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Running Command

python3 << 'EOF' import pdfplumber files = { "HLA_B27_ANA": "/tmp/workspace/attachments/f4d3434f-9340-4b1f-a62d-59359dc039b6/DR SUDHA BLOOD REPORTS - HLA B27, ANA.pdf", "THYROID_LIPID": "/tmp/workspace/attachments/f4d3434f-9340-4b1f-a62d-59359dc039b6/DR SUDHA REPORTS - THYROID LIPID.pdf", "JUNE_2026": "/tmp/workspace/attachments/f4d3434f-9340-4b1f-a62d-59359dc039b6/DR SUDHA REPORTS JUNE 2026.pdf" } for label, path in files.items(): print(f"\n{'='*60}") print(f"FILE: {label}") print('='*60) with pdfplumber.open(path) as pdf: print(f"Pages: {len(pdf.pages)}") for i, page in enumerate(pdf.pages): print(f"\n--- Page {i+1} ---") text = page.extract_text() if text: print(text) # Also try tables tables = page.extract_tables() if tables: print(f"\n[Tables on page {i+1}]") for t_idx, table in enumerate(tables): print(f"Table {t_idx+1}:") for row in table: print(row) EOF

Running Command

python3 << 'EOF' # Try pypdf for the two empty PDFs from pypdf import PdfReader for label, path in [ ("THYROID_LIPID", "/tmp/workspace/attachments/f4d3434f-9340-4b1f-a62d-59359dc039b6/DR SUDHA REPORTS - THYROID LIPID.pdf"), ("JUNE_2026", "/tmp/workspace/attachments/f4d3434f-9340-4b1f-a62d-59359dc039b6/DR SUDHA REPORTS JUNE 2026.pdf") ]: print(f"\n{'='*50}\nFILE: {label}") reader = PdfReader(path) print(f"Pages: {len(reader.pages)}") for i, page in enumerate(reader.pages): text = page.extract_text() print(f"\n--- Page {i+1} ---") print(repr(text[:500]) if text else "[empty]") EOF

Running Command

python3 << 'EOF' # Extract images embedded in the PDF pages from pypdf import PdfReader import os for label, path in [ ("THYROID_LIPID", "/tmp/workspace/attachments/f4d3434f-9340-4b1f-a62d-59359dc039b6/DR SUDHA REPORTS - THYROID LIPID.pdf"), ("JUNE_2026", "/tmp/workspace/attachments/f4d3434f-9340-4b1f-a62d-59359dc039b6/DR SUDHA REPORTS JUNE 2026.pdf") ]: print(f"\n{'='*50}\nFILE: {label}") reader = PdfReader(path) out_dir = f"/tmp/workspace/{label}_images" os.makedirs(out_dir, exist_ok=True) for page_num, page in enumerate(reader.pages): images = page.images print(f"Page {page_num+1}: {len(images)} embedded images") for img_idx, image in enumerate(images): out_path = f"{out_dir}/page{page_num+1}_img{img_idx+1}.{image.name.split('.')[-1]}" with open(out_path, "wb") as f: f.write(image.data) print(f" Saved: {out_path} ({len(image.data)} bytes)") EOF

Running Command

ls -la /tmp/workspace/THYROID_LIPID_images/ && ls -la /tmp/workspace/JUNE_2026_images/

