directory of laboratory services · polyclinic lab : 2392 ... this is the specimen of choice for...

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DIRECTORY OF LABORATORY SERVICES

DIVISION OF LABORATORY MEDICINE DEPARTMENT OF PATHOLOGY

INTRODUCTION

This directory provides details of the extensive range of diagnostic tests offered by the various laboratories in the Division of Laboratory Medicine. If a required test is not currently offered in-house, please contact the appropriate laboratory for further information. Diagnostic laboratory tests play an increasingly crucial role in patient management. The main aim of the laboratories is to process and test clinical specimens from patients, and to offer high quality service in doing so. The patient is the primary concern of the laboratories. Therefore, to achieve quality results and optimal use of the services, a number of requirements are important and should be adhered to. Firstly, appropriate samples should be collected using the correct containers, and transported to the laboratory under optimal conditions. This information can be found in the following pages. Secondly, each sample must be accompanied by a signed request form containing all the necessary information. In particular, relevant clinical details should be provided, to assist laboratories in performing the most appropriate tests and interpreting the results. Finally, users are encouraged to talk to the Head and consultants of the laboratories, whether to discuss tests or results, to get advice or to offer feedback. A close working relationship between the users and the laboratory will ultimately benefit the patients.

GENERAL

LOCATION The Division of Laboratory Medicine (LMD – previously known as CDL) is located on the 4th floor, Menara Timur, PPUM. The Inborn Errors of Metabolism (IEM) and Toxicology and Trace Elements Analysis is located on the 6th floor, Menara Timur, PPUM. A satellite laboratory, the Polyclinic Laboratory (Polylab), serves the specialist clinics and primary care clinics is located at the ground floor of the Rawatan Utama (RUKA) Building. ORGANISATION OF SERVICE

1. The Core Laboratory which consists of a. Specimen Reception b. Routine Clinical Chemistry (RChem) c. Fluids and Excretion (F&E) d. Routine Haematology (Haem) e. Coagulation (Coag)

2. Special Chemistry (Special Chem) 3. Endocrinology (Endo) 4. Immunology (Immuno) 5. Inborn Errors of Metabolism (IEM) 6. Toxicology and Trace Elements Analysis 7. Special Haematology (Sp Haem) 8. Bone Marrow and Flowcytometry (BM) 9. Molecular and Genetic Analysis (MGAL)

a. Cytogenetics b. Molecular (Haematology) c. Immunogenetics and Transplantation (HLA)

10. Polyclinic Laboratory (Polylab)

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OPERATION HOURS The laboratory provides a 24-hour service for routine essential tests while other tests are done during office hours. For urgent tests not provided on 24-hour basis, please contact the Pathologist or senior officer on-call via hospital telephone operator. TELEPHONE EXTENSIONS FOR ENQUIRIES

Specimen Reception : 2582

Routine Clinical Chemistry : 2850

Fluids & Excretion : 2371

Routine Haematology : 2229

Special Chemistry : 2847

Special Haematology : 2848

Bone Marrow : 2739

Immunology : 2849

Endocrine : 2846

Inborn Errors of Metabolism (IEM) : 2584

Toxicology and Trace Elements Analysis : 2584

Cytogenetics

: 2656

Molecular and HLA : 2205

Polyclinic Lab : 2392

Chemical Pathologists: Assoc Prof Pavai Sthaneshwar

Assoc Prof T Malathi Thevarajah Dr Farhi Ain Jamaluddin

: 2788 : 2745 : 4885

Haematologists: Assoc Prof Veera Sekaran Nadarajan

Dr Hemalatha Shanmugam Dr Kyaw Tay Za Prof. Nicholas Jackson

: 2916 : 3121 : 2589 : 2783

Scientific Officers Chew Yee Yean Putri Junaidah Megat Yunus Mozhafar Md Yusof Nisya Mohamed Yusoff Vong Geok Swan Mohammad Zarizi Abd Ghani Nabihah Nasir

Yeoh Ai Chin

: 2670 : 2580 : 2756 : 2794 : 3031 : 6394 : 4707 : 4707

Senior MLT Mary Usin Joseph Fernandez (MLT U38) Shanmuganathan Arumugam(MLT U36)

: 3134 : 2784

MLT U32 : 2577

Medical Officers (MO) : 3278

Senior on-call, Biochemistry : 019-2008554

Senior on-call, Haematology : 019-2008553

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SPECIMEN COLLECTION AND TRANSPORT

The tests offered, specimen types and specimen containers are of various types and it is important that specimens are collected and transported properly. Deviations from the instructions given in this guide may result in pre-analytical errors with the specimens not being suitable for testing or giving test results that are of poor quality or are confusing. Specimens should be sent to the laboratory as soon as possible after collection (<4 hours after collection). BLOOD SPECIMENS Blood specimens should be introduced into the specimen tube carefully so as not to cause haemolysis. A closed vacuum blood collection system with the appropriate tubes should be used. As an alternative, a needle and syringe may be used but the blood should not be forced out through the needle as this causes gross haemolysis. The volume of blood collected should be as indicated on the sample tube. Insufficient sampling will cause an incorrect sample to anticoagulant ratio, leading to erroneous results. Blood collected into tubes with anticoagulants, preservatives or clot activators should be mixed immediately after collection by gently inverting the tubes a few times. The recommended order of draw is:

1. Tubes with no additives (plain, SST/gel) 2. Coagulation tubes (Na citrate) 3. Other tubes with additives (heparin, fl/oxalate, EDTA)

URINE SPECIMENS Urine containers should be screwed on tightly to prevent leakage. 24 hour and other timed urine collection procedures should be explained to the patients to ensure proper collection. Random Specimen This is the urine specimen most commonly sent to the laboratory for analysis. Random specimens can sometimes give an inaccurate view of a patient's health if the specimen is too diluted and analyte values are artificially lowered. Avoid the introduction of contaminants into the specimen by giving explicit instructions to patients so that they do not touch the inside of the cup or cup lid. First Morning Specimen This is the specimen of choice for urinalysis and microscopic analysis, since the urine is more concentrated and contains relatively higher levels of cellular elements and analytes. Procedure:

1. Empty the bladder before going to bed at night. 2. Collect the first morning specimen on waking up in the morning.

Midstream Clean Catch Specimen This is the preferred type of urine specimen because of the reduced incidence of cellular and microbial contamination. The procedure significantly reduces the opportunities for contaminants to enter into the urine stream. Procedure:

1. Cleanse the urethral area. 2. Pass the first portion of the urine stream into the toilet. 3. Collect the midstream urine into the container. Any excess urine should be voided into the toilet.

24 Hour Specimen A 24 hours urine specimen is collected to measure the concentration in urine over a whole day. Accurate timing is critical to the calculations that are conducted to determine analyte concentrations and ratios.

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Interpretations based on faulty calculations can result in improper diagnoses or medical treatment. The specimen should be refrigerated during the collection period. Procedure:

1. Empty the bladder into the toilet before beginning the collection. Record the date and time on the label of the container.

2. For the duration of the 24 hours, all urine MUST be collected and pooled into the container. 3. Exactly 24 hours after starting the collection, urinate one last time and add it to the container. Record

the date and time onto the label of the container. REQUEST FORMS Use the correct request forms and ensure that forms are properly and clearly filled and signed by the requesting doctor. Relevant information regarding provisional diagnosis, treatment and other information relevant to the test required should be provided. The request form should be signed by the requesting doctor and the doctor’s name stamped or clearly written. Users of the service are urged to be selective and confine tests required to those that are useful for the diagnosis or control of treatment of patients. Below is the list of forms used in or laboratory. Refer to the appendix for samples of the forms.

BIL FORM TITLE REFERENCE NUMBER

1 Molecular and Genetics Analysis Laboratory BK-MIS-1145

2 Peripheral Blood, Bone Marrow and Flow Cytometry Examination

BK-MIS-1146

3 STAT Request Form BK-MIS-330

4 Cytogenetics Laboratory BK-MIS-941

5 Inborn Errors Metabolism Laboratory (IEM Lab) BK-MIS-054

6 Routine Chemistry and Haematology BK-MIS-331

TRANSPORT OF SPECIMENS All specimens are to be sent immediately via the pneumatic tube system unless otherwise instructed in this guide. Please refer to “Panduan Cara Pembungkusan Sampel Ujian Makmal” DS0071 for detailed instructions on packaging and sending of specimens by the pneumatic tube system. SPECIMEN REJECTION Samples that do not meet the requirements will be rejected. The criteria for rejection are many and may include:

a. Incorrect tube/container b. Unlabeled samples and forms c. Wrongly labeled samples and forms d. Insufficient sample volume e. Clotted Sample f. Haemolysed sample g. Grossly Lipaemic sample h. Grossly icteric samples i. Leaking containers j. Improper transport condition k. Overnight/delayed sample l. Insufficient clinical information m. No doctor’s name and signature

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SPECIAL TEST PROCEDURE ORAL GLUCOSE TOLERANCE TEST (OGTT) Indication: This test is principally used for diagnosis when blood glucose levels are equivocal, during pregnancy or in epidemiological studies. In the absence of classical symptoms, random plasma glucose is the recommended

first test, and at least two diagnostic glucose results on different days are essential. If the fasting level is

6.1mmol/l, diabetes mellitus is excluded and a GTT is not indicated. A random level of 11.1mmol/l or a

fasting level of 7.0 mmol/l is indicative of diabetes mellitus. An oral GTT may be conducted if the random glucose is between 5.6 – 11.0 mmol/l or the fasting level is between 6.1 – 6.9 mmol/l (WHO 1999, Ann Clin Biochem 2000; 37:588-592).

