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Vitamin B12 (Cyanocobalamin)
Investigation Result Units Biological Reference Interval

Vitamin B12 (Cyanocobalamin) 219.4 pg/mL 191 - 663

• Sample type : Serum. • Method: ECLIA. • Comments : Vitamin B12 performs many important functions in the body, but the most significant function is to act as coenzyme for reducing ribonucleotides to deoxyribonucleotides, a step in the formation of genes. Inadequate dietary intake is not the commonest cause for cobalamine deficiency. The most common cause is malabsorption either due to atrophy of gastric mucosa or diseases of terminal ileum. Cobalamine deficiency leads to Megaloblastic anemia and demyelination of large nerve fibres of spinal cord. Normal body stores are sufficient to last for 3-6 years. Sources of Vitamin B12 are liver, shellfish, fish, meat, eggs, milk, cheese & yogurt. • Decreased Levels : 1. Lack of Intrinsic factor: Total or partial gastrectomy, Atrophic gastritis, Intrinsic factor antibodies. 2. Malabsorption: Regional ileitis, resected bowel, Tropical Sprue, Celiac disease, pancreatic insufficiency, bacterial overgrowth & achlorhydria. 3. Loss of ingested vitamin B12: fish tapeworm. 4. Dietary deficiency: Vegetarians. 5. Congenital disorders: Orotic aciduria & transcobalamine deficiency. 6. Increased demand: Pregnancy specially last trimester. • Increased Levels : Chronic renal failure, Congestive heart failure, Acute & Chronic Myeloid Leukemia, Polycythemia vera, Carcinomas with liver metastasis, Liver disease, Drug induced cholestasis & Protein malnutrition • Disclaimer : 1) The above result relate only to the specimens received and tested in laboratory and should be always correlate with clinical findings and other laboratory markers. 2) Improper specimen collection, handling, storage and transportation may result in false negative/Positive results.

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Vitamin D Total - 25 Hydroxy
Investigation Result Units Biological Reference Interval

25-OH Vitamin D 24.74 ng/mL Deficiency-<20
Insufficiency-20-<30
Sufficiency-30-100

• Sample type : Serum. • Method : ECLIA. Interpretation : Vitamin D is a fat soluble vitamin and exists in two main forms as cholecalciferol(vitamin D3) which is synthesized in skin from 7-dehydrocholesterol in response to sunlight exposure & Ergocalciferol(vitamin D2) present mainly in dietary sources.Both cholecalciferol & Ergocalciferol are converted to 25(OH)vitamin D in liver. Testing for 25(OH)vitamin D is recommended as it is the best indicator of vitamin D nutritional status as obtained from sunlight exposure & dietary intake. For diagnosis of vitamin D deficiency it is recommended to have clinical correlation with serum 25(OH)vitamin D, serum calcium, serum PTH & serum alkaline phosphatase. During monitoring of oral vitamin D therapy- suggested testing of serum 25(OH)vitamin D is after 12 weeks or 3 mths of treatment. However, the required dosage of vitamin D supplements & time to achieve sufficient vitamin D levels show significant seasonal(especially winter) & individual variability depending on age, body fat, sun exposure, physical activity ,genetic factors(especially variable vitamin D receptor responses), associated liver or renal disease, malabsorption syndromes and calcium or magnesium deficiency influencing the vitamin D metabolism Vitamin D toxicity is known but very rare. Disclaimer : 1) The above result relate only to the specimens received and tested in laboratory and should be always correlate with clinical findings and other laboratory markers. 2) Improper specimen collection, handling, storage and transportation may result in false negative/Positive results.

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Thyroid Function Test (TFT)
Investigation Result Units Biological Reference Interval

T3 (Triiodothyronine) 1.06 ng/mL 0.8 - 2.0
• Sample Type : Serum.
• Method : ECLIA.
T4 (Thyroxine) 8.44 ug/dl 5.1 - 14.1
• Sample Type : Serum.
• Method : ECLIA.
ULTRA Thyroid Stimulating Hormone (TSH) 2.6 uIU/mL 0.27 - 4.2
Frist trimester: 0.3- 4.5
Second trimester : 0.5 -4.6
Third trimester : 0.8 -5.2
• Sample Type : Serum.
• Method : ECLIA.

1) TSH levels are subject to circadian variation, reaching peak levels between 2 - 4.a.m. and at a minimum between 6-10 pm. The variation is of the order of 50% . hence time of the day has influence on the measured serum TSH concentrations. 2) Recommended test for T3 and T4 is unbound fraction or free levels as it is metabolically active. 3) Physiological rise in Total T3 / T4 levels is seen in pregnancy and in patients on steroid therapy. Clinical Use : • Primary Hypothyroidism • Hyperthyroidism • Hypothalamic – Pituitary hypothyroidism • Inappropriate TSH secretion • Nonthyroidal illness • Autoimmune thyroid disease • Pregnancy associated thyroid disorders. • References : - Henry’s Clinical Diagnosis and Management, 23rd edition. -Tietz Fundamentals of Clinical Chemistry and Molecular Diagnosis, 7th edition. •Disclaimer: 1) The above result relate only to the specimens received and tested in laboratory and should be always correlate with clinical findings and other laboratory markers. 2) Improper specimen collection, handling,storage and transportation may result in false negative/Positive results.

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