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The content of the QML Pathology Reference Manual is provided as current information as at July 2008. Information in this manual may change over time. For the latest information, please refer to the QML Pathology website www.qml.com.au or contact your local QML Pathology laboratory.

Appendices 12.0

Biochemistry 12.1

Common Causes of Abnormal Biochemical Results 12.1 Serum Tumour Markers 12.4 Common Biochemistry Reference Ranges 12.7 Glucose Tolerance Test 12.9 Gestational Diabetes 12.9 Dietary Restrictions and Special Diets 12.10 Qualitative Urine Drug Screen 12.13 Quantitative Drug Assays for Therapeutic Monitoring 12.15 Poisons and Toxic Substances Used in Pest Control 12.18 Acid Base Analysis 12.19 Lipids 12.21

Endocrinology 12.23

Pregnancy Timeline 12.23 Investigation of Hirsutism 12.26 Recommended Age Guidelines for Men’s Health Testing 12.27

Genetics 12.29

Cytogenetic Tests 12.29 Molecular Genetic Tests 12.30

Haematology 12.31

Basic Haematology Parameters 12.31 Leucocyte Reference Ranges 12.31 Initiating Warfarin Therapy 12.32 Range of Target INRs 12.32 Duration of Warfarin Therapy 12.33 Drugs that Interact with Warfarin 12.34

Immunology 12.35

Antibodies to Tissue Antigens (Autoantibodies) 12.35 Antibodies to Microbial and Parasitic Agents 12.36 Arbovirus Screen 12.37 Skin Tests for Allergy 12.37 RAST Allergen List 12.38 Skin Allergen List 12.40

Microbiology 12.41

Infection Control in Medical Consulting Rooms 12.41 Blood Collection, Waste Management, Handling Sharps 12.43 Guidelines for Gloves, Handwashing Protocol 12.44 Clean Up Procedure for Blood and Body Fluids 12.45 Body Fluid Exposure Procedure 12.46 Validation of your Steriliser 12.47 Symbols for Hazardous Categories 12.49

Click on the links below to jump to the required section

Test Listing A-Z 6.0

Test Selection Guide 6.1

Test Listing A-F 7.0

Test Listing G-L 8.0

Test Listing M-R 9.0

Test Listing S-Z 10.0

Contact Details 11.0

Rule 3 Exemption 11.1

Introduction 1.0

Mission Statement 1.1

Company History 1.2

Collection Facilities 2.0

Special Tests 2.13

Collection Centres A-Z 2.1

Collection Materials 4.0

Order of Draw 4.2

Blood Collection Tubes 4.3

Specimen Containers 4.6

Specimen Storage 4.1

Swabs 4.14

Skin Devices 4.16

Additional Services 3.0

Vaccine Service 3.1

Travel Health Service 3.1

Occupational Pathology 3.4

Warfarin Service 3.2

Vetnostics 3.5

Preface 5.0

Departmental Directions on Specimen Collection, Storage and Transport

Genetics 5.25

Haematology 5.31

Histology 5.35

Immunology 5.47

Biochemistry 5.1

Blood Bank 5.9

Cytology 5.11

Endocrinology 5.21

Microbiology 5.51

Full ScreenHome

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http://www.qml.com.au/CollectionCentres.aspx

http://www.qml.com.au/DoctorsDashboard/doctorstravelandvaccinationservice.aspx

http://www.qml.com.au/IamaPatient/PatientCollectionServices/SpecialTestCentres.aspx

http://www.qml.com.au/DoctorsDashboard/doctorswarfarinservice.aspx

http://www.qml.com.au/IamanEmployerOrganisation/EmployerServices/DrugScreening.aspx

http://www.qml.com.au/vetnostics.aspx

ORDER OF DRAW

COLLECTION MATERIALS

SPECIMEN STORAGE• All EDTA blood and blood films in Haematology are stored refrigerated for 1 week.

Blood films showing significant pathology are archived for 1 year.• All Bone Marrow blocks and slides are archived for 14 years.• All sera in Biochemistry, Endocrinology and Haematology are stored refrigerated

for 7 days after collectionNote: Some analytes may deteriorate in this time.• Serum collected for viral, bacterial or parasitic antibody testing is kept frozen for

12 months to follow the course of the illness or to make a diagnosis retrospectively [Immunology (07) 3121 4458 or Branch Laboratory].

• Gram-stained slides and culture plates are kept in Microbiology for 1 week should further sensitivity testing or identification be required.

• Histology tissue specimens are stored for 4 weeks before disposal. Blocks and slides are archived for 14 years.

• All cytology smears and preparations (normal and abnormal) are archived for 14 years.

Specimen Labelling RequirementsPlease ensure all request forms and specimens have correct patient details

Our minimum requirements are:• Surname • Given Names • Date of Birth • Date and time of collection

Please understand that incorrect or insufficient labelling can necessitate a recollection

All tubes MUST be signed by patient or collector to confirm patient identity.

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**If the citrate tube is the only tube to be drawn (or if it is the first tube to be drawn), this tube is acceptable for routine coagulation testing (APTT and PT/INR). For special coagulation testing (e.g. Factor VIII and Heparin Therapy) the citrate tube should not be the first tube drawn. Use of a plain ‘discard’ tube may be considered in this situation.

Vacutainer & Syringe Method

1. Blood culture bottles

2. Pale blue top (Sodium citrate)**

3. Tubes without chemical additive (SST, Red top, Navy top)

4. Green/Orange top (Lithium heparin)

5. Pink/Lavender top (EDTA)

6. ESR (if required)

7. Grey top (Fluoride oxalate)

8. Yellow top (ACD - Acid citrate dextrose)

Paediatric mini container

Paediatric micro container

Yellow rubber top



Aerobic bottle

Anaerobic bottle

Paediatric bottle




Tube MUST be filled to

indicated level

BlOOD COllECTION TUBES

Serum separation tube (SS tube)

(Yellow plastic top)

After clotting, the tube should be centrifuged for 10 minutes and may then be left refrigerated overnight.• Endocrinology tests (Thyroid function tests, FSH, LH, etc.)• E/LFT: including urea, glucose, electrolytes,

liver function tests, cholesterol, triglycerides (lipids)• Autoantibodies (Including antisperm antibodies)• Microbial, parasitic and viral serology

(hepatitis serology, rubella antibodies, etc.)• Pregnancy tests• Paul-Bunnell test• Tumour markers• Iron studies/B12

Plain tube

(Red top)• All drug assays • Vitamin D

Fluoride oxalate tube

(Grey top)• Blood alcohol• Lactate studies• Blood glucose (if a delay in cell separation is unavoidable)

Blood Bank EDTA tube

(Pink top)• Blood group • Rh antibodies• Crossmatch (+ EDTA lavender top)• Group & hold serum (+ EDTA lavender top)• HLA B27 testing• Genetics (some)

Sodium citrate tube

(Pale blue top)Coagulation studies:• Prothrombin time• Thrombophilia tests• Factor assays etc.• INR• APTT• D-Dimer• Fibrinogen.

Acid citrate dextrose - ACD tube

(Yellow rubber top)• HLA tissue typing• Leukaemia marker studies• Lymphocyte studies• Lymphocyte subset analysis• HIV viral load

EDTA tube

(lavender top)• Full blood count: including haemoglobin, white cell count,

platelet count• Red cell folate• Hb EPP• ACTH• Hb A1C• ESR



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SPECIMEN CONTAINERS

Urine for microbiology (MUC M/C/S)After collection of the urine into a sterile container, aspirate the specimen into the Monovette.Transport to the laboratory immediately.If transport to the laboratory is likely to be delayed for more than 12 hours, refrigerate until transport is available.Suprapubic aspirates should be collected into a sterile container and refrigerated if transport to the laboratory is delayed.

Urine collection bottles• Used for timed urine collections.

Patient instructions are written on the bottle.• The bottle should be refrigerated

between collections.• Certain collections may need preservative

(Check A-Z test listing of this Reference Manual).

lithium heparin tube

(Green top, orange top)• Used for a wide variety of tests covering biochemistry,

haematology and genetics• Heavy metals screens• Chromosome analysis

Trace metal tube

(Navy top)Must be centrifuged immediately for 10 minutes.• Zinc• Selenium• Aluminium.

ESR tube• ESR

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24hr urine collection bottleFunnel

8hr urine collection bottle

Sterile container

Yellow monovette

Aptima urine tube• Chlamydia trachomatis• Neisseria gonorrhoeae

Urine drug screen collection kitFor details of use and Chain-of-Custody documentation requirements, see Drug Screening section (5.4) in Biochemistry Preface of this Reference Manual.


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Anaerobic bottle

Aerobic bottle

Paediatric bottle

Faeces container

Blood culture bottles• ADULTS -

take 16-20mL of blood on each occasion and divide evenly into 2 adult culture bottles (aerobic and anaerobic).

• CHILDREN - take 1-3mL of blood on each occasion and place in a paediatric blood culture bottle.

If difficulty is experienced in obtaining blood from some patients, the paediatric blood culture bottle will suffice for adults.

Faeces containerLiquid stools should be examined promptly - please contact the laboratory to arrange pickup.Formed and semi-formed stools should be received by the laboratory within two hours of collection.


Sterile container

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Seminal fluid collectionCollect specimen into a sterile container. This sample needs to reach the laboratory within two hours.

Antibiotic transport mediumSuitable for the transport of all viable tissues.• Genetics (POC, etc.)• Tissue culture• Tissue tumour markers (lymph nodes, etc.)

Histology specimen container

Routine histology tissue and biopsy specimens are placed into 10% formalin for fixation and submitted to the laboratory for paraffin processing.

Skin scrapings containers

Superficial mycoses may infect skin, hair and nails. Skin scrapings from the active edge of the lesion and scrapings from nails, together with clippings of nails and hair, may be placed in a sterile container.The paper envelope may also be used for collecting skin scrapings.If the lesion is exuding material and may be painful to scrape, a swab may be collected as an alternative. Use a dry swab previously moistened with saline to swab the lesion. Place the swab in a container without transport medium.

Nasopharyngeal tubing

Nasopharyngeal aspirate• RSV (Respiratory Syncytial Virus)• Influenza A & B,

Parainfluenza 1, 2, 3, Adenovirus• Bordetella Pertussis PCR

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Single-use Pap smear kitsThree separate kits available:• Cervex brush• Cytobrush• Combination.


Sterile container

EDTA tube

LithiumHeparin tube

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Combination Pap smear

test kit

Cervex brush Pap smear

test kit

Cytobrush Pap smear

test kit

Synovial fluid collection kit

1. Crystals, rheumatoid factor latex, gram stain and culture. Several mL in a sterile screw top (urine) container.

2. Cell count and differential. 1-2mL in lithium heparin (green top) tube to prevent specimen clotting.

3. Protein, albumin and glucose. 1-2mL in a EDTA (lavender top) tube.

CYTOlOGY kITSMonolayer cytology kitAfter preparing a conventional Pap smear, rinse the Cervex brush or preferred collection device thoroughly in the cell preserving solution. Transport the Pap smear in slide carrier and the labelled cell preserving solution to the laboratory.


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SWABSBacteriology transport swab• May be left overnight at room temperature except where

gonorrhoea or anaerobic infection is suspected. In these cases, please contact the laboratory to arrange prompt pick up.

Viral culture transport swab• May be left overnight refrigerated.• Use for routine virology.

Fine needle aspiration kit

The fine needle aspiration kit contains all materials necessary to perform a fine needle aspiration of a lesion by any preferred technique.It comes packaged in a handy rigid transport cylinder which can be utilised to transport the specimen back to the laboratory.

SkIN DEVICESSkin punch biopsy devices

The punch biopsy with internal plunger system allows the lodged skin specimen inside the metal lumen of the punch to be easily ejected. Available in several sizes: • Punch Biopsy with internal plunger available in 2, 3 and 4mm• Punch Biopsy without plunger available in 2, 3, 4, 5, 6 and 8mm.

BIOPBlADE™ The sterile, single-use BIOPBLADE™ is a flexible scalpel used for cutaneous surgery, including: shave biopsy, saucerisation of flat lesions and levelling of pedunculated lesions. The unique design of the BIOPBLADE™ incorporates a comfortable and protective ‘Fingerguard’ in addition to the flexible super sharp blade. This flexibility allows the blade to be positioned at the correct angle for the intended procedure. The BIOPBLADE™ is utilised for removal of lesions, either elevated (shave biopsy) or flat (saucerisation). After the site is anaesthetised, the BIOPBLADE™ is held and ‘bowed’ between the thumb and fingers. The lesion is removed at or just below the surface epithelium. Cosmetic results are normally good and the wound heals without the need for suturing. The Clinician will remove all of the lesion without overly deep penetration to avoid scarring.


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2mm Punch Biopsy with internal plunger

2mm Punch Biopsy without plunger

Aptima Chlamydia trachomatis/Neisseria gonorrhoeae swab for molecular testing• Store at room temperature before and after collection.

Flocked swab (Dry flexible swab)

• Used for PCR and respiratory viruses.

• Store at room temperature before and after collection.

Nasopharyngeal swab (Dry swab)

• Store at room temperature before and after collection.• May be left overnight refrigerated.

5.2

5.1

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When using evacuated blood tubes (vacutainers) for sample collection, it is important to collect biochemistry samples before haematology. If a full vacutainer is collected, a small volume of blood usually refluxes back into the needle during withdrawal of the container.

If haematology is collected first, this blood contains the EDTA anticoagulant and can pass into the next tube attached. If the latter is used for biochemical profile assay, we occasionally note a small but significant fall in calcium and iron. Rarely, a marked suppression of these as well as suppression of alkaline phosphatase may be noted. There is concern that milder artefacts go unrecognised.

Serum Therapeutic Drugs

After administration of a drug, there is an interval between the absorption of the material and its uptake into the tissues within which it is active, during which the serum levels are misleadingly high (because they do not meaningfully reflect end-organ or tissue levels). This interval is known as the distribution phase. Clearly drug levels must be examined after this interval to give most useful information. The exception to this is seen with the antibiotics, in which the peak level itself conveys valuable information relating to bactericidal effect and to risk of toxicity.

Blood Alcohol and other Medico-legal Collections

When blood is collected for possible legal purposes (e.g. to challenge a police breathalyser finding), it is important to first of all obtain samples as close as possible to the time of the initial sampling and then to adequately seal those samples so that the pathologist can certify that no tampering has occurred between collection and testing. An appropriate method of sealing a blood tube is the placement of one QML Pathology bar code label, saddle-like across the top of the tube so that the ends reach approximately a centimetre down the glass, followed by the wrapping of a second label around the body of the tube so that it covers the ends of the first. The patient details are then completed and the collector and patient each sign across the joint of the two labels. The protocol also includes a Chain-of-Custody form which records the legally correct Chain-of-Custody of the specimen from collection to production of a report. This form is to be signed by both donor and collector. Chain-of-Custody forms detail the procedure and are available on request from QML Pathology.

We also strongly recommend that saline or sterile water only be used to cleanse the skin before venepuncture, and not alcohol swabs. Although isopropanol does not cross-react as ethanol in the laboratory assay, the necessity to argue this point in the court setting can lead to the whole collection being discounted.

Plasma Lactate

Lactic acid is the end product of anaerobic metabolism and is elevated in states associated with liver disease, ischaemia, shock and blockade of Kreb’s Citric Acid Cycle. However, it is also the normal product of red cell glycolysis. Hence if blood is collected and allowed to stand at room temperature, red cells will convert glucose to lactate and produce a spurious lactic acidosis (with lowered glucose and bicarbonate, and a raised anion gap and lactate). Examination of the results reveals a pattern that is indistinguishable from a

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Many of the range of close to 1200 tests performed by or arranged through the Biochemistry Department have requirements which, if not recognised and met, may lead to misleading or delayed results. The section below refers only to requirements at the time of collection. Those tests that require pre-test preparation of the patient are listed subsequently.

TEST REQUIREMENTS AT TIME Of COLLECTION

BLOOD, SERUM OR PLASMA TESTS

Arterial or Venous Blood Gases

Blood remains living, actively metabolising tissue after collection and unless measures are taken to slow or halt metabolic activity, misleading results will be obtained. It is important that blood collected for oxygenation and pH studies should be cooled on ice or cold packs as soon as possible (within 20 minutes) after collection or an artefactual metabolic acidosis (low pH and bicarbonate, with raised negative base excess) may ensue from red cell generation of lactic acid from glucose. A slower process, white cell aerobic metabolism leading to a slow fall of pO2 and a rise of pCO2 with apparent respiratory acidosis will further complicate interpretation.

Serum Electrolytes, Glucose, Enzymes and Phosphate

A living cell maintains a steep electrolyte gradient across the cell membrane with high extracellular sodium and chloride, and high intracellular potassium concentrations. In contrast, intracellular sodium and chloride and extracellular potassium concentrations are around 5% of the corresponding transmembrane levels. The maintenance of these gradients is an active process, requiring plentiful ATP. If blood is stored at room temperature, glucose is consumed (metabolised to lactic acid) to maintain the membrane gradients. This is accompanied by a fall of bicarbonate to <10 mmol/L. When the sample glucose falls to <2 mmol/L, cellular metabolism fails and electrolyte leakage occurs. Plasma sodium falls sequentially to as low as 80-90 mmol/L, chloride to 60-70 mmol/L, and potassium rises to as high as 15-20 mmol/L. Lactate dehydrogenase (LD/LDH) and aspartate transaminase (AST) escape and may elevate the plasma level to 4-5 times the upper limit of normal. Intracellular phosphate also escapes with the shutdown of glycolysis and may elevate the plasma phosphate to 4-5 mmol/L.

The only way to prevent this sequence of events is to centrifuge and separate the serum/plasma from the cell mass, preferably within 20 minutes of collection into a serum separation tube (SS tube), plain tube or other tube. The gel plug of the SS tube separates cells from serum. With other tubes it is advisable to decant the supernatant serum/plasma into a sterile plain tube(s) for storage. This should be stored refrigerated. Collection of the sample into fluoride oxalate preservative or refrigeration of the sample eliminates the loss of glucose and maintains a normal anion gap but other changes proceed.

5.4

5.3

true pathological lactic acidosis. To guard against this, it is necessary to centrifuge the blood within 20 minutes of collection and separate the cells from the plasma/serum. A serum separation tube (SS tube) allows this without decanting the serum. Alternatively, collection into a fluoride oxalate preservative tube inhibits metabolism such that physical separation may be deferred until the sample reaches the laboratory. Cooling the sample to refrigerator temperature also partially achieves this end but at the expense of meaningful electrolytes (see previous page).

Plasma Very Long Chain fatty Acids and Phytanic Acid

VLCFA are performed in the diagnosis of adreno-leucodystrophy, Refsum’s Disease, Zellweger’s Syndrome and related abnormalities of cellular peroxisomal function. Phytanic acid is relatively more specific to Zellweger’s Syndrome. Both of these tests are referred to Royal Brisbane Hospital for analysis. In all laboratory analyses, some clinical details are valuable in case extra testing or additional tests are indicated. However, with these tests the referral laboratory will not commence the analyses unless adequate clinical details are supplied with the sample. So as to avoid undue delay, please write appropriate clinical details on the request form.

Neonatal Screen (Heel Skin-Prick Blood)

In Queensland, the routine neonatal screen includes tests for phenylketonuria, hypothyroidism, galactosaemia and cystic fibrosis. The tests are routinely performed on paper discs punched from a standard filter paper card. Assume even application of the infant’s blood onto marked areas of the card. Uneven application, particularly reapplication onto areas previously dried may lead to falsely high results and hence potential risks of false alarms for all of the tests. If a card is not available, blood may be collected into an EDTA or Lithium heparin tube and the application to the card made in the laboratory before transfer to the screening laboratory.

Plasma Ammonia

Ammonia cannot be meaningfully assayed on skin-prick blood because the high sweat ammonia level always leads to marked false elevation of the apparent blood level from contamination.

Trace and Toxic Elements from Skin-Prick Blood

Rigorous attention to skin cleansing is always essential before collection as contamination from material on the surface of the skin can produce marked elevation.

URINE TESTS

Urinary Porphobilinogen (PBG)

A raised PBG excretion in a stat urine collection taken during a symptomatic episode is a key finding in the diagnosis of an acute porphyria (Acute Intermittent Porphyria, Hereditary Coproporphyria, or Variegate Porphyria). However, PBG is quite unstable and the sample must be refrigerated and protected from light (wrapped in foil or brown paper), as well as tested as soon as possible after collection.

Urinary Catecholamines and VMA

Epinephrine (adrenaline), norepinephrine (noradrenaline), dopamine and their metabolites vanillylmandelic acid (VMA, 4-hydroxy-3-methoxymandelic acid, HMMA), and homovanillic acid (HVA) are the key elements in the diagnosis of phaeochromocytoma and childhood neuroblastoma and ganglioneuroma. The metanephrines have declined in popularity with improvements in the former assays. Current assays are not susceptible to interference from dietary vanillin. However, mild pathophysiological elevation of excretion in response to illness, injury, psychiatric agitation and to fluctuations in blood pressure is common. Particularly difficult are the often marked elevations of excretion in response to commencement or dose increases of antihypertensive therapy; increases which may persist for 1 - 2 weeks while a new steady state is achieved. In the case of newly diagnosed or suddenly deteriorating hypertension, the ideal would be to collect a single 24 hour urine sample before changing therapy. Plasma catecholamines are available but their diagnostic value as a screen is not as clear (because of rapid elevation before or during venepuncture). Dihydroxyphenylglycol assay is also available but again this is not as attractive as a first line test because it has a turnaround time of several weeks.

24 hour urinary catecholamines must be collected into acid preservative (or if collected as a stat or random collection, the sample must be kept refrigerated until acidified in the laboratory). Please refer to the specific test in the A-Z listing for full collection details.

Urinary Drug Screen for Overdose

Please notify the laboratory and seal samples as described under ‘blood alcohol and other medico-legal collections’ (5.2) if foul play or potentially lethal toxicity is suspected. Clearly, there may be medico-legal implications.

Urine Drug Screen for Industry, Occupational and Drugs of Abuse

This test is probably the one most likely to give misleading results as a direct result of deliberate interference with the collection by the patient. Substitution with urine from another, dilution with tap or toilet water or saliva, oral water loading to dilute urine, consumption of other substances in an attempt to mask drug findings and addition of chemicals to the urine to attempt to breakdown urinary drug metabolites are common occurrences among the group of patients who find themselves required to undergo this testing. Supervision of the collection and sealing of the sample is essential. The QML Pathology protocol complies with Australian/New Zealand Standard AS/NZS4308. The protocol includes a specifically designed tamper-evident urine specimen bottle, a procedure designed to ensure collection of a truly representative sample of urine from an identified patient, and documentation that is signed by the donor and collector and that records the legally correct Chain-of-Custody of the specimen from collection to production of a report. Chain-of-Custody forms detail the procedure and are available on request from QML Pathology. Please refer to the Biochemistry Appendix (12.13) for a full list of drugs assayed.


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5.5

fAECES TESTSNOTE: faeces has a proportionally huge bacterial load and their continuing metabolism may significantly alter the faecal biochemical profile.

WITH ALL biochemical faecal tests, it is essential that the sample be refrigerated or frozen as soon as possible after collection.

faecal Analysis for Reducing Substances and Sugar Chromatography

When testing for sugar/lactose intolerance, it is advisable to ascertain that the child has not commenced a lactose-free diet. Parents have been known to commence treatment before firm diagnosis, and this will certainly produce a false negative (normal) result.

NOTE: It is the fluid component of the faeces specimen that is required for testing. Use of a non-absorbing liner such as ‘Glad Wrap’ to prevent absorption by the baby’s nappy when collecting a specimen is advised.

faecal fat Analysis

Refrigerated sample storage is very important (see above). Fly larvae (maggots), an occasional finding in the laboratory, may both consume malabsorbed triglyceride and produce their own. Nappy liners must not be used during collection. The patient must be taking an adequate diet not excluding fat or a falsely normal test will result.

faecal Porphyrin Excretion

In addition to standard sample-handling procedures, it is essential that the patient should avoid contamination of the collection with urine. The high urinary uroporphyrin and coproporphyrin will falsely elevate the total and mask the characteristic faecal pattern.

faecal Alpha-1-Antitrypsin Analysis

Alpha-1-antitrypsin is used as the marker of choice for the detection of enteric protein-losing states, not because of any unique handling of this protein but simply because it is relatively resistant to bacterial degradation. However, the sample must be refrigerated as soon as possible after collection.

faecal Pancreatic Elastase-1 (PE1)

The faecal elastase-1 concentration reflects the secretory capacity of the pancreas. That is, the diagnosis or exclusion of pancreatic exocrine insufficiency. The concentration of PE1 may be lowered in very watery stool samples. Formed stool samples are the preferred sample. Samples should be frozen ASAP.

CSf TESTS

Cerebrospinal fluid Protein

Rarely, we receive CSF which has been contaminated with myelogram contrast material. This results in a false elevation of the assayed protein level which may be marked (e.g. up to 20 g/L {R.R 0.4 g/L}). If there is any suspicion of this, the situation can be rapidly clarified with CSF albumin assay.

SWEAT TESTS

Sweat Electrolytes

Only under exceptional circumstances will the clinician collect sweat samples. We strongly support this - the collection is too difficult unless performed by trained and experienced staff. However, should a collection be unavoidable, it is essential that any evaporative loss must be avoided as it leads to false elevation of electrolytes and, potentially, misdiagnosis of Cystic Fibrosis.

SALIVA TESTS

Salivary Screen for Drugs of Abuse

This test requires 10 mL of saliva in a sterile screw top (urine) container. Collection must be supervised as described for urine.

HAIR AND/OR NAILS TESTS

Hair or Nail Analysis for Toxic Elements

Hair or nails must be thoroughly cleaned without shampoo, soap or detergents before collection. Because maximal deposition takes place in the keratin being laid down while the metal level is maximal in soft tissue, nail can detect exposure 4 to 8 months previously and hair 2 to 6 months previously (depending on the length).

Quantity of material for analysis:

Hair - A packed matchbox

Nail - As much as possible from fingers and toes. Clearly, if exposure is very recent, i.e. of the order of weeks, blood or urine testing may be more appropriate.

STOMACH CONTENTS/VOMITUS TESTS

Vomitus Analysis for Drugs in Suspected Overdose

In addition to standard requirements of refrigeration to stabilise the sample both chemically and microbiologically, it is essential that any suspicions of possible exposure should be noted on the request form. This is to expedite testing the more likely drug classes. If there is any possibility of medico-legal implications, this should be noted on the request form and the sample should be sealed as described for blood alcohol.


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5.8

5.7

BREAST MILK TESTS

Breast Milk Analysis for Nutritional Qualities

In cases of maternal concern, we occasionally test breast milk for glucose, lactose, lipid and protein content. Because the sample is invariably contaminated during collection, it must be refrigerated promptly until arrival at the laboratory.

DETECTION AND IDENTIfICATION Of SNAKE VENOM IN SUSPECTED SNAKE BITEThe most appropriate and preferred sample for testing is snake venom from the site of the bite. Moisten a cotton swab or cotton bud with saline or tap water and swab the site of the puncture wound(s). A small piece of clothing cut from the bite site may also be taken if appropriate. The swab(s) and the cloth sample should be placed in a labelled dry sterile screw top container (microurine container) - one sample per jar. Please contact the laboratory and forward the specimen as soon as possible.

Urine collected in a sterile screw top container and blood collected in a Lithium Heparin tube may also be tested, however, the swab and/or cloth from the bite site(s) are the preferred samples.

The service is available on an urgent basis 24 hours per day.

TESTS REQUIRING PRE-TEST PATIENT PREPARATION• Breath hydrogen analysis

(general fasting instructions and no smoking one hour prior to test)

• Cholesterol and triglycerides (may require fasting if directed by doctor)

• Glucose tolerance test

• 5-Hydroxyindoleacetic Acid (5-H.I.A.A.)

• Water deprivation test

Details of preparation for these tests can be found by referring to the A-Z test listing and the Dietary Section (12.10) of the Biochemistry Appendix.

Printed instruction forms for patient preparation for these tests are available on request from QML Pathology Collection Centres, QML Pathology Brisbane Liaison Services (07) 3121 4943 or your local Branch Laboratory.


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5.105.9

PREFACE - blood bAnk

HOMOLOGOUS BLOOD TRANSfUSION SERVICEQML Pathology provides a Cross Match Service for elective surgery using homologous random donor blood provided through the Australian Red Cross Blood Service.

AUTOLOGOUS BLOOD TRANSfUSION SERVICEQML Pathology offers an Autologous Blood Donation Program for patients desiring an alternative to homologous random donor blood provided through the Australian Red Cross Blood Transfusion Service. There are many recognised advantages for autologous transfusion in selected patients undergoing elective surgical procedures, including the elimination of serological incompatibility and transfusion acquired HIV and Hepatitis infection.

Patients who are excluded by the Red Cross guidelines may be acceptable for autologous blood collection by QML Pathology. The referring practitioner must indicate that in his/her opinion the patient’s physical condition will permit venesections to be performed safely. It is emphasised that initiation of the collection request should allow sufficient time for clinical review, an achievable collection plan for the desired number of autologous donations and coordination of iron supplement therapy where directed by the QML Pathologist.

If autologous blood collection is desired, the following important information should be noted:

1. Prior to venesection it is requested that basic testing (full blood count, blood group and antibody screen) be performed to ensure there is no haematological contraindication to the procedure. All autologous units collected will be screened for Syphilis, Hepatitis B and C, HTLV-1 and HIV by QML Pathology. This is in accordance with the recommendations by NATA/RCPA Accreditation Authority and the Australian New Zealand Society for Blood Transfusion. Referring doctors should advise their patients accordingly.

2. Blood donations are collected into CPD-Adenine anticoagulant and have a shelf life of approximately 35 days. Donations are collected at weekly intervals for a maximum of four donations, and preferably no venesections are performed in the week prior to surgery. The expected fall in haemoglobin for an average adult male is approximately 10 gm per litre per donation (the fall will be somewhat greater in females). A check haemoglobin is therefore performed prior to each venesection. Patients are usually placed on an oral iron supplementation (Ferrous Sulphate - 350 mg -1 tablet twice daily prior to their procedure) by the QML Pathologist.

3. On admission to hospital, a specimen is collected for Cross Match and Antibody Screening. Although the patient is to receive autologous blood it is essential for safety and medico-legal reasons (clerical errors, etc.) that compatibility tests be performed. Secondly, the autologous collection procedure is only performed on the proviso that if additional blood is required beyond the autologous reserve the patient will accept homologous (Red Cross) blood. Should this prove necessary the laboratory will have a stored cross match specimen available and there will be no additional fee applicable for cross matching the homologous blood.

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bAnk Requests for autologous transfusion should be written on the special QML Pathology

form and be accompanied by request forms for:

1. Serology for Syphilis, Hepatitis B and C, HTLV-1 and HIV

2. Hb, Antibody Screen and Cross Match.

Pre-printed request forms for collection of autologous donations by QML Pathology and the patient information brochure ‘Autologous Blood Donations’ are available on request from QML Pathology Collection Centres, QML Pathology Brisbane Liaison Services (07) 3121 4943 or your local Branch Laboratory.

For further details please contact QML Pathology Blood Bank (07) 3876 8371 or your local Branch Laboratory. PR

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5.12

5.11

PREFACE - Cytology

SPECIMEN COLLECTION fOR GYNAECOLOGICAL CYTOLOGYMost cervical cancers and precancers arise in the transformation zone – that is, where everted endocervical epithelium comes to be replaced by metaplastic squamous epithelium. Therefore, it is crucial that this area is well visualised and adequately sampled. The location of the transformation zone may vary depending on a woman’s age and menstrual history.

The use of the modified Ayre’s spatula or Cervex sampler is adequate in most instances. A cytobrush may be used when the transformation zone is located further up the endocervical canal, as is the case in post-menopausal women.

Preparation

• Label frosted-ended glass slides with the patient’s name and date of birth using a pencil.

• Complete the request form including the patient’s name, date of birth, date of last menstrual period and other relevant clinical information e.g. pregnant, post natal, post menopausal, use of hormones, presence of IUD.

• Record any high risk factors including prior treatment for CIN, abnormal cervical appearance, presence of contact or post coital bleeding.

• Check whether the patient wishes her name to be withheld from the Pap Smear Register. If there is no indication on the form the result details will automatically be sent to the register.

Collection

• After introduction of a vaginal speculum and proper visualisation of the cervix, gently rotate the spatula 360˚ about its axis to ensure sampling of the entire transformation zone. If a Cervex sampler is used, rotate through 360˚, three times in both clockwise and anticlockwise directions. Press the outer bristles of the brush firmly against the ectocervix.

• If using a cytobrush in conjunction with the spatula, perform this sampling after an ectocervix specimen has been collected to avoid contamination by blood. Avoid inserting the cytobrush too far into the os, in order to minimise sampling of the lower uterine segment. Some bristles should still be visible. Rotate the brush twice (180˚).

• It is advisable not to use the cytobrush if the patient is pregnant.

Preparing and fixing the Sample onto the Slide

• Transfer the sample onto the slide using a painting action, with just enough pressure to ensure cell transfer. This is best achieved by smearing the spatula or Cervex sampler, or by rolling the brush.

• Fix the smear quickly to prevent air drying by spraying with Cytospray at a distance of 15-20cm from the slide. Alternatively immerse the slide immediately in 95% ethanol for 15 minutes.

• Leave the slide to dry for 15 minutes and place into the plastic slide carrier provided. Place the carrier along with the patient request form into a plastic specimen bag.

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Cervex SamplerSpatula & Cytobrush

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5.13

PREFACE - Cytology

ThinPrep Specimens and HPV Testing

• The ThinPrep Imaging System utilises cells harvested from the collection device by rinsing into a preservative fluid.

• HPV DNA Testing for high risk HPV types can also be performed from the ThinPrep vial.

• It is desirable when collecting a liquid-based sample to use either a cervex sampler or a plastic spatula. A wooden spatula is not recommended as cells tend to stick to the wood and are not easily released into solution.

• Prepare the conventional slide and rinse the device(s) in the PreservCyt solution. Push the Cervex brush into the bottom of the vial and twirl vigorously to ensure as much cellular material as possible is released in the solution.

• Discard the collection device after rinsing.

• Replace the PreservCyt cap and tighten so that the small black mark passes the corresponding line on the vial.

• Label the vial with the patient name and date of birth, and place into the plastic specimen bag along with the conventional smear and completed request form.

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gyPAP SMEAR COLLECTION KITSQML Pathology supplies various collection kits for cervical smears which are conveniently packaged to suit different clinical indications.

Single Use Pap Smear Kits: May be left overnight at room temperature after fixing. These kits are suitable for conventional Pap smears and ThinPrep.

Monolayer Cytology:

After preparing a conventional Pap smear, rinse the cervex brush or preferred collection device thoroughly in the cell preserving solution. Transport the labelled Pap smear in slide carrier, and labelled cell preserving solution to the laboratory.

Cervex Pap smear test kit Cytobrush Pap smear test kit

Combination Pap smear test kit

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5.15

PREFACE - Cytology

NIPPLE DISCHARGE• Label slide/s with a pencil.

• Gently squeeze the nipple until fluid appears.

• Smear the fluid directly onto the glass slide.

• Fix the slide immediately.

• Allow slides to dry.

• Send to the laboratory - in a slide carrier with the request form.

fLUIDS

Sputum

• Collect deep cough early morning specimens preferably on three consecutive days. Instruct the patient to collect specimens before breakfast preferably after rinsing out the mouth.

• Collect each specimen in a sterile container. Use one container for each collection.

• Label the specimen container and send each one to the laboratory as soon as possible or

• Refrigerate if a delay in sending the specimen is anticipated.

Note: Please specify X 3 sputum collection on consecutive days on request form.

Urine

• Urine may be collected as a random specimen or as a series of three specimens preferably on consecutive days.

• Collect the first part, or all (not mid stream) of the second or later void of the day. The first void contains cells which have been sitting in urine for hours and will show degenerative changes.

• Collect the urine in a sterile container.

• Label the specimen container and send it to the laboratory as soon as possible or

• Refrigerate if a delay in sending the specimen is anticipated (Do not add any fixative).

Note: Please specify X 3 urine collection on consecutive days on request form.

Cerebrospinal fluid - CSf

• Collect the CSF in a sterile dry container.

• Label the specimen container, mark the request form as urgent and send to the laboratory as soon as possible or


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• Collect in a sterile dry container of appropriate size.

• The entire effusion specimen should be submitted.

• Label the specimen container and send to the laboratory as soon as possible or


• If Lymphoma is suspected then immediate transportation to the laboratory should be arranged.

• Consider requesting fluid protein examination.

Transudates have a protein content of <3.0 g/dL and a specific gravity of <1.015. Exudates have higher protein and specific gravity, and are more likely to be inflammatory or neoplastic.

fINE NEEDLE ASPIRATION CYTOLOGY

Scope for Use

Fine needle aspiration (FNA) is a branch of diagnostic cytology that interprets changes in cells extracted from within organs, tumours and non-neoplastic abnormal tissues.

FNA contrasts with exfoliative cytology, which studies cells shed or scraped from surface epithelia or mesothelia. The diagnostic criteria of both branches have many common features as well as many important differences.

Just as FNA is an extension of morphologic diagnosis within both diagnostic cytology and histology, it is also a useful tool for the oncologist who deals with undiagnosed palpable and non palpable masses and lesions. It is a short cut to direct diagnosis and can be carried out at the surgery, clinic or bedside. It may also obviate the need for radiographic and surgical procedures, and save time, expenses and morbidity, and allay anxiety.

The common targets currently being aspirated are thyroid, liver, breast and lung. Multiple sites of cyst formation are easily aspirated. These include breast, thyroid gland, parotid gland, branchial cysts and cavitating squamous cell carcinoma. Aspiration of cysts can be both diagnostic and therapeutic.

Basic Equipment

• Syringe pistol (now commercially available - but not essential).

• 10/20 mL disposable plastic syringe - can be used without a syringe pistol. Apply negative pressure by pulling on the piston in the usual way.

• Plastic extension tubing.

• Fine needles of 25-20 gauge varying from 1cm to 20cm in length (23 gauge needles are used for most aspirations of palpable lumps).

• Alcohol prep sponges.

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5.18

5.17

PREFACE - Cytology

• Sterile gauze pads.

• Microscope glass slides with frosted ends (label with pencil).

• Suitable spray fixative (Cytofix) or a coplin jar of 95% ethyl alcohol, to hold glass slides for immediate fixation of wet smears.

• 2 mL jars of sterile normal saline.

• Transport cylinders for recapped, secured, labelled needles and syringes.

NOTE: QML Pathology can supply the necessary equipment and materials contained in a handy rigid transport cylinder kit on request (illustrated in Collection Materials Section (4.13) of this Manual).

A small plastic tray easily holds all the equipment as well as longer needles measuring 15cm and 20cm, employed for transthoracic and transabdominal aspirations. Local anaesthesia, 1% or 2% lignocaine (Xylocaine), may be required for needle aspiration of transthoracic or transabdominal masses, but it is rarely necessary for other clinically palpable lumps. Since FNA is virtually non-traumatic, it may be repeated frequently enough to procure adequate amounts of material for diagnostic purposes.

NOTE: If an immediate diagnosis is required with FNA biopsy, attendance by a pathologist at the procedure can be arranged with prior notification to the laboratory.

Aspiration Techniques

There are 3 routine methods of aspiration for palpable masses:

1. Apply negative pressure for aspiration using a 10 or 20 mL syringe attached to a 25 or 23G needle by a flexible plastic extension tube (Diagram A)

2. Apply negative pressure for aspiration using a 20 mL syringe in a syringe pistol (Diagram B)

3. Using a needle alone (no syringe), substitute a negative pressure with capillary action only (Diagram C).

Our preferred method is (1). Note that QML Pathology FNA kits contain flexible plastic extension tubing. This method has the advantage of allowing greater sensitivity and accuracy in placement of the needle. A disadvantage is that an assistant is required to hold the syringe and to pull back on the syringe. This is, however, a simple procedure - once the needle is in position in the lump, indicate for the assistant to draw the syringe plunger back (8 mLs in a 10 mL syringe and 15 mLs in a 20 mL syringe); then, on completion, allow the plunger to return over 1-2 seconds before withdrawing the needle from the tissue.

Method (2) using a syringe pistol has the advantage that only one operator is required, BUT we have found it to be clumsy.

Method (3) (no syringe - using needle only - repeatedly rapidly inserted into and withdrawn from the lesion inducing cells into the bore of the needle by capillary action) is preferred in many centres but is not appropriate for cysts and has not, in our hands, produced consistently good material.

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Diagram A

Insert needle into mass

Apply suction

Move needle back and forth in slightlydifferent directions through mass

Release suction, then withdraw slowly D

C

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Diagram B

mass

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Syringe pistol Standard syringe

Diagram C

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Diagram A


Apply suction



C

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Diagram B

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Diagram C

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Diagram A


Apply suction



C

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5.19

• One smear should be immediately fixed (in 95% ethyl alcohol or spray fixed), the other allowed to air dry.

NOTE: It is very important when using spray fixatives to avoid holding the can closer than 15cm from the slide.

Place labelled smears in slide carriers for transport to laboratory.

2. Preservation of Aspirated Material

Residual material always remains in the needle after smear preparation. On the other hand it may not always be possible or desirable to prepare a smear in the clinic or at the bedside. This material may be preserved and transported as outlined below.

i. Syringes and Needles

Syringes and needles used in preparation of smears should not be discarded following preparation of smears. Rinse material remaining in needle and syringe into a labelled 2 mL jar containing normal saline and send to laboratory where cells will be retrieved by centrifugation and/or filter techniques. The syringe and needle may now be discarded.

ii. fluid or Bloody Aspirates

Where specimens are diluted by fluid or blood, or for specimens which are largely fluid e.g. cyst fluid obtained from breast or thyroid, immediate despatch of the carefully recapped, labelled needle and syringe with contents to the laboratory is recommended. The cap should be secured, syringe labelled and placed in a transport cylinder. This should be forwarded to the laboratory in an insulated container with ice brick as soon as possible. Standard cytologic filter and centrifuged preparations can then be prepared in the laboratory. Rinsings are preferable.

Transport of fNA to the Laboratory

• Preparation of smears and rinsing of syringe and needle into saline as described above in ‘handling of specimens’.

• Labelled smears should be placed into slide carriers.

• Store the labelled saline specimens in a refrigerator (crisper bin area).

• Transport specimen to laboratory in a rigid transport cylinder, placed in a cooled (ice brick) insulated container as soon as possible.

NOTE: QML Pathology can supply the necessary equipment and materials on request.

PREFACE - Cytology

For all of these techniques, the basic procedure is as follows:

• Thoroughly palpate the target area and delineate the most suspicious, usually the most firm portion

• Fix the mass with the palpating hand

• Prepare the skin with an alcohol swab, alcoholic chlorhexidine or povidone iodine

• Introduce the needle into the mass.

In the case of the vacuum assisted technique:

• Application of full vacuum to the syringe with needle in the mass

• Continuously apply full suction to the aspirating syringe while the needle is moved back and forth with short quick strokes and in slightly different directions. (The variation in needle direction has been greatly exaggerated in the illustration.) This alteration in direction should be fairly minimal in practice, and, coupled with the forward and backward motion, is carried out within the mass

• Cease aspiration when material enters the transparent hub of the needle

• Release suction before withdrawing the needle, and then apply pressure to the puncture site with the patient’s or nurse’s assistance.

In the case of the needle-only technique:

• Rapidly and repeatedly insert the needle into and withdraw it from the lesion inducing the cells into the bore of the needle by capillary action

• Cease when material is seen to enter the hub of the needle and slowly and gently withdraw

• To make smear preparations, attach a syringe - with the plunger drawn back a few mL - to the needle and proceed as outlined below.

HANDLING Of SPECIMENS

1. Preparation of Smears

Making the smear is critical because it determines the quality of the material the microscopist will examine. In practical terms, it may be the most important manoeuvre in the whole range of steps in the aspiration.

• Rapidly separate the needle containing the aspirated material from the syringe and draw a few mL of air into the syringe.

• Reattach the needle to the syringe.

• Express the material onto a glass slide, generally forming a drop or droplets with small particles of tissue. Care must be taken to place the bevel of the needle against the slide so there are no intervening air gaps allowing the material to splatter across the slide.

• Place a second glass slide on top and pull both slides rapidly apart (see diagram above right).

• Two slides (smears) are thus prepared from each drop.

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Diagram A


Apply suction



C

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Diagram B

mass

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Diagram C

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Diagram A


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Diagram C

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5.21

PREFACE - EndoCRinology

The Endocrinology Department is located in the Brisbane Central Laboratory of QML Pathology. The activities of this laboratory involve measurement of a range of over 30 low-level concentration substances using sensitive Immunoassay technologies.

Substances measured include:

• Hormones

• Tumour markers

• Special proteins.

The specific laboratory tests performed by the Endocrinology Department are listed alphabetically in the A-Z test listing (6.0) of this Reference Manual. This listing will include alternative names for tests, instructions for collection including the specified container, storage and transport, any special requirements and an indication of turnaround time of results.

SPECIMEN COLLECTIONIn general serum from clotted blood is the preferred specimen (SS tube - yellow top tube). Usually 1 mL of blood is adequate per test. After collection the specimen should be kept cool (refrigerated) and transported to the laboratory in an insulated container with ice bricks (except Renin which should remain at room temperature).

Any variation from this routine collection procedure will be specified in the comment section of the alphabetical listing for the particular test.

SPECIMEN PROCESSING

freezing Serum

Due to the instability of some hormones the serum may need to be frozen prior to transport to the laboratory. This may be particularly important for rural and remote regions where transportation time is prolonged. This requirement will be indicated in the comment section for any particular test. 20 minutes after collection into an SS tube (Yellow top tube) the completely clotted specimen should be centrifuged to separate the serum from the cells. The serum should be decanted into labelled plain 5 mL plastic screw cap container(s). This may be frozen by placing in the freezer compartment of a refrigerator. The frozen specimen should be transported to the nearest Branch Laboratory or directly to the central laboratory in Brisbane in an insulated container with dry ice. If dry ice is unavailable please contact the Branch Laboratory or Endocrinology Department (07 3121 4439) for assistance.

Snap freezing Serum

The procedures outlined above are adequate for most specimens. However, for Renin Assay the specimen should be collected in EDTA tubes. It is then centrifuged at room temperature; the serum decanted into labelled plain 5 mL plastic screw cap container(s) and snap frozen within one hour of collection.

To Snap freeze - pour alcohol (ethanol, methylated spirits, methanol) into a beaker to a depth of 4 cm. Drop 3 or 4 small pieces of dry ice into the alcohol. The addition of the dry

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temperature to the desired level. The tubes containing the separated serum are placed upright in the alcohol (taking care not to contaminate the contents with the alcohol) and will freeze immediately. The frozen specimens can then be transferred to and stored within the freezing compartment of a standard refrigerator. The frozen specimen should be transported in an insulated container with dry ice to the laboratory.

Note: Slow freezing of Renin specimens by placing in a standard freezer without the snap freezing procedure will cause falsely high values as Renin is activated by cold temperatures.

Reporting Time

This varies from same day - 24 hours for the majority of assays (e.g. thyroid function studies, pregnancy-related tests) - to days and weeks for less commonly required assays (e.g. aldosterone). These are specified for the individual tests in the A-Z list (6.0).

fERTILITY TESTING AND CYCLE TRACKINGThe object of testing is to detect when and whether ovulation is occurring or whether there is any follicular response or an excessive follicular response to any follicular stimulation protocols being used in assisted fertility programs. The following tests are available:

1. Is ovulation occurring - Weekly progesterones

2. Precise timing of ovulation - Daily LH/Progesterone levels in late follicular phase of the menstrual cycle

3. Follicular response to stimulation protocol - Oestradiol levels during stimulation

4. Investigation of possible androgen excess - LH/FSH ratio, Oestradiol and Androgens.

If you have a requirement for this service please contact the Endocrinology Department (07) 3121 4439 or the nearest Branch Laboratory and this can be arranged. With prior notice results for Oestrogen, Progesterone, LH and FSH assays can be available 90 minutes after arrival of the specimen in our Brisbane Central Laboratory, and selected Branch Laboratories.

HELICOBACTER PYLORI CARBON-14 UREA BREATH TESTThis test involves ingestion of low dose carbon-14 labelled urea and measurement of carbon-14 labelled CO2, in expired air, released by the enzyme urease produced by Helicobacter pylori.

It is preferred for the patient to fast before the test, but not necessary. The dose is swallowed (-tasteless in water) and mouth is rinsed, 20 minutes later, a breath sample is collected in a glass vial containing a CO2 trapping liquid.

The glass vial is identified by name, sealed, placed in a plastic bag and transported to the laboratory where the activity of the trapped labelled CO2 is measured.

Please contact Brisbane QML Pathology Collection Department (07) 3121 4450 or your local Branch Laboratory for details of collection centres equipped to perform this test.

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5.23

PREFACE - EndoCRinology

THYROID fUNCTION TESTSA full thyroid function test incorporates a TSH assay and a Free T4 assay. The current Medicare schedule will provide a rebate for TSH only as a preliminary test. A full thyroid function test (TSH and Free T4 assay) will be rebated if at least one of the following conditions is satisfied:

1. The patient has an abnormal level of TSH

2. The tests are performed for the purpose of: i. Monitoring thyroid disease in the patient; or ii. If the patient is in hospital - investigating the sick euthyroid syndrome; or iii. Investigating Dementia or psychiatric illness of the patient; or iv. Investigating Amenorrhoea or infertility of the patient.

3. The treating practitioner suspects the patient has Pituitary Dysfunction

4. The patient is taking drugs that interfere with thyroid hormone metabolism or function (e.g. Lithium, Amiodarone).

To assist the laboratory, when requesting thyroid function tests, please supply a comprehensive history, including medication, so that the correct range of tests may be performed.

Patient History

Please supply relevant clinical history, details of medication or hormone therapies and the results of any relevant previous investigations which may have been carried out. Such details are important in the interpretation of serum levels. Even factors such as the time of day and stage of the menstrual cycle may be important in the interpretation of levels. This will assist in the provision of appropriate comments on the report.

SPECIMEN STORAGESamples are kept within the laboratory for one week, should further testing or comparative testing become necessary. The key to referencing the sample is the quote number printed in the lower right hand corner of the pathology report. If this is unavailable patient name and date of birth will suffice.

The Endocrinology Department is staffed routinely 6.00am to 1.00am Monday to Friday, and 8.00am to 7.00pm Saturday. For advice on any aspect please contact the Endocrinology Department (07) 3121 4439 or the nearest Branch Laboratory.

Brisbane Endocrinology Department Direct

Telephone Numbers

Pathologist Dr Kerry DeVoss (07) 3121 4412

Manager Mark Blakey (07) 3121 4433

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5.25

PREFACE - gEnEtiCs

The QML Pathology Genetics Department is responsible for the molecular detection of a number of known genetic mutations, the detection of chromosome abnormalities in various tissues, and for the non-endocrinological aspects of fertility testing.

MOLECULAR GENETIC TESTINGThe department offers a comprehensive and expanding range of molecular tests in the areas of genetic disorders, microbiology and oncology.

These tests include:

GENETIC DISORDERS:Hereditary Haemochromatosis (HfE gene)

Hereditary haemochromatosis is an autosomal recessive disorder of iron metabolism that results in iron overload and may be fatal if allowed to progress but well treated if detected early. It affects approximately 1 in 200 people, and has a carrier frequency of 1 in 7 in individuals of Northern European descent. Three missense mutations, C282Y, H63D, and S65C have been identified in the HFE gene and are tested for by QML Pathology.

factor V Leiden and Prothrombin G20210A Mutation Analysis

Resistance to activated protein C is the most common defect associated with an inherited predisposition to venous thrombosis, resulting from a mutation in the Factor V gene. Heterozygosity to this mutation is associated with an 8 fold increased risk of venous thrombosis, whereas a homozygous patient has an 80-100 fold increased risk.

Another common genetic variation associated with an increased risk of venous thrombosis involves a mutation in the prothrombin gene (G20210A). The prevalence of the mutated allele is 6% among deep venous thrombosis cases and is associated with a 3 to 4 fold increased risk.

Methylenetetrahydrofolate Reductase (MTHfR) Mutation

Hyperhomocysteinaemia has been identified as a risk factor for coronary artery disease, stroke and venous thromboembolic disease. A common mutation (C677T) in the MTHFR gene has been described that renders the MTHFR protein thermolabile. Homozygosity for the mutation may interact with environmental factors, such as folic acid deficiency, to predispose to Hyperhomocysteinaemia.

Apolipoprotein E Genotyping

Genotyping identifies alleles associated with type III hyperlipidaemia (allele 2).

fragile X Syndrome (fRAXA)

Fragile X syndrome is the most important cause of mental retardation after Down Syndrome and is due to a trinucleotide repeat (CCG) expansion of the FMR1 gene located on the X chromosome. It occurs in individuals with an FMR1 full mutation (>230 repeats) and is characterised by moderate mental retardation in affected males and mild mental

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Cs retardation in affected females. Expansions in the premutation range (55 – 230 repeats) have been linked with disorders such as fragile X ataxia/tremor syndrome and FMR1-related premature ovarian failure.

Y Chromosome Microdeletion Analysis

The deletion of the AZF (azoospermic factor) region on the Y chromosome is thought to be pathogenically involved in male infertility associated with azoospermia or severe oligospermia. Microdeletions involving the DAZ gene account for approximately 6% of infertile men classified as idiopathic oligo/azoospermia.

Sex Determining Region (Sry) Gene

The SRY gene is present on the short arm of the Y chromosome and is one of the switches for sex determination in humans. This test is useful as a screening test in cases of newborn babies with ambiguous genitalia.

HLA-B27 Gene Testing

HLA-B27 is a Class I antigen that is found on the surface of all nucleated cells and platelets. It is found in 90% of patients with ankylosing spondylitis. However, it is also present in 5-10% of a normal Caucasian population. All known B27 subtypes including the rare B2707 and B2711 subtypes are detected by QML Pathology.

MICROBIAL TESTING:Clostridium Difficile Testing

Clostridium Difficile causes pseudomembranous colitis and antibiotic-associated diarrhoea. It is also one of the most important causes of nosocomial infections. The organism has genes that produce two toxins, A and B. These genes can be detected by PCR.

Cat Scratch Disease Following a bite, scratch or lick from a cat, a person may develop swollen lymph glands, fever and malaise. The usual causative bacterial agent of cat scratch disease, Bartonella henselae, can be detected by PCR.

Malarial Parasite Detection Using PCR

Molecular analysis may be used for the sensitive detection of the four Plasmodium species. This can be useful when parasite levels are very low, or in the detection of mixed species infections. It can be a useful diagnostic tool when used in conjunction with routine methods.

ONCOLOGY:BCR-ABL RQ-PCR

The Philadelphia translocation and the associated BCR-ABL fusion genes are found in approximately 95% of Chronic Myeloid Leukaemia (CML) and 20% of adult precursor B-cell Acute Lymphoblastic Leukaemias (B-ALL). Real-time quantitative PCR (RQ-PCR) for

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PREFACE - gEnEtiCs

the BCR-ABL transcript has become an important tool in patient diagnosis and response to treatment. Analysis is performed on extracted RNA and due to RNA degradation samples must reach the Genetics Department within 24-48 hours post collection.

JAK2 Mutation Analysis

Janus Kinase 2 (JAK2) is a cytoplasmic tyrosine kinase which is essential in signal transduction from multiple hemopoietic growth factor receptors. This mutation is one of the first diagnostic molecular genetic abnormalities in Myeloproliferative disorders and is present in 90-95% of patients with polycythemia vera (PV) who are more prone to have homozygous JAK2 mutation. The mutation is also present in 50-70% of patients with essential thrombocytosis and in 40-50% of patients with myelofibrosis.

LYMPHOCYTE GENE REARRANGEMENT STUDIES:B-cell Immunoglobulin Heavy Chain (IgH) Gene Rearrangements

This test is for the IgH gene rearrangement (FR2 and FR3) and will detect greater than 80% of B-cell lymphoproliferative disorders.

Bcl-2

This test is specific for the major breakpoint region (mbr) of the IgH-bcl-2 associated translocation [t(14;18)]. This translocation is associated with up to 85% of lymphomas with a follicular morphology, and with approximately one third of diffuse large cell lymphomas.

Bcl-1

This test is specific for the translocation involving the Cyclin D1 gene [t(11;14)] which is commonly associated with Mantle Cell Lymphoma (MCL).

T-cell Receptor (beta and gamma) Gene Rearrangements

This test is for detecting monoclonality of T lymphocytes using primers targeted at both beta and gamma gene rearrangements, and will detect greater than 80% of T-cell lymphoproliferative disorders.

OTHER MOLECULAR GENETIC TESTS:

Genetic testing for a number of disorders is available throughout Australasia. See Genetics Appendix (12.30). QML Pathology will perform sample collection and forward the samples to the appropriate testing facility. It is important to note that many disorders require genetic counselling prior to testing and most incur an out of pocket expense to the patient. The Genetics Department maintains a list of tests available in Australasia complete with costing and collection requirements. Please contact the department on (07) 3121 4461 regarding availability of testing.

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Cs CHROMOSOME ANALYSIS (CYTOGENETICS)Cytogenetic analysis is a method for scanning a whole genome to provide information about the number and structure of chromosomes. Analysis may be performed on many tissue types and is an important tool in the identification of constitutional chromosome abnormalities, the identification of haematological malignancies and in prenatal diagnosis. Please see Genetics Appendix (12.29).

Tissue submitted for chromosome studies must reach the laboratory in a viable state. Cells are grown in culture media until sufficient material is available for analysis. The rate at which specimens grow is the principal factor determining the turnaround times of the tests.

CONSTITUTIONAL: Blood

Peripheral blood is the tissue of choice when investigating possible constitutional chromosomal abnormalities in neonates, children and adults.

Skin

A skin biopsy can be performed for confirmation of mosaicism or the establishment of a cell line for further study, e.g. Molecular DNA or biochemical testing. Samples from children and adults may be taken by a QML Pathology doctor at one of our special test collection centres or a Branch Laboratory.

ONCOLOGY:Bone Marrow

Aspirated bone marrow is used for the investigation of haematological malignancies. Chromosome abnormalities detected, (often specific for a particular disorder), are acquired as part of the neoplastic process and are therefore present only in the affected cell lines.

Lymph Nodes

Lymph node is the best tissue to culture for chromosome analysis when investigating lymphomas. The sample is usually shared between several departments (Histology, Haematology and Genetics). Refer to detailed guidelines in Histology Preface (5.35).

Unstimulated Blood

Peripheral blood may be used to detect acquired haematological malignancies (e.g. CML) which have large numbers of precursor cells circulating in the blood.

Solid Tumours

A representative sample of tumour tissue should be selected. Areas of necrosis, adherent fat and extraneous tissues should be aseptically dissected from the tumour tissue. It should then be placed in antibiotic transport medium (not formalin) and forwarded, cooled, to the Genetics Department as soon as possible.

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PRENATAL:Chorionic Villus

A chorionic villus sample (CVS), is taken by a specialist obstetrician under ultrasound guidance from the developing placenta at around 10 to 12 weeks gestation. This tissue can be cultured for fetal karyotype assessment.

Amniotic fluid

Amniotic fluid surrounding the developing fetus contains a small but adequate number of viable cells of fetal origin. These can be cultured for fetal chromosome investigation at ≥14 weeks gestation.

Rapid Screening (fISH) Test for fetal Aneuploidy

A rapid screening test for fetal aneuploidy using FISH probes specific for chromosomes 13, 18, 21, X and Y is available with results usually reported within 24 hours. It is recommended that any abnormal results obtained by FISH are confirmed by full chromosome analysis prior to any therapeutic intervention.

Products of Conception/IUfD

Chromosome abnormalities are found in >50% of spontaneous miscarriages occurring in the first trimester of pregnancy. Cytogenetic analysis of tissue obtained from products of conception is useful in investigating the cause of recurrent miscarriage/IUFD and in the identification of chromosome abnormalities which may potentially pose problems in future pregnancy attempts.

Aborted tissue should be placed in a sterile container, preferably in antibiotic transport medium (or, if unavailable, in sterile normal saline), and forwarded, cooled, to the Genetics Department or Branch Laboratory as soon as possible. The material required for cell culture will be isolated by the laboratory staff and the remainder of the material will be submitted for histological examination.

Note: The membranes and placental specimens may be the only viable tissue of fetal origin available for cell culture. If available, fetal skin is also cultured but there may be limited success if the fetus is autolysed.

MOLECULAR CYTOGENETICS fISH Analysis

FISH (Fluorescent in situ hybridisation) is a technique that allows the hybridisation of a fluorescent DNA probe to a specific region on a specific chromosome. It is selectively used in conjunction with conventional chromosome analysis for a wide range of applications in prenatal diagnosis, constitutional studies and in oncology.

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Cs ANDROLOGYSeminal fluid Analysis

Male fertility is assessed using seminal fluid in cases of unexplained infertility, as well as post-vasectomy or after vasectomy reversal. The entire sample is required and must be examined for motility within 2 hours of collection. The specimen should be kept at room temperature (do not refrigerate).

The following are available on request from QML Pathology:

• Printed patient instruction form, ‘Instruction to patients for the collection of seminal fluid’.

• Plastic seminal fluid collection (SFC) containers (red screw cap).

The patient should follow the clear instructions on the printed form from QML Pathology.

Note: The patient should contact his nearest QML Pathology collection centre to establish the best time to take the sample so the transit time is kept to a minimum.

Seminal fluid fructose

Fructose is used as a source of energy by spermatozoa, and may be depleted if the transit time to the laboratory for examination is extended or in the presence of polyzoospermia. Low fructose levels may be associated with low motility.

The sample is collected in the same way as for seminal fluid analysis and the test may be performed at the same time, on the same sample. Regional or Branch Laboratories that perform seminal fluid analysis, on completion should forward the remainder of the specimen to the Brisbane Genetics Department for seminal fluid fructose assay. The specimen must be frozen or transported on ice.

Antisperm Antibodies (Indirect Immunobead Test - IBT)

Antisperm antibodies may be present in either the male or female. Their presence may reduce sperm motility and/or interfere with sperm penetration of the ovum. This test is recommended as part of a comprehensive fertility screen of couples.

Samples required are:

female - 10 mL clotted blood sample (SS tube).

Male - 10 mL clotted blood sample (SS tube) and/or seminal fluid.

The antisperm antibody test is performed on an irregular basis, usually every two weeks, depending on batch size and the availability of a normal semen sample that is used as a substrate in the tests. Results are released on the day of testing.

PATERNITY INVESTIGATIONQML Pathology acts as a collection and transport agency only.

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The Haematology Department provides a comprehensive range of tests in the following speciality areas:

• Blood counts

• Coagulation

• Bone marrow examination

• Anaemia assays (vitamin B12, folate assays and iron studies)

• Haemoglobin electrophoresis/thalassaemia screening

• Flow cytometry (lymphocyte/leukaemia/lymphoma marker studies)

• Special tests (haemolytic studies, isotopic blood volume and cytochemistry).

COLLECTION REQUIREMENTS

General

Collection requirements for all tests are individually detailed in the A-Z test listing (6.0).

BLOOD COUNTSBlood collected into EDTA for Blood Counts must be well mixed by inversion immediately after collection. It is best that blood films are prepared at the time of collection, particularly if the sample processing is expected to be delayed by more than 12 hours. Specimens will be suitable for testing up to 24 hours after collection provided that the sample is kept refrigerated and the blood films have been prepared.

Making a Blood film

1. Prepare slide: Ensure slide is clean and grease-free.

2. Place blood: Place drop of blood sufficiently large enough to at least produce a smear of 4 cm.

3. Spread blood: The spreader is held at 45° angle to the slide and then drawn back until it touches the blood. Allow the blood to spread the width of spreader.

4. Making film: Move the spreader in a swift steady motion towards the end of the slide. The blood should spread to a thin film at the end.

5. Label slide: Write patient’s name and date of birth onto the upper half of frosted end of slide using a pencil, leaving lower half of frosted end of slide free for laboratory use.

6. Packaging: Ensure slide is completely dry before placing in slide carrier for transport.

NOTE: Air dry slide only. DO NOT blow on slide or use any heating device to dry slide more quickly.

COAGULATION TESTSSpecimens for coagulation tests must be collected into sodium citrate tubes (blue top) and filled to the level indicated on the tube. (The correct dilution of blood with citrate is

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y most important). As many of the coagulation factors are labile the sample should be kept refrigerated and should be forwarded, cooled, to the laboratory as soon as possible (preferably within 2 hours). Samples for factors and thrombotic assays must reach the laboratory within two hours. For prothrombin time/INR (warfarin control), the sample should reach the laboratory within four hours. Complete clinical and medication details

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SUGGESTED SCREENING fOR THROMBOPHILIA

VENOUS THROMBOEMBOLISM ARTERIAL THROMBOEMBOLISM

Age < 50 Age > 50 Age < 50 Age > 50

First Line Investigations

FBC + E/LFT FBC + E/LFT FBC + E/LFT FBC + E/LFT

APC-Resistance Lupus Anticoagulant Duplex Imaging Duplex Imaging

Factor V Leiden ACLA HDL/LDL HDL/LDL

II 20210A Mutation Homocysteine Lipoprotein (a) Lipoprotein (a)

Protein S/C Malignancy Screen Homocysteine Homocysteine

AT III APC-Resistance Lupus Anticoagulant Lupus Anticoagulant

Lupus Anticoagulant Factor V Leiden ACLA ACLA

ACLA II 20210A Mutation APC-Resistance

Homocysteine Factor V Leiden

II 20210A Mutation

Protein S/C

AT III

Second Line Investigations

Factor VIII, IX, XI Protein S/C Clot Lysis Protein S/C

PAI-1 AT III Plasminogen AT III

Clot Lysis Plasminogen Fibrinogen Plasminogen

Plasminogen PNH APC-Resistance

Fibrinogen Assays Factor V Leiden

PNH II 20210A Mutation

Heparin Cofactor II

Note these are CONDITIONAL MEDICARE items.

NOTE: A personal history of thrombo-embolism or a FIRST DEGREE relative having an abnormal thrombotic profile test result must be stated on the request form to attract the medicare refund.

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are required including any family history of bleeding or clotting problems.

BONE MARROW BIOPSYAll registered medical practitioners can order a bone marrow biopsy. Appointments for bone marrow biopsies may be arranged by telephoning the Haematology Department, Brisbane (07 3121 4573) or the nearest Branch Laboratory. Practitioners who wish to carry out the bone marrow biopsy procedure should contact the laboratory and arrange for a QML Pathology staff member to be present to assist in making smears and handling the specimen.

Information Required:

1. Anatomical site of collection

2. If the aspirate was obtained with/without difficulty

3. Consistency of bone

4. Provisional diagnosis.

Samples Required:

1. Labelled bone marrow aspirate smears x 12-15

2. Aspirate sample in Lithium heparin (black top) tube (required for chromosome analysis and marker studies) and an EDTA tube

3. Trephine and/or aspirate sample in formalin.

CELL MARKER STUDIES (Leucocyte/Leukaemia/Lymphoma)

Blood Specimens

Collect blood specimens into an ACD tube (yellow top) or if unavailable a Lithium heparin tube (green top). An EDTA tube must also be collected and a blood film prepared if there is no accompanying full blood count. Samples must be kept at room temperature (cool) and are suitable for analysis up to 24 hours after collection.

Bone Marrow Aspirate Specimen

A sample in a sterile Lithium heparin tube (green or black top) and 12-15 aspirate smears are required.

Lymph Nodes and fine Needle Aspirates

Place lymph node specimens in antibiotic transport medium and keep cool. Important: Please refer to Histology Preface (5.35) for more details on specimen handling. Please refer to Cytology Preface (5.16) for details of FNA smear preparation and specimen handling.

Leucocyte Reference Ranges

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yPlease see Haematology Appendix (12.31).

ORAL ANTICOAGULANT CONTROL SERVICEOnly suitable patients can be enrolled in this service.

Patients must be registered by calling 1300 795 355.

The following information is required for registration:

• Patient details

• Present dose

• Reason for therapy

• Other existing medical conditions

• Required INR range

• Other current medication

• Duration of therapy

• Please notify the controlling laboratory if there is a change in the nature and/or dosage of any concurrent medication the patient is taking as this may affect significantly the INR.

Unregistered patients will be returned as Doctor Controls.

For further information please refer to additional services section ‘Warfarin Services’ (3.2) or to the Haematology Appendix (12.32).

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REQUEST REQUIREMENTS • Please supply relevant patient and clinical information with each specimen.

• Please indicate special requirements where appropriate e.g. tissue for microbial culture, special stains, cell marker studies, immunofluorescence, electron microscopy, suspicious or doubtful surgical margins, etc.

