HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 1
Pathology
Department,
Hospital Ampang
2017
Handbook of Pathology Services
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 2
Foreword by the Director of Ampang Hospital
Ampang Hospital is a tertiary care center catering to the needs of the patients in the
Ampang and Hulu Langat district and is also the Haematology Referral Center for Malaysia
public hospitals. The laboratory also provides special protein tests services to all the
hospitals in Malaysia. This entails rigorous and careful medical work for all the staffs in the
hospital to ensure that patient care and management is at its best and that the quality of
medical and its supporting services are of optimal standards.
Pathology services are important and key in the swift and rapid diagnosis of patient
conditions in order that the correct and suitable treatment may be administered.
Therefore, the onus is on the Pathology Department to continue improving the standards of
their service in order that the demands and needs of the clients are met.
The Pathology Department has taken big strides in achieving these goals by setting high
standards and by being assessed by Standards Malaysia for MS ISO 15189:2014 and by the
Malaysia Productivity Corporation for 5S. This revision of the Pathology Services Handbook
is another feather in their cap for their efforts in improving the quality of their service.
The objectives of this book are to provide excellent, committed and quality services for the
benefit of their customers and it is my sincere hope that they continue to aspire and strive
to meet those goals on a daily basis. I would like to extend my congratulations and thanks
to the Pathology Head of Department, Datin Dr Baizurah Mohd Hussain and her team of
editorial committee members and contributors in their success of preparing, revising,
editing and eventually publishing of the Pathology Services Handbook, 5th edition.
Dato Dr Aishah Ahmad Makinuddin,
Director
Ampang Hospital
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 3
Preface by the Head of Pathology Department,
Ampang Hospital.
The Pathology Department in Ampang Hospital has always been striving to deliver the best to our clients in light of achieving the department’s vision and mission. The Pathology Service handbook is part of our on-going initiative to satisfy the needs of the clients by providing a clear, concise, comprehensive and informative guide on testing performed in the laboratory and those outsourced to other reference laboratories. The book also details the list of tests and specimen collection as well as rejection criteria so as to guide the clinicians and clients on the intricacies of testing and what they should do in order to obtain their desired outcome. This guideline meets the MS ISO 15189/IEC Standards to provide and communicate information to our clients. Also, this edition of the Service Handbook is the 5th and latest edition of the already available and older edition and it also boasts a completely new format of presenting the lists of tests as well as a very comprehensive list of specimen containers and special instructions regarding tests performed in the laboratory and those outsourced. We sincerely hope that this new presentation format will ease the searches of our clients who will be using the book as a reference. This handbook will be revised every 3 years or whenever necessary in order to update information regarding the services provided in Ministry of Health (MOH). This edition was re-written with a lot of effort and hard work by the Pathology Service Handbook Editorial Board. With this in mind, I hereby extend my heartiest congratulations and appreciation to all the committee members in the development and publication of this handbook with tireless and determined dedication to improve the quality of service in Pathology Department, Ampang Hospital. Datin Dr Baizurah Mohd Hussain, Senior Consultant Chemical Pathologist Head of Pathology Department Ampang Hospital
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 4
Advisor:
Datin Dr Baizurah bt. Mohd Hussain (Senior Consultant Chemical Pathologist & Head Department of Pathology)
Co-ordinator:
Dr Rashidah Mohamed (Hematopathologist)
Committee members: Dr Nafishah bt. Ahmad Dr Noorhayati bt. Abdul Rahman Dr Siti Sarah bt. Mustapa Dr Munirah Abdul Razak Pn. Siti Gayah bt. Loman Pn. Norhayati Mohd Noh
Our appreciation also goes to: Head of Department of Haematology
Head of Clinical Haematology Laboratory (MKH) Miss Phan Chin Lee
All staff of Pathology Department Hospital Ampang who indirectly involved in
re production of this handbook.
HANDBOOK OF
PATHOLOGY SERVICES
Fifth Edition
Pathology Department
Hospital Ampang
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 5
CONTENTS
Pages
Pathology Department Oath, Vision and Mission Statements 6
A. General Operating Policies 7 – 14
B. List Of Tests 15 - 80
C. Special Test Instructions: Chemical Patology 81 – 99
D. Special Test Instructions: Medical Microbiology 100 -115
E. Special Test Instructions: General Haematology 116 - 118
F. Special Test Instructions: Blood Transfusion Service 119– 123
G. Special Test Instructions: Cytology 124 – 127
H. Special Test Instructions: Histopathology 128 – 131
I. Critical Results in Pathology Department 132 – 135
J. List Of Specimen Container/Tubes 136 – 143
K. Specimen Rejection Criteria 144 – 145
L. Special Test Request Forms 146 – 161
M. List of Pathology telephone numbers 162
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 6
We, the Pathology Department of Hospital Ampang, pledge to provide
excellent, committed and quality services for the benefit of our customers
through:
1. Fair, friendly and compassionate treatment for all customers.
2. Provision of clear and complete explanations for all tests when
necessary.
3. The use of affordable, appropriate and quality methods in all services
provided by competent staff.
4. Appropriate and prompt handling of all urgent specimens according to
the Laboratory Turn-Around-Time (LTAT) of the department.
5. Maintaining confidentiality and secrecy of all patients’ information.
To be recognized as a medical laboratory providing quality diagnostic,
screening and consultancy services.
We aim to provide our community an efficient, and customer friendly service
towards achieving quality vision through a committed work force,
professionalism and research.
PATHOLOGY DEPARTMENT OATH
VISION OF PATHOLOGY DEPARTMENT
MISSION OF PATHOLOGY DEPARTMENT
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 7
A. GENERAL OPERATING POLICIES
1. INTRODUCTION
Pathology Department is one of the Clinical Support Services in Hospital Ampang. It
provides medical laboratory diagnostic and consultation services to the entire clinical
services in the hospital and external health facilities. The diagnostic services comprised of
several discipline in medical pathology, concerned with testing of biological samples
obtained from patients and non patient sample. The department also actively involved in
the hospital activities and provides training and research related to Pathology.
This handbook is designed to be a comprehensive guideline on the Pathology Services in
Hospital Ampang for medical practitioners and healthcare workers during their orientation
to the Pathology Services in Hospital Ampang.
This handbook is also used in the for the purpose of refreshing users on the proper
collection, packaging and transportation of specimens especially for specimens that are to
be outsourced for testing.
This handbook also provides special instructions pertaining to patient preparation for
before collecting a specimen, including type or number of specimens that are needed to be
sent to the laboratory.
This is to ensure meaningful, accurate and timely results are obtained after testing, which
are required in the management of patients.
2. LOCATION
Pathology Department is located on the second floor of the hospital building, adjacent to
the IT Department and CSSD unit. Access to the working areas in the department is limited
to authorized personnel and staff.
3. FUNCTIONS
3.1 To provide diagnostic services in the field of Chemical Pathology, Haematology,
Medical Microbiology, Histopathology, Cytopathology and Blood Transfusion
Medicine. These services are provided to Hospital Ampang, health clinics, other
government agencies, university hospitals and private health institution.
3.2 To provide advisory and consultancy services to customers in matters related to
Pathology services.
3.3 To provide training in technical and analytical skills for laboratory personnel and
staff from other hospitals, health clinics, institution of higher learning and other
government agencies.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 8
3.4 To involve in collaborative research and method development in Pathology and
other relevant clinical fields.
4. SCOPE OF SERVICES
The Department of Pathology provides the following services:
Unit Scope
1. Chemical Pathology Routine chemistry, endocrinology, lipids, special
protein, Therapeutic Drug Monitoring (TDM) and
clinical Toxicology.
2. Haematology
General Haematology and Coagulation.
3. Medical Microbiology Diagnostic Bacteriology, Serology, Immunology,
Virology screening, Parasitology and Mycology.
4. Blood Transfusion Immunohaematology and supply of blood
products and irradiated blood components.
5. Histopathology/
Cytopathology
Outsourced to Hospital Serdang and HKL.
The lists of tests offered by Pathology Department include the tests that are outsourced to:
For other location or tests, which are not listed in this book, prior arrangement and
approval by the Hospital Director is required.
For any enquiries on our services, please refer to the last page of this handbook for the
telephone or extension numbers of the laboratory units in the Pathology Department.
� Hospital Kuala Lumpur Pathology Department (HKL)
� Institute of Medical Research (IMR)
� Institut Perubatan Respiratori (IPR)
� Hospital Serdang Pathology Department
� Hospital Selayang Pathology Department
� Hospital Sungai Buloh Pathology Department
� Hospital Putrajaya Pathology Department
� Makmal Kesihatan Awam Sg Buloh (MKAK)
� The Chemistry Department of Malaysia
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 9
5. SERVICE HOURS
Urgent Tests (Refer to page 15 – 75 for the list of tests) is provided as 24 hours service in:
i. Chemical Pathology & Hematology (Integrated Lab)
ii. Microbiology
iii. Blood Transfusion Laboratory
Routine Tests:
iv. Microbiology Laboratory :
- 8.00am until 5.00pm (weekdays, weekends and public holiday)
v. Integrated Laboratory:
- 7.30am until 9.00pm (weekdays)
- 8.00am until 9.00pm (weekends and public holiday)
vi. Protein Laboratory:
- 8.00am until 5.00pm (weekdays)
vii. Blood Transfusion Laboratory:
- 8.00am until 5.00pm (weekdays, weekends and public holiday)
24 hours counter service for receiving specimen:
i. Common Receiving Area (CRA) – For all specimens (except for blood
transfusion specimens).
ii. Blood Transfusion Laboratory – For blood and blood components issuance
and tests.
.
6. QUALITY ASSURANCE & QUALITY IMPROVEMENT ACTIVITIES
The following quality assurance programs are carried out in the department:
• Internal quality control programs in all disciplines.
• External quality assurance participation
• Method validation and evaluation.
• Quality system review and audit.
• Timeliness of result by conducting turn-around-time studies.
• Customer Satisfaction Survey.
• Quality Study-Department Specific Approach
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 10
7. SAFETY MEASURES
Strict safety measures are practiced as outlined in Laboratory Safety Manual. Safety
measures should also be adhered to by all clients to ensure no potential hazards to
laboratory personnel.
8. TEST REQUEST INSTRUCTIONS
8.1 Laboratory requests are made through HIS except:
i. When system is down
ii. Request from external agencies
8.2 All tests for referral laboratory shall be accompanied by system generated PER PAT
301 or other special forms related to the tests.
8.3 All forms must be completely filled and should be signed by the medical officer
(except for system generated form) and accompanied by properly labeled
specimens. Relevant information on clinical history, provisional diagnosis and
treatment should be provided. The type of test requested must be clearly indicated.
In addition, site of tissue/specimen taken should be stated for Medical Microbiology,
Histopathology and Cytology.
9. SPECIMEN COLLECTION INSTRUCTIONS
9.1 Specimen collected must be properly labeled
9.2 Specimen must be properly managed i.e. collect and dispatch in system before
sending it to the laboratory.
9.3 Specimen must be dispatched to the laboratory in appropriate container or blood
collection tube as specified and according to transport requirement for the test.
(Refer to page 15 – 80 for the list of tests)
9.4 Specimen container or blood collection tube must be placed in a biohazard plastic
bag with the request form (where applicable) inserted into the pocket of the plastic
bag. The pink biohazard plastic bag is used for urgent test specimen only.
9.5 Routine test specimens can be placed into the clear biohazard plastic bag.
9.6 The blue biohazard plastic bag is mainly reserved for prioritized specimens such as
during outbreak.
9.7 Do not put more than one patient’s sample into one biohazard plastic bag.
9.8 Specimen must be send immediately to the laboratory after collection either by
pneumatic tube or porter system.
9.9 Outsource specimens will be dispatched out to the respective referral centre by 9.30
am during working days. Specimens must reach the laboratory before 9 am.
Inability to comply will result in delay of samples delivery (will be delivered to the
respective laboratory on the next working day)
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 11
10 BLOOD COLLECTION PROCEDURE
10.1 Venous blood is preferred.
10.2 To ensure consistent and accurate result, follow strictly the volume of blood required
for the type of test specified or fill blood till the mark on the label. (Refer to page 136 –
143)
10.3 To prevent haemolysis:
• avoid collecting blood from an area of haematoma.
• the site of collection should be allowed to air dry after cleansing with 70%
isoprophyl or ethyl alcohol.
• ensure smooth venipuncture and steady flow of blood into the syringe.
• do not force blood through needle while transferring blood into collection
tube.
10.4 Strict aseptic technique should be practiced when performing blood collection for
culture and sensitivity.
10.5 Draw of blood should be in a correct order beginning with blood culture followed by
other routine blood collection tubes. (Refer to page 136)
10.6 Immediately and gently mix blood collection tube by inverting several times. Do not
mix vigorously.
11 RESULTS/REPORTS
11.1 Results will be released to the LIS/CIS via Hospital Information System after
verification except for confidential result. Confidential result such as all HIV results
will only be released in a hardcopy format to the Head of Department.
11.2 During down time/system off-line, hardcopy of all results will be made available for
collection.
11.3 Hardcopy report will be made available for external clients.
11.4 All the outsource results will be entered into LIS manually.
11.5 Results exceeding critical limit or findings will be notified to the clinician.
11.6 Any discrepancy between clinical findings and report/results should be conveyed
immediately to relevant Pathology personnel.
12 REJECTION
Please refer to page 144 - 145 for the rejection criteria list.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 12
13 GENERAL WORKFLOW OF PATHOLOGY DEPARTMENT
Receive specimen from clinics/ wards
Results reporting
Yes No
Results received
Outsourced to reference lab
Integrated lab
Blood transfusion services lab
Microbiology lab
Process and analyze specimen
Distribute specimen to respective units
Print results (if external request : post the results or place in the KK pigeon-hole)
Protein lab
Request accepted?
Reject specimen Centrifuge specimen (if needed)
Inform clinics/ wards and document
End
Register and sorting of samples
Validation
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 13
14 LABORATORY TURN-AROUND-TIME (LTAT)
Priority Details Expected Time After
Specimen Received
Urgent tests • Chemical Pathology(Refer page 14)
• Full Blood Count
• CSF Microscopic Examination, CSF
‘Bacterial Antigen’ Test, BFMP1st case
( from ED)
• Emergency cross matching - first phase
• Safe O (uncross matched packed cell O)
• Conversion GSH to GXM
• Full cross matching
� 45 minutes
� 30 minutes
� 60 minutes
� 20 minutes
� Immediate
� 45 minutes
� 45 minutes
Routine tests • All Chemistry Pathology and
Hematology specimens
• Full cross matching
• Bacterial culture
• Mycology tests
• Mycobacterium culture
• FNAC and ‘Non gynecology’
� 3 hours
� 2 hours
� 3-7 days
� 14 days
� 2-8 weeks
� 1 week
Scheduled tests • Chemical Pathology, Hematology
(depending on test)
� 1-4 weeks
• Immunology and Virology
� 1 day – 3 weeks
(depending on test,
test done by
batches)
Outsourced
tests
Please refer to tables from pages 15 - 75
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 14
15 LIST OF URGENT TESTS / AFTER OFFICE HOURS
Test Name • Full Blood Count (FBC)
• APTT/PT/INR Ratio
• Urine Biochemistry
• Renal Profile (BUSE, Na, K, Cl and Creatinine)
• Liver Function Test ( ALP, ALT, total bilirubin, total protein and albumin)
• Blood Glucose
• Amylase/Diastase
• Troponin-T
• Total CK (if total CK high, will proceed to CKMB-mass)
• Arterial Blood Gas (ABG)
• Serum Calcium
• Serum Magnesium
• Serum Creatinine
• Serum Salicylates
• Serum Paracetamol
• Urine Paraquat
• Serum Bilirubin-Total, Direct and Indirect (for Neonatal cases only)
• Beta HCG/Urine Pregnancy Test (for cases suspected Molar pregnancy and Ectopic
Pregnancy)
• CSF Biochemistry
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 15
B. LIST OF TESTS Note:
i)TAT stated are based on working days . For outsource tests, TAT given is inclusive of estimated time taken for dispatching of
sample to referral lab till the time taken for the result to be reported or printed out.
ii) R: Routine. U: Urgent iii)NA: Not Applicable NOTE: Test highlighted in ‘GREY’ = Test offered to other hospitals.
1. CHEMICAL PATHOLOGY
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
1 Acetaminophen
(Paracetamol) Blood
Plain Gel
Tube 3ml
Internal 1 hour
2
Acid Alpha
Glucosidase Enzyme
(POMPE)
Blood
spot
S & S filter
paper
3 circles
of 1 cm
each
Special filter paper is used.
Please indent from CRA IMR 1 month
3 Acyl Carnitine
Profile Blood
Heparin
tube
3ml IMR 1 month
4 Acyl Carnitine Blood
spot
S&S filter
paper
3 circles
of 1cm
each
Special filter paper is used.
Please indent from CRA IMR 1 month
5 Adrenocorticotrophi
c Hormone (ACTH) Blood
Special
K3 EDTA 3ml Send specimen in ice bag HKL 1 month
6
Adequacy of
Haemodialysis
(kt/V)
Blood Plain Gel
Tube 3ml
Send sample for Urea pre and
post Haemodialysis
Internal R: 3 hours
U: 45 mins
7 Alanine
Transaminase Blood
Lithium
Heparin 3ml Internal
R: 3 hours
U: 45 mins
8 Albumin
Blood Lithium
Heparin 3ml
Internal
R: 3 hours
U: 45 mins
Urine
(UACR)
Universal
container 20ml
Early morning urine collection
is required Same day
Urine,
24hr
24 hr
Container
as per
collection Same day
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 16
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
9 Alcohol (Ethanol) Blood Fluoride
Oxalate 3ml
For Alcohol Poisoning, use
BORANG KIMIA-15 (Put all 3
orders in one form)
Chemistry
Dept, PJ 2 weeks
Alcohol (Methanol)
Blood Fluoride
Oxalate 3ml
Urine Universal
container 20ml
10 Alpha-1-Acid
Glycoprotein Blood
Plain Gel
Tube 3ml Internal 7 days
11 Alpha-1-Antitrypsin Blood Plain Gel
Tube 3ml HKL 2 weeks
12 Alpha-1-Antitrypsin-
Phenotyping Blood
Plain Gel
Tube 3ml Internal 1 month
13 Alpha 2-
Macroglobulin Blood
Plain
GelTube 3ml Internal 7 days
14 Alpha Feto-Protein
(AFP) Blood
Plain Gel
Tube 3ml HKL 10 days
15 Aluminum
Blood Plain Gel
Tube 3ml
Indicate the time of collection
and treatment given HKL
2 – 3
months Urine
Universal
container 20ml
Dialysate Plain gel
tube 2ml
16 Amino Acid
Blood Plain Gel
Tube 3ml
Send specimen in ice bag
IMR 1 month Urine
Universal
container 20ml
CSF Bijou
Bottle 1ml
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 17
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
17 Amikacin, Peak Serum Plain Gel
Tube 3ml
Specimen received after 4.00
pm will be tested on the next
working day
Internal Same day
18 Amikacin, Random Serum Plain Gel
Tube 3ml Internal Same day
19 Amikacin, Trough Serum Plain Gel
Tube 3ml Internal Same day
20 Ammonia Blood EDTA 3ml By Appointment. Send specimen
in ice bag Internal
R: 3 hours
U: 45 mins
21 Ammonium Chloride
Loading Test
Refer to page 90 for Ammonium
Chloride Loading Test. HKL 5 days
22 Amphetamine Urine Universal
container 20ml HKL
1 – 2
months
23 Amphetamine Types
Stimulant Drugs Urine
Universal
container 50 ml HKL
1 – 2
months
24 Amylase
Blood Lithium
Heparin 3ml
Internal R: 3 hours
U: 45 mins Urine
Universal
container 20ml
25 Antimony Dialysate Plain gel
tube 2ml
Chemistry
Dept, PJ
2 – 3
months
26 Aspartate
Transaminase Blood
Lithium
Heparin 3ml Internal
R: 3 hours
U: 45 mins
27 Apolipoprotein A-1 Blood Plain Gel
Tube 3ml IMR 1 month
28 Apolipoprotein B Blood Plain Gel
Tube 3ml IMR 1 month
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 18
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
29 Apolipoprotein C Blood Plain Gel
Tube 3ml IMR 1 month
30 Apolipoprotein D Blood Plain Gel
Tube 3ml IMR 1 month
31 Apolipoprotein E Blood Plain Gel
Tube 3ml IMR 1 month
32 Apolipoprotein E
(Phenotyping) Blood
Plain Gel
Tube
3ml IMR 1 month
33 Arsenic
Urine Special
container
as per
collection
Chemistry
Dept., PJ 2-3 months
Dialysate
Plain
Sterile
Tube
2ml
34 B 12, Vitamin Blood Plain Gel
Tube 3ml Internal 3 days
35 Barbiturate
Blood Plain Gel
Tube 3ml
Chemistry
Dept., PJ 2-3 months
Urine Universal
container 20ml
Chemistry
Dept., PJ 2-3 months
36 Barium Dialysate Plain gel
tube 2ml
Chemistry
Dept., PJ 2-3 months
37 Benzodiazepine Blood Plain Gel
Tube 3ml TDM Request form HKL 3 days
38 Beta Carotene Blood Plain Gel
Tube 3ml Private Lab NA
39
Beta Human
Chorionic
Gonadotrophin
Blood Plain Gel
Tube 3ml Internal
R: 3 hours
U: 1 hour
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 19
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
40 Beta-2
Microglobulin
Blood Plain Gel
Tube 3ml
Internal 7 days
Urine Universal
container 20ml
41 Beryllium Dialysate Plain gel
tube 2ml
Chemistry
Dept., PJ 2-3 months
42 Bicarbonate Dialysate Plain gel
tube 2ml Internal
R: 3 hours
U: 1 hour
43 Bilirubin, pediatric Blood
Lithium
Heparin,
Pead tube
1ml Protect from light Internal R: 3 hours
U: 45 mins
44 Bilirubin, Direct Blood Lithium
Heparin 3ml Protect from light Internal
R: 3 hours
U: 45 mins
45 Bilirubin, Total Blood Lithium
Heparin 3ml Protect from light Internal
R: 3 hours
U: 45 mins
46 Blood Gases Arterial,
Venous
Heparinis
ed
syringe
2ml Send specimen in ice bag Internal R: 3 hours
U: 45 mins
47 C-Reactive Protein
(CRP) Blood
Plain Gel
Tube 3ml Internal 3 hours
48 C-Peptide Blood Plain Gel
Tube 3ml HKL 1 month
49 Cadmium
Blood Plain Gel
Tube 3ml
Jabatan
Kimia
2-3 months
Urine Universal
container 20ml
Urine,
24hr
24 hr
Container
as per
collection
Dialysate Plain gel
tube 2ml
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 20
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
50 Caeruloplasmin Blood Plain Gel
Tube 3ml HKL 2 weeks
51 Calcium
Blood Lithium
Heparin 3ml
Internal R: 3 hours
U: 45 mins Dialysate
Plain gel
tube 2ml
Urine,
24hr
24 hr
Container
as per
collection
52 Calcitonin Blood Plain Gel
Tube 3ml
Send specimen in ice packs. At
lab, separate the serum
immediately, store at -20OC if
not outsourced on the same day.
