Antenatal Profile Comprehensive

Hemoglobin (Hb) Electrophoresis by HPLC test measures and identifies different types of hemoglobin in the blood. A human body contains various types of hemoglobin in their blood. With age, the percentage of hemoglobin present in the body changes. Hemoglobin is the protein which is present inside the red blood cells. Its function is to transport oxygen to the tissues and organs of the body.

When there is a change in DNA sequence commonly called a mutation, the production of hemoglobin gets affected. These type of changes cause abnormality in hemoglobin and the normal working of healthy hemoglobin gets defected. This will result in a decreased amount of required oxygen transported to tissues and organs. 

The different types of hemoglobin included in this test are:

• Hemoglobin A - Adult hemoglobin 

• Hemoglobin F

Hemoglobin F is found in growing fetuses and newborns. It is soon replaced with hemoglobin A after birth. Hemoglobin A is found in children and adults. It is the most common type of hemoglobin. Hemoglobin C, D, E, M, and S are rare types of abnormal hemoglobin that occur due to genetic mutations.

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Blood Stag is composed of blood cells suspended in blood plasma (yellowish-colored liquid). The blood cells include red blood cells (also called RBCs or erythrocytes), white blood cells (also called WBCs or leukocytes), and platelets (also called thrombocytes).

Red blood cells (RBCs) are the most abundant blood cells. RBCs contain hemoglobin which helps in the transportation of oxygen to the tissues. RBC count is the measurement of the number of RBCs in a given volume of blood.

Packed Cell Volume (PCV) or Hematocrit (Hct) is the measurement of the blood volume occupied by RBCs. It is expressed in percentage.

White blood cells (WBCs) are key components of the immune system and thus protect the body from various infections and cancers. Total Leucocyte count (TLC) is the measurement of the total number of leukocytes (WBCs) in a given volume of blood.

There are five types of WBCs:

1. Neutrophils

2. Basophils

3. Eosinophils

4. Lymphocytes

5. Monocytes

Differential Leucocyte Count (DLC) determines the percentage of different types of WBCs.

Neutrophils, Basophils, and Eosinophils are called Granulocytes because of the presence of granules inside these cells.

Absolute count of different types of WBCs is the measurement of their absolute numbers in the given volume of blood.

Platelet count - Platelets (also called thrombocytes) are disc-shaped cell fragments without a nucleus that help in blood clotting. Platelet count is the measurement of the number of platelets in a given volume of blood.

Mean Platelet Volume (MPV) is a measurement of the average size of platelets.

PDW or platelet distribution width refers to the variation of platelet size distribution

Hemoglobin (Hb) -  Hemoglobin (Hb) is a protein found in red blood cells (RBCs) that carries oxygen from the lungs to the body tissues, exchanges the oxygen for carbon dioxide, and then carries the carbon dioxide back to the lungs where it is exchanged for oxygen.

Mean Corpuscular Volume (MCV) is the average volume of a red blood cell.

Mean Corpuscular Hemoglobin (MCH) is the average amount of hemoglobin in the average red blood cell.

Mean Corpuscular Hemoglobin Concentration (MCHC) is the average concentration of hemoglobin in a given volume of red cells.

Red Cell Distribution Width Coefficient of variation (RDW CV)is a measurement of the variability of the red blood distribution curve and their mean size. 

Glucose - Fasting Blood Test is done to measure the levels of glucose in blood during period of fasting.

Glucose is the main source of energy for body. Carbohydrates consumed in the diet are broken down in the body to glucose, which is absorbed by the intestines and transported by the blood to various organs. The cells of these organs utilize the glucose to produce energy when required, and the excess is stored either as glycogen in the liver for short-term storage or in fat tissues as triglycerides for long-term storage. The uptake, utilization, and storage of glucose after it is absorbed in the intestines is facilitated by the hormone- insulin which is secreted by the pancreas. Insulin influences the transport of glucose to the organs like heart, brain, working muscles, etc. It also directs storage of excess glucose. The action of insulin reduces sugar levels in the blood.

