Dedicated to the memory of my father and our founder Late Dr. (Major) S K Lal

Dr Lal PathLabsREFERENCE GUIDE

LPL/G/DAT/005

Ninth Edition

Copyright © 2018 Dr Lal PathLabs Ltd, New Delhi 110 085

No part of this publication may be stored in a retrieval system, transmitted,or reproduced in any form or by any means without the prior agreementand permission in writing of the publisher.

Published by Dr Lal PathLabs, Sector 18, Block E, Rohini, New Delhi - 110085

For private circulation only

Dr Lal PathLabs Corporate OfficeNational Reference Laboratory 12th Floor, Tower BSector 18, Block E, Rohini New Delhi 110 085 SAS Tower, Medicity, Sector 38Tel: 91-11-3025 8600, 3024 4100 Gurgaon-122001E-mail: lalpathlabs@lalpathlabs.com Tel: 0124-3016500Website: www.lalpathlabs.com

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QUALITY POLICY LPLWe at LPL endeavour to provide our patients timely, accurate, cost-effective and error freeresults from the widest test menu.

We strive to understand and meet our patients’ requirements and to exceed theirexpectations.

(Dr Arvind Lal)29 November 1998 Chairman & Managing Director

SAFETY POLICY

We at LPL endeavour to provide a safe working environment for our personnel, patients,clients & visitors.

(Dr. Vandana Lal)11th February, 2000 Executive Director

IT POLICYDr Lal Pathlabs is committed to provide Management direction and supoort for informationsecurity in accordance with business requirements and relevant regulatory compliances to

the trust and reliability of all stakeholders by effectively implementing and continuallyimproving the Information Security Management System (ISMS). The objective is to createa secure business environment by virtue of a resilient & immune IT System for the upkeepof the continual IT services at Dr Lal Pathlabs.

(DR VANDANA LAL)12th May, 2016

QUALITY POLICY LPL CLINICAL RESEARCH SERVICES

ensure timely reporting.

We also endeavour to service our clients with customized, accurate, cost-effective and error

(Dr.Vandana Lal)05 November 2007 Executive Director

FROM THE CMD'S DESK

Dear Colleague,

It is my proud privilege to be launching the Ninth edition of Dr. Lal PathLabs Reference Guide. It is a matter of great

LPL has taken a giant leap forward by collaborating with Institute of Integrative Biology & Genomics (IGIB), aninitiative of Govt. of India under CSIR to introduce assays like Exome sequencing & Pharmacogenomics. IGIB has thelargest genomic database of Indian population which will be accessible to LPL to design assays. This will also reducecosts substantially for the masses.

LPL has also collaborated with Jawaharlal Nehru University (JNU) for Bioinformatics of complex tests like analysisof Fetal DNA in Maternal blood. LPL shall work with Centre for Computational Biology, JNU to develop & validatethis software.

Two special portfolios have been introduced - an initiative of the Marketing Department of LPL namely OncoPro &NeuroPro. Under the OncoPro brand, comprehensive cancer reports have been introduced spanning IHC, FISH & NGStests. Liquid biopsy has been introduced on Digital PCR which offers unparallel sensitivity for detection & monitoringvarious cancers. NeuroPro brand includes tests for Neuroviruses, Hungtinton's disease & Spinocerebellar ataxias.

At the beginning of the year we have launched another Reference Laboratory in Kolkata to service the East & NorthEast regions of India providing highly specialized platforms like LC-MS/MS, Luminex for HLA Typing, AAS for Trace

International Laboratory was launched in Kathmandu, Nepal & the second one is coming up in Dhaka, Bangla Desh.Construction of Reference Laboratories in Kolkata and Lucknow has been initiated in order to bring specialized testingcloser to our clients.

LPL has been recognized as a centre to offer DNB (Pathology) by National Board of Examinations. Two seats have beenallotted to LPL per year- one primary & one secondary.

of embryos to exclude genetic abnormalities.

With the endeavour of providing faster turn around time, Digital scanning & microscopy has been introduced in theDepartment of Histopathology. High resolution scanners picturize the entire sections to maintain specimen integrity.

We thank all our clients, National & International who continue to repose faith in us to deliver high Quality accurateresults.

(Hony) Brig. Dr.Arvind LalPadma ShriChairman & Managing Director 3rd January, 2018

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CONTENTS

1. Our History vii

2. Honours & Awards viii

3. Landmark Achievements xi

4. LPL Laboratories xv

5. Radiology & Cardiology Services xxiii

6. Quality Assurance xxix

7. Services xxxi

8. General Instructions & Specimen Collection 1

9. Alphabetical List of Tests 19

10. Listing of Clinical Information Forms 365

11. OncoPro, NeuroPro & TransplantPro Tests 414

12. Pathvets - Veterinary Tests 434

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OUR HISTORYDr. Lal PathLabs Pvt. Ltd. (LPL), a centre of innovation, is the premier clinical pathology laboratory in

India with the best international standards. It is known for pioneering the introduction of new tests, maximizingthe quality of testing with state of the art technology and transferring academic knowledge to the entire

had been trained in the Army and later at the Cook County Hospital, Chicago, USA, the laboratory with its

laboratory of repute in Delhi and Northern India.

The present Chairman & Managing Director, (Hony) Brig. Dr. Arvind Lal, a post-graduate from the ArmedForces Medical College, Pune, took over the reins of the laboratory in 1977. His aim has been to provide thebest laboratory services to patients in India at the most economical costs. He embarked upon a modernisation

upgradation of equipment, introduction of newer diagnostic parameters, automation and strict quality assurancewere the hallmarks of his able guidance. Today, LPLoffers the most extensive clinical testing network inIndia and beyond, operating laboratories in most major cities with a vast network of Patient Service Centres,Collection Centres & Pickup points.In addition, Radiology & Cardiology services have also been introducedin some of the centres.

Healthcare model

LPL has grown to be a proven model of healthcare services that meets and exceeds the expectations ofits clients. Over the years, it has established strong relationships with patients, doctors, hospitals and clientsand provides outstanding customer service. Our long term employees contribute to the personal relationshipswhich have been nurtured between LPL & our clients.

Our healthcare model provides quality services, innovation and testing capabilities that is unique to theindustry thereby making costs affordable to the patients. Our hub and spoke model ensures percolation ofQuality from the National Reference Laboratory & Regional Reference Laboratories to the Satellite labs andthe Patient Service Centres.

Credibility And Strengths

Our strength lies in our commitment to Quality. We strive to provide every patient with timely, accurate,cost effective & error free results at all times.Credibility is the key to our success and hence all our processes,decisions and actions are driven by integrity. We are forthright in dealing with all our customers and strictlycomply with all laws and regulations governing our business. We constantly innovate to enhance patient careand add value. As a company we accept full responsibility for our performance, thereby making us accountable

process.

LPL has not only collaborated with several hospital based laboratories but has also set up Public PrivatePartnerships (PPP) to provide technical support thereby improving the quality of Pathology services and thusserving mankind. We strive to be the best at what we do both as a company and as individuals. We providegrowth opportunities for our employees, quality services and new tests to our customers.

Support Services

LPL provides an extensive array of support services to complement its organizational structure, improvepatient and clinician satisfaction and enhance full utilization of laboratory resources.The services and operating

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HONOURS AND AWARDS

1970 : Approved Lab for World Health Organisation Staff in India.

1979 :

1982 : Stand-by laboratory for DRUG-ABUSE testing for Athletes participating in IX ASIAN GAMES,New Delhi.

1985 :

1988 : The President of India and his Staff start utilising its facilities.

1990 : Selected to train French laboratory technicians, during the Festival of France in India.

1991 :for the US Embassy staff & emigrants.

1992 : DR. VANDANA LAL honoured with the SHIROMANI AWARD for outstanding achievements inPathology.

1993 : DR. VANDANA LAL honoured with INTERNATIONAL BUSINESS COUNCIL AWARD.

1994 : DR. ARVIND LAL honoured with the International Business Council Award.

: DR. VANDANA LAL honoured with GEM OF INDIA award by the all India Achiever'sconference.

: Laboratory selected to train PostGraduate students of UNIVERSITY of DELHI.

: DR. ARVIND LAL honoured with INDIRA GANDHI SOLIDARITY Award.

1995 : First Indian laboratory to have a technical alliance with USA's most esoteric Laboratory, QuestDiagnostics Nichols Institute for specialised testing facilities.

: DR. ARVIND LAL (Director) appointed as CHAIRMAN.

1998 : DR. ARVIND LAL selected as Advisor by the Drugs Controller General ( India) to advise import

2001 : DR. ARVIND LAL appointed as Honorary Physician to the President of India

: DR. VANDANA LAL honoured as "Woman of the Year" by the American Biographical Institute.

2003 : DR. ARVIND LAL honoured with "Lifetime Achievement Award" by International MedicalIntegration Council. Award Presented by the Honorable Governor of Maharashtra.

2005 : DR. ARVIND LAL awarded the Delhi Ratan Award

2008 : DR. VANDANA LAL honoured as "Woman of the Year representing India" by the AmericanBiographical Institute

: LPL wins the CNBC Business Award

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2009 : DR. ARVIND LAL awarded Padma Shri by the President of India

: DR. ARVIND LAL conferred the rank of Honorary Brigadier in Armed Forces MedicalServices

: Dr Lal Pathlabs wins Franchisee Awards 2009 for excellence in Innovation & Technology

2010 : Dr Lal Pathlabs wins the MILAGROW BRAND INNOVATOR AWARD in Healthcare Sector

: Dr Lal Pathlabs wins the FRANCHISEE INDIA EXCELLENCE AWARD for best customerservice

: Dr Lal Pathlabs wins the FRANCHISEE PLUS 2010 - FRANCHISOR OF THE YEAR AWARDin Healthcare Category

2011 : Dr Lal Pathlabs wins PAUL WRITER FUTURIST MARKETING HALL OF FAME AWARD

: (Hony) Brig. Dr. Arvind Lal - CMD felicitated with OUTSTANDING ENTREPRENEURSHIPAWARD ( ASIA PACIFIC ENTEPRENEURSHIP AWARDS - APEA, 2011)

: DR. ARVIND LAL awarded LIFETIME ACHIEVEMENT AWARD by AFMC Alumni Association,Delhi

: Dr Lal Pathlabs wins FRANCHISEE INDIA EXCELLENCE AWARD IN HALL OF FAMECATEGORY

: Dr. Lal Pathlabs wins BEST PRIVATE SECTOR INITIATIVE OF THE YEAR by Department ofIT, Govt. of India & State Govt. of Gujarat.

