Appendix C: Laboratory Values of Clinical Importance in Medical-Surgical Nursing

Appendix

C
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Medical-Surgical Nursing

Laboratory Values of Clinical Importance in

R
eference laboratory values can provide guidelines for the clinician to use when assessing clients with a wide variety of problems. The laboratory values given here are for reference only and are not absolute normal values. Remember, there is no sharp dividing line between normal and abnormal. Clients with only slightly elevated values may have apparent disease, whereas those with more elevated values may not. Trends in laboratory values are often much more important than the single value. When analyzing laboratory values, consider the following questions: complete explanation of the diagnostic study and its meaning is covered in the appropriate section (such as liver function studies in Chapter 49). This Appendix simply provides a convenient way to check the normal values for the most common diagnostic studies. For details concerning the meaning of the value, see the appropriate section in the textbook. The following abbreviations are used throughout the laboratory studies: g = gram kg = kilogram mg = milligram (103) g = microgram (106) ng = nanogram (109) pg = picogram (1012) L = liter ml = milliliter dl = deciliter (100 ml) fL = femtoliter mm = millimeter mm3 = cubic millimeter U = unit mU = milliunit U = microunit mOsm = milliosmole mol = mole mol = micromole nmol = nanomole pmol = picomole fmol = femtomole (1015) mEq = milliequivalent m = micrometer

Is the value an expected abnormal nding? For example, creatinine is normally elevated in clients with renal failure. Is the value an unexpected abnormal nding? For example, elevated blood glucose levels in a client without diabetes may signal a disease. Is the value an unexpected normal nding? For example, a client with angina and probable myocardial infarction would be expected to have elevated isoenzymes. Normal levels may mean that the client has another cause of chest pain. Is the value an expected normal nding? For example, a healthy client should have a normal complete blood count. Use the analytic technique as a guide to determine when to call the physician. Remember, the laboratory only reports ndings; nurses help interpret their signicance. Appendix C summarizes the common laboratory diagnostic studies for use as a quick reference. A

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Appendix C: Laboratory Values of Clinical Importance in Medical-Surgical Nursing

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REFERENCE VALUES IN HEMATOLOGY* Test

Acid hemolysis test (Hams test) Alkaline phosphatase, leukocyte Cell counts Erythrocytes (red blood cells, RBCs) Males Females Children (varies with age) Leukocytes (white blood cells, WBCs), total Leukocytes, differential Myelocytes Band neutrophils Segmented neutrophils Lymphocytes Monocytes Eosinophils Basophils Platelets Reticulocytes Percentage 0 3 to 5 54 to 62 25 to 33 3 to 7 1 to 3 0 to 1 4.6 to 6.2 million/mm3 4.2 to 5.4 million/mm 4500 to 11,000/mm3 Absolute 0/mm
3 3

Conventional Units
No hemolysis Total score 14 to 100

SI Units
No hemolysis Total score 14 to 100

4.6 to 6.2 1012/L 4.2 to 5.2 1012/L 4.5 to 5.1 1012/L 4.5 to 11.0 109/L Absolute 0/L 150 to 400 106/L 3000 to 5800 106/L 1500 to 3000 106/L 300 to 500 106/L 50 to 250 106/L 15 to 50 106/L 150 to 400 109/L 25 to 75 109/L

4.5 to 5.1 million/mm3

150 to 400/mm3 3000 to 5800/mm3 1500 to 3000/mm 300 to 500/mm3 50 to 250/mm3 15 to 50/mm3 150,000 to 400,000/mm3 25,000 to 75,000/mm3 (0.5% to 1.5% of erythrocytes)
3

Coagulation tests Bleeding time (template) Coagulation time (glass tubes) D-Dimer Factor VIII and other coagulation factors Fibrin split products (Thrombo-Welco test) Fibrinogen International normalized ratio (INR) Partial thromboplastin time (PTT) Partial thromboplastin time, activated (aPTT) Prothrombin time (PT) Coombs test Direct Indirect Corpuscular values of erythrocytes Mean corpuscular hemoglobin (MCH) Mean corpuscular volume (MCV) Mean corpuscular hemoglobin concentration (MCHC) Haptoglobin 26 to 34 pg/cell 80 to 96 m
3

