Severe anemia: extremely low rbc...

low wbc, but high platelet

Resolved Question:

severe anemia: extremely low rbc... low wbc, but high platelet count..
Female, age 79
Already had one blood transfusion on July 24, and this is the blood test result for today... Doctor had ordered bone marrow aspiration, but we won't be able to get it
done until mid September.... Does this look like some sort of leukemia? Please help ....
(*** : abnormal result)
*** rbc 1.85 (normal range reference: 3.5-5.5)
*** wbc 3.75 (4.0-10.0)
*** hgb 62 g/L(110-150)
*** hct 18.4 %(34-45)
*** mcv 99.2 fL(82-99)
*** mch 33.5 pg(27-33)
mchc 337 g/L (320-360)
*** rbc-dw 18.8 %(11-16)
*** platelet count 361(100-360)
pdw 16.3 % (10-20)
mpv 12 fL (6.0-12.5)
pct 0.43 %(0.11-0.43)
*** NEUT# XXXXX(2.0-7.0)
LYM# XXXXX (0.8-4.0)
MONO# XXXXX (0.1-1.0)
EOS# XXXXX (0.0-0.5)
BAS# XXXXX (0.0-0.1)
*** NEUT% 36.7 (50-70)
*** LYMPH% 45.2 (20-40)
*** MONO 10.9 (2.0-10.0)
*** EOS% 5.60 (0.0-5.0)
*** BAS% 1.60 (0.0-1.0)
Submitted: 1 year ago.
Category: Health
Expert: Dr. Brims replied 1 year ago.
Dr Brims :
Hello, welcome to Justanswer, I will try to assist you with your medical question, and any medical information you seek
Dr Brims :
This does not seem like leukemia at all, it seems like there is some bone marrow failure, although the platelet count is high, so that is a bit odd.I suspect that is the
reason why they want to do a bone marrow biopsy
Dr Brims :
I'm sorry to hear about this, but try to be patient, the bone marrow biopsy will shed mo
re light, and this is not leukemia
Customer:
Thank you so much for your reply!
It is such a big relief for us to hear that this is not leukemia...
Before the blood transfusion, her platelet count was even higher than this, and she also had a high iron blood level (35.0 umol/L compare to normal upper limit 30.4),
and she has uncontrolled type II diabetes for many years (around 10 mmol/L compare to normal range<3.6-6.1>), but she's quite healthy other than the diabetic
problem...
I understand without seeing the bone marrow biopsy result, it is very hard to guess what is really causing her problem, but based on the the blood test result, could
you give us a little bit hint on what type of bone marrow failure this could be? Could it be aplastic anemia, sideroblastic anemia or myelodysplastic syndromes, or
something else....?
the following is her blood test result before the blood transfusion on July 24th, just in case it might provide some more useful information for you.

*** rbc 1.42 (normal range reference: 3.5-5.5) *** wbc 3.91 (4.0-10.0) *** hgb 51 g/L(110-150) *** hct 15.4 %(34-45) *** mcv 108.7 fL(82-99) *** mch 35.9
pg(27-33) mchc 331 g/L (320-360) *** rbc-dw 16.7 %(11-16) *** platelet count 380(100-360) pdw 16.0 % (10-20) mpv 12.2 fL (6.0-12.5) pct 0.46 %(0.11-0.43)
*** NEUT# XXXXX(2.0-7.0) LYM# XXXXX (0.8-4.0) MONO# XXXXX (0.1-1.0) EOS# XXXXX (0.0-0.5) BAS# XXXXX (0.0-0.1) *** NEUT% 43.8 (50-70) *** LYMPH%
45.3 (20-40) *** MONO 8.2 (2.0-10.0) *** EOS% 1.30 (0.0-5.0) *** BAS% 1.40 (0.0-1.0)

Customer:
BTW, the above test was done right before the blood transfusion...
Dr Brims :
Sorry, please let me read your reply
Customer:
Hi Doctor, are you there?
Dr Brims :
I am here now
Customer:
Thanks for your reply doctor!
Customer:
I was just wondering if you have got a chance to take a look at her blood test result right before the blood transfusion..
Customer:
She had a high iron blood level and even higher blood platelet count....
Dr Brims :
I saw it, sorry for the delay
Customer:
no problem :)
Dr Brims :
The truth is , these results don't fit into any disease profile exactly, that is why there is no way to classify it, but it may be a type of myelody
splastic syndrome
Customer:
i see......
Customer:
Is there anything we could do to help her feel better before we can get the bone marrow biopsy done? The test was scheduled in 3 weeks from now...
Dr Brims :
Is she taking any iron supplements?
Customer:
no... I don't think so, she's been taking folic acid and B12
Dr Brims :
Okay, then she may want to consider also taking iron supplements as well
Customer:
Her iron blood level is already higher than the normal range now... is it ok to take more iron supplement?
Dr Brims :
What are her serum iron levels?
Customer:
her iron blood level was at 35.0 umol/L (compare to normal upper limit reference 30.4), that was right before the blood transfusion...
Dr Brims :
Okay, then she should not take iron supplements