Transport with ice packs
IKN 4-6 weeks
53 Calculi Analysis
Billiary/
Renal
Stone
Plain
Container HKL 2 weeks
54 Catecholamine Urine,
24hr
24 hr
Container
as per
collection
Urine with pH < 6.1 will be
rejected
Hospital
Putrajaya 2 weeks
55
Cancer Antigen 125
Blood Plain Gel
Tube 3ml HKL 10 days
56 Cancer Antigen 15-3 Blood Plain Gel
Tube 3ml HKL 10 days
57 Cancer Antigen 19-9 Blood Plain Gel
Tube 3ml HKL 10 days
58
Cannabis
(Cannabinoids)
Urine Universal
container 20ml HKL 1-2 months
59 Carcinoembryonic
Antigen (CEA) Blood
Plain Gel
Tube
3ml HKL 10 days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 21
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
60 Carbamazepine Blood
Plain Gel
Tube
3ml HKL 3 days
61 CAPD Adequacy of
Dialysis (kt/V)
Refer to page 91 for CAPD
Adequacy of Dialysis (kt/V).
Internal
3 hours
62 Chloride
Blood Lithium
Heparin 3ml
Internal
R: 3 hours
U: 45 mins
CSF Bijou
bottle 1-2ml
Dialysate Plain gel
tube 2ml
Sweat Plain gel
tube 2ml
Urine Universal
container 20ml Same day
Urine,
24hr
24 hr
Container
as per
collection Same day
63
Cholesterol-Total Blood Plain Gel
Tube 3ml Internal 3 hours
64 Cholinesterase Blood Plain Gel
Tube 3ml HKL 2 weeks
65 Chromium
Blood Plain Gel
Tube 3ml
Jabatan
Kimia 2-3 months
Dialysate Plain gel
tube 2ml
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 22
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
66 Cocaine Urine Universal
container 20ml
Chemistry
Dept., PJ 2-3 months
67 Complement 3 (C3) Blood Plain Gel
Tube 3ml HKL 10 days
68 Complement 4 (C4) Blood Plain Gel
Tube 3ml HKL 10 days
69 Copper
Urine 24 hr
Container
as per
collection
HKL 1 month
Dialysate
Plain gel
tube
2ml
70 Corporphyrin Urine Urine Universal
container 20ml Private Lab NA
71 Cortisol
Blood Plain Gel
Tube 3ml Internal 3 days
Urine Universal
container 20ml
HKL 3 weeks Urine,
24hr
24 hr
Container
as per
collection
72
Creatine Kinase
Isoenzyme (CK-MB)
Mass
Blood Plain Gel
Tube 3ml Internal
R: 3 hours
U: 1 hour
73 Cryoglobulin Blood Provided
by lab NA
By appointment (Ext : 6216).
Refer to Special Test Instruction
(Cryoglobulin)
Internal 21 days
74 Creatine Kinase Blood Lithium
Heparin 3ml Internal
R: 3 hours
U: 45 mins
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 23
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
75 Creatinine
Dialysate Plain gel
tube 2ml
Internal
Same day
Blood Lithium
Heparin 3ml
R: 3 hours
U : 45 mins
Urine Universal
container 40 ml Early morning specimen Same day
Urine,
24hr
24 hr
Container
as per
collection Same day
76 Creatinine Clearance
Urine,
24hr and
Blood
24 hr
urine
Container
& Lithium
Heparin
(blood)
Both 24hour urine and blood
sample required. Internal Same day
77 Cyclosporine,
Random Blood
Plain Gel
Tube
3ml
Specimen received after 4.00
pm will be tested on the next
working day
Internal Same day
78 Cyclosporine, 12H Blood
79 Cyclosporine, 24H Blood
80 Cyclosporine, 0 H Blood
81 Cyclosporine, 2 H Blood
82 CSF Biochemistry CSF
Bijoux
bottle, &
Fluoride
Oxalate
1-2ml Require 2 samples in 2 different
containers Internal 1 hour
83
Dehydroepiandroste
rone Sulphate
(DHEAS)
Blood Plain Gel
Tube 3ml HKL 3 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 24
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
84 Digoxin Blood Plain Gel
Tube 3ml TDM Request form HKL 3 days
85 Delta Amino
Laevulinic Acid Urine
24 hr
Container
as per
collection IMR 4-6 weeks
86 Electrolytes (ISE) Blood Lithium
Heparin 3ml Internal
R: 3 hours
U: 45 mins
87 Epinephrine
Urine Universal
Container 50ml
HKL 2 weeks Urine,
24hr
24 hr
Container
as per
collection
88 Estradiol Blood
Plain Gel
Tube
3ml HKL 3 weeks
89 Ferritin Blood Plain Gel
Tube 3ml Internal 3 days
90 Folate Blood Plain Gel
Tube 3ml Internal 3 days
91 Follicle Stimulating
Hormone Blood
Plain Gel
Tube 3ml HKL 3 weeks
92 Fluconazole Blood EDTA
tube 3ml
Post = 2 days after first injection
Steady state = 4/5 days after
daily injections
Internal 7 days
93 Fluoride
Blood Plain Gel
Tube 3ml
Chemistry
Dept, PJ 2-3 months Urine
Universal
container 20ml
Dialysis
Fluid
Plain gel
tube 2ml
94
Free Light Chain,
Kappa & Lambda
Blood Plain gel
tube 5ml
Internal 7 days
Urine Universal
container 20 ml
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 25
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
95 Free Chloride
Dialysis Fluid
Dialysis
Fluid
Plain gel
tube 2ml Internal Same day
96 Fructosamine Blood Plain Gel
Tube 3 ml Internal 7 days
97 Galactose, Total
Blood spot
Blood
spot
S&S filter
paper
3 circles
of 1cm
each
Special filter paper is used.
Please indent from CRA IMR 1 month
98
GALT Assay
(Galactose
Transferase)
Blood
spot
S&S filter
paper
3 circles
of 1cm
each
Special filter paper is used.
Please indent from CRA IMR 1 month
99
Gamma Glutamyl
Transferase
Blood Lithium
Heparin 3ml Internal 3 hours
100 Gentamycin,
Random Serum
Plain Gel
Tube 3ml Specimen received after 4.00
pm will be tested on the next
working day
Internal
Same day 101 Gentamycin, Trough Serum Plain Gel
Tube 3ml
Internal
102 Gentamycin, Peak Serum Plain Gel
Tube 3ml
Internal
103 Globulins,
Qualitative CSF CSF
Bijoux
bottle 1-2ml Internal 1 hour
104 Glucose
Urine Universal
container 20ml
Internal
Same day
Blood Fluoride
Oxalate 2ml
R: 3 hours
U: 1 hour
CSF Fluoride
Oxalate 1-2ml U: 1 hour
105 Glucose Tolerance
Test Blood
Fluoride
Oxalate 2ml
Send sample for Glucose Fasting
and Glucose 2 hour Internal
R: 3 hours
U: 45 mins
106 Gonadotropin
Releasing Hormone
Refer to page 93-94 for
Gonadotropin Releasing HKL 1 month
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 26
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
Stimulation Test Hormone Stimulation Test (FSH,
LH)
107 Growth Hormone
(Somatotrophin) Blood
Plain Gel
Tube 3ml HKL 1 month
108 Hemoglobin A1c Blood EDTA
Tube 3ml Internal 3 days
109 Haptoglobin Blood Plain Gel
Tube 3ml HKL 2 weeks
110
High Dose
Dexamethasone
Suppression Test
(HDDST)
Refer to page 94 for High Dose
Dexamethasone Suppression
Test (HDDST) - Cortisol
Internal 3 days
111 Homocysteine Blood Heparin
tube 3ml HKL 1 month
112 Homogentisic Acid Urine Universal
container 30 ml Fresh random urine IMR 4-6 weeks
113 Immunoglobulin A
(IgA) Blood
Plain Gel
Tube 3ml Internal
7 days 114 Immunoglobulin G
(IgG) Blood
Plain Gel
Tube 3ml Internal
115 Immunoglobulin M
(IgM) Blood
Plain Gel
Tube 3ml Internal
116 Immunoglobulin E
(IgE) Blood
Plain Gel
Tube 3ml IMR 1-2 months
117 Immunoglobulin
Levels Blood
Plain Gel
Tube 3ml
Send sample for Ig A, Ig G and Ig
M Internal 7 days
118 Inborn Errors Of
Metabolism
Refer to page 94 for Inborn
Errors Of Metabolism IMR 1 month
119 Insulin Blood Plain Gel
Tube 3ml HKL 3 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 27
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
120 Insulin-like Growth
Factor, Binding Blood
Plain Gel
Tube 3ml IMR 1-2 months
121 Insulin-like Growth
Factor, I Blood
Plain Gel
Tube 3ml IMR 1-2 months
122 Insulin Stress Test Refer to page 95 for Insulin
Stress Test HKL 1 month
123 Insulin Tolerance
Test
Refer to page 95 for Insulin
Tolerance Test HKL 1 month
125 Iron Binding
Capacity, Total Blood
Plain Gel
Tube 3ml Internal 3 days
126 Iron, Total Blood Plain Gel
Tube 3ml Internal 3 days
127 Ketones Urine Universal
container 20ml Send fasting urine
Internal
R: 3 hours
U: 45 mins
128
Lactate
CSF
Fluoride
Oxalate
1-2ml
By Appointment. Send specimen
in ice bag
Internal
U: 1 hour
Blood Fluoride
Oxalate 2ml
129
Lactate
Dehydrogenase
(LDH)
Blood Lithium
Heparin 3ml Internal
3 hours
130 Lead
Blood Plain Gel
Tube 3ml
HKL 6-10 weeks Urine Universal
container 20ml
Urine,
24H
24 hr
Container
as per
collection
Hair Universal
container NA
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 28
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
Dialysate Plain gel
tube 2ml
131 Lipid Profile Blood Plain Gel
Tube 3ml Internal
3 hours
132 Lipoprotein (a) Blood Plain Gel
Tube 3ml HKL 1 month
133 Lipoprotein
Electrophoresis Blood
Plain Gel
Tube 3ml
IMR 1 month
134 Lithium Blood Plain Gel
Tube 3ml HKL 10 days
135 Liver Function Test Blood
Lithium
Heparin
3ml Internal 3 hours
136
Low-Dose
Dexamethasone
Suppress
Blood Plain Gel
Tube 3 ml
Refer to page 96 for Low-Dose
Dexamethasone Suppress
(Cortisol test)
HKL 3 days
137 Luteinizing
Hormone (LH) Blood
Plain Gel
Tube 3ml HKL 3 weeks
138
Lysosomal Storage
Disorders Screening
(LSDS)
Blood
spot
S & S filter
paper
3 circles
of 1 cm
each
Special filter paper is used.
Please indent from CRA IMR 1 month
139 Magnesium
Blood
Lithium
Heparin
3ml
Internal R: 3 hours
U: 1 hour Dialysate
Plain gel
tube 2ml
Urine,
24hr
24 hr
Container
as per
collection
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 29
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
140
141 Mercury
Blood Plain Gel
Tube 3ml
IMR 6-10 weeks Urine Universal
container 20ml
Dialysate Plain gel
tube 2ml
142 Metabolic Screen Blood
spot
S&S filter
paper
3 circles
of 1cm
each
Special filter paper is used.
Please indent from CRA IMR 1 month
143 Methamphetamine
Urine Urine
Universal
container 20ml HKL 1-2 months
144 Methotrexate (MTX) Blood Plain Gel
Tube 3ml
Specimen received after 4.00
pm will be tested on the next
working day
Internal Same day
145 Methylenedioxyamp
hetamine Urine
Universal
container 20ml
Chemistry
Dept., PJ 2-3 months
146 Methylenedioxymet
hamphetamine Urine
Universal
container 20ml
Chemistry
Dept., PJ 2-3 months
147 Morphine Urine Universal
container 20ml HKL 1-2 months
148
Mycophenolic acid
(MPA)
Blood EDTA 3ml Test performed in HKL every
Wednesday in batches. HKL 1 week
149
Netilmicin Serum,
Peak
Serum
Plain Gel
Tube
3ml TDM Request form HKL 3 days
150 Netilmicin Serum,
Random Serum
Plain Gel
Tube 3ml TDM Request form HKL 3 days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 30
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
151 Netilmicin Serum,
Trough Serum
Plain Gel
Tube 3ml TDM Request form HKL 3 days
152 Nor epinephrine
Urine Universal
Container 50ml
Hospital
Putrajaya 2 weeks
Urine,
24hr
24 hr
Container
as per
collection
Please see request for
Cathecolamine
153 Oestradiol Blood Plain Gel
Tube 3ml
HKL 3 weeks
154 Osmolality
Blood Plain Gel
Tube 3ml
Internal 1 day
Urine Universal
Container 20ml
Urine samples MUST be sent
together with blood sample.
155 Organic Acids Urine Universal
container 20ml IMR 1 month
156 Orotic Acid
(Orotate) Urine
Universal
container 20ml IMR 1 month
157
Over night Low-Dose
Dexamethasone
Suppress
Blood Plain Gel
Tube 3 ml
Refer to page 96 for Overnight
Low-Dose Dexamethasone
Suppress (Cortisol test)
Internal 3 days
158
Over night single
dose Metyrapone
Stimulation
Blood Plain Gel
Tube 3 ml
Send sample for Cortisol and
ACTH at 8.00am HKL 14 days
159 Paracetamol
(Acetaminophen) Blood
Plain Gel
Tube 3ml Internal 1 hour
160 Paraquat Urine Universal
container 20ml Internal 1 hour
161 Parathyroid
Hormone (intact) Blood
Plain Gel
Tube 3ml Send specimen in ice bag HKL 3 weeks
162 Peritoneal
Equilibrium Test
Refer to page 97 for Peritoneal
Equilibrum Test (Urea,
Creatinine, Glucose)
Internal Same day
163 Phencyclidine Urine Universal 20ml HKL 3 days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 31
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
container
164 Phentermine Urine Universal
container 20ml HKL 3 days
165 Phenobarbital Level
Assay Blood
Plain gel
tube 3 ml TDM Request form HKL 3 days
166 Phenytoin (Dilantin) Blood Plain Gel
Tube 3ml TDM Request form HKL 3 days
167 Phosphate Inorganic
Blood Lithium
Heparin 3ml
Internal R: 3 hours
U: 1 hour Urine,
24hr
24 hr
Container
as per
collection
168 pH
Blood,
Arterial
Heparinis
ed
syringe
3ml
Strictly use dry heparin (coated)
syringe
Internal
45 mins
Blood,
Venous
Heparinis
ed
syringe
3ml 45 mins
Body
Fluid
Plain gel
tube 2ml
3 hours
Urine
Universal
container
20ml R: 3 hours
S: 45 mins
169 Plasma Very Long
Chain Fatty Acid Blood EDTA 3ml IMR 1 month
170 Potassium
Dialysate Plain gel
tube 2ml
Internal
R: 3 hours
U: 45 mins
Blood Lithium
Heparin 3ml
R: 3 hours
U: 45 mins
Sweat Plain gel
tube 2ml
R: 3 hours
U: 45 mins
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 32
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
Urine,
24hr
24 hr
Container
as per
collection Same day
171 Porphobilinogen Urine Universal
container 50ml IMR 2-4 weeks
172 Porphyrins
Stool Universal
container 30g
IMR 2-4 weeks
Urine
Universal
container
50ml
173 Pre-Albumin,
Quantitative Blood
Plain Gel
Tube 3ml Internal 7 days
174 Progesterone Blood Plain Gel
Tube 3ml HKL 3 weeks
175 Progesterone, 17
Hydroxyl Blood
Plain Gel
Tube 3ml IMR 6-7 weeks
176 Prolactin Blood Plain Gel
Tube 3ml HKL 3 weeks
177
Prostate Specific
Antigen (PSA) Total
Blood Plain Gel
Tube 3ml HKL 10 days
178 Protein,
Electrophoresis CSF
Bijou
bottle 1-2ml
CSF protein electrophoresis :
Sample must come in pair of CSF
and BLOOD
Refer to Special Test Instruction
(CSF Protein Electrophoresis)
Internal 21 days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 33
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
Blood Plain Gel
Tube 3ml
Serum Protein Electrophoresis
(SPE): Sample shall come in pair
of URINE and BLOOD
Refer to Special Test Instruction
(Serum Protein
Electrophoresis)
Urine Universal
container 20ml
179 Protein, Total
Blood Plain Gel
Tube 3ml
Internal
R: 3 hours
U: 45 mins
Amniotic
Fluid
Plain gel
tube 2ml
CSF Bijou
bottle 1-2ml
Dialysate Plain gel
tube 2ml
Body
Fluid
Plain gel
tube 2ml
Urine Universal
container 20ml 1 day
Urine,
24hr
24 hr
Container
as per
collection 1 day
180 Protein Creatinine
Index Urine
Universal
container 20ml Fresh morning sample. Internal 1 day
181 Pyruvate Blood Special
Container 3ml
Indent container from pediatric
lab HKL. Send specimen in ice
bag
HKL 2 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 34
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
182
Reducing Sugar
Urine Universal
container 20ml
Internal 1 day
Stool Universal
container 20ml
183 Renal Profile Blood Lithium
Heparin 3ml Internal
R: 3 hours
U: 45 mins
184 Renin Plasma EDTA
Tube 3ml
Hospital
Putrajaya 2 months
185 Renin/Aldosterone
Postural Test Blood
EDTA
tube 3ml
Refer to page 97 for
Renin/Aldosterone Postural
Test
Hospital
Putrajaya 2 months
186 Reverse Osmosis
Water Analysis RO Water
Universal
container 20 ml
Chemistry
Dept., PJ
2-3 months
187 Salicylate
Blood Plain Gel
Tube 3ml
Internal 1 hour Urine Plain Gel
Tube 3ml
Dialysate Plain gel
tube 2ml
188
Serum-Ascites
Albumin Gradients
(SAAG)
Blood Lithium
Heparin 3 ml
Internal 1 day Ascites
Fluid
Plain gel
tube 3 ml
189 Silver Dialysate Plain gel
tube 2ml
Chemistry
Dept., PJ 2-3 months
190 Sodium Dialysate Plain gel 2ml Internal R: 3 hours
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 35
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
tube U: 45 mins
Blood Lithium
Heparin 3ml
R: 3 hours
U: 45 mins
Sweat Universal
container 20ml
R: 3 hours
U: 45 mins
Urine,
24hr
24 hr
Container
as per
collection Same day
191 Sulphate Dialysate Plain gel
tube 2ml
Chemistry
Dept., PJ 2-3 months
192
Synacthen
(Cosyntropin) test,
short.
Blood Plain Gel
Tube 3 ml
Withold steroids for 24 hrs.