2.75 to 8.0 min 5 to 15 min < 0.5 g/ml 50% to 150% of normal < 10 g/ml 200 to 400 mg/dl 1.5 to 4.0 60 to 70 sec 30 to 40 sec 11.0 to 14.0 sec Negative Negative

2.75 to 8.0 min 5 to 15 min < 0.5 mg/L 0.5 to 1.5 of normal < 10 mg/L 2.0 to 4.0 g/L 60 to 70 sec 30 to 40 sec 11.0 to 14.0 sec Negative Negative 26 to 34 pg/cell 80 to 96 fL 320 to 360 g/L 0.20 to 1.65 g/L Table continued on following page

32 to 36 g/dl 20 to 165 mg/dl

Appendix C: Laboratory Values of Clinical Importance in Medical-Surgical Nursing

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REFERENCE VALUES IN HEMATOLOGY* continued Test

Hematocrit Males Females Newborns Children (varies with age) Hemoglobin Males Females Newborns Children (varies with age) Hemoglobin, fetal Hemoglobin A1C Hemoglobin A2 Hemoglobin, plasma Methemoglobin Sedimentation rate (ESR) Wintrobe Males Females Westergren Males Females 0 to 15 mm/hr 0 to 20 mm/hr 0 to 15 mm/hr 0 to 20 mm/hr 0 to 5 mm/hr 0 to 15 mm/hr 0 to 5 mm/hr 0 to 15 mm/hr 13.0 to 18.0 g/dl 12.0 to 16.0 g/dl 16.5 to 19.5 g/dl 11.2 to 16.5 g/dl < 1.0% of total 3% to 5% of total 1.5% to 3.0% of total 0 to 5.0 mg/dl 30 to 130 mg/dl 8.1 to 11.2 mmol/L 7.4 to 9.9 mmol/L 10.2 to 12.1 mmol/L 7.0 to 10.2 mmol/L < 0.01 of total 0.03 to 0.05 of total 0.015 to 0.03 of total 0 to 3.2 mol/L 19 to 80 mol/L 40 to 54 ml/dl 37 to 47 ml/dl 49 to 54 ml/dl 35 to 49 ml/dl 0.40 to 0.54 volume fraction 0.37 to 0.47 volume fraction 0.49 to 0.54 volume fraction 0.35 to 0.49 volume fraction

Conventional Units

SI Units

*For some procedures, reference values may vary, depending on the method used. Pagana, K. & Pagana, T. (2003). Mosbys diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby.

Appendix C: Laboratory Values of Clinical Importance in Medical-Surgical Nursing

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REFERENCE VALUES FOR BLOOD, PLASMA, AND SERUM* Test

Acetoacetate plus acetone Qualitative Quantitative Acid phosphatase, serum (thymolphthalein monophosphate substrate) Adrenocorticotropin, plasma (ACTH) 8:00 AM Alanine aminotransferase, serum (ALT, SGPT) Albumin, serum Aldolase, serum Aldosterone, plasma Standing Recumbent Alkaline phosphatase, serum (ALP) Adult Adolescent Child Alpha-fetoprotein (AFP) Ammonia nitrogen, plasma Amylase, serum Anion gap, serum, calculated Antinuclear antibody (ANA) Apolipoproteins Apolipoprotein A-1 (Apo A-1) Males Females Apolipoprotein B (Apo B) Males Females Apo A-1/Apo B ratio Males Females Ascorbic acid, blood Aspartate aminotransferase, serum (AST, SGOT) Base excess, arterial blood, calculated Bicarbonate Venous plasma Arterial blood Bile acids, serum Bilirubin, serum Conjugated Total 0.1 to 0.4 mg/dl 0.3 to 1.1 mg/dl 1.7 to 6.8 mol/L 5.1 to 19 mol/L Table continued on following page 23 to 29 mEq/L 21 to 27 mEq/L 0.3 to 3.0 mg/dl 23 to 29 mmol/L 21 to 27 mmol/L 0.8 to 7.6 mol/L 0.85 to 2.24 0.76 to 3.23 0.4 to 1.5 mg/dl 1 to 36 U/L 0 2 mEq/L 23 to 85 mol/L 1 to 36 U/L 0 2 mmol/L 50 to 125 mg/dl 45 to 120 mg/dl 75 to 160 mg/dl 80 to 175 mg/dl 35 to 150 U/L 100 to 500 U/L 100 to 350 U/L < 40 ng/ml 10 to 50 mol/L 25 to 125 U/L 8 to 16 mEq/L none 35 to 150 U/L 100 to 500 U/L 100 to 350 U/L < 40 g/L 10 to 50 mol/L 25 to 125 U/L 8 to 16 mmol/L none 5 to 30 ng/dl 3 to 10 ng/dl 140 to 830 pmol/L 80 to 275 pmol/L Negative 0.3 to 2.0 mg/dl 0.11 to 0.60 U/L 10 to 80 pg/ml 1 to 45 U/L 3.3 to 5.2 g/dl 0.0 to 7.0 U/L Negative 3 to 20 mg/L 0.11 to 0.60 U/L 2 to 18 pmol/L 1 to 45 U/L 33 to 52 g/L 0.0 to 7.0 U/L

