Factors contributing serum calcium, magnesium and phosphorous

concentration
Several factors have been shown to affect reference intervals. According to IFCC (1979) the
analytical outcome is affected by genetic make-up, dietary habits, life style, socio-economic and
many other environmental and biological factors of different population. There is reasonable
agreement between different authors regarding the effects of age and sex (Table 5.1)

Table. 5.1. The effect of sex and age on serum calcium, magnesium and phosphorous.
Constituent Sex Difference Effect of Increasing Age
Calcium M > F Falls, especially M
Magnesium M > F Rises, especially F
Phosphate F > M Little change apart from post-menopausal rise
See especially: Wilding, Rollason and Robinson, (1972); Williams, Widdowson, and Penton
(1978);Goldberg, Handyside and Winfield (1973)andRoberts (1967).

The effect of variations in the state of the subject and the method of blood collection may be
more important. Careful studies by Bokelund, Winkel and Statland(1974) showed significant
differences in results attributable to the collection of specimens, centrifugation, separation and
storage.
The effect of venous occlusion by tourniquet (Statland, Bokelund and Winkel, 1974) even for
periods as short as 3 minutes is significant. The changes can be rapid, occurring, within 40
seconds of occluding the vein and this has led Alstrmet al (1975) to recommend that the
tourniquet should be avoided if possible.
Changes in posture are also important factors. Statlandet al (1974) found percentage changes for
this factor when isolated from analytical, tourniquet, and diurnal effects to be significant. After
lying supine for 30 minutes the main effects (as percentage change) were for calcium (-5). Such
changes are in relation to samples taken with the subject seated for 15 minutes. If the subject
stands for 30 minutes, the changes are less marked and in the opposite direction for phosphate.
Mild exercise produces significant changes in calcium and phosphate (Galteau, Siest and Boura,
1974;Statland, Winkel and Bokelund, 1973b).
The taking of meal also produces significant changes in phosphate (statlandet al, 1973b).
While it seems likely that variations in sampling procedures are an important fraction of the total
intra- individual variation, other variations are apparent both in the short term and the long term
without apparent changes in the health of the subject. Changes occurring within the hour are
probably attributable to tourniquet variations (Winkel, statland, and Bokelund, 1974) but changes
over 6 hours (diurnal variations) are well- documented for phosphate (statland, Winkel and
Bokelund, 1973a;Winkel, statland, and Bokelund, 1975; Roberts 1967).
When we go through the study, the present study showed lower mean serum calcium and
magnesium concentration than other countries. For this study participants were selected
apparently healthy subjects who wished to donate blood. Therefore several limitations occurred.
One was age (20 60 years). Therefore age related changes could not be identified. Second was
number of samples, in reference to Reed, Henry and Mason (1971), the subcommittee of the
NCCLS Guideline recommends a minimum size of 120 observations, by obtaining a sufficiently
large number of samples it would be possible to reduce vulnerability to outliers. In the present
study blood sample collection criteria was not biased. All of them are volunteers and other
medical examinations such as bone disease, heart disease was not carried out.