Administer Tetrasactrin 250ug
iv or im. Send sample for
Cortisol at 0hr, 30min and
60min
Internal 3 days
193 Tacrolimus Blood Plain Gel
Tube 3ml TDM Request form HKL 3 days
194 Testosterone Blood Plain Gel
Tube 3ml HKL 3 weeks
195
Thyroglobulin
Blood Plain Gel
Tube 3ml Send sample in ice IMR 1-2 months
Transferrin Blood
Plain Gel
Tube 3ml HKL 2 weeks
197
Tri-lodothyronine,
Free(FT3)
Blood Plain Gel
Tube 3ml Internal 3 days
198
Triglycerides,
Fasting
Blood Plain Gel
Tube 3ml Internal 3 hours
199
Troponin-T
Blood Plain Gel
Tube 3ml Internal 1 hour
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 36
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
200 Thyroid Function
Test Blood
Plain Gel
Tube 3ml Internal 3 days
201 Theophylline Blood Plain Gel
Tube 3ml
TDM Request form
HKL 3 days
202 Theophylline,
Trough Blood
Plain Gel
Tube 3ml TDM Request form HKL 3 days
203 Thyroid Stimulating
Hormone Blood
Plain Gel
Tube 3ml Internal 3 days
204 Thyroglobulin Blood Plain Gel
Tube 3ml Send sample in ice IMR 1-2 months
205 Thyroxine, Free
(FT4) Blood
Plain Gel
Tube 3ml Internal 3 days
206 Urine Biochemistry Urine Universal
container 20ml Fresh morning sample. Internal
R: 3 hours
U: 45 mins
Urine FEME Urine Universal
container 20ml
Refer Special Test Instruction
(UFEME) Internal
R: 3 hours
U: 45 mins
Urine Microscopy Urine Universal
container 20ml Internal 3 hours
207 Urine Myoglobin Urine Universal
container 10 ml
Around 10 ml urine collected in a
container that contains 200 mg of
sodium bicarbonate (2% final
concentration)
Internal 7 days
208 Uric Acid (Urates)
Blood Lithium
Heparin 3ml
Internal 3 hours Urine,
24hr
24 hr
Container
as per
collection
209 Urea
Blood Lithium
Heparin 3ml
Internal R: 3 hours
U: 45 mins Dialysate
Plain gel
tube 2ml
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 37
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
Urine Universal
container 20ml
Urine,
24hr
24 hr
Container
as per
collection
210 Urea & Electrolytes Blood Lithium
Heparin 3ml Internal
R: 3 hours
U: 45 mins
211
Urine
Glycosaminoglycan
or
Mucopolysaccharide
s
(GAGS/MPS)
Urine Universal
container 20ml IMR 1 month
212
Urine
Oligosaccharide
(OLIGO)
Urine Universal
container 20ml IMR 1 month
213
Valproic acid
Blood Plain Gel
Tube 3ml TDM Request form HKL 3 days
214
Valproic acid,
Trough
Serum Plain Gel
Tube 3ml TDM Request form HKL 3 days
215 Vancomycin, Peak Serum Plain Gel
Tube 3ml
Specimen received after 4.00
pm will be tested on the next
working day
Internal 1 day
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 38
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions Perform Site TAT
216 Vancomycin,
Random Serum
Plain Gel
Tube 3ml Internal
217 Vancomycin, Trough Serum Plain Gel
Tube 3ml Internal
218
Water Deprivation
Test
Refer to page 97 for Water
Deprivation Test Internal 1 day
219 Water Loading Test Refer to page 98 for Water
Loading Test Internal Same day
220 Xylose Absorption
Test Urine Urine
Plain
Container
Timed
Urine
Refer to page 98-99 for Xylose
Absorption Test Urine
By
Appointmen
t (Internal)
3 days
221 Zinc Blood Plain Gel
Tube 3ml
Jabatan
Kmia 2-3 months
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 39
2. MEDICAL MICROBIOLOGY
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
1 Acid Fast Bacilli
Stain (AFB)
Body Fluid ,Bronchial
Alveolar Lavage (BAL),
Nasopharyngeal
Aspirate (NPA),
Tracheal Aspirate,
Urine
Sterile
Container 3 ml Specify site of collection.
Internal 24 hours
Sputum Sterile
Container 3 ml
Collect 3 consecutive early
morning (after rising mouth)
sputum aseptically into the
container.
2 Acanthamoeba Cornea scrape, contact
lens
Sterile
container filled
with sterile
saline
NA By Appointment with IMR one
week earlier. IMR 3-4 weeks
3 Adenovirus
Antigen, IFAT
Bronchial Lavage,
Nasopharyngeal
Aspirate, Tracheal
Aspirate
Sterile
Container
NA
To get the slides from
microbiology laboratory
HKL 1-2 weeks
4
Adenovirus
Antigen,IFAT-
Skin
Skin Lesion Smears on slide
NA HKL 1-2 weeks
5 Adenovirus
PCR
Nasopharyngeal
Aspirate, BAL
Sterile
Container 3 ml Pack specimen in ice
MKAK 3-4 weeks
Throat swab Viral Transport
Media (VTM)
NA To get VTM from lab. Pack
specimen in ice
6 Air Sampling
Air Not Applicable
NA By Appointment. Internal 3-7 days
7 Allergy Testing
Blood Gel Tube 5 ml
IMR 3-4 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 40
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
8 Amoebiasis
Antibody(Ab) Blood Plain gel tube 5 ml IMR 2-3 weeks
9
Anti-
Acetylcholine
Receptor
Blood Plain gel tube 5 ml IMR 21 days
10 Anti Double-
Stranded DNA Blood Plain gel tube 5 ml Internal 2-4 weeks
11
Anti-Cyclic
Citrullinated
Peptides
Blood Plain gel tube 5 ml IMR 21 days
12 Anti-Gastric
Parietal
Blood Plain gel tube 5 ml IMR 2-3 weeks
13
Anti-
Mitochondrial
Ab
Blood Plain gel tube 5 ml IMR 2-3 weeks
14
Anti
Mycoplasma
pneumoniae
IgM
Blood Plain gel tube 5 ml Internal 1-7 days
15 Antinuclear Ab
(ANA) Blood Plain gel tube 5 ml
Internal 1-3weeks
16
Anti-Smooth
Muscle Ab
(ASMA)
Blood
Plain gel tube
5 ml IMR 2-3 weeks
17
Anti-
Streptolysin ‘O’
Titre (ASOT)
Blood
Plain gel tube
5 ml Internal 1-3 days
18 Aspergillus
Galactomannan
Ag
Blood
Plain gel tube 5 ml Transport at ambient
temperature. If delayed, keep
at 2-80C
HSB 1-2 weeks
Bronchial Alveolar
Lavage
Sterile
Container 3 ml
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 41
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
19 Bacterial
Antigen Test CSF
Sterile Bijoux
bottle 1-3 ml
Internal 1 hour
20
Blood Film For
Malaria
Parasites
(BFMP)
Blood Smears on slide NA
Send 2 slides consist of thin
and thick blood smears. Please
ensure air-dried for 10-20min.
Refer to pages from 112-115
for smear preparation
guideline.
Internal 1 hour
(new case)
21 Blood film for
Microfilaria Blood Smears on slide NA
Thick blood smear from
fingerprick taken from 9pm –
12 midnight
Makmal
Vektor 2-7days
22 Blood Film For
Trypanosoma Blood Smears on slide NA
Send thin blood smear. Air-
dried the slide for 5 to 10 min IMR 1 month
23
Bordetella
pertussis PCR
NPA or
Nasopharyngeal swab
NPA in sterile
container/
Dacron swab in
Stuart’s
transport
media
Pack specimen in ice IMR 1-2 weeks
24
Brucella sp Ab
Blood
Plain gel tube
5 ml Fresh specimen. To inform lab
prior sending sample.
To use special form (refer to
page 149)
IMR 1-2 weeks
25 Brucella sp PCR
Blood
EDTA tube
5 ml IMR 1-2 weeks
26
BK virus
Genome
Detection
Blood
EDTA tube
5 ml
Send in ice pack HSB 1-2 weeks
Urine Sterile
container NA
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 42
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
27
Borrelia
burgdoferi Ab
Blood Plain gel tube
5 ml HSB 1-2 weeks
28 Candida
Antigen
Blood
Plain gel tube
5 ml
HSB 1-2 weeks Transport at ambient
temperature. If delayed, keep
at 2-8ºC Bronchial Alveolar
Lavage
Sterile
container 3 ml
29
Cardiolipin Ab
(Anti-
Cardiolipin)
Blood Plain gel tube 5 ml Send immediately.
Transport at ambient
temperature. If delayed, keep
at 2-8ºC
IMR 2-3 weeks
30 Cat scratch
disease Ab Blood Plain gel tube 5 ml IMR 2-3 weeks
31
Chlamydia
pneumoniae
Antibody
Blood Plain gel tube
3 ml HSB 1-2 weeks
32
Chlamydia
trachomatis
Antibody
Blood
Plain gel tube
5 ml HSB 1-2 weeks
33 Chlamydia
trachomatis -IF Genital/eye discharge
Smears on
Teflon slide NA
Smears to be fixed with
acetone. HKL 2-3 weeks
34 Clostridium
difficile Toxin Stool
Sterile
Container NA Fresh loose stool required. Internal 1 day
35 Cryptococcal
Antigen
CSF Sterile Bijoux
bottle 3 ml Internal I hour
Blood Plain gel tube 5 ml HKL 1 week
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 43
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
36 Culture &
Sensitivity
Bronchial Lavage,
Nasopharyngeal
Aspirate,
Tracheal Aspirate,
Corneal Scrapping,
Intravascular Device
Catheter
Sterile
Container NA Internal 3-7 days
37
Culture &
Sensitivity-
Aqueous Fluid
Aqueous Fluid Sterile
Container 3 ml Internal 3-7 days
38
Culture &
Sensitivity-
Blood
Blood Blood Culture
Bottle
5-10 ml
for Adult /
1-2 ml for
Pediatric
Refer to page 102-103 for
Blood Cultures
Internal 3-7 days
39
Culture &
Sensitivity-
Body Fluid
Body Fluid Sterile
Container 5 ml Specify site of collection. Internal 3-7 days
40
Culture &
Sensitivity-
Bone
Bone Sterile
Container
Not
Applicable Do not put in formalin Internal 3-7 days
41
Culture &
Sensitivity-
Bone Marrow
Bone Marrow Blood Culture
Bottle
5-10 ml
for Adult /
1-2 ml for
Pediatric
Inoculate into a manufacturer
Blood Culture bottle. Do not
refrigerate.
Internal 3-7 days
42 Culture &
Sensitivity-CSF CSF
Sterile Bijoux
bottle 3 ml Send immediately to lab Internal 3-7 days
43
Culture &
Sensitivity-
Contact Lens
Contact Lens Sterile
Container NA Do not put in formalin. Internal 3-7 days
44
Culture &
Sensitivity-Ear
Swab
Ear discharge
Amies
Transport
Medium
NA Do not refrigerate. Send
immediately. Internal 3-7 days
45 Culture & Eye discharge Amies NA Do not refrigerate. Send Internal 3-7 days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 44
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
Sensitivity-Eye
Swab
Transport
Medium
immediately.
46
Culture &
Sensitivity-
Environment
Environment Samples Sterile Swab
NA By Appointment. Internal 3-7 days
47
Culture &
Sensitivity-
High Vaginal
Swab
High Vaginal Swab
(HVS)
Amies
Transport
Medium
NA
Internal 3-7 days
48
Culture &
Sensitivity-Low
Vaginal Swab
Low Vaginal Swab
(LVS)
Amies
Transport
Medium
NA Do not refrigerate. Send
immediately. Internal 3-7 days
49
Culture &
Sensitivity-
Nasal Swab
Nasal Swab
Amies
Transport
Medium
NA Mainly for MRSA screening Internal 2-3 days
50
Culture &
Sensitivity-
Peritoneal
Fluid
Peritoneal Fluid Sterile
Container 5 ml Internal 3-7 days
51
Culture
&Sensitivity-
Pleural Fluid
Pleural Fluid Sterile
Container 3 ml Internal 3-7 days
52 Culture &
Sensitivity-Pus Pus
Sterile
Container
NA Internal 3-7 days
53
Culture &
Sensitivity-
Rectal Swab
Rectal Swab
Cary-Blair
transport
medium
NA Internal 3-7 days
54
Culture &
Sensitivity-
Sputum
Sputum Sterile
Container 3 ml Internal 3-7 days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 45
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
55
Culture &
Sensitivity-
Stool
Stool
Cary-Blair
transport
medium /
Fresh stool in
stool container
NA/ 5 gm Internal 3-7 days
56
Culture &
Sensitivity-
Throat Swab
Throat Swab
Amies
Transport
Medium
NA Internal 3-7 days
57
Culture &
Sensitivity-
Tissue
Tissue Sterile
Container
NA Internal 3-7 days
58
Culture &
Sensitivity-
Urine
Urine Sterile
Container 5 ml
Please indicate method of
collection Internal 3-7 days
59
Culture &
Sensitivity-
Urethral Swab
Urethral Swab
Amies
Transport
Medium
NA Do not refrigerate. Send
immediately. Internal 3-7 days
60
Culture &
Sensitivity-
Vitreous Tap
Vitreous Tap Sterile
Container 3 ml Internal 3-7 days
61
Culture &
Sensitivity-
Wound Swab
Wound Swab
Amies
Transport
Medium
NA Specify site of collection. Internal 3-7 days
62 Cysticercosis
Antibody Blood Plain gel tube 5 ml IMR 3-4 weeks
63 Cytomegalovirus (CMV) IgM
Blood Plain gel tube 5 ml HSB 1-2 weeks
64 Cytomegalovirus (CMV) IgG
Blood Plain gel tube 5 ml HSB
1-2 weeks
65
Cytomegalovirus (CMV)Genome
Detection-Blood
EDTA tube
5 ml Send specimen in ice pack
HSB 1-2 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 46
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
Blood
66
Cytomegalovirus (CMV)Genome
Detection-CSF CSF
Sterile Bijoux
bottle 1 ml Send specimen in ice pack HSB 1-2 weeks
67
Cytomegalovirus (CMV)Genome
Detection-Body
Fluid
Body Fluid Sterile
Container 3 ml
Specify site of collection. Pack
specimen in ice. HKL 1-2 weeks
68
Cytomegalovirus (CMV)Genome
Detection-BAL
Bronchial Alveolar
Lavage
Sterile
Container 3 ml Send specimen in ice pack HSB 1-2 weeks
69 Dengue IgG Blood Plain gel tube 5 ml HKL 1-2 weeks
70 Dengue IgM Blood Plain gel tube 5 ml Internal 2-7 days
71
Dengue Virus
Genome
Detection-
Blood
Blood EDTA tube
5 ml Send specimen in ice pack IMR 1-2 weeks
72
Dengue Virus
Genome
Detection-
Tissue
Tissue Sterile
Container NA
Specify site of collection. Do
not put in formalin. Pack
specimen in dried ice. Send
immediately.
IMR 1-2 weeks
73
Diphteria PCR
or culture
Nasopharyngeal/
throat swab
Dacron swab in
Stuart’s
transport
media NA
To get the swab from
Microbiology lab. Send in ice
pack IMR 1-2 days
Tissue ( pseudo-
membrane)
Put with sterile
saline in sterile
container
Send specimen in ice pack
74 Echinococcosis
Antibody Blood Plain gel tube 5 ml Send immediately. IMR 2-3 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 47
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
75 Enterovirus
Antigen, IFAT Skin lesion Smears on slide NA
Smears on Teflon coated micro
well slide. Air dry the slide for
5-10 minutes
HKL 1-2 weeks
76
Epstein Barr
Virus (EBV)
Genome
Detection-
Blood
Blood EDTA tube
5 ml Send specimen in ice pack HSB 1-2 weeks
77
Epstein Barr
Virus Genome
Detection-
CSF Sterile Bijoux
bottle
NA Send specimen in ice pack HSB 1-2 weeks
78
Epstein Barr
Virus Genome
Detection-
Tissue
Tissue Sterile
Container
NA Specify site of collection. Do
not put in formalin. Pack
specimen with ice.
HSB 1-2 weeks
79
Epstein Barr
Virus (EBV)
IgG
Blood Plain gel tube 5 ml HSB 1-2 weeks
80 Epstein Barr
Virus IgM Blood Plain gel tube 5 ml HSB 1-2 weeks
81
Extractable
Nuclear Ag - Scl
70,Sm,SSB/La,
Anti Jo-
1,RNP,SSA/Ro
Blood Plain gel tube 5 ml IMR 2-3 weeks
82
Filarial
Serology
(Antibody for
B. malayi ,
W.bancrofti)
Blood Plain gel tube 3 ml IMR 2-3 weeks
83 Fungal Culture Hair, Nail Directly onto
an agar plate NA Internal 14-21 days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 48
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
84 Fungal Culture-
Aqueous Fluid Aqueous Fluid
Sterile
Container 3 ml Send immediately. Internal 14-21 days
85 Fungal Culture-
Blood Blood
Fungal Culture
Bottle
5-10ml for
Adult /
1-2 ml for
Pediatric
Internal 14-21 days
86 Fungal Culture-
Bone Marrow Bone Marrow
Fungal Culture
Bottle
3-5ml for
Adult /0.5-
1ml for
Pediatric
Internal 14-21 days
87 Fungal Culture-
sterile Fluid
Body Fluid, Peritoneal
Fluid, pleural
fluid,vitreous fluid
Sterile
container 3 ml Send immediately. Internal 14-21 days
88 Fungal Culture-
CSF Cerebral Spinal Fluid Bijoux bottle 3ml Internal 14-21 days
89
Fungal Culture-
Corneal
Scrapping
Corneal Scrapping Directly onto
an agar plate NA Send immediately. Internal 14-21 days
90 Fungal Culture-
Pus Pus
Sterile
Container
NA Internal 14-21 days
91 Fungal Culture-
Sputum Sputum
Sterile
Container
NA Collect three consecutive early
morning. Send immediately. Internal 14-21 days
92 Fungal Culture-
Tissue Tissue
Sterile
Container
NA Internal 14-21 days
93 Fungal Culture-
Urine Urine
Sterile
Container 5 ml
Collect early morning
midstream urine Internal 14-21 days
94 Fungal Culture-
Wound Swab Wound Swab
Amies
Transport
Medium
NA Send immediately. Internal 14-21 days
95 Fungal PCR-
Blood Blood EDTA Tube 2-3 ml
Send immediately. IMR 1-2 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 49
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
96 Fungal PCR-
sterile isolates
BAL, body fluid,
aspirates, CSF, tissue
Sterile
Container 2-3 ml
Send immediately. IMR 1-2 weeks
97 Hanta Virus Ab Blood Plain gel tube 5 ml HSB 1-2 weeks
98 Hepatitis A IgM Blood Plain gel tube 5 ml HSB 1-2 weeks
99 Hepatitis A IgG Blood Plain gel tube 5 ml HKL 1-2 weeks
100 Hepatitis B
core Ab Total Blood Plain gel tube 5 ml Internal 1-7 days
101 Hepatitis B
core IgM Blood Plain gel tube 5 ml HSB 1-2 weeks
102 Hepatitis B e
Antibody Blood Plain gel tube 5 ml Internal
1-7 days
103 Hepatitis B e
Antigen Blood Plain gel tube 5 ml Internal
1-7 days
104
Hepatitis B
surface
Antibody
Blood Plain gel tube 5 ml Internal 1-7 days
105 Hepatitis B
surface Antigen Blood Plain gel tube 5 ml Internal 1-7 days
106
Hepatitis B
Virus DNA Genome
Detection
(viral load)-
Blood
Blood EDTA tube 5 ml Send specimen in ice pack HSB 1-2 weeks
107
Hepatitis B
Virus DNA
Genome
Detection
(viral load)-
Tissue
Liver Tissue Sterile
Container NA
Do not put in formalin.
Send specimen in ice pack HSB 1-2 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 50
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
108 Hepatitis C
Antibody Blood Plain gel tube 5 ml Internal 1-7 days
109
Hepatitis C _
Immunoblot
(confirmatory)
Blood Plain gel tube 5 ml HSB 2-3 weeks
110
Hepatitis C
Virus RNA
Genome
Detection-
Blood (viral
load)
Blood EDTA tube 5 ml Send specimen in ice pack HSB 1-2 weeks
111
Hepatitis C
Virus RNA Genome
Detection-
Tissue (viral
load)
Liver Tissue Sterile
Container NA
Do not put in formalin.
Send specimen in ice pack HSB 1-2 weeks
112 Hepatitis C
Genotyping Blood Plain gel tube 5 ml
Send in ice pack. To fill up PER
PAT 301 form & signed by
Gastro Specialist only.
HKL 2-3 weeks
113 Herpes simplex
1+2 Virus IgG Blood Plain gel tube 5 ml HSB 1-2 weeks
114 Herpes simplex
1+2 Virus IgM Blood Plain gel tube 5 ml HSB 1-2 weeks
115
Herpes simplex
1 Virus
Antigen,IFAT-
Skin
Skin lesion Smears on slide NA
Smears on Teflon coated micro
well slide. Air dry the slide for
5-10 minutes.
HKL 3-4 weeks
116
Herpes simplex
2 Virus
Antigen,IFAT-
Skin
Skin lesion Smears on slide NA
Smears on Teflon coated micro
well slide. Air dry the slide for
5-10 minutes. HKL 3-4 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 51
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
117
Herpes simplex
Virus
1&2,IFAT-
Genital
Genital Smears on slide
NA Smears on Teflon coated micro
well slide. Air dry the slide for
5-10 minutes. HKL 3-4 weeks
118
Herpes simplex
Virus 1 &
2,IFAT-Others
Smears from any
lesion Smears on slide
NA Smears on Teflon coated micro
well slide. Air dry the slide for
5-10 minutes.
HKL 3-4 weeks
119
Herpes simplex
Virus (HSV)
1 & 2 Genome
detection
Blood EDTA tube
5 ml
Send specimen in ice pack HSB 1-2 weeks CSF
Sterile
container
1 ml
Vesicle fluids
120 HIV Antibody
(Screening) Blood Plain gel tube 5 ml Internal 2-7 days
121 HIV- Particle
Agglutination (supplementary)
Blood Plain gel tube 5 ml Internal 2-7 days
122
HIV-
Immunoblot
(confirmatory)
Blood Plain gel tube 5 ml HSB 2-3 weeks
123
HIV Genome
Detection
(cDNA) PCR for
Peadiatric
Blood EDTA Tube 5 ml
Use special request form (page
152). To send with mother’s
blood if available.
