QO ge wererarferer at me sreieere fei. Krsnac’ aren wg sao ada eronht unflent acarar ‘SI. DIAGNOSTICS Medical Laboratory Report Patient Name 2 Mrs SONALI NAVALE Patient UID No :KNHP231100748602 Age and Gender: 36 Years / Female PRN No NHP231100748602 Category OPD - PMC KNH OPD Registered On 17 Nov 2023 15:46 Referring Doctor: MEDICINE OPD Sample UID No. # ‘Sample Processed at : KDLKNHMHPUNE411002 IMMUNOASSAY Test Done Observed Value Units Biological Reference Interval ‘anti CcP ( Cyclic -Citrulinated Peptide) 070 U/mt Negative: =<5.0 SERUM Postive:> 50 Indirect Chemiluminescence Immunoassay. TEST DESCRIPTION: ‘+ Rheumatoid arthritis (RA) is considered a systemic autoimmune disease with a main characteristic of chronic ointdestruction + RA affects 1% of the world’s population and can lead to severe disability. Evidence gained over the last few years suggests that aggressive therapy ven eatly inthe disease has the greatest therapeutic potential. Modern treatment of RAs shifting toward aggressive antirheumatic therapy in an early phase ofthe disease. «The identification of citrulline as a target of whole set of autoantibodies like antl perinuclear factor (APF), ant-Keratin antibodies (AKA), ant flaggrin antibodies (AFA), ete. It has been shown that all of these antibodies are directed to citruline-containing epitopes. «+ Gtulline is 2 non-standard amino acid, as it's not incorporated into proteins curing protein synthesis. Gut it can be generated via post-transation ‘masifcation of arginine residues by the enayme peptidyl arginine deiminase. ‘TEST INTERPRETATION: in 2007, the European League agninst Rheumatism (EULAR) published guidelines for the diagnosis of early RA, and the measurement of antibodies to ant-CCP was included as a serology marker. And then, in 2010, the American College of Rheumatology(ACR) also recommend anti-CCP as 8 serology ‘marker forthe early diagnosis of RA ‘TEST UMITATION: + Bacterial contamination or heat inactivation ofthe specimens may affect the test results + A result within expected range dose not rule out the presence of disease and shouldbe Interpreted together with the patient's clinical picture and other diagnostics procedures. «+ Diagnosis of a disease should not be based on the result of single test, but should be determined in conjunction with clinical findings in association with medical judgement. “+ Any therapeutical decision should aso be taken on a case bass ‘+ Patient sample containing human anti: mouse antibodies (HAMA) may ge falsely elevated or decreased values. Although HAMA- neutralizing a are added, extremely high HAMA plasma concentrations may occasionally infiuence results. Reflex Test = cRP ANALIEA, REFERENCES Maglumi 4000 Plus (kit Insert) Vitamin B12 - Serum 254.00 pe./ mi. Sample Type- Serum MIA, Test Description: + Vitamin 812 (B12), a member ofthe cori family, i cofactor forthe conversion of methyimalonyl Coensym '312{s.a cofactor inthe synthesis of methionine from homocysteine is implicated inthe formation of myelin, an synthesis. 