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www.qml.com.au

Reference Manual

CONTENTS

CONTENTS

The content of the QML Pathology Reference Manual is provided as current information as at July 2008. Information in this manual may change over time.
For the latest information, please refer to the QML Pathology website www.qml.com.au or contact your local QML Pathology laboratory.

Click on the links below to jump to the required section


Introduction 1.0

Preface 5.0

Mission Statement

1.1

Company History

1.2

Collection Facilities 2.0


Collection Centres A-Z
Special Tests

2.1
2.13

Additional Services 3.0


Vaccine Service

3.1

Travel Health Service

3.1

Warfarin Service

3.2

Occupational Pathology

3.4

Vetnostics

3.5

Collection Materials 4.0

Full Screen

Appendices 12.0

Departmental Directions on Specimen


Collection, Storage and Transport
Biochemistry

5.1

Blood Bank

5.9

Cytology

5.11

Endocrinology

5.21

Genetics

5.25

Haematology

5.31

Histology

5.35

Immunology

5.47

Microbiology

5.51

Biochemistry
Common Causes of Abnormal
Biochemical Results
Serum Tumour Markers
Common Biochemistry
Reference Ranges
Glucose Tolerance Test
Gestational Diabetes
Dietary Restrictions and
Special Diets
Qualitative Urine Drug Screen
Quantitative Drug Assays for
Therapeutic Monitoring
Poisons and Toxic Substances
Used in Pest Control
Acid Base Analysis
Lipids
Endocrinology
Pregnancy Timeline
Investigation of Hirsutism
Recommended Age Guidelines
for Mens Health Testing

Test Listing A-Z 6.0


Test Selection Guide

6.1

Test Listing A-F

7.0

Test Listing G-L

8.0

Test Listing M-R

9.0

Specimen Storage

4.1

Order of Draw

4.2

Blood Collection Tubes

4.3

Specimen Containers

4.6

Test Listing S-Z

10.0

Swabs

4.14

Contact Details

11.0

Skin Devices

4.16

Rule 3 Exemption

11.1

Genetics
Cytogenetic Tests
Molecular Genetic Tests
Haematology
Basic Haematology Parameters
Leucocyte Reference Ranges
Initiating Warfarin Therapy
Range of Target INRs
Duration of Warfarin Therapy
Drugs that Interact with Warfarin

12.1
12.1
12.4
12.7
12.9
12.9
12.10
12.13
12.15
12.18
12.19
12.21
12.23
12.23
12.26

Immunology
Antibodies to Tissue Antigens
(Autoantibodies)
Antibodies to Microbial and
Parasitic Agents
Arbovirus Screen
Skin Tests for Allergy
RAST Allergen List
Skin Allergen List
Microbiology
Infection Control in Medical
Consulting Rooms
Blood Collection, Waste
Management, Handling Sharps
Guidelines for Gloves,
Handwashing Protocol
Clean Up Procedure for Blood
and Body Fluids
Body Fluid Exposure Procedure
Validation of your Steriliser
Symbols for Hazardous Categories

12.35
12.35
12.36
12.37
12.37
12.38
12.40
12.41
12.41
12.43
12.44
12.45
12.46
12.47
12.49

12.27
12.29
12.29
12.30
12.31
12.31
12.31
12.32
12.32
12.33
12.34

Home

CONTENTS

SPECIMEN STORAGE
All EDTA blood and blood films in Haematology are stored refrigerated for 1 week.
Blood films showing significant pathology are archived for 1 year.
All Bone Marrow blocks and slides are archived for 14 years.
All sera in Biochemistry, Endocrinology and Haematology are stored refrigerated
for 7 days after collection
Note: Some analytes may deteriorate in this time.
Serum collected for viral, bacterial or parasitic antibody testing is kept frozen for
12 months to follow the course of the illness or to make a diagnosis retrospectively
[Immunology (07) 3121 4458 or Branch Laboratory].
Gram-stained slides and culture plates are kept in Microbiology for 1 week should
further sensitivity testing or identification be required.
Histology tissue specimens are stored for 4 weeks before disposal. Blocks and
slides are archived for 14 years.
All cytology smears and preparations (normal and abnormal) are archived for
14 years.

ORDER OF DRAW

Vacutainer & Syringe Method


1. Blood culture bottles

Aerobic
bottle

Anaerobic
bottle

Paediatric
mini container

2. Pale blue top (Sodium citrate)**

3. Tubes without chemical additive


(SST, Red top, Navy top)

Paediatric
bottle

Tube MUST
be filled to
indicated level

COLLECTION MATERIALS

COLLECTION MATERIALS

COLLECTION MATERIALS

Paediatric
micro container

Paediatric
mini container

Paediatric
micro container

4. Green/Orange top (Lithium heparin)

Specimen Labelling Requirements


Please ensure all request forms and
specimens have correct patient details

5. Pink/Lavender top (EDTA)

Paediatric
mini container

Paediatric
micro container

6. ESR (if required)

Our minimum requirements are:


Surname Given Names Date of Birth Date and time of collection

Please understand that incorrect or insufficient


labelling can necessitate a recollection

7. Grey top (Fluoride oxalate)

Paediatric
micro container

8. Yellow top (ACD - Acid citrate dextrose)

All tubes MUST be signed by patient or


collector to confirm patient identity.

Yellow rubber top

4.2

4.1

**If the citrate tube is the only tube to be drawn (or if it is the first tube to be drawn), this tube is
acceptable for routine coagulation testing (APTT and PT/INR). For special coagulation testing
(e.g. Factor VIII and Heparin Therapy) the citrate tube should not be the first tube drawn. Use of
a plain discard tube may be considered in this situation.

Blood Collection Tubes

Blood Bank EDTA tube

Serum separation tube (SS tube)

(Pink top)
Blood group
Rh antibodies
Crossmatch (+ EDTAlavender top)
Group & hold serum (+ EDTAlavender top)
HLA B27 testing
Genetics (some)

(Yellow plastic top)


After clotting, the tube should be centrifuged for 10 minutes
and may then be left refrigerated overnight.
Endocrinology tests (Thyroid function tests, FSH, LH, etc.)
E/LFT: including urea, glucose, electrolytes,
liver function tests, cholesterol, triglycerides (lipids)
Autoantibodies (Including antisperm antibodies)
Microbial, parasitic and viral serology
(hepatitis serology, rubella antibodies, etc.)
Pregnancy tests
Paediatric
Paul-Bunnell test
micro container
Tumour markers
Iron studies/B12
Plain tube
(Red top)
All drug assays
Vitamin D

COLLECTION MATERIALS

COLLECTION MATERIALS

COLLECTION MATERIALS

Sodium citrate tube


(Pale blue top)
Coagulation studies:
Prothrombin time
Thrombophilia tests
Factor assays etc.
INR
APTT
D-Dimer
Fibrinogen.

Tube MUST
be filled to
indicated level

Paediatric
mini container

Acid citrate dextrose - ACD tube


Paediatric
micro container

(Yellow rubber top)


HLA tissue typing
Leukaemia marker studies
Lymphocyte studies
Lymphocyte subset analysis
HIV viral load

Fluoride oxalate tube

4.3

Paediatric
micro container

EDTA tube
(Lavender top)
F
 ull blood count: including haemoglobin, white cell count,
platelet count
Paediatric
Paediatric
Red cell folate
micro container
mini container
Hb EPP
ACTH
Hb A1C
ESR

4.4

(Grey top)
Blood alcohol
Lactate studies
Blood glucose (if a delay in cell separation is unavoidable)

Lithium heparin tube

SPECIMEN CONTAINERS

(Green top, orange top)


Used for a wide variety of tests covering biochemistry,
haematology and genetics
Heavy metals screens
Chromosome analysis
Paediatric
Paediatric

Urine for microbiology (MUC M/C/S)


After collection of the urine into a sterile container,
aspirate the specimen into the Monovette.
Transport to the laboratory immediately.
If transport to the laboratory is likely to be delayed
for more than 12 hours, refrigerate until
transport is available.
Suprapubic aspirates should be collected into
a sterile container and refrigerated if transport
to the laboratory is delayed.

micro container

mini container

Trace metal tube


(Navy top)
Must be centrifuged immediately for 10 minutes.
Zinc
Selenium
Aluminium.

COLLECTION MATERIALS

COLLECTION MATERIALS

COLLECTION MATERIALS

Sterile
container

Yellow monovette

Urine collection bottles


Used for timed urine collections.
Patient instructions are written on the bottle.
The bottle should be refrigerated
between collections.
Certain collections may need preservative
(Check A-Z test listing of this Reference Manual).

ESR tube
ESR

8hr urine
collection bottle

24hr urine
collection bottle

4.6

4.5

Funnel

Aptima urine tube


Chlamydia trachomatis
Neisseria gonorrhoeae

Urine drug screen collection kit


For details of use and
Chain-of-Custody documentation
requirements, see Drug Screening
section (5.4) in Biochemistry Preface
of this Reference Manual.

COLLECTION MATERIALS

COLLECTION MATERIALS

COLLECTION MATERIALS
Blood culture bottles
Adults take 16-20mL of blood on each
occasion and divide evenly into 2
adult culture bottles (aerobic and
anaerobic).
Children take 1-3mL of blood on each
occasion and place in a paediatric
blood culture bottle.
If difficulty is experienced in obtaining
blood from some patients, the
paediatric blood culture bottle will
suffice for adults.

Aerobic
bottle

Anaerobic
bottle

Paediatric
bottle

Faeces container
Liquid stools should be examined
promptly - please contact the
laboratory to arrange pickup.
Formed and semi-formed stools
should be received by the laboratory
within two hours of collection.

4.8

4.7

Faeces
container

Seminal fluid collection


Collect specimen into a sterile container.
This sample needs to reach the laboratory
within two hours.

Skin scrapings containers

Sterile
container

Superficial mycoses may infect skin,


hair and nails. Skin scrapings from
the active edge of the lesion and
scrapings from nails, together with
clippings of nails and hair, may be
placed in a sterile container.
The paper envelope may also be
used for collecting skin scrapings.
If the lesion is exuding material and
may be painful to scrape, a swab
may be collected as an alternative.
Use a dry swab previously
moistened with saline to swab the
lesion. Place the swab in a container
without transport medium.

COLLECTION MATERIALS

COLLECTION MATERIALS

COLLECTION MATERIALS

Antibiotic transport medium


Suitable for the transport of all viable tissues.
Genetics (POC, etc.)
Tissue culture
Tissue tumour markers (lymph nodes, etc.)

Nasopharyngeal tubing

4.9

Routine histology tissue and biopsy


specimens are placed into 10% formalin
for fixation and submitted to the laboratory
for paraffin processing.

4.10

Histology specimen container

Nasopharyngeal aspirate
RSV (Respiratory Syncytial Virus)
Influenza A & B,
Parainfluenza 1, 2, 3, Adenovirus
Bordetella Pertussis PCR

Synovial fluid collection kit


1. Crystals, rheumatoid factor latex, gram
stain and culture. Several mL in a
sterile screw top (urine) container.
2. Cell count and differential. 1-2mL in
lithium heparin (green top) tube to
prevent specimen clotting.
3. Protein, albumin and glucose. 1-2mL
in a EDTA (lavender top) tube.

Lithium
Heparin tube

EDTA tube

Single-use Pap smear kits


Three separate kits available:
Cervex brush
Cytobrush
Combination.

Cervex brush
Pap smear
test kit

COLLECTION MATERIALS

COLLECTION MATERIALS

COLLECTION MATERIALS

Sterile
container
Cytobrush
Pap smear
test kit

Cytology kits
Monolayer cytology kit
After preparing a conventional Pap
smear, rinse the Cervex brush or
preferred collection device thoroughly
in the cell preserving solution.
Transport the Pap smear in slide carrier
and the labelled cell preserving solution
to the laboratory.

4.12

4.11

Combination
Pap smear
test kit

Fine needle aspiration kit

Swabs

The fine needle aspiration kit contains all materials necessary to


perform a fine needle aspiration of a lesion by any preferred technique.
It comes packaged in a handy rigid transport cylinder which can be
utilised to transport the specimen back to the laboratory.

Bacteriology transport swab


May be left overnight at room temperature except where
gonorrhoea or anaerobic infection is suspected. In these cases,
please contact the laboratory to arrange prompt pick up.

COLLECTION MATERIALS

COLLECTION MATERIALS

COLLECTION MATERIALS

4.14

4.13

Viral culture transport swab


May be left overnight refrigerated.
Use for routine virology.

Aptima Chlamydia trachomatis/Neisseria gonorrhoeae swab


for molecular testing
Store at room temperature before and after collection.

Skin Devices
Skin punch biopsy devices
The punch biopsy with internal plunger system allows the lodged skin specimen
inside the metal lumen of the punch to be easily ejected. Available in several sizes:
Punch Biopsy with internal plunger available in 2, 3 and 4mm
Punch Biopsy without plunger available in 2, 3, 4, 5, 6 and 8mm.

COLLECTION MATERIALS

COLLECTION MATERIALS

COLLECTION MATERIALS

2mm Punch Biopsy with internal plunger

2mm Punch Biopsy without plunger

Flocked swab (Dry flexible swab)


Used for PCR and respiratory viruses.
Store at room temperature before and after collection.

BIOPBLADE
The sterile, single-use BIOPBLADE is a flexible scalpel used for cutaneous surgery,
including: shave biopsy, saucerisation of flat lesions and levelling of pedunculated lesions.
The unique design of the BIOPBLADE incorporates a comfortable and protective
Fingerguard in addition to the flexible super sharp blade. This flexibility allows the blade to
be positioned at the correct angle for the intended procedure.
The BIOPBLADE is utilised for removal of lesions, either elevated (shave biopsy) or flat
(saucerisation). After the site is anaesthetised, the BIOPBLADE is held and bowed
between the thumb and fingers. The lesion is removed at or just below the surface epithelium.
Cosmetic results are normally good and the wound heals without the need for suturing. The
Clinician will remove all of the lesion without overly deep penetration to avoid scarring.

Nasopharyngeal swab (Dry swab)

4.16

4.15

Store at room temperature before and after collection.


May be left overnight refrigerated.

Serum Calcium, Iron and Alkaline Phosphatase

Many of the range of close to 1200 tests performed by or arranged through the
Biochemistry Department have requirements which, if not recognised and met, may
lead to misleading or delayed results. The section below refers only to requirements
at the time of collection. Those tests that require pre-test preparation of the patient
are listed subsequently.

When using evacuated blood tubes (vacutainers) for sample collection, it is important to
collect biochemistry samples before haematology. If a full vacutainer is collected, a small
volume of blood usually refluxes back into the needle during withdrawal of the container.

Test Requirements at Time of Collection


BLOOD, SERUM OR PLASMA TESTS
Arterial or Venous Blood Gases
Blood remains living, actively metabolising tissue after collection and unless measures are
taken to slow or halt metabolic activity, misleading results will be obtained. It is important
that blood collected for oxygenation and pH studies should be cooled on ice or cold
packs as soon as possible (within 20 minutes) after collection or an artefactual metabolic
acidosis (low pH and bicarbonate, with raised negative base excess) may ensue from
red cell generation of lactic acid from glucose. A slower process, white cell aerobic
metabolism leading to a slow fall of pO2 and a rise of pCO2 with apparent respiratory
acidosis will further complicate interpretation.
Serum Electrolytes, Glucose, Enzymes and Phosphate
A living cell maintains a steep electrolyte gradient across the cell membrane with high
extracellular sodium and chloride, and high intracellular potassium concentrations. In
contrast, intracellular sodium and chloride and extracellular potassium concentrations
are around 5% of the corresponding transmembrane levels. The maintenance of
these gradients is an active process, requiring plentiful ATP. If blood is stored at room
temperature, glucose is consumed (metabolised to lactic acid) to maintain the membrane
gradients. This is accompanied by a fall of bicarbonate to <10 mmol/L. When the sample
glucose falls to <2 mmol/L, cellular metabolism fails and electrolyte leakage occurs.
Plasma sodium falls sequentially to as low as 80-90 mmol/L, chloride to 60-70 mmol/L,
and potassium rises to as high as 15-20 mmol/L. Lactate dehydrogenase (LD/LDH) and
aspartate transaminase (AST) escape and may elevate the plasma level to 4-5 times
the upper limit of normal. Intracellular phosphate also escapes with the shutdown of
glycolysis and may elevate the plasma phosphate to 4-5 mmol/L.

5.1

The only way to prevent this sequence of events is to centrifuge and separate the
serum/plasma from the cell mass, preferably within 20 minutes of collection into a serum
separation tube (SS tube), plain tube or other tube. The gel plug of the SS tube separates
cells from serum. With other tubes it is advisable to decant the supernatant serum/plasma
into a sterile plain tube(s) for storage. This should be stored refrigerated. Collection of the
sample into fluoride oxalate preservative or refrigeration of the sample eliminates the loss
of glucose and maintains a normal anion gap but other changes proceed.

If haematology is collected first, this blood contains the EDTA anticoagulant and can
pass into the next tube attached. If the latter is used for biochemical profile assay,
we occasionally note a small but significant fall in calcium and iron. Rarely, a marked
suppression of these as well as suppression of alkaline phosphatase may be noted. There
is concern that milder artefacts go unrecognised.
Serum Therapeutic Drugs
After administration of a drug, there is an interval between the absorption of the material
and its uptake into the tissues within which it is active, during which the serum levels are
misleadingly high (because they do not meaningfully reflect end-organ or tissue levels). This
interval is known as the distribution phase. Clearly drug levels must be examined after this
interval to give most useful information. The exception to this is seen with the antibiotics,
in which the peak level itself conveys valuable information relating to bactericidal effect
and to risk of toxicity.

PREFACE - BIOCHEMISTRY

TESTS WITH SPECIAL COLLECTION REQUIREMENTS

Blood Alcohol and other Medico-legal Collections


When blood is collected for possible legal purposes (e.g. to challenge a police breathalyser
finding), it is important to first of all obtain samples as close as possible to the time of the
initial sampling and then to adequately seal those samples so that the pathologist can
certify that no tampering has occurred between collection and testing. An appropriate
method of sealing a blood tube is the placement of one QML Pathology bar code label,
saddle-like across the top of the tube so that the ends reach approximately a centimetre
down the glass, followed by the wrapping of a second label around the body of the
tube so that it covers the ends of the first. The patient details are then completed and
the collector and patient each sign across the joint of the two labels. The protocol also
includes a Chain-of-Custody form which records the legally correct Chain-of-Custody of
the specimen from collection to production of a report. This form is to be signed by both
donor and collector. Chain-of-Custody forms detail the procedure and are available on
request from QML Pathology.
We also strongly recommend that saline or sterile water only be used to cleanse the
skin before venepuncture, and not alcohol swabs. Although isopropanol does not crossreact as ethanol in the laboratory assay, the necessity to argue this point in the court
setting can lead to the whole collection being discounted.
Plasma Lactate
Lactic acid is the end product of anaerobic metabolism and is elevated in states associated
with liver disease, ischaemia, shock and blockade of Krebs Citric Acid Cycle. However,
it is also the normal product of red cell glycolysis. Hence if blood is collected and allowed
to stand at room temperature, red cells will convert glucose to lactate and produce a
spurious lactic acidosis (with lowered glucose and bicarbonate, and a raised anion gap
and lactate). Examination of the results reveals a pattern that is indistinguishable from a

5.2

PREFACE - BIOCHEMISTRY

PREFACE - biochemistry

true pathological lactic acidosis. To guard against this, it is necessary to centrifuge the
blood within 20 minutes of collection and separate the cells from the plasma/serum. A
serum separation tube (SS tube) allows this without decanting the serum. Alternatively,
collection into a fluoride oxalate preservative tube inhibits metabolism such that physical
separation may be deferred until the sample reaches the laboratory. Cooling the sample to
refrigerator temperature also partially achieves this end but at the expense of meaningful
electrolytes (see previous page).
Plasma Very Long Chain Fatty Acids and Phytanic Acid
VLCFA are performed in the diagnosis of adreno-leucodystrophy, Refsums Disease,
Zellwegers Syndrome and related abnormalities of cellular peroxisomal function. Phytanic
acid is relatively more specific to Zellwegers Syndrome. Both of these tests are referred
to Royal Brisbane Hospital for analysis. In all laboratory analyses, some clinical details are
valuable in case extra testing or additional tests are indicated. However, with these tests
the referral laboratory will not commence the analyses unless adequate clinical details are
supplied with the sample. So as to avoid undue delay, please write appropriate clinical
details on the request form.
Neonatal Screen (Heel Skin-Prick Blood)
In Queensland, the routine neonatal screen includes tests for phenylketonuria,
hypothyroidism, galactosaemia and cystic fibrosis. The tests are routinely performed on
paper discs punched from a standard filter paper card. Assume even application of the
infants blood onto marked areas of the card. Uneven application, particularly reapplication
onto areas previously dried may lead to falsely high results and hence potential risks of
false alarms for all of the tests. If a card is not available, blood may be collected into an
EDTA or Lithium heparin tube and the application to the card made in the laboratory
before transfer to the screening laboratory.
Plasma Ammonia
Ammonia cannot be meaningfully assayed on skin-prick blood because the high sweat
ammonia level always leads to marked false elevation of the apparent blood level from
contamination.
Trace and Toxic Elements from Skin-Prick Blood
Rigorous attention to skin cleansing is always essential before collection as contamination
from material on the surface of the skin can produce marked elevation.

URINE TESTS
Urinary Porphobilinogen (PBG)

Urinary Catecholamines and VMA


Epinephrine (adrenaline), norepinephrine (noradrenaline), dopamine and their metabolites
vanillylmandelic acid (VMA, 4-hydroxy-3-methoxymandelic acid, HMMA), and
homovanillic acid (HVA) are the key elements in the diagnosis of phaeochromocytoma
and childhood neuroblastoma and ganglioneuroma. The metanephrines have declined in
popularity with improvements in the former assays. Current assays are not susceptible to
interference from dietary vanillin. However, mild pathophysiological elevation of excretion
in response to illness, injury, psychiatric agitation and to fluctuations in blood pressure is
common. Particularly difficult are the often marked elevations of excretion in response
to commencement or dose increases of antihypertensive therapy; increases which
may persist for 1 - 2 weeks while a new steady state is achieved. In the case of newly
diagnosed or suddenly deteriorating hypertension, the ideal would be to collect a single
24 hour urine sample before changing therapy. Plasma catecholamines are available but
their diagnostic value as a screen is not as clear (because of rapid elevation before or
during venepuncture). Dihydroxyphenylglycol assay is also available but again this is not
as attractive as a first line test because it has a turnaround time of several weeks.

PREFACE - BIOCHEMISTRY

PREFACE - BIOCHEMISTRY

PREFACE - biochemistry

24 hour urinary catecholamines must be collected into acid preservative (or if collected
as a stat or random collection, the sample must be kept refrigerated until acidified in the
laboratory). Please refer to the specific test in the A-Z listing for full collection details.
Urinary Drug Screen for Overdose
Please notify the laboratory and seal samples as described under blood alcohol
and other medico-legal collections (5.2) if foul play or potentially lethal toxicity is suspected.
Clearly, there may be medico-legal implications.
Urine Drug Screen for Industry, Occupational and Drugs of Abuse
This test is probably the one most likely to give misleading results as a direct result of
deliberate interference with the collection by the patient. Substitution with urine from
another, dilution with tap or toilet water or saliva, oral water loading to dilute urine,
consumption of other substances in an attempt to mask drug findings and addition of
chemicals to the urine to attempt to breakdown urinary drug metabolites are common
occurrences among the group of patients who find themselves required to undergo this
testing. Supervision of the collection and sealing of the sample is essential. The
QML Pathology protocol complies with Australian/New Zealand Standard AS/NZS4308.
The protocol includes a specifically designed tamper-evident urine specimen bottle, a
procedure designed to ensure collection of a truly representative sample of urine from
an identified patient, and documentation that is signed by the donor and collector and
that records the legally correct Chain-of-Custody of the specimen from collection to
production of a report. Chain-of-Custody forms detail the procedure and are available on
request from QML Pathology. Please refer to the Biochemistry Appendix (12.13) for a full
list of drugs assayed.

5.4

5.3

A raised PBG excretion in a stat urine collection taken during a symptomatic episode is a
key finding in the diagnosis of an acute porphyria (Acute Intermittent Porphyria, Hereditary
Coproporphyria, or Variegate Porphyria). However, PBG is quite unstable and the sample
must be refrigerated and protected from light (wrapped in foil or brown paper), as well as
tested as soon as possible after collection.

CSF TESTS

NOTE: Faeces has a proportionally huge bacterial load and their continuing
metabolism may significantly alter the faecal biochemical profile.

Cerebrospinal Fluid Protein

WITH ALL biochemical faecal tests, it is essential that the sample be refrigerated or
frozen as soon as possible after collection.
Faecal Analysis for Reducing Substances and Sugar Chromatography
When testing for sugar/lactose intolerance, it is advisable to ascertain that the child has
not commenced a lactose-free diet. Parents have been known to commence treatment
before firm diagnosis, and this will certainly produce a false negative (normal) result.
NOTE: It is the fluid component of the faeces specimen that is required for testing. Use
of a non-absorbing liner such as Glad Wrap to prevent absorption by the babys nappy
when collecting a specimen is advised.
Faecal Fat Analysis
Refrigerated sample storage is very important (see above). Fly larvae (maggots), an
occasional finding in the laboratory, may both consume malabsorbed triglyceride and
produce their own. Nappy liners must not be used during collection. The patient must be
taking an adequate diet not excluding fat or a falsely normal test will result.
Faecal Porphyrin Excretion
In addition to standard sample-handling procedures, it is essential that the patient should
avoid contamination of the collection with urine. The high urinary uroporphyrin and
coproporphyrin will falsely elevate the total and mask the characteristic faecal pattern.
Faecal Alpha-1-Antitrypsin Analysis
Alpha-1-antitrypsin is used as the marker of choice for the detection of enteric proteinlosing states, not because of any unique handling of this protein but simply because it is
relatively resistant to bacterial degradation. However, the sample must be refrigerated as
soon as possible after collection.
Faecal Pancreatic Elastase-1 (PE1)

5.5

The faecal elastase-1 concentration reflects the secretory capacity of the pancreas. That
is, the diagnosis or exclusion of pancreatic exocrine insufficiency. The concentration of
PE1 may be lowered in very watery stool samples. Formed stool samples are the preferred
sample. Samples should be frozen ASAP.

Rarely, we receive CSF which has been contaminated with myelogram contrast material.
This results in a false elevation of the assayed protein level which may be marked (e.g.
up to 20 g/L {R.R 0.4 g/L}). If there is any suspicion of this, the situation can be rapidly
clarified with CSF albumin assay.

SWEAT TESTS
Sweat Electrolytes
Only under exceptional circumstances will the clinician collect sweat samples. We strongly
support this - the collection is too difficult unless performed by trained and experienced
staff. However, should a collection be unavoidable, it is essential that any evaporative loss
must be avoided as it leads to false elevation of electrolytes and, potentially, misdiagnosis
of Cystic Fibrosis.

PREFACE - BIOCHEMISTRY

FAECES TESTS

SALIVA TESTS
Salivary Screen for Drugs of Abuse
This test requires 10 mL of saliva in a sterile screw top (urine) container. Collection must
be supervised as described for urine.

HAIR AND/OR NAILS TESTS


Hair or Nail Analysis for Toxic Elements
Hair or nails must be thoroughly cleaned without shampoo, soap or detergents before
collection. Because maximal deposition takes place in the keratin being laid down while
the metal level is maximal in soft tissue, nail can detect exposure 4 to 8 months previously
and hair 2 to 6 months previously (depending on the length).
Quantity of material for analysis:
Hair - A packed matchbox
Nail - As much as possible from fingers and toes. Clearly, if exposure is very recent,
i.e. of the order of weeks, blood or urine testing may be more appropriate.

STOMACH CONTENTS/VOMITUS TESTS


Vomitus Analysis for Drugs in Suspected Overdose
In addition to standard requirements of refrigeration to stabilise the sample both chemically
and microbiologically, it is essential that any suspicions of possible exposure should be
noted on the request form. This is to expedite testing the more likely drug classes. If there
is any possibility of medico-legal implications, this should be noted on the request form
and the sample should be sealed as described for blood alcohol.

5.6

PREFACE - BIOCHEMISTRY

PREFACE - biochemistry

BREAST MILK TESTS


Breast Milk Analysis for Nutritional Qualities
In cases of maternal concern, we occasionally test breast milk for glucose, lactose, lipid
and protein content. Because the sample is invariably contaminated during collection, it
must be refrigerated promptly until arrival at the laboratory.

DETECTION AND IDENTIFICATION OF SNAKE VENOM


IN SUSPECTED SNAKE BITE
The most appropriate and preferred sample for testing is snake venom from the site of
the bite. Moisten a cotton swab or cotton bud with saline or tap water and swab the site
of the puncture wound(s). A small piece of clothing cut from the bite site may also be
taken if appropriate. The swab(s) and the cloth sample should be placed in a labelled dry
sterile screw top container (microurine container) - one sample per jar. Please contact the
laboratory and forward the specimen as soon as possible.

PREFACE - BIOCHEMISTRY

PREFACE - BIOCHEMISTRY

PREFACE - biochemistry

Urine collected in a sterile screw top container and blood collected in a Lithium Heparin
tube may also be tested, however, the swab and/or cloth from the bite site(s) are the
preferred samples.
The service is available on an urgent basis 24 hours per day.

TESTS REQUIRING PRE-TEST PATIENT PREPARATION


Breath hydrogen analysis
(general fasting instructions and no smoking one hour prior to test)
Cholesterol and triglycerides (may require fasting if directed by doctor)
Glucose tolerance test
5-Hydroxyindoleacetic Acid (5-H.I.A.A.)
Water deprivation test
Details of preparation for these tests can be found by referring to the A-Z test listing and
the Dietary Section (12.10) of the Biochemistry Appendix.

5.8

5.7

Printed instruction forms for patient preparation for these tests are available on
request from QML Pathology Collection Centres, QML Pathology Brisbane Liaison
Services (07) 3121 4943 or your local Branch Laboratory.

HOMOLOGOUS BLOOD TRANSFUSION SERVICE


QML Pathology provides a Cross Match Service for elective surgery using
homologous random donor blood provided through the Australian Red Cross
Blood Service.

AUTOLOGOUS BLOOD TRANSFUSION SERVICE


QML Pathology offers an Autologous Blood Donation Program for patients desiring an
alternative to homologous random donor blood provided through the Australian Red Cross
Blood Transfusion Service. There are many recognised advantages for autologous transfusion
in selected patients undergoing elective surgical procedures, including the elimination of
serological incompatibility and transfusion acquired HIV and Hepatitis infection.

Requests for autologous transfusion should be written on the special QML Pathology
form and be accompanied by request forms for:
1. Serology for Syphilis, Hepatitis B and C, HTLV-1 and HIV
2. Hb, Antibody Screen and Cross Match.
Pre-printed request forms for collection of autologous donations by QML Pathology
and the patient information brochure Autologous Blood Donations are available
on request from QML Pathology Collection Centres, QML Pathology Brisbane Liaison
Services (07) 3121 4943 or your local Branch Laboratory.
For further details please contact QML Pathology Blood Bank (07) 3876 8371 or your
local Branch Laboratory.