Send specimen in ice pack
IMR 2-3 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 52
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
124
HIV RNA PCR
Viral Load
(Quantitative)
Blood EDTA Tube 5ml Send specimen in ice pack HSB 1-2 weeks
125 H1N1/H7N9/
H5N1(PCR)
Sputum, BAL, NPA
Sterile
container
Send specimen in ice pack
HSB
1-2 weeks
Nasopharyngeal or
throat swab VTM NA HSB
1-2 weeks
For all request associated with HLA- prior appointment and special form (refer page158-161) are required to send specimen
for this test. Please call 03-26162581 (Unit AIRC, IMR)
126
HLA Typing
Class I (Loci A ,
B & C) –PCR
Blood EDTA Tube 6 ml
By Appointment. Transport at
room temperature. Use
form”BMT HLA-Molecular
Typing-PCR”
IMR 1 month
127
HLA Typing
Class I &II (Loci
A , B & DR )PCR
Blood EDTA Tube 6 ml IMR 1 month
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 53
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
128
HLA Typing
Class II (Loci
DR and DQ)-
PCR
Blood EDTA Tube 6 ml
By Appointment. Transport at
room temperature. Use
form”BMT HLA-Molecular
Typing-PCR”
IMR 1 month
129
HLA Typing
Allele Specific
High
Resolution-PCR
Blood EDTA Tube 6 ml
By Appointment. Transport at
room temperature. Use form
“ HLA-PCR method”
IMR 1 month
130
HLA Typing for
Disease
Association
(B27,B15:02,
B05, others)-
PCR
Blood EDTA Tube 6 ml IMR 1 month
131
HLA Antibody
Screening
(Panel reactive
Blood Plain Tube 10 ml
By Appointment. Transport at
room temperature. Use form
for “request for PRA/DSA test”
IMR 1 month
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 54
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
Antibody-
PRA)- Elisa
method
132
HLA Antibody
Detection
(Donor Specific
Antibody-DSA)-
Luminex
method
Blood Plain Tube 10 ml IMR 1 month
133
HLA
Crossmatch-
Complement
Dependent
Cytoxicity
(CDC) method
Blood
Donor: Sodium
Heparin 18 ml
By Appointment. Transport at
room temperature. Use special
request form (Request for
HLA Crossmatch Test)
IMR 1 month Patient: Plain
Tube 5 ml
134
HLA
Crossmatch-
Flow
Cytometry
method
Blood
Donor: Sodium
Heparin 18 ml
By Appointment. Transport at
room temperature. Use special
request form (Request for
HLA Crossmatch Test)
IMR 1 month Patient: Plain
Tube 5 ml
Blood Donor- Heparin
Tube 15 ml
135
Human T-
Lymphocyte
Virus
(HTLV)1+2Ab
Screening
Blood Plain gel tube 5 ml . HSB 1-2 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 55
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
136
Intestinal
Protozoa
(E.histolytica,
Giardia
instestinalis)
Stool Sterile
Container
5 gm
(thumb
nail
size)/5ml
diarrhea
stool
Please provide 1 fresh and 1
PVA preserved stool (1 part
faecal mix with 3 parts PVA). 5
gm is equivalent to thumb nail
size
IMR 3-4 weeks
137
Japanese
encephalitis
(JE) Serology
CSF Sterile
Container 3 ml
MKAK 3-4 weeks
Blood Plain gel tube 5 ml
138
Japanese
encephalitis
PCR
CSF Sterile
Container 0.5 ml
IMR 1-2 weeks
Blood Plain gel tube 5 ml
139
Legionella
Antigen
Legionella
Antibody
( IgG, IgM)
Urine
Blood
Sterile
Container
Plain gel tube
5 ml
5 ml
Internal
MKAK
1-3 days
1-2 weeks
140 Leptospira IgM
Blood Plain gel tube 5 ml Internal 1-7 days
141 Leptospira
MAT Blood Plain gel tube 5 ml
Only if Leptospira IgM
positive/inconclusive. Use
Lepto IMR form(page 148).
IMR 2-3 weeks
142 Leptospira
culture Blood
Sodium
heparin tube 2-3 ml
Within first 10 days from onset
and prior to antibiotics. Use
special IMR form (page 148).
IMR 4 weeks
143 Leishmaniasis
Antibody Blood Plain gel tube 5 ml IMR 3-4 weeks
144 Leishmaniasis
microscopy
Bone marrow, Skin
ulcer Smears on slide NA
By Appointment. Air-dried
smear.
IMR 1-2 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 56
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
145 Line Probe
Assay Sputum
Sterile
Container 3 ml
For sample with AFB smear
positive MKAK
4days-1
week
146
Malaria
Antibody
Blood Plain gel tube 5 ml IMR 1 week
147
Measles IgG
,IgM
Blood Plain gel tube 5 ml IgM: To use special request
form (refer page 150)
MKAK
3-4 weeks
148
Melioidosis
Antibody
(Burkholderia
pseudomallei )
Blood
Plain gel tube
5 ml
IMR 2-3weeks
149
MERS-CoV
(Coronavirus)
PCR
Recommended (LRT ):
BAL/ tracheal
aspirate
Sterile
Container
Transport in blue biohazard
plastic bag with ice .. Lower
Respiratory Tract (LRT)
specimens are strongly
recommended.
Send specimen in ice pack.
HSB 2 days – 1
week
If LRT specimen not
available:
Nasopharyngeal AND
Oropharyngeal swab
Viral Transport
Media (VTM)
Positive result will be
informed verbally first by
referral lab.
Send specimen in ice pack
150 Mumps IgG
Blood Plain gel tube 5 ml HKL 2-3 weeks
151 Mumps IgM
Blood Plain gel tube 5 ml HKL 2-3 weeks
152 Mycobacterium
C&S
Bronchial Lavage,
Tracheal Asp
Sterile
Container 3 ml Send immediately. IPR
10-20
weeks
153 Mycobacterium
C&S - Blood Blood
TB Culture
Bottle
5-10 ml
for Adult /
1-2 ml for
Inoculate into a manufacturer
TB Culture bottle and send
immediately.
Internal
&
IPR
10-20
weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 57
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
Pediatric Specimen will be send to IPR if
positive for further testing.
154
Mycobacterium
C&S - Body
Fluid
Body Fluid, pleural
fluid, gastric lavage
Sterile
Container 5 ml
Specify site of collection. Send
immediately.
IPR 10-20
weeks
155
Mycobacterium
C&S- Bone
marrow
Bone Marrow Sterile
Container 0.5 ml Send immediately.
IPR, 10-20
weeks
156 Mycobacterium
C&S - CSF CSF
Sterile
Container 0.5 ml Send immediately.
IPR 10-20
weeks
157 Mycobacterium
C&S - Pus Pus
Sterile
Container 3 ml Specify site of collection.
IPR 10-20
weeks
158 Mycobacterium
C&S - Sputum Sputum
Sterile
Container 3 ml
Collect 3 consecutive early
morning (after rising mouth)
sputum aseptically into the
container.
IPR
10-20
weeks
159 Mycobacterium
C&S -Tissue Tissue
Sterile
Container NA
Specify site of collection. Do
not put in formalin.
IPR 10-20
weeks
160 Mycobacterium
C&S - Urine Urine
Sterile
Container 50 ml
Collect early morning
midstream urine on 3
consecutive mornings.
IPR 10-20
weeks
161
Mycobacterium
TB Genome
Detection
Bronchial Alveolar
Lavage, Tracheal
aspirate, sputum
Sterile
Container NA Send immediately. MKAK
10-20
weeks
162
Mycobacterium
TB Genome
Detection-Tissue
Tissue Sterile
Container
NA Specify site of collection. Do
not put in formalin.
MKAK 10-20
weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 58
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
163 Mycobacterium
TB Gene Expert
Sputum
Sterile
container
NA Smear negative with:
-poor/non respond to
treatment
-relapsed patient, defaulted
-suspected TB before
bronchoscopy
IPR
1-5 days
CSF
Suspected TB meningitis
Tracheal
asp/BAL/sterile body
fluid/urine
Sterile
container
NA
Clinician to get prior approval
from respiratory consultant in
IPR
IPR 1-5 days
164 Nipah IgM
Blood Plain gel tube 5 ml IMR 2-3 weeks
165 Nipah IgG
Blood Plain gel tube 5 ml IMR 2-3 weeks
166
Opportunistic
Intestinal
Parasites (Microsporidium
Isospora,
Cryptosporidium
,Protozoan cysts,
Helminth ova &
larvae)
Stool Sterile
Container
5 gm
(thumb
nail
size)/5ml
diarrhea
stool
Provide 1 fresh and 1 PVA
preserved stool (1 part faecal
mix with 3 parts PVA).
IMR 3-4 weeks
167 Occult Blood Stool Sterile NA Internal 1-2 days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 59
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
(Haema Test)
Container
168
Parvo Virus
( IgG, IgM)
Blood Plain gel tube 5 ml HSB 1-2 weeks
169 Pneumocystis
carinii
Induced Sputum or
BAL
Sterile
Container 3 ml IMR 1-2 weeks
170
Dihydrorhoda
mine test
Blood Lithium
Heparin
2 ml from
patient &
2 ml from
unrelated
healthy
person
For Primary
Immunodeficiency (PID)
screening, to use special form
from AIRC, IMR (provided in
Public Folder, Hospital
Ampang).
By Appointment in IMR
(call 03-26162581/26162782
for appointment).
To call Microbiology lab at
6224/6057 before sending to
the lab.
Please use PINK biohazard
plastic bag.
To arrive at lab by 8.30 am
IMR 2-3 weeks 171
T and B cells
enumeration
Test
Blood (fresh) EDTA
2 ml
172
Immunoglobulin and
Complement
Blood Plain 5 ml
173 Poliovirus-stool Stool Sterile
Container
For investigations of AFP, need
2 stool sample 24 hours apart,
within 14 days of onset. To use
special AFP IMR form (refer
page 147). Please inform the
lab prior to sending specimen.
IMR 2-3 weeks
174
Respiratory
Virus Antigen
Screening-IFAT
(Adenovirus,
RSV, influenza
Nasopharyngeal Asp,
Bronchial lavage,
tracheal aspirate
Sterile
Container 5 ml Send specimen in ice pack HSB 1-2 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 60
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
A/B,
parainfluenza
1/2/3
175
Rheumatoid
Factor (RA
Factor)
Blood Plain gel tube 5 ml Internal 1-7 days
176 Rotavirus
Antigen Stool
Sterile
container NA Send immediately. Internal Same day
177 Rubella IgG
Blood Plain gel tube 5 ml HKL 2-3 weeks
178 Rubella IgM
Blood Plain gel tube 5 ml HKL 2-3 weeks
179
Salmonella
serology
Blood Plain gel tube 5 ml HKL 2-3 weeks
180
Schistosomiasis
Antibody
Blood Plain gel tube 5 ml Send immediately. IMR 3-4 weeks
181
Sterility
Testing-
Biological
Indicator
Biological Indicator NA NA Send immediately. Internal 2 days
182
Toxocara
Antibody
Blood Plain gel tube 5 ml IMR 3-4 weeks
183
Toxoplasma
IgG
Blood Plain gel tube 5 ml HSB 1-2 weeks
184 Toxoplasma
IgM Blood Plain gel tube 5 ml HSB 1-2 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 61
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
185
Treponema
pallidum-
(TPPA)
Blood Plain gel tube 5 ml Internal 2-7 days
186
TORCHES
(IgG, IgM)
Blood Plain gel tube 5 ml HKL 1-2 weeks
187
Treponema
pallidum
(VDRL)-CSF
CSF Sterile
Container 3 ml Send immediately. HKL 1-2 weeks
188
Treponema
pallidum-RPR
(Screening)
Blood Plain gel tube 5 ml Send immediately. Internal 1-7 days
189
Trichomonas
vaginalis
Antigen
HVS
Amies
Transport
Medium
NA Send immediately. HKL 1-2 weeks
190
Varicella zoster
IgG, IgM
Blood Plain gel tube 5 ml HSB 1-2 weeks
191
Varicella zoster
Virus Antigen,
IFAT
Skin lesion Smears on slide NA
Smears (minimum 2) on
Teflon coated micro well slide.
Air dries the slide for 5-10
minutes. HKL 1-2 weeks
Bronchial Lavage,
Nasopharyngeal
aspirate
Sterile Container
3 ml Send specimen in ice pack
192
Varicella zoster
Genome
detection
Blood EDTA tube 5 ml Send specimen in ice pack HSB 1-2 weeks
193
Varicella zoster
Genome
detection
CSF, Vesicle fluids Sterile
Container 1 ml Send specimen in ice pack HSB 1-2 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 62
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
194 Viral Isolation
Study
Bronchial Lavage,
Tracheal Asp,
Nasopharyngeal
aspirate
Sterile
Container 3 ml Send specimen in ice pack IMR I month
195
Viral Culture-
Body Fluid
Body Fluid Sterile
Container 3 ml
Specify site of collection. Send
specimen in ice pack. IMR I month
196
Viral Culture-
Blood
Blood Sterile
Container 5 ml IMR I month
197 Viral Culture-
CSF CSF
Sterile
Container 3 ml Send specimen in ice pack. IMR I month
198 Viral Culture-
rectal swab Rectal swab VTM NA
Insert swab tips pass the anal
sphincter and rotate gently.
Keep specimens chilled at all
times
IMR I month
199 Viral Culture-
throat swab Throat swab VTM NA
Swab tonsils and the posterior
pharynx vigorously. Keep
specimens chilled at all times.
IMR I month
200 Viral Culture-
Tissue Tissue
Sterile
Container NA
Specify site of collection. Do
not put in formalin. Send
specimen in ice bag.
IMR I month
201
Viral Culture-
Stool
Stool Sterile
Container NA Send specimen in ice pack. IMR I month
202 Zika Virus PCR
Blood
Serum
AND
Plasma
Plain tube
AND
EDTA
Adult :5 ml
Paediatrik:
1-3 ml
Fill-in PERT301 form 3copies).
BLOOD (Serum and Plasma)
AND URINE MUST BE SENT
TOGETHER.
Send specimen in ice pack.
HSB 1 day
203 Zika Virus PCR
Urine Urine
Sterile
Container 5-10 ml
HSB 1 day
204 Zika Virus PCR Amniotic Fluid Sterile 3-5 ml
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 63
No. Test Name Specimen Type Container
Type
Volume
Required Department Instructions
Perform
Site TAT
Amniotic Fluid Container
205 Zika Virus
CSF CSF
Bijoux Sterile
Container 1 ml
206 Zika Virus
Tissue Tissue
Sterile
Container with
Sterile
Saline/VTM
3. GENERAL HAEMATOLOGY
No Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions
Perform
Site TAT
1 Activated Partial
Thromboplastin Time (APTT)
Blood
Trisodium
Citrate Tube
To mark on tube
Internal
R: 3
hours
U: 1
hour
2
Erythrocyte Sedimentation
Rate
Blood Trisodium
Citrate Tube
1.8 ml
Internal
R: 3
hours
3
Full Blood Count
Blood
EDTA Tube
2.5ml
Internal
R: 3
hours
U: 1
hour
4
G6PD Screen
Blood
Filter Paper
With blood
spot
0.5ml
Internal
Same
day
5
G6PD Confirmation
Blood EDTA Tube
0.5 mls
To fill PER PAT 301 form
HKL
1-2
weeks
6 Trisodium To mark on tube Internal R: 3
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 64
International Normalised
Ratio (INR)
Blood Citrate Tube
hours
U: 1
hour
7 Prothrombin Time
Blood
Trisodium
Citrate Tube
To mark on tube
Internal 1 hour
8 CD4/CD8 Enumeration Test
Blood EDTA
2.5 ml
(To mark on
tube)
Mix by inverting container
6-10 times HKL 10 days
9
T & B cells Enumeration Test
Blood EDTA 2 ml fresh blood
For PID screening, to
follow instruction as for
Phagocytic Function Test
IMR 2-3
weeks
4. SPECIALIZED / CLINICAL HAEMATOLOGY
-These tests are provided by Clinical Haematology Laboratory (MKH) which is under the Haematology Department. Some
tests are offered as internal tests only to Hospital Ampang, some are offered to other hospitals. NOTE: Test highlighted in ‘GREY’ = Test offered to other hospitals.
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
A
1
RED CELL TEST
Hemoglobin
analysis
Gel electrophoresis
Capillary
electrophoresis
Blood
1 tube
Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Deliver tubes
immediately to the
laboratory at room
temperature
1 month
2 Osmotic Fragility
Test
Spectrophotometry Blood 1 tube Heparin
1 week
Kleihauer Test Lavender cap 1 week
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 65
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
3
Blood
1 tube
(K2EDTA)
Ethylenediamine
tetraacetic acid
4 DNA Analysis for
Alpha Thalasemia
Molecular
Blood
2.5 ml
EDTA
Index to be sent
together. To fill
DNA Analysis form.
All requests must
be accompanied
with FBC & Hb
analysis results.
Perform
site: HKL
4-8 weeks
5
DNA Analysis for
Beta Thalasemia
Molecular
Blood
2.5 ml
EDTA
Index to be sent
together. To fill
DNA Analysis form.
All requests must
be accompanied
with FBC & Hb
analysis results.
Perform
site: IMR
4-8 weeks
B
1
MORPHOLOGY
TEST
Full Blood Picture
(FBP)
Wright Staining
Blood
3 ml
Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport at RT,
within 6 hours of
collection
1 hour
after
reception
2 Full Blood Count Flowcytometry/
RF-DC Method
Blood 3 ml Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport at RT,
within 6 hours of
collection
2 Hours
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 66
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
4 Body Fluid
Morphology
Cytospin Body Fluid 3 ml Bijou Bottle Transport to lab
immediately after
collection
48 hours
5 Bone Marrow
Aspirate for May-
Grundwald
Giemsa Stain
May Grundwald
Giemsa Staining
Marrow
Aspirate
Smear
Minimum 2
Slides
NA Air Dry and
transport in Slide
Holder
7 days
6 Iron Stain Perl’s Prussian
Blue Staining
Marrow
Aspirate
Smear or
Peripheral
Blood
Smear
Minimum 2
Slides
NA Air Dry and
transport in Slide
Holder
7 days
C
1
FLOWCYTOMETRY
Leukemia/Lymph
oma
Immunophenotypi
ng/ Flowcytometry
( Adult)
Marrow /
Peripheral
Blood
3 ml
Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport at RT,
within 24 hours of
collection
48 hours
Peripheral
Blood
1.5 ml
( to mark
on tube)
EDTA tube
FRESH sample
required. Avoid
direct contact with
ice. Specimens kept
more than 48 hours
are not suitable for
analysis.
To liaise with
Perform
site: HKL
Verbal 36
hours
Formal: 10-
14 days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 67
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
Immunophenotypi
ng/ Flowcytometry
( Paeds)
Pathology MO
before sending the
sample.
Body fluid
2.5 ml
( minimal
volume)
Sterile container/ Bijou
bottle
FRESH sample
required ( within 4
hours after
collection). Avoid
direct contact with
ice. To liaise with
Pathology MO
before sending the
sample.
Perform
site: HKL
Verbal 36
hours
Formal: 10-
14 days
2
Myeloma Immunophenotypi
ng/ Flowcytometry
Marrow/
Peripheral
Blood
3 ml Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport at RT,
within 24 hours of
collection
48 hours
3 PNH White Cells Immunopheno
typing/
Flowcytometry
Peripheral
Blood
3 ml Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport at RT,
within 48 hours of
collection
48 hours
D MARROW TRANSPLANT EXT:6390 offer to in patient or referred case in H.Ampang with approval from Consultant Haematologist
1. Stem Cell
Cryopreservation
• CD34
Enumeration
• CD3
Enumeration
CD34/CD3
enumeration
protocol and 7AAD
stem cell viability
protocol
PBSC/BM/
cord blood
2ml
1. PB in EDTA tube (for
CD34 enumeration prior
collection)
2. Stem cells collection in
apheresis bag / marrow
harvesting bag in
Room Temperature
(fresh collected
stem cell)
Cryo-thermos
(cryopreserved
segment)
24hr
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 68
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
• Viability
assays
Hospital Ampang
3. Cryopreserved vial /
segment
(from N2 gas tank in
BMT lab / cord blood
bank prior infusion)
2. Stem cell derived
services include:
• Ex vivo T cell
depletion such
as CD34+
Stem Cell
selection etc.
• Volume
Reduction
• Red Cell
Depletion
CD34/CD3
enumeration
protocol and 7AAD
stem cell viability
protocol
PBSC/BM/
cord blood
2ml 1. PB in EDTA tube (for
CD34 enumeration prior
collection)
2. Stem cells collection in
apheresis bag / marrow
harvesting bag in
Hospital Ampang
3. Cryopreserved vial /
segment
(from N2 gas tank in
BMT lab / cord blood
bank prior infusion)
Room Temperature
(fresh collected
stem cell)
Cryo-thermos
(cryopreserved
segment)
24hr
E
1.
MOLECULAR
BCR-ABL1
(CML case only)
Qualitative PCR
BMA / PB
Minimum
4.0 mL
Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport samples
without delay
preferably within
24 hours at room
temperature.
4 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 69
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
NEVER freeze
specimens.
Accompanied with
one unstained
smear of sample
(only at diagnosis).
Slide Not
returned.
2. BCR-ABL1
(CML case only)
Quantitative RT-
PCR
Follow-up
:
BMA
PB
Minimum
4.0 mL
Minimum
10.0 mL
Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport samples
without delay
preferably within
24 hours at room
temperature.
NEVER freeze
specimens.
8 weeks
3. JAK2 Qualitative PCR BMA / PB Minimum
4.0 mL
Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport samples
without delay
preferably within
24 hours at room
temperature.
NEVER freeze
specimens.
Accompanied with
one unstained
smear of sample
(only at diagnosis).
Slide Not
returned.
8 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 70
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
4. PML-RARA
(Initial / Follow-
up case)
Quantitative RT-
PCR
BMA Minimum
4.0 mL
Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport samples
without delay
preferably within
24 hours at room
temperature.
NEVER freeze
specimens.
Accompanied with
one unstained
smear of sample
(only at diagnosis).
Slide Not
returned.
10 weeks
5. RUNX1-RUNX1 T1 Qualitative PCR BMA / PB Minimum
4.0 mL
Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport samples
without delay
preferably within
24 hours at room
temperature.
NEVER freeze
specimens.
4 weeks
6. RUNX1-RUNX1 T1 Quantitative RT-
PCR
Follow-up
- BMA
Minimum
4.0 mL
Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport samples
without delay
preferably within
24 hours at room
temperature.
NEVER freeze
specimens.
10 weeks
7. CBFβ-MYH11A Qualitative PCR BMA / PB Minimum
4.0 mL
Lavender cap
(K2EDTA)
Transport samples
without delay
4 weeks
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 71
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
Ethylenediamine
tetraacetic acid
preferably within
24 hours at room
temperature.
NEVER freeze
specimens.
8. CBFβ-MYH11A Quantitative RT-
PCR
Follow-up
- BMA
Minimum
4.0 mL
Lavender cap
(K2EDTA)
Ethylenediamine
tetraacetic acid
Transport samples
without delay
preferably within
24 hours at room
temperature.
