PdfText23 03 29T07490

Name : Mrs. AASHWANI BHARDWAJ Patient UID.
: 2597276
Age/Gender : 33 Yrs/Female Visit No. : 24072303290011
Referred Client : LDPL351X-LDPL-CP Collected on : 28-Mar-2023 10:00AM
Referred By : JUNEJA CLINIC Received on : 29-Mar-2023 03:45AM
Doctor Name : Reported on : 29-Mar-2023 06:28AM
Sample Type : Sod.Fluoride - F - 9999839,Serum - 9999837,Whole Blood EDTA - 9999838, -
HAEMATOLOGY
Test Name Results Unit Bio. Ref. Interval
COMPLETE BLOOD COUNT (CBC)
HAEMOGLOBIN (Hb) 13.3 g/dL 12.0-15.0
Methodology: colorimetric method
RED BLOOD CELLS- RBC COUNT 4.17 millions/mm³ 3.8 - 4.8
Methodology: electric impedance
PACKED CELL VOLUME (PCV) -HEMATOCRIT 38.9 % 40.0-50.0
Methodology: Pulse Height detection method
MCV 93.29 fL 83-101
Methodology: Automated/Calculated
MCH 31.89 pg 27.0-32.0
Methodology: by Automated/Calculated
MCHC 34.19 g/dL 31.5-34.5
RED CELL DISTRIBUTION WIDTH (RDW-CV) 15.2 % 11.6-14.0
RED CELL DISTRIBUTION WIDTH (RDW-SD) 53.4 fL 39.0- 46.0
MENTZER INDEX 22.37
Methodology: Calculated
PLATELET COUNT 107 10^3/µL 150-410
PLATELET DISTRIBUTION WIDTH (PDW) 16.2 fL 9.00-17.00
PCT(PLATELETCRIT) 0.179 % 0.108-0.282
MEAN PLATELET VOLUME - MPV 16.7 fL 7.00-12.0
Methodology: Plt Histogram
P-LCR 71.20 % 11.0-45.0
P-LCC 76.00 % 30.0-90.0
TOTAL LEUKOCYTE COUNT (TLC) 6.45 10^3/µL 4.00-10.0
DIFFERENTIAL LEUCOCYTE COUNT
Neutrophils 57.4 % 40 - 80
Methodology: Flow cytometry/Manual
Lymphocytes 34.1 % 20 - 40
Eosinophils 0.7 % 1.00-6.00
Monocytes 7.6 % 2.00-10.0
Page 1 of 9
Name : Mrs. AASHWANI BHARDWAJ Patient UID. : 2597276
Basophils 0.2 % 0.00-1.00
ABSOLUTE NEUTROPHIL COUNT 3.70 10^3/µL 2.00-7.00
ABSOLUTE LYMPHOCYTE COUNT 2.20 10^3/µL 1.00-3.00
ABSOLUTE EOSINOPHIL COUNT 0.04 10^3/µL 0.02-0.50
ABSOLUTE MONOCYTE COUNT 0.49 10^3/µL 0.20-1.00
ABSOLUTE BASOPHIL COUNT 0.02 10^3/µL 0.02-0.10
CLINICAL NOTES
A complete blood count (CBC) is used to evaluate overall health and detect wide range of disorders, including anemia, infection and leukemia.
There have been some reports of WBC and platelet counts being lower in venous blood than in capillary blood samples ,although still within these reference ranges.
POSSIBLE CAUSES OF ABNORMAL PARAMETERS:-

