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PATHOLOGY HANDBOOK

SIXTH EDITION 2003

Issued: July 2003

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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

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LABORATORY PERSONNEL
Dr Max Wolf Dr Peter Harper Dr Ann Read Dr Ian Denham Dr Bernard Treister Dr Gerry Wagner Mrs Heather Seaman Mr Ron Bell Mr Ed Sorich Mr Nick Pagonis Mrs Julie Ryan Mr Ian Goodall Mr John Robert Mrs Heather Seaman Mr Tim Lo Mrs Fiona Brady Mrs Kathleen White Mr Bill Anton Mr Peter Gotis Mr Marios Theocharous Mr Gary Smith Mr Steven Sioulas Ms Stella Flaskis Ms Marlene Sinclair Mr Nick Gianopoulos Medical Director/Pathologist/Physician/ Clinical Haematologist Supervising General Pathologist, Pathologist, Biochemist Pathologist, Microbiologist Cardiologist Cardiologist Laboratory Manager, Main Laboratory Laboratory Manager, Epping Laboratory. Night Supervisor, Integrative Medicine Senior Scientist, Immunology/Serology Senior Scientist, Biochemistry Consultant, Biochemistry Senior Scientist, Haematology Senior Scientist, Histopathology Senior Scientist, Microbiology Specimen Reception/External Testing Pathology Collection Manager Chief Executive Officer General Manager Operations Manager Finance Manager IT/Computing Director of Sales and Marketing Business Development Manager Courier Manager

HOURS OF OPERATION
Monday to Friday: Saturday: Sunday & Public Holidays: 8.00 am - 12.00 midnight 9.00 am - 11.00 pm 9.00 am - 11.00 pm

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ACCREDITED COLLECTION CENTRES
As at 1 July 2003.
BLACKBURN SOUTH 164 Middleborough Road Mon - Fri: 8.30 am - 1.00 pm Sat: 8.30 am - 12.00 pm 50 – 52 Bamburg Street Mon - Fri: 8.00 am - 12.00 pm 1.00 pm - 5.00 pm Sat: 8.00 am - 12.00 pm 68 Burwood Hwy Mon - Fri: 8.00 am – 4.00 pm 1328 Centre Road Mon - Fri: 8.30 am - 5.00 pm Sat: 8.30 am - 12.00 pm 1045 Doncaster Road Mon - Fri: 8.30 am - 5.00 pm Sat: 8.30 am - 12.00 pm 48-50 Childs Road Mon - Fri: 9.00 am - 5.00 pm Tues: 5.00 pm – 8.00pm Sat: 9.00 am - 12.00 pm 155 Jukes Road Mon - Fri: 8.30 am – 1.00 pm 63 Mahoneys Road Mon - Fri: 9.00 am – 5.00 pm 393 Swanston Street Mon - Fri: 8.00 am - 4.00 pm 1098 Heatherton Road Mon - Fri: 9.00 am – 1.00 pm Sat: 9.00 am - 11.30 am 68 Oakhill Avenue Mon - Fri: 8.30 am – 12.00 pm 307 Burnley Street Mon - Fri: 9.00 am - 2.00 pm Sat: 9.00 am - 12.00 pm 40 Anderson Street Mon - Fri: 8.30 am - 6.00 pm Sat: 8.30 am -1.00 pm 34 Riddell Road Mon - Fri: 9.00 am - 1.00 pm 9890-0031

BROADMEADOWS

9302-3822

BURWOOD (Main Laboratory) CLAYTON

8831-3004 9544-6277

DONCASTER EAST

9841-8962

EPPING (Branch Laboratory)

9401-2346

FAWKNER FOREST HILL MELBOURNE NOBLE PARK

9357-3870 9877-0022 9662-3322 9546-9477

RESERVIOR RICHMOND

9478-2900 9429-5499

TEMPLESTOWE

9846-4000

WANTIRNA SOUTH

9801-9055

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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). Call 8831-3041 (Mon - Fri: 9.00 am - 5.00 pm), otherwise 8831-3000.

COURIER SERVICE 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: Blood samples, Swabs, smears, biopsies Genital swabs, "hot" faeces for amoebae semen samples and cold agglutinins Cryoglobulins, Blood Cultures:

2 - 8o C
) ) Room temperature )

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.

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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
EDTA

Vacutainer Cap Colour
Violet

Tests
FBE/ESR, HbA1C, ACTH (2) Blood Groups Hb Electrophoresis, Renin (2) Glucose, GTT. Prothrombin, APTT(KPTT) Fibrinogen Clotting Profile. Lymphocyte Typing, Chromosomes, HLA B27, Vitamins (Except B12), Heavy Metals (Except Iron) Blood Groups, X-Match. All other biochemical and serological tests.

Fluoride/Oxalate Citrate

Grey Light Blue

Heparin

Green

Plain without gel Plain Gel (SST) White (Plain 5mL)

Red Yellow

Non-Vacutainer Tube 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 Reference range When done Usage Plain Gel (SST) tube. 0 – 3 units/ml Sent to reference laboratory (3-4 weeks). Diagnosis and monitoring of myasthenia gravis.

ACID ELUTION (KLEIHAUER TEST)
Specimen When done Usage Note EDTA tube Sent to reference laboratory, (2 –3 days) Foetal Maternal bleed, thalassaemia, hereditary persistence of Hb F. See also HAEMOGLOBIN ELECTROPHORESIS

ACTH (ADRENOCORTICOTROPHIC HORMONE)
Specimen Reference range When done Usage Notes Two EDTA tubes on ICE and sent immediately to laboratory. Collect in morning between 8 to 10 am 2 - 12 pmol/L Sent to reference laboratory (weekly). To differentiate the cause of Cushing’s Syndrome. Increased levels seen in ectopic or pituitary cause of Cushing’s syndrome Decreased levels seen in Adrenal tumours.

ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT)
Specimen Reference range When done Usage Citrate Tube 23-35 sec Daily Detection of Coagulation factor deficiency.

ACTIVATED PROTEIN C RESISTANCE (APCR)
Specimen Reference range When done Usage Note Citrate Tube 1.9 - 7.5 (ratio) Sent to reference laboratory (3 times per fortnight). Screening test for Factor V Leiden mutation. Investigation of tendency to venous thromboembolism. 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 Reference range When done Usage Plain Gel (SST) tube. 10 – 50 u/L Daily upon arrival at the laboratory. hepatocellular damage.

ALBUMIN, Serum
Specimen Reference range When done Usage Notes Gel (SST) tube. 35 – 50 g/L (Age dependent). Daily upon arrival at the laboratory. Liver function, protein loss. Decreased levels in chronic disease, acute phase reactions, liver disease and protein losing conditions such as nephritic syndrome.

ALBUMIN /CREATININE RATIO, Urine
Specimen Reference Range When done Usage Random Urine specimen Males <3.0 g/mmol Females <3.5 g/mmol Daily Early detection of Diabetic nephropathy 19

ALCOHOL (Ethanol)
Specimen Reference range When done Usage Note Fluoride-Oxalate tube, (Do not use alcohol swab for venepuncture). Not detected Sent to reference laboratory (Weekly). Alcoholism, legal. 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 Reference Range Gel (SST) tube delivered to laboratory within 2 hours or 24 hour urine without preservative. 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 Sent to reference laboratory (weekly). Used in diagnosis of aetiology of hypertension Level depends on sodium intake and posture. 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.

When done Usage Note

ALKALINE PHOSPHATASE
Specimen Reference range When done Usage Note Gel (SST) tube. 45 - 125U/L (Age Dependent). Daily on arrival at laboratory. Liver disease, bone disease. Raised in children and pregnancy.

ALKALINE PHOSPHATASE ISOENZYMES
Specimen When done Usage Note Gel (SST) tube. Sent to reference laboratory (Daily). Identifying the tissue source of the ALP elevation. Isoenzymes performed only if alkaline phosphatase is significantly elevated. 20

ALLERGY TESTING
See RAST

ALPHA-1-ANTI-TRYPSIN
Specimen Reference Range When done Usage Gel (SST) tube. 1.0 - 2.1 g/L Sent to reference laboratory (once a fortnight) investigation of emphysema and cirrhosis Raised levels are seen in acute phase response.

ALPHA-FOETO PROTEIN (AFP)
Specimen Reference Range When done Usage Notes Gel (SST) tube. 0 - 10.9 ug/L, Higher in pregnancy Daily Cancer marker, some foetal abnormalities (part of triple test). Elevated levels are seen in hepatocellular carcinoma and non-malignant liver disease.

ALUMINIUM
Specimen Reference Range When done Usage Whole blood Lithium Heparin, EDTA, urine (no Preservative), serum or plasma. < 0.8 umol/L < 2.0 umol/L for dialysis patients. Sent to reference laboratory (weekly). Monitoring dialysis, investigating dementia.

AMINO ACIDS
Specimen Reference Range When done Usage spot urine. Age Dependent Sent to reference laboratory (Weekly) Diagnosis of metabolic disease, cystinuria, and Fanconi syndrome.

AMIODARONE
Specimen Reference Range When done Usage Note Gel (SST) tube. 0.8 – 3.9 umol/L Sent to reference laboratory (Weekly). Monitoring amiodarone therapy. 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 Reference Range When done Usage Note Heparin tube- filled to top ( 10 mls) and held on ice. Deliver immediately to Laboratory 20 - 60 umol/L Sent to Reference laboratory (Weekly). hepatic coma and some genetic diseases 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 Reference range When done Usage Gel (SST) tube. Serum: up to 100 U/L Commenced on arrival at laboratory. 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 When done Usage Note Gel (SST) tube. Sent to reference laboratory (Twice Weekly ) Suspected vasculitis and renal disease, microscopic polyarteritis, idiopathic necrotising and crescentic glomerulonephritis. 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 Reference range When done Usage Gel (SST) tube. Male 1.0 - 11.0 nmol/L Female 0.4 - 11.0 nmol/L Post menopausal < 3.5 nmol/L Sent to reference laboratory (Weekly) Investigation of female hirsutism, PCOS and congenital adrenal hyperplasia and some virilising tumours.

