Pathology User Handbook
Section 3: Department of Haematology & Immunology
Table of Contents
3.3 Urgent Requests during Normal Working Hours
3.4 General Haematology Laboratory Tests
3.5 Special Haematology Laboratory Tests
- Haematinic Assays
- Sickle cell Anaemia and Haemoglobinopathy Screen
- Thalassaemia Screen
- Haemolysis Screen
- Haemochromatosis
- Blood Group and Antibody Screen
- Crossmatch and Electronic Issue
- Antenatal Serology
- Cord Blood Samples and Kleihauer Test at Delivery
- Anti Rh(D) Prophylaxis
- Blood Components and Products
3.6 Immunology Laboratory Tests
3.7 Clinical Haematology Service
3.1 Useful Phone Numbers
You may dial directly through to the extension you require by prefixing the extension number with the numbers (01225) 82.
Urgent Requests |
01225 824740 |
Results |
01225 824700 |
Haematology Laboratory Enquiries |
01225 824728 |
Haematology Clinical Enquiries/Referrals |
Lab Registrar 01225 824463 or |
Haematology Inpatient Enquiries |
Ward Registrar 01225 828331 or |
Senior Staff of the Haematology Department
Dr Christopher Knechtli |
Consultant Haematologist |
01225 824654 |
Dr Charles Singer |
Consultant Haematologist |
01225 824488 |
Dr Sarah Wexler |
Consultant Haematologist |
01225 824487 |
Dr Josephine Crowe |
Consultant Haematologist |
01225 821799 |
Mr Nigel Roberts |
Laboratory Manager Haematology |
01225 824727 |
Mr Richard Gardiner |
Chief BMS Blood Bank |
01225 824739 |
Mrs Christine Williams |
Chief BMS Haematology |
01225 824728 |
3.2 Advice and Information
Haematology Department staff are always available to give advice on technical matters. During "office hours" please contact extension 4728. For clinical advice please contact the Haematology Registrar through the switchboard on bleep 7559 or on extension 4463. Outside normal working hours the on-call BMS (Bleep 7555) and on-call member of the Medical Staff are available for advice through the RUH switchboard. A senior Haematologist is available to give advice on weekdays between 3 and 5 pm via a dedicated mobile number 07789 928466.
3.3 Urgent Requests during Normal Working Hours
The Haematology Department needs prior notification to process requests urgently. If you require an urgent analysis please telephone the Laboratory Specimen Reception on 01225 824740.
The laboratory may need to discuss with you the validity of the urgent test; please indicate on the request form how you may be contacted. The results of urgent requests will be telephoned to the ward or Practice and made available on Ultra and ICE, providing the instructions above are followed. The Haematology Department cannot guarantee that specimen request forms labelled "urgent" will be fast-tracked service unless prior notification is received by telephone.
3.4 General Haematology Laboratory Tests
Full Blood count
Sample:
Peripheral blood EDTA (Mauve capped Vacutainer)
Differential Leucocyte Count
Films are examined on all samples with any result significantly outside the normal range, samples on which morphological abnormalities are flagged by the machine analysis. This test can be performed on the FBC sample.
Plasma Viscosity
This investigation is performed at the clinician's request. It is a sensitive index of plasma protein changes resulting from inflammation and tissue damage. It is a more reliable test than the ESR as it is unchanged by variation of the haematocrit and delay in analysis up to 24 hours. This test can be performed on the FBC sample.
Reticulocyte Count
This test for circulating immature red cells is a useful confirmatory investigation in patients in whom haemolysis recent blood loss or a response to haematinics is suspected. This test can be performed on the FBC.
Infectious Mononucleosis Screen
The test can be negative in the early stage of EBV infection but the presence of atypical mononuclears and a negative IM screen is more likely to be due to other viral infections most notably CMV or to infection by Toxoplasma gondii. This test can be performed on an SST sample.
Malaria Screen
Please indicate the countries visited by any patient who has been abroad. Symptoms can develop more than a year after a visit to a malarial area and it is important to remember that a negative screening test does not exclude malaria. If symptoms persist the screen must be repeated. This test can be performed on the FBC sample.