• Please ensure all specimens are accurately labelled.

• Where appropriate, specimen orientation should be indicated by the use of suture(s) or clearly indicated incisions or nicks placed on the tissue specimen together with an accompanying diagram and/or written explanation. In turn a diagram illustrating how the specimen was processed and, where appropriate, location of involved margins, etc. should accompany the pathology report.

• Advance notice of elective frozen section, pending cell tumour marker studies, skeletal muscle biopsy, cilial biopsy or renal biopsy is required.

ROUTINE SPECIMENSSpecimens for routine histologic examination should be placed in 10% buffered formalin. Optimally the specimen should be placed in 10 times the volume of formalin to the volume of the specimen. Pre-labelled containers of all sizes are available from QML Pathology on request.

NON-ROUTINE SPECIMENSCertain specimens and investigations require different or additional processing.

TISSUE fOR BACTERIAL, fUNGAL AND VIRAL CULTURETissue suspected of being infected is a better source of a positive culture than a swab. If possible a portion of the infected tissue should be placed into a dry sterile container, without additives, for the purpose of culture. This should be forwarded to the laboratory with appropriate clinical history (including history of antibiotic therapy) as soon as possible. If transport delay is anticipated (e.g. overnight, rural area, etc.) the tissue may be placed in Stuart’s transport medium. It is important to prevent dehydration of the tissue. If transport medium is unavailable add a few drops of sterile saline to the dry tissue container. The remainder of the material may be placed in buffered formalin and submitted in the usual way.

CELL TUMOUR MARKER STUDIES

Lymphoma

Lymph nodes and tissues infiltrated by lymphoma (e.g. skin, gastrointestinal mucosa, etc.) and fluids heavily infiltrated by lymphoma (e.g. pleural fluid, ascitic fluid and CSF) may be submitted for cell marker studies.

1. Lymph nodes: In the metropolitan area if the lymph node can be sent directly to the laboratory without delay, it may be placed dry in a dry sterile, screw top (urine) container and sent immediately to Histology (07) 3121 4426 or to the nearest Branch Laboratory where it will be aseptically divided and shared appropriately.

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ogy In the non-metropolitan region and rural areas, and in the metropolitan area where

delays greater than 2 hours may be expected (e.g. after hours, distance and transportation, etc.) the lymph node must not be placed in a dry container. Lymphocytes die soon after loss of blood supply resulting in inability to culture the tissue and to detect markers with the flow cytometer. Also autolysis occurs rapidly and there is loss of crucial cytomorphological detail in histology. Under these circumstances the lymph node should be transected and half the lymph node placed in antibiotic transport medium. If unavailable, normal saline may be used as a substitute. Overnight the antibiotic transport medium should be stored in the bottom (crisper bin area) of a refrigerator. The specimen should be transported to the laboratory as soon as possible in a cooled insulated container.

Note: The ice brick should be separated from the tissue by packing material to prevent freezing.

The other half of the lymph node should be utilised for the production of touch imprints from the cut surface on two glass slides labelled with the patient’s name and date of birth. This is performed by gently grasping the capsular side of the lymph node with clean forceps and gently touching with a perpendicular motion the cut surface on each clean glass slide. It is essential not to use a lateral smearing motion. One of these slides is allowed to AIR DRY. The other slide is fixed by spraying with cytospray. Following this, the lymph node tissue should be immersed in formalin. If the lymph node(s) is/are very large they should be transected further into several thinner slices before being immersed in formalin to ensure adequate fixation of the entire specimen.

These procedures will ensure preservation of tissue viability and morphological detail both of which are essential in the diagnosis and classification of lymphoma.

2. Tissues from other body sites which are suspected of being infiltrated by lymphoma should be treated in a similar way.

3. fluids such as pleural fluid, ascitic fluid and CSF should be placed in a sterile container, without additives, kept cool and submitted to the laboratory as soon as possible.

Peripheral Blood and Bone Marrow

Cell marker studies on peripheral blood and bone marrow are useful in the identification of:

• Acute leukaemias

• Chronic leukaemias

• Malignant lymphomas

• Myeloma.

The specimens (peripheral blood and bone marrow aspirate) may be collected in Lithium heparin tubes (green top and black top) and should be forwarded cooled to the laboratory as soon as possible with full clinical history and details of previous tests.

NOTE: The cell surface marker studies are carried out on a flow cytometer in the Brisbane Central Laboratory. Tissue from country regions should be forwarded cooled to the nearest Branch Laboratory, which in turn will forward the specimen to the Brisbane Central Laboratory for processing.

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CHROMOSOME ANALYSIS ON PRODUCTS Of CONCEPTION/IUfD

first Trimester Abortions

All the aborted tissue should be placed in sterile antibiotic transport medium (or, if unavailable, in sterile normal saline), refrigerated, and forwarded cooled to the Genetics Department (07) 3121 4461 or Branch Laboratory as soon as possible. The material required for cell culture will be isolated by the laboratory staff and the remainder of the material will be submitted for histological examination.

Second Trimester Abortions and Still Births

Please collect sterile samples of fetal skin from the back, and membranes and chorionic villi from the placenta and place in sterile antibiotic transport medium (or if unavailable, in sterile normal saline), refrigerate, and forward cooled to the laboratory as soon as possible. The remainder of the tissue may be placed in buffered formalin. However, if there is an intact fetus, the fetus should be kept refrigerated and discussed with a supervising pathologist as to what further actions and/or investigations are required. A fetus/stillbirth which is to undergo a subsequent autopsy (with parental consent required) must NOT be placed into formalin.

NOTE:

1. If the fetus is autolysed the membranes and placental specimens are particularly important as they may be the only viable tissue of fetal origin available for cell culture.

2. Antibiotic transport medium, suitable for transportation of all viable tissues, is available on request from QML Pathology (07) 3121 4461, (07) 3121 4502 or Branch Laboratory. This should be stored frozen and thawed to room temperature when required.

3. A detailed pro forma outlining requirements for chromosome analysis of fetal tissue is available on request from QML Pathology.

CILIAL BIOPSYCilial biopsies should have motility studies performed as part of their assessment. Advance notice (preferably a day) of the impending biopsy will enable the laboratory to prepare for the procedure. Two specimens are ideal, one for motility studies and the other for electron microscopy. If only one specimen is available, it must be placed into Hartmann’s buffer which is available on request from Histology (07) 3121 4426.

If unavailable in Branch Laboratories, saline can be used. This must be submitted in a container at room temperature to the main Histology Department without delay (within 12 hours). The specimen for electron microscopy is submitted in 3% buffered glutaraldehyde, which is available on request.

CONJUNCTIVAL/LIMBAL TISSUE/DELICATE TISSUEThin, delicate tissue such as specimens of conjunctival and limbal lesions but also including small skin samples from the inner canthus and mucus membranes, if placed directly in formalin for fixation tend to become twisted and distorted, making subsequent orientation and accurate sampling difficult or impossible. When fresh, these tissues should be placed

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ogy flat on a small piece of blotting paper with the cut surface down to ensure adhesion.

Please check the tissue is not folded over on itself and that folds and creases have been eliminated. Now place the blotting paper with adherent tissue carefully into a container of formalin ensuring they do not become separated. The tissue will become fixed in its flattened state. The use of a marking suture and diagram will greatly assist the pathologist to orientate the specimen for processing.

These simple procedures will ensure an optimum pathology report. Where appropriate an orientating diagram will accompany the report.

DISACCHARIDASE ESTIMATION ON SMALL INTESTINAL MUCOSASmall intestinal mucosal biopsy tissue for estimation of disaccharidase activity should be collected before the histology specimen as contact with formalin on biopsy forceps (even formalin vapour) will partially or totally destroy enzyme activity. The tissue should be wrapped in aluminium foil, placed in a labelled dry sterile screw top (urine) container and frozen immediately after collection. It should be forwarded to the laboratory on dry ice or packed in ice bricks, as soon as possible.

ELECTRON MICROSCOPYThis may be performed on request under special circumstances. We suggest consultation with the nearest QML Pathology laboratory prior to referral. Glutaraldehyde is available on request. The fresh specimen should be finely diced into 1 mm cubes and placed immediately into buffered glutaraldehyde and submitted to the laboratory.

fROzEN SECTION SERVICETissue for frozen section should be submitted FRESH in a DRY container (not in formalin). Please telephone Histology (07) 3121 4426 or your Branch Laboratory for booking elective frozen sections. QML Pathology endeavours to provide a frozen section service where main laboratories are sited with pathologists on site – however, this does not apply to stat laboratory locations such as Ipswich.

IMMUNOfLUORESCENCESkin biopsies and renal biopsies may be submitted for immunofluorescence detection of antibodies or antibody-antigen complexes. A detailed clinical history and provisional diagnosis should accompany the biopsy. It is preferable to submit two separate skin biopsies from the same lesion. If only one renal biopsy is available this can be divided into two. One biopsy specimen should be placed in immunofluorescence transport medium (available on request from Histology (07) 3121 4426 or your Branch Laboratory) and the other placed in 10% buffered formalin. Before use the transport medium should be stored refrigerated (not frozen). The specimens should be sealed and forwarded to the laboratory for testing as soon as possible. The transport medium preserves fresh tissue reactivity for up to 5 days at ambient temperature and provided it is correctly packaged the specimen may be posted. If immunofluorescence transport medium is unavailable two alternatives are available. The specimen may be snap-frozen, in liquid nitrogen, stored in a freezer and transported frozen (dry ice) to the laboratory.

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Provided the specimen has been snap-frozen, preservation with this technique is excellent. Alternatively, if transport time to the laboratory is less than four hours the specimen may be placed on a cotton wool ball moistened with saline or in a container with only a few drops of normal saline.

IMMUNOPEROXIDASE STAINSQML Pathology tests for a wide range of cell markers with immunoperoxidase techniques. These will be performed as required in any individual case. In most cases routine buffered formalin fixation is adequate.

LIVER BIOPSYIn most cases liver biopsy tissue for histology may be submitted in buffered formalin in the routine way. For diagnostic purposes multiple levels of the biopsy are examined using routine H&E and a number of special stains.

If quantitative estimation of liver iron (haemochromatosis) or liver copper (Wilson’s disease) is required a separate biopsy should be submitted. The tissue should be wrapped in aluminium foil, placed in a dry sterile container without additives and stored frozen. It should be transferred to the laboratory cooled on an ice brick in an insulated container.

(SKELETAL) MUSCLE BIOPSYAll muscle biopsies should have histochemistry performed as part of the morphological assessment. Advance notice (preferably a few days) of the impending biopsy will enable the laboratory to prepare for the complex procedure of freezing and processing. Occasionally electron microscopy will also be required. The muscle tissue must not be frozen and it must not be placed in formalin prior to collection of the sample for histochemistry. An ideal sample is a block of muscle 20mm in length by 5 to 10mm in diameter. This should be placed in a dry sterile container without additives, cooled and sent to the laboratory without delay (within 60 minutes). If a delay greater than 60 minutes is unavoidable then it is preferable to refer the patient to a regional centre near the laboratory for the biopsy.

OESTROGEN RECEPTOR ASSAYOestrogen and progesterone receptor status in breast cancer can be evaluated semi-quantitatively by immunohistochemical methods. This routine method of analysis is available on formalin fixed tissue, and has replaced the previous assay requiring fresh frozen tumour tissue.

RENAL BIOPSYRenal biopsy performed for assessment of glomerular disease requires complex processing including standard H&E and special stains on paraffin embedded tissue, immunofluorescence techniques to demonstrate antibody or antibody-antigen complexes and electron microscopy. Two renal biopsy cores are ideal. If only one core of tissue is available it may need to be divided into fragments for any or all of these procedures according to the requirements of the individual case. Such division should be carried out by a skilled operator with the assistance of a microscope to ensure glomeruli are

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ogy present in each of the samples. Advance notice (preferably a few days) of the impending

biopsy will enable the laboratory to have available the different fixation and transport media required and if necessary the equipment to divide the specimen.

NOTE: The specimen will be transported from Branch Laboratories to Brisbane for processing and reporting.

TESTICULAR BIOPSYFor optimal preservation of morphology, testicular biopsy tissue taken for investigation of infertility should be fixed in Bouin’s Fixative Solution rather than buffered formalin. Bouin’s fixative Solution is available on request from Histology (07) 3121 4426 or your Branch Laboratory. Testicular biopsy for tumour diagnosis should only be performed if orchidectomy can proceed immediately after a positive diagnosis is made (usually by frozen section).

If you have any doubts or queries please contact the laboratory prior to surgery.

SKIN BIOPSIES

Why Biopsy?

Skin biopsy is a rapid procedure useful in the diagnosis of many neoplastic and inflammatory conditions, and therefore a valuable tool when the clinical differential diagnosis encompasses different treatment options.

Many skin conditions are clinically distinctive, whilst others may require histology for specific diagnosis. At times, however, skin rashes may be both clinically and histologically puzzling, and we may only be able to offer a range of possible diagnoses suggested by the histology.

The value of the biopsy may be limited by its size, the site selected for sampling, superimposed inflammatory changes, the application of topical agents, or concurrent use of medications. One of the major limiting factors is lack of sufficient clinical information.

The histological report should be available one working day after the specimen is collected, although urgent results may be obtained within six hours if indicated. Delays may occur when further investigations, such as special stains, need to be performed, or if further clinical information is required.

What Sort of Biopsy?

Incisional Biopsy

This is preferred by the pathologist as it is orientated and gives more information. It need only be about 6mm long, 2mm wide and 4mm deep. A biopsy for deeper lesions (including panniculitis) will obviously need to be longer and deeper. It should be orientated radially (not tangentially) and should include about 1mm of normal skin. Distinguishing between keratoacanthoma and squamous cell carcinoma may be very difficult on biopsy, and only an incisional biopsy provides adequate information.

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ogyPunch Biopsy

This is technically easier, but sometimes harder to interpret, as orientation in the laboratory is more difficult. This means that sections cut from the biopsy may not be in the optimal plane, and the lesion may be missed. For this reason it is better not to include any normal skin in a punch biopsy. There is a preference for 3mm or 4mm punch biopsies rather than 1mm and 2mm, as the latter options may be inadequate.

Shave Biopsy

Shave biopsies and skin currettings are usually successful in diagnosing skin tumours. They fail when the keratin layer is deceptively thick or when the sample is too superficial. This is particularly important in solar keratosis when invasive squamous cell carcinoma cannot be ruled out unless the specimen includes all of the basal layer and a little underlying dermis.

Selecting the Biopsy Site

In neoplasms, the thickest region will generally provide the most diagnostic information. In some broad and multifocal tumours it may be necessary to biopsy several areas, including the centre and periphery of the lesion in order to make a diagnosis.

Site selection is more critical in inflammatory rashes. It is difficult to generalise about which lesion to biopsy, but usually the more florid the lesion clinically, the more pathology that will be revealed. Sometimes biopsying two lesions of different ages is helpful. Blisters and vasculitic lesions must be biopsied at an early stage as their diagnostic features may disappear after about 24 hours.

Pigmented Lesions

The main role of biopsy in these cases is to distinguish between melanocytic tumours and other pigmented lesions such as seborrhoeic keratoses, solar lentigines, basal cell carcinomas, etc. If a lesion is suspected to be melanocytic (and especially if it is suspicious of melanoma), then complete excision with narrow margins is strongly recommended for the purpose of diagnosis. This is because biopsies may be misdiagnosed as either benign or malignant. In addition, if the lesion is a melanoma, then important prognostic features may be distorted in the re-excision specimen. Also, if a benign nevus regrows after biopsy it can develop a pseudomalignant histological pattern, thus risking misdiagnosis of melanoma.

Immunofluorescence

This study is frequently necessary for the diagnosis of blistering/bullous rashes, and is also useful in lupus erythematosus and occasionally vasculitis. The specimen must be submitted in an immunofluorescence transport medium which we supply from the laboratory. It must not be placed in formalin. Because this medium is not a good tissue fixative, we also need a biopsy submitted in formalin. It is better to take two separate biopsies rather than divide a single biopsy. In the case of blisters, perilesional skin should be biopsied for immunofluorescence, whilst the formalin fixed specimen should include the edge of a fresh blister and adjacent intact skin (see above ‘Selecting the Biopsy Site’).

Consider Culture

If there is a possibility that the lesion is due to an infection, take a swab of the biopsy wound or even send a small piece of tissue for culture (put it in a sterile jar with a small amount of sterile normal saline and send it to the lab as soon as possible). Do not divide a biopsy specimen.

Important Notes for Skin Biopsies

• Carefully select the biopsy site so that it is representative of the lesion or rash. Consider more than one biopsy.

• Mark the biopsy site prior to performing the procedure.

• Be gentle with the specimen to avoid crush artefact.

• Consider special investigations such as immunofluorescence and culture. Send separate specimens for different tests - do not divide biopsies.

• The major role of biopsy in pigmented lesions is to confirm the clinical diagnosis of a pigmented, nonmelanocytic lesion. If a lesion is thought to be melanocytic, and especially if it is atypical, then narrow, but complete excision rather than biopsy is strongly recommended.

• Take the time to write clinical notes and a provisional diagnosis.

TECHNICAL DETAILS

What to Call Your Specimen

The pathologist performing the macroscopic examination needs to know whether a piece of skin this shape is an excision biopsy or an incision biopsy.

Most specimens require division before being processed. A piece of skin this shape should be divided this way if it is an excision specimen as these transverse sections will display the margins of excision in relation to a tumour.

If, however, it is an incision specimen, it will remain whole so that sections display the full length of the specimen. If it is more than 3.0mm wide, it will be divided longitudinally:

For technical reasons we reduce our tissue blocks to about 2.0mm thickness. To avoid a good incision biopsy being partly wasted or an excision biopsy that cannot be assessed for completeness of tumour removal, please specify excision or incision biopsy.

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INCISION BIOPSY PUNCH BIOPSY

Blotchy, macular

Annular sometimes unsuitable for punch

Discoid, plaque

Papular

Vesicular, bullous unsuitable for punch

Nodule, tumour

Selecting the Biopsy Site How to Biopsy

1. Mark the Site Select and mark the site(s) to be biopsied. An ink marker is useful.

2. Skin Preparation Be thorough but gentle, so that no scale or scab is rubbed off. Allow alcohol to dry before starting a biopsy.

3. Local Anaesthesia 1 or 2% lignocaine with 1:100 000 adrenaline is suggested.

NOTE: Adrenaline should not be used in certain sites.

4. Punch Biopsies Stretch the skin between index or middle fingers, or thumb and index finger of one hand, and press the punch in, rotating as you press until you feel it pop through the dermis into the subcutaneous fat. Remove the punch and separate the biopsy from the surrounding skin at the level of the fat using scissors or a scalpel blade. If the biopsy retracts into the skin, then gentle pressure on either side of the site will usually pop the biopsy core into view. Be gentle with the biopsy and never grasp it with non-toothed forceps as this will crush artefact and may render the biopsy useless. Use fine toothed forceps, a skin hook or a needle. Stretching the skin will produce an oval rather than a round hole, and one suture will repair the site.

5. Incision Biopsies Make a vertical elliptical incision about 2-3mm wide and down to fat. Try not to undercut the edges. Grasp the biopsy by the deep edge using a skin hook or fine single tooth forceps and free the base of the biopsy with curved scissors or scalpel dissection. Repair with sutures.

6. Afterwards Place the biopsy in formalin. If necessary, submit further biopsies fresh for culture (or lymphocyte marker) or in immunofluorescence transport medium for immunofluorescence (sent out by the laboratory on request). Label the specimen, and please write some clinical notes on the pathology request form.

Clinical NotesA clinical description (including clinical diagnosis or differential) is frequently useful in the diagnosis of tumours, and is usually essential in the diagnosis of rashes. Information should include:• Exact site• Size• Duration• Appearance• Symptoms• Drugs• Clinical diagnosis.

for further information please contact the Histology Department on (07) 3121 4495.

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BIOPBLADE™

The sterile, single-use BIOPBLADE™ is a flexible scalpel used for cutaneous surgery, including: shave biopsy, saucerisation of flat lesions and levelling of pedunculated lesions. The unique design of the BIOPBLADE™ incorporates a comfortable and protective ‘Fingerguard’ in addition to the flexible super sharp blade. This flexibility allows the blade to be positioned at the correct angle for the intended procedure.

The BIOPBLADE™ is utilised for removal of lesions, either elevated (shave biopsy) or flat (saucerisation). After the site is anaesthetised, the BIOPBLADE™ is held and ‘bowed’ between the thumb and fingers. The lesion is removed at or just below the surface epithelium. Cosmetic results are normally good and the wound heals without the need for suturing. The Clinician will remove all of the lesion without overly deep penetration to avoid scarring.

Skin Punch Biopsy Devices

The punch biopsy with internal plunger system allows the lodged skin specimen inside the metal lumen of the punch to be easily ejected.

Punch Biopsy with internal plunger

Punch Biopsy without plunger

for further information or to order any of these devices, please contact our Stores Department on (07) 3121 4328 or your local QML Pathology Branch Laboratory.

TYPE Of BIOPSY SIzES AVAILABLE (mm)

Punch Biopsy with internal plunger

2, 3, 4

Punch Biopsy without plunger

2, 3, 4, 5, 6, 8

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MICROBIAL SEROLOGY

General Comments

Microbial serology is not an exact science. Problems can occur with false positive reactions and cross reactivity. Clinicians should interpret the serological results in conjunction with their own findings from the patient’s history and examination.

The laboratory relies heavily on the information provided with a request. The three most important pieces of information required to aid with interpreting serological results are:

• The clinical features and provisional diagnosis

• The date of onset of the condition

• If the patient is pregnant.

Please refer to the Immunology Appendix (12.36) for a comprehensive list of antibodies to microbial and parasitic agents available for testing. It is a Medicare requirement that microbial and parasitic agents be listed individually on the request form.

Antibody Profiles

The detection of microbial infection using serological methods relies on observing the pattern of IgM and IgG responses. The first detectable response in a primary infection is IgM which usually lasts for a few weeks to months. A few days after the IgM appears it is usually possible to detect an IgG response, which lasts for an extended period of time (several years) and confirms the primary infection. The presence of IgG without IgM in a serum specimen normally reflects past exposure to the infectious agent and not acute infection.

Although serological assays for the majority of infectious agents involve measurement of both IgM and IgG, there are some agents for which these two assays are not yet available. These are assayed by methods such as agglutination or complement fixation which may not discriminate IgG from IgM.

Specimen Collection

In most instances the serum from a full SS tube (yellow top) is sufficient for all combinations of viral, bacterial, fungal and parasitic serology. Plasma (from an EDTA or Lithium heparin collection) is generally not suitable because of an increased tendency to give false positive results.

Note: The laboratory stores a patient’s serum for up to 12 months to enable further tests to be added as the clinical picture evolves, or to compare with specimens collected later in the clinical presentation.

Microbial Serology in Pregnancy

The standard antenatal tests consist of serology for one or more of the following agents:• Hepatitis B surface antigen • Syphilis • Rubella IgG • Hepatitis C.

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y HIV may be added to this panel. ‘TORCH’ screening (including Toxoplasma, Rubella, CMV and Herpes antibodies) is no longer recommended unless clinically indicated.

Hepatitis Serology

There are many serological tests available that are performed in the course of investigation of clinical hepatitis or in the assessment of vaccination against either Hepatitis A or B.

To enable QML Pathology to comply with the requirements of the Medicare Schedule, it is essential that the clinician either list the exact test required or specify the clinical condition (e.g. resolving Hepatitis B, acute viral Hepatitis, post-vaccination, etc.) The main clinical grouping from the Schedule are listed below for Hepatitis A, B and C:

• Investigation for acute Hepatitis A (HAVIgM)

• Immune status for Hepatitis A (HAVIgG) - pre- or post-vaccination

• Investigation of acute or resolving Hepatitis B (HBsAg, HBcAb, HBsAb)

• Immune status for Hepatitis B (HBsAb) - pre- or post-vaccination (Note: tests for HBsAg and HBcAb may be indicated in some pre-vaccination screens)

• Chronic infection/carriage of Hepatitis B (HBsAg and HBeAg, but may include HBsAb, HBcIgM, HBcAb if appropriate)

• Hepatitis C (HCV) - all clinical conditions

• Hepatitis D (HDV) - in individuals chronically infected with HBV

• Hepatitis of uncertain etiology - (HBsAg, HBcAb, HAVIgM, HCV).

There are clinical situations where other combinations of the above tests are more appropriate - if the clinician is uncertain then please consult the Immunology Department (07) 3121 4458 or Branch Laboratory.

Hepatitis C RNA PCR Testing

There is a Medicare rebate available under some circumstances for HCV RNA. To qualify for this rebate, the patient must fulfil at least one of the following criteria:

• They are HCV antibody positive

• They are HCV antibody positive and immunosuppressed/immunocompromised

• They have indeterminate HCV serology

• They are being investigated for acute HCV infection prior to seroconversion.

Only 1 estimation is allowed in a 12 month period.

If the patient does not qualify by these criteria, a non-refundable fee will be charged. If the patient does qualify, the relevant information should be supplied on the request In addition, there is now provision for extra Hepatitis C testing in patients undergoing specific antiviral therapy.

Quantitative HCV RNA and HCV genotype may be performed on HCV antibody positive patients, when requested by or on behalf of a specialist physician or consultant managing the therapy. Only a single genotype determination is allowed in a 12 month period,

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and 2 quantitative RNA determinations per 12 months. However, patients undergoing therapy may be entitled to an extra 4 qualitative RNA tests in that 12 month period to assist in monitoring the therapy. Please contact the Immunology Department on (07) 3121 4458 for further information.

Molecular Testing

QML Pathology can provide Molecular testing using the Polymerase Chain Reaction (PCR) to assist in the diagnosis of certain infectious diseases. At present we can test for the presence of Chlamydia trachomatis, Adenovirus, Neisseria gonorrhoeae, Neisseria meningitidis, CMV, Hepatitis C RNA, Bordetella pertussis, Trichomonas vaginalis, Herpes Simplex virus, Pneumocystis, Legionella, and Varicella Zoster virus, as well as testing for HCV and HIV viral load. More tests will be added at a future date.

Molecular testing offers highly sensitive and specific techniques for the investigation of infectious diseases. Its value lies in its ability to detect an infectious agent that may be present in very low numbers or cannot be cultivated. It can also assist in confirming the presence of infection should the results of antibody detection be unclear.

Prior to ordering the use of this test method, clinicians should consult the A-Z listing (6.0), the Immunology Department (07) 3121 4458 or Branch Laboratory for details about the collection method. It should also be noted that at present there are restrictions on the Medicare rebate for Hepatitis C and the laboratory may charge a non-refundable fee for some of these services.

Tests Referred to Other Laboratories

In certain circumstances, e.g. when QML Pathology does not perform a test or when our result requires confirmation by another laboratory, the patient’s serum will be forwarded to an appropriate laboratory for testing. This results in a delay in issuing a final report. The delay depends on the frequency of testing and the complexity of the test and in most cases is of the order of 2-4 weeks. An interim report will be issued notifying when a specimen is referred.

ALLERGY TESTINGA detailed patient history is very important in the diagnosis of an allergy. Sometimes, the history alone can pinpoint the allergen responsible for symptoms but in many cases, the history is less revealing. However, laboratory tests should not be used as a substitute for a good clinical history. Test results should always be interpreted in relation to the clinical picture. Tests routinely available for the diagnosis of allergy include:

Total IgE in Serum

Healthy, non-atopic individuals have a very low amount of IgE present in the serum, whereas in many patients with allergic disorders, IgE is significantly increased.

High serum IgE levels are not specific for atopic diseases and can be seen in parasitic infestations and in some immunodeficiency states. Conversely, a normal or modestly raised serum IgE does not exclude allergy as, in some patients, a high proportion of the total IgE present is directed against a specific allergen.

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y Allergen-Specific IgE in Serum (RAST)

The radioallergosorbent test (RAST) measures allergen-specific IgE in serum. The result is unaffected by antihistamine or corticosteroid therapy. Whilst the term ‘RAST’ is still reasonably used to describe these tests, the current laboratory method utilised is immunoCAP.

RAST is the method of choice for allergy testing in patients who:

• Have extensive skin disorders

• Have dermatographism

• Are taking antihistamines or steroids which cannot be temporarily discontinued

• Are unable to attend for skin testing.

RAST testing is the first line test for insect venom allergy and penicillin allergy, however the sensitivity of RAST in these disorders is poor, and frequently skin allergy testing is required for venom and drug allergy.

An extensive range of single allergens, multiple allergens (e.g. grass pollen mix) and an inhalant allergen screen are available. A full listing is provided in the Immunology Appendix (12.37).

Please note:

• Medicare refunds a MAXIMUM of 4 RAST estimations in a 12 month period. This restriction is intended to minimise indiscriminate use of RAST for screening purposes. QML Pathology will test up to 4 allergens (single or multiple) per patient episode. This allows up to 16 RAST estimations for the 4 allowable patient episodes in 1 year.

• Each allergen (single or multiple) required must be specified on the request form. A separate request form is required for each group of 4 allergens.

• Serum is stored in the Immunology Department for up to 12 months.

Skin Prick Testing

Skin prick testing demonstrates tissue bound specific IgE and identifies the atopic state. It is the in vivo counterpart of RAST although the results do not always parallel each other. Antihistamines interfere with the test and should be discontinued seven days prior to testing. Steroid therapy may also interfere with the test. If steroid medication can be safely ceased, this should be ceased one week before the skin test. If steroids cannot be ceased an alternative such as RAST testing should be considered.

An extensive range of local allergens is available. A full listing is provided in the Immunology Appendix (12.37). Allergy testing for food additives and food chemicals is not available.

Skin testing is available by appointment at QML Pathology special test collection centres. Please contact (07) 3121 4414 (Brisbane patients only) or your nearest QML Pathology Branch Laboratory to arrange an appointment.

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REQUEST fORMThe following relevant information should always accompany any request for bacteriological examination:

• Patient’s name and date of birth

• Date and time of specimen collection

• Site of sample and if the site is a surgical wound

• Clinical history

• Antibiotic therapy - past and present

• Please indicate if the patient is immunosuppressed/immunocompromised

• Please indicate if culture for Mycobacterium spp., fungi or unusual organisms such as Bartonella spp. Actinomyces, Nocardia, etc. is required.

TISSUE, BODY fLUIDS AND WOUND SWABS – GENERAL PRINCIPLESPlease note that aspirated pus and/or tissue samples are far superior to a swab for isolation and identification of organisms.

Tissue samples may be submitted in a dry sterile container if no delay in transportation is anticipated. It is important to prevent dehydration of the tissue. If transportation is delayed, add a few drops of sterile saline to the dry tissue container.

Aspirated material may be left in the syringe (carefully remove and discard the needle, expel all air, seal with a cap and tape securely) or it may be placed in a dry sterile container, if the specimen can be submitted to laboratory without delay.

If a delay is anticipated, a swab in Stuart’s transport medium should be collected in addition.

ANAEROBIC CULTUREClinical specimens suitable for anaerobic culture:

• Tissue biopsy

• Blood

• CSF

• Bone marrow

• Fluid from a sterile site (e.g. joint)

• Material aspirated from abscesses

• Peritoneal fluid

• Suprapubic bladder aspirate

• Bronchial washings obtained with double lumen plugged catheter

• Decubitus ulcer, if obtained from the base of the ulcer after debridement of surface debris

• Transtracheal aspirate.

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ogy Clinical specimens unsuitable for anaerobic culture:

• Coughed sputum • Rectal swab

• Urine • Swabs of superficial skin lesion

• Faeces • Throat swab

• Ileostomy/colostomy drainage • Urethral swab

• Nasopharyngeal swab • Vaginal or cervical swab.

The diagnosis of ANAEROBIC INfECTIONS is highly dependent on the correct method of collection and handling of the sample. It is imperative that the sample is collected from the centre of the abscess or other infected site, avoiding contamination from surrounding tissue, as skin and mucous membranes have large numbers of anaerobes as normal flora. Following specimen collection, samples must be transported in an environment that is devoid of oxygen and has a low oxidation-reduction potential.

Specimens aspirated by needle and syringe are ideal, provided all air is expelled. The needle should be carefully removed and discarded. The syringe should be recapped (held by tape), labelled and transported promptly to laboratory at ambient temperature. Broth media can also be provided for inoculation immediately after aspiration of the sample. If broth inoculation is carried out, a swab should also be collected.

Carefully remove needle and discard. Recap syringe and tape securely to syringe. Label syringe with patient details.

Swabs with bacteriology transport medium (blue top swab) are also suitable for anaerobic culture but at least two swabs must be collected. Anaerobic infections are often mixed infections and one swab is used for examination of Gram stain and aerobic culture while the other is reserved for anaerobic culture.

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BLOOD CULTUREA series of three paired culture bottles (one aerobic, one anaerobic) is required for adults.

A series of three single culture bottles (Paediatric) is required for children.

Mycobacterial culture media are available for immunosuppressed patients.

For VERY ILL patients three sets may be taken over a period of 30 minutes (10 minutes apart). Timing of cultures with fever peaks may be useful; however, clinical conditions may make this impractical.

For CHRONIC ILLNESS the three cultures may be taken at intervals coinciding with fever peaks, the periodicity of which may be quite variable (hours to days).

Venous and arterial blood are equally suitable. The bottles need to be marked so that only the correct amount is collected (8-10 mL for adults and 1-3 mL for children). If left to fill automatically they will continue to fill above the desired volume. The bottles also contain a resin which eliminates antibiotics and other toxins from the cultures.

If difficulty is experienced in obtaining adequate blood volume from some patients, the following is advised:

• One single adult aerobic bottle or one single paediatric bottle for smaller volumes.

NOTE: The formulation of the culture broth in the paediatric bottle optimizes bacterial growth for small volumes (1-3 mL) of blood regardless of the source.

Storage

Blood cultures should be kept at room temperature and forwarded to the laboratory for incubation as soon as possible.

BODY fLUIDSBody fluids should be collected in a labelled sterile container and capped immediately. The specimen should be submitted to the laboratory as soon as possible. If delay is anticipated the specimen should be stored in a refrigerator.

fAECESQML Pathology provides containers for the collection and transport of faeces. For infants a piece of glad wrap may be put into a nappy to collect the sample. Specimens in toilet paper or nappy liners are unsuitable.

Ideally patients should not have received preparations containing antimicrobials, bismuth, barium, kaolin, mineral oil, antidiarrhoeal or laxative agents during the 10 days prior to collection.

In general three faeces specimens each spaced a week apart (for Medicare rebate) will detect most parasitic infections.

formed and Semi-formed StoolsThe laboratory should receive the specimen kept at room temperature within two hours of collection. After hours or if any further delay is anticipated when culture is required, place

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ogy a pea-sized sample of the original specimen into faeces transport medium (bacterial)

and send both containers to the laboratory.

If several hours delay is anticipated before examination for ova, cysts and parasites, a small amount of semi-formed stool (the size of a pea) should also be placed into OCP (ova, cysts and parasites) transport medium.

NOTE: It is not necessary for a formed stool specimen to be put into OCP transport medium, provided it arrives at the laboratory the same day as specimen collection.

Both transport media are stored at room temperature. The remaining faeces specimen should be refrigerated until submitted to the laboratory.

Special Cases

Liquid stools - should be examined promptly. Please contact the laboratory to arrange immediate pick up.

Amoebae - faeces for suspected amoebiasis must be examined within 30 minutes of collection. Contact the laboratory to arrange for immediate pick up and transport of specimen. Do not refrigerate.

Rotavirus - faeces collected for Rotavirus do not require special transport media or precautions. The virus is only found in faeces during the acute stage of the illness. The specimen should be refrigerated while awaiting transportation and transported cooled to the laboratory as soon as possible.

Clostridium difficile - faeces should be collected in a standard faeces container. The specimen should be refrigerated while awaiting transportation and transported to the laboratory within 24 hours. The specimen should be submitted for Clostridium difficile Enterotoxin assay/PCR

NASOPHARYNGEAL SECRETIONSNasopharyngeal secretions may be collected for viral PCR and Bordetella pertussis PCR.

a) for Viral PCR (Respiratory Viruses)

The method of choice for the collection of nasopharyngeal secretions, particularly from children under five years of age is the suction technique. A fine bore catheter is passed through the nostril, along the nasal floor to the posterior pharyngeal wall.

Secretions are then aspirated by suction, e.g. by Oxyviva equipment into a trap or into a syringe of 20 mL or 50 mL capacity attached to the end of the catheter. Secretions should be obtained from both nostrils whenever possible and the secretions flushed from the catheter into the trap/syringe by aspirating 2-5 mL of sterile saline. When a syringe is used, expel the contents of the syringe into a sterile container e.g. a urine container.

Specimens should be sent to the laboratory as soon as possible and kept refrigerated (not frozen) until tested.

b) for Bordetella pertussis PCR

Specimens of choice are a Nasopharyngeal aspirate (collected as described in the Viral PCR section) or a Nasopharyngeal swab (dry swab not collected into any viral transport medium).

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y Equipment

8 FG Feeding tube is suitable for use with a 20-50 mL capacity syringe.

8 FG Suction catheter is suitable for use with Oxyviva suction equipment. This should be connected to a sterile specimen trap as shown in the diagram.

SPUTUMSputum should be collected in a labelled dry sterile screw cap (urine) container and capped immediately. This should be submitted to the laboratory as soon as possible. If delay is anticipated the specimen should be stored in a refrigerator.

URINEAfter cleaning the external genitalia, a midstream voided urine should be collected by the clean catch method into a sterile container or for babies in a paediatric bag. An early morning collection is preferred. Other sources include catheters, cystoscopes, suprapubic aspirates and urines from ileal conduits.

After collection aspirate the urine into the Monovette. Transport to the laboratory immediately. If transport to the laboratory is likely to be delayed refrigerate until transport is available. Suprapubic aspirates should be collected into a sterile container and refrigerated if transport to the laboratory is delayed.

URINE fOR MTB CULTUREFor Mycobacterial cultures collect a full 70 mL container of an early morning specimen. Monovettes are NOT acceptable for Mtb culture.

CATHETER TIPS fOR CULTURETips from indwelling venous and arterial catheters or cannulas may be submitted for culture purposes. Skin around the catheterized site should be disinfected prior to catheter removal. One to two centimetres of catheter tip should be cut with sterile scissors and dropped into a sterile container. Store at room temperature and transport to the laboratory as soon as possible.

OPHTHALMOLOGY MICROBIOLOGY KITMaterial from an ocular lesion for the purposes of microbiological culture is often very limited in quantity. In some circumstances it may be warranted to use some or all of the components of the Ophthalmology Microbiology Kit to ensure isolation of the pathogen or pathogens.

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ogyThe kit includes the following material:

• Bacterial transport swab (Stuart’s transport medium)

• Viral culture transport swab (for viral PCR)

• Two glass slides and slide carriers (smears)

• Blood agar plate

• Chocolate agar plate

• Sabouraud’s dextrose fungal plate

• Enrichment broth.

These components are available on request from Microbiology (07) 3121 4438 or your local Branch Laboratory. A variety of storage requirements and expiry dates indicate that the components of the kit are better obtained freshly on request from the laboratory when they are needed rather than them being stored at the surgery.

CUTANEOUS fUNGAL CULTUREIf superficial or deep mycoses are clinically suspected please indicate suspicion and specify fungal culture on the request form since superficial and deep fungi are not routinely screened for in material submitted for bacterial culture.

Deep Mycoses

If a deep mycosis is suspected a tissue biopsy offers an excellent source of material for culture and isolation of deep fungi. fresh tissue should be placed in a sterile dry container, without additives, and submitted to the laboratory as soon as possible. If transport delay is anticipated add a few drops of sterile saline to the dry tissue container to prevent dehydration.

Superficial Mycoses

Superficial mycoses may infect skin, hair and nails. The two most important factors leading to a false negative mycological result are antifungal medication received by the patient at the time of specimen collection, and a suboptimal amount of specimen.

• Antifungal medication (topical and systemic) should be ceased for at least two days, optimally for a week, prior to collection of the specimen.

• Please indicate on the request form the nature of the antifungal agent and the time of discontinuation.

• Cosmetic preparations should be ceased one to two days prior to collection of the specimen.

Skin (tinea or ringworm)

Sterile normal saline is suitable for cleansing skin lesions from heavily contaminated sites such as feet and sweat areas. The active edge of the skin lesion should be scraped with a sterile scalpel blade and as many flakes and fragments as possible collected in a sterile dry screw top container or a fungal scrapings envelope. In cases of vesicular tinea pedis, the tops of any fresh vesicles should be removed as the fungus is often plentiful in the roof of

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y the vesicle. If the lesion is exuding material and may be painful to scrape, a swab may be collected as an alternative. Use a dry swab previously moistened with saline to swab the lesion. Place the swab in a container without transport medium. The scalpel blade should be included with the specimen. Place the blade in a sterile dry screw top (urine) container NOT in a paper envelope. Please avoid sites with obvious secondary bacterial infection.

Scalp

Broken diseased hair including the basal portion should be gently removed with sterile epilation forceps. If scales are present on scalp lesions these may be collected in addition to, but not instead of hair specimens. Specimens may be placed in a dry sterile screw top (urine) container (a clean, sealable paper envelope will suffice).

Nail (onychomycosis)

Seventy percent (70%) alcohol is a suitable agent for cleansing nail lesions. Use a sterile scalpel blade, scraping with the tip if necessary, to obtain the invaded nail tissue. The nail should be pared and scraped until the crumbling white degenerating portion is reached. Any white keratin debris beneath the free edge of the nail should also be collected. Collected material should be placed in a dry sterile screw cap container or a fungal scrapings envelope.

Please note:• All collected material should be placed in clearly labelled sterile screw top containers or

fungal scrapings envelopes. • Material from different sites should be placed in different containers (identified to site). • For site cleansing, a gauze square is preferable to a cotton wool ball. • If the scalpel blade used to scrape the skin is forwarded to the laboratory it must be

placed in a sterile screw top (urine) container (NOT a paper envelope).

CUTANEOUS ECTOPARASITESScabies

The operator should wear gloves and materials required will be a sterile scalpel blade, paraffin oil, glass slide with frosted end labelled with patient identification (pencil) and cover slip.

Examine the area for unexcoriated papules or for linear or wavy erythematous lines or burrows. Having found a likely area, place a drop of paraffin oil on the scalpel blade. Apply the scalpel blade to the papule so that the mineral oil goes onto the papule surface.

Next, scrape vigorously about six to seven times with the blade to remove the entire top of the papule. Tiny flecks of blood should be mixed with the oil. Then, with the blade, remove all of the oil to a glass slide. Repeat this procedure with four or five different papules to the same glass slide. Apply the coverslip.

The slide should be clearly labelled with the patient identification. It should be placed in a slide carrier and forwarded to the laboratory as soon as possible.

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The diagnosis of head and crab lice is made by finding lice or nits on the hairs. Pull out diseased hairs with forceps and place in a sterile screw top container.

The diagnosis of body lice can be confirmed by finding lice and nits in the seams of clothing, particularly underclothing. Samples of lice and nits may be placed in a sterile screw top container. These containers should be clearly labelled with patient identification and forwarded to the laboratory as soon as possible.

Demodex

Demodex folliculorum is a microscopic, cigar-shaped creature with eight stumpy legs and an annulate abdomen. They are found in the hair follicles and sebaceous glands, particularly on the nose and face, and probably infest over half of middle-aged adults. The infestation is usually asymptomatic and is often noted incidentally on skin biopsies and excisions of facial skin. Infestation may be associated with blackheads.

Infestation of eyelashes or hairs may be symptomatic. In order to sample it is necessary to pull out an eyelash. This may be placed in a sterile screw top container. Alternatively, it may be placed on a glass slide with oil, and coverslipped.

Containers should be clearly labelled with patient identification. Slides should be clearly labelled with patient identification and placed in a slide carrier. The specimen should be forwarded to the laboratory as soon as possible.

CHLAMYDIA/GONORRHOEA PCRChlamydia PCR

QML Pathology has introduced an APTIMA assay for the simultaneous detection of both Chlamydia trachomatis and Neisseria gonorrhoeae in the same sample. Both swabs and urines are suitable samples for detection of Chlamydia with this assay. QML Pathology supplies an APTIMA collection kit with detailed instructions on collection techniques. The swab pack contains a white shaft swab which is a cleaning swab and a blue shaft swab which is a collection swab. The blue shaft swab should be placed in the APTIMA tube containing transport medium. There are no special storage conditions for these collection kits. Chlamydia are obligatory intracellular parasites, which survive and multiply only within living cells. for diagnostic purposes it is essential to collect infected epithelial cells rather than mucopurulent exudate. Any purulent exudate or secretions should first be removed with a sterile swab. Swabs for conventional bacterial cultures should be taken prior to that for Chlamydia PCR.

In WOMEN endocervical or urethral swabs should be collected. First catch urine is also a suitable alternative. In MEN a urethral swab OR a first catch urine sample may be collected.

Swabs from the vagina or from the penile meatus are unsuitable. If clinically indicated throat or rectal swabs should be collected. The swab should be gently rotated and remain inserted sufficiently long to allow adequate sampling and absorption (5 seconds within the urethra, 20 seconds within the endocervical canal). Try to avoid touching the swab on the vaginal wall on entry or exit.

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y first catch urine samples are the recommended urine specimen. The first 20 mL of any voided urine collected in a sterile urine container is an acceptable alternative to a swab. (Note: the blue Monovette containing preservative is not suitable for PCR testing.) The patient should not have urinated for two hours prior to the test.

In the case of conjunctival, throat or rectal infection, the sampling swab should be firmly rotated over the epithelial surface for between 10 and 20 seconds. In the case of the eye, the lower palpebral fissure is the most suitable site to sample. In infants nasopharyngeal swab or aspirate is appropriate. These swabs may cause some discomfort to the patient.

After collecting the sample with the swab it is placed into the white capped transport medium tube, snapped off and the cap screwed down tightly. There are no special storage or transport conditions for sending the specimen to the laboratory. If delay is anticipated, urine specimens should be refrigerated and referred to the laboratory within 72 hours.

Gonorrhoea PCR

Using an APTIMA collection kit, collect swabs as per the instructions. Alternatively, a first catch urine may be used. If culture is required, a bacterial swab should be collected and sent in Stuart’s transport medium.

VIRAL CULTUREQML Pathology supplies viral culture swabs and transport medium for detection of viruses including Herpes simplex I and II, and Varicella zoster in the sample by PCR (polymerase chain reaction - Nucleic acid detection) method. Detailed instructions on specimen collection are supplied with each kit. The swabs should be placed on an ice brick in an insulated container and sent to the laboratory as soon as possible. They should be refrigerated if stored overnight. Results of the PCR are available within 24 hours.

Special Collections for Cytomegalovirus Culture

Positive CMV IgM serology under certain circumstances may require confirmation by detection of virus by PCR (e.g. suspected antenatal or neonatal infection).

In these circumstances the specimens required include:

• Further serum sample (SS tube) PLUS

• 10 mL EDTA blood

• Saliva swab in viral culture transport medium (Virocult)

• Midstream urine in a sterile screw top (urine) container

• High vaginal swab in viral culture transport medium (Virocult) (antenatal cases only).

Results of PCR are generally available in 24 hours.

PREF

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ogyMANTOUX TEST

The objective of the Mantoux test is to examine an immune response 48 to 72 hours after an intradermal injection of purified protein derivative (PPD) of Mycobacterium tuberculosis and Mycobacterium avium. The technique involves injecting 0.1 mL of a solution containing 100 IU/mL of PPD (i.e. 10 IU per dose of 0.1 mL) using a 25 gauge needle into the dermis. This should raise a lump in the skin 5-6 mm in diameter. The injection should be repeated if it is too deep or if leakage occurs. The results are read 48 to 72 hours later. The clinician should palpate the site for the presence of oedema (induration). Erythema should be ignored. The diameter of the area of oedema measured at right angles to the long axis of the arm is recorded.

Note: A handy card giving guidance on the performance and interpretation of the Mantoux test is available on request from QML Pathology Liaison Department (07) 3121 4943 or your local Branch Laboratory.

Interpretation

A positive result is indicated by an area of induration 10mm or more in diameter. This indicates previous exposure to Mycobacterium tuberculosis, atypical mycobacteria or previous BCG vaccination. A negative result does not exclude active tuberculosis as the reaction may be suppressed by concurrent viral infection, cancer, drug therapy or severe bacterial infections (including tuberculosis).

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PATHOLOGY TESTS

TEST SELECTION GUIDE

ChEmISTryAcceptable test groupings approved abbreviations in parenthesis

Blood Gases• pO2 • HCO3• pCO2 • Base excess• pH • O2 saturation

Electrolytes (E)• Sodium (Na) • Bicarbonate (HCO3)• Potassium (K) • Anion Gap• Chloride (Cl)

Immunoglobulins• IgG • IgA• IgM • IgE

Lipid Studies• Cholesterol (CHOL)• Triglycerides (TRIG)• Classification of hyperlipidaemia

where indicated• High density lipoprotein cholesterol

when specifically requested (HDL)

Liver Function Tests (LFT)• Total Bilirubin (BILI.T)• Conjugated Bilirubin (BILI.D)• Alkaline Phosphatase (ALP)• Gamma Glutamyl Transferase (GGT)• Alanine Amino Transferase (ALT)• Aspartate Amino Transferase (AST)• Albumin (ALB)• Globulins• Total Protein• Lactate Dehydrogenase (LDH)

markers of heart Disease• Troponin (most specific)• Myoglobin (earliest)• BNP (heart failure)Others:• Aspartate Amino Transferase (AST)• Lactate Dehydrogenase (LDH)• Creatine Kinase (CK), CKMB

Specific Protein Quantitation• IgG • Alpha-1 antitrypsin• IgA • ACE (Angiotensin• IgM Converting Enzyme)• IgE • APO B• C3 • APO A1• C4 • Haptoglobin• IgG Subclasses

Therapeutic Drug monitoring

Analgesics• Salicylate• Paracetamol

Antibiotics• Amikacin• Gentamicin• Tobramycin• Vancomycin

Antiepileptics• Carbamazepine• Clonazepam• Lamotrigine• Gabapentin• Vigabatrin• Phenobarbital• Phenytoin• Primidone• Sulthiame• Valproate

Antineoplastic• Methotrexate

Bronchodilators• Theophylline

Cardiac• Digoxin• Quinidine• Perhexilene• Amiodarone• Mexilitene• Flecainide

Immunosuppressive• Cyclosporine• Tacrolimus (FK506)• Sirolimus (Rapamycin)• Mycophenolicacid

Vitamins• Vitamin A• Vitamin B1• Vitamin B2• Vitamin B6• Vitamin C• Vitamin D• Vitamin E

Drug Screening

• Cotinine (Urine/Serum)

Psychoactive• Benzodiazepines

(list specific requirements) - clobazam - clonazepam - diazepam - nitrazepam - oxazepam - temazepam

• Clozapine• Thioridazine• Mianserin

• Fluoxetine• Olanzapine• Lithium• Tricyclics

- amitriptyline - clomipramine (norclomipramine) - desipramine - doxepin (nordoxepin) - imipramine - nortriptyline - trimipramine

multiple Biochemical Analysis (E/LFT)• Sodium (Na)• Potassium (K)• Chloride (Cl)• Bicarbonate (HCO3)• Anion Gap• Glucose (GLUC)• Urea (U)• Creatinine (C)• Estimated GFR (eGFR)• Urate (URAT)• Total Bilirubin (BILI.T)• Alkaline Phosphatase (ALP)• Gamma Glutamyl Transferase (GGT)• Alanine Amino Transferase (ALT)• Aspartate Amino Transferase (AST)• Lactate Dehydrogenase (LD)• Calcium (Ca)• Corrected Calcium• Inorganic Phosphate (PHOS)• Total Protein (PROT)• Albumin (ALB)• Total Globulins• Iron• Cholesterol (CHOL)• Triglycerides (TRIG)

Contd.

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PATHOLOGY TESTS

Change in Cardiac markers Following myocardial Infarction* Peaks not drawn to same scale

Abnormal Protein Investigation• Serum Protein Electrophoresis• Cryoglobulins/Cryofibrinogen• Immunoglobulin Quantification• Immunofixation Studies

• Bence Jones Protein• Serum Free Light Chains

Amniotic Fluid• Alpha Fetoprotein• Bilirubin• Cytogenetics • L/S ratio

Calcium metabolism• Serum Ionised Calcium• Serum Parathormone• Serum 25 Hydroxy Vitamin D

Gastrointestinal• 24hr Urinary 5-H.I.A.A.• Serum Serotonin• Other gut derived hormones

on request.By appointment:• Xylose Absorption/3 Day Faecal Fat• Breath hydrogen study with lactose or

other sugar loading.

renal Function• Serum Urea• Creatinine Clearance• Serum Creatinine• 24hr Urinary Protein• Serum Urate• Timed Urinary Albumin

Toxicology• Comprehensive drug screen

on urine, blood or saliva (urine preferred except for alcohol).

• Heavy metals: - Lead - Mercury - Cadmium

• Red Cell & Serum Cholinesterase• Carboxyhaemoglobin• Methaemoglobin• Carbohydrate Deficient Transferrin

miscellaneous• Porphyrins:

- Blood, Urine, Faeces • Ammonia & Lactate• Metabolic Disease Screen• Faecal Sugar• Copper• Zinc• Magnesium• Special Proteins• Urine & Serum Osmolality (assayed)• Serum Cholinesterase

with Dibucaine Inhibition• Sweat Electrolytes• Glucose Tolerance Test• HbA1c/Fructosamine• Urinary Microalbumin• Amylase/Lipase• Acid Phosphatase• Muscle CK

• Alkaline Phosphatase & LD Isoenzymes• Urinary VMA (HMMA)• Metanephrines/Catecholamines• Intestinal Disaccharidases• Pancreatic Elastase• Zinc Protoporphyrin• NTX (N-Telopeptide Cross–Links)• DPD (Deoxypyridinoline)• Homocysteine

Occupational Drug Screen to AS/NZS 4308:2008• Immunoassay

- Cannabinoids

- Benzodiazepines - Cocaine - Sympathomimetic Amines - Opiates - Methadone (as requested) - Barbiturates (as requested) - Ethanol (alcohol, as requested)

• GCMS and LCMS confirmation - Cannabinoids (TCC) - Benzodiazepines (BDC) - Cocaine (CME) - Sympathomimetic Amines (SYM) - Opiates (OPC)

0 6 12 18 24 2 3 4 5 6 7 8 9 10

Normal

CK, ASTTroponinMyoglobin

LDH

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Hours DaysTIME AFTER INFARCT

CyTOLOGy/hISTOLOGy

Non Gynaecological Cytology

Body Fluids• Pleural Fluid• Ascitic/Peritoneal Fluids• Peritoneal Washings• Pericardial Fluid• Synovial Fluid• Ovarian Fluid• Gastric Fluid• Cerebrospinal Fluid

Fine Needle Aspirate• Breast • Head & Neck• Lung • Lymph Node• Thyroid • Soft Tissues• Prostate • Superficial

Palpable Lesions

respiratory• Sputum• Bronchial Brushings• Bronchial Washings• Bronchoalveolar Lavage

Urinary Tract• Urine• Bladder Washings• Urothelial Washings

miscellaneous• Nipple Discharge• Oral Cavity Smears

Gynaecological Cytology• Cervical Smear• Vaginal Smear • ThinPrep Imaging• HPV DNA Typing

hISTOLOGyTissue and Biopsy Specimens• Routine Tissue Diagnosis• Muscle Biopsy• Renal Biopsy• Nerve Biopsy• Cilial Biopsy

• Immunofluorescence• Frozen Section Service• Immunoperoxidase Stains

- oestrogen - progesterone - c-erbB2 studies - others as indicated

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ENDOCrINOLOGy

Thyroid Function Tests (TFT)• TSH as screen• Free T4 if:

- TSH is abnormal - Follow Up - Dementia/Psychiatric - Amenorrhoea/Infertility - ? Pituitary Disease - On Amiodarone, Lithium - Sick euthyroid in hospital

• Thyroid Antibodies, TSH Receptor Ab, ESR if: - ? Chronic Thyroiditis

- ? Acute Thyroiditis - ? Graves’/Hashimoto’s - ? Follow Up

Diabetes• 1 or 2 hr post prandial glucose & insulin• C Peptide• Glucagon Stimulation Test

Gastritis• Gastrin • Urea Breath Test

Growth• Growth Hormone• Somatomedian C (IGF-1)

Adrenal Function

Cushing’s• Cortisol + ACTH• 24hr Urinary Cortisol• Overnight Dexamethasone

Suppression Test

Addison’s• Cortisol + ACTH• Synacthen Stimulation Test

Amenorrhoea• Pregnancy Test • Oestradiol• LH:FSH • Prolactin•? Adrenal/Thyroid/Pituitary Disease

hypertension• Renin + Aldosterone

hirsutism• LH:FSH • DHEA Sulphate• Oestradiol • Androstenedione• Testosterone • SHBG

Antenatal• HCG • Progesterone• ? Ectopic - lower than expected HCG

Down's Screen

First Trimester (111/2 -13 wks 6 days)

• Free ßHCG• PAPP-A

Second Trimester including Spina Bifida Screen (15-18 wks is best but can be done at 14-22 wks)• AFP • HCG • Free Oestriol

Calcium homeostasis• Parathyroid Hormone (PTH)• Calcium + Albumin + Ionised Calcium• Random Urinary Calcium Clearance

Tumour markers

Prostate• PSA

Breast• CA 15-3 • CEA

Ovary• CA 125 • CA 19-9

Colon• CEA • CA 19-9

hAEmATOLOGy/BLOOD BANKQML Pathology Warfarin Care Clinic Patient Registration 1300 795 355

Acceptable test groupings approved abbreviations in parenthesis

Complete Blood Examination (FBC, FBE, CBE, CBP)• Haemoglobin (Hb)• Haematocrit (PCV)• Red Cell Count (RBC)• Red Cell Indices• Leucocyte Count (WBC)• Platelet Count• Differential Leucocyte Count• Blood Film Examination

Thalassaemia/ haemoglobinopathy Screen• Hb• Red Cell Indices• Hb Electrophoresis• HbA2• HbF Quantification• HbH Bodies

Coagulation Screen (COAG)Includes:• PT• APTT• Fibrinogen• Platelet Count• TCT

GENETICS

Andrology• Seminal Analysis• Antisperm Antibodies

Cytogenetics

Chromosome Analysis• Prenatal• Postnatal• Oncology

Fluorescent In Situ hybridisation (FISh)• Microdeletion Syndromes• Aneuploidy Screening• Telomere Screening• Oncology

- Fusion Probes for common haematological malignancies e.g. t(9;22) bcr/abl - Multiple Myeloma Panel - CLL Panel

• Paraffin Tissue Studies - Her2/Neu - Oligodendroglioma - Lymphoma

molecular Genetics• Haemochromatosis

(C282Y, H63D & S65C)• Factor V Leiden• Prothrombin G20210A• Apolipoprotein E Genotyping• MTHFR Mutation• B Cell IgH Gene Rearrangement• Bcl-1• Bcl-2• T cell Receptor Gene Rearrangement• Bcr/abl• Fragile X Syndrome• Y chromosome Deletion Analysis

(AZFa, AZFb, AZFc) for Male Infertility.• Sex Determining Region of the

Y Chromosome (SRY)• Cat Scratch Disease• Clostridium Difficile• Cystic Fibrosis• HLA-B27• Malaria

Contd.

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Cross matchingIncludes test for Rh and/or other blood group antibodies.

Bone marrow ExaminationPlease state if cytogenetics or markers are required.

marrow Booking: (07) 3121 4573

Suggested tests for common haematological disorders from which a selection may be made. These tests must be requested individually.

Leukaemia/Lymphoma• FBC• Bone Marrow Examination• Cytogenetics• Molecular Genetics• Cell surface markers as indicated.

Polycythaemia• EPO• JAK-2

Anaemias

haemolytic• FBC/Retics• Bilirubin/LDH• Haptoglobin• Coombs testWhere indicated:• Hypertonic Cryohaemolysis• Cold Agglutinins• ANA• G6PD• Unstable Hb• PNH Screen• Flow cytometry screening for

hereditary spherocytosis.

macrocytic• FBC/Retics/Coombs Test• E/LFT• Red Cell Folate/B12

• TSHWhere necessary:• Intrinsic Factor Abs• Bone Marrow Examination

microcytic• FBC/Retics• Iron Studies• Zinc Protoporphyrin (ZPP)If unhelpful consider Haemoglobinopathy, Thalassaemia or Sideroblastic Anaemia.

Normocytic• FBC/Retics• ESR• Iron Studies• Red Cell Folate/B12• E/LFT• EPP/Urine Bence Jones Protein• TSH• ANA• LH/Testosterone (Males)Where indicated:• Bone Marrow Examination

Leucocyte Disorders

Neutrophilia• ESR/CRP• Iron Studies• B12• NAP Score• E/LFT• ANAWhere indicated:• Bone Marrow Biopsy

• BCR - ABL

Neutropenia• FBC/Retics• Coombs• Iron Studies• B12/Folate

• GIFT• ANA• Lymphocyte MarkersWhere indicated:• Bone Marrow Examination

Eosinophilia• Faecal O/C/P• IgE• Serology for parasites e.g. strongyloides• NAP• TSH• B12

Lymphocytosis• Lymphocyte Surface Markers

Immunoproliferative Diseases• Serum EPP• Immunofixation• Quantitation of Immunoglobulins• Bence Jones Protein• Bone Marrow Examination• Lymphocyte Marker Studies• 2 Microglobulin

Thrombocytosis• ESR/CRP• Iron Studies• B12• NAP Score• Faecal Occult Blood

Thrombocytopenia• FBC/Retics• Coombs• Haptoglobin• B12/Folate• PIFT• ANA/ACLA• Lupus Anticoagulant• PT/APPTT/Fibrinogen• D-Dimer

Coagulation

Anticoagulant Control Oral Therapy• Prothrombin Time/INR

Unfractionated heparin• APTTTherapeutic range 60-95 seconds for continuous infusion or intermittent therapy (sample collected 30-45 minutes before next injection).

LmWh• Monitoring is rarely needed.

haemorrhagic DisordersIf abnormal coagulation screen or if significant family/clinical history of bleeding, von Willebrand’s Disease or other deficiency states may be considered:• F VIII:C• vWF:Ag• vWF:RiCoFIf required:• Collagen Binding Assays• Other specific factor assays as indicated.• Platelet Aggregation Studies• Circulating Inhibitor Tests

recurrent Thrombosis/Thrombophilia• FBC• APTT/PT/Fibrinogen• Antithrombin III• Lupus Inhibitor• Protein C/Protein S• Plasminogen• Cardiolipin Antibodies• APC Resistance• Factor V Leiden/

Prothrombin G20210A Mutation• E/LFT - Homocysteine

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ImmUNOLOGyrequired tests must be ordered individually.

Allergic Disorders• Total IgE• Skin Testing• RAST - single or multiple allergens

(max. 4 per request).

Arthritis

• Anti CCP

• ANA

• Anti DNA

• ENA

• ANCA

• C Reactive Protein

• HLA B27 Typing

• Rheumatoid Factor

• Serology - Streptococci - Ross River - Parvovirus - Barmah Forest - Rubella - Shigella - Yersinia - Campylobacter

• Uric Acid

Autoimmune Disease

• Antinuclear Antibodies (ANA)

• Anti-DNA

• Anti-extractable Nuclear Antigens (ENA)

• ANCA

• C3

• C4

• Haemolytic Complement

• Rheumatoid Factor

• Rose-Waaler

• Antiphospolipid Antibodies - Cardiolipin Ab - Lupus anticoagulant

• Other tissue autoantibodies as indicated. e.g.: - Mitochondrial Ab (AMA)

- Smooth Muscle Ab (SMA) - Parietal Cell Ab (PCA)

Coeliac Disease

Adults

• Anti TTG or anti EMA

Children

• Anti TTG or anti EMA

• Anti Gliadin IgA

• Anti Gliadin IgG

Immunodeficiency States

• EPP

• lgG

• IgA

• IgM

• IgG Subclasses

• C3

• C4

• Haemolytic Complement

• Neutrophil Oxidative Burst

• Neutrophil Function Tests

• T & B Cell Quantitation

• Lymphocyte Function Tests

mICrOBIOLOGy and mICrOBIAL SErOLOGyNotesComplete clinical history (including recent travel) is important. Please request tests individually (profiles not acceptable) and include the nature and site of the specimen. Some serological tests can be diagnostic on testing of acute phase serum (e.g. detecting IgM antibodies), while some tests require paired sera 14 days apart.

Antenatal Screening• HepBsAg • HIV• Rubella • Syphilis

CNS• Blood culture• CSF

- Differential Cell Count - Glucose - Chloride - Protein - Bacterial Culture - TB Culture - Virus PCR - HSV - Enterovirus - CMV - HIV - Bacterial PCR - N. Meningitidis - Cryptococcus Antigen

• Serology - Arbovirus - HSV - Meningococcal IgM - Measles - Mumps - Syphilis - Cryptococcus - Toxoplasma - Rubella

Cardiac

Serology• Cat Scratch Disease (CSD)• Enterovirus • Q Fever• Streptococcal • Toxoplasma• Syphilis

PCr• Cat Scratch Disease (CSD)

- Cardiac Tissue

Congenital Screening• CMV• Rubella• Toxoplasma• HSV 1&2• Syphilis

DiarrhoeaFaeces• Microscopy

- Ova - Cysts - Parasites

• Culture for pathogens - Bacteria - Viral culture not performed

• Rotavirus Assay• PCR

- Clostridium difficile toxin gene (antibiotic associated diarrhoea) - EHEC (Enterohaemorrhagic E coli) PCR

Genital

Genital herpes• PCR • Serology

Contd.

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Genital Sore• HSV PCR• Microscopy/Culture• Syphilis Serology

Genital Discharge• Chlamydia PCR • Gonococcal PCR• Microscopy/Culture • Syphilis Serology• Trichomonas

- PCR

hepatitis A, B, CPlease request specific tests.

Acute Investigation• Hep A IgM • HBsAg• HCV

Infectivity Status• HBsAg • HCV

Immunity/Post Vaccination• HBsAb • Hep A IgG

Other hepatitis• Amoebic • Brucella • CMV • EBV• Hep E • Hydatid• Leptospira • Q Fever

Lymphadenopathy/mononucleosis

Serology• Adenovirus • HIV• Brucella• Cytomegalovirus• Cat Scratch Disease (CSD)• EBV• Mumps• Rubella• Syphilis• Toxoplasma

PCr• Cat Scratch Disease (CSD)

- Lymph node tissue

Pyrexia of Unknown Origin (PUO)• Blood Culture x 3• Urine Micro & Culture• Malarial Films• Culture of any cutaneous lesion

or exudate (e.g. sputum)• Serology

- Leptospira - Brucella - Q Fever - Mycoplasma - Toxoplasma - Dengue PCR - Arbovirus - Influenza - Salmonella - Rickettsia - Cat Scratch Disease

• Mantoux Skin Test

rash

Vesicular• HSV PCR• VZV PCR• Enterovirus PCR (Throat, Skin Lesions)• Micro & Culture for Bacteria• Serology

- Echocoxsackie - HSV - VZV - Rickettsiae

Nonvesicular• Micro & Culture for Dermatophytes• Serology

- Rubella - Ross River - Barmah Forest - Dengue

- Measles - Arbovirus - Rickettsia - CMV - Syphilis - Parvovirus - HIV - Streptococcus

renal Tract Infection• Urine & Micro Culture• Blood Cultures (Systemic Symptoms) x 2• Serology

- ASOT/Anti DNase B titres (nephritis)

respiratory Infections

Upper• Culture (Throat Swab)• Bordetella Pertussis PCR

(Throat Swab/NPA)• Respiratory Virus PCR (NPA)

- RSV - Influenza - Parainfluenza - Adenovirus

• Serology - ASOT/Anti DNase B - Bordetella Pertussis - Influenza

with adenopathy:• Infectious Mononucleosis• Toxoplasma

• CMV• Adenovirus

Lower - Acute• Micro & Culture (Sputum)• Blood Cultures x 2• Legionella PCR (Sputum)• Legionella Urinary Antigen (Urine)• Mycoplasma PCR (Sputum)• Serology

- Mycoplasma - Psittacosis - Q Fever - Legionella - Cryptococcus - Influenza - Chlamydia pneumoniae

Lower - Non resolving• Culture (Sputum)• Fungi x 3• MTB Micro & Culture x 3• Sputum Malignant Cells x 3• Mantoux Skin Test• Serology

- Mycoplasma - Legionella - Fungal Precipitins (Aspergillus, Micropolyspora, Thermoactinomyces) - HIV - Herpes

• BAL (Bronchial Alveolar Large) - D/w Microbiologist

Interpretation of hepatitis B Serology

Pattern hBsAg hBeAg hBcAb hBc Igm hBeAb hbsAb Infective

Early Acute + + ++Acute + + + + ++Resolving + + + +/- +/-Past + +/- +/- -Chronic + +/- + +/- ++Post Immunisation +

TEST NAME DEPARTMENT SPECIMEN CONTAINER REPORTING TIME COMMENTS

1,1,1,- TRICHLOROETHANE, BLOOD

Biochemistry Please refer to SOLVENTS, BLOOD for all details.

