Laboratory Reference Values

The
new england journal
of
medicine
case records of the massachusetts general hospital

Founded by Richard C. Cabot
Nancy Lee Harris, m.d., Editor
Jo-Anne O. Shepard, m.d., Associate Editor
Sally H. Ebeling, Assistant Editor
Stacey M. Ellender, Assistant Editor

Christine C. Peters, Assistant Editor
Laboratory Reference Values

Alexander Kratz, M.D., Ph.D., M.P.H., Maryjane Ferraro, Ph.D., M.P.H.,
Patrick M. Sluss, Ph.D., and Kent B. Lewandrowski, M.D.
From the Department of Pathology Clinical

Hematology Laboratory (A.K.), Microbiology Laboratory (M.F.), and Immunodiagnostics Laboratory (P.M.S.) and the Department of Pathology (K.B.L.), Massachusetts
General Hospital; and Harvard Medical
School (A.K., M.F., P.M.S., K.B.L.).
N Engl J Med 2004;351:1548-63.
Copyright 2004 Massachusetts Medical Society.
1548
The following is a table of reference values for adults for laboratory tests commonly ordered at the Massachusetts General Hospital (MGH) and recorded in the Case Records.
The table revises the most recently published data (Normal Reference Laboratory Values.
N Engl J Med 1998;339:1063-72). Laboratory values are expressed in the units used at
the MGH and the units of the Systme International dUnits (SI units). The table is not
intended to provide a comprehensive review of reference values, since this information
is widely available in standard textbooks. To avoid suggesting an endorsement of commercial products by the hospital or the Journal, information on specific methods and
instruments is not provided. Reference values are affected by many variables, including
the patient population and the laboratory methods used. The ranges used at the MGH
may therefore not be appropriate for other institutions and may not be optimal in some
situations.
n engl j med 351;15
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Downloaded from www.nejm.org by A MARK B. CLARFIELD on October 7, 2005 .

Copyright 2004 Massachusetts Medical Society. All rights reserved.
Hematology and Coagulation.

Analyte
Specimen*
Units Used at MGH
SI Units
WB
70180 sec
70180 sec
Activated protein C resistance (factor V Leiden)
Ratio >2.1
Not applicable
Alpha2-antiplasmin
80130%
0.801.30
Partial-thromboplastin timelupus anticoagulant screen
Negative
Negative
Platelet-neutralization procedure
Negative
Negative
Dilute viper-venom screen
Negative
Negative
Anticardiolipin antibody
IgG
015 GPL units
015 arbitrary units
IgM
015 MPL units
015 arbitrary units
Activated clotting time
Antiphospholipid-antibody panel
Antithrombin III
Antigenic
2239 mg/dl
Functional
80130%
0.81.30 U/liter
Unfractionated heparin
0.30.7 IU/ml
0.30.7 kIU/liter
Low-molecular-weight heparin
0.51.0 IU/ml
0.51.0 kIU/liter
Danaparoid
0.50.8 IU/ml
0.50.8 kIU/liter
Anti-Xa assay (heparin assay)
220390 mg/liter
Bleeding time
2.09.5 min
Carboxyhemoglobin
2.09.5 min
WB
Nonsmoker
Smoker
02.3%
00.023
2.14.2%
0.0210.042
Clot retraction
WB
50100%/2 hr
Cryofibrinogen
Negative
Negative
d-Dimer
<0.5 g/ml
<0.5 mg/liter
Neutrophils
4070%
0.400.70
Band forms
010%
00.10
Lymphocytes
2244%
0.220.44
Monocytes
411%
0.040.11
Eosinophils
08%
00.08
Basophils
03%
00.03
Differential blood count
0.501.00/2 hr
WB
Erythrocyte count
WB
Male
4.505.90106/mm3
4.505.901012/liter
Female
4.005.20106/mm3
4.005.201012/liter
Erythrocyte lifespan
WB
Normal survival
120 days
120 days
2535 days
2535 days
Female
125 mm/hr
125 mm/hr
Male
017 mm/hr
017 mm/hr
Chromium labeled, half-life

Erythrocyte sedimentation rate
WB
Factor II, prothrombin
60140%
0.601.40
Factor V
60140%
0.601.40
Factor VII
60140%
0.601.40
Factor VIII
50200%
0.502.00
Factor IX
60140%
0.601.40
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1549
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Hematology and Coagulation. (Continued.)

Analyte
Specimen*
Units Used at MGH
SI Units
Factor X
60140%
0.601.40
Factor XI
60140%
0.601.40
Factor XII
60140%
0.601.40
Factor XIII screen
No deficiency detected
Not applicable
Factor-inhibitor assay
<0.5 Bethesda unit
<0.5 Bethesda unit
Ferritin
Male
30300 ng/ml
30300 g/liter
Female
10200 ng/ml
10200 g/liter
<2.5 g/ml
<2.5 mg/liter
150400 mg/dl
1.504.00 g/liter
Normal
3.117.5 ng/ml
7.039.7 nmol/liter
Borderline deficient
2.23.0 ng/ml
5.06.8 nmol/liter
Fibrin and fibrinogen-degradation products

