QML Pathology Test Reference Manual

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Reference Manual

CONTENTS

CONTENTS

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

Click on the links below to jump to the required section Introduction 1.0

Preface 5.0

Mission Statement

1.1

Company History

1.2

Collection Facilities 2.0 Collection Centres A-Z Special Tests

2.1 2.13

Additional Services 3.0 Vaccine Service

3.1

Travel Health Service

3.1

Warfarin Service

3.2

Occupational Pathology

3.4

Vetnostics

3.5

Collection Materials 4.0

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Full Screen

Appendices 12.0

Departmental Directions on Specimen Collection, Storage and Transport Biochemistry

5.1

Blood Bank

5.9

Cytology

5.11

Endocrinology

5.21

Genetics

5.25

Haematology

5.31

Histology

5.35

Immunology

5.47

Microbiology

5.51

Biochemistry Common Causes of Abnormal Biochemical Results Serum Tumour Markers Common Biochemistry Reference Ranges Glucose Tolerance Test Gestational Diabetes Dietary Restrictions and Special Diets Qualitative Urine Drug Screen Quantitative Drug Assays for Therapeutic Monitoring Poisons and Toxic Substances Used in Pest Control Acid Base Analysis Lipids Endocrinology Pregnancy Timeline Investigation of Hirsutism Recommended Age Guidelines for Men’s Health Testing

Test Listing A-Z 6.0 Test Selection Guide

6.1

Test Listing A-F

7.0

Test Listing G-L

8.0

Test Listing M-R

9.0

Specimen Storage

4.1

Order of Draw

4.2

Blood Collection Tubes

4.3

Specimen Containers

4.6

Test Listing S-Z

10.0

Swabs

4.14

Contact Details

11.0

Skin Devices

4.16

Rule 3 Exemption

11.1

Genetics Cytogenetic Tests Molecular Genetic Tests Haematology Basic Haematology Parameters Leucocyte Reference Ranges Initiating Warfarin Therapy Range of Target INRs Duration of Warfarin Therapy Drugs that Interact with Warfarin

12.1 12.1 12.4 12.7 12.9 12.9 12.10 12.13 12.15 12.18 12.19 12.21 12.23 12.23 12.26

Immunology Antibodies to Tissue Antigens (Autoantibodies) Antibodies to Microbial and Parasitic Agents Arbovirus Screen Skin Tests for Allergy RAST Allergen List Skin Allergen List Microbiology Infection Control in Medical Consulting Rooms Blood Collection, Waste Management, Handling Sharps Guidelines for Gloves, Handwashing Protocol Clean Up Procedure for Blood and Body Fluids Body Fluid Exposure Procedure Validation of your Steriliser Symbols for Hazardous Categories

12.35 12.35 12.36 12.37 12.37 12.38 12.40 12.41 12.41 12.43 12.44 12.45 12.46 12.47 12.49

12.27 12.29 12.29 12.30 12.31 12.31 12.31 12.32 12.32 12.33 12.34

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Home

CONTENTS

SPECIMEN STORAGE • All EDTA blood and blood films in Haematology are stored refrigerated for 1 week. Blood films showing significant pathology are archived for 1 year. • All Bone Marrow blocks and slides are archived for 14 years. • All sera in Biochemistry, Endocrinology and Haematology are stored refrigerated for 7 days after collection Note: Some analytes may deteriorate in this time. • Serum collected for viral, bacterial or parasitic antibody testing is kept frozen for 12 months to follow the course of the illness or to make a diagnosis retrospectively [Immunology (07) 3121 4458 or Branch Laboratory]. • Gram-stained slides and culture plates are kept in Microbiology for 1 week should further sensitivity testing or identification be required. • Histology tissue specimens are stored for 4 weeks before disposal. Blocks and slides are archived for 14 years. • All cytology smears and preparations (normal and abnormal) are archived for 14 years.

ORDER OF DRAW

Vacutainer & Syringe Method 1. Blood culture bottles

Aerobic bottle

Anaerobic bottle

Paediatric mini container

2. Pale blue top (Sodium citrate)**

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

Paediatric bottle

Tube MUST be filled to indicated level

COLLECTION MATERIALS



Paediatric micro container



4. Green/Orange top (Lithium heparin)

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

5. Pink/Lavender top (EDTA)



6. ESR (if required)

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

Please understand that incorrect or insufficient labelling can necessitate a recollection

7. Grey top (Fluoride oxalate)


8. Yellow top (ACD - Acid citrate dextrose)

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

Yellow rubber top

4.2

4.1

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

Blood Collection Tubes

Blood Bank EDTA tube

Serum separation tube (SS tube)

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

(Yellow plastic top) After clotting, the tube should be centrifuged for 10 minutes and may then be left refrigerated overnight. • Endocrinology tests (Thyroid function tests, FSH, LH, etc.) • E/LFT: including urea, glucose, electrolytes, liver function tests, cholesterol, triglycerides (lipids) • Autoantibodies (Including antisperm antibodies) • Microbial, parasitic and viral serology (hepatitis serology, rubella antibodies, etc.) • Pregnancy tests Paediatric • Paul-Bunnell test micro container • Tumour markers • Iron studies/B12 Plain tube (Red top) • All drug assays • Vitamin D




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

Tube MUST be filled to indicated level


Acid citrate dextrose - ACD tube Paediatric micro container

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

Fluoride oxalate tube

4.3


EDTA tube (Lavender top) •F ull blood count: including haemoglobin, white cell count, platelet count Paediatric Paediatric • Red cell folate micro container mini container • Hb EPP • ACTH • Hb A1C • ESR

4.4

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

Lithium heparin tube

SPECIMEN CONTAINERS

(Green top, orange top) • Used for a wide variety of tests covering biochemistry, haematology and genetics • Heavy metals screens • Chromosome analysis Paediatric Paediatric

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

micro container

mini container

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




Sterile container

Yellow monovette

Urine collection bottles • Used for timed urine collections. Patient instructions are written on the bottle. • The bottle should be refrigerated between collections. • Certain collections may need preservative (Check A-Z test listing of this Reference Manual).

ESR tube • ESR

8hr urine collection bottle

24hr urine collection bottle

4.6

4.5

Funnel

Aptima urine tube • Chlamydia trachomatis • Neisseria gonorrhoeae

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



COLLECTION MATERIALS Blood culture bottles • Adults take 16-20mL of blood on each occasion and divide evenly into 2 adult culture bottles (aerobic and anaerobic). • Children take 1-3mL of blood on each occasion and place in a paediatric blood culture bottle. If difficulty is experienced in obtaining blood from some patients, the paediatric blood culture bottle will suffice for adults.

Aerobic bottle

Anaerobic bottle

Paediatric bottle

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

4.8

4.7

Faeces container

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

Skin scrapings containers

Sterile container

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




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

Nasopharyngeal tubing

4.9

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

4.10

Histology specimen container

Nasopharyngeal aspirate • RSV (Respiratory Syncytial Virus) • Influenza A & B, Parainfluenza 1, 2, 3, Adenovirus • Bordetella Pertussis PCR

Synovial fluid collection kit 1. Crystals, rheumatoid factor latex, gram stain and culture. Several mL in a sterile screw top (urine) container. 2. Cell count and differential. 1-2mL in lithium heparin (green top) tube to prevent specimen clotting. 3. Protein, albumin and glucose. 1-2mL in a EDTA (lavender top) tube.

Lithium Heparin tube

EDTA tube

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

Cervex brush Pap smear test kit




Sterile container Cytobrush Pap smear test kit

Cytology kits Monolayer cytology kit After preparing a conventional Pap smear, rinse the Cervex brush or preferred collection device thoroughly in the cell preserving solution. Transport the Pap smear in slide carrier and the labelled cell preserving solution to the laboratory.

4.12

4.11

Combination Pap smear test kit

Fine needle aspiration kit

Swabs

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

Bacteriology transport swab • May be left overnight at room temperature except where gonorrhoea or anaerobic infection is suspected. In these cases, please contact the laboratory to arrange prompt pick up.




4.14

4.13

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

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

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




2mm Punch Biopsy with internal plunger

2mm Punch Biopsy without plunger

Flocked swab (Dry flexible swab) • Used for PCR and respiratory viruses. • Store at room temperature before and after collection.

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

Nasopharyngeal swab (Dry swab)

4.16

4.15

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

Serum Calcium, Iron and Alkaline Phosphatase

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

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

Test Requirements at Time of Collection BLOOD, SERUM OR PLASMA TESTS Arterial or Venous Blood Gases Blood remains living, actively metabolising tissue after collection and unless measures are taken to slow or halt metabolic activity, misleading results will be obtained. It is important that blood collected for oxygenation and pH studies should be cooled on ice or cold packs as soon as possible (within 20 minutes) after collection or an artefactual metabolic acidosis (low pH and bicarbonate, with raised negative base excess) may ensue from red cell generation of lactic acid from glucose. A slower process, white cell aerobic metabolism leading to a slow fall of pO2 and a rise of pCO2 with apparent respiratory acidosis will further complicate interpretation. Serum Electrolytes, Glucose, Enzymes and Phosphate A living cell maintains a steep electrolyte gradient across the cell membrane with high extracellular sodium and chloride, and high intracellular potassium concentrations. In contrast, intracellular sodium and chloride and extracellular potassium concentrations are around 5% of the corresponding transmembrane levels. The maintenance of these gradients is an active process, requiring plentiful ATP. If blood is stored at room temperature, glucose is consumed (metabolised to lactic acid) to maintain the membrane gradients. This is accompanied by a fall of bicarbonate to 50

First Line Investigations FBC + E/LFT

FBC + E/LFT

APC-Resistance

Lupus Anticoagulant Duplex Imaging

Duplex Imaging

Factor V Leiden

ACLA

HDL/LDL

HDL/LDL

II 20210A Mutation

Homocysteine

Lipoprotein (a)

Lipoprotein (a)

BLOOD COUNTS

Protein S/C

Malignancy Screen

Homocysteine

Homocysteine

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

AT III

APC-Resistance

Lupus Anticoagulant Lupus Anticoagulant

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

FBC + E/LFT

Lupus Anticoagulant Factor V Leiden

ACLA

ACLA

APC-Resistance

II 20210A Mutation

Homocysteine

FBC + E/LFT

ACLA

Factor V Leiden

Making a Blood Film

II 20210A Mutation

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

Protein S/C AT III

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

5.31

ARTERIAL THROMBOEMBOLISM Age < 50

PREFACE - HAEMATOLOGY

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

Second Line Investigations

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

Factor VIII, IX, XI

Protein S/C

Clot Lysis

Protein S/C

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

PAI-1

AT III

Plasminogen

AT III

Clot Lysis

Plasminogen

Fibrinogen

Plasminogen

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

Plasminogen

PNH

Fibrinogen Assays

Factor V Leiden

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

PNH

II 20210A Mutation

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

Heparin Cofactor II

APC-Resistance

COAGULATION TESTS

Note these are CONDITIONAL MEDICARE items.

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

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

5.32



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

Please see Haematology Appendix (12.31).

BONE MARROW BIOPSY

ORAL ANTICOAGULANT CONTROL SERVICE

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

Only suitable patients can be enrolled in this service.

Information Required:

• Present dose

1. Anatomical site of collection

• Reason for therapy

2. If the aspirate was obtained with/without difficulty

• Other existing medical conditions

3. Consistency of bone

• Required INR range

4. Provisional diagnosis.

• Other current medication

Samples Required: 1. Labelled bone marrow aspirate smears x 12-15 2. Aspirate sample in Lithium heparin (black top) tube (required for chromosome analysis and marker studies) and an EDTA tube 3. Trephine and/or aspirate sample in formalin.

Patients must be registered by calling 1300 795 355. The following information is required for registration: • Patient details




• Duration of therapy • Please notify the controlling laboratory if there is a change in the nature and/or dosage of any concurrent medication the patient is taking as this may affect significantly the INR. Unregistered patients will be returned as Doctor Controls. For further information please refer to additional services section ‘Warfarin Services’ (3.2) or to the Haematology Appendix (12.32).

CELL MARKER STUDIES (Leucocyte/Leukaemia/Lymphoma) Blood Specimens Collect blood specimens into an ACD tube (yellow top) or if unavailable a Lithium heparin tube (green top). An EDTA tube must also be collected and a blood film prepared if there is no accompanying full blood count. Samples must be kept at room temperature (cool) and are suitable for analysis up to 24 hours after collection. Bone Marrow Aspirate Specimen A sample in a sterile Lithium heparin tube (green or black top) and 12-15 aspirate smears are required. Lymph Nodes and Fine Needle Aspirates Place lymph node specimens in antibiotic transport medium and keep cool. Important: Please refer to Histology Preface (5.35) for more details on specimen handling. Please refer to Cytology Preface (5.16) for details of FNA smear preparation and specimen handling.

5.34

5.33

Leucocyte Reference Ranges

• Please supply relevant patient and clinical information with each specimen. • Please indicate special requirements where appropriate e.g. tissue for microbial culture, special stains, cell marker studies, immunofluorescence, electron microscopy, suspicious or doubtful surgical margins, etc. • Please ensure all specimens are accurately labelled. • Where appropriate, specimen orientation should be indicated by the use of suture(s) or clearly indicated incisions or nicks placed on the tissue specimen together with an accompanying diagram and/or written explanation. In turn a diagram illustrating how the specimen was processed and, where appropriate, location of involved margins, etc. should accompany the pathology report. •A dvance notice of elective frozen section, pending cell tumour marker studies, skeletal muscle biopsy, cilial biopsy or renal biopsy is required.

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

Non-Routine Specimens Certain specimens and investigations require different or additional processing.

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

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

5.35

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

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

PREFACE - Histology

REQUEST REQUIREMENTS

The other half of the lymph node should be utilised for the production of touch imprints from the cut surface on two glass slides labelled with the patient’s name and date of birth. This is performed by gently grasping the capsular side of the lymph node with clean forceps and gently touching with a perpendicular motion the cut surface on each clean glass slide. It is essential not to use a lateral smearing motion. One of these slides is allowed to AIR DRY. The other slide is fixed by spraying with cytospray. Following this, the lymph node tissue should be immersed in formalin. If the lymph node(s) is/are very large they should be transected further into several thinner slices before being immersed in formalin to ensure adequate fixation of the entire specimen. These procedures will ensure preservation of tissue viability and morphological detail both of which are essential in the diagnosis and classification of lymphoma. 2. Tissues from other body sites which are suspected of being infiltrated by lymphoma should be treated in a similar way. 3. Fluids such as pleural fluid, ascitic fluid and CSF should be placed in a sterile container, without additives, kept cool and submitted to the laboratory as soon as possible. Peripheral Blood and Bone Marrow Cell marker studies on peripheral blood and bone marrow are useful in the identification of: • Acute leukaemias • Chronic leukaemias • Malignant lymphomas • Myeloma. The specimens (peripheral blood and bone marrow aspirate) may be collected in Lithium heparin tubes (green top and black top) and should be forwarded cooled to the laboratory as soon as possible with full clinical history and details of previous tests. Note: The cell surface marker studies are carried out on a flow cytometer in the Brisbane Central Laboratory. Tissue from country regions should be forwarded cooled to the nearest Branch Laboratory, which in turn will forward the specimen to the Brisbane Central Laboratory for processing.

5.36

PREFACE - Histology

PREFACE - Histology

First Trimester Abortions All the aborted tissue should be placed in sterile antibiotic transport medium (or, if unavailable, in sterile normal saline), refrigerated, and forwarded cooled to the Genetics Department (07) 3121 4461 or Branch Laboratory as soon as possible. The material required for cell culture will be isolated by the laboratory staff and the remainder of the material will be submitted for histological examination. Second Trimester Abortions and Still Births Please collect sterile samples of fetal skin from the back, and membranes and chorionic villi from the placenta and place in sterile antibiotic transport medium (or if unavailable, in sterile normal saline), refrigerate, and forward cooled to the laboratory as soon as possible. The remainder of the tissue may be placed in buffered formalin. However, if there is an intact fetus, the fetus should be kept refrigerated and discussed with a supervising pathologist as to what further actions and/or investigations are required. A fetus/stillbirth which is to undergo a subsequent autopsy (with parental consent required) must NOT be placed into formalin.

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

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

Note:

Electron Microscopy

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

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

2. Antibiotic transport medium, suitable for transportation of all viable tissues, is available on request from QML Pathology (07) 3121 4461, (07) 3121 4502 or Branch Laboratory. This should be stored frozen and thawed to room temperature when required. 3. A detailed pro forma outlining requirements for chromosome analysis of fetal tissue is available on request from QML Pathology.

Cilial Biopsy Cilial biopsies should have motility studies performed as part of their assessment. Advance notice (preferably a day) of the impending biopsy will enable the laboratory to prepare for the procedure. Two specimens are ideal, one for motility studies and the other for electron microscopy. If only one specimen is available, it must be placed into Hartmann’s buffer which is available on request from Histology (07) 3121 4426. If unavailable in Branch Laboratories, saline can be used. This must be submitted in a container at room temperature to the main Histology Department without delay (within 12 hours). The specimen for electron microscopy is submitted in 3% buffered glutaraldehyde, which is available on request.

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

5.37

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

PREFACE - Histology

Chromosome Analysis on Products of Conception/IUFD

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

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

5.38

PREFACE - Histology

PREFACE - Histology

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

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

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

Testicular Biopsy For optimal preservation of morphology, testicular biopsy tissue taken for investigation of infertility should be fixed in Bouin’s Fixative Solution rather than buffered formalin. Bouin’s Fixative Solution is available on request from Histology (07) 3121 4426 or your Branch Laboratory. Testicular biopsy for tumour diagnosis should only be performed if orchidectomy can proceed immediately after a positive diagnosis is made (usually by frozen section). If you have any doubts or queries please contact the laboratory prior to surgery.

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

SKIN BIOPSIES

(Skeletal) Muscle Biopsy

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

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

Oestrogen Receptor Assay Oestrogen and progesterone receptor status in breast cancer can be evaluated semiquantitatively by immunohistochemical methods. This routine method of analysis is available on formalin fixed tissue, and has replaced the previous assay requiring fresh frozen tumour tissue.

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

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present in each of the samples. Advance notice (preferably a few days) of the impending biopsy will enable the laboratory to have available the different fixation and transport media required and if necessary the equipment to divide the specimen.

PREFACE - Histology

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

Why Biopsy?

Many skin conditions are clinically distinctive, whilst others may require histology for specific diagnosis. At times, however, skin rashes may be both clinically and histologically puzzling, and we may only be able to offer a range of possible diagnoses suggested by the histology. The value of the biopsy may be limited by its size, the site selected for sampling, superimposed inflammatory changes, the application of topical agents, or concurrent use of medications. One of the major limiting factors is lack of sufficient clinical information. The histological report should be available one working day after the specimen is collected, although urgent results may be obtained within six hours if indicated. Delays may occur when further investigations, such as special stains, need to be performed, or if further clinical information is required. What Sort of Biopsy? Incisional Biopsy This is preferred by the pathologist as it is orientated and gives more information. It need only be about 6mm long, 2mm wide and 4mm deep. A biopsy for deeper lesions (including panniculitis) will obviously need to be longer and deeper. It should be orientated radially (not tangentially) and should include about 1mm of normal skin. Distinguishing between keratoacanthoma and squamous cell carcinoma may be very difficult on biopsy, and only an incisional biopsy provides adequate information.

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PREFACE - Histology

PREFACE - Histology

Punch Biopsy

Consider Culture

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

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

Shave Biopsy

Important Notes for Skin Biopsies

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

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

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

• Mark the biopsy site prior to performing the procedure. • Be gentle with the specimen to avoid crush artefact. • Consider special investigations such as immunofluorescence and culture. Send separate specimens for different tests - do not divide biopsies. • The major role of biopsy in pigmented lesions is to confirm the clinical diagnosis of a pigmented, nonmelanocytic lesion. If a lesion is thought to be melanocytic, and especially if it is atypical, then narrow, but complete excision rather than biopsy is strongly recommended.

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

Technical Details

Pigmented Lesions

What to Call Your Specimen

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

PREFACE - Histology

PREFACE - Histology

PREFACE - Histology

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

The pathologist performing the macroscopic examination needs to know whether a piece of skin this shape is an excision biopsy or an incision biopsy. Most specimens require division before being processed. A piece of skin this shape should be divided this way if it is an excision specimen as these transverse sections will display the margins of excision in relation to a tumour.

Immunofluorescence If, however, it is an incision specimen, it will remain whole so that sections display the full length of the specimen. If it is more than 3.0mm wide, it will be divided longitudinally: For technical reasons we reduce our tissue blocks to about 2.0mm thickness. To avoid a good incision biopsy being partly wasted or an excision biopsy that cannot be assessed for completeness of tumour removal, please specify excision or incision biopsy.

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

Selecting the Biopsy Site

How to Biopsy Incision Biopsy

Punch Biopsy

1. Mark the Site Select and mark the site(s) to be biopsied. An ink marker is useful. 2. Skin Preparation Be thorough but gentle, so that no scale or scab is rubbed off. Allow alcohol to dry before starting a biopsy.

Blotchy, macular

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

sometimes unsuitable for punch

NOTE: Adrenaline should not be used in certain sites.

Papular

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

Vesicular, bullous

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

Discoid, plaque

Nodule, tumour

unsuitable for punch

PREFACE - Histology

PREFACE - Histology

PREFACE - Histology

6. Afterwards Place the biopsy in formalin. If necessary, submit further biopsies fresh for culture (or lymphocyte marker) or in immunofluorescence transport medium for immunofluorescence (sent out by the laboratory on request). Label the specimen, and please write some clinical notes on the pathology request form. Clinical Notes A clinical description (including clinical diagnosis or differential) is frequently useful in the diagnosis of tumours, and is usually essential in the diagnosis of rashes. Information should include: • Exact site • Size • Duration • Appearance • Symptoms • Drugs • Clinical diagnosis.

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

Skin Pathology Collection Devices

Skin Punch Biopsy Devices

BIOPBLADE™

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

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

Type of biopsy

Sizes available (mm)

Punch Biopsy with internal plunger

2, 3, 4

Punch Biopsy without plunger

2, 3, 4, 5, 6, 8

PREFACE - Histology

PREFACE - Histology

PREFACE - Histology

Punch Biopsy with internal plunger

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

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

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

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

• The clinical features and provisional diagnosis

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

• The date of onset of the condition

• Investigation for acute Hepatitis A (HAVIgM)

• If the patient is pregnant.

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

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

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

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

Antibody Profiles The detection of microbial infection using serological methods relies on observing the pattern of IgM and IgG responses. The first detectable response in a primary infection is IgM which usually lasts for a few weeks to months. A few days after the IgM appears it is usually possible to detect an IgG response, which lasts for an extended period of time (several years) and confirms the primary infection. The presence of IgG without IgM in a serum specimen normally reflects past exposure to the infectious agent and not acute infection. Although serological assays for the majority of infectious agents involve measurement of both IgM and IgG, there are some agents for which these two assays are not yet available. These are assayed by methods such as agglutination or complement fixation which may not discriminate IgG from IgM. Specimen Collection In most instances the serum from a full SS tube (yellow top) is sufficient for all combinations of viral, bacterial, fungal and parasitic serology. Plasma (from an EDTA or Lithium heparin collection) is generally not suitable because of an increased tendency to give false positive results. Note: The laboratory stores a patient’s serum for up to 12 months to enable further tests to be added as the clinical picture evolves, or to compare with specimens collected later in the clinical presentation. Microbial Serology in Pregnancy The standard antenatal tests consist of serology for one or more of the following agents: • Hepatitis B surface antigen • Syphilis • Rubella IgG • Hepatitis C.

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

PREFACE - IMMUNOLOGY

Microbial Serology

• Immune status for Hepatitis B (HBsAb) - pre- or post-vaccination (Note: tests for HBsAg and HBcAb may be indicated in some pre-vaccination screens) • Chronic infection/carriage of Hepatitis B (HBsAg and HBeAg, but may include HBsAb, HBcIgM, HBcAb if appropriate) • Hepatitis C (HCV) - all clinical conditions • Hepatitis D (HDV) - in individuals chronically infected with HBV • Hepatitis of uncertain etiology - (HBsAg, HBcAb, HAVIgM, HCV). There are clinical situations where other combinations of the above tests are more appropriate - if the clinician is uncertain then please consult the Immunology Department (07) 3121 4458 or Branch Laboratory. Hepatitis C RNA PCR Testing There is a Medicare rebate available under some circumstances for HCV RNA. To qualify for this rebate, the patient must fulfil at least one of the following criteria: • They are HCV antibody positive • They are HCV antibody positive and immunosuppressed/immunocompromised • They have indeterminate HCV serology • They are being investigated for acute HCV infection prior to seroconversion. Only 1 estimation is allowed in a 12 month period. If the patient does not qualify by these criteria, a non-refundable fee will be charged. If the patient does qualify, the relevant information should be supplied on the request In addition, there is now provision for extra Hepatitis C testing in patients undergoing specific antiviral therapy. Quantitative HCV RNA and HCV genotype may be performed on HCV antibody positive patients, when requested by or on behalf of a specialist physician or consultant managing the therapy. Only a single genotype determination is allowed in a 12 month period,

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Molecular Testing

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

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

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

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

• Are unable to attend for skin testing.

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

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

Tests Referred to Other Laboratories

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

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

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

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Allergen-Specific IgE in Serum (RAST)

• Have extensive skin disorders • Have dermatographism • Are taking antihistamines or steroids which cannot be temporarily discontinued


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

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

Please note:

• Each allergen (single or multiple) required must be specified on the request form. A separate request form is required for each group of 4 allergens. • Serum is stored in the Immunology Department for up to 12 months. Skin Prick Testing

Total IgE in Serum

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

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

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

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

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

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Request Form

Clinical specimens unsuitable for anaerobic culture:

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

• Coughed sputum

• Rectal swab

• Urine

• Swabs of superficial skin lesion

• Faeces

• Throat swab

• Ileostomy/colostomy drainage

• Urethral swab

• Nasopharyngeal swab

• Vaginal or cervical swab.

• Patient’s name and date of birth • Date and time of specimen collection • Site of sample and if the site is a surgical wound • Clinical history • Antibiotic therapy - past and present • Please indicate if the patient is immunosuppressed/immunocompromised • Please indicate if culture for Mycobacterium spp., fungi or unusual organisms such as Bartonella spp. Actinomyces, Nocardia, etc. is required.

Tissue, Body Fluids and Wound Swabs – General Principles Please note that aspirated pus and/or tissue samples are far superior to a swab for isolation and identification of organisms. Tissue samples may be submitted in a dry sterile container if no delay in transportation is anticipated. It is important to prevent dehydration of the tissue. If transportation is delayed, add a few drops of sterile saline to the dry tissue container. Aspirated material may be left in the syringe (carefully remove and discard the needle, expel all air, seal with a cap and tape securely) or it may be placed in a dry sterile container, if the specimen can be submitted to laboratory without delay.

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

PREFACE - MICROBIOLOGY



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

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

Anaerobic Culture Clinical specimens suitable for anaerobic culture: • Tissue biopsy • Blood • Bone marrow • Fluid from a sterile site (e.g. joint) • Material aspirated from abscesses • Peritoneal fluid • Suprapubic bladder aspirate • Bronchial washings obtained with double lumen plugged catheter • Decubitus ulcer, if obtained from the base of the ulcer after debridement of surface debris

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• Transtracheal aspirate.

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

2 x Blue Top Swabs

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• CSF

A series of three paired culture bottles (one aerobic, one anaerobic) is required for adults. A series of three single culture bottles (Paediatric) is required for children. Mycobacterial culture media are available for immunosuppressed patients. For VERY ILL patients three sets may be taken over a period of 30 minutes (10 minutes apart). Timing of cultures with fever peaks may be useful; however, clinical conditions may make this impractical. For CHRONIC ILLNESS the three cultures may be taken at intervals coinciding with fever peaks, the periodicity of which may be quite variable (hours to days). Venous and arterial blood are equally suitable. The bottles need to be marked so that only the correct amount is collected (8-10 mL for adults and 1-3 mL for children). If left to fill automatically they will continue to fill above the desired volume. The bottles also contain a resin which eliminates antibiotics and other toxins from the cultures. If difficulty is experienced in obtaining adequate blood volume from some patients, the following is advised: • One single adult aerobic bottle or one single paediatric bottle for smaller volumes. Note: The formulation of the culture broth in the paediatric bottle optimizes bacterial growth for small volumes (1-3 mL) of blood regardless of the source.

If several hours delay is anticipated before examination for ova, cysts and parasites, a small amount of semi-formed stool (the size of a pea) should also be placed into OCP (ova, cysts and parasites) transport medium. Note: It is not necessary for a formed stool specimen to be put into OCP transport medium, provided it arrives at the laboratory the same day as specimen collection. Both transport media are stored at room temperature. The remaining faeces specimen should be refrigerated until submitted to the laboratory. Special Cases Liquid stools - should be examined promptly. Please contact the laboratory to arrange immediate pick up. Amoebae - faeces for suspected amoebiasis must be examined within 30 minutes of collection. Contact the laboratory to arrange for immediate pick up and transport of specimen. Do not refrigerate. Rotavirus - faeces collected for Rotavirus do not require special transport media or precautions. The virus is only found in faeces during the acute stage of the illness. The specimen should be refrigerated while awaiting transportation and transported cooled to the laboratory as soon as possible.

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

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

Body Fluids

Nasopharyngeal Secretions

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

Nasopharyngeal secretions may be collected for viral PCR and Bordetella pertussis PCR.

Storage

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

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a pea-sized sample of the original specimen into faeces transport medium (bacterial) and send both containers to the laboratory.


Blood Culture

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

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

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

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

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

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

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

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Inferior Turbinate

8 FG Feeding tube is suitable for use with a 2050 mL capacity syringe. 8 FG Suction catheter is suitable for use with Oxyviva suction equipment. This should be connected to a sterile specimen trap as shown in the diagram.

• Bacterial transport swab (Stuart’s transport medium) • Viral culture transport swab (for viral PCR) • Two glass slides and slide carriers (smears)

Suction

• Blood agar plate • Chocolate agar plate

Catheter Trap

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

Urine After cleaning the external genitalia, a midstream voided urine should be collected by the clean catch method into a sterile container or for babies in a paediatric bag. An early morning collection is preferred. Other sources include catheters, cystoscopes, suprapubic aspirates and urines from ileal conduits. After collection aspirate the urine into the Monovette. Transport to the laboratory immediately. If transport to the laboratory is likely to be delayed refrigerate until transport is available. Suprapubic aspirates should be collected into a sterile container and refrigerated if transport to the laboratory is delayed.

Urine for Mtb Culture

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

Cutaneous Fungal Culture If superficial or deep mycoses are clinically suspected please indicate suspicion and specify fungal culture on the request form since superficial and deep fungi are not routinely screened for in material submitted for bacterial culture. Deep Mycoses If a deep mycosis is suspected a tissue biopsy offers an excellent source of material for culture and isolation of deep fungi. Fresh tissue should be placed in a sterile dry container, without additives, and submitted to the laboratory as soon as possible. If transport delay is anticipated add a few drops of sterile saline to the dry tissue container to prevent dehydration. Superficial Mycoses

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

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

Catheter Tips for Culture

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

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

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

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The kit includes the following material:


Equipment

• Please indicate on the request form the nature of the antifungal agent and the time of discontinuation. • Cosmetic preparations should be ceased one to two days prior to collection of the specimen. Skin (tinea or ringworm) Sterile normal saline is suitable for cleansing skin lesions from heavily contaminated sites such as feet and sweat areas. The active edge of the skin lesion should be scraped with a sterile scalpel blade and as many flakes and fragments as possible collected in a sterile dry screw top container or a fungal scrapings envelope. In cases of vesicular tinea pedis, the tops of any fresh vesicles should be removed as the fungus is often plentiful in the roof of

5.56



Scalp Broken diseased hair including the basal portion should be gently removed with sterile epilation forceps. If scales are present on scalp lesions these may be collected in addition to, but not instead of hair specimens. Specimens may be placed in a dry sterile screw top (urine) container (a clean, sealable paper envelope will suffice). Nail (onychomycosis) Seventy percent (70%) alcohol is a suitable agent for cleansing nail lesions. Use a sterile scalpel blade, scraping with the tip if necessary, to obtain the invaded nail tissue. The nail should be pared and scraped until the crumbling white degenerating portion is reached. Any white keratin debris beneath the free edge of the nail should also be collected. Collected material should be placed in a dry sterile screw cap container or a fungal scrapings envelope. Please note: • All collected material should be placed in clearly labelled sterile screw top containers or fungal scrapings envelopes. • Material from different sites should be placed in different containers (identified to site). • For site cleansing, a gauze square is preferable to a cotton wool ball. • If the scalpel blade used to scrape the skin is forwarded to the laboratory it must be placed in a sterile screw top (urine) container (NOT a paper envelope).

Cutaneous Ectoparasites Scabies The operator should wear gloves and materials required will be a sterile scalpel blade, paraffin oil, glass slide with frosted end labelled with patient identification (pencil) and cover slip. Examine the area for unexcoriated papules or for linear or wavy erythematous lines or burrows. Having found a likely area, place a drop of paraffin oil on the scalpel blade. Apply the scalpel blade to the papule so that the mineral oil goes onto the papule surface. Next, scrape vigorously about six to seven times with the blade to remove the entire top of the papule. Tiny flecks of blood should be mixed with the oil. Then, with the blade, remove all of the oil to a glass slide. Repeat this procedure with four or five different papules to the same glass slide. Apply the coverslip.

5.57

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

Pediculosis The diagnosis of head and crab lice is made by finding lice or nits on the hairs. Pull out diseased hairs with forceps and place in a sterile screw top container. The diagnosis of body lice can be confirmed by finding lice and nits in the seams of clothing, particularly underclothing. Samples of lice and nits may be placed in a sterile screw top container. These containers should be clearly labelled with patient identification and forwarded to the laboratory as soon as possible. Demodex Demodex folliculorum is a microscopic, cigar-shaped creature with eight stumpy legs and an annulate abdomen. They are found in the hair follicles and sebaceous glands, particularly on the nose and face, and probably infest over half of middle-aged adults. The infestation is usually asymptomatic and is often noted incidentally on skin biopsies and excisions of facial skin. Infestation may be associated with blackheads.