Conventional Units

SI Units

Appendix C: Laboratory Values of Clinical Importance in Medical-Surgical Nursing

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REFERENCE VALUES FOR BLOOD, PLASMA, AND SERUM* continued Test

C-reactive protein (CRP) Calcium, serum Calcium, ionized, serum Cancer antigens (CA) CA 15-3 CA 27.29 CA 19-9 CA 125 Carbon dioxide, total, serum or plasma Carbon dioxide tension, blood (PCO2) Carcinoembryonic antigen (CEA) -Carotene serum Catecholamines, plasma Epinephrine (supine) Norepinephrine (supine) Ceruloplasmin, serum Chloride, serum or plasma Cholesterol, serum or EDTA plasma Desirable range Low-density lipoproteins (LDL) High-density lipoproteins (HDL) Copper Cortisol, plasma 8:00 AM 4:00 PM 10:00 PM Creatine, serum Males Females Creatine kinase or phosphokinase, serum (CK, CPK) Males Females Creatine kinase MB isozyme, serum 55 to 170 U/L 30 to 135 U/L < 5% of total CK activity < 5% ng/ml by immunoassay Creatinine, serum Ferritin, serum Fibrinogen, plasma Folate Serum Erythrocytes 3.0 to 18.0 ng/ml 145 to 540 ng/ml 6.8 to 41.0 nmol/L 330 to 1220 nmol/L Table continued on following page 0.5 to 1.2 mg/dl 20 to 200 ng/ml 200 to 400 mg/dl 55 to 170 U/L 30 to 135 U/L < 5% of total CK activity < 5% ng/ml by immunoassay 50 to 110 mol/L 20 to 200 g/L 2.0 to 4.0 g/L 0.2 to 0.5 mg/dl 0.3 to 0.9 mg/dl 15 to 40 mol/L 25 to 70 mol/L 6 to 23 g/dl 3 to 15 g/dl < 50% of 8 am value 170 to 630 nmol/L 80 to 410 nmol/L < 0.5 of 8 am value < 200 mg/dl 60 to 180 mg/dl > 45 mg/dl 70 to 140 g/dl < 5.20 mmol/L 1.55 to 4.65 mmol/L > 0.75 mmol/L 11 to 22 mol/L < 50 pg/ml 110 to 410 pg/ml 23 to 44 mg/dl 96 to 106 mEq/L < 273 pmol/L 650 to 2,423 pmol/L 230 to 440 mg/L 96 to 106 mmol/L < 22 U/ml < 38 U/ml < 37 U/ml < 35 U/ml 24 to 31 mEq/L 35 to 45 mm Hg < 5 ng/ml 60 to 260 g/dl < 22 kU/L < 38 kU/L < 37 kU/L < 35 kU/L 24 to 31 mmol/L 35 to 45 mm Hg < 5 g/L 1.1 to 8.6 mol/L

Conventional Units
< 1 mg/dl 8.4 to 10.6 mg/dl 4.25 to 5.25 mg/dl

SI Units
< 10 mg/L 2.10 to 2.65 mmol/L 1.05 to 1.30 mmol/L

Appendix C: Laboratory Values of Clinical Importance in Medical-Surgical Nursing

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REFERENCE VALUES FOR BLOOD, PLASMA, AND SERUM* continued Test

