Statistically derived reference ranges encompass the tested mean ±2 standard deviations.

This
means that 1 in 20 normal test results fall outside the reference range.

Table 5-1. Adult Cardiovascular Laboratory Reference Values (Based on Serum Tests)
Data from Kratz A, Ferraro M, Sluss PM, et al: Laboratory reference values. N Engl J Med
351:1548-1563, 2004; Sacher RA, McPherson RA: Widmann’s clinical interpretation of
laboratory tests, ed 11, Philadelphia, 2000, FA Davis.
Index Reference Range
Creatine kinase
Female 40-150 units/L
Male 60-400 units/L
Creatine kinase MB fraction (CK-MB) 0-7 ng/mL
C-reactive protein 0.08-3.1 mg/L
Lactic dehydrogenase (LDH) 100-190 units/L
LDH isoenzymes
LDH1 14-26%
LDH2 29-39%
LDH3 20-26%
LDH4 8-16%
LDH5 6-16%
Lipids
Cholesterol, total <200 mg/dL
Triglycerides, fasting <160 mg/dL
Troponins
Troponin I 0-0.4 ng/mL
Troponin T 0-0.1 ng/mL
Table 5-2. Adult Endocrine Laboratory Reference Values
Data from Kratz A, Ferraro M, Sluss PM, et al: Laboratory reference values. N Engl J Med
351:1548-1563, 2004; Sacher RA, McPherson RA: Widmann’s clinical interpretation of
laboratory tests, ed 11, Philadelphia, 2000, FA Davis.
Index Source Reference Range
THYROID
Free thyroxine index S 4.6-11.2
Thyroid-stimulating hormone (TSH) S 0.5-4.7 μU/mL
Total triiodothyronine (T3) S 60-181 ng/dL
Total thyroxine (T4) S 4.5-10.9 mcg/dL
PITUITARY
Index Source Reference Range
Adrenocorticotropic hormone (ACTH) P 6-76 pg/mL
Growth hormone (fasting) S 0.5-17.0 ng/mL
Prolactin
Female S 0-20 ng/mL
Male S 0-15 ng/mL
ADRENAL CORTEX
Aldosterone (recumbent, normal salt diet) S, P 2-9 ng/dL
Cortisol (8 AM fasting) P 0-10 mcg/dL
Renin (6 hr, recumbent, normal salt diet) P 0.5-1.6 ng/mL/hr
ADRENAL MEDULLA AND CATECHOL SECRETIONS
Epinephrine U 0-20 mcg/24 hr
Norepinephrine U 15-80 mcg/24 hr
Vanillylmandelic acid (VMA) U 0.15-1.2 mg/24 hr
GONADS
Estradiol
Female
Premenopausal S, P <20-443 pg/mL
Postmenopausal S, P <59 pg/mL
Male S, P <20 pg/mL
Testosterone
Female S 6-86 ng/dL
Male S 270-1070 ng/dL
PANCREAS
Amylase S 60-180 units/L
Glucose (fasting) P 75-115 mg/dL
Insulin (fasting) S, P 2-20 μU/mL
Lipase S 0-160 units/dL
PARATHYROID
Calcium S 9.0-10.5 mg/dL
Parathyroid hormone P, S 10-60 pg/mL
Phosphorus S 3.0-4.5 mg/dL
P, Plasma; S, serum; U, urine.
Table 5-3. Adult Gastrointestinal Laboratory Reference Values
Data from Kratz A, Ferraro M, Sluss PM, et al: Laboratory reference values. N Engl J Med
351:1548-1563, 2004; Sacher RA, McPherson RA: Widmann’s clinical interpretation of
laboratory tests, ed 11, Philadelphia, 2000, FA Davis.
Index Source Reference Range
Alanine aminotransferase (ALT) S 0-35 units/L
Alkaline phosphatase S 30-120 units/L
Ammonia P 10-80 mcg/dL
Aspartate aminotransferase (AST) S 0-35 units/L
Bilirubin
Total S 0.3-1.0 mg/dL
Direct S 0.1-0.3 mg/dL
Indirect S 0.2-0.7 mg/dL
Delta
Gamma glutamyl transpeptidase (GGT) S 1-94 units/L
Lactate dehydrogenase (LDH) S 100-190 units/L
Partial thromboplastin time, activated (aPTT) P 22-35 sec
Protein
Albumin S 3.5-5.5 g/dL