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

Infestation of eyelashes or hairs may be symptomatic. In order to sample it is necessary to pull out an eyelash. This may be placed in a sterile screw top container. Alternatively, it may be placed on a glass slide with oil, and coverslipped. Containers should be clearly labelled with patient identification. Slides should be clearly labelled with patient identification and placed in a slide carrier. The specimen should be forwarded to the laboratory as soon as possible.

Chlamydia/Gonorrhoea PCR Chlamydia PCR QML Pathology has introduced an APTIMA assay for the simultaneous detection of both Chlamydia trachomatis and Neisseria gonorrhoeae in the same sample. Both swabs and urines are suitable samples for detection of Chlamydia with this assay. QML Pathology supplies an APTIMA collection kit with detailed instructions on collection techniques. The swab pack contains a white shaft swab which is a cleaning swab and a blue shaft swab which is a collection swab. The blue shaft swab should be placed in the APTIMA tube containing transport medium. There are no special storage conditions for these collection kits. Chlamydia are obligatory intracellular parasites, which survive and multiply only within living cells. For diagnostic purposes it is essential to collect infected epithelial cells rather than mucopurulent exudate. Any purulent exudate or secretions should first be removed with a sterile swab. Swabs for conventional bacterial cultures should be taken prior to that for Chlamydia PCR. In WOMEN endocervical or urethral swabs should be collected. First catch urine is also a suitable alternative. In MEN a urethral swab OR a first catch urine sample may be collected. Swabs from the vagina or from the penile meatus are unsuitable. If clinically indicated throat or rectal swabs should be collected. The swab should be gently rotated and remain inserted sufficiently long to allow adequate sampling and absorption (5 seconds within the urethra, 20 seconds within the endocervical canal). Try to avoid touching the swab on the vaginal wall on entry or exit.

5.58



First catch urine samples are the recommended urine specimen. The first 20 mL of any voided urine collected in a sterile urine container is an acceptable alternative to a swab. (Note: the blue Monovette containing preservative is not suitable for PCR testing.) The patient should not have urinated for two hours prior to the test. In the case of conjunctival, throat or rectal infection, the sampling swab should be firmly rotated over the epithelial surface for between 10 and 20 seconds. In the case of the eye, the lower palpebral fissure is the most suitable site to sample. In infants nasopharyngeal swab or aspirate is appropriate. These swabs may cause some discomfort to the patient. After collecting the sample with the swab it is placed into the white capped transport medium tube, snapped off and the cap screwed down tightly. There are no special storage or transport conditions for sending the specimen to the laboratory. If delay is anticipated, urine specimens should be refrigerated and referred to the laboratory within 72 hours. Gonorrhoea PCR Using an APTIMA collection kit, collect swabs as per the instructions. Alternatively, a first catch urine may be used. If culture is required, a bacterial swab should be collected and sent in Stuart’s transport medium.

Viral Culture

Mantoux Test The objective of the Mantoux test is to examine an immune response 48 to 72 hours after an intradermal injection of purified protein derivative (PPD) of Mycobacterium tuberculosis and Mycobacterium avium. The technique involves injecting 0.1 mL of a solution containing 100 IU/mL of PPD (i.e. 10 IU per dose of 0.1 mL) using a 25 gauge needle into the dermis. This should raise a lump in the skin 5-6 mm in diameter. The injection should be repeated if it is too deep or if leakage occurs. The results are read 48 to 72 hours later. The clinician should palpate the site for the presence of oedema (induration). Erythema should be ignored. The diameter of the area of oedema measured at right angles to the long axis of the arm is recorded. Note: A handy card giving guidance on the performance and interpretation of the Mantoux test is available on request from QML Pathology Liaison Department (07) 3121 4943 or your local Branch Laboratory.




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

QML Pathology supplies viral culture swabs and transport medium for detection of viruses including Herpes simplex I and II, and Varicella zoster in the sample by PCR (polymerase chain reaction - Nucleic acid detection) method. Detailed instructions on specimen collection are supplied with each kit. The swabs should be placed on an ice brick in an insulated container and sent to the laboratory as soon as possible. They should be refrigerated if stored overnight. Results of the PCR are available within 24 hours. Special Collections for Cytomegalovirus Culture Positive CMV IgM serology under certain circumstances may require confirmation by detection of virus by PCR (e.g. suspected antenatal or neonatal infection). In these circumstances the specimens required include: • Further serum sample (SS tube) PLUS • 10 mL EDTA blood • Saliva swab in viral culture transport medium (Virocult) • Midstream urine in a sterile screw top (urine) container • High vaginal swab in viral culture transport medium (Virocult) (antenatal cases only).

5.60

5.59

Results of PCR are generally available in 24 hours.

Chemistry Acceptable test groupings approved abbreviations in parenthesis Blood Gases • pO2 • pCO2 • pH Electrolytes (E) • Sodium (Na) • Potassium (K) • Chloride (Cl)

• HCO3 • Base excess • O2 saturation

• Bicarbonate (HCO3) • Anion Gap

Immunoglobulins • IgG • IgA • IgM • IgE Lipid Studies • Cholesterol (CHOL) • Triglycerides (TRIG) • Classification of hyperlipidaemia where indicated • High density lipoprotein cholesterol when specifically requested (HDL)

6.1

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

Markers of Heart Disease • Troponin (most specific) • Myoglobin (earliest) • BNP (heart failure) Others: • Aspartate Amino Transferase (AST) • Lactate Dehydrogenase (LDH) • Creatine Kinase (CK), CKMB Specific Protein Quantitation • IgG • Alpha-1 antitrypsin • IgA • ACE (Angiotensin • IgM Converting Enzyme) • IgE • APO B • C3 • APO A1 • C4 • Haptoglobin • IgG Subclasses Therapeutic Drug Monitoring Analgesics • Salicylate • Paracetamol Antibiotics • Amikacin • Gentamicin • Tobramycin • Vancomycin Antiepileptics • Carbamazepine • Clonazepam • Lamotrigine • Gabapentin • Vigabatrin • Phenobarbital • Phenytoin • Primidone • Sulthiame • Valproate

Antineoplastic • Methotrexate Bronchodilators • Theophylline Cardiac • Digoxin • Quinidine • Perhexilene • Amiodarone • Mexilitene • Flecainide Immunosuppressive • Cyclosporine • Tacrolimus (FK506) • Sirolimus (Rapamycin) • Mycophenolicacid Vitamins • Vitamin • Vitamin • Vitamin • Vitamin • Vitamin • Vitamin • Vitamin

A B1 B2 B6 C D E

Drug Screening • Cotinine (Urine/Serum) Psychoactive • Benzodiazepines (list specific requirements) - clobazam - clonazepam - diazepam - nitrazepam - oxazepam - temazepam • Clozapine • Thioridazine • Mianserin

• • • •

Fluoxetine Olanzapine Lithium Tricyclics - amitriptyline - clomipramine (norclomipramine) - desipramine - doxepin (nordoxepin) - imipramine - nortriptyline - trimipramine

PATHOLOGY TESTS

TEST SELECTION GUIDE

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

Contd.

6.2

PATHOLOGY TESTS

PATHOLOGY TESTS

Normal

0 6 12 18 24 2 3 4 5 6 7 8 9 10 Hours Days TIME AFTER INFARCT

Abnormal Protein Investigation • Serum Protein Electrophoresis • Cryoglobulins/Cryofibrinogen • Immunoglobulin Quantification • Immunofixation Studies • Bence Jones Protein • Serum Free Light Chains Amniotic Fluid • Alpha Fetoprotein • Bilirubin • Cytogenetics • L/S ratio Calcium Metabolism • Serum Ionised Calcium • Serum Parathormone • Serum 25 Hydroxy Vitamin D

6.3

Gastrointestinal • 24hr Urinary 5-H.I.A.A. • Serum Serotonin • Other gut derived hormones on request. By appointment: • Xylose Absorption/3 Day Faecal Fat • Breath hydrogen study with lactose or other sugar loading.

Toxicology • Comprehensive drug screen on urine, blood or saliva (urine preferred except for alcohol). • Heavy metals: - Lead - Mercury - Cadmium • Red Cell & Serum Cholinesterase • Carboxyhaemoglobin • Methaemoglobin • Carbohydrate Deficient Transferrin Miscellaneous • Porphyrins: - Blood, Urine, Faeces • Ammonia & Lactate • Metabolic Disease Screen • Faecal Sugar • Copper • Zinc • Magnesium • Special Proteins • Urine & Serum Osmolality (assayed) • Serum Cholinesterase with Dibucaine Inhibition • Sweat Electrolytes • Glucose Tolerance Test • HbA1c/Fructosamine • Urinary Microalbumin • Amylase/Lipase • Acid Phosphatase • Muscle CK

• • • • • • • • •

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

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

Cytology/Histology Non Gynaecological Cytology Body Fluids • Pleural Fluid • Ascitic/Peritoneal Fluids • Peritoneal Washings • Pericardial Fluid • Synovial Fluid • Ovarian Fluid • Gastric Fluid • Cerebrospinal Fluid Fine Needle Aspirate • Breast • Head & Neck • Lung • Lymph Node • Thyroid • Soft Tissues • Prostate • Superficial Palpable Lesions

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

- Benzodiazepines - Cocaine - Sympathomimetic Amines - Opiates - Methadone (as requested) - Barbiturates (as requested) - Ethanol (alcohol, as requested) • GCMS and LCMS confirmation - Cannabinoids (TCC) - Benzodiazepines (BDC) - Cocaine (CME) - Sympathomimetic Amines (SYM) - Opiates (OPC)

PATHOLOGY TESTS

Myoglobin Troponin CK, AST LDH

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

Respiratory • Sputum • Bronchial Brushings • Bronchial Washings • Bronchoalveolar Lavage Urinary Tract • Urine • Bladder Washings • Urothelial Washings Miscellaneous • Nipple Discharge • Oral Cavity Smears Gynaecological Cytology • Cervical Smear • Vaginal Smear • ThinPrep Imaging • HPV DNA Typing • Immunofluorescence • Frozen Section Service • Immunoperoxidase Stains - oestrogen - progesterone - c-erbB2 studies - others as indicated

6.4

Change in Cardiac Markers Following Myocardial Infarction * Peaks not drawn to same scale RELATIVE CONCENTRATION

PATHOLOGY TESTS

PATHOLOGY TESTS

Andrology • Seminal Analysis • Antisperm Antibodies Cytogenetics Chromosome Analysis • Prenatal • Postnatal • Oncology Fluorescent In Situ Hybridisation (FISH) • Microdeletion Syndromes • Aneuploidy Screening • Telomere Screening • Oncology - Fusion Probes for common haematological malignancies e.g. t(9;22) bcr/abl - Multiple Myeloma Panel - CLL Panel • Paraffin Tissue Studies - Her2/Neu - Oligodendroglioma - Lymphoma

Endocrinology

6.5

Thyroid Function Tests (TFT) • TSH as screen • Free T4 if: - TSH is abnormal - Follow Up - Dementia/Psychiatric - Amenorrhoea/Infertility - ? Pituitary Disease - On Amiodarone, Lithium - Sick euthyroid in hospital • Thyroid Antibodies, TSH Receptor Ab, ESR if: - ? Chronic Thyroiditis

Molecular Genetics • Haemochromatosis (C282Y, H63D & S65C) • Factor V Leiden • Prothrombin G20210A • Apolipoprotein E Genotyping • MTHFR Mutation • B Cell IgH Gene Rearrangement • Bcl-1 • Bcl-2 • T cell Receptor Gene Rearrangement • Bcr/abl • Fragile X Syndrome • Y chromosome Deletion Analysis (AZFa, AZFb, AZFc) for Male Infertility. • Sex Determining Region of the Y Chromosome (SRY) • Cat Scratch Disease • Clostridium Difficile • Cystic Fibrosis • HLA-B27 • Malaria

- ? Acute Thyroiditis - ? Graves’/Hashimoto’s - ? Follow Up Diabetes • 1 or 2 hr post prandial glucose & insulin • C Peptide • Glucagon Stimulation Test Gastritis • Gastrin • Urea Breath Test Growth • Growth Hormone • Somatomedian C (IGF-1)

Adrenal Function

Down's Screen

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

First Trimester (111/2 -13 wks 6 days) • Free ßHCG • PAPP-A

Addison’s • Cortisol + ACTH • Synacthen Stimulation Test Amenorrhoea • Pregnancy Test • Oestradiol • LH:FSH • Prolactin •? Adrenal/Thyroid/Pituitary Disease Hypertension • Renin + Aldosterone Hirsutism • LH:FSH • Oestradiol • Testosterone

• DHEA Sulphate • Androstenedione • SHBG

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

Haematology/BLOOD BANK QML Pathology Warfarin Care Clinic Patient Registration 1300 795 355 Acceptable test groupings approved abbreviations in parenthesis Complete Blood Examination (FBC, FBE, CBE, CBP) • Haemoglobin (Hb) • Haematocrit (PCV) • Red Cell Count (RBC) • Red Cell Indices • Leucocyte Count (WBC) • Platelet Count • Differential Leucocyte Count • Blood Film Examination

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

PATHOLOGY TESTS

Genetics

Calcium Homeostasis • Parathyroid Hormone (PTH) • Calcium + Albumin + Ionised Calcium • Random Urinary Calcium Clearance Tumour Markers Prostate • PSA Breast • CA 15-3

• CEA

Ovary • CA 125

• CA 19-9

Colon • CEA

• CA 19-9

Thalassaemia/ Haemoglobinopathy Screen • Hb • Red Cell Indices • Hb Electrophoresis • HbA2 • HbF Quantification • HbH Bodies Coagulation Screen (COAG) Includes: • PT • APTT • Fibrinogen • Platelet Count • TCT

Contd.

6.6

PATHOLOGY TESTS

PATHOLOGY TESTS

Bone Marrow Examination Please state if cytogenetics or markers are required. Marrow Booking: (07) 3121 4573

Suggested tests for common haematological disorders from which a selection may be made. These tests must be requested individually. Leukaemia/Lymphoma • FBC • Bone Marrow Examination • Cytogenetics • Molecular Genetics • Cell surface markers as indicated. Polycythaemia • EPO • JAK-2 Anaemias Haemolytic • FBC/Retics • Bilirubin/LDH • Haptoglobin • Coombs test Where indicated: • Hypertonic Cryohaemolysis • Cold Agglutinins • ANA • G6PD • Unstable Hb • PNH Screen • Flow cytometry screening for hereditary spherocytosis.

6.7

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

• TSH Where necessary: • Intrinsic Factor Abs • Bone Marrow Examination Microcytic • FBC/Retics • Iron Studies • Zinc Protoporphyrin (ZPP) If unhelpful consider Haemoglobinopathy, Thalassaemia or Sideroblastic Anaemia. Normocytic • FBC/Retics • ESR • Iron Studies • Red Cell Folate/B12 • E/LFT • EPP/Urine Bence Jones Protein • TSH • ANA • LH/Testosterone (Males) Where indicated: • Bone Marrow Examination

• GIFT • ANA • Lymphocyte Markers Where indicated: • Bone Marrow Examination

Leucocyte Disorders

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

Neutrophilia • ESR/CRP • Iron Studies • B12 • NAP Score • E/LFT • ANA Where indicated: • Bone Marrow Biopsy • BCR - ABL Neutropenia • FBC/Retics • Coombs • Iron Studies • B12/Folate

Eosinophilia • Faecal O/C/P • IgE • Serology for parasites e.g. strongyloides • NAP • TSH • B12 Lymphocytosis • Lymphocyte Surface Markers Immunoproliferative Diseases • Serum EPP • Immunofixation • Quantitation of Immunoglobulins • Bence Jones Protein • Bone Marrow Examination • Lymphocyte Marker Studies • 2 Microglobulin

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

Coagulation Anticoagulant Control Oral Therapy • Prothrombin Time/INR Unfractionated Heparin • APTT Therapeutic range 60-95 seconds for continuous infusion or intermittent therapy (sample collected 30-45 minutes before next injection).

PATHOLOGY TESTS

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

LMWH • Monitoring is rarely needed. Haemorrhagic Disorders If abnormal coagulation screen or if significant family/clinical history of bleeding, von Willebrand’s Disease or other deficiency states may be considered: • F VIII:C • vWF:Ag • vWF:RiCoF If required: • Collagen Binding Assays • Other specific factor assays as indicated. • Platelet Aggregation Studies • Circulating Inhibitor Tests Recurrent Thrombosis/Thrombophilia • FBC • APTT/PT/Fibrinogen • Antithrombin III • Lupus Inhibitor • Protein C/Protein S • Plasminogen • Cardiolipin Antibodies • APC Resistance • Factor V Leiden/ Prothrombin G20210A Mutation • E/LFT - Homocysteine

6.8

PATHOLOGY TESTS

PATHOLOGY TESTS

Required tests must be ordered individually. Allergic Disorders • Total IgE • Skin Testing • RAST - single or multiple allergens (max. 4 per request). Arthritis • Anti CCP • ANA • Anti DNA • ENA • ANCA • C Reactive Protein • HLA B27 Typing • Rheumatoid Factor •S erology - Streptococci - Ross River - Parvovirus - Barmah Forest - Rubella - Shigella - Yersinia - Campylobacter

•O ther tissue autoantibodies as indicated. e.g.: - Mitochondrial Ab (AMA) - Smooth Muscle Ab (SMA) - Parietal Cell Ab (PCA) Coeliac Disease Adults • Anti TTG or anti EMA Children • Anti TTG or anti EMA • Anti Gliadin IgA • Anti Gliadin IgG Immunodeficiency States • EPP • lgG • IgA • IgM • IgG Subclasses • C3 • C4 • Haemolytic Complement • Neutrophil Oxidative Burst

• Uric Acid

• Neutrophil Function Tests

Autoimmune Disease

• T & B Cell Quantitation

• Antinuclear Antibodies (ANA)

• Lymphocyte Function Tests

• Anti-DNA • Anti-extractable Nuclear Antigens (ENA) • ANCA • C3 • C4 • Haemolytic Complement • Rheumatoid Factor • Rose-Waaler

6.9

•A ntiphospolipid Antibodies - Cardiolipin Ab - Lupus anticoagulant

Microbiology and Microbial Serology Notes Complete clinical history (including recent travel) is important. Please request tests individually (profiles not acceptable) and include the nature and site of the specimen. Some serological tests can be diagnostic on testing of acute phase serum (e.g. detecting IgM antibodies), while some tests require paired sera 14 days apart. Antenatal Screening • HepBsAg • HIV • Rubella • Syphilis CNS • Blood culture • CSF - Differential Cell Count - Glucose - Chloride - Protein - Bacterial Culture - TB Culture - Virus PCR - HSV - Enterovirus - CMV - HIV - Bacterial PCR - N. Meningitidis - Cryptococcus Antigen • Serology - Arbovirus - HSV - Meningococcal IgM - Measles - Mumps - Syphilis - Cryptococcus - Toxoplasma - Rubella

PATHOLOGY TESTS

Immunology

Cardiac Serology • Cat Scratch Disease (CSD) • Enterovirus • Q Fever • Streptococcal • Toxoplasma • Syphilis PCR • Cat Scratch Disease (CSD) - Cardiac Tissue Congenital Screening • CMV • Rubella • Toxoplasma • HSV 1&2 • Syphilis Diarrhoea Faeces • Microscopy - Ova - Cysts - Parasites • Culture for pathogens - Bacteria - Viral culture not performed • Rotavirus Assay • PCR - Clostridium difficile toxin gene (antibiotic associated diarrhoea) - EHEC (Enterohaemorrhagic E coli) PCR Genital Genital Herpes • PCR • Serology

Contd.

6.10

PATHOLOGY TESTS

PATHOLOGY TESTS

PCR • Cat Scratch Disease (CSD) - Lymph node tissue

Genital Discharge • Chlamydia PCR • Gonococcal PCR • Microscopy/Culture • Syphilis Serology • Trichomonas - PCR Hepatitis A, B, C Please request specific tests. Acute Investigation • Hep A IgM • HBsAg • HCV Infectivity Status • HBsAg

• HCV

Immunity/Post Vaccination • HBsAb • Hep A IgG Other Hepatitis • Amoebic • CMV • Hep E • Leptospira

• • • •

Brucella EBV Hydatid Q Fever

Lymphadenopathy/Mononucleosis

6.11

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

Pyrexia of Unknown Origin (PUO) • Blood Culture x 3 • Urine Micro & Culture • Malarial Films • Culture of any cutaneous lesion or exudate (e.g. sputum) • Serology - Leptospira - Brucella - Q Fever - Mycoplasma - Toxoplasma - Dengue PCR - Arbovirus - Influenza - Salmonella - Rickettsia - Cat Scratch Disease • Mantoux Skin Test Rash Vesicular • HSV PCR • VZV PCR • Enterovirus PCR (Throat, Skin Lesions) • Micro & Culture for Bacteria • Serology - Echocoxsackie - HSV - VZV - Rickettsiae Nonvesicular • Micro & Culture for Dermatophytes • Serology - Rubella - Ross River - Barmah Forest - Dengue

-

Measles Arbovirus Rickettsia CMV Syphilis Parvovirus HIV Streptococcus

• CMV • Adenovirus

Renal Tract Infection • Urine & Micro Culture • Blood Cultures (Systemic Symptoms) x 2 • Serology - ASOT/Anti DNase B titres (nephritis) Respiratory Infections Upper • Culture (Throat Swab) • Bordetella Pertussis PCR (Throat Swab/NPA) • Respiratory Virus PCR (NPA) - RSV - Influenza - Parainfluenza - Adenovirus • Serology - ASOT/Anti DNase B - Bordetella Pertussis - Influenza with adenopathy: • Infectious Mononucleosis • Toxoplasma

Lower - Acute • Micro & Culture (Sputum) • Blood Cultures x 2 • Legionella PCR (Sputum) • Legionella Urinary Antigen (Urine) • Mycoplasma PCR (Sputum) • Serology - Mycoplasma - Psittacosis - Q Fever - Legionella - Cryptococcus - Influenza - Chlamydia pneumoniae

PATHOLOGY TESTS

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

Lower - Non Resolving • Culture (Sputum) • Fungi x 3 • MTB Micro & Culture x 3 • Sputum Malignant Cells x 3 • Mantoux Skin Test • Serology - Mycoplasma - Legionella - Fungal Precipitins (Aspergillus, Micropolyspora, Thermoactinomyces) - HIV - Herpes • BAL (Bronchial Alveolar Large) - D/w Microbiologist

Interpretation of Hepatitis B Serology Pattern Early Acute Acute

HBsAg

HBeAg

+ +

+ +

Resolving Past Chronic Post Immunisation

+

+/-

HBcAb

HBcIgM

+ + + +

+ +

HBeAb

+ +/+/-

HbsAb

+/+/-

Infective

++ ++ +/++

+

6.12

PATHOLOGY TESTS

PATHOLOGY TESTS

DEPARTMENT

Biochemistry

Blood/SS tube or Red top tube

2 weeks

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

17-HYDROXYPROGESTERONE, SERUM 1-HYDROXYPYRENE, URINE

Endocrinology

Blood/SS tube

1 week

Please provide clinical and medication details.

Biochemistry

Urine/50 mL urine container

2 - 3 weeks

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

1-METHYL HISTAMINE, URINE

Biochemistry

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

2, 4, 5-T (HERBICIDE), URINE

Biochemistry

Test for unusual exposure - note this herbicide is no longer in use. Please refer to HERBICIDES, URINE.

2, 4-D (HERBICIDE), URINE

Biochemistry

Please refer to HERBICIDES, URINE.

25-HYDROXY CHOLECALCIFEROL, SERUM 25-HYDROXY VITAMIN D, SERUM 25-HYDROXY VITAMIN D3, SERUM 3-HYDROXYBUTYRATE, SERUM OR PLASMA

Biochemistry

Please refer to VITAMIN D, SERUM.

Biochemistry


Biochemistry


4-HYDROXY-3-METHOXY MANDELIC ACID, URINE

Biochemistry

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

Biochemistry

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

Biochemistry

Blood/Lithium heparin tube or SS tube

1 week

PATHOLOGY TESTS - A

TEST NAME 1,1,1,TRICHLOROETHANE, BLOOD 1,25-DIHYDROXY CHOLECALCIFEROL 1,25-DIHYDROXY VITAMIN D, SERUM

Ketone body quantitative assay. Referred test. Please refer to CATECHOLAMINES, URINE.

Results (07) 3121 4555 7.0

7.0

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Urine/Urine container

2 - 3 weeks

Occasionally used in testing for acute intermittent porphyria. Also raised in lead poisoning. Collect while patient is experiencing symptoms. Protect sample from light. Store and transport frozen. Referred test.

5-H.I.A.A., URINE

Biochemistry

Urine/24 hour urine container with 25 mL 6M HCI preservative

1 - 2 weeks

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

5-HYDROXY TRYPTAMINE, URINE 6-THIOGUANINE (6-TG), BLOOD

Biochemistry

7-BIOPTERIN, URINE

Biochemistry

7-DEHYDROCHOLESTEROL, PLASMA

Biochemistry

A/G RATIO, SYNOVIAL FLUID

Biochemistry

Please refer to ALBUMIN, SYNOVIAL FLUID.

ACE, SERUM

Biochemistry

Please refer to ANGIOTENSIN CONVERTING ENZYME, SERUM.

ACETAMINOPHEN, SERUM

Biochemistry

Please refer to PARACETAMOL, SERUM.

ACETOACETATE, SERUM

Biochemistry

Please refer to KETONE SCREEN, SERUM.

ACETOACETATE, URINE

Biochemistry

Please refer to PIGMENTS, URINE.

ACETONE, BLOOD

Biochemistry


ACETONE, URINE

Biochemistry

ACETYL SALICYCLIC ACID, SERUM

Biochemistry

www.qml.com.au

Biochemistry

PATHOLOGY TESTS - A

TEST NAME 5-ALA, URINE

Please refer to SEROTONIN, URINE 24 HOUR. Blood/EDTA tube

3 weeks

Transport at 4°C. Please refer to PTERINS, URINE for details. Referred test.

Blood/Lithium heparin tube


3 weeks

3 weeks

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

Random urine collected at the end of work shift or exposure. This test will only be performed with the permission of the patient or their employer due to the cost of the assay. If the patient wishes to proceed with the test, indicate on the request form that permission has been granted to perform the test. Please refer to SALICYLATE, SERUM.

Results (07) 3121 4555 7.1

7.1

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

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

Immunology

Blood/SS tube

1 week

Refer to ADENOVIRUS SEROLOGY for collection details.

Biochemistry

Amniotic fluid/Plain plastic tube

1 week

Test for open neural tube defects.

ACETYLCHOLINESTERASE, RED CELL

Biochemistry

Blood/Lithium heparin tube or EDTA tube

1 day

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

ACID MALTASE, BLOOD

Biochemistry

ACID PHOSPHATASE (FEMALE), SERUM ACID PHOSPHATASE (PROSTATIC), SERUM

Biochemistry

Blood/SS tube

Biochemistry

Blood/SS tube (Preserved by 24 hours the addition of 1 drop of acid phosphatase preservative per 1 mL of serum)

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

ACIDIFIED SERUM TEST (HAM TEST), BLOOD

Haematology

Blood/SS tube and EDTA tube

24 hours

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

ACTH STIMULATION TEST

Endocrinology


24 hours

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

www.qml.com.au

PATHOLOGY TESTS - A

TEST NAME ACETYLATOR PHENOTYPE, BLOOD/URINE ACETYLCHOLINE RECEPTOR ANTIBODY, SERUM ACETYLCHOLINESTERASE, AMNIOTIC FLUID

Please refer to LYSOSOMAL ENZYMES, BLOOD. 24 hours

Process sample as for ACID PHOSPHATASE (PROSTATIC), SERUM.

Results (07) 3121 4555 7.2

7.2

PATHOLOGY TESTS - A

PATHOLOGY TESTS

TEST NAME ACTH, PLASMA

DEPARTMENT

SPECIMEN CONTAINER


Endocrinology

Blood/2 x EDTA tubes

24 hours

Specimen should be kept cold in transit. Plasma specimen must not be frozen until separated from red cells, decanted and stored in a plain plastic tube.

ACTINOMYCES CULTURE

Microbiology

Swab/Swab collected in transport medium or specimen in a sterile container

Initial culture results available 48 hours, final report 7 days.

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

ACTIVATED PROTEIN C RESISTANCE (APC)

Haematology

Blood/EDTA tube and Sodium citrate tube

24 hours

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

PATHOLOGY TESTS - A

PATHOLOGY TESTS - A

PATHOLOGY TESTS

PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Thrombotic assay requests are only Medicare refundable if one of the following is stated on the request form by the patient’s doctor: 1. That the patient has a personal history of venous thromboembolism (DVT) or arterial thrombosis (PE); 2. That a first degree relative of the patient has a proven defect in one or more of the thrombotic test(s) requested and that the particular defect(s) are stated on the request form; or 3. That the request is to confirm an abnormal or indeterminate result.

ACTIVE VITAMIN B12

Haematology

Blood/SS tube

3 days

If requested with VITAMIN B12, SERUM a non Medicare rebatable fee of approx. $25.00 is charged to the patient.

ACYL CARNITINE, NEONATAL SCREEN

Biochemistry

Capillary blood sample (heel prick)/Neonatal screening card

2 - 4 weeks

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

ACYL CARNITINE, SERUM

Biochemistry

Blood/SS tube

1 - 2 weeks

Fresh random sample required. Transport in esky at 4°C. Referred test.

ADENOSINE DEAMINASE, BLOOD

Biochemistry


Indeterminate

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

www.qml.com.au

Results (07) 3121 4555 7.3

7.3

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

DEPARTMENT

SPECIMEN CONTAINER


Immunology

Blood/SS tube

72 hours

Assay run Tuesday and Friday.

ADENYLSUCCINASE, URINE

Biochemistry


1 - 2 weeks

Random early morning urine collection preferred. Refrigerate for transfer to laboratory. Referred test.

ADRENAL ANTIBODIES, SERUM

Immunology

Blood/SS tube

2 weeks

ADRENAL CORTICOSTEROID LEVEL, SERUM

Endocrinology

Blood/SS tube

24 hours

ADRENALIN, URINE

Biochemistry

ADRENOCORTICOTROPHIC HORMONE (ACTH) STIMULATION TEST

Endocrinology


24 hours

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

ADRENOCORTICOTROPHIC HORMONE (ACTH), PLASMA

Endocrinology


24 hours

Specimen should be kept cold in transit. Plasma specimen must not be frozen until separated from red cells, decanted and stored in a plain plastic tube.

AFP (ALPHA FOETOPROTEIN) - TUMOUR MARKER, SERUM

Endocrinology

Blood/SS tube

24 hours

Alpha foetoprotein is used as an aid in the management of patients with nonseminomatous testicular carcinoma (embryonal carcinoma and yolk sac carcinoma) and hepatocellular carcinoma.

AFP (ALPHA FOETOPROTEIN), SERUM

Endocrinology

Blood/SS tube

24 hours

Period of amenorrhoea (A=) and estimated date of confinement (EDC) required for test interpretation.

AIDS ANTIBODY INSURANCE/VISA

Immunology

Blood/SS tube

24 hours

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

AIDS SEROLOGY

Immunology

Blood/SS tube (extra SS tube 24 hours if other tests requested)

ALA, URINE

Biochemistry

ALBUMIN, FLUID

Biochemistry

ALBUMIN, SERUM

Biochemistry

ALBUMIN, SYNOVIAL FLUID

Biochemistry

www.qml.com.au

Patient should rest for 20 minutes prior to testing. Note time of collection on specimen and request form.

PATHOLOGY TESTS - A

TEST NAME ADENOVIRUS SEROLOGY

Please refer to CATECHOLAMINES, URINE.

Assay run daily (Monday - Saturday). HIV1/HIV2/HIV antigen routinely performed. Please refer to 5-ALA, URINE.

Fluid/Plain tube/Container

Same day

Specify site of fluid on specimen container and request form. Please refer to E/LFT, SERUM.

Synovial fluid/ Plain plastic tube

Same day

Please provide clinical and medication details. Raised in joint inflammation. Synovial fluid collection kits are provided on request.

Results (07) 3121 4555 7.4

7.4

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Urine/Urine container. No preservative

24 hours

ALBUMIN/GLOBULIN RATIO, SYNOVIAL FLUID ALBUTEROL, URINE

Biochemistry

Please refer to ALBUMIN, SYNOVIAL FLUID.

Biochemistry

Please refer to SALBUTAMOL, URINE.

ALCOHOL, SERUM (BLOOD) LEGAL

Biochemistry

Blood/Fluoride oxalate tube

By midday next working day

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

ALCOHOL, SERUM (BLOOD) NON-LEGAL

Biochemistry

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

Same day

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

ALCOHOL, URINE (NON-OCCUPATIONAL)

Biochemistry

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

ALDICARB (PESTICIDE), BLOOD

Biochemistry

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

ALDOLASE, SERUM

Biochemistry

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

ALDOSTERONE, SERUM

Endocrinology

www.qml.com.au

Blood/SS tube

24 hours

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

PATHOLOGY TESTS - A

TEST NAME ALBUMIN, URINE

Aldosterone is a steroid hormone produced by the adrenal cortex. It promotes sodium reabsorption, water retention, and potassium excretion. It is often measured in conjunction with Renin in the investigation of causes of hypertension.

Results (07) 3121 4555 7.5

7.5

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Endocrinology

24 hour urine collection/ Urine collection bottle. No preservative

1 week

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

ALDOSTERONE/RENIN RATIO, PLASMA

Endocrinology

Blood/2 x EDTA tubes, SS tube

24 hours

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

ALDRIN (ORGANOCHLORINE PESTICIDES), BLOOD ALEPAM, SERUM

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Biochemistry

Please refer to OXAZEPAM, SERUM.

