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Guide to Pathology Tests GUIDE TO PATHOLOGY TESTS This quick reference guide may be useful in some clinical situations. The suggested investigations are neither comprehensive nor applicable in all circumstances. Tests should be selected after consideration of the patient’s clinical history, signs, symptoms and previous test results. For further information, please contact our pathologists, senior scientists or refer to The Royal College of Pathologists of Australia manual at www.rcpamanual.edu.au A ABDOMINAL PAIN ANAEMIA Baseline: ECU, LFT, CRP, cTn, Lipase, Amylase, HCG, FBE, urine MCS Macrocytic Additional: Calcium, Phosphate, Lactate, Blood Gas, faeces Baseline: FBE, blood film, ECU, LFT, LDH, B12, Folate, TSH (MCS, OCP, PCR), Urine Porphobilinogen Additional: AIF, PCA, EPG, FLC, Haptoglobin Supplementary: Blood Culture, H. Pylori Faecal Antigen Test, Supplementary: Bone marrow biopsy Urea Breath Test Microcytic: Baseline: FBE, IS, ECU, LFT ADRENOCORTICAL FUNCTION Additional: FOB, EPG, Hb-electrophoresis Supplementary: Blood Lead Addison’s disease Baseline: S-Cortisol, ACTH, ECU Normocytic: Additional: Synacthen stimulation test. Baseline: FBE, Reticulocyte count, ESR, ECU, CRP Supplementary: Adrenal-Ab, thyroid-Ab, ovarian-Ab, Tuberculosis, Additional: IS, B12, folate, LFT septicaemia, HIV, 17-OHP, VLCFA, Fine Needle Biopsy Supplementary: EPG, Bone marrow biopsy Cushing syndrome Baseline: 3 x 24 hour urinary free cortisol, or 1 mg overnight ANTENATAL TESTING Dexamethasone Suppression Test, am serum Cortisol. Note: "Antenatal Screen" is no longer a valid test request. Additional: Prolonged Dexamethasone Suppression test, ACTH, Please specify which of the tests below are requested. Electrolytes, midnight salivary Cortisol. Supplementary: Diagnostic imaging First visit and < 20 weeks: FBE, ECU, LFT, TFT, Blood group and antibodies, Fasting glucose, Rubella Ab status, Hep B surface Antigen Congenital Adrenal Hyperplasia and Hep C antibody, HIV serology, Syphilis serology, Urine Baseline: 17-OHP, Electrolytes MCS, Cervical Cytology Additional: Renin Also consider: Maternal antenatal screening (triple test) First Trimester Supplementary: Synacthen Stimulation with 17-OHP determination Screen (FTS), or Non-Invasive Pre-Natal test to exclude partial 21-Hydroxylase deficiency 26 – 28 weeks: FBE, blood group and antibodies, glucose tolerance test. Phaeochromocytoma Baseline: Plasma Metanephrines or 24 hour Urinary 30 – 36 weeks: FBE, Group B Streptococcal vaginal rectal swab for culture Fractionated Metanephrines Additional: Down syndrome and Neural Tube Defect risk assessment Additional: 24 hour Urinary Catecholamines High risk patients: TSH, Thyroid Ab, Vitamin D ALLERGY ARTHRITIS Baseline: RAST Baseline: Rh factor, anti-CCP Ab, ANA, ENA, anti-dsDNA Additional: IgE, FBE, ESR Additional: FBE, ESR, CRP, Synovial fluid examination and biopsy if indicated AMENORRHOEA BLEEDING DISORDERS B Baseline: HCG, LH, FSH Additional: E2, Prolactin, TFT Baseline: FBE and film, PTT/INR, APTT, Fibrinogen, TT Supplementary: Cytogenetics, Ovarian-Ab, Urinary Anabolic Steroids, Additional: Blood: Lupus anticoagulant Testosterone, DHEAs, Androstenedione, 17-OHP