PATHOLOGY HANDBOOK
SIXTH EDITION 2003
Issued: July 2003
1 Table of Contents
LABORATORY PERSONNEL ...... 12 HOURS OF OPERATION ...... 12 ACCREDITED COLLECTION CENTRES ...... 13 HOME VISITS ...... 14 SPECIMEN TRANSPORT & STORAGE ...... 14 TAXIS & EXTERNAL COURIER PICK UPS...... 14 SPECIMEN COLLECTION ...... 15 BLOOD & SALIVA COLLECTION TUBES ...... 15 SPECIMEN COLLECTION ...... 16 Mid-stream urine collection...... 16 Females ...... 16 Males...... 16 Timed urine collection (24 Hour) ...... 16 Request forms ...... 16 RESULTS...... 17 Reference Ranges...... 17 Turnaround Times ...... 17 Tests In Alphabetical Order...... 18 ACETYLCHOLINE RECEPTOR ANTIBODIES ...... 18 ACID ELUTION (KLEIHAUER TEST)...... 18 ACTH (ADRENOCORTICOTROPHIC HORMONE)...... 18 ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) ...... 18 ACTIVATED PROTEIN C RESISTANCE (APCR)...... 18 ADDIS COUNT...... 19 ALANINE AMINOTRANSFERASE (ALT, SGPT) ...... 19 ALBUMIN, Serum...... 19 ALBUMIN /CREATININE RATIO, Urine...... 19 ALCOHOL (Ethanol) ...... 20 ALDOSTERONE ...... 20 ALKALINE PHOSPHATASE ...... 20 ALKALINE PHOSPHATASE ISOENZYMES ...... 20 ALPHA-1-ANTI-TRYPSIN ...... 21 ALPHA-FOETO PROTEIN (AFP) ...... 21 ALUMINIUM ...... 21 AMINO ACIDS...... 21 AMIODARONE...... 21 AMMONIA ...... 22 AMYLASE ...... 22 ANCA (ANTI-NEUTROPHIL CYTOPLASMIC AB's)...... 22 ANDROSTENEDIONE...... 23 ANGIOTENSIN CONVERTING ENZYME (ACE) ...... 23 ANION GAP ...... 23 ANTE-NATAL SCREEN...... 23 2 ANTIBODY SCREEN - (BLOOD GROUP) ...... 24 ANTI-DNASE B, TITRE...... 24 ANTI-GLOMERULAR BASEMENT MEMBRANE (Anti-GBM)...... 24 ANTI-ENDOMYSIAL ANTIBODIES ...... 24 ANTI-EXTRACTABLE NUCLEAR ANTIGENS (ENA) ...... 24 ANTI-INSULIN ANTIBODIES...... 24 ANTI-LIVER-KIDNEY MICROSOMAL ANTIBODIES ...... 25 ANTI-MITOCHONDRIAL ANTIBODIES (AMA) ...... 25 ANTI-NUCLEAR ANTIBODIES ( ANF or ANA ) ...... 25 ANTI-OVARY ANTIBODIES ...... 25 ANTI-PARIETAL CELL ANTIBODIES...... 25 ANTI-RETICULIN ANTIBODIES ...... 26 ANTI-RIBOSOMAL ANTIBODIES...... 26 ANTI-SMOOTH MUSCLE ANTIBODIES ...... 26 ANTI-STREPTOLYSIN O TITRE (ASOT)...... 26 ANTI-THROMBIN III (AT3)...... 26 ANTI-THYROID ANTIBODIES...... 27 ANTI-TSH RECEPTOR ANTIBODIES...... 27 APOLIPOPROTEINS ...... 27 ARSENIC (As), Blood...... 27 ARSENIC (As), Hair ...... 27 ARSENIC (As), Urine ...... 27 ASPARTATE AMINOTRANSFERASE ( AST, SGOT)...... 28 AVIAN (BIRD) PRECIPITINS...... 28 BENCE JONES PROTEIN...... 28 BETA-2-MICROGLOBULIN ...... 28 BICARBONATE...... 28 BILIRUBIN...... 29 BLOOD CULTURE...... 29 BLOOD GROUP AND Rh ...... 29 BONE MARROW ...... 29 BORDATELLA PERTUSSIS SEROLOGY...... 29 BORELLIA SEROLOGY ...... 30 BRUCELLA ANTIBODIES ...... 30 CA 125 ...... 30 Ca (Hair)...... 30 CADMIUM (Cd), Blood...... 30 CADMIUM (Cd), Hair ...... 30 CADMIUM (Cd), Urine ...... 30 CAERULOPLASMIN ...... 31 CALCITONIN...... 31 CALCIUM ...... 31 CALCULUS ...... 31 CARBAMAZEPINE (TEGRETOL)...... 32 CARCINOEMBRYONIC ANTIGEN (CEA)...... 32
3 CARDIAC ENZYMES...... 32 CARDIO VASCULAR PROFILE (CVP) ...... 32 Cardiac Risk Assessment...... 32 CARDIOLIPIN ANTIBODIES ...... 33 β CAROTENE...... 33 CATECHOLAMINES...... 33 CERVICAL SMEAR (PAP SMEAR) ...... 33 CH50 (Total Haemolytic Complement) ...... 34 CHLAMYDIA ANTIBODIES ...... 34 CHLAMYDIA PCR...... 34 CHLORIDE...... 34 CHOLESTEROL...... 34 CHOLINESTERASE...... 34 CHROMOSOMES...... 35 CKMB ...... 35 CLONAZEPAM (Rivotril) ...... 35 CLOSTRIDIUM DIFFICLE ENDOTOXIN...... 35 CMV SEROLOGY ...... 36 COAGULATION STUDIES ...... 36 COLD AGGLUTININS...... 36 COMPLEMENT (C3, C4) ...... 36 COPPER ...... 37 CORD BLOOD STUDIES ...... 37 CORTISOL ...... 37 CORTISOL (saliva) ...... 37 COTININE ...... 38 C-PEPTIDE ...... 38 C-REACTIVE PROTEIN ...... 38 CREATINE KINASE (CK) ...... 38 CREATININE...... 38 CREATININE CLEARANCE ...... 39 CROSSMATCH...... 39 CRYOGLOBULINS ...... 40 CRYPTOSPORIDIUM...... 40 CSF FOR MICRO & CULTURE...... 40 CYCLOSPORIN A...... 40 CYTOLOGY OF BODY FLUIDS ...... 40 CYTOMEGALOVIRUS ANTIBODIES (CMV) ...... 41 D DIMER TEST ...... 41 DEHYDROEPIANDROSTERONE...... 41 DENGUE FEVER SEROLOGY...... 41 DHEAS, Saliva ...... 41 DHEAS, Serum ...... 41 DIGOXIN ...... 42 DIRECT ANTIGLOBULIN (DAT, COOMBS) TEST ...... 42
4 DNA ANTIBODIES...... 42 DRUGS OF ABUSE SCREEN ...... 43 EBV SEROLOGY ...... 43 ELECTROLYTES...... 43 ELECTROPHORESIS...... 44 ENA (EXTRACTABLE NUCLEAR ANTIGENS)...... 44 ENDOMYSIAL ANTIBODIES...... 44 EPSTEIN BARR VIRUS (EBV) ANTIBODIES ...... 44 ERYTHROCYTE SEDIMENTATION RATE (ESR)...... 44 ESR ...... 44 FAECAL FAT...... 45 FAECES FOR MICRO & CULTURE...... 45 FAECES FOR OCCULT BLOOD...... 45 FAECES FOR OVA, CYSTS AND PARASITES...... 46 FAECES FOR REDUCING SUGARS...... 46 FAECES FOR ROTAVIRUS ...... 46 FAECES FOR TRYPTIC ACTIVITY...... 46 FERRITIN...... 46 FIBRINOGEN ...... 47 FIBRINOGEN DEGRADATION PRODUCTS...... 47 FINE NEEDLE ASPIRATE (FNA) ...... 47 FLOW CYTOMETRY ...... 47 FLUORESCENT TREPONEMA ANTIBODIES...... 47 FLUORIDE NUMBER ...... 47 FLUIDS & ASPIRATES...... 47 FLUIDS AND ASPIRATES - MICRO & CULTURE...... 48 FNA ...... 48 FOLIC ACID ...... 48 FOLLICLE STIMULATING HORMONE (FSH) ...... 48 FRAGILE X CHROMOSOME ...... 48 FREE ANDROGEN INDEX (FAI)...... 49 FRUCTOSAMINE...... 49 FULL BLOOD EXAMINATION (FBE)...... 49 FUNGAL MICRO & CULTURE ...... 49 GAD ANTIBODIES...... 50 GALLSTONE ANALYSIS ...... 50 GAMMA GLUTAMYL TRANSFERASE (Gamma GT) ...... 50 GASTRIC PARIETAL CELL ANTIBODIES...... 50 GASTRIN ...... 50 GENTAMYCIN ...... 50 GLIADIN ANTIBODIES ...... 51 GLUCOSE...... 51 GLUCOSE GESTATIONAL CHALLENGE TEST ...... 51 GLUCOSE TOLERANCE TEST ...... 51 Patient preparation...... 51
5 Performance of the GTT ...... 52 GLUCOSE-6-PHOSPHATE DEHYDROGENASE...... 52 GLYCOSYLATED HAEMOGLOBIN ...... 52 GOLD ...... 52 GONORRHOEA PCR ...... 53 GROWTH HORMONE ...... 53 HAEMOCHROMATOSIS PCR...... 53 HAEMOGLOBIN...... 53 HAEMOGLOBIN A1c ...... 53 HAEMOGLOBIN A2 ...... 53 HAEMOGLOBIN ELECTROPHORESIS...... 53 HAEMOGLOBIN F ...... 54 HAEMOGLOBIN H INCLUSIONS...... 54 HAEMATOCRIT ...... 54 HAIR ANALYSIS ...... 54 HAPTOGLOBIN ...... 54 HEAVY METALS...... 54 HELICOBACTER PYLORI BREATH TEST ...... 55 HELICOBACTER PYLORI SEROLOGY...... 55 HEPATITIS A ...... 55 HEPATITIS B SEROLOGY ...... 55 HEPATITIS C ANTIBODIES ...... 55 HEPATITIS C PCR (POLYMERASE CHAIN REACTION ...... 55 HERPES SIMPLEX ANTIBODIES ...... 56 HERPES SIMPLEX ANTIGEN, TYPES I & II...... 56 HERPES SIMPLEX CULTURE...... 56 HIAA (5-HYDROXY-INDOLE-ACETIC ACID)...... 56 HIGH DENSITY LIPOPROTEIN CHOLESTEROL (HDLC) ...... 56 HISTOPATHOLOGY...... 57 HIV ANTIBODY (AIDS SCREEN) ...... 57 HLA TISSUE TYPING...... 57 HLA B27 ...... 57 HMMA...... 58 HOMOCYSTEINE ...... 58 HTLV III ANTIBODIES ...... 58 HUMAN CHORIONIC GONADOTROPHIN (HCG) ...... 58 HYDATID...... 58 5-HYDROXY-INDOLE-ACETIC ACID ...... 58 17 HYDROXYPROGESTERONE...... 58 IgA ...... 59 IgD...... 59 IgE ...... 59 IGF-1 ...... 59 IgG...... 59 IgG-SUBCLASSES ...... 59
6 IgM...... 59 IMMUNOGLOBULINS-IgA, IgG, IgM LEVELS ...... 59 IM TEST (Glandular Fever Test)...... 60 INDIRECT BILIRUBIN...... 60 INFLUENZA A & B SEROLOGY...... 60 INFLUENZA IMMUNOFLUORESCENCE ...... 60 INSULIN - Fasting ...... 60 INSULIN - POST PRANDIAL 2 HR...... 60 INSULIN ANTIBODIES ...... 61 INSULIN RECEPTOR ANTIBODIES ...... 61 INTRINSIC FACTOR ANTIBODIES...... 61 IRON...... 61 IRON (Hair) ...... 61 IRON STUDIES...... 61 Interpretation of Iron Studies Results ...... 62 Decreased ...... 62 JOINT FLUID...... 62 KARYOTYPING ...... 62 KLEIHAUER TEST...... 62 KPTT ...... 62 LACTATE ...... 62 LACTATE DEHYDROGENASE (LDH) ...... 62 LACTIC ACID ...... 62 LATS (TSH RECEPTOR AB'S)...... 63 LE CELLS...... 63 LEAD (Pb), Blood...... 63 LEAD (Pb), Hair...... 63 LEAD (Pb), Urine...... 63 LEGIONELLA ANTIBODIES (SEROLOGY) ...... 63 LEGIONELLA ANTIGEN...... 63 LEGIONELLA CULTURE...... 63 LEPTOSPIRA SEROLOGY ...... 63 LFT ...... 64 LH...... 64 LIPASE...... 64 LIPIDS - SERUM/PLASMA ...... 64 LIPOPROTEIN (a)...... 64 LIPOPROTEIN ELECTROPHORESIS ...... 64 LITHIUM - SERUM...... 64 LIVER FUNCTION TESTS...... 64 LUPUS ANTI-COAGULANT SCREEN ...... 65 LUTEINISING HORMONE...... 65 LYME DISEASE ...... 65 LYMPHOCYTE SURFACE MARKERS ...... 65 MAGNESIUM (Mg), Blood ...... 65
7 MAGNESIUM (Mg), Hair ...... 66 MAGNESIUM (Mg), Urine ...... 66 MALARIAL PARASITES - (THICK & THIN FILMS) ...... 66 MANGANESE (Mn), Blood...... 66 MANGANESE (Mn), Hair ...... 67 MANTOUX ...... 67 MC&S ...... 67 MCH ...... 67 MCHC...... 67 MCV...... 67 MEASLES SEROLOGY - IgG & IgM...... 67 MELATONIN ...... 67 MERCURY, Blood (Hg)...... 67 MERCURY, Hair (Hg) ...... 68 MERCURY, Urine (Hg) ...... 68 MICROALBUMIN (Albumin Excretion Rate) ...... 68 MRSA SCREEN, (Methicillin Resistant S. Aureus)...... 68 MSU...... 68 MUMPS SEROLOGY...... 68 MUSCLE ENZYMES...... 68 MYCOLOGY...... 68 MYCOBACTERIA...... 69 MYCOPLASMA SEROLOGY, Total Antibody & IgM ...... 69 MYOGLOBIN...... 69 MYSOLINE (PRIMIDONE)...... 69 NEEDLE STICK INJURY ...... 69 NEUTROPHIL ALKALINE PHOSPHATASE (NAP)...... 69 NEUTROPHIL CYTOPLASMIC ANTIBODIES ...... 69 NEUTROPHIL FUNCTION ...... 69 NORADRENALINE ...... 70 OCCULT BLOOD...... 70 OESTRADIOL - Saliva (E2, Estradiol, 17B Estradiol)...... 70 OESTRADIOL - Serum (E2, Estradiol, 17B Estradiol)...... 70 OPIATES...... 70 OSMOLALITY (Measured) - Serum/Plasma...... 70 OSMOLALITY (MEASURED) - Urine...... 70 OSMOTIC FRAGILITY (RED CELL FRAGILITY) ...... 71 OVA & PARASITE EXAMINATION - FAECES...... 71 OXALATE - Urine 24 hrs...... 71 PAP SMEAR ...... 71 PACKED CELL VOLUME (PCV) ...... 71 PARACETAMOL (ACETAMINOPHEN) ...... 71 PARAINFLUENZA VIRUS IMMUNOFLUORESCENCE ...... 71 PARASITE EXAMINATION - STOOL (FAECES) ...... 72 PARATHYROID ANTIBODIES ...... 72
8 PARATHYROID HORMONE (PTH)...... 72 PARIETAL CELL ANTIBODIES ...... 72 PATERNITY TESTING (DNA TESTING)...... 72 PAUL BUNNELL (HETEROPHILE AGGLUTININS)...... 72 PARVO VIRUS B19 ANTIBODIES ...... 72 PCV ...... 72 PHENOBARBITONE - Serum...... 72 PHENYLALANINE...... 73 PHENYTOIN (DILANTIN) ...... 73 PHOSPHATE - Plasma/Serum (PO4)...... 73 PINWORM EXAMINATION...... 73 PLASMINOGEN ACTIVATOR ...... 74 PLASMINOGEN ASSAY...... 74 PLATELET ANTIBODIES, DIRECT ...... 74 PLATELET ANTIBODIES INDIRECT ...... 74 PLATELET COUNT...... 74 PORPHYRIN SCREEN...... 74 POTASSIUM ...... 75 PREGNANCY TEST ...... 75 PRIMIDONE (MYSOLINE, METHYL PHENOBARBITONE) ...... 75 PROGESTERONE, Saliva ...... 76 PROGESTERONE, Serum ...... 76 PROLACTIN...... 76 PROSTATE SPECIFIC ANTIGEN (PSA)...... 76 PROTEIN, Serum...... 77 PROTEIN, Urine...... 77 PROTEIN C, PROTEIN S, Plasma ...... 77 PROTEIN ELECTROPHORESIS, serum ...... 77 PROTEIN ELECTROPHORESIS, Urine...... 77 PROTHROMBIN TIME (INR) ...... 78 PSEUDOCHOLINESTERASE ...... 78 PSITTACOSIS SEROLOGY ...... 78 PTTK (APTT)...... 78 PYRIDINOLINE CROSS LINKS (DPD) ...... 78 PYRIDOXINE ...... 79 PYRUVATE KINASE...... 79 Q FEVER SEROLOGY ...... 79 QUADRUPLE TEST...... 79 QUANTIFERON ASSAY ...... 79 QUINIDINE...... 79 RAST...... 79 RED CELL FOLATE...... 79 RENIN ACTIVITY, Plasma...... 80 RESPIRATORY VIRUS IMMUNOFLUORESCENCE...... 80 RESPIRATORY SYNCYTIAL VIRUS ANTIGEN ...... 80
9 RETICULOCYTE COUNT - blood...... 80 REVERSE TRI-IODOTHYRONINE (RT3) ...... 80 RHEUMATOID FACTOR (RA TEST)...... 81 RIBOFLAVINE...... 81 RIVOTRIL (CLONAZEPAM) ...... 81 ROSS RIVER ANTIBODIES ...... 81 ROTAVIRUS ...... 81 RPR...... 81 RUBELLA ANTIBODIES ...... 81 SALICYLATE...... 81 SALIVARY HORMONES ...... 82 SELENIUM ...... 82 SEMEN ANALYSIS FOR INFERTILITY...... 82 SEMEN ANALYSIS, POST VASECTOMY ...... 82 SENSITIVITIES (Antibiotic)...... 82 SEX HORMONE BINDING GLOBULIN (SHBG) ...... 82 SGOT ...... 83 SGPT...... 83 SHBG ...... 83 SKELETAL MUSCLE ANTIBODIES ...... 83 SKIN SCRAPINGS...... 83 SMOOTH MUSCLE ANTIBODIES...... 83 SODIUM, Serum ...... 83 SODIUM, Urine ...... 84 SOMATOMEDIN C (IGF1) ...... 84 SPUTUM FOR CYTOLOGY ...... 84 SPUTUM FOR MICRO & CULTURE...... 84 SPUTUM FOR MYCOBACTERIA (AFBs) ...... 84 STEROIDS ...... 84 SWABS...... 84 SYNACTHEN STIMULATION TEST...... 85 SYPHILIS SEROLOGY...... 85 TEGRETOL ...... 85 TESTOSTERONE, FREE ...... 85 TESTOSTERONE, TOTAL, Serum...... 85 TESTOSTERONE, TOTAL, Saliva ...... 85 THALASSAEMIA SCREEN...... 85 THEOPHYLLINE...... 85 THIAMINE ...... 86 THIN PREP ...... 86 THYROGLOBULIN...... 86 THYROGLOBULIN ANTIBODIES...... 86 THYROID ANTIBODIES ...... 86 THYROID FUNCTION TESTS...... 86 THYROID PEROXIDASE ANTIBODIES...... 87