If you require clinical advice on the management of a patient with malaria, 24 hours advice is available from the Department of Clinical Parasitology at the Hospital for Tropical Diseases on 0171-387-4411.
Coagulation Laboratory Tests
Sample:
4.5 mL citrated blood (Light-blue capped Vacutainer)
Blood samples for coagulation tests should preferably reach the laboratory within 4 hours. All INR and APTT requests will be carried out on the day of sampling. Sample tubes for coagulation tests must always be filled with the correct amount of blood. Four citrate samples are required for coagulation factor assays, lupus screen and acquired or inherited thrombophilia screens
Coagulation Screen
The one stage prothrombin time (PT) allows calculation of the INR result (International Normalised Ratio) and in combination with the activated partial thromboplastin time (APTT) provides a basic screen of the clotting mechanism. It is the first step of any investigation of coagulation and should always be requested prior to the initiation of anticoagulant therapy.
Control of Anticoagulant Therapy
Warfarin and heparin therapy are monitored using the INR and APTT respectively. Baseline evaluation of these tests is recommended prior to commencement of therapy.
Disseminated Intravscular Coagulation (DIC) Screen
If this condition is suspected a coagulation screen should be performed with a full blood count to exclude any fall in the haemoglobin or platelet count, a blood film to evaluate red cell fragmentation and a fibrinogen assay. If there is any abnormality in the coagulation screen or fibrinogen level, a D-dimer assay should be performed and this will provide evidence of intravascular coagulation.
Note: D-dimer result is commonly elevated in sick patients.
Sample:
4.5 mL citrated blood (Light-blue capped Vacutainer)
Peripheral blood EDTA (Mauve capped Vacutainer)
Thrombophilia Investigations
Referrals should be addressed to Dr Jo Crowe, Consultant Haematologist.
Sample:
4x4.5 mL citrated blood (Light-blue capped Vacutainer)
Four citrate specimens required.
Consultations and referrals to the clinic are welcomed for:
- Venous thromboembolism at a young age (including childhood)
- Recurrent venous thromboembolism
- Unusual site of thrombosis (eg mesenteric, renal, portal veins, cerebral venous sinuses)
- Thrombosis during pregnancy or puerperium
- Recurrent superficial thrombophlebitis
- Arterial thrombosis at a young age (<40 years)
- A family history of any of the above
- A first degree relative with diagnosed thrombophilia
- Recurrent pregnancy loss (3 or more in the second trimester)
- Severe or recurrent intrauterine growth retardation
- Severe or recurrent pre-eclampsia
- Other recurrent obstetric complications (abruptio placentae, pre-term delivery)
- Neonatal purpura fulminars or massive thrombosis in newborn
- Perthe's disease of the lip
- Warfarin-induced skin necrosis
Blood specimens are best to be processed within four hours of collection.
PCR tests
As part of the thrombophilia screen PCR analysis for the factor 5 Leiden and prothrombin 20210 gene mutations are undertaken.
No extra specimens are required as analysis can be undertaken on the citrate specimens sent for thrombophilia testing.
Prothrombotic tests are best performed when the patient:
- has fully recovered from an acute thrombotic event
- is on no anticoagulants e.g. warfarin
- is not taking oestrogen-containing oral contraceptives or HRT
A patient may still be referred when these conditions are not met for limited investigations and planned future investigations.
Coagulation Screening
Specific assay of coagulation factors will be undertaken by the laboratory for the investigation of patients with suspected inherited or acquired deficiencies. In addition factor assays may be required prior to surgery and to monitor therapy in patients with known deficiencies. These investigations require fresh samples and may involve several tests to fully identify the abnormality. It is recommended that outpatients are referred to a Haematology Clinic (see below) and inpatients are referred for a Haematology consultation.
Other assays are available please contact the laboratory for further advice 4728
3.5 Special Haematology Laboratory Tests
Haematinic Assays
These should be performed to establish the cause of macrocytic (serum vitamin B12 & Serum Folate ) or microcytic anaemia (serum ferritin). The serum ferritin may be elevated as an acute phase protein in patients with underlying neoplasia inflammatory disease e.g. rheumatoid arthritis and this may give an apparently normal result in an iron deficient patient.
