87 path handbook 14th edition intranet b

Bayside Health

PATHOLOGY HANDBOOK

14th EDITION FEBRUARY 2004

CONTACTING THE SERVICE DETAILS ON PAGE (iv)

GENERAL ENQUIRIES—9276 3888 FAX—9276 3781 ALFRED PATHOLOGY SERVICE FOR— ￭ ALFRED HOSPITAL ￭ CAULFIELD GENERAL MEDICAL CENTRE ￭ SANDRINGHAM & DISTRICT MEMORIAL HOSPITAL

——∞——

ALFRED PATHOLOGY SERVICE

TABLE OF CONTENTS

NOTES ABOUT THIS BOOK .................................................................... (iii)

SERVICE TELEPHONE DIRECTORY .........................................................(iv)

GENERAL NOTES ABOUT SERVICE ........................................................(ix)

ALFRED HOSPITAL ........................................................................(vi)

CAULFIELD GENERAL MEDICAL CENTRE................................... (vii)

SANDRINGHAM & DISTRICT MEMORIAL HOSPITAL .............. (viii)

SPECIMEN COLLECTION AND IDENTIFICATION ....................................(x)

ALPHABETIC LIST OF TESTS......................................................... 1⎯102

APPENDICES— A. BIOPSY SERVICE.....................................................................................103

B. CYTOLOGY SERVICE ...............................................................................105

C. NECROPSY SERVICE ...............................................................................109

D. ANTIBIOTIC ASSAYS..............................................................................110

E. THERAPEUTIC DRUG PHARMACOKINETICS ...........................................112

F. DRUG IDENTIFICATION...........................................................................113

G. IRON STUDIES ........................................................................................114

H. GLUCOSE TOLERANCE TESTS ................................................................115

I. BLOOD BANK LABORATORY —Table of Blood Order Schedule for Elective Procedures..........................117

J. SNAKE VENOM DETECTION....................................................................128

K. PAEDIATRIC COLLECTION REQUIREMENTS............................................129

L. COAGULATION TESTS —Table of Reference Ranges ...................................................................130

M. FULL BLOOD EXAMINATION —Table of Reference Ranges ...................................................................131

N. COMMON BIOCHEMISTRY TESTS —Table of Reference Ranges ...................................................................132

O. CONTAINERS FOR PATHOLOGY SPECIMENS..........................................133

(i)


BAYSIDE HEALTH PATHOLOGY HANDBOOK 14th Edition, January 2004

Alfred Pathology Service

Commercial Road, Melbourne 3004,

Melbourne, Australia.

Edited by Robert Leonard in collaboration with senior medical and scientific staff.

filename =Phb_04_draft_j

© Text copyright Alfred Pathology Service, 2004. All rights reserved.

© Design by Robert Leonard, 1996. All rights reserved.

(ii)


NOTES ABOUT THIS BOOK

SCOPE OF BOOK This book lists pathology tests and procedures that are reasonably often requested. Alfred Pathology Service (APS) handles all Pathology tests and, for those not listed here, consultation is suggested.

TESTS AND PROCEDURES Tests and procedures are listed alphabetically, with cross–references where thought helpful. Entries that consist of large tracts of text, or that are stand–alone instructions, appear as appendices.

DRUG NAMES Drugs are listed—and should be requested—under their generic names. A few cross–references are included where the trade name has common usage.

SPECIMENS REQUIRED Results of pathology tests can only be interpreted in relation to the specimen analysed. If an incorrect specimen type is supplied, or the specimen is incorrectly handled, results may be meaningless or totally misleading. Please read notes on Patient and Specimen Identification, page(xi).

REFERENCE RANGES Unless stated otherwise, Reference Ranges are for adults. Paediatric ranges not listed in this book may be obtained from the laboratory. Many Reference Ranges depend on methodology and so may change during the life of this book.

For results viewed on a computer terminal, or printed on a report, the appropriate age/sex Reference Range is always provided.

NOTES/ENQUIRIES— Particular features or limitations of some tests are highlighted under ‘Notes/Enquiries’. However, it is not possible, or intended in this book, to say everything of importance about each test.

(iii)


SERVICE TELEPHONE DIRECTORY

When calling from outside the Alfred Hospital dial 9276 before the extension number.

GENERAL ENQUIRIES and RESULTS (24 hours) ...................3888

Accounts Queries......................... ...................................................... 2442

Specimen Collection and Reception (ALFRED) ...................................3888

—— For CGMC see page (vii). For SDMH see page (viii) —— Collection Supervisor ...................Donna Williams ............................... 3140 Reception Supervisor ................... ...................................................... 3102 Blood Collection—For late rounds (11:00—13:00) pager 4421 .................... 3140

Anatomical Pathology .........................................................................3150 Head............................................Prof. John P. Dowling..................... 3155 Senior Scientist ...........................John Hall ........................................ 2767

Clinical Biochemistry...........................................................................3888 Head............................................A/Prof. Hans Schneider................... 3081 Senior Scientists .........................David Rutherford ............................ 3080 ...................................................Joe D’Agostino ............................... 3033 STAT Laboratory......................... ...................................................... 3554 Drug Laboratory .......................... ...................................................... 3049

Endocrinology and Diabetes................................................................2460 Head............................................A/Prof. Duncan Topliss ................... 3493 Consultant...................................Prof. J. Stockigt ............................. 2387

Haematology ........................................................................................3116 Head............................................A/Prof. Alison Street....................... 3120 Senior Scientists .........................Geoff Magrin .................................. 3266 ...................................................Damian McVeigh............................. 3082 Laboratory................................... ...................................................... 3116 Blood Bank .................................. ............................................3100, 3104

(iv)


Immunology ..........................................................................................3616

Clinical Immunologist ...................Prof. Ban Hock Toh ..................5030713 ...................................................Mobile ..............................0419 770 041

Microbiology ........................................................................................3089 Head............................................A/Prof. Denis Spelman .................... 3073 Senior Scientists .........................Jennifer Williams ............................ 3388 ...................................................Clare Franklin ................................. 3292 Main Laboratory .......................... ...................................................... 3089 Microbiology Serology ................. ...................................................... 3354 Molecular Biology Laboratory ...... ...................................................... 3516

Pathology Executive ............................................................................3118 Director .......................................A/Prof. Hans Schneider................... 3118 Principal Managing Scientist........Robert Leonard ............................... 2829 Quality Officer .............................Cathy O’Dwyer............................... 2689 Finance Officer ............................Noelene Browne ............................. 3112 Clinical Trials Enquiries ................Sarah Green ................................... 2725

Pathology Computing ..........................................................................3031 (ISIS—Investigative Services Information Systems) Team Leader................................Phuong Pham.................................. 2383 Team Leader................................Leanne Arnold................................. 2345 Hospital Computing Help Desk ..... ...................................................... 3300

CAULFIELD GENERAL MEDICAL CENTRE ........................ see p. (vii)

Pathology Collection Centre ...............................................................6712

SANDRINGHAM & DISTRICT MEMORIAL HOSPITAL.... see p. (viii)

Pathology Collection Centre & Enquiries.........................................11555

Pathology Laboratory ........................................................................11247

(v)


ALFRED HOSPITAL

LOCATION & CONTACTS

Laboratories—are located on the ground floor of the Main Ward Block, towards the rear (south) of the building.

Collection Centre—is located on the ground floor of the Main Ward Block, in the major east-west corridor (behind the Post Office/Newsagency).

Staff—See page (iv) for a listing of senior staff and contact numbers.

LABORATORY SERVICE HOURS

STAFF ON DUTY Mon—Fri Sat—Sun

AFTER HOURS TESTING

Core Laboratory 24 Hours 24 Hours See next paragraph

Anatomical Path 08:00—17:30 (On call) Page via switch

Microbiology 08:00—20:30 08:00—17:00 Page via switch

The Alfred has many acutely ill patients so after–hours staff are often extremely busy. Pressure to perform routine testing jeopardises the critical care service.

SPECIMEN COLLECTION

Urgent specimens must be collected by doctors or ward nurses. Important........See SPECIMEN COLLECTION AND IDENTIFICATION on page (x).

Inpatient Collection Service.............. Routine rounds from 07:00—11:00 daily A collector is also available from 11:00—13:00, on beeper 4421

Outpatient Collection Room ............................Monday—Friday, 08:00—17:00

At the Alfred, request forms completed by 18:00 each day are pre–registered into the pathology computer. This expedites specimen collection and processing, and so provides results sooner. Early completion of request forms is encouraged.

NOTE—If it is convenient for them, outpatients of the Alfred can also have their blood taken at the CGMC or Sandringham Collection Centres. It is generally easier to find car parking at these sites.

(vi)


CAULFIELD GENERAL MEDICAL CENTRE

LOCATION & CONTACTS

The Pathology Collection Centre is located on the first floor of the acute building, adjacent to the Consulting Suites. Alfred Pathology couriers make regular pick-ups from this point.

Specimen Collection and Reception ...................................................6712 Senior Collector .......................................................................... Patsy Dale

ENQUIRIES (INCLUDING RESULTS)

During Collection Centre Hours ........................................................ Ext. 6712

All Hours Biochemistry ................................................................ 3888 Haematology ................................................................ 3888 Microbiology................................................................. 3089 Anatomical Pathology................................................... 3150

COLLECTION CENTRE HOURS

Monday to Friday ......................................................................08:30—17:00

Saturday ...................................................................................09:00—11:00

NOTE—Outpatients of The Alfred Hospital and Sandringham & Memorial District Hospital may attend this collection centre if it is more convenient for them.

WARD COLLECTION ROUNDS

Monday to Friday ........................................ 07:00—10:30 and 11:00—12:00

Saturday ...................................................................................07:00—09:00

Sunday ......................................................Collection service does not operate

Collection rounds for Extended Care, Hostel and Rehabilitation are only between the hours 07:00—09:30 on Monday—Friday.

DOMICILIARY NURSE

A Domiciliary Nurse operates between 09:30—15:00 and must be booked through the Collection Centre, Ext. 6712.

(vii)


SANDRINGHAM & DISTRICT MEMORIAL HOSPITAL

LOCATION & CONTACTS

The Pathology Collection Centre and Laboratories are located adjacent to the Consulting Suites in the north-west corner of the site.

Laboratory ..........................................................................................11247 Senior Scientist & Site Manager............................................ Patricia Ablitt

Collection............................................................................................11555 Senior Collector ......................................................... Bo Kozlowski-Gorecki

SERVICES • Inpatient Collection. • Outpatient Collection. • On-site laboratory. • STAT analysers in the Emergency Department. • Full 24-hour analytical and consultation service. • On-site supply of Blood Products (Ward G3).

SPECIMEN COLLECTION INPATIENTS Monday to Friday ..................................... Rounds at 07:30, 11:00 and 13:30 Page 6351 for urgent collection 07:30—15:15 Weekends & Pub. Hols.................. Rounds and beeper between 07:30—12:30

OUTPATIENTS Monday to Friday ......................................................................08:00—17:30 Weekends........................................................ Mornings, by appointment only

LABORATORY Monday to Friday Between 08:00—17:30, the on-site laboratory provides the routine and emergency Biochemistry, Haematology and Blood Banking service. After hours STAT testing is available in Emergency Department. Other tests are sent to the central laboratory in Prahran.

(viii)


GENERAL NOTES ABOUT SERVICE

LABORATORY HOURS & TESTS PERFORMED

All pathology tests may be sent to APS. A comprehensive range of routine and special tests is performed on–site. Rare and selected special tests are forwarded to accredited external laboratories. APS is also responsible for many ward–based analysers and other Point-Of-Care testing.

TURN–AROUND TIME & URGENT REQUESTS

Tests important to immediate patient care are performed on demand. Most other common tests are performed daily. Less–common and complex tests may take longer, especially if sent to an external laboratory or requested after-hours.

Four things determine the turn–around time for urgent requests— • How long it takes the specimen to reach the laboratory. • How long the analysis takes. • How easy it is to return the results—we need a pager or phone number. • How busy the laboratory is—it is impossible to handle every specimen with top

priority; please do not mark everything ‘urgent’.

REPORTS AND FILE ENQUIRY Results are available for enquiry on computer terminals as soon as they are validated. It is usually quicker—and always more reliable—to obtain results from a terminal than from a telephone call.

Results are phoned or faxed if this is requested and a contact number supplied.

Cumulative reports for each admission are printed at patient discharge. Interim reports are issued for some locations, according to demand.

TEST REQUESTS (PLEASE HELP ACCURACY BY WRITING CLEARLY)

A single form may be used for all tests except Blood Bank. Note the legal and practical requirements for—

• adequate patient and specimen identification (see page xi) • tests in the doctor’s handwriting • name and signature of requesting doctor and the request date • patient location and financial classification • relevant clinical notes • doctor’s beeper or telephone number (a space is provided on the form).

(ix)


SPECIMEN COLLECTION AND HANDLING

Test results are meaningless or—worse—totally misleading unless obtained from valid specimens. A valid specimen is one collected from the correct patient, in the correct container and receiving the correct handling.

CORRECT PATIENT

See the instruction on the following page regarding minimum identification requirements for patients and specimens.

CORRECT CONTAINER

Many tests rely on the specimen being collected into a specific container, for example, with EDTA anticoagulant. The required container for each test is listed in this book.

Also, on the rear cover there is a chart that summarises the appropriate containers for common tests. Containers are described in more detail in Appendix O.

CORRECT HANDLING

Transport—many specimens require special handling, such as being transported while packed in ice or sent to the laboratory with minimal delay.

Contamination—For hospitalised patients, a common source of misleading results is contamination of the specimen with i.v. fluid. Contamination can cause high results (e.g. infusion of a concentrate), low results (dilution of specimen) or can have unpredictable effects (e.g. drug interference with analytical reaction).

Haemolysis—Haemolysis releases cellular contents, notably potassium, into plasma. It can also cause interference with analytical reactions and so haemolysed specimens are unsuitable for many tests, including all serology. In vitro haemolysis can be caused by excessive drawing or expelling pressure on a syringe, or by use of a small–bore needle. NB for ward–based analysers—even specimens taken from cannulas may be haemolysed. Haemolysis cannot be seen in whole blood!

(x)


PATIENT AND SPECIMEN IDENTIFICATION In the interests of patient safety, all specimens must be accurately labelled. Minimum identification for all Request Forms and Specimens is—

FULL NAME (Family Name plus at least first Given Name)

plus

UR NUMBER* (of the Hospital where currently admitted)

* (if no valid UR number is available, supply patient’s Date of Birth (day, month, year format).

NO TESTING WILL BE PERFORMED UNLESS ALL THE FOLLOWING CRITERIA ARE MET—

1. The Request Form must bear the minimum Patient Identification (if not, no specimens should be collected).

2. The Request Form must have the Collection Certification completed with the Printed Name and Signature of the person who collected the sample(s).

3. Each Specimen must bear the minimum Patient Identification. 4. Each Pre-Printed Label on a specimen must bear the Collector’s signature

or initials. 5. Patient Identification on the Request Form must not conflict in any way

with the Patient Identification on the Specimen. IF ANY OF THE ABOVE CRITERIA IS NOT MET—

• The specimen(s) will not be analysed. • The collector will be notified. Where this is not possible, another doctor or

nurse will be notified. NOTES

• Any discussion related to application of these criteria MUST be directed to the relevant Pathologist on-call. No discussion will be entered into by Specimen Reception staff.

• In the absence of a valid Group & Screen, O-negative un-crossmatched blood can be issued immediately in urgent situations.

(xi)


——∞——

(xii)


ACID PHOSPHATASE, PROSTATIC—blood 1. PROSTATE SPECIFIC ANTIGEN (PSA) has replaced this test

for investigating prostatic carcinoma —see page 81. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3888.

ACTH 1. See—ADRENOCORTICOTROPHIC HORMONE Notes/Enquiries—

ACTIVATED PARTIAL THROMBOPLASTIN TIME—blood 1. Acronym/Synonym—APTT Notes/Enquiries— 2. This test is insensitive to therapeutic doses of Low Molecular

Weight Heparin (see—ANTI-Xa ASSAY). 3. APTT may be artefactually shortened if the venesection is

traumatic or artefactually prolonged if the tube is ‘under-filled’ or the patient has a raised haemoglobin/haematocrit.

4. See also—COAGULATION TESTS (regarding specimen collection) and ANTICOAGULANT THERAPY CONTROL.

5. Enquiries—Haematology, Ext. 3109. Citrate plasma (tube C3); add exactly 2.7 mL of blood and mix by inversion. ...................................................................... 26—38 seconds IV heparin therapeutic range .................... 48—100 seconds

Specimen required—

Reference range—

ACTIVATED PROTEIN C RESISTANCE 1. Acronym/Synonym—APCR Notes/Enquiries— 2. May identify venous thrombotic risk. 3. Can be performed on patients taking Warfarin and/or Heparin. 4. See also—FACTOR V LEIDEN 5. Enquiries—Haematology, Ext. 3109.

Citrate plasma (tube C3); add exactly 2.7 mL of blood and mix by inversion. ................................................................... 2.00—2.86 (ratio)


Reference range—

Fourteenth Edition, 2004 Page 1


ADENOVIRUS 1. This is a PCR-based assay (assay sent out). Notes/Enquiries— 2. Enquiries—Microbiology, Ext. 3354.

Blood—EDTA blood (separate tube E9) Tissue— Either unfixed or in VTM CSF, NPA, BAL—Plain Container Eye Swab—in VTM.


ADRENALINE 1. See—CATECHOLAMINES Notes/Enquiries—

ADRENOCORTICOTROPHIC HORMONE—blood 1. Acronym/Synonym—ACTH Notes/Enquiries— 2. Consultation with endocrinologist suggested. 3. Enquiries—Clinical Biochemistry, Ext. 3076.

Collect in the morning between 8—10 am EDTA blood (tube E9) on ice. Send to laboratory for immediate centrifugation. at 8—10 am...........................................................< 46 ng/L


Reference range—

ALANINE AMINOTRANSFERASE—blood 1. Acronym/Synonym—ALT, ALAT Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3076.

Serum (tube SG8) or heparin plasma (tube HG8). ...............................................................................< 40 U/L

Specimen required— Reference range— Notes/Enquiries— 1. Acronym/Synonym—ALB

2. Enquiries—Clinical Biochemistry, Ext. 3076. Serum (tube SG8) or heparin plasma (tube HG8). ..............................................................................35—52 g/L

Specimen required— Reference range—

ALBUMIN—urine 1. Acronym/Synonym—’micro–Albumin’ Notes/Enquiries— 2. This test not indicated if urine Total Protein > 0.3 g/L. 3. Enquiries—Clinical Biochemistry, Ext. 3076.

24 hour collection in a PLAIN bottle. .............................................................................< 29 mg/d


Page 2 Pathology Handbook


ALCOHOL 1. See—ETHANOL Notes/Enquiries—

ALDOSTERONE—blood 1. Blood levels are not appropriate as an initial investigation.

Used as part of protocols available on consultation. Notes/Enquiries—

2. Serum aldosterone has substantial physiological variation and interpretation may be difficult. Plasma renin activity is a more useful initial test in the evaluation of hypertension.

3. Aldosterone/Renin ratio has a limited role in the evaluation of hypertension; it will be calculated only if full clinical and drug therapy details are provided (further information on request).

4. Enquiries—Clinical Biochemistry, Ext. 3141. Serum (tube SG8). Deliver to laboratory within 2 hours. Recumbent..................................................... 30—440 pmol/L Ambulant ..................................................... 110—860 pmol/L Note: These ranges are for serum or heparin plasma. EDTA plasma yields results approximately 15% higher.

Specimen required— Reference ranges—

ALDOSTERONE—urine 1. Aldosterone excretion is, physiologically, inversely influenced

by sodium status and must be interpreted in relation to sodium excretion.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3141. 24 hour collection in a PLAIN bottle; keep refrigerated during collection. Send to laboratory immediately on completion. Reference Range is related to salt intake— High Salt Intake ................................................. < 17 nmol/d Normal Salt Intake ........................................... 17—69 nmol/d Low Salt Intake.............................................. 47—122 nmol/d


Reference ranges—

ALKALINE PHOSPHATASE—blood 1. Acronym/Synonym—ALP Notes/Enquiries— 2. Reference range is for adults. Higher levels seen during

infancy, childhood and adolescent growth periods, pregnancy, and in adults over 60 years.

3. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). .............................................................................< 110 U/L




ALKALINE PHOSPHATASE ISOENZYMES—blood 1. Test not indicated unless total ALP is significantly elevated. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) or heparin plasma (tube HG8). Qualitative assessment is made of a stained electrophoretic strip and a report issued on the tissue source of the isoenzyme (ie. bone, liver, intestine or placenta).

Specimen required— Report—

ALP 1. See—ALKALINE PHOSPHATASE Notes/Enquiries—

alpha–1 ANTITRYPSIN 1. See—ANTITRYPSIN, alpha–1 Notes/Enquiries—

alpha–FOETOPROTEIN 1. See—FOETOPROTEIN, alpha Notes/Enquiries—

alpha–SUBUNIT GLYCOPROTEIN HORMONE—blood 1. Indicated in investigation of some pituitary tumours. Notes/Enquiries— 2. Enquiries— Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8). .................................................................printed with results


ALT 1. See—ALANINE AMINOTRANSFERASE Notes/Enquiries—

ALUMINIUM—blood 1. Consult Duty Biochemist if the test is required for other than

assessment of aluminium toxicity in dialysis patients. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3141. Metal-free hearin plasma in a special container (tube M7). Normal subjects ............................................... < 0.8 µmol/L




AMIKACIN—blood 1. See also—ANTIBIOTIC ASSAYS (APPENDIX D, page 110) Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3076.

Serum (tube SG8), pre–dose & 30 min. post—dose. Request should specify dose, route, time(s) of dose/infusion and time of sample collection. Pre-dose..................................................................< 5 mg/L Post-dose......consult Aminoglycoside Consulting Service (Ext. 3579)


Therapeutic range—

AMINO ACIDS—urine 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

20 mL urine (early morning specimen, delivered immediately). Comment on pattern of amino acid excretion.

Notes/Enquiries— Specimen required— Report—

AMINOLEVULINIC ACID, delta– —urine 1. Acronym/Synonym—ALA Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

AMIODARONE—blood 1. Desethylamiodarone, the major active metabolite of

Amiodarone, will also be measured. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3049. Pre–dose. Serum (tube SG8) or heparin plasma (tube HG8). Amiodarone (+Desethylamiodarone) .................... < 6 µmol/L


AMMONIA—blood 1. Acronym/Synonym—NH3 Notes/Enquiries— 2. False high levels are obtained after muscular exercise and

with incorrectly handled specimens. 3. Enquiries—Clinical Biochemistry, Ext. 3076.

EDTA blood (tube E3). Pack in ice and deliver immediately. ........................................................................15—55 µmol/L


AMOEBIASIS 1. Amoebic Serology—by Indirect Immunofluorescence Notes/Enquiries— 2. Enquiries—Microbiology, Ext. 3354.

• Serology—Serum (tube SG8). • Exam. for Cysts and Trophozoite—faeces in SAF fixative.




AMPRENAVIR—blood 1. Acronym/Synonym—AMPR Notes/Enquiries— 2. All Protease Inhibitors can be analysed on the same

specimen. 3. Enquiries—Clinical Biochemistry, Ext. 3049 (assay sent out).

EDTA blood (tube E9). ................................................................................... Consult

Specimen required— Therapeutic range—

AMYLASE—blood 1. Acronym/Synonym—AMS Notes/Enquiries— 2. Blood amylase is transiently elevated in acute pancreatitis,

usually returning to normal within 48 hours. Elevation of urinary amylase (diastase) may persist for up to 72 hours.

3. Falsely high values may occur with the following drugs—codeine, morphine, pethidine and pancreozymin.

4. Non–pancreatic causes of elevated amylase include—perforated peptic ulcer, appendiceal abscess, ectopic pregnancy, mumps, parotitis, dissecting aneurysm and intestinal obstruction.

5. Enquiries—Clinical Biochemistry, Ext. 3076. Serum (tube SG8) or heparin plasma (tube HG8). ............................................................................. 23—96 U/L


AMYLASE—urine 1. For investigation of chronic pancreatitis. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3076.

24 hour collection in a PLAIN bottle. .............................................................................< 400 U/d


ANCA (Anti-Neutrophil Cytoplasmic Antigen) 1. See—AUTOANTIBODY TESTS Notes/Enquiries—

ANDROSTENEDIONE, delta 4– —blood 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8) or heparin plasma (tube HG8). .................................................................printed with results

Notes/Enquiries— Specimen required— Reference range—



ANGIOTENSIN CONVERTING ENZYME—blood 1. Acronym/Synonym—ACE Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8). Fasting specimen preferred. ............................................................................. 30—90 U/L


ANION GAP—blood 1. Calculation: (NA + K) – (CL + BIC) = Anion Gap. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

........................................................................12—20 mmol/L Reference range—

ANTI… 1. See also—AUTOANTIBODY TESTS for "Anti–" tests. Notes/Enquiries—

ANTIBIOTIC ASSAYS 2. See—Individual test names and APPENDIX D (page 110) Notes/Enquiries—

ANTICARDIOLIPIN ANTIBODIES—blood 1. May be associated with arterial/venous thrombosis. Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3114.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. ................................................................................. Negative


Reference range—

ANTICOAGULANT THERAPY CONTROL 1. See—Alfred Hospital Anticoagulant Guidelines. Notes/Enquiries— 2. HMO's are required to familiarise themselves with the

discharge responsibilities for patients on oral anticoagulants, i.e. requirements for ‘Alfred@Home’ or the Anticoagulant Clinic (ACC) if the patient is to be followed at the Alfred, or notification of local medical officer. Referral forms to ACC, which are available in wards or from Haematology, must be completed. All queries about anticoagulant therapy should be directed to the Haematology clinical staff.

