DIRECTORY OF LABORATORY SERVICES

 

INTRODUCTION

Diagnostic laboratory tests play an increasingly crucial role in patient management. The main aim of the laboratories is to process and test clinical specimens from patients, and to offer high quality service in doing so. The patient is the primary concern of the laboratories. Therefore, to achieve quality results and optimal use of the services, a number of requirements are important and should be adhered to.

Firstly, appropriate samples should be collected using the correct containers, and transported to the laboratory under optimal conditions. This information can be found in the following pages. Secondly, each sample must be accompanied by a signed request form containing all the necessary information. In particular, relevant clinical details should be provided, to assist laboratories in performing the most appropriate tests and interpreting the results. Finally, users are encouraged to talk to the Head and consultants of the laboratories, whether to discuss tests or results, to get advice or to offer feedback. A close working relationship between the users and the laboratory will ultimately benefit the patients.

 

SPECIMEN COLLECTION AND TRANSPORT

The tests offered, specimen types and specimen containers are of various types and it is important that specimens are collected and transported properly. Deviations from the instructions given in this guide may result in pre-analytical errors with the specimens not being suitable for testing or giving test results that are of poor quality or are confusing.

Specimens should be sent to the laboratory as soon as possible after collection (<4 hours after collection).

 

BLOOD SPECIMENS

Blood specimens should be introduced into the specimen tube carefully so as not to cause haemolysis. A closed vacuum blood collection system with the appropriate tubes should be used. As an alternative, a needle and syringe may be used but the blood should not be forced out through the needle as this causes gross haemolysis.

The volume of blood collected should be as indicated on the sample tube. Insufficient sampling will cause an incorrect sample to anticoagulant ratio, leading to erroneous results. Blood collected into tubes with anticoagulants, preservatives or clot activators should be mixed immediately after collection by gently inverting the tubes a few times. The recommended order of draw is :

  1. Tubes with no additives (plain, SST/gel)
  2. Coagulation tubes (Na citrate)
  3. Other tubes with additives (heparin, fl/oxalate, EDTA)

 

URINE SPECIMENS

Urine containers should be screwed on tightly to prevent leakage. 24 hour and other timed urine collection procedures should be explained to the patients to ensure proper collection.

 

Random Specimen

This is the urine specimen most commonly sent to the laboratory for analysis. Random specimens can sometimes give an inaccurate view of a patient's health if the specimen is too diluted and analyte values are artificially lowered. Avoid the introduction of contaminants into the specimen by giving explicit instructions to patients so that they do not touch the inside of the cup or cup lid.

 

First Morning Specimen

This is the specimen of choice for urinalysis and microscopic analysis, since the urine is more concentrated and contains relatively higher levels of cellular elements and analytes.

Procedure :

  1. Empty the bladder before going to bed at night.
  2. Collect the first morning specimen on waking up in the morning.

 

Midstream Clean Catch Specimen

This is the preferred type of urine specimen because of the reduced incidence of cellular and microbial contamination. The procedure significantly reduces the opportunities for contaminants to enter into the urine stream.

Procedure :

  1. Cleanse the urethral area.
  2. Pass the first portion of the urine stream into the toilet.
  3. Collect the midstream urine into the container. Any excess urine should be voided into the toilet.

 

24 Hour Specimen

A 24 hours urine specimen is collected to measure the concentration in urine over a whole day. Accurate timing is critical to the calculations that are conducted to determine analyte concentrations and ratios. Interpretations based on faulty calculations can result in improper diagnoses or medical treatment. The specimen should be refrigerated during the collection period.

Procedure :

  1. Empty the bladder into the toilet before beginning the collection. Record the date and time on the label of the container.
  2. For the duration of the 24 hours, all urine MUST be collected and pooled into the container.
  3. Exactly 24 hours after starting the collection, urinate one last time and add it to the container. Record the date and time onto the label of the container.

 

REQUEST FORMS

Use the correct request forms and ensure that forms are properly and clearly filled and signed by the requestor. Relevant information regarding provisional diagnosis, treatment and other information relevant to the test required should be provided. The request form should be signed by the requestor and the name stamped or clearly written. Users of the service are urged to be selective and confine tests required to those that are useful for the diagnosis or control of treatment of patients.

 

SPECIMEN REJECTION

Samples that do not meet the requirements will be rejected. The criteria for rejection are many and may include :

  1. Incorrect tube/container
  2. Unlabelled samples and forms
  3. Wrongly labeled samples and forms
  4. Insufficient sample volume
  5. Clotted Sample
  6. Haemolysed sample
  7. Grossly Lipaemic sample
  8. Grossly icteric samples
  9. Leaking containers
  10. Improper transport condition
  11. Overnight/delayed sample
  12. Insufficient clinical information
  13. No requestor’s name and signature

 

SPECIAL TEST PROCEDURE

 

ORAL GLUCOSE TOLERANCE TEST (OGTT)

Indication :

This test is principally used for diagnosis when blood glucose levels are equivocal, during pregnancy or in epidemiological studies. In the absence of classical symptoms, random plasma glucose is the recommended first test, and at least two diagnostic glucose results on different days are essential. If the fasting level is < 6.1mmol/l, diabetes mellitus is excluded and a GTT is not indicated. A random level of ³ 11.1mmol/l or a fasting level of ³ 7.0 mmol/l is indicative of diabetes mellitus. An oral GTT may be conducted if the random glucose is between 5.6 – 11.0 mmol/l or the fasting level is between 6.1 – 6.9 mmol/l (WHO 1999, Ann Clin Biochem 2000; 37:588-592).