ANGIOTENSIN CONVERTING ENZYME (ACE)
Specimen Reference range When done Usage Note Gel (SST) tube. 8 - 21 U/L Sent to reference laboratory (Weekly). Monitoring of Sarcoidosis. Fairly non-specific, so not good diagnostic test. ACE inhibitor drugs cause low levels.

ANION GAP
Specimen Reference range When done Usage Note Usage Gel (SST) tube. 10 - 18 mmol/L Daily Acid base metabolism. Calculated from the following formula:( Na+ + K+ ) - (Cl- + HCO3-) Investigation of aetiology of metabolic acidosis.

ANTE-NATAL SCREEN
Specimen When done Note Suggested tests are: FBE Blood Group Rh and antibody screen Rubella antibodies Hepatitis B surface antigen 23 Gel (SST) tube, EDTA, PLAIN (NON-GEL) tube. Daily The H.I.C. requires that the individual tests be requested.

RPR/TPHA

ANTIBODY SCREEN - (BLOOD GROUP)
Specimen When done Note Plain (NON-Gel) tube Daily 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 Reference range When done Usage Notes Gel (SST) tube. 0 – 100 units/mL Sent to reference laboratory (Weekly). Recent Streptococcal skin or soft tissue infections. Performed together with ASOT, although Anti DNAse B is more sensitive than ASOT for the diagnosis of poststreptococcal glomerulonephritis and serious streptococcal skin infections. Anti DNAse B titres remain higher for longer than ASOT.

ANTI-GLOMERULAR BASEMENT MEMBRANE (Anti-GBM)
Specimen Reference range When done Usage Gel (SST) tube. Not Detected Referred Daily 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 Reference Range When done Usage Gel (SST) tube. -17 to +35 U/L Sent to reference laboratory, (Monthly). Diabetes 24

Notes

Can combine with test for Anti-GAD Antibodies (antigamma amino decarboxylase antibodies).

ANTI-LIVER-KIDNEY MICROSOMAL ANTIBODIES
Specimen Reference range When done Usage Gel (SST) tube. Not Detected Referred Daily Are found in a sub-group of patients with ANA-negative autoimmune chronic active hepatitis.

ANTI-MITOCHONDRIAL ANTIBODIES (AMA)
Specimen Reference range When done Usage Note Gel (SST) tube. Positive titre is significant Sent to reference laboratory (daily). Diagnosis of primary biliary cirrhosis. A positive result at high titre is highly sensitive and specific for primary biliary cirrhosis.

ANTI-NUCLEAR ANTIBODIES ( ANF or ANA )
Specimen Reference range When done Usage Note Gel (SST) tube. Titre less than 40 Daily Diagnosing SLE and a screen for systemic rheumatic diseases. 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 Reference range When done Usage Gel (SST) tube. Not Detected Referred Daily are found in 15-50% of patients with premature ovarian failure.

ANTI-PARIETAL CELL ANTIBODIES
Specimen Reference range When done Usage Gel (SST) tube. Not Detected Referred Daily Incidence increases with age, aswell as in the presence of insulin-dependent diabetes mellitus. 25

ANTI-RETICULIN ANTIBODIES
Specimen Reference range When done Usage Gel (SST) tube. Not Detected Referred Daily Combined screening with for celiac disease recommended but highly specific for untreated celiac disease.

ANTI-RIBOSOMAL ANTIBODIES
Specimen Reference range When done Usage Gel (SST) tube. Not Detected Referred Daily 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 Reference range When done Usage Gel (SST) tube. Not Detected Referred Daily High titres (>1:160) are found in approximately 97% patients with auto-immune chronic active hepatitis.

ANTI-STREPTOLYSIN O TITRE (ASOT)
Specimen Reference Range: When done Usage Notes Gel (SST) tube. 0 - 200 IU/ml Children up to 150 IU/ml Daily Useful in excluding recent streptococcal infection in rheumatic fever, glomerulo-nephritis, Henoch Schonlein purpura and cellulitis. High titres or two fold increases in titre indicate recent infection.

ANTI-THROMBIN III (AT3)
Specimen Reference range When done Usage Notes Citrate tube Functional: 80-120% Antigen: 80-120% Sent to reference laboratory, (3 times per week). Investigation of tendency to venous thromboembolism. 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 Reference range EDTA tube 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 Daily Used in assessment of atherosclerosis risk factors. In general no benefit over LDL and HDL.

When done Usage

APTT
See ACTIVATED PARTIAL THROMBOPLASTIN TIME

ARSENIC (As), Blood
Specimen Reference range When done Usage Heparin tube 0.2 - 2.0 umol/L Sent to reference laboratory, (2 weeks). Industrial exposure, poisoning.

ARSENIC (As), Hair
Specimen Reference range When done Usage Hair: 50 gram of hair 0.13 - 3.7 ppm Weekly Industrial exposure, poisoning.

ARSENIC (As), Urine
Specimen Reference range When done Usage Urine: Spot Urine or 24 hour (No preservative) Random urine: < 1.3 umol/L Sent to reference laboratory, (2 weeks). Industrial exposure, poisoning.

ASCORBIC ACID
See VITAMINS

27

ASPARTATE AMINOTRANSFERASE ( AST, SGOT)
Specimen Reference range When done Usage Note Gel (SST) tube. 10.0 – 50.0 U/L Commenced on arrival at laboratory. Raised in hepatocellular liver disease, AMI, and damage to skeletal muscle. 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 Reference range When done Usage Gel (SST) tube. Not detected Sent to reference laboratory, (monthly). Investigation of hypersensitivity pneumonitis.

B12
See VITAMIN B12

BARBITURATES
See PHENOBARBITONE or DRUGS OF ABUSE SCREEN

BENCE JONES PROTEIN
Specimen When done Usage Note Spot specimen of urine. Sent to reference laboratory, (Daily). Investigation of monoclonal gammopathies and, hypogammaglobulinaemia. Serum protein electrophoresis Should also be done.

BETA HUMAN CHORIONIC GONADOTROPHIN
See βHCG

BETA-2-MICROGLOBULIN
Specimen Reference Range When done Usage Gel (SST) tube. Serum: 0 - 3.0 mg/L Sent to reference laboratory (Weekly). May be useful in monitoring progress of myeloma especially if measurement of paraprotein is not possible.

BICARBONATE
Specimen Reference range When done Gel (SST) tube. – 22 - 32 mmol/L Commenced on arrival at laboratory. 28

Usage Note

Electrolyte and acid-base metabolism. 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 When done Note Plain (NON-Gel) tube or EDTA tube Daily Blood group card is issued to the patient.

BONE MARROW
Usage When done Note Anaemias, leukaemias, marrow infiltrations, myeloproliferative disorders. By appointment with the Pathologist. Sternal marrow aspiration or iliac crest aspiration or trephine can be performed.

BORDATELLA PERTUSSIS SEROLOGY
Specimen When done Usage Gel (SST) tube. Sent to reference laboratory (weekly) Detection of Whooping cough in its early stages, along with the swab culture. 29

BORELLIA SEROLOGY
Specimen When done Usage Gel (SST) tube. Sent to reference laboratory (2 months) Suspected Lyme Disease.

BRUCELLA ANTIBODIES
Specimen When done Usage Gel (SST) tube. Sent to reference laboratory (weekly) Investigation of prior exposure to Brucellosis.

C3
See COMPLEMENT

C4
See COMPLEMENT

CA 125
Specimen Reference Range When done Usage Gel (SST) tube. 0 - 35 U/L Monday, Wednesday & Friday. 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 Reference Range When done Usage Whole blood EDTA or LithiumHeparin tube 0 - 27 umol/L for whole blood, 0-0.1 umol/L for urine Sent to reference laboratory (weekly) Industrial exposure, poisoning.

CADMIUM (Cd), Hair
Specimen Reference Range When done Usage 50 gram of hair. 0.24 – 2.70 ppm Weekly. Industrial exposure, poisoning.

CADMIUM (Cd), Urine
Specimen Reference Range 24 hour (No preservative) 0 - 0.1 umol/L 30

When done Usage

Sent to reference laboratory (weekly) Industrial exposure, poisoning.

CAERULOPLASMIN
Specimen Reference Range When done Usage Notes Gel (SST) tube or Heparin tube. 0.2 - 0.42 g/L Sent to reference laboratory (weekly) Suspected Wilson’s disease. Decreased in Wilson’s disease. Oestrogen therapy and pregnancy increase caeruloplasmin as does anacute phase response and liver disease.

CALCITONIN
Specimen Reference Range When done Usage Notes Gel (SST) tube or Heparin tube. Calcitonin is extremely labile and must be kept cold and spun as soon as possible. < 30 ng/L Sent to reference laboratory (weekly) Diagnosis of medullary carcinoma of thyroid. A stimulation test must be done –contact the laboratory.

CALCIUM
Specimen Reference range When done Usage Note Gel (SST) tube or 24 hour urine specimen with acid preservative. (Avoid stasis). Serum 2.1 – 2.6 mmol/L Urine 2.5 - 7.5 mmol/day Daily Investigation of the cause of hyper calcaemia (malignancy, primary hyperparathyroidism etc) and hypocalcaemia (osteomalacia, hypoparathyroidsim etc) 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 When done Usage Renal Calculus Sent to reference laboratory (Weekly). Identification of risk factors for stone recurrence.