High RBC, Hb, or HCT - dehydration, polycythemia, shock, chronic hypoxia
Low RBC, Hb, or HCT - anemia, thalassemia, and other hemoglobinopathies
Low MCV - microcytic anemia
High MCV - macrocytic anemia, liver disease
Low WBC - sepsis, marrow hypoplasia
High WBC - acute stress, infection, malignancies
Low platelets - risk of bleeding
High platelets - risk of thrombosis
Notes
1.Macrocytic Anemia/Dimorphic Anemia can have low platelet count.
2.Microcytic Anemia/Leucocytosis can have Reactive thrombocytosis.
For microcytic indices a Mentzer index of less than 13 suggests that the patient may have thalassemia trait, and an index of more than 13 suggests that the patient may
have iron deficiency.
Reference ranges are from Dacie and Lewis Practical Hematology 12th edition(2016)
Page 2 of 9
HAEMATOLOGY
ERYTHROCYTE SEDIMENTATION RATE (ESR)
ESR [WESTERGREN] 27 mm/1st 0 - 15
Methodology: Sedimentation
CLINICAL NOTES
The erythrocyte sedimentation rate (ESR ) is a relatively simple, inexpensive, non-specific test that has been used for many years to help detect inflammation associated
with conditions such as infections, cancers, and autoimmune diseases.ESR is said to be a non-specific test because an elevated result often indicates the presence of
inflammation but does not tell the health practitioner exactly where the inflammation is in the body or what is causing it. An ESR can be affected by other conditions besides
inflammation. For this reason, the ESR is typically used in conjunction with other tests, such as C-reactive protein.ESR is used to help diagnose certain specific inflammatory
diseases, including temporal arteritis, systemic vasculitis and polymyalgia rheumatica. A significantly elevated ESR is one of the main test results used to support the
diagnosis.This test may also be used to monitor disease activity and response to therapy in both of the above diseases as well as some others, such as lupus.
Factors increasing ESR

-Old age
-Pregnancy
-Anemia
-Elevated fibrinogen
-Macrocytosis
Factors decreasing ESR
-Microcytosis
-Low fibrinogen
-Polycythemia
-Marked leukocytosis
Page 3 of 9
BIOCHEMISTRY
CALCIUM-SERUM
CALCIUM , Serum 9.64 mg/dL 8.4 - 10.6
Methodology: BAPTA
CLINICAL NOTES
A blood calcium test is ordered to screen for, diagnose, and monitor a range of conditions relating to the bones, heart, nerves, kidneys, and teeth. The test may also be
ordered if a person has symptoms of a parathyroid disorder, malabsorption, or an overactive thyroid. To help diagnose the underlying problem, additional tests are often
done to measure ionized calcium, urine calcium, phosphorus, magnesium, vitamin D, parathyroid hormone (PTH) and PTH-related peptide (PTHrP). PTH and vitamin D are
responsible for maintaining calcium concentrations in the blood within a narrow range of values. Measuring urine calcium can help determine whether the kidneys are
excreting the proper amount of calcium,
Serum calcium is decreased (hypocalcemia) in following conditions-

-Hypoparathyroidism,Pseudohypoparathyroidism
-Vitamin D deficiency (either from intake deficiency or decreased conversion/activation) or resistance (osteomalacia and rickets)
-Chronic renal diseases (eg, renal acidosis, Fanconi syndrome),Chronic liver disease and biliary obstructive diseases
-Magnesium deficiency (PTH glandular release is magnesium-dependent),Hyperphosphatemia,Hypoalbuminemia
-Overexpression of fibroblast growth factor 23 (oncogenic osteomalacia)
-Severe calcium dietary deficiency,Hungry bone syndrome,Severe pancreatitis (calcium saponification),Massive transfusion
Serum calcium is Increased (hypercalcemia) in following conditions-