10 THYROID STIMULATING HORMONE (TSH) ...... 87 THYROXINE, FREE (FT4)...... 87 TISSUE TYPING ...... 87 TOXOPLASMA ANTIBODIES...... 87 TPHA (TREPONEMA PALLIDUM HAEMAGGLUTINATION) ...... 88 TRANSFERRIN...... 88 TRIGLYCERIDES ...... 88 TRI-IODO-THYRONINE FREE, (FT3) ...... 88 TRIPLE TEST / QUADRUPLE TEST...... 88 TROPONIN I ...... 89 TSH RECEPTOR ANTIBODIES (LATS)...... 89 UBIQUINONE (COENZYME Q10)...... 89 UNCONJUGATED BILIRUBIN...... 89 UREA, Serum...... 89 URIC ACID (URATE) ...... 89 URINE CYTOLOGY ...... 90 URINE HORMONE EVALUATIONS...... 90 Growth Hormone ...... 90 URINE METABOLIC SCREEN ...... 90 URINE MICRO & CULTURE...... 90 URINE FOR MYCOBACTERIA (AFBs) ...... 91 VAGINAL SMEAR FOR HORMONAL STATUS ...... 91 VALPROIC ACID (EPILIM) ...... 91 VARICELLA ZOSTER ( CHICKEN POX ) ANTIBODY...... 91 VASOPRESSIN (Anti-Diuretic Hormone) ...... 91 VIRAL CULTURE...... 91 VITAMIN B12 ...... 91 VITAMINS ...... 92 VMA (VANILLYLMANDELIC ACID)...... 92 WHOOPING COUGH (PERTUSSIS) ...... 92 WHOOPING COUGH ANTIBODIES (PERTUSSIS)...... 92 WIDAL SEROLOGY...... 92 ZARONTIN (Ethosuximide)...... 92 ZINC ...... 92 ZINC (Hair) ...... 93 BD Vacutainer™ Tube Guide...... 94 Disclaimer and Terms of Issue...... 95
11 LABORATORY PERSONNEL Dr Max Wolf Medical Director/Pathologist/Physician/ Clinical Haematologist Dr Peter Harper Supervising General Pathologist, Dr Ann Read Pathologist, Biochemist Dr Ian Denham Pathologist, Microbiologist Dr Bernard Treister Cardiologist Dr Gerry Wagner Cardiologist Mrs Heather Seaman Laboratory Manager, Main Laboratory Mr Ron Bell Laboratory Manager, Epping Laboratory. Mr Ed Sorich Night Supervisor, Integrative Medicine Mr Nick Pagonis Senior Scientist, Immunology/Serology Mrs Julie Ryan Senior Scientist, Biochemistry Mr Ian Goodall Consultant, Biochemistry Mr John Robert Senior Scientist, Haematology Mrs Heather Seaman Senior Scientist, Histopathology Mr Tim Lo Senior Scientist, Microbiology Mrs Fiona Brady Specimen Reception/External Testing Mrs Kathleen White Pathology Collection Manager
Mr Bill Anton Chief Executive Officer Mr Peter Gotis General Manager Mr Marios Theocharous Operations Manager Mr Gary Smith Finance Manager Mr Steven Sioulas IT/Computing Ms Stella Flaskis Director of Sales and Marketing Ms Marlene Sinclair Business Development Manager Mr Nick Gianopoulos Courier Manager
HOURS OF OPERATION Monday to Friday: 8.00 am - 12.00 midnight Saturday: 9.00 am - 11.00 pm Sunday & Public Holidays: 9.00 am - 11.00 pm
12 ACCREDITED COLLECTION CENTRES As at 1 July 2003. BLACKBURN SOUTH 164 Middleborough Road 9890-0031 Mon - Fri: 8.30 am - 1.00 pm Sat: 8.30 am - 12.00 pm
BROADMEADOWS 50 – 52 Bamburg Street 9302-3822 Mon - Fri: 8.00 am - 12.00 pm 1.00 pm - 5.00 pm Sat: 8.00 am - 12.00 pm
BURWOOD 68 Burwood Hwy 8831-3004 (Main Laboratory) Mon - Fri: 8.00 am – 4.00 pm
CLAYTON 1328 Centre Road 9544-6277 Mon - Fri: 8.30 am - 5.00 pm Sat: 8.30 am - 12.00 pm
DONCASTER EAST 1045 Doncaster Road 9841-8962 Mon - Fri: 8.30 am - 5.00 pm Sat: 8.30 am - 12.00 pm
EPPING 48-50 Childs Road 9401-2346 (Branch Laboratory) Mon - Fri: 9.00 am - 5.00 pm Tues: 5.00 pm – 8.00pm Sat: 9.00 am - 12.00 pm
FAWKNER 155 Jukes Road 9357-3870 Mon - Fri: 8.30 am – 1.00 pm
FOREST HILL 63 Mahoneys Road 9877-0022 Mon - Fri: 9.00 am – 5.00 pm
MELBOURNE 393 Swanston Street 9662-3322 Mon - Fri: 8.00 am - 4.00 pm
NOBLE PARK 1098 Heatherton Road 9546-9477 Mon - Fri: 9.00 am – 1.00 pm Sat: 9.00 am - 11.30 am
RESERVIOR 68 Oakhill Avenue 9478-2900 Mon - Fri: 8.30 am – 12.00 pm
RICHMOND 307 Burnley Street 9429-5499 Mon - Fri: 9.00 am - 2.00 pm Sat: 9.00 am - 12.00 pm
TEMPLESTOWE 40 Anderson Street 9846-4000 Mon - Fri: 8.30 am - 6.00 pm Sat: 8.30 am -1.00 pm
WANTIRNA SOUTH 34 Riddell Road 9801-9055 Mon - Fri: 9.00 am - 1.00 pm
13 HOME VISITS
For patient convenience we can arrange to have a pathology collector attend the patient's home, hospital or work place to have their pathology samples collected. Please call the laboratory on: 8831-3004 to organise these visits.
ECGs/Holters/B.Ps Call 8831-3004 (Mon - Fri: 9.00 am - 5.00 pm).
COURIER SERVICE Call 8831-3041 (Mon - Fri: 9.00 am - 5.00 pm), otherwise 8831-3000.
STORES ORDER Please contact our Stores Department on 03 88313042. Send a completed supply order form with our courier or send by fax to 03 9808 2259.
SPECIMEN TRANSPORT & STORAGE Most specimens should be transported in specimen bags and stored as follows:
Urine, faeces samples: 2 - 8o C
Blood samples, Swabs, smears, biopsies ) Genital swabs, "hot" faeces for amoebae ) Room temperature semen samples and cold agglutinins )
Cryoglobulins, Blood Cultures: 37o C
Faeces for reducing substances need to be frozen if they cannot reach the laboratory within 1 hour.
Some specimens require special attention. See instructions under the individual tests or phone the laboratory,
TAXIS & EXTERNAL COURIER PICK UPS When transporting samples to the lab by taxi or an external courier company, specimens should be transported in the foam eskies provided with an ice brick enclosed, NOT as loose specimen bags.
14 SPECIMEN COLLECTION Correct labeling of all specimens is essential by NATA/RCPA requirements.
Patient surname & first name and date of birth are the minimal Requirements for accreditation. Medicare number and/or surgery UR number should be included on the request slip for further identification purposes. Time and date of specimen collection are now required (for accreditation) by NATA to be indicated on samples and request slips.
Checking of the patient's identity is important, particularly with crossmatches and blood groups. The identification of these specimens must be checked by another responsible person or by the patient themselves.
Glass slides (Pap smears, Blood films, etc) should be labeled in pencil, with the patient’s full name and date of birth.
BLOOD & SALIVA COLLECTION TUBES
Additive Vacutainer Cap Colour Tests
EDTA Violet FBE/ESR, HbA1C, ACTH (2) Blood Groups Hb Electrophoresis, Renin (2)
Fluoride/Oxalate Grey Glucose, GTT.
Citrate Light Blue Prothrombin, APTT(KPTT) Fibrinogen Clotting Profile.
Heparin Green Lymphocyte Typing, Chromosomes, HLA B27, Vitamins (Except B12), Heavy Metals (Except Iron)
Plain without gel Red Blood Groups, X-Match.
Plain Gel (SST) Yellow All other biochemical and serological tests. Non-Vacutainer Tube White (Plain 5mL) White Saliva Testing / Integrative Med. E1, E2, E3, Testosterone, Prog, DHEAS,Cortisol, Melatonin
15 SPECIMEN COLLECTION
Mid-stream urine collection
Females Instruct the patient to insert a tampon if appropriate, to cleanse the genitals by wiping from front to back with a sterile towelette, then to commence passing urine into the toilet, then collect some in the container without stopping the stream and finally pass the remainder into the toilet.
Males Instruct the patient to retract the foreskin, cleanse the urethral opening with a sterile towelette, then to commence passing urine into the toilet, then to collect some in the container without stopping the stream and finally pass the remainder into the toilet.
Timed urine collection (24 Hour) At the commencement of the timed collection, usually 24 hours, the bladder is emptied and this urine is discarded. Thereafter, all urine passed is added to the container until the end of the 24 hr period, when the bladder is again emptied and this urine is added to the container. Urine may be better collected in a clean & dry open necked container before transfer to the 24-hour bottle. Preservative, in the form of 50 ml of 2N HCL has been added beforehand (when indicated, see individual tests), and the patient should be warned of the dangerous nature of the acid.
Request forms
Request forms should be completed fully, including:
o All patient details; First name, Surname, Sex, Date of Birth, Medicare\Repat No. o Referring Doctor’s details; Full name, practice address, provider Number. o Copy to Doctors’ details; Full name, practice address. o Date & time of Specimen Collection. o Clinical Notes; Medications, History. Q Q Q Q Q Q
16 RESULTS
Hardcopies of reports are delivered several times per day through our courier system.
Electronic downloads of results are available to computerised practices. Please contact our public relations staff to attend to your requirements.
Reference Ranges Reference ranges for certain tests are subject to change from time to time as methodologies and technologies improve and change. At the time of publication all reference ranges were correct.
Turnaround Times As certain tests are performed at reference laboratories, the turnaround times (where listed) are correct at the time of publication.
Q Q Q Q Q Q Q Q Q
Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q q Q Q 17 Tests In Alphabetical Order
ACETAMINOPHEN See PARACETAMOL
ACETYLCHOLINE RECEPTOR ANTIBODIES Specimen Plain Gel (SST) tube. Reference range 0 – 3 units/ml When done Sent to reference laboratory (3-4 weeks). Usage Diagnosis and monitoring of myasthenia gravis.
ACID ELUTION (KLEIHAUER TEST) Specimen EDTA tube When done Sent to reference laboratory, (2 –3 days) Usage Foetal Maternal bleed, thalassaemia, hereditary persistence of Hb F. Note See also HAEMOGLOBIN ELECTROPHORESIS
ACTH (ADRENOCORTICOTROPHIC HORMONE) Specimen Two EDTA tubes on ICE and sent immediately to laboratory. Collect in morning between 8 to 10 am Reference range 2 - 12 pmol/L When done Sent to reference laboratory (weekly). Usage To differentiate the cause of Cushing’s Syndrome. Notes Increased levels seen in ectopic or pituitary cause of Cushing’s syndrome Decreased levels seen in Adrenal tumours.
ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) Specimen Citrate Tube Reference range 23-35 sec When done Daily Usage Detection of Coagulation factor deficiency.
ACTIVATED PROTEIN C RESISTANCE (APCR) Specimen Citrate Tube Reference range 1.9 - 7.5 (ratio) When done Sent to reference laboratory (3 times per fortnight). Usage Screening test for Factor V Leiden mutation. Investigation of tendency to venous thromboembolism. Note Plasma frozen immediately after separation at the lab.
18 The test is highly sensitive and specific, and is an adequate initial test, except for patients receiving heparin or warfarin and those with other coagulation abnormalities.
ADDIS COUNT Specimen A timed urine collection –24 hours and the specimen kept refrigerated until sent to the laboratory.
ADH See Vasopressin
ADRENALINE See Catecholamines
AFP See Alpha Foeto Protein
AIDS ANTIBODIES See HIV ANTIBODIES
ALANINE AMINOTRANSFERASE (ALT, SGPT) Specimen Plain Gel (SST) tube. Reference range 10 – 50 u/L When done Daily upon arrival at the laboratory. Usage hepatocellular damage.
ALBUMIN, Serum Specimen Gel (SST) tube. Reference range 35 – 50 g/L (Age dependent). When done Daily upon arrival at the laboratory. Usage Liver function, protein loss. Notes Decreased levels in chronic disease, acute phase reactions, liver disease and protein losing conditions such as nephritic syndrome.
ALBUMIN /CREATININE RATIO, Urine Specimen Random Urine specimen Reference Range Males <3.0 g/mmol Females <3.5 g/mmol When done Daily Usage Early detection of Diabetic nephropathy
19 ALCOHOL (Ethanol) Specimen Fluoride-Oxalate tube, (Do not use alcohol swab for venepuncture). Reference range Not detected When done Sent to reference laboratory (Weekly). Usage Alcoholism, legal. Note Alcohol may be detected in any blood, or urine specimen for analysis/legal requirements. For legal measurements a sealed tamperproof container provided by the police. This must not be opened or tampered with in any way. Reference lab usually requires prepayment by the patient.
ALDOSTERONE Specimen Gel (SST) tube delivered to laboratory within 2 hours or 24 hour urine without preservative. Reference Range Serum: Standing: 110 - 860 pmol/L Lying: 28 - 440 pmol/L Urine: Normal Diet: 17- 70 nmol/day Low Salt Diet: 47-120 nmol/day High Salt Diet: 0 - 17 nmol/day When done Sent to reference laboratory (weekly). Usage Used in diagnosis of aetiology of hypertension Level depends on sodium intake and posture. Note Prior to testing the potassium should be in the reference interval and patients should be withdrawn from diuretics, ACE inhibitors, angiotensin II receptor antagonists, beta blockers and calcium channel blockers for 3 weeks. Aldosterone/Renin ratio may be requested.
ALKALINE PHOSPHATASE Specimen Gel (SST) tube. Reference range 45 - 125U/L (Age Dependent). When done Daily on arrival at laboratory. Usage Liver disease, bone disease. Note Raised in children and pregnancy.
ALKALINE PHOSPHATASE ISOENZYMES Specimen Gel (SST) tube. When done Sent to reference laboratory (Daily). Usage Identifying the tissue source of the ALP elevation. Note Isoenzymes performed only if alkaline phosphatase is significantly elevated.
20
ALLERGY TESTING See RAST
ALPHA-1-ANTI-TRYPSIN Specimen Gel (SST) tube. Reference Range 1.0 - 2.1 g/L When done Sent to reference laboratory (once a fortnight) Usage investigation of emphysema and cirrhosis Raised levels are seen in acute phase response.