CANNABINOIDS
See DRUG SCREEN 31

CARBAMAZEPINE (TEGRETOL)
Specimen Therapeutic range When done Usage Notes Gel (SST) tube. 20 – 50 umol/L Daily Therapeutic monitoring. Collect just before next dose (trough). Record time of last dose and time of collection on the request slip.

CARCINOEMBRYONIC ANTIGEN (CEA)
Specimen Reference range When done Usage Notes Gel (SST) tube. 0 - 5 g/L (Non smokers )check units 0 - 10 g/L (Smokers) Weekly Used for monitoring progress of malignancies such as GIT tumours, and breast carcinoma. Raised in inflammatory bowel disease. Slight increases may be seen in smokers.

CARDIAC ENZYMES
Specimen Reference Range When done Usage Gel (SST) tube. troponin I 0 – 1.0 ng/ml CK 24-204 U/L CKMB 0 – 24 units/L Daily 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 Reference range When done Usage Notes Gel (SST) tube. IgG: <12 GPL IU/mL IgM: <10 GPL IU/mL Sent to reference laboratory (weekly). Investigating features suggestive of phospholipid antibody syndrome (recurrent unexplained venous or arterial thrombosis, thrombocytopenia, fetal loss). Increased IgG levels are seen in phospholipid antibody syndrome but may also be seen in SLE and other immune disorders.

β CAROTENE
Specimen Reference Range When done Usage Note Heparin tube (protect from light) 50 - 250 ug/100ml Sent to reference laboratory (fortnightly) Malabsorption. Patient should have fasted for 12 hours. Faecal fats is more reliable as an indicator of fat malabsorption.

CATECHOLAMINES
Specimen Reference Range When done Usage Note 24 hour urine specimen, acidified with 50 ml of 2MHCL. Adrenaline 0 - 80 nmol/24 hours Noradrenaline 40 - 780 nmol/24 hours Dopamine 200 - 3500 nmol/24 hours Sent to reference laboratory, (weekly). Diagnosis of phaeochromocytoma, neuroblastoma and ganglioneuroma. 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 Usage Referred Daily 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 When done Usage Gel (plain) tube. by appointment at hospital A normal CH50 assay indicates that C1-C9 are present in serum being tested.

CHLAMYDIA ANTIBODIES
Specimen When done Usage Note Gel (SST) tube. Sent to reference laboratory (weekly) Atypical pneumonia. Two specimens 10 - 14 days apart.

CHLAMYDIA PCR
Specimen When done Usage Note Swab or morning first catch urine sample. Daily Urethritis, cervicitis, conjunctivitis. Method of choice for chlamydia antigen detection.

CHLORIDE
Specimen Reference range When done Usage Gel (SST) tube or 24 hour urine. Serum: – 95 - 108mmol/L Urine: 110 – 250 mmol/24 hr Daily Electrolytes and acid base metabolism

CHOLESTEROL
Specimen Reference range When done Usage Gel (SST) tube, preferably with patient fasting. Up to 5.5 mmol/L (NHF recommendation). Desirable Target Level <4.0 mmol/L Daily 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. Serum: 650 – 1500 IU/L Red Cell: 29 – 44 units/g Hb Sent to reference laboratory (fortnightly) Organo-phosphate exposure, scoline hypersensitivity. 34

Reference range When done Usage

Note

Genetic variants can be tested for by dibucaine number and fluoride number in suspected scoline apnoea.

CHROMIUM (Hair)
See Heavy Metals

CHROMOSOMES
Specimen When done Usage Note Heparin tube. Sent to reference laboratory (fortnightly) Congenital and dyssexual syndromes. Must be taken early, on a weekday, so as to reach the reference laboratory in time.

CK
See CREATINE KINASE

CKMB
Specimen Reference range When done Usage Note Gel (SST) tube. Normal: 0 - 25 U/L Post-Infarct: > 25 U/L CKMB Index: 6 - 25% Performed when CK is elevated. When significance of an elevated CK is uncertain. 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 Reference range When done Usage Note Gel (SST) tube. 32-160 ug/L Sent to reference laboratory (weekly) Monitoring Clonazepam therapy. Collect sample at least 4 hours after last dose. The drug has a half-life of approximately 40 hours.

CLOSTRIDIUM DIFFICLE ENDOTOXIN
Specimen When done Usage Faeces Daily Unexplained diarrhoea, antibiotic associated diarrhoea.

CLOTTING PROFILE
See COAGULATION STUDIES 35

CMV SEROLOGY
Specimen When done Usage Note Gel (SST) tube. Daily, (IgG & IgM). Mononucleosis syndrome (negative IM results). IgG antibodies indicate recent or past infection, IgM antibodies indicate recent or current infection.

COAGULATION STUDIES
Specimen When done Usage Note EDTA tube PLUS citrate tube Daily Investigation of coagulation problems 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 When done Usage Gel (SST) tube. Sent to reference laboratory, (Daily). 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 Reference Range When done Usage Note Blood: Heparin or Plain (Gel) tube. Urine: 24 hour urine (No preservative). Blood: 11- 22 umol/L Urine: 0 – 1.0 umol/24 hr Sent to reference laboratory (weekly) Wilson's disease Serum levels reduced and urine levels elevated in Wilson's disease.

CORD BLOOD STUDIES
Specimen When done Usage Note 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. Daily Foetal-Maternal Incompatibility. 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 Reference range When done Usage Note 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 Serum: AM 200 - 700 nmol/L PM 100 - 400 nmol/L – Urine Free Cortisol up to 250 nmol/day Daily Assessment of adrenocortical function. 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 When done Usage

Saliva: AM 5 - 60 nmol/L PM 5 - 30 nmol/L Evening 0 - 15 nmol/L Daily Adrenal function, Helps in responding and coping with stress, trauma, infection, and environmental extremes. Helps regulate blood pressure.

COTININE
Specimen Reference range When done Usage Note Spot urine. 0 – 500 ng/mL Sent to reference laboratory, (Weekly). Detection of nicotine intake. Passive smoking does not give rise to high levels, but will be detected.

C-PEPTIDE
Specimen Reference range When done Usage Heparin tube, after fasting for 12 hours. 0 – 1.6 nmol/L Sent to reference laboratory (weekly) investigation of hypoglycaemia

C-REACTIVE PROTEIN
Specimen Reference range When done Usage Note Specimen Reference range When done Usage Note Gel (SST) tube. 0 - 5 mg/L Daily Inflammatory conditions. Has shorter half life than ESR. Gel (SST) tube. Male: up to 200U/L Female: – up to 180 U/L Daily muscle disease or damage. Elevated levels indicate muscle injury which could be of skeletal, myocardial or smooth muscle origin.

CREATINE KINASE (CK)

CREATININE
Specimen Reference range Gel (SST) tube, or 24 hour urine (No preservative) 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 Usage Note

Daily Renal function. Increased levels indicate reduced glomerular filtration rate. Slightly high levels may be due to large muscle mass

CREATININE CLEARANCE
Specimen Reference range When done Usage Note 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. 1 - 2 mls/sec. Daily Renal Function (glomerular filtration rate). Height and weight required for children. Creatinine clearance is more sensitive than creatinine as an early detector of glomerular dysfunction.

CROSSMATCH
Specimen When done Usage Note EDTA tube PLUS plain (NON-gel) tube. Daily Transfusion of whole blood or packed cells. 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. Patient identification is particularly important.

Identification

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 When done Usage Note Plain (NON-Gel) tube. Specimen must be collected warm (37 degrees) and kept warm until separated. Sent to reference laboratory, (Daily). To investigate Raynaud’s phenomenon, vascular disease and in hepatitis C. 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 When done Faeces samples on 3 consecutive days. Daily

CSF FOR MICRO & CULTURE
Specimen Note Collect into sterile tubes and send immediately to the laboratory. Micro, culture, glucose and protein are performed.

Cu (Hair)
See heavy metals

CYCLOSPORIN A
Specimen Reference range When done Usage Notes EDTA tube 100-400 ng/mL Sent to reference laboratory (fortnightly) Maintenance of therapeutic levels in patients receiving immunosuppressive therapy, to avoid rejection of organ transplants. Increased levels are an early indicator of possible toxicity.

CYSTINE
See AMINO ACIDS

CYTOLOGY OF BODY FLUIDS
Specimen Pleural fluid, peritoneal fluid, cyst aspirate, nippledischarge, 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

When Done

Giemsa stains are done; and wherever possible a cell block (also done on the Cytospin) is prepared. Daily.

CYTOMEGALOVIRUS ANTIBODIES (CMV)
See CMV Serology

D DIMER TEST
Specimen Reference range When done Usage EDTA or Citrate tube (Preferably Citrate). 0 - 0.19 mg/L Immediately. 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 When done Usage Gel (SST) tube. Sent to reference laboratory (fortnightly) Exposure to Dengue Virus.

DEXAMETHASONE SUPPRESSION TEST
See CORTISOL

DHEAS, Saliva
Specimen Reference range Saliva 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 Weekly To monitor hormone replacement therapy.

When done Usage

DHEAS, Serum
Specimen Reference range When done Usage Gel (SST) tube. Male: 2.2 - 15.0 umol/L Female: 0.9 – 12.0 umol/L Sent to reference laboratory, (weekly). Adrenogenital syndrome, hirsutism, virilisation. 41

Note

Increased levels indicative of congenital adrenal hyperplasia or adrenal tumour.