-Hyperparathyroidism (primary, such MEN type 1, hyperplasia, adenoma, or carcinoma; or secondary, from chronic kidney injury and hyperphosphatemia)
-Malignancies (humoral hypercalcemia of malignancy) that secrete PTH–related protein, especially squamous cell carcinoma of lung and renal cell carcinoma
-Vitamin D excess,Vitamin A intoxication,Milk-alkali syndrome
-Multiple myeloma, owing to bone lesions,Paget disease of bone with prolonged immobilization,Sarcoidosis,Other granulomatous disorders
-Familial hypocalciuria hypercalcemia,Addison disease
-Thyrotoxicosis,Hypothyroidism, owing to prolongation of vitamin D action as its metabolism is slowed down
-Drug exposure: Some drugs that can increase serum calcium are as follows antacids (some), calcium salts, long-term thiazide therapy, lithium
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BIOCHEMISTRY
BLOOD GLUCOSE FASTING
BLOOD GLUCOSE FASTING 78.20 mg/dL <100
Methodology: Hexokinase
CLINICAL NOTES
Elevated glucose levels (hyperglycemia) are most often encountered clinically in the setting of diabetes mellitus, but they may also occur with pancreatic neoplasms,
hyperthyroidism, and adrenocortical dysfunction. Decreased glucose levels (hypoglycemia) may result from endogenous or exogenous insulin excess, prolonged starvation,
or liver disease.
Fasting Glucose 2 HOURS PP Glucose Diagnosis
<100 <140 Normal
100 to 125 140 to 199 Pre Diabetes
>126 >200 Diabetes
Impaired glucose tolerance (IGT) fasting, means a person has an increased risk of developing type 2 diabetes but does not have it yet. A level of 126 mg/dL or above,
confirmed by repeating the test on another day, means a person has diabetes. IGT (2 hrs Post meal), means a person has an increased risk of developing type 2 diabetes
but does not have it yet. A 2-hour glucose level of 200 mg/dL or above, confirmed by repeating the test on another day, means a person has diabetes
Note: Blood glucose level is maintained by a very complex integrated mechanism involving a critical interplay of the release of hormones and action of enzymes on key
metabolic pathways. If postprandial glucose is lower than fasting glucose, it is termed as postprandial reactive hypoglycemia (PRH). The possible cause of PRH are high
insulin sensitivity, exaggerated response of insulin and glucagon-like peptide 1, defects in counter-regulation, very lean individuals, anxious individuals, after massive weight
reduction, women with lower body overweight physical activity prior test, hypoglycemic medication, deliberately eating less or eat a non-carbohydrate meal before testing.
Ref : American Diabetes association standards of medical care.
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BIOCHEMISTRY
LIVER FUNCTION TEST (LFT) - EXTENDED
BILIRUBIN TOTAL 0.39 mg/dL 0.10 - 1.20
Methodology: Diazonium Ion Blanked
DIRECT BILIRUBIN(CONJUGATED), Serum 0.12 mg/dl 0.00-0.20
Methodology: Diazo Method
INDIRECT BILIRUBIN,Serum 0.27 mg/dL 0.80
SGPT (ALT), SERUM 27.30 U/L 0-35
Methodology: UV without P5P
SGOT (AST) ,SERUM 31.80 IU/L 0.0-32.0
Methodology: UV With P5P
ALKALINE PHOSPHATASE ,Serum 52.6 U/L 42-98
Methodology: IFCC
GAMMA GLUTAMYL TRANSFERASE (GGT) 15.20 U/L 12.0-43.0
Methodology: IFCC
TOTAL PROTEIN , Serum 7.6 g/dL 6.00-8.30
Methodology: Biuret
ALBUMIN,SERUM 4.60 g/dL 3.2-5.20
Methodology: BCG
GLOBULIN,SERUM 3 g/dL 2.30-4.50
A/G Ratio ,Serum 1.53 1.0 - 2.3
SGOT/SGPT RATIO 1.16
COMMENT
These are group of tests that can be used to detect the presence of liver disease, distinguish among different types of liver disorders, gauge the extent of known liver
damage, and monitor the response to treatment. Most liver diseases cause only mild symptoms initially, but these diseases must be detected early. Some tests are
associated with functionality (e.g., albumin), some with cellular integrity (e.g., transaminase), and some with conditions linked to the biliary tract (gamma-glutamyl transferase
and alkaline phosphatase). Conditions with elevated levels of ALT and AST include hepatitis A,B ,C ,paracetamol toxicity etc.Several biochemical tests are useful in the
evaluation and management of patients with hepatic dysfunction. Some or all of these measurements are also carried out (usually about twice a year for routine cases) on
those individuals taking certain medications, such as anticonvulsants, to ensure that the medications are not adversely impacting the person's liver.
Reference ranges are from Teitz fundamental of clinical chemistry 8th ed (2018)
Page 6 of 9
BIOCHEMISTRY
KIDNEY FUNCTION TEST (KFT)-BASIC
UREA - SERUM 18.8 mg/dL 15.0 - 40.0
Methodology: Urease UV
CREATININE-SERUM 0.65 mg/dL 0.40-1.10
Methodology: Jaffe Kinetic
URIC ACID - SERUM 3.30 mg/dL 2.40 - 6.00
Methodology: Colorimetric
SODIUM (SERUM) 135.9 mmol/L 135 - 150
Methodology: ISE
POTASSIUM-SERUM 3.70 mmol/L 3.5 - 5.5
Methodology: ISE
CHLORIDE ,Serum 96.90 mmol/L 94 - 110
Methodology: ISE
BLOOD UREA NITROGEN (BUN) 8.79 mg/dL 8.00-23.0
BUN/CREATININE RATIO 13.52 Ratio 10-20:1 Normal
UREA / CREATININE RATIO 28.92 Ratio 40-100:1 Normal
INTERPRETATION
Kidney function tests are group of tests that can be used to evaluate how well the kidneys are functioning.Creatinine is a waste product produced by muscles from the
breakdown of a compound called creatine. In blood, it is a marker of GFR ,in urine, it can remove the need for 24-hour collections for many analytes or be used as a quality
assurance tool to assess the accuracy of a 24-hour collection . It is removed from the body by the kidneys, which filter almost all of it from the blood and release it into the
urine. This test measures the amount of creatinine in the blood and/or urine.Creatine is part of the cycle that produces energy needed to contract muscles. Both creatine and
creatinine are produced by the body at a relatively constant rate. Since almost all creatinine is filtered from the blood by the kidneys and released into the urine, blood levels
are usually a good indicator of how well the kidneys are working.
REMARK-The amount of creatinine you produce depends on your body size and your muscle mass. For this reason, creatinine levels are usually slightly higher in men than
in women and children.Certain drugs are nephrotoxic hence KFT is done before and after initiation of treatment with these drugs.
Higher creatinine than normal level may be due to: • Blockage in the urinary tract • Kidney problems, such as kidney damage or failure, infection, or reduced blood

