ACB recommends the use of CALIPER database

The Canadian Laboratory Initiative on Paediatric Reference Intervals (CALIPER) 

The derivation of reference ranges is a challenging exercise for most clinical laboratories. There have been many attempts to achieve harmonisation of adult values, most notably that of the Pathology Harmony Group first conceived in Birmingham, UK in 2007 (1). 

Harmonisation of reference ranges in the area of paediatrics is particularly challenging where the dynamic changes associated with the developing physiology of children from birth through puberty to adulthood can see significant changes in the values of most analytes. 

In addition, the challenges of obtaining adequate blood samples in younger children frequently means that capillary samples are submitted to the laboratory which often need specialist handling. 

In 2004, the Paediatric Focus Group of the Canadian Society of Clinical Chemists launched collaborative studies to determine the effect of age, gender and ethnic origin on blood test results in children and adolescents. These studies have resulted in the creation of a comprehensive database of paediatric reference intervals on multiple analytical platforms. It has since become known as the Canadian Laboratory Initiative on Paediatric Reference Intervals (CALIPER). 

Under the leadership of CALIPER principal investigator, Dr. Khosrow Adeli, and, over the course of several decades, CALIPER has succeeded in establishing reference intervals through the informed participation of more than 12,000 children and their families for numerous common biochemical, immunological, haematological, nutritional, endocrine and fertility markers (2).  

The methodology employed has been extensively documented and was published as a white paper in 2017 (3). Additional information is available online at: and 

CALIPER was launched first as a website but, more recently, has been made available as a comprehensive mobile app for both Android and iOS, and is freely available to healthcare professionals worldwide. 

The Association for Clinical Biochemistry and Laboratory Medicine’s Scientific and Clinical Practice Committee have reviewed the resource and recommended to ACB Council that links to the CALIPER database be placed on the ACB website, as a useful resource to aid harmonisation of reference ranges in paediatric population.  

It should be noted that this would not be national harmonisation, but laboratories on the same equipment could achieve harmonisation. This recommendation was ratified on 14 Sept 14 2022. 


  1. J Berg. The Approach to Pathology Harmony in the UK. Clin Biochem Rev 2012; 33(3):89-93. 

  2. H. Tahmasebi, V. Higgins, A. Fung, D. Truong, N. White-Al Habeeb, K. Adeli. Pediatric reference intervals for biochemical markers. EJIFCC. 2017; 28(1): 43-63. Published online 2017 Feb 8. Accessed 2022 Jan 12. 

  3. Adeli K, Higgins V, Trajcevski K, White-Al Habeeb N. The Canadian laboratory initiative on pediatric reference intervals: A CALIPER white paper. Crit Rev Clin Lab Sci. 2017; 54(6):358-413.  


The CALIPER mobile app is available for download: