Section 7.1 Laboratory

Laboratory Report #30

Date

Collection Date: September 12, 2023
Report Date: September 14, 2023

Laboratory

Labcorp

Ordering Physician

Dr. Billy R. Boring, Jr.

Report Type

Comprehensive Health Evaluation with Anemia Follow-up

Laboratory testing included:

Complete Blood Count (CBC) with Differential
Comprehensive Metabolic Panel (CMP)
Hemoglobin A1c
Free T4
TSH
Antinuclear Antibody (ANA Direct)
Erythrocyte Sedimentation Rate (ESR)
Ferritin
(Urinalysis ordered but not performed)

Original Report

PDF: Labcorp – September 12, 2023

One-Page Summary

Purpose of Testing

This comprehensive evaluation was performed to investigate the continued decline in hemoglobin that had been documented during the summer of 2023 while also monitoring kidney function, thyroid replacement therapy, glucose metabolism, inflammatory activity, and possible autoimmune disease. Ferritin and ESR were added to help determine whether the worsening anemia was related to iron deficiency or active inflammation. Overall, the report shows continued mild normocytic anemia, but reassuring findings for inflammation, autoimmune disease, iron stores, thyroid function, and kidney function.

Major Findings

Complete Blood Count

Results

Test	Result	Interpretation
WBC	5.9 ×10³/µL	Normal
RBC	3.73 ×10⁶/µL	Low
Hemoglobin	11.3 g/dL	Low
Hematocrit	33.9%	Low
MCV	91 fL	Normal
Platelets	295 ×10³/µL	Normal

Interpretation

The anemia progressed further.

Comparison:

Date	Hemoglobin
December 2022	13.8
June 2023	12.3
July 2023	11.8
September 2023	11.3

The normal MCV and RDW continue to indicate a normocytic, normochromic anemia, rather than iron-deficiency anemia.

Iron Stores

Ferritin

Result

144 ng/mL

Reference Range:

30–400 ng/mL

Interpretation

Ferritin was well within the normal range and substantially higher than the previous value (43 ng/mL in December 2021).

This finding argues against iron deficiency as the cause of the anemia.

Inflammatory Evaluation

Erythrocyte Sedimentation Rate (ESR)

Result

27 mm/hr

Reference Range:

0–30 mm/hr

ANA Direct

Result

Negative

Interpretation

Two important findings emerge:

ESR remained within the normal laboratory range, although higher than the 13 mm/hr recorded in July 2022.
ANA remained negative, providing no evidence of a newly developing systemic autoimmune disorder.

Unlike the severe inflammatory illness of 2021, this report does not demonstrate marked laboratory evidence of active systemic inflammation.

Kidney Function

Results

BUN: 28 mg/dL (High)
Creatinine: 0.93 mg/dL
eGFR: 80 mL/min/1.73 m²

Interpretation

Kidney function remained excellent.

Although the BUN and BUN/Creatinine ratio were mildly elevated, the normal creatinine and improved eGFR argue against intrinsic kidney disease. Mild dehydration or increased protein intake are among the possible explanations and should be interpreted in the clinical context.

Liver Function

Results

AST: 27 IU/L
ALT: 18 IU/L
Alkaline Phosphatase: 61 IU/L
Bilirubin: 0.2 mg/dL

Interpretation

Liver function remained completely normal.

Metabolic Health

Results

Glucose: 87 mg/dL
Hemoglobin A1c: 5.8%

Interpretation

Fasting glucose remained excellent.

However, Hemoglobin A1c increased from 5.6% → 5.8%, returning to the laboratory’s prediabetes range.

This difference between normal glucose and mildly elevated A1c becomes especially interesting when viewed alongside the developing anemia because anemia can influence A1c measurements. This relationship should be interpreted cautiously.

Thyroid Function

Results

Free T4: 1.27 ng/dL
TSH: 1.090 μIU/mL

Interpretation

Thyroid replacement therapy continued to provide excellent control.

Both thyroid measurements remained comfortably within the normal reference range.

Urinalysis

Status

A routine urinalysis was ordered but was not performed because a specimen could not be obtained during the visit.

Overall Interpretation

This report confirms the continued progression of mild normocytic anemia while providing reassuring findings in nearly every other category. Iron stores remained normal, ANA testing remained negative, ESR stayed within the reference range, thyroid function was stable, kidney function remained preserved, and liver function was normal. The principal clinical question raised by this report is the cause of the persistent anemia, as neither iron deficiency nor obvious autoimmune disease appears to explain the declining hemoglobin.

Longitudinal Significance

This report contributes to:

CBC Trend Table
Hemoglobin Trend Table
Ferritin Trend Table
ESR Trend Table
ANA Trend Table
Kidney Function Trend Table
Glucose Trend Table
Thyroid Trend Table
Medical History Timeline

The historical graphs on pages 4 and 5 clearly demonstrate the continuing decline in hemoglobin and hematocrit while showing stable kidney function and glucose measurements.

Clinical Importance

⭐⭐⭐⭐⭐ Key Diagnostic Evaluation

This is one of the most valuable reports of 2023 because it expands the evaluation beyond simply documenting anemia. It also investigates possible causes, including iron deficiency, autoimmune disease, inflammation, thyroid dysfunction, and kidney disease. Several important possibilities were effectively ruled out.

Key Changes Since Previous Report

Compared with July 19, 2023:

Hemoglobin decreased from 11.8 → 11.3 g/dL.
Hematocrit decreased from 35.6% → 33.9%.
RBC count decreased from 3.96 → 3.73 ×10⁶/µL.
Ferritin was normal (144 ng/mL).
ANA remained negative.
ESR measured 27 mm/hr (within reference range).
Kidney function improved slightly (eGFR 71 → 80).
Hemoglobin A1c increased from 5.6% → 5.8%.

Related Reports

June 28, 2023 – Comprehensive Health Evaluation
July 19, 2023 – CBC Follow-up Evaluation
Hematology Trend Table
Ferritin Trend Table
ESR Trend Table
ANA Trend Table
Medical History Timeline

Navigation

Previous Report: July 19, 2023 – CBC Follow-up Evaluation
Next Report: November 2023 Comprehensive Laboratory Evaluation
Return to Laboratory Library
Return to Health Inventory

Observation

This report marks the peak of the unexplained anemia that developed during 2023. Looking back with the benefit of your later laboratory history, it becomes clear that your physicians approached the problem methodically:

Iron deficiency was investigated (normal ferritin).
Autoimmune disease was evaluated (negative ANA).
Active inflammation was assessed (ESR within the normal range).
Thyroid disease was excluded (normal TSH and Free T4).
Kidney disease was not supported (normal creatinine and eGFR).

One of the strengths of your Health Inventory is that it preserves this diagnostic process. Future physicians will be able to see not only that anemia occurred, but also which potential causes were carefully investigated and found to be unlikely.