Specimen Collection Requirements for Neonates

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Alicia Beatrix Miller
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1 Neonatal Page 1 of 21 ABG-Arterial Blood Gases Hep. Syringe 0.3 ml Send on ice ACTH (Adrenocorticotrophic hormone) 15 days Lavender (Serum, heparin NOT suitable) 1 ml Pre chill tubes Mix gently after drawing Send to lab on ice Cold centrifuge ASAP -Use non-glass pipettes / vials. -Send frozen - EDTA only - Minimum amount 400ul. SB ACYL- CARNITINES Request free and total carnitine also with this orderrequired for appropriate interpretation of carnitine status 7-10 Working Days (1.5 ml if free/ total carnitine are ordered) On ice Send to lab ASAP Send out on ice specify serum or Send frozen Min. 0.1 ml serum or acylcarnitine alone Min 0.5 ml acylcarnitine and carnitine ALBUMIN 0.5 ml 0.6 ml for panel with Cal/Phos/Mg)

2 Neonatal Page 2 of 21 ALDO- STERONE ALP (Alkaline Phosphatase) ALPHA FETO- PROTEIN 10 days 7 DAYS Yellow 2 TUBES 1.2mL (0.6 for liver panel) Indicate all drugs administered in last two weeks Included in liver panel Spin- cold centrifuge Send frozen Baby - min 0.5 ml serum (Hemolysed sample unsuitable). Minimum amount 500uL HICL (HAM 6) 0.1 ml serum ALPHA 1 ANTI- TRYPSIN 7 days (Wed.) 0.5 ml Save in weekly INT4 rack in fridge ALT (Alanine Aminotransferase) AMIKACIN - Trough - Peak - Random Mon- Fri (0.6 for full liver panel) 0.6 ml Non Stat Trough: 0-30 min Before next dose Peak: min after IV completed Separate, store and send out frozen. Min vol. 0.2 ml serum or Note sample type -serum daily approx 1430 hours

3 Neonatal Page 3 of 21 or AMINO ACID SCREEN - Blood 10 days Heparin syringe, Send to lab immediately Separate ASAP REFRIGERATE Send on ice Min 0.1 ml serum or AMINO ACID BLOOD (Quantitative) AMINO ACID URINE Screen (Qualitative) 10 days Heparin syringe, M-F STERILE Urine container no preservative 0.5 ml Send to lab immediately 2 ml minimum Keep sample cool Refrigerate Send on ice Separate ASAP And freeze Min. 0.2 ml serum or Indicate serum or Send on ice AMINO ACID URINE Quantitative (Order urine screen unless diagnosis is M-F STERILE Urine container no preservative 2 ml minimum Keep sample cool For quantitation, provide tentative diagnosis Refrigerate Send on ice

4 Neonatal Page 4 of 21 known) AMMONIA 2 hours Purple (EDTA) AMYLASE ANTI Factor Xa 24 hr BLUE COAG (Axa) MiniCollect tube (3.2% sodium citrate) APT GASTRIC ASPIRATE 2 DAYS Sterile urine container Send on ice immediately and Indicate time drawn 0.9mL of blood to 0.1 ml 3.2% sodium citrate. Notify Haem Lab first -Add exactly 0.9 ml blood to liquid in each tube, -Invert gently and thoroughly 4-6 times -Send to lab ASAP. For STAT testing, Hematologist approval required. -Baby must be <72 hours old - Sample must be pink Centrifuge in refrigerated centrifuge, separate and test ASAP. Min. vol 50 ul Not done if mod/gross haemolysis or lipemia Performed at 24/7 until further notice. Double spin and freeze if assay cannot be done on day shift. Centrifuge and send cold if assay can be done on day shift. Sample must be pink or red. (Colorimetric reaction with brown end point. Any red-brown or black samples not accepted.) WCH Special Haem. Lab.

5 Neonatal Page 5 of 21 STOOL VOMITUS or red for test to be performed. This test is used for testing presence of maternal blood in fetal sample. AST (Aspartate Aminotransferase) (0.6 for total liver panel) BETA HYDROXY BUTYRATE BILIRUBIN -TOTAL (Alt. Name Microbilirubin or MBR) BILIRUBIN DIRECT (Alt name: Bilirubin Conjugated) 7 DAYS Yellow preferred Green acceptable Can be combined with Free Fatty Acids 0.6 ml both Send immediately on ice. Spin, freeze -Send out on ice -Specify serum or -Min vol 0.1 ml serum or -Add 0.1 if FFA ordered Light sensitive Add to order with Bilirubin, Total