Fibrinogen
Folate (folic acid)
S, P
Deficient
<2.2 ng/ml
<5.0 nmol/liter
Excess
>17.5 ng/ml
>39.7 nmol/liter
Not applicable
Glucose-6-phosphate dehydrogenase, erythrocyte
WB
No gross deficiency
Hams test (acidified serum test)
WB
Negative
Negative
Haptoglobin
16199 mg/dl
0.161.99 g/liter
Hematocrit
WB
Male
41.053.0%
0.410.53
Female
36.046.0%
0.360.46
15 mg/dl
0.010.05 g/liter
Male
WB
13.517.5 g/dl
8.410.9 mmol/liter
Female
WB
12.016.0 g/dl
7.49.9 mmol/liter
Hemoglobin
Plasma
Whole blood
Hemoglobin electrophoresis
WB
Hemoglobin A
9598%
0.950.98
Hemoglobin A2
1.53.5%
0.0150.035
Hemoglobin F
02.0%
Hemoglobins other than A, A2, or F
Absent
Heparin-induced thrombocytopenia antibody
Negative
Negative
Homocysteine
012 mol/liter
012 mol/liter
Iron
30160 g/dl
5.428.7 mol/liter
Iron-binding capacity
1550
00.02
Absent
228428 g/dl
40.876.7 mol/liter
Leukocyte count (WBC)
WB
4.511.0103/mm3
4.511109/liter
Mean corpuscular hemoglobin (MCH)
WB
26.034.0 pg/cell
26.034.0 pg/cell
Mean corpuscular hemoglobin concentration (MCHC)
WB
31.037.0 g/dl
310370 g/liter
Mean corpuscular volume (MCV)
WB
80100 m3
80100 fl
Methemoglobin
WB
1% of total hemoglobin
Osmotic fragility of erythrocytes
WB
No increased hemolysis as compared with

normal control
Partial-thromboplastin time, activated
Plasminogen
22.135.1 sec
Not applicable
22.135.1 sec
Antigenic
8.414.0 mg/dl
84140 mg/liter
Functional
80130%
0.801.30
n engl j med 351;15
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october 7 , 2004

Hematology and Coagulation. (Continued.)

Analyte
Specimen*
Units Used at MGH
SI Units
443 ng/ml
443 g/liter
Platelet aggregation
PRP
>65% aggregation in response to adenosine

diphosphate, epinephrine,
collagen, ristocetin, and
arachidonic acid
Not applicable
Platelet count
WB
150350103/mm3
150350109/liter
Plasminogen activator inhibitor 1
Prekallikrein assay
60140%
0.601.40
Prekallikrein screen
Deficiency not detected
Not applicable
Protein C
Total antigen
70140%
0.701.40
Functional
70140%
0.701.40
Total antigen
70140%
0.701.40
Functional
70140%
0.701.40
Free antigen
70140%
0.701.40
WB
Not present
Not applicable
11.113.1 sec
11.113.1 sec
Protoporphyrin, free erythrocyte
WB
1636 g/dl red cells
0.280.64 mol/liter
red cells
Red-cell distribution width
WB
11.514.5%
0.1150.145
1624 sec
1624 sec
Reticulocyte count
WB
0.52.5% red cells
0.0050.025 red cells
Reticulocyte hemoglobin content
WB
>26 pg/cell
>26 pg/cell
Blood group O
75% mean of normal
0.75 mean of normal
Blood group A
105% mean of normal
1.05 mean of normal
Blood group B
115% mean of normal
1.15 mean of normal
Blood group AB
125% mean of normal
1.25 mean of normal
740%
Not applicable
Sickle-cell test
WB
Negative
Negative
Sucrose hemolysis
WB
<10%
<0.1
1624 sec
1624 sec
S, P
9.629.6 nmol/liter
9.629.6 nmol/liter
P
S
1.72.1
1.41.8
1.72.1
1.41.8
Protein S
Prothrombin-gene mutation G20210A

Prothrombin time
Reptilase time
Ristocetin cofactor (functional von Willebrand factor)
Schilling test, orally administered vitamin B12 excreted

in urine
Thrombin time
Transferrin receptor
Viscosity
S, P
Vitamin B12
Normal
>250 pg/ml
>185 pmol/liter
125250 pg/ml
92185 pmol/liter
<125 pg/ml
<92 pmol/liter
Blood group O
75% mean of normal
0.75 mean of normal
Blood group A
105% mean of normal
1.05 mean of normal
Blood group B
115% mean of normal
1.15 mean of normal
125% mean of normal
1.25 mean of normal
Normal distribution
Normal distribution
Borderline
Deficient
von Willebrand factor (vWF) antigen (factor VIII:R antigen)
Blood group AB
von Willebrand factor multimers
White cells: see Leukocytes
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1551
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Immunology.
Analyte
Specimen*
Units Used at MGH
SI Units
Antiadrenal antibody
Negative at 1:10 dilution
Not applicable
Antidouble-stranded (native) DNA
Not applicable
Antiglomerular basement membrane antibody
Qualitative
Negative
Negative
Quantitative
<5 U/ml
<5 kU/liter
Autoantibodies
Antigranulocyte antibody
Negative
Not applicable
AntiJo-1 antibody
Negative
Not applicable
Anti-La antibody
Negative
Not applicable
Antimitochondrial antibody
Negative
Not applicable
Antineutrophil cytoplasmic autoantibody, cytoplasmic

(c-ANCA)
Qualitative
Negative
Negative
Quantitative (antibody to proteinase 3)
<2.8 U/ml
<2.8 kU/liter
Qualitative
Negative
Negative
Quantitative (antibody to myeloperoxidase)
<1.4 U/ml
<1.4 kU/liter
Antineutrophil cytoplasmic autoantibody, perinuclear

