What’s happenes when increasing or decreasing according to above normal values and diagnosis
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bilirubin total indirect elevation decrease causes diagnosis liver hemolysis
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serum iron ferritin iron binding capacity increased decreased anemia hemochromatosis diagnosis
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glucose hyperglycemia hypoglycemia diabetes diagnosis glycated hemoglobin HbA1c
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cholesterol HDL LDL triglycerides elevated decreased cardiovascular risk atherosclerosis diagnosis
Here is a comprehensive breakdown of every marker shown in the image — what happens when values rise above or fall below the reference range, and the associated diagnoses.
Biochemical Blood Serum Tests: Abnormal Values & Their Clinical Significance
1. Bilirubin — Total (8.5–20.5 µmol/L) & Indirect/Unconjugated (<16.5 µmol/L)
| Direction | Value | Clinical Meaning / Diagnoses |
|---|---|---|
| ↑ Total (Jaundice) | >20.5 µmol/L | Visible jaundice appears at ~35 µmol/L |
| ↑ Indirect (unconjugated) | Isolated rise | Hemolytic anemias (spherocytosis, sickle cell, G6PD deficiency), Gilbert's syndrome, Crigler-Najjar syndrome (neonates), transfusion reactions |
| ↑ Direct (conjugated) | — | Hepatocellular disease (viral hepatitis, cirrhosis, alcoholic liver disease), cholestasis (intrahepatic: PBC, PSC; extrahepatic: gallstones, pancreatic cancer, cholangiocarcinoma), Dubin-Johnson syndrome, Rotor syndrome |
| ↓ Bilirubin | Below normal | Rarely clinically significant; can be seen in certain anemias or as a normal variant |
Harrison's (p. 9324): Isolated unconjugated hyperbilirubinemia with <15% direct fraction should prompt hemolysis workup; if no hemolysis, Gilbert's syndrome is the diagnosis.
2. Serum Iron — Male (10–30 µmol/L), Female (9–29 µmol/L)
| Direction | Diagnoses |
|---|---|
| ↑ High serum iron | Hemochromatosis (hereditary), hemosiderosis, hemolytic anemia, aplastic anemia, lead poisoning, excessive iron supplementation, liver disease (hepatic necrosis releases stored iron) |
| ↓ Low serum iron | Iron-deficiency anemia (most common), chronic blood loss (GI, menorrhagia), malnutrition, malabsorption (celiac disease), chronic disease/infection |
3. Serum Fe-Binding Capacity / TIBC (50–84 µmol/L)
| Direction | Diagnoses |
|---|---|
| ↑ High TIBC | Iron-deficiency anemia (liver produces more transferrin), pregnancy, oral contraceptive use |
| ↓ Low TIBC | Hemochromatosis, anemia of chronic disease, nephrotic syndrome, malnutrition, liver failure (reduced transferrin synthesis) |
Key pattern: Iron ↓ + TIBC ↑ = Iron-deficiency anemia; Iron ↑ + TIBC ↓ + Ferritin ↑ = Hemochromatosis
4. Serum Ferritin (30–300 µg/L)
| Direction | Diagnoses |
|---|---|
| ↑ High ferritin | Hemochromatosis (>1000 µg/L is the strongest predictor of C282Y homozygous disease expression), hemosiderosis, liver disease (hepatitis, cirrhosis), inflammatory states (acute-phase reactant — infection, malignancy, rheumatoid arthritis), ferritin is unreliable for iron stores in inflammation |
| ↓ Low ferritin | Iron-deficiency anemia (most sensitive and specific marker) — depleted body iron stores |
Harrison's (p. 11774): Ferritin >1000 µg/L is the strongest predictor of disease expression in hemochromatosis.
5. Glucose
Fasting Venous Blood (4.2–6.1 mmol/L)
| Direction | Value | Diagnoses |
|---|---|---|
| ↑ Hyperglycemia | 6.1–7.0 | Impaired fasting glucose (pre-diabetes) |
| >7.0 mmol/L (×2) | Diabetes mellitus (Type 1 or 2) | |
| Very high (>13–15) | Diabetic ketoacidosis (DKA) — Type 1; Hyperosmolar hyperglycemic state (HHS) — Type 2 | |
| Elevated + stress | Stress hyperglycemia (MI, stroke, sepsis, surgery), Cushing's syndrome, acromegaly, glucocorticoid therapy, pheochromocytoma | |
| ↓ Hypoglycemia | <3.3 mmol/L | Insulin overdose (in diabetics), insulinoma, Addison's disease, hypopituitarism, severe liver failure, prolonged fasting, alcohol ingestion, reactive hypoglycemia |
2-Hour Post-Load Glucose Tolerance Test
| Result | Interpretation |
|---|---|
| ≤7.8 mmol/L | Normal |
| 7.8–11.0 mmol/L | Impaired glucose tolerance (pre-diabetes) |
| ≥11.1 mmol/L | Diabetes mellitus |
Glycated Hemoglobin HbA1c (4.5–6.1%)
| Value | Meaning |
|---|---|
| 5.7–6.4% | Pre-diabetes |
| ≥6.5% | Diabetes mellitus (diagnostic) |
| >8% | Poor glycemic control — high risk of complications |
| ↓ Low HbA1c | Hemolytic anemia, recent blood transfusion (falsely low — red cells replaced faster) |
6. Total Cholesterol (3.9–5.2 mmol/L)
| Direction | Diagnoses |
|---|---|
| ↑ Hypercholesterolemia | Primary: Familial hypercholesterolemia, familial combined hyperlipidemia; Secondary: Hypothyroidism, nephrotic syndrome, diabetes, obesity, cholestasis, high saturated fat diet. Risk: coronary artery disease, stroke, peripheral artery disease |
| ↓ Hypocholesterolemia | Severe liver disease (cirrhosis), malnutrition/malabsorption, hyperthyroidism, chronic infection, myeloproliferative disorders |
7. HDL (0.9–1.9 mmol/L)
| Direction | Diagnoses |
|---|---|
| ↑ High HDL | Protective — reduces cardiovascular risk. Exercise, alcohol (moderate), estrogen, certain medications |
| ↓ Low HDL (<0.9 mmol/L) | Major independent risk factor for coronary artery disease. Causes: sedentary lifestyle, smoking, obesity, hypertriglyceridemia, Type 2 diabetes, metabolic syndrome, androgenic steroids, beta-blockers |
8. LDL (<2.2 mmol/L)
| Direction | Diagnoses |
|---|---|
| ↑ High LDL | Familial hypercholesterolemia, metabolic syndrome, hypothyroidism, nephrotic syndrome, Cushing's. Direct driver of atherosclerosis → CAD, MI, stroke |
| ↓ Very low LDL | Hyperthyroidism, malabsorption, abetalipoproteinemia, liver disease |
9. Atherogenic Coefficient (≤3.0)
Formula: (Total Cholesterol – HDL) / HDL
| Value | Risk |
|---|---|