ALPHA-FOETO PROTEIN (AFP) Specimen Gel (SST) tube. Reference Range 0 - 10.9 ug/L, Higher in pregnancy When done Daily Usage Cancer marker, some foetal abnormalities (part of triple test). Notes Elevated levels are seen in hepatocellular carcinoma and non-malignant liver disease.
ALUMINIUM Specimen Whole blood Lithium Heparin, EDTA, urine (no Preservative), serum or plasma. Reference Range < 0.8 umol/L < 2.0 umol/L for dialysis patients. When done Sent to reference laboratory (weekly). Usage Monitoring dialysis, investigating dementia.
AMINO ACIDS Specimen spot urine. Reference Range Age Dependent When done Sent to reference laboratory (Weekly) Usage Diagnosis of metabolic disease, cystinuria, and Fanconi syndrome.
AMIODARONE Specimen Gel (SST) tube. Reference Range 0.8 – 3.9 umol/L When done Sent to reference laboratory (Weekly). Usage Monitoring amiodarone therapy. Note Collect sample pre dose Amiodarone has a long half life. Levels should be measured approx 3 months after a change in dosage.
21 TFTss should be measured prior to starting treatment to ensure there is no thyroid abnormality and monitored throughout as the drug can cause hypothyroidism and hyperthyroidism.
AMINOPHYLLINE See THEOPHYLLINE
AMMONIA Specimen Heparin tube- filled to top ( 10 mls) and held on ice. Deliver immediately to Laboratory Reference Range 20 - 60 umol/L When done Sent to Reference laboratory (Weekly). Usage hepatic coma and some genetic diseases Note Must be spun and plasma frozen within 15 minutes of collection. (Preferable to send patient to our main laboratory) Increased levels occur in hepatic coma, genetic hyperamonaemias and Reye syndrome.
AMYLASE Specimen Gel (SST) tube. Reference range Serum: up to 100 U/L When done Commenced on arrival at laboratory. Usage Acute pancreatitis (although Lipase is more sensitive and specific), parotitis, and other causes of an acute abdomen.
ANA See Anti Nuclear Antibodies
ANCA (ANTI-NEUTROPHIL CYTOPLASMIC AB's) Specimen Gel (SST) tube. When done Sent to reference laboratory (Twice Weekly ) Usage Suspected vasculitis and renal disease, microscopic polyarteritis, idiopathic necrotising and crescentic glomerulonephritis. Note The different ANCA staining patterns are not entirely sensitive or specific for any particular form of vasculitis. ANCA positivity should be used to select those patients requiring more extensive investigation, including tissue biopsy, to exclude systemic necrotising vasculitis. Q Q Q 22 ANDROGENS See ANDROSTENEDIONE DHEAS FREE ANDROGEN INDEX SHBG TESTOSTERONE, FREE TESTOSTERONE, TOTAL
ANDROSTENEDIONE Specimen Gel (SST) tube. Reference range Male 1.0 - 11.0 nmol/L Female 0.4 - 11.0 nmol/L Post menopausal < 3.5 nmol/L When done Sent to reference laboratory (Weekly) Usage Investigation of female hirsutism, PCOS and congenital adrenal hyperplasia and some virilising tumours.
ANGIOTENSIN CONVERTING ENZYME (ACE) Specimen Gel (SST) tube. Reference range 8 - 21 U/L When done Sent to reference laboratory (Weekly). Usage Monitoring of Sarcoidosis. Note Fairly non-specific, so not good diagnostic test. ACE inhibitor drugs cause low levels.
ANION GAP Specimen Gel (SST) tube. Reference range 10 - 18 mmol/L When done Daily Usage Acid base metabolism. Note Calculated from the following formula:- ( Na+ + K+ ) - (Cl- + HCO3-) Usage Investigation of aetiology of metabolic acidosis.
ANTE-NATAL SCREEN Specimen Gel (SST) tube, EDTA, PLAIN (NON-GEL) tube. When done Daily Note The H.I.C. requires that the individual tests be requested. Suggested tests are: FBE Blood Group Rh and antibody screen Rubella antibodies Hepatitis B surface antigen 23 RPR/TPHA
ANTIBODY SCREEN - (BLOOD GROUP) Specimen Plain (NON-Gel) tube When done Daily Note Screen for blood group and Rh antibodies. Includes saline, indirect anti-globulin (Coombs).
ANTI-CARDIOLIPIN ANTIBODIES See Cardiolipin Antibodies
ANTI-DNA ANTIBODIES See DNA ANTIBODIES
ANTI-DNASE B, TITRE Specimen Gel (SST) tube. Reference range 0 – 100 units/mL When done Sent to reference laboratory (Weekly). Usage Recent Streptococcal skin or soft tissue infections. Notes Performed together with ASOT, although Anti DNAse B is more sensitive than ASOT for the diagnosis of post- streptococcal glomerulonephritis and serious streptococcal skin infections. Anti DNAse B titres remain higher for longer than ASOT.
ANTI-GLOMERULAR BASEMENT MEMBRANE (Anti-GBM) Specimen Gel (SST) tube. Reference range Not Detected When done Referred Daily Usage Detected in patients with classical, untreated Goodpasture syndrome
ANTI-ENDOMYSIAL ANTIBODIES See ENDOMYSIAL ANTIBODIES
ANTI-EXTRACTABLE NUCLEAR ANTIGENS (ENA) See ENA
ANTI-INSULIN ANTIBODIES Specimen Gel (SST) tube. Reference Range -17 to +35 U/L When done Sent to reference laboratory, (Monthly). Usage Diabetes
24 Notes Can combine with test for Anti-GAD Antibodies (anti- gamma amino decarboxylase antibodies).
ANTI-LIVER-KIDNEY MICROSOMAL ANTIBODIES Specimen Gel (SST) tube. Reference range Not Detected When done Referred Daily Usage Are found in a sub-group of patients with ANA-negative autoimmune chronic active hepatitis.
ANTI-MITOCHONDRIAL ANTIBODIES (AMA) Specimen Gel (SST) tube. Reference range Positive titre is significant When done Sent to reference laboratory (daily). Usage Diagnosis of primary biliary cirrhosis. Note A positive result at high titre is highly sensitive and specific for primary biliary cirrhosis.
ANTI-NUCLEAR ANTIBODIES ( ANF or ANA ) Specimen Gel (SST) tube. Reference range Titre less than 40 When done Daily Usage Diagnosing SLE and a screen for systemic rheumatic diseases. Note Positive in > 95% of patients with SLE. Its specificity in other systemic rheumatic conditions however is low with up to 70%of these conditions being positive. If positive, the pattern (homogeneous, speckled, etc.) and the titre is reported.
ANTI-OVARY ANTIBODIES Specimen Gel (SST) tube. Reference range Not Detected When done Referred Daily Usage are found in 15-50% of patients with premature ovarian failure.
ANTI-PARIETAL CELL ANTIBODIES Specimen Gel (SST) tube. Reference range Not Detected When done Referred Daily Usage Incidence increases with age, aswell as in the presence of insulin-dependent diabetes mellitus.
25 ANTI-RETICULIN ANTIBODIES Specimen Gel (SST) tube. Reference range Not Detected When done Referred Daily Usage Combined screening with for celiac disease recommended but highly specific for untreated celiac disease.
ANTI-RIBOSOMAL ANTIBODIES Specimen Gel (SST) tube. Reference range Not Detected When done Referred Daily Usage Antibodies to Ribosomes are found in about 5-12% of patients with systemic SLE and are quite rare in other rheumatic disease.
ANTI-SMOOTH MUSCLE ANTIBODIES Specimen Gel (SST) tube. Reference range Not Detected When done Referred Daily Usage High titres (>1:160) are found in approximately 97% patients with auto-immune chronic active hepatitis.
ANTI-STREPTOLYSIN O TITRE (ASOT) Specimen Gel (SST) tube. Reference Range: 0 - 200 IU/ml Children up to 150 IU/ml When done Daily Usage Useful in excluding recent streptococcal infection in rheumatic fever, glomerulo-nephritis, Henoch Schonlein purpura and cellulitis. Notes High titres or two fold increases in titre indicate recent infection.
ANTI-THROMBIN III (AT3) Specimen Citrate tube Reference range Functional: 80-120% Antigen: 80-120% When done Sent to reference laboratory, (3 times per week). Usage Investigation of tendency to venous thromboembolism. Notes Test should be performed whilst patient is on heparin therapy. Levels are affected by liver disease, nephrotic syndrome, DIC, heparin therapy and oral contraception. Deficiency increases the risk of venous thromboembolism.
26 Deficiency may be inherited or acquired (liver disease, estrogen therapy, nephrotic syndrome).
ANTI-THYROID ANTIBODIES See Thyroid Antibodies
ANTI-TSH RECEPTOR ANTIBODIES See TSH Receptor Antibodies
APOLIPOPROTEINS Specimen EDTA tube Reference range Apo A1:male 1.1– 2.0 female 1.1 – 2.2 g/L Apo B: male 0.6 – 1.3 female 0.6 – 1.2 g/L Ratio Apo B/Apo A1 : male 0.45 – 1.25 female 0.35 – 1.15 When done Daily Usage Used in assessment of atherosclerosis risk factors. In general no benefit over LDL and HDL.
APTT See ACTIVATED PARTIAL THROMBOPLASTIN TIME
ARSENIC (As), Blood Specimen Heparin tube Reference range 0.2 - 2.0 umol/L When done Sent to reference laboratory, (2 weeks). Usage Industrial exposure, poisoning.
ARSENIC (As), Hair Specimen Hair: 50 gram of hair Reference range 0.13 - 3.7 ppm When done Weekly Usage Industrial exposure, poisoning.
ARSENIC (As), Urine Specimen Urine: Spot Urine or 24 hour (No preservative) Reference range Random urine: < 1.3 umol/L When done Sent to reference laboratory, (2 weeks). Usage Industrial exposure, poisoning.
ASCORBIC ACID See VITAMINS
27 ASPARTATE AMINOTRANSFERASE ( AST, SGOT) Specimen Gel (SST) tube. Reference range 10.0 – 50.0 U/L When done Commenced on arrival at laboratory. Usage Raised in hepatocellular liver disease, AMI, and damage to skeletal muscle. Note Less specific for liver disease than ALT. May be artefactually elevated if plasma/serum is not separated from cells within 4-6 hours after collection and in haemolysed specimens.
AVIAN (BIRD) PRECIPITINS Specimen Gel (SST) tube. Reference range Not detected When done Sent to reference laboratory, (monthly). Usage Investigation of hypersensitivity pneumonitis.
B12 See VITAMIN B12
BARBITURATES See PHENOBARBITONE or DRUGS OF ABUSE SCREEN
BENCE JONES PROTEIN Specimen Spot specimen of urine. When done Sent to reference laboratory, (Daily). Usage Investigation of monoclonal gammopathies and, hypogammaglobulinaemia. Note Serum protein electrophoresis Should also be done.
BETA HUMAN CHORIONIC GONADOTROPHIN See βHCG
BETA-2-MICROGLOBULIN Specimen Gel (SST) tube. Reference Range Serum: 0 - 3.0 mg/L When done Sent to reference laboratory (Weekly). Usage May be useful in monitoring progress of myeloma especially if measurement of paraprotein is not possible.
BICARBONATE Specimen Gel (SST) tube. Reference range – 22 - 32 mmol/L When done Commenced on arrival at laboratory. 28 Usage Electrolyte and acid-base metabolism. Note Increased levels seen in metabolicalkalosis & decreased levels in metabolic acidosis.
BILIRUBIN Specimen Adults: Gel (SST) tube. Babies: 100 uL in microtainer. Do not use a tight tourniquet as this may raise the bilirubin. Reference ranges 0 - 24 hours < 65 umol/L 24 - 48 hours < 115 umol/L 3 - 5 days < 155 umol/L > 1 month < 10 umol/L Adult (Conjugated) <6 umol/L Adult up to 22 umol/L When done Commenced on arrival at laboratory. Usage Liver function and haemolytic processes. Note Protect specimen from light. Increased levels are seen in liver, extrahepatic biliary obstruction and in haemolysis.
BLOOD CULTURE Specimen 10 mls blood, collected under very strict aseptic conditions. Add to blood culture bottle which has been prewarmed, and keep at a room temperature till it reaches the laboratory.
BLOOD GROUP AND Rh Specimen Plain (NON-Gel) tube or EDTA tube When done Daily Note Blood group card is issued to the patient.
BONE MARROW Usage Anaemias, leukaemias, marrow infiltrations, myeloproliferative disorders. When done By appointment with the Pathologist. Note Sternal marrow aspiration or iliac crest aspiration or trephine can be performed.
BORDATELLA PERTUSSIS SEROLOGY Specimen Gel (SST) tube. When done Sent to reference laboratory (weekly) Usage Detection of Whooping cough in its early stages, along with the swab culture.
29
BORELLIA SEROLOGY Specimen Gel (SST) tube. When done Sent to reference laboratory (2 months) Usage Suspected Lyme Disease.
BRUCELLA ANTIBODIES Specimen Gel (SST) tube. When done Sent to reference laboratory (weekly) Usage Investigation of prior exposure to Brucellosis.
C3 See COMPLEMENT
C4 See COMPLEMENT
CA 125 Specimen Gel (SST) tube. Reference Range 0 - 35 U/L When done Monday, Wednesday & Friday. Usage Used for monitoring progress of ovarian cancer. May be raised in other diseases of peritoneum including ascites,and other malignancies.
Ca (Hair) See Heavy Metals
CADMIUM (Cd), Blood Specimen Whole blood EDTA or LithiumHeparin tube Reference Range 0 - 27 umol/L for whole blood, 0-0.1 umol/L for urine When done Sent to reference laboratory (weekly) Usage Industrial exposure, poisoning.
CADMIUM (Cd), Hair Specimen 50 gram of hair. Reference Range 0.24 – 2.70 ppm When done Weekly. Usage Industrial exposure, poisoning.
CADMIUM (Cd), Urine Specimen 24 hour (No preservative) Reference Range 0 - 0.1 umol/L
30 When done Sent to reference laboratory (weekly) Usage Industrial exposure, poisoning.
CAERULOPLASMIN Specimen Gel (SST) tube or Heparin tube. Reference Range 0.2 - 0.42 g/L When done Sent to reference laboratory (weekly) Usage Suspected Wilson’s disease. Notes Decreased in Wilson’s disease. Oestrogen therapy and pregnancy increase caeruloplasmin as does anacute phase response and liver disease.
CALCITONIN Specimen Gel (SST) tube or Heparin tube. Calcitonin is extremely labile and must be kept cold and spun as soon as possible. Reference Range < 30 ng/L When done Sent to reference laboratory (weekly) Usage Diagnosis of medullary carcinoma of thyroid. Notes A stimulation test must be done –contact the laboratory.
CALCIUM Specimen Gel (SST) tube or 24 hour urine specimen with acid preservative. (Avoid stasis). Reference range Serum 2.1 – 2.6 mmol/L Urine 2.5 - 7.5 mmol/day When done Daily Usage Investigation of the cause of hyper calcaemia (malignancy, primary hyperparathyroidism etc) and hypocalcaemia (osteomalacia, hypoparathyroidsim etc) Note Can be corrected for albumin by the formula: Corrected Ca = Ca + [ (40 - alb) x 0.02] When hypercalcaemia is borderline, the result should be confirmed by repeating it, with the patient fasting, after being seated for 15 minutes and without a tourniquet.
CALCULUS Specimen Renal Calculus When done Sent to reference laboratory (Weekly). Usage Identification of risk factors for stone recurrence.
CANNABINOIDS See DRUG SCREEN
31 CARBAMAZEPINE (TEGRETOL) Specimen Gel (SST) tube. Therapeutic range 20 – 50 umol/L When done Daily Usage Therapeutic monitoring. Notes Collect just before next dose (trough). Record time of last dose and time of collection on the request slip.
CARCINOEMBRYONIC ANTIGEN (CEA) Specimen Gel (SST) tube. Reference range 0 - 5 g/L (Non smokers )check units 0 - 10 g/L (Smokers) When done Weekly Usage Used for monitoring progress of malignancies such as GIT tumours, and breast carcinoma. Raised in inflammatory bowel disease. Notes Slight increases may be seen in smokers.
CARDIAC ENZYMES Specimen Gel (SST) tube. Reference Range troponin I 0 – 1.0 ng/ml CK 24-204 U/L CKMB 0 – 24 units/L When done Daily Usage Cardiac disease.
CARDIO VASCULAR PROFILE (CVP) Cardiac Risk Assessment Specimen Gel (SST) tube, EDTA, Fluor Oxolate, Sodium Citrate. Tests CV Factors: Cholesterol, Triglycerides, LDL, Apo B Independent CV Factors: Lipo (a), Homocysteine, CRP, Fibrinogen. Protective Factors: HDL, Apo A-1 Ratios: LDL/HDL, APOB/APO A-1 Glucose Diabetic Status, BP, Smoking incorporated in Risk Equations. When done Daily Usage Cardiac disease. Note: More comprehensive assessment of cardiovascular disease.
32 CARDIOLIPIN ANTIBODIES (Anti-phospholipid antibodies) Specimen Gel (SST) tube. Reference range IgG: <12 GPL IU/mL IgM: <10 GPL IU/mL When done Sent to reference laboratory (weekly). Usage Investigating features suggestive of phospholipid antibody syndrome (recurrent unexplained venous or arterial thrombosis, thrombocytopenia, fetal loss). Notes Increased IgG levels are seen in phospholipid antibody syndrome but may also be seen in SLE and other immune disorders.
