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1 Welcome to the online QML Pathology Reference Manual For ease of use please download this manual to your desktop. Viewing via your web browser may take time to reload depending on internet connection speeds. This manual is best viewed in Full Screen mode in Adobe Acrobat Reader version 7 or higher. Press Escape key to exit Full Screen Mode. Use the buttons below to navigate this manual. Search Manual Contents Page Launch Full Screen Mode Reference Manual

2 CONTENTS Home Full Screen CONTENTS The content of the QML Pathology Reference Manual is provided as current information as at July Information in this manual may change over time. For the latest information, please refer to the QML Pathology website or contact your local QML Pathology laboratory. Click on the links below to jump to the required section Introduction 1.0 Preface 5.0 Appendices 12.0 CONTENTS Mission Statement 1.1 Company History 1.2 Collection Facilities 2.0 Collection Centres A-Z 2.1 Special Tests 2.13 Additional Services 3.0 Vaccine Service 3.1 Travel Health Service 3.1 Warfarin Service 3.2 Occupational Pathology 3.4 Vetnostics 3.5 Departmental Directions on Specimen Collection, Storage and Transport 5.1 Blood Bank 5.9 Cytology 5.11 Endocrinology 5.21 Genetics 5.25 Haematology 5.31 Histology 5.35 Immunology 5.47 Microbiology 5.51 C C Test Listing A-Z Common Causes of Abnormal Biochemical Results 12.1 Serum Tumour Markers 12.4 Common Reference Ranges 12.7 Glucose Tolerance Test 12.9 Gestational Diabetes 12.9 Dietary Restrictions and Special Diets Qualitative Urine Drug Screen Quantitative Drug Assays for Therapeutic Monitoring Poisons and Toxic Substances Used in Pest Control Acid Base Analysis Lipids Endocrinology Pregnancy Timeline Investigation of Hirsutism Recommended Age Guidelines for Men s Health Testing Immunology Antibodies to Tissue Antigens (Autoantibodies) Antibodies to Microbial and Parasitic Agents Arbovirus Screen Skin Tests for Allergy RAST Allergen List Skin Allergen List Microbiology Infection Control in Medical Consulting Rooms Blood Collection, Waste Management, Handling Sharps Guidelines for Gloves, Handwashing Protocol Clean Up Procedure for Blood and Body Fluids Body Fluid Exposure Procedure Validation of your Steriliser Symbols for Hazardous Categories Collection Materials 4.0 Specimen Storage 4.1 Order of Draw 4.2 Blood Collection Tubes 4.3 Specimen Containers 4.6 Swabs 4.14 Skin Devices 4.16 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 Genetics Cytogenetic Tests Molecular Genetic Tests Haematology Basic Haematology Parameters Leucocyte Reference Ranges Initiating Warfarin Therapy Range of Target INRs Duration of Warfarin Therapy Drugs that Interact with Warfarin 12.34

3 COLLECTION MATERIALS COLLECTION MATERIALS 4.1 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, Endocrinology and Haematology are stored refrigerated for 7 days after collection Note: 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) 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 Requirements Please 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. ORDER OF DRAW 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) Aerobic bottle Anaerobic bottle Paediatric micro container Paediatric mini container Paediatric mini container Paediatric mini container Paediatric micro container Paediatric bottle Yellow rubber top Tube MUST be filled to indicated level Paediatric micro container Paediatric micro container **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. 4.2 COLLECTION MATERIALS

4 COLLECTION MATERIALS COLLECTION MATERIALS 4.3 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 Paediatric micro container Paediatric micro container Fluoride oxalate tube (Grey top) Blood alcohol Lactate studies Blood glucose (if a delay in cell separation is unavoidable) Paediatric micro container 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 Paediatric mini container Paediatric micro container Tube MUST be filled to indicated level Paediatric mini container 4.4 COLLECTION MATERIALS

5 COLLECTION MATERIALS COLLECTION MATERIALS 4.5 Lithium heparin tube (Green top, orange top) Used for a wide variety of tests covering biochemistry, haematology and genetics Heavy metals screens Chromosome analysis Paediatric Paediatric micro container mini container Trace metal tube (Navy top) Must be centrifuged immediately for 10 minutes. Zinc Selenium Aluminium. ESR tube ESR 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). Funnel 8hr urine collection bottle Sterile container 24hr urine collection bottle Yellow monovette 4.6 COLLECTION MATERIALS

6 COLLECTION MATERIALS COLLECTION MATERIALS 4.7 Aptima urine tube Chlamydia trachomatis Neisseria gonorrhoeae Urine drug screen collection kit For details of use and Chain-of-Custody documentation requirements, see Drug Screening section (5.4) in Preface of this Reference Manual. 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 container Liquid 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. Faeces container Aerobic bottle Anaerobic bottle Paediatric bottle 4.8 COLLECTION MATERIALS

7 COLLECTION MATERIALS COLLECTION MATERIALS Seminal fluid collection Collect specimen into a sterile container. This sample needs to reach the laboratory within two hours. Sterile container 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. COLLECTION MATERIALS Antibiotic transport medium Suitable for the transport of all viable tissues. Genetics (POC, etc.) Tissue culture Tissue tumour markers (lymph nodes, etc.) Nasopharyngeal tubing Nasopharyngeal aspirate RSV (Respiratory Syncytial Virus) Influenza A & B, Parainfluenza 1, 2, 3, Adenovirus Bordetella Pertussis PCR Histology specimen container Routine histology tissue and biopsy specimens are placed into 10% formalin for fixation and submitted to the laboratory for paraffin processing

8 COLLECTION MATERIALS COLLECTION MATERIALS 4.11 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. Sterile container Cytology kits Monolayer cytology kit After 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. EDTA tube Lithium Heparin tube Single-use Pap smear kits Three separate kits available: Cervex brush Cytobrush Combination. Cervex brush Pap smear test kit Cytobrush Pap smear test kit Combination Pap smear test kit 4.12 COLLECTION MATERIALS

9 COLLECTION MATERIALS COLLECTION MATERIALS 4.13 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. Swabs Bacteriology 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 COLLECTION MATERIALS

10 COLLECTION MATERIALS COLLECTION MATERIALS 4.15 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. Skin Devices 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. 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. 2mm Punch Biopsy with internal plunger 2mm Punch Biopsy without plunger 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 COLLECTION MATERIALS

11 PREFACE - biochemistry PREFACE - BIOCHEMISTRY TESTS WITH SPECIAL COLLECTION REQUIREMENTS Many of the range of close to 1200 tests performed by or arranged through the 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 po 2 and a rise of pco 2 with apparent respiratory acidosis will further complicate interpretation. Serum Calcium, Iron and Alkaline Phosphatase 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 crossreact as ethanol in the laboratory assay, the necessity to argue this point in the court setting can lead to the whole collection being discounted. PREFACE - BIOCHEMISTRY 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 mmol/l, chloride to mmol/l, and potassium rises to as high as 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. 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

12 PREFACE - biochemistry 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. 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. 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 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 Appendix (12.13) for a full list of drugs assayed PREFACE - BIOCHEMISTRY PREFACE - BIOCHEMISTRY

13 PREFACE - biochemistry FAECES TESTS NOTE: 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. 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. 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 proteinlosing 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. 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 PREFACE - BIOCHEMISTRY PREFACE - BIOCHEMISTRY

14 PREFACE - biochemistry 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 BITE The 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 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) or your local Branch Laboratory PREFACE - BIOCHEMISTRY PREFACE - BIOCHEMISTRY

15 PREFACE - blood bank PREFACE - BLOOD BANK HOMOLOGOUS BLOOD TRANSFUSION SERVICE QML 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 SERVICE QML 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 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 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) or your local Branch Laboratory. For further details please contact QML Pathology Blood Bank (07) or your local Branch Laboratory. PREFACE - BLOOD BANK

16 PREFACE - cytology PREFACE - CYTOLOGY SPECIMEN COLLECTION FOR GYNAECOLOGICAL CYTOLOGY Most 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. If collecting a biopsy specimen at the same time, it is important to keep histology specimens and cytology slides physically separated during storage and transport. Liquid formalin vapour has an adverse effect on Pap smears which can make morphological assessment difficult. Spatula & Cytobrush Cervex Sampler 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 PREFACE - CYTOLOGY

17 PREFACE - cytology 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. Pap Smear Collection Kits QML 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. PREFACE - CYTOLOGY 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. Cervex Pap smear test kit Cytobrush Pap smear test kit Combination Pap smear test kit 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.

18 PREFACE - cytology 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. Effusions and Washings 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 Refrigerate if a delay in sending the specimen is anticipated (Do not add any fixative). 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 < Exudates have higher protein and specific gravity, and are more likely to be inflammatory or neoplastic. PREFACE - CYTOLOGY 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 Refrigerate if a delay in sending the specimen is anticipated (Do not add any fixative) 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 gauge varying from 1cm to 20cm in length (23 gauge needles are used for most aspirations of palpable lumps). Alcohol prep sponges.

19 PREFACE - cytology 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. Diagram A Syringe pistol Standard syringe PREFACE - CYTOLOGY Insert needle into mass A Apply suction B 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) Move needle back and forth in slightly different directions through mass C 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). Release suction, then withdraw slowly 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 D Diagram B Diagram C mass

20 PREFACE - cytology 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 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. 1 2 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. 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

21 PREFACE - Endocrinology 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 lowlevel 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. ice will be accompanied by spluttering, however, it results in a rapid drop of the alcohol 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). PREFACE - ENDOCRINOLOGY SPECIMEN COLLECTION In 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 ( ) 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 FERTILITY TESTING AND CYCLE TRACKING The 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) 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 TEST This test involves ingestion of low dose carbon-14 labelled urea and measurement of carbon-14 labelled CO 2, 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 CO 2 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 CO 2 is measured. Please contact Brisbane QML Pathology Collection Department (07) or your local Branch Laboratory for details of collection centres equipped to perform this test.

22 PREFACE - Endocrinology THYROID FUNCTION TESTS A 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 STORAGE Samples 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) or the nearest Branch Laboratory. Brisbane Endocrinology Department Direct Telephone Numbers Pathologist Dr Kerry DeVoss (07) Manager Mark Blakey (07) PREFACE - ENDOCRINOLOGY PREFACE - ENDOCRINOLOGY

23 PREFACE - Genetics 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 TESTING The 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. retardation in affected females. Expansions in the premutation range ( 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. 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 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 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. PREFACE - GENETICS 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

24 PREFACE - Genetics 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 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. 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. 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) regarding availability of testing PREFACE - GENETICS 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.

25 PREFACE - Genetics 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 PREFACE - GENETICS ANDROLOGY Seminal 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. PREFACE - GENETICS 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 INVESTIGATION QML Pathology acts as a collection and transport agency only.

26 PREFACE - HAEMATOLOGY PREFACE - HAEMATOLOGY 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). 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 Suggested screening for Thrombophilia VENOUS THROMBOEMBOLISM ARTERIAL THROMBOEMBOLISM Age < 50 Age > 50 Age < 50 Age > 50 First Line Investigations PREFACE - HAEMATOLOGY COLLECTION REQUIREMENTS General Collection requirements for all tests are individually detailed in the A-Z test listing (6.0). BLOOD COUNTS Blood 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 FBC + E/LFT FBC + E/LFT FBC + E/LFT FBC + E/LFT 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 TESTS Specimens 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 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.

27 PREFACE - HAEMATOLOGY are required including any family history of bleeding or clotting problems. BONE MARROW BIOPSY All registered medical practitioners can order a bone marrow biopsy. Appointments for bone marrow biopsies may be arranged by telephoning the Haematology Department, Brisbane ( ) 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 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 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 PREFACE - HAEMATOLOGY Please see Haematology Appendix (12.31). ORAL ANTICOAGULANT CONTROL SERVICE Only suitable patients can be enrolled in this service. Patients must be registered by calling 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). PREFACE - HAEMATOLOGY

28 PREFACE - Histology PREFACE - Histology 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 Specimens Specimens 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 Specimens Certain specimens and investigations require different or additional processing. Tissue for Bacterial, Fungal and Viral Culture Tissue 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) or to the nearest Branch Laboratory where it will be aseptically divided and shared appropriately 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. PREFACE - Histology

29 PREFACE - Histology PREFACE - Histology 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) 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) , (07) 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 Biopsy Cilial 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) 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 Tissue Thin, 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 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 Mucosa Small 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 Microscopy This 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 Service Tissue for frozen section should be submitted FRESH in a DRY container (not in formalin). Please telephone Histology (07) 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. Immunofluorescence Skin 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) 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. PREFACE - Histology

30 PREFACE - Histology PREFACE - Histology 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 Stains QML 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 Biopsy In 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. 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 Biopsy For 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) 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. (Skeletal) Muscle Biopsy All 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 Assay Oestrogen and progesterone receptor status in breast cancer can be evaluated semiquantitatively 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 Biopsy Renal 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 PREFACE - Histology 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.

31 PREFACE - Histology PREFACE - Histology Punch 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. 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. PREFACE - Histology 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. 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 Pigmented Lesions What to Call Your Specimen 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 ). 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.

32 PREFACE - Histology PREFACE - Histology Selecting the Biopsy Site Blotchy, macular Annular Discoid, plaque Papular Vesicular, bullous Incision Biopsy Punch Biopsy sometimes unsuitable for punch unsuitable for punch 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: adrenaline is suggested. NOTE: Adrenaline should not be used in certain sites 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. PREFACE - Histology Nodule, tumour 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 Notes A 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)

33 PREFACE - Histology PREFACE - Histology Skin Pathology Collection Devices 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. 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. Type of biopsy Punch Biopsy with internal plunger Punch Biopsy without plunger Sizes available (mm) 2, 3, 4 2, 3, 4, 5, 6, PREFACE - Histology Punch Biopsy with internal plunger 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. Punch Biopsy without plunger For further information or to order any of these devices, please contact our Stores Department on (07) or your local QML Pathology Branch Laboratory.

34 PREFACE - IMMUNOLOGY PREFACE - IMMUNOLOGY 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 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) 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, PREFACE - IMMUNOLOGY

35 PREFACE - IMMUNOLOGY PREFACE - IMMUNOLOGY 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) 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) 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 Testing A 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 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) (Brisbane patients only) or your nearest QML Pathology Branch Laboratory to arrange an appointment. PREFACE - IMMUNOLOGY

36 PREFACE - MICROBIOLOGY PREFACE - MICROBIOLOGY Request Form The 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. 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. PREFACE - MICROBIOLOGY Tissue, Body Fluids and Wound Swabs General Principles Please 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 Culture Clinical 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 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. 2 x Blue Top Swabs

37 PREFACE - MICROBIOLOGY PREFACE - MICROBIOLOGY Blood Culture A 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 Fluids Body 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. Faeces QML 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 Stools The 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 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 PREFACE - MICROBIOLOGY Nasopharyngeal Secretions Nasopharyngeal 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).

38 PREFACE - MICROBIOLOGY PREFACE - MICROBIOLOGY Equipment 8 FG Feeding tube is suitable for use with a 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. Suction Trap Inferior Turbinate Catheter Sputum Sputum 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 The 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) 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 Culture If 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. PREFACE - MICROBIOLOGY Urine After 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 Culture For Mycobacterial cultures collect a full 70 ml container of an early morning specimen. Monovettes are NOT acceptable for Mtb culture. Catheter Tips for Culture Tips 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 Kit Material 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. 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

39 PREFACE - MICROBIOLOGY PREFACE - MICROBIOLOGY 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 Ectoparasites Scabies 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 Pediculosis 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 PCR Chlamydia 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. PREFACE - MICROBIOLOGY

40 PREFACE - MICROBIOLOGY PREFACE - MICROBIOLOGY 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 Culture QML 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. Mantoux 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) 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). PREFACE - MICROBIOLOGY

41 PATHOLOGY TESTS 6.1 TEST SELECTION GUIDE Chemistry Acceptable test groupings approved abbreviations in parenthesis Blood Gases po 2 HCO 3 pco 2 Base excess ph O 2 saturation Electrolytes (E) Sodium (Na) Bicarbonate (HCO 3 ) 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 (HCO 3 ) 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. 6.2 PATHOLOGY TESTS

42 PATHOLOGY TESTS 6.3 Change in Cardiac Markers Following Myocardial Infarction * Peaks not drawn to same scale RELATIVE CONCENTRATION Myoglobin Troponin CK, AST LDH Normal Hours Days TIME AFTER INFARCT 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 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 Histology Tissue and Biopsy Specimens Routine Tissue Diagnosis Muscle Biopsy Renal Biopsy Nerve Biopsy Cilial Biopsy - 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) 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 Immunofluorescence Frozen Section Service Immunoperoxidase Stains - oestrogen - progesterone - c-erbb2 studies - others as indicated 6.4 PATHOLOGY TESTS

43 PATHOLOGY TESTS 6.5 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 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 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 -? 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 Haematology/BLOOD BANK QML Pathology Warfarin Care Clinic Patient Registration 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 Down's Screen First Trimester (11 1 / 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 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 Thalassaemia/ Haemoglobinopathy Screen Hb Red Cell Indices Hb Electrophoresis HbA2 HbF Quantification HbH Bodies Coagulation Screen (COAG) Includes: PT APTT Fibrinogen Platelet Count TCT Contd. 6.6 PATHOLOGY TESTS

44 PATHOLOGY TESTS 6.7 Cross Matching Includes test for Rh and/or other blood group antibodies. Bone Marrow Examination Please state if cytogenetics or markers are required. Marrow Booking: (07) 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 test Where 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 TSH Where 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 ANA Where indicated: Bone Marrow Biopsy BCR - ABL Neutropenia FBC/Retics Coombs Iron Studies B12/Folate GIFT ANA Lymphocyte Markers Where 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 APTT Therapeutic range seconds for continuous infusion or intermittent therapy (sample collected minutes before next injection). LMWH Monitoring is rarely needed. Haemorrhagic Disorders If 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:ricof If 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 6.8 PATHOLOGY TESTS

45 PATHOLOGY TESTS 6.9 Immunology Required 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 Serology Notes Complete 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 Diarrhoea Faeces 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 PATHOLOGY TESTS

46 PATHOLOGY TESTS 6.11 Genital Sore HSV PCR Microscopy/Culture Syphilis Serology Genital Discharge Chlamydia PCR Gonococcal PCR Microscopy/Culture Syphilis Serology Trichomonas - PCR Hepatitis A, B, C Please request specific tests. Acute Investigation Hep A IgM HBsAg HCV Infectivity Status HBsAg HCV Immunity/Post Vaccination HBsAb Hep A IgG Other Hepatitis Amoebic CMV Hep E Leptospira Brucella EBV Hydatid 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 Interpretation of Hepatitis B Serology 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 Pattern HBsAg HBeAg HBcAb HBc IgM HBeAb HbsAb Infective Early Acute Acute Resolving /- +/- Past + +/- +/- - Chronic + +/- + +/- ++ Post Immunisation PATHOLOGY TESTS

47 PATHOLOGY TESTS - A 7.0 1,1,1,- Please refer to SOLVENTS, BLOOD for all details. TRICHLOROETHANE, BLOOD 1,25-DIHYDROXY CHOLECALCIFEROL Please refer to 1,25-DIHYDROXY VITAMIN D, SERUM. 1,25-DIHYDROXY VITAMIN D, SERUM Blood/SS tube or Red top tube 17-HYDROXYPROGESTERONE, SERUM 1-HYDROXYPYRENE, URINE Urine/50 ml urine container 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. Endocrinology Blood/SS tube 1 week Please provide clinical and medication details. 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 Please refer to HISTAMINE, URINE. 1-methyl histamine is a dietary derivative. 2, 4, 5-T (HERBICIDE), URINE Test for unusual exposure - note this herbicide is no longer in use. Please refer to HERBICIDES, URINE. 2, 4-D (HERBICIDE), URINE Please refer to HERBICIDES, URINE. 25-HYDROXY Please refer to VITAMIN D, SERUM. CHOLECALCIFEROL, SERUM 25-HYDROXY VITAMIN D, Please refer to VITAMIN D, SERUM. SERUM 25-HYDROXY VITAMIN D3, SERUM Please refer to VITAMIN D, SERUM. 3-HYDROXYBUTYRATE, SERUM OR PLASMA 4-HYDROXY-3-METHOXY MANDELIC ACID, URINE Blood/Lithium heparin tube or SS tube 1 week Ketone body quantitative assay. Referred test. Please refer to CATECHOLAMINES, URINE. 7.0 PATHOLOGY TESTS - A

48 PATHOLOGY TESTS - A ALA, URINE 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 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 staff prior to collection (07) HYDROXY TRYPTAMINE, Please refer to SEROTONIN, URINE 24 HOUR. URINE 6-THIOGUANINE (6-TG), BLOOD Blood/EDTA tube 3 weeks Transport at 4 C. 7-BIOPTERIN, URINE Please refer to PTERINS, URINE for details. Referred test. 7-DEHYDROCHOLESTEROL, PLASMA Blood/Lithium heparin 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 Please refer to ALBUMIN, SYNOVIAL FLUID. ACE, SERUM Please refer to ANGIOTENSIN CONVERTING ENZYME, SERUM. ACETAMINOPHEN, SERUM Please refer to PARACETAMOL, SERUM. ACETOACETATE, SERUM Please refer to KETONE SCREEN, SERUM. ACETOACETATE, URINE Please refer to PIGMENTS, URINE. ACETONE, BLOOD Please refer to SOLVENTS, BLOOD for all details. ACETONE, URINE 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 Please refer to SALICYLATE, SERUM. 7.1 PATHOLOGY TESTS - A

49 PATHOLOGY TESTS - A 7.2 ACETYLATOR PHENOTYPE, Test is currently unavailable due to withdrawal of the sulphonamines used in the test. BLOOD/URINE ACETYLCHOLINE RECEPTOR ANTIBODY, SERUM Immunology Blood/SS tube 1 week Refer to ADENOVIRUS SEROLOGY for collection details. ACETYLCHOLINESTERASE, AMNIOTIC FLUID ACETYLCHOLINESTERASE, RED CELL Amniotic fl uid/plain plastic tube Blood/Lithium heparin tube or EDTA tube 1 week Test for open neural tube defects. 1 day Test for organophosphate or carbamate insecticide toxicity. Please provide clinical details including exposure to pesticides etc. Leave as whole blood. Refer to 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 Please refer to LYSOSOMAL ENZYMES, BLOOD. ACID PHOSPHATASE (FEMALE), Blood/SS tube 24 hours Process sample as for ACID PHOSPHATASE (PROSTATIC), SERUM. SERUM ACID PHOSPHATASE (PROSTATIC), SERUM ACIDIFIED SERUM TEST (HAM TEST), BLOOD Haematology Blood/SS tube (Preserved by the addition of 1 drop of acid phosphatase preservative per 1 ml of serum) Blood/SS tube and EDTA tube ACTH STIMULATION TEST Endocrinology Blood/SS tube and EDTA tube 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. 24 hours Test for detection of Paroxysmal Nocturnal Haemoglobinuria (Haemolytic Anaemia). Please contact Haematology (07) or Branch Laboratory for details. Flow cytometry for PNH is the preferred 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. 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). 7.2 PATHOLOGY TESTS - A

50 PATHOLOGY TESTS - A 7.3 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 ACTIVATED PROTEIN C - RESISTANCE (APC) Haematology Blood/EDTA tube and Sodium citrate tube Initial culture results available 48 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. 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 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 Blood/SS tube 1-2 weeks Fresh random sample required. Transport in esky at 4 C. Referred test. ADENOSINE DEAMINASE, BLOOD Blood/Lithium heparin tube 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. 7.3 PATHOLOGY TESTS - A

51 PATHOLOGY TESTS - A 7.4 ADENOVIRUS SEROLOGY Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday. ADENYLSUCCINASE, URINE 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 Please refer to CATECHOLAMINES, URINE. ADRENOCORTICOTROPHIC HORMONE (ACTH) STIMULATION TEST ADRENOCORTICOTROPHIC HORMONE (ACTH), PLASMA AFP (ALPHA FOETOPROTEIN) - TUMOUR MARKER, SERUM AFP (ALPHA FOETOPROTEIN), SERUM AIDS ANTIBODY - INSURANCE/VISA Endocrinology Blood/SS tube and 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). 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. 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. Endocrinology Blood/SS tube 24 hours Period of amenorrhoea (A=) and estimated date of confi nement (EDC) required for test interpretation. 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 24 hours Assay run daily (Monday - Saturday). HIV1/HIV2/HIV antigen routinely performed. if other tests requested) ALA, URINE Please refer to 5-ALA, URINE. ALBUMIN, FLUID Fluid/Plain tube/container Same day Specify site of fl uid on specimen container and request form. ALBUMIN, SERUM Please refer to E/LFT, SERUM. ALBUMIN, SYNOVIAL FLUID 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. 7.4 PATHOLOGY TESTS - A

52 PATHOLOGY TESTS - A 7.5 ALBUMIN, URINE 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, Please refer to ALBUMIN, SYNOVIAL FLUID. SYNOVIAL FLUID ALBUTEROL, URINE Please refer to SALBUTAMOL, URINE. ALCOHOL, SERUM (BLOOD) LEGAL ALCOHOL, SERUM (BLOOD) NON-LEGAL ALCOHOL, URINE (NON-OCCUPATIONAL) ALDICARB (PESTICIDE), BLOOD Blood/Fluoride oxalate tube Blood/Fluoride oxalate tube (SS tube also acceptable for non-legal) By midday next working day Same day Clean skin with aqueous chlorhexidine or water. Seal tops of tubes and sign across label (see Preface 5.2). The specimens should be accompanied by Chainof-Custody documentation signed by both patient and collector. Forms are available from QML Pathology on request. Please contact (07) or Branch Laboratory. Non Medicare refundable cost to patient. Clean skin with aqueous chlorhexidine or water. If the possibility of a legallyrequired sample exists, an additional Fluoride oxalate tube should be collected. This tube should be sealed as for a legally-required test (see 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. Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER CHROMATOGRAPHY), URINE. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. ALDOLASE, SERUM 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. 7.5 PATHOLOGY TESTS - A

53 PATHOLOGY TESTS - A 7.6 ALDOSTERONE, URINE 24 HOUR ALDOSTERONE/RENIN RATIO, PLASMA ALDRIN (ORGANOCHLORINE PESTICIDES), BLOOD Endocrinology Endocrinology 24 hour urine collection/ Urine collection bottle. No preservative Blood/2 x EDTA tubes, SS tube 1 week Urine should be refrigerated during the collection period and transported cooled to the laboratory. 24 hours Special collection and handling of Renin specimen required. Refer to RENIN, PLASMA. Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. ALEPAM, SERUM Please refer to OXAZEPAM, SERUM. ALIPHATIC SOLVENTS Please refer to SOLVENTS, BLOOD for all details. ALKALINE PHOSPHATASE ISOENZYMES, SERUM ALKALINE PHOSPHATASE, FLUID ALKALINE PHOSPHATASE, SERUM Blood/SS tube 2-3 days Test to determine nature of unexplained elevation of alk. phos. Provide clinical and medication details. Fluid/Plain tube/ Container Same day Specify source of fl uid on sample and request form. Please refer to E/LFT, SERUM. ALKAPTONURIA SCREEN, URINE Please refer to HOMOGENTISIC ACID, URINE. ALLEGRON, SERUM 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) 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 Please refer to OXYPURINOL, PLASMA for details. ALODORM, SERUM Please refer to NITRAZEPAM, SERUM. 7.6 PATHOLOGY TESTS - A

54 PATHOLOGY TESTS - A 7.7 ALPHA 2 ANTIPLASMIN Haematology Blood/Sodium citrate tube ALPHA SUBUNIT (FREE) Endocrinology Blood/SS tube 1-2 weeks Referred test. ALPHA THALASSAEMIA GENE TESTING ALPHA-1-ACID GLYCOPROTEIN, SERUM ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM ALPHA-1-ANTITRYPSIN PHENOTYPE/GENOTYPE, PLASMA ALPHA-1-ANTITRYPSIN, FAECES ALPHA-1-ANTITRYPSIN, SERUM ALPHA-1,4 GLUCOSIDASE, BLOOD ALPHA-2 MACROGLOBULIN, SERUM ALPHA-FOETOPROTEIN (AFP) - TUMOUR MARKER, SERUM Haematology Blood/2 x EDTA tubes, 1 x SS tube 5 weeks Please contact Haematology (07) 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. 4 weeks Incurs non-medicare refundable fee. 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. Please refer to ALPHA-1-ANTITRYPSIN PHENOTYPE/GENOTYPE, PLASMA. 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 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. 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. Please refer to LYSOSOMAL ENZYMES, BLOOD. Blood/SS tube 1-2 weeks Transport in esky at 4 C. Referred test. 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. 7.7 PATHOLOGY TESTS - A

55 PATHOLOGY TESTS - A 7.8 ALPHA-FOETOPROTEIN (AFP), AMNIOTIC FLUID ALPHA-FOETOPROTEIN (AFP), SERUM ALPHA-FUCOSIDASE, BLOOD ALPHA-GALACTOSIDASE, BLOOD ALPHA-TOCOPHEROL, SERUM ALPRAZOLAM, SERUM 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. Endocrinology Blood/SS tube 24 hours Period of amenorrhoea (A=) and estimated date of confi nement (EDC) required for test interpretation. Blood/Plain plastic tube - no gel or anticoagulant (Lithium heparin tube acceptable) Please refer to LYSOSOMAL ENZYMES, BLOOD. Please refer to LYSOSOMAL ENZYMES, BLOOD. Please refer to VITAMIN E, SERUM. 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 Please refer to E/LFT, SERUM. ALT, FLUID Fluid/Plain tube/container Same day Specify source of fl uid on sample and request form. ALUMINIUM (AL), HAIR Hair/Dry sterile screw cap (urine) container ALUMINIUM, SERUM Blood/Trace element free tube (e.g. navy top) 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*** 1-2 weeks Test for aluminium accumulation generally in renal failure. Provide clinical and medication details. Referred test. ALUMINIUM, URINE Urine/Urine container 1 week Fresh random collection required. AMIKACIN, SERUM Blood/Lithium heparin tube - no gel or 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 Appendix (12.15). 7.8 PATHOLOGY TESTS - A

56 PATHOLOGY TESTS - A 7.9 AMINO ACIDS, PLASMA Blood/Lithium heparin tube AMINO ACIDS, URINE (CHROMATOGRAPHY) AMINO ACIDS, URINE (SCREEN) Random early morning urine/urine container 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. Please refer to AMINO ACIDS, URINE (SCREEN). 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, Please refer to 5-ALA, URINE. URINE AMINOPHYLLINE Please refer to THEOPHYLLINE, SERUM. PRE/POST DOSE, SERUM AMINOPHYLLINE, SERUM Please refer to THEOPHYLLINE, SERUM. AMIODARONE, SERUM 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 Please refer to SOLIAN, SERUM for details. AMITRIPTYLINE, SERUM Blood/Plain plastic tube - no gel (Plastic Lithium heparin tube acceptable) 1 week Collect immediately prior to next dose. Please provide clinical and medication details including time and date of last dose. AMITROLE (HERBICIDE), URINE Please refer to HERBICIDES, URINE. AML1-ETO 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. 7.9 PATHOLOGY TESTS - A

57 PATHOLOGY TESTS - A 7.10 AMMONIA, PLASMA 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 (NH 3 ), URINE 24hr urine container. No preservative AMMONIUM CHLORIDE LOAD TEST AMNIOTIC FLUID, CHROMOSOMES Genetics Amniotic fl uid/2 x sterile 10 ml black top tubes 24 hours Provide clinical and medication details. Refrigerate sample during collection and transport to the laboratory. Test for renal tubular acidosis. Contact House Collection (07) or Branch Laboratory for appointment. 1-2 weeks Average reporting time of 10 days. AMOEBIC SEROLOGY Immunology Blood/SS tube 1 week Assay run Wednesday. AMPHETAMINES - Please refer to SYMPATHOMIMETIC AMINES - GCMS CONFIRMATION. GCMS CONFIRMATION AMPRENAVIR, PLASMA 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 Fluid/Plain tube/container Same day Note fl uid site on specimen container and request form. AMYLASE, PLEURAL FLUID 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 Blood/SS tube Same day Test for acute pancreatitis. Please provide clinical and medication details. AMYLASE, URINE Urine/24 hour urine container with no preservative or Random urine container AMYLO-1,6-GLUCOSIDASE, BLOOD ANA (ANTINUCLEAR ANTIBODY), SERUM Blood/Lithium heparin tube 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. 2 weeks Please contact on (07) to advise of expected time of arrival, as sample must be referred to RBH on same day of collection. Referred test. Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday). Please refer to Immunology Appendix (12.35) for a comprehensive list of autoantibodies PATHOLOGY TESTS - A

