Pathology Services Handbook 2021 - hsgbuloh.moh.gov.my

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Pathology Services Handbook 2021

Hospital Sungai Buloh

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Foreword

Pathology services play an important role in diagnostic

services and acts as part of crucial steps in the diagnosis,

prognosis and management of a disease. It is in line with our

hospital vision in which to provide world class patient care

including research and educational programs. I would like to

thank all the working committee of Pathology Department for

their commitment in preparing this 6th Edition of the HSgB

Pathology Services Handbook 2021. We hope that this will be

a great help and useful reference for clinicians and laboratory

staff requiring this service.

Kind Regards,

Dr Kuldip Kaur A/P Prem Singh

Hospital Director


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Preface

Pathology take pride in providing superior quality pathology

service to the medical profession. In the light of this, we

always strive to ensure our service users were well informed

of the preanalytical requirements for the tests offered. This

new edition of Pathology Handbook has added new tests,

specimen handling requirement for infectious diseases,

reviewed test schedule and turnaround time, and easy format

to ease user navigation. Though this handbook is mainly for

clinicians, it is also relevant for lab members and trainees

who needs to know the preanalytical requirements as well

as quick reference for tests. We welcome your feedback

regarding this publication and please feel free to contact the

laboratory with comments or criticism. We hope that you will

find this user–friendly reference guide very useful.

Kind Regards,

Dr Afifah Hj Hassan

Senior Consultant Pathologist &

Head of Pathology Department


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Contents General Information

Our Location 7

Scope of Service 8

List of Referral Labs 8

Operating Hours 9

Complaints & Concerns 9

Type of Request 10

Specimen Registration 12

Specimen Collection 13

Unmanaged Specimen 14

Specimen Transportation 16

Specimen Rejection Criteria 17

Result Reporting & Tracing 23

Tracing Outsource Results 24

Critical Result Notification 27

Lab Directory 29

Requesting Test During LIS Downtime 30

Sending for Covid-19 Specimen 32

Test offered during Covid-19 Outbreak 33

Requesting for Covid-19 RTK (Rapid Test Kit) Antigen 35

Chemical Pathology

Introduction 36

List of factors affecting tests results 37

Uncertainty of Measurements 38

Specimen Collection Chart 39

List of Tests (in–house) and Reference Interval 42

Therapeutic Drug Monitoring (TDM) Range 54

List of Tests (outsourced) 55

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List of Request Forms 63

Patient Information Sheet for Glucose Tolerance Test (GTT) 64

Patient Instructions for the Collection of Mid–Stream Urine 65

Patient Instructions for the Collection of 24–Hour Urine 66

Medical Microbiology

Introduction 67


Specific Collection Guideline 71

List of Test (in-house) 83

List of Test (outsourced) 92


Haematology

Introduction 102

Pre- Analytical Variables in Haematology Testing 103

Measurement of Uncertainty 104


List of Tests (in–house) and Reference Interval 108

List of Tests (Outsourced) 111


Full Blood Count Reference Interval 124

Transfusion Medicine

Introduction 125

List of Test & Turn Around Time (TAT) 125

Blood Transfusion Procedures 126



Histopathology & Cytology

Histopathology Procedures 143

Cytology Procedures 146

Tracing Histopathology & Cytology Results 150

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List of Tests (outsourced) 153


PLEASE NOTE: Information is subject to change without notice. For latest and most up-

to-date information, always refer online at https://hsgbuloh.moh.gov.my

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Our Location Department of Pathology, Hospital Sungai Buloh provides medical laboratory

diagnostic and consultation services to the entire clinical services in the hospital

and external health facilities. The Department is located at Level 1, Block B of the

hospital, next to the Radiology Department.

All specimens in our lab were received at the Central Receiving Area (CRA) which

serves as the common centralized counter for the department, except for Blood

Transfusion services, where they have a separate reception counter adjacent to

the CRA. In CRA we checks, barcodes, sorts and process all specimens before

they are sent to specific laboratories for analysis. Here, we also supply special

containers or preservatives for certain tests.

Central Reception Area

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Scope of Service

The scope of services offered including those that were outsourced are listed as follows:

Unit Scope of Services

Medical Microbiology Serology, Virology, Immunology, Bacteriology, Parasitology and Mycology

Chemical Pathology Routine Chemistry, Endocrine & Metabolic, Cardiac Markers, Tumour Markers, TDM, Toxicology, Dynamic Function Test, Special Proteins and Proteomics

Haematology Haemostasis, General and Specialised Haematology

Transfusion Medicine Supply of blood products and components.

Immunohematology tests will be outsourced to PDN


Outsourced to Hospital Selayang, Hospital Kuala Lumpur, IMR and UiTM Sungai Buloh

List of Referral Labs Where tests cannot be performed in–house, we outsource the tests to various

referral labs. Please refer to respective unit section for the list of tests

outsourced. The labs were selected based on certain criteria to ensure quality is

maintained. The list of our referral labs include:

i. Institute of Medical Research (IMR)

ii. Hospital Kuala Lumpur (HKL)

iii. Pusat Darah Negara (PDN)

iv. Hospital Putrajaya

v. Hospital Selayang

vi. Hospital Ampang

vii. Chemistry Department of Malaysia

viii. UiTM Sg Buloh

ix. Makmal Kesihatan Awam Kebangsaan (MKAK) Sungai Buloh

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Operating Hours

Internal specimens

Monday to Friday 8:00 am – 4:30 pm (for all tests offered)

Saturday After office hours tests only – Refer to Section Type

of Request Sunday & Public Holidays

External specimens

Monday to Friday 8:00 am – 4:30 pm (for all tests offered)

Saturday Urgent tests only – Refer to Section Type of Request

Sunday & Public Holidays

Complaints & Concerns Users wishing to raise a concern, make a complaint or compliment the

department may do so by scanning the QR code below and fill up the details:

If users need to discuss further, please contact the Quality Manager or Head of

Unit. Please refer to the Lab Directory section for contact details.

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Type of Request

The scope of tests were grouped into 4 categories as follows:

Tests offered as urgent

Tests offered after office hour

Tests by batches / schedule

Tests by appointment

MICROBIOLOGY

• AFB stain

• BFMP

• Cryptococcal antigen

• CSF Bacterial antigen

• Microfilaria (Blood film)

• Stool for ova & cyst

• Stool for microscopy examination

• Infective screening (Needle Stick Injury case)

• Merscov–PCR

• AFB stain

• BFMP

• Cryptococcal antigen

• CSF Bacterial antigen

• Microfilaria (Blood film)

• Stool for ova & cyst

• Stool for microscopy examination

• All culture & sensitivity

• Molecular

• Serology

Refer to Section Microbiology

CHEMICAL PATHOLOGY

• BUSE

• Creatinine

• Bilirubin

• ALT

• ALP

• AST

• LDH

• Amylase

• Calcium

• Ammonia

• Lactate

• CSF Biochemistry

• hs–Troponin I

• Urine Paraquat

• Acetaminophen

• Salicylate

• BUSE

• Creatinine

• Serum Bilirubin

• ALT

• ALP

• AST

• LDH

• Amylase

• Calcium

• Ammonia

• Lactate

• CSF Biochemistry

• hs–Troponin I

• Urine Paraquat

• Acetaminophen

• Salicylate

• FSH, LH, Progesterone, Oestradiol, Testosterone (Tuesday)

• Tumour markers (Thursday)

• Iron, Transferrin, Folate, B12 (Wednesday & Friday)

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Tests offered as urgent

Tests offered after office hour

Tests by batches / schedule

Tests by appointment

HEMATOLOGY

• FBC

• FBP

• PT

• APTT

• Fibrinogen

• D–Dimer

• FBC

• FBP

• PT

• APTT

• Fibrinogen

• ESR

• G6PD Screening

• D–Dimer

• Hb Analysis

• Bone Marrow Aspiration

• Bone Marrow Trephine Biopsy

• Kleihauer test

• Mixing Test

TRANSFUSION SERVICES

• First stage Crossmatch

• Antibody Identification (send to PDN)

• GSH

• GXM

• Antibody Identification (send to PDN)

• Phenotype Blood for Thalassemia Patient

• Rhesus Negative for Elective OT Cases

• Rare phenotype blood (Anti–JK3, etc.)

HISTOPATHOLOGY AND CYTOLOGY (OUTSOURCED)

• Unstained slides (for special staining, etc.)

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Specimen Registration All tests can be requested through CA (Clinical Access) in Hospital Information

System (HIS). Clinical summary and diagnosis in the clinical comment must be

clearly entered and abbreviations are discouraged.

For specimens which need to accompany by request form, all the necessary

information listed below MUST be filled in completely:

a. Patient’s identification data (Name, I/C or passport number, hospital number,

age and gender)

b. Relevant clinical summary and diagnosis

c. History of administration of drug, where relevant

d. Ward or clinic and hospital’s official rubber stamp

e. Name of test requested

f. Type of specimen and anatomic site of origin, where appropriate

g. Special timing of specimen collected, where indicated

h. Doctor’s name and signature

Incomplete form filling may delay the specimen processing which subsequently

delay the final report

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Specimen Collection Correct containers for each specimen or test requested must be ensured at all time.

Correct labelling of all specimens is essential as per MS ISO 15189 requirements.

Patient name, hospital number and test name are the minimal requirements on the

specimen. This must be clearly written or available on the printed barcode.

All specimen containers for each patient should be put in one biohazard plastic bag.

For test that were outsourced, the biohazard bag should be stapled together with

the accompanied request form.

Barcoding of samples

The Chemical Pathology lab has started implementing full automation starting

April 2021. Hence, with the sample track system, all tubes were changed to 5 ml

to allow the system to read the barcode on the sample. See details below on how

to stick the barcode on the sample. Failure to adhere to this will result in delayed

anlysis

3 cm dari atas tiub

2.5 cm dari bawah tiub

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Unmanaged Specimen For all tests ordered in the CA, it must be managed (specimen collection and

despatch) prior sending to the lab as unmanaged specimen could not be

recognized in the lab and therefore impossible to register in our Laboratory

Information System (LIS).

LIS system prompt on Unmanaged Samples

All these unmanaged specimens will be

retained for a certain period to allow for the

wards to manage it. After a certain period, if

the samples were still not managed, it will be

discarded as the specimens are no longer

suitable for analysis. It is very important that

the requester in the wards and clinics to

ensure that all samples are managed

before sending to the lab.

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How to Manage Samples

1. Click Place Order

2. Select Record Collection

3. Select Record Dispatch

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Specimen Transportation All specimens must be packed appropriately before sending to the laboratory.

Where indicated, use dry ice instead of wet ice. All specimens must be sent to

laboratory immediately via porter or pneumatic tube with exception for some tests.

Tests or specimen that need to be sent manually includes:

i. Histopathology & Cytology

ii. Blood C&S

iii. Blood Gases

iv. 24–hour urine

v. Ammonia & Lactate

vi. Transfusion Reactions Workout

vii. Blood & Blood product

viii. ESR tube

ix. Specimen in Sterile Urine Container

x. CSF Bijou Bottle

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Specimen Rejection Criteria Samples that do not meet criteria will be rejected. All rejection shall be informed by phone or via rejection slip to notify.

1. Counter

All specimen will be screened at the counter upon receipt, before sent to each respective Unit to be processed or analysed. Below is the list of rejection criteria at the counter:

1. Order cancelled by doctor

2. Unreadable barcode (please refer to table below for examples)

3. Tests which cannot be shared in one container received in one container

4. Test not offered

5. Temporarily no reagent

6. Tube cracked/broken while spinning

7. Empty container received

8. Specimen leakage

9. Specimen not in ice (ammonia & lactate)

10. Delayed in sending blood more than 2 hours

11. Unmanaged specimen more than 1 hour

12. Need separated barcode

13. Improper barcode labelling

14. Mislabelling of specimen

15. Double sticker of different ID

16. Wrong container / tube

17. Tube/container not labelled

18. No request form attached

19. Wrong request form

20. Wrong test request

21. Test requested not stated in the form

22. No requesting Dr's name/not clear

23. Incomplete request form

24. SYSTEM House Cleaning

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Causes of unreadable barcode

Barcode issues

Poor distribution of ink on this

test tube barcode label has

resulted in some white spots

within the bar elements, which

may lead to readability issues.

Please contact Unit IT if this

happens.

Barcode were paste

horizontally or slanted which

cannot be read by the

instrument.

Barcode were pasted on the

cap and impossible to read

Barcode were pasted

overlapped and impossible to

read

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In the respective unit, the specimen and test will be screened again. Rejection can be done before the specimen are processed, while its being processed and after it has been processed. The rejection criteria differs according to test in the Unit:

2. Chemical Pathology

1. Duplicate order

2. Blood clotted

3. Insufficient sample

4. Contaminated specimen

5. Specimen leakage

6. Blood haemolysed


8. No sample received

9. Mucoid specimen

10. Lipemic sample received

11. Icteric sample received

12. Unsuitable sample for analysis

13. CSF heavy blood stained

14. Urine pH >4 for 24 hrs urine metanephrine

15. Total urine volume for 24 hrs urine metanephrine < 750ml

16. HbA1C requested less than 3 months from previous request

17. Urine pH >4 for 24h urine catecholamine

18. No clinical indication

19. No clinical history/patient diagnosis

20. Delayed in sending ABG more than 30 mins

21. Specimen not in ice (ammonia & lactate)

22. Delayed in sending blood more than 2 hours


24. Test not offered



27. Interface down


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3. Hematology

1. Duplicate order

2. Blood clotted

3. Delayed in sending FBC more than 2 hrs

4. Delayed in sending FBP more than 4 hrs

5. Delayed in sending PT/APTT more than 2 hrs

6. CD4/CD8 – less than 4 months


8. Icteric serum received


10. Blood haemolysed


12. Wrong tube/container




16. No MO code




20. Interface down


3. Transfusion Medicine

1. Duplicate order

2. Blood clotted

3. No MO code



6. Insufficient sample (less than 3mls)

7. Blood haemolysed


9. Wrong tube/container


11. Post transfusion sample


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14. Test not done (empty blood bag received)

15. Incorrect information





4. Microbiology

1. Duplicate order


3. Blood clotted

4. Delayed in sending blood more than 2 hrs

5. Delayed in sending urine C&S more than 2 hrs


7. Lipemic blood received

8. Blood haemolysed

9. CSF heavy blood stained

10. Salivary specimen

11. Contaminated specimen


13. Test not offered


15. No thin film received

16. No thick film received

17. Need separate barcode

18. Earlier BFMP positive

19. Earlier AFB positive







26. Wrong container/transport medium

27. No sample received



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30. Wrong order at receiving counter



4. Outsource

1. Duplicate order

2. Insufficient formalin











13. No specialist signature on request form




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Result Reporting & Tracing

Result Reporting

All results requested via the CA can be viewed in the HIS. For outsourced tests,

results can be viewed in specific outsourced folder. For external results, results will

be printed out and send to the respective institution by post or dispatch via porter.

Result Tracing

Any inquiry regarding result, kindly call the RESPECTIVE unit i.e. Chemical

Pathology, Microbiology, Haematology, Transfusion Medicine and Histopathology

/ Cytology. Refer to the Lab Directory

Result tracing will only be entertained if the result has exceeded its turnaround time

(TAT). Please refer to each tests’ TAT in respective unit section

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Tracing Outsource Results

1. Copy the unique number as stated in the eHIS system (refer picture below)

2. Go to MY COMPUTER PUBLIC FOLDER ‘OUTSOURCE PATHOLOGY RESULTS’ folder

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3. Click ‘Search’ ‘All Files and Folder’

4. Paste the copied number in the column as shown below.

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5. List of result/s (PDF form) will be shown

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Critical Result Notification All critical limit results shall be informed to respective ward or clinic once the result is ready. Refer to list below for the critical limits that shall be informed.

Test Critical Limit

Lower Limit Upper Limit

ADULT

Potassium < 2.8 mmol/L > 6.0 mmol/L

Sodium < 125 mmol/L > 155 mmol/L

Calcium < 1.5 mmol/L > 3.0 mmol/L

Hemoglobin < 6.0 g/dL > 19.0 g/dL

Hematocrit < 0.2 > 0.6

Platelet < 20 X 103 / µL > 1000 X 103 / µL

PEDIATRIC

Potassium < 2.8 mmol/L > 6.0 mmol/L

Sodium < 125 mmol/L > 155 mmol/L

Calcium < 1.7 mmol/L >3.1 mmol/L

Ammonia - >100 µmol/L

Bilirubin - > 300 µmol/L



Platelet < 50 X 103 / µL > 1000 X 103 / µL

WBC < 2.0 X 103 / µL > 50 X 103 / µL

NEONATES



Reference: Pekeliling KPK KKM Bil 3/2016: Penambahbaikan Malaysian Patient Safety Goals No 8: To improve clinical communication by implementing critical value programme

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Critical Value Notification Policy

1. Only first time critical value will be reported

2. The authorised receiver shall only be:

a. Specialist

b. Medical Officer

c. Postgraduate Medical Officer

d. Nurse (SN & JM)

3. Result shall be reported according to the location specified on the form/

request. It is the responsibility of the requester to inform the subsequent ward

where the patient was transferred

4. If location is not specified, result shall not be informed

5. The first person who receives the notification shall accept and take the call

even though the patient is not under his/her care. The same applies in the event

the patient has transferred to other location.

6. The waiting time shall be until the ringing ends. Lab shall make second attempt

after 5 to 10 minutes after the first call. Only 2 call attempts shall be made for

each notification

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Lab Directory

Staff / Location Position / Unit Ext. Number

Pathology Fax Number Admin 03-61562645

Clerk / General Office Admin 2100 / 2103

Dr Afifah Haji Hassan Head of Department 4236

Dr Tuan Suhaila Tuan Soh Clinical Microbiologist 2130

Dr Adilahtul Bushro Clinical Microbiologist / QM I 2140

Dr Nur Izati Clinical Microbiologist 2149

Dr Nur Hanani Clinical Microbiologist 2149

Dr Idimaz Hajar Clinical Microbiologist 2162

Dr Syarifah Khairul Atikah Chemical Pathologist 7020

Dr Firdaus Mashuri Haematologist / QM II 7020

Dr Nor Khairina Haematologist 2150

Dr Sarojini Transfusionist 2150

Medical Officers’ Room MO 2141 / 2147

Scientific Officers’ Room Biochemist / Microbiologist 2108 / 2109 / 2110

Senior MLT –

2111 / 2114 / 2115

Counter Receiving Area (CRA) – 2121

Microbiology Lab Culture & Sensitivity 2128 / 2129

Parasitology 2127

Mycology 2136

Molecular (PCR / Viral Load) 2131

Serology / Virology 2139 / 2148

Media 2132

Chemical Pathology Lab Routine Chemistry & HbA1c 2119

Haematology Lab Routine Test & BMT 2116

FBP / MO in charge 2117

G6PD / CD4 / CD8 2152

Blood Transfusion Lab Blood Bank Lab 2154

MO in charge 2151

Outsource & HPE MO in charge 2122

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Requesting Test During LIS Downtime

LIS Downtime is a condition where the LIS in the lab cannot be used to perform the

lab processes that was LIS–assisted. All samples will need to be registered,

barcoded, processes and validated manually. Since the processes are laborious,

only limited samples are able to be processed during downtime. The test which can

be requested during downtime is listed below.

