DIAGNOSTIC REPORT

CLIENT CODE : C000041656 Cert. No. MC-2941

CLIENT'S NAME AND ADDRESS : SRL LIMITED

SRL LTD - IGMC SHIMLA-OPD INDIRA GANDHI MEDICAL COLLEGE
IGMC SHIMLA DIST. SHIMLA SHIMLA, 171001
HIMACHAL PRADESH, INDIA
SHIMLA 171001 Tel : 8894725124, Fax :
HIMACHAL PRADESH INDIA CIN - U74899PB1995PLC045956
08894725124 08894725124

PATIENT NAME : RUPA DEVI PATIENT ID : RUPAF200651141

ACCESSION NO : 0141SF010202 AGE : 68 Years SEX : Female DATE OF BIRTH :

DRAWN : 20/06/2019 16:04 RECEIVED : 20/06/2019 16:07 REPORTED : 20/06/2019 18:23

REFERRING DOCTOR : SELF CLIENT PATIENT ID :

Test Report Status Final Results Biological Reference Interval Units

LFT
BILIRUBIN, DIRECT, SERUM
BILIRUBIN, DIRECT 0.14 0.0 - 0.2 mg/dL
METHOD : DIAZOTIZATION

BILIRUBIN, TOTAL, SERUM

BILIRUBIN, TOTAL 0.88 0.3 - 1.2 mg/dL
METHOD : 5-DICHLOROPHENYLDIAZONIUM TETRAFLUOROBORATE(DPD)

ALANINE AMINOTRANSFERASE, SERUM

ALANINE AMINOTRANSFERASE (ALT/SGPT) 21 < 35 U/L
METHOD : UV WITHOUT P5P

ASPARTATE AMINOTRANSFERASE, SERUM

ASPARTATE AMINOTRANSFERASE (AST/SGOT) 38 High < 35 U/L
METHOD : UV WITHOUT P5P

ALKALINE PHOSPHATASE, SERUM

ALKALINE PHOSPHATASE 153 High 30 - 120 U/L
METHOD : P-NITROPHENYL PHOSPHATE, AMP BUFFER

Interpretation(s)
BILIRUBIN, DIRECT, SERUM-Conjugated (direct) bilirubin is elevated more than unconjugated (indirect) bilirubin in Viral hepatitis, Drug reactions, Alcoholic liver disease
Conjugated (direct) bilirubin is also elevated more than unconjugated (indirect) bilirubin when there is some kind of blockage of the bile ducts like in Gallstones getting into
the bile ducts, tumors & Scarring of the bile ducts.

Source: Tietz Text book of Clinical Chemistry & Molecular Diagnostics, 4th ed
BILIRUBIN, TOTAL, SERUM-Bilirubin is a yellowish pigment found in bile and is a breakdown product of normal heme catabolism. Bilirubin is excreted in bile and urine, and
elevated levels may give yellow discoloration in jaundice.Elevated levels results from increased bilirubin production (eg, hemolysis and ineffective erythropoiesis), decreased
bilirubin excretion (eg, obstruction and hepatitis), and abnormal bilirubin metabolism (eg, hereditary and neonatal jaundice).

An elevated bilirubin level in a newborn may be temporary and resolve itself within a few days to two weeks. However, if the bilirubin level is above a critical threshold or
rapidly increases, an investigation of the cause is needed so appropriate treatment can be initiated.