Follicle-stimulating hormone, plasma (FSH) Males Females Postmenopausal Gamma-glutamyltranspeptidase (GGT) -Glutamyltransferase, serum Gastrin, (fasting) serum Glucose (fasting), plasma or serum Growth hormone, plasma (HGH) Haptoglobin, serum Homocysteine (Hcy) Immunoglobulins, serum IgG IgA IgM IgD IgE Insulin (fasting), plasma Iron, serum Iron-binding capacity, serum Total Saturation Lactate Venous blood Arterial blood Lactate dehydrogenase, serum (LD, LDH) Lipase, serum Lipids, total, serum Luteinizing hormone, serum (LH) Males Females Follicular phase Midcycle peak Luteal phase Postmenopausal Magnesium, serum Osmolality Oxygen, blood, arterial, room air Saturation (SaO2) Partial pressure (PaO2) pH, arterial blood 95% to 98% 80 to 100 mm Hg 7.35 to 7.45 95% to 98% 80 to 100 mm Hg 7.35 to 7.45 Table continued on following page 2 to 10 U/L 15 to 65 U/L 1 to 12 U/L 12 to 65 U/L 1.3 to 2.1 mg/dl 275 to 295 mOsm/kg H2O 2 to 10 U/L 15 to 65 U/L 1 to 12 U/L 12 to 65 U/L 0.65 to 1.05 mmol/L 275 to 295 mOsm/kg H2O 1 to 9 mU/ml 1 to 9 U/L 5.0 to 20.0 mg/dl 5.0 to 15.0 mg/dl 110 to 220 U/L 10 to 140 U/L 400 to 800 mg/dl 0.6 to 2.2 mmol/L 0.6 to 1.7 mmol/L 110 to 220 U/L 10 to 140 U/L 4.0 to 8.0 g/L 250 to 410 g/dl 20% to 55% 45 to 73 mol/L 0.20 to 0.55 640 to 1350 mg/dl 70 to 310 mg/dl 90 to 350 mg/dl 0.0 to 6.0 mg/dl 0.0 to 430 ng/ml 5 to 25 U/ml 75 to 175 g/dl 6.4 to 13.5 g/L 0.70 to 3.1 g/L 0.90 to 3.5 g/L 0.0 to 60 mg/L 0.0 to 430 g/L 36 to 179 pmol/L 13 to 31 mol/L 4 to 25 mU/ml 4 to 30 mU/ml 40 to 250 mU/ml 5 to 38 U/L 5 to 40 U/L 0 to 110 pg/ml 70 to 110 mg/dl 0 to 6 ng/ml 26 to 165 mg/dl 4 to 14 mol/L 4 to 25 U/L 4 to 30 U/L 40 to 250 U/L 5 to 38 IU/L 5 to 40 IU/L 0 to 110 ng/L 3.9 to 6.4 nmol/L 0 to 6 g/L 0.20 to 1.65 g/L 4 to 14 mol/L

Conventional Units

SI Units

Appendix C: Laboratory Values of Clinical Importance in Medical-Surgical Nursing

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REFERENCE VALUES FOR BLOOD, PLASMA, AND SERUM* continued Test

