Clinical Chemistry

	Laboratory Services

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Department of Clinical Biochemistry
	Contacting the Department Turnaround Times Rejections of Specimens Emergency Samples Routine Profiles Biochemistry Analysis Details on OGTT and Synacthen Tests Paracetamol Nomogram

Contacting the Department

Name/Location	Title	Extension
Dr Peter C Sharpe	Lead Consultant	2889
Miss Susan Trueman	Secretary	2657
Mr David Thompson	Principal Biomedical Scientist	2663
Dr Derek McKillop	Clinical Scientist	3709
Biochemistry Lab		2660
Specimen Reception		2548
General Enquiries		2660

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Turnaround times

All routine specimens received before 4.30 pm will be processed the same day. Specimens received after 4.30 pm will be centrifuged and stored for analysis the following day. Therefore it is important that specimens should be sent to the laboratory as early as possible to facilitate rapid reporting. The turnaround time for specialist analyses can vary widely, however it is the aim of the Department to keep turnaround times to a minimum.

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Reasons for rejection of specimens

Inadequate information on the request form or specimen to permit positive patient identification.
Improperly labelled specimens and specimens from patients whose details do not correspond with the request form.
Specimens which have leaked or where the container has been damaged during transport.
Wet faeces samples for occult blood testing.
Haemolysed blood.

Important

Fill container to the mark indicated.
Do not inject blood into the container through a needle or shake violently as this will haemolyse the specimen.
Telephone requests for results must be kept to a minimum in the interest of both the efficient running of the Department and safety, as verbal reports may lead to transcription errors. Ward access to the authorised reports is also available

EMERGENCY SAMPLES

The Biomedical Scientist On Call must be contacted to arrange emergency work between the following hours.

Mon - Fri	12 Midnight - 9am
Sat - Sun - B.Holidays	1pm - 9am
Internal Contact No: Cell Phone Number	#6565 07801458695

The clinician may request as many profiles/test groups listed below as may be necessary using one 5 ml blood sample collected into a yellow capped vacutainer.

Electrolyte Profile	Na, K, Cl, Urea, Creatinine, (HC03 - if specifically requested)
Liver Profile	T Protein, Albumin, Bilirubin, ALP, ALT, AST, and GGT.
Cardiac Profile	CK (Troponin T - if requested)
Bone Profile	Albumin, ALP, Calcium, Calcium (corrected), Phosphate.
Lipid Profile	Chol, Trig, HDL Chol, LDL Chol (calculated), Chol/HDL ratio.
Protein Profile & Electrophoresis	T Protein, Albumin, IgA, IgG, IgM, Alpha, beta, and gamma globulin, Quantitation by electrophoresis.
Thyroid Function	Free T4, TSH.
Prostatic Profile	Prostate specific antigen - PSA.
Iron Profile	Ferritin (Fe, TIBC if requested).
B12 & Folate	Vitamin B12 & Folic acid.

NOTES

The serum glucose result is unreliable unless the sample is separated within two hours.
Routine blood samples should be sent in a grey topped fluoride/oxalate tube.
CK-MB is only measured when the CK is greater than 195 U/L.
Triglyceride levels are only of real clinical value if measured in a fasting sample taken 10 - 14 hours after the last meal.
The free PSA is measured when the Total PSA value is between 4 - 10 ng/mL.

