1
R AFFIX BARCODE LABEL HERE LAB NO. Form No.: G0070 Universal Request Form Coagulation Hepatitis Viruses Haematology HIV Microbiology Other Infectious Diseases HIV ELISA HIV PCR DNA qualitative CD4 count HIV Viral load - PCR HIV Monitoring (HIV VL + CD4) HIV Resistance H455 D232 G397 F401 X547 R553 F9 F9 R657 K406 F432 T895 B277 F462 K178 K861 A617 G914 Y297 S612 Q427 V340 X504 F440 E852 Y343 A189 R169 S337 M730 P438 B479 W345 C756 X296 L407 Microscopy only MC&S TB - Quantiferon gold Carbapenemase scr. - PCR CMV Ab CMV qualitative PCR (no EDTA) (*samples: CSF, U, E, SP, Tissue, Aspirates) CMV Viral load PCR U293 Coxsackie Ab EBV Ab EBV Viral load PCR B300 H.Pylori Ab Respiratory virus panel PCR Rubella Ab RSV PCR (*Respiratory swab) Atypical pneumonia PCR (*samples: Dry swab / Sputum) Bordetella PCR (Dry swab) Inuenza PCR (*Respiratory swab / Nasopharyngeal aspirate) PCP PCR Malaria species genotyping PCR Toxoplasma Ab Tick Bite Fever Rickettsia PCR CSF Viruses PCR (*Samples:CSF/Saliva/U) Adenovirus PCR (*samples: E, S, U, CSF, Aspirates) Genital discharge scr. (no HIV) (*urine, 1 x Urethral or Vaginal swab) Genital ulcer screen. (no HIV) (*1 xSST, Swab from Ulcer or Urine) Syphilis serology Fungal microscopy only Fungal MC&S TB (ZN AFB - micro only) TB AFB/PCR/Culture/Sens Fungitell assay Clostridium difcile PCR *Specimen: *Site: Other: S360 Y366 V363 X365 V386 G351 H352 F396 L019 K355 P358 R359 L355 M356 N357 Hb electrophoresis screen Indirect anti-globulin (indirect coombs) Blood group + Rhesus Coombs - direct ESR FBC / ESR / platelets FBC / platelets Flow immunopheno (*Samples:1xE,2xH) Haemolytic prole Hb only Malaria screen Paul bunnell Platelet count Reticulocytes White cell count + Diff White cell count W223 Anti-phospholipid Ab D-Dimer - quantitative Fibrinogen Full bleeder screen DIC screen (*samples:1xE,2xC,1xH) Inherited thrombophilia (*samples:3xC,2xE,1xE on ice) Lupus inhibitor (*samples:2xC) Thrombosis scr. - arterial Thrombosis scr. - venous HAV IgM HAV IgG HBV immunity (sAb) Hepatitis B & C Chronic status Hepatitis A, B, C (with common Caucasion mutations) (*samples:3xC,1xB,1xE) PI / INR PTT PI / INR dosage- Fill in MRI no F373 D881 C393 BOOK Z367 BOOK H445 K325 BOOK T968 E303 G385 H306 H749 C301 B369 C370 F402 Limited bleeder screen (Incl. Von willebrands) General Endocrine Thyroid Pregnancy Hypertension/Neuro Endocrine X204 W203 E349 C560 C164 C481 C155 W812 W437 W965 V202 H260 N196 G882 B542 F9 or F9 F9 X227 B412 B231 E211 C209 W226 B208 K216 V225 Y228 T223 Z229 P415 A307 D210 K239 L217 Aldosterone Renin Serotonin - on ice Chromogranin A 5HIAA VMA + Metanephrine Catechol + Metanephrine TSH T4 Thyroid Ab T3 (free tri-iodothyronine) Ante natal screen with HIV (*samples:2xE,2xB) Ante natal screen no HIV (*samples:2xE,1xB) βHCG qualitative (Pos / Neg) βHCG quantitative Hirsutism prole Testosterone / FTI DHEA Androstenedione Infertility screen 17-OH Progesterone FSH E2 Progesterone LH Prolactin Anti-mullerian hormone ACTH - on ice Cortisol Growth hormone Insulin Parathyroid hormone IGF1 + IGFBP3 Gastrin - fasting Cortisol - 24hr urine free F M Folate - serum + RBC Nutrition / Iron Studies Ferritin Iron prole Soluble transferrin receptor Vitamin B12 Routine semen analysis Post vascetomy D141 R152 F144 Z496 C163 Drug of abuse screen Digoxin Epilim - valproic acid Ethanol - alcohol Tacrolimus Lamictin Lithium Paracetamol Phenytoin Sirolimus levels Carbamazepine Overdose drug screen M471 L470 R175 S176 F189 F410 W547 W180 X181 Z183 H482 B812 Bone specic alk. phos. Osteocalcin - on ice Parathormone Vitamin D C-terminal crosslinks fasting R778 E120 G400 X227 R994 Tumour Markers Pharmacology Bone Turnover PSA (+Free PSA if Total 2.6-10) B2 microglobulin Malignant melanoma S-100B CEA PSA - complexed CA 153 - breast CA 125 - ovary PSA only - monitoring CA 199 CA 724 βHCG quantitative B E P E x2 AFP L192 X432 C118 K193 M195 D119 S443 E E E E P E E E E E E E E E C C C C E E E E E E E H100 B117 F121 S100 N288 Autoimmune Andrology Allergy c-ANCA/p-ANCA Rheumatoid factor Auto-immune hepatitis (SM Ab, LKM-1, SLA) Coeliac disease HLA B27 CTD screen Total IgE Food screen (FX5) adult Food screen (FX5) <12yrs Aero-allergen screen (Phadiotop) dsDNA - specic ANA - includes pattern Anti CCP N334 W593 A996 H584 G282 W476 C821 A322 Z424 C256 B254 C255 F884 B B B B B E B B B B B B B B B B B HBV qualitative PCR HBV Viral load - quant PCR HCV Viral load - quant PCR HCV Ab HCV qualitative PCR HCV Genotyping Z352 E395 P140 G305 K561 W487 E E E E E B B B B B B B B S B SP SP * * * * * * * * * * E E * * * * * E E E B B B B B B B B B B U B B B B B B F B S B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B B EB HC BE U 24 U 24 U 24 U 24 E x2 E x2 Inam / Infection Markers CRP PCT B B E475 B139 R900 Porphyrin scr (samples:U, E, F) N150 Immunoglobulins B162 Protein electrophoresis Gamma GT LDH Lactate - on ice Alkaline phosphatase Amylase AST ALT LFT Bilirubin - neonatal (SBR) Bilirubin - total + conj. Liver / Pancreas / GIT Lipid Metabolism Lipogram Cholesterol only Cholesterol / HDL LDL - measured Triglycerides W134 F9 F9 K492 G167 B B B B B B B B B B B B B B FL * Chest pain prole Troponin CK CKMB Ultrasensitive CRP Myoglobin Homocysteine(fasting)(on ice) Pro BNP Heart and Muscle W354 F9 F9 K400 P129 X284 H168 V142 B B E BH B/H B/H BH BH F143 V156 F246 E119 L125 K126 K124 B234 F232 A391 W157 D118 Lipase Aldolase CDT - on ice B B B B U155 Lung, Kidney, Skeleton U & E / Creatinine Magnesium (serum) Magnesium (RBC) Uric acid Protein - 24hr urine Protein / Creatinine ratio Alpha-1 Antitrypsin ACE Urea & Creatinine Calcium Phosphate Creatinine clearance (*Samples:1xB,1x24hr U) Potassium Sodium S130 D394 X158 K228 L171 U247 H685 G121 B B B B B * U E B B B B B A115 K170 A161 F166 M402 J169 U 24 HBA1C / Glycosylated Hb Microalbumin - urine Glucose - fasting Glucose - random GTT 2hr 75g - standard Glucose Metabolism L148 K958 G144 H145 T407 FL FL U E FL X2 B x2 B x2 Status(Prior Expos) Swichboard Numbers 0703061000 020 250 8456 AFFIX BARCODE LABEL HERE LAB NO. Rev: 015 Pathologists Lancet Kenya_PLK www.lancet.co.ke Follow us on Facebook @LancetKenya_plk S199 Thyroid Profile (TSH/FT3/ FT4) B