58 PATHOLOGY TESTS - A 7.11 ANAEROBIC CULTURE FOR ACTINOMYCES Microbiology Aspirated pus/anaerobic transport medium Up to 7 days ANAFRANIL, SERUM Please refer to CLOMIPRAMINE, SERUM. ANCA (ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY), SERUM ANDROGEN INSENSITIVITY SYNDROME GENETIC TESTING Immunology Blood/SS tube 72 hours Assay run Monday, Wednesday, Friday. Please provide relevant clinical history. 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. 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 Genetics Blood/EDTA tube 1-2 months Incurs non-medicare refundable fee. DNA TESTING ANGIOSTRONGYLUS SEROLOGY Immunology Blood/SS tube 2-3 weeks ANGIOTENSIN CONVERTING ENZYME, SERUM Blood/SS tube 24 hours Test for pulmonary sarcoidosis. Please provide clinical details. ANGIOTENSIN/RENIN RATIO, PLASMA ANTI D SCREEN AND INJECTION ANTI DOUBLE-STRANDED DNA ANTIBODY, SERUM Endocrinology Blood Bank Blood/2 x EDTA tubes, SS tube Blood/Pink top EDTA tube 24 hours Special collection and handling of renin specimen required. Refer to RENIN, PLASMA. 24 hours and urgently Blood sample for antibody screen should be drawn before Anti-D injection. Record date Anti-D injection given. 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 Endocrinology Blood/SS tube 24 hours (THYROID), SERUM ANTI MULLERIAN HORMONE, SERUM 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 7.11 PATHOLOGY TESTS - A

59 PATHOLOGY TESTS - A 7.12 ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA), SERUM ANTI THYROGLOBULIN ANTIBODY, SERUM ANTI THYROID ANTIBODIES, SERUM ANTI THYROID PEROXIDASE ANTIBODY, SERUM ANTI-BETA2 GLYCOPROTEIN I ANTIBODY ANTIBIOTIC RESISTANT ORGANISMS ANTIBODIES TO EXTRACTABLE NUCLEAR ANTIGENS (ENA), SERUM ANTIBODIES TO MICROBIAL AND PARASITIC AGENTS, SERUM ANTIBODIES TO TISSUE ANTIGENS (AUTOANTIBODIES), SERUM ANTIBODY SCREEN/TITRE, SERUM ANTI-CYCLIC CITRULLATED PEPTIDE (CCP) ANTIBODY Immunology Blood/SS tube 72 hours Please provide relevant clinical history. Assay run Monday, Wednesday, Friday. Endocrinology Blood/SS tube 24 hours Endocrinology Blood/SS tube 24 hours Measure antimicrosomal and antithyroglobulin antibodies (Thyroid Tissue Antibodies). Endocrinology Blood/SS tube 24 hours Immunology Blood/SS tube 2-4 weeks Microbiology Rectal swab/rectal swab in transport medium 48 hours 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. Immunology Blood/SS tube Variable from 24 hours to weeks depending on agent requested Immunology Blood/SS tube Variable from 24 hours depending on antibody tests required Blood Bank Blood/Pink top EDTA tube 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) or Branch Laboratory. 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) or Branch Laboratory. 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. Immunology Blood/SS tube 72 hours Assay run Monday and Thursday. Next day results PATHOLOGY TESTS - A

60 PATHOLOGY TESTS - A 7.13 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 Blood/Lithium heparin tube (EDTA tube acceptable) 4 weeks Please provide clinical and medication details. Urine is the preferred sample for exposure. Referred test. ANTIMONY (Sb), URINE 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. ANTINUCLEAR ANTIBODY (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 Blood/SS tube or Lithium heparin tube ANTISPERM ANTIBODIES (INDIRECT IMMUNOBEAD TEST - IBT) Genetics Female - Blood/SS tube, Male - Blood/SS tube and/ or Seminal plasma 4 weeks The sample must arrive at the main laboratory by 2:30pm on the same day. Please contact Department to notify of expected time of arrival (07) This is a non-medicare rebate test. Please contact the laboratory for current charge for this assay. Referred test. Test performed fortnightly Assay dependent on normal semen for substrate. Test performed when normal semen available PATHOLOGY TESTS - A

61 PATHOLOGY TESTS - A 7.14 ANTITHROMBIN III Haematology Blood/Sodium citrate tube ANTITHROMBIN III, PLASMA Haematology Blood/Sodium citrate tube APC (ACTIVATED PROTEIN C - RESISTANCE) Haematology Blood/EDTA tube and Sodium citrate 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 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. 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. 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 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 PATHOLOGY TESTS - A

62 PATHOLOGY TESTS - A 7.15 APO A1, SERUM Please refer to APOLIPOPROTEIN A1, SERUM. APO B, SERUM Please refer to APOLIPOPROTEIN B, SERUM. APOLIPOPROTEIN A1, SERUM Blood/SS tube 24 hours Please provide clinical and medication details. APOLIPOPROTEIN B, SERUM Blood/SS tube 24 hours Please provide clinical and medication details. APOLIPOPROTEIN B100, SERUM Blood/SS tube 2 weeks Please provide clinical and medication details. APOLIPOPROTEIN E GENOTYPING APOLIPOPROTEIN STUDIES, SERUM Genetics Blood/Pink top EDTA tube APTT (COAGULATION PROFILE) Haematology Blood/Sodium citrate tube APTT: HEPARIN THERAPY, BLOOD ARBOVIRUS ISOLATION, BLOOD, SYNOVIAL FLUID, CSF 1 week Incurs non-medicare refundable fee. Transport at room temperature or cooled. Blood/SS tube 24 hours Please provide clinical and medication details. Haematology Immunology Blood/Sodium citrate and EDTA tubes Blood/SS tube, Other fl uids/ Sterile container Same day Same day Days to weeks Also refer to COAGULATION STUDIES. If for Warfarin care please refer to Haematology Appendix (12.32) for further information. Please provide clinical and medication details. Transport to laboratory within 2 hours of collection. Monday to Wednesday only. 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). ARGININE GROWTH HORMONE STIMULATION TEST ARGININE/INSULIN GROWTH 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) for details. 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) for details PATHOLOGY TESTS - A

63 PATHOLOGY TESTS - A 7.16 ARIPIPRAZOLE, SERUM 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 Please refer to SOLVENTS, BLOOD for all details. ARSENIC - INORGANIC, URINE Please refer to INORGANIC ARSENIC, URINE. ARSENIC, BLOOD Blood/Lithium heparin tube (EDTA tube acceptable) 4 weeks Test for current toxicity. Provide clinical and medication details. Do not separate sample. Referred test. ARSENIC, HAIR 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 ( grams). Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED*** ARSENIC, NAIL 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 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, Please refer to LYSOSOMAL ENZYMES, BLOOD. LEUCOCYTES ASCA (ANTI-SACCROMYCES Immunology Blood/SS tube 3-4 weeks CEREVISEIA ANTIBODY) ASCITIC FLUID BIOCHEMISTRY Fluid/Sterile container Same day Please provide clinical and medication details, and tests required. ASCORBIC ACID, SERUM Please refer to VITAMIN C, SERUM. ASHPLEX 1, BLOOD Blood/EDTA tube 4 weeks Transport at 4 C. Referred test. ASHPLEX 2, BLOOD Blood/EDTA tube 4 weeks Transport at 4 C. Referred test. ASHPLEX CF, BLOOD 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) PATHOLOGY TESTS - A

64 PATHOLOGY TESTS - A 7.17 ASPARTATE TRANSAMINASE, Please refer to VITAMIN B6, BLOOD for details. RED CELL ASPERGILLUS SEROLOGY Immunology Blood/SS tube 1 week Assay run Monday. 24 hour results. ASPIRIN, SERUM Please refer to SALICYLATE, SERUM. AST (SGOT), SERUM Please refer to E/LFT, SERUM. AST, FLUID Fluid/Plain tube/container Same day Specify source of fl uid on sample and request form. ATRIAL NATRIURETIC PEPTIDE, PLASMA 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. ATYPICAL MYCOBACTERIA MICROSCOPY AND CULTURE AUSTRALIAN (MURRAY VALLEY) ENCEPHALITIS VIRAL SEROLOGY AUSTRALIAN BAT LYSSAVIRUS SEROLOGY 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). Immunology Blood/SS tube 2 weeks Referred test. 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. 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 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) or Branch Laboratory PATHOLOGY TESTS - A

65 PATHOLOGY TESTS - A 7.18 AUTOCLAVE VALIDATION TEST WITH BIOLOGICAL INDICATORS AUTOPSY (ADULT/CHILDREN/ NEONATES) Microbiology Histology AUTOCLAVE TEST VIAL x 7 (NB: All must have the same lot number.) AVIAN PRECIPITINS SEROLOGY Immunology Blood/SS tube 3-4 weeks Referred test. AZINPHOS (PESTICIDE), SERUM 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) for vials and request books. Laboratory not accredited for this service. Contact Forensic and Scientifi c Services (formerly Queensland Health Scientifi c Services) John Tonge Centre (07) Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity PATHOLOGY TESTS - A

66 PATHOLOGY TESTS - B B2 GLYCOPROTEIN Immunology Blood/SS tube 2 weeks BARBITURATES SCREEN, SERUM Please refer to DRUG SCREEN, SERUM. BARBITURATES SCREEN, URINE BARMAH FOREST VIRUS SEROLOGY BASEMENT MEMBRANE ZONE (BMZ) ANTIBODY/PEMPHIGOID ANTIBODY, SERUM Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER CHROMATOGRAPHY), URINE. 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 Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Referred test. B-CELL (IgH) GENE REARRANGEMENT STUDIES BCL-1 [t(11;14)] DNA TESTING BCL-2 [t(14;18)] DNA TESTING Genetics Genetics Genetics Blood or Bone marrow/pink top EDTA tube, or bone marrow or lymph node or tumour EDTA Blood, bone marrow, lymph node, aspirate, tissue EDTA Blood, bone marrow, lymph node, aspirate, tissue BCR-ABL [t(9;22)] FISH Genetics Blood or Bone marrow/ Lithium heparin tube or min. 1mL bone marrow in Lithium heparin tube 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 Incurs non-medicare refundable fee. Transport at room temperature or cooled. 2 weeks Incurs non-medicare refundable fee. 2 weeks Incurs non-medicare refundable fee. 1-2 days 2 weeks Please send to the laboratory without delay. PATHOLOGY TESTS - B

67 PATHOLOGY TESTS - B BECKER MUSCULAR Please refer to DYSTROPHIN GENE ANALYSIS, BLOOD. DYSTROPHY, BLOOD BENCE JONES PROTEIN, SERUM Please refer to FREE LIGHT CHAINS, SERUM. BENCE JONES PROTEIN, URINE BENDIOCARB (PESTICIDE), BLOOD 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. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. BENZENE, BLOOD Please refer to SOLVENTS, BLOOD for all details. For Urine - see HIPPURIC ACID, URINE. BENZODIAZEPINES - GCMS CONFIRMATION BENZODIAZEPINES SCREEN, URINE Urine/Urine drug screen collection kit with tamper evident packaging 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 Preface (5.4). Confi rmation and quantitation by GCMS of positive fi ndings may be requested separately. 48 hours Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER CHROMATOGRAPHY), URINE. BERYLLIUM (Be), BLOOD Blood/EDTA tube 2 weeks Please provide details of exposure (clinical and occupational). BERYLLIUM (Be), URINE Urine/24 hour urine collection in acid washed container. Random urine container BETA GALACTOSIDASE, BLOOD 2 weeks Test for recent exposure. Consultation with referring laboratory required before collection. Phone on (07) 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. Please refer to LYSOSOMAL ENZYMES, BLOOD. PATHOLOGY TESTS - B

68 PATHOLOGY TESTS - B BETA HCG - QUANTITATIVE, SERUM BETA HCG - TUMOUR MARKER, 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). 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 Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. PESTICIDE), BLOOD BETA HYDROXYBUTYRATE, Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA. PLASMA BETA-2 MICROGLOBULIN, Blood/SS tube 24 hours Assay run daily (Monday - Friday). Provide clinical and medication details. SERUM BETA-2 MICROGLOBULIN, Urine/Urine container 2 weeks Transport at 4 C. URINE BETA-2 TRANSFERRIN, FLUID Please refer to TAU PROTEIN, FLUID. BETA-ALANINE, SERUM OR URINE 24 HOUR For serum please refer to AMINO ACIDS, PLASMA. For urine please refer to AMINO ACIDS, URINE. Referred test. BICARBONATE, FLUID Fluid/Plain tube/container Same day Specify source of fl uid on sample and request form. BICARBONATE, SERUM Please refer to E/LFT, SERUM. BILE ACIDS, SERUM 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 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. PATHOLOGY TESTS - B

69 PATHOLOGY TESTS - B BILIRUBIN (CONJUGATED/ Blood/SS tube Same day Protect sample from light. DIRECT), SERUM BILIRUBIN (NEONATAL), SERUM BILIRUBIN, AMNIOTIC FLUID Blood/SS tube or Paediatric SS tube Amniotic fl uid/ Plain plastic tube BILIRUBIN, CORD BLOOD Cord blood/ss tube or plain tube Same day Same day 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. Test for fetal liver disease, high red cell turnover, etc. Protect from light (wrap in foil or brown paper). Test for fetal liver disease, high red cell turnover, etc. Please provide clinical details. Protect sample from light. BILIRUBIN, FLUID 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 Protect sample from light. Please refer to E/LFT, SERUM. BILIRUBIN, URINE Please refer to BILE PIGMENTS, URINE for details. BIOCHEMISTRY, CSF 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 Please refer to PTERINS, URINE for details. Referred test. BIOTINIDASE, PLASMA Blood/Lithium 2 weeks Referred test. heparin tube BISCODYL, FAECES Please refer to LAXATIVES, FAECES. BISMUTH, BLOOD Blood/EDTA tube 2 weeks Test for exposure. Referred test. BK VIRUS Immunology Blood and urine/ss tube and Urine container 2-3 weeks PATHOLOGY TESTS - B

70 PATHOLOGY TESTS - 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) or Branch Laboratory. BLOOD COAGULATION STUDIES Haematology Blood/3 Sodium Citrate tubes, 1 EDTA tube, 1 blood fi lm prepared at time of collection BLOOD CROSSMATCH Blood Bank Blood/Pink top EDTA tube 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 BLOOD GASES, ARTERIAL Arterial blood/ Blood gas syringe BLOOD GASES, VENOUS Venous Blood/Blood gas syringe BLOOD GROUP Blood Bank Blood/Pink top EDTA tube BLOOD GROUP AND COOMBS TEST Blood Bank Blood/Pink top EDTA tube Same day Same day or urgently Interim report after 2 days. Final report after 7 days. Mycobacteria report after 6 weeks. 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. 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. Please contact Microbiology (07) or Branch Laboratory for details of collection methods for Mycobacteria and Fungi. Indicate recent history of antibiotics. Test for respiratory disease, acid/base imbalance. Please refer to Preface (5.1) and Appendix (12.19). Same day Please refer to Preface (5.1) and Appendix (12.19). 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. Same day PATHOLOGY TESTS - B

71 PATHOLOGY TESTS - B BLOOD GROUP ANTIBODIES Blood Bank Blood/Pink top EDTA tube BLOOD GROUP GENOTYPE Blood Bank Blood/Pink top EDTA tube BLOOD GROUP PHENOTYPE Blood Bank Blood/Pink top EDTA tube BLOOD TRANSFUSION REACTION INVESTIGATION, BLOOD AND URINE Blood Bank Blood/Plain plastic tube, EDTA tube. Urine/Urine container BLOOD VOLUME STUDIES Haematology Blood/Sterile vials available on request from Haematology 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. 24 hours Please indicate reason for genotyping request (e.g. possibility of fetal or neonatal haemolysis). 24 hours Please indicate reason for phenotyping request. 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 laboratory. 24 hours Appointment required. This test MUST NOT be performed on children, pregnant or breast feeding women. Please contact Haematology (07) or Branch Laboratory for details. BNP, PLASMA 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 BOLVIDON, SERUM Please refer to MIANSERIN, SERUM. BONE MARROW CULTURE Microbiology Bone marrow aspirate/ Sterile container BONE MARROW EXAMINATION Haematology Bone marrow aspirate, trephine and smears/ Appropriate containers Interim report after 48 hours. Final report 21 days. 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. Please provide clinical details including antibiotic therapy. Specimen will be cultured for Mycobacteria and fungi. 24 hours Please contact Haematology (07) or Branch Laboratory for appointment. Refer to Haematology Preface (5.33) for specimen collection and preparation details. BONE MINERALS, SERUM 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 Please refer to N-TELOPEPTIDE, URINE. PATHOLOGY TESTS - B

72 PATHOLOGY TESTS - B BONE SPECIFIC ALKALINE Endocrinology Blood/SS tube 1 week PHOSPHATASE BORDETELLA PERTUSSIS PCR Immunology Nasopharyngeal aspirate or 24 hours Assay run daily (Monday - Friday). Nasopharyngeal swab (dry) BORDETELLA PERTUSSIS Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). SEROLOGY BORON, URINE 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 BRAIN NATRIURETIC PEPTIDE, PLASMA BRATTON-MARSHALL TEST, URINE BREAST CANCER GENETIC TESTING (BRCA1 BRCA2) BREAST CYST ASPIRATE CYTOLOGY Endocrinology Blood/SS tube 24 hours Infl ammatory or neoplastic conditions of mucinous epithelium - see Appendix (12.4). Blood/EDTA tube Same day Please refer to BNP, PLASMA. Please refer to SAICAR, URINE. 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) 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 24 hours For specimen preparation please refer to Cytology Preface (5.16). 24 hours For specimen preparation please refer to Cytology Preface (5.16). Endocrinology Blood/SS tube 24 hours Breast Carcinoma - see Appendix (12.4). PATHOLOGY TESTS - B

73 PATHOLOGY TESTS - B BREATH HYDROGEN (MULTIPLE) 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) , (07) or Branch Laboratory for details and appointment. BREATH HYDROGEN (SINGLE) Expired air samples 48 hours BREATH TEST (CARBON - 14 UREA) FOR HELICOBACTER PYLORI BROMIDE, BLOOD and SERUM Endocrinology 1 glass vial containing CO 2 trapping liquid. Blood/Lithium heparin serum/ss tube 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 CO 2 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 CO 2 is measured. Appointment is required for test. 4 weeks Referred test. BROMIDE, URINE 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 Please refer to HERBICIDES, URINE. BRONCHIAL BRUSHING CYTOLOGY BRONCHIAL WASHING CYTOLOGY BRONCHIAL WASHINGS, MICROSCOPY AND CULTURE Cytology Smears and/or fl uid. Bronchial brush in normal saline 24 hours For specimen preparation please refer to Cytology Preface (5.16). Cytology Fluid/Aspirating trap 24 hours For specimen preparation please refer to Cytology Preface (5.16). 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 Cytology Fluid/Aspirating trap 24 hours For specimen preparation please refer to Cytology Preface (5.16). (BAL), CYTOLOGY BRUCELLA SEROLOGY Immunology Blood/SS tube 72 hours Assay run Monday and Thursday. PATHOLOGY TESTS - B

74 PATHOLOGY TESTS - B 7.27 B-TYPE NATRIURETIC PEPTIDE, Blood/EDTA tube Same day Please refer to BNP, PLASMA. PLASMA BUPIVACAINE, PLASMA Blood/Plain tube - no gel or anticoagulant BUPRENORPHINE SCREEN, URINE 4-6 weeks Centrifuge and separate serum into a plain 5 ml tube. Keep cool. Referred test. Urine/Urine container 2 weeks Transport to central laboratory on ice. There is currently no Medicare rebate for this test. Referred test PATHOLOGY TESTS - B

75 PATHOLOGY TESTS - C C - 14 UREA BREATH TEST FOR HELICOBACTER PYLORI C1 ESTERASE INHIBITOR FUNCTIONAL, SERUM C1 ESTERASE INHIBITOR, SERUM Endocrinology 1 glass vial containing CO 2 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 CO 2 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 CO 2 is measured. Appointment is required for test. 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. 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 Please refer to COMPLEMENT-C1 for details. Referred test. C2, SERUM Please refer to COMPLEMENT-C2 for details. Referred test. C3 NEPHRITIC FACTOR, SERUM Blood/SS tube and Lithium heparin tube 3 weeks Please keep sample cool and transport to the laboratory without delay. Referred test. C3, SERUM Please refer to COMPLEMENT-C3 for details. C4, SERUM Please refer to COMPLEMENT-C4 for details. C5, SERUM Please refer to COMPLEMENT-C5 for details. Referred test. CA 125, SERUM Endocrinology Blood/SS tube 24 hours Serous Carcinoma of ovary - see Appendix (12.4). CA 15-3, SERUM Endocrinology Blood/SS tube 24 hours Breast Carcinoma - see Appendix (12.4). CA 19-9, SERUM Endocrinology Blood/SS tube 24 hours Infl ammatory or neoplastic conditions of mucinous epithelium. See Appendix (12.4). CA 724, SERUM Endocrinology Blood/SS tube 4-5 weeks A marker for stomach tumours. See 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 Blood/EDTA tube (Lithium heparin tube acceptable) 1 week Please provide clinical, medication and exposure details. PATHOLOGY TESTS - C

76 PATHOLOGY TESTS - C CADMIUM (Cd), HAIR 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 ( g) or to half fi ll a sterile screw top (urine) container. Please refer to Preface (5.6). Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED*** CADMIUM (Cd), URINE 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 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 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) 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 Fluid/Plain tube/container Same day Specify source of fl uid on sample and request form. CALCIUM, SERUM Blood/SS tube Same day Please refer to E/LFT, SERUM. Fasting is desirable. Rest the patient for minutes prior to collection. The sample should be collected without venous stasis (i.e. tourniquet should not be used). PATHOLOGY TESTS - C

77 PATHOLOGY TESTS - C CALCIUM, URINE Urine/24 hour urine container with 25 ml 6M HCl preservative CALCULUS ANALYSIS Calculus/Screw capped container CAMPYLOBACTER JEJUNI SEROLOGY 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. 1 week Please state anatomical site of origin. Forward sample to the laboratory in a screw capped container (not in formalin). Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). CANDIDA SEROLOGY Immunology Blood/SS tube 1 week Assay run Friday. CANNABINOIDS - Please refer to THC-COOH - GCMS CONFIRMATION for details. GCMS CONFIRMATION CARBAMATE PESTICIDES Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. CARBAMAZEPINE, SERUM CARBARYL (PESTICIDE), BLOOD CARBOHYDRATE DEFICIENT TRANSFERRIN, SERUM CARBON - 14 UREA BREATH TEST FOR HELICOBACTER PYLORI CARBON TETRA CHLORIDE, BLOOD Blood/Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin acceptable) Same day or urgently Please provide clinical and medication details. Collect at least 8 hours after last dose or just prior to next dose. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Blood/SS tube 1 week Test for recent alcohol abuse. Please keep the sample cool and forward to the laboratory without delay. Endocrinology 1 glass vial containing CO 2 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 CO 2 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 CO 2 is measured. Appointment is required for test. Please refer to SOLVENTS, BLOOD for all details. PATHOLOGY TESTS - C

78 PATHOLOGY TESTS - C CARBOXYHAEMOGLOBIN, BLOOD CARCINOEMBRYONIC ANTIGEN (CEA), SERUM 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. 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 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, Immunology Blood/SS tube 72 hours Assay run twice a week. SERUM CARNITINE, Please refer to ACYL CARNITINE, NEONATAL SCREEN for details. Referred test. NEONATAL SCREEN CARNITINE, SERUM Please refer to ACYL CARNITINE, SERUM. CAROTENE (BETA), SERUM Please refer to CAROTENOIDS, SERUM for details. CAROTENOIDS, SERUM 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). PATHOLOGY TESTS - C

79 PATHOLOGY TESTS - C CATECHOLAMINES, BLOOD Blood/Lithium heparin tube with 1 mg of sodium metabisulphite added CATECHOLAMINES, URINE Urine/24 hour urine container with 25 ml 6M HCl preservative CD34 PROGENITOR CELLS Haematology Blood/EDTA tube or ACD yellow top tube CD4/CD8 T LYMPHOCYTE RATIO, BLOOD Haematology Blood/ACD tube, EDTA tube, Blood fi lm 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 on (07) 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 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. 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 staff prior to collection (07) Same day Transport to laboratory as soon as possible. 24 hours Lithium heparin tube may be used if ACD tube unavailable. CDT, SERUM Please refer to CARBOHYDRATE DEFICIENT TRANSFERRIN, SERUM. CEA (CARCINOEMBRYONIC ANTIGEN), SERUM CELL PANEL HLA AB RBH HOSP Haematology Blood/SS tube or Plain tube 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. 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 Please refer to MYCOPHENOLIC ACID, PLASMA. PATHOLOGY TESTS - C

80 PATHOLOGY TESTS - C CEPHALOSPORINS, SERUM/PLASMA CERVICAL PAP SMEAR CYTOLOGY CHARCOT MARIE TOOTH SYNDROME - DNA Cytology Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable) Labelled fi xed smear/ Slide carrier 1-2 weeks Collect just prior to next dose. Provide clinical and medication details hours For specimen preparation and details of adjunctive tests (ThinPrep), please refer to Cytology Preface (5.11). 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 CHLAMYDIA PCR, URINE Immunology First catch Urine/ Urine container CHLAMYDIA SEROLOGY SCREEN CHLORDANE (ORGANOCHLORINE PESTICIDES), BLOOD 24 hours Assay runs daily (Monday to Saturday). Please see Microbiology Preface (5.58) and contact Immunology (07) or Branch Laboratory for details. 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. Immunology Blood/SS tube 72 hours Assay run Monday, Wednesday and Friday. Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. CHLORIDE, CSF Please refer to BIOCHEMISTRY, CSF for details. CHLORIDE, FAECES Faeces/Faeces container 24 hours Keep sample cool during collection and transport to the laboratory. CHLORIDE, FLUID Fluid/Plain tube/container Same day Specify source of fl uid on sample and request form. CHLORIDE, SERUM Please refer to E/LFT, SERUM. CHLORIDE, SWEAT Sweat/Sweat tube 1 week Test for cystic fi brosis. Please contact Collections (07) or Branch Laboratory for appointment. CHLORIDE, URINE 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 Please refer to SOLVENTS, BLOOD for all details. CHLOROETHANE, BLOOD Please refer to SOLVENTS, BLOOD for all details. PATHOLOGY TESTS - C

81 PATHOLOGY TESTS - C CHLOROFORM, BLOOD Please refer to SOLVENTS, BLOOD for all details. CHLOROQUINE, SERUM Blood/Fluoride oxalate tube or EDTA tube (preferred) or (Lithium heparin tube acceptable) CHLORPROMAZINE, SERUM Blood/Plain plastic 6 ml tube - no gel or anticoagulant CHLORPYRIFOS (PESTICIDE), SERUM CHOLECALCIFEROL (HYDROXY), SERUM 2 weeks Please provide clinical and medication details, including time and date of last dose. Referred Test. 2 weeks Please provide clinical and medication details. Sample collection is independent of time of dose. Referred test. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Please refer to VITAMIN D, SERUM. CHOLESTEROL, FLUID 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 Please refer to E/LFT, SERUM. CHOLINESTERASE TYPING FOR SUXAMETHONIUM, SERUM CHOLINESTERASE, RED CELL Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM (SCOLINE) SENSITIVITY, SERUM. Test for organophosphate or carbamate insecticide toxicity. Please provide clinical details including exposure to pesticides etc. Leave as whole blood. Refer to 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. PATHOLOGY TESTS - C

82 PATHOLOGY TESTS - C CHOLINESTERASE, SERUM Blood/SS tube (EDTA tube and Lithium heparin tube acceptable) CHROMATOGRAPHY, FAECES (SUGAR) 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 Appendix for list. 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 Preface (5.5). CHROMIUM, BLOOD Blood/Lithium heparin tube 2 weeks Please provide clinical and medication details. Referred test. or EDTA tube CHROMIUM, URINE Urine/Urine container 2 weeks Please provide details of exposure (clinical and occupational). A random collection is preferred. Referred test. CHROMOGRANIN A, SERUM 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 CHROMOSOMES, CHORIONIC VILLI CHROMOSOMES, LYMPH NODE Genetics Genetics Genetics Bone marrow aspirate/ Lithium heparin tube Chorionic villus biopsy/ Antibiotic transport medium Lymph node/antibiotic transport medium 2 weeks Minimum 2 days if urgent. Transport in esky at 4 C or room temperature. 1-2 weeks Antibiotic transport medium available from Genetics (07) or Branch Laboratory. 2-6 weeks DO NOT use formalin. Transport to laboratory as soon as possible. Antibiotic transport medium available from Genetics (07) or Branch Laboratory. PATHOLOGY TESTS - C

83 PATHOLOGY TESTS - C CHROMOSOMES, PRODUCTS OF CONCEPTION Genetics Products of conception (placenta, membrane, fetal tissue and skin)/antibiotic transport medium CHROMOSOMES, TISSUE Genetics Skin and other tissues (not prenatal)/antibiotic transport medium CHROMOSOMES, TUMOUR Genetics Selected tumour tissue dissected free of necrotic tissue, adherent fat and extraneous tissue and sliced into small pieces/antibiotic transport medium CHROMOSOMES, UNSTIMULATED BLOOD CHRONIC RENAL DISEASE GENETIC TESTING Genetics Blood/Lithium heparin tube Genetics Blood/EDTA tube Indeterminate CIGUATERA POISONING, FISH Frozen fi sh (cooked or uncooked)/clean plastic container Indeterminate CILIAL BIOPSY Histology Hartmann s Solution Motility - 2 hours Electron Microscopy - 7 days CITRATE, URINE Urine/24 hour urine container with 25 ml 6M HCl preservative 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) or Branch Laboratory. 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) or Branch Laboratory. 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) or Branch Laboratory. 2 weeks DIFFICULT collection should be noted on the form. Transport cool or at room temperature. Please contact or Branch Laboratory regarding details of collection of fi sh samples. Testing on human samples is not available. 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. 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 Please refer to CK ISOENZYME ELECTROPHORESIS, SERUM. PATHOLOGY TESTS - C

84 PATHOLOGY TESTS - C CK ISOENZYMES Blood/SS tube 2 weeks Please provide clinical and medication details. ELECTROPHORESIS, SERUM CK ISOENZYMES, SERUM Blood/SS tube Same day Please provide clinical and medication details. CK, SERUM 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 CLOBAZAM, SERUM Blood/Plain plastic tube - no gel (Plastic lithium heparin tube acceptable) CLOMIPRAMINE, SERUM Blood/Plain plastic tube - no gel (Plastic lithium heparin tube acceptable) CLONAZEPAM, SERUM Blood/Plain plastic tube - no gel (Plastic lithium heparin tube acceptable) CLONIDINE GROWTH HORMONE STIMULATION TEST CLOPYRALID (HERBICIDE), URINE CLOSTRIDIUM DIFFICILE TOXIN, FAECES 1-2 months 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. 1 week Please provide clinical and medication details, including time and date of last dose. Collect sample immediately prior to next dose. 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. 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) or Branch Laboratory for collection details and dose. Microbiology Faeces/Faeces container Same day - 24 hours Please refer to HERBICIDES, URINE. 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). PATHOLOGY TESTS - C

85 PATHOLOGY TESTS - C CLOZAPINE, SERUM 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 Please refer to CLOZAPINE, SERUM. CMV (CYTOMEGALOVIRUS) PCR CMV (CYTOMEGALOVIRUS) SEROLOGY COAGULATION STUDIES, BLOOD 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. Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). 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 Blood/EDTA tube (Lithium 4 weeks Please provide exposure details. Referred test. heparin tube acceptable) COBALT, URINE Urine/Urine container 1 week Please provide details of exposure (clinical and occupational). A random collection is preferred. Referred test. COCAINE METABOLITES - GCMS CONFIRMATION 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 Preface (5.4). Confi rmation and quantitation by GCMS of positive fi ndings may be requested separately. PATHOLOGY TESTS - C