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BIOCHEMISTRY ANALYSES

TEST		REFERENCE RANGE	COMMENTS
ADRENOCORTICOTROPHIC HORMONE (ACTH) Plasma		<55 ng/L	3mL EDTA blood on ice (purple tubes) send to Lab immediately.
ALANINE AMINOTRANSFERASE (ALT) Serum		5 - 40 U/L	5mL clotted blood (yellow cap); avoid haemolysis when taking blood. See Liver Profile.
ALBUMIN Serum		30 -50 g/L	5mL clotted blood (yellow cap); see Liver and Bone Profiles.
ALCOHOL (ETHANOL) Serum		Not normally detected.	5mL clotted blood (yellow cap).
ALDOSTERONE Serum		Supine <400 pmol/L Upright <820pmol/L Saline Suppression Test (2 litres in 4 hours) < 120 pmol/L	5mL clotted blood in plain tube (red top), not in gel tube.
ALKALINE PHOSPHATASE Serum		Age dependent. Up to 4 times adult upper limit during growth. Adults 35 - 116 U/L	5mL clotted blood (yellow cap).
ALKALINE PHOSPHATASE ISOENZYMES Serum			5mL clotted blood (yellow cap).
ALPHA-1-ACID GLYCOPROTEIN Serum		0.47 - 1.25 g/L	5mL clotted blood (yellow cap).
ALPHA-1-ANTICHYMOTRYPSIN Serum		0.30 - 0.60 g/L	5mL clotted blood (yellow cap).
ALPHA-1-ANTITRYPSIN Serum		0.89 - 1.89 g/L	5mL clotted blood (yellow cap).
ALPHA-1-ANTITRYPSIN PHENOTYPES Serum			5mL clotted blood (yellow cap).
ALPHA-FETOPROTEIN (AFP) Serum		<2mths contact Lab 2mths - 50yrs: <10 kU/L 50yrs - 70yrs: <15 kU/L 70yrs - 90yrs: <20 kU/L Pregnant: Contact Lab. BCH Ext.3096 for expected values.	5mL clotted blood (yellow cap).
ALPHA-FETOTROTEIN Amaiotic Fluid		Varies with gestation, contact BCH, Ext.3096 for expected values.	5mL amniotic fluid.
ALPHA-1-MICROGLOBULIN Urine		0 - 12.5 mg/L	Random urine or 24hr urine collection.
ALPHA-2-MACROGLOBULIN Serum		1.09 - 2.83 g/L	5mL clotted blood (yellow cap).
ALPHA SUB UNIT Serum		Contact RVH, Ext.3180.	5mL clotted blood (In plain tube - Red Top).
ALUMINIUM Serum		<10 ug/L	5mL clotted blood in special tube; contact Ext.2548 for tubes.
AMINO ACIDS PlasmaUrine (10ml)		Age related. Qualitative report.	3mL EDTA blood, send to Lab immediately. It is important to give full clinical details including diet and any drug treatments.For diagnostic purposes should examine both plasma and urine. Random urine sample . See note above.
AMMONIA Plasma		Prem.neonate: <200 umol/L Term neonate: <100 umol/L 1month - adult: 13 - 52 umol/L	3mL EDTA or heparinised blood, must be sent to Lab. immediately on ice. Patient should be resting and fasting if possible.
AMPHETAMINE Urine		Not normally detected.	Random urine sample in preservative-free bottle. Send to Lab. immediately. See Drugs of Abuse Screening.
AMYLASE Serum Urine		28 - 100 U/L 120 - 648 U/24hrs 80 - 432 U/L	5mL clotted blood (yellow cap). 24hr urine collection.
AMYLOID A Serum		0-6.5 mg/L	5ml clotted blood (yellow tube)
ANDROSTENEDIONE Serum		Female: 3.0 - 12.5 nmol/L Male: 3.0 - 15.0 nmol/L	5mL clotted blood, in plain tube (red top), not a gel tube.
ANGIOTENSIN CONVERTING ENZYME (ACE) Serum		8 - 52 U/L	5ml clotted blood (yellow top).
ANTIASTHMATICS Serum THEOPHYLLINE		10 - 20 mg/L	5mL clotted blood (yellow top).
Notes: Patients on IV infusions should be monitored in the first 12hr (plus a baseline level if there is a likelihood of prior administration). Ideally the infusion should be stopped for 15min before sampling. Overdose: Patients with an acute overdose and serum levels > 100 mg/L or chronic overdose and levels > 60 mg/L may require haemodialysis. If severe side effects are present earlier intervention is necessary. Repeat serum theophylline and potassium levels every 2 - 3 hours.
ANTIDEPRESSANTS Serum			5mL clotted blood in a plain red-topped tube, not a gel tube. Sample should be taken with the patient at a steady state, immediately pre-dose. For details contact BCH, Ext.3168.
Notes: In tricyclic overdose, a useful clue to serious toxicity is a QRS interval greater than 0.11sec. Adequate oxygenation, correction of any acidosis and maintenance of serum potassium should be ensured.
ANTIEPILEPTICS Serum PHENOBARBITONE SODIUM VALPROATE CARBAMAZEPINE PHENYTOIN LAMOTRIGINE CLOBAZAM NORCLOBAZAM		15 - 40 mg/L 50 - 100 mg/L 4 - 10 mg/L 10 - 20 mg/L	5mL clotted blood (yellow top). Trough levels For Lamotrigine, Clobazam and Norclobazam use plain tube (red cap), without gel.
APOLIPOPROTEINS Serum Lp (a) Apo A1 Apo B		<30 mg/L 104 - 225 mg/100mL 60 - 133 mg/100mL	5mL clotted blood (yellow cap).
APOLIPOPROTEIN E PHENOTYPE Plasma			3mL EDTA blood.
ARGININE VASOPRESSIN (AVP)			Contact RVH Ext.3230 for information.
ASCORBATE			See Vitamin C.
ASPARTATE AMINOTRANSFERASE (AST) Serum		7 - 40 U/L	5mL clotted blood (yellow cap); avoid haemolysis when taking blood.See Liver/Cardiac Profile.
BARBITURATES Serum PENTOBARBITONE PHENOBARBITONE THIOPENTONE			5mL clotted blood in plain tube (red cap), not gel tube.Contact BCH, Ext.3168 for ranges.
BARBITURATE SCREENING Serum			5mL clotted blood in a plain tube (red top), not gel tube.
BENCE-JONES PROTEIN Urine		Not normally detected.	Early morning sample in Universal container. For quantitative analysis, 24hr collection required.