DIBUCAINE NUMBER
See CHOLINESTERASE

DIGOXIN
Specimen Therapeutic range When done Usage Note Gel (SST) tube. 0.8 – 2.6 nmol/L Toxic: > 2.6 nmol/L Daily Confirmation of suspected toxicity. 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 When done Usage Note EDTA tube. Immediately. Haemolytic or drug induced anaemias, haemolytic disease of the newborn. Can be done on the same specimen as FBE.

DIRECT BILIRUBIN
See BILIRUBIN

DNA ANTIBODIES
Specimen When done Usage Gel (SST) tube. Sent to reference laboratory (weekly) 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 When done Usage Note Random urine specimen. Daily Screening test for Methadone and detection of illicit drugs. 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 Opiates Sympathomimetic amines Tricyclic antidepressants Not detected include Pethidine, oxycodone Phentermine (duromine) Detected include Codeine 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 When done Usage Notes Gel (SST) tube. Monday, Wednesday and Friday. Mononucleosis syndrome (negative IM results). IM and post viral syndromes. IgG and IgM are performed.

ELECTROLYTES
Specimen When done Usage Note Gel (SST) tube. Also can be done on a 24 hour urine (unpreserved). Commenced on arrival at the laboratory. Electrolytes, acid-base metabolism and renal function. 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 When done Usage Note Gel (SST) tube. Sent to reference laboratory, (weekly). Systemic rheumatic diseases. 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 When done Usage Gel (SST) tube. Sent to reference laboratory, (Weekly). 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 When done EDTA tube Commenced on arrival at the laboratory. 44

Usage disease. Note

Non-specific indicator of inflammatory and neoplastic 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 Reference Range When done Usage Note 72 hour collection of faeces in single container. 0.0 - 6.0 g/day Sent to reference laboratory. Investigation of malabsorption. 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. Daily Identification of pathogenic organisms (parasitic and bacterial).

When done Usage

FAECES FOR OCCULT BLOOD
Specimen Reference Range 3 small faecal specimens on separate days. Special diet no longer required, and the specimens can be delivered together on third day. Negative 45

When done Usage Note

Daily Screening for colorectal carcinoma and iron deficiency anaemia. 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 When done Usage Note Faeces placed in a special collection container. Daily Identification of faecal pathogens (parasitic and bacterial). 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 When done Usage Specimen When done Note Faeces placed in a special collection container. If specimen cannot reach laboratory within 1 hour, freeze and transport frozen. Daily Sugar intolerance. Faeces placed in a special collection container. Daily Micro and culture, occult blood and Rotavirus can all be done on the same faecal specimen.

FAECES FOR ROTAVIRUS

FAECES FOR TRYPTIC ACTIVITY
Specimen When done Usage Faeces in specimen container. If specimen cannot reach lab immediately, freeze and transport frozen. Sent to reference laboratory. Pancreatic exocrine failure.

FERRITIN
Specimen Reference range When done Usage Note . 46 Gel (SST) tube. Male 30 – 400 ug/L Female 15 – 150 ug/L Daily Investigation of iron deficiency anaemia and haemochromatosis. Part of Iron studies. Raised in inflammation, malignancy liver disorders and iron overload (haemochromatosis). Decreased levels indicate iron deficiency.

FIBRINOGEN
Specimen Reference range When done Usage Note Sodium citrate tube 2.0 - 4.0 g/L. Immediately Investigation of possible acquired or inherited bleeding disorder. 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. Daily 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.

When done Usage

FLOW CYTOMETRY
See LYMPHOCYTE SURFACE MARKERS

FLUORESCENT TREPONEMA ANTIBODIES
Specimen When done Usage Note Gel (SST) tube. Sent to VIDRL. Specific syphilis serology 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

When done Usage

possible. If the volume is small, smears can be made and fixed with spray fixative. Daily Primary diagnosis of neoplasia in superficial and readily accessible lesions.

FLUIDS AND ASPIRATES - MICRO & CULTURE
Specimen When done Usage Place fluid in a sterile container and refrigerate Daily Identification of pathogenic bacteria in superficial and readily accessible lesions.

FNA
See FINE NEEDLE ASPIRATE

FOLIC ACID
Specimen Reference range When done Usage Note Serum Folate: Gel (SST) tube. Red cell: EDTA tube Serum: 6.0 – 33.0nmol/L Red cell: 360 – 1600nmol/L Daily Investigation of macrocytic anaemias. Serum and red cell folate levels are low in megaloblastic anaemia.

FOLLICLE STIMULATING HORMONE (FSH)
Specimen Reference range Gel (SST) tube. 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 Daily Investigation of gonadal and pituitary function.,

When done Usage

FRAGILE X CHROMOSOME
Specimen When done Usage Note Heparin tube Sent to reference laboratory (monthly). Detection of fragile X mutation, in conjunction with cytogenetics. Collection should occur in the morning.

48

FREE ANDROGEN INDEX (FAI)
Specimen Reference range When done Usage Note Gel (SST) tube. Male 40 - 170 Female 0.1 - 7.0 Daily Use in addition to total testosterone to estimate free level. 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 Reference range When done Usage Note Gel (SST) tube. 180 - 285 umol/L Sent to reference laboratory.( weekly) Assessment of diabetic control in a patient in whom glycated haemoglobin cannot be used (increased red cell turnover) Sample should be kept cool and transported as soon as possible.

FULL BLOOD EXAMINATION (FBE)
Specimen Reference ranges When done Usage Note EDTA tube Age dependent. Refer patient reports Daily Anaemia, bacterial and viral infections, IM, bone marrow involvement, inflammatory and neoplastic conditions. Includes haemoglobin, haematocrit, red cell values, white cell count, platelet count,differential count and a blood film examination if indicated..

FUNGAL MICRO & CULTURE
Specimen When done Usage Skin scrapings, nail clippings or scrapings, or epilated hair, placed in a sterile container. Daily. 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 Reference range When done Usage Note Gel (SST) tube. 0 – 5 AU Sent to reference laboratory (Monthly). Identification of diabetic patients with a high risk of developing insulin dependence. 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 Reference range When done Usage Gel (SST) tube. Female: 7 –32 U/L Male: 11 – 50 U/L Commenced on arrival at laboratory. 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 Reference range When done Usage Note Gel (SST) tube. Not detected Sent to reference laboratory (Fortnightly). Test suggestive of pernicious anaemia. Positive in 80% of patients with pernicious anaemia and 40-50% of patients with other organ specific autoimmune diseases.

GASTRIN
Specimen Reference Range When done Usage Gel (SST) tube. Patient must be fasting strictly for 12 hrs. 0 - 115 pg/mL Sent to reference laboratory. (weekly) pernicious anaemia, ZE syndrome.

GENTAMYCIN
See ANTIBIOTIC ASSAY 50

GLIADIN ANTIBODIES
Specimen Reference Range Gel (SST) tube. 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 Sent to Reference Laboratory. (Weekly) Detection of Coeliac disease and dermatitis herpetiformis. 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.

When done Usage Note

GLUCOSE
Specimen Reference Range When done Usage Fluoride-Oxalate tube, fasting if so requested Fasting 3.0 – 6.0mmol/L Random 3.0- 7.7mmol/L Commenced on arrival at laboratory. 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. Commenced on arrival at laboratory. For gestational diabetes (at 26 - 28 weeks).

When done Usage

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 g Normal <6.1 Diabetes mellitus >6.9 Impaired glucose <7.0 tolerance Impaired fasting glycaemia 6.1-6.9 When done Usage Note:

2 hour post glucose <7.8 >11.0 7.8-11.0 <7.8

Commenced on arrival at laboratory. Diabetes diagnosis where fasting or random glucoses are inconclusive. 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 Reference Range When done Usage Note EDTA tube 8.8 – 17.6 U/g Hb Sent to reference laboratory. Congenital haemolytic anaemia. 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 Therapeutic range When done Usage

< 0.5 umol/L. 5.1-10.2 umol/L. Sent to reference laboratory. Gold therapy.

GONORRHOEA PCR
Specimen When done Usage Swab or First catch urine. Weekly. Detection of N. gonorrhoeae.

GROWTH HORMONE
Specimen Reference range When done Usage Gel (SST) tube. Male: < 10 ug/L Female: <20 ug/L Sent to reference laboratory. Diagnosis and monitoring of acromegaly. IGF1 is a better test.

HAEMOCHROMATOSIS PCR
Specimen When done Usage EDTA X2 Sent to reference laboratory (Weekly). To detect the genetic abnormalities in the C282Y and H63D genes.

HAEMOGLOBIN
See FBE

HAEMOGLOBIN A1c
Specimen Reference range When done Usage

EDTA tube Non Diabetic 0 - 5.9 % Good Control 6.0 - 9.0 % Poor Control > 9.1 % Daily 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 Usage Note

Twice weekly, Sent to reference laboratory. Thalassaemia, Haemoglobinopathies. Includes Haemoglobins F and A2 and Test for abnormal haemaglobins.

HAEMOGLOBIN F
See HAEMOGLOBIN ELECTROPHORESIS

HAEMOGLOBIN H INCLUSIONS
Specimen When done Usage Note EDTA tube Daily. Done in suspected Thalassaemia. Insensitive test not done routinely.

HAEMATOCRIT
See FBE

HAIR ANALYSIS
Specimen When done Usage Note 50g of hair (see collection kit details available from laboratory) 2 x week Evaluation of toxic and/or nutrient mineral storage / exposure Accredited test, see also heavy metals

HAPTOGLOBIN
Specimen Reference Range When done Usage Gel (SST) tube. 0.5 - 3.3 g/L Sent to reference laboratory, (Weekly). A low level indicates haemolysis. The level may be raised in acute phase rections.