Ions and trace metals

Further information: Trace metals
Included here are also related binding proteins, like ferritin and transferrin for iron, and ceruloplasmin for copper.
Test
Sodium (Na)

Lower limit

Upper limit

Unit

135,[8] 137[9][4]

145,[9][4] 147[8]

mmol/L or mEq/L[8]

Comments

310,[10] 320[10]

330,[10] 340[10]

mg/dl

3.5,[8][4] 3.6[9]

5.0,[8][9][4] 5.1

mmol/L or mEq/L[8]

14[11]

20[11]

mg/dl

95,[8] 98,[12] 100[4]

105,[8] 106,[12] 110[4]

mmol/L or mEq/L[8]

340[13]

370[13]

mg/dl

1.03,[14] 1.10[4]

1.23,[14] 1.30[4]

mmol/L

4.1,[15] 4.4[15]

4.9,[15] 5.2[15]

[8][16]

[16][4]

Potassium (K)

Chloride (Cl)

Ionized calcium (Ca)

2.1,
Total calcium (Ca)

Total serum iron (TSI) - male

Total serum iron (TSI) - female

Total serum iron (TSI) - newborns

Total iron-binding capacity (TIBC)

Transferrin
Transferrin saturation
Ferritin - Male

Ferritin - Female

Phosphate (HPO42)
Inorganic phosphorus (serum)
Copper (Cu)
Zinc (Zn)

Magnesium

2.8

mmol/L
mg/dL

65,[18] 76[9]

176,[18] 198[9]

g/dL

11.6,[19][20] 13.6[20]

30,[19] 32,[20] 35[20]

mol/L

26,[9] 50[18]

170[9][18]

g/dL

4.6,[20] 8.9[19]

30.4[19]

mol/L

100[18]

250[18]

g/dL

18[20]

45[20]

mol/L

[18]

120

[18]

g/dL

9[20]

21[20]

mol/L

240,[18] 262[9]

450,[18] 474[9]

g/dL

43,[20] 47[20]

81,[20] 85[20]

mol/L

190,[21] 194,[4] 204[9]

326,[4] 330,[21] 360[9]

mg/dL

25[22]

45[22]

mol/L

20[18]

50[18]

12[23]

300[23]

ng/mL

27[24]

670[24]

pmol/L

12[23]

150[23]

ng/mL

27[24]

330[24]

pmol/L

10,[25] 20[26]

35,[25] 65[26]

17,

Ceruloplasmin

2.6,

mg/dL
[8]

10.2,[8] 10.5[17]

Ammonia

Copper

2.5,

[16]

8.4,[8] 8.5[17]

50
Total serum iron (TSI) - children

2.2

[4]

[27]

34

[27]

60,

[27]

110

See hypokalemia
or hyperkalemia

mol/L

[27]

g/dL

70[17]

150[17]

g/dL

11[28]

24[28]

mol/L

15[17]

60[17]

mg/dL

1[29]

4[29]

mol/L

0.8

1.5[30]

mmol/L

1.0[8]

1.5[8]

mmol/L

3.0[8]

4.5[8]

mg/dL

11[31]

24

mol/L

60,[32] 72[33]

110,[33] 130[32]

g/dL

9.2,[34] 11[4]

17,[4] 20[34]

mol/L

1.5,[17] 1.7[35]

2.0,[17] 2.3[35]

mEq/L or mg/dL

0.6,[36] 0.7[4]

0.82,[36] 0.95[4]

mmol/L

Acid-base and blood gases

Further information: Acid-base homeostasis
Further information: Arterial blood gas
If arterial/venous is not specified for an acid-base or blood gas value, then it generally refers to arterial, and not venous which otherwise is standard for other blood tests.
Acid-base and blood gases are among the few blood constituents that exhibit substantial difference between arterial and venous values. [5] Still, pH, bicarbonate and base
excess show a high level of inter-method reliability between arterial and venous tests, so arterial and venous values are roughly equivalent for these. [37]
Test

Arterial/Venous

Lower limit

Upper limit

Arterial

7.34,[9] 7.35[8]

7.44,[9] 7.45[8]

Venous

7.31[38]

7.41[38]

36[8]

44[8]

nmol/L

3.6[39]

4.4[39]

ng/dL

pH

[H+]
Base excess

Arterial
Arterial & venous
Arterial pO2

oxygen partial pressure (pO2)

Venous

[38]

-3

[38]

+3

[38]

mEq/L

10,[8] 11[40]

13,[40] 14[8]

kPa

75,[8][9] 83[17]

100,[9] 105[8]

mmHg or torr

4.0[40]

5.3[40]

kPa

30[38]

40[38]

mmHg or torr

Arterial

94,[38] 95,[12] 96[17] 100[12][17]

Venous

Approximately 75[12]