86 PATHOLOGY TESTS - C COCCIDIOIDES SEROLOGY Immunology Blood/SS tube 2-3 weeks CODEINE, SERUM 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 Please refer to CODEINE, SERUM. CODRAL, SERUM Please refer to CODEINE, SERUM. COENZYME Q10, PLASMA 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 COLLAGEN BINDING ASSAY, BLOOD COMBINED DEXAMETHASONE/ SYNACTHEN TEST COMPATIBILITY TESTING (CROSSMATCH), BLOOD COMPLEMENT - TOTAL HAEMOLYTIC (CH50), SERUM Haematology Endocrinology Blood Bank Blood/Sodium citrate tube Blood/SS tube and EDTA tube Blood/1 Pink top EDTA tube, 1 Lavender top EDTA tube 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. 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) or Branch Laboratory for details. 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) or Branch Laboratory for collection details and supply of Dexamethasone tablets and Synacthen ampoule (0.25mg/1 ml). 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. 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 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. PATHOLOGY TESTS - C

87 PATHOLOGY TESTS - C COMPLEMENT-C2, SERUM 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. COMPLEMENT-C3, SERUM Blood/SS tube 24 hours Please provide clinical and medication details. Sample must be stored and transported to the laboratory REFRIGERATED. COMPLEMENT-C4, SERUM Blood/SS tube 24 hours Please provide clinical and medication details. Sample must be stored and transported to the laboratory REFRIGERATED. COMPLEMENT-C5, SERUM 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. COMPLEMENT-C6, SERUM 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. COMPLEMENT-C9, SERUM 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. COMPLEMENTS, SERUM 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 Please refer to NEONATAL SCREENING TEST. SCREENING TEST, BLOOD CONNEXION 26 Genetics Blood/EDTA tube 1 month Incurs non-medicare refundable fee. GENETIC TESTING 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 Hair/Dry sterile screw cap (urine) container COPPER, LIVER BIOPSY Liver biopsy/dry sterile screw top (urine) container COPPER, RED BLOOD CELLS 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*** 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. 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. PATHOLOGY TESTS - C

88 PATHOLOGY TESTS - C COPPER, SERUM Blood/SS tube 1 week Please provide clinical history and medication details. CAERULOPLASMIN, SERUM may often be requested concurrently. COPPER, URINE 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 Please refer to PORPHYRIN, URINE. Fractionation and PBG analysis is routinely performed. COPROPORPHYRIN SCREEN, Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES. FAECES COPROPORPHYRIN/ PROTOPORPHYRIN, FAECES Faeces/Faeces container Screen: 1-7 days Quantitation: 1-2 weeks Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES. CORDARONE, SERUM 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 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 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. PATHOLOGY TESTS - C

89 PATHOLOGY TESTS - C 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) or Branch Laboratory. CPK, SERUM Please refer to CK ISOENZYMES, SERUM. C-REACTIVE PROTEIN, HIGH SENSITIVITY, SERUM C-REACTIVE PROTEIN, SERUM Blood/SS tube (EDTA tube and Lithium heparin tube acceptable if centrifuged without delay) 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. Same day Test for infection/infl ammation. With low level elevation, test for active coronary atherosclerosis. Please provide clinical and medication details. CREATINE KINASE Please refer to CK ISOENZYMES, SERUM. ISOENZYMES, SERUM CREATINE KINASE, SERUM Please refer to CK, SERUM. CREATINE, PLASMA Blood/Lithium heparin tube 3 weeks Centrifuge sample and separate plasma where possible. Transport sample on dry ice. CREATININE CLEARANCE 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 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 Please refer to E/LFT, SERUM. PATHOLOGY TESTS - C

90 PATHOLOGY TESTS - C CREATININE, URINE 24 HOUR CREATININE, URINE RANDOM 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. 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 Same day or urgently Please refer to N-TELOPEPTIDE, URINE. 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 Please refer to C REACTIVE PROTEIN, HIGH SENSITIVITY, SERUM. CRP, SERUM Please refer to C-REACTIVE PROTEIN, SERUM. CRYOFIBRINOGEN, PLASMA AND SERUM Please refer to CRYOFIBRINOGEN/CRYOGLOBULINS, PLASMA AND SERUM. PATHOLOGY TESTS - C

91 PATHOLOGY TESTS - C CRYOFIBRINOGEN/ CRYOGLOBULINS, PLASMA AND SERUM CRYOGLOBULINS, PLASMA AND SERUM CRYOGLOBULINS/ CRYOFIBRINOGEN, PLASMA AND SERUM CRYPTOCOCCUS ANTIGEN, SERUM OR CSF CSF - LEUKAEMIA/LYMPHOMA CELLS Immunology Haematology Blood/Lithium heparin tube and a plain tube - no gel Blood/SS tube; Cerebrospinal fl uid (5-10 ml)/csf collection tubes CSF/CSF collection tubes CSF - VIROLOGY Immunology CSF/Plain tube (minimum 0.5 ml required) 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 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) or Branch Laboratory. Same day Same day Please refer to CRYOFIBRINOGEN/CRYOGLOBULINS, PLASMA AND SERUM. Please refer to CRYOFIBRINOGEN/CRYOGLOBULINS, PLASMA AND SERUM. Examination of cytospin preparation for leukaemia/lymphoma cells. 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 Please refer to TAU PROTEIN, FLUID. CSF CYTOLOGY Cytology CSF/Sterile screw top 24 hours For specimen preparation please refer to Cytology Preface (5.15). container PATHOLOGY TESTS - C

92 PATHOLOGY TESTS - C CSF MALIGNANT CELLS Cytology Fluid/Sterile 24 hours For specimen preparation please refer to Cytology Preface (5.15). screw top container CSF MICROSCOPY AND CULTURE Microbiology Cerebrospinal fl uid/sterile tubes labelled 1, 2, 3 or 4 CSF MICROSCOPY ONLY Microbiology Cerebrospinal fl uid/ Sterile tubes labelled 1, 2, 3 or 4 Interim microscopy report same day. Culture up to 3 days. Same day 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 TRANSFERRIN ASSAY, Please refer to TAU PROTEIN, FLUID. FLUID CYANIDE, BLOOD This test is not available. THIOCYANATE, BLOOD (metabolite of cyanide) is more appropriate. CYANIDE, URINE 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 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 Please refer to NEONATAL SCREENING TEST. CYSTIC FIBROSIS DNA TEST Blood/Refer to specifi c collection details CYSTINE, URINE Urine/24 hour urine container with 25 ml 6M HCI preservative 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) for instructions. 2 weeks Please provide clinical history and medication details. Refrigerate from start of collection. 24 hour collection is preferred. Referred test. PATHOLOGY TESTS - C

93 PATHOLOGY TESTS - C 7.46 CYTOMEGALOVIRUS (CMV) PCR Immunology Blood/SS tube and 2 x EDTA tubes. Random (mid-stream) urine/urine container. Swab/Viral culture transport medium CYTOMEGALOVIRUS (CMV) SEROLOGY CYTOTOXIC FOOD TESTING 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. Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). Specimen Distribution Blood/ACD tube Collection and transfer only 7.46 PATHOLOGY TESTS - C

94 PATHOLOGY TESTS - D DANTHRON, BLOOD This test is performed on faeces. Please refer to LAXATIVES, FAECES. DANTHRON, FAECES 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 Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. D-DIMER TEST Haematology Blood/Sodium Citrate tube Same day Transport to laboratory as soon as possible. DDT LEVELS (ORGANOCHLORINE PESTICIDES), BLOOD Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. DELTA ALA, URINE 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 Genetics Blood/EDTA tube 1-2 months Incurs non-medicare refundable fee. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. DEOXYCORTICOSTERONE, Endocrinology Blood/SS tube 2-5 weeks Referred test. SERUM DEOXYCORTISOL, SERUM Endocrinology Blood/SS tube 2-5 weeks Referred test. DEOXYPYRIDINIUM, URINE Please refer to DEOXYPYRIDINOLINE, URINE. DEOXYPYRIDINOLINE, URINE 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 Please refer to DOXEPIN, SERUM. PATHOLOGY TESTS - D

95 PATHOLOGY TESTS - D DESIPRAMINE, SERUM Blood/Plain plastic tube - no gel (Plastic lithium heparin tube (no gel) acceptable) DESMOSINE PYRIDINOLINE, URINE DEXAMETHASONE SUPPRESSION TEST DEXAMETHASONE SUPPRESSION TEST - EXTENDED DEXAMETHASONE SUPPRESSION TEST - PSYCHIATRIC Endocrinology Endocrinology Endocrinology Blood/SS tube and EDTA tube Blood/SS tube and EDTA tube Blood/SS tube and EDTA tube 1 week Please provide clinical and medication details, including time and date of last dose. Collect immediately prior to next dose. Please refer to DEOXYPYRIDINOLINE, URINE. 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) or Branch Laboratory for test and collection details. 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) or Branch Laboratory for test and collection details. 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) or Branch Laboratory for test and collection details. DEXTRONE, URINE Please refer to PARAQUAT, URINE. DHEA, SERUM Endocrinology Blood/SS tube 24 hours Please note date of last normal menstrual period (LNMP). PATHOLOGY TESTS - D

96 PATHOLOGY TESTS - D DIALKYL PHOSPHATE METABOLITES, URINE DIALYSIS FLUID, PRE-DIALYSIS Urine/Urine container OCCUPATIONAL - Up to 10 working days NON- OCCUPATIONAL - Up to 4 weeks Dialysis fl uid/ Plain plastic tube Same day - 24 hours 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. Obtained from unopened dialysis fl uid bottle. DIASTASE, URINE Please refer to AMYLASE, URINE. DIAZEPAM, SERUM 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 Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. DIBUCAINE NUMBER, SERUM Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM (SCOLINE) SENSITIVITY, SERUM. DICHLOROMETHANE, BLOOD Please refer to SOLVENTS, BLOOD for all details. DICHROMATE, BLOOD Please refer to CHROMIUM, BLOOD for all details. DICOFOL (ORGANOCHLORINE Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. PESTICIDES), BLOOD DIELDRIN (ORGANOCHLORINE Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. PESTICIDES), BLOOD DIELDRIN, BREAST MILK Breast milk/glass sterile container 4 weeks Keep sample cool. Referred test. DIETARY URIC ACID EXCRETION TEST Blood and Urine/24 hour urine container with 15 ml 2M NaOH x 4, SS tube x 2 24 hours Please contact Collections (07) 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 Appendix (12.12). DIGITALIS, SERUM Please refer to DIGOXIN, SERUM. PATHOLOGY TESTS - D

97 PATHOLOGY TESTS - D DIGOXIN, SERUM Blood/Plain plastic tube - no gel (Plastic lithium heparin tube (no gel) acceptable) DIHYDROTESTOSTERONE, PLASMA DIHYDROXY CHOLECALCIFEROL, SERUM DIHYDROXY VITAMIN D, SERUM Endocrinology Blood/Lithium heparin tube DILANTIN, SERUM Blood/Plain plastic tube - no gel (Plastic lithium heparin tube (no gel) acceptable) DIMETHOATE (PESTICIDE), SERUM 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. 6 weeks Please keep specimen cold in transit. Referred test. Same day Please refer to 1,25-DIHYDROXY VITAMIN D, SERUM. Please refer to 1,25-DIHYDROXY VITAMIN D, SERUM. DIPHENYLHYDANTOIN, SERUM Please refer to DILANTIN, SERUM. DIPHTHERIA SEROLOGY Immunology Blood/SS tube 2-4 weeks Referred test. (TOXIN ANTIBODY SCREEN) DIQUAT, URINE Please refer to PARAQUAT, URINE. DIRECT ANTIGEN TEST FOR RESPIRATORY VIRUSES (INCLUDING RSV, INFLUENZA, PARAINFLUENZA, ADENOVIRUS) DIRECT ANTIGLOBULIN TEST Immunology Blood Bank Nasopharyngeal aspirate/ Aspirating trap Blood/Pink top EDTA tube DIRECT COOMBS TEST Blood Bank Blood/Pink top EDTA tube 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). Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. 24 hours Refrigerate specimen and transport cooled to laboratory as soon as possible. Results usually available same day for urgent specimens. Same day Same day Please provide provisional diagnosis and medication history. On neonatal requests provide details of maternal obstetric and transfusion history. Please provide provisional diagnosis and medication history. On neonatal requests provide details of maternal obstetric and transfusion history. PATHOLOGY TESTS - D

98 PATHOLOGY TESTS - D DIRECT IMMUNO FLUORESCENT ASSAY (GIARDIA) DISACCHARIDASES, INTESTINAL BIOPSY TISSUE 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. DISOPYRAMIDE, SERUM Blood/Plain plastic tube - no gel D-LACTATE, PLASMA Blood/Lithium heparin tube D-LACTATE, URINE Urine/Plain random urine container or 24 hour urine container with no preservative DNA TESTING Genetics Blood/EDTA tube Dependent on test DNAse B TITRE (STREPTOCOCCI), SERUM DONATH LANDSTEINER ANTIBODY Please refer to INTESTINAL DISACCHARIDASES, BIOPSY TISSUE. 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. 2 weeks For investigation of intestinal bacterial overgrowth. Referred test. 1 week Keep sample cold during transport. Referred test. Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). Haematology Blood/Refer Haematology Department DONOVANOSIS Cytology Labelled fi xed or unfi xed smear/slide carrier DOPAMINE, URINE 24 HOUR 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) or Branch laboratory for further information. 24 hours Please contact Haematology (07) or Branch Laboratory for collection details. 24 hours Skin biopsy for Histology may also be appropriate to rule out other pathology. Refer collection enquiries to QML Pathology Dermatopathologists. Please refer to CATECHOLAMINES, URINE. DOTHEP, SERUM Please refer to DOTHIEPIN, SERUM. DOTHIEPIN, SERUM 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. PATHOLOGY TESTS - D

99 PATHOLOGY TESTS - D DOUBLE-STRANDED Immunology Blood/SS tube 72 hours Assay run daily (Monday - Friday). DNA ANTIBODY, SERUM DOXEPIN, SERUM 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 Please refer to DEOXYPYRIDINOLINE, URINE. DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER CHROMATOGRAPHY), URINE DRUG SCREEN (OCCUPATIONAL/INDUSTRY (AS/NZS4308 GUIDELINES)), URINE DRUG SCREEN (NON OCCUPATIONAL), URINE 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 Preface (5.4). Provide clinical, medication and suspected drug usage details. Urine/Urine drug screen collection kit with tamper evident packaging Urine/Urine drug screen collection kit with tamper evident packaging DRUG SCREEN, HAIR Hair roots/hair drug screen collection kit with tamper evident packaging 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 Preface (5.4). Confi rmation and quantitation by GC/MS of positive fi ndings may be requested separately. 48 hours Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER CHROMATOGRAPHY), URINE. 2 weeks Contact Referred Tests Department on (07) for a hair drug screen collection kit, containing full collection instructions. PATHOLOGY TESTS - D

100 PATHOLOGY TESTS - D 7.53 DRUG SCREEN, SERUM 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 Please contact the Drug Testing Laboratory,, Murarrie on (07) for all information on urine, saliva and breath on-site drug testing. DRUGS, QUANTITATIVE ASSAY, SERUM 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 Appendix (12.13) for a full list of drugs assayed. Contact (07) or Branch Laboratory for further details. DUCENE, SERUM Please refer to DIAZEPAM, SERUM. DUCHENNE MUSCULAR Please refer to DYSTROPHIN GENE ANALYSIS, BLOOD. DYSTROPHY, BLOOD DURSBAN (PESTICIDE), SERUM DYSTROPHIN GENE ANALYSIS, BLOOD Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. 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 PATHOLOGY TESTS - D

101 PATHOLOGY TESTS - E E/LFT, SERUM Blood/SS tube Same day or urgently 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. 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. 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 Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday. VIRUS SEROLOGY EFAVIRENZ, PLASMA 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 Please refer to VENLAFAXINE, SERUM/PLASMA. ELAIDIC/STEARIC ACID RATIO, PLASMA ELECTROLYTES AND LIVER FUNCTION TESTS, SERUM 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. Please refer to E/LFT, SERUM. ELECTROLYTES, FAECES Faeces/Faeces container 24 hours Please provide clinical and medication details. Keep sample cool during collection and transport to the laboratory. ELECTROLYTES, SERUM Please refer to E/LFT, SERUM. ELECTROLYTES, SWEAT Sweat/Sweat tube 1 week Diagnostic test for cystic fi brosis. Please contact Collections (07) or Branch Laboratory for appointment. Sweat sodium and chloride measured. PATHOLOGY TESTS - E

102 PATHOLOGY TESTS - E ELECTROLYTES, URINE Urine/24 hour urine container with no preservative or Random urine container ELECTROLYTES/UREA/ CREATININE, SERUM 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. Please refer to E/LFT, SERUM. ENDEP, SERUM Please refer to AMITRIPTYLINE, SERUM. ENDOGENOUS ENDORPHINS Please phone (07) or Branch Laboratory for availability. ENDOMYSIAL ANTIBODY, SERUM Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). ENDOSCOPE CULTURE Microbiology Water samples/ Urine container ENDOSCOPE CULTURE FOR TB Microbiology Water samples/ Urine container ENDOSULFAN (ORGANOCHLORINE PESTICIDES), BLOOD 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. 4-6 weeks Washings from the endoscope channels are collected after cleaning by endoscopy unit staff at the hospital. Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. ENDRIN (ORGANOCHLORINE Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. PESTICIDES), BLOOD ENTAMOEBA HISTOLYTICA Immunology Blood/SS tube 1 week Assay run Wednesday. SEROLOGY 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. PATHOLOGY TESTS - E

103 PATHOLOGY TESTS - E ENVIRONMENTAL SPECIMEN Microbiology Dust and other environmental specimens/ Swab or Sterile container 48 hours EPILIM, SERUM Please refer to VALPROATE, SERUM. EPINEPHRINE, Please refer to CATECHOLAMINES, URINE. URINE 24 HOUR EPP, SERUM Please refer to PROTEIN ELECTROPHORESIS, SERUM. EPP, URINE 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 ERYTHROCYTE PBG DEAMINASE, BLOOD ERYTHROCYTE SEDIMENTATION RATE ERYTHROPOIETIN ASSAY, SERUM Immunology Blood/SS tube 2-3 weeks Please provide details of clinical history and exposure. Referred test. Haematology Blood/EDTA tube Same day Please refer to PORPHOBILINOGEN DEAMINASE, RED CELL. Haematology Blood/SS tube 1 week Specimen must reach laboratory within 24 hours of collection. Referred test. ESGRAM, URINE Please refer to PARAQUAT, URINE. ESR, BLOOD Haematology Blood/EDTA tube Same day ESSENTIAL FATTY ACIDS, Please refer to FATTY ACID PROFILE, PLASMA. PLASMA ETHYL ACETATE, BLOOD Please refer to SOLVENTS, BLOOD for all details. ETHYLENE DI BROMIDE, URINE Please refer to BROMIDE, URINE for details. PATHOLOGY TESTS - E

104 PATHOLOGY TESTS - E 7.57 ETHYLENE GLYCOL, SERUM/PLASMA EUGLOBULIN CLOT LYSIS TIME, BLOOD Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin tube (no gel) acceptable) Haematology Blood/Sodium citrate tube 2 weeks Please keep the sample cool and forward to the laboratory without delay. 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) or Branch Laboratory for collection details and appointment. EVEROLIMUS, BLOOD 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 EXTENDED CF MUTATION, BLOOD EXTRACTABLE NUCLEAR ANTIGENS (ENA), ANTIBODIES TO, SERUM EYE LESION, MICROSCOPY AND CULTURE 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. Blood/EDTA tube 4 weeks Transport at room temperature. Referred test. 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. Microbiology Swab/Ophthalmology Microbiology kit Requirements are determined by clinical factors. Please refer to Microbiology Preface (5.55) for details and contact Microbiology (07) or Branch Laboratory PATHOLOGY TESTS - E

105 PATHOLOGY TESTS - F 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 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 FACTOR VII ASSAY, BLOOD Haematology Refer to FACTOR VIII ASSAY. FACTOR VIII ASSAY, BLOOD Haematology Blood/Sodium citrate 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 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) or Branch Laboratory for details. FACTOR VIII INHIBITOR ASSAY, Haematology Refer to FACTOR VIII ASSAY. BLOOD 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 Please refer to PANCREATIC ELASTASE 1, FAECES. FAECAL FAT, TOTAL Please refer to FAECES FAT, TOTAL-3 DAY COLLECTION. FAECAL HAEMOGLOBIN (HUMAN) - OCCULT BLOOD Microbiology Faeces/Faeces container Same day - 24 hours 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. PATHOLOGY TESTS - F

106 PATHOLOGY TESTS - F FAECAL SUGAR Please refer to CHROMATOGRAPHY, FAECES. CHROMATOGRAPHY FAECES FAT, TOTAL-3 DAY COLLECTION FAECES MICROSCOPY (OVA, CYSTS, PARASITES) FAECES MICROSCOPY AND CULTURE FAECES, CLOSTRIDIUM DIFFICILE TOXIN FAMILIAL ADENOMATOUS POLYPOSIS (FAP) GENETIC TESTING FAMILIAL MEDITERRANEAN FEVER (FMF) GENETIC TESTING 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. Microbiology Faeces/Faeces container 24 hours Indicate if recent history of travel overseas. Please refer to Microbiology Preface (5.53). Microbiology Faeces/Faeces container Microscopy same day, culture report 48 hours Microbiology Faeces/Faeces container Same day - 24 hours Indicate if recent history of travel overseas or antibiotics. Please refer to Microbiology Preface (5.53). 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). 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) 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 Blood/Lithium heparin 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. $ (approx. $30.15 Medicare rebate) from the referring laboratory. Referred test. PATHOLOGY TESTS - F

107 PATHOLOGY TESTS - F FATTY ACIDS, PLATELET Blood/Lithium heparin tube FATTY ACIDS, RED CELL Blood/Lithium heparin tube FATTY ACIDS-VERY LONG CHAIN, PLASMA FENITROTHION (PESTICIDE), SERUM 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) or Branch Laboratory. Transport sample to the laboratory on ice. Referred test. 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) or Branch Laboratory. Transport sample to the laboratory on ice. Referred test. 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. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. FENTANYL, URINE Urine/Urine container 2-3 months Please keep the sample refrigerated or frozen. A random urine is required. FENTHIONETHYL (PESTICIDE), SERUM Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. FERRITIN, SERUM Please refer to IRON (Fe) STUDIES, SERUM for collection details. FERROPORTIN GENE ANALYSIS FETAL RED CELL SCREEN (KLEIHAUER TEST), MATERNAL BLOOD 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. Haematology Maternal blood/ 1 EDTA tube, 2 blood fi lms Same day or urgently Examination of maternal blood for evidence of foeto-maternal transfusion. FMH test usually performed. FIBRINOGEN, PLASMA Haematology Blood/Sodium Same day Refer to COAGULATION STUDIES. citrate tube FIBRONECTIN, PLASMA Blood/EDTA tube 2 weeks Transport in esky at 4 C. FICAM (PESTICIDE), BLOOD 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. PATHOLOGY TESTS - F

108 PATHOLOGY TESTS - 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 FIP1L1-PDGFR (HES) GENETIC TESTING FIRST TRIMESTER DOWNS SCREEN Cytology Genetics Labelled fi xed and air dried smears/labelled capped needle and syringe/ Needle rinsings Blood or Bone marrow/ EDTA tube or min. 1mL bone marrow in EDTA tube 24 hours For specimen preparation please refer to Cytology Preface. 2 months Specimen needs to be received by QML Pathology Genetics Department within 24 hours. Please transport and store at room temperature. 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 Please refer to TACROLIMUS, BLOOD. FLAVIVIRUS SEROLOGY Immunology Blood/SS tube 24 hours FLECAINIDE, SERUM 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 Blood/Red top tube 3 weeks Please provide clinical and medication details. Keep sample cool. FLUCONAZOLE, PLASMA Blood/EDTA tube 2 weeks Please provide clinical and medication details. Keep sample cool. FLUCYTOSINE, SERUM Blood/Lithium heparin tube 1 week Collect just prior to next dose. Provide clinical and medication details. FLUID CSF TRANSFERRIN Please refer to TAU PROTEIN, FLUID. PATHOLOGY TESTS - F

109 PATHOLOGY TESTS - F FLUID TAU PROTEIN Please refer to TAU PROTEIN, FLUID. FLUNITRAZEPAM, SERUM Blood/Plain plastic tube - no gel or anticoagulant (EDTA tube or Plastic lithium heparin tube acceptable) FLUORESCENT IN SITU HYBRIDISATION (FISH) FLUORESCENT IN SITU HYBRIDISATION (FISH) FLUORESCENT IN SITU HYBRIDISATION (FISH) FLUORESCENT IN SITU HYBRIDISATION (FISH) FLUORESCENT TREPONEMA ANTIBODY ABSORPTION TEST (FTA-ABS), SERUM 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. Genetics Amniotic fl uid 24 hours Rapid Detection of Fetal Aneuploidy. Genetics Genetics Blood/Lithium heparin tube Bone Marrow, Lymph Node 2 weeks Testing available for microdeletion syndromes - DiGeorge, Williams, Prader-Willi, Angelman, Miller-Dieker, Smith-Magenis. 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. Immunology Blood/SS tube 72 hours Supplementary test for Syphilis. Referred test. FLUORIDE, BLOOD Blood/EDTA tube (Lithium heparin tube acceptable) FLUORIDE, URINE Urine/Urine container (random collection) or plain 24 hour urine container FLUOXETINE, SERUM Blood/Plain plastic tube - no gel or anticoagulant (EDTA tube or Plastic lithium heparin tube acceptable) 4 weeks Please provide clinical, medication and exposure details. Referred test. 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. 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) of the expected time of arrival. PATHOLOGY TESTS - F

110 PATHOLOGY TESTS - 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 Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. FRAGILE-X-SYNDROME (FRAXA) MUTATION ANALYSIS Genetics Blood/Pink top EDTA tube 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, Endocrinology Blood/SS tube 24 hours This test is a ratio of total testosterone and sex hormone binding globulin. SERUM FREE CORTISOL, URINE 24 HOUR FREE CORTISOL, URINE RANDOM Endocrinology Endocrinology 24 hour urine collection/ Urine collection bottle. No preservative Random urine collection/ Urine collection bottle. No preservative (Must not use acid 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. 24 hours Record patient s height and weight on request form. FREE LIGHT CHAINS, SERUM 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. PATHOLOGY TESTS - F

111 PATHOLOGY TESTS - F 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 Please refer to CLOBAZAM, SERUM. FROZEN SECTION, TISSUE Histology Biopsy tissue/dry container (No formalin) Immediate. Full report 24 hours Please telephone Histology (07) or Branch Laboratory for booking. FRUCTOSAMINE, SERUM Blood/SS tube 24 hours Please provide clinical and medication details. A medium term assay (approximately 1 month) of diabetic control. FRUCTOSE, SEMINAL FLUID 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 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 FULL BLOOD EXAMINATION (FBE), BLOOD Haematology Blood/EDTA tube Immediate; Same day Haematology Blood/EDTA tube Immediate; Same day FUNGAL CULTURE (SYSTEMIC) Microbiology Tissue, biopsy or body fl uid in a sterile container Microscopy - 24 hours; Culture - up to 4 weeks Please see Haematology Appendix (12.32). Transport specimen cooled. Please do not add formalin to the sample. PATHOLOGY TESTS - F

112 PATHOLOGY TESTS - F 7.65 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 FUNGAL PRECIPITINS, SERUM Immunology Blood/SS tube 2-4 weeks Referred test. 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) PATHOLOGY TESTS - F

113 PATHOLOGY TESTS - G 8.0 G6PD QUANTITATIVE ASSAY Blood/EDTA tube 1 week Do not freeze EDTA. GABAPENTIN, SERUM Blood/Plain plastic tube - no gel or anticoagulant (EDTA tube or Plastic lithium heparin tube acceptable) GAD (GLUTAMIC ACID DECARBOXYLASE) ANTIBODIES, SERUM Immunology Blood/SS tube or Lithium heparin tube GALACTOKINASE, BLOOD Blood/Lithium heparin tube GALACTOSAEMIA CONFIRMATION, BLOOD GALACTOSAEMIA SCREEN, BLOOD Blood/Lithium heparin tube Blood/Lithium heparin tube 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. 2 weeks Test run fortnightly. Next day results. Please provide clinical and medication details. 2 weeks Please advise (07) or your Branch Laboratory of expected arrival time. Send sample without delay. 1-2 weeks Transport sample refrigerated and must reach laboratory as soon as possible. Please contact (07) or Branch Laboratory for details. Referred test. 1-2 weeks Transport sample refrigerated and must reach laboratory as soon as possible. Please contact (07) or Branch Laboratory for details. Referred test. GALACTOSE, PLASMA Please refer to GALACTOSAEMIA SCREEN, BLOOD. GALACTOSE-1-PHOSPHATE URIDYL TRANSFERASE, RED CELL Please refer to GALACTOSAEMIA SCREEN, BLOOD. GALACTOSE-1-PHOSPHATE, Please refer to GALACTOSAEMIA SCREEN, BLOOD. RED CELL GAMMA GT (GAMMA GLUTAMYL Please refer to E/LFT, SERUM. TRANSPEPTIDASE), SERUM GAMMA GT, FLUID 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 GAS ANALYSIS, VENOUS BLOOD Arterial blood/blood gas syringe Same day Please refer to Preface (5.1). Please refer to BLOOD GASES, VENOUS. 8.0 PATHOLOGY TESTS - G

114 PATHOLOGY TESTS - G GASTRIC ASPIRATE CYTOLOGY GASTRIC ASPIRATE MICROSCOPY/CULTURE GASTRIC BRUSHING CYTOLOGY Cytology Microbiology Cytology Fluid/Sterile screw top container Gastric Aspirate/ Sterile screw top (urine) container Fixed Smears/Slide carrier and/or fl uid/sterile screw top container. Brush in a container of normal saline 24 hours For specimen preparation please refer to Cytology Preface (5.17). Microscopy phoned same day. Culture 48 hours Transport to the laboratory immediately. 24 hours For specimen preparation please refer to Cytology Preface (5.16). 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) GENITAL SWAB INCLUDING ANAEROBES AND GONOCOCCUS GENTAMICIN ASSAY - SINGLE DAILY DOSE (BOLUS DOSE), SERUM GESTATIONAL DIABETES SCREEN 48 hours Specify site of collection. Transport to the laboratory as soon as possible (viability of N. gonorrhoeae decreases after several hours). 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. Blood/Plain plastic tube - no gel or anticoagulant Blood/SS tube or Fluoride oxalate tube Urgently Same day GHRELIN, SERUM Blood/SS tube 2 weeks Patient MUST be fasting. 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 Appendix (12.17). Fasting is not required. At 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. PATHOLOGY TESTS - G

115 PATHOLOGY TESTS - G GLIADIN ANTIBODIES Immunology Blood/SS tube 48 hours Assay run daily (Monday - Friday). (COELIAC DISEASE), SERUM GLIADIN IGA/IGG SEROLOGY Immunology Blood/SS tube 24 hours GLOBULINS (CALCULATED), Please refer to E/LFT, SERUM. SERUM GLOBULINS, FLUID Fluid/Plain tube or container Same day Specify site of fl uid on specimen container and request form. GLOMERULAR BASEMENT MEMBRANE ANTIBODY, SERUM Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday. GLUCAGON STIMULATION TEST OF C- PEPTIDE/INSULIN Endocrinology Blood/SS tube or Fluoride oxalate tube GLUCAGON, PLASMA Endocrinology Blood/EDTA tube with Trasylol GLUCOSE (1HR POST LOAD), SERUM GLUCOSE TOLERANCE TEST - 2 HOUR, NON-PREGNANCY GLUCOSE TOLERANCE TEST - 3 HOUR GLUCOSE TOLERANCE TEST - EXTENDED (4, 5 AND 6 HOURS) Blood/SS tube or Fluoride oxalate tube Blood/SS tubes and Urine/Urine containers Blood/SS tubes and Urine/Urine containers Blood/SS tubes and Urine/Urine containers 24 hours Test requires IV administration of glucagon and collection of timed blood samples. Please contact Collections (07) or Branch Laboratory for appointment and Endocrinology (07) for details. 4 weeks Patient must be fasting. Special handling and transport required. Please contact Endocrinology (07) or Branch Laboratory. Referred test. Same day Other than for 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. 24 hours Please refer to Appendix (12.9) for pre test dietary requirements and restrictions. Contact (07) 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. 24 hours Same as 2 hour GTT except blood also collected at 3 hours post glucose dose. Appointment required. Please contact nearest collection centre. 24 hours Please refer to Appendix (12.9) for pre test dietary requirements and restrictions. Investigation of Hypoglycaemia may require a 6 hour GTT. Please contact (07) , Endocrinology (if serum insulins are also required) (07) 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. PATHOLOGY TESTS - G