2012 : Dr. Lal Pathlabs wins e-India Award in the category - BEST USE OF TECHNOLOGY BY ADIAGNOSTIC SERVICE PROVIDER

: Dr. Lal Pathlabs wins FRANCHISEE INDIA EXCELLENCE AWARD IN HALL OF FAMECATEGORY

: Dr. Lal Pathlabs conferred MICROSOFT CUSTOMER SPOTLIGHT AWARD

: Dr. Lal Pathlabs presented with COMPUTERWORLD HONORS LAUREATE PROGRAM atWashington DC, USA

: Dr. Lal Pathlabs recognised by IBM amongst TOP 50 BRANDS IN INDIA FOR MARKETINGAND IT (MITR-50)

: Dr. Lal Pathlabs honored with FROST AND SULLIVAN 4TH ANNUAL INDIA HEALTHCAREEXCELLENCE AWARD - DIAGNOSTIC SERVICE PROVIDER OF THE YEAR

2013 : Dr. Lal Pathlabs awarded by Business Standard as THE BEST EMPLOYABLE COMPANY ININDIA

: Dr. Vandana Lal awarded by Delhi Medical Association for DISTINGUISHED SERVICES INPATHOLOGY

: Dr Lal PathLabs wins FRANCHISE INDIA EXCELLENCE AWARD for Best CustomerService

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: Dr Lal PathLabs wins PAUL WRITERS MARKETING HALL OF FAME award

: Dr Lal PathLabs adjudged as the BEST DIAGNOSTIC COMPANY IN INDIA at VCCircleHealthcare Summit

2014 : Dr Lal Pathlabs wins the Top 100 CISO Award by CISO Platform

: Dr Lal Pathlabs conferred award for Excellence in Innovation by Achiever’s Club, Interop

: Dr Lal Pathlabs wins the EDGE 2014 Award by InformationWeek

: Dr Lal Pathlabs wins the The Dynamic CIO 100 – Honoree 2014 by IDG

2015 : Dr Lal Pathlabs wins the Dataquest Business Technology Award by Dataquest (Delhi Chapter)

: Dr Lal Pathlabs wins the Infosec Maestro award 2015 by Nexus group

: Dr Lal Pathlabs wins the Healthcare Heroes award by Dynamic CIO.com

: Dr Lal Pathlabs wins the CIO Power List award by Core – Media group

: Dr Lal Pathlabs wins the Dataquest Business Technology Award by Dataquest (Mumbai Chapter)

: Dr Lal Pathlabs wins the Top 100 CIO award by IDG group

: Dr Lal Pathlabs wins the South Asia eHealth Summit Award 2015 ICT post

2016 : DR. ARVIND LAL honored with "Entrepreneur of the Year” award by All India ManagementAssociation (AIMA)

2017 : DR. ARVIND LAL honored with "Lifetime Achievement Award” by Federation of Indian Chambersand Commerce (FICCI)

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LANDMARK ACHIEVEMENTS

Pioneered the following in Pathology:

Year Achievement

1977 : First Lab in India to introduce Gelman Electrophoresis for lipoproteins, proteins and hemoglobinopa-thies.

1978 : First Lab in India to install Coulter Dn Hematology Analyser.

1981 : First Private Lab in Northern India to introduce RIA's for hormones (Thyroid Testing etc).

1982 : First Lab in Northern India to install Ames Autopacer Chemistry Autoanalyser.

1983 : First Lab in India to install NOVA-5 Ion Selective Electrode Electrolytes Analyser.

1986 : First Lab in India to fully computerise Lab operations.

1987 : First Lab in India to install Berthold 12 Well Counter for RIA (Hormone Testing).

: First Lab in India to install Helena EDC for electrophoresis of Serum Proteins, Hemoglobin, HDL -Cholesterol.

1988 : First Lab in India to install Baker 900 Hematology Analyser.

: First Lab in Northern India to introduce Fluorescent Microscopy for Anti-Nuclear Factor,Anti-Smooth Muscle Antibodies etc.

1989 : First Lab in India to install Amerlite Immuno Chemiluminescence Assays (ICMA) for HIV andHBsAg.

: First Private Lab in India to introduce HLA Tissue Typing for Organ Transplants.

First Private Lab to start HIV/AIDS testing.

1990 : First Lab in India, Middle East and South East Asia to install BM-Hitachi-717 Random ExcessAutoanalyser.

: First Lab in India to introduce RAST Testing — full Allergy panel.

: First Private Lab to start Western Blot testing for HIV.

1991 : First Lab in India to install Coulter MAXM Hematology Analyser.

1993 : First Lab in India to install BioRad Variant & other HPLCs for HbA1c, Thalassemias, VMA, Catecho-lamines, Cyclosporine-A etc.

: First Lab in India, Middle-East Asia to install BM-Hitachi - 917 Chemistry Autoanalyser.

1995 : First Lab in India to have THREE Abbott AXSYM MEIA & FPIA Auto-Analysers under one roof.

1996 : First Lab in India to install Behring Nephelometer for special Protein analysis (Lipoprotein `a' etc.).

1997 : First Lab in Northern India to install IMMULITE from Diagnostic Products Corp., USA, for rareimmunoassays.

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1998 : First Lab in India to install Electro-Chemiluminiscence ELECSYS - 2010 from Boehringer Mannheim,Germany.

: First Lab in India to install FTIR for kidney & Gall stones analysis.

: First Lab in India to install BD's FACS CALIBUR Flow Cytometer for Immunophenotyping (CD4 /CD8 Counts etc).

: First Lab in India to install Atomic Absorption for rare metal toxicity.

: First in North India to install bDNA for viral loads in AIDS and Hepatitis.

1999 : First Indian lab to install world famous Triple G laboratory software ( Ultra).

: First lab in Asia to introduce Bayer's Centaur for sophisticated hormonal immunoassays (e.g. Thyroidtests etc).

2000 : First Indian Laboratory to be accredited by the NABL ( National Accreditation Board for Testing andCalibration Laboratories) against the standard NABL 100.

2001 : First laboratory in India to link satellite labs (Kanpur) through VSAT & ISDN lines for real time andonline data transfer to and from the main laboratory at New Delhi.

:Reference Labs

2002 : First Indian Lab to get an International accreditation from the prestigious College of American Patholo-gists (CAP).

: First Indian Lab to install Lipoprint LDL system for LDL subfractions.

2003 : Satellite laboratories at Preet Vihar, Gurgaon and Safdarjung Development Area received accreditationfrom NABL ( National Accreditation Board for Testing and Calibration Laboratories) Min. of Science& Technology, Govt. of India.

2004 :in South East Asia.

: India's First Laboratory to introduce Public Private Partnership laboratory services with the Govt. ofTripura.

: Successful launch of in-house developed kit ( Mycosure test) for Mycobacterium PCR.

2005 : Mumbai laboratory received accreditation from NABL ( National Accreditation Board for Testing andCalibration Laboratories) Min. of Science & Technology, Govt. of India as per ISO / IEC 17025.

2006 : A dedicated Research and development (R&D) department setup at the Reference laboratory inOkhla.

: Six Laboratories of Dr.Lal Pathlabs namely Main Laboratory, Reference Laboratory, Satellitelaboratories at Gurgaon, SDA, Preet Vihar and Mumbai successfully upgrade the NABL QualityStandard from ISO / IEC 17025 to ISO / IEC 15189

2007 : R & D division of LPL develops an HIV viral load kit which can detect as low as 30 copies per mL

: Satellite laboratories at Punjabi Bagh & NOIDA & Clinical Trials Laboratory, Gurgaon receive NABLaccreditation as per ISO 15189.

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2008 : Modular systems of Roche Biochemistry & Immunoassay units introduced

2009 : First Lab across Eastern Europe, Middle East, Africa, South Asia & South East Asia to upgrade ULTRAIT System to 4.1.5

: First Private Lab to get Government approval for Swine Flu Testing in different Indian states

2010 : Asia's largest & most advanced lab becomes operational at Rohini, New Delhi

2011 : Successful installation of automate Pre-analytic systems for automated aliquoting, bar coding &archival of samples

: Dr. Lal Pathlabs selected by Gujarat Government for Public Private Partnership (PPP) in NewbornScreening & Inborn Errors of Metabolism

: Introduction of Gas Chromatography / Mass Spectrometry ( GC / MS) by the laboratory

2012 : R & D Division of LPL develops Tests for Cancer markers like t(1;19), t(12;21). t(4;11), t(11;19) &t(9;11)

: First Commercial Lab to offer Luminex based Histocompatibility (HLA) DNA Typing

2013 : NABL Preassessment / Assessment of 15 new Satellite Laboratories achieved

: R & D Division of LPL develops Tests for the Detection & Genotyping of Human Papilloma Virus(HPV), KRAS & Molecular prediction of TB Drug Resistance

: LPL introduced International Scale Reporting for BCR - ABL

: LPL joins INITIATIVE FOR PROMOTING AFFORDABLE AND QUALITY TB (IPAQT) under theChairmanship of Dr.Arvind Lal

: LPL automates Accessioning by introducing Pre-analytic Automation for Sorting, Aliquoting & Archivalof patient samples.

: Quality Assurance Department introduces Quality Dashboard for automation of systems andprocesses

:

2014 : LPL introduces the facility to book home collection on the Mobile App or on desktop

:designed to create awareness and further educate Diabetics and the community in general

: LPL introduces a privilege program for our valued customers which gives access to a world

: LPL introduces the Mobile App on Android and iOS for booking tests and viewing current & pastreports

:

2015 : First Lab in India to install Previ ISOLA, a state of art equipment for plate streaking of microbiology

xiv

: First Lab in India to install AES SYSTEM with MASTERCLAVE, a fully automated system for makingvarious types of plate and tube media

: First Lab in India to install RAL Stainer for AFB STAINING, a fully automated, closed system forZN & Auramine staining

: First Lab in India to install fully automated Previ color Gram Stainer

:products of conception

: First lab in India to install Leica GSL-120 fully Robotic microscope for metaphase capturing

: First Lab in India to introduce CYP3A5 Genotyping for Tacrolimus, Split cell analysis T & B cell forBone Marrow Engraftment & Maternal Blood Fetal DNA Tests

: LPL opens First branch of PathVets - Veterinary Diagnostic Lab in New Delhi

: First private Lab in India to introduce Transmission Electron Microscopy for Ultrastructural studies

: LPL IPO launched.

2016 : First lab in India to install FDA approved Affymetrix Genechip Microarray system and introduce 750Kand Optima chip for Prenatal and Postnatal diagnosis.

: First private standalone lab to be recognized by National Board of Examinations (NBE) for the DNBPathology program

: Introduction of Digital Scanning & Microscopy in the Department of Histopathology

2017 : Collaboration with Jawaharlal Nehru University (JNU), Centre for Computational Biology for developingand validating Bioinformatics software

: Collaboration with Institute of Genomics and Integrative Biology (IGIB) – CSIR for introducingGenomic testing like Exome sequencing & Pharmacogenomics

: Introduction of new brands - OncoPro for Oncology testing & NeuroPro for Neurology segments

: Successful installation of Next Generation Sequencing (NGS) specially for High Resolution HLAtyping

: Introduction of MICA typing

: Launch of Kolkata Reference Laboratory (KRL)

: Introduction of highly specialized investigations for Pre-implantation genetics & Liquid biopsy forCancers

xv

LPL LABORATORIES

National Reference Lab Block-E, Sector-18, Rohini Tel: 011 - 3024 4100New Delhi New Delhi – 110 085 011 - 3025 8600

Fax: 011 - 2334 1638

Mumbai Reference Lab Shop No. 2-6 Ground Floor, Tel: 022 - 2431 1156 / 57Mumbai Shilpa Apartments, Shankar Ghanekar Marg

Prabhadevi, Near Siddhivanayak Mandir,Opp. IDBI Bank, Dadar West, Mumbai – 400 028

Kolkata Reference Lab Plot No:CB-31/1,Premises No:031-0199, Tel: 033 - 3262 6184 / 85 / 86 / 87Kolkata Street No:199 Action area1C,

Newtown, Kolkata-700156

Bengaluru Reference Lab # 17/1, Outer Ring Road, Tel: 080 - 39885050,Bengaluru Opposite Prestige Cessna Business Park, Fax: 080 - 67917917

Kadubeesanahalli, Varthur Hobli,Bengaluru – 560 103

DELHILab Address Phone Numbers

Ashok Vihar Phase II B 2/9, Anmol House, Near Syndicate Bank, Ashok ViharPhase -II, New Delhi - 110 052 9015086687

Ashok Vihar Phase III Sunder Lal Jain Hospital, Ashok Vihar Phase-III, AshokVihar, New Delhi - 110 052 011-4703 0931

Budh Vihar Brahm Shakti Hospital, U-1/78, Budh Vihar, New Delhi -110 086 011-2753 1683 / 2753 6428

Connaught Place Dwarka Eskay House, 54 Hanuman Road, New Delhi - 110 001 PlotNo.60, Sector 12B, Dwarka, New Delhi - 110 075