Source: Wallach"s Interpretation of Diagnostic tests, 9th ed2) Wallach"s interpretation of diagnostic tests, 9th ed
ALANINE AMINOTRANSFERASE, SERUM-Alanine aminotransferase (ALT) test measures the amount of this enzyme in the blood. ALT is found mainly in the liver, but also in
smaller amounts in the kidneys, heart, muscles, and pancreas. It is commonly measured as a part of a diagnostic evaluation of hepatocellular injury, to determine liver
health. . AST levels increase during acute hepatitis, sometimes due to a viral infection, ischemia to the liver, chronic hepatitis, obstruction of bile ducts, cirrhosis.
ASPARTATE AMINOTRANSFERASE, SERUM-Aminotransferase (AST) is an enzyme found in various parts of the body .AST is found in the liver, heart, skeletal muscle, kidneys,
brain, and red blood cells, and it is commonly measured clinically as a marker for liver health. AST levels increase during chronic viral hepatitis, blockage of the bile duct,
cirrhosis of the liver, liver cancer, kidney failure, hemolytic anemia, pancreatitis, hemochromatosis. AST levels may also increase after a heart attack or strenuous activity.
ALKALINE PHOSPHATASE, SERUM-Alkaline phosphatase (ALP) is a protein found in almost all body tissues. Tissues with higher amounts of ALP include the liver, bile ducts,
and bone. Elevated Alkaline Phosphaqtase levels are seen in Biliary obstruction,Osteoblastic bone tumors, osteomalacia, hepatitis, Hyperparathyroidism,Leukemia,
Lymphoma,Paget''''''''s disease,Rickets,Sarcoidosis etc. Lower-than-normal ALP levels seen in Hypophosphatasia, Malnutrition, Protein deficiency,Wilson''''''''s disease .

HAEMATOLOGY

CBC + ESR
BLOOD COUNTS
HEMOGLOBIN 12.6 12.0 - 15.0 g/dL
METHOD : CYANMETHEMOGLOBIN METHOD

RED BLOOD CELL COUNT 3.81 3.8 - 4.8 mil/µL

Page 1 Of 6
 DIAGNOSTIC REPORT

CLIENT CODE : C000041656

CLIENT'S NAME AND ADDRESS : SRL LIMITED

SRL LTD - IGMC SHIMLA-OPD INDIRA GANDHI MEDICAL COLLEGE
IGMC SHIMLA DIST. SHIMLA SHIMLA, 171001
HIMACHAL PRADESH, INDIA
SHIMLA 171001 Tel : 8894725124, Fax :
HIMACHAL PRADESH INDIA CIN - U74899PB1995PLC045956
08894725124 08894725124

PATIENT NAME : RUPA DEVI PATIENT ID : RUPAF200651141

ACCESSION NO : 0141SF010202 AGE : 68 Years SEX : Female DATE OF BIRTH :

DRAWN : 20/06/2019 16:04 RECEIVED : 20/06/2019 16:07 REPORTED : 20/06/2019 18:23

REFERRING DOCTOR : SELF CLIENT PATIENT ID :

