CPDRL Laboratory Handbook - The Centre for Pathology Diagnostic

Transcription

Second Edition
CREED OF CPDRL
In the spirit of team work we shall provide
an efficient, reliable service towards achieving excellence
in patient care and to pursue professional and technological
advancement through training, research and innovation
to improve the health of our community.
Fakulti Perubatan
Universiti Teknologi MARA,
Kampus Sungai Buloh
Selangor Darul Ehsan.
International Standard Book Number: 978-983-42902-3-8
This publication is meant for internal circulation of Universiti Teknologi MARA Malaysia.
This book contains information obtained from authentic and highly regarded sources. Reprinted material
is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable
efforts have been made to publish reliable data and information, but the author and the publisher cannot
assume responsibility for the validity of all materials or for the consequences of their use.
No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic,
mechanical, or other means, now known or hereafter invented, including photocopying, microfilming,
and recording, or in any information storage or retrieval system, without written permission from the
publishers.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are
used only for identification and explanation without intent to infringe.
Library of Congress Cataloging‑in‑Publication Data
CPDRL Handbook, Second Edition / edited by Dr. Fadzilah Mohd Nor @ Ghazali et.al
First Edition, June 2013
Second Edition, January 2014
ISBN : 978-983-42902-3-8
Visit the Faculty of Medicine Web site at
http://medicine.uitm.edu.my/
LIST OF EDITORS & CONTRIBUTORS
ADVISOR
PROF. DR. HAPIZAH NAWAWI
A/P DR. ARIZA ADNAN
CO-ORDINATOR
DR. FADZILAH MOHD NOR @ GHAZALI
WORKING COMMITTEE
DR. THUHAIRAH HASRAH ABD. RAHMAN
DR. NORIZAL MOHD NOOR
CONTRIBUTORS
CHEMICAL PATHOLOGY
DR.ALETZA ISMAIL
MEDICAL MICROBIOLOGY
DR. FADZILAH MOHD NOR @ GHAZALI
ANATOMIC PATHOLOGY
A/P DR. NOOR KASLINA KORNAIN
HAEMATOLOGY
DR. AMIR MUHRIZ ABD. LATIFF
TABLE OF CONTENT
Page
Foreword........................................................................................1
Organization Chart.........................................................................2
General Operating Policies............................................................3
Phone Directory.............................................................................6
Chemical Pathology.......................................................................8
* List of test...................................................................................11
Anatomic Pathology......................................................................21
* Histopathology............................................................................21
*Frozen Section............................................................................22
*Cytology.......................................................................................23
Haematology.................................................................................24
*List of test....................................................................................26
Medical Microbiology....................................................................28
*List of test....................................................................................31
Appendix
i. Chemical Pathology Test Indication.......................................... 41
ii. Chemical Pathology Reference Range.....................................43
iii. Haematology Reference Range...............................................49
iv. Haematology Turn-Around-Time..............................................50
v. Medical Microbiology Turn-Around-Time.................................. 50
FOREWORD
Laboratory medicine is a field that is constantly evolving which requires regular updating of technologies and development of
new diagnostic tools. We in CPDRL are continuously striving to
meet the expectation of our clients to ensure quality in our services in diagnostics and in complementing research activities.
The first edition of this handbook list the available laboratory tests with specific guidelines for the proper collection and handling of samples as well as results retrieval.
I would like to congratulate the CPDRL colleagues who have contributed
to this publication of this handbook. We intend to revise the handbook
in line with expansion of the laboratory in future and thus we welcome
comments and suggestions which will be incorporated in the next edition.
We hope that you will find the handbook beneficial and that
it will serve as a guide to your laboratory tests requirements.
Assoc. Prof. Dr. Ariza Adnan
Coordinator
Centre for Pathology Diagnostic and Rersearch Laboratories
Clinical Training Centre
Faculty of Medicine
Universiti Teknologi MARA
1
2
SCIENCE
OFFICER
(1)
S CI EN CE
O FFI CE R
(3)
ASSISTANT
SCIENCE
OFFICER
(2)
( 15)
LABORATORY
ASSISTANT
(1)
ME DI CAL LA BOR ATO RY
TE CHN O LOG IS T
(2)
HEALTH
ATTENDANT
MEDICAL
LABORATORY
TECHNOLOGIST
(6)
(1)
SCIENCE
OFFICER
(6)
(4)
CHE M ICA L
PATHO LOG IS T
(6)
MEDICAL
MICROBIOLOGY
UNIT
C O O R D I N AT O R
Dr. Fadzilah
Mohd Nor
@ Ghazali
MEDICAL
MICROBIOLOGIST
HA EM AT O L O G Y
UNIT
C O OR DI N AT O R
Dr. Amir Mukhriz
Abd Latif
HAEMATOLOGIST
CH EMI CA L
PATH OLO GY
U NIT
C OOR D INATO R
Professor Dr.
Hapizah
Mohd Nawawi
CPDRL COORDINATOR
Associate Professor Dr. Ariza Adnan
MEDICAL
LABORATORY
TECHNOLOGIST
(7)
(5)
ANATOMIC
PATHOLOGIS T
A NAT O MI C
PAT H O L O G Y
UNI T
C O O R D I NAT O R
Associate
Professor
Dr. Noor Kaslina
Mohd Kornain
C LI N ICAL TRAINING CENTRE COORDINATOR
Dato’ Dr. Ahmad Ridzuan Arshad
C P D R L O R G A N I Z AT I O N C H A R T
(2)
FORENSIC
PAT HOLOGIST
FORENSIC
MEDICINE
UNIT
COORDINATOR
Professor Dr.
Mohamed Nasimul
Islam
(2)
CLERK
GENERAL OPERATING POLICIES
INTRODUCTION
The CPDRL of Faculty of Medicine, UiTM started its operation in
October 2010.
LOCATION
The CPDRL is located in Sg. Buloh Campus and Selayang Campus.
The CPDRL Sg Buloh Campus is located on the first floor of the Clinical Training Centre (CTC) and CPDRL of Selayang Campus is
located on the 5th floor of Specialist Clinic Complex. The CPDRL
comprises of 5 units/specialties including Chemical Pathology,
Haematology, Anatomic Pathology, Medical Microbiology with
Parasitology and Forensic Medicine.
ORGANIZATIONAL STRUCTURE
Figure 1
FUNCTIONS
To provide diagnostic and consultancy services in the field of
Chemical Pathology, Haematology, Anatomic Pathology,
Medical Microbiology with Parasitology and Forensic medicine
for the Clinical Training Centre (CTC).
To conduct and facilitate research and development in the Pathology and other clinical disciplines.
SERVICE HOURS
The CPDRL service hours are outline in the table below:
CPDRL (Sg. Buloh Campus)
CPDRL (Selayang Campus)
The CPDRL of Sg. Buloh campus provides 24 hours service in all units
except Anatomic Pathology.
The Pathologist is available for consultation or assistance after office hours for both campuses. (One Pathologist for each unit / call)
24 hours
8.00am - 5.00pm
The Counter service for receiving specimens at the Main Specimen
Reception Area is provided from:
Monday to Friday
: 7.30am to 4.45pm
Saturday and Sunday
: 8.00am to 4.00pm
SCOPE OF SERVICE
The CPDRL provides the following services:
Main Specimen Reception Area
Chemical Pathology
Haematology & Transfusion services
Anatomic Pathology ( Histopathology & Cytology)
Medical Microbiology with Parasitology
3
TEST REQUESTS
Test Requests
The ‘CPDRL Request Form’ are colour coded as follows:
Chemical Pathology/Haematology: Pink
Anatomic Pathology (Gynaecology & Non Gynaecology): White
Pap Smear: Blue
Medical Microbiology/Parasitology: Green
All request shall be authorized by Medical Officer and accompanied by the properly collected specimens. Relevant clinical information with
provisional diagnosis and treatment should be provided.
All test request from Selayang Campus can be requested from the
Laboratory Information System (LIS) and on manual basis by using
‘CPDRL request form’ in the event that the online system breaks down. Standard request form KKM - PER PAT-301 and PDN format form should
be used for outsourced tests where relevant.
All test request from Sg. Buloh Campus can be requested by using
‘CPDRL request form’. Standard request form KKM - PER PAT-301
and PDN format form should be used for outsourced test where relevant.
SPECIMENS / SAMPLES
All specimens / samples should be collected from the patients in the wards, operating theatre, daycare or clinics and dispatched to the
laboratory in the appropriate containers as specified.
All specimens / samples should be placed into appropriate containers
and thereafter put into a biohazard plastic bag.
Urgent requests must be justified by clinical history and diagnosis.
Urgent specimens / samples must be brought to the laboratory by the ward,operating theatre, daycare or clinic staff. The time of specimens
received at the counter must be acknowledged by the respective
laboratory personnel / scientific officer / Pathologist, and the specimens / samples will be sent to the respective laboratory for the ‘URGENT’ test to
be done.
The result of urgent test will be informed to the ward / clinic by
Pathologist in-charge / Science Officer.
RESULTS
All the results of in-house tests from various units in CPDRL will be
validated by Pathologist on duty/ Science Officer. A preliminary report and urgent results will be informed to the Specialist / Medical Officer in charge via phone call and documented.
4
All the outsource test results will be acknowledged by Pathologist on duty/ Science Officer. The original results will be dispatched to the ward/clinic.
A hard copy of the outsource test results will be kept in CPDRL for documentation.
Inquiry of tests can be made via telephone, but this should be kept to a minimum so that it does not disrupt the work in the laboratory.
QUALITY ASSURANCE PROGRAMMES
The following quality control and quality assurance programmes are
carried out in the CPDRL:
Reagent assessment
Method validation to ensure test method implemented meets the requirement for accuracy, recovery, precision and detection limits.
Method calibration
Method quality control
Internal and external quality assurance programme
Quality system review and audit
Turn around time (TAT)
SAFETY MEASURES
Strict safety measures are practiced in CPDRL according to the CPDRL Safety Manual.
Phlebotomists should follow safety measures and proper sample
collection technique as in WHO Guidelines on Drawing Blood: Best
Practices in Phlebotomy.
FUTURE DIRECTION
To make available of appropriate skills, and subspecialty services to meet the expanding clinical requirements.
To strive towards achieving the medical diagnostic and research
accreditation and certification according to ISO 15189 and Good
Labaratory Practices ( GLP).
