III.

LABORATORY AND DIAGNOSTIC EXAMINATIONS

HEMATOLOGY
June 20, 2016/ 11:22 am
EXAMINATION

RESULT

NORMAL

Hemoglobin

150

VALUES
F:
120.00 Within normal range. Red
-150.00
M:

134.00

150.00 g/L

INTERPRETATION

blood cells carry oxygen

from the lungs to the rest of
the body. They also carry
carbon dioxide back to the
lungs so it can be exhaled.
If the RBC count is low
(anemia), the body may not
be getting the oxygen it
needs. If the count is too
high

(a

condition

called polycythemia), there

is a chance that the red
blood
together

cells
and

will

clump

block

tiny

blood vessels (capillaries).

This also makes it hard for
your red blood cells to carry
oxygen.Low

hemoglobin

values are seen in patients

with hemoglobinopathies,
or inherited blood disorders
that

either affect

hemoglobin
Hematocrit

0.45

structure

or

F: 0.36 0.45

synthesis.
Within normal range. This

M: 0.40 0.54

test measures the amount

of space (volume) red blood
cells take up in the blood.
The value is given as a
percentage of red blood
cells in a volume of blood.
For

example,

a hematocrit of 38 means
that 38% of the blood's
volume is made of red
blood

cells.

Hematocrit

and hemoglobin values are

the two major tests that
show
Leukocytes No.

3.94

if

anemia

or

polycythemia is present.
5.00 10.00 x White blood cells protect
10^ 9/L

the body against infection.

Lymphocytes

0.15

0.25 0.35 %

(Decreased)

If an infection develops,
white blood cells attack and

Monocytes

0.12

0.01 0.12 %

destroy the bacteria, virus,

Eosinophil

0.02

0.01 0.05

or other organism causing

0.005

it. White blood cells are

Basophils
Segmenters

0.69

0.40 - 0.60

bigger than red blood cells

Stabs

0.02

0.01-0.05

but fewer in number. When

a person has a bacterial
infection, the number of
white

cells

rises

quickly. When

very
the

lymphocyte

count

is

lowered, the body's ability

to

resist

and

infections

fight

is

compromised

off

severely
and

its

susceptibility to cancer is
increased. In addition, low
lymphocyte

counts

may

also lead to damage to

various

organs. Elevated

levels of neutrophils in your

blood,

known

as

neutrophilia, can indicate

an infection and physical
Thrombocytes

180.0

stress.
150.00 440.00 Within
x 10 ^9/L

normal

Platelets

range.

(thrombocytes)

are the smallest type of

blood

cell.

They

are

important in blood clotting.

When bleeding occurs, the
platelets

swell,

clump

together, and form a sticky

plug that helps stop the
bleeding. If there are too
few platelets, uncontrolled
bleeding may be a problem.
If

there

are

too

many

platelets, there is a chance

of a blood clot forming in a
blood vessel. Also, platelets
may
Blood Type

be

involved

in

hardening of the arteries

Blood typing is a method to
tell what specific type of
blood you have. What type

you

have

depends

on

whether or not there are

certain

proteins,

called

antigens, on your red blood

cells.

HEMATOLOGY
June 21, 2016/ 8:11AM
EXAMINATION
Hematocrit

RESULT

NORMAL

INTERPRETATION

0.45

VALUES
F: 0.36 0.45

Within normal range. This

M: 0.40 0.54

test

measures

amount

of

the
space

(volume) red blood cells

take up in the blood. The
value

is

given

as

percentage of red blood

cells in a volume of blood.
For

example,

a hematocrit of 38 means
that 38% of the blood's
volume is made of red
blood cells. Hematocrit
and hemoglobin values

are the two major tests

that show if anemia or
Thrombocytes

169.2

polycythemia is present.
150.00 440.00 Within normal range.
x 10 ^9/L

Platelets

(thrombocytes)

are the smallest type of

blood

cell.

They

important

in

are
blood

clotting. When bleeding

occurs,
swell,

the

platelets

clump

together,

and form a sticky plug

that

helps

stop

the

bleeding. If there are too

few

platelets,

uncontrolled

bleeding

may be a problem. If
there

are

too

platelets,

there

chance

of

many
is

a blood

clot forming in a blood

vessel.
may

Also,
be

platelets

involved

in

hardening of the arteries

URINALYSIS
June 20, 2016/ 10:46am
Color

Dark Yellow

The normal color of urine ranges

from a deep amber to a pale
yellow,

depending

upon

how

diluted or concentrated
The urine is. Therefore, a visual
observation
colored

alone

urine

will

of

normal-

prove

quite

limited in determining any

Sugar

Negative

Real challenges to wellness.

The urine glucose reagent area of
the dipstick measures the amount
of glucose (sugar) in the sample of
urine
Provided

for

studying.

The

presence of glucose in the urine is

called glycosuria or glycosuria.
Glucose is not usually
Found in urine. If it is, further
testing is needed to determine if
the subject has diabetes mellitus.
Presently, only the

Blood glucose test, and not urine,

is done to confirm if a person is a
diabetic. Other conditions that are
possible
when there is glycosuria include
renal glycosuria (when glucose is
released from the kidneys into the
urine) and
Albumin

Trace

Pregnancy.
Albumin urine levels drop when the
immune system engages in a
battle with invading bacteria, fungi,
prions, and
Viruses. Moreover, levels will tend
to decrease when the body is
overwhelmed by toxins and other
dangerous
Substances that enter the body
through the skin or are inhaled,
drunk, or eaten. Notwithstanding, if
albumin levels
remain low (below 3.5 mg/dl) for
long periods of time (several
months or longer), there is a

serious challenge to
Wellness that must be considered.
Reaction
SP Gravity

6.5
1.015

Specific gravity (often abbreviated

as sg and sp gr) is the ratio
(comparison)

of

the

density

(compactness the degree to

which something is filled) of a
substance (urine) to that of distilled
water at a specified temperature
{39.2F (4.0C)}. Hence, it is,
actually, a physical characteristic of
the urine measured through a
chemical test to determine how
concentrated the urine is. Knowing
urine concentration aids in the
decision-making

processes

that

determine if a urine specimen

under evaluation is the best one to
use when attempting to detect a
particular substance. For example,
if a lab technician is looking for
very small amounts of protein, a
concentrated

morning

urine

specimen would be a superior

Epithelial Cells

FEW

sample to a diluted sample. (

Normally in men and women, a few
epithelial cells from the bladder
(transitional epithelial cells) or from
the external urethra (squamous
epithelial cells) can be found in the
urine sediment. Cells from the
kidney (kidney cells) are

less

common. In urinary tract conditions

such as infections, inflammation,
and malignancies, more epithelial
cells are present. Determining the
kinds of cells present helps the
health care provider pinpoint where
the

condition

is

located.

For

example, a bladder infection may

result

in

large

numbers

of

transitional epithelial cells in urine

sediment.
usually

Epithelial
reported

cells
as

are
"few,"

"moderate," or "many" present per

M. Threads

FEW

low power field (LPF).

The mucus threads in urine appear

as small ribbons that are not visible

to eyes. If they are present in large
amounts then this means there is
some underlying infection in any
part of the urinary tract. In normal
conditions there amount is less
Pus cells

1-3

and would disappear in few days.