Procedure:

To conduct an oral GTT, the patient should have been on a normal diet (containing at least 150g of carbohydrate daily) and usual physical activity for at least 3 days prior to the test. The patient must fast overnight (8-14 hours). Plain water is allowed. Smoking is not permitted during the test and the presence of factors that influence interpretation of the results must be recorded (eg. medications, inactivity, infection etc.).

Take a fasting venous blood sample for glucose estimation. An adult patient should drink 75g of anhydrous glucose (or 82.5g of glucose monohydrate) in a glass of water (300 ml) over 5 mins. For children, the test load should be 1.75g of glucose/kg body weight up to a maximum of 75g. At 2 hours after the glucose load, take a venous blood sample for glucose estimations. For a 3-point GTT, take an additional sample at 1 hour after the glucose load. Send all samples together to the laboratory, clearly labelled with the times of collection.

Interpretation of results:

Based on WHO guidelines for venous plasma samples:

Condition Glucose concentration (mmol/l)

Diabetes mellitus Fasting or 2 hours after glucose load

7.0

11.1

Impaired glucose tolerance (IGT) Fasting (if measured) and 2 hours after glucose load

7.0

7.8 – 11.0

Impaired fasting glycemia (IFG) Fasting and (if measured) 2 hours after glucose load

6.1 – 6.9

7.8

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TUMOUR MARKERS – A brief clinical practice guide

The table below is a brief guideline on clinical significance of the various tumour markers. Tumour markers should not be used for screening, the exception being AFP.

Tumour Marker

Malignancy Clinical Significance *

S D P M R

AFP Yolk sac tumour, Hepatoma HCG Trophoblastic tumour,

choriocarcinoma

CEA Colorectal carcinoma PSA Prostatic carcinoma CA 125 Ovarian carcinoma CA 15-3 Breast carcinoma CA 19-9 Pancreatic carcinoma hTG Thyroid carcinoma

* S - Screening M - Monitoring and Treatment D - Diagnosis R - Reduction of recurrence P - Prognosis

Reference: Clinical Practice Guidelines on Serum Tumour Markers, Dr. Leslie Lai. Academy of Medicine of Malaysia, Serial No. 7/2003.

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Primary hyperaldosteronism – guidelines for investigation

Patient preparation: The renin-aldosterone axis is primarily regulated by renal blood flow, therefore: 1. Subjects under investigation should ideally not be taking any drugs that interfere with fluid balance or

potassium (Table 1).

2. Patients should not consume products derived from liquorice root e.g. confectionary liquorice and

chewing tobacco.

3. Patient should be having normal sodium diet (100-200 mmol/day) for at least three days.

4. Plasma potassium levels should be normal when collecting sample for aldosterone and renin

Drug Time to remove interference ACE inhibitors 2 weeks β-blockers 2 weeks Calcium channel blockers 2 weeks Diuretics 2 weeks NSAIDs 2 weeks Oestradiol 6 weeks Spironolactone 6 weeks Table 1: Interfering drugs and period of withdrawal If these drugs cannot be withdrawn, please refer to Table 2 for interpretation of the results.

PHA-2 Pseudohypoaldosteronism type 2

Table 2: Factors that may affect the ARR and thus lead to false-positive or false-negative results

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Sample collection: The Aldosterone renin ratio is most sensitive when used in patients from whom samples

are collected in the morning after patients have been out of bed for at least 2 h, usually after they have been

seated for 5–15 min.

Samples for both renin and aldosterone should be sent together. Isolated aldosterone or renin may not help

in the diagnosis. Sample for renin should be collected in EDTA tube. Sample for aldosterone should be

collected in plain tube. After collection of the samples, it should be sent to the lab immediately within 30

minutes.

Please note:

1. If the posture is not mentioned in the requesting form, it will be assumed that the sample is

collected in the upright posture and the results will be reported as per that reference interval.

2. If only aldosterone or renin is requested, lab will not proceed with the investigation and the sample

will be rejected.

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SERVICES PROVIDED

24 HOUR ROUTINE ESSENTIAL OR STAT SERVICE

The laboratory offers a range of important and essential tests for STAT and for after office hours. The service is restricted and is offered for patients faced with life threatening situations requiring emergency testing. It should not be used to investigate ‘cold’ cases for elective surgery or for screening for admission. If the service is abused, the turn-around time for STAT testing will be severely affected. The STAT tests offered are as below. If a test not listed is required urgently, please contact the Pathologist or M.O. on-call via hospital telephone operator.

Biochemistry Profiles Toxicology Arterial Blood Gases Paracetamol Renal Function Test Paraquat - Urine Salicylate Biochemistry Tests Alanine Aminotransferase (ALT) Fluids & Excretion Ammonia CSF Examination Amylase – Urine and Serum Urine Pregnancy Test AST Urinalysis (UFEME) Bilirubin - Total FEME - Synovial Fluid Calcium FEME - Other Body Fluids Glucose Lactate Haematology Osmolality – Urine and Serum CBC Phosphate CBC + Differential Count PBF (reported the next working

day) PT Cardiac Markers APTT CKMB Mass Coagulation Screen Troponin I DIVC Screen

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THERAPEUTIC DRUG MONITORING (TDM) CLINICAL PHARMACOKINETIC SERVICE:

This is a combined service provided by Division of Laboratory Medicine and the Pharmacy Department. Please follow the instructions on the Therapeutic Drug Monitoring Form (TDM) (BK-MIS-413) and submit samples together with this form to the Department of Pharmacy for screening. These tests are offered during office hour. Please make appointment with the laboratory/pharmacist if service needed during non-office hour.

TEST NAME SAMPLE CONTAINER CAP

COLOUR VOLUME

Expected TAT

REMARKS

Amikacin

Serum Plain Red 5 ml 1 working

days

Carbamazepine


days

Digoxin Serum

Plain Red 5 ml 1 working

days

Gentamicin Serum


days

Phenobarbitone Serum


days

Phenytoin (Dilantin)

Serum


days

Theophylline (Aminophylline)


days

Valproic acid (Epilim)


days

Vancomycin


days

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LABORATORY SERVICES The services available are listed here in alphabetical order as single tests. If a test is not found in the single tests list, it may be under the profiles/packages lists (for Chemistry, Immunology, Endocrine and Haematology), which can be found further down in the directory. Specimen collection/tube guides and specimen volumes given are for adults. For paediatrics when only small volumes of blood can be taken, please use similar paediatric tubes.


COLOUR VOLUME

Expected TAT

REMARKS LAB

17-OH Progesterone Serum Plain Red 5 ml

One Month (Freq of testing is Monthly)

Endo

5- Hydroxyl Indole Acetic Acid (5HIAA)

Urine Glacial acetic acid (24 hr)

As

collected

7 working days (freq of

testing is weekly)

Special Chem

Acetylcholine Receptor Antibody

Serum Plain Red 5 ml

1 month (Freq of testing is by batch)

Immuno

Activated Protein C Resistance (APCR)

Plasma Na citrate Blue 2 x 2.7 ml

Every 2 weeks

( sample received

office hour)

Blood volume to be followed strictly. Patient’s anticoagulant therapy must be indicated in the request form.

Sp Haem

Adrenocorticotropic Hormone (ACTH)

Plasma EDTA Purple 3 ml

5 working days (Freq of

testing is Weekly)

Place specimen on ice water and send to lab immediately within 30 mins.

Endo

Alanine Aminotransferase (ALT)

Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Albumin Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Aldosterone Serum Plain Red 5 ml

One Month (Freq of testing is Monthly)

Must be requested together with Renin. If the posture is not mentioned in the requesting form, it will be assumed that the sample is collected in the upright posture and the results will be reported as per that reference interval.