1,25-DIHYDROXY CHOLECALCIFEROL

Biochemistry Please refer to 1,25-DIHYDROXY VITAMIN D, SERUM.

1,25-DIHYDROXY VITAMIN D, SERUM

Biochemistry Blood/SS tube or Red top tube

2 weeks 25-Hydroxy calciferol and 1,25-Dihydroxy calciferol may be measured. Ideally, patient should fast but this is not essential. Specimen should be centrifuged and serum separated. Active form of vitamin D - not useful unless in renal failure because of variability.

17-HYDROXYPROGESTERONE, SERUM

Endocrinology Blood/SS tube 1 week Please provide clinical and medication details.

1-HYDROXYPYRENE, URINE Biochemistry Urine/50 mLurine container

2 - 3 weeks Random urine collected at the end of work shift or exposure. This test attracts a charge of approximately $110 from the referring laboratory, payable by the patient or their employer. Please indicate on the request form if permission or prior arrangement has been granted to perform test.

1-METHYL HISTAMINE, URINE Biochemistry Please refer to HISTAMINE, URINE. 1-methyl histamine is a dietary derivative.

2, 4, 5-T (HERBICIDE), URINE Biochemistry Test for unusual exposure - note this herbicide is no longer in use. Please refer to HERBICIDES, URINE.

2, 4-D (HERBICIDE), URINE Biochemistry Please refer to HERBICIDES, URINE.

25-HYDROXY CHOLECALCIFEROL, SERUM

Biochemistry Please refer to VITAMIN D, SERUM.

25-HYDROXY VITAMIN D, SERUM


25-HYDROXY VITAMIN D3, SERUM


3-HYDROXYBUTYRATE, SERUM OR PLASMA

Biochemistry Blood/Lithium heparin tube or SS tube

1 week Ketone body quantitative assay. Referred test.

4-HYDROXY-3-METHOXY MANDELIC ACID, URINE

Biochemistry Please refer to CATECHOLAMINES, URINE.

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Results (07) 3121 4555www.qml.com.au


5-ALA, URINE Biochemistry Urine/Urine container 2 - 3 weeks Occasionally used in testing for acute intermittent porphyria. Also raised in lead poisoning. Collect while patient is experiencing symptoms. Protect sample from light. Store and transport frozen. Referred test.

5-H.I.A.A., URINE Biochemistry Urine/24 hour urine container with 25 mL 6M HCI preservative

1 - 2 weeks Tumour marker - carcinoid tumour. Also raised if patient fails to avoid dietary serotonin. Please provide clinical and medication details, especially recent changes in medication. Please refer to: ‘Urine Collection Diet for 5-H.I.A.A and Catecholamine (12.11)’ for dietary and drug restrictions during or just prior to collection. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Under certain special circumstances, e.g. small children, a random urine can be collected. If this is required, contact senior Biochemistry staff prior to collection (07) 3121 4083.

5-HYDROXY TRYPTAMINE, URINE

Biochemistry Please refer to SEROTONIN, URINE 24 HOUR.

6-THIOGUANINE (6-TG), BLOOD Biochemistry Blood/EDTA tube 3 weeks Transport at 4°C.

7-BIOPTERIN, URINE Biochemistry Please refer to PTERINS, URINE for details. Referred test.

7-DEHYDROCHOLESTEROL, PLASMA

Biochemistry Blood/Lithiumheparin tube

3 weeks Sample must be centrifuged, serum separated into a 6 mL Falcon tube and frozen within 30 minutes of collection. Transport on dry ice. Referred test.

A/G RATIO, SYNOVIAL FLUID Biochemistry Please refer to ALBUMIN, SYNOVIAL FLUID.

ACE, SERUM Biochemistry Please refer to ANGIOTENSIN CONVERTING ENZYME, SERUM.

ACETAMINOPHEN, SERUM Biochemistry Please refer to PARACETAMOL, SERUM.

ACETOACETATE, SERUM Biochemistry Please refer to KETONE SCREEN, SERUM.

ACETOACETATE, URINE Biochemistry Please refer to PIGMENTS, URINE.

ACETONE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

ACETONE, URINE Biochemistry Urine/Urine container 3 weeks Random urine collected at the end of work shift or exposure. This test will only be performed with the permission of the patient or their employer due to the cost of the assay. If the patient wishes to proceed with the test, indicate on the request form that permission has been granted to perform the test.

ACETYL SALICYCLIC ACID, SERUM

Biochemistry Please refer to SALICYLATE, SERUM.

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ACETYLATOR PHENOTYPE, BLOOD/URINE

Biochemistry Test is currently unavailable due to withdrawal of the sulphonamines used in the test.

ACETYLCHOLINE RECEPTOR ANTIBODY, SERUM

Immunology Blood/SS tube 1 week Refer to ADENOVIRUS SEROLOGY for collection details.

ACETYLCHOLINESTERASE, AMNIOTIC FLUID

Biochemistry Amniotic fl uid/Plain plastic tube

1 week Test for open neural tube defects.

ACETYLCHOLINESTERASE, RED CELL

Biochemistry Blood/Lithium heparin tube or EDTA tube

1 day Test for organophosphate or carbamate insecticide toxicity. Please provide clinical details including exposure to pesticides etc. Leave as whole blood. Refer to Biochemistry Appendix (12.18) for a comprehensive list of organophosphate and carbamate pesticides. Reduced red cell levels of cholinesterase usually equate with organophosphate and carbamate toxicity. Test can be performed on urgent basis. Screening test intervals depend on levels of exposure. Local and Regional Councils routinely recommend 3-6 monthly screens for exposed staff. Heavy users recommend 3 monthly screen and screening anytime after intensive use.

ACID MALTASE, BLOOD Biochemistry Please refer to LYSOSOMAL ENZYMES, BLOOD.

ACID PHOSPHATASE (FEMALE), SERUM

Biochemistry Blood/SS tube 24 hours Process sample as for ACID PHOSPHATASE (PROSTATIC), SERUM.

ACID PHOSPHATASE (PROSTATIC), SERUM

Biochemistry Blood/SS tube (Preserved by the addition of 1 drop of acid phosphatase preservative per 1 mL of serum)

24 hours Tumour marker - original test for prostatic malignancy. Not as sensitive as prostate-specifi c antigen but less prone to elevation in benign disease. This test has been largely replaced by prostate-specifi c antigen (PSA) and no longer attracts a Medicare refund.

ACIDIFIED SERUM TEST (HAM TEST), BLOOD

Haematology Blood/SS tubeand EDTA tube

24 hours Test for detection of Paroxysmal Nocturnal Haemoglobinuria (Haemolytic Anaemia). Please contact Haematology (07) 3121 4451 or Branch Laboratory for details. Flow cytometry for PNH is the preferred test.

ACTH STIMULATION TEST Endocrinology Blood/SS tubeand EDTA tube

24 hours Give intramuscular injection of Synacthen (0.25mg/1 mL). Collect blood samples prior to injection and at 30 and 60 minutes post injection. Also collect an EDTA tube on the basal specimen. Cortisol is measured on all the 3 specimens and if results are abnormal an ACTH is measured on the basal EDTA tube. Please contact your local QML Pathology laboratory for supply of Synacthen ampoule. Please include details of any corticosteroids taken recently (especially in the past 24 hours).

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ACTH, PLASMA Endocrinology Blood/2 x EDTA tubes 24 hours Specimen should be kept cold in transit. Plasma specimen must not be frozen until separated from red cells, decanted and stored in a plain plastic tube.

ACTINOMYCES CULTURE Microbiology Swab/Swab collected in transport medium or specimen in a sterile container

Initial culture results available48 hours, fi nal report 7 days.

Please specify site of collection and provide clinical details including antibiotic therapy. Culture performed on mandible swabs and mouth swabs sent from dentists.

ACTIVATED PROTEIN C - RESISTANCE (APC)

Haematology Blood/EDTA tube and Sodium citrate tube

24 hours Specimens should be stored and transported cooled. They must reach the laboratory within 2 hours of collection. A history of thromboembolism or a proven APC defect in a fi rst degree relative must be stated on the request form to attract the Medicare rebate.

PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Thrombotic assay requests are only Medicare refundable if one of the following is stated on the request form by the patient’s doctor:1. That the patient has a personal history of venous thromboembolism (DVT) or

arterial thrombosis (PE);2. That a fi rst degree relative of the patient has a proven defect in one or more of

the thrombotic test(s) requested and that the particular defect(s) are stated on the request form; or

3. That the request is to confi rm an abnormal or indeterminate result.

IF THE REQUEST IS NOT REFUNDABLE BECAUSE OF THE ABOVE CONDITIONS, THE PATIENT WILL BE CHARGED A NON-REFUNDABLE AMOUNT. PLEASE INFORM THE PATIENT IF THE TESTING WILL RESULT IN AN ACCOUNT BEING SENT TO THE PATIENT.

ACTIVE VITAMIN B12 Haematology Blood/SS tube 3 days If requested with VITAMIN B12, SERUM a non Medicare rebatable fee of approx. $25.00 is charged to the patient.

ACYL CARNITINE, NEONATAL SCREEN

Biochemistry Capillary blood sample (heel prick)/Neonatal screening card

2 - 4 weeks HEEL PRICK SAMPLE REQUIRED. Please refer to the instructions on the Neonatal Screening Test card. Please note: Card must be completely air dried and transported in a paper bag or envelope. Referred test.

ACYL CARNITINE, SERUM Biochemistry Blood/SS tube 1 - 2 weeks Fresh random sample required. Transport in esky at 4°C. Referred test.

ADENOSINE DEAMINASE, BLOOD


Indeterminate Only available as a test for severe combined immunodefi ciency. Clinical reason for the test must be stated. Referred test. Please advise patient that this test attracts a non-Medicare refundable fee from the referring laboratory.

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PATHOLOGY TESTS



ADENOVIRUS SEROLOGY Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday.

ADENYLSUCCINASE, URINE Biochemistry Urine/Urine container 1 - 2 weeks Random early morning urine collection preferred.Refrigerate for transfer to laboratory. Referred test.

ADRENAL ANTIBODIES, SERUM Immunology Blood/SS tube 2 weeks

ADRENAL CORTICOSTEROID LEVEL, SERUM

Endocrinology Blood/SS tube 24 hours Patient should rest for 20 minutes prior to testing. Note time of collection on specimen and request form.

ADRENALIN, URINE Biochemistry Please refer to CATECHOLAMINES, URINE.

ADRENOCORTICOTROPHIC HORMONE (ACTH) STIMULATION TEST

Endocrinology Blood/SS tubeand EDTA tube

24 hours Give intramuscular injection of Synacthen (0.25mg/1 mL). Collect blood samples prior to injection and at 30 and 60 minutes post injection. Also collect an EDTA tube on the basal specimen. Cortisol is measured on all the 3 specimens and if results are abnormal an ACTH is measured on the basal EDTA specimen. Please contact your local QML Pathology laboratory for supply of Synacthen ampoule. Please include details of any corticosteroids taken recently (especially in the past 24 hours).

ADRENOCORTICOTROPHIC HORMONE (ACTH), PLASMA

Endocrinology Blood/2 x EDTA tubes 24 hours Specimen should be kept cold in transit. Plasma specimen must not be frozen until separated from red cells, decanted and stored in a plain plastic tube.

AFP (ALPHA FOETOPROTEIN) - TUMOUR MARKER, SERUM

Endocrinology Blood/SS tube 24 hours Alpha foetoprotein is used as an aid in the management of patients with nonseminomatous testicular carcinoma (embryonal carcinoma and yolk sac carcinoma) and hepatocellular carcinoma.

AFP (ALPHA FOETOPROTEIN), SERUM

Endocrinology Blood/SS tube 24 hours Period of amenorrhoea (A=) and estimated date of confi nement (EDC) required for test interpretation.

AIDS ANTIBODY - INSURANCE/VISA

Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday). HIV1/HIV2/HIV antigen routinely performed.

AIDS SEROLOGY Immunology Blood/SS tube (extra SS tube if other tests requested)

24 hours Assay run daily (Monday - Saturday). HIV1/HIV2/HIV antigen routinely performed.

ALA, URINE Biochemistry Please refer to 5-ALA, URINE.

ALBUMIN, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify site of fl uid on specimen container and request form.

ALBUMIN, SERUM Biochemistry Please refer to E/LFT, SERUM.

ALBUMIN, SYNOVIAL FLUID Biochemistry Synovial fl uid/Plain plastic tube

Same day Please provide clinical and medication details. Raised in joint infl ammation. Synovial fl uid collection kits are provided on request.

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PATHOLOGY TESTS



ALBUMIN, URINE Biochemistry Urine/Urine container.No preservative

24 hours Test for progression of diabetic nephropathy. Please provide clinical and medication details. An 8 hour overnight timed sample is the preferred specimen for this test (i.e. void urine prior to retiring and collect all urine over the next 8 hours). PLEASE PROVIDE START AND FINISH TIMES OF URINE COLLECTION. If specifi cally required, a random sample or a 24 hour collection may be collected instead.

ALBUMIN/GLOBULIN RATIO, SYNOVIAL FLUID

Biochemistry Please refer to ALBUMIN, SYNOVIAL FLUID.

ALBUTEROL, URINE Biochemistry Please refer to SALBUTAMOL, URINE.

ALCOHOL, SERUM(BLOOD) LEGAL

Biochemistry Blood/Fluorideoxalate tube

By midday next working day

Clean skin with aqueous chlorhexidine or water. Seal tops of tubes and sign across label (see Biochemistry Preface 5.2). The specimens should be accompanied by Chain-of-Custody documentation signed by both patient and collector. Forms are available from QML Pathology on request. Please contact Biochemistry (07) 3121 4971 or Branch Laboratory. Non Medicare refundable cost to patient.

ALCOHOL, SERUM(BLOOD) NON-LEGAL

Biochemistry Blood/Fluoride oxalate tube (SS tube also acceptable for non-legal)

Same day Clean skin with aqueous chlorhexidine or water. If the possibility of a legally-required sample exists, an additional Fluoride oxalate tube should be collected. This tube should be sealed as for a legally-required test (see Biochemistry Preface 5.2) accompanied by Chain-of-Custody documentation signed by both patient and collector (available from QML Pathology on request). This will be stored and if the medical result is required subsequently for legal purposes, the result will be validated from the held specimen.

ALCOHOL, URINE(NON-OCCUPATIONAL)

Biochemistry Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER CHROMATOGRAPHY), URINE.

ALDICARB (PESTICIDE), BLOOD

Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity.

ALDOLASE, SERUM Biochemistry Test for skeletal muscle injury. Refer to LACTATE DEHYDROGENASE (LD/LDH) ISOENZYMES, SERUM.

ALDOSTERONE, SERUM Endocrinology Blood/SS tube 24 hours Aldosterone is a steroid hormone produced by the adrenal cortex. It promotes sodium reabsorption, water retention, and potassium excretion. It is often measured in conjunction with Renin in the investigation of causes of hypertension.

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PATHOLOGY TESTS



ALDOSTERONE,URINE 24 HOUR

Endocrinology 24 hour urine collection/Urine collection bottle.No preservative

1 week Urine should be refrigerated during the collection period and transported cooled to the laboratory.

ALDOSTERONE/RENIN RATIO, PLASMA

Endocrinology Blood/2 x EDTA tubes, SS tube

24 hours Special collection and handling of Renin specimen required. Refer to RENIN, PLASMA.

ALDRIN (ORGANOCHLORINE PESTICIDES), BLOOD

Biochemistry Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

ALEPAM, SERUM Biochemistry Please refer to OXAZEPAM, SERUM.

ALIPHATIC SOLVENTS Biochemistry Please refer to SOLVENTS, BLOOD for all details.

ALKALINE PHOSPHATASE ISOENZYMES, SERUM

Biochemistry Blood/SS tube 2 - 3 days Test to determine nature of unexplained elevation of alk. phos. Provide clinical and medication details.

ALKALINE PHOSPHATASE, FLUID

Biochemistry Fluid/Plain tube/Container

Same day Specify source of fl uid on sample and request form.

ALKALINE PHOSPHATASE, SERUM

Biochemistry Please refer to E/LFT, SERUM.

ALKAPTONURIA SCREEN, URINE Biochemistry Please refer to HOMOGENTISIC ACID, URINE.

ALLEGRON, SERUM Biochemistry Please refer to NORTRIPTYLINE, SERUM.

ALLERGEN-SPECIFIC IgE (RAST), SERUM

Immunology Blood/SS tube 72 hours Assay run daily (Monday to Friday). Doctors can only order four allergens per patient episode. Medicare will only pay for four episodes per patient per year. A year is taken as a calendar year. For details of testing, allergens and Medicare restrictions please refer to Immunology Preface (5.49) and Appendix (12.37) or contact Immunology (07) 3121 4458 or Branch Laboratory.

ALLERGY SKIN TEST Immunology Skin Prick Test 72 hours Test performed by appointment at our special test collection centres. Please contact your local Branch Laboratory for locations.

ALLOPURINOL, PLASMA Biochemistry Please refer to OXYPURINOL, PLASMA for details.

ALODORM, SERUM Biochemistry Please refer to NITRAZEPAM, SERUM.

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PATHOLOGY TESTS



ALPHA 2 ANTIPLASMIN Haematology Blood/Sodiumcitrate tube

5 weeks Please contact Haematology (07) 3121 4451 or your Branch Laboratory for details before collection. Referred test. NOTE: This test is referred to Austin Hospital. Inform patient that they will be charged a non-refundable fee of approx. $30 by Austin Repatriation Hospital.

ALPHA SUBUNIT (FREE) Endocrinology Blood/SS tube 1 - 2 weeks Referred test.

ALPHA THALASSAEMIA GENE TESTING

Haematology Blood/2 x EDTA tubes,1 x SS tube

4 weeks Incurs non-Medicare refundable fee.

ALPHA-1-ACID GLYCOPROTEIN, SERUM

Biochemistry Serum/SS tube 1 - 2 weeks Please advise patient that this test attracts a non-Medicare refundable fee from the referring laboratory. Transport at 4°C.

ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM

Biochemistry Please refer to ALPHA-1-ANTITRYPSIN PHENOTYPE/GENOTYPE, PLASMA.

ALPHA-1-ANTITRYPSIN PHENOTYPE/GENOTYPE, PLASMA

Biochemistry Blood/EDTA tube 2 - 3 weeks Defi ciency predisposes to premature severe emphysema - genotype more useful in family studies. Please provide clinical and medication details. Referred test. Please advise patient that Genotype testing attracts a non-Medicare refundable fee from the referring laboratory

ALPHA-1-ANTITRYPSIN, FAECES

Biochemistry Faeces/Faeces container 2 weeks A marker for the detection of enteric protein loosing states. Freeze sample as soon as possible after collection. Referred test.

ALPHA-1-ANTITRYPSIN, SERUM

Biochemistry Blood/SS tube 24 hours Defi ciency predisposes to premature severe emphysema. Please provide clinical and medication details. If phenotyping is also required also collect 1 x EDTA tube.

ALPHA-1,4 GLUCOSIDASE, BLOOD

Biochemistry Please refer to LYSOSOMAL ENZYMES, BLOOD.

ALPHA-2 MACROGLOBULIN, SERUM

Biochemistry Blood/SS tube 1 - 2 weeks Transport in esky at 4°C. Referred test.

ALPHA-FOETOPROTEIN (AFP) - TUMOUR MARKER, SERUM

Endocrinology Blood/SS tube 24 hours Alpha foetoprotein is used as an aid in the management of patients with nonseminomatous testicular carcinoma (embryonal carcinoma and yolk sac carcinoma) and hepatocellular carcinoma. Please provide date and details of previous AFP assay if patient is being monitored following treatment.

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PATHOLOGY TESTS



ALPHA-FOETOPROTEIN (AFP), AMNIOTIC FLUID

Endocrinology Amniotic Fluid/Amber sterile 10 mL Black top tube

24 hours Date of last normal menstrual period (LNMP), period of amenorrhoea (A=) and estimated date of confi nement (EDC) required.

ALPHA-FOETOPROTEIN (AFP), SERUM

Endocrinology Blood/SS tube 24 hours Period of amenorrhoea (A=) and estimated date of confi nement (EDC) required for test interpretation.

ALPHA-FUCOSIDASE, BLOOD


ALPHA-GALACTOSIDASE, BLOOD


ALPHA-TOCOPHEROL, SERUM

Biochemistry Please refer to VITAMIN E, SERUM.

ALPRAZOLAM, SERUM

Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (Lithium heparin tube acceptable)

2 weeks Provide clinical and medication details. Record time and date of last dose. Collect just prior to next dose. Please keep sample refrigerated. Referred test.

ALT (GPT), SERUM Biochemistry Please refer to E/LFT, SERUM.

ALT, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify source of fl uid on sample and request form.

ALUMINIUM (AL), HAIR Biochemistry Hair/Dry sterilescrew cap (urine) container

4 weeks Fill sterile container as full as possible with hair. Clippings from the patient’s last hair cut can be used (should be at least 0.5 grams of hair). Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

ALUMINIUM, SERUM Biochemistry Blood/Trace elementfree tube (e.g. navy top)

1 - 2 weeks Test for aluminium accumulation generally in renal failure. Provide clinical and medication details. Referred test.

ALUMINIUM, URINE Biochemistry Urine/Urine container 1 week Fresh random collection required.

AMIKACIN, SERUM Biochemistry Blood/Lithiumheparin tube - no gelor anticoagulant

3 days Record the time and date of commencement of the last dose, and also the patient’s normal dose on the request form. Please refer to Biochemistry Appendix (12.15).

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PATHOLOGY TESTS



AMINO ACIDS, PLASMA Biochemistry Blood/Lithiumheparin tube

2 weeks Test for inborn errors of amino acid metabolism. Fasting samples are preferable. SST serum is an acceptable alternative, although plasma is preferred. Centrifuge, separate and FREEZE the sample where possible. If there is to be a delay of 2 hours or more before transportation, sample MUST be frozen immediately. Referred test.

AMINO ACIDS, URINE (CHROMATOGRAPHY)

Biochemistry Please refer to AMINO ACIDS, URINE (SCREEN).

AMINO ACIDS, URINE (SCREEN)

Biochemistry Random early morning urine/Urine container

2 weeks Test for inborn errors of amino acid metabolism. Random early morning urine collection required. Please provide clinical and medication details. Refrigerate for transfer to laboratory. If specifi cally requested, a 24 hour urine may be collected. Referred test.

AMINO LAEVULINIC ACID, URINE

Biochemistry Please refer to 5-ALA, URINE.

AMINOPHYLLINEPRE/POST DOSE, SERUM

Biochemistry Please refer to THEOPHYLLINE, SERUM.

AMINOPHYLLINE, SERUM Biochemistry Please refer to THEOPHYLLINE, SERUM.

AMIODARONE, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic Lithium heparin tube acceptable)

1 week Collect immediately prior to next dose. Collect sample 8-12 hours after last dose (preferably immediately before next dose). Please provide clinical and medication details including time and date of last dose.

AMISULPRIDE, SERUM Biochemistry Please refer to SOLIAN, SERUM for details.

AMITRIPTYLINE, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic Lithium heparin tube acceptable)

1 week Collect immediately prior to next dose. Please provide clinicaland medication details including time and date of last dose.

AMITROLE (HERBICIDE), URINE Biochemistry Please refer to HERBICIDES, URINE.

AML1-ETO RT-PCR Genetics Blood or Bone marrow/EDTA tube or min. 1 mL bone marrowin EDTA tube

1 month Specimen needs to be received within 48 hours.

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PATHOLOGY TESTS



AMMONIA, PLASMA Biochemistry Blood/EDTA tube Same day Test for late stage liver disease. Collect FULL EDTA tube. Blood must be centrifuged and separated IMMEDIATELY into a 2 mL tube (fi ll to top) then freeze immediately for transmission to the laboratory.

AMMONIA (NH3), URINE Biochemistry 24hr urine container. No preservative

24 hours Provide clinical and medication details. Refrigerate sample during collection and transport to the laboratory.

AMMONIUM CHLORIDE LOAD TEST

Biochemistry Test for renal tubular acidosis. Contact House Collection (07) 3121 4450 or Branch Laboratory for appointment.

AMNIOTIC FLUID, CHROMOSOMES

Genetics Amniotic fl uid/2 x sterile 10 mL black top tubes

1 - 2 weeks Average reporting time of 10 days.

AMOEBIC SEROLOGY Immunology Blood/SS tube 1 week Assay run Wednesday.

AMPHETAMINES - GCMS CONFIRMATION

Biochemistry Please refer to SYMPATHOMIMETIC AMINES - GCMS CONFIRMATION.

AMPRENAVIR, PLASMA Biochemistry Blood/EDTA tube 3 weeks Plasma must be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Please provide clinical and medication details. Referred test.

AMYLASE, FLUID Biochemistry Fluid/Plain tube/Container Same day Note fl uid site on specimen container and request form.

AMYLASE, PLEURAL FLUID Biochemistry Pleural fl uid/Plain tube Same day Test for pancreatic aetiology of pleural effusion. Please provide clinical and medication detail. Refrigerate sample during storage and transport.

AMYLASE, SERUM Biochemistry Blood/SS tube Same day Test for acute pancreatitis. Please provide clinical and medication details.

AMYLASE, URINE Biochemistry Urine/24 hour urine container with no preservative orRandom urine container

Same day Test for pancreatitis. Please provide clinical and medication details. Refrigerate sample during storage and transport. Under rare circumstances or if specifi cally requested, a random urine may be collected.

AMYLO-1,6-GLUCOSIDASE, BLOOD


2 weeks Please contact Biochemistry on (07) 3121 4420 to advise of expected time of arrival, as sample must be referred to RBH on same day of collection. Referred test.

ANA (ANTINUCLEAR ANTIBODY), SERUM

Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday). Please refer to Immunology Appendix (12.35) for a comprehensive list of autoantibodies.

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PATHOLOGY TESTS



ANAEROBIC CULTUREFOR ACTINOMYCES

Microbiology Aspirated pus/Anaerobic transport medium

Up to 7 days Please provide clinical details including site of collection and antibiotic therapy. Note if history of chronic infection. Refer to Microbiology Preface (5.51) for collection details.

ANAFRANIL, SERUM Biochemistry Please refer to CLOMIPRAMINE, SERUM.

ANCA (ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY), SERUM

Immunology Blood/SS tube 72 hours Assay run Monday, Wednesday, Friday. Please provide relevant clinical history.

ANDROGEN INSENSITIVITY SYNDROME GENETIC TESTING

Genetics Blood/EDTA tube 1 month Please provide details regarding patients eligibility for Medicare rebate, i.e. proven mutation. If no history, incurs fee to patient.

ANDROSTENEDIONE, SERUM Endocrinology Blood/SS tube 24 hours Please provide clinical and medication details.

ANGELMAN SYNDROME DNA TESTING

Genetics Blood/EDTA tube 1 - 2 months Incurs non-Medicare refundable fee.

ANGIOSTRONGYLUS SEROLOGY Immunology Blood/SS tube 2 - 3 weeks

ANGIOTENSIN CONVERTING ENZYME, SERUM

Biochemistry Blood/SS tube 24 hours Test for pulmonary sarcoidosis. Please provide clinical details.

ANGIOTENSIN/RENIN RATIO, PLASMA

Endocrinology Blood/2 x EDTA tubes, SS tube

24 hours Special collection and handling of renin specimen required. Refer to RENIN, PLASMA.

ANTI D SCREENAND INJECTION

Blood Bank Blood/Pink topEDTA tube

24 hours and urgently

Blood sample for antibody screen should be drawn before Anti-D injection. Record date Anti-D injection given.

ANTI DOUBLE-STRANDED DNA ANTIBODY, SERUM

Immunology Blood/SS tube 72 hours Assay run daily (Monday to Friday). Please refer to Immunology Appendix (12.35)for comprehensive list of circulating Autoantibodies.

ANTI IGA ANTIBODY Immunology Blood/SS tube 4 weeks

ANTI MICROSOMAL ANTIBODY (THYROID), SERUM

Endocrinology Blood/SS tube 24 hours

ANTI MULLERIAN HORMONE, SERUM

Biochemistry Blood/SS tube 2 weeks Transport to central laboratory on dry ice. There is currently no Medicare rebate for this test. Referred test.

ANTI NEURONAL ANTIBODY Immunology Blood/SS tube 2 - 3 weeks

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PATHOLOGY TESTS



ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA), SERUM

Immunology Blood/SS tube 72 hours Please provide relevant clinical history. Assay run Monday, Wednesday, Friday.

ANTI THYROGLOBULIN ANTIBODY, SERUM


ANTI THYROID ANTIBODIES, SERUM

Endocrinology Blood/SS tube 24 hours Measure antimicrosomal and antithyroglobulin antibodies (Thyroid Tissue Antibodies).

ANTI THYROID PEROXIDASE ANTIBODY, SERUM


ANTI-BETA2 GLYCOPROTEIN I ANTIBODY

Immunology Blood/SS tube 2 - 4 weeks

ANTIBIOTIC RESISTANT ORGANISMS

Microbiology Rectal swab/Rectal swab in transport medium

48 hours

ANTIBODIES TO EXTRACTABLE NUCLEAR ANTIGENS (ENA), SERUM

Immunology Blood/SS tube 48 hours Assay run daily (Monday to Friday). Please refer to Immunology Appendix (12.35)for a full list of Extractable Nuclear Antigens.

ANTIBODIES TO MICROBIAL AND PARASITIC AGENTS, SERUM

Immunology Blood/SS tube Variable from 24 hours to weeks depending on agent requested

Please refer to Immunology Appendix (12.36) for a comprehensive list of antibodies to microbial and parasitic agents. It is a Medicare requirement that microbial and parasitic agents be listed individually on the request form. For enquiries please contact Immunology (07) 3121 4458 or Branch Laboratory.

ANTIBODIES TO TISSUE ANTIGENS (AUTOANTIBODIES), SERUM

Immunology Blood/SS tube Variable from 24 hours depending on antibody tests required

Please refer to Immunology Appendix (12.35) for a comprehensive list of autoantibody tests available. It is a Medicare requirement that autoantibodies required for testing should be listed individually on the request form. For enquiries please contact Immunology (07) 3121 4458 or Branch Laboratory.

ANTIBODY SCREEN/TITRE, SERUM

Blood Bank Blood/Pink topEDTA tube

24 hours If history of antibodies or transfusion complications collect additional 6 mL plain plastic tube (red top). Record estimated date of confi nement (EDC) for antenatal patients. If associated with Anti-D injection, collect blood sample prior to injection.

ANTI-CYCLIC CITRULLATED PEPTIDE (CCP) ANTIBODY

Immunology Blood/SS tube 72 hours Assay run Monday and Thursday. Next day results.

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PATHOLOGY TESTS



ANTIDIURETIC HORMONE (ADH), PLASMA

Endocrinology Blood/4 x EDTA tubes 2 - 3 weeks Collect into the chilled EDTA tubes. Invert to mix and keep cold (4°C) in transit to arrive in Endocrinology within 24 hours of collection. If >24 hours spin EDTA tubes and separate plasma and transport on ice. Referred test. There is currently no Medicare rebate for this test.

ANTI-GQ1B ANTIBODY Immunology Blood/SS tube 2 - 3 weeks

ANTI-HU ANTIBODIES Immunology Blood/SS tube 2 - 3 weeks

ANTIMONY (Sb), BLOOD Biochemistry Blood/Lithiumheparin tube (EDTAtube acceptable)

4 weeks Please provide clinical and medication details. Urine is the preferred sample for exposure. Referred test.

ANTIMONY (Sb), URINE Biochemistry Urine/Urine container 4 weeks This is the preferred sample for exposure. A random sample is required. Please provide clinical and medication details. Referred test.

ANTINUCLEARANTIBODY (ANA), SERUM

Immunology Blood/SS tube 24 hours Assay run daily (Monday to Saturday). Please refer to Immunology Appendix (12.35) for a comprehensive list of autoantibodies.

ANTIOXIDANTS, BLOOD Biochemistry Blood/SS tube or Lithium heparin tube

4 weeks The sample must arrive at the main laboratory by 2:30pm on the same day. Please contact Biochemistry Department to notify of expected time of arrival (07) 3121 4420. This is a non-Medicare rebate test. Please contact the laboratory for current charge for this assay. Referred test.

ANTISPERM ANTIBODIES (INDIRECT IMMUNOBEAD TEST - IBT)

Genetics Female - Blood/SS tube, Male - Blood/SS tube and/or Seminal plasma

Test performed fortnightly

Assay dependent on normal semen for substrate. Test performed when normal semen available.

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PATHOLOGY TESTS



ANTITHROMBIN III Haematology Blood/Sodiumcitrate tube

24 hours Transport at 4°C. Must reach laboratory within 2 hours of collection.

PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Thrombotic assay requests are only Medicare refundable if one of the following is stated on the request form by the patient’s doctor:1. That the patient has a personal history of venous thromboembolism (DVT) or

arterial thrombosis (PE); 2. That a fi rst degree relative of the patient has a proven defect in one or more of




ANTITHROMBIN III, PLASMA Haematology Blood/Sodiumcitrate tube

24 hours Please provide details of thrombotic history of patient and family members and any anticoagulant therapy. Must reach laboratory within 2 hours of collection.

APC(ACTIVATED PROTEIN C - RESISTANCE)

Haematology Blood/EDTA tube and Sodium citrate tube

24 hours Specimens should be stored and transported cooled. They must reach the laboratory within 2 hours of collection. A history of thromboembolism or a proven APC defect in a fi rst degree relative must be stated on the request form to attract the Medicare rebate.

PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Thrombotic assay requests are only Medicare refundable if one of the following is stated on the request form by the patient’s doctor:1. That the patient has a personal history of venous thromboemblism (DVT) or





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PATHOLOGY TESTS



APO A1, SERUM Biochemistry Please refer to APOLIPOPROTEIN A1, SERUM.

APO B, SERUM Biochemistry Please refer to APOLIPOPROTEIN B, SERUM.

APOLIPOPROTEIN A1, SERUM Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details.

APOLIPOPROTEIN B, SERUM Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details.

APOLIPOPROTEIN B100, SERUM Biochemistry Blood/SS tube 2 weeks Please provide clinical and medication details.

APOLIPOPROTEIN E GENOTYPING

Genetics Blood/Pink topEDTA tube

1 week Incurs non-Medicare refundable fee. Transport at room temperature or cooled.

APOLIPOPROTEIN STUDIES, SERUM

Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details.

APTT (COAGULATION PROFILE) Haematology Blood/Sodiumcitrate tube

Same day Also refer to COAGULATION STUDIES. If for Warfarin care please refer to Haematology Appendix (12.32) for further information.

APTT: HEPARIN THERAPY, BLOOD

Haematology Blood/Sodium citrate and EDTA tubes

Same day Please provide clinical and medication details. Transport to laboratory within 2 hours of collection. Monday to Wednesday only.

ARBOVIRUS ISOLATION, BLOOD, SYNOVIAL FLUID, CSF

Immunology Blood/SS tube, Other fl uids/Sterile container

Days to weeks Clinical details including date of onset of illness and clinical fi ndings should accompany the specimen. Material for isolation should be collected aseptically and kept under sterile conditions. Specimen should be frozen and kept frozen during storage and transportation.

ARBOVIRUS SEROLOGY Immunology Blood/SS tube 24 hours Available serology includes Ross River Virus, Barmah Forest Virus and Dengue virus. (Refer to Immunology Appendix (12.37) for a full list.) It is a Medicare requirement that viruses be listed individually on the request form. Blood samples should be taken on presentation and 14 to 21 days after disease onset. Assay run daily (Monday to Friday).

ARGININEGROWTH HORMONE STIMULATION TEST

Endocrinology Blood/SS tube 24 hours This test involves an infusion of arginine and an injection of insulin. A series of blood samples are collected over 2-3 hours and tested for cortisol, growth hormone and glucose. Please contact Branch Laboratory for appointment, Endocrinology (07) 3121 4439 for details.

ARGININE/INSULINGROWTH HORMONE STIMULATION TEST

Endocrinology Blood/SS tube 24 hours This test involves an infusion of arginine and an injection of insulin. A series of blood samples are collected over 2-3 hours and tested for cortisol, growth hormone and glucose. Please contact Branch Laboratory for appointment, Endocrinology (07) 3121 4439 for details.

PATH

OLOG

Y TE

STS

- A

7.15

PATH

OLOG

Y TE

STS

- A

7.15

PATHOLOGY TESTS



ARIPIPRAZOLE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant

4 weeks Provide clinical and medication details. Transport to central laboratory on ice. Referred test.

AROMATIC SOLVENTS Biochemistry Please refer to SOLVENTS, BLOOD for all details.

ARSENIC - INORGANIC, URINE Biochemistry Please refer to INORGANIC ARSENIC, URINE.

ARSENIC, BLOOD Biochemistry Blood/Lithiumheparin tube (EDTAtube acceptable)

4 weeks Test for current toxicity. Provide clinical and medication details.Do not separate sample. Referred test.

ARSENIC, HAIR Biochemistry Hair/Dry sterile container 4 weeks Test for exposure in the past. Please provide exposure and occupation details. For long term exposure, collect enough hair to half fi ll container (0.2 - 0.4 grams). Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

ARSENIC, NAIL Biochemistry Toe and fi ngernail clippings/Dry sterile container

4 weeks Test for exposure in the past. Please provide exposure and occupation details. Cut clean fi nger and toe nails. Referred test.

ARSENIC, URINE Biochemistry Urine/Urine container 1 week Test for exposure not necessarily toxic. Please provide clinical and medication details. A random collection is preferred. A 24 hour specimen (with no preservative) should only be collected if specifi cally requested by the referring doctor. Referred test.

ARYL SULPHATASE A, LEUCOCYTES


ASCA (ANTI-SACCROMYCES CEREVISEIA ANTIBODY)


ASCITIC FLUID BIOCHEMISTRY Biochemistry Fluid/Sterile container Same day Please provide clinical and medication details, and tests required.

ASCORBIC ACID, SERUM Biochemistry Please refer to VITAMIN C, SERUM.

ASHPLEX 1, BLOOD Biochemistry Blood/EDTA tube 4 weeks Transport at 4°C. Referred test.

ASHPLEX 2, BLOOD Biochemistry Blood/EDTA tube 4 weeks Transport at 4°C. Referred test.

ASHPLEX CF, BLOOD Biochemistry Blood/EDTA tube 4 weeks Transport at 4°C. Referred test.

ASOT (ANTI STREPTOLYSIN O TITRE), SERUM

Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

PATH

OLOG

Y TE

STS

- A

7.16

PATH

OLOG

Y TE

STS

- A

7.16

PATHOLOGY TESTS



ASPARTATE TRANSAMINASE, RED CELL

Biochemistry Please refer to VITAMIN B6, BLOOD for details.

ASPERGILLUS SEROLOGY Immunology Blood/SS tube 1 week Assay run Monday. 24 hour results.

ASPIRIN, SERUM Biochemistry Please refer to SALICYLATE, SERUM.

AST (SGOT), SERUM Biochemistry Please refer to E/LFT, SERUM.

AST, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify source of fl uid on sample and request form.

ATRIAL NATRIURETIC PEPTIDE, PLASMA

Biochemistry This test in currently unavailable. Please refer to BNP, PLASMA.

ATYPICAL ANTIBODIES, BLOOD Blood Bank Blood/Pink top EDTA tube 24 hours If history of antibodies or transfusion complications collect additional 6 mL plain plastic tube. Record estimated date of confi nement (EDC) for antenatal patients.

ATYPICALMYCOBACTERIA MICROSCOPYAND CULTURE

Microbiology/Histology

Tissue, sputum, pus/Dry sterile screw top (urine) container (NO formalin)

Microscopy - same day. Culture - majority provisionally identifi ed within 2 weeks(up to 12 weeks).

If infection by atypical Mycobacteria is suspected in a tissue specimen (e.g. skin) indicate suspicion and submit specimen in a dry, sterile screw top container (NO formalin). The laboratory will process for both culture and histology. Note: Tissue is essential for Histology. Tissue is preferable to pus. Sputum - 3 consecutive early morning specimens.

AUSTRALIAN (MURRAY VALLEY) ENCEPHALITIS VIRAL SEROLOGY

Immunology Blood/SS tube 2 weeks Referred test.

AUSTRALIAN BAT LYSSAVIRUS SEROLOGY

Immunology Blood/SS tube 2 - 3 weeks Please provide details of clinical history and exposure, including species of bat. Referred test.

AUTOANTIBODY TEST, SERUM Immunology Blood/SS tube Variable from24 hours depending on antibody tests required


PATH

OLOG

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STS

- A

7.17

PATH

OLOG

Y TE

STS

- A

7.17

PATHOLOGY TESTS



AUTOCLAVE VALIDATION TEST WITH BIOLOGICAL INDICATORS

Microbiology AUTOCLAVE TEST VIALx 7 (NB: All must havethe same lot number.)

48 hours The autoclave test vials are collected from the surgery after autoclaving. A complete autoclave validation request form must be completed and submitted with the vial. Please contact the Microbiology Department (07) 3121 4438 for vials and request books.

AUTOPSY (ADULT/CHILDREN/NEONATES)

Histology Laboratory not accredited for this service. Contact Forensic and Scientifi c Services (formerly Queensland Health Scientifi c Services) John Tonge Centre (07) 3274 9111.

AVIAN PRECIPITINS SEROLOGY Immunology Blood/SS tube 3 - 4 weeks Referred test.

AZINPHOS (PESTICIDE), SERUM


PATH

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STS

- A

7.18

PATH

OLOG

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STS

- A

7.18

PATHOLOGY TESTS



B2 GLYCOPROTEIN Immunology Blood/SS tube 2 weeks

BARBITURATES SCREEN, SERUM

Biochemistry Please refer to DRUG SCREEN, SERUM.

BARBITURATES SCREEN, URINE

Biochemistry Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER CHROMATOGRAPHY), URINE.

BARMAH FOREST VIRUS SEROLOGY


BASEMENT MEMBRANE ZONE (BMZ) ANTIBODY/PEMPHIGOID ANTIBODY, SERUM

Immunology Blood/SS tube 2 weeks Skin biopsies for immunofl uorescence and histology advised. Please refer to Histology Preface (5.38) for details.

BASUDIN (PESTICIDE), SERUM Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Referred test.

B-CELL (IgH) GENE REARRANGEMENT STUDIES

Genetics Blood or Bone marrow/Pink top EDTA tube, or bone marrow or lymph node or tumour

2 weeks Incurs non-Medicare refundable fee. Transport at room temperature or cooled.

BCL-1 [t(11;14)]DNA TESTING

Genetics EDTA Blood, bone marrow, lymph node, aspirate, tissue


BCL-2 [t(14;18)]DNA TESTING



BCR-ABL [t(9;22)] FISH Genetics Blood or Bone marrow/Lithium heparin tube or min. 1mL bone marrow in Lithium heparin tube

1 - 2 days

BCR-ABL [t(9;22)] RQ-PCR Genetics Blood and/or Bone marrow/Pink top EDTA tube and/or min. 1mL bone marrow in EDTA tube

2 weeks Please send to the laboratory without delay.

7.19

7.19

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- B

PATH

OLOG

Y TE

STS

- B


BECKER MUSCULAR DYSTROPHY, BLOOD

Biochemistry Please refer to DYSTROPHIN GENE ANALYSIS, BLOOD.

BENCE JONES PROTEIN, SERUM

Biochemistry Please refer to FREE LIGHT CHAINS, SERUM.

BENCE JONES PROTEIN, URINE

Biochemistry Urine/Urine container or 24 hour urine container with no preservative - random or 24 hour only

24 hours Component of testing for myeloma. Qualitative test. Please provide clinical and medication details. A random collection is preferred. Do not collect in acid preservative. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

BENDIOCARB (PESTICIDE), BLOOD


BENZENE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details. For Urine - see HIPPURIC ACID, URINE.

BENZODIAZEPINES - GCMS CONFIRMATION

Biochemistry Urine/Urine drug screen collection kit with tamper evident packaging

48 hours This is requested in cases concerned with occupational drug screening for drugs of abuse. The QML Pathology protocol complies with Standards Australia AS/NZS4308 for the assay of cannabinoids, opiates, cocaine metabolites, benzodiazepines and sympathomimetic amines. A Chain-of-Custody form should be completed. Additional classes (methadone, barbiturates, alcohol) should be specifi cally requested if required. Please also refer to the Biochemistry Preface (5.4). Confi rmation and quantitation by GCMS of positive fi ndings may be requested separately.

BENZODIAZEPINES SCREEN, URINE


48 hours Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER CHROMATOGRAPHY), URINE.

BERYLLIUM (Be), BLOOD Biochemistry Blood/EDTA tube 2 weeks Please provide details of exposure (clinical and occupational).

BERYLLIUM (Be), URINE Biochemistry Urine/24 hour urine collection in acid washed container. Random urine container

2 weeks Test for recent exposure. Consultation with referring laboratory required before collection. Phone Biochemistry on (07) 3121 4420 or Branch Laboratory for details. Provide details of exposure (clinical and occupational). An early morning spot urine should be collected for initial screening. Follow-up testing should be performed on a 24 hour urine collection. Keep cool. Referred test.

BETA GALACTOSIDASE, BLOOD


7.20

7.20

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- B

PATH

OLOG

Y TE

STS

- B


BETA HCG - QUANTITATIVE, SERUM

Endocrinology Blood/SS tube 24 hours Note date of last normal menstrual period (LNMP), period of amenorrhoea (A=) and estimated date of confi nement (EDC).

BETA HCG - TUMOUR MARKER, SERUM

Endocrinology Blood/SS tube 24 hours -HCG can be used as a tumour marker for trophoblastic disease (hydatidiform mole, invasive mole, persistent mole, partial hydatidiform mole, placental site trophoblastic tumour and gestational choriocarcinoma). Complete obstetric history is essential for result interpretation. Elevated levels are also seen in both ovarian and testicular germ cell tumours and some breast carcinomas. When used in conjunction with AFP, -HCG may prove useful in assessing prognosis, monitoring therapy and detecting recurrence of gonadal germ cell neoplasms.

BETA HCH, (ORGANOCHLORINE PESTICIDE), BLOOD


BETA HYDROXYBUTYRATE, PLASMA

Biochemistry Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA.

BETA-2 MICROGLOBULIN, SERUM

Biochemistry Blood/SS tube 24 hours Assay run daily (Monday - Friday). Provide clinical and medication details.

BETA-2 MICROGLOBULIN, URINE

Biochemistry Urine/Urine container 2 weeks Transport at 4°C.

BETA-2 TRANSFERRIN, FLUID Biochemistry Please refer to TAU PROTEIN, FLUID.

BETA-ALANINE, SERUM OR URINE 24 HOUR

Biochemistry For serum please refer to AMINO ACIDS, PLASMA. For urine please refer to AMINO ACIDS, URINE. Referred test.

BICARBONATE, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify source of fl uid on sample and request form.

BICARBONATE, SERUM Biochemistry Please refer to E/LFT, SERUM.

BILE ACIDS, SERUM Biochemistry Blood/SS tube 2 weeks Test for cholestasis. Please provide clinical and medication details. A fasting sample is necessary to provide consistency for clinical interpretation. Keep cool and transport at 4°C. Referred test.

BILE PIGMENTS, URINE Biochemistry Urine/Urine container Same day Test for conjugated hyperbilirubinaemia or in investigation of pigmenturia. Fresh random sample required. Please provide clinical and medication details. Protect sample from light.

7.21

7.21

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- B

PATH

OLOG

Y TE

STS

- B


BILIRUBIN (CONJUGATED/DIRECT), SERUM

Biochemistry Blood/SS tube Same day Protect sample from light.

BILIRUBIN (NEONATAL), SERUM

Biochemistry Blood/SS tube or Paediatric SS tube

Same day Test for neonatal liver disease, high red cell turnover, breast milk jaundice, etc. Please provide clinical details. Heel prick or venipuncture sample. Paediatric container must be at least half full. Protect sample from light.

BILIRUBIN, AMNIOTIC FLUID

Biochemistry Amniotic fl uid/Plain plastic tube

Same day Test for fetal liver disease, high red cell turnover, etc. Protect from light (wrap in foil or brown paper).

BILIRUBIN, CORD BLOOD Biochemistry Cord blood/SS tube or plain tube

Same day Test for fetal liver disease, high red cell turnover, etc. Please provide clinical details. Protect sample from light.

BILIRUBIN, FLUID Biochemistry Fluid/Plain tube/Container Same day Test for haematoma source. Protect sample from light and specify source/nature of fl uid on both sample and form.

BILIRUBIN, SERUM Biochemistry Protect sample from light. Please refer to E/LFT, SERUM.

BILIRUBIN, URINE Biochemistry Please refer to BILE PIGMENTS, URINE for details.

BIOCHEMISTRY, CSF Biochemistry CSF/Plain tube Same day Please provide clinical and medication details and indicate individual tests required. Treat sample with priority.

BIOPSY TISSUE FOR MICROSCOPY AND CULTURE

Microbiology Sterile dry container (not in formalin)

Interim microscopy report same day. Interim culture report 48 hours. Final culture report in 5 days.

Please provide clinical details including site and antibiotic therapy. Specify if specimen is to be cultured for fungi, Mycobacteria or exotic organisms (Actinomyces, Nocardia, etc). Prompt transport to the laboratory is essential.

BIOPTERIN, URINE Biochemistry Please refer to PTERINS, URINE for details. Referred test.

BIOTINIDASE, PLASMA Biochemistry Blood/Lithium heparin tube

2 weeks Referred test.

BISCODYL, FAECES Biochemistry Please refer to LAXATIVES, FAECES.

BISMUTH, BLOOD Biochemistry Blood/EDTA tube 2 weeks Test for exposure. Referred test.

BK VIRUS Immunology Blood and urine/SS tube and Urine container

2 - 3 weeks

7.22

7.22

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- B

PATH

OLOG

Y TE

STS

- B


BLADDER WASHINGS, CYTOLOGY

Cytology Fluid/Appropriate sterile container

24 hours For specimen preparation please refer to Cytology Preface (5.16).

BLEEDING STUDIES Haematology Same day Refer to COAGULATION STUDIES.

BLEEDING TIME Haematology Same day Please contact Haematology (07) 3121 4451 or Branch Laboratory.

BLOOD COAGULATION STUDIES Haematology Blood/3 Sodium Citrate tubes, 1 EDTA tube, 1 blood fi lm prepared at time of collection

Same day Studies include Platelet count, Prothrombin time, APTT and Fibrinogen. Please specify if a bleeding time is required. Transport to laboratory within 4 hours. Please provide clinical and medication details.

BLOOD CROSSMATCH Blood Bank Blood/Pink top EDTA tube

Same day or urgently

If history of antibodies or transfusion complications collect additional 10 mL plain plastic tube. Note special requests (e.g. irradiated/CMV negative). Crossmatch must be signed by patient or collector to verify patient identity. Complete blue box on request form, collector to sign Certifi cation statement.

BLOOD CULTURE FOR MAC/MAIC/MYCOBACTERIA

Microbiology Blood/Blood culture bottles. For small blood volumes (5 mL or less) use a paediatric bottle - see Microbiology Preface (5.35). Blood cultures for Mycobacteria require 2 x Bact/Alert MB bottles

Interim report after 2 days. Final report after 7 days. Mycobacteria report after 6 weeks.

Please contact Microbiology (07) 3121 4438 or Branch Laboratory for details of collection methods for Mycobacteria and Fungi. Indicate recent history of antibiotics.

BLOOD GASES, ARTERIAL Biochemistry Arterial blood/Blood gas syringe

Same day Test for respiratory disease, acid/base imbalance. Please refer to Biochemistry Preface (5.1) and Appendix (12.19).

BLOOD GASES, VENOUS Biochemistry Venous Blood/Blood gas syringe

Same day Please refer to Biochemistry Preface (5.1) and Appendix (12.19).

BLOOD GROUP Blood Bank Blood/Pink top EDTA tube

24 hours The volume of blood in the EDTA sample tube should be not less than 4 mL. If a full blood count or haemoglobin is required use a lavender top EDTA tube for haematology.

BLOOD GROUP AND COOMBS TEST

Blood Bank Blood/Pink top EDTA tube

Same day

7.23

7.23

PATHOLOGY TESTS


PATH

OLOG

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STS

- B

PATH

OLOG

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STS

- B


BLOOD GROUP ANTIBODIES Blood Bank Blood/Pink top EDTA tube

24 hours If history of antibodies or transfusion complications collect additional 6 mL plain plastic tube. Record estimated date of confi nement (EDC) for antenatal patients.

BLOOD GROUP GENOTYPE Blood Bank Blood/Pink top EDTA tube

24 hours Please indicate reason for genotyping request (e.g. possibility of fetal or neonatal haemolysis).

BLOOD GROUP PHENOTYPE Blood Bank Blood/Pink top EDTA tube

24 hours Please indicate reason for phenotyping request.

BLOOD TRANSFUSION REACTION INVESTIGATION, BLOOD AND URINE

Blood Bank Blood/Plain plastic tube, EDTA tube. Urine/Urine container

Same day Obstetric, transfusion and drug history essential. Sample of fi rst urine voided post reaction. Please forward ALL transfused and partly transfused blood bagsto the laboratory.

BLOOD VOLUME STUDIES Haematology Blood/Sterile vials available on request from Haematology

24 hours Appointment required. This test MUST NOT be performed on children, pregnant or breast feeding women. Please contact Haematology (07) 3121 4451 or Branch Laboratory for details.

BNP, PLASMA Biochemistry Blood/EDTA tube Same day Please provide clinical and medication details. Keep sample cool and transport to the laboratory without delay.

BODY FLUID MICROSCOPY AND CULTURE

Microbiology Body fl uid/Sterile container Interim microscopy report same day. Culture report 48 hours

Please provide clinical details including antibiotic therapy and specify if specimen is to be cultured for fungi and/or mycobacteria. Transport cooled to laboratory as soon as possible.

BOLVIDON, SERUM Biochemistry Please refer to MIANSERIN, SERUM.

BONE MARROW CULTURE Microbiology Bone marrow aspirate/Sterile container

Interim report after 48 hours. Final report 21 days.

Please provide clinical details including antibiotic therapy. Specimen will be cultured for Mycobacteria and fungi.

BONE MARROW EXAMINATION Haematology Bone marrow aspirate, trephine and smears/ Appropriate containers

24 hours Please contact Haematology (07) 3121 4573 or Branch Laboratory for appointment. Refer to Haematology Preface (5.33) for specimen collection and preparation details.

BONE MINERALS, SERUM Biochemistry Blood/SS tube Same day Please request individual tests. (Usually Calcium and Phosphate). Medicare requires that the individual tests be written on the request form.

BONE RESORPTION MARKER, URINE

Biochemistry Please refer to N-TELOPEPTIDE, URINE.

7.24

7.24

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- B

PATH

OLOG

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STS

- B


BONE SPECIFIC ALKALINE PHOSPHATASE

Endocrinology Blood/SS tube 1 week

BORDETELLA PERTUSSIS PCR Immunology Nasopharyngeal aspirate or Nasopharyngeal swab (dry)

24 hours Assay run daily (Monday - Friday).

BORDETELLA PERTUSSIS SEROLOGY


BORON, URINE Biochemistry Urine/Urine container 1 - 2 weeks Random urine sample. This test attracts a non-Medicare refundable fee from the reference laboratory, so prior arrangement by the doctor or employer must be given. Referred test.

BOWEL TUMOUR MARKERS (CA 19-9, CEA), SERUM

Endocrinology Blood/SS tube 24 hours Infl ammatory or neoplastic conditions of mucinous epithelium - see Biochemistry Appendix (12.4).

BRAIN NATRIURETIC PEPTIDE, PLASMA

Biochemistry Blood/EDTA tube Same day Please refer to BNP, PLASMA.

BRATTON-MARSHALL TEST, URINE

Biochemistry Please refer to SAICAR, URINE.

BREAST CANCER GENETIC TESTING (BRCA1 BRCA2)

Genetics Blood/EDTA tube Indeterminate Genetic counselling is required before the blood specimen can be taken. Genetic counselling is available from Genetic Health Queensland at the Royal Brisbane Hospital on (07) 3636 1686.

BREAST CYST ASPIRATE CYTOLOGY

Cytology Fluid and/or Smear/Sterile container and slide carrier x 2


BREAST FNA CYTOLOGY Cytology Fixed and air dried smears/Needle and syringe/Needle rinsings


BREAST TUMOUR MARKER (CA 15-3), SERUM

Endocrinology Blood/SS tube 24 hours Breast Carcinoma - see Biochemistry Appendix (12.4).

7.25

7.25

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- B

PATH

OLOG

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STS

- B


BREATH HYDROGEN (MULTIPLE) Biochemistry Expired air samples 48 hours This test is useful to assess intestinal disaccharidase defi ciency and Foregut Bacterial Overgrowth Syndromes (oesophageal pouch, blind loop). The test takes 4 hours and requires a special collection kit from QML Pathology. It should be performed at a Collection Clinic or Branch Laboratory. The patient should fast and not have smoked for at least one hour prior to the test. Please telephone Alexandra Clinic (07) 3831 2614, Biochemistry (07) 3121 4971 or Branch Laboratory for details and appointment.

BREATH HYDROGEN (SINGLE) Biochemistry Expired air samples 48 hours

BREATH TEST (CARBON - 14 UREA) FOR HELICOBACTER PYLORI

Endocrinology 1 glass vial containing CO2 trapping liquid.

24 hours It is preferred for the patient to fast before the test, but not necessary. A test dose is ingested and mouth is rinsed. 20 minutes later, a breath sample is collected in a glass vial containing CO2 trapping liquid. The glass vial is identifi ed by name, sealed, placed in a plastic bag and transported cooled to the laboratory where the activity of the trapped labelled CO2 is measured. Appointment is required for test.

BROMIDE, BLOOD and SERUM

Biochemistry Blood/Lithium heparin serum/SS tube


BROMIDE, URINE Biochemistry Urine/Urine container 4 weeks Test for occupational exposure. Please provide details of exposure (clinical and occupational). A random collection is preferred. Referred test.

BROMINAL (HERBICIDE), URINE Biochemistry Please refer to HERBICIDES, URINE.

BRONCHIAL BRUSHING CYTOLOGY

Cytology Smears and/or fl uid. Bronchial brush in normal saline


BRONCHIAL WASHING CYTOLOGY

Cytology Fluid/Aspirating trap 24 hours For specimen preparation please refer to Cytology Preface (5.16).

BRONCHIAL WASHINGS, MICROSCOPY AND CULTURE

Microbiology Fluid/Aspirating trap Interim microscopy report same day. Culture report 48 hours

Please provide clinical details including antibiotic therapy. Specimen will be cultured for fungi. Specify if TB culture is required.

BRONCHO-ALVEOLAR LAVAGE (BAL), CYTOLOGY

Cytology Fluid/Aspirating trap 24 hours For specimen preparation please refer to Cytology Preface (5.16).

BRUCELLA SEROLOGY Immunology Blood/SS tube 72 hours Assay run Monday and Thursday.

7.26

7.26

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- B

PATH

OLOG

Y TE

STS

- B


B-TYPE NATRIURETIC PEPTIDE, PLASMA

Biochemistry Blood/EDTA tube Same day Please refer to BNP, PLASMA.

BUPIVACAINE, PLASMA Biochemistry Blood/Plain tube - no gel or anticoagulant

4 - 6 weeks Centrifuge and separate serum into a plain 5 mL tube. Keep cool. Referred test.

BUPRENORPHINE SCREEN, URINE

Biochemistry Urine/Urine container 2 weeks Transport to central laboratory on ice. There is currently no Medicare rebate for this test. Referred test.PA

THOL

OGY

TEST

S -

B

7.27

PATH

OLOG

Y TE

STS

- B

7.27

PATHOLOGY TESTS



C - 14 UREA BREATH TEST FOR HELICOBACTER PYLORI

Endocrinology 1 glass vial containing CO2 trapping liquid.


C1 ESTERASE INHIBITOR FUNCTIONAL, SERUM

Biochemistry Blood/SS tube 2 weeks Test for hereditary angioedema. Please provide clinical and medication details. Keep sample cool and transport to the laboratory without delay. Referred test.

C1 ESTERASE INHIBITOR, SERUM

Biochemistry Blood/SS tube 3 days Test for hereditary angioedema. Please provide clinical and medication details. Keep sample cool and transport to the laboratory without delay.

C1, SERUM Biochemistry Please refer to COMPLEMENT-C1 for details. Referred test.


C3 NEPHRITIC FACTOR, SERUM

Biochemistry Blood/SS tube and Lithium heparin tube

3 weeks Please keep sample cool and transport to the laboratory without delay. Referred test.

C3, SERUM Biochemistry Please refer to COMPLEMENT-C3 for details.

C4, SERUM Biochemistry Please refer to COMPLEMENT-C4 for details.


CA 125, SERUM Endocrinology Blood/SS tube 24 hours Serous Carcinoma of ovary - see Biochemistry Appendix (12.4).

CA 15-3, SERUM Endocrinology Blood/SS tube 24 hours Breast Carcinoma - see Biochemistry Appendix (12.4).

CA 19-9, SERUM Endocrinology Blood/SS tube 24 hours Infl ammatory or neoplastic conditions of mucinous epithelium. See Biochemistry Appendix (12.4).

CA 724, SERUM Endocrinology Blood/SS tube 4 - 5 weeks A marker for stomach tumours. See Biochemistry Appendix (12.4). Referred test.

CADASIL GENETIC TESTING Genetics Blood/EDTA tube 4 - 6 weeks Blood should be kept at room temperature at all times. Incurs non-Medicare refundable fee.

CADMIUM (Cd), BLOOD Biochemistry Blood/EDTA tube (Lithium heparin tube acceptable)

1 week Please provide clinical, medication and exposure details.

7.28

7.28

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- C

PATH

OLOG

Y TE

STS

- C


CADMIUM (Cd), HAIR Biochemistry Hair/Dry sterile screw cap (urine) container

4 weeks Test for historical cadmium exposure. Please provide exposure details. For long term exposure, collect enough hair to pack a matchbox tightly (0.2- 0.4g) or to half fi ll a sterile screw top (urine) container. Please refer to Biochemistry Preface (5.6). Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

CADMIUM (Cd), URINE Biochemistry Urine/Urine container 1 week Please provide details of exposure (clinical and occupational). Collect the sample immediately after a working shift (where cadmium exposure has occurred). Alternatively, a fi rst morning sample can be collected.

CAERULOPLASMIN, SERUM Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details.

CALCITONIN, SERUM Endocrinology Blood/SS tube 1 weeks Tumour marker for Medullary Carcinoma of thyroid gland. Transport to laboratory within 2 hours of collection. Specimens must be kept cold.

CALCIUM IONISED, SERUM Biochemistry Blood/SS tube Same day Please provide clinical and medication details. The sample must be collected anaerobically into an SS tube and centrifuged as soon as it has clotted. The collection tube must be full. Place a label over the tube stopper to indicate that the tube must not be opened prior to analysis. Transport cool to laboratory. UNDER NO CIRCUMSTANCES MUST THE SAMPLE BE OPENED TO AIR.

CALCIUM SENSING RECEPTOR GENETIC TESTING

Genetics Blood/EDTA tube 2 months Incurs non-Medicare refundable fee.

CALCIUM STIMULATION OF GASTRIN

Endocrinology Blood/SS tube 2 - 3 weeks Please contact Endocrinology Department (07) 3121 4435 for details of collection. To make an appointment, contact the nearest collection centre that performs special tests. Fasting specimen is required (12 hr overnight fast or >5 hrs since last food). This test involves an IV Calcium gluconate, 10 mL slowly over 5 minutes (comes only as 10 mL ampoules). If Calcium is contraindicated rough whisky is an alternative. Contraindicated if on Cardiac glycosides, e.g. digoxin, risk of arrhythmias. Blood is collected at 0, 5, 10, 30, 40, 60 minutes and analysed for Gastrin.

CALCIUM, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify source of fl uid on sample and request form.

CALCIUM, SERUM Biochemistry Blood/SS tube Same day Please refer to E/LFT, SERUM. Fasting is desirable. Rest the patient for 15 - 30 minutes prior to collection. The sample should be collected without venous stasis (i.e. tourniquet should not be used).

7.29

7.29

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- C

PATH

OLOG

Y TE

STS

- C


CALCIUM, URINE Biochemistry Urine/24 hour urine container with 25 mL 6M HCl preservative

24 hours Please provide clinical and medication details. 24 hour collection is preferred. Under rare circumstances or if specifi cally requested, a random urine may be collected. Keep sample refrigerated.

CALCULUS ANALYSIS Biochemistry Calculus/Screw capped container

1 week Please state anatomical site of origin. Forward sample to the laboratory in a screw capped container (not in formalin).

CAMPYLOBACTER JEJUNI SEROLOGY


CANDIDA SEROLOGY Immunology Blood/SS tube 1 week Assay run Friday.

CANNABINOIDS - GCMS CONFIRMATION

Biochemistry Please refer to THC-COOH - GCMS CONFIRMATION for details.

CARBAMATE PESTICIDES Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity.

CARBAMAZEPINE, SERUM

Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin acceptable)


Please provide clinical and medication details. Collect at least 8 hours after last dose or just prior to next dose.

CARBARYL (PESTICIDE), BLOOD


CARBOHYDRATE DEFICIENT TRANSFERRIN, SERUM

Biochemistry Blood/SS tube 1 week Test for recent alcohol abuse. Please keep the sample cool and forward to the laboratory without delay.

CARBON - 14 UREA BREATH TEST FOR HELICOBACTER PYLORI

Endocrinology 1 glass vial containing CO2 trapping liquid


CARBON TETRA CHLORIDE, BLOOD


7.30

7.30

PATHOLOGY TESTS


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CARBOXYHAEMOGLOBIN, BLOOD

Biochemistry Blood/Blood gas syringe NEVER use plastic collection tubes

Same day Test for carbon monoxide exposure including cigarette smoking. Sample required is anticoagulated uncentrifuged whole blood (venous usually) TAKEN ANAEROBICALLY. ENSURE THAT SAMPLE IS NOT EXPOSED TO AIR NOR OPENED PRIOR TO ASSAY, BY PLACING A SEAL OVER THE STOPPER. FORWARD TO THE LAB WITHOUT DELAY.

CARCINOEMBRYONIC ANTIGEN(CEA), SERUM

Endocrinology Blood/SS tube 24 hours Please provide clinical and medication details. Provide date of previous CEA assay if patient is being monitored post operatively.

CARDIAC ENZYMES, SERUM Biochemistry Blood/SS tube Same day Please provide clinical and medication details. Troponin T only is assayed. If Serum AST, Lactate Dehydrogenase (LD), Creatine Kinase (CK) are required, these must be requested separately.

CARDIOLIPIN ANTIBODY, SERUM

Immunology Blood/SS tube 72 hours Assay run twice a week.

CARNITINE, NEONATAL SCREEN

Biochemistry Please refer to ACYL CARNITINE, NEONATAL SCREEN for details. Referred test.

CARNITINE, SERUM Biochemistry Please refer to ACYL CARNITINE, SERUM.

CAROTENE (BETA), SERUM Biochemistry Please refer to CAROTENOIDS, SERUM for details.

CAROTENOIDS, SERUM Biochemistry Blood/SS tube 24 hours Low levels in fat malabsorption; raised with increased dietary intake. Please provide clinical, dietary and medication details. Protect from light.

CAT SCRATCH DISEASE PCR Genetics Swab of infected site, CSF lymph nodes, aspirate

2 days Incurs non-Medicare refundable fee.

CAT SCRATCH DISEASE SEROLOGY

Immunology Blood/SS tube 24 hours Assay run Monday. If appropriate, a lymph node biopsy may be considered. The lymph node should be managed as for Marker Studies - see Histology Preface (5.35).

7.31

7.31

PATHOLOGY TESTS


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CATECHOLAMINES, BLOOD Biochemistry Blood/Lithium heparin tube with 1 mg of sodium metabisulphite added

1 - 2 weeks Test for phaeochromocytoma - plasma metanephrines or urinary catecholamines may be a more suitable alternative - please consult with Pathologist if in doubt. Please contact Biochemistry on (07) 3121 4045 or Branch Laboratory if you require a pre-prepared collection tube to be sent to you. An appointment is required for collection by a QML Pathology doctor at a Special Tests Collection Centre or Branch Laboratory. Blood specimens should be collected at rest (20-30 minutes) in the supine position. Collection should be through a heparinised indwelling catheter inserted 20-30 minutes prior to collection. Collect a FULL Lithium heparin tube containing 1 mg sodium metabisulphite. Blood should be centrifuged and plasma frozen immediately and the sample transported frozen. Referred test.