Procedure :

To conduct an oral GTT, the patient should have been on a normal diet (containing at least 150g of carbohydrate daily) and usual physical activity for at least 3 days prior to the test. The patient must fast overnight (8-14 hours). Plain water is allowed. Smoking is not permitted during the test and the presence of factors that influence interpretation of the results must be recorded (eg. medications, inactivity, infection etc.).

Take a fasting venous blood sample for glucose estimation. An adult patient should drink 75g of anhydrous glucose (or 82.5g of glucose monohydrate) in a glass of water (300 ml) over 5 mins. For children, the test load should be 1.75g of glucose/kg body weight up to a maximum of 75g.

At 2 hours after the glucose load, take a venous blood sample for glucose estimations. For a 3-point GTT, take an additional sample at 1 hour after the glucose load. Send all samples together to the laboratory, clearly labelled with the times of collection.

Interpretation of results :

Based on WHO guidelines for venous plasma samples:

Condition Glucose concentration (mmol/l)
Diabetes mellitusFastingor2 hours after glucose load ³ 7.0³ 11.1
Impaired glucose tolerance (IGT)Fasting (if measured)and2 hours after glucose load < 7.07.8 – 11.0
Impaired fasting glycemia (IFG)Fasting       and (if measured)2 hours after glucose load 6.1 – 6.9< 7.8

 

TUMOUR MARKERS – A brief clinical practice guide

The table below is a brief guideline on clinical significance of the various tumour markers.

Tumour markers should not be used for screening, the exception being AFP.

Tumour Marker Malignancy Clinical Significance *
S D P M R
AFP Yolk sac tumour, Hepatoma Ö Ö Ö Ö Ö
HCG Trophoblastic tumour, choriocarcinoma Ö Ö Ö Ö
CEA Colorectal carcinoma Ö Ö Ö
PSA Prostatic carcinoma Ö Ö Ö Ö
CA 125 Ovarian carcinoma Ö Ö Ö
CA 15-3 Breast carcinoma Ö Ö
CA 19-9 Pancreatic carcinoma Ö Ö Ö Ö
hTG Thyroid carcinoma Ö Ö Ö Ö

 

* S   -   Screening M - Monitoring and Treatment
   D   -   Diagnosis R - Reduction of recurrence
   P   -   Prognosis

Reference: Clinical Practice Guidelines on Serum Tumour Markers, Dr. Leslie Lai. Academy of Medicine of Malaysia, Serial No. 7/2003.

 

SERVICES PROVIDED

 

LABORATORY SERVICES

The services available are listed here in alphabetical order as single tests. If a test is not found in the single tests list, it may be under the profiles/packages lists (for Chemistry, Immunology, Endocrine and Haematology), which can be found further down in the directory. Specimen collection/tube guides and specimen volumes given are for adults. For paediatrics when only small volumes of blood can be taken, please use similar paediatric tubes.