BENZODIAZEPINE SCREENING Serum			5mL clotted blood in a plain tube (red top), not a gel tube.
BETA-2-MICROGLOBULIN Serum		0.8 - 2.2 mg/L	5mL clotted blood (yellow cap).
BETA CAROTENE Serum		Male 0.1 - 1.6 umol/L Female 0.1 - 1.1 umol/l	5mL clotted blood (yellow cap).
BILE ACIDS Serum			5mL plain red tube.
BILE PIGMENTS Urine			30mL urine in sterile bottle.
BILIRUBIN (TOTAL) Serum		1 - 21 umol/L	5mL clotted blood (yellow cap). See Liver Profile.
Up to 24 hours Up to 48 hours 3 - 5 days	Premature Neonate Bilirubin 17 - 103 umol/L 103 - 137 umol/L 171 - 257 umol/L		Full term Newborn Bilirubin 34 - 103 umol/L 103 - 120 umol/L 68 - 205 umol/L
BILIRUBIN (CONJUGATED/DIRECT) Serum		< 5 umol/L	5mL clotted blood (yellow cap).
BLOOD GASES Arterial blood PH P02 PC02 Bicarbonate Total C02 Base Excess		7.35 - 7.45 kPa 11.3 - 14.6 kPa 4.7 - 6.0 mmol/L 21 - 29 mmol/L 24 - 30 mmol/L -2.5 - +2.5	Send to Lab. immediately on ice.
BLOOD VOLUME			Contact BCH, Ext. 2697.
BNP (NT-proBNP)		< 70 yrs ( <150 pg/ml) > 70 yrs ( <300 pg/ml)	5mls clotted blood (yellow cap) Concentrations in normal range rule-out heart failure. Concentrations above require Echocardiograph
BONE PROFILE Serum Calcium Phosphate Albumin Alkaline Phosphatase (ALP) Corrected Calcium		2.10 - 2.6 mmol/L 0.80 - 1.5 mmol/L 30 - 50 g/L 35 - 116 U/L 2.1 - 2.6 mmol/L	5mL clotted blood (yellow cap).
C1 ESTERASE INHIBITOR		0.15 - 0.35 g/L	5mL clotted blood (yellow cap).
CA 125 Serum		0 - 35 U/mL	5mL clotted blood (yellow cap).
CA 19-9 Serum		0 - 37 U/mL	5mL clotted blood (yellow cap).
CAFFEINE		5 - 20 mg/L	5mL clotted blood in plain red tube (no gel) trough sample
CALCITONIN Plasma		Male: <6.5 ng/L Female: <8 ng/L	5mL heparinised blood; must be sent to Lab.on ice immediately.
CALCIUM Serum Urine		2.1 - 2.6 mmol/L 1.67 - 5.0 mmol/L 2.5 - 7.5 mmol/24hrs	5mL clotted blood. Avoid stasis when taking the sample. 24hr collection in special bottle containing acid. Contact Ext 2548
CALCULI			Send to Lab. in sterile container.
CANNABANOIDS Urine			30mL urine in a preservative- free, sterile bottle. See Drugs of Abuse Screening.
CARBAMAZEPINE			5mL clotted blood (yellow cap)
CARBOXYHAEMOGLOBIN Blood		Non-smokers: 0 - 2% Smokers: 2 - 10% Toxic symptoms: >10%	5mL blood in heparinised syringe. (ICU Analyser) Patients treated with oxygen prior to sampling may show normal levels even after severe poisoning.
CARCINOEMBRYONIC ANTIGEN (CEA) Serum		Non-smoker: 0 - 4 ng/mL Smoker: 0 - 10 ng/mL	5mL clotted blood (yellow cap).
CARDIAC PROFILE Serum Total CK		1 - 195 U/L	5mL clotted blood (yellow cap).
CARNITINE		Total 23 - 60 umol/L Free 15 - 53 umol/L	5mL heparined blood (green tube)
CAROTENE Serum		1.1 - 3.7 mmol/L	5mL clotted blood (yellow cap).
CATECHOLAMINES Plasma Urine		Adrenaline 5 - 120 nmol/24hr Noradrenaline 50 - 560 nmol/24hr Dopamine 300 - 3900 nmol/24hr	By special arrangement only. Phone RVH, Ext.3309. 24hr.urine collection in special bottle. Contact Ext.2548 to obtain bottles. In children one plain, one acid MSSU bottle.
CERULOPLASMIN Serum		0.21 - 0.58 g/L	5mL clotted blood (yellow cap).
CHLORIDE Serum		98 - 108 mmol/L	5mL clotted blood (yellow cap).
CHOLECALCIFEROL			See Vitamin D.
CHOLESTEROL Serum		Desirable < 4 mmol/L	5mL clotted blood (yellow cap); see Lipid Profile.
CHOLINESTERASE Serum		2.3 - 9.0 kU/L	5mL clotted blood (yellow cap).
CHOLINESTERASE PHENOTYPING Serum			5mL clotted blood (yellow cap).
CHROMIUM Urine		0 - 2.0 nmol/mmol creat.	Random urine in plastic universal container. DO NOT collect urine in metal bedpan.
CHROMOGRANIN A		0 - 30 U/L	3mL EDTA (purple tube) on Ice
CICLOSPORIN Blood		100 - 250 ug/L	3mL EDTA blood (renal transplant patients) Trough sample.
COBALT Urine		0 - 3.0 nmol/mmol creat.	Random urine in plastic universal container. DO NOT collect urine in metal bedpan.
CODEINE Serum		Toxic > 0.5 mg/L	5mls clotted blood (yellow cap).
COPPER Plasma Urine		12.6 - 26.7 umol/L 0.2 - 1.6 umol/24hr	5mL heparinised blood (green). Sterile plastic universal for random + plastic 24 hour collection bottle for 24 hour urines.
CORTISOL Serum Urine		170 - 530 nmol/L < 350 nmol/24hr	5mL clotted blood (yellow cap).Note time of sample on request form. 24hr urine collection.
C-PEPTIDE Serum		< 3.0 ug/L (fasting)	5mL clotted blood in plain tube (red cap), not a gel tube. Must be sent to the Lab immediately.
C-REACTIVE PROTEIN (CRP) Serum		< 5.0 mg/L	5mL clotted blood (yellow cap).
CREATINE KINASE Serum		1 - 195 U/L	5mL clotted blood (yellow cap), see Cardiac Profile.
CREATINE KINASE MB MASS Serum		Male: < 6.73 Female: < 3.77	Only available for Cardiac Catheterisation Laboratory
CREATINE KINASE ISOENZYME ELECTROPHORESIS			5mL clotted blood (yellow tube)
