SI UNITS

&
REFERENCE
INTERVALS
Januarti Sururi
Pembimbing : dr. Yusra, SpPK, PhD

SI UNIT

Some laboratories may report test results using

different units from other laboratories
universal units needed so that the reports can
be understood by and compared with,
internationally.

SI UNIT
1873

: CGS (centimeter, gram, second) system

1901 : MKS (meter, kilogram, second) system
1950 : MKSA (meter, kilogram, second, ampere)
extended to SI units
= International system of units
= Systme International dUnits
1960 : SI units adopted by > 50 countries at 11th
Confrence Gnraldes Poids et Mesures (CGPM)
1966 : International Federation of Clinical Chemistry (IFCC)
recommended the use of SI units for clinical laboratory

Van Assendelft OW. The international system of units (SI) in historical perspective. American Journal of
Public Health. 1987;77(11):1400-1403.

SI UNIT
Two classes of units:
(1) Base units
(2) Derived units:
Coherent units - derived directly from the
base units
without using conversion
factors
Noncoherent units - constructed from the
base units
and contain a
numerical factor
to make the numbers
more

SI UNIT

Lehmann HP, Henry JB. SI Units. McPherson RA, Pincus RR. Henrys Clinical Diagnosis and
Management by Laboratory Methods 22 nd Edition. Philadelphia: WB Saunders Co, 2011 p
1491.

SI UNIT

Lehmann HP, Henry JB. SI Units. McPherson RA, Pincus RR. Henrys Clinical Diagnosis and
Management
by Laboratory Methods 22nd Edition. Philadelphia: WB Saunders Co, 2011 p 1491..

SI UNIT

Lehmann HP, Henry JB. SI Units. McPherson RA, Pincus RR. Henrys Clinical Diagnosis and
Management

SI UNIT

Advantages of SI units in clinical use:

Universality of measurement units worldwide (reports,
studies, journals, textbooks)
Adequate and unambiguous expression of measurement
Making it easier to compare measurement results between
labs

However, some conventional units are still used until now, eg:
Enzyme units
conventional U/L
coherent SI unit katal (for catalytic activity, incl. enzymes)
Katal : the number of moles of substrate converted per
second under defined conditions

H Lehmann HP, Henry JB. SI Units. McPherson RA, Pincus RR. Henrys Clinical Diagnosis and Management
by Laboratory Methods 22nd Edition. Philadelphia: WB Saunders Co, 2011 p 1491..

REFERENCE INTERVALS

Lab tests to detect, diagnose, or monitor disease, or

predisposition to disease test results
interpretation medical decision

Test results
Normal values = disease-free?
Abnormal test results = diseased?

Reference Values/ Intervals

H Lehmann HP, Henry JB. Post Analysis: Medical Decision Making. McPherson RA, Pincus RR. Henrys Clinical
Diagnosis and Management by Laboratory Methods 21 nd Edition. Philadelphia: WB Saunders Co, 2007 p 68-75

REFERENCE INTERVALS

A reference interval is defined as the range of values

that represents the central 95% tendency of
measurements from a population of non-diseased or
normal individuals.

An attempt to distinguish normal from abnormal

patient populations help clinicians interpret results
& take decisions.
Eg: reference interval has 2 cut-offs: lower end,
upper end low values (abnormal), normal values
(normal), high values (abnormal)

H Lehmann HP, Henry JB. Post Analysis: Medical Decision Making. McPherson RA, Pincus RR. Henrys Clinical
Diagnosis and Management by Laboratory Methods 21 nd Edition. Philadelphia: WB Saunders Co, 2007 p 6875

REFERENCE INTERVALS
Random variability
What accounts for the spread of a reference interval:
1. Analytical variability
imprecision
2. Biological variability
- intra-individuals -> biological changes over time,
(eg: kortisol, vitamin D), food intake, exercise
- inter-individuals -> age, sex, disease
H Lehmann HP, Henry JB. Post Analysis: Medical Decision Making. McPherson RA, Pincus RR. Henrys
Clinical Diagnosis and Management by Laboratory Methods 21 nd Edition. Philadelphia: WB Saunders Co,
2007 p 68-75

REFERENCE INTERVALS

Ideally, a distribution of test results from normal individuals

would be completely distinct from abnormal individuals
Test result reflects with certainty whether disease is present
or absent. Unfortunately, even near perfect tests are not
ideal

H Lehmann HP, Henry JB. Post Analysis: Medical Decision Making. McPherson RA, Pincus RR. Henrys
Clinical Diagnosis and Management by Laboratory Methods 21 nd Edition. Philadelphia: WB Saunders Co,
2007 p 68-75

REFERENCE INTERVALS
Tests yield a continuum of results and some overlap of values
between individuals with and without disease.
In the overlap area, the tests cant discriminate disease from
no disease migh cause false results

H Lehmann HP, Henry JB. Post Analysis: Medical Decision Making. McPherson RA, Pincus RR. Henrys
Clinical Diagnosis and Management by Laboratory Methods 21 nd Edition. Philadelphia: WB Saunders Co,
2007 p 68-75

REFERENCE INTERVALS
False positive -> inapproppriate admission/ therapy
False negative -> undertreatment, transmission of infection,
death

H Lehmann HP, Henry JB. Post Analysis: Medical Decision Making. McPherson RA, Pincus RR. Henrys
Clinical Diagnosis and Management by Laboratory Methods 21 nd Edition. Philadelphia: WB Saunders
Co, 2007 p 68-75

SENSITIVITY & SPECIFICITY

Sensitivity: the ability of a test to detect disease
Specificity: the ability of a test to detect absence of
disease
Two key parameters describing accuracy of a test
Altering cutoff changes a tests sensitivity & specificity
lowered cutoff increased sens, decreased spec
raised cutoff increased spec, decreased sens

H Lehmann HP, Henry JB. Post Analysis:

Medical Decision Making. McPherson RA,
Pincus RR. Henrys Clinical Diagnosis and
Management by Laboratory Methods 21 nd
Edition. Philadelphia: WB Saunders Co,
2007 p 68-75

SENSITIVITY & SPECIFICITY

ROC plot: a graphic representation of the varying

sensitivities & specificities that are possible by
varying a tests cutoff.

H Lehmann HP, Henry JB. Post Analysis: Medical Decision Making. McPherson RA, Pincus RR.
Henrys Clinical Diagnosis and Management by Laboratory Methods 21 nd Edition. Philadelphia:
WB Saunders Co, 2007 p 68-75

SENSITIVITY & SPECIFICITY

Which one is the priority: sens or spec?
Screening test with high sensitivity, so we
will not miss any disease
Diagnostic test with high specificity, so we
can be sure of the diagnosis

H Lehmann HP, Henry JB. Post Analysis: Medical Decision Making. McPherson
RA, Pincus RR. Henrys Clinical Diagnosis and Management by Laboratory
Methods 21 nd Edition. Philadelphia: WB Saunders Co, 2007 p 68-75