Note For H.

Pylori Antigen Test:

Helicobacter pylori Antigen Test is a qualitative assay for the detection of H. pylori antigens in
human stool specimens. The test results are intended to aid in the diagnosis of H. pylori infection,
to monitor the effectiveness of therapeutic treatment, and to confirm the eradication of H.
pylori in peptic ulcer patients.

Note For Cyclospora:

Newly emerging Cyclospora cayetanensis is a coccidian protozoan parasite found in the chronic diarrhoeal
disease patient and in immunocompetent and immunocompromised patients worldwide
Individuals infected with Cyclospora may experience prolonged watery diarrhea, abdominal cramping, weight
loss, anorexia, myalgia, and occasionally vomiting and/or fever. Symptoms generally begin approximately 1 week
(5-8 days) after ingestion of oocysts and these may persist for a month or more. The small intestine becomes
inflammed, and the parasite causes mucosal changes that include villous atropy and crypt hyperplasia.

Note for Clue Cells:

Clue cells are epithelial cells of the vagina that get their distinctive stippled appearance by being covered
with bacteria. The detection of clue cells is the most useful single procedure for the diagnosis of bacterial
vaginosis. Women suffering from (BV) are at greatest risk of UTI than others.  If bacterial vaginosis and urinary
tract infections are misdiagnosed or mismanaged during pregnancy, the baby can become infected and
develop sepsis, meningitis, brain damage and conditions such as hypoxic ischemic encephalopathy
(HIE) and cerebral palsy.

Note for high platelets count:

Result is validated and verified by performing manual platelets count.
A high platelet count may be referred to as thrombocytosis. This is usually the result of an existing
condition (also called secondary or reactive thrombocytosis) such as:
- Cancer, most commonly lung, gastrointestinal, ovarian, breast or lymphoma
- Anemia, in particular iron-deficiency anemia and hemolytic anemia
- Inflammatory conditions such as inflammatory bowel disease (IBD) or rheumatoid arthritis
- Infectious diseases such as tuberculosis
- If an individual has had their spleen removed surgically
Some conditions may cause a temporary (transitory) increased platelet count. These may include:
- Recovery from significant blood loss such as from trauma or major surgery
- After physical activity or exertion
- Recovery from excess alcohol consumption and vitamin B12 and folate deficiency
NOTE FOR STOOL TEST:
The negative stool report does not mean you have no problem. Because single stool test gives only
33 % of sensitivity, it is advisable to test sample for 3 consecutive days to increase sensitivity
more than 90 %.

Note for TSH:

TSH concentrations are measured as part of a thyroid function test in patients suspected of having an
excess (hyperthyroidism) or deficiency (hypothyroidism) of thyroid hormones. Interpretation of the
results depends on both the TSH and T4 concentrations. In some situations measurement of T3 may also
be useful. A TSH assay is now also the recommended screening tool for thyroid disease. Recent
advances in increasing the sensitivity of the TSH assay make it a better screening tool than free T 4.A
TSH level test is also used to screen newborns for an underactive thyroid and to diagnose and monitor
female infertility problems. Occasionally, it is used to evaluate pituitary gland function. TSH
concentrations in children are normally higher than in adults.
Endocrine Research reveals that Production of TSH follows a circadian rhythm that is it follows a 24-
hour cycle with regular fluctuations.  TSH production peaks at its highest level between 2:00 and 4:00
am each morning and then drops reaching its low point between 4 and 8 pm in the evening. TSH levels
measured in blood samples drawn in the afternoon should be viewed with caution, as they may be
falsely low and appear normal.  Samples for all thyroid tests should be collected first thing in the
morning.  

Note For PT:

Normal range of INR: 0.8 -1.2
Therapeutic Normal range: 2 - 4
Note for PT: Prothrombin Time assesses the extrinsic and common coagulation pathway from
Factor VII through fibrin formation. Results are interpreted based on INR. A prolonged INR
suggests a potential bleeding disorder or if on warfarin therapy, a potential for bleeding
complications.

Note for Vitamin D Assay:

*Could be associated with osteomalacia or rickets
**May be associated with increased risk of osteoporosis or secondary hyperparathyroidism
***Optimum levels in the normal population
****80 ng/mL is the lowest reported level associated with toxicity in patients without primary hyperparathyroidism
who have normal renal function. Most patients with toxicity have levels >150 ng/mL. Patients with renal failure can have
very high 25-OH-VitD levels without any signs of toxicity, as renal conversion to the active hormone 1,25-OH-VitD is
impaired or absent.
These reference ranges represent clinical decision values that apply to males and females of all ages, rather than
population-based reference values. Population reference ranges for 25-OH-VitD vary widely depending on ethnic
background, age, geographic location of the studied populations, and the sampling-season. Population-based ranges
correlate poorly with serum 25-OH-VitD concentrations that are associated with biologically and clinically relevant
vitamin D effects and are therefore of limited clinical.