flow • Loss of body fluid (dehydration) • Muscle problems, such as breakdown of muscle fibers • Problems during pregnancy, such as seizures (eclampsia)), or high blood
pressure caused by pregnancy (preeclampsia)
Lower than normal creatinine level may be due to: • Myasthenia Gravis • Muscular dystrophy.Low serum creatinine values are rare; they almost always reflect low
muscle mass.
Page 7 of 9
BIOCHEMISTRY
LIPID PROFILE BASIC
CHOLESTEROL -TOTAL 133.60 mg/dL <200 Desirable
Methodology: Cholesterol Oxidase,Esterase,Peroxidase 200-239 Borderline high risk
>240 High risk
TRIGLYCERIDES - SERUM 85.50 mg/dL <150
Methodology: Enzymatic End Point
CHOLESTEROL - HDL (DIRECT) 43.60 mg/dL >40 Recommended Range
Methodology: Direct Enzymatic Colorimetric
NON-HDL CHOLESTEROL 90.00 mg/dL <130
CHOLESTEROL-LDL (DIRECT) 72.90 mg/dL <130 Recommended Range
VLDL ,SERUM 17.10 mg/dL 0.00 - 45.0
Methodology: Spectrophotmetry/Calculated
CHOL/HDL Ratio 3.06 Ratio 3.40-4.40
LDL/HDL Ratio 1.67 Ratio 1.0-3.5
HDL/LDL CHOLESTEROL RATIO 0.60 Ratio <3.50
REFERENCE RANGES AS PER NCEP ATP III GUIDLINES
TOTAL CHOLESTEROL mg/dl HDL mg/dl LDL mg/dl TRIGLYCERIDES mg/dl

Desirable <200 Low <40 Optimal <100 Normal <150
Near Optimal 100-129
Borderline High 200-239 High >60 Borderline High 150-199
Borderline High 130-159
High 160-189 High 200-499
High >240 - -
Very High >190 Very High >500
ALERT!!! 10-12 hours fasting is mandatory for lipid parameters.If not,values might fluctuate.
CLINICAL NOTES
Lipid profile is initial screening tool for abnormalities in lipids. The results of this test can identify certain genetic diseases & can determine approximate risks for
cardiovascular disease, certain forms of pancreatitis. Hypertriglyceridemia is indicative of insulin resistance when present with low HDL & elevated LDL, while elevated TG
is risk factor for coronary artery disease,especially when low HDL is present.TG of 500mg/dL or more can be concerning for development of pancreatitis.
Remark-Measurements in the same patient can show physiological & analytical variations. 3 serial samples 1 week apart are recomended for Total Cholesterol, TG, HDL &
LDL Cholesterol.As per NCEP guidelines, all adults above the age of 20 years should be screened for lipid status.Selective screening of children above the age of 2 years
with a family history of premature cardiovascular disease or those with at least one parent with high total cholesterol is recommended.NCEP Identifies elevated Triglycerides
as an independent risk factor for Coronary Heart Disease (CHD) .
Page 8 of 9
IMMUNOLOGY
THYROID PROFILE : T3, T4 & TSH(TFT)
TRIODOTHYRONINE TOTAL (T3) 1.37 ng/mL 0.70-2.04
Methodology: ECLIA
THYROXINE TOTAL (T4) 7.68 ug/dl 5.1-14.1
Methodology: ECLIA
THYROID STIMULATING HORMONE (TSH) 1.406 µIU/ml 0.35-5.50
Methodology: ECLIA
NOTE-TSH levels are subject to circardian variation,reaching peak levels between 2-4 AM and min between 6-10 PM. The variation is the order of 50% hence time of the day has influence on the
measures serum TSH concentration.Dose and time of drug intake also influence the test result.
Transient increase in TSH levels or abnormal TSH levels can be seen in some non thyroidal conditions,simoultaneous measurement of TSH with free T4 is useful in evaluating differantial diagnosis.
INTERPRETATION-Ultra Sensitive 4th generation assay

