Borderline Lab Values

Borderline lab values fall in a gray zone between clearly normal and clearly abnormal reference ranges, requiring the NP to integrate clinical context, pre-test probability, and patient-specific factors to determine clinical significance. Reference ranges are statistically derived — they represent the central 95% of values in a healthy reference population, meaning 5% of healthy individuals will fall outside the range by definition. Biological variation introduces further complexity: intra-individual coefficient of variation (CV) differs by analyte — serum sodium has a CV of approximately 0.6% (very stable), while serum ferritin has a CV of approximately 15% (highly variable). When a value falls near the reference range boundary, the NP must consider whether the result represents true pathology, biological variation, or pre-analytical error. Critical delta checks compare current values to prior results — a hemoglobin drop from 14.0 to 11.5 g/dL (both within some reference ranges) is clinically significant even if the current value is technically normal. The concept of positive and negative predictive value is essential: a borderline TSH of 5.2 mIU/L (upper limit 4.5-5.0) has very different implications in a...