TEST NAME SAMPLE CONTAINER CAP COLOUR VOLUME REMARKS
Bone Marrow Examination Bone Marrow Aspirate/ Trephine Biopsy BM - Slides Trephine - Formalin tube Appointment required. Refer to profile list for more information.
Cytospin CSF Plain sterile White 0.5 ml Haematological malignancies.
Immunophenotyping – Leukemia Whole Blood EDTA Purple 2 x 3 ml Appointment required. Refer to profile list for more information.
Immunophenotyping – Leukemia Bone Marrow Aspirate EDTA Purple 2 x 3 ml Appointment required. Refer to profile list for more information.
Immunophenotyping – Leukemia CSF Plain sterile White 2 ml Appointment required. Refer to profile list for more information.
Paroxysmal Nocturnal Haemoglobinuria (PNH) by flowcytometry Whole Blood EDTA Purple 3 ml Appointment required.
17-OH Progesterone Serum Plain Red 5 ml
Adrenocorticotropic Hormone (ACTH) Plasma EDTA Purple 3 ml Place specimen on ice water and send to lab immediately within 30 mins.
Aldosterone Serum Plain Red 5 ml Must be requested together with Renin.
Alpha-Fetoprotein (AFP) Serum Gel Yellow 3 ml Patients undergoing amniocentesis should have their blood for AFP drawn first.
CA 125 Serum Gel Yellow 3 ml Tumour marker primarily for the monitoring of ovarian cancer.
CA 15-3 Serum Plain Red 5 ml Tumour marker primarily for the monitoring of breast cancer.
CA 19-9 Serum Plain Red 5 ml
Carcinoembryonic Antigen (CEA) Serum Gel Yellow 3 ml
Cortisol, Serum Serum Gel Yellow 3 ml Patients should not be on Prednisolone, Prednisone or other synthetic corticosteroids.
Cortisol, Urine Urine Plain (24 hr) As collected
C-Peptide Serum Plain Red 5 ml
Dehydroepiandroster-one Sulfate (DHEA-S) Serum Plain Red 5 ml
Erythropoitein (EPO) Serum Plain Red 5 ml
Estradiol Serum Gel Yellow 3 ml
Ferritin Serum Gel Yellow 3 ml Clinical information must be provided.
Folate Serum Gel Yellow 3 ml Clinical information must be provided.
Follicle-stimulating Hormone (FSH) Serum Gel Yellow 3 ml
Growth Hormone Serum Plain Red 5 ml
Human Chorionic Gonadotropin (HCG) Serum Gel Yellow 3 ml
Insulin Serum Gel Yellow 3 ml Fasting sample should be checked in a fasting ssample, during hypoglycamia or as part of a dynamic function test.
Insulin-like Growth Factor – 1 (IGF-1) Serum Plain Red 5 ml
Luteinising Hormone (LH) Serum Gel Yellow 3 ml
Parathyroid Hormone (PTH), intact Serum Plain Red 5 ml Send immediately to laboratory after sample collection.
Progesterone Serum Gel Yellow 3 ml
Prolactin Serum Gel Yellow 3 ml
Prostate Specific Antigen (PSA), Total Serum Gel Yellow 3 ml
Renin Plasma EDTA Purple 2 x 3 ml Must be requested together with Aldosterone. Sample should be sent immediately in ice water within 30 mins.
Sex Hormone Binding Globulin (SHBG) Serum Plain Red 5 ml
Testosterone Serum Gel Yellow 3 ml
Thyroglobulin Serum Plain Red 5 ml Test is mainly indicated in the monitoring of thyroid cancer after thyroidectomy or ablation therapy. Thyroglobulin Ab (TgAb) should also be requested.
Thyroglobulin Ab (TgAb) Serum Plain Red 5 ml
Thyroid Peroxidase Ab (TPO) Serum Plain Red 5 ml
Thyroid-stimulating hormone (TSH) Serum Gel Yellow 3 ml
Thyroxine (T4), Free Serum Gel Yellow 3 ml
Tri-iodothyronine (T3), Free Serum Gel Yellow 3 ml
Vitamin B12 Serum Gel Yellow 3 ml Clinical information must be provided.
CSF FEME CSF Plain (Sterile) 2 ml Send immediately
Fat Globules Faeces Plain cup Small amount
Fluid FEME Fluid Plain (Sterile) 2 ml Send immediately.
Occult Blood Faeces Plain cup Small amount Patient must be off iron supplement for 4 days prior to testing and red meat-free diet for 3 days prior to collection of faeces.
Bence Jones Protein Urine Plain cup 5 ml Early morning sample preferred.
Urinalysis (Urine FEME) Urine Plain cup 10 ml Specimen received >3 hours after collection will be rejected.
Urine Pregnancy Test (UPT) Urine Plain cup 2 ml First morning or random specimen.
Complete Blood Count (CBC) Whole Blood EDTA Purple 3 ml Sample should be sent to the laboratory within 2 hours of collection.
ESR Whole Blood EDTA Purple 3 ml Sample to be sent to the laboratory within 2 hours of collection.
Peripheral Blood Film (PBF) Morphology Whole Blood EDTA Purple 3 ml Sample to be sent to the laboratory within 2 hours of collection.
Reticulocyte count Whole blood EDTA Purple 3 ml Sample to be sent to the laboratory within 2 hours of collection
Amino Acids & Acylcarnitines Dried Blood Filter Paper
Amino Acids, CSF CSF Plain sterile 1-2 ml
Amino Acids, plasma Blood Heparin Green 1 - 2 ml
Amino Acids, Urine Urine Plain cup 10 ml
Galactose-1-Phosphate Uridyl Transferase (GPUT/GALT) Whole blood Heparin Green 3 ml
IEM Screen Urine Plain cup 5 ml
Mucopolysaccharides Urine Plain cup 10 ml
Newborn Screening Dried Blood Filter Paper
Organic Acids Urine Plain cup 5 ml
Pyruvate, blood Blood Perchloric acid tube 2 ml
Pyruvate, CSF CSF Perchloric acid tube 1 ml
Reducing Sugars, stool Stool Plain cup As collected
Reducing Sugars, Urine Urine Plain cup 5 ml
Sulphite Test Urine Plain cup 5 ml
Sweat test for NaCl Sweat
Alpha-1 Antitrypsin (AAT) Serum Plain Red 5 ml
Anticardiolipin Ab (ACA) Serum Plain Red 5 ml
