That night, Aliyah wrote a new lab policy. They would adopt the manufacturer’s broader interval for patients over 65—not out of laziness, but out of a deeper respect for EP28’s core principle: A reference interval is only as good as its reference population.
Dr. Aliyah Vargas had run the University Hospital’s clinical chemistry lab for twelve years, and in that time, she had learned to trust two things: cold logic and the CLSI guidelines. EP28, specifically—the standard for defining, establishing, and verifying reference intervals—was her bible. It told her what “normal” looked like for a patient population. clsi ep28
Aliyah nodded. “But EP28 says if we have 120 subjects, nonparametric ranking is the gold standard. The 2.5th and 97.5th percentiles are 0.6 and 3.2. That’s our truth.” That night, Aliyah wrote a new lab policy
“That’s too narrow,” her senior technologist, Marcus, said, frowning at the scatter plot. “Manufacturer says 0.4 to 4.0. If we use ours, we’ll flag half our outpatients as abnormal.” Aliyah Vargas had run the University Hospital’s clinical
Mrs. Eleanor Park, 68, came in for fatigue. Her TSH was 3.9 mIU/L—within the manufacturer’s range but above Aliyah’s verified upper limit of 3.2. Using the lab’s new narrow interval, the computer flagged it as Abnormal-High . The junior resident started her on low-dose levothyroxine.