ALIPHATIC SOLVENTS

Biochemistry


ALKALINE PHOSPHATASE ISOENZYMES, SERUM

Biochemistry

Blood/SS tube

2 - 3 days

Test to determine nature of unexplained elevation of alk. phos. Provide clinical and medication details.

ALKALINE PHOSPHATASE, FLUID

Biochemistry

Fluid/Plain tube/ Container

Same day

Specify source of fluid on sample and request form.

7.6

ALKALINE PHOSPHATASE, Biochemistry SERUM ALKAPTONURIA SCREEN, URINE Biochemistry ALLEGRON, SERUM Biochemistry

Please refer to E/LFT, SERUM. Please refer to HOMOGENTISIC ACID, URINE. Please refer to NORTRIPTYLINE, SERUM.

ALLERGEN-SPECIFIC IgE (RAST), SERUM

Immunology

Blood/SS tube

72 hours

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

ALLERGY SKIN TEST

Immunology

Skin Prick Test

72 hours

Test performed by appointment at our special test collection centres. Please contact your local Branch Laboratory for locations.

ALLOPURINOL, PLASMA

Biochemistry

Please refer to OXYPURINOL, PLASMA for details.

ALODORM, SERUM

Biochemistry

Please refer to NITRAZEPAM, SERUM.

www.qml.com.au

PATHOLOGY TESTS - A

TEST NAME ALDOSTERONE, URINE 24 HOUR

Results (07) 3121 4555 7.6

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Haematology

Blood/Sodium citrate tube

5 weeks

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

ALPHA SUBUNIT (FREE)

Endocrinology

Blood/SS tube

1 - 2 weeks

Referred test.

ALPHA THALASSAEMIA GENE TESTING

Haematology

Blood/2 x EDTA tubes, 1 x SS tube

4 weeks

Incurs non-Medicare refundable fee.

ALPHA-1-ACID GLYCOPROTEIN, SERUM

Biochemistry

Serum/SS tube

1 - 2 weeks

Please advise patient that this test attracts a non-Medicare refundable fee from the referring laboratory. Transport at 4°C.

ALPHA-1-ANTITRYPSIN PHENOTYPE, SERUM ALPHA-1-ANTITRYPSIN PHENOTYPE/GENOTYPE, PLASMA

Biochemistry Biochemistry

Blood/EDTA tube

2 - 3 weeks

Deficiency predisposes to premature severe emphysema - genotype more useful in family studies. Please provide clinical and medication details. Referred test. Please advise patient that Genotype testing attracts a non-Medicare refundable fee from the referring laboratory

ALPHA-1-ANTITRYPSIN, FAECES

Biochemistry

Faeces/Faeces container

2 weeks

A marker for the detection of enteric protein loosing states. Freeze sample as soon as possible after collection. Referred test.

ALPHA-1-ANTITRYPSIN, SERUM

Biochemistry

Blood/SS tube

24 hours

Deficiency predisposes to premature severe emphysema. Please provide clinical and medication details. If phenotyping is also required also collect 1 x EDTA tube.

ALPHA-1,4 GLUCOSIDASE, BLOOD ALPHA-2 MACROGLOBULIN, SERUM ALPHA-FOETOPROTEIN (AFP) - TUMOUR MARKER, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - A

TEST NAME ALPHA 2 ANTIPLASMIN

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

Please refer to LYSOSOMAL ENZYMES, BLOOD.

Biochemistry

Blood/SS tube

1 - 2 weeks

Transport in esky at 4°C. Referred test.

Endocrinology

Blood/SS tube

24 hours

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

Results (07) 3121 4555 7.7

7.7

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Endocrinology

Amniotic Fluid/ Amber sterile 10 mL Black top tube

24 hours

Date of last normal menstrual period (LNMP), period of amenorrhoea (A=) and estimated date of confinement (EDC) required.

ALPHA-FOETOPROTEIN (AFP), SERUM

Endocrinology

Blood/SS tube

24 hours

Period of amenorrhoea (A=) and estimated date of confinement (EDC) required for test interpretation.

ALPHA-FUCOSIDASE, BLOOD ALPHA-GALACTOSIDASE, BLOOD ALPHA-TOCOPHEROL, SERUM ALPRAZOLAM, SERUM

Biochemistry


Biochemistry


Biochemistry

Please refer to VITAMIN E, SERUM.

ALT (GPT), SERUM

Biochemistry

ALT, FLUID

Biochemistry


Same day


ALUMINIUM (AL), HAIR

Biochemistry

Hair/Dry sterile screw cap (urine) container

4 weeks

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

ALUMINIUM, SERUM

Biochemistry

Blood/Trace element free tube (e.g. navy top)

1 - 2 weeks

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

ALUMINIUM, URINE

Biochemistry


1 week

Fresh random collection required.

AMIKACIN, SERUM

Biochemistry

Blood/Lithium heparin tube - no gel or anticoagulant

3 days

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

www.qml.com.au

Biochemistry

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

2 weeks

PATHOLOGY TESTS - A

TEST NAME ALPHA-FOETOPROTEIN (AFP), AMNIOTIC FLUID

Provide clinical and medication details. Record time and date of last dose. Collect just prior to next dose. Please keep sample refrigerated. Referred test. Please refer to E/LFT, SERUM.

Results (07) 3121 4555 7.8

7.8

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry


2 weeks

AMINO ACIDS, URINE (CHROMATOGRAPHY) AMINO ACIDS, URINE (SCREEN)

Biochemistry

AMINO LAEVULINIC ACID, URINE AMINOPHYLLINE PRE/POST DOSE, SERUM AMINOPHYLLINE, SERUM

Biochemistry

Please refer to 5-ALA, URINE.

Biochemistry

Please refer to THEOPHYLLINE, SERUM.

Biochemistry


AMIODARONE, SERUM

Biochemistry

AMISULPRIDE, SERUM

Biochemistry

AMITRIPTYLINE, SERUM

Biochemistry

AMITROLE (HERBICIDE), URINE

Biochemistry

AML1-ETO RT-PCR

Genetics

www.qml.com.au

Biochemistry

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

Random early morning urine/Urine container

Blood/Plain plastic tube no gel (Plastic Lithium heparin tube acceptable)

2 weeks

1 week

PATHOLOGY TESTS - A

TEST NAME AMINO ACIDS, PLASMA

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

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

Blood/Plain plastic tube no gel (Plastic Lithium heparin tube acceptable)

1 week

Collect immediately prior to next dose. Please provide clinical and medication details including time and date of last dose. Please refer to HERBICIDES, URINE.

Blood or Bone marrow/ EDTA tube or min. 1 mL bone marrow in EDTA tube

1 month

Specimen needs to be received within 48 hours.

Results (07) 3121 4555 7.9

7.9

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/EDTA tube

Same day

Test for late stage liver disease. Collect FULL EDTA tube. Blood must be centrifuged and separated IMMEDIATELY into a 2 mL tube (fill to top) then freeze immediately for transmission to the laboratory.

AMMONIA (NH3), URINE

Biochemistry

24hr urine container. No preservative

24 hours

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

AMMONIUM CHLORIDE LOAD TEST

Biochemistry

AMNIOTIC FLUID, CHROMOSOMES

Genetics

Amniotic fluid/2 x sterile 10 mL black top tubes

1 - 2 weeks

Average reporting time of 10 days.

AMOEBIC SEROLOGY

Immunology

Blood/SS tube

1 week

Assay run Wednesday.

AMPHETAMINES GCMS CONFIRMATION AMPRENAVIR, PLASMA


Blood/EDTA tube

3 weeks

Plasma must be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Please provide clinical and medication details. Referred test.

AMYLASE, FLUID

Biochemistry


Same day

Note fluid site on specimen container and request form.

AMYLASE, PLEURAL FLUID

Biochemistry

Pleural fluid/Plain tube

Same day

Test for pancreatic aetiology of pleural effusion. Please provide clinical and medication detail. Refrigerate sample during storage and transport.

AMYLASE, SERUM

Biochemistry

Blood/SS tube

Same day

Test for acute pancreatitis. Please provide clinical and medication details.

AMYLASE, URINE

Biochemistry

Urine/24 hour urine container with no preservative or Random urine container

Same day

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

AMYLO-1,6-GLUCOSIDASE, BLOOD

Biochemistry


2 weeks

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

ANA (ANTINUCLEAR ANTIBODY), Immunology SERUM

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday). Please refer to Immunology Appendix (12.35) for a comprehensive list of autoantibodies.

www.qml.com.au

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

PATHOLOGY TESTS - A

TEST NAME AMMONIA, PLASMA

Please refer to SYMPATHOMIMETIC AMINES - GCMS CONFIRMATION.

Results (07) 3121 4555

7.10

7.10

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Microbiology

Aspirated pus/Anaerobic transport medium

Up to 7 days

ANAFRANIL, SERUM

Biochemistry

ANCA (ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY), SERUM ANDROGEN INSENSITIVITY SYNDROME GENETIC TESTING

Immunology

Blood/SS tube

72 hours

Assay run Monday, Wednesday, Friday. Please provide relevant clinical history.

Genetics

Blood/EDTA tube

1 month

Please provide details regarding patients eligibility for Medicare rebate, i.e. proven mutation. If no history, incurs fee to patient.

ANDROSTENEDIONE, SERUM

Endocrinology

Blood/SS tube

24 hours


Blood/EDTA tube

1 - 2 months


Blood/SS tube

2 - 3 weeks

Blood/SS tube

24 hours

Test for pulmonary sarcoidosis. Please provide clinical details.

Blood/2 x EDTA tubes, SS tube

24 hours

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

7.11

ANGELMAN SYNDROME Genetics DNA TESTING ANGIOSTRONGYLUS SEROLOGY Immunology ANGIOTENSIN CONVERTING Biochemistry ENZYME, SERUM ANGIOTENSIN/RENIN RATIO, Endocrinology PLASMA

Please provide clinical details including site of collection and antibiotic therapy. Note if history of chronic infection. Refer to Microbiology Preface (5.51) for collection details. Please refer to CLOMIPRAMINE, SERUM.

ANTI D SCREEN AND INJECTION

Blood Bank

Blood/Pink top EDTA tube

24 hours and urgently

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

ANTI DOUBLE-STRANDED DNA ANTIBODY, SERUM

Immunology

Blood/SS tube

72 hours

Assay run daily (Monday to Friday). Please refer to Immunology Appendix (12.35) for comprehensive list of circulating Autoantibodies.

ANTI IGA ANTIBODY

Immunology

Blood/SS tube

4 weeks

ANTI MICROSOMAL ANTIBODY (THYROID), SERUM ANTI MULLERIAN HORMONE, SERUM

Endocrinology

Blood/SS tube

24 hours

Biochemistry

Blood/SS tube

2 weeks

ANTI NEURONAL ANTIBODY

Immunology

Blood/SS tube

2 - 3 weeks

www.qml.com.au

PATHOLOGY TESTS - A

TEST NAME ANAEROBIC CULTURE FOR ACTINOMYCES

Transport to central laboratory on dry ice. There is currently no Medicare rebate for this test. Referred test.

Results (07) 3121 4555

7.11

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Immunology

Blood/SS tube

72 hours

Endocrinology

Blood/SS tube

24 hours

Endocrinology

Blood/SS tube

24 hours

ANTI THYROID PEROXIDASE ANTIBODY, SERUM ANTI-BETA2 GLYCOPROTEIN I ANTIBODY ANTIBIOTIC RESISTANT ORGANISMS

Endocrinology

Blood/SS tube

24 hours

Immunology

Blood/SS tube

2 - 4 weeks

Microbiology

Rectal swab/Rectal swab in transport medium

48 hours

ANTIBODIES TO EXTRACTABLE NUCLEAR ANTIGENS (ENA), SERUM ANTIBODIES TO MICROBIAL AND PARASITIC AGENTS, SERUM

Immunology

Blood/SS tube

48 hours

Assay run daily (Monday to Friday). Please refer to Immunology Appendix (12.35) for a full list of Extractable Nuclear Antigens.

Immunology

Blood/SS tube

Variable from 24 hours to weeks depending on agent requested

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

ANTIBODIES TO TISSUE ANTIGENS (AUTOANTIBODIES), SERUM

Immunology

Blood/SS tube

Variable from 24 hours depending on antibody tests required

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

ANTIBODY SCREEN/TITRE, SERUM

Blood Bank


24 hours

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

ANTI-CYCLIC CITRULLATED PEPTIDE (CCP) ANTIBODY

Immunology

Blood/SS tube

72 hours

Assay run Monday and Thursday. Next day results.

www.qml.com.au

Please provide relevant clinical history. Assay run Monday, Wednesday, Friday.

Measure antimicrosomal and antithyroglobulin antibodies (Thyroid Tissue Antibodies).

Results (07) 3121 4555

PATHOLOGY TESTS - A

TEST NAME ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA), SERUM ANTI THYROGLOBULIN ANTIBODY, SERUM ANTI THYROID ANTIBODIES, SERUM

7.12

7.12

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Endocrinology


2 - 3 weeks

ANTI-GQ1B ANTIBODY

Immunology

Blood/SS tube

2 - 3 weeks

ANTI-HU ANTIBODIES

Immunology

Blood/SS tube

2 - 3 weeks

ANTIMONY (Sb), BLOOD

Biochemistry

Blood/Lithium heparin tube (EDTA tube acceptable)

4 weeks

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

ANTIMONY (Sb), URINE

Biochemistry


4 weeks

This is the preferred sample for exposure. A random sample is required. Please provide clinical and medication details. Referred test.

ANTINUCLEAR ANTIBODY (ANA), SERUM

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday to Saturday). Please refer to Immunology Appendix (12.35) for a comprehensive list of autoantibodies.

ANTIOXIDANTS, BLOOD

Biochemistry

Blood/SS tube or Lithium heparin tube

4 weeks

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

ANTISPERM ANTIBODIES (INDIRECT IMMUNOBEAD TEST - IBT)

Genetics

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

Test performed fortnightly

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

www.qml.com.au

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

Results (07) 3121 4555

PATHOLOGY TESTS - A

TEST NAME ANTIDIURETIC HORMONE (ADH), PLASMA

7.13

7.13

PATHOLOGY TESTS - A

PATHOLOGY TESTS

TEST NAME ANTITHROMBIN III

DEPARTMENT

SPECIMEN CONTAINER


Haematology


24 hours

Transport at 4°C. Must reach laboratory within 2 hours of collection. PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Thrombotic assay requests are only Medicare refundable if one of the following is stated on the request form by the patient’s doctor: 1. That the patient has a personal history of venous thromboembolism (DVT) or arterial thrombosis (PE); 2. That a first degree relative of the patient has a proven defect in one or more of the thrombotic test(s) requested and that the particular defect(s) are stated on the request form; or 3. That the request is to confirm an abnormal or indeterminate result.

PATHOLOGY TESTS - A

PATHOLOGY TESTS - A

PATHOLOGY TESTS

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

Haematology


24 hours

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

APC (ACTIVATED PROTEIN C RESISTANCE)

Haematology

Blood/EDTA tube and Sodium citrate tube

24 hours

Specimens should be stored and transported cooled. They must reach the laboratory within 2 hours of collection. A history of thromboembolism or a proven APC defect in a first degree relative must be stated on the request form to attract the Medicare rebate. PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Thrombotic assay requests are only Medicare refundable if one of the following is stated on the request form by the patient’s doctor: 1. That the patient has a personal history of venous thromboemblism (DVT) or arterial thrombosis (PE); 2. That a first degree relative of the patient has a proven defect in one or more of the thrombotic test(s) requested and that the particular defect(s) are stated on the request form; or 3. That the request is to confirm an abnormal or indeterminate result.

www.qml.com.au

Results (07) 3121 4555

7.14

7.14

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

DEPARTMENT Biochemistry

Please refer to APOLIPOPROTEIN A1, SERUM.

APO B, SERUM

Biochemistry

Please refer to APOLIPOPROTEIN B, SERUM.

APOLIPOPROTEIN A1, SERUM

Biochemistry

Blood/SS tube

24 hours


APOLIPOPROTEIN B, SERUM

Biochemistry

Blood/SS tube

24 hours


APOLIPOPROTEIN B100, SERUM Biochemistry APOLIPOPROTEIN E Genetics GENOTYPING

Blood/SS tube

2 weeks



1 week

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

APOLIPOPROTEIN STUDIES, SERUM APTT (COAGULATION PROFILE)

Biochemistry

Blood/SS tube

24 hours


Haematology


Same day

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

APTT: HEPARIN THERAPY, BLOOD

Haematology

Blood/Sodium citrate and EDTA tubes

Same day

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

ARBOVIRUS ISOLATION, BLOOD, SYNOVIAL FLUID, CSF

Immunology

Blood/SS tube, Other fluids/ Sterile container

Days to weeks

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

ARBOVIRUS SEROLOGY

Immunology

Blood/SS tube

24 hours

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

ARGININE GROWTH HORMONE STIMULATION TEST

Endocrinology

Blood/SS tube

24 hours

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

ARGININE/INSULIN GROWTH HORMONE STIMULATION TEST

Endocrinology

Blood/SS tube

24 hours

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

www.qml.com.au

SPECIMEN CONTAINER


Results (07) 3121 4555

PATHOLOGY TESTS - A

TEST NAME APO A1, SERUM

7.15

7.15

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/Plain plastic tube no gel or anticoagulant

4 weeks

AROMATIC SOLVENTS

Biochemistry


ARSENIC - INORGANIC, URINE

Biochemistry

Please refer to INORGANIC ARSENIC, URINE.

ARSENIC, BLOOD

Biochemistry


4 weeks

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

ARSENIC, HAIR

Biochemistry

Hair/Dry sterile container

4 weeks

Test for exposure in the past. Please provide exposure and occupation details. For long term exposure, collect enough hair to half fill container (0.2 - 0.4 grams). Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

ARSENIC, NAIL

Biochemistry

Toe and fingernail clippings/ Dry sterile container

4 weeks

Test for exposure in the past. Please provide exposure and occupation details. Cut clean finger and toe nails. Referred test.

ARSENIC, URINE

Biochemistry


1 week

Test for exposure not necessarily toxic. Please provide clinical and medication details. A random collection is preferred. A 24 hour specimen (with no preservative) should only be collected if specifically requested by the referring doctor. Referred test.

ARYL SULPHATASE A, LEUCOCYTES ASCA (ANTI-SACCROMYCES CEREVISEIA ANTIBODY) ASCITIC FLUID BIOCHEMISTRY

Biochemistry

ASCORBIC ACID, SERUM

Biochemistry

ASHPLEX 1, BLOOD

Biochemistry

Blood/EDTA tube

4 weeks

Transport at 4°C. Referred test.

ASHPLEX 2, BLOOD

Biochemistry

Blood/EDTA tube

4 weeks


ASHPLEX CF, BLOOD

Biochemistry

Blood/EDTA tube

4 weeks


ASOT (ANTI STREPTOLYSIN O TITRE), SERUM

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

www.qml.com.au

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

PATHOLOGY TESTS - A

TEST NAME ARIPIPRAZOLE, SERUM


Immunology

Blood/SS tube

3 - 4 weeks

Biochemistry

Fluid/Sterile container

Same day

Please provide clinical and medication details, and tests required. Please refer to VITAMIN C, SERUM.

Results (07) 3121 4555

7.16

7.16

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

ASPIRIN, SERUM

Biochemistry

Please refer to SALICYLATE, SERUM.

AST (SGOT), SERUM

Biochemistry

Please refer to E/LFT, SERUM.

AST, FLUID

Biochemistry

ATRIAL NATRIURETIC PEPTIDE, PLASMA

Biochemistry

ATYPICAL ANTIBODIES, BLOOD

Blood Bank


24 hours

If history of antibodies or transfusion complications collect additional 6 mL plain plastic tube. Record estimated date of confinement (EDC) for antenatal patients.

ATYPICAL MYCOBACTERIA MICROSCOPY AND CULTURE

Microbiology/ Histology

Tissue, sputum, pus/Dry sterile screw top (urine) container (NO formalin)

Microscopy same day. Culture - majority provisionally identified within 2 weeks (up to 12 weeks).

If infection by atypical Mycobacteria is suspected in a tissue specimen (e.g. skin) indicate suspicion and submit specimen in a dry, sterile screw top container (NO formalin). The laboratory will process for both culture and histology. Note: Tissue is essential for Histology. Tissue is preferable to pus. Sputum - 3 consecutive early morning specimens.

AUSTRALIAN (MURRAY VALLEY) Immunology ENCEPHALITIS VIRAL SEROLOGY AUSTRALIAN BAT LYSSAVIRUS Immunology SEROLOGY

Blood/SS tube

2 weeks

Referred test.

Blood/SS tube

2 - 3 weeks

Please provide details of clinical history and exposure, including species of bat. Referred test.

AUTOANTIBODY TEST, SERUM

Blood/SS tube



www.qml.com.au

SPECIMEN CONTAINER


Biochemistry Immunology

Immunology

Please refer to VITAMIN B6, BLOOD for details. Blood/SS tube


1 week

Same day

Assay run Monday. 24 hour results.

PATHOLOGY TESTS - A

TEST NAME ASPARTATE TRANSAMINASE, RED CELL ASPERGILLUS SEROLOGY

Specify source of fluid on sample and request form. This test in currently unavailable. Please refer to BNP, PLASMA.

Results (07) 3121 4555

7.17

7.17

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Microbiology

AUTOCLAVE TEST VIAL x 7 (NB: All must have the same lot number.)

48 hours

AUTOPSY (ADULT/CHILDREN/ NEONATES)

Histology

AVIAN PRECIPITINS SEROLOGY

Immunology

AZINPHOS (PESTICIDE), SERUM

Biochemistry

www.qml.com.au

The autoclave test vials are collected from the surgery after autoclaving. A complete autoclave validation request form must be completed and submitted with the vial. Please contact the Microbiology Department (07) 3121 4438 for vials and request books. Laboratory not accredited for this service. Contact Forensic and Scientific Services (formerly Queensland Health Scientific Services) John Tonge Centre (07) 3274 9111.

Blood/SS tube

3 - 4 weeks

Referred test.

PATHOLOGY TESTS - A

TEST NAME AUTOCLAVE VALIDATION TEST WITH BIOLOGICAL INDICATORS


Results (07) 3121 4555

7.18

7.18

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Immunology

Blood/SS tube

2 weeks

BARBITURATES SCREEN, SERUM BARBITURATES SCREEN, URINE

Biochemistry

Please refer to DRUG SCREEN, SERUM.

Biochemistry


BARMAH FOREST VIRUS SEROLOGY BASEMENT MEMBRANE ZONE (BMZ) ANTIBODY/PEMPHIGOID ANTIBODY, SERUM BASUDIN (PESTICIDE), SERUM

Immunology

Blood/SS tube

24 hours


Immunology

Blood/SS tube

2 weeks

Skin biopsies for immunofluorescence and histology advised. Please refer to Histology Preface (5.38) for details.

B-CELL (IgH) GENE REARRANGEMENT STUDIES

Genetics

Blood or Bone marrow/Pink top EDTA tube, or bone marrow or lymph node or tumour

2 weeks

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

BCL-1 [t(11;14)] DNA TESTING

Genetics

EDTA Blood, bone marrow, lymph node, aspirate, tissue

2 weeks


BCL-2 [t(14;18)] DNA TESTING

Genetics

EDTA Blood, bone marrow, lymph node, aspirate, tissue

2 weeks


BCR-ABL [t(9;22)] FISH

Genetics

1 - 2 days Blood or Bone marrow/ Lithium heparin tube or min. 1mL bone marrow in Lithium heparin tube

BCR-ABL [t(9;22)] RQ-PCR

Genetics

Blood and/or Bone marrow/Pink top EDTA tube and/or min. 1mL bone marrow in EDTA tube

www.qml.com.au

Biochemistry

PATHOLOGY TESTS - B

TEST NAME B2 GLYCOPROTEIN

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

2 weeks

Please send to the laboratory without delay.

Results (07) 3121 4555

7.19

7.19

PATHOLOGY TESTS - B

PATHOLOGY TESTS

DEPARTMENT

BENDIOCARB (PESTICIDE), BLOOD

Biochemistry


BENZENE, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details. For Urine - see HIPPURIC ACID, URINE.

BENZODIAZEPINES GCMS CONFIRMATION

Biochemistry

Urine/Urine drug screen collection kit with tamper evident packaging

48 hours

This is requested in cases concerned with occupational drug screening for drugs of abuse. The QML Pathology protocol complies with Standards Australia AS/NZS4308 for the assay of cannabinoids, opiates, cocaine metabolites, benzodiazepines and sympathomimetic amines. A Chain-of-Custody form should be completed. Additional classes (methadone, barbiturates, alcohol) should be specifically requested if required. Please also refer to the Biochemistry Preface (5.4). Confirmation and quantitation by GCMS of positive findings may be requested separately.

BENZODIAZEPINES SCREEN, URINE

Biochemistry


48 hours


BERYLLIUM (Be), BLOOD

Biochemistry

Blood/EDTA tube

2 weeks

Please provide details of exposure (clinical and occupational).

BERYLLIUM (Be), URINE

Biochemistry

Urine/24 hour urine collection in acid washed container. Random urine container

2 weeks

Test for recent exposure. Consultation with referring laboratory required before collection. Phone Biochemistry on (07) 3121 4420 or Branch Laboratory for details. Provide details of exposure (clinical and occupational). An early morning spot urine should be collected for initial screening. Follow-up testing should be performed on a 24 hour urine collection. Keep cool. Referred test.

BETA GALACTOSIDASE, BLOOD

Biochemistry

www.qml.com.au

SPECIMEN CONTAINER


Biochemistry

Please refer to DYSTROPHIN GENE ANALYSIS, BLOOD.

Biochemistry

Please refer to FREE LIGHT CHAINS, SERUM.

Biochemistry

Urine/Urine container or 24 hours 24 hour urine container with no preservative - random or 24 hour only

Component of testing for myeloma. Qualitative test. Please provide clinical and medication details. A random collection is preferred. Do not collect in acid preservative. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

PATHOLOGY TESTS - B

TEST NAME BECKER MUSCULAR DYSTROPHY, BLOOD BENCE JONES PROTEIN, SERUM BENCE JONES PROTEIN, URINE


Results (07) 3121 4555

7.20

7.20

PATHOLOGY TESTS - B

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Endocrinology

Blood/SS tube

24 hours

Note date of last normal menstrual period (LNMP), period of amenorrhoea (A=) and estimated date of confinement (EDC).

BETA HCG - TUMOUR MARKER, SERUM

Endocrinology

Blood/SS tube

24 hours

-HCG can be used as a tumour marker for trophoblastic disease (hydatidiform mole, invasive mole, persistent mole, partial hydatidiform mole, placental site trophoblastic tumour and gestational choriocarcinoma). Complete obstetric history is essential for result interpretation. Elevated levels are also seen in both ovarian and testicular germ cell tumours and some breast carcinomas. When used in conjunction with AFP, -HCG may prove useful in assessing prognosis, monitoring therapy and detecting recurrence of gonadal germ cell neoplasms.

BETA HCH, (ORGANOCHLORINE PESTICIDE), BLOOD BETA HYDROXYBUTYRATE, PLASMA BETA-2 MICROGLOBULIN, SERUM BETA-2 MICROGLOBULIN, URINE BETA-2 TRANSFERRIN, FLUID

Biochemistry


Biochemistry

Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA.

Biochemistry

Please refer to TAU PROTEIN, FLUID.

BETA-ALANINE, SERUM OR URINE 24 HOUR

Biochemistry

For serum please refer to AMINO ACIDS, PLASMA. For urine please refer to AMINO ACIDS, URINE. Referred test.

BICARBONATE, FLUID

Biochemistry

BICARBONATE, SERUM

Biochemistry

BILE ACIDS, SERUM

Biochemistry

Blood/SS tube

2 weeks

Test for cholestasis. Please provide clinical and medication details. A fasting sample is necessary to provide consistency for clinical interpretation. Keep cool and transport at 4°C. Referred test.

BILE PIGMENTS, URINE

Biochemistry


Same day

Test for conjugated hyperbilirubinaemia or in investigation of pigmenturia. Fresh random sample required. Please provide clinical and medication details. Protect sample from light.

www.qml.com.au

Biochemistry

Blood/SS tube

24 hours

Assay run daily (Monday - Friday). Provide clinical and medication details.

Biochemistry


2 weeks

Transport at 4°C.


Same day

PATHOLOGY TESTS - B

TEST NAME BETA HCG - QUANTITATIVE, SERUM

Specify source of fluid on sample and request form. Please refer to E/LFT, SERUM.

Results (07) 3121 4555

7.21

7.21

PATHOLOGY TESTS - B

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/SS tube

Same day

Protect sample from light.

Biochemistry

Blood/SS tube or Paediatric SS tube

Same day

Test for neonatal liver disease, high red cell turnover, breast milk jaundice, etc. Please provide clinical details. Heel prick or venipuncture sample. Paediatric container must be at least half full. Protect sample from light.

BILIRUBIN, AMNIOTIC FLUID

Biochemistry

Amniotic fluid/ Plain plastic tube

Same day

Test for fetal liver disease, high red cell turnover, etc. Protect from light (wrap in foil or brown paper).

BILIRUBIN, CORD BLOOD

Biochemistry

Cord blood/SS tube or plain tube

Same day

Test for fetal liver disease, high red cell turnover, etc. Please provide clinical details. Protect sample from light.

BILIRUBIN, FLUID

Biochemistry


Same day

Test for haematoma source. Protect sample from light and specify source/nature of fluid on both sample and form.

BILIRUBIN, SERUM

Biochemistry

Protect sample from light. Please refer to E/LFT, SERUM.

BILIRUBIN, URINE

Biochemistry

Please refer to BILE PIGMENTS, URINE for details.

BIOCHEMISTRY, CSF

Biochemistry

CSF/Plain tube

Same day

BIOPSY TISSUE FOR MICROSCOPY AND CULTURE

Microbiology

Sterile dry container (not in formalin)

Please provide clinical details including site and antibiotic therapy. Interim microscopy report Specify if specimen is to be cultured for fungi, Mycobacteria or exotic organisms same day. Interim (Actinomyces, Nocardia, etc). Prompt transport to the laboratory is essential. culture report 48 hours. Final culture report in 5 days.

BIOPTERIN, URINE

Biochemistry

BIOTINIDASE, PLASMA

Biochemistry

BISCODYL, FAECES

Biochemistry

BISMUTH, BLOOD

Biochemistry

Blood/EDTA tube

2 weeks

BK VIRUS

Immunology

Blood and urine/SS tube and Urine container

2 - 3 weeks

www.qml.com.au

PATHOLOGY TESTS - B

TEST NAME BILIRUBIN (CONJUGATED/ DIRECT), SERUM BILIRUBIN (NEONATAL), SERUM

Please provide clinical and medication details and indicate individual tests required. Treat sample with priority.

Please refer to PTERINS, URINE for details. Referred test. Blood/Lithium heparin tube

2 weeks

Referred test. Please refer to LAXATIVES, FAECES. Test for exposure. Referred test.

Results (07) 3121 4555

7.22

7.22

PATHOLOGY TESTS - B

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Cytology

Fluid/Appropriate sterile container

24 hours

For specimen preparation please refer to Cytology Preface (5.16).

BLEEDING STUDIES

Haematology

Same day

Refer to COAGULATION STUDIES.

BLEEDING TIME

Haematology

Same day

Please contact Haematology (07) 3121 4451 or Branch Laboratory.

BLOOD COAGULATION STUDIES Haematology

Blood/3 Sodium Citrate tubes, 1 EDTA tube, 1 blood film prepared at time of collection

Same day

Studies include Platelet count, Prothrombin time, APTT and Fibrinogen. Please specify if a bleeding time is required. Transport to laboratory within 4 hours. Please provide clinical and medication details.

BLOOD CROSSMATCH

Blood Bank


Same day or urgently

If history of antibodies or transfusion complications collect additional 10 mL plain plastic tube. Note special requests (e.g. irradiated/CMV negative). Crossmatch must be signed by patient or collector to verify patient identity. Complete blue box on request form, collector to sign Certification statement.

BLOOD CULTURE FOR MAC/ MAIC/MYCOBACTERIA

Microbiology

Blood/Blood culture bottles. For small blood volumes (5 mL or less) use a paediatric bottle - see Microbiology Preface (5.35). Blood cultures for Mycobacteria require 2 x Bact/Alert MB bottles

Interim report after 2 days. Final report after 7 days. Mycobacteria report after 6 weeks.

Please contact Microbiology (07) 3121 4438 or Branch Laboratory for details of collection methods for Mycobacteria and Fungi. Indicate recent history of antibiotics.

BLOOD GASES, ARTERIAL

Biochemistry

Arterial blood/ Blood gas syringe

Same day

Test for respiratory disease, acid/base imbalance. Please refer to Biochemistry Preface (5.1) and Appendix (12.19).

BLOOD GASES, VENOUS

Biochemistry

Venous Blood/Blood gas syringe

Same day

Please refer to Biochemistry Preface (5.1) and Appendix (12.19).

BLOOD GROUP

Blood Bank


24 hours

The volume of blood in the EDTA sample tube should be not less than 4 mL. If a full blood count or haemoglobin is required use a lavender top EDTA tube for haematology.

BLOOD GROUP AND COOMBS TEST

Blood Bank


Same day

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - B

TEST NAME BLADDER WASHINGS, CYTOLOGY

7.23

7.23

PATHOLOGY TESTS - B

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Blood Bank


24 hours

If history of antibodies or transfusion complications collect additional 6 mL plain plastic tube. Record estimated date of confinement (EDC) for antenatal patients.

BLOOD GROUP GENOTYPE

Blood Bank


24 hours

Please indicate reason for genotyping request (e.g. possibility of fetal or neonatal haemolysis).

BLOOD GROUP PHENOTYPE

Blood Bank


24 hours

Please indicate reason for phenotyping request.