After a meal, sugar levels increase in blood and insulin is secreted in response to reduce sugar levels until it becomes normal. If glucose levels fall too low in blood, another pancreatic hormone called glucagon is released, which directs the liver to convert stored glycogen into glucose and releases it into the blood. The insulin and glucagon hormones create a feedback mechanism to keep blood glucose levels within the normal range. Imbalance in their activity causes an excess or shortage of blood sugar.

Glucose - Fasting blood Test helps to determine if the body is able to utilize or store glucose efficiently. High levels of sugar in blood indicates diabetes or resistance to insulin. Type 1 Diabetes is caused when insulin is not produced or produced in very little quantity. Type 2 Diabetes is caused when insulin produced is not utilized effectively by the body. In both these cases, blood sugar level rises, while cells are deprived of nutrition.

Acquired Immunodeficiency Syndrome (AIDS) is caused by the Human Immunodeficiency Virus (HIV). HIV Virus is of two types: HIV-1 and HIV-2. HIV-1 is found in AIDS patients, AIDS-related complex patients, and those persons who are at high risk of getting affected by AIDS. HIV virus can be transmitted by sexual contact, exposure to blood or blood products of AIDS infected patients or transfer of infection from AIDS-infected mother to the fetus. Most of the cases of HIV-2 infected patients are seen in West Africa, and it is detected in patients who had sexual contact with people of that geographic region. These viruses have the same morphology, overall genomic structure, and ability to cause infection. 

When the patient gets infected with the virus, the virus attacks the immune system called CD4 and combines with antibodies to use them for making a large number of copies inside the body of the patient by replication. During the first few weeks of infection, the amount of virus present and the level of p24 antigen in the blood becomes very high. After another 2-8 weeks, these increased levels start to fall as the body of the infected patient starts producing antibodies against the antigen of the virus. At this time, the HIV virus antibody can be detected in the patient’s blood via tests. The tests should be performed at this brief time because after some time both the levels of antigen and antibody in the blood falls. This will make the detection of virus infection difficult as the initial infection may have been resolved and you may not get a positive result against the infection.

The patients who fall under the risk for HIV-1 or HIV-2 infection are screened for HIV-1 or HIV-2 antigen or antibody screening test.

Syphilis is a sexually transmitted disease (STD), caused by the bacteria Treponema pallidum. It is most commonly spread by sexual route (through contact with syphilis sore (Chancre)). Syphilis is easily treatable with antibiotics. However, it can cause severe health problems if left untreated and can be potentially fatal. Maternal transfer to unborn child through an infected mother can cause serious and potentially fatal consequences for the baby.

There are several stages of syphilis:

·       Primary syphilis: Primary stage starts 2-3 weeks after being infected. It usually appears as one or more painless chancres on the sexual partner's chancre exposed body parts such as on the penis or vagina. Since it is painless, it may go unnoticed, especially if it is in the rectum or on the cervix. It usually disappears within 4-6 weeks even without any treatment.

·       Secondary syphilis: Primary syphilis can progress to secondary syphilis if the infected person is left untreated. The symptoms generally develop from 6 weeks to 6 months after the chancre first appears. It is mainly observed as non-itchy skin rash (rough, red, and spotted), appearing typically on the palms of the hands and the bottoms of the feet. Other associated symptoms could be fever, fatigue, swollen lymph nodes, sore throat, and body aches.

·       Late or tertiary syphilis: Secondary syphilis can progress to late or tertiary stage if it is further left untreated. In this, an infected person may remain without any symptoms (asymptomatic) but continues to have the infection and can last for years. There are various complications associated with tertiary syphilis which can occur if still left untreated such as the bacteria can damage the heart, eyes, brain, central nervous system (Neurosyphilis), bones, joints, or almost any other part of the body. Tertiary syphilis can last for years, with the final stage leading to mental illness, blindness, other neurological problems, heart disease, and death.

