COMPLETE OR FULL BLOOD COUNT (1)

(CBC, FBC or Blood C/E)

Normal Report
Test Result Reference Values
Hb 15.4 14 to 18 g/dL (males), 12 to 16 g/dL (females)
HCT 46 40 to 55% (males), 36 to 48% (females)
WBC Count (TLC) 6.0 4000 to 11000 /mm3
Total RBC 5.0 4.5 to 6.5 x 1012/l
Differential count
Neutrophils (Polys) 65 40 to 75%
Lymphocytes 30 20 to 45%
Monocytes 2 2 to 10%
Eosinophils 2 1 to 6%
Basophils 1 0 to 1%
Indices
MCV 92 80 to 100 fl (femtoliters)
MCH 31 27 to 33 pg (picograms)
MCHC 34 32 to 36 g/dl (grams per deciliter)
RDW 14 12-15 %
Platelet count 340,000 150,000 to 400,000 / mm3
MPV 10 7 – 11 fl
Normocytic, normochromic
Basic Hematological Terminologies
MCV mean corpuscular volume
MCH mean corpuscular hemoglobin
MCHC mean corpuscular hemoglobin concentration
MPV mean platelet volume
Anisocytosis: Unequal size of red cells. Reflected in increased red cell distribution
width (RDW).
Hypochromia: Decreased amount of hemoglobin in red cells.
Macrocytosis: Large red cells. Microcytosis: Small red cells
Poikilocytosis: Altered shape of cells. Can be any shape.
Reticulocytosis: Premature RBCs with nuclei
1
 COMPLETE OR FULL BLOOD COUNT (2)
(CBC, FBC or Blood C/E)
Iron deficiency anemia
Test Result Reference Values
Hb 9.0 14 to 18 g/dL (males), 12 to 16 g/dL (females)
HCT 30 40 to 55% (males), 36 to 48% (females)
Total RBC 4.1 4.5 to 6.5 x 1012/l
WBC Count (TLC) 5.6 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 65 40 to 75%
Lymphocytes 28 20 to 45%
Monocytes 4 2 to 10%
Eosinophils 3 1 to 6%
Basophils 0 0 to 1%
Indices
MCV 72 80 to 100 fl (femtoliters)
MCH 24 27 to 33 pg (picograms)
MCHC 30 32 to 36 g/dl (grams per deciliter)
RDW 17 12-15 %
Platelet count 250,000 150,000 to 400,000 / mm3
Blood smear:
Hypochromic, microcytic, anisocytosis
Teaching points:
In iron deficiency anemia, the Hb is low and so are all the indices, while the RDW is
increased.

2
 COMPLETE OR FULL BLOOD COUNT (3)
(CBC, FBC or Blood C/E)
B12 / Folate deficiency anemia
Test Result Reference Values
Hb 11.4 14 to 18 g/dL (males), 12 to 16 g/dL (females)
HCT 34 40 to 55% (males), 36 to 48% (females)
Total RBC 4.2 4.5 to 6.5 x 1012/l
WBC Count (TLC) 4.6 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 68 40 to 75%
Lymphocytes 30 20 to 45%
Monocytes 1 2 to 10%
Eosinophils 1 1 to 6%
Basophils 0 0 to 1%
Indices
MCV 110 80 to 100 fl (femtoliters)
MCH 32 27 to 33 pg (picograms)
MCHC 31 32 to 36 g/dl (grams per deciliter)
RDW 14 12-15 %
Platelet count 320,000 150,000 to 400,000 / mm3
Hypochromic, macrocytic
Teaching points:
In folate and B12 deficiency anemia, the Hb is low while the red blood cells are larger
in size i.e., increased mean corpuscular volume.

3
 COMPLETE OR FULL BLOOD COUNT (4)
(CBC, FBC or Blood C/E)
Thalassemia Minor
Test Result Reference Values
Hb 9.8 14 to 18 g/dL ( males), 12 to 16 g/dL ( females)
HCT 28.5 40 to 55% (males), 36 to 48% (females)
Total RBC 4.2 4.5 to 6.5 x 1012/l
WBC Count (TLC) 5000 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 70 40 to 75%
Lymphocytes 24 20 to 45%
Monocytes 3 2 to 10%
Eosinophils 2 1 to 6%
Basophils 1 0 to 1%
Indices
MCV 74 80 to 100 fl (femtoliters)
MCH 24 27 to 33 pg (picograms)
MCHC 30 32 to 36 grams per deciliter
RDW 15 12-15 %
Platelet count 250,000 150,000 to 400,000 / mm3
Blood smear:
Microcytic, hypochromic, tear drop cells, target cells, and basophilic stippling.
Teaching points:
In thalassemia minor, the Hb is low and so are all other indices as in iron deficiency,
but the peripheral film will show tear drop cells, target cells and basophilic stippling.

4
 COMPLETE OR FULL BLOOD COUNT (5)
(CBC, FBC or Blood C/E)

Thalassemia Major
Test Result Reference Values
Hb 5.6 14 to 18 g/dL (males ), 12 to 16 g/dL (females )

HCT 16.2 40 to 55% (males), 36 to 48% (females)

Total RBC 3.2 4.5 to 6.5 x 1012/l
WBC Count (TLC) 5.2 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 60 40 to 75%
Lymphocytes 35 20 to 45%
Monocytes 2 2 to 10%
Eosinophils 3 1 to 6%
Basophils 0 0 to 1%
Indices
MCV 68 80 to 100 fl (femtoliters)
MCH 20 27 to 33 pg (picograms)
MCHC 27 32 to 36 g/dl (grams per deciliter)
RDW 14 12-15 %
Platelet count 300,000 150,000 to 400,000 / mm3
Blood smear:
Microcytosis, target cells, nucleated red cells, and anisopoikilocytosis (varying
shapes and sizes of RBCs).
Teaching points:
In thalassemia major the Hb is very low and so are all other indices due to a severe
deficiency of Hb. The peripheral film also supports thalassemia major.

5
 COMPLETE OR FULL BLOOD COUNT (6)
(CBC, FBC or Blood C/E)Sickle cell anemia
Test Result Reference Values
Hb 11.8 14 to 18 g/dL (men), 12 to 16 g/dL (women)
HCT 34.4 40 to 55% (males), 36 to 48% (females)
Total RBC 4.2 4.5 to 6.5 x 1012/l
WBC Count (TLC) 10.1 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 70 40 to 75%
Lymphocytes 26 20 to 45%
Monocytes 2 2 to 10%
Eosinophils 1 1 to 6%
Basophils 1 0 to 1%
Indices
MCV 82 80 to 100 fl (femtoliters)
MCH 28 27 to 33 pg (picograms)
MCHC 33 32 to 36 g/dl (grams per deciliter)
RDW 14 12-15 %
Platelet count 340,000 150,000 to 400,000 / mm3
Blood smear:
Sickle cells, polychromatophilic RBCs, target cells, and Howell-Jolly bodies (DNA
material).
Teaching points:
Hb and HCT are low.
In someone who has SCD, the hemoglobin is abnormal, which causes the red blood cells to
become hard and sticky and look like a C-shaped farm tool called a “sickle.”

6
 COMPLETE OR FULL BLOOD COUNT (7)
(CBC, FBC or Blood C/E)
Blood dyscrasias
Test Result Reference Values
Hb 12 14 to 18 g/dL (males ), 12 to 16 g/dL (females )
HCT 36 40 to 55% (males), 36 to 48% (females)
Total RBC 4.8 4.5 to 6.5 x 1012/l
WBC Count (TLC) 45,000 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 58 40 to 75%
Lymphocytes 34 20 to 45%
Monocytes 4 2 to 10%
Eosinophils 3 1 to 6%
Basophils 1 0 to 1%
Indices
MCV 92 80 to 100 fl (femtoliters)
MCH 30 27 to 33 pg (picograms)
MCHC 34 32 to 36 g/dl (grams per deciliter)
RDW 14.5 12-15 %
Platelet count 120,000 150,000 to 400,000 / mm3
Blood smear:
Numerous immature blast cells seen
Teaching points:
In infiltration of the bone marrow with leukemia or lymphoma, the other cell lines i.e.,
RBC and platelets may be low and large number of immature white blood cells will be
seen on the peripheral film.