Test Report Status Final Results Biological Reference Interval Units

METHOD : ELECTRICAL IMPEDANCE

WHITE BLOOD CELL COUNT 9.47 4.0 - 10.0 thou/µL

METHOD : ELECTRICAL IMPEDANCE

PLATELET COUNT 93 Low 150 - 410 thou/µL

METHOD : ELECTRICAL IMPEDANCE

RBC AND PLATELET INDICES

HEMATOCRIT 37.0 36 - 46 %
METHOD : ELECTRICAL IMPEDANCE

MEAN CORPUSCULAR VOL 97.0 83.0 - 101.0 fL

METHOD : CALCULATED PARAMETER

MEAN CORPUSCULAR HGB. 33.0 High 27.0 - 32.0 pg

METHOD : CALCULATED PARAMETER

MEAN CORPUSCULAR HEMOGLOBIN 34.0 31.5 - 34.5 g/dL

CONCENTRATION
METHOD : CALCULATED PARAMETER

RED CELL DISTRIBUTION WIDTH 12.2 11.6 - 14.0 %

METHOD : CALCULATED PARAMETER

MEAN PLATELET VOLUME 10.6 6.8 - 10.9 fL

METHOD : CALCULATED PARAMETER

WBC DIFFERENTIAL COUNT

SEGMENTED NEUTROPHILS 80 40 - 80 %
METHOD : LIGHT ABSORBANCE OF CYTOCHEMICAL STAINED CELLS IMPEDANCE

ABSOLUTE NEUTROPHIL COUNT 7.58 High 2.0 - 7.0 thou/µL

EOSINOPHILS 01 1-6 %
METHOD : LIGHT ABSORBANCE OF CYTOCHEMICAL STAINED CELLS IMPEDANCE

ABSOLUTE EOSINOPHIL COUNT 0.09 0.02 - 0.50 thou/µL

LYMPHOCYTES 16 Low 20 - 40 %
METHOD : LIGHT ABSORBANCE OF CYTOCHEMICAL STAINED CELLS IMPEDANCE

ABSOLUTE LYMPHOCYTE COUNT 1.52 1.0 - 3.0 thou/µL

MONOCYTES 03 2 - 10 %
METHOD : LIGHT ABSORBANCE OF CYTOCHEMICAL STAINED CELLS IMPEDANCE

ABSOLUTE MONOCYTE COUNT 0.28 0.2 - 1.0 thou/µL

BASOPHILS 00 <1-2 %
METHOD : LIGHT ABSORBANCE OF CYTOCHEMICAL STAINED CELLS IMPEDANCE

ABSOLUTE BASOPHIL COUNT 0 Low 0.02 - 0.10 thou/µL

DIFFERENTIAL COUNT PERFORMED ON: EDTA SMEAR
METHOD : AUTOMATED ANALYZER / MICROSCOPY

DISCLAIMER: THE ABSOLUTE WHITE CELL COUNTS ARE OUTSIDE THE NABL ACCREDITED SCOPE OF THE LABORATORY.
ERYTHRO SEDIMENTATION RATE, BLOOD

Page 2 Of 6
 DIAGNOSTIC REPORT

CLIENT CODE : C000041656

CLIENT'S NAME AND ADDRESS : SRL LIMITED

SRL LTD - IGMC SHIMLA-OPD INDIRA GANDHI MEDICAL COLLEGE
IGMC SHIMLA DIST. SHIMLA SHIMLA, 171001
HIMACHAL PRADESH, INDIA
SHIMLA 171001 Tel : 8894725124, Fax :
HIMACHAL PRADESH INDIA CIN - U74899PB1995PLC045956
08894725124 08894725124

PATIENT NAME : RUPA DEVI PATIENT ID : RUPAF200651141

ACCESSION NO : 0141SF010202 AGE : 68 Years SEX : Female DATE OF BIRTH :

DRAWN : 20/06/2019 16:04 RECEIVED : 20/06/2019 16:07 REPORTED : 20/06/2019 18:23

REFERRING DOCTOR : SELF CLIENT PATIENT ID :

Test Report Status Final Results Biological Reference Interval Units

SEDIMENTATION RATE (ESR) 60 High 0 - 20 mm at 1 hr

METHOD : MODIFIED WESTERGREN

PERIPHERAL SMEAR EXAM, EDTA WHOLE

BLOOD
RBC NORMOCYTIC AND NORMOCHROMIC
WBC WBCS ARE NORMAL IN NUMBER WITH ABSOLUTE NEUTROPHILIA
PLATELETS PLATELETS ARE MILDLY REDUCED IN NUMBER
METHOD : ROMANOWSKY STAINING + MICROSCOPIC EXAMINATION

IMPRESSION NEUTROPHILIA WITH MILD THROMBOCYTOPENIA

Interpretation(s)
BLOOD COUNTS-The cell morphology is well preserved for 24hrs. However after 24-48 hrs a progressive increase in MCV and HCT is observed leading to a decrease in MCHC.
A direct smear is recommended for an accurate differential count and for examination of RBC morphology.
RBC AND PLATELET INDICES-The cell morphology is well preserved for 24hrs. However after 24-48 hrs a progressive increase in MCV and HCT is observed leading to a
decrease in MCHC. A direct smear is recommended for an accurate differential count and for examination of RBC morphology.
ERYTHRO SEDIMENTATION RATE, BLOOD-Erythrocyte sedimentation rate (ESR) is a non - specific phenomena and is clinically useful in the diagnosis and monitoring of
disorders associated with an increased production of acute phase reactants. The ESR is increased in pregnancy from about the 3rd month and returns to normal by the 4th
week post partum. ESR is influenced by age, sex, menstrual cycle and drugs (eg. corticosteroids, contraceptives). It is especially low (0 -1mm) in polycythaemia,
hypofibrinogenemia or congestive cardiac failure and when there are abnormalities of the red cells such as poikilocytosis, spherocytosis or sickle cells.

