The following text is based on the document published in: 1) Pure and Appl Chem 1995; 67: 1563-1574; 2) Eur J Clin Chem Clin Biochem 1995; 33: 627-636.
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The present document is the first part of a series on properties measured in the clinical laboratory sciences initiated in 1987.
| The series will comprise: | |
|---|---|
| I | Syntax and semantic rules |
| II | Kinds-of-property |
| III | Terms and codevalues |
| IV | Properties and codevalues |
| V | Properties and units in Thrombosis and Haemostasis |
| VI | Properties and units in Drugs of Abuse |
| VII | Properties and units in Inborn Errors of Metabolism |
| VIII | Properties and units in Microbiology |
| IX | Properties and units in Trace Elements |
| X | Properties and units in General Clinical Chemistry |
| XI | Coding systems - Structure and Guidelines |
The size and complexity of part III and IV is such that they will be presented in
electronic format only. This is for ease of handling and to facilitate expression of
concepts in different languages.
The overall aim is access by electronic media of:
'Compendium of terminology and nomenclature of properties in clinical laboratory
sciences'.
'Glossary of terms in quantities and units in clinical chemistry'.
'Properties and units in the clinical laboratory sciences'.
The following colleagues have contributed significantly to part I on Syntax and
semantic rules through correspondence and discussions:
Kjeld J�rgensen (Denmark); Christopher Rigg (The Netherlands); Georges F�rard (France);
Peter Felding (Denmark); Ren� Dybk�r (Denmark); Renze Bais (Australia); J Lindemans (The
Netherlands).
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This document is an updating of previous recommendations on the presentation of
quantities and units in clinical laboratory sciences from IFCC, IUPAC and WHO. It is harmonised with a document
summarizing and updating recommendations on terminology nomenclature, syntax, convention
and units prepared for IFCC-IUPAC: Compendium of nomenclature and terminology of
properties in clinical laboratory sciences - "The Silver Book", Oxford:
Blackwell Science, 1995.
As the present document thus emanates from the efforts of the Commission-Committee on
Quantities and Units (in Clinical Chemistry), i.e. its members over many years, it is
presented as a C-QU(CC) recommendation.
The standard systematic names for properties in clinical laboratory sciences are intended
to serve as 'point d'appui' or 'bridge' for mapping and translation.
Each property is structured according to IUPAC-IFCC syntax rules and the terms (semantic
part) defining the property follow recommendations by international organisations.
Standard systematic names and codes are to be used as a bridge between formats in
different 'cultural' areas of language or local technical language, to ensure unambiguous
and fully informative communication.
It is not intended that they be used to standardize the language used by individual clinicians or laboratory practitioners.
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Basic research in biology and medicine and innovations in laboratory methodology have
greatly increased the range of properties available to medical staff to help them in
decisions on diagnosis and prevention of disease, and treatment of patients.
The plethora is now such that the individual doctor may have insight into or understanding
of only a few of the properties offered to him from the various clinical laboratory
specialities. Further, recent development tends to blur the boundaries between the various
disciplines of clinical laboratory sciences and the same properties are being reported
differently in different disciplines.
The terminology used by one laboratory speciality may vary even within the speciality, and
may be incomprehensible to another speciality. This is a minor inconvenience to the
laboratory specialities, each one being concerned essentially with its own area of
activity. However for the user, this is unsatisfactory and it may even hinder treatment of
the patient.
Why this document? The document is intended to address issues in clinical
laboratory sciences in general and as such is not confined to issues in clinical
chemistry.
It is part of the ongoing international effort to agree on some sort of 'standardisation'
of the transmission and presentation of 'laboratory results'. Schematically, a simple
laboratory report could look like Table 1.
A report may be elaborate with for example some quantities being grouped with a common
heading. Further, some 'result x' may itself be an interval, a list, a table or a
graph.
Only quantities and results are considered here, because these are the areas where
interdisciplinary problems are found. In particular, the document lists examples of
quantities, relevant to various laboratory disciplines, given with a meaningful
nomenclature and a common flexible structure. A subsequent part of the document will
present a more extensive list.
The present recommendation is a balance of the existing partly conflicting recommendations
from several international bodies, suitably extended to meet the needs of to-day's
clinical practice.