1.Primary hyperthyroidism is accompanied by ↑serum T3 & T4 values along with ↓ TSH level.
2.Low TSH,high FT4 and TSH receptor antibody(TRAb) +ve seen in patients with Graves disease
3.Low TSH,high FT4 and TSH receptor antibody(TRAb) -ve seen in patients with Toxic adenoma/Toxic Multinodular goiter
4.HighTSH,Low FT4 and Thyroid microsomal antibody increased seen in patients with Hashimotos thyroiditis
5.HighTSH,Low FT4 and Thyroid microsomal antibody normal seen in patients with Iodine deficiency/Congenital T4 synthesis deficiency
6.Low TSH,Low FT4 and TRH stimulation test -Delayed response seen in patients with Tertiary hypothyroidism
7.Primary hypothyroidism is accompanied by ↓ serum T3 and T4 values & ↑serum TSH levels
8.Normal T4 levels accompanied by ↑ T3 levels and low TSH are seen in patients with T3 Thyrotoxicosis
9.Normal or↓ T3 & ↑T4 levels indicate T4 Thyrotoxicosis ( problem is conversion of T4 to T3)
10.Normal T3 & T4 along with ↓ TSH indicate mild / Subclinical Hyperthyroidism .
11.Normal T3 & ↓ T4 along with ↑ TSH is seen in Hypothyroidism .
12.Normal T3 & T4 levels with ↑ TSH indicate Mild / Subclinical Hypothyroidism .
13.Slightly ↑ T3 levels may be found in pregnancy and in estrogen therapy while ↓ levels may be encountered in severe illness , malnutrition , renal failure and during therapy with drugs like
propanolol.
14.Although ↑ TSH levels are nearly always indicative of Primary Hypothroidism ,rarely they can result from TSH secreting pituitary tumours.
DURING PREGNANCY - REFERENCE RANGE for TSH IN uIU/mL (As per American Thyroid Association)
1st Trimester : 0.10-2.50 uIU/mL
2nd Trimester : 0.20-3.00 uIU/mL
3rd Trimester : 0.30-3.00 uIU/mL
The production, circulation, and disintegration of thyroid hormones are altered throughout the stages of pregnancy.
REMARK-Assay results should be interpreted in context to the clinical condition and associated results of other investigations. Previous treatment with corticosteroid therapy may result in lower TSH
levels while thyroid hormone levels are normal. Results are invalidated if the client has undergone a radionuclide scan within 7-14 days before the test. Abnormal thyroid test findings often found in
critically ill patients should be repeated after the critical nature of the condition is resolved.TSH is an important marker for the diagnosis of thyroid dysfunction.Recent studies have shown that the
TSH distribution progressively shifts to a higher concentration with age ,and it is debatable whether this is due to a real change with age or an increasing proportion of unrecognized thyroid disease in
the elderly.
Nabl Scope.
*** End Of Report ***
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Name : Mrs. AASHWANI BHARDWAJ Patient UID.

POSSIBLE CAUSES OF ABNORMAL PARAMETERS:-

Factors increasing ESR

Serum calcium is decreased (hypocalcemia) in following conditions-

Serum calcium is Increased (hypercalcemia) in following conditions-

Ref : American Diabetes association standards of medical care.

Higher creatinine than normal level may be due to: • Blockage in the urinary tract • Kidney problems, such as kidney damage or failure, infection, or reduced blood

TOTAL CHOLESTEROL mg/dl HDL mg/dl LDL mg/dl TRIGLYCERIDES mg/dl

INTERPRETATION-Ultra Sensitive 4th generation assay

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