Running Command

python3 << 'EOF' from PIL import Image import os # Combine thyroid/lipid pages 1-3 into one tall image def combine_images(image_paths, output_path): imgs = [Image.open(p) for p in image_paths] # Scale all to same width target_width = max(img.width for img in imgs) resized = [] for img in imgs: ratio = target_width / img.width new_h = int(img.height * ratio) resized.append(img.resize((target_width, new_h), Image.LANCZOS)) total_height = sum(img.height for img in resized) combined = Image.new('RGB', (target_width, total_height), (255, 255, 255)) y = 0 for img in resized: combined.paste(img, (0, y)) y += img.height combined.save(output_path, 'JPEG', quality=85) print(f"Saved {output_path} ({os.path.getsize(output_path)} bytes)") # Thyroid/Lipid: 6 pages -> 2 groups of 3 thyroid_dir = "/tmp/workspace/THYROID_LIPID_images" combine_images( [f"{thyroid_dir}/page{i}_img1.jpg" for i in range(1, 4)], "/tmp/workspace/thyroid_p1to3.jpg" ) combine_images( [f"{thyroid_dir}/page{i}_img1.jpg" for i in range(4, 7)], "/tmp/workspace/thyroid_p4to6.jpg" ) # June 2026: 4 pages -> 2 groups of 2 june_dir = "/tmp/workspace/JUNE_2026_images" combine_images( [f"{june_dir}/page{i}_img1.jpg" for i in range(1, 3)], "/tmp/workspace/june_p1to2.jpg" ) combine_images( [f"{june_dir}/page{i}_img1.jpg" for i in range(3, 5)], "/tmp/workspace/june_p3to4.jpg" ) EOF

Running Command

python3 << 'EOF' from PIL import Image import os files = [ "/tmp/workspace/thyroid_p1to3.jpg", "/tmp/workspace/thyroid_p4to6.jpg", "/tmp/workspace/june_p1to2.jpg", "/tmp/workspace/june_p3to4.jpg" ] for f in files: img = Image.open(f) # Resize to max width 1600 if img.width > 1600: ratio = 1600 / img.width new_size = (1600, int(img.height * ratio)) img = img.resize(new_size, Image.LANCZOS) img.save(f, 'JPEG', quality=70) size = os.path.getsize(f) print(f"{f}: {img.size}, {size/1024:.0f} KB") EOF

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Here is the complete compiled summary of all three blood report files for Dr. Sudha (Sree Sudha Ty / Sree Sudha Tanguturi), 41 Yr/F.

Dr. Sudha - Complete Blood Report Summary

Reports from three labs/institutions across June and July 2026:
  • AIIMS Deoghar (Jharkhand) - Dept. Psychiatry / OBG / Pathology
  • AIIMS Mangalagiri
  • Lupin Diagnostics (Ranchi) - collected 24-Jul-2026

1. COMPLETE BLOOD COUNT (CBC / Haemogram)

Lupin Diagnostics — 24-Jul-2026

ParameterResultReference RangeStatus
Haemoglobin11.50 g/dL12–15⬇ LOW
PCV/Haematocrit34.4%36–46⬇ LOW
RBC Count4.41 M/cu.mm3.8–4.8Normal
MCV78.0 fL83–101⬇ LOW (microcytic)
MCH26.1 pg27–32⬇ LOW
MCHC33.5 g/dL31.5–34.5Normal
RDW-CV19.7%11.6–14⬆ HIGH (anisocytosis)
TLC7,290 cells/cu.mm4,000–10,000Normal
Neutrophils59.4%40–80Normal
Lymphocytes33.2%20–40Normal
Platelet Count3,96,000 /cu.mm1,50,000–4,10,000Normal
MPV7.8 fL7.4–12.0Normal
ESR5 mm0–15Normal
PBSNormocytic normochromic with anisocytosis, microcytes, polychromatic cells

AIIMS Mangalagiri — 02-Jul-2026

ParameterResultReference RangeStatus
Haemoglobin11.0 g/dL12–15⬇ LOW
RBC4.58 x10⁶/µL3.8–4.8Normal
HCT36.2%31–46Normal
MCV79.0 fL83–101⬇ LOW
MCH24.0 pg27–32⬇ LOW
MCHC30.4 g/dL31.5–34.5⬇ LOW
RDW CV19.0%11.6–14⬆ HIGH
TLC8.53 x10³/µL4–10Normal
Platelet421 x10³/µL150–450Normal
MPV8.1 fL8–11Normal

AIIMS Deoghar (June 2026) — 02-Jun-2026

ParameterResultReference RangeStatus
WBC8.61 x10³/µL4.0–11.0Normal
RBC4.73 x10⁶/µL3.5–5.5Normal
HGB10.9 g/dL11.0–15.5⬇ LOW (borderline)
HCT36.4%37.0–50.0⬇ LOW (borderline)
MCV77.0 fL76.0–96.0Low-normal
MCH23.0 pg27.0–32.0⬇ LOW
MCHC29.9 g/dL30.0–35.0⬇ LOW
PLT454 x10³/µL150–400⬆ mildly elevated
RDW-CV16.0%11.5–14.0⬆ HIGH
Neutrophils59.9%40–75Normal
Lymphocytes32.3%20–45Normal
ESR129 mm/hr⬆⬆ MARKEDLY HIGH