CATECHOLAMINES, URINE

Biochemistry Urine/24 hour urine container with 25 mL 6M HCl preservative

1 week Test for phaeochromocytoma and childhood neuroblastoma. Please provide clinical and medication details, especially recent changes in medication. PLEASE INSTRUCT PATIENT TO AVOID PARACETAMOL PRIOR TO AND DURING THE PERIOD OF COLLECTION. Please refer to: ‘Urine Collection Diet for 5HIAA and Catecholamine (12.11)’ for dietary and drug restrictions during or just prior to collection. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Under certain special circumstances, e.g. small children, a random urine can be collected. If this is required, contact senior Biochemistry staff prior to collection (07) 3121 4083.

CD34 PROGENITOR CELLS Haematology Blood/EDTA tube or ACD yellow top tube

Same day Transport to laboratory as soon as possible.

CD4/CD8 T LYMPHOCYTE RATIO, BLOOD

Haematology Blood/ACD tube, EDTA tube, Blood fi lm

24 hours Lithium heparin tube may be used if ACD tube unavailable.

CDT, SERUM Biochemistry Please refer to CARBOHYDRATE DEFICIENT TRANSFERRIN, SERUM.

CEA (CARCINOEMBRYONIC ANTIGEN), SERUM

Endocrinology Blood/SS tube 24 hours Please provide clinical and medication details. Provide date of previous CEA assay if patient is being monitored post operatively.

CELL PANEL HLA AB RBH HOSP Haematology Blood/SS tube or Plain tube

4 weeks Provide clinical and medication details. Centrifuge samples and transport at room temperature.

CELL PANEL HLA AB SYDNEY Haematology Blood/SS tube or Plain tube 4 weeks Provide clinical and medication details. Centrifuge samples and transport at room temperature.

CELLCEPT, PLASMA Biochemistry Please refer to MYCOPHENOLIC ACID, PLASMA.

7.32

7.32

PATHOLOGY TESTS


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CEPHALOSPORINS, SERUM/PLASMA

Biochemistry Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable)

1 - 2 weeks Collect just prior to next dose. Provide clinical and medication details.

CERVICAL PAP SMEAR CYTOLOGY

Cytology Labelled fi xed smear/Slide carrier

48 - 72 hours For specimen preparation and details of adjunctive tests (ThinPrep), please refer to Cytology Preface (5.11).

CHARCOT MARIE TOOTH SYNDROME - DNA

Genetics Blood/Pink top EDTA tube 1 - 2 months Patient needs to have genetics counselling prior to testing and consent form signed by patient and doctor. Send specimen at room temperature. Referred test.

CHLAMYDIA PCR, SWAB Immunology Swab/White top Chlamydia PCR tube

24 hours Assay runs daily (Monday to Saturday). Please see Microbiology Preface (5.58) and contact Immunology (07) 3121 4458 or Branch Laboratory for details.

CHLAMYDIA PCR, URINE Immunology First catch Urine/Urine container

24 hours The fi rst 20 mL of any voided urine is an acceptable alternative to a swab. The patient should not have urinated for one hour prior to the test.

CHLAMYDIA SEROLOGY SCREEN

Immunology Blood/SS tube 72 hours Assay run Monday, Wednesday and Friday.

CHLORDANE (ORGANOCHLORINE PESTICIDES), BLOOD


CHLORIDE, CSF Biochemistry Please refer to BIOCHEMISTRY, CSF for details.

CHLORIDE, FAECES Biochemistry Faeces/Faeces container 24 hours Keep sample cool during collection and transport to the laboratory.

CHLORIDE, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify source of fl uid on sample and request form.

CHLORIDE, SERUM Biochemistry Please refer to E/LFT, SERUM.

CHLORIDE, SWEAT Biochemistry Sweat/Sweat tube 1 week Test for cystic fi brosis. Please contact Collections (07) 3121 4450 or Branch Laboratory for appointment.

CHLORIDE, URINE Biochemistry Urine/Urine container (preferred) or 24 hour urine container with no preservative

24 hours Urine should be refrigerated after the collection period and transported cooled to the laboratory.

CHLORINATED SOLVENTS Biochemistry Please refer to SOLVENTS, BLOOD for all details.

CHLOROETHANE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

7.33

7.33

PATHOLOGY TESTS


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CHLOROFORM , BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

CHLOROQUINE, SERUM Biochemistry Blood/Fluoride oxalate tube or EDTA tube (preferred) or (Lithium heparin tube acceptable)

2 weeks Please provide clinical and medication details, including time and date of last dose.Referred Test.

CHLORPROMAZINE, SERUM Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant

2 weeks Please provide clinical and medication details. Sample collection is independent of time of dose. Referred test.

CHLORPYRIFOS (PESTICIDE), SERUM


CHOLECALCIFEROL (HYDROXY), SERUM


CHOLESTEROL, FLUID Biochemistry Fluid/Plain tube/Container Same day If testing for chyluria, chylothorax or chylous ascites, triglycerides is more appropriate. Specify source of fl uid on sample and request form.

CHOLESTEROL, SERUM Biochemistry Please refer to E/LFT, SERUM.

CHOLINESTERASE TYPING FOR SUXAMETHONIUM, SERUM

Biochemistry Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM (SCOLINE) SENSITIVITY, SERUM.

CHOLINESTERASE, RED CELL

Biochemistry Test for organophosphate or carbamate insecticide toxicity. Please provide clinical details including exposure to pesticides etc. Leave as whole blood. Refer to Biochemistry Appendix (12.18) for a comprehensive list of organophosphate and carbamate pesticides. Reduced red cell levels of cholinesterase usually equate with organophosphate and carbamate toxicity. Test can be performed on urgent basis. Screening test intervals depend on levels of exposure. Local and Regional Councils routinely recommend 3-6 monthly screens for exposed staff. Heavy users recommend 3 monthly screen and screening anytime after intensive use.

7.34

7.34

PATHOLOGY TESTS


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CHOLINESTERASE, SERUM Biochemistry Blood/SS tube (EDTA tube and Lithium heparin tube acceptable)

24 hours Test CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. The CHOLINESTERASE (PSEUDOCHOLINESTERASE) is also low in inherited forms of scoline sensitivity. Please provide clinical and medication details including exposure to organophosphate pesticides etc. Serum cholinesterase levels drop fi rst and provide a sensitive screening test for occupational organophosphate exposure. Reduced red cell levels usually equate with organophosphate toxicity. Screening test intervals depend on levels of exposure. Local and Regional Councils routinely recommend 3 - 6 monthly screens for exposed staff. Heavy users recommend 3 monthly screen and screening anytime after intensive use. Refer to Biochemistry Appendix 12.18 for list.

CHROMATOGRAPHY, FAECES (SUGAR)

Biochemistry Faeces/Faeces container 1 week Test for lactase defi ciency or malabsorption. Please provide clinical details. Collect FRESH sample (ideally should be fl uid to semi-fl uid). Freeze specimen, and store and transport frozen. Transport to laboratory as soon as possible. Please also refer to the Biochemistry Preface (5.5).

CHROMIUM, BLOOD Biochemistry Blood/Lithium heparin tube or EDTA tube

2 weeks Please provide clinical and medication details. Referred test.

CHROMIUM, URINE Biochemistry Urine/Urine container 2 weeks Please provide details of exposure (clinical and occupational). A random collection is preferred. Referred test.

CHROMOGRANIN A, SERUM Biochemistry Blood/SS tube 3 weeks Keep sample cool during collection and transport to the laboratory.

CHROMOSOMES, AMNIOTIC FLUID

Genetics Amniotic fl uid/2 x sterile 10 mL black top tubes

1 - 2 weeks Average reporting time of 12 days. For overnight transport, the sample should be cooled NOT FROZEN.

CHROMOSOMES, BLOOD Genetics Blood/Lithium heparin tube 2 weeks Reporting time less than 1 week if urgent. Diffi cult collection should be noted on the form. Please refer to Genetics Preface (5.28).

CHROMOSOMES, BONE MARROW

Genetics Bone marrow aspirate/Lithium heparin tube

2 weeks Minimum 2 days if urgent. Transport in esky at 4°C or room temperature.

CHROMOSOMES, CHORIONIC VILLI

Genetics Chorionic villus biopsy/Antibiotic transport medium

1 - 2 weeks Antibiotic transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

CHROMOSOMES, LYMPH NODE

Genetics Lymph node/Antibiotic transport medium

2 - 6 weeks DO NOT use formalin. Transport to laboratory as soon as possible. Antibiotic transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

7.35

7.35

PATHOLOGY TESTS


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CHROMOSOMES, PRODUCTS OF CONCEPTION

Genetics Products of conception (placenta, membrane, fetal tissue and skin)/Antibiotic transport medium

3 weeks DO NOT freeze or place in formalin. Sample must be kept sterile and moist. Transport to laboratory as soon as possible. Antibiotic transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

CHROMOSOMES, TISSUE Genetics Skin and other tissues (not prenatal)/Antibiotic transport medium

3 weeks DO NOT freeze or place in formalin. Sample must be kept sterile and moist. Transport to laboratory as soon as possible. Antibiotic transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

CHROMOSOMES, TUMOUR Genetics Selected tumour tissue dissected free of necrotic tissue, adherent fat and extraneous tissue and sliced into small pieces/Antibiotic transport medium

2 - 6 weeks DO NOT freeze or place in formalin. Sample must be kept sterile and moist. Transport to laboratory as soon as possible. Please refer to Genetics Preface (5.28). Antibiotic transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

CHROMOSOMES, UNSTIMULATED BLOOD

Genetics Blood/Lithium heparin tube

2 weeks DIFFICULT collection should be noted on the form. Transport cool or at room temperature.

CHRONIC RENAL DISEASE GENETIC TESTING

Genetics Blood/EDTA tube Indeterminate

CIGUATERA POISONING, FISH Biochemistry Frozen fi sh (cooked or uncooked)/Clean plastic container

Indeterminate Please contact Biochemistry or Branch Laboratory regarding details of collection of fi sh samples. Testing on human samples is not available.

CILIAL BIOPSY Histology Hartmann’s Solution Motility - 2 hours Electron Microscopy - 7 days

Two specimens are required, the fi rst specimen collected placed in Hartmann’s Buffer for Motility studies, the second specimen placed in 3% Buffered Glutaraldehyde for Electron Microscopy. Refer to Histology Preface (5.37). Advance notice of the impending biopsy should be given to the laboratory.

CITRATE, URINE Biochemistry Urine/24 hour urine container with 25 mL 6M HCl preservative

1 - 2 weeks Please provide clinical and medication details. Refrigerate sample during collection and transport to the laboratory. Acid preserved sample is preferred, but the sample may be collected into a plain container if the sample is kept refrigerated and acid added as soon as possible i.e. at the laboratory. Referred test.

CK ELECTROPHORESIS, SERUM Biochemistry Please refer to CK ISOENZYME ELECTROPHORESIS, SERUM.

7.36

7.36

PATHOLOGY TESTS


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CK ISOENZYMES ELECTROPHORESIS, SERUM

Biochemistry Blood/SS tube 2 weeks Please provide clinical and medication details.

CK ISOENZYMES, SERUM Biochemistry Blood/SS tube Same day Please provide clinical and medication details.

CK, SERUM Biochemistry Blood/SS tube Same day Please provide clinical and medication details.

C-KIT D816V (MASTOCYTOSIS) GENETIC TESTING

Genetics Bone marrow and trephine/Min. 2 mL bone marrow in EDTA or Lithium heparin tubes, and bone marrow trephone (20mm) in 10% neutral buffered formalin

1 - 2 months

CLOBAZAM, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube acceptable)

1 week Please provide clinical and medication details, including time and dosage of last dose. Collect just prior to the next dose or at least 8 hours after the last dose.

CLOMIPRAMINE, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube acceptable)

1 week Please provide clinical and medication details, including time and date of last dose. Collect sample immediately prior to next dose.

CLONAZEPAM, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube acceptable)


CLONIDINE GROWTH HORMONE STIMULATION TEST

Endocrinology Blood/SS tube 24 hours Test involves administration of Clonidine tablets, the dose dependent on the body surface area, which is calculated by measuring the height and weight of the patient. Contact Endocrinology (07) 3121 4439 or Branch Laboratory for collection details and dose.

CLOPYRALID (HERBICIDE), URINE

Biochemistry Please refer to HERBICIDES, URINE.

CLOSTRIDIUM DIFFICILE TOXIN, FAECES

Microbiology Faeces/Faeces container Same day - 24 hours

Routine faeces sample. Refrigerate and transport cooled to laboratory within 24 hours of collection. Please indicate any recent history of antibiotics. If causes of diarrhoea other than Clostridium diffi cile are possible or suspected a faeces sample for microscopy and culture should also be submitted. Refer to Microbiology Preface (5.54).

7.37

7.37

PATHOLOGY TESTS


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CLOZAPINE, SERUM Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant (EDTA tube or Lithium heparin tube acceptable)

1 week Please provide clinical and medication details, including time of last dose and dosage. Collect trough level for monitoring purposes (i.e. immediately before next dose). Although it is generally optimal to collect trough drug levels so as to avoid misleading elevated clozapine samples can be collected at the same time as the Haematology sample levels arising from drug distribution effects, as long as the time of collection is no closer than 12 hours after the dose - typically evening dose followed by late morning collection.

CLOZARIL, SERUM Biochemistry Please refer to CLOZAPINE, SERUM.

CMV (CYTOMEGALOVIRUS) PCR

Immunology Blood/SS tube and 2 EDTA tubes.Random (mid-stream) urine/urine container Swab/ Viral culture transport medium

1 week Under certain circumstances e.g. suspected antenatal or neonatal infection, positive CMV IgM serology requires confi rmation by virus isolation. Saliva and high vaginal swabs are required together with blood and urine.

CMV (CYTOMEGALOVIRUS) SEROLOGY


COAGULATION STUDIES, BLOOD

Haematology Blood/3 Sodium citrate tubes, 1 EDTA tube, 1 blood fi lm prepared at time of collection

Same day Studies include Platelet count, Prothrombin time, APTT and Fibrinogen. Please specify if a bleeding time is required. Transport to laboratory within 4 hours. Please provide clinical and medication details.

COBALT, BLOOD Biochemistry Blood/EDTA tube (Lithium heparin tube acceptable)

4 weeks Please provide exposure details. Referred test.

COBALT, URINE Biochemistry Urine/Urine container 1 week Please provide details of exposure (clinical and occupational). A random collection is preferred. Referred test.

COCAINE METABOLITES - GCMS CONFIRMATION


48 hours This is requested in cases concerned with occupational drug screening for drugs of abuse. The QML Pathology protocol complies with Standards Australia AS/NZS4308 for the assay of cannabinoids, opiates, cocaine metabolites, benzodiazepines and sympathomimetic amines. A Chain-of Custody form should be completed. Additional classes (methadone, barbiturates, alcohol) should be specifi cally requested if required. Please also refer to the Biochemistry Preface (5.4). Confi rmation and quantitation by GCMS of positive fi ndings may be requested separately.

7.38

7.38

PATHOLOGY TESTS


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COCCIDIOIDES SEROLOGY Immunology Blood/SS tube 2 - 3 weeks

CODEINE, SERUM Biochemistry Blood/Lithium heparin tube or plain plastic tube - no gel

2 weeks Peak level should be taken 1-2 hours after dose. Please provide clinical and medication details including time and dosage of last dose. Referred test.

CODIPHEN, SERUM Biochemistry Please refer to CODEINE, SERUM.

CODRAL, SERUM Biochemistry Please refer to CODEINE, SERUM.

COENZYME Q10, PLASMA Biochemistry Blood/Lithium heparin tube 1 - 2 weeks Please protect the sample from light and send to the laboratory without delay. Referred test.

COLD AGGLUTININS, SERUM Blood Bank Blood/SS tube pre-warmed to 37°C

Same day Pre-warm all collection materials to 37°C. Maintain specimen at 37°C by immersion in a water bath until clotted. Separate serum by centrifugation IMMEDIATELY after clotting (i.e. at 37°C). The separated specimen may be sent to the laboratory at room temperature.

COLLAGEN BINDING ASSAY, BLOOD

Haematology Blood/Sodium citrate tube

1 - 4 weeks Clinical and medication details required. Transport at 4°C to reach the laboratory within 2 hours of collection. Please contact Haematology (07) 3121 4451 or Branch Laboratory for details.

COMBINED DEXAMETHASONE/ SYNACTHEN TEST

Endocrinology Blood/SS tube and EDTA tube

48 hours This is a combined test for Androgen Excess/Hirsutism in females and also a test for the rare Congenital Adrenal Hyperplasia (CAH). See Endocrinology Appendix (12.26) This procedure involves an intramuscular injection of Synacthen and Dexamethasone tablets. Please contact Endocrinology (07) 3121 4439 or Branch Laboratory for collection details and supply of Dexamethasone tablets and Synacthen ampoule (0.25mg/1 mL).

COMPATIBILITY TESTING (CROSSMATCH), BLOOD

Blood Bank Blood/1 Pink top EDTA tube, 1 Lavender top EDTA tube

Same day If history of antibodies or transfusion complications collect additional 6 mL plain plastic tube. Note special requests e.g. CMV negative, irradiated. Record date and hospital where blood required. Sample must be signed by patient or collector to verify. Complete blue box on request form, collector to sign Certifi cation statement.

COMPLEMENT - TOTAL HAEMOLYTIC (CH50), SERUM

Immunology Blood/SS tube 24 hours Assay run daily (Monday to Friday). The specimen must be centrifuged immediately after clotting and refrigerated during transport.

COMPLEMENT-C1, SERUM Biochemistry Blood/SS tube 2 - 3 weeks Please provide clinical and medication details. Centrifuge, separate and FREEZE serum immediately. Transport to the laboratory on dry ice. Referred test.

7.39

7.39

PATHOLOGY TESTS


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COMPLEMENT-C3, SERUM Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details. Sample must be stored and transported to the laboratory REFRIGERATED.

COMPLEMENT-C4, SERUM Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details. Sample must be stored and transported to the laboratory REFRIGERATED.


COMPLEMENT-C6, SERUM Biochemistry Blood/SS tube 4 weeks Please provide clinical and medication details. Centrifuge, separate and FREEZE serum immediately. Transport to the laboratory on dry ice. Referred test.


COMPLEMENTS, SERUM Biochemistry If COMPLEMENTS, SERUM is requested, C3 and C4 are performed.

CONGENITAL ADRENAL HYPOPLASIA GENETIC TESTING

Genetics Blood/EDTA tube 2 months Incurs non-Medicare refundable fee.

CONGENITAL HYPOTHYROIDISM SCREENING TEST, BLOOD

Biochemistry Please refer to NEONATAL SCREENING TEST.

CONNEXION 26 GENETIC TESTING

Genetics Blood/EDTA tube 1 month Incurs non-Medicare refundable fee.

COOMBS TEST, DIRECT Blood Bank Blood/Pink top EDTA tube Same day Please provide provisional diagnosis and medication history. On neonatal requests provide details of maternal obstetric and transfusion history.

COPPER, HAIR Biochemistry Hair/Dry sterile screw cap (urine) container

4 weeks Fill sterile container as full as possible with hair. Clippings from the patient’s last hair cut can be used. Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

COPPER, LIVER BIOPSY Biochemistry Liver biopsy/Dry sterile screw top (urine) container

2 weeks Wash excess blood away with 0.9% saline. Wrap in aluminium foil to transport. Place in urine container and FREEZE. DO NOT place in formalin. Referred test.

COPPER, RED BLOOD CELLS

Biochemistry Blood/EDTA tube 2 weeks This analysis should only be performed if specifi cally requested. The preferred analysis for Copper is serum (SS tube). Referred test.

7.40

7.40

PATHOLOGY TESTS


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COPPER, SERUM Biochemistry Blood/SS tube 1 week Please provide clinical history and medication details. CAERULOPLASMIN, SERUM may often be requested concurrently.

COPPER, URINE Biochemistry Urine/24 hour urine container with no preservative

1 week Please provide clinical and medication details. Refrigerate sample and forward to the laboratory. 24 hour collection is preferred. Under rare circumstances or if specifi cally requested, a random urine may be collected.

COPROPORPHYRIN, URINE Biochemistry Please refer to PORPHYRIN, URINE. Fractionation and PBG analysis is routinely performed.

COPROPORPHYRIN SCREEN, FAECES

Biochemistry Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES.

COPROPORPHYRIN/PROTOPORPHYRIN, FAECES

Biochemistry Faeces/Faeces container Screen: 1 - 7 days Quantitation: 1 - 2 weeks

Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES.

CORDARONE, SERUM Biochemistry Please refer to AMIODARONE, SERUM.

CORTISOL, SERUM Endocrinology Blood/SS tube 24 hours Note time of collection and any medications on specimen and request form.

COTININE, SERUM Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant

1 week Required for insurance testing. Patient must be fasting. Please store specimen refrigerated and transport cooled to the laboratory without delay. If a delay is envisaged, separate serum, freeze and transport frozen. Please note on the request if the patient is a diabetic, as elevated glucose levels may affect the test. Serum is the preferred sample. Referred test.

COTININE, URINE Biochemistry Urine/Urine container 1 week Required for insurance testing. Patient should be fasting prior to collection. A random urine collection is required. Keep cool and forward to the laboratory as soon as possible. Note on the request if the patient is diabetic, as elevated glucose levels may affect the test. Serum is the preferred sample. If a delay is envisaged, freeze sample and transport frozen. Referred test.

COWDEN SYNDROME GENETIC TESTING

Genetics Blood/EDTA tube Indeterminate Store at 4°C until transported at room temperature. Patient consent form for genetic testing to be completed and signed by patient and clinician. Form to be sent with sample.

COXIELLA (Q FEVER) SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

COXSACKIE SEROLOGY Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday.

7.41

7.41

PATHOLOGY TESTS


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C-PEPTIDE SERUM Endocrinology Blood/SS tube 24 hours C-peptide is a remnant of proinsulin after cleavage to produce insulin. This test can be used to assess pancreatic reserve in patients on insulin therapy or if not on insulin as an alternative to blood insulin measurement. Please state whether you require fasting, 1 hour post prandial or random blood collection.

C-PEPTIDE SUPPRESSION TEST USING INSULIN

Endocrinology Blood/SS tube 24 hours This test involves an infusion of insulin and the measurement of glucose and c-peptide, usually investigating insulinoma. Other hormones may be required to exclude Cushing’s Syndrome or other pituitary/hypothalamic disorders. Appointment is required. Please contact Endocrinology (07) 3121 4439 or Branch Laboratory.

CPK, SERUM Biochemistry Please refer to CK ISOENZYMES, SERUM.

C-REACTIVE PROTEIN, HIGH SENSITIVITY, SERUM

Biochemistry Blood/SS tube (EDTA tube and Lithium heparin tube acceptable if centrifuged without delay)

24 hours Marker for increased risk of premature cardiovascular disease. Keep sample cool.

C-REACTIVE PROTEIN, SERUM

Biochemistry Blood/SS tube (EDTA tube and Lithium heparin tube acceptable if centrifuged without delay)

Same day Test for infection/infl ammation. With low level elevation, test for active coronary atherosclerosis. Please provide clinical and medication details.

CREATINE KINASEISOENZYMES, SERUM

Biochemistry Please refer to CK ISOENZYMES, SERUM.

CREATINE KINASE, SERUM Biochemistry Please refer to CK, SERUM.

CREATINE, PLASMA Biochemistry Blood/Lithium heparin tube 3 weeks Centrifuge sample and separate plasma where possible. Transport sample on dry ice.

CREATININE CLEARANCE Biochemistry Blood and urine/SS tube and 24 hour urine container with no preservative OR 24 hour urine container with 25 mL 6M HCl preservative

24 hours Record patient’s height and weight on request form and on urine container. Refrigerate urine during collection. Collect blood sample at end of 24 hour urine collection. Send blood and urine sample to laboratory at the same time. Requests for GFR/calculated GFR do not require urine collection.

CREATININE, FLUID Biochemistry Fluid/Plain tube/Container Same day Test to determine if originates from urine. Specify source of fl uid on sample and request form.

CREATININE, SERUM Biochemistry Please refer to E/LFT, SERUM.

7.42

7.42

PATHOLOGY TESTS


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CREATININE, URINE 24 HOUR

Biochemistry Urine/24 hour urine container with no preservative or 24 hour urine container with 25 mL 6M HCl preservative

24 hours Test for completeness of 24 hour collection. Please provide clinical and medication details. CREATININE ASSAY CAN BE PERFORMED ON PLAIN OR PRESERVED URINES. Refrigerate from start of collection, and during storage and transport.

CREATININE, URINE RANDOM

Biochemistry Urine/Urine container Same day Test of overall concentration of urine. Please provide clinical and medication details. CREATININE ASSAY CAN BE PERFORMED ON PLAIN OR PRESERVED URINES. Refrigerate during storage and transport.

CROSS LINKED N-TELOPEPTIDES, URINE


CROSSMATCH, BLOOD Blood Bank Blood/1 Pink top EDTA tube, 1 Lavender top EDTA tube


If history of antibodies or transfusion complications collect additional 6 mL. Note special requests e.g. CMV negative/irradiated. Sample must be signed by patient or collector to verify patient identity. Complete blue box on request form, collector to sign Certifi cation statement.

CRP HIGH SENSITIVITY, SERUM Biochemistry Please refer to C REACTIVE PROTEIN, HIGH SENSITIVITY, SERUM.

CRP, SERUM Biochemistry Please refer to C-REACTIVE PROTEIN, SERUM.

CRYOFIBRINOGEN, PLASMA AND SERUM

Biochemistry Please refer to CRYOFIBRINOGEN/CRYOGLOBULINS, PLASMA AND SERUM.

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CRYOFIBRINOGEN/CRYOGLOBULINS, PLASMA AND SERUM

Biochemistry Blood/Lithium heparin tube and a plain tube - no gel

72 hours Analysis includes Cryofi brinogen. Samples must be taken into tubes pre-warmed to approximately 37°C (e.g. water bath, oven, hold in hand for approximately 5 minutes). Transfer to the central laboratory immediately, keeping specimens at approximately 37 degrees centigrade, using a vacuum fl ask or similar. Do not centrifuge samples. IF UNABLE TO TRANSFER TO LABORATORY AT 37°C: 1. Samples must be taken into tubes pre-warmed to 37 degrees centigrade. 2. Allow samples to stand in 37 degrees centigrade water bath for 0.5-1.0 hr to allow separation of red cells to occur without centrifugation. If a water-bath is not available, a container of warm water (topped-up frequently) may be used. 3. When separation has occurred, transfer serum and plasma to Falcon tubes and identify each tube appropriately (i.e. PLASMA - CRY and/or SERUM-CRY). 4. The separated serum and plasma samples may now be transported to the laboratory at ambient temperature. If these procedures cannot be followed, please contact the laboratory on (07) 3121 4460 or Branch Laboratory.

CRYOGLOBULINS, PLASMA AND SERUM


CRYOGLOBULINS/CRYOFIBRINOGEN, PLASMA AND SERUM


CRYPTOCOCCUS ANTIGEN, SERUM OR CSF

Immunology Blood/SS tube; Cerebrospinal fl uid (5- 10 mL)/CSF collection tubes

Same day

CSF - LEUKAEMIA/LYMPHOMA CELLS

Haematology CSF/CSF collection tubes

Same day Examination of cytospin preparation for leukaemia/lymphoma cells.

CSF - VIROLOGY Immunology CSF/Plain tube (minimum 0.5 mL required)

1 week Referred test. Test performed by PCR (Viral culture not routinely performed). Please request specifi c tests and include clinical details.

CSF CONTAMINATION, FLUID Biochemistry Please refer to TAU PROTEIN, FLUID.

CSF CYTOLOGY Cytology CSF/Sterile screw top container


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CSF MALIGNANT CELLS Cytology Fluid/Sterile screw top container


CSF MICROSCOPY AND CULTURE

Microbiology Cerebrospinal fl uid/Sterile tubes labelled 1, 2, 3 or 4

Interim microscopy report same day. Culture up to 3 days.

Please provide clinical details including antibiotic therapy and specify if specimen is to be cultured for Mycobacteria, Viruses, Cryptococci or other fungi or exotic organisms (Nocardia, etc.).

CSF MICROSCOPY ONLY Microbiology Cerebrospinal fl uid/Sterile tubes labelled 1, 2, 3 or 4

Same day

CSF TRANSFERRIN ASSAY, FLUID

Biochemistry Please refer to TAU PROTEIN, FLUID.

CYANIDE, BLOOD Biochemistry This test is not available. THIOCYANATE, BLOOD (metabolite of cyanide) is more appropriate.

CYANIDE, URINE Biochemistry This test is not available. THIOCYANATE, URINE (metabolite of cyanide) is more appropriate.

CYCLIC AMP, BLOOD AND URINE 24 HOUR

Endocrinology Blood/SS tube and 24 hour Urine collection/Urine collection bottle. No preservative

4 - 5 weeks Record patient’s height and weight on request form. Collect blood sample on return of urine and forward to laboratory at same time. Total volume of urine is required. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

CYCLOSPORIN, BLOOD Biochemistry Blood/EDTA tube 3 -5 days Please provide clinical and medication details. Collect sample just prior to next dose. This test can be performed urgently if required.

CYSTIC FIBROSIS (CF) SCREENING TEST, BLOOD


CYSTIC FIBROSIS DNA TEST Biochemistry Blood/Refer to specifi c collection details

2 - 3 weeks If patient less than 2 years, collect neonatal screening card. If patient greater than 2 years, collect EDTA blood. If pre-natal testing is required (CF status on unborn baby), please phone the laboratory on (07) 3121 4420 for instructions.

CYSTINE, URINE Biochemistry Urine/24 hour urine container with 25 mL 6M HCI preservative

2 weeks Please provide clinical history and medication details. Refrigerate from start of collection. 24 hour collection is preferred. Referred test.

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CYTOMEGALOVIRUS (CMV) PCR Immunology Blood/SS tube and 2 x EDTA tubes. Random (mid-stream) urine/urine container. Swab/Viral culture transport medium

24 - 48 hours Under certain circumstances e.g. suspected antenatal or neonatal infection, positive CMV IgM serology requires confi rmation by virus isolation. Saliva and high vaginal swabs are required together with blood and urine.

CYTOMEGALOVIRUS (CMV) SEROLOGY


CYTOTOXIC FOOD TESTING Specimen Distribution

Blood/ACD tube Collection and transfer only

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DANTHRON, BLOOD Biochemistry This test is performed on faeces. Please refer to LAXATIVES, FAECES.

DANTHRON, FAECES Biochemistry Please refer to LAXATIVES, FAECES.

DAZ GENE ANALYSIS Genetics Blood/Pink top EDTA tube 2 weeks Incurs non-Medicare refundable fee.

DDE LEVELS (ORGANOCHLORINE PESTICIDES), BLOOD


D-DIMER TEST Haematology Blood/Sodium Citrate tube Same day Transport to laboratory as soon as possible.

DDT LEVELS (ORGANOCHLORINE PESTICIDES), BLOOD


DELTA ALA, URINE Biochemistry Please refer to 5-ALA, URINE.

DEMETON (PESTICIDE), SERUM


DENGUE SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

DENTATORUBRAL-PALLIDOLUYSIAN ATROPHY (DRPLA) GENETIC TESTING


DEOXYCORTICOSTERONE, SERUM

Endocrinology Blood/SS tube 2 - 5 weeks Referred test.

DEOXYCORTISOL, SERUM Endocrinology Blood/SS tube 2 - 5 weeks Referred test.

DEOXYPYRIDINIUM, URINE Biochemistry Please refer to DEOXYPYRIDINOLINE, URINE.

DEOXYPYRIDINOLINE, URINE

Biochemistry Urine/Urine container (random) or 24 hour urine container with no preservative

1 week An early morning urine specimen is preferred. A 24 hour specimen may be collected if specifi cally requested. No preservative. Keep specimen refrigerated during collection and transport. A highly specifi c marker of bone resorption used in investigation and monitoring of osteoporosis, Paget’s disease, steroid therapy, malignancies, infl ammatory diseases and metabolic bone diseases.

DEPTRAN, SERUM Biochemistry Please refer to DOXEPIN, SERUM.

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DESIPRAMINE, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube (no gel) acceptable)

1 week Please provide clinical and medication details, including time and date of last dose. Collect immediately prior to next dose.

DESMOSINE PYRIDINOLINE, URINE

Biochemistry Please refer to DEOXYPYRIDINOLINE, URINE.

DEXAMETHASONE SUPPRESSION TEST


48 hours Collect baseline cortisol specimen between 8am and 10am day 1. Also collect a baseline EDTA specimen. This is used to perform an ACTH if dexamethasone suppression test results are abnormal. Give 1 mg oral Dexamethasone at 11pm. Patient to remain awake for at least 30 minutes post dose to ensure absorption. Collect second cortisol specimen between 8am and 10am day 2. Note this test must be varied for shift workers. Please note - for children (<40kgs) give half the dose (i.e. 0.5mg Dexamethasone) and make a note of it on request form. Please contact Endocrinology (07) 3121 4439 or Branch Laboratory for test and collection details.

DEXAMETHASONE SUPPRESSION TEST - EXTENDED


48 hours This test is used as an indicator of stress levels (is used for endogenous depression). Collect baseline cortisol specimen between 8am and 10am day 1. Also collect an EDTA at this stage to do an ACTH if results are abnormal. Give 1mg oral Dexamethasone at 11pm. Patient to remain awake for at least 30 minutes post dose to ensure absorption. Collect cortisol specimens (SS tube) between 8am and 10am, at 4pm and at 10pm day 2. Please ensure tubes are labelled with date, times and PRE or POST. Please contact Endocrinology (07) 3121 4439 or Branch Laboratory for test and collection details.

DEXAMETHASONE SUPPRESSION TEST - PSYCHIATRIC


72 hours This test is used as an indicator of stress levels (is used for endogenous depression). Collect baseline cortisol specimen between 8am and 10am day 1. Also collect an EDTA at this stage to do an ACTH if results are abnormal. Give 1 mg oral Dexamethasone at 11pm. Patient to remain awake for at least 30 minutes post dose to ensure absorption. Collect cortisol specimens between 8am and 10am and at 4pm and 10pm day 2. Please ensure tubes are labelled with date, times and PRE or POST. Please contact Endocrinology (07) 3121 4439 or Branch Laboratory for test and collection details.

DEXTRONE, URINE Biochemistry Please refer to PARAQUAT, URINE.

DHEA, SERUM Endocrinology Blood/SS tube 24 hours Please note date of last normal menstrual period (LNMP).

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DIALKYL PHOSPHATE METABOLITES, URINE

Biochemistry Urine/Urine container OCCUPATIONAL - Up to 10 working days NON-OCCUPATIONAL - Up to 4 weeks

Random urine collected at the end of work shift or exposure. PLEASE NOTE: The preferred collection for Organophosphates is serum. Collect urine only where specifi cally required OR permission has been granted to perform the analysis by the doctor, patient or employer. This analysis attracts a non-Medicare rebatable fee from the reference laboratory.

DIALYSIS FLUID, PRE-DIALYSIS

Biochemistry Dialysis fl uid/Plain plastic tube

Same day - 24 hours

Obtained from unopened dialysis fl uid bottle.

DIASTASE, URINE Biochemistry Please refer to AMYLASE, URINE.

DIAZEPAM, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube (no gel) acceptable)

1 week Collect just prior to the next dose or at least 8 hours after the last dose. Please provide clinical and medication details, including time and dosage of last dose.

DIAZINON (PESTICIDE), SERUM Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity.

DIBUCAINE NUMBER, SERUM Biochemistry Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM (SCOLINE) SENSITIVITY, SERUM.

DICHLOROMETHANE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

DICHROMATE, BLOOD Biochemistry Please refer to CHROMIUM, BLOOD for all details.

DICOFOL (ORGANOCHLORINE PESTICIDES), BLOOD


DIELDRIN (ORGANOCHLORINE PESTICIDES), BLOOD


DIELDRIN, BREAST MILK Biochemistry Breast milk/Glass sterile container

4 weeks Keep sample cool. Referred test.

DIETARY URIC ACID EXCRETION TEST

Biochemistry Blood and Urine/24 hour urine container with 15 mL 2M NaOH x 4, SS tube x 2

24 hours Please contact Collections (07) 3121 4450 or Branch Laboratory for specimen collection details. Baseline 24 Hour urine urate and creatinine clearance must be established prior to the patient commencing a special low purine diet. See Biochemistry Appendix (12.12).

DIGITALIS, SERUM Biochemistry Please refer to DIGOXIN, SERUM.

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DIGOXIN, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube (no gel) acceptable)

Same day Please provide clinical and medication details. Collect sample 8-48 hrs after last dose (preferably immediately before next dose). Record last dose and time taken.

DIHYDROTESTOSTERONE, PLASMA

Endocrinology Blood/Lithiumheparin tube

6 weeks Please keep specimen cold in transit. Referred test.

DIHYDROXY CHOLECALCIFEROL, SERUM


DIHYDROXY VITAMIN D, SERUM


DILANTIN, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube (no gel) acceptable)

Same day Please provide clinical and medication details including last dosage and time taken. Take sample just prior to next dose (the timing of sampling for this test is not obligatory for adult patients with no recent change in medication as there is only minor in inter dose variation in drug levels).

DIMETHOATE (PESTICIDE), SERUM


DIPHENYLHYDANTOIN, SERUM Biochemistry Please refer to DILANTIN, SERUM.

DIPHTHERIA SEROLOGY (TOXIN ANTIBODY SCREEN)

Immunology Blood/SS tube 2 - 4 weeks Referred test.

DIQUAT, URINE Biochemistry Please refer to PARAQUAT, URINE.

DIRECT ANTIGEN TEST FOR RESPIRATORY VIRUSES (INCLUDING RSV, INFLUENZA, PARAINFLUENZA, ADENOVIRUS)

Immunology Nasopharyngeal aspirate/Aspirating trap

24 hours Refrigerate specimen and transport cooled to laboratory as soon as possible. Results usually available same day for urgent specimens.

DIRECT ANTIGLOBULIN TEST

Blood Bank Blood/Pink top EDTA tube

Same day Please provide provisional diagnosis and medication history.On neonatal requests provide details of maternal obstetric and transfusion history.

DIRECT COOMBS TEST Blood Bank Blood/Pink top EDTA tube

Same day Please provide provisional diagnosis and medication history. On neonatal requests provide details of maternal obstetric and transfusion history.

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DIRECT IMMUNO FLUORESCENT ASSAY (GIARDIA)

Microbiology Faeces/Faeces container 48 hours Specimen can be refrigerated for up to 48 hours if transport to laboratory is delayed. QML Pathology no longer performs the Giardia Specifi c Antigen (GSA) test. The new procedure is the Direct Immuno Fluorescent Assay.

DISACCHARIDASES, INTESTINAL BIOPSY TISSUE

Biochemistry Please refer to INTESTINAL DISACCHARIDASES, BIOPSY TISSUE.

DISOPYRAMIDE, SERUM Biochemistry Blood/Plain plastic tube - no gel

1 - 2 weeks Please provide clinical and medication details. For monitoring purposes, collect sample immediately prior to next dose. Record last dosage and time taken. Referred test.

D-LACTATE, PLASMA Biochemistry Blood/Lithium heparin tube

2 weeks For investigation of intestinal bacterial overgrowth. Referred test.

D-LACTATE, URINE Biochemistry Urine/Plain random urine container or 24 hour urine container with no preservative

1 week Keep sample cold during transport. Referred test.

DNA TESTING Genetics Blood/EDTA tube Dependent on test

Genetics Department tests for a variety of disorders. Some of the rarer disorders are diagnosed in other laboratories. Many disease mutations are still to be characterised. Please contact Genetics (07) 3121 4461 or Branch laboratory for further information.

DNAse B TITRE (STREPTOCOCCI), SERUM


DONATH LANDSTEINER ANTIBODY

Haematology Blood/Refer Haematology Department

24 hours Please contact Haematology (07) 3121 4451 or Branch Laboratory for collection details.

DONOVANOSIS Cytology Labelled fi xed or unfi xed smear/slide carrier

24 hours Skin biopsy for Histology may also be appropriate to rule out other pathology. Refer collection enquiries to QML Pathology Dermatopathologists.

DOPAMINE, URINE 24 HOUR


DOTHEP, SERUM Biochemistry Please refer to DOTHIEPIN, SERUM.

DOTHIEPIN, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube (no gel) acceptable)

1 week Collect immediately prior to next dose. Please provide clinical and medication details, including time and date of last dose.

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DOUBLE-STRANDED DNA ANTIBODY, SERUM


DOXEPIN, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube (no gel) acceptable)

1 week Collect immediately prior to next dose. Please provide clinical and medication details, including time and date of last dose.

DPYD, URINE Biochemistry Please refer to DEOXYPYRIDINOLINE, URINE.

DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER CHROMATOGRAPHY), URINE

Biochemistry Urine/Urine container 48 hours If occupational or industry, please refer to DRUG SCREEN (OCCUPATIONAL/INDUSTRY (AS/NZS4308 GUIDELINES)), URINE. NB: Blood (Plain tube with no gel or Lithium heparin) in special circumstances only (Occupational/Industry (AS/NZS4308 Guidelines)), URINE otherwise see below. Requested in cases concerned with: - monitoring of compliance with therapy - query drug used - drug rehabilitation program - custody cases - correctional centres - suspected overdose. We recommend screening for drugs be performed on urine rather than blood, due to urinary concentration of metabolites. In some cases (e.g. suspected overdose) blood may be collected, with urine being collected as soon as practicable. A Chain-of-Custody form is recommended for all medico/legal cases. Please also refer to the Biochemistry Preface (5.4). Provide clinical, medication and suspected drug usage details.

DRUG SCREEN (OCCUPATIONAL/INDUSTRY (AS/NZS4308 GUIDELINES)), URINE


48 hours Requested in cases concerned with occupational drug screening for drugs of abuse. The QML Pathology protocol complies with Australian Standard AS4308 for the assay of Cannabinoids, Opiates, Cocaine metabolites, Benzodiazepines, Sympathomimetic amines. A Chain-of-Custody form should be completed. Additional classes (methadone, barbiturates, alcohol) should be specifi cally requested if required. Please also refer to the Biochemistry Preface (5.4). Confi rmation and quantitation by GC/MS of positive fi ndings may be requested separately.

DRUG SCREEN(NON OCCUPATIONAL), URINE


48 hours Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER CHROMATOGRAPHY), URINE.

DRUG SCREEN, HAIR Biochemistry Hair roots/Hair drug screen collection kit with tamper evident packaging

2 weeks Contact Referred Tests Department on (07) 3121 4045 for a hair drug screen collection kit, containing full collection instructions.

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DRUG SCREEN, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (plastic lithium heparin tube (no gel) acceptable)

24 hours We recommend that screening for drugs (except alcohol) should be performed on urine instead of serum, as urine has higher sensitivity due to urinary concentration of metabolites. However, in some cases (e.g. suspected overdose, or doctor insists on serum testing) blood may be collected. Urine should always be collected as soon as practicable. PROVIDE CLINICAL, MEDICATION AND SUSPECTED DRUG USAGE DETAILS.

DRUG TESTING ON-SITE Biochemistry Please contact the Drug Testing Laboratory, Biochemistry, Murarrie on(07) 3121 4419 for all information on urine, saliva and breath on-site drug testing.

DRUGS, QUANTITATIVE ASSAY, SERUM

Biochemistry Blood/Plain plastic tube See individual drugs or Appendix. Some results available urgently when required.

Therapeutic monitoring, investigation of toxicity etc. Please give full clinical details including dose and time of last dose. Please refer to individual drug (listed alphabetically under generic name). See Biochemistry Appendix (12.13) for a full list of drugs assayed. Contact Biochemistry (07) 3121 4083 or Branch Laboratory for further details.

DUCENE, SERUM Biochemistry Please refer to DIAZEPAM, SERUM.

DUCHENNE MUSCULAR DYSTROPHY, BLOOD


DURSBAN (PESTICIDE), SERUM


DYSTROPHIN GENE ANALYSIS, BLOOD

Biochemistry Blood/EDTA tube 3 - 4 weeks Transport at 4°C to reach laboratory within 24 hours of collection. Please provide clinical and medication details. This test detects cases only - not suitable for determining carrier status. Referred test.

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E/LFT, SERUM Biochemistry Blood/SS tube Same day or urgently

Reporting time depends on degree of urgency. It is most important that the sample is collected without venous stasis. The sample must be handled with care to avoid haemolysis and serum separation must take place within half an hour of collection. Transport to the laboratory without delay.

EAR, EYE, THROAT SWAB FOR MICROSCOPY/CULTURE

Microbiology Swab in Transport Medium Interim microscopy report same day for ear and eye swabs. Culture report 48 hours.

Please specify site of collection and provide clinical details including antibiotic therapy. Specify if specimen is to be cultured for exotic organisms such as Actinomyces, fungi and/or Mycobacteria. For Chlamydia please use yellow top Chlamydia culture collection kit.

ECHIS TIME Haematology Blood/Sodium citrate tube Same day Details of medication required.

ECHO-COXSACKIE VIRUS SEROLOGY

Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday.

EFAVIRENZ, PLASMA Biochemistry Blood/EDTA tube 3 weeks Please provide clinical and medication details. Plasma to be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Referred test.

EFEXOR, SERUM/PLASMA Biochemistry Please refer to VENLAFAXINE, SERUM/PLASMA.

ELAIDIC/STEARIC ACID RATIO, PLASMA

Biochemistry Blood/Lithium heparin tube 2 weeks Please provide family and clinical history. Sample should be forwarded on an ice brick to arrive at the central laboratory within 4 hours. If these requirements cannot be met, please separate serum into 6 mL Falcon tube and store and transport frozen. Referred test.

ELECTROLYTES AND LIVER FUNCTION TESTS, SERUM


ELECTROLYTES, FAECES Biochemistry Faeces/Faeces container 24 hours Please provide clinical and medication details. Keep sample cool during collection and transport to the laboratory.

ELECTROLYTES, SERUM Biochemistry Please refer to E/LFT, SERUM.

ELECTROLYTES, SWEAT Biochemistry Sweat/Sweat tube 1 week Diagnostic test for cystic fi brosis. Please contact Collections (07) 3121 4450 or Branch Laboratory for appointment. Sweat sodium and chloride measured.

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ELECTROLYTES, URINE Biochemistry Urine/24 hour urine container with no preservative or Random urine container

24 hours Please provide clinical and medication details. 24 hour collection is preferred. Under rare circumstances or if specifi cally required, a random urine may be collected. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

ELECTROLYTES/UREA/CREATININE, SERUM


ENDEP, SERUM Biochemistry Please refer to AMITRIPTYLINE, SERUM.

ENDOGENOUS ENDORPHINS Biochemistry Please phone Biochemistry (07) 3121 4420 or Branch Laboratory for availability.

ENDOMYSIAL ANTIBODY, SERUM


ENDOSCOPE CULTURE Microbiology Water samples/Urine container

48 hours for bacterial culture - 14 Days if mycobacterial culture is required.

Please submit washings from air/water, biopsy and suction channels in separate containers.

ENDOSCOPE CULTURE FOR TB Microbiology Water samples/Urine container

4 - 6 weeks Washings from the endoscope channels are collected after cleaning by endoscopy unit staff at the hospital.

ENDOSULFAN (ORGANOCHLORINE PESTICIDES), BLOOD


ENDRIN (ORGANOCHLORINE PESTICIDES), BLOOD


ENTAMOEBA HISTOLYTICA SEROLOGY

Immunology Blood/SS tube 1 week Assay run Wednesday.

ENTEROVIRUS PCR Immunology Skin swabs, CSF/Virocult (Green top) and Viral transport medium (VTM)

1 week Assay run Tuesday.

ENTEROVIRUS SEROLOGY Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday.

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ENVIRONMENTAL SPECIMEN Microbiology Dust and other environmental specimens/Swab or Sterile container

48 hours

EPILIM, SERUM Biochemistry Please refer to VALPROATE, SERUM.

EPINEPHRINE, URINE 24 HOUR


EPP, SERUM Biochemistry Please refer to PROTEIN ELECTROPHORESIS, SERUM.

EPP, URINE Biochemistry Please refer to PROTEIN ELECTROPHORESIS, URINE.

EPSTEIN-BARR VIRUS (EBV) SEROLOGY

Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday).

EQUINE MORBILLIVIRUS ANTIBODIES, SERUM

Immunology Blood/SS tube 2 - 3 weeks Please provide details of clinical history and exposure. Referred test.

ERYTHROCYTE PBG DEAMINASE, BLOOD

Biochemistry Please refer to PORPHOBILINOGEN DEAMINASE, RED CELL.

ERYTHROCYTE SEDIMENTATION RATE

Haematology Blood/EDTA tube Same day

ERYTHROPOIETIN ASSAY, SERUM

Haematology Blood/SS tube 1 week Specimen must reach laboratory within 24 hours of collection. Referred test.

ESGRAM, URINE Biochemistry Please refer to PARAQUAT, URINE.

ESR, BLOOD Haematology Blood/EDTA tube Same day

ESSENTIAL FATTY ACIDS, PLASMA

Biochemistry Please refer to FATTY ACID PROFILE, PLASMA.

ETHYL ACETATE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

ETHYLENE DI BROMIDE, URINE

Biochemistry Please refer to BROMIDE, URINE for details.

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ETHYLENE GLYCOL, SERUM/PLASMA

Biochemistry Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin tube (no gel) acceptable)

2 weeks Please keep the sample cool and forward to the laboratory without delay.

EUGLOBULIN CLOT LYSIS TIME, BLOOD


24 hours Patient should be rested for 15 minutes prior to collection and NO tourniquet should be used. Blood should be placed in melting ice water and delivered to laboratory within 30 minutes of collection. Please contact Haematology (07) 3121 4451 or Branch Laboratory for collection details and appointment.

EVEROLIMUS, BLOOD Biochemistry Blood/EDTA tube 1 week Please provide time and date of last dose.

EXAM FOR PARASITES Microbiology Sealed container/Slide Same day Special collection procedures are required for Scabies, Demodex and Enterobius (pin worm). Please record the site of the collection on the Request Form. Urine for Schistosomiasis should be collected between noon and 3.00pm. The terminal portion of the specimen is the most useful.

EXERCISE GROWTH HORMONE STIMULATION TEST

Endocrinology Blood/SS tube 24 hours Test involves patient exercising for 8-10 minutes and collecting blood before, immediately after and 10 minutes after exercise. Exercise causes a rise in core body temperature which stimulates Growth Hormone release. Test is used to exclude Growth Hormone release and defi ciency. Please contact Branch Laboratory for appointment.

EXTENDED CF MUTATION, BLOOD

Biochemistry Blood/EDTA tube 4 weeks Transport at room temperature. Referred test.

EXTRACTABLE NUCLEAR ANTIGENS (ENA), ANTIBODIES TO, SERUM

Immunology Blood/SS tube 48 hours Assay run daily (Monday to Friday). Please refer to Immunology Appendix (12.35) for a full list of extractable nuclear antigens.

EYE LESION, MICROSCOPY AND CULTURE

Microbiology Swab/Ophthalmology Microbiology kit

Requirements are determined by clinical factors. Please refer to Microbiology Preface (5.55) for details and contact Microbiology (07) 3121 4438 or Branch Laboratory.

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F.T.A. (ABS) Immunology Blood, Cerebrospinal fl uid, Synovial fl uid/SS tube, 2 x Plain containers (urine)

72 hours Assay run Tuesday and Friday.

FABRY HETEROZYGOTE, BLOOD & URINE

Biochemistry Whole blood and Urine/2 x EDTA tubes, 1 x Random urine container (frozen)

Up to 5 months Transport blood at 4°C. Transport urine on dry ice.

FACTOR II ASSAY, BLOOD Haematology Refer to FACTOR VIII ASSAY.

FACTOR IX ASSAY, BLOOD Haematology Refer to FACTOR VIII ASSAY.

FACTOR V ASSAY, BLOOD Haematology Refer to FACTOR VIII ASSAY.

FACTOR V LEIDEN MUTATION ANALYSIS

Genetics Blood/Pink top EDTA tube

1 week Please provide details regarding patients eligibility for Medicare rebate, i.e. proven venous thrombosis or pulmonary embolism or fi rst degree relative with mutation. If no history incurs fee to patient.

FACTOR VII ASSAY, BLOOD Haematology Refer to FACTOR VIII ASSAY.

FACTOR VIII ASSAY, BLOOD Haematology Blood/Sodium citrate tube

24 - 48 Hours. Urgently if required.

Clinical and medication details please. Document bleeding/bruising history of patient and any signifi cant family history. Keep specimen at 4°C and MUST reach laboratory within 2 hours of collection. Please contact Haematology (07) 3121 4451 or Branch Laboratory for details.

FACTOR VIII INHIBITOR ASSAY, BLOOD

Haematology Refer to FACTOR VIII ASSAY.

FACTOR X ASSAY, BLOOD Haematology Refer to FACTOR VIII ASSAY.

FACTOR XI ASSAY, BLOOD Haematology Refer to FACTOR VIII ASSAY.

FACTOR XII ASSAY, BLOOD Haematology Refer to FACTOR VIII ASSAY.

FACTOR XIII ASSAY, BLOOD Haematology Refer to FACTOR VIII ASSAY.

FAECAL ELASTASE, FAECES Biochemistry Please refer to PANCREATIC ELASTASE 1, FAECES.

FAECAL FAT, TOTAL Biochemistry Please refer to FAECES FAT, TOTAL-3 DAY COLLECTION.

FAECAL HAEMOGLOBIN (HUMAN) - OCCULT BLOOD


The Monoclonal Antibody test for human haemoglobin is routinely performed. A special diagnostic diet is no longer required for this test. Refrigerate after collection and transport cooled.

7.58

7.58

PATHOLOGY TESTS


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- F

PATH

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- F


FAECAL SUGAR CHROMATOGRAPHY

Biochemistry Please refer to CHROMATOGRAPHY, FAECES.

FAECES FAT, TOTAL-3 DAY COLLECTION

Biochemistry Faeces/Faeces container 1 week Please provide clinical and medication details. A controlled fat intake may be required and each day’s collection may be collected either into a separate tin or all three days collected into the one tin (preferred). Use only the tins supplied for collection. Ensure lids are securely placed on the tins and keep the tins UPRIGHT at all times. Also instruct the patient to not place foreign objects e.g. nappy liners, plastic bags etc. in with the sample.

FAECES MICROSCOPY (OVA, CYSTS, PARASITES)

Microbiology Faeces/Faeces container 24 hours Indicate if recent history of travel overseas. Please refer to Microbiology Preface (5.53).

FAECES MICROSCOPY AND CULTURE

Microbiology Faeces/Faeces container Microscopy same day, culture report 48 hours

Indicate if recent history of travel overseas or antibiotics. Please refer to Microbiology Preface (5.53).

FAECES, CLOSTRIDIUM DIFFICILE TOXIN


Random faeces sample. Refrigerate and transport cooled to laboratory within 24 hours of collection. Please indicate any recent history of antibiotics. If causes of diarrhoea other than Clostridium diffi cile are possible or suspected, a faeces sample for microscopy and culture should also be submitted. The specimen can be used for up to 3 days if stored at 2 - 8°C. Refer to Microbiology Preface (5.54).

FAMILIAL ADENOMATOUS POLYPOSIS (FAP) GENETIC TESTING

Genetics Blood/EDTA tube Indeterminate GENETIC COUNSELLING IS REQUIRED BEFORE THE BLOOD SPECIMEN CAN BE TAKEN. GENETIC COUNSELLING IS AVAILABLE FROM GENETIC HEALTH QUEENSLAND AT THE ROYAL BRISBANE HOSPITAL ON (07) 3636 1686.

FAMILIAL MEDITERRANEAN FEVER (FMF) GENETIC TESTING

Genetics Blood/EDTA tube 6 weeks Incurs non-Medicare refundable fee. Patient consent for billing must be marked on the request form.

FASCIOLA HEPATICA SEROLOGY Immunology Blood/SS tube 2 - 3 weeks

FATTY ACID PROFILE, PLASMA

Biochemistry Blood/Lithiumheparin tube (EDTA tube acceptable)

2 weeks Fasting samples are preferred. Family and clinical history must be provided. The specimen should be refrigerated and transported immediately, cooled, to the laboratory. The patient will receive an account of approx. $110.00 (approx. $30.15 Medicare rebate) from the referring laboratory. Referred test.

7.59

7.59

PATHOLOGY TESTS


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- F

PATH

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- F


FATTY ACIDS, PLATELET Biochemistry Blood/Lithium heparin tube

2 weeks Samples must be collected on a MONDAY MORNING ONLY and reach the laboratory no later than 14:30 hrs. Due to the instability of samples, referral within 48 hours is required. If these instructions cannot be followed, please phone the laboratory on (07) 3121 4420 or Branch Laboratory. Transport sample to the laboratory on ice. Referred test.

FATTY ACIDS, RED CELL Biochemistry Blood/Lithium heparin tube

1 - 2 weeks Samples must be collected on a MONDAY MORNING ONLY and arrive at the laboratory by 14:30 hrs. Due to the instability of samples, referral within 48 hours is required. If these requirements cannot be followed, please phone the laboratory on (07) 3121 4420 or Branch Laboratory. Transport sample to the laboratory on ice. Referred test.

FATTY ACIDS-VERY LONG CHAIN, PLASMA

Biochemistry Blood/Lithium heparin tube 4 weeks Please provide family and clinical history. Separate plasma from red cells as soon as possible. Transport to laboratory on dry ice. Referred test.

FENITROTHION (PESTICIDE), SERUM


FENTANYL, URINE Biochemistry Urine/Urine container 2 - 3 months Please keep the sample refrigerated or frozen. A random urine is required.

FENTHIONETHYL (PESTICIDE), SERUM


FERRITIN, SERUM Biochemistry Please refer to IRON (Fe) STUDIES, SERUM for collection details.

FERROPORTIN GENE ANALYSIS

Biochemistry Blood/2 x EDTA tubes 6 - 8 weeks Patient must complete and sign consent form (QIMR P191) provided by requesting doctor. Transport to central laboratory on ice - DO NOT FREEZE.

FETAL RED CELL SCREEN (KLEIHAUER TEST), MATERNAL BLOOD

Haematology Maternal blood/1 EDTA tube, 2 blood fi lms


Examination of maternal blood for evidence of foeto-maternal transfusion. FMH test usually performed.

FIBRINOGEN, PLASMA Haematology Blood/Sodium citrate tube

Same day Refer to COAGULATION STUDIES.

FIBRONECTIN, PLASMA Biochemistry Blood/EDTA tube 2 weeks Transport in esky at 4°C.

FICAM (PESTICIDE), BLOOD Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity.

FILARIA ANTIBODY, SERUM Immunology Blood/SS tube 2 - 4 weeks Referred test.

7.60

7.60

PATHOLOGY TESTS


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- F

PATH

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STS

- F


FILARIA, BLOOD Haematology Blood/1 EDTA tube, 2 blood fi lms

Same day Many species of microfi lariae exhibit nocturnal periodicity in the blood of the host to coincide with the biting habits of the insect vector. This periodicity appears linked to the circadian rhythm (sleeping habit) of the host and will take about a week to adjust to a new pattern as would occur in migration to a different time zone. Optimum time for blood collection in an acclimatised host is 10pm to 4am.

FILARIASIS SEROLOGY Immunology Blood/SS tube 2 - 3 weeks Refer to ADENOVIRUS SEROLOGY for collection details.

FINE NEEDLE ASPIRATE (FNA) CYTOLOGY

Cytology Labelled fi xed and air dried smears/Labelled capped needle and syringe/Needle rinsings

24 hours For specimen preparation please refer to Cytology Preface.

FIP1L1-PDGFR (HES) GENETIC TESTING

Genetics Blood or Bone marrow/EDTA tube or min. 1mL bone marrow in EDTA tube

2 months Specimen needs to be received by QML Pathology Genetics Department within 24 hours. Please transport and store at room temperature.

FIRST TRIMESTER DOWNS SCREEN

Endocrinology Blood/SS tube 48 hours Tests performed are free BHCG and PAPP-A. This is a fi rst trimester screening test for Down’s Syndrome and is usually done in combination with the patient having an ultrasound scan measuring the nuchal translucency at 8-13 weeks, 6 days. The blood test is done 1-2 days before the scan so that our results are ready for use at their appointment. Note the patient’s weight and CMP/EDC. See Endocrinology Appendix (12.23).

FK506, BLOOD Biochemistry Please refer to TACROLIMUS, BLOOD.

FLAVIVIRUS SEROLOGY Immunology Blood/SS tube 24 hours

FLECAINIDE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable)

1 week Please provide clinical and medication details including time and date of last dose. Collected sample immediately prior to next dose.

FLUCLOXACILLIN, SERUM Biochemistry Blood/Red top tube 3 weeks Please provide clinical and medication details. Keep sample cool.

FLUCONAZOLE, PLASMA Biochemistry Blood/EDTA tube 2 weeks Please provide clinical and medication details. Keep sample cool.

FLUCYTOSINE, SERUM Biochemistry Blood/Lithium heparin tube 1 week Collect just prior to next dose. Provide clinical and medication details.

FLUID CSF TRANSFERRIN Biochemistry Please refer to TAU PROTEIN, FLUID.

7.61

7.61

PATHOLOGY TESTS


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PATH

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FLUID TAU PROTEIN Biochemistry Please refer to TAU PROTEIN, FLUID.

FLUNITRAZEPAM, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (EDTA tube or Plastic lithium heparin tube acceptable)


FLUORESCENT IN SITU HYBRIDISATION (FISH)

Genetics Amniotic fl uid 24 hours Rapid Detection of Fetal Aneuploidy.


Genetics Blood/Lithium heparin tube

2 weeks Testing available for microdeletion syndromes - DiGeorge, Williams, Prader-Willi, Angelman, Miller-Dieker, Smith-Magenis.


Genetics Bone Marrow, Lymph Node

1 - 2 weeks Probes specifi c for common Haematological malignancies e.g. CML Panel of specifi c probes for CLL and Multiple Myeloma.


Genetics Paraffi n Embedded Tissue 1 - 2 weeks Testing available for HER2/neu gene in breast cancer, and 1p/19q deletions seen in oligodendromas.

FLUORESCENT TREPONEMA ANTIBODY ABSORPTION TEST (FTA-ABS), SERUM

Immunology Blood/SS tube 72 hours Supplementary test for Syphilis. Referred test.

FLUORIDE, BLOOD Biochemistry Blood/EDTA tube (Lithium heparin tube acceptable)

4 weeks Please provide clinical, medication and exposure details. Referred test.

FLUORIDE, URINE Biochemistry Urine/Urine container (random collection) or plain 24 hour urine container

4 weeks Please provide details of exposure (clinical and/or occupational). For occupational monitoring, random samples should be collected Pre- and Post- work shift, unless directed otherwise. For single exposures, a random urine collected after end of work shift/exposure is preferred. A 24 hour urine is not the preferred sample. Referred test.

FLUOXETINE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (EDTA tube or Plastic lithium heparin tube acceptable)

2 weeks Please provide clinical and medication details. Centrifuge and separate serum as soon as possible. Referred test.

FMH TEST Haematology Blood/EDTA tube 24 hours It is recommended that blood is collected within 12 hours after birth and preferably before injection of anti D. If anti D has been administered please indicate on the form. If patient is pregnant note gestation stage. If the test is critically urgent notify Haematology (07) 3121 4451 of the expected time of arrival.

7.62

7.62

PATHOLOGY TESTS


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STS

- F

PATH

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- F


FOLATE, RED CELL Endocrinology Blood/EDTA tube 24 hours This measures the steady state level unaffected by the fl uctuations of dietary intake or tissue utilisation of folate.

FOLATE, SERUM Endocrinology Blood/SS tube 24 hours

FOLIC ACID (FOLATE), RED CELL

Endocrinology Blood/EDTA tube 24 hours This measures the steady state level unaffected by the fl uctuations of dietary intake or tissue utilisation of folate.

FOLIC ACID (FOLATE), SERUM Endocrinology Blood/SS tube 24 hours

FOLIDOL (PESTICIDE), SERUM Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity.

FRAGILE-X-SYNDROME (FRAXA) MUTATION ANALYSIS


1 week PCR screening test performed initially and if positive/inconclusive, further testing (Southern blotting) performed at RBH.

FREE ALPHA SUBUNIT, SERUM Endocrinology Blood/SS tube 1 - 2 weeks Referred test.

FREE ANDROGEN INDEX, SERUM

Endocrinology Blood/SS tube 24 hours This test is a ratio of total testosterone and sex hormone binding globulin.

FREE CORTISOL,URINE 24 HOUR

Endocrinology 24 hour urine collection/Urine collection bottle. No preservative

48 hours Dexamethasone not to be taken 72 hours prior to or during test, unless as part of a prolonged Dexamethasone Suppression Test. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Record patient’s height and weight.

FREE CORTISOL, URINE RANDOM

Endocrinology Random urine collection/Urine collection bottle. No preservative (Must not use acid preservative)

24 hours Record patient’s height and weight on request form.

FREE LIGHT CHAINS, SERUM Biochemistry Blood/SS tube 1 - 2 weeks Please provide clinical and medication details.

FREE PSA Endocrinology Blood/SS tube 24 hours A free PSA can not be requested on its own. It can only be reported in conjunction with a PSA.

FREE T3, SERUM Endocrinology Blood/SS tube 24 hours Please note all Thyroid medication e.g. Propylthiouracil (PTU), Neomercazole (NMZ), Thyroxine (T4) and Carbimazole (CBZ).

FREE T4, SERUM Endocrinology Blood/SS tube 24 hours TSH is routinely performed. Free T4 will be measured in addition to TSH in certain patients. Please supply a comprehensive history including exactly what medication the patient is taking. Please refer to Endocrinology Preface (5.23) for details.

7.63

7.63

PATHOLOGY TESTS


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STS

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PATH

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FREE TESTOSTERONE, SERUM

Endocrinology Blood/SS tube 24 hours This test measures a sub fraction of albumin bound testosterone. Collect a fasting specimen or a specimen at greater than 3 hours post-prandial as food absorption may infl uence blood levels.

FRIEDREICHS ATAXIA GENETIC TESTING

Genetics Blood/EDTA tube 1 - 2 months

FRISIUM, SERUM Biochemistry Please refer to CLOBAZAM, SERUM.

FROZEN SECTION, TISSUE

Histology Biopsy tissue/DRY container (No formalin)

Immediate. Full report 24 hours

Please telephone Histology (07) 3121 4495 or Branch Laboratory for booking.

FRUCTOSAMINE, SERUM Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details. A medium term assay (approximately 1 month) of diabetic control.

FRUCTOSE, SEMINAL FLUID

Biochemistry Seminal fl uid/Semen container

1 week An instruction sheet can be provided for the patient. Specimen must reach laboratory within 2 hours of collection. Keep at room temperature. If there is a delay between sperm count and fructose estimation (e.g. transport to central laboratory) REFRIGERATE after sperm count has been completed. Please refer to Genetics Preface (5.30) for full details.

FRUSEMIDE, URINE Biochemistry Urine/Urine container 1 - 2 weeks This test attracts a fee from the referring laboratory, payable by the patient. Please indicate on the request form if permission or prior arrangement has been granted by the doctor or patient to perform test.

FSH, SERUM Endocrinology Blood/SS tube 24 hours Please include clinical notes and date of last normal menstrual period (LNMP). Include information regarding any hormone replacement therapy or contraceptive use.

FULL BLOOD COUNT (FBC), BLOOD

Haematology Blood/EDTA tube Immediate; Same day

Please see Haematology Appendix (12.32).

FULL BLOOD EXAMINATION (FBE), BLOOD

Haematology Blood/EDTA tube Immediate; Same day

Transport specimen cooled.

FUNGAL CULTURE (SYSTEMIC) Microbiology Tissue, biopsy or body fl uid in a sterile container

Microscopy - 24 hours; Culture - up to 4 weeks

Please do not add formalin to the sample.

7.64

7.64

PATHOLOGY TESTS


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PATH

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FUNGAL MICROSCOPY/CULTURE, SKIN

Microbiology Skin scrapings/Paper envelope, Petri dish, dry sterile screw top (urine) container. Include blade used to collect sample. Moist sterile swab/ DRY transport tube

Interim microscopy report 24 hours. Culture report up to 4 Weeks

Please indicate recent history of therapy. Antifungal therapy should be ceased at least two days (optimally one week) prior to collection of specimen. Scrape active edge of lesion. If the lesion is exuding material and painful to scrape, a swab may be collected as an alternative. Use a dry swab previously moistened with saline to swab the lesion. Place the swab in a container without transport medium. Refer to Cutaneous Fungal Culture in Microbiology Preface (5.56) for details of specimen collection, storage and transport. Blade should be transported in screw top container (NOT paper envelope).

