Department of Diagnostic Medicine - Jewish General Hospital

Laboratory Handbook | Department of Diagnostic Medicine | Jewish General Hospital | 2012-2013 Page 1

Department of Diagnostic Medicine

Laboratory Handbook


Table of contents

Our mission ............................................................................................................... 3 Where to find us ....................................................................................................... 4 Pavillion and area map ............................................................................................ 5 Calendar of Statutory Holidays 2009-2010 .......................................................... 6 Phlebotomy services................................................................................................ 7 Important Numbers .................................................................................................. 9 Requisition Form .................................................................................................... 10 Specimen ID & Rejection ...................................................................................... 12 Biohazard specimen bags .................................................................................... 13 Specimen Delivery ................................................................................................. 14 Blood ........................................................................................................................ 16 Results Reporting................................................................................................... 18 Panic Values (Telephone limits) .......................................................................... 18 Therapeutic Drug Monitoring ................................................................................ 21 Analytical interferences ......................................................................................... 22 Near patient testing................................................................................................ 23 Research and Trials............................................................................................... 24 Reference Intervals ................................................................................................ 25 Various tests requiring special collection ........................................................... 40 Glucose tolerance test........................................................................................... 43 Patient Instructions for a Clean-Catch Urine Collection................................... 44 Patient instructions for 24-Hour urine collection................................................ 45 24-Hour urine collection bottles ........................................................................... 46 Patient instructions for sputum collection ........................................................... 47 Patient instructions for stool collection................................................................ 48 Patient instructions for stool O&P collection ...................................................... 49 The following protocol is to be used for diagnosing Influenza. ....................... 50 Hemoccult screening - Patient information ........................................................ 51 Labeling of cytology specimens ........................................................................... 52 Procurement of cytology specimens ................................................................... 53 Transfusion service ................................................................................................ 55


Our mission

To provide medical laboratory services consistent with the needs of the health care team and their patients in a professional and caring manner.

To initiate and collaborate in research activities directed towards the improved understanding of disease, its diagnosis and monitoring

To ensure the optimal use of the laboratory service

To encourage and develop all staff to attain their true potential and to develop a milieu which promotes teamwork


Where to find us

Address:

Pavillion D-136

Jewish General Hospital

3755 Côte-Sainte-Catherine Road

Montréal, Québec, Canada

H3T 1E2

Entrances:

1. Main entrance on Côte-Sainte-Catherine

Road (Pavilion B)

This above entrance is temporarily closed

due to construction.

2. Légaré Street (Pavilion E) entrance,

across from the hospital's parking lot

3. Côte-des-Neiges Road (Pavilion A)

entrance

4. For Pavilion H, the entrance can be found

on Côte-des-Neiges Road

Parking:

A parking lot charging hourly or daily rates is

located on Légaré Street, between Côte-

Ste-Catherine Road and Bourret Avenue.

Valet parking is available at the Côte-des-

Neiges and Légaré entrances of the

hospital. Parking is also possible on many of

the nearby streets (some of which have

parking meters), but there may be limitations

or restrictions on the hours and days when

parking is permitted.

Public transportation:

The hospital is accessible through many

MTC/STM bus and metro lines.

Metro - Côte-Sainte-Catherine and

Plamondon (orange line), as well as Côte-

des-Neiges (blue line)

Bus Lines - 165, 535, 129, 124, 160, 161,

119 and 51

(Night bus lines - 368, 369 and 370)

Contact us:

Tel: 514-340-8222 ext 5094

Fax: 514-340-7510

Laboratory Hours

The laboratory operates 24 hours a day 7 days a week (including statutory holidays). Tests with turnaround times less than 24h are performed daily. Tests with turnaround times greater than 24h are performed Monday to Friday: 08h30 - 16h30 (excluding statutory holidays).


Pavillion and area map

Laboratory and Test Centre are located here on the first floor


Calendar of Statutory Holidays

2012-2013

*

Dimanche Sunday

1er juillet 2012 July 1st, 2012

CONFÉDÉRATION CANADA DAY

Lundi Monday

3 septembre 2012 September 3rd,2012

FÊTE DU TRAVAIL LABOUR DAY

Lundi Monday

17 septembre 2012 September 17th, 2012

1er JOUR DE LA ROSH HASHONAH 1ST DAY ROSH HASHONAH

Mercredi Wednesday

26 septembre 2012 September 26th, 2012

YOM KIPPOUR YOM KIPPUR

Lundi Monday

8 octobre 2012 October 8th, 2012

ACTION DE GRACE THANKSGIVING

Mardi Tuesday

25 décembre 2012 December 25th, 2012

NOËL CHRISTMAS DAY

Mercredi Wednesday

26 décembre 2012 December 26th, 2012

LENDEMAIN DE NOËL BOXING DAY

Lundi Monday

31 décembre 2012 December 31st, 2012

VEILLE DU JOUR DE L’AN NEW YEAR’S EVE

Mardi Tuesday

1er janvier 2013 January 1st, 2013

JOUR DE L’AN NEW YEAR’S DAY

Mardi Tuesday

26 mars 2013 March 26th, 2013

1er JOUR DE LA PASSOVER 1ST DAY PASSOVER

Vendredi Friday

29 mars 2013 March 29th, 2013

VENDREDI SAINT GOOD FRIDAY

Lundi Monday

20 mai 2013 May 20th, 2013

FÊTE DE LA REINE VICTORIA VICTORIA DAY

Lundi Monday

24 juin 2013 June 24th, 2013

SAINT-JEAN BAPTISTE

* *

Le lundi 2 juillet 2012 sera fêté et chômé en remplacement du dimanche 1er juillet 2012. Monday July 2nd, 2012 will be observed in lieu of Sunday, July 1st, 2012.


Phlebotomy services Patients must have a valid JGH Hospital

Card. Should you not have a Hospital Card

or your card has expired please collect a

new card at ground floor E Pavallion -

Legare entrance before arriving at the Test

Centre. Phlebotomy services cannot be

provided without a valid JGH Hospital Card.

The Test Centre operates as a "drop-in"

service and patients are seen on a first-

come first-serve basis. No appointments

are made.

Peak hours are between 09h00 and 11h00,

when a 1-1.5 hour wait can be expected.

Patients must arrive with the Physician's

requisition form for the test. Tests cannot be

performed without a valid requisition.

24 hour urine collections, swabs and stool

samples may be dropped off at the Test

Centre, however please ensure that the

Specimen Containers are correctly labeled.

Fasting generally means no food or drinks

are to be ingested for 8-12 hours except for

water. Please consult your physician

regarding any medication you may be

taking.

The following phlebotomy services are

offered:

Location Days Times Remarks

Test Centre 1st Floor, Pavillion

E, Room 102

Mon - Thurs

Friday

07h30 - 20h00

07h30 - 16h00

No appointments

required.

Coagulation

Clinic

1st Floor, Pavillion

E, Room 103.

Monday

Wednesday

08h00 - 11h00

07h00 10h00

Appointments

pre-scheduled.

Endocrinology

1st Floor, Pavillion

E, Opposite the

elevators.

Monday - Friday 08h00 - 11h00Appointments

pre-scheduled.

Haematology 1st Floor, Pavillion

E, Room 103.1

Mon, Tues, Thur, Fri.

Wednesday

08h00 - 16h00

07h00 - 15h00

Appointments

pre-scheduled.

Oncology 7th Floor, Pavillion

E, Room 778 Monday - Friday 07h00 - 15h00

Appointments

pre-scheduled.


Director of Professional Services

Laboratory Chief

Division Chief:Microbiology

Division Chief:Hematology and Transfusion

Division Chief:Biochemistry

Quality and Safety Officer

Microbiologists

HematologistsBiochemists

Chief TechnologistMicrobiology

Assistant Chief Technologist

Chief TechnologistTransfusion

Chief TechnologistCorelab

TechnicalCoordinators

PhlebotomistsClerks Medical Technologists Graduate Technologists

Medical TechnologistBlood Bank Clerks

Transfusion Nurseand Technologist

Medical TechnologistsGraduate Technologists

Senior Clerk

Medical Technologist (BG)

Laboratory Manager



Technical Coordinators

Department Organigram


Important Numbers General Enquiries (514) 340-8222 ext. 5094

Test Results

Biochemistry & Haematology ext. 8212

Microbiology ext. 8261

Blood Transfusion Services ext. 5072

Laboratory Manager

Mr Rocco Starnino ext. 5092

Laboratory Chief

Dr E. MacNamara ext. 5091 (Laboratory Chief and Medical Biochemist)

Section Heads

Dr E. MacNamara ext. 5091 (Section Chief Biochemistry)

Dr S. Caplan ext. 8207 (Section Chief Hematology & Transfusion Services)

Dr A Dascal ext. 2933 (Section Chief Microbiology)


Requisition Form The requisition form must be completed legibly.

The following patient information must be recorded:

Unit number or RAMQ number

Last Name and First Name

Date of birth

The following physician details must be recorded:

Name or code

Location

The following specimen information must be recorded

Date of sample collection

Time of sample collection

Check the box corresponding to the required test(s)

Additional tests can be requested in the space indicated

Specify copies to:


Remember, please complete the requisition legibly.