HEAVY METALS
Specimen When done Usage Note Heparin tube, except lead (EDTA). Hair (see hair collection kit details) or Urine also suitable. Weekly Industrial/Environmental exposure, poisoning. 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 When done Usage Breath test kit provided by laboratory. Sent to reference laboratory daily Detection of Helicobacter pylori organism in GIT.

HELICOBACTER PYLORI SEROLOGY
Specimen When done Usage Note Gel (SST) tube. Sent to reference laboratory, (Weekly). Investigation of peptic ulcers, gastritis. If total antibody is positive, IgG is also tested for.

HEPATITIS A
Specimen When done Usage Note Gel (SST) tube. Daily. Acute hepatitis infection. Total antibody level indicates recent or past infection. Preimmunisation IgM levels indicate recent infection. Gel (SST) tube. Daily. Acute or chronic hepatitis infection. Markers available:HbSAg (infective, new infection or carrier) HbSAb (post vaccination) HbC-IgM (acute infection) HbC-Total (Carrier status & past infection)

HEPATITIS B SEROLOGY
Specimen When done Usage Note

HEPATITIS C ANTIBODIES
Specimen When done Usage Note Gel (SST) tube. Daily Detection of Hepatitis C as the cause of acute hepatitis infection. 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 When done Usage Note Plain (NON-Gel) tube. A separate plain tube must be sent. Sent to VIDRL Confirmatory test of Hepatitis C infection. This test is non-debatable and VIDRL 55

will charge the patient $80.00.

HERPES SIMPLEX ANTIBODIES
Specimen When done Usage Gel (SST) tube. Weekly, Sent to reference laboratory. 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. Daily. Identification of herpes infection by direct immunofluorescence. Culture (q.v.) is preferable.

When done Usage Note

HERPES SIMPLEX CULTURE
Specimen When done Usage Note Fluid or swab in viral transport medium Daily. Identification of herpes infection Types I & II can be distinguished.

HIAA (5-HYDROXY-INDOLE-ACETIC ACID)
Specimen Reference range When done Usage Note 24 hour urine specimen with acid preservative. 5 - 36 umol/day Sent to reference laboratory. Carcinoid tumours. 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

Cardiovascular disease, lipid studies. LDLC is calculated from the formula:LDLC = Cholesterol - (HDLC + Triglyceride/2.2) The formula is not valid for triglycerides greater than 4.5mmol/L

Usage Note

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. Daily Investigation of tissue lesions.

When done Usage

HIV ANTIBODY (AIDS SCREEN)
Specimen When done Usage Note Gel (SST) tube. Daily, Sent to reference laboratory. Diagnosis of HIV infection 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 When done Usage ACD (specific) tubes available from specimen reception on request. Must be booked with Royal Melbourne Hospital. Histocompatability testing for transplantation.

HLA B27
Specimen When done Usage Heparin tube Sent to reference laboratory. Arthritis, collagen disease. Diagnostic test for ankylosing spondylitis 57

HMMA
See VMA

HOMOCYSTEINE
Specimen Reference Range When done Usage EDTA tube 0 – 60 years: 5 – 15 umol/L > 60 years: 5 – 20 umol/L Tri-weekly. 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 Reference range When done Usage Gel (SST) tube or heparin tube or spot urine Quantitatively, levels < 5 mIU/mL are considered to be negative. Qualitatively, positive results are observed at 25 mIU/mL or higher. Daily Pregnancy, This test is sometimes used as a tumour marker but the manufacturers have not designed the test for this purpose.. Blood level becomes positive approximately 10 days after conception, i.e., before next period due.

Note

HYDATID
Specimen When done Usage Gel (SST) tube. Sent to reference laboratory Confirmation of diagnosis of hydatid cysts.

5-HYDROXY-INDOLE-ACETIC ACID
See HIAA

17 HYDROXYPROGESTERONE
Specimen Reference Range Gel (SST) tube. Female: Follicular < 2 nmol/L. Luteal < 8.7 nmol/L. Pregnant < 36.0 nmol/L. Male: <5 nmol/L Sent to reference laboratory 58

When done

Usage

Diagnosis and management of congenital adrenal hyperplasia.

IgA
See IMMUNOGLOBULINS

IgD
See IMMUNOGLOBULINS

IgE
Specimen Reference range When done Usage Note Gel (SST) tube. Adult 0 - 120 U/ml Child 0 - 32 U/ml Daily Allergic diseases. RAST can be performed for certain allergens or groups of allergens.

IGF-1
Specimen Reference range When done Usage Gel (SST) tube. 0.34 - 1.42 U/mL Sent to reference laboratory (Fortnightly). Diagnosis and monitoring of acromegaly

IgG
See IMMUNOGLOBULINS

IgG-SUBCLASSES
Specimen When done Usage Gel (SST) tube. Sent to reference laboratory (daily). 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 Reference ranges When done Gel (SST) tube. Age dependent Daily

59

Usage Note

Investigation of recurrent infections (low levels) and in conditions with raised globulins along with protein electrophoresis.gammopathies. IgA, IgG and IgM are usually done together.

IM TEST (Glandular Fever Test)
Specimen Reference Range When done Usage Note Plain Gel (SST) tube and EDTA tube (for film) Negative Daily Non specific test for IM (glandular fever). 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 Reference Range When Done Usage Notes Gel (SST) tube, acute & convalescent specimens. Four-fold increase in titre is significant Sent to reference laboratory, (weekly). Investigation of serious respiratory infections and atypical pneumonia. 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 Reference Range When done Usage Notes Gel (SST) tube and Fluoride-oxalate tube. Patient must fast for 15 hours before hand. up to 20.0uIU/mL Weekly Insulinomas, Insulin resistance (syndrome x). Glucose should be measured concurrently.

INSULIN - POST PRANDIAL 2 HR
Specimen Reference Range When done Usage Gel (SST) tube and Fluoride-oxalate tube. Patient must have sugar load (glucose drink or high glycaemic meal 2hrs previously). 20 – 80 IU/ml. Weekly 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 Reference Range When done Gel (SST) tube. Negative Sent to reference laboratory, (Monthly).

INTRINSIC FACTOR ANTIBODIES
Specimen Reference Range When done Usage Notes Gel (SST) tube. Negative Sent to reference laboratory, (Weekly). Diagnosis of pernicious anaemia. Positive result is sufficient to establish the diagnosis. Specimen should be taken one or more weeks after any B12 administration.

IRON
Specimen Reference range When done Usage Note Gel (SST) tube. Female: – 9 - 27 umol/L Male: – 10 - 30 umol/L Daily Investigation of iron status. 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 Reference Range When done Usage Note Gel (SST) tube. 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 Daily Investigation of iron status. Includes iron, transferrin and ferritin.

61

Interpretation of Iron Studies Results

Iron Iron deficiency Iron deficiency + acute phase response Acute phase response Iron overload Decreased Decreased

Iron Binding Capacity Increased Normal or decreased

Transferrin Saturation Decreased Normal or decreased

Ferritin Decrease d “Normal” <100 ug/L

Trial of Oral Iron Haemoglobin normalises Partial response

Decreased Decreased

Decreased Normal or decreased

Decreased Increased

Increased Increased

No response Not 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 Reference range When done Gel (SST) tube. 211 - 423 U/L Daily

LACTIC ACID
Specimen Reference range When done Usage Fluoride Oxalate (Call lab first). 0.5 - 2.2 mmol/L Sent to reference laboratory. 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 Reference range When done Usage Heparin or EDTA tube. Unexposed 0.0 – 0.72 umol/L Sent to reference laboratory. Industrial exposure, poisoning.

LEAD (Pb), Hair
Specimen Reference Range When done Usage Hair (50 g) in envelope or urine jar. (Special hair collection kit available from lab) 3 – 51 ppm Weekly. Industrial exposure, poisoning. Spot urine OR 24 hour urine (No preservative) Unexposed < 60 ug/L Sent to reference laboratory. Industrial exposure, poisoning.

LEAD (Pb), Urine
Specimen Reference range When done Usage

LEGIONELLA ANTIBODIES (SEROLOGY)
Specimen When done Usage Gel (SST) tube. Sent to reference laboratory, (Weekly). Investigation of pneumonia, fever.

LEGIONELLA ANTIGEN
Specimen When done Usage Notes Spot urine Sent to reference laboratory, (Weekly). Investigation of severe or unresponsive pneumonia. Detects only L. pneumophilia Group 1 Antigen

LEGIONELLA CULTURE
Specimen When done Fluid, sputum or tissue from suspected site. Sent to reference laboratory, (Weekly).

LEPTOSPIRA SEROLOGY
Specimen When done Usage Gel (SST) tube. Sent to reference laboratory, (Weekly). Suspected leptospirosis. 63

LFT
See Liver Function Tests

LH
See Luteinizing Hormone - Serum

LIPASE
Specimen Reference Range When done Usage Gel (SST) tube. 13 - 60 units/L same day Suspected pancreatitis.

LIPIDS - SERUM/PLASMA
See CHOLESTEROL

LIPOPROTEIN (a)
Specimen Reference Range When done Usage EDTA tube 0 – 270 mg/L Daily. Part of Cardio-vascular profile, Independent factor

LIPOPROTEIN ELECTROPHORESIS
Specimen Reference Range When done Usage Notes Get (SST) tube or EDTA tube, collected after minimum 12hr fast. Qualitative Test. Sent to reference laboratory. Investigation of hyperlipidaemias. Patient must fast for 10 hours. The main importance of this testing is to identify patients with a Type III pattern.

