Harmonized Reference Intervals
| Implementation | Publications | Presentations |
| Lipid Subcommittee | hCAMI Subcommittee | Resources |
| hRI Guidelines |
Introduction
The CSCC Working Group on Reference Interval Harmonization (hRI) aims to develop and implement evidence-based recommendations for pediatric, adult, and geriatric biochemical hRIs and test reporting across Canada. Since 2015, the CSCC hRI WG has applied evidence-based statistical analysis to determine indirect hRIs from ~300,000 – 13,000,000 datapoints per analyte obtained from community and hospital laboratories. Additionally, the CSCC hRI WG has provided key recommendations on the reporting of national clinical guidelines, including dyslipidemia reporting. The adoption of hRIs nationally is critical for improving and standardizing the interpretation of laboratory test results and for fostering cohesion between test providers.
Key objectives of The CSCC hRI WG include:
- Standardize Reference Intervals – Develop and align reference intervals for common clinical laboratory tests.
- Promote Evidence-Based Practices – Use robust methodologies and population-based data.
- Enhance Quality & Patient Safety – Reduce variability in test interpretation.
- Collaborate with Stakeholders – Engage health agencies, professional societies, and laboratory networks.
- Advance Research & Knowledge Translation – Establish evidence-based reference intervals and create practical guidelines.
- Advocate for Global Harmonization – Contribute to international efforts and share best practices.
- Facilitate Education & Training – Provide resources to laboratory professionals and raise awareness among clinicians.
These efforts aim to enhance laboratory result reliability and improve healthcare outcomes in Canada.
Please contact us with any questions, suggestions, feedback, or speaking requests!
- Khosrow Adeli (khosrow.adeli@sickkids.ca)
- Christine Collier (christinecollier064@gmail.com)
Mission Statement
Establish evidence-based harmonized/common reference intervals (hRIs) and support their implementation in laboratories across Canada.
Upcoming Presentations
hRI Working Group Meeting
- Monday July 28, 2025, 7:30 AM – 8:30 AM Central Time
- Grant Park BC, Hyatt Conference Centre, First Floor
Poster at ADLM/CSCC 2025 in Chicago, IL
- Wednesday July 30, 2025, 9:30 AM – 5:00 PM Central Time (Presentation: 1:30 PM – 2:30 PM)
- Poster Board Number: B-102
- Poster Title: Harmonizing cerebrospinal fluid analysis for multiple sclerosis investigation: An update from the hCAMI subcommittee of the Canadian Society of Clinical Chemists (CSCC)
Timeline of Key Deliverables
Ongoing Projects
Implementation – Phase I Analytes
We are working with laboratories to verify and implement harmonized reference intervals for Phase I analytes (alkaline phosphatase (ALP), alanine aminotransferase (ALT), albumin bromocresol Green (BCG), bilirubin total, calcium, carbon dioxide, chloride, creatinine, lactate dehydrogenase (LD), magnesium, phosphate, potassium, sodium, and thyroid-stimulating hormone (TSH)). See Implementation Page for more information.
Analysis – Phase II Analytes
The CSCC hRI WG is determining harmonized reference intervals for a second phase of analytes (including approximately 20 biochemical markers, 15 endocrine and fertility markers, and 15 hematology markers). The same indirect statistical approach will be used with verification of proposed hRIs using direct methods and verification in hospital sites.
Integrating guidelines into practice
Clinical guidelines are regularly published in areas of cardiovascular disease, diabetes, multiple sclerosis, endocrinology, and others. Although these guidelines provide clear instructions on how to screen for, treat, and monitor patients, they provide few details, if any, on how to appropriately present laboratory test results. To fill this gap and to ensure consistency in reporting across laboratories, the CSCC hRI WG regularly reviews clinical guidelines and provides recommendations on how to present laboratory reports.
- Harmonizing Lipid Reporting
The Lipids subcommittee was formed in 2018 with the goal of establishing recommendations for laboratory reporting of lipid tests in pediatric and adult patients to align with Canadian clinical guidelines. See the Lipid Harmonization Subcommittee Page for more information.
- Harmonizing CSF Analysis for MS Investigation
The Harmonized CSF Analysis for MS Investigation (hCAMI) subcommittee was formed in 2023 with the goal of establishing recommendations for laboratory processes and reporting of CSF oligoclonal banding and associated tests supporting MS diagnosis. See the Harmonized CSF Analysis for MS Investigation (hCAMI) Subcommittee Page for more information.
Membership
| Co-Chairs | Khosrow Adeli Christine Collier |
| Members | Cynthia Balion Mary Kathryn Bohn George Cembrowski Victoria Higgins Benjamin Jung Zahraa Mohammed Ali Dana Nyholt Atoosa Rezvanpour Karina Rodriguez-Capote David Seccombe Jennifer Taher Albert Tsui Allison Venner Nicole White-Al Habeeb |
| Past Members/Other Contributors | Terence Agbor Berna Aslan Daniel Beriault David Blank Jake Cosme Anna Fuezery Angela Fung Trefor Higgins Josko Ivica Felix Leung Joe Macri Amber Marcano Pierre-Olivier Hetu Michelle Parker Isolde Seiden Long Janet Simons Julie Shaw Julia Stemp Vinita Thakur Dorothy Truong Uvaraj Uddayasankar Paul Yip |
| CSCC Head Office Support | Erica Lattimore |
| Academic Assistant | Olivia Landon |
| Representatives to Other Societies | Khosrow Adeli (ADLM, IFCC) Berna Aslan (IQMH) Mary Kathryn Bohn (TF-GRID) Joseph Macri (IFCC) Karina Rodriguez-Capote (IFCC cRIDL) Karen Scraba (BD) David Seccombe (ADLM) Isolde Seiden-Long (ISO) |
| Other Associations, Collaborators, and Consultants | Russell Price (President, Ontario Association of Pathologists –Barrie) Graham Jones (Australia) Ken Sikaris (Australia) Lina Santaguida (Epidemiologist (methodology), McMaster) Qing Fan (LifeLabs) |
| Lipid Harmonization Subcommittee Members | Co-Chairs: Victoria Higgins and Nicole White-Al Habeeb Khosrow Adeli Daniel Beriault Christine Collier Dana Nyholt Allison Venner |
| Harmonized CSF Analysis for MS Investigation (hCAMI) Subcommittee Members | Chairs: Victoria Higgins, Daniel Beriault and Michelle Parker Basma Ahmed Vipin Bhayana Ron Booth Yu Chen Christine Collier Mark Freedman Myriam Gagné Jessica Gifford Fabrizio Guiliani Ola Ismail Joe Macri Craig Moore Ashley Newbigging Lily Olayinka Ilia Poliakov Karina Rodriguez-Capote Raphael Schneider Simon Thebault Liju Yang |