ENQUIRY, FEEDBACK AND SUGGESTION
For any suggestion, please contact the respective person-in-charge
Chemical Pathology : Cik Sarina Ali ( 03 - 61265209 / 5215 )
Haematology : Cik Halimatun Radziah ( 03 -61265209 / 5215 )
Anatomic Pathology : En. Faiz ( 03-61265053 )
Medical Microbiology : Pn. Norzilawati Mohd Isa ( 03-61265139 )
Selayang Campus CPDRL : Pn. Che Wan Juliana ( 03 - 61264813/4814 )
5
PHONE DIRECTORY
MAIN OFFICE
Assoc. Prof Dr. Ariza Adnan.......................................61267400
Coordinator of CPDRL and Consultant Pathologist
(Medical Microbiology)
Clerk........................................................................ 61267663/4
CHEMICAL PATHOLOGY
Prof. Dr. Hapizah Nawawi...........................................61267405
Unit Coordinator and Senior Consultant Pathologist
(Chemical Pathology)
Dr. Thuhairah Hasrah Abd. Rahman...........................61267637
Quality Manager of CPDRL and Pathologist
(Chemical Pathology)
Dr. Aletza Ismail..........................................................61267440
Pathologist (Chemical Pathology)
Dr. Nadzimah Mohd Nasir
Pathologist (Chemical Pathology) ................................................61267647
Dr. Noor Alicezah Mohd Kasim
Pathologist (Chemical Pathology).................................................61267646
Dr, Fathimah Mohamad
Pathologist (Chemical Pathology) .............................................. 61267444
Cik Sarina Ali..............................................................61265230
Science Officer
Main Laboratory...........................................................61265029
Pn. Che Wan Juliana Che Wan Jaafar........................61265213
Science Officer
ANATOMIC PATHOLOGY
A/P Dr. Nor Kaslina Mohd Kornain..............................61267642
Unit Coordinator and Consultant Pathologist
(Anatomic Pathology)
Prof. Dr. Sabariah Abd Rahman
Consultant Pathologist (Anatomic Pathology............................... 61267734
Dr. Effat Omar.............................................................61265073
Consultant Pathologist (Anatomic Pathology)
Dr. Nur Salmah Abu Bakar..........................................61265239
Consultant Pathologist (Anatomic Pathology)
6
PHONE DIRECTORY
Dr. Norizal Mohd Noor................................................61267426
Pathologist (Anatomic Pathology)
Main Laboratory...........................................................61265053
HAEMATOLOGY
Dr. Amir Mukhriz Abdul Latiff.......................................61265238
Unit Coordinator and Consultant Pathologist (Haematology)
Dr. Madyhah Monir).....................................................61267395
Pathologist (Haematology)
Dr. Fatmawati Kamal....................................................61267394
Dr. Zalizah Khalid.........................................................61267395
Cik Halimatun Radziah...............................................61265213
Science Officer
Main Laboratory..........................................................61265029
MEDICAL MICROBIOLOGY & PARASITOLOGY
Dr. Fadzilah Mohd Nor @ Ghazali..............................61267436
Unit Coordinator and Pathologist (Medical Microbiology)
Dr. Syahrul Azlin bt. Shaari.........................................61267437
Pathologist (Medical Microbiology)
Dr. Siti Farah Alwani Mohd Nawi................................61267645
Dr. Nurul Azira Mohd Shah.........................................61267641
Dr. Farah Roslinda Mohd Radzi................................. 61267445
Pn. Norzilawati Isa......................................................61265095
Science Officer
Main Laboratory..........................................................61265139
7
CHEMICAL PATHOLOGY
INTRODUCTION
The Chemical Pathology Unit falls within the Centre for
Pathology Diagnostic and Research Laboratories (CPDRL). The Chemical Pathology Unit services cover pre-examination, examination and post examination (interpretation of
biochemical results, diagnostic, monitoring and screening of diseases) as well as providing consultative services to our internal and external customers.
SERVICES
The Chemical Pathology Unit provides laboratory and
consultative services in the areas of Diagnostic and Research as follows:
a) Clinical stat and Appointment day stat services
b) 24 hour service
c) Routine service
d) Specialised service
Clinical stat service:
Definition - urgent tests which require stat analysis . Turn
around time - 1 hour.
Appointment day stat service:
Definition - tests requested by clinicians for clients that attend the day’s clinic without prior blood sampling for the tests
requested. Turnaround time - 3 hours.
24 hour service:
Definition - tests which are offered over a 24 hour priod . List of tests offered: Renal Profile, Arterial Blod Gases, Liver Function Test, Glucose, Calcium, Creatine Kinase, Amylase, CSF Biochemistry,Bilirubin(total/direct), Magnesium and
Phosphate
Routine service:
Definition - tests offered during office hours. Turnaround time – 4-5 working days.
Specialised service:
Definition - tests that are run in batches (eg endocrine tests, HbA1c, and functional tests). Turnaround time – 5 working days.
REQUEST FORMS
All Chemical Pathology tests from Sg. Buloh Campus should be requested using ‘CPDRL request form’.
All tests from Selayang Campus can be requested from the Hospital Information System (HIS) and on manual basis in the event that the online system breaks down. Tests to be run in Ministry of Health hospitals should use the PER PAT-301 form.
8
CHEMICAL PATHOLOGY
Additional tests: Additional tests to primary samples can be requested within 5 days of sample collection except for glucose (3 days) and
phosphate (4 days).
SPECIAL COLLECTION PROCEDURES
24-Hour Urine Collection.
Most quantitative assays are performed on urine specimen
collected over 24 hours. The 24-hour timing allows for
circadian rhythmic changes in excretion at certain time of day.
Procedure Of Collection
The 24 hour urine bottle which contains preservative for the required test (preservative depend on the test requested) is available at the Central Specimen Reception Area and
provided on request.
On the day of collection, the first urine voided must be thrown away. Time of first urine voided is the start of the timing for the 24 hour collection.
Collect the second and subsequent voided urine for 24 hours from the timed start into the 24 hour urine bottle.
At the end of 24 hour, the last urine voided is collected. For best result, refrigerate if possible.
Label the bottle as directed and send immediately to the
laboratory.
Oral Glucose Tolerance Test (OGTT)
Procedure of Collection
Check that the patient has fasted from midnight.
Perform venepuncture and collect blood sample into fluoride oxalate
collection container and label with patient identification, date and “0” minutes in time on sample.
Collect a further blood sample in a fluoride oxalate bottle for glucose
measurement two hours after the glucose solution has been given.
Blood samples must be labelled with patient details, date and time of sample (0 and 120 minutes.)
Send samples all together with request form to CPDRL.
9
CHEMICAL PATHOLOGY
IRECEIPT OF SPECIMEN
All specimens will be received at the Central Specimen
Reception Area either send by pneumatic tube or by a porter.
REPORTING OF RESULTS
All results will be verified by the Medical Laboratory
Technologists (MLTs) and validated by the Science Officer and Chemical Pathologist on duty.
Critical results as listed below will be informed via phone and documented :
Sodium
Potassium
Calcium
Bilirubin
Glucose
Amylase
10
CHEMICAL PATHOLOGY
LIST OF TEST (Clinical Indications for each test is attached in Appendix)
NO.
TEST
DESTINATION
Hosp. Sg Buloh
Plasma
2 ml
K2EDTA tube
in ice
Complete PER
PAT.301 form and
send immediately
to CPDRL.
HKL
Alanine transferase (ALT)
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Alkaline phosphatase (ALP)
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
UMMC
2.
3.
4.
5.
Aldosterone
6.
Albumin
7.
Albumin: creatinine ratio
11.
INSTRUCTION
Plain tube
Adrenocorticotrophin Hormone
(ACTH)
10.
SPECIMEN
CONTAINER
3 ml
Acetaminophen
(PCM)
9.
VOLUME
REQUIRED
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
1.
8.
SPECIMEN
TYPE
Alpha-1-antitrypsin
Alpha fetoprotein
(AFP)
Ammonia
Amylase
12.
Anti-thyroglobulin
13.
Anti-thyroid
peroxidase
Serum
Serum
3 ml
Plain tube
By appointment,
Complete PER
PAT.301 form and
send immediately
to CPDRL.
Serum
Urine (random)
3 ml
20 ml
Plain tube
Urine collection
container
Send to CPDRL
within 2-4 hours.
CPDRL
Urine
3 ml
Urine collection
container
Send to CPDRL
within 2-4 hours.
CPDRL
Plain tube
By appointment,
Complete PER
PAT.301 form and
send immediately
to CPDRL.
HKL
3 ml
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
2 ml
K2EDTA tube
in ice
Complete PER
PAT.301 form and
send immediately
to CPDRL.
Hosp. Sg Buloh
Serum
Serum
Plasma
3 ml
Serum
3 ml
Urine (random)
20 ml
Serum
Serum
Plain tube
Urine collection
container
3 ml
3 ml
11
Send to CPDRL
within 2-4 hours
Complete PER
PAT.301 form and
send immediately
to CPDRL.
CPDRL
Hosp. Sg Buloh
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
UMMC
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
UMMC
CHEMICAL PATHOLOGY
NO.
TEST
14.
Aspartate transaminase (AST)
15.
16.
Benzodiazepine
Beta HCG
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
Serum
3 ml
Serum
Serum
3 ml
3 ml
INSTRUCTION
DESTINATION
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
CPDRL
17.
Bilirubin(Total/
direct)
Serum
3 ml
Plain tube
Avoid sample
being exposed to
light (cover collection tube with
aluminium foil).
Send to CPDRL
within 2-4 hours.
18.
Blood
gases(arterial and
venous)
Blood
1 ml
Heparinized
syringe in ice
Send to CPDRL
immediately.
CPDRL
19.
Caeruloplasmin
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
HKL
Plain tube
Do not use tourniquet during blood
samplingSend to
CPDRL within 2-4
hours.
Serum
20.
Calcium
Urine(24 hours)
21.
22.
23.
24.
3 ml
Carbamazepine
CA-125
CA 15-3
CA 19-9
Serum
Serum
Serum
Serum
24 hours collection
3 ml
3 ml
3 ml
3 ml
12
24-hour urine
container
CPDRL
For 24 hour
urine collection,
refrigerate during
sample collection
Plain tube
Complete TDM
form and send it
along with sample
to CPDRL within
2-4 hours.
HKL
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
CHEMICAL PATHOLOGY
NO.
TEST
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
Hosp. Sg Buloh
25.
CEA
Serum
3 ml
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
26.
Chloride
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
27.
Cholesterol (total)
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
HKL
28.
C-peptide
Serum
3 ml
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
29.
C-reactive protein
(CRP)
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
30.
31.
Complement 3
Complement 4
Serum
Serum
Serum
32.
Cortisol
Urine (random)
24-hours urine
33.
Copper
3 ml
3 ml
Plain tube
3 ml
20 ml
Urine collection
container
24 hours urine
24 hours urine
container
Serum
3 ml
Plain tube
Urine (random)
20 ml
Urine collection
container
24-hours urine
24 hours urine
container
13
Send to CPDRL
within 2-4 hours.