Note for Glucose (2 Hrs PP):

In the following condition (2 hrs PP test) may be lower than fasting blood sugar level.
1)Taking a hypoglycemic medicines
2)Not taking a proper lunch
3)Not in a actual fasting condition.(Attained late night party, taking high sugar containing meal in last night, Not in a
proper rest, )
4)In case of dawn Phenomenon
5) In case of the Somogyi effect

Note for H. pylori (IgG/IgM Antibody) test:

H.pylori antibody test can only detect the presence of H. pylori antibodies in the blood. It cannot
distinguish it is a current infection or previous one. This is because the test can be positive for years, even
if the infection is cured. As a result, blood tests cannot be used to see if the infection has been cured
after treatment.H.Pylori antigen test is used to diagnose the infection and confirm that it has been cured
after treatment.
Note For H.Pylori Antigen Test:
Helicobacter pylori Antigen Test is a qualitative assay for the detection of H. pylori antigens in
human stool specimens. The test results are intended to aid in the diagnosis of H. pylori infection,
to monitor the effectiveness of therapeutic treatment, and to confirm the eradication of H.
pylori in peptic ulcer patients.

Note for Mantoux Test:

Induration measuring 10 mm or more, This indicates hypersensetivity to tuberculoprotein and
indicates past or present infection with Mycobacterium tuberculosis.A positive tuberculine
reaction does not necessarily diagnose the presence of active disease.It searve only as an aid in
the diagnosis of Tubeculous infection.

Note for Hba1c:

Method: Immunofluorescence detection method.
Target HbA1c for diabeteic patient is 6.5% to 7.5%.
This assay is useful for diagnosing diabetes and evaluating long term control of blood glucose concentrations in
diabetic patients. It reflects the mean glucose concentration over the previous period of 8 to 12 weeks and is a
better indicator of long term glycemic control as compared with blood and urine glucose measurements.
Blood Culture Note:
The culture will be maintained for 5 days. In case if there is evidence of growth in between that, you will
be informed.
Note for Vitamin B12 Level:
A vitamin B12 level test measures the amount of B12 in your blood. B12 is an important vitamin for many
basic bodily functions, such as brain health, blood cell production, and proper nerve functioning. Low B12
levels can lead to serious nerve damage and deteriorating brain functions. New mothers who breastfeed
should also watch their vitamin B12 levels. Deficiency of this vitamin in the mother puts children at a
greater risk for neurological damage and developmental problems.
A vitamin B12 test is used to:
 Check for vitamin B12 deficiency anemia. There are several risk factors for this anemia, such as those
who have had stomach or intestinal surgery, small intestine problems, or people with a family history of
this anemia.
 Diagnose the cause of certain types of anemia, such as megaloblastic anemia.
 Help find the cause of dementia or other nervous system symptoms, such as tingling or numbness of the
arms or legs (peripheral neuropathy).
 See if vitamin B12 deficiency anemia is present after a person has been diagnosed with atrophic
gastritis.

Note for Iron:

Iron is an essential trace element primarily derived from dietary sources that is necessary for the
formation of red blood cells. Iron deficiency will lead to anemia (low levels of red blood cells), while
persistently high levels can be toxic to the body’s organs.
Abnormally high iron serum levels can indicate, hemolytic anemia or hemolysis (when your body does not
have enough healthy red blood cells) liver conditions, such as hepatic necrosis and hepatitis, iron poisoning
(when you’ve taken more than the recommended dose of iron supplements),iron overload (when your body
naturally retains too much iron)
Abnormally low iron levels may mean that you have not consumed enough iron or that your body is not
absorbing the iron properly. Regularly having heavy menstrual periods can also lead to low iron levels. In
other cases, low iron levels can indicate anemia, pregnancy, gastrointestinal blood loss

Note for Ferritin :

Ferritin functions as an intracellular site of iron storage.
Clinically significant concentrations are found in serum, and the
concentration of serum ferritin is directly related to total body iron
stores. Serum ferritin concentrations are determined to evaluate iron
stores in normal patients, patients with iron deficiency and iron
overload, and to monitor the response to iron therapy.