Endo

Alkaline Phosphatase Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

ALL screen (E2A-PBX1, ETV6-RUNX1, MLL-AF4, BCR-ABL1 e1a2, SIL-TAL1)

Whole blood/ Bone marrow

EDTA Purple 2 x 3ml 7 working

days

Send sample within 24hrs of collection

MGAL - Molecular

Alpha Thalassaemia Whole blood

EDTA Purple 3ml

One month (Freq of testing is montly)


MGAL - Molecular

Alpha-1 Antitrypsin (AAT)



testing is weekly)

Immuno

Alpha-Fetoprotein (AFP)

Serum Gel Yellow 3 ml 1 working

day

Patients undergoing amniocentesis should have their blood for AFP drawn first.

Endo

Amikacin Serum Plain Red 5 ml 1 working

day

Please fill up TDM Form (BK-MIS-413) and send sample with form to pharmacy department

Special Chem /TDM

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Amino Acids & Acylcarnitines

Dried Blood Spots

Whatmann 903 special filter paper

Fill all the circles with

blood


testing is daily)

Completely dry the blood spots at room temperature. Place dried filter paper in an individual envelope or plastic bag for transport.

IEM

Amino Acids, CSF CSF Plain sterile 0.5-1 ml


testing is daily)

Send together with plasma. Transport immediately to the lab or freeze sample.

IEM

Amino Acids, plasma Blood Heparin Green 1 – 2 ml


testing is daily)

Avoid haemolysis. Send blood immediately to the lab. (For plasma, centrifuge and freeze immediately. Transport frozen)

IEM

Amino Acids, Urine Urine Plain cup 5 ml


testing is daily)

Send together with plasma. Transport immediately to the lab or freeze sample.

IEM

AML screen (RUNX1-RUNX1T1, CBFB-MYH11)



days


MGAL - Molecular

Ammonia Plasma Heparin Green 3.0 ml 2 Hours

Inform lab if after office hours (ext 2582/2850). Send fresh sample immediately.

R Chem

Amylase, Serum Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Amylase, Urine Urine random

Plain cup Yellow 5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Angelman and Prader Willi (15q11-13)

Whole blood

EDTA Purple 3ml



MGAL - Molecular

Anticardiolipin Ab (ACA)



testing is weekly)

Immuno

Anti-CCP Serum Plain Red 5 ml


testing is weekly)

Immuno

Anti-Neutrophilic Cytoplasmic Antibodies (ANCA)



testing is weekly)

Immuno

Antinuclear Ab (ANF) Serum Plain Red 5 ml


testing is weekly)

Immuno

Antistreptolysin-O (ASO)



testing is weekly)

Immuno

Anti-thrombin III Plasma Na Citrate Blue 2 x 2.7 ml

Every 2 weeks

( sample received

office hour)

Blood volume to be followed strictly. Clinical information must be provided.

Sp Haem

APTT (activated partial thromboplastin time)

Plasma Na Citrate Blue 1.8 / 2.7

ml

2 Hours (STAT: 90

mins)

Blood volume to be followed strictly. Sample should be sent to the laboratory within 2 hours of collection.

Sp Haem

Aspartate Aminotransferase (AST)


Routine : 2 Hours

STAT : 60 mins

Routine Chem

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Autoimmune Liver Antibody Profile (LKM1, LC1, SLA, AMA2/PHD-E2

Serum Plain Red 5 ml One month Immuno

BCR-ABL1 detection (e1a2, e13a2, e14a2)

Whole blood

EDTA Purple 2 x 3ml



MGAL - Molecular

BCR-ABL1 quantitation (e13a2, e14a2)

Whole blood


days


MGAL - Molecular

BCR-ABL1 TKD Mutation Analysis

Whole blood

EDTA Purple 2 x 3ml



MGAL - Molecular

Bence Jones Protein Urine Plain cup 5 ml 1 working

day Early morning sample preferred.

F&E / Poly

Beta Thalassaemia, molecular

Whole blood

EDTA Purple 3ml



MGAL - Molecular

Beta-2 Microglobulin Serum Plain Red 5 ml

1 Week (Freq of testing is weekly)

Endo

Bicarbonate Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Bile Acids, Total Serum Plain Red 5 ml 3 working

days

Main indication is suspected obstetric cholestasis in pregnant women. Fasting sample is preferred though not essential.

Special Chem

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Bilirubin, Conjugated Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Bilirubin, Total Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Bleeding Time Whole Blood

Ear prick - 1 prick 1 working

day

Please call ext. 2848 to make an appointment.

Sp Haem

Blood Gases, Arterial Whole Blood, arterial

Heparinised syringe

2 ml 30 mins

Clotted sample will be rejected. Cap syringe and send in ice water ASAP to reach Lab within 30 mins

Routine Chem

Bone Marrow Examination

Bone Marrow Aspirate/ Trephine Biopsy

BM - Slides Trephine -

Formalin tube

5 working days

Appointment required (ext 2739). Refer to profile list for more information.

BM

CA 125 Serum Gel Yellow 3 ml 1 working

day

Tumour marker primarily for the monitoring of ovarian cancer.

Endo

CA 15-3 Serum Plain Red 5 ml


testing is Weekly)

Tumour marker primarily for the monitoring of breast cancer.

Endo

CA 19-9 Serum Plain Red 5 ml


testing is Weekly)

Endo

Caeruloplasmin Serum Plain Red 5 ml 1 working

day

Special Chem

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Calcium, Serum Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Avoid prolonged venous stasis. Albumin shall be ordered together for calculation of corrected calcium

Routine Chem

Calcium, Urine 24H Urine 24 hr

6N HCl (24 hr) As

collected

Routine : 2 Hours

Routine Chem

Cannabinoids Screen Urine Plain cup 10 ml 1 working

day

Only for samples from Psychiatry and Staff Health Clinic

Special Chem

Carbamazepine Serum Plain Red 5 ml 1 working

day


Special Chem /TDM

Carcinoembryonic Antigen (CEA)


day Endo

Catecholamines Urine 24 hr

6N HCl (24 hr) As

collected 14 working

days

Special Chem

Chimerism Analysis (STR)

Whole blood

EDTA Purple 3ml



MGAL - Molecular

Chloride Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Chloride , Urine 24H Urine 24 hr

Plain (24 hr) As

collected

Routine : 2 Hours

Routine Chem

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Cholesterol, HDL Serum Plain SST Yellow 3.5 ml 2 Hours

Fasting sample preferred.

Routine Chem

Cholesterol, LDL Serum Plain SST Yellow 3.5 ml 2 Hours


Routine Chem

Cholesterol, Total Serum Plain SST Yellow 3.5 ml 2 Hours


Routine Chem

Cholinesterase Serum Plain Red 5 ml 1 working

day

Special Chem

CKMB - mass Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

If results support diagnosis of MI, Troponin is NOT required.

Routine Chem

Coagulation Factor Assay (FII, FV, FVII, FVIII, FIX, FX, FXI or FXII)

Plasma Na Citrate Blue 2 x 2.7 ml 5 working

days

Blood volume to be followed strictly. Clinical information must be provided

Sp Haem

Complement 3 (C3) Serum Plain Red 5 ml 1 working

day Immuno

Complement 4 (C4) Serum Plain Red 5 ml 1 working

day Immuno

Complete Blood Count (CBC)

Whole Blood

EDTA Purple 3 ml

Routine: 2 hour

STAT : 45 mins

Sample to be sent to the laboratory within 2 hours of collection.

Haem

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Conventional Chromosome Analysis (karyotyping)

Whole Blood

Lithium Heparin

Green Paeds 2

ml Adult 3 ml

28 days MGAL -

Cytogenetic

Conventional Chromosome Analysis (karyotyping), haematology cases

Bone Marrow

Lithium Heparin

Green Paeds 2

ml Adult 3 ml

21 days MGAL -

Cytogenetic

Copper, Serum Serum Plain (trace

element free) Dark Blue 5 ml


testing is weekly)

Collect special tube from laboratory

Toxicology

Copper, Urine 24H Urine 24 hr

Acid washed As

collected


testing is weekly)

Toxicology

Cortisol, Serum Serum Gel Yellow 3 ml 1 working

day

Patients should not be on Prednisolone, Prednisone or other synthetic corticosteroids.

Endo

Cortisol, Urine Urine Plain (24 hr) As

collected 1 working

day Endo

C-Peptide Serum Plain Red 5 ml


testing is Weekly)

Endo

C-Reactive Protein (CRP)


day Immuno

Creatine Kinase Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

If results support diagnosis of MI, Troponin is NOT required.

Routine Chem

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Creatinine Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Creatinine , Urine 24H Urine 24 hr

Plain (24 hr) As

collected 2 Hours

Routine Chem

Cryoglobulin Serum Plain Red 2 x 5 ml 3 working

day

Overnight fasting is required. Please call ext. 2848 to make an appointment.