3. Enquiries—Haematology, Ext. 3075.



ANTIGEN RECEPTORS (IMMUNOGLOBULIN & T CELL) GENE REARRANGEMENT STUDIES

1. See—BONE MARROW EXAMINATION Notes/Enquiries—

ANTIPHOSPHOLIPID ANTIBODIES 1. See—ANTICARDIOLIPIN ANTIBODIES Notes/Enquiries— 2. See also—LUPUS ANTICOAGULANT

ANTI–STREPTOCOCCAL DNAse B—blood 1. Enquiries—Microbiology Serology, Ext. 3354.

Serum (tube SG8). Adults Children ≤ 200 U/mL—Normal ≤ 300 U/mL—Normal > 200 U/mL—Raised > 300 U/mL—Raised

Notes/Enquiries— Specimen required— Interpretation—

ANTI–STREPTOLYSIN O TITRE—blood 1. Acronym/Synonym—ASOT Notes/Enquiries— 2. Because ASOT elevation is not a reliable marker of all

streptococcal syndromes (especially pyoderma), anti–streptococcal DNAse B is also routinely measured in samples sent for ASOT.

3. Enquiries—Microbiology Serology, Ext. 3354. Serum (tube SG8). Normal .....................................................................≤ 200 IU High titre.................................................................> 200 IU (Evidence of recent β–haemolytic Streptococcal infection)

Specimen required— Interpretation—

ANTITHROMBIN III—blood 1. Acronym/Synonym—AT III Notes/Enquiries— 2. Results are not valid while the patient is receiving heparin. 3. Enquiries—Haematology, Ext. 3109.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. Functional ........................................................... 86%—134%


Reference range—



ANTITHYROID PEROXIDASE ANTIBODIES 1. Acronym/Synonym—AntiTPO Antibodies, ATA Notes/Enquiries— 2. Thyroid autoimmune disease is the major factor underlying

hypothyroidism and hyperthyroidism and tends to occur in a genetically-predisposed population. In virtually all cases of Hashimoto’s disease and in the majority of Grave’s disease cases, TPO auto antibodies are elevated.Thyrotropin Receptor Antibodies may also aid the diagnosis of Graves Disease.

3. Anti-Thyroglobulin Antibody (ATG) can be sent to an outside laboratory, but only after consultation with A/Prof. Duncan Topliss or a Chemical Pathologist.

4. Enquiries—Clinical Biochemistry, Ext. 3141. Serum (tube SG8) or EDTA blood (tube E3). ............................................................................. < 35 kU/L


ANTITRYPSIN, alpha–1—blood 1. Acronym/Synonym—AAT Notes/Enquiries— 2. If indicated, alpha–1 Antitrypsin phenotyping is available.

Consult Duty Biochemist. 3. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) or heparin plasma (tube HG8). ........................................................................0.88—1.74 g/L


ANTI Xa ASSAY—blood 1. Used for monitoring therapeutic doses of LMW heparin ( e.g.

Clexane) and heparinoid (e.g. Orgaran). Notes/Enquiries—

2. A pre–dose level should be measured when the creatinine clearance is known or estimated to be below 0.5 mL/sec. If the pre–dose level is at the higher end or above the reference range, please discuss with the Haematologist (Ext. 3075).

3. Clexane measured against Fragmin standard. 4. Enquiries—Haematology, Ext. 3109.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. Keep at room temperature and deliver to the laboratory within 60 minutes. Orgaran.............................................................0.3—0.8 U/mL Fragmin.............................................................0.5—1.0 U/mL Clexane and Fraxiparine ......................................... See note 3


Reference range—



APOLIPOPROTEINS—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

EDTA blood (tube E3) preferred. Heparin plasma (tube HG9) is acceptable. .................................................................printed with results

Notes/Enquiries— Specimen required—

Reference ranges—

APTT 1. See—ACTIVATED PARTIAL THROMBOPLASTIN TIME Notes/Enquiries—

ARSENIC 1. Consult Duty Biochemist. Ext 3076. Notes/Enquiries—

ASCITIC FLUID 1. See—FLUIDS Notes/Enquiries—

ASIALOTRANSFERRIN 1. See—TRANSFERRIN, ASIALO– Notes/Enquiries—

ASOT 1. See—ANTI–STREPTOLYSIN O TITRE Notes/Enquiries—

ASPARTATE AMINOTRANSFERASE—blood 1. Acronym/Synonym—AST, ASAT Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3076.

Serum (tube SG8) or heparin plasma (tube HG8). ...............................................................................< 50 U/L


ASPERGILLUS PRECIPITINS—blood 1. Enquiries—Microbiology Serology, Ext. 3354 (assay sent out).

Serum (tube SG8). Notes/Enquiries— Specimen required—

AST 1. See—ASPARTATE AMINOTRANSFERASE Notes/Enquiries—



AUTOANTIBODY TESTS—blood 1. Individual tests must be clearly specified. “Autoantibody

Screen” is NOT acceptable. Notes/Enquiries—

2. Enquiries— (Tests marked ) Anat. Path., Ext. 2767 (Tests marked ◊) Immunology, Ext. 3616.

Serum (tube SG8). Specimen required— • Anti–ADRENAL Tests available— • Anti–CENTROMERE ◊ Anti–DOUBLE STRANDED DNA (DDNA)

RIA, Reference range ... ........................0—6 U/mL • Anti–ENDOMYSIAL ◊ Anti–EXTRACTABLE NUCLEAR ANTIGENS (ENA)—

Including U1RNP, Sm, Ro, La, Scl 70, Jol • Anti–GASTRIC PARIETAL CELL ◊ Anti-GLIADIN

Reference ranges ......... IgA ......................< 34 U .................................... IgG ......................< 42 U

• Anti–HEART ◊ Anti–HISTONES ........................ ...........................< 25 U ◊ Anti–INTRINSIC FACTOR .......... ......................0—10 U/mL • Anti–LIVER–KIDNEY MICROSOME • Anti–MITOCHONDRIA ◊ Anti–MYELOPEROXIDASE (MPO)

Reference range........... ........................0—8 U/mL • Anti–NEURONAL—Including Purkinje Cell • Anti–NEUTROPHIL CYTOPLASMIC (ANCA) • Anti–NUCLEAR

Hep–2000 cells, Reference range.......0—100 titre ◊ Anti-PROTEINASE 3 (PR3)

Reference range........... ........................0—8 U/mL • Anti–RETICULIN • Anti–RIBOSOME • Anti–SKELETAL MUSCLE • Anti–SKIN—Basement Membrane, Intercellular Substance • Anti–SMOOTH MUSCLE



AUTOHAEMOLYSIS 1. Only perfomed after consultation with a Haematologist, and

then by appointment (Ext. 3114) on Mon., Tue. or Wed. only. Notes/Enquiries—

2. Enquiries—Haematology, 3114 10 mL of blood in a special (sterile, preservative-free) sodium heparin tube obtained from Haematology. After 48 hours incubation at 37°C— Without added Glucose...................................0.2—2.0% Lysis With added Glucose........................................0.0—0.9% Lysis


Reference ranges—

AUTOPSY 1. See— NECROPSY SERVICE (Appendix C, page 109) Notes/Enquiries—

AVIAN PRECIPITINS—blood 1. The species of bird must be supplied. Notes/Enquiries— 2. Enquiries—Microbiology Serology, Ext. 3354 (assay sent out).

Serum (tube SG8). Specimen required—

BENCE–JONES PROTEIN 1. See—LIGHT CHAINS Notes/Enquiries—

Beta–2–GLYCOPROTEIN 1. Enquiries—Haematology, Ext. 3114 (assay sent out).

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. .................................................................. printed with result


Reference range—

beta–HCG 1. See—CHORIONIC GONADOTROPHIN Notes/Enquiries—

beta–HYDROXYBUTYRATE 1. See—HYDROXYBUTYRATE, beta Notes/Enquiries—

beta–2–MICROGLOBULIN 1. See—MICROGLOBULIN, beta–2 Notes/Enquiries—

beta–2–TRANSFERRIN 1. See—TRANSFERRIN, ASIALO– Notes/Enquiries—



BETHESDA ASSAY—blood 1. This quantifies antibodies to specific coagulation factors. Notes/Enquiries— 2. By consultation with Haematologist. 3. Enquiries—Haematology, Ext. 3109.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion.


BICARBONATE—blood 1. Acronym/Synonym—Total CO2 Notes/Enquiries— 2. Measurement must occur within a few hours of sampling.

Bicarbonate will not be measured on old specimens. A calculated “actual bicarbonate” is part of Blood Gases.

3. Enquiries— Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). ........................................................................21—32 mmol/L


BILIRUBIN, CONJUGATED—blood 1. Acronym/Synonym—CBIL, Direct Bilirubin Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). ........................................................................... < 6 µmol/L


BILIRUBIN, TOTAL—blood 1. Acronym/Synonym—TBIL Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). Male ................................................................. < 21 µmol/L Female .............................................................. < 15 µmol/L


BIOPSY SERVICE (Including Surgical Pathology) 1. See—APPENDIX A (page 103) Notes/Enquiries—

BLOOD BANK 1. See—APPENDIX I (page 117) Notes/Enquiries—



BLOOD CULTURES 1. Only one set of blood cultures is required prior to

commencement of antibiotic therapy. Notes/Enquiries—

2. For patients with suspected bacterial endocarditis, 2 to 3 sets taken at different times should be sufficient to establish the diagnosis.

3. Enquiries—Microbiology, Ext. 3089. Add 10 mL blood to each of an aerobic bottle and an anaerobic bottle.


BLOOD CULTURES for MYCOBACTERIA 1. This test is for Mycobacterium avium complex (MAC) sepsis

in HIV antibody positive patients. Notes/Enquiries—

2. Enquiries—Microbiology, Ext. 3089. Add 3—5 mL blood to one MB/Bact bottle. These are available from Microbiology.


BLOOD FILM 1. See—FULL BLOOD EXAMINATION Notes/Enquiries—



BLOOD GASES, ARTERIAL—blood 1. Acronym/Synonym—BG Notes/Enquiries— 2. SYRINGES WITH THE NEEDLE STILL ATTACHED WILL NOT

BE ACCEPTED! 3. Arterial blood collections must be performed ONLY by

appropriately trained staff. 4. Collect specimens into special sampling devices, carefully

following manufacturer's instructions. Expel any air bubbles. 5. Only a limited range of tests can be performed on a Blood

Gas sample. For additional tests, a separate specimen must be obtained by venepuncture.

6. Measured at 37°C; correction for patient temperature is not routinely performed.

7. Actual Bicarbonate and percent Oxygen Saturation are routinely reported.

8. Enquiries—Clinical Biochemistry, Ext. 3554. Use the special Arterial Sampler, or 2 mL arterial blood in a heparinised syringe. MIX THOROUGHLY, pack in crushed ice and take to the laboratory IMMEDIATELY. Mark request form “URGENT”. Breathing room air— pH.......................7.38—7.43 ................... (36—44 nmol/L H+) pCO2 ...................35—45 mm Hg.......................(4.7—6.0 kPa) pO2 .....................75—99 mm Hg...................(10.0—13.3 kPa)


Reference ranges—

BLOOD VOLUME 1. Only by appointment with Nuclear Medicine. Notes/Enquiries— 2. Enquiries—Ext. 2432.

Female Male Red Cell Mass ......................... 20—30............. 28—35 mL/kg Calculated Plasma Volume....... 40—50............. 40—50 mL/kg Total Blood Volume ................. 60—80............. 68—85 mL/kg

Reference ranges—



BONE MARROW EXAMINATION 1. Only by consultation with Laboratory Haematology Registrar;

telephone 3075/3077, Pager 4757. Notes/Enquiries—

2. Not less than 6 hours fasting pre-procedure is required. 3. A Patient Information sheet is available from the

Haematology Unit. • Aspirate • Trephine • Microbial Culture • Cytogenetic Analysis • Immunophenotypic Analysis (Flow Cytometry) • IgH/TCR Gene Rearrangement Studies • Other Specialised and/or Molecular Studies

Testing available—

BRUCELLA AGGLUTINATION TESTS 1. Enquiries—Microbiology Serology, Ext. 3354.


C1 ESTERASE INHIBITOR—blood 1. Enquiries—Immunology, Ext. 3616 (assay sent out).

Serum (tube SG8). Pack in ice and deliver immediately. .................................................................. printed with result


C3 COMPLEMENT—blood 1. Acronym/Synonym—C3 Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8). Deliver as soon as possible. ........................................................................0.79—1.52 g/L


C4 COMPLEMENT—blood 1. Acronym/Synonym—C4 Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8). Deliver as soon as possible. ........................................................................0.16—0.38 g/L




C PEPTIDE—blood 1. May be helpful in distinguishing insulinopenic versus

hyperinsulinaemic forms of diabetes. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3049. Serum (tube SG8) or heparin plasma (tube HG8). Fasting specimen. Pack in ice and immediately deliver to the laboratory for separation. .................................................................. 364—1655 pmol/L


Reference range—

C–REACTIVE PROTEIN—blood 1. Acronym/Synonym—CRP Notes/Enquiries— 2. CRP is an acute phase reactant useful in the diagnosis and

monitoring of acute inflammatory disorders. However, a normal CRP does not exclude the presence of inflammation. CRP is not usually increased in viral infections.

3. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8). ...............................................................................< 5 mg/L


C–REACTIVE PROTEIN, ULTRASENSITIVE—blood 1. A cardiac risk marker, normally only performed on

Outpatients. Notes/Enquiries—

2. If the standard CRP assay result is > 4 mg/L then the ultrasensitive assay will not be performed.

3. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8). ................................................................................<5 mg/L


CA 125—blood 1. CA–125 is a tumour marker that is elevated in approximately

80% of patients with ovarian carcinoma (predominantly epithelial, non–mucinous, cystic types) and may be of value for monitoring selected patients. Do not use for diagnostic purposes as this tumour marker is relatively non–specific.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3141. Serum (tube SG8). ............................................................................. < 35 kU/L




CA 153—blood 1. CA 153 is a tumour marker that is used in conjunction with

other clinical methods for monitoring breast cancer. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3141. Serum (tube SG8). ............................................................................. < 31 kU/L


CA 19–9—blood 1. CA 19–9 is raised in many gastrointestinal malignancies and

also in non–malignant conditions e.g. cholangitis, cirrhosis and pancreatitis. It is most often used as a tumour marker for pancreatic cancer. About 70% of patients with pancreatic cancer have values greater than 70 U/L but 25% have values in the Reference Range. (source: Austin & Repat. Div. Lab. Med.).

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3141. Serum (tube SG8). 96% of healthy subjects have CA–19–9 levels < 37 kU/L 99% of healthy subjects have CA–19–9 levels < 60 kU/L


CADMIUM 1. Consult Duty Biochemist, Ext. 3888. Notes/Enquiries—

CAERULOPLASMIN—blood 1. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) or heparin plasma (tube HG8). ........................................................................0.22—0.58 g/L


CALCITONIN—blood 1. A marker of medullary carcinoma of the thyroid. Notes/Enquiries— 2. Endocrine consultation suggested. 3. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8) or heparin plasma (tube HG8). Pack in ice and deliver immediately to the laboratory for separation. ..............................................................................< 30 ng/L


Reference range—



CALCIUM—blood 1. Acronym/Synonym—CA Notes/Enquiries— 2. Stasis must be avoided when taking blood as prolonged use

of a tourniquet gives falsely high values, as does haemolysis. 3. Serum total calcium rises or falls approximately 0.02 mmol/L

for each g/L change in serum albumin. 4. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). ................................................................. 2.23—2.50 mmol/L


CALCIUM—urine 1. Enquiries—Clinical Biochemistry, Ext. 3554.

24 hour collection in ACID bottle. With restricted calcium diet, collect specimens for calcium measurement on days 5 and 6. Random diet.................................................. 0.2—7.0 mmol/d 400 mg calcium daily for 6 days.................... 0.7—5.3 mmol/d


Reference ranges—

CALCIUM, IONISED—blood 1. May be of value when doubt exists about calcium status in

the presence of hypoalbuminaemia and in acid/base disturbances.

Notes/Enquiries—

2. Where no acid/base disturbance exists, test may be available on retrospective samples.

3. Syringes containing 125 USP units of heparin are unsuitable due to binding of ionised calcium.

4. Enquiries—Clinical Biochemistry, Ext. 3554. Specimen must not be exposed to air. Supply either— Specimen required— • a separate, full Serum container (tube SG8) or— • a venous or arterial specimen collected in a syringe with

low-dose heparin (7 USP units)—as for BLOOD GASES. MIX well and deliver immediately.

................................................................. 1.18—1.35 mmol/L Reference range—



CALCULI 1. Acronym/Synonym—Renal Stones Notes/Enquiries— 2. Urinary calculi can be tested qualitatively for the presence of

ammonium, calcium, cystine, carbonate, magnesium, oxalate, phosphate and urate.

3. Gallstones consist primarily of cholesterol and/or pigment and are not analysed chemically.


CARBAMAZEPINE—blood 1. Acronym/Synonym—Tegretol® Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Pre–dose. Serum (tube SG8) or heparin plasma (tube HG8). Pre-dose...........................................................17—42 µmol/L


CARBON DIOXIDE, TOTAL 1. See—BICARBONATE, see also—BLOOD GASES. Notes/Enquiries—

CARBON MONOXIDE HAEMOGLOBIN—blood 1. Acronym/Synonym—Carboxyhaemoglobin Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Specimen as for BLOOD GASES; delivered to laboratory immediately. Oxalated blood is unsuitable. Non–smokers .............................................. < 2% saturation Smokers.....................................................5—10% saturation


Reference ranges—

CARCINOEMBRYONIC ANTIGEN—blood 1. Acronym/Synonym—CEA Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) or heparin plasma (tube HG8). ............................................................................< 3.0 µg/L The upper limit of the reference range is 5 µg/L in otherwise–normal smokers.


CARDIAC ENZYMES 1. This test group includes only total CK and Troponin. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.



CAROTENES 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8). Pack in ice and protect from light. .................................................................printed with results


CATECHOLAMINES—urine 1. Drugs to avoid before or during urine collection—

Aldomet, methenamine, methenamine hippurate, levodopa, caffeine, aminophylline, theophylline, ethanol, guanethidine and reserpine.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out). 24 hour urine collection in ACID bottle. .................................................................printed with results


CATHETER TIPS 1. Urinary catheter tips will not be cultured as misleading results

are frequent. Intravenous catheter tips should be cultured only when the catheter is suspected to be the cause of sepsis.

Notes/Enquiries—

2. A semi–quantitative count of organisms is made following culture to help distinguish contamination from colonisation.

3. Enquiries—Microbiology, Ext. 3089. With sterile scissors, cut off only the terminal 5 cm of the tip into a dry, sterile container.


CD2/CD3 COUNTS 1. Useful in monitoring Antithymocyte Globulin Therapy. Notes/Enquiries— 2. See—LEUCOCYTE IMMUNOPHENOTYPING

CD4/CD8 COUNTS 1. See—LEUCOCYTE IMMUNOPHENOTYPING Notes/Enquiries—

CD23, soluble 1. Acronym/Synonym—soluble CD23, sol CD23

Serum (tube SG8). ............................................................................ < 2.5 kU/L

Notes/Enquiries— Specimen required— Reference ranges—

CEA 1. See—CARCINOEMBRYONIC ANTIGEN Notes/Enquiries—



CEREBROSPINAL FLUID SPECIMEN COLLECTION 1. Acronym/Synonym—CSF, Spinal Fluid Notes/Enquiries— 2. See also—APPENDIX B, CYTOLOGY SERVICE 3. Enquiries—Microbiology, Ext. 3089 or Anat Path, Ext. 3150.

A collection kit is available from CSSD. Collect into three separate, sterile, screw–capped tubes provided (labelled 1, 2 and 3). Tube 1 is for Biochemistry, Tube 2 for Cytology and Tube 3 for Microbiology. For Flow Cytometry (leucocyte immunophenotyping) an extra tube—with at least 2 mL of CSF—is required.

Specimen collection—

CEREBROSPINAL FLUID—BIOCHEMISTRY 1. Glucose and Protein are determined routinely, see individual

tests for further details. Notes/Enquiries—

2. Glucose result should be compared with plasma glucose taken at the same time.

3. Results on blood–stained CSF are unreliable. 4. Testing for oligoclonal bands performed on request (serum

must also be provided)—see OLIGOCLONAL BANDS of IgG. 5. Enquiries—Clinical Biochemistry, Ext. 3554.

See notes on collection under CEREBROSPINAL FLUID SPECIMEN COLLECTION. At least 1 mL is required. ....................................................... See individual test entries


Reference ranges—



CEREBROSPINAL FLUID—MICROBIOLOGY 1. Out–of–hours—

Notify on–call staff if microscopy and culture required (not usually indicated if CSF is clear macroscopically).

Notes/Enquiries—

2. Special tests available on specific request— • PCR for viruses • Acid fast stain and/or culture for Mycobacteria • Cryptococcal antigen • Serologic tests for syphilis (must be paired with 5 mL serum sample or test will not be done) • Viral serology, if CSF is accompanied by serum sample.

3. Enquiries—Microbiology, Ext. 3089. See notes on collection under CEREBROSPINAL FLUID SPECIMEN COLLECTION. At least 1 mL is required. Third collected tube is preferred.

RBC .................... .....................................................0 x 106/L

WBC ...................Lymphocytes ........................... < 5 x 106/L

...........................Other WBC ....................................0 x 106/L


Reference ranges—

CHLAMYDIA SEROLOGY—blood C. PNEUMONIAE, C. TRACHOMATIS, C. PSITTACI

1. Specify which Chlamydial agent required. Notes/Enquiries— 2. Chlamydia pneumoniae serology is part of Atypical

Respiratory Screen. 3. Enquiries—Microbiology Serology, Ext. 3354.

TWO separate Serum containers (tube SG8) taken 3 weeks apart, for C. pneumoniae and C. psittaci.


CHLAMYDIA TRACHOMATIS INVESTIGATION—urine/swab 1. Enquiries—Microbiol. Serology, Ext. 3354 (assay sent out). Notes/Enquiries— 2. Antigen detection by PCR of Urine or Genital Swab. 3. See also—GONORRHOEA INVESTIGATION

URINE: 15–20 mL of first-stream urine collected at least one hour since the patient last passed urine. Refrigerate immediately. GENITAL SWAB:

Male—urethral swab Female—endocervical swab Collection kits for swabs from Microbiology.




CHLORIDE—blood 1. Acronym/Synonym—CL Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). ..................................................................... 98—107 mmol/L


CHLORIDE—urine 1. Urinary chloride is not routinely analysed. Consult Duty

Biochemist. Notes/Enquiries—


CHOLESTEROL—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554.

FASTING serum (tube SG8) or heparin plasma (tube HG8). The Heart Foundation recommends that serum cholesterol should be < 5.5 mmol/L.


CHOLESTEROL, HIGH DENSITY LIPOPROTEIN—blood 1. Acronym/Synonym—HDL, HDLC Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

FASTING serum (tube SG8) or heparin plasma (tube HG8). Desirable.......................................................... > 1.0 mmol/L


CHOLESTEROL, LOW DENSITY LIPOPROTEIN—blood 1. Acronym/Synonym—LDL, LDLC Notes/Enquiries— 2. LDL is not measured directly, but is calculated using the

Friedewald formula— (LDLC) = (total CHOL) – (HDLC) – (TG/2.2).

3. This formula cannot be used where TG > 4.5 mmol/L. 4. Enquiries—Clinical Biochemistry, Ext. 3554.

FASTING serum (tube SG8) or heparin plasma (tube HG8). Desirable.......................................................... < 3.5 mmol/L




CHOLINESTERASE—blood 1. Acronym/Synonym—Pseudocholinesterase Notes/Enquiries— 2. In cases where prolonged apnoea follows suxamethonium

administration an assessment of atypical cholinesterase can be made using the Dibucaine and Fluoride Numbers. Such assessment should not be made until 24 hours after suxamethonium administration.

3. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out). Serum (tube SG8) or heparin plasma (tube HG8) (avoid haemolysis). .................................................................printed with results


Reference ranges—

CHORIONIC GONADOTROPHIN, HUMAN—blood 1. Acronym/Synonym—βHCG Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). When used as Pregnancy Test— Not consistent with Pregnancy........................... < 5 U/L Equivocal. Re–test in 24 hours ......................... 5—25 U/L Consistent with Pregnancy............................... > 25 U/L


CK 1. See—CREATINE KINASE Notes/Enquiries—

CKMB 1. See—CREATINE KINASE, MB FRACTION Notes/Enquiries—

CLONAZEPAM—blood 1. Acronym/Synonym—Rivotril® Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3049 (assay sent out).

Pre-dose Serum (tube SG8) or Heparin plasma (tube HG8). .................................................................printed with results


CLOSTRIDIUM DIFFICILE TOXIN ASSAY 1. See—FAECES for MICROBIOLOGY Notes/Enquiries—



CLOZAPINE—blood 1. Acronym/Synonym—Clozaril® Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3049 (assay sent out).

Pre–dose Serum (tube SG8) or Heparin plasma (tube HG8). ....................................................................... 350—450 µg/L


CMV 1. See—CYTOMEGALOVIRUS Notes/Enquiries—

CMV–negative BLOOD PRODUCTS 1. See—APPENDIX I (page 122) Notes/Enquiries—

COAGULATION FACTOR ASSAYS—II, V, VII, VIII, IX, X, XI, XII, XIII 1. By consultation with Haematologist. Notes/Enquiries— 2. See also—FACTOR V LEIDEN 3. Enquiries—Haematology, Ext. 3109.