Phenylalanine, serum (Guthrie test) Phosphate, inorganic, serum Potassium, serum Prolactin, serum Males Females Protein, serum Total Albumin 1-Globulin 2-Globulin -Globulin -Globulin Pyruvate, blood Sodium, serum or plasma Testosterone, plasma Males Females Pregnant Thyroglobulin Thyroid-stimulating hormone, serum (TSH) Thyroxine, free, serum (FT4) Thyroxine, serum (T4) Triglycerides, serum, after 12 hr fast Triiodothyronine, serum (T3) Triiodothyronine uptake, resin (T3RU) Urate Males Females Urea, serum or plasma Urea nitrogen, serum or plasma (Blood urea nitrogen or BUN) Viscosity, serum Vitamin A, serum Vitamin B12, serum 2.5 to 8.0 mg/dl 2.2 to 7.0 mg/dl 24 to 49 mg/dl 11 to 23 mg/dl 1.4 to 1.8 water 20 to 80 g/dl 180 to 900 pg/ml 150 to 480 mol/L 130 to 420 mol/L 4.0 to 8.2 nmol/L 8.0 to 16.4 nmol/L 1.4 to 1.8 water 0.70 to 2.80 mol/L 133 to 664 pmol/L 300 to 1200 ng/dl 20 to 75 ng/dl 40 to 200 ng/dl 3 to 42 ng/ml 0.4 to 4.8 IU/ml 0.9 to 2.1 ng/dl 4.5 to 12.0 g/dl 40 to 150 mg/dl 70 to 190 ng/dl 25% to 38% uptake 10.4 to 41.6 nmol/L 0.7 to 2.6 nmol/L 1.4 to 6.9 nmol/L 3 to 42 g/L 0.4 to 4.8 mIU/L 12 to 27 pmol/L 58 to 154 nmol/L 0.4 to 1.5 g/L 1.1 to 2.9 nmol/L 0.25 to 0.38 uptake 6.0 to 8.0 g/dl 3.5 to 5.5 g/dl 0.2 to 0.4 g/dl 0.5 to 0.9 g/dl 0.6 to 1.1 g/dl 0.7 to 1.7 g/dl 0.3 to 0.9 mg/dl 135 to 145 mEq/L 60 to 80 g/L 35 to 55 g/L 2 to 4 g/L 5 to 9 g/L 6 to 11 g/L 7 to 17 g/L 0.03 to 0.10 mmol/L 135 to 145 mmol/L 1 to 15 ng/ml 1 to 20 ng/ml 1 to 15 g/L 1 to 20 g/L

Conventional Units
< 2 mg/dl 3.0 to 4.5 mg/dl 3.5 to 5.0 mEq/L

SI Units
121 mol/L 1.0 to 1.5 mmol/L 3.5 to 5.0 mmol/L

*For some procedures, reference values may vary, depending on the method used. Pagana, K. & Pagana, T. (2003). Mosbys diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby.

Appendix C: Laboratory Values of Clinical Importance in Medical-Surgical Nursing

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REFERENCE VALUES FOR URINE* Test

Acetone and acetoacetate, qualitative Albumin Qualitative Quantitative Aldosterone -Aminolevulinic acid Amylase Amylase/creatinine clearance ratio Bilirubin, qualitative Calcium (usual diet) Catecholamines Epinephrine Norepinephrine Total free catecholamines Total metanephrines Chloride (varies with intake) Copper Cortisol, free Creatine Males Females Creatinine Creatinine clearance (corrected to 1.73 m body surface area)
2

Conventional Units
Negative Negative 10 to 100 mg/24 hr 3 to 20 g/24 hr 1.3 to 7.0 mg/24 hr < 17 U/hr 0.01 to 0.04 Negative < 250 mg/24 hr < 10 g/24 hr < 100 g/24 hr 4 to 126 g/24 hr 0.1 to 1.6 mg/24 hr 110 to 250 mEq/24 hr 0 to 50 g/24 hr 10 to 100 g/24 hr 0 to 40 mg/24 hr 0 to 80 mg/24 hr 15 to 25 mg/kg/24 hr

SI Units
Negative Negative 0.15 to 1.5 mol/24 hr 8.3 to 55 nmol/24 hr 10 to 53 mol/24 hr < 17 U/hr 0.01 to 0.04 Negative < 6.3 nmol/24 hr < 55 nmol/24 hr < 590 nmol/24 hr 24 to 745 nmol/24 hr 0.5 to 8.1 mol/24 hr 110 to 250 nmol/24 hr 0 to 0.80 mol/24 hr 27.6 to 276 nmol/24 hr 0.0 to 0.30 mmol/24 hr 0.0 to 0.60 mmol/24 hr 0.130.22 mmol/kg/24 hr

Males Females Dehydroepiandrosterone Males Females Estrogens, total Males Females Glucose (as reducing substance) Hemoglobin and myoglobin, qualitative 17-Hydroxycorticosteroids Males Females 5-Hydroxyindoleacetic acid Qualitative Quantitative

110 to 150 ml/min/1.73 m2 105 to 132 ml/min/1.73 m2 0.2 to 2.0 mg/24 hr 0.2 to 1.8 mg/24 hr 4 to 25 g/24 hr 5 to 100 g/24 hr < 250 mg/24 hr Negative 3 to 9 mg/24 hr 2 to 8 mg/24 hr Negative 2 to 6 mg/24 hr