Oxygen saturation

Unit

Comments

4.4,[8] 4.7[40]

5.9,[8] 6.0[40]

kPa

44,[8] 45[9]

mmHg or torr

5.5[40]

6.8[40]

kPa

41[38]

51[38]

mmHg or torr

23[38]

30[38]

mmol/L

100[41]

132[41]

mg/dL

18[17]

23[17]

mmol/L

110[42]

140[42]

mg/dL

21, 22[8]

27, 28[8]

mmol/L or mEq/L[8]

Arterial PaCO2
33,
Carbon dioxide partial pressure (PCO2)
Venous

Absolute content of carbon dioxide (CO2) Arterial

Bicarbonate (HCO3-)

Arterial & venous

Standard bicarbonate (SBCe)

[8]

Arterial & venous

134

35

[9]

[42]

170

[42]

mg/dL

Liver function
Further information: Liver function tests
Test

Patient type

Total Protein

Albumin

Globulins

Lower limit

Upper limit

Unit

Comments

60,[8] 63[9]

78,[8] 82,[9] 84[17]

g/L

see hypoproteinemia

35[8][43]

48,[9] 55[8]

g/L

see hypoalbuminemia

3.5[9]

4.8,[9] 5.5[8]

U/L

540[44]

740[44]

mol/L

23[8]

35[8]

1.7,
Total Bilirubin

Male

2, 3.4,

[45]

[4]

mg/dL

5,[47] 7,[9] 8[8]

20,[8] 21,[12] 56[9]

U/L

0.15[4]

0.75[4]

[4]

1.1

kat/L

[4]

34[48]

IU/L

0.60[4]

kat/L

8[48]

40[48]

IU/L

0.25[4]

0.75[4]

kat/L

0.25

[4]

[47]

Female

42

Male

53[47]

98[47]
U/L

128[47]

[4]

1.8

5,[47] 8[9]

[4]

kat/L

40,[47] 78[9]

U/L

Women

0.63[49]

kat/L

Men

0.92[49]

kat/L

Cardiac tests
Test

Patient type Lower limit

24,

[50]

38,

[9]

60

Upper limit
[47]

174,

[17]

320

[47]

200

[47]

male
0.42

[51]

1.5

[51]

Unit
U/L
or ng/mL
kat/L

Creatine kinase (CK)

24,

[50]

38,

[9]

96

[17]

140,

[17]

female
0.17[51]
CK-MB

1.17[51]
3,

[52]

Female

Male

17[52]

Myoglobin

[9]

66

3.8,

U/L
or ng/mL
kat/L

[4]

[47]

ng/mL or g/L[4]

[52]

106[52]

ng/mL or g/L

Cutoffs and ranges for troponin types, 12 hrs after onset of pain
Test

Lower limit

Upper limit Unit

ng/mL or g/L Upper limit of normal

0.2[53]

1.0[53]

ng/mL or g/L Acute Coronary Syndrome

[54]

2.0[54]

ng/mL or g/L Moderately increased[54]

0.4

1.0,

[53]

1.5

[55]

Troponin-T 0.02[53]
0.10[53]

n/a

[53][55]

ng/mL or g/L Myocardial Infarction likely

0.02[53]

ng/mL or g/L Upper limit of normal

0.10[53]

ng/mL or g/L Acute Coronary Syndrome

n/a[53]

ng/mL or g/L Myocardial Infarction likely

Brain natriuretic peptide (BNP)

-more detailed ranges in BNP article
Interpretation

Range / Cutoff

Congestive heart failure unlikely < 100 pg/mL[56][57]

"Gray zone"

100-500 pg/mL[56][57]

Congestive heart failure likely

>500 pg/mL[56][57]

NT-proBNP

Comments

0.2[53]
Troponin-I

mol/L

mol/L

(Enzyme activity) 0.6

Gamma glutamyl transferase(GGT)

25

0.3,[8][9] 0.4[17]

Female

Alkaline phosphatase (ALP)

22,

[4]

5,[8] 7[45][4]

[8][9]

6[48]

Male

g/L
[45]

0.0[8] or N/A[4]

0.15

Aspartate transaminase(AST/ASAT[4])

17,

[8][45]

1.0,[8][17] 1.3,[9]1.4[46] mg/dL

Female

[8]

0.1,[8] 0.2,[9]0.29[46]

Direct/Conjugated Bilirubin

Alanine transaminase(ALT/ALAT[4])

[45]

Comments

Also called serum glutamic pyruvic

transaminase (SGPT)

Also called
serum glutamic oxaloacetic
transaminase(SGOT)

-more detailed ranges in NT-proBNP article

Interpretation

Age

Cutoff

< 75years > 125 pg/mL[51]

Congestive heart failure likely

>75 years >450pg/mL[51]

Lipids
Further information: Blood lipids
Test

Patient type
10 39 years

Triglycerides

40 59 years

> 60 years

Total cholesterol

HDL cholesterol

HDL cholesterol

female

male

Lower limit

Upper limit

Unit

54[17]

