LABORATORIUM

Jl. Siloam No. 6, Lippo Karawaci 1600, Tangerang 15811

Telp. (+62 21) 8064 6900 Fax. (+62 21) 5460 066
LIPPO VILLAGE
LABORATORY RESULT
Patient Name : LANITA TERTAMULIA Order Time : 28-02-23 18:14
Address : Taman Ayu No.515 Specimen Received : 01-03-23 09:16
Lippo Karawaci-Tangerang Print Out : 01-03-23 15:09
DOB/Sex : 10-05-1944 / Female Lab No. : 23047171
Ward : OUTPATIENT Room :
Physician : Reg. No. : HPA2302280003
MR. No. : 00214031 Page :1 / 4
Clinical Info : RUTIN

Test Result Unit Reference Range

HEMATOLOGY

Full Blood Count

Haemoglobin 12.40 g/dL 11.70 - 15.50
Hematocrit L 34.20 % 35.00 - 47.00
Erythrocyte (RBC) L 3.74 10^6/µL 3.80 - 5.20
White Blood Cell (WBC) 10.63 10^3/µL 3.60 - 11.00
Differential Count
Basophil 0 % 0 - 1
Eosinophil 1 % 1 - 3
Band Neutrophil 3 % 2 - 6
Segment Neutrophil 65 % 50 - 70
Lymphocyte 25 % 25 - 40
Monocyte 6 % 2 - 8
Platelet Count 263.00 10^3/µL 150.00 - 440.00
ESR H 29 mm/hours 0 - 20
MCV, MCH, MCHC
MCV 91.40 fL 80.00 - 100.00
MCH 33.20 pg 26.00 - 34.00
MCHC H 36.30 g/dL 32.00 - 36.00

D-dimer H 0.42 µg/mL 0.00 - 0.3

Thrombocyte Aggregation
Agregasi + 1 µM ADP 2.1 % 0.5 - 14.3
Agregasi + 2 µM ADP 8.6 % 12.3 - 32.1
Agregasi + 5 µM ADP 25.9 % 41.6 - 76.4
Agregasi + 10 µM ADP 44.0 % 57.5 - 89.1
Conclusion Hipoagregasi

BIOCHEMISTRY

Fungsi Ginjal
Ureum 30.0 mg/dL <71.00
 LABORATORIUM
Jl. Siloam No. 6, Lippo Karawaci 1600, Tangerang 15811
Telp. (+62 21) 8064 6900 Fax. (+62 21) 5460 066
LIPPO VILLAGE
LABORATORY RESULT
Patient Name : LANITA TERTAMULIA Order Time : 28-02-23 18:14
Address : Taman Ayu No.515 Specimen Received : 01-03-23 09:16
Lippo Karawaci-Tangerang Print Out : 01-03-23 15:09
DOB/Sex : 10-05-1944 / Female Lab No. : 23047171
Ward : OUTPATIENT Room :
Physician : Reg. No. : HPA2302280003
MR. No. : 00214031 Page :2 / 4
Clinical Info : RUTIN

Test Result Unit Reference Range

Creatinine
Creatinine 0.58 mg/dL 0.5 - 1.1
eGFR 92.6 mL/mnt/1.73 m^2 GFR Comment
>= 90 Normal kidney function
CKD EPI 2021
Uric Acid 3.30 mg/dL 2.6 - 6.0

SGOT - SGPT
SGOT (AST) 19 U/L 0 - 32
SGPT (ALT) 31 U/L 0 - 33

Lipid Profile
Total Cholesterol 91 mg/dL Lipid Consensus 2004:
- <200 Desirable
- 200 - 239 Moderate
- >=240 High
HDL Cholesterol (Direct) L 30.0 mg/dL Lipid Consensus 2004:
- <40 Low
- >=60 High
non-HDL Cholesterol 61.0 mg/dL Treatment goal :
<80 Extreme risk
<100 Very high risk
<130 High risk
<130 Moderate risk
<160 Low risk
Reff : AACE 2020 clinical
assessment based on risk factors.
LDL Cholesterol (Direct) 50 mg/dL Lipid Consensus 2004:
- <100 Optimal
- 100-129 Near Optimal
- >=130 High
Trygliceride 130 mg/dL 50 - 150

