INTRODUCTION

What is meant by reference range? It is known as a set information given based on a bunch of
healthy individuals that involve the upper and lower limit of a laboratory test. Certain
component for an instance as age,sex and medical testing(blood,urine,etc) are relying on the
values in between those limit.It can also be affected by surrounding conditions such as
starving and exercise. These intervals are thought of as "normal ranges or limits. Healthcare
supplier are being assigned with the values of reference ranges for the purpose to differentiate
the test results. After all this being carried out,it would be easier for the healthcare providers
to discover patient’s current health status.Nevertheless, the actual interpretation of a
successful lab test result to determine if that individuals are not well,healthy or their
conditions of healths deteriorates, would only be known when the rest of the complete
information are collected by healthcare team.It comprises of the results of a physical exam,
your health and family history, recent changes in your health, any medications you are taking,
and other non-laboratory testing.

The most usual laboratory test that gives information related to patient’s healthcare issue are
as such hemoglobin (Hgb), haematocrit (Hct), white blood cells (WBCs), red blood cells
(RBCs), and red cell indices—mean corpuscular volume (MCV), mean corpuscular
haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC).Not only
that, few components are also important such as platelet count and WBC differential.
Haemoglobin is well known as a protein located in red blood cell and are made up of four
chains. There is one component found in each of these chain of haemoglobin, called as heme.
It holds iron which function in transportation of oxygen in the bloodstream. Next,
haematocrit is present in the blood to count the number of red blood cells that gives to the
whole blood amount.Subsequently,the MCH level are known as to determine the mean
number of haemoglobin developed in the red blood cells in the body.Lastly,trial lab
experiment to determine the degree of inflammation present in the body is well known as
Erythrocyte sedimentation rate (ESR).

Next the phrase “liver function tests” does not mean to check the compatibility of of liver to
work properly.It is just a misconception among the patients. The enzymes level familiar as as
aminotransferases and alkaline phosphatase are utilize to distinguish any destruction to liver
cells and the presence of barrier by bile (a substance produced by liver cells to help digest
fats) respectively. Not only that, liver function can simply be carried out to observe the
development of sickness and reaction to the theraphy performed.Liver function test are
usually carried out after a simple blood test. The test that quantify all the amount of protein
present in blood is the total serum test. Function of albumin in blood is to distribute
medicines and hormones throughout the body. Not only that, it also aid in tissue growth and
healing.

Globulin is a class of proteins where they are produce by the liver and act as an immune
system.They play a role in combat against infection and in transportation of nutrients.While
Bilirubin is an orange-yellow pigment, a waste product primarily produced by the normal
breakdown of heme. Bilirubin basically produced by liver to make sure it eliminates from the
body and this test quantify the bilirubin level in the blood to determine the liver function of
patient and to distinguish anemias originate by demolition by RBC.An alkaline phosphatase
level test (ALP test) measures the amount of alkaline phosphatase enzyme in your
bloodstream. Gamma-glutamyl transferase (GGT) is an enzyme that is found in many organs
throughout the body, with the highest concentrations found in the liver.

A test called urinalysis are used to check the composition of urine, thus to identify the
presence of any abnormalities such as urinary tract infection, kidney disease and diabetes.
Then only those abnormalities could be supervise to bring back them to normal state.Most
important aspect in urinalysis is to detect the appearance, concentration and content of
urine.Unusual urinalysis outcome will show out a disease or illness.For an instance, if the
patient have an urinary tract infection then it can be shown in the urinalysis test by showing a
cloudy look urine instead of clear urine. Then if protein levels is elevated in the urine, then it
signify to kidney disease.

Next test in laborartory data analysis is the lipid profile.It is a class of test that used to check
the possibilities of patients in getting any cardiovascular related disease(heart disease, stroke
and related diseases), thus to plan a medical theraphy of these condition that can cause
obstruction of blood vessels.(“hardening of the arteries”). The lipid profile commonly
comprise total cholesterol, HDL (usually referred to as good cholesterol), LDL (usually
referred to as bad cholesterol) and triglycerides. Sometimes the report contains non-HDL-
cholesterol and additional values are calculated like total cholesterol / HDL ratio or a risk
score based on lipid profile results, age, sex and other risk factors.
FULL BLOOD COUNT

The first report that was being analysed is from a female patient which is aged 50 above.
From her clinical data, it can be observed that her haemoglobin level is 124g/L which is
within the normal range ( 115-165g/L).Next the RBC count is 4.16x10^12/L also within the
normal range (3.80-5.80).The red cells are normochromic normocytic. Haematocrit levels are
0.38 L/L also within the normal range (0.38-0.48). The MCV are 92 fL which is within the
normal range also (78-98). MCH level is also within the normal range (30pg) and her MCHC
level is in the normal range (27-32).

