method 0.01667
mined)
Lipase S 3–19 U/dl 0.5–3.17 µkat/liter Kinetic method 0.1667
Lipoprotein(a) S 0–30 mg/dl 0–300 mg/liter Nephelometry 10
Low-density lipoprotein cholesterol S Calculation 0.02586
Desirable <130 mg/dl <3.36 mmol/liter
Borderline high risk 130–159 mg/dl 3.36–4.11 mmol/liter
High risk »160 mg/dl »4.13 mmol/liter
Luteinizing hormone (LH) S, P Immunoassay 1
Female
Menstruating
Follicular phase 2.0–15.0 U/liter 2.0–15.0 U/liter
Ovulatory phase 22.0–105.0 U/liter 22.0–105.0 U/liter
Luteal phase 0.6–19.0 U/liter 0.6–19.0 U/liter
Postmenopausal 16.0–64.0 U/liter 16.0–64.0 U/liter
Male 2.0–12.0 U/liter 2.0–12.0 U/liter
Magnesium S 1.4–2.0 meq/liter 0.7–1.0 mmol/liter Colorimetry 0.5
Metanephrines U Chromatography
Metanephrine 45–290 µg/24 hr 245–1583 nmol/24 hr 5.458
Normetanephrine 82–500 µg/24 hr 448–2730 nmol/24 hr 5.46
Total 120–700 µg/24 hr 655–3821 nmol/24 hr 5.458
Methemoglobin P 0.4–1.5% of total hemo- 0.004–0.015 Co-oximetry 0.01
globin
Microalbumin, random urine U <20 µg/ml <20 mg/liter Nephelometry 1
5'-Nucleotidase S 0–11 U/liter 0.02–0.18 µkat/liter Kinetic method 0.01667
Osmolality S, P 280–296 mOsm/kg of 280–296 mmol/kg of Freezing-point 1
water water depression
Oxygen, partial pressure, arterial (PaO2) WB 80–100 mm Hg 10.7–13.3 kPa Oxygen electrode 0.1333
(room air, age dependent)
Parathyroid hormone S 10–60 pg/ml 10–60 ng/liter Immunoassay 1
Parathyroid hormone–related protein P <1.3 pmol/liter <1.3 pmol/liter Immunoassay 1
pH, arterial WB 7.35–7.45 pH units 7.35–7.45 pH units pH electrode 1
Phosphorus, inorganic (adult) S 2.6–4.5 mg/dl 0.84–1.45 mmol/liter Spectrophotometry 0.3229
U average, 1 g/day average, 32 mmol/day 32.29
Potassium P 3.4–4.8 mmol/liter 3.4–4.8 mmol/liter Ion-selective electrode 1
S 3.5–5.0 mmol/liter 3.5–5.0 mmol/liter
U Depends on diet Depends on diet
Prealbumin (adult) S 19.5–35.8 mg/dl 195–358 mg/liter Nephelometry 10
Progesterone S,P Immunoassay 3.18
Female
Follicular phase <1.0 ng/ml <3.18 nmol/liter
Midluteal phase 3–20 ng/ml 9.54–63.6 nmol/liter
Male <1.0 ng/ml <3.18 nmol/liter
Prolactin S Immunoassay 1
Female
Premenopausal 0–20 ng/ml 0–20 µg/liter
Postmenopausal 0–15 ng/ml 0–15 µg/liter
Male 0–15 ng/ml 0–15 µg/liter
Prostate-specific antigen (PSA) S Immunoassay 1
Female <0.5 ng/ml <0.5 µg/liter
Male
<40 yr old 0.0–2.0 ng/ml 0.0–2.0 µg/liter
»40 yr old 0.0–4.0 ng/ml 0.0–4.0 µg/liter
Prostate-specific antigen (PSA), free, in S >25% associated with benign >0.25 associated with Immunoassay, calculation 0.01
males 45–75 yr old, with PSA values prostatic hyperplasia benign prostatic hyper-
between 4 and 20 ng/ml plasia
Protein, total S 6.0–8.0 g/dl 60–80 g/dl Colorimetry 10
U <165 mg/day <0.165 g/day Turbidometry 0.001
Renin (adult, normal-sodium diet) P Immunoassay 0.2778
Supine 0.3–3.0 ng/ml/hr 0.08–0.83 ng/(liter . sec)
Upright 1.0–9.0 mg/ml/hr 0.28–2.5 ng/(liter . sec)
Serotonin WB 55–260 ng/ml 0.31–1.48 µmol/liter High-pressure liquid 0.00568
chromatography
Sex hormone–binding globulin (adult) S Immunoassay 1
Male 6–44 mmol/liter 6–44 mmol/liter
Female 8–85 mmol/liter 8–85 mmol/liter