Unit 8 a.m. – 5 p.m. 5 p.m. – 8 a.m. Including Saturday, Sunday and

Public holiday


All tests • Cultures

• Serology & Virology

• NS1 Antigen

• Dengue rapid

• Organ transplant

• Needle Stick Injury (NSI)

• BFMP

• AFB

Chemical Pathology

All tests

Note: Batch tests will still be run according to its schedule

• BUSE

• Creatinine

• ABG

• Amylase

• Lactate

• Ammonia

• Calcium

• Bilirubin

Haematology • FBC

• PT/APTT

• Fibrinogen

• G6PD

• FBC

• PT/APTT

• Fibrinogen

Note: For other tests, kindly call

MO/Specialist to request

Blood Transfusion Service

• GSH

• GXM

• Antibody Identification

• GSH

• GXM

• Antibody Identification


All tests None

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LIS Downtime Procedure

After 30 mins of downtime, IT will activate Business Continuity Plan (BCP) manual form

Send all samples using Per-Pat 301 form (3 copy);

regardless barcode has already been generated or not, with exception for transfusion; use GXM manual form

Note:

• Send separate Per-Pat 301 form for each unit’s test

• All outsourced samples (without barcode/not registered) during downtime are advised to hold from sending to the lab until system recover to avoid problem

Fill up Per-Pat 301 form with all the following details:

Patient’s identification data (Name, I/C or passport number, hospital number, age and gender)

Relevant clinical summary and diagnosis

History of administration of drug, where relevant

Ward or clinic and hospital’s official rubber stamp

Name of test requested

Type of specimen and anatomic site of origin, where appropriate

Special timing of specimen collected, where indicated

Doctor’s name and signature

Note: Please ensure LOCATION is specified as result will be dispatched according to location

Note:

Collect the hard copy results at the counter

• Please expect delay in TAT as all processes were done manually

• We do not encourage tracing during downtime as all manpower will be mobilised for manual work processes

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Sending Covid-19 Specimen General workflow for Covid-19 samples

DO’S DON’TS

1. Collect Specimen

Note: For Paediatrics (< 8 yrs.)

FBC & G6PD, use elevated

EDTA Paediatric microtainer

DO NOT open the tube cap

(loose cap will cause spillage during

centrifugation)

DO NOT use normal paediatric

microtainer

2. Label Specimen

DO NOT wrap the

tube with gauze/ plaster

3. Put into double biohazard plastics

For Hematology & Biochemistry DO NOT put into cylinder

tube Cylinder tube can ONLY be used for Microbiology

4. Put the biohazard plastic into polystyrene box

Note:

• Hematology and biochemistry samples from multiple patients can share the same polystyrene box.

• For Microbiology samples, use separate polystyrene box

5. Label the box with patients’ stickers

Note: Ensure barcodes on box matches the samples

6. Seal the box and send by to the lab by porter.

Note: DO NOT use pneumatic tube for Covid-19 samples

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Test Offered During Covid-19 Outbreak

Unit Tests Specific Requirements


All tests None

Chemical Pathology

All test EXCEPT:

• HbA1c – will be suspended (in eHIS)

• Batch test (hormones, tumour marker)

• Serum / urine osmolality

• 24 hours urine chemistries

• 24 hours urine protein will be advised for Urine PCI

• Ferritin for Routine monitoring (from haemodialysis unit and Thalassemia clinic)

Procalcitonin Daily

Ferritin Daily

ABG Will be done at POCT location

Test to be OUTSOURCED:

• Digoxin (Hospital Selayang)

• Urine myoglobin (IMR)

Haematology FBC • Send Paediatric samples in Elevated K2EDTA microtainer (Pierceable cap)

G6PD • Daily (9 am)

PT/APTT • Received once patients getting ill

FBP (Full Blood Picture) • By appointment with Haematologist

• (Urgent cases only; To rule out hemolysis, Acute Leukemia)

D-dimer • Daily

• Ordered by Specialists only

Fibrinogen • Done together with D-Dimer

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• Use derived method

CD4/CD8 • Not indicated

Blood Transfusion Service

As usual


As usual

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Requesting for Covid-19 RTK (Rapid Test Kit) Antigen

Inform MO Covid at 2128 / 2129 (8 a.m. to 5 p.m.) or MO on-call Microbiology (after office hours)

Wear appropriate PPE

Swab using NPS without VTM

Order in system: Test: Covid-19 Antigen Type of Specimen: NPS without VTM Form: PER-PAT-301

Send to Microbiology Lab with triple packaging

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Chemical Pathology

Introduction

The unit offers a full service, including: General Biochemistry, Hormones, Anaemia

Profiles, Tumour Markers, HbA1C, Urine analyses, Therapeutic Drug Monitoring,

Special Protein & Immunology, hs–Troponin I and Osmometry. List of tests and

specimen requirements for each test is described in the Chemical Pathology list of

tests section.

All analytes are monitored by extensive external assurance schemes including

RIQAS and EQAS. A full programme of internal quality assurance also operates.

All reports issued to clinicians are reviewed by the chemical pathologist, medical

officers, clinical biochemist and medical lab technologists; and clinical interpretation

are provided by the chemical pathologist when appropriate. All critical abnormal

results are communicated to clinical staff.

The laboratory has expertise to advise users concerning the selection and

installation of instruments for point of care testing. The laboratory manages POCT

through the Hospital POCT Committee. Quality Performance monitoring (IQC and

EQA) and audit is conducted by the lab regularly.

Analytical / biological factors affecting the performance of tests

There are many factors which may cause an interference in the performance of a

test including physiological aspects such as age and sex of the patient, whether

patient is supine or erect, fasting or non–fasting. In general reference ranges will

allow for these factors. The table below indicates some common analytical factors

which can cause an interference, but the list is by no means exhaustive.

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List of factors affecting tests results

Factors Precautions

Hemolysis Avoid shaking blood tubes which may cause trauma to the red cells (for tubes containing anti-coagulant, gently invert the tubes 3 times immediately on collection).

Never inject a syringe needle into the vacutainer to empty the syringe.

Avoid extremes of temperature. Hemolysis badly affects, potassium, folate, bilirubin, AST, ALT, LDH, CK, Mg, PO4

Contamination Avoid taking blood from the arm where an IV infusion has been set up, which can cause a dilution effect of most analytes also depending on the infusion may increase glucose, sodium and potassium levels.

Avoid decanting blood from one tube to another. Blood requiring K+EDTA preservative must be taken after samples for Chemistry tests (serum separator tubes, SST). K+EDTA will badly affect potassium, calcium, ALP

Venous Constriction Avoid a tourniquet where possible or at least keep its use to a minimum. Constriction can badly affect calcium, lactate, electrolytes, proteins

Icterus Icterus can badly affect Creatinine, Cholesterol, Ammonia, Triglycerides

Lipaemia Lipaemia can badly affect sodium, Ammonia, ALT, AST, Salicylate

Drugs It is not possible to list all the drugs that may cause interference in analysis. Advice can be obtained from the Clinical laboratory staff if required

Delay in transit of specimens (more than 4 hr)

Delays in transit can cause significant changes in analyte concentrations. The most commonly affected analyte is potassium, but others could also be affected

Incorrect specimen received Ensure the correct blood collecting tube is used to take the sample.

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Uncertainty of Measurements

Biochemical tests are subject to a degree of uncertainty in their measurement. This

may be due to a variety of factors including:

Biological variation within individuals

Analytical measurement imprecision

Pre–analytical factors

Please contact the Chemical Pathology Unit if you wish to know or discuss the

uncertainty values for each analyte measured in the laboratory

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Collection Chart – Chemical Pathology

Tube / Container Sample/Tube Description

Common Use Special Instruction

Adult

Serum / SST Gel

Clinical Chemistry:

Routine Biochemistry analysis.

Special Protein & Immunology:

C3, C4, hs–CRP, RF, ASOT

Anaemia Profiles: Iron, Transferrin, Ferritin & Folate, B12

Mix sample gently 8 – 10 times

Then stand for 15 mins before centrifuging

Paeds

Hs–Trop I Tumour Markers Hormones

Adult

Paeds

Whole blood / K2EDTA

HbA1c (Glycosylated Haemoglobin)


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Adult

Paeds

Plasma / Sodium fluoride

Clinical Chemistry:

Glucose testing, GTT Mix well gently.

Please specify if fasting or non–fasting and any glucose load given to patient

Lithium Heparin Specialised test (Outsourced):

Plasma Amino acid

Mix sample gently 8 - 10 times

Heparinised syringe

Blood Gases Mix Well. Please send samples in slurry ice water

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Tube/Container Tube Description


Bijou sterile bottle

CSF biochemistry and body fluids biochemistry

Please ensure cap is tight and secure

Sterile urine container

Urine and other body fluids biochemistry


Dried blood spot NA NA

24 hr urine sterile container

24 hr urine chemistries Additives will be added by lab staff depending on the test requested

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List of Test (in–house) & Reference Interval

Test Sample Container

TAT Reference Interval Remarks

Acetaminophen Plain tube 2 hrs Therapeutic level 9.98 – 19.95 ug/mL

Toxic level >15 ug/mL

Alanine Transaminases (ALT/ SGPT)

Plain tube / Heparinised

4 hrs 10 – 49 U/L

Albumin Plain tube / Heparinised

4 hrs 32 – 48 g/L

Albumin to Creatinine ratio, strip

Spot urine in Sterile urine container

4 hrs < 3.4 mg/mmol

Alkaline phosphatase (ALP)


4 hrs 46 – 116 U/L

Alpha Fetoprotein (AFP) Plain tube 5 working days

< 8.1 ng/mL Run every Thursday

Ammonia EDTA 60 mins 11 – 32 μmol/L (adults) Send in ice

Amylase, serum Plain tube / Heparinised

4 hrs 30 – 118 U/L

Amylase, urine (Diastase)


4 hrs ≤ 650 U/L

Anti–streptolysin ‘O’ Titre (ASOT)


4 hrs Children preschool

≤100.0 IU/mL Children school age ≤ 250.0 IU/mL Adult

≤ 200.0 IU/mL

Aspartate Transaminase (AST)

Plain tube/ Heparinised

4 hrs 34 U/L

Beta HCG (Quantitative) Plain tube 60 mins Non-pregnant females

1.5 – 4.2 mIU/mL

Bilirubin, direct Plain tube / Heparinised

4 hrs ≤ 5 μmol/L

Bilirubin, total Plain tube / Heparinised

4 hrs 0 – 1 day <137 μmol/L 1 – 2 days <205 μmol/L 3 – 5 days <274 μmol/L

> 5 days – 60 years 5 – 21 μmol/L 60 – 90 years

43



3 –19 μmol/L > 90 years

3 – 15 μmol/L

Blood Gases (Arterial / Venous)

Heparinised syringe

60 mins pH

7.35 – 7.45 pCO2 35 – 45 mmHg Base Excess –2.0 – +2.0 mmol/L Actual Bicarbonate 22.0 – 28.0 mmol/L Total CO2 22.0 – 28.0 mmol/L pO2 80 – 100 mmHg Oxygen Saturation

95.0 – 98.0 %

Send in slurry ice

Body fluids biochemistry (pleural / peritoneal / synovial)


4 hrs Reference interval for body fluids are not available

Calcium, serum Plain tube 4 hrs 2.08 – 2.65 mmol/L

Calcium, urine 24 hr 24 hr urine container

4 hrs 2.50 – 7.50 mmol/day

Cancer Antigen (CA125) Plain tube 5 working days

<35 U/mL Run every Thursday

Carbamazepine Plain tube without gel

60 mins Therapeutic level 16.9 – 50.8 μmol/L

Carbohydrate Antigen (CA19–9)

Plain tube 5 working days

<37 U/mL Run every Thursday

Carcinoembryonic Antigen (CEA)


<5 ng/mL Run every Thursday

Chloride, 24 hr urine 24 hr urine container

4 hrs 110 – 250 mmol/day

Chloride, serum Plain tube 4 hrs 98 – 107 mmol/L

Cholesterol, total Plain tube 4 hrs Risk level Desirable < 5.2 mmol/L Borderline 5.2 – 6.1 mmol/L High

≥ 6.2 mmol/L

Complement C3 Plain tube 4 hrs Newborns

0.60 – 1.10 g/L 3 months

44



0.70 – 1.20 g/L 6 months

0.70 – 1.40 g/L

Complement C4 Plain tube 4 hrs 0.12 – 0.36 g/L

Cortisol, serum Plain tube 4 hrs Morning (7 – 9 am)

145.4 – 619.4 nmol/L Afternoon (3 – 5 pm) 94.9 – 462.4 nmol/L

Cortisol, urine 24 hr 24 hr urine container

4 hrs 57.7 – 806.8 nmol/day

C–Reactive protein, high sensitive

Plain tube 4 hrs <1.0 mg/dL

Creatine kinase (CK) Plain tube 4 hrs Males 46 – 171 U/L Females 34 – 145 U/L

Creatinine Plain tube / Heparinised

4 hrs Males 62 – 115 μmol/L Females 49 – 90 μmol/L

Creatinine clearance 24 hr urine container & Plain tube

4 hrs

Creatinine, urine 24 hr 24 hr urine container

4 hrs Males

8.4 – 22 mmol/day Females 5.3 – 15.9 mmol/day

CSF Protein Sterile urine container / Bijou container

60 mins 0.08 – 0.32 g/L

CSF Chloride Sterile urine container / Bijou container

60 mins 116 – 130 mmol/L

CSF Glucose Sterile urine container / Bijou container

60 mins Adult 2.2 – 3.9 mmol/L Infant / child 3.3 – 4.4 mmol/L

Concurren t Random

Blood Sugar

(RBS) test

CSF Lactate Fluoride Oxalate

60 mins 1.2 – 2.1 mmol/L

Estradiol Plain tube 5 working days

Adult Reference Interval Run every Tuesday

45



Female

Follicular Phase 71.6 – 529.2 pmol/L Luteal Phase 240.8 – 786.1 pmol/L Mid luteal phase 234.5 – 1309.1 pmol/L Post–menopausal

ND – 118.2 pmol/L Male ND – 146.1 pmol/L

Pediatric Reference Interval

Female 2 – 3 years

<43.3 – 106.8 pmol/L 4 – 9 years <43.3 – 160.3 pmol/L 10 – 11 years

<43.3 – 644.5 pmol/L 12 – 21 years 59.1 – 874.6 pmol/L

Male 2 – 3 years <43.3 – 188.6 pmol/L 4 – 9 years

<43.3 – 97.1 pmol/L 10 – 13 years <43.3 – 134.4 pmol/L 14 – 21 years

<43.3 – 179.5 pmol/L

Ferritin Plain tube 4 hrs Males

22 – 322 ng/mL Females 10 – 291 ng/mL

Folate Plain tube 3 working days

Deficient 0.79 – 7.63 nmol/L Indeterminate 7.64 – 12.19 nmol/L Normal 12.19 – 46.4 nmol/L

Run every Wednesda

y

46



Follicle–stimulating hormone (FSH)


Adult Reference Interval

Female Follicular phase

2.5 – 10.2 IU/L Mid cycle Peak

3.4 – 33.4 IU/L Luteal phase 1.5 – 9.1 IU/L Pregnant

<0.3 IU/L Post–Menopausal 23.0 – 116.3 IU/L

Male 13 – 70 years 1.4 – 18.1 IU/L


Female 2 – 3 years 1.3 – 5.0 IU/L 4 – 9 years 0.5 – 5.0 IU/L 10 – 11 years 1.4 – 9.3 IU/L 12 – 21 years 2.2 – 10.1 IU/L

Male 2 – 3 years <0.3 – 1.3 IU/L 4 – 9 years 0.4 – 2.0 IU/L 10 – 13 years 0.4 – 4.6 IU/L 14 – 21 years

1.4 – 7.5 IU/L

Run every Tuesday

Gentamicin Plain tube 4 hrs Peak level 8.64 – 21.6 μmol/L

Globulins, qualitative Plain tube 4 hrs

Glucose tolerance test Fluoride Oxalate

Fasting <6.1 mmol/L 2 hours post prandial <7.8 mmol/L

Please mix well

47



Glucose, 2 hr post prandial

Fluoride Oxalate

4 hrs <7.8 mmol/L Please mix well

Glucose, fasting Fluoride Oxalate

4 hrs <6.1 mmol/L Please mix well

Glucose, random Fluoride Oxalate

4 hrs <11.1 mmol/L Adults 4.1 – 5.9 mmol/L Newborn 2.2 – 3.3 mmol/L Newborn (1 day) 2.8 – 4.4 mmol/L Child 3.3 – 5.6 mmol/L

Please mix well

Glucose, urine 4 hrs < 2.8 mmol/day

Hemoglobin A1c EDTA 5 working days

Normal < 5.6 % Prediabetes 5.6 – 6.2 % Diabetes > 6.3 %

High density lipoprotein cholesterol (HDL-C)

Plain tube 4 hrs <1.03 mmol/L

Interleukin-6 (IL6) Plain tube 24 hours

2.7 - <4.4 pg/mL

Iron Plain tube 3 working days

Male

11.6 – 31.3 μmol/L Female 9.0 – 30.4 μmol/L

Run every Wednesda y & Friday

Lactate Dehydrogenase Plain tube / Heparinised

4 hrs 120 – 246 U/L

Lactate, plasma Fluoride Oxalate

60 mins 0.50 – 2.20 mmol/L Send in ice

Low density lipoprotein cholesterol (LDL–C)

Plain tube 4 hrs <3.0 mmol/L

Luteinising Hormone (LH) Plain tube 5 working days


Female Follicular phase

1.9 – 12.5 IU/L Mid cycle Peak 8.7 – 76.3 IU/L Luteal phase 0.5 – 16.9 IU/L

Pregnant <0.1 – 1.5 IU/L

Run every Tuesday

48



Post–Menopausal 7.9 – 53.8 IU/L

Male 20 – 70 years 1.5 – 9.3 IU/L >70 years 3.1 – 34.6 IU/L Children <0.1 – 6.0 IU/L


Female 2 – 3 years <0.07 IU/L 4 – 9 years < 0.07 – 0.2 IU/L 10 – 12 years <0.07 – 11.8 IU/L 13 – 21 years