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
For 24-hour urine
sample,
refrigerate during
collection.
Send to CPDRL
within 2-4 hours.
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
For 24-hour urine
sample,
refrigerate during
collection.
CPDRL
HKL
HKL
HKL
CHEMICAL PATHOLOGY
NO.
TEST
34.
Creatine kinase
Serum
35.
Creatine kinase
– MB isoenzyme
(CKMB-mass)
Serum
36.
Creatinine
Serum
37.
38.
Creatinine clearance
DHEAS
SPECIMEN
TYPE
Serum & urine
VOLUME
REQUIRED
INSTRUCTION
DESTINATION
Plain tube
Send to CPDRL
within 2- 4 hours.
CPDRL
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Plain tube &
24 hours urine
container
Send to CPDRL
within 2-4 hours.
For For 24-hour
urine sample,
refrigerate during
collection.
CPDRL
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
HKL
HKL
3 ml
3 ml & 24 hours
collection
Serum
3 ml
SPECIMEN
CONTAINER
39.
Digoxin level
Serum
3 ml
Plain tube
Complete TDM
Form and send it
along with sample
to CPDRL within
2-4 hours.
40.
Estradiol
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
41.
Faecal occult
blood
Stool (random)
-
Plain container
Send to CPDRL
within 2-4 hours.
CPDRL
42.
Fat globules
Stool
-
Plain container
By appointment.
UMMC
Hosp. Sg Buloh
43.
Ferritin
Serum
3 ml
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
44.
Free T4
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
45.
Free T3
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
UMMC
CPDRL
46.
Folate
Serum
3 ml
47.
Fructosamine
Serum
3 ml
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
48.
Follicular stimulating hormone
Serum
(FSH)
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
14
CHEMICAL PATHOLOGY
NO.
TEST
49.
Gamma glutamyl
transferase
(GGT)
50.
51.
52.
Gentamicin
Haptoglobulin
HbA1c
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
Serum
3 ml
Serum
3 ml
Serum
3 ml
Blood
3 ml
INSTRUCTION
DESTINATION
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
HKL
EDTA
Send to CPDRL
within 2-4 hours.
Test will be
rejected if last request was within
8 weeks.
CPDRL
HKL
53.
Homocysteine
Serum
3 ml
Plain tube in ice
By appointment.
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
54.
High sensitive
CRP
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
HKL
UMMC
55.
Insulin
Serum
3 ml
56.
Insulin growth
factor (IGF-1)
Serum
3 ml
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
57.
Iron
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
58.
Ketones
Urine
20 ml
Urinecollection
container
Send to CPDRL
within 2-4 hours.
CPDRL
59.
Lactate
Plasma
3 ml
Flouride tube
in ice
Send to CPDRL
immediately.
CPDRL
60.
Lactate dehydrogenase (LDH)
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
61.
Luteinising
hormone (LH)
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
62.
Magnesium
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
15
CHEMICAL PATHOLOGY
NO.
63.
64.
65.
66.
TEST
Metanephrine
Osmolality
Parathyroidhormone (intact)
Phenytoin
67.
Phosphate
68.
Potassium
69.
Progesterone
SPECIMEN
TYPE
24 hours urine
VOLUME
REQUIRED
24 hours urine
collection
Serum
3 ml
Urine
20 ml
Serum
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
Refrigerate during
collection.
HKL
Send to CPDRL
within 2-4 hours.
CPDRL
K2EDTA in ice
Byappointment.
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
UMMC
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
Send to CPDRL
within 2-4 hours.
CPDRL
24 hour urine collection container
with 10 ml of 25%
HCL
Plain tube
Urine collection
container
3 ml
Serum
3 ml
Serum
3 ml
Urine (random)
20 ml
Urine collection
container
SerumUrine
(random)
3 ml20 ml
Plain tubeUrine collection
container
Send to CPDRL
within 2-4 hours.
CPDRL
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
IMR
Plain tube
70.
17-hydroxyprogesterone
Serum
3 ml
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
71.
Prolactin
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
72.
Protein (spot
urine)
Urine
10 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
73.
Protein: creatinine
ratio
Urine
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
74.
Protein
electrophoresis
Serum
3ml2
Urine
0 ml
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
HKL
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
75.
PSA (total)
Serum
Plain tube
Urine collection
container
3 ml
Plain tube
16
CHEMICAL PATHOLOGY
NO.
76.
77.
TEST
Renin
Salicylate Acid
SPECIMEN
TYPE
EDTA
Serum
VOLUME
REQUIRED
3 ml
3 ml
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
EDTA in ice
By appointment,
Complete PER
PAT.301 form and
send it along with
sample immediately to CPDRL.
UMMC
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
Gribbles
78.
SHBG
Serum
3 ml
Plain tube
Complete
Gribbles
Laboratory
Request Form
and send it along
with sample to
CPDRL within 2-4
hours.
79
Sodium
SerumUrine
(random)
3 ml20 ml
container
Send to CPDRL
within 2-4 hours.
CPDRL
IMR
80.
Thyroglobulin
Serum
3 ml
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
81.
Testosterone
(total)
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Hosp. Sg Buloh
82.
Total iron binding
capacity (TIBC)
Serum
3 ml
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
83.
Triglyceride
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
84.
Troponin T
Serum
3 ml
Plain tube
Send to CPDRL
immediately.
CPDRL
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
Test will be
rejected if last request was within
6 weeks.
CPDRL
3ml20 ml/24
hours urine collection
container
Send to CPDRL
within 2-4 hours
For 24 hours
urine, refrigerate
during collection.
CPDRL
85.
TSH
Serum
SerumUrine
(random/
24 hours)
86.
Total protein
87.
Urea
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
88.
Uric acid
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
17
CHEMICAL PATHOLOGY
NO.
TEST
89.
Urine pregnancy
test (UPT)
Urine
90.
Urobilinogen
Urine
91.
92.
93.
Valproic acid
Vancomycin
Vitamin B12
SPECIMEN
TYPE
Serum
Serum
Serum
VOLUME
REQUIRED
2ml
10 ml
3 ml
3 ml
3 ml
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
Urine collection
container
Send to CPDRL
within 2-4 hours.
CPDRL
Urine collection
container
Send to CPDRL
within 2-4 hours.
CPDRL
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
Plain tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
Hosp. Sg Buloh
INSTRUCTION
DESTINATION
CPDRL
PROFILE
NO.
TEST
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
Fasting serum
lipids
1
1. TC
2. TG
3. LDL-c
4. HDL-c
Serum
3 ml
Plain tube
Fasting sample
required (at least
8 hours fasted)
Send to CPDRL
within 2-4 hours.
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Liver Function
Test
2
1. Total protein
2.Albumin
3. Total bilirubin
4. Conjugated
bilirubin
5. ALT
6. ALP
7. GGT
Renal Profile
3
1. Urea
2. Creatinine
3. Sodium
4. Potassium
18
CHEMICAL PATHOLOGY
PROFILE
NO.
TEST
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
Serum
3 ml
Flouride tube
Send to CPDRL
within 2-4 hours.
CPDRL
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Urine
20 ml
Urine collection
container
Send to CPDRL
within 2-4 hours.
CPDRL
CSF
1-2 ml
Bijou bottle
Send to CPDRL
within 2-4 hours.
CPDRL
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
MGTT
4
1. Glucose
2. Glucose-2HPP
BUSE
5
1. Urea
2. Sodium
3. Potassium
Urine FEME
(urine dipstick)
6
1. Blood
2. Bilirubin
3. Urobilinogen
4. Ketone
5. Protein
6. Nitrite
7. Glucose
8. pH
9 Specific gravity
10. Leucocytes
CSF
biochemistry
7
1. Glucose
2. Chloride
3. Protein, Total
Female infertility
studies
8
1. FSH
2. LH
3. Estradiol
4. Progesterone
Thyroid Function Test
9
1. TSH
2. Free T4
19
CHEMICAL PATHOLOGY
PROFILES
NO.
TEST
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Serum
3 ml
Plain tube
Send to CPDRL
within 2-4 hours.
CPDRL
Plain tube
Complete BP Lab
Request Form
and send it along
with sample to
CPDRL within 2-4
hours.
BP Lab
HKL
CPDRL
Amenorrhea
studies
10
1. FSH
2. LH
3. Oestradiol
Short Synacthen
Test (cortisol)
11
1. Cortisol,
0 hour
2. Cortisol,
30 min
3. Cortisol,
60 min
Screening
test for Down
Syndrome
12
1. Alpha fetoprotein (AFP)
2. Beta HCG
(total)
3. Estriol
Serum
3 ml
24 hours urine
24 hours urine
collection
Urine 24 hours
container
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
Refrigerate during
collection.
Whole Blood
1ml
Heparin 1cc
syringe
Send to lab
immediately in ice
waterbath
Cathecolamines
13
14
1. Epinephrine
2. Norepinephrine
3. Dopamine
Arterial Blood
Gases
1.pH
2.PCO2
3.PO2
4.HCO3
5.Sodium
6.Potassium
7.Chloride
8.Calcium
20
ANATOMIC PATHOLOGY
INTRODUCTION
The Anatomic Pathology Unit provides two main services:
Histopathology
Macroscopic and microscopic examination of tissue with
interpretative diagnosis. This concerned on the assessment
of specimens removed at surgery or non-surgical biopsy
procedures.
Cytology
Diagnostic and screening services based on the morphologic study of cells. It is divided into two categories:
i) Gynae based cytology – Conventional pap smear or
Thin Prep.
ii) Non-gynae based cytology – Fine needle aspiration
cytology, brushings and fluid cytology.
HISTOPATHOLOGY
ROUTINE SURGICAL AND BIOPSY SPECIMEN
SPECIMEN COLLECTION
All specimen must be sent to the reception counter of the
histopathology laboratory at Ground Floor, IMMB building.
Multiple specimens must be completely collected prior to
arrival to the counter.
REQUISITION FORM
All specimen have to be accompanied by requisition form.
All required areas MUST be filled LEGIBLY.
All specific details MUST be written on the form (e.g urgent/
early/biohazard).
Request for histopathology or cytology have to be filled in a different form.
SPECIMEN
All specimens MUST be labelled with the name and one
identification number. If multiple labelling needed, ensure no overlapping occur.
All specimen for routine histopathological examination should be fixed in 10% of formalin in suitable leak-proof container,
unless stated otherwise ( eg. renal biopsy ). The volume of formalin used is at least 10 times of the specimen / samples
to be fixed. Formalin and containers can be collected at
pharmacy during office hours.
Do not put large specimen in small container as this would prevent proper fixation of the tissue and it may cause distortion to the specimen.