Finding a few pus cells or white
blood cells (WBCs) in urine is quite
normal. But too many of them may
signal a problem somewhere in
your urinary tract, the commonest
of

which

is

infection (UTI).
RBC

a urinary

tract

IV. REVIEW OF ANATOMY AND PHYSIOLOGY

Figure 1. The
A second line

Immune System
of defense is housed within the body: a finely tuned
immune system that recognizes and destroys
foreign substances and organisms that
enter the body. The immune system can
distinguish between the body's own tissues and
outside substances called antigens. This allows
cells of the immune army to identify and
destroy only those enemy antigens. The ability

to

identify an antigen also permits the immune system to

"remember" antigens the body has been exposed to in

the past; so
immune
The immune
assist

that the body can mount a better and faster

response the next time any of these antigens appear.
system also includes other proteins and chemicals that
antibodies and T cells in their work. Among them are

chemicals that alert phagocytes to the site of the infection. The complement system, a

group of proteins that normally float freely in the blood, move toward infections, where
they combine to help destroy microorganisms and foreign particles. They do this by
changing the surface of bacteria or other microorganisms, causing them to die.
*

enzyme (EN-zime) is a protein that helps speed up a chemical reaction In the body.

antigens (AN-tih-jens) are substances that are recognized as a threat by the body's

immune system, which triggers the formation of specific antibodies against the
substance.
*

bone marrow is the soft tissue inside bones where blood cells are made.

lymphatic (lim-FAH-tik) system is a system that contains lymph nodes and a network

of channels that carry fluid and cells of the immune system through the body.
*

immunity (ih-MYOON-uh-tee) is the condition of being protected against an infectious

disease. Immunity often develops after a germ is introduced to the body. One type of
immunity occurs when the body makes special protein molecules called antibodies to
fight the disease-causing germ. The next time that germ enters the body, the antibodies
quickly attack it, usually preventing the germ from causing disease.
Primarily, the immune system classifies a substance as:

a. Self-non-foreign they are normally ignored and tolerance and is exhibited

towards these substances. They are not deemed harmful.

b. Non-self termed as an antigen; a specific response is developed to a specific

antigen. The response is then stored in the immune systems memory cells for
future reference.
Components of the Immune System:

1. Lymphoid Structures

Spleen
-

Composed of red and white pulp, acts somewhat like a filter.

The red pulp is the site where old and injured red blood cells are
destroyed.

The white pulp contains concentrations of lymphocytes.

Lymph Nodes
-

Are distributed throughout the body

Are connected by lymph channels and capillaries, which remove

foreign material from the lymph before it enters the bloodstream.

2. Immune Cells Lymphocytes

a. B lymphocytes (or B cells) - produce immunoglobulins.
b. T lymphocytes (or T cells) - help control the immune response and destroy
foreign antigens directly.
c. Plasma Cells - are white blood cells that produce large volumes of
antibodies.

3. Tissues The remaining lymphoid tissues, such as the tonsils and adenoids and
other.

Mucoid Lymphatic Tissue contain immune cells that defend the bodys
mucosal surfaces against microorganisms.

Types of Immune Defense:

a. Innate or Nonspecific Immunity

Also termed as the persons natural resistance, and are the most basic and
primary of all defenses in the body. (skin, mucus membranes, phagocytic
activity)

4. Immune Cells Lymphocytes

d. B lymphocytes (or B cells) - produce immunoglobulins.
e. T lymphocytes (or T cells) - help control the immune response and destroy
foreign antigens directly.
f. Plasma Cells - are white blood cells that produce large volumes of
antibodies.

5. Tissues The remaining lymphoid tissues, such as the tonsils and adenoids and
other.

Mucoid Lymphatic Tissue contain immune cells that defend the bodys
mucosal surfaces against microorganisms.

2 Types of Immunity

Active acquired through previous exposure of the disease or through

immunization wherein the body actively participates in formation of antibodies
for future reference.

Passive refers to whole, ready made immunity acquired from another, the
body is just passive in the process of developing antibodies, as it is already
made and given readily.

4 Types of Active Immunity

a. Humoral Immunity
b. Mucosal Immunity
c. Cell-mediated Immunity
d. Delayed HypersensitivityReaction

Antibodies or Immunoglobulins developed from B-cells through the stimulation

of cytokines produced by helper T-cells in the presence of an antigen. They attach to
specific determinant sites on antigens, and carries out phagocytosis and initiating
inflammation.