Sample:
6 mL clotted blood (Yellow capped Vacutainer)
Peripheral blood EDTA for FBC (Mauve capped Vacutainer)
Sickle cell Anaemia and Haemoglobinopathy Screen
A screening test for sickle cell anaemia and trait is available on a 24 hour basis. Full diagnosis of sickle cell disease and other haemoglobinopathies requires HPLC analysis.
Sample:
Peripheral blood EDTA (Mauve capped Vacutainer)
Thalassaemia/Haemoglobinopathy Screen
This should be suspected in any individual with hypochromic microcytic red cell indices and normal iron stores. Diagnosis will require HPLC analysis and may involve other studies.
Sample:
Peripheral blood EDTA (Mauve capped Vacutainer)
Haemolysis Screen
Patients suspected of having haemolytic anaemia should have haemolysis confirmed prior to proceeding to complex investigations designed to establish the cause. All such patients should have a blood film, direct Coombs test, reticulocyte count, unconjugated serum bilirubin, urinalysis and if intravascular haemolysis is suspected, haptoglobin quantitation, methaemalbumin and urinary haemosiderin.
Subsequent appropriate investigations may be discussed with Haematoloty medical staff.
Haemochromatosis
PCR gene analysis is available for Haemochromatosis. An EDTA specimen should be sent along with a SST specimen, for iron studies.
Sample:
6 mL clotted blood (Yellow capped Vacutainer)
Peripheral blood EDTA (Mauve capped Vacutainer)
Blood Group and Antibody Screen
Patients for whom elective surgery is planned should have a blood group and antibody screen at pre-admission. A repeat blood group & antibody screen will need to be taken on admission so that the laboratory has a valid sample if blood or blood products are required (sample viability, see below).
Crossmatch and Electronic Issue
Electronic issue means that blood can be issued instantly if the patient has been grouped twice and the antibody screen is negative as long as there is a valid sample in the laboratory. In the majority of cases there is no need to reserve blood for surgery as it can be provided immediately there is a need, as long as the above conditions are met.
If irregular antibodies to red cell antigens are identified the blood will need to be crossmatched. Compatible donor blood can usually then be arranged in advance to cover surgery and allow the procedure to go ahead without delay. Where possible a sample should be submitted for the crossmatch 24 hours before blood is required for an elective procedure. If irregular antibodies in the patient serum make provision of the requested blood difficult the Blood Bank will liaise with the requesting clinician.
Crossmatch or electronic issue samples can only be held for 7 days. This period is reduced to 3 days if the patient has been transfused within 28 days.
Neonates:
The neonate's blood group must be known before blood can be issued. No crossmatch is required for neonates up to 4 months old, unless the serum of the mother contains an antibody.
Sample:
5 mL EDTA blood (Pink capped Vacutainer)
Coombs Direct Anti-human Globulin Test (DAGT)
This test should be performed on all patients in whom an acquired haemolytic anaemia is suspected. All samples for group and save or crossmatch have a Coombs' DAGT performed.
Sample:
5 mL EDTA blood (Pink capped Vacutainer)
Antenatal Serology
Blood group and antibody screen samples should be submitted for all pregnant women during the first trimester and at 28 weeks. If irregular antibodies are detected the sample will be sent to the Regional Blood Transfusion Centre for confirmation and antibody quantitation. Follow-up samples will be requested as required.
Sample:
5 mL EDTA blood (Pink capped Vacutainer)
All rhesus D negative women must be offered anti-D prophylaxis. A 1500 IU dose should be given at 28 weeks. No further testing is required until delivery (see below).
Cord Blood Samples and Kleihauer Test at Delivery
Cord blood samples should be examined on all babies born to Rh(D) negative women and women found to have irregular antibodies during pregnancy. The Kleihauer test for circulating foetal red cells should be performed on all Rh(D) negative women who deliver a Rh(D) positive baby.