Besides that, her WBC values are 6.7x10^9/L also in the normal range(4.0-11.0). WBC count
is normal with normal morphology. Neutrophils level are 3.5x10^9/L within the normal
range(2.0-7.5). Next lymphocytes level are 2.5x10^9/L within the normal range also(1.5-4.0).
Then the monocyte level are 0.5x10^9/L also to be found within the normal range(0.2-0.8).
Proceed to the next one eosinophills level are 0.2x10^9/L that is also within the normal
range(˂0.4). Basophils level is 0.1x10^9/L which also having within the normal range(˂0.2).
Not only that,platelets count are 173x10^9/L also found to be within the normal range (140-
400).Platelets are appearing adequately. Lastly is the ESR value is 2mm/hr which appear
within the normal range (˂40)

LIVER FUNCTION

This patient’s total protein is 69g/L which is within the normal range value(64-83g/L).It
review the synthetic functions of the liver. Next albumin is 44 g/L which inflects within the
normal range(35-52g/L).Globulin level is recorded to be 25g/L which is within the normal
range (21-35g/L).Albumin/Globulin ratio is 1.8 Ratio which is within the normal ratio
also.(0.8-2.0 Ratio).Total bilirubin collected is 20 also found within the normal range (˂21
umol/L).Next, alkaline phosphatase is 75 within the normal range also (30-120U/L).The
GGT level is 5 recorded within the normal range(˂50U/L).Aspartase Transferase(AST) of
the patient is (43U/L) which exceeds the normal range (˂40). Elevated levels of ALT can
signify the patient of having liver damage.Not only that, raised level of ALT may be a
consequences of hepatitis, which is an inflammatory state of the liver and cirrhosis, which is
acute damage of the liver. Lastly is the Alanine Transaminase(ALT) level is 18 U/L which is
within the normal range(˂43).
URINEALYSIS

Appearance of the patient’s urine is clear and the colour is found to be yellow. Normal urine
colour appearance is because of the presence of urochrome stain. Its specific gravity value is
1.019 which falls within the normal range (1.004-1.030). The urine pH is 5.0 which also
within the normal range (4.8-7.4).Normally, pH urine would be less as it constitude a slightly
acidic nature. This is due to the obligate renal H+ ion excretion, due to the normal daily
average endogenous acid production of 1 mEq/kg required to maintain acid-base balance in
the body. Next her leucocytes, blood and nitrite found in the urine is negative. Usually
absence of nitrites are found in the urine. Urinary nitrates are transformed to nitrites by
bacteria in the urine. Her protein level is ˂0.25g/L which is the same as the normal value.
Glucose is ˂3.0mmol/L which is also same as the normal value. Ketones is ˂0.5mmol/L same
as the normal values. Then, urobilinogen and bilirubin level is ˂17µmol/L which is the same
as the normal value. Red blood cell count is ˂5/µL same as the normal value and the white
blood cell count is ˂10/µL which is also equivalent to its normal value. Lastly, the epithelial
cell count, bacteria, and others are absent in the urine analysis of the patient. This indicate
that urinary specimen is not contaminated.

LIPID STUDIES

The total cholesterol present in the patient is 5.42mmol/L which is expected to be higher than
the normal range(˂5.20). Total cholesterol level is high because of a high LDL level, she may
be at higher risk of heart disease or stroke.The triglyceride value is 0.79mmol/L is within the
normal range given(˂1.70). Next the HDL cholesterol is 2.09mmol/L which is within the
normal range also (˃1.03). But her LDL cholesterol is 2.97mmol/L which is found to be
elevated from the normal range(˂2.58). Increased levels of LDL in the blood are correlated
with higher possibilities of getting atherosclerosis and heart disease. There are differentiated
receptors situated on cell surfaces that bind LDL, these are called LDL-receptors. Reduced
number of LDL-receptors may lessen the intake of cholesterol by the cells, enforce it to stay
in the blood flow thus increase blood levels. A diet high in saturated and trans fat is
poisonous as it able to increase LDL cholesterol levels. The total cholesterol/HDL is
2.59Ratio which is within the normal range(˂5.00).Lastly her non-HDL cholesterol is
3.33mmol/L which is also within the normal range. Non-HDL has been shown to be a better
marker of risk in both primary and secondary prevention studies.
FULL BLOOD COUNT