IgG

75%

Crosses placental barrier; present in circulation and tissue

spaces; antiviral, antitoxic and anti-bacterial properties;

IgA

15%

activates complement
Found in body secretions and breast milk; protects mucous

IgM
IgE
IgD

10%

membranes from microorganisms

Forms natural ABO antibodies; present in early immune

.2%

responses; activates complement

Hypersensitivity reaction mediator; Involved in parasitic

.004%

infectious
Necessary for maturation of B lymphocytes

Hematologic System
Two types of blood vessels carry blood throughout our bodies:
1. Arteries carry oxygenated blood (blood that has received oxygen from the lungs) from
the heart to the rest of the body.
2. Blood then travels through veins back to the heart and lungs, where it receives more
oxygen.

The blood that flows through this network of veins and arteries is whole blood,
which contains three types of blood cells:
1. Red blood cells (RBCs)
- (also called erythrocytes) are shaped like slightly indented,
flattened disks. RBCs contain the iron-rich protein hemoglobin.
Blood gets its bright red color when hemoglobin picks up
oxygen in the lungs. As the blood travels through the body, the
hemoglobin releases oxygen to the tissues.

The body contains more RBCs than any other type of cell, and each has a life span of
about 4 months. Each day, the body produces new RBCs to replace those that die or are
lost from the body.

2. White blood cells (WBCs)

- (also called leukocytes) are a key part of the body's system for
defending itself against infection. They can move in and out
of the bloodstream to reach affected tissues. Blood contains
far fewer WBCs than red blood cells, although the body can
increase WBC production to fight infection. There are several types of WBCs, and their
life spans vary from a few days to months. New cells are constantly being formed in the
bone marrow.
-

Certain types of WBCs produce antibodies, special proteins that recognize foreign
materials and help the body destroy or neutralize them. The white cell count (the number
of cells in a given amount of blood) in someone with an infection often is higher than
usual because more WBCs are being produced or are entering the bloodstream to battle
the infection.

3. Platelets
- (Also called thrombocytes) are tiny oval-shaped cells made in
the bone marrow. They help in the clotting process. When a
blood vessel breaks, platelets gather in the area and help
seal off the leak. Platelets survive only about 9 days in the
bloodstream and are constantly being replaced by new cells.
-

Platelets and clotting factors work together to form solid lumps to seal leaks, wounds,
cuts, and scratches and to prevent bleeding inside and on the surfaces of our bodies.
The process of clotting is like a puzzle with interlocking parts. When the last part is in

place, the clot happens but if even one piece is missing, the final pieces can't come
together.

V. SYMPTOMATOLOGY
SYMPTOMATOLOGY

ACTUAL

IMPLICATION

High Fever

SYMPTOM
/

Is defined as a body temperature

above the normal range due to an
increase in the temperature regulatory
set-point. There is not a single agreed
upon

upper

limit

for

normal

temperature with sources using values

between 37.5 and 38.3 C (99.5 and
100.9 F).
Barone JE (January 2015). "Fever:
Fact and fiction". J Trauma 67 (2):
4069. Retrieved on June 25, 2016

A headache or cephalalgia is pain

Headache

anywhere in the region of the head or

neck. It can be a symptom of a number
of different conditions of the head and
neck. Headaches can result from a
wide range of causes both benign and
more serious. Brain tissue itself is not
sensitive to pain as it lacks pain
receptors. Rather, the pain is caused
by disturbance of the pain-sensitive
structures around the brain. Nine areas
of the head and neck have these painsensitive structures, which are the
cranium (the periosteum of the skull),
muscles, nerves, arteries and veins,
subcutaneous

tissues,

eyes,

ears,

sinuses and mucous membranes.

Strain JD, Strife JL, Kushner DC, et al.
Headache.

American

Radiology.