Fasting Blood Glucose 108.0 mg/dL DIABETIC CONSENSUS 2011:

Moderate - < 100 Desireable
- 101 - 125 Moderate
- >= 126 High Risk
Impaired Fasting Blood Glucose if
100 <= FBG <= 126
and 2-hours Glucose Tolerance
Test <140
 LABORATORIUM
Jl. Siloam No. 6, Lippo Karawaci 1600, Tangerang 15811
Telp. (+62 21) 8064 6900 Fax. (+62 21) 5460 066
LIPPO VILLAGE
LABORATORY RESULT
Patient Name : LANITA TERTAMULIA Order Time : 28-02-23 18:14
Address : Taman Ayu No.515 Specimen Received : 01-03-23 09:16
Lippo Karawaci-Tangerang Print Out : 01-03-23 15:09
DOB/Sex : 10-05-1944 / Female Lab No. : 23047171
Ward : OUTPATIENT Room :
Physician : Reg. No. : HPA2302280003
MR. No. : 00214031 Page :3 / 4
Clinical Info : RUTIN

Test Result Unit Reference Range

HbA1C (Glyco Hb)

HbA1C (NGSP) 5.4 % Immunoturbidimetry Method
PERKENI Consensus 2015 for
Diagnosis Diabetes & Pre-Diabetes:
< 5.7 Normal
5.7 - 6.4 Pre-Diabetes
>= 6.5 Diabetes Mellitus
Controlled Diabetic recommendation
< 7
Estimated Average Glucose 108 mg/dL
HbA1C (IFCC) 35.52 mmol/mol 20 - 40

Electrolyte (Na, K, Cl)

Sodium (Na) L 126 mmol/L 137 - 145
Potasium (K) 3.7 mmol/L 3.6 - 5.0
Chloride (Cl) L 90 mmol/L 98 - 107

IMMUNOLOGY/SEROLOGY

Vitamin D Total (25 OH) L 27.5 ng/mL Status Vitamin D :

- Normal : > 30
- Insufisiensi : 21 - 29
- Defisiensi : =< 20
CRP-Hs 0.54 mg/L 0.00 - 3.00

HORMONE

Cortisol ( Morning ) L 0.49 µg/dL 6.2 - 19.4

Nilai rujukan Cortisol Jam 07.00 -
10.00
Cortisol ( Afternoon ) Pending

URINALYSIS

Urine Feme
Macroscopic
Color Yellow
Appearance Slightly Cloudy Clear
 LABORATORIUM
Jl. Siloam No. 6, Lippo Karawaci 1600, Tangerang 15811
Telp. (+62 21) 8064 6900 Fax. (+62 21) 5460 066
LIPPO VILLAGE
LABORATORY RESULT
Patient Name : LANITA TERTAMULIA Order Time : 28-02-23 18:14
Address : Taman Ayu No.515 Specimen Received : 01-03-23 09:16
Lippo Karawaci-Tangerang Print Out : 01-03-23 15:09
DOB/Sex : 10-05-1944 / Female Lab No. : 23047171
Ward : OUTPATIENT Room :
Physician : Reg. No. : HPA2302280003
MR. No. : 00214031 Page :4 / 4
Clinical Info : RUTIN

Test Result Unit Reference Range

Specific Gravity 1.005 1.000 - 1.030

pH 7.0 4.50 - 8.00
Leucocyte Esterase (1+) 70 cells/µL Negative
Nitrit Negative Negative
Protein Negative mg/dL Negative
Glucose Negative mg/dL Negative
Keton Negative mg/dL Negative
Urobilinogen 0.2 mg/dL 0.10 - 1.00
Bilirubin Negative Negative
Occult Blood Negative cells/µL Negative
Microscopic
Erythrocyte 1 cells/µL 0 - 3
Leucocyte H 11 cells/µL 0 - 10
Epithel (1+) (1+)
Casts Negative
Crystals Negative
Others Bacteria (1+)

Aerob M.O. Culture Pending

Clinical Pathologist : NAMA & PARAF DOKTER

David Rustandi, dr. SpPK
Tandry Meriyanti, dr. SpPK Authorized By Nuraini Alawiyah
TGL JAM: Authorisation Date : 01-03-23 14:10
A laboratory assessment can only be given by a doctor who has patient clinical data.
This laboratory has been verified electronically, no signature required