Note for CA-125:

Cancer antigen 125 “CA-125” is a protein found in ovarian cancer cells. The protein is produced by the cells
and is also found in the blood. The CA-125 blood test is used to measure the amount of CA-125 protein in
the bloodstream. Measurement of the protein using the CA-125 test is used to track response to treatment
for ovarian cancer. It is not used to screen for ovarian cancer because it can appear in high levels during
pregnancy, pelvic infections, or during normal menstruation. Elevated levels of CA-125 do not necessarily
confirm the presence of ovarian cancer or any other type of cancer. CA-125 levels may be elevated due to a
number of reproductive health issues. Treating a patient with ovarian cancer can use the CA-125 test to
help determine if treatment is effective. If CA-125 levels remain unchanged or increase during treatment,
this indicates that the cancer is not responding to treatment.

Note for AFP:

This is a useful assay for management of patients undergoing cancer therapy especially for testicular
tumors, ovarian tumors, metastatic cancers of liver and Hepatocellular carcinoma. It is often used in
conjunction with Human Chorionic Gonadotropin (hCG) test and unconjugated estriol as Triple screen or
Quad screen (inhibin A).
Maternal AFP: This is a useful test for prenatal screening for a subset of developmental abnormalities. It
is also used as a follow up testing for patients with elevated serum AFP or in conjunction with cytogenetic
testing. Some diseases in which AFP may be elevated are Omphalocele, Neural tube defects, Ataxia
telangectasia, Nonseminomatous germ cell tumors, viral hepatitis, alcoholic cirrhosis, adenocarcinomas of
lung, pancrease and gall blader etc.
Note for Carcinoembryonic antigen (CEA):
Application of CEA:
 To monitor the treatment of people diagnosed with colon cancer. As a marker for medullary thyroid
cancer and cancers of the rectum, lung, breast, liver, pancreas, stomach and ovaries. An initial CEA test
is ordered prior to treatment as a baseline value. Then it can be used to monitor a person’s response to
therapy and to determine whether the cancer has progressed or recurred.
 To determine prognosis and to stage cancer.
 In body fluids, helps determine if the cancer has spread to a body cavity.
A CEA test may be used in conjunction with other tumor markers in the evaluation of cancer. Do not
interpret serum CEA levels as absolute evidence of presence or the absence of malignant disease.
Higher levels can be found in non-cancerous disorders such as infections, cirrhosis of the liver, smoking,
and inflammatory bowel disease.
Smokers show a higher baseline level of CEA.

Notes on Total PSA:

Elevated concentration of PSA in serum is generally indicative of a pathological condition of the prostate
(prostatitis, benign hyperplasia or CA). Noncancerous condition such as enlarged or inflamed prostate can
also increase PSA levels. Free PSA levels should be estimated whenever total PSA is high. Higher total PSA
levels and lower percentages of free PSA are associated with higher risks of prostate cancer.
Males: When total PSA is in the range of 4.0-10.0 ng/mL, a free:total PSA ratio < or =0.10 indicates 49% to
65% risk of prostate cancer depending on age; a free:total PSA ratio >0.25 indicates a 9% to 16% risk of
prostate cancer, depending on age.
Females: Not applicable.

Note for TFT:

Free T3 is a supplemental test to TSH and Free T4 for confirmation of thyroid status. This assay also helps to
monitor thyroid hormone replacement therapy. Elevated levels are associated with Thyrotoxicosis or excess
thyroid hormone replacement. Free T4 is the metabolically active fraction of thyroxine. FT4 along with TSH
gives an accurate picture of thyroid status in patients with abnormal thyroid binding globulin (TBG) like in
pregnancy and individuals on treatment with estrogens, androgens, phenytoin or salicylates. This assay is useful
for diagnosing both Hypo / Hyper-thyroidism. TSH is an early indicator of decreased thyroid reserve. This assay
helps to diagnose hypothyroidism and hyperthyroidism, monitors T4 replacement or T4 suppressive therapy and
quantifies TSH levels in the subnormal range.

Note For Microalbumin:

This assay is used to evaluate diabetic patients to assess the potential of early onset of nephropathy before over
proteinuria develops. It is recommended that all Type 1 diabetic patients >12 years and all Type 2 diabetic patients < 70
years should be tested for microalbuminuria annually. Random collection of urine is acceptable, but preferred specimen
is 24 hour urine.
NOTE FOR BLASTOCYSTIS:
Blastocystis is a protozoal Parasite that inhabits the gastrointestinal tracts of humans and other
animals which may or may not cause disease in people. in some cases parasite causes diarrhea,
watery or loose stools, and abdominal pain. Many individuals carry the parasite but are
asymptomatic so correlate clinically.