Globulin S 2.0-3.5 g/dL
Total S 5.5-8.0 g/dL
Prothrombin time (PT) P 11-13 sec
Stool fat Stool 1-7 g/day
P, Plasma; S, serum.
Table 5-4. Adult Hematology Laboratory Reference Values
Data from Kratz A, Ferraro M, Sluss PM, et al: Laboratory reference values. N Engl J Med
351:1548-1563, 2004; Sacher RA, McPherson RA: Widmann’s clinical interpretation of
laboratory tests, ed 11, Philadelphia, 2000, FA Davis.
Index Source Reference Range
Bleeding time 2.0-9.5 min
Blood volume 8.5-9.5% of body weight in kg
Erythrocyte count (RBCs)
Female WB 4.0-5.2 × 106/mm3
Male WB 4.5-5.9 × 106/mm3
Erythrocyte sedimentation rate (ESR)
Female WB 1-25 mm/hr
Male WB 1-17 mm/hr
Ferritin
Index Source Reference Range
Female S 10-200 ng/mL
Male S 30-300 ng/mL
Fibrin degradation products P <2.5 mcg/mL
Folic acid S, P 3.1-17.5 ng/mL
Hematocrit
Female WB 36-46%
Male WB 41-53%
Hemoglobin
Female WB 12-16 g/dL
Male WB 13.5-17.5 g/dL
Hemoglobin A1C WB 3.8-6.4%
Iron S 30-160 mcg/dL
Iron-binding capacity S 228-428 mcg/dL
Leukocyte count (WBCs) WB 4.5-11.0 × 103/mm3
T lymphocytes WB 74-86% of circulating lymphocytes
B lymphocytes WB 5-25% of circulating lymphocytes
T4 lymphocytes (CD4) WB 38-52% of circulating lymphocytes
T8 lymphocytes (CD8) WB 22-36% of circulating lymphocytes
T4/T8 ratio 1.0:2.2
Mean corpuscular volume (MCV) WB 80-100 μm3
Mean corpuscular hemoglobin (MCH) WB 26-34 pg/cell
Mean cell hemoglobin concentration (MCHC) WB 31-37 g/dL
Partial thromboplastin time, activated (aPTT) P 22-35 sec
Platelet count WB 150-350 × 103/mm3
Prothrombin time (PT) P 11-13 sec
Red cell distribution width WB 11.5-14.5%
Reticulocyte count WB 0.5-2.5% of red cells
Thrombin time P Control ± 5 sec
Vitamin B12 S, P >250 pg/mL
P, Plasma; S, serum; WB, whole blood.
Table 5-5. Adult Immunologic Laboratory Reference Values (Based on Serum Tests)
Data from Kratz A, Ferraro M, Sluss PM, et al: Laboratory reference values. N Engl J Med
351:1548-1563, 2004; Sacher RA, McPherson RA: Widmann’s clinical interpretation of
laboratory tests, ed 11, Philadelphia, 2000, FA Davis.
Index Reference Range
Index Reference Range
Alpha1 antitrypsin 85-213 mg/dL
Alpha fetoprotein <15 IU/mL
Antineutrophil cytoplasmic antibodies Negative
Antinuclear antibodies Negative at 1:40 dilution
Anti–native DNA antibodies Negative at 1:10 dilution
Anti-Smith antibodies Negative
Anti–ribonucleic protein antibodies Negative
Antibodies to SS-A (Ro) Negative
Antibodies to SS-B (La) Negative
Complement
C3 86-184 mg/dL
C4 20-58 mg/dL
Total hemolytic (CH50) 150-250 units/mL
Rheumatoid factor <30 IU/mL
Uric acid
Female 1.5-6.0 mg/dL
Male 2.5-8.0 mg/dL
Table 5-6. Adult Nutritional Laboratory Reference Values
Data from Kratz A, Ferraro M, Sluss PM, et al: Laboratory reference values. N Engl J Med
351:1548-1563, 2004; Sacher RA, McPherson RA: Widmann’s clinical interpretation of
laboratory tests, ed 11, Philadelphia, 2000, FA Davis.
Index Source Reference Range
Alanine aminotransferase (ALT) S 0-35 units/mL
Aspartate aminotransferase (AST) S 0-35 units/mL