| <3.0 | Low cardiovascular risk |
| 3.0–4.0 | Moderate risk |
| >4.0 | High risk — accelerated atherosclerosis |
10. Triglycerides (0.40–2.1 mmol/L)
| Direction | Diagnoses |
|---|---|
| ↑ Hypertriglyceridemia | Metabolic syndrome, Type 2 diabetes, obesity, alcohol excess, hypothyroidism, nephrotic syndrome, familial hypertriglyceridemia. >5.6 mmol/L → risk of acute pancreatitis |
| ↓ Low triglycerides | Malnutrition, malabsorption, hyperthyroidism |
11. Total Protein (65–85 g/L)
| Direction | Diagnoses |
|---|---|
| ↑ Hyperproteinemia | Dehydration (hemoconcentration), multiple myeloma (paraprotein), Waldenström's macroglobulinemia, chronic infections (raised globulins) |
| ↓ Hypoproteinemia | Malnutrition (kwashiorkor), liver failure (↓ synthesis), nephrotic syndrome (urinary loss), protein-losing enteropathy, severe burns |
12. Protein Fractions
| Fraction | ↑ Increased | ↓ Decreased |
|---|---|---|
| Albumin (56–66%) | Dehydration | Liver disease, nephrotic syndrome, malnutrition, malabsorption, acute inflammation (negative acute-phase reactant), burns |
| α₁-globulins (2.5–5%) | Acute inflammation, pregnancy, malignancy | α₁-antitrypsin deficiency (emphysema, liver cirrhosis in young patients) |
| α₂-globulins (5–9%) | Nephrotic syndrome, acute inflammation, Cushing's | Hemolysis (haptoglobin consumed) |
| β-globulins (8–12%) | Iron-deficiency anemia (↑ transferrin), hyperlipidemia, biliary cirrhosis | Liver disease |
| γ-globulins (12.8–19%) | Chronic infections, autoimmune disease (SLE, RA), cirrhosis, multiple myeloma (monoclonal spike on electrophoresis) | Immunodeficiency states (common variable immunodeficiency, agammaglobulinemia), prolonged corticosteroid therapy |
13. Troponin I (≤0.5 µg/L) & Troponin T (≤0.4 µg/L)
| Direction | Diagnoses |
|---|---|
| ↑ Elevated | Acute myocardial infarction (STEMI/NSTEMI) — primary indication; myocarditis, pulmonary embolism (right heart strain), cardiac contusion, heart failure (chronic elevation), sepsis, rhabdomyolysis, renal failure (reduced clearance of TnT), cardiotoxic chemotherapy |
| ↓ Below normal | Not clinically significant (undetectable is the baseline) |
Serial troponin (at 0h, 3h, 6h) is used to confirm or rule out ACS.
14. Seromucoid / Orosomucoid (0.13–0.2 units)
| Direction | Diagnoses |
|---|---|
| ↑ Elevated | Acute-phase reactant — infections, inflammation, malignancy, rheumatic diseases, trauma, surgery, MI |
| ↓ Decreased | Malnutrition, liver disease, nephrotic syndrome |
15. Haptoglobin (0.9–4 g/L)
| Direction | Diagnoses |
|---|---|
| ↑ Elevated | Acute-phase reactant — infections, inflammatory conditions, malignancy, corticosteroid therapy, nephrotic syndrome |
| ↓ Decreased / Absent | Intravascular hemolysis (the most sensitive marker) — haptoglobin binds free hemoglobin and is consumed: autoimmune hemolytic anemia, transfusion reactions, mechanical hemolysis; also in liver disease (↓ synthesis) |
16. Thymol Test / Thymol Turbidity (≤5 units)
| Direction | Diagnoses |
|---|---|
| ↑ Elevated | Reflects hypergammaglobulinemia and/or elevated β-lipoproteins — viral hepatitis (especially in active phase), liver cirrhosis, collagenous diseases (SLE, RA) |
| Normal | Does not rise in obstructive jaundice (differentiates from hepatocellular jaundice) |
17. Rheumatoid Factor / RF (≤8 IU/mL)
| Direction | Diagnoses |
|---|---|
| ↑ Elevated | Rheumatoid arthritis (present in ~75–80%); also: Sjögren's syndrome, SLE, scleroderma, mixed connective tissue disease, chronic infections (TB, subacute bacterial endocarditis, viral hepatitis), sarcoidosis, cryoglobulinemia |
| Note | RF is not specific — can be positive in 5% of healthy elderly |
18. Antistreptolysin-O / ASO (≤250 IU/mL)
| Direction | Diagnoses |
|---|---|
| ↑ Elevated | Evidence of recent Group A Streptococcal (GAS) infection. Diagnoses: Acute rheumatic fever (ARF), post-streptococcal glomerulonephritis (PSGN), streptococcal pharyngitis/scarlet fever. Peaks 3–5 weeks post-infection |
| Normal | Does not exclude GAS infection (only 80% sensitivity for ARF) |
19. C-Reactive Protein / CRP (0–6 mg/L)
| Direction | Diagnoses |
|---|---|
| ↑ Mildly elevated (6–10 mg/L) | Low-grade inflammation, cardiovascular risk (high-sensitivity CRP) |
| ↑ Markedly elevated (>10 mg/L) | Bacterial infections (CRP rises higher with bacterial than viral), autoimmune flares (RA, vasculitis), MI, tissue necrosis, surgery, trauma |
| Very high (>100 mg/L) | Severe bacterial infection/sepsis |
| Note | CRP is not elevated in SLE flares despite active disease (useful differentiator from infection in lupus) |
20. Circulating Immune Complexes / CIC (0–120 units)
| Direction | Diagnoses |
|---|---|
| ↑ Elevated | Autoimmune diseases: SLE, RA, vasculitis, glomerulonephritis; Chronic infections: viral hepatitis B/C, subacute bacterial endocarditis, HIV; Malignancies; Serum sickness |
| Clinical significance | CIC deposition in vessel walls/glomeruli causes type III hypersensitivity damage |
21. Sialic Acids (125–200 units)
| Direction | Diagnoses |
|---|---|
| ↑ Elevated | Acute-phase reactant — bacterial and viral infections, malignancies (elevated in many cancers; used as a non-specific tumor marker), rheumatic diseases, MI, autoimmune conditions |
| ↓ Decreased | Liver disease, malnutrition |
22. Ceruloplasmin (1.5–2.3 g/L)
| Direction | Diagnoses |
|---|---|
| ↑ Elevated | Acute-phase reactant — infections, inflammation, malignancy; pregnancy, estrogen therapy, biliary cirrhosis, rheumatoid arthritis |
| ↓ Decreased | Wilson's disease (hepatolenticular degeneration — copper accumulates in liver, brain, cornea → Kayser-Fleischer rings); Menkes disease (X-linked copper transport disorder); malnutrition; malabsorption; nephrotic syndrome (urinary loss); severe liver failure |
Wilson's disease: ceruloplasmin <0.2 g/L + elevated 24h urine copper + Kayser-Fleischer rings = diagnostic triad.