NOTE FOR ENDOLIMAX NANA:

Endolimax nana is a amoeba that are found in the intestines of various animals, including in humans.
Originally thought to be non-pathogenic, studies suggest it can cause intermittent or chronic diarrhea so
correlate clinically.
NOTE FOR IODAMOEBA BUTSCHLII:
I. bütschlii is identified as a non-pathogenic parasite In terms of illnesses, humans have a low prevalence
of I. bütschlii (4-8%).I. butschlii is an indicator of oral-fecal contamination and humans may
experience diarrhea.

Note for Anti-TPO:

Note for Anti TPO
Determination of TPO antibody levels is the most sensitive test for detecting autoimmune thyroid disease like
Hashimoto thyroiditis (90%), Idiopathic myxedema and Graves’s disease (60-80%). Presence of TPO antibodies it
is especially useful in patients presenting with subclinical hypothyroidism where TSH is elevated but free T4 levels
are normal This assay helps in the diagnosis of thyroid autoimmune disorders and serves as a diagnostic tool in
deciding therapy for subclinical hypothyroidism.
Clinical Use
Confirm presence of autoimmune thyroid disease
Increased Levels
• Hashimoto thyroiditis
• Graves’s disease
• Postpartum thyroiditis
• Primary hypothyroidism due to Hashimoto thyroiditis

Interpretation of widal test:

 Timing of test is important, as antibodies begin to arise during end of first week. The titres increase
during second, third and fourth week after which it gradually declines. The test may be negative in early
part of first week.
 Single test is usually of not much value. A rise in titre between two sera specimens is more meaningful
than a single test. If the first sample is taken late in the disease, a rise in titre may not be demonstrable.
Instead, there may be a fall in titre.
 Baseline titre of the population must be known before attaching significance to the titres. The antibody
levels of individuals in a population of a given area give the baseline titre. A titre of 100 or more for O
antigen is considered significant and a titre in excess of 200 for H antigens is considered significant.
 Patients already treated with antibiotics may not show any rise in titre, instead there may be fall in titre.
Patients treated with antibiotics in the early stages may not give positive results.
 Patients who have received vaccines against Salmonella may give false positive reactions. This can be
differentiated from true infection by repeating the test after a week. True untreated infection results in rise
in titre whereas vaccinated individuals don’t demonstrate any rise in titre.
 Those individuals, who had suffered from enteric fever in the past, sometimes develop anti-Salmonella
antibodies during an unrelated or closely related infection. This is termed anamnestic response and can
be differentiated from true infection by lack of any rise in titre on repetition after a week.

Not for TPHA: A highly sensitive and specific test for the serologic diagnosis of syphilis, TPHA
is an indirect agglutination assay used for detection and titration of antibodies against the causative agent
of syphilis, Treponema pallidum subspecies pallidum.
Note for GCT:
Glucose challenge Test is done to screen for diabetes at 26-28 weeks of pregnancy called ‘Gestational
diabetes’. It is important to recognize diabetes in pregnancy because untreated diabetes can have negative
health effects for birth mother and baby.

Note for Beta hCG:

hCG under 5 mIU/ml: Negative, not pregnant.
hCG between 5-25 mIU/ml: Uncertain; possible pregnancy but not definitive. Repeat test in a couple of days.
hCG over 25 mIU/ml: You are pregnant!
Reference range for beta hCG in serum during pregnancy:
Weeks of gestation Beta hCG (mIU/mL)
3-4 weeks 16-156
4-5 weeks 101-4870
5-6 weeks 1110-31500
6-7 weeks 2560-82300
7-13 weeks 23100-291000
13-18 weeks 6140-103000
18-23 weeks 4720- 80100
23-41 weeks 2700- 78100

