Lab Results & Monitoring

ANC Trend

Absolute Neutrophil Count (ref: 2.0-7.0)

Lab Value Trends

Historical trends from all lab panels

ANC (Neutrophil Count)

0.8 x10³/µL

Ammonia

1.04 ug/mL

Creatinine

0.56 mg/dL

Sodium

137 mmol/L

Vitamin B12

1109 pg/mL

ESR (Sed Rate)

30 mm/hr

Fibrinogen

428 mg/dL

INR

1.14

Serum Osmolality

279 mOsm/kg

Ferritin

19.4 ng/mL

Albumin

3.9 g/dL

Urea (BUN)

13 mg/dL

WBC (White Blood Cells)

2.9 x10³/µL

Platelet Count

186 x10³/µL

Tumor Markers — Alfa Labs

Download PDF تحميل PDF01 Mar 2026

Normal — Reassuring (1)

Test	Result	Comment
CEA	4.9 ng/mL	Within normal range. Previously 6.3 (11 Feb 2026). Trend improving.

Comprehensive Panel — Alfa Labs

Download PDF تحميل PDF28 Feb 2026

Abnormal — Requiring Attention (11)

Test	Result	Reference	Status	Clinical Significance
Vitamin B12	1109 pg/mL	180-914	HIGH	Elevated — likely from supplementation. Monitor but not clinically concerning.
Ammonia	1.04 ug/mL	0.19-0.87	HIGH	Elevated above reference. Monitor — VPA (Depakine) can raise ammonia. Consider L-Carnitine.
Creatinine	0.56 mg/dL	0.63-1.16	LOW	Below reference — consistent with sarcopenia (low muscle mass). Cystatin C normal rules out renal impairment.
Magnesium	1.8 mg/dL	1.9-2.5	LOW	Below reference. Supplementing with Mg Glycinate 2000mg/day. Low Mg worsens seizures.
Fibrinogen	428 mg/dL	200-400	HIGH	Elevated — may indicate inflammation or acute phase response. Monitor.
Hematocrit	35.5 %	36-46	LOW	Slightly below reference. Monitor with hemoglobin.
WBC	2.9 x10³/µL	4-10	LOW	Low — leukopenia. Consistent with chronic pattern. Monitor for infection signs.
ANC	0.8 x10³/µL	2-7	CRITICAL	Severe neutropenia (ANC <1.0). High infection risk. Neutropenic precautions required.
Lymphocytes	60 %	20-40	HIGH	Relatively elevated — compensatory for low neutrophils.
Monocytes	11 %	2-10	HIGH	Slightly elevated. May indicate chronic inflammation.
MCHC	34.9 g/dL	31.5-34.5	HIGH	Slightly above reference. Not clinically significant in isolation.

Normal — Reassuring (11)

Test	Result	Comment
CEA	4.8 ng/mL	Within normal range. Previously 6.3 (11 Feb 2026). Trend improving.
Homocysteine	11.40 µmol/L	Normal. Good B-vitamin status.
CK	26 U/L	Normal. No evidence of muscle breakdown.
eGFR	>90	Normal kidney function.
Sodium	137 mmol/L	Normal. Previously borderline low.
Hemoglobin	12.40 g/dL	Normal.
Platelets	186 x10³/µL	Normal.
RBC	4.21 x10⁶/µL	Normal.
MCV	84.3 fL	Normal.
MCH	29.5 pg	Normal.
RDW	13.3 %	Normal.

Comprehensive Panel — Alfa Labs

Download PDF تحميل PDF11 Feb 2026

Abnormal — Requiring Attention (13)