110[17]

mg/dL

0.61[59]

1.2[59]

mmol/L

[17]

150[17]

mg/dL

0.77[59]

1.7[59]

mmol/L

80[17]

150[17]

mg/dL

0.9[59]

1.7[59]

mmol/L

3.0,[60] 3.6[8][60]

5.0,[4][61] 6.5[8]

mmol/L

< 3.9[58]

120,[9] 140[8]

200,[9] 250[8]

mg/dL

< 150[58]

70

1.0,[62] 1.2,[4] 1.3[60] 2.2[62]

mmol/L

40,[63] 50[65]

86[63]

mg/dL

0.9[62][4]

2.0[62]

mmol/L

80[63]

mg/dL

35[63]
2.0,

LDL cholesterol
(Not valid when
triglycerides >5.0 mmol/L)

80,

LDL/HDL quotient

Therapeutic target

[62]

[63]

2.4
94

[61]

< 100 mg/dL[58]

or 1.1[58] mmol/L

> 1.0[62] or 1.6[60] mmol/L

> 40[63] or 60[64] mg/dL

3.0,[61][4] 3.4[62] mmol/L

[63]

120,

n/a

[63]

130

[63]

[4]

< 2.5[62]
< 100[63]

mg/dL
(unitless)

Tumour markers
Further information: Tumour markers
Test

Cutoff

Unit

Comments

Alpha fetoprotein (AFP)

44[9]

ng/mL or g/L

Hepatocellular carcinoma or testicular cancer

IU/l or mU/ml

in male and non-pregnant female

U/ml

Pancreatic cancer

Beta Human chorionic gonadotrophin (bHCG) 5[9]

CA19-9

40[9]

CA-125

30,[66] 35[67] kU/L or U/mL

Carcinoembryonic antigen (CEA)

non-smokers at 50 years

3.4,[4] 3.6[68] g/l

Carcinoembryonic antigen (CEA)

non-smokers at 70 years

4.1[68]

g/l

[69]

g/l

Carcinoembryonic antigen (CEA) - smokers

Prostate specific antigen (PSA)

2.5,[4] 4[9]

g/L[9][4] or ng/mL[17]

[17]

PAP

Calcitonin
-more detailed cutoffs in Calcitonin article

5,[70] 15[70]

below age 45 <2.5 g/L

units/dL (Bodansky units)

Cutoff against medullary thyroid cancer[70]

ng/L or pg/mL

Endocrinology
Thyroid hormones
Further information: Thyroid function tests
Test

Thyroid stimulating hormone

(TSH or thyrotropin)

Patient type

0.3,[72] 0.5[73]

2.0,[73] 3.0[72]

mIU/L or IU/mL

Infants

1.3[74]

19[74]

mIU/L or IU/mL

0.7,[75] 0.8[9]

1.4,[75] 1.5,[9] 1.8[76] ng/dL

9,[77][4] 10,[78] 12[79]

18,[4][77] 23[79]

0.4,

[9]

Child/Adolescent 0.8
31 d - 18 y
10[77]

Normal adult
Free triiodothyronine (FT3)
Children 2-16 y

Thyroglobulin (Tg)

[4]

[75]

Total thyroxine

Thyroxine-binding globulin (TBG)

Unit

Adults optimal range

Pregnant

Total triiodothyronine

Upper limit

0.3,

Normal adult
Free thyroxine (FT4)
-more detailed ranges in
Thyroid function tests article

Lower limit

Adults standard range

0.5,

[17]

0.6

[71]

4.0,

2.0

[4]

4.5,

[9]

6.0

[75]

[17]

mIU/L or IU/mL

pmol/L
ng/dL

26[77]

pmol/L

0.5[75]

1.0[75]

ng/dL

6.5[77]

13[77]

pmol/L

4,[78] 5.5[9]

11,[78] 12.3[9]

g/dL

60[78][79]

140,[78] 160[79]

nmol/L

0.2[78]

0.5[78]

ng/dL

3.1[80]

7.7[80]

pmol/L

0.1[81]

0.6[81]

ng/dL

1.5[80]

9.2[80]

pmol/L

60,[9] 75[78]

175,[78] 181[9]

ng/dL

0.9,[4] 1.1[78]

2.5,[4] 2.7[78]

nmol/L

12[9]

30[9]

mg/L

1.5[78]

30[78]

pmol/L

1[78]

20[78]

g/L

Sex hormones
Levels of estradiol (the main estrogen), progesterone,luteinizing hormone andfollicle-stimulating hormoneduring the menstrual cycle.[82]

The diagrams at right take inter-cycle and inter-woman variability into account in displaying reference ranges for estradiol, progesterone, FSH and LH.[82]
Test
Dihydrotestosterone

Patient type

Lower limit

Upper limit

30[83]

adult male

8,[84] 10[85]
Male, overall
230,

[86]