21
ANATOMIC PATHOLOGY
Specimens not in fixative must be kept in the aquisition place within a freezer until specimen could be sent to the counter when its reopens. If the specimen is of utmost importance the pathologist must be notified by the requesting specialist.
Multiple specimens must be labelled properly and this must be done by the medical officer/specialist. The staff must be responsible to re-check the details on the specimen package prior to dispatch.
REJECTION CRITERIA
Specimen with no request form, damaged or incompletely filled request forms.
Unsuitable material, biological or non-biological material, sent for histopathological examination ( eg. gallstone, pus,
prosthesis etc)
FROZEN SECTION
This service is ONLY offered during office hours ( 8 am- 4pm )
The laboratory must be informed not less than 24 hours prior to the frozen section ( with a requisition form )
Any urgent/unbooked frozen section request must involve the communication with the requesting surgeon and the
pathologist.
If booked frozen section is not required, the laboratory must be informed of the cancellation.
All specimen for frozen section must be sent fresh without any preservative in a closed container.
All the specimen should be sent immediately upon removal to the laboratory
Interpretation will be given to the requesting surgeon via phone call and documented.
High risk infectious material WILL NOT be accepted for
processing.
22
ANATOMIC PATHOLOGY
CYTOLOGY
NON-GYNAE CYTOLOGY
REQUESTS
All specimens MUST be appropriately identified and
accompanied by a completed request form.
Details of hazard status where relevant must be indicated on both the request form and specimen container
Inadequately labelled specimens/incomplete request forms will not be accepted by laboratory staff.
Specimens should be transported to the laboratory on the same day as collection.
Specimens should be refrigerated if transport is delayed
(e.g. weekends).
Fine Needle Aspiration Cytology and brushings
Spread aspirated material onto glass slides labelled in pencil with the patient’s name.
The smears should be fixed immediately with fixative.
Body Fluid Cytology
Collect specimens into sterile universal containers and l
abelled.
Sputum Cytology
The specimen should be obtained from early morning deep cough sputum, before the patient eats, drinks or cleans their teeth, and collected into a sterile sputum container.
GYNAECOLOGICAL CYTOLOGY
SAMPLES AND REQUEST FORMS
Please use legible handwriting when completing request forms.
SAMPLING
Use appropriate method (Conventional or Thin Prep )
Conventional smear have to be fixed with alcohol and dried.
Histopathologist on duty will validate all results of all tests
during office hours and results will be released manually. There would be no results generated and released after
office hours.
Turn Around Time ( TAT )
Urgent/Biopsy Specimen : 3 days ( except for complicated cases )
Surgical Specimen : 14 days
Gynae cytology : 14 days | Non-Gynae : 14 days
23
HAEMATOLOGY
INTRODUCTION
The Haematology Unit provides diagnostic and consultative services to CTC for patient management. It also serves as
a centre of excellence for research purposes.
There are two main services operating in Haematology Unit:
a) Routine haematological test
(please refer to the attached list)
b) Transfusion service:
The National Blood Bank (PDN) on periodic basis supplies blood bags and blood products to our blood bank.
Patients admitted to the wards and require transfusion will have their blood grouped and cross-matched by our blood bank staff.
The attending physician needs to fill up the blood transfusion form (PDN form) to request for blood or blood products for patients. Blood samples should be collected in one EDTA and one plain tubes. Both form and tubes must be sent to the CPDRL in a biohazard bag.
Cross matching will only be performed for requests of blood packs and compatible blood packs will be released to the wards.
In the event where antibodies are detected during the
screening procedure, fresh blood samples will be requested and should be collected in similar manner. These samples will be sent to the National Blood Bank for antibody identification and acquisition of compatible blood.
All blood packs i.e. whole blood (WB) and packed cells (PC) and other blood products (fresh frozen plasma, platelet) MUST be kept AND remain in the CPDRL UNTIL the time of
transfusion. This is very IMPORTANT as cell viability and
functionality will be SIGNIFICANTLY affected with improper storage.
24
HAEMATOLOGY
REQUEST FORMS
All haematology tests from Sg. Buloh Campus should be requested using ‘CPDRL request form’.
All tests from Selayang Campus can be requested from the Laboratory Information System (LIS) and on manual basis in the event that the online system breaks down.
Standard request form KKM - PER PAT-301 and PDN format form should be used for outsourced test.
DISPATCH OF SPECIMENS / SAMPLES
Urgent specimens should be sent to the laboratory by the clinic/ward staff.
RECEIPT OF SPECIMEN
All specimens will be received at the Main Specimen Reception Area either send by pneumatic tube or porter.
SERVICE AFTER OFFICE HOURS AND DURING PUBLIC HOLIDAYS
The haematology laboratory provide 24 hour service for all
routine tests.
Urgent request must involve the communication between the requesting clinician and the haematologist.
Urgent results will be informed via phone to ward/clinic.
Haematologist / Scientific Officer (SO) on duty will validate all abnormal results during office hours prior to them being released manually.
Normal results will be released manually without requiring validation by Haematologist and Scientific Officer.
For Turn-Around-Time ( TAT ), please refer appendix.
25
HAEMATOLOGY
LIST OF TEST
NO.
TEST
1.a
Complete Blood
Count
1.b
Complete Blood
Count + Differential Count
(CBC+Diff)
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
Blood
EDTA Tube
2.5ml
To reach laboratory within 4
hours.
CPDRL
Blood
EDTA Tube
2.5ml
hours.
CPDRL
Sodium Citrate
1.8 ml
Specialised
container.
CPDRL
2.
Erythrocyte
Sedimentation
Rate (ESR)
Blood
3.
G6PD Screen
Blood
Filter Paper
0.5ml
4.
Osmotic Fragility
Blood
Heparinised Tube
5 ml
By appointment
HKL
5.
Reticulocyte
Count
Blood
EDTA Tube
2.5ml
hours.
CPDRL
6.
Bone Marrow
Aspiration (BMA)
Bone Marrow
EDTA Tube/Slide
2.5ml + 5 fresh
smears
By Appointment
CPDRL
7.
Bone Marrow
Trephine Biopsy
BM Trephine
Plastic tube with
10% formalin
Not Applicable
By Appointment
CPDRL
8.
Full Blood Picture
(FBP)
Blood
EDTA Tube
2.5ml
hours.
CPDRL
9.
Immunophenotyping for CD55 and
CD59
Blood
ACD
4ml
Send sample
immediately
HKL
10.
Hb Analysis
Blood
EDTA Tube
2.5ml
By Appointment
HKL
11.
D-Dimer
Blood
Trisodium Citrate
Tube
To mark on tube
Send the sample
immediately
CPDRL
12.
DNA Analysis for
Alpha Thalassaemia
Blood
EDTA
2.5ml.
By appointment
& Send the
sample
immediately
HKL
13.
DNA Analysis for
Beta Thalassaemia
Blood
EDTA
2.5ml.
Send the sample
immediately
IMR
14.
Fibrinogen
Activity
Blood
Trisodium Citrate
Tube
To mark on tube
Send the sample
immediately
PDN
15.
Immunophenotyping
Blood
EDTA Tube
2.5 ml.
By appointment &
send the sample
immediately
HKL
16.
Sickle test
Blood
EDTA Tube
2.5ml
By appointment
HKL
17.
Sucrose Lysis
Test
Blood
ACD
4ml
By Appointment
HKL
18.
T and B Cell
Enumeration
Blood
EDTA Tube
2.5ml
By appointment &
send the sample
immediately
HKL
26
CPDRL
HAEMATOLOGY
LIST OF TEST
NO.
TEST
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
19.
Von Willebrand
Factor Activity
(VWF)
Blood
Trisodium Citrate
Tube
To mark on tube
By appointment &
send the sample
immediately
PDN
20.
Prothrombin Time
Blood
Trisodium Citrate
Tube
Fill to the mark
on tube
Send the sample
immediately
CPDRL
21.
Activated Partial
Thromboplastin
Time (APTT)
Blood
Trisodium Citrate
Tube
Fill to the mark
on tube
Send the sample
immediately
CPDRL
22.
International
Normalised Ratio
(INR)
Blood
Trisodium Citrate
Tube
Fill to the mark
on tube
Send the sample
immediately
CPDRL
23.
Fibrinogen
Blood
Trisodium Citrate
Tube
Fill to the mark
on tube
Send the sample
immediately
CPDRL
24.
Thrombin Time
Blood
Trisodium Citrate
Tube
Fill to the mark
on tube
Send the sample
immediately
CPDRL
INSTRUCTION
DESTINATION
SPECIAL TESTS
NO.
TEST
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
1
COAGULATION
SCREEN ( Prothrombin Time,
APTT, INR )
Blood
Trisodium Citrate
Tube
To mark on tube
By appointment &
send the sample
immediately
CPDRL
2
DIVC SCREEN
(PT, INR, APTT,
TT, Fibrinogen,
D-Dimer)
Blood
Trisodium Citrate
Tube
To mark on tube
To reach lab
within 4 hours
CPDRL
3
THROMBOPHILIA SCREEN
Blood
Trisodium Citrate
Tube (x3)
To mark on tube
By appointment &
send the sample
immediately
PDN
27
INTRODUCTION
Medical microbiology plays a major role in the infectious disease discipline and knowledge in this field is essential to the clinical management of infections.
Microbiology unit is particularly involved in the identification of the causative organism, as well as management of the patient, screening, monitoring and research development.
SERVICES
Microbiology unit provides the following services:
Diagnostic and research services which comprise bacteriology, virology,mycology, parasitology and immunology.
Participation in hospital infection control activities related to
antibiotic monitoring and surveillance, as well as control and prevention of hospital acquired infections.
REQUEST FORMS
All Microbiology and Parasitology tests from Sg. Buloh Campus should be requested using ‘CPDRL request form’.
All tests from Selayang Campus should be requested from the Laboratory Information System (LIS) and on manual basis in the event that the online system breaks down. Standard
request form KKM - PER PAT-301 should be used for
outsourced test.
SPECIAL COLLECTION PROCEDURES
BLOOD
Specimen collection
All blood C&S specimens should be collected prior to antibiotic administration.
Skin decontamination with 70% alcohol followed by povidone iodine should be carried out prior to venepuncture.
CSF
Specimen collection
CSF specimens must be collected prior to antimicrobial therapy.
Place CSF into sterile leak-proof container.
Submit a sufficient volume of fluid. Suggested volumes are:
2 ml for bacterial culture
2 ml for fungal culture
2 ml for mycobacterial culture
28
Specimen transport
Transport CSF specimens to the laboratory immediately.