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 C AS E R EC O R D S O F T H E M AS SAC H U S ET T S G E N E R A L H O S P I TA L

CHEMISTRY (Continued)

FACTOR FOR
CONVERSION
ANALYTE SPECIMEN* MGH UNIT SI UNIT METHOD OR INSTRUMENT TO SI UNIT

Sodium P 135–145 mmol/liter 135–145 mmol/liter Ion-selective electrode 1

U Depends on diet Depends on diet
Somatomedin C (insulin-like growth factor I) S Immunoassay 1
16–24 yr 182–780 ng/ml 182–780 µg/liter
25–39 yr 114–492 ng/ml 114–492 µg/liter
40–54 yr 90–360 ng/ml 90–360 µg/liter
>54 yr 71–290 ng/ml 71–290 µg/liter
Testosterone, total (morning sample) S Immunoassay 0.03467
Female 6–86 ng/dl 0.21–2.98 nmol/liter
Male 270–1070 ng/dl 9.36–37.10 nmol/liter
Testosterone, unbound (morning sample) S Immunoassay 34.67
Female
20–40 yr 0.6–3.1 pg/ml 20.8–107.5 pmol/liter
41–60 yr 0.4–2.5 pg/ml 13.9–86.7 pmol/liter
61–80 yr 0.2–2.0 pg/ml 6.9–69.3 pmol/liter
Male
20–40 yr 15.0–40.0 pg/ml 520–1387 pmol/liter
41–60 yr 13.0–35.0 pg/ml 451–1213 pmol/liter
61–80 yr 12.0–28.0 pg/ml 416–971 pmol/liter
Thyroglobulin S 0–60 ng/ml 0–60 µg/liter Immunoassay 1
Thyroid hormone–binding index S 0.77–1.23 0.77–1.23 Immunoassay 1
(THBI; T3RU)
Thyroid-stimulating hormone S 0.5–5.0 µU/ml 0.5–5.0 µU/ml Immunoassay 1
Thyroxine, total (T4) S 4.5–10.9 µg/dl 58–140 nmol/liter Immunoassay 12.87
Transferrin S 191–365 mg/dl 1.91–3.65 g/liter Nephelometry 0.01
Triglycerides (fasting) S 40–150 mg/dl 0.45–1.69 mmol/liter Spectrophotometry 0.01129
Triiodothyronine, total (T3) S 60–181 ng/dl 0.92–2.78 nmol/liter Immunoassay 0.01536
Troponin I S <0.6 ng/ml <0.6 µg/liter Immunoassay 1
>1.5 ng/ml consistent with >1.5 µg/liter
acute myocardial infarct
Urea nitrogen (BUN) (adult) P 8–25 mg/dl 2.9–8.9 mmol/liter Conductivity 0.357
Urea nitrogen, urine U 6–17 g/day 6–17 g/day Conductivity 1
Uric acid S Colorimetry 59.48
Male 3.6–8.5 mg/dl 214–506 µmol/liter
Female 2.3–6.6 mg/dl 137–393 µmol/liter
Urinalysis U Reflectance
pH 5.0–9.0 5.0–9.0 Spectrophotometry 1
Specific gravity 1.001–1.035 1.001–1.035 1
Chemical screens Negative Negative
Urine sediment U Manual method
White cells 0–2/high-power field 0–2/high-power field 1
Red cells 0–2/high-power field 0–2/high-power field 1
Vasoactive intestinal polypeptide (VIP) P <75 pg/ml <75 ng/liter Immunoassay 1
Xylose Colorimetric
U 4–9 g/5 hr 4–9 g/5 hr 1
S None detected None detected
(fasting)