2. INFLAMMATORY MARKERS (Lupin Diagnostics — 24-Jul-2026)

TestResultReferenceStatus
ESR5 mm0–15 mmNormal
CRP (Quantitative)8.70 mg/L<10.0Normal (upper limit)
Note: ESR was markedly elevated at 129 mm/hr in the June 2026 AIIMS Deoghar report, which has come down significantly to 5 mm by July 2026.

3. AUTOIMMUNE / RHEUMATOLOGY PANEL (Lupin Diagnostics — 24-Jul-2026)

TestResultReferenceStatus
HLA B-27 (PCR)POSITIVENegative⬆ POSITIVE
ANA IFAModerate Positive (++)Negative⬆ POSITIVE
ANA Fluorescence PatternSpeckled
ANA Estimated Titer1:320Moderate positive
Anti-CCP<0.5 U/mL<5.0 = NegativeNormal (Negative)
Rheumatoid Factor (RF)9.60 IU/mL<12Normal (Negative)
ANA Speckled pattern at 1:320 is associated with: SLE, MCTD, RA, PM, DM, Sjögren's syndrome (target antigens: Sm, U1-snRNP, SSA/Ro, SSB/La, Ku).

4. THYROID PROFILE

AIIMS Mangalagiri — 02-Jul-2026

TestResultReferenceStatus
Total T3116 ng/dL70–204Normal
Total T45.23 µg/dL5.5–11.0⬇ LOW (borderline)
TSH6.84 mIU/L0.4–4.2⬆ HIGH (Hypothyroidism)

Anti-TPO (AIIMS Deoghar — 23-Jul-2026)

TestResultReferenceStatus
Anti-TPO48.43 IU/mL<34⬆ HIGH (positive)
TSH elevated + Anti-TPO elevated = consistent with Hashimoto's thyroiditis / autoimmune hypothyroidism.

5. LIPID PROFILE

AIIMS Deoghar — 23-Jul-2026

TestResultReferenceStatus
Total Cholesterol196 mg/dL0–200Normal (borderline)
VLDL Cholesterol64 mg/dL2–30⬆ HIGH
Triglycerides322 mg/dL40–160⬆⬆ HIGH
HDL Cholesterol34 mg/dL35.3–79.5⬇ LOW
LDL Cholesterol98 mg/dL0–100Normal (borderline)

AIIMS Deoghar (June 2026) — 02-Jun-2026

TestResultReferenceStatus
Total Cholesterol225 mg/dL0–200⬆ HIGH
VLDL Cholesterol96 mg/dL2–30⬆⬆ HIGH
Triglycerides478 mg/dL40–160⬆⬆⬆ VERY HIGH
HDL Cholesterol38 mg/dL35.3–79.5⬇ LOW-normal
LDL Cholesterol91 mg/dL0–100Normal
Triglycerides have improved from 478 (June) to 322 (July) but remain significantly elevated. This degree of hypertriglyceridaemia, combined with low HDL, is a significant cardiovascular and pancreatitis risk.

6. GLUCOSE / DIABETES MARKERS

TestResultReferenceStatus
HbA1c (Jul-2026, Lupin)5.70%<5.7% NormalBorderline (at the pre-diabetic threshold)
Estimated Average Glucose116.89 mg/dL
Random Blood Sugar81 mg/dL70–140Normal
HbA1c (Jun-2026, AIIMS Deoghar)5.4%4.0–6.0%Normal

7. VITAMINS, MINERALS & OTHER BIOCHEMISTRY

AIIMS Deoghar — 23-Jul-2026

TestResultReferenceStatus
Vitamin D (25-OH)46.98 ng/mL>30Normal (adequate)
Serum Iron31 µg/dL65–175⬇⬇ VERY LOW
Vitamin B12803.7 pg/mL197–771⬆ mildly elevated (supplementation?)
Calcium (Jul-2026)8.7 mg/dL8.4–10.2Normal
Uric Acid6.50 mg/dL2.5–6.2⬆ HIGH (hyperuricaemia)