Anti-CCP Serum Plain Red 5 ml
Anti-Neutrophilic Cytoplasmic Antibodies (ANCA) Serum Plain Red 5 ml
Antinuclear Ab (ANF) Serum Plain Red 5 ml
Antistreptolysin-O (ASO) Serum Plain Red 5 ml
Complement 3 (C3) Serum Plain Red 5 ml
Complement 4 (C4) Serum Plain Red 5 ml
C-Reactive Protein (CRP) Serum Plain Red 5 ml
ds-DNA Ab (Screen - Crithedia) Serum Plain Red 5 ml
ds-DNA Ab Quantitative (ELISA) Serum Plain Red 5 ml
Electrophoresis : IFE (CSF) CSF Plain (Sterile) 5 ml Clinical information must be provided.
Electrophoresis : IFE (Serum) Serum Plain Red 5 ml Clinical information must be provided.
Electrophoresis : IFE (Urine) Urine Na azide As collected Clinical information must be provided.
Electrophoresis, Protein (CSF) CSF Plain (Sterile) 5 ml Clinical information must be provided.
Electrophoresis, Protein (Serum) Serum Plain Red 5 ml Clinical information must be provided.
Electrophoresis, Protein (Urine) Urine Na azide (24 hr) As collected Clinical information must be provided.
Extractable Nuclear Antigen (ENA) Serum Plain Red 5 ml
Free Light Chain (kappa and lamda) Serum Plain Red 5 ml Clinical information must be provided.
Haptoglobulin Serum Plain Red 5 ml
Immunoglobulin A (IgA) CSF Plain (Sterile) 5 ml
Immunoglobulin A (IgA) Serum Plain Red 5 ml
Immunoglobulin E (IgE) Serum Plain Red 5 ml
Immunoglobulin G (IgG), CSF CSF Plain (Sterile) 5 ml
Immunoglobulin G (IgG), Serum Serum Plain Red 5 ml
Immunoglobulin M (IgM) CSF Plain (Sterile) 5 ml
Immunoglobulin M (IgM) Serum Plain Red 5 ml
Lymphocyte Subset quant – CD4/CD8 Whole blood EDTA Purple 3 ml
Lymphocyte subset quant – full (B-cell and T-cell Subset) Whole blood EDTA Purple 3 ml
Mitochondria Ab (AMA) Serum Plain Red 5 ml
Parietal Cell Ab Serum Plain Red 5 ml
Rheumatoid Factor Serum Plain Red 5 ml
Smooth Muscle Ab (SMA) Serum Plain Red 5 ml
Conventional Chromosome Analysis (karyotyping) Whole Blood Lithium Heparin Green Paeds 2 ml   Adult 3 ml
Conventional Chromosome Analysis (karyotyping), haematology cases Bone Marrow Lithium Heparin Green Paeds 2 ml   Adult 3 ml
Fluorescent In Situ Hybridization (FISH) Whole Blood Lithium Heparin Green Paeds 2 ml   Adult 3 ml Only one tube of sample is required to do conventional cytogenetics and FISH tests at the same time
Fluorescent In Situ Hybridization (FISH), haematology cases Bone Marrow Lithium Heparin Green Paeds 2 ml   Adult 3 ml Only one tube of sample is required to do conventional cytogenetics and FISH tests at the same time
ALL screen (E2A-PBX1, ETV6-RUNX1, MLL-AF4, BCR-ABL1 e1a2, SIL-TAL1) Whole blood/ Bone marrow EDTA Purple 2 x 3ml Send sample within 24hrs of collection
Alpha Thalassaemia Whole blood EDTA Purple 3ml Send sample within 24hrs of collection
AML screen (RUNX1-RUNX1T1, CBFB-MYH11) Whole blood/ Bone marrow EDTA Purple 2 x 3ml Send sample within 24hrs of collection
Angelman and Prader Willi (15q11-13) Whole blood EDTA Purple 3ml Send sample within 24hrs of collection
BCR-ABL1 detection (e1a2, e13a2, e14a2) Whole blood EDTA Purple 2 x 3ml Send sample within 24hrs of collection
BCR-ABL1 quantitation (e13a2, e14a2) Whole blood EDTA Purple 2 x 3ml Send sample within 24hrs of collection
BCR-ABL1 TKD Mutation Analysis Whole blood EDTA Purple 2 x 3ml Send sample within 24hrs of collection
Beta Thalassaemia, molecular Whole blood EDTA Purple 3ml Send sample within 24hrs of collection
Chimerism Analysis (STR) Whole blood EDTA Purple 3ml Send sample within 24hrs of collection
Duchenne/Becker Muscular dystrophy Whole blood EDTA Purple 3ml Send sample within 24hrs of collection
FLT3-ITD / D835 mutation Whole blood/ Bone marrow EDTA Purple 3ml Send sample within 24hrs of collection
Fragile X (FMR1, AFF2) Whole blood EDTA Purple 3ml Send sample within 24hrs of collection
HLA B*1502 Typing Whole blood EDTA Purple 3ml Send sample within 24hrs of collection
HLA B27 Typing Whole blood EDTA Purple 3ml Send sample within 24hrs of collection
HLA Typing Class I/II (Medium resolution) Whole blood EDTA Purple 3 x 3ml Send sample within 24hrs of collection
IgH Gene Rearrangements Whole blood/ Bone marrow EDTA Purple 3ml Send sample within 24hrs of collection
JAK2 V617F mutation Whole blood EDTA Purple 3ml Send sample within 24hrs of collection
MHC Block Matching Whole blood EDTA Purple 3 x 3ml Send sample within 24hrs of collection
NPM1 mutation Whole blood/ Bone marrow EDTA Purple 3ml Send sample within 24hrs of collection
PML-RARA detection (bcr1, bcr2, bcr3) Whole blood/ Bone marrow EDTA Purple 2 x 3ml Send sample within 24hrs of collection
Spinal Muscular Atrophy (SMN1, SMN2) Whole blood EDTA Purple 3ml Send sample within 24hrs of collection
TCRB Gene Rearrangements Whole blood/ Bone marrow EDTA Purple 3ml Send sample within 24hrs of collection
Ammonia Plasma Heparin Green 3.0 ml Send fresh sample immediately.
Alanine Aminotransferase (ALT) Serum Plain SST Yellow 3.5 ml
Albumin Serum Plain SST Yellow 3.5 ml
Alkaline Phosphatase Serum Plain SST Yellow 3.5 ml
Amylase, Serum Serum Plain SST Yellow 3.5 ml
Amylase, Urine Urine random Plain cup Yellow 5 ml
Aspartate Aminotransferase (AST) Serum Plain SST Yellow 3.5 ml