Quick Reference Summary Table
| Marker | ↑ Elevated → Diagnoses | ↓ Decreased → Diagnoses |
|---|---|---|
| Total/Indirect Bilirubin | Hemolysis, Gilbert's, Crigler-Najjar | Rarely significant |
| Direct Bilirubin | Hepatitis, cirrhosis, cholestasis, obstruction | — |
| Serum Iron | Hemochromatosis, hemolysis, liver necrosis | Iron-deficiency anemia, chronic disease |
| TIBC | Iron deficiency, pregnancy | Hemochromatosis, chronic disease |
| Ferritin | Hemochromatosis, inflammation, liver disease | Iron-deficiency anemia |
| Glucose (fasting) | Diabetes, Cushing's, stress, pheochromocytoma | Insulinoma, Addison's, insulin overdose |
| HbA1c | DM (≥6.5%), poor control | Hemolytic anemia, transfusion |
| Total Cholesterol | FH, hypothyroidism, nephrotic syndrome | Liver failure, malnutrition, hyperthyroidism |
| HDL | Protective; exercise, estrogen | CVD risk: smoking, obesity, T2DM |
| LDL | CVD risk: FH, hypothyroidism | Malabsorption, hyperthyroidism |
| Triglycerides | Metabolic syndrome, DM, pancreatitis risk | Malnutrition |
| Total Protein | Myeloma, dehydration | Liver failure, nephrotic syndrome, malnutrition |
| Albumin | Dehydration | Liver disease, nephrotic syndrome, inflammation |
| γ-globulins | Myeloma, autoimmune, chronic infection | Immunodeficiency |
| Troponin I/T | AMI, myocarditis, PE, sepsis | Not significant |
| Haptoglobin | Infection, inflammation | Intravascular hemolysis (most sensitive) |
| RF | RA, Sjögren's, SLE, chronic infections | — |
| ASO | Post-streptococcal: ARF, PSGN | — |
| CRP | Bacterial infection, sepsis, autoimmune flare, MI | — |
| CIC | SLE, RA, vasculitis, chronic infections | — |
| Ceruloplasmin | Infection, pregnancy, RA | Wilson's disease, Menkes, malnutrition |
Same things to these as above diagnosis according to increasing and decreasing
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urinalysis abnormal findings proteinuria glucosuria hematuria pyuria casts diagnosis
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urine specific gravity diuresis Zimnitsky Nechiporenko sediment analysis kidney disease
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Here is the complete clinical interpretation for every parameter in the urinalysis tables shown in the image.
Urinalysis (General) — Abnormal Values & Diagnoses
1. Specific Gravity (Normal: 1008–1026)
| Direction | Value | Diagnoses |
|---|---|---|
| ↑ Increased (Hypersthenuria) | >1026 | Dehydration, concentrated urine; diabetes mellitus (glycosuria raises SG); heart failure, nephrotic syndrome (oliguria + concentrated urine); vomiting/diarrhea, fever, sweating |
| ↓ Decreased (Hyposthenuria) | <1008 | Diabetes insipidus (central or nephrogenic — hallmark: fixed low SG ~1001–1005); chronic renal failure (loss of concentrating ability); excessive water intake (polydipsia), diuretic therapy |
| Fixed SG (Isosthenuria) | ~1010 | Severe chronic kidney disease / renal failure — kidneys lose all concentrating and diluting capacity |
2. Color (Normal: Straw-yellow)
| Color | Diagnoses |
|---|---|
| Dark yellow / amber | Dehydration, concentrated urine, fever |
| Red / pink | Hematuria (kidney stones, glomerulonephritis, tumors, trauma); hemoglobinuria (hemolysis); myoglobinuria (rhabdomyolysis); beetroot, rifampicin ingestion |
| Brown / tea-colored | Hepatitis / jaundice (bilirubinuria); hemoglobinuria; acute glomerulonephritis ("Coca-Cola urine") |
| White / milky | Pyuria (UTI, pyelonephritis); chyluria (lymphatic fistula — filariasis) |
| Orange | Bile pigments (obstructive jaundice), urobilinuria, rifampicin |
| Colorless | Diabetes insipidus, overhydration, severe CKD |
3. Transparency (Normal: Complete/Clear)
| Appearance | Diagnoses |
|---|---|
| Turbid / cloudy | Pyuria (UTI, pyelonephritis), bacteriuria, phosphaturia (alkaline urine), uraturia (acid urine — gout), hematuria, chyluria |
| Normal to slightly turbid | Can be normal if refrigerated (phosphate precipitation) |
4. Reaction / pH (Normal: 4.5–8.0, typically slightly acidic)
| Direction | Diagnoses |
|---|---|
| ↑ Alkaline (pH >7–8) | UTI with urease-producing bacteria (Proteus, Klebsiella — ammonia production → alkaline urine, struvite stones); vegetarian diet; renal tubular acidosis (RTA) Type I & II; vomiting (loss of HCl); metabolic alkalosis; diuretics (acetazolamide) |
| ↓ Acidic (pH <4.5) | Diabetic ketoacidosis (DKA); high-protein diet; gout (uric acid stones); fever; severe exercise; metabolic acidosis; respiratory acidosis; starvation |
5. Protein (Normal: Absent or traces ≤25–75 mg/day)
| Level | Diagnoses |
|---|---|
| Microalbuminuria (30–300 mg/day) | Early diabetic nephropathy, early hypertensive nephropathy, cardiovascular risk marker |
| Proteinuria >150 mg/day | Glomerulonephritis (IgA nephropathy, FSGS, lupus nephritis), nephrotic syndrome (>3.5 g/day), diabetic nephropathy, pre-eclampsia, multiple myeloma (Bence Jones protein), amyloidosis |
| Heavy proteinuria >3.5 g/day | Nephrotic syndrome (minimal change disease, membranous nephropathy, FSGS, diabetic nephropathy) |
| Functional/transient | Fever, strenuous exercise, orthostatic proteinuria (benign, postural) |
| ↓ / Absent | Normal; cannot be "below normal" clinically |
6. Glucose (Normal: Absent or ≤0.02%)
| Finding | Diagnoses |
|---|---|
| ↑ Glucosuria | Diabetes mellitus (blood glucose exceeds renal threshold ~10 mmol/L); Fanconi syndrome (proximal tubular damage — glucosuria with normal blood glucose); renal glucosuria (isolated tubular defect); pregnancy (lowered renal threshold); Cushing's syndrome; glucocorticoid therapy |
| Note | Glucosuria with normal blood glucose → suspect tubular disorder |
7. Acetone / Ketones (Normal: Absent)
| Finding | Diagnoses |
|---|---|
| ↑ Ketonuria | Diabetic ketoacidosis (DKA) — type 1 DM most commonly; Starvation / fasting; prolonged vomiting; alcoholic ketoacidosis; high-fat/low-carb diet; hyperemesis gravidarum; febrile illness in children |
8. Urobilin / Urobilinogen (Normal: Absent or traces)
| Direction | Diagnoses |
|---|---|