BLOOD TRANSFUSION REACTION INVESTIGATION, BLOOD AND URINE

Blood Bank

Blood/Plain plastic tube, EDTA tube. Urine/Urine container

Same day

Obstetric, transfusion and drug history essential. Sample of first urine voided post reaction. Please forward ALL transfused and partly transfused blood bags to the laboratory.

BLOOD VOLUME STUDIES

Haematology

Blood/Sterile vials available on request from Haematology

24 hours

Appointment required. This test MUST NOT be performed on children, pregnant or breast feeding women. Please contact Haematology (07) 3121 4451 or Branch Laboratory for details.

BNP, PLASMA

Biochemistry

Blood/EDTA tube

Same day

Please provide clinical and medication details. Keep sample cool and transport to the laboratory without delay.

BODY FLUID MICROSCOPY AND CULTURE

Microbiology

Body fluid/Sterile container

Interim Please provide clinical details including antibiotic therapy and specify if specimen microscopy report is to be cultured for fungi and/or mycobacteria. Transport cooled to laboratory as same day. Culture soon as possible. report 48 hours

BOLVIDON, SERUM

Biochemistry

BONE MARROW CULTURE

Microbiology

Bone marrow aspirate/ Sterile container

Interim report after Please provide clinical details including antibiotic therapy. 48 hours. Final Specimen will be cultured for Mycobacteria and fungi. report 21 days.

BONE MARROW EXAMINATION

Haematology

Bone marrow aspirate, trephine and smears/ Appropriate containers

24 hours

Please contact Haematology (07) 3121 4573 or Branch Laboratory for appointment. Refer to Haematology Preface (5.33) for specimen collection and preparation details.

BONE MINERALS, SERUM

Biochemistry

Blood/SS tube

Same day

Please request individual tests. (Usually Calcium and Phosphate). Medicare requires that the individual tests be written on the request form.

BONE RESORPTION MARKER, URINE

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - B

TEST NAME BLOOD GROUP ANTIBODIES

Please refer to MIANSERIN, SERUM.

Please refer to N-TELOPEPTIDE, URINE.

Results (07) 3121 4555

7.24

7.24

PATHOLOGY TESTS - B

PATHOLOGY TESTS

PATHOLOGY TESTS - B

TEST NAME BONE SPECIFIC ALKALINE PHOSPHATASE BORDETELLA PERTUSSIS PCR

DEPARTMENT

SPECIMEN CONTAINER


Endocrinology

Blood/SS tube

1 week

Immunology

Nasopharyngeal aspirate or Nasopharyngeal swab (dry)

24 hours


BORDETELLA PERTUSSIS SEROLOGY BORON, URINE

Immunology

Blood/SS tube

24 hours


Biochemistry


1 - 2 weeks

Random urine sample. This test attracts a non-Medicare refundable fee from the reference laboratory, so prior arrangement by the doctor or employer must be given. Referred test.

BOWEL TUMOUR MARKERS (CA 19-9, CEA), SERUM

Endocrinology

Blood/SS tube

24 hours

Inflammatory or neoplastic conditions of mucinous epithelium - see Biochemistry Appendix (12.4).

BRAIN NATRIURETIC PEPTIDE, PLASMA BRATTON-MARSHALL TEST, URINE BREAST CANCER GENETIC TESTING (BRCA1 BRCA2)

Biochemistry

Blood/EDTA tube

Same day

Please refer to BNP, PLASMA.

Genetics

Blood/EDTA tube

Indeterminate

Genetic counselling is required before the blood specimen can be taken. Genetic counselling is available from Genetic Health Queensland at the Royal Brisbane Hospital on (07) 3636 1686.

BREAST CYST ASPIRATE CYTOLOGY

Cytology

Fluid and/or Smear/ Sterile container and slide carrier x 2

24 hours


BREAST FNA CYTOLOGY

Cytology

Fixed and air dried smears/Needle and syringe/Needle rinsings

24 hours


BREAST TUMOUR MARKER (CA 15-3), SERUM

Endocrinology

Blood/SS tube

24 hours

Breast Carcinoma - see Biochemistry Appendix (12.4).

www.qml.com.au

Biochemistry

Please refer to SAICAR, URINE.

Results (07) 3121 4555

7.25

7.25

PATHOLOGY TESTS - B

PATHOLOGY TESTS

SPECIMEN CONTAINER


Expired air samples

48 hours

BREATH HYDROGEN (SINGLE)

Biochemistry

Expired air samples

48 hours

BREATH TEST (CARBON - 14 UREA) FOR HELICOBACTER PYLORI

Endocrinology

1 glass vial containing CO2 trapping liquid.

24 hours

It is preferred for the patient to fast before the test, but not necessary. A test dose is ingested and mouth is rinsed. 20 minutes later, a breath sample is collected in a glass vial containing CO2 trapping liquid. The glass vial is identified by name, sealed, placed in a plastic bag and transported cooled to the laboratory where the activity of the trapped labelled CO2 is measured. Appointment is required for test.

BROMIDE, BLOOD and SERUM

Biochemistry

Blood/Lithium heparin serum/SS tube

4 weeks

Referred test.

BROMIDE, URINE

Biochemistry


4 weeks

Test for occupational exposure. Please provide details of exposure (clinical and occupational). A random collection is preferred. Referred test.

BROMINAL (HERBICIDE), URINE

Biochemistry

BRONCHIAL BRUSHING CYTOLOGY

Cytology

Smears and/or fluid. Bronchial brush in normal saline

24 hours


BRONCHIAL WASHING CYTOLOGY BRONCHIAL WASHINGS, MICROSCOPY AND CULTURE

Cytology

Fluid/Aspirating trap

24 hours


Microbiology


Interim Please provide clinical details including antibiotic therapy. microscopy report Specimen will be cultured for fungi. Specify if TB culture is required. same day. Culture report 48 hours

BRONCHO-ALVEOLAR LAVAGE (BAL), CYTOLOGY BRUCELLA SEROLOGY

Cytology


24 hours


Immunology

Blood/SS tube

72 hours

Assay run Monday and Thursday.

www.qml.com.au

This test is useful to assess intestinal disaccharidase deficiency and Foregut Bacterial Overgrowth Syndromes (oesophageal pouch, blind loop). The test takes 4 hours and requires a special collection kit from QML Pathology. It should be performed at a Collection Clinic or Branch Laboratory. The patient should fast and not have smoked for at least one hour prior to the test. Please telephone Alexandra Clinic (07) 3831 2614, Biochemistry (07) 3121 4971 or Branch Laboratory for details and appointment.

PATHOLOGY TESTS - B

TEST NAME DEPARTMENT BREATH HYDROGEN (MULTIPLE) Biochemistry

Please refer to HERBICIDES, URINE.

Results (07) 3121 4555

7.26

7.26

PATHOLOGY TESTS - B

PATHOLOGY TESTS

SPECIMEN CONTAINER


Blood/EDTA tube

Same day

Please refer to BNP, PLASMA.

Blood/Plain tube no gel or anticoagulant

4 - 6 weeks

Centrifuge and separate serum into a plain 5 mL tube. Keep cool. Referred test.

BUPRENORPHINE SCREEN, URINE


2 weeks

Transport to central laboratory on ice. There is currently no Medicare rebate for this test. Referred test.

www.qml.com.au

Biochemistry

Results (07) 3121 4555

PATHOLOGY TESTS - B

TEST NAME DEPARTMENT B-TYPE NATRIURETIC PEPTIDE, Biochemistry PLASMA BUPIVACAINE, PLASMA Biochemistry

7.27

7.27

PATHOLOGY TESTS - B

PATHOLOGY TESTS

SPECIMEN CONTAINER


1 glass vial containing CO2 trapping liquid.

24 hours


C1 ESTERASE INHIBITOR FUNCTIONAL, SERUM

Biochemistry

Blood/SS tube

2 weeks

Test for hereditary angioedema. Please provide clinical and medication details. Keep sample cool and transport to the laboratory without delay. Referred test.

C1 ESTERASE INHIBITOR, SERUM

Biochemistry

Blood/SS tube

3 days

Test for hereditary angioedema. Please provide clinical and medication details. Keep sample cool and transport to the laboratory without delay.

C1, SERUM

Biochemistry

Please refer to COMPLEMENT-C1 for details. Referred test.

C2, SERUM

Biochemistry


C3 NEPHRITIC FACTOR, SERUM

Biochemistry

C3, SERUM

Biochemistry

Please refer to COMPLEMENT-C3 for details.

C4, SERUM

Biochemistry

Please refer to COMPLEMENT-C4 for details.

C5, SERUM

Biochemistry


CA 125, SERUM

Endocrinology

Blood/SS tube

24 hours

Serous Carcinoma of ovary - see Biochemistry Appendix (12.4).

CA 15-3, SERUM

Endocrinology

Blood/SS tube

24 hours

Breast Carcinoma - see Biochemistry Appendix (12.4).

CA 19-9, SERUM

Endocrinology

Blood/SS tube

24 hours

Inflammatory or neoplastic conditions of mucinous epithelium. See Biochemistry Appendix (12.4).

CA 724, SERUM

Endocrinology

Blood/SS tube

4 - 5 weeks

A marker for stomach tumours. See Biochemistry Appendix (12.4). Referred test.

CADASIL GENETIC TESTING

Genetics

Blood/EDTA tube

4 - 6 weeks

Blood should be kept at room temperature at all times. Incurs non-Medicare refundable fee.

CADMIUM (Cd), BLOOD

Biochemistry

Blood/EDTA tube (Lithium heparin tube acceptable)

1 week

Please provide clinical, medication and exposure details.

www.qml.com.au

Blood/SS tube and Lithium heparin tube

3 weeks

PATHOLOGY TESTS - C

TEST NAME DEPARTMENT C - 14 UREA BREATH TEST FOR Endocrinology HELICOBACTER PYLORI

Please keep sample cool and transport to the laboratory without delay. Referred test.

Results (07) 3121 4555

7.28

7.28

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry


4 weeks

Test for historical cadmium exposure. Please provide exposure details. For long term exposure, collect enough hair to pack a matchbox tightly (0.2- 0.4g) or to half fill a sterile screw top (urine) container. Please refer to Biochemistry Preface (5.6). Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

CADMIUM (Cd), URINE

Biochemistry


1 week

Please provide details of exposure (clinical and occupational). Collect the sample immediately after a working shift (where cadmium exposure has occurred). Alternatively, a first morning sample can be collected.

CAERULOPLASMIN, SERUM

Biochemistry

Blood/SS tube

24 hours


CALCITONIN, SERUM

Endocrinology

Blood/SS tube

1 weeks

Tumour marker for Medullary Carcinoma of thyroid gland. Transport to laboratory within 2 hours of collection. Specimens must be kept cold.

CALCIUM IONISED, SERUM

Biochemistry

Blood/SS tube

Same day

Please provide clinical and medication details. The sample must be collected anaerobically into an SS tube and centrifuged as soon as it has clotted. The collection tube must be full. Place a label over the tube stopper to indicate that the tube must not be opened prior to analysis. Transport cool to laboratory. UNDER NO CIRCUMSTANCES MUST THE SAMPLE BE OPENED TO AIR.

CALCIUM SENSING RECEPTOR GENETIC TESTING CALCIUM STIMULATION OF GASTRIN

Genetics

Blood/EDTA tube

2 months


Endocrinology

Blood/SS tube

2 - 3 weeks

Please contact Endocrinology Department (07) 3121 4435 for details of collection. To make an appointment, contact the nearest collection centre that performs special tests. Fasting specimen is required (12 hr overnight fast or >5 hrs since last food). This test involves an IV Calcium gluconate, 10 mL slowly over 5 minutes (comes only as 10 mL ampoules). If Calcium is contraindicated rough whisky is an alternative. Contraindicated if on Cardiac glycosides, e.g. digoxin, risk of arrhythmias. Blood is collected at 0, 5, 10, 30, 40, 60 minutes and analysed for Gastrin.

CALCIUM, FLUID

Biochemistry


Same day


CALCIUM, SERUM

Biochemistry

Blood/SS tube

Same day

Please refer to E/LFT, SERUM. Fasting is desirable. Rest the patient for 15 - 30 minutes prior to collection. The sample should be collected without venous stasis (i.e. tourniquet should not be used).

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - C

TEST NAME CADMIUM (Cd), HAIR

7.29

7.29

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Urine/24 hour urine container with 25 mL 6M HCl preservative

24 hours

Please provide clinical and medication details. 24 hour collection is preferred. Under rare circumstances or if specifically requested, a random urine may be collected. Keep sample refrigerated.

CALCULUS ANALYSIS

Biochemistry

Calculus/Screw capped container

1 week

Please state anatomical site of origin. Forward sample to the laboratory in a screw capped container (not in formalin).

CAMPYLOBACTER JEJUNI SEROLOGY CANDIDA SEROLOGY

Immunology

Blood/SS tube

24 hours


Immunology

Blood/SS tube

1 week

Assay run Friday.

CANNABINOIDS GCMS CONFIRMATION CARBAMATE PESTICIDES

Biochemistry

Please refer to THC-COOH - GCMS CONFIRMATION for details.

Biochemistry


CARBAMAZEPINE, SERUM

Biochemistry

CARBARYL (PESTICIDE), BLOOD

Biochemistry

CARBOHYDRATE DEFICIENT TRANSFERRIN, SERUM

Biochemistry

Blood/SS tube

1 week

Test for recent alcohol abuse. Please keep the sample cool and forward to the laboratory without delay.

CARBON - 14 UREA BREATH TEST FOR HELICOBACTER PYLORI

Endocrinology

1 glass vial containing CO2 trapping liquid

24 hours


CARBON TETRA CHLORIDE, BLOOD

Biochemistry

www.qml.com.au

Blood/Plain plastic tube - no gel or anticoagulant (Plastic lithium heparin acceptable)


PATHOLOGY TESTS - C

TEST NAME CALCIUM, URINE

Please provide clinical and medication details. Collect at least 8 hours after last dose or just prior to next dose. Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity.


Results (07) 3121 4555

7.30

7.30

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/Blood gas syringe NEVER use plastic collection tubes

Same day

Test for carbon monoxide exposure including cigarette smoking. Sample required is anticoagulated uncentrifuged whole blood (venous usually) TAKEN ANAEROBICALLY. ENSURE THAT SAMPLE IS NOT EXPOSED TO AIR NOR OPENED PRIOR TO ASSAY, BY PLACING A SEAL OVER THE STOPPER. FORWARD TO THE LAB WITHOUT DELAY.

CARCINOEMBRYONIC ANTIGEN (CEA), SERUM

Endocrinology

Blood/SS tube

24 hours

Please provide clinical and medication details. Provide date of previous CEA assay if patient is being monitored post operatively.

CARDIAC ENZYMES, SERUM

Biochemistry

Blood/SS tube

Same day

Please provide clinical and medication details. Troponin T only is assayed. If Serum AST, Lactate Dehydrogenase (LD), Creatine Kinase (CK) are required, these must be requested separately.

CARDIOLIPIN ANTIBODY, SERUM CARNITINE, NEONATAL SCREEN CARNITINE, SERUM

Immunology

Blood/SS tube

72 hours

Assay run twice a week.

Biochemistry

Please refer to ACYL CARNITINE, NEONATAL SCREEN for details. Referred test.

Biochemistry

Please refer to ACYL CARNITINE, SERUM.

CAROTENE (BETA), SERUM

Biochemistry

Please refer to CAROTENOIDS, SERUM for details.

CAROTENOIDS, SERUM

Biochemistry

Blood/SS tube

24 hours

Low levels in fat malabsorption; raised with increased dietary intake. Please provide clinical, dietary and medication details. Protect from light.

CAT SCRATCH DISEASE PCR

Genetics

Swab of infected site, CSF lymph nodes, aspirate

2 days


CAT SCRATCH DISEASE SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run Monday. If appropriate, a lymph node biopsy may be considered. The lymph node should be managed as for Marker Studies - see Histology Preface (5.35).

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - C

TEST NAME CARBOXYHAEMOGLOBIN, BLOOD

7.31

7.31

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/Lithium heparin tube with 1 mg of sodium metabisulphite added

1 - 2 weeks

Test for phaeochromocytoma - plasma metanephrines or urinary catecholamines may be a more suitable alternative - please consult with Pathologist if in doubt. Please contact Biochemistry on (07) 3121 4045 or Branch Laboratory if you require a pre-prepared collection tube to be sent to you. An appointment is required for collection by a QML Pathology doctor at a Special Tests Collection Centre or Branch Laboratory. Blood specimens should be collected at rest (20-30 minutes) in the supine position. Collection should be through a heparinised indwelling catheter inserted 20-30 minutes prior to collection. Collect a FULL Lithium heparin tube containing 1 mg sodium metabisulphite. Blood should be centrifuged and plasma frozen immediately and the sample transported frozen. Referred test.

CATECHOLAMINES, URINE

Biochemistry


1 week

Test for phaeochromocytoma and childhood neuroblastoma. Please provide clinical and medication details, especially recent changes in medication. PLEASE INSTRUCT PATIENT TO AVOID PARACETAMOL PRIOR TO AND DURING THE PERIOD OF COLLECTION. Please refer to: ‘Urine Collection Diet for 5HIAA and Catecholamine (12.11)’ for dietary and drug restrictions during or just prior to collection. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Under certain special circumstances, e.g. small children, a random urine can be collected. If this is required, contact senior Biochemistry staff prior to collection (07) 3121 4083.

CD34 PROGENITOR CELLS

Haematology

Blood/EDTA tube or ACD yellow top tube

Same day

Transport to laboratory as soon as possible.

CD4/CD8 T LYMPHOCYTE RATIO, BLOOD

Haematology

Blood/ACD tube, EDTA tube, Blood film

24 hours

Lithium heparin tube may be used if ACD tube unavailable.

CDT, SERUM

Biochemistry

CEA (CARCINOEMBRYONIC ANTIGEN), SERUM

Endocrinology

Please refer to CARBOHYDRATE DEFICIENT TRANSFERRIN, SERUM. Blood/SS tube

24 hours

Please provide clinical and medication details. Provide date of previous CEA assay if patient is being monitored post operatively.

CELL PANEL HLA AB RBH HOSP Haematology

Blood/SS tube or Plain tube

4 weeks

Provide clinical and medication details. Centrifuge samples and transport at room temperature.

CELL PANEL HLA AB SYDNEY

Haematology


4 weeks

Provide clinical and medication details. Centrifuge samples and transport at room temperature.

CELLCEPT, PLASMA

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME CATECHOLAMINES, BLOOD

Please refer to MYCOPHENOLIC ACID, PLASMA.

Results (07) 3121 4555

7.32

7.32

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Biochemistry

Plain plastic tube - no gel or 1 - 2 weeks anticoagulant (Plastic lithium heparin tube acceptable)

Collect just prior to next dose. Provide clinical and medication details.

CERVICAL PAP SMEAR CYTOLOGY

Cytology

Labelled fixed smear/ Slide carrier

48 - 72 hours

For specimen preparation and details of adjunctive tests (ThinPrep), please refer to Cytology Preface (5.11).

CHARCOT MARIE TOOTH SYNDROME - DNA

Genetics


1 - 2 months

Patient needs to have genetics counselling prior to testing and consent form signed by patient and doctor. Send specimen at room temperature. Referred test.

CHLAMYDIA PCR, SWAB

Immunology

Swab/White top Chlamydia PCR tube

24 hours

Assay runs daily (Monday to Saturday). Please see Microbiology Preface (5.58) and contact Immunology (07) 3121 4458 or Branch Laboratory for details.

CHLAMYDIA PCR, URINE

Immunology

First catch Urine/ Urine container

24 hours

The first 20 mL of any voided urine is an acceptable alternative to a swab. The patient should not have urinated for one hour prior to the test.

CHLAMYDIA SEROLOGY SCREEN CHLORDANE (ORGANOCHLORINE PESTICIDES), BLOOD CHLORIDE, CSF

Immunology

Blood/SS tube

72 hours

Assay run Monday, Wednesday and Friday.

CHLORIDE, FAECES

Biochemistry


24 hours

Keep sample cool during collection and transport to the laboratory.

CHLORIDE, FLUID

Biochemistry


Same day


CHLORIDE, SERUM

Biochemistry

CHLORIDE, SWEAT

Biochemistry

Sweat/Sweat tube

1 week

Test for cystic fibrosis. Please contact Collections (07) 3121 4450 or Branch Laboratory for appointment.

CHLORIDE, URINE

Biochemistry

Urine/Urine container (preferred) or 24 hour urine container with no preservative

24 hours

Urine should be refrigerated after the collection period and transported cooled to the laboratory.

CHLORINATED SOLVENTS

Biochemistry


CHLOROETHANE, BLOOD

Biochemistry


www.qml.com.au


Biochemistry


Biochemistry

Please refer to BIOCHEMISTRY, CSF for details.

PATHOLOGY TESTS - C

TEST NAME CEPHALOSPORINS, SERUM/PLASMA


Results (07) 3121 4555

7.33

7.33

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT


CHLOROQUINE, SERUM

Biochemistry

Blood/Fluoride oxalate tube or EDTA tube (preferred) or (Lithium heparin tube acceptable)

2 weeks

Please provide clinical and medication details, including time and date of last dose. Referred Test.

CHLORPROMAZINE, SERUM

Biochemistry

Blood/Plain plastic 6 mL tube - no gel or anticoagulant

2 weeks

Please provide clinical and medication details. Sample collection is independent of time of dose. Referred test.

CHLORPYRIFOS (PESTICIDE), SERUM

Biochemistry

Biochemistry

CHOLECALCIFEROL (HYDROXY), Biochemistry SERUM CHOLESTEROL, FLUID Biochemistry

7.34

SPECIMEN CONTAINER


Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Please refer to VITAMIN D, SERUM. Fluid/Plain tube/Container

Same day

If testing for chyluria, chylothorax or chylous ascites, triglycerides is more appropriate. Specify source of fluid on sample and request form.

CHOLESTEROL, SERUM

Biochemistry


CHOLINESTERASE TYPING FOR SUXAMETHONIUM, SERUM

Biochemistry

Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM (SCOLINE) SENSITIVITY, SERUM.

CHOLINESTERASE, RED CELL

Biochemistry

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

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME CHLOROFORM , BLOOD

Results (07) 3121 4555

7.34

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/SS tube (EDTA tube and Lithium heparin tube acceptable)

24 hours

Test CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. The CHOLINESTERASE (PSEUDOCHOLINESTERASE) is also low in inherited forms of scoline sensitivity. Please provide clinical and medication details including exposure to organophosphate pesticides etc. Serum cholinesterase levels drop first and provide a sensitive screening test for occupational organophosphate exposure. Reduced red cell levels usually equate with organophosphate toxicity. Screening test intervals depend on levels of exposure. Local and Regional Councils routinely recommend 3 - 6 monthly screens for exposed staff. Heavy users recommend 3 monthly screen and screening anytime after intensive use. Refer to Biochemistry Appendix 12.18 for list.

CHROMATOGRAPHY, FAECES (SUGAR)

Biochemistry


1 week

Test for lactase deficiency or malabsorption. Please provide clinical details. Collect FRESH sample (ideally should be fluid to semi-fluid). Freeze specimen, and store and transport frozen. Transport to laboratory as soon as possible. Please also refer to the Biochemistry Preface (5.5).

CHROMIUM, BLOOD

Biochemistry


2 weeks

Please provide clinical and medication details. Referred test.

CHROMIUM, URINE

Biochemistry


2 weeks

Please provide details of exposure (clinical and occupational). A random collection is preferred. Referred test.

CHROMOGRANIN A, SERUM

Biochemistry

Blood/SS tube

3 weeks


CHROMOSOMES, AMNIOTIC FLUID

Genetics

Amniotic fluid/2 x sterile 10 mL black top tubes

1 - 2 weeks

Average reporting time of 12 days. For overnight transport, the sample should be cooled NOT FROZEN.

CHROMOSOMES, BLOOD

Genetics


2 weeks

Reporting time less than 1 week if urgent. Difficult collection should be noted on the form. Please refer to Genetics Preface (5.28).

CHROMOSOMES, BONE MARROW

Genetics

Bone marrow aspirate/ Lithium heparin tube

2 weeks

Minimum 2 days if urgent. Transport in esky at 4°C or room temperature.

CHROMOSOMES, CHORIONIC VILLI

Genetics

Chorionic villus biopsy/ Antibiotic transport medium

1 - 2 weeks

Antibiotic transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

CHROMOSOMES, LYMPH NODE

Genetics

Lymph node/Antibiotic transport medium

2 - 6 weeks

DO NOT use formalin. Transport to laboratory as soon as possible. Antibiotic transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - C

TEST NAME CHOLINESTERASE, SERUM

7.35

7.35

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Genetics

Products of conception (placenta, membrane, fetal tissue and skin)/Antibiotic transport medium

3 weeks

DO NOT freeze or place in formalin. Sample must be kept sterile and moist. Transport to laboratory as soon as possible. Antibiotic transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

CHROMOSOMES, TISSUE

Genetics

Skin and other tissues (not 3 weeks prenatal)/Antibiotic transport medium

DO NOT freeze or place in formalin. Sample must be kept sterile and moist. Transport to laboratory as soon as possible. Antibiotic transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

CHROMOSOMES, TUMOUR

Genetics

Selected tumour tissue dissected free of necrotic tissue, adherent fat and extraneous tissue and sliced into small pieces/Antibiotic transport medium

2 - 6 weeks

DO NOT freeze or place in formalin. Sample must be kept sterile and moist. Transport to laboratory as soon as possible. Please refer to Genetics Preface (5.28). Antibiotic transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

CHROMOSOMES, UNSTIMULATED BLOOD

Genetics


2 weeks

DIFFICULT collection should be noted on the form. Transport cool or at room temperature.

CHRONIC RENAL DISEASE GENETIC TESTING CIGUATERA POISONING, FISH

Genetics

Blood/EDTA tube

Indeterminate

Biochemistry

Frozen fish (cooked or uncooked)/Clean plastic container

Indeterminate

Please contact Biochemistry or Branch Laboratory regarding details of collection of fish samples. Testing on human samples is not available.

CILIAL BIOPSY

Histology

Hartmann’s Solution

Motility 2 hours Electron Microscopy 7 days

Two specimens are required, the first specimen collected placed in Hartmann’s Buffer for Motility studies, the second specimen placed in 3% Buffered Glutaraldehyde for Electron Microscopy. Refer to Histology Preface (5.37). Advance notice of the impending biopsy should be given to the laboratory.

CITRATE, URINE

Biochemistry


1 - 2 weeks

Please provide clinical and medication details. Refrigerate sample during collection and transport to the laboratory. Acid preserved sample is preferred, but the sample may be collected into a plain container if the sample is kept refrigerated and acid added as soon as possible i.e. at the laboratory. Referred test.

7.36

CK ELECTROPHORESIS, SERUM Biochemistry

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME CHROMOSOMES, PRODUCTS OF CONCEPTION

Please refer to CK ISOENZYME ELECTROPHORESIS, SERUM.

Results (07) 3121 4555

7.36

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/SS tube

2 weeks


Biochemistry

Blood/SS tube

Same day


CK, SERUM

Biochemistry

Blood/SS tube

Same day


C-KIT D816V (MASTOCYTOSIS) GENETIC TESTING

Genetics

Bone marrow and trephine/ Min. 2 mL bone marrow in EDTA or Lithium heparin tubes, and bone marrow trephone (20mm) in 10% neutral buffered formalin

1 - 2 months

CLOBAZAM, SERUM

Biochemistry

Blood/Plain plastic tube no gel (Plastic lithium heparin tube acceptable)

1 week

Please provide clinical and medication details, including time and dosage of last dose. Collect just prior to the next dose or at least 8 hours after the last dose.

CLOMIPRAMINE, SERUM

Biochemistry


1 week

Please provide clinical and medication details, including time and date of last dose. Collect sample immediately prior to next dose.

CLONAZEPAM, SERUM

Biochemistry


1 week

Please provide clinical and medication details, including time and dosage of last dose. Collect just prior to the next dose or at least 8 hours after the last dose.

CLONIDINE GROWTH HORMONE STIMULATION TEST

Endocrinology

Blood/SS tube

24 hours

Test involves administration of Clonidine tablets, the dose dependent on the body surface area, which is calculated by measuring the height and weight of the patient. Contact Endocrinology (07) 3121 4439 or Branch Laboratory for collection details and dose.

7.37

CLOPYRALID Biochemistry (HERBICIDE), URINE CLOSTRIDIUM DIFFICILE TOXIN, Microbiology FAECES

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME CK ISOENZYMES ELECTROPHORESIS, SERUM CK ISOENZYMES, SERUM

Please refer to HERBICIDES, URINE. Faeces/Faeces container

Same day 24 hours

Routine faeces sample. Refrigerate and transport cooled to laboratory within 24 hours of collection. Please indicate any recent history of antibiotics. If causes of diarrhoea other than Clostridium difficile are possible or suspected a faeces sample for microscopy and culture should also be submitted. Refer to Microbiology Preface (5.54).

Results (07) 3121 4555

7.37

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/Plain plastic 6 mL tube - no gel or anticoagulant (EDTA tube or Lithium heparin tube acceptable)

1 week

CLOZARIL, SERUM

Biochemistry

CMV (CYTOMEGALOVIRUS) PCR

Immunology

Blood/SS tube and 1 week 2 EDTA tubes. Random (mid-stream) urine/ urine container Swab/ Viral culture transport medium

Under certain circumstances e.g. suspected antenatal or neonatal infection, positive CMV IgM serology requires confirmation by virus isolation. Saliva and high vaginal swabs are required together with blood and urine.

CMV (CYTOMEGALOVIRUS) SEROLOGY COAGULATION STUDIES, BLOOD

Immunology

Blood/SS tube

24 hours


Haematology

Blood/3 Sodium citrate tubes, 1 EDTA tube, 1 blood film prepared at time of collection

Same day

Studies include Platelet count, Prothrombin time, APTT and Fibrinogen. Please specify if a bleeding time is required. Transport to laboratory within 4 hours. Please provide clinical and medication details.

COBALT, BLOOD

Biochemistry


4 weeks

Please provide exposure details. Referred test.

COBALT, URINE

Biochemistry


1 week

Please provide details of exposure (clinical and occupational). A random collection is preferred. Referred test.

COCAINE METABOLITES - GCMS CONFIRMATION

Biochemistry


48 hours

This is requested in cases concerned with occupational drug screening for drugs of abuse. The QML Pathology protocol complies with Standards Australia AS/NZS4308 for the assay of cannabinoids, opiates, cocaine metabolites, benzodiazepines and sympathomimetic amines. A Chain-of Custody form should be completed. Additional classes (methadone, barbiturates, alcohol) should be specifically requested if required. Please also refer to the Biochemistry Preface (5.4). Confirmation and quantitation by GCMS of positive findings may be requested separately.

www.qml.com.au

Please provide clinical and medication details, including time of last dose and dosage. Collect trough level for monitoring purposes (i.e. immediately before next dose). Although it is generally optimal to collect trough drug levels so as to avoid misleading elevated clozapine samples can be collected at the same time as the Haematology sample levels arising from drug distribution effects, as long as the time of collection is no closer than 12 hours after the dose - typically evening dose followed by late morning collection.

PATHOLOGY TESTS - C

TEST NAME CLOZAPINE, SERUM

Please refer to CLOZAPINE, SERUM.

Results (07) 3121 4555

7.38

7.38

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Immunology

Blood/SS tube

2 - 3 weeks

CODEINE, SERUM

Biochemistry

Blood/Lithium heparin tube or plain plastic tube - no gel

2 weeks

CODIPHEN, SERUM

Biochemistry

Please refer to CODEINE, SERUM.

CODRAL, SERUM

Biochemistry

Please refer to CODEINE, SERUM.

COENZYME Q10, PLASMA

Biochemistry


1 - 2 weeks

Please protect the sample from light and send to the laboratory without delay. Referred test.

COLD AGGLUTININS, SERUM

Blood Bank

Blood/SS tube pre-warmed to 37°C

Same day

Pre-warm all collection materials to 37°C. Maintain specimen at 37°C by immersion in a water bath until clotted. Separate serum by centrifugation IMMEDIATELY after clotting (i.e. at 37°C). The separated specimen may be sent to the laboratory at room temperature.

COLLAGEN BINDING ASSAY, BLOOD

Haematology


1 - 4 weeks

Clinical and medication details required. Transport at 4°C to reach the laboratory within 2 hours of collection. Please contact Haematology (07) 3121 4451 or Branch Laboratory for details.

COMBINED DEXAMETHASONE/ SYNACTHEN TEST

Endocrinology


48 hours

This is a combined test for Androgen Excess/Hirsutism in females and also a test for the rare Congenital Adrenal Hyperplasia (CAH). See Endocrinology Appendix (12.26) This procedure involves an intramuscular injection of Synacthen and Dexamethasone tablets. Please contact Endocrinology (07) 3121 4439 or Branch Laboratory for collection details and supply of Dexamethasone tablets and Synacthen ampoule (0.25mg/1 mL).

COMPATIBILITY TESTING (CROSSMATCH), BLOOD

Blood Bank

Blood/1 Pink top EDTA tube, Same day 1 Lavender top EDTA tube

If history of antibodies or transfusion complications collect additional 6 mL plain plastic tube. Note special requests e.g. CMV negative, irradiated. Record date and hospital where blood required. Sample must be signed by patient or collector to verify. Complete blue box on request form, collector to sign Certification statement.

COMPLEMENT TOTAL HAEMOLYTIC (CH50), SERUM COMPLEMENT-C1, SERUM

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday to Friday). The specimen must be centrifuged immediately after clotting and refrigerated during transport.

Biochemistry

Blood/SS tube

2 - 3 weeks

Please provide clinical and medication details. Centrifuge, separate and FREEZE serum immediately. Transport to the laboratory on dry ice. Referred test.

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Peak level should be taken 1-2 hours after dose. Please provide clinical and medication details including time and dosage of last dose. Referred test.

Results (07) 3121 4555

PATHOLOGY TESTS - C

TEST NAME COCCIDIOIDES SEROLOGY

7.39

7.39

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/SS tube

2 - 3 weeks


COMPLEMENT-C3, SERUM

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details. Sample must be stored and transported to the laboratory REFRIGERATED.


Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details. Sample must be stored and transported to the laboratory REFRIGERATED.


Biochemistry

Blood/SS tube

2 - 3 weeks



Biochemistry

Blood/SS tube

4 weeks



Biochemistry

Blood/SS tube

2 - 3 weeks


COMPLEMENTS, SERUM

Biochemistry

CONGENITAL ADRENAL HYPOPLASIA GENETIC TESTING CONGENITAL HYPOTHYROIDISM SCREENING TEST, BLOOD CONNEXION 26 GENETIC TESTING COOMBS TEST, DIRECT

Genetics

If COMPLEMENTS, SERUM is requested, C3 and C4 are performed. Blood/EDTA tube

2 months

Biochemistry


Please refer to NEONATAL SCREENING TEST.

Genetics

Blood/EDTA tube

1 month


Blood Bank


Same day

Please provide provisional diagnosis and medication history. On neonatal requests provide details of maternal obstetric and transfusion history.

COPPER, HAIR

Biochemistry


4 weeks

Fill sterile container as full as possible with hair. Clippings from the patient’s last hair cut can be used. Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

COPPER, LIVER BIOPSY

Biochemistry

Liver biopsy/Dry sterile screw top (urine) container

2 weeks

Wash excess blood away with 0.9% saline. Wrap in aluminium foil to transport. Place in urine container and FREEZE. DO NOT place in formalin. Referred test.

COPPER, RED BLOOD CELLS

Biochemistry

Blood/EDTA tube

2 weeks

This analysis should only be performed if specifically requested. The preferred analysis for Copper is serum (SS tube). Referred test.

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PATHOLOGY TESTS - C

TEST NAME COMPLEMENT-C2, SERUM

Results (07) 3121 4555

7.40

7.40

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/SS tube

1 week

Please provide clinical history and medication details. CAERULOPLASMIN, SERUM may often be requested concurrently.

COPPER, URINE

Biochemistry

Urine/24 hour urine container with no preservative

1 week

Please provide clinical and medication details. Refrigerate sample and forward to the laboratory. 24 hour collection is preferred. Under rare circumstances or if specifically requested, a random urine may be collected.

COPROPORPHYRIN, URINE

Biochemistry

Please refer to PORPHYRIN, URINE. Fractionation and PBG analysis is routinely performed.

COPROPORPHYRIN SCREEN, FAECES COPROPORPHYRIN/ PROTOPORPHYRIN, FAECES

Biochemistry

Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES.

CORDARONE, SERUM

Biochemistry

CORTISOL, SERUM

Endocrinology

Blood/SS tube

24 hours

Note time of collection and any medications on specimen and request form.

COTININE, SERUM

Biochemistry


1 week

Required for insurance testing. Patient must be fasting. Please store specimen refrigerated and transport cooled to the laboratory without delay. If a delay is envisaged, separate serum, freeze and transport frozen. Please note on the request if the patient is a diabetic, as elevated glucose levels may affect the test. Serum is the preferred sample. Referred test.

COTININE, URINE

Biochemistry


1 week

Required for insurance testing. Patient should be fasting prior to collection. A random urine collection is required. Keep cool and forward to the laboratory as soon as possible. Note on the request if the patient is diabetic, as elevated glucose levels may affect the test. Serum is the preferred sample. If a delay is envisaged, freeze sample and transport frozen. Referred test.

COWDEN SYNDROME GENETIC TESTING

Genetics

Blood/EDTA tube

Indeterminate

Store at 4°C until transported at room temperature. Patient consent form for genetic testing to be completed and signed by patient and clinician. Form to be sent with sample.

Blood/SS tube

24 hours


Blood/SS tube

72 hours


Biochemistry

7.41

COXIELLA (Q FEVER) SEROLOGY Immunology COXSACKIE SEROLOGY Immunology

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Screen: 1 - 7 days Quantitation: 1 - 2 weeks

PATHOLOGY TESTS - C

TEST NAME COPPER, SERUM

Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES.

Please refer to AMIODARONE, SERUM.

Results (07) 3121 4555

7.41

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Endocrinology

Blood/SS tube

24 hours

C-peptide is a remnant of proinsulin after cleavage to produce insulin. This test can be used to assess pancreatic reserve in patients on insulin therapy or if not on insulin as an alternative to blood insulin measurement. Please state whether you require fasting, 1 hour post prandial or random blood collection.

C-PEPTIDE SUPPRESSION TEST Endocrinology USING INSULIN

Blood/SS tube

24 hours

This test involves an infusion of insulin and the measurement of glucose and c-peptide, usually investigating insulinoma. Other hormones may be required to exclude Cushing’s Syndrome or other pituitary/hypothalamic disorders. Appointment is required. Please contact Endocrinology (07) 3121 4439 or Branch Laboratory.

CPK, SERUM

Biochemistry

C-REACTIVE PROTEIN, HIGH SENSITIVITY, SERUM

Biochemistry

Blood/SS tube (EDTA tube and Lithium heparin tube acceptable if centrifuged without delay)

24 hours

Marker for increased risk of premature cardiovascular disease. Keep sample cool.

C-REACTIVE PROTEIN, SERUM

Biochemistry

Blood/SS tube (EDTA tube and Lithium heparin tube acceptable if centrifuged without delay)

Same day

Test for infection/inflammation. With low level elevation, test for active coronary atherosclerosis. Please provide clinical and medication details.

CREATINE KINASE ISOENZYMES, SERUM CREATINE KINASE, SERUM

Biochemistry

Please refer to CK ISOENZYMES, SERUM.

Biochemistry

Please refer to CK, SERUM.

CREATINE, PLASMA

Biochemistry


CREATININE CLEARANCE

Biochemistry

Blood and urine/SS tube and 24 hours 24 hour urine container with no preservative OR 24 hour urine container with 25 mL 6M HCl preservative

Record patient’s height and weight on request form and on urine container. Refrigerate urine during collection. Collect blood sample at end of 24 hour urine collection. Send blood and urine sample to laboratory at the same time. Requests for GFR/calculated GFR do not require urine collection.

CREATININE, FLUID

Biochemistry


Test to determine if originates from urine. Specify source of fluid on sample and request form.

CREATININE, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME C-PEPTIDE SERUM

Please refer to CK ISOENZYMES, SERUM.

3 weeks

Same day

Centrifuge sample and separate plasma where possible. Transport sample on dry ice.


Results (07) 3121 4555

7.42

7.42

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Biochemistry

Urine/24 hour urine 24 hours container with no preservative or 24 hour urine container with 25 mL 6M HCl preservative

Test for completeness of 24 hour collection. Please provide clinical and medication details. CREATININE ASSAY CAN BE PERFORMED ON PLAIN OR PRESERVED URINES. Refrigerate from start of collection, and during storage and transport.

CREATININE, URINE RANDOM

Biochemistry


Test of overall concentration of urine. Please provide clinical and medication details. CREATININE ASSAY CAN BE PERFORMED ON PLAIN OR PRESERVED URINES. Refrigerate during storage and transport.

CROSS LINKED N-TELOPEPTIDES, URINE CROSSMATCH, BLOOD

Biochemistry

CRP HIGH SENSITIVITY, SERUM

Biochemistry

Please refer to C REACTIVE PROTEIN, HIGH SENSITIVITY, SERUM.

CRP, SERUM

Biochemistry

Please refer to C-REACTIVE PROTEIN, SERUM.

CRYOFIBRINOGEN, PLASMA AND SERUM

Biochemistry

Please refer to CRYOFIBRINOGEN/CRYOGLOBULINS, PLASMA AND SERUM.

www.qml.com.au

Blood Bank


Same day

PATHOLOGY TESTS - C

TEST NAME CREATININE, URINE 24 HOUR

Please refer to N-TELOPEPTIDE, URINE. Blood/1 Pink top EDTA tube, Same day 1 Lavender top EDTA tube or urgently

If history of antibodies or transfusion complications collect additional 6 mL. Note special requests e.g. CMV negative/irradiated. Sample must be signed by patient or collector to verify patient identity. Complete blue box on request form, collector to sign Certification statement.

Results (07) 3121 4555

7.43

7.43

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/Lithium heparin tube and a plain tube - no gel

72 hours

CRYOGLOBULINS, PLASMA AND SERUM CRYOGLOBULINS/ CRYOFIBRINOGEN, PLASMA AND SERUM CRYPTOCOCCUS ANTIGEN, SERUM OR CSF

Biochemistry


Biochemistry


Immunology

Blood/SS tube; Cerebrospinal fluid (5- 10 mL)/CSF collection tubes

Same day

CSF - LEUKAEMIA/LYMPHOMA CELLS

Haematology

CSF/CSF collection tubes

Same day

Examination of cytospin preparation for leukaemia/lymphoma cells.

CSF - VIROLOGY

Immunology

CSF/Plain tube (minimum 0.5 mL required)

1 week

Referred test. Test performed by PCR (Viral culture not routinely performed). Please request specific tests and include clinical details.

CSF CONTAMINATION, FLUID

Biochemistry

CSF CYTOLOGY

Cytology

www.qml.com.au

Analysis includes Cryofibrinogen. Samples must be taken into tubes pre-warmed to approximately 37°C (e.g. water bath, oven, hold in hand for approximately 5 minutes). Transfer to the central laboratory immediately, keeping specimens at approximately 37 degrees centigrade, using a vacuum flask or similar. Do not centrifuge samples. IF UNABLE TO TRANSFER TO LABORATORY AT 37°C: 1. Samples must be taken into tubes pre-warmed to 37 degrees centigrade. 2. Allow samples to stand in 37 degrees centigrade water bath for 0.5-1.0 hr to allow separation of red cells to occur without centrifugation. If a water-bath is not available, a container of warm water (topped-up frequently) may be used. 3. When separation has occurred, transfer serum and plasma to Falcon tubes and identify each tube appropriately (i.e. PLASMA - CRY and/or SERUM-CRY). 4. The separated serum and plasma samples may now be transported to the laboratory at ambient temperature. If these procedures cannot be followed, please contact the laboratory on (07) 3121 4460 or Branch Laboratory.

PATHOLOGY TESTS - C

TEST NAME CRYOFIBRINOGEN/ CRYOGLOBULINS, PLASMA AND SERUM

Please refer to TAU PROTEIN, FLUID. CSF/Sterile screw top container

24 hours


Results (07) 3121 4555

7.44

7.44

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Cytology

Fluid/Sterile screw top container

24 hours

CSF MICROSCOPY AND CULTURE

Microbiology

Cerebrospinal fluid/Sterile tubes labelled 1, 2, 3 or 4

Interim Please provide clinical details including antibiotic therapy and specify if specimen microscopy report is to be cultured for Mycobacteria, Viruses, Cryptococci or other fungi or exotic same day. Culture organisms (Nocardia, etc.). up to 3 days.

CSF MICROSCOPY ONLY

Microbiology

Cerebrospinal fluid/ Sterile tubes labelled 1, 2, 3 or 4

Same day

CSF TRANSFERRIN ASSAY, FLUID CYANIDE, BLOOD

Biochemistry

Please refer to TAU PROTEIN, FLUID.

Biochemistry

This test is not available. THIOCYANATE, BLOOD (metabolite of cyanide) is more appropriate.

CYANIDE, URINE

Biochemistry

This test is not available. THIOCYANATE, URINE (metabolite of cyanide) is more appropriate.

CYCLIC AMP, BLOOD AND URINE 24 HOUR

Endocrinology

Blood/SS tube and 24 hour Urine collection/ Urine collection bottle. No preservative

4 - 5 weeks

Record patient’s height and weight on request form. Collect blood sample on return of urine and forward to laboratory at same time. Total volume of urine is required. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

CYCLOSPORIN, BLOOD

Biochemistry

Blood/EDTA tube

3 -5 days

Please provide clinical and medication details. Collect sample just prior to next dose. This test can be performed urgently if required.

CYSTIC FIBROSIS (CF) SCREENING TEST, BLOOD CYSTIC FIBROSIS DNA TEST


Blood/Refer to specific collection details

2 - 3 weeks

If patient less than 2 years, collect neonatal screening card. If patient greater than 2 years, collect EDTA blood. If pre-natal testing is required (CF status on unborn baby), please phone the laboratory on (07) 3121 4420 for instructions.

CYSTINE, URINE

Biochemistry


2 weeks

Please provide clinical history and medication details. Refrigerate from start of collection. 24 hour collection is preferred. Referred test.

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PATHOLOGY TESTS - C

TEST NAME CSF MALIGNANT CELLS

Please refer to NEONATAL SCREENING TEST.

Results (07) 3121 4555

7.45

7.45

PATHOLOGY TESTS - C

PATHOLOGY TESTS

CYTOMEGALOVIRUS (CMV) SEROLOGY CYTOTOXIC FOOD TESTING

www.qml.com.au

SPECIMEN CONTAINER


Blood/SS tube and 24 - 48 hours 2 x EDTA tubes. Random (mid-stream) urine/urine container. Swab/Viral culture transport medium

Under certain circumstances e.g. suspected antenatal or neonatal infection, positive CMV IgM serology requires confirmation by virus isolation. Saliva and high vaginal swabs are required together with blood and urine.

Immunology

Blood/SS tube

24 hours


Specimen Distribution

Blood/ACD tube

Collection and transfer only

Results (07) 3121 4555

PATHOLOGY TESTS - C

TEST NAME DEPARTMENT CYTOMEGALOVIRUS (CMV) PCR Immunology

7.46

7.46

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT Biochemistry

This test is performed on faeces. Please refer to LAXATIVES, FAECES.

DANTHRON, FAECES

Biochemistry

Please refer to LAXATIVES, FAECES.

DAZ GENE ANALYSIS

Genetics

DDE LEVELS (ORGANOCHLORINE PESTICIDES), BLOOD D-DIMER TEST

Biochemistry

DDT LEVELS (ORGANOCHLORINE PESTICIDES), BLOOD DELTA ALA, URINE

Biochemistry


Biochemistry

Please refer to 5-ALA, URINE.

DEMETON (PESTICIDE), SERUM

Biochemistry


DENGUE SEROLOGY

Immunology

Blood/SS tube

24 hours


DENTATORUBRALPALLIDOLUYSIAN ATROPHY (DRPLA) GENETIC TESTING DEOXYCORTICOSTERONE, SERUM DEOXYCORTISOL, SERUM

Genetics

Blood/EDTA tube

1 - 2 months


Endocrinology

Blood/SS tube

2 - 5 weeks

Referred test.

Endocrinology

Blood/SS tube

2 - 5 weeks

Referred test.

DEOXYPYRIDINIUM, URINE

Biochemistry

DEOXYPYRIDINOLINE, URINE

Biochemistry

DEPTRAN, SERUM

Biochemistry

www.qml.com.au

Haematology

SPECIMEN CONTAINER



2 weeks

Incurs non-Medicare refundable fee. Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Blood/Sodium Citrate tube

Same day

PATHOLOGY TESTS - D

TEST NAME DANTHRON, BLOOD

Transport to laboratory as soon as possible.

Please refer to DEOXYPYRIDINOLINE, URINE. Urine/Urine container (random) or 24 hour urine container with no preservative

1 week

An early morning urine specimen is preferred. A 24 hour specimen may be collected if specifically requested. No preservative. Keep specimen refrigerated during collection and transport. A highly specific marker of bone resorption used in investigation and monitoring of osteoporosis, Paget’s disease, steroid therapy, malignancies, inflammatory diseases and metabolic bone diseases. Please refer to DOXEPIN, SERUM.

Results (07) 3121 4555

7.47

7.47

PATHOLOGY TESTS - D

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Biochemistry

Blood/Plain plastic tube 1 week no gel (Plastic lithium heparin tube (no gel) acceptable)

DESMOSINE PYRIDINOLINE, URINE DEXAMETHASONE SUPPRESSION TEST

Biochemistry Endocrinology


48 hours

Collect baseline cortisol specimen between 8am and 10am day 1. Also collect a baseline EDTA specimen. This is used to perform an ACTH if dexamethasone suppression test results are abnormal. Give 1 mg oral Dexamethasone at 11pm. Patient to remain awake for at least 30 minutes post dose to ensure absorption. Collect second cortisol specimen between 8am and 10am day 2. Note this test must be varied for shift workers. Please note - for children (2 years: Collect 6-10 hair roots. Secure hairs with sticky tape to paper, leaving roots uncovered. Children 5 days, contact Endocrinology or Branch laboratory for details (plasma needs to be snap frozen).

REPTILASE TIME

Haematology


Same day

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PATHOLOGY TESTS - R

TEST NAME

Referred test. Please refer to MAGNESIUM, RED CELL.

Results (07) 3121 4555

9.34

9.34

PATHOLOGY TESTS - R

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Cytology

Sputum, brushings and washings, FNA/Labelled fixed smears, appropriate sterile containers and aspirating traps

24 hours


RESPIRATORY SYNCYTIAL VIRUS (RSV) SEROLOGY RESPIRATORY VIRAL ANTIGEN TEST (DFA), INCLUDING RSV, INFLUENZA, PARAINFLUENZA, ADENOVIRUS RESPIRATORY VIRUS PCR

Immunology

Blood/SS tube

24 hours


Immunology

Nasopharyngeal Aspirate/ Aspirating trap

24 hours

Refrigerate specimen and transport cooled to laboratory as soon as possible. Results usually available same day for urgent specimens.

Immunology

Nasopharyngeal Aspirate or Nasopharyngeal swab (dry)/ Luki tube or Sterile container or Viral swab (VIROCULT)

24 - 48 hours

PCR test detects RSV, Influenza A&B, Parainfluenza 1 2 3, and Adenovirus.

RET PROTO-ONCOGENE DNA TEST

Genetics

Blood/EDTA tube

8 weeks for full screen, 4 weeks for known family mutation

Store at 4°C until transported at room temperature. Patient consent form for genetic testing is to be completed and signed by patient and clinician. Form to be sent with sample.

RETICULIN ANTIBODY

Immunology

Blood/SS tube

24 hours


RETICULOCYTE COUNT, BLOOD

Haematology

Blood/EDTA tube

Same day

RETINOL BINDING PROTEIN, SERUM

Biochemistry

Blood/SS tube or Lithium heparin tube

1 - 2 weeks

RETINOL, SERUM

Biochemistry

RETT SYNDROME GENETIC TESTING REVERSE T3

Genetics

Blood/EDTA tube

3 months

Patient consent for billing must be marked on the request form.

Endocrinology

Blood/SS tube

1 - 2 months

There is currently no Medicare rebate for this test. Referred test.

RHEIN, FAECES

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - R

TEST NAME RESPIRATORY CYTOLOGY

Ensure sample is protected from light. Transport in esky at 4°C. Referred test. Please refer to VITAMIN A, SERUM.

Please refer to LAXATIVES, FAECES.

Results (07) 3121 4555

9.35

9.35

PATHOLOGY TESTS - R

PATHOLOGY TESTS

SPECIMEN CONTAINER


Amniotic fluid/ Sterile container

Indeterminate

Please phone and organise in advance as this is not a routine test.

RHEUMATOID ARTHRITIS SEROLOGY RHEUMATOID FACTOR (RF), RA LATEX TEST, SERUM RIBOFLAVIN, BLOOD

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

Immunology

Blood/SS tube

24 hours


RICKETTSIA SEROLOGY

Immunology

RISPERDAL, PLASMA

Biochemistry

RISPERIDONE, PLASMA

Biochemistry


1 - 2 weeks

Please provide clinical and medication details. Keep the sample cool and send to the laboratory without delay. Referred test.

RISTOCETIN COFACTOR ASSAY (VON WILLEBRAND DISEASE), PLASMA

Haematology


24 hours

Please provide clinical and medication details. Keep specimen at 4°C and must reach laboratory within 2 hours of collection. Please contact Haematology (07) 3121 4451 or Branch Laboratory for details.

RITONAVIR, PLASMA

Biochemistry

Blood/EDTA tube

3 weeks

Please provide clinical and medication details. Plasma to be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Referred test.

RIVOTRIL, SERUM

Biochemistry

Please refer to CLONAZEPAM, SERUM.

ROGOR (PESTICIDE), SERUM

Biochemistry


ROHYPNOL, SERUM

Biochemistry

Please refer to FLUNITRAZEPAM, SERUM.

ROSS RIVER VIRUS (RRV) SEROLOGY ROTAVIRUS AGGLUTINATION TEST, FAECES ROUNDUP, URINE

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday to Friday, plus Saturday during late Summer).

Microbiology


Same day

Please specify if culture for other enteric viruses is required.

RPR (RAPID PLASMA REAGIN) -VDRL, SERUM

Immunology

www.qml.com.au

Biochemistry

PATHOLOGY TESTS - R

TEST NAME DEPARTMENT RHESUS DNA TESTING (AMNIO) Genetics

Please refer to VITAMIN B2, BLOOD for details. Blood/SS tube

72 hours

Assay run Tuesday and Friday. Please refer to RISPERIDONE, PLASMA.

Biochemistry

Please refer to GLYPHOSATE, URINE. Blood/SS tube

24 hours

Supplementary test. Performed if Syphilis EIA test is positive. Assay run daily (Monday - Saturday).

Results (07) 3121 4555

9.36

9.36

PATHOLOGY TESTS - R

PATHOLOGY TESTS

SPECIMEN CONTAINER


Nasopharyngeal Aspirate/ Aspirating trap

24 hours

Refrigerate specimen and transport cooled to laboratory as soon as possible. Results available same day for urgent specimens. See Microbiology Preface (5.54) for collection details.

RSV (RESPIRATORY SYNCYTIAL VIRUS) SEROLOGY RUBELLA SEROLOGY

Immunology

Blood/SS tube

24 hours


Immunology

Blood/SS tube

24 hours


RYTHMODAN, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - R

TEST NAME DEPARTMENT RSV (RESPIRATORY SYNCYTIAL Immunology VIRUS) ANTIGEN - DIRECT FLUORESCENT ANTIBODY TEST

Please refer to DISOPYRAMINE, SERUM.

Results (07) 3121 4555

9.37

9.37

PATHOLOGY TESTS - R

PATHOLOGY TESTS

DEPARTMENT

SAICAR, URINE

Biochemistry


2 - 3 weeks

Please provide clinical and medication details. Random early morning urine collection preferred. Refrigerate for transfer to laboratory. Referred test.

SALBUTAMOL, URINE

Biochemistry

Urine/Tamper-proof urine container or Urine container enclosed in a tamper-evident bag

24 hours

Urine specimen should be collected as per protocol on Chain-of-Custody form (FORM/BI/07/014), into a tamper-proof container or container enclosed in a tamper-evident bag. ENSURE CHAIN-OF-CUSTODY FORM IS COMPLETED. The original copy must always accompany the primary sample to the testing laboratory. NB: Due to possible legal implications, contact the laboratory (07) 3121 4419 if the correct procedure cannot be followed.

SALICYLATE, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant (Plastic lithium heparin tube acceptable)

Same day

Please note time and dosage of last medication. Collect 1-3 hours after oral dose.

SALIVA DRUG SCREEN, QUALITATIVE ASSAY

Biochemistry

Supervised random Saliva (10 mL)/Sterile screw cap container

48 hours

Please contact Biochemistry (07) 3121 4419 or Branch Laboratory for further details.

SALIVARY DUCT/GLANDS ANTIBODY, SERUM SALIVARY PROGESTERONE

Immunology

Blood/SS tube

2 weeks

Referred test.

Endocrinology

Saliva/Sterile container (urine)

24 hours

It is recommended that the patient not eat two hours prior to test. Collect by spitting into the container. The specimen should be kept cool. Record clinical details e.g. LMP and Hysterectomy. Record medications, e.g. HRT, oral contraceptive, creams used including the type and when applied.

SALMONELLA TYPHI SEROLOGY Immunology (WIDAL SEROLOGY) SAN FILLIPO SYNDROME Genetics/ GENETIC TESTING Biochemistry

Blood/SS tube

24 hours


Blood and CVS or Amino fluid/EDTA tube and Sterile Container (Amino) or Transport media for tissue

Indeterminate

If the mutation within the family is known, the details of the mutation and, preferably, how the patient is related to the proband should be stated. Request inclusion of clinical history. For Prenatal Diagnosis samples should be sent by overnight courier at room temperature.

SANDHOFF DISEASE GENETIC TESTING

Blood/EDTA tube and SS tube

1 month

Transport frozen or at 4°C. Specimen to be received within 24 hours.

www.qml.com.au

SPECIMEN CONTAINER


Biochemistry

Genetics/ Biochemistry

Please refer to VIGABATRIN, SERUM.

Results (07) 3121 4555

PATHOLOGY TESTS - S

TEST NAME SABRIL, SERUM

10.0

10.0

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/EDTA tube

3 weeks

SAROTEN, SERUM

Biochemistry

Sb (ANTIMONY), BLOOD

Biochemistry


4 weeks

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

Sb (ANTIMONY), URINE

Biochemistry


4 weeks

This is the preferred sample for exposure. A random sample is required. Referred test.

SCABIES

Microbiology

QML Pathology collectors required for specialised collection procedure

Same day

Refer to Microbiology Preface (5.57) for details. Please contact Microbiology (07) 3121 4438 or Branch Laboratory for further details of collection and transport.

SCHIRMER TEAR TEST (TEAR LYSOZYME CONCENTRATION)

Haematology

Tears/Special tubes provided by Haematology Department

24 hours

By appointment only. Please contact Haematology (07) 3121 4451 or Branch Laboratory.

SCHISTOSOMA SEROLOGY

Immunology

Blood/SS tube

1 week


SCHUMM’S TEST, PLASMA

Biochemistry

Please refer to METHAEMALBUMIN, PLASMA.

SCOLINE SENSITIVITY, SERUM

Biochemistry


SECOND TRIMESTER DOWNS SCREEN

Endocrinology

Blood/SS tube

48 hours

This test gives a calculated risk for Down’s and Spina Bifida at term. Collect specimen between 15th and 18th week of pregnancy. Includes-Beta HCG, AFP, Free Oestriol. Please make note of the following: 1: LMP/EDC and/or scan results. 2: Patient’s weight. 3: Family history of Down’s or Spina Bifida and which family member it was. 4: Is it a single or multiple pregnancy? 5: Is patient an insulin dependent diabetic?

SELENIUM, BLOOD

Biochemistry


2 weeks

Please provide clinical, medication and exposure details. NOTE: Selenium blood analysis will only be performed where both serum AND blood levels are specifically requested. In all other cases, please collect for Selenium, serum only. Referred test.

SELENIUM, SERUM

Biochemistry

Serum/Trace element free tube (Navy-top)

1 - 2 weeks

Please provide clinical, medication and exposure details. If a trace element free tube is unavailable, collect blood into an EDTA or Lithium heparin tube. Keep sample cool. Referred test.

www.qml.com.au

Please provide clinical and medication details. Plasma to be separated and frozen if sample will not reach the central laboratory within 24 hours of collection. Referred test. Please refer to AMITRIPTYLINE, SERUM.

Results (07) 3121 4555

PATHOLOGY TESTS - S

TEST NAME SAQUINAVIR, PLASMA

10.1

10.1

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry


4 weeks

24 hour urine is preferred. Please provide exposure and occupation details. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

SEMINAL FLUID ANALYSIS

Genetics

Seminal fluid/Plain sterile container (semen container)

24 hours

Instruction sheet provided for patient. Specimen must reach laboratory within 2 hours of collection. Keep at room temperature. DO NOT REFRIGERATE. Please refer to Genetics Preface (5.30) for full details.

SEMINAL FLUID MICROSCOPY (POST VASECTOMY)

Genetics

Seminal fluid/Plain sterile container (semen container)

24 hours

Instruction sheet provided for patient. Specimen must reach laboratory within 2 hours of collection. Keep at room temperature. DO NOT REFRIGERATE. Please refer to Genetics Preface (5.30) for full details.

SERAPAX, SERUM

Biochemistry

Please refer to OXAZEPAM, SERUM.

SEROQUEL, SERUM

Biochemistry

Please refer to QUETIAPINE, SERUM for details.

SEROTONIN, PLATELET

Biochemistry

Blood/2 x 5 mL EDTA tubes

3 weeks

Test for carcinoid syndrome. Collect 2 X 5 mL EDTA tubes - one to be frozen (as whole blood). Referred test. A marker for carcinoid syndrome. See also 5-H.I.A.A.

SEROTONIN, SERUM

Biochemistry

Blood/SS tube

3 weeks

Test for carcinoid syndrome. Please contact Biochemistry on (07) 3121 4420 or Branch Laboratory as 5-H.I.A.A, URINE may be preferred test. (Serotonin or 5-HT is referred test). Transport to laboratory as soon as possible.

SEROTONIN, URINE 24 HOUR

Biochemistry


2 weeks

Tumour marker - carcinoid tumour. Uncommonly used. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

SERTRALINE, SERUM

Biochemistry


2 weeks

Please provide clinical and medication details. Please keep the sample cool.

SERUM TRYPASE

Immunology

Blood/SS tube

Results available on the day the test is run

Assay run every week. Collect an SS tube 1-3 hours after reaction (anaphylaxis) or anytime if suspected mastocytosis. Samples need to be separated and serum frozen within 24 hours of collection. Doctor must supply comprehensive clinical history, including: 1. Time of onset of anaphylaxis. 2. Drugs or other agents and time administered before onset of reaction. 3. Clinical details.

SEVIN (PESTICIDE), BLOOD

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - S

TEST NAME SELENIUM, URINE

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

Results (07) 3121 4555

10.2

10.2

PATHOLOGY TESTS - S

PATHOLOGY TESTS

PATHOLOGY TESTS - S

TEST NAME SEX DETERMINING REGION Y (SRY) GENE ANALYSIS SEX HORMONE BINDING GLOBULIN, SERUM SHIGELLA DYSENTERIAE SEROLOGY SHIGELLA FLEXNERI SEROLOGY

DEPARTMENT

SPECIMEN CONTAINER


Genetics


2 weeks

Endocrinology

Blood/SS tube

24 hours

Immunology

Blood/SS tube

24 hours


Immunology

Blood/SS tube

24 hours


SHORT SYNACTHEN STIMULATION TEST

Endocrinology


24 hours

Give intramuscular injection of Synacthen (0.25mg/1 mL). Collect blood samples prior to injection and at 30 and 60 minutes post injection. Please contact Branch Laboratory for supply of Synacthen ampoule. Also collect an EDTA on the basal specimen to perform ACTH if these results are abnormal. Please include details of any corticosteroids taken recently (especially in the past 24 hours).

SHOX GENE ANALYSIS

Genetics

Blood or fixed cell suspension from blood/ Lithium heparin tube

3 weeks

Patient consent for billing must be marked on the request form.

SICKLE CELL TEST, BLOOD

Haematology

Blood/EDTA tube

24 hours

SILVER, BLOOD

Biochemistry

Blood/EDTA tube

4 weeks


SILVER, URINE

Biochemistry


4 weeks

Please provide exposure details (clinical and occupational). A random collection is preferred. A 24 hour specimen should only be collected if specifically required. Referred test.

SIMPLIRED D-DIMER

Haematology

Blood/Sodium citrate tube or Lithium heparin tube

Same day

Please forward to laboratory as soon as possible.

SINDBIS SEROLOGY

Immunology

Blood/SS tube

2 - 3 weeks

SINEQUAN, SERUM

Biochemistry

SINGLE BIOLOGICAL INDICATOR (AUTOCLAVE) TEST

Microbiology

www.qml.com.au


Please refer to DOXEPIN, SERUM. Autoclave test vial

48 hours

The autoclave test vial is collected from the surgery after autoclaving. The vial may be autoclaved alone or during any other cycle. A complete autoclave test request form must be completed and submitted with the vial. Please contact the Microbiology Department (07) 3121 4438 for vials and request books.

Results (07) 3121 4555

10.3

10.3

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/EDTA tube

2 - 3 weeks

Please protect the sample from light, keep cool and send to the laboratory without delay. Referred test.

SKELETAL MUSCLE ANTIBODY, SERUM

Immunology

Blood/SS tube

2 weeks

Assay run Thursday (fortnightly). Results available day after the test is run.

SKIN ALLERGY TEST

Immunology

Skin Prick Test

72 hours

Please refer to the list of QML Pathology Collection Centres which perform special tests in the ‘Collection Facilities’ section of this manual (2.13). Please refer to Immunology Appendix (12.37) for a comprehensive list of Allergens tested.

SKIN SCRAPINGS FOR FUNGI

Microbiology

Preferred container is a sterile screw capped container. Scalpel blade can be included. Other containers include paper envelopes and Petri dishes

Interim microscopy report 24 hours. Culture report up to 4 Weeks

Please indicate recent history of therapy. Antifungal therapy should be ceased at least 2 days (optimally one week) prior to collection of specimen. Scrape active edge of lesion. If the lesion is exuding material and painful to scrape, a swab may be collected as an alternative. Use a dry swab previously moistened with saline to swab the lesion. Place the swab in a container without transport medium. Refer to Cutaneous Fungal Culture in Microbiology Preface (5.56) for details of specimen collection, storage and transport. Blade should be transported in screw top container (NOT paper envelope).

SMOOTH MUSCLE ANTIBODY, SERUM SNAKE BITE IDENTIFICATION

Immunology

Blood/SS tube

24 hours


Biochemistry

Bite site swab (preferred), 2 - 4 hours urine or blood. Swab/Urine - sterile urine container. Blood - Lithium heparin tube (NOT preferred)

SODIUM VALPROATE, SERUM

Biochemistry

Please refer to VALPROATE, SERUM.

SODIUM, CSF

Biochemistry

Please refer to BIOCHEMISTRY, CSF for details.

SODIUM, FAECES

Biochemistry


24 hours


SODIUM, FLUID

Biochemistry


Same day


SODIUM, SERUM

Biochemistry


SODIUM, SWEAT

Biochemistry

Please refer to ELECTROLYTES, SWEAT.

www.qml.com.au

PATHOLOGY TESTS - S

TEST NAME SIROLIMUS, BLOOD

Please refer to Biochemistry Preface (5.7). SWAB - use cotton swab/bud moisten with saline or tap water and swab over site of puncture wound/s. A small piece of clothing may also be used. The swab and/or piece of cloth should be placed in separate labelled plain containers. URINE - sterile urine container. BLOOD - NOT preferred but acceptable.