300

[87]

ng/dL

27,[84] 35[85]

nmol/L

780[86] - 1000[87] ng/dL

10[4]

45[4]

nmol/L

1300[86]

ng/dL

6.2[4]

26[4]

nmol/L

180[86]

740[86]

ng/dL

0.7[85]

2.8[85] - 3.0[4]

nmol/L

20[87]

80[87] - 85[86]

ng/dL

0.06[17]

3.0[17]

mg/L

0.18[88]

9.1[88]

mol/l

0.2[17]

1.0[17]

mg/L

0.6[88]

3.0[88]

mol/l

Prepubertal

<1[89]

3[89]

Adult male

1[89]

8[89]

Adult female (follicular

and luteal phase)

1[89]

11[89]

6[89]

26[89]

95% PI (standard)

95% PI)

5[90]

15[90]

Male < 50 years

290
Testosterone
Male > 50 years

Female

male
17-Hydroxyprogesterone
Female (Follicular phase)

Follicle-stimulating
hormone (FSH)
-more detailed menstrual cycle
ranges in separate diagram

Unit

85[83]

Adult female (Ovulation)

[86]

IU/L

90% PI (used in diagram) (90% PI)

Luteinizing hormone (LH)

-more detailed menstrual cycle
ranges in separate diagram

Post-menopausal female

30[89]

118[89]

Female, peak

20[90]

75[90]

Female, post-menopausal

15[91]

60[91]

[92]

[92]

90% PI (used in diagram) (90% PI)

Male aged 18+

50[93]

200[93]

pmol/L

55[94]

pg/mL

70[93]

500,[93]600[93]

pmol/L

19[94]

140,[94]160[94]

pg/mL

0.5[95]

9[95]

pg/mL

1.7[95]

33[95]

pmol/L

N/A[93]

< 130[93]

pmol/L

N/A[94]

< 35[94]

pg/mL

17,[90] 35[96]

92[96]

nmol/L

Adult male
14
Estradiol
(an estrogen)
-more detailed ranges in
estradiol article

Adult female (day 5 of follicular phase,

and luteal phase)

Adult female - free (not protein bound)

Post-menopausal female
Progesterone
-more detailed ranges
in Progesterone article

Female in mid-luteal phase (day 21-23)

6,

Androstenedione

Anti-Mllerian hormone(AMH)
-more detailed ranges in
AMH article

[90]

11

[97]

29

< 180[91]

Prepubertal

< 60[91]

Adult female
Adult male

30[98]

400[98]

40[99]

120[99]

20

1345 years

[99]

60[99]

Patient type

Adrenocorticotropic hormone (ACTH)

ng/mL

140[101]

pmol/l

Upper limit

Unit

18,[103] 22[102]

pmol/L

20[9]

80,[104] 100[9]

pg/mL

700

[105]

nmol/L

5[106]

25[106]

g/dL

80[105]

350[105]

nmol/L

2.9[106]

13[106]

g/dL

Growth hormone (fasting)

5[8]

ng/mL

Growth hormone (arginine stimulation)

7[8]

n/a

ng/mL

Cortisol
Midnight

Female, 20 yrs 110[107]

420[107]

Female, 75 yrs 55[107]

220[107]

Male, 20 yrs

160

[107]

nmol/L

5[101]

4.4[102]

140
09:00 am

g/dL

20[100]

Lower limit

[105]

ng/dL

0.7[100]

Further information: Hormones

Test

ng/mL

270[91]

Other hormones

IGF-1
-more detailed ranges in
IGF-1 article

[97]

Post-menopausal female

Dehydroepiandrosterone sulfate
-more detailed ranges
Adult male and female
in DHEA-S article
SHBG
-more detailed ranges
in SHBG article

[94]

60[91]

Adult male and female

IU/L

390

[107]

ng/mL

48[107]

Male, 75 yrs

71,
Prolactin
-more detailed ranges in
Prolactin article

200[107]

[108]

Female
3.4,

105

[108]

3.9

[108]

348,[108] 548[108]

[108]

16.4,[108] 20.3[108] g/L

58,[108] 89[108]
Male
2.7,

[108]

3.3

277,[108] 365[108]

[108]

65,[109] 70[110]

pg/mL

[111]

6.9,[4] 7.5[111]

pmol/L

8,[17][112] 9[112]

40,[112] 80[17]

ng/mL

20,[113] 23[114]

95,[114] 150[113]

nmol/L

30,[115] 40[116]

65,[116] 100[115]

ng/mL

85,[58] 100[116]

120,[58] 160[116]

nmol/L

1.1,

25-hydroxycholecalciferol
-Therapeutic target range

Plasma renin activity

Aldosterone
-more detailed ranges in
Aldosterone article
Aldosterone-to-renin ratio
-more detailed ranges in
Aldosterone/renin ratio article

mIU/L

13.0,[108] 13.5[108] g/L

10,[109] 17[110]
Parathyroid hormone (PTH)

