Clinical Chem Reference Ranges, Calculations, Formulas

Front 1

Total protein

Back 1

6.5 - 8.3 g/dl

Front 2

Serum albumin

Back 2

3.5 - 5.0 g/dl

Front 3

CSF total protein

Back 3

15 - 45 mg/dl (1% of serum TP)

Front 4

PSA

Back 4

<2.5% = normal
>2.5% = perform biopsy

Lower % free PSA = higher risk of prostate cancer

Front 5

alphafetoprotein (AFP)
1. during 1st trimester?
2. at birth?
3. during adulthood?

Back 5

1st trimester: 2-3 mg/ml (peak)
at birth: 50 ug/ml
Adult: <20 ng/ml

Front 6

BUN

Back 6

6 - 20 mg/dl

Front 7

Serum Creatinine

Back 7

0.9 - 1.3 mg/dl

Front 8

Creatinine clearance (formula and reference range)

Back 8

Creatinine clearance = [(U * V)/P] * (1.73sq m/body surface area)

Males: 105 +/- 20 mL/min/1.73sqm
Females: 95 +/- 20 mL/min/1.73sqm

Front 9

TP measurement: biuret vs. dye binding vs. kjeldahl

Back 9

Biuret: cupric ions complex with peptide bonds, causing color change

Bye binding: Protein binds a dye, such as Coomasie

Kjeldahl: Quantification of Nitrogen; reference method; not routine

Front 10

BUN measurement: Kinetic vs. Chemical

Back 10

Kinetic: Urease converts urea to ammonium and bicarbonate; glutamate dehydrogenase oxidizes NADH to NAD+, causing chang in absorbance

Chemical: Diacetyl reacts with urea to produce a yellow diazine compound

Front 11

Creatinine measurement: Jaffe vs. enzymatic

Back 11

Jaffe: creatinine reacts with picric acid to produce red creatinine picrate

Enzymatic:
Creatinine converted to creatine (creatininase)
Creatine converted to sarcosine (creatinase)
Sarcosine oxidized to glycine, formaldehyde and peroxide (sarcosine oxidase)
peroxidase reaction detects color change to oxidized reagent

Front 12

Uric acid measurement: chemical vs enzymatic

Back 12

Chemical: Uric acid and phosphotungstic acid react to form allantoin and TUNGSTEN BLUE in the presence of oxygen

Enzymatic: URICASE oxidizes uric acid, oxygen, and water to allantoin, peroxide and CO2. Decrease in absorbance at 293nm is read.

Front 13

Uric acid reference range

Back 13

Males: 3.5-7.2 mg/dl
Females: 2.6-6.0 mg/dl

Front 14

Ammonia measurement

Back 14

Alpha-ketoglutarate is reduced to glutamate in the presence of ammonium and NADPH via GLUTAMATE DEHYDROGENASE

Front 15

Glucose:
Reference range

Back 15

74-99 mg/dl

Front 16

Glucose:
Hyperglycemic vs. hypoglycemic

Back 16

Hyperglycemic: >100 mg/dl
Hypoglycemic: <50 mg/dl

Front 17

Ammonia reference range

Back 17

11- 32 umol/L

Front 18

Glucose:
"Impaired fasting glucose" range

Back 18

Fasting glucose: 100< [glucose] <125 mg/dl

Front 19

Glucose:
"Diabetes mellitus diagnosis" level

Back 19

Fasting glucose >126 mg/dl
Casual glucose >200 mg/dl
OGTT glucose @ 2hrs, >200 mg/dl

Front 20

Hb A1c reference range

Back 20

4-6%; <7% indicates effective treatment

Front 21

Glucose measurement: glucose oxidase vs. hexokinase

Back 21

Glucose oxidase: Glucose oxidized to gluconic acid (glucose oxidase); yields peroxide. Peroxide reduced to water via Peroxidase; dye is oxidized and measured.

Hexokinase: Hexokinase phosphorylates glucose to glucose-6-phosphate. Glucose-6-phosphate is oxidized to 6-phosphogluconate by G6P-dehydrogenase; NADP+ is reduced to NADPH (change in abs is read)

Front 22

Lactate reference range

Back 22

0.5 - 1.3 mmol/L

Front 23

Lactate measurement method

Back 23

Lactate oxidized to pyruvate and peroxide; peroxide is used to oxidize a chromogen via peroxidase reaction

Front 24

Chylomicrons:
% trig?
% cholesterol?
% protein? [what is primary lipoprotein?]

Back 24

86% trig
5% cholesterol
2% apolipoprotein (B-48)

Front 25

VLDL
% trig?
% cholesterol?
% protein? [what is primary lipoprotein?]