| ↑ Increased | Hemolytic anemia (excess bilirubin produced → more urobilinogen); hepatocellular disease (hepatitis, cirrhosis — liver fails to re-process urobilinogen returned from gut) |
| ↓ Absent | Complete biliary obstruction (no bile reaches the gut → no urobilinogen formed → absent from urine and stool → pale/clay-colored stools) |
9. Bilirubin in Urine (Normal: Absent)
| Finding | Diagnoses |
|---|---|
| ↑ Bilirubinuria | Only conjugated (direct) bilirubin appears in urine (water-soluble). Indicates: obstructive jaundice (gallstones, pancreatic head cancer, cholangiocarcinoma), hepatocellular jaundice (hepatitis, cirrhosis) |
| Absent | Normal; also absent in pre-hepatic/hemolytic jaundice (only unconjugated bilirubin produced — not water-soluble, cannot pass into urine) |
Differentiating jaundice: Bilirubin in urine (+) + Urobilinogen absent = Obstructive; Bilirubin (+) + Urobilinogen ↑ = Hepatocellular; Bilirubin absent + Urobilinogen ↑ = Hemolytic
10. Plate (Squamous) Epithelium (Normal: ≤5/field)
| Finding | Diagnoses |
|---|---|
| ↑ Increased | Usually indicates urethral or vaginal contamination (not true pathology). Large amounts: cystitis (bladder inflammation), urethritis |
11. Renal Epithelium (Normal: Absent)
| Finding | Diagnoses |
|---|---|
| ↑ Present | Renal tubular damage — acute tubular necrosis (ATN), pyelonephritis, glomerulonephritis, renal infarction, nephrotoxic drug injury (aminoglycosides, NSAIDs, cisplatin), viral nephritis (CMV — "owl-eye" inclusions) |
12. Leucocytes / WBCs in Urine (Normal: ≤2–3/field)
| Finding | Diagnoses |
|---|---|
| ↑ Pyuria (>5 WBCs/HPF) | Urinary tract infection (UTI) — cystitis, urethritis; pyelonephritis; prostatitis; renal tuberculosis (sterile pyuria — WBCs without bacterial growth on standard culture); interstitial nephritis (drug-induced, autoimmune); glomerulonephritis |
| Sterile pyuria (WBC+ but culture–) | TB of the kidney, chlamydia (requires special culture), interstitial nephritis, analgesic nephropathy |
13. Erythrocytes / RBCs in Urine (Normal: Absent)
| Finding | Diagnoses |
|---|---|
| ↑ Hematuria | Glomerulonephritis (IgA nephropathy, post-streptococcal GN — dysmorphic RBCs + RBC casts); kidney stones (urolithiasis); renal/bladder tumors; pyelonephritis; renal tuberculosis; trauma; coagulation disorders; anticoagulant therapy |
| Gross hematuria with clots | Suggests lower urinary tract source (bladder, urethra, prostate) rather than glomerular |
| Dysmorphic RBCs | Strongly suggests glomerular origin (acanthocytes) |
Harrison's (p. 1377): Persistent microscopic hematuria (>3 RBCs/HPF on 3 urinalyses) warrants full evaluation including imaging and cystoscopy.
14. Casts / Cylinders (Normal: Absent)
Casts form in renal tubules — their type indicates the level and nature of injury:
| Cast Type | Diagnoses |
|---|---|
| Hyaline casts | Can be normal in small numbers; ↑ in dehydration, fever, exercise, diuretics, early CKD |
| RBC casts (erythrocyte) | Pathognomonic of glomerulonephritis — IgA nephropathy, lupus nephritis, post-streptococcal GN, vasculitis (ANCA) |
| WBC casts | Pyelonephritis, interstitial nephritis, severe glomerulonephritis |
| Granular casts | Tubular cell degeneration — acute tubular necrosis (ATN), chronic renal disease; "muddy brown" granular casts = ATN |
| Waxy / broad casts | Advanced CKD / chronic renal failure — formed in dilated tubules |
| Fatty casts | Nephrotic syndrome — lipiduria |
| Epithelial cell casts | Acute tubular necrosis, toxic nephropathy, viral nephritis |
15. Mucus (Normal: Insignificant amount)
| Finding | Diagnoses |
|---|---|
| ↑ Increased | Urethritis, cystitis, prostatitis (lower urinary tract inflammation); contamination from genital secretions |
16. Bacteria (Normal: Insignificant, <50,000/mL)
| Finding | Diagnoses |
|---|---|
| ↑ Bacteriuria (>100,000 CFU/mL = significant) | Urinary tract infection (UTI): cystitis, pyelonephritis, urethritis, prostatitis; asymptomatic bacteriuria (common in elderly, pregnant women — treat only in pregnancy) |
| Gram-negative rods | E. coli (80%), Klebsiella, Proteus, Enterobacter |
| Gram-positive cocci | Staphylococcus saprophyticus (young women), Enterococcus |
17. Non-Organized Sediment / Crystals
| Crystal | Condition / Significance |
|---|---|
| Oxalates | Any urine pH; calcium oxalate stones (most common kidney stones), hyperoxaluria, ethylene glycol poisoning, high oxalate diet (spinach, nuts) |
| Uric acid / urates (acid urine) | Gout, Lesch-Nyhan syndrome, high purine diet, tumor lysis syndrome, chronic dehydration |
| Amorphous phosphates, triple phosphates (struvite) (alkaline urine) | UTI with urease-producing bacteria (Proteus, Klebsiella) → struvite "staghorn" kidney stones; hyperphosphaturia |
| Cystine crystals | Cystinuria (autosomal recessive transport disorder) → recurrent kidney stones |
| Cholesterol crystals | Nephrotic syndrome, chyluria |
Nechiporenko's Urine Sediment Analysis (per 1 mL)
| Parameter | Normal | ↑ Increased → Diagnoses |
|---|---|---|
| Leucocytes | ≤4.0×10⁶/L | >4.0×10⁶/L: Pyelonephritis (predominant WBCs), cystitis, interstitial nephritis, prostatitis, renal TB (sterile pyuria) |
| Erythrocytes | ≤1.0×10⁶/L | >1.0×10⁶/L: Glomerulonephritis (predominant RBCs, dysmorphic), urolithiasis, renal tumors, hemorrhagic cystitis, TB of kidney |
| Casts | ≤250×10³/L | >250×10³/L: Glomerulonephritis, pyelonephritis, ATN, CKD |
Key differential using Nechiporenko:
- WBC dominant → pyelonephritis / interstitial nephritis
- RBC dominant → glomerulonephritis / urolithiasis / tumor
Addis-Kakovsky Analysis (per 24 hours)
| Parameter | Normal | ↑ Increased → Diagnoses |
|---|---|---|
| Leucocytes | ≤1.0×10⁶/day | Pyelonephritis, cystitis, interstitial nephritis, renal TB |
| Erythrocytes | ≤2.0×10⁶/day | Glomerulonephritis, urolithiasis, renal tumors, coagulopathy |
| Casts | ≤20.0×10⁴/day | ATN, glomerulonephritis, pyelonephritis, severe CKD |
Zimnitsky's Analysis (Urine Concentration Test)
Tests the kidney's ability to concentrate and dilute urine throughout 24 hours (8 × 3-hour portions).
