Report 190a3 1695110951228
Report 190a3 1695110951228
Report 190a3 1695110951228
BIOCHEMISTRY
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HbA1C is used to monitor fluctuations in blood glucose concentration in the past 8 to 12 week’s period.
The reference interval defined as per American Diabetes Association guidelines 2016:
a) Less than 5.7% : Non Diabetic
b) 5.7 to 6.4% : at increased risk of developing diabetes in the future
c) More than 6.5% : Diabetic
d) Therapeutic glycemic target:
i. Adults: less than 7%
ii. Children with Type 1 diabetes : less than 7 %
e) Pregnant diabetic patients : less than 6.5%
Note:
• Targets may be individualized based on: Age/life expectancy, Comorbid conditions, Diabetes duration , Hypoglycemia status,
Individual patient considerations
Reference: American Diabetes Association. Standards of medical care in diabetes—2021.
Mean Blood Glucose is average Blood glucose which directly correlates with A1C, reported in the same units as blood sugar levels
(mg/dl). Thus it reflects the average glucose concentration in the past 8 to 12 weeks period. This should not be compared with
Fasting or Post prandial or random blood sugar which measures glucose concentration at that point of time of testing.
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Lipid profile is a group test consisting of various lipids. Lipid profiles are generally collected with overnight fasting. However, Recent guidelines have
recommended non fasting samples for lipid profile for assessment of cardiovascular risk. The details for the study can be checked at
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2733560
In certain instances measurements in the same patient can show physiological and analytical variations. In such cases three serial samples at an interval of 1
week each are recommended for Total cholesterol, TG, HDL and LDL.
Cholesterol levels are increased in primary hypercholesterolemia; secondary hyperlipoproteinemia, including nephrotic syndrome; primary biliary cirrhosis;
hypothyroidism; and in some cases, diabetes mellitus. Low cholesterol levels may be found in malnutrition, malabsorption, advanced malignancy, and
hyperthyroidism.
Triglyceride levels are used in the diagnosis and treatment of patients with diabetes mellitus, nephrosis, liver obstruction, other diseases involving lipid
metabolism, or various endocrine disorders.
High Density Lipoprotein (HDL) cholesterol levels is used to evaluate the risk of developing coronary heart disease (CHD). The risk of CHD increases with
lower HDL cholesterol concentrations.
LDL (low-density lipoprotein) cholesterol level, sometimes called “bad” cholesterol, makes up most of our body’s cholesterol. High levels of LDL cholesterol
raise your risk for heart disease and stroke.
Very-low-density lipoprotein (VLDL) cholesterol is produced in the liver and released into the bloodstream to supply body tissues with triglycerides. High
levels of VLDL cholesterol have
been associated with the development of plaque deposits on artery walls, which narrow the passage and restrict blood flow.
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IMMUNOLOGY
Thyroid Stimulating Hormone (TSH), also called Thyrotropin is a hormone secreted into the blood by the Pituitary gland (a gland present in the
brain)). It signals the thyroid gland to make and release the thyroid hormones (T3 & T4) into the blood.
High TSH level indicates that the thyroid gland is not making enough thyroid hormone (primary hypothyroidism).
Low TSH level usually indicates that the thyroid is producing too much thyroid hormone (hyperthyroidism).
Fasting: TSH level shows a significant decline after meal intake in comparison to fasting values. This may have clinical implications in the
diagnosis and management of hypothyroidism, especially Subclinical hypothyroidism.1
Circadian Rhythm: TSH levels follow a circadian variation, reaching peak levels between Morning 2 – 4 am and at a minimum between Evening 6-
10 pm. The variation is of the order of 50%. hence time of sample collection during a day can significantly influence on the measured serum TSH
concentrations.2
Other Factors: Genetics, Poisonous substances and radiation exposure, Inflammation of the thyroid gland, Deficiency or excess of iodine in the
diet, Pregnancy, Certain medications – antidepressants, cholesterol lowering drugs, chemotherapy drugs, steroids, Thyroid cancer.
References:
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2. efaidnbmnnnibpcajpcglclefindmkaj/http://www.pnei-it.com/1/upload/thyrotropin_secretion_patterns_i n_health_and_disease.pdf
In pregnant females the reference range of TSH differs. Please refer the table below for the same:-
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CLINICAL PATHOLOGY
PHYSICAL EXAMINATION
Volume 28 ml
CHEMICAL EXAMINATION
pH 6.0 5.0-8.0
Double indicator method
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MICROSCOPY EXAMINATION
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