25-hydroxycholecalciferol (a vitamin D)
-Standard reference range

mIU/L

[4]

1.8

0.29,[117] 1.9[118] 3.7[117][118]

ng/(mL*hour)

3.3,[119] 21[120]

mcU/mL

41[119][120]
19,[119] 34.0[119]

Adult
530,

[121]

940

[121]

ng/dL
pmol/L

13.1,[122] 35.0[122] ng/dl per ng/(mLh)

Adult

360,[122] 970[122]

pmol/liter per g/(Lh)

Vitamins
Also including the vitamin B12)-related amino acid homocysteine.
Standard range
Test

Optimal range

Patient type

Unit
Lower limit

Vitamin A

30

Vitamin B9
(Folic acid/Folate) - Serum

Upper limit

[17]

65

3.0[123]

16[123]

[125]

[125]

Age > 1year

6.8

200

36

[123]

600

450[125]

Vitamin B9
(Folic acid/Folate) - Red blood cells

Lower limit

[17]

Upper limit

g/dL
ng/mL or g/L 5[124]
11[125]

nmol/l

[123]

ng/mL or g/L

1400[125]

nmol/L
ng/mL or g/L 400[123]

Pregnant

900[123]

nmol/L
130,
Vitamin B12 (Cobalamin)
Homocysteine
-more detailed ranges in
Homocysteine article

[126]

160

[127]

700,

[126]

950

[127]

ng/L

100,[128] 120[4]

520,[128] 700[4]

pmol/L

3.3,[129] 5.9[129]

7.2,[129]15.3[129]

mol/L

6.3[58]

g/dL

85[58]

45,

[130]

80

[130]

100,

[130]

0.4[17]

1.5[17]

[131]

[131]

Vitamin C (Ascorbic acid)

23
8,

85

[17][112]

25-hydroxycholecalciferol (a vitamin D)
20,

[113]

[112]

23

[114]

40,

[112]

95,

[114]

210

80

[130]

[17]

150

[113]

mg/dL

0.9[58]

mol/L

50[58]

ng/mL

30,[115] 40[116] 65,[116] 100[115]

nmol/L

85,[58]100[116] 120,[58] 160[116]

mol/L

28[58]

mg/dL

1.2[58]

Vitamin E

Toxins
Test

Limit type

Limit

Unit

Lead

Optimal health range

< 20[12] or 40[17]

g/dL

0,[132] 0.2,[132] 0.8[132] or g/L

Blood ethanol content Limit for drunk driving

17.4[133]

mmol/L

Hematology
Red blood cells
These values (except Hemoglobin in plasma) are for total blood and not only blood plasma.
Test

Patient
male

Hemoglobin (Hb)

Lower limit

Upper limit

Unit

2.0,[134]2.1[135][8]

2.5,[134]2.7[135][8]

mmol/L

130,[4] 132,[9]135[8]

162,[9] 170,[4]175[8]

g/L

1.8,[134]1.9[135][8]

2.3,[134]2.5[8][135][134]

mmol/L

150,[4] 152,[9]160[8][17]

g/L

Sex difference negligible until

adulthood.

mmol/L

4 per hemoglobin molecule

female
120
Hemoglobin subunits (sometimes displayed
simply as "Hemoglobin")

male
female

[4][8][9]

8.0,[136] 8.4[136]
7.2,

[136]

7.6

Higher in neonates, lower in children.

10.0,[136]10.8[136]

[136]

9.2,[136] 10.0[136]

0.16[8]

0.62[8]

mol/L

mg/dL

Hemoglobin in plasma
< 50 years

3.6[4]

5.0[4]

> 50 years

[4]

5.3[4]

Glycosylated hemoglobin (HbA1c)

3.9

[4]

< 50 years

0.35

> 50 years

0.47[4]

Haptoglobin

[4]

1.9

0.4, 0.41,

[8]

male

0.39,

female

0.35,[4] 0.36,[8]0.37[9][17]

Hematocrit (Hct)

% of Hb

[4]

g/L

2.1[4]
[9]

Comments

0.45

[17]

0.50,

[4]

[9]

0.52, 0.53,

0.46,[8][9][4]0.48[17]

[8]

0.62

[17]

Normally diminutive compared with

inside red blood cells

0.31[9]

Child
Male

76,

Mean cell volume (MCV)

Female

78

Red blood cell distribution width (RDW)

[17]

82

[9]

0.54[8]

fmol/cell

[9]

32

32,[17] 33,[4]35[8]

[17][4]

35,

4.8,[137] 5.0[137]
[17]

4.3

36

Female

3.5,[8] 3.8,[9]3.9[4]

g/dL
or %[note 1]
mmol/L

5.1,[4] 5.5[8][9]

Infant/Child 3.8[9]

5.5[9]

[4]

130[4]

[8][9]

1.5

x1012/L
or
mln/mm3
x109/L

[8][9]

Adult

0.5

Newborn

1.1[9]