NEVER freeze
specimens.
10 weeks
F
1
CYTOGENETIC
Bone Marrow
Chromosome
study
Karyotyping. A
minimum of 20 G-
banded
metaphases
studied
Bone
marrow
aspirate
Minimum
1-2.0mL
Sterile transport medium
with heparin is always
preferred (available from
lab).
Transport samples
without delay at
room temperature.
NEVER freeze
specimens.
30 days
2 Leukemia
(Neoplasia) Blood
Chromosome
analysis
Karyotyping. A
minimum of 20 G-
banded
metaphases
studied
Leukemic
Blood
Minimum
5.0 mL
Two (2) tubes of
transport medium with
heparin are required for
blood collection (2.5mL
in each tube).
If transport medium not
available, collect sample
in sterile sodium
heparin whole blood
Transport samples
without delay at
room temperature.
NEVER freeze
specimens
30 days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 72
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
tube.
3 Leukemia FISH
analysis
FISH interphase
analysis
BMA
Leukemic
Blood
Minimum 1
-2.0mL
Minimum
5.0 mL
Sterile transport medium
with heparin is always
preferred (available from
lab).
Two (2) tubes of
transport medium with
heparin are required for
blood collection (2.5mL
in each tube).
If transport medium not
available collect sample
in sterile sodium
heparin whole blood
tube.
Transport samples
without delay at
room temperature.
NEVER freeze
specimens
10 days
G HAEMOSTASIS TEST
A Coagulation S creen
1 Prothrombin Time (PT) / INR
Clot based assay
Blood (Plasma)
Collect until indicated mark x 1 tube
Trisodium Citrate 3.2%
Deliver tubes immediately to the laboratory at room temperature
1 hour
2 Activated Partial Thromboplastin Time (APTT)
3 Fibrinogen
4 Thrombin Time 5 D-Dimer
Latex Immunoassay (LIA)
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 73
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
B Factor Assay
1 Factor II/V/ VII/
VIII/IX/X/XI/XII
Clot based assay Blood (Plasma)
Collect until indicated mark x 3 tube
Trisodium Citrate 3.2% Deliver tubes immediately to the laboratory at room temperature. OR Separate plasma from cells as soon as possible. Store frozen at -40°C and transport frozen plasma on dried ice.
U:1 day
R:2days
2 Factor XIII Screening Assay (clot stability test) or Semi-quantitative assay
Blood (Plasma)
Collect until indicated mark x 3 tube
Trisodium Citrate 3.2% Factor VIII, and to a lesser extent factor V, degrade if specimens are kept unfrozen for prolonged periods.
U:1 day
R:2days
C Von Willebrand Factor Assay
1 Von Willebrand Factor Antigen
Latex Immunoassay
Blood (Plasma)
Collect until indicated mark x 3 tube
Trisodium Citrate 3.2%
Deliver tubes immediately to the laboratory at room temperature OR Separate plasma from cells as soon as possible. Store frozen at -40°C and transport frozen plasma on dried ice.
U:1 day
R:2days
2 Von Willebrand Factor Activity
3 VWF:Ricof Aggregometry
4 Collagen Binding Assay
ELISA (Enzyme-linked immunosorbant assay)
D Lupus Anticoagulant Assay
1 Lupus Anticoagulant Clot based assay Blood (Plasma)
Collect until indicated mark x 4 tube
Trisodium Citrate 3.2%
Deliver tubes immediately to the laboratory at room temperature OR
2 weeks 2 Anti Beta2 Glycoprotein1
ELISA (Enzyme-linked immunosorbant assay)
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 74
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
Separate plasma from cells as soon as possible. Store frozen at -40°C and transport frozen plasma on dried ice. Platelet count must be <10 x 10 9/L in plasma prior to freezing
E Thrombophilia Screeni ng
1 Antithrombin Chromogenic Assay
Blood (Plasma)
Collect until indicated mark x 4 tube
Trisodium Citrate 3.2%
Deliver tubes immediately to the laboratory at room temperature OR Separate plasma from cells as soon as possible. Store frozen at -40°C and transport frozen plasma on dried ice.
2 weeks 2 Protein C Activity 3 Protein S Activity Clot based assay
4 Free Protein S Latex Immunoassay
5 Factor Inhibitor Assay Clot based assay Blood (Plasma)
Collect until indicated mark x 2 tubes
Trisodium Citrate 3.2% Deliver tubes immediately to the laboratory at room temperature OR Separate plasma from cells as soon as possible. Store frozen at -40°C and transport frozen plasma on dried ice.
1 day
6 Fibrinogen Degradation Products (FDP)
Semi-quantitative assay
Blood (Plasma)
Collect until indicated mark x 2 tubes
Trisodium Citrate 3.2% Deliver tubes immediately to the laboratory at room temperature
1 day
7 Reptilase Time Clot based assay Blood (Plasma)
Collect until indicated mark x 1 tube
Trisodium Citrate 3.2%
Deliver tube to laboratory immediately. OR Separate plasma from
1 day 8 Anti Xa (Please contact Coagulation lab staff
Chromogenic Assay
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 75
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
prior to sample collection.
cells as soon as possible, ideally within 1 hour of specimen collection Store frozen at -40°C and transport frozen plasma on dried ice.
9 Platelet Aggregation Test By appointment only (Ext: 6461)
Aggregometry assay Blood (Platelet Rich Plasma)
Collect until indicated mark x 2 tubes 1 tube
Trisodium Citrate 3.2% K2EDTA
Deliver tubes immediately to the laboratory at room temperature (platelets are activated at cold temperatures). Do not refrigerate or freeze specimen.
1 day
10 ADAMTS13 (offered to Haematologists only)
ELISA (Enzyme-linked immunosorbant assay)
Blood (Plasma)
Collect until indicated mark x 1 tube
Trisodium Citrate 3.2%
Deliver tubes immediately to the laboratory at room temperature OR Separate plasma from cells as soon as possible. Store frozen at -40°C and transport frozen plasma on dried ice.
Batch test
(4-8
weeks)
11 HIT (Heparin Induced Thrombocytopenia)
Particle Immunofiltration Assay
Blood (Serum)
1 tube Plain tube (without preservative)
Fresh sample required. Deliver tubes immediately to the laboratory at room temperature Do not refrigerate or freeze specimen.
1 day
F Fibrinolysis
1 Plasminogen Chromogenic Assay Blood (Plasma)
Collect until indicated mark x 2 tubes
Trisodium Citrate 3.2%
Deliver tubes immediately to the laboratory at room temperature OR Separate plasma from cells as soon as
2 days
2 Plasminogen inhibitor Chromogenic Assay
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 76
No Test Name Method Specimen
Type
Volume
Required
Container Type Specimen
Transport
Guidelines
TAT
possible. Store frozen at -40°C and transport frozen plasma on dried ice.
5.MOLECULAR CYTOGENETICS (PRENATAL & CARYOLITE BoBs)
No. Test Name
Specimen
Type
Container
Type
Volume
Required Department Instructions
Perform
Site TAT
1 Conventional cytogenetics Blood Lithium
Heparin
2.5 ml -
5 ml
For syndrome:Down,
Patau,Edwards,Turner,Cri Du
Chat,
Klinefelter,Angelman,Prader-
Willi,DiGeorge,Smith-Magenis,
Miller-Diecker,Wolf-Hirschhom
HKL
(Genetic
Laboratory)
To fill
Chromosom
al Study
Form
U:10da
ys
R;3
months 2
Molecular Cytogenetics Blood EDTA Tube
*TAT subjected to type of cases
etc..Please call HKL ext:5637 for
further enquiry
6. BLOOD TRANSFUSION SERVICES
No. Test Name
Specimen
Type
Container
Type
Volume
Required Department Instructions
Perform
Site TAT
1 Antibody Screening Blood EDTA Tube 5 ml Internal 2 hours
2 Direct Coombs test Blood EDTA Tube 5 ml Send immediately Internal 2 hours
3 Blood group & Rh Type Blood EDTA Tube 5 ml Internal 2 hours
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 77
4
Group & Cross match (GXM)
Blood
EDTA Tube
5 ml For paediatric (< 4months old), to
send mother’s sample.
Internal
R:2
hours
U:1
hour
5 Group & Rh Phenotype Cross
match
Blood EDTA Tube 5 ml
Internal See *
6 Group Screen & Hold (GSH) Blood
EDTA Tube 5 ml
Internal 2 hours
7
Investigation of Transfusion
Reaction Post
Refer to page 121 for
Investigation of Transfusion
Reaction Post
Internal
8
Investigation of Delayed
Transfusion Reaction
Refer to page 122 for
Investigation of Delayed
Transfusion Reaction
Internal
9 Antibody Identification Blood EDTA Tube 6 ml Require 3 samples in 3 different
container
Internal 14 days
10 Red cell phenotyping Blood EDTA Tube 6 ml Require 3 samples in 3 different
container
Internal 14 days
*Depends on availability of type blood from the National Blood Centre.
7. CYTOLOGY
No. Test name Specimen Type Container
Type
Volume
Required
Department
Instructions
Perform
site
Schedule Lab
TAT
1.
Non-
gynaecology:
a) Fluid
• Ascitic
• Peritoneal
• Pericardial
• Cyst
Sterile plain
container
As collected Send immediately.
If delay anticipated
refrigerate at 4C
Hospital
Serdang
Daily 7 – 14
days
b) Eye fluid/eye
washing
Sterile plain
tube
As collected Send immediately.
If delay anticipated
refrigerate at 4C
Hospital
Serdang
Daily 7 – 14
days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 78
No. Test name Specimen Type Container
Type
Volume
Required
Department
Instructions
Perform
site
Schedule Lab
TAT
c) Cerebrospinal fluid Sterile bijoux
bottle
As collected Send immediately.
If delay anticipated,
refrigerate at 4°C.
Hospital
Serdang
Daily 7 – 14
days
d) Esophageal
washing
Sterile plain
container
As collected Send specimen in
ice container.
Hospital
Serdang
Daily 7 – 14
days
e) Bronchial brushing Smear on
slide -
Fixed
immediately
with 95%
ethyl alcohol
in the coplin
jar or spray
fix.
1-3 smears Send slide in the
slide folder/box.
Hospital
Serdang
Daily
7 – 14
days
f) Bronchial
washing/aspirate
Sterile plain
container
As collected Send immediately.
If delay anticipated,
add 50% Etoh 1:1
Hospital
Serdang
Daily
7 – 14
days
g) Bronchial alveolar
lavage
Sterile plain
container
As collected Send immediately. Hospital
Serdang
Daily 7 – 14
days
h) Sputum Sterile plain
container
As collected
(3 consecutive
early morning
deep cough
specimen)
Send immediately.
*If delay
anticipated, add
50% Etoh 1:1 or
*Refrigerate
specimen at 4°C up
to 24 hours.
Hospital
Serdang
Daily 7 – 14
days
2. Gynaecology Pap smear Smear on
slide - Fixed
immediately
with 95%
ethyl alcohol
in the coplin
jar or spray
1-2 smears Send slide in the
slide folder/box.
Hospital
Serdang
Daily 7 – 14
days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 79
No. Test name Specimen Type Container
Type
Volume
Required
Department
Instructions
Perform
site
Schedule Lab
TAT
fix.
3. Fine Needle
Aspiration
(FNAC)
Smear on slide.
*Fix smear
immediately
with 95%
ethyl alcohol
in the coplin
jar or spray
fix.
*Air dried
smears.
As collected Send slide in the
slide folder/box.
Hospital
Serdang Daily 7 – 14
days
Specimen for cell
block
10 mls
CytoLyt
solution in
conical tube
As collected If delay, specimen
will keep for about
1 month.
Hospital
Serdang Daily 7 – 14
days
HOSPITALAMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 80
8. HISTOPATHOLOGY
No. Test Name Specimen
Type
Container
Type
Volume
Required Department Instructions
Perform
Site
Schedule Lab TAT
1
Surgical specimen Tissue
Plain
Container
with 10%
Neutral
Buffered
Formalin
Not
Applicable
Clinical data including
provisional diagnosis must
be completely fill up
Hospital
Serdang
Daily
14 – 30 days
2 Frozen section Tissue Plain
Container
Not
Applicable
Fresh specimen. Do not
put in Formalin. Please
discuss with
histopathologist in
Serdang and pathologist
on call at least 1 day before
procedure.
Hospital
Serdang
Daily
(by
appoint
-ment)
Verbal report
(In the system:
Daily)
3 Haematoxylin & eosin stain Slide Not
Applicable
Not
Applicable
Hospital
Serdang
Daily 14 – 30 days
4 Enzyme Histochemistry Tissue Plain
Container
Not
Applicable
Fresh specimen. Do not
put in Formalin.
Hospital
Serdang
Daily 14 – 30 days
5 Immunofluorescence test
for skin and renal biopsies Tissue
Plain
Container
Not
Applicable
Fresh specimen. Do not
put in Formalin.
Hospital
Serdang
Daily 14 – 30 days
6 Special stain Slide Not
Applicable
Not
Applicable
Hospital
Serdang
Daily 14 – 30 days
7 Immunohistochemical
stain Slide
Not
Applicable
Not
Applicable
Hospital
Serdang
Daily 14 – 30 days
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 81
C. SPECIAL TEST
INSTRUCTIONS:
CHEMICAL PATHOLOGY
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 82
INTRODUCTION
The Chemical Pathology is a unit in Integrated Laboratory of Pathology Department. Its services
cover pre-analysis, analysis and interpretation of biochemical changes in serum/plasma and body
fluids for diagnostic, monitoring and screening of diseases. The Chemical Pathology also provides
consultative laboratory services to Hospital Ampang for patient managements.
SERVICES
Common Receiving Area (CRA)
Samples for chemical pathology tests will be received at CRA either by pneumatic tube or via
porter. These samples will be sorted based on tests requested and processed accordingly.
The diagnostic services provided are:
i. Urgent service
These are short turn-around-time tests which are required for immediate patient management as
indicated by the clinician in the eHIS/request form. Service provided 24 hours e.g. Renal Profile,
Blood Gases, Calcium, Glucose, Amylase, Cardiac Enzyme, Neonates Bilirubin and CSF
Biochemistry.
ii. Routine service
These include all the tests that are offered 24 hours and routine test such as Liver Function Test,
Lipid Profile, Magnesium, Thyroid Function test, Anemia Study etc.
iii. Special Service
These are test which require to be run in batches such as HbA1c and Protein Electrophoresis etc.
REQUEST OF TESTS
All chemical pathology tests can be requested from CA (Clinical Access) in Hospital Ampang
Information System (eHIS). Standard request form (PER PAT 301) can be used for external clients
and in cases of eHIS breakdown.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 83
Therapeutic Drug Monitoring (TDM) request form should be used for any outsource TDM request.
Each patient’s request should be accompanied with 2 request forms.
• Make sure all outsourced TDM tests requested in the request form TALLY
with the orderable test in eHIS to avoid misleading of reporting results later
• Ensure the timing of the sample and the request information is appropriate to
ensure outcome results are accurate and clinically meaningful.
SAMPLE COLLECTION
For special test which are not mentioned, please call the laboratory for specimen instructions or
requirements.
Most chemical pathology tests are performed using serum and plasma heparin samples. Type of
specimen for each test is listed for reference. Proper collection is essential to provide accurate
results for patient management and care. The quality of specimen provided will determine the
quality, reliability and accuracy of the laboratory result.
For collection of specimen for clinical chemistry analysis, minimum tourniquet pressure should be
applied during venipuncture in order to avoid forcing of free fluid from capillaries which may result
in hemoconcentration and spurious elevations of protein and protein bound substance e.g. total
protein, calcium. If possible, tourniquet should be released after no more than 1 minute from the
initial placement.
Hemolysis can affect clinical chemistry test by interfering with the photometric determination of
the analyte concentration in the sample leading to erroneous results. If considerable hemolysis is
noted, another sample will be requested upon rejection of the first sample.
Avoid mixing or transferring blood from different tubes as certain tubes may contain anticoagulant
substance which will falsely elevated the concentration of certain analyte in the sample.
Avoid collection of blood from limbs being infused with intravenous solution. This will lead to
hemodilution and measurements on these sample produces erroneous results which is not the
actual presentation of the analyte concentration in the specimen.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 84
SPECIAL TEST INSTRUCTION AND COLLECTION PROCEDURE
Arterial Blood Gases
Procedure of collection
i. Use a 1 ml disposable heparinised syringe.
ii. Draw 1 ml of arterial blood. Invert the syringe and remove all air bubbles inside the
syringe. Discard the needle to prevent needle stick injury incidence and recap with
special stopper provided to avoid specimen exposure to air.
iii. Mix well by rolling the syringe between palms to prevent clotting.
iv. Put syringe of blood in slurry ice bath and send immediately to the lab.
Important notes
i. After the blood is drawn into the syringe, any air space or bubbles must be removed.
ii. The specimen must be kept embedded in crushed ice and sent immediately for
analysis (within 30 min). Specimen exceeding this time frame may be rejected.
iii. Specimen should not be sent by pneumatic tube.
iv. The attendant is advised to wait for the result if the eHIS is down, which will be ready
within few minutes.
(24 Hour) 24H Urine Collection
Procedure of collection
i. The 24 hour urine bottle is available at CRA.
ii. Bring the test ordered barcode to the lab for bottle collection.
iii. On the day of collection, the first urine voided must be discarded. Time of first urine
voided is the start of the timing for the 24 hour collection.
iv. At the end of 24 hour, the last urine voided is collected. For best result, refrigerate
sample if possible.
v. Send the urine sample immediately to the laboratory.
Important notes
i. Some 24 hour urine container contain preservatives. Do not discard the preservative.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 85
Lactate
Collection of satisfactory specimen for lactate analysis requires special procedure to prevent
changes in lactate concentration while and after the specimen is drawn.
Procedure of collection
i. Patient should be fasting and at complete rest.
ii. A venous specimen is best drawn without a tourniquet or immediately after the
tourniquet has been applied briefly.
iii. If the tourniquet has been applied very long, it should be removed after the puncture
has been performed and blood allowed circulating for at least 2 minutes before the
blood is withdrawn.
iv. 2 ml of blood is collected in a container with sodium fluoride as anticoagulant.
Important notes
i. Sample should be chilled in the ice bath and sent to the laboratory within 1 hour.
ii. Separation of cell through centrifugation at the laboratory is done within 30 minutes.
iii. Haemolysed specimen may affect the results.
Ammonia
Procedure of collection
i. A venous specimen is best drawn without a tourniquet or immediately after the
tourniquet has been applied briefly. If the tourniquet has been applied very long, it
should be removed after the puncture has been performed and blood allowed
circulating for at least 2 minutes before the blood is withdrawn.
ii. 2 mL blood in EDTA tube on ice. Send to laboratory on ice within 15 minutes of
collection. For paediatric patients a minimum of 1 mL blood (full micro tube) is
required.
Important notes
i. This test must be processed urgently.
ii. Please notify the Laboratory that the specimen is on its way.
iii. Ammonia levels may be elevated due to pre-analytical sources. These include:
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 86
Poor collection technique. The skin must be thoroughly cleaned prior to collection.
Haemolysed specimens and prolonged storage (even once frozen) will result in
elevated levels making interpretation difficult. Ammonia can be performed on a
micro-collect, but the slower collection procedure increases the level.
Exogenous sources of ammonia, e.g. smokers (patient or phlebotomist), cleaning
solutions and urine may lead to elevated levels.
G6PD Screening
Procedure of collection
i. Apply a drop of cord blood to a piece of filter paper.
ii. Avoid thick smear of blood which will cause false positive result.
iii. Allow it to dry completely.
iv. Dispatch to the laboratory in Biohazard plastic bag with barcode attached to the filter
paper.
Important notes
Request for G6PD samples will be accepted until 3.00 pm on working days and until
10.00 am on weekends and public holidays.
HbA1c
Procedure of collection
2 ml of blood is collected in a container with EDTA as anticoagulant.
Important notes
i. Test should be performed for monitoring of patients diagnosed with diabetes mellitus.
ii. Repeated testing should be done six monthly if stable and 3 monthly if the glycemic
control is poor and recent adjustment in medication being done.
iii. Several condition may affect the HbA1c result (haemolytic anemia, iron deficiency
anemia, end stage renal failure and hemoglobinopathies) leading to possible
misinterpretation of the result. In this condition, blood glucose monitoring or
fructosamine is preferrable.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 87
Therapeutic Drug Monitoring
Procedure of collection
i. Many of these samples require to be taken at a specific time pre(trough) or post(peak)
dose.
ii. Failure to collect the blood at the appropriate time will make it impossible to compare
the measured concentration with the accepted therapeutic range.
iii. Therefore, blood samples should be collected once the drug concentrations have
attained steady-state.
iv. Strictly NO hemolysed serum samples as it will interfere the TDM results.
Important notes
i. All outsourced TDM samples should reach CRA, Pathology Department by 9.00 am
every morning during working days.
ii. Outsourced TDM samples received after 9.00 am will be sending to the referral
centres on the next working day.
iii. All in-house TDM samples received after 4.00 p.m will be tested on the next working
days.
iv. TDM testing is not available during weekends and public holidays (except PCM and
Salicylate).
Pyruvate (Outsource test)
Procedure of collection
i. Patient should be unstressed and resting.
ii. Skin must be well cleansed prior to sampling to eliminate skin lactate contamination.
The arm should be relaxed (DO NOT clench fist.)
iii. Tourniquet must be released at least 30 seconds before blood collection or stasis may
raise lactate level.
iv. Freshly prepared anticoagulant tube with 6% perchloric acid is required for the best
result. The tube is available at CRA.
Creatinine Clearance Test
Procedure of collection
i. A 24 hour period of urine collection is recommended.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 88
ii. A careful and accurate 24 hour collection of urine must be ensured.
iii. At the same time during the day, a blood sample is taken for serum creatinine
analysis. Both blood and 24 hour urine sample are sent to the laboratory.