7
 COMPLETE OR FULL BLOOD COUNT (8)
(CBC, FBC or Blood C/E)
Bone marrow failure / Aplastic anemia
Test Result Reference Values
Hb 7.2 14 to 18 g/dL (males ), 12 to 16 g/dL (females )
HCT 22.1 40 to 55% (males), 36 to 48% (females)
Total RBC 3.2 4.5 to 6.5 x 1012/l
WBC Count (TLC) 2.6 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 64 40 to 75%
Lymphocytes 33 20 to 45%
Monocytes 2 2 to 10%
Eosinophils 1 1 to 6%
Basophils 0 0 to 1%
Indices
MCV 100 80 to 100 fl (femtoliters)
MCH 30 27 to 33 pg (picograms)
MCHC 31 32 to 36 g/dl (grams per deciliter)
RDW 13 12-15 %
Platelet count 80,000 150,000 to 400,000 / mm3
Blood smear:
Pancytopenia
Teaching points:
In aplastic anemia or bone marrow failure, all the cell lines are low. The reticulocyte
count is also low.

8
 COMPLETE OR FULL BLOOD COUNT (9)
(CBC, FBC or Blood C/E)Acute bacterial infection
Test Result Reference Values
Hb 15.4 14 to 18 g/dL (males , 12 to 16 g/dL (females
HCT 46.2 40 to 55% (males), 36 to 48% (females)
Total RBC 5.6 4.5 to 6.5 x 1012/l
WBC Count (TLC) 14000 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 85 40 to 75%
Lymphocytes 12 20 to 45%
Monocytes 2 2 to 10%
Eosinophils 1 1 to 6%
Basophils 0 0 to 1%
Indices
MCV 90 80 to 100 fl (femtoliters)
MCH 32 27 to 33 pg (picograms)ll
MCHC 34 32 to 36 g/dl (grams per deciliter)
RDW 13 12-15 %
Platelet count 270,000 150,000 to 400,000 / mm3
Blood smear:
Leukocytosis with left shift (early forms of leucocytes)

Teaching points:
In acute bacterial infection, the WBC count is high and most of the WBCs are
neutrophils.

9
 COMPLETE OR FULL BLOOD COUNT (10)
(CBC, FBC or Blood C/E)
Acute viral infection
Test Result Reference Values
Hb 16 14 to 18 g/dL (males ), 12 to 16 g/dL (females )
HCT 36 40 to 55% (males), 36 to 48% (females)
Total RBC 6.2 4.5 to 6.5 x 1012/l
WBC Count (TLC) 8200 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 34 40 to 75%
Lymphocytes 60 20 to 45%
Monocytes 3 2 to 10%
Eosinophils 2 1 to 6%
Basophils 1 0 to 1%
Indices
MCV 88 80 to 100 fl (femtoliters)
MCH 29 27 to 33 pg (picograms)
MCHC 34 32 to 36 g/dl (grams per deciliter)
RDW 14.6 12-15 %
Platelet count 170,000 150,000 to 400,000 / mm3
Blood smear:
Lymphocytosis
Acute viral infection may or may not have an effect on the CBC. WBC count may be
slightly high, low or within normal range. The differential count will show a higher
percentage of lymphocytes.

10
 COMPLETE BLOOD COUNT (11)
(CBC, FBC or Blood C/E)
Tuberculosis (Chronic bacterial infection)
Test Result Reference Values
Hb 12 14 to 18 g/dL (males ), 12 to 16 g/dL (females )
HCT 35.8 40 to 55% (males), 36 to 48% (females)
Total RBC 5.2 4.5 to 6.5 x 1012/l
WBC Count (TLC) 10.2 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 42 40 to 75%
Lymphocytes 56 20 to 45%
Monocytes 1 2 to 10%
Eosinophils 1 1 to 6%
Basophils 0 0 to 1%
Indices
MCV 91 80 to 100 fl (femtoliters)
MCH 30 27 to 33 pg (picograms) l
MCHC 33 32 to 36 g/dl (grams per deciliter)
RDW 13 12-15 %
Platelet count 320,000 150,000 to 400,000 / mm3
Blood smear:
Lymphocytosis
Teaching points:
In chronic bacterial infections, like tuberculosis, Hb may be low which is called anemia
of chronic disease. The WBC count may be high or within normal range but in any case
the percentage of the lymphocytes will be the highest.
In addition the ESR may be significantly raised.

11
 COMPLETE OR FULL BLOOD COUNT (12)
(CBC, FBC or Blood C/E)
Typhoid
Test Result Reference Values
Hb 15 14 to 18 g/dL (males ), 12 to 16 g/dL (females )
HCT 45 40 to 55% (males), 36 to 48% (females)
WBC Count (TLC) Low or high 4000 to 11000 /mm3
Differential count
Neutrophils (Polys) 78 40 to 75%
Lymphocytes 20 20 to 45%
Monocytes 1 2 to 10%
Eosinophils 1 1 to 6%
Basophils 0 0 to 1%
Indices
MCV 91 80 to 100 fl (femtoliters)
MCH 30 27 to 33 pg (picograms)
MCHC 33 32 to 36 g/dl (grams per deciliter)
RDW 13 12-15 %
Platelet count 220,000 150,000 to 400,000 / mm3

Teaching points:
In typhoid, the WBC count may or may not be raised due to infiltration of the
reticuloendothelial system by Salmonella typhi. WBCs differential count will
predominantly show neutrophils like other acute bacterial infections.

12
 C - REACTIVE PROTEIN (CRP) (1)
Normal Report
Result Normal Range
CRP Level
1.0 < 3.0 mg/dL

C - REACTIVE PROTEIN (CRP) (2)

High
Result Normal Range
CRP Level
14.0 < 3.0 mg/dL
Teaching points:
CRP is increased in acute or chronic inflammatory conditions, tissue necrosis or tissue
injury, ischemia or infarction of tissues, infection, malignant tumors, post-surgery and
burns.
It is a non-specific marker of inflammation, infection and malignancy, therefore,
needs a correlation with the clinical picture and other investigations.

ERYTHROCYTE SEDIMENTATION RATE (ESR) (1)

Normal Report
Result Normal Range
ESR
12 Male: ≤15 mm/hr, Female: ≤ 20 mm/hr
Teaching points:
ESR is increased in chronic inflammatory conditions, chronic infections, malignant
tumors and autoimmune conditions
It is neither sensitive nor specific and needs a correlation with the clinical picture and
other investigations.

ERYTHROCYTE SEDIMENTATION RATE (ESR) (2)

Slightly high
Result Normal Range

13
ESR 35 Male: ≤15 mm/hr, Female: ≤ 20 mm/hr
Teaching points:
ESR is increased in chronic inflammatory conditions, chronic infections, malignant
tumors and autoimmune conditions
It is neither sensitive nor specific and needs a correlation with the clinical picture and
other investigations.