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Some words and concepts. To facilitate understanding and use of the rules, some
words and concepts are briefly explained in their contexts in the following, beginning
with the more general ones.
A measurement is a description of a property of a system by means of a set of
specified rules, that maps the property onto a scale of specified values, by direct or
'mathematical' comparison with specified reference(s).
The demand for rules makes 'measurement' a scientific concept in contrast to the mere
colloquial sense of 'description'. However, in the present definition, 'measurement' has a
wider meaning than given in (elementary) physics. Even a very incomplete description of,
for instance, a patient (at a stated time) has to be given by a set of measurements, that
are easier to manage and grasp.
In the present context, the object described is generally a patient, but could be
any related object, e.g. a portion of food. In any case, it has to be identified in some
unequivocal way, and the ID has to be given together with the local calendar
time or period for which the reported measurement values are applicable.
Any information about the object's preparation for measurement, or state at measurement
time may be given, whenever such information is considered relevant for a subsequent
clinical evaluation.
system
demarcated arrangement of a set of elements and a set of relationships between these
elements
component
definable part of a system
kind-of-property
attribute of phenomena, bodies or substances that may be distinguished qualitatively
EXAMPLES: colour (value: green; blue; ..), transparency, length (value: long; short; 2 m;
5 m; ...), amount-of-substance (value: 2 mol; 5 mol; ..)
Note 1: Kind- of- property includes the concept kind- of- quantity . All kinds- of-
property may be related to nominal (ex. green; blue) and ordinal scales (ex. small;
large), but kinds- of- quantity are generally related to difference (ex. 10 �C (i.e. 10
�C more than an arbitrary zero)) or ratio scales (length 2 m or 5 m)
property
set of data elements (system, component, kind-of-property) common to a set of particular
properties
EXAMPLE: Substance concentration of glucose in blood plasma
Note 1. Information about identification, time and result is not considered.
particular property
property of a given object (phenomenon, body or substance)
Note 1: 'Particular property' includes the concept of particular quantity
Note 2: The adjective 'particular' may be omitted, if no ambiguity is caused.
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The parts of a request and a report are presented in Table 2.
'Administrative data' (Table 1) are not dealt with further,
because they are governed by local usage and pertain to a medical record in general.
Essential for a request (Table 2) is part 1 and 2, that is
information on patient identification, time or time interval for sampling, and information
on the property requested.
The laboratory report on a particular property comprises the three subdivisions 1,
2 and 3.
To each element in part 2 may be added a specification as a parenthetic suffix for
clarification or identification.
Remarks (part 4) relating to diagnosis, medication, haemolysis or hardware breakdown are
not included, except when needed for the interpretation of results such as pretreatment of
patient in functional quantities.
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System(specification)--Component(specification); kind-of-property(specification)
System. The rules are
- initial upper- case letter, except for any alphanumeric indications of, for instance,
chemical structure
- full name or an abbreviated or coded form of one or a few letters
- specification in parenthesis following the name without a space
- elements of specification in lower- case letters when unabbreviated, in abbreviated or
coded form according to given lists, and separated by a semicolon and a space
- A long dash (em dash) or two hyphens following the name, code, or parenthesis, and
without a space, separating system from component
- no space before the component
Component. The rules are
- initial upper- case letter, except for any alphanumeric indications of, for instance,
chemical structure
- unabbreviated systematic or other recommended name
- final part of a composite name transposed to the front to group related properties in
alphabetic list, the two parts separated by comma and space
- names of two covalently bound parts of a compound separated by a hyphen without space
before or after
- names of two or more parts of a component, having a complex structure, joined by a
hyphen without space before or after and with the word 'complex' at the end of the
component name
- names of two or more distinct entities regarded as one component, separated by a plus
sign without space before or after
- names of two separate entities entering into numerator and denominator respectively of a
ratio between two quantities of the same system and having the same kind- of- property,
both names with initial upper- case letter and separated by a slash with no space before
or after
- specification in parenthesis following the name without space
- elements of specification separated by semicolon and space
- a semicolon following name or parenthesis without a space and separating component from
kind-of-property
- a space before the kind-of-property
The component name may be used to put a list of properties in alphabetical order.