011-3040 3210, 3021 8027 / 23 / 46 / 55011-28081722 / 23/25

Durgapuri Shop No.A-5, Ground Floor, Loksatta building, Near PNB ATM,Main 100 ft road, Kabir Nagar, Durgapuri, Delhi-110 094 011-6464 0872/73

East Of Kailash A-15 Ground Floor, Near Kailash Colony Metro Station,Kailash Colony, New Delhi - 110 048 9015087045

Janakpuri Bhagat Hospital, D-2/48-49, Janakpuri, Block C 2,Delhi - 110 058 011-45102061

Janakpuri Shishu Sadan Children Hospital, A-1/169-A, Janakpuri,Opposite Metro Pillar No. 616, New Delhi - 110 058 011-4106 0610-17

Mahavir Enclave Bhagat Chandra Hospital, RZF 1/1, Near Dwarka PalamFlyover, Mahavir Enclave II, New Delhi - 110 045 011- 4525 4525

Mayur Vihar Shop No. G-3, 4, 5, Sikka Plaza-II, Behind Café Coffee Day,Mayur Vihar Phase - I, New Delhi - 110 092 9015088330

Meera Bagh Sehgal Neo Hospital / Sehgal Nursing Home, B-364, MeeraBagh, Outer Ring Road, New Delhi - 110 063 011-45565656 / 80

New Friends Colony D-819, Ground Floor, Near Escorts Hospital, New FriendsColony, New Delhi - 110 025 9015088484

Preet Vihar C-49, Main Vikas Marg, Preet Vihar, Near Metro PillarNumber 85, New Delhi - 110 092 011-3040 3240

Punjabi Bagh 8, West Avenue Road, Punjabi Bagh (W),New Delhi - 110 026 011-3040 3250

Punjabi Bagh 8, West Avenue Road, Punjabi Bagh (W),New Delhi - 110 026 011-3040 3250, 3040 3100, 3040 3101

SDA C-2/6, Safdarjung Development Area,New Delhi - 110 016 011-3040 3230

xvi

Shahdara East Delhi Medical Centre, 1/550, Mansarovar Park, G.T.Road,Shahdara, Delhi – 110 032 011-22596736, 2258 3204 Extn 139

Tilak Nagar 4B/13, Near Metro Pillar No. 494, Tilak Nagar,New Delhi - 110 018 9015088801

Vasant Kunj Nelson Mandela Marg, Building No.1, L.S.C., Sector-B,Pocket-7, Vasant Kunj, New Delhi - 110 070 011-2613 4825

Yusuf Sarai Upper Ground Floor, 4/1-3, Aurobindo Marg, Near AIIMSGate no.3, Yusuf Sarai, New Delhi - 110 016 011-6557 7801 / 02

NCRFaridabad SCO-30, Sector-16, Faridabad - 121 002, Haryana 0129-3988505

Ghaziabad C-30, RDC, Near Krishna Sagar, Rajnagar,Ghaziabad - 201 002, U.P 0120-3010561

Greater NoidaShop No: G-18 -21, MSX Tower-II, B-2, Alpha-1, AlphaCommercial Belt, Greater Noida, Gautam Budh Nagar - 201308, U.P

0120-4225746

Gurgaon C-1/B, Clear View, Old DLF Colony, Sector-14, Gurgaon -122 001, Haryana 0124-3988505

Gurgaon Shop No. 9, 10, 30, 31, DLF City Court, Sikanderpur,Gurgaon - 122 001, Haryana 9015087107

IndirapuramGround Floor, Shop No BG-03, Aditya Shopping Complex,Plot No. C/GH-3, Vaibhav Khand, Indirapuram, Ghaziabad- 201 014, U.P

9015087682

IndirapuramShop no. C3,C4, Ground Floor, Satya Buildcon, AhinsaKhand -2, Plot No. GH11, Near CISF Camp, Indirapuram,Ghaziabad

0120 4080939 / 935

Indirapuram Amicare Hospital, 15/16, Nyay Khand – 1.Indirapuram, Ghaziabad - 201014 0120 6999114

Noida N-27, Sector-18, Noida - 201 301, U.P 0120-3988505Noida B-1/1, Central Market, Sector – 50, Noida - 201 301, U.P 9015088500

Vaishali Chandra Laxmi Hospital , Plot No. 337, Sector-4, Vaishali,Ghaziabad - 201 010, U.P 0120-4212714, 9015086819

Vasundhara Ground Floor, Plot No.20, Sector-15C, Near SBI,Vasundhara, Ghaziabad - 201 012, U.P 120-4243929, 4162567 / 568

JAMMU & KASHMIR, HIMACHAL PRADESH, PUNJAB & HARYANA

Ambala1179, GF, B-9, Amrit Nagar, Opp. Ambala Club, NearINCO Chowk, Old Delhi Road, Ambala City, Ambala - 134003, Haryana

0171-3021000 / 01-03

Amritsar S.S. Tower, Plot No. 59, Shop No. 4, Opp. E.N.T. Hospital,Majitha Road, Amritsar - 143 001, Punjab 0183-3988505, 3067790

Anantnag Saba Complex, Khah Bazar, Anantnag - 192 101, J&K 01932-223361 / 62, 08491058281

Bhatinda 3025 /26, Guru Kanshi Marg, Near Fouji Chowk, Bhatinda- 151 001 Punjab 0164-5011513 / 14

Chandigarh SCO-16, Sector 16 D, Chandigarh - 160 015, Punjab 0172-3988505, 3017495 / 96

Hissar Aadhar Hospital, Near Easyday Store, Tosham Road, Hissar-125050, Haryana 01662-249018 / 20

Hissar N.C. Jindal Institute Of Medical Sciences, Model Town,Hissar - 125 005, Haryana 098964 44433

Hissar Kapil Jain Hospital, Shanti Devi GI Institute, OppositeCMC Hospital, Dabara Chowk, Hissar 7082319859

xvii

Hoshiarpur Ram Complex, Mohalla Kamalpur, Near Civil Hospital,Jalandhar Road, Hoshiarpur - 146 001, Punjab 01882-252050, 253050

Jalandhar1200-1201, Ajit Nagar, Opp. City Garden, Near Ajit NagarGurudwara, Nakodar Chowk,Jalandhar - 144 001, Punjab

0181-3988505, 4613873

Jammu 88, B. C. Road, Rehari, Jammu - 180 001, J&K 0191-2564903 / 06/ 12 / 17 / 20

Jammu Ground Floor, 21C, B Block, Gandhi Nagar,Jammu - 180 004, J&K 0191-2459229

Kangra Ground Floor, Jaswal Complex, Opp. Rajput Sabha,Dharamshala Road, Kangra - 176 001, HP 01892-260373 / 83

Kurukshetra Aarogyam Hospital, Behind Old Bus Stand, Thanesar,Kurukshetra - 136 118, Haryana 0174-4259221

Khanna Plot No.B007 / 1684, Ambica complex, Opposite Main Busstand, G.T. road, Khanna -141 401 01628-502002

Karnal Amritdhara Hospital, ITI Chowk, Kunjpura Road,Karnal – 132 001 0184-2200010 / 11/12, 9896539094

Ludhiana 12-C, Sarabha Nagar, Ludhiana - 141 001, Punjab 0161-2455337 / 38

LudhianaDr. B.D. Sabharwal, # 907/19, Adjacent to School ForDeaf And Dumb Children, Tagore Nagar– A,Ludhiana - 141 001, Punjab

0161-2301707

LudhianaB-19, 1121/A, Ground Floor, N.C Complex, Near DMC,Tagore Nagar, Rajpura Road, Civil Lines,Ludhiana - 141 001, Punjab

0161-4644111 / 10

LudhianaGround Floor, Unit No. B-XI-964, Baba Than SinghChowk, Samrala-Chandigarh Road, Ludhiana - 141 008, Punjab

0161-5016230

Ludhiana 4047, LIG Flats, Phase II, Urban state, Dugri,Ludhiana – 141 002 0161-4654110

Mandi Shri Harihar Hospital & Research Center, NH-21, Gutkar,Dist. Mandi - 175 021, H.P 01905-246507

Moga City complex, Near Planet fashion showroom, Partap road,Moga- 142001 01636 – 509800, 502002

Panipat SCF -35, Ground Floor, Sector-11, Near New Angel Mall,HUDA, Panipat - 132 103, Haryana 7876996098, 7876996103

Pathankot Ground Floor, MK2 Complex, Near KaaluKa Petrol Pump,Dalhousie Road, Pathankot - 145 001, Punjab 0186-3988505, 9023187113 / 105

Patiala Leela Bhawan Chowk, Opposite Gopal Sweets, Patiala -147 001, Punjab 0175-3988505

Rewari Near Ambedkar Chowk, Rewari - 123 401, Haryana 7876996082 / 6105

Rohtak 1267, Chotu Ram Chowk, Opp. Nilli Kothi, Civil Road,Rohtak - 124 001, Haryana 7876996106 / 09

Shimla Sarab Complex, N.H. 22, Shimla To Rampur Highway,Main Market, Sanjauli, Shimla - 171 006, H.P 0177-3988505, 2844881

Sirsa Circular Road, Near Apex Hospital, Sirsa - 125 055,Haryana. 01666-232132 / 33

Sonipat SCF – 3, Sector – 14, Main Market, Sonipat - 131 001,Haryana 7876996115 / 104

Sonipat Abhishek Memorial Hospital, Baroda road,Gohana, Sonipat 7644838383

Srinagar 140-A, Kak Sarai, Karan Nagar, Srinagar - 190 010, J&K 0194-2504490, 095965 00848

Yamuna Nagar 67 A/L, Model Town, Opp. PNB, Nehru Park Road,Yamuna Nagar - 135 001, Haryana 01732-220984 / 85

xviii

KARNATAKA

Bengaluru1st Floor, Rhythm Square, Site No. 94, Opp. Ajmera

Electronic City, Phase-I, Bengaluru - 560 100080-4957 7214 / 15

Bengaluru 1st Floor, No. 183/1B, Sai Harsha Tower, Opp. ForumValue Mall, Main Road, Bengaluru - 560 066 9036026096 / 97

Bengaluru Koshys Hospital, T.C.Palya Road, Raghavendra Nagar,Ramamurthy Nagar Extension, Bengaluru - 560 016 080-6452 2218 / 19

Bengaluru Santosh Diagnostic, No. 69, St Johns Church Road,Near Coles Park, Bengaluru - 560 005 080-4925 4925

Bengaluru Santosh Diagnostic, No. 19, HMT Lay Out, 80 FeetRoad, RT Nagar, Bengaluru - 560 032 080-4256 6000

MysorePlot No. C-1, Sigma Complex, Near KPR Suzukishowroom, New Kantharaja Urs Road, Kuvempunagar,Mysore - 570 023

0821-3258615

CENTRAL

Agra G1, Vinayak Mall, Surya Nagar, Civil Lines, Near DiwaniChowk, Agra - 282 002, U.P 9528545411 / 16

Agra Pushpanjali Hospital & Research Centre, Delhi Gate,Hariparwat , Agra - 282 002, U.P 0562-3106051 / 52

Aligarh3/168, Kushwaha Complex, Vidhya Nagar Colony, Opp.OBC Bank, Near Great Shopping Mall, Ramghat Road,Aligarh - 202 001, U.P

7055182333

Allahabad 29B, P.B. Tandon marg, Vivekanand chauraha, Civil Lines,Allahabad - 211 001, U.P 7851810456

Azamgarh Shop No.120 & 121, Civil Lines, Opposite Civil Court,Near bus stand, Azamgarh-276001 7851810461

Ajmer 348, Todarmal Marg, Civil Lines, Opposite PHED Regional 0145-2426224, 2425224

Bareilly Jaihind Kothi, Maccaniar Road, Prem Nagar, Bareilly - 243 005, U.P 9528545430

Bijnore Upper Ground Floor, Near Main Branch of Punjab NationalBank, Civil Lines, Bijnore - 246 701, U.P 01342-261136 / 37