COAGULATION FACTOR INHIBITOR SCREENS 1. Enquiries—Haematology, Ext. 3109.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion.




COAGULATION TESTS 1. A history of a bleeding disorder or a sudden unexplained

episode of bleeding requires a consultation with Haematology Medical Staff to ascertain the range of diagnostic tests that should be performed. Relevant clinical details, including drug intake, are most important.

Notes/Enquiries—

2. When blood is collected for an APTT or ANTI–Xa ASSAY for control of heparin or low molecular weight heparin therapy it is essential that correct conditions are observed. See details below.

3. Enquiries—Haematology, Ext. 3109. Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. Keep at room temperature and deliver to the laboratory within 60 minutes. When the collection is by vacuum tube, the coagulation tube should be collected second to avoid artefactual shortening of coagulation assays due to trauma of venesection. When syringes are used, have ready two plastic syringes. A butterfly needle may be used. Withdraw 5 mL blood into the first syringe and discard the syringe (or use it for other tests). With the second syringe, withdraw the required amount of blood for the coagulation tests. When blood is collected from an arterial line it is necessary to discard the first 20 mL of blood to clear any heparin from the line before collecting the blood for coagulation tests. NOTE: Specimens cannot be analysed or re-analysed beyond 4 to 6 hours after collection, depending on the test required.



COLD AGGLUTININS—blood 1. Investigation of cold agglutinin specificity, thermal range and

titre by consultation with haematologist. Notes/Enquiries—

2. See also—CRYOPROTEINS 3. Enquiries—Blood Bank, Ext. 3100.

EDTA plasma, 6 mL (tube E6) collected with a 37°C syringe and maintained at 37°C until specimens reach Blood Bank laboratory. Cold specimens may give erroneous results. Will indicate whether or not cold agglutinins are present.


Report—



COLLAGEN BINDING ASSAY 1. See—von WILLEBRAND FACTOR Notes/Enquiries—

COLLAGEN CROSS LINKS—urine 1. Used as an indicator of bone resorption. Useful for monitoring

effect of anti-resorptive therapy and patient compliance. Notes/Enquiries—

2. Usefulness in predicting osteoporosis, or future risk of fracture, is not yet established.

3. Higher levels seem to indicate higher levels of bone loss. 4. Enquiries—Clinical Biochemistry, Ext. 3076 (assay sent out).

Second early-morning void in a PLAIN bottle. Specimen required—

COMPLEMENT 1. See—HAEMOLYTIC COMPLEMENT, TOTAL Notes/Enquiries— 2. See also—C3 COMPLEMENT and C4 COMPLEMENT

COOMBS TEST, DIRECT—blood 1. Acronym/Synonym—DCT, Direct Antihuman Globulin Test,

DAT Notes/Enquiries—

2. Positive in most Autoimmune Haemolytic Anaemias, and post incompatible blood transfusion.

3. Some drugs may cause the result to be positive, e.g. Aldomet.

4. See also—APPENDIX I (page 117) 5. Enquiries—Haematology, Ext. 3100.

EDTA plasma (tube E3). ................................................................................. Negative


COPPER—blood 1. Acronym/Synonym—CU Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Heparin plasma in special, metal–free container (tube M7). Male ................................................................14—22 µmol/L Female .............................................................15—29 µmol/L




COPPER—urine 1. Enquiries—Clinical Biochemistry, Ext. 3141.

24 hour collection in a special ACID bottle obtained from Pathology. ........................................................................ < 0.6 µmol/d


Reference range—

CORTISOL—blood 1. Endocrine consultation is suggested for dynamic testing. Notes/Enquiries— 2. Addison's disease cannot reasonably be excluded unless the

morning cortisol level is > 550 nmol/L. 3. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). Mark collection time on tube. Specify protocol when requests are part of Stimulation or Suppression test. 0800 h......................................................... 140—500 nmol/L 1700 h........................................................... 55—360 nmol/L


Reference ranges—

CORTISOL, dynamic tests 1. Endocrine consultation is suggested for dynamic testing—

e.g. Short/Long Stimulation or Suppression Tests using Synacthen or Dexamethasone.

Notes/Enquiries—

2. All samples must be clearly marked with time, date, patient's name and UR number. Sampling times must also be clearly written on the request form.

3. For details of clinical indications, test performance and significance of changes consult Endocrinology.


CORTISOL (FREE)—urine 1. Used in diagnosis of Cushing’s Disease. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

24 hour collection in a PLAIN bottle. Measurements on random (spot) specimens are of little value. ........................................................................< 250 nmol/d


Reference range—



COTININE—urine 1. Cotinine is the major metabolite of nicotine. Its detection in

blood or urine is an indicator of a patient’s tobacco smoking status or use of nicotine–containing gum or nicotine patch.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3049. 10 mL random urine specimen. .................................................................printed with results


CREATINE KINASE—blood 1. Acronym/Synonym—CK Notes/Enquiries— 2. CK should be used only in the early stages of myocardial

infarction. If the CK is normal shortly after onset of chest pain thought to be of myocardial origin then a repeat estimation 3—4 hours later may be helpful.

3. Skeletal muscle CK is elevated in several situations, e.g. post–operatively, after intramuscular injections, following trauma or vigorous exercise, and in some diseases of skeletal muscle.

4. See also—CREATINE KINASE, MB FRACTION and TROPONIN I

5. The Reference range is skewed. CK values > 200 U/L are not uncommon in healthy 'normals'.

6. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). .............................................................................< 200 U/L


CREATINE KINASE, MB FRACTION—blood 1. Acronym/Synonym—CKMB Notes/Enquiries— 2. Cardiac Troponin I is a more sensitive and more specific

marker of cardiac damage than CKMB. 3. All CKMB requests require individual approval by the Head of

Clinical Biochemistry. 4. Enquiries—Clinical Biochemistry, Ext. 3554.



CREATININE—blood 1. Acronym/Synonym—CR Notes/Enquiries— 2. Falsely high creatinine values may be obtained in therapy

with ascorbic acid and in the presence of ketones, alpha–methyldopa, haemolysis or high glucose concentrations.

3. Cephalosporins in high concentration also give falsely high serum creatinine. Blood samples for creatinine should not be taken within one hour of i.v. Cephalosporin administration.

4. Assay methods are affected differently by interferences so the routine and the STAT analysers sometimes produce significantly different results. If creatinine levels are being closely monitored it is preferable that all assays be performed on the routine analyser. Where necessary to resolve discrepancies, an enzymatic method is available after consultation.

5. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). Male ......................................................... 0.06—0.11 mmol/L Female ...................................................... 0.04—0.08 mmol/L


CREATININE—urine 1. Enquiries—Clinical Biochemistry, Ext. 3554.

24 hour collection in a PLAIN bottle. Male ........................................................... 3.5—23.0 mmol/d ........................................................... (approx. 3—17 mmol/L) Female ........................................................ 2.5—19.0 mmol/d ........................................................... (approx. 2—14 mmol/L)




CREATININE CLEARANCE—blood and urine 1. Acronym/Synonym—CRCL Notes/Enquiries— 2. Request 'Blood Creatinine' on one form and 'Creatinine

Clearance (urine)' on a second form. BOTH forms should clearly indicate that they are part of a 24 hour Creatinine Clearance study.

3. Accurate timing of the urine collection is essential. 4. Calculation— (Urine CR) x (Urine Volume in mL)

(Blood CR) x 86,400 5. Enquiries—Clinical Biochemistry, Ext. 3554.

Two specimens are required—a 24 hour collection of urine in a PLAIN bottle, plus a blood sample (tube SG8 or HG8) taken during, or immediately after, the urine collection. ..................................................................... 1.50—2.50 mL/s

Specimens required—

Reference range—

CROSSMATCHING 1. See—APPENDIX I (page 119) Notes/Enquiries—

CRP 1. See—C–REACTIVE PROTEIN Notes/Enquiries—

CRYOPROTEINS—blood 1. Acronym/Synonym—CRYOGLOBULIN and CRYOFIBRINOGEN Notes/Enquiries— 2. Collection of blood for cryoprotein studies MUST be arranged

directly with the Protein Laboratory Section (Ext. 3141). 3. All tubes MUST be kept at 37°C in a thermos flask and be

delivered to the laboratory within 2 hours of collection. 4. Quantitation of cryoprecipitate has little clinical value, and is

available only after consultation. 5. Cryoglobulin Typing is available—consult laboratory. 6. See also—COLD AGGLUTININS. 7. Enquiries—Clinical Biochemistry, Protein Section, 3141.

Total of 3 tubes, all kept at 37°C Cryofibrinogen (plasma)— 1x 8 mL EDTA blood (tube HG8) Cryoglobulin (serum)— 1x 9 mL Plain blood in non–gel tubes (tube S9). ...........................................................................Not detected


Reference range—



CRYPTOCOCCAL ANTIGEN—blood/CSF 1. Enquiries—Blood test: Serology Lab, Ext. 3354,

CSF test: Microbiology, Ext. 3089. Plain blood (tube SG8) or 0.5 mL CSF.

Notes/Enquiries—


CYCLOSPORIN—blood 1. Acronym/Synonym—CSPA Notes/Enquiries— 2. Assay is Abbott ‘Axsym®’ monoclonal, specific for parent

drug. 3. Enquiries—Clinical Biochemistry, Ext. 3049.

Pre-dose or 2h post-dose (must indicate on request form) EDTA WHOLE blood (tube E3). Cyclosporin values may vary widely. The following table should be used as a guide only. All values are pre–dose in µg/L.

Transplant < 6 mo 6—12 mo > 12 mo Bone M. ............. 100—300 Heart ................. 300—450........... 200—300 ........ 100—200 Kidney ............... 100—200............. 80—200 .......... 80—200 Liver .................. 150—300........... 100—200 ........ 100—200 Lung................... 300—450........... 275—375 ........ 200—300


Therapeutic ranges—

1. A qualitative amino acid screen is performed initially. Only if this test shows increased cystine will a quantitation be performed.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out). Random, early morning urine (50 mL). .................................................................printed with results


CYTOCHEMISTRY / IMMUNOCYTOCHEMISTRY OF LEUCOCYTES 1. Consult Haematology Registrar, Ext. 3075. Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3114.



CYTOGENETIC ANALYSIS—Blood and/or Bone Marrow 1. See also—BONE MARROW EXAMINATION Notes/Enquiries— 2. These studies are generally performed for additional

diagnostic information at the time of marrow biopsy in patients with acute leukaemia, myeloproliferative disorders and stem cell transplant recipients.

3. Enquiries—Contact the Laboratory Haematology Registrar, Ext 3075, 3888, 3077 for further information.

CYTOLOGY SERVICE 1. See—APPENDIX B (page 105) Notes/Enquiries—

CYTOMEGALOVIRUS (CMV) 1. Enquiries—Microbiology, Ext. 3354. Notes/Enquiries— • SEROLOGY


• PCR (assay sent out) EDTA blood (separate tube E9), Tissue, CSF, NPA, BAL, Urine, other fluids, Saliva swab in VTM.

• VIRAL LOAD Blood—A separate, unopened EDTA blood (tube E3). BAL—5 mL in a plain container Conditions—Collect in the morning to allow for the lengthy preparation that must occur on the same day. Specimen must be less than 24 hours old.

D–DIMER—blood 1. Assay of D–DIMER may be part of the investigation for DIC. Notes/Enquiries— 2. This test is not sufficiently sensitive to exclude the diagnosis

of venous thrombo-embolism. See—LIA-DIMER. 3. Enquiries—Haematology, Ext. 3109.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. Range for exclusion of DIC .................................< 0.20 mg/L


Reference range—



DEHYDROEPIANDROSTERONE SULPHATE—blood 1. Acronym/Synonym—DHEAS Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) or heparin plasma (tube HG8). Male ............................................................2.2—15.2 µmol/L Female .........................................................1.0—11.7 µmol/L


DEXAMETHASONE SUPPRESSION TEST 1. See—CORTISOL, dynamic tests Notes/Enquiries—

DHEAS 1. See—DEHYDROEPIANDROSTERONE SULPHATE Notes/Enquiries—

DIC SCREEN 1. See—DISSEMINATED INTRAVASCULAR COAGULATION

SCREEN Notes/Enquiries—

DIGOXIN—blood 1. Acronym/Synonym—DIG, Lanoxin® Notes/Enquiries— 2. The following information must be provided⎯time of last

digoxin dose, time of sample collection and dose regimen. 3. Enquiries—Clinical Biochemistry, Ext. 3141.

Draw before morning dose of digoxin, or > 6 hours post–dose. Serum (tube SG8) or heparin plasma (tube HG8). Pre-dose......................................................... 0.6—2.6 nmol/L Toxic range ..................................................... > 3.2 nmol/L


Therapeutic range—

DILANTIN® 1. See—PHENYTOIN Notes/Enquiries—

DIRECT BILIRUBIN 1. See—BILIRUBIN, CONJUGATED Notes/Enquiries—

DIRECT COOMBS TEST 1. See—COOMBS TEST, DIRECT Notes/Enquiries—



DISSEMINATED INTRAVASCULAR COAGULATION SCREEN 1. Acronym/Synonym—DIC SCREEN Notes/Enquiries— 2. The appropriate tests to determine DIC depend upon the

clinical situation. The actual tests performed will depend on initial results and the clinical notes given.

3. Consultation is often necessary, so ensure beeper number is clearly printed.

4. Enquiries—Haematology, Ext. 3109. Two specimens are required—

EDTA plasma (tube E3). Citrate plasma (tube C3);

add exactly 2.7 mL blood and mix by inversion.


DONATH–LANDSTEINER TEST (qualitative/quantitative) 1. Only perfomed after consultation with a Haematologist. Notes/Enquiries— 2. Normal result indicates the absence of the antibody of

paroxysmal cold haemoglobinuria. 3. Enquiries—Haematology, 3114.

Plain blood (tube S9). Specimen required—

DOPAMINE 1. See—CATECHOLAMINES Notes/Enquiries—

DRUG IDENTIFICATION 1. See—APPENDIX F (page 113) Notes/Enquiries—

DUODENAL ASPIRATES 1. Enquiries—Microbiology, Ext. 3089.

Place aspirate in a sterile container, and take directly to the laboratory for examination for Giardia lamblia and Strongyloides stercoralis.

Notes/Enquiries— Specimen collection—

ECHIS TIME—blood 1. Differentiates deficiency of Factor II from inactivation due to

Warfarin use/Vitamin K deficiency. Notes/Enquiries—

2. Enquiries—Haematology, Ext. 3109. Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. ...................................................................... 12—17 seconds


Reference range—



EFAVIRENZ—blood 1. A Non-Nucleoside Reverse Transcriptase Inhibitor. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3049 (assay sent out).

EDTA plasma (tube E9). ................................................................................... Consult


ELECTROCARDIOGRAPH 1. Acronym/Synonym—ECG Notes/Enquiries 2. During normal hours Alfred Pathology provides an ECG

service to the CGMC and SDMH Consulting Suites, SDMH wards and a limited Domiciliary Service.

ELECTROLYTES—blood 1. Acronym/Synonym—EL, ELEC Notes/Enquiries— 2. A request for 'electrolytes' will give sodium, potassium,

chloride and bicarbonate results. 3. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). See individual entries or table in APPENDIX N (page 132)


ELECTROPHORESIS 1. See—PROTEIN ELECTROPHORESIS Notes/Enquiries— 2. See also—HAEMOGLOBIN ANALYSIS

ENA (Extractable Nuclear Antigens) 1. See—AUTOANTIBODY TESTS Notes/Enquiries—

ENTEROVIRUS 1. Enquiries—Microbiology, Ext. 3354. Notes/Enquiries— • SEROLOGY

Plain Serum (tube S9) Specimen required—

• PCR (assay sent out) EDTA blood (separate tube E9), tissue, CSF, faeces.



EPSTEIN BARR VIRUS 1. Acronym/Synonym—EBV Notes/Enquiries— 2. Enquiries—Microbiology Serology, Ext. 3354. • SEROLOGY

Plain Serum (tube S9) Specimen required—

• PCR EDTA blood (separate tube E9), tissue, CSF, NPA, BAL

• VIRAL LOAD EDTA blood (separate tube E9), CSF.

ERYTHROCYTE SEDIMENTATION RATE 1. Acronym/Synonym—ESR Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3116.

1.5 mL Citrate blood into test–specific container (tube ESR). ...................................... see table in APPENDIX M (page 131)


ERYTHROPOIETIN 1. Useful in differentiating primary from secondary

polycythaemia. Notes/Enquiries—

2. Enquiries—Special Haematology, 3114 Serum (tube SG8) or heparin plasma (tube HG8). Note: EDTA blood is not suitable. ....................................................................... 4.8—21.9 kU/L


Reference range—

ESR 1. See—ERYTHROCYTE SEDIMENTATION RATE Notes/Enquiries—

ESTRADIOL 1. See—OESTRADIOL Notes/Enquiries—



ETHANOL—blood 1. Acronym/Synonym—ETOH, ”Alcohol” Notes/Enquiries— 2. Results are reported in mmol/L.

Conversion to old units is—mmol/L x 0.0046 = g/dL (ie. 10 mmol/L is approximately 0.05 g/dL or 0.05%).

3. This test is only performed for clinical reasons and the results supplied cannot be used for medico–legal purposes. Samples taken in the Emergency Department in relation to the law applying to motor car accidents are not analysed by the Alfred Pathology Service. All queries regarding these samples should be directed to the Secretary or Director, Emergency Department (Ext. 2138).

4. Enquiries—Clinical Biochemistry, Ext. 3554. Heparin plasma (tube SG8) delivered immediately. ...............................................................Not normally present


EUGLOBULIN CLOT LYSIS TIME 1. By consultation with Haematologist. Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3109.

.................................................................... 90—240 minutes Reference range—

FACS ANALYSIS 1. See—LEUCOCYTE IMMUNOPHENOTYPING Notes/Enquiries

FACTOR ASSAYS—II, V, VII, VIII, IX, X, XI, XII, XIII 1. See—COAGULATION FACTOR ASSAYS Notes/Enquiries—

FACTOR V LEIDEN 1. PCR assay for detection of Factor V nucleotide substitution

causing Activated Protein C Resistance. Notes/Enquiries—

2. Enquiries—Haematology, Ext. 3109 (assay sent out). EDTA plasma (tube E3). ...................................Normal or Heterozygote or Homozygote




FACTOR VIII BINDING ASSAY 1. Performed as part of von Willebrand Factor studies to detect

von Willebrand Factor Normandy. Notes/Enquiries—

2. See—von WILLEBRAND FACTOR 3. Enquiries—Haematology, Ext. 3109.

FAECAL BLOOD LOSS (Radioactive Studies) 1. By appointment through Gastroenterology, Ext. 3326.

........................................................................< 2.5 mL/day Notes/Enquiries— Reference range—

FAECES for MICROBIOLOGY 1. Rectal swabs are not suitable. Read further for correct

specimens. Notes/Enquiries—

2. Investigations for Salmonella, Shigella, Campylobacter and Parasites are restricted to Outpatients and patients hospitalised for less than 4 days.

3. Culture for Clostridium difficile is performed only on loose, watery stools, or if specifically requested.

4. Enquiries—Microbiology, Ext. 3089. • CULTURE

Faecal collection kits available from Microbiology must be used. Collect 10—20 g into each container.


• PARASITES Send 1 specimen, collected in SAF fixative. Detection of parasites in faeces may be interfered with by presence of urine, kaolin, magnesia, bismuth, barium, antibiotics, antihelmintics or antiprotozoal substances.



FAT—faeces 1. Patients must be on a standard dietary intake of 50—100 g

of fat per day. Notes/Enquiries—

2. A faecal weight of < 200 g per 72 hours is not consistent with malabsorption and the assay will not then be performed without consultation (source: NWH Pathology).

3. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out). 72 hour collection of faeces in special metal containers obtained from Pathology. It is preferred that the whole 72 hour collection be sent in the one container. If more than one is used, a separate request form, with the collection period stated, must accompany each container. ......................................... < 6 g/d, averaged over three days


Reference range—

FBE 1. See—FULL BLOOD EXAMINATION Notes/Enquiries—

FECES 1. See—FAECES Notes/Enquiries—



FERRITIN—blood 1. See also—IRON STUDIES (APPENDIX G, page 114)

See also—RED CELL FERRITIN (page 84) Notes/Enquiries—

2. Serum ferritin does not always reflect the state of body iron stores. In a number of conditions ferritin levels may be elevated independently of the patient's iron stores and confuse the interpretation. Ferritin is an acute phase reactant and may be elevated in acute and chronic inflammatory states. It is also present in hepatocytes and may be elevated in hepatocellular damage. Thus, assessment of iron deficiency or overload using serum ferritin is difficult in these circumstances.

3. Most patients have a low serum iron for a few weeks after major surgery, even though ferritin is frequently raised. It is a waste of time and money to attempt assessment of iron stores until after convalescence.

4. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). Male ................................................................. 22—275 µg/L Female (pre–menopausal) .................................... 5—204 µg/L Female (post–menopausal)................................. 15—230 µg/L Untreated haemochromatosis ............................> 1000 µg/L Iron deficiency anaemia, Male ...............................< 20 µg/L Iron deficiency anaemia, Female ............................< 10 µg/L (N.B. Ranges not applicable to children < 2 years).


Interpretation—

FIBRINOGEN—blood 1. Enquiries—Haematology, Ext. 3109.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. ............................................................................2.0—4.0 g/L


Reference range—

FINE-NEEDLE ASPIRATION 1. See—CYTOLOGY SERVICE (APPENDIX B, page 105) Notes/Enquiries—

FK506 ® 1. See—TACROLIMUS Notes/Enquiries—



FLECAINIDE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3049 (assay sent out).

Pre-dose. Serum (tube SG8) or heparin plasma (tube HG8). Pre-dose.........................................................0.4—2.1 µmol/L

Notes/Enquiries— Specimen required— Therapeutic range—

FLUCYTOSINE—blood 1. Please consult with the Microbiology laboratory or the

Infectious Diseases Unit. Notes/Enquiries—

2. Enquiries—Microbiology, Ext. 3089 (assay sent out). Pre-dose and post-dose (soon after infusion finished). Serum (tube S9). Expected Trough ................................................. 20—30 mg/L Expected Peak .................................................... 50—80 mg/L


Reference range—

FLUIDS—for CELL COUNT and CULTURE 1. Examination for mycobacteria performed only on specific

request. Notes/Enquiries—

2. Enquiries—Microbiology, Ext. 3089. a) ASCITIC, SYNOVIAL, PLEURAL Specimen should be collected in a sterile container. These fluids are often clotted on arrival and only a qualitative count and Gram stain are performed. Synovial fluids are routinely examined for crystals. b) PERITONEAL DIALYSATE Specimen should be sent in a sterile container for cell count and culture.


FLUIDS, MISCELLANEOUS—for BIOCHEMISTRY 1. Viscous fluids will not be analysed without consultation. Notes/Enquiries— 2. Please indicate on the request form the fluid type and the

test/s required. Requests marked 'Fluid for Biochemistry' will be analysed only for Protein and Glucose.

3. Enquiries—Clinical Biochemistry, Ext. 3554. 5—10 mL collected in a Plain blood tube (tube S9). Specimen required—

FOETAL HAEMOGLOBIN—blood

1. Acronym/Synonym—HbF, Alkali Resistant Haemoglobin Notes/Enquiries— 2. See—HAEMOGLOBIN ANALYSIS



FOETOPROTEIN, alpha—blood 1. Acronym/Synonym—AFP Notes/Enquiries— 2. AFP is useful in monitoring some testicular germ cell tumours

and primary hepatocellular carcinoma. After treatment, e.g. orchidectomy, levels fall with a half–life of approximately 45 days. Values > 500 µg/L are virtually diagnostic of malignancy. However, 50% of all malignancies have values < 500 µg/L. AFP can also be raised in a variety of non–malignant liver disorders, where levels are usually < 100 µg/L.

3. Enquiries—Clinical Biochemistry, Ext. 3141. Serum (tube SG8) or heparin plasma (tube HG8). .............................................................................< 11 µg/L


FOLATE, RED CELL—blood 1. Acronym/Synonym—Folic Acid Notes/Enquiries— 2. See also—VITAMIN B12 3. 'Serum' Folate is an inferior test for assessing Folate status.

Please only request Red Cell Folate. 4. Enquiries—Biochemistry, Ext. 3141.

EDTA blood (tube E3). .................................................................... 200—900 nmol/L


FOLIC ACID 1. See—FOLATE, RED CELL Notes/Enquiries—

FOLLICLE STIMULATING HORMONE—blood 1. Acronym/Synonym—FSH Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) or heparin plasma (tube HG8). Follicular ................................................................. 4—13 U/L Mid–cycle ............................................................... 5—22 U/L Luteal...................................................................... 2—13 U/L Post–Menopausal....................................................> 20 U/L Male ......................................................................... 1—8 U/L


FREE PHENYTOIN 1. See—PHENYTOIN, FREE Notes/Enquiries—



FREE T3 and FREE T4

1. See—THYROID FUNCTION TESTS Notes/Enquiries—

FROZEN SECTIONS 1. See—BIOPSY SERVICE, APPENDIX A (page 103) Notes/Enquiries—

FSH 1. See—FOLLICLE STIMULATING HORMONE Notes/Enquiries—

FULL BLOOD EXAMINATION 1. Acronym/Synonym—FBE Notes/Enquiries— 2. The parameters measured will be Hb, WCC, platelet count,

RBC, HCT, MCV, MCH, MCHC, and WBC differential. 3. Examination of a Blood Film will be performed if requested as

‘FILM’, or if indicated by the results. 4. Enquiries—Haematology, Ext. 3116.