Form No.: G0070 LAB NO. Universal Request Form

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AFFIX BARCODE LABEL HERE

LAB NO.Form No.: G0070Universal Request Form

Coagulation

Hepatitis Viruses

Haematology HIV

Microbiology

Other Infectious Diseases

HIV ELISAHIV PCR DNA qualitativeCD4 countHIV Viral load - PCRHIV Monitoring (HIV VL + CD4)

HIV Resistance

H455D232G397F401X547R553

F9F9R657K406F432

T895B277F462K178

K861

A617

G914

Y297

S612

Q427

V340

X504

F440

E852

Y343

A189

R169S337

M730

P438B479

W345

C756X296

L407

Microscopy onlyMC&S

TB - Quantiferon gold

Carbapenemase scr. - PCR

CMV AbCMV qualitative PCR (no EDTA)(*samples: CSF, U, E, SP, Tissue, Aspirates)

CMV Viral load PCRU293 Coxsackie Ab

EBV AbEBV Viral load PCR

B300 H.Pylori Ab

Respiratory virus panelPCRRubella AbRSV PCR (*Respiratory swab)

Atypical pneumonia PCR(*samples: Dry swab / Sputum)

Bordetella PCR (Dry swab)

In�uenza PCR(*Respiratory swab / Nasopharyngeal aspirate)

PCP PCR

Malaria speciesgenotyping PCR

Toxoplasma Ab

Tick Bite Fever RickettsiaPCR

CSF Viruses PCR(*Samples:CSF/Saliva/U)

Adenovirus PCR(*samples: E, S, U, CSF, Aspirates)

Genital discharge scr. (no HIV)(*urine, 1 x Urethral or Vaginal swab)

Genital ulcer screen. (no HIV)(*1 xSST, Swab from Ulcer or Urine)

Syphilis serology

Fungal microscopy onlyFungal MC&STB (ZN AFB - micro only)TB AFB/PCR/Culture/Sens

Fungitell assayClostridium dif�cile PCR

*Specimen:

*Site:

Other:

S360Y366

V363X365V386G351H352F396

L019K355P358R359L355M356N357

Hb electrophoresis screenIndirect anti-globulin(indirect coombs)Blood group + RhesusCoombs - directESRFBC / ESR / plateletsFBC / plateletsFlow immunopheno(*Samples:1xE,2xH)

Haemolytic pro�leHb onlyMalaria screenPaul bunnellPlatelet count ReticulocytesWhite cell count + DiffWhite cell count W223

Anti-phospholipid AbD-Dimer - quantitative

FibrinogenFull bleeder screen

DIC screen(*samples:1xE,2xC,1xH)

Inherited thrombophilia(*samples:3xC,2xE,1xE on ice)

Lupus inhibitor(*samples:2xC)

Thrombosis scr. - arterialThrombosis scr. - venous

HAV IgMHAV IgGHBV immunity (sAb)Hepatitis B & C Chronic status

Hepatitis A, B, C

(with common Caucasion mutations)(*samples:3xC,1xB,1xE)

PI / INR

PTT

PI / INR dosage-Fill in MRI no

F373D881

C393BOOK

Z367

BOOK

H445

K325

BOOKT968

E303G385H306H749C301

B369

C370

F402

Limited bleeder screen(Incl. Von willebrands)

General Endocrine

Thyroid

Pregnancy

Hypertension/Neuro Endocrine

X204W203

E349

C560

C164C481

C155W812W437

W965

V202

H260N196

G882

B542

F9 or

F9F9

X227B412

B231E211C209W226

B208

K216

V225Y228

T223Z229P415A307D210K239L217

AldosteroneRenin

Serotonin - on iceChromogranin A5HIAA

VMA + MetanephrineCatechol + Metanephrine

TSHT4

Thyroid AbT3 (free tri-iodothyronine)

Ante natal screen with HIV(*samples:2xE,2xB)Ante natal screen no HIV(*samples:2xE,1xB)βHCG qualitative (Pos / Neg)βHCG quantitative

Hirsutism pro�leTestosterone / FTIDHEA Androstenedione

Infertility screen17-OH Progesterone

FSH

E2Progesterone

LHProlactinAnti-mullerian hormoneACTH - on iceCortisol

Growth hormoneInsulin

Parathyroid hormoneIGF1 + IGFBP3

Gastrin - fastingCortisol - 24hr urine free

FM

Folate - serum + RBC

Nutrition / Iron Studies

FerritinIron pro�le

Soluble transferrin receptorVitamin B12

Routine semen analysis Post vascetomy

D141R152

F144Z496

C163

Drug of abuse screen

DigoxinEpilim - valproic acidEthanol - alcohol

Tacrolimus

LamictinLithiumParacetamolPhenytoinSirolimus levels

CarbamazepineOverdose drug screen

M471L470R175S176F189F410W547W180X181Z183H482B812

Bone speci�c alk. phos.Osteocalcin - on iceParathormoneVitamin D

C-terminal crosslinksfasting

R778

E120G400X227R994

Tumour Markers

Pharmacology

Bone Turnover

PSA (+Free PSA if Total 2.6-10)

