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