Do not refrigerate CSF specimens unless viral studies are requested
SPUTUM
Specimen collection
First morning sputum should be collected as the specimen of choice.
Mycobacteriology request (AFB and TB culture) :
Three (3) consecutive days (morning) sputum should be collected as the specimen of choice.
Sputum is expectorated directly into a sterile container.
Specimen that is grossly salivary is unsatisfactory for bacteriological examination and such specimen will be
rejected.
URINE
Specimen collection
First morning voided urine should be collected as the
specimen of choice.
If this is not possible, the urine should be allowed to incubate in the bladder a minimum of 2 hours before collection.
This is an important point to remember for patients with
indwelling catheters.
Midstream urine (MSU) - The periurethral area (tip of penis in male, labial folds and vulva in female) is cleansed well with soap and water. The first portion of the voiding urine is not collected. At least 5ml of the midstream portion of the early morning is voided directly into a sterile container.
Catheterized urine - These specimens are obtained by
aspirating urine from the proximal lumen of the catheter with a syringe (Do NOT collect specimen from the urine bag).
Suprapubic aspiration - Direct the needle into the urinary
bladder just above the symphysis pubis after the suprapubic skin decontamination done. Aspirate the urine with a syringe, and transfer to a sterile container.
Specimen transport
Immediate dispatch(1-2 hours) is expected.
If this is not possible, specimen should be kept in the
refrigerator (no longer than 18 hours). Therefore it is important that the time of specimen collection is marked on the patient’s request.
29
RECEIPT OF SPECIMEN
All specimens will be received at the Specimen Reception Counter of
Medical Microbiology laboratory send by a porter.
A preliminary report of positive results of all sterile body fluids/‘alert
organism’ will be informed via phone, and by Clinical Microbiologist or
Scientific officer on duty and documented. Final report will be issued on manual basis for Sg. Buloh Campus and via LIS/HIS for Selayang Campus respectively.\
For Turn-Around-Time ( TAT ), please refer appendix.
SERVICE AFTER OFFICE HOURS AND DURING PUBLIC HOLIDAYS
Specimens sent for bacteriology, mycology and serology will be processed as usual on weekends and public holidays from 8.00 am to 4.00 pm.
Urgent test request must involve the communication between the requesting clinician and the Clinical Microbiologist.
There is one (1) MLT working on stand-by basis to process urgent(eg: CSF) specimen.
SUPPLIES
The supply of containers relevant to microbiological examination can be obtained from the central store for Sg. Buloh Campus and Selayang
Campus respectively.
30
LIST OF TEST
NO.
1.
TEST
AFB stain
SPECIMEN
TYPE
Sputum/tracheal
aspirates/BAL/
NPA/
VOLUME
REQUIRED
3ml
SPECIMEN
CONTAINER
Sterile
Pleural fluids and
other body fluids
2.
TB Culture
All specimens
3ml
Sterile
INSTRUCTION
DESTINATION
Collect 3
consecutive early
morning (Fresh)
sputum (Not Saliva) aseptically
into the container.
Send to the lab
within 2-4 hours.
CPDRL
Collect 3
consecutive early
morning (Fresh)
sputum (Not Saliva) aseptically
into the container.
UMMC
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
3.
Bacterial Antigen
(Latex Antigen
detection)
4.
Burkholderia
pseudomallei
antibody
5.
Chlamydophila
pneumoniae/
C.trachomatis/
C.psittaci
antibody
6.
Clostridium
difficile Toxin and
culture
7.
Culture and
Sensitivity
CSF
Blood
Blood
Stool (fresh)
Blood
3ml
5ml
5ml
Not applicable
5ml-10ml (adult)
31
Sterile
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
immediately.
HOSP.
SG.BULOH
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
IMR
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
HOSP.
SG.BULOH
Stool container
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
HOSP.
SG.BULOH
Inoculate blood
under aseptic
technique into
a manufacturer
Blood Culture
bottle. If the
sample is not
sent immediately,
please do not
refrigerate it.
Please leave it at
room temperature.
CPDRL
Blood culture
bottle
LIST OF TEST
NO.
TEST
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
8.
Culture and
Sensitivity
Sputum/tracheal
aspirates/BAL/
NPA/Pleural fluids
3ml
Sterile
Send sample to
CPDRL within 2-4
hours
CPDRL
9.
Culture and
Sensitivity
Per nasal swab
Not applicable
Amies Transport
Medium
Send sample to
CPDRL within 2-4
hours
CPDRL
10.
Culture and
Sensitivity
Throat Swab
Not applicable
Amies Transport
Medium
Send sample to
CPDRL within 2-4
hours
CPDRL
11.
Culture and
Sensitivity
Nasal Swab
Not applicable
Amies Transport
Medium
Send sample to
CPDRL within 2-4
hours
CPDRL
12.
Culture and
Sensitivity
CSF
1- 3ml
Sterile
Do not refrigerate.
Send immediately.
CPDRL
13.
Culture and
Sensitivity
Peritoneal fluid
5ml
Sterile
Send immediately.
CPDRL
14.
Culture and
Sensitivity
Ear discharge
Not applicable
Sterile
Send sample to
CPDRL within 2-4
hours.
CPDRL
15.
Culture and
Sensitivity
Vitreous and
Aqueous Fluid
1-3ml
Sterile
Send immediately.
CPDRL
16.
Culture and
Sensitivity
Eye discharge
Not applicable
Sterile
Send sample to
CPDRL within 2-4
hours
CPDRL
17.
Culture and
Sensitivity
Contact lens
Not applicable
Sterile
Send sample to
CPDRL within 2-4
hours
CPDRL
18.
Culture and
Sensitivity
Corneal Scrapping
Not applicable
Sterile
Send immediately.
CPDRL
19.
Culture and
Sensitivity
HVS
Not applicable
Amies Transport
Medium
Send sample to
CPDRL within 2-4
hours
CPDRL
CPDRL
20.
Culture and
Sensitivity
LVS
Not applicable
Amies Transport
Medium
Only for the rape
(medicolegal)
case investigation. Send
immediately.
21.
Culture and
Sensitivity
Urethral Swab
Not applicable
Amies Transport
Medium
Send sample to
CPDRL within 2-4
hours.
CPDRL
CPDRL
CPDRL
22.
Culture and
Sensitivity
Urine
5ml
Sterile
Please collect
early morning
midstream urine
and send it along
with sample to
CPDRL within 2-4
hours
23.
Culture and
Sensitivity
Stool
Not applicable
Stool container
Send sample to
CPDRL within 2-4
hours.
32
LIST OF TEST
NO.
TEST
24.
Culture and
Sensitivity
25.
Culture and
Sensitivity
Pus
26.
Culture and
Sensitivity
Wound swab/
ulcer swab
27.
Culture and
Sensitivity
28.
29.
30.
Culture and
Sensitivity
Legionella
Antigen
Leptospira
antibody
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
Rectal swab
Not applicable
Tissue
Bone marrow
Urine
Blood
INSTRUCTION
DESTINATION
Cary-Blair transport medium
Send sample to
CPDRL within 2-4
hours
CPDRL
Not applicable
Sterile
Please specify
site of collection.
Send it along with
sample to CPDRL
within 2-4 hours
CPDRL
Not applicable
Amies Transport
Medium
Please specify
site of collection.
Send it along with
sample to CPDRL
within 2-4 hours
CPDRL
Sterile
Please specify
site of collection.
Send it along with
sample to CPDRL
within 2-4 hours
CPDRL
Blood culture
bottle
Inoculate bone
marrow under
aseptic technique
into a manufacturer Blood
Culture bottle. If
the sample is not
sent immediately,
please do not
refrigerate it.
Please leave it at
room temperature.
CPDRL
Sterile
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours.
HOSP. SG.
BULOH
HOSP. SG.
BULOH
Not applicable
5-10ml (adult)
2-3ml (paediatric)
5ml
5ml
Gel tube
31.
Rickettsia
antibody
Blood
5ml
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
32.
RPR
Blood
5ml
Gel tube
Send sample to
CPDRL within 2-4
hours
CPDRL
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
33.
TPPA/TPHA
Blood
5ml
33
LIST OF TEST
NO.
34.
TEST
Widal Test (Salmonella antibody)
SPECIMEN
TYPE
VOLUME
REQUIRED
Blood
5ml
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
UMMC
INSTRUCTION
DESTINATION
Sterile
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Sterile
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Sterile
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
VIROLOGY AND SEROLOGY
NO.
TEST
1.
Adenovirus
Antigen ( IF)
2.
Cytomegalovirus
IgM
3.
Cytomegalovirus
IgG
4.
5.
6.
7.
8.
Dengue IgM
NS1
Antigen(Dengue)
Enterovirus
Antigen(IF)
Epstein Barr Virus
IgM
Epstein Barr Virus
IgG
SPECIMEN
TYPE
Sputum/tracheal
aspirates/NPA/
BAL
Blood
Blood
Blood
Blood
CSF
Blood
Blood
VOLUME
REQUIRED
Not applicable
5ml
5ml
5ml
5ml
1ml
5ml
SPECIMEN
CONTAINER
Gel tube
5ml
Gel tube
34
LIST OF TEST
NO.
TEST
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
HOSP. SG.
BULOH
9.
Hepatitis A Virus
IgM
Blood
5ml
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
10.
Hepatitis B
surface antigen
(HBsAg)
Blood
5ml
Gel tube
Send sample to
CPDRL within 2-4
hours
CPDRL
11.
Hepatitis B
surface antibody)
(HBsAb)
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
12.
Hepatitis B core
IgM (HBc IgM)
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
13.
Hepatitis B core
total antibody
(HBc total Ab)
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
14.
Hepatitis B e
Antigen (HBeAg)
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
15.
Hepatitis B e Antibody (HBeAb)
Blood
5ml
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
16.
Hepatitis C Antibody (Anti HCV)
Blood
5ml
Gel tube
Send sample to
CPDRL within 2-4
hours
CPDRL
17.
Herpes simplex
Type 1 & 2
Antigen (IF)
Skin lesion/genital
lesion
Smears on slide
Please call the
‘MLT’ for smears
on teflon coated
slide
HOSP. SG.
BULOH
18.
Herpes simplex
Type 1 & 2
Antibody (IgM)
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Blood
Blood
Blood
Blood
Blood
5ml
5ml
5ml
5ml
Gel tube
Not applicable
5ml
35
LIST OF TEST
NO.
TEST
19.
Herpes simplex
Type 1 & 2
Antibody (IgG)
20.
21.
SPECIMEN
TYPE
VOLUME
REQUIRED
Blood
HIV 1 &2 Antigen/
antibody COMBI
5ml
Blood
HIV 1 &2 (Particle
agglutination)
5ml
Blood
22.