ERYTHROCYTE SEDIMENTATION RATE (ESR) (3)

High
Result Normal Range
ESR
55 Male: ≤15 mm/hr, Female: ≤ 20 mm/hr
Teaching points:
ESR is increased in chronic inflammation, chronic infections affecting the bone, heart,
skin, lungs, tissue injury or ischemia, blood cancers, diabetes, heart disease, kidney
disease, obesity, thyroid disease, Rheumatic fever, autoimmune disorders

ERYTHROCYTE SEDIMENTATION RATE (ESR) (4)

Very High
Result Normal Range
ESR
110 Male: ≤15 mm/hr, Female: ≤ 20 mm/hr
Teaching points:
ESR above 100 mm/hr is increased in malignancies, tuberculosis and autoimmune
conditions

14
 SERUM FERRITIN
Iron Deficiency Anemia (IDA)
Result Normal Range
Ferritin
9 12-300 ng/mL (male), 12-150 ng/mL (female)
Teaching points:
Ferritin is the stored form of iron in the body. It directly measures the iron stores.
Hence a low ferritin level indicates a low level of iron in the body.
In CBC report Hb, MCV, MCH and MCHC will be low.

HEMOGLOBIN ELECTROPHORESIS (1)

Normal Result
Type of Hb Result Normal Range
HbA 1: 97 95-98%
HbA 2 2 2: 2-3%
HbF: 1 0.8-2%
HbS: 0 0%
Teaching points:
Hemoglobin electrophoresis is a blood test that measures different types of
hemoglobin, including the abnormal ones, in the blood.
Results given above show the normal distribution of different types of hemoglobin in
a normal adult.
In different hemoglobinopathies, the proportion of each type of hemoglobin varies.
HbA 1: Adult hemoglobin type 1; most common type in normal adults.

HbA 2: Adult hemoglobin type 2.

HbF: Fetal hemoglobin; present at birth and gradually disappears in the first year of
life.

HbS: Sickle Cell hemoglobin; present in sickle cell disease.

15
It is important to note that if in the result, either Hb A2, HbF or HbS are above their
normal ranges but still less than HbA1, then the electrophoresis result is interpreted
as “trait” e.g., sickle cell trait or thalassemia minor trait.

If either Hb A2, HbF or HbS are above their normal ranges and also more than HbA1,
then the result is interpreted as “disease” e.g., sickle cell disease or thalassemia
major

HEMOGLOBIN ELECTROPHORESIS (2)

Thalassemia minor
Type of Hb Result (%) Normal Range

HbA 1: 49 95-98%

HbA 2 42 2: 2-3%

HbF: 9 0.8-2%

HbS: 0 0%
Teaching points:
If Hb A2, is above its normal range but is still less than HbA1, then it is interpreted as
“trait” e.g., thalassemia minor trait.

If either Hb A2, HbF or HbS are above their normal ranges and also more than HbA1,
then the electrophoresis result is interpreted as “disease” e.g., sickle cell disease or
thalassemia major.

HEMOGLOBIN ELECTROPHORESIS (3)

Thalassemia major
Type of Hb Result (%) Normal Range
HbA 1: 12 95-98%
HbA 78 2: 2-3%

16
HbF: 10 0.8-2%
HbS: 0 0%
Teaching points:
If Hb A2, is above its normal range and is also more than HbA1, then the result is
interpreted as “disease” e.g., thalassemia major

If Hb A2, is above its normal range but still less than HbA1, then the result is
interpreted as “trait” e.g., thalassemia minor

HEMOGLOBIN ELECTROPHORESIS (4)

Sickle cell disease
Type of Hb Result (%) Normal Range
HbA 1 39 95-98%
HbA 2 2 2: 2-3%
HbF: 1 0.8-2%
HbS: 58 0%
Teaching points:
HbS: Sickle cell hemoglobin; present in sickle cell disease.

If HbS is above its normal range and also more than HbA1, then it is interpreted as
“disease” e.g., sickle cell disease.

MALARIAL PARASITE (MP) (1)

Normal Result
Result Normal Range
MP
Negative Negative

17
Teaching points:
A diagnosis of malaria is made by the identification of parasites on a thin or thick
blood smear. The thick smear allows detection of malarial parasites and the thin film
identifies species.
One negative smear does not rule out malaria. At least three smears should be
examined over a 36-hour period to rule out malaria.
Although the highest yield of MP smears occurs during or soon after a fever spike;
the smears should not be delayed awaiting fever spikes.

MALARIAL PARASITE (MP) (2)

Positive for P. vivax
Result Normal Range
MP
Plasmodium Vivax seen Negative
Teaching points:
In case of P. vivax treat acute malaria and also treat the hypnozoites in the liver with
Primaquine..
Ask the patient about any drug reactions, episodes of anemia or jaundice in the past
to suspect G6PD deficiency. If suspected perform G6PD test before prescribing
Primaquine.
Ask the female patients about pregnancy as treatment of malaria in pregnancy is
different.

MALARIAL PARASITE (MP) (3)

Positive for P. Falciparum
Result Normal Range
MP
Plasmodium falciparum seen Negative
Teaching points:
In case of P. falciparum aggressively treat acute malaria.
Ask the female patients about pregnancy as treatment of falciparum is different in
pregnancy.

MALARIAL IMMUNOCHROMATOGRAPHIC ASSAY (ICT) (1)

18
 Positive for P. vivax
Result Normal Range
MP
Plasmodium Vivax positive Negative
Teaching points:
The ICT Malaria (P.falciparum /P.vivax) test is a rapid immunochromatographic assay
and is performed as a bed side rapid diagnostic test (RDT).
Malaria ICT may be falsely negative when parasite levels are below 100 parasites/mL
of blood. A negative ICT result does not rule out malaria.

The malaria ICT may be falsely positive due persistence of malaria antigens in the
blood up to 2 weeks after treatment.

Confirm RDT test results with MP smear when possible.

DENGUE SEROLOGY (1)

Normal Result

Test Result Reference range

Dengue NS1 antigen Negative Negative

Dengue IgM Negative Negative

Dengue IgG Negative Negative

Teaching points:
Early in the illness (≤5 days after symptom onset), laboratory confirmation can be
made from a single acute-phase serum specimen by detecting dengue virus genomic
sequences with RT-PCR or Dengue nonstructural protein 1 (NS1) antigen via
immunoassay.
After 1 week of symptom onset, Dengue IgM can be detected with ELISA. The CDC
currently recommends that, within the first week of illness, diagnostic testing should
include a test for dengue virus (RT-PCR or NS1) and Dengue IgM.
For patients seen more than 1 week after fever onset, Dengue IgM is more useful,
although NS1 may still be positive up to 12 days after fever onset.

DENGUE SEROLOGY (2)

19
 Early Dengue infection (≤5 days after symptom onset)

Test Result Reference range

Dengue NS1 antigen Positive Negative

Dengue IgM Negative Negative

Dengue IgG Negative Negative

Teaching points:
Early in the illness (≤5 days after symptom onset), laboratory confirmation can be
made from a single acute-phase serum specimen by detecting dengue virus genomic
sequences with RT-PCR or Dengue nonstructural protein 1 (NS1) antigen via
immunoassay.

DENGUE SEROLOGY (3)

Acute Dengue infection (1 week after symptom onset)

Test Result Reference range

Dengue NS1 antigen Positive Negative

Dengue IgM Positive Negative

Dengue IgG Negative Negative

Teaching points:
After 1 week of symptom onset, Dengue IgM can be detected with ELISA. The CDC
currently recommends that, within the first week of illness, diagnostic testing should
include a test for dengue virus (RT-PCR or NS1) and Dengue IgM.

DENGUE SEROLOGY (4)

Recovery phase

Test Result Reference range

Dengue NS1 antigen Negative Negative

Dengue IgM Negative Negative

20
Dengue IgG Positive Negative
Teaching points:
In recovery phase, the Dengue NS1 antigen and Dengue IgM become normal and
Dengue IgG remains positive.

