Handbook of Pathology Services - Hospital...

HOSPITAL AMPANG 2017 PATHOLOGY DEPARTMENT

[HANDBOOK OF PATHOLOGY SERVICES,5 th Edition] 1

Pathology

Department,

Hospital Ampang

2017

Handbook of Pathology Services



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



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



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



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



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



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.



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



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



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)



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.



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



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



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



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




Type

Container

Type

Volume


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




Type

Container

Type

Volume


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


R: 3 hours

U: 45 mins

27 Apolipoprotein A-1 Blood Plain Gel

Tube 3ml IMR 1 month

28 Apolipoprotein B Blood Plain Gel





Type

Container

Type

Volume


29 Apolipoprotein C Blood Plain Gel


30 Apolipoprotein D Blood Plain Gel


31 Apolipoprotein E Blood Plain Gel


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


35 Barbiturate

Blood Plain Gel

Tube 3ml

Chemistry


Urine Universal

container 20ml

Chemistry


36 Barium Dialysate Plain gel

tube 2ml

Chemistry


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




Type

Container

Type

Volume


40 Beta-2

Microglobulin

Blood Plain Gel

Tube 3ml

Internal 7 days

Urine Universal

container 20ml

41 Beryllium Dialysate Plain gel

tube 2ml

Chemistry


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




Type

Container

Type

Volume


50 Caeruloplasmin Blood Plain Gel


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


56 Cancer Antigen 15-3 Blood Plain Gel


57 Cancer Antigen 19-9 Blood Plain Gel


58

Cannabis

(Cannabinoids)

Urine Universal

container 20ml HKL 1-2 months

59 Carcinoembryonic

Antigen (CEA) Blood

Plain Gel

Tube

3ml HKL 10 days




Type

Container

Type

Volume


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


64 Cholinesterase Blood Plain Gel


65 Chromium

Blood Plain Gel

Tube 3ml

Jabatan

Kimia 2-3 months

Dialysate Plain gel

tube 2ml




Type

Container

Type

Volume


66 Cocaine Urine Universal

container 20ml

Chemistry


67 Complement 3 (C3) Blood Plain Gel


68 Complement 4 (C4) Blood Plain Gel


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


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


R: 3 hours

U: 45 mins




Type

Container

Type

Volume


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



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





Type

Container

Type

Volume


84 Digoxin Blood Plain Gel


85 Delta Amino

Laevulinic Acid Urine

24 hr

Container

as per

collection IMR 4-6 weeks

86 Electrolytes (ISE) Blood Lithium


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


90 Folate Blood Plain Gel


91 Follicle Stimulating

Hormone Blood

Plain Gel


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




Type

Container

Type

Volume


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



98

GALT Assay

(Galactose

Transferase)

Blood

spot

S&S filter

paper

3 circles

of 1cm

each



99

Gamma Glutamyl

Transferase

Blood Lithium

Heparin 3ml Internal 3 hours

100 Gentamycin,

Random Serum

Plain Gel

Tube 3ml Specimen received after 4.00


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




Type

Container

Type

Volume


Stimulation Test Hormone Stimulation Test (FSH,

LH)

107 Growth Hormone

(Somatotrophin) Blood

Plain Gel


108 Hemoglobin A1c Blood EDTA


109 Haptoglobin Blood Plain Gel


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





Type

Container

Type

Volume


120 Insulin-like Growth

Factor, Binding Blood

Plain Gel


121 Insulin-like Growth

Factor, I Blood

Plain Gel


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


126 Iron, Total Blood Plain Gel


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


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




Type

Container

Type

Volume


Dialysate Plain gel

tube 2ml

131 Lipid Profile Blood Plain Gel

Tube 3ml Internal

3 hours

132 Lipoprotein (a) Blood Plain Gel


133 Lipoprotein

Electrophoresis Blood

Plain Gel

Tube 3ml

IMR 1 month

134 Lithium Blood Plain Gel


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


138

Lysosomal Storage

Disorders Screening

(LSDS)