β CAROTENE Specimen Heparin tube (protect from light) Reference Range 50 - 250 ug/100ml When done Sent to reference laboratory (fortnightly) Usage Malabsorption. Note Patient should have fasted for 12 hours. Faecal fats is more reliable as an indicator of fat malabsorption.
CATECHOLAMINES Specimen 24 hour urine specimen, acidified with 50 ml of 2MHCL. Reference Range Adrenaline 0 - 80 nmol/24 hours Noradrenaline 40 - 780 nmol/24 hours Dopamine 200 - 3500 nmol/24 hours When done Sent to reference laboratory, (weekly). Usage Diagnosis of phaeochromocytoma, neuroblastoma and ganglioneuroma. Note Patients are requested to limit their intake of tea, coffee, alcohol and to avoid vigorous excercise prior to testing.
CERVICAL SMEAR (PAP SMEAR) Kits are supplied from the main laboratory. The kits contain a disposable speculum (medium and large sizes), Ayres spatula and endocervical brush, frosted end slide. Label the frosted end of slide. Take the endocervical sample by inserting the cytobrush into the os and rotating. Smear cellular material evenly on the other end of the slide. Fix immediately.
When done Referred Daily Usage Investigation of abnormal vaginal bleeding. Screening of asymptomatic women according to current guidelines.
33 Notes Results transmitted to Victorian Cytology Registry, unless otherwise indicated.
CH50 (Total Haemolytic Complement) Specimen Gel (plain) tube. When done by appointment at hospital Usage A normal CH50 assay indicates that C1-C9 are present in serum being tested.
CHLAMYDIA ANTIBODIES Specimen Gel (SST) tube. When done Sent to reference laboratory (weekly) Usage Atypical pneumonia. Note Two specimens 10 - 14 days apart.
CHLAMYDIA PCR Specimen Swab or morning first catch urine sample. When done Daily Usage Urethritis, cervicitis, conjunctivitis. Note Method of choice for chlamydia antigen detection.
CHLORIDE Specimen Gel (SST) tube or 24 hour urine. Reference range Serum: – 95 - 108mmol/L Urine: 110 – 250 mmol/24 hr When done Daily Usage Electrolytes and acid base metabolism
CHOLESTEROL Specimen Gel (SST) tube, preferably with patient fasting. Reference range Up to 5.5 mmol/L (NHF recommendation). Desirable Target Level <4.0 mmol/L When done Daily Usage Lipid studies and cardiovascular disease
CHOLINESTERASE Specimen Plasma/Serum: Plain (Non-Gel) tube or Lithium Heparin for scoline hypersensitivity. Red Cell: Heparin tube for organophosphate poisoning. Reference range Serum: 650 – 1500 IU/L Red Cell: 29 – 44 units/g Hb When done Sent to reference laboratory (fortnightly) Usage Organo-phosphate exposure, scoline hypersensitivity. 34 Note Genetic variants can be tested for by dibucaine number and fluoride number in suspected scoline apnoea.
CHROMIUM (Hair) See Heavy Metals
CHROMOSOMES Specimen Heparin tube. When done Sent to reference laboratory (fortnightly) Usage Congenital and dyssexual syndromes. Note Must be taken early, on a weekday, so as to reach the reference laboratory in time.
CK See CREATINE KINASE
CKMB Specimen Gel (SST) tube. Reference range Normal: 0 - 25 U/L Post-Infarct: > 25 U/L CKMB Index: 6 - 25% When done Performed when CK is elevated. Usage When significance of an elevated CK is uncertain. Note More specific for cardiac muscle than CK. CKMB becomes elevated 6 hours after myocardial infarct and returns to normal within 48 hours. Troponin I is a more specific test for myocardial infarction.
CLONAZEPAM (Rivotril) Specimen Gel (SST) tube. Reference range 32-160 ug/L When done Sent to reference laboratory (weekly) Usage Monitoring Clonazepam therapy. Note Collect sample at least 4 hours after last dose. The drug has a half-life of approximately 40 hours.
CLOSTRIDIUM DIFFICLE ENDOTOXIN Specimen Faeces When done Daily Usage Unexplained diarrhoea, antibiotic associated diarrhoea.
CLOTTING PROFILE See COAGULATION STUDIES
35 CMV SEROLOGY Specimen Gel (SST) tube. When done Daily, (IgG & IgM). Usage Mononucleosis syndrome (negative IM results). Note IgG antibodies indicate recent or past infection, IgM antibodies indicate recent or current infection.
COAGULATION STUDIES Specimen EDTA tube PLUS citrate tube When done Daily Usage Investigation of coagulation problems Note Includes platelet count and morphology, prothrombin, fibrinogen and ATTT Further studies, such as factor assays can be arranged through a hospitallaboratory, and may involve the attendance of the patient by appointment at the laboratory.
COENZYME Q10 SEE UBIQUINONE
COLD AGGLUTININS Specimen Gel (SST) tube. When done Sent to reference laboratory, (Daily). Usage Mycoplasma infection, haemolytic states Note Specimen must be allowed to clot at 37oC for 30 minutes, and then transported to the lab at 37oC
COMPLEMENT (C3, C4) Specimen Gel (SST) tube. Separate immediately and analyse promptly Reference range C3 0.9 - 1.8 g/L C4 0.1 - 0.4 g/L When done In house Usage Inflammatory diseases, renal disease, collagen diseases. Note C4 reduced + C3 Normal: classical pathway (SLE, immune complex disease). C3 reduced+ C4 normal: alternative pathway (e.g. sepsis, endotoxin). C3 elevated + C4 elevated: Acute phase reaction.
CONJUGATED BILIRUBIN See BILIRUBIN 36
COOMBS TEST See DIRECT ANTIGLOBULIN TEST
COPPER Specimen Blood: Heparin or Plain (Gel) tube. Urine: 24 hour urine (No preservative). Reference Range Blood: 11- 22 umol/L Urine: 0 – 1.0 umol/24 hr When done Sent to reference laboratory (weekly) Usage Wilson's disease Note Serum levels reduced and urine levels elevated in Wilson's disease.
CORD BLOOD STUDIES Specimen 2.5 ml cord blood in an EDTA tube and 5 ml of cord blood in a plain tube AND 10 ml of blood in a plain tube from the mother. When done Daily Usage Foetal-Maternal Incompatibility. Note Blood group and Rh as well as direct anti-globulin (Coombs) test are performed on the cord blood, and the mother's blood is checked for antibodies.
CORTISOL Specimen Blood: 5 mls Plain Gel (SST) tube, please state the time of collection as there is usually a marked diurnal variation. Urine: 24 hour unpreserved urine Reference range Serum: AM 200 - 700 nmol/L PM 100 - 400 nmol/L – Urine Free Cortisol up to 250 nmol/day When done Daily Usage Assessment of adrenocortical function. Note Suggest a A short Dexamethasone suppression test for investigation of hyperfunction and a synacthen stimulation testfor hypofunction Significant diurnal variation occurs in the circulating cortisol concentration. Peak values occur between 0800 hr - 1000 hrs and trough values occur in the late afternoon and evening. Please ensure that the time is written on the sample.
CORTISOL (saliva) Specimen 5 mls Plain tube x 4 specimens (6-8am),12pm,4pm,10pm or if single specimen only (6-8am)
37 Reference range Saliva: AM 5 - 60 nmol/L PM 5 - 30 nmol/L Evening 0 - 15 nmol/L When done Daily Usage Adrenal function, Helps in responding and coping with stress, trauma, infection, and environmental extremes. Helps regulate blood pressure.
COTININE Specimen Spot urine. Reference range 0 – 500 ng/mL When done Sent to reference laboratory, (Weekly). Usage Detection of nicotine intake. Note Passive smoking does not give rise to high levels, but will be detected.
C-PEPTIDE Specimen Heparin tube, after fasting for 12 hours. Reference range 0 – 1.6 nmol/L When done Sent to reference laboratory (weekly) Usage investigation of hypoglycaemia
C-REACTIVE PROTEIN Specimen Gel (SST) tube. Reference range 0 - 5 mg/L When done Daily Usage Inflammatory conditions. Note Has shorter half life than ESR.
CREATINE KINASE (CK) Specimen Gel (SST) tube. Reference range Male: up to 200U/L Female: – up to 180 U/L When done Daily Usage muscle disease or damage. Note Elevated levels indicate muscle injury which could be of skeletal, myocardial or smooth muscle origin.
CREATININE Specimen Gel (SST) tube, or 24 hour urine (No preservative) Reference range Serum, Male: 0.06 – 0.11 mmol/L Female: 0.05 – 0.09 mmol/L Urine, Male: 8.0 – 19.0mmol/day Female 5.0 – 13.0mmol/day 38 When done Daily Usage Renal function. Note Increased levels indicate reduced glomerular filtration rate. Slightly high levels may be due to large muscle mass
CREATININE CLEARANCE Specimen Gel (SST) tube, and 24 hour urine (No preservative) Blood must be taken during the 24 hour period of collection or within 24 hours of commencement or finish. Reference range 1 - 2 mls/sec. When done Daily Usage Renal Function (glomerular filtration rate). Note Height and weight required for children. Creatinine clearance is more sensitive than creatinine as an early detector of glomerular dysfunction.
CROSSMATCH Specimen EDTA tube PLUS plain (NON-gel) tube. When done Daily Usage Transfusion of whole blood or packed cells. Note A blood group and antibody screen is always performed. If blood is not used within 72 hours from the time of collection from the patient it should be returned to the laboratory. Identification Patient identification is particularly important. There must be 2 identifiers on the specimen. The labeling of the blood specimens must be checked by the patient themselves or another responsible person. Information Required 1. Reason for transfusion 2. Where blood is required 3. Where blood is to be delivered Service The service is only available for elective transfusions, for any urgent transfusions patient should be sent to major hospital. Emergencies. As stocks of blood are not held at the laboratory, time must be allowed for the blood to come from the Red Cross Blood Bank in South Melbourne by taxi, after the blood group is known. Transfusion reactions. In any transfusion reaction, cease giving blood, and return the used pack together with a fresh 10 ml sample of plain blood from the patient, and a fresh urine sample if possible, immediately to the reference laboratory direct.
39 CRYOGLOBULINS Specimen Plain (NON-Gel) tube. Specimen must be collected warm (37 degrees) and kept warm until separated. When done Sent to reference laboratory, (Daily). Usage To investigate Raynaud’s phenomenon, vascular disease and in hepatitis C. Note Contact lab before collecting sample. Tubes, needles and syringes must be pre-warmed to 37oC. Sample must be kept at 37oC until it reaches the laboratory.
CRYPTOSPORIDIUM Specimen Faeces samples on 3 consecutive days. When done Daily
CSF FOR MICRO & CULTURE Specimen Collect into sterile tubes and send immediately to the laboratory. Note Micro, culture, glucose and protein are performed.
Cu (Hair) See heavy metals
CYCLOSPORIN A Specimen EDTA tube Reference range 100-400 ng/mL When done Sent to reference laboratory (fortnightly) Usage Maintenance of therapeutic levels in patients receiving immunosuppressive therapy, to avoid rejection of organ transplants. Notes Increased levels are an early indicator of possible toxicity.
CYSTINE See AMINO ACIDS
CYTOLOGY OF BODY FLUIDS Specimen Pleural fluid, peritoneal fluid, cyst aspirate, nipple- discharge, etc, can be placed in a sterile containeror syringe, refrigerated, and sent to the laboratoryas soon as possible. If the volume is small, smears can be made and fixed with fixative. It is advised that the sample be prepared at the laboratory in our "Cytospin" centrifuge for more accurate cellular collection. Routinely, Pap and
40 Giemsa stains are done; and wherever possible a cell block (also done on the Cytospin) is prepared. When Done Daily.
CYTOMEGALOVIRUS ANTIBODIES (CMV) See CMV Serology
D DIMER TEST Specimen EDTA or Citrate tube (Preferably Citrate). Reference range 0 - 0.19 mg/L When done Immediately. Usage Breakdown product of fibrin. Raised in DIC and thrombosis. Not recommended for diagnosis or exclusion of venous thromboembolism.
DEHYDROEPIANDROSTERONE See DHEAS
DENGUE FEVER SEROLOGY Specimen Gel (SST) tube. When done Sent to reference laboratory (fortnightly) Usage Exposure to Dengue Virus.
DEXAMETHASONE SUPPRESSION TEST See CORTISOL
DHEAS, Saliva Specimen Saliva Reference range Male: 5.0 – 30.0 nmol/L Female: Premenopausal, no oral contraceptives: 2.5 – 25 nmol/L Premenopausal, with oral contraceptives: 2.0 – 8.0 nmol/L Postmenopausal: < 6.5 nmol/L When done Weekly Usage To monitor hormone replacement therapy.
DHEAS, Serum Specimen Gel (SST) tube. Reference range Male: 2.2 - 15.0 umol/L Female: 0.9 – 12.0 umol/L When done Sent to reference laboratory, (weekly). Usage Adrenogenital syndrome, hirsutism, virilisation.
41 Note Increased levels indicative of congenital adrenal hyperplasia or adrenal tumour.
DIBUCAINE NUMBER See CHOLINESTERASE
DIGOXIN Specimen Gel (SST) tube. Therapeutic range 0.8 – 2.6 nmol/L Toxic: > 2.6 nmol/L When done Daily Usage Confirmation of suspected toxicity. Note Toxicity can occur at lower levels especially if there is associated hypokalaemia. Some patients can achieve an effect at less than the bottom of the quoted therapeutic range. Specimen should preferably be collected before the next dose ( Trough Level) or at least 6 hours post dose.
DILANTIN See PHENYTOIN
DIRECT ANTIGLOBULIN (DAT, COOMBS) TEST Specimen EDTA tube. When done Immediately. Usage Haemolytic or drug induced anaemias, haemolytic disease of the newborn. Note Can be done on the same specimen as FBE.
DIRECT BILIRUBIN See BILIRUBIN
DNA ANTIBODIES Specimen Gel (SST) tube. When done Sent to reference laboratory (weekly) Usage Confirmation and monitoring of SLE in the presence of symptoms.
DNA TESTING See PATERNITY TESTING
DOPAMINE See CATECHOLAMINES
DOWNS SYNDROME 42 See TRIPLE TEST
DRUGS OF ABUSE SCREEN Specimen Random urine specimen. When done Daily Usage Screening test for Methadone and detection of illicit drugs. Note Detection of opiates, amphetamines, cocaine, barbiturates, methadone, benzodiazepines and cannabinoids are reported. Being a screening test, positive results may need to be confirmed if being used for legal purposes.
This is a screening test only and unexpected results should be confirmed with a more specific method such as GCMS. Please telephone the laboratory to arrange this. There are examples of drugs which may react differently from your expectations (See common ones below)
Drug group Not detected include Detected include Opiates Pethidine, oxycodone Codeine Sympathomimetic amines Phentermine (duromine) Tricyclic antidepressants Phenothiazines
Screeningis not generally done using blood. However, specific drugs and confirmatories can be done using blood. Blood testing is sent to reference laboratory.
E2 See Oestradiol
EBV SEROLOGY Specimen Gel (SST) tube. When done Monday, Wednesday and Friday. Usage Mononucleosis syndrome (negative IM results). IM and post viral syndromes. Notes IgG and IgM are performed.
ELECTROLYTES Specimen Gel (SST) tube. Also can be done on a 24 hour urine (unpreserved). When done Commenced on arrival at the laboratory. Usage Electrolytes, acid-base metabolism and renal function. Note Includes sodium, potassium, chloride, and bicarbonate. Anion gap can also be calculated.
43
ELECTROPHORESIS See HAEMOGLOBIN ELECTROPHORESIS LIPOPROTEIN ELECTROPHORESIS PROTEIN ELECTROPHORESIS
ENA (EXTRACTABLE NUCLEAR ANTIGENS) Specimen Gel (SST) tube. When done Sent to reference laboratory, (weekly). Usage Systemic rheumatic diseases. Note Generally ordered following a positive ANA (especially if speckled pattern) to identify ANA specificities. Antigen specificities include:- Sm highly specific for SLE RNP mixed connective tissue disease Ro (SS-A) subacute cutaneous lupus associated with recurrent abortion, congenital heat block, SJ syndrome. Jo-1 has been identified in Myositis, cryptogenic fibrosing alveolitis. Scl-70 Scleroderma La (SSB) SJ syndrome
ENDOMYSIAL ANTIBODIES Specimen Gel (SST) tube. When done Sent to reference laboratory, (Weekly). Usage Detection of Coeliac disease and dermatitis herpetiformis. Endomysial antibodies have > 90% specificity for the diagnosis of coeliac disease and should be used in preference to gliadin antibodies.
EPILIM See VALPROIC ACID
EPSTEIN BARR VIRUS (EBV) ANTIBODIES See EBV SEROLOGY
ERYTHROCYTE SEDIMENTATION RATE (ESR) See ESR
ESR Specimen EDTA tube When done Commenced on arrival at the laboratory. 44 Usage Non-specific indicator of inflammatory and neoplastic disease. Note Can be done from the same specimen as FBE if a 4.5 ml EDTA tube is used. CRP is a more sensitive, early indicator of an acute phase response.
ETHANOL See ALCOHOL
ETHOSUXIMIDE See ZARONTIN
FACTOR VIII ASSAY See COAGULATION STUDIES
FACTOR XIII ASSAY See COAGULATION STUDIES
FACTOR IX ASSAY See COAGULATION STUDIES
FAECAL FAT Specimen 72 hour collection of faeces in single container. Reference Range 0.0 - 6.0 g/day When done Sent to reference laboratory. Usage Investigation of malabsorption. Note Very high levels seen in steatorrhoea caused by pancreatic disorders.