DehradunComplex Kuber Tower, Near Surbhi Hotel, Next toUttarakhand Gramin Bank, Chakrata Road, Dehradun - 248001, Uttarakhand

0135-3988505

Deoria Rani Ghati Kothi, Near J K Mittal Academy, SalempurRoad, Deoria - 274 001, U.P 9918777284

Etawah 609, Kachehri road, Near UCO bank, Balram singhcrossing, Civil Lines, Etawah- 206001 7235807268

Farrukhabad PDPL, Awas Vikas Tiraha, Barpur, Near City Hospital,Farrukhabad - 209 601, U.P 05692-240033

Farrukhabad Near BLM Hospital, Kanpur Road, Fatehgarh, Farrukhabad,UP 0569-2234370

Fatehpur PDPL, 306/627 Civil Lines, Near Pathar Kata Chauraha,Opp. SBI Bank, Fatehpur - 212 601, U.P 0518-0222244

Fatehpur 306/627, Civil Lines, Near Patthar kata Chauraha, Opp SBI,Fatehpur, UP 05180-222244

xix

Faizabad Hall No.2, Mukut complex, Rikubganj,Faizabad – 224 001 7521046046

Gorakhpur 170 B, Park Road, Near Shambhawi Hospital, Civil Lines-2,Gorakhpur - 273 001, U.P 0551-3016214

HaldwaniOpp. Bhartiya Bal Vidya Mandir Inter College, AnandAmber Building, Talli Bamori, Kaladungi Road, DistrictNainital, Haldwani - 263 139, Uttarakhand

9837170338

Haridwar GF & 1st Floor, Plot No - 9 ABC, Near Shankar AshramChowk, Main Road, Haridwar - 249 401, Uttarakhand 9528545465 / 67

Jaipur A-34, Prabhu Marg, Centre Point Building, Opp. A.C.Market, Tilak Nagar, Raja Park, Jaipur - 302 004, Rajasthan 0141- 4916625 / 26

Jodhpur E-123, Shastri Nagar, Opp. Manidhari Hospital, ResidencyRoad, Jodhpur - 342 001, Rajasthan 0291-3058115, 3988505

Jhansi Vijay Chemist complex, Opposite MLB Medical college,Gate No. 1 & 2, Kanpur Road, Jhansi- 284 128, UP 8808540404

Kanpur Bhargav Hospital, 30E, Block- O,Kidwai Nagar Kanpur, U.P 0512-2600580

Kanpur Fortune Hospital, 117/02/40A, Sharda Nagar,Kanpur, U.P 098390 73574

Kanpur Raksha Hospital, H.No 240, A-1 Kaali Badi, Nai SabjiMandi, Harjinder Nagar, Lal Bangla, Kanpur, U.P 090052 77951, 080054 66102

Kanpur Kanpur Medical Center, Lajpat Nagar, Near J K TempleGate, Kanpur, U.P 0512-2297131, 2295152

Kanpur Kulwanti Hospital, 117/N/8, Kaka Deo,Kanpur - 208 025, U.P 0512-3259945

Kanpur Parakh Diagnostics Center, 37/17 West Cott Building,Mall Road, Kanpur - 208 001, U.P 0512-363605, 3915227

Kanpur PDPL South Branch, Matrachaya 621/37, W-2, Juhi Barra,Kanpur - 208 027, U.P 0512-2611767, 093350 93357

Kanpur Santosh Hospital, Bara Devi Chauraha, Kanpur, U.P 097946 11307

Kanpur Sushil Diagnostics, G.C-75 Keshavpuram Awas Vikas No-1Panki Road, Kalyanpur, Kanpur, U.P 095989 93820

Kanpur 117/H-2/168-A, Pandu Nagar, Kanpur - 208 005, U.P 0512-3988505, 2215757 / 58, 2236328

Kanpur Paliwal Medicare Private Limited, 117/H-1/02, PanduNagar, Opp. J.K Temple Gate, Kanpur - 208 005, U.P

0512-3262052, 3915220, 2235821,2232962

KanpurPDPL, 63/3D, Harbans Mohalla, The Mall Road, NearMurrey Company Bridge & Heer Palace Cinema, Opp.Brahmanand College, Kanpur - 208 001, U.P

0512-2303932, 2303319

Kanpur Parakh Diagnostics, 37/17, Westcott Building, The Mall,Kanpur, UP 0512-2363605, 2304005

Kota 1-B-32 & 33, Talwandi, RHB, Commerce College Road,Kota - 324 005, Rajasthan 0744-3007591 / 94, 3988505

LucknowPlot No. 292/6C & 292/8, Adjacent Subhash Complex, NearMandi Crossing, Tulsidas Marg,Lucknow -226 003, U.P

0522-3988505, 4004070 / 71

Meerut 1st Floor Vardhman Plaza, C 9-J Pocket, Pallavpuram Phase1, Meerut - 250110, U.P. 0121-2579157,597

Moradabad G-3, Ground Floor, Chadha Shopping Complex, Moradabad- 244 001, U.P 0591-2417744 / 45

Pukhraya PDPL, 78 Sachan Market, Jawahar Nagar, Main Road,Pukhraya, U.P 095328 07475

xx

Pukhrayan Sachan Market, Ramabai Nagar, Pukhrayan, UP 9415487001, 9532807475

Saharanpur 2/880/37, Dr. Bheem Rao Ambedkar Marg, Opp. SophiaMarket, Court Road, Saharanpur - 247 001, U.P 0132-2711051 / 052

Udaipur1-TA-25 & -TA-13, Ground Floor, RHB Colony, NearShastri Mishthan Bhandar, Sector -5, Hirang Magri, Udaipur- 313 002, Rajasthan

0294 - 2464635

Udaipur Amolak Diagnostics Pvt Ltd, 24-C, Madhuban, Near ChetakCircle, Opp. GPO, Udaipur - 313 001, Rajasthan 0294-2427055 / 56

Unnao Muskan Hospital, B-1071, Avas Vikas Colony, Unnao, U.P 090053 07334

Unnao Parakh Diagnostics, 3/90, Old Ashirwad Guest House,Sushma Hospital, Shuklaganj, Unnao, U.P 051528 38483

Unnao Muskan Hospital, B-1071, Awas Vikas Colony, Unnao, UP 9005307334Varanasi Nidan Kendra, Godowlia, Varanasi - 221 010, U.P 0542-2412375 / 8448 / 49

Varanasi B-31/82, Rashmi Nagar Lanka, Near BHU Emergency Gate,Naria Road, Varanasi - 221 005, U.P 0542-3014233, 3988505

Varanasi road, Cantt, Varanasi 0542-2508751

EAST

Agartala Dr. P. B. Das Memorial Diagnostic Centre, BidurkartaChowmohani, Agartala - 799 001, Tripura 0381-2319781 / 82 / 83 / 84

Bhubaneswar Purabi Plot No. 2084/4837, Vivekananda Marg, GautamNagar, Bhubaneswar - 751 014, Odisha 9778267183 /84

CuttackMangalabag 1st & Ground Floor, Sur Complex, NearJayaram Lenka Store, Mangalabag,Cuttack - 753 001, Odisha

9692269553 /54

Dhanbad Unit G-3, Ozone Center, Ashok Nagar, Dhansar,Dhanbad - 828 106, Jharkhand 0326-6450662 / 63

Durgapur Pinacle building, Saheed Khudiram Bose, Sarani,Durgapur- 713216 0343-2543456

Guwahati F- Fort Building, Ground Floor, Kachari Basti Road, NearKFC, G S Road, Ulubari, Guwahati - 781 007, Assam 0361-2220906

Howrah 2 /1, Krishna enclave, Bhajanlal Lohia lane, P.O.Salkia,Golabari, Howrah - 711 106, West Bengal 8443948780

Jamshedpur Shop No. 2, 3 & 4, Sai Jumbo Tower, Straight MileRoad, Bhalubasa, Jamshedpur- 831 009, Jharkhand 0657-3021020 / 21

Kolkata 71 Siddhi apartments, 1st Floor, VIP road, Teghoria,Kolkata - 700 059, West Bengal 033-32626184 -87

Kolkata P-845, Block-A, Lake Town, Kolkata - 700 089, WestBengal 033-4066 3042, 64553783

Kolkata Medicave Diagnostic Pvt. Ltd, 48-B, B.T Road, Sinthi,Kolkata - 700 050, West Bengal 033-2557 7455

KolkataMedicave Barasat Unit, No. 12 Rail gate, Noapara,Barasat, 24 Parganas North, Kolkata - 700 124,West Bengal

033-2542 8802

KolkataMedicave Barrackpore Unit, 8 (4/D), Barasat Road,Nonachandanpukur, Barrackpore, 24 Parganas North,Kolkata - 700 122, West Bengal

033-2594 4899

Muzaffarpur Chetan Sadan, Opposite Zilla parishad market, JuranChapra main road, Muzaffarpur- 842003 9102699415 / 16

xxi

Patna A-214, P.C.Colony, Kankarbagh, Patna - 800 020, Bihar 8102298022, 8102294623,8102246204

PatnaR.K.Estate, Basement, 2nd & 3rd Floor, OppositeIGIMS, Near Pillar No.62, Raja bazar, Bailey road,Patna- 800014

0612-2295550 / 51, 7632995990 / 91

Ranchi 1st Floor, Sourabh Tower, Plot No 615, Bariatu Road,Near KaramToli Chowk, Ranchi - 834 008, Jharkhand 8102299906

Silchar Ground & 1st Floor, Sree Ram Tower, Opp. SanjoyMarket, N.S. Avenue, Silchar - 788 005, Assam 03842-221114 / 16

Siliguri 175, Sevoke Road, Unity Building, Near KFC, Siliguri -734 001, West Bengal 0353-3203440 / 48

Shillong Economic medical hall, Police bazar, Shillong - 793001 0364-25505555

SOUTH & WEST

Ahmedabad APL, A103/104/203, Aasthan Complex, Opp. Polytechnic, PanjaraPole, Ahmedabad - 380 015, Gujarat 079-2630 4010

AhmedabadAPL, 002/101/102, Titanium City Centre Mall, 100 Feet Ring Road,Next To Sachin Towers, Prahlad Nagar,Ahmedabad - 380 015, Gujarat

079-40394600, 9723898811

Ahmedabad APL, Pir Mohamad shah Mansion, Gheekanta Char Rasta, ReliefRoad, Ahmedabad - 380 001, Gujarat 7621013903

Aurangabad 227, Near Kasbekar Hospital, Varad Ganesh Mandir Road, SamarthNagar, Aurangabad - 431 001, Maharashtra 0240-3988505, 3081201

Bhillai Plot No. 4, Buniyad complex, Nehru nagar east,Bhilai - 490 020, Chhattisgarh 0788-4035245

Bhopal Plot No. 05, Mandakini Housing Society, Near Apurti ShoppingMall, Kolar Main Road, Bhopal - 462 042, M.P 0755-4223727

Bhopal Delta R.I.A & Pathology Lab, 77, Motia Talab, Opp. Tajul Masjid,Bhopal - 462 001, M.P 0755- 4242363

Bilaspur Plot No. 109/3 & 110/4, Tilak Nagar, Chatapara, Near Petrol Pump,Bilaspur - 495 001, Chhattisgarh 0775-250885 / 86

Chennai 873 & 874, Ground Floor, 17th Main Road, J Block, Anna Nagar(West), Chennai - 600 040, Tamil Nadu 044-3058 9140 / 41

CoimbatoreGround Floor, Shop No. 1113, 1114, Natraj Medical Centre, Opp.Central Theatre, R S Puram, Mettupalayam Road, Coimbatore - 641002, Tamil Nadu

0422-3226209 / 10, 4395959

Goa Shop No.1-7, Zarina Towers, Near Magnum Plaza & SiddhivinayakTemple, St. Inez, Panaji - 403 001, Goa 9579249594

