HEMATOLOGY REQUEST FORM

Surname: ANAYO Others: EZINNE

Nature of Specimen: BLOOD Age: AD Doctor’s name/signature
Lab Request No:B/06/058 Sex: F
Date:11/06/24 Time: Clinical summary/diagnosis:
HBSAG,HCV,PCV,RVS,VDRL
Parameter Unit Normal CLOTOLOGY

o HB ………… g/dl 12-18 o PT -----------

o PCV 32 % 35-54 o Bleeding time -------

o TWBC ………… X109/L 3-10.8 o Clothing Time --------

o PLATELET………… X109/L 150-400

o RETICS …………… % 0-2 o HCV: Non-reactive

o ESR ………… mm/hr 5-7

o HBSAG: Non-reactive

o Differentials o RVST: Non-reactive

Neutrophil ………… 40-75

o VDRL: Non-reactive

Lymphocyte ………… 20-40

o Hb Genotype: …………

Monocyte ………… 2-10 o Blood Group: ……………

Eosinophil ………… 1-6
FILM REPORT:
Basophil ………… 0-1
Blast …………
Promyelo …………
Myelo …………
Metamylocyte …………
Normoblast …………

OTHERS:

SIGN …………………………………….. DATE…………………..

MEDICAL LAB. SCIENTIST