Bicarbonate Serum Plain SST Yellow 3.5 ml
Bilirubin, Conjugated Serum Plain SST Yellow 3.5 ml
Bilirubin, Total Serum Plain SST Yellow 3.5 ml
Calcium, Serum Serum Plain SST Yellow 3.5 ml Avoid prolonged venous stasis.
Calcium, Urine 24H Urine 24 hr 6N HCl (24 hr) As collected
Chloride Serum Plain SST Yellow 3.5 ml
Chloride , Urine 24H Urine 24 hr Plain (24 hr) As collected
Cholesterol, HDL Serum Plain SST Yellow 3.5 ml Fasting sample preferred.
Cholesterol, LDL Serum Plain SST Yellow 3.5 ml Fasting sample preferred.
Cholesterol, Total Serum Plain SST Yellow 3.5 ml Fasting sample preferred.
CKMB - mass Serum Plain SST Yellow 3.5 ml
Creatine Kinase Serum Plain SST Yellow 3.5 ml
Creatinine Serum Plain SST Yellow 3.5 ml
Creatinine , Urine 24H Urine 24 hr Plain (24 hr) As collected
Gamma Glutamyl Transferase (GGT) Serum Plain SST Yellow 3.5 ml
Glucose Plasma Fluoride-Oxalate Grey 3 ml
Glucose, CSF CSF Plain cup 3ml
Lactate Dehydrogenase (LDH) Serum Plain SST Yellow 3.5 ml Avoid prolonged venous stasis.
Lactate, CSF CSF Plain (Sterile) 3ml Send sample immediately.
Lactate, plasma plasma Fluoride-Oxalate Grey 3 ml
Magnesium Urine 24 hr 6N HCl (24 hr) As collected
Paracetamol Serum Plain SST Yellow 3.5 ml
Phosphate Serum Plain SST Yellow 3.5 ml
Phosphate , Urine 24H Urine 24 hr 6N HCl (24 hr) As collected
Potassium Serum Plain SST Yellow 3.5 ml
Potassium, Urine 24H Urine 24 hr Plain (24 hr) As collected
Protein Total Serum Plain SST Yellow 3.5 ml
Protein Total, CSF CSF Plain cup 3ml
Protein Total, Urine Urine 24 hr Na azide (24 hr) As collected
Salicylate Serum Plain SST Yellow 3.5 ml
Sodium Serum Plain SST Yellow 3.5 ml
Sodium, Urine 24H Urine 24 hr Plain (24 hr) As collected
Triglyceride Serum Plain SST Yellow 3.5 ml 12 hr fasting sample required
Urea Serum Plain SST Yellow 3.5 ml
Urea, Urine 24H Urine 24 hr Plain (24 hr) As collected
Uric Acid Serum Plain SST Yellow 3.5 ml
Uric Acid, Urine 24H Urine 24 hr Plain (24 hr) As collected
5- Hydroxyl Indole Acetic Acid (5HIAA) Urine Glacial acetic acid (24 hr) As collected
Amikacin Serum Plain Red 5 ml
Bile Acids, Total Serum Plain Red 5 ml Main indication is suspected obstetric cholestasis in pregnant women. Fasting sample is preferred though not essential.
Caeruloplasmin Serum Plain Red 5 ml
Cannabinoids Screen Urine Plain cup 10 ml
Carbamazepine Serum Plain Red 5 ml
Catecholamines Urine 24 hr 6N HCl (24 hr) As collected
Cholinesterase Serum Plain Red 5 ml
Cyclosporin A Whole Blood EDTA Purple 3 ml Clotted sample will be rejected
Digoxin Serum Plain Red 5 ml
Fructosamine Serum Plain Red 5 ml
Gentamicin Serum Plain Red 5 ml
HbA1C Whole Blood EDTA Purple 3 ml
Homocysteine, Total Plasma EDTA Purple 3 ml Fasting specimen is preferred. Collect blood in pre-chilled EDTA tube. Send immediately to laboratory on wet ice within 30 minutes.
Lithium Serum Plain Red 5 ml
Metanephrines Urine 6N HCl (24 hr) As collected
Methotrexate Serum Plain Red 5 ml
Microalbumin Urine, random or 24 hr Plain As collected
Opiates Screen Urine Plain cup 10 ml
Paraquat Urine Plain cup 10 ml
Phenobarbitone Serum Plain Red 5 ml
Phenytoin (Dilantin) Serum Plain Red 5 ml
Sirolimus Whole Blood EDTA Purple 3 ml Clotted sample will be rejected
Tacrolimus (FK 506) Whole Blood EDTA Purple 3 ml Clotted sample will be rejected
Theophylline (Aminophylline) Serum Plain Red 5 ml
Valproic acid (Epilim) Serum Plain Red 5 ml
Vancomycin Serum Plain Red 5 ml
Vanillylmandelic Acid (VMA) Screen Urine 6N HCL random or 24 hr As collected
Activated Protein C Resistance (APCR) Plasma Na citrate Blue 2 x 2.7 ml Blood volume to be followed strictly. Patient’s anticoagulant therapy must be indicated in the request form.
Anti-thrombin III Plasma Na Citrate Blue 2 x 2.7 ml Blood volume to be followed strictly. Clinical information must be provided.
APTT (activated partial thromboplastin time) Plasma Na Citrate Blue 1.8 / 2.7 ml Blood volume to be followed strictly. Sample should be sent to the laboratory within 2 hours of collection.
Bleeding Time Whole Blood Ear prick Please call to make an appointment.
Coagulation Factor Assay   (FII, FV, FVII, FVIII, FIX, FX, FXI or FXII) Plasma Na Citrate Blue 2 x 2.7 ml Blood volume to be followed strictly.
D-Dimer Plasma Na Citrate Blue 1 x 2.7 ml Blood volume to be followed strictly.
Fibrinogen Plasma Na Citrate Blue 2.7ml Blood volume to be followed strictly.
G6PD Screening Blood EDTA/Filter paper Purple 1 ml State “cord blood” or “venous blood” and sex of patient.
Iron serum plain red 3ml Clinical information must be provided.
Kleihauer Test Whole blood EDTA Purple 3ml
Protein C & Protein S activity Plasma Na Citrate Blue 2 x 2.7 ml Blood volume to be followed strictly. Patient’s anticoagulant therapy must be indicated in the request form.
PT/INR Plasma Na Citrate Blue 1.8 or 2.7 ml Blood volume to be followed strictly.
Copper, Serum Serum Plain (trace element free) Dark Blue 5 ml Collect special tube from laboratory
Copper, Urine 24H Urine 24 hr Acid washed As collected
Lead Whole Blood EDTA Purple 5 ml
Toxicology Screen, Urine Urine Plain cup 20 ml