Results (07) 3121 4555

10.4

10.4

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Urine/24 hour urine container with no preservative or random urine container

Same day

Please provide clinical and medication details. 24 hour collection is preferred. Under rare circumstances or if specifically required, a random urine may be collected. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

SOLIAN, SERUM

Biochemistry


4 weeks

Please provide clinical and medication details. Please keep the sample cool.

SOLUBLE MESOTHELIN RELATED PROTEIN

Biochemistry


3 weeks

Provide clinical details such as exposure to asbestos. Keep sample on ice brick for arrival to Biochemistry Department within 24 hours.

SOLUBLE TRANSFERRIN RECEPTOR, SERUM

Biochemistry

Blood/SS tube

2 weeks

Please keep the sample cool and forward to the laboratory without delay. Referred test.

SOLVENTS, BLOOD

Biochemistry


2 weeks

Please provide exposure and occupation details. Contact Biochemistry (07) 3121 4420 or Branch Laboratory for full list of solvents screened. Keep chilled at all times. Tube should have minimal air space between top of blood and lid. Referred test. This test attracts a charge of approximately $100 from the referring laboratory, payable by the patient or their employer.

SOMATOMEDIN C (IGF-I), SERUM

Endocrinology

Blood/SS tube

24 hours

Growth hormone is secreted in a pulsatile fashion and levels fluctuate under external influences. IGF-I/ Somatomedin C is a relatively long lived stable protein product of growth hormone action produced mainly by the liver. It may assist assessment of pituitary regulation of growth. Please consult Endocrinology (07) 3121 4439 or Branch Laboratory.

SORBITOL DEHYDROGENASE, RED CELL SOTACOR, SERUM

Biochemistry


2 weeks

Referred test.

SOTALOL, BLOOD

Biochemistry


1 - 2 weeks

Please provide clinical and medication details including date and time of last dose. Collect trough sample just prior to next dose. Keep the sample cool and forward to the laboratory without delay. Referred test.

SPECIFIC GRAVITY, URINE

Biochemistry


24 hours

Random or 24 hour urine acceptable.

www.qml.com.au

Biochemistry

PATHOLOGY TESTS - S

TEST NAME SODIUM, URINE

Please refer to SOTALOL, BLOOD.

Results (07) 3121 4555

10.5

10.5

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Genetics

Blood/SS tube and/or Seminal fluid/ Semen container

1 - 2 weeks

FEMALE - serum MALE - serum and seminal fluid. Please refer to Genetics Preface (5.30) and contact Genetics (07) 3121 4461 or Branch Laboratory for collection details. Performed fortnightly.

SPINOCEREBELLAR ATAXIA (SCA1 & SCA2) GENETIC TESTING SPONTANEOUS ERYTHROID COLONIES

Genetics

Blood/EDTA tube

1 - 2 months


Haematology

Blood or Bone marrow/ ACD tube or Bone marrow heparin

2 weeks

SPORANOX, SERUM

Biochemistry

SPUTUM STAIN FOR EOSINOPHILS

Microbiology

Sputum/Sterile dry, screw top (urine) container

Same day

Specify site of collection.

SPUTUM CYTOLOGY

Cytology


24 hours

Specimen should be refrigerated and transported cooled to the laboratory as soon as possible. For specimen preparation please refer to Cytology Preface (5.15).

SPUTUM MALIGNANT CELLS

Cytology


24 hours

Specimen should be refrigerated and transported cooled to the laboratory as soon as possible. For specimen preparation please refer to Cytology Preface (5.15).

SPUTUM MICROSCOPY AND CULTURE

Microbiology


Please indicate if special examinations are required (e.g. Fungi, Nocardia, Interim microscopy report Legionella and Acid-Fast Bacilli). Early morning samples are recommended. Specimen should be transported cooled to laboratory as soon as possible. - same day. Routine culture report - 48 hours; Legionella 10 days; Acid-Fast Bacilli - up to 6 weeks

STEARIC ACID, PLASMA

Biochemistry

STEROID PROFILE, RANDOM URINE

Endocrinology

www.qml.com.au

PATHOLOGY TESTS - S

TEST NAME SPERM ANTIBODIES (IMMUNOBEAD TEST)

Please refer to ITRACONAZOLE, SERUM.

Please refer to ELAIDIC/STEARIC ACID RATIO. Random urine/ Urine container

4 - 5 weeks

Urine screen for steroid breakdown products. Elevated levels correspond to excess production. Used mainly in children. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

Results (07) 3121 4555

10.6

10.6

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Endocrinology


4 - 5 weeks

Urine screen for steroid breakdown products. Elevated levels correspond to excess production. Used mainly in children. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Referred test.

STEROID SCREEN, URINE

Biochemistry

Urine/Tamper evident collection kit

Indeterminate

This test is only performed on Defence and Police Force personnel. A Chain-of-Custody form and justification letter are required. Referred test.

STOCRIN, PLASMA

Biochemistry

Blood/EDTA tube

3 weeks

This test is only performed on Defence and Police Force personnel. A Chain-of-Custody form and justification letter are required. Referred test.

STREPTOCOCCAL SEROLOGY

Immunology

Blood/SS tube

24 hours


STRONGYLOIDES SEROLOGY

Immunology

Blood/SS tube

1 week


STRYCHNINE, BLOOD

Biochemistry

Blood/Fluoride oxalate tube

4 weeks

Please provide exposure details. This test performed only on legal request. Contact Biochemistry (07) 3121 4420 or Branch Laboratory for availability. Referred test.

STYRENE EXPOSURE, URINE

Biochemistry

Please refer to MANDELIC ACID, URINE.

STYRENE, BLOOD

Biochemistry


SUCCINYLAMINOIMIDAZOLE CARBOXAMIDE RIBOSIDE, URINE SUCROSE LYSIS TEST, RED CELL

Biochemistry

Please refer to SAICAR, URINE.

SUGAR CHROMATOGRAPHY, FAECES SUGAR CHROMATOGRAPHY, URINE



1 week

Please provide clinical details. FRESH random urine sample. Store and transport frozen. Please also refer to the Biochemistry Preface (5.4).

SULPHAEMOGLOBIN, BLOOD

Biochemistry


Same day

Please provide clinical and medication details. Do not separate plasma.

SULPHONYLUREAS, PLASMA

Biochemistry


4 weeks

Referred test.

SULTHIAME, SERUM

Biochemistry


1 week

Please provide clinical and medication details including time and date of last dose. Collect sample a minimum of 8 hours after the last dose or immediately prior to the next dose.

www.qml.com.au

Haematology


PATHOLOGY TESTS - S

TEST NAME STEROID PROFILE, URINE 24 HOUR

24 hours Please refer to CHROMATOGRAPHY, FAECES.

Results (07) 3121 4555

10.7

10.7

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Microbiology

Swab in Transport Medium

48 hours

SURMONTIL, SERUM

Biochemistry

Please supply clinical history including mode of injury (e.g. dog bite) and specify site and any recent antibiotic therapy. Indicate if post-operative. Please indicate if exotic or unusual organisms are suspected. Prompt transport to the laboratory is essential. Please refer to TRIMIPRAMINE, SERUM.

SUXAMETHONIUM SENSITIVITY, Biochemistry SERUM


SYMPATHOMIMETIC AMINES GCMS CONFIRMATION

Biochemistry


48 hours


SYNACTHEN STIMULATION TEST

Endocrinology


24 hours

Give intramuscular injection of Synacthen (0.25mg/1mL). Collect blood samples prior to injection and at 30 and 60 minutes post injection. Please contact Branch Laboratory for supply of Synacthen ampoule. Also collect an EDTA on the basal specimen to perform ACTH if these results are abnormal. Please include details of any corticosteroids taken recently (especially in the past 24 hours).

SYNOVIAL FLUID ANALYSIS

Microbiology

Synovial fluid/Sterile dry screw top (urine) container, Lithium heparin tube, Fluoride EDTA tube

24 hours

Synovial fluid collection kits are provided on request by QML Pathology.

SYNOVIAL FLUID CYTOLOGY

Cytology

Synovial fluid/Appropriate 24 hours sterile container and labelled fixed and air dried smear preparations


SYNOVIAL FLUID MICROSCOPY AND CULTURE

Microbiology

Synovial fluid/Plain sterile container or Lithium heparin tube

Please specify site of collection and previous antibiotic therapy.

www.qml.com.au

48 hours

Results (07) 3121 4555

PATHOLOGY TESTS - S

TEST NAME SUPERFICIAL WOUND SWABS

10.8

10.8

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

Immunology

Blood/SS tube

24 hours

SYSTEMIC FUNGAL CULTURE (TISSUE)

Microbiology

Tissue or Biopsy/ Sterile container

24 hours for Specimen MUST NOT be in formalin. microscopy, 4 weeks for culture

www.qml.com.au

SPECIMEN CONTAINER


Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details. The standard EIA screening test is performed daily (Monday to Saturday). If positive, supplemental Syphilis testing will be performed.

Results (07) 3121 4555

PATHOLOGY TESTS - S

TEST NAME SYNTHETIC PYRETHROIDS, BLOOD SYPHILIS SEROLOGY

10.9

10.9

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Genetics

Bone marrow (EDTA tube) 2 weeks or Lymph node (EDTA tube) or Tumour or Blood (Pink top EDTA tube)

Transport at room temperature or cooled on ice brick.

T LYMPHOCYTE 4/8 RATIO (LYMPHOCYTE SUBSET ANALYSIS), BLOOD TACROLIMUS, BLOOD

Haematology

Blood/ACD tube, EDTA tube, Blood film

24 hours

Lithium heparin tube may be used if ACD tube unavailable.

Biochemistry

Blood/EDTA tube

24 hours

Please provide clinical and medication details. Collect a trough sample and transport at 4°C.

TAMBOCOR, SERUM

Biochemistry

TAU PROTEIN, FLUID

Biochemistry

Fluid/Plain tube

24 - 48 hours

TAY SACHS GENETIC TESTING

Genetics

Blood/EDTA tube

Indeterminate

TB CULTURE (URINE, SPUTA ETC.)

Microbiology

Sputum, Urine, Swabs, Pus, Tissue/Sterile container

Interim microscopy 3 early morning urine and/or sputa are recommended. report 2 days. Tissue in sterile container (NOT in formalin). Culture - 6 weeks

T-CELL RECEPTOR GENE REARRANGEMENT

Genetics

2 weeks Bone marrow (EDTA tube) or Lymph node (EDTA tube) or Tumour or Blood (Pink top EDTA tube)

TEGRETOL, SERUM

Biochemistry

TELLURIUM, BLOOD

Biochemistry


TEL-PDGFR GENE ANALYSIS

Genetics

Blood or Bone marrow/EDTA 1 - 2 months tube or min. 2 mL bone marrow in EDTA tube

Specimen to be received within 24 hours.

TEMAZEPAM, SERUM

Biochemistry

Blood/Plain plastic tube 1 week no gel. Plastic lithium heparin tube acceptable

Please provide clinical and medication detail, including time and date of last dose. Collect just prior to the next dose or at least 8 hours after the last dose.

www.qml.com.au


PATHOLOGY TESTS - T

TEST NAME T & B CELL GENE REARRANGEMENT STUDIES

Please refer to FLECAINIDE, SERUM. Test for CSF contamination of nasal fluids, etc. Please provide clinical details. Note fluid site on specimen container and request form.


Please refer to CARBAMAZEPINE, SERUM. 4 weeks


Results (07) 3121 4555

10.10

10.10

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

TERBUTALINE, URINE

Biochemistry

TERSEL, SERUM

Biochemistry

TESTICULAR AUTOANTIBODIES

Immunology

Blood/SS tube

1 week

Refer to ADENOVIRUS SEROLOGY for collection details.

TESTICULAR BIOPSY (INFERTILITY INVESTIGATION)

Histology

Biopsy tissue/Bouin’s Fixative solution

24 hours

Bouin’s fixative solution is essential for optimum fixation and preservation of detail. It is available on request from Histology (07) 3121 4495 or Branch Laboratory.

TESTOSTERONE FREE, SERUM

Endocrinology

Blood/SS tube

24 hours

This test measures a sub fraction of albumin bound testosterone. Collect a fasting specimen or a specimen at greater than 3 hours post-prandial as food absorption may influence blood levels.

TESTOSTERONE, SALIVA

Endocrinology

Saliva/Sterile container (urine)

2 weeks

Referred test. Incurs non-Medicare refundable fee.

TESTOSTERONE, SERUM

Endocrinology

Blood/SS tube

24 hours

Morning specimen is preferred (not essential) and fasting is not required.

TESTOSTERONE, URINE

Endocrinology

Urine/24 hr urine container. No preservative

2 - 3 weeks

Patient must provide a certificate signed by the requesting doctor that the test is required for a medical reason e.g. for a tumour, not for athletes.

TETANUS SEROLOGY

Immunology

Blood/SS tube

1 week

Assay run Tuesday.

TETRACHLOROETHANE, BLOOD TETRACHLOROETHYLENE, BLOOD TETRAMETHYLHEXADECANOIC ACID, PLASMA THALASSAEMIA SCREEN/ STUDIES, BLOOD

Biochemistry


Biochemistry


Biochemistry

Please refer to FATTY ACIDS-VERY LONG CHAIN, PLASMA.

www.qml.com.au

SPECIMEN CONTAINER


Biochemistry

Haematology

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for toxicity. Urine/Tamper-proof urine container or Urine container enclosed in a tamper-evident bag

Next day following assay

Urine specimen should be collected as per protocol on Chain-of-Custody form, into a tamper-proof container or container enclosed in a tamper-evident bag. ENSURE CHAIN-OF-CUSTODY FORM IS COMPLETED. The original copy must always accompany the primary sample to the testing laboratory. NB: Due to possible legal implications, contact the Central Laboratory (07) 3121 4419 if the correct procedure cannot be followed.

PATHOLOGY TESTS - T

TEST NAME TEMIK (PESTICIDE), BLOOD

Please refer to CARBAMAZEPINE, SERUM.

Blood/2 x EDTA tubes, 1 Blood film

1 - 3 days

Tests performed Tuesday and Friday. Results available same day of test.

Results (07) 3121 4555

10.11

10.11

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry


4 weeks

Test for toxicity. Please provide clinical and medication details. Referred test.

THALLIUM, URINE

Biochemistry


4 weeks

Test for unusual exposure. Please provide details of exposure (clinical and occupational). A random collection is preferred. Refrigerate specimen and transport cooled to laboratory. Referred test.

THC-COOH - GCMS CONFIRMATION

Biochemistry


Next day following assay


THEODUR PRE/POST DOSE, SERUM THEODUR, SERUM

Biochemistry


Biochemistry


THEOPHYLLINE PRE/POST DOSE, SERUM THEOPHYLLINE, SERUM

Biochemistry


THIAMINE, BLOOD

Biochemistry

THINPREP (MONOLAYER) CYTOLOGY

Cytology

Labelled fixed smear/slide carrier. Rinse collection device in labelled PreservCyt Solution

24 - 48 hours

ThinPrep is performed as an adjunct to conventional screening. A conventional Pap smear must be performed and the collection device rinsed in labelled PreservCyt Solution (available from QML Pathology Collection Centres). Transport Pap smear and PreservCyt Solution to the laboratory. This test incurs a non rebatable fee.

THIOCYANATE, BLOOD

Biochemistry


2 weeks

Test for cyanide exposure. Please provide details of exposure to chemicals. Please collect the sample immediately after the exposure or work shift. Thiocyanate is the metabolic product of inactivation of cyanide. Raised in cigarette smokers. Referred test.

www.qml.com.au

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant (Plastic lithium heparin tube acceptable)


PATHOLOGY TESTS - T

TEST NAME THALLIUM, BLOOD

Please note type of medication, sampling times and dosage given. PRE (TROUGH LEVEL): Immediately prior to next dose. POST (PEAK LEVEL): RAPID RELEASE - 2 hours after dose. SLOW RELEASE - 4 hours after dose (e.g. Theodur). Please refer to VITAMIN B1, BLOOD for details.

Results (07) 3121 4555

10.12

10.12

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry


4 weeks

Raised in cyanide exposure including cigarette smoking. The cost of this analysis is not Medicare refundable. Cost to patient or employer is approximately $100. Please indicate on request if permission or prior arrangement has been given to perform test by the requesting doctor, patient or employer. Please provide details of exposure to chemicals. Collect a random urine as soon as possible after exposure or work shift. Thiocyanate is a metabolic product of cyanide. Referred test.

THIOPURINE Biochemistry METHYLTRANSFERASE, BLOOD


2 weeks

Test for genetically-determined sensitivity to potential for toxic accumulation of certain drugs. Transport in esky at 4°C. Referred test.

THIORIDAZINE, SERUM

Biochemistry


2 weeks

Specimen must be collected into plastic tube and protected from light (wrap in foil or brown paper). Keep sample cooled and transport to the laboratory without delay. Referred test.

THROMBIN CLOTTING TIME

Haematology


Same day

Keep at 4°C. Must reach laboratory within 2 hours of collection. Refer to COAGULATION STUDIES.

THROMBOTIC ASSAYS - ALL

Haematology

Blood/3 x Sodium citrate tubes, 1 x EDTA tube

24 hours

Please provide thrombotic history of patient and family members and any anticoagulant therapy. Must reach laboratory within 2 hours of collection. PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Medicare refundable if one of the following is stated on the request form by the patient’s doctor: 1. That the patient has a personal history of venous thromboembolism (DVT) or arterial thrombosis (PE); or 2. That a first degree relative of the patient has a proven defect in one or more of the thrombotic test(s) requested and that the particular defect(s) are stated on the request form; or 3. That the request is to confirm an abnormal or indeterminate result. IF THE REQUEST IS NOT REFUNDABLE BECAUSE OF THE ABOVE CONDITIONS, THE PATIENT WILL BE CHARGED A NON-REFUNDABLE AMOUNT. PLEASE INFORM THE PATIENT IF THE TESTING WILL RESULT IN AN ACCOUNT BEING SENT TO THE PATIENT.

THYROGLOBULIN ANTIBODY, SERUM THYROGLOBULIN, SERUM

Endocrinology

Blood/SS tube

24 hours

Endocrinology

Blood/SS tube

24 hours

www.qml.com.au

PATHOLOGY TESTS - T

TEST NAME THIOCYANATE, URINE

Used as a tumour marker.

Results (07) 3121 4555

10.13

10.13

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Cytology

Labelled fixed and air dried smears/Labelled capped needle and syringe

24 hours


THYROID FUNCTION TESTS, SERUM

Endocrinology

Blood/SS tube

24 hours

TSH is routinely performed. Free T4 will be measured in addition to TSH in certain patients. Please supply a comprehensive history including exactly what medication the patient is taking. Please refer to Endocrinology Preface (5.23) for details.

THYROID STIMULATING HORMONE (TSH), SERUM

Endocrinology

Blood/SS tube

24 hours

TSH is routinely performed. Free T4 will be measured in addition to TSH in certain patients. Please supply a comprehensive history including exactly what medication the patient is taking. Please refer to Endocrinology Preface (5.23) for details.

THYROID STIMULATING IMMUNOGLOBULIN (TSI), SERUM

Endocrinology

Blood/SS tube

4 days

Alternative names for this test include LATS, (LONG ACTING THYROID STIMULATOR) and TSH RECEPTOR ANTIBODIES. Assay of this autoantibody may be useful to monitor patients with Graves’ disease while on treatment.

THYROID TISSUE ANTIBODIES, SERUM

Endocrinology

Blood/SS tube

24 hours

Measure antimicrosomal and antithyroglobulin antibodies (Thyroid Tissue Antibodies).

THYROXINE BINDING GLOBULIN, SERUM TIN, BLOOD

Endocrinology

Blood/SS tube

24 hours

Biochemistry


2 weeks

Referred test.

TISSUE AUTOANTIBODIES, SERUM

Immunology

Blood/SS tube



TISSUE PLASMINOGEN ACTIVATOR

Haematology


5 weeks

Referred test. NOTE: This test is referred to Austin Hospital. Inform patient that they will be charged a non-refundable fee of approx. $30 by Austin Repatriation Hospital.

TISSUE PLASMINOGEN ACTIVATOR INHIBITOR

Haematology


5 weeks

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

TISSUE TRANSGLUTAMINASE ABS

Immunology

Blood/SS tube

24 hours

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - T

TEST NAME THYROID FNA CYTOLOGY

10.14

10.14

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Biochemistry

Blood/Plain plastic tube Same day no gel or anticoagulant. Plastic lithium heparin tube (no gel) acceptable

TOFRANIL, SERUM

Biochemistry

Please refer to IMIPRAMINE, SERUM.

TOLUENE, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details. For Urine - see HIPPURIC ACID, URINE.

TOLUENE/XYLENE EXPOSURE, URINE TOLVON, SERUM

Biochemistry

Please refer to HIPPURIC ACID, URINE.

Biochemistry

Please refer to MIANSERIN, SERUM.

TOMACULOUS NEUROPATHY GENETIC TESTING TOPAMAX, SERUM

Genetics

TOPIRAMATE, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant. Plastic lithium heparin tube (no gel) acceptable

2 weeks

Please provide medication details. Referred test.

TORCH/TORCHES SEROLOGY

Immunology

Blood/SS tube

24 hours

TORCH includes Toxoplasma, Rubella, CMV, and Herpes serology. TORCHES includes syphilis as well. Note that TORCH and TORCHES are not recognised profiles and it is a Medicare requirement that each test be listed individually on the request form. This testing is no longer recommended as part of a routine antenatal screen.

TOTAL AND FRACTIONATED PORPHYRIN, URINE TOTAL ANTIOXIDANT STATUS, SERUM TOXOCARA SEROLOGY

Biochemistry

Please refer to PORPHYRIN, URINE.

Biochemistry

Please refer to ANTIOXIDANTS, BLOOD.

Immunology

Blood/SS tube

2 - 3 weeks

Referred test.

TOXOPLASMA SEROLOGY

Immunology

Blood/SS tube

24 hours


TRACE ELEMENTS, BLOOD

Biochemistry

www.qml.com.au

Blood/EDTA tube


6 weeks

Biochemistry

Please refer to Biochemistry Appendix (12.15).

PATHOLOGY TESTS - T

TEST NAME TOBRAMICIN, SERUM

Patient consent for billing must be marked on the request form. Please refer to TOPIRAMATE, SERUM.

Please refer to individual trace elements.

Results (07) 3121 4555

10.15

10.15

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Hair/Dry sterile container

4 weeks

TRACE ELEMENTS, URINE

Biochemistry

TRANSFERRIN ISOFORMS, SERUM TRANSFERRIN SATURATION, SERUM TRANSFERRIN, SERUM

Biochemistry

Blood/SS tube

2 weeks

Keep sample cool during collection and transport to the laboratory. Referred test.

Biochemistry

Blood/SS tube

24 hours

Part of IRON (Fe) STUDIES, SERUM. Includes Iron, TIBC and % saturation.

Biochemistry

Blood/SS tube

24 hours


TRANSFUSION REACTION INVESTIGATION, BLOOD AND URINE

Blood Bank

Blood/Plain plastic tube, EDTA tube. Urine/ Urine container

Same day

Obstetric, transfusion and drug history essential. Sample of first urine voided post reaction. Please forward ALL transfused and partly transfused blood bags to the Blood Bank.

TRANSKETOLASE, RED CELL

Biochemistry

TREPONEMA PALLIDUM EIA, SERUM

Immunology

Blood/SS tube

24 hours

The standard EIA screening test is performed daily (Monday to Saturday). If positive, supplemental Syphilis testing will be performed.

TREPONEMA PALLIDUM PARTICLE AGGLUTINATION TEST (TPPA), SERUM TRICHLOROACETIC ACID, URINE

Immunology

Blood/SS tube

24 hours

Supplementary test. Performed if Syphilis EIA test is positive.

Biochemistry


2 weeks

Please provide exposure and occupation details. Random urine collected immediately after the work shift or exposure.

TRICHLOROETHANE, BLOOD

Biochemistry


TRICHLOROETHYLENE, BLOOD

Biochemistry


TRICHOMONAS PCR - SWAB

Immunology

Dry swab/Dry swab

24 hours

Dry Swab Note: Aptima Swab, Virocult (viral swab), STM not to be used.

TRICHOMONAS, EXAMINATION FOR

Microbiology

Swab/Transport medium

Same day

Wet mount examination for Trichomonas vaginalis is no longer available. Trichomonas vaginalis nucleic acid detection by PCR is now performed on vaginal and urine specimens.

TRICLOPYR, BLOOD

Biochemistry

www.qml.com.au

Please provide exposure and occupation details. Clippings from the patients last hair cut can be used. Half full dry sterile screw top container. Please specify which trace elements are required. Broad screen of trace elements in hair is not generally accepted as being of diagnostic value. Blood may be the preferred sample. Referred test. Please refer to individual trace elements.

PATHOLOGY TESTS - T

TEST NAME TRACE ELEMENTS, HAIR

Please refer to VITAMIN B1, BLOOD for details.


Results (07) 3121 4555

10.16

10.16

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry


4 weeks

Qualitative level only. Referred test.

TRIGLYCERIDES, FLUID

Biochemistry


Same day

Usually ordered to confirm suspicion of lymph leakage, e.g. chylous pleural effusion, ascites, etc. Specify site of fluid on specimen container and request form.

TRIGLYCERIDES, SERUM

Biochemistry

Blood/SS tube

Same day

Fasting sample with no alcohol consumed for the previous 72 hours is preferred but do not turn patient away if non-fasting unless doctor specifically requests FASTING. Please refer to E/LFT, SERUM.

TRIMETHYLAMINE, URINE

Biochemistry


3 - 4 weeks

Test for a rare benign disorder characterised by a strong fishy body/urine odour. Collect early morning urine following fish and egg meal the night before. FREEZE sample immediately after collection. Do not allow to thaw.

TRIMIPRAMINE, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant. Plastic lithium heparin tube acceptable

1 week

Please provide clinical and medication details, including time and date of last dose. Collect immediately prior to next dose.

TRIPLE TEST (SCREEN)

Endocrinology

Blood/SS tube

48 hours

This test gives a calculated risk for Down’s and Spina Bifida at term. Collect specimen between 15th and 18th week of pregnancy. Includes-Beta HCG, AFP, Free Oestriol. Please make note of the following: 1: LMP/EDC and/or scan results, 2: Patient’s weight and family history of Down’s or Spina Bifida and which family member it was, 3: Is it a single or multiple pregnancy?, 4: Is patient an insulin dependent diabetic?

TROPONIN T, SERUM

Biochemistry

Blood/SS tube

Urgently

This test, in the context of investigating chest pain or heart attack, is treated as urgent.

TRYPSIN ACTIVITY, FAECES

Biochemistry


1 week

Test of pancreatic exocrine activity. Please provide clinical details. FRESH sample of faeces required (ideally should be fluid to semi-fluid). Freeze specimen and store and transport frozen. Transport to laboratory as soon as possible.

TRYPTANOL, SERUM

Biochemistry

TRYPTASE, SERUM

Immunology

TRYPTINE, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - T

TEST NAME TRICRESYL PHOSPHATE, BLOOD

Please refer to AMITRIPTYLINE, SERUM. Blood/SS tube

2 - 3 weeks

Test for anaphylactic reaction. Collect a SS tube 2 hours after reaction (anaphylaxis). Separate serum and FREEZE as soon as possible. Comprehensive clinical history must be supplied, including: 1. Time of onset of Anaphylaxis. 2. Drugs or other agents and time administered before onset of reaction. 3. Clinical details. Please refer to AMITRIPTYLINE, SERUM.

Results (07) 3121 4555

10.17

10.17

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Endocrinology

Blood/SS tube

4 days

Alternative names for this test include LATS (LONG ACTING THYROID STIMULATOR) and THYROID STIMULATING IMMUNOGLOBULIN (TSI). Assay of this autoantibody may be useful to monitor patients with Graves’ disease while on treatment.

TUBERCULOSIS, SPUTUM

Microbiology

Sputum/Dry, sterile screw top (urine) container

Microscopy - 2 days. Culture up to 6 weeks

Please refer to URINE FOR MTB CULTURE and Microbiology Preface (5.55).

TUMOR NECROSIS FACTOR RECEPTOR-ASSOCIATED PERIODIC SYNDROME (TRAPS) GENETIC TESTING TUMOUR MARKERS, SERUM

Genetics

Blood/1 x EDTA tube, 1 x ACD tube, 1 x Lithium heparin tube

1 - 2 months


Biochemistry/ Endocrinology

Blood/SS tube

TYPHOID FEVER SEROLOGY

Immunology

Blood/SS tube

24 hours


TYPHUS SEROLOGY

Immunology

Blood/SS tube

72 hours


TYROSINE, PLASMA

Biochemistry


2 weeks

Provide clinical details. Transport on dry ice. Referred test.

www.qml.com.au

PATHOLOGY TESTS - T

TEST NAME TSH RECEPTOR ANTIBODIES, SERUM

Individual tumour markers are listed alphabetically in the A-Z listing and in the Biochemistry Appendix (12.5).

Results (07) 3121 4555

10.18

10.18

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

UBIQUINONE, PLASMA

Biochemistry

UCCINYLAMINOIMIDAZOLE CARBOXAMIDE RIBOSIDE (SAICAR), URINE UDPG TRANSFERASE, RED CELL UNSTABLE HAEMOGLOBIN

Biochemistry


2 - 3 weeks

Please provide clinical and medication details. Random early morning urine collection preferred. Refrigerate for transfer to laboratory. Referred test.

Biochemistry


1 - 2 weeks

Please refer to GALACTOSAEMIA SCREEN, BLOOD.

Haematology

Blood/EDTA tube

24 hours

Tests performed Tuesday and Friday. Results available same day of test.

UPG DECARBOXYLASE, RED CELL URANIUM, BLOOD

Biochemistry


1 - 2 months

Please send to the laboratory without delay. Referred test.

Biochemistry

Blood/EDTA tube

4 weeks

Please provide clinical and exposure details.

URATE CLEARANCE

Biochemistry

Blood and Urine/24 hour urine, SS tube container with 15 mL 2M NaOH preservative

24 hours

Please record patient’s height and weight on request form. Patient may be placed on a low purine diet (refer to dietary restrictions in Biochemistry Appendix (12.12)) 3 days prior to test if requested. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Collect blood specimen after urine collection is completed.

URATE, FLUID

Biochemistry


Same day

Test to confirm suspected gouty origin e.g. of joint effusion. Specify site of fluid on specimen container and request form.

UREA, FLUID

Biochemistry


Same day

Test to confirm presence of urine leakage into abnormal site. Specify site of fluid on specimen container and request form.

UREA, SERUM

Biochemistry

UREA, URINE

Biochemistry


24 hours

Please provide clinical and medication details. 24 hour collection is preferred, however random may be collected. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

URIC ACID, SERUM

Biochemistry

Blood/SS tube

Same day

Test for risk of gout. Values exceeding 0.42 mmol/L (i.e. within the male reference range - see Biochemistry Appendix (12.7)) may be associated with acute gout. In pregnancy, test for risk on pre-eclampsia.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS Please refer to COENZYME Q10, PLASMA.

PATHOLOGY TESTS - U

TEST NAME


Results (07) 3121 4555

10.19

10.19

PATHOLOGY TESTS - U

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Urine/24 hour urine container with 15 mL 2M NaOH preservative (preferred) or plain 24 hour container if other tests are requested

24 hours

Test of uric acid excretion to differentiate gout due to urate overproduction from urate under-excretion. Patient may be placed on a low purine diet (refer to dietary restrictions in Biochemistry Appendix (12.12)) 3 days prior to test if required. 24 hour collection is preferred, however random may be collected. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

URINARY ALDOSTERONE

Endocrinology

Urine/24 hour urine collection bottle. No preservative. Aliquot with blue Monovette

1 week

Record 24 hour urine total volume. No preservative to be added to 24 hour urine container.

URINARY CROSS LINKED Biochemistry N- TELOPEPTIDES (NTx, BONE RESORPTION MARKERS), URINE 24 HOUR OR RANDOM

24 hour urine collection/ Urine collection bottle. No preservative. Random Urine/Urine container

1 week

A highly specific marker of bone resorption used in investigation and monitoring of osteoporosis, Paget’s disease, steroid therapy, malignancies, inflammatory diseases and metabolic bone diseases.

URINARY TRACT CYTOLOGY

Cytology

Urine and or Bladder and Ureteric Washings/ Urine container

24 hours

SECOND voided urine specimen of the morning. For specimen preparation please refer to Cytology Preface (5.15).

URINE FREE CORTISOL, URINE 24 HOUR

Endocrinology


48 hours

Dexamethasone not to be taken 36 hours prior to or during test, unless as part of a prolonged Dexamethasone Suppression Test. Urine should be refrigerated during the collection period and transported cooled to the laboratory.

URINE MALIGNANT CELLS

Cytology


24 hours

Collect the FIRST part, or all (not mid stream), of the SECOND or later VOID of the day.

URINE MICROSCOPY AND CULTURE

Microbiology

Random or early morning Urine/Monovette urine container. Collect supra pubic aspirates into a sterile container

Interim microscopy Transfer the Monovette to the laboratory as soon as possible. report same Refrigerate if an extended delay is expected. day. Culture and sensitivity 24 - 48 hours

URINE MTB CULTURE

Microbiology

Urine/70 mL sterile container Microscopy 2 (NOT a monovette) days; Culture 6 weeks

www.qml.com.au

PATHOLOGY TESTS - U

TEST NAME URIC ACID, URINE

Submit a full 70 mL container of an early morning sample.