LITHIUM - SERUM
Specimen Reference range When done Usage Gel (SST) tube. Therapeutic: 0.5 – 1.0 mmol/L Daily Therapeutic monitoring. Collect either pre dose (trough) or 12 hours post dose sample.

LIVER FUNCTION TESTS
Specimen Reference Ranges Gel (SST) tube. See individual analytes 64

When done Usage Note

Daily Liver function/status. Includes total protein, albumin, ALT, Alkaline Phosphatase, Total bilirubin, and Gamma GT.

LUPUS ANTI-COAGULANT SCREEN
Specimen Reference Range When done Usage Notes 10 mls Sodium citrate. Negative Must be received in laboratory in morning to arrive at Reference Laboratory on same day. Test done once a week. Investigation of prolonged APTT not corrected by normal plasma. SLE, Vascular thrombosis and recurrent foetal loss. Tests include Kaolin Clot Time, Dilute Russell Viper Venom, Platelet Neutralisation. Lupus anticoagulant presents in 5 - 10% of SLE patients.

LUTEINISING HORMONE
Specimen Reference range Gel (SST) tube. 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 Daily Investigation of gonadal and pituitary disease Raised LH/FSH ratio in a female is suggestive of PCOS

When done Usage Notes

LYME DISEASE
See Borellia Serology

LYMPHOCYTE SURFACE MARKERS
Specimen When done Usage Notes Heparin and EDTA tubes. Sent to reference laboratory. Diagnosis and monitoring of immune deficient states, or unexplained lymphocytosis, e.g. viral infections, leukaemia and lymphoma. 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 When done Usage Note

Serum: 0.7 – 1.1 mmol/L Red Cell: 1.70 - 2.80 mmol/L Daily. (Red Cell sent to reference laboratory). to investigate cause of hypocalcaemia or monitor patients at risk of developing hypomagnesaemia such as oncology patients. Decreased levels due to increases in renal loss, usually from alcohol, antibiotics or oncology medication

MAGNESIUM (Mg), Hair
Specimen Reference Range When done Usage Hair (50 g) in envelope or urine jar. (Special hair kit available from lab) 30 - 122 ppm Weekly. Industrial exposure, poisoning.

MAGNESIUM (Mg), Urine
Specimen Reference Range When done Usage 24 hour urine 2.5 – 6.3 mmol/24hr Weekly. Industrial exposure, poisoning.

MALARIAL PARASITES - (THICK & THIN FILMS)
Specimen Reference Range When done Usage Notes EDTA tube Negative Daily Malaria, PUO. 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 Reference Range When done Usage Note Gel (SST) tube or lithium heparin tube. Serum: 8 – 24 nmol/L Whole blood: 200-800 nmol/L Sent to reference laboratory. Industrial exposure, poisoning. 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 Reference Range When done Usage Hair (50 g) in envelope or urine jar. (Special hair kit available from lab) 0.25 – 0.75 ppm Weekly. Industrial exposure, poisoning.

MANTOUX
Specimen Reference Range Note Patient is given an injection of tuberculin and the size of response measured after 48-72 hours <5mm Negative Please phone Supervising Pathologist at Laboratory

MC&S
See MSU

MCH
See FBE

MCHC
See FBE

MCV
See FBE

MEASLES SEROLOGY - IgG & IgM
Specimen When done Usage Gel (SST) tube. IgG and IgM levels twice weekly. Investigation of suspected measles.

MELATONIN
Specimen Reference Range When done Usage Notes Saliva 5mL plain tube x 4 specimens (9-11pm, 3-4am, 68am, 12pm). If single specimen only should be 3am. 0 – 5.0 pg/mL (daytime) > 10 pg/ml (nocturnal) Weekly Depression, sleep disorders, jet lag, cancer marker. Daytime without stimulation. Regulates sleep and wake cycle.

MERCURY, Blood (Hg)
Specimen Reference range Heparin tube 0 – 20 nmol/L 67

When done Usage

Sent to reference laboratory. -weekly Industrial exposure, poisoning.

MERCURY, Hair (Hg)
Specimen Reference range When done Usage Notes Hair, (50 g) in envelope, MSU jar or hair collection kit 1.25 – 7.6 ppm Weekly. Industrial exposure, poisoning. Hair collection kit available from laboratory

MERCURY, Urine (Hg)
Specimen Reference range When done Usage 24 hour urine (No preservative) < 0.2 micromol/24 hr > 0.5 micromol/24 hr indicates probable poisoning Sent to reference laboratory- weekly. Industrial exposure, poisoning.

MICROALBUMIN (Albumin Excretion Rate)
Specimen Reference range When done Usage 12 hr timed or 24 hour urine (No preservative) 0-15 ug/min. Daily Early detection of diabetic nephropathy.

MRSA SCREEN, (Methicillin Resistant S. Aureus)
Specimen When done Usage Note Swab of infected site area to be tested. Daily Detection of the presence of MRSA. Three MRSA negative swabs taken 1 or 2 weeks apart suggest MRSA carriage has been terminated.

MSU
See URINE MIDSTREAM

MUMPS SEROLOGY
Specimen When done Usage Gel (SST) tube. IgG levels twice weekly. 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 When done Usage Note Plain Gel (SST) tube. Sent to reference laboratory. Detection of Mycoplasma pneumoniae as a possible cause of pneumonia. 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) Daily (Mon-Fri) To diagnose infection from injury through contaminated collection equipment.

When done Usage

NEUTROPHIL ALKALINE PHOSPHATASE (NAP)
Specimen Reference Range When done Usage Note Heparin 30-180 Daily (Mon - Fri) Inflammatory and malignant conditions. Differentiates chronic myeloid leukaemia (low NAP value) from reactive leucocytosis (high NAP value)

NEUTROPHIL CYTOPLASMIC ANTIBODIES
See ANCA

NEUTROPHIL FUNCTION
Specimen When done Usage Notes Heparin tube. Daily (Mon-Fri) Investigation of recurrent pyogenic or fungal infections. Test rarely used. 69

NORADRENALINE
See CATECHOLAMINES

OCCULT BLOOD
See FAECES FOR OCCULT BLOOD

OESTRADIOL - Saliva (E2, Estradiol, 17B Estradiol)
Specimen Reference range Saliva Male 0 - 15 pmol/L Female Follicular Phase < 20 pmol/L Luteal Phase 30 - 60 pmol/L Post-menopausal < 15 pmol/L Daily (Mon-Fri). Fertility & menstrual problems, feminisation, gynaecomastia.

When done Usage

OESTRADIOL - Serum (E2, Estradiol, 17B Estradiol)
Specimen Reference range Gel (SST) tube. 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 Daily (Mon-Fri). Fertility & menstrual problems, feminisation, gynaecomastia.

When done Usage

OPIATES
See DRUG SCREEN

OSMOLALITY (Measured) - Serum/Plasma
Specimen Reference range When done Usage Gel (SST) tube. 280 - 300 mOsmol/kg Sent to reference laboratory. 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. An increased osmolar gap indicates the presence of alcohol or other osmotically active substances. Spot Urine in MSU container 70

Note

OSMOLALITY (MEASURED) - Urine
Specimen

Reference range When done Usage

40-1400mOsmol/kg Sent to reference laboratory. To determine concentrating ability.

OSMOTIC FRAGILITY (RED CELL FRAGILITY)
Specimen When done Usage EDTA tube Same day (Sent to reference lab) Confirms hereditary spherocytosis.

OVA & PARASITE EXAMINATION - FAECES
See Faeces - Ova, Cysts & Parasites

OXALATE - Urine 24 hrs
Specimen Reference range When done Usage Notes 24 hour urine collection with hydrochloric acid as preservative 0 – 0.34 mmol/24 hr Sent to reference laboratory. Renal, GIT disease, ethylene glycol poisoning. Urinary calculi. 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 Therapeutic range Gel (SST) tube. 60 - 120 umol/L Toxicity: Moderate (4 hrs): < 800 umol/L Severe (4 hrs): > 2000 umol/L Severe (12 hrs): > 330 umol/L Sent to reference laboratory, (Daily). Assessing toxic overdose of paracetamol. 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.

When done Usage Note

PARAINFLUENZA VIRUS IMMUNOFLUORESCENCE
Specimen When done Gel (SST) tube. 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 When done Usage Note Gel (SST) tube. Sent to reference laboratory. (once a fortnight) Assessing patients with hypercalcaemia or suspected hypoparathyroidism. Positive results favour the possibility of idiopathic hypoparathyroidism. Negative results do not however exclude the possibility of idiopathic hypoparathyroidism.

PARATHYROID HORMONE (PTH)
Specimen Reference Range When done Usage Gel (SST) tube. 1.4 - 5.7 pmol/l weekly 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 Reference Range When done Gel (SST) tube. Negative Sent to reference laboratory, (Weekly).

PCV
See FBE

PHENOBARBITONE - Serum
Specimen Therapeutic range Gel (SST) tube. 40 - 150 umol/L 72

When done Usage Note

Sent to reference laboratory. Therapeutic Drug Monitoring of phenobarbitone or primidone. 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 Reference Range When done Usage Heparin tube 40-120umol/L Sent to reference laboratory. Diagnosis and monitoring of phenylketonuria and maternal hyperphenylalaninaemia.

PHENYTOIN (DILANTIN)
Specimen Therapeutic range When done Note Gel (SST) tube. 40 - 80 umol/L Daily Collect pre-dose (trough). Please record time and amount of last dose on request form.