EDTA blood (tube E3). ...................................... see table in APPENDIX M (page 131)


GAD ANTIBODIES—blood 1. Acronym/Synonym—Glutamic Acid Decarboxylase Antibodies Notes/Enquiries— 2. Indicative of insulin–dependent diabetes mellitus. 3. 80% of newly–diagnosed Type 1 diabetics have a value

> 5 units (source: NWH Pathology). 4. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Plain blood (tube SG8). ...............................................................................< 5 units


gamma GT 1. See—GLUTAMYLTRANSFERASE, gamma Notes/Enquiries—

GASTRIC ASPIRATE 1. Enquiries—Microbiology, Ext. 3089.

Place in a sterile container and send immediately to the laboratory for microscopy and culture.




GASTRIC LAVAGE for TUBERCULOSIS 1. Enquiries—Microbiology, Ext. 3089.

Following a 100 mL saline lavage, after an overnight fast, place the aspirate in a sterile container and send directly to the laboratory. Culture for mycobacteria must be specifically requested.


GASTRIC SECRETION TESTS 1. Consult Gastroenterology, Ext. 2223. Notes/Enquiries—

GASTRIN—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out). Notes/Enquiries— 2. Specimens are no longer collected on ice.

Plain blood (tube SG8), delivered immediately. Patient must fast for 12 hours prior. If possible, withdraw acid control medication. Fasting...............................................................< 43 pmol/L


Reference range—

GENTAMICIN—blood 1. See also—ANTIBIOTIC ASSAYS (APPENDIX D, page 110) Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) (pre–dose & 30 min. post–dose). Request should specify dose, route, time(s) of dose/infusion and time of sample Pre-dose...............................................................< 0.5 mg/L Post-dose ......consult Aminoglycoside Consulting Service (Ext. 3579)


Therapeutic ranges—

GLANDULAR FEVER—blood 1. See also—EPSTEIN BARR VIRUS Notes/Enquiries— 2. The Monotest is used for diagnosis. An FBE should also be

requested for blood film examination. 3. A negative test where there are appropriate clinical findings

may be repeated in 2 weeks. 4. EBV studies are more specific. 5. Enquiries—Haematology, Ext. 3116.

Plain blood (tube SG8). Specimen required—

GLUCAGON—blood 1. Available after consultation with Endocrinologist. Notes/Enquiries—



GLUCOSE—blood 1. Acronym/Synonym—GL Notes/Enquiries— 2. Routine glucose analysis is performed on serum or plasma. On

fresh samples, results are approximately 10% higher than for whole blood (direct analysis)—dependent on the haematocrit.

3. Diagnosis of Diabetes Mellitus can be made on the basis of two abnormal blood glucose measurements made on separate occasions, in the absence of acute illness. In general, fasting glucose— < 5.5 mmol/L ....................................................Normal 5.5—6.9 mmol/L ..................... GTT should be performed ≥ 7.0 mmol/L ............................ Diabetes Mellitus likely.

4. See also—GLUCOSE TOLERANCE TEST and GLUCOSE CHALLENGE TEST.

5. Enquiries—Clinical Biochemistry, Ext. 3554. Routine—Serum (tube SG8) or heparin plasma (tube HG8). GTT or Delayed analysis—fluoride/oxalate plasma (tube F2). If the specimen will not be transported immediately to the laboratory there may be some loss of glucose. Where this is NOT acceptable (e.g. GTT) blood should be collected in a fluoride/oxalate vacuum tube. (N.B. specimens collected in this tube are unsuitable for most other tests). (Plasma or Serum) Fasting............................................................. < 5.5 mmol/L Random ........................................................... < 7.0 mmol/L


Reference ranges—

GLUCOSE—CSF 1. Enquiries—Clinical Biochemistry, Ext. 3554.

0.5 mL CSF. For meaningful interpretation, a specimen for blood glucose must be taken at the same time. ......................................................................2.5—4.5 mmol/L


Reference range—

GLUCOSE TOLERANCE TEST 1. Acronym/Synonym—GTT Notes/Enquiries— 2. See—APPENDIX H (page 115)



GLUCOSE-6-PHOSPHATE DEHYDROGENASE SCREEN—blood 1. Acronym/Synonym—G6PD Screen Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3114.

EDTA blood (tube E3). Specimen required—

GLUTAMYLTRANSFERASE, gamma—blood 1. Acronym/Synonym—gamma–GT, γGT, GGT Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). Male ..................................................................... 12—64 U/L Female .................................................................... 9—36 U/L


GLYCATED HAEMOGLOBIN 1. See—HAEMOGLOBIN A1c Notes/Enquiries—

GONORRHOEA 1. If requested, Chlamydia trachomatis assay is performed on

the same specimen. Notes/Enquiries—

2. Enquiries—Microbiology Ext. 3089 (Culture) or 3354 (PCR). • CULTURE

Swabs taken are⎯cervical, urethral, rectal and throat depending on gender and type of sexual activity. Transport swabs (available from CSSD) should be used. (N. gonorrhoeae dies very rapidly on a dry cotton swab).


• PCR (assay sent out) Urine: 15–20 mL of first-stream urine collected at least one hour since the patient last passed urine. Refrigerate immediately. Genital Swab (Collection kits available from Microbiology):

Male—urethral swab Female—endocervical swab.

GROUP / ANTIBODY SCREENING (ANTIBODIES /BLOOD GROUP) 1. See—BLOOD BANK LABORATORY (APPENDIX I, page 117). Notes/Enquiries— 2. Enquiries—Blood Bank Laboratory, 3100

Cross-match container, EDTA (tube E6). Specimen required—



GROWTH HORMONE—blood 1. Acronym/Synonym—GH Notes/Enquiries— 2. Random blood samples are of limited value in diagnosis

because of variation with food, exercise and stress. 3. Stimulation tests— Hypoglycaemia, Exercise.

Suppression test— Glucose load. 4. Endocrine consultation suggested. 5. Enquiries—Clinical Biochemistry, Ext. 3554.

Plain blood (tube SG8). Fasting.................................................................... < 5 µg/L


HAEMOCHROMATOSIS (HLA–H) GENOTYPING—blood 1. Enquiries—Blood Bank, Ext. 3100.

Two 9 mL ACD containers (tube A8). Notes/Enquiries— Specimen required—

HAEMOGLOBIN—blood 1. Acronym/Synonym—Hb Notes/Enquiries— 2. This test is part of FBE. See pages 45 and 131. 3. Enquiries—Haematology, Ext. 3114.

EDTA blood (tube E3). Male ..................................................................128—175 g/L Female ...............................................................113—159 g/L


HAEMOGLOBIN—plasma 1. Acronym/Synonym—Free Haemoglobin Notes/Enquiries— 2. Haemolysis during collection must be avoided. 3. Enquiries—Clinical Biochemistry, Ext. 3554.

Heparin blood (tube P6), drawn without stasis using a large bore needle. ............................................................................ < 0.05 g/L


Reference range—



HAEMOGLOBIN ANALYSIS (including ELECTROPHORESIS) 1. Acronym/Synonym—Unstable Haemoglobin,

Haemoglobins A2, F, H, S Notes/Enquiries—

2. Ethnic origin must be stated to allow appropriate testing. 3. Enquiries—Haematology, Ext. 3114 (assay sent out).

Three (3)x EDTA blood (tube E3) delivered before 4 p.m. Specimen required— • Haemoglobin A2 (by HPLC) ........................... 1.8%—3.5% Reference ranges—

• Haemoglobin F (by HPLC).............................. 0.0%—2.0% • Haemoglobin H, Haemoglobin S and other abnormal

haemoglobins of clinical significance individually reported. • Isopropanol Test for unstable haemoglobin. Positive

result indicates presence of an unstable haemoglobin.

HAEMOGLOBIN A1c—blood 1. Acronym/Synonym—HbA1c Notes/Enquiries— 2. False results may occur after blood transfusion, venesection,

in anaemia associated with haemolysis or reticulocytosis. 3. This test has replaced 'Glycated Haemoglobin' (total HbA1) in

the monitoring of Diabetes Mellitus. 4. Enquiries—Clinical Biochemistry, Ext. 3049.

EDTA blood (tube E3). Do not centrifuge! ....................................................< 6% of total haemoglobin


HAEMOLYTIC COMPLEMENT, TOTAL—blood 1. Time and date must be recorded on request form. Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3616.

Plain blood (tube SG8), collected on ice and delivered immediately to Pathology Specimen Reception. .......................................................................... > 390 U/mL


Reference range—

HAEMOLYTIC STUDIES 1. By discussion—Please contact Special Haematology. Notes/Enquiries— 2. Enquiries—Haematology, 3114.



HAEMOSIDERIN—urine 1. Presence of intracellular haemosiderin indicates chronic

intravascular haemolysis. Notes/Enquiries—

2. Enquiries—Special Haematology, 3114. Contact laboratory and collect instruction sheet and special urine container from Haematology. Normal result ............................................................ Negative


Reference range—

HAEMOSTATIC STUDIES 1. By consultation with Haematologist. Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3109.

HAM’S TEST—blood 1. Only perfomed after consultation with a Haematologist, and

then by appointment (Ext. 3114). Notes/Enquiries—

2. A normal result indicates absence of Paroxysmal Nocturnal Haemoglobinuria, or certain types of congenital dyserythropoietic anaemias.

3. See PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA. 4. Enquiries—Haematology, Ext. 3114.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. .......................................................... ‘Positive’ or ‘Negative’


Reported as—

HAPTOGLOBIN—blood 1. This test is useful for diagnosis of intravascular haemolysis. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Plain blood (tube SG8) for serum. ........................................................................0.36—1.95 g/L


HCG 1. See—CHORIONIC GONADOTROPHIN Notes/Enquiries—

HDL–CHOLESTEROL 1. See—CHOLESTEROL, HIGH DENSITY LIPOPROTEIN Notes/Enquiries—



HEINZ BODIES—blood 1. The presence of Heinz bodies indicates oxidant drug

haemolysis, asplenia or unstable haemoglobin. Notes/Enquiries—

2. Enquiries—Haematology, Ext. 3116. EDTA blood (tube E3). An FBE is usually performed concurrently. ................................................................................. Negative


Reference range—

HEPARIN COFACTOR II 1. Results not valid while the patient is receiving heparin. Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3109 (assay sent out).

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. Functional ........................................................... 65%—145%


Reference range—

HEPARIN-INDUCED THROMBOCYTOPENIA SCREEN—blood 1. Acronym/Synonym—HITS Notes/Enquiries— 2. Testing may also be required in patients receiving Low

Molecular Weight Heparin or Heparinoid who develop unexplained thrombocytopenia.

3. By consultation with Haematologist. 4. Enquiries—Haematology, Ext. 3109.

From patients (TWO tubes are required)— 2x Citrate plasma (tube C3); add exactly 2.7 mL blood to each tube and mix by inversion. From normal donors (12 tubes in all)— FOUR Citrate tubes, 2.7 mL must be collected from EACH of three normal donors who have not taken NSAIDs/aspirin within the previous 7 days. Add exactly 2.7 mL blood to each tube and mix by inversion.Keep samples at room temperature and send to laboratory immediately.


HEPARINOID ANTI–Xa ASSAY 1. See—ANTI–Xa ASSAY Notes/Enquiries—



HEPATITIS SEROLOGY—blood 1. Please request each specific antigen and/or antibody

required and supply clinical notes. Notes/Enquiries—

2. Enquiries—Microbiology Serology, Ext. 3354. Container—Serum (tube SG8). Conditions—PCR-based tests require a separate (unopened) container. Multiple PCR-based tests can be performed on the same container, but other tests require a separate container. * PCR-based test

HepA IgM.......................................Microbiology HepA Total Ab ...............................Microbiology

HepB surface Ag ............................Microbiology HepB surface Ab ............................Microbiology HepB core Ab (total).......................Microbiology HepB core IgM ...............................Microbiology HepBe Ag.......................................VIDRL HepBe Ab.......................................VIDRL * HepB DNA ..................................VIDRL * Hep B Sequencing .......................VIDRL

HepC Ab ........................................Microbiology * HepC PCR...................................VIDRL * HepC Genotype ...........................VIDRL * HepC Viral Load ..........................VIDRL

Delta antigen/antibody ...................VIDRL

HepE Viral antibody ........................VIDRL HepE Western blot .........................VIDRL

* HepG PCR ..................................VIDRL


HEPATITIS A

HEPATITIS B

HEPATITIS C

HEPATITIS D

HEPATITIS E

HEPATITIS G

HERPES SIMPLEX 1. Enquiries—Microbiology, Ext. 3354. Notes/Enquiries— • SEROLOGY


• PCR (assay sent out) EDTA blood (separate tube E9), Tissue, CSF, NPA, BAL, Urine, other fluids. Saliva swab in VTM.

HIAA, 5– 1. See—HYDROXYINDOLACETIC ACID Notes/Enquiries—



HIV 1. See—HUMAN IMMUNODEFICIENCY VIRUS Notes/Enquiries—

HLA ANTIBODIES 1. By consultation with Blood Bank, Ext 3100. Notes/Enquiries— 2. This test is perfumed by ARCB. 3. Enquiries—Blood Bank, Ext. 3100.


HLA ANTIGEN 1. By consultation with Haematologist, Ext. 3075. Notes/Enquiries— 2. This test is performed at the Royal Melbourne Hospital. 3. Enquiries—Haematology Procedure Room, Ext. 3111.

Special tube and request form obtainable from Haematology. Specimen required—

HLA B27 1. By consultation with Haematologist, Ext. 3075. Notes/Enquiries— 2. Enquiries—Haematology Procedure Room, Ext. 3111.

ACD plasma (tube A8). Specimen required—

HOMOCYSTEINE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3141.

EDTA blood (tube E3).packed in ice. Adult Male & Female..........................................5—15 µmol/L Elderly, > 60 years...........................................5—20 µmol/L


HTLV ANTIBODIES—blood 1. The current assay detects both HTLV1 and HTLV2. Notes/Enquiries— 2. Enquiries—Microbiology, Ext. 3354.


HUMAN CHORIONIC GONADOTROPHIN (HCG) 1. See—CHORIONIC GONADOTROPHIN, HUMAN Notes/Enquiries—

HUMAN HERPES 6 VIRUS DNA BY PCR—blood/CSF 1. Enquiries—Microbiology Serology, Ext. 3354.

Blood—A separate (unopened) EDTA (tube E9). CMV Viral Load can be performed on the same specimen. CSF—At least of 1 mL CSF in a screw-cap, plain plastic tube.

Notes/Enquiries— Specimens required—



HUMAN HERPES 6 SEROLOGY 1. Enquiries—Microbiology Serology, Ext. 3354.

Serum (tube SG8). Notes/Enquiries— Specimens required—

HUMAN HERPES 8 VIRUS DNA BY PCR—blood/CSF 1. Causative agent of Kaposi’s sarcoma, Castleman’s disease

and body cavity lymphoma. Notes/Enquiries—

2. Enquiries—Microbiology Serology, Ext. 3354. EDTA blood (tube E9) or Cerebrospinal Fluid. Specimens required—

HUMAN IMMUNODEFICIENCY VIRUS—blood 1. Acronym/Synonym—HIV Notes/Enquiries— 2. It is a LEGAL REQUIREMENT that patient consent is sought and

the patient is counselled before and after the test result is known.

3. Enquiries—Microbiology Serology, Ext. 3354. Serum (tube SG8). Serum (tube SG8). Unopened ACD container (tube A8). Do NOT refrigerate. Separate (unopened) EDTA container (tube E9). Mon–Fri only. Must be < 24 hours old. Do NOT refrigerate. Separate (unopened) EDTA container (tube E9). Mon–Fri only. Must be < 24 hours old. Do NOT refrigerate. CANNOT be same tube as VIRAL LOAD. Note—This test is commonly used to detect recent seroconversion to HIV (in conjunction with serological investigations). It is not the same as the Viral Load Test. Separate (unopened) EDTA container (tube E9)—can be shared with HIV VIRAL LOAD assay. Mon–Fri only. Must be <24 hours old. Do NOT refrigerate.

Specimen required— SEROLOGY—

P24 ANTIGEN—

HIV CULTURE—

VIRAL LOAD— (RT—PCR METHOD)

HIV PROVIRAL DNA—

HIV GENOTYPIC— RESISTANCE—

HYDATID DISEASE 1. Direct microscopy on aspirates from cysts collected in a

sterile container. Notes/Enquiries—

2. Serology—Immunoelectrophoresis performed at Melbourne University, Werribee (at least 5 mL blood required).

3. Enquiries—Microbiology, Ext. 3089 (assay sent out). Serum (tube SG8). Specimen required—



HYDROXYBUTYRATE, beta—blood 1. Acronym/Synonym—beta–Hydroxybutyric Acid Notes/Enquiries— 2. This specific assay replaces blood ketones. 3. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8) or EDTA plasma (tube E3). ........................................................................ < 0.5 mmol/L


Reference range—

HYDROXYINDOLACETIC ACID, 5– —urine 1. Acronym/Synonym—5HIAA Notes/Enquiries— 2. Falsely elevated results may occur after ingestion of

phenothiazines or serotonin–containing foods such as bananas, pineapples, red plums, walnuts, avocados, eggplant or tomatoes.

3. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out). 24 hour collection in an ACID bottle. ......................................................................... < 50 µmol/d


HYDROXYPROLINE—urine 1. See—COLLAGEN CROSS LINKS Notes/Enquiries—

IgA, IgG, IgM 1. See—IMMUNOGLOBULINS Notes/Enquiries— 2. See also—IgG SUBCLASSES

IgE, ALLERGEN SPECIFIC—blood 1. See—RAST Notes/Enquiries—

IgE, TOTAL—blood 1. Enquiries—Immunology, Ext. 3616.

Serum (tube SG8). ...........................................................................< 120 kU/L




IGF-1—blood 1. Acronym/Synonym—SOMATOMEDIN–C Notes/Enquiries— 2. Useful in assessment of hormonal control of acromegaly. 3. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8), pack in ice and send to laboratory for immediate centrifugation. .................................................................printed with results


Reference range—

IgG/ALBUMIN RATIO—CSF 1. See—OLIGOCLONAL BANDS of IgG Notes/Enquiries—

IgG SUBCLASSES—blood 1. Enquiries—Clinical Biochemistry, Ext. 3049. Notes/Enquiries— 2. Age-related Reference Ranges are printed with results.

Serum (tube SG8). IgG1 ....................................................................3.8—9.3 g/L IgG2 ....................................................................2.4—7.0 g/L IgG3 ................................................................0.22—1.76 g/L IgG4 ................................................................0.04—0.86 g/L


IMMUNOGLOBULINS—blood 1. Acronym/Synonym—IMM Notes/Enquiries— 2. Request PARAPROTEIN QUANTITATION when it is

necessary to follow monoclonal protein concentrations. 3. See also— IgE and IGG SUBCLASSES 4. Enquiries—Clinical Biochemistry, Ext. 3049.

Serum (tube SG8) or heparin plasma (tube HG8). IgA.......................................................................0.8—4.5 g/L IgG.....................................................................7.5—15.6 g/L IgM......................................................................0.5—3.0 g/L


IMMUNOPHENOTYPING 1. See—LEUCOCYTE IMMUNOPHENOTYPING Notes/Enquiries—



INDINAVIR—blood 1. Acronym/Synonym—INDR Notes/Enquiries— 2. All Protease Inhibitors can be analysed on the same




INFECTIOUS MONONUCLEOSIS SCREEN 1. See—GLANDULAR FEVER Notes/Enquiries—

INORGANIC PHOSPHATE 1. See—PHOSPHATE, INORGANIC Notes/Enquiries—

INR 1. See—PROTHROMBIN TIME Notes/Enquiries—

INSULIN—blood 1. Useful in investigation of fasting hypoglycaemia. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3049.

TWO required— Serum (tube SG8), taken on ice. Simultaneous fluoride/oxalate specimen (tube F2) for Glucose. Send to laboratory for immediate centrifugation. Fasting................................................................. < 15 mU/L Interpretation depends on glucose level, body weight and age.


Reference range—

INTRINSIC FACTOR ANTIBODY—blood 1. For diagnosis of autoimmune vitamin B12 malabsorption

(pernicious anaemia). Notes/Enquiries—

2. Enquiries—Immunology, Ext. 3616. Serum (tube SG8). ............................................................................. < 10 kU/L




IRON—blood 1. Acronym/Synonym—FE Notes/Enquiries— 2. See also—IRON STUDIES (APPENDIX G, page 114) 3. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). Specimen should be drawn no later than 0900 h; serum iron values show a marked diurnal variation. ..........................................................................7—32 µmol/L


Reference range—

IRON—liver 1. Enquiries—Clinical Biochemistry, Ext. 3076 (assay sent out). Notes/Enquiries— 2. Hepatic Iron Index =

(Hepatic Iron Concentration divided by age in years). Values > 2 indicate haemochromatosis (source: ARL).

Liver biopsy specimen placed directly into a clean, dry container and delivered to the laboratory as soon as possible. Minimum sample size for accurate analysis is 1—2 mg. Normal...................................................5—40 µmol/g dry wt. Untreated idiopathic haemochromatosis or secondary haemochromatosis............... > 80 µmol/g dry wt. Alcoholic liver disease or early idiopathic haemochromatosis...............40—80 µmol/g dry wt.


Reference range—

IRON BINDING CAPACITY, TOTAL 1. See—TRANSFERRIN Notes/Enquiries—

IRRADIATED BLOOD PRODUCTS 1. See—BLOOD BANK LABORATORY (APPENDIX I, page 120) Notes/Enquiries—

ISOELECTRIC FOCUSING—CSF 1. See—OLIGOCLONAL BANDS of IgG Notes/Enquiries—

KCCT 1. See—ACTIVATED PARTIAL THROMBOPLASTIN TIME Notes/Enquiries—

KETONES 1. See—HYDROXYBUTYRATE, beta– for the blood test. Notes/Enquiries— 2. The urine test is performed by Ward Staff, using dipsticks.



KLEIHAUER TEST—blood 1. Test is performed as required. Notes/Enquiries— 2. Enquiries—Monday to Friday, 08:30—17:30, contact

Sandringham Laboratory, Ext. 1247. After hours, contact Alfred Blood Bank, Ext. 3100.


LACTATE—blood 1. Acronym/Synonym—Lactic Acid Notes/Enquiries— 2. Confirm presence of acidaemia before ordering lactate. 3. Specimens must be collected without venous stasis. 4. Delayed analysis will cause falsely elevated levels. 5. For non–urgent lactate estimation (e.g. exercise test) consult

Duty Biochemist about sampling and preservation protocol. 6. Enquiries—Clinical Biochemistry, Ext. 3554.

Preferred—Fluoride/oxalate (tube F2). (N.B. specimens collected in this tube are unsuitable for most other tests). Acceptable—Heparin plasma (tube H9), or blood in a blood gas syringe, packed in ice and delivered within five minutes of collection. ..................................................................... 0.6—2.2 mmol/L


Reference range—

LACTATE DEHYDROGENASE—blood 1. Acronym/Synonym—LD Notes/Enquiries— 2. Reference range is for adults. Higher values may be seen in

children. 3. Haemolysed specimens are unsuitable (false elevation). 4. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). ......................................................................... 125—243 U/L


LD 1. See—LACTATE DEHYDROGENASE Notes/Enquiries—



LEAD—blood 1. For specimen types other than blood consult the Duty

Biochemist. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3888 (assay sent out). Heparin blood in special container (tube M7). Do NOT centrifuge.


LEGIONNAIRES' DISEASE 1. Culture of respiratory secretions must be specifically

requested. Notes/Enquiries—

2. The urinary antigen test does not detect other species or serogroups of Legionella.

3. Enquiries—Microbiology, Ext. 3089. Respiratory secretions— (e.g. bronchial washings, broncho-alveolar lavage, sputum, lung tissue) for Legionella culture. Urine— Random specimen for Legionella pneumophila serogroup 1 antigen test. Blood—Serum (tube SG8). Collect as early in the illness as possible as well as at 3 and 8 weeks (if required). Acute serum will be tested only in parallel with convalescent serum. For advice, consult Serology laboratory (Ext. 3354).


LEPTOSPIRA 1. Serology is test of choice. Isolation is unlikely unless urine

collection is performed at the patient’s bedside. Notes/Enquiries—

2. Enquiries—Microbiology Serology, Ext. 3354. Serum (tube SG8). Specimen required—



LEUCOCYTE IMMUNOPHENOTYPING 1. Samples must be marked ‘URGENT’, must reach the

laboratory as soon as possible, and will not normally be accepted after 5 pm, Monday—Friday. All out-of-hours testing requires notification to Haematology.

Notes/Enquiries—

2. Time and date of collection must be recorded on request form.

3. Enquiries—Immunology, Ext. 3616. Blood—Heparin blood (tube E9). An FBE must also be requested (an extra E3 tube). Bone marrow aspirate—in heparinised tubes. Fresh tissue samples—unfixed, on saline–soaked gauze or in RPMI. CSF/Other Fluids—at least 2 mL is preferred. Flow Cytometric analysis of cells stained by Immunofluorescence with a range of antibodies against lymphoid and myeloid markers. The panel of markers used will be appropriate to the clinical notes supplied, or as arranged by prior consultation.