BLOOD SUGAR (1)

Impaired Fasting Glucose (Pre-diabetes)

Test Result Reference Values

Normal: 60 – 109 mg/dl
Fasting Blood Sugar 120 Pre-diabetes: 110-125 mg/dl
Diabetes: ≥126 mg/dl
Normal: ≤140 mg/dl
2 hours post prandial 138 Pre-diabetes: 140-199 mg/dl
Diabetes: ≥200 mg/dl
Normal: ≤6.0 %
HbA1c 6.3 Pre-diabetes: 6.0-6.4 %
Diabetes: ≥ 6.5 %
Teaching points:
Impaired fasting glucose is also called pre-diabetes. In IFG, the fasting blood sugar
level is between 110 and 126 mg/dl and HbA1c is between 5.7 and 6.4 %. RBS
remains normal.

BLOOD SUGAR (2)

Impaired Glucose Tolerance (Pre-diabetes)

Test Result Reference Values

Normal: 60 – 109 mg/dl
Fasting Blood Sugar 109 Pre-diabetes: 110-125 mg/dl
Diabetes: ≥126 mg/dl
Normal: ≤140 mg/dl
2 hours post prandial 190 Pre-diabetes: 140-199 mg/dl
Diabetes: ≥200 mg/dl
HbA1c 6.3 Normal: ≤6.0 %
21
 Pre-diabetes: 6.0-6.4 %
Diabetes: ≥ 6.5 %
Teaching points:
Impaired glucose tolerance is also called pre-diabetes. In IGT, the random BSL is
above 140 mg/dl but below 200 mg/dl. HbA1c is between 5.7 and 6.4 %.
FBS remains normal.
BLOOD SUGAR (3)
Diabetes

Test Result Reference Values

Normal: 60 – 109 mg/dl
Fasting Blood Sugar 130 Pre-diabetes: 110-125 mg/dl
Diabetes: ≥126 mg/dl
Normal: ≤140 mg/dl
2 hours post prandial 270 Pre-diabetes: 140-199 mg/dl
Diabetes: ≥200 mg/dl
Normal: ≤6.0 %
HbA1c 7.8 Pre-diabetes: 6.0-6.4 %
Diabetes: ≥ 6.5 %
Teaching points:
Diabetes is confirmed when FBS is above 126 mg/dl, RBS is above 200 mg/dl and
HbA1c is above 6.4 %. In symptomatic patients one reading above abnormal may
be enough for a diagnosis, while in asymptomatic patients two abnormal readings
may be required to reach a diagnosis. .

BLOOD SUGAR (4)

Uncontrolled diabetes

Test Result Reference Values

Normal: 60 – 109 mg/dl
Fasting Blood Sugar 380 Pre-diabetes: 110-125 mg/dl
Diabetes: ≥126 mg/dl
Normal: ≤140 mg/dl
2 hours post prandial 520 Pre-diabetes: 140-199 mg/dl
Diabetes: ≥200 mg/dl

22
 Normal: ≤6.0 %
HbA1c 13 Pre-diabetes: 6.0-6.4 %
Diabetes: ≥ 6.5 %
Teaching points:
HbA1c is above 7.5 %. FBS and RBS are also very high.

LIPID PROFILE (1)

Dyslipidemia

Test Result Reference Values

Total Cholesterol 230 • < 200 Desirable
• 200 to 239 Borderline high
• ≥ 240 High
HDL Cholesterol 40 • < 40 Low
• ≥ 60 High
LDL Cholesterol 154 • < 100 Optimal
• 100 to 129 Near optimal
• 130 to 159 Borderline high
• 160 to 189 High
• ≥ 190 Very high
Triglycerides 210 • < 150 Normal
• 150 to 199 Borderline high
• 200 to 499 High
• ≥ 500 Very high

23
 LIPID PROFILE (2)
Hypertriglyceridemia

Test Result Reference Values

Total Cholesterol 180 • < 200 Desirable
• 200 to 239 Borderline high
• ≥ 240 High
HDL Cholesterol 55 • < 40 Low
• ≥ 60 High
LDL Cholesterol 138 • < 100 Optimal
• 100 to 129 Near optimal
• 130 to 159 Borderline high
• 160 to 189 High
• ≥ 190 Very high
Triglycerides 980 • < 150 Normal
• 150 to 199 Borderline high
• 200 to 499 High
• ≥ 500 Very high

24
 LIPID PROFILE (3)
Familial Dyslipidemia

Test Result Reference Values

Total Cholesterol 272 • < 200 Desirable

• 200 to 239 Borderline high
• ≥ 240 high
HDL Cholesterol 50 • < 40 Low
• ≥ 60 High
LDL Cholesterol 220 • < 100 Optimal
• 100 to 129 Near optimal
• 130 to 159 Borderline high
• 160 to 189 High
• ≥ 190 Very high
Triglycerides 550 • < 150 Normal
• 150 to 199 Borderline high
• 200 to 499 High
• ≥ 500 Very high
In familial dyslipidemia, the levels of Cholesterol, LDL-Cholesterol and TG are very high
and this condition occurs in patients belonging to a relatively younger age group.

25
 THYROID FUNCTION TESTS (1)
Normal (Euthyroid state)

Test Result Reference Values

FT4 18 (11.0-21.0) pmol/L
TSH 2.4 (0.4-4.0) mU/L

THYROID FUNCTION TESTS (2)

Primary Hypothyroidism

Test Result Reference Values

FT4 8 (11.0-21.0) pmol/L
TSH 78 (0.4-4.0) mU/L
Teaching points:
In primary hypothyroidism, the thyroid gland does not make enough thyroxin (low FT4)
and in response, the pituitary gland tries to stimulate the thyroid gland by secreting
excessive TSH (high TSH).

THYROID FUNCTION TESTS (3)

Primary Hyperthyroidism

Test Result Reference Values

FT4 28 (11.0-21.0) pmol/L
TSH 0.001 (0.4-4.0) mU/L
Teaching points:
In primary hyperthyroidism, the thyroid gland makes excessive Thyroxin (high FT4)
which inhibits the pituitary gland from making and releasing TSH (low TSH).

26
 THYROID FUNCTION TESTS (4)
Subclinical Hypothyroidism

Test Result Reference Values

FT4 15.8 (11.0-21.0) pmol/L
TSH 7.2 (0.4-4.0) mU/L
Teaching points:
In sub-clinical hypothyroidism, the patients are clinically euthyroid and the thyroid
gland produces normal levels of thyroxin (normal FT4) but in response to a higher level
of stimulation by the pituitary gland (high TSH but <10mU/L).

THYROID FUNCTION TESTS (5)

Subclinical Hyperthyroidism

Test Result Reference Values

FT4 16.8 (11.0-21.0) pmol/L
TSH 0.02 (0.4-4.0) mU/L
Teaching points:
In sub-clinical hyperthyroidism, the patients are clinically euthyroid and the thyroid
gland produces normal levels of thyroxin (normal FT4) but in response to a a lower
level of stimulation by the pituitary gland (low TSH).