HIV 1 &2 (Western Blot)
Blood
23.
Influenza A Virus
Antigen (IF)
Sputum/tracheal
aspirates/NPA/
BAL
24.
Influenza B Virus
Antigen (IF)
Sputum/tracheal
aspirates/NPA/
BAL
25.
Japanese
encephalitis
Antibody (IgM)
26.
Japanese
encephalitis
Antibody (IgG)
5ml
5ml
Not applicable
Not applicable
Blood
Blood
5ml
5ml
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
CPDRL
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Sterile
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
UMMC
Sterile
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
UMMC
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
36
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
LIST OF TEST
NO.
27.
28.
29.
TEST
Measles Virus
Antibody (IgM)
Measles Virus
Antibody (IgG)
Mumps Virus
Antibody (IgM)
SPECIMEN
TYPE
Blood
Blood
Blood
30.
Mumps Virus
Antibody (IgG)
31
Nipah Virus
Antibody (IgM)
32.
Nipah Virus
Antibody (IgG)
33
Parvo Virus
Antibody (IgM)
34
Parvo Virus
Antibody (IgG)
Blood
35
Respiratory
Syncytial Virus
Antigen (IF)
Sputum/tracheal
aspirates/NPA/
BAL
Blood
Blood
Blood
Blood
VOLUME
REQUIRED
5ml
5ml
5ml
5ml
5ml
5ml
5ml
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
Sterile
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Sterile
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
UMMC
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
UMMC
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Sterile
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Gel tube
5ml
Not applicable
37
LIST OF TEST
MYCOLOGY
NO.
1.
2.
TEST
Aspergillus Species Antibody
Cryptococcal
Antigen
SPECIMEN
TYPE
Blood
CSF/Blood
VOLUME
REQUIRED
5ml
5ml
5-10ml (adult)
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Sterile/Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP. SG.
BULOH
Blood culture
bottle
Inoculate blood
under aseptic
technique into
a manufacturer
Blood Culture
bottle. If the
sample is not
sent immediately,
please do not
refrigerate it.
Please leave it at
room temperature.
CPDRL
3.
Fungal Culture
and Sensitivity
Blood/bone marrow and other
body fluids
2-3ml (paediatric)
4.
Fungal Culture
and Sensitivity
CSF
1-3ml
Sterile
Send immediately
CPDRL
5.
Fungal Culture
and Sensitivity
Pleural fluid
5ml
Sterile
Send immediately
CPDRL
6.
Fungal Culture
and Sensitivity
Peritoneal fluid
5-10ml
Sterile
Send immediately
CPDRL
7.
Fungal Culture
and Sensitivity
Pus
Not applicable
Sterile
Send sample to
CPDRL within 2-4
hours
CPDRL
8.
Fungal Culture
and Sensitivity
Vitreous/Aqueous Fluid
3ml
Sterile
Send immediately
CPDRL
9.
Fungal Culture
and Sensitivity
Hair
Not applicable
Wrap with filter
paper
Send sample to
CPDRL within 2-4
hours
CPDRL
10.
Fungal Culture
and Sensitivity
Nail
Not applicable
Wrap with filter
paper
Send sample to
CPDRL within 2-4
hours
CPDRL
CPDRL
HOSP. SG.
BULOH
11.
Fungal Culture
and Sensitivity
Tiissue
Not applicable
Sterile
Please specify
site of collection.
Send sample to
CPDRL within 2-4
hours
12.
Histoplasma
Antibody
Blood
5ml
Gel tube
Send sample to
CPDRL within 2-4
hours
38
LIST OF TEST
IMMUNOLOGY
NO.
TEST
1.
Anti-nuclear
antibody (ANA)
2.
Anti - double
stranded DNA
antibody (AntidsDNA)
3.
Anti- mitochondrial antibody
(AMA)
4.
5.
6.
7.
Anti - phospholipid antibody
Lupus anticoagulant
Anti-cardiolipin
Anti-Ro (SS-A)
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
Blood
5ml
Blood
Blood
Blood
Blood
Blood
Blood
5ml
5ml
5ml
5ml
5ml
5ml
INSTRUCTION
DESTINATION
Gel tube
Send sample to
CPDRL within 2-4
hours
CPDRL
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP.
SELAYANG
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP.
SELAYANG
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP.
SELAYANG
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP.
SELAYANG
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP.
SELAYANG
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
HOSP.
SELAYANG
HOSP.
SELAYANG
CPDRL
Gel tube
8.
Anti - La (SS-B)
Blood
5ml
Gel tube
Complete PER
PAT.301 form and
send it along with
sample to CPDRL
within 2-4 hours
9.
Rheumatoid factor (RF)
Blood
5ml
Gel tube
Send sample to
CPDRL within 2-4
hours
39
LIST OF TEST
PARASITOLOGY
NO.
TEST
SPECIMEN
TYPE
VOLUME
REQUIRED
SPECIMEN
CONTAINER
INSTRUCTION
DESTINATION
1.
Malaria Microscopy (BFMP)Thin & Thick
Blood Smears
Blood
2ml
EDTA
Send immediately
CPDRL
2.
Microfilaria Microscopy – Thin
& Thick Blood
Smear
Blood
2ml
EDTA
Send sample to
CPDRL within
operational hours
CPDRL
3.
Microfilaria
Microscopy (Knott
Method)
Blood
2ml
EDTA
Send sample to
CPDRL within
operational hours
CPDRL
4.
Trichomonas
vaginalis – wet
mount
HVS
Not applicable
Amies Transport
Medium
Send immediately
CPDRL
5
Ova & Cysts – Microscopy (Direct
Smear)
Stool
20-50 gm
Stool container
Send sample to
CPDRL within 2-4
hours
CPDRL
6
Ova & Cysts –
Microscopy (FEC
method)
Stool
20-50 gm
Stool container
Send sample to
CPDRL within 2-4
hours
CPDRL
7
Coccidian Oocysts
(Crypto, Isospora,
Cyclospora) –
special staining
methods
Stool
20-50 gm
Send sample to
CPDRL within 2-4
hours
CPDRL
40
Stool container
APPENDIX
CHEMICAL PATHOLOGY TESTS AND INDICATIONS
TEST
INDICATIONS
Hemoglobin A1c
1.To monitor blood glucose control in individuals with diabetes mellitus.
(Indicate the mean blood glucose level in 3 months)
2.HbA1c predicts the development of diabetic complications in diabetes patients and can be
used for the diagnosis of diabetes mellitus.
HDL-C
1.To determine the risk of atherosclerotic disease.
2.Elevated HDL-cholesterol concentrations are protective against coronary heart disease,
while reduced HDL-cholesterol concentrations, particularly in conjunction with elevated
triglycerides, increase the cardiovascular risk
Potassium
1.To evaluate an electrolyte imbalance.
2.Hypokalaemia can be found in reduced intake of dietary potassium or excessive loss of
potassium from the body by prolonged vomiting, diarrhea, or increased kidney excretion.
3. Hyperkalaemia may be caused by dehydration or shock, severe burns, diabetic ketoacidosis, and retention of potassium by the kidney.
Sodium
1.To evaluate electrolyte imbalance.
2.Decreased levels of sodium include prolonged vomiting or diarrhea, diminished reabsorption in the kidney and excessive fluid retention.
3.Increased sodium includes excessive fluid loss, high salt intake, and increased kidney
reabsorption.
Chloride
2.Decreased chloride includes reduced dietary intake, prolonged vomiting, reduced renal
reabsorption as well as some forms of acidosis and alkalosis.
3.Increased chloride values are found in dehydration, kidney failure, some forms of acidosis,
high dietary or parenteral chloride intake, and salicylate poisoning
LDL
1.To determine the risk of atherosclerotic disease.
2. Strong predictor for coronary atherosclerosis.
Magnesium
2.Increased serum magnesium concentrations occur in renal
failure, acute diabetic acidosis, dehydration, or Addison’s disease.
3. Hypomagnesemia may be observed in chronic alcoholism, malabsorption, severe diarrhea,
acute pancreatitis, diuretic therapy, prolonged parenteral fluid therapy without magnesium
supplementation, and kidney disorders such as glomerulonephritis and tubular reabsorption
defects.
Phosphorus
To evaluate the level of phosphorus and a as a marker to evaluate an abnormal calcium level.
Total protein
Total protein measurements are used in the diagnosis and treatment of a variety of diseases
involving the liver, kidney, or bone marrow, as well as other metabolic or nutritional disorders.
Triglycerides
The determination of triglycerides is utilized in the diagnosis and treatment of patients having
diabetes mellitus, nephrosis, liver obstruction, lipid metabolism disorders and numerous other
endocrine diseases.
41
APPENDIX
CHEMICAL PATHOLOGY TESTS AND INDICATIONS
TEST
INDICATIONS
Uric acid
Uric acid measurements are used in the diagnosis and treatment of numerous renal and
metabolic disorders, including renal failure, gout, leukemia, psoriasis, starvation or other
wasting conditions, and of patients receiving cytotoxic drugs.
Urea
Urea is the most widely used screening test for renal function
Free T4
1.To evaluate thyroid gland function
2.To help in the diagnosis of hypothyroidism or hyperthyroidism.
3.To screen for hypothyroidism in newborns
CK-MB
The determination of CK-MB mass in serum is an important element in the diagnosis of
myocardial ischemia.
Cortisol
The cortisol status of a patient is used to diagnose the function or malfunction of the adrenal
gland, the pituitary, and the hypothalamus
eg: 1) Overproduction (e.g. Cushing’s syndrome)
2) Underproduction (e.g. Addison’s disease)
Estradiol
1.The determination of estradiol is utilized clinically in the elucidation of fertility disorders
in the hypothalamus-pituitary-gonad axis, gynecomastia, estrogen-producing ovarian and
testicular tumors and in hyperplasia of the adrenal cortex.
2.Further clinical indications are the monitoring of fertility therapy and determining the time of
ovulation within the framework of in vitro fertilization
FSH
1.Determination of the FSH concentration is used in the elucidation of dysfunctions within the
hypothalamus-pituitary-gonads system.
2.The determination of FSH in conjunction with LH is utilized for the following indications:
congenital diseases with chromosome aberrations, polycystic ovaries (PCO), amenorrhea
(causes), and menopausal syndrome.
LH
1.Determination of the LH concentration is used in the elucidation of dysfunctions within the
hypothalamus-pituitary-gonads system.
2.The determination of LH in conjunction with FSH is utilized for the following indications: congenital diseases with chromosome aberrations (e.g. Turner’s syndrome), polycystic ovaries
(PCO), clarifying the causes of amenorrhea, menopausal syndrome, and suspected Leydig
cell insufficiency
PROGESTERONE
The determination of progesterone is utilized in fertility diagnosis for the detection of ovulation
and assessment of the luteal phase.