Back 25

55% triglyceride
19% cholesterol
8% apolipoprotein (B-100)

Front 26

LDL
% trig?
% cholesterol?
% protein? [what is primary lipoprotein?]

Back 26

50% cholesterol
6% triglyceride
22% protein (B-100)

Front 27

HDL
% trig?
% cholesterol?
% protein? [what is primary lipoprotein?]

Back 27

50% protein (A-I)
19% cholesterol
3% triglyceride

Front 28

Triglyceride reference range

Back 28

<150 mg/dl = normal
150-199 = borderline high
200-499 = high
>500 = very high

Front 29

Total cholesterol reference range

Back 29

<200 = normal
200-239 = borderline high
>240 = high

Front 30

HDL cholesterol reference range

Back 30

>60 mg/dl= protective against heart disease
40-59 = intermediate; higher is better
<40 = risk factor for CVD

Front 31

LDL cholesterol reference range

Back 31

<100 mg/dl= optimal
100-190 = high
>190 = very high

Front 32

Cholesterol measurement method

Back 32

1. Cholesteryl esters hydrolyzed to cholesterol and fatty acid by cholesteryl esterase
2. Cholesterol oxidized by cholesterol oxidase to cholestenone and peroxide
3. Peroxide measured via colorimetric peroxidase method

Front 33

Friedwald formula

Back 33

Total cholesterol = HDL + LDL + VLDL

Total cholesterol is measured (enzymatic method)
HDL cholesterol is measured (precipitate LDL/VLDL, then enzymatic method)
VLDL = Trigylcerides/5 (if triglycerides < 400 mg/dl)
LDL is then calculated

Front 34

HDL cholesterol measurement method

Back 34

LDL and VLDL are precipitate via Dextran Sulfate-Magnesium Chloride or Heparin Sulfate-Magnesium Chloride; then, cholesterol in supernatant is measured via enzymatic technique.

Front 35

Trigylceride measurement method

Back 35

1. Trigylceride is hydrolyzed to glycerol and 3 fatty acids [Lipase]
2. Glycerol is phosphorylated to glycerophosphate [Glycerokinase]
3. Glycerophosphate is oxidized to dihydroxyacetone and peroxide [glycerophosphate oxidase]
4. Peroxide reacts in colormetric peroxidase reaction

Front 36

Apolipoprotein reference ranges:
Apo-A?
Apo-B?
Lp(a)?

Back 36

Apo-A: 120-160 mg/dl
Apo-B: <120 mg/dl
Lp(a): <30 mg/dl (CHD risk factor)

Front 37

Lactate dehydrogenase reference range

Back 37

100 - 225 U/L

Front 38

Reference range of total CK, CK-MB, CK-MB index

Back 38

Total CK: 15-150 U/L
CK-MB: 0-5 ng/mL
CK-MB index: <6% of total CK

Front 39

Reference range: ALT and AST

Back 39

~5-30 U/L

(ALT more specific for hepatocellular disease)

Front 40

ALP reference range

Back 40

50 - 115 U/L

Front 41

GGT reference range

Back 41

<55 U/L for males
<38 U/L for females

Front 42

Amylase reference range

Back 42

28 - 100 U/L

Front 43

Lipase reference range

Back 43

< 38 U/L

Front 44

Pseudocholinesterase reference range

Back 44

40-78 U/L

Front 45

Sodium reference range

Back 45

135 - 145 mmol/L

Front 46

Potassium reference range

Back 46

3.5 - 5.0 mmol/L

Front 47

Chloride reference range

Back 47

95 - 105 mmol/L

Front 48

Ionized calcium reference range

Back 48

1.1 - 1.3 mmol/L

Front 49

Total calcium reference range

Back 49

8.5 - 10.5 mg/dl

Front 50

Serum iron reference range (male vs female)

Back 50

Male: 75 - 200 ug/dl
Female: 26 - 170 ug/dl

Front 51

TIBC reference range

Back 51

250 - 450 ug/dl

Front 52

Transferrin saturation reference range

Back 52

20 - 50%

Front 53

Phosphate reference range

Back 53

0.8 - 1.5 mmol/L

Front 54

pH reference range

Back 54

7.35 - 7.45

Front 55

Bicarbonate reference range

Back 55

18 - 23 mmol/L

Front 56

Total CO2 reference range

Back 56

23 - 30 mmol/L

Front 57

B-type Natriuretic Peptide "reference ranges"

Back 57

<100 pg/mL = CHF unlikely
>500 = CHF likely

between 100-500 = "grey zone"

Front 58

TSH reference range

Back 58

0.5 - 4.0 mIU/L