(p-ANCA)
Antinuclear antibody
Not applicable
Antiparietal-cell antibody
Not applicable
Anti-Ro antibody
Negative
Not applicable
Antiplatelet antibody
Negative
Not applicable
Anti-RNP antibody
Negative
Not applicable
AntiScl-70 antibody
Negative
Not applicable
Anti-Smith antibody
Negative
Not applicable
Antismooth-muscle antibody
Not applicable
Antithyroglobulin
Negative
Not applicable
Antithyroid antibody
<0.3 IU/ml
<0.3 kIU/liter
None detected
Not applicable
Qualitative
None detected in 50-fold

concentrated specimen
Not applicable
Quantitative
Kappa
<2.5 mg/dl
<0.03 g/liter
Lambda
<5.0 mg/dl
<0.05 g/liter
<0.27 mg/dl
<120 g/day
<2.7 mg/liter
<120 g/day
Antigenic
12.424.5 mg/dl
0.120.25 g/liter
Functional
Present
Present
Routine
0.083.10 mg/liter
0.083.10 mg/liter
High-sensitivity
0.028.00 mg/liter
0.028.00 mg/liter
Bence Jones protein
Beta2-microglobulin
S
U
C1-esteraseinhibitor protein
C-reactive protein
Complement
1552
C3
86184 mg/dl
0.861.84 g/liter
C4
2058 mg/dl
0.200.58 g/liter
Total complement, enzyme immunoassay
63145 U/ml
63145 kU/liter
Factor B
1742 mg/dl
0.170.42 g/liter
n engl j med 351;15
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october 7 , 2004

Immunology. (Continued.)
Analyte
Specimen*
Units Used at MGH
SI Units
Cryoproteins
Negative
Not applicable
Immunofixation
Negative
Not applicable
IgA
60309 mg/dl
0.603.09 g/liter
IgD
014 mg/dl
0140 mg/liter
IgE
10179 IU/ml
24430 g/liter
IgG
6141295 mg/dl
6.1412.95 g/liter
IgG1
2701740 mg/dl
2.717.4 g/liter
IgG2
30630 mg/dl
0.36.3 g/liter
IgG3
13320 mg/dl
0.133.20 g/liter
IgG4
11620 mg/dl
0.116.20 g/liter
53334 mg/dl
0.533.34 g/liter
Joint-fluid crystal
JF
Negative
Not applicable
Joint-fluid mucin
JF
Only type I mucin present Not applicable
Immunoglobulin
IgM
LE-cell test
WB
Negative
Negative
Rheumatoid factor
S, JF
<30.0 IU/ml
<30 kIU/liter
Normal pattern
Not applicable
Serum protein electrophoresis
Clinical Chemistry.
Analyte
Specimen*
Units Used at MGH
SI Units
<100 mol/liter
Acetoacetate
<1 mg/dl
Albumin
3.55.5 g/dl
3555 g/liter
Aldolase
06 U/liter
0100 nkat/liter
Alpha1-antitrypsin
85213 mg/dl
0.82.1 g/liter
Alpha-fetoprotein
<15 ng/ml
<15 g/liter
Aminotransferases
Aspartate (AST, SGOT)
035 U/liter
00.58 kat/liter
Alanine (ALT, SGPT)
035 U/liter
00.58 kat/liter
Ammonia, as NH3
1080 g/dl
647 mol/liter
Amylase
60180 U/liter
0.83.2 kat/liter
Angiotensin-converting enzyme (ACE)
<40 U/liter
<670 nkat/liter
Anion gap
716 mmol/liter
716 mmol/liter
Apolipoprotein
Apolipoprotein A-1
119240 mg/dl
1.22.4 g/liter
Apolipoprotein B
52163 mg/dl
0.521.63 g/liter
0.350.98
0.350.98
2130 mEq/liter
2128 mmol/liter
3545 mm Hg
4.75.9 kPa
Apolipoprotein B:apolipoprotein A-1

Arterial blood gases, sea level
WB, arterial
Bicarbonate (HCO3)
Partial pressure of carbon dioxide (PCO2)
pH
Partial pressure of oxygen (PO2)
P
b-Hydroxybutyrate
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7.387.44
7.387.44
80100 mg Hg
1113 kPa
<3 mg/dl
<300 mol/liter
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1553
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Clinical Chemistry. (Continued.)

Analyte
Specimen*
Units Used at MGH
SI Units
Beta2-microglobulin
S
U
1.22.8 mg/liter
200 g/liter
1.22.8 mg/liter
200 g/liter
Bilirubin
Total
0.31.0 mg/dl
5.117.0 mol/liter
Direct
0.10.3 mg/dl
1.75.1 mol/liter
0.20.7 mg/dl
3.412.0 mol/liter
Brain-type natriuretic peptide (BNP)
Indirect
P
<167 pg/ml (age- and