PREFACE - BLOOD BANK

PREFACE - BLOOD BANK

PREFACE - blood bank

Patients who are excluded by the Red Cross guidelines may be acceptable for autologous
blood collection by QML Pathology. The referring practitioner must indicate that in his/her
opinion the patients physical condition will permit venesections to be performed safely. It
is emphasised that initiation of the collection request should allow sufficient time for clinical
review, an achievable collection plan for the desired number of autologous donations and
coordination of iron supplement therapy where directed by the QML Pathologist.
If autologous blood collection is desired, the following important information should
be noted:
1. Prior to venesection it is requested that basic testing (full blood count, blood group and
antibody screen) be performed to ensure there is no haematological contraindication
to the procedure. All autologous units collected will be screened for Syphilis,
Hepatitis B and C, HTLV-1 and HIV by QML Pathology. This is in accordance with
the recommendations by NATA/RCPA Accreditation Authority and the Australian New
Zealand Society for Blood Transfusion. Referring doctors should advise their patients
accordingly.
2. Blood donations are collected into CPD-Adenine anticoagulant and have a shelf life
of approximately 35 days. Donations are collected at weekly intervals for a maximum
of four donations, and preferably no venesections are performed in the week prior to
surgery. The expected fall in haemoglobin for an average adult male is approximately
10 gm per litre per donation (the fall will be somewhat greater in females). A check
haemoglobin is therefore performed prior to each venesection. Patients are usually
placed on an oral iron supplementation (Ferrous Sulphate - 350 mg -1 tablet twice daily
prior to their procedure) by the QML Pathologist.

5.10

5.9

3. On admission to hospital, a specimen is collected for Cross Match and Antibody
Screening. Although the patient is to receive autologous blood it is essential for safety
and medico-legal reasons (clerical errors, etc.) that compatibility tests be performed.
Secondly, the autologous collection procedure is only performed on the proviso that
if additional blood is required beyond the autologous reserve the patient will accept
homologous (Red Cross) blood. Should this prove necessary the laboratory will have
a stored cross match specimen available and there will be no additional fee applicable
for cross matching the homologous blood.

SPECIMEN COLLECTION FOR GYNAECOLOGICAL CYTOLOGY


Most cervical cancers and precancers arise in the transformation zone that is, where
everted endocervical epithelium comes to be replaced by metaplastic squamous
epithelium. Therefore, it is crucial that this area is well visualised and adequately sampled.
The location of the transformation zone may vary depending on a womans age and
menstrual history.
The use of the modified Ayres spatula or Cervex sampler is adequate in most instances.
A cytobrush may be used when the transformation zone is located further up the
endocervical canal, as is the case in post-menopausal women.
Preparation

If collecting a biopsy specimen at the same time, it is important to keep histology
specimens and cytology slides physically separated during storage and transport.
Liquid formalin vapour has an adverse effect on Pap smears which can make
morphological assessment difficult.
Spatula & Cytobrush

Cervex Sampler

PREFACE - CYTOLOGY

PREFACE - CYTOLOGY

PREFACE - cytology

Label frosted-ended glass slides with the patients name and date of birth using
a pencil.
Complete the request form including the patients name, date of birth, date of last
menstrual period and other relevant clinical information e.g. pregnant, post natal, post
menopausal, use of hormones, presence of IUD.
Record any high risk factors including prior treatment for CIN, abnormal cervical
appearance, presence of contact or post coital bleeding.
Check whether the patient wishes her name to be withheld from the Pap Smear
Register. If there is no indication on the form the result details will automatically be sent
to the register.
Collection
After introduction of a vaginal speculum and proper visualisation of the cervix, gently
rotate the spatula 360 about its axis to ensure sampling of the entire transformation
zone. If a Cervex sampler is used, rotate through 360, three times in both clockwise
and anticlockwise directions. Press the outer bristles of the brush firmly against
the ectocervix.
If using a cytobrush in conjunction with the spatula, perform this sampling after an
ectocervix specimen has been collected to avoid contamination by blood. Avoid
inserting the cytobrush too far into the os, in order to minimise sampling of the lower
uterine segment. Some bristles should still be visible. Rotate the brush twice (180).
It is advisable not to use the cytobrush if the patient is pregnant.
Preparing and Fixing the Sample onto the Slide
Transfer the sample onto the slide using a painting action, with just enough pressure to
ensure cell transfer. This is best achieved by smearing the spatula or Cervex sampler,
or by rolling the brush.
Fix the smear quickly to prevent air drying by spraying with Cytospray at a distance of
15-20cm from the slide. Alternatively immerse the slide immediately in 95% ethanol for
15 minutes.

5.12

5.11

Leave the slide to dry for 15 minutes and place into the plastic slide carrier provided.
Place the carrier along with the patient request form into a plastic specimen bag.

ThinPrep Specimens and HPV Testing

Pap Smear Collection Kits

The ThinPrep Imaging System utilises cells


harvested from the collection device by rinsing into
a preservative fluid.

QML Pathology supplies various collection kits for cervical smears which are conveniently
packaged to suit different clinical indications.

HPV DNA Testing for high risk HPV types can also
be performed from the ThinPrep vial.
It is desirable when collecting a liquid-based sample
to use either a cervex sampler or a plastic spatula.
A wooden spatula is not recommended as cells
tend to stick to the wood and are not easily released
into solution.

Single Use Pap Smear Kits:


May be left overnight at room temperature after fixing. These kits are suitable for
conventional Pap smears and ThinPrep.

PREFACE - CYTOLOGY

PREFACE - CYTOLOGY

PREFACE - cytology

Prepare the conventional slide and rinse the


device(s) in the PreservCyt solution. Push the
Cervex brush into the bottom of the vial and twirl
vigorously to ensure as much cellular material as
possible is released in the solution.
Discard the collection device after rinsing.
Replace the PreservCyt cap and tighten so that the
small black mark passes the corresponding line on
the vial.
Label the vial with the patient name and date of
birth, and place into the plastic specimen bag
along with the conventional smear and completed
request form.

Cervex Pap smear test kit

Combination Pap smear test kit

Cytobrush Pap smear test kit

Monolayer Cytology:

5.14

5.13

After preparing a conventional Pap


smear, rinse the cervex brush or
preferred collection device thoroughly
in the cell preserving solution.
Transport the labelled Pap smear
in slide carrier, and labelled cell
preserving solution to the laboratory.

Nipple Discharge

Effusions and Washings

Label slide/s with a pencil.

Collect in a sterile dry container of appropriate size.

Gently squeeze the nipple until fluid appears.

The entire effusion specimen should be submitted.

Smear the fluid directly onto the glass slide.

Label the specimen container and send to the laboratory as soon as possible or

Fix the slide immediately.

Refrigerate if a delay in sending the specimen is anticipated (Do not add any fixative).

Allow slides to dry.

If Lymphoma is suspected then immediate transportation to the laboratory should


be arranged.

Send to the laboratory - in a slide carrier with the request form.

Fluids
Sputum

Consider requesting fluid protein examination.


Transudates have a protein content of <3.0 g/dL and a specific gravity of <1.015.
Exudates have higher protein and specific gravity, and are more likely to be inflammatory
or neoplastic.

Collect deep cough early morning specimens preferably on three consecutive


days. Instruct the patient to collect specimens before breakfast preferably after rinsing
out the mouth.

FINE NEEDLE ASPIRATION CYTOLOGY

Collect each specimen in a sterile container. Use one container for each collection.

Scope for Use

Label the specimen container and send each one to the laboratory as soon as possible
or
Refrigerate if a delay in sending the specimen is anticipated.

Fine needle aspiration (FNA) is a branch of diagnostic cytology that interprets changes in
cells extracted from within organs, tumours and non-neoplastic abnormal tissues.

Note: Please specify X 3 sputum collection on consecutive days on request form.


Urine
Urine may be collected as a random specimen or as a series of three specimens
preferably on consecutive days.
Collect the first part, or all (not mid stream) of the second or later void of the day.
The first void contains cells which have been sitting in urine for hours and will show
degenerative changes.
Collect the urine in a sterile container.
Label the specimen container and send it to the laboratory as soon as possible or
Refrigerate if a delay in sending the specimen is anticipated (Do not add any fixative).
Note: Please specify X 3 urine collection on consecutive days on request form.
Cerebrospinal Fluid - CSF
Collect the CSF in a sterile dry container.
Label the specimen container, mark the request form as urgent and send to the
laboratory as soon as possible or
Refrigerate if a delay in sending the specimen is anticipated (Do not add any fixative).

PREFACE - CYTOLOGY

PREFACE - CYTOLOGY

PREFACE - cytology

FNA contrasts with exfoliative cytology, which studies cells shed or scraped from surface
epithelia or mesothelia. The diagnostic criteria of both branches have many common
features as well as many important differences.
Just as FNA is an extension of morphologic diagnosis within both diagnostic cytology
and histology, it is also a useful tool for the oncologist who deals with undiagnosed
palpable and non palpable masses and lesions. It is a short cut to direct diagnosis and
can be carried out at the surgery, clinic or bedside. It may also obviate the need for
radiographic and surgical procedures, and save time, expenses and morbidity, and
allay anxiety.
The common targets currently being aspirated are thyroid, liver, breast and lung. Multiple
sites of cyst formation are easily aspirated. These include breast, thyroid gland, parotid
gland, branchial cysts and cavitating squamous cell carcinoma. Aspiration of cysts can
be both diagnostic and therapeutic.
Basic Equipment
Syringe pistol (now commercially available - but not essential).
10/20 mL disposable plastic syringe - can be used without a syringe pistol.
Apply negative pressure by pulling on the piston in the usual way.
Plastic extension tubing.
Fine needles of 25-20 gauge varying from 1cm to 20cm in length (23 gauge needles are
used for most aspirations of palpable lumps).

5.16

5.15

Alcohol prep sponges.

Sterile gauze pads.


Microscope glass slides with frosted ends (label with pencil).
Suitable spray fixative (Cytofix) or a coplin jar of 95% ethyl alcohol, to hold glass slides
for immediate fixation of wet smears.

Diagram A
Diagram A

2 mL jars of sterile normal saline.

Syringe pistol

Transport cylinders for recapped, secured, labelled needles and syringes.


NOTE: QML Pathology can supply the necessary equipment and materials contained in
a handy rigid transport cylinder kit on request (illustrated in Collection Materials Section
(4.13) of this Manual).

A small plastic tray easily holds all the equipment as well as longer needles measuring
15cm and 20cm, employed for transthoracic and transabdominal aspirations. Local
anaesthesia, 1% or 2% lignocaine (Xylocaine), may be required for needle aspiration
of transthoracic or transabdominal masses, but it is rarely necessary for other clinically
palpable lumps. Since FNA is virtually non-traumatic, it may be repeated frequently
enough to procure adequate amounts of material for diagnostic purposes.

Syringe pistol

Insert needle into mass

D
Insert needle into mass

Apply suction

Apply suction

Aspiration Techniques

Move needle back and forth in slightly


different directions through mass
Move needle back and forth in slightly
C
different directions through mass

Release suction, then withdraw slowly

1. Apply negative pressure for aspiration using a 10 or 20 mL syringe attached to a 25 or


23G needle by a flexible plastic extension tube (Diagram A)

Diagram
A
2. Apply negative
pressure
for aspiration using a 20 mL syringe in a syringe pistol
(Diagram B)
3. Using a needle alone (no syringe), substitute a negative pressure with capillary action
only (Diagram C).
Our preferred method is (1). Note that QML Pathology FNA kits contain flexible plastic
Standard
syringe
extension tubing. This method has the advantage of Syringe
allowingpistol
greater sensitivity
and
accuracy in placement of the needle. A disadvantage is that an assistant is required to
hold the syringe and to pull back on the syringe. This is, however, a simple procedure
- once the needle is in position in the lump, indicate for the assistant to draw the syringe
needle
masssyringe and 15 mLs inA a 20 mL syringe); then, on
plunger back Insert
(8 mLs
in a into
10 mL
completion, allow the plunger to return over 1-2 seconds before withdrawing the
needle from the tissue.

Standard syringe

NOTE: If an immediate diagnosis is required with FNA biopsy, attendance by a


pathologist at the procedure can be arranged with prior notification to the laboratory.

There are 3 routine methods of aspiration for palpable masses:

Standard syringe

PREFACE - CYTOLOGY

PREFACE - CYTOLOGY

PREFACE - cytology

Release suction, then withdraw slowly

Diagram B

Diagram C
Diagram C

Method (2) using a syringe pistol has the advantage that only one operator is required,
BUT we have found it to be clumsy.

Move needle back and forth in slightly


different directions through mass

5.17

mass

5.18

Apply suction

Method (3) (no syringe - using needle only - repeatedly rapidly inserted into and withdrawn
from the lesion inducing cells into the bore of the needle by capillary action) is preferred
in many centres but is not appropriate for cysts and has not, in our hands, produced
consistently good material.

Thoroughly palpate the target area and delineate the most suspicious, usually the most
firm portion

1
2

Fix the mass with the palpating hand

Prepare the skin with an alcohol swab, alcoholic chlorhexidine or povidone iodine
Introduce the needle into the mass.
In the case of the vacuum assisted technique:
Application of full vacuum to the syringe with needle in the mass

One smear should be immediately fixed (in 95% ethyl alcohol or spray fixed), the
other allowed to air dry.

Continuously apply full suction to the aspirating syringe while the needle is moved
back and forth with short quick strokes and in slightly different directions. (The variation
in needle direction has been greatly exaggerated in the illustration.) This alteration
in direction should be fairly minimal in practice, and, coupled with the forward and
backward motion, is carried out within the mass

NOTE: It is very important when using spray fixatives to avoid holding the can closer than
15cm from the slide.

Cease aspiration when material enters the transparent hub of the needle

Residual material always remains in the needle after smear preparation. On the other
hand it may not always be possible or desirable to prepare a smear in the clinic or at the
bedside. This material may be preserved and transported as outlined below.

Release suction before withdrawing the needle, and then apply pressure to the puncture
site with the patients or nurses assistance.

Place labelled smears in slide carriers for transport to laboratory.


2. Preservation of Aspirated Material

In the case of the needle-only technique:

i. Syringes and Needles

Rapidly and repeatedly insert the needle into and withdraw it from the lesion inducing
the cells into the bore of the needle by capillary action

Syringes and needles used in preparation of smears should not be discarded following
preparation of smears. Rinse material remaining in needle and syringe into a labelled
2 mL jar containing normal saline and send to laboratory where cells will be retrieved by
centrifugation and/or filter techniques. The syringe and needle may now be discarded.

Cease when material is seen to enter the hub of the needle and slowly and gently withdraw
To make smear preparations, attach a syringe - with the plunger drawn back a few mL
- to the needle and proceed as outlined below.

HANDLING OF SPECIMENS
1. Preparation of Smears
Making the smear is critical because it determines the quality of the material the
microscopist will examine. In practical terms, it may be the most important manoeuvre in
the whole range of steps in the aspiration.
Rapidly separate the needle containing the aspirated material from the syringe and draw
a few mL of air into the syringe.
Reattach the needle to the syringe.
Express the material onto a glass slide, generally forming a drop or droplets with small
particles of tissue. Care must be taken to place the bevel of the needle against the slide
so there are no intervening air gaps allowing the material to splatter across the slide.
Place a second glass slide on top and pull both slides rapidly apart
(see diagram above right).
Two slides (smears) are thus prepared from each drop.

5.19

PREFACE - CYTOLOGY

For all of these techniques, the basic procedure is as follows:

ii. Fluid or Bloody Aspirates


Where specimens are diluted by fluid or blood, or for specimens which are largely
fluid e.g. cyst fluid obtained from breast or thyroid, immediate despatch of the carefully
recapped, labelled needle and syringe with contents to the laboratory is recommended.
The cap should be secured, syringe labelled and placed in a transport cylinder. This
should be forwarded to the laboratory in an insulated container with ice brick as soon as
possible. Standard cytologic filter and centrifuged preparations can then be prepared in
the laboratory. Rinsings are preferable.
Transport of FNA to the Laboratory
Preparation of smears and rinsing of syringe and needle into saline as described above
in handling of specimens.
Labelled smears should be placed into slide carriers.
Store the labelled saline specimens in a refrigerator (crisper bin area).
Transport specimen to laboratory in a rigid transport cylinder, placed in a cooled
(ice brick) insulated container as soon as possible.
NOTE: QML Pathology can supply the necessary equipment and materials on request.

5.20

PREFACE - CYTOLOGY

PREFACE - cytology

Substances measured include:


Hormones
Tumour markers
Special proteins.
The specific laboratory tests performed by the Endocrinology Department are listed
alphabetically in the A-Z test listing (6.0) of this Reference Manual. This listing will include
alternative names for tests, instructions for collection including the specified container,
storage and transport, any special requirements and an indication of turnaround time
of results.

Note: Slow freezing of Renin specimens by placing in a standard freezer without


the snap freezing procedure will cause falsely high values as Renin is activated by
cold temperatures.
Reporting Time
This varies from same day - 24 hours for the majority of assays (e.g. thyroid function
studies, pregnancy-related tests) - to days and weeks for less commonly required assays
(e.g. aldosterone). These are specified for the individual tests in the A-Z list (6.0).

SPECIMEN COLLECTION

FERTILITY TESTING AND CYCLE TRACKING

In general serum from clotted blood is the preferred specimen (SS tube - yellow top
tube). Usually 1 mL of blood is adequate per test. After collection the specimen should
be kept cool (refrigerated) and transported to the laboratory in an insulated container with
ice bricks (except Renin which should remain at room temperature).

The object of testing is to detect when and whether ovulation is occurring or whether there
is any follicular response or an excessive follicular response to any follicular stimulation
protocols being used in assisted fertility programs. The following tests are available:

Any variation from this routine collection procedure will be specified in the comment
section of the alphabetical listing for the particular test.

1. Is ovulation occurring - Weekly progesterones


2. P
 recise timing of ovulation - Daily LH/Progesterone levels in late follicular phase of the
menstrual cycle

SPECIMEN PROCESSING

3. Follicular response to stimulation protocol - Oestradiol levels during stimulation

Freezing Serum

4. Investigation of possible androgen excess - LH/FSH ratio, Oestradiol and Androgens.

Due to the instability of some hormones the serum may need to be frozen prior to
transport to the laboratory. This may be particularly important for rural and remote regions
where transportation time is prolonged. This requirement will be indicated in the comment
section for any particular test. 20 minutes after collection into an SS tube (Yellow top
tube) the completely clotted specimen should be centrifuged to separate the serum
from the cells. The serum should be decanted into labelled plain 5 mL plastic screw cap
container(s). This may be frozen by placing in the freezer compartment of a refrigerator.
The frozen specimen should be transported to the nearest Branch Laboratory or directly
to the central laboratory in Brisbane in an insulated container with dry ice. If dry ice
is unavailable please contact the Branch Laboratory or Endocrinology Department
(07 3121 4439) for assistance.

If you have a requirement for this service please contact the Endocrinology Department
(07) 3121 4439 or the nearest Branch Laboratory and this can be arranged. With prior
notice results for Oestrogen, Progesterone, LH and FSH assays can be available 90
minutes after arrival of the specimen in our Brisbane Central Laboratory, and selected
Branch Laboratories.

Snap Freezing Serum


The procedures outlined above are adequate for most specimens. However, for Renin
Assay the specimen should be collected in EDTA tubes. It is then centrifuged at room
temperature; the serum decanted into labelled plain 5 mL plastic screw cap container(s)
and snap frozen within one hour of collection.
To Snap Freeze - pour alcohol (ethanol, methylated spirits, methanol) into a beaker to a
depth of 4 cm. Drop 3 or 4 small pieces of dry ice into the alcohol. The addition of the dry

5.21

ice will be accompanied by spluttering, however, it results in a rapid drop of the alcohol
temperature to the desired level. The tubes containing the separated serum are placed
upright in the alcohol (taking care not to contaminate the contents with the alcohol) and
will freeze immediately. The frozen specimens can then be transferred to and stored
within the freezing compartment of a standard refrigerator. The frozen specimen should
be transported in an insulated container with dry ice to the laboratory.

PREFACE - ENDOCRINOLOGY

The Endocrinology Department is located in the Brisbane Central Laboratory of QML


Pathology. The activities of this laboratory involve measurement of a range of over 30 lowlevel concentration substances using sensitive Immunoassay technologies.

HELICOBACTER PYLORI CARBON-14 UREA BREATH TEST


This test involves ingestion of low dose carbon-14 labelled urea and measurement of
carbon-14 labelled CO2, in expired air, released by the enzyme urease produced by
Helicobacter pylori.
It is preferred for the patient to fast before the test, but not necessary. The dose is
swallowed (-tasteless in water) and mouth is rinsed, 20 minutes later, a breath sample is
collected in a glass vial containing a CO2 trapping liquid.
The glass vial is identified by name, sealed, placed in a plastic bag and transported to the
laboratory where the activity of the trapped labelled CO2 is measured.
Please contact Brisbane QML Pathology Collection Department (07) 3121 4450 or your
local Branch Laboratory for details of collection centres equipped to perform this test.

5.22

PREFACE - ENDOCRINOLOGY

PREFACE - Endocrinology

THYROID FUNCTION TESTS


A full thyroid function test incorporates a TSH assay and a Free T4 assay. The current
Medicare schedule will provide a rebate for TSH only as a preliminary test. A full thyroid
function test (TSH and Free T4 assay) will be rebated if at least one of the following
conditions is satisfied:
1. The patient has an abnormal level of TSH
2. The tests are performed for the purpose of:
i. Monitoring thyroid disease in the patient; or
ii. If the patient is in hospital - investigating the sick euthyroid syndrome; or
iii. Investigating Dementia or psychiatric illness of the patient; or
iv. Investigating Amenorrhoea or infertility of the patient.
3. The treating practitioner suspects the patient has Pituitary Dysfunction

PREFACE - ENDOCRINOLOGY

PREFACE - ENDOCRINOLOGY

PREFACE - Endocrinology

4. The patient is taking drugs that interfere with thyroid hormone metabolism or function
(e.g. Lithium, Amiodarone).
To assist the laboratory, when requesting thyroid function tests, please supply a
comprehensive history, including medication, so that the correct range of tests may
be performed.
Patient History
Please supply relevant clinical history, details of medication or hormone therapies and the
results of any relevant previous investigations which may have been carried out. Such
details are important in the interpretation of serum levels. Even factors such as the time
of day and stage of the menstrual cycle may be important in the interpretation of levels.
This will assist in the provision of appropriate comments on the report.

SPECIMEN STORAGE
Samples are kept within the laboratory for one week, should further testing or comparative
testing become necessary. The key to referencing the sample is the quote number printed
in the lower right hand corner of the pathology report. If this is unavailable patient name
and date of birth will suffice.
The Endocrinology Department is staffed routinely 6.00am to 1.00am Monday to
Friday, and 8.00am to 7.00pm Saturday. For advice on any aspect please contact the
Endocrinology Department (07) 3121 4439 or the nearest Branch Laboratory.
Brisbane Endocrinology Department Direct
Pathologist

Dr Kerry DeVoss

(07) 3121 4412

Manager

Mark Blakey

(07) 3121 4433

5.24

5.23

Telephone Numbers

retardation in affected females. Expansions in the premutation range (55 230 repeats)
have been linked with disorders such as fragile X ataxia/tremor syndrome and FMR1related premature ovarian failure.

MOLECULAR GENETIC TESTING

Y Chromosome Microdeletion Analysis

The department offers a comprehensive and expanding range of molecular tests in the
areas of genetic disorders, microbiology and oncology.

The deletion of the AZF (azoospermic factor) region on the Y chromosome is thought
to be pathogenically involved in male infertility associated with azoospermia or severe
oligospermia. Microdeletions involving the DAZ gene account for approximately 6% of
infertile men classified as idiopathic oligo/azoospermia.

These tests include:

GENETIC DISORDERS:
Hereditary Haemochromatosis (HFE gene)
Hereditary haemochromatosis is an autosomal recessive disorder of iron metabolism that
results in iron overload and may be fatal if allowed to progress but well treated if detected
early. It affects approximately 1 in 200 people, and has a carrier frequency of 1 in 7 in
individuals of Northern European descent. Three missense mutations, C282Y, H63D, and
S65C have been identified in the HFE gene and are tested for by QML Pathology.
Factor V Leiden and Prothrombin G20210A Mutation Analysis

5.25

Resistance to activated protein C is the most common defect associated with an inherited
predisposition to venous thrombosis, resulting from a mutation in the Factor V gene.
Heterozygosity to this mutation is associated with an 8 fold increased risk of venous
thrombosis, whereas a homozygous patient has an 80-100 fold increased risk.

PREFACE - GENETICS

The QML Pathology Genetics Department is responsible for the molecular detection of
a number of known genetic mutations, the detection of chromosome abnormalities in
various tissues, and for the non-endocrinological aspects of fertility testing.

Sex Determining Region (Sry) Gene


The SRY gene is present on the short arm of the Y chromosome and is one of the
switches for sex determination in humans. This test is useful as a screening test in cases
of newborn babies with ambiguous genitalia.
HLA-B27 Gene Testing
HLA-B27 is a Class I antigen that is found on the surface of all nucleated cells and
platelets. It is found in 90% of patients with ankylosing spondylitis. However, it is also
present in 5-10% of a normal Caucasian population. All known B27 subtypes including
the rare B2707 and B2711 subtypes are detected by QML Pathology.

MICROBIAL TESTING:

Another common genetic variation associated with an increased risk of venous thrombosis
involves a mutation in the prothrombin gene (G20210A). The prevalence of the mutated
allele is 6% among deep venous thrombosis cases and is associated with a 3 to 4 fold
increased risk.

Clostridium Difficile Testing

Methylenetetrahydrofolate Reductase (MTHFR) Mutation

Cat Scratch Disease

Hyperhomocysteinaemia has been identified as a risk factor for coronary artery disease,
stroke and venous thromboembolic disease. A common mutation (C677T) in the MTHFR
gene has been described that renders the MTHFR protein thermolabile. Homozygosity
for the mutation may interact with environmental factors, such as folic acid deficiency, to
predispose to Hyperhomocysteinaemia.

Following a bite, scratch or lick from a cat, a person may develop swollen lymph glands,
fever and malaise. The usual causative bacterial agent of cat scratch disease, Bartonella
henselae, can be detected by PCR.

Apolipoprotein E Genotyping
Genotyping identifies alleles associated with type III hyperlipidaemia (allele 2).

Molecular analysis may be used for the sensitive detection of the four Plasmodium species.
This can be useful when parasite levels are very low, or in the detection of mixed species
infections. It can be a useful diagnostic tool when used in conjunction with routine methods.

Fragile X Syndrome (FRAXA)

ONCOLOGY:

Fragile X syndrome is the most important cause of mental retardation after Down
Syndrome and is due to a trinucleotide repeat (CCG) expansion of the FMR1 gene located
on the X chromosome. It occurs in individuals with an FMR1 full mutation (>230 repeats)
and is characterised by moderate mental retardation in affected males and mild mental

BCR-ABL RQ-PCR

Clostridium Difficile causes pseudomembranous colitis and antibiotic-associated diarrhoea.


It is also one of the most important causes of nosocomial infections. The organism has
genes that produce two toxins, A and B. These genes can be detected by PCR.

Malarial Parasite Detection Using PCR

The Philadelphia translocation and the associated BCR-ABL fusion genes are found
in approximately 95% of Chronic Myeloid Leukaemia (CML) and 20% of adult precursor
B-cell Acute Lymphoblastic Leukaemias (B-ALL). Real-time quantitative PCR (RQ-PCR) for

5.26

PREFACE - GENETICS

PREFACE - Genetics

the BCR-ABL transcript has become an important tool in patient diagnosis and response
to treatment. Analysis is performed on extracted RNA and due to RNA degradation
samples must reach the Genetics Department within 24-48 hours post collection.
JAK2 Mutation Analysis
Janus Kinase 2 (JAK2) is a cytoplasmic tyrosine kinase which is essential in signal
transduction from multiple hemopoietic growth factor receptors. This mutation is one of
the first diagnostic molecular genetic abnormalities in Myeloproliferative disorders and is
present in 90-95% of patients with polycythemia vera (PV) who are more prone to have
homozygous JAK2 mutation. The mutation is also present in 50-70% of patients with
essential thrombocytosis and in 40-50% of patients with myelofibrosis.

CHROMOSOME ANALYSIS (Cytogenetics)


Cytogenetic analysis is a method for scanning a whole genome to provide information
about the number and structure of chromosomes. Analysis may be performed on
many tissue types and is an important tool in the identification of constitutional
chromosome abnormalities, the identification of haematological malignancies and in
prenatal diagnosis. Please see Genetics Appendix (12.29).
Tissue submitted for chromosome studies must reach the laboratory in a viable state.
Cells are grown in culture media until sufficient material is available for analysis. The rate at
which specimens grow is the principal factor determining the turnaround times of the tests.

CONSTITUTIONAL:

LYMPHOCYTE GENE REARRANGEMENT STUDIES:

Blood

B-cell Immunoglobulin Heavy Chain (IgH) Gene Rearrangements

Peripheral blood is the tissue of choice when investigating possible constitutional


chromosomal abnormalities in neonates, children and adults.

This test is for the IgH gene rearrangement (FR2 and FR3) and will detect greater than
80% of B-cell lymphoproliferative disorders.
Bcl-2
This test is specific for the major breakpoint region (mbr) of the IgH-bcl-2 associated
translocation [t(14;18)]. This translocation is associated with up to 85% of lymphomas with
a follicular morphology, and with approximately one third of diffuse large cell lymphomas.

PREFACE - GENETICS

PREFACE - GENETICS

PREFACE - Genetics

Skin
A skin biopsy can be performed for confirmation of mosaicism or the establishment of
a cell line for further study, e.g. Molecular DNA or biochemical testing. Samples from
children and adults may be taken by a QML Pathology doctor at one of our special test
collection centres or a Branch Laboratory.

ONCOLOGY:
Bcl-1

Bone Marrow

This test is specific for the translocation involving the Cyclin D1 gene [t(11;14)] which is
commonly associated with Mantle Cell Lymphoma (MCL).

Aspirated bone marrow is used for the investigation of haematological malignancies.


Chromosome abnormalities detected, (often specific for a particular disorder),
are acquired as part of the neoplastic process and are therefore present only in the
affected cell lines.

This test is for detecting monoclonality of T lymphocytes using primers targeted at


both beta and gamma gene rearrangements, and will detect greater than 80% of T-cell
lymphoproliferative disorders.

Other Molecular Genetic tests:

5.27

Genetic testing for a number of disorders is available throughout Australasia. See


Genetics Appendix (12.30). QML Pathology will perform sample collection and forward
the samples to the appropriate testing facility. It is important to note that many disorders
require genetic counselling prior to testing and most incur an out of pocket expense to
the patient. The Genetics Department maintains a list of tests available in Australasia
complete with costing and collection requirements. Please contact the department on
(07) 3121 4461 regarding availability of testing.