Blood

spot

S & S filter

paper

3 circles

of 1 cm

each



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




Type

Container

Type

Volume


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



143 Methamphetamine

Urine Urine

Universal


144 Methotrexate (MTX) Blood Plain Gel

Tube 3ml



working day

Internal Same day

145 Methylenedioxyamp

hetamine Urine

Universal

container 20ml

Chemistry


146 Methylenedioxymet

hamphetamine Urine

Universal

container 20ml

Chemistry


147 Morphine Urine Universal


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





Type

Container

Type

Volume


151 Netilmicin Serum,

Trough Serum

Plain Gel


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


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




Type

Container

Type

Volume


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


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




Type

Container

Type

Volume


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


174 Progesterone Blood Plain Gel


175 Progesterone, 17

Hydroxyl Blood

Plain Gel

Tube 3ml IMR 6-7 weeks

176 Prolactin Blood Plain Gel


177

Prostate Specific

Antigen (PSA) Total

Blood Plain Gel


178 Protein,

Electrophoresis CSF

Bijou

bottle 1-2ml

CSF protein electrophoresis :

Sample must come in pair of CSF

and BLOOD


(CSF Protein Electrophoresis)

Internal 21 days




Type

Container

Type

Volume


Blood Plain Gel

Tube 3ml

Serum Protein Electrophoresis

(SPE): Sample shall come in pair

of URINE and BLOOD


(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




Type

Container

Type

Volume


182

Reducing Sugar

Urine Universal

container 20ml

Internal 1 day

Stool Universal

container 20ml

183 Renal Profile Blood Lithium


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


190 Sodium Dialysate Plain gel 2ml Internal R: 3 hours




Type

Container

Type

Volume


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


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


194 Testosterone Blood Plain Gel


195

Thyroglobulin

Blood Plain Gel

Tube 3ml Send sample in ice IMR 1-2 months

Transferrin Blood

Plain Gel


197

Tri-lodothyronine,

Free(FT3)

Blood Plain Gel


198

Triglycerides,

Fasting

Blood Plain Gel


199

Troponin-T

Blood Plain Gel

Tube 3ml Internal 1 hour




Type

Container

Type

Volume


200 Thyroid Function

Test Blood

Plain Gel


201 Theophylline Blood Plain Gel

Tube 3ml

TDM Request form

HKL 3 days

202 Theophylline,

Trough Blood

Plain Gel


203 Thyroid Stimulating

Hormone Blood

Plain Gel


204 Thyroglobulin Blood Plain Gel

Tube 3ml Send sample in ice IMR 1-2 months

205 Thyroxine, Free

(FT4) Blood

Plain Gel


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




Type

Container

Type

Volume


Urine Universal

container 20ml

Urine,

24hr

24 hr

Container

as per

collection

210 Urea & Electrolytes Blood Lithium


R: 3 hours

U: 45 mins

211

Urine

Glycosaminoglycan

or

Mucopolysaccharide

s

(GAGS/MPS)

Urine Universal


212

Urine

Oligosaccharide

(OLIGO)

Urine Universal


213

Valproic acid

Blood Plain Gel


214

Valproic acid,

Trough

Serum Plain Gel


215 Vancomycin, Peak Serum Plain Gel

Tube 3ml



working day

Internal 1 day




Type

Container

Type

Volume


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



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




Type

Volume


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


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




Type

Volume


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




Type

Volume


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


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


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




Type

Volume


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




Type

Volume


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



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


51

Culture

&Sensitivity-

Pleural Fluid

Pleural Fluid Sterile


52 Culture &

Sensitivity-Pus Pus

Sterile

Container

NA Internal 3-7 days

53

Culture &

Sensitivity-

Rectal Swab

Rectal Swab

Cary-Blair

transport

medium


54

Culture &

Sensitivity-

Sputum

Sputum Sterile





Type

Volume


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


57

Culture &

Sensitivity-

Tissue

Tissue Sterile

Container


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



60

Culture &

Sensitivity-

Vitreous Tap

Vitreous Tap Sterile


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




Type

Volume


Perform

Site TAT

Blood

66


Detection-CSF CSF

Sterile Bijoux

bottle 1 ml Send specimen in ice pack HSB 1-2 weeks

67


Detection-Body

Fluid

Body Fluid Sterile

Container 3 ml

Specify site of collection. Pack

specimen in ice. HKL 1-2 weeks

68


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




Type

Volume


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


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


82

Filarial

Serology

(Antibody for

B. malayi ,

W.bancrofti)


83 Fungal Culture Hair, Nail Directly onto

an agar plate NA Internal 14-21 days




Type

Volume


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


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


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




Type

Volume


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


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




Type

Volume


Perform

Site TAT

108 Hepatitis C

Antibody Blood Plain gel tube 5 ml Internal 1-7 days

109

Hepatitis C _

Immunoblot

(confirmatory)


110

Hepatitis C

Virus RNA

Genome

Detection-

Blood (viral

load)


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



5-10 minutes.