6 Neonatal Page 6 of 21 BLOOD CULTURE -Baby < 24 hrs old BACTEC PEDS PLUS BOTTLE -(Pink top and label) 1-3 ml (As per manufacturer s label) Aerobic organisms only. -For suspected anaerobic organisms use Isolator 1.5 tube BLOOD CULTURE -Baby > 24 hours old BUN Alt. Name: UREA Isolator 1.5 tube (yellow top with pink label) ml If less than 0.5 ml aerobic culture only will be performed (0.5 ml for renal function = BUN/ CREAT) CALCIUM (Total) Can be ordered as Ca/Alb/Phos/Mg panel CBC and DIFF Lavender ml Mix gently 10 times after drawing to prevent formation of clots

7 Neonatal Page 7 of 21 CAPILLARY BLOOD GASES (CBG) Capillary tube 0.14 ml (full cap tube) Insert metal mixing flea and cap ends. Send on ice. CARNITINE Free and total Weekly Yellow preferred Green acceptable 1 ml Send on ice Spin and freeze Send on ice Min. 0.5mL serum or CHOLESTEROL CHROMOSOMES (KARYO) 7-12 days HEP. SYRINGE 1-3 ml A chromosome requisition must be filled out Send to the lab at room temp. Do not take sample on the weekend or late Friday. For Ashkenazi panel or Tay-Sachs see Tay-Sachs Do not refrigerate or freeze. Store and send at room temp. Do not send if it will not arrive at before 4pm

8 Neonatal Page 8 of 21 COCAINE-URINE 24 hr Sterile urine container no preservative 2 ml A toxicology form must be filled out. See Biochemistry section of SCI. For STAT testing Biochemist approval required. COCAINE HAIR M-F Sterile urine container 5 GRAM Done only if urine screen is negative See Biochemistry Section of SCI Check if urine has been sent and is negative. If both urine and hair are received at the same time, send both together. -Mother Risk CORD GASES -Arterial -Venous Cord Blood -Blood Bank (Routine) HEP SYRINGE 0.3 ml Indicate arterial cord or venous cord. Send on ice immediately. Pink top vacutainer 6 ml draw CORTISOL 3 days Yellow 3 ml SIGNED, completely filled-in pink requisition MUST accompany FULLY labelled sample 1.0 ml 0.5 for Aliquot tube SB

9 Neonatal Page 9 of 21 CREATININE (Renal Panel = Bun/ Creat) CK (Creatine Kinase) CSF Cell Count 1 hr CSF collection tube 0.05 ml Send to lab ASAP. If delay anticipated, keep specimen at room temperature. If multiple tubes of CSF are collected, the first tube shall not be used for microbiological examination. CSF Differential 2 hr CSF collection tube ml (cell count also performed) See CSF Cell Count

10 Neonatal Page 10 of 21 D-DIMER BLUE COAG MiniCollect tube (3.2% sodium citrate) 2 citrated MiniCollect TUBES for full Coag panel PT/PTT, DD, and Fibrinogen -Add exactly 0.9 ml blood to liquid in each tube -Invert gently and thoroughly 4-6 times -Send to lab ASAP. Centrifuge and separate within 1 hr. Spin rpm. Should be tested within 4 hours. 7 DEHYDRO CHOLESTEROL 20 days 0.7 ml Send to the lab protected from light Separate, protect from light, freeze Send frozen Min 0.3 ml serum or HICL DIHYDRO- TESTOSTERONE (DHT) 20 days Yellow 2.0 ml Separate and freeze Minimum amount 1 ml serum HICL DIGOXIN DILANTIN Same (Phenytoin) day 0.3 ml Min. 0.1 ml serum or 0.3 ml Min. 0.1 ml serum or

11 Neonatal Page 11 of 21 DRUG SCREEN BLOOD DRUG SCREEN URINE (Preferred sample for Street Drugs screening) STAT same day STAT -Same day Yellow (not serum separator) Sterile urine container ELECTROLYTES GRNMCT or YELLOW SST MICRO-TAINER ELECTROLYTES URINE FACTOR ASSAYS - COAG PLAIN CONTAINER BLUE COAG MiniCollect tube (3.2% sodium citrate) FERRITIN Mon-Fri Green or Yellow 1.5 ml An drug screen requisition must be filled out 1.5 ml Drug screen requisition to be filled out -Add exactly 0.9 ml blood to liquid in the 1 ml MiniCollect tube. 0.5 ml Notify Haem lab -Add exactly 0.9 ml blood to liquid in each tube, -Invert gently and thoroughly 4-6 times -Send to lab ASAP. Send STAT. Do not have to separate. If serum send minimum amount 800ul. Centrifuge and separate. Should be tested within 4 hours. If assays are not performed within 4 hours, freeze at - 70 C or 80 C. SB