FAECES FOR MICRO & CULTURE Specimen Faeces placed in special collection container, at least a teaspoonful. If 3 specimens are requested, they should reach the laboratory on the day they are collected "hot". Specimens for amoebae should reach the laboratory within 1 hour. When done Daily Usage Identification of pathogenic organisms (parasitic and bacterial).
FAECES FOR OCCULT BLOOD Specimen 3 small faecal specimens on separate days. Special diet no longer required, and the specimens can be delivered together on third day. Reference Range Negative 45 When done Daily Usage Screening for colorectal carcinoma and iron deficiency anaemia. Note Both chemical and immunological methods areperformed. Special diet avoiding bananas, horseradish or red meat, is no longer required.
FAECES FOR OVA, CYSTS AND PARASITES Specimen Faeces placed in a special collection container. When done Daily Usage Identification of faecal pathogens (parasitic and bacterial). Note For investigation of thread worms in children, a piece of clear sticky tape is placed over the anus in the early morning.
FAECES FOR REDUCING SUGARS Specimen Faeces placed in a special collection container. If specimen cannot reach laboratory within 1 hour, freeze and transport frozen. When done Daily Usage Sugar intolerance.
FAECES FOR ROTAVIRUS Specimen Faeces placed in a special collection container. When done Daily Note Micro and culture, occult blood and Rotavirus can all be done on the same faecal specimen.
FAECES FOR TRYPTIC ACTIVITY Specimen Faeces in specimen container. If specimen cannot reach lab immediately, freeze and transport frozen. When done Sent to reference laboratory. Usage Pancreatic exocrine failure.
FERRITIN Specimen Gel (SST) tube. Reference range Male 30 – 400 ug/L Female 15 – 150 ug/L When done Daily Usage Investigation of iron deficiency anaemia and haemochromatosis. Note Part of Iron studies. Raised in inflammation, malignancy liver disorders and iron overload (haemochromatosis). Decreased levels indicate iron deficiency. . 46 FIBRINOGEN Specimen Sodium citrate tube Reference range 2.0 - 4.0 g/L. When done Immediately Usage Investigation of possible acquired or inherited bleeding disorder. Note Reduced levels indicate either; (i) a reduced fibrinogen production (liver disease or an inherited deficiency), or (ii) an increased consumption of fibrinogen (DIC, fibrinolysis). Increased levels are seen in acute phase response.
FIBRINOGEN DEGRADATION PRODUCTS No longer performed
FINE NEEDLE ASPIRATE (FNA) Specimen The material should be spread onto one or (preferably) 2 slides, one of which is fixed with fixative, and the other air dried. Alternatively, the aspirate is collected in the syringe, the needle removed, the syringe capped and sent to the lab. An appointment for a pathologist to perform the aspirate can be made by ringing the laboratory. When done Daily Usage Primary diagnosis of neoplasia in superficial and readily accessible lesions. Also for the assessment of disease recurrence. Infections and benign lesions are also readily evaluated.
FLOW CYTOMETRY See LYMPHOCYTE SURFACE MARKERS
FLUORESCENT TREPONEMA ANTIBODIES Specimen Gel (SST) tube. When done Sent to VIDRL. Usage Specific syphilis serology Note Done if TPHA is positive.
FLUORIDE NUMBER See CHOLINESTERASE
FLUIDS & ASPIRATES Specimen Pleural fluid, peritoneal fluid, cyst aspirate, nipple discharge, joint fluids etc, can be placed in a sterile container, refrigerated and sent to the lab as soon as
47 possible. If the volume is small, smears can be made and fixed with spray fixative. When done Daily Usage Primary diagnosis of neoplasia in superficial and readily accessible lesions.
FLUIDS AND ASPIRATES - MICRO & CULTURE Specimen Place fluid in a sterile container and refrigerate When done Daily Usage Identification of pathogenic bacteria in superficial and readily accessible lesions.
FNA See FINE NEEDLE ASPIRATE
FOLIC ACID Specimen Serum Folate: Gel (SST) tube. Red cell: EDTA tube Reference range Serum: 6.0 – 33.0nmol/L Red cell: 360 – 1600nmol/L When done Daily Usage Investigation of macrocytic anaemias. Note Serum and red cell folate levels are low in megaloblastic anaemia.
FOLLICLE STIMULATING HORMONE (FSH) Specimen Gel (SST) tube. Reference range Male 1.0 - 8.0 mIU/ml Female, Follicular Phase 4.0 - 13.0 mIU/ml Mid-cycle peak 5.0 - 22.0 mIU/ml Luteal Phase 2.0 - 13.0 mIU/ml Post-menopause 20 - 138 mIU/ml When done Daily Usage Investigation of gonadal and pituitary function.,
FRAGILE X CHROMOSOME Specimen Heparin tube When done Sent to reference laboratory (monthly). Usage Detection of fragile X mutation, in conjunction with cytogenetics. Note Collection should occur in the morning.
48 FREE ANDROGEN INDEX (FAI) Specimen Gel (SST) tube. Reference range Male 40 - 170 Female 0.1 - 7.0 When done Daily Usage Use in addition to total testosterone to estimate free level. Note Calculated from the sex hormone binding globulin and total testosterone. Testosterone X 100 SHBG
FREE T3 See TRIIODOTHYRONINE, FREE
FREE THYROXINE See THYROXINE, FREE
FRUCTOSAMINE Specimen Gel (SST) tube. Reference range 180 - 285 umol/L When done Sent to reference laboratory.( weekly) Usage Assessment of diabetic control in a patient in whom glycated haemoglobin cannot be used (increased red cell turnover) Note Sample should be kept cool and transported as soon as possible.
FULL BLOOD EXAMINATION (FBE) Specimen EDTA tube Reference ranges Age dependent. Refer patient reports When done Daily Usage Anaemia, bacterial and viral infections, IM, bone marrow involvement, inflammatory and neoplastic conditions. Note Includes haemoglobin, haematocrit, red cell values, white cell count, platelet count,differential count and a blood film examination if indicated..
FUNGAL MICRO & CULTURE Specimen Skin scrapings, nail clippings or scrapings, or epilated hair, placed in a sterile container. When done Daily. Usage Investigation and identification of suspected dermatophyte infections. 49 Note Microscopy results are available within 24 hours, but cultures may take up to 6 weeks.
GAD ANTIBODIES (Anti-Glutamic Acid Decarboxylase Antibodies) Specimen Gel (SST) tube. Reference range 0 – 5 AU When done Sent to reference laboratory (Monthly). Usage Identification of diabetic patients with a high risk of developing insulin dependence. Note GAD antibodies are present in >70% of diabetic patients treated with insulin but only 10% of those maintained on oral hypoglycaemic agents.
GALLSTONE ANALYSIS See Calculus
GAMMA GLUTAMYL TRANSFERASE (Gamma GT) Specimen Gel (SST) tube. Reference range Female: 7 –32 U/L Male: 11 – 50 U/L When done Commenced on arrival at laboratory. Usage Sensitive indicator of liver disease particularly cholestatic liver disease and metastatic liver disease. GGT can also be induced by certain drugs such as alcohol and antiepileptics.
GASTRIC PARIETAL CELL ANTIBODIES Specimen Gel (SST) tube. Reference range Not detected When done Sent to reference laboratory (Fortnightly). Usage Test suggestive of pernicious anaemia. Note Positive in 80% of patients with pernicious anaemia and 40-50% of patients with other organ specific autoimmune diseases.
GASTRIN Specimen Gel (SST) tube. Patient must be fasting strictly for 12 hrs. Reference Range 0 - 115 pg/mL When done Sent to reference laboratory. (weekly) Usage pernicious anaemia, ZE syndrome.
GENTAMYCIN See ANTIBIOTIC ASSAY 50
GLIADIN ANTIBODIES Specimen Gel (SST) tube. Reference Range IgA 0-13 years: 0 – 25 units, 13 years and over: 0 – 20 units IgG 0-13 years: 0 – 46 units, 13 years and over: 0 – 20 units When done Sent to Reference Laboratory. (Weekly) Usage Detection of Coeliac disease and dermatitis herpetiformis. Note A positive result for either IgG or IgA is found in 10% of the population and as such the diagnosis of coeliac disease should not be made on the basis of these antibodies. Positive results for both IgG and IgA identifies patients who merit further testing for definitive diagnosis of coeliac disease. Endomysial antibodies are more specific for the diagnosis of coeliac disease.
GLUCOSE Specimen Fluoride-Oxalate tube, fasting if so requested Reference Range Fasting 3.0 – 6.0mmol/L Random 3.0- 7.7mmol/L When done Commenced on arrival at laboratory. Usage Diabetes diagnosis and control.
GLUCOSE GESTATIONAL CHALLENGE TEST Specimen Fluoride-Oxalate Patient is given 75g glucose. Blood is collected at 1 hour after glucose dose. It is essential that the woman is quietly seated throughout the test.Reference Range A glucose greater than 8.0 mmol/L is consistent with Gestational Diabetes. Recommend confirmation by performing a Glucose Tolerance Test. When done Commenced on arrival at laboratory. Usage For gestational diabetes (at 26 - 28 weeks).
GLUCOSE TOLERANCE TEST Specimen 1. Fasting Fluoride-Oxalate tube 2.Patient is given 75g glucose (Children 1.75g/kg) 3. Second blood and urine samples at 1 hour. 4. Third blood and urine at 2 hours. Patient preparation 150g CHO diet for 3 days. Must NOT be on diabetic or other special diet Must be fasting for 8-16 hours prior to the test
51 In a good state of health with normal activity, Not on drugs which may interfere such as steroids
Performance of the GTT The test must be done in the morning. No smoking 1 hour prior to GTT Rest for 30 minutes before starting GTT. (During this time the fasting glucose specimen may be taken. Before proceeding, ensure this level is less than 10 mmol/L) Give 75 ml of glucose. Ensure this is drunk within 5 minutes.
Please see patient instruction sheet available from the laboratory.
Reference Range Diagnostic Criteria for Diabetes Fastin 2 hour post g glucose Normal <6.1 <7.8 Diabetes mellitus >6.9 >11.0 Impaired glucose <7.0 7.8-11.0 tolerance Impaired fasting glycaemia 6.1-6.9 <7.8
When done Commenced on arrival at laboratory. Usage Diabetes diagnosis where fasting or random glucoses are inconclusive. Note: Not indicated if, fasting glucose is greater than or equal to 8.0 mmol/L, patient is taking corticosteroids or β adrenergic agonists.
GLUCOSE-6-PHOSPHATE DEHYDROGENASE Specimen EDTA tube Reference Range 8.8 – 17.6 U/g Hb When done Sent to reference laboratory. Usage Congenital haemolytic anaemia. Note Screening test is done, and if positive, a measurement can be performed. Genetic variants occur in different racial groups ( S.E. Asia, Mediterranean and Africa).
GLYCOSYLATED HAEMOGLOBIN See HbA1
GOLD Specimen Gel (SST) tube. 52 Reference range < 0.5 umol/L. Therapeutic range 5.1-10.2 umol/L. When done Sent to reference laboratory. Usage Gold therapy.
GONORRHOEA PCR Specimen Swab or First catch urine. When done Weekly. Usage Detection of N. gonorrhoeae.
GROWTH HORMONE Specimen Gel (SST) tube. Reference range Male: < 10 ug/L Female: <20 ug/L When done Sent to reference laboratory. Usage Diagnosis and monitoring of acromegaly. IGF1 is a better test.
HAEMOCHROMATOSIS PCR Specimen EDTA X2 When done Sent to reference laboratory (Weekly). Usage To detect the genetic abnormalities in the C282Y and H63D genes.
HAEMOGLOBIN See FBE
HAEMOGLOBIN A1c Specimen EDTA tube Reference range Non Diabetic 0 - 5.9 % Good Control 6.0 - 9.0 % Poor Control > 9.1 % When done Daily Usage Diabetic control. Long term monitoring of glycaemia. Cannot be used in conditions of increased red cell turnover, eg venesection for Haemochromatosis.
HAEMOGLOBIN A2 See HAEMOGLOBIN ELECTROPHORESIS
HAEMOGLOBIN ELECTROPHORESIS Specimen EDTA tube 53 When done Twice weekly, Sent to reference laboratory. Usage Thalassaemia, Haemoglobinopathies. Note Includes Haemoglobins F and A2 and Test for abnormal haemaglobins.
HAEMOGLOBIN F See HAEMOGLOBIN ELECTROPHORESIS
HAEMOGLOBIN H INCLUSIONS Specimen EDTA tube When done Daily. Usage Done in suspected Thalassaemia. Note Insensitive test not done routinely.
HAEMATOCRIT See FBE
HAIR ANALYSIS Specimen 50g of hair (see collection kit details available from laboratory) When done 2 x week Usage Evaluation of toxic and/or nutrient mineral storage / exposure Note Accredited test, see also heavy metals
HAPTOGLOBIN Specimen Gel (SST) tube. Reference Range 0.5 - 3.3 g/L When done Sent to reference laboratory, (Weekly). Usage A low level indicates haemolysis. The level may be raised in acute phase rections.
HEAVY METALS Specimen Heparin tube, except lead (EDTA). Hair (see hair collection kit details) or Urine also suitable. When done Weekly Usage Industrial/Environmental exposure, poisoning. Note In House; Arsenic, Cadmium, Calcium, Chromium, Copper, Iron, Lead, Magnesium, Manganese, Mercury, Zinc. Reference Lab; Gold, Lead (EDTA tube), Mercury (24hr urine with acid), Selenium.
54 HELICOBACTER PYLORI BREATH TEST Specimen Breath test kit provided by laboratory. When done Sent to reference laboratory daily Usage Detection of Helicobacter pylori organism in GIT.
HELICOBACTER PYLORI SEROLOGY Specimen Gel (SST) tube. When done Sent to reference laboratory, (Weekly). Usage Investigation of peptic ulcers, gastritis. Note If total antibody is positive, IgG is also tested for.
HEPATITIS A Specimen Gel (SST) tube. When done Daily. Usage Acute hepatitis infection. Note Total antibody level indicates recent or past infection. Preimmunisation IgM levels indicate recent infection.
HEPATITIS B SEROLOGY Specimen Gel (SST) tube. When done Daily. Usage Acute or chronic hepatitis infection. Note Markers available:- HbSAg (infective, new infection or carrier) HbSAb (post vaccination) HbC-IgM (acute infection) HbC-Total (Carrier status & past infection)
HEPATITIS C ANTIBODIES Specimen Gel (SST) tube. When done Daily Usage Detection of Hepatitis C as the cause of acute hepatitis infection. Note When positive result obtained, the test is repeated with a secondary method to verify (Hepatitis C PCR), and reported to Health Dept.
HEPATITIS C PCR (POLYMERASE CHAIN REACTION Specimen Plain (NON-Gel) tube. A separate plain tube must be sent. When done Sent to VIDRL Usage Confirmatory test of Hepatitis C infection. Note This test is non-debatable and VIDRL 55 will charge the patient $80.00.
HERPES SIMPLEX ANTIBODIES Specimen Gel (SST) tube. When done Weekly, Sent to reference laboratory. Usage Differentiation of HSV Types I and II.
HERPES SIMPLEX ANTIGEN, TYPES I & II Specimen Collection is extremely important. Virus infected cells are at the base of lesions and these need to be scraped with a swab and smeared onto the special slide. Fix with acetone. When done Daily. Usage Identification of herpes infection by direct immunofluorescence. Note Culture (q.v.) is preferable.
HERPES SIMPLEX CULTURE Specimen Fluid or swab in viral transport medium When done Daily. Usage Identification of herpes infection Note Types I & II can be distinguished.
HIAA (5-HYDROXY-INDOLE-ACETIC ACID) Specimen 24 hour urine specimen with acid preservative. Reference range 5 - 36 umol/day When done Sent to reference laboratory. Usage Carcinoid tumours. Note If possible take patient off all medication for one week prior to testing. If unable to do so, please supply a comprehensive list. Walnuts, bananas, avocados, eggplant, pineapple, plums and tomatoes must be excluded from the diet 48 hours before the collection.
HIGH DENSITY LIPOPROTEIN CHOLESTEROL (HDLC) Specimen Gel (SST) tube. HDLC Reference Range Male 1.0 – 1.9 mmol/L Female 1.2 – 2.6 mmol/L HDLC Desirable Range Male >1.0 mmol/L Female >1.0 mmol/L LDLC Reference Range 0.5 – 3.5 mmol/L LDLC Desirable Range <2.5 mmol/L MJA 2001, Vol 175 Supp S57-85 When done Daily, 56 Usage Cardiovascular disease, lipid studies. Note LDLC is calculated from the formula:- LDLC = Cholesterol - (HDLC + Triglyceride/2.2) The formula is not valid for triglycerides greater than 4.5mmol/L
HISTOPATHOLOGY Specimens: For histology must be placed immediately in 10% buffered formalin. The volume of formalin should be at least several times that of the specimen for adequate fixation to occur. If infection is suspected e.g. TB in lymph nodes, the specimen can be halved, one half placed in a sterile container for culture, and the rest in formalin. Lymph node imprints can be made by halving the fresh node, touching the cut surface onto a labeled slide and immediately fixing the slide with alcohol or cytology spray fixative.