Samples:
Kleihauer kit Cord blood EDTA (Mauve capped Vacutainer)
Maternal blood EDTA (Mauve capped Vacutainer)
Anti Rh(D) Prophylaxis
Prophylaxis with anti-Rh(D) immunoglobulin should be administered within 72 hours of the event to Rh(D) negative women without detectable circulating anti-Rh(D) antibodies as follows:
1500 IU |
All Rh D negative women must be offered anti-D prophylaxis. A 1500 IU dose should be given at 28 weeks. No further testing is required until delivery. |
250 IU |
Miscarriage before 20 weeks gestation |
500 IU |
All patients delivered after 20 weeks |
Blood Components and Products
The following are available through the RUH Blood Transfusion Department:
Red cells (leucodepleted) |
CMV negative products |
Platelets (leucodepleted) |
Irradiated products |
Beriplex CMV |
Paediatric red cell packs |
HLA-matched platelets |
Anti-Rh(D) immunoglobulin |
Paediatric platelet packs |
Cryoprecipitate |
Fresh frozen plasma |
Human albumin 20% |
Human albumin 4.5% |
Factor IX concentrates |
Factor VIII concentrates |
|
3.6 Immunology Laboratory Tests
Immunology is supported by a Consultant Immunologist, Dr Sarah Johnston based at the RUH most Wednesdays. Tel 01225 821406, email: SarahJohnston1@nhs.net or tel. 0117 959 6307 (not Wednesdays).
A 5mL clotted sample is required for immunology tests, in addition to samples required for any Biochemistry tests requested at the same time.
Auto-immune Profile
Patients in whom an organ-specific or organ-non-specific auto-immune condition is suspected may have an auto-immune profile performed which will screen for auto-antibodies to nuclear protein, mitochondria, gastric parietal cells, reticulin and smooth muscle.
Immunoglobulins
Quantitation of IgG, IgM and IgA : see Clinical Biochemistry. This investigation is of value in patients suspected of having inherited or acquired immunodeficiency, hypergammaglobulinaemia, lymphoid neoplasia and myeloma.
It may be appropriate in some circumstances to assay in addition the serum levels of IgD and IgE or IgG subclasses. This should be discussed with the laboratory.
Immunophenotyping
The surface antigens of leucocytes in the peripheral blood or bone marrow can be identified by fluorescent antibody studies and the lineage of abnormal cell populations determined. This investigation is of value in the diagnosis of acute and chronic leukaemias and atypical leukocytoses.
This investigation should be arranged in advance with the Immunology Laboratory and the panel of markers used in the analysis will be determined by the clinical information.
HLA-B27
This tissue type which is associated with ankylosing spondylitis can be quickly identified on fluorescent antibody analysis of peripheral blood lymphocytes.
A PCR test is used for confirmation.
Anticardiolipin Antibodies
This antibody is associated with the presence of an anti-phospholipid antibody and the condition known as "lupus anticoagulant syndrome". In combination with a coagulation screen, it is a useful screening test for patients with recurrent miscarriage or thrombosis in whom this condition should be excluded. However it is neither diagnostic nor specific for this condition and has many other clinical associations. Full lupus anticoagulant screening coagulation assays should be performed in any patient in whom there is a strong suspicion of this diagnosis.
Rheumatoid Factor
This test is important in the diagnosis of polyarthropathy. The result should be assessed in the context of clinical and other laboratory findings. Low levels of rheumatoid factor do not necessarily exclude the diagnosis of rheumatoid arthritis, nor are high levels restricted to this condition.
Further advice and information
If a clinician wishes investigations which are not in the RUH Laboratory Test Index to be carried out, advice will be given about where these can be obtained, please contact the laboratory for advice Telephone 01225 824730 (Lab) or 01225 821406 (Lead BMS).
The following table provides all details of sample requirements, special instructions, reference range, etc.
Immunology Sample Requirements
3.7 Clinical Haematology Service
Outpatient Clinics
Three primarily general haematology clinics are held weekly (Tuesday a.m., Wednesday a.m., Friday a.m.) for the investigation and treatment of patients with primarily non-malignant haematological diseases. Two primarily haematological-oncology clinics are held weekly (Tuesday a.m., Thursday a.m.) for the treatment of patients with leukaemia, lymphoma, myeloma and related disorders at which outpatient intravenous chemotherapy can be administered.
Referrals may be faxed to the department on 01225-461044. Under normal circumstances urgent referrals are seen within 2 weeks and routine referrals are seen within 12 weeks. Emergency referrals will be admitted through MAU if they cannot be admitted directly to the Clinical Haematology Unit.