Reference :
1. Nathan and Oski’s Haematology of Infancy and Childhood, 5th edition
2. Paediatric reference intervals. AACC Press, 7th edition. Edited by S. Soldin
3. The reference for the adult reference range is “Practical Haematology by Dacie and Lewis, 10th Edition”

COAGULATION

PROTHROMBIN TIME, PLASMA

PROTHROMBIN TIME (PT) 13.1 11.4 - 13.7 SECONDS
METHOD : CLOT DETECTION BY ELECTROMECHANICAL METHOD

INTERNATIONAL NORMALIZED RATIO (INR) 0.99 < 1.4 RATIO

METHOD : CALCULATED PARAMETER

MEAN NORMAL PT 13.3 SECONDS

Interpretation(s)
PROTHROMBIN TIME, PLASMA-Prothrombin Time measures the integrity of the extrinsic pathway and the adequacy of critical coagulation factors involved in it, namely, Factor
VII. This test is therefore, used for monitoring oral anticoagulation therapy which lowers the levels of multiple vitamin K dependent coagulation factors in blood (Factors II,
VII, IX and X) including Factor VII. The result of PT is expressed as International Normalized Ratio (INR) to neutralize the influence of variable sensitivity of the reagents
(thromboplastin) used in the assay by different laboratories.

Prolonged PT/INR is observed in hereditary or acquired deficiency of the relevant coagulation factors, vitamin K deficiency, liver disease, specific coagulation factor inhibitors
and nonspecific inhibitors of PT (eg, monoclonal immunoglobulins, elevated fibrin degradation products).

The following INR ranges are recommended for achieving optimal anticoagulation in different clinical conditions:

Diagnosis Target INR

Treatment of venous thrombosis 2.0 - 3.0

Treatment of pulmonary embolism 2.0 - 3.0
Prevention of systemic embolism 2.0 - 3.0
Tissue heart valves 2.0 - 3.0
Hypercoagulable states 2.0 - 3.0
Atrial fibrillation 2.0 - 3.0
Mechanical prosthetic valves (high risk) 2.5 - 3.5

Page 3 Of 6
 DIAGNOSTIC REPORT

CLIENT CODE : C000041656

CLIENT'S NAME AND ADDRESS : SRL LIMITED

SRL LTD - IGMC SHIMLA-OPD INDIRA GANDHI MEDICAL COLLEGE
IGMC SHIMLA DIST. SHIMLA SHIMLA, 171001
HIMACHAL PRADESH, INDIA
SHIMLA 171001 Tel : 8894725124, Fax :
HIMACHAL PRADESH INDIA CIN - U74899PB1995PLC045956
08894725124 08894725124

PATIENT NAME : RUPA DEVI PATIENT ID : RUPAF200651141

ACCESSION NO : 0141SF010202 AGE : 68 Years SEX : Female DATE OF BIRTH :

DRAWN : 20/06/2019 16:04 RECEIVED : 20/06/2019 16:07 REPORTED : 20/06/2019 18:23

REFERRING DOCTOR : SELF CLIENT PATIENT ID :