Special Stains, including immunoperoxidases can be arranged. For immunofluorescent studies on skin, the specimen should be halved, (or two punch biopsies taken), one part placed in a sterile container and frozen immediately in a deep freeze, and the rest placed in formalin. When done Daily Usage Investigation of tissue lesions.
HIV ANTIBODY (AIDS SCREEN) Specimen Gel (SST) tube. When done Daily, Sent to reference laboratory. Usage Diagnosis of HIV infection Note This test is not a rebateable item and the patient will be charged. Confidentiality can be maintained by using a code such as the first 2 letters of both names and the date of birth and postcode.
HLA TISSUE TYPING Specimen ACD (specific) tubes available from specimen reception on request. When done Must be booked with Royal Melbourne Hospital. Usage Histocompatability testing for transplantation.
HLA B27 Specimen Heparin tube When done Sent to reference laboratory. Usage Arthritis, collagen disease. Diagnostic test for ankylosing spondylitis 57
HMMA See VMA
HOMOCYSTEINE Specimen EDTA tube Reference Range 0 – 60 years: 5 – 15 umol/L > 60 years: 5 – 20 umol/L When done Tri-weekly. Usage Marker for vascular disease. Elevated levels can be associated with an increased risk of cardiovascular disease.
HTLV III ANTIBODIES See HIV ANTIBODIES
HUMAN CHORIONIC GONADOTROPHIN (HCG) Specimen Gel (SST) tube or heparin tube or spot urine Reference range Quantitatively, levels < 5 mIU/mL are considered to be negative. Qualitatively, positive results are observed at 25 mIU/mL or higher. When done Daily Usage Pregnancy, This test is sometimes used as a tumour marker but the manufacturers have not designed the test for this purpose.. Note Blood level becomes positive approximately 10 days after conception, i.e., before next period due.
HYDATID Specimen Gel (SST) tube. When done Sent to reference laboratory Usage Confirmation of diagnosis of hydatid cysts.
5-HYDROXY-INDOLE-ACETIC ACID See HIAA
17 HYDROXYPROGESTERONE Specimen Gel (SST) tube. Reference Range Female: Follicular < 2 nmol/L. Luteal < 8.7 nmol/L. Pregnant < 36.0 nmol/L. Male: <5 nmol/L When done Sent to reference laboratory 58 Usage Diagnosis and management of congenital adrenal hyperplasia.
IgA See IMMUNOGLOBULINS
IgD See IMMUNOGLOBULINS
IgE Specimen Gel (SST) tube. Reference range Adult 0 - 120 U/ml Child 0 - 32 U/ml When done Daily Usage Allergic diseases. Note RAST can be performed for certain allergens or groups of allergens.
IGF-1 Specimen Gel (SST) tube. Reference range 0.34 - 1.42 U/mL When done Sent to reference laboratory (Fortnightly). Usage Diagnosis and monitoring of acromegaly
IgG See IMMUNOGLOBULINS
IgG-SUBCLASSES Specimen Gel (SST) tube. When done Sent to reference laboratory (daily). Usage Selective deficiencies of one or more IgG subclasses are associated with sinusitis, recurrent otitis and/or asthma, recurrent respiratory tract infections.
IgM See IMMUNOGLOBULINS
IMMUNOGLOBULINS-IgA, IgG, IgM LEVELS Specimen Gel (SST) tube. Reference ranges Age dependent When done Daily
59 Usage Investigation of recurrent infections (low levels) and in conditions with raised globulins along with protein electrophoresis.gammopathies. Note IgA, IgG and IgM are usually done together.
IM TEST (Glandular Fever Test) Specimen Plain Gel (SST) tube and EDTA tube (for film) Reference Range Negative When done Daily Usage Non specific test for IM (glandular fever). Note Replaces Paul Bunnell test. Repeat test after several days if the test is negative and symptoms persist. More specific tests are CMV and EBV.
INDIRECT BILIRUBIN See BILIRUBIN
INFLUENZA A & B SEROLOGY Specimen Gel (SST) tube, acute & convalescent specimens. Reference Range Four-fold increase in titre is significant When Done Sent to reference laboratory, (weekly). Usage Investigation of serious respiratory infections and atypical pneumonia. Notes Acute bleed is stored until convalescent bleed is received in 2-3 weeks and tested in parallel.
INFLUENZA IMMUNOFLUORESCENCE See Respiratory Virus Immunofluorescence
INSULIN - Fasting Specimen Gel (SST) tube and Fluoride-oxalate tube. Patient must fast for 15 hours before hand. Reference Range up to 20.0uIU/mL When done Weekly Usage Insulinomas, Insulin resistance (syndrome x). Notes Glucose should be measured concurrently.
INSULIN - POST PRANDIAL 2 HR Specimen Gel (SST) tube and Fluoride-oxalate tube. Patient must have sugar load (glucose drink or high glycaemic meal 2hrs previously). Reference Range 20 – 80 IU/ml. When done Weekly Usage Insulinomas, Insulin resistance (syndrome x). 60 Notes 2hr Post Prandial Glucose should be measured concurrently. Test to be done with a Fasting Glucose and Fasting Insulin test first as a comparison.
INSULIN ANTIBODIES See Anti-Insulin Antibodies
INSULIN RECEPTOR ANTIBODIES Specimen Gel (SST) tube. Reference Range Negative When done Sent to reference laboratory, (Monthly).
INTRINSIC FACTOR ANTIBODIES Specimen Gel (SST) tube. Reference Range Negative When done Sent to reference laboratory, (Weekly). Usage Diagnosis of pernicious anaemia. Notes Positive result is sufficient to establish the diagnosis. Specimen should be taken one or more weeks after any B12 administration.
IRON Specimen Gel (SST) tube. Reference range Female: – 9 - 27 umol/L Male: – 10 - 30 umol/L When done Daily Usage Investigation of iron status. Note Iron alone is of little use .Ferritin and possibly transferrin are also required to assess iron status.
IRON (Hair) See Hair analysis & Heavy Metals.
IRON STUDIES Specimen Gel (SST) tube. Reference Range Ferritin Female: 15 - 150ng/mL, Male: 30 – 400 ng/ml Iron Female: 9 - 27 umol/L, Male: 10 - 30 umol/L Transferrin 2.0 - 3.6 g/L When done Daily Usage Investigation of iron status. Note Includes iron, transferrin and ferritin.
61 Interpretation of Iron Studies Results Iron Iron Transferrin Ferritin Trial of Oral Binding Saturation Iron Capacity Iron Decreased Increased Decreased Decrease Haemoglobin deficiency d normalises Iron Decreased Normal or Normal or “Normal” Partial deficiency decreased decreased <100 ug/L response + acute phase response Acute Decreased Decreased Decreased Increased No response phase response Iron Decreased Normal or Increased Increased Not overload decreased appropriate
JOINT FLUID See FLUIDS
KARYOTYPING See CHROMOSOMES
KLEIHAUER TEST See ACID ELUTION TEST
KPTT See PTTK
LACTATE See LACTIC ACID
LACTATE DEHYDROGENASE (LDH) Specimen Gel (SST) tube. Reference range 211 - 423 U/L When done Daily
LACTIC ACID Specimen Fluoride Oxalate (Call lab first). Reference range 0.5 - 2.2 mmol/L When done Sent to reference laboratory. Usage Investigation of metabolic acidosis.
62 LATS (TSH RECEPTOR AB'S) See TSH RECEPTOR ANTIBODIES
LE CELLS See Anti-Nuclear Antibodies, test discontinued.
LEAD (Pb), Blood Specimen Heparin or EDTA tube. Reference range Unexposed 0.0 – 0.72 umol/L When done Sent to reference laboratory. Usage Industrial exposure, poisoning.
LEAD (Pb), Hair Specimen Hair (50 g) in envelope or urine jar. (Special hair collection kit available from lab) Reference Range 3 – 51 ppm When done Weekly. Usage Industrial exposure, poisoning. LEAD (Pb), Urine Specimen Spot urine OR 24 hour urine (No preservative) Reference range Unexposed < 60 ug/L When done Sent to reference laboratory. Usage Industrial exposure, poisoning.
LEGIONELLA ANTIBODIES (SEROLOGY) Specimen Gel (SST) tube. When done Sent to reference laboratory, (Weekly). Usage Investigation of pneumonia, fever.
LEGIONELLA ANTIGEN Specimen Spot urine When done Sent to reference laboratory, (Weekly). Usage Investigation of severe or unresponsive pneumonia. Notes Detects only L. pneumophilia Group 1 Antigen
LEGIONELLA CULTURE Specimen Fluid, sputum or tissue from suspected site. When done Sent to reference laboratory, (Weekly).
LEPTOSPIRA SEROLOGY Specimen Gel (SST) tube. When done Sent to reference laboratory, (Weekly). Usage Suspected leptospirosis.
63
LFT See Liver Function Tests
LH See Luteinizing Hormone - Serum
LIPASE Specimen Gel (SST) tube. Reference Range 13 - 60 units/L When done same day Usage Suspected pancreatitis.
LIPIDS - SERUM/PLASMA See CHOLESTEROL
LIPOPROTEIN (a) Specimen EDTA tube Reference Range 0 – 270 mg/L When done Daily. Usage Part of Cardio-vascular profile, Independent factor
LIPOPROTEIN ELECTROPHORESIS Specimen Get (SST) tube or EDTA tube, collected after minimum 12hr fast. Reference Range Qualitative Test. When done Sent to reference laboratory. Usage Investigation of hyperlipidaemias. Notes Patient must fast for 10 hours. The main importance of this testing is to identify patients with a Type III pattern.
LITHIUM - SERUM Specimen Gel (SST) tube. Reference range Therapeutic: 0.5 – 1.0 mmol/L When done Daily Usage Therapeutic monitoring. Collect either pre dose (trough) or 12 hours post dose sample.
LIVER FUNCTION TESTS Specimen Gel (SST) tube. Reference Ranges See individual analytes
64 When done Daily Usage Liver function/status. Note Includes total protein, albumin, ALT, Alkaline Phosphatase, Total bilirubin, and Gamma GT.
LUPUS ANTI-COAGULANT SCREEN Specimen 10 mls Sodium citrate. Reference Range Negative When done Must be received in laboratory in morning to arrive at Reference Laboratory on same day. Test done once a week. Usage Investigation of prolonged APTT not corrected by normal plasma. SLE, Vascular thrombosis and recurrent foetal loss. Notes Tests include Kaolin Clot Time, Dilute Russell Viper Venom, Platelet Neutralisation. Lupus anticoagulant presents in 5 - 10% of SLE patients.
LUTEINISING HORMONE Specimen Gel (SST) tube. Reference range Follicular Phase 1.0 - 18.0 mIU/ml Mid-cycle peak 24.0 - 105.0 mIU/ml Luteal Phase 0.4 - 20.0 mIU/ml Post-menopausal 15.0 - 62.0 mIU/ml Male, 2.0 - 12.0 mIU/ml When done Daily Usage Investigation of gonadal and pituitary disease Notes Raised LH/FSH ratio in a female is suggestive of PCOS
LYME DISEASE See Borellia Serology
LYMPHOCYTE SURFACE MARKERS Specimen Heparin and EDTA tubes. When done Sent to reference laboratory. Usage Diagnosis and monitoring of immune deficient states, or unexplained lymphocytosis, e.g. viral infections, leukaemia and lymphoma. Notes Performed by flow cytometry specimen must be collected early in the day and do not collect on a Friday.
MAGNESIUM (Mg), Blood Specimen Serum: Gel (SST) tube. Red Cell: Heparin or EDTA tube. 65 Reference range Serum: 0.7 – 1.1 mmol/L Red Cell: 1.70 - 2.80 mmol/L When done Daily. (Red Cell sent to reference laboratory). Usage to investigate cause of hypocalcaemia or monitor patients at risk of developing hypomagnesaemia such as oncology patients. Note Decreased levels due to increases in renal loss, usually from alcohol, antibiotics or oncology medication
MAGNESIUM (Mg), Hair Specimen Hair (50 g) in envelope or urine jar. (Special hair kit available from lab) Reference Range 30 - 122 ppm When done Weekly. Usage Industrial exposure, poisoning.
MAGNESIUM (Mg), Urine Specimen 24 hour urine Reference Range 2.5 – 6.3 mmol/24hr When done Weekly. Usage Industrial exposure, poisoning.
MALARIAL PARASITES - (THICK & THIN FILMS) Specimen EDTA tube Reference Range Negative When done Daily Usage Malaria, PUO. Notes Collect the sample during a fever as this is when the parasites are most concentrated. Three consecutive daily specimens should be tested on negative results.
MANGANESE (Mn), Blood Specimen Gel (SST) tube or lithium heparin tube. Reference Range Serum: 8 – 24 nmol/L Whole blood: 200-800 nmol/L When done Sent to reference laboratory. Usage Industrial exposure, poisoning. Note Elevated levels are usually attributed to contamination of specimen. Manganese products are common in the environment and may contaminate the skin and blood collection equipment.
66 MANGANESE (Mn), Hair Specimen Hair (50 g) in envelope or urine jar. (Special hair kit available from lab) Reference Range 0.25 – 0.75 ppm When done Weekly. Usage Industrial exposure, poisoning.
MANTOUX Specimen Patient is given an injection of tuberculin and the size of response measured after 48-72 hours Reference Range <5mm Negative Note Please phone Supervising Pathologist at Laboratory
MC&S See MSU
MCH See FBE
MCHC See FBE
MCV See FBE
MEASLES SEROLOGY - IgG & IgM Specimen Gel (SST) tube. When done IgG and IgM levels twice weekly. Usage Investigation of suspected measles.
MELATONIN Specimen Saliva 5mL plain tube x 4 specimens (9-11pm, 3-4am, 6- 8am, 12pm). If single specimen only should be 3am. Reference Range 0 – 5.0 pg/mL (daytime) > 10 pg/ml (nocturnal) When done Weekly Usage Depression, sleep disorders, jet lag, cancer marker. Notes Daytime without stimulation. Regulates sleep and wake cycle.
MERCURY, Blood (Hg) Specimen Heparin tube Reference range 0 – 20 nmol/L
67 When done Sent to reference laboratory. -weekly Usage Industrial exposure, poisoning.
MERCURY, Hair (Hg) Specimen Hair, (50 g) in envelope, MSU jar or hair collection kit Reference range 1.25 – 7.6 ppm When done Weekly. Usage Industrial exposure, poisoning. Notes Hair collection kit available from laboratory
MERCURY, Urine (Hg) Specimen 24 hour urine (No preservative) Reference range < 0.2 micromol/24 hr > 0.5 micromol/24 hr indicates probable poisoning When done Sent to reference laboratory- weekly. Usage Industrial exposure, poisoning.
MICROALBUMIN (Albumin Excretion Rate) Specimen 12 hr timed or 24 hour urine (No preservative) Reference range 0-15 ug/min. When done Daily Usage Early detection of diabetic nephropathy.
MRSA SCREEN, (Methicillin Resistant S. Aureus) Specimen Swab of infected site area to be tested. When done Daily Usage Detection of the presence of MRSA. Note Three MRSA negative swabs taken 1 or 2 weeks apart suggest MRSA carriage has been terminated.
MSU See URINE MIDSTREAM
MUMPS SEROLOGY Specimen Gel (SST) tube. When done IgG levels twice weekly. Usage Diagnosis of infection with mumps virus.
MUSCLE ENZYMES See CARDIAC ENZYMES
MYCOLOGY See FUNGAL CULTURE
68
MYCOBACTERIA See SPUTUM or URINE FOR MYCOBACTERIA.
MYCOPLASMA SEROLOGY, Total Antibody & IgM Specimen Plain Gel (SST) tube. When done Sent to reference laboratory. Usage Detection of Mycoplasma pneumoniae as a possible cause of pneumonia. Note If total antibody is positive, IgM is tested for.
MYOGLOBIN Suggest CK instead for assessing likelihood of myoglobinuria .
MYSOLINE (PRIMIDONE) See DRUGS, THERAPEUTIC
NEEDLE STICK INJURY Specimen From the Health worker: Gel (SST) tube (Hep B surface Ab, Hold serum) From the Source: Gel (SST) tube (Hep B surface Ab, HIV Ab, Hold serum) When done Daily (Mon-Fri) Usage To diagnose infection from injury through contaminated collection equipment.
NEUTROPHIL ALKALINE PHOSPHATASE (NAP) Specimen Heparin Reference Range 30-180 When done Daily (Mon - Fri) Usage Inflammatory and malignant conditions. Note Differentiates chronic myeloid leukaemia (low NAP value) from reactive leucocytosis (high NAP value)
NEUTROPHIL CYTOPLASMIC ANTIBODIES See ANCA
NEUTROPHIL FUNCTION Specimen Heparin tube. When done Daily (Mon-Fri) Usage Investigation of recurrent pyogenic or fungal infections. Notes Test rarely used.
69 NORADRENALINE See CATECHOLAMINES
OCCULT BLOOD See FAECES FOR OCCULT BLOOD
OESTRADIOL - Saliva (E2, Estradiol, 17B Estradiol) Specimen Saliva Reference range Male 0 - 15 pmol/L Female Follicular Phase < 20 pmol/L Luteal Phase 30 - 60 pmol/L Post-menopausal < 15 pmol/L When done Daily (Mon-Fri). Usage Fertility & menstrual problems, feminisation, gynaecomastia.