110 to 150 ml/min/1.73 m2 105 to 132 ml/min/1.73 m2 0.7 to 6.9 mol/24 hr 0.7 to 6.2 mol/24 hr 14 to 90 nmol/24 hr 18 to 360 nmol/24 hr < 250 mg/24 hr Negative 8.3 to 25 mol/24 hr 5.5 to 22 mol/24 hr Negative 10 to 31 mol/24 hr Table continued on following page

Appendix C: Laboratory Values of Clinical Importance in Medical-Surgical Nursing

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REFERENCE VALUES FOR URINE* continued Test

17-Ketosteroids Males Females Magnesium Metanephrines (see Catecholamines) Osmolality pH Phenylpyruvic acid, qualitative Phosphate Porphobilinogen Qualitative Quantitative Porphyrins Coproporphyrin Uroporphyrin Potassium Pregnanediol Males Females Proliferative phase Luteal phase Postmenopausal Pregnanetriol Protein Qualitative Quantitative Protein-creatinine ratio Sodium (usual diet) Specic gravity, random Urate (usual diet) Urobilinogen Vanillylmandelic acid (VMA) (4-hydroxy-3methoxymandelic acid) Negative 10 to 150 mg/24 hr < 0.2 60 to 260 mEq/24 hr 1.003 to 1.030 250 to 750 mg/24 hr 0.5 to 4.0 mg/24 hr 1 to 8 mg/24 hr Negative 10 to 150 mg/24 hr < 0.2 60 to 260 mmol/24 hr 1.003 to 1.030 1.5 to 4.4 mmol/24 hr 0.6 to 6.8 mol/24 hr 5 to 40 mol/24 hr 0.0 to 2.6 mg/24 hr 2.6 to 10.6 mg/24 hr 0.2 to 1.0 mg/24 hr < 2.5 mg/24 hr 0.0 to 8.0 mol/24 hr 8 to 33 mol/24 hr 0.6 to 3.1 mol/24 hr < 7.4 mol/24 hr 0.0 to 1.9 mg/24 hr 0.0 to 6.0 mol/24 hr 50 to 250 g/24 hr 10 to 30 g/24 hr 25 to 125 mEq/24 hr 77 to 380 nmol/24 hr 12 to 36 nmol/24 hr 25 to 125 mmol/24 hr Negative < 2.0 mg/24 hr Negative < 9 mol/24 hr 38 to 1,400 mOsm/kg H2O 4.6 to 8.0 Negative 0.4 to 1.3 g/24 hr 38 to 1,400 mOsm/kg H2O 4.6 to 8.0 Negative 13 to 42 mmol/24 hr 8 to 22 mg/24 hr 6 to 15 mg/24 hr 6.0 to 10 mEq/24 hr 28 to 76 mol/24 hr 21 to 52 mol/24 hr 3.0 to 5.0 mmol/24 hr

Conventional Units

SI Units

*For some procedures, reference values may vary, depending on the method used. Pagana, K. & Pagana, T. (2003). Mosbys diagnostic and laboratory test reference (6th ed.). St. Louis: Mosby.

Appendix C: Laboratory Values of Clinical Importance in Medical-Surgical Nursing

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REFERENCE VALUES FOR CEREBROSPINAL FLUID Conventional Units

Cells Electrophoresis Glucose < 5/mm
3

SI Units
< 5 106/L All mononuclear Predominantly albumin 2.8 to 4.2 mmol/L (1.1 mmol/L less than serum) < 0.08 of total protein < 0.14 of total protein 0.3 to 0.6

All mononuclear Predominantly albumin 50 to 75 mg/dl (20 mg/dl less than serum) IgG Children < 14 yr Adults IgG index CSF/serum IgG ratio CSF/serum albumin ratio Oligoclonal banding on electrophoresis Pressure, opening Protein, total Absent 70 to 180 mm H2O 15 to 45 mg/dl < 8% of total protein < 14% of total protein 0.3 to 0.6

Absent 70 to 180 mm H2O 150 to 450 mg/L

Modied from Conn, R. B., Borer, W. Z., & Snyder, J. W. (1997). Current diagnosis (9th ed., pp. 12351241). Philadelphia: W. B. Saunders; and data from Malarkey, L. M., & McMorrow, M. E. (2000). Nurses manual of laboratory tests and diagnostic procedures (2nd ed.). Philadelphia: W. B. Saunders.