Next report being analysed is from a male patient which is aged below 70 years old. From his
clinical data, it can be observed that his haemoglobin level is 126g/L which is lower than the
normal values( 130-180).Not only that,his RBC level is 4.40x10^12/L which is also found to
be lower than the normal values(4.50-6.50).Red cells are normochromic normocytic.This
patient are experiencing borderline anaemia as his haemoglobin and RBC count are low.Not
only that, he might have lack of nutrition like iron, folate or B12 deficiency. Next his MCV
value is 87fL which is within the normal range(78-98).Proceed to the HCT value is 0.38L/L
which is lower than the normal value(0.40-0.54).Values of lower haematocrit stipulate
inadequate source of healthy red blood cells (anemia),vitamin or lack of minerals.His MCH
level is 29pg which is found to be within the normal values(27-32). The MCHC level is
332g/L is within the normal values also(300-360)

Next his WBC is being analysed and its level is 7.2x10^9/L which is within the normal
range(4.0-11.0).WBC count is normal with normal morphology. Neutrophils level is
4.2x10^9/L which is also within the normal range(2.0-7.5). Lympocytes level is 2.0x10^9/L
which is within the normal values(1.50-4.0).Next going on the monocytes level is 0.6x10^9/L
which is also found to be within the normal range(0.2-0.8). Eosinophills level is 0.2x10^9/L
having within the normal range(˂0.4).His basophils level is 0.1x10^9/L given within the
normal range of (˂0.2).Next his platelets is 258x10^9/L which is within the normal
range(140-400).Platelets appear adequate. Lastly, his ESR level 33mm/hr which is also
within the normal range(˂40).

LIVER FUNCTION

Total protein contains for this patient is 73g/L which is within the normal range(64-83).Next
his albumin level is 40g/L which is also within the normal level(35-52).Globulin level in the
blood is 33g/L which is also within the normal range(21-35).So his total albumin/globulin
ratio found is 1.2 Ratio(0.8-2.0).Proceeding to next analysis is the total bilirubin is 18umol/L
which is within the normal range(˂21).His alkaline phosphatase is 65U/L which is also
within the normal given(30-120).Next his GGT level is found to be 29U/L which is within
the normal range(˂50).The aspartate transferase(AST) is 26 U/L which is within the normal
range(˂45).Lastly is the alanine transaminase(ALT) is 27 U/L which is within the normal
range also(˂55).
URINEALYSIS

In his urinalysis test,it is to be observed that his urine’s appearance is clear and the colour is
yellow. Vitamins will make his urine appear a brighter yellow because he consistently taking
extra supplements daily. Its specific gravity level is 1.014 which falls within the normal
range(1.004-1.030).Next the urine pH is 6.5 which is also normal(4.8-7.4).Neutral number of
pH of urine is 7, since this patient’s pH is 6.5,then it is slightly acidic. The leucocyte and
nirite content in the urine is negative.This shows that he doesn not have an urinary tract
infection.For protein level that is ˂0.25g/L within the normal ranges(˂0.25).Next glucose
level is ˂3.0mmol/L which is also in the given normal range(˂3.0).Ketones is ˂0.5mmol/L
which is also within the normal range (˂0.5).Urobilinogen and bilirubin level is ˂17µmol/L
which is also within the normal range(˂17).His blood in the urinalysis shows a negative
result.Red bloos cell count is ˂5/µL which falls within the normal range(˂5).Next white
blood cell count is ˂10/µL which also within the normal range(˂10).Lastly,his epithelial cell
count and bacteria are found to Nil in the urinalysis.

LIPID STUDIES

The total cholesterol present in the patient is 5.31mmol/L which is expected to be higher than
the normal range(˂5.20). Total cholesterol level is high because of a high LDL level, he may
be at higher risk of heart disease or stroke.The triglyceride value is 0.85mmol/L is within the
normal range given(˂1.70). Next the HDL cholesterol is 1.26mmol/L which is within the
normal range also (˃1.03). But his LDL cholesterol is 3.66mmol/L which is found to be
elevated from the normal range(˂2.58). Elevated levels of LDL in the blood are associated
with increased risk of atherosclerosis and heart disease.There are specialized receptors on cell
surfaces that bind LDL, these are called LDL-receptors. A lack of LDL-receptors may reduce
the uptake of cholesterol by the cells, forcing it to remain in the circulation thereby raising
blood levels. A diet high in saturated and trans fat is unhealthy because it tends to raise LDL
cholesterol levels.The total cholesterol/HDL is 4.21Ratio which is within the normal
range(˂5.00).Lastly his non-HDL cholesterol is 4.05mmol/L which is found to be higher than
the normal range. It is considered to be above desirable level which need to cut down.
PHARMACEUTICAL CARE APPROACH.