OESTRADIOL - Serum (E2, Estradiol, 17B Estradiol) Specimen Gel (SST) tube. Reference range Male 73 - 282 pmol/L Female Follicular Phase 143 - 693 pmol/L Mid-cycle peak 345 - 1864 pmol/L Luteal Phase 176 - 1134 pmol/L Post-menopausal 73 - 150 pmol/L When done Daily (Mon-Fri). Usage Fertility & menstrual problems, feminisation, gynaecomastia.
OPIATES See DRUG SCREEN
OSMOLALITY (Measured) - Serum/Plasma Specimen Gel (SST) tube. Reference range 280 - 300 mOsmol/kg When done Sent to reference laboratory. Usage Acid-base and metabolic function. Suspected poisoning with alcohol, methanol, ethylene glycol, acetone, isopropanol, diethyl ether, or paraldehyde. Note however, that some of these substance may be toxic at levels too low to detect an increased osmolar gap. Note An increased osmolar gap indicates the presence of alcohol or other osmotically active substances.
OSMOLALITY (MEASURED) - Urine Specimen Spot Urine in MSU container 70 Reference range 40-1400mOsmol/kg When done Sent to reference laboratory. Usage To determine concentrating ability.
OSMOTIC FRAGILITY (RED CELL FRAGILITY) Specimen EDTA tube When done Same day (Sent to reference lab) Usage Confirms hereditary spherocytosis.
OVA & PARASITE EXAMINATION - FAECES See Faeces - Ova, Cysts & Parasites
OXALATE - Urine 24 hrs Specimen 24 hour urine collection with hydrochloric acid as preservative Reference range 0 – 0.34 mmol/24 hr When done Sent to reference laboratory. Usage Renal, GIT disease, ethylene glycol poisoning. Urinary calculi. Notes Contact laboratory for 24 hr urine collection bottle with HCl. Very high levels seen in ethylene glycol poisoning.
PAP SMEAR See Cervical Smear
PACKED CELL VOLUME (PCV) See FBE
PARACETAMOL (ACETAMINOPHEN) Specimen Gel (SST) tube. Therapeutic range 60 - 120 umol/L Toxicity: Moderate (4 hrs): < 800 umol/L Severe (4 hrs): > 2000 umol/L Severe (12 hrs): > 330 umol/L When done Sent to reference laboratory, (Daily). Usage Assessing toxic overdose of paracetamol. Note Note on request form amount of paracetamol ingested, suspected time of ingestion, time of blood collection, other drugs ingested (including alcohol), whether patient is a chronic alcoholic.
PARAINFLUENZA VIRUS IMMUNOFLUORESCENCE Specimen Gel (SST) tube. When done Sent to reference laboratory. (once a fortnight) 71 Usage Performed with testing for influenza virus A and B, for the retrospective diagnosis of serious respiratory infections or atypical pneumonia.
PARASITE EXAMINATION - STOOL (FAECES) See FAECES FOR OVA, CYSTS AND PARASITES
PARATHYROID ANTIBODIES Specimen Gel (SST) tube. When done Sent to reference laboratory. (once a fortnight) Usage Assessing patients with hypercalcaemia or suspected hypoparathyroidism. Note Positive results favour the possibility of idiopathic hypoparathyroidism. Negative results do not however exclude the possibility of idiopathic hypoparathyroidism.
PARATHYROID HORMONE (PTH) Specimen Gel (SST) tube. Reference Range 1.4 - 5.7 pmol/l When done weekly Usage Hypercalcaemia, parathyroid tumours, postthyroidectomy.
PARIETAL CELL ANTIBODIES See ANTI-GASTRIC PARIETAL CELL ANTIBODIES
PATERNITY TESTING (DNA TESTING) Please contact laboratory manager regarding this test and its requirements.
PAUL BUNNELL (HETEROPHILE AGGLUTININS) See IM TEST
PARVO VIRUS B19 ANTIBODIES Specimen Gel (SST) tube. Reference Range Negative When done Sent to reference laboratory, (Weekly).
PCV See FBE
PHENOBARBITONE - Serum Specimen Gel (SST) tube. Therapeutic range 40 - 150 umol/L
72 When done Sent to reference laboratory. Usage Therapeutic Drug Monitoring of phenobarbitone or primidone. Note Primidone is metabolised to Phenobarbitone. Collect pre-dose (trough). Please record time of last dose on request form. Specimen should be taken prior to next dose but timing is not critical.
PHENYLALANINE Specimen Heparin tube Reference Range 40-120umol/L When done Sent to reference laboratory. Usage Diagnosis and monitoring of phenylketonuria and maternal hyperphenylalaninaemia.
PHENYTOIN (DILANTIN) Specimen Gel (SST) tube. Therapeutic range 40 - 80 umol/L When done Daily Note Collect pre-dose (trough). Please record time and amount of last dose on request form.
PHOSPHATE - Plasma/Serum (PO4) Specimen Gel (SST) tube, or 24 hour urine without preservative. Reference range Serum: 0.6 - 1.4 mmol/L Urine: 10.0 - 40.0 mmol/24 hr When done Daily Usage Bone disease, Notes Increased concentrations are seen in haemolysed or aged blood specimens (> 6hrs after collection), acidosis and renal failure. Decreased levels seen in alkalosis, post prandial and primary hyperparathyroidism.
PINWORM EXAMINATION Specimen Tape Specimen is best collected 1st thing in the morning and can be collected by a member of patients family. Peel back cellotape dab the anal area several times with sticky surface of tape fold down the tape onto the slide. Place in slide carrier and submit to the laboratory. Specimens over 4 consecutive days is preferred.
73 When done Daily
PLASMINOGEN ACTIVATOR When done Fortnightly by Austin Hospital Range Non-stress: 3-10ng/mL
PLASMINOGEN ASSAY Specimen 5mL Sodium Citrate Therapeutic range 75-140% When done Fortnightly, referred daily to reference lab.
PLATELET ANTIBODIES, DIRECT (Platelet Associate Immunoglobulin) Specimen 10 mls EDTA blood. or [2 x EDTA tubes], Collect in a separate tubes from the FBE tube. When done Daily (Mon - Fri) Usage Investigation of probable immune thrombocytopenia. Note Must reach lab within 4 hours of collection and no later than 4 pm. May not be possible if platelet count very low.
PLATELET ANTIBODIES INDIRECT Specimen Gel (SST) tube. Range Total IgG <25% When done Every 2 days, referred daily to reference lab. Note May be tested with or without addition of drugs. Please specify drug type
PLATELET COUNT Specimen EDTA tube Reference range 150 – 400x10 ^9/l Done immediatly Usage Coagulation (history of excessive and/or inappropriate bleeding, bruising), monitoring, monitoring heparin therapy, post splenectomy monitoring. Note Platelet morphology can be assessed on a blood film. Further platelet studies such as platelet antibodies and platelet adhesiveness can be arranged with a reference laboratory.
PORPHYRIN SCREEN Specimen Gel (SST) tube or Heparin tube, and random urine sample
74 (preferably early morning) and portion of faecal sample. Wrap all specimen containers in foil to protect from light and refrigerate.
For the investigation of abdominal pain, porphobilinogen is required. A random urine is required protected from light. Reference range see report When done Sent to reference laboratory. Usage Porphyrias. Note Collect on a weekday morning so the sample can be sent to reference laboratory the same day. If positive, relevant porphyrins can be measured.
POTASSIUM Specimen Gel (SST) tube, or 24 hour urine without preservative. Reference range Plasma 3.5 – 5.0 mmol/L Urine 25 - 100 mmol/day When done Daily Usage Electrolytes, Renal function. Note Factors influencing artefactual elevation of potassium levels include: Haemolysis at collection Refrigeration prior to separation Delay in separation from whole blood (>6hrs) Marked leucocytosis and thrombocytosis Muscle activity of limb prior to venepuncture Increased levels in acidosis, tissue damage, renal failure, mineralocorticoid deficiency. Decreased levels in diuretic therapy, vomiting/diarrhoea, mineralocorticoid excess, alkalosis.
PREGNANCY TEST See HCG
PRIMIDONE (MYSOLINE, METHYL PHENOBARBITONE) Specimen Gel (SST) tube. Reference Range Therapeutic: 23 - 55 umol/L When done Sent to reference laboratory (Daily). Note Please state dose and last dose time. Primidone metabolises rapidly to phenobarbitone in vitro and is therefore measured as phenobarbitone. However in the overdose situation, it is important that Primidone is also measured.
75 PROGESTERONE, Saliva Specimen Saliva Reference ranges Male: 0 – 125 pmol/L Female: Follicular Phase < 250 pmol/L Luteal Phase 250 - 800 pmol/L Post-menopausal < 125 pmol/L Pregnancy 250 - 1050 nmol/L When done Weekly Usage Menstrual or fertility problems, ovarian or adrenal disease. Note Can also be done on 24 hour urine specimen (no preservative), or on blood serum. When testing for ovulation assessment, test should be collected daily for four consecutive days between days 19 and 23 of the menstrual cycle.
PROGESTERONE, Serum Specimen Gel (SST) tube. Reference ranges Male: <0.6 nmol/L Female: Follicular Phase <4.8 nmol/L Luteal Phase 7.3 – 79.5 nmol/L Post-menopausal <2.2 nmol/L Pregnancy 3rd Trimester 156 – 722 nmol/L When done Daily Usage Menstrual or fertility problems, ovarian or adrenal disease. Note Can also be done on 24 hour urine specimen (no preservative). When testing for ovulation assessment, test should be collected on day 21 of menstrual cycle.
PROLACTIN Specimen Gel (SST) tube. Reference range Male 62 - 435 mIU/L Female, Pre-menopausal 29 - 718 mIU/L When done Daily Usage Pituitary disease, amenorrhoea, galactorrhoea. there is a diurnal variation and levels are affected by drugs including major tranquillisers and oestrogen.
PROSTATE SPECIFIC ANTIGEN (PSA) Specimen Gel (SST) tube. Reference Range: 0 - 4.0 ng/ml When done Daily Usage Prostatic cancer marker.
76 Note Elevated results are seen in most but not all cases of prostatic cancer, Mild elevations may be seen with age, rectal examination and other prostatic conditions.PSA is used to monitor prostatic carcinoma.
PROTEIN, Serum Specimen Gel (SST) tube. Reference range Serum 60 - 83 g/L When done Daily Usage Liver function, malabsorption, protein loss, renal disease.
PROTEIN, Urine Specimen Spot urine or 24 hour urine, without preservative. Reference range Spot urine: < 0.10 g/L 24 hour urine: < 0.14 g/day When done Daily Usage Proteinuria may be due to physiological, tubular and glomerular proteinuria.
PROTEIN C, PROTEIN S, Plasma Specimen 10 mls sodium citrate (2 Citrate tubes) Reference range Chromogenic: Protein C: 70 - 140 % Chromogenic Protein S: 66 - 149 % When done Sent same day to Reference Lab (Mon-Fri). Usage Investigation of tendency to venous thromboembolism. Note Specimen should be collected prior to anticoagulant being commenced.
PROTEIN ELECTROPHORESIS, serum Specimen Gel (SST) tube. When done Sent to reference laboratory. Usage Detection of paraprotein bands Note A urine should accompany the serum specimen. Further investigations may be required to characterise abnormalities. See also paraprotein typing.
PROTEIN ELECTROPHORESIS, Urine Specimen Spot urine When done Sent to reference laboratory. Usage Detection of light chain (Bence Jones) proteinuria. Differentiation of glomerular and tubular proteinuria. Further investigations may be required to characterise abnormalities. See paraprotein typing.
77 PROTHROMBIN TIME (INR) Specimen Citrate Tube Reference range Normal 0.8 - 1.2 INR Therapeutic 2.0 - 4.5 INR (depends on condition) When done Immediately Usage Investigation of coagulation, controlof oral anticoagulant therapy.
PSEUDOCHOLINESTERASE See CHOLINESTERASE
PSITTACOSIS SEROLOGY Specimen Gel (SST) tube, acute & convalescent specimens. Reference range four (4)-fold increase is significant When done Sent to reference laboratory. Note Acute specimen stored until convalescent specimen is received and tested in parallel. Single specimens will only be tested if clinical notes suggest an illness of ≥ 14 days.
PTTK (APTT) Specimen Citrate Tube Reference range Normal 23 - 35 seconds Therapeutic 45 - 85 seconds When done Immediately Usage Control of heparin therapy, screen for coagulation abnormality.
PYRIDINOLINE CROSS LINKS (DPD) Specimen Spot urine Reference range Pyridinoline (Pdx) Female: Pre-menopausal: 21 - 90 nmol/mmol Creatinine Post-menopausal: 33 -110 nmol/mmol Creatinine Male: 45 - 83 nmol/mmol Creatinine Deoxypyridinoline (DPD) Female: Pre-menopausal: 4.6 - 17.0 nmol/mmol Creatinine Post-menopausal: 3.0 - 26.0 nmol/mmol Creatinine Male: 8.0 - 14.0 nmol/mmol Creatinine When done Sent to reference laboratory Usage Bone resorption markers. Useful diagnosis of osteoporosis.
78 PYRIDOXINE See VITAMINS
PYRUVATE KINASE Specimen Heparin or EDTA tube Reference Range Normal or Deficient (quantitative test). When done Sent to reference laboratory - once a week. Usage Investigation of non-spherocytic haemolytic anaemia. Notes Low levels confirm pyruvate kinase deficiency.
Q FEVER SEROLOGY Specimen Gel (SST) tube. When done Sent to reference laboratory. Usage Diagnosis of suspected Q fever.
QUADRUPLE TEST See TRIPLE TEST
QUANTIFERON ASSAY Specimen Heparin tube When done Sent to reference laboratory. Usage A measure of past exposure to TB. Note Must be tested within 2 hours of collection.
QUINIDINE Specimen Gel (SST) tube. Reference Range 5 – 17 umol/L When done Sent to reference laboratory, (Daily). Usage Maintenance therapy to prevent atrial fibrillation. Note Specimen should be collected prior to next dose and time of last dose noted.
RAST Specimen Gel (SST) tube. When done once a week Usage Investigation of allergy. Note MEDICARE allows for charging for no more than 4 Allergens or allergen groups. Available allergens include many foods household dusts and mites, many grasses, moulds, weeds and trees, and dog and cat allergens.
RED CELL FOLATE See Folic Acid
79 RENIN ACTIVITY, Plasma Specimen EDTA tube delivered ASAP to laboratory on melting ice. Reference Range Standing: 1.31 – 3.95 ug/L/hour Lying: 0.15 – 2.33 ug/L/hour When done Sent to reference laboratory - Once a week. Prior arrangements with laboratory necessary. Usage Investigation of hypertension
RESPIRATORY VIRUS IMMUNOFLUORESCENCE (Respiratory Antigen) Specimen Nasal-pharyngeal Aspirate preferred When done Mon-Fri, referred daily Note Test detects influenza virus, parainfluenza virus, RSV, adenovirus, bordetella pertussis. If Negative result, specimen is referred for viral culture.
RESPIRATORY SYNCYTIAL VIRUS ANTIGEN Specimen Nasopharyngeal Swab and RSV Slide. Reference range NEGATIVE When done Weekly. Usage Investigation of severe respiratory illness in infants (bronchiolitis, pneumonia, croup). Notes This rapid antigen detection method is the preferred test for the diagnosis of RSV, instead of the serum antibody test which requires acute and convalescent sera over 4 weeks.
RETICULOCYTE COUNT - blood Specimen EDTA tube. Specimen must be < 6 hrs old. Normal Range 0.5-2.0 % When done Daily Usage Assessment of anaemia. Note Reflects bone marrow erythropoietic activity and polychromasia on blood film. A low reticulocyte count in the presence of anaemia indicates bone marrow failure or haematinic deficiency.
REVERSE TRI-IODOTHYRONINE (RT3) Specimen Gel (SST) tube. When done Sent to reference laboratory, (Weekly); Assay only rarely performed. Reference Range 0.26-0.54 nmol/L
80 RHEUMATOID FACTOR (RA TEST) Specimen Gel (SST) tube. Reference range < 10 IU/mL When done Daily Usage Rheumatoid arthritis, systemic rheumatic disorders.
RIBOFLAVINE See VITAMINS
RIVOTRIL (CLONAZEPAM) See DRUGS, THERAPEUTIC
ROSS RIVER ANTIBODIES Specimen Gel (SST) tube. When done Sent to reference laboratory, (Weekly). Usage Rheumatoid arthritis, systemic rheumatic disorders.
ROTAVIRUS See FAECES FOR ROTAVIRUS
RPR Specimen Gel (SST) tube. When done Daily. Usage Non-specific test for syphilis, equivalent to WR, VDRL, etc.
RUBELLA ANTIBODIES Specimen Gel (SST) tube. When done IgG Daily IGM Daily Usage IgG antibodies are performed to assess immunity and IgM antibodies to detect recent infection.
SALICYLATE Specimen Gel (SST) tube. Reference Range Therapeutic: 1-2.5 mmol/L Toxic: > 3.0 mmol/L When done Sent to Reference Laboratory, (Daily). Usage Primarily for detection of overdose. Occasionally used for therapeutic monitoring.
