Section 7.1 Laboratory

Laboratory Report #13

Date

Collection Date: October 13, 2021
Report Date: October 19, 2021

Laboratory

Labcorp

Ordering Physician

Dr. Billy R. Boring, Jr.

Report Type

Comprehensive Systemic Inflammatory Disease Evaluation

Laboratory testing included:

Complete Blood Count (CBC) with Differential
Comprehensive Metabolic Panel
Urinalysis
Serum Protein Electrophoresis
Lipid Panel
Hemoglobin A1c
Free T4
TSH
B-Type Natriuretic Peptide (BNP)
Lactate Dehydrogenase (LDH)
Erythrocyte Sedimentation Rate (ESR)
Creatine Kinase (CK)
Aldolase
Urine Myoglobin
C-Reactive Protein (CRP)
Blood Culture
Urine Culture

Original Report

PDF: Labcorp – October 13, 2021

One-Page Summary

Purpose of Testing

This report represents one of the most comprehensive evaluations performed during the peak of the systemic inflammatory illness of 2021. The extensive testing was designed to investigate inflammatory disease, muscle injury, infection, kidney function, liver function, metabolic status, and possible hematologic disorders. This study documents the highest level of systemic inflammation observed in your laboratory history and serves as one of the defining reports in the Health Inventory.

Major Findings

Inflammatory Markers

Erythrocyte Sedimentation Rate (ESR)

Result

71 mm/hr (Markedly Elevated)

C-Reactive Protein (CRP)

Result

32 mg/L (Markedly Elevated)

Interpretation

Only one month earlier, ESR and CRP had improved dramatically (ESR 19, CRP 7). This report documents a significant recurrence of systemic inflammation:

ESR increased from 19 → 71 mm/hr
CRP increased from 7 → 32 mg/L

These findings indicate severe active inflammation and represent the highest ESR recorded in your laboratory history.

Complete Blood Count

Results

WBC: 7.8 ×10³/µL
RBC: 3.84 ×10⁶/µL (Low)
Hemoglobin: 11.4 g/dL (Low)
Hematocrit: 33.7% (Low)
Platelets: 309 ×10³/µL

Interpretation

This report documents progression of normocytic anemia.

Compared with August 31:

Hemoglobin declined from 12.3 → 11.4 g/dL
Hematocrit declined from 37.9% → 33.7%
RBC count continued to decrease.

These findings are highly consistent with anemia associated with active systemic inflammation. White blood cell and platelet counts remained within normal limits.

Kidney Function

Results

BUN: 13 mg/dL
Creatinine: 0.86 mg/dL
eGFR: 79 mL/min/1.73 m²

Interpretation

Despite severe systemic inflammation, kidney function remained well preserved with no laboratory evidence of renal injury.

Liver Function

Results

AST: 20 IU/L
ALT: 14 IU/L
Alkaline Phosphatase: 65 IU/L
Bilirubin: 0.4 mg/dL

Interpretation

Liver function tests remained normal throughout the inflammatory illness, demonstrating that hepatic function was not significantly affected.

Electrolytes

Results

Sodium: 129 mmol/L (Low)
Chloride: 91 mmol/L (Low)
Potassium: 4.2 mmol/L

Interpretation

This report documents significant hyponatremia and hypochloremia, abnormalities commonly associated with severe systemic illness. These findings became important features of your inflammatory disease course.

Metabolic Health

Results

Glucose: 90 mg/dL
Hemoglobin A1c: 5.8% (Prediabetes Range)

Interpretation

Glucose remained normal; however, Hemoglobin A1c increased into the laboratory’s prediabetes range (5.7–6.4%). While notable, this finding should be interpreted cautiously during active systemic illness.

Lipid Profile

Results

Total Cholesterol: 177 mg/dL
LDL Cholesterol: 105 mg/dL
HDL Cholesterol: 60 mg/dL
Triglycerides: 64 mg/dL

Interpretation

Despite severe inflammation, the lipid profile remained relatively favorable with:

High HDL cholesterol
Low triglycerides
Mildly elevated LDL cholesterol

This preserved the characteristic lipid pattern documented throughout previous years.