812 Is absorbed from food ater binding toa protein called intrinsic factor which ts produced by the st Geficiency can be divided into three classes: nutritional deficiency, malabsorption syndromes, and other gastroi 1 12 deficiency can cause megaloblaste anemia MA), nerve damage and degeneration ofthe spinal cord. Lack «damages the myelin sheath that surrounds and protects nerves, which may lead to peripheral neuropathy. The ne ‘may become permanent debilitating, the underying condition isnot treated. People with intrinsic factor + Defects that do not gt treatment eventually develop a pernicious anemia. Test interpretation: ‘+A serum B1? level below the normal expected range may indicate that tissue B12 levels are hecoming depleted. Howeve Ksnae Diagnoses Ld (Formerly Krsnaa Diagnostics Put. Ltd.) Shad, Acta Noe OTS No 4518, Near Mayr Trade Cente, Cinchwad, Pune ti iisneadagnsice come UMONECM Page tof 8 11019, IndiaQO ge wererarferer at me sreieere fei. Krsnac’ aren wg sao ada eronht unflent acarar ‘SI. DIAGNOSTICS Medical Laboratory Report Patient Name Mrs SONALI NAVALE Patient UID No :KNHP231100748602 ‘Age and Gender: 36 Years / Female PRN No :KNHP231100748602 Category (PD - PMC KNH OPD Registered On :17 Nov 2023 15:46 Referring Doctor: MEDICINE OPD ‘Sample UID No. u ‘Sample Processed at : KDLKNHMHPUNE4 11002 IMMUNOASSAY Test Done Observed Value Units iological Reference Interval normal range does not ensure that 812 levels are healthy and symptomatic patients should be further evaluated with tests for holotranscobalamin. homocysteine and methyl malonic acid. ‘There are a number of conditions that are associated with low serum 812 levels, including iron deficiency, normal near-term pregnancy, vegetarianism, partial gastrectomy ileal damage, celiac disease, use of oral contraception, parasitic competition, pancreatic deficiency treated epilepsy and advancing age. * Disorders associated with elevated serum #12 levels include renal fallur, Iver ciseace, and mycloproliferative ceases. Test Umitation: Potentially Interfering Substances are + Biicubin ‘Total Protein + Triglycerides Reflex Tests: «+ Active Vitamin B12 10H + Homocysteine References: Insert (Alinity TSH 1.05 ul/mL —— 030-5S0uu/m. Tau Inpregeant Women = Fist timester-01-250 Second imester-0.2-30 Third vimester03-30 Neonate-070152 ay~2 Month~9 72-13 MIA, Test Description: ‘+ Human thyroid stimulating hormone (TSH) or thyrotropin isa glycoprotein with 2 molecular weight of approximatet the basophilic cells (thyrotropes) of tne anterioepruitary. “TSH composed of two non covalently linked subunits designated alpha and beta, Alpha subunit of TSH is comm follicle stimulating hormone (FSH) and human chorionic gonadotropin (nCG}, the beta subunits of these glycopr biological as well as immunological specificity. ‘TSH stimulate the production and secreation of the metabolically actve thyroid hormones, thyroxine (T4) And with a specfc receptor on the thyroid cells surface, T3 and Té ate responsible for reguating diverse blachemica {are essential for normal development and metabolic and neural activity, ‘Test Interpretation: in cases of primary hypothyroidism, 73 and T4 levels are low and TSH levels are significantly elevated, inthe a to intrinsic hypothalamic or pitultary disease: Le, central Hypothyroidism, normal or marginally elevated basal TS Significant. Secondary hypothyroidism typically results in an impaired TSH response of TRH, while in tertiary hypoth ‘may be normal, prolonged or exaggerated. ‘Test Limitation: + Result should be used in conjunction with other data: e.g. symptoms, result of other tests, and clinical impression. Ksnae Diagnoses Ld (Former Krsnaa Diagnostics Pt Ltd) Shad, Acta Noe OTS No 4518, Near Mayr