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 The Ne w E n g l a nd Jo u r n a l o f Me d ic i ne

TOXICOLOGY AND THERAPEUTIC DRUG MONITORING

FACTOR FOR
CONVERSION
ANALYTE SPECIMEN* MGH UNIT SI UNIT METHOD OR INSTRUMENT TO SI UNIT

Acetaminophen, toxicity S >120 µg/ml at 2–4 hr >794 µmol/liter at 2–4 hr Liquid chromatography 6.62
Amikacin S Immunoassay 1.71
Trough 1–7 µg/ml 1.7–12 µmol/liter
Peak 15–25 µg/ml 26–43 µmol/liter
Amitriptyline S Liquid chromatography 3.61
Amitriptyline 120–250 µg/liter 433–903 nmol/liter
Nortriptyline 50–150 µg/liter 181–542 nmol/liter
Barbiturate screen S Negative Negative Liquid chromatography
Basic drug screen S Negative Negative Liquid chromatography
Benzodiazepine screen S Negative Negative Liquid chromatography
Carbamazepine (adult) S 4–12 µg/ml 17–51 µmol/liter Immunoassay 4.23
Chlordiazepoxide S 1.0–3.0 mg/liter 3.3–10 µmol/liter Liquid chromatography 3.336
Clomipramine S 150–450 µg/liter 476–1427 nmol/liter Liquid chromatography 3.17
Clonazepam S 10–70 µg/liter 32–222 nmol/liter Liquid chromatography 3.17
Clozapine S Liquid chromatography
Clozapine 150–500 µg/liter 459–1530 nmol/liter 3.06
Norclozapine 100–450 µg/liter 320–1440 nmol/liter 3.20
Desipramine S 150–300 µg/liter 563–1125 nmol/liter Liquid chromatography 3.75
Diazepam S 100–1000 µg/liter 0.35–3.50 µmol/liter Liquid chromatography 0.0035
Digoxin S 0.9–2.0 ng/ml 1.2–2.6 nmol/liter Immunoassay 1.28
Doxepin S 150–250 µg/liter 537–895 nmol/liter Liquid chromatography 3.58
Ethanol S Clinical intoxication: Clinical intoxication: Gas chromatography 0.001
>1000 mg/liter >1 g/liter
Fluoxetine S Liquid chromatography
Fluoxetine 50–450 µg/liter 162–1454 nmol/liter 3.23
Norfluoxetine 50–450 µg/liter 169–1521 nmol/liter 3.38
Fluvoxamine S 12–240 µg/liter 38–756 nmol/liter Liquid chromatography 3.15
Gentamicin S Immunoassay
Trough <2.1 µg/ml <4.4 µmol/liter 2.09
Peak 4–8 µg/ml 8.4–16.7 µmol/liter 2.09
Imipramine S Liquid chromatography
Imipramine 150–250 µg/liter 536–893 nmol/liter 3.57
Desipramine 150–300 µg/liter 563–1125 nmol/liter 3.75
Lithium S, P 0.5–1.5 mmol/liter 0.5–1.5 mmol/liter Ion-selective electrode 1
Methadone S 50–800 µg/liter 0.16–2.58 µmol/liter Liquid chromatography 0.00323
Methotrexate S Immunoassay 1
24 hr after high-dose infusion <10 µmol/liter <10 µmol/liter
48 hr after high-dose infusion <1 µmol/liter <1 µmol/liter
72 hr after high-dose infusion <0.4 µmol/liter <0.4 µmol/liter
Nordiazepam S 100–800 µg/liter 0.37–2.95 µmol/liter Liquid chromatography 0.00369
Paroxetine S 20–190 µg/liter 61–576 nmol/liter Liquid chromatography 3.03
Phenobarbital S 15–50 µg/ml 65–216 µmol/liter Immunoassay 4.31
Phenytoin S 5–20 µg/ml 20–79 µmol/liter Immunoassay 3.96
Quinidine S 1.2–4.0 µg/ml 3.7–12.3 µmol/liter Liquid chromatography 3.08
Salicylate intoxication >500 mg/liter >3.62 mmol/liter 0.00724
Sertraline S 40–160 µg/liter 130–522 nmol/liter Liquid chromatography 3.26
Sulfamethoxazole S 5–15 mg/dl 19.8–59.2 nmol/liter Liquid chromatography 3.95
Theophylline S 10–20 µg/ml 56–111 µmol/liter Immunoassay 5.55
For apnea control 5–15 µg/ml 28–83 µmol/liter
Thiocyanate, toxic range S >100 mg/liter >1720 µmol/liter Spectrophotometry 17.2
Tobramycin S Immunoassay 2.14
Trough <2.0 µg/ml <4.3 µmol/liter
Peak 4.0–8.0 µg/ml 8.6–17.1 µmol/liter
Trazodone S 800–1600 µg/liter 2152–4304 nmol/liter Liquid chromatography 2.69
Valproic acid S 50–100 µg/ml 347–693 µmol/liter Immunoassay 6.93
Vancomycin S Immunoassay 0.690
Trough <10.1 µg/ml <7.0 µmol/liter
Peak (2 hr after infusion) 18–26 µg/ml 12–18 µmol/liter