116 PATHOLOGY TESTS - G GLUCOSE TOLERANCE TEST - GLUCOSE AND GROWTH HORMONE GLUCOSE TOLERANCE TEST - GLUCOSE AND INSULIN Endocrinology Blood/SS tube 24 hours Please refer to Appendix (12.9) for pre test dietary requirements and restrictions. Please contact Branch Laboratory or Endocrinology (07) for details. Appointment required. Please contact nearest collection centre. Endocrinology Blood/SS tube 24 hours Please refer to Appendix (12.9) for pre test dietary requirements and restrictions. Appointment required. Please contact nearest collection centre. GLUCOSE, CSF Test for bacterial meningitis. Please refer to BIOCHEMISTRY, CSF for details. GLUCOSE, FLUID Fluid/Plain tube/container Same day Keep sample refrigerated. Specify site of fl uid on specimen container and request form. GLUCOSE, PLEURAL FLUID Pleural fl uid/plain tube Same day Please provide clinical and medication details. Refrigerate sample during storage and transport. GLUCOSE, SERUM Blood/SS tube or Fluoride oxalate tube GLUCOSE, SYNOVIAL FLUID GLUCOSE, URINE Urine/Urine container or 24 hour urine container with no preservative Same day 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 is low in joint infection. Please refer to ALBUMIN, SYNOVIAL FLUID. 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 Blood/SS tube 1 week Please provide clinical and medication details. The patient must be FASTING. Please refer to dietary restrictions in 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 Please refer to GLUTAMATE, SERUM. GLUTAMINE, SERUM Please refer to GLUTAMATE, SERUM. GLUTATHIONE PEROXIDASE, BLOOD GLUTATHIONE PEROXIDASE, PLASMA Blood/Lithium heparin tube Blood/Lithium heparin tube or EDTA tube 1-2 weeks Glutathione peroxidase, red cells AND plasma can be performed on this collection. Referred test. 1-2 weeks Referred test. PATHOLOGY TESTS - G

117 PATHOLOGY TESTS - G GLUTATHIONE REDUCTASE, Please refer to VITAMIN B2, BLOOD for details. BLOOD GLYCATED ALBUMIN, SERUM Please refer to FRUCTOSAMINE, SERUM. GLYCATED HAEMOGLOBIN, Please refer to HAEMOGLOBIN A1c (HbA1c), BLOOD. BLOOD GLYCEROL, PLASMA Blood/Lithium heparin tube 1 week Sample must be stored and transported cool. GLYCEROL, URINE Urine/Urine container 1 week Random urine collection. Transport at 4 C. Referred test. GLYCOGEN DEBRANCHER Please refer to AMYLO-1,6-GLUCOSIDASE, BLOOD for details. ENZYME, BLOOD GLYCOLATE, URINE Urine/Urine container 3-4 weeks Transport in esky at 4 C. Referred test. GLYPHOSATE, URINE 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 $ 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 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 Please refer to PARAQUAT, URINE. GRANULOCYTE ANTIBODY SCREEN GROWTH HORMONE SUPPRESSION TEST (USING GLUCOSE) Haematology Blood/2 EDTA tubes, SS tube 24 hours Test performed daily. No booking or appointment required. Please notify Haematology (07) or your Branch Laboratory of all urgent specimens and weekend collections. 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. PATHOLOGY TESTS - G

118 PATHOLOGY TESTS - G GTT - INSULIN AND C-PEPTIDE GTT (2 OR 3 HOUR), NON-PREGNANCY GTT (2 OR 3 HOUR), PREGNANCY GTT, EXTENDED OR MODIFIED GUSATHION (PESTICIDE), SERUM GUT TUMOUR MARKERS (CA 19-9, CEA), SERUM 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. Blood and urine/ss tube or Fluoride oxalate tube. Urine container Blood and urine/ss tube or Fluoride oxalate tube. Urine container Blood and urine/ss tube or Fluoride oxalate tube. Urine container 24 hours Please refer to GLUCOSE TOLERANCE TEST - 2 HOUR, NON-PREGNANCY. 24 hours Please refer to Appendix (12.9) for pre test dietary requirements and restrictions. Contact (07) 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. 24 hours Please refer to GLUCOSE TOLERANCE TEST - EXTENDED (4,5 AND 6 HOURS). Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Endocrinology Blood/SS tube 24 hours Infl ammatory or neoplastic conditions of mucinous epithelium - see Appendix (12.5). GUTHRIE TEST Please refer to NEONATAL SCREENING TEST. PATHOLOGY TESTS - G

119 PATHOLOGY TESTS - H 8.6 H G PHOSPHORIBOSYL TRANSFERASE, BLOOD HAEMATOCRIT Haematology Blood/EDTA tube Same day HAEMOCHROMATOSIS GENE MUTATION ANALYSIS Genetics Blood/Pink top EDTA tube Please refer to HYPOXANTHINE GUANINE PHOSPHORIBOSYL TRANSFERASE, BLOOD. 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 HAEMOGLOBIN A1c (HbA1c), BLOOD HAEMOGLOBIN A1c, BLOOD HAEMOGLOBIN AND SMEAR HAEMOGLOBIN ELECTROPHORESIS (EPP), BLOOD Microbiology Faeces/Faeces container Same day - 24 hours The Monoclonal Antibody test for human haemoglobin is routinely performed. Refrigerate after collection and transport cooled. Blood/EDTA tube 24 hours Please provide clinical and medication details. Keep sample refrigerated during transport and storage. Please refer to HAEMOGLOBIN A1c (HbA1c), BLOOD. Haematology Blood/EDTA tube Same day Blood fi lms made at time of collection are preferred. 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, Please refer to HAEMOGLOBIN A1c (HbA1c), BLOOD. BLOOD HAEMOGLOBIN, PLASMA Haematology Blood/Lithium 24 hours Avoid haemolysis during collection. heparin tube HAEMOGLOBIN, URINE Urine/Urine container 24 hours Please provide clinical and medication details. Random sample required. 8.6 PATHOLOGY TESTS - H

120 PATHOLOGY TESTS - H HAEMOGLOBINOPATHY STUDIES Haematology Blood/2 EDTA tubes, 1 blood fi lm 1-3 days Tests performed Tuesday and Friday. Results available same day of test. 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 HAEMOPHILIA GENETIC TESTING HAEMOPHILUS INFLUENZAE B AB HAEMOSIDERIN, URINE RANDOM HAIR, MICROSCOPIC EXAMINATION HAM TEST (ACIDIFIED SERUM TEST), BLOOD HAND, FOOT AND MOUTH SEROLOGY Haematology/ Genetics Blood/2 EDTA tubes, blood fi lm and 1 SS tube are required for initial screening tests Blood/2 x Sodium citrate tubes, 4 x EDTA tubes Same day Immunology Blood/SS tube 3-4 weeks Haematology Histology Haematology Random urine/urine container Hair/Sterile dry container Blood/1 SS tube, 1 EDTA tube 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. 6 weeks Please contact Genetics (07) or Branch Laboratory prior to collection. Referred test. Same day 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. 24 hours Test for detection of Paroxysmal Nocturnal Haemoglobinuria (Haemolytic Anaemia). Please contact Haematology (07) or Branch Laboratory for details. Flow cytometry for PNH is the preferred test. Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday. HAPTOGLOBIN, SERUM 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 PATHOLOGY TESTS - H HCB (ORGANOCHLORINE PESTICIDE), BLOOD Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details

121 PATHOLOGY TESTS - H 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 Endocrinology Blood/SS tube 24 hours This test involves an injection of HCG and the measurement of Testosterone. 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 Blood/SS tube Same day Patient need not be fasting unless other fasting tests e.g. triglycerides are also required. HEAVY METAL SCREEN, BLOOD HEAVY METAL SCREEN, URINE 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. 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 HELICOBACTER PYLORI CARBON-14 UREA BREATH TEST Immunology Faeces/Faeces container 2-3 weeks Endocrinology 1 glass vial containing CO 2 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 CO 2 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 CO 2 is measured. Appointment is required for test. HELICOBACTER PYLORI SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday) PATHOLOGY TESTS - H

122 PATHOLOGY TESTS - H 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 HEPARIN ASSAY, BLOOD Haematology Blood/Sodium citrate tube, EDTA tube HEPARIN COFACTOR II Haematology Blood/Sodium citrate tube HEPARIN-INDUCED AGGREGATION HEPATITIS (A OR B) IMMUNE STATUS Haematology Blood/Sodium citrate tube or SS tube, EDTA 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. 24 hours Time of collection is important. Please contact Haematology (07) or Branch Laboratory for collection details. 5 weeks Please contact Haematology (07) 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. Same day Clinical and medication details required. Specimens to arrive at the laboratory within 4 hours. 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) or Branch Laboratory for further details. Assay run daily (Monday to Saturday). HEPATITIS B CORE Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday). ANTIBODY (HBcAb) HEPATITIS B CORE IgM Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday). ANTIBODY (HBcAb-IgM) HEPATITIS B DNA Immunology Blood/SS tube 1 week Assay run on Wednesdays. Results next day after testing. PATHOLOGY TESTS - H 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

123 PATHOLOGY TESTS - H HEPATITIS B SURFACE Immunology Blood/SS tube Same day Assay run daily (Monday - Saturday). ANTIGEN (HBsAg) HEPATITIS C ANTIBODY (HCV Ab) Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday). HEPATITIS C VIRUS GENOTYPE HEPATITIS C VIRUS RNA, QUALITATIVE HEPATITIS C VIRUS RNA, QUANTITATIVE 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. 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. 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 Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. HEPTANE, BLOOD Please refer to SOLVENTS, BLOOD for all details. PATHOLOGY TESTS - H

124 PATHOLOGY TESTS - H HERBICIDES, URINE 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 (07) or your Branch Laboratory for current cost details. Also refer to Appendix (12.18) for a comprehensive list of weedicides/ herbicides. Referred test. HEREDITARY NEUROPATHY GENETIC TESTING HEREDITARY SPHEROCYTOSIS BY FLOW 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. Haematology Blood/EDTA tube Same day HERPES SIMPLEX SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). HERPES SIMPLEX VIRUS PCR HERPES VIRUS-6, HUMAN (HHV-6), BLOOD Immunology Viral Culture Swab (green top) in transport medium 24 hours Assay run daily (Monday - Friday). Immunology Blood/SS tube 2-4 weeks Referred test. HERPES ZOSTER SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). HERPES ZOSTER VIRUS PCR HESS TEST (CAPILLARY INTEGRITY/FRAGILITY TEST) HEXACHLOROBENZENE (ORGANOCHLORINE PESTICIDE), BLOOD HEXOSE-1-PHOSPHATE URIDYL TRANSFERASE, BLOOD Immunology Viral Culture Swab (green top) in transport medium 1 week Assay run daily (Monday - Friday). Haematology Same day Please contact Haematology (07) or Branch Laboratory for collection details. Blood/Lithium heparin tube Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. 1-2 weeks Please refer to GALACTOSAEMIA SCREEN, BLOOD. Hg, BLOOD Please refer to MERCURY, BLOOD. HGPRT, BLOOD Please refer to HYPOXANTHINE GUANINE PHOSPHORIBOSYL TRANSFERASE, BLOOD. PATHOLOGY TESTS - H

125 PATHOLOGY TESTS - H HIAA, URINE 24 HOUR Please refer to 5-H.I.A.A, URINE. HIPPURIC ACID, URINE 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 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 Blood/Lithium heparin tube 2 weeks There is currently no Medicare rebate for this test. Referred test. PATHOLOGY TESTS - H HISTOLOGY - FROZEN SECTION HISTOLOGY - IMMUNOFLUORESCENCE Histology Histology Biopsy tissue/dry container (No formalin) Skin, Kidney etc./ 1. Immunofl uorescence transport medium, 2. 10% Buffered formalin HISTOLOGY MACRO/MICRO Histology Tissue and biopsy specimens/formalin containers in a variety of sizes Immediate. Full report 24 hours Please contact Histology (07) or Branch Laboratory for booking 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) or Branch Laboratory for details. 24 hours for simple non-complex specimens 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) 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)

126 PATHOLOGY TESTS - H HIV PROVIRAL DNA Immunology Blood/2 x EDTA tubes (5 ml), 1 x SS tube HIV VIRAL LOAD TEST (HIV VIRAL QUANTITATION) HLA TISSUE TYPING, BLOOD HLA TYPING FOR COELIAC DISEASE Immunology Haematology Blood/ACD tube (preferred). EDTA tube is an acceptable substitute Blood/ACD tube, 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. 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). 2 weeks By appointment only. Please contact Haematology (07) or Branch Laboratory for collection details or to organise collection. Lithium heparin tube may be used if ACD tube unavailable. Referred test. Haematology Blood/2 x ACD tubes 2 weeks By appointment only. Please contact Haematology (07) 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) 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) 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 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 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. PATHOLOGY TESTS - H

127 PATHOLOGY TESTS - H HOMOCYSTINE, URINE 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 Urine/Urine container 48 hours Fresh random collection, protected from light. HOMOVANILLIC ACID, URINE 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 Immunology Blood/SS tube 2-4 weeks 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 HUMAN CHORIONIC GONADOTROPHIN (HCG) - TUMOUR MARKER, 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). 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 PATHOLOGY TESTS - H

128 PATHOLOGY TESTS - H 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) HVA, URINE 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, Please refer to SOLVENTS, BLOOD for all details. BLOOD HYDROCARBONS, BLOOD Please refer to SOLVENTS, BLOOD for all details. HYDROGEN, Please refer to BREATH HYDROGEN (MULTIPLE). BREATH (MULTIPLE) HYDROGEN, BREATH (SINGLE) Expired air samples 48 hours Please refer to BREATH HYDROGEN (MULTIPLE). HYDROXY CHOLECALCIFEROL Please refer to VITAMIN D, SERUM. PATHOLOGY TESTS - H HYDROXY METHOXY MANDELIC ACID, URINE 24 HOUR Please refer to CATECHOLAMINES, URINE. HYDROXY PROGESTERONE, SERUM Endocrinology Blood/SS tube 1 week Please provide clinical and medication details. HYDROXY VITAMIN D, SERUM Please refer to VITAMIN D, SERUM. HYDROXYBUTYRATE (BETA OR 3), PLASMA Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA. HYDROXYBUTYRATE (BETA OR 3), SERUM Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA. HYDROXYCHLOROQUINE, PLASMA 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 Please refer to 5-H.I.A.A, URINE

129 PATHOLOGY TESTS - H HYDROXYTRYPTAMINE, Please refer to SEROTONIN, SERUM. SERUM HYDROXYTRYPTAMINE, Please refer to SEROTONIN, URINE 24 HOUR. URINE HYPERTONIC CRYOHAEMOLYSIS Haematology Blood/EDTA tube 24 hours HYPNODORM, SERUM Please refer to FLUNITRAZEPAM, SERUM. PATHOLOGY TESTS - H HYPOTHYROIDISM CONGENITAL SCREENING TEST, BLOOD Please refer to NEONATAL SCREENING TEST. HYPOXANTHINE GUANINE PHOSPHORIBOSYL TRANSFERASE, BLOOD Blood/Lithium heparin tube plus EDTA tube 4 weeks Transport in esky at 4 C. Referred test

130 PATHOLOGY TESTS - I 8.17 IA2 ANTIBODIES (A512 Immunology Blood/SS tube 2 weeks Please provide clinical and medication details. ANTIBODIES), SERUM ICS (INTERCELLULAR CEMENT SUBSTANCE) ANTIBODY/ PEMPHIGUS 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. ICT MALARIAL PF TEST Haematology Blood/EDTA tube or Lithium heparin tube IgA, SALIVA Saliva/Plain tube or Urine container Same day 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 Blood/SS tube 24 hours Please provide clinical and medication details. IgA, URINE Urine/Random 2 weeks Transport in esky at 4 C. Referred test. urine container 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 FOOD ALLERGY PANEL 5 IGG FOOD ALLERGY PANEL 93 Specimen Distribution Specimen Distribution Serum/SS tube or Plain tube (red top) Serum/SS tube or Plain tube (red top) Collection and transfer only Collection and transfer only IgG, SERUM Blood/SS tube 24 hours Please provide clinical and medication details. IgM, SERUM Blood/SS tube 24 hours Please provide clinical and medication details. IMIPRAMINE, SERUM 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 Please refer to IMIPRAMINE, SERUM PATHOLOGY TESTS - I

131 PATHOLOGY TESTS - I IMMUNOFIXATION (PROTEIN), SERUM IMMUNOFIXATION (PROTEIN), URINE IMMUNOFLUORESCENCE, HISTOLOGY Blood/SS tube hours Qualitative test for presence of abnormal or malignancy-associated proteins. Please provide clinical and medication details. Histology Random urine/urine container or 24 hour urine collection/urine collection bottle. No preservative Skin - Kidney etc./ 1. Immunofl uorescence transport medium, 2. 10% Buffered formalin 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 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) or Branch Laboratory for details. IMMUNOGLOBULIN D, SERUM Blood/SS tube 2 weeks Transport on dry ice. IMMUNOGLOBULINS, SERUM Blood/SS tube 24 hours Includes IgG, IgA and IgM (but not IgE). Please provide clinical and medication details. IMMUNOREACTIVE Please refer to NEONATAL SCREENING TEST for details. TRYPSINOGEN, BLOOD INDINAVIR, PLASMA 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 INFLAMMATORY BOWEL DISEASE STUDY 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. 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 INR - PROTHROMBIN TIME, BLOOD 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. Haematology Blood/Sodium citrate tube Same day Please see Warfarin section in Haematology Appendix (12.32) for further information. PATHOLOGY TESTS - I

132 PATHOLOGY TESTS - I 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 Endocrinology Blood/SS tube and EDTA tube Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. 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) or Branch Laboratory for appointment, call Endocrinology (07) 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 INTACT PARATHORMONE, SERUM INTERCELLULAR CEMENT SUBSTANCE (ICS) ANTIBODY/ PEMPHIGUS ANTIBODY, 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) or Branch Laboratory. 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. Immunology Blood/SS tube 2 weeks Skin biopsies for immunofl uorescence and histology advised. Please refer to Histology Preface (5.38) for details. 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 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). PATHOLOGY TESTS - I

133 PATHOLOGY TESTS - I 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 IODINE, URINE Urine/Urine container or plain 24 hour urine container 1 month Specimen needs to be received within 48 hours. 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 Urine/24 hour urine container with no preservative 1 week Please provide clinical and medication details. IRON, FLUID Fluid/Plain tube/container Same day Specify site of fl uid on specimen container and request form. IRON, LIVER BIOPSY Liver biopsy/dry sterile screw top (urine) container IRON, SERUM Please refer to E/LFT, SERUM. ISCHAEMIC EXERCISE TEST Blood/7 x fl uoride oxalate tubes, 7 x Lithium heparin tubes ISLET CELL AB/PANCREATIC Immunology Blood/SS tube 2 weeks ISONIAZID, PLASMA Blood/2 x EDTA tubes - no gel 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. 24 hours Please contact (07) or Branch Laboratory for details. 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 Blood/Plain plastic tube 2 weeks Please provide clinical and medication details. Referred test. - no gel IUD FOR CULTURE Microbiology IUD/Sterile container Up to 7 days Unusual organisms may be isolated e.g. Actinomyces. PATHOLOGY TESTS - I

134 PATHOLOGY TESTS - J/K 8.21 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) Genetics Blood/EDTA tube 1-2 months Also known as Spinal Bulbar Muscular Atrophy (SBMA). GENETIC TESTING KEROSENE, BLOOD Please refer to SOLVENTS, BLOOD for all details. KETONE BODIES, PLASMA Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA for details. KETONE SCREEN, SERUM Blood/SS tube Same day Semi-quantitative test. Acetoacetate only is detected. KETONE SCREEN, URINE Urine/Urine container Same day Semi-quantitative test. Acetoacetate only is detected. KINIDIN, SERUM Please refer to QUINIDINE, SERUM. KLEIHAUER TEST (FETAL RED CELL SCREEN), MATERNAL BLOOD Haematology Maternal blood/1 EDTA tube, 2 blood fi lms Same day or urgently KUNJIN SEROLOGY Immunology Blood/SS tube 2 weeks Examination of maternal blood for evidence of Foeto-Maternal transfusion. FMH Test usually performed PATHOLOGY TESTS - J/K

135 PATHOLOGY TESTS - L 8.22 L/S RATIO, AMNIOTIC FLUID Amniotic fl uid/plain plastic container Same day Test for fetal lung maturity. Please provide clinical details including period of gestation. L-LACTATE, PLASMA Blood/Lithium heparin tube 2 weeks Transport to Central Laboratory on dry ice. Referred test. LACTATE (PRE+POST STRESS), PLASMA LACTATE DEHYDROGENASE (LD/LDH) ISOENZYMES, SERUM LACTATE DEHYDROGENASE (LD/LDH), SERUM Blood/Fluoride oxalate tube Same day Please contact (07) or Branch Laboratory for details on conducting test. NB. DO NOT USE TOURNIQUET OR HAND FLEXING; SIGNIFICANT FALSE ELEVATION WILL RESULT. 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. 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 Fluid/Plain tube/container Same day Specify site of fl uid on specimen container and request form. LACTATE, PLASMA Blood/Fluoride oxalate tube LACTATE, URINE Blood/Urine container or plain 24 hour urine container LACTOSE TOLERANCE TEST Blood/4 x Fluoride oxalate tubes Same day Please provide clinical and medication details. NB. DO NOT USE TOURNIQUET OR HAND FLEXING; SIGNIFICANT FALSE ELEVATION WILL RESULT. 24 hours Urine should be refrigerated after the collection period and transported cooled to the laboratory. 24 hours Please contact (07) or Branch Laboratory for dosage and collection details. NB: Breath Hydrogen may be a more suitable test. LAMICTAL, PLASMA Please refer to LAMOTRIGINE, SERUM. LAMOTRIGINE, PLASMA Please refer to LAMOTRIGINE, SERUM. LAMOTRIGINE, SERUM 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 Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. LANOXIN, SERUM Please refer to DIGOXIN, SERUM. LARGACTIL, SERUM Please refer to CHLORPROMAZINE, SERUM PATHOLOGY TESTS - L

136 PATHOLOGY TESTS - L LAROXYL, SERUM 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 Faeces/Faeces container 1 week Transport at 4 C. or urine container LD ISOENZYMES, SERUM Please refer to LACTATE DEHYDROGENASE (LD/LDH) ISOENZYMES, SERUM. LD, FLUID Fluid/Plain tube/container Same day Specify site of fl uid on specimen container and request form. LD, PLEURAL FLUID Pleural fl uid/plain tube Same day Please provide clinical and medication details. Refrigerate sample during storage and transport. LD, SERUM 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 Please refer to LACTATE DEHYDROGENASE (LD/LDH) ISOENZYMES, SERUM. LD/LDH (LACTATE DEHYDROGENASE), SERUM LDL CHOLESTEROL, SERUM 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. Please refer to HDL CHOLESTEROL, SERUM. LEAD, BLOOD Blood/EDTA tube 24 hours Please provide clinical, medication and lead exposure details. Leave as whole blood. LEAD, HAIR Hair/Dry sterile screw cap (urine) container LEAD, PAINT FLAKES Paint fl akes/ Dry sterile screw top (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*** 4 weeks Referred test. PATHOLOGY TESTS - L

137 PATHOLOGY TESTS - L LEAD (Pb), URINE Urine/Urine container with no preservative LEBER S NEURORETINOPATHY TEST, DNA PROBE LEGIONELLA ANTIBODY Immunology Blood/SS tube 24 hours LEGIONELLA PCR Immunology Respiratory aspirate sputum, Lavage 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. Please refer to MITOCHONDRIAL DISORDERS (LEBERS, LEIGHS, MELAS, NARP), BLOOD. 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 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, Please refer to LYSOSOMAL ENZYMES, BLOOD. BLOOD LEUKAEMIA MARKER STUDIES Haematology Blood/ACD tube, 24 hours Lithium heparin tube may be used if ACD tube unavailable. EDTA tube, Blood fi lm LiCO3, SERUM Please refer to LITHIUM, SERUM. LIDOCAINE, SERUM Please refer to LIGNOCAINE, SERUM. LIGNOCAINE, SERUM Blood/Plain plastic tube - no gel or anticoagulant LINDANE (ORGANOCHLORINE PESTICIDES), BLOOD 2 weeks Please provide clinical and medication details especially time of last dose. Collect just prior to next dose. Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. LIPASE, SERUM Blood/SS tube Same day Please provide clinical and medication details. LIPID ELECTROPHORESIS, SERUM 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. PATHOLOGY TESTS - L

138 PATHOLOGY TESTS - L LIPID STUDIES, SERUM Blood/SS tube Same day Includes Cholesterol, Triglycerides and HDL. See Appendix (12.21) Medicare requires that each test is requested separately on the request. LIPID TYPING, SERUM Please refer to LIPID ELECTROPHORESIS, SERUM. LIPOPROTEIN (a), SERUM 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 Please refer to APOLIPOPROTEIN A1, SERUM. LIPOPROTEIN PATTERN Please refer to LIPID ELECTROPHORESIS, SERUM. (ELECTROPHORESIS), SERUM LITHICARB, SERUM Please refer to LITHIUM, SERUM. LITHIUM, SERUM 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 Please refer to COPPER, LIVER BIOPSY for details. Referred test. LIVER BIOPSY IRON Please refer to IRON, LIVER BIOPSY for details. Referred test. LIVER FUNCTION TESTS, SERUM LIVER/KIDNEY MICROSOMAL ANTIBODY 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. Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). LOPINIVIR, PLASMA 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 Please refer to FLUOXETINE, SERUM. LP(a), SERUM Please refer to LIPOPROTEIN (a), SERUM. LUCIJET (PESTICIDE), SERUM Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. PATHOLOGY TESTS - L

139 PATHOLOGY TESTS - L LUPUS ANTICOAGULANT SCREEN LUTEINIZING HORMONE (LH), SERUM Haematology Blood/Sodium citrate tube 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 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. 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 Immunology Blood/SS tube 2-3 weeks WESTERN BLOT LYMPH NODE CELL MARKER STUDIES, TISSUE LYMPHOCYTE FUNCTION TESTS, BLOOD Haematology/ Histology Haematology Lymph Node/Antibiotic Transport Medium, formalin container, 6 labelled glass slides Blood/2 x Lithium heparin tubes, 1 x SS tube, 1 x EDTA tube 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) or Branch Laboratory to inform of impending biopsy and for assistance. 2 weeks Please contact Haematology (07) or Branch Laboratory for appointment. Referred test. PATHOLOGY TESTS - L

140 PATHOLOGY TESTS - L LYMPHOCYTE GENE REARRANGEMENT STUDIES LYMPHOCYTE MARKER STUDIES, BLOOD LYMPHOCYTE SUBSET ANALYSIS (INCLUDES T4/T8 RATIO), BLOOD LYMPHOGRANULOMA VENEREUM (LGV) SEROLOGY LYSOSOMAL ENZYMES, BLOOD Genetics Haematology Haematology EDTA Blood, bone marrow, lymph node, aspirate, tissue Blood/ACD tube, EDTA tube, Blood fi lm Blood/ACD tube, EDTA tube, Blood fi lm 2 weeks IgH and T-cell receptor (beta and gamma) gene rearrangements. Incurs fee to patient. 24 hours Lithium heparin tube may be used if ACD tube unavailable. 24 hours Lithium heparin tube may be used if ACD tube unavailable. Immunology Blood/SS tube 72 hours Assay run Monday and Wednesday. 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, Murarrie 11.00am at the latest. Please contact (07) 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 PATHOLOGY TESTS - L

141 PATHOLOGY TESTS - M 9.0 MACRO CK, SERUM Please refer to CK ISOENZYME ELECTROPHORESIS, SERUM. MAGNESIUM, FLUID Fluid/Plain tube/container Same day Specify site of fl uid on specimen container and request form. MAGNESIUM, RED CELL 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 Blood/SS tube Same day Please provide clinical and medication details. MAGNESIUM, URINE 24 HOUR Urine/24 hour urine container with 25 ml 6M HCI preservative 24 hours Urine should be refrigerated after the collection period and transported cooled to the laboratory. 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 MALIGNANT HYPERTHERMIA GENETIC TESTING Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. See specifi c specimen or site. Genetics Blood/Lithium heparin tube 4-6 weeks Keep at room temperature. MANDELIC ACID, URINE 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 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 Blood/SS tube 4 weeks Please provide clinical and medication details. Transport in esky at 4 C. Referred test. MANGANESE (Mn), URINE Urine/Urine container 4 weeks Test for excessive exposure. Referred test. MANNOSE BINDING LECTIN, WHOLE BLOOD 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 $ Referred test. 9.0 PATHOLOGY TESTS - M

142 PATHOLOGY TESTS - M MANTOUX TEST - HUMAN Microbiology Skin test/0.1 ml of human PPD hours Intradermal injection volar aspect LEFT forearm. Read at hours. Please contact Consultant Pathologist on (07) for details. Refer to Microbiology Preface (5.60). MARCAIN, PLASMA Please refer to BUPIVACAINE, PLASMA for details. MARFAN SYNDROME Genetics Blood/EDTA tube Up to 9 months Patient consent for billing must be marked on the request form. GENETIC TESTING MATRX NTX STUDY Specimen Distribution Urine/Random urine container Collection and transfer only MBOCA, URINE Please refer to MOCA, URINE. MCAD (MEDIUM CHAIN ACYL CO A DEHYDROGENASE DEFICIENCY) TEST, DNA PROBE Please refer to MCAD GENE ANALYSIS. MCAD GENE ANALYSIS Blood/EDTA tube 4 weeks Please contact (07) 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 Please refer to VITAMIN B3, URINE for details. MCPA (HERBICIDE), URINE 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, 48 hours Transport at room temperature. culture/sterile container MEDIUM CHAIN ACYL CO A DEHYDROGENASE DEFICIENCY (MCAD) TEST, DNA PROBE Blood/EDTA tube 2-4 weeks Please contact (07) 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. PATHOLOGY TESTS - M

143 PATHOLOGY TESTS - M MELIOIDOSIS SEROLOGY (BURKHOLDERIA PSEUDOMALLEI) Immunology Blood/SS tube 1 week Assay run Monday. MELIPRAMINE, SERUM Please refer to IMIPRAMINE, SERUM. MELLERIL, SERUM 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 Urine/Urine container 2 weeks Random urine to be collected at the end of work shift. MERCURY, BLOOD Blood/EDTA tube (Lithium heparin tube acceptable) MERCURY, HAIR Hair/Dry sterile screw cap (urine) container MERCURY, NAIL Toe and fi ngernail clippings/dry sterile screw cap (urine) container 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. 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*** 4 weeks Please provide exposure and occupation details. Cut clean fi nger and toe nails. Referred test. MERCURY, URINE 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 METABOLIC SCREEN, BLOOD METANEPHRINE, BLOOD 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). Blood/Lithium heparin tube 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. Please refer to METANEPHRINE, PLASMA. PATHOLOGY TESTS - M

144 PATHOLOGY TESTS - M METANEPHRINE, PLASMA METANEPHRINE, URINE 24 HOUR METASYSTOX (PESTICIDE), SERUM METHADONE, BLOOD METHAEMALBUMIN, PLASMA METHAEMOGLOBIN REDUCTASE, BLOOD METHAEMOGLOBIN, BLOOD METHAEMOGLOBIN, URINE METHOMYL (PESTICIDE), BLOOD METHOTREXATE, SERUM Blood/Lithium heparin tube 1-2 weeks Tumour marker - phaeochromocytoma. Please keep the sample cool and forward to the laboratory without delay. Please refer to CATECHOLAMINES, URINE. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Blood/Lithium heparin tube 2-3 weeks Please provide clinical and medication details including time and date of last dose. Do not separate plasma. 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. Blood/Lithium heparin tube 4 weeks Keep sample cool. DO NOT FREEZE. Blood/Lithium heparin tube or EDTA tube Random urine/ Urine container Blood/Plain plastic 6 ml tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable) Same day Same day Please provide clinical and medication details. Forward UNOPENED TUBE to lab promptly. DO NOT SEPARATE plasma. Random urine sample. Provide clinical and medication details. Forward to laboratory promptly. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. 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 Please refer to BROMIDE, BLOOD and SERUM for details. METHYL CARBOXYLAMIDE Please refer to VITAMIN B3, URINE for details. PYRIDONE, URINE METHYL CHLORIDE, BLOOD Please refer to SOLVENTS, BLOOD for all details. METHYL ETHYL KETONE, BLOOD Please refer to SOLVENTS, BLOOD for all details. PATHOLOGY TESTS - M