CREATININE Serum Adult Male Adult Female Children Neonates (premature) Neonates (full term) 2 - 12 months 1 - <3 yrs 3 - <5 yrs 5 - <7 yrs 7 - <9 yrs 9 - <11 yrs 11 - <13 yrs 13 - <15 yrs > 15 yrs Urine Adult Male Adult Female		62 - 106 umol/L 44 - 80 umol/L 25 - 91 umol/L 21 - 75 umol/L 15 - 37 umol/L 21 - 36 umol/L 27 - 42 umol/L 28 - 52 umol/L 35 - 53 umol/L 34 - 65 umol/L 46 - 70 umol/L 50 - 77 umol/L See Adult Ranges 6.0 - 11.3 mmol/L 9.0 - 17.0 mmol/24hr 5.0 - 8.3 mmol/L 7.5 - 12.5 mmol/24hr	5mL clotted blood. 24hr urine collection, no preservative.
CREATININE CLEARANCE Serum and Urine		70 - 150 mL/min	24hr urine collection and 5ml clotted blood (yellow cap) taken during the 24hrs. Need to take account of body surface area when dealing with Paediatric samples.
CRYOGLOBULINS		Not normally detected	By arrangement with Lab. Contact CAH, Ext. 2660.
CSF GLUCOSE		2.5 - 4.4 mmol/L 75% of plasma level
CSF PROTEIN		0.15 - 0.46 g/L
DEHYDROEPIANDROSTERONE SULPHATE Serum		Varies with age. Contact RVH Ext: 3180.	5mL of clotted blood in a plain tube (red cap), not a gel tube.
DIGOXIN Serum		0.9 - 2.0 ug/L	5mL clotted blood (yellow cap) Sample should be taken > 6 hr after IV or oral dose. Hypokalaemia potentiates toxicity.
DIHYDROCODEINE Serum		Toxic range > 0.5 mg/L	5mL clotted blood (yellow gel tube)
DRUGS OF ABUSE, SCREENING Urine Amphetamines, Barbiturates, Benzo- diazepines, Cannabanoids, Cocaine Metabolites, LSD, Opiates. Phencyclidine, Alcohol and Methadone available on request. Buprenorphine, Nalbuphine and Tramadol) available on request.			30mL urine in a preservative- free bottle
Note: If there is any delay in sending the sample to the Lab., check urine pH and record it on the request form. Please test the pH on a separate urine aliquot from that sent to Lab. for analysis.
EDTA MEASUREMENT OF GFR			Contact BCH, Ext.2697 for details.
ELASTASE, PANCREATIC Faeces		Normal > 200 ug/g stool Mod. Pancreatic insufficiency: 100 - 200 ug/g stool. Severe pancreatic insufficiency: <100 ug/g stool.	Random sample of faeces.
ELECTROLYTE PROFILE Serum Sodium Potassium Chloride Urea Creatinine Male Female Bicarbonate (if requested)		135 - 145 mmol/L 3.5 - 5.1 mmol/L 98 - 108 mmol/L 3 - 8 mmol/L 62 - 106 umol/L 44 - 80 umol/L 24 - 30 mmol/L	5mL clotted blood (yellow cap).
ETHYLENE GLYCOL Blood		Not normally detected.	5mL clotted blood (yellow cap).
Note: Difficult to measure out of hours. Should be suspected if there is a high osmolal gap and/or high anion gap acidosis. Toxicity can be reduced by giving ethanol IV to keep blood ethanol levels 100 - 200 mg/100mL.For levels of ethylene glycol > 0.5 g/L (>50 mg/100mL), haemodialysis should be considered. Most antifreeze solutions also contain methanol.
FAECAL FAT Faeces		Adults < 7g/24hr 2 months - 6 years < 2g/24hr.	Complete 3 day collection. contact BCH Ext.2670
FAECAL pH Faeces		pH 6-9	1g faeces in a sterile container. Send to Lab immediately.
FERRITIN Male Female		30 - 400 ug/L 13 - 150 ug/L	See Iron Profile.
FOLATE Serum Red Cell		4.6 - 18.7 ug/L >120 ug/L	5mL clotted blood (yellow cap). 3mL EDTA blood.
FOLLICLE STIMULATING HORMONE (FSH) Serum		Male: 1.5 - 8.0 U/L Female: 0.4 - 8.0 U/L Pre-pubertal < 0.5 U/L Postmenopausal: >25 U/L	5mL of clotted blood in plain tube (red cap), not a gel tube.
FREE LIGHT CHAINS Serum Urine		Kappa 3.3 - 19.4 ug/L Lambda 5.7 - 26.3 ug/L Kappa 0.39 - 15.1 ug/L Lambda 0.81 - 10.1 ug/L	5mL clotted blood (yellow gel tube). Random or 24 hr
FRUCTOSAMINE Serum		1.8 - 2.8 mmol/L	5mL clotted blood (yellow gel tube)
GALACTOSE-1-PHOSPHATE Red Blood Cells		Treated Galactosaemic (non fasting): < 0.6 umol/g Hb	1mL heparinised or EDTA blood.
GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE Red Blood Cells		Qualitative report.	0.5mL heparinised or EDTA blood. Exchange transfusion invalidates result. Contact RVH, Ext.2148 for information.
GAMMA GLUTAMYL TRANSPEPTIDASE (GGT) Serum Male Female		10 - 71 U/L 6 - 42 U/L	3mL EDTA blood (purple tube)
GASTRIN Plasma		Fasting 0 - 40 pmol/L	3mL EDTA blood (purple tube) on ice
GASTROINTESTINAL PROTEIN LOSS (Alpha 1 antrtrypsin)			Contact BCH, Ext.2697 for details.
GLUCAGON N-terminal (GL-N) C-terminal (GL-C)		0 - 70 pmol/L 0 - 45 pmol/L	3mL EDTA blood (purple tube) on ice.
GLUCOSE Plasma Fasting Non-Fasting Emergency CSF		4 - 7.0 mmol/L 4 - 7.8 mmol/L 75% of plasma level	3mL of blood in grey-topped fluoride/oxalate tube. Glucose can be in 5 ml clotted tube (yellow cap). 0.5mL in a plain sterile container. Plasma glucose should be measured at the same time.
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G-6-PD) Red Blood Cells		120 - 240 U/10¹² RBC	3mL EDTA blood. The sample should not be refrigerated.
GLYCEROL Serum		0.02 - 0.15 mmol/L	5mL clotted blood (yellow cap).
GLYCOSAMINOGLYCANS Urine		Qualitative report.	Three early morning urine samples. If there is an abnormality in the screening result, a follow-up blood enzyme analysis is required for diagnosis.
GOLD Serum			5mL blood in glass tube. Contact BCH Ext. 2017 for a bottle.
GROWTH HORMONE Serum			5mL clotted blood in a plain tube (red top), not a gel tube.Phone RVH, Ext.3230 for advice on patient preparation and interpretation of results. Random levels are not usually useful.
