Reference Ranges for All: Implementing Reference Ranges for Transgender and Nonbinary Patients.

Area of Science:

• Medical Informatics
• Clinical Pathology
• Health Equity

Background:

• Current laboratory systems often lack specific reference ranges for transgender and nonbinary (TGNB) individuals.
• This absence can lead to misinterpretation of diagnostic test results for TGNB patients.
• Ensuring accurate lab interpretation is vital for providing equitable healthcare.

Purpose of the Study:

• To underscore the need for tailored reference ranges for TGNB populations.
• To address the challenges posed by undefined laboratory reference ranges for gender diverse patients.
• To promote the development and implementation of inclusive laboratory practices.

Main Methods:

• A case report detailing a situation where a TGNB patient's abnormal lab values were missed due to lack of "X" gender reference ranges.
• Implementation of sex-invariant reporting as an interim measure.
• Mapping additional reference ranges to the "X" sex label within the Laboratory Information System (LIS).

Main Results:

• The implementation of "X" sex label reference ranges significantly improved the flagging of abnormal laboratory results.
• Sex-invariant reporting served as an effective interim solution.
• Monitoring for emerging TGNB-specific reference ranges is ongoing.

Conclusions:

• Informatics professionals must review and update institutional policies for TGNB patient registration and lab reporting.
• Failure to implement appropriate reference ranges presents significant patient safety risks.
• Adopting emerging TGNB-specific reference ranges and utilizing sex-invariant reporting are recommended best practices.