sex-dependent)
<167 ng/liter (age- and

sex-dependent)
Calcium
9.010.5 mg/dl
2.22.6 mmol/liter
Calcium, ionized
WB
4.55.6 mg/dl
1.11.4 mmol/liter
CA 15-3
030 U/ml
030 kU/liter
CA 19-9
037 U/ml
037 kU/liter
CA 27-29
032 U/ml
032 kU/liter
CA 125
035 U/ml
035 kU/liter
Calcitonin
Male
326 pg/ml
326 ng/liter
Female
217 pg/ml
217 ng/liter
2130 mEq/liter
2130 mmol/liter
WB, arterial
3545 mm Hg
Carbon dioxide
Content, sea level
Partial pressure (PCO2), sea level
Carbon monoxide content
WB
4.75.9 kPa
Symptoms with 20%
saturation of hemoglobin
Carcinoembryonic antigen (CEA)
03.4 ng/ml
03.4 g/liter
Ceruloplasmin
2737 mg/dl
270370 mg/liter
Cholinesterase
512 U/ml
512 kU/liter
Chloride
98106 mEq/liter
98106 mmol/liter
Cholesterol
P
<100 mg/dl
<2.59 mmol/liter
Near or above normal
100129 mg/dl
2.593.34 mmol/liter
Borderline high
130159 mg/dl
3.364.11 mmol/liter
High
160189 mg/dl
4.134.88 mmol/liter
190 mg/dl
4.91 mmol/liter
Low
<40 mg/dl
<1.03 mmol/liter
High
60 mg/dl
1.55 mmol/liter
Low-density lipoprotein (LDL) cholesterol

Optimal
Very high
High-density lipoprotein (HDL) cholesterol
Total cholesterol
Desirable
Borderline high
High
1554
<200 mg/dl
<5.17 mmol/liter
200239 mg/dl
5.176.18 mmol/liter
240 mg/dl
6.18 mmol/liter
Copper
S
U
70140 g/dl
335 g/24 hr
1122 mol/liter
0.0470.55 mol/24 hr
Coproporphyrins, types I and III
100300 g/24 hr
150460 mol/24 hr
C-peptide
0.52.0 ng/ml
0.170.66 nmol/liter
n engl j med 351;15
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october 7 , 2004


Analyte
Specimen*
Units Used at MGH
SI Units
Female
40150 U/liter
0.672.50 kat/liter
Male
60400 U/liter
1.006.67 kat/liter
Creatine kinase
Total
MB isoenzyme
07 ng/ml
07 g/liter
Relative index
Method-dependent
Method-dependent
<1.5 mg/dl
<133 mol/liter
Creatinine
Erythropoietin
536 IU/liter
536 IU/liter
Fatty acids, free (nonesterified)
<825 mg/dl
0.280.89 mmol/liter
Fibrinogen and fibrinogen-degradation products:

see under Hematology and Coagulation
Folic acid
RC
g-Glutamyltransferase
Glucose
150450 ng/ml/cells 3401020 nmol/liter/cells

194 U/liter
194 U/liter
75115 mg/dl
4.26.4 mmol/liter
>125 mg/dl
>7.0 mmol/liter
Fasting
Normal
Diabetes mellitus
2 Hr postprandial
120 mg/dl
<6.7 mmol/liter
WB
3.86.4%
0.0380.064 hemoglobin
fraction
Homocysteine
412 mol/liter
412 mol/liter
Hydroxyproline
01.3 mg/24 hr
010 mol/24 hr
Iron
50150 g/dl
927 mol/liter
Iron-binding capacity
250370 g/dl
4566 mol/liter
Hemoglobin A1c
Iron-binding capacity, saturation

Ketone (acetone)
Lactate
2045%
0.20.45
S, U
Negative
Negative
P, venous
515 mg/dl
0.61.7 mmol/liter
Lactate dehydrogenase
100190 U/liter
1.73.2 kat/liter
Lactate dehydrogenase isoenzymes
Fraction 1 (of total)
1426%
0.140.25
Fraction 2
2939%
0.290.39
Fraction 3
2026%
0.200.25
Fraction 4
816%
0.080.16
Fraction 5
616%
0.060.16
Lead (adult)
<1020 g/dl
<0.51 mol/liter
Lipase
0160 U/liter
02.66 kat/liter
Lipids, triglyceride: see Triglycerides

Lipoprotein(a)
030 mg/dl
0300 mg/liter
Magnesium
1.83.0 mg/dl
0.81.2 mmol/liter
WB
U, 24 hr
0.659 g/liter
<20 g/liter
3.0294 nmol/liter
<99.8 nmol/liter
Mercury
Microalbumin
24-hr
<20 mg/liter or <31 mg/ <0.02 g/liter or <0.031

24 hr
g/24 hr
Spot, morning
<0.03 mg albumin/mg
creatinine
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<0.03 g albumin/g
creatinine
october 7, 2004

1555
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Analyte
Specimen*
Myoglobin
Units Used at MGH
SI Units
Male
1992 g/liter
Female
1276 g/liter
5'-Nucleotidase
011 U/liter
0.020.18 kat/liter
Osmolality
285295 mOsm/kg
serum water
300900 mOsm/kg
285295 mmol/kg
serum water
300900 mmol/kg
U
Oxygen
Content, sea level
WB, arterial
WB, venous
(arm)
1721 vol%
1016 vol%
Saturation, sea level
WB, arterial
WB, venous
(arm)
97%
6085%
0.97 mol/mol
0.600.85 mol/mol
WB
80100 mm Hg
1113 kPa
WB
7.387.44
<1.3 pmol/liter
<1.3 pmol/liter
Acid
05.5 U/liter
0.90 nkat/liter
Alkaline
Partial pressure (PO2)

pH
Parathyroid hormonerelated peptide
Phosphatase
30120 U/liter
0.52.0 nkat/liter
Phosphorus, inorganic
34.5 mg/dl
1.01.4 mmol/liter
Porphobilinogen
None
None
Potassium
3.55.0 mEq/liter
3.55.0 mmol/liter
Prealbumin
19.535.8 mg/dl
195358 mg/liter
Prostate-specific antigen (PSA)
S
<0.5 ng/ml
<0.5 g/liter
40 yr
02.0 ng/ml
02.0 g/liter
>40 yr
04.0 ng/ml
04.0 g/liter
>25% associated with

benign prostatic
hyperplasia
>0.25 associated with

benign prostatic
hyperplasia
5.58.0 g/dl
5580 g/liter
Female
Male
Prostate-specific antigen (PSA), free (men 4575 yr

with PSA values between 4 and 20 ng/ml)
Protein
Total
Fractions
Albumin
3.55.5 g/dl (5060%)
3555 g/liter
Alpha1
0.20.4 g/dl (4.2