1.0 – 52.2 IU/L

Male 2 – 3 years

<0.07 IU/L 10 – 13 years <0.07 – 2.9 IU/L 14 – 21 years

1.0 – 7.1 IU/L

Magnesium Plain tube / Heparinised

4 hrs 0.66 – 1.07 mmol/L

Magnesium, 24 hr Urine 24 hr urine container

4 hrs 0.99 – 10.45 mmol/day

Osmolality, serum Plain tube 4 hrs 270 – 295 mOsm/kg

Osmolality, urine Sterile urine container

4 hrs 300 – 900 mOsm/kg

Paraquat, urine Sterile urine container

4 hrs Negative

pH, urine Sterile urine container

60 mins 4.5 – 7.5

Phenytoin Plain tube 4 hrs Peak level 39.6 – 79.2 μmol/L

49



Phosphate Inorganic Plain tube / Heparinised

4 hrs 0.78 – 1.65 mmol/L

Phosphate Inorganic, 24 hr urine

24 hr urine container

4 hrs 12.9 – 42.0 mmol/day (on restricted diet)

Potassium Plain tube/ Heparinised

2 hrs 3.5 – 5.1 mmol/L

Potassium, spot urine Sterile urine container

2 hrs

Potassium, urine 24 hr 24 hr urine container

2 hrs 25 – 125 mmol/day

Procalcitonin Plain tube 60 mins < 0.05 ng/mL

Progesterone Plain tube 5 working days

Males

0.89 – 3.88 nmol/L

Females 12 years

<0.67 – 5.53 nmol/L 13 – 21 years <0.67 – 39.43 nmol/L Follicular Phase

ND – 4.45 nmol/L Luteal Phase

10.62 – 81.28 nmol/L Mid luteal phase 14.12 – 89.14 nmol/L Post–menopausal

ND – 2.32 nmol/L

Pregnant 1st trimester 35.68 – 286.2 nmol/L 2nd trimester 81.25 – 284.29 nmol/L

3rd trimester 153.91 – 1343.55 nmol/L

Run every Tuesday

Prolactin Plain tube 5 working days


Females Non pregnant 59 – 619 mIU/L Pregnant 206 – 4420 mIU/L Post–menopausal 36 – 430 mIU/L Males

Run every Tuesday

50



45 – 375 mIU/L Pediatric Reference Interval

Females

2 – 3 years 65.7 – 332.8 mIU/L 4 – 9 years 66.6 – 334.1 mIU/L 10 – 16 years

75.0 – 386.7 mIU/L 17 – 21 years 89.9 – 489.7 mIU/L

Males 2 – 3 years 76.3 – 606.3 mIU/L 4 – 9 years

95.4 – 382.2 mIU/L 10 – 16 years 67.8 – 284.9 mIU/L 17 – 21 years

115.1 – 326.7 mIU/L

Prostate Specific Antigen, total


<4 ng/mL Run every Thursday

Protein total, serum Plain tube / Heparinised

4 hrs 57 – 82 g/L

Protein, 24 hr urine 24 hr urine container

4 hrs 0.01 – 0.14 g/L

At rest 0.05 – 0.08 g/day After intense exercise 0.25 g/day

Rheumatoid factor (RF) Plain tube / Heparinised

4 hrs < 14 IU/mL

Salicylate Plain tube 4 hrs Toxic level >300 mg/L

Sodium Plain tube / Heparinised

4 hrs 136 – 145 mmol/L

Sodium, spot urine Sterile urine container

20 mmol/L

Sodium, 24 hr urine 24 hr urine container

4 hrs 40 – 220 mmol/L/24 hr

51



Testosterone Plain tube 5 working days


Male 21 – 49 years 5.72 – 26.14 nmol/L 50 – 89 years

3.00 – 27.35 nmol/L

Female Pre–menopause 0.42 – 2.06 nmol/L Post–menopause <0.24 – 1.70 nmol/L


Males 2 – 10 years <0.24 – 0.90 nmol/L 11 years <0.24 – 11.85 nmol/L 12 years <0.24 – 19.52 nmol/L 13 years 0.32 – 19.53 nmol/L 14 years 0.81 – 25.76 nmol/L 15 years 5.00 – 29.20 nmol/L 16 – 20 years

4.10 – 32.92 nmol/L

Females 2 – 10 years

<0.24 – 3.76 nmol/L 11 – 15 years <0.24 – 1.68 nmol/L 16 – 20 years

0.61 – 1.75 nmol/L

Run every Tuesday

Thyroid Stimulating Hormone (TSH)

Plain tube 24 hrs 1 – 23 months

0.87 – 6.15 mIU/L 2 – 12 years 0.67 – 4.16 mIU/L 13 – 20 years

0.48 – 4.17 mIU/L

Thyroxine, free (FT4) Plain tube 24 hrs Infants 1 – 23 month

12.1 – 18.6 pmol/L

52



Children 2 – 12 years 11.1 – 18.1 pmol/L Adult: 13 – 20 years 10.7 – 18.4 pmol/L

Transferrin Plain tube 3 working days

Males 2.15 – 3.65 g/L Females 2.50 – 3.80 g/L


Triglycerides, total Plain tube 4 hrs Normal 1.70 mmol/L

Borderline high 1.70 – 2.25 mmol/L High 2.26 – 5.64 mmol/L Very high ≥2.26 – 5.64 mmol/L

Tri–Iodothyronine free (FT3)

Plain tube 24 hrs Adult 3.5 – 6.5 pmol/L Infants 1 – 23 months 5.1 – 8.0 pmol/L Children 2 – 12 years 5.1 – 7.4 pmol/L

Troponin I, high–sensitive

Plain tube 60 mins Female < 38.64 pg/mL Male < 53.53 pg/mL

Urea Plain tube / Heparinised

4 hrs 3.2 – 8.2 mmol/L

Urea, 24 hr urine 24 hr urine container

4 hrs 0.43 – 0.71 mol/24 hr

Uric Acid Plain tube / Heparinised

4 hrs Male

220 – 547 μmol/L Female

184 – 464 μmol/L

Uric Acid, urine 24 hr 24 hr urine container

4 hrs 1.48 – 4.43 mmol/24 hr

Valproic acid Plain tube 4 hrs Therapeutic level 346 – 693 μmol/L

Vancomycin Plain tube 4 hrs Peak 12.4 – 17.9 µmol/L Trough 3.5 – 6.9 µmol/L

Vitamin B12 Plain tube 3 working days

Normal 156 – 672 pmol/L Deficient


53



24 – 181 pmol/L

Note:

• All tests were run daily, otherwise specified

• TAT for samples received from Klinik Kesihatan and other hospital is 5 working days and

10 working days for batch testing

• Reference interval that were not based on clinical decision limit are set according to the

methodology and equipment used. Therefore, it could vary between hospital.

• Reference interval for all outsourced test will follow the ranges specified by the perform

site/location.

54

Therapeutic Drug Monitoring (TDM) Range

Test Dosing umol/l mg/l

Amikacin Multiple Dosing

Peak Adult 34-51 20-30

Paeds

Trough Adult <17 <10

Paeds 3.4-8.5 2-5

Single Daily Dosing

Peak Adult 102 60

Paeds 34-51 20-30

Trough Adult <1.71 <1

Paeds 3.4-8.5 2-5

Gentamicin Multiple Dosing

Peak Adult 10.5-21 5-10

Paeds 10.5-25 5-12

Trough Adult <4.2 <2

Paeds <2.1 <1

Single Daily Dosing

Peak Adult 21-42 10-20

Paeds 11-25 5-12

Trough Adult < 2.1 <1

Paeds

Vancomycin Peak 17.3-27.6 25-40

Trough Non-complicated infection

6.9-10.4 10-15

Complicated Infection 10.4-13.8 15-20

Paediatric & neonates 6.9-13.8 10-20

Continuous Infection 10.4-17.3 15-25

Digoxin CHF 0.64-1.15 nmol/L 0.5-0.9 ng/ml

AF 1-2.5 nmol/L 0.8-2 ng/ml

Theophylline Apnoea / Bradycardia in neonates

27.75-55.5 5-10

Asthma / COAD 55.5-111 10-20

Valproic Acid Epilepsy 347-693 50-100

Psychiatry Disorder 347-866 50-125

Phenobarbitone Epilepsy 65-172 15-40

Refractory status epilepticus >302 (up to 431) >70 (up to 100)

Phenytoin 40-80 10-20

Carbamazepine 17-51 4-12

Reference:

1. Clinical Pharmacokinetics Pharmacy Handbook, Pharmaceutical Service Division, MOH, 2015 2. Basic Clinical Pharmacokinetic (Winter) 2004 3. Drug Doses, Frank Shann 16th Edition 2014 4. Drug Information Handbook 10th Edition 2003

55

List of Test (outsourced)

Please refer to website below for the latest list of tests offered by each referral lab:

1. HOSPITAL KUALA LUMPUR (GENERAL) http://www.hkl.gov.my/index.php/services/clinical-department?id=%20158

2. CHEMICAL PATHOLOGY, HKL http://www.hkl.gov.my/content/2020/Patologi/Unit%20Patologi%20Kimia/Chemical%20Pathology_ENGLISH.pdf

3. CORE LAB, HKL http://www.hkl.gov.my/content/2020/Patologi/Unit%20Makmal%20Teras/Core%20Laboratory%20Unit_BI.pdf

4. CLINICAL TOXICOLOGY, HKL http://www.hkl.gov.my/content/2020/Patologi/Unit%20Toksikologi/Toaxicology%20Unit_BI.pdf

5. HOSPITAL AMPANG https://hampg.moh.gov.my/images/DokumenJabatan/Patologi/Handbook_of_Pathology_Services_2017_5th_Edition.pdf

6. INSTITUTE MEDICAL RESEARCH (IMR) https://www.imr.gov.my/testlist

Test Perform Site / Referral Lab

Sample/ Container

Volume TAT (Working

days)

Forms / Special

Requirement

Adrenocorticotrophic Hormone

Chemical Pathology, HKL

Plain tube 3 ml 5 days PER–PAT 301

Aldosterone Endocrine Unit, Hospital Putrajaya

EDTA 4 ml 30 days PER–PAT 301

Alpha–1–Acid Glycoprotein

Unit Patologi Kimia, Hospital Ampang


Alpha-1-antitrypsin Quantitation

Special Protein Unit, IMR (03-26162669 /2731)

Plain tube 3 ml 7 days Request Form for Multiple Myeloma and Specific Proteins

Alpha 1-Antitrypsin Deficiency (SERPINA1)

Molecular Diagnostic, IMR (03-26162540)

EDTA 1-2x2.5ml blood EDTA or dried blood spots

3 months

Request Form for Molecular Diagnostic Services Must have specialist Signature

By consultation only

http://www.hkl.gov.my/index.php/services/clinical-department?id=%20158

http://www.hkl.gov.my/content/2020/Patologi/Unit%20Patologi%20Kimia/Chemical%20Pathology_ENGLISH.pdf

http://www.hkl.gov.my/content/2020/Patologi/Unit%20Makmal%20Teras/Core%20Laboratory%20Unit_BI.pdf

http://www.hkl.gov.my/content/2020/Patologi/Unit%20Toksikologi/Toaxicology%20Unit_BI.pdf

https://hampg.moh.gov.my/images/DokumenJabatan/Patologi/Handbook_of_Pathology_Services_2017_5th_Edition.pdf

https://www.imr.gov.my/testlist

56


Sample/ Container

Volume TAT (Working

days)

Forms / Special

Requirement

Amino Acid (plasma) (for Amino acid disorders)

Biochemistry Unit, IMR (03-2616 2640 / 2649)

Lithium heparin (Send in ice)

2 ml 15 days Special Form (IEM Request Form)

Amino Acid (CSF) (for Amino acid disorders)

Biochemistry Unit, IMR (03–26162627 / 2498)

Sterile container

1 ml 15 days Special Form (IEM Request Form) Must send together with plasma

Amino Acid (Urine) (for Amino acid disorders)


Sterile container (Send in ice)

2 ml 15 days Special Form (IEM Request Form) After consultation only

Amikacin Chemical Pathology, Hospital Selayang

Plain tube 3 ml 3 days TDM Form

Anti-Mullerian Hormone Assay

Endocrine Unit, IMR (03-26162636 / 2644 / 2645)

Plain tube 2-3 ml 14 days PER–PAT 301 to be REQUESTED ONLY by O&G Specialist from Infertility Clinics/OBG clinics.

Anti–Thyroglobulin (anti-TG)

Chemical Pathology, Hospital Selayang

Plain tube 3 ml 7 days PER–PAT 301 Please provide relevant history & latest TFT result

Anti–thyroid Peroxidase (anti-TPO)


Plain tube 3 ml 7 days PER–PAT 301 Please provide relevant history & latest TFT result

57


Sample/ Container

Volume TAT (Working

days)

Forms / Special

Requirement

Beta–2 Microglobulin Chemical Pathology, Hospital Ampang

Plain tube 3 ml/ 20 ml

7 days PER–PAT 301

Caeruloplasmin Chemical Pathology, HKL


Cancer Antigen 15–3 (CA 15–3)

Clinical Toxicology, HKL


Carnitine Free & Total Biochemistry Unit, IMR (03–26162792 / 2498)


Cholinesterase Chemical Pathology, Hospital Selayang


Copper, 24H urine Toxicology & Pharmacology Unit, IMR (03-26162626)

24H urine container

5 ml

14 days

PER–PAT 301 Samples must be collected using an appropriate container, free of heavy metal or trace elements

Copper, Serum Toxicology & Pharmacology Unit, IMR (03-26162626)

Plain tube 1-3 ml

C–Peptide Chemical Pathology, HKL


By Appointment

Metanephrines, 24 hr Urine

Endocrine Unit, Hospital Putrajaya

24H urine container * Acidify with 10 ml of 25% HCl

- 30 days PER–PAT 301 Must have specialist signature

Cyclosporine Clinical Toxicology, HKL

EDTA 3 ml 5 days TDM Form

Dehydroepiandrostero ne Sulphate (DHEA–S)


Plain tube 3 ml 10 days PER–PAT 301 Once a week

Panel Diabetes antibodies: Anti- Glutamic Acid Decarboxylase (GAD),

Endocrine Unit, IMR 03-26162636

Plain tube 3 ml 14 days PER–PAT 301 To be requested ONLY by endocrinologist / general physician

58


Sample/ Container

Volume TAT (Working

days)

Forms / Special

Requirement

Anti-Insulinoma- associated Antigen 2 (IA2) & Anti Islet Cells (ICA)

/ Family medicine specialist (for hospital without in house endocrinologist)

Digoxin Chemical Pathology, Hospital Selayang


Fructosamine Chemical Pathology, Hospital Ampang


Gamma Glutamyl Transpeptidase (GGT)



Galactosemia Screening (Total Galactose & Galactose–1–Uridyl Transferase), blood spot


Dried blood spot (DBS) on Whatman 903 Filter paper

3 circles of DBS

5 days Special Form (IEM Request Form)

Growth Hormone (Somatotropin)



Haptoglobin Chemical Pathology, HKL


Immunoglobulin A (IgA)

Makmal Protein, Hospital Ampang


Immunoglobulin G (IgG)



Immunoglobulin M (IgM)



Immunoglobulin E (IgE) – Total

Allergy Unit, IMR (03–26162587 / 2804 / 2789)

Plain tube 0.5 ml / 3 ml

5 days PER–PAT 301

Immunoglobulin E (IgE) – Specific (per– allergen)

Allergy Unit, IMR (03–26162587 / 2804 / 2789)

Plain tube 0.5 ml / 3 ml

5 days PER–PAT 301 Send immediately to the lab

Insulin Chemical Pathology, HKL


59


Sample/ Container

Volume TAT (Working

days)

Forms / Special

Requirement

Insulin–like Growth Factor I (IGF–1)

Endocrine Unit, Hospital Putrajaya


Inborn Error Metabolism (IEM) screening, blood spot

Unit Biokimia, IMR (03–26162792 / 2498)

Dried blood spot (DBS) on Whatmann 903 Filter paper

3 circles of DBS

3 days Special Form (IEM Request Form)

Inborn Error Metabolism (IEM) Screening, Urine


Sterile container


Lead MKAK EDTA 2 ml 14 days Send at ambient temperature If > 3hrs, keep sample cooled & Protect from freezing

Lithium Core Lab, HKL Plain tube 3.5 ml 1 day PER–PAT 301

Mercury, Urine MKAK Sterile container

15 ml 4 – 6 weeks

Daily

Mucopolysaccharide (GAGs / HRE) Urine


Sterile container (1st Morning Urine)


Methotrexate (MXT) Clinical Toxicology, HKL

Plain tube 3 ml 5 days PER–PAT 301 Daily (office hrs)

Mycophenolic acid Clinical Toxicology, HKL

EDTA 3 ml 1 day TDM Form Every Thursday

Organic Acid, Urine Biochemistry Unit, IMR (03–26162594 / 2792)



Transport FROZEN, easily destroyed by heat

60


Sample/ Container

Volume TAT (Working

days)

Forms / Special

Requirement

Orotic Acid, Urine Biochemistry Unit, IMR



Parathyroid Hormone (PTH 1–84)


EDTA (Send in ice)

3 ml 5 days PER–PAT 301 Please provide relevant history and latest calcium and ALP result

To be REQUESTED ONLY by endocrinologi st/general physician/Fam ily medicine specialist (for hospital without in house endocrinologi st)

Porphyrin / porphobilinogen / Uroporphobilinogen Urine


Sterile container


Protect from light, easily destroyed by light

61


Sample/ Container

Volume TAT (Working

days)

Forms / Special

Requirement

Progesterone, 17–OH

Endocrine Unit, IMR (03–26162645)

Plain tube 3 ml 20 days PER–PAT 301 Keep FROZEN or within 2– 8’C during transportation

Protein Electrophoresis (Serum / Urine)


Plain tube/ 24 hour urine container

3 ml / 20 ml

– PER–PAT 301 Must send serum & urine together

Protein Electrophoresis CSF (CSF Oligoclonal Band)


Bijou bottle 1–2 ml 21 days PER–PAT 301 Must send CSF & Serum together

CSF must be FROZEN immediately after collection

CSF (frozen) and serum (at 2–8’C) must reach lab not more than 7 days after collection

Phenobarbital Chemical Pathology, Hospital Selayang


Prostate Specific Antigen (PSA), Free


Plain tube 3 ml – PER–PAT 301

Renin Endocrine Unit, Hospital Putrajaya

EDTA 3 ml 30 days PER–PAT 301 Must have specialist signature

Sirolimus Clinical Toxicology, HKL

EDTA 3 ml 1 day TDM Form

Succinyl acetone, urine Biochemistry Unit, IMR

Sterile container

2 ml 15 days IEM Request Form

62


Sample/ Container

Volume TAT (Working

days)

Forms / Special

Requirement

03-26162640/ 2511

Tacrolimus Clinical Toxicology, HKL

EDTA 3 ml 5 days TDM Form

Theophylline Clinical Toxicology, HKL


Total Homocysteine, Plasma

Biochemistry Unit, IMR

EDTA 2 ml 10 days IEM Request Form

Separate plasma immediately

Thyroglobulin Chemical Pathology, HKL

Plain tube 3 ml 20 days PER–PAT 301 Please provide relevant history and latest TFT result

Thyroid Stimulating Hormone Receptor Antibody (anti-TSHR)



Please provide relevant history and latest TFT result

Urine Myoglobin & Haemoglobin


Sterile container


Urine Tetra glucoside Biochemistry Unit, IMR

Sterile container

15 ml 4 weeks PER–PAT 301

Urine Oligosaccharide Biochemistry Unit, IMR (03–26162791 / 2498)

Sterile container / 1st Morning Urine


Vitamin D Level Chemical Pathology, Hospital Putrajaya

Plain tube 3 ml 2 – 4 weeks

PER–PAT 301 Must have specialist signature

63

List of Request Forms – Chemical Pathology

FORMS CODE DESCRIPTION

General PER-PAT Form PER-PAT 301 For other tests

Molecular Diagnostics Services Request Form

IMR/SDC/UMDP/MOLDX/ REQUEST FORM

IMR

Multiple Myeloma and Specific Proteins Request Form

IMR/SDC/UMDP/PROTEIN/R EQUEST FORM

IMR

Inborn Error Metabolism (IEM) Request Form

IMR/SDC/BC/FORM-RQ IMR

Primary Immunodeficiency (PID) Request Form

IMR/AIRC/PID/RF For PID Quantitation of Immunoglobulin & Complement IMR

Borang Permintaan Ujian Pengesanan Dadah Dalam Air Kencing

- HKL

Therapeutic Drug Monitoring Request Form

TDM FORM (dari Jabatan Farmasi)

Biochemistry Unit, Hospital Selayang and Toxicology Unit, HKL

*All request forms can be downloaded from the P:\borang-borang\borang pathology

*For latest IMR forms (Diagnostic Services Forms), can refer website : https://www.imr.gov.my/en/services-menu/menu-specific-request-form

https://www.imr.gov.my/en/services-menu/menu-specific-request-form

64

Patient Information Sheet for Glucose Tolerance Test (GTT)

Purpose of Test:

Used in the diagnosis of Diabetes Mellitus

Preparation for the Test:

1. You should have an unrestricted diet containing at least 150g of carbohydrates

per day over the three (3) days preceding the test.