Trade Cente, Cinchwad, Pune ti iisneadagnsice come UME Page 20f8 11019, IndiaQO ge wererarferer at me sreieere fei. Krsnac’ aren wg sao ada eronht unflent acarar ‘SI. DIAGNOSTICS Medical Laboratory Report Patient Name Mrs SONALI NAVALE Patient UID No :KNHP231100748602 ‘Age and Gender: 36 Years / Female PRN No :KNHP231100748602 Category (PD - PMC KNH OPD Registered On :17 Nov 2023 15:46 Referring Doctor: MEDICINE OPD ‘Sample UID No. u ‘Sample Processed at : KDLKNHMHPUNE4 11002 IMMUNOASSAY Test Done Observed Value Units iological Reference Interval ‘if the alinity 1 1SH results are inconsistent with clinical evidence, adltional testing ls recommended to confirm the result. + Suspected hyperthyroidism based oa low or undetectable TSH levels should confirmed with additonal «+ Function testing along with other clinical information + Specimens from patients who have received preparation of mouse monoclonal antibodies for diagnosis or therapy may contain human anti-mouse antibodies (HAMA). Such specimens may show either falsely elevated or depressed valves when tested with assay kts such as linity TSH that employ ‘mouse monoclonal antibodies. Additional information may be required for dlagnoss. ‘+ Heterothalic antibodies in human serum can react with reagent immunoglobulins, interfering with in Vitro immunoassays Patients routinely exposed to.animar's serum product can be prone to this Interference, and anomalous value may be required for dlagnosis. Reflex test: #713, FTA, Anti TPO , Anti TS References: kit insert (Alinity i) VITAMIN D TOTAL (25-OH) SERUM 21.90 ng/ml. utr Sample Type Serum Denient:<20 pie type: Insufficient : 20 -< 30 Sufficient: 30- 100 PEDIATRICS: Deficient: <15 Insufficient: 15 -< 20 Sufficient :20- 100 Toxicity: > 100 Mia, ‘Test Description: + Vitamin Disa fat-soluble steroid prohormone mainly produced photochemically in the ski from 7-dehyérocholestero. ‘Two forms of vitamin O are biologically relevant - vitamin 03 (Cholecalcferoljand vitamin 02 (Ergocalerol). oth vitamins D3 and D2 can be absorbed from food, with vitamin 02 being an artfcial source, but oniyan estimated 10-20% of vitamin 0 i supplied through nutritional + Vitamins D3 and 02 can be found in vitamin supplements, Vitamin Dis converted to the ative hormone 3,25-(0H)2-vitamin (Cal hydroxylation reactions. The fist hydroxylation converts vitamin D into 25-OH vitamin D and occursin the liver «The second hydroxylation converts 25-OH vitamin D into the biologically active 2,250#)2-vitamin D and occurs in the kd other calls ofthe body. Most cells express the vitamin D receptor and about 3% of the human genome i directly or indi endocrine system. Test interpretation: + Rsk factors for vitamin D deficiency include low sun exposure, malnutrition, some malabsorption syndromes, ani ‘The measurement of vitamin D status provides opportunities for preventive and therapeutic interventions. + Vitamin D deficiency sa cause of secondary hyperparathyroidism and diseases resulting in impaired bone met osteomalacia). Test Limitation: Potential interferent + Conjugated Bilirubin + Unconjugated stirubin ++ Hemoglobin ‘Total Protein + Trigiycerides = Biotin + Cholesterol + Rheumatoid Factor Kesnaa Diagnosis Lid (Formerly Krsnaa Diagnostics Put. Ltd.) Shots Aaa Ne CTS Nos, Nea Mayur Trade Cane, Chnchwad, Pune 0 2788002526271 noaronadagresice cm orwtereatlagnsies com 9 Page 3 of 