HKL 3-4 weeks

116

Herpes simplex

2 Virus

Antigen,IFAT-

Skin




5-10 minutes. HKL 3-4 weeks




Type

Volume


Perform

Site TAT

117

Herpes simplex

Virus

1&2,IFAT-

Genital

Genital Smears on slide

NA Smears on Teflon coated micro


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


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)


122

HIV-

Immunoblot

(confirmatory)


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.


IMR 2-3 weeks




Type

Volume


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


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


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




Type

Volume


Perform

Site TAT

128

HLA Typing

Class II (Loci

DR and DQ)-

PCR



room temperature. Use

form”BMT HLA-Molecular

Typing-PCR”

IMR 1 month

129

HLA Typing

Allele Specific

High

Resolution-PCR



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


room temperature. Use form

for “request for PRA/DSA test”

IMR 1 month




Type

Volume


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


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


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




Type

Volume


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


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


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




Type

Volume


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.


150 Mumps IgG

Blood Plain gel tube 5 ml HKL 2-3 weeks

151 Mumps IgM


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




Type

Volume


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


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




Type

Volume


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


165 Nipah IgG


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




Type

Volume


Perform

Site TAT

(Haema Test)

Container

168

Parvo Virus

( IgG, IgM)


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





Type

Volume


Perform

Site TAT

A/B,

parainfluenza

1/2/3

175

Rheumatoid

Factor (RA

Factor)


176 Rotavirus

Antigen Stool

Sterile

container NA Send immediately. Internal Same day

177 Rubella IgG


178 Rubella IgM


179

Salmonella

serology


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


183

Toxoplasma

IgG


184 Toxoplasma

IgM Blood Plain gel tube 5 ml HSB 1-2 weeks




Type

Volume


Perform

Site TAT

185

Treponema

pallidum-

(TPPA)


186

TORCHES

(IgG, IgM)


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


191

Varicella zoster

Virus Antigen,

IFAT


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


193

Varicella zoster

Genome

detection

CSF, Vesicle fluids Sterile





Type

Volume


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


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




Type

Volume


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


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



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




Type

Volume

Required


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




Type

Volume

Required


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




Type

Volume

Required


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




Type

Volume

Required


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




Type

Volume

Required


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


Slide Not

returned.

8 weeks




Type

Volume

Required


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


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




Type

Volume

Required


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




Type

Volume

Required


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)




Type

Volume

Required


Transport

Guidelines

TAT

B Factor Assay

1 Factor II/V/ VII/

VIII/IX/X/XI/XII

Clot based assay Blood (Plasma)


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)


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)



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)



Deliver tubes immediately to the laboratory at room temperature OR

2 weeks 2 Anti Beta2 Glycoprotein1





Type

Volume

Required


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)




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)


Trisodium Citrate 3.2% Deliver tubes immediately to the laboratory at room temperature

1 day

7 Reptilase Time Clot based assay Blood (Plasma)



Deliver tube to laboratory immediately. OR Separate plasma from

1 day 8 Anti Xa (Please contact Coagulation lab staff

Chromogenic Assay




Type

Volume

Required


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)


Blood (Plasma)




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)



Deliver tubes immediately to the laboratory at room temperature OR Separate plasma from cells as soon as

2 days

2 Plasminogen inhibitor Chromogenic Assay




Type

Volume

Required


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


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


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



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


Internal See *

6 Group Screen & Hold (GSH) Blood

EDTA Tube 5 ml

Internal 2 hours

7

Investigation of Transfusion

Reaction Post


Investigation of Transfusion

Reaction Post

Internal

8

Investigation of Delayed

Transfusion Reaction


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


If delay anticipated

refrigerate at 4C

Hospital

Serdang

Daily 7 – 14

days




Type

Volume

Required

Department

Instructions

Perform

site

Schedule Lab

TAT

c) Cerebrospinal fluid Sterile bijoux

bottle


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


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




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



8. HISTOPATHOLOGY


Type

Container

Type

Volume


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


put in Formalin.