"ACR

of

appropriateness

criteria."
2000;215(suppl):855860.
on June 25, 2016

College

Radiology.
Retrieved

Eye pain can occur on the surface of

Pain behind eyes

your eye or within your eye's deeper

structures. Eye pain that's on the
surface of your eye might be described
as itching, burning or shooting pain.
Surface eye pain is often related to a
foreign object in your eye, an eye
infection, or anything that irritates or
inflames the membrane covering the
surface of your eye.
Muscle pain is most frequently related
to tension, overuse, or muscle injury

Muscle and joint pain

from exercise or physically-demanding

work. In these situations, the pain
tends to involve specific muscles and
starts during or just after the activity. It
is usually obvious which activity is
causing the pain.

Muscle pain also can be a sign of

conditions affecting your whole body,
like some infections (including the flu)
and disorders that affect connective

tissues throughout the body (such as

lupus).
One common cause of muscle aches
and pain is fibromyalgia, a condition
that

includes

tenderness

in

your

muscles and surrounding soft tissue,

sleep

difficulties,

fatigue,

and

headaches.
Bennett RM. Fibromyalgia and chronic
fatigue syndrome. In: Goldman L,
Schafer AI, eds. Goldman's Cecil
Medicine. 24th ed. Philadelphia, Pa:
Saunders Elsevier; 2011:chap 282.
Bleeding, one of the major problem
encountered in DF, contributes to
worsening

morbidity.

The

toxic

hemorrhagic state appears during the

Minor Bleeding on gums

3rd to 5th day of illness following the

and nose

onset of fever followed by convalescent

stage.http://www.ncbi.nlm.nih.gov/pmc/
articles/PMC3800419/

Retrieved

on

June 25, 2016

The Dengue fever rash commonly

Rashes

presents a few days after the initial

onset of fever. It is not uncommon for
the rash to appear twice, once in the
initial stages and a second time much

Nausea and womiti

later in the disease. Before the main

rash

appears

the

individual

may

experience a lesser rash which gives a

'flushed'

appearance,

on

the

face.http://skincare.lovetoknow.com/De
ngue_Fever_Rash Retrieved on June
25, 2016
Nausea

is

an

uneasiness

of

the stomach that often comes before

vomiting. Vomiting is
voluntary

or

the

forcible

involuntary

emptying

("throwing up") of stomach contents

through the mouth. It is common for
vomiting to occur from a viral infection
http://www.webmd.com/digestivedisorders/digestive-diseases-nauseavomiting Retrieved on June 25, 2016

VI.
Etiology
Aedes
aegypti

Actual Symptom

ETIOLOGY

Implication
The Aedes aegypti mosquito can transmit the
viruses that cause dengue fever. The female
mosquito lays eggs in containers with water
and plants near the home. It bites people and
animals. This species can survive year round
in

tropical

and

subtropical

climates.

https://www.cdc.gov/dengue/resources/30Jan2
012/aegyptifactsheet.pdf retrieved on June 26,
2016

VII.

PATHOPHYSIOLOGY

A. Written Pathophysiology
Dengue fever is a painful, debilitating mosquito-borne disease caused by any one of
four closely related dengue viruses. The course of dengue virus infection is
characterized by early events, dissemination, and the immune response and
subsequent viral clearance Dengue virus is introduced into the skin by the bite of an
infected mosquito, most commonly Aedes aegypti.
The spread of virus early after subcutaneous injection has been studied in rhesus
monkeys during the first 24 hours, virus could only be isolated from the injection site.
The major cell type infected was not defined; Both Langerhans cells and dermal
fibroblasts have been proposed to be target cells for dengue virus infection in the skin.
One study using human skin dendritic cells demonstrated expression of dengue virus
antigens following in vitro exposure, suggesting that these cells are permissive for
dengue viral infection. In rhesus monkeys, virus was detected in regional lymph nodes
24 hours after infection. In one study using a mouse model deficient in both type I and
type II interferon (IFN) receptors, macrophages and dendritic cells were demonstrated
to be early cellular targets for infection. Mosquitoes become infected when they bite
infected humans, and later transmit infection to other people they bite. Two main
species of mosquito, Aedes aegypti and Aedes albopictus, have been responsible for all
cases of dengue transmitted in this country. Dengue is not contagious from person to
person.