GwaliorShop No. 1, Ground Floor, Central Mall, Opp. Achleshwar Mandir,Sanatan Dharm Mandir Road, Lashkar,Gwalior - 474 009, M.P

0751-3012672 / 73

HyderabadG29 & G30, Ground Floor, Swarna Jayanti Complex, BesideHUDA, Maitrivanam Building, Ameerpet,Hyderabad - 500 038, Telangana

040-2373 7323 / 3913 1283

Indore H. No -1, Santoshi Height, Chandralok Colony, Khajrana MainRoad, Indore - 452 001, M.P 7067314279 / 87

Jabalpur 46, Ahuja Towers, Napier Town, Russel Chowk,Jabalpur - 482 001, M.P 0761-6995473, 3265473 / 74

Karad Shree Hospital, Plot No 269, Mangalwar Peth 747,Rukmini Nagar Karad - 415 110, Maharashtra 02164-656561

xxii

Kochi Ayyappankavu Centre, Building No. 43/623C, Cemetry Junction,Chittoor Road, Ernakulam, Kochi, Kerala 0484-4015693

KochiDoctors Diagnostic Centre International, Thampi Building, Opp.College Ground, M.G. Road, Ernakulam,Kochi - 682 011, Kerala

0484-2368383, 2363000, 2364000

Kochi Desabhimani-Centre, Building No 48/1004, Karukappily Junction,Deshabhimani Road, Elamakkara P.O. Ernakulam, Kochi, Kerala 0484-3200551

Kochi K K Road-Centre, Odathekal Trinity Building, KaloorKadavanchra, Ernakulam, Kochi, Kerala 0484-3200552

Kochi Kalamassery-Centre, Building No. VIII/46 B, C, D Edathala GramaPanchayath Manalimukku, Kalamassery, Ernakulam, Kochi, Kerala 094470 57821

Kochi Thampy Building Opp. Maharaja College Ground, M G Road,Ernakulam, Kochi - 682011, Kerala 0484-2363000 / 2368383 / 2364000

Kochi Palluruthy-Centre, Building No. 23/2425, Vipin Arcade,Palluruthy Veli, Kochi, Kerala 0484-3243584

Kochi Building No 39/5306, Plot No.16, Kerala State Housing Board,Panampilly Nagar, Ernakulam, Kochi, Kerala 0484-4015695

Kochi Thevara Centre, Building No 27/4277, Anika Complex, PanditKaruppan Road, Thevara, Ernakulam, Kochi, Kerala 0484-4015694

Kochi Tripunithura Centre, Building No XII/399 D, S.N Junction,Tripunithura, Ernakulam, Kochi, Kerala 0484-3248500

Kochi Edapally Centre, Near Edapally Toll, beside Best Bakers, Edapally,Ernakulam, Kochi, Kerala 0484-4015691

Kozhikode (Calicut)Ground Floor, Hill View Building, Krishnapoyil PadinhareParambu, Kovoor Desam, Nellikode Village, Kozhikode Taluk, NearMedical College, Kozhikode - 673 008, Kerala

0495-2355526 / 27

MumbaiOscar Multi Speciality Hospital, Pooja Enclave 15-16 , D WingGanesh Nagar, Kandivali West,Mumbai - 400 067, Maharashtra

022-2967 2024

Nagpur Plot No.7, Ground Floor, Wardha Road, Dhangoli, Opposite bigbazar, Nagpur - 440 012, Maharashtra 0712-3988505, 3014401

Pune Anand Emerald GF, Sakore Nagar, Near Symbiosis University,Viman Nagar, New Airport Road, Pune - 411 014, Maharashtra 020-3005 0900 / 01

PuneShinagare Lab, Shop no. 2 & 3, Vikram Chambers, NearProf. Ramkrishna More Sabhagruha, Near Gokhale Plaza,Chinchwadgaon, Pune - 411 033, Maharashtra

020-2735 5019, 6410 3679

Raipur Ground Floor, Bhatia Complex, Opp. Rajkumar College, GE Road,Raipur - 492 001, Chhattisgarh 7067314289

Raipur Modern Pathology Lab, Shop No 1-4, Garcha Complex, Jail Road,Kutchery Chowk, Raipur - 492 001, Chhattisgarh 7067314277, 7067314290

Sagar Ground Floor, Opposite Bundelkhand Medical College, Tilli, NearGoutam Traders, Sagar - 470 001, M.P 7582237004 / 05

Thane 16A-16B, Sohum Plaza, Godbunder Road, Opp. Manpada Bus Stop,Thane (West), Mumbai - 400 607, Maharashtra 022-67935311 / 12

ThaneSushil Apt., Ground Floor, Behind Dhanvantri Hospital, Lal Chakki,Holy Family School Road, Shiv Nagar, Ulhasnagar, Thane - 421004, Maharashtra

022- 2520028, 3236377

Thiruvanantha-puram

TC No. 1/801(3,4,&5), Opp. Tagore Garden, Medical College, P.O,Kumarpuram Road, Thiruvananthapuram, Kerala 0471-3004330 / 31

Vadodara Shop No 1- 4, Capri House II, 15 Sudha Nagar, Jetalpur Road,Vadodara - 390 007, Gujarat 0265-2342472

Vijayawada 29-4-30, Kodanda Rami Reddy Street, Governorpet (Near AndhraHospital), Vijayawada - 520 002, A.P 8688279251, 8688279242

xxix

QUALITY ASSURANCE

laboratories (NABL) & College of American Pathologists (CAP) for its entire scope of testing. All processes are ISO

AUTOMATION IN QUALITY

QUALITY CONTROL

All tests at LPL are conducted in strict accordance with standard protocols complying with CLSI (NCCLS) guidelines,

reliability of test results specially when testing is performed using different methodologies / instruments or at different testingsites.

QUALITY IMPROVEMENT PROGRAMS

LPLencourages innovative thinking and promotes high performance in its daily operations. Continuous improvement is a

and materials in order to eliminate waste, process variation and imbalance in work areas. Continuous improvement is also ameans to constantly enhance customer experience. The best demonstration of Quality and customer satisfaction is our highclient base and retention rate.

PROCESS IDENTIFICATION FOR RISK-Identify the system processes

-Identify the hazards and possible risks

RISK EVALUATION- Existing control measures

-Estimate and document risk level (probability /severity)

RISK CONTROL MEASURES-Compare risk with acceptance criteria

-lrnplernent Corrective &: Preventive Actions

ON-GOING EVALUATION-Monitor new risks-Monitor risk level

-Update, plan and take actions

RISK MANAGEMENT PLAN

xxx

LABORATORY ACCREDITATIONS

College of American Pathologists (CAP) — Accreditation for National Reference laboratory (CAP 7171001).

National Accreditation Board for Testing and Calibration Laboratories (NABL), Ministry of Science and Technology,Government of India accreditation for its:

o National Reference Laboratory, New Delhi

o Satellite Laboratories

APL, Ahmedabad Kolkata, West Bengal

Amritsar, Punjab Ludhiana, Punjab

Bangalore, Karnataka Meerut, UP

Bhagat Chandra Hospital, Delhi Mumbai, Maharashtra

Chandigarh, Haryana NOIDA, UP

Chennai, Tamil Nadu Panipat, Haryana

Dehradun, Uttarakhand Patna, Bihar

Faridabad, Haryana Pune, Maharashtra

Ghaziabad, UP Preet Vihar, New Delhi

Gurgaon, Haryana PDPL, Kanpur, UP

Hyderabad, AP Patiala, Punjab

Haldwani, Uttarakhand Thane, Maharashtra

Jalandhar, Punjab Vastnt kunj, New Delhi

Jaipur, Rajasthan Vasundhara, New Delhi

Kochi, Kerala

ISO 9001:2008Diagnostic Pathology Testing Services & Clinical Trials

ISO 27001:2013

Exo College of American Pathologists (CAP)

o All India Institute of Medical Sciences (AIIMS)

o Histopathology, by Anand Labs

o Cytopathology by PGI Chandigarh

o Indian Association of Medical Microbiology (IAMM)

o CMC Vellore for Blood Group, PT & APTT

o BIO-RAD EQAS - Chemistry, Immunology, HbA1c & A2.

o CDC, Atlanta, Georgia, USA for New Born Screening for Inborn Errors of Metabolism.

o G6PD Quality Assurance Program from Taipei General Veterans Hospital, Taiwan

o American Society for Histocompatibility & Immunogenetics (ASHI) for HLA

o National DNA Exchange Program, AIIMS for HLA DNA PCR

o United Kingdom National EQAS program for Renal biopsies

o Royal College of Pathologists of Australasia (RCPA): Electron Microscopy

xxxi

SERVICESLogistics

providinglogisticsoverbroadgeographicalboundaries.TrainedLogisticpersonnel,providesupportinspecimenpickup,distribution ofsupplies and test reports.LPL utilises the services of various modes like air, road and trains to ensure sample delivery to the nearestlaboratory depending on the test menu. The logistic team utilizes specially designed transport boxes to maintain sample stabilityat the recommended transport temperature.

Customer care

7.30 am to 9 pm) to handle all customer queries. In addition they also deal with activities pertaining to customer complaints &customer satisfaction assessment. Customer care channelises calls to the technical personnel to provide interpretive informationwhenever required.

Home Collection

To facilitate patient convenience trained home collection team is available on appointment by calling STD code + 39885050(only applicable for 7 and 8 digit calling Metro cities) only for Pathology tests. In addition clients can also book home collectionof samples through the website and mobile App.

Clinical Trials

Dr.Lal Pathlabs Clinical Trials provides global central laboratory services, to meet the needs of our pharmaceutical and

to its clients.

Testing Policies

Repeat determination: Performed routinely as part of the laboratory's ongoing Quality Assurance Program. In addition,tests can be repeated when requested by the attending physician. Samples are routinely retained as per the Lab Retention Policyat appropriate temperatures to maintain stability during storage. All Preanalytical / Analytical / Post analytical repeats requestedrequire fresh sampling within 7 days of original sample collection.Contact Customer care services for repeat determinations.

Test Additions / Cancellations: Tests may be cancelled without charge while specimens are in transit. Once the specimenhas been registered, cancellation requires authorisation from concerned department through the Customercare. Cancellations shallnot be entertained once the specimen has been assayed. Test Additions can be requested provided the specimen is adequate andviable. Addition of tests requires authorisation from concerned department through the Customercare.

Veterinary Testing

LPL has opened a Veterinary Pathology Diagnostic centre "PathVets" ( Block B, 40/50 GF, Chittaranjan Park, New Delhi-110019, Tel no. 011-49058406/407) where Pan India samples are tested. This diagnostic centre provides facilities for Pathologytests, X-Rays and Ultrasounds for all Domestic pets, Poultry farms, Dairy animals, Animal breeding farms & National Zoologicalparks.

it is considered life threatening unless a corrective action is undertaken. Critical values do not necessarily correspond with normalreference ranges, toxic range or therapeutic ranges but are based on a level at which medical action is considered necessary. Allcritical value limits are informed ASAP to the concerned client through SMS & emails. The SMS facility is available till 8 pm.

xxxii

Turnaround Time ( TAT)

providing the fastest turnaround time possible to improve patient management. The lab monitors the TAT stringently and evaluatesareas for improvement on a daily basis.

Storage of Primary Sample

The collection centres / patient service centres store the primary sample at required temperatures till their dispatch to thetesting laboratory where all samples requiring scheduled tests are stored at the designated temperatures till they are tested. Alltested samples are stored as per their documented retention time.

HIV Counselling

As per NACO guidelines, LPL offers Pre & Post test counselling to all its clients registered for an HIV test. Special formshave been designed for Pre-Test counselling and patient consent. Post Test counselling is available at all our laboratories.