Lymph Nodes
Lymph node is the best tissue to culture for chromosome analysis when investigating
lymphomas. The sample is usually shared between several departments (Histology,
Haematology and Genetics). Refer to detailed guidelines in Histology Preface (5.35).
Unstimulated Blood
Peripheral blood may be used to detect acquired haematological malignancies (e.g. CML)
which have large numbers of precursor cells circulating in the blood.
Solid Tumours
A representative sample of tumour tissue should be selected. Areas of necrosis, adherent
fat and extraneous tissues should be aseptically dissected from the tumour tissue. It
should then be placed in antibiotic transport medium (not formalin) and forwarded,
cooled, to the Genetics Department as soon as possible.

5.28

T-cell Receptor (beta and gamma) Gene Rearrangements

PRENATAL:

ANDROLOGY

Chorionic Villus

Seminal Fluid Analysis

A chorionic villus sample (CVS), is taken by a specialist obstetrician under ultrasound


guidance from the developing placenta at around 10 to 12 weeks gestation. This tissue
can be cultured for fetal karyotype assessment.

Male fertility is assessed using seminal fluid in cases of unexplained infertility, as well as
post-vasectomy or after vasectomy reversal. The entire sample is required and must be
examined for motility within 2 hours of collection. The specimen should be kept at room
temperature (do not refrigerate).

Amniotic Fluid

The following are available on request from QML Pathology:

Amniotic fluid surrounding the developing fetus contains a small but adequate number
of viable cells of fetal origin. These can be cultured for fetal chromosome investigation at
14 weeks gestation.

Printed patient instruction form, Instruction to patients for the collection of seminal fluid.

PREFACE - GENETICS

PREFACE - GENETICS

PREFACE - Genetics

Plastic seminal fluid collection (SFC) containers (red screw cap).


The patient should follow the clear instructions on the printed form from QML Pathology.

Rapid Screening (FISH) Test for Fetal Aneuploidy


A rapid screening test for fetal aneuploidy using FISH probes specific for chromosomes 13,
18, 21, X and Y is available with results usually reported within 24 hours. It is recommended
that any abnormal results obtained by FISH are confirmed by full chromosome analysis
prior to any therapeutic intervention.
Products of Conception/IUFD
Chromosome abnormalities are found in >50% of spontaneous miscarriages occurring in
the first trimester of pregnancy. Cytogenetic analysis of tissue obtained from products of
conception is useful in investigating the cause of recurrent miscarriage/IUFD and in the
identification of chromosome abnormalities which may potentially pose problems in future
pregnancy attempts.
Aborted tissue should be placed in a sterile container, preferably in antibiotic transport
medium (or, if unavailable, in sterile normal saline), and forwarded, cooled, to the Genetics
Department or Branch Laboratory as soon as possible. The material required for cell
culture will be isolated by the laboratory staff and the remainder of the material will be
submitted for histological examination.
Note: The membranes and placental specimens may be the only viable tissue of fetal
origin available for cell culture. If available, fetal skin is also cultured but there may be
limited success if the fetus is autolysed.

Note: The patient should contact his nearest QML Pathology collection centre to establish
the best time to take the sample so the transit time is kept to a minimum.
Seminal Fluid Fructose
Fructose is used as a source of energy by spermatozoa, and may be depleted if the transit
time to the laboratory for examination is extended or in the presence of polyzoospermia.
Low fructose levels may be associated with low motility.
The sample is collected in the same way as for seminal fluid analysis and the test may be
performed at the same time, on the same sample. Regional or Branch Laboratories
that perform seminal fluid analysis, on completion should forward the remainder of
the specimen to the Brisbane Genetics Department for seminal fluid fructose assay.
The specimen must be frozen or transported on ice.
Antisperm Antibodies (Indirect Immunobead Test - IBT)
Antisperm antibodies may be present in either the male or female. Their presence may
reduce sperm motility and/or interfere with sperm penetration of the ovum. This test is
recommended as part of a comprehensive fertility screen of couples.
Samples required are:
Female - 10 mL clotted blood sample (SS tube).

MOLECULAR CYTOGENETICS

Male - 10 mL clotted blood sample (SS tube) and/or seminal fluid.

FISH Analysis

The antisperm antibody test is performed on an irregular basis, usually every two weeks,
depending on batch size and the availability of a normal semen sample that is used as a
substrate in the tests. Results are released on the day of testing.

FISH (Fluorescent in situ hybridisation) is a technique that allows the hybridisation of a


fluorescent DNA probe to a specific region on a specific chromosome. It is selectively used
in conjunction with conventional chromosome analysis for a wide range of applications in
prenatal diagnosis, constitutional studies and in oncology.

PATERNITY INVESTIGATION

5.30

5.29

QML Pathology acts as a collection and transport agency only.

Blood counts
Coagulation

most important). As many of the coagulation factors are labile the sample should be
kept refrigerated and should be forwarded, cooled, to the laboratory as soon as possible
(preferably within 2 hours). Samples for factors and thrombotic assays must reach the
laboratory within two hours. For prothrombin time/INR (warfarin control), the sample
should reach the laboratory within four hours. Complete clinical and medication details

Bone marrow examination


Anaemia assays (vitamin B12, folate assays and iron studies)
Haemoglobin electrophoresis/thalassaemia screening
Flow cytometry (lymphocyte/leukaemia/lymphoma marker studies)
Special tests (haemolytic studies, isotopic blood volume and cytochemistry).

Suggested screening for Thrombophilia


VENOUS THROMBOEMBOLISM
Age < 50

Age > 50

Age > 50

First Line Investigations


FBC + E/LFT

FBC + E/LFT

APC-Resistance

Lupus Anticoagulant Duplex Imaging

Duplex Imaging

Factor V Leiden

ACLA

HDL/LDL

HDL/LDL

II 20210A Mutation

Homocysteine

Lipoprotein (a)

Lipoprotein (a)

BLOOD COUNTS

Protein S/C

Malignancy Screen

Homocysteine

Homocysteine

Blood collected into EDTA for Blood Counts must be well mixed by inversion immediately
after collection. It is best that blood films are prepared at the time of collection,
particularly if the sample processing is expected to be delayed by more than 12 hours.
Specimens will be suitable for testing up to 24 hours after collection provided that the
sample is kept refrigerated and the blood films have been prepared.

AT III

APC-Resistance

Lupus Anticoagulant Lupus Anticoagulant

COLLECTION REQUIREMENTS
General
Collection requirements for all tests are individually detailed in the A-Z test listing (6.0).

FBC + E/LFT

Lupus Anticoagulant Factor V Leiden

ACLA

ACLA

APC-Resistance

II 20210A Mutation

Homocysteine

FBC + E/LFT

ACLA

Factor V Leiden

Making a Blood Film

II 20210A Mutation

1. Prepare slide: Ensure slide is clean and grease-free.

Protein S/C
AT III

2. Place blood: Place drop of blood sufficiently large enough to at least produce a smear
of 4 cm.

5.31

ARTERIAL THROMBOEMBOLISM
Age < 50

PREFACE - HAEMATOLOGY

The Haematology Department provides a comprehensive range of tests in the following


speciality areas:

Second Line Investigations

3. Spread blood: The spreader is held at 45 angle to the slide and then drawn back until
it touches the blood. Allow the blood to spread the width of spreader.

Factor VIII, IX, XI

Protein S/C

Clot Lysis

Protein S/C

4. Making film: Move the spreader in a swift steady motion towards the end of the slide.
The blood should spread to a thin film at the end.

PAI-1

AT III

Plasminogen

AT III

Clot Lysis

Plasminogen

Fibrinogen

Plasminogen

5. Label slide: Write patients name and date of birth onto the upper half of frosted end of
slide using a pencil, leaving lower half of frosted end of slide free for laboratory use.

Plasminogen

PNH

Fibrinogen Assays

Factor V Leiden

6. Packaging: Ensure slide is completely dry before placing in slide carrier for transport.

PNH

II 20210A Mutation

NOTE: Air dry slide only. DO NOT blow on slide or use any heating device to dry slide
more quickly.

Heparin Cofactor II

APC-Resistance

COAGULATION TESTS

Note these are CONDITIONAL MEDICARE items.

Specimens for coagulation tests must be collected into sodium citrate tubes (blue top)
and filled to the level indicated on the tube. (The correct dilution of blood with citrate is

NOTE: A personal history of thrombo-embolism or a FIRST DEGREE relative having an


abnormal thrombotic profile test result must be stated on the request form to attract the
medicare refund.

5.32

PREFACE - HAEMATOLOGY

PREFACE - HAEMATOLOGY

are required including any family history of bleeding or clotting problems.

Please see Haematology Appendix (12.31).

BONE MARROW BIOPSY

ORAL ANTICOAGULANT CONTROL SERVICE

All registered medical practitioners can order a bone marrow biopsy. Appointments for
bone marrow biopsies may be arranged by telephoning the Haematology Department,
Brisbane (07 3121 4573) or the nearest Branch Laboratory. Practitioners who wish to
carry out the bone marrow biopsy procedure should contact the laboratory and arrange
for a QML Pathology staff member to be present to assist in making smears and handling
the specimen.

Only suitable patients can be enrolled in this service.

Information Required:

Present dose

1. Anatomical site of collection

Reason for therapy

2. If the aspirate was obtained with/without difficulty

Other existing medical conditions

3. Consistency of bone

Required INR range

4. Provisional diagnosis.

Other current medication

Samples Required:
1. Labelled bone marrow aspirate smears x 12-15
2. Aspirate sample in Lithium heparin (black top) tube (required for chromosome
analysis and marker studies) and an EDTA tube
3. Trephine and/or aspirate sample in formalin.

Patients must be registered by calling 1300 795 355.


The following information is required for registration:
Patient details

PREFACE - HAEMATOLOGY

PREFACE - HAEMATOLOGY

PREFACE - HAEMATOLOGY

Duration of therapy
Please notify the controlling laboratory if there is a change in the nature and/or dosage of
any concurrent medication the patient is taking as this may affect significantly the INR.
Unregistered patients will be returned as Doctor Controls.
For further information please refer to additional services section Warfarin Services (3.2)
or to the Haematology Appendix (12.32).

CELL MARKER STUDIES (Leucocyte/Leukaemia/Lymphoma)


Blood Specimens
Collect blood specimens into an ACD tube (yellow top) or if unavailable a Lithium heparin
tube (green top). An EDTA tube must also be collected and a blood film prepared if there
is no accompanying full blood count. Samples must be kept at room temperature (cool)
and are suitable for analysis up to 24 hours after collection.
Bone Marrow Aspirate Specimen
A sample in a sterile Lithium heparin tube (green or black top) and 12-15 aspirate smears
are required.
Lymph Nodes and Fine Needle Aspirates
Place lymph node specimens in antibiotic transport medium and keep cool. Important:
Please refer to Histology Preface (5.35) for more details on specimen handling. Please
refer to Cytology Preface (5.16) for details of FNA smear preparation and specimen
handling.

5.34

5.33

Leucocyte Reference Ranges

Please supply relevant patient and clinical information with each specimen.
Please indicate special requirements where appropriate e.g. tissue for microbial
culture, special stains, cell marker studies, immunofluorescence, electron microscopy,
suspicious or doubtful surgical margins, etc.
Please ensure all specimens are accurately labelled.
Where appropriate, specimen orientation should be indicated by the use of suture(s)
or clearly indicated incisions or nicks placed on the tissue specimen together with an
accompanying diagram and/or written explanation. In turn a diagram illustrating how
the specimen was processed and, where appropriate, location of involved margins, etc.
should accompany the pathology report.
A
 dvance notice of elective frozen section, pending cell tumour marker studies, skeletal
muscle biopsy, cilial biopsy or renal biopsy is required.

Routine Specimens
Specimens for routine histologic examination should be placed in 10% buffered formalin.
Optimally the specimen should be placed in 10 times the volume of formalin to the volume of the
specimen. Pre-labelled containers of all sizes are available from QML Pathology on request.

Non-Routine Specimens
Certain specimens and investigations require different or additional processing.

Tissue for Bacterial, Fungal and Viral Culture


Tissue suspected of being infected is a better source of a positive culture than a
swab. If possible a portion of the infected tissue should be placed into a dry sterile
container, without additives, for the purpose of culture. This should be forwarded to the
laboratory with appropriate clinical history (including history of antibiotic therapy) as soon
as possible. If transport delay is anticipated (e.g. overnight, rural area, etc.) the tissue
may be placed in Stuarts transport medium. It is important to prevent dehydration of
the tissue. If transport medium is unavailable add a few drops of sterile saline to the dry
tissue container. The remainder of the material may be placed in buffered formalin and
submitted in the usual way.

Cell Tumour Marker Studies


Lymphoma
Lymph nodes and tissues infiltrated by lymphoma (e.g. skin, gastrointestinal mucosa,
etc.) and fluids heavily infiltrated by lymphoma (e.g. pleural fluid, ascitic fluid and CSF)
may be submitted for cell marker studies.

5.35

1. Lymph nodes: In the metropolitan area if the lymph node can be sent directly to the
laboratory without delay, it may be placed dry in a dry sterile, screw top (urine) container
and sent immediately to Histology (07) 3121 4426 or to the nearest Branch Laboratory
where it will be aseptically divided and shared appropriately.

In the non-metropolitan region and rural areas, and in the metropolitan area where
delays greater than 2 hours may be expected (e.g. after hours, distance and
transportation, etc.) the lymph node must not be placed in a dry container. Lymphocytes
die soon after loss of blood supply resulting in inability to culture the tissue and to detect
markers with the flow cytometer. Also autolysis occurs rapidly and there is loss of crucial
cytomorphological detail in histology. Under these circumstances the lymph node should
be transected and half the lymph node placed in antibiotic transport medium. If unavailable,
normal saline may be used as a substitute. Overnight the antibiotic transport medium
should be stored in the bottom (crisper bin area) of a refrigerator. The specimen should be
transported to the laboratory as soon as possible in a cooled insulated container.
Note: The ice brick should be separated from the tissue by packing material to
prevent freezing.

PREFACE - Histology

REQUEST REQUIREMENTS

The other half of the lymph node should be utilised for the production of touch imprints
from the cut surface on two glass slides labelled with the patients name and date of
birth. This is performed by gently grasping the capsular side of the lymph node with
clean forceps and gently touching with a perpendicular motion the cut surface on each
clean glass slide. It is essential not to use a lateral smearing motion. One of these slides
is allowed to AIR DRY. The other slide is fixed by spraying with cytospray. Following this,
the lymph node tissue should be immersed in formalin. If the lymph node(s) is/are very
large they should be transected further into several thinner slices before being immersed
in formalin to ensure adequate fixation of the entire specimen.
These procedures will ensure preservation of tissue viability and morphological detail both
of which are essential in the diagnosis and classification of lymphoma.
2. Tissues from other body sites which are suspected of being infiltrated by lymphoma
should be treated in a similar way.
3. Fluids such as pleural fluid, ascitic fluid and CSF should be placed in a sterile container,
without additives, kept cool and submitted to the laboratory as soon as possible.
Peripheral Blood and Bone Marrow
Cell marker studies on peripheral blood and bone marrow are useful in the identification of:
Acute leukaemias
Chronic leukaemias
Malignant lymphomas
Myeloma.
The specimens (peripheral blood and bone marrow aspirate) may be collected in Lithium
heparin tubes (green top and black top) and should be forwarded cooled to the laboratory
as soon as possible with full clinical history and details of previous tests.
Note: The cell surface marker studies are carried out on a flow cytometer in the
Brisbane Central Laboratory. Tissue from country regions should be forwarded cooled to
the nearest Branch Laboratory, which in turn will forward the specimen to the Brisbane
Central Laboratory for processing.

5.36

PREFACE - Histology

PREFACE - Histology

First Trimester Abortions


All the aborted tissue should be placed in sterile antibiotic transport medium (or, if
unavailable, in sterile normal saline), refrigerated, and forwarded cooled to the Genetics
Department (07) 3121 4461 or Branch Laboratory as soon as possible. The material
required for cell culture will be isolated by the laboratory staff and the remainder of the
material will be submitted for histological examination.
Second Trimester Abortions and Still Births
Please collect sterile samples of fetal skin from the back, and membranes and chorionic
villi from the placenta and place in sterile antibiotic transport medium (or if unavailable,
in sterile normal saline), refrigerate, and forward cooled to the laboratory as soon as
possible. The remainder of the tissue may be placed in buffered formalin. However,
if there is an intact fetus, the fetus should be kept refrigerated and discussed with a
supervising pathologist as to what further actions and/or investigations are required.
A fetus/stillbirth which is to undergo a subsequent autopsy (with parental consent required)
must NOT be placed into formalin.

These simple procedures will ensure an optimum pathology report. Where appropriate an
orientating diagram will accompany the report.

Disaccharidase Estimation on Small Intestinal Mucosa


Small intestinal mucosal biopsy tissue for estimation of disaccharidase activity should
be collected before the histology specimen as contact with formalin on biopsy forceps
(even formalin vapour) will partially or totally destroy enzyme activity. The tissue should be
wrapped in aluminium foil, placed in a labelled dry sterile screw top (urine) container and
frozen immediately after collection. It should be forwarded to the laboratory on dry ice or
packed in ice bricks, as soon as possible.

Note:

Electron Microscopy

1. If the fetus is autolysed the membranes and placental specimens are particularly
important as they may be the only viable tissue of fetal origin available for cell culture.

This may be performed on request under special circumstances. We suggest consultation


with the nearest QML Pathology laboratory prior to referral. Glutaraldehyde is available
on request. The fresh specimen should be finely diced into 1 mm cubes and placed
immediately into buffered glutaraldehyde and submitted to the laboratory.

2. Antibiotic transport medium, suitable for transportation of all viable tissues,


is available on request from QML Pathology (07) 3121 4461, (07) 3121 4502 or
Branch Laboratory. This should be stored frozen and thawed to room temperature
when required.
3. A detailed pro forma outlining requirements for chromosome analysis of fetal tissue is
available on request from QML Pathology.

Cilial Biopsy
Cilial biopsies should have motility studies performed as part of their assessment. Advance
notice (preferably a day) of the impending biopsy will enable the laboratory to prepare for
the procedure. Two specimens are ideal, one for motility studies and the other for electron
microscopy. If only one specimen is available, it must be placed into Hartmanns buffer
which is available on request from Histology (07) 3121 4426.
If unavailable in Branch Laboratories, saline can be used. This must be submitted in a
container at room temperature to the main Histology Department without delay (within 12
hours). The specimen for electron microscopy is submitted in 3% buffered glutaraldehyde,
which is available on request.

Conjunctival/Limbal Tissue/Delicate Tissue


Thin, delicate tissue such as specimens of conjunctival and limbal lesions but also including
small skin samples from the inner canthus and mucus membranes, if placed directly in
formalin for fixation tend to become twisted and distorted, making subsequent orientation
and accurate sampling difficult or impossible. When fresh, these tissues should be placed

5.37

flat on a small piece of blotting paper with the cut surface down to ensure adhesion.
Please check the tissue is not folded over on itself and that folds and creases have been
eliminated. Now place the blotting paper with adherent tissue carefully into a container
of formalin ensuring they do not become separated. The tissue will become fixed in its
flattened state. The use of a marking suture and diagram will greatly assist the pathologist
to orientate the specimen for processing.

PREFACE - Histology

Chromosome Analysis on Products of Conception/IUFD

Frozen Section Service


Tissue for frozen section should be submitted FRESH in a DRY container (not in formalin).
Please telephone Histology (07) 3121 4426 or your Branch Laboratory for booking elective
frozen sections. QML Pathology endeavours to provide a frozen section service where
main laboratories are sited with pathologists on site however, this does not apply to stat
laboratory locations such as Ipswich.

Immunofluorescence
Skin biopsies and renal biopsies may be submitted for immunofluorescence detection
of antibodies or antibody-antigen complexes. A detailed clinical history and provisional
diagnosis should accompany the biopsy. It is preferable to submit two separate skin
biopsies from the same lesion. If only one renal biopsy is available this can be divided
into two. One biopsy specimen should be placed in immunofluorescence transport
medium (available on request from Histology (07) 3121 4426 or your Branch Laboratory)
and the other placed in 10% buffered formalin. Before use the transport medium should
be stored refrigerated (not frozen). The specimens should be sealed and forwarded to the
laboratory for testing as soon as possible. The transport medium preserves fresh tissue
reactivity for up to 5 days at ambient temperature and provided it is correctly packaged
the specimen may be posted. If immunofluorescence transport medium is unavailable two
alternatives are available. The specimen may be snap-frozen, in liquid nitrogen, stored in
a freezer and transported frozen (dry ice) to the laboratory.

5.38

PREFACE - Histology

PREFACE - Histology

Immunoperoxidase Stains
QML Pathology tests for a wide range of cell markers with immunoperoxidase techniques.
These will be performed as required in any individual case. In most cases routine buffered
formalin fixation is adequate.

Liver Biopsy
In most cases liver biopsy tissue for histology may be submitted in buffered formalin in
the routine way. For diagnostic purposes multiple levels of the biopsy are examined using
routine H&E and a number of special stains.

Note: The specimen will be transported from Branch Laboratories to Brisbane for
processing and reporting.

Testicular Biopsy
For optimal preservation of morphology, testicular biopsy tissue taken for investigation
of infertility should be fixed in Bouins Fixative Solution rather than buffered formalin.
Bouins Fixative Solution is available on request from Histology (07) 3121 4426 or your
Branch Laboratory. Testicular biopsy for tumour diagnosis should only be performed if
orchidectomy can proceed immediately after a positive diagnosis is made (usually by
frozen section).
If you have any doubts or queries please contact the laboratory prior to surgery.

If quantitative estimation of liver iron (haemochromatosis) or liver copper (Wilsons disease)


is required a separate biopsy should be submitted. The tissue should be wrapped in
aluminium foil, placed in a dry sterile container without additives and stored frozen. It
should be transferred to the laboratory cooled on an ice brick in an insulated container.

SKIN BIOPSIES

(Skeletal) Muscle Biopsy

Skin biopsy is a rapid procedure useful in the diagnosis of many neoplastic and inflammatory
conditions, and therefore a valuable tool when the clinical differential diagnosis encompasses
different treatment options.

All muscle biopsies should have histochemistry performed as part of the morphological
assessment. Advance notice (preferably a few days) of the impending biopsy will enable the
laboratory to prepare for the complex procedure of freezing and processing. Occasionally
electron microscopy will also be required. The muscle tissue must not be frozen and it
must not be placed in formalin prior to collection of the sample for histochemistry. An
ideal sample is a block of muscle 20mm in length by 5 to 10mm in diameter. This should
be placed in a dry sterile container without additives, cooled and sent to the laboratory
without delay (within 60 minutes). If a delay greater than 60 minutes is unavoidable then it
is preferable to refer the patient to a regional centre near the laboratory for the biopsy.

Oestrogen Receptor Assay


Oestrogen and progesterone receptor status in breast cancer can be evaluated semiquantitatively by immunohistochemical methods. This routine method of analysis is
available on formalin fixed tissue, and has replaced the previous assay requiring fresh
frozen tumour tissue.

Renal Biopsy
Renal biopsy performed for assessment of glomerular disease requires complex
processing including standard H&E and special stains on paraffin embedded tissue,
immunofluorescence techniques to demonstrate antibody or antibody-antigen complexes
and electron microscopy. Two renal biopsy cores are ideal. If only one core of tissue is
available it may need to be divided into fragments for any or all of these procedures
according to the requirements of the individual case. Such division should be carried
out by a skilled operator with the assistance of a microscope to ensure glomeruli are

5.39

present in each of the samples. Advance notice (preferably a few days) of the impending
biopsy will enable the laboratory to have available the different fixation and transport
media required and if necessary the equipment to divide the specimen.

PREFACE - Histology

Provided the specimen has been snap-frozen, preservation with this technique is excellent.
Alternatively, if transport time to the laboratory is less than four hours the specimen may
be placed on a cotton wool ball moistened with saline or in a container with only a few
drops of normal saline.

Why Biopsy?

Many skin conditions are clinically distinctive, whilst others may require histology for
specific diagnosis. At times, however, skin rashes may be both clinically and histologically
puzzling, and we may only be able to offer a range of possible diagnoses suggested by
the histology.
The value of the biopsy may be limited by its size, the site selected for sampling, superimposed
inflammatory changes, the application of topical agents, or concurrent use of medications.
One of the major limiting factors is lack of sufficient clinical information.
The histological report should be available one working day after the specimen is
collected, although urgent results may be obtained within six hours if indicated. Delays
may occur when further investigations, such as special stains, need to be performed, or
if further clinical information is required.
What Sort of Biopsy?
Incisional Biopsy
This is preferred by the pathologist as it is orientated and gives more information. It
need only be about 6mm long, 2mm wide and 4mm deep. A biopsy for deeper lesions
(including panniculitis) will obviously need to be longer and deeper. It should be orientated
radially (not tangentially) and should include about 1mm of normal skin. Distinguishing
between keratoacanthoma and squamous cell carcinoma may be very difficult on biopsy,
and only an incisional biopsy provides adequate information.

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PREFACE - Histology

Punch Biopsy

Consider Culture

This is technically easier, but sometimes harder to interpret, as orientation in the


laboratory is more difficult. This means that sections cut from the biopsy may not be in
the optimal plane, and the lesion may be missed. For this reason it is better not to include
any normal skin in a punch biopsy. There is a preference for 3mm or 4mm punch biopsies
rather than 1mm and 2mm, as the latter optionsmay be inadequate.

If there is a possibility that the lesion is due to an infection, take a swab of the biopsy
wound or even send a small piece of tissue for culture (put it in a sterile jar with a small
amount of sterile normal saline and send it to the lab as soon as possible). Do not divide
a biopsy specimen.

Shave Biopsy

Important Notes for Skin Biopsies

Shave biopsies and skin currettings are usually successful in diagnosing skin tumours.
They fail when the keratin layer is deceptively thick or when the sample is too superficial.
This is particularly important in solar keratosis when invasive squamous cell carcinoma
cannot be ruled out unless the specimen includes all of the basal layer and a little
underlying dermis.

Carefully select the biopsy site so that it is representative of the lesion or rash.
Consider more than one biopsy.

Selecting the Biopsy Site


In neoplasms, the thickest region will generally provide the most diagnostic information.
In some broad and multifocal tumours it may be necessary to biopsy several areas,
including the centre and periphery of the lesion in order to make a diagnosis.

Mark the biopsy site prior to performing the procedure.


Be gentle with the specimen to avoid crush artefact.
Consider special investigations such as immunofluorescence and culture.
Send separate specimens for different tests - do not divide biopsies.
The major role of biopsy in pigmented lesions is to confirm the clinical diagnosis of a
pigmented, nonmelanocytic lesion. If a lesion is thought to be melanocytic, and especially
if it is atypical, then narrow, but complete excision rather than biopsy is
strongly recommended.

Site selection is more critical in inflammatory rashes. It is difficult to generalise about


which lesion to biopsy, but usually the more florid the lesion clinically, the more
pathology that will be revealed. Sometimes biopsying two lesions of different ages
is helpful. Blisters and vasculitic lesions must be biopsied at an early stage as their
diagnostic features may disappear after about 24 hours.

Technical Details

Pigmented Lesions

What to Call Your Specimen

The main role of biopsy in these cases is to distinguish between melanocytic


tumours and other pigmented lesions such as seborrhoeic keratoses, solar
lentigines, basal cell carcinomas, etc. If a lesion is suspected to be melanocytic
(and especially if it is suspicious of melanoma), then complete excision with narrow
margins is strongly recommended for the purpose of diagnosis. This is because
biopsies may be misdiagnosed as either benign or malignant. In addition, if the
lesion is a melanoma, then important prognostic features may be distorted in the
re-excision specimen. Also, if a benign nevus regrows after biopsy it can develop a
pseudomalignant histological pattern, thus risking misdiagnosis of melanoma.

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Take the time to write clinical notes and a provisional diagnosis.

The pathologist performing the macroscopic


examination needs to know whether a piece of skin
this shape is an excision biopsy or an incision biopsy.
Most specimens require division before being
processed. A piece of skin this shape should be
divided this way if it is an excision specimen as these
transverse sections will display the margins of excision
in relation to a tumour.

Immunofluorescence
If, however, it is an incision specimen, it will remain
whole so that sections display the full length of the
specimen. If it is more than 3.0mm wide, it will be
divided longitudinally:
For technical reasons we reduce our tissue blocks to about 2.0mm thickness.
To avoid a good incision biopsy being partly wasted or an excision biopsy that cannot be
assessed for completeness of tumour removal, please specify excision or incision biopsy.

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5.41

This study is frequently necessary for the diagnosis of blistering/bullous rashes, and
is also useful in lupus erythematosus and occasionally vasculitis. The specimen must
be submitted in an immunofluorescence transport medium which we supply from
the laboratory. It must not be placed in formalin. Because this medium is not a good
tissue fixative, we also need a biopsy submitted in formalin. It is better to take two
separate biopsies rather than divide a single biopsy. In the case of blisters, perilesional
skin should be biopsied for immunofluorescence, whilst the formalin fixed specimen
should include the edge of a fresh blister and adjacent intact skin (see above Selecting
the Biopsy Site).

Selecting the Biopsy Site

How to Biopsy
Incision Biopsy

Punch Biopsy

1. Mark the Site


Select and mark the site(s) to be biopsied. An ink marker is useful.
2. Skin Preparation
Be thorough but gentle, so that no scale or scab is rubbed off. Allow alcohol to dry
before starting a biopsy.

Blotchy, macular

3. Local Anaesthesia
1 or 2% lignocaine with 1:100 000 adrenaline is suggested.
Annular

sometimes
unsuitable for punch

NOTE: Adrenaline should not be used in certain sites.

Papular

4. Punch Biopsies
Stretch the skin between index or middle fingers, or thumb and index finger of one
hand, and press the punch in, rotating as you press until you feel it pop through
the dermis into the subcutaneous fat. Remove the punch and separate the biopsy
from the surrounding skin at the level of the fat using scissors or a scalpel blade. If
the biopsy retracts into the skin, then gentle pressure on either side of the site will
usually pop the biopsy core into view. Be gentle with the biopsy and never grasp
it with non-toothed forceps as this will crush artefact and may render the biopsy
useless. Use fine toothed forceps, a skin hook or a needle. Stretching the skin will
produce an oval rather than a round hole, and one suture will repair the site.

Vesicular, bullous

5. Incision Biopsies
Make a vertical elliptical incision about 2-3mm wide and down to fat. Try not to
undercut the edges. Grasp the biopsy by the deep edge using a skin hook or fine
single tooth forceps and free the base of the biopsy with curved scissors or scalpel
dissection. Repair with sutures.

Discoid, plaque

Nodule, tumour

unsuitable for punch

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6. Afterwards
Place the biopsy in formalin. If necessary, submit further biopsies fresh for
culture (or lymphocyte marker) or in immunofluorescence transport medium for
immunofluorescence (sent out by the laboratory on request). Label the specimen,
and please write some clinical notes on the pathology request form.
Clinical Notes
A clinical description (including clinical diagnosis or differential) is frequently useful in the
diagnosis of tumours, and is usually essential in the diagnosis of rashes. Information
should include:
Exact site
Size
Duration
Appearance
Symptoms
Drugs
Clinical diagnosis.

