Tyler Bishop | Voluntary Public Medical Records

Notes: All CBC values remain within normal reference ranges. Most recent values (01/16/2026) show stable WBC, RBC, hemoglobin and hematocrit. Platelet count increased to 324 but remains well within normal range (150-450). WBC slightly increased from 5.0 to 5.6 but still normal.

Trends & Notes: Glucose levels stable and normal (77-92 mg/dL). Creatinine improved to 0.95 in Jan 2026 (lowest in years). eGFR excellent at 105 mL/min/1.73, indicating strong kidney function. 24-hour urine creatinine (1861 mg/24 hr, ref 1000-2000) confirms normal renal clearance. BUN normalized to 13. Potassium improved from borderline-high 5.3 (Jul 2025) to normal 4.5. All electrolytes (Na, K, Cl, Ca) within normal ranges.

Trends & Notes: *Alert: AST and ALT were significantly elevated in Nov 2024 (62 and 95 IU/L respectively), but improved dramatically by July 2025. Current values (AST 26, ALT 25) are excellent and well within normal limits. GGT is normal at 15 IU/L. LDH slightly elevated at 232 (ref 121-224) — see LDH Isoenzymes section for detailed analysis. Total bilirubin normalized. Albumin (4.9) and total protein (6.9) excellent, indicating strong liver synthetic function. *Imaging (02/17/2026): Abdominal ultrasound reveals diffusely increased hepatic parenchymal echogenicity, typical of fatty infiltration (NAFLD/MASLD). Despite normalized liver enzymes, the imaging finding suggests underlying hepatic steatosis. Tiny gallbladder polyp (3 mm) noted — benign, monitor on follow-up. All other abdominal organs normal.

Interpretation: All values within normal limits on both test dates. C1 Esterase Inhibitor Functional test (82%) confirms adequate enzyme activity, definitively ruling out hereditary angioedema (HAE) Types I and II. Normal serum C1 Inhibitor levels (26-29 mg/dL) are stable. Normal Tryptase levels (5.9-6.0 ug/L) rule out systemic mastocytosis and mast cell activation disorder. Complement C1q slightly increased from 12.6 to 14.5 but remains well within normal range.

Summary: All infectious disease screening tests (Hepatitis B, C, TB) negative or show immunity to Hepatitis B. All autoimmune markers (ANA, Rheumatoid Factor, Anti-CCP, connective tissue disease antibodies) are negative, effectively ruling out systemic autoimmune conditions. No evidence of celiac disease.

Repeat ANA (07/02/2026): A repeat ANA Screen (IFA) was again Negative — the second negative ANA on record. This reinforces the picture above: consistently negative ANA and connective-tissue antibodies point away from classical adaptive-autoimmune disease. View ANA report →

Interpretation: Both inflammatory markers are excellent. ESR of 2 mm/hr and CRP <1 mg/L indicate no significant systemic inflammation. This is reassuring given the recent hemarthrosis finding — it suggests the joint bleeding is not associated with a systemic inflammatory process or active infection.

Interpretation: Urinalysis is largely unremarkable. The low specific gravity (<1.005) and alkaline pH (8.0) suggest the patient was well-hydrated at the time of collection, which can dilute urine and raise pH. All other markers negative — no evidence of urinary tract infection (negative WBC esterase, nitrite), no proteinuria, no glucosuria, and no blood in urine. No microscopic examination was required.

Summary: Comprehensive allergen panel shows no detectable IgE antibodies to any tested allergens. Total IgE is low (9 IU/mL, normal <100). This indicates no allergic sensitization to common environmental, food, or inhalant allergens. Patient is not at risk for typical allergic reactions from these common sources.

Summary: Genetic profile shows generally favorable markers with normal drug metabolism for most medications. MTHFR heterozygous status (both variants) suggests mild reduction in methylation capacity but not clinically significant. Coagulation workup (01/16 & 02/24/2026): Factor V Leiden negative, full Antiphospholipid panel negative on two occasions, von Willebrand Disease ruled out (vWF Antigen 143%, Activity 126% — both normal). Comprehensive coagulation factors (VIII, IX, XI, Fibrinogen, APTT, PT, INR, D-Dimer) all normal. Notable finding: Factor VIII Activity elevated at 147% (ref 56-140) on vWF panel — recognized independent risk factor for venous thromboembolism. Uric acid normal (5.6 mg/dL), ruling out gout. Lipid metabolism markers (ApoE ε3/ε3, ACE II, CETP BB) are associated with better cardiovascular health outcomes. CYP2C19 intermediate metabolizer status may warrant dose adjustments for certain SSRIs or warfarin if prescribed.

Archive Summary: Medical records spanning 9 years (2017-2026) show overall good health trajectory. Key findings in January 2026: hemarthrosis (bleeding in right elbow joint) detected via synovial fluid analysis on 01/04/2026. Extensive follow-up testing completed 01/16/2026: Factor V Leiden negative, Antiphospholipid panel negative, C1 Esterase Inhibitor (serum & functional) normal, Tryptase normal. CBC and CMP all within normal limits with excellent kidney function (eGFR 105). Inflammatory markers (ESR 2, CRP <1) show no systemic inflammation. Liver enzymes fully normalized (AST 26, ALT 25). LDH slightly elevated at 232 but isoenzymes show normal distribution. February 2026 workup (02/24): Comprehensive coagulation factor panel (VIII, IX, XI, Fibrinogen, APTT, PT, INR, D-Dimer) all normal. Von Willebrand Disease assessment: vWF Antigen 143% and Activity 126% — both normal, ruling out vWD. Antiphospholipid antibodies repeated — all negative (second confirmation). Uric acid 5.6 mg/dL — normal, ruling out gout. Notable: Factor VIII Activity elevated at 147% (ref 56-140), a recognized VTE risk factor. Current status: Hemarthrosis cause remains undetermined; no inherited coagulopathy, vWD, APS, or crystal arthropathy identified. Elevated Factor VIII requires monitoring. June-July 2026 workup (06/29 & 07/02): Monoclonal / plasma-cell screen — serum protein electrophoresis showed a normal pattern with no monoclonal protein, serum free kappa was normal (10.6 mg/L), and total protein was normal (6.5 g/dL), together arguing against a plasma-cell dyscrasia / AL amyloidosis. A repeat ANA screen was again negative. Note this screen was not exhaustive: serum free lambda with kappa/lambda ratio, serum immunofixation, and urine studies were not included and would be needed to fully exclude a low-level light-chain process.