Test	Result	Reference	Status	Clinical Significance
WBC	2.8 x10³/μL	4-10	LOW	Leucopenia - likely carbamazepine-induced
ANC	0.7 x10³/μL	2-7	CRITICAL	Moderate neutropenia. Infection risk. Threshold for CBZ stop
CEA	6.3 ng/mL	≤5.0	HIGH	Mildly elevated. Oncologist follow-up. Likely inflammatory
Magnesium	1.7 mg/dL	1.9-2.5	LOW	Low (ref 1.9-2.5). Now supplementing with Mg Glycinate 2000mg/day. Low Mg worsens seizures.
ESR	30 mm/hr	0-20	HIGH	Chronic inflammation marker
Fibrinogen	443 mg/dL	200-400	HIGH	Acute phase reactant (inflammation)
INR	1.14	<1.0	HIGH	Mildly prolonged clotting
Creatinine	0.57 mg/dL	0.63-1.16	LOW	Sarcopenia marker (NOT kidney problem - CysC confirms normal)
Ammonia	0.86 μmol/L	0.19-0.87	BORDERLINE	At upper limit. Valproate effect. Monitor with protein supplementation
LDL	101 mg/dL	<100	HIGH	Marginally above target
Sodium	137 mEq/L	136-146	BORDERLINE	Low-normal. SIADH history. CBZ-related
Serum Osmolality	279 mOsm/kg	275-295	BORDERLINE	Low-normal, consistent with mild dilution (SIADH pattern)
Valproic Acid Trough	23.10 μg/mL	50-100	LOW	Sub-therapeutic - intentionally tapering

Normal — Reassuring (26)

Test	Result	Comment
Hemoglobin	13.90 g/dL	Normal
Platelets	169 x10³/μL	Normal
Carbamazepine Level	7.77 μg/mL	Therapeutic
Cystatin C	0.88 mg/L	Normal (eGFR CysC >90) - CONFIRMS normal kidneys
Fasting Glucose	86 mg/dL	Normal
HbA1c	5.1 %	Normal
HOMA-IR	0.56	Excellent insulin sensitivity
ALT	13 U/L	Normal
AST	17 U/L	Normal
Total Protein	7.6 g/dL	Normal
Albumin	3.9 g/dL	Normal
Vitamin D	33.2 ng/mL	Sufficient
TSH	1.26 mIU/L	Normal
Free T4	0.71 ng/dL	Normal
NT-proBNP	30.8 pg/mL	No heart failure
CA 15-3	9.1 U/mL	Normal
CA 125	3.5 U/mL	Normal
Ferritin	19.4 ng/mL	Low-normal
Calcium	9.3 mg/dL	Normal
Potassium	4.5 mEq/L	Normal
Iron	92 μg/dL	Normal
Cholesterol	191 mg/dL	Normal
HDL	63 mg/dL	Normal
Triglycerides	139 mg/dL	Normal
Blood Urea Nitrogen	13 mg/dL	Normal BUN.
Vitamin B12	876 pg/mL	Upper end of normal range. Supplementation effect.

Comprehensive Blood Panel — Alfa Lab

Download PDF تحميل PDF10 Dec 2025

Abnormal — Requiring Attention (7)

Test	Result	Reference	Status	Clinical Significance
CRP	59.1 mg/L	<5	CRITICAL	12x upper limit — active systemic infection
WBC (TLC)	3.4 x10³/µL	4-10	LOW	Leucopenia during active infection
ANC	1.5 x10³/µL	2-7	LOW	Neutropenic during active infection
Platelets	139 x10³/µL	150-410	LOW	Mild thrombocytopenia
Creatinine	0.57 mg/dL	0.63-1.16	LOW
Albumin	3.5 g/dL	3.5-5.2	BORDERLINE
Urea	16 mg/dL	17-43	LOW	Slightly below reference. May indicate low protein intake.

Normal — Reassuring (3)

Test	Result	Comment
Hemoglobin	13.3 g/dL	Normal
INR	1.08	Normal
Sodium	138 mmol/L	Normal.

CBC — Alfa Labs

Download PDF تحميل PDF01 Oct 2025

Abnormal — Requiring Attention (4)

Test	Result	Reference	Status	Clinical Significance
Platelets	139 x10³/μL	150-410	LOW	Mild thrombocytopenia
WBC	3.4 x10³/μL	4-10	LOW	Mild leucopenia
ANC	1.5 x10³/μL	2-7	LOW	Mild neutropenia (improved)
Lymphocytes	43% %	20-40%	HIGH

Normal — Reassuring (3)

Test	Result	Comment
Hemoglobin	13.30 g/dL	Normal
Hematocrit	38.5 %	Normal
Monocytes	10% %	Normal

Comprehensive Panel — Alfa Labs

Download PDF تحميل PDF03 Jun 2025

Abnormal — Requiring Attention (10)