Kind-of-property. The rules are
- initial lower-case letter
- full name or an abbreviation
- specification in parenthesis following the name or abbreviation without a space
- elements of specification in full, in abbreviated or coded form, separated by semicolon
and space
In documents from ISO, IEC , CEN
and CENELEC, including documents in the English language, the
decimal mark is a comma on the line. The same convention is followed by IFCC and the IUPAC
Clinical Chemistry Division in their recommendations.
To facilitate the reading of numerical values with many numerals/digits, groups of 3
digits may be separated by a small space out from the decimal mark .
In some cases, a request for a single property elicits a report with several properties or a result consisting of a set of values or a matrix of values. Such situations require special formats.
Header
The name or part of the name of the property used for the request may be considered as a
header and printed in italics.
A request for one property elicits several particular properties
The requested property is given as a header and the measured properties are listed
separately in extensive form, usually with accepted abbreviations and symbols.
One requested property elicits a matrix of values
Formally, a two-dimensional matrix may be reported as a composite result.
Expression by other properties
It may not always be feasible to determine the function of the organism or one of its
organs by direct means; then a related property must suffice.
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The terms used in clinical laboratory reporting are best spelled out in full because
specialisation in medicine and in the clinical laboratory sciences precludes insight into
more than just a few areas of specialisation. However, in order to save space the use of
abbreviations is unavoidable. To assist with interdisciplinary, international, and
interlingual communication, the number of accepted abbreviations and codes should be kept
to a minimum. They should be recognizable to a variety of language groups by being
derivated from Greek or Latin.
Ideally, such abbreviations and codes should not be the same as other symbols,
abbreviations or codes recommended by IUPAC or IUBMB.
Only one term or name has been selected in each instance. It is appreciated that routine
use in some English- speaking countries differs from the standard systematic name
proposed, for example 'Haemoglobin' (e.g. Britain) and 'Hemoglobin' (e.g. United States).
When applying terms pertaining to humans only clinically relevant expressions are used.
By plasma is meant the blood plasma such as it occurs in the patient. EDTA plasma, serum,
etc. are artefacts needed for laboratory processing and are judged irrelevant to the
doctor treating the patient.
The names used for anatomical structures are from Nomina Anatomica (6th
edition, 1989). Other systems or components (e.g. Air, Food, Dust) are named in accordance
with the Concise Oxford Dictionary (8th edition, 1990).
For systems (or components) defined as a kind-of-entity, the distinction between singular
and plural (with -s) is essential to indicate whether the object is a single entity or a
collection of entities.
For thirteen of the physiological systems, a symbol derived from the Greek, Latin, or
both, can be recommended (Table 3). Essentially such symbols are as
defined by IUPAC-IFCC [Hill 1991].
'S' for serum is included because of its widespread use, although it is not a `clinical'
system but an artefact.
Specification to the system may have one of two purposes: to circumscribe the term or to indicate sampling conditions. The two types of specification are separated by a semicolon, and the ones on sampling conditions are mentioned last. Some of the common system- related specifications are given codes to narrow the term (Table 4). The specifications needed may represent a supersystem or a subsystem.
EXAMPLES
Haemoglobin(Amniotic fluid)
Patient(Urine)
Blood(capillary; fasting patient)
| Table 4. System related codes | |
|---|---|
| Name | Code |
| arterial | a |
| arteriolar (commonly called capillary) | c |
| cultured | cult. |
| day; collected over or change in 24 h | d |
| fasting | f |
| venous | v |
Names used for components are the official names according to rules of nomenclature for
inorganic, organic and biological chemistry, that is of IUPAC, IUBMB - ISO - of WHO (INN) - BAN - USAN - MartindaleMartindale and names recommended by international
societies, e.g. ISTH and International Committee on Taxonomy of
Viruses. Abbreviations are to be avoided, also when the system is given by code.
When more than one component is part of the name, they are joined by a '+' sign with no
space before or after the names.
For ease of use in daily medical practice, the usual way of presenting a component name is
sometimes transposed. In this way the first part of a component name functions as a header
for listing of related properties.
For some chemical components an entity has to be specified (obligatory), and in some cases a traditional word as a specification is helpful (occasional).
| EXAMPLES of entitic specifications are | EXAMPLES of occasional specifications are |
| Haemoglobin(Fe) | Chromium(III) |
| Haemoglobin(Fe4) | Chromium(IV) |
| Base(site binding H+) | Calcium ion(free) |
| Nitrogen(N) | Calcium(total) |
The names of the kinds-of-property follow the rules given by IUPAC-IFCC 1995. Apart from these, some names given to properties by WHO 1992 are also applied.