12 Neonatal Page 12 of 21 FIBRINOGEN BLUE COAG MiniCollect tube (3.2% sodium citrate) Add exactly 0.9 ml blood to liquid in the 1 ml MiniCollect tube. Add exactly 0.9 ml blood to liquid in the 1 ml MiniCollect tube. -Invert gently and thoroughly4-6 times -Send to lab ASAP. FREE T3 Mon-Fri Green or Yellow 0.8 ml with TSH for full thyroid panel FREE T4 Mon-Fri Green or Yellow FREE FATTY Weekly Yellow ACIDS preferred Green acceptable G-6-P-D screen 24 hr Lavender G-6-P-D assay 2 working days Lavender 0.8 ml with TSH for full thyroid panel Can be combined with Beta Hydroxybutyrate (0.6 ml for both). FASTING Sample preferred Separate, freeze Send frozen on ice Min. 0.1 ml serum or. Add 0.1 ml extra for BHB ml Order a CBC ml G-6-P-D screen results must be indeterminate or deficient.

13 Neonatal Page 13 of 21 GALACTOSEMIA SCREEN Done on Fridays HEPARIN SYRINGE Send on ice immediately to lab Test invalid if baby has been transfused Do not separate Send on ice - Test done on red cells, invalid if baby transfused. GAMMA GT (γgt) (Gamma-glutamyl transferase) GASES see ABG, Capillary Blood Gases (CBG), CORD GASES GENTAMICIN -Trough -Peak -Random Green or Yellow Heparin sample Green or Yellow (0.6 ml with liver panel) 0.3 ML SYRINGE Or full cap tube (0.1 ml) Send immediately on ice 0.5 ml Trough: 0-30 min before next dose Peak: min after IV completed GLUCOSE Green or Yellow Send on ice

14 Neonatal Page 14 of 21 GROUP & SCREEN - Blood Bank Lavender 1.0 ml SIGNED, completely filled-in pink requisition MUST accompany FULLY labelled sample Perform Group & Screen and DAT. GROWTH HORMONE 2 weeks Yellow 0.5 ml Separate, freeze Min 200ul serum HAPTOGLOBIN 2 days Yellow 0.5 ml Serum only Min 0.2 ml HEMOGLOBIN ELECTRO- PHORESIS 2 working days Lavender ml STAT requests must be approved by haematologist CBC must be ordered. 17 HYDROXY- PROGESTERONE HOMOCYSTEINE (TOTAL) 2 weeks Yellow 7-10 Green, Yellow, days or Lavender 0.8 ml Min. 0.3 ml serum HICL 0.5 ml Send on ice Separate immediately - Freeze Send out on ice Min. 0.2 ml

15 Neonatal Page 15 of 21 Human Immunodeficiency Virus (HIV 1 and 2) 6 days Yellow INSULIN 2 days Green or Yellow Need 2 to 3 ml of clotted blood 2 tubes 1.2 ml Complete the PHL HIV Serology Test Requisition Send on ice IONIZED CALCIUM STAT Heparin syringe 0.3 ml Send on ice IMMEDIATELY KARYO See Chromosome studies KETONES Green or Yellow Send on ice LACTATE STAT Heparin syringe 0.3 ml Send to lab on ice IMMEDIATELY Spin down blood for serum -Separate -Do NOT freeze -Send on ice-stat -Order LINF result as specimen sent to MSH -Min. 0.5mL serum or Send out syringe on ice immediately -Must be received within 60 min of draw. Separate Must reach within 30 min of draw time Minimum amount 100ul serum PHL Mt. Sinai Hospital

16 Neonatal Page 16 of 21 LDH (Lactate dehydrogenase) LIVER PANEL (Includes ALP, AST, ALT, and TBIL) Green or Yellow Green or Yellow 0.6 ml MAGNESIUM Green or Yellow (0.5 ml -panel with Cal /Phos / Alb) METABOLIC SCREEN - URINE (Includes Amino Acid screen, DNPH, NITROPRUSSIDE) METABOLIC SCREEN=Serum or MET- HAEMOGLOBIN 7-10 DAYS Same day RANDOM URINE - Plain container 3-5 ml Do NOT freeze, Send out on ice Refer to Amino Acids for instructions Heparin syringe 0.5 ml Send to lab on ice Immediately. -Do not separate Send out on ice Must be processed within 2 hours

17 Neonatal Page 17 of 21 MUCOPOLY- SACCHARIDES (SCREEN) 7-10 days RANDOM URINE 1 ml Refrigerate if sample not completed in one collection Min. 0.3mL Refrigerate do not freeze Send on ice OLIGO- SACCHARIDES (SCREEN) 7-10 days RANDOM URINE 1 ml Refrigerate if sample not completed in one collection Refrigerate do not freeze Send on ice ORGANIC ACIDS SCREEN 5 days RANDOM URINE 2 ml Refrigerate if sample not completed in one collection Refrigerate do not freeze Send out on ice OSMOLALITY - Blood Green or Yellow OSMOLALITY Urine PLAIN CONTAINER 0.3 ml