| Parameter | Normal | Abnormal → Diagnoses |
|---|---|---|
| Diurnal diuresis | 1000–2000 mL (65–75% of water intake) | ↓ Oliguria (<500 mL): Acute renal failure, dehydration, heart failure, shock; ↑ Polyuria (>2000 mL): Diabetes insipidus, DM, CKD (polyuric phase), diuretics |
| Daily vs. Nocturnal ratio | Day = 3/4 of total diuresis | Nocturia / Nycturia (night > day): Early heart failure (lying position increases renal perfusion at night), CKD, BPH, diabetes insipidus |
| Specific Gravity | 1008–1024 | See table below |
| Fluctuation of SG | ≤0.008 (varies between portions) | Monotonous fixed SG = Isosthenuria |
Zimnitsky SG Patterns:
| Pattern | SG Range | Diagnoses |
|---|---|---|
| Hypersthenuria | >1024 (at least one portion) | Dehydration, DM (concentrated urine), ADH excess (SIADH) |
| Hyposthenuria | All portions <1010 | Diabetes insipidus (central or nephrogenic), CKD (loss of concentrating ability), psychogenic polydipsia |
| Isosthenuria | Fixed ~1010 (fluctuation <0.008) | Severe CKD / renal failure — kidneys cannot concentrate OR dilute urine; also pyelonephritis (chronic), amyloidosis of the kidney |
| Normal variation | 1008–1024 with fluctuation >0.008 | Healthy kidneys responding to fluid intake |
Summary: Key Diagnostic Patterns
| Syndrome | Key Urinalysis Features |
|---|---|
| Nephrotic syndrome | Heavy proteinuria (>3.5 g/day), fatty casts, lipiduria, normal SG initially |
| Nephritic / Glomerulonephritis | Hematuria, RBC casts, proteinuria, WBC casts, ↓ urine output |
| Pyelonephritis | Pyuria, bacteriuria, WBC casts, renal epithelial cells, alkaline urine (if Proteus) |
| Acute Tubular Necrosis (ATN) | Renal epithelial cells, granular "muddy brown" casts, SG fixed ~1010 |
| Diabetes Mellitus | Glucosuria, ketonuria (DKA), high SG, microalbuminuria |
| Diabetes Insipidus | Colorless urine, very low SG (1001–1005), polyuria, no glucose/protein |
| UTI (cystitis) | Pyuria, bacteriuria, turbid urine, alkaline pH, squamous epithelium |
| Urolithiasis | Hematuria, crystals (oxalate/urate/struvite), acidic or alkaline pH |
| Obstructive Jaundice | Bilirubinuria (dark brown), absent urobilinogen, foamy urine |
| Hemolytic anemia | Urobilinogen ↑↑, no bilirubinuria, possible hemoglobinuria |
Make in table
Here is everything organized into clean tables.
Urinalysis — Complete Abnormal Values & Diagnoses
General Urinalysis
| Parameter | Normal | ↑ Increased / Present | ↓ Decreased / Absent |
|---|---|---|---|
| Specific Gravity | 1008–1026 | >1026 → Dehydration, DM (glucosuria), heart failure, nephrotic syndrome, fever, SIADH | <1008 → Diabetes insipidus, CKD, excessive water intake, diuretics; Fixed ~1010 = Isosthenuria (severe CKD/renal failure) |
| Color | Straw-yellow | Red/pink → Hematuria, hemoglobinuria, myoglobinuria; Brown/tea → Hepatitis, obstructive jaundice, glomerulonephritis ("Coca-Cola"); White/milky → Pyuria, chyluria; Orange → Bilirubinuria, rifampicin; Dark yellow → Dehydration | Colorless → Diabetes insipidus, overhydration, severe CKD |
| Transparency | Complete (clear) | Turbid/cloudy → UTI (pyuria, bacteriuria), phosphaturia, uraturia (gout), hematuria, chyluria | — |
| pH / Reaction | 4.5–8.0 (slightly acidic) | Alkaline (>7) → UTI with urease bacteria (Proteus, Klebsiella), RTA Type I/II, vomiting, metabolic alkalosis, vegetarian diet | Acidic (<4.5) → DKA, gout (uric acid stones), high-protein diet, fever, metabolic acidosis, starvation |
| Protein | Absent or traces (≤25–75 mg/day) | Microalbuminuria (30–300 mg/day) → Early diabetic/hypertensive nephropathy; >150 mg → Glomerulonephritis, nephrotic syndrome (>3.5 g/day), DM nephropathy, pre-eclampsia, myeloma (Bence Jones), amyloidosis | Cannot fall below normal; absence is normal |
| Glucose | Absent or ≤0.02% | Diabetes mellitus (blood glucose >10 mmol/L exceeds renal threshold); Fanconi syndrome (glucosuria with normal blood glucose); renal glucosuria; pregnancy; Cushing's syndrome; corticosteroids | Cannot fall below normal; absence is normal |
| Acetone / Ketones | Absent | DKA (Type 1 DM), starvation/fasting, prolonged vomiting, alcoholic ketoacidosis, high-fat diet, hyperemesis gravidarum | Absence is normal |
| Urobilin / Urobilinogen | Absent or traces | Hemolytic anemia (excess bilirubin → excess urobilinogen); Hepatocellular disease (hepatitis, cirrhosis — impaired re-uptake) | Absent → Complete biliary obstruction (no bile reaches gut → no urobilinogen formed → pale/clay stools) |
| Bilirubin | Absent | Only conjugated bilirubin appears in urine: Obstructive jaundice (gallstones, pancreatic head cancer, cholangiocarcinoma), hepatocellular jaundice (hepatitis, cirrhosis) | Absent → Normal; also absent in hemolytic jaundice (unconjugated bilirubin is not water-soluble) |
| Squamous/Plate Epithelium | ≤5/field | Large amounts → Urethral/vaginal contamination, cystitis, urethritis | — |
| Renal Epithelium | Absent | Present → Acute tubular necrosis (ATN), pyelonephritis, glomerulonephritis, nephrotoxic drugs (aminoglycosides, NSAIDs, cisplatin), viral nephritis | Absence is normal |
| Leucocytes (WBCs) | ≤2–3/field | >5/field (pyuria) → UTI (cystitis, urethritis), pyelonephritis, prostatitis, renal TB (sterile pyuria), interstitial nephritis, glomerulonephritis | Below normal is not significant |
| Erythrocytes (RBCs) | Absent | Glomerulonephritis (dysmorphic RBCs + RBC casts), urolithiasis (kidney stones), renal/bladder tumors, pyelonephritis, renal TB, trauma, coagulopathy, anticoagulants | Absence is normal |
| Casts / Cylinders | Absent | Hyaline → Dehydration, fever, exercise (can be normal in small amounts); RBC casts → Glomerulonephritis (IgA, lupus, post-strep, ANCA vasculitis); WBC casts → Pyelonephritis, interstitial nephritis; Granular "muddy brown" → ATN; Waxy/broad → Advanced CKD; Fatty casts → Nephrotic syndrome; Epithelial casts → ATN, toxic nephropathy | Absence is normal |