Hospital

Serdang


5 Immunofluorescence test

for skin and renal biopsies Tissue

Plain

Container

Not

Applicable


put in Formalin.

Hospital

Serdang


6 Special stain Slide Not

Applicable

Not

Applicable

Hospital

Serdang


7 Immunohistochemical

stain Slide

Not

Applicable

Not

Applicable

Hospital

Serdang




C. SPECIAL TEST

INSTRUCTIONS:

CHEMICAL PATHOLOGY



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.



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.



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


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.



Lactate

Collection of satisfactory specimen for lactate analysis requires special procedure to prevent

changes in lactate concentration while and after the specimen is drawn.


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


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:



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


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


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.



Therapeutic Drug Monitoring


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)


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


i. A 24 hour period of urine collection is recommended.



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


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)


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


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.



CSF Protein Electrophoresis


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


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)



ix. Immediately placed all the samples into the flask and transport to Protein lab,

Special Biochemistry Unit, Hospital Ampang for further processing.

UFEME


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


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.



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







CAPD Adequacy of Dialysis (kt/V)

Collect samples as follow:


Urea

Peritoneal

dialysate 24 Hour Plain gel tube 3 ml

Urine 24 hour 24 hour container as per

collection


Creatinine


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



• Give insulin 0.1 – 0.5 unit/kg body weight and GnRH 100ug intravenously

• Collect samples as follow:


FSH 0 min Blood Plain gel tube 3ml






LH 0 min Blood Plain gel tube 3ml






Glucose, 0 min Blood Fluoride oxalate 2.5 ml

Glucose,30 min Blood Fluoride oxalate 2.5 ml



Cortisol,0 min Blood Plain gel tube 3ml




Growth Hormone,0 min Blood Plain gel tube 3ml




TSH,0 min Blood Plain gel tube 3ml






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:


Cortisol 0hr Blood Plain gel tube 3 ml

Cortisol 15min Blood Plain gel tube 3 ml






ACTH 0hr Blood Plain gel tube 3 ml

ACTH 15min Blood Plain gel tube 3 ml






Gonadotropin Releasing Hormone Stimulation Test

• 100ug GnRH is given intravenously



FSH 0min Blood Plain gel tube 3ml










LH 0min 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.



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



Insulin Stress Test





• Give insulin 0.1 – 0.5 unit/kg body weight



Cortisol, 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



Insulin Tolerance Test





• Give insulin 0.1 – 0.5 unit/kg body weight








GH, 0 min Blood Plain gel tube 3ml








GLU, 0 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



Creatinine

Peritoneal dialysate at 0Hr,2Hr, 4Hr

and Overnight 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



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:


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:


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



(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:


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.



• 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.



D. SPECIAL TEST

INSTRUCTIONS:

MEDICAL MICROBIOLOGY



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.



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.



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.


iv. Send to the laboratory as soon as possible.

Urethral Discharge (Male)

i. Wipe the urethra with a sterile gauze or swab.



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


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)



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.



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



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.



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.



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.



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.



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.



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



� 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)



(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)



(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!



E. SPECIAL TEST

INSTRUCTIONS:

GENERAL HAEMATOLOGY



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)



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



F. SPECIAL TEST

INSTRUCTIONS:

BLOOD TRANSFUSION

SERVICE



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.



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



Investigation of Delayed Transfusion Reaction

• Transfusion reaction which happen after 24 hours of transfusion

• List of samples taken as follows:


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



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



G. SPECIAL TEST

INSTRUCTIONS:

CYTOLOGY



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.



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



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.


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



H. SPECIAL TEST

INSTRUCTIONS:

HISTOPATHOLOGY



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.



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.


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.



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.



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 -



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



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



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



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






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.







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





MICROBIOLOGY


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



MICROBIOLOGY


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



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



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



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)



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



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



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)



*This form is used when ordering AFP (Acute Flaccid Paralysis) test for suspected Polio

virus infection case.

















*This form is used to request for Immunohaematology tests (Antibody Identification, RBC

Phenotype, Antibody Titration).















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

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