FUNGAL PRECIPITINS, SERUM Immunology Blood/SS tube 2 - 4 weeks Referred test.

PATH

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STS

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7.65

PATH

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STS

- F

7.65

PATHOLOGY TESTS



G6PD QUANTITATIVE ASSAY Biochemistry Blood/EDTA tube 1 week Do not freeze EDTA.

GABAPENTIN, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (EDTA tube or Plastic lithium heparin tube acceptable)

2 weeks Please provide clinical and medication details, including time, date and dosage of last dose. Please collect trough sample just prior to next dose. Please keep the sample cool and transport to the laboratory without delay. Referred test.

GAD (GLUTAMIC ACID DECARBOXYLASE) ANTIBODIES, SERUM

Immunology Blood/SS tube or Lithium heparin tube

2 weeks Test run fortnightly. Next day results. Please provide clinical and medication details.

GALACTOKINASE, BLOOD Biochemistry Blood/Lithium heparin tube

2 weeks Please advise Biochemistry (07) 3121 4420 or your Branch Laboratory of expected arrival time. Send sample without delay.

GALACTOSAEMIA CONFIRMATION, BLOOD

Biochemistry Blood/Lithium heparin tube

1 - 2 weeks Transport sample refrigerated and must reach laboratory as soon as possible. Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for details. Referred test.

GALACTOSAEMIA SCREEN, BLOOD


1 - 2 weeks Transport sample refrigerated and must reach laboratory as soon as possible. Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for details. Referred test.

GALACTOSE, PLASMA Biochemistry Please refer to GALACTOSAEMIA SCREEN, BLOOD.

GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE, RED CELL

Biochemistry Please refer to GALACTOSAEMIA SCREEN, BLOOD.

GALACTOSE-1-PHOSPHATE, RED CELL

Biochemistry Please refer to GALACTOSAEMIA SCREEN, BLOOD.

GAMMA GT (GAMMA GLUTAMYL TRANSPEPTIDASE), SERUM


GAMMA GT, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify site of fl uid on specimen container and request form.

GANGLIOSIDE ANTIBODIES Immunology Blood/SS tube 2 - 3 weeks Referred test.

GAS ANALYSIS, ARTERIAL BLOOD

Biochemistry Arterial blood/Blood gas syringe

Same day Please refer to Biochemistry Preface (5.1).

GAS ANALYSIS, VENOUS BLOOD

Biochemistry Please refer to BLOOD GASES, VENOUS.

PATH

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8.0

PATH

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8.0

PATHOLOGY TESTS



GASTRIC ASPIRATE CYTOLOGY

Cytology Fluid/Sterile screw top container


GASTRIC ASPIRATE MICROSCOPY/CULTURE

Microbiology Gastric Aspirate/Sterile screw top (urine) container

Microscopy phoned same day. Culture 48 hours

Transport to the laboratory immediately.

GASTRIC BRUSHING CYTOLOGY

Cytology Fixed Smears/Slide carrier and/or fl uid/Sterile screw top container. Brush in a container of normal saline


GASTRIN, SERUM Endocrinology Blood/SS tube 1 week May collect a fasting specimen, a one hour post-prandial specimen or both Transport to Endocrinology within 4 hours of collection. Specimen must be kept cold.

GAUCHER’S DISEASE (SCREENING)

Genetics Blood/EDTA tube 1 - 2 weeks Keep at room temperature. DO NOT SPIN. Need family history.

GENITAL MICRO/CULTURE Microbiology Genital swab or IUD/Swab in bacteriology transport media or Sterile container (IUD)

48 hours Specify site of collection. Transport to the laboratory as soon as possible (viability of N. gonorrhoeae decreases after several hours).

GENITAL SWAB INCLUDING ANAEROBES AND GONOCOCCUS

Microbiology Swab in Transport Medium 48 hours For Actinomyces culture IUD should be submitted. Wet preparation performed for Yeasts and Trichomonas. Gonococcus swab in transport medium should be forwarded to the laboratory as soon as possible.

GENTAMICIN ASSAY - SINGLE DAILY DOSE (BOLUS DOSE), SERUM

Biochemistry Blood/Plain plastic tube - no gel or anticoagulant

Urgently Please supply details of dose schedule. Collect one sample only 6 - 14 hours after the dose. Result to be available before next dose due to enable adjustment if required. QML Pathology will report the serum gentamicin in mg/L, the time and date of last dose and time since last dose. Based on this data, the recommended serum level. Please refer to Biochemistry Appendix (12.17).

GESTATIONAL DIABETES SCREEN

Biochemistry Blood/SS tube or Fluoride oxalate tube

Same day Fasting is not required. At 26-28 weeks gestation, give the patient 50g or 75g glucose dose - collect sample 1 hour later. Indicate glucose dosage and the time it was given on request form. If a SS tube is collected, the sample must be centrifuged after clotting has occurred (no longer than 30 minutes). Nothing should be taken by mouth after the dose and prior to the blood sample collection except water.

GHRELIN, SERUM Biochemistry Blood/SS tube 2 weeks Patient MUST be fasting.

8.1

8.1

PATHOLOGY TESTS


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PATH

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GLIADIN ANTIBODIES (COELIAC DISEASE), SERUM


GLIADIN IGA/IGG SEROLOGY Immunology Blood/SS tube 24 hours

GLOBULINS (CALCULATED), SERUM


GLOBULINS, FLUID Biochemistry Fluid/Plain tube or container Same day Specify site of fl uid on specimen container and request form.

GLOMERULAR BASEMENT MEMBRANE ANTIBODY, SERUM


GLUCAGON STIMULATION TEST OF C- PEPTIDE/INSULIN

Endocrinology Blood/SS tube or Fluoride oxalate tube

24 hours Test requires IV administration of glucagon and collection of timed blood samples. Please contact Collections (07) 3121 4450 or Branch Laboratory for appointment and Endocrinology (07) 3121 4439 for details.

GLUCAGON, PLASMA Endocrinology Blood/EDTA tube with Trasylol

4 weeks Patient must be fasting. Special handling and transport required. Please contact Endocrinology (07) 3121 4439 or Branch Laboratory. Referred test.

GLUCOSE (1HR POST LOAD), SERUM

Biochemistry Blood/SS tube or Fluoride oxalate tube

Same day Other than for 26-28 weeks of pregnancy, this test is of limited value in the assessment of glucose tolerance. We do not recommend it as a standard test and 2 hours post 75g load is preferable.

GLUCOSE TOLERANCE TEST - 2 HOUR, NON-PREGNANCY

Biochemistry Blood/SS tubes and Urine/Urine containers

24 hours Please refer to Biochemistry Appendix (12.9) for pre test dietary requirements and restrictions. Contact Biochemistry (07) 3121 4420 or Branch Laboratory for further details. Blood - PRE, 1 and 2 hour POST glucose dose. Urine - PRE and 2 hour POST glucose dose. Appointment required. Please contact nearest collection centre.

GLUCOSE TOLERANCE TEST - 3 HOUR


24 hours Same as 2 hour GTT except blood also collected at 3 hours post glucose dose.Appointment required. Please contact nearest collection centre.

GLUCOSE TOLERANCE TEST - EXTENDED (4, 5 AND 6 HOURS)


24 hours Please refer to Biochemistry Appendix (12.9) for pre test dietary requirements and restrictions. Investigation of Hypoglycaemia may require a 6 hour GTT. Please contact Biochemistry (07) 3121 4420, Endocrinology (if serum insulins are also required) (07) 3121 4435 or Branch Laboratory for advice. Appointment required. ‘Modifi ed’ has no specifi c meaning in this context and period of sample collection should be specifi ed.

8.2

8.2

PATHOLOGY TESTS


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PATH

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GLUCOSE TOLERANCE TEST - GLUCOSE AND GROWTH HORMONE

Endocrinology Blood/SS tube 24 hours Please refer to Biochemistry Appendix (12.9) for pre test dietary requirements and restrictions. Please contact Branch Laboratory or Endocrinology (07) 3121 4439 for details. Appointment required. Please contact nearest collection centre.

GLUCOSE TOLERANCE TEST - GLUCOSE AND INSULIN

Endocrinology Blood/SS tube 24 hours Please refer to Biochemistry Appendix (12.9) for pre test dietary requirements and restrictions. Appointment required. Please contact nearest collection centre.

GLUCOSE, CSF Biochemistry Test for bacterial meningitis. Please refer to BIOCHEMISTRY, CSF for details.

GLUCOSE, FLUID Biochemistry Fluid/Plain tube/Container Same day Keep sample refrigerated. Specify site of fl uid on specimen container and request form.

GLUCOSE, PLEURAL FLUID Biochemistry Pleural fl uid/Plain tube Same day Please provide clinical and medication details. Refrigerate sample during storage and transport.

GLUCOSE, SERUM Biochemistry Blood/SS tube or Fluoride oxalate tube

Same day Please provide clinical and medication details. Note whether fasting or post-prandial and time of collection. If SS tube is collected, it must be centrifuged within half an hour. Use GREY FLUORIDE OXALATE TUBE if DELAY IN SEPARATION IS EXPECTED.

GLUCOSE, SYNOVIAL FLUID

Biochemistry Glucose is low in joint infection. Please refer to ALBUMIN, SYNOVIAL FLUID.

GLUCOSE, URINE Biochemistry Urine/Urine container or 24 hour urine container with no preservative

Same day A random collection is preferred. 24 hour collections must be refrigerated whilst being collected. NB. If a delay in transport to the laboratory is envisaged, prevent bacterial breakdown by the addition of a crystal of thymol or 150mg of merthiolate.

GLUTAMATE, SERUM Biochemistry Blood/SS tube 1 week Please provide clinical and medication details. The patient must be FASTING. Please refer to dietary restrictions in Biochemistry Appendix (12.9). Referred test.

GLUTAMIC ACID DECARBOXYLASE (GAD) ANTIBODIES, SERUM

Immunology Blood/SS tube Up to 6 weeks Please provide clinical and medication details. Specimen should be kept cool during storage and transport. Referred test.

GLUTAMIC ACID, SERUM Biochemistry Please refer to GLUTAMATE, SERUM.

GLUTAMINE, SERUM Biochemistry Please refer to GLUTAMATE, SERUM.

GLUTATHIONE PEROXIDASE, BLOOD


1 - 2 weeks Glutathione peroxidase, red cells AND plasma can be performed on this collection. Referred test.

GLUTATHIONE PEROXIDASE, PLASMA


1 - 2 weeks Referred test.

8.3

8.3

PATHOLOGY TESTS


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PATH

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GLUTATHIONE REDUCTASE, BLOOD


GLYCATED ALBUMIN, SERUM Biochemistry Please refer to FRUCTOSAMINE, SERUM.

GLYCATED HAEMOGLOBIN, BLOOD

Biochemistry Please refer to HAEMOGLOBIN A1c (HbA1c), BLOOD.

GLYCEROL, PLASMA Biochemistry Blood/Lithium heparin tube 1 week Sample must be stored and transported cool.

GLYCEROL, URINE Biochemistry Urine/Urine container 1 week Random urine collection. Transport at 4°C. Referred test.

GLYCOGEN DEBRANCHER ENZYME, BLOOD

Biochemistry Please refer to AMYLO-1,6-GLUCOSIDASE, BLOOD for details.

GLYCOLATE, URINE Biochemistry Urine/Urine container 3 - 4 weeks Transport in esky at 4°C. Referred test.

GLYPHOSATE, URINE Biochemistry Urine/50 mL urine container

4 weeks Random urine collected at the end of work shift or exposure. This test attracts a charge of approximately $175.00 from the reference laboratory, payable by the patient or their employer. Please indicate on the request form if permission or prior arrangement has been granted to perform test. Sample must be collected within 48 hours of exposure. Referred test.

GOLD, SERUM Biochemistry Blood/EDTA tube 2 weeks Please provide clinical and medication details. Collect immediately prior to next dose or at least 8 hrs after last dose. Referred test.

GRAM STAIN Microbiology Swab and/or prepared smear

Same day Please provide clinical details including antibiotic therapy and specify site of collection.

GRAMOXONE, URINE Biochemistry Please refer to PARAQUAT, URINE.

GRANULOCYTE ANTIBODY SCREEN

Haematology Blood/2 EDTA tubes, SS tube 24 hours Test performed daily. No booking or appointment required. Please notify Haematology (07) 3121 4451 or your Branch Laboratory of all urgent specimens and weekend collections.

GROWTH HORMONE SUPPRESSION TEST (USING GLUCOSE)

Endocrinology Blood/SS tube 24 hours Please contact Branch Laboratory for appointment.

GROWTH HORMONE, SERUM Endocrinology Blood/SS tube 24 hours Please state whether fasting or non-fasting and any relevant clinical information.

8.4

8.4

PATHOLOGY TESTS


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STS

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PATH

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GTT - INSULIN AND C-PEPTIDE

Endocrinology Blood/SS tube 24 hours Routine GTT pre test preparation including overnight fast. Test duration - 3 hours with half-hourly blood collections. Glucose, insulin and c-peptide to be assayed. No urine collection or testing required. Appointment required. Please contact nearest collection centre.

GTT (2 OR 3 HOUR), NON-PREGNANCY

Biochemistry Blood and urine/SS tube or Fluoride oxalate tube. Urine container

24 hours Please refer to GLUCOSE TOLERANCE TEST - 2 HOUR, NON-PREGNANCY.

GTT (2 OR 3 HOUR), PREGNANCY


24 hours Please refer to Biochemistry Appendix (12.9) for pre test dietary requirements and restrictions. Contact Biochemistry (07) 3121 4420 or Branch Laboratory for further details. Blood - PRE, 1, 2 and 3 hour POST glucose dose unless otherwise specifi ed. Urine - PRE glucose dose only. Appointment required. Please contact nearest collection centre.

GTT, EXTENDED OR MODIFIED


24 hours Please refer to GLUCOSE TOLERANCE TEST - EXTENDED (4,5 AND 6 HOURS).

GUSATHION (PESTICIDE), SERUM


GUT TUMOUR MARKERS (CA 19-9, CEA), SERUM

Endocrinology Blood/SS tube 24 hours Infl ammatory or neoplastic conditions of mucinous epithelium - see Biochemistry Appendix (12.5).

GUTHRIE TEST Biochemistry Please refer to NEONATAL SCREENING TEST.

8.5

8.5

PATHOLOGY TESTS


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H G PHOSPHORIBOSYL TRANSFERASE, BLOOD

Biochemistry Please refer to HYPOXANTHINE GUANINE PHOSPHORIBOSYL TRANSFERASE, BLOOD.

HAEMATOCRIT Haematology Blood/EDTA tube Same day

HAEMOCHROMATOSISGENE MUTATION ANALYSIS

Genetics Blood/Pink topEDTA tube

1 week Transport at room temperature or cooled. Advise patient that there will be a non-Medicare rebatable fee if they do not meet the following criteria: a) the patient has an elevated transferrin saturation or elevated serum ferritin on testing of repeated specimens; or b) the patient has a fi rst degree relative with haemochromatosis; or c) the patient has a fi rst degree relative with homozygosity for the C282Y compound hetrozygosity for recognised genetic mutations for haemochromatosis. Criteria MUST be stated on the request form by the Doctor.

HAEMOGLOBIN Haematology Blood/EDTA tube Same day Please see Haematology Appendix (12.31).

HAEMOGLOBIN (HUMAN), FAECAL - OCCULT BLOOD


The Monoclonal Antibody test for human haemoglobin is routinely performed. Refrigerate after collection and transport cooled.

HAEMOGLOBIN A1c (HbA1c), BLOOD

Biochemistry Blood/EDTA tube 24 hours Please provide clinical and medication details. Keep sample refrigerated during transport and storage.

HAEMOGLOBIN A1c, BLOOD


HAEMOGLOBIN AND SMEAR

Haematology Blood/EDTA tube Same day Blood fi lms made at time of collection are preferred.

HAEMOGLOBIN ELECTROPHORESIS (EPP), BLOOD

Haematology Blood/EDTA tube, blood fi lm

1 - 3 days Tests performed Tuesday and Friday. Results available same day of test.

HAEMOGLOBIN F, BLOOD Haematology Blood/EDTA tube 1 - 3 days Tests performed Tuesday and Friday. Results available same day of test.

HAEMOGLOBIN GLYCATED, BLOOD


HAEMOGLOBIN, PLASMA Haematology Blood/Lithium heparin tube

24 hours Avoid haemolysis during collection.

HAEMOGLOBIN, URINE Biochemistry Urine/Urine container 24 hours Please provide clinical and medication details. Random sample required.

PATH

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8.6

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8.6

PATHOLOGY TESTS



HAEMOGLOBINOPATHY STUDIES

Haematology Blood/2 EDTA tubes, 1 blood fi lm


HAEMOLYTIC COMPLEMENT Immunology Blood/SS tube 24 hours Assay run daily (Monday to Friday). Separate serum by centrifugation immediately after collection and decant into a labelled plain plastic tube. Refrigerate during storage and transport cold. Ideally sample should NOT be shared.

HAEMOLYTIC SCREEN Haematology/Biochemistry

Blood/2 EDTA tubes, blood fi lm and 1 SS tubeare required for initial screening tests

Same day Initial screening tests should include FBC, Reticulocyte count, Coombs test, Bilirubin, LDH and Haptoglobin. Further tests will depend on the results of screening tests and the provisional diagnosis. Please note that Medicare does not recognise ‘Haemolytic Screen’ as an acceptable group of tests.

HAEMOPHILIA GENETIC TESTING

Genetics Blood/2 x Sodium citrate tubes, 4 x EDTA tubes

6 weeks Please contact Genetics (07) 3121 4461 or Branch Laboratory prior to collection. Referred test.

HAEMOPHILUS INFLUENZAE B AB


HAEMOSIDERIN, URINE RANDOM

Haematology Random urine/Urine container

Same day

HAIR, MICROSCOPIC EXAMINATION

Histology Hair/Sterile dry container

24 - 48 hours 50 or more hairs is desirable for telogen counts. Generally performed by clinicians experienced in the diagnosis and management of alopecia. Hair is obtained by either (A) gentle stroking or tugging to obtain hair being shed excessively or by (B) forceful hair pluck. IT IS IMPORTANT to indicate on the request form the method of collection.

HAM TEST (ACIDIFIED SERUM TEST), BLOOD

Haematology Blood/1 SS tube, 1 EDTA tube

24 hours Test for detection of Paroxysmal Nocturnal Haemoglobinuria (Haemolytic Anaemia). Please contact Haematology (07) 3121 4451 or Branch Laboratory for details. Flow cytometry for PNH is the preferred test.

HAND, FOOT AND MOUTH SEROLOGY


HAPTOGLOBIN, SERUM Biochemistry Blood/SS tube 24 hours Blood must be collected without haemolysis occurring. Also, avoid agitation of the blood after collection to avoid causing in vitro haemolysis.

HB WHITE CELL AND DIFF Haematology Blood/EDTA tube Same day

HCB (ORGANOCHLORINE PESTICIDE), BLOOD


8.7

8.7

PATHOLOGY TESTS


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HCG - TUMOUR MARKER, SERUM

Endocrinology Blood/SS tube 24 hours -HCG can be used as a tumour marker for trophoblastic disease (hydatidiform mole, invasive mole, persistent mole, partial hydatidiform mole, placental site trophoblastic tumour and gestational choriocarcinoma). Complete obstetric history is essential for history is essential for result interpretation. Elevated levels are also seen in both ovarian and testicular germ cell tumours and some breast carcinomas. When used in conjunction with AFP, -HCG may prove useful in assessing prognosis, monitoring therapy and detecting recurrence of gonadal germ cell neoplasms.

HCG STIMULATION OF TESTOSTERONE

Endocrinology Blood/SS tube 24 hours This test involves an injection of HCG and the measurement of Testosterone.

HCG TITRE, SERUM Endocrinology Blood/SS tube 24 hours Note date of last normal menstrual period (LNMP), period of amenorrhoea (A=) and estimated date of confi nement (EDC).

HDL CHOLESTEROL, SERUM Biochemistry Blood/SS tube Same day Patient need not be fasting unless other fasting tests e.g. triglycerides are also required.

HEAVY METAL SCREEN, BLOOD

Biochemistry Blood/EDTA tube (Lithium heparin tube acceptable)

1 week Please provide clinical, medication and exposure details and indicate which heavy metals are required (usually cadmium, lead, mercury). There are Medicare restrictions on refunding.

HEAVY METAL SCREEN, URINE

Biochemistry Urine/Urine container 1 week Please provide clinical, medication and exposure details (clinical and occupational) and indicate which heavy metals are required (usually cadmium, lead, mercury). A random collection is required. Keep sample refrigerated. Medicare restrictions apply on refunding in this context.

HEINZ BODIES, BLOOD Haematology Blood/EDTA tube Same day

HELICOBACTER FAECAL ANTIGEN

Immunology Faeces/Faeces container 2 - 3 weeks

HELICOBACTER PYLORI CARBON-14 UREA BREATH TEST

Endocrinology 1 glass vial containing CO2 trapping liquid


HELICOBACTER PYLORI SEROLOGY


8.8

8.8

PATHOLOGY TESTS


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HENDRA VIRUS SEROLOGY Immunology Blood/SS tube 2 - 4 weeks Referred test. Please provide details of clinical history and exposure.

HEPARIN ANTI FACTOR XA Haematology Blood/Sodium citrate tube

Same day The specimen must be kept at 4°C and delivered to the laboratory within 2 hours. A coagulation questionnaire card is required, noting the type of heparin the patient is on.

HEPARIN ASSAY, BLOOD Haematology Blood/Sodium citrate tube, EDTA tube

24 hours Time of collection is important. Please contact Haematology (07) 3121 4451 or Branch Laboratory for collection details.

HEPARIN COFACTOR II Haematology Blood/Sodium citrate tube

5 weeks Please contact Haematology (07) 3121 4451 or your Branch Laboratory for details before collection. Referred Test. NOTE: This test is referred to Austin Hospital. Inform patient that they will be charged a non-refundable fee of approx. $30 by Austin Repatriation Hospital.

HEPARIN-INDUCED AGGREGATION

Haematology Blood/Sodium citrate tube or SS tube, EDTA tube

Same day Clinical and medication details required. Specimens to arrive at the laboratory within 4 hours.

HEPATITIS (A OR B) IMMUNE STATUS

Immunology Blood/SS tube 24 hours Please note if Hepatitis A or B assay is PRE or POST vaccination. Assay run daily (Monday to Saturday).

HEPATITIS A IgG ANTIBODY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday).

HEPATITIS A IgM ANTIBODY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday).

HEPATITIS ACUTE SEROLOGY Immunology Blood/SS tube 24 hours To determine the appropriate tests please provide clinical details including Liver Function Studies. If cause unknown the tests performed routinely are HAIgM, HBsAg, HBcAB and HCV. Others for consideration include EBV, CMV, Toxoplasmosis, Brucellosis and Leptospirosis. Please refer to Immunology Preface (5.48) or contact Immunology (07) 3121 4458 or Branch Laboratory for further details. Assay run daily (Monday to Saturday).

HEPATITIS B CORE ANTIBODY (HBcAb)


HEPATITIS B CORE IgM ANTIBODY (HBcAb-IgM)


HEPATITIS B DNA Immunology Blood/SS tube 1 week Assay run on Wednesdays. Results next day after testing.

HEPATITIS B SURFACE ANTIBODY (HBsAb)

Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday). Please indicate on request form if Hep B serology is required for PRE or POST vaccination.

8.9

8.9

PATHOLOGY TESTS


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HEPATITIS B SURFACE ANTIGEN (HBsAg)

Immunology Blood/SS tube Same day Assay run daily (Monday - Saturday).

HEPATITIS C ANTIBODY (HCV Ab)


HEPATITIS C VIRUS GENOTYPE

Immunology Blood/SS tube 1 week Assay run on Fridays. Results next day after testing. Note: there is a Medicare rebate under some circumstances (see Immunology Preface (5.48) for qualifying conditions.) If patient does not qualify, a non-refundable fee may be charged. Essential to state on request form if patient qualifi es for Medicare rebate.

HEPATITIS C VIRUS RNA, QUALITATIVE

Immunology Blood/SS tube 1 - 2 weeks Note: there is a Medicare rebate under some circumstances (see Immunology Preface (5.48) for qualifying conditions.) If patient does not qualify, a non-refundable fee may be charged. Essential to state on request form if patient qualifi es for Medicare rebate.

HEPATITIS C VIRUS RNA, QUANTITATIVE

Immunology Blood/SS tube 1 week Assay run on Wednesdays. Results next day after testing. Note: there is a Medicare rebate under some circumstances (see Immunology Preface (5.48) for qualifying conditions). The patient should be having a pre or post treatment evaluation and the test should be requested by or on the advice of a specialist or consultant physician. Two tests are allowed in a 12 month period. If patient does not qualify, a non-refundable fee may be charged. Essential to state on request form if patient qualifi es for Medicare rebate.

HEPATITIS D (DELTA) VIRUS Immunology Blood/SS tube 1 week Assay run Wednesday.

HEPATITIS E VIRUS Immunology Blood/SS tube 1 week Assay run Wednesday.

HEPATITIS G VIRUS Immunology Blood/SS tube 2 - 4 weeks Referred test.

HEPTACHLOR, (ORGANOCHLORINE PESTICIDE), BLOOD


HEPTANE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

8.10

8.10

PATHOLOGY TESTS


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HERBICIDES, URINE Biochemistry Urine/50 mL urine container 4 weeks Please provide specifi c details of particular weedicide patient has been exposed to. Random urine collected immediately after work shift/exposure. If used as a screening test cost of this test NOT covered by Medicare. Please phone Biochemistry (07) 3121 4420 or your Branch Laboratory for current cost details. Also refer to Biochemistry Appendix (12.18) for a comprehensive list of weedicides/herbicides. Referred test.

HEREDITARY NEUROPATHY GENETIC TESTING

Genetics Blood/EDTA tube 4 - 6 weeks Specimen to be sent at room temperature within 48 hours. Patient consent form to be signed before testing.

HEREDITARY SPHEROCYTOSIS BY FLOW


HERPES SIMPLEX SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

HERPES SIMPLEX VIRUS PCR

Immunology Viral Culture Swab (green top) in transport medium


HERPES VIRUS-6, HUMAN (HHV-6), BLOOD


HERPES ZOSTER SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

HERPES ZOSTER VIRUS PCR


1 week Assay run daily (Monday - Friday).

HESS TEST (CAPILLARY INTEGRITY/FRAGILITY TEST)

Haematology Same day Please contact Haematology (07) 3121 4451 or Branch Laboratory for collection details.

HEXACHLOROBENZENE (ORGANOCHLORINE PESTICIDE), BLOOD


HEXOSE-1-PHOSPHATE URIDYL TRANSFERASE, BLOOD


1 - 2 weeks Please refer to GALACTOSAEMIA SCREEN, BLOOD.

Hg, BLOOD Biochemistry Please refer to MERCURY, BLOOD.

HGPRT, BLOOD Biochemistry Please refer to HYPOXANTHINE GUANINE PHOSPHORIBOSYL TRANSFERASE, BLOOD.

8.11

8.11

PATHOLOGY TESTS


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HIAA, URINE 24 HOUR Biochemistry Please refer to 5-H.I.A.A, URINE.

HIPPURIC ACID, URINE Biochemistry Urine/Urine container 3 weeks Hippuric Acid assay is an index of toluene and xylene exposure. Specimen should be stored frozen. Random urine is preferred. Referred test.

HISTAMINE, URINE Biochemistry Urine/24 hour urine container with 25 mL 6M HCI preservative

6 - 8 weeks Please provide clinical and medication details. Low histamine diet required 24 hours prior to and during test. Refrigerate sample during collection and transport cooled. HISTAMINE, SERUM test not available. Referred test.

HISTAMINE, WHOLE BLOOD Biochemistry Blood/Lithium heparin tube 2 weeks There is currently no Medicare rebate for this test. Referred test.

HISTOLOGY - FROZEN SECTION

Histology Biopsy tissue/DRY container (No formalin)

Immediate. Full report 24 hours

Please contact Histology (07) 3121 4495 or Branch Laboratory for booking.

HISTOLOGY - IMMUNOFLUORESCENCE

Histology Skin, Kidney etc./1. Immunofl uorescence transport medium, 2. 10% Buffered formalin

24 - 48 hours Two biopsies should be taken or the tissue should be split - half in Immunofl uorescence transport medium and the rest into buffered formalin. Please refer to Histology Preface (5.38) or contact Histology (07) 3121 4495 or Branch Laboratory for details.

HISTOLOGY MACRO/MICRO Histology Tissue and biopsy specimens/formalin containers in a variety of sizes

24 hours for simple non-complex specimens. 48 - 72 hours for complex specimens.

Please ensure the specimen container is labelled with patient’s full name,type and number of specimens. Refer to Histology Preface (5.35) or contact Histology (07) 3121 4495 or Branch Laboratory for assistance.

HISTONE AUTOANTIBODIES Immunology Blood/SS tube 2 - 3 weeks

HISTOPLASMOSIS SEROLOGY Immunology Blood/SS tube 2 - 3 weeks

HIV 1 AND 2 SEROLOGY Immunology Blood/SS tube (extra SS tube if other tests requested)

24 hours Assay run daily (Monday to Saturday). HIV1/HIV2/HIV antigen routinely performed.

HIV GENOTYPE Immunology Blood/3 x EDTA tubes 4 weeks Referred test. Specimen must reach laboratory within 6 hours of collection. If not possible specimen must be centrifuged, plasma decanted into a plain plastic tube and frozen. Transport specimen frozen (dry ice).

8.12

8.12

PATHOLOGY TESTS


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HIV PROVIRAL DNA Immunology Blood/2 x EDTA tubes (5 mL), 1 x SS tube

Indeterminate Blood tubes to be transported at ROOM TEMPERATURE. Specimens are to be marked URGENT. Contact the Immunology Department when specimens are collected and to be sent.

HIV VIRAL LOAD TEST (HIV VIRAL QUANTITATION)

Immunology Blood/ACD tube (preferred). EDTA tube is an acceptable substitute

1 week A PCR test that measures viral RNA. The specimen MUST reach laboratory within 6 hours of collection. If this is not possible specimen must be centrifuged, plasma decanted into a plain plastic tube and frozen. Transport specimen frozen (dry ice).

HLA TISSUE TYPING, BLOOD

Haematology Blood/ACD tube, SS tube

2 weeks By appointment only. Please contact Haematology (07) 3121 4451 or Branch Laboratory for collection details or to organise collection. Lithium heparin tube may be used if ACD tube unavailable. Referred test.

HLA TYPING FOR COELIAC DISEASE

Haematology Blood/2 x ACD tubes 2 weeks By appointment only. Please contact Haematology (07) 3121 4451 or Branch Laboratory for collection details or to organise collection. Lithium heparin tube may be used if ACD tube unavailable. Referred test.

HLA TYPING FOR NARCOLEPSY Haematology Blood/2 x ACD tubes 2 weeks By appointment only. Please contact Haematology (07) 3121 4451 or Branch Laboratory for collection details or to organise collection. Lithium heparin tube may be used if ACD tube unavailable. Referred test.

HLA-B27 GENETIC TESTING Genetics/Haematology

Blood/Pink top EDTA tube 1 week Test performed daily. No booking or appointment required. Please notify Haematology (07) 3121 4451 or your Branch Laboratory of all urgent specimens and weekend collections. Test contributory in suspected cases of ankylosing spondylitis. Transport cooled or at room temperature.

HMMA, URINE 24 HOUR Biochemistry Please refer to CATECHOLAMINES, URINE.

HOLD SERUM FOR POSSIBLE COMPATIBILITY

Blood Bank Blood/1 Pink top EDTA tube, 1 Lavender top EDTA tube for Haematology

Same day

HOLO (ACTIVE) B12, BLOOD Haematology Blood/SS tube 72 hours If requested with VITAMIN B12, SERUM a non Medicare rebatable fee of approx. $25.00 is charged to the patient.

HOMOCYSTEINE, SERUM Biochemistry Blood/SS tube 24 hours Fasting sample is preferred. Spin as usual, defi nitely within 1.5 hours of collection and send to the laboratory on ice with the routine courier. If ‘Homocysteine pre and post methionine load’ is requested, please refer to METHIONINE LOADING TEST.

8.13

8.13

PATHOLOGY TESTS


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HOMOCYSTINE, URINE Biochemistry Urine/Urine container 1 - 2 weeks Test for homozygote. Fresh random sample of urine required. Please transport cooled to the laboratory as soon as possible. Referred test.

HOMOGENTISIC ACID, URINE Biochemistry Urine/Urine container 48 hours Fresh random collection, protected from light.

HOMOVANILLIC ACID, URINE Biochemistry Please refer to CATECHOLAMINES, URINE.

HPV DNA TYPING Cytology ThinPrep PreservCyt Collection Vial

2 weeks HPV DNA Typing is performed as an adjunct to conventional screening. A cervical sample is collected and the collection device rinsed in labelled PreservCyt Solution (available from QML Pathology Collection Centres). If collected simultaneously with a conventional Pap smear, a request for HPV DNA typing may be made up to 1 month after receipt as the PreservCyt fl uid is stored for this time. Relevant clinical history to be included on request form for patient to be eligible for Medicare rebate.

HSP-70 (HEAT SHOCK PROTEIN-70), BLOOD


HTLV-1 SEROLOGY Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday. HTLV-1 Serology is now part of the routine infectious screen for autologous blood transfusions.

HUMAN CHORIONIC GONADOTROPHIN (HCG) - QUANTITATIVE, SERUM

Endocrinology Blood/SS tube 24 hours Note date of last normal menstrual period (LNMP), period of amenorrhoea (A=) and estimated date of confi nement (EDC).

HUMAN CHORIONIC GONADOTROPHIN (HCG) - TUMOUR MARKER, SERUM

Endocrinology Blood/SS tube 24 hours -HCG can be used as a tumour marker for trophoblastic disease (hydatidiform mole, invasive mole, persistent mole, partial hydatidiform mole, placental site trophoblastic tumour and gestational choriocarcinoma). Complete obstetric history is essential for result interpretation. Elevated levels are also seen in both ovarian and testicular germ cell tumours and some breast carcinomas. When used in conjunction with AFP, -HCG may prove useful in assessing prognosis, monitoring therapy and detecting recurrence of gonadal germ cell neoplasms.

HUMAN METAPNEUMOVIRUS Immunology Respiratory samples, nasopharyngeal aspirate, nasal washings/Luki tube or Sterile container

1 - 2 weeks

8.14

8.14

PATHOLOGY TESTS


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PATH

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HUNTINGTONS DISEASE GENETIC TESTING

Genetics Blood/EDTA tube Indeterminate GENETIC COUNSELLING IS REQUIRED BEFORE THE BLOOD SPECIMEN CAN BE TAKEN. GENETIC COUNSELLING IS AVAILABLE FROM THE GENETIC HEALTH QUEENSLAND AT THE ROYAL BRISBANE HOSPITAL ON (07) 3636 1686.

HVA, URINE Biochemistry Please refer to CATECHOLAMINES, URINE.

HYBRID GENE TEST Genetics Blood/EDTA tube 3 - 4 weeks Specimen to be sent at room temperature.

HYDATID SEROLOGY Immunology Blood/SS tube 1 week Assay run Wednesday.

HYDROCARBON SOLVENTS, BLOOD


HYDROCARBONS, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

HYDROGEN, BREATH (MULTIPLE)

Biochemistry Please refer to BREATH HYDROGEN (MULTIPLE).

HYDROGEN, BREATH (SINGLE) Biochemistry Expired air samples 48 hours Please refer to BREATH HYDROGEN (MULTIPLE).

HYDROXY CHOLECALCIFEROL Biochemistry Please refer to VITAMIN D, SERUM.

HYDROXY METHOXY MANDELIC ACID, URINE 24 HOUR


HYDROXY PROGESTERONE, SERUM

Endocrinology Blood/SS tube 1 week Please provide clinical and medication details.

HYDROXY VITAMIN D, SERUM


HYDROXYBUTYRATE (BETA OR 3), PLASMA


HYDROXYBUTYRATE (BETA OR 3), SERUM


HYDROXYCHLOROQUINE, PLASMA

Biochemistry Blood/Plain plastic tube - no gel

2 weeks Usually peak and post trough samples collected (i.e. pre and 2 hour post tablet). Transport on dry ice.

HYDROXYINDOLEACETIC ACID, URINE

Biochemistry Please refer to 5-H.I.A.A, URINE.

8.15

8.15

PATHOLOGY TESTS


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HYDROXYTRYPTAMINE, SERUM

Biochemistry Please refer to SEROTONIN, SERUM.

HYDROXYTRYPTAMINE, URINE

Biochemistry Please refer to SEROTONIN, URINE 24 HOUR.

HYPERTONIC CRYOHAEMOLYSIS Haematology Blood/EDTA tube 24 hours

HYPNODORM, SERUM Biochemistry Please refer to FLUNITRAZEPAM, SERUM.

HYPOTHYROIDISM CONGENITAL SCREENING TEST, BLOOD


HYPOXANTHINE GUANINE PHOSPHORIBOSYL TRANSFERASE, BLOOD

Biochemistry Blood/Lithium heparin tube plus EDTA tube

4 weeks Transport in esky at 4°C. Referred test.

8.16

8.16

PATHOLOGY TESTS


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PATH

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IA2 ANTIBODIES (A512 ANTIBODIES), SERUM

Immunology Blood/SS tube 2 weeks Please provide clinical and medication details.

ICS (INTERCELLULAR CEMENT SUBSTANCE) ANTIBODY/PEMPHIGUS ANTIBODY, SERUM


ICT MALARIAL PF TEST Haematology Blood/EDTA tube or Lithium heparin tube

Same day

IgA, SALIVA Biochemistry Saliva/Plain tube or Urine container

3 days Please provide clinical and medication details. Refrigerate or freeze sample immediately after collection, and during storage and transport. Please note that SALIVA is required, not sputum. The saliva should be unstimulated.

IgA, SERUM Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details.

IgA, URINE Biochemistry Urine/Random urine container

2 weeks Transport in esky at 4°C. Referred test.

IgE LEVELS, SERUM Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

IGF-BINDING PROTEIN 3 Endocrinology Blood/SS tube 3 weeks Referred test.

IGF-I (SOMATOMEDIN C) Endocrinology Blood/SS tube 24 hours

IGG FOOD ALLERGY PANEL 40 Specimen Distribution

Serum/SS tube or Plain tube (red top)

Collection and transfer only







IgG, SERUM Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details.

IgM, SERUM Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details.

IMIPRAMINE, SERUM Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube (no gel) acceptable)

1 week Please provide clinical and medication details. Assay cannot be performed from glass collection tubes. Collect immediately prior to next dose.

IMIPRIM, SERUM Biochemistry Please refer to IMIPRAMINE, SERUM.

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8.17

PATH

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8.17

PATHOLOGY TESTS



IMMUNOFIXATION (PROTEIN), SERUM

Biochemistry Blood/SS tube 24 - 48 hours Qualitative test for presence of abnormal or malignancy-associated proteins. Please provide clinical and medication details.

IMMUNOFIXATION (PROTEIN), URINE

Biochemistry Random urine/Urine container or 24 hour urine collection/Urine collection bottle. No preservative

24 - 48 hours Qualitative test - random urine. Quantitative estimation - 24 hour urine collection. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

IMMUNOFLUORESCENCE, HISTOLOGY

Histology Skin - Kidney etc./1. Immunofl uorescence transport medium, 2. 10% Buffered formalin

24 - 48 hours Two biopsies should be taken or the tissue should be split - half in Immunofl uorescence transport medium and the rest into buffered formalin. Please refer to Histology Preface (5.38) or contact Histology (07) 3121 4495 or Branch Laboratory for details.

IMMUNOGLOBULIN D, SERUM Biochemistry Blood/SS tube 2 weeks Transport on dry ice.

IMMUNOGLOBULINS, SERUM Biochemistry Blood/SS tube 24 hours Includes IgG, IgA and IgM (but not IgE). Please provide clinical and medication details.

IMMUNOREACTIVE TRYPSINOGEN, BLOOD

Biochemistry Please refer to NEONATAL SCREENING TEST for details.

INDINAVIR, PLASMA Biochemistry Blood/EDTA tube 3 weeks Please provide clinical and medication details. Plasma to be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Referred test.

INFECTIOUS MONONUCLEOSIS SEROLOGY (PAUL-BUNNELL TEST), SERUM

Haematology Blood/SS tube Same day Epstein-Barr Virus (EBV) Serology may be helpful if Paul-Bunnell test is negative and clinical features are suggestive.

INFLAMMATORY BOWEL DISEASE STUDY

Specimen Distribution

Blood/5 x EDTA tubes Collection and transfer only

Keep samples at room temperature. Send sample to laboratory without delay.

INFLUENZA A SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

INFLUENZA B SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

INHIBIN, BLOOD Endocrinology Blood/SS tube 2 - 5 weeks There is currently no Medicare rebate for this test. Referred test.

INORGANIC ARSENIC, URINE

Biochemistry Urine/Urine container 2 weeks Due to the instability of samples, referral must be made on the same day as collection, hence samples must reach the central laboratory no later than 2.30pm. Do not collect samples on Friday.

INR - PROTHROMBIN TIME, BLOOD


Same day Please see Warfarin section in Haematology Appendix (12.32) for further information.

8.18

8.18

PATHOLOGY TESTS


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PATH

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INSECTICIDES (ORGANOPHOSPHATE/CARBAMATE), SERUM


INSECTIGAS (PESTICIDE), SERUM


INSULIN ANTIBODIES, SERUM Immunology Blood/SS tube 2 - 3 weeks Referred test.

INSULIN TOLERANCE TEST - FOR CORTISOL RESPONSE


24 hours The test involves an infusion of insulin and the measurement of cortisol and glucose, usually investigating Cushing’s Syndrome. However, other hormones may be done to exclude other conditions. Please contact Collections (07) 3121 4450 or Branch Laboratory for appointment, call Endocrinology (07) 3121 4439 for details.

INSULIN, SERUM Endocrinology Blood/SS tube 24 hours Usually fasting unless otherwise required.

INSULIN-LIKE GROWTH FACTOR-I (IGF- I/SOMATOMEDIN C), SERUM

Endocrinology Blood/SS tube 24 hours Growth hormone is secreted in a pulsatile fashion and levels fl uctuate under external infl uences. IGF-I/ Somatomedin C is a relatively long lived stable protein product of growth hormone action produced mainly by the liver. It may assist assessment of pituitary regulation of growth. Please consult Endocrinology (07) 3121 4439 or Branch Laboratory.

INTACT PARATHORMONE, SERUM

Endocrinology Blood/SS tube 24 hours PTH is stable if the specimen is kept cold (4°C) for up to 10 hours. However, hormone activity decreases signifi cantly at room temperature. Please note on form if kept at room temperature for prolonged periods.

INTERCELLULAR CEMENT SUBSTANCE (ICS) ANTIBODY/PEMPHIGUS ANTIBODY, SERUM


INTERLEUKIN 2 RECEPTOR Endocrinology Blood/SS tube 1 week Specimen stable for 2 days if kept cold (4°C). If longer, please spin, separate and freeze serum and transport.

INTERLEUKIN 6 Endocrinology Blood/SS tube 48 hours Specimen stable for one day if kept cold (4°C). If longer, please spin, separate and freeze serum and transport.

INTESTINAL DISACCHARIDASES, BIOPSY TISSUE

Biochemistry Small intestinal biopsy tissue. Wrap in aluminium foil and place in a DRY sterile screw top (urine) container

24 hours Please provide clinical history. Collect this specimen fi rst to avoid any possibility of contact with formalin. Wrap fresh tissue in aluminium foil, place in a DRY sterile screw top (urine) container and freeze immediately after collection. Transport on dry ice. DO NOT PLACE IN FORMALIN. Please refer to Histopathology Preface (5.35).

8.19

8.19

PATHOLOGY TESTS


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INTRINSIC FACTOR ANTIBODY, SERUM

Immunology Blood/SS tube 1 week Sera on all patients with low Vitamin B12 levels are stored for 2 weeks. Assay performed once per week.

INVERSION 16 RT-PCR Genetics Blood or Bone marrow/EDTA tube or min. 1 mL bone marrow in EDTA tube

1 month Specimen needs to be received within 48 hours.

IODINE, URINE Biochemistry Urine/Urine container or plain 24 hour urine container

2 weeks While 24 hour urine collections are preferred, timed samples or spot urines are acceptable for initial testing. Keep cool and transport without delay to reach the laboratory no later than 2.30pm on the day of collection. Collect Monday to Thursday only. There is currently no Medicare rebate for this test. Referred test.

IRON (Fe) STUDIES, SERUM Haematology Blood/SS tube 24 hours Includes Iron, TIBC, % saturation and Ferritin.

IRON (Fe), URINE Biochemistry Urine/24 hour urine container with no preservative

1 week Please provide clinical and medication details.

IRON, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify site of fl uid on specimen container and request form.

IRON, LIVER BIOPSY Biochemistry Liver biopsy/Dry sterile screw top (urine) container

2 weeks Saline washed sample is wrapped in aluminium foil, placed in a DRY sterile screw top (urine) container and frozen. Transport on dry ice. DO NOT place in formalin. Referred test.

IRON, SERUM Biochemistry Please refer to E/LFT, SERUM.

ISCHAEMIC EXERCISE TEST

Biochemistry Blood/7 x fl uoride oxalate tubes, 7 x Lithium heparin tubes

24 hours Please contact Biochemistry (07) 3121 4971 or Branch Laboratory for details.

ISLET CELL AB/PANCREATIC Immunology Blood/SS tube 2 weeks

ISONIAZID, PLASMA Biochemistry Blood/2 x EDTA tubes - no gel

3 weeks Patient must be fasting. The blood samples should be collected 2 hours after the Isoniazid dose is given. Samples must be centrifuged, separated into 2 x 6 mL Falcon tubes containing 5 mg Ascorbic acid and frozen IMMEDIATELY (no longer than 1 hour after collection). Protect from light.

ITRACONAZOLE, SERUM Biochemistry Blood/Plain plastic tube - no gel

2 weeks Please provide clinical and medication details. Referred test.

IUD FOR CULTURE Microbiology IUD/Sterile container Up to 7 days Unusual organisms may be isolated e.g. Actinomyces.

8.20

8.20

PATHOLOGY TESTS


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STS

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PATH

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JAK 2 MUTATION ANALYSIS Genetics Blood or Bone marrow/Pink top EDTA tube or min. 2 mL bone marrow in EDTA tube

2 weeks Transport at room temperature or cooled on ice brick.

KENNEDY’S DISEASE (SBMA) GENETIC TESTING

Genetics Blood/EDTA tube 1 - 2 months Also known as Spinal Bulbar Muscular Atrophy (SBMA).

KEROSENE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

KETONE BODIES, PLASMA Biochemistry Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA for details.

KETONE SCREEN, SERUM Biochemistry Blood/SS tube Same day Semi-quantitative test. Acetoacetate only is detected.

KETONE SCREEN, URINE Biochemistry Urine/Urine container Same day Semi-quantitative test. Acetoacetate only is detected.

KINIDIN, SERUM Biochemistry Please refer to QUINIDINE, SERUM.

KLEIHAUER TEST(FETAL RED CELL SCREEN), MATERNAL BLOOD

Haematology Maternal blood/1 EDTA tube, 2 blood fi lms


Examination of maternal blood for evidence of Foeto-Maternal transfusion. FMH Test usually performed.

KUNJIN SEROLOGY Immunology Blood/SS tube 2 weeks

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8.21

PATH

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8.21

PATHOLOGY TESTS



L/S RATIO, AMNIOTIC FLUID Biochemistry Amniotic fl uid/Plain plastic container

Same day Test for fetal lung maturity. Please provide clinical details including period of gestation.

L-LACTATE, PLASMA Biochemistry Blood/Lithium heparin tube 2 weeks Transport to Central Laboratory on dry ice. Referred test.

LACTATE (PRE+POST STRESS), PLASMA

Biochemistry Blood/Fluoride oxalate tube

Same day Please contact Biochemistry (07) 3121 4971 or Branch Laboratory for details on conducting test. NB. DO NOT USE TOURNIQUET OR HAND FLEXING; SIGNIFICANT FALSE ELEVATION WILL RESULT.

LACTATE DEHYDROGENASE (LD/LDH) ISOENZYMES, SERUM

Biochemistry Blood/SS tube 24 hours LD-1 may be a useful marker for Seminoma/Dysgerminoma and LD-2 and 3 may be elevated in epithelial and lymphoid malignancy. LD-5 may be used in place of alpha Hydroxybutyrate dehydrogenase and Aldolase assays in muscle injury.

LACTATE DEHYDROGENASE (LD/LDH), SERUM

Biochemistry Please refer to E/LFT, SERUM. Avoid haemolysis and prolonged contact of serum with cells. If stored overnight, blood should be centrifuged to separate serum from cells.

LACTATE, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify site of fl uid on specimen container and request form.

LACTATE, PLASMA Biochemistry Blood/Fluoride oxalate tube

Same day Please provide clinical and medication details. NB. DO NOT USE TOURNIQUET OR HAND FLEXING; SIGNIFICANT FALSE ELEVATION WILL RESULT.

LACTATE, URINE Biochemistry Blood/Urine container or plain 24 hour urine container


LACTOSE TOLERANCE TEST

Biochemistry Blood/4 x Fluoride oxalate tubes

24 hours Please contact Biochemistry (07) 3121 4971 or Branch Laboratory for dosageand collection details. NB: Breath Hydrogen may be a more suitable test.

LAMICTAL, PLASMA Biochemistry Please refer to LAMOTRIGINE, SERUM.

LAMOTRIGINE, PLASMA Biochemistry Please refer to LAMOTRIGINE, SERUM.

LAMOTRIGINE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin tube (no gel) acceptable)

1 week Please provide clinical and medication details, including time, date and amount of last dose. Collect sample immediately prior to next dose.

LANNATE (PESTICIDE), BLOOD Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity.

LANOXIN, SERUM Biochemistry Please refer to DIGOXIN, SERUM.

LARGACTIL, SERUM Biochemistry Please refer to CHLORPROMAZINE, SERUM.

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8.22

PATH

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8.22

PATHOLOGY TESTS



LAROXYL, SERUM Biochemistry Please refer to AMITRIPTYLINE, SERUM.

LATS (LONG ACTING THYROID STIMULATOR), SERUM

Endocrinology Blood/SS tube 4 days Alternative names include LATS-P (Long Acting Thyroid Stimulator- Protector), TSH Receptor antibody, TSI (Thyroid Stimulating Immunoglobulin) and TBII (TSH Binding Inhibiting IgG). Assay of this autoantibody may be useful to monitor patients with Graves disease while on treatment.

LAXATIVES, FAECES Biochemistry Faeces/Faeces container or urine container

1 week Transport at 4°C.

LD ISOENZYMES, SERUM Biochemistry Please refer to LACTATE DEHYDROGENASE (LD/LDH) ISOENZYMES, SERUM.

LD, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify site of fl uid on specimen container and request form.

LD, PLEURAL FLUID Biochemistry Pleural fl uid/Plain tube Same day Please provide clinical and medication details. Refrigerate sample during storage and transport.

LD, SERUM Biochemistry Please refer to E/LFT, SERUM. Avoid haemolysis and prolonged contact of serum with cells. If stored overnight, blood should be centrifuged to separate serum from cells.

LD/LDH ISOENZYMES, SERUM

Biochemistry Please refer to LACTATE DEHYDROGENASE (LD/LDH) ISOENZYMES, SERUM.

LD/LDH (LACTATE DEHYDROGENASE), SERUM

Biochemistry Please refer to E/LFT, SERUM. Avoid haemolysis and prolonged contact of serum with cells. If stored overnight, blood should be centrifuged to separate serum from cells.

LDL CHOLESTEROL, SERUM

Biochemistry Please refer to HDL CHOLESTEROL, SERUM.

LEAD, BLOOD Biochemistry Blood/EDTA tube 24 hours Please provide clinical, medication and lead exposure details. Leave as whole blood.

LEAD, HAIR Biochemistry Hair/Dry sterile screw cap (urine) container

4 weeks Fill sterile container as full as possible with hair. Clippings from the patient’s last hair cut can be used. Please provide full details of long term exposure. Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

LEAD, PAINT FLAKES Biochemistry Paint fl akes/Dry sterile screw top (urine) container


8.23

8.23

PATHOLOGY TESTS


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LEAD (Pb), URINE Biochemistry Urine/Urine container with no preservative

1 day Please provide clinical, medication and lead exposure details. A spot urine should be collected for ORGANIC LEAD (petrol workers). Collect immediately after work shift where exposure may have occurred. A 24 hour urine collection is required for post chelation patients.

LEBER’S NEURORETINOPATHY TEST, DNA PROBE

Biochemistry Please refer to MITOCHONDRIAL DISORDERS (LEBERS, LEIGHS, MELAS, NARP), BLOOD.

LEGIONELLA ANTIBODY Immunology Blood/SS tube 24 hours

LEGIONELLA PCR Immunology Respiratory aspirate sputum, Lavage

24 hours Results usually available same day for urgent specimens.

LEGIONELLA SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

LEGIONELLA URINARY ANTIGEN Immunology Urine/Urine container 24 hours Not suitable for routine diagnosis - only useful in cases from suspected Legionella outbreaks.

LEISHMANIA SEROLOGY Immunology Blood/SS tube 2 - 3 weeks

LEPTIN, PLASMA Biochemistry Blood/Lithium heparin tube 2 - 3 weeks Please keep the sample cool and forward to the laboratory without delay. Referred test.

LEPTOSPIRA SEROLOGY Immunology Blood/SS tube 72 hours Assay run Monday and Thursday.

LEUKOCYTE ENZYMES, BLOOD


LEUKAEMIA MARKER STUDIES Haematology Blood/ACD tube, EDTA tube, Blood fi lm


LiCO3, SERUM Biochemistry Please refer to LITHIUM, SERUM.

LIDOCAINE, SERUM Biochemistry Please refer to LIGNOCAINE, SERUM.

LIGNOCAINE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant

2 weeks Please provide clinical and medication details especially time of last dose. Collect just prior to next dose.

LINDANE (ORGANOCHLORINE PESTICIDES), BLOOD


LIPASE, SERUM Biochemistry Blood/SS tube Same day Please provide clinical and medication details.

LIPID ELECTROPHORESIS, SERUM

Biochemistry Blood/SS tube 1 week Patient should have fasted for 12 hours and have abstained from drinking alcohol for 72 hours (unless otherwise requested). Referred test.

8.24

8.24

PATHOLOGY TESTS


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LIPID STUDIES, SERUM Biochemistry Blood/SS tube Same day Includes Cholesterol, Triglycerides and HDL. See Biochemistry Appendix (12.21)Medicare requires that each test is requested separately on the request.

LIPID TYPING, SERUM Biochemistry Please refer to LIPID ELECTROPHORESIS, SERUM.

LIPOPROTEIN (a), SERUM Biochemistry Blood/SS tube 24 hours If a transport delay of more than 2 hours is anticipated centrifuge specimen to separate red cells from serum and transport cooled to the laboratory.

LIPOPROTEIN A1, SERUM Biochemistry Please refer to APOLIPOPROTEIN A1, SERUM.

LIPOPROTEIN PATTERN (ELECTROPHORESIS), SERUM

Biochemistry Please refer to LIPID ELECTROPHORESIS, SERUM.

LITHICARB, SERUM Biochemistry Please refer to LITHIUM, SERUM.

LITHIUM, SERUM Biochemistry Blood/SS tube Same day Collect sample 12 hours after last dose. Note time, date and amount of last dose on the request form.

LIVER BIOPSY COPPER Biochemistry Please refer to COPPER, LIVER BIOPSY for details. Referred test.

LIVER BIOPSY IRON Biochemistry Please refer to IRON, LIVER BIOPSY for details. Referred test.

LIVER FUNCTION TESTS, SERUM

Biochemistry Blood/SS tube Same day Includes: Bilirubin (total/conjugated), Alkaline Phosphatase, Gamma GT, ALT AST, LD, Albumin and Globulins. Please refer to E/LFT, SERUM for details.

LIVER/KIDNEY MICROSOMAL ANTIBODY


LOPINIVIR, PLASMA Biochemistry Blood/EDTA tube 3 weeks Please provide clinical and medication details. Plasma to be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Referred test.

LOVAN, SERUM Biochemistry Please refer to FLUOXETINE, SERUM.

LP(a), SERUM Biochemistry Please refer to LIPOPROTEIN (a), SERUM.

LUCIJET (PESTICIDE), SERUM


8.25

8.25

PATHOLOGY TESTS


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LUPUS ANTICOAGULANT SCREEN


24 hours Transport at 4°C. Must reach laboratory within 2 hours of collection. This is a conditional Medicare item if requested with thrombotic assays. PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Thrombotic assay requests are only Medicare refundable if one of the following is stated on the request form by the patient’s doctor:1. That the patient has a personal history of venous thromboembolism (DVT) or



3. That the request is to confi rm an abnormal or indeterminate result. IF THE REQUEST IS NOT REFUNDABLE BECAUSE OF THE ABOVE CONDITIONS, THE PATIENT WILL BE CHARGED A NON-REFUNDABLE AMOUNT. PLEASE INFORM THE PATIENT IF THE TESTING WILL RESULT IN AN ACCOUNT BEING SENT TO THE PATIENT.

LUTEINIZING HORMONE (LH), SERUM

Endocrinology Blood/SS tube 24 hours Please provide clinical notes and last normal menstrual period (LNMP). Include information regarding any hormone replacement therapy or contraceptive use.

LYME DISEASE SEROLOGY Immunology Blood/SS tube 3 - 4 weeks Assay run Tuesday and Friday.

LYME DISEASE WESTERN BLOT


LYMPH NODE CELL MARKER STUDIES, TISSUE

Haematology/Histology

Lymph Node/Antibiotic Transport Medium, formalin container, 6 labelled glass slides

24 hours Using a sterile technique, dissect the Lymph node free of adherent fat and tissue. Slice the node into 2mm slices and place a sample in Antibiotic Transport Medium. With the other slices, make 6 touch imprints onto glass slides, 2 of which are air dried and 2 are fi xed in 95% alcohol or Diff Quik fi xative. The remaining two slides can be forwarded to Haematology with tissue submitted for marker studies. A slice should be fi xed for 6 hours and processed overnight, while the remainder is allowed to fi x in buffered formalin for 24 hours and then placed on a 12 hour processing cycle. Store cooled and transport cooled to laboratory as soon as possible. Please see Histology Preface (5.35) for full details. Please contact Histology (07) 3121 4495 or Branch Laboratory to inform of impending biopsy and for assistance.

LYMPHOCYTE FUNCTION TESTS, BLOOD

Haematology Blood/2 x Lithium heparin tubes, 1 x SS tube, 1 x EDTA tube

2 weeks Please contact Haematology (07) 3121 4451 or Branch Laboratory for appointment. Referred test.

8.26

8.26

PATHOLOGY TESTS


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LYMPHOCYTE GENE REARRANGEMENT STUDIES


2 weeks IgH and T-cell receptor (beta and gamma) gene rearrangements. Incurs fee to patient.

LYMPHOCYTE MARKER STUDIES, BLOOD



LYMPHOCYTE SUBSET ANALYSIS (INCLUDES T4/T8 RATIO), BLOOD



LYMPHOGRANULOMA VENEREUM (LGV) SEROLOGY

Immunology Blood/SS tube 72 hours Assay run Monday and Wednesday.

LYSOSOMAL ENZYMES, BLOOD

Biochemistry Blood/2 x EDTA tubes 2 weeks Sample MUST be kept at room temperature. Samples MUST only be collected Monday - Thursday due to instability of specimen and MUST arrive at Biochemistry, Murarrie 11.00am at the latest. Please contact Biochemistry (07) 3121 4420 or Branch Laboratory to advise of expected arrival time or if any queries.

LYSOZYME, SERUM Haematology Blood/SS tube 24 hours

LYSSAVIRUS SEROLOGY Immunology Blood/SS tube 2 - 3 weeks

8.27

8.27

PATHOLOGY TESTS


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MACRO CK, SERUM Biochemistry Please refer to CK ISOENZYME ELECTROPHORESIS, SERUM.

MAGNESIUM, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify site of fl uid on specimen container and request form.

MAGNESIUM, RED CELL Biochemistry Blood/Plastic lithium heparin tube or EDTA tube

2 weeks Please provide clinical and medication details. Do not separate sample. Transport at 4°C. Referred test.

MAGNESIUM, SERUM Biochemistry Blood/SS tube Same day Please provide clinical and medication details.

MAGNESIUM, URINE 24 HOUR

Biochemistry Urine/24 hour urine container with 25 mL 6M HCI preservative


MALARIAL PARASITES Haematology Blood/EDTA tube, 4 x slides Same day 2 x thin fi lm slides and 2 x thick fi lm slides are to be prepared.

MALARIAL PARASITES PCR Genetics Blood/EDTA tube 1 week Speciation of Malaria. Transport at room temperature or cooled on an ice brick.

MALATHION (PESTICIDE), SERUM


MALIGNANT CELLS Cytology Various sites, samples and presentations

See specifi c specimen or site.

MALIGNANT HYPERTHERMIA GENETIC TESTING

Genetics Blood/Lithium heparin tube 4 - 6 weeks Keep at room temperature.

MANDELIC ACID, URINE Biochemistry Urine/Urine container 3 weeks Please collect a random urine after work shift or suspected exposure. Keep the sample refrigerated. Referred test.

MANGANESE (Mn), BLOOD Biochemistry Blood/EDTA tube (Lithium heparin tube acceptable)

4 weeks Please provide clinical and medication details. Transport in esky at 4°C. Referred test.

MANGANESE (Mn), SERUM Biochemistry Blood/SS tube 4 weeks Please provide clinical and medication details. Transport in esky at 4°C. Referred test.

MANGANESE (Mn), URINE Biochemistry Urine/Urine container 4 weeks Test for excessive exposure. Referred test.

MANNOSE BINDING LECTIN, WHOLE BLOOD

Biochemistry Whole blood/EDTA tube 1 - 2 months Band both samples together and transport on ice to the central laboratory. There is currently no charge for this test but there is a collection and handling fee of approximately $40.00. Referred test.

PATH

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9.0

PATH

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9.0

PATHOLOGY TESTS



MANTOUX TEST - HUMAN Microbiology Skin test/0.1 mL of human PPD

48 - 72 hours Intradermal injection volar aspect LEFT forearm. Read at 48-72 hours. Please contact Consultant Pathologist on (07) 3121 4475 for details. Refer to Microbiology Preface (5.60).

MARCAIN, PLASMA Biochemistry Please refer to BUPIVACAINE, PLASMA for details.

MARFAN SYNDROME GENETIC TESTING

Genetics Blood/EDTA tube Up to 9 months Patient consent for billing must be marked on the request form.

MATRX NTX STUDY Specimen Distribution

Urine/Random urine container


MBOCA, URINE Biochemistry Please refer to MOCA, URINE.

MCAD (MEDIUM CHAIN ACYL CO A DEHYDROGENASE DEFICIENCY) TEST, DNA PROBE

Biochemistry Please refer to MCAD GENE ANALYSIS.

MCAD GENE ANALYSIS Biochemistry Blood/EDTA tube 4 weeks Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for specifi c collection details as this may differ quantitatively or qualitatively for different diseases. Please indicate which diseases are being investigated. Referred test.

MCP, URINE Biochemistry Please refer to VITAMIN B3, URINE for details.

MCPA (HERBICIDE), URINE Biochemistry Please refer to HERBICIDES, URINE

MEAN CELL VOLUME Haematology Blood/EDTA tube Same day

MEASLES PCR Immunology Blood, Nasopharyngeal aspirate, Nasopharyngeal swab (viral transport medium or Virocult)

1 week Referred test.

MEASLES SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

MEC-A GENE ANALYSIS Genetics Swab of infected site, culture/Sterile container

48 hours Transport at room temperature.

MEDIUM CHAIN ACYL CO A DEHYDROGENASE DEFICIENCY (MCAD) TEST, DNA PROBE

Biochemistry Blood/EDTA tube 2 - 4 weeks Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for specifi c collection details as this may differ quantitatively or qualitatively for different diseases. Please indicate which diseases are being investigated. Referred test.

9.1

9.1

PATHOLOGY TESTS


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PATH

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MELIOIDOSIS SEROLOGY (BURKHOLDERIA PSEUDOMALLEI)

Immunology Blood/SS tube 1 week Assay run Monday.

MELIPRAMINE, SERUM Biochemistry Please refer to IMIPRAMINE, SERUM.

MELLERIL, SERUM Biochemistry Please refer to THIORIDAZINE, SERUM.

MENINGOCOCCAL PCR Immunology CSF, EDTA plasma/Sterile container and EDTA tube

24 hours or same day if requested

MENINGOCOCCAL SEROLOGY Immunology Blood/SS tube 2 - 3 weeks

MERCAPTURIC ACID, URINE Biochemistry Urine/Urine container 2 weeks Random urine to be collected at the end of work shift.

MERCURY, BLOOD Biochemistry Blood/EDTA tube (Lithium heparin tube acceptable)

4 weeks Please provide clinical and exposure details. For occupational inorganic mercury exposure, spot urine is the preferred sample. Transport in esky at 4°C. Referred test.

MERCURY, HAIR Biochemistry Hair/Dry sterile screw cap (urine) container

4 weeks Please provide clinical and exposure details. Fill sterile container with hair, as full as possible. Provide full details of long term exposure. Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

MERCURY, NAIL Biochemistry Toe and fi ngernail clippings/Dry sterile screw cap (urine) container

4 weeks Please provide exposure and occupation details. Cut clean fi nger and toe nails. Referred test.

MERCURY, URINE Biochemistry Urine/Urine container 4 weeks Please provide details of exposure (clinical and occupational). A random collection is preferred. However, for occupational inorganic mercury exposure, spot urine is the preferred sample. Referred test.

METABOLIC SCREEN (MUCOPOLYSACCHARIDES, AMINO ACIDS/ORGANIC ACID), URINE

Biochemistry Urine/Urine container 1 week A random (early morning) collection or during an episode is preferred. Please provide clinical and medication details. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Profi le includes amino acids (and organic acids and mucopolysaccharides if the patient is less than 12 years of age).

METABOLIC SCREEN, BLOOD


1 week If presentation is episodic collect during an episode. Please provide clinical and medication details. The specimen should be transported cooled to the laboratory as soon as possible. Referred test.

METANEPHRINE, BLOOD

Biochemistry Please refer to METANEPHRINE, PLASMA.

9.2

9.2

PATHOLOGY TESTS


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METANEPHRINE, PLASMA


1 - 2 weeks Tumour marker - phaeochromocytoma. Please keep the sample cool and forward to the laboratory without delay.

METANEPHRINE, URINE 24 HOUR


METASYSTOX (PESTICIDE), SERUM


METHADONE, BLOOD

Biochemistry Blood/Lithium heparin tube 2 - 3 weeks Please provide clinical and medication details including time and date of last dose. Do not separate plasma.

METHAEMALBUMIN, PLASMA

Biochemistry Blood/Lithium heparin tube Same day Investigation of intravascular haemolysis. Handle carefully to avoid damaging red blood cells during collection. Centrifuge and separate plasma from cells immediately. Decant plasma into a labelled plain plastic tube. Transport cooled to the laboratory.

METHAEMOGLOBIN REDUCTASE, BLOOD

Biochemistry Blood/Lithium heparin tube 4 weeks Keep sample cool. DO NOT FREEZE.

METHAEMOGLOBIN, BLOOD


Same day Please provide clinical and medication details. Forward UNOPENED TUBE to lab promptly. DO NOT SEPARATE plasma.

METHAEMOGLOBIN, URINE

Biochemistry Random urine/Urine container

Same day Random urine sample. Provide clinical and medication details. Forward to laboratory promptly.

METHOMYL (PESTICIDE), BLOOD


METHOTREXATE, SERUM

Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable)

1 - 2 days Please provide clinical, medication and dosage details. Following a 4 - 6 hour infusion, serum samples should be collected at 24hrs, 48hrs and 72hrs post infusion. Referred test.

METHYL BROMIDE, PLASMA Biochemistry Please refer to BROMIDE, BLOOD and SERUM for details.

METHYL CARBOXYLAMIDE PYRIDONE, URINE

Biochemistry Please refer to VITAMIN B3, URINE for details.

