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Updated: Dec 15, 2025

A Semi-Automated and Reproducible Biological-Based Method to Quantify Calcium Deposition In Vitro
Published on: June 2, 2022
Albumin and calcium reference interval using healthy individuals and a data-mining approach
N Jassam1, A Luvai2, D Narayanan3
1Department of Clinical Biochemistry, Harrogate Foundation Trust, Harrogate, UK.
Insights
Harmonizing calcium reference intervals shows promise across UK platforms, but albumin intervals exhibit significant variation, challenging common reference ranges. Further investigation is needed for albumin standardization.
Area of Science:
- Clinical Chemistry
- Laboratory Medicine
- Analytical Chemistry
Background:
- Harmonization of reference intervals is recommended for analytes with established calibration and traceability.
- The UK Pathology Harmony initiative has recently harmonized reference intervals for calcium and albumin.
- This study aimed to determine reference intervals for calcium and albumin on common UK analytical platforms.
Purpose of the Study:
- To assess the feasibility of harmonizing reference intervals for calcium and albumin.
- To compare newly determined reference intervals with existing UK Pathology Harmony intervals.
- To evaluate the performance of different analytical platforms in relation to these harmonized intervals.
Main Methods:
- Recruited a prospective reference population (n=299) following IFCC CRIDL criteria.
- Collected a second, indirect population from 14 primary care settings.
- Measured analytes using Roche, Abbott, Beckman, and Siemens analytical platforms and methods.
Main Results:
- Calcium reference intervals largely agreed with UK Pathology Harmony intervals (2.2-2.6 mmol/L) across three of four platforms.
- BCG methods yielded higher reference limits for both calcium and albumin compared to BCP methods.
- Indirect study revealed age-related variations in reference intervals, up to 14% for older populations.
Conclusions:
- Calcium reference intervals demonstrate potential for harmonization across different analytical platforms.
- Albumin reference intervals showed substantial variation, indicating that a common reference interval is not currently supported.
- Analytical platform and method choice significantly impact reference intervals, particularly for albumin.
Background:
Harmonization of reference intervals for analytes that have a sound calibration and metrological traceability is a widely recommended practice. The UK Pathology Harmony has recently harmonized reference intervals for calcium and albumin. In this study, we have determined the reference intervals for calcium and albumin on the UK's most commonly used analytical platforms.
Method:
A prospective reference population of healthy individuals was recruited according to the IFCC CRIDL criteria. A second indirect population was collected from 14 primary care setting and measured in laboratories using various analytical platforms and methods (Roche, Abbott, Beckman and Siemens analytical platforms).
Results:
In total, 299 subjects were recruited; the central 95th centile values for calcium for three out of four analytical platforms were in a close agreement with UK Pathology Harmony reference intervals of 2.2-2.6 mmol/L. Reference intervals of BCG methods from both cohorts and irrespective of analytical platforms were higher for both lower and upper reference limits than those for BCP. In comparison, the indirect study showed an age-related variation. The younger population reference intervals varied by up to 5.7% at the lower reference limit and up to 12% at the upper reference limit compared with Pathology Harmony reference intervals, and the older population showed a variation of up to 14% at both limits.
Conclusion:
While calcium reference intervals can be a subject for harmonization, albumin reference intervals studied showed large variation which is unsupportive of embracing a common reference interval for albumin.
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