 

REFERENCE RANGES

The reference ranges given here are for adults unless otherwise indicated. These ranges given are only to be used as a guide and may change from time to time. Please refer to the result report for the current reference range or if a range is not given.

TEST NAME SAMPLE REFERENCE RANGE
17-OH Progesterone Serum Males (20-59 years) :               1.8 – 10.3 nmol/L
Females:
Follicular phase (22-45 years)   0.6 – 5.5 nmol/L
Luteal phase (22-45 years)       0.7 – 14.2 nmol/L
Oral Contraceptives                 0.5 – 7.6 nmol/L
Post Menopausal :                  0.6 – 5.2 nmol/L
5- Hydroxyl Indole Acetic Acid (5HIAA) Urine < 6.0 mmol/mol creat
Activated Protein C Resistance (APCR) Plasma < 2.22
Adrenocorticotropic Hormone (ACTH) Plasma 0 – 46 pg/mL
Alanine Aminotransferase (ALT) Serum 10-49 U/L
Albumin Serum 32-48 g/L
Aldosterone Serum Supine   28 – 444 pmol/L
Upright   111 – 860 pmol/L
Alkaline Phosphatase Serum 45 – 129 U/L
Alpha-1 Antitrypsin (AAT) Serum 81 – 171 mg/dL
Alpha-Fetoprotein (AFP) Serum 0 – 6.7 IU/mL
Amino Acids Blood, CSF, urine Refer to report
Ammonia Plasma 11.2-35.4 umol/L
Amylase (Serum) Serum 30 – 118 U/L
Amylase (Urine random) Urine random 0 - 650 U/L
Anticardiolipin Ab Serum < 20 units
Anti-CCP Serum < 7.4 U/mL
Anti-Neutrophilic Cytoplasmic Antibodies (ANCA) Serum Neg
Antinuclear Ab (ANF) Serum Neg
Antistreptolysin-O (ASO) Serum Adults   < 200 IU/mL
<7yr     < 100 IU/mL
Anti-thrombin III Plasma 80-140 %
APTT (activated partial thromboplastin time) Plasma 25.0 - 36.8 sec (changes with reagent lot. Refer to range given with result)
Aspartate Aminotransferase (AST) Serum < 34 U/L
Bence Jones Protein Urine Neg
Bile Acids, Total Serum A well-defined local reference range for serum bile acids is not available. Please refer to the literature and current guidelines for the interpretation of bile acids results. There is some evidence that serum bile acids levels >10 µmol/L may be associated with increased maternal and/or fetal risks. Serum bile acids levels >40 µmol/L can be considered markedly high.
Bicarbonate Serum 21 – 32 mmol/L
Bilirubin, Conjugated Serum 0 – 3 umol/L
Bilirubin, Total Serum < 17 umol/L
Bleeding Time Whole Blood 1 – 5 minutes
Blood Gases Whole Blood, arterial pH 7.36 – 7.44
pCO2 4.5 – 6.1 kPa
pO2 11 – 15 kPa
BE (-2) – 3
Bicarb 21 – 28 mmol/l
Bone Marrow Examination Bone Marrow Aspirate / Trephine Biopsy Refer to report
CA 125 Serum 0 – 30 U/ml
CA 15-3 Serum 6.4 - 58 U/ml
CA 19-9 Serum 0 – 33 U/ml
Caeruloplasmin Serum 0.20– 0.60 g/L
Calcium Serum 2.2 – 2.6 mmol/L
Calcium (Urine 24 H) Urine 24 hr 1.0– 8.8 mmol/24H
Cannabinoids Screen Urine Neg
Carcinoembryonic Antigen (CEA) Serum 0 – 2.5 ng/mL
Catecholamines Urine 24 hr Adrenaline   9.2 – 122.3 nmol/24H
Noradrenaline   71.5 – 505.3 nmol/24H
Dopamine   0 – 3237 nmol/24H
Chloride Serum 99 – 109 mmol/L
Cholesterol, HDL Serum > 1.1   mmol/L
Cholesterol, LDL Serum < 2.59 mmol/L (NCEP)*
Cholesterol, Total Serum < 5.2   mmol/L (desirable)
Cholinesterase Serum Male     4389 – 10928 U/L
Female 2879 – 12669 U/L
Chromosome Analysis (karyotyping) Whole Blood Refer to report
CKMB Mass Serum < 5.0 ug/L
Coagulation Factors Assay Plasma FII   :   70 - 146%
(FII, FV, FVII, FVIII, FIX, FX, FXI or FXII) FV : 62 - 150%
FVII : 67 - 150%
FVIII : 50 - 150%
FIX :     50 - 163%
FX :     60 - 150%
FXI :     50 - 163%
FXII :     52 - 164%
Complement 3 (C3) Serum 86 – 184 mg/dL
Complement 4 (C4) Serum 20 – 59 mg/dL
Complete Blood Count (CBC) Whole Blood Hb (Male) 130 – 170 g/L, (Female) 120 – 150 g/L
Hct (Male) 0.4 0 – 0.50 l/l, (Female) 0.36 – 0.46 l/l
RBC (Male) 4.5 – 5.5, (Female) 3.8 – 4.8 x1012 /L
MCV 77 – 97 fl
MCH 27 – 32 pg
MCHC 315– 345 g/L
WBC 4 – 10 x109 /L
Plt 150 – 400 x109 /L
Reticulocyte   0.5-2.5 %
Neutrophils 2.0 - 7.0 x 109/L
Lymphocytes   1.0 - 3.0 x 109/L
Eosinophil 0.02- 0.5 x109/L
Monocytes   0.2 - 1.0 x 109/L
Basophil   0.02 - 0.1 x 109/L