7.2%)
24 g/liter
Alpha2
0.50.9 g/dl (6.812%)
59 g/liter
Beta
0.61.1 g/dl (9.315%)
611 g/liter
Gamma
0.71.7 g/dl (1323%)
717 g/liter
Globulin
2.03.5 g/dl (4050%)
2035 g/liter
Pyruvate
P, venous
0.51.5 mg/dl
60170 mol/liter
Sodium
136145 mEq/liter
136145 mmol/liter
Transferrin
230390 mg/dl
2.33.9 g/liter
Triglycerides
<160 mg/dl
<1.8 mmol/liter
00.4 ng/ml
00.4 g/liter
00.1 ng/ml
00.1 g/liter
Troponin
1556
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october 7 , 2004


Analyte
Specimen*
Units Used at MGH
SI Units
Urea nitrogen
1020 mg/dl
3.67.1 mmol/liter
Uric acid
S
2.58.0 mg/dl
150480 mol/liter
Male
1.56.0 mg/dl
90360 mol/liter
Urobilinogen
Female
U
13.5 mg/24 hr
1.75.9 mol/24 hr
Vitamin A
20100 g/dl
0.73.5 mol/liter
Vitamin B1 (thiamine)
02 g/dl
075 nmol/liter
Vitamin B2 (riboflavin)
424 g/dl
106638 nmol/liter
Vitamin B6
530 ng/ml
20121 nmol/liter
Vitamin C (ascorbic acid)
0.41.0 mg/dl
2357 mol/liter
Vitamin D3 (1,25-dihydroxyvitamin D)
2545 pg/ml
60108 pmol/liter
Vitamin D3 (25-hydroxyvitamin D)
1068 ng/ml
24.9169.5 nmol/liter
Vitamin E
518 g/ml
1242 mol/liter
Vitamin K
0.131.19 ng/ml
0.292.64 nmol/liter
Specimen*
Units Used at MGH
SI Units
6.076.0 pg/ml
1.316.7 pmol/liter
55250 pmol/liter
Metabolic and Endocrine Tests.

Analyte
Adrenocorticotropin (ACTH)
Aldosterone
Supine, normal-sodium diet
S, P
29 ng/dl
Upright, normal-sodium diet
S, P
25 times supine value

with normal-sodium diet
Supine, low-sodium diet
S, P
25 times supine value

with normal-sodium diet
2.321.0 g/24 hr
6.3858.25 nmol/24 hr
50250 ng/dl
1.758.73 nmol/liter
525 g/dl
138690 nmol/liter
Noon8 p.m.
515 g/dl
138414 nmol/liter
8 p.m.8 a.m.
010 g/dl
0276 nmol/liter
2070 g/24 hr
55193 nmol/24 hr
1801250 ng/dl
6.2441.6 nmol/liter
130980 ng/dl
4.534.0 nmol/liter
Random, low-sodium diet

Androstenedione
Cortisol
Fasting, 8 a.m.noon
Cortisol, free
Dehydroepiandrosterone (DHEA)
Male
Female
Dehydroepiandrosterone (DHEA) sulfate
Male
10619 g/dl
1006190 g/liter
Female (premenopausal)
12535 g/dl
1205350 g/liter
Female (postmenopausal)
30260 g/dl
3002600 g/liter
219 ng/dl
61576 nmol/liter
11-Deoxycortisol (8 a.m.)
12158 ng/dl
0.344.56 nmol/liter
Dopamine
P
U
<87 pg/ml
65400 g/day
<475 pmol/liter
4252610 nmol/day
Deoxycorticosterone (DOC)
n engl j med 351;15
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october 7, 2004

1557
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Metabolic and Endocrine Tests. (Continued.)

Analyte
Specimen*
Units Used at MGH
SI Units
Supine (30 min)
<50 pg/ml
<273 pmol/liter
Sitting
<60 pg/ml
<328 pmol/liter
Standing (30 min)
P
U
<900 pg/ml
020 g/day
<4914 pmol/liter
0109 nmol/day
Epinephrine
Estradiol
S, P
Female
Menstruating
Follicular phase
<20145 pg/ml
184532 pmol/liter
Mid-cycle peak
112443 pg/ml
4111626 pmol/liter
Luteal phase
<20241 pg/ml
184885 pmol/liter
<59 pg/ml
217 pmol/liter
<20 pg/ml
184 pmol/liter
Follicular phase
1.515.0 pg/ml
55555 pmol/liter
Luteal phase
1.520.0 pg/ml
55740 pmol/liter
Postmenopausal
1.55.5 pg/ml
55204 pmol/liter
1.56.5 pg/ml
55240 pmol/liter
Follicular phase
3.020.0 mIU/ml
3.020.0 IU/liter
Ovulatory phase
9.026.0 mIU/ml
9.026.0 IU/liter
Postmenopausal
Male
Estrone
S, P
Female
Menstruating
Male
Follicle-stimulating hormone (FSH)
S, P
Female
Menstruating
Luteal phase
Postmenopausal
1.012.0 mIU/ml
1.012.0 IU/liter
18.0153.0 mIU/ml
18.0153.0 IU/liter
Male
Fructosamine
1.012.0 mIU/ml
1.012.0 IU/liter
1.612.68 mmol/liter
1.612.68 mmol/liter
Gastrin
<100 pg/ml
<100 ng/liter
Glucagon
20100 pg/ml
20100 ng/liter
Growth hormone (resting)
0.517.0 ng/ml
0.517.0 g/liter
Human chorionic gonadotropin (hCG)