Specification to kind-of-property
Names of kinds- of- property may be supplemented with specifications necessary to avoid
misunderstandings. Specifications are mandatory, for, inter alia 'functional' quantities,
for which the name is followed by : '(procedure)'.
The specifications are related to the measurement procedure, including previous events,
time-related information, calibration, and notes on the analytical procedure.
EXAMPLES
(60 min after oral load of glucose 278 mmol)
(1994-08-10 09:30; 1994-08-13 09:30)
(-08-10 09:30; [[Delta]]t = 3 d)
([[Delta]]t =3 d; 94-08-13 09:30)
or for short-term variation
(94-08-10 09:30; 11:15) or (24 h)
(IRP 67/40); and (30 �C; King & King).
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Numerical values should be written in accordance with international rules, the last
digit containing the uncertainty.
Text' values, for instance 'green' or 'Staphylococcus aureus', are written in full.
Prefix symbols (Table 5) have been applied throughout in the
present document. Although the prefixes hecto, deca, deci and centi are part of the BIPM 1991 recommendation, they have been omitted because in the clinical
laboratory factors and multiples in steps of a factor 1 000 are preferred.
Only one prefix should be attached to a numerator unit-symbol of a compound unit-symbol.
The prefix together with a unit-symbol represents a new unit.
The unit 'one' is omitted throughout.
The units used in the lists are the ones given in Table 6 or a combination of these. SI units are preferred, but have to be supplemented with units from various biological fields to reflect the 'state-of-the-art'. The unit 'one' (symbol '1') of dimensionless quantities is not stated.
Note 1. Conversion of unit for enzyme activity (U) to unit for catalytic activity (kat)
is 60 x 106 U
= 1 katal. The non-coherent unit U was originally suggested by IUB in Recommendation 1964.
Note 2. The symbol 'l' is used in this document.
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The terms recommended (entries 1 to 6) are given in bold, that is: the codevalue, the standard systematic name, and the unit.
| Entry: | |
|---|---|
| 1 | NPU03192 |
| 2 | Plasma-- |
| 4 | Plasminogen activator, tissue type; |
| 5 | arbitrary substance concentration(enz.; IS 86/670; procedure) |
| 6 | international unit/litre |
| 7 | P--Plasminogen activator, tissue type; arb.subst.c.(enz.; IS 86/670; procedure) = ? int. unit/l |
| 8 | M = 60 000 g/mol |
| 9 | Calibrator: WHO 2nd IS 86/670 |
| 10 | Previous calibrator(s): WHO 1st IS 83/517 |
| 11 | Not recommended term(s): Blood plasminogen activator; t-PA; Tissue plasminogen activator; Vascular plasminogen activator |
| 12 | Authority: ISTH/SSC93 |
| Entry: | |
|---|---|
| 1 | NPU01037 |
| 2 | Amniotic fluid-- |
| 3 | N- |
| 4 | Acetylgalactosamine-4-sulfatase; |
| 5 | catalytic activity concentration(37 �C; procedure) |
| 6 | microkatal/litre |
| 7 | Amf--N-Acetylgalactosamine-4-sulfatase; cat.c.(37 �C; procedure) = ? ukat/l |
| 11 | Other names or codes: Arylsulfatase B; Chondroitinase; Chondroitinsulfatase; Chondrosulfatase |
| 12 | Authority: IUBMB/EC EC 3.1.6.12 |
| Entry: | |
|---|---|
| 1 | NPU01446 |
| 2 | Plasma-- |
| 4 | Calcium ion(free); |
| 5 | substance concentration |
| 6 | millimole/litre |
| 7 | P--Calcium ion(free); subst.c. = ? mmol/l |
| 8 | M = 40,080 g/mol |
| 11 | Other names or codes: Coagulation factor IV |
| 12 | Authority: IFCC/C-BGE |
| Entry: | |
|---|---|
| 1 | NPU02821 |
| 2 | Urine-- |
| 4 | Microorganism; |
| 5 | taxon(procedure) |
| 7 | U--Microorganism; taxon(5 % blood agar) = Proteus vulgaris, Escherichia coli |
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Primary sources
Additional references
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