METHYL CHLORIDE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

METHYL ETHYL KETONE, BLOOD


9.3

9.3

PATHOLOGY TESTS


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METHYL ETHYL KETONE, URINE

Biochemistry Urine/Urine container 4 weeks Urine should be collected at the end of the work shift. Referred test.

METHYL HISTAMINE, URINE

Biochemistry Please refer to HISTAMINE, URINE. Methyl histamine is a dietary derivative.

METHYL ISOBUTYL KETONE (MIBK), BLOOD


METHYL ISOBUTYL KETONES, URINE

Biochemistry Urine/Urine container 4 weeks Widely used solvent. Please collect the sample at the end of work shift or exposure. The sample must be kept cold and forwarded to the laboratory without delay. No Medicare rebate applicable. Referred test.

METHYLENE CHLORIDE, BLOOD


METHYLENE-BIS-2-CHLORANILINE, URINE

Biochemistry Please refer to MOCA, URINE.

METHYLMALONIC ACID, SERUM Biochemistry Blood/SS tube 1 - 2 weeks Sample must be kept cool and transported to the laboratory without delay. Referred test.

METHYLMALONIC ACID, URINE Biochemistry Urine/50 mL urine container 2 weeks Please provide clinical and medication details.A random urine collection is required. Referred test.

MEVINPHOS (PESTICIDE), SERUM


MEXILETINE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant

2 weeks Please provide clinical and medication details including time and date of last dose. Collect just prior to next dose.

MEXITIL, SERUM Biochemistry Please refer to MEXILETINE, SERUM.

MIANSERIN, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (EDTA tube or Plastic lithium heparin (no gel) acceptable)

1 - 2 weeks Please provide clinical and medication details including time and date of last dose. Collect just prior to next dose. Referred test.

MIBK (METHYL ISOBUTYL KETONE), BLOOD

Biochemistry Blood/Lithium heparin tube 2 weeks Widely used solvent. Please refer to SOLVENTS, BLOOD for all details. Collect the sample at the end of work shift or exposure. No Medicare rebate applicable. Referred test.

MIBK, URINE Biochemistry Please refer to METHYL ISOBUTYL KETONES, URINE.

9.4

9.4

PATHOLOGY TESTS


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MICROALBUMIN, URINE Biochemistry Please refer to ALBUMIN, URINE.

MICROALBUMIN/CREATININE RATIO, URINE

Biochemistry Please refer to ALBUMIN, URINE.

MICROBIAL SEROLOGY Immunology Blood/SS tube Variable from 24 hours to weeks depending on agent requested


MICROSOMAL ANTIBODY, SERUM (THYROID)


MIDAZOLAM, URINE Biochemistry Urine/Urine container 4 weeks Transport to central laboratory on ice. Referred test.

MINERAL TURPENTINE, BLOOD


MINIMUM INHIBITORY CONCENTRATION

Microbiology In vitro test on isolate 24 hours Please contact Medical Microbiologist (07) 3121 4436 or (07) 3121 4475 for further details.

MITOCHONDRIAL ANTIBODY, SERUM


MITOCHONDRIAL DISORDERS (LEBERS, LEIGHS, MELAS, NARP), BLOOD

Biochemistry Blood/EDTA tube 4 weeks ADULT: Collect 2 x 4 mL EDTA and transport to laboratory at 4°C within 12 hours of collection. CHILD: Collect minimum 2 mL EDTA whole blood and transport to laboratory at 4°C within 12 hours of collection. A neonatal screening card MAY be collected instead of whole blood. Please contact Biochemistry (07) 3121 4420 for collection details. This screen includes Leber’s Hereditary Optic Neuroretinopathy, Myoclonus Epilepsy Ragged Red Fibres, Mitochondrial Encephalopathy, Lactic Acidosis and Stroke-like episodes, Mitochondrial DNA Deletion studies, Neurogenetic Muscle Weakness, Ataxia and retinitis Pigmentosa, Leighs disease. Referred Test.

MITOCHONDRIAL DISORDERS, HAIR ROOTS

Biochemistry Hair roots/Taped to paper backing with roots uncovered

Indeterminate Blood is the preferred sample for this test. Adults and children >2 years: Collect 6-10 hair roots. Secure hairs with sticky tape to paper, leaving roots uncovered. Children <2 years: Apply blood to Neonatal screening card. Referred test.

MIXED LYMPHOCYTE CULTURE, BLOOD

Haematology Blood/ACD tube 2 weeks Please contact Haematology (07) 3121 4451 or Branch Laboratory for appointment. Referred test.

9.5

9.5

PATHOLOGY TESTS


PATH

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Y TE

STS

- M

PATH

OLOG

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MOCA, URINE Biochemistry Urine/Urine container 8 working days Sample to be collected post work shift. Refrigerate sample and transport to laboratory cooled.

MOGADON, SERUM Biochemistry Please refer to NITRAZEPAM, SERUM.

MOLYBDENUM, BLOOD Biochemistry Blood/Lithium heparin tube or EDTA tube


MONOLAYER CYTOLOGY (THINPREP)

Cytology Labelled fi xed smear/slide carrier. Rinse collection device in labelled PreservCyt Solution

24 - 48 hours ThinPrep is performed as an adjunct to conventional screening. A conventional Pap smear must be performed and the collection device rinsed in labelled PreservCyt Solution (available from QML Pathology Collection Centres). Transport Pap smear and PreservCyt Solution to the laboratory. This test is a non rebatable fee.

MORPHINE, SERUM (QUANTITATIVE)

Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant

2 weeks Please provide clinical and medication details, including time and dosage of last dose.

MOTOR NEURON DISEASE FAMILIAL GENETIC TESTING

Genetics Blood/EDTA tube 2 months Transport at room temperature. Please note: This test requires extensive history and family history to be performed. Family linkages: Require at least two members with linkage numbers or three known infected members who have been clinically diagnosed. Patient consent form to be fi lled out prior to testing.

MRSA SCREEN VRE/ESBL Microbiology Swab in Stuart’s transport medium

48 hours Specify sites: Rectal - ESBL/VRE; Nasal/groin/wounds/axilla - MRSA.

MTHFR (C677T) MUTATION ANALYSIS

Genetics Blood/EDTA tube 1 week Please provide details regarding patient’s eligibility for Medicare rebate, i.e. proven venous thrombosis or pulmonary embolism or fi rst degree relative with mutation.

MUCONIC ACID, URINE Biochemistry Urine/Urine container 2 weeks Random urine to be collected at the end of work shift.

MUCOPOLYSACCHARIDES, URINE

Biochemistry Urine/Urine container Screen: Next day, Quantitation: 1-2 weeks

Please provide clinical and medication details. Refrigerate for transport to the laboratory. A random urine collection is required.

MULTIPLE BIOCHEMICAL ANALYSIS (MBA), SERUM


MULTIPLE ENDOCRINE NEOPLASIA (MEN1) GENETIC TESTING

Genetics Blood/EDTA tube 2 months

9.6

9.6

PATHOLOGY TESTS


PATH

OLOG

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STS

- M

PATH

OLOG

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STS

- M


MUMPS SEROLOGY Immunology Blood/SS tube 24 - 48 hours Assay run daily (Monday - Friday).

MURAMIDASE, SERUM Haematology Blood/SS tube 24 hours

MURELAX, SERUM Biochemistry Please refer to OXAZEPAM, SERUM.

MURRAY VALLEY (AUSTRALIAN) ENCEPHALITIS VIRAL SEROLOGY

Immunology Blood/SS tube 2 weeks Serology is referred to Qld Health Scientifi c Services Laboratory.

MUSCLE BIOPSY Histology Fresh Muscle Tissue 20 mm x 5 mm/DRY sterile screw top (urine) container

24 - 48 hours Requires Histochemistry and sometimes electron microscopy. Please submit cooled fresh specimen within 4 hours of surgery - DO NOT place in formalin and DO NOT freeze. If transport time will exceed 1 hour it is preferable to perform the biopsy in a location closer to the laboratory. Please refer to Histology Preface (5.39). Prior notice of biopsy to QML Pathology is desirable.

MUSCULAR DYSTROPHY- BECKER/DUCHENNE, BLOOD


MUTABON, SERUM Biochemistry Please refer to AMITRIPTYLINE, SERUM.

MYCOBACTERIA ATYPICAL, MICROSCOPY AND CULTURE

Microbiology/Histology

Tissue, sputum, pus/Dry sterile screw top (urine) container (NO formalin)

Microscopy - same day. Culture - majority provisionally identifi ed within 2 weeks (up to 12 weeks).

If infection by atypical Mycobacteria is suspected in a tissue specimen (e.g. skin) indicate suspicion and submit specimen in a dry, sterile screw top container (NO formalin). The laboratory will process for both culture and histology. Note: Tissue is essential for Histology. Tissue is preferable to pus. Sputum - 3 consecutive early morning specimens.

MYCOBACTERIUM TUBERCULOSIS, SPUTUM MICROSCOPY AND CULTURE

Microbiology Sputum/Dry, sterile screw top (urine) container

Microscopy - 2 days. Culture - up to 6 weeks

Sputum - 3 consecutive early morning specimens.

MYCOPHENOLATE, PLASMA Biochemistry Please refer to MYCOPHENOLIC ACID, PLASMA.

MYCOPHENOLIC ACID, PLASMA

Biochemistry Blood/EDTA tube 2 weeks Please keep sample cool and transport to the laboratory without delay. Referred Test.

9.7

9.7

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- M

PATH

OLOG

Y TE

STS

- M


MYCOPLASMA PNEUMONIAE PCR

Immunology Nasopharyngeal aspirate, nasopharyngeal swab (dry swab), Sputum/Luki tube or sterile container or dry swab

24 hours This test is only performed on specifi c request for respiratory Mycoplasma (Mycoplasma pneumoniae).

MYCOPLASMA SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday).

MYCOPLASMA/UREA PLASMA ISOLATION

Microbiology Genital or urine swab/Swab in transport medium

5 days

MYOGLOBIN, SERUM Biochemistry Blood/Plain tube - no gel or anticoagulant. Lithium heparin tube/EDTA tube (no gel) plasma also acceptable

Same day Please provide clinical and medication details.

MYOGLOBIN, URINE Biochemistry Urine/Urine container Same day Random urine sample required. Please provide clinical and medication details.

MYOTONIC DYSTROPHY Biochemistry Blood/EDTA tube 4 weeks Transfer sample at 4°C to reach the laboratory without delay. Referred test.

MYSOLINE, SERUM Biochemistry Please refer to PRIMIDONE, SERUM.

9.8

9.8

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- M

PATH

OLOG

Y TE

STS

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N-1-METHYL NICOTINAMIDE, URINE

Biochemistry Please refer to VITAMIN B3, URINE for details.

N-ACETYL PROCAINAMIDE, SERUM

Biochemistry Please refer to PROCAINAMIDE, SERUM.

N-ACETYL-GLUCOSE-AMINIDASE, URINE

Biochemistry Urine/Plain random urine container

2 weeks Freeze specimen immediately after collection.

NALTREXONE, SERUM or URINE

Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant (Plastic lithium heparin tube or EDTA tube acceptable) or Urine/Urine container

Indeterminate Keep sample cool and send to the laboratory as soon as possible. Please contact Biochemistry, central laboratory to check availability.

NARCOLEPSY Haematology Blood/ACD tube Indeterminate

NASOPHARYNGEAL ASPIRATE MICROSCOPY AND CULTURE

Microbiology Nasopharyngeal Aspirate/Aspirating trap

Interim microscopy report - same day. Routine culture report - 48 Hours

Please provide clinical details including antibiotic therapy and indicate if specimen is for virology.

NEISSERIA GONORRHOEAE, MICROSCOPY AND CULTURE

Microbiology Swab in Transport Medium Interim microscopy report - same day. Routine culture report - 48 Hours

Using fi ne wire swabs collect at least two (2) swabs from the penile urethra or endocervical canal. Contact Microbiology (07) 3121 4438 to arrange rapid transport and processing without delay.

NEISSERIA MENINGITIDIS PCR Immunology Blood and CSF/EDTA tube and Sterile container

24 hours

NELFINAVIR, PLASMA Biochemistry Blood/EDTA tube 3 weeks Please provide clinical and medication details. Plasma to be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Referred test.

PATH

OLOG

Y TE

STS

- N

9.9

PATH

OLOG

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STS

- N

9.9

PATHOLOGY TESTS



NEONATAL SCREENING TEST Biochemistry Capillary blood sample (heel prick)/Neonatal screening card

2 weeks HEEL PRICK SAMPLE REQUIRED. This screen includes:- Phenylketonuria (PKU), Congenital Hypothyroidism, Cystic Fibrosis (CF), Galactosaemia. Ensure even application of infant’s blood to cover entirely the marked areas of the card. Refer to the instructions on the card and the Biochemistry Preface. Please note: Card must be completely air dried and transported in a paper bag or envelope. Referred test.

NEOPTERIN, URINE Biochemistry Please refer to PTERINS, URINE for details. Referred test.

NEORAL, BLOOD Biochemistry Please refer to CYCLOSPORIN, BLOOD.

NEULIN PRE/POST DOSE, SERUM


NEUROFIBROMATOSIS, TYPE 1 (NF1) GENETIC TESTING

Genetics Blood/EDTA tube or Lithium heparin tube

1 - 2 months Keep at room temperature. Please note: This test requires detailed family history for test to be performed. Family linkages: Require at least two members with linkage numbers or three known infected members who have been clinically diagnosed.

NEURONE SPECIFIC ENOLASE, SERUM

Biochemistry Blood/SS tube 2 weeks Centrifuge, separate and freeze serum. Referred test.

NEURONTIN, SERUM Biochemistry Please refer to GABAPENTIN, SERUM.

NEUTROPHIL AB TO MYELOID PRECURSORS

Haematology Bone marrow and blood/3-4 fresh bone marrow slides, 3-4 normal bone marrow slides, 1 x SS tube

1 month Marrow collection performed by Haematologist.

NEUTROPHIL ALKALINE PHOSPHATASE (NAP), BLOOD

Haematology Blood/EDTA tube, 4 Original blood fi lms

24 hours Blood fi lms made at time of collection are essential, EDTA interferes with test.

NEUTROPHIL ANTIBODIES, BLOOD

Haematology Blood/2 EDTA tubes, SS tube

24 hours Test performed daily. No booking or appointment required. Please notify Haematology (07) 3121 4451 or your Branch Laboratory of all urgent specimens and weekend collections.

NEUTROPHIL FUNCTION STUDIES, BLOOD

Haematology Blood/EDTA tube, Plastic lithium heparin tube, 2 blood fi lms, SS tube

24 hours Please contact Haematology (07) 3121 4451 or Branch Laboratory prior to collection.

NEVIRAPINE, PLASMA Biochemistry Blood/EDTA tube 3 weeks Please provide clinical and medication details. Plasma to be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Referred test.

9.10

9.10

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- N

PATH

OLOG

Y TE

STS

- N


NH3, PLASMA Biochemistry Please refer to AMMONIA, PLASMA.

NIACIN, URINE Biochemistry Please refer to VITAMIN B3, URINE for details.

NICKEL, BLOOD Biochemistry Blood/EDTA tube (Lithium heparin tube acceptable)


NICKEL, URINE Biochemistry Urine/Urine container 1 week Please provide details of exposure (clinical and occupational). A random collection is preferred. Referred test.

NICOTINE METABOLITES, SERUM

Biochemistry Please refer to COTININE, SERUM.

NICOTINE METABOLITES, URINE

Biochemistry Please refer to COTININE, URINE.

NICOTINE, URINE RANDOM

Biochemistry Please refer to COTININE, URINE.

NIPPLE DISCHARGE CYTOLOGY

Cytology Fixed smear of nipple discharge/Slide carrier


NITRAZEPAM, SERUM Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant


NITROGEN EXCRETION, URINE

Biochemistry Urine/24 hour urine container with no preservative


NMN, URINE Biochemistry Please refer to VITAMIN B3, URINE for details.

NORADRENALIN, URINE


NORADRENALINE, URINE 24 HOUR


NORDIN TEST, URINE AND SERUM

Biochemistry Blood and Urine/24 hour urine container - no preservative and SS tube

24 hours The patient fasts overnight. The protocol requires fl uid ingestion and timed urine collection. Please contact Biochemistry (07) 3121 4971 or Branch Laboratory for test and collection details.

9.11

9.11

PATHOLOGY TESTS


PATH

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STS

- N

PATH

OLOG

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NOREPINEPHRINE, URINE


NOREPINEPHRINE, URINE 24 HOUR


NORFLUOXETINE, SERUM Biochemistry Metabolite of Fluoxetine. Please refer to FLUOXETINE, SERUM.

NORMALISED ANDROGEN RATIO, SERUM


NORMETANEPHRINE, URINE Biochemistry Please refer to CATECHOLAMINES, URINE.

NORMISON, SERUM Biochemistry Please refer to TEMAZEPAM, SERUM.

NOROVIRUS TESTING Immunology Faeces/Faeces container 1 - 2 weeks

NORPACE, SERUM Biochemistry Please refer to DISOPYRAMINE, SERUM.

NORTAB, SERUM Biochemistry Please refer to NORTRIPTYLINE, SERUM.

NORTRIPTYLINE, SERUM

Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (plastic lithium heparin tube acceptable)

1 week Please provide clinical and medication details, including time and date of next dose. Collect immediately prior to next dose.

NORVAL, SERUM Biochemistry Please refer to MIANSERIN, SERUM.

NORVIR, PLASMA Biochemistry Blood/EDTA tube 3 weeks Please provide clinical and medication details. Plasma to be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Referred test.

N-TELOPEPTIDE, URINE

Biochemistry Urine/Urine container (random) (preferred) or 24 hour urine container

1 week A highly specifi c marker of bone resorption used in investigation and monitoring of osteoporosis, Paget’s disease, steroid therapy, malignancies, infl ammatory diseases and metabolic bone diseases. Please provide details of patient height and weight. NO dietary restriction is required. A random early morning urine specimen is preferred. A 24 hour sample can be collected if required. Urine specimen should be refrigerated during the collection period and transported cooled to the laboratory.

NTPROBNP (CHAT STUDY) Specimen Distribution

Blood/Patient presents with test kit/tubes


Forward sample to laboratory without delay.

NTX, URINE Biochemistry Please refer to N-TELOPEPTIDE, URINE.

9.12

9.12

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- N

PATH

OLOG

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STS

- N


NUCLEIC ACID GENETIC INVESTIGATION FOR INHERITED DISEASES (CYSTIC FIBROSIS, LEBERS NEURORETINOPATHY, MCAD, PHENYLKETONURIA), DNA PROBE

Biochemistry Blood/EDTA tube 4 weeks Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for specifi c collection details as this may differ quantitatively or qualitatively for different diseases. Please indicate which diseases are being investigated. Referred test.

NUELIN, SERUM Biochemistry Please refer to THEOPHYLLINE, SERUM.

9.13

9.13

PATHOLOGY TESTS


PATH

OLOG

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STS

- N

PATH

OLOG

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STS

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OB PROTEIN, PLASMA Biochemistry Please refer to LEPTIN, PLASMA.

OCCULT BLOOD, FAECES

Microbiology Faeces/Faeces container Same day No need for patient to fast or require a special diet. Refrigerate after collection and transport cooled. Samples may be stored for 5 days at 25°C or 4 weeks at 4°C.

OCTANE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

OCULAR LESION, MICROSCOPY AND CULTURE

Microbiology Swab/Ophthalmology Microbiology kit

Requirements are determined by clinical factors. Please refer to Microbiology Preface (5.55) for details and contact Microbiology (07) 3121 4438 or Branch Laboratory.

OESTRADIOL, SALIVA Endocrinology Saliva/Sterile container (urine)

2 weeks Sample must be collected between 7.00am and 10.00am following an overnight fast. Referred test. Incurs non-Medicare refundable fee.

OESTRADIOL, SERUM Endocrinology Blood/SS tube 24 hours Please provide medication and clinical notes including date of last normal menstrual period (LNMP). Include information regarding any hormone replacement therapy or contraceptive use.

OESTRONE, SERUM Biochemistry Blood/SS tube 2 weeks Transport to Central Laboratory on dry ice. Referred test.

OLANZAPINE, PLASMA Biochemistry Blood/Lithium heparin tube (EDTA tube acceptable)

1 - 2 weeks Please keep the sample cool and forward to the laboratory without delay.

OLIGOCLONAL BAND STUDIES, CSF

Biochemistry Please refer to PROTEIN ELECTROPHORESIS, CSF for details.

OLIGOSACCHARIDES, URINE

Biochemistry Urine/Urine container 2 weeks Please collect a random urine after work shift or suspected exposure. Keep the sample refrigerated. Referred test.

ON-SITE DRUG TESTING Biochemistry Please contact the Drug Testing Laboratory, Biochemistry, Murarrie (07) 3121 4419 for all information on urine, saliva and breath on-site drug testing.

OPIATES - GCMS CONFIRMATION



OPTICAL DENSITY, AMNIOTIC FLUID

Biochemistry Please refer to BILIRUBIN, AMNIOTIC FLUID for details.

PATH

OLOG

Y TE

STS

- O

9.14

PATH

OLOG

Y TE

STS

- O

9.14

PATHOLOGY TESTS



ORAL CAVITY CYTOLOGY Cytology Labelled fi xed smear/Slide carrier


ORGANIC ACID SCREEN (CHROMATOGRAPHY), URINE

Biochemistry Urine/Urine container 2 weeks Please provide clinical and medication details. A random urine collection is required. Referred test.

ORGANOCHLORINE PESTICIDES, BLOOD

Biochemistry Blood/Lithium heparin tube 4 weeks Please provide exposure details, including the names of pesticides the patient has been in contact with. Please refer to Biochemistry Appendix (12.18) for a comprehensive list of organochlorine pesticides and synthetic pyrethroids. If herbicides are also requested, a random URINE must be collected and the herbicides the patient has been in contact with must be listed. Referred test.

ORGANOPHOSPHATE PESTICIDES, SERUM


ORNITHINE TRANSCARBAMYLASE DEFICIENCY

Genetics Blood/EDTA tube 3 months Patient consent for billing must be marked on the request form.

OROSOMUCOID, SERUM Biochemistry Please refer to ALPHA-1-ACID GLYCOPROTEIN, SERUM

OROTIC ACID, URINE Biochemistry Urine/Urine container 3 weeks A fresh random urine should be collected and frozen as soon as possible. Do not allow to thaw. Referred test.

OSMOLALITY, FAECES Biochemistry Faeces/Faeces container 24 hours Please keep the sample cool during collection and transport to the laboratory.

OSMOLALITY, FLUID Biochemistry Fluid/Plain tube/Container Same day Please note fl uid site on specimen container and request form.

OSMOLALITY, SERUM Biochemistry Blood/SS tube Same day Please provide clinical and medication details. If urine osmolality is also required, both specimens MUST be collected at the same time.

OSMOLALITY, URINE Biochemistry Urine/Urine container Same day Please provide clinical and medication details. A random urine collection is required. If serum osmolality is also requested, both specimens MUST be collected at the same time.

OSPOLOT, SERUM Biochemistry Please refer to SULTHIAME, SERUM.

OSTEOCALCIN, SERUM Endocrinology Blood/SS tube 4 weeks Vitamin D dependent, calcium-binding protein synthesized by osteoblasts. It is a possible marker for bone turnover and may be assayed in metabolic bone disease or other causes of increased bone turnover. Specimen should reach laboratory within 2 hours of collection. Keep specimen cold and transport on dry ice to Endocrinology ASAP. There is currently no Medicare rebate for this test.

9.15

9.15

PATHOLOGY TESTS


PATH

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STS

- O

PATH

OLOG

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STS

- O


OSTEOPOROSIS MARKERS, URINE


OVARIAN ANTIBODY Immunology Blood/SS tube 1 week Refer to ADENOVIRUS SEROLOGY for collection details.

OVARIAN CANCER TUMOUR MARKERS, SERUM

Biochemistry/Endocrinology

Blood/SS tube 24 hours CA 125 - serous carcinoma CA 19-9 - mucinous carcinoma Lactate dehydrogenase isoenzyme - 1 (LD-1) - dysgerminoma Human chorionic gonadotrophin (HCG) - choriocarcinoma.

OVARIAN CYST ASPIRATE CYTOLOGY

Cytology Fluid/Sterile screw top container


OVPLEX OVARIAN CANCER TEST Specimen Distribution

Blood/1 x SS tube and 1 x EDTA tube


Transport to Central Laboratory on dry ice.

OXALATE, URINE Biochemistry Urine/24 hour urine container with 25 mL 6M HCI preservative

2 weeks Please provide clinical and medication details. Sample MUST be collected into acid preservative. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

OXAZEPAM, SERUM Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable)


OXYPURINOL, PLASMA Biochemistry Blood/EDTA tube 2 - 3 weeks Keep cool during transport to laboratory. Referred test.

9.16

9.16

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- O

PATH

OLOG

Y TE

STS

- O


P24 ANTIGEN (HIV), SERUM Immunology Blood/SS tube 1 - 2 weeks Referred test.

P53 DNA TESTING Genetics Blood/EDTA tube 6 - 8 weeks

PACKED CELL VOLUME (PCV), BLOOD


PAINT THINNERS, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

PANADOL, SERUM Biochemistry Please refer to PARACETAMOL, SERUM.

PANCREATIC ELASTASE 1, FAECES

Biochemistry Faeces/Faeces container 4 weeks This is a non-invasive test for assessing exocrine pancreatic function. Please keep the sample cool and transport to the laboratory without delay. If there will be a delay, please freeze the sample.

PANCREATIC POLYPEPTIDE, SERUM

Biochemistry Blood/SS tube 2 weeks Patient should fast overnight. Collect SS tube and centrifuge immediately after clotting, remove serum into 5 mL plastic tube and freeze. Referred test.

PAP SMEAR Cytology Labelled fi xed smear/Slide carrier

48 - 72 hours For specimen preparation please refer to Cytology Preface (5.11).

PARACETAMOL, SERUM Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable)

Same day Please provide clinical and medication details. (a) RANDOM - Collect 1 hour post dose. Note time of last dose and dosage. (b) OVERDOSE - Collect 1 and 4 hours after the overdose. Note time of suspected overdose and time of collection.

PARAINFLUENZA SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

PARAPERTUSSIS SEROLOGY Immunology Blood/SS tube 24 hours Assay run Monday - Friday. Please note: the assay for Pertussis antibodies also detects antibodies to Parapertussis.

PARAPROTEIN, SERUM Biochemistry Please refer to IMMUNOFIXATION (PROTEIN), SERUM.

PARAPROTEIN, URINE Biochemistry Please refer to IMMUNOFIXATION (PROTEIN), URINE.

PARAQUAT, URINE Biochemistry Urine/Urine container 2 weeks Test for toxicity - usually only required in cases of high level poisoning e.g. ingestion. These analyses are not performed on a routine basis in biological fl uids. This test will only be referred with prior permission from the requesting doctor or patient’s employer. Qualitative screen only is performed. Referred test.

PATH

OLOG

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STS

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9.17

PATH

OLOG

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STS

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9.17

PATHOLOGY TESTS



PARASITE SEROLOGY Immunology Blood/SS tube Variable from 24 hours to weeks depending on agent requested


PARASITES AND ECTOPARASITES, EXAMINATION FOR

Microbiology Faeces/Faeces container and slide. Skin scrapings, hairs, nits/Glass slide and cover slip, sterile screw top containers

24 - 48 hours Refer to Microbiology Preface (5.53) for details. Please contact Microbiology (07) 3121 4438 or Branch Laboratory for further details of collection and transport.

PARATHION (ORGANOPHOSPHATE PESTICIDE), SERUM AND BLOOD


PARATHION (PESTICIDE), SERUM


PARATHORMONE (PTH) - RELATED PEPTIDE, PLASMA

Endocrinology Blood/EDTA tube with Trasylol

2 weeks Special collection and handling of specimen required. Appointment is required in order to organise special tube with Trasylol added. Please contact Endocrinology (07) 3121 4439 or Branch Laboratory for details. Referred test.

PARATHORMONE (PTH) INTACT, SERUM

Endocrinology Blood/SS tube 24 hours Parathyroid hormone is stable if the specimen is kept cold (4°C) for up to 10 hours. However, hormone activity decreases signifi cantly at room temperature. Please note on form if kept at room temperature for prolonged periods.

PARATHYROID HORMONE (PTH), SERUM

Endocrinology Blood/SS tube 24 hours Parathyroid hormone is stable if the specimen is kept cold (4°C) for up to 10 hours. However, hormone activity decreases signifi cantly at room temperature. Please note on form if kept at room temperature for prolonged periods.

PARATYPHI SEROLOGY Immunology Blood/SS tube 24 hours

PARIETAL CELL ANTIBODY, SERUM


PARVOVIRUS B19 PCR Immunology Blood/SS tube 4 - 6 weeks

9.18

9.18

PATHOLOGY TESTS


PATH

OLOG

Y TE

STS

- P

PATH

OLOG

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STS

- P


PARVOVIRUS B19 SEROLOGY (FIFTH DISEASE OR SLAPPED CHEEK SYNDROME)

Immunology Blood/SS tube 48 hours Assay run Monday, Wednesday and Friday.

PAUL-BUNNELL TEST (INFECTIOUS MONONUCLEOSIS SEROLOGY)

Haematology Blood/SS tube Same day Epstein-Barr virus (EBV) serology may be helpful if Paul-Bunnell test is negative and clinical features are suggestive.

PBG (PORPHOBILINOGEN) SCREEN, URINE

Biochemistry Urine/Urine container (preferred) or 24 hour urine container with no preservative

Same day Test for acute intermittent porphyria. Please provide clinical and medication details. PORPHOBILINOGEN DECREASES RAPIDLY ON STANDING - forward to laboratory promptly, keep cool and protect from light during transit. Preferable collection is during an episode of abdominal pain or neurological disturbance. A random sample is preferred (not a 24 hour sample). If the patient is collecting a 24 hour urine for Porphyrins, then a small portion e.g. 20 mL collected separately into a urine container during an episode would be suffi cient for porphobilinogen.

PBG DEAMINASE, RED CELL Biochemistry Please refer to PORPHOBILINOGEN DEAMINASE, RED CELL.

PCB OILS, BLOOD Biochemistry Blood/Glass lithium heparin tube

4 weeks PCB oils are mainly used in the cooling systems of some electrical transformers. Please provide exposure details and medication of patient. Keep sample cool during transport to the laboratory. Referred test.

PEMPHIGOID ANTIBODY/BASEMENT MEMBRANE ZONE (BMZ) ANTIBODY, SERUM


PEMPHIGUS ANTIBODY/INTERCELLULAR CEMENT SUBSTANCE (ICS) ANTIBODY, SERUM


PERCHLOROETHYLENE, BLOOD


PERCHLOROETHYLENE, URINE

Biochemistry Urine/Urine container 4 weeks Random urine collected at the end of work shift or exposure. This test attracts a charge of approximately $165.00 from the reference laboratory, payable by the patient or their employer. Please indicate on the request form if permission or prior arrangement has been made.

9.19

9.19

PATHOLOGY TESTS


PATH

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STS

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PATH

OLOG

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STS

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PERHEXILINE, SERUM

Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (plastic lithium heparin tube acceptable)

2 weeks Please provide clinical and medication details. Collect just prior to next dose. Referred test.

PERITONEAL DIALYSIS FLUID FOR MICROSCOPY AND CULTURE

Microbiology Fluid in sterile container or peritoneal dialysis bottle

Interim microscopy report same day. Culture report 48 hours

Please transport specimen cooled to laboratory as soon as possible after collection.

PERITONEAL FLUID CYTOLOGY Cytology Fluid/Sterile container of appropriate size

24 hours Submit ENTIRE specimen to laboratory as soon as possible. Please refer to Cytology Preface (5.16).

PERITONEAL WASHING CYTOLOGY

Cytology Fluid/Sterile container of appropriate size

24 hours Submit ENTIRE specimen to laboratory as soon as possible. Please refer to Cytology Preface (5.16).

PERTOFRAN, SERUM Biochemistry Please refer to DESIPRAMINE, SERUM.

PERTUSSIS SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

PESTICIDES (ORGANOPHOSPHATE/CARBAMATE), SERUM


PESTICIDES, BLOOD Biochemistry Blood/Lithium heparin tube and/or SS tube

Organophosphates:24 hours Organochlorines: 4 weeks

Please provide details of organochlorine and/or organophosphate pesticides and circumstances of exposure. Please refer to Biochemistry Appendix (12.18) for a comprehensive list.

PETROL, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

PEXID, SERUM Biochemistry Please refer to PERHEXILINE, SERUM.

pH, BLOOD Biochemistry Please refer to BLOOD GASES, VENOUS.

pH, FAECES Biochemistry Faeces/Plain tube 24 hours Collect sample anaerobically and refrigerate until the pH is assayed. Submit to the laboratory as soon as possible. Request for Faecal Reducing Substances will include pH (separate sample/data entry of pH not required).

9.20

9.20

PATHOLOGY TESTS


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pH, FLUID Biochemistry Any biological fl uid other than blood or serum/Plain tube (Note that FRS includes pH - separate sample/data entry not required for pH)

Same day Collect sample anaerobically and refrigerate until the pH is assayed. Submit to the laboratory as soon as possible.

pH, URINE Biochemistry Urine/Plain tube 24 hours Collect sample anaerobically and refrigerate until the pH is assayed. Submit to the laboratory as soon as possible.

PHENOBARBITONE, SERUM

Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable)

Same day Please provide clinical and medication details. Collect sample at least 8 hours after last dose or immediately prior to next dose.

PHENOLS, URINE Biochemistry Urine/Urine container 2 weeks Please provide exposure and occupation details. Collect random urine immediately after the work shift or exposure. Referred test.

PHENYLALANINE, SERUM Biochemistry Blood/Lithium heparin tube 2 weeks Monitoring of known patients with phenylketonuria. Please provide clinical details. Fasting samples are preferable. Referred test.

PHENYLKETONURIA, BLOOD


PHENYTOIN, SERUM Biochemistry Please refer to DILANTIN, SERUM.

PHOSDRIN (PESTICIDE) Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity.

PHOSPHATE, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify site of fl uid on specimen container and request form.

PHOSPHATE, SERUM Biochemistry Blood/SS tube Same day Please refer to E/LFT, SERUM. Avoid haemolysis and prolonged contact of serum with cells. If stored overnight, blood should be centrifuged to separate serum from cells.

PHOSPHATE, URINE Biochemistry Urine/24 hour urine container with 25 mL 6M HCI preservative

24 hours 24 hour urine preferred. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

PHOSPHATE, WHOLE BLOOD

Biochemistry Blood/Lithium heparin tube and SS tube

24 hours Please provide clinical and medication details.

9.21

9.21

PATHOLOGY TESTS


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PHOSPHOLIPID, FATTY ACID


2 weeks Fasting samples are preferred. Family and clinical history must be provided. Clinics should forward sample on an ice brick to arrive at the central laboratory within 4 hours. If these requirements cannot be met, please separate serum into 6 mL Falcon tube and freeze.

PHOSPHORYLASE B KINASE, BLOOD


2 weeks Transport sample cool. Referred test.

PHYTANIC ACID, BLOOD Biochemistry Please refer to FATTY ACIDS-VERY LONG CHAIN, PLASMA.

PHYTANIC ACID, PLASMA Biochemistry Please refer to FATTY ACIDS-VERY LONG CHAIN, PLASMA.

PIGMENTS, URINE Biochemistry Urine/Urine container Same day A random urine collection is required. Please provide HISTORY OF MEDICATION AND DIET and clinical details.

PKU TEST Biochemistry Please refer to NEONATAL SCREENING TEST.

PLASMA VISCOSITY Haematology Blood/EDTA tube 24 hours Specimen must NOT be refrigerated.

PLASMINOGEN ACT INHIBITOR, BLOOD

Haematology Blood/Sodium citrate tube 2 - 4 weeks Rest patient for 20 minutes prior to collection. Then collect the specimen without cuff. These specimens are to reach the Laboratory within 2 hours of collection. If unable to do this, the specimens are to be double spun and sent frozen.

PLASMINOGEN ACTIVATOR, BLOOD


2 - 4 weeks

PLASMINOGEN ASSAY, BLOOD


24 hours Patient must rest for 15 minutes prior to collection. Collect without a tourniquet. Please provide thrombotic history of patient and family members and any anticoagulant therapy. Specimen must reach laboratory within 2 hours of collection.

PLATELET AGGREGATION STUDIES, BLOOD

Haematology Blood/5 Sodium citrate tubes, 1 EDTA tube

Same day Specimens must reach laboratory within 5 hours of collection. Please contact Haematology (07) 3121 4451 or Branch Laboratory for details. DO NOT REFRIGERATE.

PLATELET ANTIBODY SCREEN, BLOOD

Haematology Blood/3 EDTA tubes, 1 SS tube, 2 Blood fi lms

24 hours Test is performed Monday - Friday. For collection late Friday and weekends, please contact Haematology on (07) 3121 4451 or Branch Laboratory. Transport at room temperature, NOT on ice.

PLATELET COUNT, BLOOD Haematology Blood/1 EDTA tube, 2 blood fi lms

Same day Please see Haematology Appendix (12.32).

PLATELET FACTOR 3, BLOOD Haematology Blood/Sodium citrate tube

24 hours Please contact Coagulation Section (07) 3121 4451 or Branch Laboratory before collection.

9.22

9.22

PATHOLOGY TESTS


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PLATELET FUNCTIONPFA 100

Haematology Blood/4 x Sodium citrate tubes, 1 x EDTA tube

Same day The specimen must be tested within 5 hours of collection. Forward with a Coag. questionnaire. DO NOT centrifuge samples.

PLATELET GLYCOPROTEIN Haematology Blood/4 x Sodium citrate tubes, 1 x SS tube

1 week By appointment with Red Cross Transfusion Service.

PLATINUM, BLOOD Biochemistry Blood/EDTA tube 2 weeks Please provide clinical and exposure details.

PLEURAL FLUID CYTOLOGY Cytology Pleural fl uid/Appropriate sterile container

24 hours Please submit ENTIRE specimen to laboratory as soon as possible. For specimen preparation please refer to Cytology Preface (5.15).

PML-RAR RT-PCR Genetics Blood or Bone marrow/EDTA tube or min. 2 mL bone marrow in EDTA tube

2 weeks Specimen to be received within 24 hours.

PNEUMOCOCCAL (STREPTOCOCCUS PNEUMONIAL) SEROLOGY


PNEUMOCOCCAL ANTIBODIES Immunology Blood/SS tube Up to 3 months

PNEUMOCOCCAL ANTIGEN, URINE

Immunology Urine/Urine container 1 - 2 weeks Referred test.

PNEUMOCYSTIS PCR Immunology Sputum/Nasopharyngeal aspirate sterile container

Same day

PNH SCREEN FLOWCYTOMETRY Haematology Blood/EDTA tube 24 hours

PORPHOBILINOGEN DEAMINASE, RED CELL


2 - 4 weeks Test for Acute Intermittent Porphyria - useful only if 5ALA or PBG screen positive. Please contact Biochemistry (07) 3121 4420 or Branch Laboratory before collection. Pre-treated sample must arrive at the Reference Laboratory by late morning. Referred test.

PORPHOBILINOGEN, URINE

Biochemistry Please refer to PBG (PORPHOBILINOGEN) SCREEN, URINE.

PORPHYRIN PEPTIDE X, BLOOD


2 weeks Protect from light. Transport to laboratory on ice.

9.23

9.23

PATHOLOGY TESTS


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PORPHYRIN, FAECES Biochemistry Faeces/Faeces container, no preservative

1 week Raised with porphyria cutanea tarda and with other rare hepatic porphyrias. Always provide clinical and medication details, including whether the patient is suffering from skin and/or neurological symptoms, and include any family history of porphyrin abnormalities. Refrigerate and protect from light immediately after collection.

PORPHYRIN, PLASMA Biochemistry Blood/Lithium heparin tube 3 weeks Refrigerate and protect from light immediately after collection. Please contact Biochemistry on (07) 3121 4420 as a Blood Porphyrin may be preferred. Referred test.

PORPHYRIN, RED CELL Biochemistry Whole blood/Lithium heparin tube or EDTA tube

1 week Refrigerate and protect from light immediately after collection.

PORPHYRIN, URINE Biochemistry Urine/Random urine container

1 week Please provide clinical and medication details. Preferred sample - collected during or immediately after an acute episode of skin rash, pain, neurological or psychological disturbance etc. Alternatively collect a fi rst morning sample. Any other random sample may be collected but is the least desirable of the three options. Refrigerate sample immediately after collection, protect from light and send to the laboratory without delay.

POST OPERATIVE WOUND INFECTION

Microbiology Pus/Sterile container, Swab in Transport Medium

48 hours Please provide clinical details including site and antibiotic therapy. Please specify if specimen is to be cultured for exotic organisms, fungi and/or Mycobacteria. Transport to the laboratory without delay.

POTASSIUM, CSF Biochemistry Please refer to BIOCHEMISTRY, CSF for details.

POTASSIUM, FAECES Biochemistry Faeces/Faeces container 24 hours Test for unexplained hypokalaemia - raised with colonic villous adenoma. Keep sample cool during collection and transport to the laboratory.

POTASSIUM, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify site of fl uid on specimen container and request form.

POTASSIUM, PLASMA Biochemistry Blood/Lithium heparin tube

Same day Plasma potassium is predominantly requested to confi rm an elevated serum potassium when it is suspected that the elevation is due to the SS tube clotting process. THE SAMPLE MUST BE CENTRIFUGED AS SOON AS POSSIBLE AFTER COLLECTION AND THEN THE PLASMA SEPARATED FROM THE CELLS IN A SECOND TUBE. If in doubt, contact the Biochemistry Department (07 3121 4927).

POTASSIUM, SERUM Biochemistry Blood/SS tube Same day Please refer to E/LFT, SERUM. Avoid haemolysis and prolonged contact of serum with cells. If stored overnight, blood should be centrifuged to separate serum from cells.

9.24

9.24

PATHOLOGY TESTS


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POTASSIUM, URINE Biochemistry Urine/Random urine container or plain 24 hour urine container

24 hours 24 hour urine preferred. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

POTASSIUM, WHOLE BLOOD

Biochemistry Blood/Lithium heparintube and SS tube

24 hours Please provide clinical and medication details.

POUCH OF DOUGLAS FLUID Cytology Fluid/Sterile container of appropriate size

24 hours Collected by Doctor.

PRADER WILLI DNA TESTING Genetics Blood/Pink top EDTA tube 1 - 2 months

PREALBUMIN, PLASMA Biochemistry Blood/Lithium heparin tube 2 weeks Test for protein malnutrition. Referred test.

PREGNANCY TEST, SERUM Endocrinology Blood/SS tube Same day Please note date of last normal menstrual period (LNMP).

PREGNANCY TEST, URINE Endocrinology Random urine/Urine container

Same day Early morning urine recommended. For urine specimens no preservative or acid can be added. Monovette urine collection tubes must not be used.

PREGNANEDIOL, URINE 24 HOUR


4 - 5 weeks Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

PREGNANETRIOL, URINE Endocrinology 24 hour urine collection/Urine collection bottle. No preservative

4 - 5 weeks Total volume to be recorded.

PREGNENOLONE, SERUM Endocrinology Blood/SS tube 2 - 5 weeks Referred test.

PRIADEL, SERUM Biochemistry Please refer to LITHIUM, SERUM.

PRIMIDONE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (plastic lithium heparintube acceptable)

Same day Please provide clinical and medication details. Collect sample at least 8 hours after last dose or immediately prior to next dose.

PRO INSULIN Endocrinology Blood/SS tube 4 - 5 weeks

PROCAINAMIDE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant

2 weeks Please provide clinical and medication details, including time and dosage of last dose. Collect sample just prior to next dose. Test includes assay of N-Acetyl Procainamide (NAPA), an active metabolite. Referred test.

9.25

9.25

PATHOLOGY TESTS


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PROGESTERONE, SERUM Endocrinology Blood/SS tube 24 hours Please provide medical and clinical details, and date of last normal menstrual period (LNMP).

PROGNOSTIC MARKERS BREAST CARCINOMA - CISH, SISH, CerbB2 (BREAST CANCER TISSUE)

Histology Formalin fi xed tissue 2 weeks Qualitative detection with Immunoperoxidase stain on formalin fi xed tissue section, depending on result, confi rmatory studies with FISH/CISH or SISH studies.

PROGNOSTIC MARKERS BREAST CARCINOMA - PROGESTERONE RECEPTOR (BREAST CANCER TISSUE)

Histology Formalin fi xed tissue 48 hours Qualitative detection with Immunoperoxidase stain on formalin fi xed tissue section.

PROGNOSTIC MARKERS BREAST CARCINOMA - OESTROGEN RECEPTOR (BREAST CANCER TISSUE)

Histology Formalin fi xed tissue 48 hours Qualitative detection with Immunoperoxidase stain on formalin fi xed tissue section.

PROLACTIN, SERUM Endocrinology Blood/SS tube 24 hours Please provide date of last normal menstrual period (LNMP) clinical and drug history. If possible, avoid collecting blood within one hour of the patient rising in the morning, or early afternoon after lunch, as Prolactin levels may be raised.

PROMINAL, SERUM Biochemistry Please refer to PHENOBARBITONE, SERUM.

PRONESTYL, SERUM Biochemistry Please refer to PROCAINAMIDE, SERUM.

PROPOXUR (PESTICIDE), BLOOD


PROSTATE SPECIFIC ANTIGEN (PSA), SERUM


PROSTATIC ACID PHOSPHATASE, SERUM

Biochemistry Please refer to ACID PHOSPHATASE (PROSTATIC), SERUM.

PROSTATIC FNA CYTOLOGY Cytology Labelled fi xed and air dried smears/Labelled capped needle and syringe/Needle rinsings


9.26

9.26

PATHOLOGY TESTS


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PROSTATIC SECRETIONS MICROSCOPY AND CULTURE

Microbiology Prostatic fl uid in sterile container

Interim microscopy report same day. Culture report 48 hours

Please transport to laboratory as soon as possible. Samples may be stored for 72 hours after collection at 2 - 8°C.

PROTEASE INHIBITOR PHENOTYPING, PLASMA


PROTEASE INHIBITOR, PLASMA


PROTEIN C ASSAY, PLASMA


24 hours Please provide thrombotic history of patient and family members and any anticoagulant therapy. Must reach laboratory within 2 hours of collection. PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Medicare refundable if one of the following is stated on the request form by the patient’s doctor:1. That the patient has a personal history of venous thromboembolism (DVT) or




PROTEIN ELECTROPHORESIS, CSF

Biochemistry CSF/CSF in plain tube. Collect blood in SS tube

1 week Please provide clinical details. Blood for serum EPP should also be taken at this time to maximise information obtainable from this test.

PROTEIN ELECTROPHORESIS, SERUM

Biochemistry Blood/SS tube 24 hours Test for B-cell malignancy such as multiple myeloma. Quantitative. Please provide clinical and medication details.

PROTEIN ELECTROPHORESIS, URINE

Biochemistry Urine/24 hour urine container with no preservative or random urine container

48 hours Test for B-cell malignancy such as multiple myeloma. Quantitative. Please provide clinical and medication details. This includes protein electrophoresis and immunofi xation, if warranted. A random collection is preferred. Urine should be refrigerated during the collection and transported cooled to the laboratory.

9.27

9.27

PATHOLOGY TESTS


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PROTEIN IMMUNOFIXATION, SERUM

Biochemistry Please refer to IMMUNOFIXATION (PROTEIN), SERUM.

PROTEIN IMMUNOFIXATION, URINE

Biochemistry Please refer to IMMUNOFIXATION (PROTEIN), URINE.

PROTEIN S ASSAY, PLASMA

Haematology Blood/Sodiumcitrate tube

24 hours Please provide thrombotic history of patient and family members and any anticoagulant therapy. Must reach laboratory within 2 hours of collection. PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Thrombotic assay requests are only Medicare refundable if one of the following is stated on the request form by the patient’s doctor:1. That the patient has a personal history of venous thromboembolism (DVT) or




PROTEIN STUDIES, CSF Biochemistry Includes protein electrophoresis and immunofi xation. Elevated in infl ammation within the CSF and obstruction to CSF fl ow. Please refer to BIOCHEMISTRY, CSF for details.

PROTEIN, CSF Biochemistry Please refer to BIOCHEMISTRY, CSF for details.

PROTEIN, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify site of fl uid on specimen container and request form.

PROTEIN, PLEURAL FLUID Biochemistry Pleural fl uid/Plain tube Same day Test used to differentiate infl ammatory exudates from transudates of heart failure. Please provide clinical and medication details. Refrigerate sample during storage and transport.

PROTEIN, SERUM Biochemistry Please refer to E/LFT, SERUM.

PROTEIN, SYNOVIAL FLUID Biochemistry Please refer to ALBUMIN, SYNOVIAL FLUID.

9.28

9.28

PATHOLOGY TESTS


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PROTEIN, URINE Biochemistry Urine/24 hour urine container withno preservative

24 hours Test for glomerular damage and disease. Please provide clinical and medication details. Urine should be refrigerated during the collection period and transported cooled to the laboratory. DO NOT collect in acid preservative. 24 hour collection is preferred, however random may be collected.

PROTHIADEN, SERUM Biochemistry Please refer to DOTHIEPIN, SERUM.

PROTHROMBIN (G20210A) MUTATION ANALYSIS


1 week Please provide details regarding patient’s eligibility for Medicare rebate, i.e. proven venous thrombosis or pulmonary embolism or fi rst degree relative with mutation.

PROTHROMBIN TIME COAG Haematology Blood/Sodium citrate tube

Same day If for oral anticoagulant therapy, record warfarin dosage and time last tablet was taken. Please see Haematology Appendix (12.32) for further information.

PROTHROMBIN TIME-INR, BLOOD


Same day If for oral anticoagulant therapy control, please indicate on the request form:INR as directed Rule 3 Exemption. Please see Haematology Appendix (12.32) for further information.

PROTOPORPHYRIN SCREEN, FAECES

Biochemistry Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES.

PROTOPORPHYRIN/COPROPORPHYRIN, FAECES

Biochemistry Faeces/Faeces container Screen: 1 - 7 days. Quantitation: 1 - 2 weeks

Test for Porphyria Cutanea Tarda, Hereditary Coproporphyria, or Porphyria Variegats. Refrigerate sample. Protect from light. Serum is the preferred sample. Please provide clinical and medication details. Referred test.

PROZAC, SERUM Biochemistry Please refer to FLUOXETINE, SERUM.

PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM (SCOLINE) SENSITIVITY, SERUM

Biochemistry Blood/SS tube 1 day Test for inherited forms of prolonged scoline paralysis. Please provide clinical and medication details and FAMILY HISTORY, noting the names of any previously tested patients. Delay sample collection if the patient has been exposed to Suxamethonium for up to 14 days prior to the test. This test includes total enzyme and Dibucaine Number. Fluoride Number is no longer offered. Please ensure that these are requested if required.

PSEUDOCHOLINESTERASE, SERUM

Biochemistry Please refer to CHOLINESTERASE, SERUM.

PSITTACOSIS SEROLOGY Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday.

9.29

9.29

PATHOLOGY TESTS


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PTEN GENETIC TESTING Genetics Blood/EDTA tube Indeterminate Store at 4°C until transported at room temperature. Patient consent form for genetic testing is to be completed and signed by patient and clinician. Form to be sent with sample.

PTERINS, URINE Biochemistry Urine/Urine container 2 weeks The sample must be protected from light and frozen immediately after collection. Transport to the laboratory frozen. Referred test.

PTH (INTACT) Endocrinology Blood/SS tube 24 hours Once centrifuged specimen is stable if kept cold (4°C ) for up to 10 hours. If longer, separate and freeze serum and transport frozen. Parathyroid hormone is an unstable hormone and loses 10% of activity after 24 hours at 4°C. It loses 30% of activity after 24 hours at room temperature. Please note on form if kept at room temperature for prolonged periods.

PTH RELATED PEPTIDE Endocrinology Blood/EDTA tube with Trasylol

2 weeks Special collection and handling of specimen required. Appointment is required so that special EDTA tube with Trasylol can be ordered. Please contact Endocrinology Department on (07) 3121 4439 or Branch Laboratory for details. Forward to the Central Laboratory on ice. There is currently no Medicare rebate for this test.

PURINE AND PYRIMIDINE, BLOOD

Biochemistry Blood/Lithium heparin tube 2 weeks Forward to the Central Laboratory on ice. Referred test.

PURINE AND PYRIMIDINE, URINE

Biochemistry Urine/Random early morning urine

2 weeks Please provide clinical and medication details.

PURKINJE ANTIBODY SEROLOGY


PYRETHRINS (SYNTHETIC), BLOOD


PYREXIA UNKNOWN ORIGIN (PUO), SEROLOGY


This test comprises a mixture of Viral and Bacterial serologies which clinically are most likely causes. It is a Medicare requirement that they be listed individually. See Immunology Preface (5.47) and refer to Immunology Appendix (12.36).

PYRIDOXAL PHOSPHATE, BLOOD


PYRIDOXINE, BLOOD Biochemistry Please refer to VITAMIN B6, BLOOD for details.

9.30

9.30

PATHOLOGY TESTS


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PYRUVATE KINASE (SCREEN) Haematology Blood/EDTA tube 4 weeks Referred test.

PYRUVATE, BLOOD Biochemistry Blood/Plain tube with special preservative

1 week Please contact Biochemistry on (07) 3121 4971 or Branch Laboratory for details and special collection tube. Provide clinical and medication details. Patient should have half an hour of rest with no physical activity prior to blood collection.

9.31

9.31

PATHOLOGY TESTS


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Q FEVER PCR Immunology Blood or Tissue/EDTA tube

4 - 6 weeks

Q FEVER PREVACCINATION Immunology Blood/SS tube 24 hours Clearly indicate on request form that test is for prevaccination screening.

Q FEVER PROFILE Immunology Blood/SS tube 24 hours

Q FEVER SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

QT-PCR (BCR-ABL) Genetics Blood or Bone marrow/Pink top EDTA tube or min. 1 mL bone marrow in EDTA tube

2 weeks Send to Genetics Department within 24 hours. Please transport and store at room temperature.

QUALITATIVE DRUG SCREEN (INDUSTRY, OCCUPATIONAL, DRUG ABUSE ETC.), URINE RANDOM

Biochemistry Supervised random urine/Doxtech security urine container

1 - 2 days In cases of occupational drug screen, suspected drug abuse or monitoring of compliance with therapy or Drug Rehabilitation Programme, urine collection must be supervised. Chain-of-Custody form must be completed (available from QML Pathology). Protocol is detailed on Chain-of-Custody form and in the Biochemistry Preface (5.4) of this manual. The QML Pathology protocol complies with Australian Standard AS4308. See Biochemistry Appendix (12.13) for a full list of drugs assayed. Please contact Biochemistry (07) 3121 4419 or Branch Laboratory for further details.

QUANTIFERON TEST FOR TB IMMUNITY

Immunology Blood/TB gold blood collection tube - 3 tubes each patient

1 - 2 weeks Do not centrifuge tubes after collection. Sample to be sent to Immunology Department ASAP. If cannot reach laboratory within 16 hours, incubate tubes upright for 16 to 24 hours.

QUEEN MULTI PANEL Specimen Distribution

Blood and Urine/Serum - 3 x SS tubes, Blood - 3 x EDTA tubes, 2 x Fluoride oxalate tubes, 1 x Lithium heparin tube, Urine - 1 x MSU, 1 x spot urine


Protect urine and 1 x SS tube from light.

QUEEN PROFILE II PANEL Specimen Distribution

Blood and Urine/Serum - 2 x SS tubes, Blood - 2 x EDTA tubes, 1 x Fluoride oxalate tube, Urine - 1 x MSU, 1 x spot urine


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9.32

PATH

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9.32

PATHOLOGY TESTS



QUETIAPINE, SERUM Biochemistry Blood/Lithium heparin tube (no gel or anticoagulant)

4 weeks Please provide clinical and medication details. Collect sample prior to next dose.

QUINIDINE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (plastic lithium heparin tube acceptable)

Same day Please provide clinical and medication details, including date and time of last dose. Collect trough sample just prior to next dose. Keep the sample cool and send to the laboratory without delay.

QUITAXON, SERUM Biochemistry Please refer to DOXEPIN, SERUM.

9.33

9.33

PATHOLOGY TESTS


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RABIES VIRUS SEROLOGY Immunology Blood/SS tube 3 - 4 weeks Referred test. A fee is charged for this test, and the patient must agree to this payment before the test can be performed.

RAPID PLASMA REAGIN (RPR) - VDRL, SERUM

Immunology Blood/SS tube 24 hours Supplementary test. Performed if Syphilis EIA test is positive.

RAST TEST - ALLERGY, SERUM

Immunology Blood/SS tube 48 hours Assay run daily (Monday to Friday). For details of testing, allergens and Medicare restrictions please refer to Immunology Preface (5.49) and Appendix (12.37) or contact Immunology (07) 3121 4458 or Branch Laboratory.

RED CELL COUNT Haematology Blood/EDTA tube Same day

RED CELL ENZYMES Haematology Blood/Lithium heparin tube or EDTA tube


RED CELL MAGNESIUM Biochemistry Please refer to MAGNESIUM, RED CELL.

RED CELL MASS Haematology Blood/Sterile vials available on request from Haematology

24 hours Appointment required. Please contact Haematology (07) 3121 4451 or Branch Laboratory.

REDUCING SUBSTANCES, FAECES

Biochemistry Faeces/Faeces container 24 hours Test useful in infants for intestinal lactase defi ciency. Please provide clinical and medication details. Collect FRESH sample (ideally should be fl uid to semi-fl uid). Freeze specimen and store and transport frozen. Transport to laboratory as soon as possible.

REDUCING SUBSTANCES, URINE

Biochemistry Urine/Urine container Same day Please provide clinical and medication details. Keep sample cool after collection and during transport to the laboratory. A random urine collection is required.

RENIN, PLASMA Endocrinology Blood/2 x EDTA tubes 24 hours Samples are stable at room temperature (18-25°C) but not lower temperatures:- unspun - for 24 hours- as separated EDTA plasma for 5 days, cooling the tubes in the fridge or in transit has been found to falsely elevate values. Either send whole blood in at room temperature within 24 hours, or as separated plasma within 5 days. If transit to the laboratory will take >5 days, contact Endocrinology or Branch laboratory for details (plasma needs to be snap frozen).

REPTILASE TIME Haematology Blood/Sodium citrate tube

Same day

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9.34

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9.34

PATHOLOGY TESTS



RESPIRATORY CYTOLOGY Cytology Sputum, brushings and washings, FNA/Labelled fi xed smears, appropriate sterile containers and aspirating traps


RESPIRATORY SYNCYTIAL VIRUS (RSV) SEROLOGY


RESPIRATORY VIRAL ANTIGEN TEST (DFA), INCLUDING RSV, INFLUENZA, PARAINFLUENZA, ADENOVIRUS

Immunology Nasopharyngeal Aspirate/Aspirating trap

24 hours Refrigerate specimen and transport cooled to laboratory as soon as possible. Results usually available same day for urgent specimens.

RESPIRATORY VIRUS PCR Immunology Nasopharyngeal Aspirate or Nasopharyngeal swab (dry)/Luki tube or Sterile container or Viral swab (VIROCULT)

24 - 48 hours PCR test detects RSV, Infl uenza A&B, Parainfl uenza 1 2 3, and Adenovirus.

RET PROTO-ONCOGENE DNA TEST

Genetics Blood/EDTA tube 8 weeks for full screen, 4 weeks for known family mutation

Store at 4°C until transported at room temperature. Patient consent form for genetic testing is to be completed and signed by patient and clinician. Form to be sent with sample.

RETICULIN ANTIBODY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

RETICULOCYTE COUNT, BLOOD Haematology Blood/EDTA tube Same day

RETINOL BINDING PROTEIN, SERUM

Biochemistry Blood/SS tube orLithium heparin tube

1 - 2 weeks Ensure sample is protected from light. Transport in esky at 4°C. Referred test.

RETINOL, SERUM Biochemistry Please refer to VITAMIN A, SERUM.

RETT SYNDROME GENETIC TESTING

Genetics Blood/EDTA tube 3 months Patient consent for billing must be marked on the request form.

REVERSE T3 Endocrinology Blood/SS tube 1 - 2 months There is currently no Medicare rebate for this test. Referred test.

RHEIN, FAECES Biochemistry Please refer to LAXATIVES, FAECES.

9.35

9.35

PATHOLOGY TESTS


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RHESUS DNA TESTING (AMNIO) Genetics Amniotic fl uid/Sterile container

Indeterminate Please phone and organise in advance as this is not a routine test.

RHEUMATOID ARTHRITIS SEROLOGY


RHEUMATOID FACTOR (RF), RA LATEX TEST, SERUM


RIBOFLAVIN, BLOOD Biochemistry Please refer to VITAMIN B2, BLOOD for details.

RICKETTSIA SEROLOGY Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday.

RISPERDAL, PLASMA Biochemistry Please refer to RISPERIDONE, PLASMA.

RISPERIDONE, PLASMA Biochemistry Blood/Lithium heparin tube (EDTA tube acceptable)

1 - 2 weeks Please provide clinical and medication details. Keep the sample cool and send to the laboratory without delay. Referred test.

RISTOCETIN COFACTOR ASSAY (VON WILLEBRAND DISEASE), PLASMA

Haematology Blood/Sodium citrate tube 24 hours Please provide clinical and medication details. Keep specimen at 4°C and must reach laboratory within 2 hours of collection. Please contact Haematology (07) 3121 4451 or Branch Laboratory for details.

RITONAVIR, PLASMA Biochemistry Blood/EDTA tube 3 weeks Please provide clinical and medication details. Plasma to be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Referred test.

RIVOTRIL, SERUM Biochemistry Please refer to CLONAZEPAM, SERUM.

ROGOR (PESTICIDE), SERUM Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity.

ROHYPNOL, SERUM Biochemistry Please refer to FLUNITRAZEPAM, SERUM.

ROSS RIVER VIRUS (RRV) SEROLOGY

Immunology Blood/SS tube 24 hours Assay run daily (Monday to Friday, plus Saturday during late Summer).

ROTAVIRUS AGGLUTINATION TEST, FAECES

Microbiology Faeces/Faeces container Same day Please specify if culture for other enteric viruses is required.

ROUNDUP, URINE Biochemistry Please refer to GLYPHOSATE, URINE.

RPR (RAPID PLASMA REAGIN) -VDRL, SERUM

Immunology Blood/SS tube 24 hours Supplementary test. Performed if Syphilis EIA test is positive. Assay run daily (Monday - Saturday).

9.36

9.36

PATHOLOGY TESTS


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RSV (RESPIRATORY SYNCYTIAL VIRUS) ANTIGEN - DIRECT FLUORESCENT ANTIBODY TEST

Immunology Nasopharyngeal Aspirate/Aspirating trap

24 hours Refrigerate specimen and transport cooled to laboratory as soon as possible. Results available same day for urgent specimens. See Microbiology Preface (5.54) for collection details.

RSV (RESPIRATORY SYNCYTIAL VIRUS) SEROLOGY


RUBELLA SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday).

RYTHMODAN, SERUM Biochemistry Please refer to DISOPYRAMINE, SERUM.

9.37

9.37

PATHOLOGY TESTS


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SABRIL, SERUM Biochemistry Please refer to VIGABATRIN, SERUM.

SAICAR, URINE Biochemistry Random early morning urine/Urine container

2 - 3 weeks Please provide clinical and medication details. Random early morning urine collection preferred. Refrigerate for transfer to laboratory. Referred test.

SALBUTAMOL, URINE Biochemistry Urine/Tamper-proof urine container or Urine container enclosed in a tamper-evident bag

24 hours Urine specimen should be collected as per protocol on Chain-of-Custody form (FORM/BI/07/014), into a tamper-proof container or container enclosed in a tamper-evident bag. ENSURE CHAIN-OF-CUSTODY FORM IS COMPLETED. The original copy must always accompany the primary sample to the testing laboratory. NB: Due to possible legal implications, contact the laboratory (07) 3121 4419 if the correct procedure cannot be followed.

SALICYLATE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable)

Same day Please note time and dosage of last medication. Collect 1-3 hours after oral dose.

SALIVA DRUG SCREEN, QUALITATIVE ASSAY

Biochemistry Supervised random Saliva (10 mL)/Sterile screw cap container

48 hours Please contact Biochemistry (07) 3121 4419 or Branch Laboratory for further details.

SALIVARY DUCT/GLANDS ANTIBODY, SERUM

Immunology Blood/SS tube 2 weeks Referred test.

SALIVARY PROGESTERONE Endocrinology Saliva/Sterile container (urine)

24 hours It is recommended that the patient not eat two hours prior to test. Collect by spitting into the container. The specimen should be kept cool. Record clinical details e.g. LMP and Hysterectomy. Record medications, e.g. HRT, oral contraceptive, creams used including the type and when applied.

SALMONELLA TYPHI SEROLOGY (WIDAL SEROLOGY)


SAN FILLIPO SYNDROME GENETIC TESTING

Genetics/ Biochemistry

Blood and CVS or Amino fl uid/EDTA tube and Sterile Container (Amino) or Transport media for tissue

Indeterminate If the mutation within the family is known, the details of the mutation and, preferably, how the patient is related to the proband should be stated. Request inclusion of clinical history. For Prenatal Diagnosis samples should be sent by overnight courier at room temperature.

SANDHOFF DISEASE GENETIC TESTING

Genetics/ Biochemistry

Blood/EDTA tube and SS tube

1 month Transport frozen or at 4°C. Specimen to be received within 24 hours.

PATH

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10.0

PATH

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10.0

PATHOLOGY TESTS



SAQUINAVIR, PLASMA Biochemistry Blood/EDTA tube 3 weeks Please provide clinical and medication details. Plasma to be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Referred test.

SAROTEN, SERUM Biochemistry Please refer to AMITRIPTYLINE, SERUM.

Sb (ANTIMONY), BLOOD Biochemistry Blood/Lithium heparin tube or EDTA tube

4 weeks Please provide clinical and medication details. Urine is the preferred sample for exposure. Referred test.

Sb (ANTIMONY), URINE Biochemistry Urine/Urine container 4 weeks This is the preferred sample for exposure. A random sample is required. Referred test.

SCABIES Microbiology QML Pathology collectors required for specialised collection procedure

Same day Refer to Microbiology Preface (5.57) for details. Please contact Microbiology (07) 3121 4438 or Branch Laboratory for further details of collection and transport.

SCHIRMER TEAR TEST (TEAR LYSOZYME CONCENTRATION)

Haematology Tears/Special tubes provided by Haematology Department

24 hours By appointment only. Please contact Haematology (07) 3121 4451 or Branch Laboratory.

SCHISTOSOMA SEROLOGY Immunology Blood/SS tube 1 week Assay run Wednesday.

SCHUMM’S TEST, PLASMA Biochemistry Please refer to METHAEMALBUMIN, PLASMA.

SCOLINE SENSITIVITY, SERUM Biochemistry Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM (SCOLINE) SENSITIVITY, SERUM.

SECOND TRIMESTER DOWNS SCREEN

Endocrinology Blood/SS tube 48 hours This test gives a calculated risk for Down’s and Spina Bifi da at term. Collect specimen between 15th and 18th week of pregnancy. Includes-Beta HCG, AFP, Free Oestriol. Please make note of the following: 1: LMP/EDC and/or scan results. 2: Patient’s weight. 3: Family history of Down’s or Spina Bifi da and which family member it was. 4: Is it a single or multiple pregnancy? 5: Is patient an insulin dependent diabetic?

SELENIUM, BLOOD Biochemistry Blood/Lithium heparin tube or EDTA tube

2 weeks Please provide clinical, medication and exposure details. NOTE: Selenium blood analysis will only be performed where both serum AND blood levels are specifi cally requested. In all other cases, please collect for Selenium, serum only. Referred test.

SELENIUM, SERUM Biochemistry Serum/Trace element free tube (Navy-top)

1 - 2 weeks Please provide clinical, medication and exposure details. If a trace element free tube is unavailable, collect blood into an EDTA or Lithium heparin tube. Keep sample cool. Referred test.

10.1

10.1

PATHOLOGY TESTS


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SELENIUM, URINE Biochemistry Urine/24 hour urine container with no preservative

4 weeks 24 hour urine is preferred. Please provide exposure and occupation details. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

SEMINAL FLUID ANALYSIS Genetics Seminal fl uid/Plain sterile container (semen container)

24 hours Instruction sheet provided for patient. Specimen must reach laboratory within 2 hours of collection. Keep at room temperature. DO NOT REFRIGERATE. Please refer to Genetics Preface (5.30) for full details.