Test Report Status Final Results Biological Reference Interval Units

Bileaflet mechanical valve in aortic position 2.0 - 3.0

BIO CHEMISTRY

CREATININE, SERUM
CREATININE 1.05 High 0.51 - 0.95 mg/dL
METHOD : ALKALINE PICRATE-KINETIC

SERUM BLOOD UREA NITROGEN

BLOOD UREA NITROGEN 23 High 8 - 20 mg/dL
METHOD : UREASE - UV

ELECTROLYTES (NA/K/CL), SERUM

SODIUM 140 136 - 146 mmol/L
METHOD : ISE INDIRECT

POTASSIUM 3.25 Low 3.5 - 5.1 mmol/L

METHOD : ISE INDIRECT

CHLORIDE 104 101 - 109 mmol/L

METHOD : ISE INDIRECT

TOTAL PROTEIN,ALBUMIN,GLOBULIN, SERUM

TOTAL PROTEIN 8.2 6.6 - 8.3 g/dL
METHOD : BIURET, REAGENT BLANK, END POINT

ALBUMIN 4.0 3.5 - 5.2 g/dL

METHOD : BROMOCRESOL GREEN

GLOBULIN 4.2 g/dL

METHOD : CALCULATED PARAMETER

ALBUMIN/GLOBULIN RATIO 1.0 1.0 - 2.1 Ratio

METHOD : CALCULATED PARAMETER

PHOSPHORUS, SERUM
PHOSPHORUS 2.9 2.5 - 4.5 mg/dL
METHOD : PHOSPHOMOLYBDATE UV FORMATION

CALCIUM, SERUM
CALCIUM 9.4 8.8 - 10.6 mg/dL
METHOD : O-CRESOLPHTHALEIN COMPLEXONE

Interpretation(s)
CREATININE, SERUM-Higher 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 level may be due to:

• Myasthenia Gravis
• Muscular dystrophy
SERUM BLOOD UREA NITROGEN-Causes of Increased levels

Page 4 Of 6
 DIAGNOSTIC REPORT

CLIENT CODE : C000041656

CLIENT'S NAME AND ADDRESS : SRL LIMITED

SRL LTD - IGMC SHIMLA-OPD INDIRA GANDHI MEDICAL COLLEGE
IGMC SHIMLA DIST. SHIMLA SHIMLA, 171001
HIMACHAL PRADESH, INDIA
SHIMLA 171001 Tel : 8894725124, Fax :
HIMACHAL PRADESH INDIA CIN - U74899PB1995PLC045956
08894725124 08894725124

PATIENT NAME : RUPA DEVI PATIENT ID : RUPAF200651141

ACCESSION NO : 0141SF010202 AGE : 68 Years SEX : Female DATE OF BIRTH :

DRAWN : 20/06/2019 16:04 RECEIVED : 20/06/2019 16:07 REPORTED : 20/06/2019 18:23

REFERRING DOCTOR : SELF CLIENT PATIENT ID :

Test Report Status Final Results Biological Reference Interval Units

Pre renal
• High protein diet, Increased protein catabolism, GI haemorrhage, Cortisol, Dehydration, CHF Renal
• Renal Failure
Post Renal
• Malignancy, Nephrolithiasis, Prostatism

Causes of decreased levels

• Liver disease
• SIADH.
ELECTROLYTES (NA/K/CL), SERUM-ELECTROLYTES (NA/K/CL), SERUM

Sodium levels are Increased in dehydration, cushing''''''''s syndrome, aldosteronism & decreased in Addison''''''''s disease, hypopituitarism,liver disease. Hypokalemia (low K)
is common in vomiting, diarrhea, alcoholism, folic acid deficiency and primary aldosteronism. Hyperkalemia may be seen in end-stage renal failure, hemolysis, trauma,
Addison''''''''s disease, metabolic acidosis, acute starvation, dehydration, and with rapid K infusion.Chloride is increased in dehydration, renal tubular acidosis (hyperchloremia
metabolic acidosis), acute renal failure, metabolic acidosis associated with prolonged diarrhea and loss of sodium bicarbonate, diabetes insipidus, adrenocortical hyperfuction,
salicylate intoxication and with excessive infusion of isotonic saline or extremely high dietary intake of salt.Chloride is decreased in overhydration, chronic respiratory acidosis,
salt-losing nephritis, metabolic alkalosis, congestive heart failure, Addisonian crisis, certain types of metabolic acidosis, persistent gastric secretion and prolonged vomiting,
TOTAL PROTEIN,ALBUMIN,GLOBULIN, SERUM-TOTAL PROTEIN,ALBUMIN,GLOBULIN RATIO

Serum total protein,also known as total protein, is a biochemical test for measuring the total amount of protein in serum..Protein in the plasma is made up of albumin and
globulin.