Results (07) 3121 4555

10.20

10.20

PATHOLOGY TESTS - U

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Supervised random urine/ Doxtech security urine container

1 - 2 days

In cases of occupational drug screen, suspected drug abuse or monitoring of compliance with therapy or Drug Rehabilitation Programme, urine collection must be supervised. Chain-of-Custody form must be completed (available from QML Pathology). Protocol is detailed on Chain-of-Custody form and in the Biochemistry Preface (5.4) of this manual. The QML Pathology protocol complies with Australian Standard AS4308. See Biochemistry Appendix (12.13) for a full list of drugs assayed. Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for further details.

UROBILINOGEN, URINE

Biochemistry


Same day

Please provide a FRESH random sample and protect from light. Transport cooled to laboratory as soon as possible.

UROPORPHYRIN, URINE

Biochemistry

UROPORPHYRINOGEN-1SYNTHETASE, RED CELL

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - U

TEST NAME URINE QUALITATIVE DRUG SCREEN (INDUSTRY, OCCUPATIONAL, DRUG ABUSE ETC.), URINE RANDOM

Please refer to PORPHYRIN, URINE. Blood/Lithium heparin tube

2 - 4 weeks

Please contact Biochemistry prior to collection on (07) 3121 4420.

Results (07) 3121 4555

10.21

10.21

PATHOLOGY TESTS - U

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


VAGINAL PAP SMEAR CYTOLOGY

Cytology

Labelled fixed smear/ Slide carrier

48 - 72 hours

Sample cells from the mid to upper third of lateral vaginal wall with Ayre spatula or cytobrush and produce a conventional labelled Pap smear. Fix immediately in 95% ethanol or with Cytofix aerosol spray. Please contact Cytology (07) 3121 4485 or Branch Laboratory.

VAGINAL/CERVICAL/URETHRAL CULTURE FOR BACTERIA, FUNGI, VIRUSES AND CHLAMYDIA

Microbiology

Swab/Stuart’s Transport Medium (Bacteria, Fungi)/ Viral transport medium/ Chlamydia transport medium (Aptima Collection)

Routine microbiology 48 hours, Chlamydia PCR 24 hours, Viral PCR 24 hours

Wet preparation performed for Yeasts. Viability of Neisseria gonorrhoeae decreases after several hours. Please see instructions with kit for PCR techniques. Forward specimen to laboratory as soon as possible.

VALIUM, SERUM

Biochemistry

VALPROATE, SERUM

Biochemistry

VALPROIC ACID, SERUM

Biochemistry

VANCOMYCIN, SERUM (TROUGH AND PEAK)

Biochemistry

VANILLYLMANDELIC ACID, URINE 24 HOUR VARICELLA ZOSTER DFA SLIDE (IMMUNOFLUORESCENCE)

Biochemistry Immunology

Viral Culture Swab (green top) in transport medium

24 hours

A slide may be made from the swab if CRITICALLY URGENT. Testing by PCR is recommended.

VARICELLA ZOSTER SEROLOGY

Immunology

Blood/SS tube

24 hours


VARICELLA ZOSTER VIRUS PCR

Immunology

Viral Culture Swab (green top) in transport medium

24 hours


www.qml.com.au

PATHOLOGY TESTS - V

TEST NAME

Please refer to DIAZEPAM, SERUM. Blood/Plain plastic tube no gel or anticoagulant

Same day

Please provide clinical and medication details including dosage and time of last dose. Collect just prior to next dose. Please refer to VALPROATE, SERUM.

Blood/Plain plastic tube no gel or anticoagulant. Plastic lithium heparin tube (no gel) acceptable


TROUGH LEVEL: Collect sample just prior to next dose. PEAK LEVEL: Collect sample one hour after IM injection or 10 minutes after the end of infusion. KINETIC STUDIES: Please contact the laboratory. Please note time and date of last dose, dosage and method on request form. Please refer to CATECHOLAMINES, URINE.

Results (07) 3121 4555

10.22

10.22

PATHOLOGY TESTS - V

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Blood/Glass EDTA tube with Trasylol preservative

2 weeks

Tumour marker - pancreatic ‘vipoma’. Contact Biochemistry (07) 3121 4420 or Branch Laboratory to order special EDTA tubes containing Trasylol preservative. This tube must be kept cold until required. If there will be a delay in collection, store the empty Trasylol tube frozen and thaw immediately prior to use. Sample must be collected on ice, centrifuged in a refrigerated centrifuge or chilled centrifuge buckets within 30 minutes and plasma frozen immediately. Transfer to the laboratory on dry ice. Referred test.

VASOPRESSIN, BLOOD

Endocrinology


2 - 3 weeks

Collect into chilled EDTA tubes. Invert to mix and keep cold (4°C) in transit. To arrive in Endocrinology within 24 hours of collection. If >24 hours, spin EDTA tubes and separate plasma and transport on ice. Referred test.

VDRL (RPR - RAPID PLASMA REAGIN TEST), SERUM VENLAFAXINE, SERUM/PLASMA

Immunology

Blood/SS tube

24 hours

Supplementary test. Performed if Syphilis EIA test is positive.

Biochemistry

Blood/Plain plastic tube - no 4 weeks gel (Plastic lithium heparin tube or EDTA tube acceptable)

VIGABATRIN, SERUM

Biochemistry


VIP, PLASMA

Biochemistry

VIRAL SEROLOGY

Immunology

VIRAMUNE, PLASMA

Biochemistry

www.qml.com.au

2 weeks

PATHOLOGY TESTS - V

TEST NAME VASOACTIVE INTESTINAL PEPTIDE, PLASMA

Please provide clinical and medication details. Keep sample cool.

Please provide clinical and medication details. Keep sample cold. Referred test.

Please refer to VASOACTIVE INTESTINAL PEPTIDE, PLASMA. Blood/SS tube


Please provide clinical details and nominate specific viruses (a Medicare requirement) to be tested. Please refer to Immunology Preface (5.49) for a comprehensive list of viruses. Assay run Monday - Friday. Please refer to NEVIRAPINE, PLASMA for details.

Results (07) 3121 4555

10.23

10.23

PATHOLOGY TESTS - V

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Immunology

Swabs and secretions from Throat, Skin vesicles etc. Urine, Faeces etc. Viral Culture Swabs/Viral Transport Medium or 30- 50 mL dry sterile screw top (urine) containers

1 - 2 weeks

Please keep specimen cool and transport to laboratory as soon as possible. QML Pathology performs PCR on various viruses. Some tests may also be referred.

VISCOSITY, PLASMA

Haematology

Blood/EDTA tube

24 hours

DO NOT refrigerate prior to testing.

VITAMIN A, SERUM

Biochemistry

Blood/SS tube (Lithium heparin tube acceptable)

1 week

Test for vitamin A deficiency or excess. A fasting sample is required. Please provide clinical details and medication history. Samples must be refrigerated and protected from light after collection. Serum/Plasma must be frozen within 6 hours of collection. Forward to the laboratory without delay.

VITAMIN B1, BLOOD

Biochemistry

Blood/EDTA tube

1 week

Test for thiamine (vitamin B1) deficiency. A fasting sample is required. Please provide clinical details including medication and protect the sample from light. Forward to the laboratory without delay.

VITAMIN B12, SERUM

Endocrinology

Blood/SS tube

24 hours

VITAMIN B2, BLOOD

Biochemistry

Blood/EDTA tube

1 week

Test for riboflavin (vitamin B2) deficiency. A fasting sample is required. Please provide clinical and medication details and protect the sample from light. Whole blood must be frozen within 6 hours after collection. Forward to the laboratory without delay.

VITAMIN B3, URINE

Biochemistry


3 weeks

Test for niacin (vitamin B3) deficiency. Random urine collections are NOT acceptable for analysis. Referred test.

VITAMIN B6, BLOOD

Biochemistry

Blood/EDTA tube

1 week

Test for pyridoxine (vitamin B6) deficiency. A fasting sample is required. Please provide clinical details and medication history. Samples must be refrigerated and protected from light after collection. Serum/Plasma must be frozen within 6 hours of collection. Forward to the laboratory without delay.

VITAMIN C, SERUM

Biochemistry

Blood/SS tube

1 week

Test for ascorbate (vitamin C) deficiency. Please provide clinical and medication details. A fasting sample is required. Vitamin C is particularly unstable. NB: Serum should be separated and frozen immediately after clotting and centrifuging. If unable to separate or centrifuge, the sample may be sent to the laboratory at 4°C to be separated and serum frozen within two hours of collection.

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - V

TEST NAME VIRUS DETECTION

10.24

10.24

PATHOLOGY TESTS - V

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


Biochemistry

Hair roots/Hair roots (6-10) taped to piece of paper with roots left uncovered

4 - 6 weeks

Hair should be plucked from the scalp and placed in an envelope or dry sterile screw top (urine) container. If hair is unobtainable, collect blood in 1 x 5 mL EDTA tube (whole blood). Referred test.

VITAMIN D, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant

1 week

Test for cholecalciferol (vitamin D) deficiency. A fasting sample is required. Please provide clinical details and medication history. Samples must be refrigerated and protected from light after collection. Serum/Plasma must be frozen within 6 hours of collection. Forward to the laboratory without delay.

VITAMIN E, SERUM

Biochemistry

Blood/SS tube (Lithium heparin tube acceptable)

1 week

Test for vitamin E deficiency. A fasting sample is required. Please provide clinical details and medication history. Samples must be refrigerated and protected from light after collection. Serum/Plasma must be frozen within 6 hours of collection. Forward to the laboratory without delay.

VMA, URINE

Biochemistry

VON HIPPEL-LINDAU GENETIC TESTING

Genetics

Blood/EDTA tube

1 - 2 months

GENETIC COUNSELLING IS REQUIRED BEFORE THE BLOOD SPECIMEN CAN BE TAKEN. GENETIC COUNSELLING IS AVAILABLE FROM THE GENETIC HEALTH QUEENSLAND AT THE ROYAL BRISBANE HOSPITAL ON (07) 3636 1686.

VON WILLEBRAND FACTOR ANTIGEN, PLASMA

Haematology


24 hours

Keep sample at 4°C. Specimen must reach laboratory within 2 hours of collection. Rural patients may be referred to nearest Branch Laboratory for specimen collection. Please contact Haematology (07) 3121 4451 or Branch Laboratory. Refer to FACTOR VIII ASSAY.

VWF MULTIMER ASSAY

Haematology


Up to 3 months

Please contact Haematology (07) 3121 4451 or your Branch Laboratory for details before collection. Referred test.

www.qml.com.au

PATHOLOGY TESTS - V

TEST NAME VITAMIN D RECEPTOR ALLELES, HAIR ROOTS

Please refer to CATECHOLAMINES, URINE.

Results (07) 3121 4555

10.25

10.25

PATHOLOGY TESTS - V

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER


WATER DEPRIVATION TEST

Biochemistry

Blood and urine/SS tube and Urine container

24 hours

Test for diabetes insipidus - overnight fluid restriction with serum and urine osmolality in the morning is best initial screen. Note specimens should be collected simultaneously. Please contact chemical pathologist or Branch Laboratory for details. This test should be performed under supervision at a special tests collection centre or Branch Laboratory. Please phone for an appointment.

WEEDICIDES, URINE

Biochemistry


2 weeks

Please provide specific details of particular weedicide patient has been exposed to. Random urine collected immediately after work shift/exposure. If used as a screening test cost of this test NOT covered by Medicare. Please phone Biochemistry (07) 3121 4420 or your Branch Laboratory for current cost details. Referred test.

WHITE CELL COUNT AND DIFFERENTIAL, BLOOD

Haematology

Blood/EDTA tube and Blood film

Same day

Blood films made at time of collection are preferred. Please see Haematology Appendix (12.32).

WHITE CELL COUNT, BLOOD

Haematology

Blood/EDTA tube

Same day

WHITE CELL ENZYMES, BLOOD WHOOPING COUGH SEROLOGY (BORDETELLA PERTUSSIS) WIDAL SEROLOGY (SALMONELLA TYPHI) WOUND SWAB MICROSCOPY AND CULTURE

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - W

TEST NAME


Immunology

Blood/SS tube

24 hours


Immunology

Blood/SS tube

24 hours


Microbiology

Swab/Transport Medium

Please provide clinical details including mode of injury (e.g. dog bite), site, antibiotic Interim microscopy report therapy and indicate if the wound is post operative. Please indicate if exotic or same day. Culture unusual organisms are suspected. Prompt transport to the laboratory is essential. report 48 hours

Results (07) 3121 4555

10.26

10.26

PATHOLOGY TESTS - W

PATHOLOGY TESTS

DEPARTMENT

XANAX, SERUM

Biochemistry

XANTHINE, URINE

Biochemistry


1 - 2 months

A random urine is preferred. Please store and transport the sample frozen.

XANTHOCHROMIA, CSF

Biochemistry

CSF/Plain tube

Same day

Keep sample cool and protect from light.

XYLENE/TOLUENE EXPOSURE, URINE XYLENES, BLOOD

Biochemistry

Please refer to HIPPURIC ACID, URINE.

Biochemistry


XYLOCAINE, SERUM

Biochemistry

Please refer to LIGNOCAINE, SERUM.

XYLOSE EXCRETION TEST (ADULT)

Biochemistry


1 week

Test for malabsorption of simple sugars. Please contact laboratory well in advance for XYLOSE dose and collection details. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Adult XYLOSE dose 25g given orally.

XYLOSE EXCRETION TEST (CHILD)

Biochemistry


1 week

Test for malabsorption of simple sugars. Please contact laboratory well in advance for XYLOSE dose and collection details. Urine should be refrigerated during the collection period and transported cooled to the laboratory. Child XYLOSE dose: 5g given orally.

Y CHROMOSOME MICRODELETION ANALYSIS AZFa, AZFb, AZFc YELLOW FEVER VIRUS SEROLOGY

Genetics

Blood/EDTA tube

1 - 2 weeks

DAZ gene is encompassed within AZFc region. Incurs non Medicare refundable fee.

Immunology

Blood/SS tube

4 - 6 weeks

Referred test. Note all requests for yellow fever serology must be notified to the relevant health authorities.

YERSINIA ENTEROCOLITICA SEROLOGY

Immunology

Blood/SS tube

24 hours


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SPECIMEN CONTAINER

REPORTING TIME COMMENTS Please refer to ALPRAZOLAM, SERUM.

Results (07) 3121 4555

PATHOLOGY TESTS - X/Y

TEST NAME

10.27

10.27

PATHOLOGY TESTS - X/Y

PATHOLOGY TESTS

DEPARTMENT

ZACTIN, SERUM

Biochemistry

Please refer to FLUOXETINE, SERUM.

ZERO, URINE

Biochemistry

Please refer to GLYPHOSATE, URINE.

ZIEHL-NEELSEN STAIN

Microbiology

Swab, pus, fluid, urine, tissue etc./Appropriate sterile container

24 hours

Please transport specimen to laboratory as soon as possible. See also TB CULTURE.

ZINC PROTOPORPHYRIN, RED CELL

Biochemistry

Blood/EDTA tube, Lithium heparin tube or Sodium citrate tube

1 week

Test for long-term lead exposure. May be raised in iron-deficiency anaemia. Please provide clinical, medication and lead exposure details.

ZINC, HAIR

Biochemistry


4 weeks

Please provide full details of long term exposure. Fill sterile container with hair, as full as possible. Clippings from the patient’s last hair cut can be used. Referred test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

ZINC, RED CELL

Biochemistry

Blood/EDTA tube and Trace metal tube (Navy stopper)

1 week

Serum Zinc must also be collected (trace metal tube) - refer to ZINC, SERUM for collection details. Leave EDTA tube as whole blood. Please provide clinical details. Referred test.

ZINC, SERUM

Biochemistry

Blood/Special plain Vacutainer tube with navy stopper and no gel

24 hours

Sample must be collected into a trace metal tube (Navy stopper), allowed to clot, centrifuged and serum removed from cells as soon as possible. Serum must not be haemolysed.

ZINC, URINE

Biochemistry


4 weeks

Please provide clinical, medication and exposure details. Random collection is preferred, however 24 hour urine may be collected. Referred test.

ZOLOFT, SERUM

Biochemistry

Please refer to SERTRALINE, SERUM for details.

ZYPREXA, PLASMA

Biochemistry

Please refer to OLANZAPINE, PLASMA.

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SPECIMEN CONTAINER


Results (07) 3121 4555

PATHOLOGY TESTS - Z

TEST NAME

10.28

10.28

PATHOLOGY TESTS - Z

PATHOLOGY TESTS

CONTACT DETAILS DEPARTMENTS Central Laboratory (07) 3121 4444 Biochemistry Department (07) 3121 4420Department Biochemistry (07) 3121 4420 Blood Bank (07) 3876 8371 Blood Bank (07) 3876 8371 Cytology Department (07) 3121 Department 4494 Cytology (07) 3121 4494 Endocrinology Department (07) 3121 4439 Department Endocrinology (07) 3121 4439 Genetics Department (07) 3121 Department 4461 Genetics (07) 3121 4461 Haematology Department (07) 3121 4451Department Haematology (07) 3121 4451 Histology Department (07) 3121 4426 Histology Department (07) 3121 4426 Immunology Department (07) 3121 4458 Immunology Department (07) 3121 4458 Microbiology Department (07) 3121 4438Department Microbiology (07) 3121 4438 Liaison Department (07) 3121 4943 Liaison Department (07) 3121 4943

RULE 3 EXEMPTION LABORATORIES

Pindara (07) 5510 0400

Brisbane & Surrounding Areas Central Laboratory Brisbane (07) 3121 4444

Southport (07) 5668 4444

Greenslopes (07) 3121 4444

Ipswich, Darling Downs & Granite Belt Ipswich (07) 3281 8888

North West Everton Park (07) 3353 0382 St Andrew’s Spring Hill (07) 3832 6011 Wesley Auchenflower (07) 3371 9462 Bundaberg Bundaberg (07) 4152 8411 Cairns Cairns (07) 4051 8944

Tugun (07) 5598 0822

Toowoomba (07) 4638 9149 Kingaroy Kingaroy (07) 4162 1499 Mackay Mackay (07) 4951 2999 Redcliffe Redcliffe (07) 3049 4410

Rule 3 of the Pathology Services Table limits the benefits payable for pathology items during a single patient episode. Exemptions to this rule have been granted for certain specified tests in certain clinical circumstances. The exemption is referred to as ‘Rule 3 Exemption’. A summary of Rule 3 Exemption circumstances for Out Patients is given below. In these instances, the request form is valid for the earlier of either test frequency limit or 6 months. Patient’s Clinical Circumstance

Tests Eligible for Rule 3 Exemption

Test Frequency

Anticoagulant (Warfarin) therapy

INR

Unlimited tests up to 6 months of request

Cancer patients receiving bisphosphonate infusions

Calcium, phosphate, magnesium, Up to 6 tests within urea, creatinine and electrolytes 6 months of request

Chemotherapy for neoplastic disease Clozaril therapy Gold therapy Immunosuppressant therapy Penicillamine therapy Sulphasalazine therapy Ticlopidine hydrochloride therapy

FBE, ESR

Up to 6 tests within 6 months of request

Chronic renal failure of a patient in a dialysis program conducted by a recognised hospital

Urea, creatinine and electrolytes


Cis-platinum therapy



Cyclosporin therapy



Leflunomide therapy

E/LFT (or part thereof)


Lithium therapy

Lithium


Central Queensland Emerald (07) 4982 0306

Sunshine Coast & Gympie Buderim (07) 5441 0200

Gladstone (07) 4972 2877

Gympie (07) 5482 1511

Methotrexate therapy

FBE, ESR, E/LFT (or part thereof)

Rockhampton (07) 4921 2155


Noosa (07) 5441 0200

Vitamin D (metabolites or analogues) therapy

Calcium and albumin


Gold Coast, Tugun & Northern Rivers Ballina (02) 6686 6424

Townsville Townsville (07) 4779 0158

PATHOLOGY TESTS - RULE 3

PATHOLOGY TESTS - CONTACT DETAILS

PATHOLOGY TESTS

Procedure for Rule 3 Exemption i. Request the pathology test in the normal way with the usual request form. ii. Specify the number of and frequency of the test.

11.1

11.0

iii. Clearly endorse the form by writing ‘Rule 3 exemption’.

DECREASED

INCREASED

DECREASED

Water loss (e.g. dehydration, diabetes insipidus) Salt overload Renal impairment

Water overload (e.g. cirrhosis, CCF, inappropriate ADH) Salt loss (e.g. diuretic therapy, adrenal failure, gut or sweat loss, renal impairment)

Gamma GT

Hepatitis, biliary obstruction, drugs, alcohol, renal damage, pancreatitis

Rarely significant

ALT (SGPT)

Liver disease or damage e.g. hepatitis (>500), non-specific viraemia, drugs, fatty liver, alcohol, haemochromatosis

Renal failure, vitamin B6 deficiency

Potassium

Oral overload, cell leakage (sepsis or post-collection), renal disease, adrenal insufficiency Acidosis (ketoacidosis, lactic acidosis)

Diuretics, dietary deficiency, renal tubular disease, steroid excess, gut loss, insulin effect

AST (SGOT)

Myocardial damage or necrosis, liver disease, skeletal muscle damage, muscular dystrophy, haemolysis

Renal failure, vitamin B6 deficiency

Chloride

Dehydration, diarrhoea, pancreatic or biliary drainage, renal tubular acidosis, ureterosigmoidostomy

Vomiting, water overload, diuretics Children - cystic fibrosis

Lactate Dehydrogenase (LDH)

Myocardial damage or necrosis, liver disease, muscle disease, malignancy, haemolysis, post-collection cell leakage

Rarely significant

Bicarbonate

Respiratory acidosis - lung disease Metabolic alkalosis - vomiting, diuretics, oral antacids, steroid excess

Respiratory alkalosis - hyperventilation Metabolic acidosis - renal failure, liver failure, diabetes mellitus, diarrhoea, drugs, dehydration

Calcium

Hyperparathyroidism, malignancy (including myeloma), vitamin D & A excess, sarcoidosis, thyrotoxicosis, milk-alkali syndrome

Low albumin, acidosis, renal disease, hypoparathyroidism, vitamin D deficiency, acute pancreatitis (significant values 80%) and dysgerminoma (40%)

seminoma (20%) and non-trophoblastic ca. (10%)

Beta 2 Microglobulin

myeloma, plasmacytoma

CA 125 (cervix, pancreas, stomach)

epithelial ovarian cancer (>80%) pancreatitis, peritonitis

endometrium, fallopian tube

endometriosis, PID, CRF

CA 15.3

metastatic breast ca. (70%)

localised breast ca. (10%), ovary

non-malignant liver disease

CA 19.9 (Fetoacinar Pancreatic Antigen)

pancreas (80%), gastric (50%), bile duct (65%), hepatoma (50%)

colorectal (25%)

cirrhosis, cholangitis and rarely pancreas & colorectal inflammation, pulmonary fibrosis

Calcitonin

medullary thyroid carcinoma, carcinoid

liver, lung, renal, breast

Carcinoembryonic Antigen (CEA)

colorectal, gastric, liver, pancreatic and breast ca. (all >60%)

lung, prostate, cervix, uterus, ovary

Catecholamines, HMMA (VMA)

phaeochromocytoma, neuroblastoma

Human Chorionic Gonadotrophin

Refer Beta HCG

Lactate Dehydrogenase (LD) Isoenzymes

seminoma, lymphoma and epithelial carcinoma

Paraprotein, Bence Jones Protein

multiple myeloma (98%) and plasmacytoma

non-neoplastic liver disease

renal or inflammatory disease

MARKER

MAJOR TUMOUR SOURCE

LESSER TUMOUR SOURCE

FALSE POSITIVE

Placental Alkaline Phosphatase

seminoma (>80%), ovary, lung, uterus cancer

smoking

Prostatic Acid Phosphatase (ACP)

metastatic prostate (>70%)

Prostate Specific Antigen (PSA)

prostatic adenocarcinoma intracapsular (65%), metast (90%)

benign prostatic hypertrophy (30%)

Serotonin, 5-H.I.A.A.

carcinoid tumour

diet, diarrhoea, coeliac disease

Soluble MesothelinRelated Protein (SMRP)

Mesothelial tumours mesothelioma

Thyroglobulin

differentiated thyroid ca.

Vasoactive Intestinal Polypeptide (VIP)

bronchogenic lung, pancreatic islet, neuroblastoma, thyroid medullary, phaeochromocytoma

intracapsular prostate (50 F

2.0 - 8.0 2.0 - 7.5 2.5 - 7.5 2.0 - 7.0 2.5 - 8.0 2.0 - 7.0 3.0 - 8.5 2.5 - 7.5

50 M >50 F

10 - 60 10 - 70 20 - 80 40 - 120 40 - 100 60 - 130 40 - 110 60 - 140 50 - 120

M F

0.12 - 0.45 0.14 - 0.35

umol/L

mmol/L

umol/L

Chemistry

Units

Conj. Bilirubin

umol/L

Total Alk. Phos.

U/L

25 - 33

Bicarbonate mmol/L Glucose

Normal

Age/Sex/ Rand/Fast.

Normal 0-8

0 - 18 yrs

30 - 300

>18 yrs

30 - 115

ALT

U/L

0 - 45

AST

U/L

0 - 41

GGT

U/L

M F

0 - 70 0 - 45

LDH

U/L

0 - 9 days 10 days 18 mths 19 mths 3 yrs 4 - 8 yrs 9 - 11 yrs 12 - 14 yrs 15 - 16 yrs >16 yrs

500 - 1000

Calcium

mmol/L

Phosphate

mmol/L

210 - 470 200 - 400

Chemistry

Cholesterol mmol/L

Triglyceride

Fasting

HDL Chol. High Risk Patients LDL Chol. High Risk Patients

2.25 - 2.65

Without other risk factor

1.3 - 2.8 1.3 - 2.3

7 days 1 yr

1.1 - 2.3

2 - 5 yrs 6 - 10 yrs 11 - 20 yrs >20 yrs

1.0 - 2.0 1.0 - 1.9 0.9 - 1.7 0.8 - 1.5

2 months

17 - 140 17 - 170 17 - 100

Total Protein

g/L

60 - 82

Albumin

g/L

35 - 50

4 - 20

Iron

umol/L

10 - 33

mmol/L

Age/Sex/ Rand/Fast.

Normal

60 yrs

3.1 - 6.5 3.6 - 6.7 3.6 - 6.9 3.9 - 7.4 3.6 - 7.3

60 yrs

0.3 - 2.2 0.3 - 2.3 0.3 - 2.3 0.3 - 2.2 0.0 - 4.0

Random

190 - 380 180 - 330 140 - 320 120 - 280 80 - 250

1 day 2 - 6 days

Units

Diab. or ATSIC Patient

Biochemistry

Units

Urea

12.7

Age/Sex/ Rand/Fast.

Chemistry

APPENDICIES

Common Biochemistry Reference Ranges/ Flagging Rules

> 1.00

mmol/L

15 yrs

10 - 140 20 - 320 10 - 290

2 - 20

12.8

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

Diagnostic values of the oral glucose tolerance test Glucose Concentration, mmol/L

Venous plasma

Capillary plasma

Venous whole blood

Capillary whole blood

• Three months after delivery, women with gestational diabetes should have a repeat 75g OGTT. This should be evaluated by standard World Health Organisation criteria for the non-pregnant state. Women who do not have diabetes mellitus at this time should still be considered as ‘at risk’ for developing diabetes mellitus later in life. Procedure for diagnosis of gestational diabetes

Impaired Fasting Glucose (IFG) Fasting

>6.0 and 6.0 and 5.5 and 5.5 and 10 with liver transplant 17-58 1 2 1-5 2 2 1-3 1-3 0.5-1 2 5(3-9) 2-4

Therapeutic Range

Assay Frequency

50-200 ug/L 10-120 ug/L 100-300 ug/L 50-170 ug/L 90-150 ug/L

Weekly Weekly Weekly Weekly Weekly

HPLC-100-300 ug/L** TDx - 135-400 ug/L** 0.5-1.0 mmol/L @ 24hr < 5 umol/L @ 48hr < 0.5 umol/L @ 72hr < 0.1 umol/L 10-20 mg/L 150-300 mg/L 10-20 mg/L

On demand Daily On demand

Biochemistry

Absorption Peak Drug

APPENDICIES

Quantitative Drug Assays for Therapeutic Monitoring

On demand Daily Daily

NOTE: (i) For IV antibiotic administration peak blood level occurs at the end of injection/infusion. (ii) For IM injection peak blood level occurs 30–60 minutes after injection. (iii) Trough levels should be measured just prior to next dose. * Indicates a potential of unexpected toxicity from a major active metabolite with a half-life longer than the parent drug. ** Values differ with method of assay.

12.16

12.15

APPENDICIES

Biochemistry


Poisons and Toxic Substances used in Pest Control Herbicides/Weedicides

Time Since Dose

Range (mg/L)

less than 6 hours

greater than 5.0 mg/L

6 hours

7.0 mg/L

7 hours

5.7 mg/L

8 hours

4.5 mg/L

9 hours

3.5 mg/L

10 hours

2.8 mg/L

11 hours

2.2 mg/L

• Synthetic Pyrethroids (assay: blood/lithium heparin tube).

12 hours

1.7 mg/L

• Arsenic (assay: blood/lithium heparin tube; long term exposure - hair and nail clippings).

13 hours

1.3 mg/L

14 hours

1.1 mg/L

16 hours

less than 0.7 mg/L

18 hours

less than 0.4 mg/L

20 hours or greater

less than 0.3 mg/L

• Phenoxyacetic acid group (2,4-D; 2,4,5-T; MCPA; Triclopyr) (assay: random urine). • Glyphosate (Roundup; Zero) (assay: urine specimen collected at the end of work shift or exposure). • Paraquat/Diquat (true toxicity irreversibly lethal - assay difficult to arrange). Pesticides/Insecticides • Organochlorines (DDE; DDT; Endosulfan; Dieldrin/Endrin/Aldrin; Chlordane; Heptachlor; Lindane) (assay: blood/lithium heparin tube). • Organophosphates (Chlorpyrifos; Malathion; Parathion) (assay: serum/red cell cholinesterase).

Biochemistry

Recommended Levels for Single Daily Dosage Regime for Gentamicin

APPENDICIES

APPENDICIES

Biochemistry


• Carbamates (Carbaryl) (assay: serum/red cell cholinesterase).

(From Antibiotic Guidelines, 9th ed. 1996-97)

Fungicides • Dithiocarbamates (Zineb; Maneb; Mancozeb) (assay: serum/red cell cholinesterase). • HCB (Hexachlorobenzene) - organochlorine (assay: blood/lithium heparin tube). Rodenticides • Coumarin derivatives (assay: prothrombin time). • Strychnine (assay: blood/fluoride oxalate tube). Molluscicides

12.18

12.17

• Metaldehyde (no assay available).

The value of arterial blood gases in assessing pulmonary gas exchange is well established. However, blood gas analysis (arterial or venous) may also play a key role in assessing the acid-base balance of the body. An easy approach to interpretation of this function is presented below.

Examine the Anion Gap

Interpreting Acid-Base Balance from the Blood Gas Profile

pH

LOW Acidaemia

pCO2

LOW

Primary Metabolic Acidosis with Respiratory Compensation 1. Raised Anion Gap - Fixed or organic acid accumulation 2. Normal Anion Gap - Bicarbonate loss, Chloride excess

RAISED

Primary Respiratory Acidosis 1. Normal Base Excess - Acute Respiratory Acidosis 2. Raised (+) Base Excess - With Metabolic Compensation 3. Lowered (-) Base Excess -C ombined Respiratory and Metabolic Acidosis

RAISED Alkalaemia

pCO2

RAISED

Primary Metabolic Alkalosis with Respiratory Compensation 1. Urine pH > 7.4 - Gastrointestinal acid loss 2. Urine pH < 7.4 - Urinary acid loss

LOW

Primary Respiratory Alkalosis

12.19

1. Normal Base Excess - Acute hyperventilation 2. Lowered (-) Base Excess - Hyperventilation with compensation - Salicylate Therapy

1. Raised Anion Gap i) Phosphate and sulphate accumulation in renal failure. ii) Ketoacid generation in insulin-dependent diabetes mellitus. iii) Lactate accumulation in shock, liver disease, or exertion. iv) Accumulation of an acidic toxin, drug, or drug metabolite e.g. in salicylate overdose. v) Accumulation of an unusual organic acid form inherited blockage of metabolic pathway e.g. methylmalonic acid. 2. Normal Anion Gap i) Enteric bicarbonate loss - biliary or pancreatic drainage. ii) Chloride excess - rapid I.V. infusion of normal saline or urine chloride reabsorption (ureterosigmoidostomy, ileal conduit). iii) Renal bicarbonate loss from effective hypoaldosteronism (Adrenocortical failure, Spironolactone therapy, aldosterone receptor defect). iv) Renal bicarbonate loss from a tubular resorptive defect (Renal tubular acidosis, Fanconi syndrome, carbonic anhydrase inhibitor therapy).

Biochemistry

Primary Metabolic Acidosis with Respiratory Compensation

APPENDICIES

Acid-Base Analysis

In categories i) and ii), the urine pH will be less than 5.0, in iii), the pH will be 6.5 or greater, and in iv) the pH will vary depending on the site of the resorptive defect (proximal or distal tubular) and the state of compensation. Primary Respiratory Acidosis Examine the Base Excess 1. Respiratory Acidaemia with Normal Base Excess Acute respiratory failure, airway obstruction or asphyxia. 2. Respiratory Acidaemia with Raised (+) Base Excess Long standing or chronic respiratory acidosis (e.g. chronic obstructive lung disease) with metabolic compensation. 3. Combined Respiratory and Metabolic Acidosis (Low (-) Base Excess) Seen almost exclusively as a preterminal event. Primary Metabolic Alkalosis with Respiratory Compensation Examine the Urinary pH 1. Alkaline Urinary pH (pH 7.5 - 8.2) This indicates gastrointestinal loss of acid. i) Protracted vomiting. ii) Long-term nasogastric suction or gastric fistula.