8 11019, IndiaQO krsnagt Medical Laboratory Report Patient Name 3 Mrs SONALI NAVALE Patient UID No :KNHP231100748602 ‘Age and Gender: 36 Years / Female PRN No :KNHP231100748602 Category + OPD- PMC KNH OPD Registered On : Referring Doctor: MEDICINE OPD ‘Sample UID No. ‘Sample Processed at : KDLKNHMHPUNE41 1002 IMMUNOASSAY ‘Test Done Observed Value Units Biological Reference Interval + Goat Ant-Rabbit Antibodies Reflex Tests: + 1,25-(0H) vito Ta calcium References: kit insert (Alinity i) DR.MANISH D KAREKAR (MD-PATHOLOGY) COO. LAB MEDICINE/PATHOLOGY ~~ ENO OF REPORT ~~ ‘Sample Golecied On = 17.11.2023 15:47 Sample Accepted On 17.11.2023 16:18, 14201 Rosule Autenteatod : 17.11.2023 1746 FRoeults Roperiod 17.11.2023 17346 Prntod On = 18.11.2028-14:10, Kesnaa Diagnosis Lid (Famoiyteonoe Dastosics Pt Lid) Shoes Aten NO I CTS Nos, Near Mayur Trade Cente, Chnchwad, Pune-411 019, nea 0 2788002526271 noaronadagresice cm orwtereatlagnsies com 9 Page 4 of 8QO ge wererarferer at me sreieere fei. Krsnac’ aren wg sao ada eronht unflent acarar ‘SI. DIAGNOSTICS Medical Laboratory Report Patient Name Mrs SONALI NAVALE Patient UID No :kNHP231100748602 Age and Gender: 36 Years / Female PRN No Category + OPD - PMC KNH OPD- Registered On Referring Doctor MEDICINE OPD_ ‘Sample UID No. ‘Sample Processed at : KDLKNHMHPUNES1 1002 HEMATOLOGY Test Done ‘Observed Value Units Biological Reference Interval COMPLETE BLOOD COUNT COMPLETE BLOOD COUNT ( Sam 2 EDTA Haemoglobin 13.00 e/dl 110-160 Photometric Total Leucocyte Count 934 x10°3 ful 40-320 Eloctrical impedence Total Erythrocyte Count 397 x10%6 /uL 35-55 Elcctrical impedence Platelet count 263.00 x10°3 Jub 150-450 Electrical impedence ev 8.20 a Caleulated Pct 022 % Electrical impedence Pow 12.80 % Caleulated RBC, Indices HCT (P.CV.) 37.50 % 35-48 Caleulated Mv. 94.50 i 82-950 Measured MH. 32.90 pg 25-33 Measured MCHC 34.80 em/dl 33-37 Caleulated RD.W.CV 14.10 % a. Caleulated Differential W.B.¢. Count Neutrophils 52.40 % Cytochemistry & impedence/?S Lymphocytes 42.00 % Cytochemistry & impedence/?S Eosinophils 1.00 % Cytochemistry & impedence/?S Monocytes, 4.60 % Cytochemistry & impedence/PS Basophils 0.00 % Cytochemistry & impedence/PS ‘Absolute Count ‘Absolute Neutrophil Count aon x 10°3 Jub Caleulated Krsnaa Diagnostics Lt (Formerly Krsnaa Dlagnestics Pvt. Ltd.) 'S.No.243, A-Hissa No.6/6 CTS No.4519, Near Mayur Trade Centre, Chinchwad, Pune- 411 019, India 020 27350025 / 26/27 | info@krsnadiagnostics.com ww krsnaadiagnostics.com Page 5 of 8QO ge wererarferer at me sreieere fei. Krsna’ aia vig SaRORTER dures rorht rftenet aaTeR ‘SI. DIAGNOSTICS Medical Laboratory Report Patient Name Mrs SONALI NAVALE Patient UID No :KNHP231100748602 ‘Age and Gender: 36 Years / Female PRN No :KNHP231100748602 Category (PD - PMC KNH OPD Registered On :17 Referring Doctor: MEDICINE OPD sample UID No, HNMR IML FILLE Am ‘Sample Processed at : KDLKNHMHPUNE41 1002 HEMATOLOGY ‘Test Done Observed Value Units Biological Reference Interval COMPLETE BLOOD COUNT Absolute Count ‘Absolute Lymphocyte Count 3.92 1093 /ul Caleulated ‘Absolute Eosinophil Count 0.09 x 103 ul 9.04-0.48 Caleulated ‘Absolute Monocyte Count 0.42 10°3 /ul Caleulated ‘Absolute Basophil Count 0.02 41083 Jub Caleulated Peripheral Smear Findings: Abnormalities of Erythrocytes Normocytic Normochromic ‘Abnormalities of Leucocytes Within normal limits Platelets on smear Adequate ‘Test performed on fully automated 5 part differential cll counter. DR.SAURABH GUJRATHI (MD PATHOLOGY ) =~ END OF REPORT ~~~ Sample Colocted On 17.11.2023 15:47 ‘Sampo Accopieé On 17.11.2023 16:18. enon Feuts Aubertestod 517.11 2003 17:22 Results Repored 47.11.2023 17:23 Printed On: 18. Krsnaa Diagnostics Lt (Formerly Krsnaa Dlagnestics Pvt. Ltd.) 