| Mucus | Insignificant | ↑ → Urethritis, cystitis, prostatitis, genital contamination | — |
| Bacteria | Insignificant (<50,000/mL) | >100,000 CFU/mL (significant bacteriuria) → UTI: cystitis, pyelonephritis; Asymptomatic bacteriuria (treat in pregnancy); E. coli (80%), Klebsiella, Proteus, Staphylococcus saprophyticus | — |
Non-Organized Sediment / Crystals
| Crystal Type | Urine pH | Diagnoses |
|---|---|---|
| Oxalates | Any pH | Calcium oxalate kidney stones, hyperoxaluria, ethylene glycol poisoning, high oxalate diet (spinach, nuts) |
| Uric acid / Urates | Acidic | Gout, Lesch-Nyhan syndrome, high purine diet, tumor lysis syndrome, chronic dehydration |
| Amorphous phosphate / Triple phosphate (Struvite) | Alkaline | UTI with urease bacteria (Proteus, Klebsiella) → Staghorn kidney stones |
| Cystine | Acidic | Cystinuria (autosomal recessive) → recurrent kidney stones |
| Cholesterol | Any | Nephrotic syndrome, chyluria |
Nechiporenko's Urine Sediment Analysis (per 1 mL)
| Parameter | Normal | ↑ Increased → Diagnoses |
|---|---|---|
| Leucocytes | ≤4.0×10⁶/L | Pyelonephritis (WBC dominant), cystitis, interstitial nephritis, prostatitis, renal TB (sterile pyuria) |
| Erythrocytes | ≤1.0×10⁶/L | Glomerulonephritis (RBC dominant, dysmorphic), urolithiasis, renal/bladder tumors, hemorrhagic cystitis, renal TB |
| Casts | ≤250×10³/L | Glomerulonephritis, pyelonephritis, ATN, CKD |
Addis-Kakovsky Analysis (per 24 hours)
| Parameter | Normal | ↑ Increased → Diagnoses |
|---|---|---|
| Leucocytes | ≤1.0×10⁶/day | Pyelonephritis, cystitis, interstitial nephritis, renal TB |
| Erythrocytes | ≤2.0×10⁶/day | Glomerulonephritis, urolithiasis, renal tumors, coagulopathy |
| Casts | ≤20.0×10⁴/day | ATN, glomerulonephritis, pyelonephritis, severe CKD |
Zimnitsky's Analysis
| Parameter | Normal | ↑ Increased | ↓ Decreased |
|---|---|---|---|
| Diurnal (24h) Diuresis | 1000–2000 mL (65–75% of water intake) | Polyuria (>2000 mL) → Diabetes insipidus, DM, CKD polyuric phase, diuretics | Oliguria (<500 mL) → Acute renal failure, dehydration, heart failure, shock |
| Daily vs. Nocturnal ratio | Day = 3/4 of total diuresis | Nocturia (night > day) → Early heart failure, CKD, BPH, diabetes insipidus | — |
| Specific Gravity | 1008–1024 | Hypersthenuria (>1024) → Dehydration, DM, SIADH | Hyposthenuria (all portions <1010) → Diabetes insipidus, CKD; Isosthenuria (fixed ~1010) → Severe CKD, chronic pyelonephritis, renal amyloidosis |
| Fluctuation of SG | ≤0.008 between portions | Normal if varies widely (>0.008) = healthy kidneys | Monotonous/fixed SG (fluctuation <0.008) = Isosthenuria → Severe CKD, renal failure |
Key Diagnostic Syndromes — Urine Pattern Summary
| Syndrome | Protein | RBCs | WBCs | Casts | SG | Other |
|---|---|---|---|---|---|---|
| Nephrotic syndrome | >3.5 g/day | — | — | Fatty, hyaline | Normal early | Glucosuria if DM; lipiduria |
| Glomerulonephritis | + | Dysmorphic RBCs | + | RBC casts | Variable | Oliguria, hypertension |
| Pyelonephritis | Trace | — | ↑↑ | WBC casts | Low-normal | Bacteriuria, alkaline pH |
| ATN | + | Renal epithelium | — | Granular "muddy brown" | Fixed ~1010 | Oliguria → anuria |
| Diabetes Mellitus | Microalbumin | — | — | — | ↑ | Glucosuria, ketonuria (DKA) |
| Diabetes Insipidus | — | — | — | — | ↓↓ (1001–1005) | Colorless, polyuria, nocturia |
| UTI / Cystitis | Trace | — | ↑↑ | — | Normal | Bacteriuria, turbid, alkaline |
| Urolithiasis | — | ↑ | — | — | Variable | Crystals, colicky pain |
| Obstructive Jaundice | — | — | — | — | Normal | Bilirubinuria ↑, urobilinogen absent |
| Hemolytic Anemia | — | — | — | — | Normal | Urobilinogen ↑↑, no bilirubinuria, hemoglobinuria |
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Here is the complete biochemical blood serum panel in full table format.
Biochemical Blood Serum Tests — Complete Abnormal Values & Diagnoses
Bilirubin
| Parameter | Normal | ↑ Increased → Diagnoses | ↓ Decreased → Diagnoses |
|---|---|---|---|
| Total Bilirubin | 8.5–20.5 µmol/L | >20.5 → Jaundice visible at ~35 µmol/L; hepatitis, cirrhosis, hemolysis, cholestasis, biliary obstruction | Rarely significant; seen in some anemias or as normal variant |
| Indirect (Unconjugated) | <16.5 µmol/L | Hemolytic anemias (spherocytosis, sickle cell, G6PD deficiency), Gilbert's syndrome, Crigler-Najjar syndrome, transfusion reactions, neonatal jaundice | Rarely clinically significant |
| Direct (Conjugated) | Minority of total | Hepatocellular disease (viral hepatitis, alcoholic hepatitis, cirrhosis); Intrahepatic cholestasis (PBC, PSC, drugs); Extrahepatic obstruction (gallstones, pancreatic cancer, cholangiocarcinoma); Dubin-Johnson syndrome; Rotor syndrome | Not clinically significant |
Iron Metabolism
| Parameter | Normal | ↑ Increased → Diagnoses | ↓ Decreased → Diagnoses |
|---|---|---|---|
| Serum Iron | Male: 10–30 µmol/L; Female: 9–29 µmol/L | Hemochromatosis (hereditary), hemosiderosis, hemolytic anemia, aplastic anemia, lead poisoning, excessive iron supplementation, acute liver necrosis (iron released from hepatocytes) | Iron-deficiency anemia, chronic blood loss (GI, menorrhagia), malnutrition, malabsorption (celiac disease), anemia of chronic disease |
| TIBC (Fe-binding capacity) | 50–84 µmol/L | Iron-deficiency anemia (liver produces more transferrin), pregnancy, oral contraceptive use | Hemochromatosis, anemia of chronic disease, nephrotic syndrome, malnutrition, liver failure (↓ transferrin synthesis) |
| Serum Ferritin | 30–300 µg/L | Hemochromatosis (>1000 µg/L = strongest predictor), hemosiderosis, liver disease (hepatitis, cirrhosis), acute-phase inflammation (infection, malignancy, RA — unreliable for iron stores when inflamed) | Iron-deficiency anemia (most sensitive and specific marker of depleted iron stores) |
