IX.

LABORATORY AND DIAGNOSTIC RESULTS

A. Hematology

NORMAL REFERENCE
TEST March 25, 2017 (ER)
VALUE
Hemoglobin 129 - 159 g/L 100
RBC 4.06 - 5.58 106uL 3.69
Hematocrit 0.377 - 0.537 0.295
WBC 3.370 - 10.1 103uL 6.89
Lymphocytes 18.0 - 48.3 25.0
Neutrophils 39.3 - 73.7 55.6
Eosinophils 0.600 - 7.30 13.0
Monocytes 4.40 -12.7 5.5
Platelet 155 - 366 309
MCV 81.1 - 96.0 fL 80.1
MCH 27.0 - 31.2 pg 27.0
MCHC 31.8 - 35.4 33.8

NORMAL REFERENCE
TEST March 30 ( MED-ANNEX)
VALUE
Hemoglobin 129 - 159 g/L 90
RBC 4.06 - 5.58 106uL 3.48
Hematocrit 0.377 - 0.537 0.284
WBC 3.370 - 10.1 103uL 8.15
Lymphocytes 18.0 - 48.3 30.1
Neutrophils 39.3 - 73.7 43.1
Eosinophils 0.600 - 7.30 19.6
Monocytes 4.40 -12.7 6.1
Platelet 155 - 366 311
MCV 81.1 - 96.0 fL 81.6
MCH 27.0 - 31.2 pg 25.9
MCHC 31.8 - 35.4 31.8

IMPLICATIONS

Low Hgb, Hct, and RBC

Anemia is relatively common in patients with diabetes mellitus, and low haemoglobin concentration

contributes to many clinical aspects of diabetes mellitus or its progression. Low haemoglobin concentrations in patients

with diabetes mellitus are associated with a more rapid decline in glomerular filtration rate than that of other kidney

diseases. Diabetic nephropathy and diabetic retinopathy result in increased susceptibility to low haemoglobin.

It should also be noted that, due to the development of diabetes mellitus, the nephropathy may arise,

which further undermines the renal production of erythropoietin positively contributing to an increased anaemic

framework. According to Escorci et. al approximately 40% of diabetic patients are affected by kidney diseases. The
decreased renal functions and proinflammatory cytokines are the most important factors in determining reduction of

haemoglobin levels in these patients.

The inflammatory situation created by kidney disease also interferes with intestinal iron absorption.

Therefore, diabetic patients with kidney disease have higher risk for developing anemia.

Low haematocrit is a common side effect of many illnesses and of drug therapies like metformin. Reduction

in kidney function that occurs in diabetes can also cause lower haematocrit level.

Increase Eosinophil

A chronic low-grade activation of the immune system, which can be detected by an increase in number of

markers, including white blood cells count and cytokines, may play a major role in the pathogenesis of Type 2 Diabetes.

Eosinophil, one type of WBC becomes active when people have certain allergic diseases and infection. Elevated levels of

white blood cells in your blood are a good indicator that you have an illness or infection. Elevated levels mean your body

is sending more and more WBC to fight off infections.

Low Mean Corpuscular volume (MCV)

 - It measures the size of a patient’s red blood cells; a low MCV number indicates smaller-than-

normal RBCs. A decrease in the MCV implies some abnormality in Hgb synthesis. The most

common cause of microcytic erythrocytes (microcytosis) is iron deficiency.

B.1 Blood Chemistry

Date Conducted: March 25, 2017

CONVENTIONAL
TEST SI UNITS
RESULT RESULT UNITS
NAME
RANGE UNIT RANGE UNIT
136-145 136-145
Sodium 123.21 mmol/L 123.21 mmol/L
mmol/L mmol/L
3.5-5.1 3.5-5.1
Potassium 4.49 mmol/L 4.49 mmol/L
mmol/L mmol/L
45-84 0.51-0.95
Creatinine 185.70 umol/L 2.10 mg/Dl
umol/L mg/dL
2.86-8.21 8-23
BUN 10.75 mmol/L 30.12 mg/dL
mmol/L mg/dL
39.7-49.4 3.97-4.94
Albumin 22.15 g/L 2.22 g/dL
g/L g/dL
0.66- 0.99 1.6-2.4
Magnesium 0.89 mmol/L 2.17 mg/dL
mmol/L mg/dl
202.3-416.5 3.4-7.0
BUA 455.34 umol/L 7.66 Mg/dL
umol/L mg/dL
SGPT/ALT 12.56 0-41 U/L U/L 12.56 0-41 U/L U/L
SGOT/AST 12.96 0-40 U/L U/L 12.96 0-40 U/L U/L
Date Conducted: March 30, 2017

CONVENTIONAL
TEST SI UNITS
RESULT RESULT UNITS
NAME
RANGE UNIT RANGE UNIT
136-145 136-145
Sodium 132.10 mmol/L 132.10 mmol/L
mmol/L mmol/L
3.5-5.1 3.5-5.1
Potassium 4.91 mmol/L 4.91 mmol/L
mmol/L mmol/L
2.15- 2.55 0.51-0.95
Calcium 2.01 mmol/L mg/Dl
mmol/L mg/dL
Albumin 21.20 39.7-49.4 g/L 21.20 3.97-4.94 g/dL
g/L g/dL
Magnesium 0.87 0.66- 0.99 mmol/L 0.87 1.6-2.4 mg/dL
mmol/L mg/dl
4.11- 74-106
FBS 18.63 Mmol/L 338.65 Mg/dl
5.89mmol/L mg/dL
Total 0- 5.20 0-200
6.51 Mmol/L 251.3 Mg/dl
cholesterol mmol/L mg/dl
Triglycerides 0-2.26 0-200 Mg/dl
1.70 Mmol/L 150.78
mmol/L mg/dl
> 1.45
HDL 1.22 Mmol/L 47.20 >55 mg/dl Mg/dl
mmol/L
2.6- 4.1
LDL 4.52 Mmol/L 180.80
mmol/L

IMPLICATIONS

Low Sodium
 Hyperglycaemia increases serum osmolality, resulting in movement of water out of the cells and subsequently

in a reduction of serum sodium levels by dilution. Patients with diabetic nephropathy and chronic renal failure are very

prone to the development of hyponatremia due to decreased water excretion.