Sp Haem

CSF FEME CSF Plain (Sterile) 2 ml 4 Hours

Send immediately to the lab (within 30 mins)

F&E

Cyclosporin A Whole Blood

EDTA Purple 3 ml 1 working

day Clotted sample will be rejected

Special Chem

Cytospin CSF Plain sterile White 0.5 ml 2 working

days

Haematological malignancies.

BM

D-Dimer Plasma Na Citrate Blue 1 x 2.7 ml 2 Hours Blood volume to be followed strictly.

Sp Haem

Dehydroepiandroster-one Sulfate (DHEA-S)



testing is Weekly)

Endo

Digoxin Serum Plain Red 5 ml 1 working

day


Special Chem /TDM

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COLOUR VOLUME

Expected TAT

REMARKS LAB

ds-DNA Ab (Screen – Crithedia)



testing is weekly)

Immuno

ds-DNA Ab Quantitative (ELISA)



testing is weekly)

Immuno

Duchenne/Becker Muscular dystrophy

Whole blood

EDTA Purple 3ml



MGAL - Molecular

Electrophoresis : IFE (CSF)

CSF Plain (Sterile) 5 ml


testing is weekly)

Clinical information must be provided.

Immuno

Electrophoresis : IFE (Serum)



testing is weekly)


Immuno

Electrophoresis : IFE (Urine)

Urine Na azide As

collected


testing is weekly)


Immuno

Electrophoresis, Protein (CSF)

CSF Plain (Sterile) 5 ml


testing is weekly)


Immuno

Electrophoresis, Protein (Serum)



testing is weekly)


Immuno

Electrophoresis, Protein (Urine)

Urine Na azide (24

hr)

As collected


testing is weekly)


Immuno

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Erythropoitein (EPO) Serum Plain Red 5 ml

One Month (Req of

testing is Monthly)

Endo/

SpHaem

ESR Whole Blood

EDTA Purple 3 ml 2 Hours


Haem

Estradiol Serum Gel Yellow 3 ml 1 working

day Endo

Everolimus Whole Blood

EDTA Purple 3 ml


testing is weekly)

Clotted sample will be rejected

Special Chem

Extractable Nuclear Antigen (ENA)



testing is every 2 week)

Immuno

Fat Globules Faeces Plain cup Small

amount 1 working

day F&E

Ferritin Serum Gel Yellow 3 ml 1 working

day


Endo/ SpHaem

Fibrinogen Plasma Na Citrate Blue 2.7ml 2 Hours Blood volume to be followed strictly.

Sp Haem

FLT3-ITD / D835 mutation


EDTA Purple 3ml



MGAL - Molecular

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COLOUR VOLUME

Expected TAT

REMARKS LAB

Fluid FEME Fluid Plain (Sterile) 2 ml 4 Hours

Send immediately to the lab(within 30 mins)

F&E

Fluorescent In Situ Hybridization (FISH)

Whole Blood

Lithium Heparin

Green Paeds 2

ml Adult 3 ml

28 days)

Only one tube of sample is required to do conventional cytogenetics and FISH tests at the same time

MGAL - Cytogenetic

Fluorescent In Situ Hybridization (FISH), haematology cases

Bone Marrow

Lithium Heparin

Green Paeds 2

ml Adult 3 ml

21 days

Only one tube of sample is required to do conventional cytogenetics and FISH tests at the same time

MGAL - Cytogenetic

Folate Serum Gel Yellow 3 ml 1 working

day


Endo/ SpHaem

Follicle-stimulating Hormone (FSH)


day Endo

Fragile X (FMR1, AFF2) Whole blood

EDTA Purple 3ml One month Send sample within 24hrs of collection

MGAL - Molecular

Free Light Chain (kappa and lamda)


1 month (Freq of testing is monthly)


Immuno

Fructosamine Serum Plain Red 5 ml


testing is weekly)

Special Chem

24/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

G6PD Screening Blood EDTA/Filter

paper Purple 1 ml 1 day

State “cord blood” or “venous blood” and sex of patient.

Sp Haem

Galactose-1-Phosphate Uridyl Transferase (GPUT/GALT)

Whole blood

Heparin Green 3 ml


testing is every 2 weeks)

Send sample immediately to the lab. Otherwise, keep sample at 4°C and transport in ice.

IEM

Gamma Glutamyl Transferase (GGT)


Routine : 2 Hours

STAT : 60 mins

Routine Chem

Gentamicin Serum Plain Red 5 ml 1 working

day


Special Chem /TDM

Glucose Plasma Fluoride-Oxalate

Grey 3 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Glucose, CSF CSF Plain cup 3ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Growth Hormone Serum Plain Red 5 ml


testing is Weekly)

Sample should reach the lab in less than 30 mins.

Endo

Haptoglobulin Serum Plain Red 5 ml


testing is weekly)

Immuno

HbA1C Whole Blood


day

Special Chem

25/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

HLA B*1502 Typing Whole blood

EDTA Purple 3ml 7 working

days


MGAL - HLA

HLA B27 Typing Whole blood


days


MGAL - HLA

HLA Typing Class I/II (Medium resolution)

Whole blood


days


MGAL - HLA

Homocysteine, Total Plasma EDTA Purple 3 ml



Fasting specimen is preferred. Collect blood in pre-chilled EDTA tube. Send immediately to laboratory on wet ice within 30 minutes.

Special Chem

Human Chorionic Gonadotropin (HCG)


day Endo

IEM Screen Urine Plain cup 5 ml


testing is weekly)

Send sample immediately to the lab. Otherwise, freeze the sample and transport frozen.

IEM

IgH Gene Rearrangements


EDTA Purple 3ml



MGAL - Molecular

Immunoglobulin A (IgA)

CSF Plain (Sterile) 5 ml 1 working

day Immuno

Immunoglobulin A (IgA)


day Immuno

26/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Immunoglobulin E (IgE)


day Immuno

Immunoglobulin G (IgG), CSF


day Immuno

Immunoglobulin G (IgG), Serum


day Immuno

Immunoglobulin M (IgM)


day Immuno

Immunoglobulin M (IgM)


day Immuno

Immunophenotyping – Leukemia

Whole Blood

EDTA Purple 2 x 3 ml 5 working

days


BM


Bone Marrow Aspirate

EDTA Purple 2 x 3 ml 5 working

days


BM


CSF Plain sterile White 2 ml 5 working

days


BM

Insulin Serum Gel Yellow 3 ml 1 working

day

Fasting sample should be checked in a fasting sample, during hypoglycemia or as part of a dynamic function test. Sample should

Endo

27/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

reach the lab in less than 30 mins.

Insulin-like Growth Factor – 1 (IGF-1)



testing is Weekly)

Endo

Iron serum plain Red 3ml 1 working

day


Sp Haem

JAK2 ex12 mutation Whole blood

EDTA Purple 3ml One Month Send sample within 24hrs of collection

MGAL - Molecular

JAK2 V617F mutation Whole blood


days


MGAL - Molecular

Kleihauer Test Whole blood


day


Sp Haem

Lactate Dehydrogenase (LDH)


Routine : 2 Hours

STAT : 60 mins

Avoid prolonged venous stasis.

Routine Chem

Lactate, CSF CSF Plain (Sterile) 3ml

Routine : 2 Hours

STAT : 60 mins

If after office hours inform lab (ext 2582/2850). Send sample immediately.

Routine Chem

Lactate, plasma plasma Fluoride-Oxalate

Grey 3 ml

Routine : 2 Hours

STAT : 60 mins

Routine

Chem

28/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Lead Whole Blood

EDTA Purple 5 ml


testing is weekly)

Toxicology

Lithium Serum Plain Red 5 ml 1 working

day

Special Chem

Luteinising Hormone (LH)


day Endo

Lymphocyte Subset quant – CD4/CD8

Whole blood

EDTA Purple 3 ml

3 working days

(Freq of testing is every Tue and Fri)

Immuno

Lymphocyte subset quant – full (B-cell and T-cell Subset)

Whole blood

EDTA Purple 3 ml

3 working days

(Freq of testing is every Tue and Fri)

Immuno

Magnesium Urine 24 hr

6N HCl (24 hr) As

collected

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Metanephrines Urine 6N HCl (24 hr) As

collected

14 working days

(Freq of testing is every 2 weeks)

Special Chem

Methotrexate Serum

Plain Red 5 ml

1 working day

Appointment required for

weekends/public holiday (ext:

2847)

Special Chem

MHC Block Matching Whole blood


days


MGAL - Molecular

29/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Microalbumin Urine, random or 24 hr

Plain As

collected 1 working

day

Special Chem

Mitochondria Ab (AMA)


10 working days


Immuno

MPL ex10 mutation Whole blood

EDTA Purple 3ml One Month Send sample within 24hrs of collection

MGAL - Molecular

MPO quantitation Serum Plain Red 5 ml

10 working days


Immuno

Mucopolysaccharides Urine Plain cup 10 ml



Early morning urine is preferred. Send sample immediately to the lab. Otherwise, freeze the sample and transport frozen.