GUT AND ISLET HORMONES Serum			20mL EDTA blood (purple tube). 4 x EDTA bottles, fasting on ice.
HAPTOGLOBIN Serum Male Female		0.3 - 1.7 g/L 0.39 - 2.1 g/L	5mL clotted blood (yellow top).
HbA1c DCCT HbA1c IFCC		4.0-6.0 % 20-42 mmol/mol	3mls of blood in EDTA tube (purple top).
HDL CHOLESTEROL Serum Desirable		> 1 mmol/L	5mL clotted blood (yellow top), fasting. See Lipid profile.
HOMOCYSTEINE Plasma		5.5 - 13.6 umol/L	3mLs EDTA blood sample must arrive in the Lab within 30 mins on ice.
HOMOGENTISIC ACID Urine		Not normally detected.	Random sample of urine, send to Lab. immediately.
HUMAN CHORIONIC GONADOTROPHIN (HCG) Serum		< 4.0 U/L. Contact Lab In pregnancy, levels vary with gestation.	5mL clotted blood (yellow cap)
3-HYDROXY BUTYRATE Plasma		0.03 - 0.3 mmol/L	3mL blood in grey fluoride oxalate tube.
5-HYDROXYINDOLEACETIC ACID (5-HIAA) Urine		10 - 47 umol/24hr	24hr urine collection in plain bottle. Patient should avoid pineapple, banana, plums, tomatoes, kiwi fruit and walnuts for 3 days before and during the collection period.
5-HYDROXYTRYPTAMINE (5-HT) Urine		0.30 - 1.30 umol/24hr	Can be analysed on the same sample as 5-HIAA. See note above.
17-HYDROXYPROGESTERONE Serum		Male: 2.0 - 10.5 nmol/L Female: 2.0 - 12.0 nmol/L	5mL clotted blood in a plain tube (red cap), not a gel tube.
HYDROXYPROLINE Urine (Random) Urine (24 hour)		Age, height and weight dependant. 0.006 - 0.034 mmol/mmol creatinine. Age dependent ranges	Fasting urine. Discard first urine sample in the morning. Keep the patient fasting, but allow 150mL water. Collect urine sample after 1 - 2 hours 24hr urine collection. Avoid meat, fish and gelatine for 24hr before collection.
IMMUNOGLOBULINS Serum (Adults) IgG IgA IgM		7.0 - 16.0 g/L 0.7 - 4.0 g/L 0.4 - 2.3 g/L	5mL clotted blood (yellow tube)
INSULIN Serum		<10 mU/L (fasting).	5mL clotted blood in a plain tube (red cap), not a gel tube.Blood glucose estimation must be carried out at the same time. Serum should be separated from cells within 4 hours.
INSULIN-LIKE GROWTH FACTOR (IGF 1) Serum		Varies with age. Tel. RVH, Ext. 3230.	5mL clotted blood; must be sent to Lab. immediately.
INTESTINAL DISACCHARIDASES Jejunal biopsy sample		Qualitative report.	Biopsy specimen. Contact RVH, Ext. 2148 for details.
IRON PROFILE Serum FERRITIN Male Female IRON TIBC % IRON SATURATION Male Female		30 - 400 ug/L 13 - 150 ug/L 10 - 30 umol/L 45 - 70 umol/L 20 - 55 % 15 - 50 %	5mL clotted blood (yellow cap).
IRON Serum Urine		< 55 umol/L mild 55 - 90 moderate >90 umol/L severe >180 umol/L very severe	5mL clotted blood. Overdose: Levels at 2hr for Children, 4 - 6hr for adults. 24 hr collection in plastic bottle
LACTATE Blood		0.5 - 2.2 mmol/L	2mL of blood in grey top bottle.
LACTATE DEHYDROGENASE (LDH) Serum		240 - 480 U/L	5mL clotted blood (yellow tube). Haemolysis causes increase in results.
LACTATE DEHYDROGENASE ISOENZYMES Serum			5mL clotted blood (yellow tube).
LEAD Blood Urine		0.03 - 0.50 umol/L <0.25 umol/24hr	5mL blood in a heparinised or EDTA tube. + plastic collection bottle for 24 hour urines.
LIPID PROFILE Serum Cholesterol Triglyceride HDL - Cholesterol Calculated LDL Cholesterol : HDL Ratio		Desirable Values < 4.0 mmol/L < 2.0 mmol/L > 1.0 mmol/L < 2.0 mmol/L < 4.0	5mL clotted blood (yellow cap). Patient should be fasting for 10 - 14 hours before the sample is taken.
LIPOPROTEIN ELECTROPHORESIS Plasma		Contact BCH, Ext. 3096	3mL EDTA blood, patient should be fasting.
LITHIUM Serum		0.4 - 1.0 mmol/L	5mL clotted blood (yellow cap).Sample should be taken 12hr after dose.
Note: If serum Li >5mmol/L, haemodialysis is required. Haemodialysis should be considered at Li >3 mmol/L if the patient is toxic as serum levels do not reflect the severity of an overdose.
LIVER PROFILE Serum TOTAL BILIRUBIN ALP AST ALT GGT Male Female ALBUMIN TOTAL PROTEIN		1 - 21µmol/L 35 - 116 U/L (Adult) 7 - 40 U/L 5 - 40 U/L 10 - 71 U/L 6 - 42 U/L 30 - 50 g/L 60 - 80 g/L	5mL clotted blood (yellow tube).
LUTEINISING HORMONE (LH) Serum		Male: 1.5 - 9.0 U/L Female: 0.8 - 10.0 U/L Ovulatory Peak 9.0 - 80 U/L Postmenopausal: 11 - 70 U/L. Prepubertal < 0.5 U/L	5mL clotted blood in a plain tube (red top), not a gel tube.
MAGNESIUM Serum Urine		0.7 - 1.05 mmol/L 3.30 - 4.9 mmol/24 hr 2.2 - 3.26 mmol/L	5mL clotted blood (yellow top). 24hr collection in special acid bottle. (Contact CAH Ext 2548)
MANGANESE Blood		76 - 396 nmol/L	5mL blood in a special bottle.Contact CAH, Ext.2548.
MERCURY Urine		<5 nmol/mmol creatinine	Sterile plastic universal for random + plastic 24 hour collection bottle for 24 hour urines.
METHAEMOGLOBIN Blood		<1.5 %	5mL fresh heparinised blood in a syringe. (ICU Analyser)
METHANOL Blood		Not normally detected.	5mL clotted blood (yellow top).
Note: Methanol should be suspected if there is a high osmolar gap &/or high anion gap acidosis. Treatment: Ethanol IV or , if >0.5 g/L (>50mg/100mL), haemodialysis.
METHOTREXATE Serum			5mL clotted blood (yellow top).