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 C AS E R EC O R D S O F T H E M AS SAC H U S ET T S G E N E R A L H O S P I TA L

IMMUNOLOGY

FACTOR FOR
CONVERSION
ANALYTE SPECIMEN* MGH UNIT SI UNIT METHOD OR INSTRUMENT† TO SI UNIT

Alpha1-antitrypsin (adult) S 76–189 mg/dl 0.76–1.89 g/liter Nephelometry 0.01

Anti–glomerular basement membrane S
antibodies
Qualitative Negative Negative Western blot assay
Quantitative <5 U/ml <5 kU/liter ELISA 1
Antineutrophil cytoplasmic autoanti- S
bodies, cytoplasmic (C-ANCA)
Qualitative Negative Negative Indirect immunofluorescence
Quantitative (antibodies to <2.8 U/ml <2.8 kU/liter ELISA 1
proteinase 3)
Antineutrophil cytoplasmic autoanti- S
bodies, perinuclear (P-ANCA)
Qualitative Negative Negative Indirect immunofluorescence
Quantitative (antibodies to myeloper- <1.4 U/ml <1.4 kU/liter ELISA 1
oxidase)
Autoantibodies
Antiadrenal antibody S Negative at 1:10 dilution Not applicable Indirect immunofluorescence
Anti–double-stranded (native) DNA S Negative at 1:10 dilution Not applicable Indirect immunofluorescence
Antigranulocyte antibody S Negative Not applicable ELISA
Anti–Jo-1 antibody S Negative Not applicable ELISA
Anti-La antibody S Negative Not applicable ELISA
Antimitochondrial antibody S Negative Not applicable Indirect immunofluorescence
Antinuclear antibody S Negative at 1:40 dilution Not applicable Indirect immunofluorescence
Anti–parietal-cell antibody S Negative at 1:20 dilution Not applicable Indirect immunofluorescence
Anti-Ro antibody S Negative Not applicable ELISA
Anti-RNP antibody S Negative Not applicable ELISA
Anti–Scl-70 antibody S Negative Not applicable ELISA
Anti-Smith antibody S Negative Not applicable ELISA
Anti–smooth-muscle antibody S Negative at 1:20 dilution Not applicable Indirect immunofluorescence
Antithyroglobulin antibody S Negative Not applicable Immunoassay
Antithyroid antibody S <0.3 IU/ml <0.3 kIU/liter Immunoassay 1
Bence Jones protein S None detected Not applicable Immunoelectrophoresis
Qualitative U None detected in a Not applicable Immunoelectrophoresis
50-fold concentration
Quantitative U Nephelometry
Kappa <2.5 mg/dl <0.03 g/liter 0.01
Lambda <5.0 mg/dl <0.05 g/liter 0.01
C1-esterase–inhibitor protein S
Antigenic 12.4–24.5 mg/dl 0.12–0.25 g/liter Nephelometry 0.01
Functional Present Present Immunodiffusion
Complement
C3 (adult) S 86–184 mg/dl 0.86–1.84 g/liter Nephelometry 0.01
C4 (adult) S 20–58 mg/dl 0.20–0.58 g/liter Nephelometry 0.01
Total complement (adult) S 63–145 U/ml 63–145 kU/liter Immunoassay 1
Factor B S 17–42 mg/dl 0.17–0.42 g/liter Nephelometry 0.01
Cryocrit S None detected Not applicable Manual method
Cryoproteins S None detected Not applicable Manual method
Cryoprotein identification S None detected Not applicable Immunodiffusion
CSF CSF
Agarose electrophoresis No banding seen in an Not applicable Agarose electrophoresis
80-fold concentration
Quantitation of albumin (adult) 11.0–50.9 mg/dl 0.11–0.51 g/liter Nephelometry 0.01
Quantitation of IgG (adult) 0.0–8.0 mg/dl 0.0–0.08 g/liter Nephelometry 0.01
Haptoglobin S 16–199 mg/dl 0.16–1.99 g/liter Nephelometry 0.01
Immunofixation S None detected Not applicable Agarose electrophoresis
Immunoglobulin (adult)
IgA S 60–309 mg/dl 0.60–3.09 g/liter Nephelometry 0.01
IgE S 10–179 IU/ml 24–430 µg/liter Immunoassay 2.4
IgG S 614–1295 mg/dl 6.14–12.95 g/liter Nephelometry 0.01
IgM S 53–334 mg/dl 0.53–3.34 g/liter Nephelometry 0.01
Joint fluid crystal JF No crystals seen Not applicable Microscopy
Joint fluid mucin JF Only type I mucin Not applicable Manual method
present
Rheumatoid factor S, JF <30 IU/ml <30 kIU/liter Nephelometry 1
Serum protein electrophoresis S Normal pattern Not applicable Agarose electrophoresis
Viscosity S 1.4–1.8 relative viscosity 1.4–1.8 relative viscosity Ostwald viscosimetry 1
units, as compared with units, as compared with
water water

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 The Ne w E n g l a nd Jo u r n a l o f Me d ic i ne