Copper Serum 11 – 22 umol/L
Copper Urine 24 hr 0.2 – 0.5 umol/24H
Cortisol Serum 7-9am: 119 – 618 nmol /L
3-5pm:   85 – 460 nmol /L
Cortisol Urine 57.7 – 806.8 nmol /24H
C-Peptide Serum 0.9 – 7.1 ng/mL (Fasting)
C-Reactive Protein (CRP) Serum < 0.8 mg/dL
C-Reactive Protein, Hypersensitive (hsCRP) Serum < 1.0 mg/L (Low Risk)
10 - 3.0 mg/L (Average Risk)
>3.0 mg/L (High Risk)
>10.0 mg/L ( Acute Inflammation)
Creatine Kinase Serum Males 32-294 U/L
Females 33-211 U/L
Creatinine (Serum) Serum Males     54 – 97 umol/L
Females 44 – 71 umol/L
Creatinine (Urine) Urine 24 hr 7 – 18 mmol/24H
Cryoglobulin Serum Refer to report
CSF FEME CSF Refer to report
Cytospin CSF Refer to report
D-Dimer Plasma < 250 ng/mL
Dehydroepiandrosterone Sulfate (DHEA-S) Serum Males     2.2 – 15.2 umol/L
Females 0.9 – 11.7 umol/L
ds-DNA Ab Quantitation Serum < 200 IU/mL
ds-DNA Ab Screen Serum Neg
Erythropoeitin(EPO) Serum 4.3 - 29 IU/L
ESR Whole Blood 2 – 10 mm/Hr
Estradiol Serum Males                             ND - 146 pmol/L
Menstruating Female :
Follicular Phase     72 - 529 pmol/L
Midcycle               235 - 1309 pmol/L
Luteal Phase       205   – 786 pmol/L
Post Menopausal Female (untreated)ND - 118 pmol/L
Extractable Nuclear Antigen (ENA) Serum Negative
Fat Globules Faeces Negative
Ferritin Serum Males     22.0 – 322.0 ug/L
Females 10.0 – 291.0 ug/L
Fibrinogen Plasma 2.0 – 4.0 g/L
Fluid FEME Fluid Refer to report
Folate Serum >12.19 nmol/L
Follicular Stimulating Hormone (FSH) Serum Males (13 – 70yr):       1.4 – 18.1 IU/L
Menstruating Females :
 Follicular Phase         2.5 – 10.2 IU/L
Midcycle   Peak           3.4 – 33.4 IU/L
Luteal Phase             1.5 – 9.1 IU/L
Pregnant                   < 0.3 IU/L
Post Menopausal Female
                                 23.0 – 116 IU/L
Free Light Chain Kappa& Lambda Serum Kappa   3.3-19.4 mg/L; Lambda     5.7-26.3 mg/L; Kappa/Lambda Ratio   0.26-1.65
Fructosamine Serum Male: 118 - 282 umol/L
Female: 161 - 351 umol/L
Gamma Glutamyl Transferase (GGT) Serum Males     < 73 IU/L
Females   <38   IU/L
Glucose Plasma < 5.6 mmol/L (Fasting)
< 7.8 mmol/L (Random)
<11.1 mmol/L (Post Prandial)
Growth Hormone Serum Males: Up to 3 ng/mL
Females: Up to 8 ng/mL
Haptoglobulin Serum 33 – 171 mg/dL
HbA1C Whole Blood < 6.5% (NGSP)
< 48 mmol/mol (IFCC)
Human Chorionic Gonadotropin (HCG) Serum Premenopausal Females   <6 IU/L
Postmenopausal Females   <10 IU/L
Males   <2 IU/L
Immunoglobulin A (IgA) Serum 70 – 473 mg/dL
Immunoglobulin E (IgE) Serum ≤ 165 IU/mL
Immunoglobulin G (IgG) Serum 931 – 1916 mg/dL
CSF 0.48 - 5.86 mg/dL
Immunoglobulin M (IgM) Serum 34 – 265 mg/dL
Insulin Serum 3.0    - 25.0 mU/L(Fasting)
Insulin-like Growth Factor - 1 (IGF-1) Serum Age(Y): Reference ranges
1: 55 - 327 ng/mL
2: 51-303 ng/mL
3: 49-289 ng/mL
4: 49 -283 ng/mL
5: 50- 286 ng/mL
6: 52 - 297 ng/mL
7: 57 - 316 ng/mL
8: 64 -345 ng/mL
9: 74 -388 ng/mL
10: 88 - 452 ng/mL
11: 111-551 ng/mL
12: 143 -693 ng/mL
13: 183 -850 ng/mL
14: 220 -972 ng/mL
15: 237-996 ng/mL
16: 226-903 ng/mL
17: 193-731 ng/mL
18: 163 -584 ng/mL
19: 141-483 ng/mL
20: 127-424 ng/mL
21-25: 116-358 ng/mL
26-30: 117-329 ng/mL
31-35: 115-307 ng/mL
36-40: 109-284 ng/mL
41-45: 101-267 ng/mL
46-50: 94-252 ng/mL
51-55: 87-238 ng/mL
56-60: 81-225 ng/mL
61-65: 75-212 ng/mL
66-70: 69-200 ng/mL
71-75: 64-188 ng/mL
76-80: 59-177 ng/mL
81-85: 55-166 ng/mL
Iron Serum Males     11.6 – 31.3 umol/L
Females 9.0 – 30.4 umol/L
Lactate Plasma < 2.2 mmol/L
CSF Neonate 1.1 – 6.7 mmol/LAdult         1.1 – 2.4 mmol/L
Lactate Dehydrogenase Serum 120 - 246 U/L
Lead Whole Blood Reference Range
0-16 years : 0-0.09 umol/L
>=17 years : 0 - 0.22 umol/L
Alert Value
0-16 years : > 0.12 umol/L
Actioin Value
0-16 years : > 0.48 umol/L
>=17 years : > 1.00 umol/L
Lithium Serum 0.3 – 1.3 mmol/L
Luteinising Hormone (LH) Serum Females:
 Normal Menstruating:
 Follicular               1.9 - 12.5 IU/L
