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Chemical Pathology Unit

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Chemical Pathology Unit PATOLOGI KIMIA Head of Unit : Dr Nur Shafini Binti Che Rahim Phone : +60326155555 ext 5284 1. INTRODUCTION Chemical Pathology unit provides diagnostic and consultative services to Hospital Kuala Lumpur and also serves as referral center for hospitals and clinics in Malaysia. Our services cover analysis and interpretation of results for screening, diagnostics and monitoring of diseases. 2. SERVICES Chemical Pathology Unit offers specialized biochemical testing. The list of services include: i. Endocrine Thyroid Function Test, Fertility Test, Serum and Urinary Cortisol, Urine Catecholamine, Extended Hormone (Dehydroepiandrosterone sulphate (DHEAS), Insulin, C-peptide, Growth Hormone, Adrenocorticotrophic Hormone (ACTH)) and Parathyroid Hormone (PTH), Thyroglobulin, Anti-thyroglobulin, Anti-thyroid specific peroxidase and Anti-thyroid stimulating hormone receptor. ii. Metabolic HbA1c, Gamma Glutamyl transferase (GGT) and Cholinesterase (CHE) iii. Protein and Proteomic Serum and Urine Protein Electrophoresis, Specific Protein (Ceruloplasmin, Immunoglobulin IgG, Immunoglobulin IgA, Immunoglobulin IgM, Transferrin, Haptoglobin, Alpha -1-antitrypsin) iv. Hematological Biochemistry Iron,UIBC, Ferritin,Folate, Vitamin B12 3. SERVICE HOURS Operating hours: 7.30 am – 5.30 pm (Monday to Friday) URGENT request: Arrangement should be made by contacting Pathologist, Medical Officer or Scientific Officer in-charge. 4. REQUEST FORMS All specimens must be accompany with PER.PAT 301 form. Forms must be filled LEGIBLY and COMPLETELY with the following information: Patient`s details: Name, IC number, sex, age and ward/hospital name Patient`s clinical and test details: relevant clinical history, diagnosis, test required, type of sample, time and date of sample collection. Requesting doctors details: name, stamp and signature. 5. SAMPLE COLLECTION 5.1 BLOOD Most of tests in Chemical Pathology require serum sample that need to be collected in plain tube. Special requirements are require for certain tests: HbA1c: require whole blood sample that need to be collected in EDTA tube. Request less than 3 months from previous result will be rejected. Morning serum cortisol: between 8 to 10 am; midnight serum cortisol: between 10 to 12 pm. Fertility tests: Sample for progesterone should be collected at day 21 of menstrual cycle, while sample for estradiol, FSH and LH should be collected at day 2 to 5 of menstrual cycle. Certain tests require to be sending in ice such as ACTH. Serum and Urine Protein Electrophoresis should be send as paired sample for better interpretation of test results 5.2 URINE 24 hours Urine Collection 24 hours urine collection require due to certain test which effected by circadian rhythmic changes. Procedure of collection: On the day of collection, the first urine voided must be thrown away. Time of first urine voided is the start of the timing for the 24 hours collection. Collect the second and subsequent voided urine for 24 hours into the 24 hours urine container until completed. For male patient, it is advisable NOT to void the urine directly into the 24 hours urine container. This is to avoid possible chemical burns. Refrigerate urine sample if possible. Label the bottle as directed and send immediately to the laboratory. eg. Tests include 24-hours urine cortisol and 24-hours urine catecholamines. 24-hours Urine Catecholamine Please refer to procedure 24 hours urine collection to collect urine for 24 hours urine catecholamines. For adult minimum 750ml of urine should be collected. For paediatric samples urine creatinine are perform for every request. Please note that, 10ml of 6M HCl (preservative) is added into the bottle to preserve the analytes. It is important for the requesting physician to advise the patient NOT to discard the preservative. Instruction on patient preparation and specimen collection o Certain drugs or their metabolites are a source of possible interference with catecholamines quantification. List of drugs that may interference with catecholamines quantification: a) Acetaminophen (paracetamol) b) Cimetidine (Tagamet®) c) Alpha-methyldopa (Aldomet®) d) Isoproterenol e) Labetalol f) Mandelamine g) Metoclopramide o Please advise patient to avoid stress, exercise, smoking and pain prior to and during urine collection. 24-hours Urine Cortisol Please refer to procedure 24 hours urine collection to collect urine for 24 hours urine cortisol. Minimum of 500 ml of urine should be collected. 6. RECEIPT OF SPECIMEN Specimens are receive at the main counter (Kaunter Penerimaan Utama Unit Makmal Teras). 