'S.No.243, A-Hissa No.6/6 CTS No.4519, Near Mayur Trade Centre, Chinchwad, Pune- 411 019, India 020 27350025 / 26/27 | info@krsnadiagnostics.com ww krsnaadiagnostics.com Page 6 of 8QO ge wererarferer at me sreieere fei. Krsnac’ aren wg sao ada eronht unflent acarar ‘SI. DIAGNOSTICS Medical Laboratory Report Patient Name 2 Mrs SONALI NAVALE Patient UID No :KNHP231100748602 Age and Gender: 36 Years / Female PRN No NHP231 100748602 Category OPD - PMC KNH OPD Registered On 17 Nov 2023 15:46 Referring Doctor : MEDICINE OPD ‘Sample UID No. a ‘Sample Processed at : KDLKNHMHPUNE411002 BIOCHEMISTRY Test Done Observed Value Units Biological Reference Interval RA Factor <200 lu/mi Negative Less than 30.0 Serum Positve More than 300 Immunoturbidometric Test Description: “The sera of most Rheumatoid arthritis patients will react with human IgG and the IgG of other animals due tothe presence of animmunoglobulin [in ‘most cases ofthe IgM type] known as the RF, During this reaction, which ison the antigen-antibody type, RF acts as an anti-IgG antibody. Test interpretation: + Positive tests, indicating the existence of RF, may be decisive forthe diagnosis ofthe RA inpatients with inlammatory arthits, Test Limitation: + Trighcerides, Hemoglobin(Ht), Intralipid are potentially interfering endogenous substances. ‘+ For diagnostic purpose, the test finding should always be assessed in conjunction with the patient's medical history, cinical ecaminations and other findings. Reflex Test: Serum Anti CCP References: Alnity ci (Kit Insert) Uric Acid - Serum 2.90 mg/dl. 26-60 Serum Uriease Test Description: + Uric acid isa metabolite of purines, nucleic acids and nucleaproteins. + Consequently, abnormal levels may be indicative of a disorder in the metabolism of these substances. ‘Test Interpretation: ‘+ Hyperuriceria may be observed in renal dysfunction, gout, leukemia, polycythemia, atherosclerosis, diabetes, hypothyroidism diseases. *+ Decreased levels ae presentin patients with Wilson's disease. ‘Test Limitation: + ascorbate, bilirubin, glucose, hernoglobin,itralipid are potentially interfering endogenous substances. + For diagnostic purpose, the test finding should always be assessed in conjunction with the patient's medical histo finaings. Reflex Test + Creatinine Reforences:Alinity cl (Kit Insert) Kesnaa Diagnosis Lid (Formerly Krsnaa Diagnostics Put. Ltd.) Shoes Aten NO I CTS Nos, Near Mayur Trade Cente, Chnchwad, Pune-411 019, nea 0 2788002526271 noaronadagresice cm orwtereatlagnsies com 9 Page 7 of 8QO krsnad DIAGNOSTICS DR.SAURABH GUJRATHI (MD PATHOLOGY ) ~~ END OF REPORT ——~ ‘Sampo Collected On = 17.11.2023 15:47 ‘Sample Accopted On 17.11.2023 16:18, 18828 Resute Auentested : 17.11.2023 1746 Resuts Reported “17.11.2023 17-45 Printed On: 18.17.2028 11:10 Krsnaa Diagnostics Ltd. (Formerly Krsnaa Diagnostics Pvt.Ltd.) S.No 243, A-Hissa No 6/6 CTS No 4519, Near Mayur Trade Centre, Chinchwad, Pune- 411 019 , India (020 27850025 / 26 27 | info@krsnadiagnostics.com _werw.krsniaadiagnosties.com Page 8 of 8