Glucose Tolerance Test
Procedure of collection
i. Fast the patient overnight.
ii. Collect fasting blood specimen.
iii. Give patient 75g glucose in 250 – 300 ml water and drink within 5 minutes. For
children weighing less than 43 kg should take 1.75g/kg body weight.
iv. Collect a 2nd blood specimen after exactly two hours of glucose consumption.
Important notes
i. GTT is a test to determine the body’s ability to handle glucose. It may be used for
screening and diagnosis of diabetes, prediabetes and gestational diabetes.
ii. For three days prior to the test, the patient must be on a diet containing no less than
200 g of carbohydrate daily.
iii. Do not perform this test when patient acutely unwell.
iv. The glucose solution for this test should be obtained from the pharmacy.
Serum-Ascites Albumin Gradient(SAAG)
Procedure of collection
Collect a blood sample and ascites fluid at the same time during the days for albumin
measurement.
Important notes
SAAG = (albumin concentration of serum) - (albumin concentration of ascitic fluid).
Serum Protein Electrophoresis
Procedure of collection
i. Samples shall come in pair (Serum & Urine) especially for screening purpose
ii. Request shall be rejected if only urine sample received.
iii. Strictly NO haemolysed / plasma / aged samples.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 89
CSF Protein Electrophoresis
Procedure of collection
Serum and CSF from the same patient must be collected at the same day (ideally within
4 hours) and sent in pair (Serum & CSF) to the lab for analyses
Cryoglobulin
Procedure of collection
i. Test is offered by appointment to :
a) In patient Hospital Ampang, Hospital Kuala Lumpur and National Heart
Centre (IJN).
b) External patient refer for blood taking procedure at FNAC Clinic Hospital
Ampang.
ii. Appointment shall be made by Physicians to the respective laboratory personnel in
the laboratory in Special Biochemistry Unit Hospital Ampang (03 - 4289 6216)
iii. The particular of requesting physician, patient’s Identification and respective
contact number will be recorded.
iv. In charge Laboratory personnel shall contact the patient for confirmation few days
before the appointment date.
v. Blood taking equipment (the tubes, syringe and needle and flask) are incubated at
37oC for at least 24 hours before appointment date.
vi. In charge Laboratory personnel shall attend to the respective site with the flask
containing pre-warmed blood taking equipment on the day of appointment.
a) For External patient, blood sampling procedure will be done at FNAC
Clinic (nearby O&G Clinic) located at level 1, Hospital Ampang by Pathology
Medical Officer.
b) For Inpatient Hospital Ampang, Hospital Kuala Lumpur and National
Heart Centre (IJN) blood taking procedure must be done by Physician In
Charge
vii. Blood collection must be carried out using instruments and containers provided
viii. Samples will be drawn into two separate tube as follows:
-EDTA tube (sample volume is 3mls)
-Plain tube without gel (sample volume is 8mls)
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 90
ix. Immediately placed all the samples into the flask and transport to Protein lab,
Special Biochemistry Unit, Hospital Ampang for further processing.
UFEME
Procedure of collection
Ensure midstream urine is collected and send immediately for analysis
Important Notes
Urine microscopy examination shall be a reflex testing following significant
abnormal urine biochemistry according to the laboratory protocol (e.g. protein,
white cells, hemoglobin and nitrite)
Urine Myoglobin
Procedure of collection
Collect 10 ml urine in a container that contains 0.2 g of sodium bicarbonate (2%
final concentration.
Ammonium Chloride Loading Test
The test starts first thing in the morning. The patient should be fasting and has previously been
weighed to allow calculation of the ammonium chloride dose. Patient should drink 200 ml of water
per hour while the test is in progress. Normal diet should be maintained during the test.
06 00 hour: ask patient to drink.
07 00 hour: empty the bladder and discard the urine.
A dose 0.1g/kg body weight of Ammonium chloride is given orally in gelatin capsules (not enteric
coated capsules or tablets). The whole dose should be taken between 07 00 and 08 00 hours. If
vomiting occurs, this must be reported and the test may have to be abandoned.
09 - 1500 hour: The patient empties the bladder completely at hourly intervals each time into a
separate urine container, label and immediately capped and sent to the lab without delay.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 91
Collect samples as follows:
Test Name Specimen Type Container Type Volume
Urinary pH , 09 00 Hour Urine Universal container 20 ml
Urinary pH, 10 00 Hour Urine Universal container 20 ml
Urinary pH, 11 00 Hour Urine Universal container 20 ml
Urinary pH, 12 00 Hour Urine Universal container 20 ml
Urinary pH, 13 00 Hour Urine Universal container 20 ml
Urinary pH, 14 00 Hour Urine Universal container 20 ml
Urinary pH, 15 00 Hour Urine Universal container 20 ml
Urinary pH, 16 00 Hour Urine Universal container 20 ml
CAPD Adequacy of Dialysis (kt/V)
Collect samples as follow:
Test Name Specimen Type Container Type Volume
Urea
Peritoneal
dialysate 24 Hour Plain gel tube 3 ml
Urine 24 hour 24 hour container as per
collection
Blood Plain gel tube 3 ml
Creatinine
Blood Plain gel tube 3 ml
Peritoneal
dialysate 24 Hour Plain gel tube 3 ml
Urine 24 hour 24 hour container as per
collection
Albumin Blood Plain gel tube 3 ml
Glucose Blood Fluoride oxalate 2.5 ml
Combined Anterior Pituitary Function Test
• Fast the patient overnight
• Insert intravenous catheter or intravenous line
• Rest for 30 minutes
• Sample are taken for baseline control for Glucose, Growth Hormone, Cortisol, LH and FSH
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 92
• Give insulin 0.1 – 0.5 unit/kg body weight and GnRH 100ug intravenously
• Collect samples as follow:
Test Name Specimen Type Container Type Volume
FSH 0 min Blood Plain gel tube 3ml
FSH 15 min Blood Plain gel tube 3ml
FSH 30 min Blood Plain gel tube 3ml
FSH 45 min Blood Plain gel tube 3ml
FSH 90 min Blood Plain gel tube 3ml
FSH 120 min Blood Plain gel tube 3ml
LH 0 min Blood Plain gel tube 3ml
LH 15 min Blood Plain gel tube 3ml
LH 30 min Blood Plain gel tube 3ml
LH 45 min Blood Plain gel tube 3ml
LH 90 min Blood Plain gel tube 3ml
LH 120 min Blood Plain gel tube 3ml
Glucose, 0 min Blood Fluoride oxalate 2.5 ml
Glucose,30 min Blood Fluoride oxalate 2.5 ml
Glucose,90 min Blood Fluoride oxalate 2.5 ml
Glucose,120 min Blood Fluoride oxalate 2.5 ml
Cortisol,0 min Blood Plain gel tube 3ml
Cortisol,30 min Blood Plain gel tube 3ml
Cortisol,90 min Blood Plain gel tube 3ml
Cortisol,120 min Blood Plain gel tube 3ml
Growth Hormone,0 min Blood Plain gel tube 3ml
Growth Hormone,30 min Blood Plain gel tube 3ml
Growth Hormone,90 min Blood Plain gel tube 3ml
Growth Hormone,120 min Blood Plain gel tube 3ml
TSH,0 min Blood Plain gel tube 3ml
TSH,30 min Blood Plain gel tube 3ml
TSH,90 min Blood Plain gel tube 3ml
TSH,120 min Blood Plain gel tube 3ml
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 93
Note:
1. Patient should sweat or plasma glucose level fall below 2.2 mmol/l
2. Additional intravenous insulin may be given if this does not occur by 30 minutes and
sampling should be prolonged by 30 minutes.
3. Physician should be in attendance throughout the test and 50% i.v dextrose should be kept
by bed side if severe hypoglycemia is documented.
4. Test is contraindicated for patient with seizure, IHD, Cardiovascular insufficiency and
children. Normal ECG is mandatory
CRH Stimulation Test
Collect samples as follow:
Test Name Specimen Type Container Type Volume
Cortisol 0hr Blood Plain gel tube 3 ml
Cortisol 15min Blood Plain gel tube 3 ml
Cortisol 30min Blood Plain gel tube 3 ml
Cortisol 45min Blood Plain gel tube 3 ml
Cortisol 60min Blood Plain gel tube 3 ml
Cortisol 75min Blood Plain gel tube 3 ml
Cortisol 105min Blood Plain gel tube 3 ml
ACTH 0hr Blood Plain gel tube 3 ml
ACTH 15min Blood Plain gel tube 3 ml
ACTH 30min Blood Plain gel tube 3 ml
ACTH 45min Blood Plain gel tube 3 ml
ACTH 60min Blood Plain gel tube 3 ml
ACTH 75min Blood Plain gel tube 3 ml
ACTH 105min Blood Plain gel tube 3 ml
Gonadotropin Releasing Hormone Stimulation Test
• 100ug GnRH is given intravenously
• Collect samples as follow:
Test Name Specimen Type Container Type Volume
FSH 0min Blood Plain gel tube 3ml
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 94
Test Name Specimen Type Container Type Volume
FSH 15min Blood Plain gel tube 3ml
FSH 30min Blood Plain gel tube 3ml
FSH 45min Blood Plain gel tube 3ml
FSH 60min Blood Plain gel tube 3ml
FSH 60min Blood Plain gel tube 3ml
FSH 120min Blood Plain gel tube 3ml
LH 0min Blood Plain gel tube 3ml
LH 15min Blood Plain gel tube 3ml
LH 30min Blood Plain gel tube 3ml
LH 45min Blood Plain gel tube 3ml
LH 60min Blood Plain gel tube 3ml
LH 90min Blood Plain gel tube 3ml
LH 120min Blood Plain gel tube 3ml
High Dose Dexamethasone Suppression Test (HDDST)
• To rule out pituitary dependant Cushing's Disease.
• Cortisol taken at 9.00 am on D1.
• 2mg Dexamethasone is given 6 hourly for 48 hrs.
• Cortisol level repeated at 9.00 am Day 3.
Inborn Errors of Metabolism
• Fill special request form completely.
• Collect samples as follow:
Test Name Specimen Type Container Type Volume
Orotic Acid Urine Universal container 20 ml
Amino Acid Urine Universal container 20 ml
Amino acid CSF Bijou Bottle 1.0 ml
Amino acid Blood Heparin tube 2.0 ml
Organic Acids Urine Universal container 20 ml
Acyl Carnitine Blood spot S&S filter paper 3 circles of 1cm
each
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 95
Insulin Stress Test
• Fast the patient overnight
• Insert intravenous catheter or intravenous line
• Rest for 30 minutes
• Sample are taken for baseline control for Glucose, Growth Hormone, Cortisol, LH and FSH
• Give insulin 0.1 – 0.5 unit/kg body weight
• Collect samples as follow:
Test Name Specimen Type Container Type Volume
Cortisol, 0 min Blood Plain gel tube 3ml
Cortisol, 30 min Blood Plain gel tube 3ml
Cortisol, 60 min Blood Plain gel tube 3ml
Growth Hormone,0 min Blood Plain gel tube 3ml
Growth Hormone, 30 min Blood Plain gel tube 3ml
Growth Hormone, 60 min Blood Plain gel tube 3ml
Glucose, 0 min Blood Fluoride Oxalate 2.5 ml
Glucose, 30 min Blood Fluoride Oxalate 2.5 ml
Glucose, 60 min Blood Fluoride Oxalate 2.5 ml
Insulin Tolerance Test
• Fast the patient overnight
• Insert intravenous catheter or intravenous line
• Rest for 30 minutes
• Sample are taken for baseline control for Glucose, Growth Hormone, Cortisol, LH and FSH
• Give insulin 0.1 – 0.5 unit/kg body weight
• Collect samples as follow:
Test Name Specimen Type Container Type Volume
Cortisol, 0 min Blood Plain gel tube 3ml
Cortisol, 30 min Blood Plain gel tube 3ml
Cortisol, 60 min Blood Plain gel tube 3ml
Cortisol, 90 min Blood Plain gel tube 3ml
Cortisol, 120 min Blood Plain gel tube 3ml
GH, 0 min Blood Plain gel tube 3ml
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 96
Test Name Specimen Type Container Type Volume
GH, 30 min Blood Plain gel tube 3ml
GH, 60 min Blood Plain gel tube 3ml
GH, 90 min Blood Plain gel tube 3ml
GH, 120 min Blood Plain gel tube 3ml
GLU, 0 min Blood Fluoride oxalate 2.5 ml
GLU, 30 min Blood Fluoride oxalate 2.5 ml
GLU, 60 min Blood Fluoride oxalate 2.5 ml
GLU, 90 min Blood Fluoride oxalate 2.5 ml
GLU, 120 min Blood Fluoride oxalate 2.5 ml
Low-Dose Dexamethasone Suppress
• Confirmation of Cushing's Syndrome.
• Cortisol taken at 9.00 am on D1.
• 0.5mg Dexamethasone is given 6 hourly for 48 hrs.
• Cortisol level repeated at 9.00 am Day 3.
Overnight Low-Dose Dexamethasone Suppress
• Outpatient screening test for Cushing's Syndrome.
• 1mg of Dexamethasone to be given between 2300 hour and 2400 hour.
• Cortisol taken at 8.00 am
Peritoneal Equilibrium Test
• Collect samples as follow:
Test Name Specimen Type Container Type Volume
Creatinine
Peritoneal dialysate at 0Hr,2Hr, 4Hr
and Overnight Plain gel tube 3 ml
Blood Plain gel tube 3 ml
Urea Blood Plain gel tube 3 ml
Peritoneal dialysate overnight Plain gel tube 3 ml
Glucose Peritoneal dialysate at 0Hr,2Hr and 4Hr Plain gel tube 3 ml
Blood Fluoride oxalate 2.5 ml
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 97
Renin/Aldosterone Postural Test
• Withhold antihypertensive for 2 weeks and spironolactone/ amiloride for week.
• Correct hypokalemia.
• Admit patient overnight.
• Send all specimens in ice bag.
• Collect sample as follow:
Test Name Specimen Type Container Type Volume
Renin 8.00am (supine) Blood EDTA tube 3 ml
Renin 12.00pm (erect) Blood EDTA tube 3 ml
Aldosterone 8.00am (supine) Blood EDTA tube 3 ml
Aldosterone12.00pm (erect) Blood EDTA tube 3 ml
Syndrome of Inappropriate Antidiuretic Hormone
• Document plasma osmolality < or = 275 mOsm/kg and hyponatremic <or = 130 mmol/l
• Exclude cardiac,hepatic,renal,thyroid or adrenal failure, effect of pituitary surgery, diuretic
therapy and medication known to stimulate ADH secretion
• Collect sample as follows:
Test Name Specimen Type Container Type Volume
Sodium, urine Urine Universal container 20 ml
Osmolality Blood Plain gel tube 3ml
Osmolality Urine Universal container 20 ml
Water Deprivation Test
This test is dangerous for patient which clinically dehydrated.
• Test can be conducted if plasma osmolality is less than 295 mOsmol/kg.
• At 10.00pm weigh the patient, collect plasma and urine sample for Osmolality and Sodium.
• No water intake is allowed until test is terminated.
• Care should be taking to ensure that body weighed doses not decrease by more than 5%.
• At 6.00am, the patient is weighed again. All urine passed out hourly is collected for measurement
of volume and osmolality.
• When
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 98
(i) urine osmolality is stable (a change of <= 30mOsmol/kg for 2 consecutive hours-usually
takes 8-12 hours to occur)
(ii) or patient lost>=3kg in body weight
Specimens are collected for plasma osmolality and sodium level.
• 5 unit of aqueous vasopressin (ADH) is given subcutaneously.
• Collect urine for osmolality one hour after injection.
• List of samples as follow:
Test Name Specimen Type Container Type Volume
Sodium 10.00 pm Blood Plain gel tube 3ml
Sodium 10.00 pm urine Urine Universal container As per collection
Osmolality 10.00 pm Blood Plain gel tube 3ml
Osmolality 10.00 pm urine Urine Universal container As per collection
Osmolality 6.00 am urine Urine Universal container As per collection
Volume Urine Urine Universal container As per collection
Osmolality 1 hour after ADH
dose, urine Urine Universal container 30 ml
Water Loading Test
Test is started 2 hours after patient has eaten light breakfast.
• 8.00am: Patient is given a light breakfast.
• Plasma and urine osmolality are measured.
• 8.30 am: Patient is given water to drink (20 ml/kg) over 15 to 30 minutes; light salted crackers
may be given with water if needed.
• Patient is kept in recumbent position.
• 10.30 am: Collect all urine that is passed out for urine volume and osmolality measurements and
blood sample is also taken for plasma osmolality
• Repeat specimen collection as above every hour for next 4 hours (11.30am, 12.30pm, 1.30pm and
2.30pm) and label all containers with patient information and time collected.
Xylose Absorption Test Urine
• The patient is fasted overnight.
• 8.00am: Empty the bladder and discard the urine specimen. Give the patient an oral dose of 5g
d(+)-Xylose in a glass of water. For the 5-hour test period, allow the patient to drink water but no
solid food intake. All urine passed between 8.00a.m. are put into Bottle 1.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 99
• 10.00 am: The bladder is emptied and the specimen is put into Bottle 1 which is now complete. All
urine passed between 10.00 am. and 1.00 p.m. are into Bottle 2.
• 1.00p.m.-The bladder is emptied and the specimen is put into Bottle 2 which is now complete.
Both bottles are sent to laboratory for analysis.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 100
D. SPECIAL TEST
INSTRUCTIONS:
MEDICAL MICROBIOLOGY
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 101
INTRODUCTION
Medical microbiology is an essential component in the infectious disease field and knowledge in
this area is vital to the clinical management of infections. The microbiology laboratory is
particularly involved in the isolation or establishing the causative organisms as well as monitoring
and screening of diseases.
List of Services
Microbiology unit provides the following services:
a) Diagnostic microbiological services which comprise of bacteriology, mycology, parasitology,
virology and basic immunology.
b) Participation in hospital wide infection control activities related to surveillance, control and
prevention of nosocomial infections.
c) Provision of microbiologic studies of the hospital environment and sterility testing.
d) Microbiological investigations for medico-legal case
Request Form
a. All microbiology tests can be requested from CA (Clinical Access) in Hospital Ampang
called Total Hospital Information System (THIS). Standard request form (PER PAT
301) are also can be used for our external clients and if the computer system
breakdown.
b. Most of the outsource tests can use the PER PAT 301 form except for certain tests
which are required to use special request form (refer PUBLIC FOLDER PATHOLOGY or
see page 132-146).The form should include patient’s biodata, clinical features,
indication of test and the appropriate test request and sample type.
General Guidelines for Specimen Collection and Handling
a. The quality of laboratory results depends greatly on the proper collection and handling of
the specimen as well as obtaining satisfactory material for examination.
b. The clinical specimen must be material from the actual infection site and must be collected
with minimum contamination from adjacent tissues, organs or secretions.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 102
c. A sufficient quantity of specimen must be obtained in order to perform the examination
required.
d. Appropriate collection devices, specimen containers and culture media must be used to
ensure optimal recovery of microorganisms.
e. Ideally, the specimen must be collected before the commencement of antibiotic therapy.
f. The specimen container must be properly labeled, placed in a biohazard plastic bag and
accompanied by a completed laboratory request form for outsource sample.
g. Specimens are best transported immediately to the laboratory.
Specific Collection Guidelines
Bacteriology
Blood Cultures and bone marrow aspirate
An Automated blood culture system with different types of bottles (according to age and incubation
requirements) is used:
Adults: Aerobic and anaerobic culture bottle
Volume: 10 ml into each bottle
Pediatric: A single blood culture bottle
Volume: 0.5-5 ml
Fungal C&S: Myco F/Lytic (incubated for 14 days)
TB Blood culture (Mycobacterium): Myco/F Lytic (incubated for 42 days)
For bone marrow aspirate, 1-2 mls of aspirate is required and to be inoculated directly into the
bottles.
Method of collection:
i. Before venepuncture, the skin must be carefully disinfected with alcoholic antiseptic.
ii. Clean the top of the bottle with alcohol swab.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 103
iii. Inoculate the specified volume of blood /bone marrow aspirate into each bottle.
iv. Do not store specimens in the refrigerator.
Note:
In the suspicion of catheter- related blood stream infection (CRBSI), blood drawn from both the line
and peripheral vein are indicated. All samples to be taken at the same setting and labeled
accordingly on the barcode sticker and in the clinical comment column in the eHIS.
Cerebrospinal Fluid (CSF)
i. Collect 3-4 ml of CSF into sterile bijoux bottles for the examination of:
- microscopy and culture for bacterial (Cryptococcus and mycobacterium if indicated)
ii. Send the specimen immediately to the laboratory.
iii. Do not store in the refrigerator.
Genital Samples
High Vaginal Swabs
i. This is NOT for diagnosis of gonorrhoea in female but mainly for candidiasis and
other causes of vaginitis.
ii. Use sterile speculum lubricated with sterile normal saline swab either from the
posterior fornix or the lateral wall of vagina.
iii. Inoculate the swab into Amies transport media.
iv. Send to the laboratory as soon as possible.
Endocervical Swab
i. This is the best specimen for the diagnosis of gonorrhoea and puerperal sepsis.
ii. Under direct vision, gently compress cervix with blades of speculum and use
rotating motion with swab, obtain exudates from the endocervical canal.
iii. Inoculate the swab into Amies transport media.
iv. Send to the laboratory as soon as possible.
Urethral Discharge (Male)
i. Wipe the urethra with a sterile gauze or swab.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 104
ii. Collect the exudates with a sterile swab. If discharge cannot be obtained by
“milking” the urethra, use a sterile swab to collect material from about 2 cm inside
the urethra
iii. Inoculate the swab into Amies transport media.
Note: Do not refrigerate swabs
Pus/ Swabs/ Tissue
i. Clean with sterile water or disinfect with mild alcohol antiseptic at the skin area.
ii. Send aspirated pus if available, in a sterile universal container.
iii. Swab is an inferior substitute, and should be sent in an Amies transport medium
iv. Send all tissue for culture in a sterile container. Do not add formalin to the specimen.