There is a weekly (Friday a.m.) clinic for the investigation of patients with haematinic and thrombotic disorders
There is a weekly anticoagulant clinic in the RUH for monitoring the warfarin treatment of patients for whom their general practitioners would prefer hospital follow-up. Twice monthly an anticoagulant clinic is held in Devizes for patients for whom hospital follow-up is required.
A weekly immunodeficiency clinic takes place in the RUH and there is a bimonthly joint Haematology-Paediatric clinic for the investigation and treatment of children with haematological disorders.
An outpatient INR service, compliant with NPSA guidance on anticoagulation is run from the RUH. This service is provided in two formats.
- Staff attend GP surgeries where a one stop service is offered, testing and dosing patients at the same appointment.
- A blood sample is taken and sent to the laboratory where testing, and dosing takes place. The laboratory communicates to the patient the next appointment time and the dosage.
As part of the service initiation of patients on warfarin is undertaken by the department.
Contact Anticoagulation Administrator Mandy Budds on 5504.
Inpatient Services
Patients with serious haematological disease are investigated and treated in single rooms in the William Budd Unit by an experienced team of nursing and medical staff. Patients who require short term admission or less intensive nursing care (i.e. do not require reverse barrier nursing) are treated in the 6 patient bays in William Budd Ward.
Patients with leukaemia, lymphoma and myeloma receive therapy as part of (if the patient consents) or based on current national, international, MRC and multicentre clinical trials including, if appropriate, high dose chemotherapy and chemo-irradiation with autologous bone marrow or peripheral blood progenitor cell transplantation. Patients requiring allogenic (sibling or unrelated donor) BMT are referred to centres in Bristol, Royal Free or UCH.
Bone Marrow Analysis
Outpatients will generally undergo bone marrow sampling on William Budd Day Care Unit with sedation if a trephine biopsy is also required. New outpatient referrals for whom it is clear that a bone marrow is required may have this arranged prior to the first outpatient consultation. Please refer patients to a Consultant Haematologist.
A bone marrow/trephine will only be performed at the discretion of the haematology medical staff and a request for a haematology consultation.
Telephone Advice
A member of the Haematology medical staff is always available to discuss Haematology problems. During office hours please contact the Haematology Registrar on bleep 7559 or 7702. Out of hours please contact the Hospital Switchboard (01225 428331) who will put you in touch with the on-call medical Haematologist.
3.8 Main Laboratory
Full Blood Count
WBC |
|
4.0 – 11.0 x 10 9 /l |
RBC |
Male |
4.5 – 6.5 x 1012 /l |
Female |
3.5 – 5.5 x 1012 /l |
|
Hb |
Male |
13.5 – 18.0 g/dl |
Female |
11.5 –16.5 g/dl |
|
HCT |
Male |
0.35 – 0.540 l/l |
Female |
0.370 – 0.470 l/l |
|
MCV |
|
78.0 – 100.0 fl |
MCH |
|