Test	Result	Reference	Status	Clinical Significance
WBC	2.5 x10³/μL	4-11	LOW	Leucopenia
ANC	0.7 x10³/μL	2-7	CRITICAL	Moderate neutropenia
Lymphocytes	52% %	20-45%	HIGH	Relative lymphocytosis
Monocytes	19% %	1-10%	HIGH	Relative monocytosis
Urea	12 mg/dL	17-43	LOW	Below reference. Low urea can indicate low protein intake or liver issues. Consistent with sarcopenia pattern.
Creatinine	0.45 mg/dL	0.63-1.16	LOW	Below reference — consistent with sarcopenia (low muscle mass).
Uric Acid	1.9 mg/dL	2.6-6	LOW	Below reference. Low uric acid consistent with poor nutritional status.
Magnesium	1.8 mg/dL	1.9-2.5	LOW	Below reference. Low Mg worsens seizures. Supplementation recommended.
Zinc	43 µg/dL	50-120	LOW	Below reference. Zinc deficiency impairs immune function and wound healing.
Vitamin B12 (cyanocobalamin)	987 pg/mL	180-914	HIGH	Slightly elevated — likely from supplementation. Not clinically concerning.

Normal — Reassuring (13)

Test	Result	Comment
Hemoglobin	12.3 g/dL	Normal
Hematocrit	36.7 %	Normal
Platelets	150 x10³/μL	Normal
RBC	4.25 x10⁶/µL	Normal.
MCV	86.4 fL	Normal.
MCH	28.9 pg	Normal.
MCHC	33.5 g/dL	Normal.
RDW	13.2 %	Normal.
Calcium	8.8 mg/dL	At lower end of normal range.
Phosphorus	3.9 mg/dL	Normal.
Ferritin	75.8 ng/mL	Normal iron stores.
Folic Acid	13.07 ng/ml	Normal folate status.
Vitamin D	35.9 ng/mL	Sufficient. Maintain supplementation.

Renal Function + Electrolytes — Alfa Lab

Download PDF تحميل PDF07 May 2025

Abnormal — Requiring Attention (2)

Test	Result	Reference	Status	Clinical Significance
Creatinine	0.53 mg/dL	0.63-1.16	LOW
Sodium	135 mmol/L	136-146	LOW	Mild hyponatremia

Normal — Reassuring (2)

Test	Result	Comment
Urea	25 mg/dL	Normal
Potassium	4.2 mmol/L	Normal

Tumor Markers — External Lab

Download PDF تحميل PDF04 May 2025

Normal — Reassuring (2)

Test	Result	Comment
CEA	3.83 ng/mL	Normal
CA 15.3	13.41 U/mL	Normal

CBC + Coagulation — Hospital Lab

Download PDF تحميل PDF30 Apr 2025

Abnormal — Requiring Attention (2)

Test	Result	Reference	Status	Clinical Significance
WBC (TLC)	3.4 x10³/µL	4-11	LOW	Leucopenia
ANC	0.9 x10³/µL	2-7	LOW	Moderate absolute neutropenia

Normal — Reassuring (3)

Test	Result	Comment
Hemoglobin	13.4 g/dL	Normal
Platelets	163 x10³/µL	Normal
INR	1.01	Normal

CBC + Chemistry + Electrolytes — Alfa Lab

Download PDF تحميل PDF08 Jan 2025

Abnormal — Requiring Attention (4)

Test	Result	Reference	Status	Clinical Significance
WBC (TLC)	2.4 x10³/µL	4-11	LOW	Leucopenia (Depakine effect)
ANC	0.8 x10³/µL	2-7	LOW	Moderate absolute neutropenia
Creatinine	0.59 mg/dL	0.63-1.16	LOW	Low muscle mass
Sodium	134 mmol/L	136-146	LOW	Mild hyponatremia

Normal — Reassuring (5)

Test	Result	Comment
Hemoglobin	13.7 g/dL	Normal
Platelets	158 x10³/µL	Normal
Potassium	4.9 mmol/L	Normal
Urea	23 mg/dL	Normal.
Albumin	3.8 g/dL	Normal.