18 Neonatal Page 18 of 21 PCR CSF for Streptococcus pneumoniae and Neisseria meningitidis PCR VIROLOGY Testing-blood 24 hr CSF sterile container Varies Lavender Minimum volume is 0.2 ml Request must be approved by Medical Microbiologist. -Indicate virus test required Storage at 4 C for up to 48 h prior to testing; If >48 h, storage at 20 C. Send whole blood sample SB PCR-VIROLOGY Testing-CSF Varies CSF sterile container PHENOBARB 24 hr Green or Yellow ml -Indicate virus test required -Indicate pre, post dose or random Min 0.1 ml serum or PHENYTOIN (Dilantin) 24 hr Green or Yellow -Indicate pre, post dose or random Min 0.1 ml serum or PHOSPHATE (Inorganic) Green or Yellow 0.6mL for Cal/Alb/ Phos/Mg panel PTH, (Intact) 7 days Yellow 0.6 ml On ice ASAP Note time of draw Separate immediately and freeze Minimum amount 250ul

19 Neonatal Page 19 of 21 PT/PTT BLUE COAG MiniCollect tube (3.2% sodium citrate) PYRUVATE REDUCING SUBSTANCES Same day Add exactly 0.9 ml blood to liquid in the 1 ml MiniCollect tube. HEP SYRINGE -Lactate and pyruvate done on same sample 5 days PLAIN CONTAINER RENIN 3 weeks Lavender URINE: 1 mlscreen - 5 ml full sugar panel (only done if reducing subs. POS and Glucose NEG) -Add exactly 0.9 ml blood to liquid in the 1 ml MiniCollect tube. -Invert gently and thoroughly 4-6 times -Send to lab ASAP. On ice to lab immediately -(Must reach within 30 min of collection) -Will only measure if lactate is >2.5 3 ml 3 tubes Send immediately on ice Centrifuge and separate. Centrifuge and separate within 1 hr if patient is on heparin. Should be tested within 4 hours, particularly from patients on therapeutic heparin. to receive within 30 min of collection -Send syringe on ice STAT Send on ice Separate in cold centrifuge within 30 min. - Send frozen Min: 1.2 ml RETICULOCYTE COUNT Lavender ml Same sample as CBC Must be a fresh sample. Test within 8 hours of draw

20 Neonatal Page 20 of 21 SIROLIMUS 3 days Mon. to Thur. Lavender 0.5 ml Trough sample 0-30 min before next dose -Whole blood -Do not separate TML TAY-SACHS (Hexosaminidase) TESTOSTERONE -Total 7-12 days Heparin syringe 1-3 ml A Molecular Genetics requisition must be filled out. Do not take on weekend or late Friday. Send to the lab at room temp. 7 days Yellow Do not refrigerate or freeze. Store at room temp. Do not send if it will not arrive at before 4pm 1 ml SB TESTOSTERONE -Free TOBRAMYCIN -Trough -Peak -Random TORCH SCREEN serology for Toxoplasmosis, Rubella, Cytomegalovirus, 15 days Yellow 7-10 days Green or Yellow YELLOW SST MICRO-TAINER 0.5 ml Min. 0.2 ml serum Freeze aliquot, put in RIA rack. Indicate trough, peak or random 1-2 ml Follow PHL requisition instructions. Parvovirus not part of TORCH panel. Provincial Health Lab

21 Neonatal Page 21 of 21 Herpes Simplex TRANSFERRIN 7 days Done on Wed. Yellow 0.6 ml Save in weekly INT4 rack in fridge TRIGLYCERIDE Green or Yellow UREA Alt. Name: BUN URINALYSIS PLAIN CONTAINER VANCOMYCIN 24 hr Green or Yellow. (Renal panel urea/creat 0.5 ml ) 2 ml urine Microscopic always done on babies 0.5 ml Indicate pre, post dose or random Virus Isolation Varies according to specimen type. Refer to SCI [Para-Link]

Epic Labs Orderable As STAT PRIORITY As of 06/22/2016

Epic Labs Orderable As STAT PRIORITY As of 06/22/2016 ABG+HB(CORDARTERIAL) - BABY A ABG+HB(CORD ARTERIAL)- BABY B ABG+HB(CORD ARTERIAL)- BABY C ACETAMINOPHEN LEVEL ALANINE AMINOTRANSFERASE (ALT) ALBUMIN, FLUID ALBUMIN, PLEURAL FLUID ALBUMIN, SYNOVIAL FLUID