PHOSPHATE - Plasma/Serum (PO4)
Specimen Reference range When done Usage Notes Gel (SST) tube, or 24 hour urine without preservative. Serum: 0.6 - 1.4 mmol/L Urine: 10.0 - 40.0 mmol/24 hr Daily Bone disease, 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 Range Fortnightly by Austin Hospital Non-stress: 3-10ng/mL

PLASMINOGEN ASSAY
Specimen Therapeutic range When done 5mL Sodium Citrate 75-140% Fortnightly, referred daily to reference lab.

PLATELET ANTIBODIES, DIRECT (Platelet Associate Immunoglobulin)
Specimen When done Usage Note 10 mls EDTA blood. or [2 x EDTA tubes], Collect in a separate tubes from the FBE tube. Daily (Mon - Fri) Investigation of probable immune thrombocytopenia. 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 Range When done Note Gel (SST) tube. Total IgG <25% Every 2 days, referred daily to reference lab. May be tested with or without addition of drugs. Please specify drug type

PLATELET COUNT
Specimen Reference range Usage Note EDTA tube 150 – 400x10 ^9/l Done immediatly Coagulation (history of excessive and/or inappropriate bleeding, bruising), monitoring, monitoring heparin therapy, post splenectomy monitoring. 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. see report Sent to reference laboratory. Porphyrias. Collect on a weekday morning so the sample can be sent to reference laboratory the same day. If positive, relevant porphyrins can be measured.

Reference range When done Usage Note

POTASSIUM
Specimen Reference range When done Usage Note Gel (SST) tube, or 24 hour urine without preservative. Plasma 3.5 – 5.0 mmol/L Urine 25 - 100 mmol/day Daily Electrolytes, Renal function. 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 Reference Range When done Note Gel (SST) tube. Therapeutic: 23 - 55 umol/L Sent to reference laboratory (Daily). 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 Reference ranges Saliva 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 Weekly Menstrual or fertility problems, ovarian or adrenal disease. 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. Gel (SST) tube. 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 Daily
Menstrual or fertility problems, ovarian or adrenal disease.

When done Usage Note

PROGESTERONE, Serum
Specimen Reference ranges

When done Usage 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 Reference range When done Usage Gel (SST) tube. Male 62 - 435 mIU/L Female, Pre-menopausal 29 - 718 mIU/L Daily 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 Reference Range: When done Usage Gel (SST) tube. 0 - 4.0 ng/ml Daily 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 Reference range When done Usage Gel (SST) tube. Serum 60 - 83 g/L Daily Liver function, malabsorption, protein loss, renal disease.

PROTEIN, Urine
Specimen Reference range When done Usage Spot urine or 24 hour urine, without preservative. Spot urine: < 0.10 g/L 24 hour urine: < 0.14 g/day Daily Proteinuria may be due to physiological, tubular and glomerular proteinuria.

PROTEIN C, PROTEIN S, Plasma
Specimen Reference range When done Usage Note 10 mls sodium citrate (2 Citrate tubes) Chromogenic: Protein C: 70 - 140 % Chromogenic Protein S: 66 - 149 % Sent same day to Reference Lab (Mon-Fri). Investigation of tendency to venous thromboembolism. Specimen should be collected prior to anticoagulant being commenced.

PROTEIN ELECTROPHORESIS, serum
Specimen When done Usage Note Gel (SST) tube. Sent to reference laboratory. Detection of paraprotein bands A urine should accompany the serum specimen. Further investigations may be required to characterise abnormalities. See also paraprotein typing.

PROTEIN ELECTROPHORESIS, Urine
Specimen When done Usage Spot urine Sent to reference laboratory. 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 Reference range When done Usage Citrate Tube Normal 0.8 - 1.2 INR Therapeutic 2.0 - 4.5 INR (depends on condition) Immediately Investigation of coagulation, controlof oral anticoagulant therapy.

PSEUDOCHOLINESTERASE
See CHOLINESTERASE

PSITTACOSIS SEROLOGY
Specimen Reference range When done Note Gel (SST) tube, acute & convalescent specimens. four (4)-fold increase is significant Sent to reference laboratory. 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 Reference range When done Usage Citrate Tube Normal 23 - 35 seconds Therapeutic 45 - 85 seconds Immediately Control of heparin therapy, screen for coagulation abnormality.

PYRIDINOLINE CROSS LINKS (DPD)
Specimen Reference range Spot urine 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 Sent to reference laboratory Bone resorption markers. Useful diagnosis of osteoporosis.

When done Usage

78

PYRIDOXINE
See VITAMINS

PYRUVATE KINASE
Specimen Reference Range When done Usage Notes Heparin or EDTA tube Normal or Deficient (quantitative test). Sent to reference laboratory - once a week. Investigation of non-spherocytic haemolytic anaemia. Low levels confirm pyruvate kinase deficiency.

Q FEVER SEROLOGY
Specimen When done Usage Gel (SST) tube. Sent to reference laboratory. Diagnosis of suspected Q fever.

QUADRUPLE TEST
See TRIPLE TEST

QUANTIFERON ASSAY
Specimen When done Usage Note Heparin tube Sent to reference laboratory. A measure of past exposure to TB. Must be tested within 2 hours of collection.

QUINIDINE
Specimen Reference Range When done Usage Note Gel (SST) tube. 5 – 17 umol/L Sent to reference laboratory, (Daily). Maintenance therapy to prevent atrial fibrillation. Specimen should be collected prior to next dose and time of last dose noted.

RAST
Specimen When done Usage Note Gel (SST) tube. once a week Investigation of allergy. 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 When done Usage 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 Sent to reference laboratory - Once a week. Prior arrangements with laboratory necessary. 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 Reference range When done Usage Notes Nasopharyngeal Swab and RSV Slide. NEGATIVE Weekly. Investigation of severe respiratory illness in infants (bronchiolitis, pneumonia, croup). 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 Normal Range When done Usage Note EDTA tube. Specimen must be < 6 hrs old. 0.5-2.0 % Daily Assessment of anaemia. 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 When done Reference Range Gel (SST) tube. Sent to reference laboratory, (Weekly); Assay only rarely performed. 0.26-0.54 nmol/L

80

RHEUMATOID FACTOR (RA TEST)
Specimen Reference range When done Usage Gel (SST) tube. < 10 IU/mL Daily Rheumatoid arthritis, systemic rheumatic disorders.

RIBOFLAVINE
See VITAMINS

RIVOTRIL (CLONAZEPAM)
See DRUGS, THERAPEUTIC

ROSS RIVER ANTIBODIES
Specimen When done Usage Gel (SST) tube. Sent to reference laboratory, (Weekly). Rheumatoid arthritis, systemic rheumatic disorders.

ROTAVIRUS
See FAECES FOR ROTAVIRUS

RPR
Specimen When done Usage Gel (SST) tube. Daily. Non-specific test for syphilis, equivalent to WR, VDRL, etc.

RUBELLA ANTIBODIES
Specimen When done Usage Gel (SST) tube. IgG Daily IGM Daily IgG antibodies are performed to assess immunity and IgM antibodies to detect recent infection.

SALICYLATE
Specimen Reference Range When done Usage Gel (SST) tube. Therapeutic: 1-2.5 mmol/L Toxic: > 3.0 mmol/L Sent to Reference Laboratory, (Daily). Primarily for detection of overdose. Occasionally used for therapeutic monitoring.

81

SALIVARY HORMONES
Specimen Reference Range When done Usage Saliva Plain 5mL tube multiple samples may be required for certain hormone evaluations. See Individual Report Daily 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 . See also individual hormones or phone laboratory to receive “Saliva Hormone Testing-Practitioners Reference manual”. See HEAVY METALS

Note

SELENIUM SEMEN ANALYSIS FOR INFERTILITY
Specimen Usage Specimen preferably produced by masturbation, following 3 days of abstinence, placed in a clean container. Male infertility.

SEMEN ANALYSIS, POST VASECTOMY
Specimen Usage Collected as for semen analysis for infertility, but does not need to be sent to the laboratory within 1 hour. 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. Antibiotics other than those routinely performed are available on request.

Note

SEX HORMONE BINDING GLOBULIN (SHBG)
Specimen Reference range Gel (SST) tube. Male: 9 - 111 nmol/L 82

When done Usage Note

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 Weekly. Virilisation, adrenal and gonadal tumours, 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 Reference range When done Usage Notes Gel (SST) tube. Not detected Sent to reference laboratory (Fortnightly). Assessing patients documented with Myasthenia gravis. Acetylcholine receptor antibodies should also be requested. A positive result indicates that the possibility of thymoma should be actively investigated.

SKIN SCRAPINGS
See FUNGAL MICRO & CULTURE

SMOOTH MUSCLE ANTIBODIES
Specimen When done Usage Note Gel (SST) tube. Sent to reference laboratory (Weekly). Suspected autoimmune hepatitis. Elevated titres are characteristic of autoimmune hepatitis . Lower levels are non-specific and may be seen in viral infections.

SODIUM, Serum
Specimen Reference range When done Gel (SST) tube. Serum – 135 - 145 mmol/L Commenced on arrival at the laboratory 83

Usage Note

Electrolyte, Renal function. Diuretic therapy is a common cause of hyponatraemia.

SODIUM, Urine
Specimen Reference range Usage Spot urine specimen without preservative. <20 mmol/L indicates volume depletion (dehydration), or salt depletion. It excludes the diagnosis of SIADH. When done Commenced on arrival at the laboratory 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 Note 3 separate early morning specimens in a sterile container, sent daily to the laboratory. Cytology can also be done on the same specimens.