Thyroid Function

Results

Free T4: 1.11 ng/dL
TSH: 4.170 μIU/mL

Interpretation

Free T4 remained normal. TSH increased toward the upper end of the reference range but remained within laboratory limits. These findings did not suggest that thyroid disease was responsible for the inflammatory syndrome.

Cardiac Marker

B-Type Natriuretic Peptide (BNP)

Result

26.1 pg/mL

Interpretation

BNP remained within the normal range, indicating no laboratory evidence of worsening cardiac stress during this phase of illness.

Muscle Injury Evaluation

Results

CK: 74 U/L (Normal)
Aldolase: 1.7 U/L (Low)
Urine Myoglobin: 2 ng/mL (Normal)

Interpretation

Despite significant muscle pain during this period, there was no laboratory evidence of muscle breakdown (myositis or rhabdomyolysis). This distinction was clinically important in narrowing the diagnostic possibilities.

Infection Evaluation

Blood Culture

No growth

Urine Culture

No growth

Interpretation

No bacterial infection was identified in either blood or urine cultures. These negative cultures strengthened the conclusion that the illness was non-bacterial, directing attention toward autoimmune and inflammatory causes.

Serum Protein Electrophoresis

Results

No M-spike detected
Mildly elevated globulin: 4.0 g/dL
A/G Ratio: 0.9

Interpretation

No monoclonal protein was detected, making disorders such as multiple myeloma less likely. Mild hyperglobulinemia was consistent with an active inflammatory response.

Overall Interpretation

This report documents the peak laboratory expression of your systemic inflammatory illness. ESR reached 71 mm/hr, CRP remained markedly elevated at 32 mg/L, normocytic anemia worsened, and hyponatremia developed. Despite these significant inflammatory findings, kidney function, liver function, cardiac biomarkers, and muscle injury studies remained remarkably normal. Blood and urine cultures were negative, and serum protein electrophoresis showed no monoclonal gammopathy. Collectively, these findings strongly supported a severe non-infectious systemic inflammatory process, making this one of the most important reports in your medical history.

Longitudinal Significance

This report contributes to:

ESR Trend Table
CRP Trend Table
Hematology Trend Table
Electrolyte Trend Table
Autoimmune Disease Timeline
Systemic Inflammatory Illness Timeline
Rheumatology Consultation Summary
Medical History Timeline

It documents the peak inflammatory phase of the illness.

Clinical Importance

⭐⭐⭐⭐⭐ Defining Laboratory Report

This is one of the cornerstone reports in the entire Health Inventory. It captures the inflammatory illness at its greatest laboratory severity and provides the clearest objective evidence of the disease that dominated your health during late 2021.

Key Changes Since Previous Report

Compared with September 7, 2021:

ESR increased from 19 → 71 mm/hr.
CRP increased from 7 → 32 mg/L.
Hemoglobin declined from 12.3 → 11.4 g/dL.
Hematocrit declined from 37.9% → 33.7%.
Hyponatremia developed (129 mmol/L).
Blood and urine cultures remained negative.
CK, urine myoglobin, and BNP remained normal.
No monoclonal protein was identified on serum protein electrophoresis.

Related Reports

August 31, 2021 – Initial Systemic Inflammatory Evaluation
September 7, 2021 – Inflammation Follow-up
Autoimmune Evaluation
ESR Trend Table
CRP Trend Table
Hematology Trend Table
Electrolyte Trend Table
Rheumatology Consultation Summary
Medical History Timeline

Navigation

Previous Report: September 7, 2021 – Inflammation Monitoring Evaluation
Next Report: Subsequent Rheumatology / Autoimmune Evaluation
Return to Laboratory Library
Return to Health Inventory

Observation

This report is arguably the single most important laboratory report in your Health Inventory. It documents the point at which the inflammatory illness reached its greatest objective severity. What makes it especially valuable is not only what became abnormal—ESR, CRP, anemia, and sodium—but also what remained normal. Throughout this intense inflammatory episode, your kidney function, liver function, cardiac marker (BNP), muscle injury markers, and blood cultures remained normal. That pattern helped narrow the differential diagnosis and, in retrospect, strongly supported the inflammatory/autoimmune process that your physicians ultimately pursued.