Elevated Creatinine level

As the kidneys become impaired for any reason, the creatinine level in the blood will rise due to poor

clearance of creatinine by the kidneys. Elevated creatinine level signifies impaired kidney function or kidney disease.

Elevated Blood Urea nitrogen (BUN)

BUN level is another indicator of kidney function. Urea is also a metabolic byproduct which can build up if

kidney function is impaired. The BUN- creatinine ratio generally provides more precise information about kidney function

and its possible underlying cause compared with creatinine level alone.

Elevated Albumin level

 Albumin is a protein that is present in high concentrations in the blood. Virtually no albumin is present in the

urine when the kidneys are functioning properly. Very high levels are an indication that kidney disease is present in a

more severe form.

Elevated Blood Uric Acid (BUA)

High levels of uric acid in blood typically indicate that our body is making too much uric acid or kidneys aren’t

removing enough uric acid from our body. High uric acid levels in the blood can also indicate diabetes.

Low Calcium

Decreased Calcium level in the blood indicates kidney dysfunction, which results in more calcium excreted in

urine and makes the kidneys less able to activate Vitamin D.

Increased Total Cholesterol, Low HDL and High LDL

Diabetes can upset the balance between HDL and LDL cholesterol levels. People with diabetes tend to have LDL

particles that stick to arteries and damage blood vessel walls more easily. Glucose attaches to lipoproteins ( a cholesterol-

protein package that enables cholesterol to travel through blood). Sugarcoated LDL remains in the bloodstream longer

and may lead to the formation of plaque.

 Diabetes tends to lower “good” cholesterol levels and raise triglyceride and “bad” cholesterol levels, which

increases the risk for heart disease and stroke. This common condition is called diabetic dyslipidemia. Diabetic

dyslipidemia means your lipid profile is going in the wrong direction.

High Fasting Blood Sugar level

High blood sugar usually comes on slowly. It happens when you don’t have enough insulin in your body. In

order to use the glucose, our body needs insulin. Insulin helps transport glucose into the cells, particularly in the muscle

cells. In type 2 DM, patient may have enough insulin, but their body doesn’t use it well, they’re insulin resistant. Some

people with type 2 DM may not produce enough insulin.

Date Conducted: March 26, 2017

 URINALYSIS
TEST RESULT UNIT REFERENCE RANGE REMARKS
PHYSICAL EXAMINATION
Color YELLOW
Character SLIGHTLY TURBID
Reaction 6.0
Specific Gravity 1.015
CHEMICAL EXAMINATION
Blood ++
Bilirubin NEGATIVE
Urobilinogen NORMAL
Ketone NEGATIVE
Protein ++
Glucose ++
Nitrate NEGATIVE
Leukocytes +
URINE FLOW CYTOMETRY
WBC 46.90 H /ul 0-11
* 8 /HPF 0-2
RBC 303.30 H /ul 0-11
* 55 /HPF 0-2
Epithelial Cells 50.30 H /ul 0-11
* 9 /HPF 0-2
CAST 16.57 H /ul 0-1
* 48 /HPF 0-3
Bacteria 42.70 /ul 0-111
* 8 /HPF 0-20

IMPLICATIONS

Urine tests may be done in people with diabetes to evaluate severe hyperglycemia by looking ketones in the

body. Ketones are a metabolic product produced when fat is metabolized. Ketones increase when there is insufficient

insulin to use glucose for energy. Testing for ketones is most common in people with type 1 diabetes.

Turbidity and other terms are used to characterized the appearance of urine specimen. Urine may contain

red or white blood cells, bacteria, fat, or chyle and may reflect renal or urinary tract infection.

Only a very small amount of protein should be excreted into the urine in a 24- hour period (normal is 0

trace). Albumin is usually the first protein to be excreted in disease conditions. Some of the disease conditions which can

cause proteinuria are renal disease, fever, CHF, hypertension, tumors and others.

Serum glucose levels are obviously important in diabetes, and so is the spilling of glucose into the urine.

Glucose levels may also be raised or lowered in several other conditions as well as diabetes.
 A positive chemical test for haemoglobin and an increase number of RBCs seen under the microscope

indicates that there is a blood in the urine. However, this test cannot be used to identify where the blood is coming from.

WBC’s are most common often present in the urine due to direct infection/ inflammation of the renal system.

An infection in the urinary tract or in the kidney itself is usually the most common reason for this inflammation.

Casts are solid, formed elements which appear in the urine, secondary to some other type of cell

destruction. They can also be formed from other waste material as well as from dead cells.

Epithelial cells are usually reported as few, moderate, or many present per low power field (LPF). Normally,

in men and women, a few epithelial cells can be found in the urine sediment. In urinary tract conditions such as

infections, inflammations, and malignancies, an increased number of epithelial cells are present.