81 SALIVARY HORMONES Specimen Saliva Plain 5mL tube multiple samples may be required for certain hormone evaluations. Reference Range See Individual Report When done Daily Usage Depending on hormones Oestradiol and progesterone control the rhythm of awoman’s monthly cycles. Oestradiol, estrone and estriol are being used increasingly in HRT to replace diminishing levels. Testerone wakes up the libido while DHEA aids in maintaining and creating lean muscle mass. The pineal hormone melatonin is necessary for wake and sleep cycles and the adrenal gland produces cortisol that responds to stress. These hormones can be monitored with salivar hormone testing . Note See also individual hormones or phone laboratory to receive “Saliva Hormone Testing-Practitioners Reference manual”. SELENIUM See HEAVY METALS
SEMEN ANALYSIS FOR INFERTILITY Specimen Specimen preferably produced by masturbation, following 3 days of abstinence, placed in a clean container. Usage Male infertility.
SEMEN ANALYSIS, POST VASECTOMY Specimen Collected as for semen analysis for infertility, but does not need to be sent to the laboratory within 1 hour. Usage To assess the effectiveness of vasectomy.
SENSITIVITIES (Antibiotic) Specimen Appropriate sensitivities are performed on all pathogens isolated. The reporting of sensitivities is not meant to indicate that antibiotic therapy is necessarily required. Note Antibiotics other than those routinely performed are available on request.
SEX HORMONE BINDING GLOBULIN (SHBG) Specimen Gel (SST) tube. Reference range Male: 9 - 111 nmol/L 82 Female: No oral contraceptive: 24 - 230 nmol/L With oral contraceptive: 89 - 379 nmol/L Post-menopausal: 46 - 277 nmol/L Pregnancy: 59 - 1363 nmol/L When done Weekly. Usage Virilisation, adrenal and gonadal tumours, Note Combined with total testosterone to give free testosterone index.
SGOT See AST
SGPT See Alanine Aminothransferase (ALT)
SHBG See Sex Hormone Binding Globulin
SKELETAL MUSCLE ANTIBODIES Specimen Gel (SST) tube. Reference range Not detected When done Sent to reference laboratory (Fortnightly). Usage Assessing patients documented with Myasthenia gravis. Acetylcholine receptor antibodies should also be requested. Notes A positive result indicates that the possibility of thymoma should be actively investigated.
SKIN SCRAPINGS See FUNGAL MICRO & CULTURE
SMOOTH MUSCLE ANTIBODIES Specimen Gel (SST) tube. When done Sent to reference laboratory (Weekly). Usage Suspected autoimmune hepatitis. Note Elevated titres are characteristic of autoimmune hepatitis . Lower levels are non-specific and may be seen in viral infections.
SODIUM, Serum Specimen Gel (SST) tube. Reference range Serum – 135 - 145 mmol/L When done Commenced on arrival at the laboratory 83 Usage Electrolyte, Renal function. Note Diuretic therapy is a common cause of hyponatraemia.
SODIUM, Urine Specimen Spot urine specimen without preservative. Reference range <20 mmol/L indicates volume depletion (dehydration), or salt depletion. It excludes the diagnosis of SIADH. When done Commenced on arrival at the laboratory Usage To aid in evaluating the cause of hyponatraemia.
SOMATOMEDIN C (IGF1) See IGF1
SPUTUM FOR CYTOLOGY Early morning specimens of sputum on three separate mornings are preferable. The specimens must be placed in a sterile container and refrigerated. The sputum must be the result of a deep cough. The specimens can be used for TB studies.
SPUTUM FOR MICRO & CULTURE Specimen Early morning "deep cough" specimen in a sterile container.
SPUTUM FOR MYCOBACTERIA (AFBs) Specimen 3 separate early morning specimens in a sterile container, sent daily to the laboratory. Note Cytology can also be done on the same specimens.
STEROIDS Specimen 24 hour Urine (No preservative) When done Sent to Reference laboratory. Note Used for diagnosis of CAH and causes of hirsutism and diagnosis of adrenal tumours.
SWABS Specimen Make a smear on a labeled glass slide, then place the swab in transport medium and keep at room temperature. All swabs for micro and culture to be sent in Amies Transport medium and kept at room temperature. Dry swabs required for all PCR work. For further instructions please call the Microbiology Department direct on 03 8831-3037.
84 SYNACTHEN STIMULATION TEST See CORTISOL
SYPHILIS SEROLOGY See RPR, TPHA.
TEGRETOL See CARBAMAZEPINE
TESTOSTERONE, FREE Specimen Gel (SST) tube. Reference range Male 31.0 - 163 nmol/L Female 2.5 - 12.5 nmol/L When done Sent to Reference laboratory. Usage Hirsutism, virulisation, adrenal and gonadal tumours. Note Not as readily available as free androgen index.
TESTOSTERONE, TOTAL, Serum Specimen Gel (SST) tube. Reference range Male 9.7 - 38.2 nmol/L Female 0.4 - 2.7 nmol/L When done Weekly Usage Hirsutism, virulisation, adrenal and gonadal tumours. Recommend SHBG as well.
TESTOSTERONE, TOTAL, Saliva Specimen Saliva Reference range 25 – 190 pmol/L When done Weekly Usage Hirsutism, virulisation, adrenal and gonadal tumours.
THALASSAEMIA SCREEN See HAEMOGLOBIN ELECTROPHORESIS
THEOPHYLLINE Specimen Gel (SST) tube. Reference range 55 - 110 umol/L When done Sent to reference laboratory, (Daily). Usage Therapeutic monitoring. Note Collection times; Aminophylline: Collect pre dose. Nuelin: Collect 2 hours post dose. Theo-dur: Collect 4-6 hours post dose.
85
THIAMINE See VITAMINS
THIN PREP Kits are supplied from main laboratory. Alternative to Pap Smear. When done Referred daily Usage Investigation of abnormal vaginal bleeding. Screening of asymptomatic women according to current guidelines.
THYROGLOBULIN Specimen Gel (SST) tube. Reference range < 50.0 ug/L When done Sent to reference laboratory. Usage Detection of tumour recurrence in thyroid cancer. Thyroglobulin antibody be requested also Note Detection of thyroglobulin in patients who have had a total thyroidectomy and have ceased thyroid replacement therapy for 2 weeks prior to testing, indicates the presence of residual tumour.
THYROGLOBULIN ANTIBODIES Specimen Gel (SST) tube When done Twice weekly Usage Must be measured to ensure thyroglobulin results are valid.Raised in Hashimoto’s thyroiditis but Thyroid peroxidase antibodies are more sensitive.
THYROID ANTIBODIES Specimen Gel (SST) tube. When done Weekly Note Thyroglobulin and thyroid peroxidase antibodies are tested. Usage Diagnosis of Hashimoto thyroiditis, and other autoimmune thyroid disease. Raised levels of thyroid peroxidase antibody indicate an increased propensity to develop hypothyroidism and are associated with an increased risk of postpartum thyroid disease.
THYROID FUNCTION TESTS Specimen Gel (SST) tube. Reference range TSH: 0.5 – 3.5 mIU/L FT3: 2.2 - 5.4 pmol/L FT4: 9.0 - 24.0 pmol/L 86 When done Daily Usage Thyroid function. Note Consists of TSH, and if clinically indicated, FT3 & FT4 are performed.
THYROID PEROXIDASE ANTIBODIES Specimen Gel (SST) tube Reference Range <35 IU/ml When Done Twice weekly Usage Diagnosis of Hashimoto’s Thyroiditis and other autoimmune thyroid disease. See Thyroid Antibodies.
THYROID STIMULATING HORMONE (TSH) Specimen Gel (SST) tube. Reference range 0.5 – 3.5 IU/L When done Daily Usage Confirms hypothyroid and hyperthyroid states. Monitoring of thyroid replacement or suppressive therapy. Note Elevated levels seen in primary hypothyroidism. Thyroid replacement therapy should to return the TSH to normal levels., This may take several weeks to achieve. Suppressed levels are found in hyperthyroidism. In the treatment of thyroid cancer, TSH should be suppressed but not to undetectable levels.
THYROXINE, FREE (FT4) Specimen Gel (SST) tube. Reference range 9.0 - 24.0 pmol/L When done Daily Usage Thyroid function and monitoring of patients on thyroid replacement therapy. Note TSH should be used to monitore thyroxine replacement therapy.
TISSUE TYPING Specimen ACD tubes - Contact laboratory When done Sent to reference laboratory Usage Transplant donor or recipient, some genetic linked diseases. Note The test MUST be booked with reference laboratory, so ring laboratory first.
TOXOPLASMA ANTIBODIES Specimen Gel (SST) tube. 87 When done Weekly Note IgG or IgM antibodies are performed. Usage Suspected toxoplasmosis.
TPHA (TREPONEMA PALLIDUM HAEMAGGLUTINATION) Specimen Gel (SST) tube. When done Daily Usage Specific test for syphilis. RPR also tested.
TRANSFERRIN Specimen Gel (SST) tube. Reference Range 2.0 - 3.6 g/L When done Daily Usage Usually performed as part of iron studies including serum iron, transferrin, and ferritin.
TRIGLYCERIDES Specimen Gel (SST) tube, must be fasting. Reference range 0.5 - 2.0 mmol/L When done Commenced on arrival at laboratory. Usage Lipid studies, cardiovascular disease.
TRI-IODO-THYRONINE FREE, (FT3) Specimen Gel (SST) tube. Reference range 2.2 - 5.4 pmol/L When done Daily Usage Hyperthyroid states.
TRIPLE TEST / QUADRUPLE TEST Specimen Gel (SST) tube. When done Sent to reference laboratory. Usage Identification of pregnancies at high risk of Downs Syndrome. Notes Quadruple test comprises alpha feto protein, unconjugated oestriol, free βHCG and dimeric inhibin A. This test is a 2nd.Trimester fetal Screen and should be performed at 14 – 20 weeks gestation. 1st Trimester combined screen comprises free BhCG, Pregnancy-associated plasma protein A and nuchal translucency.and should be performed at 8 – 10 weeks gestation. Accurate date of gestational age is mandatory.
88 TROPONIN I Specimen Gel (SST) tube. Reference range 0 – 1.0 ng/mL When done Daily Usage Sensitive and specific test for diagnosis of myocardial infarction. Notes Elevation of Troponin I occurs within six hours of chest pains and lasts for about seven days.
TSH RECEPTOR ANTIBODIES (LATS) Specimen Gel (SST) tube. Reference range -15 to +15 units When done Sent to reference laboratory, (fortnightly). Usage Graves’ disease. Note Antibodies are present in more than 80% of patients with Graves’ disease.
UBIQUINONE (COENZYME Q10) Specimen Lithium Heparin When done Sent to reference laboratory. Reference Range 709 – 1392 nmol/L Usage To monitor therapeutic and supplementation levels. Note: Specimen must be received by laboratory within 1 hour of collection.
UNCONJUGATED BILIRUBIN See Bilirubin
UREA, Serum Specimen Gel (SST) tube. Reference range 2.8 - 7.6 mmol/L When done Daily Usage Renal function. Note Increased levels due to reduced glomerular filtration, due to renal and pre-renal disease (dehydration), bleeding in GIT. Decreased levels due to pregnancy, low protein diet severe liver disease.
URIC ACID (URATE) Specimen Gel (SST) tube, or 24 hour urine with alkaline preservative added (Contact the laboratory). Reference range Serum, Female: 0.14 - 0.34 mmol/L Male: 0.2 - 0.42 mmol/L Urine, 1.8 – 4.0 mmol/day 89 When done Daily Usage Gout
URINE CYTOLOGY Specimen Three early morning specimens on separate days are preferred. The specimens should be mid-stream specimens in sterile containers, and should be refrigerated, and sent to the laboratory each day. When done Daily Usage Investigating possible urinogenital malignancies. Identification of malignant cells and their possible site of origin. Note The presence of infection or inflammation can also be detected and crystals may also be seen.
URINE HORMONE EVALUATIONS Specimen 24 Hour Urine or first morning void. When done Sent to reference laboratory weekly Tests Following analytes can be tested: Aldosterone Cortisol Estrogen Metabolism Growth Hormone Progesterone Status Testosterone Thyroid Hormones Usage A 24 hour urine or first morning void hormone evaluation measures the free levels of the primary hormone that are produced in a day. This evaluation provides information on the utilization oif hormones by measuring primary metabolites. Note For further information please phone laboratory to obtain a “Urinary Hormone Testing-Practitioner Reference manual”.
URINE METABOLIC SCREEN Specimen Spot urine When done Sent to reference laboratory
URINE MICRO & CULTURE Specimen Mid-stream specimen, catheter specimen, supra-pubic, aspirate or paediatric bag specimen, keep refrigerated. When done Upon arrival at laboratory.
90 Note Direct sensitivities are performed when indicated, and complete results are usually available next morning.
URINE FOR MYCOBACTERIA (AFBs) Specimen 3 separate early morning samples, sent to the laboratory each day. When done Daily Note TB culture may take 6 weeks. Cytology can also be done on the same specimens.
VAGINAL SMEAR FOR HORMONAL STATUS Specimen The smear is taken from the lateral vaginal wall and labeled and fixed as for cervical smears.
VALPROIC ACID (EPILIM) Specimen Gel (SST) tube. Therapeutic range 350 - 700 umol/L When done Daily Note Collect immediately before next dose (trough). Record date and time of last dose. Hepatotoxic levels >700 umol/L.
VARICELLA ZOSTER ( CHICKEN POX ) ANTIBODY Specimen Gel (SST) tube. When done Daily Usage Identification of chicken pox or zoster.
VASOPRESSIN (Anti-Diuretic Hormone) Specimen Heparin or EDTA tube Reference range 2.0 – 8.0 pg/mL When done Sent to Reference Laboratory (Monthly). Usage Rarely useful
VIRAL CULTURE Specimen Plain swab in viral transport medium or Virocult swab. CSF, Faeces, Urine, or products of conception can also be placed in a sterile container without preservative. Keep ice cold. When done Weekly. Note May take several weeks to grow.
VITAMIN B12 Specimen Gel (SST) tube. Reference range 140 – 780 pmol/L 91 When done Daily. Usage Macrocytic anaemias
VITAMINS Specimen Heparin tube. (plain for Vit D) Protect from light by wrapping in foil. When done Sent to reference laboratory. Note Vitamins A, B1, B6, C, D, and E, or a full screen can be performed.
VMA (VANILLYLMANDELIC ACID) See Catecholamines
WHOOPING COUGH (PERTUSSIS) Specimen Nasopharyngeal swabs are plated directly onto special agar, so should be collected at the laboratory. Note Also, sputum or pharyngeal aspirate can be placed in a sterile container and sent for immunofluorescent studies.
WHOOPING COUGH ANTIBODIES (PERTUSSIS) Specimen Gel (SST) tube. When done Sent to Reference Laboratory Usage Detection of Whooping cough in its early stages, along with the swab culture.
WIDAL SEROLOGY Specimen Gel (SST) tube. When done Sent to MDU Usage Enteric Fevers.
ZARONTIN (Ethosuximide) Specimen Gel (SST) tube. When done Sent to Reference Laboratory Reference range Therapeutic: 284-568 umol/L
ZINC Reference Range Specimen Serum: (Gel) tube 11 - 18 umol/L Plasma: Heparin tube As above. 24 Hour Urine: 8 - 11 umol/24hrs. When done Sent to reference laboratory, (weekly). Usage Suspected poor nutrition, poor wound healing, acrodermatitis enteropathica. 92 Note Interpret with serum albumin levels
ZINC (Hair) See heavy metals.
93 BD Vacutainer™ Tube Guide
Hemogard™ Catalogue Closure & Tube Number & Determinations Instructions Content Volume
Minimum two patient 367895 Blood groups, Cross-matching 10ml Identifiers for all samples.
Plain
General Biochemistry (Cardiac Enzymes, Lipids / Fats, LFT, Renal Function tests, Therapeutic Drugs)
Endocrinology (Hormones, TFT’s, B12 and Folate, Tumor Markers),
367958 Immunology (ANA, Tissue Autoantibodies, ENA,
8.5ml Complements, Immunoglobulins, RAST, Rheumatoid Factor, Protein & Immunofixation, electrophoresis, IM test),
SST II Serology (TORCH serology, EBV, RPR, TPHA, HIV, Hepatitis Serology),
Iron Studies.
367691 Coagulation Studies, Antithrombin III, INR, Fibrinogen,
4.5ml APCR, Protein C, Protein S, D. Dimer
Sodium Citrate
FBE, ESR, Platelets, Hb-EPG, HLA-B27, Red Cell Folate Reticulocytes. For vitamins, wrap specimen 367839 in foil as soon as possible 4ml Most Vitamins (not B12) & Heavy Metals. after collection
EDTA GHb (HbA1c),
Most Vitamins, Heavy Metals (Pb, Hg, Cd), T & B-cell studies 367885
6ml Chromosome studies, Pesticides, Organophosphates, Organochlorines. Lithium Heparin
367934 Glucose, Lactate, GTT, Insulin. Please specify fasting status. 4ml
Fluoride Oxalate
94 Disclaimer and Terms of Issue
While PathLab has attempted to make the information in this handbook as accurate as possible, the information contained in this book is for personal and/or educational use only and is provided in good faith without any express or implied warranty. There is no guarantee given as to the accuracy or currency of any individual item in this handbook. Persons accessing the handbook who require confirmation of any information should refer in writing to the Supervising Pathologist at PATHLAB.
The practice of any medical application should be done under the strict supervision of a registered and qualified medical practitioner only, and the patient should be thoroughly examined prior to any treatment and closely monitored after it’s commencement. By acceptance and/or using this handbook, it is implied that you have read and understood the company’s disclaimer of responsibility for the information contained herein. Should the book not be returned to the company then the reader is deemed to have agreed to these terms of issue.
95 Notes
96