Liver & Kidney Function — Medpark Labs

Download PDF تحميل PDF22 Dec 2023

Abnormal — Requiring Attention (1)

Test	Result	Reference	Status	Clinical Significance
Cholesterol	295 mg/dL	<200	HIGH	Significantly elevated. Desirable <200, Borderline 200-239, High >=240. Likely related to immobility and diet. Statin consideration if persistent.

Normal — Reassuring (8)

Test	Result	Comment
AST (GOT)	14 U/L	Normal liver enzyme.
ALT (GPT)	17 U/L	Normal liver enzyme.
Bilirubin Total	0.2 mg/dL	Normal
Bilirubin Direct	0.12 mg/dL	Normal
Bilirubin Indirect	0.1 mg/dL	Normal
Urea	25 mg/dL	Normal kidney function.
Creatinine	0.6 mg/dL	At lower end of normal — consistent with sarcopenia pattern.
Uric Acid	2.9 mg/dL	Normal

Complete Blood Picture — Al Salam Hospital Medical Lab

Download PDF تحميل PDF26 Oct 2022

Abnormal — Requiring Attention (2)

Test	Result	Reference	Status	Clinical Significance
Hemoglobin	11.7 g/dL	12.0-15.0	LOW	Mildly low — mild anaemia.
Hematocrit	35.2 %	36.0-46.0	LOW	Low — consistent with mild anaemia.

Normal — Reassuring (12)

Test	Result	Comment
RBC	4.0 x10¹²/L	Normal red blood cell count.
MCV	86 fL	Normal — normocytic.
MCH	28.5 pg	Normal
MCHC	33.1 g/dL	Normal
Platelet Count	171 x10³/µL	Normal platelets.
WBC (TLC)	6.7 x10³/µL	Normal total WBC count.
ANC	4.958 x10³/µL	* CRITICAL BASELINE: ANC was completely NORMAL (4.958) BEFORE Tegretol was started. Current ANC 0.7-0.8 — strong evidence for carbamazepine-induced neutropenia. *
Neutrophils %	74 %	Normal
Lymphocytes	1.474 x10³/µL	Normal
Lymphocytes %	22 %	Normal
Monocytes	0.201 x10³/µL	Normal
Eosinophils	0.067 x10³/µL	Normal

Imaging Results

Ultrasound — Abdomen & Pelvis

14 Feb 2026

El Faskan

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Liver: Normal (13cm), homogeneous. Gall bladder: Normal. Spleen: Normal (10cm). Kidneys: Normal, no calculi. Uterus: Normal, endometrium 4mm. Bladder: Normal.

Conclusion: Mild bowel gaseous distention only

X-ray — Chest

14 Feb 2026

El Faskan

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Clear both lung fields. Normal cardiac size and shape. No lymph node enlargement. Dorsal spondylotic changes.

Conclusion: Clear

Mammography — Right breast

14 Feb 2026

El Faskan / Dr. Engy Adel

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Scattered densities of glandular condensation. Multiple calcified and non-calcified lesions. No spiculated masses or pathological microcalcification. One right supra-areolar lesion 17x8mm. Right non-specific axillary lymph nodes. Left mastectomy bed: FREE.

Conclusion: Probably benign

BIRADS 3

Mammography — Right Breast

14 Feb 2026

Alfascan Imaging Center

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Scattered densities. Multiple scattered calcified and non-calcified lesions. No spiculated masses. Right supra-areolar hypoechoic lesion. Mild mammary fibroadenosis.

Conclusion: BIRADS 3 (stable from Feb 2025). Half-annual screening recommended. Multiple probably benign lesions — likely fat necrosis.

BIRADS 3

Ultrasound — Breast + Abdomen + Chest

08 Feb 2025

Imaging Center / Dr. Engy Adel

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Right breast: multiple probably benign lesions (fat necrosis). 17x8mm retroareolar lesion. Post left mastectomy. Abdomen: normal. Chest X-ray: clear.

Conclusion: Right breast BIRADS 3. Dynamic MRI recommended.

BIRADS 3

Echocardiogram — Heart

09 Nov 2022

Prof. Emad Mohsen Barsoom / Dr. Mohamed Mohsen

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Left ventricle: End diastolic 46mm (N to 5.7cm), End systolic 30mm (N to 4cm). Fractional shortening 36% (N 25-40%). Ejection fraction 65%. Posterior wall 9mm (N to 1.1cm). Septal wall 10mm (N to 1.1cm). Right ventricle: 21mm (N to 2.4cm). Left atrium: 31mm (N to 4cm). Aortic root: 27mm (N to 3.7cm).

