Biochemia Medica, Vol. 27 No. 3, 2017.
Review article
https://doi.org/10.11613/BM.2017.030501
Concerning the vitamin D reference range: pre-analytical and analytical variability of vitamin D measurement
Davide Ferrari
; Department of Biosciences, University of Parma, Parma, Italy
Giovanni Lombardi
; Laboratory of Experimental Biochemistry and Molecular Biology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
Giuseppe Banfi
; Vita-Salute San Raffaele University, Milano, Italy
Abstract
Unlike other vitamins, the vitamin D concentration in blood varies cyclically over the course of the year in relation to genetic (gender, ethnicity, polymorphisms) and environmental factors (sunlight exposure, diet, food-related or direct vitamin D supplementation, skin pigmentation). Although the major diagnostics manufacturers have recently developed improved automated 25-hydroxy vitamin D immunoassays, the intra- and interlaboratory variability is still high (especially at low vitamin D concentrations) which might lead to incorrect vitamin D deficiency/insufficiency diagnosis.
Moreover, despite recent efforts to standardize the assay and minimize its variability, the current bias for measured vitamin D concentrations
is often still above the desirable ± 10% criterion. Because the implications of low vitamin D concentrations in non-skeletal diseases are still partially unknown, international guideline recommendations for establishing meaningful ranges, at any time over the course of the year, irrespective not only of environmental and personal factors but also of instrumental variability, are needed. In this review, we discuss the main factors that influence the variability of vitamin D concentrations and whether a centile curve, individually calculated by a theoretical equation considering such factors, might be better suited than a fixed limit to assess abnormal vitamin D concentrations in otherwise healthy subjects. Vitamin D reference ranges during pregnancy, childhood, or diagnosed illnesses, which merit separate discussion, are beyond the scope of this review.
Keywords
vitamin D; biological variability; analytical variability; standardization; DEQAS
Hrčak ID:
187581
URI
Publication date:
15.10.2017.
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