4.5[9]

% of RBC

Infant

0.5[9]

3.1[9]

% of RBC

Reticulocytes

Cells are larger in neonates, though

smaller in other children.

pg/cell

[17][4]

5.7,[4] 5.9,[8]6.2,[9] 6.9[17]

4.2,

26

[9]

5.4,[137] 5.6[137]

[8][9][4]

male

Adult

fL

14.5[9]

31,

Erythrocytes/Red blood cells (RBC)

fL

101[9]

[8]

25,[8] 27[17][4]

Mean corpuscular hemoglobin

concentration (MCHC)

100,[17] 102[9]

11.5[9]
0.39

Mean cell hemoglobin (MCH)

0.43[9]
[9]

% of RBC

White blood cells

These values are for total blood and not only blood plasma.
Test

Patient type Lower limit

White Blood Cell Count (WBC)

Unit

3.5,[4] 3.9,[138] 4.1,[9] 4.5[8] 9.0,[4] 10.0,[138] 10.9,[9] 11[8]

Newborn

9[139]

30[139]

1 year old

6[139]

18[139]

1.3,
Adult
Neutrophil granulocytes
(A.K.A. grans, polys, PMNs, or segs)
Newborn
Neutrophilic band forms

Upper limit

Adult

Newborn

Monocytes
Newborn
Mononuclear leukocytes
(Lymphocytes + monocytes)

Adult

CD4+ cells

Adult

x103/L
9

x10 /L
% of WBC

0.7[139]

x109/L

[8]

[8]

% of WBC

0.7,[4] 1.0[138][139]

3.5,[138] 3.9,[4] 4.8[139]

16-25[8]

33,[8] 45

% of WBC

11[139]

x109/L

0.1,[4] 0.2[140][126]

0.8[126][139][4]

x109/L

3,[8] 4.0

7,[8] 10

% of WBC

0.4[139]

3.1[139]

x109/L

1.5

x109/L

20

35

% of WBC

0.4,[9] 0.5[12]

1.5,[12] 1.8[9]

x109/L

0.0,[4] 0.04[126]

0.44,[126] 0.45,[139] 0.5[4]

x109/L

[139]

[8]

3,

[8]

x109/L

% of WBC

0.02[139]

0.85[139]

x109/L

40[138]

100,[126][4] 200,[139] 900[138]

x106/L

Adult
Basophil granulocytes

[139]

x109/L

1
Newborn

7,

[138]

26[139]

Adult
Eosinophil granulocytes

5.4,

[4]

6[139]

Adult

[139]

x103/mm3 or

62,[8] 74

3
Adult

1.8,

[138]

x109/L

45-54[8]

Adult

Lymphocytes

[4]

0.0

0.75,

[8]

% of WBC

0.64[139]

Newborn

x109/L

Coagulation
Test

Lower limit

Thrombocyte/Platelet count (Plt)

140,

[9]

150

Upper limit

[8][4]

[141]

350,

[17][4]

10.4

[141]

Unit
[8]

400, 450

[9]

Comments

x109/L or
x1000/L

Mean platelet volume (MPV)

7.4

Prothrombin time (PT)

10,[12] 11,[8][142]12[9] 13,[12] 13.5,[142]14,[9] 15[8] s

fL
PT reference varies between laboratory kits - INR is standardised

INR

0.9[4]

The INR is a corrected ratio of a patient's PT to normal

1.2[4]

Activated partial thromboplastin time (APTT) 18,[9] 30[12][4]

28,[9] 42,[4] 45[12]

Thrombin clotting time (TCT)

11

18

Fibrinogen

1.7,[9] 2.0[4]

3.6,[4] 4.2[9]

g/L

Antithrombin

0.80[4]

1.2[4]

kIU/L

Bleeding time

minutes

Viscosity

1.5[143]

1.72[143]

cP

Immunology
Acute phase proteins
Acute phase proteins are markers of inflammation.
Test

Patient Lower limit Upper limit

Erythrocyte sedimentation rate Male

0
(ESR)
Female

Age2[144]

C-reactive protein (CRP)

5,

n/a

(Age+10)2[144]
[146][4]

[147]

Unit

Comments

mm/hr

ESR increases with age and tends to be higher in females. [145]

mg/L

200,[148]240[148] nmol/L
20,

[149]

89,

[151]

Alpha 1-antitrypsin (AAT)

22

[150]

38,[150] 53[149]

mol/L

[4]

170,[4] 230[151]

mg/dL

97

Isotypes of antibodies
Further information: Antibody
Test Patient Lower limit

Upper limit

Unit

IgA

70,[4] 110[152] 360,[4] 560[152]

IgD

0.5[152]

IgE

Adult

0.01

[152]

[152]

IgG

800

IgM

54[152]

Comments

3.0[152]
0.04[152]

mg/dL

1800[152]
220[152]