Conclusion: Diastolic dysfunction grade I. Normal LV internal dimensions with good global systolic function. Impaired LV diastolic filling pattern (grade I). No regional wall motion abnormality. Normal cardiac valves. No intra-cardiac masses or thrombi. No pericardial effusion.

MRI — Brain

25 Aug 2022

Dokki Scan, Cairo / Prof. Dr. Emad Mohsen Barsoom

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Thinned corpus callosum. Bilateral microbleeds on SWI. Reduced brain stem volume. Progressive ventricular dilatation.

Conclusion: Progressive post-traumatic changes. Corpus callosum thinning. Microbleeds documented.

MRI — Brain + Cervical Spine

17 Apr 2022

Dokki Scan, Cairo / Prof. Dr. Emad Mohsen Barsoom

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Brain: Accentuated sulci, moderately dilated ventricles. Bilateral frontoparietal lacunar infarcts. Subcortical arteriosclerotic leukoencephalopathy. Cervical: C3-4, C5-6, C6-7 disc bulges touching cord.

Conclusion: Progressive post-traumatic changes with small vessel disease. Cervical spondylosis.

MRI — Brain

31 May 2016

Continental Hospitals, Hyderabad / Dr. Kishore LT

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Mild cerebral atrophy. Multifocal tiny old microhemorrhages and ischemic lesions in cerebellum, brain stem, and cerebral parenchyma. No fresh infarcts. MRA normal.

Conclusion: Mild cerebral atrophy with old microhemorrhages and ischemic lesions — sequelae of old trauma.

MRI — Brain

15 Nov 2015

Dar Al Elaj Specialized Hospital, Khartoum / Dr. Shaimaa Omer

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Periventricular leukomalacia. Multiple periventricular white matter, corona radiata, and juxtacortical ischemic gliotic changes. Pons and left medulla ischemic/gliotic foci. Right mastoiditis, left maxillary sinusitis.

Conclusion: Supra and infra tentorial ischemic/gliotic foci. ?Vasculitis.

CT — Brain

29 Sep 2015

Dar Al Elaj Specialized Hospital, Khartoum / Dr. Shaimaa Omer

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SAH in right temporal, both Sylvian fissures. Bilateral DAI foci (centrum semiovale, grey-white junction, left cerebellar, midbrain). Mild brain edema. Right extracranial hematoma. Left subdural trace.

Conclusion: Post-traumatic SAH with diffuse axonal injury. No depressed fracture.

Tests Still Needed (9)

#	Test	Priority	Reason	Collection Notes
1	Levetiracetam Level	HIGH	Third AED - never checked. May be sub/supra-therapeutic	—
2	Morning Cortisol + ACTH	HIGH	Post-TBI pituitary screening (25-50% of severe TBI)	Cortisol: draw 8-9 AM. ACTH: EDTA tube on ice, process immediately.
3	IGF-1	HIGH	Most common post-TBI endocrine deficiency (GH axis)	No special prep needed
4	Intact PTH	MEDIUM	AEDs cause bone loss (11 years on AEDs!)	—
5	Bone Markers (CTX + P1NP)	MEDIUM	Bone status: immobility + AEDs + menopause = triple risk	CTX: fasting, before 10 AM
6	Urine Sodium	MEDIUM	SIADH confirmation (serum osm 279)	—
7	D-dimer	MEDIUM	DVT history - thrombotic risk	—
8	Serum Copper	MEDIUM	Deficiency causes neutropenia (commonly missed!)	—
9	DEXA Scan	HIGH	Bone density: 11 years AEDs + immobility + menopause	—

Tests Completed (4)

#	Test	Reason
1	Vitamin B12 & Folate	PENDING (ordered) - AED depletion worsens cognition
2	Homocysteine	Cerebrovascular risk - elevated by AED use
3	CK	Rosuvastatin muscle safety + pre-creatine baseline
4	Zinc	Immune support - critical with neutropenia (ANC 0.7)