From the data obtained by the clinical laboratory results of the patient, analysis had been
done and now pharmaceutical care approach need to be carried out in order to ensure a
healthy lifestyle of patient. The execution of pharmaceutical care is aided by data collection
and documentation systems that accommodate patient care communications. The
pharmaceutical practice constitude a representative of responsible pharmacist participation in
the optimization of pharmacotherapy in different comunity groups, including the elderly,
which are familiar to be at danger for drug - related issues.

Based on report 1, the patient is having blood group A Rh(D)Positive. Her full blood count
shows that she’s not having any problem as all the components are within the normal range.
After evaluating her liver function test it is to be found that her Aspartate Transferase(AST)
is high than the normal ranges. Generally, AST is to be found in elevated concentrations in
liver, muscles, heart, kidney, brain and red blood cells. Nevertheless, small scale
concentration of AST is present in the bloodstream. So, high concentration than the normal
value found in the blood would notify some health related problems.Irregular value of AST
can also causes liver damage.

First line theraphy to treat her AST abnormal values is by stopping certain medications.
Indirectly all medications have the ability to spoil the liver and elevate blood liver enzymes
(AST), but it's usually a matter of dosage and how long she been taking them.

Certain medication (or their drug disintegration), however, are naturally more liver toxic than
other molecules. For an instance, statin drugs (used to lower blood cholesterol) as she have
high cholesterol and acetaminophen (Tylenol) have a more negative effect on the liver than
most medications.But,if the patient’s AST level still considered to be more in the blood level,
and she do still need statin medication, another replacement of drug would highly considerate
to control her cholesterol level.Otherwise her statin medication dose shall be cut down as
when her intake of this kind of medication is reduced, then automatically her liver toxic level
will be decrease over a few weeks.

Next when there is high concentration of iron gathered in the body called as
hemochromatosis, it can cause to increased level of liver enzymes.Despite all this, there are a
group of drugs that can used for against the liver disease, for example viral infections
(hepatitis A, B and C), cirrhosis (assembling of fat and disturbance in function from alcohol
abuse) and cancer. Lamivudine and Adefovir Dipivoxil usually used to cured Hepatitis B
whereas hepatitis C is cured with a composition of peginterferon and ribavirin. Diuretic drugs
are used to treat cirrhosis (to remove edema), as well as laxatives (such as lactulose) to help
absorb toxins from the blood and take the workload off the liver. There a number of
chemotherapy medications (oxaliplatin, capecitabine, gemcitabine) used to fight liver cancer,
including very targeted therapies such as injecting the drug sorafenib (Nexavar) directly into
tumors.

Eat a particular diet. A diet which have low in protein lessen the possibilities of toxins to
accumulate in the body because of the incapacity of the liver to correctly process the protein.
The patient should have a hydrocarbon diet. Salt should be avoided because sodium generates
swelling in the liver.

Next her urinalysis does not show any abnormalities or complications as all the data level are
complying with the normal ranges given. She does not have any urine infection or problem
related to kidney. Since there is no blood, white blood cell and bacteria found in the urine,
then she is free from urinary tract infection also. Her sugar level is also under control since
the glucose and protein are not appeared in urine analysis, so she have high possibilities of
not getting potential diabetes. Her appearance of urine are also clear and this shows that she
had no infection since infected urine would be cloudy in colour. Next, red blood cells, are
within the normal range which shows the absence kidney diseases.

Next during the analysis of lipid studies, it is found that the total cholesterol and LDL
cholesterol level is higher than the normal range given. The total cholesterol and LDL
cholesterol need to be lowered down in order to keep this patient from getting heart disease.
Particular option of medications are needed as such statins obstruct a component that liver
needs to make cholesterol. This causes the liver to eiminate cholesterol from blood. Not only
that, statin drug also aid the reabsorption of cholesterol in the body from being accumulated
on the artery wall, thus avoiding from getting coronary artery disease.Example of drugs that
can be given would be atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Altoprev),
pitavastatin (Livalo).

