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Patient Report - Comprehensive Wellness Panel

Quest Diagnostics — collected 10/08/2019

Patient

Tyler Bishop

Date Collected

10/08/2019 10:17

Date Reported

10/25/2019

DOB

05/26/1987

Age / Sex

32 / Male

Fasting

Yes

Quest Diagnostics

Ordered Items: Homocysteine; Comprehensive Metabolic Panel; Vitamin B12/Folate Panel; Lipid Panel; hs-CRP; Hemoglobin A1c; Vitamin D 25-OH Total; TSH with reflex to FT4; Sedimentation Rate (modified Westergren); CBC; Iron and TIBC; ANA Screen IFA with reflex titer and pattern; C-Reactive Protein

⚠ Data-quality note — read before interpreting the CBC

The signed report carries a clerical error in the demographics block: "Sex: F". The patient is male (DOB and all other identifiers match). Because Quest applies sex-specific reference intervals automatically, the CBC on this report was scored against female reference ranges.

The practical consequence: hemoglobin 13.0 g/dL and hematocrit 39.4% were reported as comfortably normal against the female intervals (11.7–15.5 and 35.0–45.0). Against the male intervals used everywhere else in this archive (13.0–17.7 and 37.5–51.0), hemoglobin 13.0 sits exactly at the lower limit and hematocrit 39.4 is low-normal. These are the lowest hemoglobin and hematocrit values in the entire nine-year record, and they were not flagged at the time.

The same error affects the creatinine and eGFR flags below. Where this page cites a reference interval, it prints the interval exactly as the lab applied it, and notes where that interval is the wrong one.

Abnormal Results

Test	Result	Status	Units	Reference Range
Homocysteine	15.4	HIGH	umol/L	<10.4
Creatinine	1.20	HIGH	mg/dL	0.50-1.10
Bilirubin, Total	1.3	HIGH	mg/dL	0.2-1.2
Vitamin B12	1106	HIGH	pg/mL	200-1100
Folate, Serum	2.3	LOW	ng/mL	>5.4 normal; <3.4 low

Comment printed on the report (Homocysteine): "Homocysteine is increased by functional deficiency of folate or vitamin B12. Testing for methylmalonic acid differentiates between these deficiencies. Other causes of increased homocysteine include renal failure, folate antagonists such as methotrexate and phenytoin, and exposure to nitrous oxide."

Note on the creatinine flag: 1.20 mg/dL was flagged HIGH against the female interval (0.50-1.10) applied in error. The male interval used elsewhere in this archive is 0.76-1.27. The reported eGFR of 60 derives from the same error.

Inflammatory Markers and Autoimmune Screen

Test	Result	Status	Units	Reference Range
Sedimentation Rate (modified Westergren)	2	Normal	mm/h	≤20
hs-CRP	0.4	Optimal	mg/L	<1.0 optimal
C-Reactive Protein	0.5	Normal	mg/L	<8.0
ANA Screen, IFA	NEGATIVE (AC-0)	Negative	—	NEGATIVE

Comprehensive Metabolic Panel

Test	Result	Status	Units	Reference Range
Glucose (fasting)	93	Normal	mg/dL	65-99
Urea Nitrogen (BUN)	12	Normal	mg/dL	7-25
Creatinine	1.20	HIGH*	mg/dL	0.50-1.10 (female interval applied)
BUN/Creatinine Ratio	10	Normal	—	6-22
Sodium	138	Normal	mmol/L	135-146
Potassium	4.1	Normal	mmol/L	3.5-5.3
Chloride	100	Normal	mmol/L	98-110
Carbon Dioxide	30	Normal	mmol/L	20-32
Calcium	10.1	Normal	mg/dL	8.6-10.2
Protein, Total	7.2	Normal	g/dL	6.1-8.1
Albumin	5.1	Normal (upper limit)	g/dL	3.6-5.1
Globulin	2.1	Normal	g/dL	1.9-3.7
Albumin/Globulin Ratio	2.4	Normal (upper limit)	—	1.0-2.5
Bilirubin, Total	1.3	HIGH	mg/dL	0.2-1.2
Alkaline Phosphatase	55	Normal	U/L	33-115
AST	29	Normal	U/L	10-30
ALT	24	Normal	U/L	6-29

* Flagged HIGH by the lab against a female reference interval applied in error — see the data-quality note above.

CBC, Iron Studies, Lipids, and Other

Test	Result	Status	Units	Reference Range (as printed)
White Blood Cell Count	4.9	Normal	Thousand/uL	3.8-10.8
Red Blood Cell Count	4.37	Normal	Million/uL	3.80-5.10*
Hemoglobin	13.0	See note	g/dL	11.7-15.5*
Hematocrit	39.4	See note	%	35.0-45.0*
MCV	90.2	Normal	fL	80.0-100.0
MCH	29.7	Normal	pg	27.0-33.0
MCHC	33.0	Normal	g/dL	32.0-36.0
RDW	12.5	Normal	%	11.0-15.0
Platelet Count	224	Normal	Thousand/uL	140-400
MPV	10.1	Normal	fL	7.5-12.5
Iron, Total	67	Normal	mcg/dL	40-190
Iron Binding Capacity (TIBC)	317	Normal	mcg/dL	250-450
% Saturation	21	Normal	%	16-45
Cholesterol, Total	170	Normal	mg/dL	<200
HDL Cholesterol	89	Normal	mg/dL	>50
Triglycerides	43	Normal	mg/dL	<150
LDL Cholesterol	69	Normal	mg/dL	<100
Chol/HDL Ratio	1.9	Normal	—	<5.0
Non-HDL Cholesterol	81	Normal	mg/dL	<130
Hemoglobin A1c	5.1	Normal	% of total Hgb	<5.7
Vitamin D, 25-OH, Total	50	Optimal	ng/mL	30-100
TSH (with reflex to FT4)	1.34	Normal	mIU/L	0.40-4.50

* Female reference intervals applied by the lab in error — see the data-quality note above.

Patient Details

BISHOP, TYLER

DOB: 05/26/1987 | Age: 32 | Sex: Male

Patient ID: 052687TB

Report demographics list "Sex: F" in error

Ordering / Client

CAMHI, SETH

Direct to Patient — West Hills

8401 Fallbrook Ave

West Hills, CA 91304-3226

Client #: 91304545

Specimen Details

Specimen: EN926337B

Requisition: 0000298

Collected: 10/08/2019 10:17

Received: 10/08/2019 10:18

Reported: 10/25/2019 14:54

Report Status: FINAL

Performing Site: Quest Diagnostics — West Hills, 8401 Fallbrook Ave, West Hills, CA 91304-3226
Laboratory Director: Thomas J McDonald