AIIMS Deoghar (June 2026)

TestResultReferenceStatus
Ferritin10 ng/mL20–250⬇⬇ VERY LOW (Iron deficiency)
Calcium8.8 mg/dLNormal

8. COAGULATION STUDIES (AIIMS Mangalagiri — 02-Jul-2026)

TestResultReferenceStatus
PT14.00 sec9.7–11.9⬆ Mildly prolonged
INR1.35Mildly elevated
APTT27.90 sec19.5–31.1Normal

9. KEY ABNORMALITIES SUMMARISED

#FindingSignificance
1HLA-B27 POSITIVEStrongly associated with Ankylosing Spondylitis, reactive arthritis, psoriatic arthritis, uveitis
2ANA Positive (Speckled, 1:320)Suggests systemic autoimmune disease - SLE, MCTD, Sjögren's, overlap syndromes. Needs further specific antibody testing (anti-dsDNA, anti-Sm, anti-Ro/La, anti-U1RNP)
3TSH elevated (6.84) + Anti-TPO high (48.43)Autoimmune hypothyroidism (Hashimoto's thyroiditis) - likely needs thyroid hormone replacement
4Microcytic hypochromic anaemiaHb 10.9–11.5 g/dL, low MCV, low MCH, very low serum iron (31), very low ferritin (10) = Iron deficiency anaemia
5Very high ESR (129) in June → normalised (5) in JulyActive inflammation in June, apparently resolved or treated
6Severe hypertriglyceridaemiaTG 478 (June) → 322 (July). At 478, risk of pancreatitis. Combined with low HDL - metabolic syndrome pattern
7Serum Iron 31 µg/dL + Ferritin 10 ng/mLClear iron deficiency - needs iron supplementation
8Uric Acid 6.50 mg/dL (above female ref 2.5–6.2)Hyperuricaemia - watch for gout, kidney stones
9RF Negative, Anti-CCP NegativeRheumatoid arthritis less likely despite joint symptoms
10PT/INR mildly prolonged (1.35)Needs clinical correlation - could be related to underlying disease

CLINICAL PICTURE - PUTTING IT ALL TOGETHER

This is a 41-year-old woman with multiple autoimmune findings:
  1. Spondyloarthropathy / HLA-B27 related disease - The positive HLA-B27 by PCR is the most diagnostically significant finding. This points towards Ankylosing Spondylitis or another spondyloarthropathy (psoriatic arthritis, reactive arthritis, enteropathic arthritis). The negative RF and Anti-CCP make RA less likely.
  2. Systemic autoimmune disease (ANA positive, speckled, 1:320) - A moderate positive ANA with speckled pattern at this titer warrants follow-up with ENA panel (anti-dsDNA, anti-Sm, anti-Ro/La, anti-U1RNP) to characterise whether this is SLE, MCTD, Sjögren's, or overlap syndrome. The high ESR (129) in June also supports active systemic inflammation.
  3. Hashimoto's Thyroiditis - TSH 6.84 (high) with elevated Anti-TPO (48.43) is a classic presentation. She likely requires thyroxine replacement. Autoimmune thyroid disease is very commonly associated with other autoimmune conditions.
  4. Iron Deficiency Anaemia - Low Hb (~11 g/dL), microcytic picture, very low serum iron and ferritin confirm IDA. Iron supplementation is needed. This may be contributing to fatigue symptoms.
  5. Metabolic Syndrome pattern - Very high triglycerides (478→322 mg/dL), low HDL (34–38), borderline HbA1c (5.7%), and elevated VLDL. Lifestyle intervention and possibly lipid-lowering therapy (fenofibrate for hypertriglyceridaemia) warranted.
Important disclaimer: This is an informational summary of lab results. All clinical decisions, diagnoses, and treatment plans should be made by Dr. Sudha's treating physicians at AIIMS Deoghar, who have full access to clinical history and examination findings.
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