HEMATOLOGY AND COAGULATION

FACTOR FOR
CONVERSION
ANALYTE SPECIMEN* MGH UNIT‡ SI UNIT METHOD OR INSTRUMENT† TO SI UNIT

Activated protein C resistance (factor V P Ratio >2.0 Not applicable Automated clotting assay
Leiden)
Alpha2-antiplasmin P 80–130% 0.80–1.30 Chromogenic assay 0.01
Antiphospholipid-antibody panel
Partial-thromboplastin time–lupus P Negative Negative Dilute phospholipid clotting
anticoagulant screen assay
Platelet-neutralization procedure P Negative Negative Clotting assay
Anticardiolipin antibody S
IgG 0–15 GPL units 0–15 arbitrary units ELISA 1
IgM 0–15 MPL units 0–15 arbitrary units ELISA 1
Antithrombin III P
Immunologic 22–39 mg/dl 220–390 mg/liter Immunoassay 10
Functional 80–130% 0.8–1.30 U/liter Chromogenic assay 0.01
Anti-Xa assay (heparin assay) P Chromogenic assay
Unfractionated heparin 0.3–0.7 IU/ml 0.3–0.7 kIU/liter 1
Low-molecular-weight heparin 0.5–1.0 IU/ml 0.5–1.0 kIU/liter 1
Danaparoid 0.5–0.8 IU/ml 0.5–0.8 kIU/liter 1
Bleeding time (adult) 2–9.5 min 2–9.5 min Surgicutt 1
Clot retraction WB 50–100%/2 hr 0.50–1.00/2 hr Manual method 0.01
D -Dimer P <0.5 µg/ml <0.5 mg/liter Latex agglutination 1
Differential blood count WB Automated cell counter or
manual method
Neutrophils 45–75% 0.45–0.75 0.01
Bands 0–5% 0.0–0.05 0.01
Lymphocytes 16–46% 0.16–0.46 0.01
Monocytes 4–11% 0.04–0.11 0.01
Eosinophils 0–8% 0.0–0.8 0.01
Basophils 0–3% 0.0–0.03 0.01
Erythrocyte count (adult) WB Automated cell counter
Male 4.50–5.30¬106/mm3 4.50–5.30¬1012/liter 1¬10 6
Female 4.10–5.10¬106/mm3 4.10–5.10¬1012/liter 1¬10 6
Erythrocyte sedimentation rate WB Automated erythrocyte-sedi- 1
mentation-rate instrument
Female 1–25 mm/hr 1–25 mm/hr
Male 0–17 mm/hr 0–17 mm/hr
Factor II, prothrombin P 60–140% 0.60–1.40 Automated clotting assay 0.01
Factor V P 60–140% 0.60–1.40 Automated clotting assay 0.01