Specimen ID & Rejection 1. Specimen containers must be

labelled legibly

Full name

Date of Birth

MRN or RAMQ number

Where applicable date, collection site,

start stop times

2. The Laboratory reserves the right to

reject unacceptable samples such as:

Samples which may have leaked during

transit

Unlabeled specimen container

Inadequate or illegible information on

the requisition form

Blood gas syringes with needles

attached

Sample obtained or transported

incorrectly, or received in an incorrect

container

Grossly contaminated exterior of sample

container or biohazard bag

Misaligned secondary labeling (one example

of which is shown on the left) means extra

work and reduced efficiency in the

laboratory. Properly applied secondary label

is shown on the right. Please do not cover

the entire tube, allow enough space

lengthwise to visualize the blood

Samples received by the laboratory are potentially infectious. All laboratory staff are aware of this

fact and are trained in the handling of potentially infectious substances. However, the laboratory

reserves the right to reject samples which are received in a condition which would unduly

increase the staffs' risk of becoming infected, e.g. broken or leaking sample tubes, sample for

blood gas with needle attached, grossly contaminated exterior of containers.


Biohazard specimen bags

1. Tubes containing blood must be placed

a biohazard specimen bag.

2. Urine specimens and other biological

fluids must be placed in separate

biohazard bags. i.e. Do not put a tube

of blood and a urine specimen in the

same bag.

3. Ensure that the urine containers are

tightly closed before being placed in the

bags.

4. The requisition accompanying the

specimen should be folded and placed

in the pouch on the outside of the bag.

Do not put the requisition in the same

compartment as the specimens.

5. The label identifying the patient must be

placed directly onto the specimens and

not on the bag. Specimens identified

only on the bag, will be regarded as not

identified and will be rejected by the

laboratory.

6. Make sure the bags are tightly closed

(same principle as "Ziploc" bags).


Specimen Delivery

1. Blood samples:

Make sure tubes are properly identified

Place in a plastic biohazard bag

Only use one bag per patient

Do not glue or staple the bag (do not

use elastic bands)

2. Urine or stool samples:

Make sure containers are properly

closed and identified

Place in a plastic biohazard bag, (1

urine specimen per bag)

Do not glue or staple the bag (do not

use elastic bands).

3. When sending specimens to the

Hospital from an outside location,

place all bags in a solid polystyrene

box.

The use of a refrigerant bag to keep

specimens cool during transport is

recommended, but the specimens

should not be in direct contact with the

refrigerant bag.

4. Label the box:

Apply a "Bio Hazard" sticker and

Clearly identify the institution sending

the specimens including address.

Samples are generally received in the

Laboratory via the following means:

A. Inpatient samples:

The messenger service. Samples are

picked up from the Nursing Stations.

Nurse aids and orderlies also deliver

specimens in certain situations (e.g.

STAT samples).

Pneumatic tube, delivers samples from

the Emergency Department (Red Unit,

Blue Unit and "Resuscitation") as well as

the Oncology Department. The tube

operates 24 hours a day. Specimens on

ice may also be sent via the pneumatic

tube, however the ice must be sealed in

a separate biohazard bag and then

placed with the sample into a second

biohazard bag and sealed. The

requisition slip must be placed in the

pouch of the second biohazard bag.

Microbiology samples may also be sent

via the pneumatic tubes, except blood

culture bottles which are delivered via

messengers.

Samples for the Blood Bank are

delivered by orderlies and messengers.

There is no pneumatic tube in Blood

Bank.


STAT samples are delivered by hand to

the front window of the Laboratory.

B. Outpatient samples:

Samples from the Test Center, PAT,

Hematology Clinic and Endocrine Clinic

are picked up every 20 minutes and

delivered to the Laboratory.

Samples from the Herzl Family Practice

Center and ENT, Urology, Eye, Geriatric

and Methadone clinics are picked up at

approximately 09h00, 11h00, 13h00 and

15h00 and delivered to the Laboratory.

Samples from the Infectious Diseases

clinic are picked up every 30 min to 1

hour and delivered to the Laboratory.

CLSC's, Nursing Homes, etc make their

own arrangements for the samples to be

delivered to the Laboratory.

C. Research specimens: Person

responsible for the study arranges for

the samples to be delivered to the

Laboratory.


Blood

1. Most biochemistry assays are performed on whole blood, plasma or serum. These samples

are obtained by collecting blood into tubes which may or may not contain various additives. It

is generally more economical and easier to collect blood into evacuated tubes.

2. Certain assays are very specific regarding the sample type and acceptable sample tubes are

indicated the Test Catalogue.

3. When collecting whole blood or blood samples which require plasma for analysis, the sample

tube containing anticoagulant must be gently inverted 6-8 times. This must be performed

immediately following collection to ensure the sample remains unclotted.

Please note: vigorous shaking will cause hemolysis and possible test interference. If required,

the sample may be centrifuged immediately and the plasma separated.

4. When serum is required, the sample must be allowed to clot for 20 - 30 min following

collection, before centrifugation. Clotting is generally complete within this time period but

may be prolonged if the patient is anticoagulated. Centrifugation, before clotting is complete,

will cause sample probe blockage and spurious results.

5. When multiple samples tubes are to be collected, the "order of draw” on the next page must

be adhered to in order to prevent contamination of serial tubes and consequent spurious

results.

6. Coagulation tubes (light blue top) MUST be filled to the indicated mark.

Never top-up a tube by transferring blood from one tube to another.


Order of draw for venipuncture The following order is for all routine venipunctures methods (evacuated tube and winged collection set), regardless of the method used to collect it. MIX TUBES BY GENTLE INVERSION.

Order Color of tube Additive Mixing Instructions

1

Blood culture bottles:

aerobic then anaerobic

Aerobic = grey top Anaerobic = orange top

Minimum amount: 5 ml in each bottle; optimal amount: 8-10 ml

Mix 5 – 10 times See procedure for details

regarding pediatric culture bottles

2 Gold

Silicon gel Mix sample 5-10 times

3 Red tube (no gel)

None DO NOT MIX USE ONLY for cryoglobulins Sample should be clotted

4

Citrate Sodium citrate Tube must be full for coagulation

studies Mix gently 5-10 times

5

Green

Sodium or lithium heparin

Mix sample 5-10 times Discard sample if any clot is

present Lavender

or

6

Pink

K2 - EDTA Mix sample 5-10 times Discard sample if any clot is

present

The recommended order of draw when collecting more than one sample during a single venipuncture is as follows:

Blood culture tubes Non-additive tube (e.g. red stopper) Additive tube (e.g. lavender tube)

This order is critical for the following reasons:

Non-additive tubes are drawn before additive tubes to avoid additive contamination of the non-additive tube.

Cross contamination between different additive tubes lead to erroneous test results.


Results Reporting

As soon as test results are authorized in the

laboratory, they are available on the

laboratory computer terminals in the ward.

Hardcopies of in-patient results are printed

once a week and distributed to the wards.

Hardcopies of urgent results are printed on

the ward printer immediately after

verification.

Critical results phoned to the ward are also

printed on the ward printer following

verification.

When a patient is discharged, a cumulative

report of all the patient's results during that

stay is printed in Medical Records for

placement in the patient's hospital chart.

Outpatient results are printed daily and

mailed to the requesting clinician. The

laboratory also faxes results (replacing the

hardcopy) daily to certain clinics and doctors

who have arranged for this service with the

laboratory.

Whilst the laboratory performs internal and

external quality assurance throughout the

day, it is possible for random errors to

occur. Following technical validation it is

therefore possible for inaccurate results to

be released even though they have passed

through various checks and flags.

In this situation, the clinician is the best

person to detect these errors. Although

these errors are extremely rare, should the

situation arise where results do not agree

with the clinical condition, please contact the

laboratory and report the disagreement. We

will then be able to retest the sample if

possible and investigate a possible error.


In-Patient Critical Values All critical results must be called immediately 24 hours a day.

Exceptions are in blue.Test Result Comments

Amikacin Trough >15 mg/L APTT >150 s

Bicarbonate <16 mmol/L If from ED or ICU, CALL when bicarbonate < 10

Bilirubin Total Baby >350 umol/L Calcium Ionized <0.8 or >1.65 mmol/L Calcium <1.62 or >3.2 mmol/L Corrected Calcium <1.62 or >3.2 mmol/L Carbamazepine >48 umol/L If JGH Neurologist, do not call Carboxyhemoglobin >15 % CK >25000 U/L Clozapine >2500 nmol/L Digoxin >2.7 nmol/L Ethanol >64 mmol/L Fibrinogen >10 g/L Free T4 <4 or >100 pmol/L Gentamicin >2 mg/L Glucose <2.1 or >22 mmol/L HGB <60 or >200 g/L IgG <2 g/L INR >6 Lithium >2.5 mmol/L Magnesium <0.5 or >2 mmol/L Methemoglobin >5% Osmolality Serum <230 or >350 mOsm/kg pCO2 - arterial <15 or >65 mm Hg pH - arterial <7.1 or >7.53 Phenobarbital >225 umol/L If JGH Neurologist, do not call Phenytoin >90 umol/L If JGH Neurologist, do not call

Test Result Comments Phosphorus <0.38 or >3 mmol/L Platelets <50 or >900 x10^9/L pO2 - arterial <40 mm Hg Potassium (Age >5 years)

<2.8 or >6.0 mmol/L If from ED or ICU, CALL when K > 6.5

Potassium (Age 30 days - 5 years)

<2.8 or >6.5 mmol/L

Potassium (Age < 30 days)

<2.8 or >7.0 mmol/L

Salicylates >3 mmol/L

Sodium <125 or >150 mmol/L

1. If from ED, CALL when Na <120 or >155

2. If from ICU, CALL when Na <120 or >160

Theophylline >111 umol/L Tobramycin Trough >4 mg/L Total Hemoglobin <60 or >200 g/L Triglycerides >15 mmol/L

Urea >25 mmol/L

1. If from ED, ICU or Nephrology, DO NOT CALL

2. If urea was > 25 within last

4 days, DO NOT CALL Valproic Acid >750 umol/L If JGH Neurologist, do not call Vancomycin >21 mg/L WBC <2 or >40 x10^9/L If from ICU, do not call


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Therapeutic Drug Monitoring

Therapeutic drug monitoring is most useful

when the drug in question has a low

therapeutic index and is used chronically.