IEM

Newborn Screening Dried Blood Spots

Whatmann 903 special filter paper

Fill all the circles with

blood

3 working days

Collect blood from already fed baby at the age of 48-72 hours. Completely dry the blood spots at room temperature. Place dried filter paper in an individual envelope or plastic bag for transport.

IEM

NPM1 mutation


EDTA Purple 3ml



MGAL - Molecular

30/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Occult Blood Faeces Plain cup Small

amount 1 working

day

Patient must be off from iron supplement for 4 days and free from red meat diet for 3 days prior to collection of faeces.

F&E

Opiates Screen Urine Plain cup 10 ml 1 working

day

Only for samples from Psychiatry and Staff Health Clinic

Special Chem

Organic Acids Urine Plain cup 5 ml


testing is weekly)

Send sample immediately to the lab to prevent bacterial contamination. Otherwise, freeze the sample and transport frozen.

IEM

Osmolality, Serum Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Osmolality, Urine Urine random

Plain cup 5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Osmotic Fragility Test Whole Blood

Sterile glass bottle with 500 units heparin

Recyle 20-22 ml 7 working

day

Please call ext 2848 to make an appointment. No blood transfusion given to the patient within the last 3 months.

Sp Haem

Paracetamol Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Paraquat Urine Plain cup 10 ml 3 hours Special Chem

31/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Parathyroid Hormone (PTH), intact


day

Sample should reach the lab in less than 30 mins.

Endo

Parietal Cell Ab Serum Plain Red 5 ml

10 working days


Immuno

Paroxysmal Nocturnal Haemoglobinuria (PNH) by flowcytometry

Whole Blood

EDTA Purple 3 ml

5 working days

Appointment required (ext 2739).

BM

Peripheral Blood Film (PBF) Morphology

Whole Blood


days


Haem

Phenobarbitone Serum Plain Red 5 ml 1 working

day


Special Chem /TDM

Phenytoin (Dilantin) Serum Plain Red 5 ml 1 working

day


Special Chem /TDM

Phosphate Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Phosphate , Urine 24H Urine 24 hr

6N HCl (24 hr) As

collected

Routine : 2 Hours

Routine Chem

PML-RARA detection (bcr1, bcr2, bcr3)


EDTA Purple 2 x 3ml



MGAL - Molecular

32/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Potassium Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Potassium, Urine 24H Urine 24 hr

Plain (24 hr) As

collected

Routine : 2 Hours

Routine Chem

PR 3 quantitation Serum Plain Red 5 ml

10 working days


Immuno

Procalcitonin Plasma Lithium Heparin

Green 3 ml 1 working

day Endo

Progesterone Serum Gel Yellow 3 ml 1 working

day Endo

Prolactin Serum Gel Yellow 3 ml 1 working

day Endo

Prostate Specific Antigen (PSA), Total


day Endo

Protein C & Protein S activity

Plasma Na Citrate Blue 2 x 2.7 ml

Every 2 weeks

(sample received

office hour)

Blood volume to be followed strictly. Clinical information must be provided

Sp Haem

Protein Total Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

33/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Protein Total, CSF CSF Plain cup 3ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Protein Total, Urine Urine 24 hr

Na azide (24 hr)

As

collected

Routine : 2 Hours

STAT : 60 mins

Routine Chem

PT/INR Plasma Na Citrate Blue 1.8 or 2.7

ml 90 mins

Blood volume to be followed strictly.

Sp Haem

Pyruvate, blood Blood (fasting)

Perchloric acid tube

2 ml


testing is weekly)

Collect tube from IEM lab. Send sample in ice. (Protein-free supernatant can be sent in chilled or frozen state)

IEM

Pyruvate, CSF CSF Perchloric acid tube

1 ml


testing is weekly)

Send sample in ice

IEM

Reducing Sugars, stool Stool Plain cup As

collected


testing is weekly)

IEM

Reducing Sugars, Urine Urine Plain cup 5 ml


testing is weekly)

IEM

Renin Plasma EDTA Purple 2 x 3 ml

One Month (Req of

testing is Monthly)

Must be requested together with Aldosterone. Sample should be sent immediately in ice water within 30 mins. External samples from outside of UMMC should be delivered frozen. If the posture is not mentioned in the requesting

Endo

34/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

form, it will be assumed that the sample is collected in the upright posture and the results will be reported as per that reference interval.

Reticulocyte count Whole blood

EDTA Purple 3 ml

Routine: 2 hour

STAT : 60 mins

Sample to be sent to the laboratory within 2 hours of collection

Haem

Rheumatoid Factor Serum Plain Red 5 ml 1 working

day Immuno

Salicylate Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Seminal Fluid Analysis Seminal Fluid

Plain cup Entire

ejaculate


testing is weekly)

Patient to make appointment with the Polyclinic Lab (ext 2392).

Poly

Sex Hormone Binding Globulin (SHBG)



testing is weekly)

Endo

Sirolimus Whole Blood

EDTA Purple 3 ml


testing is weekly)

Clotted sample will be rejected

Special Chem

Smooth Muscle Ab (SMA)


10 working days


Immuno

Sodium Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

35/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Sodium, Urine 24H Urine 24 hr

Plain (24 hr) As

collected

Routine : 2 Hours

Routine Chem

Spinal Muscular Atrophy (SMN1, SMN2)

Whole blood

EDTA Purple 3ml



MGAL - Molecular

Sulphite Test Urine Plain cup 5 ml 1 working

day

Please call lab (ext. 2584) for appointment

IEM

Sweat test for NaCl, conductivity

Sweat 1 working

day

Please call lab (ext. 2584) for appointment

IEM

Tacrolimus (FK 506) Whole Blood


day Clotted sample will be rejected

Special Chem

TCRB Gene Rearrangements


EDTA Purple 3ml



MGAL - Molecular

Testosterone Serum Gel Yellow 3 ml 1 working

day Endo

Theophylline (Aminophylline)


day


Special Chem /TDM

36/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Thyroglobulin Serum Plain Red 5 ml


testing is weekly)

Test is mainly indicated in the monitoring of thyroid cancer after thyroidectomy or ablation therapy. Thyroglobulin Ab (TgAb) should also be requested.

Endo

Thyroglobulin Ab (TgAb)



testing is weekly)

Endo

Thyroid Peroxidase Ab (TPO)



testing is weekly)

Endo

Thyroid-stimulating hormone (TSH)


day TAT for neonatal

TSH is 24 hour Endo

Thyroxine (T4), Free Serum Gel Yellow 3 ml 1 working

day Endo

Toxicology Screen, Urine

Urine Plain cup

20 ml


testing is weekly)

Toxicology

Triglyceride Serum Plain SST Yellow 3.5 ml 2 Hours

12 hr fasting sample required

Routine Chem

Tri-iodothyronine (T3), Free


day Endo

37/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Troponin I Plasma Lithium Heparin

Green 3 ml 60 minutes

Endo

Urea Serum Plain SST Yellow 3.5 ml

Routine : 2 Hours

STAT : 60 mins

Routine Chem

Urea, Urine 24H Urine 24 hr

Plain (24 hr) As

collected

Routine : 2 Hours

Routine Chem

Uric Acid Serum Plain SST Yellow 3.5 ml 2 Hours

Routine Chem

Uric Acid, Urine 24H Urine 24 hr

Plain (24 hr) As

collected 2 Hours

Routine Chem

Urinalysis (Urine FEME)

Urine Plain cup 10 ml 2 Hours (STAT:45

mins)

Specimen received >3 hours after collection will be rejected.

F&E / Poly

Urine Pregnancy Test (UPT)

Urine Plain cup 2 ml 2 hours First morning or random specimen.

F&E / Poly

Valproic acid (Epilim) Serum Plain Red 5 ml 1 working

day


Special Chem /TDM

Vancomycin Serum Plain Red 5 ml 1 working

day


Special Chem /TDM

38/57


COLOUR VOLUME

Expected TAT

REMARKS LAB

Vanillylmandelic Acid (VMA) Screen

Urine 6N HCL

random or 24 hr

As

collected


testing is weekly)

Special Chem

Vitamin B12 Serum Gel Yellow 3 ml 1 working

day


Endo/ SpHaem

Vitamin D Serum Plain Red 5 ml 1 week (Freq of testing is

weekly) Endo

PROFILES AND PACKAGES The following lists profiles/packages specifically grouped for ease of ordering and reference for Chemistry, Immunology, Endocrine and Haematology. The profiles/packages also include additional comments and some common indications/utilizations.