Note:
i.A dry specimens may fail to yield organisms in smear and culture.
ii.Surface/superficial swabs of deeply infected lesions (eg.sinus tracts from osteomyelitis,
pressure sores) usually grow surface contaminants like coliforms and pseudomonads.
Respiratory Specimens
Upper Respiratory
Nasal Swab
This is commonly done for screening of MRSA carriage.
i. Moisten a swab with sterile distilled water.
ii. Swab both the anterior nares and insert the swab into the nose and gently rotate
against the nasal mucosa.
Per nasal (Nasopharyngeal swab/aspirate)
This is especially useful for the diagnosis of whooping cough caused by B.pertussis
Nasopharyngeal swab
i. A special per nasal swab mounted on a soft flexible wire is passed through the
nostril and along the floor of the nasal cavity into the nasopharynx, rotate it and
withdraw.
ii. Replace it in the carrier tube/ bag and send it immediately for processing (suitable
transport media are Amies or Stuart’s)
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 105
iii. Use Dafflon or Rayon swab for sampling of PCR testing, and place the swab into Viral
Transport Media (VTM). Do not use cotton swab to take sample for PCR as it may
inhibits the test.
Nasopharyngeal aspirate
i. Gently pass a sterile catheter through one nostril as far as the nasopharynx.
ii. Attach a sterile syringe to the catheter and aspirate a specimen of mucopus.
iii Put into a sterile container and send immediately to the laboratory.
Throat Swab
Submitted primarily for detection of Group A Streptococci (Streptococcus pyogenes)
and also for detection of Bordetella pertussis.
i. 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 uvula.
ii. Gently turn the swab, in contact with the inflamed mucosa or lesion.
iii. Avoid touching the oral mucosa or tongue with the swab.
iv. Place the swab in Amies transport media and send to laboratory immediately.
Lower respiratory
Sputum
i. Collect the sputum early in the morning, after a deep cough or after session of
physiotherapy. If tuberculosis is suspected (PTB), send 3 consecutive specimens (1
specimen per day).
ii. Ask 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.
iv. If delay is anticipated, store the sample in a refrigerator.
Swabs from mouth, gums and oral cavity
i. Rinse mouth with water before sampling.
ii. Using sterile swab, rub into areas of exudation or inflammation and place into Amies
transport medium.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 106
Tracheal Aspirate/Bronchial alveolar lavage (BAL)/bronchial washing /lung aspirate
or biopsy
i. Place specimen into sterile container.
ii. Send specimen to the laboratory immediately.
Note: Tracheostomy is followed by colonization within 24 hours of insertion of the tube.
Results must be correlated with clinical findings such as fever or infiltrate on chest x-ray.
Stool
i. Collect faeces into a sterile/ clean wide-mouthed screw capped plastic container.
ii. If the faeces is in liquid form, fill only to one third of the container (excessive
amount will cause spillage).
iii. Enrichment medium i.e. Alkaline Peptone Water for Vibrios and Selenite F for
Salmonella can be obtained from the laboratory for bedside inoculation.
iv. Send specimen to laboratory immediately.
Note:
a. Rectal swab is a poor second best alternative to faeces. If faeces is impossible to
obtain, cotton swab inserted into rectum is to be collected.
b. For stool clearance culture in cases of typhoid and cholera, stool should only be sent
upon completion of therapy.
Urine Culture
Midstream Urine (MSU)
Male Patients
i. Withdraw the prepuce and cleanse the glands penis with soapy water thoroughly
rinse with water.
ii. Pass first few millimeters of urine to flush out the bacteria from the urethra, then
collect the mid-stream portion in a sterile universal container and close it tightly.
Female Patients
i. Clean the periurethral 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
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 107
Note:
When culture for tubercle bacilli is required, collect at least 50 ml of early morning
midstream urine on 3 consecutive mornings into sterile container.
Catheterized Urine
i. Clean catheter collection port with 70% alcohol.
ii. Puncture collection port using needle attached to a syringe under strict aseptic
technique.
iii. Aspirate urine and place in a sterile container.
Note:
a.Urine from catheter bags is generally unsuitable for culture.
b.Culturing urinary catheter tip is a waste of time as it is invariably contaminated by
urethral organisms.
Bladder Urine Samples
i. This is obtained via suprapubic aspiration (SPA) or cyctoscopically.
ii. Before SPA, recommended for patient to force fluids until bladder is full.
iii. Urine is collected in a sterile container.
Note:
Specimens should be kept with ice if unable to reach the lab within one hour after collection
Serous Fluid
i. Collect 3-5 ml serous fluid into sterile container for the examination of microscopy
and culture for bacterial.
ii. Send the specimen immediately to the laboratory.
iii. Do not refrigerate.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 108
Mycology
Skin, Nails and Hair
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
i. Specimen from the scalp should include hair roots, the contents of plugged follicles
and skin scales.
ii. Hair should be plucked from the scalp with forceps or the scalp is brushes with a
plastic hairbrush and collected onto agar plate.
Nails
i. Nail specimens should be taken from any discolored, dystrophic or brittle parts of
the nail.
ii. 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 and Vagina
i. Swabs from the buccal mucosa should be moistened with sterile water prior to the
taking of sample and sent in Amies transport medium.
ii. For vaginal infections, swabs should be taken from discharge in the vagina and from
the lateral vagina walls. Swabs are to be sent to the laboratory in transport medium.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 109
Ear
i. Scraping of material from the ear canal are to be preferred, although swabs can also
be used.
Ocular Specimens
i. Material from patients with suspected fungal infection of the cornea
(keratomycosis) should be collected by scrapping the ulcer. The entire base of the
ulcer, as well as the edges, should be scraped (swabs are not suitable for sampling
corneal lesions).
ii. The material is collected directly onto agar plates for culture and glass slide for
microscopic examination.
Blood
i. Blood culture for fungal isolate is collected in the same manner as for blood culture
for bacterial isolate using a manufacturer fungal bottle (Myco F/Lytic).
ii. The request for fungal culture should be indicated clearly on the request form or
clinical comment. A total of two weeks incubation will be carried out.
Cerebrospinal Fluid (CSF)
i. CSF specimens (3-5 mls) should be collected in a sterile container for microscopy
and culture.
Bone Marrow
i. This specimen is helpful for the diagnosis in a number of deep fungal infection,
including histoplasmosis and cryptococcis
ii. 3-5 ml of aspirated material should be collected and transferred into a manufacturer
blood culture bottle
Pus
i. Pus from undrained subcutaneous abscesses or sinus.
ii. If grains are visible in the pass (as in mycetoma), these must be collected. In
mycetoma, if the crust at the opening of the sinus tracts are lifted, grains can often
be found in the pus underneath.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 110
Tissue
i. If possible, material should be obtained from both the middle and edge of the
lesions.
ii. Small cutaneous, subcutaneous or mucosal lesions can often be excised completely.
iii. Tissue specimens should be placed in a sterile container without formalin.
Specimens for Serological Tests
Serological tests comprise of immunology, serology and virology.
Routine serology/virology (ELISA based method):
i. Draw 3-5 ml of blood into a plain gel tube without anti-coagulants.
ii. Leave clot at ambient temperature.
iii. Dispatch to laboratory within 4. hours after collection of blood for serum separation
by centrifugation
Note:
Haemolysed, icteric or lipaemic specimens invalidate certain tests. If such specimens are
received, the sample will be rejected to assure that results are on clinical value.
Specialized Virology test
a) Direct Antigen Detection (IFAT):
i.Respiratory specimen (sputum, BAL, tracheal aspirate, nasopharyngeal aspirate)
• Place the specimen obtained into sterile container.
ii.Herpes Simplex(HSV) I&II virus, Varicella Zoster (VZV) and Enterovirus specimen
Lesion-samples are suitable from lesion area of oral, genital, skin, cervix and cornea.
• Vesicular lesion-open a cervical lesion with a sterile swab. For oral, genital and skin
lesion use a sterile needle and a sterile swab for sampling. Scrapping or swabbing
material from the base of lesion.
• Ulcerative lesion-remove any pus from the lesion with a sterile swab for sampling
and swabbing material from the base of lesion with sterile swab.
• Dried lesion-lift the crust from the dried lesion with a sterile needle and for
sampling, use a sterile swab to obtained cells at the base of the ulcer.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 111
Specimens are to be collected very carefully as to avoid any contamination of the sampling site and
during slide preparation procedure. Moisten swab with sterile water or saline before collecting
samples and prepare the slides at the bedside.
Special Teflon slide are recommended to be used and is available in the microbiology lab.
Special Diagnostic Test for Transplant Specimens
Serology/virology (ELISA based method):
i. Draw 3-5 mls of blood into a plain gel tube without anti-coagulants.
ii.Leave clot at ambient temperature.
iii.Dispatch to laboratory within 4 hours after collection of blood for serum separation by
centrifugation
Viral Genome Detection (PCR)
a) HBV DNA PCR, HCV RNA PCR, HIV PCR – Quantitative (viral load)
i. Draw 3-5 mls of blood into EDTA tube.
ii. Dispatch to laboratory within 2 hours after collection of blood for plasma separation
by centrifugation.
b) Other virus:
• Blood:
i. Draw 3-5 mls of blood into a plain gel tube without anti-coagulants.
ii.Leave clot at ambient temperature.
iii.Dispatch to laboratory within 2 hours after collection of blood for serum separation
by centrifugation
• CSF, BAL, Bone Marrow, other sterile Body Fluid:
i. Collect a minimum of 0.3ml of sample into a sterile container.
ii.Pack in ice for transport
iii.Send directly to laboratory within 2 hours after collection.
• Tissue Biopsy
i.If possible, specimen should consist of both middle and edge section of the lesional
area.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 112
ii.Specimen of minimum 0.3cm size is appropriate.
iii.Place tissue into empty container. DO NOT add formalin into specimen.
iv.Send directly to laboratory within 2 hours after collection.
Medico legal Cases
Specific Guidelines
i. Specimens should be sealed and send directly to the microbiology laboratory.
ii. Specimens should be sent to the laboratory by a designated personnel.
iii. Chain of custody could be maintained all the times and a record book should
accompany the samples.
Some collective of various tests should follow guidelines as of microbiological requirements
and specific headings are referred.
Autopsy material
Blood:
i. Aspirate 10 ml of blood from right heart 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 with enteric bacteria.
Tissue:
i. Best collected before the body is being handled at earlier stage. Decontaminate the
skin or sear surface of heart or other organ before inserting needle or cutting out
tissue block.
Guidelines on Preparation of Blood Film Malaria Parasite (BFMP)
Blood smear is the gold standard& recommended by WHO.
Why can’t we use blood sample in EDTA tube?
The use of anti-coagulated (EDTA) blood may cause the following:
� smears require longer time to dry (increased turn-around time up to 4 – 6 hours)
� thick smears tend to flake from the slide
� stain quality is affected
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 113
� morphology of parasite & RBC may be distorted – may leads to misinterpretation
2 types of blood film/smears prepared on SEPARATE slides should be sent to the laboratory which
are the THICK FILM and THIN FILM SLIDES. For example:
(1) Thick film
(2) Thin film
(1)Specimen Collection
a) Prepare clean glass slides (with frosted
end).
b) Wear gloves and hold the patient’s left
hand with palm facing upwards.
c) Select 3rd finger from thumb but for
infant – use toe.
d) Clean the finger with a piece of cotton
wool lightly soaked in 70% ethanol.
e) Dry the finger with a clean cotton swab,
using firm strokes to stimulate blood
circulation.
f) Use sterile lancet to prick the finger.
g) Apply gentle pressure to the finger to
allow the blood to come out.
h) Wipe off the first drop.
i) Apply further gentle pressure for more
blood.
a) b) & c)
d) & e) f)
g) & h) i)
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 114
(2) Preparation of Thin Film
a) Place blood on clean glass slide near the
frosted end of the slide.
b) Place the spreader slide in contact with
the drop of blood at an angle (~45°C).
c) Let the blood spread along the edge of
the spreader slide.
d) Gently push towards the other end of the
slide.
(3) Preparation of Thick Film
a) Place one drop of blood on clean glass
slide in the middle only.
b) Spread the drop of blood using a corner
of the spreader (slide / coverslip).
c) Spread in one circular direction to make
even thick film size ~ 1 cm diameter (10
cent coin).
d) The right thickness is when the slides
were placed on the newspaper we still
should be able to read the writing.
a) & b)
b), c) & d)
a)
b) & c)
d)
c)
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 115
(4) Labeling of slides
Print barcode sticker & place it at the
frosted end of the glass slide.
* DO NOT LABEL ON OR BELOW THE
BLOOD FILM!
(5) Drying of slides
a) Air dry the slides on a rack on bench OR
in a slide tray with the cover open.
b) Slides must be dried completely
before they are packed and transport to
the lab.
DO NOT SEND WET SMEARS!
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 116
E. SPECIAL TEST
INSTRUCTIONS:
GENERAL HAEMATOLOGY
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 117
INTRODUCTION
The services provided include basic haematology tests (Full Blood Count, coagulation profile,
Erythrocyte Sedimentation Rate (ESR) and G6PD).
More specialized haematology tests are provided by the Clinical Haematology Laboratory
(Haematology Department).
SPECIMEN COLLECTION
1.ESR
-1.8 ml blood in sodium citrate tube up to the mark as indicated.
-mix thoroughly by gentle inversion (5-6 times)to avoid clot formation.
-send to the laboratory as soon as possible.
2. Full Blood Count (FBC)
-Collect 2.0-2.5 ml of blood in EDTA tube or up to the mark as indicated.
-mix thoroughly by gentle inversion (8 times)to avoid clot formation.
-send to the laboratory as soon as possible.
3. Coagulation Screen
-please refer to the guideline for collection as below:
Guidelines for Coagulation Profile.
Collection:
- Proper identification of patient with correctly labelled sample
o Includes full name, IC no. / hospital AM no., bar code label
- Must be drawn into a citrate-based anticoagulant tube
o Sodium citrate protects the integrity of plasma sample from protease activity and
minimizes platelet activation
- Must be filled upto the mark on the tube
o For coagulation testing, the proportion of blood to the sodium citrate anticoagulant
volume is 9:1
o Inadequate filling of tube will decrease the ratio and lead to inaccurate results (i.e:
clotting times tends to increase)
- Preferably collected before other test samples are drawn into other test tubes to avoid
contamination of the test sample
- Avoid air introduction into tube
o To avoid under-filling of test tube which can result in sample dilution and may also
provide falsely prolonged clotting time
- Blood should never be transferred from 1 tube to another (even if 2 sodium citrate tubes
are combined)
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 118
o To avoid doubling up of anticoagulant citrate levels and further dilution of plasma
sample
o EDTA causes raised PT and APTT
- Mix samples thoroughly (3 to 6 end-over-end tube inversions)
o To avoid false increase in test results
- Avoid mixing samples vigorously
o Leads to in vitro hemolysis or spurious test activation � causes false shortening of
test clotting times
- Collections from arterial / venous lines should include a process for flushing and/or
discarding the initial collection
o To avoid dilution by saline or contamination with heparin
- Avoid use of heparinized needles/tubes to avoid contamination with heparin
- Avoid use of too small or too big a needle size to avoid haemolysed / clotted / or activated
samples
Transport:
- Samples to be sent at ambient room temperature (should neither be transported at
refrigerated nor at high temperature)
- To be sent in as short a time as possible (test should be completed within 4hours of
collection)
o To avoid any effects on labile factors
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 119
F. SPECIAL TEST
INSTRUCTIONS:
BLOOD TRANSFUSION
SERVICE
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 120
INTRODUCTION
The Blood Transfusion Unit in the Department of Pathology was started in 2006 since the start of
Hospital Ampang operation.
This unit has expanded its service by fully starting the antibody identification section in 2011.
Most of the antibody cases are of the Haematology which includes the haemato-oncology,
transplant and Thalassemia patients.
In 2009, Pathology Department in collaboration with clinicians in Hospital Ampang has produced
the first edition of Hospital Ampang Transfusion Policy which is available in Public Folder
(Pathology) to provide guideline and information about transfusion issue in Hospital Ampang.
REQUEST
Test request is through eHIS and manually. The appropriate form is to be filled up and send
together with specimen. ( List as below)
Test Form
Group Screen & Hold (GSH)
eHIS and Borang permohonan transfusi darah
Group & Cross match (GXM)
eHIS and Borang permohonan transfusi darah
Blood group & Rh Type eHIS
Component request
eHIs and Borang permohonan transfusi darah
Investigation of Transfusion Reaction Post I
eHIS and Borang penyiasatan reaksi pemindahan darah
Investigation of Transfusion Reaction Post 2
eHIS and Borang penyiasatan reaksi pemindahan darah
Anti Human Globulin tests ( Coombs test)
eHIS
Antibody Identification
eHIS and Borang identifikasi antibodi
Cold Agglutinin Titre
eHIS and Borang identifikasi antibodi
SPECIMEN COLLECTION
Generally, venous blood in EDTA bottle is preferred. There is no specific requirement for the
sample except for Cold Agglutinin Titre test, where it should be a fresh sample sent at an optimal
temperature of 37°C.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 121
All specimens will be received and registered at the blood bank counter. The specimens should
not be sent to the main counter of Pathology Department (CRA).
REPORTING OF RESULTS
The results will be automatically released to the eHIS. The senior Medical Laboratory
Technologists (MLT), Scientific Officer, Medical Officer or Pathologist will validate certain results
such as transfusion reaction investigations and antibody identification tests.
Any inquiries or uncertainty regarding the results can directly contact the Medical Officer or
Pathologist.
TRANSFUSION REACTION
If an adverse transfusion reaction is suspected, the transfusion should be stopped immediately. The
doctor in charge of the patient must be informed urgently to assess the patient. Further
management depends on the type and severity of the reaction.
The report of “REACTION TO BLOOD OR PLASMA TRANSFUSION” and “INVESTIGATION OF A
REPORTED TRANSFUSION REACTION” forms must be completed and sent to Blood Bank.
Investigation of Transfusion Reaction Post
• This investigation should be done immediately.
• List of samples taken as follows:
Test Name Specimen Type Container
Type Volume
Antihuman Globulin Test Blood EDTA Tube 5 ml
Blood group & Rh Type Blood EDTA Tube 5 ml
Group & Cross match (GXM) Blood EDTA Tube 5 ml
Antibody Screen Blood EDTA Tube 5 ml
Renal Profile Blood
Lithium
Heparin 3ml
Bilirubin Blood
Lithium
Heparin 3ml
Hemoglobin Urine
Universal
container 20ml
Bacterial Culture (from transfused blood bag)
Blood Culture
Bottle
5-10 ml for adult /
1-2 ml for pediatric
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 122
Investigation of Delayed Transfusion Reaction
• Transfusion reaction which happen after 24 hours of transfusion
• List of samples taken as follows:
Test Name Specimen Type Container Type Volume
Blood group & Rh Type Blood EDTA Tube 5 ml
Antibody Screen Blood EDTA Tube 5 ml
Renal Profile Blood Lithium Heparin 3ml
Bilirubin Blood Lithium Heparin 3ml
Hemoglobin Urine Universal container 20ml
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 123
PLASMA EXCHANGE PROCEDURE
*Please call MO Makmal Transfusi Darah–on-call for any urgent/change in request
*REQUEST MUST BE ACCOMPANIED WITH BORANG (PPDK 5-Pin 1/97) AND
SPECIALIST/MO/HO TO INFORM BB MO/ MO-ON-CALL AT LEAST 1 DAY PRIOR TO
TRANSFUSION. REQUEST MUST INCLUDE DATE, TIME, DURATION (DAYS), & VOLUME
REQUIRED FOR EACH TRANSFUSION. No request over weekend and public holidays until the next working day
MAKMAL TRANSFUSI DARAH, HA REQUEST FROM PDN
CLINICIAN TO CONFIRM TIME OF PLASMA
EXCHANGE (1 DAY PRIOR TO PLASMA EXCHANGE)
SEND REQUEST FORM IMMEDIATELY TO MAKMAL TRANSFUSI DARAH, HA
DAY OF PLASMA EXCHANGE:
WARD STAFF TO CONFIRM TIME OF TRANSFUSION WITH MAKMAL TRANSFUSI DARAH, HA.
MLT TO START THAWING PROCESS
Thawing process takes about 30 mins/per cycle & only 4 units of cryo can be thawed in
1 Cycle/machine.
MLT TO INFORM WARD WHEN PLASMA IS READY
WARD COLLECTS & TRANSFUSES IMMEDIATELY
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 124
G. SPECIAL TEST
INSTRUCTIONS:
CYTOLOGY
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 125
INTRODUCTION
Cytology is a discipline that involves the morphological study of cells. It is divided into two broad
categories i.e. exfoliative cytology and aspiration cytology. Exfoliative cytology involves
examination of specimens which contain exfoliated cells. The usual specimen received is cervical
smears, sputum, urine, cerebrospinal fluid, pleural fluid, peritoneal fluid and washings of various
sites. Aspiration cytology involves examination of cells that are obtained by fine needle aspiration
and brushings.
LIST OF SERVICES
These services are provided during office hours:
a) Gynecological specimen. (Cervico-vaginal specimen, i.e.: Pap smear)
b) Non-gynecological specimen.
i.Sputum.
ii.Body fluids. (e.g.: urine, CSF, pleural and ascetic fluid)
iii.Nipple discharge.
iv.Brushing. (e.g.: Bronchial / Gastric)
v.Washing. (e.g.: Bronchial / Peritoneal)
c) Fine Needle Aspiration Cytology.