Factor VII P 60–140% 0.60–1.40 Automated clotting assay 0.01
Factor VIII P 50–200% 0.50–2.00 Automated clotting assay 0.01
Factor IX P 60–140% 0.60–1.40 Automated clotting assay 0.01
Factor X P 60–140% 0.60–1.40 Automated clotting assay 0.01
Factor XI P 60–140% 0.60–1.40 Automated clotting assay 0.01
Factor XII P 60–140% 0.60–1.40 Automated clotting assay 0.01
Factor XIII screen P No deficiency detected Not applicable Urea clot dissolution
Factor-inhibitor assay P <0.5 Bethesda unit <0.5 Bethesda unit Automated clotting assay 1
Ferritin S Immunoassay 1
Male 30–300 ng/ml 30–300 µg/liter
Female 10–200 ng/ml 10–200 µg/liter
Fibrin(ogen)-degradation products P <2.5 µg/ml <2.5 mg/liter Latex agglutination 1
Fibrinogen P 175–400 mg/dl 1.75–4.00 µmol/liter Automated clotting assay 0.01
Folate (folic acid) S, P Immunoassay 2.266
Normal 3.1–17.5 ng/ml 7.0–39.7 nmol/liter
Borderline deficient 2.2–3.0 ng/ml 5.0–6.8 nmol/liter
Deficient <2.2 ng/ml <5.0 nmol/liter
Excessive >17.5 ng/ml >39.7 nmol/liter
Glucose-6-phosphate dehydrogenase WB No gross deficiency Not applicable Visual fluorescence screening
(erythrocyte)
Hematocrit (adult) WB Automated cell counter
Male 37.0–49.0 0.37–0.49 0.01
Female 36.0–46.0 0.36–0.46 0.01
Hemoglobin (adult) WB Automated cell counter 0.6206
Male 13.0–18.0 g/dl 8.1–11.2 mmol/liter
Female 12.0–16.0 g/dl 7.4–9.9 mmol/liter
Hemoglobin A2 WB <3.5% <0.04 Spectrophotometry 0.01
Hemoglobin F WB <0.02% <0.0002 Spectrophotometry 0.01
Heparin-induced thrombocytopenia P Negative Negative ELISA
antibody
Iron S 30–160 µg/dl 5.4–28.7 µmol/liter Colorimetry 0.1791
Iron-binding capacity S 228–428 µg/dl 40.8–76.7 µmol/liter Colorimetry 0.1791
Leukocyte count (WBC) WB 4.5–11.0¬103/mm3 4.5–11.0¬109/liter Automated cell counter 1¬106
Mean corpuscular hemoglobin (MCH) WB 25.0–35.0 pg/cell 25.0–35.0 pg/cell Automated cell counter 1