Description (Profile Name)

Tests Component Specimen

Requirement Expected TAT Remarks

Complete Blood Count (CBC)

Hb, Hematocrit, RBC, MCV, MCH, MCHC, RDW,

Platelet, WBC EDTA 3 ml

Routine : 2 hours

STAT: 45 mins

Ensure adequate mixing of blood and send within 2hr of

collection.

Complete Blood Count (CBC) with differential count

Hb, Hematocrit, RBC, MCV, MCH, MCHC, RDW,

Platelet, WBC, Differential count

EDTA 3 ml Routine : 2

hours STAT: 60 mins

Ensure adequate mixing of blood and send within 2hr of

collection.

Bone Marrow Aspirate Examination

Routine Stain- MGG, Perox,Perl`s Iron

stain.

Special Stains-NSE,LAP,APO4,PAS

Slides 5 working days

Investigation for haematological

disorders/malignancies. New cases will require

both marrow & trephine biopsy

Follow up cases will require a marrow aspirate

except for aplastic anaemia or secondaries in marrow, which require a trephine biopsy as well.

CKD (Simple)

CBC, RFT, Alb, Ca, P, ALP, UFEME

SST gel tube,

Urine Cup 1 working day

39/57




CKD (Complete)

CBC, RFT, LFT, Ca, P, Uric Acid, Lipid, Glu, PTH, HbA1C, UFEME, urine

protein creatinine ratio

EDTA,

SST gel tube,

Urine Cup

1 working day

Creatinine Clearance Serum Creatinine and

urine creatinine 24Hour

SST Gel tube,

24hr Plain Urine 1 working day

Ensure adequate hydration of patient

and complete collection of 24hr

urine. Urine and blood samples MUST be sent

together.

Dexamethasone Suppression Test

Serum and Urine Cortisol - Basal and Post-Dexamethasone

SST gel tube

Urine Cup

1 working day

Diabetic Annual Check

RFT, Uric Acid, Lipids, Ca, P, Glu, Urine FEME,

HbA1c, Urine ACR, CBC

SST Gel tube,

Fluoride tube,

Urine cup,

EDTA

1 working day

Dialysis Package 1

CBC, Iron Studies, RFT, PTH, LFT, Lipid, Ca, P, Glu,

CRP, HbA1C

EDTA,

SST gel tube,

Plain Tube

1 working day

Dialysis Package 2

CBC, Iron Studies, RFT, LFT, Lipid, CRP, Ca, P, Glu

EDTA,

SST gel tube,

Plain Tube

1 working day

DIVC Screen PT/APTT/TT/Fibrinogen/D

Dimer Qualitative Na Citrate tube 2 hours

Blood volume must be followed strictly.

Clinical information must be provided

Glucose Suppression Test

GH & Glucose at 0, 60, 120 minutes

Plain Tube x3

Fluoride Tube x3

1 working day

All specimens shall be sent together to the lab for easy intrepretation

GnRH Test FSH& LH at 0, 30, 60

minutes SST gel tube x3 1 working day

All specimens shall be sent together to the lab for easy interpretation

Haemophilia Screen APTT, Factor VIII, Factor

IX Na Citrate x2 5 Working days

Investigation of bleeding tendency

associated ONLY with prolonged APTT. Blood

volume must be followed strictly.

Clinical information must be provided

Immunology Screen C3, C4, ANF, dsDNA Ab,

RF

Plain Tube

7 working days

40/57




Insulin Tolerance Test Cortisol, GH, Glucose at 0,

15, 30, 45, 60, 90, 120 minutes

Plain Tube x7

Fluoride Tube x7

5 working days All specimens shall be

sent together to the lab for easy intrepretation

Iron Studies Iron, Ferritin, Transferrin,

Transferrin saturation Plain Tube 1 working day


Lipid Profile

TG, T Chol, HDL Chol, LDL Chol

SST Gel tube 2 hours 12 hr fasting sample

required.

Liver Function Tests (LFT)

Alb, T bili, ALT, ALP, GGT SST Gel tube 2 hours

Lupus Anticoagulant Screen

APTT, Silica clotting time, LA screen, LA confirm

Na Citrate x2

Every 2 weeks (samples

received during office hour

only)

Investigation of patients with suspected

thrombosis, antiphospholipid (APL)

syndrome and recurrent abortions.



Lymphocyte Subset quant – CD4/CD8

CD3,CD4,CD8 EDTA tube 3 working days


CD3, CD4, CD8, CD19, CD56

EDTA tube 3 working days

Oral GTT Glucose 2pt Fluoride tube x2 1 working day

Proper patient selection and

preparation required. See Special Test

Procedures.

Phosphate (TMP-GFR)

Serum creatinine, serum phosphate, urine

creatinine(random), urine phosphate(random)

SST gel tube,

Urine Cup 1 working day

Platelet Function Test Bleeding Time, Platelet

Aggregation Studies Na Citrate x3 5 working day

Investigation of bleeding tendency

associated with normal platelet count &

coagulation screen results.

Appointment required (ext. 2848). Blood volume must be followed strictly.


Renal Function Tests (RFT)

Na, K, Cl, HCO3, Urea, Crea, AGAP

SST Gel tube 2 hours

41/57




Renal Transplant CBC Diff, RFT, LFT, Ca, P,

Urine FEME

EDTA, SST

gel tube,

Urine Cup

3 hours

SynacthenTest Cortisol at 0, 30, 60

minutes Plain Tube x3 1 working day

All specimens shall be sent together to the lab for easy interpretation

Thrombophilia Study Antithrombin, Protein C,

Protein S, APCR Na Citrate tube x2

Every 2 weeks (sample

received office hour)



Thalassemia Screen CBC, Retic, HbH, HbEP (standard), HbA2, HbF.

EDTA 3 ml 14 working

days

Investigation of patients with suspected haemoglobinopathy or

Thalasaemia.

Trephine Biopsy Examination

Haematoxylin, Eosin, Reticulin, AFB, Fungal, Immunohistochemical

stains.

Formalin tube 14 working

days

Staging of malignancies with propensity for

bony metastasis, both marrow and trephine biopsy is mandatory.

Von Willebrand Disease Study

APTT, FVIII, vWF Ag, vWF Activity

Na Citrate tube x2 14 working

days



42/57

REFERENCE RANGES The reference ranges given here are for adults unless otherwise indicated. These ranges given are only to be used as a guide and may change from time to time. Please refer to the result report for the current reference range or if a range is not given.

TEST NAME SAMPLE REFERENCE RANGE

17-OH Progesterone Serum Males (20-59 years) : 1.9 – 6.5 nmol/L

Females:

Follicular phase (22-45 years) 1.0 – 4.5 nmol/L

Luteal phase (22-45 years) 0.8 – 8.8 nmol/L

Oral Contraceptives 0.6 – 5.8 nmol/L

Post Menopausal : 0.6 – 2.2 nmol/L

5- Hydroxyl Indole Acetic Acid (5HIAA) Urine < 6.0 mmol/mol creat

Activated Protein C Resistance (APCR) Plasma < 2.22

Adrenocorticotropic Hormone (ACTH) Plasma 0 – 46 pg/mL

Alanine Aminotransferase (ALT) Serum 10-49 U/L

Albumin Serum 32-48 g/L

Aldosterone Serum Supine 28 – 444 pmol/L

Upright 111 – 860 pmol/L

Alkaline Phosphatase Serum 0-12 yrs : 54 – 369 U/L >12 yrs : 45 – 129 U/L

Alpha-1 Antitrypsin (AAT) Serum 81 – 171 mg/dL

Alpha-Fetoprotein (AFP) Serum 0 – 6.7 IU/mL

Amino Acids Blood, CSF, urine

Refer to report

Ammonia Plasma 11.2-35.4 umol/L

Amylase (Serum) Serum 30 – 118 U/L

Amylase (Urine random) Urine random 0 - 650 U/L

Anticardiolipin Ab Serum < 20 units

Anti-CCP Serum < 7.4 U/mL

Anti-Neutrophilic Cytoplasmic Antibodies (ANCA)

Serum Negative

Antinuclear Ab (ANF) Serum Negative

Antistreptolysin-O (ASO) Serum Adults < 200 IU/mL

<7yr < 100 IU/mL

Anti-thrombin III Plasma 80-140 %

APTT (activated partial thromboplastin time) Plasma 25.0 - 36.8 sec (changes with reagent lot. Refer to range given with result)

Aspartate Aminotransferase (AST) Serum < 34 U/L

B2-Microglobulin (BMG), Serum Serum ≤ 2.5 mg/L

43/57


B2-Microglobulin (BMG), Urine

≤ 0.3 mg/L

Bence Jones Protein Urine Negative

Bile Acids, Total Serum A well-defined local reference range for serum bile acids is not available. Please refer to the literature and current guidelines for the interpretation of bile acids results. There is some evidence that serum bile acids levels >10 µmol/L may be associated with increased maternal and/or fetal risks. Serum bile acids levels >40 µmol/L can be considered markedly high.