Tests Performed—

LFT 1. See—LIVER TEST GROUP Notes/Enquiries—



LIA-DIMER—blood 1. The LIA-Dimer test is a very sensitive test to detect the

absence of venous thromboembolism. It is useful only in the investigation of patients presenting with symptoms or signs suggestive of this disorder in an outpatient setting.

Notes/Enquiries—

2. If the test is negative, it is extremely unlikely that the patient has thromboembolism, and further investigations for this diagnosis need not proceed unless there is compelling reason to do so.

3. If the result is positive, the test is inconclusive and, in the appropriate clinical setting, further imaging tests for the diagnosis of venous thromboembolism are recommended.

4. This test should not be requested as part of the diagnosis of Disseminated Intravascular Coagulation. The appropriate tests to request in that situation are PT-INR, APTT, Blood Film, Platelet Count and D-Dimer.

5. Inpatients frequently have a positive LIA test as a result of wound healing and then the test is non-diagnostic.

6. Enquiries—Haematologist On-call, Ext. 3100. Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. ................................................................................. Negative A Positive result is inconclusive, see Notes above.


Reference range—

LIGHT CHAINS (of monoclonal immunoglobulins)—blood and urine

1. Acronym/Synonym—“Bence–Jones” Protein Notes/Enquiries— 2. Light Chain Detection—The presence of free and intact

monoclonal light chains is assessed by immunofixation after electrophoresis or isoelectric focusing.

3. Light Chain Typing—The heavy and light chain classes are determined when a new monoclonal protein (paraprotein) has been detected in a previously undiagnosed patient. Consult with the Protein Section regarding possible further studies.

4. Enquiries—Clinical Biochemistry Protein Section, Ext. 3141. Serum (tube SG8). Plasma is NOT suitable. plus a 24 hour urine collection (preferable) or a 50 mL random urine specimen. ...........................................................................Not detected


Reference range—



LIGNOCAINE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3141.

Pre-dose. Serum (tube SG8) or heparin plasma (tube HG8). Pre-dose...........................................................10—21 µmol/L


LIPASE—blood 1. Lipase is the preferred analyte for urgent diagnosis of

pancreatitis in this laboratory. Notes/Enquiries—

2. Lipase should be requested where its higher specificity and longer half-life may be useful.

3. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). ..........................................................................< 8—78 U/L


LIPID STUDIES—blood 1. Acronym/Synonym—Lipids Notes/Enquiries— 2. Requests for ‘Lipids’ provide Cholesterol and Triglycerides;

HDL cholesterol is not routinely included. see—CHOLESTEROL, HIGH DENSITY LIPOPROTEIN.

3. Enquiries—Clinical Biochemistry, Ext. 3554. Collect after a 12 hour FAST. Serum (tube SG8) or heparin plasma (tube HG8).


LITHIUM—blood 1. Acronym/Synonym—LI Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8).—DO NOT use a lithium heparin tube. For assay of therapeutic levels, specimen should be collected at least twelve hours after last dose. State dosing and collection times on the request form. Therapeutic................................................... 0.5—1.0 mmol/L Toxic range .................................................... > 1.5 mmol/L


Reference ranges—



LIVER TEST GROUP—blood 1. Acronym/Synonym—LFT Notes/Enquiries— 2. The following tests are included in this group—

Bilirubin, Alkaline Phosphatase (ALP), Alanine Aminotransferase (ALT), gamma–Glutamyl–Transferase (γGT), Albumin and Total Protein.

3. Aspartate Aminotransferase (AST) is no longer part of LFT but is still available if separately requested.

4. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). See individual entries or table in APPENDIX N (page 132).


LMW HEPARIN ANTI Xa ASSAY 1. See—ANTI Xa ASSAY Notes/Enquiries—

LOPINAVIR—blood 1. Acronym/Synonym—LOPR Notes/Enquiries— 2. All Protease Inhibitors can be analysed on the same




LUPUS ANTICOAGULANT SCREEN—blood 1. May be associated with arterial/venous thrombosis. Notes/Enquiries— 2. May cause prolongation of APTT. 3. Enquiries—Haematology, Ext. 3109.

TWO specimens required— 2x Citrate plasma (tube C3); add exactly 2.7 mL blood to each tube and mix by inversion. ................................................................................. Negative


Reference range—



LUTEINIZING HORMONE—blood 1. Acronym/Synonym—LH Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8). Follicular ................................................................. 1—18 U/L Mid–cycle ........................................................... 24—105 U/L Luteal................................................................... 0.4—20 U/L Post–Menopausal....................................................> 15 U/L Male ....................................................................... 2—12 U/L


LYMPH NODE BIOPSY 1. See—BIOPSY SERVICE (APPENDIX A, page 103) Notes/Enquiries—

LYSOZYME—serum 1. Enquiries— Haematology, Ext. 3114.

Serum (tube SG8). Male ...............................................................1.9—14.3 mg/L Female ............................................................1.3—10.9 mg/L


MAGNESIUM—blood 1. Acronym/Synonym—MG Notes/Enquiries— 2. Serum magnesium concentration varies with protein

concentration (20—30% is protein–bound), acid–base status and carbohydrate intake (compare potassium) and thus may not reflect the total body stores.

3. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). ................................................................. 0.85—1.15 mmol/L


MALARIAL PARASITES—blood 1. Adequate clinical details are required. An FBE is usually

performed at the same time. Notes/Enquiries—

2. Emergency Department patients should not be discharged until report is available.

3. Enquiries—Haematology, Ext. 3116. EDTA blood (tube E3). Specimen required—



MANTOUX TEST 1. This test is performed by the Infectious Diseases Unit. Please

contact Infectious Diseases Registrar or send request form direct to Infectious Diseases Unit.

Notes/Enquiries—

2. Enquiries—Infectious Diseases Registrar, Ext. 3009.

MENINGOCOCCUS 1. This is a PCR-based assay. Notes/Enquiries— 2. Enquiries—Microbiology, Ext. 3354 (assay sent out).

EDTA blood (separate tube E9), CSF. Specimen required—

MERCURY—blood 1. For specimens other than blood consult the Duty Biochemist. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3888 (assay sent out).

Heparin blood in special container (tube M7). Do NOT centrifuge.


METHAEMOGLOBIN—blood 1. Of value in investigating patients with cyanosis and a normal

pO2. Levels may be raised in congenital haemoglobin M disorders and drug toxicity associated with nitrites or other oxidising agents.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3554. As for BLOOD GASES. ....................................................< 2% of total haemoglobin ...............................................(levels may be higher in infants)


METHOTREXATE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) or heparin plasma (tube HG8). Desirable level depends on clinical situation.


METHOXYHYDROXYMANDELIC ACID (MHMA) 1. See—VANILLYLMANDELIC ACID Notes/Enquiries—

MEXILETINE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8) or heparin plasma (tube HG8). .................................................................printed with results




MICROALBUMIN 1. See—ALBUMIN—urine

MICROBIOLOGICAL SEROLOGY 1. See—SEROLOGY (Microbiology)

MICROGLOBULIN, beta–2– —blood 1. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8). .........................................................................0.8—2.2 mg/L Higher levels may be seen in elderly patients.


MONOTEST/MONOSPOT 1. See—Glandular Fever Notes/Enquiries—

MULTIMERIC ANALYSIS 1. See—von WILLEBRAND FACTOR Notes/Enquiries—

MYCOBACTERIUM TUBERCULOSIS AND OTHER MYCOBACTERIAL SPECIES 1. Tests for Mycobacteria must be specifically requested.

Smears and cultures are made. Notes/Enquiries—

2. A PCR assay is available only after consultation. 3. Enquiries—Microbiology, Ext. 3089. • AFB CULTURE

Sputum—Three consecutive, early morning, specimens. Urine—Three consecutive, complete early morning specimens. Culture only, no smear. Blood for MAC in HIV antibody positive patients—add 3 mL to 5 mL blood to one MB/Bact bottle. Media available from Microbiology. Bone marrow—as for blood. Other Specimens—e.g. Bronchial washings, Tissues, Fluids (CSF, Pleural, Ascitic etc.), Gastric lavage, Pus. Faeces—examined only for HIV antibody positive patients. Swabs are unacceptable.




MYCOPLASMA (genital type) CULTURE 1. Enquiries—Microbiology, Ext. 3354.

Genital swab. Do NOT refrigerate specimen. Notes/Enquiries— Specimen required—

MYCOPLASMA PNEUMONIAE 1. See also—MYCOPLASMA PNEUMONIAE ANTIBODY. Notes/Enquiries— 2. Enquiries—Microbiology, Ext. 3354. • Serology

Serum (tubes SG8) Specimen required—

• PCR (assay sent out) CSF, NPA,BAL, BRW, sputum or throat swab.

MYCOPLASMA PNEUMONIAE ANTIBODY—blood 1. This is a total antibody test but predominantly detects IgM

so an early diagnosis can be made. Notes/Enquiries—

2. False–negative tests may result if serum is collected very early in infection. Collect convalescent specimen 14 days after onset of symptoms.

3. See also—MYCOPLASMA PNEUMONIAE. 4. Enquiries—Microbiology, Ext. 3354.

Serum (tube SG8). (2 samples, one at onset and one 14 days later). < 40 ..................... No evidence of recent infection. 40........................... Equivocal. 80 or 160 ............... Evidence of infection with Mycoplasma

at indeterminate time. Please send a further specimen in 14 days.

320 or greater ........ Suggests recent infection with Mycoplasma. Specimen will be additionally tested for IgM.


Reference ranges—

MYOGLOBIN—blood 1. Test not routinely available. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

MYOGLOBIN—urine 1. This test is no longer available. Use serum creatine kinase

(CK) as an indicator of rhabdomyolysis. Notes/Enquiries—




NAP 1. See—NEUTROPHIL ALKALINE PHOSPHATASE Notes/Enquiries—

NECROPSY SERVICE 1. See—APPENDIX C (page 109) Notes/Enquiries—

NELFINAVIR—blood 1. Acronym/Synonym—NELR Notes/Enquiries— 2. All Protease Inhibitors can be analysed on the same




NEONATAL SEPSIS 1. Most common bacterial causes are—

Group B Streptococcus, Haemophilus influenzae, Listeria monocytogenes, Escherichia coli.

Notes/Enquiries—

2. Enquiries—Microbiology, Ext. 3089. Gastric aspirate preferred, umbilical swab, ear swab, groin swab, and/or blood culture may also be collected.


NEUTROPHIL ALKALINE PHOSPHATASE—blood 1. Acronym/Synonym—NAP Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3114.

The test can be performed on EDTA blood only if the specimen arrives in the laboratory within 30 minutes of collection. Please mark ‘URGENT’. ........................................................................ 2—105 (score)


Reference range—

NEUTROPHIL ANTIBODIES 1. Enquiries—Consult Haematology medical staff.


NORADRENALINE 1. See—CATECHOLAMINES Notes/Enquiries—



OCCULT BLOOD—faeces 1. False positives may occur through dietary factors. The

patient should not ingest any iron medications, or any food prepared from red meat, for three days prior to the test.

Notes/Enquiries—

2. False negatives may be caused by ingestion of large doses of ascorbic acid (Vitamin C).

3. Enquiries—Clinical Biochemistry, Ext. 3141. Random specimens of faeces (3 separate occasions recommended). .............................................................Not normally detected


Reference range—

OESTRADIOL (Non–pregnant)—blood 1. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8). Follicular phase ............................................ 143—694 pmol/L Midcycle .................................................... 345—1864 pmol/L Luteal ........................................................ 176—1134 pmol/L Post–menopausal............................................. < 150 pmol/L Male ................................................................ < 283 pmol/L


OESTROGEN RECEPTOR STUDIES 1. See—CYTOLOGY SERVICE (APPENDIX B, page 105) Notes/Enquiries—

OLIGOCLONAL BANDS of IgG—CSF 1. In several diseases of the central nervous system (multiple

sclerosis and certain chronic infectious diseases such as sub–acute sclerosing pan–encephalitis and neurosyphilis) there are quantitative and qualitative alterations in immunoglobulins synthesised inside the blood–brain barrier. A relative increase in IgG in CSF, compared with serum, and the existence of oligoclonal bands (discrete bands representing IgG molecules of restricted heterogeneity) in CSF, which do not exist in serum at that time, provide strong evidence for the diagnosis of multiple sclerosis.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3141. 0.10 mL clear cerebrospinal fluid and a Serum specimen (tube SG8) collected at the same time.




OSMOLALITY—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8), collected with minimal stasis. ................................................................. 275—300 mmol/kg ................ Normally little or no change after water deprivation


Reference range—

OSMOLALITY—urine 1. Enquiries—Clinical Biochemistry, Ext. 3554.

10 mL (minimum) random specimen in small, PLAIN container. Random..................................................... 50—1200 mmol/kg After 12h fluid restriction............................... >850 mmol/kg


OSMOTIC FRAGILITY—blood 1. Only perfomed after consultation with a Haematologist. Notes/Enquiries— 2. For Osmotic fragility assays 24 hours notice is required.

Contact Special Haematology. 3. Enquiries—Special Haematology, Ext. 3114.

10 mL blood in sterile, preservative free Sodium Heparin tube obtained from Haematology. Test performed on Monday to Thursday mornings only. Demonstrated on a graph. Before incubation, haemolysis commences at 5.0 g/L and is complete by 2.0 g/L. After 24 hours incubation at 37°C haemolysis commences at 7.0 g/L and is complete by 2.0 g/L.


Reference range—

OXALATE—urine 1. This test should not be requested without adequate

indication. Please document this in clinical notes on the request form.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out). 24 hour collection in ACID bottle. .................................................................printed with results


PAI-1 1. See—PLASMINOGEN ACTIVATOR INHIBITOR Notes/Enquiries—



PARACETAMOL (overdose)—blood 1. This test is available at all times for overdoses. Notes/Enquiries— 2. Patients with potentially toxic concentrations are in danger

of serious complications, especially liver damage, which may not become apparent for 2—4 days.

3. Enquiries—Clinical Biochemistry, Ext. 3554 Serum (tube SG8) or heparin plasma (tube HG8). Specimens must be collected at least four (4) hours post–ingestion. The protocol for treatment held in the Emergency Department should be studied and followed. The table below indicates blood levels above which treatment should be considered. A half-life of 4 hours is assumed.


Toxic range—

Hours post ingestion

Paracetamol (µmol/L)

Hours post ingestion

Paracetamol (µmol/L)

4 660 16 82

6 467 18 58

8 330 20 41

10 233 22 29

12 165 24 21

14 117 26 15

NOTE: Lower levels may be toxic in chronic users and patients with certain co-morbidities.

PARAPROTEIN QUANTITATION—blood 1. Request ‘Paraprotein’, not IgG, IgM or IgA, to follow levels of

monoclonal proteins or paraproteins in patients under treatment for lymphoproliferative or related diseases.

Notes/Enquiries—

2. Paraprotein is measured by quantitative electrophoresis which, for monoclonal immunoglobulins, is more reliable than immunoquantitation.

3. Enquiries—Clinical Biochemistry, Ext. 3141 Serum (tube SG8). Specimen required—



PARATHYROID HORMONE—blood 1. Acronym/Synonym—intact PTH Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141

EDTA blood (tube E9), preferably fasting. Pack in ice and send to laboratory for immediate separation. ...................................................................... 1.3—7.6 pmol/L Interpretation depends on serum calcium level, renal function and Vitamin D status.


Reference range—

PARATHYROID HORMONE RELATED PROTEIN—blood 1. Acronym/Synonym—PTHrP Notes/Enquiries— 2. May be indicated in investigation of hypercalcaemia.

Consultation with Endocrinologist or Chemical Pathologist is required.

3. Enquiries—Clinical Biochemistry, Ext. 3888 (assay sent out). Special tube obtainable from laboratory. .........................................................................< 1.3 pmol/L


PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA (PNH) 1. Acronym/Synonym—PNH Notes/Enquiries— 2. Please request—“Cell Markers for PNH”. 3. See also—HAM’S TEST, SUCROSE LYSIS TEST 4. Enquiries—Haematology, Ext. 3616.


PARVOVIRUS 1. This is a PCR-based assay. Notes/Enquiries— 2. Enquiries—Microbiology, Ext. 3354 (assay sent out).

Serum (tube SG8) or EDTA (tube E9). Specimen required—

PAUL–BUNNELL TEST 1. See—GLANDULAR FEVER Notes/Enquiries—

PBG 1. See—PORPHOBILINOGEN Notes/Enquiries—



PCR (Polymerase Chain Reaction) for INFECTIOUS DISEASES 1. See also—Individual organism names in the test listing. Notes/Enquiries— 2. Enquiries—Microbiology, Ext. 3354 (some assays sent out).

Containers—SWABS must be in Viral Transport Medium (VTM), except for Chlamydia and Gonorrhoea which require special collection kits available from Microbiology. Conditions—All blood PCR tests require a tube of their own (no other tests to be performed on the same specimen)!

Specimens Required—

PERHEXILINE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

At least 4 hours post-dose. Heparin plasma (tube HG8). ....................................................................... 150—600 µg/L


pH, pCO2 and pO2 1. See—BLOOD GASES Notes/Enquiries—

pH—urine 1. See—URINE pH Notes/Enquiries—

PHENOBARBITONE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3141.

Pre-dose. Serum (tube SG8) or heparin plasma (tube HG8). Pre-dose.........................................................65—170 µmol/L


PHENYTOIN—blood 1. Acronym/Synonym—PTN, Dilantin® Notes/Enquiries— 2. Consultation with Laboratory is required 3. Enquiries—Clinical Biochemistry, Ext. 3141.

Pre-dose. Serum (tube SG8) or heparin plasma (tube HG8). Pre-dose...........................................................40—80 µmol/L




PHENYTOIN, FREE—blood 1. Total Phenytoin must be requested on the same specimen to

enable interpretation of results. Notes/Enquiries—

2. Normally 10% of Total Phenytoin. 3. Enquiries—Clinical Biochemistry, Ext. 3141.

Pre-dose. Serum (tube SG8) or heparin plasma (tube HG8). Pre-dose.........................................................4.0—8.0 µmol/L


PHOSPHATE, INORGANIC—blood 1. Acronym/Synonym—IP Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). ................................................................. 0.70—1.30 mmol/L


PHOSPHATE, INORGANIC—urine 1. Enquiries—Clinical Biochemistry, Ext. 3554

24 hour collection in an ACID bottle. ................................................................. 11.0—32.0 mmol/L


PLASMA HAEMOGLOBIN 2. See—HAEMOGLOBIN, PLASMA Notes/Enquiries—

PLASMINOGEN—blood 1. Enquiries—Haematology, Ext. 3109 (assay sent out).

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. .............................................................................. 80—140%


Reference range—

PLASMINOGEN ACTIVATOR INHIBITOR—blood 1. Acronym/Synonym—PAI-1 Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3109 (assay sent out).

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. ........................................................................ 0—20.0 ng/mL


Reference range—



PLATELET AGGREGATION TESTS 1. By consultation with Haematology medical staff. Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3109.

FROM PATIENT 2x Citrate plasma tubes (tube C3); add exactly 2.7 mL blood and mix by inversion. FROM DONOR 6x Citrate plasma tubes (tube C3); add exactly 2.7 mL blood and mix by inversion

Specimens required

PLATELET ANTIBODIES 1. By consultation with Haematologist. Turnaround time is

approximately 2 weeks. Notes/Enquiries—

2. Enquiries—Haematology, Ext. 3100 (assay sent out). Serum (tube SG8). Specimens required—

PLEURAL FLUID 1. See—FLUIDS Notes/Enquiries—

PNEUMOCYSTIS STAIN 1. Normally only performed on bronchial washing, lung biopsy or

induced sputum. Normal sputum is unsatisfactory. Notes/Enquiries—

2. Specimen must be received in laboratory by 2 pm for same day processing.

3. Enquiries—Microbiology, Ext. 3089.

POLYOMAVIRUS (JC and BK) 1. This is a PCR-based assay. Notes/Enquiries— 2. Enquiries—Microbiology, Ext. 3354 (assay sent out).

EDTA blood (separate tube E9), CSF, urine. Specimen required—

PORPHOBILINOGEN—urine 1. Acronym/Synonym—PBG Notes/Enquiries— 2. If Acute Intermittent Porphyria is suspected, it is important

to collect urine during an acute episode of abdominal pain. 3. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

10 mL fresh, random urine specimen. ........................................................................ Not detectable




PORPHYRINS 1. Investigation of porphyrias may require a variable combination of

assays, including urinary (porphyrins, PBG, and ALA), blood porphyrins and faecal porphyrins. Adequate clinical notes, plus requests and samples for urine PBG and porphyrins and for faecal porphyrins should be supplied. If measurement of urinary ALA or erythrocyte protoporphyrin is indicated, the laboratory will request appropriate specimens after screening results are known.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext 3554. (Detailed assays performed at an external laboratory).

PORPHYRINS—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

TWO specimens required, protected from light— EDTA blood (tube E9) plus Heparin blood, no gel (tube H6).


PORPHYRINS—faeces 1. When abnormal concentrations of porphyrins are found,

individual porphyrins will be identified and quantitated. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out). About 10 g of a fresh, random faecal specimen. Protect from light and send to laboratory without delay. .................................................................printed with results


Reference range—

PORPHYRINS—urine 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

50 mL fresh, random urine specimen (protect from light). Total porphyrins ...................... < 35 nmol/mmol of creatinine




POTASSIUM—blood 1. Acronym/Synonym—K Notes/Enquiries— 2. Potassium levels are significantly raised by haemolysis, and

by long delays before specimen separation (worse if cooled). 3. Somewhat higher values are seen in serum than in plasma. 4. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). Do not use very fine needles or draw hard on syringes. There should be minimal stasis and no fist–clenching before or during blood collection. ......................................................................3.5—5.1 mmol/L


Reference range—

POTASSIUM, DIRECT—blood 1. Results for 'direct' potassium are always comparable to

standard 'indirect' methods. However, see also SODIUM, DIRECT.

Notes/Enquiries—

2. NB for ward–based Blood Gas Analysers—haemolysis cannot be seen in whole blood specimens.


POTASSIUM—urine 1. See—SODIUM and POTASSIUM—URINE Notes/Enquiries—

PREGNANCY TEST—blood 1. See—CHORIONIC GONADOTROPHIN, HUMAN ( βHCG ) Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). Specimen required—

PRIMIDONE—blood 1. Phenobarbitone, a major metabolite of primidone, will also be

measured. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3049 (assay sent out). Pre-dose. Serum (tube SG8) or heparin plasma (tube HG8). .................................................................printed with results

Specimen required— Therapeutic ranges—



PROCAINAMIDE—blood 1. N–acetylprocainamide (NAPA), the major metabolite, will also

be measured. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3049 (assay sent out). Pre-dose. Serum (tube SG8) or heparin plasma (tube HG8). .................................................................printed with results

Specimen required— Therapeutic ranges—

PROGESTERONE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8) or heparin plasma (tube HG8). Follicular ........................................................ 0.5—4.5 nmol/L Luteal......................................................... 10.6—81.3 nmol/L Mid-Luteal .................................................. 14.1—89.1 nmol/L Post-menopausal ...............................................< 2.3 nmol/L Male .............................................................. 0.9—3.9 nmol/L


PROGESTERONE, 17 alpha–HYDROXY—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8) or heparin plasma (tube HG8). ................................................................ Printed with results


PROLACTIN—blood 1. Acronym/Synonym—PRL Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) or heparin plasma (tube HG8). Female ............................................................. 30—513 mU/L Male ................................................................ 34—398 mU/L




PROSTATE SPECIFIC ANTIGEN—blood 1. Acronym/Synonym—PSA Notes/Enquiries— 2. PSA is more sensitive and specific for carcinoma of the

prostate than prostatic Acid Phosphatase. Levels correlate well with tumour bulk and clinical stage, but significant elevations have also been seen in benign prostatic hypertrophy.

3. Increased levels of PSA occur with increasing age. This is not currently reflected in our Reference range.

4. Method used is Total PSA on the Abbott Axsym®. 5. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8). ............................................................................... < 4 µg/L


PROTEASE INHIBITORS—blood 1. See—AMPRENAVIR, INDINAVIR, LOPINAVIR, NELFINAVIR,

RITONAVIR, SAQUINAVIR Notes/Enquiries—

PROTEIN C—blood 1. Results not valid if patient receiving warfarin therapy or with

acute thrombotic event Notes/Enquiries—

2. Enquiries—Haematology, Ext. 3109. Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. Function................................................................. 72—153%


Reference ranges—

PROTEIN ELECTROPHORESIS—blood 1. Acronym/Synonym—PEP Notes/Enquiries— 2. Routinely, a qualitative, interpretive report of an agarose gel

electrophoretic pattern is made. It is important to provide adequate clinical information with the request for these interpretations to be meaningful. Gels are available for inspection in the Laboratory, and may be discussed with a senior scientist in the Protein Section.

3. Enquiries—Clinical Biochemistry Protein Section, Ext. 3141. Serum (tube SG8). NOTE: plasma is not suitable. Specimen required—



PROTEIN S—blood 1. Results not valid if patient receiving warfarin therapy or with

acute thrombotic event. Notes/Enquiries—

2. Enquiries—Haematology, Ext. 3109. Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. Functional .............................................................. 56—132%


Reference range—

PROTEIN, TOTAL—blood 1. Acronym/Synonym—TP Notes/Enquiries— 2. Plasma values average 4 g/L greater than serum. 3. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). Serum ....................................................................60—80 g/L


PROTEIN, TOTAL—CSF 1. Enquiries—Clinical Biochemistry, Ext. 3076.