27
 RENAL FUNCTION TESTS
Kidney disease
Test Result Reference Values

Blood urea 46 10 – 40 mg/dl

Blood urea Nitrogen 24 5 – 22 mg/dl

Serum Creatinine 1.5 0.5 – 1.5 mg/dl

e-GFR 55 Normal >90ml/min per 1.73 m2

Teaching points:
The kidneys have many functions like fluid balance, electrolyte balance, acid base
balance, hemopoietin secretions, vitamin D hydroxylation, excretion of waste
products, excretion of drugs and toxins. Except hemopoietin secretion and Vitamin D
hydroxylation, most of other functions depend on the process of filtration at the level
of glomerulus and reabsorption at the level of tubule.
Therefore the tests for filtration like e-GFR, creatinine, urea, BUN etc are generally
regarded as renal function tests. The radiological test for renal function is renal
perfusion scan.
The urine complete exam/detailed report shows presence of infection, blood, casts,
proteins, etc which mostly point towards structural abnormalities.
The ultrasound and CT pyelograms detect the gross structural defects.

e-GFR Value Stages of Renal Failure

Equal to or more than 90 ml/min/1.73 m2 Normal
60 – 89 ml/min/1.73 m2 Mild Renal insufficiency
45 – 59 ml/min/1.73 m2 Mild to Moderate Renal Insufficiency
30 – 44 ml/min/1.73 m2 Moderate to Severe Renal Insufficiency
15 – 29 ml/min/1.73 m2 Severe Renal Insufficiency
Less than 15 ml/min/1.73 m2 Kidney Failure

28
 SERUM URIC ACID (1)
Normal
Result Normal Range
Uric Acid Level
6.8 Male: 3.4 – 7.0 mg/dl, Female: 2.8 – 5.7 mg/dl

SERUM URIC ACID (2)

Hyperuricemia
Result Normal Range
Uric Acid Level
9.0 Male: 3.4 – 7.0 mg/dl, Female: 2.8 – 5.7 mg/dl

SERUM AMYLASE (1)

Normal Result
Result Normal Range
Serum Amylase
78 30-110 U/L
Teaching points:
Amylase is produced by both pancreas and the salivary glands (40%-45% from the
pancreas and 55%-60% from the salivary glands). The major limitation of using serum
amylase measurement in diagnosing pancreatitis is the lack of specificity.
Mild increase in amylase is also seen after ERCP, after passage of common bile duct
stone, abdominal surgery, abdominal trauma, and mumps. In acute pancreatitis,
serum amylase is usually elevated 3-fold. In chronic pancreatitis both amylase and
lipase levels are high.
The amylase also rises in salivary gland infection, obstruction or inflammation.
Clinical features like pain in salivary gland and absence of abdominal pain may
indicate salivary origin of high amylase.

29
 SERUM AMYLASE (2)
Slightly High Level
Result Normal Range
Serum Amylase
170 30-110 U/L
Teaching points:
Mild increase in amylase is also seen after ERCP, after passage of common bile duct
stone, abdominal surgery, abdominal trauma, and mumps. In acute pancreatitis,
serum amylase is usually elevated 3-fold. In chronic pancreatitis both amylase and
lipase levels are high
The amylase also rises in salivary gland infection, obstruction or inflammation.

SERUM AMYLASE (3)

Acute Pancreatitis
Result Normal Range
Serum Amylase
460 30-110 U/L
Teaching points:
In acute pancreatitis, serum amylase is usually elevated 3-fold. In chronic pancreatitis
both amylase and lipase levels are high

SERUM AMYLASE AND LIPASE (4)

Chronic Pancreatitis
Result Normal Range

Serum Amylase 230 30-110 U/L

Serum Lipase 380 0-160 U/L

Teaching points:
In acute pancreatitis, serum amylase is usually elevated 3-fold. In chronic
pancreatitis both amylase and lipase levels are high

30
 ANTI-CCP ANTIBODIES
Rheumatoid Arthritis

Result Normal Range

CRP
14.0 < 3.0 mg/dL

Anti CCP 45 < 20 u/ml

RA factor ± Negative
Teaching points:
CRP is increased in rheumatoid arthritis.
RA factor may or may not be positive
Anti CCP (Cyclic Citrulinated Peptide) antibodies are mostly positive in rheumatoid
arthritis.

D-DIMER
Deep Venous Thrombosis/Pulmonary Embolism

Result Normal Range

D-Dimer
10.0 < 0.50 mg/L
Teaching points:
D-Dimer is a small fragment of protein present in the blood after a blood clot is
degraded by fibrinolysis. It is one of the Fibrin Degradation Products (FDPs)
It is raised when there is clotting in the blood vessels like deep vein thrombosis or
pulmonary embolism.

PROSTATE SPECIFIC ANTIGEN (PSA) 1

Elevated PSA levels
Result Normal range

Serum PSA levels 100 50 – 59 years ≤ 3ng/ml

60 – 69 years ≤ 4ng/ml
> 70 years ≤ 5ng/ml
31
 PROSTATE SPECIFIC ANTIGEN (PSA) 2
Age specific borderline high levels of PSA
Result Normal range

Serum PSA levels 5 50 – 59 years ≤ 3ng/ml

60 – 69 years ≤ 4ng/ml
> 70 years ≤ 5ng/ml

OTHER TUMOR MARKERS

Tumor Marker Tumor

Alpha Feto Proteins (AFP) Hepatocellular carcinoma

Carcino Embryonic Antigen (CEA) Colon, gall blader

Cancer Antigen 125 (CA-125) Ovarian cancer

Cancer Antigen 19-9 (CA 19-9) Gall bladder carcinoma

LIVER FUNCTION TEST (1)

Gilbert Syndrome

Test Result Reference Values

Bilirubin total 5.2 0.3-1.0 mg/dL

Bilirubin conjugated 0.2 0.1-0.3 mg/dL

Bilirubin unconjugated 5.0 0.2-0.8 mg/dL

S.G.P.T. (ALT) 30 0-45 U/L

S.G.O.T (AST) 28 0-35 U/L

Alkaline phosphatase (ALP) 190 50-116mg/dl

Total Serum Proteins 7 6.5-8.5 mg/dl

32
Serum Albumin 4.5 3.5-5.5 mg/dl

Gamma GT 36 0-50 U/L

Teaching points:
Gilbert’s syndrome is a congenital disorder in which the receptors required for the
entry of unconjugated bilirubin into the liver cells are deficient. Therefore you will see
elevated unconjugated bilirubin levels.

LIVER FUNCTION TEST (2)

Acute Viral Hepatitis

Test Result Reference Values

Bilirubin total 4 0.3-1.0 mg/dL

Bilirubin conjugated 2 0.1-0.3 mg/dL

Bilirubin unconjugated 2 0.2-0.8 mg/dL

S.G.P.T. (ALT) 1600 0-45 U/L

S.G.O.T. (AST) 430 0-35 U/L

Alkaline phosphatase (ALP) 350 50-116mg/dl

Total Serum Protein 7.5 6.5-8.5 mg/dl

Serum Albumin 5 3.5-5.5 mg/dl

Gamma GT 75 0-50 U/L

Teaching points:
Acute viral hepatitis damages all liver cells, hence the intracellular enzymes like ALT
and AST increase significantly i.e., at least 10 times the normal range. The biliary
system is damaged and hence alkaline phosphatase is also raised but to a lesser extent
as compared to ALT. The liver cells can neither process nor excrete the bilirubin
normally, hence the levels of both conjugated and unconjugated bilirubin are also
high.
In short, all parameters are raised much above the normal range, but the most
significant is ALT.

33
 LIVER FUNCTION TEST (3)
Obstructive Jaundice

Test Result Reference Values

Bilirubin total 9 0.3-1.0 mg/dL

Bilirubin conjugated 7.9 0.1-0.3 mg/dL

Bilirubin unconjugated 1.1 0.2-0.8 mg/dL

S.G.P.T. (ALT) 76 0-45 U/L

S.G.O.T.(AST) 60 0-35 U/L

Alkaline phosphatase (ALP) 900 50-116mg/dl

Total Serum Protein 8 6.5-8.5 mg/dl

Serum Albumin 5 3.5-5.5 mg/dl

Gamma GT 210 0-50 U/L

Teaching points:
In obstructive jaundice, the alkaline phosphatase (ALP) and gamma glutamyl
transferase (Gamma GT) are most significantly raised.
The excretion of conjugated bilirubin is also affected, hence its level increases in the
blood.
ALT and AST usually remain normal or increase minimally.