Measurement may be of value in

assessment of compliance, therapeutic

dosing adjustment and confirmation of

clinical toxicity. It is important to note that

many factors may influence the

pharmacokinetics of a particular drug e.g.

protein binding, co-administration of other

drugs, pharmacogenetics.

Some patients may exhibit toxic effects at

concentrations less than the upper limit of

the therapeutic range.

Interpretation of a drug level is

dependant on the time the sample is

collected relative to the dosing time;

please indicate these parameters on the

requisition form.

Drug Therapeutic

Range Units Half life Sampling Time

Protein binding

Time to steady state

Carbamazepine 15-50 umol/L 12-17 hrs after repeated dosing

pre-dose ~80% 2-6 days

Digoxin 1.0-2.6 nmol/L adults 36-48 hrs 1 > 6hrs post-dose 20-30% 5 -10 days

Gentamicin trough 0.5-2 mg/L 2-3 hrs 2 trough-30 min pre dose

negligible -

0.6-1.2 mmol/Lyoung adult 18-24 hrs

12 hrs post dose negligible 3-7 days Lithium

0.6-1.2 mmol/L elderly 30-36 hrs 12 hrs post dose negligible 3-7 days Phenobarbital 65-170 umol/L 79-93 hrs pre-dose 40-60% 15-25 days

40-80 umol/L 3 pre-dose 90-95% 7-12 days Phenytoin

<3mth 39-67 umol/L children 3-4 hrs 4 pre-dose ~50% 2-3 days Theophylline adult 55-110 umol/L adults 9 hrs 4 pre-dose ~50% 2-3 days Valproic acid 350-700 umol/L 6-16 hrs in adults pre-dose ~90% 2-4 days

Vancomycin trough 10-15 mg/L 4-6 hrs 5 trough-30 min pre dose

~30% (variable)

-

1 Increases up to 6 days in renal impairment. 2 In renal failure half-life can be 24 hrs or longer. 3 Phenytoin does not obey first order kinetics at therapeutic concentrations therefore a true half-life cannot be calculated. In adults the apparent half-life is 18-36 hrs and in children 12-22 hrs. 4 In smokers half-life is 3 - 4 hrs, neonates and adults with CHF 20-30 hrs depending on degree of liver impairment. 5 In the elderly or those with renal impairment, half-life can be as long as 6 days.


Analytical interferences

Problem Common situations Interference

Delayed separation of plasma/serum from rbc

Overnight storage or delay in transit K+ , PO4 3-,

ALT, LDH HCO3

-

Hemolysis

Forcing blood through syringe needle into vacutainer tube or Overzealous mixing of specimen or Freezing sample or exposing to heat orExcessive delay in transit

K + , PO4 3-,

CK, Bilirubin, LDH, Mg 2+

Na+, Cl-, Glucose

Site of collection Specimen taken from drip arm drip analyte e.g. glucose, K+, Mg2+

Dilutional effect of non-drip analytes

1. No enzyme inhibitor Glucose

2. Topping up one tube with blood form CBC tube K+

Ca2+,ALP, Mg2+, CK

Incorrect sample container or anticoagulant

3. Contamination (Li-heparin tube, non-trace metals tube)

Li + , trace metals

Lipemia

Specimen taken after a fatty meal Na +

Very high WBC Leukemia K + glucose, K+

Very high Platelet count Thrombocythemia K+


Near patient testing

Glucometers are available on the wards.

The Accu-Chek Inform glucometers are

linked to the hospital computer system as

well as the laboratory information system.

Patients admitted to a particular ward will

appear on the Inform glucometers located in

that ward.

The laboratory is responsible for monitoring

the quality control of the devices.

Nursing staff are responsible for performing

the QC on the instruments.

Once a test is performed, the result is

available on the instrument. However, only

when the Inform glucometer is docked will

the results be transmitted to the LIS and

made available on the laboratory computer

terminals on the ward.

The laboratory provides training of nursing

staff and can be contacted at ext 5094. The

clinical nurse instructor or resource nurse on

each unit, who have been certified as

trainers by the laboratory, may also train

nursing staff.

General support for Accu-Chek Inform

glucometers is available at ext 5094; ask for

the person on-call for these devices.

In addition, near patient testing includes

fecal occult blood, urine pregnancy testing,

blood gas analysers, jaundice meter, and

activated clotting time.

Under Quebec Law, the laboratory is

required to supervise near patient testing.

The laboratory is currently producing

certification videos for near patient testing

and will include the above tests and online

certification for health care workers.


Research and Trials

To arrange for testing of samples for research and clinical trials:

Please contact

Rocco Starnino at ext. 5092

or

via email at [email protected]


Reference Intervals

Biochemistry

Test Specimen Age Male Age Female Units

ALT 12 months 5 - 50

Adult 5 - 40

12 months 5 - 50

Adult 5 - 40 U/L

AST

7 days 35 - 140

1 years 25 - 95

Adult 15 - 55

7 days 35 - 140

1 years 25 - 95

Adult 15 - 55

U/L

Albumin

4 days 28 - 44

14 years 38 - 54

Adult 35 - 51

4 days 28 - 44

14 years 38 - 54

Adult 35 - 51

g/L

Alkaline Phosphatase

12 months 150 - 600

5 years 100 - 300

8 years 100 - 400

10 years 100 - 400

12 years 140 - 430

13 years 130 - 365

14 years 130 - 365

16 years 65 - 275

18 years 335 - 400

Adult 40 - 125

12 months 150 - 600

5 years 100 - 300

8 years 170 - 340

10 years 150 - 310

12 years 60 - 340

13 years 35 - 280

14 years 35 - 170

16 years 50 - 115

18 years 25 - 120

Adult 35 - 145

U/L

Amylase Adult 25 - 115 Adult 25 - 115 U/L

Amylase pancreas Adult 13 - 53 Adult 13 - 53 U/L

Bilirubin (Conjugated) Adult 0 - 5 Adult 0 - 5 umol/L

Bilirubin (Total)

1 days 24 - 149

2 days 58 - 197

60 days 26 - 205

Adult 3 - 17

1 days 24 - 149

2 days 58 - 197

60 days 26 - 205

Adult 3 - 17

umol/L

Bicarbonate Adult 22 - 31 Adult 22 - 31 mmol/L


Calcium Adult 2.12 - 2.62 Adult 2.12 - 2.62 mmol/L

C3 Adult 80 - 190 Adult 80 - 190 mg/dL

C4 Adult 10 - 50 Adult 10 - 50 mg/dL

Carotene Adult 0.2 - 1.6 Adult 0.2 - 1.6 umol/L

Ceruloplasmin Adult 175 - 450 Adult 175 - 450 mg/L

Chloride Adult 98 - 108 Adult 98 - 108 mmol/L

Cholesterol Please see Canadian dyslipidemia guidelines.

CK

4 days 30 - 1200

14 days 80 - 700

Adult 42 - 396

4 days 30 - 1200

14 days 80 - 700

Adult 24 - 240

U/L

Creatinine

12 months 5 - 30

16 years 0 - 0

54 years 55 - 110

>54 years 55 - 120

12 months 5 - 30

16 years 0 - 0

54 years 40 - 85

>54 years 45 - 95

umol/L

Ferritin Adult 15 - 350 Adult 15 - 300 ug/L

GGT

4 months 1 - 147

10 years 1 - 90

Adult 1 - 50

4 months 1 - 147

10 years 1 - 90

Adult 1 - 40

U/L

Glucose (random) Adult 3.9 - 11 Adult 3.9 - 11 mmol/L

(fasting) Adult 3.9 - 5.5 Adult 3.9 - 5.5 mmol/L

HbA1c

Adult 0.048 - 0.06 Adult 0.048 - 0.06

HDL Please see Canadian dyslipidemia guidelines.

Ionized Calcium Adult 1.2 - 1.35 Adult 1.2 - 1.35 mmol/L

Iron Adult 14 - 29 Adult 14 - 29 umol/L


Lactic Acid on ice

Adult 0.5 - 2.5 Adult 0.5 - 2.5 mmol/L

LDH

4 days 290 - 775

10 days 545 - 2000

24 months 180 - 430

12 years 110 - 295

Adult 110 - 220

4 days 290 - 775

10 days 545 - 2000

24 months 180 - 430

12 years 110 - 295

Adult 110 - 220

U/L

LDL Please see Canadian dyslipidemia guidelines.