STEROIDS
Specimen When done Note 24 hour Urine (No preservative) Sent to Reference laboratory. 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 Reference range When done Usage Note Gel (SST) tube. Male 31.0 - 163 nmol/L Female 2.5 - 12.5 nmol/L Sent to Reference laboratory. Hirsutism, virulisation, adrenal and gonadal tumours. Not as readily available as free androgen index.

TESTOSTERONE, TOTAL, Serum
Specimen Reference range When done Usage Gel (SST) tube. Male 9.7 - 38.2 nmol/L Female 0.4 - 2.7 nmol/L Weekly Hirsutism, virulisation, adrenal and gonadal tumours. Recommend SHBG as well.

TESTOSTERONE, TOTAL, Saliva
Specimen Reference range When done Usage Saliva 25 – 190 pmol/L Weekly Hirsutism, virulisation, adrenal and gonadal tumours.

THALASSAEMIA SCREEN
See HAEMOGLOBIN ELECTROPHORESIS

THEOPHYLLINE
Specimen Reference range When done Usage Note Gel (SST) tube. 55 - 110 umol/L Sent to reference laboratory, (Daily). Therapeutic monitoring. 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 Reference range When done Usage Note Gel (SST) tube. < 50.0 ug/L Sent to reference laboratory. Detection of tumour recurrence in thyroid cancer. Thyroglobulin antibody be requested also 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 When done Usage Gel (SST) tube Twice weekly Must be measured to ensure thyroglobulin results are valid.Raised in Hashimoto’s thyroiditis but Thyroid peroxidase antibodies are more sensitive.

THYROID ANTIBODIES
Specimen When done Note Usage Gel (SST) tube. Weekly Thyroglobulin and thyroid peroxidase antibodies are tested. 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 Reference range Gel (SST) tube. TSH: 0.5 – 3.5 mIU/L FT3: 2.2 - 5.4 pmol/L FT4: 9.0 - 24.0 pmol/L 86

When done Usage Note

Daily Thyroid function. Consists of TSH, and if clinically indicated, FT3 & FT4 are performed.

THYROID PEROXIDASE ANTIBODIES
Specimen Reference Range When Done Usage Gel (SST) tube <35 IU/ml Twice weekly Diagnosis of Hashimoto’s Thyroiditis and other autoimmune thyroid disease. See Thyroid Antibodies.

THYROID STIMULATING HORMONE (TSH)
Specimen Reference range When done Usage Note Gel (SST) tube. 0.5 – 3.5 IU/L Daily Confirms hypothyroid and hyperthyroid states. Monitoring of thyroid replacement or suppressive therapy. 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 Reference range When done Usage Note Gel (SST) tube. 9.0 - 24.0 pmol/L Daily Thyroid function and monitoring of patients on thyroid replacement therapy. TSH should be used to monitore thyroxine replacement therapy.

TISSUE TYPING
Specimen When done Usage Note ACD tubes - Contact laboratory Sent to reference laboratory Transplant donor or recipient, some genetic linked diseases. The test MUST be booked with reference laboratory, so ring laboratory first.

TOXOPLASMA ANTIBODIES
Specimen Gel (SST) tube. 87

When done Note Usage

Weekly IgG or IgM antibodies are performed. Suspected toxoplasmosis.

TPHA (TREPONEMA PALLIDUM HAEMAGGLUTINATION)
Specimen When done Usage Gel (SST) tube. Daily Specific test for syphilis. RPR also tested.

TRANSFERRIN
Specimen Reference Range When done Usage Gel (SST) tube. 2.0 - 3.6 g/L Daily Usually performed as part of iron studies including serum iron, transferrin, and ferritin.

TRIGLYCERIDES
Specimen Reference range When done Usage Gel (SST) tube, must be fasting. 0.5 - 2.0 mmol/L Commenced on arrival at laboratory. Lipid studies, cardiovascular disease.

TRI-IODO-THYRONINE FREE, (FT3)
Specimen Reference range When done Usage Gel (SST) tube. 2.2 - 5.4 pmol/L Daily Hyperthyroid states.

TRIPLE TEST / QUADRUPLE TEST
Specimen When done Usage Notes Gel (SST) tube. Sent to reference laboratory. Identification of pregnancies at high risk of Downs Syndrome. 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 Reference range When done Usage Notes Gel (SST) tube. 0 – 1.0 ng/mL Daily Sensitive and specific test for diagnosis of myocardial infarction. Elevation of Troponin I occurs within six hours of chest pains and lasts for about seven days.

TSH RECEPTOR ANTIBODIES (LATS)
Specimen Reference range When done Usage Note Gel (SST) tube. -15 to +15 units Sent to reference laboratory, (fortnightly). Graves’ disease. Antibodies are present in more than 80% of patients with Graves’ disease.

UBIQUINONE (COENZYME Q10)
Specimen When done Reference Range Usage Note: Lithium Heparin Sent to reference laboratory. 709 – 1392 nmol/L To monitor therapeutic and supplementation levels. Specimen must be received by laboratory within 1 hour of collection. See Bilirubin

UNCONJUGATED BILIRUBIN UREA, Serum
Specimen Reference range When done Usage Note Gel (SST) tube. 2.8 - 7.6 mmol/L Daily Renal function. 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 Reference range Gel (SST) tube, or 24 hour urine with alkaline preservative added (Contact the laboratory). 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 Usage

Daily 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. Daily Investigating possible urinogenital malignancies. Identification of malignant cells and their possible site of origin. The presence of infection or inflammation can also be detected and crystals may also be seen.

When done Usage Note

URINE HORMONE EVALUATIONS
Specimen When done Tests 24 Hour Urine or first morning void. Sent to reference laboratory weekly Following analytes can be tested: Aldosterone Cortisol Estrogen Metabolism Growth Hormone Progesterone Status Testosterone Thyroid Hormones 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. For further information please phone laboratory to obtain a “Urinary Hormone Testing-Practitioner Reference manual”.

Usage

Note

URINE METABOLIC SCREEN
Specimen When done Spot urine Sent to reference laboratory

URINE MICRO & CULTURE
Specimen When done Mid-stream specimen, catheter specimen, supra-pubic, aspirate or paediatric bag specimen, keep refrigerated. 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 When done Note 3 separate early morning samples, sent to the laboratory each day. Daily 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 Therapeutic range When done Note Gel (SST) tube. 350 - 700 umol/L Daily Collect immediately before next dose (trough). Record date and time of last dose. Hepatotoxic levels >700 umol/L.

VARICELLA ZOSTER ( CHICKEN POX ) ANTIBODY
Specimen When done Usage Gel (SST) tube. Daily Identification of chicken pox or zoster.

VASOPRESSIN (Anti-Diuretic Hormone)
Specimen Reference range When done Usage Heparin or EDTA tube 2.0 – 8.0 pg/mL Sent to Reference Laboratory (Monthly). 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. Weekly. May take several weeks to grow.

When done Note

VITAMIN B12
Specimen Reference range Gel (SST) tube. 140 – 780 pmol/L 91

When done Usage

Daily. Macrocytic anaemias

VITAMINS
Specimen When done Note Heparin tube. (plain for Vit D) Protect from light by wrapping in foil. Sent to reference laboratory. Vitamins A, B1, B6, C, D, and E, or a full screen can be performed.

VMA (VANILLYLMANDELIC ACID)
See Catecholamines

WHOOPING COUGH (PERTUSSIS)
Specimen Note Nasopharyngeal swabs are plated directly onto special agar, so should be collected at the laboratory. Also, sputum or pharyngeal aspirate can be placed in a sterile container and sent for immunofluorescent studies.

WHOOPING COUGH ANTIBODIES (PERTUSSIS)
Specimen When done Usage Gel (SST) tube. Sent to Reference Laboratory Detection of Whooping cough in its early stages, along with the swab culture.

WIDAL SEROLOGY
Specimen When done Usage Gel (SST) tube. Sent to MDU Enteric Fevers.

ZARONTIN (Ethosuximide)
Specimen When done Reference range Gel (SST) tube. Sent to Reference Laboratory Therapeutic: 284-568 umol/L

ZINC
Specimen When done Usage Reference Range Serum: (Gel) tube 11 - 18 umol/L Plasma: Heparin tube As above. 24 Hour Urine: 8 - 11 umol/24hrs. Sent to reference laboratory, (weekly). 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™ Closure & Tube Content Catalogue Number & Volume

Determinations

Instructions

367895 10ml Plain

Minimum two patient Blood groups, Cross-matching Identifiers for all samples.

General Biochemistry (Cardiac Enzymes, Lipids / Fats, LFT, Renal Function tests, Therapeutic Drugs) Endocrinology (Hormones, TFT’s, B12 and Folate, Tumor Markers), 367958 8.5ml SST II Serology (TORCH serology, EBV, RPR, TPHA, HIV, Hepatitis Serology), Iron Studies. Immunology (ANA, Tissue Autoantibodies, ENA, Complements, Immunoglobulins, RAST, Rheumatoid Factor, Protein & Immunofixation, electrophoresis, IM test),

367691 4.5ml Sodium Citrate

Coagulation Studies, Antithrombin III, INR, Fibrinogen, APCR, Protein C, Protein S, D. Dimer

FBE, ESR, Platelets, Hb-EPG, HLA-B27, Red Cell Folate Reticulocytes. 367839 4ml EDTA Most Vitamins (not B12) & Heavy Metals. GHb (HbA1c), For vitamins, wrap specimen in foil as soon as possible after collection

367885 6ml

Most Vitamins, Heavy Metals (Pb, Hg, Cd), T & B-cell studies Chromosome studies, Pesticides, Organophosphates, Organochlorines.

Lithium Heparin

367934 4ml Fluoride Oxalate

Glucose, Lactate, GTT, Insulin.

Please specify fasting status.

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

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