Key pattern: Iron ↓ + TIBC ↑ + Ferritin ↓ = Iron-deficiency anemia; Iron ↑ + TIBC ↓ + Ferritin >1000 = Hemochromatosis
Glucose & Glycemic Markers
| Parameter | Normal | ↑ Increased → Diagnoses | ↓ Decreased → Diagnoses |
|---|---|---|---|
| Glucose (venous, fasting) | 4.2–6.1 mmol/L | 6.1–7.0 → Impaired fasting glucose (pre-diabetes); >7.0 (×2) → Diabetes mellitus; very high → DKA (Type 1), HHS (Type 2); also Cushing's syndrome, acromegaly, pheochromocytoma, glucocorticoid therapy, stress hyperglycemia (MI, sepsis, stroke) | <3.3 → Insulin overdose, insulinoma, Addison's disease, hypopituitarism, severe liver failure, alcohol ingestion, prolonged fasting, reactive hypoglycemia |
| Glucose (capillary, fasting) | 3.88–6.7 mmol/L | Same as above | Same as above |
| Glucose tolerance test (2h) | ≤7.8 mmol/L | 7.8–11.0 → Impaired glucose tolerance (pre-diabetes); ≥11.1 → Diabetes mellitus | Not clinically significant |
| Glucose tolerance test (fasting) | ≤6.7 mmol/L | >6.7 → Impaired fasting glucose / DM | — |
| HbA1c (Glycated Hemoglobin) | 4.5–6.1% | 5.7–6.4% → Pre-diabetes; ≥6.5% → Diabetes mellitus (diagnostic); >8% → Poor glycemic control, high complication risk | Falsely low: hemolytic anemia, recent blood transfusion (RBC turnover too fast for glycation to accumulate) |
Lipid Profile
| Parameter | Normal | ↑ Increased → Diagnoses | ↓ Decreased → Diagnoses |
|---|---|---|---|
| Total Cholesterol | 3.9–5.2 mmol/L | Primary: Familial hypercholesterolemia (FH), familial combined hyperlipidemia; Secondary: Hypothyroidism, nephrotic syndrome, diabetes, obesity, cholestasis, high saturated fat diet → risk of CAD, stroke, PAD | Severe liver disease (cirrhosis), malnutrition/malabsorption, hyperthyroidism, chronic infections, myeloproliferative disorders |
| HDL | 0.9–1.9 mmol/L | Protective → ↓ cardiovascular risk; associated with regular exercise, estrogen, moderate alcohol | <0.9 → Major CVD risk factor: sedentary lifestyle, smoking, obesity, hypertriglyceridemia, Type 2 DM, metabolic syndrome, androgenic steroids, beta-blockers |
| LDL | <2.2 mmol/L | Familial hypercholesterolemia, metabolic syndrome, hypothyroidism, nephrotic syndrome, Cushing's → direct driver of atherosclerosis → CAD, MI, stroke | Hyperthyroidism, malabsorption, abetalipoproteinemia, liver disease |
| Atherogenic Coefficient | ≤3.0 units | 3.0–4.0 → Moderate CVD risk; >4.0 → High cardiovascular risk, accelerated atherosclerosis | <3.0 → Low risk (favorable) |
| Triglycerides | 0.40–2.1 mmol/L | Metabolic syndrome, Type 2 DM, obesity, alcohol excess, hypothyroidism, nephrotic syndrome, familial hypertriglyceridemia; >5.6 mmol/L → risk of acute pancreatitis | Malnutrition, malabsorption, hyperthyroidism |
Proteins & Protein Fractions
| Parameter | Normal | ↑ Increased → Diagnoses | ↓ Decreased → Diagnoses |
|---|---|---|---|
| Total Protein | 65–85 g/L | Dehydration (hemoconcentration), multiple myeloma (paraprotein), Waldenström's macroglobulinemia, chronic infections (↑ globulins) | Liver failure (↓ synthesis), nephrotic syndrome (urinary loss), malnutrition (kwashiorkor), protein-losing enteropathy, severe burns |
| Albumin | 56–66% of total | Dehydration (relative rise) | Liver disease (cirrhosis — most common cause), nephrotic syndrome, malnutrition, malabsorption, acute inflammation (negative acute-phase reactant), burns, protein-losing enteropathy |
| Globulins (total) | 34–44% | Chronic infections, autoimmune disease, cirrhosis, myeloma | Immunodeficiency |
| α₁-globulins | 2.5–5% | Acute inflammation, pregnancy, malignancy | α₁-antitrypsin deficiency → emphysema in young patients, liver cirrhosis in children |
| α₂-globulins | 5–9% | Nephrotic syndrome (↑ haptoglobin, α₂-macroglobulin), acute inflammation, Cushing's syndrome | Hemolysis (haptoglobin consumed by free hemoglobin) |
| β-globulins | 8–12% | Iron-deficiency anemia (↑ transferrin), hyperlipidemia (↑ LDL), biliary cirrhosis | Liver disease |
| γ-globulins | 12.8–19% | Chronic infections (TB, hepatitis, HIV), autoimmune disease (SLE, RA), cirrhosis, multiple myeloma (monoclonal spike on electrophoresis), Waldenström's | Primary immunodeficiency (agammaglobulinemia, CVID), prolonged corticosteroid therapy, immunosuppressive drugs |
Cardiac Markers
| Parameter | Normal | ↑ Increased → Diagnoses | ↓ Decreased → Diagnoses |
|---|---|---|---|
| Troponin I | ≤0.5 µg/L | Acute MI (STEMI/NSTEMI) — primary indication; myocarditis, pulmonary embolism (right heart strain), cardiac contusion, heart failure, sepsis, rhabdomyolysis, renal failure (↓ clearance), cardiotoxic chemotherapy | Undetectable = normal baseline; not clinically significant |
| Troponin T | ≤0.4 µg/L | Same as Troponin I; more sensitive for renal failure patients (rises in CKD even without ACS — use with caution) | Undetectable = normal baseline |
Serial troponin (0h, 3h, 6h): rising then falling pattern = acute MI; persistently elevated flat = chronic myocardial injury (CKD, HF)
Acute-Phase Reactants & Inflammatory Markers
| Parameter | Normal | ↑ Increased → Diagnoses | ↓ Decreased → Diagnoses |
|---|---|---|---|
| Seromucoid (Orosomucoid) | 0.13–0.2 units | Acute-phase reactant → infections, inflammation, malignancy, rheumatic diseases, trauma, surgery, MI | Malnutrition, liver disease, nephrotic syndrome |
| Haptoglobin | 0.9–4 g/L | Acute-phase reactant → infections, inflammatory conditions, malignancy, corticosteroid therapy, nephrotic syndrome | Intravascular hemolysis (most sensitive marker — consumed by free hemoglobin): autoimmune hemolytic anemia, transfusion reactions, mechanical hemolysis; also liver disease (↓ synthesis) |
