analyse_media
Here is a full interpretation of the lab report for Neelappa M Tumbad, 55-year-old male, dated 13/07/2020.
Haematology Report - Interpretation
Abnormal Values (flagged)
| Test | Patient Value | Normal Range | Status | Significance |
|---|---|---|---|---|
| PCV (Haematocrit) | 34.2% | 35-50% | ⬇ Low | Mild anaemia |
| MCV | 75 fL | 80-97 fL | ⬇ Low | Microcytic (small RBCs) |
| MCH | 26.0 pg | 26.5-33.5 pg | ⬇ Low (borderline) | Hypochromic (less Hb per cell) |
| RDW | 16.2% | 10-15% | ⬆ High | Anisocytosis (unequal RBC sizes) |
Normal Values
- Haemoglobin: 12.3 gm% - within range (11-16.5), but on the lower side for a male
- Total WBC: 9,500 cells/cmm - normal, no infection/inflammation signal in blood
- Differential count (Neutrophils, Lymphocytes, Eosinophils, Monocytes, Basophils) - all normal
- Total RBC: 4.73 million/cmm - normal
- MCHC: 35.0 g/dL - at the upper limit of normal (31-35), slightly concentrated
- Platelet count: 3.61 lakhs/cumm - normal
Haematology Summary
The pattern of low PCV + low MCV + low MCH + elevated RDW is classic for microcytic hypochromic anaemia, most commonly caused by:
- Iron deficiency anaemia (most likely) - the raised RDW especially points to iron deficiency
- Thalassaemia trait (RDW is usually normal in thalassaemia, so less likely here)
A serum ferritin, serum iron, and TIBC would confirm iron deficiency.
Urine Examination - Interpretation
Abnormal Findings
| Finding | Value | Significance |
|---|---|---|
| Glucose | Present (1.5%) | Glucosuria - abnormal |
| Pus cells | 6-8 cells/hpf | Mildly elevated (normal: 0-5/hpf) |
| Bacteria | Present+ | Possible UTI (though lab notes sample may be stale) |
Normal Findings
- Albumin: Absent (no proteinuria - kidneys filtering protein normally)
- RBCs: Absent (no haematuria)
- Casts: Absent (no renal tubular damage)
- Crystals: Absent
Urine Summary
Glucose in urine (glucosuria) at 1.5% is a significant finding. In a 55-year-old male, this strongly suggests:
- Undiagnosed or poorly controlled Diabetes Mellitus - when blood glucose exceeds the renal threshold (~180 mg/dL), glucose spills into urine. This is the most likely cause.
- Rarely, renal glucosuria (normal blood sugar but defective tubular reabsorption).
Pus cells (6-8/hpf) with bacteria suggests a urinary tract infection (UTI), though the lab correctly notes that bacteria in a stale sample can be a contamination artifact.
Overall Clinical Picture
This 55-year-old man likely has:
- Diabetes mellitus (glucosuria - needs fasting blood glucose and HbA1c urgently)
- Iron deficiency anaemia (microcytic, hypochromic pattern with high RDW)
- Possibly a UTI (pus cells + bacteria - worth a repeat fresh-sample urine culture)
Recommended follow-up tests:
- Fasting blood glucose and HbA1c (to confirm/classify diabetes)
- Serum ferritin, iron, TIBC (to confirm iron deficiency)
- Repeat urine examination with fresh mid-stream sample + urine culture if symptoms present
- KFT (Kidney Function Tests) given glucosuria and possible diabetes
Note: This interpretation is for informational purposes. The treating physician, Dr. Veerabhadrayya M Hiremath, should review these findings in the context of the patient's clinical history and symptoms.
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