27.0 – 32.0 pg |
MCHC |
|
31.5 – 36.0 g/dl |
RDW |
|
11.5 – 15.5 |
PLTS |
|
150 - 400 x 109 /l |
MPV |
|
8 – 12 fl |
NEUT |
|
2.0 –7.5 x 109 /l |
LYMPH |
|
1.5 – 4.5 x 109 /l |
MONO |
|
0.2 – 1.0 x 109 /l |
EOS |
|
0.04 – 0.4 x 109 /l |
BASO |
|
0.0 – 0.01 x 109 /l |
Plasma Viscosity |
Reticulocytes |
|
Adult Normal Range |
1.50 – 1.72 mPa |
Normal Range 10 - 100 x 109 /l |
Children (under 3 years) |
1.25 – 1.47 mPa |
Serum Ferritin |
Serum B12 |
|
Male |
24 – 336 ng/ml |
Normal Range 150 – 914 ng/ml |
Female <50 years |
11 – 307 ng/ml |
|
Female >50 years |
20 – 307 ng/ml |
|
Serum Folate |
Normal Range |
>2.4ug/ml |
Coagulation
Clotting Screen
INR Normal Range |
0.89 – 1.11 Ratio |
Prothrombin time PT |
10.4 – 12.6 seconds |
APTT Normal Range |
23 – 32 seconds |
Therapeutic Range |
41.3 – 68.8 seconds |
Clauss Fibrinogen |
1.8 – 3.8 g/l |
Factor Assays
Factor II:C |
70 – 150 % (IU/dl) |
Factor V:C |
70 – 150 % (IU/dl) |
Factor VII:C |
70 – 150 % (IU/dl) |
Factor VIII:C |
70 – 150 % (IU/dl) |
Factor IX:C |
70 – 150 % (IU/dl) |
Factor X:C |
70 – 150 % (IU/dl) |
Factor XI:C |
70 – 150 % (IU/dl) |
Factor XII:C |
70 – 150 % (IU/dl) |
D-Dimer Assays
Normal Range |
<550 mg/ml FEU |
? DVT or PE |
<500 mg/ml FEU |
D-dimer test does not have a 100% Negative Predictive Value for DVT or PE. |
Free Protein S
Normal Range |
Male |
70 – 148 % |
Female |
50 – 134 % |
|
Age and hormonal status may affect the normal range for females |
VWF Antigen (vWF:Ag) - Ristocetin Cofactor Activity (vWF:Rco)
Normal Range |
50 – 150 IU/dl |
|
Normal Range based on blood groups: |
||
Group O |
Group O 49 – 142% |
|
Groups A+B+AB |
Group A + B + AB 66 – 183% |
VWF Ristocetin Cofactor Activity (vWF:RCo)
Normal Range |
Group O 49 – 142% Group A + B + AB 66 – 183% |
Antithrombin (AT) Activity
Normal Range |
75 – 125 IU/dl |
Protein C Activity
Normal Range |
70 – 140 IU/dl |
Activated Protein C Resistance (PCA Test)
Normal Range |
0.86 – 1.10 Ratio |
Heterozygous F5L |
0.7 Ratio |
Inhibitor Screen |
Kaolin Clotting Time (KCT) |
1:1 Mix |
Normal (Test/Normal) <1.2 Ratio |
Normal Range 0.8 – 1.2 Ratio |
Lupus Anticoagulant Screens
LA1 (dRVVT) |
LA2(dRVVT) |
|
Normal Range |
0.8 – 1.2 Ratio |
0.8 – 1.2 Ratio |
Abnormal |
>1.2 Ratio |
>1.2 |
Normalised LAC Ratio
Normal Range |
0.8 – 1.2 Ratio |
Normalise APTT |
Normal range <1.2 Ratio |
Normalise DRVTT ratio |
Normal range <1.2 ratio |
Special Haematology
Haemoglobin F (HbF) |
Haemoblobin A2 (Hb A2) |
Normal Range <1.0% |
Normal Range 1.9 – 3.2 % |
HbF forms >50% of total Hb of newborn but falls to adult level within 6 months. |
G6PD |
HAPTOGLOBIN |
Normal Range 4.6 – 13.5 U/gHb |
Normal Male & Female 0.3 – 2g/l |
Immunology
DsDNA(Grifols) |
|
Negative |
<30 IU/ml |
Positive |
>30 IU/ml |
RF(IgM) (Grifols) |
|
Negative |
<6 IU/ml |
Positive |
>6 IU/ml |
|
B2M |
IgE |
Normal Range: |
1.1 – 2.6 mg/l |
<81 kU/l |
Anticardiolipin (IgG)(Grifols) |
TPO |
Negative <20gpl/ml |
Negative <100 IU/ml |
Positive >17gpl/ml |
|
Tissue Transglutaminase (TTG) |
Rast Allergen |
|
Negative |
<10 IU/ml |
0 = negative |
Positive |
>10 IU/ml |
2 = weak positive |