(nonpregnant women)
<5 mIU/ml
<5 IU/liter
17-Hydroxyprogesterone
S
5250 ng/dl
0.15 nmol/liter
Follicular phase
20100 ng/dl
0.63.0 nmol/liter
Mid-cycle peak
100250 ng/dl
3.07.5 nmol/liter
Luteal phase
100500 ng/dl
3.015 nmol/liter
70 ng/dl
2.1 nmol/liter
Male
Female
Menstruating
Postmenopausal
5-Hydroxyindoleacetic acid (5-HIAA)
Insulin
17-Ketosteroids
1558
n engl j med 351;15
<6 mg/24 hr
<31 mol/24 hr
S, P
220 U/ml
14.35143.50 pmol/liter
312 mg/24 hr
1042 mol/24 hr
www.nejm.org
october 7 , 2004


Analyte
Specimen*
Units Used at MGH
SI Units
S, P
Luteinizing hormone (LH)

Female
Menstruating
Follicular phase
2.015.0 mIU/ml
2.015.0 IU/liter
Ovulatory phase
22.0105.0 mIU/ml
22.0105.0 IU/liter
Luteal phase
0.619.0 mIU/ml
0.619.0 IU/liter
Postmenopausal
16.064.0 mIU/ml
16.064.0 IU/liter
2.012.0 mIU/ml
2.012.0 IU/liter
Male
Metanephrine
P
U
<0.5 nmol/liter
0.051.20 g/mg
creatinine
<0.5 nmol/liter
0.030.69 mmol/mol
creatinine
Norepinephrine
1580 g/24 hr
89473 nmol/24 hr
Norepinephrine
Supine (30 min)
<110410 pg/ml
6502423 pmol/liter
Sitting
120680 pg/ml
7094019 pmol/liter
Standing (30 min)
125700 pg/ml
7394137 pmol/liter
Parathyroid hormone
1060 pg/ml
1060 ng/liter
Pregnanetriol
Age- and sex-dependent
Age- and sex-dependent
Progesterone
S, P
Menstruating female
Follicular
<0.2 ng/ml
<0.6 nmol/liter
Midluteal
320 ng/ml
9.5463.6 nmol/liter
<0.21.4 ng/ml
<0.604.45 nmol/liter
020 ng/ml
020 g/liter
Male
Prolactin
Female
Male
015 ng/ml
015 g/liter
50200 ng/ml
125500 ng/109 platelets
0.281.14 mol/liter
0.72.8 amol/platelet
1371 nmol/liter
1371 nmol/liter
18114 nmol/liter
18114 nmol/liter
<25 pg/ml
<25 ng/liter
1624 yr
182780 ng/ml
182780 g/liter
2539 yr
114492 ng/ml
114492 g/liter
4054 yr
90360 ng/ml
90360 g/liter
71290 ng/ml
71290 g/liter
Serotonin
WB
Platelets
Sex hormonebinding globulin
Male
Female
Somatostatin
Somatomedin C (insulin-like growth factor I [IGF-I])
>54 yr
Testosterone
Total, morning
Female
Male
686 ng/dl
0.212.98 nmol/liter
2701070 ng/dl
9.3637.10 nmol/liter
Unbound, morning
Female
Male
n engl j med 351;15
www.nejm.org
0.23.1 pg/ml
6.9107.5 pmol/liter
12.040.0 pg/ml
4161387 pmol/liter
october 7, 2004

1559
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Analyte
Specimen*
Units Used at MGH
SI Units
Thyroglobulin
060 ng/ml
060 g/liter
Thyroid-binding globulin
1624 g/ml
206309 nmol/liter
Thyroid-stimulating hormone
0.54.7 U/ml
0.54.7 U/liter
Thyroxine
S
4.510.9 g/dl
58140 nmol/liter
0.82.7 ng/dl
10.335.0 pmol/liter
Total (T3)
60181 ng/dl
0.922.78 nmol/liter
Free (fT3)
1.44.4 pg/ml
0.226.78 pmol/liter
Total (T4)
Free (fT4)
Triiodothyronine
Vanillylmandelic acid (VMA)
0.151.20 mg/24 hr
7.637.9 mol/24 hr
Vasoactive intestinal polypeptide (VIP)
<75 pg/ml
<75 ng/liter
Therapeutic-Drug Monitoring and Toxicology.