HIPAA (Health Insurance Portability And Accountability Act)

LPL is fully compliant with HIPAA privacy, security and electronic transaction requirements. The policies and procedures

Loyalty Card

family member, will allow you to earn loyalty points which can be redeemed after an accumulation limit.

Business Continuity Plan & Disaster Management

IT systems to provide alternate source of servers and networking which can take over the functions of the laboratory within 30minutes. The backup server is located in another state and carries complete patient and lab information.

In the event of a crises affecting patient care services, LPL has a well documented Disaster management plan for patient support

part of the contingency plan. Reference & Satellite laboratories provide facilities for alternative laboratory testing during crises.

Holiday Coverage

Dr.Lal Pathlabs National Reference Laboratory, is open 24 x7, 365 days a year except on Sunday evenings (Sunday timing -

centres & Patient Service Centres are open till 1 pm on all working days & holidays.

On LPL's listed holidays (New Year's Day, Republic Day, Holi, Independence Day, Gandhi Jayanthi, Dussehra, Diwali &Christmas) the labs remain open till 1.00 pm to provide sample collection services. Reports are provided the next working day.

1

GENERAL INSTRUCTIONS

PRE-ANALYTICAL VARIABLES

or pathophysiological state. Many factors other than disease affect the concentration or activity of these analytes. Preanalyticalvariables can be controllable or non controllable.

CONTROLLABLE VARIABLES

PostureIn an adult, change from lying to upright position reduces blood volume by about 10% thereby reducing plasma volume of theblood and increasing plasma protein concentration. Normally decrease with change from lying to standing position is complete in10 minutes. However an interval of 30 minutes is required for reverse change to occur from standing to lying position.

Application of tourniquet at the time of blood collection mimics the effect of change from lying to standing position thereby increasingthe plasma concentrations of proteins, enzymes, protein bound constituents, blood cell counts, hematocrit and hemoglobin.

VARIATION IN ANALYTE CONCENTRATION WITH CHANGE IN POSTURE FROM LYING TOSTANDING

ANALYTE AVERAGE INCREASE IN PERCENTAlanine aminotransferase 7Albumin 9Alkaline phosphatase 7Amylase 6Aspartate aminotransferase 5Calcium 3Cholesterol 7IgA 7IgG 7IgM 5Thyroxine 11Triglycerides 6

Prolonged bed restWithin a few days of the start of bed rest, plasma volume decreases thereby increasing hematocrit by 10% within 4 days. Prolongedbed rest is associated with increased urinary nitrogen excretion. Calcium excretion increases to a maximum of 60% after 7 weeksof bed rest. Excretion of sodium, potassium, phosphate and sulphate increases to a smaller extent. VMA excretion is reduced byone fourth after 2-3 weeks of bed rest. When an individual becomes active after a period of bed rest, > 3 weeks is required beforecalcium excretion reverts to normal and another 3 weeks before positive calcium balance is achieved.

ExerciseNature and extent of exercise play an important role in affecting serum analytes. Beta endorphins and Catecholamines almostdouble within a minute of strenuous exercise. Moderate exercise increases blood glucose which stimulates insulin secretion.Strenuous exercise for 10 minutes increases plasma Renin activity by 400%. Cortisol secretion is stimulated and normal diurnalvariation is abolished.

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EFFECT OF STRENUOUS EXERCISE ON SERUM CONSTITUENTS

CONSTITUENT PERCENTAGE INCREASEAcid phosphatase 11Alanine aminotransferase 41Alkaline phosphatase 3Aspartate aminotransferase 31Calcium 1Chloride 1Cholesterol 3Creatinine 17Phosphate 12Total Protein 3Urea Nitrogen 3Uric acid 4CONSTITUENT PERCENTAGE DECREASEAlbumin 4Bilirubin 4Iron 11LDH 1Potassium 8Sodium 1Total Lipids 12

Physical trainingAthletes generally have a high serum activity of enzymes of skeletal muscle origin as compared to nonathletes. Serum concentrationsof urea, uric acid, creatinine and thyroxine are higher in athletes due to increased muscle mass. Physical training also increasesHDL cholesterol and decreases LDL cholesterol and triglycerides.

Circadian variation

Many body constituents exhibit cyclical variation throughout the day. Factors contributing to this variation include posture, activity,food ingestion, stress, daylight or darkness and sleep or wakefulness. Concentration of serum iron increases as much as 50% from8 am to 2 pm. Hormones are specially affected by cyclical variations :

Corticotropin secretion increases 3-5 fold from minimum value between afternoon and midnight to its maximum aroundwaking

Cortisol is maximum between 6-8 am

Aldosterone and Renin activity is maximum in the early hours of morning during sleep reducing to a minimum byafternoon

GFR is 20% greater in the afternoon

Urinary 17 ketosteroids and 17 hydroxycorticosteroids are lowest at night reaching maximum at mid afternoon

Prolactin concentration is greatest during sleep

Serum TSH is maximum between 2-4 am and minimum between 6-10 pm

Higher glucose values occur when glucose tolerance test is done in the afternoon when the test is given early morning

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TravelTravel across several time zones affects normal circadian rhythm due to altered pituitary and adrenal function. During a 20 hour

Diet

High protein diet – Increases serum cholesterol, phosphate, urea, uric acid, ammonia and urinary urea & uric acid

High fat diet – Increases serum triglycerides

High carbohydrate diet – Decreases serum LDL cholesterol, triglyceride, total cholesterol and protein

Food IngestionPlasma analytes are affected by the time between ingestion of meal and collection of blood. Many analytes require overnightfasting for 10-14 hours before blood collection making it an optimum time. A protein rich meal in the evening may increase serumurea nitrogen, phosphorus and uric acid upto 12 hours. The effect of carbohydrate meals is less than protein meals.

Bran : Habitual ingestion of bran affects absorption of certain compounds like calcium, cholesterol and triglycerides from thegastrointestinal tract.

Food constituents : Many fruits like bananas and vegetables contain serotonin which increases excretion of 5-HIAA. Avocadosimpair glucose tolerance by affecting insulin secretion. Onions reduce plasma glucose and insulin response to glucose. Garlicingestion may reduce cholesterol level by about 9%.

Caffeine : It stimulates adrenal medulla resulting in 2-3 fold increase in plasma epinephrine concentration. It also affects adrenalcortex, increasing plasma cortisol with increased excretion of free cortisol, 11-hydroxycorticoids and 5-HIAA. Ingestion of 2 cupsof coffee may increase plasma free fatty acid level by 30%. Serum gastrin level may be increased by 5 times on drinking 3 cupsof coffee.

VegetarianismLong standing vegetarians show reduced levels of VLDL cholesterol by 12% as compared with non-vegetarians. Serum creatininelevels may also be slightly low due to reduced ingestion of proteins. An individual on a vegetarian diet for 3 months shows 20%reduction in serum copper, 10% in selenium and zinc. Urine pH is usually higher in vegetarians due to reduced intake of precursorsof acid metabolites.

MalnutritionPlasma concentrations of most proteins like total proteins, albumin, pre-albumin and beta globulin are reduced in malnutrition.Serum cholesterol and triglycerides may be only 50% of the concentration in healthy individuals. Activity of most of the enzymesis reduced.

Long Term fasting and starvationWithin 3 days of start of a fast, blood glucose decreases by 18 mg/dL. Insulin secretion is also greatly reduced. Amino acids areincreased but urea decreases. Organic acids accumulate leading to metabolic acidosis. A fasting > 60 hours shows reduced insulinby 50% and C-peptide by 30%. Glucagon, Epinephrine and Norepinephrine are doubled and growth hormone is increased 5 fold.

SmokingNicotine increases concentration of epinephrine in plasma and urinary excretion of catecholamines. Glucose levels increase by10 mg/dL within 10 minutes of smoking a cigarette and this increase persists for 1 hour. The lactate pyruvate ratio increases

minutes after smoking. Cholesterol, Triglycerides and LDL cholesterol levels are high in smokers. Smoking also affects the immuneresponse of the body lowering IgG, IgA & IgM levels. CEA is reported to be 70% higher in habitual smokers. Sperm count of malesmokers is reduced and number of abnormal forms is greater.

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AlcoholProlonged moderate ingestion of alcohol increases the blood glucose by 20-50%. Serum triglyceride levels increaseby >20 mg/dL, plasma aldosterone by 150% and prolactin by 40-50%. HDL cholesterol also rises while LDL cholesterol reduces.Chronic alcoholism increases GGT by 1000 fold, AST by 200% and ALT by 60%.

Drug Administration

and patient idiosyncratic response to their administration. Co-administration of certain drugs may affect each others metabolismand pharmacological effects. CK, Aldolase and LDH - muscle component increase in the serum on intramuscular administration.

Herbal PreparationsHerbal preparations lack regulatory standardization and may affect metabolism of therapeutic drugs. Ginseng ingestion reducesProthrombin time and INR in patients taking Warfarin. Grapefruit juice increases bioavailability of drugs like Methadone,Amiodarone and Simvastatin. Aloe vera and Senna have laxative effects and prolonged use may lead to hypokalemia. Liverdamage may be caused by impure constituents of herbal mixtures.

NON CONTROLLABLE VARIABLES

Genetics plays an important role in determining the concentration of blood constituents like cholesterol, glucose, urea, urate andbilirubin. Females with blood group ‘0’ have a lower hemoglobin concentration than other blood groups.

Age: Has a notable effect on reference intervals of each analyte and in general population is divided into 4 groups namelyNewborn, Older child to puberty, Sexually mature adult and Elderly adult.

Gender: After puberty characteristic changes in the concentrations of sex hormones affect test results. Serum levels ofAlkaline phosphatase, ALT , AST, CK & Aldolase are greater in men than in women. Hemoglobin and bilirubin levels areslightly lower in women but reticulocyte counts are higher.

Race: Total serum protein concentration is higher in blacks than in whites though serum albumin is less. Carbohydrateand Lipid metabolism differs in blacks and whites. Glucose tolerance is less in Blacks, Polynesians and Native Americans.Lipoprotein (a) level in blacks is twice as high than in whites.

Environmental factorsAltitude- Individuals living at high altitude have higher hemoglobin and PCV levels due to reduced atmospheric oxygen.Basal growth hormone levels are high in individuals living in high altitudes but concentrations of renin and aldosterone arelow.

Temperature –lead to hemoconcentration rather than hemodilution.

Place of residence –cholesterol, triglycerides and magnesium in areas rich in hard water. Carboxyhemoglobin concentration is higher in places

During summer in northern hemisphere, blood volume increases and in winter plasma proteins increase by 10%. Cholesterol ishigher in winter than in summer whereas Triglycerides are higher by 10% in summer.

Menstrual cyclePlasma corticosterone level is 50% higher in luteal phase than in follicular phase. Plasma androstenedione and aldosterone levelsincrease from follicular to luteal phase. Cholesterol and triglyceride levels are higher in mid cycle corresponding to maximumestrogen secretion. This cyclical variation of cholesterol is not observed in women with anovulatory cycles.

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ObesitySerum levels of cholesterol, triglycerides and beta lipoproteins are positively correlated with obesity. Lactate dehydrogenase andglucose are increased in both sexes with increase in body weight. In males AST, creatinine, Total protein & hemoglobin rise withincreasing body weight whereas in females calcium rises with weight gain. Acute phase reactants are higher in obese as comparedto lean individuals.

PregnancySince blood volume increases during pregnancy from 2600 mL in early pregnancy to 3500 mL at 35 weeks gestation, plasma

rd

trimester of pregnancy. All acute phase reactant proteins increase during pregnancy and ESR rises by 5 fold.

StressAnxiety stimulates increased secretion of aldosterone, angiotensin, catecholamines, cortisol, prolactin, growth hormone, TSH &renin. Stress decreases albumin by 5% but cholesterol levels increase.