Note: It is essential to contact the BCH Lab. before therapy is started. Samples should be taken at 24hr intervals after high dose therapy until serum level is <0.1 umol/L
MICROALBUMIN Urine (Albumin:Creatinine Ratio)		< 3.0mg/mmol creatinine	Random urine. 3-30 microalbumuria >30 proteinuria
MUCOPOLYSACCHARIDES		See GLYCOSAMINOGLYCANS
MUSCLE PROFILE Serum CREATINE KINASE (CK)		1 - 195 U/L	5mL clotted blood (yellow top).
NICKEL Urine		0 - 13.0 nmol/mmol creat.	Sterile plastic universal for random + plastic 24 hour collection bottle for 24 hour urines.
NON ESTERIFIED FATTY ACIDS (NEFA) Serum		0.3 - 1.0 mmol/L	5ml clotted blood (yellow top) The specimen should be delivered to the Lab. within 60min of sampling.
5'-NUCLEOTIDASE Serum		2 - 17 U/L	5mL clotted blood (yellow top).
OCCULT BLOOD Faeces		Not normally detected.	Smear of faeces on card, one card on each of three days. Patient should not eat red meat, dark fish or uncooked vegetables containing peroxidases for 3 days before sampling. No iron containing medication for two days prior to sampling and during sampling.
OESTRADIOL Serum		Male: <160 pmol/L Female: Follicular phase:70 - 460 pmol/L Luteal phase: 165 - 700 pmol/L Ovulatory peak: 280 - 1250 pmol/L Post menopausal < 160 pmol/L	5mL clotted blood in plain tube (red tube) not in gel tube.
OPIATES Urine			30mL urine in a preservative-free bottle. See Drugs of Abuse Screening.
ORGANIC ACIDS Urine specimen.		Qualitative report.	10mL random urine. It is important to give full clinical details including diet and any drug treatment.
OROSOMUCOID		See Alpha-1-acid Glycoprotein.
OROTIC ACID Urine		Age related.	10mL random sample of urine.
OSMOLALITY Serum Urine		285 - 295 m0sm/kg 250 - 1200 m0sm/kg	5mL clotted blood (yellow top). 20mL random urine sample.
OXALATE Urine		Male: 0.08 - 0.49 mmol/24 hr Female: 0.04 - 0.32 mmol/24 hr Children: Contact Lab for advice	24hr urine in special bottle containing acid. Contact CAH, Ext.2548.
PABA TEST Urine		Full test instructions can be obtained from RVH Ext. 2533
PANCREATIC POLYPEPTIDE Plasma		0 - 50 pmol/L	3mL EDTA (purple tube) fasting on ice.
PARACETAMOL Serum		If >200 mg/L at 4hr, >50 mg/L after 12hr or detectable after 24hr liver cell damage is likely. Measure AST, ALT and Prothrombin time at 3 - 4 days. See treatment Nomogram.	5mL clotted blood, taken at >4hours after overdose.
PARAQUAT Serum Urine		Not normally detected.	5mL clotted blood (yellow top), taken >4hr after an overdose. For screening send a random urine sample.
PARATHORMONE (PTH) Plasma		10 - 85 pg/mL	3mL plastic EDTA tube, on ice and send to Lab immediately. Do a serum calcium level at the same time, on a separate sample.
PHOSPHATE Serum Urine		0.80 - 1.50 mmol/L 10 - 33.3 mmol/L 15 - 50 mmol/24 hrs	5mL clotted blood (yellow top) Level increases with haemolysis or delayed separation. 24hr collection in special acid-washed container.
PLASMA VOLUME			Contact BCH, Ext.2697 for details.
PORPHYRINS			All samples should be sent immediately to Lab for screening. Please send a random sample of urine, a random sample of faeces and 5mL heparinised blood (protected from light).
POTASSIUM Serum Urine		3.5 - 5.1 mmol/L 20 - 60 mmol/L 40 - 120 mmol/ 24 hrs	5mL clotted blood (yellow cap) 24hr urine collection.
PREALBUMIN Serum		0.18 - 0.44 g/L	5mL clotted blood (yellow cap).
PROCOLLAGEN III AMINO PEPTIDE Serum		1.7 - 4.2 ug/L	5mL clotted blood (yellow gel tube).
PROGESTERONE Serum		Female: Follicular phase: <4nmol/L Luteal phase: 6 - 80 nmol/L Luteal phase peak: >30 nmol/L	5mL clotted blood (yellow cap).
PROLACTIN Serum		Male: <300 mU/L Female: <360 mU/L Levels up to 1000 mU/L can be induced by stress.	5mL clotted blood in a plain tube (red top), not a gel tube.
PROSTATIC SPECIFIC ANTIGEN (PSA) Serum		Male: 40 - 49 yrs 0 - 2.5 ng/mL 50 - 59 yrs 0 - 3.5 ng/mL 60 - 69 yrs 0 - 4.5 ng/mL 70 - 79 yrs 0 - 6.5 ng/mL	5mL clotted blood (yellow cap). Free PSA is measured when total PSA 4 - 10 ng/mL
PROTEIN ELECTROPHORESIS Serum TOTAL PROTEIN ALBUMIN GLOBULIN ELECTROPHORESIS		60 - 80 g/L 35 - 50 g/L 25 - 30 g/L Visual interpretation.	5mL clotted blood (yellow cap). Please note that albumin is measured by a specific method and may give slightly different results from a Profile.
PSEUDOCHOLINESTERASE			See CHOLINESTERASE.
PYRUVATE Blood		0.03 - 0.08 mmol/L	Contact CAH, Ext.2548 for special tubes and instructions.
QUININE Serum		3.0 - 7.0 mg/L Toxic > 10 mg/L	5mL clotted blood (yellow cap tube)
RED CELL SURVIVAL			Contact BCH, Ext.2697 for details.
RED CELL VOLUME			Contact BCH, Ext.2697 for details.
REDUCING SUBSTANCES Urine Faeces		< 50 mg/dL. < 50 mg/dL.	Random urine sample in sterile bottle, send to Lab. immediately. Random (1gm) sample of faeces sent to Lab. immediately.
RENAL STONE PROFILE			Contact Biochemistry Department for special 24 Hr Urine containers
RENIN ACTIVITY Plasma		Supine: 0.24 - 3.24 ng/ml/hr Upright: 1.8 - 6.7 ng/ml/hr	3mL of EDTA blood sent on ice to Lab, immediately. Contact Lab in advance.