TESTOSTERONE
1.The determination of testosterone in women is helpful in the diagnosis of androgenic
syndrome (AGS), polycystic ovaries (Stein-Leventhal syndrome) and when an ovarian tumor,
adrenal tumor, adrenal hyperplasia or ovarian insufficiency is suspected.
2.Testosterone is determined in men when reduced testosterone production is suspected,
e.g. in hypogonadism, estrogen therapy, chromosome aberrations (as in the Klinefelter’s
syndrome) and liver cirrhosis.
TROPONIN
Cardiac troponin T (cTnT) is an independent prognostic marker which can predict the near-,
mid- and even long-term outcome of patients with acute coronary syndrome
42
APPENDIX
CHEMICAL PATHOLOGY TESTS
REFERENCE RANGE
No.
TESTS
METHOD
SPECIMEN
TYPE
1.
Alanine
Aminotransferase
(ALT)
IFCC Modified (no
pyridox. phosphate)
Serum
Males : <41.0 U/L
Females : <33.0 U/L
2.
Albumin
BCG-Citrate Buffer
Serum
Adults : 35-52 g/L
Pediatric range:
Newborns : 0-4d : 28-44 g/L
Children : 4d-14d : 38-54 g/L
Children 14-18yr : 32-45 g/L
Immunoturbidimetric
2nd morning
Urine
Urine 24 h
REFERENCE RANGE/UNIT
Adults : <20.0 mg/L
<30 mg/24h
3.
Alkaline Phosphatase
(ALP)
AMP Buffer-rate
(IFCC)
Serum
Adults:Males : 40-130 U/L
Females : 35-105 U/L
Children:- 1 d : <250 U/L
2-5 d : <231 U/L
6d-6m : <449 U/L
7m-1yr : <462 U/L
1yr-3yr : <281 U/L
4yr-6yr : <269 U/L
7yr-12yr : <300 U/L
13yr-17yr :<187 U/L(Females)
13yr-17yr :<390 U/L(Males)
4.
Aspartate Aminotransferase (AST)
IFCC Modified (no
pyridox. phosphate)
Serum
Males : <40.0 U/L
Females : <32.0 U/L
5.
Bilirubin (direct)
Diazonium salt
Serum
Adults : < 5.0 µmol/L
6.
Bilirubin (total)
Diazonium salt
Serum
Adults : <21.0 µmol/L
Children with age > 1 month : <17.0 µmol/L
7.
Calcium
o-Cresolphthalein
complexone (no
dialysis)
Serum
0-10d : 1.89-2.59 mmol/L
10d-2yr : 2.24-2.74 mmol/L
2-12yr : 2.19-2.69 mmol/L
12-60yr : 2.09-2.54 mmol/L
60-90yr : 2.19-2.54 mmol/L
>90yr : 2.04-2.39 mmol/L
8.
CKMB-mass
Electrochemiluminescence (Sandwich)
Urine 24
Hrs
2.5-7.5 mmol/24h
Serum
Males : 4.94 µg/L
Females: 2.88 µg/L
43
APPENDIX
REFERENCE RANGE
No.
TESTS
9.
Creatinine
METHOD
SPECIMEN
TYPE
Jaffe (Alk.Picraterate,compensated)
Serum
Adults:
Males : 62-106 µmol/L Females: 44-80 µmol/L
Children
Neonates(premature) : 25-91 µmol/L
Neonates (full term) : 21-75 µmol/L
2-12m : 15-37 µmol/L
1-<3y : 21-36 µmol/L
3-<5y : 27-42 µmol/L
5-<7y : 28-52 µmol/L
7-<9y : 35-53 µmol/L
9-<11y : 34-65 µmol/L
11-<13y : 46-70 µmol/L
13-<15y : 50-77 µmol/L
10.
Creatinine
Jaffe (Alk.Picraterate,compensated)
Urine 24 Hr
Females : 7-14 mmol/24h
Males : 9-21 mmol/24h
Creatinine clearance
Adults : 71-151 mL/min
11.
Cholesterol
Cholesterol Oxidase/
Peroxidase
Serum
Adults : <5.2 mmol/L
12.
Creatinine Kinase
Catalytic CK activity
(340nm)
Serum
Men : <190.0 U/L
Women : <170.0 U/L
13.
Cortisol
Electrochemiluminescence (Competitive)
Serum
Morning(7-10 am) : 171 – 536 nmol/L
Evening(4 -8 pm) : 64 – 327 nmol/L
14.
C-Reactive Protein
(Latex)
Particle enhanced
turbimetric assay
Serum
Adults : < 5.0 mg/L
15.
Estradiol
Serum
Females:Follicular Phase : 46 – 607 pmol/L
Ovulation Phase : 315 –1828 pmol/L
Luteal Phase : 161 – 774 pmol/L
Postmenopause :<18.4– 201 pmol/L
Males: 28 – 156 pmol/L
Pregnancy(1st trimester) :789-> 15781
Children (1 -10 years)
Boys : < 18.4 – 73.4 pmol/L
Girls : 22 – 99.1 pmol/L
16.
Follicle Stimulating
Hormone (FSH)
Serum
Females:Follicular Phase : 3.5 – 12.5 IU/L
Ovulation Phase : 4.7 – 21.5 IU/L
Luteal Phase : 1.7 – 7.7 IU/L
Postmenopaus: 26 – 135 IU/L
Males : 1.5 – 12.4 IU/L
44
APPENDIX
REFERENCE RANGE
No.
TESTS
METHOD
SPECIMEN
TYPE
17.
18.
Free Triiodotyro-nine
(FT3)
Chemilumine-scent (Competitive)
Serum
Infant (1D -23M) : 5.1 - 8.0 pmol/L
Children (2Y -12Y) : 5.1 - 7.4 pmol/L
Adolescent (13Y-21Y) : 4.7 -7.2 pmol/L
Adult : 3.5 – 6.5 pmol/L
Free Thyroxine (FT4)
Chemilumine-scent
(Competitive)
Serum
Infant (1D -23M) :12.1 - 18.6 pmol/L
Children (2Y -12Y) :11.1-18.1 pmol/L
Adolescent (13Y-21Y) : 10.7-18.4 pmol/L
Adult (euthyroid) :11.5 – 22.7 pmol/L
Urine 24
Hrs
CSF
Adult: < 2.78 mmol/24h
Children : 3.33-4.44 mmol/L
Adults : 2.22-3.89 mmol/L
Synovial
Fluid
Adult : 3.5-6.0 mmol/L
Pleural fluid
Adult : 3.5-6.0 mmol/L
19.
Gamma-Glutamyltransferase (GGT)
Enzymatic colorimetric assay
Other g-Glut-3carboxy-nitro
Serum
Males: <60 U/L
Females : <40 U/L
20.
HBA1C
Immunoturbidimetric
Plasma
According to IDF
Adult : < 6.5 %
21.
HDL-Cholesterol
Non sep-DxSO4/PEG
mod enzymes
Serum
According to NCEP ATP III Guidelines
Females : >1.3 mmol/L
Males : > 1.0 mmol/L
22.
ISE (Na, K, Cl)
ISE-Indirect (diluted)
Serum
Sodium : 136-145 mmol/L
Potassium: 3.5-5.1 mmol/L
Chloride : 98-107 mmol/L
23.
LDL-Cholesterol
According to Friedewald’s formula
Serum
Target LDL-c based on 10-years CHD risk score (Framingham risk score)
Low risk : <4.1 mmol/L
Moderate risk: <3.4 mmol/L
High risk: <2.6 mmol/L
24.
Luteinizing Hormone
(LH)
Serum
Females:Follicular Phase : 2.4 – 12.6 IU/L
Ovulation Phase : 14 – 96 IU/L
Luteal Phase : 1.0 – 11.4 IU/L
Postmenopause : 7.7 – 59 IU/L
Males: 1.7 – 8.6 IU/L
25.
Magnesium
Chlorophosphonaze III
Serum
Premature: 0.57-0.78 mmol/L
Children & adults: 0.70-1.05 mmol/L
Urine 24
Hrs
2.5-8.5 mmol/24hrs
45
APPENDIX
REFERENCE RANGE
No.
TESTS
METHOD
SPECIMEN
TYPE
26.
Osmolality
Freezing point
depression
Serum
Adults : 270 - 295 mOsm/kg
Urine
Adults : 300 – 900 mOsm/kg
27.
Phosphate
Phosphomolybdate
formation
Serum
Adults : 0.87-1.45 mmol/L
Children:
Neonates(premature):1.3-2.8 mmol/L
Neonates: 1.6-3.1 mmol/L
2-12m : 1.6-3.5 mmol/L
>1y : 1.1-2.0 mmol/L
28.
Progesterone
Serum
Females:Follicular Phase : 0.6 – 4.7 nmol/L
Ovulation Phase : 2.4 – 9.4 nmol/L
Luteal Phase
: 5.3– 86 nmol/L
Postmenopaus : 0.3 – 2.5 nmol/L
Males: 0.7 – 4.3 nmol/L
29.
Prolactin
Serum
Females (not pregnant) : 102-496 µIU/mL
Males : 86-324 µIU/mL
30.
Total Protein
Biuret/endpoint (with
blank)
Serum
Adults : 66-87 g/L
Serum
31.
Testosterone
Pediatric range :Premature: 36-60 g/L
Newborn : 46-70 g/L
1 week: 44-70 g/L
7m-1yr : 51-73 g/L
1-2 yr : 56-75 g/L
>3yr : 60-80 g/L
Females
20 - 49 years : 0.084 - 0.481 ng/mL
≥ 50 years : 0.029 – 0.408 ng/mL
Men
20 – 49 years : 2.49 – 8.36 ng/mL
≥ 50 years : 1.93 – 7.40 ng/mL
32.
Thyroid Stimulating
Hormone (TSH)
33.
Total Protein Urine/
CSF
Chemilumine-scent
(sandwich)
Serum
Urine
(random)
Urine 24Hrs
CSF
Synovial
Fluid
34.
Triglycerides
Lipase/Glycerol
kinase/GPO-PAP
2 to <12y/o : 0.64 – 6.27mIU/L
12 to <18y/o : 0.51 – 4.94 mIU/L
>18 y/o : 0.55 – 4.78 mIU/L
Adults : <0.15 g/L
Adults : <0.14 g/24h
Adults : 0.15-0.45 g/L Adults : <25.0 g/L
Pleural fluid
Adults : 10.0 – 20.0 g/L
Serum
According to NCEP ATP III Guidelines
Adults : <1.7 mmol/L
46
APPENDIX
REFERENCE RANGE
No.
TESTS
35.