FeverFever provokes many hormonal responses and appears to reduce the secretion of Thyroxine. It accelerates lipid metabolism and isoften associated with respiratory alkalosis.

Shock and TraumaRegardless of the cause of shock and trauma certain characteristic biochemical changes occur like 3-5 fold increase in serumcortisol concentration, increased excretion of 17-hydroxycorticosteroid. Stress of surgery reduces serum T3 levels by 50% inpatients without thyroid disease.

Transfusion and InfusionTransfusions to replace blood loss because of injury reduces sodium & chloride. Extensive blood transfusions can lead tosiderosis and increased serum iron concentration. Infusions of glucose solution usually reduce plasma phosphate and potassiumconcentrations. After an infusion it is not advised to collect blood for 8 hours as it affects accuracy of test results.

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SPECIMEN COLLECTION

the attendant must be asked the same.

and matched visually.

Personal Protective Equipment (PPE)Phlebotomist must wear gloves, face mask and lab coat before approaching the patient and take standard precautionsagainst potentially infectious material and limit the spread of infectious disease from one patient to another.

sample collection.

Pre-test requirement checks

by the Physician.

Patient positionPatient should be comfortable, seated or supine and should be in this position as long as possible before sample is drawn.Venipuncture should never be performed on a standing patient.

Selection of Venipuncture siteMedian Cubital vein in the antecubital fossa or crook of the elbow is the preferred site for collecting venous blood in adultsbecause the vein is large and close to the surface of skin.

Veins on the back of the hand or at the ankle may be used but these are less desirable and should be avoided in patients withDiabetes and other individuals with poor circulation.

avoided.

Arm on the same side as Mastectomy should not be used as surgery causes lymphostasis thereby affecting blood compositionspecially if the surgery is within 6 months.

For severely ill patients and those requiring intravenous injections, an alternative blood drawing site should be selected.

for at least 3 minutes before specimen is collected. Specimens below the infusion site in the same arm are satisfactory formost tests except for those analytes which are present in the infusion solution like glucose and electrolytes.

Prior to VenipuncturePhlebotomist should estimate the volume of blood to be drawn and select appropriate number and types of tubes required forblood samples as per tests requested. In case of multiple collections order of draw should be decided.

Proper Labeling Of TubesEach submitted specimen tube must be labeled with the patient’s name (written exactly as it appears on the Lab Form / TestRequest Form) and the tests to be conducted. The tubes should be bar coded. The time of specimen collection and the identity ofthe phlebotomist collecting the Primary sample is recorded.

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Barcoding Instructions1. All tubes to be barcoded prior to sample collection.

3. Bar code ‘F’ is used for Blood Sugar Fasting and barcode ‘ PP’ for Blood Sugar Post Prandial.Do not use these barcodes for random sugar samples.

4. Precautions:

(a) Do not change the numbers on the barcode by hand.

(b) Do not use ink or write on the barcode label by hand.

(c) Do not soil the barcode.

(e) Barcode should not cover the entire tube as this blocks physical viewing of the sample for gross hemolysis, lipemia andsample volume.

Preparing Venipuncture siteSanitize hands & wear gloves with consideration of latex allergy.

The area around the intended puncture site should be cleaned with the spirit swab containing 70% alcohol in a circular motionfrom inside to outside.

Skin should be air-dried and no alcohol should remain on the skin as traces may lead to hemolysis. Do not touch the site after ithas been cleaned.

Venous Puncture Technique using Evacuated tubes / Vacutainer

pumping. Tourniquet should not be tied for more than 1 minute as it affects biochemistry parameters. Ideally tourniquetshould not be tied for more than 1 minute.

Holding the green colored section of the needle shield in one hand, twist and remove the white section of the needle withthe other hand.

Screw needle onto the holder. Leave the green colored shield (21 inch gauge) or if necessary black colored shield (22 inchgauge) on the needle.

Puncture the skin with the needle at approximately 15 degree angle with the bevel of the needle facing upwards.

Insert the needle smoothly and fairly rapidly to minimize patient discomfort. If using an evacuated system, as soon as theneedle is in the vein, insert the vacutainer tubes forward in the holder, puncturing the diaphragm of the stopper. Remember

holder to disengage stopper from the needle and remove tube from the holder. If more samples are needed, repeat the sameprocedure.

Remove the last tube from the holder before withdrawing needle from the vein. Never withdraw the needle without removingthe tourniquet.

Mix and invert all tubes as per page 8. Do not shake the tubes vigorously.

Dispose off contaminated material in designated containers using universal precautions as per local state guidelines.

In case of contamination of the holder / glove, discard and replace with a new one.

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Blood collection with Syringe

Keep bevel of the needle upwards.

Align syringe and needle with the vein to be punctured and push the needle into the vein at an angle of 15 degrees.

As soon as the vein is pierced, stop the forward pressure on the syringe and draw blood by gently pulling back the plungerof the syringe.

After adequate blood volume has been drawn, remove the syringe with the needle from the vein and immediately place adry swab over the puncture site.

Do not uncapand forcefully push the blood into the evacuated tube.

Venipuncture in childrenTechnique for venipuncture in adults and children is similar. However children are likely to make unexpected movements, hence

tubing to collect specimens.

Completion of sample collectionWhen blood collection is complete and needle is withdrawn, patient should be instructed to press the puncture site with adry swab and arm raised without bending at the elbow, to lessen the leakage of blood.

Apply bandaid once the bleeding has stopped.

Discard needle / syringe / swabs as per the waste disposal guidelines.

Recommended Order of Draw for multiple specimen collection

Color of Stopper Additive InversionsBlood Culture bottle Broth 8White Top No Additive 0Light Blue Top Sodium citrate 3-4 Gold Top - SST Gel Separator 5Red Top No Additive 5Green Top Sodium heparin 8Royal Blue Top K2 EDTA 8Lavender Top EDTA 8Grey Top 8Yellow Top ACD 8

Noteabove.

COMMON ERRORS IN SPECIMEN COLLECTION1.

Mislabeling of specimen2.

Short draws / wrong anticoagulant to blood ratio3.

Inadequate Mixing / clots4.

Figure of Inversion

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Wrong tubes / wrong anticoagulant5.

Hemolysis / lipemia6.

Hemoconcentration from prolonged tourniquet tying7.

Exposure to light / extreme temperatures8.

Improperly timed specimens / Delayed delivery to laboratory9.

Processing errors- Incomplete centrifugation, incorrect log-in, improper storage10.

FACTORS AFFECTING TEST RESULTSHemolysis – means lysis of RBC which affects certain test results like Potassium, Magnesium, Iron, LDH, Phosphorus,1.Ammonia & Total protein.

Causes of hemolysis :

Needle gauge too thin

Syringe plunger pulled back too fast

Expelling blood vigorously in the tubes

Mixing tubes vigorously

Collecting blood before alcohol has dried at venipuncture site

2. Lipemia

3. Clots in anticoagulated specimen

4. Non fasting specimen when test requires fasting

5. Improper blood collection tube

6. Short draws / wrong volume

7. Improper transport conditions

8. Discrepancies between requisition & specimen label

9. Unlabeled or mislabeled specimen

10. Contaminated specimen / leaking container

BLOOD COLLECTION PROCEDURE IN NEWBORNS ON FILTER PAPER

Materials required:Sterile, disposable lancet or automated lancet device (maximum tip length 2.4 mm)

70% alcohol swab

3 sterile cotton wool or gauze swabs

Disposable gloves

Blood collection card / Filter paper

Sample Collection ProcedureWear gloves

Ask the mother to cuddle the baby on her knee to assist you and comfort the baby

Place a paper towel on the lap of the person holding the baby to protect from any blood drips

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Ensure that the heel is warm. Holdthe heel in warm hands for 3 minutesor dip heel in warm (not hot) water.Warming the heel will enhance the

downward position from the heart willhelp to collect specimen adequately

Clean the heel with sterile spirit swaband air dry

Do not leave any alcohol on the skin asthis may dilute the sample and adverselyaffect the test results. Encircle the heel

gently until skin is taut and suffusedwith blood

stab with lancet

The length of the puncture should notexceed 2.4 mm

If a second puncture is necessary, makethis a few millimeters away from the

as vasoconstriction occurs initially. Then gently apply intermittent pressure with the thumb to the area surrounding thepuncture site. Avoid excessive pressure as this may bruise the site

Touch the circle marked on the card gently to the hanging drop so that blood soaks through to the other side. Do not evertry to put blood drop on both sides of the card. It is very important that blood should soak through the card

Do not press the card on to the skin

over skin puncture sites in newborns

Dry the sample at room temperature on a clean non-adsorbent surface for 4 hours

Never prick bruised heel

Filling Out IEM Cards

requested is vitally important for screening and follow up.

Accurate and complete patient and physician information is critical for rapid follow up in the event of abnormal test result.Name, date of birth and specimen date are particularly important. Ensure physician information is accurate and complete. Thetiming of collection and medical information on transfusion, medication, pre-maturity and other requested data are needed tointerpret results and determine appropriate follow up procedures. Use ball point pen only to enter information on the card.

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Preferably send the cards on the same day of collection. If it is not possible to send the sample on the day of collection, then

store at 4 C after the sample has dried.

If stacking several cards, do not directly place one blood spot on top of another as this can cause contamination; rotate eachcard in the stack to alternate the collection areas.

Place the blood specimen card in paper envelope. If paper envelope is not available then wrap a sheet of clean white paperaround the cards ensuring that the blood spots are completely covered.

There is minimal risk of infection from dried blood samples.

Dried blood specimens must NOT be packaged in airtight, leak proof plastic bags. The lack of air exchange in a sealedplastic bag causes heat buildup and moisture accumulation which can damage the dried blood spot.

High temperatures can degrade enzymes. Sample card must be transported refrigerated.

Layering or applying successive drops of blood in the same printed circle causes caking and /or non-uniform concentrationsof blood.

Ensure that blood soaks through the card. Do not apply blood on both sides of the card.

Contamination of sample during collection, drying, or mailing with urine samples will render the results unreliable. Suchsamples will be rejected.

Inadequate or inappropriate drying.

Humidity and moisture adversely affect the quality of sample and analyte recovery.

Excess heat or sunlight bakes the sample.

Excess cold leads to separation of red blood cells and serum.

Placing the sample in a plastic bag generates moisture and promotes bacterial growth.

Urine Specimen CollectionA clean early morning fasting specimen is usually the most concentrated and is preferred for microscopic examination anddetection of abnormal amounts of constituents like proteins and HCG.

First 10 mL of urine voided is most appropriate for bacterial examination.

Mid stream specimen is best for investigating bladder disorders.

Catheter specimens can be used in critically ill patients or in those with urinary tract obstruction.

It is advisable to clean patient’s genitalia before voiding urine for routine and culture examinations in order to obtain trueconcentration of white cells.

24 hour Urine CollectionPatient must be properly instructed on the collection technique.

If container has preservatives like HCl, each void should be in a separate container which is emptied into the largercontainer. This two step procedure prevents danger of patients splashing themselves with the acid. Add appropriate volumeof 50% or 6N HCl as per table 1 & 2 to stabilize the pH between 1 & 3.

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Keep the container at 40C during the entire collection period or alternatively keep the container in a bucket of ice.

For specialized urine tests like VMA, Catecholamines etc., patient must be given written instructions with regard to dietor drug instructions.

Urine should not be collected at the same time for 2 or more tests requiring different preservatives.

Removal of an aliquot is not permissible during 24 hour collection, because excretion of most compounds variesthroughout the day and test results will be affected.

Prior to testing, smaller aliquots must be made after thoroughly mixing the urine in the 24 hour container to ensurehomogeneity. Measure and note the total volume of the well-mixed 24 hour urine collection and send 50 mL aliquot in ascrew-cap plastic container refrigerated (2-8ºC), for analysis. Record 24-hour urine volume on test request form (TRF)and urine container.