Autoantibodies
For clinical associations, see Autoantibody.
Autoantibodies are usually absent or very low, so instead of being given in standard reference ranges, the values usually denote where they are said to be present, or whether
the test is a positive test. There may also be an equivocal interval, where it is uncertain whether there is a significantly increased level. All included values [153] are given for
the ELISA test.
Test

Negative Equivocal Positive Unit

anti-SS-A (Ro)

< 15[154]

anti-SS-B (La)

<3

Anti ds-DNA

< 40

Anti ss-DNA

<8

15-25[154]

[154]

34

[154]

40 60

[154]

8 - 10

[154]

Anti-histone antibodies

< 25

Cytoplasmic/classical
anti-neutrophil cytoplasmic
antibodies (c-ANCA)

< 20[154]

Perinuclear
anti-neutrophil cytoplasmic
antibodies (p-ANCA)

< 5[154]

> 25[154]

[154]

> 4[154]

[154]

> 60[154]

[154]

> 10

[154]

[154]

> 25[154]

21 - 30[154]

> 30[154]

n/a

Units
per
millilitre
(U/mL)

n/a

> 5[154]

Anti-mitochondrial antibodies (AMA) < 10[154]

n/a[154]

> 10[154]

Rheumatoid factor (RF)

20 - 30

> 30[9]

< 20

Antistreptolysin O titre
(ASOT) in
preschoolers

> 100

ASOT at school age

> 250[9]

ASOT in adults

> 125[9]

Test

Negative Low/weak positive Moderate positive High/strong positive Unit

Anti-phospholipid IgG

< 20[154]

Anti-phospholipid IgM

< 1.5

Anti-phospholipid IgA

< 10

20 30[154]

[154]

1.5 2.5

[154]

10 -20

Anti-citrullinated protein antibodies < 20[154]

31 50[154]

[154]

2 9.9

[154]

21 30

20 39[154]

> 51[154]

[154]
[154]

40 - 59[154]

GPLU/ml[154]

> 10

[154]

MPL /ml[154]

> 31

[154]

arb U/ml[154]

> 60[154]

EU[154]

Other enzymes and proteins

Test

Lactate dehydrogenase (LDH)

Amylase

D-dimer

Lower limit

Upper limit

Unit

50[17]

150[17]

U/L

0.4[47]

1.7[47]

mol/L

1.8

[4]

25,

[8]

3.4
30,

[9]

53

[17]

[4]

110,

[9]

kat/L
120,

[155]

123,

[17]

[8]

125, 190

[47]

1.1[4]

kat/L

200[148]

240[148]

nmol/L

500[156]

ng/mL

0.5[4]

mg/L

7,[9] 10,[17] 23[47] 60,[9] 150,[17] 208[47]

Lipase

57[47]

U/L

Acid phosphatase

3.0[47]

ng/mL

16[4]

g/L

2.3[4]

[4]

Higher in pregnant women[157]

U/L

Angiotensin-converting enzyme(ACE) 23[47]

Eosinophil cationic protein (ECP)

< 70 years old

U/L

0.15[4]

n/a

Comments

Other electrolytes and metabolites

Electrolytes and Metabolites: For iron and copper, some related proteins are also included.
Test

Patient type Lower limit

Upper limit

Unit

Comments

Osmolality

275,[8] 280,[17]281[4] 295,[8] 296,[17]297[4] mOsm/kg Plasma weight excludes solutes

Osmolarity

Slightly less than osmolality

mOsm/l

3.0[158]

7.0[158]

mmol/L

7[8]

18,[8] 21[9]

mg/dL

Urea

0.18[8]
* Uric acid

Creatinine

[9]

BUN - blood urea nitrogen

0.48[8]

mmol/L

Female

2.0

[17]

7.0[17]

mg/dL

Male

2.1[17]

8.5[17]

mg/dL

60,[4] 68[159]

90,[4] 118[159]

mol/L

0.7,[160] 0.8[160]

1.0,[160] 1.3[160]

mg/dL

male

Plasma volume includes solutes

May be complemented with creatinine clearance

50,[4] 68[159]

90,[4] 98[159]

mol/L

1.0,[160] 1.1[160]

mg/dL

5[17]

35[17]

3.8,[8] 4.0[4]

6.0,[4] 6.1[161]

mmol/L

65,[9] 70,[8] 72[162]

100,[161] 110[17]

mg/dL

3.3[4]

female
0.6,
BUN/Creatinine Ratio
Plasma glucose(fasting)

Pyruvate

See also glycosylated hemoglobin (in hematology)

5.6[4]

mmol/L

100[162]

mg/dL

4.5[17]

19.8[17]

mg/dL

0.5[163]

2.2[163]

mmol/L

4.5[17]

14.4[17]

mg/dL

0.5[163]

1.6[163]

mmol/L

300[17]

900[17]

g/dL

34[164]

102[164]

mol/L

60

Lactate (Arterial)

0.8

[160]

[162]

Full blood glucose (fasting)

Lactate (Venous)

[160]