SEMINAL FLUID MICROSCOPY (POST VASECTOMY)

Genetics Seminal fl uid/Plain sterile container (semen container)

24 hours Instruction sheet provided for patient. Specimen must reach laboratory within 2 hours of collection. Keep at room temperature. DO NOT REFRIGERATE. Please refer to Genetics Preface (5.30) for full details.

SERAPAX, SERUM Biochemistry Please refer to OXAZEPAM, SERUM.

SEROQUEL, SERUM Biochemistry Please refer to QUETIAPINE, SERUM for details.

SEROTONIN, PLATELET Biochemistry Blood/2 x 5 mL EDTA tubes

3 weeks Test for carcinoid syndrome. Collect 2 X 5 mL EDTA tubes - one to be frozen (as whole blood). Referred test. A marker for carcinoid syndrome. See also 5-H.I.A.A.

SEROTONIN, SERUM Biochemistry Blood/SS tube 3 weeks Test for carcinoid syndrome. Please contact Biochemistry on (07) 3121 4420 or Branch Laboratory as 5-H.I.A.A, URINE may be preferred test. (Serotonin or 5-HT is referred test). Transport to laboratory as soon as possible.

SEROTONIN, URINE 24 HOUR

Biochemistry Urine/24 hour urine container with 25 mL 6M HCI preservative

2 weeks Tumour marker - carcinoid tumour. Uncommonly used. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

SERTRALINE, SERUM Biochemistry Blood/Lithium heparin tube

2 weeks Please provide clinical and medication details. Please keep the sample cool.

SERUM TRYPASE Immunology Blood/SS tube Results available on the day the test is run

Assay run every week. Collect an SS tube 1-3 hours after reaction (anaphylaxis) or anytime if suspected mastocytosis. Samples need to be separated and serum frozen within 24 hours of collection. Doctor must supply comprehensive clinical history, including: 1. Time of onset of anaphylaxis. 2. Drugs or other agents and time administered before onset of reaction. 3. Clinical details.

SEVIN (PESTICIDE), BLOOD Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Referred test.

10.2

10.2

PATHOLOGY TESTS


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SEX DETERMINING REGION Y (SRY) GENE ANALYSIS

Genetics Blood/Pink top EDTA tube 2 weeks Incurs non-Medicare refundable fee.

SEX HORMONE BINDING GLOBULIN, SERUM


SHIGELLA DYSENTERIAE SEROLOGY


SHIGELLA FLEXNERI SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

SHORT SYNACTHEN STIMULATION TEST


24 hours Give intramuscular injection of Synacthen (0.25mg/1 mL). Collect blood samples prior to injection and at 30 and 60 minutes post injection. Please contact Branch Laboratory for supply of Synacthen ampoule. Also collect an EDTA on the basal specimen to perform ACTH if these results are abnormal. Please include details of any corticosteroids taken recently (especially in the past 24 hours).

SHOX GENE ANALYSIS Genetics Blood or fi xed cell suspension from blood/Lithium heparin tube

3 weeks Patient consent for billing must be marked on the request form.

SICKLE CELL TEST, BLOOD Haematology Blood/EDTA tube 24 hours

SILVER, BLOOD Biochemistry Blood/EDTA tube 4 weeks Please provide exposure details. Referred test.

SILVER, URINE Biochemistry Urine/Urine container 4 weeks Please provide exposure details (clinical and occupational). A random collection is preferred. A 24 hour specimen should only be collected if specifi cally required. Referred test.

SIMPLIRED D-DIMER Haematology Blood/Sodium citrate tube or Lithium heparin tube

Same day Please forward to laboratory as soon as possible.

SINDBIS SEROLOGY Immunology Blood/SS tube 2 - 3 weeks

SINEQUAN, SERUM Biochemistry Please refer to DOXEPIN, SERUM.

SINGLE BIOLOGICAL INDICATOR (AUTOCLAVE) TEST

Microbiology Autoclave test vial 48 hours The autoclave test vial is collected from the surgery after autoclaving. The vial may be autoclaved alone or during any other cycle. A complete autoclave test request form must be completed and submitted with the vial. Please contact the Microbiology Department (07) 3121 4438 for vials and request books.

10.3

10.3

PATHOLOGY TESTS


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SIROLIMUS, BLOOD Biochemistry Blood/EDTA tube 2 - 3 weeks Please protect the sample from light, keep cool and send to the laboratory without delay. Referred test.

SKELETAL MUSCLE ANTIBODY, SERUM

Immunology Blood/SS tube 2 weeks Assay run Thursday (fortnightly). Results available day after the test is run.

SKIN ALLERGY TEST Immunology Skin Prick Test 72 hours Please refer to the list of QML Pathology Collection Centres which perform special tests in the ‘Collection Facilities’ section of this manual (2.13). Please refer to Immunology Appendix (12.37) for a comprehensive list of Allergens tested.

SKIN SCRAPINGS FOR FUNGI Microbiology Preferred container is a sterile screw capped container. Scalpel blade can be included. Other containers include paper envelopes and Petri dishes

Interim microscopy report 24 hours. Culture report up to 4 Weeks

Please indicate recent history of therapy. Antifungal therapy should be ceased at least 2 days (optimally one week) prior to collection of specimen. Scrape active edge of lesion. If the lesion is exuding material and painful to scrape, a swab may be collected as an alternative. Use a dry swab previously moistened with saline to swab the lesion. Place the swab in a container without transport medium. Refer to Cutaneous Fungal Culture in Microbiology Preface (5.56) for details of specimen collection, storage and transport. Blade should be transported in screw top container (NOT paper envelope).

SMOOTH MUSCLE ANTIBODY, SERUM


SNAKE BITE IDENTIFICATION Biochemistry Bite site swab (preferred), urine or blood. Swab/Urine - sterile urine container. Blood - Lithium heparin tube (NOT preferred)

2 - 4 hours Please refer to Biochemistry Preface (5.7). SWAB - use cotton swab/bud moisten with saline or tap water and swab over site of puncture wound/s. A small piece of clothing may also be used. The swab and/or piece of cloth should be placed in separate labelled plain containers. URINE - sterile urine container. BLOOD - NOT preferred but acceptable.

SODIUM VALPROATE, SERUM Biochemistry Please refer to VALPROATE, SERUM.

SODIUM, CSF Biochemistry Please refer to BIOCHEMISTRY, CSF for details.

SODIUM, FAECES Biochemistry Faeces/Faeces container 24 hours Keep sample cool during collection and transport to the laboratory.

SODIUM, FLUID Biochemistry Fluid/Plain tube/Container Same day Specify source of fl uid on sample and request form.

SODIUM, SERUM Biochemistry Please refer to E/LFT, SERUM.

SODIUM, SWEAT Biochemistry Please refer to ELECTROLYTES, SWEAT.

10.4

10.4

PATHOLOGY TESTS


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SODIUM, URINE Biochemistry Urine/24 hour urine container with no preservative or random urine container

Same day Please provide clinical and medication details. 24 hour collection is preferred. Under rare circumstances or if specifi cally required, a random urine may be collected. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

SOLIAN, SERUM Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant

4 weeks Please provide clinical and medication details. Please keep the sample cool.

SOLUBLE MESOTHELIN RELATED PROTEIN

Biochemistry Blood/SS tube or Plain tube

3 weeks Provide clinical details such as exposure to asbestos. Keep sample on ice brick for arrival to Biochemistry Department within 24 hours.

SOLUBLE TRANSFERRIN RECEPTOR, SERUM

Biochemistry Blood/SS tube 2 weeks Please keep the sample cool and forward to the laboratory without delay. Referred test.

SOLVENTS, BLOOD Biochemistry Blood/Lithium heparin tube 2 weeks Please provide exposure and occupation details. Contact Biochemistry (07) 3121 4420 or Branch Laboratory for full list of solvents screened. Keep chilled at all times. Tube should have minimal air space between top of blood and lid. Referred test. This test attracts a charge of approximately $100 from the referring laboratory, payable by the patient or their employer.

SOMATOMEDIN C (IGF-I), SERUM

Endocrinology Blood/SS tube 24 hours Growth hormone is secreted in a pulsatile fashion and levels fl uctuate under external infl uences. IGF-I/ Somatomedin C is a relatively long lived stable protein product of growth hormone action produced mainly by the liver. It may assist assessment of pituitary regulation of growth. Please consult Endocrinology (07) 3121 4439 or Branch Laboratory.

SORBITOL DEHYDROGENASE, RED CELL

Biochemistry Blood/Lithium heparin tube 2 weeks Referred test.

SOTACOR, SERUM Biochemistry Please refer to SOTALOL, BLOOD.

SOTALOL, BLOOD Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant (EDTA tube or Lithium heparin tube acceptable)

1 - 2 weeks Please provide clinical and medication details including date and time of last dose. Collect trough sample just prior to next dose. Keep the sample cool and forward to the laboratory without delay. Referred test.

SPECIFIC GRAVITY, URINE Biochemistry Urine/Urine container 24 hours Random or 24 hour urine acceptable.

10.5

10.5

PATHOLOGY TESTS


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SPERM ANTIBODIES (IMMUNOBEAD TEST)

Genetics Blood/SS tube and/or Seminal fl uid/Semen container

1 - 2 weeks FEMALE - serum MALE - serum and seminal fl uid. Please refer to Genetics Preface (5.30) and contact Genetics (07) 3121 4461 or Branch Laboratory for collection details. Performed fortnightly.

SPINOCEREBELLAR ATAXIA (SCA1 & SCA2) GENETIC TESTING


SPONTANEOUS ERYTHROID COLONIES

Haematology Blood or Bone marrow/ACD tube or Bone marrow heparin

2 weeks

SPORANOX, SERUM Biochemistry Please refer to ITRACONAZOLE, SERUM.

SPUTUM - STAIN FOR EOSINOPHILS

Microbiology Sputum/Sterile dry, screw top (urine) container

Same day Specify site of collection.

SPUTUM CYTOLOGY Cytology Sputum/Sterile dry, screw top (urine) container

24 hours Specimen should be refrigerated and transported cooled to the laboratory as soon as possible. For specimen preparation please refer to Cytology Preface (5.15).

SPUTUM MALIGNANT CELLS Cytology Sputum/Sterile dry, screw top (urine) container

24 hours Specimen should be refrigerated and transported cooled to the laboratory as soon as possible. For specimen preparation please refer to Cytology Preface (5.15).

SPUTUM MICROSCOPY AND CULTURE

Microbiology Sputum/Sterile dry, screw top (urine) container

Interim microscopy report - same day. Routine culture report - 48 hours; Legionella - 10 days; Acid-Fast Bacilli - up to 6 weeks

Please indicate if special examinations are required (e.g. Fungi, Nocardia, Legionella and Acid-Fast Bacilli). Early morning samples are recommended. Specimen should be transported cooled to laboratory as soon as possible.

STEARIC ACID, PLASMA Biochemistry Please refer to ELAIDIC/STEARIC ACID RATIO.

STEROID PROFILE, RANDOM URINE

Endocrinology Random urine/Urine container

4 - 5 weeks Urine screen for steroid breakdown products. Elevated levels correspond to excess production. Used mainly in children. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

10.6

10.6

PATHOLOGY TESTS


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STEROID PROFILE, URINE 24 HOUR


4 - 5 weeks Urine screen for steroid breakdown products. Elevated levels correspond to excess production. Used mainly in children. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

STEROID SCREEN, URINE

Biochemistry Urine/Tamper evident collection kit

Indeterminate This test is only performed on Defence and Police Force personnel. A Chain-of-Custody form and justifi cation letter are required. Referred test.

STOCRIN, PLASMA Biochemistry Blood/EDTA tube 3 weeks This test is only performed on Defence and Police Force personnel. A Chain-of-Custody form and justifi cation letter are required. Referred test.

STREPTOCOCCAL SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

STRONGYLOIDES SEROLOGY Immunology Blood/SS tube 1 week Assay run Wednesday.

STRYCHNINE, BLOOD Biochemistry Blood/Fluoride oxalate tube

4 weeks Please provide exposure details. This test performed only on legal request. Contact Biochemistry (07) 3121 4420 or Branch Laboratory for availability. Referred test.

STYRENE EXPOSURE, URINE Biochemistry Please refer to MANDELIC ACID, URINE.

STYRENE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

SUCCINYLAMINOIMIDAZOLE CARBOXAMIDE RIBOSIDE, URINE

Biochemistry Please refer to SAICAR, URINE.

SUCROSE LYSIS TEST, RED CELL


24 hours

SUGAR CHROMATOGRAPHY, FAECES

Biochemistry Please refer to CHROMATOGRAPHY, FAECES.

SUGAR CHROMATOGRAPHY, URINE

Biochemistry Urine/Urine container 1 week Please provide clinical details. FRESH random urine sample. Store and transport frozen. Please also refer to the Biochemistry Preface (5.4).

SULPHAEMOGLOBIN, BLOOD Biochemistry Blood/Lithium heparin tube

Same day Please provide clinical and medication details. Do not separate plasma.

SULPHONYLUREAS, PLASMA Biochemistry Blood/Lithium heparin tube


SULTHIAME, SERUM Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant

1 week Please provide clinical and medication details including time and date of last dose. Collect sample a minimum of 8 hours after the last dose or immediately prior to the next dose.

10.7

10.7

PATHOLOGY TESTS


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SUPERFICIAL WOUND SWABS

Microbiology Swab in Transport Medium

48 hours Please supply clinical history including mode of injury (e.g. dog bite) and specify site and any recent antibiotic therapy. Indicate if post-operative. Please indicate if exotic or unusual organisms are suspected. Prompt transport to the laboratory is essential.

SURMONTIL, SERUM Biochemistry Please refer to TRIMIPRAMINE, SERUM.

SUXAMETHONIUM SENSITIVITY, SERUM

Biochemistry Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM (SCOLINE) SENSITIVITY, SERUM.

SYMPATHOMIMETIC AMINES - GCMS CONFIRMATION



SYNACTHEN STIMULATION TEST


24 hours Give intramuscular injection of Synacthen (0.25mg/1mL). Collect blood samples prior to injection and at 30 and 60 minutes post injection. Please contact Branch Laboratory for supply of Synacthen ampoule. Also collect an EDTA on the basal specimen to perform ACTH if these results are abnormal. Please include details of any corticosteroids taken recently (especially in the past 24 hours).

SYNOVIAL FLUID ANALYSIS Microbiology Synovial fl uid/Sterile dry screw top (urine) container, Lithium heparin tube, Fluoride EDTA tube

24 hours Synovial fl uid collection kits are provided on request by QML Pathology.

SYNOVIAL FLUID CYTOLOGY Cytology Synovial fl uid/Appropriate sterile container and labelled fi xed and air dried smear preparations


SYNOVIAL FLUID MICROSCOPY AND CULTURE

Microbiology Synovial fl uid/Plain sterile container or Lithium heparin tube

48 hours Please specify site of collection and previous antibiotic therapy.

10.8

10.8

PATHOLOGY TESTS


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SYNTHETIC PYRETHROIDS, BLOOD


SYPHILIS SEROLOGY Immunology Blood/SS tube 24 hours The standard EIA screening test is performed daily (Monday to Saturday). If positive, supplemental Syphilis testing will be performed.

SYSTEMIC FUNGAL CULTURE (TISSUE)

Microbiology Tissue or Biopsy/Sterile container

24 hours for microscopy, 4 weeks for culture

Specimen MUST NOT be in formalin.

10.9

10.9

PATHOLOGY TESTS


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T & B CELL GENE REARRANGEMENT STUDIES

Genetics Bone marrow (EDTA tube) or Lymph node (EDTA tube) or Tumour or Blood (Pink top EDTA tube)

2 weeks Transport at room temperature or cooled on ice brick.

T LYMPHOCYTE 4/8 RATIO (LYMPHOCYTE SUBSET ANALYSIS), BLOOD



TACROLIMUS, BLOOD Biochemistry Blood/EDTA tube 24 hours Please provide clinical and medication details. Collect a trough sample and transport at 4°C.

TAMBOCOR, SERUM Biochemistry Please refer to FLECAINIDE, SERUM.

TAU PROTEIN, FLUID Biochemistry Fluid/Plain tube 24 - 48 hours Test for CSF contamination of nasal fl uids, etc. Please provide clinical details. Note fl uid site on specimen container and request form.

TAY SACHS GENETIC TESTING Genetics Blood/EDTA tube Indeterminate

TB CULTURE (URINE, SPUTA ETC.)

Microbiology Sputum, Urine, Swabs, Pus, Tissue/Sterile container

Interim microscopy report 2 days. Culture - 6 weeks

3 early morning urine and/or sputa are recommended. Tissue in sterile container (NOT in formalin).

T-CELL RECEPTOR GENE REARRANGEMENT

Genetics Bone marrow (EDTA tube) or Lymph node (EDTA tube) or Tumour or Blood (Pink top EDTA tube)


TEGRETOL, SERUM Biochemistry Please refer to CARBAMAZEPINE, SERUM.

TELLURIUM, BLOOD Biochemistry Blood/Lithium heparin tube 4 weeks Please provide exposure details. Referred test.

TEL-PDGFR GENE ANALYSIS Genetics Blood or Bone marrow/EDTA tube or min. 2 mL bone marrow in EDTA tube

1 - 2 months Specimen to be received within 24 hours.

TEMAZEPAM, SERUM Biochemistry Blood/Plain plastic tube - no gel. Plastic lithium heparin tube acceptable

1 week Please provide clinical and medication detail, including time and date of last dose. Collect just prior to the next dose or at least 8 hours after the last dose.

PATHOLOGY TESTS


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PATH

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.10

10.1

0


TEMIK (PESTICIDE), BLOOD Biochemistry Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity.

TERBUTALINE, URINE Biochemistry Urine/Tamper-proof urine container or Urine container enclosed in a tamper-evident bag

Next day following assay

Urine specimen should be collected as per protocol on Chain-of-Custody form, into a tamper-proof container or container enclosed in a tamper-evident bag. ENSURE CHAIN-OF-CUSTODY FORM IS COMPLETED. The original copy must always accompany the primary sample to the testing laboratory. NB: Due to possible legal implications, contact the Central Laboratory (07) 3121 4419 if the correct procedure cannot be followed.

TERSEL, SERUM Biochemistry Please refer to CARBAMAZEPINE, SERUM.

TESTICULAR AUTOANTIBODIES Immunology Blood/SS tube 1 week Refer to ADENOVIRUS SEROLOGY for collection details.

TESTICULAR BIOPSY (INFERTILITY INVESTIGATION)

Histology Biopsy tissue/Bouin’s Fixative solution

24 hours Bouin’s fi xative solution is essential for optimum fi xation and preservation of detail. It is available on request from Histology (07) 3121 4495 or Branch Laboratory.

TESTOSTERONE FREE, SERUM Endocrinology Blood/SS tube 24 hours This test measures a sub fraction of albumin bound testosterone. Collect a fasting specimen or a specimen at greater than 3 hours post-prandial as food absorption may infl uence blood levels.

TESTOSTERONE, SALIVA Endocrinology Saliva/Sterile container (urine)

2 weeks Referred test. Incurs non-Medicare refundable fee.

TESTOSTERONE, SERUM Endocrinology Blood/SS tube 24 hours Morning specimen is preferred (not essential) and fasting is not required.

TESTOSTERONE, URINE Endocrinology Urine/24 hr urine container. No preservative

2 - 3 weeks Patient must provide a certifi cate signed by the requesting doctor that the test is required for a medical reason e.g. for a tumour, not for athletes.

TETANUS SEROLOGY Immunology Blood/SS tube 1 week Assay run Tuesday.

TETRACHLOROETHANE, BLOOD


TETRACHLOROETHYLENE, BLOOD


TETRAMETHYLHEXADECANOIC

ACID, PLASMABiochemistry Please refer to FATTY ACIDS-VERY LONG CHAIN, PLASMA.

THALASSAEMIA SCREEN/STUDIES, BLOOD

Haematology Blood/2 x EDTA tubes, 1 Blood fi lm


PATHOLOGY TESTS


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.11

10.1

1


THALLIUM, BLOOD Biochemistry Blood/EDTA tube (Lithium heparin tube acceptable)

4 weeks Test for toxicity. Please provide clinical and medication details. Referred test.

THALLIUM, URINE Biochemistry Urine/Urine container 4 weeks Test for unusual exposure. Please provide details of exposure (clinical and occupational). A random collection is preferred. Refrigerate specimen and transport cooled to laboratory. Referred test.

THC-COOH - GCMS CONFIRMATION


Next day following assay

This is requested in cases concerned with occupational drug screening for drugs of abuse. The QML Pathology protocol complies with Standards Australia AS/NZS4308 for the assay of cannabinoids, opiates, cocaine metabolites, benzodiazepines and sympathomimetic amines. A Chain-of Custody form should be completed. Additional classes (methadone, barbiturates, alcohol) should be specifi cally requested if required. Please also refer to the Biochemistry Preface (5.4). Confi rmation and quantitation by GCMS of positive fi ndings may be requested separately.

THEODUR PRE/POST DOSE, SERUM


THEODUR, SERUM Biochemistry Please refer to THEOPHYLLINE, SERUM.

THEOPHYLLINE PRE/POST DOSE, SERUM


THEOPHYLLINE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable)


Please note type of medication, sampling times and dosage given. PRE (TROUGH LEVEL): Immediately prior to next dose. POST (PEAK LEVEL): RAPID RELEASE - 2 hours after dose. SLOW RELEASE - 4 hours after dose (e.g. Theodur).

THIAMINE, BLOOD Biochemistry Please refer to VITAMIN B1, BLOOD for details.

THINPREP (MONOLAYER) CYTOLOGY

Cytology Labelled fi xed smear/slide carrier. Rinse collection device in labelled PreservCyt Solution

24 - 48 hours ThinPrep is performed as an adjunct to conventional screening. A conventional Pap smear must be performed and the collection device rinsed in labelled PreservCyt Solution (available from QML Pathology Collection Centres). Transport Pap smear and PreservCyt Solution to the laboratory. This test incurs a non rebatable fee.

THIOCYANATE, BLOOD Biochemistry Blood/Lithium heparin tube

2 weeks Test for cyanide exposure. Please provide details of exposure to chemicals. Please collect the sample immediately after the exposure or work shift. Thiocyanate is the metabolic product of inactivation of cyanide. Raised in cigarette smokers. Referred test.

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THIOCYANATE, URINE Biochemistry Urine/Urine container 4 weeks Raised in cyanide exposure including cigarette smoking. The cost of this analysis is not Medicare refundable. Cost to patient or employer is approximately $100. Please indicate on request if permission or prior arrangement has been given to perform test by the requesting doctor, patient or employer. Please provide details of exposure to chemicals. Collect a random urine as soon as possible after exposure or work shift. Thiocyanate is a metabolic product of cyanide. Referred test.

THIOPURINE METHYLTRANSFERASE, BLOOD


2 weeks Test for genetically-determined sensitivity to potential for toxic accumulation of certain drugs. Transport in esky at 4°C. Referred test.

THIORIDAZINE, SERUM Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant

2 weeks Specimen must be collected into plastic tube and protected from light (wrap in foil or brown paper). Keep sample cooled and transport to the laboratory without delay. Referred test.

THROMBIN CLOTTING TIME Haematology Blood/Sodium citrate tube Same day Keep at 4°C. Must reach laboratory within 2 hours of collection. Refer to COAGULATION STUDIES.

THROMBOTIC ASSAYS - ALL Haematology Blood/3 x Sodium citrate tubes, 1 x EDTA tube

24 hours Please provide thrombotic history of patient and family members and any anticoagulant therapy. Must reach laboratory within 2 hours of collection. PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Medicare refundable if one of the following is stated on the request form by the patient’s doctor:1. That the patient has a personal history of venous thromboembolism (DVT) or

arterial thrombosis (PE); or2. That a fi rst degree relative of the patient has a proven defect in one or more of



THYROGLOBULIN ANTIBODY, SERUM


THYROGLOBULIN, SERUM Endocrinology Blood/SS tube 24 hours Used as a tumour marker.

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THYROID FNA CYTOLOGY Cytology Labelled fi xed and air dried smears/Labelled capped needle and syringe


THYROID FUNCTION TESTS, SERUM

Endocrinology Blood/SS tube 24 hours TSH is routinely performed. Free T4 will be measured in addition to TSH in certain patients. Please supply a comprehensive history including exactly what medication the patient is taking. Please refer to Endocrinology Preface (5.23) for details.

THYROID STIMULATING HORMONE (TSH), SERUM

Endocrinology Blood/SS tube 24 hours TSH is routinely performed. Free T4 will be measured in addition to TSH in certain patients. Please supply a comprehensive history including exactly what medication the patient is taking. Please refer to Endocrinology Preface (5.23) for details.

THYROID STIMULATING IMMUNOGLOBULIN (TSI), SERUM

Endocrinology Blood/SS tube 4 days Alternative names for this test include LATS, (LONG ACTING THYROID STIMULATOR) and TSH RECEPTOR ANTIBODIES. Assay of this autoantibody may be useful to monitor patients with Graves’ disease while on treatment.

THYROID TISSUE ANTIBODIES, SERUM

Endocrinology Blood/SS tube 24 hours Measure antimicrosomal and antithyroglobulin antibodies (Thyroid Tissue Antibodies).

THYROXINE BINDING GLOBULIN, SERUM


TIN, BLOOD Biochemistry Blood/2 x EDTA tubes 2 weeks Referred test.

TISSUE AUTOANTIBODIES, SERUM



TISSUE PLASMINOGEN ACTIVATOR


5 weeks Referred test. NOTE: This test is referred to Austin Hospital. Inform patient that they will be charged a non-refundable fee of approx. $30 by Austin Repatriation Hospital.

TISSUE PLASMINOGEN ACTIVATOR INHIBITOR

Haematology Blood/Sodium citrate tube 5 weeks Please contact Haematology (07) 3121 4451 or your Branch Laboratory for details before collection. Referred Test. NOTE: This test is referred to Austin Hospital. Inform patient that they will be charged a non-refundable fee of approx. $30 by Austin Repatriation Hospital.

TISSUE TRANSGLUTAMINASE ABS

Immunology Blood/SS tube 24 hours

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TOBRAMICIN, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant. Plastic lithium heparin tube (no gel) acceptable

Same day Please refer to Biochemistry Appendix (12.15).

TOFRANIL, SERUM Biochemistry Please refer to IMIPRAMINE, SERUM.

TOLUENE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details. For Urine - see HIPPURIC ACID, URINE.

TOLUENE/XYLENE EXPOSURE, URINE

Biochemistry Please refer to HIPPURIC ACID, URINE.

TOLVON, SERUM Biochemistry Please refer to MIANSERIN, SERUM.

TOMACULOUS NEUROPATHY GENETIC TESTING

Genetics Blood/EDTA tube 6 weeks Patient consent for billing must be marked on the request form.

TOPAMAX, SERUM Biochemistry Please refer to TOPIRAMATE, SERUM.

TOPIRAMATE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant. Plastic lithium heparin tube (no gel) acceptable

2 weeks Please provide medication details. Referred test.

TORCH/TORCHES SEROLOGY Immunology Blood/SS tube 24 hours TORCH includes Toxoplasma, Rubella, CMV, and Herpes serology. TORCHES includes syphilis as well. Note that TORCH and TORCHES are not recognised profi les and it is a Medicare requirement that each test be listed individually on the request form. This testing is no longer recommended as part of a routine antenatal screen.

TOTAL AND FRACTIONATED PORPHYRIN, URINE

Biochemistry Please refer to PORPHYRIN, URINE.

TOTAL ANTIOXIDANT STATUS, SERUM

Biochemistry Please refer to ANTIOXIDANTS, BLOOD.

TOXOCARA SEROLOGY Immunology Blood/SS tube 2 - 3 weeks Referred test.

TOXOPLASMA SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday).

TRACE ELEMENTS, BLOOD Biochemistry Please refer to individual trace elements.

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TRACE ELEMENTS, HAIR Biochemistry Hair/Dry sterile container

4 weeks Please provide exposure and occupation details. Clippings from the patients last hair cut can be used. Half full dry sterile screw top container. Please specify which trace elements are required. Broad screen of trace elements in hair is not generally accepted as being of diagnostic value. Blood may be the preferred sample. Referred test.

TRACE ELEMENTS, URINE Biochemistry Please refer to individual trace elements.

TRANSFERRIN ISOFORMS, SERUM

Biochemistry Blood/SS tube 2 weeks Keep sample cool during collection and transport to the laboratory. Referred test.

TRANSFERRIN SATURATION, SERUM

Biochemistry Blood/SS tube 24 hours Part of IRON (Fe) STUDIES, SERUM. Includes Iron, TIBC and % saturation.

TRANSFERRIN, SERUM Biochemistry Blood/SS tube 24 hours Please provide clinical and medication details.

TRANSFUSION REACTION INVESTIGATION, BLOOD AND URINE

Blood Bank Blood/Plain plastic tube, EDTA tube. Urine/Urine container

Same day Obstetric, transfusion and drug history essential. Sample of fi rst urine voided post reaction. Please forward ALL transfused and partly transfused blood bags to the Blood Bank.

TRANSKETOLASE, RED CELL Biochemistry Please refer to VITAMIN B1, BLOOD for details.

TREPONEMA PALLIDUM EIA, SERUM

Immunology Blood/SS tube 24 hours The standard EIA screening test is performed daily (Monday to Saturday). If positive, supplemental Syphilis testing will be performed.

TREPONEMA PALLIDUM PARTICLE AGGLUTINATION TEST (TPPA), SERUM


TRICHLOROACETIC ACID, URINE

Biochemistry Urine/Urine container 2 weeks Please provide exposure and occupation details. Random urine collected immediately after the work shift or exposure.

TRICHLOROETHANE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

TRICHLOROETHYLENE, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

TRICHOMONAS PCR - SWAB Immunology Dry swab/Dry swab 24 hours Dry Swab Note: Aptima Swab, Virocult (viral swab), STM not to be used.

TRICHOMONAS, EXAMINATION FOR

Microbiology Swab/Transport medium Same day Wet mount examination for Trichomonas vaginalis is no longer available. Trichomonas vaginalis nucleic acid detection by PCR is now performed on vaginal and urine specimens.

TRICLOPYR, BLOOD Biochemistry Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

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TRICRESYL PHOSPHATE, BLOOD


4 weeks Qualitative level only. Referred test.

TRIGLYCERIDES, FLUID Biochemistry Fluid/Plain tube/Container Same day Usually ordered to confi rm suspicion of lymph leakage, e.g. chylous pleural effusion, ascites, etc. Specify site of fl uid on specimen container and request form.

TRIGLYCERIDES, SERUM Biochemistry Blood/SS tube Same day Fasting sample with no alcohol consumed for the previous 72 hours is preferred but do not turn patient away if non-fasting unless doctor specifi cally requests FASTING. Please refer to E/LFT, SERUM.

TRIMETHYLAMINE, URINE Biochemistry Urine/Urine container 3 - 4 weeks Test for a rare benign disorder characterised by a strong fi shy body/urine odour. Collect early morning urine following fi sh and egg meal the night before. FREEZE sample immediately after collection. Do not allow to thaw.

TRIMIPRAMINE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant. Plastic lithium heparin tube acceptable

1 week Please provide clinical and medication details, including time and date of last dose. Collect immediately prior to next dose.

TRIPLE TEST (SCREEN) Endocrinology Blood/SS tube 48 hours This test gives a calculated risk for Down’s and Spina Bifi da at term. Collect specimen between 15th and 18th week of pregnancy. Includes-Beta HCG, AFP, Free Oestriol. Please make note of the following: 1: LMP/EDC and/or scan results, 2: Patient’s weight and family history of Down’s or Spina Bifi da and which family member it was, 3: Is it a single or multiple pregnancy?, 4: Is patient an insulin dependent diabetic?

TROPONIN T, SERUM Biochemistry Blood/SS tube Urgently This test, in the context of investigating chest pain or heart attack, is treated as urgent.

TRYPSIN ACTIVITY, FAECES Biochemistry Faeces/Faeces container 1 week Test of pancreatic exocrine activity. Please provide clinical details. FRESH sample of faeces required (ideally should be fl uid to semi-fl uid). Freeze specimen and store and transport frozen. Transport to laboratory as soon as possible.

TRYPTANOL, SERUM Biochemistry Please refer to AMITRIPTYLINE, SERUM.

TRYPTASE, SERUM Immunology Blood/SS tube 2 - 3 weeks Test for anaphylactic reaction. Collect a SS tube 2 hours after reaction (anaphylaxis). Separate serum and FREEZE as soon as possible. Comprehensive clinical history must be supplied, including: 1. Time of onset of Anaphylaxis. 2. Drugs or other agents and time administered before onset of reaction. 3. Clinical details.

TRYPTINE, SERUM Biochemistry Please refer to AMITRIPTYLINE, SERUM.

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TSH RECEPTOR ANTIBODIES, SERUM

Endocrinology Blood/SS tube 4 days Alternative names for this test include LATS (LONG ACTING THYROID STIMULATOR) and THYROID STIMULATING IMMUNOGLOBULIN (TSI). Assay of this autoantibody may be useful to monitor patients with Graves’ disease while on treatment.

TUBERCULOSIS, SPUTUM Microbiology Sputum/Dry, sterile screw top (urine) container

Microscopy - 2 days. Culture - up to 6 weeks

Please refer to URINE FOR MTB CULTURE and Microbiology Preface (5.55).

TUMOR NECROSIS FACTOR RECEPTOR-ASSOCIATED PERIODIC SYNDROME (TRAPS) GENETIC TESTING

Genetics Blood/1 x EDTA tube, 1 x ACD tube, 1 x Lithium heparin tube

1 - 2 months Incurs non-Medicare refundable fee.

TUMOUR MARKERS, SERUM Biochemistry/Endocrinology

Blood/SS tube Individual tumour markers are listed alphabetically in the A-Z listing and in the Biochemistry Appendix (12.5).

TYPHOID FEVER SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

TYPHUS SEROLOGY Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday.

TYROSINE, PLASMA Biochemistry Blood/Lithium heparin tube

2 weeks Provide clinical details. Transport on dry ice. Referred test.

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UBIQUINONE, PLASMA Biochemistry Please refer to COENZYME Q10, PLASMA.

UCCINYLAMINOIMIDAZOLE CARBOXAMIDE RIBOSIDE (SAICAR), URINE

Biochemistry Random early morning urine/Urine container

2 - 3 weeks Please provide clinical and medication details. Random early morning urine collection preferred. Refrigerate for transfer to laboratory. Referred test.

UDPG TRANSFERASE, RED CELL

Biochemistry Blood/Lithium heparin tube 1 - 2 weeks Please refer to GALACTOSAEMIA SCREEN, BLOOD.

UNSTABLE HAEMOGLOBIN Haematology Blood/EDTA tube 24 hours Tests performed Tuesday and Friday. Results available same day of test.

UPG DECARBOXYLASE, RED CELL

Biochemistry Blood/Lithium heparin tube 1 - 2 months Please send to the laboratory without delay. Referred test.

URANIUM, BLOOD Biochemistry Blood/EDTA tube 4 weeks Please provide clinical and exposure details.

URATE CLEARANCE Biochemistry Blood and Urine/24 hour urine, SS tube container with 15 mL 2M NaOH preservative

24 hours Please record patient’s height and weight on request form. Patient may be placed on a low purine diet (refer to dietary restrictions in Biochemistry Appendix (12.12)) 3 days prior to test if requested. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Collect blood specimen after urine collection is completed.

URATE, FLUID Biochemistry Fluid/Plain tube/Container Same day Test to confi rm suspected gouty origin e.g. of joint effusion. Specify site of fl uid on specimen container and request form.

UREA, FLUID Biochemistry Fluid/Plain tube/Container Same day Test to confi rm presence of urine leakage into abnormal site. Specify site of fl uid on specimen container and request form.

UREA, SERUM Biochemistry Please refer to E/LFT, SERUM.

UREA, URINE Biochemistry Urine/24 hour urine container with no preservative

24 hours Please provide clinical and medication details. 24 hour collection is preferred, however random may be collected. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

URIC ACID, SERUM Biochemistry Blood/SS tube Same day Test for risk of gout. Values exceeding 0.42 mmol/L (i.e. within the male reference range - see Biochemistry Appendix (12.7)) may be associated with acute gout. In pregnancy, test for risk on pre-eclampsia.

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URIC ACID, URINE Biochemistry Urine/24 hour urine container with 15 mL 2M NaOH preservative (preferred) or plain 24 hour container if other tests are requested

24 hours Test of uric acid excretion to differentiate gout due to urate overproduction from urate under-excretion. Patient may be placed on a low purine diet (refer to dietary restrictions in Biochemistry Appendix (12.12)) 3 days prior to test if required. 24 hour collection is preferred, however random may be collected. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

URINARY ALDOSTERONE Endocrinology Urine/24 hour urine collection bottle. No preservative. Aliquot with blue Monovette

1 week Record 24 hour urine total volume. No preservative to be added to 24 hour urine container.

URINARY CROSS LINKED N- TELOPEPTIDES (NTx, BONE RESORPTION MARKERS),URINE 24 HOUR OR RANDOM

Biochemistry 24 hour urine collection/Urine collection bottle. No preservative. Random Urine/Urine container

1 week A highly specifi c marker of bone resorption used in investigation and monitoring of osteoporosis, Paget’s disease, steroid therapy, malignancies, infl ammatory diseases and metabolic bone diseases.

URINARY TRACT CYTOLOGY Cytology Urine and or Bladder and Ureteric Washings/Urine container

24 hours SECOND voided urine specimen of the morning. For specimen preparation please refer to Cytology Preface (5.15).

URINE FREE CORTISOL, URINE 24 HOUR


48 hours Dexamethasone not to be taken 36 hours prior to or during test, unless as part of a prolonged Dexamethasone Suppression Test. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

URINE MALIGNANT CELLS Cytology Urine/Urine container 24 hours Collect the FIRST part, or all (not mid stream), of the SECOND or later VOID of the day.

URINE MICROSCOPY AND CULTURE

Microbiology Random or early morning Urine/Monovette urine container. Collect supra pubic aspirates into a sterile container

Interim microscopy report same day. Culture and sensitivity 24 - 48 hours

Transfer the Monovette to the laboratory as soon as possible. Refrigerate if an extended delay is expected.

URINE MTB CULTURE Microbiology Urine/70 mL sterile container (NOT a monovette)

Microscopy 2 days; Culture 6 weeks

Submit a full 70 mL container of an early morning sample.

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URINE QUALITATIVE DRUG SCREEN (INDUSTRY, OCCUPATIONAL, DRUG ABUSE ETC.), URINE RANDOM

Biochemistry Supervised random urine/Doxtech security urine container

1 - 2 days In cases of occupational drug screen, suspected drug abuse or monitoring of compliance with therapy or Drug Rehabilitation Programme, urine collection must be supervised. Chain-of-Custody form must be completed (available from QML Pathology). Protocol is detailed on Chain-of-Custody form and in the Biochemistry Preface (5.4) of this manual. The QML Pathology protocol complies with Australian Standard AS4308. See Biochemistry Appendix (12.13) for a full list of drugs assayed. Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for further details.

UROBILINOGEN, URINE Biochemistry Urine/Urine container Same day Please provide a FRESH random sample and protect from light. Transport cooled to laboratory as soon as possible.

UROPORPHYRIN, URINE Biochemistry Please refer to PORPHYRIN, URINE.

UROPORPHYRINOGEN-1-SYNTHETASE, RED CELL

Biochemistry Blood/Lithium heparin tube 2 - 4 weeks Please contact Biochemistry prior to collection on (07) 3121 4420.

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VAGINAL PAP SMEAR CYTOLOGY

Cytology Labelled fi xed smear/Slide carrier

48 - 72 hours Sample cells from the mid to upper third of lateral vaginal wall with Ayre spatula or cytobrush and produce a conventional labelled Pap smear. Fix immediately in 95% ethanol or with Cytofi x aerosol spray. Please contact Cytology (07) 3121 4485 or Branch Laboratory.

VAGINAL/CERVICAL/URETHRAL CULTURE FOR BACTERIA, FUNGI, VIRUSES AND CHLAMYDIA

Microbiology Swab/Stuart’s Transport Medium (Bacteria, Fungi)/Viral transport medium/Chlamydia transport medium (Aptima Collection)

Routine microbiology 48 hours, Chlamydia PCR 24 hours, Viral PCR 24 hours

Wet preparation performed for Yeasts. Viability of Neisseria gonorrhoeae decreases after several hours. Please see instructions with kit for PCR techniques. Forward specimen to laboratory as soon as possible.

VALIUM, SERUM Biochemistry Please refer to DIAZEPAM, SERUM.

VALPROATE, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant

Same day Please provide clinical and medication details including dosage and time of last dose. Collect just prior to next dose.

VALPROIC ACID, SERUM Biochemistry Please refer to VALPROATE, SERUM.

VANCOMYCIN, SERUM (TROUGH AND PEAK)

Biochemistry Blood/Plain plastic tube - no gel or anticoagulant. Plastic lithium heparin tube (no gel) acceptable


TROUGH LEVEL: Collect sample just prior to next dose. PEAK LEVEL: Collect sample one hour after IM injection or 10 minutes after the end of infusion. KINETIC STUDIES: Please contact the laboratory. Please note time and date of last dose, dosage and method on request form.

VANILLYLMANDELIC ACID, URINE 24 HOUR


VARICELLA ZOSTER DFA SLIDE (IMMUNOFLUORESCENCE)


24 hours A slide may be made from the swab if CRITICALLY URGENT. Testing by PCR is recommended.

VARICELLA ZOSTER SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday).

VARICELLA ZOSTER VIRUS PCR Immunology Viral Culture Swab (green top) in transport medium


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VASOACTIVE INTESTINAL PEPTIDE, PLASMA

Biochemistry Blood/Glass EDTA tube with Trasylol preservative

2 weeks Tumour marker - pancreatic ‘vipoma’. Contact Biochemistry (07) 3121 4420 or Branch Laboratory to order special EDTA tubes containing Trasylol preservative. This tube must be kept cold until required. If there will be a delay in collection, store the empty Trasylol tube frozen and thaw immediately prior to use. Sample must be collected on ice, centrifuged in a refrigerated centrifuge or chilled centrifuge buckets within 30 minutes and plasma frozen immediately. Transfer to the laboratory on dry ice. Referred test.

VASOPRESSIN, BLOOD Endocrinology Blood/4 x EDTA tubes 2 - 3 weeks Collect into chilled EDTA tubes. Invert to mix and keep cold (4°C) in transit. To arrive in Endocrinology within 24 hours of collection. If >24 hours, spin EDTA tubes and separate plasma and transport on ice. Referred test.

VDRL (RPR - RAPID PLASMA REAGIN TEST), SERUM


VENLAFAXINE, SERUM/PLASMA

Biochemistry Blood/Plain plastic tube - no gel (Plastic lithium heparin tube or EDTA tube acceptable)

4 weeks Please provide clinical and medication details. Keep sample cool.

VIGABATRIN, SERUM Biochemistry Blood/Plain plastic 6 mL tube - no gel or anticoagulant (EDTA tube or Lithium heparin tube acceptable)

2 weeks Please provide clinical and medication details. Keep sample cold. Referred test.

VIP, PLASMA Biochemistry Please refer to VASOACTIVE INTESTINAL PEPTIDE, PLASMA.

VIRAL SEROLOGY Immunology Blood/SS tube Variable from 24 hours depending on antibody tests required

Please provide clinical details and nominate specifi c viruses (a Medicare requirement) to be tested. Please refer to Immunology Preface (5.49) for a comprehensive list of viruses. Assay run Monday - Friday.

VIRAMUNE, PLASMA Biochemistry Please refer to NEVIRAPINE, PLASMA for details.

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VIRUS DETECTION Immunology Swabs and secretions from Throat, Skin vesicles etc. Urine, Faeces etc. Viral Culture Swabs/Viral Transport Medium or 30- 50 mL dry sterile screw top (urine) containers

1 - 2 weeks Please keep specimen cool and transport to laboratory as soon as possible. QML Pathology performs PCR on various viruses. Some tests may also be referred.

VISCOSITY, PLASMA Haematology Blood/EDTA tube 24 hours DO NOT refrigerate prior to testing.

VITAMIN A, SERUM

Biochemistry Blood/SS tube (Lithium heparin tube acceptable)

1 week Test for vitamin A defi ciency or excess. A fasting sample is required. Please provide clinical details and medication history. Samples must be refrigerated and protected from light after collection. Serum/Plasma must be frozen within 6 hours of collection. Forward to the laboratory without delay.

VITAMIN B1, BLOOD Biochemistry Blood/EDTA tube 1 week Test for thiamine (vitamin B1) defi ciency. A fasting sample is required. Please provide clinical details including medication and protect the sample from light. Forward to the laboratory without delay.

VITAMIN B12, SERUM Endocrinology Blood/SS tube 24 hours

VITAMIN B2, BLOOD Biochemistry Blood/EDTA tube 1 week Test for ribofl avin (vitamin B2) defi ciency. A fasting sample is required. Please provide clinical and medication details and protect the sample from light. Whole blood must be frozen within 6 hours after collection. Forward to the laboratory without delay.

VITAMIN B3, URINE Biochemistry Urine/24 hour urine container with 25 mL 6M HCI preservative

3 weeks Test for niacin (vitamin B3) defi ciency. Random urine collections are NOT acceptable for analysis. Referred test.

VITAMIN B6, BLOOD Biochemistry Blood/EDTA tube 1 week Test for pyridoxine (vitamin B6) defi ciency. A fasting sample is required. Please provide clinical details and medication history. Samples must be refrigerated and protected from light after collection. Serum/Plasma must be frozen within 6 hours of collection. Forward to the laboratory without delay.

VITAMIN C, SERUM Biochemistry Blood/SS tube 1 week Test for ascorbate (vitamin C) defi ciency. Please provide clinical and medication details. A fasting sample is required. Vitamin C is particularly unstable. NB: Serum should be separated and frozen immediately after clotting and centrifuging. If unable to separate or centrifuge, the sample may be sent to the laboratory at 4°C to be separated and serum frozen within two hours of collection.

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VITAMIN D RECEPTOR ALLELES, HAIR ROOTS

Biochemistry Hair roots/Hair roots (6-10) taped to piece of paper with roots left uncovered

4 - 6 weeks Hair should be plucked from the scalp and placed in an envelope or dry sterile screw top (urine) container. If hair is unobtainable, collect blood in 1 x 5 mL EDTA tube (whole blood). Referred test.

VITAMIN D, SERUM Biochemistry Blood/Plain plastic tube - no gel or anticoagulant

1 week Test for cholecalciferol (vitamin D) defi ciency. A fasting sample is required. Please provide clinical details and medication history. Samples must be refrigerated and protected from light after collection. Serum/Plasma must be frozen within 6 hours of collection. Forward to the laboratory without delay.

VITAMIN E, SERUM Biochemistry Blood/SS tube (Lithium heparin tube acceptable)

1 week Test for vitamin E defi ciency. A fasting sample is required. Please provide clinical details and medication history. Samples must be refrigerated and protected from light after collection. Serum/Plasma must be frozen within 6 hours of collection. Forward to the laboratory without delay.

VMA, URINE Biochemistry Please refer to CATECHOLAMINES, URINE.

VON HIPPEL-LINDAU GENETIC TESTING

Genetics Blood/EDTA tube 1 - 2 months GENETIC COUNSELLING IS REQUIRED BEFORE THE BLOOD SPECIMEN CAN BE TAKEN. GENETIC COUNSELLING IS AVAILABLE FROM THE GENETIC HEALTH QUEENSLAND AT THE ROYAL BRISBANE HOSPITAL ON (07) 3636 1686.

VON WILLEBRAND FACTOR ANTIGEN, PLASMA

Haematology Blood/Sodium citrate tube 24 hours Keep sample at 4°C. Specimen must reach laboratory within 2 hours of collection. Rural patients may be referred to nearest Branch Laboratory for specimen collection. Please contact Haematology (07) 3121 4451 or Branch Laboratory. Refer to FACTOR VIII ASSAY.

VWF MULTIMER ASSAY Haematology Blood/Sodium citrate tube Up to 3 months Please contact Haematology (07) 3121 4451 or your Branch Laboratory for details before collection. Referred test.

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WATER DEPRIVATION TEST Biochemistry Blood and urine/SS tube and Urine container

24 hours Test for diabetes insipidus - overnight fl uid restriction with serum and urine osmolality in the morning is best initial screen. Note specimens should be collected simultaneously. Please contact chemical pathologist or Branch Laboratory for details. This test should be performed under supervision at a special tests collection centre or Branch Laboratory. Please phone for an appointment.

WEEDICIDES, URINE Biochemistry Urine/Urine container 2 weeks Please provide specifi c details of particular weedicide patient has been exposed to. Random urine collected immediately after work shift/exposure. If used as a screening test cost of this test NOT covered by Medicare. Please phone Biochemistry (07) 3121 4420 or your Branch Laboratory for current cost details. Referred test.

WHITE CELL COUNT AND DIFFERENTIAL, BLOOD

Haematology Blood/EDTA tube and Blood fi lm

Same day Blood fi lms made at time of collection are preferred. Please see Haematology Appendix (12.32).

WHITE CELL COUNT, BLOOD Haematology Blood/EDTA tube Same day

WHITE CELL ENZYMES, BLOOD


WHOOPING COUGH SEROLOGY (BORDETELLA PERTUSSIS)


WIDAL SEROLOGY (SALMONELLA TYPHI)


WOUND SWAB MICROSCOPY AND CULTURE

Microbiology Swab/Transport Medium Interim microscopy report same day. Culture report 48 hours

Please provide clinical details including mode of injury (e.g. dog bite), site, antibiotic therapy and indicate if the wound is post operative. Please indicate if exotic or unusual organisms are suspected. Prompt transport to the laboratory is essential.

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XANAX, SERUM Biochemistry Please refer to ALPRAZOLAM, SERUM.

XANTHINE, URINE Biochemistry Urine/Urine container 1 - 2 months A random urine is preferred. Please store and transport the sample frozen.

XANTHOCHROMIA, CSF Biochemistry CSF/Plain tube Same day Keep sample cool and protect from light.

XYLENE/TOLUENE EXPOSURE, URINE

Biochemistry Please refer to HIPPURIC ACID, URINE.

XYLENES, BLOOD Biochemistry Please refer to SOLVENTS, BLOOD for all details.

XYLOCAINE, SERUM Biochemistry Please refer to LIGNOCAINE, SERUM.

XYLOSE EXCRETION TEST (ADULT)


1 week Test for malabsorption of simple sugars. Please contact laboratory well in advance for XYLOSE dose and collection details. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Adult XYLOSE dose 25g given orally.

XYLOSE EXCRETION TEST (CHILD)


1 week Test for malabsorption of simple sugars. Please contact laboratory well in advance for XYLOSE dose and collection details. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Child XYLOSE dose: 5g given orally.

Y CHROMOSOME MICRODELETION ANALYSIS AZFa, AZFb, AZFc

Genetics Blood/EDTA tube 1 - 2 weeks DAZ gene is encompassed within AZFc region. Incurs non Medicare refundable fee.

YELLOW FEVER VIRUS SEROLOGY

Immunology Blood/SS tube 4 - 6 weeks Referred test. Note all requests for yellow fever serology must be notifi ed to the relevant health authorities.

YERSINIA ENTEROCOLITICA SEROLOGY


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ZACTIN, SERUM Biochemistry Please refer to FLUOXETINE, SERUM.

ZERO, URINE Biochemistry Please refer to GLYPHOSATE, URINE.

ZIEHL-NEELSEN STAIN Microbiology Swab, pus, fl uid, urine, tissue etc./Appropriate sterile container

24 hours Please transport specimen to laboratory as soon as possible. See also TB CULTURE.

ZINC PROTOPORPHYRIN, RED CELL

Biochemistry Blood/EDTA tube, Lithium heparin tube or Sodium citrate tube

1 week Test for long-term lead exposure. May be raised in iron-defi ciency anaemia. Please provide clinical, medication and lead exposure details.

ZINC, HAIR Biochemistry Hair/Dry sterile screw cap (urine) container

4 weeks Please provide full details of long term exposure. Fill sterile container with hair, as full as possible. Clippings from the patient’s last hair cut can be used. Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

ZINC, RED CELL Biochemistry Blood/EDTA tube and Trace metal tube (Navy stopper)

1 week Serum Zinc must also be collected (trace metal tube) - refer to ZINC, SERUM for collection details. Leave EDTA tube as whole blood. Please provide clinical details. Referred test.

ZINC, SERUM Biochemistry Blood/Special plain Vacutainer tube with navy stopper and no gel

24 hours Sample must be collected into a trace metal tube (Navy stopper), allowed to clot, centrifuged and serum removed from cells as soon as possible. Serum must not be haemolysed.

ZINC, URINE Biochemistry Urine/Urine container 4 weeks Please provide clinical, medication and exposure details. Random collection is preferred, however 24 hour urine may be collected. Referred test.

ZOLOFT, SERUM Biochemistry Please refer to SERTRALINE, SERUM for details.

ZYPREXA, PLASMA Biochemistry Please refer to OLANZAPINE, PLASMA.

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CONTACT DETAILS

Central Laboratory(07) 3121 4444

Biochemistry Department(07) 3121 4420

Blood Bank(07) 3876 8371

Cytology Department(07) 3121 4494

Endocrinology Department(07) 3121 4439

Genetics Department(07) 3121 4461

Haematology Department(07) 3121 4451

Histology Department(07) 3121 4426

Immunology Department(07) 3121 4458

Microbiology Department(07) 3121 4438

Liaison Department(07) 3121 4943

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LE 3RULE 3 EXEMPTION

Rule 3 of the Pathology Services Table limits the benefits payable for pathology items during a single patient episode. Exemptions to this rule have been granted for certain specified tests in certain clinical circumstances. The exemption is referred to as ‘Rule 3 Exemption’. A summary of Rule 3 Exemption circumstances for Out Patients is given below. In these instances, the request form is valid for the earlier of either test frequency limit or 6 months.

Procedure for Rule 3 Exemption

i. Request the pathology test in the normal way with the usual request form.

ii. Specify the number of and frequency of the test.

iii. Clearly endorse the form by writing ‘Rule 3 exemption’.

DEPARTMENTS

Biochemistry Department(07) 3121 4420

Blood Bank(07) 3876 8371

Cytology Department(07) 3121 4494

Endocrinology Department(07) 3121 4439

Genetics Department(07) 3121 4461

Haematology Department(07) 3121 4451

Histology Department(07) 3121 4426

Immunology Department(07) 3121 4458

Microbiology Department(07) 3121 4438

Liaison Department(07) 3121 4943

LABORATORIES

Brisbane & Surrounding AreasCentral Laboratory - Brisbane (07) 3121 4444

Greenslopes (07) 3121 4444

North West - Everton Park (07) 3353 0382

St Andrew’s - Spring Hill (07) 3832 6011

Wesley - Auchenflower (07) 3371 9462

BundabergBundaberg(07) 4152 8411

CairnsCairns(07) 4051 8944

Central QueenslandEmerald(07) 4982 0306

Gladstone(07) 4972 2877

Rockhampton(07) 4921 2155

Gold Coast, Tugun & Northern RiversBallina(02) 6686 6424

Pindara(07) 5510 0400

Southport(07) 5668 4444

Tugun(07) 5598 0822

Ipswich, Darling Downs & Granite BeltIpswich(07) 3281 8888

Toowoomba(07) 4638 9149

KingaroyKingaroy(07) 4162 1499

MackayMackay(07) 4951 2999

RedcliffeRedcliffe(07) 3049 4410

Sunshine Coast & GympieBuderim(07) 5441 0200

Gympie(07) 5482 1511

Noosa(07) 5441 0200

TownsvilleTownsville(07) 4779 0158

Patient’s Clinical Circumstance

Tests Eligible for Rule 3 Exemption

Test Frequency

Anticoagulant (Warfarin) therapy INRUnlimited tests up to 6 months of request

Cancer patients receiving bisphosphonate infusions

Calcium, phosphate, magnesium, urea, creatinine and electrolytes

Up to 6 tests within 6 months of request

Chemotherapy for neoplastic diseaseClozaril therapyGold therapyImmunosuppressant therapyPenicillamine therapySulphasalazine therapyTiclopidine hydrochloride therapy

FBE, ESRUp to 6 tests within 6 months of request

Chronic renal failure of a patient in a dialysis program conducted by a recognised hospital

Urea, creatinine and electrolytesUp to 6 tests within 6 months of request

Cis-platinum therapy Urea, creatinine and electrolytesUp to 6 tests within 6 months of request

Cyclosporin therapy Urea, creatinine and electrolytesUp to 6 tests within 6 months of request

Leflunomide therapy E/LFT (or part thereof)Up to 6 tests within 6 months of request

Lithium therapy LithiumUp to 6 tests within 6 months of request

Methotrexate therapy FBE, ESR, E/LFT (or part thereof)Up to 6 tests within 6 months of request

Vitamin D (metabolites or analogues) therapy

Calcium and albuminUp to 6 tests within 6 months of request

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APPENDICES - BIoChEmIStry

Common Causes of abnormal bioChemiCal results

INCREASED DECREASED Sodium Water loss

(e.g. dehydration, diabetes insipidus) Salt overload Renal impairment

Water overload (e.g. cirrhosis, CCF, inappropriate ADH) Salt loss (e.g. diuretic therapy, adrenal failure, gut or sweat loss, renal impairment)

Potassium Oral overload, cell leakage (sepsis or post-collection), renal disease, adrenal insufficiency Acidosis (ketoacidosis, lactic acidosis)

Diuretics, dietary deficiency, renal tubular disease, steroid excess, gut loss, insulin effect

Chloride Dehydration, diarrhoea, pancreatic or biliary drainage, renal tubular acidosis, ureterosigmoidostomy

Vomiting, water overload, diuretics Children - cystic fibrosis

Bicarbonate Respiratory acidosis - lung disease Metabolic alkalosis - vomiting, diuretics, oral antacids, steroid excess

Respiratory alkalosis - hyperventilation Metabolic acidosis - renal failure, liver failure, diabetes mellitus, diarrhoea, drugs, dehydration

Anion Gap Metabolic acidosis - renal or liver failure, diabetic ketoacidosis, salicylates, other abnormal acids

Low serum protein, hypercalcaemia

Glucose Non-fasting state, diabetes mellitus, infection, excess endogenous or exogenous steroid, burns, hypokalemia

Excess exogenous or endogenous insulin, early glucose intolerance, adrenal or pituitary failure, severe liver disease, oral hypoglycaemics

Urea Renal impairment, excessive protein catabolism, GI bleeding, congestive cardiac failure, dehydration

Protein deficient diet, diuresis, pregnancy

Creatinine Renal impairment, acute muscle wasting

Chronic muscle wastage

eGFR Not applicable Renal impairment, acute muscle wasting

Uric Acid Gout, malignancy, viral infection, psoriasis, renal failure, toxaemia of pregnancy, acidosis

Allopurinol, uricosuric drugs, diuresis, renal tubular disease, inappropriate ADH

Bilirubin Total Adult - Gilbert syndrome, hepatitis, malignancy, gall stones, cirrhosis, Dubin-Johnson syndrome Infants - physiological, biliary atresia, haemolysis, hepatitis, Crigler-Najjar syndrome

Not clinically significant

Bilirubin Conjugated

Biliary obstruction - stones, malignancy, fibrosis, congenital intrahepatic cholestasis - drugs, chemicals, Dubin-Johnson syndrome

Not clinically significant

Alkaline Phosphatase

Liver - obstruction, malignancy, hepatitis Bone - Paget’s, malignancy, fracture, hyper-PTH, period of rapid bone growth Other - third trimester pregnancy, transient benign hyperphosphatasia of childhood

Zinc deficiency, congenital hypophosphatasia (not common but important)

INCREASED DECREASED Gamma GT Hepatitis, biliary obstruction, drugs,

alcohol, renal damage, pancreatitisRarely significant

ALT (SGPT) Liver disease or damage e.g. hepatitis (>500), non-specific viraemia, drugs, fatty liver, alcohol, haemochromatosis

Renal failure, vitamin B6 deficiency

AST (SGOT) Myocardial damage or necrosis, liver disease, skeletal muscle damage, muscular dystrophy, haemolysis

Renal failure, vitamin B6 deficiency

Lactate Dehydrogenase (LDH)

Myocardial damage or necrosis, liver disease, muscle disease, malignancy, haemolysis, post-collection cell leakage

Rarely significant

Calcium Hyperparathyroidism, malignancy (including myeloma), vitamin D & A excess, sarcoidosis, thyrotoxicosis, milk-alkali syndrome

Low albumin, acidosis, renal disease, hypoparathyroidism, vitamin D deficiency, acute pancreatitis (significant values <2.10 mmol/L)

Adjusted Calcium

As for calcium - Note: if abnormality is unexplained, ionised calcium assay avoids protein binding effects

As for calcium with the exception of low albumin (corrected for changes in albumin)

Phosphate Post-collection cell leakage, haemolysis, renal impairment, severe illness, acidosis, hypoparathyroidism

Low phosphate intake (e.g. poor diet, prolonged I.V. therapy) alcoholism, diuresis, renal tubular disease, hyperparathyroidism

Total Protein Multiple myeloma, chronic liver disease, chronic inflammation or infection, dehydration

Malnutrition, severe liver disease, water overload, nephrotic syndrome, protein-losing enteropathy

Albumin Dehydration, tourniquet artifact Chronic liver disease, malnutrition, chronic inflammation, nephrotic syndrome, protein-losing enteropathy, burns

Globulins HIV infection and as for total protein Immunodeficiency and as for total protein

Iron Oral iron, haemochromatosis, gastrointestinal bleeding

Iron deficiency, infection, chronic inflammation

Cholesterol Familial hyperlipidaemia, hypothyroidism, liver disease, renal disease, diabetes mellitus

Hyperthyroidism, infection, myocardial infarction, inherited hypolipidaemias

Triglyceride Non-fasting state, alcohol intake, diabetes mellitus, familial hyperlipidaemia

Malnutrition, fasting state

tissue sourCes of elevated enzymes

* Isoenzyme subunit fractionation is available to further differentiate sources of excess activity.

+ Cardiac markers - Troponin is the most sensitive and specific marker of myocardial disease/damage.

relative ConCentrations of alt & ast differ in liver and myoCardial disease

These tables list only the common and most important causes for the given abnormal results. When there is a diagnostic problem, please consult your local QML Pathologist, or Dr Charles Appleton, Dr Nigel Brown, Dr Julia Chang or Dr Kerry DeVoss on (07) 3121 4444.

MOST COMMON OTHER* Alkaline

PhosphataseLiver (obstruction) Bone - osteoblastic regenerative

response

Intestine, placenta, atypical (immunoglobulin-bound) enzyme

Gamma GT Liver (obstruction or drugs) Renal failure, vitamin B6 deficiency

ALT (SGPT) Liver Myocardium, skeletal muscle

+ AST (SGOT) Myocardium, skeletal muscle Liver

*+ Lactate Dehydrogenase (LDH)

Red blood cells (post-collection leakage, haemolysis), myocardium, muscle

Liver, lymphoid and epithelial tissue

*+ CK (CPK) Myocardium, skeletal muscle, atypical (‘macro’)

Brain, intestinal smooth muscle

+ CK-MB Myocardium Muscle, atypical (immunoglobulin-bound)

Amylase Pancreas Salivary glands, fallopian tubes

Liver Damage Myocardial Damage

ALT ++ +

AST + ++


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Tumour markers, those materials whose presence qualitatively or quantitatively signal the presence of malignancy, offer some hope in the fight against cancer. Some well defined clinical applications include:• Thedetectionofmalignancy• Theestablishmentofprognosisasanaidindifferentiation• Themonitoringoftreatmentandthedetectionofarecurrence.

Source: A. Fetah-Moghadam, P. Stieber, 1991 Instit. of Clin. Chem., Klinikum, Grobhadern, Munich, FRG

MARKER

TUMOUR aFP

CE

A

CA

19.

9

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15.

3

CA

125

hCG

Cal

cito

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Thyr

oglo

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A

LD

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Oesophagus •

Stomach • •

Pancreas • •Colon • • •Liver •Biliary ducts •

Breast • •Ovary • • • •Cervix •Trophoblast •Germ cell • • •Prostate •Thyroid • •Medullary Ca Thyroid • •

the more Widely used serum markers

MARKER MAJOR TUMOUR SOURCE

LESSER TUMOUR SOURCE FALSE POSITIVE

ACTH pituitarybasophiladenoma, oat cell carcinoma of lung

pulmonary carcinoma

Alpha Fetoprotein hepatoma, dysgerminoma (70%), teratoma, hepatoblastoma

gastrointestinal (10%) andbrochogenicca.(10%)

non-neoplastic liver disease

Beta Human Chorionic Gonadotrophin (HCG)

choriocarcinoma (>80%) and dysgerminoma (40%)

seminoma (20%) and non-trophoblasticca.(10%)

Beta2Microglobulin myeloma, plasmacytoma

renal or inflammatory disease

CA 125 (cervix, pancreas, stomach)

epithelial ovarian cancer (>80%) pancreatitis, peritonitis

endometrium, fallopiantube

endometriosis, PID, CRF

CA 15.3 metastaticbreastca.(70%)

localisedbreastca.(10%), ovary

non-malignant liver disease

CA 19.9 (Fetoacinar Pancreatic Antigen)

pancreas (80%), gastric (50%), bileduct(65%),hepatoma (50%)

colorectal (25%) cirrhosis, cholangitis and rarely pancreas & colorectal inflammation,pulmonaryfibrosis

Calcitonin medullary thyroid carcinoma, carcinoid

liver,lung,renal,breast

CarcinoembryonicAntigen (CEA)

colorectal, gastric, liver, pancreatic and breastca.(all>60%)

lung, prostate, cervix, uterus, ovary

smoking, acute & chronic pancreatic, bowel&breastdisease

Catecholamines, HMMA (VMA)

phaeochromocytoma, neuroblastoma

non-specific illness, anti-hypertensive drugs, syncope

Human Chorionic Gonadotrophin

Refer Beta HCG

Lactate Dehydrogenase (LD) Isoenzymes

seminoma, lymphoma and epithelial carcinoma

benigndiseaseoforgans, haemolysis

Paraprotein, Bence Jones Protein

multiple myeloma (98%) and plasmacytoma

other lymphoid malignancies

autoimmune conditions


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MARKER MAJOR TUMOUR SOURCE

LESSER TUMOUR SOURCE FALSE POSITIVE

Placental Alkaline Phosphatase

seminoma (>80%), ovary, lung, uterus cancer

smoking

Prostatic Acid Phosphatase (ACP)

metastatic prostate (>70%)

intracapsular prostate (<30%)

prostatitis and prostatic massage

Prostate Specific Antigen (PSA)

prostatic adenocarcinoma intracapsular(65%),metast (90%)

benignprostatichypertrophy (30%)

Serotonin, 5-H.I.A.A. carcinoid tumour diet, diarrhoea, coeliac disease

SolubleMesothelin- Related Protein (SMRP)

Mesothelial tumours - mesothelioma

ovarian, peritoneal tumour

other lung malignancy, fibroticlungdisease

Thyroglobulin differentiated thyroid ca.