34
 LIVER FUNCTION TEST (4)
Chronic Liver Disease

Test Result Reference Values

Bilirubin total 4.2 0.3-1.0 mg/dL

Bilirubin conjugated 2 0.1-0.3 mg/dL

Bilirubin unconjugated 2.2 0.2-0.8 mg/dL

S.G.P.T. (ALT) 120 0-45 U/L

S.G.O.T.(AST) 78 0-35 U/L

Alkaline phosphatase (ALP) 350 50-116mg/dl

Total Serum Protein 3.8 6.5-8.5 mg/dl

Serum Albumin 1.9 3.5-5.5 mg/dl

Gamma GT 66 0-50 U/L

Teaching points:
Chronic hepatitis or chronic liver disease has the LFT picture similar to acute viral
hepatitis but all parameters are slightly raised i.e., mildly raised ALT, ALP, bilirubin etc,
but most significant abnormality is in the synthetic function of the liver i.e., reduction
in serum albumin. The other synthetic function which is affected is the production of
clotting factors, hence Prothrombin time (PT) is also deranged.

35
 HEPATITIS B SEROLOGY (1)
Acute Infection

Test Result

HB s Ag Positive

HB s Ab Non-Reactive

HB c IgM Reactive

HB c IgG Non-Reactive

HB e Ag Positive

HB e Ab Non-Reactive
Teaching points:
The most important clue for acute Hepatitis B virus infection, is positive report of Hep
B c IgM. Hep B s Ag and Hep B e Ag may be present in chronic Hep B virus infection as
well.

HEPATITIS B SEROLOGY (2)

Immune by Natural Infection

Test Result
HB s Ag Negative
HB s Ab Reactive
HB c IgM Non-Reactive
HB c IgG Reactive
HB e Ag Negative
HB e Ab Non-Reactive
Teaching points:
The presence of Hep B s Ab shows that the person is immune. The presence of Hep B c
IgG shows that the patient has had a natural infection.

36
 HEPATITIS B SEROLOGY (3)
Immune by Vaccination
Test Result

HB s Ag Negative

HB s Ab Reactive

HB c IgM Non-Reactive

HB c IgG Non-Reactive

HB e Ag Negative

HB e Ab Non-Reactive
Teaching points:
The presence of Hep B s Ab shows that the person is immune. The absence of Hep B c
IgG shows that the patient has never had a natural infection, therefore the only
possibility is immunity through vaccination

HEPATITIS B SEROLOGY (4)

Chronic Active Hepatitis

Test Result

HB s Ag Positive

HB s Ab Non-Reactive

HB c IgM Non-Reactive

HB c IgG Reactive

HB e Ag Positive

HB e Ab Non-Reactive
Teaching points:
The presence of Hep B s Ag shows that the person is infected with Hepatitis B virus
which is still active. The presence of Hep B c IgG shows that the patient has had an old
infection as well. Hepatitis B e Ag also confirms that the virus is replicating, hence the
virus is active.

37
 HEPATITIS B SEROLOGY (5)
Carrier State
Test/Parameter Serology Report

HB s Ag Positive

HB s Ab Non-Reactive

HB c IgM Non-Reactive

HB c IgG Reactive

HB e Ag Negative

HB e Ab Reactive
Teaching points:
The presence of Hep B s Ag shows that the person is infected with Hepatitis B virus.
The presence of Hep B c IgG shows that the patient has had an old infection. Hepatitis
B e Ag is negative which shows that the virus is not replicating, hence the virus is not
active. Hepatitis B e Ab is positive meaning that antibodies are preventing the
production of e antigen.
Actually to confirm that the patient is a carrier of Hepatitis B virus, Hep B DNA by PCR
should be done.

HEPATITIS C SEROLOGY (6)

Active State
Test Result

Hep c Ag Reactive

Hep C RNA PCR (Qualitative) Detected

ALT 46 mg/dl
Teaching points:
Hepatitis C virus does not have any antigens in the blood. The screening test for
Hepatitis C virus is Hep C Antibody. It does not tell whether it is acute or chronic, active
or inactive, it simply tells that the person is infected and it remains positive for life.
For activity HCV RNA PCR (Qualitative) is needed.
ALT may or may not be high.

38
 HEPATITIS C SEROLOGY (7)
Inactive State

Test Result

Hep c Ag Reactive

Hep C RNA PCR (Qualitative) Not Detected

ALT 36 mg/dl
Teaching points:
Hepatitis C virus does not have any antigens in the blood. The screening test for
Hepatitis C virus is Hep C Antibody. It does not tell whether it is acute or chronic, active
or inactive, it simply tells that the person is infected and it remains positive for life.
For activity HCV RNA PCR (Qualitative) is needed.
ALT may or may not be high.

HEPATITIS A SEROLOGY (8)

Acute Hepatitis A Virus (HAV) Infection
Test Result
Hepatitis A IgM Reactive
Teaching points:
Hepatitis A is the most common type of viral hepatitis which is spread by the faeco-oral
route.
It always presents as an acute infection. It does not have a chronic state.
It produces a classical clinical state of acute viral hepatitis i.e., mild fever, malaise,
lethargy, nausea, jaundice, right hypochondrial pain and dark urine.
It also produces a classical picture in LFTs i.e., ALT > 10 times normal.
Hepatitis A IgM shows an acute stage.
Hepatitis A IgG shows an immune state.

HEPATITIS A SEROLOGY (9)

Immune to Hepatitis A Virus (HAV) Infection
Test Result
Hepatitis A IgG Reactive
Teaching points:
Hepatitis A virus infection does not have a chronic state.
Hepatitis A virus IgG shows an immune state.
39
 HEPATITIS E SEROLOGY (10)
Acute Hepatitis E Virus (HEV) Infection

Test Result

Hepatitis E IgM Reactive

Teaching points:
Hepatitis E is a less common type of viral hepatitis which is spread by the feco-oral
route.
It always presents as an acute infection. It does not have a chronic state.
It produces a classical clinical state of acute viral hepatitis i.e., mild fever, malaise,
lethargy, nausea, jaundice, right hypochondrial pain and dark urine.
It also produces a classical picture in LFTs i.e., ALT > 10 times normal.
It has a high mortality in pregnancy.
Hepatitis E IgM shows an acute stage.
Hepatitis E IgG shows an immune state.

HEPATITIS E SEROLOGY (11)

Immune to Hepatitis E Virus (HEV) Infection

Test/Parameter Serology Report

Hepatitis E IgG Reactive

Teaching points:
Hepatitis E does not have a chronic state.
Hepatitis E IgG shows an immune state

40
 PAP SMEAR AND HPV TESTING (1)
Inflammatory Cells
Test Result

HPV virus Detected

Thin Liquid film Non-specific inflammatory cells

Teaching points:
Pap smear/test (Papanicolaou test) screens for precancerous cell changes on the cervix
which can lead to a full blown cervical cancer if left untreated. It can identify normal
cervical epithelium, inflammatory cells, metaplasia, dysplasia and carcinoma in situ.
This smear does not prevent cervical cancer.
The HPV (Human Papilloma Virus) test, screens for the presence of HPV virus which is a
risk factor for cervical cancer as it can cause cell changes on the cervix. Its presence
makes the findings significant. It also does not prevent cancer.
Pap smear reporting systems and recommended management steps are as follows:

Class Reagen (WHO) Ruchart Treatment

Class 1 Negative Negative Routine screening

Class 2 Inflammation ………….. Routine screening

Class 3 Mild dysplasia CIN-1(HPV) Repeat 6 monthly

Refer if HPV +

Class 4 Moderate dysplasia, Severe CIN-II Referral

dysplasia, Carcinoma in situ CIN-III
Class 5 Invasive cancer Invasive cancer Referral