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For further information please contact the Histology Department on (07) 3121 4495.

Skin Pathology Collection Devices

Skin Punch Biopsy Devices

BIOPBLADE

The punch biopsy with internal plunger system allows the lodged skin specimen inside
the metal lumen of the punch to be easily ejected.

The sterile, single-use BIOPBLADE is a flexible scalpel used for cutaneous surgery,
including: shave biopsy, saucerisation of flat lesions and levelling of pedunculated lesions.
The unique design of the BIOPBLADE incorporates a comfortable and protective
Fingerguard in addition to the flexible super sharp blade. This flexibility allows the blade
to be positioned at the correct angle for the intended procedure.

Type of biopsy

Sizes available (mm)

Punch Biopsy
with internal plunger

2, 3, 4

Punch Biopsy
without plunger

2, 3, 4, 5, 6, 8

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Punch Biopsy with internal plunger

The BIOPBLADE is utilised for removal of lesions,


either elevated (shave biopsy) or flat (saucerisation).
After the site is anaesthetised, the BIOPBLADE is
held and bowed between the thumb and fingers.
The lesion is removed at or just below the surface
epithelium. Cosmetic results are normally good and
the wound heals without the need for suturing. The
Clinician will remove all of the lesion without overly
deep penetration to avoid scarring.
Punch Biopsy without plunger

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5.45

For further information or to order any of these devices, please contact our Stores
Department on (07) 3121 4328 or your local QML Pathology Branch Laboratory.

General Comments
Microbial serology is not an exact science. Problems can occur with false positive reactions
and cross reactivity. Clinicians should interpret the serological results in conjunction with
their own findings from the patients history and examination.

Hepatitis Serology
There are many serological tests available that are performed in the course of investigation
of clinical hepatitis or in the assessment of vaccination against either Hepatitis A or B.

The clinical features and provisional diagnosis

To enable QML Pathology to comply with the requirements of the Medicare Schedule, it is
essential that the clinician either list the exact test required or specify the clinical condition
(e.g. resolving Hepatitis B, acute viral Hepatitis, post-vaccination, etc.) The main clinical
grouping from the Schedule are listed below for Hepatitis A, B and C:

The date of onset of the condition

Investigation for acute Hepatitis A (HAVIgM)

If the patient is pregnant.

Immune status for Hepatitis A (HAVIgG) - pre- or post-vaccination

Please refer to the Immunology Appendix (12.36) for a comprehensive list of antibodies
to microbial and parasitic agents available for testing. It is a Medicare requirement that
microbial and parasitic agents be listed individually on the request form.

Investigation of acute or resolving Hepatitis B (HBsAg, HBcAb, HBsAb)

The laboratory relies heavily on the information provided with a request. The three most
important pieces of information required to aid with interpreting serological results are:

Antibody Profiles
The detection of microbial infection using serological methods relies on observing the
pattern of IgM and IgG responses. The first detectable response in a primary infection is
IgM which usually lasts for a few weeks to months. A few days after the IgM appears it
is usually possible to detect an IgG response, which lasts for an extended period of time
(several years) and confirms the primary infection. The presence of IgG without IgM in a
serum specimen normally reflects past exposure to the infectious agent and not acute
infection.
Although serological assays for the majority of infectious agents involve measurement
of both IgM and IgG, there are some agents for which these two assays are not yet
available. These are assayed by methods such as agglutination or complement fixation
which may not discriminate IgG from IgM.
Specimen Collection
In most instances the serum from a full SS tube (yellow top) is sufficient for all combinations
of viral, bacterial, fungal and parasitic serology. Plasma (from an EDTA or Lithium heparin
collection) is generally not suitable because of an increased tendency to give false
positive results.
Note: The laboratory stores a patients serum for up to 12 months to enable further tests
to be added as the clinical picture evolves, or to compare with specimens collected later
in the clinical presentation.
Microbial Serology in Pregnancy
The standard antenatal tests consist of serology for one or more of the following agents:
Hepatitis B surface antigen
Syphilis
Rubella IgG
Hepatitis C.

5.47

HIV may be added to this panel. TORCH screening (including Toxoplasma, Rubella,
CMV and Herpes antibodies) is no longer recommended unless clinically indicated.

PREFACE - IMMUNOLOGY

Microbial Serology

Immune status for Hepatitis B (HBsAb) - pre- or post-vaccination (Note: tests for HBsAg
and HBcAb may be indicated in some pre-vaccination screens)
Chronic infection/carriage of Hepatitis B (HBsAg and HBeAg, but may include HBsAb,
HBcIgM, HBcAb if appropriate)
Hepatitis C (HCV) - all clinical conditions
Hepatitis D (HDV) - in individuals chronically infected with HBV
Hepatitis of uncertain etiology - (HBsAg, HBcAb, HAVIgM, HCV).
There are clinical situations where other combinations of the above tests are more
appropriate - if the clinician is uncertain then please consult the Immunology Department
(07) 3121 4458 or Branch Laboratory.
Hepatitis C RNA PCR Testing
There is a Medicare rebate available under some circumstances for HCV RNA. To qualify
for this rebate, the patient must fulfil at least one of the following criteria:
They are HCV antibody positive
They are HCV antibody positive and immunosuppressed/immunocompromised
They have indeterminate HCV serology
They are being investigated for acute HCV infection prior to seroconversion.
Only 1 estimation is allowed in a 12 month period.
If the patient does not qualify by these criteria, a non-refundable fee will be charged.
If the patient does qualify, the relevant information should be supplied on the request
In addition, there is now provision for extra Hepatitis C testing in patients undergoing
specific antiviral therapy.
Quantitative HCV RNA and HCV genotype may be performed on HCV antibody positive
patients, when requested by or on behalf of a specialist physician or consultant managing
the therapy. Only a single genotype determination is allowed in a 12 month period,

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Molecular Testing

The radioallergosorbent test (RAST) measures allergen-specific IgE in serum. The result
is unaffected by antihistamine or corticosteroid therapy. Whilst the term RAST is
still reasonably used to describe these tests, the current laboratory method utilised is
immunoCAP.

QML Pathology can provide Molecular testing using the Polymerase Chain Reaction
(PCR) to assist in the diagnosis of certain infectious diseases. At present we can test for
the presence of Chlamydia trachomatis, Adenovirus, Neisseria gonorrhoeae, Neisseria
meningitidis, CMV, Hepatitis C RNA, Bordetella pertussis, Trichomonas vaginalis, Herpes
Simplex virus, Pneumocystis, Legionella, and Varicella Zoster virus, as well as testing for
HCV and HIV viral load. More tests will be added at a future date.

RAST is the method of choice for allergy testing in patients who:

Molecular testing offers highly sensitive and specific techniques for the investigation of
infectious diseases. Its value lies in its ability to detect an infectious agent that may be
present in very low numbers or cannot be cultivated. It can also assist in confirming the
presence of infection should the results of antibody detection be unclear.

Are unable to attend for skin testing.

Prior to ordering the use of this test method, clinicians should consult the A-Z listing (6.0),
the Immunology Department (07) 3121 4458 or Branch Laboratory for details about the
collection method. It should also be noted that at present there are restrictions on the
Medicare rebate for Hepatitis C and the laboratory may charge a non-refundable fee for
some of these services.

An extensive range of single allergens, multiple allergens (e.g. grass pollen mix) and
an inhalant allergen screen are available. A full listing is provided in the Immunology
Appendix (12.37).

Tests Referred to Other Laboratories

Medicare refunds a MAXIMUM of 4 RAST estimations in a 12 month period.


This restriction is intended to minimise indiscriminate use of RAST for screening
purposes. QML Pathology will test up to 4 allergens (single or multiple) per patient
episode. This allows up to 16 RAST estimations for the 4 allowable patient episodes
in 1 year.

In certain circumstances, e.g. when QML Pathology does not perform a test or when our
result requires confirmation by another laboratory, the patients serum will be forwarded
to an appropriate laboratory for testing. This results in a delay in issuing a final report.
The delay depends on the frequency of testing and the complexity of the test and in
most cases is of the order of 2-4 weeks. An interim report will be issued notifying when
a specimen is referred.

Allergy Testing
A detailed patient history is very important in the diagnosis of an allergy. Sometimes, the
history alone can pinpoint the allergen responsible for symptoms but in many cases, the
history is less revealing. However, laboratory tests should not be used as a substitute for
a good clinical history. Test results should always be interpreted in relation to the
clinical picture. Tests routinely available for the diagnosis of allergy include:

5.49

Allergen-Specific IgE in Serum (RAST)

Have extensive skin disorders


Have dermatographism
Are taking antihistamines or steroids which cannot be temporarily discontinued

PREFACE - IMMUNOLOGY

and 2 quantitative RNA determinations per 12 months. However, patients undergoing


therapy may be entitled to an extra 4 qualitative RNA tests in that 12 month period
to assist in monitoring the therapy. Please contact the Immunology Department on
(07) 3121 4458 for further information.

RAST testing is the first line test for insect venom allergy and penicillin allergy, however the
sensitivity of RAST in these disorders is poor, and frequently skin allergy testing is required
for venom and drug allergy.

Please note:

Each allergen (single or multiple) required must be specified on the request form.
A separate request form is required for each group of 4 allergens.
Serum is stored in the Immunology Department for up to 12 months.
Skin Prick Testing

Total IgE in Serum

Skin prick testing demonstrates tissue bound specific IgE and identifies the atopic state.
It is the in vivo counterpart of RAST although the results do not always parallel each
other. Antihistamines interfere with the test and should be discontinued seven days prior
to testing. Steroid therapy may also interfere with the test. If steroid medication can be
safely ceased, this should be ceased one week before the skin test. If steroids cannot be
ceased an alternative such as RAST testing should be considered.

Healthy, non-atopic individuals have a very low amount of IgE present in the serum,
whereas in many patients with allergic disorders, IgE is significantly increased.

An extensive range of local allergens is available. A full listing is provided in the Immunology
Appendix (12.37). Allergy testing for food additives and food chemicals is not available.

High serum IgE levels are not specific for atopic diseases and can be seen in parasitic
infestations and in some immunodeficiency states. Conversely, a normal or modestly
raised serum IgE does not exclude allergy as, in some patients, a high proportion of the
total IgE present is directed against a specific allergen.

Skin testing is available by appointment at QML Pathology special test collection centres.
Please contact (07) 3121 4414 (Brisbane patients only) or your nearest QML Pathology
Branch Laboratory to arrange an appointment.

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Request Form

Clinical specimens unsuitable for anaerobic culture:

The following relevant information should always accompany any request for
bacteriological examination:

Coughed sputum

Rectal swab

Urine

Swabs of superficial skin lesion

Faeces

Throat swab

Ileostomy/colostomy drainage

Urethral swab

Nasopharyngeal swab

Vaginal or cervical swab.

Patients name and date of birth


Date and time of specimen collection
Site of sample and if the site is a surgical wound
Clinical history
Antibiotic therapy - past and present
Please indicate if the patient is immunosuppressed/immunocompromised
Please indicate if culture for Mycobacterium spp., fungi or unusual organisms such as
Bartonella spp. Actinomyces, Nocardia, etc. is required.

Tissue, Body Fluids and Wound Swabs


General Principles
Please note that aspirated pus and/or tissue samples are far superior to a swab for
isolation and identification of organisms.
Tissue samples may be submitted in a dry sterile container if no delay in transportation
is anticipated. It is important to prevent dehydration of the tissue. If transportation is
delayed, add a few drops of sterile saline to the dry tissue container.
Aspirated material may be left in the syringe (carefully remove and discard the needle,
expel all air, seal with a cap and tape securely) or it may be placed in a dry sterile container,
if the specimen can be submitted to laboratory without delay.

The diagnosis of ANAEROBIC INFECTIONS is highly dependent on the correct method


of collection and handling of the sample. It is imperative that the sample is collected from
the centre of the abscess or other infected site, avoiding contamination from surrounding
tissue, as skin and mucous membranes have large numbers of anaerobes as normal
flora. Following specimen collection, samples must be transported in an environment that
is devoid of oxygen and has a low oxidation-reduction potential.

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Specimens aspirated by needle and syringe are ideal, provided all air is expelled.
The needle should be carefully removed and discarded. The syringe should be recapped
(held by tape), labelled and transported promptly to laboratory at ambient temperature.
Broth media can also be provided for inoculation immediately after aspiration of the
sample. If broth inoculation is carried out, a swab should also be collected.
Carefully remove needle and
discard. Recap syringe and
tape securely to syringe. Label
syringe with patient details.

If a delay is anticipated, a swab in Stuarts transport medium should be collected in addition.

Anaerobic Culture
Clinical specimens suitable for anaerobic culture:
Tissue biopsy
Blood
Bone marrow
Fluid from a sterile site (e.g. joint)
Material aspirated from abscesses
Peritoneal fluid
Suprapubic bladder aspirate
Bronchial washings obtained with double lumen plugged catheter
Decubitus ulcer, if obtained from the base of the ulcer after debridement of surface debris

5.51

Transtracheal aspirate.

Swabs with bacteriology


transport medium (blue top
swab) are also suitable for
anaerobic culture but at least
two swabs must be collected.
Anaerobic infections are often
mixed infections and one swab
is used for examination of
Gram stain and aerobic culture
while the other is reserved for
anaerobic culture.

2 x Blue Top Swabs

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CSF

A series of three paired culture bottles (one aerobic, one anaerobic) is required for adults.
A series of three single culture bottles (Paediatric) is required for children.
Mycobacterial culture media are available for immunosuppressed patients.
For VERY ILL patients three sets may be taken over a period of 30 minutes (10 minutes
apart). Timing of cultures with fever peaks may be useful; however, clinical conditions may
make this impractical.
For CHRONIC ILLNESS the three cultures may be taken at intervals coinciding with fever
peaks, the periodicity of which may be quite variable (hours to days).
Venous and arterial blood are equally suitable. The bottles need to be marked so that only
the correct amount is collected (8-10 mL for adults and 1-3 mL for children). If left to fill
automatically they will continue to fill above the desired volume. The bottles also contain
a resin which eliminates antibiotics and other toxins from the cultures.
If difficulty is experienced in obtaining adequate blood volume from some patients, the
following is advised:
One single adult aerobic bottle or one single paediatric bottle for smaller volumes.
Note: The formulation of the culture broth in the paediatric bottle optimizes bacterial
growth for small volumes (1-3 mL) of blood regardless of the source.

If several hours delay is anticipated before examination for ova, cysts and parasites, a
small amount of semi-formed stool (the size of a pea) should also be placed into OCP
(ova, cysts and parasites) transport medium.
Note: It is not necessary for a formed stool specimen to be put into OCP transport
medium, provided it arrives at the laboratory the same day as specimen collection.
Both transport media are stored at room temperature. The remaining faeces specimen
should be refrigerated until submitted to the laboratory.
Special Cases
Liquid stools - should be examined promptly. Please contact the laboratory to arrange
immediate pick up.
Amoebae - faeces for suspected amoebiasis must be examined within 30 minutes of
collection. Contact the laboratory to arrange for immediate pick up and transport of
specimen. Do not refrigerate.
Rotavirus - faeces collected for Rotavirus do not require special transport media or
precautions. The virus is only found in faeces during the acute stage of the illness. The
specimen should be refrigerated while awaiting transportation and transported cooled
to the laboratory as soon as possible.

Blood cultures should be kept at room temperature and forwarded to the laboratory for
incubation as soon as possible.

Clostridium difficile - faeces should be collected in a standard faeces container. The


specimen should be refrigerated while awaiting transportation and transported to the
laboratory within 24 hours. The specimen should be submitted for Clostridium difficile
Enterotoxin assay/PCR

Body Fluids

Nasopharyngeal Secretions

Body fluids should be collected in a labelled sterile container and capped immediately.
The specimen should be submitted to the laboratory as soon as possible. If delay is
anticipated the specimen should be stored in a refrigerator.

Nasopharyngeal secretions may be collected for viral PCR and Bordetella pertussis PCR.

Storage

Faeces
QML Pathology provides containers for the collection and transport of faeces. For infants
a piece of glad wrap may be put into a nappy to collect the sample. Specimens in toilet
paper or nappy liners are unsuitable.

5.53

a pea-sized sample of the original specimen into faeces transport medium (bacterial)
and send both containers to the laboratory.

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Blood Culture

a) For Viral PCR (Respiratory Viruses)


The method of choice for the collection of nasopharyngeal secretions, particularly from
children under five years of age is the suction technique. A fine bore catheter is passed
through the nostril, along the nasal floor to the posterior pharyngeal wall.

Ideally patients should not have received preparations containing antimicrobials, bismuth,
barium, kaolin, mineral oil, antidiarrhoeal or laxative agents during the 10 days prior
to collection.

Secretions are then aspirated by suction, e.g. by Oxyviva equipment into a trap or into
a syringe of 20 mL or 50 mL capacity attached to the end of the catheter. Secretions
should be obtained from both nostrils whenever possible and the secretions flushed from
the catheter into the trap/syringe by aspirating 2-5 mL of sterile saline. When a syringe is
used, expel the contents of the syringe into a sterile container e.g. a urine container.

In general three faeces specimens each spaced a week apart (for Medicare rebate) will
detect most parasitic infections.

Specimens should be sent to the laboratory as soon as possible and kept refrigerated
(not frozen) until tested.

Formed and Semi-formed Stools


The laboratory should receive the specimen kept at room temperature within two hours of
collection. After hours or if any further delay is anticipated when culture is required, place

b) For Bordetella pertussis PCR


Specimens of choice are a Nasopharyngeal aspirate (collected as described in the Viral PCR
section) or a Nasopharyngeal swab (dry swab not collected into any viral transport medium).

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Inferior Turbinate

8 FG Feeding tube is
suitable for use with a 2050 mL capacity syringe.
8 FG Suction catheter
is suitable for use with
Oxyviva suction equipment.
This should be connected
to a sterile specimen trap
as shown in the diagram.

Bacterial transport swab (Stuarts transport medium)


Viral culture transport swab (for viral PCR)
Two glass slides and slide carriers (smears)

Suction

Blood agar plate


Chocolate agar plate

Catheter
Trap

Sputum
Sputum should be collected in a labelled dry sterile screw cap (urine) container and
capped immediately. This should be submitted to the laboratory as soon as possible. If
delay is anticipated the specimen should be stored in a refrigerator.

Urine
After cleaning the external genitalia, a midstream voided urine should be collected by
the clean catch method into a sterile container or for babies in a paediatric bag. An
early morning collection is preferred. Other sources include catheters, cystoscopes,
suprapubic aspirates and urines from ileal conduits.
After collection aspirate the urine into the Monovette. Transport to the laboratory
immediately. If transport to the laboratory is likely to be delayed refrigerate until transport
is available. Suprapubic aspirates should be collected into a sterile container and
refrigerated if transport to the laboratory is delayed.

Urine for Mtb Culture

Sabourauds dextrose fungal plate


Enrichment broth.
These components are available on request from Microbiology (07) 3121 4438 or your
local Branch Laboratory. A variety of storage requirements and expiry dates indicate that
the components of the kit are better obtained freshly on request from the laboratory when
they are needed rather than them being stored at the surgery.

Cutaneous Fungal Culture


If superficial or deep mycoses are clinically suspected please indicate suspicion and
specify fungal culture on the request form since superficial and deep fungi are not routinely
screened for in material submitted for bacterial culture.
Deep Mycoses
If a deep mycosis is suspected a tissue biopsy offers an excellent source of material
for culture and isolation of deep fungi. Fresh tissue should be placed in a sterile dry
container, without additives, and submitted to the laboratory as soon as possible. If
transport delay is anticipated add a few drops of sterile saline to the dry tissue container
to prevent dehydration.
Superficial Mycoses

For Mycobacterial cultures collect a full 70 mL container of an early morning specimen.


Monovettes are NOT acceptable for Mtb culture.

Superficial mycoses may infect skin, hair and nails. The two most important factors
leading to a false negative mycological result are antifungal medication received by the
patient at the time of specimen collection, and a suboptimal amount of specimen.

Catheter Tips for Culture

Antifungal medication (topical and systemic) should be ceased for at least two days,
optimally for a week, prior to collection of the specimen.

Tips from indwelling venous and arterial catheters or cannulas may be submitted for
culture purposes. Skin around the catheterized site should be disinfected prior to catheter
removal. One to two centimetres of catheter tip should be cut with sterile scissors and
dropped into a sterile container. Store at room temperature and transport to the laboratory
as soon as possible.

Ophthalmology Microbiology Kit


Material from an ocular lesion for the purposes of microbiological culture is often very
limited in quantity. In some circumstances it may be warranted to use some or all of the
components of the Ophthalmology Microbiology Kit to ensure isolation of the pathogen
or pathogens.

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The kit includes the following material:

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Equipment

Please indicate on the request form the nature of the antifungal agent and the time of
discontinuation.
Cosmetic preparations should be ceased one to two days prior to collection of
the specimen.
Skin (tinea or ringworm)
Sterile normal saline is suitable for cleansing skin lesions from heavily contaminated sites
such as feet and sweat areas. The active edge of the skin lesion should be scraped with a
sterile scalpel blade and as many flakes and fragments as possible collected in a sterile dry
screw top container or a fungal scrapings envelope. In cases of vesicular tinea pedis, the
tops of any fresh vesicles should be removed as the fungus is often plentiful in the roof of

5.56

PREFACE - MICROBIOLOGY

PREFACE - MICROBIOLOGY

Scalp
Broken diseased hair including the basal portion should be gently removed with sterile
epilation forceps. If scales are present on scalp lesions these may be collected in addition
to, but not instead of hair specimens. Specimens may be placed in a dry sterile screw top
(urine) container (a clean, sealable paper envelope will suffice).
Nail (onychomycosis)
Seventy percent (70%) alcohol is a suitable agent for cleansing nail lesions. Use a sterile
scalpel blade, scraping with the tip if necessary, to obtain the invaded nail tissue. The nail
should be pared and scraped until the crumbling white degenerating portion is reached.
Any white keratin debris beneath the free edge of the nail should also be collected.
Collected material should be placed in a dry sterile screw cap container or a fungal
scrapings envelope.
Please note:
All collected material should be placed in clearly labelled sterile screw top containers or
fungal scrapings envelopes.
Material from different sites should be placed in different containers (identified to site).
For site cleansing, a gauze square is preferable to a cotton wool ball.
If the scalpel blade used to scrape the skin is forwarded to the laboratory it must be
placed in a sterile screw top (urine) container (NOT a paper envelope).

Cutaneous Ectoparasites
Scabies
The operator should wear gloves and materials required will be a sterile scalpel blade,
paraffin oil, glass slide with frosted end labelled with patient identification (pencil) and
cover slip.
Examine the area for unexcoriated papules or for linear or wavy erythematous lines or
burrows. Having found a likely area, place a drop of paraffin oil on the scalpel blade. Apply
the scalpel blade to the papule so that the mineral oil goes onto the papule surface.
Next, scrape vigorously about six to seven times with the blade to remove the entire top
of the papule. Tiny flecks of blood should be mixed with the oil. Then, with the blade,
remove all of the oil to a glass slide. Repeat this procedure with four or five different
papules to the same glass slide. Apply the coverslip.

5.57

The slide should be clearly labelled with the patient identification. It should be placed in a
slide carrier and forwarded to the laboratory as soon as possible.

Pediculosis
The diagnosis of head and crab lice is made by finding lice or nits on the hairs. Pull out
diseased hairs with forceps and place in a sterile screw top container.
The diagnosis of body lice can be confirmed by finding lice and nits in the seams of
clothing, particularly underclothing. Samples of lice and nits may be placed in a sterile
screw top container. These containers should be clearly labelled with patient identification
and forwarded to the laboratory as soon as possible.
Demodex
Demodex folliculorum is a microscopic, cigar-shaped creature with eight stumpy legs
and an annulate abdomen. They are found in the hair follicles and sebaceous glands,
particularly on the nose and face, and probably infest over half of middle-aged adults. The
infestation is usually asymptomatic and is often noted incidentally on skin biopsies and
excisions of facial skin. Infestation may be associated with blackheads.

PREFACE - MICROBIOLOGY

the vesicle. If the lesion is exuding material and may be painful to scrape, a swab may be
collected as an alternative. Use a dry swab previously moistened with saline to swab the
lesion. Place the swab in a container without transport medium. The scalpel blade should
be included with the specimen. Place the blade in a sterile dry screw top (urine) container
NOT in a paper envelope. Please avoid sites with obvious secondary bacterial infection.

Infestation of eyelashes or hairs may be symptomatic. In order to sample it is necessary


to pull out an eyelash. This may be placed in a sterile screw top container. Alternatively, it
may be placed on a glass slide with oil, and coverslipped.
Containers should be clearly labelled with patient identification. Slides should be clearly
labelled with patient identification and placed in a slide carrier. The specimen should be
forwarded to the laboratory as soon as possible.

Chlamydia/Gonorrhoea PCR
Chlamydia PCR
QML Pathology has introduced an APTIMA assay for the simultaneous detection of both
Chlamydia trachomatis and Neisseria gonorrhoeae in the same sample. Both swabs and
urines are suitable samples for detection of Chlamydia with this assay. QML Pathology
supplies an APTIMA collection kit with detailed instructions on collection techniques. The
swab pack contains a white shaft swab which is a cleaning swab and a blue shaft swab
which is a collection swab. The blue shaft swab should be placed in the APTIMA tube
containing transport medium. There are no special storage conditions for these collection
kits. Chlamydia are obligatory intracellular parasites, which survive and multiply only
within living cells. For diagnostic purposes it is essential to collect infected epithelial
cells rather than mucopurulent exudate. Any purulent exudate or secretions should first
be removed with a sterile swab. Swabs for conventional bacterial cultures should be
taken prior to that for Chlamydia PCR.
In WOMEN endocervical or urethral swabs should be collected. First catch urine is also a
suitable alternative. In MEN a urethral swab OR a first catch urine sample may be collected.
Swabs from the vagina or from the penile meatus are unsuitable. If clinically indicated
throat or rectal swabs should be collected. The swab should be gently rotated and remain
inserted sufficiently long to allow adequate sampling and absorption (5 seconds within
the urethra, 20 seconds within the endocervical canal). Try to avoid touching the swab on
the vaginal wall on entry or exit.

5.58

PREFACE - MICROBIOLOGY

PREFACE - MICROBIOLOGY

First catch urine samples are the recommended urine specimen. The first 20 mL of any
voided urine collected in a sterile urine container is an acceptable alternative to a swab.
(Note: the blue Monovette containing preservative is not suitable for PCR testing.) The
patient should not have urinated for two hours prior to the test.
In the case of conjunctival, throat or rectal infection, the sampling swab should be firmly
rotated over the epithelial surface for between 10 and 20 seconds. In the case of the eye,
the lower palpebral fissure is the most suitable site to sample. In infants nasopharyngeal
swab or aspirate is appropriate. These swabs may cause some discomfort to the patient.
After collecting the sample with the swab it is placed into the white capped transport
medium tube, snapped off and the cap screwed down tightly. There are no special storage
or transport conditions for sending the specimen to the laboratory. If delay is anticipated,
urine specimens should be refrigerated and referred to the laboratory within 72 hours.
Gonorrhoea PCR
Using an APTIMA collection kit, collect swabs as per the instructions. Alternatively, a first
catch urine may be used. If culture is required, a bacterial swab should be collected and
sent in Stuarts transport medium.

Viral Culture

Mantoux Test
The objective of the Mantoux test is to examine an immune response 48 to 72 hours after
an intradermal injection of purified protein derivative (PPD) of Mycobacterium tuberculosis
and Mycobacterium avium. The technique involves injecting 0.1 mL of a solution
containing 100 IU/mL of PPD (i.e. 10 IU per dose of 0.1 mL) using a 25 gauge needle into
the dermis. This should raise a lump in the skin 5-6 mm in diameter. The injection should
be repeated if it is too deep or if leakage occurs. The results are read 48 to 72 hours later.
The clinician should palpate the site for the presence of oedema (induration). Erythema
should be ignored. The diameter of the area of oedema measured at right angles to
the long axis of the arm is recorded.
Note: A handy card giving guidance on the performance and interpretation of the Mantoux
test is available on request from QML Pathology Liaison Department (07) 3121 4943 or
your local Branch Laboratory.

PREFACE - MICROBIOLOGY

PREFACE - MICROBIOLOGY

PREFACE - MICROBIOLOGY

Interpretation
A positive result is indicated by an area of induration 10mm or more in diameter. This
indicates previous exposure to Mycobacterium tuberculosis, atypical mycobacteria or
previous BCG vaccination. A negative result does not exclude active tuberculosis as the
reaction may be suppressed by concurrent viral infection, cancer, drug therapy or severe
bacterial infections (including tuberculosis).

QML Pathology supplies viral culture swabs and transport medium for detection of viruses
including Herpes simplex I and II, and Varicella zoster in the sample by PCR (polymerase
chain reaction - Nucleic acid detection) method. Detailed instructions on specimen
collection are supplied with each kit. The swabs should be placed on an ice brick in
an insulated container and sent to the laboratory as soon as possible. They should be
refrigerated if stored overnight. Results of the PCR are available within 24 hours.
Special Collections for Cytomegalovirus Culture
Positive CMV IgM serology under certain circumstances may require confirmation by
detection of virus by PCR (e.g. suspected antenatal or neonatal infection).
In these circumstances the specimens required include:
Further serum sample (SS tube) PLUS
10 mL EDTA blood
Saliva swab in viral culture transport medium (Virocult)
Midstream urine in a sterile screw top (urine) container
High vaginal swab in viral culture transport medium (Virocult) (antenatal cases only).

5.60

5.59

Results of PCR are generally available in 24 hours.