Troponin T
36.
Urea
37.
Uric acid
METHOD
SPECIMEN
TYPE
Serum
Adults : < 0.010 µg/L
Urease-Kinetic
(340nm)
Serum
Adults (<65y) : <8.3 mmol/L
Adults (>65y) : <11.9 mmol/L
Uricase/peroxidase
Urine (24 h)
Adults : < 580 mmol/24h
1st morning
urine
Adults : 150-500 mmol/L
Serum
Males : 202.3-416.5 µmol/L
Females : 142.8-339.2 µmol/L
Blood Gases
NO.
TESTS
METHOD
SPECIMEN
TYPE
1.
pH
Potentiometric
electrodes
Blood
ABG
: 7.35 – 7.45
VBG : 7.31 - 7.41
2.
pCO2
Severinghaus
principle
3.
pO2
Clark measurement
ABG : >80.0 mmHg
VBG : 30 – 40 mmHg
4.
HCO3
Calculated test
ABG : 21 – 26 mmol/L
5.
Sodium
Potentiometric
electrodes
ABG :135 – 148 mmol/L
6.
Potassium
Potentiometric
electrodes
ABG
7.
Chloride
Potentiometric
electrodes
ABG : 98 – 107mmol/L
8.
Calcium
Potentiometric
electrodes
ABG : 1.12 – 1.32 mmol/L
*ABG – Arterial blood gases
*VBG – Venous blood gases
ABG:
Men
: 32.0 – 43.0 mmHg
Women : 35.0 – 46.0 mmHg
VBG : 41 – 51 mmHg
47
: 3.5 – 4.5 mmol/L
APPENDIX
REFERENCE RANGE
Urine Full Examination Microscopic Examination (FEME)
No
TEST
1.
Bilirubin
2.
Erythrocytes
3.
METHOD
UiTM Selayang
UiTM Sg. Buloh
Diazonium salt
Coupling of bilirubin
with diazotized
dichloroaniline
< 0.34 µmol/L
(Negative)
< 0.34 µmol/L
(Negative)
Peroxidase-like activity of Hb
Peroxidase-like activity of Hb
<5/µL (Negative)
<3/µLm (Negative)
Glucose
Glucose oxidase/
peroxidase reaction
Method
Hexokinase Assay
< 0.84 mmol/ L
(Negative)
< 1.67 mmol/L (Negative)
4.
Ketone
Legal’s test
Sodium Nitroprusside
Assay
<0.5mmol/L (Negative)
<2 mg/dL (Negative)
5.
Leucocytes
Reaction between
cleaved indoxyl ester
with diazonium salt
Hydrolysis of derivatized pyrrole amino
acid ester
<10/µL (Negative)
<10/µL (Negative)
6.
Nitrite
Griess test
Sulfanilamide-HTBQ
Assay
Negative
Negative
7.
pH
pH Meter
pH Meter
4.8 – 7.4
4.0 - 8.0
8.
Protein
Protein error of a pH
indicator
Human serum albumin indicator
<0.1 g/ L (Negative)
<0.15 g/ L (Negative)
9.
Specific gravity
Detection of ion concentration (Presence
of cation, protons are
released and produce
color change)
Total Solids meter
1.015 -1.025
1.001 -1.035
10.
Urobilinogen
Ehrlich’s Test
Watson’s Aldehyde
Assay
<16.9 µmol/L
< 16.9 µmol/L
48
UiTM Selayang
UiTM Sg. Buloh
APPENDIX
HAEMATOLOGY TESTS
REFERENCE RANGE
Parameter
Unit
Men
(Adult)
Women
(Adult)
Children
(7M – 12M)
Children
(2Y – 6 Y)
Children
(6Y – 12Y)
WBC
x109/L
4 – 10
4 – 10
6 – 16
5 - 15
5 – 13
RBC
x1012/L
4.5 – 5.5
3.8 – 4.8
3.9 – 5.1
4.0 – 5.2
4.0 – 5.2
HGB
g/dL
13.0 – 17.0
12.0 – 15.0
11.1 – 14.1
11.0 – 14.0
11.5 – 15.5
HCT
%
40 – 50
36 – 46
30 - 38
34 – 40
35 – 45
MCV
fL
83 – 101
83 – 101
72 – 84
75 – 87
77 - 95
MCH
pg
27 – 32
27 – 32
25 – 29
24 – 30
25 – 33
MCHC
g/dL
31.5 – 34.5
31.5 – 34.5
32.0 – 36.0
31.0 – 37.0
31.0 – 37.0
PLT
x109/L
150 – 410
150 – 410
200 – 550
200 – 490
170 - 450
NEUT
%
40 – 80
40 – 80
-
-
-
LYMP
%
20 - 40
20 – 40
-
-
-
MONO
%
2 - 10
2 – 10
-
-
-
EOS
%
1-6
1–6
-
-
-
BAS
%
0 – 2 0–2
-
-
-
NEUT
x109/L
2.0 – 7.0
2.0 – 7.0
1.0 – 7.0
1.5 – 8.0 2.0 – 8.0
LYMP
x109/L
1.0 – 3.0
1.0 – 3.0
3.5 – 11.0
6.0 – 9.0
1.0 – 5.0
MONO
x109/L
0.2 – 1.0
0.2 – 1.0
0.2 – 1.0
0.2 – 1.0
0.2 – 1.0
EOS
x109/L
0.02 – 0.5
0.02 – 0.5
0.1 – 1.0
0.1 – 1.0
0.1 – 1.0
BAS
x109/L
0.02 – 0.1
0.02 – 0.1
0.02 – 0.1
0.02 – 0.1
0.02 – 0.1
Reticulocytes
%
Reticulocytes
x109/L
30 – 100
30 – 100
0.5 – 2.5
50 – 100
50 – 100
30 – 100
Coagulation Test
TEST
UNIT
VALUE
REMARKS
Normal range depends
on reagent lot number
Prothrombin Time (PT)
Seconds
12 -15
Activated Partial Thromboplastin Time (APTT)
Seconds
31 - 47
Fibrinogen
Thrombin Time
g/dl
2 - 4 Seconds
14 - 21
49
APPENDIX
HAEMATOLOGY TURN AROUND TIME ( TAT )
No.
Test
TAT for STAT
TAT for Routine Inpatient
TAT for Routine Outpatient
1.
CBC
1 hour
4 hours
5 days
2.
CBC+Diff
1 hour
4 hours
5 days
3.
Coagulation tests
90 minutes
4 hours
5 days
4.
ESR
-
3 hours
5 days
5.
PBF
Pathologist to be informed on urgent case
5 working days
6.
Outsourced tests:
- Hb Analysis
- DNA Analysis
- Thrombophilia profile
- Protein C
- Protein S
- Lupus Anticoagulant
-
30 working days
MEDICAL MICROBIOLOGY TURN AROUND TIME ( TAT )
IN HOUSE SPECIMENS
No.
List of Test
1
Culture and Sensitivity- All samples
2
Blood Culture C&S
- Preliminary results
3
Serology Test
i)Anti HIV
ii)HBsAg
iii)Anti HCV
4
Needle Stick Injury
i)Anti HIV
ii)HBsAg
iii)Anti HCV
5
Rapid Test
i)RPR
ii)ANA
iii)RF
6
BFMP
TAT
2-5 days
1 hour
Run twice a week
(Tuesday and Friday)
3-7 days
2 hours
Run twice a week
(Tuesday and Friday)
3-7 days
3 hours
50
APPENDIX
OUTSOURCED SPECIMEN
NO
LIST OF TEST
OUTSOURCE LAB
1
Antinuclear cytoplasmic antibody
(ANCA)
i)p-ANCA
ii)c-ANCA
TAT
IMMUNOLOGY
2
Tryptase
3
Anti-nuclear antibody (ANA)
4
Anti - double stranded DNA
antibody (AntidsDNA)
5
Liver Autoantibody Screening
1.Anti- mitochondrial antibody
(AMA)
2.Anti Smooth Muscle Ab
(ASMA)
3.Anti Liver Kidney MicrosomalAb (anti LKM)
4.Anti Gastric Parietal Cell Ab
(GPC)
6
ENA (Extra nuclear antibody)
1.Anti Smith
2.Anti RNP
3.Anti Ro (SSA)
4.Anti La (SSB)
5.Anti Jo
6.Anti Scl 70
7.Anti Histones
7
IgA
IgM
IgG
8
Brucella IgG
Brucella IgM
9
Meliodosis IgM
10
Total IgE
IgE to Aspergillus
11
Legionella Antigen
12
Leptospira antibody
13
Rickettsia antibody
14
Toxoplasma IgG
Toxoplasma IgM
15
Mycoplasma Ab Total
16
Chlamydophila pneumoniae/
C.trachomatis/ C.psittaci
antibody
17
Anti Streptolysin O
IMR
7-10 working days
HOSPITAL SELAYANG
7-10 working days
BACTERIOLOGY AND SEROLOGY
IMR
7-10 working days
HOSPITAL SUNGAI BULOH
7-10 working days
51
APPENDIX
OUTSOURCED SPECIMEN
NO
LIST OF TEST
OUTSOURCE LAB
18
TB Culture
19
TB PCR/Line Probe Assay
20
Widal Test (Salmonella antibody)
TAT
BACTERIOLOGY AND SEROLOGY
UMMC
2 months
3 working days
7-10 working days
VIROLOGY AND SEROLOGY
21
Hepatitis B e Antigen (HBeAg)
22
Hepatitis B e Antibody (HBeAb)
23
Hepatitis A Virus IgM
24
Hepatitis B core IgM (HBc IgM)
25
Hepatitis B core total antibody
(HBc total Ab)
26
Cytomegalovirus IgM
27
Cytomegalovirus IgG
28
Dengue IgM
29
NS1 Antigen (Dengue)
30
Herpes simplex Type 1 & 2
Antibody (IgM)
31
Herpes simplex Type 1 & 2
Antibody (IgG)
32
Rubella IgG
Rubella IgM
33
HIV PA
34
HCV PA
HOSPITAL SUNGAI BULOH
52
7-10 working days
NOTES
53
Fakulti Perubatan
Universiti Teknologi MARA,
Kampus Sungai Buloh
Selangor Darul Ehsan.

CPDRL Laboratory Handbook - The Centre for Pathology Diagnostic

Transcription

Similar documents

zazu`s

Tube Lines - London Underground Network

Ampeg SVT-CL Schematics

beschriftung komplettsystem_gb

DynaShield

12 FT X 12 FT PE SUN SHELTER NETTING_instruction

DynaShield

Embedding a You Tube or Teacher tube video onto

The StethoSCOOP - University of Cincinnati College of Medicine