Lipase Adult 0 - 60 Adult 0 - 60 U/L

Magnesium

4 days 0.6 - 0.9

5 months 0.65 - 1.05

6 years 0.71 - 0.95

12 years 0.69 - 0.87

20 years 0.67 - 0.89

Adult 0.7 - 1.23

4 days 0.6 - 0.9

5 months 0.65 - 1.05

6 years 0.71 - 0.95

12 years 0.69 - 0.87

20 years 0.67 - 0.89

Adult 0.7 - 1.23

mmol/L

Osmolarity Adult 280 - 300 Adult 280 - 300 mOsm/kg

Phosphorus

10 days 1.45 - 2.91

24 months 1.45 - 2.16

12 years 1.45 - 1.78

14 years 1.05 - 1.8

16 years 0.9 - 1.55

Adult 0.7 - 1.45

10 days 1.45 - 2.91

24 months 1.45 - 2.16

12 years 1.45 - 1.78

14 years 0.9 - 1.55

16 years 0.9 - 1.55

Adult 0.7 - 1.45

mmol/L

Potassium

12 months 3.5 - 6.5

5 years 3.6 - 6.2

Adult 3.5 - 5.5

12 months 3.5 - 6.5

5 years 3.6 - 6.2

Adult 3.5 - 5.5

mmol/L

Prealbumin Adult 0.11 - 0.41 Adult 0.11 - 0.41 g/L

Sodium Adult 134 - 144 Adult 134 - 144 mmol/L

Saturation Adult 0.15 - 0.5 Adult 0.15 - 0.5

TIBC Adult 52 - 72 Adult 52 - 72 umol/L

Total Protein

1 weeks 44 - 76

7 months 46 - 74

1 years 51 - 73

Adult 60 - 80

1 weeks 44 - 76

7 months 46 - 76

1 years 51 - 73

Adult 60 - 80

g/L


Troponin-T

Adult 0 - 0.07 Adult 0 - 0.07 ng/mL

Triglycerides

9 years 0.4 - 1.24

18 years 0.36 - 1.67

Adult 0.5 - 2.6

9 years 0.4 - 1.24

18 years 0.36 - 1.67

Adult 0.5 - 2.6

mmol/L

Urea

12 months 1 - 7.5

10 years 2.3 - 8

17 years 2.3 - 8

54 years 3 - 8

>54 years 3.2 - 8.5

12 months 1 - 7.5

10 years 3.5 - 7.5

17 years 2.5 - 6.5

54 years 2.5 - 7

>54 years 3 - 8

mmol/L

Uric Acid Adult 150 - 480 Adult 150 - 480 umol/L

Endocrinology


25 Vit D

Adult 25 - 95 Adult 25 - 95 nmol/L

1,25 Vit D

Adult 38 - 134 Adult 38 - 134 pmol/L

17 - OH Progesterone

Adult 2.6 - 9.5

Follicular: 1.0- 3.0 nmol/L

Luteal : 3.9-10.7 nmol/L

Postmeno : 0.6- 3.1 nmol/L

nmol/L

Aldosterone:

Reference range based on normal sodium intake:

Upright: 110-860 pmol/L

Supine : 28-440 pmol/L

Reference range based on normal sodium intake:

Upright: 110-860 pmol/L

Supine : 28-440 pmol/L

Alpha Feto Protein

Adult 0 - 6 Adult 0 - 6 ug/L

Androstenedione

Adult 3.2 - 12.8 45 years 3.2 - 15.2

>45 years 1.2 - 10.4 nmol/L

B hCG

Positive,

negative or equivocal


CA 125

Adult 0 - 35 Adult 0 - 35 U/mL

CEA


DHEA-S

4 years 0.2 - 0.6

7 years 0.1 - 5

9 years 0.3 - 2.6

11 years 0.4 - 2

12 years 0.5 - 4.1

13 years 0.5 - 9.3

14 years 0.6 - 6.6

15 years 0.5 - 7.8

16 years 1.6 - 8.4

17 years 1.3 - 9.7

18 years 2.8 - 9.3

20 years 2.9 - 12

30 years 7.6 - 17.4

40 years 3.3 - 14.1

50 years 2.6 - 14.4

60 years 1.9 - 8.4

70 years 1.1 - 7.9

80 years 0.8 - 4.7

>80 years 2.2 - 15.2

4 years 0.2 - 2.1

7 years 0.2 - 1

9 years 0.4 - 1.8

11 years 0.4 - 4.3

12 years 0.3 - 2.7

13 years 0.8 - 4.8

14 years 0.6 - 4.5

15 years 0.9 - 8.2

16 years 1.1 - 7.8

17 years 1.6 - 9.6

18 years 2.6 - 10.8

20 years 3.9 - 10.7

30 years 1.8 - 10.3

40 years 1.2 - 7.3

50 years 0.9 - 6.5

60 years 0.7 - 5.4

70 years 0.4 - 3.5

80 years 0.5 - 2.4

>80 years 0.9 - 11.7

umol/L

Estradiol

Prepubertal: 0-130

Adult male : 55-165

Prepubertal: 0- 130

Early follicular: 90- 715

Preovulatory: 240-1510

Luteal : 147- 950

Menopausal: 0- 145

pmol/L

FSH

Adult 1.6 - 11

Follicular : 3.3-11.3 U/L

Pre-ovul.: 5.0-16.0 U/L

Ovulation: 5.2-20.4 U/L

Luteal: 1.8-8.2 U/L

Menopausal: 48.6-143.9 U/L

U/L

Insulin

16 years 0 - 0

65 years 40 - 100

16 years 0 - 0

65 years 40 - 100 pmol/L

LH

Adult 0.8 - 6.1

Follicular: 1.6- 7.9 U/L

Pre-ovulation: 7.7-23.1 U/L

Ovulation:13.2-82.7 U/L

Luteal: 0.7- 9.9 U/L

Menopausal:13.2-45.7 U/L

U/L

PTH

Adult 10 - 70 Adult 10 - 70 ng/L


0800h 1600h Cortisol:

Random

138-690 nmol/L

83-441 nmol/L

83-690 nmol/L

138-690 nmol/L

83-441 nmol/L

83-690 nmol/L

nmol/L

Free Cortisol Urine

Adult 28 - 276 Adult 28 - 276 nmol/d

Progesterone

Adult 0.1 - 5.3 Follicular: 0.1- 5.0 nmol/L

Luteal : 3.5-67.0 nmol/L nmol/L

Osteocalcin on ice.

35 years 5 - 55

>35 years 5 - 35 Adult 5 - 36 ug/L

Prolactin

Adult 2.7 - 16.9

Adult 3.9 - 29.5

1st Trimester: 8.9-191.2

2nd Trimester: 45.0-266.0

3rd Trimester: 52.3-348.8

ug/L

PSA

Adult 0 - 4 ug/L

SHBG

20 years 8.9 - 44

30 years 8.7 - 44.5

40 years 9.2 - 46.6

50 years 10.5 - 50.4

60 years 12.6 - 55.8

70 years 15.4 - 62.9

80 years 19 - 71.7

90 years 23.3 - 82.1

20 years 12.6 - 105.7

30 years 13.9 - 108

40 years 15.2 - 110.3

50 years 16.5 - 112.6

60 years 17.8 - 114.9

70 years 19 - 117.2

80 years 20.3 - 119.5

90 years 21.6 - 121.8

nmol/L

Testosterone Bioavailable (calculated)

20 years 5.06 - 16.69

30 years 4.75 - 15.12

40 years 4.38 - 13.66

50 years 3.94 - 12.31

60 years 3.44 - 11.07

70 years 2.87 - 9.94

80 years 2.24 - 8.93

90 years 1.55 - 8.03

20 years 0.18 - 1.35

30 years 0.16 - 1.3

40 years 0.15 - 1.25

50 years 0.13 - 1.2

60 years 0.12 - 1.15

70 years 0.1 - 1.1

80 years 0.09 - 1.05

90 years 0.08 - 1

nmol/L

Testosterone Free

(calculated)

20 years 214 - 692

30 years 199 - 625

40 years 182 - 564

50 years 163 - 508

60 years 142 - 456

70 years 119 - 410

80 years 94 - 368

90 years 67 - 332

20 years 7 - 59

30 years 6 - 57

40 years 6 - 55

50 years 6 - 53

60 years 6 - 51

70 years 6 - 49

80 years 5 - 48

90 years 5 - 46

pmol/L


Testosterone Total

20 years 9.15 - 24.3

30 years 8.56 - 23.9

40 years 7.96 - 23.49

50 years 7.37 - 23.08

60 years 6.77 - 22.68

70 years 6.18 - 22.27

80 years 5.59 - 21.86

90 years 4.99 - 21.46

20 years 0.57 - 3.13

30 years 0.54 - 3.1

40 years 0.51 - 3.07

50 years 0.49 - 3.04

60 years 0.46 - 3.01

70 years 0.44 - 2.98

80 years 0.41 - 2.95

90 years 0.39 - 2.91

nmol/L

Thyroglobulin


TSH

Adult 0.4 - 4.5 Adult 0.4 - 4.5 mU/L

Free T4


Free T3

Adult 2.8 - 7.1 Adult 2.8 - 7.1 pmol/L

Hematology

Test Age Male Age Female Units

HGB

7 days 140 - 240 1 months 140 - 200 10 years 90 - 150 18 years 120 - 170

Adult 140 - 175

7 days 140 - 240 1 months 140 - 200 10 years 90 - 150 18 years 115 - 150

Adult 120 - 152

g/L

RBC

1 days 4 - 6.6 7 days 3.9 - 6.3

1 months 3 - 5.4 6 months 3.1 - 4.5 6 years 3.7 - 5.3 10 years 4 - 5.2 16 years 4.5 - 5.3

Adult 4.5 - 5.9

1 days 4 - 6.6 7 days 3.9 - 6.3

1 months 3 - 5.4 6 months 3.1 - 4.5 6 years 3.7 - 5.3 10 years 4 - 5.2 16 years 4.1 - 5.1

Adult 4.1 - 5.1

x10^12/L

HCT

7 days 0.42 - 0.72

1 months 0.42 - 0.6 10 years 0.27 - 0.45

18 years 0.36 - 0.51

Adult 0.42 - 0.5

7 days 0.42 - 0.72

1 months 0.42 - 0.6 10 years 0.27 - 0.45

18 years 0.345 - 0.45

Adult 0.36 - 0.45


MCV

1 days 95 - 121 7 days 88 - 126

1 months 85 - 123 6 months 74 - 108 4 years 70 - 88 6 years 75 - 87 10 years 77 - 95 16 years 78 - 98