145 PATHOLOGY TESTS - M METHYL ETHYL KETONE, URINE METHYL HISTAMINE, URINE METHYL ISOBUTYL KETONE (MIBK), BLOOD METHYL ISOBUTYL KETONES, URINE Urine/Urine container 4 weeks Urine should be collected at the end of the work shift. Referred test. Please refer to HISTAMINE, URINE. Methyl histamine is a dietary derivative. Please refer to SOLVENTS, BLOOD for all details. 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, Please refer to SOLVENTS, BLOOD for all details. BLOOD METHYLENE-BIS-2- Please refer to MOCA, URINE. CHLORANILINE, URINE METHYLMALONIC ACID, SERUM Blood/SS tube 1-2 weeks Sample must be kept cool and transported to the laboratory without delay. Referred test. METHYLMALONIC ACID, URINE 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 Blood/Plain plastic tube - no gel or anticoagulant Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. 2 weeks Please provide clinical and medication details including time and date of last dose. Collect just prior to next dose. MEXITIL, SERUM Please refer to MEXILETINE, SERUM. MIANSERIN, SERUM Blood/Plain plastic tube - no gel or anticoagulant (EDTA tube or Plastic lithium heparin (no gel) acceptable) MIBK (METHYL ISOBUTYL KETONE), BLOOD 1-2 weeks Please provide clinical and medication details including time and date of last dose. Collect just prior to next dose. Referred test. 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 Please refer to METHYL ISOBUTYL KETONES, URINE. PATHOLOGY TESTS - M

146 PATHOLOGY TESTS - M MICROALBUMIN, URINE Please refer to ALBUMIN, URINE. MICROALBUMIN/CREATININE RATIO, URINE Please refer to ALBUMIN, URINE. MICROBIAL SEROLOGY Immunology Blood/SS tube Variable from 24 hours to weeks depending on agent requested MICROSOMAL ANTIBODY, Endocrinology Blood/SS tube 24 hours SERUM (THYROID) Please refer to Immunology Appendix (12.35) 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) or Branch Laboratory. MIDAZOLAM, URINE Urine/Urine container 4 weeks Transport to central laboratory on ice. Referred test. MINERAL TURPENTINE, Please refer to SOLVENTS, BLOOD for all details. BLOOD MINIMUM INHIBITORY CONCENTRATION MITOCHONDRIAL ANTIBODY, SERUM MITOCHONDRIAL DISORDERS (LEBERS, LEIGHS, MELAS, NARP), BLOOD MITOCHONDRIAL DISORDERS, HAIR ROOTS MIXED LYMPHOCYTE CULTURE, BLOOD Microbiology In vitro test on isolate 24 hours Please contact Medical Microbiologist (07) or (07) for further details. Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). 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 (07) 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. 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. Haematology Blood/ACD tube 2 weeks Please contact Haematology (07) or Branch Laboratory for appointment. Referred test. PATHOLOGY TESTS - M

147 PATHOLOGY TESTS - M MOCA, URINE Urine/Urine container 8 working days Sample to be collected post work shift. Refrigerate sample and transport to laboratory cooled. MOGADON, SERUM Please refer to NITRAZEPAM, SERUM. MOLYBDENUM, BLOOD Blood/Lithium heparin tube or EDTA tube 4 weeks Please provide exposure details. Referred test. MONOLAYER CYTOLOGY (THINPREP) MORPHINE, SERUM (QUANTITATIVE) MOTOR NEURON DISEASE FAMILIAL GENETIC TESTING Cytology Labelled fi xed smear/ slide carrier. Rinse collection device in labelled PreservCyt Solution Blood/Plain plastic 6 ml tube - no gel or anticoagulant 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. 2 weeks Please provide clinical and medication details, including time and dosage of last dose. 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 MTHFR (C677T) MUTATION ANALYSIS 48 hours Specify sites: Rectal - ESBL/VRE; Nasal/groin/wounds/axilla - MRSA. 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 Urine/Urine container 2 weeks Random urine to be collected at the end of work shift. MUCOPOLYSACCHARIDES, URINE MULTIPLE BIOCHEMICAL ANALYSIS (MBA), SERUM MULTIPLE ENDOCRINE NEOPLASIA (MEN1) GENETIC TESTING Urine/Urine container Screen: Next day, Quantitation: 1-2 weeks Genetics Blood/EDTA tube 2 months Please provide clinical and medication details. Refrigerate for transport to the laboratory. A random urine collection is required. Please refer to E/LFT, SERUM. PATHOLOGY TESTS - M

148 PATHOLOGY TESTS - M MUMPS SEROLOGY Immunology Blood/SS tube hours Assay run daily (Monday - Friday). MURAMIDASE, SERUM Haematology Blood/SS tube 24 hours MURELAX, SERUM 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 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- Please refer to DYSTROPHIN GENE ANALYSIS, BLOOD. BECKER/DUCHENNE, BLOOD MUTABON, SERUM Please refer to AMITRIPTYLINE, SERUM. MYCOBACTERIA ATYPICAL, MICROSCOPY AND CULTURE MYCOBACTERIUM TUBERCULOSIS, SPUTUM MICROSCOPY AND CULTURE Microbiology/ Histology Microbiology Tissue, sputum, pus/dry sterile screw top (urine) container (NO formalin) Sputum/Dry, sterile screw top (urine) container Microscopy - same day. Culture - majority provisionally identifi ed within 2 weeks (up to 12 weeks). Microscopy - 2 days. Culture - up to 6 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. Sputum - 3 consecutive early morning specimens. MYCOPHENOLATE, PLASMA Please refer to MYCOPHENOLIC ACID, PLASMA. MYCOPHENOLIC ACID, PLASMA Blood/EDTA tube 2 weeks Please keep sample cool and transport to the laboratory without delay. Referred Test. PATHOLOGY TESTS - M

149 PATHOLOGY TESTS - 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 MYOGLOBIN, SERUM Blood/Plain tube - no gel or anticoagulant. Lithium heparin tube/edta tube (no gel) plasma also acceptable 5 days Same day Please provide clinical and medication details. MYOGLOBIN, URINE Urine/Urine container Same day Random urine sample required. Please provide clinical and medication details. MYOTONIC DYSTROPHY Blood/EDTA tube 4 weeks Transfer sample at 4 C to reach the laboratory without delay. Referred test. MYSOLINE, SERUM Please refer to PRIMIDONE, SERUM. PATHOLOGY TESTS - M

150 PATHOLOGY TESTS - N 9.9 N-1-METHYL NICOTINAMIDE, Please refer to VITAMIN B3, URINE for details. URINE N-ACETYL PROCAINAMIDE, SERUM Please refer to PROCAINAMIDE, SERUM. N-ACETYL-GLUCOSE- AMINIDASE, URINE NALTREXONE, SERUM or URINE Urine/Plain random urine container Blood/Plain plastic 6 ml tube - no gel or anticoagulant (Plastic lithium heparin tube or EDTA tube acceptable) or Urine/Urine container 2 weeks Freeze specimen immediately after collection. Indeterminate NARCOLEPSY Haematology Blood/ACD tube Indeterminate NASOPHARYNGEAL ASPIRATE MICROSCOPY AND CULTURE NEISSERIA GONORRHOEAE, MICROSCOPY AND CULTURE Microbiology Nasopharyngeal Aspirate/ Aspirating trap Interim microscopy report - same day. Routine culture report - 48 Hours Microbiology Swab in Transport Medium Interim microscopy report - same day. Routine culture report - 48 Hours Keep sample cool and send to the laboratory as soon as possible. Please contact, central laboratory to check availability. Please provide clinical details including antibiotic therapy and indicate if specimen is for virology. Using fi ne wire swabs collect at least two (2) swabs from the penile urethra or endocervical canal. Contact Microbiology (07) to arrange rapid transport and processing without delay. NEISSERIA MENINGITIDIS PCR Immunology Blood and CSF/EDTA 24 hours tube and Sterile container NELFINAVIR, PLASMA 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. 9.9 PATHOLOGY TESTS - N

151 PATHOLOGY TESTS - N NEONATAL SCREENING TEST 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 Preface. Please note: Card must be completely air dried and transported in a paper bag or envelope. Referred test. NEOPTERIN, URINE Please refer to PTERINS, URINE for details. Referred test. NEORAL, BLOOD Please refer to CYCLOSPORIN, BLOOD. NEULIN PRE/POST DOSE, SERUM Please refer to THEOPHYLLINE, 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, Blood/SS tube 2 weeks Centrifuge, separate and freeze serum. Referred test. SERUM NEURONTIN, SERUM Please refer to GABAPENTIN, SERUM. NEUTROPHIL AB TO MYELOID PRECURSORS NEUTROPHIL ALKALINE PHOSPHATASE (NAP), BLOOD NEUTROPHIL ANTIBODIES, BLOOD NEUTROPHIL FUNCTION STUDIES, BLOOD Haematology Haematology Haematology Haematology Bone marrow and blood/3-4 fresh bone marrow slides, 3-4 normal bone marrow slides, 1 x SS tube Blood/EDTA tube, 4 Original blood fi lms Blood/2 EDTA tubes, SS tube Blood/EDTA tube, Plastic lithium heparin tube, 2 blood fi lms, SS tube 1 month Marrow collection performed by Haematologist. 24 hours Blood fi lms made at time of collection are essential, EDTA interferes with test. 24 hours Test performed daily. No booking or appointment required. Please notify Haematology (07) or your Branch Laboratory of all urgent specimens and weekend collections. 24 hours Please contact Haematology (07) or Branch Laboratory prior to collection. NEVIRAPINE, PLASMA 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. PATHOLOGY TESTS - N

152 PATHOLOGY TESTS - N NH 3, PLASMA Please refer to AMMONIA, PLASMA. NIACIN, URINE Please refer to VITAMIN B3, URINE for details. NICKEL, BLOOD Blood/EDTA tube (Lithium 4 weeks Please provide exposure details. Referred test. heparin tube acceptable) NICKEL, URINE Urine/Urine container 1 week Please provide details of exposure (clinical and occupational). A random collection is preferred. Referred test. NICOTINE METABOLITES, Please refer to COTININE, SERUM. SERUM NICOTINE METABOLITES, Please refer to COTININE, URINE. URINE NICOTINE, URINE RANDOM Please refer to COTININE, URINE. NIPPLE DISCHARGE CYTOLOGY Cytology Fixed smear of nipple discharge/slide carrier NITRAZEPAM, SERUM Blood/Plain plastic 6 ml tube - no gel or anticoagulant NITROGEN EXCRETION, URINE Urine/24 hour urine container with no preservative 24 hours For specimen preparation please refer to Cytology Preface (5.15). 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. 24 hours Urine should be refrigerated after the collection period and transported cooled to the laboratory. NMN, URINE Please refer to VITAMIN B3, URINE for details. NORADRENALIN, Please refer to CATECHOLAMINES, URINE. URINE NORADRENALINE, URINE 24 HOUR Please refer to CATECHOLAMINES, URINE. NORDIN TEST, URINE AND SERUM 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 (07) or Branch Laboratory for test and collection details. PATHOLOGY TESTS - N

153 PATHOLOGY TESTS - N NOREPINEPHRINE, Please refer to CATECHOLAMINES, URINE. URINE NOREPINEPHRINE, Please refer to CATECHOLAMINES, URINE. URINE 24 HOUR NORFLUOXETINE, SERUM Metabolite of Fluoxetine. Please refer to FLUOXETINE, SERUM. NORMALISED ANDROGEN Endocrinology Blood/SS tube 24 hours RATIO, SERUM NORMETANEPHRINE, URINE Please refer to CATECHOLAMINES, URINE. NORMISON, SERUM Please refer to TEMAZEPAM, SERUM. NOROVIRUS TESTING Immunology Faeces/Faeces container 1-2 weeks NORPACE, SERUM Please refer to DISOPYRAMINE, SERUM. NORTAB, SERUM Please refer to NORTRIPTYLINE, SERUM. NORTRIPTYLINE, SERUM 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 Please refer to MIANSERIN, SERUM. NORVIR, PLASMA 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 NTPROBNP (CHAT STUDY) Specimen Distribution Urine/Urine container (random) (preferred) or 24 hour urine container Blood/Patient presents with test kit/tubes 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. Collection and transfer only Forward sample to laboratory without delay. NTX, URINE Please refer to N-TELOPEPTIDE, URINE. PATHOLOGY TESTS - N

154 PATHOLOGY TESTS - N NUCLEIC ACID GENETIC INVESTIGATION FOR INHERITED DISEASES (CYSTIC FIBROSIS, LEBERS NEURORETINOPATHY, MCAD, PHENYLKETONURIA), DNA PROBE Blood/EDTA tube 4 weeks Please contact (07) 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 Please refer to THEOPHYLLINE, SERUM. PATHOLOGY TESTS - N

155 PATHOLOGY TESTS - O 9.14 OB PROTEIN, PLASMA 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 Please refer to SOLVENTS, BLOOD for all details. OCULAR LESION, MICROSCOPY AND CULTURE Microbiology Swab/Ophthalmology Microbiology kit OESTRADIOL, SALIVA Endocrinology Saliva/Sterile container (urine) Requirements are determined by clinical factors. Please refer to Microbiology Preface (5.55) for details and contact Microbiology (07) or Branch Laboratory. 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 Blood/SS tube 2 weeks Transport to Central Laboratory on dry ice. Referred test. OLANZAPINE, PLASMA Blood/Lithium heparin tube 1-2 weeks Please keep the sample cool and forward to the laboratory without delay. (EDTA tube acceptable) OLIGOCLONAL BAND STUDIES, CSF Please refer to PROTEIN ELECTROPHORESIS, CSF for details. OLIGOSACCHARIDES, URINE 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 Please contact the Drug Testing Laboratory,, Murarrie (07) for all information on urine, saliva and breath on-site drug testing. OPIATES - GCMS CONFIRMATION OPTICAL DENSITY, AMNIOTIC FLUID 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 Preface (5.4). Confi rmation and quantitation by GCMS of positive fi ndings may be requested separately. Please refer to BILIRUBIN, AMNIOTIC FLUID for details PATHOLOGY TESTS - O

156 PATHOLOGY TESTS - O ORAL CAVITY CYTOLOGY Cytology Labelled fi xed smear/ 24 hours For specimen preparation please refer to Cytology Preface (5.19). Slide carrier ORGANIC ACID SCREEN (CHROMATOGRAPHY), URINE ORGANOCHLORINE PESTICIDES, BLOOD ORGANOPHOSPHATE PESTICIDES, SERUM ORNITHINE TRANSCARBAMYLASE DEFICIENCY Urine/Urine container 2 weeks Please provide clinical and medication details. A random urine collection is required. Referred test. 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 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. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Genetics Blood/EDTA tube 3 months Patient consent for billing must be marked on the request form. OROSOMUCOID, SERUM Please refer to ALPHA-1-ACID GLYCOPROTEIN, SERUM OROTIC ACID, URINE 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 Faeces/Faeces container 24 hours Please keep the sample cool during collection and transport to the laboratory. OSMOLALITY, FLUID Fluid/Plain tube/container Same day Please note fl uid site on specimen container and request form. OSMOLALITY, SERUM 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 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 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. PATHOLOGY TESTS - O

157 PATHOLOGY TESTS - O OSTEOPOROSIS MARKERS, Please refer to N-TELOPEPTIDE, URINE. URINE OVARIAN ANTIBODY Immunology Blood/SS tube 1 week Refer to ADENOVIRUS SEROLOGY for collection details. OVARIAN CANCER TUMOUR MARKERS, SERUM / Endocrinology OVARIAN CYST ASPIRATE Cytology CYTOLOGY OVPLEX OVARIAN CANCER TEST Specimen Distribution Blood/SS tube 24 hours CA serous carcinoma CA mucinous carcinoma Lactate dehydrogenase isoenzyme - 1 (LD-1) - dysgerminoma Human chorionic gonadotrophin (HCG) - choriocarcinoma. Fluid/Sterile screw top container Blood/1 x SS tube and 1 x EDTA tube OXALATE, URINE Urine/24 hour urine container with 25 ml 6M HCI preservative OXAZEPAM, SERUM Blood/Plain plastic 6 ml tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable) 24 hours For specimen preparation please refer to Cytology Preface (5.17). Collection and transfer only Transport to Central Laboratory on dry ice. 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. 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. OXYPURINOL, PLASMA Blood/EDTA tube 2-3 weeks Keep cool during transport to laboratory. Referred test. PATHOLOGY TESTS - O

158 PATHOLOGY TESTS - P 9.17 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), Haematology Blood/EDTA tube Same day BLOOD PAINT THINNERS, BLOOD Please refer to SOLVENTS, BLOOD for all details. PANADOL, SERUM Please refer to PARACETAMOL, SERUM. PANCREATIC ELASTASE 1, FAECES PANCREATIC POLYPEPTIDE, SERUM 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. 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 PARACETAMOL, SERUM Blood/Plain plastic 6 ml tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable) hours For specimen preparation please refer to Cytology Preface (5.11). 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 Please refer to IMMUNOFIXATION (PROTEIN), SERUM. PARAPROTEIN, URINE Please refer to IMMUNOFIXATION (PROTEIN), URINE. PARAQUAT, URINE 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 PATHOLOGY TESTS - P

159 PATHOLOGY TESTS - P PARASITE SEROLOGY Immunology Blood/SS tube Variable from 24 hours to weeks depending on agent requested PARASITES AND ECTOPARASITES, EXAMINATION FOR PARATHION (ORGANOPHOSPHATE PESTICIDE), SERUM AND BLOOD PARATHION (PESTICIDE), SERUM PARATHORMONE (PTH) - RELATED PEPTIDE, PLASMA PARATHORMONE (PTH) INTACT, SERUM PARATHYROID HORMONE (PTH), SERUM Microbiology Endocrinology Faeces/Faeces container and slide. Skin scrapings, hairs, nits/glass slide and cover slip, sterile screw top containers Blood/EDTA tube with Trasylol 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) or Branch Laboratory hours Refer to Microbiology Preface (5.53) for details. Please contact Microbiology (07) or Branch Laboratory for further details of collection and transport. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. 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) or Branch Laboratory for details. Referred test. 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. 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, Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). SERUM PARVOVIRUS B19 PCR Immunology Blood/SS tube 4-6 weeks PATHOLOGY TESTS - P

160 PATHOLOGY TESTS - 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) PBG (PORPHOBILINOGEN) SCREEN, URINE 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. 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 Please refer to PORPHOBILINOGEN DEAMINASE, RED CELL. PCB OILS, BLOOD Blood/Glass lithium heparin tube PEMPHIGOID ANTIBODY/ BASEMENT MEMBRANE ZONE (BMZ) ANTIBODY, SERUM PEMPHIGUS ANTIBODY/ INTERCELLULAR CEMENT SUBSTANCE (ICS) ANTIBODY, SERUM PERCHLOROETHYLENE, BLOOD PERCHLOROETHYLENE, URINE 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. Immunology Blood/SS tube 2 weeks Skin biopsies for immunofl uorescence and histology advised. Please refer to Histology Preface (5.38) for details. Immunology Blood/SS tube 2 weeks Skin biopsies for immunofl uorescence and histology advised. Please refer to Histology Preface (5.38) for details. Please refer to SOLVENTS, BLOOD for all details. Urine/Urine container 4 weeks Random urine collected at the end of work shift or exposure. This test attracts a charge of approximately $ 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. PATHOLOGY TESTS - P

161 PATHOLOGY TESTS - P PERHEXILINE, SERUM PERITONEAL DIALYSIS FLUID FOR MICROSCOPY AND CULTURE Blood/Plain plastic tube - no gel or anticoagulant (plastic lithium heparin tube acceptable) Microbiology Fluid in sterile container or peritoneal dialysis bottle PERITONEAL FLUID CYTOLOGY Cytology Fluid/Sterile container of appropriate size PERITONEAL WASHING CYTOLOGY Cytology Fluid/Sterile container of appropriate size 2 weeks Please provide clinical and medication details. Collect just prior to next dose. Referred test. Interim microscopy report same day. Culture report 48 hours Please transport specimen cooled to laboratory as soon as possible after collection. 24 hours Submit ENTIRE specimen to laboratory as soon as possible. Please refer to Cytology Preface (5.16). 24 hours Submit ENTIRE specimen to laboratory as soon as possible. Please refer to Cytology Preface (5.16). PERTOFRAN, SERUM Please refer to DESIPRAMINE, SERUM. PERTUSSIS SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). PESTICIDES (ORGANOPHOSPHATE/ CARBAMATE), SERUM PESTICIDES, BLOOD Blood/Lithium heparin tube and/or SS tube Organophosphates: 24 hours Organochlorines: 4 weeks Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Please provide details of organochlorine and/or organophosphate pesticides and circumstances of exposure. Please refer to Appendix (12.18) for a comprehensive list. PETROL, BLOOD Please refer to SOLVENTS, BLOOD for all details. PEXID, SERUM Please refer to PERHEXILINE, SERUM. ph, BLOOD Please refer to BLOOD GASES, VENOUS. ph, FAECES 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). PATHOLOGY TESTS - P

162 PATHOLOGY TESTS - P ph, FLUID 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 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 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 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 Blood/Lithium heparin tube 2 weeks Monitoring of known patients with phenylketonuria. Please provide clinical details. Fasting samples are preferable. Referred test. PHENYLKETONURIA, Please refer to NEONATAL SCREENING TEST. BLOOD PHENYTOIN, SERUM Please refer to DILANTIN, SERUM. PHOSDRIN (PESTICIDE) Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. PHOSPHATE, FLUID Fluid/Plain tube/container Same day Specify site of fl uid on specimen container and request form. PHOSPHATE, SERUM 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 Urine/24 hour urine container with 25 ml 6M HCI preservative PHOSPHATE, WHOLE BLOOD Blood/Lithium heparin tube and SS tube 24 hours 24 hour urine preferred. Urine should be refrigerated during the collection period and transported cooled to the laboratory. 24 hours Please provide clinical and medication details. PATHOLOGY TESTS - P

163 PATHOLOGY TESTS - P PHOSPHOLIPID, FATTY ACID PHOSPHORYLASE B KINASE, BLOOD Blood/Lithium heparin tube Blood/Lithium heparin tube 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. 2 weeks Transport sample cool. Referred test. PHYTANIC ACID, BLOOD Please refer to FATTY ACIDS-VERY LONG CHAIN, PLASMA. PHYTANIC ACID, PLASMA Please refer to FATTY ACIDS-VERY LONG CHAIN, PLASMA. PIGMENTS, URINE Urine/Urine container Same day A random urine collection is required. Please provide HISTORY OF MEDICATION AND DIET and clinical details. PKU TEST Please refer to NEONATAL SCREENING TEST. PLASMA VISCOSITY Haematology Blood/EDTA tube 24 hours Specimen must NOT be refrigerated. PLASMINOGEN ACT INHIBITOR, BLOOD PLASMINOGEN ACTIVATOR, BLOOD PLASMINOGEN ASSAY, BLOOD PLATELET AGGREGATION STUDIES, BLOOD PLATELET ANTIBODY SCREEN, 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. Haematology Haematology Haematology Haematology Blood/Sodium citrate tube Blood/Sodium citrate tube Blood/5 Sodium citrate tubes, 1 EDTA tube Blood/3 EDTA tubes, 1 SS tube, 2 Blood fi lms PLATELET COUNT, BLOOD Haematology Blood/1 EDTA tube, 2 blood fi lms PLATELET FACTOR 3, BLOOD Haematology Blood/Sodium citrate tube 2-4 weeks 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. Same day Specimens must reach laboratory within 5 hours of collection. Please contact Haematology (07) or Branch Laboratory for details. DO NOT REFRIGERATE. 24 hours Test is performed Monday - Friday. For collection late Friday and weekends, please contact Haematology on (07) or Branch Laboratory. Transport at room temperature, NOT on ice. Same day Please see Haematology Appendix (12.32). 24 hours Please contact Coagulation Section (07) or Branch Laboratory before collection. PATHOLOGY TESTS - P

164 PATHOLOGY TESTS - P PLATELET FUNCTION PFA 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 1 week By appointment with Red Cross Transfusion Service. tubes, 1 x SS tube PLATINUM, BLOOD Blood/EDTA tube 2 weeks Please provide clinical and exposure details. PLEURAL FLUID CYTOLOGY Cytology Pleural fl uid/appropriate sterile container PML-RAR RT-PCR Genetics Blood or Bone marrow/ EDTA tube or min. 2 ml bone marrow in EDTA tube PNEUMOCOCCAL (STREPTOCOCCUS PNEUMONIAL) SEROLOGY 24 hours Please submit ENTIRE specimen to laboratory as soon as possible. For specimen preparation please refer to Cytology Preface (5.15). 2 weeks Specimen to be received within 24 hours. Immunology Blood/SS tube 2-4 weeks Referred test. PNEUMOCOCCAL ANTIBODIES Immunology Blood/SS tube Up to 3 months PNEUMOCOCCAL ANTIGEN, Immunology Urine/Urine container 1-2 weeks Referred test. URINE PNEUMOCYSTIS PCR Immunology Sputum/Nasopharyngeal aspirate sterile container Same day PNH SCREEN FLOWCYTOMETRY Haematology Blood/EDTA tube 24 hours PORPHOBILINOGEN DEAMINASE, RED CELL PORPHOBILINOGEN, URINE PORPHYRIN PEPTIDE X, BLOOD Blood/Lithium heparin tube Blood/Lithium heparin tube 2-4 weeks Test for Acute Intermittent Porphyria - useful only if 5ALA or PBG screen positive. Please contact (07) or Branch Laboratory before collection. Pretreated sample must arrive at the Reference Laboratory by late morning. Referred test. Please refer to PBG (PORPHOBILINOGEN) SCREEN, URINE. 2 weeks Protect from light. Transport to laboratory on ice. PATHOLOGY TESTS - P

165 PATHOLOGY TESTS - P PORPHYRIN, FAECES 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 Blood/Lithium heparin tube 3 weeks Refrigerate and protect from light immediately after collection. Please contact on (07) as a Blood Porphyrin may be preferred. Referred test. PORPHYRIN, RED CELL Whole blood/ Lithium heparin tube or EDTA tube 1 week Refrigerate and protect from light immediately after collection. PORPHYRIN, URINE Urine/Random urine container POST OPERATIVE WOUND INFECTION Microbiology Pus/Sterile container, Swab in Transport Medium 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. 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 Please refer to BIOCHEMISTRY, CSF for details. POTASSIUM, FAECES 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 Fluid/Plain tube/container Same day Specify site of fl uid on specimen container and request form. POTASSIUM, PLASMA 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 Department ( ). POTASSIUM, SERUM 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. PATHOLOGY TESTS - P

166 PATHOLOGY TESTS - P POTASSIUM, URINE Urine/Random urine container or plain 24 hour urine container POTASSIUM, WHOLE BLOOD Blood/Lithium heparin tube and SS tube 24 hours 24 hour urine preferred. Urine should be refrigerated during the collection period and transported cooled to the laboratory. 24 hours Please provide clinical and medication details. POUCH OF DOUGLAS FLUID Cytology Fluid/Sterile container 24 hours Collected by Doctor. of appropriate size PRADER WILLI DNA TESTING Genetics Blood/Pink top EDTA tube 1-2 months PREALBUMIN, PLASMA 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 PREGNANEDIOL, URINE 24 HOUR Endocrinology 24 hour urine collection/ Urine collection bottle. No preservative PREGNANETRIOL, URINE Endocrinology 24 hour urine collection/ Urine collection bottle. No preservative Same day Early morning urine recommended. For urine specimens no preservative or acid can be added. Monovette urine collection tubes must not be used. 4-5 weeks Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test. 4-5 weeks Total volume to be recorded. PREGNENOLONE, SERUM Endocrinology Blood/SS tube 2-5 weeks Referred test. PRIADEL, SERUM Please refer to LITHIUM, SERUM. PRIMIDONE, SERUM Blood/Plain plastic tube - no gel or anticoagulant (plastic lithium heparin tube acceptable) Same day PRO INSULIN Endocrinology Blood/SS tube 4-5 weeks PROCAINAMIDE, SERUM Blood/Plain plastic tube - no gel or anticoagulant Please provide clinical and medication details. Collect sample at least 8 hours after last dose or immediately prior to next dose. 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. PATHOLOGY TESTS - P

167 PATHOLOGY TESTS - P 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) PROGNOSTIC MARKERS BREAST CARCINOMA - PROGESTERONE RECEPTOR (BREAST CANCER TISSUE) PROGNOSTIC MARKERS BREAST CARCINOMA - OESTROGEN RECEPTOR (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. Histology Formalin fi xed tissue 48 hours Qualitative detection with Immunoperoxidase stain on formalin fi xed tissue section. 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 Please refer to PHENOBARBITONE, SERUM. PRONESTYL, SERUM Please refer to PROCAINAMIDE, SERUM. PROPOXUR (PESTICIDE), BLOOD PROSTATE SPECIFIC ANTIGEN Endocrinology Blood/SS tube 24 hours (PSA), SERUM PROSTATIC ACID PHOSPHATASE, SERUM PROSTATIC FNA CYTOLOGY Cytology Labelled fi xed and air dried smears/labelled capped needle and syringe/ Needle rinsings Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Please refer to ACID PHOSPHATASE (PROSTATIC), SERUM. 24 hours For specimen preparation please refer to Cytology Preface (5.16). PATHOLOGY TESTS - P

168 PATHOLOGY TESTS - P PROSTATIC SECRETIONS MICROSCOPY AND CULTURE PROTEASE INHIBITOR PHENOTYPING, PLASMA PROTEASE INHIBITOR, PLASMA PROTEIN C ASSAY, PLASMA PROTEIN ELECTROPHORESIS, CSF PROTEIN ELECTROPHORESIS, SERUM PROTEIN ELECTROPHORESIS, URINE Microbiology Haematology Prostatic fl uid in sterile container Blood/Sodium citrate tube CSF/CSF in plain tube. Collect blood in SS tube 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. Please refer to ALPHA-1-ANTITRYPSIN PHENOTYPE/GENOTYPE, PLASMA. Please refer to ALPHA-1-ANTITRYPSIN PHENOTYPE/GENOTYPE, 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 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. 1 week Please provide clinical details. Blood for serum EPP should also be taken at this time to maximise information obtainable from this test. Blood/SS tube 24 hours Test for B-cell malignancy such as multiple myeloma. Quantitative. Please provide clinical and medication details. 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. PATHOLOGY TESTS - P

169 PATHOLOGY TESTS - P PROTEIN IMMUNOFIXATION, Please refer to IMMUNOFIXATION (PROTEIN), SERUM. SERUM PROTEIN IMMUNOFIXATION, URINE Please refer to IMMUNOFIXATION (PROTEIN), URINE. PROTEIN S ASSAY, PLASMA Haematology Blood/Sodium citrate 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 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. PROTEIN STUDIES, CSF 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 Please refer to BIOCHEMISTRY, CSF for details. PROTEIN, FLUID Fluid/Plain tube/container Same day Specify site of fl uid on specimen container and request form. PROTEIN, PLEURAL FLUID 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 Please refer to E/LFT, SERUM. PROTEIN, SYNOVIAL FLUID Please refer to ALBUMIN, SYNOVIAL FLUID. PATHOLOGY TESTS - P

170 PATHOLOGY TESTS - P PROTEIN, URINE Urine/24 hour urine container with no 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 Please refer to DOTHIEPIN, SERUM. PROTHROMBIN (G20210A) MUTATION ANALYSIS Genetics Blood/Pink top EDTA tube PROTHROMBIN TIME COAG Haematology Blood/Sodium citrate tube PROTHROMBIN TIME-INR, BLOOD PROTOPORPHYRIN SCREEN, FAECES PROTOPORPHYRIN/ COPROPORPHYRIN, FAECES Haematology Blood/Sodium citrate 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. Same day Same day Faeces/Faeces container Screen: 1-7 days. Quantitation: 1-2 weeks If for oral anticoagulant therapy, record warfarin dosage and time last tablet was taken. Please see Haematology Appendix (12.32) for further information. 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. Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES. PROZAC, SERUM Please refer to FLUOXETINE, SERUM. PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM (SCOLINE) SENSITIVITY, SERUM 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. 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, Please refer to CHOLINESTERASE, SERUM. SERUM PSITTACOSIS SEROLOGY Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday. PATHOLOGY TESTS - P