Chemistry
Acceptable test groupings
approved abbreviations in parenthesis
Blood Gases
pO2
pCO2
pH
Electrolytes (E)
Sodium (Na)
Potassium (K)
Chloride (Cl)

HCO3
Base excess
O2 saturation

Bicarbonate (HCO3)
Anion Gap

Immunoglobulins
IgG
IgA
IgM
IgE
Lipid Studies
Cholesterol (CHOL)
Triglycerides (TRIG)
Classification of hyperlipidaemia
where indicated
High density lipoprotein cholesterol
when specifically requested (HDL)

6.1

Liver Function Tests (LFT)


Total Bilirubin (BILI.T)
Conjugated Bilirubin (BILI.D)
Alkaline Phosphatase (ALP)
Gamma Glutamyl Transferase (GGT)
Alanine Amino Transferase (ALT)
Aspartate Amino Transferase (AST)
Albumin (ALB)
Globulins
Total Protein
Lactate Dehydrogenase (LDH)

Markers of Heart Disease


Troponin (most specific)
Myoglobin (earliest)
BNP (heart failure)
Others:
Aspartate Amino Transferase (AST)
Lactate Dehydrogenase (LDH)
Creatine Kinase (CK), CKMB
Specific Protein Quantitation
IgG
Alpha-1 antitrypsin
IgA
ACE (Angiotensin
IgM
Converting Enzyme)
IgE
APO B
C3
APO A1
C4
Haptoglobin
IgG Subclasses
Therapeutic Drug Monitoring
Analgesics
Salicylate
Paracetamol
Antibiotics
Amikacin
Gentamicin
Tobramycin
Vancomycin
Antiepileptics
Carbamazepine
Clonazepam
Lamotrigine
Gabapentin
Vigabatrin
Phenobarbital
Phenytoin
Primidone
Sulthiame
Valproate

Antineoplastic
Methotrexate
Bronchodilators
Theophylline
Cardiac
Digoxin
Quinidine
Perhexilene
Amiodarone
Mexilitene
Flecainide
Immunosuppressive
Cyclosporine
Tacrolimus (FK506)
Sirolimus (Rapamycin)
Mycophenolicacid
Vitamins
Vitamin
Vitamin
Vitamin
Vitamin
Vitamin
Vitamin
Vitamin

A
B1
B2
B6
C
D
E

Drug Screening
Cotinine (Urine/Serum)
Psychoactive
Benzodiazepines
(list specific requirements)
- clobazam
- clonazepam
- diazepam
- nitrazepam
- oxazepam
- temazepam
Clozapine
Thioridazine
Mianserin

Fluoxetine
Olanzapine
Lithium
Tricyclics
- amitriptyline
- clomipramine (norclomipramine)
- desipramine
- doxepin (nordoxepin)
- imipramine
- nortriptyline
- trimipramine

PATHOLOGY TESTS

TEST SELECTION GUIDE

Multiple Biochemical
Analysis (E/LFT)
Sodium (Na)
Potassium (K)
Chloride (Cl)
Bicarbonate (HCO3)
Anion Gap
Glucose (GLUC)
Urea (U)
Creatinine (C)
Estimated GFR (eGFR)
Urate (URAT)
Total Bilirubin (BILI.T)
Alkaline Phosphatase (ALP)
Gamma Glutamyl Transferase (GGT)
Alanine Amino Transferase (ALT)
Aspartate Amino Transferase (AST)
Lactate Dehydrogenase (LD)
Calcium (Ca)
Corrected Calcium
Inorganic Phosphate (PHOS)
Total Protein (PROT)
Albumin (ALB)
Total Globulins
Iron
Cholesterol (CHOL)
Triglycerides (TRIG)

Contd.

6.2

PATHOLOGY TESTS

PATHOLOGY TESTS

Normal

0 6 12 18 24 2 3 4 5 6 7 8 9 10
Hours
Days
TIME AFTER INFARCT

Abnormal Protein Investigation


Serum Protein Electrophoresis
Cryoglobulins/Cryofibrinogen
Immunoglobulin Quantification
Immunofixation Studies
Bence Jones Protein
Serum Free Light Chains
Amniotic Fluid
Alpha Fetoprotein
Bilirubin
Cytogenetics
L/S ratio
Calcium Metabolism
Serum Ionised Calcium
Serum Parathormone
Serum 25 Hydroxy Vitamin D

6.3

Gastrointestinal
24hr Urinary 5-H.I.A.A.
Serum Serotonin
Other gut derived hormones
on request.
By appointment:
Xylose Absorption/3 Day Faecal Fat
Breath hydrogen study with lactose or
other sugar loading.

Toxicology
Comprehensive drug screen
on urine, blood or saliva
(urine preferred except for alcohol).
Heavy metals:
- Lead
- Mercury
- Cadmium
Red Cell & Serum Cholinesterase
Carboxyhaemoglobin
Methaemoglobin
Carbohydrate Deficient Transferrin
Miscellaneous
Porphyrins:
- Blood, Urine, Faeces
Ammonia & Lactate
Metabolic Disease Screen
Faecal Sugar
Copper
Zinc
Magnesium
Special Proteins
Urine & Serum Osmolality (assayed)
Serum Cholinesterase
with Dibucaine Inhibition
Sweat Electrolytes
Glucose Tolerance Test
HbA1c/Fructosamine
Urinary Microalbumin
Amylase/Lipase
Acid Phosphatase
Muscle CK

Alkaline Phosphatase & LD Isoenzymes


Urinary VMA (HMMA)
Metanephrines/Catecholamines
Intestinal Disaccharidases
Pancreatic Elastase
Zinc Protoporphyrin
NTX (N-Telopeptide CrossLinks)
DPD (Deoxypyridinoline)
Homocysteine

Occupational Drug Screen


to AS/NZS 4308:2008
Immunoassay
- Cannabinoids

Cytology/Histology
Non Gynaecological Cytology
Body Fluids
Pleural Fluid
Ascitic/Peritoneal Fluids
Peritoneal Washings
Pericardial Fluid
Synovial Fluid
Ovarian Fluid
Gastric Fluid
Cerebrospinal Fluid
Fine Needle Aspirate
Breast
Head & Neck
Lung
Lymph Node
Thyroid
Soft Tissues
Prostate
Superficial
Palpable Lesions

Histology
Tissue and Biopsy Specimens
Routine Tissue Diagnosis
Muscle Biopsy
Renal Biopsy
Nerve Biopsy
Cilial Biopsy

- Benzodiazepines
- Cocaine
- Sympathomimetic Amines
- Opiates
- Methadone (as requested)
- Barbiturates (as requested)
- Ethanol (alcohol, as requested)
GCMS and LCMS confirmation
- Cannabinoids (TCC)
- Benzodiazepines (BDC)
- Cocaine (CME)
- Sympathomimetic Amines (SYM)
- Opiates (OPC)

PATHOLOGY TESTS

Myoglobin
Troponin
CK, AST
LDH

Renal Function
Serum Urea
Creatinine Clearance
Serum Creatinine
24hr Urinary Protein
Serum Urate
Timed Urinary Albumin

Respiratory
Sputum
Bronchial Brushings
Bronchial Washings
Bronchoalveolar Lavage
Urinary Tract
Urine
Bladder Washings
Urothelial Washings
Miscellaneous
Nipple Discharge
Oral Cavity Smears
Gynaecological Cytology
Cervical Smear
Vaginal Smear
ThinPrep Imaging
HPV DNA Typing
Immunofluorescence
Frozen Section Service
Immunoperoxidase Stains
- oestrogen
- progesterone
- c-erbB2 studies
- others as indicated

6.4

Change in Cardiac Markers


Following Myocardial Infarction
* Peaks not drawn to same scale
RELATIVE CONCENTRATION

PATHOLOGY TESTS

PATHOLOGY TESTS

Andrology
Seminal Analysis
Antisperm Antibodies
Cytogenetics
Chromosome Analysis
Prenatal
Postnatal
Oncology
Fluorescent In Situ Hybridisation (FISH)
Microdeletion Syndromes
Aneuploidy Screening
Telomere Screening
Oncology
- Fusion Probes for common
haematological malignancies
e.g. t(9;22) bcr/abl
- Multiple Myeloma Panel
- CLL Panel
Paraffin Tissue Studies
- Her2/Neu
- Oligodendroglioma
- Lymphoma

Endocrinology

6.5

Thyroid Function Tests (TFT)


TSH as screen
Free T4 if:
- TSH is abnormal
- Follow Up
- Dementia/Psychiatric
- Amenorrhoea/Infertility
- ? Pituitary Disease
- On Amiodarone, Lithium
- Sick euthyroid in hospital
Thyroid Antibodies,
TSH Receptor Ab, ESR if:
- ? Chronic Thyroiditis

Molecular Genetics
Haemochromatosis
(C282Y, H63D & S65C)
Factor V Leiden
Prothrombin G20210A
Apolipoprotein E Genotyping
MTHFR Mutation
B Cell IgH Gene Rearrangement
Bcl-1
Bcl-2
T cell Receptor Gene Rearrangement
Bcr/abl
Fragile X Syndrome
Y chromosome Deletion Analysis
(AZFa, AZFb, AZFc) for Male Infertility.
Sex Determining Region of the
Y Chromosome (SRY)
Cat Scratch Disease
Clostridium Difficile
Cystic Fibrosis
HLA-B27
Malaria

- ? Acute Thyroiditis
- ? Graves/Hashimotos
- ? Follow Up
Diabetes
1 or 2 hr post prandial glucose & insulin
C Peptide
Glucagon Stimulation Test
Gastritis
Gastrin
Urea Breath Test
Growth
Growth Hormone
Somatomedian C (IGF-1)

Adrenal Function

Down's Screen

Cushings
Cortisol + ACTH
24hr Urinary Cortisol
Overnight Dexamethasone
Suppression Test

First Trimester (111/2 -13 wks 6 days)


Free HCG
PAPP-A

Addisons
Cortisol + ACTH
Synacthen Stimulation Test
Amenorrhoea
Pregnancy Test
Oestradiol
LH:FSH
Prolactin
? Adrenal/Thyroid/Pituitary Disease
Hypertension
Renin + Aldosterone
Hirsutism
LH:FSH
Oestradiol
Testosterone

DHEA Sulphate
Androstenedione
SHBG

Antenatal
HCG
Progesterone
? Ectopic - lower than expected HCG

Haematology/BLOOD BANK
QML Pathology Warfarin Care Clinic
Patient Registration 1300 795 355
Acceptable test groupings
approved abbreviations in parenthesis
Complete Blood Examination
(FBC, FBE, CBE, CBP)
Haemoglobin (Hb)
Haematocrit (PCV)
Red Cell Count (RBC)
Red Cell Indices
Leucocyte Count (WBC)
Platelet Count
Differential Leucocyte Count
Blood Film Examination

Second Trimester including Spina


Bifida Screen (15-18 wks is best but
can be done at 14-22 wks)
AFP
HCG
Free Oestriol

PATHOLOGY TESTS

Genetics

Calcium Homeostasis
Parathyroid Hormone (PTH)
Calcium + Albumin + Ionised Calcium
Random Urinary Calcium Clearance
Tumour Markers
Prostate
PSA
Breast
CA 15-3

CEA

Ovary
CA 125

CA 19-9

Colon
CEA

CA 19-9

Thalassaemia/
Haemoglobinopathy Screen
Hb
Red Cell Indices
Hb Electrophoresis
HbA2
HbF Quantification
HbH Bodies
Coagulation Screen (COAG)
Includes:
PT
APTT
Fibrinogen
Platelet Count
TCT

Contd.

6.6

PATHOLOGY TESTS

PATHOLOGY TESTS

Bone Marrow Examination


Please state if cytogenetics or
markers are required.
Marrow Booking: (07) 3121 4573

Suggested tests for common


haematological disorders from which
a selection may be made. These tests
must be requested individually.
Leukaemia/Lymphoma
FBC
Bone Marrow Examination
Cytogenetics
Molecular Genetics
Cell surface markers as indicated.
Polycythaemia
EPO
JAK-2
Anaemias
Haemolytic
FBC/Retics
Bilirubin/LDH
Haptoglobin
Coombs test
Where indicated:
Hypertonic Cryohaemolysis
Cold Agglutinins
ANA
G6PD
Unstable Hb
PNH Screen
Flow cytometry screening for
hereditary spherocytosis.

6.7

Macrocytic
FBC/Retics/Coombs Test
E/LFT
Red Cell Folate/B12

TSH
Where necessary:
Intrinsic Factor Abs
Bone Marrow Examination
Microcytic
FBC/Retics
Iron Studies
Zinc Protoporphyrin (ZPP)
If unhelpful consider Haemoglobinopathy,
Thalassaemia or Sideroblastic Anaemia.
Normocytic
FBC/Retics
ESR
Iron Studies
Red Cell Folate/B12
E/LFT
EPP/Urine Bence Jones Protein
TSH
ANA
LH/Testosterone (Males)
Where indicated:
Bone Marrow Examination

GIFT
ANA
Lymphocyte Markers
Where indicated:
Bone Marrow Examination

Leucocyte Disorders

Thrombocytosis
ESR/CRP
Iron Studies
B12
NAP Score
Faecal Occult Blood

Neutrophilia
ESR/CRP
Iron Studies
B12
NAP Score
E/LFT
ANA
Where indicated:
Bone Marrow Biopsy
BCR - ABL
Neutropenia
FBC/Retics
Coombs
Iron Studies
B12/Folate

Eosinophilia
Faecal O/C/P
IgE
Serology for parasites e.g. strongyloides
NAP
TSH
B12
Lymphocytosis
Lymphocyte Surface Markers
Immunoproliferative Diseases
Serum EPP
Immunofixation
Quantitation of Immunoglobulins
Bence Jones Protein
Bone Marrow Examination
Lymphocyte Marker Studies
2 Microglobulin

Thrombocytopenia
FBC/Retics
Coombs
Haptoglobin
B12/Folate
PIFT
ANA/ACLA
Lupus Anticoagulant
PT/APPTT/Fibrinogen
D-Dimer

Coagulation
Anticoagulant Control Oral Therapy
Prothrombin Time/INR
Unfractionated Heparin
APTT
Therapeutic range 60-95 seconds
for continuous infusion or intermittent
therapy (sample collected 30-45 minutes
before next injection).

PATHOLOGY TESTS

Cross Matching
Includes test for Rh and/or other
blood group antibodies.

LMWH
Monitoring is rarely needed.
Haemorrhagic Disorders
If abnormal coagulation screen or if
significant family/clinical history of bleeding,
von Willebrands Disease or other
deficiency states may be considered:
F VIII:C
vWF:Ag
vWF:RiCoF
If required:
Collagen Binding Assays
Other specific factor assays as indicated.
Platelet Aggregation Studies
Circulating Inhibitor Tests
Recurrent Thrombosis/Thrombophilia
FBC
APTT/PT/Fibrinogen
Antithrombin III
Lupus Inhibitor
Protein C/Protein S
Plasminogen
Cardiolipin Antibodies
APC Resistance
Factor V Leiden/
Prothrombin G20210A Mutation
E/LFT - Homocysteine

6.8

PATHOLOGY TESTS

PATHOLOGY TESTS

Required tests must be


ordered individually.
Allergic Disorders
Total IgE
Skin Testing
RAST - single or multiple allergens
(max. 4 per request).
Arthritis
Anti CCP
ANA
Anti DNA
ENA
ANCA
C Reactive Protein
HLA B27 Typing
Rheumatoid Factor
S
 erology
- Streptococci
- Ross River
- Parvovirus
- Barmah Forest
- Rubella
- Shigella
- Yersinia
- Campylobacter

O
 ther tissue autoantibodies
as indicated.
e.g.: - Mitochondrial Ab (AMA)
- Smooth Muscle Ab (SMA)
- Parietal Cell Ab (PCA)
Coeliac Disease
Adults
Anti TTG or anti EMA
Children
Anti TTG or anti EMA
Anti Gliadin IgA
Anti Gliadin IgG
Immunodeficiency States
EPP
lgG
IgA
IgM
IgG Subclasses
C3
C4
Haemolytic Complement
Neutrophil Oxidative Burst

Uric Acid

Neutrophil Function Tests

Autoimmune Disease

T & B Cell Quantitation

Antinuclear Antibodies (ANA)

Lymphocyte Function Tests

Anti-DNA
Anti-extractable Nuclear Antigens (ENA)
ANCA
C3
C4
Haemolytic Complement
Rheumatoid Factor
Rose-Waaler

6.9

A
 ntiphospolipid Antibodies
- Cardiolipin Ab
- Lupus anticoagulant

Microbiology and
Microbial Serology
Notes
Complete clinical history (including recent
travel) is important. Please request tests
individually (profiles not acceptable)
and include the nature and site of the
specimen. Some serological tests can
be diagnostic on testing of acute phase
serum (e.g. detecting IgM antibodies),
while some tests require paired sera 14
days apart.
Antenatal Screening
HepBsAg
HIV
Rubella
Syphilis
CNS
Blood culture
CSF
- Differential Cell Count
- Glucose
- Chloride
- Protein
- Bacterial Culture
- TB Culture
- Virus PCR
- HSV
- Enterovirus
- CMV
- HIV
- Bacterial PCR
- N. Meningitidis
- Cryptococcus Antigen
Serology
- Arbovirus
- HSV
- Meningococcal IgM
- Measles
- Mumps
- Syphilis
- Cryptococcus
- Toxoplasma
- Rubella

PATHOLOGY TESTS

Immunology

Cardiac
Serology
Cat Scratch Disease (CSD)
Enterovirus
Q Fever
Streptococcal
Toxoplasma
Syphilis
PCR
Cat Scratch Disease (CSD)
- Cardiac Tissue
Congenital Screening
CMV
Rubella
Toxoplasma
HSV 1&2
Syphilis
Diarrhoea
Faeces
Microscopy
- Ova
- Cysts
- Parasites
Culture for pathogens
- Bacteria
- Viral culture not performed
Rotavirus Assay
PCR
- Clostridium difficile toxin gene
(antibiotic associated diarrhoea)
- EHEC (Enterohaemorrhagic E coli) PCR
Genital
Genital Herpes
PCR
Serology

Contd.

6.10

PATHOLOGY TESTS

PATHOLOGY TESTS

PCR
Cat Scratch Disease (CSD)
- Lymph node tissue

Genital Discharge
Chlamydia PCR
Gonococcal PCR
Microscopy/Culture
Syphilis Serology
Trichomonas
- PCR
Hepatitis A, B, C
Please request specific tests.
Acute Investigation
Hep A IgM
HBsAg
HCV
Infectivity Status
HBsAg

HCV

Immunity/Post Vaccination
HBsAb
Hep A IgG
Other Hepatitis
Amoebic
CMV
Hep E
Leptospira

Brucella
EBV
Hydatid
Q Fever

Lymphadenopathy/Mononucleosis

6.11

Serology
Adenovirus
HIV
Brucella
Cytomegalovirus
Cat Scratch Disease (CSD)
EBV
Mumps
Rubella
Syphilis
Toxoplasma

Pyrexia of Unknown Origin (PUO)


Blood Culture x 3
Urine Micro & Culture
Malarial Films
Culture of any cutaneous lesion
or exudate (e.g. sputum)
Serology
- Leptospira
- Brucella
- Q Fever
- Mycoplasma
- Toxoplasma
- Dengue PCR
- Arbovirus
- Influenza
- Salmonella
- Rickettsia
- Cat Scratch Disease
Mantoux Skin Test
Rash
Vesicular
HSV PCR
VZV PCR
Enterovirus PCR (Throat, Skin Lesions)
Micro & Culture for Bacteria
Serology
- Echocoxsackie
- HSV
- VZV
- Rickettsiae
Nonvesicular
Micro & Culture for Dermatophytes
Serology
- Rubella
- Ross River
- Barmah Forest
- Dengue

Measles
Arbovirus
Rickettsia
CMV
Syphilis
Parvovirus
HIV
Streptococcus

CMV
Adenovirus

Renal Tract Infection


Urine & Micro Culture
Blood Cultures (Systemic Symptoms) x 2
Serology
- ASOT/Anti DNase B titres (nephritis)
Respiratory Infections
Upper
Culture (Throat Swab)
Bordetella Pertussis PCR
(Throat Swab/NPA)
Respiratory Virus PCR (NPA)
- RSV
- Influenza
- Parainfluenza
- Adenovirus
Serology
- ASOT/Anti DNase B
- Bordetella Pertussis
- Influenza
with adenopathy:
Infectious Mononucleosis
Toxoplasma

Lower - Acute
Micro & Culture (Sputum)
Blood Cultures x 2
Legionella PCR (Sputum)
Legionella Urinary Antigen (Urine)
Mycoplasma PCR (Sputum)
Serology
- Mycoplasma
- Psittacosis
- Q Fever
- Legionella
- Cryptococcus
- Influenza
- Chlamydia pneumoniae

PATHOLOGY TESTS

Genital Sore
HSV PCR
Microscopy/Culture
Syphilis Serology

Lower - Non Resolving


Culture (Sputum)
Fungi x 3
MTB Micro & Culture x 3
Sputum Malignant Cells x 3
Mantoux Skin Test
Serology
- Mycoplasma
- Legionella
- Fungal Precipitins (Aspergillus,
Micropolyspora, Thermoactinomyces)
- HIV
- Herpes
BAL (Bronchial Alveolar Large)
- D/w Microbiologist

Interpretation of Hepatitis B Serology


Pattern
Early Acute
Acute

HBsAg

HBeAg

+
+

+
+

Resolving
Past
Chronic
Post
Immunisation

+/-

HBcAb

HBcIgM

+
+
+
+

+
+

HBeAb

+
+/+/-

HbsAb

+/+/-

Infective

++
++
+/++

6.12

PATHOLOGY TESTS

PATHOLOGY TESTS

DEPARTMENT

Biochemistry

Blood/SS tube
or Red top tube

2 weeks

25-Hydroxy calciferol and 1,25-Dihydroxy calciferol may be measured. Ideally,


patient should fast but this is not essential. Specimen should be centrifuged and
serum separated. Active form of vitamin D - not useful unless in renal failure
because of variability.

17-HYDROXYPROGESTERONE,
SERUM
1-HYDROXYPYRENE, URINE

Endocrinology

Blood/SS tube

1 week

Please provide clinical and medication details.

Biochemistry

Urine/50 mL
urine container

2 - 3 weeks

Random urine collected at the end of work shift or exposure. This test attracts
a charge of approximately $110 from the referring laboratory, payable by the
patient or their employer. Please indicate on the request form if permission or prior
arrangement has been granted to perform test.

1-METHYL HISTAMINE, URINE

Biochemistry

Please refer to HISTAMINE, URINE. 1-methyl histamine is a dietary derivative.

2, 4, 5-T (HERBICIDE), URINE

Biochemistry

Test for unusual exposure - note this herbicide is no longer in use.


Please refer to HERBICIDES, URINE.

2, 4-D (HERBICIDE), URINE

Biochemistry

Please refer to HERBICIDES, URINE.

25-HYDROXY
CHOLECALCIFEROL, SERUM
25-HYDROXY VITAMIN D,
SERUM
25-HYDROXY VITAMIN D3,
SERUM
3-HYDROXYBUTYRATE,
SERUM OR PLASMA

Biochemistry

Please refer to VITAMIN D, SERUM.

Biochemistry

Please refer to VITAMIN D, SERUM.

Biochemistry

Please refer to VITAMIN D, SERUM.

4-HYDROXY-3-METHOXY
MANDELIC ACID, URINE

Biochemistry

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

Biochemistry

Please refer to 1,25-DIHYDROXY VITAMIN D, SERUM.

Biochemistry

Blood/Lithium heparin tube


or SS tube

1 week

PATHOLOGY TESTS - A

TEST NAME
1,1,1,TRICHLOROETHANE, BLOOD
1,25-DIHYDROXY
CHOLECALCIFEROL
1,25-DIHYDROXY VITAMIN D,
SERUM

Ketone body quantitative assay. Referred test.


Please refer to CATECHOLAMINES, URINE.

Results (07) 3121 4555


7.0

7.0

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/Urine container

2 - 3 weeks

Occasionally used in testing for acute intermittent porphyria.


Also raised in lead poisoning. Collect while patient is experiencing symptoms.
Protect sample from light. Store and transport frozen. Referred test.

5-H.I.A.A., URINE

Biochemistry

Urine/24 hour urine


container with 25 mL
6M HCI preservative

1 - 2 weeks

Tumour marker - carcinoid tumour. Also raised if patient fails to avoid dietary
serotonin. Please provide clinical and medication details, especially recent
changes in medication. Please refer to: Urine Collection Diet for 5-H.I.A.A and
Catecholamine (12.11) for dietary and drug restrictions during or just prior to
collection. Urine should be refrigerated during the collection period and transported
cooled to the laboratory. Under certain special circumstances, e.g. small children, a
random urine can be collected. If this is required, contact senior Biochemistry staff
prior to collection (07) 3121 4083.

5-HYDROXY TRYPTAMINE,
URINE
6-THIOGUANINE (6-TG), BLOOD

Biochemistry

7-BIOPTERIN, URINE

Biochemistry

7-DEHYDROCHOLESTEROL,
PLASMA

Biochemistry

A/G RATIO, SYNOVIAL FLUID

Biochemistry

Please refer to ALBUMIN, SYNOVIAL FLUID.

ACE, SERUM

Biochemistry

Please refer to ANGIOTENSIN CONVERTING ENZYME, SERUM.

ACETAMINOPHEN, SERUM

Biochemistry

Please refer to PARACETAMOL, SERUM.

ACETOACETATE, SERUM

Biochemistry

Please refer to KETONE SCREEN, SERUM.

ACETOACETATE, URINE

Biochemistry

Please refer to PIGMENTS, URINE.

ACETONE, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

ACETONE, URINE

Biochemistry

ACETYL SALICYCLIC ACID,


SERUM

Biochemistry

www.qml.com.au

Biochemistry

PATHOLOGY TESTS - A

TEST NAME
5-ALA, URINE

Please refer to SEROTONIN, URINE 24 HOUR.


Blood/EDTA tube

3 weeks

Transport at 4C.
Please refer to PTERINS, URINE for details. Referred test.

Blood/Lithium
heparin tube

Urine/Urine container

3 weeks

3 weeks

Sample must be centrifuged, serum separated into a 6 mL Falcon tube and frozen
within 30 minutes of collection. Transport on dry ice. Referred test.

Random urine collected at the end of work shift or exposure. This test will only be
performed with the permission of the patient or their employer due to the cost of
the assay. If the patient wishes to proceed with the test, indicate on the request
form that permission has been granted to perform the test.
Please refer to SALICYLATE, SERUM.

Results (07) 3121 4555


7.1

7.1

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Test is currently unavailable due to withdrawal of the sulphonamines used in the test.

Immunology

Blood/SS tube

1 week

Refer to ADENOVIRUS SEROLOGY for collection details.

Biochemistry

Amniotic fluid/Plain
plastic tube

1 week

Test for open neural tube defects.

ACETYLCHOLINESTERASE,
RED CELL

Biochemistry

Blood/Lithium heparin tube


or EDTA tube

1 day

Test for organophosphate or carbamate insecticide toxicity. Please provide clinical


details including exposure to pesticides etc. Leave as whole blood. Refer to
Biochemistry Appendix (12.18) for a comprehensive list of organophosphate and
carbamate pesticides. Reduced red cell levels of cholinesterase usually equate
with organophosphate and carbamate toxicity. Test can be performed on urgent
basis. Screening test intervals depend on levels of exposure. Local and Regional
Councils routinely recommend 3-6 monthly screens for exposed staff. Heavy users
recommend 3 monthly screen and screening anytime after intensive use.

ACID MALTASE, BLOOD

Biochemistry

ACID PHOSPHATASE (FEMALE),


SERUM
ACID PHOSPHATASE
(PROSTATIC), SERUM

Biochemistry

Blood/SS tube

Biochemistry

Blood/SS tube (Preserved by 24 hours


the addition of 1 drop of acid
phosphatase preservative
per 1 mL of serum)

Tumour marker - original test for prostatic malignancy. Not as sensitive as


prostate-specific antigen but less prone to elevation in benign disease. This test
has been largely replaced by prostate-specific antigen (PSA) and no longer attracts
a Medicare refund.

ACIDIFIED SERUM TEST


(HAM TEST), BLOOD

Haematology

Blood/SS tube
and EDTA tube

24 hours

Test for detection of Paroxysmal Nocturnal Haemoglobinuria (Haemolytic Anaemia).


Please contact Haematology (07) 3121 4451 or Branch Laboratory for details.
Flow cytometry for PNH is the preferred test.

ACTH STIMULATION TEST

Endocrinology

Blood/SS tube
and EDTA tube

24 hours

Give intramuscular injection of Synacthen (0.25mg/1 mL). Collect blood samples


prior to injection and at 30 and 60 minutes post injection. Also collect an EDTA tube
on the basal specimen. Cortisol is measured on all the 3 specimens and if results
are abnormal an ACTH is measured on the basal EDTA tube. Please contact your
local QML Pathology laboratory for supply of Synacthen ampoule. Please include
details of any corticosteroids taken recently (especially in the past 24 hours).

www.qml.com.au

PATHOLOGY TESTS - A

TEST NAME
ACETYLATOR PHENOTYPE,
BLOOD/URINE
ACETYLCHOLINE RECEPTOR
ANTIBODY, SERUM
ACETYLCHOLINESTERASE,
AMNIOTIC FLUID

Please refer to LYSOSOMAL ENZYMES, BLOOD.


24 hours

Process sample as for ACID PHOSPHATASE (PROSTATIC), SERUM.

Results (07) 3121 4555


7.2

7.2

PATHOLOGY TESTS - A

PATHOLOGY TESTS

TEST NAME
ACTH, PLASMA

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/2 x EDTA tubes

24 hours

Specimen should be kept cold in transit. Plasma specimen must not be frozen until
separated from red cells, decanted and stored in a plain plastic tube.

ACTINOMYCES CULTURE

Microbiology

Swab/Swab collected in
transport medium
or specimen in a
sterile container

Initial culture
results available
48 hours, final
report 7 days.

Please specify site of collection and provide clinical details including antibiotic
therapy. Culture performed on mandible swabs and mouth swabs sent from dentists.

ACTIVATED PROTEIN C RESISTANCE (APC)

Haematology

Blood/EDTA tube and


Sodium citrate tube

24 hours

Specimens should be stored and transported cooled. They must reach the laboratory
within 2 hours of collection. A history of thromboembolism or a proven APC defect in a
first degree relative must be stated on the request form to attract the Medicare rebate.

PATHOLOGY TESTS - A

PATHOLOGY TESTS - A

PATHOLOGY TESTS

PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW.


Thrombotic assay requests are only Medicare refundable if one of the following is
stated on the request form by the patients doctor:
1. That the patient has a personal history of venous thromboembolism (DVT) or
arterial thrombosis (PE);
2. That a first degree relative of the patient has a proven defect in one or more of
the thrombotic test(s) requested and that the particular defect(s) are stated on
the request form; or
3. That the request is to confirm an abnormal or indeterminate result.

ACTIVE VITAMIN B12

Haematology

Blood/SS tube

3 days

If requested with VITAMIN B12, SERUM a non Medicare rebatable fee of approx.
$25.00 is charged to the patient.

ACYL CARNITINE,
NEONATAL SCREEN

Biochemistry

Capillary blood sample


(heel prick)/Neonatal
screening card

2 - 4 weeks

HEEL PRICK SAMPLE REQUIRED. Please refer to the instructions on the Neonatal
Screening Test card. Please note: Card must be completely air dried and
transported in a paper bag or envelope. Referred test.

ACYL CARNITINE, SERUM

Biochemistry

Blood/SS tube

1 - 2 weeks

Fresh random sample required. Transport in esky at 4C. Referred test.

ADENOSINE DEAMINASE,
BLOOD

Biochemistry

Blood/Lithium
heparin tube

Indeterminate

Only available as a test for severe combined immunodeficiency. Clinical reason for
the test must be stated. Referred test. Please advise patient that this test attracts a
non-Medicare refundable fee from the referring laboratory.

www.qml.com.au

Results (07) 3121 4555


7.3

7.3

IF THE REQUEST IS NOT REFUNDABLE BECAUSE OF THE ABOVE CONDITIONS, THE


PATIENT WILL BE CHARGED A NON-REFUNDABLE AMOUNT. PLEASE INFORM THE
PATIENT IF THE TESTING WILL RESULT IN AN ACCOUNT BEING SENT TO THE PATIENT.

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

72 hours

Assay run Tuesday and Friday.

ADENYLSUCCINASE, URINE

Biochemistry

Urine/Urine container

1 - 2 weeks

Random early morning urine collection preferred.