0.6 mL cerebrospinal fluid. ........................................................................0.15—0.40 g/L


PROTEIN, TOTAL—urine 1. Consult Protein Laboratory Section if further identification of

urine protein is required. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3554. 24 hour collection in a PLAIN bottle. ............................................................................ < 0.15 g/d


PROTHROMBIN G20210A—blood 1. Acronym/Synonym—Prothrombin Gene Mutation Notes/Enquiries— 2. May identify venous thrombotic risk. 3. Enquiries—Haematology, Ext. 3109 (assay sent out).

A separate container of EDTA blood (tube E3). ..........................................................Polymorphism not found

Specimen required— Normal Report—



PROTHROMBIN TIME—blood 1. Acronym/Synonym—PT Notes/Enquiries— 2. Prothrombin activity is expressed as the International

Normalised Ratio (INR). 3. See also—ANTICOAGULANT THERAPY CONTROL 4. Enquiries—Haematology, Ext. 3109.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. ...........................................................................1.0—1.3 INR Prophylaxis for atrial fibrillation...........................2.0—3.0 INR Treatment of deep vein thrombosis......................2.0—3.0 INR Tissue heart valve replacement ...........................2.0—3.0 INR Mechanical heart valve replacement ....................2.5—3.5 INR


Reference range— Therapeutic ranges—

PSA 1. See—PROSTATE SPECIFIC ANTIGEN Notes/Enquiries—

PSEUDOCHOLINESTERASE 1. See—CHOLINESTERASE Notes/Enquiries—

PSITTACOSIS ANTIBODY 1. See—CHLAMYDIA Notes/Enquiries—

PT 1. See—PROTHROMBIN TIME Notes/Enquiries—

PTH 1. See—PARATHYROID HORMONE Notes/Enquiries—

PTHrP 1. See—PARATHYROID HORMONE RELATED PROTEIN Notes/Enquiries—

PUS 1. Enquiries—Microbiology, Ext. 3089.

Where sufficient pus is available this should be aspirated and placed in a sterile container. Otherwise, collect as much pus as possible on a swab.




QUAD TEST 1. Pre-natal screening dor Down’s Syndrome, other trisomies

and neural tube defects is available in the form of 1st and 2nd trimester blood screening and/or ultrasound.

Notes/Enquiries—

2. Enquiries—SDMH Laboratory, Ext. 11247. Serum (tube SG8). .................................................................printed with results

Specimen required— Reference ranges

QUINIDINE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3141.

Pre-dose. Serum (tube SG8) or heparin plasma (tube HG8). Pre-dose.............................................................6—15 µmol/L


RAST—blood 1. Acronym/Synonym—ALLERGEN SPECIFIC IgE Notes/Enquiries— 2. Specify each allergen required. A list of available allergens

can be obtained from the laboratory. 3. Maximum of 4 specific allergens or mixes for each request. 4. Enquiries—Immunology, Ext. 3616.

Serum (tube SG8). ...........................................................................<0.35 kU/L

Specimen required— Reference Range—

RED CELL ENZYME SCREENING 1. Enquiries—Special Haematology Laboratory, 3114. Notes/Enquiries—

RED CELL FERRITIN 1. Indicated in clinical situations of iron overload. Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3114.


RED CELL FOLATE ASSAY 1. See—VITAMIN B12 and FOLATE Notes/Enquiries—

RED CELL MASS/VOLUME 1. See—BLOOD VOLUME Notes/Enquiries—



RENIN ACTIVITY—blood 1. Endocrine consultation required in planning renal vein

sampling. Notes/Enquiries—

2. Samples must NOT be collected on ice. 3. Enquiries—Clinical Biochemistry, Ext. 3141.

EDTA blood (tube E9) at room temperature. Deliver to laboratory within 2 hours. Recumbent..................................................... 0.3—1.4 µg/L.h Ambulant ....................................................... 0.6—2.8 µg/L.h


Reference ranges—

REPTILASE TIME—blood 1. To differentiate a prolonged Thrombin Time due to heparin

use from other causes. Notes/Enquiries—

2. Enquiries—Haematology, Ext. 3109. Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. ........................................................................< 24 seconds


Reference range—

RESPIRATORY VIRUSES 1. Includes Influenza A and B, Parainfluenza types 1/2/3, RSV,

Adenovirus and Picornovirus. Notes/Enquiries—

2. These are PCR-based assays. 3. Enquiries—Microbiology, Ext. 3354 (assay sent out).

NPA, BAL, BRW. Specimen required—

RETICULOCYTES—blood 1. Enquiries—Haematology, Ext. 3116.

EDTA blood (tube E3). An FBE is performed at the same time. Female .............................................................8—104 x 109/L Male ................................................................9—116 x 109/L


RHEUMATOID FACTOR—blood 1. Acronym/Synonym—RF Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8). ............................................................................. < 20 kU/L




RICKETTSIA CULTURE—blood 1. See also—SEROLOGY Notes/Enquiries— 2. Enquiries—Microbiology, Ext. 3089 (assay sent out).


RITONAVIR—blood 1. Acronym/Synonym—RITR Notes/Enquiries— 2. All Protease Inhibitors can be analysed on the same


EDTA blood (tube E9). .................................................................printed with results


RUBELLA SEROLOGY—blood 1. Enquiries—Serology, Ext. 3354.


SALBUTAMOL—urine 1. Enquiries—For information on the usefulness of this test

contact David Rutherford, Clinical Biochemistry, Ext. 3080. Random urine.

Notes/Enquiries—


SALICYLATE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). After overdose, specimens should be collected at least six (6) hours post–ingestion. Therapeutic................................................... 1.0—2.5 mmol/L Toxic range .................................................... > 3.5 mmol/L


Reference ranges—



SAQUINAVIR—blood 1. Acronym/Synonym—SAQR Notes/Enquiries— 2. All Protease Inhibitors can be analysed on the same


EDTA blood (tube E9). .................................................................printed with results


SCHILLING’S TEST 1. By appointment only with Nuclear Medicine. Notes/Enquiries— 2. Enquiries—Ext. 2432.

14—40% excretion in 24 h, with and without intrinsic factor. Reference range—

SELENIUM 1. Consult Duty Biochemist, Ext. 3888 (assay sent out).

Heparin blood in special container (tube M7). Do NOT centrifuge. .................................................................printed with results


Reference range—



SEROLOGY (Microbiology) 1. See also—VIRUS SEROLOGY Notes/Enquiries— 2. Enquiries—Microbiology Serology, Ext. 3354.

(most assays sent out). Serum (tube SG8). Specimen required—

ORGANISM/DISEASE ACRONYM / SYNONYM / NOTE ADENOVIRUS AMOEBA.............................................................. see entry in alphabetic listing ANGIOSTRONGYLUS ARBOVIRUSES, GROUP B ASPERGILLUS PRECIPITINS ............................. see entry in alphabetic listing AUSTRALIAN ENCEPHALITIS ....................................Murray Valley Encephalitis AVIAN PRECIPITINS .......................................................Bird Fancier’s Serology BARMAH FOREST VIRUS BARTONELLA .........................................................................Cat Scratch Fever BORDETELLA PERTUSSIS ........................................................Whooping Cough BORRELIA..................................................................................... Lyme Disease BRUCELLA CAMPYLOBACTER JEJUNI CHLAMYDIA........................................................ see entry in alphabetic listing COXSACKIE ............................................................ part of Enterovirus Serology CRYPTOCOCCUS CYSTICERCOSIS CYTOMEGALOVIRUS ..................................................................................CMV DENGUE FEVER DIPHTHERIA ANTIBODY TITRE EPSTEIN BARR VIRUS ................................................................................. EBV ENTEROVIRUS CF (includes Coxsackie, Echovirus & Enterovirus) FASCIOLIASIS FILARIASIS HAEMOPHILUS INFLUENZAE, type b HELICOBACTER PYLORI HERPES SIMPLEX HEPATITIS .......................................................... see entry in alphabetic listing HISTOPLASMA HUMAN HERPES 6 ............................................ see entry in alphabetic listing HUMAN IMMUNODEFICIENCY VIRUS (HIV) ..... see entry in alphabetic listing HYDATID INFLUENZA (Type A and B) JAPANESE B ENCEPHALITIS

Table continued on next page……



ORGANISM/DISEASE ACRONYM / SYNONYM / NOTE LEISHMANIA LEGIONELLA LEPTOSPIRA................................................................... repeat test at 2 weeks LISTERIA MEASLES MELIOIDOSIS MYCOPLASMA ....................................................see entry in alphabetic listing MUMPS PARVOVIRUS PNEUMOCOCCAL ANTIBODY TITRE Q FEVER RESPIRATORY SYNCYTIAL VIRUS .............................................................. RSV RICKETTSIA ROSS RIVER RUBELLA SALMONELLA (WIDAL) SCHISTOSOMA STRONGYLOIDES SYPHILIS (RPR, TPHA, FTA) ...............................see entry in alphabetic listing TETANUS ANTIBODIES TOXOCARA TOXOPLASMA TRYPANOSOMIASIS.......................................................causes Chagas Disease TYPHOID VARICELLA ZOSTER ........................................................................ chicken pox YERSINIA

SEROTONIN 1. Consult Duty Biochemist, Ext. 3076 (assay sent out). Notes/Enquiries—

SEX HORMONE BINDING GLOBULIN—blood 1. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8). Male ................................................................ 13—71 nmol/L Female ........................................................... 18—114 nmol/L




SIROLIMUS—blood 1. Dose and Time of Dose must be supplied. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3049.

EDTA blood (tube E3). Do NOT centrifuge. .................................................................printed with results


SKIN SCRAPINGS for FUNGI 1. Do not treat the affected area prior to scraping. Notes/Enquiries— 2. Enquiries—Microbiology, Ext. 3089.

Implant the scrapings into the surface of the special agar plates supplied by the laboratory.


SNAKE VENOM DETECTION 1. See—SNAKE VENOM DETECTION (APPENDIX J, page 128) Notes/Enquiries—

SODIUM—blood 1. Acronym/Synonym—NA Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). ................................................................... 136—145 mmol/L


SODIUM, DIRECT—blood 1. In very lipaemic samples, falsely low values are obtained with

some routine methods for sodium or potassium measurement. Direct analysis with ion–selective electrodes is used when significant lipaemia is noted, or when particular urgency dictates analysis of whole blood (e.g. during cardiac surgery).

Notes/Enquiries—

2. All blood gas analysers use ‘direct’ methods of measurement. 3. Enquiries—Clinical Biochemistry, Ext. 3554.



SODIUM and POTASSIUM—urine A. RANDOM URINE SODIUM AND POTASSIUM 1. These tests are of value principally—

• in differentiation of the cause of low plasma sodium. • to differentiate between pre–renal and renal failure in certain circumstances where oliguria is present (urine Na). • in acute disturbances of sodium and potassium homeostasis, as a guide to immediate therapy • to assess volume status.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3554. 10 mL urine in small, PLAIN container.


B. 24 HOUR EXCRETION OF SODIUM AND POTASSIUM 24 hour collection in a PLAIN bottle. Specimen required— Variable; many factors determine excretion rates, e.g. intake, renal function, hormonal influences and drug therapy.

Reference range—

SOLUBLE TRANSFERRIN RECEPTORS 1. See—TRANSFERRIN RECEPTORS, SOLUBLE Notes/Enquiries—

SOMATOMEDIN–C 1. See—IGF–1 Notes/Enquiries—

SPUTUM MICROBIOLOGY 1. TB culture must be specifically requested. Three consecutive

early morning specimens are required. Notes/Enquiries—

2. Legionella culture must be specifically requested—see alphabetic listing.

3. Enquiries—Microbiology, Ext. 3089. Sputum should be expectorated into a specimen container. Saliva is unsuitable.


STEROID PROFILE—urine 1. Acronym/Synonym—GC Profile Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

24 hour collection in a PLAIN bottle. Qualitative assessment of pattern of steroid excretion as seen by gas chromatography.




STONE ANALYSIS 1. See—CALCULI Notes/Enquiries—

SUCROSE LYSIS TEST—blood 1. Acronym/Synonym—Sugar Water Test Notes/Enquiries— 2. Only perfomed after consultation with a Haematologist. 3. A screening test for Paroxysmal Nocturnal Haemoglobinuria. 4. See—PAROXYSMAL NOCTURNAL HAEMOGLOBINURIA. 5. Enquiries—Special Haematology, Ext. 3114.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. ...................................................................................No lysis


Reference range—

SUGAR WATER TEST 1. See—SUCROSE LYSIS TEST Notes/Enquiries—

SWABS (Pus, wound, exudate, vaginal, etc.) 1. Enquiries—Microbiology, Ext. 3089

Labelled, sterile cotton swabs should be sent promptly after obtaining a representative sample of material. Swabs with transport medium (available from CSSD) are preferred for— • trichomonas • gonorrhoea • delay in processing e.g. after hours.


SYNACTHEN TEST 1. See—CORTISOL, dynamic tests Notes/Enquiries—

SYPHILIS SEROLOGY—blood/CSF 1. Enquiries—Microbiology Serology, Ext. 3354. Notes/Enquiries— 2. CSF specimens for serology should be accompanied by a

serum specimen. Serum (tube SG8). Specimen required—



T CELL SUBSETS—blood 1. Acronym/Synonym—CD 4/8 and CD 2/3 Notes/Enquiries— 2. Used to monitor T Cell numbers. 3. Enquiries—Haematology, Ext. 3616.

EDTA blood (tube E3). CD 3+ ............................................................530—2030 /µL CD 3+/CD 4+ ................................................410—1545 /µL CD 3+/CD 8+ .................................................. 220—860 /µL CD 2+ ............................................................600—2100 /µL CD 3+ ............................................................530—2030 /µL


TACROLIMUS—blood 1. Acronym/Synonym—FK506® Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3049.

Pre-dose. EDTA blood (tube E3). Do NOT centrifuge. Heart/Lung Transplantation ................................. 15—25 µg/L Liver/Kidney .......................................................... 5—20 µg/L Desirable level depends on organ transplant, time post transplant and clinical situation. Clinicians not experienced in interpreting Tacrolimus levels must consult the relevant Transplant Team or Drug Laboratory.


TEGRETOL® 1. See—CARBAMAZEPINE Notes/Enquiries—

TEICOPLANIN—blood 1. Routine post-dose levels, to avoid toxicity, are not necessary. Notes/Enquiries— 2. See also—ANTIBIOTIC ASSAYS (APPENDIX D, page 110) 3. Enquiries—Clinical Biochemistry, Ext. 3076.

Pre-dose). Serum (tube SG8). Pre-dose.............................................................. 10—20 mg/L Patients with endocarditis may require levels above 20 mg/L.

Specimens required— Reference range—

TESTOSTERONE—blood 1. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) or heparin plasma (tube HG8). Male ............................................................ 6.9—28.1 nmol/L ............................. (lower levels may be normal in elderly men) Female .............................................................. < 3.8 nmol/L




THALASSAEMIA SCREEN 1. See—HAEMOGLOBIN ANALYSIS Notes/Enquiries—

THEOPHYLLINE—blood 1. Acronym/Synonym—Aminophylline®, Nuelin® Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Pre-dose. Serum (tube SG8) or heparin plasma (tube HG8). Pre-dose........................................................ 55—110 µmol/L


THIOCYANATE—blood 1. This test is occasionally required for the monitoring of

nitroprusside therapy. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). Patients on nitroprusside ............................. 100—500 µmol/L Signs of toxicity may be expected at levels...... > 850 µmol/L


THROMBIN CLOTTING TIME—blood 1. Acronym/Synonym—TCT Notes/Enquiries— 2. Used to detect heparin presence/contamination. 3. Enquiries—Haematology, Ext. 3109.

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. ........................................................................< 24 seconds


Reference range—

THYROGLOBULIN—blood 1. Useful in monitoring of differentiated thyroid carcinoma. Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8). .............................................................................< 60 µg/L




THYROID FUNCTION TESTS—blood 1. Acronym/Synonym—TFT Notes/Enquiries— 2. It is suggested that only TSH is requested. If this is

abnormal, FT4 and/or FT3 will be perfomed, as appropriate. 3. Clinical notes are essential for interpretive comments—

especially a record of therapy with thyroxine or anti–thyroid drugs, suspicion of pituitary disease, drug therapy with amiodarone, lithium, phenytoin, etc.—which will permit additional tests as required.

4. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). Thyroid Stimulating. Hormone (TSH)............. 0.30—5.00 mU/L Free Thyroxine (FT4) .................................... 9.1—19.6 pmol/L Free Triiodothyronine (FT3) ............................ 2.4—5.9 pmol/L


THYROTROPIN–RECEPTOR ANTIBODIES—blood 1. Acronym/Synonym—TSHR A Notes/Enquiries— 2. Indicative of Graves’ disease. Also refer to notes under

Antithyroid Peroxidase Antibodies. 3. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8). ...................................................................... +15% to –15%


TISSUE PLASMINOGEN ACTIVATOR—blood 1. Acronym/Synonym—TPA Notes/Enquiries— 2. Enquiries—Haematology, Ext. 3109 (assay sent out).

Citrate plasma (tube C3); add exactly 2.7 mL blood and mix by inversion. ....................................................................... 3.0—10.0 µg/L


Reference range—

TOBRAMYCIN—blood 1. See also—ANTIBIOTIC ASSAYS (APPENDIX D, page 110) Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3141.

Pre-dose & 30 min. post-dose. Serum (tube SG8). Request should specify dose, route, time(s) of dose/infusion and time of sample. Pre-dose...............................................................< 0.5 mg/L Post-dose.......consult Aminoglycoside Consulting Service (Ext 3579)


Reference range—



TOXOPLASMA 1. Enquiries—Microbiology, Ext. 3354. Notes/Enquiries— • Serology


• PCR (assay sent out) EDTA blood (separate tube E9), tissues (unfixed), BAL, BRW, CSF.

TRANSFERRIN—blood 1. Acronym/Synonym—TFER Notes/Enquiries— 2. See also—IRON STUDIES (APPENDIX G, page 114). 3. An approximate TIBC value (in µmol/L) may be obtained by

multiplying Transferrin value by 25. 4. Percent Transferrin Saturation = Iron x 100

TFER x 25 5. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8) or heparin plasma (tube HG8). Transferrin ...........................................................2.1—3.6 g/L Percent Transferrin Saturation ...................................< 50%


TRANSFERRIN, ASIALO– —fluid 1. The presence of asialotransferrin in a fluid suggests that it is,

or contains, CSF. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3141. 0.1 mL fluid. Specimen required—

TRANSFERRIN RECEPTORS, SOLUBLE—blood 1. Acronym/Synonym—sTfR Notes/Enquiries— 2. Detects iron-deficient erythropoiesis. 3. Not influenced by acute or chronic inflammatory states. 4. Enquiries—Haematology, Ext. 3114.

Serum (tube SG8) or heparin plasma (tube HG8). .....................................................................1.15—2.75 mg/L Specific, age-related reference ranges appear on printed reports and computer screens.


TRANSFUSION REACTION 1. See—APPENDIX I (page 118) Notes/Enquiries—



TRIGLYCERIDES—blood 1. Acronym/Synonym—TG Notes/Enquiries— 2. See also—LIPID STUDIES 3. It is the responsibility of the RMO ordering the test to give

the necessary instructions about fasting, and of the person taking the blood to check, and confirm on the request form, that the patient has fasted prior to collection.

4. Enquiries—Clinical Biochemistry, Ext. 3554. Serum (tube SG8) or heparin plasma (tube HG8). PATIENT MUST HAVE FASTED FOR 12 HOURS. Fasting............................................................. < 2.0 mmol/L


Reference range—

TROPONIN I (cardiac)—blood 1. Cardiac Troponin I is a more sensitive and more specific

marker of cardiac damage than CKMB. It rises in the same time frame as CKMB but remains elevated longer.

Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3554. Heparin plasma only (tube HG8). ............................................................................< 0.6 µg/L Levels > 2.0 µg/L are an independent predictor of 30-day mortality.


TRYPTASE—blood 1. Increased levels of Tryptase can normally be detected up to 3

to 6 hours after the anaphylactic reaction. Levels return to normal within 12—14 hours after release.

Notes/Enquiries—

2. Enquiries—Immunology, Ext. 3616. Serum (tube SG8) or heparin plasma (tube HG8). ..........................................................................< 15.0 µg/L


TSH RECEPTOR ANTIBODIES 1. See—THYROTROPIN RECEPTOR ANTIBODIES Notes/Enquiries—

TUBERCULOSIS 1. See—MYCOBACTERIUM Notes/Enquiries—



URATE—blood 1. Acronym/Synonym—UA, Uric Acid Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). Male ......................................................... 0.15—0.50 mmol/L Female ...................................................... 0.11—0.44 mmol/L


URATE—urine 1. Enquiries—Clinical Biochemistry, Ext. 3554.

24 hour collection in a CARBONATE bottle. Male ............................................................. 2.2—6.6 mmol/d Female .......................................................... 1.6—5.6 mmol/d


UREA—blood 1. Acronym/Synonym—UR Notes/Enquiries— 2. Enquiries—Clinical Biochemistry, Ext. 3554.

Serum (tube SG8) or heparin plasma (tube HG8). ..................................................................... 2.0—8.5 mmol/L


UREA—urine 1. Used to assess total urea excretion in patients receiving

parenteral nutrition. Notes/Enquiries—

2. Enquiries—Clinical Biochemistry, Ext. 3554. 24 hour collection in a PLAIN bottle. Bottle should be refrigerated during collection and be delivered promptly.


UREAPLASMA CULTURE 1. Enquiries—Microbiology Serology, Ext. 3354.

Genital swab. DO NOT REFRIGERATE. Notes/Enquiries— Specimen required—



URINE for MICROBIOLOGY 1. Enquiries—Microbiology, Ext. 3089.

Midstream specimens are always preferred. Male Patients—The foreskin should be gently retracted and the glans cleaned with cotton wool and sterile water. Do not use soap or disinfectants. When urinary stream is well established, place a sterile container to obtain 10—20 mL of urine. Female Patients—The labia must be separated and washed with cotton wool and sterile water from front to back. Ideally, the patient should straddle the toilet. A vaginal tampon is useful if there is a vaginal discharge. Better results will be obtained if the patient is carefully instructed and then allowed to collect the specimen herself, rather than attempting to collect the urine with the patient in bed. Indwelling Catheters—Urine must not be obtained from the bag, but by sterile syringe from the catheter tubing which has been temporarily clipped off.

Notes/Enquiries— Specimen collection—

URINE pH 1. Enquiries—Clinical Biochemistry, Ext. 3554.

Fresh, random urine in a closed container. Notify laboratory in advance and deliver immediately. ............................................................................ pH 6.0—8.0


Reference range—

VALPROATE—blood 1. Acronym/Synonym—Epilim® Notes/Enquiries— 2. There is poor correlation between concentration and

effect/toxicity. 3. Enquiries—Clinical Biochemistry, Ext. 3141.

Pre-dose. Serum (tube SG8) or heparin plasma (tube HG8). Pre-dose.......................................................350—700 µmol/L




VANCOMYCIN—blood 1. Peak or post–dose levels of Vancomycin have no useful

purpose and should not be requested. Notes/Enquiries—

2. See also—ANTIBIOTIC ASSAYS (APPENDIX D, page 110) 3. Enquiries—Clinical Biochemistry, Ext. 3141.

Serum (tube SG8), pre–dose and 30 min. post–dose. Request should specify: dose, route, time(s) of dose/infusion and time of sample. Pre-dose or trough...............................................10—15 mg/L


Reference range—

VANILLYLMANDELIC ACID—urine 1. Acronym/Synonym—VMA Notes/Enquiries— 2. Test no longer available, see CATECHOLAMINES. 3. Enquiries—Clinical Biochemistry, Ext. 3141.

VARICELLA-ZOSTER 1. Enquiries—Microbiology, Ext. 3354. Notes/Enquiries— • Serology


• PCR (assay sent out) EDTA blood (separate tube E9), tissue, CSF and various fluids (consult laboratory), nose & throat swabs in Viral Transport Medium.

VASOACTIVE INTESTINAL PEPTIDE—blood 1. Acronym/Synonym—VIP Notes/Enquiries— 2. May be indicated in chronic diarrhoeal states to investigate

the possibility of VIPoma. 3. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

EDTA blood (tube E9), on ice and delivered to laboratory immediately for separation. .................................................................printed with results


Reference range—

VIP 1. See—VASOACTIVE INTESTINAL PEPTIDE Notes/Enquiries—



VIRUS DIRECT TEST (Electron Microscopy) 1. Enquiries—Microbiology Serology, Ext. 3354 (assay sent out). Notes/Enquiries— 2. See also—PCR

• Poxvirus—vesicle fluid, scrapings, crusts Specimens required—

• Rotavirus, other gastroenteritis viruses—faeces

VIRUS SEROLOGY—blood 1. See also—SEROLOGY (page 88) Notes/Enquiries— 2. Requests must be specific. Sera with requests for "viral

serology" or "atypical pneumonia" will be stored until a specific test is requested. Serum will also be stored in cases where the acute illness is detailed but undiagnosed. Specific test requests should then accompany the convalescent serum.

3. The specific information needed is whether the illness is respiratory, exanthematous, neurological, gastrointestinal, cardiovascular or hepatic, and whether any specific virus is considered likely.

4. Enquiries—Microbiology Serology, Ext. 3354 (assay sent out). Serum (tube SG8) collect in the acute phase and then another Serum (tube SG8) collected 2—3 weeks later.