171 PATHOLOGY TESTS - P 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 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 PURINE AND PYRIMIDINE, BLOOD PURINE AND PYRIMIDINE, URINE PURKINJE ANTIBODY SEROLOGY PYRETHRINS (SYNTHETIC), BLOOD PYREXIA UNKNOWN ORIGIN (PUO), SEROLOGY 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) or Branch Laboratory for details. Forward to the Central Laboratory on ice. There is currently no Medicare rebate for this test. Blood/Lithium heparin tube 2 weeks Forward to the Central Laboratory on ice. Referred test. Urine/Random early morning urine Immunology Blood/SS tube 2-3 weeks Immunology Blood/SS tube Variable from 24 hours depending on antibody tests required 2 weeks Please provide clinical and medication details. Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. 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, Please refer to VITAMIN B6, BLOOD for details. BLOOD PYRIDOXINE, BLOOD Please refer to VITAMIN B6, BLOOD for details. PATHOLOGY TESTS - P

172 PATHOLOGY TESTS - P PYRUVATE KINASE (SCREEN) Haematology Blood/EDTA tube 4 weeks Referred test. PYRUVATE, BLOOD Blood/Plain tube with special preservative 1 week Please contact on (07) 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. PATHOLOGY TESTS - P

173 PATHOLOGY TESTS - Q 9.32 Q FEVER PCR Immunology Blood or Tissue/ 4-6 weeks EDTA tube 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 QUALITATIVE DRUG SCREEN (INDUSTRY, OCCUPATIONAL, DRUG ABUSE ETC.), URINE RANDOM QUANTIFERON TEST FOR TB IMMUNITY QUEEN MULTI PANEL QUEEN PROFILE II PANEL Immunology Specimen Distribution Specimen Distribution Supervised random urine/ Doxtech security urine container Blood/TB gold blood collection tube - 3 tubes each patient 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 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 2 weeks Send to Genetics Department within 24 hours. Please transport and store at room temperature. 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 Preface (5.4) of this manual. The QML Pathology protocol complies with Australian Standard AS4308. See Appendix (12.13) for a full list of drugs assayed. Please contact (07) or Branch Laboratory for further details. 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. Collection and transfer only Collection and transfer only Protect urine and 1 x SS tube from light PATHOLOGY TESTS - Q

174 PATHOLOGY TESTS - Q QUETIAPINE, SERUM Blood/Lithium heparin tube (no gel or anticoagulant) QUINIDINE, SERUM Blood/Plain plastic tube - no gel or anticoagulant (plastic lithium heparin tube acceptable) 4 weeks Please provide clinical and medication details. Collect sample prior to next dose. Same day QUITAXON, SERUM Please refer to DOXEPIN, SERUM. 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. PATHOLOGY TESTS - Q

175 PATHOLOGY TESTS - R 9.34 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) or Branch Laboratory. RED CELL COUNT Haematology Blood/EDTA tube Same day RED CELL ENZYMES Haematology Blood/Lithium heparin 4 weeks Referred test. tube or EDTA tube RED CELL MAGNESIUM Please refer to MAGNESIUM, RED CELL. RED CELL MASS Haematology Blood/Sterile vials available on request from Haematology REDUCING SUBSTANCES, FAECES REDUCING SUBSTANCES, URINE 24 hours Appointment required. Please contact Haematology (07) or Branch Laboratory. 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. 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 9.34 PATHOLOGY TESTS - R

176 PATHOLOGY TESTS - R RESPIRATORY CYTOLOGY Cytology Sputum, brushings and washings, FNA/Labelled fi xed smears, appropriate sterile containers and aspirating traps 24 hours For specimen preparation please refer to Cytology Preface (5.15). RESPIRATORY SYNCYTIAL VIRUS (RSV) SEROLOGY RESPIRATORY VIRAL ANTIGEN TEST (DFA), INCLUDING RSV, INFLUENZA, PARAINFLUENZA, ADENOVIRUS Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). Immunology Nasopharyngeal Aspirate/ Aspirating trap RESPIRATORY VIRUS PCR Immunology Nasopharyngeal Aspirate or Nasopharyngeal swab (dry)/ Luki tube or Sterile container or Viral swab (VIROCULT) RET PROTO-ONCOGENE DNA TEST Genetics Blood/EDTA tube 8 weeks for full screen, 4 weeks for known family mutation 24 hours Refrigerate specimen and transport cooled to laboratory as soon as possible. Results usually available same day for urgent specimens hours PCR test detects RSV, Infl uenza A&B, Parainfl uenza 1 2 3, and Adenovirus. 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 Blood/SS tube or Lithium heparin tube 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. 1-2 weeks Ensure sample is protected from light. Transport in esky at 4 C. Referred test. RETINOL, SERUM Please refer to VITAMIN A, SERUM. RETT SYNDROME Genetics Blood/EDTA tube 3 months Patient consent for billing must be marked on the request form. GENETIC TESTING REVERSE T3 Endocrinology Blood/SS tube 1-2 months There is currently no Medicare rebate for this test. Referred test. RHEIN, FAECES Please refer to LAXATIVES, FAECES. PATHOLOGY TESTS - R

177 PATHOLOGY TESTS - R RHESUS DNA TESTING (AMNIO) Genetics Amniotic fl uid/ Indeterminate Please phone and organise in advance as this is not a routine test. Sterile container RHEUMATOID ARTHRITIS Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday). SEROLOGY RHEUMATOID FACTOR (RF), Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday). RA LATEX TEST, SERUM RIBOFLAVIN, BLOOD Please refer to VITAMIN B2, BLOOD for details. RICKETTSIA SEROLOGY Immunology Blood/SS tube 72 hours Assay run Tuesday and Friday. RISPERDAL, PLASMA Please refer to RISPERIDONE, PLASMA. RISPERIDONE, PLASMA Blood/Lithium heparin tube (EDTA tube acceptable) RISTOCETIN COFACTOR ASSAY (VON WILLEBRAND DISEASE), PLASMA 1-2 weeks Please provide clinical and medication details. Keep the sample cool and send to the laboratory without delay. Referred test. 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) or Branch Laboratory for details. RITONAVIR, PLASMA 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 Please refer to CLONAZEPAM, SERUM. ROGOR (PESTICIDE), SERUM Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. ROHYPNOL, SERUM Please refer to FLUNITRAZEPAM, SERUM. ROSS RIVER VIRUS (RRV) Immunology Blood/SS tube 24 hours Assay run daily (Monday to Friday, plus Saturday during late Summer). SEROLOGY ROTAVIRUS AGGLUTINATION Microbiology Faeces/Faeces container Same day Please specify if culture for other enteric viruses is required. TEST, FAECES ROUNDUP, URINE 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). PATHOLOGY TESTS - R

178 PATHOLOGY TESTS - R RSV (RESPIRATORY SYNCYTIAL VIRUS) ANTIGEN - DIRECT FLUORESCENT ANTIBODY TEST RSV (RESPIRATORY SYNCYTIAL VIRUS) SEROLOGY 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. Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). RUBELLA SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Saturday). RYTHMODAN, SERUM Please refer to DISOPYRAMINE, SERUM. PATHOLOGY TESTS - R

179 PATHOLOGY TESTS - S 10.0 SABRIL, SERUM Please refer to VIGABATRIN, SERUM. SAICAR, URINE Random early morning urine/urine container SALBUTAMOL, URINE Urine/Tamper-proof urine container or Urine container enclosed in a tamper-evident bag SALICYLATE, SERUM Blood/Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable) SALIVA DRUG SCREEN, QUALITATIVE ASSAY Supervised random Saliva (10 ml)/sterile screw cap container SALIVARY DUCT/GLANDS ANTIBODY, SERUM SALIVARY PROGESTERONE Endocrinology Saliva/Sterile container (urine) SALMONELLA TYPHI SEROLOGY (WIDAL SEROLOGY) SAN FILLIPO SYNDROME GENETIC TESTING SANDHOFF DISEASE GENETIC TESTING 2-3 weeks Please provide clinical and medication details. Random early morning urine collection preferred. Refrigerate for transfer to laboratory. Referred test. 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) if the correct procedure cannot be followed. Same day Immunology Blood/SS tube 2 weeks Referred test. Please note time and dosage of last medication. Collect 1-3 hours after oral dose. 48 hours Please contact (07) or Branch Laboratory for further details. 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. Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). Genetics/ Genetics/ Blood and CVS or Amino fl uid/edta tube and Sterile Container (Amino) or Transport media for tissue Blood/EDTA tube and SS tube 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. 1 month Transport frozen or at 4 C. Specimen to be received within 24 hours PATHOLOGY TESTS - S

180 PATHOLOGY TESTS - S SAQUINAVIR, PLASMA 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 Please refer to AMITRIPTYLINE, SERUM. Sb (ANTIMONY), BLOOD 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 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 SCHIRMER TEAR TEST (TEAR LYSOZYME CONCENTRATION) Haematology Tears/Special tubes provided by Haematology Department Same day Refer to Microbiology Preface (5.57) for details. Please contact Microbiology (07) or Branch Laboratory for further details of collection and transport. 24 hours By appointment only. Please contact Haematology (07) or Branch Laboratory. SCHISTOSOMA SEROLOGY Immunology Blood/SS tube 1 week Assay run Wednesday. SCHUMM S TEST, PLASMA Please refer to METHAEMALBUMIN, PLASMA. SCOLINE SENSITIVITY, SERUM 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 Blood/Lithium heparin tube or EDTA tube SELENIUM, SERUM Serum/Trace element free tube (Navy-top) 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. 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. PATHOLOGY TESTS - S

181 PATHOLOGY TESTS - S SELENIUM, URINE Urine/24 hour urine container with no preservative SEMINAL FLUID ANALYSIS Genetics Seminal fl uid/plain sterile container (semen container) SEMINAL FLUID MICROSCOPY (POST VASECTOMY) Genetics Seminal fl uid/plain sterile container (semen container) 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. 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. 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 Please refer to OXAZEPAM, SERUM. SEROQUEL, SERUM Please refer to QUETIAPINE, SERUM for details. SEROTONIN, PLATELET 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 Blood/SS tube 3 weeks Test for carcinoid syndrome. Please contact on (07) 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 Urine/24 hour urine container with 25 ml 6M HCI preservative SERTRALINE, SERUM Blood/Lithium heparin tube SERUM TRYPASE Immunology Blood/SS tube Results available on the day the test is run 2 weeks Tumour marker - carcinoid tumour. Uncommonly used. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test. 2 weeks Please provide clinical and medication details. Please keep the sample cool. 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 Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Referred test. PATHOLOGY TESTS - S

182 PATHOLOGY TESTS - S SEX DETERMINING REGION Y Genetics Blood/Pink top EDTA tube 2 weeks Incurs non-medicare refundable fee. (SRY) GENE ANALYSIS SEX HORMONE BINDING Endocrinology Blood/SS tube 24 hours GLOBULIN, SERUM SHIGELLA DYSENTERIAE Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). SEROLOGY SHIGELLA FLEXNERI SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). SHORT SYNACTHEN STIMULATION TEST Endocrinology Blood/SS tube and EDTA tube SHOX GENE ANALYSIS Genetics Blood or fi xed cell suspension from blood/ Lithium heparin 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. 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). 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 Blood/EDTA tube 4 weeks Please provide exposure details. Referred test. SILVER, URINE 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 Same day Please forward to laboratory as soon as possible. or Lithium heparin tube SINDBIS SEROLOGY Immunology Blood/SS tube 2-3 weeks SINEQUAN, SERUM 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) for vials and request books. PATHOLOGY TESTS - S

183 PATHOLOGY TESTS - S SIROLIMUS, BLOOD 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 SMOOTH MUSCLE ANTIBODY, SERUM SNAKE BITE IDENTIFICATION Bite site swab (preferred), urine or blood. Swab/Urine - sterile urine container. Blood - Lithium heparin tube (NOT preferred) Interim microscopy report 24 hours. Culture report up to 4 Weeks Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). 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). 2-4 hours Please refer to 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 Please refer to VALPROATE, SERUM. SODIUM, CSF Please refer to BIOCHEMISTRY, CSF for details. SODIUM, FAECES Faeces/Faeces container 24 hours Keep sample cool during collection and transport to the laboratory. SODIUM, FLUID Fluid/Plain tube/container Same day Specify source of fl uid on sample and request form. SODIUM, SERUM Please refer to E/LFT, SERUM. SODIUM, SWEAT Please refer to ELECTROLYTES, SWEAT. PATHOLOGY TESTS - S

184 PATHOLOGY TESTS - S SODIUM, URINE Urine/24 hour urine container with no preservative or random urine container SOLIAN, SERUM Blood/Plain plastic 6 ml tube - no gel or anticoagulant SOLUBLE MESOTHELIN RELATED PROTEIN SOLUBLE TRANSFERRIN RECEPTOR, SERUM Blood/SS tube or Plain tube 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. 4 weeks Please provide clinical and medication details. Please keep the sample cool. 3 weeks Provide clinical details such as exposure to asbestos. Keep sample on ice brick for arrival to Department within 24 hours. Blood/SS tube 2 weeks Please keep the sample cool and forward to the laboratory without delay. Referred test. SOLVENTS, BLOOD Blood/Lithium heparin tube 2 weeks Please provide exposure and occupation details. Contact (07) 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) or Branch Laboratory. SORBITOL DEHYDROGENASE, Blood/Lithium heparin tube 2 weeks Referred test. RED CELL SOTACOR, SERUM Please refer to SOTALOL, BLOOD. SOTALOL, BLOOD 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 Urine/Urine container 24 hours Random or 24 hour urine acceptable. PATHOLOGY TESTS - S

185 PATHOLOGY TESTS - S SPERM ANTIBODIES (IMMUNOBEAD TEST) SPINOCEREBELLAR ATAXIA (SCA1 & SCA2) GENETIC TESTING SPONTANEOUS ERYTHROID COLONIES 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) or Branch Laboratory for collection details. Performed fortnightly. Genetics Blood/EDTA tube 1-2 months Incurs non-medicare refundable fee. Haematology Blood or Bone marrow/ ACD tube or Bone marrow heparin 2 weeks SPORANOX, SERUM Please refer to ITRACONAZOLE, SERUM. SPUTUM - STAIN FOR EOSINOPHILS Microbiology Sputum/Sterile dry, screw top (urine) container SPUTUM CYTOLOGY Cytology Sputum/Sterile dry, screw top (urine) container SPUTUM MALIGNANT CELLS Cytology Sputum/Sterile dry, screw top (urine) container SPUTUM MICROSCOPY AND CULTURE Microbiology Sputum/Sterile dry, screw top (urine) container Same day Specify site of collection. 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). 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). 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 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. PATHOLOGY TESTS - S

186 PATHOLOGY TESTS - S STEROID PROFILE, URINE 24 HOUR STEROID SCREEN, URINE Endocrinology 24 hour urine collection/ Urine collection bottle. No preservative Urine/Tamper evident collection kit 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. 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 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 Blood/Fluoride oxalate tube 4 weeks Please provide exposure details. This test performed only on legal request. Contact (07) or Branch Laboratory for availability. Referred test. STYRENE EXPOSURE, URINE Please refer to MANDELIC ACID, URINE. STYRENE, BLOOD Please refer to SOLVENTS, BLOOD for all details. SUCCINYLAMINOIMIDAZOLE CARBOXAMIDE RIBOSIDE, URINE Please refer to SAICAR, URINE. SUCROSE LYSIS TEST, RED CELL SUGAR CHROMATOGRAPHY, FAECES SUGAR CHROMATOGRAPHY, URINE Haematology Blood/Sodium citrate tube 24 hours Please refer to CHROMATOGRAPHY, FAECES. Urine/Urine container 1 week Please provide clinical details. FRESH random urine sample. Store and transport frozen. Please also refer to the Preface (5.4). SULPHAEMOGLOBIN, BLOOD Blood/Lithium heparin tube SULPHONYLUREAS, PLASMA Blood/Lithium heparin tube SULTHIAME, SERUM Blood/Plain plastic 6 ml tube - no gel or anticoagulant Same day 4 weeks Referred test. Please provide clinical and medication details. Do not separate plasma. 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. PATHOLOGY TESTS - S

187 PATHOLOGY TESTS - S 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 Please refer to TRIMIPRAMINE, SERUM. SUXAMETHONIUM SENSITIVITY, SERUM SYMPATHOMIMETIC AMINES - GCMS CONFIRMATION SYNACTHEN STIMULATION TEST Endocrinology Urine/Urine drug screen collection kit with tamper evident packaging Blood/SS tube and EDTA tube SYNOVIAL FLUID ANALYSIS Microbiology Synovial fl uid/sterile dry screw top (urine) container, Lithium heparin tube, Fluoride EDTA tube 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 Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM (SCOLINE) SENSITIVITY, SERUM. 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 Preface (5.4). Confi rmation and quantitation by GCMS of positive fi ndings may be requested separately. 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). 24 hours Synovial fl uid collection kits are provided on request by QML Pathology. 24 hours For specimen preparation please refer to Cytology Preface (5.19). 48 hours Please specify site of collection and previous antibiotic therapy. PATHOLOGY TESTS - S

188 PATHOLOGY TESTS - S SYNTHETIC PYRETHROIDS, Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. 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. PATHOLOGY TESTS - S

189 PATHOLOGY TESTS - T T & B CELL GENE REARRANGEMENT STUDIES T LYMPHOCYTE 4/8 RATIO (LYMPHOCYTE SUBSET ANALYSIS), BLOOD Genetics Haematology Bone marrow (EDTA tube) or Lymph node (EDTA tube) or Tumour or Blood (Pink top EDTA tube) Blood/ACD tube, EDTA tube, Blood fi lm 2 weeks Transport at room temperature or cooled on ice brick. 24 hours Lithium heparin tube may be used if ACD tube unavailable. TACROLIMUS, BLOOD Blood/EDTA tube 24 hours Please provide clinical and medication details. Collect a trough sample and transport at 4 C. TAMBOCOR, SERUM Please refer to FLECAINIDE, SERUM. TAU PROTEIN, FLUID Fluid/Plain tube 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.) T-CELL RECEPTOR GENE REARRANGEMENT Microbiology Genetics Sputum, Urine, Swabs, Pus, Tissue/Sterile container Bone marrow (EDTA tube) or Lymph node (EDTA tube) or Tumour or Blood (Pink top EDTA tube) Interim microscopy report 2 days. Culture - 6 weeks 3 early morning urine and/or sputa are recommended. Tissue in sterile container (NOT in formalin). 2 weeks Incurs non-medicare refundable fee. TEGRETOL, SERUM Please refer to CARBAMAZEPINE, SERUM. TELLURIUM, BLOOD 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 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 - T

190 PATHOLOGY TESTS - T TEMIK (PESTICIDE), BLOOD Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. TERBUTALINE, URINE 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) if the correct procedure cannot be followed. TERSEL, SERUM 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) 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 2 weeks Referred test. Incurs non-medicare refundable fee. container (urine) 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, Please refer to SOLVENTS, BLOOD for all details. BLOOD TETRACHLOROETHYLENE, Please refer to SOLVENTS, BLOOD for all details. BLOOD TETRAMETHYLHEXADECANOIC ACID, PLASMA Please refer to FATTY ACIDS-VERY LONG CHAIN, PLASMA. THALASSAEMIA SCREEN/ STUDIES, BLOOD Haematology Blood/2 x EDTA tubes, 1 Blood fi lm 1-3 days Tests performed Tuesday and Friday. Results available same day of test. PATHOLOGY TESTS - T

191 PATHOLOGY TESTS - T THALLIUM, BLOOD Blood/EDTA tube (Lithium 4 weeks Test for toxicity. Please provide clinical and medication details. Referred test. heparin tube acceptable) THALLIUM, URINE 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 Urine/Urine drug screen collection kit with tamper evident packaging Next day following assay THEODUR PRE/POST DOSE, Please refer to THEOPHYLLINE, SERUM. SERUM THEODUR, SERUM Please refer to THEOPHYLLINE, SERUM. THEOPHYLLINE PRE/POST DOSE, SERUM Please refer to THEOPHYLLINE, SERUM. THEOPHYLLINE, SERUM Blood/Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin tube acceptable) Same day or urgently 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 Preface (5.4). Confi rmation and quantitation by GCMS of positive fi ndings may be requested separately. 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 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 THIOCYANATE, BLOOD Blood/Lithium heparin tube 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. 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. PATHOLOGY TESTS - T

192 PATHOLOGY TESTS - T THIOCYANATE, URINE 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 Blood/Lithium heparin tube THIORIDAZINE, SERUM Blood/Plain plastic 6 ml tube - no gel or anticoagulant 2 weeks Test for genetically-determined sensitivity to potential for toxic accumulation of certain drugs. Transport in esky at 4 C. Referred test. 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 THYROGLOBULIN ANTIBODY, Endocrinology Blood/SS tube 24 hours SERUM THYROGLOBULIN, SERUM Endocrinology Blood/SS tube 24 hours Used as a tumour marker. 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); or 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. PATHOLOGY TESTS - T

193 PATHOLOGY TESTS - T THYROID FNA CYTOLOGY Cytology Labelled fi xed and air dried smears/labelled capped needle and syringe 24 hours For specimen preparation please refer to Cytology Preface (5.16). THYROID FUNCTION TESTS, SERUM THYROID STIMULATING HORMONE (TSH), SERUM THYROID STIMULATING IMMUNOGLOBULIN (TSI), SERUM THYROID TISSUE ANTIBODIES, SERUM THYROXINE BINDING GLOBULIN, 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. 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. 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. Endocrinology Blood/SS tube 24 hours Measure antimicrosomal and antithyroglobulin antibodies (Thyroid Tissue Antibodies). Endocrinology Blood/SS tube 24 hours TIN, BLOOD Blood/2 x EDTA tubes 2 weeks Referred test. TISSUE AUTOANTIBODIES, SERUM TISSUE PLASMINOGEN ACTIVATOR TISSUE PLASMINOGEN ACTIVATOR INHIBITOR TISSUE TRANSGLUTAMINASE ABS Immunology Blood/SS tube Variable from 24 hours depending on antibody tests required Haematology Blood/Sodium citrate tube 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) or Branch Laboratory. 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. Haematology Blood/Sodium citrate tube 5 weeks Please contact Haematology (07) 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. Immunology Blood/SS tube 24 hours PATHOLOGY TESTS - T

194 PATHOLOGY TESTS - T TOBRAMICIN, SERUM Blood/Plain plastic tube - no gel or anticoagulant. Plastic lithium heparin tube (no gel) acceptable Same day Please refer to Appendix (12.15). TOFRANIL, SERUM Please refer to IMIPRAMINE, SERUM. TOLUENE, BLOOD Please refer to SOLVENTS, BLOOD for all details. For Urine - see HIPPURIC ACID, URINE. TOLUENE/XYLENE EXPOSURE, Please refer to HIPPURIC ACID, URINE. URINE TOLVON, SERUM Please refer to MIANSERIN, SERUM. TOMACULOUS NEUROPATHY Genetics Blood/EDTA tube 6 weeks Patient consent for billing must be marked on the request form. GENETIC TESTING TOPAMAX, SERUM Please refer to TOPIRAMATE, SERUM. TOPIRAMATE, SERUM 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 Please refer to PORPHYRIN, URINE. PORPHYRIN, URINE TOTAL ANTIOXIDANT STATUS, Please refer to ANTIOXIDANTS, BLOOD. SERUM 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 Please refer to individual trace elements. PATHOLOGY TESTS - T

195 PATHOLOGY TESTS - T TRACE ELEMENTS, HAIR 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 Please refer to individual trace elements. TRANSFERRIN ISOFORMS, Blood/SS tube 2 weeks Keep sample cool during collection and transport to the laboratory. Referred test. SERUM TRANSFERRIN SATURATION, Blood/SS tube 24 hours Part of IRON (Fe) STUDIES, SERUM. Includes Iron, TIBC and % saturation. SERUM TRANSFERRIN, SERUM 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 Please refer to VITAMIN B1, BLOOD for details. TREPONEMA PALLIDUM EIA, SERUM TREPONEMA PALLIDUM PARTICLE AGGLUTINATION TEST (TPPA), SERUM TRICHLOROACETIC ACID, URINE 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. Immunology Blood/SS tube 24 hours Supplementary test. Performed if Syphilis EIA test is positive. Urine/Urine container 2 weeks Please provide exposure and occupation details. Random urine collected immediately after the work shift or exposure. TRICHLOROETHANE, BLOOD Please refer to SOLVENTS, BLOOD for all details. TRICHLOROETHYLENE, BLOOD 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 Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. PATHOLOGY TESTS - T

196 PATHOLOGY TESTS - T TRICRESYL PHOSPHATE, BLOOD Blood/Lithium heparin tube 4 weeks Qualitative level only. Referred test. TRIGLYCERIDES, FLUID 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 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 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 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 Blood/SS tube Urgently This test, in the context of investigating chest pain or heart attack, is treated as urgent. TRYPSIN ACTIVITY, FAECES 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 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 Please refer to AMITRIPTYLINE, SERUM. PATHOLOGY TESTS - T

197 PATHOLOGY TESTS - T 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 TUMOR NECROSIS FACTOR RECEPTOR-ASSOCIATED PERIODIC SYNDROME (TRAPS) GENETIC TESTING TUMOUR MARKERS, SERUM Genetics / Endocrinology Blood/1 x EDTA tube, 1 x ACD tube, 1 x Lithium heparin tube Blood/SS tube Microscopy - 2 days. Culture - up to 6 weeks Please refer to URINE FOR MTB CULTURE and Microbiology Preface (5.55). 1-2 months Incurs non-medicare refundable fee. Individual tumour markers are listed alphabetically in the A-Z listing and in the 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 Blood/Lithium heparin tube 2 weeks Provide clinical details. Transport on dry ice. Referred test. PATHOLOGY TESTS - T

198 PATHOLOGY TESTS - U UBIQUINONE, PLASMA Please refer to COENZYME Q10, PLASMA. UCCINYLAMINOIMIDAZOLE CARBOXAMIDE RIBOSIDE (SAICAR), URINE UDPG TRANSFERASE, RED CELL 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. 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, Blood/Lithium heparin tube 1-2 months Please send to the laboratory without delay. Referred test. RED CELL URANIUM, BLOOD Blood/EDTA tube 4 weeks Please provide clinical and exposure details. URATE CLEARANCE 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 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 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 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 Please refer to E/LFT, SERUM. UREA, URINE 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 Blood/SS tube Same day Test for risk of gout. Values exceeding 0.42 mmol/l (i.e. within the male reference range - see Appendix (12.7)) may be associated with acute gout. In pregnancy, test for risk on pre-eclampsia. PATHOLOGY TESTS - U

199 PATHOLOGY TESTS - U URIC ACID, URINE Urine/24 hour urine container with 15 ml 2M NaOH preservative (preferred) or plain 24 hour container if other tests are requested URINARY ALDOSTERONE Endocrinology Urine/24 hour urine collection bottle. No preservative. Aliquot with blue Monovette URINARY CROSS LINKED N- TELOPEPTIDES (NTx, BONE RESORPTION MARKERS), URINE 24 HOUR OR RANDOM 24 hour urine collection/ Urine collection bottle. No preservative. Random Urine/Urine container URINARY TRACT CYTOLOGY Cytology Urine and or Bladder and Ureteric Washings/ Urine container URINE FREE CORTISOL, URINE 24 HOUR Endocrinology 24 hour urine collection/ Urine collection bottle. No preservative 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 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. 1 week Record 24 hour urine total volume. No preservative to be added to 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. 24 hours SECOND voided urine specimen of the morning. For specimen preparation please refer to Cytology Preface (5.15). 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 URINE MTB CULTURE Microbiology Urine/70 ml sterile container (NOT a monovette) Interim microscopy report same day. Culture and sensitivity hours Microscopy 2 days; Culture 6 weeks Transfer the Monovette to the laboratory as soon as possible. Refrigerate if an extended delay is expected. Submit a full 70 ml container of an early morning sample. PATHOLOGY TESTS - U

200 PATHOLOGY TESTS - U URINE QUALITATIVE DRUG SCREEN (INDUSTRY, OCCUPATIONAL, DRUG ABUSE ETC.), URINE RANDOM 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 Preface (5.4) of this manual. The QML Pathology protocol complies with Australian Standard AS4308. See Appendix (12.13) for a full list of drugs assayed. Please contact (07) or Branch Laboratory for further details. UROBILINOGEN, URINE 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 Please refer to PORPHYRIN, URINE. UROPORPHYRINOGEN-1- SYNTHETASE, RED CELL Blood/Lithium heparin tube 2-4 weeks Please contact prior to collection on (07) PATHOLOGY TESTS - U

201 PATHOLOGY TESTS - V VAGINAL PAP SMEAR CYTOLOGY VAGINAL/CERVICAL/URETHRAL CULTURE FOR BACTERIA, FUNGI, VIRUSES AND CHLAMYDIA Cytology Microbiology Labelled fi xed smear/ Slide carrier Swab/Stuart s Transport Medium (Bacteria, Fungi)/ Viral transport medium/ Chlamydia transport medium (Aptima Collection) 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) or Branch Laboratory. Routine microbiology 48 hours, Chlamydia PCR 24 hours, Viral PCR 24 hours VALIUM, SERUM Please refer to DIAZEPAM, SERUM. VALPROATE, SERUM Blood/Plain plastic tube - no gel or anticoagulant Same day VALPROIC ACID, SERUM Please refer to VALPROATE, SERUM. VANCOMYCIN, SERUM (TROUGH AND PEAK) VANILLYLMANDELIC ACID, URINE 24 HOUR VARICELLA ZOSTER DFA SLIDE (IMMUNOFLUORESCENCE) Blood/Plain plastic tube - no gel or anticoagulant. Plastic lithium heparin tube (no gel) acceptable Immunology Viral Culture Swab (green top) in transport medium Same day or urgently 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. Please provide clinical and medication details including dosage and time of last dose. Collect just prior to next dose. 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. Please refer to CATECHOLAMINES, URINE. 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 24 hours Assay run daily (Monday - Friday). top) in transport medium PATHOLOGY TESTS - V

202 PATHOLOGY TESTS - V VASOACTIVE INTESTINAL PEPTIDE, PLASMA Blood/Glass EDTA tube with Trasylol preservative 2 weeks Tumour marker - pancreatic vipoma. Contact (07) 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 Immunology Blood/SS tube 24 hours Supplementary test. Performed if Syphilis EIA test is positive. VENLAFAXINE, SERUM/PLASMA Blood/Plain plastic tube - no gel (Plastic lithium heparin tube or EDTA tube acceptable) VIGABATRIN, SERUM Blood/Plain plastic 6 ml tube - no gel or anticoagulant (EDTA tube or Lithium heparin tube acceptable) 4 weeks Please provide clinical and medication details. Keep sample cool. 2 weeks Please provide clinical and medication details. Keep sample cold. Referred test. VIP, PLASMA 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 Please refer to NEVIRAPINE, PLASMA for details. PATHOLOGY TESTS - V

203 PATHOLOGY TESTS - V VIRUS DETECTION Immunology Swabs and secretions from Throat, Skin vesicles etc. Urine, Faeces etc. Viral Culture Swabs/Viral Transport Medium or 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 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 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 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 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 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 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. PATHOLOGY TESTS - V

204 PATHOLOGY TESTS - V VITAMIN D RECEPTOR ALLELES, HAIR ROOTS Hair roots/hair roots (6-10) taped to piece of paper with roots left uncovered VITAMIN D, SERUM Blood/Plain plastic tube - no gel or anticoagulant VITAMIN E, SERUM Blood/SS tube (Lithium heparin tube acceptable) 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. 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. 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 Please refer to CATECHOLAMINES, URINE. VON HIPPEL-LINDAU GENETIC TESTING VON WILLEBRAND FACTOR ANTIGEN, PLASMA 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) 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) or Branch Laboratory. Refer to FACTOR VIII ASSAY. VWF MULTIMER ASSAY Haematology Blood/Sodium citrate tube Up to 3 months Please contact Haematology (07) or your Branch Laboratory for details before collection. Referred test. PATHOLOGY TESTS - V