Bilirubin
Direct S 0.1-0.3 mg/dL
Indirect S 0.2-0.7 mg/dL
Total S 0.3-1.0 mg/dL
Blood urea nitrogen (BUN) S 10-20 mg/dL
Calcium, ionized WB 4.5-5.6 mg/dL
Calcium, total S 9.0-10.5 mg/dL
Glucose (fasting) P 75-115 mg/dL
Hemoglobin
Female WB 12-16 g/dL
Male WB 13.5-17.5 g/dL
Index Source Reference Range
Iron S 30-160 mcg/dL
Magnesium S 1.8-3.0 mEq/L
Partial thromboplastin time, activated (aPTT) P 22-35 sec
Phosphorus, inorganic S 3-4.5.0 mg/dL
Protein
Albumin S 3.5-5.5 g/dL
Total S 5.5-8.0 g/dL
Total U <165 mg/day
Transferrin S 230-390 mg/dL
P, Plasma; S, serum; U, urine; WB, whole blood.
Table 5-7. Adult Renal and Mineral Laboratory Reference Values
Data from Kratz A, Ferraro M, Sluss PM, et al: Laboratory reference values. N Engl J Med
351:1548-1563, 2004; Sacher RA, McPherson RA: Widmann’s clinical interpretation of
laboratory tests, ed 11, Philadelphia, 2000, FA Davis.
Index Source Reference Range
Arterial blood gases
pH WB 7.35-7.45
PCO2 WB 35-45 mm Hg
PO2 WB 75-100 mm Hg
Bicarbonate WB 21-30 mEq/L
Oxygen saturation WB 96-100%
Base excess WB −2 to +2
Venous blood gases
pH WB 7.32-7.43
PCO2 WB 38-50 mm Hg
PO2 WB 40 mm Hg
Oxygen saturation WB 60-85%
Calcium, ionized WB 4.5-5.6 mg/dL
Calcium, total S 9.0-10.5 mg/dL
CO2 content P 21-30 mEq/L
Chloride S 98-106 mEq/L
Creatinine S <1.5 mg/dL
Creatinine U 1.0-1.6 g/24 hr
Magnesium S 1.8-3.0 mEq/L
Phosphorus S 3.0-4.5 mg/dL
Index Source Reference Range
Potassium S 3.5-5.0 mEq/L
Potassium U 25-100 mEq/24 hr
Protein U <150 mg/24 hr
Sodium S 135-145 mEq/L
Sodium U 100-260 mEq/24 hr
Specific gravity U 1.001-1.035
Urea nitrogen S 10-20 mg/dL
Urea nitrogen U 6-17 g/24 hr
Urine pH U 5-9
P, Plasma; PCO2, carbon dioxide partial pressure; PO2, oxygen partial pressure; S, serum; U,
urine; WB, whole blood.

Factors to consider when interpreting individual test results include patient age, gender, timing of
the test result in relationship to drug administration, concomitant drug therapy, concurrent
diseases, organ function (e.g., renal function, liver function, cardiac function), test sensitivity
(the proportion of true-positive results), test specificity (the proportion of true-negative results),
timing of the test in relation to drug dosing or known circadian rhythms, genetics (e.g., glucose-
6-phosphate deficiency), and fluid status (e.g., euvolemia, dehydration, fluid overload). Refer to
laboratory textbooks or the published literature for detailed discussions of these factors.

General Organ Systems

A variety of tests and procedures are used to diagnose and monitor conditions that affect various
organ systems. The applications and uses of these tests and procedures continue to expand with
experience and the integration of new technology.

Laboratory Tests and Diagnostic Procedures

Angiography

Angiography is a radiographic test used to evaluate blood vessels and the circulation (Figure 5-
1). Radiopaque material is injected through a catheter inserted in the blood vessel, and images
are recorded using standard radiographic techniques.