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 C AS E R EC O R D S O F T H E M AS SAC H U S ET T S G E N E R A L H O S P I TA L

HEMATOLOGY AND COAGULATION (Continued)

FACTOR FOR
CONVERSION
ANALYTE SPECIMEN* MGH UNIT SI UNIT METHOD OR INSTRUMENT TO SI UNIT

Mean corpuscular hemoglobin concen- WB 31.0–37.0 g/dl 310–370 g/liter Automated cell counter 10
tration (MCHC)
Mean corpuscular volume (MCV) WB Automated cell counter 1
(adult)
Male 78–100 µm 3 78–100 fl
Female 78–102 µm3 78–102 fl
Osmotic fragility of erythrocytes WB Increased hemolysis as Not applicable Spectrophotometry
compared with normal
control
Partial-thromboplastin time, activated P 22.1–34.1 sec 22.1–34.1 sec Automated clotting assay 1
Plasminogen P
Antigen 8.4–14.0 mg/dl 84–140 mg/liter Immunoassay 10
Functional 80–130% 0.80–1.30 Chromogenic assay 0.01
Platelet aggregation PRP >65% aggregation in Not applicable Platelet aggregometry
response to adenosine
diphosphate, epineph-
rine, collagen, ristoce-
tin, and arachidonic
acid
Platelet count WB 150–350¬103/mm3 150–350¬109/liter Automated cell counter 1¬106
Platelet, mean volume WB 6.4–11.0 µm3 6.4–11.0 fl Automated cell counter 1
Prekallikrein assay P 60–140% 0.60–1.40 Chromogenic assay 0.01
Prekallikrein screen P No deficiency detected Automated clotting assay
Protein C P
Total antigen 70–140% 0.70–1.40 Immunoassay 0.01
Functional 70–140% 0.70–1.40 Chromogenic assay 0.01
Protein S P
Total antigen 70–140% 0.70–1.40 Immunoassay 0.01
Functional 70–140% 0.70–1.40 Automated clotting assay 0.01
Free antigen 70–140% 0.70–1.40 Immunoassay 0.01
Prothrombin time P 11.2–13.2 sec 11.2–13.2 sec Automated clotting assay 1
Red-cell distribution width WB 11.5–14.5% 0.115–0.145 Automated cell counter 0.01
Reptilase time P 16–24 sec 16–24 sec Automated clotting assay 1
Reticulocyte count WB 0.5–2.5% red cells 0.005–0.025 red cells Flow cytometry 0.01
Ristocetin cofactor (functional P Platelet aggregometry 0.01
von Willebrand factor)
Blood group O 75% mean of normal 0.75 mean of normal
Blood group A 105% mean of normal 1.05 mean of normal
Blood group B 115% mean of normal 1.15 mean of normal
Blood group AB 125% mean of normal 1.25 mean of normal
Sucrose hemolysis WB <10% <0.1 Spectrophotometry 0.01
Thrombin time P 16–24 sec 16–24 sec Automated clotting assay 1
Total eosinophils WB 70–440/mm3 70–440¬106/liter Automated cell counter 1¬103
Vitamin B12 S, P Immunoassay 0.7378
Normal >250 pg/ml >184 pmol/liter
Borderline 125–250 pg/ml 92–184 pmol/liter
Deficient <125 pg/ml <92 pmol/liter
von Willebrand factor (vWF) antigen P Immunoassay
(factor VIII:R antigen)
Blood group O 75% mean of normal 0.75 mean of normal 0.01
Blood group A 105% mean of normal 1.05 mean of normal 0.01
Blood group B 115% mean of normal 1.15 mean of normal 0.01
Blood group AB 125% mean of normal 1.25 mean of normal 0.01
von Willebrand factor multimers P Normal distribution Normal distribution Western blot assay