Refrigerate for transfer to laboratory. Referred test.

ADRENAL ANTIBODIES, SERUM

Immunology

Blood/SS tube

2 weeks

ADRENAL CORTICOSTEROID
LEVEL, SERUM

Endocrinology

Blood/SS tube

24 hours

ADRENALIN, URINE

Biochemistry

ADRENOCORTICOTROPHIC
HORMONE (ACTH)
STIMULATION TEST

Endocrinology

Blood/SS tube
and EDTA tube

24 hours

Give intramuscular injection of Synacthen (0.25mg/1 mL). Collect blood samples


prior to injection and at 30 and 60 minutes post injection. Also collect an EDTA tube
on the basal specimen. Cortisol is measured on all the 3 specimens and if results
are abnormal an ACTH is measured on the basal EDTA specimen. Please contact
your local QML Pathology laboratory for supply of Synacthen ampoule. Please
include details of any corticosteroids taken recently (especially in the past 24 hours).

ADRENOCORTICOTROPHIC
HORMONE (ACTH), PLASMA

Endocrinology

Blood/2 x EDTA tubes

24 hours

Specimen should be kept cold in transit. Plasma specimen must not be frozen until
separated from red cells, decanted and stored in a plain plastic tube.

AFP (ALPHA FOETOPROTEIN)


- TUMOUR MARKER, SERUM

Endocrinology

Blood/SS tube

24 hours

Alpha foetoprotein is used as an aid in the management of patients with


nonseminomatous testicular carcinoma (embryonal carcinoma and yolk sac
carcinoma) and hepatocellular carcinoma.

AFP (ALPHA FOETOPROTEIN),


SERUM

Endocrinology

Blood/SS tube

24 hours

Period of amenorrhoea (A=) and estimated date of confinement (EDC) required for
test interpretation.

AIDS ANTIBODY INSURANCE/VISA

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).


HIV1/HIV2/HIV antigen routinely performed.

AIDS SEROLOGY

Immunology

Blood/SS tube (extra SS tube 24 hours


if other tests requested)

ALA, URINE

Biochemistry

ALBUMIN, FLUID

Biochemistry

ALBUMIN, SERUM

Biochemistry

ALBUMIN, SYNOVIAL FLUID

Biochemistry

www.qml.com.au

Patient should rest for 20 minutes prior to testing. Note time of collection on
specimen and request form.

PATHOLOGY TESTS - A

TEST NAME
ADENOVIRUS SEROLOGY

Please refer to CATECHOLAMINES, URINE.

Assay run daily (Monday - Saturday). HIV1/HIV2/HIV antigen routinely performed.


Please refer to 5-ALA, URINE.

Fluid/Plain tube/Container

Same day

Specify site of fluid on specimen container and request form.


Please refer to E/LFT, SERUM.

Synovial fluid/
Plain plastic tube

Same day

Please provide clinical and medication details. Raised in joint inflammation.


Synovial fluid collection kits are provided on request.

Results (07) 3121 4555


7.4

7.4

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/Urine container.
No preservative

24 hours

ALBUMIN/GLOBULIN RATIO,
SYNOVIAL FLUID
ALBUTEROL, URINE

Biochemistry

Please refer to ALBUMIN, SYNOVIAL FLUID.

Biochemistry

Please refer to SALBUTAMOL, URINE.

ALCOHOL, SERUM
(BLOOD) LEGAL

Biochemistry

Blood/Fluoride
oxalate tube

By midday next
working day

Clean skin with aqueous chlorhexidine or water. Seal tops of tubes and sign across
label (see Biochemistry Preface 5.2). The specimens should be accompanied by Chainof-Custody documentation signed by both patient and collector. Forms are available
from QML Pathology on request. Please contact Biochemistry (07) 3121 4971 or
Branch Laboratory. Non Medicare refundable cost to patient.

ALCOHOL, SERUM
(BLOOD) NON-LEGAL

Biochemistry

Blood/Fluoride oxalate tube


(SS tube also acceptable
for non-legal)

Same day

Clean skin with aqueous chlorhexidine or water. If the possibility of a legallyrequired sample exists, an additional Fluoride oxalate tube should be collected.
This tube should be sealed as for a legally-required test (see Biochemistry Preface
5.2) accompanied by Chain-of-Custody documentation signed by both patient
and collector (available from QML Pathology on request). This will be stored and
if the medical result is required subsequently for legal purposes, the result will be
validated from the held specimen.

ALCOHOL, URINE
(NON-OCCUPATIONAL)

Biochemistry

Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER


CHROMATOGRAPHY), URINE.

ALDICARB (PESTICIDE),
BLOOD

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

ALDOLASE, SERUM

Biochemistry

Test for skeletal muscle injury. Refer to LACTATE DEHYDROGENASE (LD/LDH)


ISOENZYMES, SERUM.

ALDOSTERONE, SERUM

Endocrinology

www.qml.com.au

Blood/SS tube

24 hours

Test for progression of diabetic nephropathy. Please provide clinical and medication
details. An 8 hour overnight timed sample is the preferred specimen for this test
(i.e. void urine prior to retiring and collect all urine over the next 8 hours). PLEASE
PROVIDE START AND FINISH TIMES OF URINE COLLECTION. If specifically required,
a random sample or a 24 hour collection may be collected instead.

PATHOLOGY TESTS - A

TEST NAME
ALBUMIN, URINE

Aldosterone is a steroid hormone produced by the adrenal cortex. It promotes sodium


reabsorption, water retention, and potassium excretion. It is often measured in
conjunction with Renin in the investigation of causes of hypertension.

Results (07) 3121 4555


7.5

7.5

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

24 hour urine collection/


Urine collection bottle.
No preservative

1 week

Urine should be refrigerated during the collection period and transported cooled to
the laboratory.

ALDOSTERONE/RENIN RATIO,
PLASMA

Endocrinology

Blood/2 x EDTA tubes,


SS tube

24 hours

Special collection and handling of Renin specimen required.


Refer to RENIN, PLASMA.

ALDRIN (ORGANOCHLORINE
PESTICIDES), BLOOD
ALEPAM, SERUM

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Biochemistry

Please refer to OXAZEPAM, SERUM.

ALIPHATIC SOLVENTS

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

ALKALINE PHOSPHATASE
ISOENZYMES, SERUM

Biochemistry

Blood/SS tube

2 - 3 days

Test to determine nature of unexplained elevation of alk. phos.


Provide clinical and medication details.

ALKALINE PHOSPHATASE,
FLUID

Biochemistry

Fluid/Plain tube/
Container

Same day

Specify source of fluid on sample and request form.

7.6

ALKALINE PHOSPHATASE,
Biochemistry
SERUM
ALKAPTONURIA SCREEN, URINE Biochemistry
ALLEGRON, SERUM
Biochemistry

Please refer to E/LFT, SERUM.


Please refer to HOMOGENTISIC ACID, URINE.
Please refer to NORTRIPTYLINE, SERUM.

ALLERGEN-SPECIFIC IgE
(RAST), SERUM

Immunology

Blood/SS tube

72 hours

Assay run daily (Monday to Friday). Doctors can only order four allergens per
patient episode. Medicare will only pay for four episodes per patient per year.
A year is taken as a calendar year. For details of testing, allergens and Medicare
restrictions please refer to Immunology Preface (5.49) and Appendix (12.37) or
contact Immunology (07) 3121 4458 or Branch Laboratory.

ALLERGY SKIN TEST

Immunology

Skin Prick Test

72 hours

Test performed by appointment at our special test collection centres.


Please contact your local Branch Laboratory for locations.

ALLOPURINOL, PLASMA

Biochemistry

Please refer to OXYPURINOL, PLASMA for details.

ALODORM, SERUM

Biochemistry

Please refer to NITRAZEPAM, SERUM.

www.qml.com.au

PATHOLOGY TESTS - A

TEST NAME
ALDOSTERONE,
URINE 24 HOUR

Results (07) 3121 4555


7.6

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Haematology

Blood/Sodium
citrate tube

5 weeks

Please contact Haematology (07) 3121 4451 or your Branch Laboratory for details
before collection. Referred test. NOTE: This test is referred to Austin Hospital.
Inform patient that they will be charged a non-refundable fee of approx. $30 by
Austin Repatriation Hospital.

ALPHA SUBUNIT (FREE)

Endocrinology

Blood/SS tube

1 - 2 weeks

Referred test.

ALPHA THALASSAEMIA
GENE TESTING

Haematology

Blood/2 x EDTA tubes,


1 x SS tube

4 weeks

Incurs non-Medicare refundable fee.

ALPHA-1-ACID GLYCOPROTEIN,
SERUM

Biochemistry

Serum/SS tube

1 - 2 weeks

Please advise patient that this test attracts a non-Medicare refundable fee from the
referring laboratory. Transport at 4C.

ALPHA-1-ANTITRYPSIN
PHENOTYPE, SERUM
ALPHA-1-ANTITRYPSIN
PHENOTYPE/GENOTYPE,
PLASMA

Biochemistry
Biochemistry

Blood/EDTA tube

2 - 3 weeks

Deficiency predisposes to premature severe emphysema - genotype more useful in


family studies. Please provide clinical and medication details. Referred test.
Please advise patient that Genotype testing attracts a non-Medicare refundable fee
from the referring laboratory

ALPHA-1-ANTITRYPSIN,
FAECES

Biochemistry

Faeces/Faeces container

2 weeks

A marker for the detection of enteric protein loosing states. Freeze sample as soon as
possible after collection. Referred test.

ALPHA-1-ANTITRYPSIN,
SERUM

Biochemistry

Blood/SS tube

24 hours

Deficiency predisposes to premature severe emphysema. Please provide clinical


and medication details. If phenotyping is also required also collect 1 x EDTA tube.

ALPHA-1,4 GLUCOSIDASE,
BLOOD
ALPHA-2 MACROGLOBULIN,
SERUM
ALPHA-FOETOPROTEIN (AFP)
- TUMOUR MARKER, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - A

TEST NAME
ALPHA 2 ANTIPLASMIN

Please refer to ALPHA-1-ANTITRYPSIN PHENOTYPE/GENOTYPE, PLASMA.

Please refer to LYSOSOMAL ENZYMES, BLOOD.

Biochemistry

Blood/SS tube

1 - 2 weeks

Transport in esky at 4C. Referred test.

Endocrinology

Blood/SS tube

24 hours

Alpha foetoprotein is used as an aid in the management of patients with


nonseminomatous testicular carcinoma (embryonal carcinoma and yolk sac
carcinoma) and hepatocellular carcinoma. Please provide date and details of
previous AFP assay if patient is being monitored following treatment.

Results (07) 3121 4555


7.7

7.7

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Amniotic Fluid/
Amber sterile 10 mL Black
top tube

24 hours

Date of last normal menstrual period (LNMP), period of amenorrhoea (A=) and
estimated date of confinement (EDC) required.

ALPHA-FOETOPROTEIN (AFP),
SERUM

Endocrinology

Blood/SS tube

24 hours

Period of amenorrhoea (A=) and estimated date of confinement (EDC) required for
test interpretation.

ALPHA-FUCOSIDASE,
BLOOD
ALPHA-GALACTOSIDASE,
BLOOD
ALPHA-TOCOPHEROL,
SERUM
ALPRAZOLAM,
SERUM

Biochemistry

Please refer to LYSOSOMAL ENZYMES, BLOOD.

Biochemistry

Please refer to LYSOSOMAL ENZYMES, BLOOD.

Biochemistry

Please refer to VITAMIN E, SERUM.

ALT (GPT), SERUM

Biochemistry

ALT, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify source of fluid on sample and request form.

ALUMINIUM (AL), HAIR

Biochemistry

Hair/Dry sterile
screw cap (urine) container

4 weeks

Fill sterile container as full as possible with hair. Clippings from the patients last
hair cut can be used (should be at least 0.5 grams of hair). Referred test.
***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

ALUMINIUM, SERUM

Biochemistry

Blood/Trace element
free tube (e.g. navy top)

1 - 2 weeks

Test for aluminium accumulation generally in renal failure. Provide clinical and
medication details. Referred test.

ALUMINIUM, URINE

Biochemistry

Urine/Urine container

1 week

Fresh random collection required.

AMIKACIN, SERUM

Biochemistry

Blood/Lithium
heparin tube - no gel
or anticoagulant

3 days

Record the time and date of commencement of the last dose, and also the patients
normal dose on the request form. Please refer to Biochemistry Appendix (12.15).

www.qml.com.au

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant


(Lithium heparin
tube acceptable)

2 weeks

PATHOLOGY TESTS - A

TEST NAME
ALPHA-FOETOPROTEIN (AFP),
AMNIOTIC FLUID

Provide clinical and medication details. Record time and date of last dose.
Collect just prior to next dose. Please keep sample refrigerated.
Referred test.
Please refer to E/LFT, SERUM.

Results (07) 3121 4555


7.8

7.8

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Lithium
heparin tube

2 weeks

AMINO ACIDS, URINE


(CHROMATOGRAPHY)
AMINO ACIDS,
URINE (SCREEN)

Biochemistry

AMINO LAEVULINIC ACID,


URINE
AMINOPHYLLINE
PRE/POST DOSE, SERUM
AMINOPHYLLINE, SERUM

Biochemistry

Please refer to 5-ALA, URINE.

Biochemistry

Please refer to THEOPHYLLINE, SERUM.

Biochemistry

Please refer to THEOPHYLLINE, SERUM.

AMIODARONE, SERUM

Biochemistry

AMISULPRIDE, SERUM

Biochemistry

AMITRIPTYLINE, SERUM

Biochemistry

AMITROLE (HERBICIDE), URINE

Biochemistry

AML1-ETO RT-PCR

Genetics

www.qml.com.au

Biochemistry

Test for inborn errors of amino acid metabolism. Fasting samples are preferable.
SST serum is an acceptable alternative, although plasma is preferred. Centrifuge,
separate and FREEZE the sample where possible. If there is to be a delay of 2 hours
or more before transportation, sample MUST be frozen immediately. Referred test.
Please refer to AMINO ACIDS, URINE (SCREEN).

Random early morning


urine/Urine container

Blood/Plain plastic tube no gel (Plastic Lithium


heparin tube acceptable)

2 weeks

1 week

PATHOLOGY TESTS - A

TEST NAME
AMINO ACIDS, PLASMA

Test for inborn errors of amino acid metabolism. Random early morning urine
collection required. Please provide clinical and medication details. Refrigerate for
transfer to laboratory. If specifically requested, a 24 hour urine may be collected.
Referred test.

Collect immediately prior to next dose. Collect sample 8-12 hours after last dose
(preferably immediately before next dose). Please provide clinical and medication
details including time and date of last dose.
Please refer to SOLIAN, SERUM for details.

Blood/Plain plastic tube no gel (Plastic Lithium


heparin tube acceptable)

1 week

Collect immediately prior to next dose. Please provide clinical


and medication details including time and date of last dose.
Please refer to HERBICIDES, URINE.

Blood or Bone marrow/


EDTA tube or min.
1 mL bone marrow
in EDTA tube

1 month

Specimen needs to be received within 48 hours.

Results (07) 3121 4555


7.9

7.9

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/EDTA tube

Same day

Test for late stage liver disease. Collect FULL EDTA tube. Blood must be centrifuged
and separated IMMEDIATELY into a 2 mL tube (fill to top) then freeze immediately
for transmission to the laboratory.

AMMONIA (NH3), URINE

Biochemistry

24hr urine container.


No preservative

24 hours

Provide clinical and medication details. Refrigerate sample during collection and
transport to the laboratory.

AMMONIUM CHLORIDE
LOAD TEST

Biochemistry

AMNIOTIC FLUID,
CHROMOSOMES

Genetics

Amniotic fluid/2 x sterile


10 mL black top tubes

1 - 2 weeks

Average reporting time of 10 days.

AMOEBIC SEROLOGY

Immunology

Blood/SS tube

1 week

Assay run Wednesday.

AMPHETAMINES GCMS CONFIRMATION


AMPRENAVIR, PLASMA

Biochemistry
Biochemistry

Blood/EDTA tube

3 weeks

Plasma must be separated and frozen if sample will not reach the central
laboratory within 24 hours of collection. Please provide clinical and medication
details. Referred test.

AMYLASE, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Note fluid site on specimen container and request form.

AMYLASE, PLEURAL FLUID

Biochemistry

Pleural fluid/Plain tube

Same day

Test for pancreatic aetiology of pleural effusion. Please provide clinical and
medication detail. Refrigerate sample during storage and transport.

AMYLASE, SERUM

Biochemistry

Blood/SS tube

Same day

Test for acute pancreatitis. Please provide clinical and medication details.

AMYLASE, URINE

Biochemistry

Urine/24 hour urine


container with no
preservative or
Random urine container

Same day

Test for pancreatitis. Please provide clinical and medication details.


Refrigerate sample during storage and transport. Under rare circumstances
or if specifically requested, a random urine may be collected.

AMYLO-1,6-GLUCOSIDASE,
BLOOD

Biochemistry

Blood/Lithium
heparin tube

2 weeks

Please contact Biochemistry on (07) 3121 4420 to advise of expected time of


arrival, as sample must be referred to RBH on same day of collection.
Referred test.

ANA (ANTINUCLEAR ANTIBODY), Immunology


SERUM

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday). Please refer to Immunology Appendix (12.35)
for a comprehensive list of autoantibodies.

www.qml.com.au

Test for renal tubular acidosis. Contact House Collection (07) 3121 4450 or
Branch Laboratory for appointment.

PATHOLOGY TESTS - A

TEST NAME
AMMONIA, PLASMA

Please refer to SYMPATHOMIMETIC AMINES - GCMS CONFIRMATION.

Results (07) 3121 4555

7.10

7.10

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Microbiology

Aspirated pus/Anaerobic
transport medium

Up to 7 days

ANAFRANIL, SERUM

Biochemistry

ANCA (ANTI NEUTROPHIL


CYTOPLASMIC ANTIBODY),
SERUM
ANDROGEN INSENSITIVITY
SYNDROME GENETIC TESTING

Immunology

Blood/SS tube

72 hours

Assay run Monday, Wednesday, Friday.


Please provide relevant clinical history.

Genetics

Blood/EDTA tube

1 month

Please provide details regarding patients eligibility for Medicare rebate,


i.e. proven mutation. If no history, incurs fee to patient.

ANDROSTENEDIONE, SERUM

Endocrinology

Blood/SS tube

24 hours

Please provide clinical and medication details.

Blood/EDTA tube

1 - 2 months

Incurs non-Medicare refundable fee.

Blood/SS tube

2 - 3 weeks

Blood/SS tube

24 hours

Test for pulmonary sarcoidosis. Please provide clinical details.

Blood/2 x EDTA tubes,


SS tube

24 hours

Special collection and handling of renin specimen required.


Refer to RENIN, PLASMA.

7.11

ANGELMAN SYNDROME
Genetics
DNA TESTING
ANGIOSTRONGYLUS SEROLOGY Immunology
ANGIOTENSIN CONVERTING
Biochemistry
ENZYME, SERUM
ANGIOTENSIN/RENIN RATIO,
Endocrinology
PLASMA

Please provide clinical details including site of collection and antibiotic therapy. Note if
history of chronic infection. Refer to Microbiology Preface (5.51) for collection details.
Please refer to CLOMIPRAMINE, SERUM.

ANTI D SCREEN
AND INJECTION

Blood Bank

Blood/Pink top
EDTA tube

24 hours
and urgently

Blood sample for antibody screen should be drawn before Anti-D injection. Record
date Anti-D injection given.

ANTI DOUBLE-STRANDED
DNA ANTIBODY, SERUM

Immunology

Blood/SS tube

72 hours

Assay run daily (Monday to Friday). Please refer to Immunology Appendix (12.35)
for comprehensive list of circulating Autoantibodies.

ANTI IGA ANTIBODY

Immunology

Blood/SS tube

4 weeks

ANTI MICROSOMAL ANTIBODY


(THYROID), SERUM
ANTI MULLERIAN HORMONE,
SERUM

Endocrinology

Blood/SS tube

24 hours

Biochemistry

Blood/SS tube

2 weeks

ANTI NEURONAL ANTIBODY

Immunology

Blood/SS tube

2 - 3 weeks

www.qml.com.au

PATHOLOGY TESTS - A

TEST NAME
ANAEROBIC CULTURE
FOR ACTINOMYCES

Transport to central laboratory on dry ice. There is currently no Medicare rebate for
this test. Referred test.

Results (07) 3121 4555

7.11

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

72 hours

Endocrinology

Blood/SS tube

24 hours

Endocrinology

Blood/SS tube

24 hours

ANTI THYROID PEROXIDASE


ANTIBODY, SERUM
ANTI-BETA2 GLYCOPROTEIN I
ANTIBODY
ANTIBIOTIC RESISTANT
ORGANISMS

Endocrinology

Blood/SS tube

24 hours

Immunology

Blood/SS tube

2 - 4 weeks

Microbiology

Rectal swab/Rectal swab


in transport medium

48 hours

ANTIBODIES TO EXTRACTABLE
NUCLEAR ANTIGENS (ENA),
SERUM
ANTIBODIES TO MICROBIAL
AND PARASITIC AGENTS,
SERUM

Immunology

Blood/SS tube

48 hours

Assay run daily (Monday to Friday). Please refer to Immunology Appendix (12.35)
for a full list of Extractable Nuclear Antigens.

Immunology

Blood/SS tube

Variable from 24
hours to weeks
depending on
agent requested

Please refer to Immunology Appendix (12.36) for a comprehensive list of antibodies


to microbial and parasitic agents. It is a Medicare requirement that microbial and
parasitic agents be listed individually on the request form. For enquiries please
contact Immunology (07) 3121 4458 or Branch Laboratory.

ANTIBODIES TO TISSUE
ANTIGENS (AUTOANTIBODIES),
SERUM

Immunology

Blood/SS tube

Variable from 24
hours depending
on antibody tests
required

Please refer to Immunology Appendix (12.35) for a comprehensive list of


autoantibody tests available. It is a Medicare requirement that autoantibodies
required for testing should be listed individually on the request form. For enquiries
please contact Immunology (07) 3121 4458 or Branch Laboratory.

ANTIBODY SCREEN/TITRE,
SERUM

Blood Bank

Blood/Pink top
EDTA tube

24 hours

If history of antibodies or transfusion complications collect additional 6 mL plain


plastic tube (red top). Record estimated date of confinement (EDC) for antenatal
patients. If associated with Anti-D injection, collect blood sample prior to injection.

ANTI-CYCLIC CITRULLATED
PEPTIDE (CCP) ANTIBODY

Immunology

Blood/SS tube

72 hours

Assay run Monday and Thursday. Next day results.

www.qml.com.au

Please provide relevant clinical history.


Assay run Monday, Wednesday, Friday.

Measure antimicrosomal and antithyroglobulin antibodies


(Thyroid Tissue Antibodies).

Results (07) 3121 4555

PATHOLOGY TESTS - A

TEST NAME
ANTI NEUTROPHIL
CYTOPLASMIC ANTIBODY
(ANCA), SERUM
ANTI THYROGLOBULIN
ANTIBODY, SERUM
ANTI THYROID ANTIBODIES,
SERUM

7.12

7.12

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/4 x EDTA tubes

2 - 3 weeks

ANTI-GQ1B ANTIBODY

Immunology

Blood/SS tube

2 - 3 weeks

ANTI-HU ANTIBODIES

Immunology

Blood/SS tube

2 - 3 weeks

ANTIMONY (Sb), BLOOD

Biochemistry

Blood/Lithium
heparin tube (EDTA
tube acceptable)

4 weeks

Please provide clinical and medication details.


Urine is the preferred sample for exposure. Referred test.

ANTIMONY (Sb), URINE

Biochemistry

Urine/Urine container

4 weeks

This is the preferred sample for exposure. A random sample is required.


Please provide clinical and medication details. Referred test.

ANTINUCLEAR
ANTIBODY (ANA), SERUM

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday to Saturday). Please refer to Immunology Appendix


(12.35) for a comprehensive list of autoantibodies.

ANTIOXIDANTS, BLOOD

Biochemistry

Blood/SS tube or
Lithium heparin tube

4 weeks

The sample must arrive at the main laboratory by 2:30pm on the same day.
Please contact Biochemistry Department to notify of expected time of arrival
(07) 3121 4420. This is a non-Medicare rebate test.
Please contact the laboratory for current charge for this assay. Referred test.

ANTISPERM ANTIBODIES
(INDIRECT IMMUNOBEAD
TEST - IBT)

Genetics

Female - Blood/SS tube,


Male - Blood/SS tube and/
or Seminal plasma

Test performed
fortnightly

Assay dependent on normal semen for substrate.


Test performed when normal semen available.

www.qml.com.au

Collect into the chilled EDTA tubes. Invert to mix and keep cold (4C) in transit to
arrive in Endocrinology within 24 hours of collection. If >24 hours spin EDTA tubes
and separate plasma and transport on ice. Referred test. There is currently no
Medicare rebate for this test.

Results (07) 3121 4555

PATHOLOGY TESTS - A

TEST NAME
ANTIDIURETIC
HORMONE (ADH), PLASMA

7.13

7.13

PATHOLOGY TESTS - A

PATHOLOGY TESTS

TEST NAME
ANTITHROMBIN III

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Haematology

Blood/Sodium
citrate tube

24 hours

Transport at 4C. Must reach laboratory within 2 hours of collection.


PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW.
Thrombotic assay requests are only Medicare refundable if one of the following is
stated on the request form by the patients doctor:
1. That the patient has a personal history of venous thromboembolism (DVT) or
arterial thrombosis (PE);
2. That a first degree relative of the patient has a proven defect in one or more of
the thrombotic test(s) requested and that the particular defect(s) are stated on
the request form; or
3. That the request is to confirm an abnormal or indeterminate result.

PATHOLOGY TESTS - A

PATHOLOGY TESTS - A

PATHOLOGY TESTS

IF THE REQUEST IS NOT REFUNDABLE BECAUSE OF THE ABOVE CONDITIONS, THE


PATIENT WILL BE CHARGED A NON-REFUNDABLE AMOUNT. PLEASE INFORM THE
PATIENT IF THE TESTING WILL RESULT IN AN ACCOUNT BEING SENT TO THE PATIENT.
ANTITHROMBIN III, PLASMA

Haematology

Blood/Sodium
citrate tube

24 hours

Please provide details of thrombotic history of patient and family members and
any anticoagulant therapy. Must reach laboratory within 2 hours of collection.

APC
(ACTIVATED PROTEIN C RESISTANCE)

Haematology

Blood/EDTA tube and


Sodium citrate tube

24 hours

Specimens should be stored and transported cooled. They must reach the laboratory
within 2 hours of collection. A history of thromboembolism or a proven APC defect in a
first degree relative must be stated on the request form to attract the Medicare rebate.
PLEASE NOTE RESTRICTIONS ON MEDICARE REBATES BELOW.
Thrombotic assay requests are only Medicare refundable if one of the following is
stated on the request form by the patients doctor:
1. That the patient has a personal history of venous thromboemblism (DVT) or
arterial thrombosis (PE);
2. That a first degree relative of the patient has a proven defect in one or more of
the thrombotic test(s) requested and that the particular defect(s) are stated on
the request form; or
3. That the request is to confirm an abnormal or indeterminate result.

www.qml.com.au

Results (07) 3121 4555

7.14

7.14

IF THE REQUEST IS NOT REFUNDABLE BECAUSE OF THE ABOVE CONDITIONS, THE


PATIENT WILL BE CHARGED A NON-REFUNDABLE AMOUNT. PLEASE INFORM THE
PATIENT IF THE TESTING WILL RESULT IN AN ACCOUNT BEING SENT TO THE PATIENT.

DEPARTMENT
Biochemistry

Please refer to APOLIPOPROTEIN A1, SERUM.

APO B, SERUM

Biochemistry

Please refer to APOLIPOPROTEIN B, SERUM.

APOLIPOPROTEIN A1, SERUM

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details.

APOLIPOPROTEIN B, SERUM

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details.

APOLIPOPROTEIN B100, SERUM Biochemistry


APOLIPOPROTEIN E
Genetics
GENOTYPING

Blood/SS tube

2 weeks

Please provide clinical and medication details.

Blood/Pink top
EDTA tube

1 week

Incurs non-Medicare refundable fee.


Transport at room temperature or cooled.

APOLIPOPROTEIN STUDIES,
SERUM
APTT (COAGULATION PROFILE)

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details.

Haematology

Blood/Sodium
citrate tube

Same day

Also refer to COAGULATION STUDIES. If for Warfarin care please refer to


Haematology Appendix (12.32) for further information.

APTT: HEPARIN THERAPY,


BLOOD

Haematology

Blood/Sodium citrate
and EDTA tubes

Same day

Please provide clinical and medication details. Transport to laboratory


within 2 hours of collection. Monday to Wednesday only.

ARBOVIRUS ISOLATION,
BLOOD, SYNOVIAL FLUID, CSF

Immunology

Blood/SS tube,
Other fluids/
Sterile container

Days to weeks

Clinical details including date of onset of illness and clinical findings should
accompany the specimen. Material for isolation should be collected aseptically and
kept under sterile conditions. Specimen should be frozen and kept frozen during
storage and transportation.

ARBOVIRUS SEROLOGY

Immunology

Blood/SS tube

24 hours

Available serology includes Ross River Virus, Barmah Forest Virus and Dengue virus.
(Refer to Immunology Appendix (12.37) for a full list.) It is a Medicare requirement that
viruses be listed individually on the request form. Blood samples should be taken on
presentation and 14 to 21 days after disease onset. Assay run daily (Monday to Friday).

ARGININE
GROWTH HORMONE
STIMULATION TEST

Endocrinology

Blood/SS tube

24 hours

This test involves an infusion of arginine and an injection of insulin.


A series of blood samples are collected over 2-3 hours and tested for cortisol,
growth hormone and glucose. Please contact Branch Laboratory for appointment,
Endocrinology (07) 3121 4439 for details.

ARGININE/INSULIN
GROWTH HORMONE
STIMULATION TEST

Endocrinology

Blood/SS tube

24 hours

This test involves an infusion of arginine and an injection of insulin. A series


of blood samples are collected over 2-3 hours and tested for cortisol, growth
hormone and glucose. Please contact Branch Laboratory for appointment,
Endocrinology (07) 3121 4439 for details.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Results (07) 3121 4555

PATHOLOGY TESTS - A

TEST NAME
APO A1, SERUM

7.15

7.15

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant

4 weeks

AROMATIC SOLVENTS

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

ARSENIC - INORGANIC, URINE

Biochemistry

Please refer to INORGANIC ARSENIC, URINE.

ARSENIC, BLOOD

Biochemistry

Blood/Lithium
heparin tube (EDTA
tube acceptable)

4 weeks

Test for current toxicity. Provide clinical and medication details.


Do not separate sample. Referred test.

ARSENIC, HAIR

Biochemistry

Hair/Dry sterile container

4 weeks

Test for exposure in the past. Please provide exposure and occupation details.
For long term exposure, collect enough hair to half fill container (0.2 - 0.4 grams).
Referred test.
***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

ARSENIC, NAIL

Biochemistry

Toe and fingernail clippings/


Dry sterile container

4 weeks

Test for exposure in the past. Please provide exposure and occupation details.
Cut clean finger and toe nails. Referred test.