Adult 80 - 96

1 days 95 - 121 7 days 88 - 126

1 months 85 - 123 6 months 74 - 108 4 years 70 - 88 6 years 75 - 87 10 years 77 - 95 16 years 78 - 102

Adult 80 - 96

fL

MCH

1 days 31 - 37 1 months 28 - 40 6 months 25 - 35 4 years 23 - 31 6 years 24 - 30 10 years 25 - 33 16 years 25 - 35

Adult 27 - 33

1 days 31 - 37 1 months 28 - 40 6 months 25 - 35 4 years 23 - 31 6 years 24 - 30 10 years 25 - 33 16 years 25 - 33

Adult 27 - 33

pg

MCHC

1 days 290 - 370 7 days 260 - 380

1 months 290 - 370 16 years 300 - 360

Adult 310 - 370

1 days 290 - 370 7 days 260 - 380

1 months 290 - 370 16 years 300 - 360

Adult 310 - 370

g/L

RDW

7 days 13 - 18 4 years 11.5 - 16 10 years 11.5 - 15

Adult 11.5 - 14.5

7 days 13 - 18 4 years 11.5 - 16 10 years 11.5 - 15

Adult 11.5 - 14.5

c/v

WBC

1 days 9.4 - 34 7 days 5 - 21

1 months 6 - 19.5 1 years 6 - 17.5 4 years 6 - 17 6 years 5.5 - 15.5 8 years 5 - 14.5 10 years 4.5 - 13.5 16 years 4.5 - 13

Adult 4 - 11

1 days 9.4 - 34 7 days 5 - 21

1 months 6 - 19.5 1 years 6 - 17.5 4 years 6 - 17 6 years 5.5 - 15.5 8 years 5 - 14.5 10 years 4.5 - 13.5 16 years 4.5 - 13

Adult 4 - 11

x10^9/L

LYMP%

1 years 60 - 67 Adult 25 - 45

1 years 60 - 67 Adult 25 - 45

%

MONO%

Adult 2 - 12 Adult 2 - 12 %


BAND%

1 days 0 - 15 7 days 0 - 12

6 months 0 - 10 2 years 0 - 8 16 years 0 - 6

Adult 0 - 2

1 days 0 - 15 7 days 0 - 12

6 months 0 - 10 2 years 0 - 8 16 years 0 - 6

Adult 0 - 2

%

NEUTRO%

1 days 51 - 60 7 days 30 - 46

1 months 20 - 45 6 months 15 - 48 2 years 25 - 50 6 years 27 - 55 8 years 33 - 59 10 years 40 - 59 16 years 40 - 62

Adult 45 - 75

1 days 51 - 60 7 days 30 - 46

1 months 20 - 45 6 months 15 - 48 2 years 25 - 50 6 years 27 - 55 8 years 33 - 59 10 years 40 - 59 16 years 40 - 62

Adult 45 - 75

%

EOS%

Adult 0 - 6 Adult 0 - 6 %

BASO%

16 years 0 - 2 Adult 0 - 2

16 years 0 - 2 Adult 0 - 2

%

LYMP#

1 days 2 - 11.6 7 days 2 - 17

1 months 3 - 16.6 6 months 4 - 13.5 1 years 3.6 - 11.7 2 years 3 - 9.4 4 years 2 - 8.1 6 years 1.5 - 7 8 years 1.5 - 6.8 10 years 1.5 - 6.5 16 years 1.3 - 5.2

Adult 1.2 - 3.5

1 days 2 - 11.6 7 days 2 - 17

1 months 3 - 16.6 6 months 4 - 13.5 1 years 3.6 - 11.7 2 years 3 - 9.4 4 years 2 - 8.1 6 years 1.5 - 7 8 years 1.5 - 6.8 10 years 1.5 - 6.5 16 years 1.3 - 5.2

Adult 1.2 - 3.5

x10^9/L

MONO#

1 days 0.3 - 3.4 7 days 2.2 - 2.1

1 months 0.2 - 2 1 years 0.2 - 1.8 2 years 0.2 - 1.7 4 years 0.2 - 1.6 8 years 0.2 - 1.5 16 years 0.1 - 1.4

Adult 0.2 - 0.8

1 days 0.3 - 3.4 7 days 2.2 - 2.1

1 months 0.2 - 2 1 years 0.2 - 1.8 2 years 0.2 - 1.7 4 years 0.2 - 1.6 8 years 0.2 - 1.5 16 years 0.1 - 1.4

Adult 0.2 - 0.8

x10^9/L


NEUTRO#

1 days 4.8 - 20.4 7 days 1.5 - 9.7

1 months 1.2 - 8.8 6 months 0.9 - 8.4 4 years 1.5 - 8.5 8 years 1.5 - 8 16 years 1.8 - 8.1

Adult 1.8 - 7.5

1 days 4.8 - 20.4 7 days 1.5 - 9.7

1 months 1.2 - 8.8 6 months 0.9 - 8.4 4 years 1.5 - 8.5 8 years 1.5 - 8 16 years 1.8 - 8.1

Adult 1.8 - 7.5

x10^9/L

EOS#

1 days 0 - 1.4 1 months 0 - 0.8 2 years 0 - 0.7 6 years 0 - 0.6 16 years 0 - 0.5

Adult 0 - 0.5

1 days 0 - 1.4 1 months 0 - 0.8 2 years 0 - 0.7 6 years 0 - 0.6 16 years 0 - 0.5

Adult 0 - 0.5

x10^9/L

BASO#

10 days 0 - 0.7 10 years 0 - 0.4 16 years 0 - 0.3

Adult 0 - 0.2

10 days 0 - 0.7 10 years 0 - 0.4 16 years 0 - 0.3

Adult 0 - 0.2

x10^9/L

PLAT

Adult 150 - 400 Adult 150 - 400

Adult 150 - 400 Adult 150 - 400

x10^9/L

MPV

Adult 9.9 - 11.8 Adult 9.9 - 11.8 fL

B2-microglobulin

Adult 0 - 2.2 Adult 0 - 2.2 mg/L

RCV Adult 24 - 32 Adult 22 - 28 mL/kg TBV Adult 55 - 69 Adult 56 - 66 mL/kg

Blood volume

Plasma volume

By appointment only

Adult 30 - 38 Adult 32 - 40 mL/kg

Blood viscosity

Adult 3.6 - 5.4 Adult 3.6 - 5.4

Cryoglobulin

Send at 37 degrees Negative Negative

Folate (Serum/plasma)

Adult 11 - 46 Adult 11 - 46 nmol/L

Haptoglobin

Adult 0.3 - 2 Adult 0.3 - 2 g/L

Heat stability test

Adult 0 - 5 Adult 0 - 5


HGB A2

Adult 0.01 - 0.035 Adult 0.01 - 0.035

HGB F

Adult 0.001 - 0.02 Adult 0.001 - 0.02

IgA

1 years 0 - 0.83 3 years 0.2 - 1 6 years 0.27 - 1.95

9 years 0.34 - 3.05

11 years 0.53 - 2.04

13 years 0.58 - 3.58

15 years 0.47 - 2.49

19 years 0.61 - 3.48

Adult 0.9 - 4

1 years 0 - 0.83 3 years 0.2 - 1 6 years 0.27 - 1.95

9 years 0.34 - 3.05

11 years 0.53 - 2.04

13 years 0.58 - 3.58

15 years 0.47 - 2.49

19 years 0.61 - 3.48

Adult 0.9 - 4

g/L

IgG

1 years 2.32 - 14.11

3 years 4.53 - 9.16

6 years 5.04 - 14.64

9 years 5.72 - 14.74

11 years 6.98 - 15.6

13 years 7.59 - 15.49

15 years 7.16 - 17.11

19 years 5.49 - 15.84

Adult 7 - 16.2

1 years 2.32 - 14.11

3 years 4.53 - 9.16

6 years 5.04 - 14.64

9 years 5.72 - 14.74

11 years 6.98 - 15.6

13 years 7.59 - 15.49

15 years 7.16 - 17.11

19 years 5.49 - 15.84

Adult 7 - 16.2

g/L Immuno- globulins

IgM

1 years 0 - 1.45 3 years 0.19 - 1.46

6 years 0.24 - 2.1 9 years 0.31 - 2.08

11 years 0.31 - 1.79

13 years 0.35 - 2.39

15 years 0.15 - 1.88

19 years 0.23 - 2.59

Adult 0.6 - 2.6

1 years 0 - 1.45 3 years 0.19 - 1.46

6 years 0.24 - 2.1 9 years 0.31 - 2.08

11 years 0.31 - 1.79

13 years 0.35 - 2.39

15 years 0.15 - 1.88

19 years 0.23 - 2.59

Adult 0.6 - 2.6

g/L

Leukocyte alkaline phosphatase

Adult 25 - 100 Adult 25 - 100

Malaria

Negative Negative

Methemoglobin

Adult 1 - 2 Adult 1 - 2 %

Plasma free hemoglobin

Adult 0 - 0.085 Adult 0 - 0.085 g/L

Protein Electro- Albumin Adult 35 - 51 Adult 35 - 51 g/L


Alpha 1 Adult 1 - 3 Adult 1 - 3 g/L

Alpha 2 Adult 5 - 10 Adult 5 - 10 g/L

Beta Adult 6 - 11 Adult 6 - 11 g/L

phoresis

Gamma Adult 6 - 15 Adult 6 - 15 g/L

Retics

Adult 7 - 31 Adult 7 - 31 x-10^3

Without Intrinsic factor

Adult 8 - 50 Adult 8 - 50 % Schilling test

With Intrinsic factor

By appointment only

Adult 8 - 50 Adult 8 - 50 %

Sed. rate (Westergren)