PAP SMEAR AND HPV TESTING (2)

Metaplasia
Test Result

HPV virus Detected

Thin Liquid film Cervical Metaplasia

41
 PAP SMEAR AND HPV TESTING (3)
Dysplasia
Test Result

HPV virus Detected

Thin Liquid film Cervical Dysplasia

PAP SMEAR AND HPV TESTING (4)

Intraepithelial Neoplasia
Test Result

HPV virus Detected

Thin Liquid film Cervical Intraepithelial Neoplasia

42
URINE DETAILED REPORT/URINALYSIS/COMPLETE EXAMINATION OF URINE (1)
Urinary Tract Infection (UTI)

Feature Result Range

Color Yellow Yellow
Appearance Turbid Clear
Specific gravity 1.023 1.005-1.030
pH 7.0 5.0-8.0
Glucose Negative Negative
Bilirubin Nil Nil
Albumin + Nil
Blood Nil Nil
Nitrite Positive Nil
Leukocyte esterase Positive Nil
WBC > 20 0-5 / HPF
RBC Nil Nil
Epithelial cells 2-4 <6 /PHF
Bacteria Numerous 1-2
Casts Nil Nil
Amorphous sediments Nil Nil
Crystals Nil Nil
Yeast Nil Nil
Teaching points:
When suspecting UTI, consider two features each, for bacteria and WBCs in the urine.
These are given below: Bacteria: Presence of bacteria on microscopy, and detection of
nitrite.

WBC: Presence of WBCs on microscopy, and detection of leukocyte esterase. Presence

of mild proteinuria in the presence of UTI is not significant and should be repeated at
least two weeks after the completion of the treatment of UTI.

43
URINE DETAILED REPORT/URINALYSIS/COMPLETE EXAMINATION OF URINE (2)
Acute Glomerulonephritis (AGN)/Nephritic syndrome

Feature Result Range

Color Yellow Yellow
Appearance Cloudy Clear
Specific gravity 1.038 1.005-1.030
pH 7.0 5.0-8.0
Glucose Negative Negative
Bilirubin Nil Nil
Albumin ++ Nil
Blood ++ Nil
Nitrite Nil Nil
Leukocyte esterase Nil Nil
WBC 4-6 0-5 / HPF
RBC ++ Nil
Epithelial cells 2-4 <6 /PHF
Bacteria 1-2 1-2
Casts RBC casts, Hyaline casts Nil
Amorphous sediments Nil Nil
Crystals Nil Nil
Yeast Nil Nil
Teaching points:
Damage to the glomerulus causes leakage of proteins and blood in the urine, therefore
protein (albumin), blood and RBCs will be seen on microscopy. In addition, the leaked
RBCs will form RBC casts and the leaked proteins will form hyaline casts.
The WBC, leukocyte esterase and nitrite remain negative.

44
URINE DETAILED REPORT/URINALYSIS/COMPLETE EXAMINATION OF URINE (3)

Nephrotic syndrome

Feature Result Range

Color Yellow Yellow
Appearance Cloudy Clear
Specific gravity 1.023 1.005-1.030
pH 5.6 5.0-8.0
Glucose Negative Negative
Bilirubin Nil Nil
Albumin ++++ Nil
Blood Nil Nil
Nitrite Nil Nil
Leukocyte esterase Nil Nil
WBC 2-4 0-5 / HPF
RBC Nil Nil
Epithelial cells 2-4 <6 /PHF
Bacteria 1-2 1-2
Casts Hyaline casts Nil
Amorphous sediments Nil Nil
Crystals Nil Nil
Yeast Nil Nil
Teaching points:
The most important feature of nephrotic syndrome is heavy proteinuria due to
leakage, specifically of albumin, in the urine. This protein also forms the hyaline casts.
Blood on dipstick and RBC on microscopy are negative.

45
URINE DETAILED REPORT/URINALYSIS/COMPLETE EXAMINATION OF URINE (4)
Uric Acid Stones

Feature Result Range

Color Yellow Yellow
Appearance Clear Clear
Specific gravity 1.023 1.005-1.030
pH 7.0 5.0-8.0
Glucose Negative Negative
Bilirubin Nil Nil
Albumin Nil Nil
Nitrite Nil Nil
Leukocyte esterase Nil Nil
WBC 1-2 Nil
RBC 10-12 0-5 / HPF
Epithelial cells 2-4 Nil
Bacteria Nil <6 /PHF
Casts Nil 1-2
Amorphous sediments Urates positive Nil
Crystals Uric acid crystals Nil
Yeast Nil Nil
Teaching points:
In excessive excretion of uric acid in the urine and formation of uric acid stones, you
may see crystals of uric acid or amorphous urates in the urine.
Secondly, like any other stone, uric acid stones can also cause hematuria.

46
STOOL DETAILED REPORT/STOOL ROUTINE EXAMINATION/STOOL ANALYSIS (1)
Normal

Physical examination Result Normal reference

Color Brown Brown

Odour Fecal Fecal

Consistency Semi formed Semi formed

Mucus Nil Nil

Frank blood Nil Nil

Adult parasites Nil Nil

Microscopic examination Reference ranges

Ova Nil Nil / HPF

Cysts Nil Nil / HPF

Vegetative forms Nil Nil / HPF

Pus cells 1-2/HPF 1-2 / HPF

Epithelial cells Nil Nil / HPF

RBCs Nil Nil / HPF

Yeast 1-2 /HPF 1-2 / HPF

47
STOOL DETAILED REPORT/STOOL ROUTINE EXAMINATION/STOOL ANALYSIS (2)
Giardia and Helminths

Physical examination Result Normal reference

Color Brown Brown

Odour Fecal Fecal

Consistency Loose Semi formed

Mucus Positive Nil

Frank blood Nil Nil

Adult parasites Nil Nil

Microscopic examination Reference ranges

Ova Pin worms Nil / HPF

Cysts Nil Nil / HPF

Vegetative forms Giardia lamblia Nil / HPF

Pus cells 1-2 /HPF 1-2 / HPF

Epithelial cells Nil Nil / HPF

RBCs Nil Nil / HPF

Yeast 1-2/HPF 1-2 / HPF

48
STOOL DETAILED REPORT/STOOL ROUTINE EXAMINATION/STOOL ANALYSIS (3)
Amoebiasis

Physical examination Result Normal reference

Color Brown Brown

Odour Fecal Fecal

Consistency Loose Semi formed

Mucus Positive Nil

Frank blood Nil Nil

Adult parasites Nil Nil

Microscopic examination Reference ranges

Ova Nil Nil / HPF

Cysts Entamoeba histolytica Nil / HPF

Vegetative forms Entamoeba histolytica Nil / HPF

Pus cells 4-6/HPF 1-2 / HPF

Epithelial cells Nil Nil / HPF

RBCs 6-8/HPF Nil / HPF

Yeast Nil 1-2 / HPF

49
STOOL DETAILED REPORT/STOOL ROUTINE EXAMINATION/STOOL ANALYSIS (4)
Tape worms

Physical examination Result Normal reference

Color Brown Brown

Odour Fecal Fecal

Consistency Semi formed Semi formed

Mucus Nil Nil

Frank blood Nil Nil

Adult parasites Nil Nil

Microscopic examination Reference ranges

Ova Hymenolepis nana Nil / HPF

Cysts Nil Nil / HPF

Vegetative forms Nil Nil / HPF

Pus cells Nil 1-2 / HPF

Epithelial cells Nil Nil / HPF

RBCs Nil Nil / HPF

Yeast Nil 1-2 / HPF

50
 STOOL REDUCING SUBSTANCE TEST
Result Normal reference
Normal <0.25 mg/dL
0.24 Suspicious 0.25–0.5 mg/dL
Abnormal >0.5 mg/dL
Teaching points:
The stool reducing substance is done for check for presence of reducing sugar
(glucose, fructose, lactose) in the stool in conditions such as lactose intolerance.
For the reducing substance test, the fecal sample should be fresh and reach the
laboratory in 1/2 hours at the latest, because disintegration of lactose may result in
false negative test.