ARSENIC, URINE

Biochemistry

Urine/Urine container

1 week

Test for exposure not necessarily toxic. Please provide clinical and medication details.
A random collection is preferred. A 24 hour specimen (with no preservative) should
only be collected if specifically requested by the referring doctor. Referred test.

ARYL SULPHATASE A,
LEUCOCYTES
ASCA (ANTI-SACCROMYCES
CEREVISEIA ANTIBODY)
ASCITIC FLUID BIOCHEMISTRY

Biochemistry

ASCORBIC ACID, SERUM

Biochemistry

ASHPLEX 1, BLOOD

Biochemistry

Blood/EDTA tube

4 weeks

Transport at 4C. Referred test.

ASHPLEX 2, BLOOD

Biochemistry

Blood/EDTA tube

4 weeks

Transport at 4C. Referred test.

ASHPLEX CF, BLOOD

Biochemistry

Blood/EDTA tube

4 weeks

Transport at 4C. Referred test.

ASOT (ANTI STREPTOLYSIN O


TITRE), SERUM

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

www.qml.com.au

Provide clinical and medication details. Transport to central laboratory on ice.


Referred test.

PATHOLOGY TESTS - A

TEST NAME
ARIPIPRAZOLE, SERUM

Please refer to LYSOSOMAL ENZYMES, BLOOD.

Immunology

Blood/SS tube

3 - 4 weeks

Biochemistry

Fluid/Sterile container

Same day

Please provide clinical and medication details, and tests required.


Please refer to VITAMIN C, SERUM.

Results (07) 3121 4555

7.16

7.16

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

ASPIRIN, SERUM

Biochemistry

Please refer to SALICYLATE, SERUM.

AST (SGOT), SERUM

Biochemistry

Please refer to E/LFT, SERUM.

AST, FLUID

Biochemistry

ATRIAL NATRIURETIC PEPTIDE,


PLASMA

Biochemistry

ATYPICAL ANTIBODIES, BLOOD

Blood Bank

Blood/Pink top EDTA tube

24 hours

If history of antibodies or transfusion complications collect additional 6 mL plain


plastic tube. Record estimated date of confinement (EDC) for antenatal patients.

ATYPICAL
MYCOBACTERIA MICROSCOPY
AND CULTURE

Microbiology/
Histology

Tissue, sputum, pus/Dry


sterile screw top (urine)
container (NO formalin)

Microscopy same day.


Culture - majority
provisionally
identified within
2 weeks
(up to 12 weeks).

If infection by atypical Mycobacteria is suspected in a tissue specimen (e.g. skin)


indicate suspicion and submit specimen in a dry, sterile screw top container (NO
formalin). The laboratory will process for both culture and histology. Note: Tissue
is essential for Histology. Tissue is preferable to pus. Sputum - 3 consecutive early
morning specimens.

AUSTRALIAN (MURRAY VALLEY) Immunology


ENCEPHALITIS
VIRAL SEROLOGY
AUSTRALIAN BAT LYSSAVIRUS Immunology
SEROLOGY

Blood/SS tube

2 weeks

Referred test.

Blood/SS tube

2 - 3 weeks

Please provide details of clinical history and exposure, including species of bat.
Referred test.

AUTOANTIBODY TEST, SERUM

Blood/SS tube

Variable from
24 hours
depending on
antibody tests
required

Please refer to Immunology Appendix (12.35) for a comprehensive list of


autoantibody tests available. It is a Medicare requirement that autoantibodies
required for testing should be listed individually on the request form. For enquiries
please contact Immunology (07) 3121 4458 or Branch Laboratory.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry
Immunology

Immunology

Please refer to VITAMIN B6, BLOOD for details.


Blood/SS tube

Fluid/Plain tube/Container

1 week

Same day

Assay run Monday. 24 hour results.

PATHOLOGY TESTS - A

TEST NAME
ASPARTATE TRANSAMINASE,
RED CELL
ASPERGILLUS SEROLOGY

Specify source of fluid on sample and request form.


This test in currently unavailable.
Please refer to BNP, PLASMA.

Results (07) 3121 4555

7.17

7.17

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Microbiology

AUTOCLAVE TEST VIAL


x 7 (NB: All must have
the same lot number.)

48 hours

AUTOPSY (ADULT/CHILDREN/
NEONATES)

Histology

AVIAN PRECIPITINS SEROLOGY

Immunology

AZINPHOS (PESTICIDE),
SERUM

Biochemistry

www.qml.com.au

The autoclave test vials are collected from the surgery after autoclaving. A complete
autoclave validation request form must be completed and submitted with the vial.
Please contact the Microbiology Department (07) 3121 4438 for vials and request books.
Laboratory not accredited for this service. Contact Forensic and Scientific Services
(formerly Queensland Health Scientific Services) John Tonge Centre (07) 3274 9111.

Blood/SS tube

3 - 4 weeks

Referred test.

PATHOLOGY TESTS - A

TEST NAME
AUTOCLAVE VALIDATION TEST
WITH BIOLOGICAL INDICATORS

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

Results (07) 3121 4555

7.18

7.18

PATHOLOGY TESTS - A

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

2 weeks

BARBITURATES SCREEN,
SERUM
BARBITURATES SCREEN,
URINE

Biochemistry

Please refer to DRUG SCREEN, SERUM.

Biochemistry

Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER


CHROMATOGRAPHY), URINE.

BARMAH FOREST VIRUS


SEROLOGY
BASEMENT MEMBRANE ZONE
(BMZ) ANTIBODY/PEMPHIGOID
ANTIBODY, SERUM
BASUDIN (PESTICIDE), SERUM

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Immunology

Blood/SS tube

2 weeks

Skin biopsies for immunofluorescence and histology advised.


Please refer to Histology Preface (5.38) for details.

B-CELL (IgH) GENE


REARRANGEMENT STUDIES

Genetics

Blood or Bone marrow/Pink


top EDTA tube, or bone
marrow or lymph node or
tumour

2 weeks

Incurs non-Medicare refundable fee.


Transport at room temperature or cooled.

BCL-1 [t(11;14)]
DNA TESTING

Genetics

EDTA Blood, bone marrow,


lymph node, aspirate, tissue

2 weeks

Incurs non-Medicare refundable fee.

BCL-2 [t(14;18)]
DNA TESTING

Genetics

EDTA Blood, bone marrow,


lymph node, aspirate, tissue

2 weeks

Incurs non-Medicare refundable fee.

BCR-ABL [t(9;22)] FISH

Genetics

1 - 2 days
Blood or Bone marrow/
Lithium heparin tube or min.
1mL bone marrow in Lithium
heparin tube

BCR-ABL [t(9;22)] RQ-PCR

Genetics

Blood and/or
Bone marrow/Pink top EDTA
tube and/or min. 1mL bone
marrow in EDTA tube

www.qml.com.au

Biochemistry

PATHOLOGY TESTS - B

TEST NAME
B2 GLYCOPROTEIN

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity. Referred test.

2 weeks

Please send to the laboratory without delay.

Results (07) 3121 4555

7.19

7.19

PATHOLOGY TESTS - B

PATHOLOGY TESTS

DEPARTMENT

BENDIOCARB (PESTICIDE),
BLOOD

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

BENZENE, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.


For Urine - see HIPPURIC ACID, URINE.

BENZODIAZEPINES GCMS CONFIRMATION

Biochemistry

Urine/Urine drug screen


collection kit with tamper
evident packaging

48 hours

This is requested in cases concerned with occupational drug screening for drugs of
abuse. The QML Pathology protocol complies with Standards Australia AS/NZS4308
for the assay of cannabinoids, opiates, cocaine metabolites, benzodiazepines and
sympathomimetic amines. A Chain-of-Custody form should be completed. Additional
classes (methadone, barbiturates, alcohol) should be specifically requested if
required. Please also refer to the Biochemistry Preface (5.4). Confirmation and
quantitation by GCMS of positive findings may be requested separately.

BENZODIAZEPINES SCREEN,
URINE

Biochemistry

Urine/Urine drug screen


collection kit with tamper
evident packaging

48 hours

Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER


CHROMATOGRAPHY), URINE.

BERYLLIUM (Be), BLOOD

Biochemistry

Blood/EDTA tube

2 weeks

Please provide details of exposure (clinical and occupational).

BERYLLIUM (Be), URINE

Biochemistry

Urine/24 hour urine


collection in acid washed
container. Random urine
container

2 weeks

Test for recent exposure. Consultation with referring laboratory required before
collection. Phone Biochemistry on (07) 3121 4420 or Branch Laboratory for
details. Provide details of exposure (clinical and occupational). An early morning
spot urine should be collected for initial screening. Follow-up testing should be
performed on a 24 hour urine collection. Keep cool. Referred test.

BETA GALACTOSIDASE,
BLOOD

Biochemistry

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to DYSTROPHIN GENE ANALYSIS, BLOOD.

Biochemistry

Please refer to FREE LIGHT CHAINS, SERUM.

Biochemistry

Urine/Urine container or
24 hours
24 hour urine container with
no preservative - random or
24 hour only

Component of testing for myeloma. Qualitative test. Please provide clinical


and medication details. A random collection is preferred. Do not collect in acid
preservative. Urine should be refrigerated during the collection period and
transported cooled to the laboratory.

PATHOLOGY TESTS - B

TEST NAME
BECKER MUSCULAR
DYSTROPHY, BLOOD
BENCE JONES PROTEIN,
SERUM
BENCE JONES PROTEIN,
URINE

Please refer to LYSOSOMAL ENZYMES, BLOOD.

Results (07) 3121 4555

7.20

7.20

PATHOLOGY TESTS - B

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/SS tube

24 hours

Note date of last normal menstrual period (LNMP), period of amenorrhoea (A=) and
estimated date of confinement (EDC).

BETA HCG - TUMOUR MARKER,


SERUM

Endocrinology

Blood/SS tube

24 hours

-HCG can be used as a tumour marker for trophoblastic disease (hydatidiform


mole, invasive mole, persistent mole, partial hydatidiform mole, placental site
trophoblastic tumour and gestational choriocarcinoma). Complete obstetric history
is essential for result interpretation. Elevated levels are also seen in both ovarian
and testicular germ cell tumours and some breast carcinomas. When used in
conjunction with AFP, -HCG may prove useful in assessing prognosis, monitoring
therapy and detecting recurrence of gonadal germ cell neoplasms.

BETA HCH, (ORGANOCHLORINE


PESTICIDE), BLOOD
BETA HYDROXYBUTYRATE,
PLASMA
BETA-2 MICROGLOBULIN,
SERUM
BETA-2 MICROGLOBULIN,
URINE
BETA-2 TRANSFERRIN, FLUID

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Biochemistry

Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA.

Biochemistry

Please refer to TAU PROTEIN, FLUID.

BETA-ALANINE, SERUM OR
URINE 24 HOUR

Biochemistry

For serum please refer to AMINO ACIDS, PLASMA.


For urine please refer to AMINO ACIDS, URINE. Referred test.

BICARBONATE, FLUID

Biochemistry

BICARBONATE, SERUM

Biochemistry

BILE ACIDS, SERUM

Biochemistry

Blood/SS tube

2 weeks

Test for cholestasis. Please provide clinical and medication details. A fasting
sample is necessary to provide consistency for clinical interpretation. Keep cool
and transport at 4C. Referred test.

BILE PIGMENTS, URINE

Biochemistry

Urine/Urine container

Same day

Test for conjugated hyperbilirubinaemia or in investigation of pigmenturia.


Fresh random sample required. Please provide clinical and medication details.
Protect sample from light.

www.qml.com.au

Biochemistry

Blood/SS tube

24 hours

Assay run daily (Monday - Friday). Provide clinical and medication details.

Biochemistry

Urine/Urine container

2 weeks

Transport at 4C.

Fluid/Plain tube/Container

Same day

PATHOLOGY TESTS - B

TEST NAME
BETA HCG - QUANTITATIVE,
SERUM

Specify source of fluid on sample and request form.


Please refer to E/LFT, SERUM.

Results (07) 3121 4555

7.21

7.21

PATHOLOGY TESTS - B

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/SS tube

Same day

Protect sample from light.

Biochemistry

Blood/SS tube or
Paediatric SS tube

Same day

Test for neonatal liver disease, high red cell turnover, breast milk jaundice, etc.
Please provide clinical details. Heel prick or venipuncture sample. Paediatric
container must be at least half full. Protect sample from light.

BILIRUBIN,
AMNIOTIC FLUID

Biochemistry

Amniotic fluid/
Plain plastic tube

Same day

Test for fetal liver disease, high red cell turnover, etc.
Protect from light (wrap in foil or brown paper).

BILIRUBIN, CORD BLOOD

Biochemistry

Cord blood/SS tube


or plain tube

Same day

Test for fetal liver disease, high red cell turnover, etc.
Please provide clinical details. Protect sample from light.

BILIRUBIN, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Test for haematoma source. Protect sample from light and specify source/nature of
fluid on both sample and form.

BILIRUBIN, SERUM

Biochemistry

Protect sample from light. Please refer to E/LFT, SERUM.

BILIRUBIN, URINE

Biochemistry

Please refer to BILE PIGMENTS, URINE for details.

BIOCHEMISTRY, CSF

Biochemistry

CSF/Plain tube

Same day

BIOPSY TISSUE
FOR MICROSCOPY
AND CULTURE

Microbiology

Sterile dry container


(not in formalin)

Please provide clinical details including site and antibiotic therapy.


Interim
microscopy report Specify if specimen is to be cultured for fungi, Mycobacteria or exotic organisms
same day. Interim (Actinomyces, Nocardia, etc). Prompt transport to the laboratory is essential.
culture report
48 hours. Final
culture report in
5 days.

BIOPTERIN, URINE

Biochemistry

BIOTINIDASE, PLASMA

Biochemistry

BISCODYL, FAECES

Biochemistry

BISMUTH, BLOOD

Biochemistry

Blood/EDTA tube

2 weeks

BK VIRUS

Immunology

Blood and urine/SS tube


and Urine container

2 - 3 weeks

www.qml.com.au

PATHOLOGY TESTS - B

TEST NAME
BILIRUBIN (CONJUGATED/
DIRECT), SERUM
BILIRUBIN (NEONATAL),
SERUM

Please provide clinical and medication details and indicate individual tests required.
Treat sample with priority.

Please refer to PTERINS, URINE for details. Referred test.


Blood/Lithium
heparin tube

2 weeks

Referred test.
Please refer to LAXATIVES, FAECES.
Test for exposure. Referred test.

Results (07) 3121 4555

7.22

7.22

PATHOLOGY TESTS - B

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Cytology

Fluid/Appropriate sterile
container

24 hours

For specimen preparation please refer to Cytology Preface (5.16).

BLEEDING STUDIES

Haematology

Same day

Refer to COAGULATION STUDIES.

BLEEDING TIME

Haematology

Same day

Please contact Haematology (07) 3121 4451 or Branch Laboratory.

BLOOD COAGULATION STUDIES Haematology

Blood/3 Sodium Citrate


tubes, 1 EDTA tube, 1 blood
film prepared at
time of collection

Same day

Studies include Platelet count, Prothrombin time, APTT and Fibrinogen.


Please specify if a bleeding time is required. Transport to laboratory within 4 hours.
Please provide clinical and medication details.

BLOOD CROSSMATCH

Blood Bank

Blood/Pink top
EDTA tube

Same day or
urgently

If history of antibodies or transfusion complications collect additional 10 mL plain


plastic tube. Note special requests (e.g. irradiated/CMV negative). Crossmatch
must be signed by patient or collector to verify patient identity. Complete blue box
on request form, collector to sign Certification statement.

BLOOD CULTURE FOR MAC/


MAIC/MYCOBACTERIA

Microbiology

Blood/Blood culture bottles.


For small blood volumes
(5 mL or less) use a
paediatric bottle - see
Microbiology Preface (5.35).
Blood cultures for
Mycobacteria require
2 x Bact/Alert MB bottles

Interim report
after 2 days.
Final report
after 7 days.
Mycobacteria
report after 6
weeks.

Please contact Microbiology (07) 3121 4438 or Branch Laboratory for


details of collection methods for Mycobacteria and Fungi. Indicate recent
history of antibiotics.

BLOOD GASES, ARTERIAL

Biochemistry

Arterial blood/
Blood gas syringe

Same day

Test for respiratory disease, acid/base imbalance.


Please refer to Biochemistry Preface (5.1) and Appendix (12.19).

BLOOD GASES, VENOUS

Biochemistry

Venous Blood/Blood
gas syringe

Same day

Please refer to Biochemistry Preface (5.1) and Appendix (12.19).

BLOOD GROUP

Blood Bank

Blood/Pink top
EDTA tube

24 hours

The volume of blood in the EDTA sample tube should be not less than 4 mL.
If a full blood count or haemoglobin is required use a lavender top EDTA tube
for haematology.

BLOOD GROUP
AND COOMBS TEST

Blood Bank

Blood/Pink top
EDTA tube

Same day

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - B

TEST NAME
BLADDER WASHINGS,
CYTOLOGY

7.23

7.23

PATHOLOGY TESTS - B

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Blood Bank

Blood/Pink top
EDTA tube

24 hours

If history of antibodies or transfusion complications collect additional 6 mL plain


plastic tube. Record estimated date of confinement (EDC) for antenatal patients.

BLOOD GROUP GENOTYPE

Blood Bank

Blood/Pink top
EDTA tube

24 hours

Please indicate reason for genotyping request


(e.g. possibility of fetal or neonatal haemolysis).

BLOOD GROUP PHENOTYPE

Blood Bank

Blood/Pink top
EDTA tube

24 hours

Please indicate reason for phenotyping request.

BLOOD TRANSFUSION
REACTION INVESTIGATION,
BLOOD AND URINE

Blood Bank

Blood/Plain plastic tube,


EDTA tube. Urine/Urine
container

Same day

Obstetric, transfusion and drug history essential. Sample of first urine voided
post reaction. Please forward ALL transfused and partly transfused blood bags
to the laboratory.

BLOOD VOLUME STUDIES

Haematology

Blood/Sterile vials
available on request
from Haematology

24 hours

Appointment required. This test MUST NOT be performed on children, pregnant or


breast feeding women. Please contact Haematology (07) 3121 4451 or Branch
Laboratory for details.

BNP, PLASMA

Biochemistry

Blood/EDTA tube

Same day

Please provide clinical and medication details.


Keep sample cool and transport to the laboratory without delay.

BODY FLUID MICROSCOPY


AND CULTURE

Microbiology

Body fluid/Sterile container

Interim
Please provide clinical details including antibiotic therapy and specify if specimen
microscopy report is to be cultured for fungi and/or mycobacteria. Transport cooled to laboratory as
same day. Culture soon as possible.
report 48 hours

BOLVIDON, SERUM

Biochemistry

BONE MARROW CULTURE

Microbiology

Bone marrow aspirate/


Sterile container

Interim report after Please provide clinical details including antibiotic therapy.
48 hours. Final
Specimen will be cultured for Mycobacteria and fungi.
report 21 days.

BONE MARROW EXAMINATION

Haematology

Bone marrow aspirate,


trephine and smears/
Appropriate containers

24 hours

Please contact Haematology (07) 3121 4573 or Branch Laboratory for


appointment. Refer to Haematology Preface (5.33) for specimen collection
and preparation details.

BONE MINERALS, SERUM

Biochemistry

Blood/SS tube

Same day

Please request individual tests. (Usually Calcium and Phosphate). Medicare


requires that the individual tests be written on the request form.

BONE RESORPTION MARKER,


URINE

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - B

TEST NAME
BLOOD GROUP ANTIBODIES

Please refer to MIANSERIN, SERUM.

Please refer to N-TELOPEPTIDE, URINE.

Results (07) 3121 4555

7.24

7.24

PATHOLOGY TESTS - B

PATHOLOGY TESTS

PATHOLOGY TESTS - B

TEST NAME
BONE SPECIFIC ALKALINE
PHOSPHATASE
BORDETELLA PERTUSSIS PCR

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/SS tube

1 week

Immunology

Nasopharyngeal aspirate or
Nasopharyngeal swab (dry)

24 hours

Assay run daily (Monday - Friday).

BORDETELLA PERTUSSIS
SEROLOGY
BORON, URINE

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Biochemistry

Urine/Urine container

1 - 2 weeks

Random urine sample. This test attracts a non-Medicare refundable fee from the
reference laboratory, so prior arrangement by the doctor or employer must be
given. Referred test.

BOWEL TUMOUR MARKERS


(CA 19-9, CEA), SERUM

Endocrinology

Blood/SS tube

24 hours

Inflammatory or neoplastic conditions of mucinous epithelium - see Biochemistry


Appendix (12.4).

BRAIN NATRIURETIC PEPTIDE,


PLASMA
BRATTON-MARSHALL TEST,
URINE
BREAST CANCER GENETIC
TESTING (BRCA1 BRCA2)

Biochemistry

Blood/EDTA tube

Same day

Please refer to BNP, PLASMA.

Genetics

Blood/EDTA tube

Indeterminate

Genetic counselling is required before the blood specimen can be taken. Genetic
counselling is available from Genetic Health Queensland at the Royal Brisbane
Hospital on (07) 3636 1686.

BREAST CYST
ASPIRATE CYTOLOGY

Cytology

Fluid and/or Smear/


Sterile container and
slide carrier x 2

24 hours

For specimen preparation please refer to Cytology Preface (5.16).

BREAST FNA CYTOLOGY

Cytology

Fixed and air dried


smears/Needle and
syringe/Needle rinsings

24 hours

For specimen preparation please refer to Cytology Preface (5.16).

BREAST TUMOUR MARKER


(CA 15-3), SERUM

Endocrinology

Blood/SS tube

24 hours

Breast Carcinoma - see Biochemistry Appendix (12.4).

www.qml.com.au

Biochemistry

Please refer to SAICAR, URINE.

Results (07) 3121 4555

7.25

7.25

PATHOLOGY TESTS - B

PATHOLOGY TESTS

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Expired air samples

48 hours

BREATH HYDROGEN (SINGLE)

Biochemistry

Expired air samples

48 hours

BREATH TEST
(CARBON - 14 UREA) FOR
HELICOBACTER PYLORI

Endocrinology

1 glass vial containing CO2


trapping liquid.

24 hours

It is preferred for the patient to fast before the test, but not necessary. A test dose
is ingested and mouth is rinsed. 20 minutes later, a breath sample is collected in a
glass vial containing CO2 trapping liquid. The glass vial is identified by name, sealed,
placed in a plastic bag and transported cooled to the laboratory where the activity of
the trapped labelled CO2 is measured. Appointment is required for test.

BROMIDE,
BLOOD and SERUM

Biochemistry

Blood/Lithium heparin
serum/SS tube

4 weeks

Referred test.

BROMIDE, URINE

Biochemistry

Urine/Urine container

4 weeks

Test for occupational exposure. Please provide details of exposure (clinical and
occupational). A random collection is preferred. Referred test.

BROMINAL (HERBICIDE), URINE

Biochemistry

BRONCHIAL BRUSHING
CYTOLOGY

Cytology

Smears and/or fluid.


Bronchial brush in
normal saline

24 hours

For specimen preparation please refer to Cytology Preface (5.16).

BRONCHIAL WASHING
CYTOLOGY
BRONCHIAL WASHINGS,
MICROSCOPY
AND CULTURE

Cytology

Fluid/Aspirating trap

24 hours

For specimen preparation please refer to Cytology Preface (5.16).

Microbiology

Fluid/Aspirating trap

Interim
Please provide clinical details including antibiotic therapy.
microscopy report Specimen will be cultured for fungi. Specify if TB culture is required.
same day. Culture
report 48 hours

BRONCHO-ALVEOLAR LAVAGE
(BAL), CYTOLOGY
BRUCELLA SEROLOGY

Cytology

Fluid/Aspirating trap

24 hours

For specimen preparation please refer to Cytology Preface (5.16).

Immunology

Blood/SS tube

72 hours

Assay run Monday and Thursday.

www.qml.com.au

This test is useful to assess intestinal disaccharidase deficiency and Foregut Bacterial
Overgrowth Syndromes (oesophageal pouch, blind loop). The test takes 4 hours and
requires a special collection kit from QML Pathology. It should be performed at a
Collection Clinic or Branch Laboratory. The patient should fast and not have smoked for
at least one hour prior to the test. Please telephone Alexandra Clinic (07) 3831 2614,
Biochemistry (07) 3121 4971 or Branch Laboratory for details and appointment.

PATHOLOGY TESTS - B

TEST NAME
DEPARTMENT
BREATH HYDROGEN (MULTIPLE) Biochemistry

Please refer to HERBICIDES, URINE.

Results (07) 3121 4555

7.26

7.26

PATHOLOGY TESTS - B

PATHOLOGY TESTS

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Blood/EDTA tube

Same day

Please refer to BNP, PLASMA.

Blood/Plain tube no gel or anticoagulant

4 - 6 weeks

Centrifuge and separate serum into a plain 5 mL tube.


Keep cool. Referred test.

BUPRENORPHINE SCREEN,
URINE

Urine/Urine container

2 weeks

Transport to central laboratory on ice.


There is currently no Medicare rebate for this test. Referred test.

www.qml.com.au

Biochemistry

Results (07) 3121 4555

PATHOLOGY TESTS - B

TEST NAME
DEPARTMENT
B-TYPE NATRIURETIC PEPTIDE, Biochemistry
PLASMA
BUPIVACAINE, PLASMA
Biochemistry

7.27

7.27

PATHOLOGY TESTS - B

PATHOLOGY TESTS

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

1 glass vial containing


CO2 trapping liquid.

24 hours

It is preferred for the patient to fast before the test, but not necessary. A test dose
is ingested and mouth is rinsed. 20 minutes later, a breath sample is collected in a
glass vial containing CO2 trapping liquid. The glass vial is identified by name, sealed,
placed in a plastic bag and transported cooled to the laboratory where the activity of
the trapped labelled CO2 is measured. Appointment is required for test.

C1 ESTERASE INHIBITOR
FUNCTIONAL, SERUM

Biochemistry

Blood/SS tube

2 weeks

Test for hereditary angioedema. Please provide clinical and medication details.
Keep sample cool and transport to the laboratory without delay. Referred test.

C1 ESTERASE INHIBITOR,
SERUM

Biochemistry

Blood/SS tube

3 days

Test for hereditary angioedema. Please provide clinical and medication details.
Keep sample cool and transport to the laboratory without delay.

C1, SERUM

Biochemistry

Please refer to COMPLEMENT-C1 for details. Referred test.

C2, SERUM

Biochemistry

Please refer to COMPLEMENT-C2 for details. Referred test.

C3 NEPHRITIC FACTOR,
SERUM

Biochemistry

C3, SERUM

Biochemistry

Please refer to COMPLEMENT-C3 for details.

C4, SERUM

Biochemistry

Please refer to COMPLEMENT-C4 for details.

C5, SERUM

Biochemistry

Please refer to COMPLEMENT-C5 for details. Referred test.

CA 125, SERUM

Endocrinology

Blood/SS tube

24 hours

Serous Carcinoma of ovary - see Biochemistry Appendix (12.4).

CA 15-3, SERUM

Endocrinology

Blood/SS tube

24 hours

Breast Carcinoma - see Biochemistry Appendix (12.4).

CA 19-9, SERUM

Endocrinology

Blood/SS tube

24 hours

Inflammatory or neoplastic conditions of mucinous epithelium.


See Biochemistry Appendix (12.4).

CA 724, SERUM

Endocrinology

Blood/SS tube

4 - 5 weeks

A marker for stomach tumours. See Biochemistry Appendix (12.4). Referred test.

CADASIL GENETIC TESTING

Genetics

Blood/EDTA tube

4 - 6 weeks

Blood should be kept at room temperature at all times.


Incurs non-Medicare refundable fee.

CADMIUM (Cd), BLOOD

Biochemistry

Blood/EDTA tube
(Lithium heparin
tube acceptable)

1 week

Please provide clinical, medication and exposure details.

www.qml.com.au

Blood/SS tube and


Lithium heparin tube

3 weeks

PATHOLOGY TESTS - C

TEST NAME
DEPARTMENT
C - 14 UREA BREATH TEST FOR Endocrinology
HELICOBACTER PYLORI

Please keep sample cool and transport to the laboratory without delay.
Referred test.

Results (07) 3121 4555

7.28

7.28

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Hair/Dry sterile screw cap


(urine) container

4 weeks

Test for historical cadmium exposure. Please provide exposure details. For long
term exposure, collect enough hair to pack a matchbox tightly (0.2- 0.4g) or to half
fill a sterile screw top (urine) container. Please refer to Biochemistry Preface (5.6).
Referred test.
***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

CADMIUM (Cd), URINE

Biochemistry

Urine/Urine container

1 week

Please provide details of exposure (clinical and occupational). Collect the sample
immediately after a working shift (where cadmium exposure has occurred).
Alternatively, a first morning sample can be collected.

CAERULOPLASMIN, SERUM

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details.

CALCITONIN, SERUM

Endocrinology

Blood/SS tube

1 weeks

Tumour marker for Medullary Carcinoma of thyroid gland. Transport to laboratory


within 2 hours of collection. Specimens must be kept cold.

CALCIUM IONISED, SERUM

Biochemistry

Blood/SS tube

Same day

Please provide clinical and medication details. The sample must be collected
anaerobically into an SS tube and centrifuged as soon as it has clotted. The
collection tube must be full. Place a label over the tube stopper to indicate that the
tube must not be opened prior to analysis. Transport cool to laboratory. UNDER NO
CIRCUMSTANCES MUST THE SAMPLE BE OPENED TO AIR.

CALCIUM SENSING RECEPTOR


GENETIC TESTING
CALCIUM STIMULATION
OF GASTRIN

Genetics

Blood/EDTA tube

2 months

Incurs non-Medicare refundable fee.

Endocrinology

Blood/SS tube

2 - 3 weeks

Please contact Endocrinology Department (07) 3121 4435 for details of collection. To
make an appointment, contact the nearest collection centre that performs special tests.
Fasting specimen is required (12 hr overnight fast or >5 hrs since last food). This test
involves an IV Calcium gluconate, 10 mL slowly over 5 minutes (comes only as 10 mL
ampoules). If Calcium is contraindicated rough whisky is an alternative. Contraindicated
if on Cardiac glycosides, e.g. digoxin, risk of arrhythmias. Blood is collected at 0, 5, 10,
30, 40, 60 minutes and analysed for Gastrin.

CALCIUM, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify source of fluid on sample and request form.

CALCIUM, SERUM

Biochemistry

Blood/SS tube

Same day

Please refer to E/LFT, SERUM. Fasting is desirable. Rest the patient for 15 - 30 minutes
prior to collection. The sample should be collected without venous stasis (i.e. tourniquet
should not be used).

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - C

TEST NAME
CADMIUM (Cd), HAIR

7.29

7.29

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/24 hour urine


container with 25 mL
6M HCl preservative

24 hours

Please provide clinical and medication details. 24 hour collection is preferred.


Under rare circumstances or if specifically requested, a random urine may be
collected. Keep sample refrigerated.