2. You should fast (no food or energy supplying substance) for at least eight hrs

prior to the test (but no longer than 16 hrs). Water is permitted during this period

and during the test procedure.

Test Procedure:

1. All tests are preferably done in the morning because of variations in sugar levels

during the course of the day.

2. On arrival, a fasting blood is collected.

3. Following this, you will be given a glucose (sugar) drink. You should drink all the

liquid over a period of no more than five (5) mins.

4. Blood sample is collected after 60 mins (1 hour), and 120 mins (2 hrs) from the

start of you drinking the glucose drink.

Note:

1. You should not have the test if you are ill or if you are known to have diabetes

mellitus.

2. Smoking is not permitted during the fasting period and throughout the duration

of the collection procedure.

3. Any form of exercise (walking) during the test period should be avoided.

65

Patient Instructions for the Collection of Mid- Stream Urine

General Information:

If your doctor suspects you have a bladder infection, a carefully collected and tested

Urine sample is an important part of the assessment.

Method of Collection

1. You will be given a supply of tissues and a sterile plastic container with a Yellow

Top.

2. Wash your hands before you collect the sample.

3. Wet a tissue and wash the tip of your penis. Uncircumcised patients should

retract the foreskin.

4. Dry the tip of your penis with a tissue.

5. Pass the first part of Urine into the toilet without stopping. The middle portion

is passed into the sterile Yellow Top container. The container should be at least

¼ full.

6. Void the final part of Urine into the toilet.

Note:

A. When you handle the Yellow Top container, it is important that you don’t touch

the inside of the container as this may introduce unwanted germs which will

complicate testing.

B. If the specimen is to be collected at home, store the specimen in the refrigerator

(not freezer)

66

Patient Instructions for the Collection of 24-Hour Urine

1. Empty bladder into toilet after 6:00am on the morning of the

commencement of the test (this specimen is not to be collected into the

24-Hour Sterile urine container)

2. Record on the 24-Hour Sterile urine container the time and date you

passed the Urine.

3. Collect all Urine over the next 24 hrs directly into the 24-Hour Sterile urine

container provided.

4. The 24-Hour Sterile urine container should at all times be stored in the

refrigerator.

67


Introduction

The Microbiology Unit is a full service laboratory offering diagnostic, consultative,

training, research and development services in diagnostic bacteriology, virology,

mycology, parasitology, serology and mycobacteriology. Services also include

tests for screening and monitoring of diseases. The laboratory also participates in

hospital wide infection control activities in relation to surveillance, control and

prevention of nosocomial infections.

Collection Chart – Medical Microbiology

Tube / Container Sample/Tube

Description Common Use Special Instruction

Adult Serum / SST Gel

Serology tests Mix sample gently 8 – 10 times

Then stand for 15 mins before centrifuging

Paeds

68



Adult Whole blood / Molecular test: Mix sample gently

K2EDTA For blood PCR such as HIV viral load, Hep B viral load, Hep C viral, etc.

8 – 10 times

Paeds

Amies Transport Media

Swab sample for culture

High vaginal swab, eye, ear, nasal swab, etc.

Viral Transport Media (VTM) and

Dacron swab

Swab sample for viral/bacterial PCR (throat swab, nasopharyngeal swab)

For Rapid Test Kit (RTK) Antigen for Covid, no need VTM

Bijou sterile bottle

For fluid sample (CSF, pleural fluid, peritoneal fluid, etc.)


DO NOT STORE IN THE REFRIGERATOR

69




Urine and other body fluids biochemistry


DO NOT ADD FORMALIN FOR TISSUE CULTURE

Stool Container NA DO NOT CONTAMINATE STOOL WITH URINE

Sputum cup

Blood culture bottle (Aerobic/

Anaerobic)

Mix with swirling method


Adult

Paeds

70

Myco F/ Lytic bottle

Mix with swirling method


71

Specific Collection Guideline - Microbiology

1. Bacteriology

Autopsy material Blood

i. Aspirate 10 ml of right heart blood from right heart either

through skin and chest wall or (through unopened heart) from

right ventricle after removal of sternum into a set of blood

culture broths or a sterile tube.

ii. Avoid contamination with bacteria from the water faucet and

with enteric bacteria.

Tissue

i. Best collected before the body is being handled at an earlier

stage

ii. Decontaminate the skin or sear surface of heart or other

organ before inserting needle or cutting out tissue block

iii. Collect the tissue and placed in a sterile container. Large

piece is preferred (because aseptic collection is difficult).

In the laboratory, 1 cm cube will be aseptically cut from the

suspicious area including some normal tissue for processing

Blood cultures An automated blood culture system with different types of

bottles according to age is used:

i. Adults: Aerobic and anaerobic culture bottle

Volume: 3 – 10 ml each bottle

ii. Pediatric: A single pediatric blood culture bottle

Volume: 0.5 – 5 ml

iii. Fungal C&S: Mycobacteria/Yeast/Fungi blood culture bottle

Volume: 1-5 ml

iv. TB Blood Culture: Mycobacteria/Yeast/Fungi blood culture

bottle

Volume: 1-5 ml

Note: In the suspicion of catheter-related bacteremia, blood

drawn from both the line and peripheral vein is indicated

Bone marrow

aspirate

1 – 2 ml of aspirate is required and to be inoculated directly into

the bottles.

72

1. Bacteriology

i. Before venipuncture, the skin must be carefully disinfected

with alcoholic antiseptic

ii. Clean the tops of the bottle with alcohol

iii. Inoculate the specified volume of blood / bone marrow

aspirate into each bottle

iv. Do not store the specimens in the refrigerator

Cerebrospinal

Fluid (CSF)

i. Collect 3 – 4 ml of CSF into sterile Bijoux bottles for the

examination of:

a. microscopy and culture for bacterial (Cryptococcus and

mycobacterium if indicated)

b. bacterial antigen

ii. Send the specimen immediately to the laboratory

iii. Do not store in the refrigerator

Clostridium

difficile culture

and toxin

detection

i. Collect fresh stool in a sterile container. Specimens collected

in formalin or swabs are not acceptable

ii. Transport to the laboratory immediately

Genital samples High vaginal swabs

i. This is suitable for the diagnosis of candidiasis and other

causes of vaginitis but NOT gonorrhea in the female

ii. Using a sterile speculum lubricated with sterile normal saline

and not antiseptic cream, swab either from the posterior fornix

or the lateral wall of the vagina

iii. Inoculate the swab into Amies transport media and send the

specimen to the laboratory as soon as possible

Endocervical swab

i. This is the best specimen for the diagnosis of gonorrhea and

puerperal sepsis

ii. Under direct vision, gently compress cervix with blades of

speculum and use a rotating motion with swab, obtain

exudates from the endocervical canal

iii. Inoculate the swab into Amies transport media

73

1. Bacteriology

Urethral discharge (Male)

i. Wipe the urethra with a sterile gauze or swab

ii. Collect the exudates with a sterile swab and inoculate into

Amies transport media

iii. If discharge cannot be obtained by ‘milking’ the urethra, use a

sterile swab to collect material from about 2 cm inside the

urethra

iv. Place the swab into Amies transport media

Mycobacterium:

Acid-fast bacilli

stains and culture

Acceptable specimens:

Respiratory secretions, urine, CSF, body fluids, whole blood and

tissue biopsies. Swab specimens are NOT acceptable.

i. Collect in a sterile container

ii. Collect a minimum of 3 early morning sputum or urine

specimens in successive 24-hour period

iii. Place whole blood, body fluids and CSF into a manufacturer

TB culture bottle

Pus/ Swabs/

Tissue

i. Send pus if available, in a sterile universal container

ii. Swab is an inferior substitute and should be sent in an Amies

transport medium.

iii. Send all tissues for culture in a sterile container. Do not add

formalin to the specimen

Note:

A ‘dry’ swab may fail to yield organisms in smear and culture

Surface swabs of deeply infected lesions (e.g.; sinus tracks from

osteomyelitis, pressure sores) usually grow surface contaminants

like coliforms and pseudomonas.

Respiratory

specimens

Nasal swab

i. Commonly done for screening of MRSA carriage

ii. Moisten a swab with sterile saline

iii. Swab both the anterior nares and insert the swab into the

nose and gently rotate against the nasal mucosa

74

1. Bacteriology

Throat swab

i. In the majority of cases, throat swabs are obtained to recover

Group A Streptococcus (Streptococcus pyogenes) which

causes pharyngitis.

ii. Ask the patient to open his mouth widely. Gently depress the

tongue with a tongue depressor and rub the sterile swab over

the tonsillar areas and the mucosa on the posterior

pharyngeal wall behind the uvula.

iii. Gently turn the swab so that its whole surface comes in

contact with the inflamed mucosa or lesion

iv. Avoid touching the oral mucosa or tongue with the swab

v. Place the swab in Amies transport medium immediately

Swab from mouth, gums and oral cavity

i. Rinse mouth with water before sampling

ii. Using a sterile swab, rub into areas of exudation or

inflammation and place into Amies transport medium

Sputum

i. Collect the sputum early in the morning, after a deep cough

or after a session of physiotherapy. If tuberculosis is

suspected, send 3 consecutive specimens (1 specimen per-

day).

ii. Ask the patient to cough deeply and spit directly into a sterile

universal container

iii. The material expectorated should be secretions from the

bronchi and not merely saliva from the mouth

iv. If delay is anticipated, store the sample in a refrigerator

Bronchial alveolar lavage (BAL) / brushings / biopsies

i. Place the specimen which is obtained via bronchoscopy into

a sterile container

ii. Send the specimen to the laboratory immediately

Stool i. Collect faeces into a sterile / clean wide-mouth screw-capped

plastic container.

ii. If the faeces is liquid, the container may be filled to one-third

full (excessive amount will result in spillage when opened)

75

1. Bacteriology

iii. Enrichment medium i.e., Alkaline peptone for Vibrios and

Selenite F for Salmonella can be obtained from the laboratory

for bedside inoculation

Note:

• Rectal swab is a poor second-best alternative to faeces. If it is

not possible to obtain faeces, collect a specimen by inserting

a cotton swab into the rectum

• For stool clearance culture in cases of typhoid, stool should

only be sent upon completion of therapy

Urine Midstream urine Male patients

Note:

When culture for tubercle bacilli is

required, collect at least 50 ml of

early morning midstream urine on

3 consecutive mornings into

sterile containers

i. Withdraw the prepuce

and cleanse the glans

penis with soapy water

and thoroughly rinse with

water

ii. Pass the first few

millimeters of urine to

flush out the bacteria

from the urethra,

iii. Collect the mid-stream

portion in a sterile

universal container and

close it tightly

Female patients

i. Clean the peri-urethral

area and perineum with

soapy water and

thoroughly rinse with

water.

ii. Hold the labia apart

during voiding and pass

the first few millimeters of

urine.

iii. Collect the midstream

portion in a sterile

container and close it

tightly

76

1. Bacteriology

Catheterized urine

i. Catheter urine specimens should be taken by aseptic

puncture of the catheter conduit and syringe out into a sterile

container

ii. Urine from catheter bags is generally unsuitable for culture

Note:

Culturing urinary catheter tips is a waste of time because the

catheter tips are invariably contaminated with urethral organisms

Bladder urine

i. This is obtained via suprapubic aspiration or cystoscopically

ii. Urine is collected in a sterile container

2. Mycology

Skin, nails and

hair

General Note:

• Clean cutaneous and scalp lesions with 70% alcohol prior to

sampling as this will improve the chances of detecting fungus

on microscopic examination, as well as reducing the

likelihood of bacterial contamination of cultures. Prior cleaning

is essential if ointments, creams or powders have been

applied to the lesion

• Skin, nails and hair specimens should be collected into folded

squares of paper or directly onto an agar plate

Skin

• Material should be collected from cutaneous lesions by

scraping outwards from the margin of the lesion with the edge

of a glass microscope slide or a blunt scalpel

Hair

Specimen from the scalp should include hair roots, the

contents of plugged follicles and skin scales.

Hairs should be plucked from the scalp with forceps or the

scalp is brushed with a plastic hairbrush and collected onto

an agar plate

77

2. Mycology

Nail

Nail specimens should be taken from any discolored,

dystrophic or brittle parts of the nail

Specimen should be cut as far back as possible from the

edge of the nail and should include the full thickness of the

nail

Mouth • Swabs from the buccal mucosa should be moistened with

sterile water prior to taking the sample and sent in Amies

transport medium

Ear • Scrapings of material from the ear canal are to be preferred,

although swabs can also be used

Ocular specimens Material from patients with suspected fungal infection of the

cornea (keratomycosis) should be collected by scraping the

ulcer. The entire base of the ulcer, as well as the edges,

should be scrapped. (Swabs are not suitable for sampling

corneal lesions)

The material is collected directly onto agar plates for culture

and to a glass slide for microscopic examination

Blood Blood culture for fungal is collected in the same manner as for

blood culture for bacterial using a manufacturer fungal bottle

The request for fungal culture should be indicated clearly on

the request form and a total of two weeks incubation will be

carried out

Bone marrow This specimen is helpful for making the diagnosis in a number

of deep fungal infections, including histoplasmosis and

cryptococcosis.

1 – 5 ml of aspirated material should be collected and

transferred into a manufacturer blood culture bottle

Cerebrospinal

fluid • CSF specimens (3 – 5 ml) should be collected in a sterile

container for microscopy and culture

Pus Pus from undrained subcutaneous abscesses or sinus tracts

should be collected with a sterile needle and syringe

78

2. Mycology

If grains are visible in the pus (as in mycetoma), these must

be collected. In mycetoma, if the crusts at the opening of the

sinus tracts are lifted, grains can often be found in the pus

underneath

Tissue If possible, material should be obtained from both the middle

and edge of the lesions

Small cutaneous, subcutaneous or mucosal lesions can often

be excised completely

Tissue specimens should be placed in a sterile container

without formalin

Vagina • For vaginal infections, swabs should be taken from discharge

in the vagina and from the lateral vaginal walls. The swabs

should be sent to the laboratory in transport medium

3. Serology

Blood Method of collection:

i. Draw 3 – 5 ml of blood into a Plain tube with gel without

anticoagulants.

ii. Clot at ambient temperature.

iii. Dispatch to the laboratory within 4 hours of collection for

serum separation by centrifugation

Note:

Haemolysed, icteric or lipaemic specimens invalidate certain

tests. If such specimens are received, the samples will be rejected

to assure that results are of clinical value

Cerebrospinal

fluid

Method of collection:

i. CSF specimens (3-4 ml) should be collected in a sterile

container

Note:

Blood stained specimens invalidate certain tests.

If such specimens are received, the samples will be rejected to

assure that results are of clinical value

79

Urine Method of collection:

i. Urine specimens should be collected in a sterile container for

antigen test

4. Virology

Blood i. Collect 3 – 5 ml blood in Plain tube (without anticoagulant)

ii. Clot at room temperature for 10 min and sent to laboratory

Serum i. Follow procedure as for blood collection above, and spin the

collected blood by centrifuge at 3,000 rpm for 10 minutes

ii. Aliquot the serum into sterile container if necessary, for

outsource sample

5. Special Diagnostic Test for Transplant

ELISA - based

tests

i. Collect 3 – 5 ml blood in Plain tube (without the anticoagulant)

ii. Clot at room temperature for 10 minutes.

iii. Sent to laboratory immediately

iv. Spin the blood by centrifuge at 3,000 rpm for 10 minutes to

obtain serum

6. MOLECULAR

Viral Genome Detection using polymerase chain reaction (PCR) method

Blood i. Collect 3 – 5 ml of blood into EDTA tube

ii. Sent directly to laboratory within 4 hours after being taken

CSF i. Collect minimum of 0.3 ml of CSF into a sterile Bijoux bottle

ii. Packed in ice for transport

iii. Sent directly to laboratory within 2 hours after being taken

Tissue Biopsy i. If possible, sample should consist of both the middle and the

edge section of the tissue

ii. Small sample of minimum roughly 0.3 cm size is appropriate

80

iii. Place tissue in an empty sterile container and do not add

formalin into the specimen

iv. Sent directly to laboratory within 2 hours after being taken

Ocular specimens i. Specimens from patients with suspected infection of cornea

(ocular fluids) should be collected properly. Take a minimum

of 0.3 ml of sample

ii. Place specimen into an empty sterile Bijoux bottle

iii. Sent directly to Virology Lab within 2 hours after collection

Vesicles fluids i. Collect a minimum of 0.3 ml of sample using a sterile needle

by puncturing the lesion


iii. Sent directly to laboratory in ice within 2 hours after collection

Bone Marrow i. Collect a minimum of 0.3 ml of the aspirated sample


iii. Send directly to laboratory within 2 hours after collection

Respiratory

specimen

i. Nasopharyngeal / Oropharyngeal swab to be sent in Viral

Transport Medium (VTM), packed in ice using triple layer

packaging and send to lab immediately. Must ensure the

temperature is maintained between 2 – 8°C throughout

transport.

ii. Sputum / Tracheal aspirate need to send in sterile container,

packed with ice using triple layer packaging and send to lab

immediately. Must ensure the temperature is maintained

between 2 – 8°C throughout transport

7. HIV RNA , HCV RNA & HBV DNA Genome Detection (Quantitative assay

by PCR method)

Blood i. Collect 10 ml of blood into an EDTA bottle

ii. Sample should reach the laboratory within 2 hours upon

collection of the sample from the patient

81

8. Viral Isolation

Blood i. Sample should be taken as early as possible

ii. Collect aseptically 5 – 10 ml of blood (3 – 5 ml for children)

iii. Chill the blood and send it to the lab as soon as possible

Brain tissue for

viral diagnosis

i. Remove portions, about 1.5 cm cube, of various parts of the

brain and the upper spinal cord with as little contamination as

possible

ii. Place tissue in a sterile container and transport in ice as soon

as possible

CSF i. Aseptically collect 1 – 3 ml into a sterile container

ii. Keep the specimen chilled at all time

Vesicular lesion i. Unroofed a fresh vesicular lesion using sterile needle and

swab the base of the vesicle with sterile swab lesion preferred

rayon or Dacron plastic shafted swab to obtained cells for

sampling

ii. Place swab lesion into VTM bottle

iii. Sent directly to laboratory in ice within 2 hours after collection

Conjunctival

scraping

i. Collect the scraping in a screw-capped test tube containing

Viral Transport Media (VTM), which is available in the lab

ii. Keep it chilled at all times

Eye swab i. Firmly rub the lesion with a sterile swab, which has been

moistened with nutrient broth, or sterile distilled water

ii. Put the swab in a screw-capped test tube containing Viral

Transport Media (VTM), which is available in the laboratory

Note:

DO NOT moisten swab with normal saline

Throat swab i. Put the patient at a sitting position. Ask the patient to tilt the

head slightly and open the mouth

ii. Depress the tongue with tongue depressor. Use a sweeping

motion to swab the posterior pharyngeal wall and tonsillar

pillars. Have the subject say “aah” to elevate the uvula.