RETINOL BINDING PROTEIN Serum		Male 39 - 67 mg/L Female 33 - 60 mg/L	5mL clotted blood (yellow tube).
SALICYLATE Serum			5mL clotted blood (yellow cap), taken > 4hr after overdose.
Notes: The prognosis for acute salicylate poisoning cannot be determined by serum concentration alone; clinical features, particularly impaired conciousness and acidosis must be taken into consideration. Haemodialysis is the treatment of choice for severe intoxication(>750 mg/L) or at a lower level if there are complications.
SELECTIVITY OF PROTEINURIA Urine		Selective: <0.16 Moderately selective: 0.16 - 0.30 Non-selective: >0.30	5mL clotted blood and random sample of urine in a special bottle. Contact CAH Ext 2548.
SELENIUM Plasma		0.60 - 1.30 umol/L	5mL blood in a heparinised tube. Contact CAH, Ext.2548
SEX HORMONE BINDING GLOBULIN (SHBG) Serum		Female: 25 - 90 nmol/L Male: 5 - 50 nmol/L	5mL clotted blood in plain tube (red cap), not a gel tube. Measured in all female patients when testosterone is requested and used to calculate the Free Androgen Index(FAI).
SIROLIMUS Plasma		Monotheraphy 12 - 20 ng/mL with ciclosporin 4 - 12 ng/mL	3mL EDTA blood (purple tube).
SODIUM Serum Urine		135 - 145 mmol/L 50 - 125 mmol/L 100 - 250 mmol/24 hrs	5mL clotted blood (yellow cap). Random urine sample; interpretation depends on associated clinical details.
SULPHAEMOGLOBIN Blood		<0.4 %	5mL fresh, heparinised blood in a syringe (ICU analyser).
SWEAT TEST Sweat			Contact RVH 2148 to arrange
TACROLIMUS (FK 506) Blood		5.0 - 15.0 ug/L	3mL EDTA sample (purple tube).
Note: Analysed on Wednesday only. Blood must be in BCH Clinical Chemistry Lab before 12 noon for results to be available the same day.
TESTOSTERONE Serum		Female: 0.7 - 2.8 nmol/L Male: 10.5 - 30.0 nmol/L	5mL clotted blood in plain tube (red tube) not gel tube.
THEOPHYLLINE			See Antiasthmatics.
THALLIUM Urine		<2ug/L	Sterile plastic universal for random + plastic 24 hour collection bottle for 24 hour urines.
THIOCYANATE Serum			5mL clotted blood in a plain tube (red top), not a gel tube. Measured during sodium nitroprusside infusion. If infusion is administered for more than 3 days, thiocyanate concentration should be monitored and should not exceed 1700 umol/L.
THIOPURINE METHYLTRANSFERASE (TPMT) Plasma			3mL EDTA (purple tube)
THIORIDAZINE Serum		0.4 - 2.0 mg/L	5mL clotted blood in plain red tube, not gel tube.
THIOPENTONE Serum			By special arrangement only contact BCH 3168
THYROGLOBULIN Serum		1.7 - 35 ng/mL	5mL clotted blood (yellow cap). Haemolysis invalidates the result.
THYROID PROFILE Adult Serum Free Thyroxine (FT4) Thyroid Stimulatiing Hormone (TSH) Paediatric Serum 0 - 12 Months (FT4) 0 - 12 Monhts (TSH) 1 - 6 years (FT4) 1 - 6 years (TSH)		10.6 - 22.7 pmol/L 0.3 - 4.5 mU/L 13.9 - 26.1 pmol/L 1.36 - 8.8 mU/L 12.1 - 22.0 pmol/L 0.85 - 6.5 mU/L	5mL clotted blood (yellow cap).
TRANSFERRIN Serum		1.78 - 2.86 g/L	5mL clotted blood (yellow cap).
TRANSFERRIN RECEPTOR (soluble) Serum		0.83 - 1.76 mg/L	5mL clotted blood (yellow tube).
TRICYCLIC ANTIDEPRESSANTS			See Antidepressants.
TRIGLYCERIDE Serum		Desirable < 2.0 mmol/L	5mls clotted blood (yellow cap) Patient must fast for 10 - 14 hours before the sample is taken.
TRIIODOTHYRONINE (fT3) Serum		3.9 - 6.8 pmol/L	5mL clotted blood (yellow cap).
TROPONIN T		< 0.03 ng/mL Normal 0.03 - 0.10 ng/mL consistent with minimal myocardial damage > 0.1 ng/mL consistent with myocardial damage.	5mL clotted blood (yellow cap).
TUMOUR MARKERS			See individual tests
URATE Serum Urine In Pregnancy		Female: 0.14 - 0.34 mmol/L Male : 0.2 - 0.42 mmol/L < 5.0 mmol/24 hrs < 3.3 mmol/L < 7.0 mmol/24 hrs < 4.7 mmol/L	5mL clotted blood (yellow cap). 24hr urine collection. Obtain special bottle from CAH Ext 2548.
UREA Serum Urine		3.0 - 8.0 mmol/L 167 - 333 mmol/L 250 - 500 mmol/24 hrs	5mL clotted blood (yellow cap). 24hr urine collection.
URINARY PROTEIN Urine In Pregnancy		< 120 mg/24 hr < 80 mg/L < 300 mg/24 hr < 200 mg/L	24 hr urine collections rarely required. Random urine for protein creatinine ratio should suffice.
URINARY TOTAL PROTEIN CREATININE RATIO		<30 mg/mmol	Random urine
VASOACTIVE INTESTINAL POLYPEPTIDE		0 - 25 pmol/L	5mL EDTA blood (on ice)
VERY LONG CHAIN FATTY ACID			5mL heparinised blood
VITAMIN A Serum		1.1 - 3.5 umol/L	5mL clotted blood (yellow cap). Send the sample in an envelope to shield from light. Analysed with Vitamin E.
VITAMIN B12 Serum		140 - 640 ng/L	5mL clotted blood (yellow cap).
VITAMIN C (ASCORBATE) Plasma		>32 umol/L	5mL EDTA blood. Sample must be sent to Lab.,on ice, within 30 min of taking the sample.
VITAMIN D Serum		50 - 100 nmol/L 2 5 - 50 nmol/L insufficient < 25 nmol/L deficient	5mL clotted blood (yellow cap).Specimen must be sent to Lab. immediately.
VITAMIN E Serum		16.0 - 35.0 umol/L	5mL clotted blood (yellow cap). Analysed with Vitamin A.
ZINC Plasma		7.7 - 23.0 umol/L	5mL blood in a heparinised bottle (green tube).