VITAMIN ASSAYS 1. Specimens for vitamin assays must be taken before dietary

changes are implemented. Notes/Enquiries—

2. Enquiries—See subsequent entries for individual test details.

VITAMIN A—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8). Pack in ice and protect from light. ......................................................................0.8—3.1 µmol/L


VITAMIN B12—blood 1. See also—FOLATE, RED CELL Notes/Enquiries— 2. Enquiries—Biochemistry, Ext. 3141.

Serum (tube SG8). .................................................................... 140—520 pmol/L




VITAMIN D 1. 25–Hydroxy Vitamin D3 is the appropriate test in suspected

dietary deficiency states. Notes/Enquiries—

2. Occasionally 1,25 di–Hydroxy Vitamin D3 is indicated, but discussion with an Endocrinologist or Chemical Pathologist is required (this assay sent out).

3. Enquiries—Clinical Biochemistry, Ext. 3141. Serum (tube SG8) or heparin plasma (tube HG8). 25–Hydroxy Vitamin D3 .................................. 23—113 nmol/L Values < 25 nmol/L are indicative of hypovitaminosis D. Values 25—38 nmol/L are often associated with increased PTH and may indicate a lesser degree of Vitamin D deficiency.


VITAMIN E—blood 1. Enquiries—Clinical Biochemistry, Ext. 3554 (assay sent out).

Serum (tube SG8). Pack in ice and protect from light. .................................................................printed with results


von WILLEBRAND FACTOR—blood 1. Acronym/Synonym—VWF Notes/Enquiries— 2. By consultation. 3. Enquiries—Haematology, Ext. 3109.

TWO specimens are required. 2x Citrate plasma (tube C3); add exactly 2.7 mL blood to each tube and mix by inversion. Antigen .................................................................. 50—200% Collagen Binding Assay (CBA)................................. 50—200% Multimeric Analysis ..................................interpretative report


Reference ranges—

ZINC—blood 1. Acronym/Synonym—ZN Notes/Enquiries— 2. Diurnal variation occurs; highest values are seen in early am. 3. Enquiries—Clinical Biochemistry, Ext. 3141.

Heparin blood in special container (tube M7). Do NOT centrifuge. Haemolysed specimens are unsuitable. ........................................................................11—19 µmol/L


Reference range—

—— —— Page 102 Pathology Handbook


APPENDIX A

BIOPSY SERVICE Including Surgical Pathology

Location ......... .....................Main Ward Block, Ground Floor, SouthWest

Laboratory Hours ........................................................... 8:00 am—5:30 pm

Telephone: General Queries ................................................. 9276 3150 Histology Laboratory ......................................... 9276 2476 Pathologist On-Call ....................................Page via switch

An Anatomical Pathologist is available for advice at all times.

Specimens for histological examination must be labelled and accompanied by a completed and signed pathology request form.

Large specimens (e.g. resections of alimentary tract) should be sent unfixed as soon as possible after their removal. If any delay in reaching the laboratory is anticipated these specimens should be kept refrigerated (up to 24 hrs only—beyond this time please add 10% buffered formalin or contact the pathologist or laboratory for advice).

Smaller specimens are placed in 10% buffered formalin prior to dispatch.

Any material to be discarded should be marked accordingly. No examination or record is kept of this material.

Certain specimens require special treatment, these are—

(a) Voluntary muscle for enzyme histochemistry. (b) Needle biopsies of kidney. (c) Lymph node biopsy (eg T&B cells or Culture). (d) Skin and other tissues for immunofluorescence. (e) Specimens for electron microscopy.

These examinations require fresh tissue or special fixation. Advice is available from the Anatomical Pathology Unit regarding handling of these specimens.

A courier service can be provided for the collection of specimens from external clients, and taxis may be used for urgent specimens (Cabcharge® vouchers are available from Pathology Specimen Reception).



The Examination of Excised Lymphoid Tissue in Suspected or Known Sufferers from Lymphoma

The following advice has been prepared regarding lymph node biopsies as difficulties often arise—

The full investigation of patients with established, or suspected, lymphoma is a necessary preliminary to effective treatment. All means of investigation currently available should be utilised efficiently. For optimal examination, specimens should be sent in toto and intact to Anatomical Pathology as soon as possible following removal. Specimens from external hospitals should be placed in a clean, dry container and transported on ice as soon as possible. The ad hoc division of fresh material prior to its examination by the anatomical pathologist can lead to confusion, misinterpretation and misdiagnosis. The pathologist, on receipt of the specimen, will divide it appropriately and supply specimens in optimum condition to any other laboratories concerned. Established channels of communication exist with these laboratories.

It must be emphasised that certain investigations (e.g. T and B cells) require that the specimen be in the laboratory before 12 midday on the day of biopsy. If it is not received by then, the investigation cannot be carried out until the next day.

Frozen Sections Frozen sections can only be performed on fresh, unfixed tissue. Pre–operative warning to the Anatomical Pathology Unit is appreciated if the need for a frozen section is anticipated.

Alfred Campus For a frozen section the fresh tissue is sent to the Anatomical Pathology Unit in a labelled container with an accompanying request form. The request form should note the clinical and operative findings. The pathologist performing the examination is available for consultation via the theatre intercom system.

External hospitals Prior bookings are essential to ensure that a pathologist is in attendance at the required time (telephone 9276 3150). The surgeon performing the operation should discuss the case with a pathologist to confirm the frozen section requirement.



APPENDIX B

CYTOLOGY SERVICE Location ......... .....................Main Ward Block, Ground Floor, SouthWest

Laboratory Hours ........................................................... 8:30 am—5:30 pm

Telephone: General Queries ................................................. 9276 3150 Cytology Laboratory .......................................... 9276 3088 Pathologist On-Call ............. contact through Switchboard FAX .............................................................9276 2899 (fax)

Specimens for Cytology should be sent without delay to the Anatomical Pathology Laboratory, accompanied by request forms containing relevant clinical notes, including a brief history and provisional diagnosis. Specimens collected after-hours or at weekends should be sent to Pathology Specimen Reception, together with the request form.

Urgent requests are to be made directly to the Laboratory by phone or personally, or indicated with “URGENT” on the request form. Doctor’s name and contact/beeper number must be clearly written for rapid return of results.

Fine Needle Aspiration

The laboratory provides a Fine Needle Aspiration biopsy (FNAB) service. Clinicians who are proficient in the technique may wish to perform their own FNA’s. Slides and fixative are available on request (Ext. 3088). The laboratory operates an open access FNA service during office hours (08:30—17:00) whereby outpatients can be referred to our Procedure Room by arrangement with the pathologist (Ext. 3150). This service is open to ambulant, well patients. For non-ambulant/sick inpatients, FNA’s can be performed at the bedside.

FNAB’s of deeply placed organs and lesions requiring radiological or ultrasound guidance should be discussed with the Department of Radiology (Ext. 2118, 2388) in the first instance. Cytopathology staff routinely attend these procedures to ensure specimen adequacy, smear preparation and triage of material for special investigations (eg. EM and Immunocytochemistry). Wherever possible, results are available on the same day as the procedure.



Tzanck smears

These smears are taken for the detection of Herpesvirus cytopathic effect. Samples should be taken from the edges of the lesion rather than the base of the ulcer. Smears should be placed in fixative immediately (within a few seconds) they are obtained. Glass slides and containers with fixative (a green solution of 95% Ethyl Alcohol containing Carbowax) are available from the Anatomical Pathology Unit.

Bronchial brushing’s/smears

Place smears in fixative immediately (within a few seconds) they are obtained. Glass slides and containers with fixative (a green solution of 95% Ethyl Alcohol containing Carbowax) are available from the Anatomical Pathology Unit.

Bronchial and Broncho–Alveolar Lavage

These specimens require NO fixative and must be sent to the Anatomical Pathology Unit without delay.

Sputum Specimens

As malignant cells may be shed intermittently, a series of sputum specimens are collected over three consecutive days, increasing the chances of detection. Early morning specimens are best with the patient instructed to cough up deep sputum. Assistance from a Physiotherapist and/or inhalation of nebulised saline will increase the chances of success. Specimens should be submitted to the laboratory without delay. For outpatients, a reasonable compromise is to submit the first specimen from the outpatient department, the next two can be submitted together with the second sample standing overnight in the patient’s refrigerator.

A post–bronchoscopy sputum specimen is well worth while and should be submitted immediately following the bronchial brushing.

Body Cavity Fluids

Pleural, pericardial, ascitic and other body cavity fluids should be placed in 120-ml specimen containers, available from the laboratory. This allows sufficient material for any special investigations. Large volumes of effusion fluids in drainage bags and bottles are difficult for the laboratory to handle and should not be submitted.



Cerebro-Spinal Fluid (CSF)

Specimens should be sent to the Anatomical Pathology Unit immediately (within 10 minutes if possible). If the first few drops are blood–stained due to a traumatic tap, they must be discarded before collection of as much fluid as clinical judgement allows. If several samples are collected, submit the No. 2 sample for Cytological examination.

Urine Specimens

Generally one freshly-voided sample is sufficient for investigation of bladder lesions.

Urine specimens should be collected by a clean catch technique to avoid contamination from the lower genital tract, particularly in females. The first bladder void of the day should be discarded (as the cells are likely to be degenerate) and samples collected from subsequent bladder voids. Information regarding indwelling catheters and post-cystoscopy collection must be documented on the request slip to enable accurate interpretation of findings.

NOTES

1. 24-hour urine collections and materials from catheter collection bags are unacceptable and should be avoided.

2. Bladder lavage often yields more and better-preserved tumour cells than those obtained from voided urine and should be performed whenever cystoscopy is necessary as part of a cancer monitoring program.

3. For correct interpretation of the findings it is important to document on the request slip that the specimen is from bladder lavage

Fluids from Cysts & Joints

The specimen is collected in sterile containers and sent to the laboratory. Information regarding intra-cystic/intra-articular medication must be given to avoid misinterpretation of foreign and refractile material.

Specimens from Hepatobiliary Tree

Biliary and pancreatic ductal epithelium degenerates rapidly in bile. Specimens taken at ERCP should be submitted immediately to the laboratory or alcohol– fixed smears made from brushings at the time of the procedure.



Gynaecological Smears

Smear takers should be fully proficient at the procedure. It is essential to visualise the cervix and to sample its entire circumference. Glass slides, Ayre’s spatulae, endocervical brushes and Coplin jars containing 95% ethyl alcohol are available in wards and outpatient clinics. The use of an endocervical brush improves sampling of the cervical transformation zone (where squamous abnormalities develop) and the endocervical canal. It is extremely important that the smear is fixed immediately in 95% alcohol, since air-drying can render the smear uninterpretable.

The request form and smear must be clearly labelled with the patient’s name. The request form should state the patient’s menstrual status, and whether or not pregnant, or post partum. Information on hormone, tamoxifen and contraceptive therapy should also be included. If an IUCD is present this should also be stated.

Reporting of all gynaecological smears is performed by the Victorian Cytology Service (VCS) and not by the Alfred Pathology Service. A copy of their report is sent to the relevant clinician by the VCS.



APPENDIX C

NECROPSY SERVICE Location ......... ................ Ground floor, Monash Medical School Building

Mortuary Hours.............................................................. 8:00 am—4:30 pm

Telephone: Mortuary ............................................................ 9276 2684

Information regarding death certification and deaths reportable to the Coroner is noted in The Alfred Medical Services HMO Handbook.

Requests for Post Mortem examination are covered by the Victorian Human Tissue Act that requires appropriate consent be sought before any Post Mortem examination can be carried out in the hospital. The Act empowers a designated officer for a hospital to authorise Post Mortem examinations and at the Alfred Hospital the designated officer is the Anatomical Pathologist.

Prior to authorising a Post Mortem examination the designated officer must be satisfied that either the senior available next of kin has signed the consent form for the Post Mortem examination or that the patient had consented to such an examination at admission to hospital. The designated officer will not authorise a Post Mortem examination if they have reason to believe the deceased had, at any time, expressed an objection to a Post Mortem examination of their body. The requirements of the Human Tissue Act 1982 will be satisfied if the Necropsy Request Form is completed by medical staff involved in the care of the deceased patient. These forms are available in all ward areas.

In non–coronial cases medical staff should make every effort to obtain permission for a Post Mortem examination as the examination acts as an audit and quality control mechanism for clinical and investigative medicine. Necropsies will not be performed unless the Necropsy Request Form, death and cremation certificates, and a clinical summary have been completed. These documents must accompany the UR folder and the body, to the mortuary.

Viewing of bodies within the Department by friends and relatives is not encouraged. If this is unavoidable, the mortuary technician must be contacted to make suitable arrangements. When notified that the viewing has been prepared, the relatives or friends must be accompanied by a Social Worker or Nurse. Under no circumstances should people be taken to the Anatomical Pathology Unit without these prior arrangement having been made.



APPENDIX D

ANTIBIOTIC ASSAYS Measurement of antibiotic serum concentrations (“levels”) is only indicated for antibiotics that show a correlation between concentration and efficacy or toxicity.

Parenterally Administered Antibiotics Assays are available for the parenterally administered aminoglycoside antibiotics, Gentamicin, Tobramycin and Amikacin, and the glycopeptides, Vancomycin, and Teicoplanin. These assays are performed in Clinical Biochemistry, enquiries—Ext. 3141. Other assays (e.g. Flucytosine) may be available on a limited basis. See alphabetic listing for details, or contact Microbiology (Ext. 3292).

SPECIMEN COLLECTION The following four pieces of information are essential for proper interpretation of drug concentrations and must be provided— Time of Sampling, Time of Last Dose, Dose Quantity and Administration Route. Gentamicin, Tobramycin, Amikacin Pre-dose (trough) ....................................within 30 minutes of next dose. Post-dose (“peak”) ................................ 30 minutes after end of infusion. Vancomycin Pre-dose (trough) ....................................within 30 minutes of next dose. Post-dose (“peak”) ................ 30 minutes after end of infusion (see note). Note—Routine post-dose levels are seldom necessary. Teicoplanin Pre-dose (trough) ....................................within 30 minutes of next dose. Post-dose (“peak”) ................ 60 minutes after end of infusion (see note). Note—Routine post-dose levels to avoid toxicity are seldom necessary.

INTERPRETATION OF CONCENTRATIONS Gentamicin, Tobramycin For these two antibiotics, the Aminoglycoside Consultative Service provides computer modelling with interpretation of concentrations and recommendations for appropriate dose changes. This service operates Mon—Fri, plus a limited service on Sunday am (Ext. 3579, pager 4376, or contact via ward pharmacist).



ADDITIONAL INFORMATION

Aminoglycosides For patients on continuous therapy for more than 48 hours, monitoring of concentrations should commence by day 3. Monitoring of all patients should be repeated where necessary, especially if renal function alters.

Vancomycin The micro-organism killing ability of Vancomycin is time-dependent, not concentration-dependent. This means that “peak” concentrations are not as important as time at, or above, the MIC and so the relationship between concentration and efficacy or toxicity is not as well supported as with the aminoglycosides.

For patients with normal renal function a pre–dose specimen at steady state, aiming to keep the concentration above or equal to the MIC during the dosing interval should be sufficient. Serum creatinine should be checked regularly and the dose adjusted if necessary.

More frequent monitoring of Vancomycin may be needed with patients who have a poor therapeutic response, very high MICs, renal impairment or concurrent aminoglycoside toxicity. These cases should be discussed with the ID physician.

Teicoplanin Teicoplanin, like Vancomycin, exhibits time-dependent killing of micro-organisms. Current evidence suggests that failure of therapy is related to trough concentrations that are below 10-15mg/L (or below 20mg/L in staphylococcal infective endocarditis).

For most patients, a trough concentration measured at steady state (ie. 8 days after commencement of a dose, if no loading dose has been given) is sufficient. Further concentrations are necessary only in those patients who don’t appear to be responding to treatment, in IV drug users or in-patients with renal impairment. Routine measurements to avoid toxicity are not necessary.

Orally Administered Antibiotics For information on assays of orally administered antibiotics contact Microbiology (Ext. 3292).



APPENDIX E

THERAPEUTIC DRUG PHARMACOKINETICS ENQUIRIES ........................................ Biochemistry Drug Laboratory, Ext. 3049

NOTE—Except for Cyclosporin (µg/L), Digoxin (nmol/L) and Tacrolimus (µg/L), the unit of measure for all other drugs listed is µmol/L.

PHARMACOKINETICS TIME to TIME to HALF– STEADY Therapeutic PEAK LIFE STATE DRUG Range (hours) (hours) (days)

Amiodarone (+ Desethyl) ...... < 6 Carbamazepine ..................... 17—42............... 8—12 .................10—60 ...............3—18 Cyclosporin (µg/L)................. consult Digoxin (nmol/L) .................... 0.6—2.6............. 1.5—5.0 .............36—51 ...............7—11 Lignocaine ............................ 10—21............... BOLUS................1.5—4.0 .........0.5—1.0 Phenobarbitone..................... 65—170............. 6—18 .................50—40 .............15—42 Phenytoin ............................. 40—80............... 2—6....................10—110 .............3—33 Quinidine .............................. 6—15................. 1—3....................4—7 . ...................1—2 Tacrolimus (µg/L).................. 15—25 (heart/lung) Tacrolimus (µg/L).................. 5—20 (liver kidney) Theophylline ......................... 55—110............. 0.5—2.0 .............2—9 . .............0.5—3.0 Valproate.............................. 350—700 .......... 1—2....................5—15 .............1.5—4.5



APPENDIX F

DRUG IDENTIFICATION ENQUIRIES ........................................ Biochemistry Drug Laboratory, Ext. 3049

NOTES

1. Consult the laboratory if unsure which tests to order. 2. All tests below are available 7 days a week, except GCMS Drug Screen.

SPECIMENS................ 50 mL Urine and 8 mL Blood (Serum or Heparin Plasma).

TESTING PROTOCOLS

a) Urine (Qualitative Only) A 'Urine Drug Screen' includes— • Drugs of Abuse immunoassays—this covers tests for Barbiturates,

Benzodiazepines, Cannabinoids, Cocaine, Opiates and Sympathomimetic Amines (i.e. Amphetamines and related compounds).

• Drug screen using GCMS (Gas Chromatography Mass Spectrometry). The GCMS screen is performed on all urine specimens, but only during the hours 8.30am—4.30pm, Monday to Friday.

b) Blood A 'Blood Drug Screen' includes— • Qualitative screening tests for Barbiturates, Benzodiazepines and

Tricyclic Antidepressants. • Quantitative tests for Ethanol and Paracetamol.

Salicylate is also available but must be requested separately. • NOTE—Separate requests are also required for the following blood assays

if indicated—Lithium (9mL PLAIN blood, NOT a lithium heparin tube), Carbamazepine, Digoxin, Phenytoin, Theophylline.

INTERPRETATION OF QUALITATIVE DRUG SCREEN RESULTS

A positive test does not necessarily distinguish between drugs taken in therapeutic doses and those in toxic doses.

A negative test does not mean no drugs are present, only the absence of the drugs specifically tested for. Even the GCMS Drug Screen will not detect all possible ingested drugs.



APPENDIX G

IRON STUDIES

Iron Deficiency In iron–deficiency states, particularly iron deficiency anaemia, typically the requirements to be satisfied before initiating studies are the presence of anaemia and microcytosis (MCV < 80 fL). In individuals with anaemia, but a normal MCV, there are other more important contributions to the anaemic state. Both serum iron and ferritin will be decreased in uncomplicated iron deficiency. However, in anaemia of chronic inflammatory disease, serum iron is decreased whether or not there is coexistent iron deficiency. A low serum iron coupled with a serum ferritin of > 50 µg/L indicates absence of significant iron deficiency, whereas a low serum iron, together with a serum ferritin of < 50 µg/L, indicates coexistent iron deficiency. The findings in the various states will be— Serum Iron Serum Ferritin Uncomplicated iron deficiency (Male) ............< 7 µmol/L ............< 20 µg/L (Female).........< 7 µmol/L ............< 10 µg/L Uncomplicated anaemia of chronic disease (ACD) .....................< 7 µmol/L ............> 50 µg/L

Notes 1. Iron therapy usually results in an acute increase in serum iron and ferritin.

Therefore, to interpret the findings, the patient should not be on iron therapy. 2. Sometimes, Soluble Transferrin Receptors may be useful in distinguishing

between Iron Deficiency and ACD. Enquiries to Haematology (Ext. 3114).

Iron Overload Although, in the majority of instances, serum ferritin will be elevated, the earliest finding in iron overload is an increase in %–transferrin–saturation. Normal %–Transferrin–Saturation, however, does not absolutely exclude significant iron overload, hence the need to determine serum, and sometimes red–cell ferritin.



APPENDIX H

GLUCOSE TOLERANCE TEST, Oral (GTT)

A. Formal Procedure Notes/Enquiries

1. For the diagnosis of Diabetes Mellitus in asymptomatic individuals. Do NOT perform— (a) to screen for gestational diabetes (see part B of this Appendix) (b) if random blood glucose > 11.1 mmol/L (c) if fasting blood glucose > 6.9 mmol/L.

2. Patient must have a carbohydrate–sufficient diet (at least 250 g/day) for 2—3 days prior to test.

3. Avoid testing in the afternoon. 4. Enquiries—Clinical Biochemistry, Ext. 3554.

Protocol Collect all blood specimens into appropriately–labelled fluoride-oxalate tubes.

• Patient must fast for at least 8 hours prior to the test • A fasting blood specimen is taken • A 75 g glucose drink is given • Blood specimens are taken at precisely 1 and 2 hours post-drink.

Interpretation Based on fasting and 2–hour glucose levels. Reports include— Normal glucose tolerance Impaired fasting glucose Impaired glucose tolerance Abnormal glucose tolerance—consistent with Diabetes Mellitus Consistent with Gestational Diabetes Uninterpretable. Reference— Definition, diagnosis and classification of diabetes mellitus and its

complications. Report of a WHO Consultation. Part 1: diagnosis and classification of diabetes. Geneva: WHO Department of Noncommunicable Disease Surveillance, 1999; 1—59



B. Screening Test for Gestational Diabetes (Glucose Challenge Test)

Notes/Enquiries 1. Important— NOT to be performed when random blood glucose values

are already diagnostic of diabetes (see GLUCOSE, page 47). 2. This test should be conducted at 26—28 weeks gestation. 3. Enquiries—Clinical Biochemistry, Ext. 3554.

Glucose Load and Specimen A fifty (50) gram load of glucose is given to a non-fasting woman. Exactly one hour post-loading, collect a specimen into a fluoride/oxalate tube.

Interpretation 1. Target blood glucose level is— 1-hour post-loading .......................................................< 7.8 mmol/L 2. Confirmatory testing is recommended if the venous plasma glucose

level equals or exceeds 7.8 mmol/L at one (1) hour post-glucose load. See—"Formal Procedure" on page 115.

Treatment and Follow–up 1. Gestational diabetes is usually controlled adequately by diet. If target

values are exceeded in > 10% of the monitored blood glucose tests then insulin therapy should be considered. Oral hypoglycaemic agents should not be used.

2. Women with gestational diabetes are at high risk of subsequent progression to Type 2 diabetes. Follow-up testing should occur at 6–8 weeks post-partum and then at 2-yearly intervals.

Reference— From: Therapeutic Guidelines Endocrinology, 1st Ed. and the Consensus

Statement for Diabetes in Pregnancy, MJA 1998;169: 93—97.



APPENDIX I

BLOOD BANK LABORATORY A section of the Haematology Unit

Service Telephone ............................................................................3100, 3104

A Blood Bank Scientist is in attendance in the hospital at all times. Voice page if the phone is not answered after a reasonable time.

Stocks Limited supplies of blood and blood components supplied by the Red Cross Transfusion Service are held in the Department for issue in emergency. Medical staff may be required to order replacements from the Red Cross Transfusion Service.

These products include—

• Red Cell Concentrates • Factor VIII Concentrate • Platelets • Factor IX Concentrate • FFP—Frozen Fresh Plasma • Cryoprecipitate • Albumex 20 • Prothrombinex • Albumex 4 • Immunoglobulins • Anti-D • Snake Venom Detection Kits • Recombinant Factor Note—Haemacel is issued from Pharmacy. Platelet preparations have to be requested directly from the Red Cross Transfusion Service. Phone requests for platelet units should be completed before 11.00 am whenever possible. The patient's Surname and Identification Number should be the minimum information relayed to the Red Cross Transfusion Service. An emergency reserve of platelets is kept on site when available from Red Cross. This is kept for acute trauma requirements.

Blood Bank must be notified by the requesting doctor that platelet preparations will be arriving from the Red Cross, and should also be notified if ordered platelets are no longer required as the units may then be used for other patients.



Special Products available on consultation with the haematologist—

• Modified red cell components • Cryodeplete FFP • Granulocyte collections • Single Donor Platelets • Individual plasma factor concentrates

Blood Group/Antibody Screen/Crossmatching All specimens are to be non–contaminated and collected in a 6 mL cross-matching vacuum tube (tube E6, pale pink top). Specimens are valid for 48 hours from day of collection.

Blood Transfusion Requirements Please consult the table located at the end of this Appendix— BLOOD ORDER SCHEDULE FOR ELECTIVE PROCEDURES Note—All samples must be correctly labelled (re-labelling is not permitted) and the blood collector’s signature and printed surname must be written in the appropriate area of the request form. The specimen label must also be signed or initialled by the collector. Specimens cannot be processed if there is missing or incomplete collector’s certification. See criteria as set out on page (xi).

Blood Transfusion Reaction A transfusion reaction is any unfavourable event occurring in a patient during or following transfusion of blood or blood products that can be related to that transfusion.