7. REPORTING OF RESULTS Results are validated by Chemical Pathologist/Medical Officer/Scientific Officer according to the test following laboratory turnaround time. Reference ranges are provided for all results. These may be subject to variation differentiated by age and sex where important / available. Reports are dispatched to the respective pigeon hole or posted via mail for external samples. 8. ENQUIRY OF RESULTS Enquiry of test results can be made using: 1) Form for tracing laboratory results i.e Borang Mendapatkan Keputusan Ujian Patologi, HKL/JP/PA/AK-05-01 at Kaunter Penerimaan Utama Unit Makmal Teras in Pathology Department. 2) Labviewer in respective ward or clinic 3) Phone extension 5284, For external clients tracing can be made via official letters to: Head of Department, Pathology Department, Jalan Pahang, 50586 Hospital Kuala Lumpur. 9. SERVICES AFTER OFFICE HOURS If test needed after working hours, consultation and agreement from Chemical Pathologist on-call are required. 10. PROTOCOLS FOR INVESTIGATION OF ENDOCRINE DISORDERS The protocols listed below are only as guide and are subjected to changes according to clinician requirement. These protocols are mainly for adult. 10.1 PITUITARY DISORDERS Assessment of Anterior pituitary Hormone 1. Pituitary Hormone Insufficiency Anterior pituitary hormones include Growth Hormone (GH), Prolactin, Thyroid Stimulating Hormone (TSH), Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH) and Adrenocorticotrophic Hormone (ACTH). Main abnormalities to look for are Corticotroph deficiency, Thyrotroph deficiency, Gonadotroph deficiency or Somatotroph deficiency. Assessment of Anterior Pituitary Reserve a) Initial assessment • Morning serum Cortisol and ACTH or Short Synachten Test • Thyroid Function Test (TSH, FT4) • Prolactin, LH, FSH • GH • Testosterone for man Estradiol for woman b) Combine Anterior Pituitary Stimulation Test (Insulin Stress Test + Gonadotrophin Stimulation Test) Procedures: • Fast the patient overnight. • Insert intravenous catheter or intravenous line. • Rest patient for 30 minutes. Take samples for glucose, growth hormone, cortisol, LH, FSH and TSH (as baseline investigation). • Give insulin 0.1-0.15 unit/kg body weight, 200µg TRH and GnRH 100ug intravenously. • Collect samples into plain tubes and Glucose tubes and label as follows: Time Tests Tube 0 min (basal) Glucose, Glucose tube Cortisol,FSH,LH 1 plain tube TSH,GH 15 min Glucose Glucose tube 20 min FSH, LH, TSH 1 plain tube 30 min Glucose Glucose tube Cortisol, GH, 1 plain tube 45 min Glucose Glucose tube 60 min Glucose Glucose tube Cortisol, FSH, LH, 1 plain tube TSH,GH 90 min Glucose, Glucose tube Cortisol, GH 1 plain tube 120 min Glucose, Glucose tube Cortisol, GH 1 plain tube * GH-Growth hormone, LH-Luteinizing hormone, FSH- Follicular stimulating hormone, TSH – Thyroid Stimulating Hormone Adapted from Clinical Chemistry Sixth Edition, William J Marshall & Stephen K Bangert, Mosby, 2008, pg 140. • Label specimens according to sampling time. • Send all samples after test is completed to main counter, Pathology Department. Notes: • Plasma glucose level must fall below 2.2 mmol/L and/or clinical signs and symptoms of hypoglycaemia (sweating, tachycardia etc) must be observed. • Additional intravenous insulin may be given if this does not occur by 30 min and sampling should be prolonged by another 30 min. • Physician should be in attendance throughout the tests and 50% i.v. dextrose should be kept by bed side if severe hypoglycemia is documented. • Giving glucose for severe hypoglycemia does not invalidate the test results. • Test is contraindicated for patient with seizure, ischeamic heart disease or cardiovascular insufficiency and in young children. • Normal ECG is mandatory. c) Insulin Hypoglycaemic Test: • Similar as Combine Anterior Pituitary Stimulation Test but without GnRH injection. Blood samples are taken at 0 minute (basal), 30 minutes and 60 minutes after insulin injection for glucose, cortisol and growth hormone (GH) as follows: Time Tests Tube 0 min (basal) Glucose Glucose tube 1 Cortisol, GH plain tube 30 min Glucose Glucose tube 1 Cortisol, GH plain tube 60 min Glucose Glucose tube 1 Cortisol, GH plain tube • Label specimens according to sampling time. • Send all samples after test is completed to main counter, Pathology Department. d) Gonadotrophin- Releasing Hormones Stimulation Test: • Collect samples into plain tubes for LH and FSH (basal sample). • Give 100 ug GnRH. • Collect samples into plain tubes at 15 minutes, 30 minutes, 60 minutes and 90 minutes after GnRH injection for Luteinizing Hormone (LH) and Follicular Stimulating Hormone (FSH). Time Tests Tube 0 min (basal) FSH, LH 1 plain tube 15 min FSH, LH 1 plain tube 30 min FSH, LH 1 plain tube 60 min FSH, LH 1 plain tube 90 min FSH, LH 1 plain tube • Label specimens according to sampling time. • Send all samples to main counter Pathology Department 2. Pituitary surgery assessment a) Pre-operative
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