| Thymol Test | ≤5 units | Viral hepatitis (rises in active phase), liver cirrhosis, collagenous diseases (SLE, RA) — reflects hypergammaglobulinemia | Does not rise in obstructive jaundice (useful differentiator from hepatocellular disease) |
| CRP (C-Reactive Protein) | 0–6 mg/L | 6–10 → Low-grade inflammation, cardiovascular risk (hsCRP); >10 → Bacterial infections, autoimmune flares (RA, vasculitis), MI, tissue necrosis, surgery, trauma; >100 → Sepsis/severe bacterial infection | Not clinically significant; notably NOT elevated in SLE flares (useful to distinguish SLE flare from infection) |
| Sialic Acids | 125–200 units | Acute-phase reactant → bacterial/viral infections, malignancies (used as non-specific tumor marker), rheumatic diseases, MI, autoimmune conditions | Liver disease, malnutrition |
| Circulating Immune Complexes (CIC) | 0–120 units | Autoimmune diseases: SLE, RA, vasculitis, glomerulonephritis; Chronic infections: hepatitis B/C, subacute bacterial endocarditis, HIV; malignancies; serum sickness (Type III hypersensitivity — CIC deposits in vessel walls/glomeruli) | Not clinically significant |
Immunological Markers
| Parameter | Normal | ↑ Increased → Diagnoses | ↓ Decreased → Diagnoses |
|---|---|---|---|
| Rheumatoid Factor (RF) | ≤8 IU/mL | Rheumatoid arthritis (~75–80% positive), Sjögren's syndrome, SLE, scleroderma, mixed connective tissue disease, chronic infections (TB, SBE, viral hepatitis), sarcoidosis, cryoglobulinemia; also 5% of healthy elderly | Not clinically significant |
| Antistreptolysin-O (ASO) | ≤250 IU/mL | Evidence of recent Group A Streptococcal (GAS) infection: Acute rheumatic fever (ARF), post-streptococcal glomerulonephritis (PSGN), streptococcal pharyngitis, scarlet fever (peaks 3–5 weeks post-infection) | Not clinically significant |
| Ceruloplasmin | 1.5–2.3 g/L | Acute-phase reactant → infections, inflammation, malignancy; pregnancy, estrogen therapy, biliary cirrhosis, RA | Wilson's disease (<0.2 g/L + ↑ urine copper + Kayser-Fleischer rings = diagnostic triad); Menkes disease (X-linked); malnutrition; malabsorption; nephrotic syndrome (urinary loss); severe liver failure |
Quick Master Summary Table
| Marker | Normal Range | ↑ Key Diagnoses | ↓ Key Diagnoses |
|---|---|---|---|
| Total Bilirubin | 8.5–20.5 µmol/L | Hepatitis, cirrhosis, hemolysis, cholestasis | Rarely significant |
| Indirect Bilirubin | <16.5 µmol/L | Hemolysis, Gilbert's, Crigler-Najjar | Rarely significant |
| Direct Bilirubin | Minority of total | Hepatitis, cirrhosis, biliary obstruction, Dubin-Johnson | Not significant |
| Serum Iron | 9–30 µmol/L | Hemochromatosis, hemolysis, liver necrosis | Iron-deficiency anemia, chronic disease |
| TIBC | 50–84 µmol/L | Iron-deficiency anemia, pregnancy | Hemochromatosis, chronic disease, liver failure |
| Ferritin | 30–300 µg/L | Hemochromatosis, inflammation, liver disease, malignancy | Iron-deficiency anemia |
| Glucose (fasting) | 4.2–6.1 mmol/L | Pre-diabetes, DM, DKA, HHS, Cushing's, pheochromocytoma | Insulinoma, Addison's, insulin overdose, liver failure |
| HbA1c | 4.5–6.1% | Pre-diabetes (5.7–6.4%), DM (≥6.5%), poor control (>8%) | Hemolytic anemia, blood transfusion (falsely low) |
| Total Cholesterol | 3.9–5.2 mmol/L | FH, hypothyroidism, nephrotic syndrome, DM | Liver failure, malnutrition, hyperthyroidism |
| HDL | 0.9–1.9 mmol/L | Protective (exercise, estrogen) | CVD risk: smoking, obesity, T2DM, metabolic syndrome |
| LDL | <2.2 mmol/L | FH, hypothyroidism, nephrotic → CAD, MI, stroke | Malabsorption, hyperthyroidism, liver disease |
| Atherogenic Coefficient | ≤3.0 | >4.0 → High CVD risk, atherosclerosis | <3.0 → Low risk (favorable) |
| Triglycerides | 0.40–2.1 mmol/L | Metabolic syndrome, DM, obesity, pancreatitis risk (>5.6) | Malnutrition, malabsorption, hyperthyroidism |
| Total Protein | 65–85 g/L | Myeloma, dehydration, Waldenström's | Liver failure, nephrotic syndrome, malnutrition, burns |
| Albumin | 56–66% | Dehydration | Liver disease, nephrotic syndrome, malnutrition, inflammation |
| α₁-globulins | 2.5–5% | Inflammation, pregnancy, malignancy | α₁-antitrypsin deficiency (emphysema, liver cirrhosis) |
| α₂-globulins | 5–9% | Nephrotic syndrome, Cushing's, inflammation | Intravascular hemolysis (haptoglobin consumed) |
| β-globulins | 8–12% | Iron-deficiency anemia (↑ transferrin), hyperlipidemia | Liver disease |
| γ-globulins | 12.8–19% | Myeloma, autoimmune, chronic infections, cirrhosis | Immunodeficiency (agammaglobulinemia, CVID) |
| Troponin I | ≤0.5 µg/L | AMI, myocarditis, PE, sepsis, CKD | Not significant (undetectable = normal) |
| Troponin T | ≤0.4 µg/L | AMI, myocarditis, CKD, heart failure | Not significant (undetectable = normal) |
| Seromucoid | 0.13–0.2 units | Infections, inflammation, malignancy, MI | Malnutrition, liver disease, nephrotic syndrome |
| Haptoglobin | 0.9–4 g/L | Infections, inflammation, malignancy, nephrotic syndrome | Intravascular hemolysis (most sensitive marker), liver disease |
| Thymol Test | ≤5 units | Viral hepatitis, cirrhosis, SLE, RA | Normal in obstructive jaundice (key differentiator) |
| CRP | 0–6 mg/L | Bacterial infection, sepsis, autoimmune flares, MI, trauma | Not significant; absent in SLE flares |
| Sialic Acids | 125–200 units | Infections, malignancy (tumor marker), rheumatic diseases, MI | Liver disease, malnutrition |
| CIC | 0–120 units | SLE, RA, vasculitis, GN, chronic infections, serum sickness | Not significant |
| RF | ≤8 IU/mL | RA, Sjögren's, SLE, chronic infections, sarcoidosis | Not significant |
| ASO | ≤250 IU/mL | Post-strep: ARF, PSGN, scarlet fever | Not significant |
| Ceruloplasmin | 1.5–2.3 g/L | Infection, pregnancy, RA, biliary cirrhosis | Wilson's disease, Menkes, malnutrition, nephrotic syndrome |
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