Higher-than-normal levels may be due to: Chronic inflammation or infection, including HIV and hepatitis B or C, Multiple myeloma, Waldenstrom''s disease

Lower-than-normal levels may be due to: Agammaglobulinemia, Bleeding (hemorrhage), Burns, Glomerulonephritis, Liver disease, Malabsorption, Malnutrition, Nephrotic
syndrome, Protein-losing enteropathy etc.Human serum albumin is the most abundant protein in human blood plasma. It is produced in the liver. Albumin constitutes about
half of the blood serum protein. Low blood albumin levels (hypoalbuminemia) can be caused by:Liver disease like cirrhosis of the liver, nephrotic syndrome, protein-losing
enteropathy, Burns, hemodilution, increased vascular permeability or decreased lymphatic clearance,malnutrition and wasting etc.
CALCIUM, SERUM-Commom causes of decreased value of calcium (hypocalcemia) are chronic renal failure, hypomagnesemia and hypoalbuminemia.

Hypercalcemia (increased value of calcium) can be caused by increased intestinal absorbtion (vitamin d intoxication), increased skeletal reasorption (immobilization),
or a combination of mechanisms (primary hyperparathyroidism). Primary hyperparathyroidism and malignancy accounts for 90-95% of all cases of hypercalcemia.

Values of total calcium is affected by serum proteins, particularly albumin thus, latter’s value should be taken into account when interpreting serum calcium
levels. The following regression equation may be helpful.
Corrected total calcium (mg/dl)= total calcium (mg/dl) + 0.8 (4- albumin [g/dl])*
because regression equations vary among group of patients in different physiological and pathological conditions, mathematical corrections are only
approximations. The possible mathematical corrections should be replaced by direct determination of free calcium by ISE (available with srl) a common and
important source of preanalytical error in the measurement of calcium is prolonged torniquet application during sampling. Thus, this along with fist clenching
should be avoided before phlebotomy.
**End Of Report**
Please visit www.srlworld.com for related Test Information for this accession

Dr. Shailja Puri

Lab Head and Consultant
Pathologist

Page 5 Of 6
 DIAGNOSTIC REPORT

CLIENT CODE : C000041656

CLIENT'S NAME AND ADDRESS : SRL LIMITED

SRL LTD - IGMC SHIMLA-OPD INDIRA GANDHI MEDICAL COLLEGE
IGMC SHIMLA DIST. SHIMLA SHIMLA, 171001
HIMACHAL PRADESH, INDIA
SHIMLA 171001 Tel : 8894725124, Fax :
HIMACHAL PRADESH INDIA CIN - U74899PB1995PLC045956
08894725124 08894725124

PATIENT NAME : RUPA DEVI PATIENT ID : RUPAF200651141

ACCESSION NO : 0141SF010202 AGE : 68 Years SEX : Female DATE OF BIRTH :

DRAWN : 20/06/2019 16:04 RECEIVED : 20/06/2019 16:07 REPORTED : 20/06/2019 18:23

REFERRING DOCTOR : SELF CLIENT PATIENT ID :

Test Report Status Final Results Biological Reference Interval Units

CONDITIONS OF LABORATORY TESTING & REPORTING

1. It is presumed that the test sample belongs to the 5. The results of a laboratory test are dependent on
patient named or identified in the test requisition form. the quality of the sample as well as the assay
2. All Tests are performed and reported as per the technology.
turnaround time stated in the SRL Directory of services 6. Result delays could be because of uncontrolled
(DOS). circumstances. e.g. assay run failure.
3. SRL confirms that all tests have been performed or 7. Tests parameters marked by asterisks are excluded
assayed with highest quality standards, clinical safety & from the “scope" of NABL accredited tests. (If
technical integrity. laboratory is accredited).
4. A requested test might not be performed if: 8. Laboratory results should be correlated with clinical
a. Specimen received is insufficient or inappropriate information to determine Final diagnosis.
specimen quality is unsatisfactory 9. Test results are not valid for Medico- legal purposes.
b. Incorrect specimen type 10. In case of queries or unexpected test results please
c. Request for testing is withdrawn by the ordering call at SRL customer care (Toll free: 1800-222-000).
doctor or patient Post proper investigation repeat analysis may be carried
d. There is a discrepancy between the label on the out.
specimen container and the name on the test
requisition form

SRL Limited
Fortis Hospital, Sector 62, Phase VIII,
Mohali 160062

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