Adult 0 - 15 Adult 0 - 20 mm/h

Serum free hemoglobin

Adult 0 - 0.085 Adult 0 - 0.085 g/L

Serum muramidase

Adult 5 - 15 Adult 5 - 15 mg/L

Serum viscosity

Adult 1 - 2 Adult 1 - 2

Sickle cell

Negative Negative

Sulphemoglobin

Adult 0 - 2.2 Adult 0 - 2.2 %

Urine eosinophil

Negative Negative

Urine free hemoglobin

Negative Negative

Urine hemosiderin

Negative Negative


Urine muramidase

Adult 0 - 2 Adult 0 - 2 mg/L

Vitamin B12


Coagulation


APTT

Adult 27 - 35 Adult 27 - 35 s

PT

Adult 11.5 - 14.5 Adult 11.5 - 14.5 s

INR

Therapeutic INR: 2.0-3.0 (Metallic valves: 2.5-3.5)

Therapeutic INR: 2.0-3.0 (Metallic valves: 2.5-3.5)

Fibrinogen

Adult 2 - 4.5 Adult 2 - 4.5 g/L

Thrombin time

Adult 13 - 18 Adult 13 - 18 s

D-dimer

Adult 0 - 0 Adult 0 - 0 ug FEU/L

Factor II

Adult 0.7 - 1.1 Adult 0.7 - 1.1

Factor V

Adult 0.7 - 1.6 Adult 0.7 - 1.6

Factor VII

Adult 0.6 - 1.55 Adult 0.6 - 1.55

Factor VIII

Adult 0.5 - 2 Adult 0.5 - 2

Factor IX

Adult 0.65 - 1.4 Adult 0.65 - 1.4

Factor X

Adult 0.7 - 1.4 Adult 0.7 - 1.4

Factor XI

Adult 0.6 - 1.35 Adult 0.6 - 1.35


Factor XII

Adult 0.5 - 1.45 Adult 0.5 - 1.45

Protein C chromogenic

Adult 0.7 - 1.3 Adult 0.7 - 1.3

Protein C clot

Adult 0.7 - 1.3 Adult 0.7 - 1.3

Protein S free (Liatest)

Adult 0.7 - 1.48 Adult 0.5 - 1.34

Protein S clotting

Adult 0.77 - 1.43 Adult 0.55 - 1.23

Reptilase time

Adult 18 - 22 Adult 18 - 22 s

VW antigen (Liatest)

Blood group "O" 0.50-1.40 Blood group non-"O" 0.70-2.00


VW ristocetin



Antithrombin III

Adult 0.8 - 1.2 Adult 0.8 - 1.2

Factor V Leiden

Absent Absent

Lupus anticoagulant screen

(Russell V.V. test) Adult 0 - 1.2 Adult 0 - 1.2

Standard heparin

Recommended range for Therapeutic treatment:0.35-0.70 Anti-Xa IU/mL

Recommended range for Therapeutic treatment: 0.35-0.70 Anti-Xa IU/mL

Danaproid assay

Recommended range forTherapeutic treatment:

0.50-0.80 Anti-Xa IU/mL

Recommended range for Therapeutic treatment:

0.50-0.80 Anti-Xa IU/mL


Dalteprin peak (3-4 hours)

Recommended range for therapeutic treatment with Dalteparin

a) Treatment dosage = 100 IU/Kg Q12H:0.40 - 0.80 Anti-Xa IU/mL

b) Treatment dosage = 120 IU/Kg Q12H:0.60 - 1.20 Anti-Xa IU/mL

c) Treatment dosage = 200 IU/Kg Q24H:0.80 - 1.60 Anti-Xa IU/mL Recommended range for

therapeutic treatment with Enoxaparin a) Treatment dosage = 1.0 mg/Kg Q12H:

0.60 - 1.00 Anti-Xa IU/mL b) Treatment dosage = 1.5 mg/Kg Q24H:

1.00 - 1.60 Anti-Xa IU/mL

Recommended range for therapeutic treatment with Dalteparin

a) Treatment dosage = 100 IU/Kg Q12H:0.40 - 0.80 Anti-Xa IU/mL

b) Treatment dosage = 120 IU/Kg Q12H:0.60 - 1.20 Anti-Xa IU/mL

c) Treatment dosage = 200 IU/Kg Q24H:0.80 - 1.60 Anti-Xa IU/mL Recommended range for

therapeutic treatment with Enoxaparin a) Treatment dosage = 1.0 mg/Kg Q12H:

0.60 - 1.00 Anti-Xa IU/mL b) Treatment dosage = 1.5 mg/Kg Q24H:

1.00 - 1.60 Anti-Xa IU/mL

Dalteprin trough

For Dalteparin Recommended range for

therapeutic treatment: 0.20-0.40 Anti-Xa IU/mL Recommended range for prophylactic treatment:

0.10-0.30 Anti-Xa IU/mL For Enoxaparin

Recommended ranges not established

For Dalteparin Recommended range for

therapeutic treatment: 0.20-0.40 Anti-Xa IU/mL Recommended range for prophylactic treatment:

0.10-0.30 Anti-Xa IU/mL For Enoxaparin

Recommended ranges not established

IgG

Adult 0 - 21 Adult 0 - 21 GPL u/mL Anticardiolipin

antibody IgM

Adult 0 - 19 Adult 0 - 19 MPL u/mL


Various tests requiring special collection

Container Test Comments

Pre-chilled

ACTH

Collect on wet ice. Send to lab ASAP with sufficient ice. Sample will be rejected if ice has fully melted. Analyte is highly unstable in whole blood; must be received in the laboratory within 30 min of collection.

Pre-chilled

ADH (Vasopressin)


Ammonia


Beta Hydroxybutyric Acid


CA 15-3

Ideally, collect on wet ice. Send to lab ASAP with sufficient ice.

CA 19-9

Ideally, collect on wet ice. Send to lab ASAP with sufficient ice.

Calcium ionized

Collect on wet ice. Avoid having the patient make a fist. The tourniquet must not be applied for greater then one minute. Do not expose the specimen to air at any time during collection or transport. Stable in whole blood at 4C for 4 hours. Do not freeze the sample tube.

Calcitonin


Carotene

Protect from light. Wrap specimen in aluminum foil.


Pre-chilled

Catecholamines (Plasma)

This is not a routine assay and must be discussed with the Biochemist on-call before requesting. Collect on wet ice. Send to lab ASAP with sufficient ice. Sample will be rejected if ice has fully melted. Analyte is highly unstable, must be received in the laboratory within 30 min of collection.

C-peptide

Collect on wet ice. Send to lab ASAP with sufficient ice. Sample will be rejected if ice has fully melted. Must be separated from cells within 6 hours of collection.

Collect 2 red top tubes

Cryoglobulins Must be kept warm (37C) from time of collection until arrival in the laboratory.

C-telopeptide

12 hours fasting. Sample must be collected before 10:00am. Offsite: please collect on wet ice. Send to lab ASAP with sufficient ice. Sample will be rejected if ice has fully melted.

Free erythrocyte protoporphyrin

Protect from light. Wrap specimen container in aluminum foil.

Gastrin

Collect on wet ice. Send to lab ASAP with sufficient ice. Sample will be rejected if ice has fully melted.

Growth hormone

Fasting 8 hours and 30 min at rest before collection. Collect on wet ice. Send to lab ASAP with sufficient ice. Sample will be rejected if ice has fully melted.

Homocysteine


Lactate

Collect on wet ice. Send to lab ASAP with sufficient ice. Sample will be rejected if ice has fully melted. Analyte is highly unstable, must be received in the laboratory within 15 min of collection.

Methotrexate

Protect from light. Wrap specimen in aluminum foil. Collect on wet ice. Send STAT.

Methylmalonic acid

Collect on wet ice. Send to lab ASAP with sufficient ice. Sample will be rejected if ice has fully melted.


Osteocalcin

Collect on wet ice. Send to lab ASAP with sufficient ice. Sample will be rejected if ice has fully melted. Analyte is highly unstable, must be received in the laboratory within 60 min of collection.

Porphyrin (Plasma)


Random urine

PBG/ALA- random urine


Random stool

Porphyrin screen- fecal


Random urine

Porphyrin screen- urine


Pre-chilled

Renin


Vitamin A


Vitamin E


AC = Fasting (at least 6 hrs); PC = 2 hours postprandial


Glucose tolerance test (GTT or OGTT)

What is the glucose tolerance test? The glucose tolerance test measures the body's ability to metabolize glucose. Why is this test performed? The oral glucose tolerance test is generally performed to diagnose diabetes mellitus when fasting blood glucose is difficult to interpret. How to prepare for the OGTT? The test is generally performed 8 to 14 hours after an overnight fast. We suggest fasting from 22h00 and then present to the test center the following morning at 08h00. The test must be performed before 10:00 am for proper interpretation. We recommend bringing along a good book or other reading material, as you will be required to remain seated for 2 hours during the test. What does fasting mean? No caloric intake for at least 8 hours before your first blood sample is taken. During this period only water may be taken. Can I drink other liquids? You may drink only water (no tea, coffee, or other beverages) Can I take my medication? A number of medications can affect the test results, therefore, it is important to inform your health professional of all medications you are currently taking. You may be instructed to stop certain medications prior

to the test. When can I resume eating? The standard glucose tolerance takes 2 hours from the 1st blood sample. You will be able to eat after the last blood sample. What other precaution must be taken prior to test? You should maintain an unrestricted diet and activity for at least three days prior to the test. Do not engage in strenuous exercise for 8 to 14 hours before the first blood sample is taken. How is the test done? On the day of test, the following steps will be done: 1. A blood sample will be collected after

you arrive and register at the test center. 2. You will be asked to drink a sweet liquid

containing 75 g of glucose. It should be drunk slowly over 5 min.