Thyroid Stimulating Hormone (TSH) test measures the amount of TSH in your blood which helps to find out if the thyroid gland is working normally or not. Low TSH levels indicate hyperthyroidism and high TSH levels indicate hypothyroidism.

In case of hyperthyroidism, the thyroid gland produces very high amounts of thyroid hormones (T3 and T4) and you may experience symptoms of weight loss, rapid heartbeat, tremors, sweating, anxiety, increased sensitivity towards heat, etc. In case of Hypothyroidism, there is a decrease in the production of thyroid hormones (T3 and T4) which may cause weight gain, fatigue, slow heart rate, increased sensitivity towards cold, depression, dry and thin hair, etc.

There is a feedback system in the body to maintain stable amounts of the thyroid hormones (T3 and T4) in the blood. TSH signals the thyroid gland to make and release the thyroid hormones (T3 & T4) into the blood when the level of thyroid hormones is low and can also signal the thyroid gland to lower the production of thyroid hormones when the level of thyroid hormones is very high. So, when the thyroid hormone (T3 and T4) levels decrease, the pituitary gland is stimulated to release TSH and this high TSH level, in turn, stimulates thyroid gland to release more thyroid hormone (T3 & T4) from the thyroid gland and the vice-versa happens when the thyroid hormone levels are very high.

The blood grouping test is done to identify blood group of a person. The blood group of a person is denoted on the basis of certain specific antigen markers present on the surface of the red blood cells. These marker antigens are glycoproteins and help the body to recognize its own type of RBCs. According to ABO and Rh blood group systems, three types of antigen markers are commonly found on RBCs, namely A, B, and Rh, and the presence or absence of these antigen markers determine the blood type of a person. Thus, a person with antigen A belongs to blood group A, one with antigen B belongs to blood group B, those with both antigens A and B belong to group AB, while those without either antigen A or B belong to group O. Also, people who have Rh antigen on their RBCs are Rh+ (positive), while those who do not are Rh- (negative).

Antibodies are naturally created by the body against incompatible blood antigens. People with blood group A have anti-B antibodies against type B antigens and those with blood group B have anti-A antibodies against type A antigens. People with blood group AB do not have any of these antibodies, while those with blood group O have both anti-A and anti-B antibodies. Rh antibodies are produced by people of Rh-blood group upon exposure to Rh antigens in Rh+ blood type. Blood transfusion between incompatible blood types causes an antigen-antibody reaction which causes the RBCs to clump together and be destroyed. Hence blood groups of donor and recipient must match to ensure the success of the blood transfusion or organ transplant.

The antigen-antibody reaction between incompatible blood types forms the basis of the Blood Typing Test. The collected specimen is treated with collected or synthetic A, B, and Rh antibodies and observed for agglutination (clumping). If agglutination (clumping) of RBCs is seen upon treatment with anti-A antibodies, the sample is of blood type A. If agglutination is seen upon treatment with anti-B antibodies, the sample is of blood type B. If agglutination does not occur upon treatment with either anti-A or anti-B antibodies, the sample is of blood group O, and if agglutination occurs with both these antibodies, the sample is of blood group AB. The occurrence of agglutination upon treatment with Rh antibodies indicates Rh+ blood type, while no agglutination indicates Rh- blood type.

ABO Typing:

Rh Typing:

Urine Routine and Microscopy test involve the three-part evaluation of the urine sample.

1. Gross Examination - It involves the visual examination of the urine sample for color and appearance.

2. Chemical Examination - It is done by urine dip-stick method which involves the use of reagent test strips. These test strips are dipped into the urine sample and the colors that develop are matched with the control for analysis. It is done to examine the urine sample for glucose, protein, pH, specific gravity, blood, nitrites, ketones, leukocyte esterase, bilirubin, and urobilinogen.

3. Microscopic Examination - It involves the examination of the urine sample under the microscope for casts, crystals, cells, bacteria, and yeast.