ALL transfusion reactions must be reported and recorded on the Blood Transfusion Reaction Report form. Blood Bank staff should be notified immediately (Ext. 3100) so that the reaction can be evaluated to the extent considered appropriate by the Haematologist. Once the attending doctor has seen the patient and determined that a significant reaction has occurred, he/she should then stop the transfusion and contact the Blood Bank Scientist (Ext. 3100) but not remove the administration needle, which should be kept open with normal saline. Consult the Blood Transfusion Reaction Report form for subsequent procedures to be followed. See Guidelines—“Management of febrile reactions to blood” on Bayside Intranet.



Crossmatching Specimen required— 6 mL cross-matching vacuum tube (pale pink top).

Notes/Enquiries— 1. The laboratory request form must contain minimum patient identifiers, the

requesting doctor's name and pager number and the collector's signature and printed surname. The specimen label must also be signed or initialled by the collector. If these details are not supplied the request will not be processed. See criteria as set out on page (xi).

2. Blood will be issued by electronic crossmatch if no atypical antibodies are identified. If patients have atypical antibodies antigen negative blood is sought through Red Cross Blood Bank and issued if the serological crossmatch is negative. There may be a delay in provision of blood.

3. The blood group is required for ordering FFP, Cryoprecipitate and Platelets. 4. The doctor should document any special blood requirements (such as

irradiated, filtered or CMV–negative blood products) for a patient. If uncertain, clinician should contact Blood Bank.

1. EMERGENCY CROSSMATCHING—IMMEDIATE DEMAND Phone laboratory, Ext. 3100. Send 6 mL of blood in a properly labelled cross-matching tube, enclosed in the completed request form.

2. ELECTIVE TRANSFUSION For patients awaiting surgery , it is essential to take blood at the first opportunity—e.g. through Surgical Outpatients or Pre-Assessment Clinic—to identify any atypical antibodies. A further request (form and specimen) is required when the patient is admitted.

The limited reserve of blood is maintained purely for emergency situations. If specimens arrive late, blood may not be available for issue at the designated time of elective procedure, particularly if atypical antibodies have been detected.

HMO’s requesting blood products for outpatient transfusion in Haematology/Oncology procedure areas must contact the Blood Bank when they organise the appointment to notify the time of the intended transfusion and the requirements for product modification—such as irradiation or filtration.



Indications for Irradiated Blood Products DEFINITE INDICATIONS—These are indications where there is strong evidence to support the requirement for use of irradiated blood components or where there is clear consensus on the requirement within published guidelines.

Allogeneic and Autologous bone marrow/PBSC transplant recipients4,8 Homologous red cells for bone marrow donors from 7 days prior to and during harvest7,8 Patients with congenital cellular immune deficiencies (but not AIDS)4,8 Patients with aplastic anaemia receiving immunosuppressive therapy4,8 Patients receiving purine antagonists (cladribine, fludarabine, pentostatin) with associated immunosuppression3,8 Patients with Hodgkin’s disease1,8 Directed donations from first or second degree relatives4,8

HLA matched single donor platelets4,8 Granulocyte transfusions7,8 Intrauterine and all subsequent transfusion and neonatal exchange transfusions1,8 *Premature infants2

POSSIBLE INDICATIONS—This includes settings where case reports have been published but where no controlled studies are available. Irradiation is not required in published international guidelines.

T cell malignancies8

Patients with B cell malignancy who receive chemotherapy and/or radiotherapy leading to lymphopenia < 0.5 x 109/L8

Patients with acute leukaemia8 Chronic myeloid leukaemia8

Patients receiving long term or high dose steroids for their malignancy2,8

Patients receiving antibodies against T cells including antithymocyte globulin8 Any patient who receives high doses of chemotherapy and/or irradiation sufficient to cause lymphopenia < 0.5 x 109/L8 *Patients with solid tumours receiving myeloablative chemotherapy2 *Solid organ transplant recipients5,6

NO INDICATION—No cases have been reported. Patients with AIDS or HIV infection (where none of the above apply)8 Patients with thalassaemias8 Patients with congenital humoral immune deficiency8 Healthy term infants (where none of the above apply)8 Haemophilia8 *Myelodysplastic syndrome (where none of the above apply)

* Please note: these indications are not included in the current ANZSBT/ARCBS/NZBS guidelines for irradiation (2003).


ALFRED PATHOLOGY SERVICE References

AABB Technical Manual 11th Edition 1993 RCPA QAP Transfusion Serology 1995 J Educational Exercise ASBT Topics in Transfusion Medicine Aug 1995 p 8-9 Haematology/Oncology Clin of N.A. Feb 1995 p 187-204 Heart & Lung Transplantation 12 (1 Pt 1): S7-12, Jan-Feb 1993 Human Pathology 23(7): 831-4, Jul 1992 Transfusion Medicine 1996, 6: 261-271, BCSH Guidelines Guidelines for gamma irradiation of blood components, ANZSBT, ARCBS, NZBS, 2003 Dr. Stephen Opat, Assoc. Prof. Alison Street, Dr. Ellen Maxwell, Dr Marija Borosak Revised June 1997; Amended January 2002, Amended September 2003.



CMV–negative Blood Products Any patient admitted in the following circumstances should be given CMV–negative products pending confirmation of their CMV status—

1. Heart/lung transplant recipient. 2. Any patient admitted under the Clinical Haematology/Bone Marrow

Transplant Unit who is a potential candidate for bone marrow/peripheral blood stem cell transplant.

3. Renal transplant recipients. 4. HIV positive patients. 5. Pregnant women.

CMV–positive recipients do not require CMV–negative blood products, unless they are regular recipients of intravenous immunoglobulin. Passive acquisition of CMV and other antibodies may confound the interpretation of serology in these patients, who should therefore be managed as CMV–negative.

It is the responsibility of the requesting Unit to notify the Blood Bank of the patient’s CMV status as soon as it is established.

CMV–negative red cell concentrates and platelets are routinely available for blood groups A and O, but are often also available in other blood groups. For patients of blood groups B or AB, in the absence of available CMV–negative blood products, the product must be filtered.

CMV status is irrelevant for FFP and cryoprecipitate, which have not been shown to result in CMV conversion.

Issue of Rh(D) Immunoglobulins This product is issued—

1. To Rh(D)–negative females who have not already been sensitised, in the following cases— Antenatal—when at risk of foeto-maternal haemorrhage Post-natal—when an Rh(D)–positive infant is delivered.

2. When Rh(D)–positive platelets are issued to females ≤ 45 years old.



SUMMARY of NHMRC/ASBT GUIDELINES (2001) For further information see NHMRC documents available on Bayside Intranet.

Code Haemoglobin Red Blood Cells—Considerations

01 < 70 g/L Lower thresholds may be acceptable in patients without symptoms and/or where specific therapy is available.

02 70—100 g/L Likely to be appropriate during surgery associated with major blood loss or if there are signs or symptoms of impaired oxygen transport.

03 > 80 g/L May be appropriate to control anaemia-related symptoms in a patient on a chronic transfusion regimen or during marrow suppressive therapy.

04 > 100 g/L Not likely to be appropriate unless there are specific indications.

Platelet Count Platelets—Considerations

05 < 10 x 109/L As prophylaxis in bone marrow failure in the absence of risk factors.

06 10—20 x 109/L Likely to be appropriate in the presence of risk factors- fever, antibiotics, evidence of systemic haemostatic failure, bone marrow failure.

07 < 50 x 109/L

Appropriate in the context of a massive haemorrhage/transfusion (confine to patients with thrombocytopenia &/or functional abnormalities who have significant bleeding from this cause). Maintain platelet count > 50 x 109/L in patients undergoing surgery or invasive procedures.

08 < 100 x 109/L

Appropriate in the presence of diffuse microvascular bleeding. For surgical procedures with a high risk of bleeding (ocular, neurosurgery) it may be appropriate to maintain platelet count >100 x 109/L.

09 Platelet function disorders

May be appropriate in inherited or acquired disorders, depending on clinical features and setting. In this situation the platelet count is not a reliable indicator

10 Bleeding May be appropriate in any patient in whom thrombocytopenia is considered a major contributory factor.

Generally NOT considered appropriate.

Immune mediated platelet destruction, Thrombotic Thrombocytopenic Purpura (TTP), Haemolytic Uraemic Syndrome or drug-induced or cardiac bypass thrombocytopenia without haemorrhage.

(table continued on next page……)



(……table continued from previous page)

FFP—Considerations 11 TTP Accepted treatment.

12

Acute Disseminated Intravascular Coagulation

Where there is bleeding and abnormal coagulation (coagulation parameters > 1—1.5 times normal range). Not indicated for chronic DIC.

13 Coagulation inhibitor deficiencies

May be appropriate in patients undergoing high-risk procedures. Use specific factors if available.

14 Massive transfusion or cardiac bypass.

In the presence of bleeding and abnormal coagulation.

15 Warfarin effect In the presence of life-threatening bleeding. Use in addition to vitamin-K-dependent concentrates.

16 Single factor deficiencies

Use specific factors if available.

17 Liver disease In the presence of bleeding and abnormal coagulation. Generally NOT considered appropriate.

Hypovolaemia, plasma exchange procedures (certain exceptions apply), treatment of immunodeficiency states.

Cryoprecipitate—Considerations

18 Fibrinogen Deficiency

May be appropriate where there is clinical bleeding, invasive procedure, trauma or DIC.

19 DIC At fibrinogen levels < 1.0 g/L and where there is clinical bleeding, use of cryoprecipitate to keep fibrinogen > 1.0 g/L.

Generally NOT considered appropriate (Use alternatives if available)

Haemophilia, von Willebrand’s disease or deficiencies of factor XIII or fibronectin.

NOTE—If transfusion is outside NHMRC/ASBT guidelines the clinical indication for transfusion must be documented in the patient’s medical record.



Blood Order Schedule For Elective Procedures All specimens are processed as ‘Group and Save’, which includes screening for atypical antibodies. Blood for procedures will be issued on request at the time transfusion is required.

Blood will only be held in reserve for a patient’s procedure if clinically significant antibodies have been newly identified or previously detected. In these circumstances, the number of units reserved will be as per the following schedule. Any variation anticipated by the Surgical unit should be discussed with Haematology Medical Staff and Senior Blood Bank Staff. General Surgery Abdomino–Perineal Resection ...................................................................................3 PC Adrenalectomy .........................................................................................................3 PC Anterior Resection....................................................................................................2 PC Breast Surgery: Lumpectomy/ Mastectomy...................................................... GRP SAVE Breast Surgery: Radical Mastectomy ........................................................................2 PC Cholecystectomy............................................................................................. GRP SAVE Gastrectomy.............................................................................................................2 PC Gastric Stapling............................................................................................... GRP SAVE Haemorrhoidectomy......................................................................................... GRP SAVE Hemicolectomy.........................................................................................................2 PC Hepatectomy (partial) ...............................................................................................5 PC Hiatus Hernia Repair........................................................................................ GRP SAVE Laparotomy, exploratory, non–trauma.............................................................. GRP SAVE Lieno Renal Shunt.....................................................................................................4 PC Oesophagectomy ......................................................................................................4 PC Pancreatectomy, total ..............................................................................................6 PC Porto–Caval Shunt ...................................................................................................4 PC Splenectomy, non–traumatic ....................................................................................2 PC Thyroidectomy ................................................................................................ GRP SAVE Vagotomy Pyloroplasty .................................................................................... GRP SAVE Whipples Procedure ..................................................................................................4 PC Cardiac Aortic or Mitral Valve Replacement...........................................................................3 PC Coronary Artery Bypass............................................................................................3 PC Heart Transplant ......................................................................................................3 PC Redo–Coronary Artery Bypass..................................................................................6 PC Redo–Heart Transplant.............................................................................................6 PC


ALFRED PATHOLOGY SERVICE ENT Laryngectomy...........................................................................................................2 PC Mastoidectomy................................................................................................GRP SAVE Radical Neck Dissection............................................................................................4 PC Tonsillectomy ..................................................................................................GRP SAVE Gynaecology Dilation and Curettage .....................................................................................GRP SAVE Ectopic Pregnancy ....................................................................................................2 PC Hysterectomy ...........................................................................................................2 PC Ovarian Cystectomy ........................................................................................GRP SAVE Vaginal Repair..................................................................................................GRP SAVE Vaginal Reconstruction ........................................................................................2—4 PC Vulvectomy, radical...................................................................................................4 PC Neurosurgery Arterio–venous Malformation Repair.........................................................................4 PC Cerebral Aneurysm Clipping ......................................................................................4 PC Craniotomy...............................................................................................................4 PC Craniotomy for Tumour Resection.............................................................................4 PC Laminectomy ...................................................................................................GRP SAVE Meningioma ..............................................................................................................4 PC Ventriculo–Peritoneal Shunt.............................................................................GRP SAVE Orthopaedic Amputation, Above or Below Knee ...................................................................GRP SAVE Femur, Fractured Neck.....................................................................................GRP SAVE Femur, Fractured Shaft.............................................................................................2 PC Hip Replacement.......................................................................................................2 PC Knee Replacement ...........................................................................................GRP SAVE Laminectomy ...................................................................................................GRP SAVE Redo Total Hip Replacement .....................................................................................3 PC Tibia Fracture ..................................................................................................GRP SAVE Upper Limb Fractures.......................................................................................GRP SAVE Thoracic Lobectomy................................................................................................................2 PC Pneumonectomy .......................................................................................................2 PC Thymectomy.............................................................................................................2 PC


ALFRED PATHOLOGY SERVICE Urological Cystectomy, total.....................................................................................................6 PC Cystectomy, partial ..................................................................................................4 PC Nephrectomy............................................................................................................2 PC Prostatectomy, Open ................................................................................................2 PC Pyelolithotomy................................................................................................. GRP SAVE Trans–Uretheral Resection Prostate ................................................................ GRP SAVE Vascular Amputations, Above or Below Knee ................................................................. GRP SAVE Aortic Aneurysm, Elective.........................................................................................2 PC Aorto–Bifemoral Bypass...........................................................................................2 PC Arterio–Venous Shunt...................................................................................... GRP SAVE Carotid Endarterectomy................................................................................... GRP SAVE Femoro–Distal Bypass Graft ............................................................................ GRP SAVE Femoro–Popliteal Bypass Graft........................................................................ GRP SAVE Ilio-Femoral Bypass Graft................................................................................. GRP SAVE Ruptured Aortic Aneurysm............................................................... 6 PC+6 plat.+6 FFP Sympathectomy, Cervical or Lumbar ................................................................ GRP SAVE

Autologous Blood Collections Patients having elective surgery who donate their own blood should be referred to the Pre-Assessment Clinic in the first instance to confirm eligibility. There are certain contraindications to collection of autologous blood and the eligibility criteria are available in the Clinic and from the Haematology Unit.

Blood can be collected at the Red Cross Blood Bank in South Melbourne or at the Alfred, in which case further review is arranged through 1st floor Haematology-Oncology Clinic, William Buckland Radiotherapy Centre, Ext. 3169.

Please note—patients who have donated blood still require testing for compatibility and issue at time of admission for surgery.



APPENDIX J

SNAKE VENOM DETECTION ENQUIRIES .....................................................................Blood Bank, Ext. 3100

NOTES 1. Venom can be detected in a swab at the bite site or from clothing surrounding the site.

Less optimally, it may be detected in urine or—last choice—blood.

2. The detection kit has two parts—the swabs for specimen collection and the reagents. All are now kept in the Blood Bank.

3. The specimen(s) must be collected in the Emergency Department (see following instruction), properly labelled and then sent to Pathology for analysis.

4. Please telephone the laboratory as far in advance as possible.

SPECIMEN COLLECTION The following instructions from CSL must be followed—

Bite site (preferred sample) Remove the lid and the dropper from one of the (yellow) sample diluent bottles and moisten the swab. Thoroughly swab the squeezed bite site. Snap the swab into the bottle and replace the dropper and lid. Mix thoroughly.

Clothing or bandages Venom may be extracted from clothing by cutting a small portion of the affected cloth, approximately 1.0—1.5 cm square, and inserting in the sample diluent bottle. Alternatively, soak the cloth in a small quantity of water to release the venom and then squeeze the water into the sample diluent bottle and test as for urine.

Urine Remove the lid and dropper from a sample diluent bottle and fill to the neck with the urine sample. Replace the dropper and lid and mix well by gentle inversion.

Blood A blood sample should only be used if a bite site or urine specimen is not available. Remove the lid and dropper from a sample diluent bottle and fill to the neck with anticoagulated (e.g. heparin) whole blood. Replace the dropper and lid and mix well by gentle inversion.

LABEL sample bottle with the patient’s name and other details and send to Pathology in a Patho-Pak marked “Urgent”.



APPENDIX K

PAEDIATRIC COLLECTION REQUIREMENTS

*Note— Combinations of tests collected in the same tube generally require a minimum of one full paediatric tube (600 µL).

TUBE TYPE & TESTS VOLUME REQUIRED*

EDTA TUBE (600 µL) FBE & Haemoglobin ......................................................................................... 250 µL G6PD Screen/Assay ........................................................................................ 500 µL Group/DAT ...................................................................................................... 500 µL Reticulocytes .................................................................................................. 250 µL

SODIUM CITRATE TUBE Coagulation Screen/Profile................................................................. tube filled to line

LITHIUM HEPARIN TUBE (1.3 mL)—GREEN Top Chromosomes/Karyotype .......................................................................minimum 2 mL Galactose Screen ..................................................................................minimum 1 mL Osmotic Fragility ............................................................................................ 2—3 mL

PLAIN (serum) TUBE with GEL (1.3 mL)—YELLOW Top Bilirubin................................................(URGENT, on ice, deliver immediately) 600 µL Biochemistry (UE, LFT, etc.) ............................................................................ 600 µL

URINE TESTS (Yellow Top Pot or Paediatric Urine Syringe) Amino Acid Screen .............................................................................................. 5 mL Drug Screen ................................................................................................. 5—10 mL Metabolic Screen................................................................................................. 5 mL



APPENDIX L

COAGULATION TESTS Table of Reference Ranges

TEST NAME REFERENCE RANGE UNITS (Adults, 15–65 years)

Anti–Xa Assay Orgaran ............................... 0.3—0.8.................................U/mL ” Fragmin ............................... 0.5—1.0.................................U/mL APTT Reference Range ............................... 26—38.............................. seconds APTT Heparin Therapeutic. Range ............................... 48—100............................ seconds Antithrombin III (functional) ............................... 86—134......................................% D–Dimer ............................... < 0.20 ................................. mg/L Euglobulin Clot Lysis Time ............................... 90—240.............................minutes Factor VIII Assay ............................... 50—150......................................% Factor IX Assay ............................... 50—150......................................% Factor XI Assay ............................... 50—150......................................% Factor XII Assay ............................... 50—150......................................% Fibrinogen ............................... 2.0—4.0.................................... g/L Platelet Aggregation ............................... .......................Interpretative report Protein C (Functional) ............................... 72—153......................................% Protein S (Functional) ............................... 56—132......................................% Prothrombin Time (PT)— Reference range ............................... 1.0—1.3................................... INR Prophylaxis for atrial fibrillation ............................ 2.0—3.0................................... INR Treatment of deep vein thrombosis ....................... 2.0—3.0................................... INR Tissue heart valve replacement............................. 2.0—3.0................................... INR Mechanical heart valve replacement ..................... 2.5—3.5................................... INR Thrombin Clotting Time (TCT) ............................... < 24 ............................... seconds Reptilase Time ............................... < 24 ............................... seconds VWF (antigen) ............................... 50—200......................................% ” (collagen binding)....................... 50—200......................................% ” (multimeric analysis) .................. .......................Interpretative report



APPENDIX M

FULL BLOOD EXAMINATION (FBE) Table of Reference Ranges

TEST NAME REFERENCE RANGE UNITS (Adults, 15–65 years) FBE and Indices** Hb Male .....................................128—175...................................... g/L ” Female ..................................113—159...................................... g/L WCC .............................................3.9—12.7 ................................x 109/L Plts .............................................150—396................................x 109/L RBC Male .....................................4.0—5.8 .................................x 1012/L ” Female ..................................3.6—5.3 .................................x 1012/L Hct Male .....................................0.36—0.50.................................... L/L ” Female ..................................0.32—0.42.................................... L/L MCV .............................................80—97 ............................................fL MCHC .............................................328—363...................................... g/L

Differential Neutrophils .............................................1.9—8.0 ..................................x 109/L Lymphocytes .............................................0.9—3.3 ..................................x 109/L Monocytes .............................................0.3—1.1 ..................................x 109/L Eosinophils .............................................0.0—0.5 ..................................x 109/L Basophils .............................................0.0—0.2 ..................................x 109/L

ESR (modified Westergren Method) Male .....................................1—10 .............................mm in 1 hour Female ..................................1—20 .............................mm in 1 hour

Reticulocytes Male .....................................9—116 ....................................x 109/L Female ..................................8—104 ....................................x 109/L

** These Reference Ranges are not broken down by patient age. Specific age/sex reference ranges appear on printed reports and on computer displays.



APPENDIX N

COMMON BIOCHEMISTRY BLOOD TESTS Table of Reference Ranges (adults)

U&E GROUP Sodium .............................................134—146.....................................mmol/L Potassium .............................................3.5—5.0.......................................mmol/L Chloride .............................................98—110.......................................mmol/L Bicarbonate .............................................22—32.........................................mmol/L Urea .............................................2.0—8.5.......................................mmol/L Creatinine Male ..... 0.06—0.11 ...........................Female...0.04—0.08.......mmol/L

LFT GROUP Bilirubin Male ..... < 21 ...................................Female...........< 15.......µmol/L ALP .............................................< 110 ............................................. U/L ALT .............................................< 40 ............................................... U/L GT, gamma Male ..... < 60 ...................................Female...........< 40............ U/L Albumin .............................................35—52............................................... g/L Protein, Total .............................................60—80............................................... g/L

OTHERS Amylase .............................................< 115 ............................................. U/L AST .............................................< 50 ............................................... U/L Calcium .............................................2.10—2.60...................................mmol/L Cholesterol .............................................< 5.5 .........................................mmol/L CK .............................................< 200 ............................................. U/L CRP .............................................< 10 ............................................. mg/L Glucose Fasting . 4.0—6.0................................Random .........<7.0.......mmol/L Iron .............................................7—32...........................................µmol/L LD .............................................< 250 ............................................. U/L Lipase .............................................< 60 ............................................... U/L Magnesium .............................................0.70—1.10...................................mmol/L Phosphate .............................................0.70—1.30...................................mmol/L Triglycerides .............................................< 2.0 .........................................mmol/L Troponin I .............................................< 0.6 ............................................ µg/L Urate Male ..... 0.15—0.50 ...........................Female ..0.11—0.44.......mmol/L



APPENDIX O

CONTAINERS FOR PATHOLOGY SPECIMENS

EVACUATED TUBES FOR BLOOD BOOK CODE

COMMONLY USED NAME

ANTICOAGULANT or PRESERVATIVE

BARRIER LAYER

STATED VOLUME

CAP COLOUR

PRODUCT CODE

A8 ACD ACD mix — 8.5 mL Yellow BD 364606

C3 Citrate Sodium Citrate — 2.7 mL Pale Blue BD 363095

E3 FBE EDTA (K2E) — 3 mL Pale Lilac BD 367838

E6 Crossmatch EDTA (K2E) — 6 mL Pink BD 367941

E9 Large EDTA EDTA (K2E) — 10 mL Purple BD 367525

ESR ESR tube Sodium Citrate — — Black (Vacu-tec)

F2 Fluoride-Oxalate Fluoride & Oxalate — 2 mL Grey BD 367934

H6 Heparin Lithium Heparin — 6 mL Dark Green

BD 367885

HG8 Heparin Gel Lithium Heparin Gel 8 mL Pale Green BD 367377

M7 Heavy Metals Sodium Heparin — 7 mL Dark Blue BD 369735

S9 Plain Serum (none) — 9 mL Red V 455092

SG8 Serum Gel (none) Gel 8.5 mL Gold BD 367958



TABLE OF CONTENTS

NOTES ABOUT THIS BOOK .................................................................... (iii)

SERVICE TELEPHONE DIRECTORY .........................................................(iv)

GENERAL NOTES ABOUT SERVICE ........................................................(ix)

ALFRED HOSPITAL ........................................................................(vi)

CAULFIELD GENERAL MEDICAL CENTRE................................... (vii)

SANDRINGHAM & DISTRICT MEMORIAL HOSPITAL .............. (viii)

SPECIMEN COLLECTION AND IDENTIFICATION ....................................(x)

ALPHABETIC LIST OF TESTS......................................................... 1⎯102

APPENDICES— A. BIOPSY SERVICE.....................................................................................103

B. CYTOLOGY SERVICE ...............................................................................105

C. NECROPSY SERVICE ...............................................................................109

D. ANTIBIOTIC ASSAYS ..............................................................................110

E. THERAPEUTIC DRUG PHARMACOKINETICS ...........................................112

F. DRUG IDENTIFICATION...........................................................................113

G. IRON STUDIES ........................................................................................114

H. GLUCOSE TOLERANCE TESTS ................................................................115

I. BLOOD BANK LABORATORY —Table of Blood Order Schedule for Elective Procedures..........................117

J. SNAKE VENOM DETECTION....................................................................128

K. PAEDIATRIC COLLECTION REQUIREMENTS............................................129

L. COAGULATION TESTS —Table of Reference Ranges ...................................................................130

M. FULL BLOOD EXAMINATION —Table of Reference Ranges ...................................................................131

N. COMMON BIOCHEMISTRY TESTS —Table of Reference Ranges ...................................................................132

O. CONTAINERS FOR PATHOLOGY SPECIMENS..........................................133


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