Next is by bile-acid-binding resins. Liver make use of use cholesterol to produce bile acids, a
component needed for digestion. The drugs such as cholestyramine (Prevalite), colesevelam
(Welchol) and colestipol (Colestid) helps to bring down the cholesterol level indirectly by
combining to bile acids. This actions trigger the liver to use excess cholesterol to produce bile
acids, which lessens the level of cholesterol in blood.

Besides that, a new group of medication that are used to aid liver take up more LDL
cholesterol that is known as injectable drugs. It is used to bring down the cholesterol level
accumulating in blood. Alirocumab (Praluent) and evolocumab (Repatha) may be utilized for
the patient who have a very high amount of LDL level or with patient whom cannot tolerate
with the statin drug.

Proceeding to next is to cut down the saturated fats in daily diet. The patient tend to take up
more saturated fats such a red meat, dairy products which are full fat and many more that
raise her cholesterol level.So she was being advised to lessen the intake of saturated fats that
can bring down her low-density lipoprotein (LDL) cholesterol called as "bad" cholesterol.
For patient 2, based on his lab data analysis, it is found that in his full blood count, the level
of haemoglobin, RBC and HCT are lower than the normal value. He is suspected to be
suffering from anaemia. He needs some theraphy in order to raise his haemoglobin, HCT and
RBC level to the normal state. Firstly, he needs to upgrade his daily diet by eating foods high
in iron and folate. Iron component is necessary in creation of haemoglobin. There is a protein
component which is known as transferrin that combines to the iron and transports throughout
the body as this will aid in the production of red blood cells by body. The very initial action
to be taken by the patient in order to elevate the haemoglobin level to the normal state again
is by changing his daily diet. As such he should eats more iron containing food like liver and
organ meats, mutton, broccoli and spinach. Subsequently, to make up heme in the body,
folate is useful B vitamin that are present in the red blood cells containing haemoglobin. Red
blood cells cannot fully grown if amount of folate is inadequate.

In his liver function test, all components are found to be normal as per the normal range
values. The normal AST and ALT level indicates that enzymes that liver releases in response
well without damaging the liver. It also diagnoses that this patient do not suffer from any
form of hepatitis.

Next his urinalysis does not show any abnormalities or complications as all the data level are
complying with the normal ranges given. He does not have any urine infection or problem
related to kidney. Since there is no blood, white blood cell and bacteria found in the urine,
then she is free from urinary tract infection also. His sugar level is also under control since
the glucose and protein are not appeared in urine analysis, so he have high possibilities of not
getting potential diabetes. His appearance of urine are also clear and this shows that he had
no infection since infected urine would be cloudy in colour. Next, red blood cells, are within
the normal range which shows the absence kidney diseases.

Small intestine take up the cholesterol from diet and releases it into bloodstream. The drug
known as cholesterol absorption inhibitors such as ezetimibe (Zetia) helps in lowering blood
cholesterol by restraining the absorption of dietary cholesterol. Ezetimibe can be used in
combination with a statin drug. In other ways, sequestrants would be another possible
mediation to substitude statins. It act by holding together to the bile in the intestines, thus
obstruct the absorption of cholesterol into the bloodstream. If the patient develop much
cholesterol level in the blood then it would be a risk for him since plague can be formed in
the arteries. This will obstruct the blood flow and heart attack will occur.
Another alternative to statins is bile acid-binding resins or sequestrants. These drugs work by
binding to the bile in your intestines, blocking cholesterol absorption into your bloodstream.A
common prescription for high LDL cholesterol is niacin or vitamin B-3. Niacin can help
lower bad cholesterol (LDL) and increase good cholesterol (HDL).

There are many differences to your lifestyle that can aid in bringing down his cholesterol.
Changes in lifestyle play an important role in combating high cholesterol. This patient is a
busy businessman whom do not really take a good care of his health as he travelling far daily.
He lacks of exercise and nutritional food. He needs to initiate by losing excess weight and
eating heart - healthy foods to lower cholesterol. To eat a healthy heart diet means he need to
reduce the saturated (animal) fat eat. It also means increasing his diet for fiber, fruit,
vegetables, whole grains and fish. Another important change in your lifestyle is to stop
smoking and reduce the amount of alcohol you use. Exercising every day is another way to
combat high cholesterol. The addition of exercise can begin with something as easy as a short
walk every day.
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