B2 microglobulin

Malignant melanomaS-100B

CEA

PSA - complexed

CA 153 - breastCA 125 - ovary

PSA only - monitoring

CA 199CA 724

βHCG quantitativeB

E P

Ex2

AFPL192X432C118K193M195D119S443

EE E

EPE

EEEE

E

E

E

E

C

CC

C

EEEEEEE

H100B117F121S100

N288

Autoimmune

Andrology

Allergy

c-ANCA/p-ANCA

Rheumatoid factor

Auto-immune hepatitis(SM Ab, LKM-1, SLA)Coeliac diseaseHLA B27CTD screen

Total IgE

Food screen (FX5) adultFood screen (FX5) <12yrs

Aero-allergen screen(Phadiotop)

dsDNA - speci�cANA - includes patternAnti CCP

N334W593A996H584G282W476

C821A322Z424

C256B254

C255F884

BBBB

BE

BB

BB

BB

BBBBB

HBV qualitative PCRHBV Viral load - quant PCR

HCV Viral load - quant PCR

HCV AbHCV qualitative PCR

HCV GenotypingZ352

E395P140

G305K561W487 E

E

EEE

B

B

B

B

B

BB

BS

B

SPSP

*

*

*

*

*

*

*

**

*

E

E*

*

*

*

*

E

E

E

B

BB

B

B

B

B

BB

BU

B

B

B

B

B

BFBS

BB

B

B

B

B

B

B

B

BB

BBB

B

B

B

B

B

BB

B

BBB

B

B

BB

B

B

B

B

B

B

B

B

B

EB

HC

BE

U24

U24

U24

U24

Ex2

Ex2

In�am / Infection MarkersCRPPCT

BBE475

B139

R900 Porphyrin scr (samples:U, E, F)

N150 ImmunoglobulinsB162 Protein electrophoresis

Gamma GTLDHLactate - on ice

Alkaline phosphataseAmylase

ASTALT

LFT

Bilirubin - neonatal (SBR)Bilirubin - total + conj.

Liver / Pancreas / GIT

Lipid MetabolismLipogramCholesterol onlyCholesterol / HDLLDL - measuredTriglycerides

W134F9F9K492G167

BBBBB

BB

B

B

BB

B

B

B

FL

*

Chest pain pro�leTroponin CKCKMB

Ultrasensitive CRP

MyoglobinHomocysteine(fasting)(on ice)

Pro BNP

Heart and Muscle

W354

F9

F9K400P129X284

H168V142

BB

E

BH

B/H

B/H

BH

BH

F143V156F246

E119

L125K126

K124

B234F232

A391W157D118

LipaseAldolase

CDT - on iceB

BB

B

U155

Lung, Kidney, SkeletonU & E / Creatinine

Magnesium (serum)Magnesium (RBC)Uric acidProtein - 24hr urineProtein / Creatinine ratioAlpha-1 AntitrypsinACE

Urea & Creatinine

CalciumPhosphate

Creatinine clearance(*Samples:1xB,1x24hr U)PotassiumSodium

S130D394X158K228L171U247H685G121

B

B

B

BB

*

U

E

B

B

BB

B

A115

K170

A161F166

M402

J169

U24

HBA1C / Glycosylated HbMicroalbumin - urine

Glucose - fastingGlucose - randomGTT 2hr 75g - standard

Glucose Metabolism

L148K958

G144H145T407

FLFL

UEFLX2

Bx2

Bx2

Status(Prior Expos)

Swichboard Numbers0703061000020 250 8456

AFFIX BARCODE LABEL HERE

LAB NO. Rev: 015

Pathologists Lancet Kenya_PLK www.lancet.co.ke

Follow us on Facebook

@LancetKenya_plk

S199 Thyroid Profile (TSH/FT3/ FT4)B