Vasoactive Intestinal Polypeptide (VIP)

bronchogeniclung,pancreatic islet, neuroblastoma,thyroid medullary, phaeochromocytoma

shock, cirrhosis, hepatic failure

Common bioChemistry referenCe ranges/ flagging rules

Chemistry Units Age/Sex/Rand/Fast. Normal

Sodium mmol/L 137 - 147

Potassium mmol/L 3.5 - 5.0

Chloride mmol/L 96 - 109

Bicarbonate mmol/L 25 - 33

Glucose mmol/L Random 3.0 - 7.7mmol/L Fasting 3.0 - 6.0

Urea mmol/L <2 yrs 2.0 - 8.02-10 yrs 2.0 - 7.511-20 M 2.5 - 7.511-20 F 2.0 - 7.021-50 M 2.5 - 8.021-50 F 2.0 - 7.0>50 M 3.0 - 8.5>50 F 2.5 - 7.5

Creatinine umol/L <2 yrs 10 - 602-5 yrs 10 - 706-10yrs 20 - 8011-20 M 40 - 12011-20 F 40 - 10021-50 M 60 - 13021-50 F 40 - 110>50 M 60 - 140>50 F 50 - 120

Uric Acid mmol/L M 0.12 - 0.45F 0.14 - 0.35

Total Bilirubin umol/L <1 day 7 - 70

2 days 17 - 1403 days 17 - 170

4 - 5 days 17 - 1006days- 2 mths 4 - 20

>2 months 2 - 20


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Conj. Bilirubin umol/L 0 - 8

Total Alk.Phos. U/L 0 - 18 yrs 30 - 300

>18 yrs 30 - 115

ALT U/L 0 - 45

AST U/L 0 - 41

GGT U/L M 0 - 70F 0 - 45

LDH U/L 0 - 9 days 500 - 100010 days - 18 mths 210 - 470

19 mths - 3 yrs 200 - 400

4 - 8 yrs 190 - 3809 - 11 yrs 180 - 33012 - 14 yrs 140 - 32015-16yrs 120 - 280

>16yrs 80 - 250

Calcium mmol/L 2.25 - 2.65

Phosphate mmol/L 1 day 1.3 - 2.82-6days 1.3 - 2.3

7 days - 1 yr 1.1 - 2.3

2 - 5 yrs 1.0 - 2.06-10yrs 1.0 - 1.911 - 20 yrs 0.9 - 1.7

>20 yrs 0.8 - 1.5

Total Protein g/L 60 - 82

Albumin g/L 35 - 50

Iron umol/L 10 - 33


Cholesterol mmol/L <30 yrs 3.1 - 6.531-40 yrs 3.6 - 6.741-50 yrs 3.6 - 6.951-60yrs 3.9 - 7.4>60yrs 3.6 - 7.3

TriglycerideFasting mmol/L <30 yrs 0.2 - 1.9

31-40 yrs 0.3 - 2.241-50 yrs 0.3 - 2.351-60yrs 0.3 - 2.3>60yrs 0.3 - 2.2

Random 0.0 - 4.0

HDL Chol. High Risk Patients

mmol/L > 1.00

LDL Chol. High Risk Patients

Diab. or ATSIC Patient

Without other risk

factor

mmol/L

<2.0

<2.6

<6.0

CRP mg/L 0 - 6

Transferrin g/L 1.7 - 3.4

RheumatoidFactor IU/L

Up to 14(>14 to

IMM for RW)

Ferritin ug/L B 0-15 yrs 10 - 140M >15 yrs 20 - 320F >15 yrs 10 - 290

gluCose toleranCe testTherevisedcriteriaforthediagnosisofimpairedglucosetoleranceanddiabetesmellitusasrecommendedbyaWorkingPartyoftheAustralianDiabetesSociety,TheAustralasianAssociation of Clinical Biochemists and the Royal College of Pathologists of Australasia (1999) are as follows:

diagnostic values of the oral glucose tolerance test

glucose Concentration, mmol/l

Venous plasma

Capillary plasma

Venous whole blood

Capillary whole blood

Impaired Fasting Glucose (IFG)

Fasting

2 hr after glucose load

>6.0and<7.0

<7.8

>6.0and<7.0

<8.9

>5.5and<6.1

<6.7

>5.5and<6.1

<7.8

Impaired Glucose Tolerance (IGT)

Fasting


<7.0

7.8 - 11.0

<7.0

8.9 - 12.2

<6.1

6.7-9.9

<6.1

7.8 - 11.0

Diabetesmellitus

Fasting value


>6.9

>11.0

>6.9

>12.1

>6.0

>9.9

>6.0

>11.0

gestational diabetes Carbohydrateintoleranceisrecognisedtoposeariskduringpregnancyandshouldbedetected if present and treated appropriately. The term gestational diabetes mellitusapplies to all degrees of carbohydrate intolerance (to include both the categories ofimpairedglucosetoleranceanddiabeticresponse).

TherecommendationsoftheAdHocWorkingPartytotheNHMRC(1991)areasfollows:

recommendations for the screening and diagnosis of glucose intolerance in pregnancy - gestational diabetes

•Allpregnantwomenshouldbescreenedforabnormalglucosetolerancebetween 26and28weeksgestation.Theplasmaglucoselevelshouldbemeasuredone hour after either a 50g or a 75g glucose load given in a non-fasting state. A value of ≥ 7.8mmol/L after a 50g load or ≥ 8.0mmol/L after 75g is regarded as positive. Womenwithpositiveresultsshouldreceiveafullglucosetolerancetest.


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bytheadministrationinthefastingstateofa75goralglucosetolerancetest(OGTT). A fasting plasma glucose level of ≥ 5.5mmol/L and/or a two hour plasma glucose level of ≥8.0mmol/Larediagnosticofgestationaldiabetes.

•Theserecommendationsmustnotprecludeconfirmationofdiabeteswitha75gOGTTat any stage of pregnancy if there are clinical features to suggest the diagnosis.

•Threemonthsafterdelivery,womenwithgestationaldiabetesshouldhavearepeat75gOGTT.ThisshouldbeevaluatedbystandardWorldHealthOrganisationcriteriaforthenon-pregnantstate.Womenwhodonothavediabetesmellitusatthistimeshouldstillbeconsideredas‘atrisk’fordevelopingdiabetesmellituslaterinlife.

Procedure for diagnosis of gestational diabetes

IndicationOptimal

Gestation WeeksTest Performed

Diagnosis Criteriavenous plasma

glucose level (mmol/L)

Clinical suspicion Anytime 75g OGTT (fasting)Fasting ≥ 5.5 or2 hours ≥ 8.0

Screening 26-28

50g glucose load(non-fasting) or

75g glucose load(non-fasting)

1 hour ≥ 7.8

Confirmation of diagnosis after positive

screening test

26-30 75g OGTT (fasting)Fasting ≥ 5.5 or2 hours ≥ 8.0

dietary restriCtions and sPeCial diets

general fasting

Onthenightbeforethetest:•Nofoodistobeeatenfor8hourspriortoorduringthetest,howeverthefasting

periodshouldnotbeinexcessof16hours•Watermaybeconsumed(recommendedintake-slightlymorethanusual)•Nootherfluid(includingalcohol)maybeconsumed•Arecordofcurrentmedicationisrequired.

Theseinstructionsshouldbeadheredtounlessadvisedotherwise.

glucose tolerance test

An appointment is required for this test. The patient should phone their nearest QML Pathology collection centre to make arrangements. A list of collection centres and phonenumberscanbefoundonthereversesideoftherequestform.

Preparation

For three days prior to the test the patient should have an adequate intake of carbohydratesequivalenttothefollowing(asaminimum)eachday:

•4 slices of bread, 1 plate of cereal and 2 medium potatoes. If the patient is on areduced, special or low-calorie diet, please inform the collection centre staff.

on the night before the test

•Itisimportantforthepatienttoeatanormaldinner,however,nottoeat,chewgumordrinkanyfluids(exceptwater)foratleast8hoursbeforethetest.Itispreferabletheydo not fast for more than 12 hours.

•Watermaybeconsumed(recommendedintake-slightlymorethanusual).

•Thepatientshouldrecordtheirheightandweight.

•Recordanyrecentandcurrentmedication.

on the morning of the test

•Thepatientshouldbringtheirlistofmedications,andheightandweightdetailswiththem.

•Thepatientshouldnotphysicallyexertthemselfpriortoorduringthetest (includingbriskwalkingtotheclinic).

•Thepatientshouldavoidsmokingforanhourpriortoandduringthetest.Ifthisisnotpossiblethenpleaseinformstaff.

•Thepatientisrequiredtobringaspecimenofurine,however,theyshouldnotbringthefirst specimen of the morning.

The test will take approximately 2.5 hours (half an hour rest prior to test and two hours testtime).Onsomeoccasionsthelengthofthetestmaybeextended.

urine Collection diet for 5hiaa & Catecholamine

A variety of drugs and foods are known or are reported to interfere with this particular test. Therefore,theintakeofthefollowingitemsshouldberestrictedforthreedayspriortoandduring the urine collection:

•Alcohol •Paracetamol.

the following drugs are also known to interfere with the test:

•Chlorpromazine •Imipramine(Tofranil)

•Promazine •Otheranti-depressants

•Promethazineandotherphenothiazinederivatives

•Isoproterenol •Methocarbamol(Robaxin)

•L-DOPA •MonoamineOxidaseInhibitors(Trandate).

The patient should not restrict or cease thesedrugsunless advisedby their referringdoctor.Pleasenote theabove listofdrugs isnot fullycomprehensive. If the patient is currentlytakinganyoftheabovedrugs,theyshouldlistthesetogetherwithafullaccountof any other medications.

food

These food items are known to contain significant quantities of serotonin (a precursor of 5HIAA)andshouldbeexcludedfromthedietforthethreedayspriortoandincludingthedayof collection:

•Avocado •Plum

•Banana •Tomato

•Coffee •Walnutsandpecans

•Eggplant •(Briefly-avoidfruitandnuts).

•Pineapple

Smoking may also produce a false positive result. The patient should reduce their tea and coffee intake for three days prior to and including the day of collection.

low Purine diet

If your patient requires a 24 hour urine collection for uric acid, you may choose for them tofollowthedietbelowforthreedayspriortotheircollection:

avoid the following:

•Organmeats(brain,kidney,liver) •Greenpeas,driedlegumes

•Wildgame •Cauliflower

•Poultry(chicken,duck,turkey) •Asparagus

•Meat(beef,lamb,pork,veal) •Spinach

•Meatextracts(Bonox,Vegemite) •Mushrooms

•Fish •Aspirin

•Shellfish •Cocoa.

•Wholegrainproducts

the following are acceptable for a low purine diet:

•Fruits

•Fruitjuices

•Vegetables(exceptthoseabove)

•Nuts

•Cereals,breads(exceptwholegrainproducts)

•Sweets

•Beverages(coffee,tea,carbonated)

•Fats

•Eggs

•Cow’smilk

•Dairyproducts.


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Qualitative urine drug sCreenThis list represents the drugs of greatest interest to the clinician and those most readily detected.

note:

1. Several categories of drugs are poorly detected. These include oral hypoglycaemics, mostdiureticsandanabolicsteroidagents.

2.Somedrugsareundetectablebyroutinescreeningprocedures.Thisgroupincludesinsulin, digoxin and lysergic acid diethylamide (LSD).

Over500drugsarelistedintheidentificationlibrary.Ifyouareconcernedaboutaspecificsubstance, or if the drug of interest is not listed please convey this to the laboratoryeither on the request form, or if the matter is sensitive or puzzling please contact Biochemistry(0731214083)orthenearestbranchlaboratory.Ifnecessaryothertestingcanbearranged.Thelistisnotstaticwithnewdrugsbeingcontinuallyaddedandolddrugsdeletedastheybecomeunavailable.Pleaserefertoouronlinereferencemanual www.qml.com.au for an updated list of drugs.

Alcohol/Ethanol AmitriptylineandmetabolitesAmobarbital/AmylobarbitoneAmphetamine AmylobarbitoneBarbiturates(genericscreen)Benzhexol BenzodiazepinemetabolitesButabarbitalCaffeine Cannabinoids/TetrahydrocannabinolCarbamazepineandmetabolitesCarisoprodolChlordiazepoxideChlorpheniramineChlorpromazineandmetabolitesCimetidineCocaineCodeineDesipramineDextromethorphan Diflunisal Dihydrocodeine Dilantin

Dimenhydrinate Diphenhydramine Dothiepin DoxepinandmetabolitesDoxylamine Ephedrine/Pseudoephedrine Erythromycin Ethanol Fenoprofen Flunitrazepam Fluoxetine Flurazepam Glutethimide Haloperidol Hydrocodone IbuprofenImipramineandmetabolitesKetamine Lignocaine (Lidocaine) MDMA (Ecstasy) Mefenamic acid MeprobamateMethadoneandmetabolitesMethamphetamine

Methaqualone MethocarbamolMethoxyphenamineandmetabolitesMethylprednisolone/Prednisolone Metoprolol 6-monoacetylmorphineMorphine NaproxenNicotineandmetabolitesNortriptylineOrphenadrine Oxazepam Oxycodone Paracetamol PentobarbitalPethidine Phenacetin Phencyclidine Pheniramine PhenobarbitalPhenolphthalein Phenothiazinemetabolites

Phentermine Phenylpropanolamine Polyethylene glycol Procyclidine PromazineandmetabolitesPropoxypheneandmetabolitesPropranolol Pseudoephedrine/Ephedrine Pyrilamine Quinine/Quinidine Ranitidine SpironolactoneandmetabolitesStrychnine SympathomimeticaminemetabolitesTemazepam Tetrahydrocannabinol/cannabinoidsTheophylline Timolol Trimethoprim TrimipramineandmetabolitesVerapamilandmetabolitesXylocaine/Lignocaine.


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Absorption PeakDrug

(Generic Name)Serum

Half-life (hrs)After Oral Dose (hrs) Therapeutic Range Assay

Frequency

Dothiepin 24(11-32) 3 50-200 ug/L WeeklyDoxepin 15(8-25) 2 10-120 ug/L Weekly

Imipramine* 14(6-20)* 4 100-300 ug/L WeeklyNortriptyline 27(15-90) 5 50-170 ug/L WeeklyTrimipramine 7.2(4-14) 2.5 90-150 ug/L Weekly

OthersCyclosporin 6-10 1-8 HPLC-100-300 ug/L** On demand

> 10 with liver transplant TDx - 135-400 ug/L**Lithium 17-58 1 0.5-1.0 mmol/L Daily

Methotrexate 2 1-5 @ 24hr < 5 umol/L On demand2 @ 48hr < 0.5 umol/L2 @ 72hr < 0.1 umol/L

Paracetamol 1-3 1-3 10-20 mg/L On demandSalicylate 0.5-1 2 150-300 mg/L Daily

Theophylline 5(3-9) 2-4 10-20 mg/L Daily

note: (i)ForIVantibioticadministrationpeakbloodleveloccursattheendofinjection/infusion.(ii)ForIMinjectionpeakbloodleveloccurs30–60minutesafterinjection.(iii)Troughlevelsshouldbemeasuredjustpriortonextdose.*Indicatesapotentialofunexpectedtoxicityfromamajoractivemetabolitewitha

half-life longer than the parent drug. ** Values differ with method of assay.


Quantitative drug assays for theraPeutiC monitoring

Absorption PeakDrug

(Generic Name)Serum

Half-life (hrs)After Oral Dose (hrs) Therapeutic Range Assay

Frequency

AntibioticsAmikacin 1.9-2.8 NA Trough < 5 mg/L Peak up to 25 mg/L On demand

Gentamicin 1.3(1-3) NA Single Daily dose peak up to 25 mg/L*** On demandTobramycin 3(2-4) NA Trough < 1 mg/L Peak up to 10 mg/L On demandVancomycin 3-8 NA Trough < 15 mg/L Peak up to 45 mg/L On demand

AnticonvulsantsCarbamazepine 31(18-65) 5(2-8) 8-12 mg/L DailyEthosuximide 54(48-60) 3(1-4) 40-100 mg/L DailyMethsuximide* 1.4(0.7-2.6)* 1 10-40 mg/L On demandPhenobarbitone 48-120 6-18 15-40 mg/L Daily

Phenytoin 18-24 8(3-10) 10-20 mg/L DailyPrimidone* 6-22* 4 5-12 mg/L DailySulthiame 8-12 mg/L WeeklyValproate 8-12 1-4 60-100mg/L Daily

BenzodiazepinesClobazam 18 1-2 200-400 ug/L Weekly

Clonazepam 19-42 1-4 25-75 ug/L WeeklyChlorazepate 100-200 ug/L Weekly

Diazepam 21-37 1 400-1500 ug/L WeeklyFlunitrazepam 19(9-25) 2 Up to 20 ug/L WeeklyNitrazepam 25-28 2 30-100 ug/L WeeklyOxazepam 5-6 1.5 200-1400 ug/L Weekly

Temazepam 7-8 0.5-1.5 80-200 ug/L WeeklyCardio-active

Amiodarone 2.5-10 5(3-6) 1.0-2.5 mg/L Referred Digoxin 36(30-45) 1-3 0.5-2.0 ug/L Daily

Disopyramide 5-6 1-3 2.0-5.0 mg/L DailyFlecainide 12-27 3(1-6) 0.2-1.0 mg/L DailyLignocaine 0.7-2.0 0.5-2 1.5-5.0 mg/L DailyMexilitine 9(8-17) 2-4 0.8-2.0 ug/L Referred

N-Acetylprocainamide 6-7 2-4 Summed with procainamide DailyProcainamide 2-5 1 5.0-30.0 mg/L Daily

Quinidine 5-12 1-4 1.3-5.0 mg/L DailyTricyclic

AntidepressantsAmitriptyline 15(9-25) 2-4 60-250ug/L Weekly

Clomipramine 23(12-36) 4 100-300 ug/L ReferredDesipramine 22(12-54) 3-6 40-150 ug/L Weekly

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Poisons and toxiC substanCes used in Pest Control

herbicides/Weedicides

•Phenoxyaceticacidgroup(2,4-D;2,4,5-T;MCPA;Triclopyr) (assay: random urine).

•Glyphosate(Roundup;Zero) (assay: urine specimen collected at the end of work shift or exposure).

•Paraquat/Diquat(truetoxicityirreversiblylethal-assaydifficulttoarrange).

Pesticides/insecticides

•Organochlorines(DDE;DDT;Endosulfan;Dieldrin/Endrin/Aldrin;Chlordane;Heptachlor;Lindane)(assay:blood/lithiumheparintube).

•Organophosphates(Chlorpyrifos;Malathion;Parathion) (assay: serum/red cell cholinesterase).

•Carbamates(Carbaryl)(assay:serum/redcellcholinesterase).

•SyntheticPyrethroids(assay:blood/lithiumheparintube).

•Arsenic (assay:blood/lithiumheparintube;longtermexposure-hairandnailclippings).

fungicides

•Dithiocarbamates(Zineb;Maneb;Mancozeb)(assay:serum/redcellcholinesterase).

•HCB(Hexachlorobenzene)-organochlorine(assay:blood/lithiumheparintube).

rodenticides

•Coumarinderivatives(assay:prothrombintime).

•Strychnine(assay:blood/fluorideoxalatetube).

molluscicides

•Metaldehyde(noassayavailable).

Time Since Dose Range (mg/L)

lessthan6hours greater than 5.0 mg/L

6hours 7.0 mg/L

7 hours 5.7 mg/L

8 hours 4.5 mg/L

9 hours 3.5 mg/L

10 hours 2.8 mg/L

11 hours 2.2 mg/L

12 hours 1.7 mg/L

13 hours 1.3 mg/L

14 hours 1.1 mg/L

16hours less than 0.7 mg/L

18 hours less than 0.4 mg/L

20 hours or greater less than 0.3 mg/L

(FromAntibioticGuidelines,9thed.1996-97)

reCommended levels for single daily dosage regime for gentamiCin


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Primary metabolic acidosis with respiratory Compensation

Examine the anion gap

1. raised anion gap i) Phosphate and sulphate accumulation in renal failure. ii) Ketoacidgenerationininsulin-dependentdiabetesmellitus. iii) Lactate accumulation in shock, liver disease, or exertion. iv) Accumulationofanacidictoxin,drug,ordrugmetabolite

e.g. in salicylate overdose. v) Accumulation of an unusual organic acid form inherited blockage of metabolic

pathway e.g. methylmalonic acid.

2. normal anion gap i) Entericbicarbonateloss-biliaryorpancreaticdrainage. ii) Chloride excess - rapid I.V. infusion of normal saline or urine chloride

reabsorption(ureterosigmoidostomy,ilealconduit). iii) Renalbicarbonatelossfromeffectivehypoaldosteronism(Adrenocorticalfailure,

Spironolactone therapy, aldosterone receptor defect). iv) Renalbicarbonatelossfromatubularresorptivedefect(Renaltubularacidosis,

Fanconisyndrome,carbonicanhydraseinhibitortherapy).

Incategories i) and ii), theurinepHwillbe less than5.0, in iii), thepHwillbe6.5or greater, and in iv) the pH will vary depending on the site of the resorptive defect (proximalordistaltubular)andthestateofcompensation.

Primary respiratory acidosis

Examine the base excess

1. respiratory acidaemia with normal base excess Acuterespiratoryfailure,airwayobstructionorasphyxia.

2. respiratory acidaemia with raised (+) base excess Longstandingorchronicrespiratoryacidosis(e.g.chronicobstructivelungdisease)

withmetaboliccompensation.

3. Combined respiratory and metabolic acidosis (low (-) base excess) Seen almost exclusively as a preterminal event.

Primary metabolic alkalosis with respiratory Compensation

Examine the urinary ph

1. alkaline urinary ph (ph 7.5 - 8.2) This indicates gastrointestinal loss of acid. i) Protracted vomiting. ii) Long-term nasogastric suction or gastric fistula.


aCid-base analysisThevalueofarterialbloodgasesinassessingpulmonarygasexchangeiswellestablished.However,bloodgasanalysis(arterialorvenous)mayalsoplayakeyroleinassessingtheacid-base balance of the body. An easy approach to interpretation of this function ispresentedbelow.

interpreting acid-base balance from the blood gas Profile

pH pCO2LOW

Acidaemia

LOW Primary Metabolic Acidosis with Respiratory Compensation

1. Raised Anion Gap - Fixed or organic acid accumulation

2. Normal Anion Gap - Bicarbonate loss, Chloride excess

Primary Respiratory Acidosis

1. Normal Base Excess - Acute Respiratory Acidosis

2. Raised (+) Base Excess - With Metabolic Compensation

3. Lowered (-) Base Excess - Combined Respiratory and

Metabolic Acidosis

RAISED

Primary Metabolic Alkalosis with Respiratory Compensation

1. Urine pH > 7.4 - Gastrointestinal acid loss

2. Urine pH < 7.4 - Urinary acid loss

pCO2RAISED

Alkalaemia

RAISED

LOWPrimary Respiratory Alkalosis

1. Normal Base Excess - Acute hyperventilation

2. Lowered (-) Base Excess - Hyperventilation with compensation - Salicylate Therapy

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2. relatively acidic ph (ph 5.2 - 7.3) This indicates renal over secretion of acid. i) Endogenous mineralocorticoid excess - adrenal or pituitary tumour. ii) Hypokalaemia - renal potassium conversation is tied to hydrogen ion dumping. iii) Exogenous steroid administration.

Primary respiratory alkalosis

Examine the base excess

1. respiratory alkalaemia with normal base excess Thisacuteuncompensatedrespiratoryalkalaemiapatterniscommon,beingseenin

anxiety-associated hyperventilation (which may accompany mild asthma, mild chest or throat constriction or pain).

2. Primary respiratory alkalaemia with low (-) base excess The metabolic compensation in this case indicates a more prolonged state of

hyperventilationusuallyassociatedwithrespiratorycentrestimulation (e.g. bymildhypoxiainpneumonia,byprotractedmildairwayobstruction,orbypainoranxiety)or with overriding of normal respiratory control e.g. with mechanical ventilation. Respiratory centre stimulation seen with high therapeutic doses of aspirin is an interesting and not uncommon cause.

liPids

Pbs eligibility Criteria for Cholesterol lowering drugs from 1 april 2006

Patientsidentifiedasbeinginoneofthefollowingveryhigh-riskcategoriesmaycommencedrugtherapywithstatinsorfibratesat any cholesterol level:

• Coronaryheartdiseasewhichhasbecomesymptomatic

• Cerebrovasculardiseasewhichhasbecomesymptomatic

• Peripheralvasculardiseasewhichhasbecomesymptomatic

• Diabetesmellituswithmicroalbuminuria(definedasurinaryalbuminexcretionrateof>20µg/minorurinaryalbumintocreatinineratioof>2.5formales,>3.5forfemales)

• DiabetesmellitusinAboriginalorTorresStraitIslanderpatients

• Diabetesmellitusinpatientsaged60yearsormore

• Familyhistoryofcoronaryheartdiseasewhichhasbecomesymptomaticbeforetheage of 55 years in two or more first degree relatives

• Familyhistoryofcoronaryheartdiseasewhichhasbecomesymptomaticbeforetheage of 45 years in one or more first degree relatives.

PATIENT CATEGORY LIPID LEVELS FOR PBS SUBSIDY

Patientswithdiabetesmellitus not otherwise included

Total cholesterol > 5.5mmol/L

Aboriginalor Torres Strait Islander patients

Patients with hypertension

Totalcholesterol>6.5mmol/LorTotal cholesterol > 5.5mmol/L andHDL cholesterol < 1mmol/L

Patients with HDL cholesterol <1 mmol/L

Totalcholesterol>6.5mmol/L

Patients with familial hypercholesterolaemiaidentifiedby:•DNAmutation;or•Tendonxanthomatainthepatientora

first or second degree relativePatients with:•Familyhistoryofcoronaryheartdisease

whichhasbecomesymptomaticbeforetheageof60yearsinoneormorefirstdegreerelatives;or

•Familyhistoryofcoronaryheartdiseasewhichhasbecomesymptomaticbeforethe age of 50 years in one or more second degree relatives.

If aged 18 years or less at treatment initiation:LDL cholesterol > 4mmol/L

If aged more than 18 years at treatment initiation:LDL cholesterol > 5mmol/LorTotalcholesterol>6.5mmol/LorTotal cholesterol > 5.5mmol/L andHDL cholesterol < 1mmol/L

Patientsnoteligibleundertheabove:•Menaged35to75years•Post-menopausalwomenagedupto

75 years.

Total cholesterol > 7.5mmol/LorTriglyceride > 4mmol/L

Patients not otherwise included Total cholesterol > 9mmol/LorTriglyceride >8mmol/L


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after at least six weeks of dietary therapy:

APPENDICES - ENDoCrINoLoGy

laboratory testing: PregnanCy timeline

4 - 12 weeks hCg-OverdueLMP.HCGusuallypositiveby10-14dayspostconception. If negative, repeat after several days.fbCiron studiesblood group and antibodies - (If patient is Rh negative see 12.25 for complications in pregnancy)hepbsag, treponemal serology and eia rubella+/- hep C+/- msuvitamin d-Fastingpreferablebutnotessentialtsh - If clinically indicatedhiv-AtDoctor’sdiscretion

11 - 13 weeks first trimester screen (free hCg, PaPP-a) -ResultscombinedwithNTtogiveDownSyndromerisk.AFPnotincludedinthistest,considerat15-18weeks.(Note:ThewindowforNuchalTranslucencyscreeningis11½-13weeks6days).Biochemistrycomponentnowavailablefrom8weeks,providingadatingultrasoundisavailable.Cvs - FISH Anueploidy testing: Rapid test for aneuploidy of chromosomes 13, 18, 21,XandYperformedoncellsobtainedfromCVSsample.Resultsareavailablewithin24-48hoursbutresultsshouldbeconsideredinteriminnatureuntilconfirmedbyfullfetal karyotype analysis.-Fetalkaryotype:PerformedonculturedChorionicVillimaybeofferedforfollowupofhigh risk FTS results or other clinical indications. Allow 10-14 days for fetal karyotype. -DNAtestingmayalsobeofferedforcertaininheritedgeneticconditions. discuss with o&g specialist.

15 - 18 weeks afP-Forneutraltubedefects.OffertopatientswhohadFirstTrimesterScreen.Please note: If the patient has the Triple Test then AFP is already included.triple test/mss (afP, free oestriol, total hCg) - For Down Syndrome and NTDrisk.IfhadFTS,thisisnotaMedicarerebatabletest.amniocentesis - FISH Aneuploidy testing: Rapid test for aneuploidy of chromosomes13,18,21,XandYperformedonfetalcellsobtainedfromamniocentesis.Resultsareavailablewithin24-48hoursbutresultsshouldbeconsideredinteriminnatureuntilconfirmedbyfullfetalkaryotypeanalysis.- Fetal karyotype: Analysis for follow up of high risk FTS results or other clinical indications. Allow 10-14 days for fetal karyotype result.-DNAtestingmayalsobeofferedforcertaininheritedgeneticconditions. discuss these tests with o&g specialist.

18 - 20 weeks anomaly scan-ImportantfollowupofhighAFPorhighriskNTDresults.

26 - 28 weeks glucose Challenge in Pregnancy-Non-fasted,50grams,1hourglucosetest. Follow up results of glucose challenge - if increased do a 2hr GTT. If GTT is positivethenGestationalDiabetesisconfirmed.Retest3monthspostpartum.fbCblood group and antibodiesiron studies - (If indicated)

28 weeks rh (d) negative -AntiDprophylaxisifantibodynegative

(see complications in pregnancy for Rh (D) negative women).

34 weeks rh (d) negative -AntiDprophylaxisifantibodynegative

See complications in pregnancy for Rh (D) negative women (12.25).

35 - 37 weeks blood group and antibodies - See complications in pregnancy for Rh (D) negative women (12.25).low vaginal swab-ConsiderforGroupBStrep+/-RectalSwab.

38 weeks fbCblood group and antibody screen

Post Partum rh negative - Fetomaternal haemorrhage test and Anti D.tsh - 7-30 days post partum (If Thyroiditis was present earlier in the pregnancy).iron studies - Follow up if iron levels are low during pregnancy.fbC - Consider for history of excessive tiredness.newborn screening blood spot (Pku)-Heelpricktestonbaby-preferredtime of sample collection is 48 - 72 hours post-partum.

ComPliCations in PregnanCy

• Sensitising Events:Foreachsensitisingevent,performFMHtestandadministerRh(D)immunoglobulin.

Sensitising events include:-Normaldelivery - Ectopic pregnancy - Miscarriage - Termination of pregnancy - Genetic studies such as chorionic villus sampling, amniocentesis, cordocentesis-Abdominaltraumasufficienttocausefetomaternalhaemorrhage - External cephalic version - Antepartum haemorrhage.

• Threatened Miscarriage: - Perform serial Quantitative HCG and Progesterone. Discuss with Chemical

Pathologist if required and consider ultrasound scan.

• Ectopic Pregnancy: - HCG: insufficient rise or fall in HCG. Discuss with Chemical Pathologist if required - Progesterone - Ultrasound.

• Recurrent Pregnancy Loss: - Products of conception for fetal karyotype - Parental chromosomes-Haematological/Immunologicaltests:ThrombophiliaScreen(ATIII,ProteinCandS,

aPCR,LupusAnticoagulant,AntiCardiolipinantibodies,Homocystine,ProthrombinGene).DiscussresultswithObstetricianorClinicalHaematologist

-ANA.

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• Rh (D) Negative Women:-AllpatientsundergoBloodgroupandRhtype,togetherwithantibodyscreenatinitial

pregnancy testing-IfpreviouspregnancyaffectedbyRhesusdisease/haemolyticdiseaseofthenewborn,

orpresenceofanti-Dantibodiesorotherantibodies,consultwithspecialistobstetrician-Checkantibodyscreenat28and34weeks-Ifantibodyscreennegativeandinfirstpregnancy,give:625IU(125µg)ofRh(D)

Immunoglobulinat28and34weeks(iMI)-Postpartum:625IU(125µg)minimumofRh(D)Immunoglobulinpostpartumwithin

72 hours (iV), together with testing for fetomaternal haemorrhage (Kleihauer test or flowcytometry)ifcordbloodisRhpositive

-Forpossiblefetomaternalhaemorrhage-Rh(D)Immunoglobulinwithin72hours,together with testing for fetomaternal haemorrhage (Kleihauer test) 1st Trimester 250 IU(50µg).Beyond1stTrimester625IU(125μg).

further advice regarding investigations, management and administration of products should be sought from a haematologist.

This information has been prepared and published by QML Pathology for the information of referring doctors. Although every effort has been made to ensure that it is free from error or omission, readers are advised that the information is not a substitute for detailed professional advice.


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Polycystic ovarian syndrome (PCos) is common (? 1 in 5-10); rest are rare

1) exclude uncommon Causes: - history - Course - appearance.

• Prolactin Mid-morning Prolactin•Hypothyroidism TSH•Cushing’s ACTHandCortisol•Adrenal,OvarianTumours DHEAs,Inhibin,(UrineSteroidProfile)•Lateonset,PartialAdrenalHyperplasia, Hydroxy-Progesterone 1in100(NewYork) ? 1 in 1000 - 10,000 (Australia)

2) look for features of Polycystic ovarian syndrome (PCos)

•LH>FSH,yetOestradiolnothighenoughtoovulate(<170)•Lowsexhormonebindingglobulin(SHBG)•Highandrogens/precursors Testosterone,DHEAs,Androstenedione•Insulinresistance-?postprandialonly

- ? fasting as well•Ultrasoundofovaries:‘Stringofpearls’appearance

-Uniformcysts3-6mmperipherally

3) suggestions•Mid-morning-LH,FSH,Oestradiol,Testosterone,SHBG,Glucose,Insulin,DHEAs•Options-TSH,ACTH,Cortisol,Prolactin,OHP•24hrurinesteroidprofile•Ultrasoundofovaries

For further information contact Dr Kerry DeVoss, Pathologist (07) 3121 4412

Polycystic ovarian syndrome (PCos)

Comparison of Ovaries

Normal Ovary Polycystic Ovary‘String of Pearls’ effect


reCommended age guidelines for men’s health testing

age: 30’s 40’s 50’s 60’s 70’s 80’s

male sPeCifiCissues:

Infertility ErectileDysfunction

↓ Energy

Gout

ProstateProblems

Cancers:(Lung,

Colorectal, Prostate etc.)

Common Causes

of death:

CardiovascularStrokeCancer (Lung, Colorectal, Prostate)

tests: Semen

Glucose

Iron

LH

FSH

Testosterone

Prolactin

(?Thyroids)

(?Cortisol)

( )

( )

Cholesterol

Triglycerides

LDL

HDL

Bilirubin

HS-CRP

Homocysteine

Uric Acid

( )

( )

PSA

(baseline)

( )

( )

PSA

(periodic)

( )

( )

PSA

?CEA

?CA19.9

( )

( )

( )

( )

( )

( )

PSA

?CEA

?CA19.9

Note:?=considerifclinicallyappropriate

For further information please contact: Dr Kerry DeVoss (07) 3121 4412 or Dr Charles Appleton (07) 3121 4512

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APPENDICES - GENEtICS

CytogenetiC tests - tissues examined and rePorting times

tissue Cell Cultured rePorting timeabnormalities

deteCted

Blood (Constitutional)

(Oncology)

Lymphocytes

Blast cells

2-3 days (newbornbabies)

14 days (routine)

2 days (diagnostic)

7-14 days (routine)

Constitutional (numerical and structural)abnormalities

Acquiredabnormalitiesrelated to the leukaemic process

Bone Marrow Myeloid disorders Lymphoid disorders

24-48 hours (diagnostic CML, ALL, AML)

7-14 days (routine)

Acquiredabnormalitiesrelated to the leukaemic process

Amniotic Fluid Fetal epithelium 10 days Antenatal diagnosis of chromosomal abnormalities

Chorionic Villi Trophoblastandmesodermal fibroblasts

10 days Antenatal diagnosis of chromosomal abnormalities

Prenatal FISH for rapid aneuploidy screening

Culture not required, direct analysis of amniocytes or trophoblastcells

24 hours Aneuploidy for chromosomes 13,18, 21, X and Y

Skin and Fetal Tissues

Fibroblasts from dermis, chorionic villi, membrane,etc.

14 days Mostly numerical abnormalities.Somestructuralabnormalities

Tumour Variable 14 days Acquiredabnormalitiesrelated to the neoplastic process

note:Allabnormalamnioticfluidandconstitutionalresultsarephonedtothereferringdoctor.Abnormalbonemarrow,tissueandtumourresultsarephonedatthediscretionof the Genetics supervisor.

moleCular genetiC tests – samPle reQuirements and rePorting times

test rePorting time samPle reQuired

Hereditary Haemochromatosis

3 days Peripheral Blood EDTA

Factor V Leiden/ProthrombinG20210A


Methylenetetrahydrofolate Reductase (MTHFR)


Apolipoprotein E 7 days Peripheral Blood EDTA

Fragile X (FRAXA) 7 days Peripheral Blood EDTA

Y Chromosome Microdeletion Studies


HLA-B27 3 days Peripheral Blood EDTA

Clostridium Difficile 2 days Faecal sample

Cat Scratch Disease 2 days Swabofinfectedsite Tissue

Malarial Parasite Detection 3 days Peripheral Blood EDTA

BCR-ABL RQ-PCR 7-14 days Peripheral Blood EDTABone Marrow Aspirate

JAK2 7-14 days Peripheral Blood EDTABone Marrow Aspirate

B and T cell Gene Rearrangement Studies

7-14 days Peripheral Blood EDTABone Marrow AspirateFresh TissueParaffinembeddedtissue

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APPENDICES - hAEmAtoLoGy

initiating Warfarin theraPyWhen initiatingwarfarin therapy the loadingof doses shouldbe avoided as it causesearlyprocoagulanteffects,andoscillatingINRsthattakelongertostabilisethanasteadyincrease in dose.

QMLPathologyusesaformulathat factors ineachpatient’sageandweighttoderivean individual dose. The formula gives us the Estimated Maintenance Dose (EMD) as demonstratedbelow.

E.g.fora75kg,60yearold

EMD= [75x(100-60)]= [75x0.4]=5.4mg 100

5mgistherecommendedstartingdose;however,thechoiceofstartingdosemayneedtobemodifiedforanumberofreasons,suchasthepatient’scurrentmedications,whichmay interact with warfarin (see upcoming section).

range of target inrs

AVR = Aortic Valve Replacement; MVR = Mitral Valve Replacement; AF= Atrial Fibrillation; DVT=DeepVenousThrombosis;PE=PulmonaryEmbolism.

* (other than Medtronic Hall)

RF–RiskFactors=includeAF,previousthromboembolism,LVdysfunction,andhypercoagulablecondition. ✝ - depends on strength of anticardiolipin or lupus anticoagulant.

EMD = square root of [ weight x (100-age) ]

100

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oGybasiC haematology Parameters

Haemoglobin g/L RCC x1012/L HCT MCV fL MCH pg

Cord 135-200 3.9-5.5 0.42-0.60 98-118 31-37

Day 1-3 145-225 4.0-6.6 0.45-0.67 95-121 31-37

Day 4-7 135-215 3.9-6.3 0.42-0.66 88-126 28-40

Day 8-14 125-205 3.6-6.2 0.39-0.63 86-124 28-40

Day 15-Week 7 100-180 3.0-5.4 0.31-0.55 85-123 28-40

Week 8-13 90-140 2.7-4.9 0.28-0.42 77-115 26-35

Month 3-6 95-135 3.1-4.5 0.29-0.41 74-108 25-35

Month 7-Year 2 105-135 3.6-5.3 0.33-0.39 70-86 23-31

Year 3-6 115-135 3.6-5.3 0.33-0.40 75-88 24-31

Year 7-14 115-155 3.6-5.2 0.33-0.45 78-95 26-34

15-99 Female 115-160 3.6-5.2 0.33-0.46 80-98 27-35

15-55 Male 135-180 4.2-6.0 0.38-0.52 80-98 27-35

56-70 Male 130-180 4.0-6.0 0.36-0.52 80-98 27-35

71-999 Male 125-180 3.8-6.0 0.34-0.52 80-98 27-35

MCHC (AllAges)310-365

RDW (All Ages) 11.3 - 15.5

Note:Inpregnancy,haemoglobinsdownto105g/Larequitecommon.

leuCoCyte referenCe ranges

WCC x109/L Neut x109/L Lymph x109/L Mono x109/L Eos x109/L

Cord 6.0-22.0 0.5-12.5 2.0-9.0 0.2-2.5 0.1-1.0

Day 1 9.0-34.0 5.0-21.0 2.0-11.0 0.2-2.5 0.1-1.0

Day 2-7 5.0-21.0 1.5-10.0 2.0-17.0 0.2-2.5 0.1-0.8

Day 8-14 5.0-20.0 1.0-9.0 2.5-16.5 0.2-2.0 0.1-0.6

Week 8-Month 6 6.0-17.5 1.0-8.5 4.0-13.5 0.2-1.8 0.1-0.6

Month 7- Year 1 6.0-17.5 1.5-8.5 4.0-10.5 0.2-1.5 0.1-0.6

Year 2 6.0-17.0 1.5-8.5 3.0-9.5 0.2-1.5 0.1-0.6

Year 3 and 4 5.5-15.5 1.5-8.5 2.0-8.0 0.2-1.5 0.1-0.6

Year 5 and 6 5.0-14.5 1.5-8.0 1.5-7.0 0.2-1.5 .04-0.6

Year 7-10 4.5-13.5 1.5-8.0 1.5-7.0 0.2-1.2 .04-0.6

Year 11-16 4.5-13.0 2.0-8.0 1.5-5.0 0.2-1.0 .04-0.4

Year 17-999 4.0-11.0 2.0-7.5 1.1-4.0 0.2-1.0 .04-0.4

Basophils (All Ages) 0-0.20 x109/L

Note: In pregnancy white cell counts up to 15.0 x109/L are quite common.

Platelet referenCe ranges

Indication INR Indication Type valve RF INR

AF 2-3 AVR Bileaflet/Medtronic Hall-ve +ve

2-3 2.5-3.5

DVT 2-3 AVR Starr-Edwards/Disc* +/-ve 2.5-3.5

Extensive DVT 2.5-3 AVR/MVR Bioprosthesis -ve Aspirin

PE - Young 2.5-3.5 MVR Any +/-ve 2.5-3.5

PE - Old 2-3 AVR Bioprosthesis +ve 2-3

Lupus Anticoagulant

2.5-3.5✝ MVR Bioprosthesis +ve 2.5-3.5

Cord Year 0-3 Year 4-7 Year 8-999

Platelet Count x109/L 150-550 150-550 150-500 150-450

APPENDICES - hAEmAtoLoGy

drugs that interaCt With Warfarin Warfarin is metabolised by the Cytochrome P450 system. As such there are manydrugs thatcancausesomechange in the INR.However, therearesome thathaveamarkedeffectandwhichpatientsshouldbewarnedabout.Ingeneral,everytimeanewmedication is commenced or one is ceased, the patient should tell the warfarin control centreortheirtreatingdoctor,andtheirINRshouldbechecked.Somemedicationsarenotoriousforinterferingwithwarfarin.Wehavecompiledalistofthemostcommonandimportantdrugsbelow.

*butincreasedriskofbleedingviaplateletinhibition =thosedrugswhichdecreaseINR

Drug Affect on INR Grade of Affect

Amiodarone Moderate - Severe

Aspirin None* Moderate

Fluconazole Marked

MostAntibiotics Moderate

Flucloxacillin rare increase Moderate

Keflex Variableoften Mild - Moderate

Metronidazole Marked

NSAIDs alsoplateletinhibition Mild - Moderate

Panadol Regular >4/day Moderate - Severe

Rifampicin Marked

Statins Mild - Moderate

Tramal Moderate

Tegretol Mild - Moderate

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Durationoftreatmentdependsonthesiteofthethrombosisandtheriskstatusofthepatient. Those risks include re-thrombosis andbleeding from thewarfarin therapy. Toenabletheformertobeevaluatedadequately,thepatientshouldbetestedforthepresenceofanyinheritedoracquiredprothromboticconditions,themostfamiliarbeingFactorVLeiden,butthereareothersmoreclinicallylikelytoaffecttheriskstore-thrombosis.

Atthecompletionofthestandardperiodofanticoagulation,decisionsneedtobemaderegarding anticoagulation:

•Shouldanticoagulationbeceased

•Shouldfullanticoagulationcontinueor

•Shouldanticoagulationbecontinuedatlowerintensity(selectedindications)?

Reversible or Time Limited Factor

Spontaneous (Idiopathic)

Higher Risk High Risk

Surgery, trauma, pregnancy/OCP, immobilisation, long haul flight

Nocausefound Factor V, PT gene (heterozygous) abovewitheitherlife threatening thrombosisorthrombosisinunusualsite (mesenteric, cerebralvein)

Active malignancy, moderate antiphospholipid syndrome, ATIII def, homozygous or compound heterozygous thrombophilias,recurrentthromboses

3 months 6-12months 12-24 months Indefinite

antibodies to miCrobial and ParasitiC agents

note: It is a Medicare requirement that autoantibodies required for testing be listedindividually on the request form.

APPENDICES - ImmUNoLoGy

antibodies to tissue antigens (autoantibodies)


Acetylcholine receptor (AChR)

Adrenal

Antinuclearantibody(ANA)includes pattern description e.g. homogeneous, speckled etc.

Avian protein precipitins

Basementmembranezone(BMZ,Pemphigoid)

Cardiolipin (phospholipid)

Cold agglutinins

DNA(doublestrandedDNA,DNAbinding)

Donath-Landsteiner

Endomysial

Extractablenuclearantigens(ENA)IncludesSS-A,SS-B,RNP,Sm,Scl70,PM-1,Jo-1

Filaggrin (Keratin)

Ganglioside (GM-1)

Gliadin

Glomerularbasementmembrane

Glutamicaciddecarboxylase(GAD)

Granulocyte

Histones

Insulin

Intercellularcementsubstance(ICS, Pemphigus)

Intrinsic factor

Islet cell (GAD, IA-2)

Microsomal - liver, kidney

Microsomal - thyroid

Mitochondrial (AMA)

Muscle - skeletal

Muscle - smooth

NeuronalAntibodies{(Hu)-ANNA-1,(R1)-ANNA-2}PurkinjeCellAb-(Yo)

Neutrophil

Neutrophilcytoplasmic(ANCA)–includescANCA,pANCA,myeloperoxidase,Proteinase-3

Nuclearantibody(ANA)

Ovarian

Pancreatic islet cell

Parathyroid

Parietal cell

Parotid (salivary gland)

Pemphigoid(basementmembranezone,BMZ)

Pemphigus (intercellular cementsubstance,ICS)

Phospholipid (cardiolipin)

Platelet

Protein tyrosine phosphatase IA-2 (IA-2)

PurkinjeCellAB(Yo)

Red cell antigens - screen, identification

Reticulin

Rheumatoid factor

Rhesusantibodies

Ribosomal

Rose-Waaler (Rheumatoid factor)

Salivary duct/gland

Skeletal (striated) muscle

Smooth muscle

Sperm

Triiodothyronine (T3)

Thyroxine (T4)

Thyroid microsomal

TSH receptor

Adenovirus

Anti streptolysin - O (ASOT)

Arbovirus

Aspergillus

Avian precipitins

Barmah Forest virus

Bartonella (Cat Scratch Disease)

Bordetella pertussis

Brucellaabortus

Campylobacter

Candida

Cat Scratch Disease

Chlamydia

Coccidiodes

Coxsackie virus

Cryptococcus

Cytomegalovirus (CMV)

Dengue

DNAseB(Streptococci)

Echinococcus (Hydatid)

Echovirus

Entamoebahistolytica

Enterovirus

Epstein - Barr virus (EBV)

Fasciola hepatica

Filaria

Flavivirus group - includes Dengue, Australian (Murray Valley) encephalitis andKunjin

Fungal precipitins

Haemophilus influenzae

Helicobacterpylori

Hepatitis A

Hepatitis B

Hepatitis C

Hepatitis D (Delta virus)

Hepatitis E

Hepatitis G

Herpes simplex - type I and II

HIV - 1 and 2

HTLV - 1

Humanherpesvirus6

Hydatid

Influenza A

Influenza B

Legionella

Leptospira

Lyme disease (Borreliosis)

Lymphogranuloma venereum (LGV)

Measles

Melioidosis

Mumps

Mycoplasma pneumoniae

Parainfluenza

Parapertussis

Parvovirus B19

Pertussis (whooping cough)

Psittacosis

Q fever

Respiratory syncytial virus (RSV)

Rickettsiae

Ross River virus

Rubella

Salmonella typhi and Paratyphoid

Schistosomiasis

Shigella

Staphylysin

Streptococci(ASOT,DNAseB)

Strongyloides

Syphilis - RPR, TPHA, FTA, EIA(Totalantibody)

Teichoic acid (staphylococci)

Tetanus

Toxocara

Toxoplasma

Typhus

Varicella-Zoster

Widaltest(typhoid)

Whoopingcough(Pertussis)

Yersinia

*Antibodiestootheragentsmaybeavailable.PleasecontactImmunology Department (07) 3121 4458

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arbovirus sCreen

Ross River Virus - IgM and IgG

Barmah Forest Virus - IgM and IgG

Flavivirus (Group) Viruses - IgM and IgG

Flavivirus Group includes - Dengue Virus - all sero types- Australian (Murray Valley) Encephalitis Virus-KunjinVirus- Japanese Encephalitis Virus


skin tests for allergyIn patients with allergy due to IgE (e.g. house dust mite allergy, pollen allergy, animal dander allergy, nut allergy) epicutaneous exposure (skin prick) to relevant allergens inducesavisiblewhealandflarereactionduetolocalmastcelldegranulation.A set of allergens which include pollens, moulds, animal danders, house dust mite and foods is used for testing. A histamine (positive) control and glycerol saline (negative) control are also tested to validate the results.

variables in skin allergy testingSeveral factors may influence skin testing. Clinically relevant factors include:• Drugse.g.: •antihistamines •tricyclicantidepressants •benzodiazepines •betablockers.• Age• Previousimmunotherapy• Afterviralexanthem.

ContraindicationsTesting is contraindicated in patients with:• Currentsevereallergicsymptoms• Recentanaphylaxis• Unstableasthma• Acuteillness• Generalisedskinrash• Pregnancy.

Patient Preparation• Noantihistaminestobetaken forsevendaysprior to test.Manyover-the-counter

medications (e.g. decongestants, cough mixtures and sinus mixtures) have antihistamines;theseshouldbeceased

• Nocreamsormoisturisers(includingsunscreen)onarmsfor48hourspriortotest• Tricyclicantidepressantdrugsoftenhaveprofound'antihistamineeffects'andmay

preclude allergy skin testing• Moderatetohighdoseoralcorticosteroids,e.g.Prednisolone25mgdailyorabove

will impair skin test reactivity• AsthmasprayssuchasVentolinshouldnotbestopped.

AllergyskintestingisperformedbyappointmentatseverallocationsacrossBrisbaneandourBranchLaboratories.For further information, please contact our Immunology Department on (07) 3121 4458 oryourlocalQMLPathologyBranchLaboratory.

rast allergen list

single allergens

grasses• Canarygrass• Cultivatedwheat• Couch(Bermuda)• Johnsongrass• Meadowgrass• Paspalum• Perennialryegrass• Timothy

Weeds• Commonragweed• Dandelion• Marguerite,Daisy• Plantain• Westernragweed

trees• Eucalyptus• Melaleuca• Wattle,Acacia

dust & mites• Housedustmite - D. pteronyssinus• Housedustmite - D. farinae• Housedust

epithelia & animal Proteins• Cat• Dogdander• Dogepithelium• Cowdander• Horsedander• Budgerigarfeathers• Chickenfeathers• Duckfeathers• Guineapig• Mouseepithelium• Mouseurineprotein• Ratepithelia• Raturineproteins• Sheepepithelium

moulds• Alternariatenuis• Aspergillusfumigatus• Candidaalbicans• Cladosporiumherbarum• Penicilliumnotatum

insects• Cockroach• Honeybeevenom• Mosquito• MUXF3• Paperwaspvenom• Yellowjacketwaspvenom

foods• Almond• Apple• Banana• Barley• Beef• Bluemussel• Brazilnut• Buckwheat• Cashew• Cheddarcheese• Chickenmeat• Chillipepper(Capsicum)• Cocoa• Coconut• Coffee• Corn(maize)• Crab• Eggwhite• Eggyolk• Fish(cod)• Garlic• Gluten• Grape• Hazelnut• Melons

(Rockmelon & Honeydew)• Macadamia

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• Mango• Milk• Mutton• Oat• Onion• Orange• Oyster• Parvalbumin• Peach• Peanut• Pineapple• Pinenut• Pork• Potato• Rice• Rye• Salmon• Sesameseed• Shrimp• Soyabean• Squid• Strawberry• Sunflowerseed• Tomato• Tropomysin• Tuna• Walnut• Wheat• Yeast

Cow milk Proteins• -lactalbumin• ß-lactoglobulin• Casein

drugs• Amoxycillin• Ampicillin• Penicilloyl-G• Penicilloyl-V

miscellaneous• Chlorhexidine• Latex• Recombinantlatex• Suxamethonium

inhalant screenContains allergens from the following groups:

• Grasses• Weeds• Moulds• Housedustmite• Animalepithelia

multiple allergens

grass Pollen mix• Couch(Bermuda)• Timothy• Meadow• Johnson• Rye• Paspalum

tree Pollen mix• Wattle• Olive• Willow• Whitepine• Eucalyptus• Melaleuca

Weed Pollen mix• Commonragweed• Mugwort• Saltwort(prickly)• Plantain• Goosefoot

animal dander mix• Cat• Dog• Horse• Cow

Caged bird mix• Budgerigar• Canary• Finch• Parakeet• Parrot

mould mix• Penicillium• Aspergillus• Cladosporium• Alternaria

house insects mix• Housedustmite - D. pteronyssinus

• Housedustmite - D. farinae• Housedust• Cockroach

food mix• Eggwhite• Milk• Yeast• Soyabean• Peanut• Fish(cod)

Cereal mix• Wheat• Oat• Buckwheat• Corn• Sesameseed

fruit mix• Peach• Kiwifruit• Rockmelon• Banana• Pineapple

nut mix• Peanut• Almond• Coconut• Hazelnut• Brazilnut

seafood mix• Cod• Shrimp• Tuna• Bluemussel• Salmon

disinfectant agent mix• Ethyleneoxide• Phthalicanhydride• Formalin/ formaldehyde• ChloramineT

reactive Chemical mix• IsocyanateTD1• IsocyanateMD1• IsocyanateHD1• Phthalicanhydride

skin allergen list

routine allergen screen

Pollens• Couch(Bermuda)• Eucalyptus• Johnsongrass• Paspalum• Pine• Plantain• Prairiegrass(Brome)• Ragweed• Timothygrass• Wattle• Wildoat

moulds• Alternaria• Aspergillusfumigatus• Aspergillusniger• Botrytis• Cladosporium

hormodendrum (Herbarum)

• Penicilliummould

epithelial extracts• Catfur• Cattlehair• Doghair• Feathermix• Horsehair

food extracts• Cashew• Eggwhite• Eggyolk• Milk-cow• Peanut• Shellfish• Shrimp• Soybean• Wheatflour(whole)

miscellaneous extracts• Housedustmite• Cockroach

additional food allergens (availableonrequest)

• Banana• Chicken• Cod• Lobster• Ricegrain• Strawberry• Tomato• Yeast(Baker'sYeast)• 7grassmix

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APPENDICES - mICroBIoLoGy

infeCtion Control in mediCal Consulting rooms Although all of us suffer from infectious illnesses from time to time, everyone would agreethattheplacewherehelp isobtained,theDoctor’s/Dentist’ssurgery,shouldnotfacilitatetransmissionofinfection.Thereisarequirementfordutyofcarebyhealthcareprofessionals to minimise transmission of infection from person to person by carefulplanning, appropriate training, and use of infection control procedures.

TheaboveconceptshavenowbeenreinforcedbyGovernmentlegislation.InQueenslandthe relevant act is the WorkplaceHealthandSafetyAct1995.InNSWtherelevantactisthe Occupational Health and Safety Act 2000. These acts apply to all work places where a person is paid to perform work. Breach of the Queensland Act may result in heavy fines and/orjailoftherelevantperson.

This document is a guide to infection control in Doctors surgeries. It does not cover all circumstances and readers should rely on their own risk assessments and choice of remedies required.

For more detailed guidelines see:

•Sterilisation/DisinfectionguidelinesforGeneralPractice(RACGP2007).

•InfectionControlinSurgery(RoyalAustralasianCollegeofSurgeons,1998,revised2001).

•HumanImmunodeficiencyVirusandHepatitisBandtheWorkplace:NationalConsensusStatements,WorksafeAustraliaCode,1993.

•AS/NZS4187:2003:Cleaning,disinfectingandsterilizingreusablemedicalandsurgicalinstruments and equipment, and maintenance of associated environments in health care facilities.

•AS/NZS4815:2006:Office-basedhealthcarefacilities-Reprocessingofreusablemedicaland surgical instruments and equipment, and maintenance of the associated environment.

•UpdatedUSGuidelinesfortheManagementofOccupationalExposurestoHBV,HCVandHIVandRecommendationsforPostexposureProphylaxis(MMWR:June2001Vol50/No.RR-II).

Allproceduresshouldbedocumentedandrecordsofpatientencounters,includingsmalloperationslists,equipmentperformance,etc.shouldbekept.

This document is a guide for surgeries where minor procedures are performed. Facilities for major procedures must be similar to those provided by accredited hospitals andhence are expensive.

factors to be considered in the control of infection are:

1. the doctor or dentist

2. the surgery staff

3. the patients

4. the physical environment

5. disinfection and sterilization of instruments and other appliances.

the doctor or dentist and staff

ThesurgerystaffandtheDoctororDentistshouldbefreefrominfectiousillness.

Theyshouldbevaccinatedagainstcommonorganisms,e.g.rubella.

AllhealthcareworkerswhoareexposedtobloodshouldbevaccinatedwithHepatitisBVirusvaccine.ChecktheserumAnti-HepatitisBSurfaceantibodies(AntiHBsAb)level2months after the third dose.

Skinlesionsandcutsshouldbecoveredwithwaterproofocclusivedressings.

Thesurgerystaffshouldbeadequatelytrainedinsurgicalproceduresincludingaseptictechniques, use of sterilizers etc.

Theseproceduresshouldbedocumented.Inductionofnewstaffandrefreshertrainingshouldberecordedalso.

Patients

Patientswithsuspectedinfectiousillnesses(e.g.rubella)arebestseenattheirhomesorshouldbeseenonarrivalatthesurgerytominimisespreadoforganismstoothers.Thestaff should arrangeblockbookings for pregnant patients and separatepatientswhoaresusceptible to infection (e.g. leukaemicpatients) frompotentialsheddersofmicro-organisms (e.g. children with chicken pox).

Individuals,however,mayhavecirculatingtransmissibleagentssuchasHepatitisBvirus(HBV)andHumanImmunodeficiencyVirus(HIV)withoutsignsorsymptoms.Theblood(andsomebodyfluids)ofsuchpersonsisinfectiousandthusrepresentsahazardwhenundergoing some medical procedures.

TheCentersforDiseaseControl,USA(MMWR1989;38:S–6)hasdevelopedthestrategyof‘universalbloodandbodyfluidprecautions’toaddressconcernsregardingtransmissionof HIV in the health care setting. The concept, previously referred to as ‘universalprecautions’, isnowcalled ‘standard precautions with additional precautions’andstresses that all patients should be assumed to be infectious for hiv and other blood-borne pathogens. In thehealthcaresetting, ‘standardprecautions’shouldbefollowedwhenworkersareexposedtobloodandotherbodyfluids.

standard Precautions are recommended for the treatment and care of all patients, andapplytoallbodyfluids,secretionsandexcretions(excludingsweat),regardlessofwhethertheycontainvisibleblood(includingdriedbodysubstancessuchasdriedbloodorsaliva),non-intactskinandmucousmembranes.

Standard Precautions include good hygiene practices, particularly washing and drying hands before and after patient contact,theuseofprotectivebarrierswhichmayincludegloves, gowns, plastic aprons, masks, eye shields or goggles, and appropriate handling and disposal of sharps and other contaminated or infectious waste, and the use of aseptic techniques.

additional Precautions are used for patients known or suspected to be infected orcolonised with epidemiologically important or highly transmissible pathogens thatcanbetransmittedbyairborneordroplet transmissionorbycontactwithdryskinorcontaminated surfaces.

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guidelines for gloves a. Use sterile gloves for procedures involving contact with normally sterile areas of

thebody, e.g.wound suturing etc.Useexamination gloves (cleanbut not sterile)for procedures involving contact with mucous membranes and for other patientcare or diagnostic procedures not requiring sterile gloves e.g. oral, vaginal or rectal examination.

b.Changeglovesbetweenpatientcontacts.

c.Washhandsbeforeandafterusinggloves.

d. do not reuse surgical or examination gloves.

e. Use rubber household gloves for housekeeping chores involving potential blood contact and for instrument cleaning and decontamination. These may bedecontaminatedandreusedbutshouldbediscardedifdamaged.

f. Powder free gloves are recommended.

hand Washing ProtoCol•Meticulous hand washing is essential in order to maintain infection control in the

General Practice.

•All staff should routinely wash their hands before and after all contact with patients,aswellaswhencleaningupbloodandbodyfluidspills inthesurgery,andremoving gloves.

•Staffshouldalsoensurethattheywashtheirhandsbeforeandaftereating,smokingand going to the toilet.

•Itisalsoessentialthatstaffdrytheirhandsthoroughlyafterwashing.

•Any cuts, abrasions or lesions should be covered at all times with water-resistantdressings,whichshouldbechangedregularly.

routine hand Washing Procedure (10-15 seconds)


AdditionalPrecautionsaredesignedtointerrupttransmissionofinfectionbytheseroutesandshouldbeusedinadditiontoStandardPrecautionswhentransmissionofinfectionmightnotbecontainedbyusingStandardPrecautionsalone.AdditionalPrecautionsmaybespecifictothesituationforwhichtheyarerequired,ormaybecombinedwheremicro-organisms have multiple routes of transmission.

Additional Precautions are used for patients with MRSA, VRE, CJD or active pulmonary tuberculosis,orwherethereisanestablishedriskoftransmissionofinfectionregardlessof thenatureof theprocedurebeingundertaken,orwheretheprocedure itselfcarriesan established risk of aerosolation, blood accident or staff/patient injury. AdditionalPrecautionsarenotrequiredforpatientswithbloodbornevirusessuchasHIV,HepatitisB or Hepatitis C, unless there are complicating factors present, such as pulmonary tuberculosis,orunless theprocedure itselfperformedon thesepatientshasaknownhigh risk, such as generation of aerosols.

TominimisetherisksofacquiringHIVandHBVduringperformanceofjobduties,workersshouldbeprotected fromexposure tobloodandother body fluids as circumstancesdictate.Protectioncanbeachievedthroughadherencetoworkpracticesdesignedtominimise risk. Personal protective equipment (i.e. gloves, masks and protective clothing) shouldbeusedtodecreaseexposuretohazards.

blood ColleCtion (always use gloves and protective glasses)

•Preferablyusetheevacuatedbloodtube(vacutainer®) system.

•Discardneedleandsyringeintosharpsbin.

•Ifanybloodremainsonsampletubestoppercleanwithanalcoholswab.

•Transportthebloodsamplesafely.

Waste management Setupproperdisposalprocedures.Usedgloves,swabs,disposabledrapesetc.shouldbebaggedinabiohazardplasticbag(yellowwithablackbiohazardsymbol),sealedanddisposedofappropriately.(SeeQldRefuseManagementRegulation(No.1)(amended1993).

environmental Protection (Waste management) regulation 2000 - Queensland

Under the Environmental Protection Act 1994, a clinical and related waste management plan is required for healthcare facilities.

handling sharPs Takecaretoprevent injurywhenhandlingsutureneedles,scalpels,sharpinstruments.do not resheath used needles.

Placealldisposablesharpitemsinanapprovedcontainer(AS4031:1992)whichshouldbelocatedascloseaspossibletotheusearea.

In the event of a sharps/needlestick injury, documented protocols should outline theactiontobetakenbytheinjuredpersonandthetreatingdoctor.

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Remove all rings, watches and jewellery.

Wet hands with warm water, apply recommended pH neutral liquid

soap, and lather vigorously.

Wash hands thoroughly beginning with the palms, then backs of hands, wrists, fingers, thumbs and between

fingers for 10 to 15 seconds.

Rinse hands thoroughly under running water.

Turn taps off using paper towel, if no elbow or foot controls

are available.

Dry hands thoroughly using paper towel.

Plus test recipient


Clean uP ProCedure for blood and body fluids

always observe standard precautions

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Barricade the area around the spill to prevent other persons going near the spillage.

Collect cleaning material and equipment.

Wear heavy duty cleaning gloves and glasses (a plastic apron and mask should be worn if there is a risk of a splash occurring).

Broken glass needs to be picked up with forceps or

scooped into an approved sharps container. Never pick up broken glass pieces by hand!

Wipe up blood spots immediately with a damp

cloth, tissue or paper towel using detergent and water.

Contain the spill with either chlorine releasing granules or Kitty Litter.

Cover the spill with the granules. Wait until the spill has been absorbed

and then use cardboard to pick up the spill.

Quarantine the affected area until dry.

Discard all contaminated materials into medical waste

container for disposal.

After discarding the disposable items,

decontaminate all reusable items, such as forceps and

safety glasses, etc.

After removal of gloves, hands must be

washed thoroughly.

See hand washing procedure (12.44).

for large spills > 10cms for small spills < 10cms

spot cleaning

Wipe up blood spill immediately with a damp

cloth, tissue or paper towel using detergent

and water.

NOTE: Chlorine releasing granules are a corrosive agent and may remove colour from carpet and soft furnishings.

body fluid exPosure ProCedure

Has true blood/body fluid exposure occurred

Complete incident record

1. Apply first aid to injury

2. Gently encourage bleeding

3. Wash thoroughly in running water

4. Bathe eyes or damaged skin with copious water and/or sterile saline if applicable

Complete incident record and medical records

Is source known

yes

no

yes

Obtain consent from source for urgent HBsAg,

HepCAb and HIV serology

Not immune HepB

Is source HIV positive

or high risk

Obtain immediate urgent advice from nearest

Infectious Diseases

Physicians regarding HIV prophylaxis

Obtain HepB Immunoglobin

from Red Cross Blood Service

within 48 hours. Offer HepB vaccination

course

Repeat baseline serology in 3 months

Urgent baseline serology testing

for HIV, HepBsAb (if immunised),

HepBsAg (if not immunised) and

HepCAb

Immune HepB No HepB

Immunoglobin or HepB vaccination

yes no

yes


12.4

8

12.4

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using biologiCal indiCator vials

Please refer to the raCgP sterilisation/disinfection guidelines (www.racgp.org.au) for further information.

1. OVERVIEW: Validation of your steriliser requires that you run three consecutive steriliser cycles. Each cycle must include two biological indicator vials inside the steriliser (one inside a pack, the other outside the pack(s)). The remaining vial is NOT sterilised, but acts as a control of storage and transport conditions.

2. Order autoclave validation test request form and seven biological indicator vials through your routine QML Pathology supply channel.

3. Validation of the sterilisation process should be performed as soon as practical after the technician’s annual service.

4. Preclean, wash and dry the items for sterilisation.

6. Select the most difficult to sterilise pack and load* and record contents. Place one indicator (i.e. '1E' for the first cycle) inside the middle of challenge pack.

5. Ensure seven vials received and all have the same lot/batch number. Label six vials to indicate their location and cycle number (see table) and label remaining vial as 'Z' to be used as a control.

* The hardest to sterilise pack possible for your surgery in terms of packaging and pack density. Must also provide the largest load possible for the steriliser.

** Heat distribution studies and penetration times should be provided by the technician as part of the annual service.

7. Put this pack in the steriliser and place a second indicator vial (i.e. '1C' for the first cycle) in the coolest position in the steriliser as identified from heat distribution studies**. NB: Ensure vial does not come into contact with metal as it will melt. Place vial on gauze or paper so that it does not make contact with the metal of the autoclave.

9. Run two more cycles, repeating steps 4 to 6 each time. Use identical packages

with new indicator vials in the same positions as before:

2nd cycle – use vials labelled 2C and 2E. 3rd cycle – use vials labelled 3C and 3E.

The one control vial 'Z' is NOT exposed to the sterilisation cycle.

12. Validation does not need to be repeated for another 12 months unless pack and/or packaging density change, or the steriliser undergoes a major service.

11. Complete validation request form and send along with the seven vials to the laboratory for processing.

8. Run the steriliser for one cycle. The length of the sterilisation period should be three minutes plus the penetration time ** if running at 134˚C.

10. Keep a record of the date and time the validation was performed, the time and temperature for the cycles, the package contents and the position of the pack(s) in the steriliser.

Steriliser chamber

Control vial outside steriliser labelled Z

Vial inside packagelabelled E

Vial inside chamber in coolest position labelled C

steriliser Chamber with Package and biological indicator vials

What to do after validation

Aftersuccessfulvalidation,biologicalindicatorvialsarenotrequiredfor routine monitoring of your steriliser. For routine monitoring you must either:

1. Record cycle parameters (time and temperature) either manually every 30 seconds or using a printout from the steriliser.

OR

2.UseaClass4,5,or6chemicalindicator.

NB.AllpackagesshouldincludeanexternalClass1indicator(autoclavetape) toidentifythosepackagesthathavebeensterilised.

QualityControl(QC)isperformedonallbatchesofvialsbeforetheyaredistributed to surgeries.

Further information on the validation of the sterilising process please contact QMLPathologyMicrobiologyDepartmenton(07)31214438.

CyCle number vial labels

1 1C (chamber); 1e (package)



Control vial z

APPENDICES - mICroBIoLoGy12

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Infectiouswastes:bagsareyellowwiththeinternationallyrecognisedbiohazardsymbolinblack.

Cytotoxicwastes:bagsarepurplewiththecytotoxicwastesymbol(denotingacellintelophase)whichhasalreadybeenacceptedwidelyinAustralia.

Radioactivewastes:bagsareredwiththeblackinternationallyrecognisedradioactivitysymbol.

all chemicals should be labelled with their generic names.Thislabelshouldindicateanyhazardanddescribeproceduresintheeventofanaccident,includingfirstaidandclean up protocols.

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