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 The Ne w E n g l a nd Jo u r n a l o f Me d ic i ne

MICROBIOLOGY

CULTURE SPECIMEN ROUTINELY CULTURED FOR ALSO REPORTED NORMAL FLORA

Throat Group A beta-hemolytic streptococci,
pyogenic groups C and G beta-
hemolytic streptococci, Arcanobac-
terium haemolyticum
Sputum Pneumococci, H. influenzae, beta-
hemolytic streptococci, Staph. aureus,
Moraxella (Branhamella) catarrhalis,
pseudomonas, Enterobacteriaceae,
yeast
Urine Aerobic bacteria and yeast: abundant,
>105 colony-forming units/ml;
moderate, 10 4–105 colony-forming
units/ml
Blood Aerobic and anaerobic bacteria, yeasts
Cerebrospinal and Aerobic and anaerobic bacteria; yeasts,
other fluids including cryptococcus
Feces Enteric pathogens: salmonella, shigella,
campylobacter, plesiomonas, and aer-
omonas when predominant
Wounds Aerobic and anaerobic bacteria, yeasts
Cervical or vaginal Gonococci, beta-hemolytic streptococ-
ci, Staph. aureus, and G. vaginalis
when predominant
If a complete throat culture is request-
ed, it will be examined for Haemoph-
ilus influenzae, Staphylococcus aureus,
Streptococcus pneumoniae, Neisseria
meningitidis, and yeast
Presence or absence of normal throat
flora
Few, 103–104 colony-forming units/ml;
rare, 102 –103 colony-forming units/
ml; no growth, <102 colony-forming
units/ml; these amounts may indicate
clinically significant bacteriuria if ac-
companied by pyuria, clinical symp-
toms, or both
Growth in both bottles is usually more
clinically significant than growth in a
single bottle
Any organism isolated
Moderate or abundant yeast or Staph.
aureus; presence or absence of nor-
mal gram-negative enteric flora; spe-
cial cultures can be specifically re-
quested for yersinia, Vibrio cholerae,
V. parahaemolyticus, or hemorrhagic
(O157) strains of Escherichia coli
Enteric gram-negative rods and candi-
da, if present in large numbers
Alpha-hemolytic streptococci, non-
hemolytic streptococci, diphtheroids,
coagulase-negative staphylococci,
saprophytic neisseria
Carefully collected specimens should
contain few or no normal throat flora
Carefully collected specimens should not
contain mixed bacterial species (i.e., two
or more of the following: lactobacilli,
non–beta-hemolytic streptococci, diph-
theroids, coagulase-negative staphylo-
cocci, Gardnerella vaginalis)
None; aerobic and anaerobic diphtheroids
and coagulase-negative staphylococci are
common contaminants
None
Enterobacteriaceae, streptococci, pseudo-
monas, small numbers of staphylococci,
and yeast (and anaerobes that are not
cultured routinely)

*P denotes plasma, S serum, U urine, WB whole blood, CSF cerebrospinal fluid, JF joint fluid, and PRP platelet-rich plasma.
†ELISA denotes enzyme-linked immunosorbent assay.
‡GPL denotes IgG phospholipid, and MPL IgM phospholipid.

©1998, Massachusetts Medical Society.

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