Bicarbonate Serum 20 – 31 mmol/L

Bilirubin, Conjugated Serum 0 – 3 umol/L

Bilirubin, Total Serum < 17 umol/L

Bleeding Time Whole Blood 1 – 5 minutes

Blood Gases Whole Blood, arterial

pH 7.36 – 7.44

pCO2 4.5 – 6.1 kPa

pO2 11 – 15 kPa

BE (-2) – 3

Bicarb 21 – 28 mmol/l

Bone Marrow Examination Bone Marrow Aspirate / Trephine Biopsy

Refer to report

CA 125 Serum 0 – 30 U/ml

CA 15-3 Serum 6.4 - 58 U/ml

CA 19-9 Serum 0 – 33 U/ml

Caeruloplasmin Serum 0.20– 0.60 g/L

Calcium Serum 2.2 – 2.6 mmol/L

Calcium (Urine 24 H) Urine 24 hr 2.2– 7.5 mmol/24H

Cannabinoids Screen Urine Neg

Carcinoembryonic Antigen (CEA) Serum 0 – 2.5 ng/mL

Catecholamines Urine 24 hr Adrenaline 9.2 – 122.3 nmol/24H

Noradrenaline 71.5 – 505.3 nmol/24H

Dopamine 0 – 3237 nmol/24H

Chloride Serum 99 – 109 mmol/L

Cholesterol, HDL Serum > 1.1 mmol/L

Cholesterol, LDL Serum < 2.59 mmol/L (NCEP)*

Cholesterol, Total Serum < 5.2 mmol/L (desirable)

Cholinesterase Serum Male 4389 – 10928 U/L

44/57


Female 2879 – 12669 U/L

Chromosome Analysis (karyotyping) Whole Blood Refer to report

CKMB Mass Serum < 5.0 ug/L

Coagulation Factors Assay Plasma FII : 70 - 146%

(FII, FV, FVII, FVIII, FIX, FX, FXI or FXII) FV : 62 - 150%

FVII : 67 - 150%

FVIII : 50 - 150%

FIX : 50 - 163%

FX : 60 - 150%

FXI : 50 - 163%

FXII : 52 - 164%

Complement 3 (C3) Serum 86 – 184 mg/dL

Complement 4 (C4) Serum 20 – 59 mg/dL

Complete Blood Count (CBC) Whole Blood Hb (Male) 130 – 170 g/L, (Female) 120 – 150 g/L

Hct (Male) 0.4 0 – 0.50 l/l, (Female) 0.36 – 0.46 l/l

RBC (Male) 4.5 – 5.5, (Female) 3.8 – 4.8 x1012 /L

MCV 77 – 97 fl

MCH 27 – 32 pg

MCHC 315– 345 g/L

WBC 4 – 10 x109 /L

Plt 150 – 400 x109 /L

Reticulocyte 0.5-2.5 %

Neutrophils 2.0 - 7.0 x 109/L

Lymphocytes 1.0 - 3.0 x 109/L

Eosinophil 0.02- 0.5 x109/L

Monocytes 0.2 - 1.0 x 109/L

Basophil 0.02 - 0.1 x 109/L

Copper Serum 11 – 22 umol/L

Copper Urine 24 hr 0.2 – 0.5 umol/24H

Cortisol Serum 7-9am: 145 – 619 nmol /L

3-5pm: 95 – 462 nmol /L

Cortisol Urine 57.7 – 806.8 nmol /24H

C-Peptide Serum 0.9 – 7.1 ng/mL (Fasting)

C-Reactive Protein (CRP) Serum < 0.8 mg/dL

C-Reactive Protein, Hypersensitive (hsCRP) Serum < 1.0 mg/L (Low Risk)

10 - 3.0 mg/L (Average Risk)

>3.0 mg/L (High Risk)

45/57


>10.0 mg/L ( Acute Inflammation)

Creatine Kinase Serum Males 32-294 U/L Females 33-211 U/L

Creatinine (Serum) Serum Males 54 – 97 umol/L

Females 44 – 71 umol/L

Creatinine (Urine) Urine 24 hr 7 – 18 mmol/24H

Cryoglobulin Serum Refer to report

CSF FEME CSF Refer to report

Cytospin CSF Refer to report

D-Dimer Plasma < 250 ng/mL

Dehydroepiandrosterone Sulfate (DHEA-S) Serum Males 2.2 – 15.2 umol/L

Females 0.9 – 11.7 umol/L

ds-DNA Ab Quantitation Serum < 200 IU/mL

ds-DNA Ab Screen Serum Negative

Erythropoeitin(EPO) Serum 4.3 - 29 IU/L

ESR Whole Blood Male < 21 mm/hr Female < 29 mm/h

Estradiol Serum Males ND - 146 pmol/L

Menstruating Female :

Follicular Phase 72 - 529 pmol/L

Midcycle 235 - 1309 pmol/L

Luteal Phase 205 – 786 pmol/L

Post Menopausal Female (untreated) ND - 118 pmol/L

Extractable Nuclear Antigen (ENA) Serum Negative

Fat Globules Faeces Negative

Ferritin Serum Males 22.0 – 322.0 ug/L

Females 10.0 – 291.0 ug/L

Fibrinogen Plasma 2.0 – 4.0 g/L

Fluid FEME Fluid Refer to report

Folate Serum >12.19 nmol/L

Follicular Stimulating Hormone (FSH) Serum Males (13 – 70yr): 1.4 – 18.1 IU/L

Menstruating Females :

Follicular Phase 2.5 – 10.2 IU/L

Midcycle Peak 3.4 – 33.4 IU/L

Luteal Phase 1.5 – 9.1 IU/L

Pregnant < 0.3 IU/L

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Post Menopausal Female

23.0 – 116 IU/L

Free Light Chain Kappa& Lambda Serum Kappa 3.3-19.4 mg/L; Lambda 5.7-26.3 mg/L; Kappa/Lambda Ratio 0.26-1.65

Fructosamine Serum Male: 118 - 282 umol/L

Female: 161 - 351 umol/L

Gamma Glutamyl Transferase (GGT) Serum Males < 73 IU/L

Females <38 IU/L

Glucose Plasma < 5.6 mmol/L (Fasting)

< 7.8 mmol/L (Random)

<11.1 mmol/L (Post Prandial)

Growth Hormone Serum Males: Up to 3 ng/mL

Females: Up to 8 ng/mL

Haptoglobulin Serum 33 – 171 mg/dL

HbA1C Whole Blood < 6.5% (NGSP)

< 48 mmol/mol (IFCC)

Human Chorionic Gonadotropin (HCG) Serum Premenopausal Females <6 IU/L

Postmenopausal Females <10 IU/L

Males <2 IU/L

Immunoglobulin A (IgA) Serum 70 – 473 mg/dL

Immunoglobulin E (IgE) Serum ≤ 165 IU/mL

Immunoglobulin G (IgG) Serum 931 – 1916 mg/dL

CSF 0.48 - 5.86 mg/dL

Immunoglobulin M (IgM) Serum 34 – 265 mg/dL

Insulin Serum 3.0 - 25.0 mU/L(Fasting)

Insulin-like Growth Factor - 1 (IGF-1) Serum Age(Y): Reference ranges

1: 55 - 327 ng/mL

2: 51-303 ng/mL

3: 49-289 ng/mL

4: 49 -283 ng/mL

5: 50- 286 ng/mL

6: 52 - 297 ng/mL

7: 57 - 316 ng/mL

8: 64 -345 ng/mL

9: 74 -388 ng/mL

10: 88 - 452 ng/mL

11: 111-551 ng/mL

12: 143 -693 ng/mL

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13: 183 -850 ng/mL

14: 220 -972 ng/mL

15: 237-996 ng/mL

16: 226-903 ng/mL

17: 193-731 ng/mL

18: 163 -584 ng/mL

19: 141-483 ng/mL

20: 127-424 ng/mL

21-25: 116-358 ng/mL

26-30: 117-329 ng/mL

31-35: 115-307 ng/mL

36-40: 109-284 ng/mL

41-45: 101-267 ng/mL

46-50: 94-252 ng/mL

51-55: 87-238 ng/mL

56-60: 81-225 ng/mL

61-65: 75-212 ng/mL

66-70: 69-200 ng/mL

71-75: 64-188 ng/mL

76-80: 59-177 ng/mL

81-85: 55-166 ng/mL

Iron Serum Males 11.6 – 31.3 umol/L

Females 9.0 – 30.4 umol/L

Lactate Plasma < 2.2 mmol/L

CSF Neonate 1.1 – 6.7 mmol/L Adult 1.1 – 2.4 mmol/L

Lactate Dehydrogenase Serum 120 - 246 U/L

Lead Whole Blood Reference Range

0-16 years : 0-0.09 umol/L

>=17 years : 0 - 0.22 umol/L

Alert Value

0-16 years : > 0.12 umol/L

Actioin Value

0-16 years : > 0.48 umol/L

>=17 years : > 1.00 umol/L

Lithium Serum 0.3 – 1.3 mmol/L

Luteinising Hormone (LH) Serum Females:

