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Reference Ranges and What They Mean

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NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.

Sources Used in Current Review

Barth JH. Editorial: Reference Ranges Still Need Further Clarity. Annals of Clinical Biochemistry. 2990;46:1-2.

Boyd JC. Defining Laboratory Reference Values and Decision Limits: Populations, Intervals, and Interpretations. Asian Journal of Andrology. 2010;12: 83–90.

Ceriotti F. Prerequisites for Use of Common Reference Intervals. Clinical Biochemistry Review. 2007;28:115-121.

Ceriotti F, Henny J. Are my laboratory results normal? Considerations to be Made Concerning Reference Intervals and Decision Limits. Pediatric Reference Intervals. 2008;19:1-9.

Jones G, Barker A. Reference Intervals. Clinical Biochemistry Review. 2008;29 (Suppl i):S93-S97.

Phillips P. Pitfalls In Interpreting Laboratory Results. Australian Prescriber. 2009;32:43-46.

(2009) Determining Laboratory Reference Intervals: CLSI Guideline Makes the Task Manageable. Available online at through Accessed August 2015.

(December 11, 2013) National Cancer Institute. Understanding Laboratory Tests. Available online at through Accessed August 2015.

Graham Jones, Antony Barker. Reference Intervals. Clin Biochem Rev. 2008 Aug; 29(Suppl 1): S93–S97. Available online at through Accessed August 2015.

(July 2012) Al-Borai A. Frequently-Asked-Questions on Reference Intervals and Biological Variation. Westgard QC. Available online at through Accessed August 2015.

Sources Used in Previous Reviews


Clinical Diagnosis and Management by Laboratory Methods. 20th ed. Henry JB, ed. New York: Saunders: 2001.

Laboratory Medicine: Test Selection and Interpretation. Howanitz JH and Howanitz PJ, eds. New York: Churchill Livingstone; 1991:6-8.

National Committee for Clinical Laboratory Standards. How to Define and Determine Reference Intervals in the Clinical Laboratory: Approved Guideline. 2nd ed. Wayne, PA: 2000.

Sacher RA, McPherson RA, Campos J. Widmann's Clinical Interpretation of Laboratory Tests. 11th ed. Philadelphia: F.A. Davis Company; 2000:10-17.

The Science of Laboratory Diagnosis. Crocker J and Burnett D, eds. Oxford: Isis Medical Media; 1998: 391-4.

Tietz Textbook of Clinical Chemistry. Burtis CA and Ashwood ER, eds. Philadelphia: W. B. Saunders Company; 1994: 454-464.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. Burtis CA, Ashwood ER, Bruns DE, eds. St. Louis: Elsevier Saunders; 2006. Pp. 425-437.

McClatchey, et al. Clinical Laboratory Medicine. Second Edition.

Tietz Textbook of Clinical Chemistry and Molecular Diagnostics, Fourth Edition.


Roberta Reed, PhD, Mary Imogene Bassett Hosp., Cooperstown, NY, (by Eric Seaborg), 6/7/01.

David Sundwall, MD, President of the American Clinical Laboratory Association, Washington, DC (by Eric Seaborg), 6/7/01.

Pennell Painter, PhD, Professor of Pathology, Technical Director of the Dynacare Tennessee Medical Laboratories at the University of Tennessee Medical Center at Knoxville (by Jason Kahn).


National Cholesterol Education Program website, available online through

Cornell University Veterinary School website, available online through

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