Note: Use sterile Dacron or rayon swab with plastic shaft.

DO NOT use calcium alginate or cotton swabs or ones

with wooden sticks

82

8. Viral Isolation

iii. Avoid swabbing the soft palate and do not touch the tongue

with the swab tip. (N.B. This procedure can induce the gag

reflex)

iv. Place the swab immediately into a viral transport media and

break applicator sticks off near the tip to permit tightening of

the cap

v. Transport on wet ice

Nasopharyngeal

swab

i. Insert a flexible, fine shafted polyester swab into the nostril

and back to the nasopharynx

ii. The swab should be slid straight into the nostril with the

patient’s head held slightly back

iii. The swab is inserted following the base of the nostril towards

the auditory pit and will need to be inserted at least 5 – 6 cm

in adults to ensure that it reaches the posterior pharynx

Note: DO NOT use rigid shafted swabs for this sampling

method – a flexible shafted swab is essential

iv. Leave the swab in place for a few seconds. Withdraw slowly

with a rotating. Use a different swab for the other nostril

v. Put the tip of swab into vial containing VTM and breaking

applicator’ stick. Close the vial and seal

Nasopharyngeal

aspirate (NPA)

i. Patient must sit comfortably, and the head tilted slightly

backward. Instill 1 – 1.5 ml of sterile, physiological saline (pH

7.0) into one nostril

ii. Flush 3 cc syringe with 2 – 3 ml of saline. Insert the syringe

into the nostril parallel to the palate. Flush in and out few

times

iii. Aspirate nasopharyngeal secretions and collect specimens in

sterile container. Transport on wet ice.

iv. If nasopharyngeal wash is not feasible, please do throat swab

83

List of Test (in-house):

1. Bacteriology & Mycology Section

TEST CONTAINER SPECIMEN VOLUME TAT

Antibiotic sensitivity testing

Not Applicable

Not Applicable

Not Applicable

3 – 4 days (positive culture)

Aspirate culture & sensitivity

Sterile Container Aspirate Not Applicable

1 – 5 days (negative culture)


Blood culture & sensitivity (aerobic)

Aerobic sterile container

Blood 3-10 ml 1 – 5 days (negative culture)


Blood culture & sensitivity (anaerobic)

Anaerobic sterile container

Blood 3-10 ml 1 – 5 days (negative culture)


Body Fluids culture & sensitivity

Sterile container Body Fluid Not Applicable



Bronchial aspirate culture & sensitivity

Sterile Container Bronchial Alveolar Lavage

Not Applicable



Cerebrospinal fluid culture & sensitivity

Sterile Tube CSF 3 ml 1 – 5 days (negative culture)


Clostridium difficile toxin

Sterile container Stool 3 ml/ peanut size

1 – 2 days

Cryptococcal antigen Sterile Container CSF 2 ml 2 hours

CSF Bacterial Antigen Sterile Tube CSF 3 ml 1 hour

Ear swab culture & sensitivity

Amies TM Pus Not Applicable



84


Fungal Blood culture & sensitivity

Fungal Blood Container

Blood 5 ml 3 – 21 days

Fungal culture & sensitivity

Sterile Container Tissue Not Applicable

3 – 21 days

Genital culture & sensitivity

Amies Pus Not Applicable



Modified Ziehl-Neelsen for Cryptosporidium

Sterile Container Stool 5 ml 1 day

MTB Gene Xpert / RIF Sterile bottle Sputum, CSF,

bronchoalveolar lavage and tracheal aspirate

Not applicable

24 hours

Nasal swabs culture & sensitivity

Amies TM Swab Not Applicable



Peritoneal Fluid culture & sensitivity

Sterile Container Peritoneal fluid

> 1 ml 1 – 5 days (negative culture)


Pus culture & sensitivity (aerobic)

Amies TM Anaerobic

Pus 3 ml 1 – 5 days (negative culture)


Pus culture & sensitivity (anaerobic)

Sterile Container Pus 3 ml 1 – 5 days (negative culture)


Rectal Swab culture & sensitivity

Sterile Container Rectal swab Not Applicable



Respiratory culture & sensitivity

Amies TM Sputum Not Applicable



85


Rotavirus Antigen Sterile container Stool 3 ml / peanut size

1 – 2 days

Stool culture & sensitivity

Sterile Container Stool 3 ml 1 – 5 days (negative culture)


Stool for Clostridium difficile culture & sensitivity

Sterile Container Stool 3 ml 1 – 5 days (negative culture)


2. Parasitology Section


Blood Film Malaria parasites (BFMP)

Thick/thin film Blood Smear 2 hours

Cryptosporidium (Modified Acid Fast Stain)

Sterile Container

Stool 3 ml 1 day

Isospora belli (Modified Acid Fast Stain)

Sterile Container

Stool 3 ml 1 day

Microfilaria (Blood film) Thick / thin film Blood (Preferred mid- night sample)

Smear 2 hours

Microsporidium (Modified Trichrome Stain)

Sterile Container

Stool Peanut size 1 day

Stool for ova & cyst Sterile Container

Stool ¾ of container volume

4 hours

Stool microscopy examination

Plain Container Stool ¾ of container volume

4 hours

86

BFMP (Blood Film Malaria Parasite)

Good quality of BFMP slide:

Completely dry

Label with patient name/SB Number/date

Thick smear: Size 1-2cm diameter

Able to read newspaper through it

Thin smear: Rounded end

87

Thick / Thin Blood Film Malaria Parasite

88

3. Molecular Section


BK Virus Genome Detection (Quantitative)

EDTA tube / Sterile container

Blood / Urine 5 ml 1 – 2 days

CMV-DNA Genome Detection (Qualitative & Quantitative)

EDTA tube / Sterile Bijoux bottle

Blood / CSF/ BAL 5 ml / min 0.3 ml

1 – 2 days

COVID-19 Genome Detection

VTM/Sterile bottle

Nasopharyngeal swab / oropharyngeal swab / tracheal aspirate / Nasopharyngeal aspirate

Not applicable

24

hours

EBV DNA Genome Detection (qualitative & quantitative)

EDTA tube Blood / CSF / TISSUE

5 ml 1 – 2

days

HBV DNA Genome Detection (quantitative)

EDTA tube Blood 5 ml 1 – 2 days

HCV RNA Genome Detection (quantitative)


HIV RNA Genome Detection (quantitative)


HSV I & II DNA Genome Detection

EDTA tube / Sterile Bijoux bottle

Blood / CSF Vesicle fluids

5 ml 1 – 2 days

Influenzae A, Influenzae B, RSV

VTM Nasopharyngeal Swab / Oropharyngeal Swab

Not applicable

1 – 2 days

Meningoencephalitis Panel (i.e. Mumps virus, Measles virus Human enterovirus, Parechovirus, HSV 1, HSV 2, VZV, EBV, CMV, Human Herpes Virus 6, Human Herpes Virus 7, Human Herpes Virus 8, Listeria monocytogenes, S. aureus, H. influenzae, Streptococcus pneumoniae, Streptococcus agalactiae, N. meningitides Borrelia burdorferi/Borr

Sterile Bijoux bottle

CSF 0.5 - 2 ml 1 – 2 days

89


E. coli K, Cryptococcus neuformans, Cryptococcus gattii

MERS Coronavirus Genome Detection

Dacron swab (for swab only) / Sterile bottle

Sputum, throat swab, bronchoalveolar lavage, tracheal aspirate, nasopharyngeal aspirate, and tissue from lung biopsy

Not applicable

24 hours

MTB/RIF Gene Xpert Ultra

Sterile bottle Sputum, CSF, bronchoalveolar lavage and tracheal aspirate

Not applicable

24 hours

Respiratory Pathogen Panel (i.e. Influenza A, Influenza A H1, Influenza A H3, Influenza B, Respiratory Syncytial Virus A, Respiratory Syncytial Virus B, Coronavirus 229E ,Coronavirus OC43, Coronavirus NL63, Coronavirus HKU1, Human Metapneumovirus, Rhinovirus/Enterovirus, Adenovirus, Parainfluenza 1, Parainfluenza 2, Parainfluenza 3, Parainfluenza 4, Human Bocavirus, Chlamydophila pneumoniae, Mycoplasma pneumoniae and Legionella pneumophila

Sterile Container

Nasopharyngeal aspirate, bronchoalveolar lavage (BAL) and tracheal aspirates

2 ml 1 – 2 days

VZV DNA Genome Detection (qualitative)

EDTA tube Blood / CSF Vesicle fluids

5 ml 1 – 2 days

ZIKA Genome Detection Plain tube/EDTA / Sterile Bijoux bottle / Sterile container

Serum/plasma CSF/Urine

0.5 - 3 ml 1 – 2 days

90

4. Serology / Virology Section


Anti-double stranded DNA Plain tube Blood 5 ml 1 – 2 days

Anti-HB core IgM Plain tube Blood 3 – 5 ml 1 – 2 days

Anti-HB core Total Plain tube Blood 3 – 5 ml 1 – 2 days

Anti-HBe Plain tube Blood 3 – 5 ml 1 – 2 days

Anti-HBs Plain tube Blood 3 – 5 ml 1 – 2 days

Anti-Mycoplasma pneumonia IgM

Plain tube Blood 5 ml 1 – 2 days

Anti-nuclear antibodies Plain tube Blood 5 ml 1 – 2 days

Aspergillus antigen Plain tube Blood / BAL 3 ml / BAL 1-3 ml

1 – 2 days

Cytomegalovirus IgG Plain tube Blood 3 – 5 ml 1 – 2 days

Cytomegalovirus IgM Plain tube Blood 3 – 5 ml 1 – 2 days

Dengue-IgG ELISA Plain tube Blood 3 – 5 ml 1 – 2 days

Dengue-IgM ELISA Plain tube Blood 3 – 5 ml 1 – 2 days

Dengue NS1 Antigen (Rapid) Plain tube Blood 3 – 5 ml 1 – 2 days

Epstein-Barr Virus IgG Plain tube Blood 3 – 5 ml 1 – 2 days

Epstein-Barr Virus IgM Plain tube Blood 3 – 5 ml 1 – 2 days

Extractable Nuclear Antigen- Anti Jo1


Extractable Nuclear Antigen- Scl 70


Extractable Nuclear Antigen- Sm


Extractable Nuclear Antigen- RNP


Extractable Nuclear Antigen- SSA/ Ro


Extractable Nuclear Antigen- SSB/ La


Hanta Virus IgM Plain tube Blood 3 – 5 ml 1 – 2 days

HAV Antibody IgM Plain tube Blood 3 – 5 ml 1 – 2 days

HBe Antigen Plain tube Blood 3 – 5 ml 1 – 2 days

HBs Antigen Plain tube Blood 3 – 5 ml 1 – 2 days

HCV-Antibody Plain tube Blood 3 – 5 ml 1 – 2 days

HIV-Antibody Confirmatory Immunoblot

Plain tube Blood 3 – 5 ml 1 – 2 days

91


HIV-Antigen & Antibody Plain tube Blood 3 – 5 ml 1 – 2 days

HIV-Particle Agglutination. Plain tube Blood 3 – 5 ml 1 – 2 days

HSV I-IgG Plain tube Blood 3 – 5 ml 1 – 2 days

HSV I-IgM Plain tube Blood 3 – 5 ml 1 – 2 days

HSV II-IgG Plain tube Blood 3 – 5 ml 1 – 2 days

HSV II-IgM Plain tube Blood 3 – 5 ml 1 – 2 days

HTLV I & II-Ab Screen ELISA Plain tube Blood 3 – 5 ml 1 – 2 days

Indirect Immunoperoxidase for Rickettsia (IIP)


Legionella Antigen Detection Sterile Container

Urine 5 ml 1 – 2 days

Leptospira Antibody IgM Plain tube Blood 5 ml 1 – 2 days

Measles-IgG Plain tube Blood 3 – 5 ml 1 – 2 days

Mumps-IgG Plain tube Blood 3 – 5 ml 1 – 2 days

Mumps-IgM Plain tube Blood 3 – 5 ml 1 – 2 days

Parvovirus B19-IgG Plain tube Blood 3 – 5 ml 1 – 2 days

Parvovirus B19-IgM Plain tube Blood 3 – 5 ml 1 – 2 days

Rapid Plasma Reagin (Syphilis)


Rubella-IgG Plain tube Blood 3 – 5 ml 1 – 2 days

Rubella-IgM Plain tube Blood 3 – 5 ml 1 – 2 days

Toxoplasma gondii-IgG Plain tube Blood 3 – 5 ml 1 – 2 days

Toxoplasma gondii-IgM Plain tube Blood 3 – 5 ml 1 – 2 days

Treponema Pallidum Particle

Agglutination Plain tube Blood 3-5 ml 1 – 2 days

Varicella Zoster Virus-IgM Plain tube Blood 3 – 5 ml 1 – 2 days

92

List of Test (outsourced) Test Perform

Site Container Sample Volume TAT

(Working days)

Schedule

Allergy Testing (Screening)

Microbiology, HKL

Plain Tube Blood 5 ml 5 days Daily (Office Hour)

Allergy Testing (Specific)

Microbiology, HKL


Anti- Acetylcholine Receptor

Immunology, IMR


Anti- Phospholipid Antibody

Microbiology, H. Selayang

Plain Tube Blood 5 ml 1 week Daily (Office Hour)

Anti-Neutrophil Cytoplasmic ANCA



Anti- Mitochondrial Antibody (AMA)



Anti- Thyroglobulin Antibody



Anti-Glomerular Baseline Antibody

Immunology, IMR


Panel Tissue Antibodies: Anti-Gastric Parietal Cell Antibody (APC), Anti Mitochondrial Antibodies, Anti Smooth Muscle

Immunology, IMR


Anti-Liver Kidney Microsome Ab (LKM)



Anti-Intrinsic Microbiology, H. Selayang


Anti-Aquaporin 4 Immunology, IMR

Plain Tube/ Bijou bottle

Blood/ CSF

5 ml 10 days Daily (Office Hour)

93

Test Perform Site

Container Sample Volume TAT (Working

days)

Schedule

Burkholderia pseudomallei Antibody IgM

Bacteriology, IMR

Plain Tube Blood 2 – 3 ml 5 days Daily (Office Hour)

Bordetella pertussis PCR

Bacteriology, IMR

For nasopharyngeal aspirates, use sterile container

For swab, use Dacron swab in Stuart's transport media

Do not use calcium alginate or cotton swab

NPA/ Swab

Transport in ice

1 – 2 ml 5 days Daily (Office Hour)

HLA Antibody Test Panel Reactive Antibody (PRA)/Donor Specific Antibody (DSA)

Immunology, IMR

Plain Tube Blood 10 ml 4 weeks Appointment is not required. For transplant recipient only (screening test)

Human Leukocyte Antigens (HLA) Crossmatch (Complement Dependent Cytotoxicity)

Immunology, IMR

Sodium Heparin (donor),

Plain Tube (patient)

Blood Donor: 18 ml

Patient:

5 ml

10 days For solid

organ

transplantati

on

Active by appointment only. Please call 03- 26162581

Human Leukocyte Antigens (HLA) Crossmatch (Flow Cytometry)

Immunology, IMR

Sodium Heparin (donor),

Plain tube (patient)

Blood Donor: 18 ml

Patient:

5 ml

10 days For solid

organ

transplantati

on

Active by

appointment

only. Please

call 03-

26162581

94

Test Perform Site


days)

Schedule

Human Leukocyte Antigens (HLA) Typing Class I (Loci A, B and C) - low/medium resolution (SSO/SSP-PCR)

Immunology, IMR

2 K2EDTA tubes

Blood 6 ml 10 days Active by appointment only

Please call 03-2616258

Human Leukocyte Antigens (HLA) Typing Class II(Loci DR,DQ) - Low/medium resolution (SSO/SSP-PCR)

Immunology, IMR

2 K2EDTA tubes



Human Leukocyte Antigens (HLA) Typing Class I and II (Loci A, B and DR) - Medium/High Resolution (SSO-PCR)

Immunology, IMR

2 K2EDTA tubes



Human Leukocyte Antigens (HLA) Typing Class I and II (Loci A, B, C, DR and DQ) - high resolution (SSO-PCR) per loci

Immunology, IMR

2 K2EDTA tubes



Human Leukocyte Antigens (HLA) Typing for Disease Association (HLA B27/B57:01/ B15:02)

Immunology, IMR

2 K2EDTA tubes

Blood 6 ml 10 days Active by appointment only Transport condition: Room Temperature (WITHOUT ICE).


95

Test Perform Site


days)

Schedule

Human Leukocyte Antigens (HLA) Typing Class I and II (Loci A, B, C, DR & DQ) - low resolution (PCR)

Immunology, IMR

2 K2EDTA tubes

Blood 6 ml 10 days Active by appointment only.