Drug
Therapeutic Level
Acetaminophen
Toxic Level
Units Used at MGH
SI Units
Units Used at MGH
SI Units
1030 g/ml
66199 mol/liter
>200 g/ml
>1324 mol/liter
Amikacin
Peak
2535 g/ml
4360 mol/liter
>35 g/ml
>60 mol/liter
Trough
48 g/ml
6.813.7 mol/liter
>10 g/ml
>17 mol/liter
Amitriptyline
120250 ng/ml
433903 nmol/liter
>500 ng/ml
>1805 nmol/liter
Amphetamine
2030 ng/ml
148222 nmol/liter
>200 ng/ml
>1480 nmol/liter
Barbiturates, most short-acting
>20 mg/liter
>88 mol/liter
Bromide
>1250 g/ml
>15.6 mmol/liter
Carbamazepine
Chlordiazepoxide
Clonazepam
Clozapine
612 g/ml
2651 mol/liter
>15 g/ml
>63 mol/liter
7001000 ng/ml
2.343.34 mol/liter
>5000 ng/ml
>16.7 mol/liter
1560 ng/ml
48190 nmol/liter
>80 ng/ml
>254 nmol/liter
200350 ng/ml
0.61.0 mol/liter
>1000 ng/ml
>3300 nmol/liter
Cocaine
Cyclosporine
Desipramine
Varies with time after

dose and type of trans- dose and type of transplantation, with ranges plantation, with ranges
of 100400 ng/ml
of 83333 nmol/liter

dose and type of trans- dose and type of transplantation
plantation
75300 ng/ml
2811125 nmol/liter
>400 ng/ml
>1500 nmol/liter
1001000 ng/ml
0.353.51 mol/liter
>5000 ng/ml
>17.55 mol/liter
Digoxin
0.82.0 ng/ml
1.02.6 nmol/liter
>2.5 ng/ml
>3.2 nmol/liter
Doxepin
30150 ng/ml
107537 nmol/liter
>500 ng/ml
>1790 nmol/liter
Diazepam
Ethanol
>300 mg/dl
>65 mmol/liter
Behavioral changes
>20 mg/dl
>4.3 mmol/liter
Clinical intoxication
>100 mg/dl
>1 g/liter
1560
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www.nejm.org
october 7 , 2004

Therapeutic-Drug Monitoring and Toxicology. (Continued.)

Drug
Therapeutic Level
Toxic Level
Units Used at MGH
SI Units
Units Used at MGH
SI Units
Ethosuximide
40100 g/ml
283708 mol/liter
>150 g/ml
>1062 mol/liter
Flecainide
0.21.0 g/ml
0.52.4 mol/liter
>1.0 g/ml
>2.4 mol/liter
810 g/ml
16.720.9 mol/liter
>10 g/ml
>21.0 mol/liter
Gentamicin
Peak
Trough
<24 g/ml
<4.28.4 mol/liter
>4 g/ml
>8.4 mol/liter
1050 g/ml
49243 mol/liter
100700 g/ml
4853395 mol/liter
Imipramine
125250 ng/ml
446893 nmol/liter
>500 ng/ml
>1784 nmol/liter
Lidocaine
1.56.0 g/ml
6.426 mol/liter
Central nervous system or cardiovascular depression
68 g/ml
2634.2 mol/liter
Seizures, obtundation, decreased

cardiac output
>8 g/ml
>34.2 mol/liter
Ibuprofen
Lithium
Methadone
Methotrexate
0.61.2 mEq/liter
0.61.2 nmol/liter
>2 mEq/liter
>2 mmol/liter
100400 ng/ml
0.321.29 mol/liter
>2000 ng/ml
>6.46 mol/liter
Variable
Variable
>9.1 ng/ml
>20 nmol/liter
12 wk after low dose
>227 ng/ml
>0.5 mol/liter
Morphine
48 hr after high dose

1080 ng/ml
35280 nmol/liter
>200 ng/ml
>700 nmol/liter
Nortriptyline
50170 ng/ml
190646 nmol/liter
>500 ng/ml
>1.9 mol/liter
Phenobarbital
1040 g/ml
43170 mol/liter
Slowness, ataxia, nystagmus
3580 g/ml
151345 mol/liter
Coma with reflexes
65117 g/ml
280504 mol/liter
Coma without reflexes
>100 g/ml
>430 mol/liter
1020 g/ml
4079 mol/liter
>20 g/ml
>79 mol/liter
Procainamide
410 g/ml
1742 mol/liter
>1012 g/ml
>4251 mol/liter
Quinidine
25 g/ml
615 mol/liter
>6 g/ml
Salicylates
150300 g/ml
10862172 mol/liter
>300 g/ml
>2172 mol/liter
820 g/ml
44111 mol/liter
>20 g/ml
>110 mol/liter
After nitroprusside infusion
629 g/ml
103499 mol/liter
>120 g/ml
>2064 mol/liter
Nonsmoker
14 g/ml
1769 mol/liter
Smoker
312 g/ml
52206 mol/liter
Peak
810 g/ml
1721 mol/liter
>10 g/ml
>21 mol/liter
Trough
<4 g/ml
<9 mol/liter
>4 g/ml
50150 g/ml
3471040 mol/liter
>150 g/ml
>1040 mol/liter
1826 g/ml
1218 mol/liter
>80100 g/ml
>5569 mol/liter
510 g/ml
37 mol/liter
Phenytoin
Theophylline
>18 mol/liter
Thiocyanate
Tobramycin
Valproic acid
>9 mol/liter
Vancomycin
Peak
Trough
n engl j med 351;15
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october 7, 2004