12.20

APPENDICIES

Biochemistry


Primary Respiratory Alkalosis Examine the Base Excess

Other patients are required to meet the lipid levels shown in the following table after at least six weeks of dietary therapy:

PATIENT CATEGORY

LIPID LEVELS FOR PBS SUBSIDY

Patients with diabetes mellitus not otherwise included

Total cholesterol > 5.5mmol/L

Aboriginal or Torres Strait Islander patients

Total cholesterol > 6.5mmol/L or Total cholesterol > 5.5mmol/L and HDL cholesterol < 1mmol/L

1. Respiratory Alkalaemia with Normal Base Excess This acute uncompensated respiratory alkalaemia pattern is common, being seen in anxiety-associated hyperventilation (which may accompany mild asthma, mild chest or throat constriction or pain).

Patients with hypertension Patients with HDL cholesterol 6.5mmol/L

2. Primary Respiratory Alkalaemia with Low (-) Base Excess The metabolic compensation in this case indicates a more prolonged state of hyperventilation usually associated with respiratory centre stimulation (e.g. by mild hypoxia in pneumonia, by protracted mild airway obstruction, or by pain or anxiety) or with overriding of normal respiratory control e.g. with mechanical ventilation. Respiratory centre stimulation seen with high therapeutic doses of aspirin is an interesting and not uncommon cause.

Patients with familial hypercholesterolaemia identified by: • DNA mutation; or • Tendon xanthomata in the patient or a first or second degree relative Patients with: • Family history of coronary heart disease which has become symptomatic before the age of 60 years in one or more first degree relatives; or • Family history of coronary heart disease which has become symptomatic before the age of 50 years in one or more second degree relatives.

If aged 18 years or less at treatment initiation: LDL cholesterol > 4mmol/L

Patients not eligible under the above: • Men aged 35 to 75 years • Post-menopausal women aged up to 75 years.

Total cholesterol > 7.5mmol/L or Triglyceride > 4mmol/L

Patients not otherwise included

Total cholesterol > 9mmol/L or Triglyceride >8mmol/L

LIPIDS PBS Eligibility Criteria for Cholesterol Lowering Drugs from 1 April 2006 Patients identified as being in one of the following very high-risk categories may commence drug therapy with statins or fibrates at any cholesterol level: • Coronary heart disease which has become symptomatic • Cerebrovascular disease which has become symptomatic • Peripheral vascular disease which has become symptomatic • Diabetes mellitus with microalbuminuria (defined as urinary albumin excretion rate of >20µg/min or urinary albumin to creatinine ratio of >2.5 for males, >3.5 for females) • Diabetes mellitus in Aboriginal or Torres Strait Islander patients • Diabetes mellitus in patients aged 60 years or more • Family history of coronary heart disease which has become symptomatic before the age of 55 years in two or more first degree relatives

Biochemistry

2. Relatively Acidic pH (pH 5.2 - 7.3) This indicates renal over secretion of acid. i) Endogenous mineralocorticoid excess - adrenal or pituitary tumour. ii) Hypokalaemia - renal potassium conversation is tied to hydrogen ion dumping. iii) Exogenous steroid administration.

APPENDICIES

APPENDICIES

Biochemistry


If aged more than 18 years at treatment initiation: LDL cholesterol > 5mmol/L or Total cholesterol > 6.5mmol/L or Total cholesterol > 5.5mmol/L and HDL cholesterol < 1mmol/L

12.22

12.21

• Family history of coronary heart disease which has become symptomatic before the age of 45 years in one or more first degree relatives.

11 - 13 weeks

15 - 18 weeks

AFP - For neutral tube defects. Offer to patients who had First Trimester Screen. Please note: If the patient has the Triple Test then AFP is already included. Triple Test/MSS (AFP, free Oestriol, Total HCG) - For Down Syndrome and NTD risk. If had FTS, this is not a Medicare rebatable test. Amniocentesis - FISH Aneuploidy testing: Rapid test for aneuploidy of chromosomes 13, 18, 21, X and Y performed on fetal cells obtained from amniocentesis. Results are available within 24-48 hours but results should be considered interim in nature until confirmed by full fetal karyotype analysis. - Fetal karyotype: Analysis for follow up of high risk FTS results or other clinical indications. Allow 10-14 days for fetal karyotype result. - DNA testing may also be offered for certain inherited genetic conditions. Discuss these tests with O&G specialist.

18 - 20 weeks

Anomaly Scan - Important follow up of high AFP or high risk NTD results.

26 - 28 weeks

Glucose Challenge in Pregnancy - Non-fasted, 50 grams, 1 hour glucose test. Follow up results of glucose challenge - if increased do a 2hr GTT. If GTT is positive then Gestational Diabetes is confirmed. Retest 3 months post partum. FBC Blood Group and Antibodies Iron Studies - (If indicated)

28 weeks

12.23

First Trimester Screen (Free HCG, PAPP-A) - Results combined with NT to give Down Syndrome risk. AFP not included in this test, consider at 15-18 weeks. (Note: The window for Nuchal Translucency screening is 11½ - 13 weeks 6 days). Biochemistry component now available from 8 weeks, providing a dating ultrasound is available. CVS - FISH Anueploidy testing: Rapid test for aneuploidy of chromosomes 13, 18, 21, X and Y performed on cells obtained from CVS sample. Results are available within 24-48 hours but results should be considered interim in nature until confirmed by full fetal karyotype analysis. - Fetal karyotype: Performed on cultured Chorionic Villi may be offered for follow up of high risk FTS results or other clinical indications. Allow 10-14 days for fetal karyotype. - DNA testing may also be offered for certain inherited genetic conditions. Discuss with O&G specialist.

Rh (D) Negative - Anti D prophylaxis if antibody negative (see complications in pregnancy for Rh (D) negative women).

34 weeks

35 - 37 weeks

38 weeks Post Partum

Rh (D) Negative - Anti D prophylaxis if antibody negative See complications in pregnancy for Rh (D) negative women (12.25). Blood Group and Antibodies - See complications in pregnancy for Rh (D) negative women (12.25). Low Vaginal Swab - Consider for Group B Strep +/- Rectal Swab. FBC Blood Group and Antibody Screen Rh Negative - Fetomaternal haemorrhage test and Anti D. TSH - 7-30 days post partum (If Thyroiditis was present earlier in the pregnancy). Iron Studies - Follow up if iron levels are low during pregnancy. FBC - Consider for history of excessive tiredness. Newborn Screening Blood Spot (PKU) - Heel prick test on baby - preferred time of sample collection is 48 - 72 hours post-partum.

Complications in Pregnancy

ENDOCRINOLOGY

4 - 12 weeks

HCG - Overdue LMP. HCG usually positive by 10-14 days post conception. If negative, repeat after several days. FBC Iron Studies Blood Group and Antibodies - (If patient is Rh negative see 12.25 for complications in pregnancy) HepBsAg, Treponemal Serology and EIA Rubella +/- Hep C +/- MSU Vitamin D - Fasting preferable but not essential TSH - If clinically indicated HIV - At Doctor’s discretion

APPENDICIES

Laboratory Testing: Pregnancy Timeline

• Sensitising Events: For each sensitising event, perform FMH test and administer Rh (D) immunoglobulin. Sensitising events include: - Normal delivery - Ectopic pregnancy - Miscarriage - Termination of pregnancy - Genetic studies such as chorionic villus sampling, amniocentesis, cordocentesis - Abdominal trauma sufficient to cause fetomaternal haemorrhage - External cephalic version - Antepartum haemorrhage. • Threatened Miscarriage: - Perform serial Quantitative HCG and Progesterone. Discuss with Chemical Pathologist if required and consider ultrasound scan. • Ectopic Pregnancy: - HCG: insufficient rise or fall in HCG. Discuss with Chemical Pathologist if required - Progesterone - Ultrasound. • Recurrent Pregnancy Loss: - Products of conception for fetal karyotype - Parental chromosomes - Haematological/Immunological tests: Thrombophilia Screen (ATIII, Protein C and S, aPCR, Lupus Anticoagulant, Anti Cardiolipin antibodies, Homocystine, Prothrombin Gene). Discuss results with Obstetrician or Clinical Haematologist - ANA.

12.24

APPENDICIES

ENDOCRINOLOGY

APPENDICES - ENDOCRINOLOGY

Further advice regarding investigations, management and administration of products should be sought from a Haematologist. This information has been prepared and published by QML Pathology for the information of referring doctors. Although every effort has been made to ensure that it is free from error or omission, readers are advised that the information is not a substitute for detailed professional advice.

Investigation of Hirsutism: A Quick Reference Guide Polycystic Ovarian Syndrome (PCOS) is common (? 1 in 5-10); rest are rare 1) Exclude Uncommon Causes: - History - Course - Appearance. • Prolactin • Hypothyroidism • Cushing’s • Adrenal, Ovarian Tumours • Late onset, Partial Adrenal Hyperplasia, 1 in 100 (New York) ? 1 in 1000 - 10,000 (Australia)

Mid-morning Prolactin TSH ACTH and Cortisol DHEAs, Inhibin, (Urine Steroid Profile) Hydroxy-Progesterone

2) Look for Features of Polycystic Ovarian Syndrome (PCOS) • LH>FSH, yet Oestradiol not high enough to ovulate (4/day

Moderate - Severe

Rifampicin

Marked

Statins

Mild - Moderate

Tramal

Moderate

Tegretol

Mild - Moderate

*but increased risk of bleeding via platelet inhibition = those drugs which decrease INR

12.34

APPENDICIES

HAEMATOLOGY

APPENDICES - HAEMATOLOGY

Acetylcholine receptor (AChR)

Microsomal - thyroid

Adenovirus

Fungal precipitins

Psittacosis

Adrenal

Mitochondrial (AMA)

Rose - Waaler (Rheumatoid factor)

Anti streptolysin - O (ASOT)

Haemophilus influenzae

Q fever

Anti nuclear antibody (ANA) includes pattern description e.g. homogeneous, speckled etc.

Muscle - skeletal

Salivary duct/gland

Arbovirus

Helicobacter pylori

Muscle - smooth

Skeletal (striated) muscle

Aspergillus

Hepatitis A

Respiratory syncytial virus (RSV)

Neuronal Antibodies {(Hu)ANNA-1, (R1)-ANNA-2} Purkinje Cell Ab-(Yo)

Smooth muscle

Avian precipitins

Hepatitis B

Rickettsiae

Sperm

Barmah Forest virus

Hepatitis C

Ross River virus

Triiodothyronine (T3)

Bartonella (Cat Scratch Disease)

Hepatitis D (Delta virus)

Rubella

Hepatitis E Hepatitis G

Salmonella typhi and Paratyphoid

Herpes simplex - type I and II

Schistosomiasis

HIV - 1 and 2

Shigella

HTLV - 1

Staphylysin

Chlamydia

Human herpes virus 6

Streptococci (ASOT, DNAse B)

Coccidiodes

Hydatid

Strongyloides

Coxsackie virus

Influenza A

Cryptococcus

Influenza B

Syphilis - RPR, TPHA, FTA, EIA (Total antibody)

Cytomegalovirus (CMV)

Legionella

Teichoic acid (staphylococci)

Dengue

Leptospira

Tetanus

DNAse B (Streptococci)

Lyme disease (Borreliosis)

Toxocara

Echinococcus (Hydatid)

Lymphogranuloma venereum (LGV)

Toxoplasma

Measles

Typhus

Melioidosis

Varicella - Zoster

Mumps

Widal test (typhoid)

Mycoplasma pneumoniae

Whooping cough (Pertussis)

Avian protein precipitins Basement membrane zone (BMZ, Pemphigoid) Cardiolipin (phospholipid) Cold agglutinins DNA (double stranded DNA, DNA binding)

Neutrophil cytoplasmic (ANCA) – includes cANCA, pANCA, myeloperoxidase, Proteinase-3 Nuclear antibody (ANA)

Donath-Landsteiner

Ovarian

Endomysial

Pancreatic islet cell

Extractable nuclear antigens (ENA) Includes SS-A, SS-B, RNP, Sm, Scl 70, PM-1, Jo-1

Parathyroid

Filaggrin (Keratin) Ganglioside (GM-1) Gliadin Glomerular basement membrane Glutamic acid decarboxylase (GAD)

Thyroxine (T4)

Bordetella pertussis

Thyroid microsomal

Brucella abortus

TSH receptor

Campylobacter

Parietal cell Parotid (salivary gland) Pemphigoid (basement membrane zone, BMZ) Pemphigus (intercellular cement substance, ICS) Phospholipid (cardiolipin) Platelet

Candida Cat Scratch Disease

Echovirus

Granulocyte

Protein tyrosine phosphatase IA-2 (IA-2)

Histones

Purkinje Cell AB (Yo)

Enterovirus

Insulin

Red cell antigens screen, identification

Epstein - Barr virus (EBV)

Reticulin

Filaria

Parainfluenza

Yersinia

Flavivirus group includes Dengue, Australian (Murray Valley) encephalitis and Kunjin

Parapertussis

* Antibodies to other agents may be available. Please contact Immunology Department (07) 3121 4458

Intercellular cement substance (ICS, Pemphigus)

12.35

Neutrophil

Intrinsic factor

Rheumatoid factor

Islet cell (GAD, IA-2)

Rhesus antibodies

Microsomal - liver, kidney

Ribosomal

NOTE: It is a Medicare requirement that autoantibodies required for testing be listed individually on the request form.

Entamoeba histolytica

Fasciola hepatica

Parvovirus B19 Pertussis (whooping cough)


IMMUNOLOGY

Antibodies to Microbial and Parasitic Agents

APPENDICIES

Antibodies to Tissue Antigens (Autoantibodies)

12.36

APPENDICIES

IMMUNOLOGY

APPENDICES - IMMUNOLOGY

- IgM and IgG

Barmah Forest Virus

- IgM and IgG

Flavivirus (Group) Viruses

- IgM and IgG

Flavivirus Group includes

- Dengue Virus - all sero types - Australian (Murray Valley) Encephalitis Virus - Kunjin Virus - Japanese Encephalitis Virus


Skin Tests for Allergy In patients with allergy due to IgE (e.g. house dust mite allergy, pollen allergy, animal dander allergy, nut allergy) epicutaneous exposure (skin prick) to relevant allergens induces a visible wheal and flare reaction due to local mast cell degranulation. A set of allergens which include pollens, moulds, animal danders, house dust mite and foods is used for testing. A histamine (positive) control and glycerol saline (negative) control are also tested to validate the results. Variables in Skin Allergy Testing Several factors may influence skin testing. Clinically relevant factors include: • Drugs e.g.: • antihistamines • tricyclic antidepressants • benzodiazepines • beta blockers. • Age • Previous immunotherapy • After viral exanthem.

12.37

Contraindications Testing is contraindicated in patients with: • Current severe allergic symptoms • Recent anaphylaxis • Unstable asthma • Acute illness • Generalised skin rash • Pregnancy.

Allergy skin testing is performed by appointment at several locations across Brisbane and our Branch Laboratories. For further information, please contact our Immunology Department on (07) 3121 4458 or your local QML Pathology Branch Laboratory.

IMMUNOLOGY

Ross River Virus

Patient Preparation • No antihistamines to be taken for seven days prior to test. Many over-the-counter medications (e.g. decongestants, cough mixtures and sinus mixtures) have antihistamines; these should be ceased • No creams or moisturisers (including sunscreen) on arms for 48 hours prior to test • Tricyclic antidepressant drugs often have profound 'antihistamine effects' and may preclude allergy skin testing • Moderate to high dose oral corticosteroids, e.g. Prednisolone 25mg daily or above will impair skin test reactivity • Asthma sprays such as Ventolin should not be stopped.

APPENDICIES

Arbovirus Screen

RAST Allergen List Single Allergens Grasses • Canary grass • Cultivated wheat • Couch (Bermuda) • Johnson grass • Meadow grass • Paspalum • Perennial rye grass • Timothy Weeds • Common ragweed • Dandelion • Marguerite, Daisy • Plantain • Western ragweed

Epithelia & Animal Proteins • Cat • Dog dander • Dog epithelium • Cow dander • Horse dander • Budgerigar feathers • Chicken feathers • Duck feathers • Guinea pig • Mouse epithelium • Mouse urine protein • Rat epithelia • Rat urine proteins • Sheep epithelium

Trees • Eucalyptus • Melaleuca • Wattle, Acacia

Moulds • Alternaria tenuis • Aspergillus fumigatus • Candida albicans • Cladosporium herbarum • Penicillium notatum

Dust & Mites • House dust mite - D. pteronyssinus • House dust mite - D. farinae • House dust

• Yellow jacket wasp venom

Insects • Cockroach • Honey bee venom • Mosquito • MUXF3 • Paper wasp venom

Foods • Almond • Apple • Banana • Barley • Beef • Blue mussel • Brazil nut • Buckwheat • Cashew • Cheddar cheese • Chicken meat • Chilli pepper (Capsicum) • Cocoa • Coconut • Coffee • Corn (maize) • Crab • Egg white • Egg yolk • Fish (cod) • Garlic • Gluten • Grape • Hazelnut • Melons (Rockmelon & Honeydew)

• Macadamia

12.38

APPENDICIES

IMMUNOLOGY


Cow Milk Proteins • - lactalbumin • ß- lactoglobulin • Casein Drugs • Amoxycillin • Ampicillin • Penicilloyl-G • Penicilloyl-V

12.39

Miscellaneous • Chlorhexidine • Latex • Recombinant latex • Suxamethonium Inhalant Screen Contains allergens from the following groups:

• • • • •

Grasses Weeds Moulds House dust mite Animal epithelia

Multiple Allergens Grass Pollen Mix • Couch (Bermuda) • Timothy • Meadow • Johnson • Rye • Paspalum Tree Pollen Mix • Wattle • Olive • Willow • White pine • Eucalyptus • Melaleuca Weed Pollen Mix • Common ragweed • Mugwort • Saltwort (prickly) • Plantain • Goosefoot Animal Dander Mix • Cat • Dog • Horse • Cow Caged Bird Mix • Budgerigar • Canary • Finch • Parakeet • Parrot Mould Mix • Penicillium • Aspergillus • Cladosporium • Alternaria House Insects Mix • House dust mite - D. pteronyssinus

• • •

House dust mite - D. farinae House dust Cockroach

Food Mix • Egg white • Milk • Yeast • Soya bean • Peanut • Fish (cod) Cereal Mix • Wheat • Oat • Buckwheat • Corn • Sesame seed Fruit Mix • Peach • Kiwi fruit • Rockmelon • Banana • Pineapple Nut Mix • Peanut • Almond • Coconut • Hazelnut • Brazil nut

Skin Allergen List Routine Allergen Screen Pollens • Couch (Bermuda) • Eucalyptus • Johnson grass • Paspalum • Pine • Plantain • Prairie grass (Brome) • Ragweed • Timothy grass • Wattle • Wild oat Moulds • Alternaria • Aspergillus fumigatus • Aspergillus niger • Botrytis • Cladosporium hormodendrum (Herbarum) • Penicillium mould

Epithelial Extracts • Cat fur • Cattle hair • Dog hair • Feather mix • Horse hair Food Extracts • Cashew • Egg white • Egg yolk • Milk - cow • Peanut • Shellfish • Shrimp • Soy bean • Wheat flour (whole)

Additional Food Allergens (available on request) • • • • • • • • •

Banana Chicken Cod Lobster Rice grain Strawberry Tomato Yeast (Baker's Yeast) 7 grass mix

IMMUNOLOGY

Mango Milk Mutton Oat Onion Orange Oyster Parvalbumin Peach Peanut Pineapple Pinenut Pork Potato Rice Rye Salmon Sesame seed Shrimp Soya bean Squid Strawberry Sunflower seed Tomato Tropomysin Tuna Walnut Wheat Yeast

APPENDICIES

• • • • • • • • • • • • • • • • • • • • • • • • • • • • •

Miscellaneous Extracts • House dust mite • Cockroach

Seafood Mix • Cod • Shrimp • Tuna • Blue mussel • Salmon Disinfectant Agent Mix • Ethylene oxide • Phthalic anhydride • Formalin/ formaldehyde • Chloramine T Reactive Chemical Mix • Isocyanate TD1 • Isocyanate MD1 • Isocyanate HD1 • Phthalic anhydride

12.40

APPENDICIES

IMMUNOLOGY


The Doctor or Dentist and Staff

Although all of us suffer from infectious illnesses from time to time, everyone would agree that the place where help is obtained, the Doctor’s/Dentist’s surgery, should not facilitate transmission of infection. There is a requirement for duty of care by health care professionals to minimise transmission of infection from person to person by careful planning, appropriate training, and use of infection control procedures.

The surgery staff and the Doctor or Dentist should be free from infectious illness.

This document is a guide to infection control in Doctors surgeries. It does not cover all circumstances and readers should rely on their own risk assessments and choice of remedies required. For more detailed guidelines see: • Sterilisation/Disinfection guidelines for General Practice (RACGP 2007). • Infection Control in Surgery (Royal Australasian College of Surgeons, 1998, revised 2001). • Human Immunodeficiency Virus and Hepatitis B and the Workplace: National Consensus Statements, Worksafe Australia Code, 1993. • AS/NZS 4187:2003: Cleaning, disinfecting and sterilizing reusable medical and surgical instruments and equipment, and maintenance of associated environments in health care facilities. • AS/NZS 4815:2006: Office-based health care facilities - Reprocessing of reusable medical and surgical instruments and equipment, and maintenance of the associated environment. • Updated US Guidelines for the Management of Occupational Exposures to HBV, HCV and HIV and Recommendations for Postexposure Prophylaxis (MMWR: June 2001 Vol 50/No. RR-II). All procedures should be documented and records of patient encounters, including small operations lists, equipment performance, etc. should be kept. This document is a guide for surgeries where minor procedures are performed. Facilities for major procedures must be similar to those provided by accredited hospitals and hence are expensive. Factors to be considered in the control of infection are: 1. The doctor or dentist 2. The surgery staff 3. The patients 4. The physical environment

12.41

5. Disinfection and sterilization of instruments and other appliances.

All health care workers who are exposed to blood should be vaccinated with Hepatitis B Virus vaccine. Check the serum Anti-Hepatitis B Surface antibodies (Anti HBs Ab) level 2 months after the third dose. Skin lesions and cuts should be covered with waterproof occlusive dressings. The surgery staff should be adequately trained in surgical procedures including aseptic techniques, use of sterilizers etc. These procedures should be documented. Induction of new staff and refresher training should be recorded also. Patients

APPENDICIES

The above concepts have now been reinforced by Government legislation. In Queensland the relevant act is the Workplace Health and Safety Act 1995. In NSW the relevant act is the Occupational Health and Safety Act 2000. These acts apply to all work places where a person is paid to perform work. Breach of the Queensland Act may result in heavy fines and/or jail of the relevant person.

They should be vaccinated against common organisms, e.g. rubella.

MICROBIOLOGY

Infection Control in Medical Consulting Rooms

Patients with suspected infectious illnesses (e.g. rubella) are best seen at their homes or should be seen on arrival at the surgery to minimise spread of organisms to others. The staff should arrange block bookings for pregnant patients and separate patients who are susceptible to infection (e.g. leukaemic patients) from potential shedders of microorganisms (e.g. children with chicken pox). Individuals, however, may have circulating transmissible agents such as Hepatitis B virus (HBV) and Human Immunodeficiency Virus (HIV) without signs or symptoms. The blood (and some body fluids) of such persons is infectious and thus represents a hazard when undergoing some medical procedures. The Centers for Disease Control, USA (MMWR 1989; 38: S–6) has developed the strategy of ‘universal blood and body fluid precautions’ to address concerns regarding transmission of HIV in the health care setting. The concept, previously referred to as ‘universal precautions’, is now called ‘standard precautions with additional precautions’ and stresses that all patients should be assumed to be infectious for HIV and other blood-borne pathogens. In the health care setting, ‘standard precautions’ should be followed when workers are exposed to blood and other body fluids. Standard Precautions are recommended for the treatment and care of all patients, and apply to all body fluids, secretions and excretions (excluding sweat), regardless of whether they contain visible blood (including dried body substances such as dried blood or saliva), non-intact skin and mucous membranes. Standard Precautions include good hygiene practices, particularly washing and drying hands before and after patient contact, the use of protective barriers which may include gloves, gowns, plastic aprons, masks, eye shields or goggles, and appropriate handling and disposal of sharps and other contaminated or infectious waste, and the use of aseptic techniques. Additional Precautions are used for patients known or suspected to be infected or colonised with epidemiologically important or highly transmissible pathogens that can be transmitted by air borne or droplet transmission or by contact with dry skin or contaminated surfaces.

12.42

APPENDICIES

MICROBIOLOGY

APPENDICES - MICROBIOLOGY

To minimise the risks of acquiring HIV and HBV during performance of job duties, workers should be protected from exposure to blood and other body fluids as circumstances dictate. Protection can be achieved through adherence to work practices designed to minimise risk. Personal protective equipment (i.e. gloves, masks and protective clothing) should be used to decrease exposure to hazards.

Blood Collection (always use gloves and protective glasses) • Preferably use the evacuated blood tube (vacutainer®) system. • Discard needle and syringe into sharps bin.

b. Change gloves between patient contacts. c. Wash hands before and after using gloves. d. Do not reuse surgical or examination gloves. e. Use rubber household gloves for housekeeping chores involving potential blood contact and for instrument cleaning and decontamination. These may be decontaminated and reused but should be discarded if damaged. f. Powder free gloves are recommended.

Hand washing Protocol • Meticulous hand washing is essential in order to maintain infection control in the General Practice. • All staff should routinely wash their hands before and after all contact with patients, as well as when cleaning up blood and body fluid spills in the surgery, and removing gloves.

• If any blood remains on sample tube stopper clean with an alcohol swab.

• Staff should also ensure that they wash their hands before and after eating, smoking and going to the toilet.

• Transport the blood sample safely.

• It is also essential that staff dry their hands thoroughly after washing.

Waste Management

• Any cuts, abrasions or lesions should be covered at all times with water-resistant dressings, which should be changed regularly.

Set up proper disposal procedures. Used gloves, swabs, disposable drapes etc. should be bagged in a biohazard plastic bag (yellow with a black biohazard symbol), sealed and disposed of appropriately. (See Qld Refuse Management Regulation (No. 1) (amended 1993). Environmental Protection (Waste Management) Regulation 2000 - Queensland Under the Environmental Protection Act 1994, a clinical and related waste management plan is required for healthcare facilities.

Handling Sharps Take care to prevent injury when handling suture needles, scalpels, sharp instruments. Do not resheath used needles.

Place all disposable sharp items in an approved container (AS 4031:1992) which should be located as close as possible to the use area.

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a. Use sterile gloves for procedures involving contact with normally sterile areas of the body, e.g. wound suturing etc. Use examination gloves (clean but not sterile) for procedures involving contact with mucous membranes and for other patient care or diagnostic procedures not requiring sterile gloves e.g. oral, vaginal or rectal examination.

In the event of a sharps/needlestick injury, documented protocols should outline the action to be taken by the injured person and the treating doctor.

MICROBIOLOGY

Additional Precautions are used for patients with MRSA, VRE, CJD or active pulmonary tuberculosis, or where there is an established risk of transmission of infection regardless of the nature of the procedure being undertaken, or where the procedure itself carries an established risk of aerosolation, blood accident or staff/patient injury. Additional Precautions are not required for patients with blood borne viruses such as HIV, Hepatitis B or Hepatitis C, unless there are complicating factors present, such as pulmonary tuberculosis, or unless the procedure itself performed on these patients has a known high risk, such as generation of aerosols.

Guidelines for Gloves

APPENDICIES

Additional Precautions are designed to interrupt transmission of infection by these routes and should be used in addition to Standard Precautions when transmission of infection might not be contained by using Standard Precautions alone. Additional Precautions may be specific to the situation for which they are required, or may be combined where microorganisms have multiple routes of transmission.

Routine Hand Washing Procedure (10-15 seconds) Remove all rings, watches and jewellery.

Wet hands with warm water, apply recommended pH neutral liquid soap, and lather vigorously.

Wash hands thoroughly beginning with the palms, then backs of hands, wrists, fingers, thumbs and between fingers for 10 to 15 seconds.

Rinse hands thoroughly under running water.

Turn taps off using paper towel, if no elbow or foot controls are available.

Dry hands thoroughly using paper towel.

12.44

APPENDICIES

MICROBIOLOGY


Always observe standard precautions Barricade the area around the spill to prevent other persons going near the spillage.

Has true blood/body fluid exposure occurred

NO

Complete incident record

YES Collect cleaning material and equipment.

APPENDICIES

Body Fluid Exposure Procedure

MICROBIOLOGY

Clean up Procedure for Blood and Body Fluids

1. Apply first aid to injury

YES

2. Gently encourage bleeding Wear heavy duty cleaning gloves and glasses (a plastic apron and mask should be worn if there is a risk of a splash occurring).

Broken glass needs to be picked up with forceps or scooped into an approved sharps container.

3. Wash thoroughly in running water

Complete incident record and medical records

4. B athe eyes or damaged skin with copious water and/or sterile saline if applicable

APPENDICIES

MICROBIOLOGY


Is source known

Never pick up broken glass pieces by hand!

For large spills > 10cms

For small spills < 10cms

YES

NO

spot cleaning Wipe up blood spots immediately with a damp cloth, tissue or paper towel using detergent and water.

Cover the spill with the granules. Wait until the spill has been absorbed and then use cardboard to pick up the spill.

Discard all contaminated materials into medical waste container for disposal.

Quarantine the affected area until dry.

See hand washing procedure (12.44).

Obtain consent from source for urgent HBsAg, HepCAb and HIV serology

Is source HIV positive or high risk

After discarding the disposable items, decontaminate all reusable items, such as forceps and safety glasses, etc. After removal of gloves, hands must be washed thoroughly.

12.45

Wipe up blood spill immediately with a damp cloth, tissue or paper towel using detergent and water.

YES

NOTE: Chlorine releasing granules are a corrosive agent and may remove colour from carpet and soft furnishings.

Obtain immediate urgent advice from nearest Infectious Diseases Physicians regarding HIV prophylaxis

Plus test recipient

Urgent baseline serology testing for HIV, HepBsAb (if immunised), HepBsAg (if not immunised) and HepCAb

Not immune HepB

Immune HepB No HepB Immunoglobin or HepB vaccination

Obtain HepB Immunoglobin from Red Cross Blood Service within 48 hours. Offer HepB vaccination course

Repeat baseline serology in 3 months

12.46

Contain the spill with either chlorine releasing granules or Kitty Litter.

1. OVERVIEW: Validation of your steriliser requires that you run three consecutive steriliser cycles. Each cycle must include two biological indicator vials inside the steriliser (one inside a pack, the other outside the pack(s)). The remaining vial is NOT sterilised, but acts as a control of storage and transport conditions.

3. Validation of the sterilisation process should be performed as soon as practical after the technician’s annual service.

4. Preclean, wash and dry the items for sterilisation.

5. Ensure seven vials received and all have the same lot/batch number. Label six vials to indicate their location and cycle number (see table) and label remaining vial as 'Z' to be used as a control.

6. Select the most difficult to sterilise pack and load* and record contents. Place one indicator (i.e. '1E' for the first cycle) inside the middle of challenge pack.

Steriliser chamber

7. Put this pack in the steriliser and place a second indicator vial (i.e. '1C' for the first cycle) in the coolest position in the steriliser as identified from heat distribution studies**. NB: Ensure vial does not come into contact with metal as it will melt. Place vial on gauze or paper so that it does not make contact with the metal of the autoclave.

Control vial outside steriliser labelled Z

Vial inside package labelled E

8. Run the steriliser for one cycle. The length of the sterilisation period should be three minutes plus the penetration time ** if running at 134˚C.

9. Run two more cycles, repeating steps 4 to 6 each time. Use identical packages with new indicator vials in the same positions as before: 2nd cycle – use vials labelled 2C and 2E. 3rd cycle – use vials labelled 3C and 3E. The one control vial 'Z' is NOT exposed to the sterilisation cycle.

10. Keep a record of the date and time the validation was performed, the time and temperature for the cycles, the package contents and the position of the pack(s) in the steriliser.

11. Complete validation request form and send along with the seven vials to the laboratory for processing.

12. Validation does not need to be repeated for another 12 months unless pack and/or packaging density change, or the steriliser undergoes a major service.

* The hardest to sterilise pack possible for your surgery in terms of packaging and pack density. Must also provide the largest load possible for the steriliser. ** Heat distribution studies and penetration times should be provided by the technician as part of the annual service.

Vial inside chamber in coolest position labelled C

CYCLE NUMBER

VIAL LABELS

1

1C (chamber); 1E (package)

2


3


Control Vial

Z

MICROBIOLOGY

Please refer to the RACGP Sterilisation/Disinfection Guidelines (www.racgp.org.au) for further information.

2. Order autoclave validation test request form and seven biological indicator vials through your routine QML Pathology supply channel.

12.47

Steriliser Chamber with Package and Biological Indicator Vials

APPENDICIES

Validation of your Steriliser Using Biological Indicator Vials

What to do after validation After successful validation, biological indicator vials are not required for routine monitoring of your steriliser. For routine monitoring you must either: 1. R ecord cycle parameters (time and temperature) either manually every 30 seconds or using a printout from the steriliser. OR 2. Use a Class 4, 5, or 6 chemical indicator. NB. All packages should include an external Class 1 indicator (autoclave tape) to identify those packages that have been sterilised. Quality Control (QC) is performed on all batches of vials before they are distributed to surgeries. Further information on the validation of the sterilising process please contact QML Pathology Microbiology Department on (07) 3121 4438.

12.48

APPENDICIES

MICROBIOLOGY


Symbols for Hazardous Categories

Infectious wastes: bags are yellow with the internationally recognised biohazard symbol in black.

APPENDICIES

MICROBIOLOGY


Cytotoxic wastes: bags are purple with the cytotoxic waste symbol (denoting a cell in telophase) which has already been accepted widely in Australia.

Radioactive wastes: bags are red with the black internationally recognised radioactivity symbol.

12.49

All chemicals should be labelled with their generic names. This label should indicate any hazard and describe procedures in the event of an accident, including first aid and clean up protocols.