Chikungunya Virus IgM / IgG

Makmal Kesihatan Awam Kebangsaan, Sg Buloh

Plain Tube Blood 1-3 ml 2 weeks Daily (Office Hour)

Chikungunya Genome Detection

Virologi, IMR Plain Tube Blood 5 ml 2 weeks Daily (Office Hour)

Dengue Genotyping (Qualitative)

Makmal Kesihatan Awam Kebangsaan, Sg Buloh

Plain sterile tube

Blood Blood: 5 ml

CSF: minimum 0.3ml

3 weeks Daily (Office Hour)

Sterile Bijoux bottle

CSF

Sterile container

Tissue

Diabetes Mellitus Autoantibodies: Anti-Glutamic Acid Decarboxylase (GAD), Anti-Insulinoma- Associated Antigen 2 (IA2) & Anti-Islet Cells (ICA)

Immunology, IMR

Plain Tube Blood 5 ml 2 weeks Daily (Office Hour)

Enterovirus Genome Detection

Virology, IMR

Sterile plain container

Stool/ BAL/ sputum

Pleural fluid

CSF

Stool:

>5 g or pea size

Pleural fluid:

1 – 3 ml

CSF:

1 – 3 ml

2 weeks By appointment

Reach lab within 12 hours after collection

96

Test Perform Site


days)

Schedule

VTM (Swab)

Serum

Rectal swab

Throat

swab

Vesical swab

Ulcer

swab

Organ biopsies

Serum: 3 – 5 ml

Enterovirus Virus Culture

Virology, IMR


VTM (Swab)

Stool/ BAL/ sputum

Pleural fluid

CSF

Serum

Rectal swab

Throat swab

Vesical

swab

Ulcer

swab

Organ biopsies

Stool: 5 g or pea size

Pleural fluid: 1 – 3 ml

CSF: 1 – 3 ml

Serum: 3 – 5 ml

4 – 6 weeks

Daily (Office Hour)

HIV Genome Detection for babies (0-18 months)

Virology, IMR

EDTA Blood 5 ml 2 weeks For newborn cases

97

Test Perform Site


days)

Schedule

Interferon Gamma Releasing Assay (IGRA)

Makmal Kesihatan Awam Kebangsaan

Special bottle from MKAK

Blood 5 ml (1 ml per tube)

4 weeks Please contact MKAK for collection tubes and special instruction. By appointment ONLY through MKAK's Clinical Microbiologist

Japanese encephalitis serology


Plain tube

Bijou Bottle

Blood

CSF

1 – 3 ml 7 days Samples should be collected within 5 days of illness

Japanese encephalitis PCR

Virology, IMR

Plain Tube

Sterile container

Sterile containers containing VTM

Blood

CSF

Organ biopsies

1 – 3 ml 2 weeks Daily (Office Hour)

Leptospira PCR Microbiology, IMR

EDTA

Sterile container

Blood

Sterile body fluid

Tissue

5 ml 2 weeks Send before start antibiotic

Daily (Office Hour)

Leptospiral Micro- agglutination Titer (LeptoMAT)

Microbiology, IMR


Mycobacterium C&S



Sputum

Tissue

CSF

Pus

Body

fluids

CSF/ fluid/ Pus: 1 – 2 ml


98

Test Perform Site


days)

Schedule

Mycobacterium TB Genome Detection

Microbiology, IMR


Sputum

Tissue

CSF

Pus

Body

fluids

CSF/ fluid/ Pus:

1 – 2 ml


Measles IgM Makmal Kesihatan Awam Kebangsaan

Plain Tube Blood 1-3 ml 1 week Daily (Office Hour)

Measles Viral Culture



VTM

Urine

NPA

Tracheal aspirate Throat swab

Urine: 10 ml

NPA/TA: 1 ml


Measles RT- PCR



VTM

Urine

NPA

Tracheal aspirate Throat swab

Urine:

10 ml

NPA/TA: 1 ml

1 week

Daily (Office Hour)

Nipah IgG Virologi, IMR Plain Tube

Sterile container

Blood

CSF

1-3 ml 2 – 4 weeks

Daily (Office Hour)

Nipah IgM Virology, IMR

Plain Tube Sterile container

Blood

CSF

1-3 ml 2 – 4 weeks

Daily (Office Hour)

Nipah Virus PCR

Virology, IMR

Leak-proof sterile container

Serum

CSF

Serum/ CSF:

2 – 3ml


99

Test Perform Site


days)

Schedule

Blood

Organ biopsies

Blood: 5 ml

Organ: 1.5 cm cube

Parvo VirusB19 DNA Detection


Plain Tube


Blood

CSF

Serum: 5 ml

CSF: 1 ml

1 week

Daily (Office Hour)

Polio virus / Acute Flaccid Paralysis (AFP)

Virology, IMR


VTM

Stool

CSF

Throat swab Rectal swab

Stool: 5 g or pea size

CSF: 1 – 2 ml

4 – 6 weeks

Daily (Office Hour)

Rubella Viral culture



VTM

Urine

NPA

Throat swab Tracheal aspirate

Urine:

10 ml

NPA/TA: 1 -3 ml


Viral Culture Makmal Kesihatan Awam Kebangsaan

Sterile bottle CSF

BAL

NPA

Vesicle fluid

Stool

Tissue

CSF: 1 – 3 ml

Others: Not applicable

4 – 6 weeks

Daily (Office Hour)

100

Test Perform Site


days)

Schedule

Viral Culture Virology, IMR

VTM bottle Throat swab

Nasal swab

Rectal swab

Lesion swab

Not applicable

4 – 6 weeks

Daily (Office Hour)

101

List of Request Forms – Microbiology



Autoimmune Request Form - IMR

Acute Flaccid Paralysis Case Investigation Form

AFP Case Investigation Form IMR AFP Case

HIV PCR Request Form (Baby)

IMR/Viro/HIV/2 IMR/VIRUS/NARL2

IMR

HIV Genotyping Resistance Testing IMR/Viro/HIV/24 IMR

Bacteriology request Form IMR/BACT/FORM/SMIS/01 IMR

Ricketsia request Form IMR/IDRC/BACT/RICK/02 IMR

Brucella Request Form IMR/IDRC/BACT/BRUCE/01 IMR

Leptospira Request Form IMR/IDRC/BACT/LEPTO/01 IMR

TB Request Form TBIS 20C All TB samples

Viability & Sensitivity Antibiotic Mycobacterium leprae Request Form

MKAK-BPU-K03 MKAK

Dengue dan Flavivirus Request Form MKAK-BPU-02 (rev_Nov_2015)

MKAK

Measles Request Form MSLF:01/2004 MKAK

MKAK Lab Request Form MKAK-BPU-U01 For MKAK viral identification

HLA Crossmatch Test Request Form (Living Donor)

IMR/AIRC/TI/RF-1 IMR

HLA Typing Test Request Form IMR/AIRC/TI/RF-2 IMR

HLA Typing Test Request Form (Disease Association)


HLA Antibody Test Request Form IMR/AIRC/TI/RF-4 IMR

HLA Crossmatch Test Request Form (Deceased Donor)



102

Haematology

Introduction

The unit provides basic and specialized Haematology testing. The tests offered are

stated in the Haematology list of tests section

All analytes are monitored by both internal and external quality assurance

programmes to ensure reliability. Reports issued to clinicians are reviewed by the

Haematologist, Medical Officers, Clinical Biochemist and Medical Lab

Technologists; and clinical interpretation is provided by the Haematologist/ Medical

Officers when appropriate.

The laboratory has expertise to advise users concerning the selection and

installation of instruments for point of care testing. The laboratory manages POCT

through the Hospital POCT Committee. Quality Performance monitoring (IQC and

EQA) and audit is conducted by the lab regularly.

103

Pre-Analytical Variables in Haematology Testing

The table below shows common factors that are known to interfere with

Haematology testing.

Factors Precautions

Hemolysis Hemolysis affects certain FBC parameters and coagulation tests

Allow alcohol to dry completely when it is used for skin sterilization prior to venipuncture

Never inject a syringe needle into the vacutainer to empty the syringe.

Samples should be mixed thoroughly but gently immediately after collection. Vigorous shaking causes red cells to rupture.

Avoid extremes of temperature. Never place a blood tube directly on ice as this may cause hemolysis

Contamination Avoid taking blood from the arm where an IV infusion has been set up. It can cause a dilution effect of most analytes.

Avoid decanting blood from one tube to another even if the tubes contain the same anticoagulant. Follow the recommended order of draw to avoid contamination.

e.g. Blood requiring K+EDTA preservative must be taken after samples for coagulation tests to avoid the possibility of falsely prolonged PT/ APTT or low fibrinogen results.

Icterus Icterus affects Coagulation tests

Lipaemia Lipaemia affects Hemoglobin, MCH, MCHC and Coagulation tests

Delay in transit of specimens (> 4 hours)

Delays in transit affects coagulation testing and cause Platelet, RBC and WBC cell degradation

Inadequate filling of

blood collection tubes

Improper ratio of blood to anticoagulant causes prolonged PT and APTT result.

Hematocrit level > 55% Improper ratio of blood to anticoagulant causes prolonged PT and APTT result. Please contact lab for further information

Improper specimen

storage/ transport

Specimens not stored or transported according to recommended temperature may cause aberrant results. e.g. CD4/CD8 Enumeration should be sent at room temperature not cold temperature (2- 8 °C)

104

Uncertainty of Measurements

Haematology tests are subject to a degree of uncertainty in their measurements.

This may be due to a variety of factors including:

Biological variation within individuals

Analytical measurement imprecision

Pre–analytical factors

Please contact the Haematology Unit if you wish to know or discuss the uncertainty

values for analytes measured in the laboratory

105

Specimen Collection Chart – Haematology


Common Use Special Instructions

Adult

Whole blood / K2EDTA

Routine Haematology:

Full Blood Count Full Blood Picture Retic Count G6PD Screening

Specialised test:

CD4/ CD8 Hb Analysis

Specialised test (Outsourced):

G6PD Assay DNA Analysis


Paeds

3.2% Sodium Citrate Coagulation test Mix sample gently 3 - 4 times

Must be filled until the marked indicator

106



3.8% Sodium Citrate (ESR tube)

ESR Fill within the 2 markers


Lithium Heparin Specialised test (Outsourced):

Chromosome Analysis / Cytogenetic for Genetic Disease


Sodium Heparin


Cytogenetic for Leukemia (Blood & Bone Marrow Aspiration)


SST Gel (Plain tube)


Serum Erythropoietin


107



Plain tube (without Gel)

Specialised test (Outsourced): Platelet Antibody Screening


Sterile urine container with added formalin


Bone marrow trephine biopsy


108

List of Test (in–house) & Reference Interval

Test Sample Container/ Volume

TAT Reference Interval

Remarks

Activated 3.2 % Sodium Urgent: 60 mins 25.1 - 36.5 secs Send immediately Partial Citrate Routine: 90 after collection Thrombin Time Paeds: 1.8 ml mins

(APTT) Adult: 2.7 ml

Bone Marrow Aspiration

Slide smear Urgent: 1 day Routine: 7 days

- By appointment

Bone Marrow Trephine Biopsy

Sterile urine container with 10% formalin

20 working days

By appointment

Bone Marrow biopsy 1.5cm

CD4/CD8 EDTA 2 ml 3 working days CD4+ cells: Mon- Thurs:

Enumeration 24-48 % 8am - 5pm 358-1279 Fri & Eve of PH: cells/µL External: 11 am Internal: 12 pm CD8+ cells:

15-38 % External: Send within 268-925 cells/µL 12 hours from blood collection without CD3+ cells: ice 56-81 %

831-2240

cells/µL

D-Dimer 3.2 % Sodium Citrate Paeds: 1.8 ml Adult: 2.7 ml

Urgent: 90 mins Routine: 3 working days

<500 ng/ ml Run twice a week (Tues & Fri)

MO Code required

Office hours: Hematology MO

After office hours: On-call MO

Erythrocyte ESR tube 3 hrs Men (mm/ hr):

Sedimentation (Sodium Citrate 17- 50 years: < Rate (ESR) 3.8 %): 1.3 ml 10

51-60 years: ≤ 12 61-70 years: ≤ 14

> 70 years: ≤ 30

109



Remarks

Women (mm/ hr): 17- 50 years: ≤ 12 51-60 years: ≤ 19 61-70 years: ≤ 20 > 70 years: ≤ 35

Reference: Dacie & Lewis 12th Edition

Fibrinogen 3.2 % Sodium Citrate Paeds: 1.8 ml Adult: 2.7 ml

90 mins 276-471 mg/ dL

Full Blood EDTA Urgent: 45 mins Refer table:

Count Paeds: 0.5 ml Routine: 2 hrs Full Blood Count Adult: 2 ml Reference

Interval

Full Blood Picture

EDTA Paeds: 0.5 ml Adult: 2 ml

Urgent: 1 day Routine: 5 days

Please call MO for urgent FBP

MO code required after office hours

G6PD screening

EDTA 2 ml 1 day Batch test performed twice daily (8 am & 3 pm)

(Peripheral/ cord blood)

3 months post transfusion

Do not send during hemolytic crisis

Haemoglobin (Hb) Analysis


6 weeks Hb A (%): 96.8-97.85

Run once a week (Thursday)

Hb F (%): <2 years: <5 <12 years: 2-3 Adult: < 1

Send immediately at Room Temperature

3 months post

transfusion Hb A2(%):

2.2-3.2

Please exclude IDA before sending

Reference: - Standardization

110



Remarks

National Hematology Workshop Langkawi, 2015

- Thalassemia Carrier Diagnosis in Malaysia, Dr Elizabeth George, 1998

For family screening, details of index case must be clearly stated

Kleihauer test EDTA Paeds: 0.5 ml Adult: 2 ml

3 days By appointment

Please provide cord blood sample as control

Mixing test 3.2 % Sodium Citrate 2.7 ml (2 tubes)

1 day By appointment

Prothrombin Time (PT)/ International normalized ratio (INR)

3.2 % Sodium Citrate Paeds: 1.8 ml Adult: 2.7 ml

Urgent: 60 mins Routine: 90 mins

9.4-12.5 secs Send immediately after collection

Reticulocyte count


2 hrs 0.5-2.5% Reference: Dacie & Lewis 12th Edition

Note:

• All tests are run daily, unless otherwise specified

• Reference intervals are set according to the methodology and equipment used,

unless otherwise specified. Any changes made will be notified.

111

List of Test (Outsourced)


Sample/ Container

Specimen Volume TAT Special Requirement/ Forms

ADAMTS-13 Clinical Hematology Lab, Hospital Ampang

3.2% Sodium citrate

Blood 1 tube

*Collect until indicated mark

4 - 6 weeks

• By appointment

• Fresh specimen

Request form: Hospital Ampang Special Hematology Lab Requisition form

Anti-Xa Clinical Hematology Lab, Hospital Ampang

3.2% Sodium citrate

Blood 1 tube

*Collect until indicated mark

7 working days

• Send immediately to lab

• By Appointment

Request form: Hospital Ampang Special Hematology Lab Requisition Form

Chromosome analysis (for genetic disease)

Cytogenetics Unit, WCH KL (ext. 2711)

Lithium heparin

Blood 4 ml 60 working days

• By appointment

• Fresh specimen

• Send to HSgB lab Mon-Wed only

• Samples must reach before 9 am

• Do not send on PH and eve of PH.

Request form: Cytogenetics Request Form

Chromosome Analysis for Leukaemia / Cytogenetic

Clinical Hematology Lab, Hospital Ampang

Sterile transport medium with heparin

Bone Marrow

Minimum 1-2 ml

30 working days

• Appointment with haematologist, Hospital Ampang

• Fresh specimen



112


Sample/ Container




Cytogenetic FISH


Sterile transport medium with heparin

BMA Minimum 1-2 ml

18 working days *Case to case basis

• Appointment with haematologist, Hospital Ampang

• Fresh specimen





2 tubes of sodium Heparin (2.5ml in each tube)

Blood Minimum 5 ml

Coagulation: • Factor

Assay • VWF test

Haemostasis Unit, PDN

3.2% Sodium citrate

Specimen: Blood

> 1 year: 2.7 mL x 5 tubes

≤ 1 year: 2.7 mL x 2 tubes

20 working days

• Send immediately to lab

Request form: PDN Haematology/ Serology Request Form

113


Sample/ Container


Dihydrorhoda- mine test (DHR)

AIRC Unit, IMR (ext. 2587)

Lithium heparin (without gel)


• By appointment

• Fresh specimen




• Send additional 2mL blood from unrelated healthy person’s blood as control

Request form: AIRC IMR PID Request Form

DNA Analysis- Alpha Thalassemia

Hematology Unit, HKL (ext. 5746/ 5748)

EDTA Blood Adult: 2 mL

Paeds: 0.5 mL

90 working days

Must attach:

• Hb Analysis Report

• latest FBC result (< 3 months)

• Detailed history on index case for family screening

Request form:

114


Sample/ Container


DNA analysis of Thalassemia Syndromes & Haemoglobinopathy’ s Request Form (Latest version)

DNA Analysis- Beta Thalassemia

Hematology Unit, HKL

HKL (ext. 5746/ 5748)


Paeds: 0.5 mL

90 working days

Must attach:

• Hb Analysis Report

• latest FBC result (< 3 months)

Patient < 12 years Must send:

• Patient’s sample

• Parent’s sample (Ordered in THIS)

• Parent’s Hb Analysis report

• Parent’s FBC result (3 months)

Request form: DNA analysis of Thalassemia Syndromes & Haemoglobinopathy’ s Request Form (Latest version)

Erythropoietin (sEPO)


Plain tube Blood 3.5 ml 6-12 weeks

• By appointment

• Fresh sample


G6PD Quantitative Assay

Hematolog y Unit, WCH KL (Ext 2169)


Paeds: 0.5 mL

25 working days

• By appointment




115


Sample/ Container


• Provide detailed

patient’s history with previous G6PD screening result

NOTE:

• Do not send during haemolytic crisis

• Send 3 months post transfusion

Request form: PER–PAT 301

Immunopheno -typing (IPT) Leukemia / Lymphoma

Hematology Unit, WCH, KL

EDTA Blood / Bone marrow

2 ml x 2 tubes

21 working days

• Fresh sample

• Send to HSgB lab Mon-Wed only before 9 am.