1561
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new england journal
of
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Urine Analysis.
Analyte
Units Used at MGH
SI Units
Acidity, titratable
2040 mEq/24 hr
2040 mmol/24 hr
Ammonia
3050 mEq/24 hr
3050 mmol/24 hr
4400 U/liter
0.077.67 nkat/liter
Amylase
Amylase:creatinine clearance ratio
15
15
<300 mg/24 hr
<7.5 mmol/24 hr
Female
<100 mg/24 hr
<760 mmol/24 hr
Male
<50 mg/24 hr
<380 mmol/24 hr
1.01.6 g/24 hr
8.814 mmol/24 hr
<100 eosinophils/ml
<100 eosinophils/ml
50300 mg/24 hr
0.31.7 mmol/24 hr
Calcium (with dietary calcium 10 mEq/24 hr or 200 mg/24 hr)

Creatine, as creatinine
Creatinine
Eosinophils
Glucose, true (oxidase method)
Microalbumin
Oxalate
pH
02.0 mg/dl
00.02 g/liter
260 mg/24 hr
228684 mmol/24 hr
5.09.0
5.09.0
Phosphate (phosphorus)
4001300 mg/24 hr
(varies with intake)
12.942.0 mmol/24 hr
Potassium
25100 mEq/24 hr
25100 mmol/24 hr
<150 mg/24 hr
<0.15 g/24 hr
Bacteria
Negative
Negative
Bladder cells
Negative
Negative
Broad casts
Negative
Negative
Crystals
Negative
Negative
Epithelial-cell casts
Negative
Negative
Protein
Sediment
Granular casts
Negative
Negative
Hyaline casts
05/low-power field
05/low-power field
Red-cell casts
Negative
Negative
02/high-power field
02/high-power field
Squamous cells
Negative
Negative
Tubular cells
Negative
Negative
Waxy casts
Negative
Negative
White cells
02/high-power field
02/high-power field
Red cells
White-cell casts
Sodium
Negative
Negative
100260 mEq/24 hr
100260 mmol/24 hr
1.0011.035
1.0011.035
Specific gravity
Urea nitrogen
Uric acid (with normal diet)
1562
n engl j med 351;15
617 g/24 hr
214607 mmol/24 hr
250800 mg/24 hr
1.494.76 mmol/24 hr
www.nejm.org
october 7 , 2004

Microbiology.
Specimen
Routinely Cultured For
Also Reported
Normal Flora
Throat
Group A beta-hemolytic streptococci,

pyogenic groups C and G betahemolytic streptococci, Arcanobacterium haemolyticum
If complete throat culture is requested: Haemophilus influenzae, Staphylococcus aureus, Streptococcus

pneumoniae, Neisseria meningitidis,
and yeast
Alpha-hemolytic streptococci, nonhemolytic streptococci, diphtheroids, coagulase-negative staphylococci, saprophytic neisseria
Sputum
Pneumococci, H. influenzae, betahemolytic streptococci, Staph.

aureus, Moraxella (Branhamella)
catarrhalis, gram-negative bacilli
Presence or absence of normal throat

flora
Little or no normal throat flora, if

specimen carefully collected
Urine
Aerobic bacteria and yeast: abundant if >105 colony-forming

units/ml, moderate if 104105
colony-forming units/ml
Few if 103104 colony-forming

units/ml, rare if 102103 colonyforming units/ml (either may indicate clinically significant bacteriuria if accompanied by pyuria, clinical symptoms, or both)
No mixed bacterial species (i.e., not

more than one of the following:
lactobacilli, nonbeta-hemolytic
streptococci, diphtheroids, coagulase-negative staphylococci, or
Gardnerella vaginalis) if specimen
carefully collected
Blood
Aerobic bacteria, anerobic bacteria,

yeasts
Cerebrospinal fluid
and other fluids
Aerobic bacteria, anaerobic bacteria,

yeasts (including cryptococcus)
Any organism isolated
None
Stool
Enteric pathogens: salmonella, shigella, campylobacter, plesiomonas, and aeromonas when predominant
Moderate or abundant yeast or Staph.

aureus; presence or absence of
normal gram-negative enteric
flora; if special cultures requested,
yersinia, Vibrio cholerae, V. parahemolyticus, or hemorrhagic
strains of Escherichia coli (O157)
Enterobacteriaceae, streptococci,
pseudomonas, small numbers of
staphylococci and yeast (and
anaerobes that are not routinely
cultured)
Wounds
Aerobic bacteria, anaerobic bacteria,

yeasts
Cervical or vaginal
Gonococci, group A beta-hemolytic

streptococci, pyogenic groups C
and G beta-hemolytic streptococci, Staph. aureus (Grams stain for
diagnosis of bacterial vaginosis
according to Nugent score)
None; common contaminants: aerobic diphtheroids, anaerobic diphtheroids, coagulase-negative

staphylococci
Yeasts and enteric gram-negative rods

if present in large numbers
* WB denotes whole blood, P plasma, S serum, PRP platelet-rich plasma, U urine, and JF joint fluid, and RC red cells.
The creatine kinase relative index is calculated as [MB isoenzyme (in nanograms per milliliter) total creatine kinase (in units per liter)]100.
The amylase:creatinine clearance ratio is calculated as [amylase clearance creatinine clearance]100.
For further information, see Kratz A, Sluss PM, Januzzi JL, Lewandrowski KB. Laboratory values of clinical importance. In: Kasper DL, Braunwald E, Fauci AS,
Hauser SL, Longo DL, Jameson JL, eds. Harrisons principles of internal medicine. 16th ed. New York: McGraw-Hill, 2004:A1-A15.
Copyright 2004 Massachusetts Medical Society.
n engl j med 351;15
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october 7, 2004

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The

new england journal

case records of the massachusetts general hospital

Stacey M. Ellender, Assistant Editor