Reliable lab normal range of s.BhCG

Interpretation:
Men < 3.0 mIU/ml
Women < 10.0 mIU/m
Pregnancy Women
Week of amenorrhoea Expected hCG value (mIU/ml)
0.2-1 week 10 - 50
1-2 weeks 50 - 500
2-3 weeks 100 - 5000
3-4 weeks 500 - 10,000
4-5 weeks 1,000- 50,000
5-6 weeks 10,000-100,000
6-8 weeks 15,000-200,000
2nd & 3rd Month 10,000-100,000
2nd trimester 10,000- 30,000
3rd trimester 5,000 - 15,000
* Serial Samples from women in the first 2 - 5 weeks of pregnancy have doubling times for HCG concentration ranging from 1.5 - 3
days, with a mean doubling time of 2.2 days.
High levels are elevated in neoplasm which may or may not be of trophoblastic origin like Cancer of small -intestine, lung, testes, breast
and prostate. Hydatidiform mole,choriocarcinoma and cerebral metastases also show elevated levels.
Iron Profile:
Interpretation:
Disease Iron TIBC % saturation Ferritin
Iron Deficiency Low High Low Low
Hemochromatosis High Low High High
Chronic illness Low Low Low Normal/High
Hemolytic Anaemia High Normal/Low High High
Sideroblastic Anemia Normal/High Normal/High High High
Iron Poisoning High Normal High Normal

Clinical Information :
Prolactin is a hormone secreted by anterior pituitary gland, its secretion is controlled by
prolactin - inhibiting and prolactin releasing factors secreted by the
hypothalamus.Increased surge of this hormone occurs during sleep breast feeding,
pregnancy, nursing, stress or exercise. It is also elevated in prolactin-secreting pituitary
tumors, amenorrhea, galactorrhea, primary hypothyroidism, PCOD, anorexia and
paraneoplastic tumors. Low level can be noted in craniopharyngioma and pituitary
apoplexy.

Reference Value for TSH:

Age Group TSH (µIU/ml)

New Born: (0 day) 1.0 – 39.0
Children: (5 days) 1.7 – 9.1
(1 year) 0.4 – 8.6
(2 years) 0.4 – 7.6
(3 years) 0.3 – 6.7
(4 – 19 years) 0.4 – 6.2
Adult: (20 – 54 years) 0.4 – 4.2
(Above 55 years) 0.5 – 8.9
Pregnancy: 1st Trimester 0.3 – 4.5
2nd Trimester 0.5 – 4.6
3rd Trimester 0.8 – 5.2
Quality is…………….
Invisible when GOOD!
Impossible to ignore
when BAD!!
APC,KTM,Pathlab

Quality is a journey………
 Not a destination.

What Does 'Post-Meal (Or Post-Prandial) Blood Sugar'

Mean And What Does It Tell You?
Answer:

The word postprandial means after a meal; therefore, PP concentrations refer to

plasma glucose concentrations after eating. Many factors determine the PP Test. In

nondiabetic individuals, fasting plasma glucose concentrations (i.e., following an overnight

8- to 10-h fast) generally range from 70 to 110 mg/dl. Glucose concentrations begin to

rise ∼10 min after the start of a meal as a result of the absorption of dietary

carbohydrates. The PP is determined by carbohydrate absorption, insulin and glucagon

secretion, and their coordinated effects on glucose metabolism in the liver and

peripheral tissues.

The magnitude and time of the peak plasma glucose concentration depend on a

variety of factors, including the TIMING, QUANTITY, AND COMPOSITION OF THE

MEAL. In nondiabetic individuals, plasma glucose concentrations peak ∼60 min after the

start of a meal, rarely exceed 140 mg/dl, and return to Fasting levels within 2–3 hours.

Absorption of food persists for 5–6 hours after a meal in both diabetic and nondiabetic

individuals, the optimal time to measure postprandial (PP) glucose concentration must
be 2 hours after the start of a meal is practical. Specific clinical conditions, such as

gestational diabetes or pregnancy complicated by diabetes, may benefit from testing at 1

h after the meal.

HbA1C (glycosylated hemoglobin) Means:

Hemoglobin A1C is a measure of the degree to which hemoglobin is glycosylated in RBC

(Glucose molecule binds with hemoglobin irreversibly) and is expressed as a percentage

of total hemoglobin concentration. HbA1c levels provide an indication of the average

blood glucose concentration during the Period of 2–3 months, Blood glucose

concentrations vary widely during a 24-h period and from day to day in diabetes, the

measurement of HbA1c is the most accepted indicator of long-term Glucose control.

However, the HbA1c level does not provide a measure of the magnitude or frequency

of short-term fluctuations of blood glucose, which are particularly great in type 1

diabetes.

GLUCOSE TOLERANCE CURVE

320
300
280
--------Glucose concentration in mg/dL-------

260
240
220
200
180
160
140
120
100
80
60
40
20
0
0 30 60 90 120 150 180
--------Time In Minutes --------

Normal Minimum Normal Maximun Pre Diabetic Diabetes

Small minds discuss people
Average minds discuss events
Great minds discuss solution
Genius silently acts!