Serum: Cardiolipin Ab, β2GP1 Supplementary: D-Dimer, Assays for Factor VIIIC, Von Willebrand Disease Screen (VIIIC, VIIIAg, VIIIVWF), Factor IX, Factor XI, XIII and Platelet Aggregation or other Factor Assays, Factor V Leiden, Prothrombin 20210, Protein C and S 1300 134 111 | ClinicalLabs.com.au ACLZBCH0010 10/16 P1of4 ACLMAR-BF-NAT-0005.9 BONE DISEASE & CALCIUM DISORDERS Hypokalaemia Baseline: ECU, Mg, Glucose. Urine Na, K, Mg Baseline: Ca, Mg, PO4, ALP, Vitamin D, PTH Additional: Aldosterone:Renin ratio. Additional: ALP isoenzymes (if ALP elevated), P1NP, CTx 24 hour Urinary Free Cortisol Urine: Na, K, Cl BULLOUS SKIN LESIONS Hyponatraemia Baseline: Swab for MCS Baseline: ECU, glucose, LFT, TSH Additional: TP, Cholesterol plus Triglycerides, Osmolality, Cortisol, ADH. Urine Osmolality, Na, K, Creatinine C CHEST PAIN Baseline: cTn, DDimer ERECTILE DYSFUNCTION Supplementary: CK, CKMB Take the following into consideration when assessing the patient: Assess cardiac risk, diabetes mellitus, testicular failure, drug therapy, CHRONIC FATIGUE post-surgical, prostate radiation, neurological disease, renal failure, Baseline: FBE, TFT, CRP, ECU, LFT, Cortisol, Glucose psychogenic causes. (There are no diagnostic tests for chronic fatigue syndrome) Baseline: ECU, LH, FSH, Testosterone, Prolactin, Glucose COELIAC DISEASE GENITAL ULCER G Baseline: Transglutaminase Ab, FBE Baseline: Swabs for PCR (Herpes) and MCS Additional: IgG Antigliadin antibody (in cases of IgA deficiency) Serum: Syphilis serology Supplementary: Small bowel biopsy HAEMATURIA H D DELIRIUM Baseline: Urinalysis, MCS and red cell morphology Baseline: FBE, ESR, ECU, LFT, TSH, Glucose, Blood Culture, Additional: Cytology Urine MCS, CRP Additional: Blood Gas, COHB, Calcium, Salicylate, Lithium, Cortisol HAEMOLYSIS CSF: MCS, blood, protein, glucose, immunoglobulins, J Urine Drug Screen Baseline: FBE, RETC, DAT, ECU, LFT (inc. bilirubin), LDH, Haptoglobin Additional: Cold Haemagglutinines CRP, ANA, DNA, NUC DIABETES MELLITUS L Baseline: Glucose or HbA1c (high risk, asymptomatic) HEPATITIS Monitoring HbA1c, Urine Albumin Additional: GTT Baseline: LFT, Urinalysis, FBE, PT Acutely ill: Glucose, ECU, Blood Gas, FBE, Hydroxybutyrate, Lactate, Acute: Infectious: Hep A, B, C exclude underlying infection, ketones Alcoholic hepatitis Drugs (Paracetamol, anticonvulsants, NSAIDS, etc.) Hepatic ischemia DIABETES (PREGNANT) Chronic: Severity and degree determined on liver biopsy GTT (Traditional): 0 min = 5.4 mmol/L, 2 hour =7.9 mmol/L Monitoring: LFTs GTT (ADIPS): 0 min = 5.0 mmol/L, 1 hour > 9.9 mmol/L, 2 hour EPG (helpful in certain cases) > 8.4 mmol/L Consider Hep B, C, autoimmune hepatitis, alcoholic hepatitis, drugs, Wilson’s disease, AAT deficiency, PBC, PSC Granulomatous: Diagnosis requires liver biopsy DIARRHOEA Causes: Idiopathic, sarcoidosis, drugs (Allopurinol), infective, Laboratory requires clinical information. Hodgkin lymphoma, Berylliosis Suggested testing: Acute: HEPARIN THERAPY Baseline: Faeces MCS (1 per 7 days), PCR, OCP Baseline: APTT M Additional: Determined by history Blood Cultures for typhoid, C. difficile toxin testing, viral outbreaks HEREDITARY HAEMOCHROMATOSIS Chronic: Baseline: Iron studies, HFE gene mutations (C282Y, H63D) Baseline: Faeces MCS, OCP, PCR Additional: HFE mutation S65C, liver biopsy Additional: Cryptosporidia/Cyclospora stains, Microsporida stain (HIV patients), Sudan black stain for fat globules HIRSUTISM Supplementary: Disaccharidases and/or Reducing Substances, Lactose Tolerance Test, H Breath Test, Coeliac Screen, Laxative Baseline: LH, FSH, E2, Testosterone, SHBG, FAI Screen Faecal Na, K, Osmolality Additional: 17-OHP, DHEAS, Androstenedione E ELECTROLYTE DISORDERS HYPERLIPIDAEMIA N Hyperkalaemia Baseline: Cholesterol and triglyceride, HDL Consider spurious result, renal failure, acidosis, adrenocortical insufficiency, drug Additional: HDL, LDL, ECU, TSH, Glucose induced, cellular injury. Supplementary: ApoB, Lp(a), Apo-A, Lipoprotein Electrophoresis Baseline: ECU, Glucose, FBE plus platelets Additional: Aldosterone:Renin ratio, random Urine K and Na HYPERTENSION Hypernatraemia Baseline: ECU, urine MCS Baseline: ECU Additional: TFT, 24 hour Urinary Free Cortisol, Plasma/Urine Additional: Serum: Osmolality Metanephrines, Aldosterone:Renin ratio Aldosterone:Renin ratio, ADH Urine: Osmolality, Na, K, Creatinine P2of4 HYPOGLYCAEMIA OSTEOPOROSIS O Baseline: Glucose, Insulin, C-peptide Calculate absolute fracture risk: Additional: Cortisol, Growth Hormone, Proinsulin, Oral Hypoglycaemia http://garvan.org.au/promotions/bone-fracture-risk/calculator/ Screen, Lactate, Hydroxybutyrate Baseline: Blood: Calcium, Phosphate, Albumin, Vitamin D, ALP, PTH Urine: Calcium, Creatinine, BTM (CTx, P1NP) I IMMUNODEFICIENCY PHARYNGITIS P Baseline: FBC, WCC diff, blood film, Ig’s (G, A, M), Blood Group, lymphocyte immunophenotyping Baseline: Throat swab MCS, EBV, CMV serology, respiratory PCR Additional: IgG subtypes, Neutrophil Function tests POLYURIA INFERTILITY - MALE Baseline: ECU, Glucose, Urine MCS Baseline: Semen analysis (must reach lab in 2 hours with completed Additional: Urine and serum Osmolality patient information sheet) Supplementary: Water Deprivation test Additional: LH, FSH, Testosterone, Prolactin, Iron Studies Supplementary: Chromosome studies, Sperm antibodies, Testicular biopsy RENAL DISORDERS/DISEASE R G INFERTILITY - FEMALE Baseline: FBE, ECU, Calcium, Phosphate, Albumin, Uric Acid, Glucose, Urine Protein and MCS Baseline: LH, FSH, day 21 Progesterone, E2 Additional: Urine Creatinine Clearance Additional: Prolactin, Testosterone, TFT Supplementary: Chromosome studies, Endometrial biopsy RESPIRATORY INFECTIONS H Exclude PID, STI Baseline: Sputum MCS, respiratory PCR INFLAMMATORY BOWEL DISEASE SEXUALLY TRANSMITTED DISEASES S Baseline: Faecal Calprotectin, M&C, CRP and ESR Baseline: Serum: HIV, Syphilis J JAUNDICE Urine: Chlamydia PCR, Gonorrhoea MC&S and PCR Urethral/vaginal Swab: Chlamydia PCR, Gonorrhoea See liver disease and haemolysis MC&S and PCR Additional: Urine: Mycoplasma genitalium PCR L LIVER DISEASE Rectal/throat Swabs: Chlamydia PCR, Gonorrhoea MC&S and PCR Baseline: ECU, Glucose, LFT, FBE, Coags, serology relevant to history Lesion: Herpes PCR if indicated Additional: Ca, PO4 Trichomonas: PCR if indicated Supplementary: AAT, Ceruloplasmin, Iron studies, EPG, Urine Copper Pap smear or dry swab: HPV PCR ANA, anti-dsDNA,
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