ENA screen (Orgentec) |
IFA (Inova) |
|
Negative |
Negative <25 iu/ml |
|
Positive. Positives referred for ENA typing |
Positive >25 iu/ml |
Paediatric Reference Ranges
Full Blood Count
Age |
Hb |
RBC |
Hct |
MCV |
WBC |
Neutrophils |
Lymphocytes |
Monocytes |
Eosinophils |
Platelets |
Birth |
14.9-23.7 |
3.7-6.5 |
0.47-0.75 |
100-135 |
10.0-26.0 |
2.7-14.4 |
2.0-7.3 |
0-1.9 |
0-0.84 |
150-450 |
2 weeks |
13.4-19.8 |
3.9-5.9 |
0.41-0.65 |
88-120 |
6.0-21.0 |
1.8-5.4 |
2.8-9.1 |
0.1-1.7 |
0-0.84 |
150-450 |
2 months |
9.4-13.0 |
3.1-4.3 |
0.28-0.42 |
84-105 |
6.0-18.0 |
1.2-7.5 |
3.0-13.5 |
0.1-1.7 |
0.1-0.8 |
150-450 |
6 months |
11.1-14.1 |
3.9-5.5 |
0.31-0.41 |
68-82 |
6.0-17.5 |
1.0-8.5 |
4.0-13.5 |
0.2-1.2 |
0.3-0.8 |
150-450 |
1 year |
11.3-14.1 |
4.1-5.3 |
0.33-0.41 |
71-85 |
6.0-17.5 |
1.5-8.5 |
4.0-10.5 |
0.2-1.2 |
0.3-0.8 |
150-450 |
2-6 years |
11.5-13.5 |
3.9-5.3 |
0.34-0.4 |
75-87 |
5.0-17.0 |
1.5-8.5 |
1.5-9.5 |
0.2-1.2 |
0.3-0.8 |
150-450 |
6-12 years |
11.5-15.5 |
4.0-5.2 |
0.35-0.45 |
77-95 |
4.5-14.5 |
1.5-8.0 |
1.5-7.0 |
0.2-1.0 |
0.1-0.5 |
150-450 |
12-18 years |
12.0-16.0 |
4.1-5.1 |
0.36-0.46 |
78-95 |
4.5-13.0 |
1.8-8.0 |
1.2-6.5 |
0.2-0.8 |
<0.1-0.5 |
150-450 |
12-18 years |
13.0-16.0 |
4.5-5.3 |
0.37-0.49 |
78 - 95 |
4.5-13.0 |
1.8-8.0 |
1.2-6.5 |
0.2-0.8 |
<0.1-0.5 |
150-450 |

* Data given as approximate ranges, compiled from various sources. Hinchliffe RF, reference values. Paediatric Haematology (1992)

Reference ranges in childhood based on literature quoted values.

Literature quoted values are generated using a specific reagent/FBC analyser combination and must therefore only be used as a guide alongside all other available clinical information.

Clotting Screen
For healthy full term infant during first 6 months of life:
PT |
Not significantly different from adult values |
APTT |
Day 1 – 30 Prolonged |
Fibrinogen |
Not significantly different from adult values |
TCT |
Not significantly different from adult values |
Factor Assays
Prothrombin |
30 – 50% of adult levels: normal by 1 – 3 months |
Factor V |
Not significantly different from adult values |
Factor VII |
30 – 50% of adult values: normal by 1 month |
Factor VIII |
Variable: 50 – 200% of adult levels |
Factor IX |
20 – 50% of adult levels: normal by 1 month |
Factor X |
30 – 50% of adult levels: normal by 1 month |
Factor XI |
20 – 50% of adult levels: normal by 1 year |
Factor XII |
20 – 50% of adult levels: normal by 3 months |
Factor XIII |
50 – 100% of adult levels: normal by 1 month |
Thrombophilia Tests
Antithrombin |
50 – 80% of adult levels: normal by 6 – 12 months |
Protein C |
30 – 50% of adult levels: normal by 3 month |
Protein S |
30 – 50% of adult levels: normal by 3 month |
Von Willebrand Screen
VWF:Ag |
Usually raised (up to 3 x adult levels) |
Reticulocytes
Age |
Range (%) |
3 days |
1.0 - 4.5 |
1 month |
0.3 - 1.0 |
6 months |
0.4 - 1.4 |
6+ months |
0.2 - 2.0 |
Serum B12 / Red Cell Folate
Not significantly different from adult values
Serum Ferritin
Similar mean values as adults
No distinction between males and females between 6 months and 12 years.