For trace metal analysis, it is mandatory to use trace metal containers. Do not measure 24 hour volume.

Table 1

Urine Output in mL Volume of HCl to be added50–100 0.5 mL101–200 1 mL201–400 2 mL401–600 3 mL601–800 4 mL801–1000 5 mL1001–1200 6 mL1201–1400 7 mL1401–1600 8 mL1601–1800 9 mL1801–2000 10 mL

Table 2Age Average Urine Output in mL

(varies with intake and other factors)New born(0–2 days)

30–60

Neonate(3–10 days)(11–60 days)

100–300250–450

Infant(2–12 months) 400–500Child(1–3 yrs)(5–8 yrs)

500–600600–700

Adolescent(8–14 yrs)(14–18 yrs)

650–1000800–1400

Adult 800–2500

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Table 3

24 hour Urine CollectionPreservatives

Tests

None Amino acids, Amylase, Citrate, Chloride, Creatinine,ALA, Immunoelectrophoresis, Phosphorus, Potassium,Protein, Protein electrophoresis, Sodium, Urea, Uricacid

10 g Boric acid Aldosterone, Cortisol10 mL 6 N HCl Catecholamines, Cystine, HVA, Hydroxyproline,

Metanephrine, Oxalate, VMA, 5HIAA, CalciumGlucose

50% Alcohol Cytological examination

Random Urine Collection

deionized water) to a pH between 1.0 and 3.0 immediately after collection. Acid should be added drop-by-drop, checkingthe pH regularly till it falls between the desired range.

Avoid excess addition of acid; do not use concentrated acid.

Well-mixed 50 mL aliquot of this collection should be sent/stored refrigerated (2–8ºC) for analysis.

HISTOPATHOLOGY SPECIMEN COLLECTION

SPECIMEN HANDLING FOR ROUTINE SUBMISSIONS:

Immediately place each specimen in a tightly secured container with 10% Neutral buffered formalin. Specimen must betotally immersed in formalin. Do not allow specimen to dry.

number.

Do not crush the specimen with forceps, hemostats, or other instruments. Cautery will cause heat artifact. DO NOT

Formalin volume to specimen ratio should be 10:1.

Label each container (not the lid) with patient’s name, source of specimen & bar code.

Complete Histopathology test requisition form and send with specimen(s). Only one Histopathology test requisition

The test requisition form should contain pertinent clinical information including Patient’s date of birth, gender,clinical information and anatomic location of tissue removed.

SPECIMEN HANDLING FOR SPECIAL TESTS

IMMUNOHISTOCHEMISTRY (IHC)

Histopathology report if available.

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Alternatively submit specimens as for Routine Histopathology.

specimen.

DIRECT IMMUNOFLUORESCENCE

Submit minimum 3 mm punch biopsy of Skin or Conjunctival specimen in buffered normal saline. Ship refrigerated.

SPECIAL STAINS

relevant clinical history.

ONCOLOGY RESECTION SPECIMENS

Collect specimens as for routine histopathology.

Complete surgical pathology requisition form for Oncology Resections and send with the specimen. Each container

Doctor/Clinician/Centre from where specimen is received.

The test requisition form should contain pertinent clinical information including Patient’s date of birth, gender,clinical information and anatomic location of tissue removed.

ELECTRON MICROSCOPY (EM)

Transmission electron microscopy (TEM) is a technique in which a beam of electrons is transmitted through an ultra-thinspecimen, interacting with the specimen as it passes through and creating its high resolution image. This analysis is performedby special microscopes called Transmission Electron Microscopes (TEMs).

object in a light microscope.

microscopy, and electron microscopy is considered to be an essential component of human diagnostic renal pathology,

In renal pathology, ultrastructural features may enable a diagnosis to be made where the light microscopy is apparently normal,eg Minimal change, Thin membrane disease, Hereditary nephropathy, Fibrillary and Immunotactoid glomerulonephritis. In

Dense deposit disease, Diabetes etc.

In muscle biopsy, the characteristic diagnostic features of several Myopathies, Glycogen storage vacuoles, Nemaline myopathy,Actinopathies, and Hyaline body myopathy etc. are seen only with the use of TEM. Additionally, when samples for electronmicroscopy are inadequate, valuable diagnostic information can be obtained from ultrastructural investigations on reprocessed

Electron Microscope facility at LPL:LPL has a dedicated Transmission Electron Microscopy laboratory, backed by experienced personnel and housing state of the art120 kV JEOL Transmission Electron Microscope.

Sample collection for Electron microscopy (TEM):Samples should be collected in special vials containing 3% buffered glutaraldehyde solution, available from LPL. Thespecimen should be shipped refrigerated.

Detailed clinical history should accompany the specimen along with contact number of the referring doctor.

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WATER COLLECTION

Collection of Water Samples For Presumptive Coliform Count:

Collection of a sample from Tap:

1. Clean the nozzle of tap with spirit

2.

3. Collect the water in a sterile bottle

Collection of water from rivers / lakes:

The stopper should be removed carefully with one hand and with the other hand bottle held at its base should be inserted, mouth

into it. The bottle is then brought to the surface and capped immediately.

CENTRIFUGATION

SST/Red top tubes must be placed vertically for 30 minutes to allow blood to clot prior to centrifugation. For all blood samplescollected, plasma/serum should be separated from cells within 2 hours. Uncentrifuged samples should be kept at room temperatureto decrease hemolysis. These samples should not be refrigerated at 4 C unless centrifuged. Plasma samples for moleculardiagnostics should be centrifuged immediately and frozen. Blood samples must be centrifuged at 3500 rpm for minimum 10minutes for proper separation of serum/plasma.

Precautions:

Tubes should be well stoppered and balanced. Weight of buckets, tubes & their contents on opposite side of the rotor should

The speed control switch should be at zero before starting the centrifuge & adjusted to the required speed.

Do not open the lid while the centrifuge is in operation.

Do not stop the rotating tubes with your hands. Let them stop on their own.

In case a tube breaks, the bucket, cushion & chamber should be carefully cleaned with 1% Sodium hypochlorite solution.

Always wear gloves to protect yourselves as any spillage can be hazardous.

Keep serum/plasma/urine refrigerated /frozen till packed and transported to the laboratory at the required temperature asper the Alphabetical List of Tests.

Note

equipment.

Incomplete centrifugation can affect test results. Centrifugation time should be strictly followed.

Tubes must be stoppered and then centrifuged to reduce evaporation and prevent aerosolization of infectious particles andvolatile substances like ethanol. Stoppers also maintain anaerobic conditions which are important for measurement ofCarbon dioxide and Ionized calcium. It also helps to preserve blood pH which is important for enzymatic measurement ofAcid phosphatase.

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Samples for Molecular diagnostics should not be exposed to repetitive cycles of freezing and thawing as this can lead to

shearing of DNA.

INSTRUCTIONS FOR PACKAGING SPECIMENS AND TEST REQUISITIONS

Enter the Patient Information, Tests requested and other details in the Test Request form.

Fold the test requisition form with the patient’s name and bar code facing out.

The specimen bag has two pouches. Place the specimen(s)wrapped in absorbent paper, in the rear pouch (printed side) andthe requisition form in the front pouch (un-printed side) with the bar code facing out.

Seal the Zip Lock bag. This will prevent the sample from contaminating the Test Request Form in cases of accidentalleakage.

Transportation to Laboratory

Transport requirements are of three types: Frozen, Refrigerated, and Ambient. Use of transport boxes supplied by LPL arerecommended. Please refer to the Stability and Minimum Volumes in the Alphabetical List of Tests before using appropriatemode of transport to laboratory.

Frozen (0-2º C) :

Remove all contents of transport box1.

Place a layer of perforated sponge at bottom of thermacol box2.

Place a prefrozen gel pack over the perforated sponge (gel packs must be prefrozen at 0ºC for 24 hours prior to use)3.

Place specimens sealed in Zip lock bag over the gel pack4.

Place another prefrozen gel pack over the samples5.

Cover with second layer of perforated sponge6.

Place unperforated sponge and close thermacol lid7.

Seal the cardboard box and transport to laboratory immediately8.

Indicate ‘Frozen Samples’ on cardboard box9.

Note: In case a transport bag is being used, place prefrozen gel packs in the pockets of the bag and ziplocked samples to beplaced in these pockets.

Alternatively samples can be transported Frozen in Dry Ice.

1. Remove all contents of transport box

2. Break dry ice into small pieces & place at bottom of the box

3. Place samples sealed in zip lock bag over the dry ice

4. Place perforated sponge over the samples

5. Close the thermacol lid

6. Seal the cardboard box and transport to laboratory immediately

7. Indicate Frozen Samples in Dry Ice on cardboard box

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Refrigerated (2-8º C) :

1. Remove all contents of transport box

2. Place a prefrozen gel pack at bottom of thermacol box (gel packs must be prefrozen at 0ºC for 24 hours prior to use)

3. Place a layer of perforated sponge over the prefrozen gel pack

4. Place specimens sealed in a zip lock bag over the perforated sponge

5. Cover specimens with second layer of perforated sponge

6. Place another prefrozen gel pack over the samples

7. Place unperforated sponge and close thermocol lid

8. Seal the cardboard box and transport to laboratory immediately

9. Indicate ‘Refrigerated Samples’ on cardboard box

Note: In case a transport bag is being used, place prefrozen gel packs in the pockets of the bag and ziplocked samples to beplaced in the centre of the bag.

Ambient / Room (18–22°C) :

1. Remove all contents of transport box

2. Place a prefrozen gel pack at bottom of thermacol box (gel packs must be prefrozen at 0º C for 24 hours prior to use)

3. Place a layer of perforated sponge over the prefrozen gel pack

4. Place a second layer of perforated sponge

5. Place another prefrozen gel pack over the perforated sponge

6. Place unperforated sponge over the second gel pack

7. Place specimens sealed in zip lock bag over the unperforated sponge

8. Seal the cardboard box and transport to laboratory immediately

9. Indicate ‘Ambient’ Samples on cardboard box

Note: In case a transport bag is being used, place the samples in the outer pockets of the bag (without gel packs).

BILLING

Payments can be made by cash / credit card / Demand Draft in favour of Dr. Lal PathLabs Ltd payable at New Delhi OR Electronictransfer directly to LPL bank accounts. An additional courier charge of Rs.1500/5500 as applicable per requested test per patientshould be included for samples to be sent to USA.

TEST REPORTS

The turnaround time for each test is indicated in the Alphabetical List of Tests. For samples sent to USA, the reports are availablein 2 to 3 weeks time from the date of dispatch to USA. Due to unforeseen circumstances, reports may not be available on the duedate. Clients are telephonically informed of all delays by Customercare department.

Dr Lal PathLabs Reference Guide Specimen Collection

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MODE OF COLLECTION OF TEST REPORTS

Self : Collection of Test reports by the patients or their representatives on production of the receipt issued.

Courier/Fax/Registered Post / e-mail on request at the time of Sample Collection.

Website: Patients may access their reports online on our website (www.lalpathlabs.com) via the link View Test Report onthe home page. Under this link there are two columns Lab/Visit ID and Password. ‘Lab/Visit ID’ is patient’s unique identifcation number and ‘password’ to be used is patient’s surname. In case patient does not have a surname, the password wouldbe his/her f rst name. Verif cation code must be typed in capitals. Online reports may be viewed only for 30 days

Mobile App:

Lal PathLabs Mobile App on Android and iOS helps to:

Find the nearest Centre / Lab based on patient’s location

Give information about various tests

Book a Home collection.

Access the current and all the past reports on the App itself.

Procedure for accessing reports

Open menu draw in the App

Click on ‘My reports’

Select ‘Check your report using lab ID and password’ and press enter

Click on the download icon to download the report or send the report to your email ID

Cumulative Reports

Current + Last 3 reports available simultaneously.

Sample to be given in the same testing laboratory.

Valid for test results with Quantitative values only.