205 PATHOLOGY TESTS - W WATER DEPRIVATION TEST 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 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 (07) 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, Please refer to LYSOSOMAL ENZYMES, BLOOD. BLOOD WHOOPING COUGH SEROLOGY Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). (BORDETELLA PERTUSSIS) WIDAL SEROLOGY (SALMONELLA TYPHI) Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). 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. PATHOLOGY TESTS - W

206 PATHOLOGY TESTS - X/Y XANAX, SERUM Please refer to ALPRAZOLAM, SERUM. XANTHINE, URINE Urine/Urine container 1-2 months A random urine is preferred. Please store and transport the sample frozen. XANTHOCHROMIA, CSF CSF/Plain tube Same day Keep sample cool and protect from light. XYLENE/TOLUENE EXPOSURE, Please refer to HIPPURIC ACID, URINE. URINE XYLENES, BLOOD Please refer to SOLVENTS, BLOOD for all details. XYLOCAINE, SERUM Please refer to LIGNOCAINE, SERUM. XYLOSE EXCRETION TEST (ADULT) XYLOSE EXCRETION TEST (CHILD) Y CHROMOSOME MICRODELETION ANALYSIS AZFa, AZFb, AZFc YELLOW FEVER VIRUS SEROLOGY YERSINIA ENTEROCOLITICA SEROLOGY Urine/24 hour urine container with no preservative Urine/24 hour urine container with no preservative 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. 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. Genetics Blood/EDTA tube 1-2 weeks DAZ gene is encompassed within AZFc region. Incurs non Medicare refundable fee. 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. Immunology Blood/SS tube 24 hours Assay run daily (Monday - Friday). PATHOLOGY TESTS - X/Y

207 PATHOLOGY TESTS - Z ZACTIN, SERUM Please refer to FLUOXETINE, SERUM. ZERO, URINE Please refer to GLYPHOSATE, URINE. ZIEHL-NEELSEN STAIN Microbiology Swab, pus, fl uid, urine, tissue etc./appropriate sterile container ZINC PROTOPORPHYRIN, RED CELL Blood/EDTA tube, Lithium heparin tube or Sodium citrate tube ZINC, HAIR Hair/Dry sterile screw cap (urine) container ZINC, RED CELL Blood/EDTA tube and Trace metal tube (Navy stopper) ZINC, SERUM Blood/Special plain Vacutainer tube with navy stopper and no gel 24 hours Please transport specimen to laboratory as soon as possible. See also TB CULTURE. 1 week Test for long-term lead exposure. May be raised in iron-defi ciency anaemia. Please provide clinical, medication and lead exposure details. 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*** 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. 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 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 Please refer to SERTRALINE, SERUM for details. ZYPREXA, PLASMA Please refer to OLANZAPINE, PLASMA PATHOLOGY TESTS - Z

208 PATHOLOGY TESTS - CONTACT DETAILS 11.0 CONTACT DETAILS Central DEPARTMENTS Laboratory (07) Department (07) Department (07) Blood Bank Blood (07) 3876 Bank 8371 (07) Cytology Department Cytology (07) 3121 Department 4494 (07) Endocrinology Department Endocrinology (07) Department (07) Genetics Department Genetics (07) 3121 Department 4461 (07) Haematology Department Haematology (07) Department (07) Histology Department Histology (07) Department (07) Immunology Department Immunology (07) Department (07) Microbiology Department Microbiology (07) Department (07) Liaison Department Liaison (07) 3121 Department 4943 (07) LABORATORIES Brisbane & Surrounding Areas Central Laboratory - Brisbane (07) Greenslopes (07) North West - Everton Park (07) St Andrew s - Spring Hill (07) Wesley - Auchenflower (07) Bundaberg Bundaberg (07) Cairns Cairns (07) Central Queensland Emerald (07) Gladstone (07) Rockhampton (07) Gold Coast, Tugun & Northern Rivers Ballina (02) Pindara (07) Southport (07) Tugun (07) Ipswich, Darling Downs & Granite Belt Ipswich (07) Toowoomba (07) Kingaroy Kingaroy (07) Mackay Mackay (07) Redcliffe Redcliffe (07) Sunshine Coast & Gympie Buderim (07) Gympie (07) Noosa (07) Townsville Townsville (07) RULE 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. Patient s Clinical Circumstance Anticoagulant (Warfarin) therapy Cancer patients receiving bisphosphonate infusions Chemotherapy for neoplastic disease Clozaril therapy Gold therapy Immunosuppressant therapy Penicillamine therapy Sulphasalazine therapy Ticlopidine hydrochloride therapy Chronic renal failure of a patient in a dialysis program conducted by a recognised hospital Cis-platinum therapy Cyclosporin therapy Leflunomide therapy Lithium therapy Methotrexate therapy Vitamin D (metabolites or analogues) therapy Tests Eligible for Rule 3 Exemption INR Calcium, phosphate, magnesium, urea, creatinine and electrolytes FBE, ESR Urea, creatinine and electrolytes Urea, creatinine and electrolytes Urea, creatinine and electrolytes E/LFT (or part thereof) Lithium FBE, ESR, E/LFT (or part thereof) Calcium and albumin Test Frequency Unlimited tests up to 6 months of request Up to 6 tests within 6 months of request Up to 6 tests within 6 months of request Up to 6 tests within 6 months of request Up to 6 tests within 6 months of request Up to 6 tests within 6 months of request Up to 6 tests within 6 months of request Up to 6 tests within 6 months of request Up to 6 tests within 6 months of request Up to 6 tests within 6 months of request 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 PATHOLOGY TESTS - RULE 3

209 APPENDICES APPENDICIES Common Causes of Abnormal Biochemical Results Sodium Potassium Chloride Bicarbonate Anion Gap Glucose Urea INCREASED Water loss (e.g. dehydration, diabetes insipidus) Salt overload Renal impairment Oral overload, cell leakage (sepsis or post-collection), renal disease, adrenal insufficiency Acidosis (ketoacidosis, lactic acidosis) Dehydration, diarrhoea, pancreatic or biliary drainage, renal tubular acidosis, ureterosigmoidostomy Respiratory acidosis - lung disease Metabolic alkalosis - vomiting, diuretics, oral antacids, steroid excess Metabolic acidosis - renal or liver failure, diabetic ketoacidosis, salicylates, other abnormal acids Non-fasting state, diabetes mellitus, infection, excess endogenous or exogenous steroid, burns, hypokalemia Renal impairment, excessive protein catabolism, GI bleeding, congestive cardiac failure, dehydration DECREASED Water overload (e.g. cirrhosis, CCF, inappropriate ADH) Salt loss (e.g. diuretic therapy, adrenal failure, gut or sweat loss, renal impairment) Diuretics, dietary deficiency, renal tubular disease, steroid excess, gut loss, insulin effect Vomiting, water overload, diuretics Children - cystic fibrosis Respiratory alkalosis - hyperventilation Metabolic acidosis - renal failure, liver failure, diabetes mellitus, diarrhoea, drugs, dehydration Low serum protein, hypercalcaemia Excess exogenous or endogenous insulin, early glucose intolerance, adrenal or pituitary failure, severe liver disease, oral hypoglycaemics Protein deficient diet, diuresis, pregnancy Creatinine Renal impairment, Chronic muscle wastage acute muscle wasting egfr Not applicable Renal impairment, acute muscle wasting Uric Acid Bilirubin Total Bilirubin Conjugated Alkaline Phosphatase Gout, malignancy, viral infection, psoriasis, renal failure, toxaemia of pregnancy, acidosis Adult - Gilbert syndrome, hepatitis, malignancy, gall stones, cirrhosis, Dubin-Johnson syndrome Infants - physiological, biliary atresia, haemolysis, hepatitis, Crigler-Najjar syndrome Biliary obstruction - stones, malignancy, fibrosis, congenital intrahepatic cholestasis - drugs, chemicals, Dubin-Johnson syndrome 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 Allopurinol, uricosuric drugs, diuresis, renal tubular disease, inappropriate ADH Not clinically significant Not clinically significant Zinc deficiency, congenital hypophosphatasia (not common but important) Gamma GT ALT (SGPT) AST (SGOT) Lactate Dehydrogenase (LDH) Calcium Adjusted Calcium Phosphate Total Protein INCREASED Hepatitis, biliary obstruction, drugs, alcohol, renal damage, pancreatitis Liver disease or damage e.g. hepatitis (>500), non-specific viraemia, drugs, fatty liver, alcohol, haemochromatosis Myocardial damage or necrosis, liver disease, skeletal muscle damage, muscular dystrophy, haemolysis Myocardial damage or necrosis, liver disease, muscle disease, malignancy, haemolysis, post-collection cell leakage Hyperparathyroidism, malignancy (including myeloma), vitamin D & A excess, sarcoidosis, thyrotoxicosis, milk-alkali syndrome As for calcium - Note: if abnormality is unexplained, ionised calcium assay avoids protein binding effects Post-collection cell leakage, haemolysis, renal impairment, severe illness, acidosis, hypoparathyroidism Multiple myeloma, chronic liver disease, chronic inflammation or infection, dehydration DECREASED Rarely significant Renal failure, vitamin B6 deficiency Renal failure, vitamin B6 deficiency Rarely significant Low albumin, acidosis, renal disease, hypoparathyroidism, vitamin D deficiency, acute pancreatitis (significant values <2.10 mmol/l) As for calcium with the exception of low albumin (corrected for changes in albumin) Low phosphate intake (e.g. poor diet, prolonged I.V. therapy) alcoholism, diuresis, renal tubular disease, hyperparathyroidism 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 Cholesterol Triglyceride Oral iron, haemochromatosis, gastrointestinal bleeding Familial hyperlipidaemia, hypothyroidism, liver disease, renal disease, diabetes mellitus Non-fasting state, alcohol intake, diabetes mellitus, familial hyperlipidaemia Iron deficiency, infection, chronic inflammation Hyperthyroidism, infection, myocardial infarction, inherited hypolipidaemias Malnutrition, fasting state APPENDICIES 12.2

210 APPENDICES APPENDICIES Tissue Sources of Elevated Enzymes * Alkaline Phosphatase MOST COMMON Liver (obstruction) Bone - osteoblastic regenerative response * Isoenzyme subunit fractionation is available to further differentiate sources of excess activity. OTHER + 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 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 *+ CK (CPK) Myocardium, skeletal muscle, atypical ( macro ) Liver, lymphoid and epithelial tissue Brain, intestinal smooth muscle + CK-MB Myocardium Muscle, atypical (immunoglobulin-bound) Amylase Pancreas Salivary glands, fallopian tubes Liver Damage Myocardial Damage ALT ++ + AST + ++ 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) Serum Tumour Markers 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: The detection of malignancy The establishment of prognosis as an aid in differentiation The monitoring of treatment and the detection of a recurrence. Tumour Oesophagus afp CEA CA 19.9 Stomach CA 15.3 MARKER Pancreas Colon Liver Biliary ducts Breast Ovary Cervix Trophoblast Germ cell Prostate Thyroid Medullary Ca Thyroid Source: A. Fetah-Moghadam, P. Stieber, 1991 Instit. of Clin. Chem., Klinikum, Grobhadern, Munich, FRG CA 125 hcg Calcitonin Thyroglobulin PSA LD isoenzymes APPENDICIES 12.4

211 APPENDICES APPENDICIES The More Widely Used Serum Markers ACTH MARKER Alpha Fetoprotein Beta Human Chorionic Gonadotrophin (HCG) Beta 2 Microglobulin CA 125 (cervix, pancreas, stomach) CA 15.3 CA 19.9 (Fetoacinar Pancreatic Antigen) Calcitonin Carcinoembryonic Antigen (CEA) Catecholamines, HMMA (VMA) Human Chorionic Gonadotrophin Lactate Dehydrogenase (LD) Isoenzymes Paraprotein, Bence Jones Protein MAJOR TUMOUR SOURCE pituitary basophil adenoma, oat cell carcinoma of lung hepatoma, dysgerminoma (70%), teratoma, hepatoblastoma choriocarcinoma (>80%) and dysgerminoma (40%) myeloma, plasmacytoma epithelial ovarian cancer (>80%) pancreatitis, peritonitis metastatic breast ca. (70%) pancreas (80%), gastric (50%), bile duct (65%), hepatoma (50%) medullary thyroid carcinoma, carcinoid colorectal, gastric, liver, pancreatic and breast ca. (all >60%) phaeochromocytoma, neuroblastoma Refer Beta HCG seminoma, lymphoma and epithelial carcinoma multiple myeloma (98%) and plasmacytoma LESSER TUMOUR SOURCE pulmonary carcinoma gastrointestinal (10%) and brochogenic ca. (10%) seminoma (20%) and non-trophoblastic ca. (10%) endometrium, fallopian tube localised breast ca. (10%), ovary colorectal (25%) liver, lung, renal, breast lung, prostate, cervix, uterus, ovary other lymphoid malignancies FALSE POSITIVE non-neoplastic liver disease renal or inflammatory disease endometriosis, PID, CRF non-malignant liver disease cirrhosis, cholangitis and rarely pancreas & colorectal inflammation, pulmonary fibrosis smoking, acute & chronic pancreatic, bowel & breast disease non-specific illness, anti-hypertensive drugs, syncope benign disease of organs, haemolysis autoimmune conditions MARKER Placental Alkaline Phosphatase Prostatic Acid Phosphatase (ACP) Prostate Specific Antigen (PSA) MAJOR TUMOUR SOURCE seminoma (>80%), ovary, lung, uterus cancer metastatic prostate (>70%) prostatic adenocarcinoma intracapsular (65%), metast (90%) LESSER TUMOUR SOURCE intracapsular prostate (<30%) FALSE POSITIVE smoking prostatitis and prostatic massage benign prostatic hypertrophy (30%) Serotonin, 5-H.I.A.A. carcinoid tumour diet, diarrhoea, coeliac disease Soluble Mesothelin- Related Protein (SMRP) Thyroglobulin Vasoactive Intestinal Polypeptide (VIP) Mesothelial tumours - mesothelioma differentiated thyroid ca. bronchogenic lung, pancreatic islet, neuroblastoma, thyroid medullary, phaeochromocytoma ovarian, peritoneal tumour other lung malignancy, fibrotic lung disease shock, cirrhosis, hepatic failure APPENDICIES 12.6

212 APPENDICES APPENDICIES Common Reference Ranges/ Flagging Rules Chemistry Units Age/Sex/ Rand/Fast. Normal Sodium mmol/l Potassium mmol/l Chloride mmol/l Bicarbonate mmol/l Glucose mmol/l Random mmol/l Fasting Urea mmol/l <2 yrs yrs M F M F >50 M >50 F Creatinine umol/l <2 yrs yrs yrs M F M F >50 M >50 F Uric Acid mmol/l M F Total Bilirubin umol/l <1 day days days days days - 2 mths 4-20 >2 months 2-20 Chemistry Conj. Bilirubin Total Alk. Phos. Units Age/Sex/ Rand/Fast. Normal umol/l 0-8 U/L 0-18 yrs >18 yrs ALT U/L 0-45 AST U/L 0-41 GGT U/L M 0-70 F 0-45 LDH U/L 0-9 days days - 18 mths mths - 3 yrs yrs yrs yrs yrs >16 yrs Calcium mmol/l Phosphate mmol/l 1 day days days - 1 yr yrs yrs yrs >20 yrs Total Protein g/l Albumin g/l Iron umol/l Chemistry Units Age/Sex/ Rand/Fast. Normal Cholesterol mmol/l <30 yrs yrs yrs yrs >60 yrs Triglyceride Fasting mmol/l <30 yrs yrs yrs yrs >60 yrs Random HDL Chol. High Risk Patients LDL Chol. High Risk Patients Diab. or ATSIC Patient Without other risk factor mmol/l > 1.00 mmol/l <2.0 <2.6 <6.0 CRP mg/l 0-6 Transferrin g/l Rheumatoid Factor IU/L Up to 14 (>14 to IMM for RW) Ferritin ug/l B 0-15 yrs M >15 yrs F >15 yrs APPENDICIES 12.8

213 APPENDICES APPENDICIES Glucose Tolerance Test The revised criteria for the diagnosis of impaired glucose tolerance and diabetes mellitus as recommended by a Working Party of the Australian Diabetes Society, The Australasian Association of Clinical Biochemists and the Royal College of Pathologists of Australasia (1999) are as follows: Diagnostic values of the oral glucose tolerance test Impaired Fasting Glucose (IFG) Fasting 2 hr after glucose load Impaired Glucose Tolerance (IGT) Fasting 2 hr after glucose load Diabetes mellitus Fasting value 2 hr after glucose load Venous plasma >6.0 and <7.0 <7.8 < >6.9 >11.0 Glucose Concentration, mmol/l Capillary plasma >6.0 and <7.0 <8.9 < >6.9 >12.1 Venous whole blood >5.5 and <6.1 <6.7 < >6.0 >9.9 Capillary whole blood >5.5 and <6.1 <7.8 < >6.0 >11.0 Gestational Diabetes Carbohydrate intolerance is recognised to pose a risk during pregnancy and should be detected if present and treated appropriately. The term gestational diabetes mellitus applies to all degrees of carbohydrate intolerance (to include both the categories of impaired glucose tolerance and diabetic response). The recommendations of the Ad Hoc Working Party to the NHMRC (1991) are as follows: Recommendations for the screening and diagnosis of glucose intolerance in pregnancy - gestational diabetes All pregnant women should be screened for abnormal glucose tolerance between 26 and 28 weeks gestation. The plasma glucose level should be measured one 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. Women with positive results should receive a full glucose tolerance test. The diagnosis of gestational diabetes should be made before 30 weeks gestation by the administration in the fasting state of a 75g oral glucose tolerance test (OGTT). A fasting plasma glucose level of 5.5mmol/L and/or a two hour plasma glucose level of 8.0mmol/L are diagnostic of gestational diabetes. These recommendations must not preclude confirmation of diabetes with a 75g OGTT at any stage of pregnancy if there are clinical features to suggest the diagnosis. Three months after delivery, women with gestational diabetes should have a repeat 75g OGTT. This should be evaluated by standard World Health Organisation criteria for the non-pregnant state. Women who do not have diabetes mellitus at this time should still be considered as at risk for developing diabetes mellitus later in life. Procedure for diagnosis of gestational diabetes Indication Optimal Gestation Weeks Test Performed Clinical suspicion Anytime 75g OGTT (fasting) Screening Confirmation of diagnosis after positive screening test 50g glucose load (non-fasting) or 75g glucose load (non-fasting) g OGTT (fasting) Dietary Restrictions and Special Diets General Fasting Diagnosis Criteria venous plasma glucose level (mmol/l) Fasting 5.5 or 2 hours hour 7.8 Fasting 5.5 or 2 hours 8.0 On the night before the test: No food is to be eaten for 8 hours prior to or during the test, however the fasting period should not be in excess of 16 hours Water may be consumed (recommended intake - slightly more than usual) No other fluid (including alcohol) may be consumed A record of current medication is required. These instructions should be adhered to unless advised otherwise. 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 phone numbers can be found on the reverse side of the request form. APPENDICIES 12.10

214 APPENDICES APPENDICIES Preparation For three days prior to the test the patient should have an adequate intake of carbohydrates equivalent to the following (as a minimum) each day: 4 slices of bread, 1 plate of cereal and 2 medium potatoes. If the patient is on a reduced, special or low-calorie diet, please inform the collection centre staff. On the night before the test It is important for the patient to eat a normal dinner, however, not to eat, chew gum or drink any fluids (except water) for at least 8 hours before the test. It is preferable they do not fast for more than 12 hours. Water may be consumed (recommended intake - slightly more than usual). The patient should record their height and weight. Record any recent and current medication. On the morning of the test The patient should bring their list of medications, and height and weight details with them. The patient should not physically exert themself prior to or during the test (including brisk walking to the clinic). The patient should avoid smoking for an hour prior to and during the test. If this is not possible then please inform staff. The patient is required to bring a specimen of urine, however, they should not bring the first specimen of the morning. The test will take approximately 2.5 hours (half an hour rest prior to test and two hours test time). On some occasions the length of the test may be extended. Urine Collection Diet For 5HIAA & Catecholamine A variety of drugs and foods are known or are reported to interfere with this particular test. Therefore, the intake of the following items should be restricted for three days prior to and during the urine collection: Alcohol Paracetamol. The following drugs are also known to interfere with the test: Chlorpromazine Imipramine (Tofranil) Promazine Other anti-depressants Promethazine and other phenothiazine derivatives Isoproterenol Methocarbamol (Robaxin) L-DOPA Monoamine Oxidase Inhibitors (Trandate). The patient should not restrict or cease these drugs unless advised by their referring doctor. Please note the above list of drugs is not fully comprehensive. If the patient is currently taking any of the above drugs, they should list these together with a full account of any other medications. Food These food items are known to contain significant quantities of serotonin (a precursor of 5HIAA) and should be excluded from the diet for the three days prior to and including the day of collection: Avocado Plum Banana Tomato Coffee Walnuts and pecans Eggplant (Briefly - avoid fruit and nuts). 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 to follow the diet below for three days prior to their collection: Avoid the following: Organ meats (brain, kidney, liver) Wild game Poultry (chicken, duck, turkey) Meat (beef, lamb, pork, veal) Meat extracts (Bonox, Vegemite) Fish Shellfish Wholegrain products The following are acceptable for a low purine diet: Fruits Fruit juices Vegetables (except those above) Nuts Cereals, breads (except wholegrain products) Sweets Beverages (coffee, tea, carbonated) Fats Eggs Cow s milk Dairy products. Green peas, dried legumes Cauliflower Asparagus Spinach Mushrooms Aspirin Cocoa. APPENDICIES 12.12

215 APPENDICES APPENDICIES Qualitative Urine Drug Screen This 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, most diuretics and anabolic steroid agents. 2. Some drugs are undetectable by routine screening procedures. This group includes insulin, digoxin and lysergic acid diethylamide (LSD). Over 500 drugs are listed in the identification library. If you are concerned about a specific substance, or if the drug of interest is not listed please convey this to the laboratory either on the request form, or if the matter is sensitive or puzzling please contact ( ) or the nearest branch laboratory. If necessary other testing can be arranged. The list is not static with new drugs being continually added and old drugs deleted as they become unavailable. Please refer to our online reference manual for an updated list of drugs. Alcohol/Ethanol Amitriptyline and metabolites Amobarbital/Amylobarbitone Amphetamine Amylobarbitone Barbiturates (generic screen) Benzhexol Benzodiazepine metabolites Butabarbital Caffeine Cannabinoids/Tetra hydro cannabinol Carbamazepine and metabolites Carisoprodol Chlordiazepoxide Chlorpheniramine Chlorpromazine and metabolites Cimetidine Cocaine Codeine Desipramine Dextromethorphan Diflunisal Dihydrocodeine Dilantin Dimenhydrinate Diphenhydramine Dothiepin Doxepin and metabolites Doxylamine Ephedrine/Pseudoephedrine Erythromycin Ethanol Fenoprofen Flunitrazepam Fluoxetine Flurazepam Glutethimide Haloperidol Hydrocodone Ibuprofen Imipramine and metabolites Ketamine Lignocaine (Lidocaine) MDMA (Ecstasy) Mefenamic acid Meprobamate Methadone and metabolites Methamphetamine Methaqualone Methocarbamol Methoxyphenamine and metabolites Methylprednisolone/Prednisolone Metoprolol 6-monoacetylmorphine Morphine Naproxen Nicotine and metabolites Nortriptyline Orphenadrine Oxazepam Oxycodone Paracetamol Pentobarbital Pethidine Phenacetin Phencyclidine Pheniramine Phenobarbital Phenolphthalein Phenothiazine metabolites Phentermine Phenylpropanolamine Polyethylene glycol Procyclidine Promazine and metabolites Propoxyphene and metabolites Propranolol Pseudoephedrine/Ephedrine Pyrilamine Quinine/Quinidine Ranitidine Spironolactone and metabolites Strychnine Sympathomimetic amine metabolites Temazepam Tetra hydro cannabinol/cannabinoids Theophylline Timolol Trimethoprim Trimipramine and metabolites Verapamil and metabolites Xylocaine/Lignocaine. APPENDICIES 12.14

216 APPENDICES APPENDICIES Quantitative Drug Assays for Therapeutic Monitoring Drug (Generic Name) Serum Half-life (hrs) After Oral Dose (hrs) Absorption Peak Therapeutic Range Assay Frequency Antibiotics Amikacin 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 demand Tobramycin 3(2-4) NA Trough < 1 mg/l Peak up to 10 mg/l On demand Vancomycin 3-8 NA Trough < 15 mg/l Peak up to 45 mg/l On demand Anticonvulsants Carbamazepine 31(18-65) 5(2-8) 8-12 mg/l Daily Ethosuximide 54(48-60) 3(1-4) mg/l Daily Methsuximide* 1.4( )* mg/l On demand Phenobarbitone mg/l Daily Phenytoin (3-10) mg/l Daily Primidone* 6-22* mg/l Daily Sulthiame 8-12 mg/l Weekly Valproate mg/l Daily Benzodiazepines Clobazam ug/l Weekly Clonazepam ug/l Weekly Chlorazepate ug/l Weekly Diazepam ug/l Weekly Flunitrazepam 19(9-25) 2 Up to 20 ug/l Weekly Nitrazepam ug/l Weekly Oxazepam ug/l Weekly Temazepam ug/l Weekly Cardio-active Amiodarone (3-6) mg/l Referred Digoxin 36(30-45) ug/l Daily Disopyramide mg/l Daily Flecainide (1-6) mg/l Daily Lignocaine mg/l Daily Mexilitine 9(8-17) ug/l Referred N-Acetylprocainamide Summed with procainamide Daily Procainamide mg/l Daily Quinidine mg/l Daily Tricyclic Antidepressants Amitriptyline 15(9-25) ug/l Weekly Clomipramine 23(12-36) ug/l Referred Desipramine 22(12-54) ug/l Weekly Drug (Generic Name) Serum Half-life (hrs) After Oral Dose (hrs) Absorption Peak Therapeutic Range Assay Frequency Dothiepin 24(11-32) ug/l Weekly Doxepin 15(8-25) ug/l Weekly Imipramine* 14(6-20)* ug/l Weekly Nortriptyline 27(15-90) ug/l Weekly Trimipramine 7.2(4-14) ug/l Weekly Others Cyclosporin HPLC ug/l** On demand > 10 with liver transplant TDx ug/l** Lithium mmol/l Daily Methotrexate 2 24hr < 5 umol/l On demand 48hr < 0.5 umol/l 72hr < 0.1 umol/l Paracetamol mg/l On demand Salicylate mg/l Daily Theophylline 5(3-9) mg/l Daily NOTE: (i) For IV antibiotic administration peak blood level occurs at the end of injection/infusion. (ii) For IM injection peak blood level occurs minutes after injection. (iii) Trough levels should be measured just prior to next dose. * Indicates a potential of unexpected toxicity from a major active metabolite with a half-life longer than the parent drug. ** Values differ with method of assay. APPENDICIES 12.16

217 APPENDICES APPENDICIES Recommended Levels for Single Daily Dosage Regime for Gentamicin Time Since Dose less than 6 hours Range (mg/l) greater than 5.0 mg/l 6 hours 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 16 hours less than 0.7 mg/l 18 hours less than 0.4 mg/l 20 hours or greater less than 0.3 mg/l (From Antibiotic Guidelines, 9th ed ) Poisons and Toxic Substances used in Pest Control Herbicides/Weedicides Phenoxyacetic acid group (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 (true toxicity irreversibly lethal - assay difficult to arrange). Pesticides/Insecticides Organochlorines (DDE; DDT; Endosulfan; Dieldrin/Endrin/Aldrin; Chlordane; Heptachlor; Lindane) (assay: blood/lithium heparin tube). Organophosphates (Chlorpyrifos; Malathion; Parathion) (assay: serum/red cell cholinesterase). Carbamates (Carbaryl) (assay: serum/red cell cholinesterase). Synthetic Pyrethroids (assay: blood/lithium heparin tube). Arsenic (assay: blood/lithium heparin tube; long term exposure - hair and nail clippings). Fungicides Dithiocarbamates (Zineb; Maneb; Mancozeb) (assay: serum/red cell cholinesterase). HCB (Hexachlorobenzene) - organochlorine (assay: blood/lithium heparin tube). Rodenticides Coumarin derivatives (assay: prothrombin time). Strychnine (assay: blood/fluoride oxalate tube). Molluscicides Metaldehyde (no assay available). APPENDICIES 12.18

218 APPENDICES APPENDICIES Acid-Base Analysis The value of arterial blood gases in assessing pulmonary gas exchange is well established. However, blood gas analysis (arterial or venous) may also play a key role in assessing the acid-base balance of the body. An easy approach to interpretation of this function is presented below. Interpreting Acid-Base Balance from the Blood Gas Profile LOW ph pco 2 Acidaemia RAISED Alkalaemia pco 2 LOW RAISED RAISED 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 Primary Metabolic Alkalosis with Respiratory Compensation 1. Urine ph > Gastrointestinal acid loss 2. Urine ph < Urinary acid loss Primary Respiratory Alkalosis 1. Normal Base Excess - Acute hyperventilation 2. Lowered (-) Base Excess - Hyperventilation with compensation - Salicylate Therapy Primary Metabolic Acidosis with Respiratory Compensation Examine the Anion Gap 1. Raised Anion Gap i) Phosphate and sulphate accumulation in renal failure. ii) Ketoacid generation in insulin-dependent diabetes mellitus. iii) Lactate accumulation in shock, liver disease, or exertion. iv) Accumulation of an acidic toxin, drug, or drug metabolite 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) Enteric bicarbonate loss - biliary or pancreatic drainage. ii) Chloride excess - rapid I.V. infusion of normal saline or urine chloride reabsorption (ureterosigmoidostomy, ileal conduit). iii) Renal bicarbonate loss from effective hypoaldosteronism (Adrenocortical failure, Spironolactone therapy, aldosterone receptor defect). iv) Renal bicarbonate loss from a tubular resorptive defect (Renal tubular acidosis, Fanconi syndrome, carbonic anhydrase inhibitor therapy). In categories i) and ii), the urine ph will be less than 5.0, in iii), the ph will be 6.5 or greater, and in iv) the ph will vary depending on the site of the resorptive defect (proximal or distal tubular) and the state of compensation. Primary Respiratory Acidosis Examine the Base Excess 1. Respiratory Acidaemia with Normal Base Excess Acute respiratory failure, airway obstruction or asphyxia. 2. Respiratory Acidaemia with Raised (+) Base Excess Long standing or chronic respiratory acidosis (e.g. chronic obstructive lung disease) with metabolic compensation. 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 ) This indicates gastrointestinal loss of acid. i) Protracted vomiting. ii) Long-term nasogastric suction or gastric fistula. APPENDICIES 12.20

219 APPENDICES APPENDICIES 2. Relatively Acidic ph (ph ) 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 This acute uncompensated respiratory alkalaemia pattern is common, being seen in 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 hyperventilation usually associated with respiratory centre stimulation (e.g. by mild hypoxia in pneumonia, by protracted mild airway obstruction, or by pain or anxiety) 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 Patients identified as being in one of the following very high-risk categories may commence drug therapy with statins or fibrates at any cholesterol level: Coronary heart disease which has become symptomatic Cerebrovascular disease which has become symptomatic Peripheral vascular disease which has become symptomatic Diabetes mellitus with microalbuminuria (defined as urinary albumin excretion rate of >20µg/min or urinary albumin to creatinine ratio of >2.5 for males, >3.5 for females) Diabetes mellitus in Aboriginal or Torres Strait Islander patients Diabetes mellitus in patients aged 60 years or more Family history of coronary heart disease which has become symptomatic before the age of 55 years in two or more first degree relatives Family history of coronary heart disease which has become symptomatic before the age of 45 years in one or more first degree relatives. Other patients are required to meet the lipid levels shown in the following table after at least six weeks of dietary therapy: PATIENT CATEGORY Patients with diabetes mellitus not otherwise included Aboriginal or Torres Strait Islander patients Patients with hypertension Patients with HDL cholesterol <1 mmol/l Patients with familial hypercholesterolaemia identified by: DNA mutation; or Tendon xanthomata in the patient or a first or second degree relative Patients with: Family history of coronary heart disease which has become symptomatic before the age of 60 years in one or more first degree relatives; or Family history of coronary heart disease which has become symptomatic before the age of 50 years in one or more second degree relatives. Patients not eligible under the above: Men aged 35 to 75 years Post-menopausal women aged up to 75 years. Patients not otherwise included LIPID LEVELS FOR PBS SUBSIDY Total cholesterol > 5.5mmol/L Total cholesterol > 6.5mmol/L or Total cholesterol > 5.5mmol/L and HDL cholesterol < 1mmol/L Total cholesterol > 6.5mmol/L 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/L or Total cholesterol > 6.5mmol/L or Total cholesterol > 5.5mmol/L and HDL cholesterol < 1mmol/L Total cholesterol > 7.5mmol/L or Triglyceride > 4mmol/L Total cholesterol > 9mmol/L or Triglyceride >8mmol/L APPENDICIES 12.22