Midcycle Peak       8.7 - 76.3 IU/L
Luteal Phase         0.5 - 16.9 IU/L
Pregnant             < 0.1 - 1.5 IU/L
Postmenopausal   15.9 - 54.0 IU/L
On contraceptives   0.7 - 5.6 IU/L
Males:
  20-70yr               1.5 - 9.3 IU/L
> 70yr                   3.1 - 34.6 IU/L
Children           <0.1 - 6.0 IU/L
Lymphocyte Subset quant – CD4/CD8 Whole Blood Pan T cells : 51 - 80% (928 - 2379 cells/uL)
CD4 : 28 - 48% (497 - 1465 cells/uL)
CD8 : 16 -36 % (307 - 925 cells/uL)
Lymphocyte subset quant – full (B-cell and T-cell Subset) Whole Blood Pan T cells : 51 - 80% (928 - 2379 cells/uL)
CD4 : 28 - 48% (497 - 1465 cells/uL)
CD8 : 16 -36 % (307 - 925 cells/uL)
Pan B cells : 7-23% (140 - 633 cells/uL)
NK Cells :   1-8% ( 17-183 cells/uL)
Magnesium Serum 0.53 – 1.11 mmol/L
Metanephrines Urine 24 Hr Normetanephrines: 0.88 - 2.88 umol/24H
Metanephrines: 0.33 - 1.53 umol/24H
Methaemoglobin Red Cells 0 – 2.0 %
Microalbumin (Random) Urine, random Males < 2.5 mg/mmol creat
Females < 3.5 mg/mmol creat
Microalbumin (24H) Urine 24 Hr < 30 mg/24H
Mitochondria Ab (AMA) Serum Neg
Mucopolysaccharides Urine Refer to report
Occult Blood Faeces Neg
Opiates Screen Urine Neg
Paracetamol Serum Therapeutic 0.07 – 0.13 mmol/L
Toxic   >2.0 mmol/L at 4h
Toxic   >0.3 mmol/L at 12h
Paraquat Urine Neg
Parathyroid Hormone (PTH) intact Serum 1.3 - 6.8 pmol/L
Phosphate Serum 0.78 – 1.65 mmol/L
Phosphate Urine 24 hr 15 - 50 mmol/24H
Porphobilinogen urine Negative
Potassium Serum 3.6 – 5.2 mmol/L
Progesterone Serum Females:
 Follicular Phase       < 4.5 nmol/L
Luteal Phase           10.6 - 81.3 nmol/L
Mid Luteal Phase     14.1 - 89.1 nmol/L
Postmenopausal     < 2.3 nmol/L
Prolactin Serum Males:                   45 - 375 mIU/L
Females:
 Nonpregnant         59 - 619 mIU/L
Pregnant             206 - 4420 mIU/L
Postmenopausal   38 - 430 mIU/L
Prostate Specific Antigen (PSA), Total Serum 0 – 4 ng/mL
Protein C Activity Plasma Protein C 70 – 140 %
Protein S activity Plasma Protein S 70 – 140 %
Protein Total (Serum) Serum 64 - 82 g/L
Protein Total, Urine Urine 24 hr 0.05 – 0.15 g/24H
Protein Total, CSF CSF 0.08 – 0.32 g/L
PT/INR Plasma PT ratio 1 – 1.2
Pyruvate Whole blood, CSF 30 – 80 umol/L
Renin Plasma Upright 1.5 - 5.7 ng/ml/hr
Supine 0.2 - 2.8 ng/ml/hr
Rheumatoid Factor Serum < 20 IU/mL
Salicylate Serum Therapeutic 0.2 – 1.45 mmol/L
Toxic   >2.17 mmol/L
Lethal   >4.25 mmol/L
Seminal Assay Semen Refer to report
Sex Hormone Binding Globulin(SHBG) Serum Males: 10 - 57 nmol/L
Females: 18 -144 nmol/L
Smooth Muscle Ab Serum Negative
Parietal Cell Ab Serum Negative
Sodium Serum 136 - 145 mmol/L
Sweat test for NaCl Sweat < 60 mmol/L
Testosterone Serum Males       8.4 - 28.7 nmol /L
Females   0.5 - 2.6     nmol /L
Thrombin time Plasma 13.0 17.0 secs
Thyroglobulin (HTG) Serum 0 – 55 ng/mL
Thyroglobulin Ab (TgAb) Serum 0 – 40 IU/mL
Thyroid Peroxidase Ab (TPO) Serum 0 – 35 IU/mL
Thyroid-stimulating hormone (TSH) Serum Adults >18 Y:   0.55 - 4.78 mIU/L
Thyroxine (T4), Free Serum Adults >18Y:     11.5 - 22.7 pmol/L
Transferrin Serum 2.0 – 3.3 g/L
Triglyceride Serum < 1.7 mmol/L (NCEP)*
Triiodothyronine (T3), Free Serum 3.5 - 6.5 pmol/L
Troponin I Plasma < 0.06 ng/mL
Urea Serum 3.2 – 8.2 mmol/L
Urea Urine 24 hr 430 - 710 mmol/24H
Uric Acid Serum Males     :   220 – 547 umol/L
Females : 184 – 464 umol/L
Uric Acid Urine 24 hr 1.5 – 4.5 mmol/24H
Urinalysis (Urine FEME) Urine SG                             1.005 – 1.030
pH                             5.0 – 7.0
Protein                   Neg
Glucose                 Neg
Ketones                 Neg
Urobilinogen       Neg
Bilirubin               Neg
Nitrite                  Neg
Hb                           Neg
Leucocyte Esterase   Neg
Urine Pregnancy Test Urine Neg
Vanillylmandelic Acid (VMA) Screen Urine Neg
Vit B12 Serum 157 – 672 pmol/L

* NCEP ATP III Guidelines At-A-Glance Quick Desk Reference.

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