Lymphocyte Proliferation Test

AIRC Unit, IMR (ext. 2587)

Sodium Heparin


• By appointment

• Fresh specimen



• Do not send on PH and eve of PH

• Send additional 2mL blood from unrelated healthy person’s blood as control

Request form: AIRC IMR PID Request Form

116


Sample/ Container


Molecular Analysis for Leukaemia


EDTA Blood

Minimum 5 ml

4 weeks

• Fresh sample





Bone marrow

Minimum 1-2 ml

Molecular BCR/ABL 1


EDTA Blood

Minimum 5 ml (2.5 ml x 2 tubes)

4 weeks

• Fresh sample





Bone marrow

Minimum 1-2 ml

Molecular Genetic Test

Unit of Molecular Diagnostics and Protein (UMDP), IMR KL

Specimen requirements are according to cases. Please refer to Request Form for Molecular Diagnostic Services or call IMR (03-26162540/2590) for details

3 months

• All cases must be referred to and endorsed by a Clinical Geneticist before sending specimens

Request form: Request Form for Molecular Diagnostics Services

Molecular JAK 2


EDTA Blood / Bone marrow

2 ml x 2 tubes

8 weeks


117


Sample/ Container


• Samples must

reach before 9 am



Osmotic Fragility Test

Hematology Unit, HKL (ext. 6549)

Lithium heparin (without gel)

Blood 2 ml x 2 tubes

15 working days

• By appointment

• Inform HSgB Lab before requesting

• Fresh sample required

• Send additional 2 mL healthy person’s blood as control

NOTE: 3 months post transfusion Request form: PER–PAT 301

Platelet Aggregation Test

Hemostasis Unit, PDN

- - - - • By appointment

• Patient to go directly to PDN

PID Lymphocytes (T & B Cell) Subset Enumeration

Measurement of :

1. Total T cells (CD3)

2. T helper cells (CD4)

3. Cytotoxic T cells (CD8)

4. B cells

AIRC Unit, NIH (ext. 8386)

EDTA Blood 2 ml 10 working days

• By appointment

basis

• Send to HSgB lab on every working Mondays and Thursdays only

• Samples must reach HSgB lab before 9 am


• Please call (2122 / 2152) if there is any

118

(CD19) 5. Natural

Killer cells

delay/ cancellation.

Request form: IMR PID Request Form

PID Immunoglobulin and complement Measurement of IgA, IgM, IgG, IgE*, C3 and C4.

Plain Blood 5 ml

119


Sample/ Container


Platelet Antibody Screening

Makmal Platelet Antibodi, PDN

EDTA & Plain tube (without gel)

Specimen: Blood Baby: - Patient: 2mL EDTA x 5 tubes

- Father’s blood: 2mL EDTA x 5 tubes

- Mother’s blood: 2mL EDTA x 5 tubes & 10mL plain tube

Adult:

2mL EDTA x 5 tubes & 10mL plain tube

20 working days

• By appointment with PDN Specialist on-call

• Register test for patient only. Write down parent’s details (Name and IC no.) on the sample tube

Request form: PDN Haematology/ Serology Request Form

PNH (Paroxysmal Nocturnal Hemoglobinuria)

Hematology Unit, WCH, KL

EDTA Blood 2 ml x 2 tubes

25 working days

• Fresh sample

• Send to HSgB Lab Mon-Wed only




Thrombophilia Screening:

• Lupus anticoagulant (LA)

• Activated Protein C Resistance

• Anti-

cardiolipin

• Anti-B2 Glycoprotein 1

Hemostasis Unit, PDN

3.2% Sodium citrate

Specimen: Blood

Adult:

6-7 tubes (15 ml)

Paeds 1- 12 years: 4-5 tubes (10 ml)

Paeds ≤ 1 year: 2-3 tubes (5 ml)

2 weeks

• Send immediately to lab (within 4 hours collection

• Please follow the PDN guidelines (Available in Public Folder)

Not indicated for:

• during acute episodes of thrombosis and pregnancy

• patients who had provoked VTE

120


Sample/ Container


• Antithrombin activity

• Protein C & S Activity

• Antiphospho- lipid Antibody

Patients on anticoagulants should be discontinued as below:

• Warfarin: suggest sending 2 weeks after discontinuation

• UFH & LMWH: suggest sending 24 hours post dose.

Request form: PDN Haematology / Serology Request Form

Note:

• All tests require freshly collected samples to be sent to the lab immediately with the exception

of DNA Analysis for Alpha and Beta Thalassemia. DNA Analysis specimen may be stored at

2- 8°C prior to sending.

• Appointments should be made with the respective referral labs and the appointment date

stated on the request form. If the given date is not within our lab’s appointed schedule (E.g.

G6PD Quantitative Assay- Mon- Wed), kindly inform us prior to sample collection for further

arrangement.

• Refer to the request forms for additional sampling guidelines.

• Reference interval for all outsourced test will follow the ranges specified by the perform site/

location.

121

List of Request Forms - Hematology


Borang Permohonan Ujian Perkhidmatan Patologi

PER-PAT 301 General form

Cytogenetic Request Form for Peripheral Blood Samples

HKL/GE/TPM/N-1-(1) Chromosome Analysis for genetic disorder (WCH,KL)

DNA Analysis for Thalassemia Syndromes & Haemoglobinopathies Form

IMR/CaRC/HAEM/22/220 3/03(1)/REQForm

DNA Analysis test (Alpha : HKL, Beta : IMR)

Hospital Ampang Special Haematology Requisition Form

Hem-RQ19 Version 2 Clinical Haematology Lab, Hospital Ampang

Hematology/Serology Request Form

PDN/H/QP-01/01 PDN

Molecular Diagnostics Services Request Form

IMR/SDC/UMDP/MOLDX/ REQUEST FORM

IMR

Primary Immunodeficiency (PID) Request Form

IMR/AIRC/PID/RF For PID Quantitation of Immunoglobulin & Complement IMR

*All request forms can be downloaded from the P:\Borang-borang\Borang pathology

122

Full Blood Count Reference Interval

TEST REFERENCE INTERVAL REFERENCE

Haemoglobin (g/dL) Male < 60 Years 13.5 - 17.4 Ambayya et al. (2014)

Male > 60 Years 11.8 - 16.9

Female 11.6 - 15.1

0 Days 14.0 - 22.0 Dacie & Lewis 12th Edition

3 - 6 Months 11.1 - 14.1

1 Years 11.1 - 14.1

2 - 6 Years 11.0 - 14.0

6 - 12 Years 11.5 - 15.5

Haematocrit (%) Male < 60 Years 40.1 - 50.6 Ambayya et al. (2014)

Male > 60 Years 35.7 - 48.9

Female 35.1 - 44.9


3 - 6 Months 0.30 - 0.40

1 Years 0.30 - 0.38

2 - 6 Years 0.34 - 0.40

6 - 12 Years 0.35 - 0.45

MCV (fL) Adult 80.6 - 95.5 Ambayya et al. (2014)

0 Days 100 - 120 Dacie & Lewis 12th Edition

3 - 6 Months 68 - 84

1 Years 72 - 84

2 - 6 Years 75 - 87

6 - 12 Years 77 - 95

MCH (pg) Adult 26.9 - 32.3 Ambayya et al. (2014)


3 - 6 Months 24 - 30

1 Years 25 - 29

2 - 6 Years 24 - 30

6 - 12 Years 25 - 33

MCHC (g/dL) Adult 31.9 - 35.3 Ambayya et al. (2014)


3 - 6 Months 30.0 - 36.0

1 Years 32.0 - 36.0

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2 - 6 Years 31.0 - 37.0

6 - 12 Years 31.0 - 37.0

RBC (x 10^12/ L) Male < 60 Years 4.53 - 5.95 Ambayya et al. (2014)

Male > 60 Years 3.86 - 5.62

Female 3.87 - 5.21


3 - 6 Months 4.1 - 5.3

1 Years 3.9 - 5.1

2 - 6 Years 4.0 - 5.2

6 - 12 Years 4.0 - 5.2

RDW-SD (fL) Adult 37.5 - 48.1 Ambayya et al. (2014)

RDW-CV (%) Adult 12.0 - 14.8 Ambayya et al. (2014)

Platelets (x 10^9/ L) Male 142 - 350 Ambayya et al. (2014)

Female 171 - 399


3 - 6 Months 200 - 550

1 Years 200 - 550

2 - 6 Years 200 - 490

6 - 12 Years 170 - 450

WBC (x 10^9/ L) Adult 4.1 - 11.4 Ambayya et al. (2014)


3 - 6 Months 6.0 - 18.0

1 Years 6.0 - 16.0

2 - 6 Years 5.0 - 15.0

6 - 12 Years 5.0 - 13.0

Neutrophils (x 10^9/ L) Adult 3.9 - 7.1 Ambayya et al. (2014)


3 - 6 Months 1.0 - 6.0

1 Years 1.0 - 7.0

2 - 6 Years 1.5 - 8.0

6 - 12 Years 2.0 - 8.0

Lymphocytes (x 10^9/ L) Adult 1.8- 4.8 Ambayya et al. (2014)


3 - 6 Months 4.0 - 12.0

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1 Years 3.5 - 11.0

2 - 6 Years 6.0 - 9.0

6 - 12 Years 1.0 - 5.0

Monocytes (x 10^9/ L) Adult 0.4 - 1.1 Ambayya et al. (2014)


3 - 6 Months 0.2 - 1.2

1 - 12 Years 0.2 - 1.0

Eosinophils (x 10^9/ L) Adult 0.0 - 0.9 Ambayya et al. (2014)

0 Days - 12 Years

0.1 - 1.0 Dacie & Lewis 12th Edition

Basophils (x 10^9/ L) Adult 0.0 - 0.9 Ambayya et al. (2014)

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Transfusion Medicine

Introduction

The blood transfusion service plays a role by ensuring a reliable and adequate

supply of safe and effective blood products. It encompasses transfusion laboratory

testing, clinical transfusion consultation, transfusion audit and monitoring of

transfusion reaction. The unit will ensure that the correct blood is given and that

any adverse reactions are dealt with promptly and efficiently

List of Test & Turn Around Time (TAT)

Test TAT

Group, Screen and Crossmatch (GXM) 2 hours

Urgent Full crossmatch (uGXM) 45 mins

Group, Screen and Hold (GSH) 2 hours

GSH convert to GXM 1 hour

Urgent GSH convert GXM (cGXM) 45 mins

Immediate spin phase/ 1st Stage GXM < 30 mins

Blood components If blood group known: Platelets 10 mins

If blood group unknown: Platelets 20 – 30 mins

Fresh Frozen Plasma, Cryoprecipitate

and Cryosupernatant 20 – 30 mins

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Blood Transfusion Procedures

The decision to transfuse should be made based on clinical judgment. The benefit

and risk must be assessed, and alternative therapy should consider. Blood

transfusion carries various risks to the health of the patient including transmission

of infectious disease agents (HIV, Hepatitis, and Syphilis), transfusion reaction and

even risk of transfusing wrong blood, which may be fatal. Process and procedure

should be in place to ensure patient safety. Blood transfusion should be avoided

after office hours except in emergency situation.

1. Consent for Transfusion

The decision to transfuse and consent should be made at advance with patient,

parent or guardian before any planned transfusion. Patient planned for transfusion

must be informed on indication, benefits, potential risk and alternatives to the

transfusion therapy. The patient should be given opportunity to ask questions. The

discussion between clinician and patient should be documented in patient’s health

records and does not require the signature of the patient.

The consent form needs to be signed by the patient before the transfusion. If the

patient is unable to give written consent, a responsible family member must be

asked to do so. In an emergency and if no family member available, when the

need for transfusion leaves no time for written consent, the decision shall be made

by two fully registered medical practitioners, note in patient’s health record and

this information should be provided to patient or family member of the patient after

transfusion.

2. Blood Ordering and Sampling

The process of taking and labelling blood samples must be done in one process

at the bedside, one patient only at any one time. The requesting doctor shall be

responsible to ensure:

i. Use own personnel log in HIS

ii. Place order on correct patient’s chart

iii. Print the specimen label, collect sample and label it

iv. Fill in the blood requesting form

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3. Patient Identification

Accurate identification of patients at all stages of the blood transfusion process is

essential. Confirm patient’s name and identification by:

i. Asking the patient to state his/her full name

ii. Read the wristband.

iii. Check the patient’s information on clinical notes and printed specimen label.

The unconscious patients MUST be identified by the information given on the

wristband. If the patient is unconscious and unknown, it is acceptable to use

“Unknown” with the Medical record number, which is assigned to the patient on

arrival. This number must be used to identify this patient until full and correct

personal details are available.

4. Labelling of Sample

i. Labelling must be done at patient’s bedside immediately after blood taking by

the person who takes the blood.

ii. Never label 2 or more patient’s sample at the same time.

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5. Blood Requesting Form

Prescribing blood and blood products is the responsibility of the doctor managing

the patient. The request form and request through the THIS system should be

complete.

The relevant patient information should include:

i. Patient’s details: Name, IC number, hospital registration number

ii. Current working diagnosis

iii. Indication for transfusion

iv. Previous transfusion history

v. Patient’s consultant name

vi. Blood group if known

vii. Latest haemoglobin level

viii. The test required (GSH /GXM/ABO grouping/ /DCT)

ix. The quantity of blood bags requested

The request form should be signed by the requesting doctor and his/her name

should be stamped or written clearly in block letters.

6. Receiving Request

The blood sample for GXM or GSH shall be sent to the blood bank either:

i. Walk in at counter blood bank

ii. Via pneumatic tube system (115)

Blood bank personnel must ensure that the request form is properly filled, and the

corresponding samples are correctly labelled before accepting the request.

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7. Pre-Transfusion Testing

Tests Remarks

ABO Grouping ABO grouping will be carried out on all requests for blood and blood component using the test tube or gel card method

Rh Typing Rh D typing will be carried out on all requests for blood and blood component using the tube or gel card method

Antibody Screening • Mandatory request for all transfusion

• Antibody screening done by gel card method

Antibody Identification • Antibody identification shall be carried out whenever the antibody screening test is positive, and/or incompatible cross match detected.

• In the event of incompatible cross match in a life- threatening situation, more time and blood should be cross match to find units that are fully compatible.

• In non-urgent situation, sample will be sent to PDN for antibody identification and supply of compatible

Group, Screen and Hold (GSH)

• Performed for cases where probability of transfusion is low

• Comprises of ABO blood grouping, Rh typing and antibody screening.

• Patient’s sample will be retained in blood bank for 48 hours.

• If transfusion required, the sample will be converted to cross matched.

• After 48 hours a fresh new sample is required for cross match.

• GSH will not be carried out at night after 9pm, except bleeding case and cases from emergency department.

Group and Cross matching (GXM)

• Performed for cases where probability of transfusion is high.

• Comprises of ABO grouping, Rh typing, antibody screening and cross matching.

• Cross matched blood units will be kept in reserved for 48 hours before blood collection.

• The samples should reach the blood bank before 5 pm

• Medical officer blood bank approval (MO code) required for blood sample processing after 5 pm

Direct coomb’s test (DCT)

• Performed if cross match not compatible (for recipient and donor)

• Investigation for transfusion reaction

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8. Blood Samples

A blood sample is required prior to a transfusion to ensure compatibility of blood

groups between donor and recipient and to screen patients for atypical red cell

antibodies which can potentially cause reactions.

Requirement for blood samples for pre-transfusion testing:

Blood sample for red cells (GSH /GXM)

i. 3 ml – 5 ml blood in EDTA tube

ii. If no previous ABO blood grouping record in the system, 2nd sample

for ABO blood grouping required.

iii. Completed blood bank request form

Blood sample for blood components

i. 3 ml – 5 ml blood in EDTA tube for blood component required.

ii. If no previous ABO blood grouping record in the system, 2nd sample

for ABO blood grouping required.

iii. If patient had received a transfusion of blood within the previous 3

months and the procedure was without any complications, a new

blood sample need NOT accompany requests for more blood

components. Only barcode for components required.

iv. Completed blood requesting form for each product one form as per

barcode.

Blood sample for infant less than 6 months old (GXM)

i. The Infant’s blood sample should be accompanied by a sample of the

mother’s blood sample.

ii. If the maternal blood is unavailable, 3 ml infant’s blood is required for

testing.

iii. 1 – 1.5ml infant blood in EDTA tube

iv. 3 ml – 5 ml mother’s blood in EDTA tube

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v. To fill in request blood form for each sample (infant and mother).

vi. Generate barcode under paedy bag request for infant and mother

sample.

vii. 2nd sample for ABO grouping required if no previous record available

in system (for baby and mother).

Blood sample for infant more than 6 months old (GSH/GXM)

i. 3 ml – 5 ml infant blood in EDTA tube

ii. One completed blood request form

iii. 2nd sample for ABO grouping required if no previous record available

in system.

Blood sample for antibody identification

If antibody screening test is positive and/or incompatible cross-match

detected, antibody identification should be performed. Referral to a

reference Laboratory may be necessary for definite identification.

Ward/ Clinician

i. 10ml of blood in EDTA tube

ii. 10ml blood in plain tube.

iii. Completed blood request form

Blood Bank

i. Provide the reference laboratory with initial laboratory findings

ii. Consult reference laboratory’s Specialist/Medical Officer before

sending the sample

Blood sample for elective transfusion and surgery (GSH/GXM)

Blood sample requirements:

i. Should be sent during office hours

ii. One day prior to blood is required (24 hours)

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iii. Request based on hospital maximum surgical blood ordering

schedules (MSBOS)

iv. GSH and GSH converting to GXM for elective operation will be

performed only during office hour.

v. Blood bank MO code is required after 5 pm

vi. 3 ml – 5 ml EDTA tube (1st sample)

vii. 2nd sample for ABO grouping as required

viii. Completed blood requesting form

Blood sample for emergency transfusion (GXM)

All emergency requests shall be followed by a phone call to alert the blood

bank staff to facilitate the process. The clinician / House officer in charge

shall send sample directly to blood bank and wait until the blood is ready

for collection.

i. 3 ml – 5 ml in EDTA tube

ii. Completed blood requesting form

Second blood sample for ABO grouping confirmation.

Second blood sample for ABO grouping confirmation is a must for patient

who has no record of his ABO blood group in the system/ first time GSH

or GXM.

i. 3ml-5ml in EDTA tube

ii. Should be collected at different time of the 1st blood sample collection

Blood sample for transfusion reaction workout

i. Order placed under post transfusion reaction profile 1 panel

ii. Order post transfusion reaction profile 2 panel for post 24 hours

iii. 3ml of venous blood sample collected in EDTA tube

iv. Additional blood for FBP, biochemistry (bilirubin, renal profile) and

screening for those suspected haemolytic transfusion reactions.

v. 20 cc of urine sample for haemoglobinuria.

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vi. The remaining blood bag (partially transfused blood or unused blood

bag) and tubing set without needle (closing it securely)

vii. Completed transfusion reaction form.

Massive Transfusion Protocol (MTP)

i. MTP activation decision should be made by attending specialist

ii. Clinical co-coordinator appointed by the attending specialist to

activate the MTP

iii. Inform blood bank and provide full required information

iv. Inform blood bank medical officer

v. Ensure sufficient blood sample in EDTA tube, completed blood

requirement forms and manage the sample before sending to blood

bank.

vi. Ensure the sample reaches the blood bank on time to avoid delay.

vii. Deactivate MTP

viii. Send completed tracking form to blood bank once MTP deactivated.

Form available in Public folder Massive Transfusion Protocol (MTP)

tracking form.