220 APPENDICES - ENDOCRINOLOGY APPENDICIES ENDOCRINOLOGY Laboratory Testing: Pregnancy Timeline 4-12 weeks HCG - Overdue LMP. HCG usually positive by days post conception. If negative, repeat after several days. FBC Iron Studies Blood Group and Antibodies - (If patient is Rh negative see for complications in pregnancy) HepBsAg, Treponemal Serology and EIA Rubella +/- Hep C +/- MSU Vitamin D - Fasting preferable but not essential TSH - If clinically indicated HIV - At Doctor s discretion weeks First Trimester Screen (Free HCG, PAPP-A) - Results combined with NT to give Down Syndrome risk. AFP not included in this test, consider at weeks. (Note: The window for Nuchal Translucency screening is 11½ - 13 weeks 6 days). component now available from 8 weeks, providing a dating ultrasound is available. CVS - FISH Anueploidy testing: Rapid test for aneuploidy of chromosomes 13, 18, 21, X and Y performed on cells obtained from CVS sample. Results are available within hours but results should be considered interim in nature until confirmed by full fetal karyotype analysis. - Fetal karyotype: Performed on cultured Chorionic Villi may be offered for follow up of high risk FTS results or other clinical indications. Allow days for fetal karyotype. - DNA testing may also be offered for certain inherited genetic conditions. Discuss with O&G specialist weeks AFP - For neutral tube defects. Offer to patients who had First Trimester Screen. 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 NTD risk. If had FTS, this is not a Medicare rebatable test. Amniocentesis - FISH Aneuploidy testing: Rapid test for aneuploidy of chromosomes 13, 18, 21, X and Y performed on fetal cells obtained from amniocentesis. Results are available within hours but results should be considered interim in nature until confirmed by full fetal karyotype analysis. - Fetal karyotype: Analysis for follow up of high risk FTS results or other clinical indications. Allow days for fetal karyotype result. - DNA testing may also be offered for certain inherited genetic conditions. Discuss these tests with O&G specialist weeks Anomaly Scan - Important follow up of high AFP or high risk NTD results weeks Glucose Challenge in Pregnancy - Non-fasted, 50 grams, 1 hour glucose test. Follow up results of glucose challenge - if increased do a 2hr GTT. If GTT is positive then Gestational Diabetes is confirmed. Retest 3 months post partum. FBC Blood Group and Antibodies Iron Studies - (If indicated) 28 weeks Rh (D) Negative - Anti D prophylaxis if antibody negative (see complications in pregnancy for Rh (D) negative women). 34 weeks Rh (D) Negative - Anti D prophylaxis if antibody negative See complications in pregnancy for Rh (D) negative women (12.25) weeks Blood Group and Antibodies - See complications in pregnancy for Rh (D) negative women (12.25). Low Vaginal Swab - Consider for Group B Strep +/- Rectal Swab. 38 weeks FBC Blood Group and Antibody Screen Post Partum Rh Negative - Fetomaternal haemorrhage test and Anti D. TSH 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) - Heel prick test on baby - preferred time of sample collection is hours post-partum. Complications in Pregnancy Sensitising Events: For each sensitising event, perform FMH test and administer Rh (D) immunoglobulin. Sensitising events include: - Normal delivery - Ectopic pregnancy - Miscarriage - Termination of pregnancy - Genetic studies such as chorionic villus sampling, amniocentesis, cordocentesis - Abdominal trauma sufficient to cause fetomaternal haemorrhage - 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/Immunological tests: Thrombophilia Screen (ATIII, Protein C and S, apcr, Lupus Anticoagulant, Anti Cardiolipin antibodies, Homocystine, Prothrombin Gene). Discuss results with Obstetrician or Clinical Haematologist - ANA. APPENDICIES ENDOCRINOLOGY 12.24

221 APPENDICES - ENDOCRINOLOGY APPENDICIES ENDOCRINOLOGY Rh (D) Negative Women: - All patients undergo Blood group and Rh type, together with antibody screen at initial pregnancy testing - If previous pregnancy affected by Rhesus disease/haemolytic disease of the newborn, or presence of anti-d antibodies or other antibodies, consult with specialist obstetrician - Check antibody screen at 28 and 34 weeks - If antibody screen negative and in first pregnancy, give: 625 IU (125 μg) of Rh (D) Immunoglobulin at 28 and 34 weeks (imi) - Post partum: 625 IU (125 μg) minimum of Rh (D) Immunoglobulin post partum within 72 hours (iv), together with testing for fetomaternal haemorrhage (Kleihauer test or flow cytometry) if cord blood is Rh positive - For possible fetomaternal haemorrhage - Rh (D) Immunoglobulin within 72 hours, together with testing for fetomaternal haemorrhage (Kleihauer test) 1st Trimester 250 IU (50 μg). Beyond 1st Trimester 625 IU (125 μg). 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. Investigation of Hirsutism: A Quick Reference Guide 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 ACTH and Cortisol Adrenal, Ovarian Tumours DHEAs, Inhibin, (Urine Steroid Profile) Late onset, Partial Adrenal Hyperplasia, Hydroxy-Progesterone 1 in 100 (New York)? 1 in ,000 (Australia) 2) Look for Features of Polycystic Ovarian Syndrome (PCOS) LH>FSH, yet Oestradiol not high enough to ovulate (<170) Low sex hormone binding globulin (SHBG) High androgens/precursors Testosterone, DHEAs, Androstenedione Insulin resistance -? post prandial only -? fasting as well Ultrasound of ovaries: String of pearls appearance - Uniform cysts 3-6mm peripherally 3) Suggestions Mid-morning - LH, FSH, Oestradiol, Testosterone, SHBG, Glucose, Insulin, DHEAs Options - TSH, ACTH, Cortisol, Prolactin, OHP 24hr urine steroid profile Ultrasound of ovaries For further information contact Dr Kerry DeVoss, Pathologist (07) Polycystic Ovarian Syndrome (PCOS) Normal Ovary Comparison of Ovaries Polycystic Ovary String of Pearls effect APPENDICIES ENDOCRINOLOGY 12.26

222 APPENDICES - ENDOCRINOLOGY APPENDICIES ENDOCRINOLOGY Recommended Age Guidelines for Men s Health Testing AGE: 30 s 40 s 50 s 60 s 70 s 80 s MALE SPECIFIC ISSUES: COMMON CAUSES OF DEATH: TESTS: Infertility Erectile Dysfunction Energy Gout Prostate Problems Cardiovascular Stroke Cancer (Lung, Colorectal, Prostate) Semen Glucose Iron LH FSH Testosterone Prolactin (?Thyroids) (?Cortisol) ( ) ( ) Cholesterol Triglycerides LDL HDL Bilirubin HS-CRP Homocysteine Uric Acid Note:? = consider if clinically appropriate ( ) ( ) PSA (baseline) ( ) ( ) PSA (periodic) Cancers: (Lung, Colorectal, Prostate etc.) ( ) ( ) PSA?CEA?CA19.9 For further information please contact: Dr Kerry DeVoss (07) or Dr Charles Appleton (07) ( ) ( ) ( ) ( ) ( ) ( ) PSA?CEA?CA19.9 APPENDICIES ENDOCRINOLOGY 12.28

223 APPENDICES - GENETICS APPENDICIES GENETICS Cytogenetic Tests - Tissues Examined and Reporting Times Tissue Cell Cultured Reporting time Blood (Constitutional) (Oncology) Bone Marrow Lymphocytes Blast cells Myeloid disorders Lymphoid disorders 2-3 days (newborn babies) 14 days (routine) 2 days (diagnostic) 7-14 days (routine) hours (diagnostic CML, ALL, AML) 7-14 days (routine) Abnormalities Detected Constitutional (numerical and structural) abnormalities Acquired abnormalities related to the leukaemic process Acquired abnormalities related to the leukaemic process Amniotic Fluid Fetal epithelium 10 days Antenatal diagnosis of chromosomal abnormalities Chorionic Villi Prenatal FISH for rapid aneuploidy screening Skin and Fetal Tissues Trophoblast and mesodermal fibroblasts Culture not required, direct analysis of amniocytes or trophoblast cells Fibroblasts from dermis, chorionic villi, membrane, etc. 10 days Antenatal diagnosis of chromosomal abnormalities 24 hours Aneuploidy for chromosomes 13,18, 21, X and Y 14 days Mostly numerical abnormalities. Some structural abnormalities Tumour Variable 14 days Acquired abnormalities related to the neoplastic process NOTE: All abnormal amniotic fluid and constitutional results are phoned to the referring doctor. Abnormal bone marrow, tissue and tumour results are phoned at the discretion of the Genetics supervisor. Molecular Genetic Tests Sample Requirements and Reporting Times Hereditary Haemochromatosis Test Reporting time Sample required Factor V Leiden/ Prothrombin G20210A Methylenetetrahydrofolate Reductase (MTHFR) 3 days Peripheral Blood EDTA 7 days Peripheral Blood EDTA 7 days Peripheral Blood EDTA Apolipoprotein E 7 days Peripheral Blood EDTA Fragile X (FRAXA) 7 days Peripheral Blood EDTA Y Chromosome Microdeletion Studies 7 days Peripheral Blood EDTA HLA-B27 3 days Peripheral Blood EDTA Clostridium Difficile 2 days Faecal sample Cat Scratch Disease 2 days Swab of infected site Tissue Malarial Parasite Detection 3 days Peripheral Blood EDTA BCR-ABL RQ-PCR 7-14 days Peripheral Blood EDTA Bone Marrow Aspirate JAK days Peripheral Blood EDTA Bone Marrow Aspirate B and T cell Gene Rearrangement Studies 7-14 days Peripheral Blood EDTA Bone Marrow Aspirate Fresh Tissue Paraffin embedded tissue APPENDICIES GENETICS 12.30

224 APPENDICES - HAEMATOLOGY APPENDICIES HAEMATOLOGY Basic Haematology Parameters Haemoglobin g/l RCC x10 12 /L HCT MCV fl MCH pg Cord Day Day Day Day 15-Week Week Month Month 7-Year Year Year Female Male Male Male MCHC (All Ages) RDW (All Ages) Note: In pregnancy, haemoglobins down to 105 g/l are quite common. Leucocyte Reference Ranges WCC x10 9 /L Neut x10 9 /L Lymph x10 9 /L Mono x10 9 /L Eos x10 9 /L Cord Day Day Day Week 8-Month Month 7- Year Year Year 3 and Year 5 and Year Year Year Basophils (All Ages) x10 9 /L Note: In pregnancy white cell counts up to 15.0 x109/l are quite common. Platelet Reference Ranges Initiating Warfarin Therapy When initiating warfarin therapy the loading of doses should be avoided as it causes early procoagulant effects, and oscillating INRs that take longer to stabilise than a steady increase in dose. QML Pathology uses a formula that factors in each patient s age and weight to derive an individual dose. The formula gives us the Estimated Maintenance Dose (EMD) as demonstrated below. EMD = square root of [ weight x (100-age) ] E.g. for a 75kg, 60 year old EMD = [75 x (100-60)] = [75 x 0.4] = 5.4mg 100 5mg is the recommended starting dose; however, the choice of starting dose may need to be modified for a number of reasons, such as the patient s current medications, which may interact with warfarin (see upcoming section). Range of Target INRs 100 Indication INR Indication Type valve RF INR AF 2-3 AVR Bileaflet/Medtronic Hall AVR = Aortic Valve Replacement; MVR = Mitral Valve Replacement; AF= Atrial Fibrillation; DVT = Deep Venous Thrombosis; PE = Pulmonary Embolism. * (other than Medtronic Hall) RF Risk Factors = include AF, previous thromboembolism, LV dysfunction, and hypercoagulable condition. - depends on strength of anticardiolipin or lupus anticoagulant. -ve +ve DVT 2-3 AVR Starr-Edwards/Disc* +/-ve Extensive DVT AVR/MVR Bioprosthesis -ve Aspirin PE - Young MVR Any +/-ve PE - Old 2-3 AVR Bioprosthesis +ve 2-3 Lupus Anticoagulant Cord Year 0-3 Year 4-7 Year Platelet Count x10 9 /L MVR Bioprosthesis +ve APPENDICIES HAEMATOLOGY 12.32

225 APPENDICES - HAEMATOLOGY APPENDICIES HAEMATOLOGY Duration of Warfarin Therapy Duration of treatment depends on the site of the thrombosis and the risk status of the patient. Those risks include re-thrombosis and bleeding from the warfarin therapy. To enable the former to be evaluated adequately, the patient should be tested for the presence of any inherited or acquired prothrombotic conditions, the most familiar being Factor V Leiden, but there are others more clinically likely to affect the risks to re-thrombosis. Reversible or Time Limited Factor Surgery, trauma, pregnancy/ocp, immobilisation, long haul flight Spontaneous (Idiopathic) No cause found Higher Risk Factor V, PT gene (heterozygous) above with either life threatening thrombosis or thrombosis in unusual site (mesenteric, cerebral vein) High Risk Active malignancy, moderate antiphospholipid syndrome, ATIII def, homozygous or compound heterozygous thrombophilias, recurrent thromboses 3 months 6-12 months months Indefinite At the completion of the standard period of anticoagulation, decisions need to be made regarding anticoagulation: Should anticoagulation be ceased Should full anticoagulation continue or Should anticoagulation be continued at lower intensity (selected indications)? Drugs that Interact with Warfarin Warfarin is metabolised by the Cytochrome P450 system. As such there are many drugs that can cause some change in the INR. However, there are some that have a marked effect and which patients should be warned about. In general, every time a new medication is commenced or one is ceased, the patient should tell the warfarin control centre or their treating doctor, and their INR should be checked. Some medications are notorious for interfering with warfarin. We have compiled a list of the most common and important drugs below. Drug Affect on INR Grade of Affect Amiodarone *but increased risk of bleeding via platelet inhibition = those drugs which decrease INR Moderate - Severe Aspirin None* Moderate Fluconazole Most Antibiotics Marked Moderate Flucloxacillin rare increase Moderate Keflex Variable often Mild - Moderate Metronidazole Marked NSAIDs also platelet inhibition Mild - Moderate Panadol Regular >4/day Rifampicin Statins Tramal Tegretol Moderate - Severe Marked Mild - Moderate Moderate Mild - Moderate APPENDICIES HAEMATOLOGY 12.34

226 APPENDICES - IMMUNOLOGY APPENDICIES IMMUNOLOGY Antibodies to Tissue Antigens (Autoantibodies) Acetylcholine receptor (AChR) Adrenal Anti nuclear antibody (ANA) includes pattern description e.g. homogeneous, speckled etc. Avian protein precipitins Basement membrane zone (BMZ, Pemphigoid) Cardiolipin (phospholipid) Cold agglutinins DNA (double stranded DNA, DNA binding) Donath-Landsteiner Endomysial Extractable nuclear antigens (ENA) Includes SS-A, SS-B, RNP, Sm, Scl 70, PM-1, Jo-1 Filaggrin (Keratin) Ganglioside (GM-1) Gliadin Glomerular basement membrane Glutamic acid decarboxylase (GAD) Granulocyte Histones Insulin Intercellular cement substance (ICS, Pemphigus) Intrinsic factor Islet cell (GAD, IA-2) Microsomal - liver, kidney Microsomal - thyroid Mitochondrial (AMA) Muscle - skeletal Muscle - smooth Neuronal Antibodies {(Hu)- ANNA-1, (R1)-ANNA-2} Purkinje Cell Ab-(Yo) Neutrophil Neutrophil cytoplasmic (ANCA) includes canca, panca, myeloperoxidase, Proteinase-3 Nuclear antibody (ANA) Ovarian Pancreatic islet cell Parathyroid Parietal cell Parotid (salivary gland) Pemphigoid (basement membrane zone, BMZ) Pemphigus (intercellular cement substance, ICS) Phospholipid (cardiolipin) Platelet Protein tyrosine phosphatase IA-2 (IA-2) Purkinje Cell AB (Yo) Red cell antigens - screen, identification Reticulin Rheumatoid factor Rhesus antibodies Ribosomal Rose - Waaler (Rheumatoid factor) Salivary duct/gland Skeletal (striated) muscle Smooth muscle Sperm Triiodothyronine (T3) Thyroxine (T4) Thyroid microsomal TSH receptor NOTE: It is a Medicare requirement that autoantibodies required for testing be listed individually on the request form. Antibodies to Microbial and Parasitic Agents Adenovirus Anti streptolysin - O (ASOT) Arbovirus Aspergillus Avian precipitins Barmah Forest virus Bartonella (Cat Scratch Disease) Bordetella pertussis Brucella abortus Campylobacter Candida Cat Scratch Disease Chlamydia Coccidiodes Coxsackie virus Cryptococcus Cytomegalovirus (CMV) Dengue DNAse B (Streptococci) Echinococcus (Hydatid) Echovirus Entamoeba histolytica Enterovirus Epstein - Barr virus (EBV) Fasciola hepatica Filaria Flavivirus group - includes Dengue, Australian (Murray Valley) encephalitis and Kunjin Fungal precipitins Haemophilus influenzae Helicobacter pylori 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 Human herpes virus 6 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, DNAse B) Strongyloides Syphilis - RPR, TPHA, FTA, EIA (Total antibody) Teichoic acid (staphylococci) Tetanus Toxocara Toxoplasma Typhus Varicella - Zoster Widal test (typhoid) Whooping cough (Pertussis) Yersinia * Antibodies to other agents may be available. Please contact Immunology Department (07) NOTE: It is a Medicare requirement that autoantibodies required for testing be listed individually on the request form. APPENDICIES IMMUNOLOGY 12.36

227 APPENDICES - IMMUNOLOGY APPENDICIES IMMUNOLOGY Arbovirus Screen Ross River Virus Barmah Forest Virus Flavivirus (Group) Viruses Flavivirus Group includes - IgM and IgG - IgM and IgG - IgM and IgG - Dengue Virus - all sero types - Australian (Murray Valley) Encephalitis Virus - Kunjin Virus - Japanese Encephalitis Virus NOTE: It is a Medicare requirement that autoantibodies required for testing be listed individually on the request form. Skin Tests for Allergy In 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 induces a visible wheal and flare reaction due to local mast cell degranulation. 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 Testing Several factors may influence skin testing. Clinically relevant factors include: Drugs e.g.: antihistamines tricyclic antidepressants benzodiazepines beta blockers. Age Previous immunotherapy After viral exanthem. Contraindications Testing is contraindicated in patients with: Current severe allergic symptoms Recent anaphylaxis Unstable asthma Acute illness Generalised skin rash Pregnancy. Patient Preparation No antihistamines to be taken for seven days prior to test. Many over-the-counter medications (e.g. decongestants, cough mixtures and sinus mixtures) have antihistamines; these should be ceased No creams or moisturisers (including sunscreen) on arms for 48 hours prior to test Tricyclic antidepressant drugs often have profound 'antihistamine effects' and may preclude allergy skin testing Moderate to high dose oral corticosteroids, e.g. Prednisolone 25mg daily or above will impair skin test reactivity Asthma sprays such as Ventolin should not be stopped. Allergy skin testing is performed by appointment at several locations across Brisbane and our Branch Laboratories. For further information, please contact our Immunology Department on (07) or your local QML Pathology Branch Laboratory. RAST Allergen List Single Allergens Grasses Canary grass Cultivated wheat Couch (Bermuda) Johnson grass Meadow grass Paspalum Perennial rye grass Timothy Weeds Common ragweed Dandelion Marguerite, Daisy Plantain Western ragweed Trees Eucalyptus Melaleuca Wattle, Acacia Dust & Mites House dust mite - D. pteronyssinus House dust mite - D. farinae House dust Epithelia & Animal Proteins Cat Dog dander Dog epithelium Cow dander Horse dander Budgerigar feathers Chicken feathers Duck feathers Guinea pig Mouse epithelium Mouse urine protein Rat epithelia Rat urine proteins Sheep epithelium Moulds Alternaria tenuis Aspergillus fumigatus Candida albicans Cladosporium herbarum Penicillium notatum Insects Cockroach Honey bee venom Mosquito MUXF3 Paper wasp venom Yellow jacket wasp venom Foods Almond Apple Banana Barley Beef Blue mussel Brazil nut Buckwheat Cashew Cheddar cheese Chicken meat Chilli pepper (Capsicum) Cocoa Coconut Coffee Corn (maize) Crab Egg white Egg yolk Fish (cod) Garlic Gluten Grape Hazelnut Melons (Rockmelon & Honeydew) Macadamia APPENDICIES IMMUNOLOGY 12.38

228 APPENDICES - IMMUNOLOGY APPENDICIES IMMUNOLOGY Mango Milk Mutton Oat Onion Orange Oyster Parvalbumin Peach Peanut Pineapple Pinenut Pork Potato Rice Rye Salmon Sesame seed Shrimp Soya bean Squid Strawberry Sunflower seed Tomato Tropomysin Tuna Walnut Wheat Yeast Cow Milk Proteins - lactalbumin ß- lactoglobulin Casein Drugs Amoxycillin Ampicillin Penicilloyl-G Penicilloyl-V Miscellaneous Chlorhexidine Latex Recombinant latex Suxamethonium Inhalant Screen Contains allergens from the following groups: Grasses Weeds Moulds House dust mite Animal epithelia Multiple Allergens Grass Pollen Mix Couch (Bermuda) Timothy Meadow Johnson Rye Paspalum Tree Pollen Mix Wattle Olive Willow White pine Eucalyptus Melaleuca Weed Pollen Mix Common ragweed 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 House dust mite - D. pteronyssinus House dust mite - D. farinae House dust Cockroach Food Mix Egg white Milk Yeast Soya bean Peanut Fish (cod) Cereal Mix Wheat Oat Buckwheat Corn Sesame seed Fruit Mix Peach Kiwi fruit Rockmelon Banana Pineapple Nut Mix Peanut Almond Coconut Hazelnut Brazil nut Seafood Mix Cod Shrimp Tuna Blue mussel Salmon Disinfectant Agent Mix Ethylene oxide Phthalic anhydride Formalin/ formaldehyde Chloramine T Reactive Chemical Mix Isocyanate TD1 Isocyanate MD1 Isocyanate HD1 Phthalic anhydride Skin Allergen List Routine Allergen Screen Pollens Couch (Bermuda) Eucalyptus Johnson grass Paspalum Pine Plantain Prairie grass (Brome) Ragweed Timothy grass Wattle Wild oat Moulds Alternaria Aspergillus fumigatus Aspergillus niger Botrytis Cladosporium hormodendrum (Herbarum) Penicillium mould Epithelial Extracts Cat fur Cattle hair Dog hair Feather mix Horse hair Food Extracts Cashew Egg white Egg yolk Milk - cow Peanut Shellfish Shrimp Soy bean Wheat flour (whole) Miscellaneous Extracts House dust mite Cockroach Additional Food Allergens (available on request) Banana Chicken Cod Lobster Rice grain Strawberry Tomato Yeast (Baker's Yeast) 7 grass mix APPENDICIES IMMUNOLOGY 12.40

229 APPENDICES - MICROBIOLOGY APPENDICIES MICROBIOLOGY Infection Control in Medical Consulting Rooms Although all of us suffer from infectious illnesses from time to time, everyone would agree that the place where help is obtained, the Doctor s/dentist s surgery, should not facilitate transmission of infection. There is a requirement for duty of care by health care professionals to minimise transmission of infection from person to person by careful planning, appropriate training, and use of infection control procedures. The above concepts have now been reinforced by Government legislation. In Queensland the relevant act is the Workplace Health and Safety Act In NSW the relevant act is the Occupational Health and Safety Act 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/or jail of the relevant person. 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/Disinfection guidelines for General Practice (RACGP 2007). Infection Control in Surgery (Royal Australasian College of Surgeons, 1998, revised 2001). Human Immunodeficiency Virus and Hepatitis B and the Workplace: National Consensus Statements, Worksafe Australia Code, AS/NZS 4187:2003: Cleaning, disinfecting and sterilizing reusable medical and surgical instruments and equipment, and maintenance of associated environments in health care facilities. AS/NZS 4815:2006: Office-based health care facilities - Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment. Updated US Guidelines for the Management of Occupational Exposures to HBV, HCV and HIV and Recommendations for Postexposure Prophylaxis (MMWR: June 2001 Vol 50/No. RR-II). All procedures should be documented and records of patient encounters, including small operations lists, equipment performance, etc. should be kept. 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 and hence 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 The surgery staff and the Doctor or Dentist should be free from infectious illness. They should be vaccinated against common organisms, e.g. rubella. All health care workers who are exposed to blood should be vaccinated with Hepatitis B Virus vaccine. Check the serum Anti-Hepatitis B Surface antibodies (Anti HBs Ab) level 2 months after the third dose. Skin lesions and cuts should be covered with waterproof occlusive dressings. The surgery staff should be adequately trained in surgical procedures including aseptic techniques, use of sterilizers etc. These procedures should be documented. Induction of new staff and refresher training should be recorded also. Patients Patients with suspected infectious illnesses (e.g. rubella) are best seen at their homes or should be seen on arrival at the surgery to minimise spread of organisms to others. The staff should arrange block bookings for pregnant patients and separate patients who are susceptible to infection (e.g. leukaemic patients) from potential shedders of microorganisms (e.g. children with chicken pox). Individuals, however, may have circulating transmissible agents such as Hepatitis B virus (HBV) and Human Immunodeficiency Virus (HIV) without signs or symptoms. The blood (and some body fluids) of such persons is infectious and thus represents a hazard when undergoing some medical procedures. The Centers for Disease Control, USA (MMWR 1989; 38: S 6) has developed the strategy of universal blood and body fluid precautions to address concerns regarding transmission of HIV in the health care setting. The concept, previously referred to as universal precautions, is now called standard precautions with additional precautions and stresses that all patients should be assumed to be infectious for HIV and other blood-borne pathogens. In the health care setting, standard precautions should be followed when workers are exposed to blood and other body fluids. Standard Precautions are recommended for the treatment and care of all patients, and apply to all body fluids, secretions and excretions (excluding sweat), regardless of whether they contain visible blood (including dried body substances such as dried blood or saliva), non-intact skin and mucous membranes. Standard Precautions include good hygiene practices, particularly washing and drying hands before and after patient contact, the use of protective barriers which may include gloves, 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 or colonised with epidemiologically important or highly transmissible pathogens that can be transmitted by air borne or droplet transmission or by contact with dry skin or contaminated surfaces. APPENDICIES MICROBIOLOGY 12.42

230 APPENDICES - MICROBIOLOGY APPENDICIES MICROBIOLOGY Additional Precautions are designed to interrupt transmission of infection by these routes and should be used in addition to Standard Precautions when transmission of infection might not be contained by using Standard Precautions alone. Additional Precautions may be specific to the situation for which they are required, or may be combined where microorganisms have multiple routes of transmission. Additional Precautions are used for patients with MRSA, VRE, CJD or active pulmonary tuberculosis, or where there is an established risk of transmission of infection regardless of the nature of the procedure being undertaken, or where the procedure itself carries an established risk of aerosolation, blood accident or staff/patient injury. Additional Precautions are not required for patients with blood borne viruses such as HIV, Hepatitis B or Hepatitis C, unless there are complicating factors present, such as pulmonary tuberculosis, or unless the procedure itself performed on these patients has a known high risk, such as generation of aerosols. To minimise the risks of acquiring HIV and HBV during performance of job duties, workers should be protected from exposure to blood and other body fluids as circumstances dictate. Protection can be achieved through adherence to work practices designed to minimise risk. Personal protective equipment (i.e. gloves, masks and protective clothing) should be used to decrease exposure to hazards. Blood Collection (always use gloves and protective glasses) Preferably use the evacuated blood tube (vacutainer ) system. Discard needle and syringe into sharps bin. If any blood remains on sample tube stopper clean with an alcohol swab. Transport the blood sample safely. Waste Management Set up proper disposal procedures. Used gloves, swabs, disposable drapes etc. should be bagged in a biohazard plastic bag (yellow with a black biohazard symbol), sealed and disposed of appropriately. (See Qld Refuse Management Regulation (No. 1) (amended 1993). Environmental Protection (Waste Management) Regulation Queensland Under the Environmental Protection Act 1994, a clinical and related waste management plan is required for healthcare facilities. Handling Sharps Take care to prevent injury when handling suture needles, scalpels, sharp instruments. Do not resheath used needles. Place all disposable sharp items in an approved container (AS 4031:1992) which should be located as close as possible to the use area. In the event of a sharps/needlestick injury, documented protocols should outline the action to be taken by the injured person and the treating doctor. Guidelines for Gloves a. Use sterile gloves for procedures involving contact with normally sterile areas of the body, e.g. wound suturing etc. Use examination gloves (clean but not sterile) for procedures involving contact with mucous membranes and for other patient care or diagnostic procedures not requiring sterile gloves e.g. oral, vaginal or rectal examination. b. Change gloves between patient contacts. c. Wash hands before and after using gloves. 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 be decontaminated and reused but should be discarded if damaged. 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, as well as when cleaning up blood and body fluid spills in the surgery, and removing gloves. Staff should also ensure that they wash their hands before and after eating, smoking and going to the toilet. It is also essential that staff dry their hands thoroughly after washing. Any cuts, abrasions or lesions should be covered at all times with water-resistant dressings, which should be changed regularly. Routine Hand Washing Procedure (10-15 seconds) 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. APPENDICIES MICROBIOLOGY 12.44

231 APPENDICES - MICROBIOLOGY APPENDICIES MICROBIOLOGY Clean up Procedure for Blood and Body Fluids Always observe standard precautions For large spills > 10cms 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. 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! spot cleaning Wipe up blood spots immediately with a damp cloth, tissue or paper towel using detergent and water. 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 small spills < 10cms 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 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 Is source known YES Obtain consent from source for urgent HBsAg, HepCAb and HIV serology Is source HIV positive or high risk YES Obtain immediate urgent advice from nearest Infectious Diseases Physicians regarding HIV prophylaxis YES NO Plus test recipient NO YES Urgent baseline serology testing for HIV, HepBsAb (if immunised), HepBsAg (if not immunised) and HepCAb Immune HepB No HepB Immunoglobin or HepB vaccination Complete incident record Complete incident record and medical records Not immune HepB Obtain HepB Immunoglobin from Red Cross Blood Service within 48 hours. Offer HepB vaccination course Repeat baseline serology in 3 months APPENDICIES MICROBIOLOGY 12.46

232 APPENDICES - MICROBIOLOGY APPENDICIES MICROBIOLOGY Validation of your Steriliser Using Biological Indicator Vials Please refer to the RACGP Sterilisation/Disinfection Guidelines ( 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. 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. 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. 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. 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. 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. 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. 11. Complete validation request form and send along with the seven vials to the laboratory for processing. 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. * 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. Steriliser Chamber with Package and Biological Indicator Vials Vial inside package labelled E CYCLE NUMBER What to do after validation Steriliser chamber Control vial outside steriliser labelled Z Vial inside chamber in coolest position labelled C VIAL LABELS 1 1C (chamber); 1E (package) 2 2C (chamber); 2E (package) 3 3C (chamber); 3E (package) Control Vial After successful validation, biological indicator vials are not required for 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. Use a Class 4, 5, or 6 chemical indicator. NB. All packages should include an external Class 1 indicator (autoclave tape) to identify those packages that have been sterilised. Quality Control (QC) is performed on all batches of vials before they are distributed to surgeries. Further information on the validation of the sterilising process please contact QML Pathology Microbiology Department on (07) Z APPENDICIES MICROBIOLOGY 12.48

233 APPENDICES - MICROBIOLOGY APPENDICIES MICROBIOLOGY Symbols for Hazardous Categories Infectious wastes: bags are yellow with the internationally recognised biohazard symbol in black. Cytotoxic wastes: bags are purple with the cytotoxic waste symbol (denoting a cell in telophase) which has already been accepted widely in Australia. Radioactive wastes: bags are red with the black internationally recognised radioactivity symbol. All chemicals should be labelled with their generic names. This label should indicate any hazard and describe procedures in the event of an accident, including first aid and clean up protocols.