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Normal Menstruating:

Follicular 1.9 - 12.5 IU/L

Midcycle Peak 8.7 - 76.3 IU/L

Luteal Phase 0.5 - 16.9 IU/L

Pregnant < 0.1 - 1.5 IU/L

Postmenopausal 15.9 - 54.0 IU/L

On contraceptives 0.7 - 5.6 IU/L

Males:

20-70yr 1.5 - 9.3 IU/L

> 70yr 3.1 - 34.6 IU/L

Children <0.1 - 6.0 IU/L

Lymphocyte Subset quant – CD4/CD8 Whole Blood Pan T cells : 51 - 80% (928 - 2379 cells/uL)

CD4 : 28 - 48% (497 - 1465 cells/uL)

CD8 : 16 -36 % (307 - 925 cells/uL)


Whole Blood Pan T cells : 51 - 80% (928 - 2379 cells/uL)

CD4 : 28 - 48% (497 - 1465 cells/uL)

CD8 : 16 -36 % (307 - 925 cells/uL)

Pan B cells : 7-23% (140 - 633 cells/uL)

NK Cells : 1-8% ( 17-183 cells/uL)

Magnesium Serum 0.53 – 1.11 mmol/L

Metanephrines Urine 24 Hr Normetanephrines: 0.88 - 2.88 umol/24H

Metanephrines: 0.33 - 1.53 umol/24H 3-Methoxytyramine: 0.6 to 2.6 umol/24H

Methaemoglobin Red Cells 0 – 2.0 %

Methotrexate Serum Toxic levels: 10 umol/L at 24 hours 1.0 umol/L at 48 hours 0.1 umol/L at 72 hours

Microalbumin (Random) Urine, random Males < 2.5 mg/mmol creat

Females < 3.5 mg/mmol creat

Microalbumin (24H) Urine 24 Hr < 30 mg/24H

Mitochondria Ab (AMA) Serum Negative

Mucopolysaccharides Urine Refer to report

Occult Blood Faeces Negative

Opiates Screen Urine Negative

Osmolality Serum 275 – 295 mmol/kg

Osmolality (Urine) Urine random 50 – 1200 mmol/kg

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Paracetamol Serum Therapeutic 0.07 – 0.13 mmol/L

Toxic >2.0 mmol/L at 4h

Toxic >0.3 mmol/L at 12h

Paraquat Urine Negative

Parathyroid Hormone (PTH) intact Serum 1.3 - 6.8 pmol/L

Phosphate Serum 0.78 – 1.65 mmol/L

Phosphate, Urine 24 Hour Urine 24 hr 15 - 50 mmol/24H

Porphobilinogen urine Negative

Potassium Serum 3.6 – 5.2 mmol/L

Potassium, Urine 24 Hour Urine 24 hr 25 – 125 mmol/24H

Procalcitonin

Plasma Normal range: <0.10 ng/ml Diagnosis of systemic bacterial infection or generalised sepsis: Systemic infection unlikely: < 0.5 ng/mL Systemic infection possible: ≥ 0.5 – < 2 ng/mL Systemic infection likely: ≥ 2 ng/mL Severe sepsis or septic shock likely: ≥ 10 ng/mL

Progesterone Serum Females:

Follicular Phase < 4.5 nmol/L

Luteal Phase 10.6 - 81.3 nmol/L

Mid Luteal Phase 14.1 - 89.1 nmol/L

Postmenopausal < 2.3 nmol/L

Prolactin Serum Males: 45 - 375 mIU/L

Females:

Nonpregnant 59 - 619 mIU/L

Pregnant 206 - 4420 mIU/L

Postmenopausal 38 - 430 mIU/L

Prostate Specific Antigen (PSA), Total Serum 0 – 4 ng/mL

Protein C Activity Plasma Protein C 70 – 140 %

Protein S activity Plasma Protein S 70 – 140 %

Protein Total (Serum) Serum 64 - 82 g/L

Protein Total, Urine 24H Urine 24 hr 0.05 – 0.15 g/24H

Protein Total, CSF CSF 0.08 – 0.32 g/L

PT/INR Plasma PT ratio 1 – 1.2

Pyruvate Whole blood, CSF

30 – 80 umol/L

Renin Plasma Upright 1.5 - 5.7 ng/ml/hr

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Supine 0.2 - 2.8 ng/ml/hr

Rheumatoid Factor Serum < 20 IU/mL

Salicylate Serum Therapeutic 0.2 – 1.45 mmol/L

Toxic >2.17 mmol/L

Lethal >4.25 mmol/L

Seminal Assay Semen Refer to report

Sex Hormone Binding Globulin(SHBG) Serum Males: 10 - 57 nmol/L

Females: 18 -144 nmol/L

Smooth Muscle Ab Serum Negative

Parietal Cell Ab Serum Negative

Sodium Serum 136 - 145 mmol/L

Sodium, Urine 24H Urine 24hr 40 - 220 mmol/24H

Sweat test for NaCl Sweat < 60 mmol/L

Testosterone Serum Males 8.4 - 28.7 nmol /L

Females 0.5 - 2.6 nmol /L

Thrombin time Plasma 13.0 17.0 secs

Thyroglobulin (HTG) Serum 0 – 55 ng/mL

Thyroglobulin Ab (TgAb) Serum 0 – 40 IU/mL

Thyroid Peroxidase Ab (TPO) Serum 0 – 35 IU/mL

Thyroid-stimulating hormone (TSH) Serum Adults >18 Y: 0.55 - 4.78 mIU/L

Thyroid-stimulating hormone (TSH), Neonatal

Cord Blood 2.6 – 20mIU/L

Thyroxine (T4), Free Serum Adults >18Y: 11.5 - 22.7 pmol/L

Transferrin Serum 2.0 – 3.3 g/L

Triglyceride Serum < 1.7 mmol/L (NCEP)*

Triiodothyronine (T3), Free Serum 3.5 - 6.5 pmol/L

Troponin I Plasma < 0.06 ng/mL

Urea Serum 3.2 – 8.2 mmol/L

Urea, urine 24H Urine 24 hr 430 - 710 mmol/24H

Uric Acid Serum Males : 220 – 547 umol/L

Females : 184 – 464 umol/L

Uric Acid, Urine 24H Urine 24 hr 1.5 – 4.5 mmol/24H

Urinalysis (Urine FEME) Urine Biochemistry: SG 1.005 – 1.030

pH 5.0 – 7.0

Protein Negative

Glucose Negative

Ketones Negative

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Urobilinogen Negative

Bilirubin Negative

Nitrite Negative

Hb Negative

Leucocyte Esterase Negative Microscopy: Erythrocyte : 0-3 / μL Leucocytes : F: 0-10 / μL; M: 0-3 μL Epithelial Cells : Negative Casts : Negative Crystals : Negative Bacteria : Negative

Urine Pregnancy Test Urine Neg

Vanillylmandelic Acid (VMA) Screen Urine Neg

Vitamin B12 Serum 157 – 672 pmol/L

Vitamin D (Total) Serum ≥ 50 nmol/L

Von Willebran : Antigen Plasma 50 – 150%

Von Willebran : Activity Plasma 50 – 170%

* NCEP ATP III Guidelines At-A-Glance Quick Desk Reference. The Laboratory Policy on Protection of Personal Information: All personnel adhere to security procedures while working in the laboratory including ensuring security of patient information. The laboratory ensures that reports are released ONLY to clinical personnel who requested for the examination or clinical personnel who is involved in the management of the patient. The Division does not issue reports directly to patients. In the rare circumstance when it is ascertained that the patient is seeking a second opinion or consultation that is relevant to his/her medical care, a DUPLICATE report may be released after approval by the reporting pathologist and the circumstance recorded. The Laboratory Complaint Procedure:

The Laboratory looks into all complaints, incidents, feedback and non-conformances in a positive manner and adheres to the University of Malaya and UMMC procedures for instituting corrective and preventive actions.

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