3. You should remain seated at the test center during the test, without smoking.

4. A second blood sample will then be collected after 2 hours.

5. You may then eat and drink. What affects the Test? 1. Acute stress (surgery, infection,

emotional cause, or fever) or Vigorous exercise

2. Certain medications, as well as alcohol. 3. Low carbohydrates diet in the days just

before the test. 4. Vomiting during the test may also cause

inaccurate results.


Patient Instructions for a Clean-Catch Urine Collection

Container: sterile container - orange top

Notes: To ensure that the urine specimen you are submitting is of good quality and not

contaminated with other germs:

1. Never collect urine from a bedpan or urinal

2. Thoroughly clean the genital area prior to collection procedures to ensure that the

specimen obtained is not contaminated with skin bacteria.

3. Transport specimen to the laboratory within 2 hours of collection. If this is not possible,

the urine specimen should be refrigerated and transported to the lab within 24 hours.

Make sure your specimen is clearly labelled with your name and information.

Procedure:

Clean-Catch urine specimens (female)

1. Sit comfortably on the toilet, and swing one knee to the side as far as you can.

2. Spread yourself with one hand, and hold yourself spread while you clean yourself

and then collect the specimen.

3. Using antibacterial soap or regular soap, wipe your vaginal area as carefully as

you can from front to back between the folds of skin.

4. After washing, rinse well with a water moistened pad or with a damp face cloth

with the same front to back motion. Use each pad only once and then discard it.

5. Hold the cup with your fingers on the outside; do not touch the rim. First, pass a

small amount of urine into the toilet, and then pass enough urine into the cup to fill

it half full.

6. Place the lid back on the cup and make sure it is closed tightly.

Clean-Catch urine specimen (Male)

1. Retract the foreskin (if uncircumcised), and clean the glans (head of the penis)

Follow steps 3 to 6 above for cleaning yourself and collecting the urine.


Patient instructions for 24-Hour urine collection

NOTE: PLEASE USE URINE CONTAINERS PROVIDED BY THE HOSPITAL. URINE COLLECTED IN ANY OTHER CONTAINER WILL NOT BE ACCEPTED. 1. On the morning that you start collecting your urine, (eg. 9:00A.M.), empty your

bladder in the toilet and discard the urine. Note: The collection starts with an empty bladder.

2. At the start of the collection, record the start date and time on the label attached to

the container. At the end of the collection, record the finish date and time as well. 3. Collect ALL the urine for the rest of the morning, afternoon, evening and night, in the

container provided. 4. Make sure the lid is tightly closed and the spout is snapped in to avoid any spillage. 5. Take the container with you if you go out. 6. Keep the container in a cold place whenever you can. 7. The following morning, (ex. 9:00 A.M. the next day), empty your bladder and collect

the urine. This is the last urine to be collected. 8. Bring in all your collected urine, along with the requisition, to the

Test Centre (Room E-102), or to the Department of Diagnostic Medicine Department (Room D-136).

If you have any questions, please call 340-8222 extension 5094. REMEMBER: You will have to start again if any urine is missed during the 24 hour collection OR if the requisition does not accompany the collection upon delivery. CAUTION: The bottles marked CORROSIVE contain acid. In order to avoid acid burns, empty your bladder in a measuring cup first and then transfer the urine to the bottle. Rinse the measuring cup with water only after each usage. Do not wash with soap or detergent. Keep the container upright to avoid acid spillage or contamination of the bottle cap. In case of skin contact with acid, wash immediately with water (5 minutes).

We do not provide the measuring cup; one can be purchased at any grocery store, pharmacy or a dollar store.


24-Hour urine collection bottles

Test Special Conditions Plain Bottle

Acid Bottle

Metal-free Bottle

ALA (or PBG) √ Aldosterone √ Amino acids √ Amylase √ Arsenic √ Bence Jones (protein) √ Calcium √ (to acidify) √ Catecholamines (Epinephrine + Nor-Epinephrine)

√

Chloride Acid unacceptable √ Citrates √ (to acidify) √ Copper √ Cortisol √ Creatinine, including creatinine clearance

Serum creatinine required for clearance

√ √

Cysteine √ Electrolytes Acid unacceptable √ 5-HIAA Special instructions

for patient (see P&P) √

Hydroxyproline √ Lead √ Magnesium √ (to acidify) √ Mercury √ Metanephrines √ Microalbumin √ Nitrogen sulphate √ Osmolality √ Oxalates √ (to acidify) √ Phosphate (Phosphorus) √ (to acidify) √ Porphyrins √ Potassium Acid unacceptable √ Protein √ Protein electrophoresis √ Sodium Acid unacceptable √ Trace elements √ Urea √ √ Urea nitrogen profile (TPNU) √ Uric acid √ Zinc √


Patient instructions for sputum collection

Container: sterile- orange top

Procedure: (Bacterial Culture)

1. If possible, rinse your mouth and gargle with water prior to sputum collection. If you have

dentures, remove them prior to specimen collection.

2. Cough deeply to produce a good sputum specimen. Expectorate this into the sterile

container provided. Do not cough spit or post nasal discharge into the container.

Procedure: (Tuberculosis)

1. Collect sputum as instructed above, but collect specimen as soon as you wake up in the

morning.

2. Collect a sample on 3 consecutive days for a total of 3 specimens.

Sputum should be brought to the laboratory as soon as possible the same day. If a delay of 1-2

hours is anticipated, refrigerate the specimen prior to bringing it to the lab.


Patient instructions for stool collection

(routine culture and Clostridium difficile)

Container: Sterile orange top

Sterile white container with spoon

To ensure that the best quality specimen is collected:

1. Stool must not be contaminated with urine or water from the toilet bowl.

2. The stool must be collected in the manner described below. Do not use toilet paper to

collect the stool sample.

3. The following medications might interfere with the results of the stool test, therefore you

should wait seven days before providing a specimen if you have taken any of the

following:

o Bismuth

o Magnesium ( e.g. Some antacids)

o Mineral oil

o Barium meal or Barium enema test

Procedure:

Collect the stool in the following manner;

1. Pass the stool sample directly into a sterile, wide mouth, leakproof container with a tight

fitting lid.

2. To prevent stool from mixing with water, place either an aluminum pie plate in the toilet

bowl, or place saran wrap over the toilet seat to collect stool sample.

3. With a cardboard stick or with the spoon provided in the white top container provided,

spoon out an egg sized portion and place it into the sterile container.

4. It is important to bring the stool specimen to the lab the same day, and preferably within 2

hours after collection. If a delay of more than 2 hours is anticipated, place the specimen

in your refrigerator prior to bringing it to the lab.

If your Doctor asks you to collect two or three specimens, these should be collected on

separate days.


Patient instructions for stool O&P collection

Container: yellow top container with liquid and spoon. DO NOT empty liquid out.

To ensure that the best quality specimen is collected:

1. Stool must not be contaminated with urine or water from the toilet bowl. 2. The stool must be collected in the manner described below. Do not use toilet paper to

collect the stool sample. 3. The following medications might interfere with the results of the stool test, therefore you

should wait seven days before providing a specimen if you have taken any of the following:

o Bismuth o Magnesium ( e.g. Some antacids) o Mineral oil o Barium meal or Barium enema test

Procedure:

Collect the stool in the following manner;

1. Pass the stool sample directly into a sterile, wide mouth, leakproof container with a tight fitting lid.

2. To prevent stool from mixing with water, place either an aluminum pie plate in the toilet bowl, or place saran wrap over the toilet seat to collect stool sample.

3. With a cardboard stick or with the spoon provided in the white top container provided, spoon out an egg sized portion and place it into the sterile container.

4. It is important to bring the stool specimen to the lab the same day, and preferably within 2 hours after collection. If a delay of more than 2 hours is anticipated, place the specimen in your refrigerator prior to bringing it to the lab.

5. The liquid in this container is poisonous. DO NOT drink this and keep away from children. 6. If your Doctor asks you to collect 2 or 3 stools, wait 48 hours between specimens.

o Since the stool is well preserved in the liquid, you can bring all 3-stool specimens to the lab on the same day.

If you are collecting stool for both culture and O&P, you can collect stool for bacterial culture and O&P at the same time and bring all specimens to the lab the day the last specimens are collected.


The following protocol is to be used for diagnosing Influenza. Influenza is diagnosed by viral culture or antigen detection.

Influenza is NOT diagnosed by a blood test.

The best specimen for viral detection in adults is a throat gargle. If this cannot be done (i.e.

intubated patients, patients with no gag reflex, patients with decreased level of consciousness or

severe dementia or unable to cooperate), then a deep nasal swab should be done.

Procedure for obtaining a throat gargle for Influenza virus detection

1. Use 2 mL of non-bacteriostatic saline (available in pink plastic unidose ampoules OR 2

mL can be aspirated from a single-dose vial of non-bacteriostatic saline for injection;

discard vial after use).

2. Place saline into sterile orange-topped specimen container

3. Ask patient to gargle with saline for 5 seconds (i.e. "count slowly to five") and then to spit

saline back into the container. Close container tightly.