REQUEST OF TEST
a) Requests are made in the computer system.
b) 3copies of PER-PAT 301 forms needs to be filled for cytological examinations as samples are
sent outsource.
c) Register and manage the specimen in the ward prior to sending it to the lab.
d) For urgent request, please mark the request form as “URGENT” in the right hand corner of the
request.
e) Stick hospital barcode at the right hand side corner of all 3copies of PER-PAT 301.
f) Fill form completely with clearly written name of doctor in charge (especially the specialist in
charge), so that they would be able to be contacted if there is any inquiry.
g) Clearly indicates the ward/clinic where the sample was taken.
SPECIMEN CONTAINER
a) All specimens for cytological examination should be put in clean universal leak-proof
containers.
b) Slides (Pap smear, nipple discharge, FNA, sputum, etc.) should be placed in slide mailer before
being dispatched to the laboratory.
c) All specimens should have the same identification as that written on the request form.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 126
SPECIMEN COLLECTION
(a) Gynecological specimen
i.Take the smear before bimanual examination.
ii.Do not use lubricant on the speculum.
iii.Place spatula at the external os and rotate through 360degrees, lightly scraping the squamo-
columnar junction.
iv.Smear the material onto a clean, labeled glass slide about as thick as a blood film.
v.Immediately place the slide in 95% alcohol for at least 15minutes. If more than one slide is to
be placed in the same container, ensure that they are not placed face to face.
(b) Sputum (Note: to be collected on three consecutive days)
i.Instruct the patient to empty the mouth of all saliva immediately after waking up in the
morning.
ii.Patient should then cough deeply and collect the resulting sputum in the container supplied.
iii.Specimen container should be labeled and dated as per the day of collection, and then sent
immediately to the laboratory.
iv.Do not forget to collect a similar specimen for the next two days.
(c) Urine
i.The requesting doctor must indicate type of urine either voided or catheterized urine.
ii.If voided urine, the patient should discard the first void in the morning and collect the next
voided urine – do not send overnight urine sample as most of the cells in this sample are
degenerated.
iii.Send the urine sample to the laboratory immediately.
(d) Body fluids
i.Specimens are collected in clean containers and dispatched immediately to the laboratory.
ii.If delay of more than 2hours is anticipated, put in the refrigerator at 4’C.
(e) Brushing specimen
- The brush must be rotated gently, and immediately smeared onto a clean slide and fix in 95%
alcohol for 30mins.
(f) Nipple discharge
i.Do imprint smear by placing the labeled slides onto the nipple. Prepare at least 2 smears.
ii.One slide is fixed in 95% alcohol and labeled as ‘fixed’. The other slide is air-dried and labeled
as ‘dry’.
(g) FNAC
i.FNAC clinic is conducted as scheduled.
ii.Appointment requests for FNAC should be ordered only by the 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
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 127
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.
iii.Consent from patient should be taken by the requesting practitioner.
iv.FNAC for superficial lesions can be performed either by medical practitioner of the respective
department or pathology department.
v.FNAC for deep seated lesions and as clinically indicated is performed by the radiologist under
radiological guidance or the respective specialized medical practitioner on appointment basis.
DISPATCH OF SPECIMEN
a) Specimen for cytological examination should be sent immediately to the common receiving
counter (CRA).
b) Specimen collected after office hours and which are unable to be sent to the laboratory shall be
kept in the refrigerator at 4’C and send on the following working day to Hospital Kuala Lumpur
(for FNAC specimens) and Hospital Serdang (other cytology specimens). Do not freeze
specimen.
REPORTING OF RESULTS
a) Completed cytology reports are received via email, followed by a printed hardcopy report.
b) These reports will then be keyed-in to the system to be viewed by the requesting doctor.
c) Cases are generally reported within LTAT as mentioned in Table: List of Test; unless the cases
need further studies, second opinion and etc.
ENQUIRY OF REPORTS
a) Enquiry of report over the phone is DISCOURAGED. It is advised to check the results from the
system.
b) It is advisable to enquire in the event the cases are not yet reported within the stipulated time.
SERVICE AFTER OFFICE HOURS
a) No specimen for cytological examination is accepted after office hours.
b) Specimens collected during non-office hours should be refrigerated at 4’C before being
dispatched to the laboratory the next day – refrigeration helps in preserving the cell. DO NOT
FREEZE SPECIMEN
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 128
H. SPECIAL TEST
INSTRUCTIONS:
HISTOPATHOLOGY
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 129
INTRODUCTION
Histopathological services are concerned with diagnostic interpretation through macroscopic and
microscopic examination of tissue. This includes the histological assessment of specimen removed
from surgery or at non-surgical biopsy procedures and the investigation of disease at autopsy. In
each case, the diagnostic examination is part of the clinical investigation of the patient and cannot
be performed satisfactorily in isolation. Quality of histopathology interpretation may depend upon
the information written on the request forms.
LIST OF SERVICES
a. Surgically removed tissue.
b. Non-surgically removed tissue.
c. Frozen section.
REQUEST OF TESTS
a) Requests are made in the computer system.
b) 3copies of PER-PAT 301 forms needs to be filled for histological examinations and
frozen section as samples are sent outsource.
c) Register and manage the specimen in the ward prior to sending it to the lab.
d) For urgent request, please mark the request form as “URGENT” in the right hand corner
of the request.
e) Stick hospital barcode at the right hand side corner of all 3copies of PER-PAT 301.
f) Fill form completely with clearly written name of doctor in charge (especially the
specialist in charge), so that they would be able to be contacted if there is any inquiry.
g) Clearly indicates the ward/clinic where the sample was taken.
SPECIMEN COLLECTION
a) Specimen for routine histological examination is to be fixed in 10% Neutral Buffered
Formalin in suitable leak-proof container. The volume of formalin used is at least 10
times the specimen to be fixed.
b) Do not put large specimen in a small container as this would prevent proper fixation of
the tissue and also distort the specimen.
c) For adequacy of surgical excision in malignant neoplasm, the margins must be marked
accordingly by suture tie / wire or by diagrammatic representation of the excised
specimen.
d) Specimens should have the same identifications as that mentioned in the system or as
written on the request forms.
e) Specimen for frozen section and enzyme histo-chemical studies are to be sent fresh
without fixative in a closed container.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 130
f) Specimen for immunofluorescence studies is to be sent on filter paper moistened with
phosphate buffered solution (PBS) to prevent drying.
DISPATCH OF SPECIMEN
a) Specimen for routine histological examination and immunofluorescence should be sent
directly to the common receiving counter (CRA).
b) Specimens for frozen section are sent immediately upon removal to the laboratory by
ward PPK.
c) All histopathology samples are sent to Hospital Serdang daily except on Saturday,
Sunday and Public Holiday.
FROZEN SECTION
a) Frozen section can only be requested by the specialist treating the patient by making an
earlier appointment with the Histopathologist oncall in Hospital Serdang and
pathologist oncall in Hospital Ampang.
b) The lab has to make an arrangement for the hospital transport.
c) All cases scheduled for frozen section examination are best placed first in the operating
list.
d) 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 cancelled.
e) The tissues for frozen section are to be sent fresh without formalin or in a gauze moister
by normal saline to prevent drying.
f) The doctor must send the specimen immediately to the laboratory with the request
form.
g) PPK from the ward will bring the samples to the designated hospital by hospital
transport (arrangement made by Pathology Department) and sent directly to
Histopathology lab Hospital Serdang.
h) Histopathologist will inform the result to the requesting doctor.
REPORTING OF RESULTS
a) Completed histopathology reports are received via email, followed by a printed
hardcopy report.
b) These reports will then be keyed-in to the system to be viewed by the requesting doctor.
c) Results of frozen section will be immediately communicated to the surgeon via
telephone, and the report will be made available subsequently in the system.
d) Cases are generally reported within LTAT as mentioned in Table: List of Test; unless the
cases need further studies, second opinion and etc.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 131
ENQUIRY OF REPORTS
e) Enquiry of report over the phone is DISCOURAGED. It is advised to check the results
from the system.
f) It is advisable to enquire in the event the cases are not yet reported within the
stipulated time.
SERVICE AFTER OFFICE HOURS
a) The specimens should be fixed in the usual manner and dispatched to the laboratory.
b) No frozen sections are available after office hours. All cases scheduled for frozen section
examination are best placed first in the operating list.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 132
I. CRITICAL RESULTS IN PATHOLOGY DEPARTMENT
All critical results will be informed.
CHEMICAL PATHOLOGY
ANALYTES
LOWER CRITICALLIMIT UPPER CRITICALLIMIT
ADULT PAED NEONATE ADULT PAED NEONATE
K 2.8 mol/L 2.8 mml/L - 6.0mmol/L 6.0
mmol/L
-
NA 125 mol/L 125
mmol/L
- 155
mmol/L
155
mmol/L
-
GLU 2.8 mmol/L - - 20 mmol/L - -
CA 1.5 mmol/L 1.7 mmol/L - 3.0 mmol/l 3.1
mmol/L
-
MG 0.41 mmol/L 0.5 mml/L - 2.0 mmol/L 1.8
mmol/L
-
PO4 0.32 mmol/L 0.4 mmol/L - 2.87
mmol/L
2.8
mmol/L
-
PH 7.2 7.2 - 7.55 7.6 -
PO2 60 mm/Hg 45 mm/Hg - - 125
mm/Hg
-
PCO2 - 20 mm/Hg - 70 mm/Hg 70 mm/Hg -
SR OSMOLAL 250 mmol/kg 250
mmol/kg
- 350
mmol/kg
310
mmol/kg
-
CSF GLU - 1.6 mmol/L - - - -
TSHN - - - - - 21 uIU/ml
NH3 - - - - 100
mmol/L
-
LACTATE - - - 5 mmol/L 3 mmol/L -
TBIL - - - - - 300
umol/L
UREA
- - - - 19 mmol/L -
CREAT
- - - - 330umol/L -
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 133
GENERAL HEMATOLOGY
PARAMETERS
LOWER CRITICAL LIMIT UPPER CRITICAL LIMIT
ADULT PAEDS NEONATE ADULT PAEDS NEONATE
HGB 6.0g/dl 7.0g/dl 8.0g/dl 19g/dl 20g/dl 22g/dl
HCT 20% 20% 25% 60% 40% 75%
PLT 20K/uL - - 1000K/uL - -
WBC - 2.0K/uL - - 50K/uL -
INR (Ratio) - - - >5 >5 -
PT (Sec) - - - >2.5 upper
limit
- -
APTT (Sec) - - - 80 sec or
>2X (Upper
reference
range)
80 sec or
>2X
(Upper
reference
range)
-
ANATOMICAL PATHOLOGY
TEST CRITICAL FINDINGS
Unexpected or discrepant findings Unexpected malignancy
Wrong organ removed
Reports of infections Bacterial in heart valves or bone marrow
Organisms in an immune-compromised patient
such as AFB, fungi, viral or protozoa.
Organisms in Cerebrospinal Fluid (CSF)
Unusual organisms or organisms in unusual
sites eg. Amoeba in the eye
Reports on critically ill patients requiring
immediate therapy
Crescents in greater than 50% of glomeruli in
renal biopsy specimen
Transplant rejections
Cases that have immediate clinical
consequences
Fat in an endometrial curettage
Mesothelial cells in a heart biopsy
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 134
Fat in snare colon biopsy specimens
BLOOD BANK
TEST CRITICAL FINDINGS
Antibody screening test Positive
ABO Blood group Rh Negative blood group
Rare blood group eg. Bombay, Parabombay
MICROBIOLOGY
MICROBIOLOGY TESTS CRITICAL RESULTS
Blood C&S Positive results from Gram Stain and/or culture.
CSF C&S Microscopy result (normal or abnormal) and positive result from
culture.
Acid fast bacilli (AFB) Positive smear and/or culture
Blood film for malaria
parasite (BFMP)
Positive smear
CSF Cryptococcal or Bacterial
antigens
Positive
Cryptococcal Indian Ink Positive
Stool C&S Salmonella typhi, Vibrio cholera, Shigella sp.
Any type of C&S Neisseria meningitidis , Burkholderia pseudomallei, MRSA, ESBL,
MRO,VRE, VISA,VRSA and CRE.
Pernasal swab Bordetella pertusis, Corynebacterium diphtheria.
Legionella Antigen Positive
Abbreviations:
• MRSA: Methycillin-Resistant Staphylococcus aureus
• ESBL: Extended Spectrum Beta Lactamases
• MRO: Multi-Resistant Organism
• VRE: Vancomycin Resistant Enterococcus
• VISA: Vancomycin Intermediate Staphylococcus aureus
• VRSA: Vancomycin Resistant Staphylococcus aureus
• CRE: Carbapenem Resistant Enterobacteriaceae
• CSF: Cerebrospinal fluid
• BAL: Bronchioalveolar Lavage
• SPA: Suprapubic aspirate
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 135
THERAPEUTIC DRUG MONITORING
DRUG TOXIC CONCENTRATION
AMIKACIN
T > 8.6 umol/l
CYCLOSPORIN (CSA)
> 400 ng/mL
GENTAMICIN
T > 4.18umol/l
METHOTREXATE
(MTX)
48hrs >1.0 µmol/L 72hrs > 0.2 µmol/L
Random > 0.02 µmol/L
VANCOMYCIN
T > 13.8umol/l
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 136
J. LIST OF SPECIMEN CONTAINERS/TUBES
Images of the
container/tube Test
Anti-
coagulant Tube type
Specimen
volume
Mixing
Frequency
INTERGRATED
LABORATORY
Glucose
Sodium
Flouride or
Potassium
Oxalate
Vacuum 2.0 ml
8 times
PT, APTT, INR
ratio, D-
Dimer,
Fibrinogen,
DIVC
screening.
Buffer Sodium
Citrate
Vacuum 1.8 ml
3 – 4
times
Adult
Paediatric
FBP, FBC
Purple cap –
EDTA
Purple cap -
EDTA
Adult-
vacuum
Paediatric-
non
vacuum
Adult:
1.0 ml
Paediatric:
250 – 500
ul
8 times
8 times
correct filling level
correct filling level
correct filling level
correct filling level
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 137
Images of the
container/tube Test
Anti-
coagulant Tube type
Specimen
volume
Mixing
Frequency
Adult
Paediatric
RP,BUSE,
Amylase,
Bilirubin,
Serum PCM,
Serum
Salicylate,
CE,FSH,LH,
Fe/TIBC.
Adult:
Plain gel tube
with gel
Paeds:
Lithium
heparin
Adult-
Vacuum
Paediatric
- Non
vacuum
Adult:
3.5 ml
Paediatric:
800 ul
5 times
5 times
ESR
Sod. Citrate
Non
vacuum
tube
1.28 ml -
1.8 ml
5 – 6
times
ABG
Heparin
0.6 ml - 1.0
ml
Mixed
well using
roller
mixer or
palm.
Send
ASAP to
lab with
ice.
correct filling level
correct filling level
correct filling level
correct filling level
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 138
Images of the
container/tube Test
Anti-
coagulant Tube type
Specimen
volume
Mixing
Frequency
BLOOD TRANSFUSION
SERVICES
GXM, GSH,
Blood
Grouping,
Coomb’s test.
Pink cap -
EDTA
Adult-
Vacuum
Paediatric-
Non
vacuum
Adult:
6.0 ml
Paeds:
2.0 ml
8 times
8 times
EDTA tube Plain tube
GXM,GSH and
Antibody
Identification.
(1 tiub EDTA
+ 2 plain
tube).
Pink cap -
EDTA
Red cap –
Plain without
anti coagulant
Vacuum
Pink cap
(EDTA) -
6.0 ml
Red cap
(Plain) –
4.5 ml
Pink cap
(EDTA -
8 times
Red cap
(Plain) –
No need
MICROBIOLOGY
LABORATORY Specimen Container Test Volume Comment
Urine, sterile
fluid, tissue,
sputum, pus
aspirate
Universal
Sterile
container
Urinalysis,
culture and
sensitivity,
molecular.
NA
DO NOT add
formalin for
tissue
culture. For
molecular
test, to send
with ice pack
correct filling level
correct filling level
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 139
MICROBIOLOGY
LABORATORY Specimen Container Test Volume Comment
Blood, bone
marrow
aspirates
Blood
culture
bottle:
Aerobe
(BLUE
CAP)
Blood
culture and
sensitivity
Adult: 10
mls
-DO NOT put
the sticker
onto the
barcode
area(X) on the
bottle
-mix with
swirling
method
Blood Blood
culture
bottle:
Anaerobe
(GOLD
CAP)
Blood for
paediatric
patient
Blood
culture
bottle:
Paeds
(SILVER
CAP)
Paed:
1-3mls
X
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 140
MICROBIOLOGY
LABORATORY Specimen Container Test Volume Comment
Blood Blood
culture
bottle:
Myco
F/Lytic
(RED CAP)
For isolation
of
Mycobacteri
um(TB) and
fungal
1-5 mls
Blood culture
bottle:
Myco F/Lytic
(RED CAP)
Swab from
vesicular
lesion, eye,
respiratory
site eg.
Nasopharyngea
l, throat swab
etc
Viral
transport
Media
(VTM)
Viral
isolation,PCR
– eg. H1N1,
MERS-CoV,
adenovirus,
NA
To get from
the lab. Put
the swab into
VTM and send
to the lab in
ice
immediately.
High vaginal,
endocervical,
swab
Amies
Transport
Media
(with
charcoal)
Culture &
sensitivity
for HVS, pus
swab, tissue
swab and
throat swab
NA
Blood
Plain tube
with gel
(yellow
cap),
without
gel (red
cap)
Serology test 5 mls
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 141
CORRECT LABELLING OF BARCODE STICKERS
Barcode can be seen clearly, Part of tube still can be seen. Does not interrupt test
in a straight line, not folded. flow.
CORRECT LABELLING OF BARCODE STICKER
The recommended way to stick the barcode
X
√
Bahagian hadapan
Bahagian belakang
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 142
PROPER SAMPLE MIXING FOR TUBE WITH ANTI COAGULANT
MIX WELL BY INVERTING TUBE. DRAW VOLUME AND NUMBER OF INVERSIONS ARE OF CRITICAL
IMPORTANCE AND CLINICALLY SIGNIFICANT!!
GUIDE TO ORDER OF DRAW FOR BLOOD SAMPLES
One Inversion
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 143
Blood Culture
Media
Buffered Sodium
Citrate
Plain or Plain
with gel Lithium Heparin K2 EDTA Fluoride
1 2 3 4 5 6 (Order of draw recommended by Clinical and Laboratory Standard Institute (CLSI), previously known
as NCCLS)
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 144
K. SPECIMEN REJECTION CRITERIA
a) GENERAL 1. Blood clotted
2. Blood haemolysed
3. Contaminated specimen
4. Decomposed specimen
5. Delayed sending the specimen
6. Deteriorated specimen
7. Duplicate order
8. Empty container received
9. Incomplete information
10. Insufficient sample
11. Mislabeling of specimen
12. No label
13. No specimen received
14. Patient detail/ container differ
15. Specimen leakage/ broken/ spill
16. Specimen not accompanied with form (outsource test)
17. Specimen not send in ice
18. Test not offered
19. Test requested is not stated
20. Wrong anticoagulant
21. Wrong container
22. Wrong request form
23. Wrong specimen
24. Wrong transport medium
25. Wrong order
26. “Unmanaged” sample
27. Slide’s label cover the smear
28. Test not ordered
29. Unsuitable sample
30. Excess sample volume
31. Barcode not readable by scanner
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 145
b) CHEMICAL PATHOLOGY 1. Icteric serum
2. Lipemic blood received
3. Mucoid specimen
4. ABG received in syringe with needle
c) ROUTINE HAEMATOLOGY 1. Incorrect ratio of blood to anticoagulant
d) MEDICAL MICROBIOLOGY 1. Poor smear for BFMP (too thick/too thin or too small)
2. Poor smear for Microfilaria (too small)
3. Salivary sputum- unsuitable for culture
4. Non sterile container for culture and sensitivity
5. Tissue culture received in formalin
6. Dry swab for culture
7. Foley catheter tip for culture
8. Sample for HBV,HCV and HIV Genome detection or viral load test received in plain tube.
e) PROTEIN 1. Previous request is less than the specified time for HbA1c
2. Previous request is ≤ 3 months for serum & urine protein electrophoresis
3. No serum or urine received for osmolality test
4. Urine pH >6 for urine cathecolamine
5. Urine 24 hours < 750ml
6. Serum is required for electrophoresis. Plasma sample is rejected.
f) HISTOPATHOLOGY 1. Insufficient fixative
2. Wrong fixative
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 146
L. SPECIAL TESTS
REQUEST FORMS
*(PLEASE NOTE THAT ALL REQUEST FORMS CAN BE FOUND AND
PRINTED FROM THE HOSPITAL AMPANG PATHOLOGY DEPARTMENT
FOLDER IN PUBLIC FOLDER)
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 147
*This form is used when ordering AFP (Acute Flaccid Paralysis) test for suspected Polio
virus infection case.
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 155
*This form is used to request for Immunohaematology tests (Antibody Identification, RBC
Phenotype, Antibody Titration).
HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT
[HANDBOOK OF PATHOLOGY SERVICES, 5 th Edition ] 162
M. LIST OF PATHOLOGY TELEPHONE NUMBERS
Hospital Ampang: 03-42896000 Pathology Department Fax number: 03-42806594
Office Ext
Head of Pathology Department and Senior Consultant Pathologist 6046
Personal assistant/general office 6460
Medical Officers Room 6528/6529
General Scientific Officer’s Room 6053
Senior Medical Lab Technologist (U38/U36) 6049
Medical Lab Technologist (U32) 6047
CRA
CRA counter
6221 (24 hours)
MICROBIOLOGY UNIT
Head Unit 6224
Senior Scientific Officer 6057
Microbiology Lab 6464/6463/6462
INTEGRATED/CHEMICAL PATHOLOGY
Head of Unit 6050
Integrated Lab 6533
BLOOD TRANSFUSION LABORATORY
Head Unit 6050
Blood Bank 6054 (24 hours)
SPECIAL PROTEIN LABORATORY
Head Unit 6534
Special Protein Laboratory 6215
Drug Laboratory 6216
Top Related