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9. Rejection of Samples

The blood sample will be rejected in the following cases:

i. Duplicate order

ii. Blood clotted

iii. No MO code

iv. Improper barcode labelling

v. Need separated barcode

vi. Insufficient sample (less than 3mls)

vii. Blood haemolysed

viii. Lipemic sample received

ix. Wrong tube/container

x. Unsuitable sample for analysis

xi. Post transfusion sample

xii. No clinical indication

xiii. No clinical history/patient diagnosis

xiv. Test not done (empty blood bag received)

xv. Incorrect information

xvi. No request form attached

xvii. Incomplete request form

Note: Exceptions are made only in life threatening situations after consulting and

obtaining the approval of the laboratory personnel.

10. Unmanaged Blood Sample

i. Unmanaged blood sample will not be able to register in blood bank

system

ii. It will be kept for 1 hour at blood bank counter awaiting ward personnel

to manage.

iii. If the sample has been managed within the 1 hour, the sample shall be

accepted to run the test.

iv. If the status of sample is still unmanaged after 1 hour, the sample will be

discarded without any notice.

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11. Selection of Red Cells for Transfusion

For routine transfusion, packed red cells should be used in preference to whole

blood.

i. Red blood cell products should be of the same ABO and Rh D type as the

patient whenever possible.

ii. The choice of red cells for infant less than 4 months of age is Group O Rh

positive pack red cells (paedy-bag).

12. Transfusion in Special Circumstances

Emergency un-crossmatched blood group O (safe O)

i. In life threatening situation, clinician shall choose to transfuse group

O Rh (D) Positive buffy coat poor packed cell or pack cell for

resuscitation which made available in Emergency Department (ED)

and Operation Theatre (OT).

ii. Decisions to transfuse un-crossmatched safe group O blood must only

be made after the responsible clinician has fully assessed the patient's

condition. The decision should not be made in haste.

iii. The requesting doctor must state the reasons for such a decision on

the request form/ clinical note/patient’s chart in THIS and sign it.

iv. Pre transfusion blood sample must be collected before the

transfusion.

v. Pre transfusion sample and the completed empty safe O bag should

be sent to blood bank immediately for ABO blood grouping and

crossmatch.

vi. Replacement of used safe O bag will be done once unit consumption

completed by the respective department/clinician in the system.

Saline phase crossmatched blood (1st stage)

i. Transfusion of ABO-matched red cell is preferable to uncrossmatched

group O Rh positive packed cell.

ii. Red cell transfusion needed urgently but not as immediate where the

patient’s lives are in immediate danger.

136

iii. Emergency cross-match is done by saline phase at room temperature

and shall be available in 20 minutes. Full cross-match shall continue

after the blood is issued and any incompatibility detected shall be

informed immediately to the requesting clinician.

13. Issue, Collection & Returned Unused Blood and

Blood Component

i. Blood bank staff shall ensure that correct blood and blood component is

being issued.

ii. The date and time of issue and collection shall be recorded by the blood

bank personnel.

iii. The record shall include the details of the person issuing and the person

collecting the blood or blood product.

iv. The person collecting the blood shall provide a documentary proof of the

patient identity (blood collection slip or barcode label).

v. The person collecting the blood shall ensure that correct blood and blood

component has been supplied to him/her before leaving the blood bank

counter.

vi. Issued blood shall be transfused without undue delay.

vii. The prepared blood and blood component shall be kept in blood

refrigerators in blood bank at appropriate temperature.

viii. Collect blood bag only if required for immediate transfusion.

ix. Transportation shall be carried out in an appropriate temperature.

x. The ward shall maintain the blood at appropriate temperatures and

condition until they are used or returned to the blood bank immediately

xi. The ward shall return untransfused blood immediately to blood bank.

xii. The ward shall inform the blood bank if any of the untransfused blood

returned has not complied with the storage or transportation temperature.

xiii. Untransfused blood that returned shall be discarded unless it is kept in an

appropriate condition and temperature.

xiv. The returned of unused blood shall be kept until the next stock check

following day (8 am and 2 pm).

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14. Return of Used Blood Bags

i. The ward shall be responsible to return used blood bags and completed

compatibility card within 24 hours.

ii. Unit consumption shall be completed in ward prior to return of the used

empty bag.

iii. The empty used bag and the completed compatibility card will be kept in

blood bank for 7 days.

15. Administration of Blood Product

Confirm the patient’s name and identification by asking the patient or

relative to and by checking:

i. The patient’s note

ii. Compatibility card

iii. Request form.

iv. Wristband

Check the expiry date of blood or blood component.

Record the blood transfusion detail in patient’s note

i. Type of product transfused

ii. Product barcode number

iii. Date of transfusion

iv. Volume transfused

v. Time transfusion started and ended.

vi. Adverse transfusion reaction, if any

The patient shall be closely observed and monitored during the

transfusion.

Parameters to be monitored shall include:

i. Blood pressure and pulse rate

ii. Temperature

iii. Clinical features of acute transfusion reactions

138

16. Storage, Transportation and Duration for Transfusion of Blood Components

BLOOD COMPONENTS

Red cells (all types of red cells)

Platelets Thawed Plasma

Thawed Cryoprecipitate/ Cryosupernatant

STORAGE 2 - 6ºC 20 - 24ºC Shall be issued once the product is thawed

Shall be issued once the product is thawed

TRANSPORTATION 2 - 10ºC Should be kept at 20 - 24ºC.

NEVER put

platelets in refrigerator

2 - 10ºC 20 - 24ºC (thawed product)

TRANSPORT BOXES

Insulated box with coolant pack. Direct contact with coolant shall be AVOIDED

Insulated box WITHOUT ICE

Insulated box with coolant pack. Direct contact with coolant shall be AVOIDED

Insulated box WITHOUT ICE

DURATION BEFORE TRANSFUSION

30 minutes after removing the packs from blood refrigerator

Start as soon as the pack is received from the blood bank

As soon as the thawed pack is received from the blood bank

As soon as the thawed pack is received from the blood bank

DURATION DURING TRANSFUSION

SHOULD NOT

more than 4 hours to completion to avoid risk of bacterial contamination

SHOULD NOT be

more than 30 minutes

- -

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17. Transfusion Reaction

All Transfusion Reactions shall be investigated, reported and managed

accordingly.

To facilitate investigation of an adverse transfusion reaction, the following

shall be carries out:

i. Blood samples in EDTA shall be taken for:

a) Repeat ABO/Regrouping

b) Repeat crossmatching

c) Direct and indirect antihuman globulin test (Combs’ test)

d) Urine examination for hemoglobin and red cells

*Refer section 8.9 for details on specimen collection

ii. In addition, for case suspected of haemolytic transfusion reactions,

further investigation should include full blood picture (FBP), liver

function test (LFT) and lactate dehydrogenase (LDH).

iii. These specimens shall be accompanied by a request form for

investigation of transfusion reaction.

iv. The remaining blood bag (partially transfused blood or unused blood

bag) and tubing set (closing it securely) should be returned to blood

bank with all attached labels.

v. If the patient needs further transfusion, new crossmatch will be

performed with fresh new samples.

18. Transfusion Record

i. All record of transfusion request shall be kept in blood bank and on the THIS

system, including those cases of screen and hold.

ii. Document the details of the transfusion including blood unit transfused in the

system / PPDK card.

iii. Return all used blood bag to blood bank - empty or not, and any unused units

together with completed PPDK card.

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19. Rare Blood Group

Rh(D) negative blood group:

i. To follow the own hospital procedure on managing RhD negative cases

ii. Minimal stock available in blood bank (only for emergency use)

iii. In elective cases, blood bank shall be informed at least one week prior to the

procedure that may require transfusion.

iv. This notification is essential to allow the blood bank enough time to source for

the required blood.

v. In emergency situation, where ABO group specific RhD negative blood is not

available in time, blood bank may issue, in order of preference:

a) Group O RhD negative blood, or

b) ABO group specific RhD positive blood, only if the patient does not have

pre-formed anti D.

c) This shall be done only after discussing with and agreed by the treating

clinician.

vi. In case of patient with a rare blood group ample notice should be provided to

blood bank so that appropriate arrangement can be made. At least one week

notice should be given prior to the operation to facilitate procurement of

sufficient compatible blood units and for screening of family members

(phenotype the siblings).

141

Collection Chart – Transfusion Medicine



Plain tube without gel

Antibody identification Mix sample gently 5 times

Adult EDTA GSH, GXM, Antibody identification


Paeds


For Urine Hb – Transfusion reaction case


142

List of Request Forms – Transfusion Medicine



Borang Pemohonan Transfusi Darah

WJD011379-PNMB., K.L.

For GSH, GXM, Antibody Identification

Borang Laporan Reaksi kepada Darah atau Komponen Darah

BTS/TR/2/2016 For Transfusion Reaction Report

Permohonan Rujukan Ujian Immunohematologi

PDN/IH/QP-01/04 For Antibody Identification PDN

Permohonan Rujukan Ujian Platelet Immunologi

PDN/IH/QP-03/03 PDN

Borang Persetujuan Pemindahan Darah atau Komponen Darah (Consent Form)

BTS/TC/2/2016 Consent form for patient

Worksheet for Investigation of Transfusion Reaction

BTS/TRW/2/2016 For pathology staff

(transfusion unit)

Reporting Form for Transfusion-Related Adverse Event

BTS/HV/3/2016 For pathology staff (transfusion unit)


143

Histopathology *All histopathology and cytology samples will be outsourced to respective referral laboratory [to refer table List of Test (Outsourced)]

1. List of Services

i. Surgically and non-surgically removed tissue

ii. Frozen section

Histopathology Procedures

2. General procedure for Submission of Specimen

All specimens for routine histological examination are to be fixed in 10%

formalin in suitable leak-proof container. The volume of formalin used is

at least 10 times the specimen to be fixed.

Seal every specimen securely to avoid leakage and pack with proper

plastic to avoid damage during transport.

Register and label the specimen with the patient’s name, registration

number and the site of origin of the specimen.

PLEASE ENSURE THE SAME IDENTIFICATION as written on the

request forms (3 copies of PER-PAT 301 forms).

Every specimen must be accompanied by a completed request form

giving full particulars of the patient including relevant clinical history,

diagnosis and previous histopathology reports if any. Clearly indicates

the ward / clinic where the sample was taken. Also, include name of

doctor in charge (especially the specialist in charge), for contact if there

is any inquiry.

144

Stick the hospital barcode at the right hand side corner of all 3 copies of

the PER-PAT 301 forms. For urgent request, please mark as “URGENT”

on the request form.

3. Specimen Collection and Preparation

The specimens should be fixed in the usual manner. DO NOT put large

specimen in small containers as this would prevent proper fixation of the

tissue and also distort the specimen.

For adequacy of surgical excision in malignant neoplasm, the margins

must be marked accordingly by sutures or by diagrammatic

representation of the excised specimen.

Specimen for immunofluorescence (IMF), enzyme histochemistry studies

are to be sent fresh without fixative in the closed containers or in gauze

moistened with normal saline to prevent drying.

For immunofluorescence specimen are sent in phosphate buffered saline

(PBS) to prevent drying.

Specimen for routine histological and immunofluorescence should be

sent directly to receiving counter.

IMF received after office hour will be frozen and send to respective

hospital during office hour.

All histopathology samples are sent to Hospital Selayang, Hospital UiTM,

Sg Buloh and Hospital Kuala Lumpur daily except on Saturday, Sunday

and Public holiday. As for stomatology, the samples are sent to IMR

4. Frozen Section

The tissues for frozen section are to be sent fresh without formalin or in

gauze moister by normal saline to prevent drying.

Frozen section can only be requested by the specialist treating the patient

by making an appointment with the histopathology’s on-call (Hospital

145

UiTM, Sg Buloh or Hospital Selayang) and pathology laboratory (ext.

2122, MO Outsource) at least ONE DAY earlier before sending sample

to the lab.

All cases scheduled for frozen section examination are best placed first

in the operating list. No frozen sections are available after office hours.

Please inform the lab when:

a) The patient is wheeled into the operating room

b) The frozen section specimen is on the way to the lab

c) The frozen section examination is cancel

The lab has to make an arrangement for the hospital transport.

The doctor must send the specimen immediately to the laboratory with

the request form. Transport arrangement will be made by Pathology

Department and Pathology PPK will send the sample to respective

laboratory.

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Cytology *All histopathology and cytology samples will be outsourced to respective referral

laboratory [to refer table List of Test (Outsourced)]

1. List of Services

Exfoliative cytopathology - involves examination of specimens which

contain exfoliated cells. The usual specimens received are cervical

smears, sputum, urine, pleural fluid, peritoneal fluid and washings of

various sites.

i. Gynaecologic – pap smear

ii. Non gynaecologic – body fluids

Aspiration cytopathology - involves examination of cells that are

obtained by fine needle aspiration and brushings.

i. Fine needle aspiration

ii. Brushings

Cytology Procedures

2. General procedure for Submission of Specimen

All specimens for cytological examination should be put in clean

universal leak – proof containers.

All specimens should have the same identification as that written on the

request forms.

The form must be completely filled including the clinical history to avoid

rejection of specimen.

Pap smear slide should be placed in a slide mailer before being

dispatched to the laboratory.

147

Specimen for cytological examination should be sent directly to the lab to

be sent to cytological laboratory, Hospital Selayang.

Specimens collected after office hours should be refrigerated at 4C

before being dispatched to the cytology laboratory the next day.

Refrigeration helps in preserving the cell.

DO NOT FREEZE SPECIMEN.

3. Specimen Collection and Preparation

Gynaecologic cytology

DO NOT use lubricant on the speculum. Place cervical spatula

at the external os and rotate through 360 degrees, lightly scraping the

squamo-columnar junction.

Smear the material onto a clean, labelled glass slide about as

thick as a blood film.

Immediately place the slide in 95% alcohol for at least 15

minutes. If more than one slide is to be placed in the same container,

ensure that they are not placed face to face.

Sputum

(Specimen must be collected on three consecutive days)

Instruct the patient to empty the mouth of all saliva immediately

after waking up in the morning.

The patient should then cough deeply and collect the resulting

sputum in the container supplied.

The specimen must be sent immediately to the laboratory.

Do not forget to collect a similar specimen on the next two days.

The specimen container should be labeled according to day

specimen is collected.

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Urine

The patient should void and discard the first morning specimen.

Do not send overnight urine sample as most of the cells in this sample

are degenerated.

Collect the next voided urine and send it immediately to the

laboratory.

Body fluids

(Pleural fluid, ascitic fluid, cerebrospinal fluid, pericardial fluid, etc)

Specimens are collected in clean containers and dispatched

immediately to the laboratory.

Vesicle fluid

Prepare two thin smears on clean glass slides

Air-dry the slides. Air- drying is done by putting the slide in a

vertical position on a slide rack or placed horizontally on a table top and

letting the smear dry. This usually takes 10 minutes to 15 minutes.

Place the slides in a slide mailer and send to the laboratory for

Giemsa staining.

Fine Needle Aspiration Cytology (FNAC)

The FNAC clinic is conducted twice a week at the surgical

outpatient department (SOPD) and once a week at the ENT clinic.

Tuesday and Thursday : 9.00 am (SOPD)

Tuesday : 2.00 pm (ENT)

Wednesday : 9.00 am (Radiology)

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Appointment requests for FNAC should be ordered only by the

medical officer / specialist. The request forms should be filled legibly,

complete with the clinical history and findings. Whenever there is more

than one lump or swelling present, the clinician should indicate which

lump/s or swelling/s to be aspirated. The clinician requesting the FNAC

procedure should have his/her name clearly written on the request form

so that they would be able to be contacted if there is any query.

Indications for FNAC

a) Breast cancer cases to confirm diagnosis.

b) Suspicious lesions to exclude breast cancer.

c) Solitary cold nodule in a thyroid gland.

d) Suspicious lesions such as salivary gland tumours and

subcutaneous nodules.

Please note that:

a) Breast and thyroid cyst may be aspirated by the surgeon and

material sent for cytologic examination.

b) There is no indication for FNAC in multinodular goitre or

diffuse goiter.

c) Vascular lesions or those of vascular origin should not be

sent for FNAC.

d) Radiologist under radiological guidance on appointment

basis performs FNAC for deep-seated lesions.

4. Collection of reports

All histopathology and cytology results are entered in LIS using report’s

unique number.

Clinician must use that unique number to view the results.

All results are available in ‘Public’ folder ‘Histo Cyto Patologi’

(which is accredited to selected clinician only).

Please refer diagram below, to see the instruction on how to view the

results.

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Tracing Histopathology & Cytology Results

1. Copy the unique number as stated in the eHIS system (eg: SP-20-xxxx SBxxxxxxxx)

2. Go to MY COMPUTER PUBLIC FOLDER ‘Histo Cyto Patologi’ Folder

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3. Click ‘Search’ ‘All Files and Folder’

4. Paste the copied number in the column provided

5. List of result/s (PDF form) will be shown

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Collection Chart – Histology & Cytology



Sterile container with 10% formalin (for Histopathology specimen)

without formalin (for Cytology specimen)

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Disposable container

For surgical specimen

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List of Test (Outsourced)


Sample/ Container

Specimen TAT (working

days)

Special Requirement/

Forms

Histopathology specimens: • Big specimen • Bone

(decalcification)

Histopathology Unit, Hospital Selayang

Leak proof container with 10% Formalin (10 x specimen)

Tissue 30 days (Routine) 7 to 14 days (urgent)

PER–PAT 301

Histopathology specimens: • Small biopsies • Big specimen

• (Breast & Colon only)

Hospital UITM, Sungai Buloh

Leak proof container with 10% Formalin

Tissue 30 days (Routine) 7 to 14 days (urgent)

PER–PAT 301

Frozen section Histopathology Unit, Hospital Selayang & Hospital UITM, Sungai Buloh

Universal Container (fresh)

Tissue - PER–PAT 301

Histopathology specimens (Brain)

Histopathology Unit, HKL / Histopathology Unit, Hospital Selayang

Plain container with 10% neutral buffered formalin (NBF)

Brain tissue

30 days (Routine) 7 to 14 days (urgent)

PER–PAT 301

Histopathology specimens (Oral)

Stomatology Unit, IMR

Leak proof container with 10% Formalin

Oral tissue

30 days (Routine) 7 to 14 days (urgent)

IMR Pathological Specimens

Cytology specimens (Non-gynaecology and FNAC)

Cytology Unit, Hospital Selayang

Leak proof container

Tissue 14 days (Routine) 7 days (urgent)

PER–PAT 301

Pap smear (Gynaecology)

Cytology Unit, Hospital Selayang

Not applicable

Slide 14 days (Routine)

Pap smear Request Form

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List of Request Forms – Histopathology & Cytology


PER-PAT 301 Form Per-pat 301 For Histopathology and Cytology H.Selayang, Hospital UiTM Sg Buloh dan Histopathology HKL

Borang Permohonan Ujian Pap Smear

PS 1/98 For Pap smear

IMR Pathological Specimens (STOMATOLOGY)

Medl. 135 For Stomatologi IMR

Permohonan untuk Pinjaman Slide Histopatologi/Sitologi

HS/JP/WI (HC:09)-001: Appendix [4]

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Pathology Services Handbook 2021 - hsgbuloh.moh.gov.my

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