4. Label specimen. Send specimen without delay to Microbiology, accompanied by a single

blue Microbiology requisition, and check off "viral culture" (specimen: throat gargle) and

also write in "Rapid Influenza Assay".

Procedure for obtaining a deep nasal swab for Influenza virus detection

1. Use the regular culture swabs.

2. Moisten culture swab first by placing it into the accompanying culture tube, which is

already filled with transport liquid in a mini-sponge. Leave swab in contact with mini-

sponge for 5-10 seconds.

3. Remove swab from culture tube, and place into posterior nostril of patient. Press against

nostril wall in a circular motion 3-5 times. Remove and place into other nostril and rotate

against nostril wall another 3-5 times. Place swab back into culture tube and close tightly

by pressing into place.

4. Label specimen. Send specimen without delay to Microbiology, accompanied by a single

blue Microbiology requisition, and check off "viral culture" (specimen: nasopharyngeal

swab) and also write in "Rapid Influenza Assay".


Fecal occult blood screening - Patient information

PURPOSE OF TEST To detect colorectal bleeding. HOW? By detecting blood in the stool that is invisible to the eye, but can be detected by a simple chemical reaction. WHAT TO DO? 2 easy steps: 1. For a period of 48 hours, and until all

stool specimens are collected, do not eat red meat, radishes, turnips, melons or horseradish. You may eat small quantities of chicken and tuna. For the same period of time take no aspirin or vitamin C. All these substances may contain blood-like material or cause the appearance of blood in the stool, and produce false results. During this testing period, eat plenty of cooked fruits and vegetables and whole grain cereals such as “All Bran.” These foods encourage bowel movements.

2. After a full 48 hours on the above diet, collect pieces of stool from the first 3 bowel movements. First Collection 1. Flip open slide 1 2. Use one stick to collect a sample from

stool 3. Apply a thin layer of stool on the

rectangle labelled A

4. Apply a second layer of stool on the rectangle labelled B

5. Close the cover flap 6. Discard the stick Second Collection 1. Flip open slide 2 2. Use one stick to collect a sample from


rectangle labelled A 4. Apply a second layer of stool on the

rectangle labelled B 5. Close the cover flap 6. Discard the stick Third Collection 1. Flip open slide 3 2. Use one stick to collect a sample from


rectangle labelled A 4. Apply a second layer of stool on the

rectangle labelled B 5. Close cover flap 6. Discard the stick NOTE: 1. Do not apply more than a thin smear,

the test result may be invalid 2. Do not expose slides to the heat,

sunlight, or fluorescent light. Keep it in cool, dark place.

3. Do not collect specimens during menstruation or hemorrhoidal bleeding.

3. Return the test card to the Test Centre.


Labeling of cytology specimens

1. All specimens must have a label affixed, pre-printed or handwritten, which supplies the following information: • Patient’s full name • Patient’s unique identifying number (RAMQ or MRN) • Site of specimen • Time of immersion into fixative. 2. To avoid mislabeled specimens, proper identification of the patient is necessary at the point of collection. Carefully verify the information on the admitted patient’s bracelet at bedside just prior to specimen collection. All outpatients are identified by asking the individual to pronounce his full name and date of birth. The information provided by the patient must exactly match the physician request, the laboratory requisition, and the specimen label prior to collection. 3. No collection containers should be pre-labeled. Containers should be

labeled directly at the patient-side immediately following collection. Immediately discard any unused labels to avoid mislabeling of the next patient. 4. Proper containers and fixatives for collection must be used. Using a wrong container or fixative may lead to erroneous results. 5. Where there is uncertainty in the identification of the primary sample or its condition, the laboratory may choose to process the sample after the requesting physician or person responsible for the primary sample collection takes the responsibility for identifying and accepting the sample, or for providing proper information, or all these. In such an instance, the signature of that person taking responsibility for the primary sample identification should be recorded on the request form and in the final report.


Procurement of cytology specimens

Please note: All specimens are to be sent accompanied with a properly completed requisition.

1. Body Fluids (Ascetic, Peritoneal, Pericardial, etc.)

• A fresh specimen is sent to the cytology laboratory in a sterile urine cup container or vacutainer.

• The specimens must be labeled as required.

• Containers must be securely tightened to avoid any leakage.

• The specimen should be delivered to the laboratory ASAP!

• If a delay is anticipated, the specimen should be refrigerated.

• DO NOT send drainage apparatus, needles or syringes to the laboratory.

2. Bronchial/Gastric Brushings

• The specimens are to be submitted in a sterile container containing 95% alcohol.

• The complete brush or slide must be immersed in the Cytolyt solution and gently shaken.


• Containers must be securely tightened to eliminate any leakage.

• The specimen should be send to cytology ASAP.


3. Bronchial / Gastric Washings

• A fresh specimen is submitted in a sterile specimen container.





4. Cerebrospinal Fluid (CSF)

• The specimen is submitted fresh in a sterile specimen container.





• If the preliminary diagnosis is leukemia or lymphoma, a second sample is required for Flow Cytometry.

5. Pap Test

• The PAP smear is to be fixed in alcohol and delivered to the cytology laboratory with properly completed requisition.

• The slide has to be labeled in pencil and should have the patient’s full name and RAMQ or MRN.

6. Fine needle Aspirations: this procedure may yield a Cytopathology specimen, a tissue specimen or both.

• The tissue core specimen must be placed in formalin container and be delivered to pathology.

• The cytopathology specimen should be smeared on a slide and fixed in alcohol or cytospray.


7. Sputum

• The specimen is submitted in a sterile urine cup with no preservative.

• A series of three early morning deep cough specimens is the most sensitive. It is recommended that patients should clean teeth and mouth prior to obtaining specimen.





8. Urine

• The specimen is submitted in a urine cup with no preservative.

• A series of three morning urines from consecutive days have to be collected.

• First morning specimens should NOT be used the second morning specimen is recommended.






Transfusion service

Starting November 19th 2007, Transfusion Service will introduce a new requisition (F161 REV 09-07 - see attached).which will replace and incorporate our present 3 requisitions (F160, 161 and 162). On the above start date, the new requisitions will be available in Stores, your old requisitions are to be discarded and the new requisition put in place. In order to meet this CCHSA requirement, it is mandatory for both the requisition and specimen to include (see attached examples):

1) Patient Identification – label, addressograph or handwritten (Full Name/Hospital # or RAMQ (date of birth if RAMQ not available))

2) Date 3) Time 4) Phlebotomist’s initials

In order to facilitate the introduction of these mandatory requirements, there will be a transition period of one month. During this time, Transfusion Service will call the location stating that a notification form (see attached) is being faxed for the charge nurse. This notification form will indicate what mandatory information the patient’s requisition and/or specimen were missing. IMPORTANT: It should be noted that the mandatory information not indicated on the notification form is already enforced. If the requisition and/or specimen are received with any of the above information missing:

1) Specimen: If the patient’s name or number is missing the specimen will be rejected. Missing collection date and time can be completed however, the phlebotomist must come to the Transfusion Service to complete this or the specimen will be rejected. If there is an urgent need for blood, the protocol for uncrossmatched blood will be applied.

2) Requisition: if only the requisition is missing mandatory information, the phlebotomist must complete another requisition and have it hand delivered to Transfusion Service or the specimen will be rejected. If there is an urgent need for blood, the protocol for uncrossmatched blood will be applied.


TRANSFUSION SERVICE REQUEST

1

2

3 4 5

6

7

RENSEIGNEMENT NÉCESSAIRE DU PROCÉDÉ NECESSARY PROCESS INFORMATION

2) INFORMATION NÉCESSAIRE– NECESSARY INFORMATION 3) TYPE D’ÉCHANTILLON – TYPE OF SPECIMEN 4) ANALYSES - TESTS 5) PRODUIT/QUANTITÉ - PRODUCT/AMOUNT 6) COMMENTAIRES - COMMENTS 7) POUR L'USAGE DU LABO SEULEMENT- LAB USE ONLY

RENSEIGNEMENT OBLIGATOIRE MANDATORY INFORMATION

NOM COMPLET – FULL NAME #DOSSIER OU RAMQ (DDN) - HOSPITAL# OR RAMQ (DOB)

INITIALES DU (DE LA) PHLÉBOTOMISTE –

PHLEBOTOMIST’S INITIALS DATE – DATE HEURE – TIME

1


ETIQUETTE “TRACELINE” LABEL ETIQUETTE “LABS” LABEL

ADDRESSOGRAPH(E) ÉCRITES Á LA MAIN -

REQUÊTE - REQUEST

RENSEIGNEMENT OBLIGATOIRE - MANDATORY INFORMATION

RAMQ = NAM - MRN


ETIQUETTE “TRACELINE” LABEL ETIQUETTE “LABS” LABEL

12

3 4 5

RENSEIGNEMENT OBLIGATOIRE - MANDATORY INFORMATION

1) NOM COMPLET – FULL NAME 2) #DOSSIER OU RAMQ - HOSPITAL# OR RAMQ 3) DATE – DATE 4) HEURE – TIME 5) INITIALES DU (DE LA) PHLÉBOTOMISTE -

PHLEBOTOMIST’S INITIALS

ÉCHANTILLON - SPECIMEN

FAKE PATIENT JANE DOE

1052135 OU/OR FAKJ 123 123 OU/OR 1890-12-31 11/11/07 4:35 GSP

ADDRESSOGRAPH(E) ÉCRITES Á LA MAIN - HANDWRITTEN

GSP GSP

GSP

11/11/07

11/11/07

4:35

4:35

RAMQ NAM - MRN

GSP 11/11/07 4:35

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Department of Diagnostic Medicine - Jewish General Hospital

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