STOOL CALPROTECTIN LEVEL

Irritable Bowel Syndrome
Result Normal reference
<50 μg/gram Normal (IBD unlikely)
35 50-100 μg/gram Intermediate (IBD likely but cannot exclude
other infections and inflammatory conditions)
>100 μg/gram High (IBD)
Teaching points:
In intestinal inflammation, the levels of fecal calprotectin increase. Therefore, it may
be useful to differentiate inflammatory causes of chronic diarrhea from non-
inflammatory causes.
Fecal calprotectin remains normal in Irritable Bowel Syndrome (IBS)

STOOL CALPROTECTIN LEVEL

Inflammatory Bowel Disease
Result Normal reference
<50 μg/gram Normal (IBD unlikely)
180 50-100 μg/gram Intermediate (IBD likely but cannot exclude
other infections and inflammatory conditions)
>100 μg/gram High (IBD)

51
Teaching points:
In intestinal inflammation, the levels of fecal calprotectin increase. Therefore, it may
be useful to differentiate inflammatory causes of chronic diarrhea from non-
inflammatory causes.
Fecal calprotectin increases in inflammatory bowel diseases (IBD).

STOOL OCCULT BLOOD

Result Normal reference

Negative Negative
Teaching points:
Tests for fecal occult blood detect blood in the stool that is not visible on gross
inspection, usually less than 50 mg of hemoglobin per gram of stool. Normal adults
usually show less than 2 to 3 mg/gm.
The test is positive in carcinoma colon and any other bleeding condition of the gut.

STOOL H. PYLORI ANTIGEN TEST

Normal
Result Normal reference

Negative Negative
Teaching points:
Presence of H pylori antigen in the stool shows active infection. This test may be used
for diagnosis of H pylori before starting treatment. The test may be used to confirm
the eradication of H pylori with standard treatment.
The repeat test for confirmation of eradication needs a 2 week washout period for
PPIs.
The eradication confirmation is done at least 4 weeks after the completion of
treatment.

52
 SEMEN ANALYSIS/ SEMINAL FLUID ANALYSIS (1)
Azoospermia
Physical Examination Result Reference range
Colour White Creamy white
Volume 4.0 2.5 to 5.0 ml
Reaction Alkaline Alkaline
Fructose Absent Positive
Viscosity Thick Thick
Liquefaction time 20 10 to 20 min
Microscopic Examination Result Reference range
Total sperm count 0 40-300 million/ml
Sperm Motility
Active 0 At least 50 %
Sluggish 0 -
Non Motile 0 -
Morphology
Normal 0 At least 30 %
Abnormal 0 ?/ HPF
Pus Cells 1-2 ?/ HPF
RBCs 0 ?/ HPF
Epithelial Cells 1-2 ?/ HPF
Teaching points:

When the sperms are totally absent in the seminal fluid, it is called azoospermia.
Azoospermia can either be because of lack of production in the testes or obstruction in
the vas deferens.

In case of obstructive azoospermia, fructose is also negative.

53
 SEMEN ANALYSIS / SEMINAL FLUID ANALYSIS (2)
Oligoasthenospermia

Physical Examination Result Reference range

Colour White Creamy white
Volume 5 ml 2.5 to 5.0 ml
Reaction Alkaline Alkaline
Fructose Positive Positive
Viscosity Thin Thick
Liquefaction time 15 min 10 to 20 min
Microscopic Examination Result Reference range
Total sperm count 10 million/ml 40-300 million/ml
Sperm Motility
Active 30 % 50 %
Sluggish 50 %
Non Motile 20 %
Morphology
Normal 90 % At least 30 %
Abnormal 10 % / HPF
Pus Cells 2 / HPF
RBCs 0 / HPF
Epithelial Cells 1 / HPF
Teaching points:
The sperms in the semen may have three types of abnormalities i.e., either the count is
low (Oligospermia), or their motility is low (Asthenospermia) or morphology is
abnormal (Teratospermia).
In this semen analysis report both the count and the motility are low, hence this is
called Oligoasthenospermia.

54
 SEMEN ANALYSIS/ SEMINAL FLUID ANALYSIS (3)
Prostatitis
Physical Examination Result Reference range
Colour Yellow Creamy white
Volume 10 ml 2.5 to 5.0 ml
Reaction Acidic Alkaline
Fructose Positive Positive
Viscosity Thin Thick
Liquefaction time 10 min 10 to 20 min
Microscopic Examination Result Reference range
Total sperm count 90 million/ml 40-300 million/ml
Sperm Motility
Active 40 % 50 %
Sluggish 30 %
Non Motile 30 %
Morphology
Normal 70 % At least 30 %
Abnormal 30 % / HPF
Pus Cells Numerous / HPF
RBCs 4-5 / HPF
Epithelial Cells 6-8 / HPF
Teaching points:
When you suspect prostatitis look for pus cells in the semen. The volume of the semen
is also increased.

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 CEREBROSPINAL FLUID (CSF) ANALYSIS (1)
Normal Result

Feature Result Range

Appearance Clear Clear
Protein 0.2 0.18-0.45 g/L
Glucose 52 45-65 mg/dl
CSF : Serum Glucose ratio 0.6 0.6
WBC 1 1-2 / HPF
Differential Nil Nil
Gram stain Nil Nil
Teaching points:
The above report of CSF analysis is within the normal range. The challenge is to
differentiate between acute bacterial, chronic bacterial (TB) and viral meningitis.
The features of CSF also apply to other body fluids like ascitic and pleural fluids.

CEREBROSPINAL FLUID (CSF) ANALYSIS (2)

Acute bacterial meningitis

Feature Result Range

Appearance Turbid Clear
Protein 2 0.18-0.45 g/L
Glucose 32 45-65 mg/dl
CSF : Serum Glucose ratio 0.2 0.6
WBC >1000 1-2 / HPF
Predominantly
Differential Nil
Neutrophils
Gram stain Gram negative diplococci Nil
Teaching points:
In acute bacterial meningitis the WBC count in the CSF is very high, WBCs are
predominantly neutrophils, glucose is low and protein is very high.

CEREBROSPINAL FLUID (CSF) ANALYSIS (3)

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 Tuberculous meningitis

Feature Result Range

Appearance Fibrin web Clear
Protein 0.5 0.18-0.45 g/L
Glucose 30 45-65 mg/dl
CSF : Serum Glucose ratio 0.2 0.6
WBC >500 1-2 / HPF
Predominantly
Differential Nil
lymphocytes
Gram stain Nill Nil
Teaching points:
In tuberculous meningitis, glucose is markedly low, WBCs are moderately raised and
WBCs are predominantly lymphocytes.

CEREBROSPINAL FLUID (CSF) ANALYSIS (4)

Viral meningitis

Feature Result Range

Appearance Clear Clear
Protein 0.3 0.18-0.45 g/L
Glucose 60 45-65 mg/dl
CSF : Serum Glucose ratio 0.6 0.6
WBC 400 1-2 / HPF
Differential Predominantly lymphocytes Nil
Gram stain Nil Nil
Teaching points:
In viral meningitis glucose and proteins are usually normal or slightly abnormal. WBCs
are raised and comprise predominantly of lymphocytes.

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