Age	IgG g/L	IgA g/L	IgM g/L
Cord	5.2 - 18.0	<0.02	0.02 - 0.2
0 - 2 weeks	5.0 - 17.0	0.01 - 0.08	0.05 - 0.2
2 - 6 weeks	3.9 -13.0	0.02 - 0.15	0.08 - 0.4
6 - 12 weeks	2.1 - 7.7	0.05 - 0.4	0.15 - 0.7
3 - 6 months	2.4 - 8.8	0.1 - 0.5	0.2 - 1.0
6 - 9 months	3.0 - 9.0	0.15 - 0.7	0.4 - 1.6
9 - 12 months	3.0 - 10.9	0.2 - 0.7	0.6 - 2.1
1 - 2 years	3.1 - 13.8	0.3 - 1.2	0.5 - 2.2
2 - 3 years	3.7 - 15.8	0.3 - 1.3	0.5 - 2.2
3 - 6 years	4.9 - 16.1	0.4 - 2.0	0.5 - 2.0
6 - 12 years	5.4 - 16.1	0.5 - 2.5	0.5 - 1.8
12 - 18 years	7.0 - 16.0	0.8 - 4.7	0.5 - 3.0

Details on OGTT and Synacthen Tests

(a) ORAL GLUCOSE TOLERANCE TEST

Indication
Used for diagnosis when blood glucose levels are equivocal.

Technique

	After at least 3 days of unrestricted diet (>150g of carbohydrate daily) and usual physical activity. Test should be preceded by an overnight fast of 8 -14 hrs, during which water may be drunk.
	Smoking not permitted during test.
	Collect fasting blood sample.
	Patient should drink 75g of anhydrous glucose or 82.5g of glucose monohydrate in 250 - 300 ml of water over 5 minutes.
	Collect 2 hr blood sample.

Values for diagnosis of diabetes mellitus and other categories of hyperglycaemia according to the WHO.

	Serum/plasma glucose (mmol/L)
DIABETES MELLITUS Fasting or	> 7.0
2hrs after glucose load	> 11.1
IMPAIRED GLUCOSE TOLERANCE (IGT)
Fasting and	< 7.0
2hrs after glucose load	> 7.8 - < 11.1
IMPAIRED FASTING GLYCAEMIA (IFG) Fasting and	> 6.1 - < 7.0
2hrs after glucose load	< 7.8

(B) SHORT SYNACTHEN TEST

1. Venous blood is taken at Time 0 (basal cortisol).
2. 250µg of Synacthen is given by IM injection (obtained from Pharmacy).
3. Venous blood is collected at Time 30 mins for cortisol.

Interpretation : 30 min cortisol must be greater than 550 nmol/L for normal response to Synacthen.

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Paracetamol Nomogram

TREATMENT NOMOGRAM FOR PARACETAMOL OVERDOSE

Patients whose serum paracetamol levels, related to time from ingestion, are above line B require specific treatment.

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