CALCULUS ANALYSIS

Biochemistry

Calculus/Screw
capped container

1 week

Please state anatomical site of origin. Forward sample to the laboratory in a screw
capped container (not in formalin).

CAMPYLOBACTER JEJUNI
SEROLOGY
CANDIDA SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Immunology

Blood/SS tube

1 week

Assay run Friday.

CANNABINOIDS GCMS CONFIRMATION


CARBAMATE PESTICIDES

Biochemistry

Please refer to THC-COOH - GCMS CONFIRMATION for details.

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

CARBAMAZEPINE,
SERUM

Biochemistry

CARBARYL (PESTICIDE),
BLOOD

Biochemistry

CARBOHYDRATE DEFICIENT
TRANSFERRIN, SERUM

Biochemistry

Blood/SS tube

1 week

Test for recent alcohol abuse.


Please keep the sample cool and forward to the laboratory without delay.

CARBON - 14 UREA
BREATH TEST FOR
HELICOBACTER PYLORI

Endocrinology

1 glass vial containing


CO2 trapping liquid

24 hours

It is preferred for the patient to fast before the test, but not necessary. A test dose
is ingested and mouth is rinsed. 20 minutes later, a breath sample is collected in a
glass vial containing CO2 trapping liquid. The glass vial is identified by name, sealed,
placed in a plastic bag and transported cooled to the laboratory where the activity of
the trapped labelled CO2 is measured. Appointment is required for test.

CARBON TETRA CHLORIDE,


BLOOD

Biochemistry

www.qml.com.au

Blood/Plain plastic tube - no


gel or anticoagulant (Plastic
lithium heparin acceptable)

Same day
or urgently

PATHOLOGY TESTS - C

TEST NAME
CALCIUM, URINE

Please provide clinical and medication details.


Collect at least 8 hours after last dose or just prior to next dose.
Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,
RED CELL for toxicity.

Please refer to SOLVENTS, BLOOD for all details.

Results (07) 3121 4555

7.30

7.30

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Blood gas syringe


NEVER use plastic
collection tubes

Same day

Test for carbon monoxide exposure including cigarette smoking. Sample required is
anticoagulated uncentrifuged whole blood (venous usually) TAKEN ANAEROBICALLY.
ENSURE THAT SAMPLE IS NOT EXPOSED TO AIR NOR OPENED PRIOR TO ASSAY, BY
PLACING A SEAL OVER THE STOPPER. FORWARD TO THE LAB WITHOUT DELAY.

CARCINOEMBRYONIC ANTIGEN
(CEA), SERUM

Endocrinology

Blood/SS tube

24 hours

Please provide clinical and medication details. Provide date of previous CEA assay
if patient is being monitored post operatively.

CARDIAC ENZYMES, SERUM

Biochemistry

Blood/SS tube

Same day

Please provide clinical and medication details. Troponin T only is assayed.


If Serum AST, Lactate Dehydrogenase (LD), Creatine Kinase (CK) are required,
these must be requested separately.

CARDIOLIPIN ANTIBODY,
SERUM
CARNITINE,
NEONATAL SCREEN
CARNITINE, SERUM

Immunology

Blood/SS tube

72 hours

Assay run twice a week.

Biochemistry

Please refer to ACYL CARNITINE, NEONATAL SCREEN for details. Referred test.

Biochemistry

Please refer to ACYL CARNITINE, SERUM.

CAROTENE (BETA), SERUM

Biochemistry

Please refer to CAROTENOIDS, SERUM for details.

CAROTENOIDS, SERUM

Biochemistry

Blood/SS tube

24 hours

Low levels in fat malabsorption; raised with increased dietary intake.


Please provide clinical, dietary and medication details. Protect from light.

CAT SCRATCH DISEASE PCR

Genetics

Swab of infected site,


CSF lymph nodes, aspirate

2 days

Incurs non-Medicare refundable fee.

CAT SCRATCH DISEASE


SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run Monday. If appropriate, a lymph node biopsy may be considered. The lymph
node should be managed as for Marker Studies - see Histology Preface (5.35).

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - C

TEST NAME
CARBOXYHAEMOGLOBIN,
BLOOD

7.31

7.31

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Lithium heparin
tube with 1 mg of sodium
metabisulphite added

1 - 2 weeks

Test for phaeochromocytoma - plasma metanephrines or urinary catecholamines


may be a more suitable alternative - please consult with Pathologist if in doubt.
Please contact Biochemistry on (07) 3121 4045 or Branch Laboratory if you require
a pre-prepared collection tube to be sent to you. An appointment is required for
collection by a QML Pathology doctor at a Special Tests Collection Centre or Branch
Laboratory. Blood specimens should be collected at rest (20-30 minutes) in the
supine position. Collection should be through a heparinised indwelling catheter
inserted 20-30 minutes prior to collection. Collect a FULL Lithium heparin tube
containing 1 mg sodium metabisulphite. Blood should be centrifuged and plasma
frozen immediately and the sample transported frozen. Referred test.

CATECHOLAMINES,
URINE

Biochemistry

Urine/24 hour urine


container with 25 mL
6M HCl preservative

1 week

Test for phaeochromocytoma and childhood neuroblastoma. Please provide clinical and
medication details, especially recent changes in medication. PLEASE INSTRUCT PATIENT
TO AVOID PARACETAMOL PRIOR TO AND DURING THE PERIOD OF COLLECTION.
Please refer to: Urine Collection Diet for 5HIAA and Catecholamine (12.11) for dietary
and drug restrictions during or just prior to collection. Urine should be refrigerated during
the collection period and transported cooled to the laboratory. Under certain special
circumstances, e.g. small children, a random urine can be collected. If this is required,
contact senior Biochemistry staff prior to collection (07) 3121 4083.

CD34 PROGENITOR CELLS

Haematology

Blood/EDTA tube or
ACD yellow top tube

Same day

Transport to laboratory as soon as possible.

CD4/CD8 T LYMPHOCYTE
RATIO, BLOOD

Haematology

Blood/ACD tube, EDTA


tube, Blood film

24 hours

Lithium heparin tube may be used if ACD tube unavailable.

CDT, SERUM

Biochemistry

CEA (CARCINOEMBRYONIC
ANTIGEN), SERUM

Endocrinology

Please refer to CARBOHYDRATE DEFICIENT TRANSFERRIN, SERUM.


Blood/SS tube

24 hours

Please provide clinical and medication details. Provide date of previous CEA assay
if patient is being monitored post operatively.

CELL PANEL HLA AB RBH HOSP Haematology

Blood/SS tube or
Plain tube

4 weeks

Provide clinical and medication details.


Centrifuge samples and transport at room temperature.

CELL PANEL HLA AB SYDNEY

Haematology

Blood/SS tube or Plain tube

4 weeks

Provide clinical and medication details.


Centrifuge samples and transport at room temperature.

CELLCEPT, PLASMA

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME
CATECHOLAMINES, BLOOD

Please refer to MYCOPHENOLIC ACID, PLASMA.

Results (07) 3121 4555

7.32

7.32

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Biochemistry

Plain plastic tube - no gel or 1 - 2 weeks


anticoagulant (Plastic lithium
heparin tube acceptable)

Collect just prior to next dose. Provide clinical and medication details.

CERVICAL PAP SMEAR


CYTOLOGY

Cytology

Labelled fixed smear/


Slide carrier

48 - 72 hours

For specimen preparation and details of adjunctive tests (ThinPrep), please refer to
Cytology Preface (5.11).

CHARCOT MARIE TOOTH


SYNDROME - DNA

Genetics

Blood/Pink top EDTA tube

1 - 2 months

Patient needs to have genetics counselling prior to testing and consent form signed
by patient and doctor. Send specimen at room temperature. Referred test.

CHLAMYDIA PCR, SWAB

Immunology

Swab/White top
Chlamydia PCR tube

24 hours

Assay runs daily (Monday to Saturday). Please see Microbiology Preface (5.58)
and contact Immunology (07) 3121 4458 or Branch Laboratory for details.

CHLAMYDIA PCR, URINE

Immunology

First catch Urine/


Urine container

24 hours

The first 20 mL of any voided urine is an acceptable alternative to a swab.


The patient should not have urinated for one hour prior to the test.

CHLAMYDIA SEROLOGY
SCREEN
CHLORDANE
(ORGANOCHLORINE
PESTICIDES), BLOOD
CHLORIDE, CSF

Immunology

Blood/SS tube

72 hours

Assay run Monday, Wednesday and Friday.

CHLORIDE, FAECES

Biochemistry

Faeces/Faeces container

24 hours

Keep sample cool during collection and transport to the laboratory.

CHLORIDE, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify source of fluid on sample and request form.

CHLORIDE, SERUM

Biochemistry

CHLORIDE, SWEAT

Biochemistry

Sweat/Sweat tube

1 week

Test for cystic fibrosis. Please contact Collections (07) 3121 4450 or Branch
Laboratory for appointment.

CHLORIDE, URINE

Biochemistry

Urine/Urine container
(preferred) or 24 hour
urine container with
no preservative

24 hours

Urine should be refrigerated after the collection period and transported cooled to
the laboratory.

CHLORINATED SOLVENTS

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

CHLOROETHANE, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

www.qml.com.au

REPORTING TIME COMMENTS

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Biochemistry

Please refer to BIOCHEMISTRY, CSF for details.

PATHOLOGY TESTS - C

TEST NAME
CEPHALOSPORINS,
SERUM/PLASMA

Please refer to E/LFT, SERUM.

Results (07) 3121 4555

7.33

7.33

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

REPORTING TIME COMMENTS

CHLOROQUINE, SERUM

Biochemistry

Blood/Fluoride oxalate
tube or EDTA tube
(preferred) or (Lithium
heparin tube acceptable)

2 weeks

Please provide clinical and medication details, including time and date of last dose.
Referred Test.

CHLORPROMAZINE, SERUM

Biochemistry

Blood/Plain plastic
6 mL tube - no gel
or anticoagulant

2 weeks

Please provide clinical and medication details.


Sample collection is independent of time of dose. Referred test.

CHLORPYRIFOS (PESTICIDE),
SERUM

Biochemistry

Biochemistry

CHOLECALCIFEROL (HYDROXY), Biochemistry


SERUM
CHOLESTEROL, FLUID
Biochemistry

7.34

SPECIMEN CONTAINER

Please refer to SOLVENTS, BLOOD for all details.

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.
Please refer to VITAMIN D, SERUM.
Fluid/Plain tube/Container

Same day

If testing for chyluria, chylothorax or chylous ascites, triglycerides is more


appropriate. Specify source of fluid on sample and request form.

CHOLESTEROL, SERUM

Biochemistry

Please refer to E/LFT, SERUM.

CHOLINESTERASE TYPING FOR


SUXAMETHONIUM, SERUM

Biochemistry

Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM


(SCOLINE) SENSITIVITY, SERUM.

CHOLINESTERASE,
RED CELL

Biochemistry

Test for organophosphate or carbamate insecticide toxicity. Please provide clinical


details including exposure to pesticides etc. Leave as whole blood. Refer to
Biochemistry Appendix (12.18) for a comprehensive list of organophosphate and
carbamate pesticides. Reduced red cell levels of cholinesterase usually equate
with organophosphate and carbamate toxicity. Test can be performed on urgent
basis. Screening test intervals depend on levels of exposure. Local and Regional
Councils routinely recommend 3-6 monthly screens for exposed staff. Heavy users
recommend 3 monthly screen and screening anytime after intensive use.

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME
CHLOROFORM , BLOOD

Results (07) 3121 4555

7.34

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/SS tube
(EDTA tube and Lithium
heparin tube acceptable)

24 hours

Test CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE, RED CELL for
toxicity. The CHOLINESTERASE (PSEUDOCHOLINESTERASE) is also low in inherited
forms of scoline sensitivity. Please provide clinical and medication details including
exposure to organophosphate pesticides etc. Serum cholinesterase levels drop first and
provide a sensitive screening test for occupational organophosphate exposure. Reduced
red cell levels usually equate with organophosphate toxicity. Screening test intervals
depend on levels of exposure. Local and Regional Councils routinely recommend 3
- 6 monthly screens for exposed staff. Heavy users recommend 3 monthly screen and
screening anytime after intensive use. Refer to Biochemistry Appendix 12.18 for list.

CHROMATOGRAPHY, FAECES
(SUGAR)

Biochemistry

Faeces/Faeces container

1 week

Test for lactase deficiency or malabsorption. Please provide clinical details. Collect
FRESH sample (ideally should be fluid to semi-fluid). Freeze specimen, and store
and transport frozen. Transport to laboratory as soon as possible. Please also refer
to the Biochemistry Preface (5.5).

CHROMIUM, BLOOD

Biochemistry

Blood/Lithium heparin tube


or EDTA tube

2 weeks

Please provide clinical and medication details. Referred test.

CHROMIUM, URINE

Biochemistry

Urine/Urine container

2 weeks

Please provide details of exposure (clinical and occupational).


A random collection is preferred. Referred test.

CHROMOGRANIN A, SERUM

Biochemistry

Blood/SS tube

3 weeks

Keep sample cool during collection and transport to the laboratory.

CHROMOSOMES,
AMNIOTIC FLUID

Genetics

Amniotic fluid/2 x sterile


10 mL black top tubes

1 - 2 weeks

Average reporting time of 12 days. For overnight transport,


the sample should be cooled NOT FROZEN.

CHROMOSOMES, BLOOD

Genetics

Blood/Lithium heparin tube

2 weeks

Reporting time less than 1 week if urgent. Difficult collection should be noted on
the form. Please refer to Genetics Preface (5.28).

CHROMOSOMES,
BONE MARROW

Genetics

Bone marrow aspirate/


Lithium heparin tube

2 weeks

Minimum 2 days if urgent. Transport in esky at 4C or room temperature.

CHROMOSOMES,
CHORIONIC VILLI

Genetics

Chorionic villus biopsy/


Antibiotic transport medium

1 - 2 weeks

Antibiotic transport medium available from Genetics (07) 3121 4461 or


Branch Laboratory.

CHROMOSOMES,
LYMPH NODE

Genetics

Lymph node/Antibiotic
transport medium

2 - 6 weeks

DO NOT use formalin. Transport to laboratory as soon as possible. Antibiotic


transport medium available from Genetics (07) 3121 4461 or Branch Laboratory.

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - C

TEST NAME
CHOLINESTERASE, SERUM

7.35

7.35

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Genetics

Products of conception
(placenta, membrane, fetal
tissue and skin)/Antibiotic
transport medium

3 weeks

DO NOT freeze or place in formalin. Sample must be kept sterile and moist.
Transport to laboratory as soon as possible. Antibiotic transport medium available
from Genetics (07) 3121 4461 or Branch Laboratory.

CHROMOSOMES, TISSUE

Genetics

Skin and other tissues (not


3 weeks
prenatal)/Antibiotic transport
medium

DO NOT freeze or place in formalin. Sample must be kept sterile and moist.
Transport to laboratory as soon as possible. Antibiotic transport medium available
from Genetics (07) 3121 4461 or Branch Laboratory.

CHROMOSOMES, TUMOUR

Genetics

Selected tumour tissue


dissected free of necrotic
tissue, adherent fat and
extraneous tissue and sliced
into small pieces/Antibiotic
transport medium

2 - 6 weeks

DO NOT freeze or place in formalin. Sample must be kept sterile and moist.
Transport to laboratory as soon as possible. Please refer to Genetics Preface
(5.28). Antibiotic transport medium available from Genetics (07) 3121 4461 or
Branch Laboratory.

CHROMOSOMES,
UNSTIMULATED BLOOD

Genetics

Blood/Lithium
heparin tube

2 weeks

DIFFICULT collection should be noted on the form.


Transport cool or at room temperature.

CHRONIC RENAL DISEASE


GENETIC TESTING
CIGUATERA POISONING, FISH

Genetics

Blood/EDTA tube

Indeterminate

Biochemistry

Frozen fish (cooked


or uncooked)/Clean
plastic container

Indeterminate

Please contact Biochemistry or Branch Laboratory regarding details of collection of


fish samples. Testing on human samples is not available.

CILIAL BIOPSY

Histology

Hartmanns Solution

Motility 2 hours Electron


Microscopy 7 days

Two specimens are required, the first specimen collected placed in Hartmanns
Buffer for Motility studies, the second specimen placed in 3% Buffered
Glutaraldehyde for Electron Microscopy. Refer to Histology Preface (5.37).
Advance notice of the impending biopsy should be given to the laboratory.

CITRATE, URINE

Biochemistry

Urine/24 hour urine


container with 25 mL
6M HCl preservative

1 - 2 weeks

Please provide clinical and medication details. Refrigerate sample during collection
and transport to the laboratory. Acid preserved sample is preferred, but the sample
may be collected into a plain container if the sample is kept refrigerated and acid
added as soon as possible i.e. at the laboratory. Referred test.

7.36

CK ELECTROPHORESIS, SERUM Biochemistry

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME
CHROMOSOMES,
PRODUCTS OF CONCEPTION

Please refer to CK ISOENZYME ELECTROPHORESIS, SERUM.

Results (07) 3121 4555

7.36

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/SS tube

2 weeks

Please provide clinical and medication details.

Biochemistry

Blood/SS tube

Same day

Please provide clinical and medication details.

CK, SERUM

Biochemistry

Blood/SS tube

Same day

Please provide clinical and medication details.

C-KIT D816V (MASTOCYTOSIS)


GENETIC TESTING

Genetics

Bone marrow and trephine/


Min. 2 mL bone marrow in
EDTA or Lithium heparin
tubes, and bone marrow
trephone (20mm) in 10%
neutral buffered formalin

1 - 2 months

CLOBAZAM, SERUM

Biochemistry

Blood/Plain plastic tube no gel (Plastic lithium


heparin tube acceptable)

1 week

Please provide clinical and medication details, including time and dosage of last
dose. Collect just prior to the next dose or at least 8 hours after the last dose.

CLOMIPRAMINE, SERUM

Biochemistry

Blood/Plain plastic tube no gel (Plastic lithium


heparin tube acceptable)

1 week

Please provide clinical and medication details, including time and date of last dose.
Collect sample immediately prior to next dose.

CLONAZEPAM, SERUM

Biochemistry

Blood/Plain plastic tube no gel (Plastic lithium


heparin tube acceptable)

1 week

Please provide clinical and medication details, including time and dosage of last
dose. Collect just prior to the next dose or at least 8 hours after the last dose.

CLONIDINE
GROWTH HORMONE
STIMULATION TEST

Endocrinology

Blood/SS tube

24 hours

Test involves administration of Clonidine tablets, the dose dependent on the body
surface area, which is calculated by measuring the height and weight of the
patient. Contact Endocrinology (07) 3121 4439 or Branch Laboratory for collection
details and dose.

7.37

CLOPYRALID
Biochemistry
(HERBICIDE), URINE
CLOSTRIDIUM DIFFICILE TOXIN, Microbiology
FAECES

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME
CK ISOENZYMES
ELECTROPHORESIS, SERUM
CK ISOENZYMES, SERUM

Please refer to HERBICIDES, URINE.


Faeces/Faeces container

Same day 24 hours

Routine faeces sample. Refrigerate and transport cooled to laboratory within 24 hours
of collection. Please indicate any recent history of antibiotics. If causes of diarrhoea
other than Clostridium difficile are possible or suspected a faeces sample for
microscopy and culture should also be submitted. Refer to Microbiology Preface (5.54).

Results (07) 3121 4555

7.37

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Plain plastic
6 mL tube - no gel or
anticoagulant (EDTA tube
or Lithium heparin tube
acceptable)

1 week

CLOZARIL, SERUM

Biochemistry

CMV (CYTOMEGALOVIRUS)
PCR

Immunology

Blood/SS tube and


1 week
2 EDTA tubes.
Random (mid-stream) urine/
urine container Swab/ Viral
culture transport medium

Under certain circumstances e.g. suspected antenatal or neonatal infection,


positive CMV IgM serology requires confirmation by virus isolation.
Saliva and high vaginal swabs are required together with blood and urine.

CMV (CYTOMEGALOVIRUS)
SEROLOGY
COAGULATION STUDIES,
BLOOD

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Haematology

Blood/3 Sodium citrate


tubes, 1 EDTA tube,
1 blood film prepared
at time of collection

Same day

Studies include Platelet count, Prothrombin time, APTT and Fibrinogen.


Please specify if a bleeding time is required. Transport to laboratory within 4 hours.
Please provide clinical and medication details.

COBALT, BLOOD

Biochemistry

Blood/EDTA tube (Lithium


heparin tube acceptable)

4 weeks

Please provide exposure details. Referred test.

COBALT, URINE

Biochemistry

Urine/Urine container

1 week

Please provide details of exposure (clinical and occupational).


A random collection is preferred. Referred test.

COCAINE METABOLITES
- GCMS CONFIRMATION

Biochemistry

Urine/Urine drug screen


collection kit with tamper
evident packaging

48 hours

This is requested in cases concerned with occupational drug screening for drugs of
abuse. The QML Pathology protocol complies with Standards Australia AS/NZS4308
for the assay of cannabinoids, opiates, cocaine metabolites, benzodiazepines and
sympathomimetic amines. A Chain-of Custody form should be completed. Additional
classes (methadone, barbiturates, alcohol) should be specifically requested if
required. Please also refer to the Biochemistry Preface (5.4). Confirmation and
quantitation by GCMS of positive findings may be requested separately.

www.qml.com.au

Please provide clinical and medication details, including time of last dose and
dosage. Collect trough level for monitoring purposes (i.e. immediately before next
dose). Although it is generally optimal to collect trough drug levels so as to avoid
misleading elevated clozapine samples can be collected at the same time as the
Haematology sample levels arising from drug distribution effects, as long as the
time of collection is no closer than 12 hours after the dose - typically evening dose
followed by late morning collection.

PATHOLOGY TESTS - C

TEST NAME
CLOZAPINE, SERUM

Please refer to CLOZAPINE, SERUM.

Results (07) 3121 4555

7.38

7.38

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

2 - 3 weeks

CODEINE, SERUM

Biochemistry

Blood/Lithium heparin tube


or plain plastic tube - no gel

2 weeks

CODIPHEN, SERUM

Biochemistry

Please refer to CODEINE, SERUM.

CODRAL, SERUM

Biochemistry

Please refer to CODEINE, SERUM.

COENZYME Q10, PLASMA

Biochemistry

Blood/Lithium heparin tube

1 - 2 weeks

Please protect the sample from light and send to the laboratory without delay.
Referred test.

COLD AGGLUTININS, SERUM

Blood Bank

Blood/SS tube
pre-warmed to 37C

Same day

Pre-warm all collection materials to 37C. Maintain specimen at 37C by


immersion in a water bath until clotted. Separate serum by centrifugation
IMMEDIATELY after clotting (i.e. at 37C). The separated specimen may be sent to
the laboratory at room temperature.

COLLAGEN BINDING ASSAY,


BLOOD

Haematology

Blood/Sodium
citrate tube

1 - 4 weeks

Clinical and medication details required. Transport at 4C to reach the laboratory


within 2 hours of collection. Please contact Haematology (07) 3121 4451 or
Branch Laboratory for details.

COMBINED DEXAMETHASONE/
SYNACTHEN TEST

Endocrinology

Blood/SS tube
and EDTA tube

48 hours

This is a combined test for Androgen Excess/Hirsutism in females and also a test
for the rare Congenital Adrenal Hyperplasia (CAH). See Endocrinology Appendix
(12.26) This procedure involves an intramuscular injection of Synacthen and
Dexamethasone tablets. Please contact Endocrinology (07) 3121 4439 or Branch
Laboratory for collection details and supply of Dexamethasone tablets and
Synacthen ampoule (0.25mg/1 mL).

COMPATIBILITY TESTING
(CROSSMATCH), BLOOD

Blood Bank

Blood/1 Pink top EDTA tube, Same day


1 Lavender top EDTA tube

If history of antibodies or transfusion complications collect additional 6 mL plain


plastic tube. Note special requests e.g. CMV negative, irradiated. Record date and
hospital where blood required. Sample must be signed by patient or collector to
verify. Complete blue box on request form, collector to sign Certification statement.

COMPLEMENT TOTAL HAEMOLYTIC (CH50),


SERUM
COMPLEMENT-C1, SERUM

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday to Friday). The specimen must be centrifuged immediately
after clotting and refrigerated during transport.

Biochemistry

Blood/SS tube

2 - 3 weeks

Please provide clinical and medication details. Centrifuge, separate and FREEZE
serum immediately. Transport to the laboratory on dry ice. Referred test.

www.qml.com.au

Peak level should be taken 1-2 hours after dose. Please provide clinical and
medication details including time and dosage of last dose. Referred test.

Results (07) 3121 4555

PATHOLOGY TESTS - C

TEST NAME
COCCIDIOIDES SEROLOGY

7.39

7.39

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/SS tube

2 - 3 weeks

Please provide clinical and medication details. Centrifuge, separate and FREEZE
serum immediately. Transport to the laboratory on dry ice. Referred test.

COMPLEMENT-C3, SERUM

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details. Sample must be stored and
transported to the laboratory REFRIGERATED.

COMPLEMENT-C4, SERUM

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details. Sample must be stored and
transported to the laboratory REFRIGERATED.

COMPLEMENT-C5, SERUM

Biochemistry

Blood/SS tube

2 - 3 weeks

Please provide clinical and medication details. Centrifuge, separate and FREEZE
serum immediately. Transport to the laboratory on dry ice. Referred test.

COMPLEMENT-C6, SERUM

Biochemistry

Blood/SS tube

4 weeks

Please provide clinical and medication details. Centrifuge, separate and FREEZE
serum immediately. Transport to the laboratory on dry ice. Referred test.

COMPLEMENT-C9, SERUM

Biochemistry

Blood/SS tube

2 - 3 weeks

Please provide clinical and medication details. Centrifuge, separate and FREEZE
serum immediately. Transport to the laboratory on dry ice. Referred test.

COMPLEMENTS, SERUM

Biochemistry

CONGENITAL
ADRENAL HYPOPLASIA
GENETIC TESTING
CONGENITAL HYPOTHYROIDISM
SCREENING TEST, BLOOD
CONNEXION 26
GENETIC TESTING
COOMBS TEST, DIRECT

Genetics

If COMPLEMENTS, SERUM is requested, C3 and C4 are performed.


Blood/EDTA tube

2 months

Biochemistry

Incurs non-Medicare refundable fee.

Please refer to NEONATAL SCREENING TEST.

Genetics

Blood/EDTA tube

1 month

Incurs non-Medicare refundable fee.

Blood Bank

Blood/Pink top EDTA tube

Same day

Please provide provisional diagnosis and medication history.


On neonatal requests provide details of maternal obstetric and transfusion history.

COPPER, HAIR

Biochemistry

Hair/Dry sterile screw cap


(urine) container

4 weeks

Fill sterile container as full as possible with hair.


Clippings from the patients last hair cut can be used. Referred test.
***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

COPPER, LIVER BIOPSY

Biochemistry

Liver biopsy/Dry sterile


screw top (urine) container

2 weeks

Wash excess blood away with 0.9% saline. Wrap in aluminium foil to transport.
Place in urine container and FREEZE. DO NOT place in formalin. Referred test.

COPPER,
RED BLOOD CELLS

Biochemistry

Blood/EDTA tube

2 weeks

This analysis should only be performed if specifically requested.


The preferred analysis for Copper is serum (SS tube). Referred test.

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME
COMPLEMENT-C2, SERUM

Results (07) 3121 4555

7.40

7.40

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/SS tube

1 week

Please provide clinical history and medication details.


CAERULOPLASMIN, SERUM may often be requested concurrently.

COPPER, URINE

Biochemistry

Urine/24 hour
urine container with
no preservative

1 week

Please provide clinical and medication details. Refrigerate sample and forward
to the laboratory. 24 hour collection is preferred. Under rare circumstances or if
specifically requested, a random urine may be collected.

COPROPORPHYRIN, URINE

Biochemistry

Please refer to PORPHYRIN, URINE. Fractionation and PBG analysis is routinely performed.

COPROPORPHYRIN SCREEN,
FAECES
COPROPORPHYRIN/
PROTOPORPHYRIN, FAECES

Biochemistry

Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES.

CORDARONE, SERUM

Biochemistry

CORTISOL, SERUM

Endocrinology

Blood/SS tube

24 hours

Note time of collection and any medications on specimen and request form.

COTININE, SERUM

Biochemistry

Blood/Plain plastic
6 mL tube - no gel
or anticoagulant

1 week

Required for insurance testing. Patient must be fasting. Please store specimen
refrigerated and transport cooled to the laboratory without delay. If a delay is
envisaged, separate serum, freeze and transport frozen. Please note on the request
if the patient is a diabetic, as elevated glucose levels may affect the test. Serum is
the preferred sample. Referred test.

COTININE, URINE

Biochemistry

Urine/Urine container

1 week

Required for insurance testing. Patient should be fasting prior to collection.


A random urine collection is required. Keep cool and forward to the laboratory as
soon as possible. Note on the request if the patient is diabetic, as elevated glucose
levels may affect the test. Serum is the preferred sample. If a delay is envisaged,
freeze sample and transport frozen. Referred test.

COWDEN SYNDROME
GENETIC TESTING

Genetics

Blood/EDTA tube

Indeterminate

Store at 4C until transported at room temperature. Patient consent form for genetic
testing to be completed and signed by patient and clinician. Form to be sent with sample.

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Blood/SS tube

72 hours

Assay run Tuesday and Friday.

Biochemistry

7.41

COXIELLA (Q FEVER) SEROLOGY Immunology


COXSACKIE SEROLOGY
Immunology

www.qml.com.au

Faeces/Faeces container

Screen:
1 - 7 days
Quantitation:
1 - 2 weeks

PATHOLOGY TESTS - C

TEST NAME
COPPER, SERUM

Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES.

Please refer to AMIODARONE, SERUM.

Results (07) 3121 4555

7.41

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/SS tube

24 hours

C-peptide is a remnant of proinsulin after cleavage to produce insulin. This test


can be used to assess pancreatic reserve in patients on insulin therapy or if not on
insulin as an alternative to blood insulin measurement. Please state whether you
require fasting, 1 hour post prandial or random blood collection.

C-PEPTIDE SUPPRESSION TEST Endocrinology


USING INSULIN

Blood/SS tube

24 hours

This test involves an infusion of insulin and the measurement of glucose and
c-peptide, usually investigating insulinoma. Other hormones may be required to
exclude Cushings Syndrome or other pituitary/hypothalamic disorders. Appointment
is required. Please contact Endocrinology (07) 3121 4439 or Branch Laboratory.

CPK, SERUM

Biochemistry

C-REACTIVE PROTEIN,
HIGH SENSITIVITY, SERUM

Biochemistry

Blood/SS tube (EDTA tube


and Lithium heparin tube
acceptable if centrifuged
without delay)

24 hours

Marker for increased risk of premature cardiovascular disease.


Keep sample cool.

C-REACTIVE PROTEIN,
SERUM

Biochemistry

Blood/SS tube (EDTA tube


and Lithium heparin tube
acceptable if centrifuged
without delay)

Same day

Test for infection/inflammation. With low level elevation, test for active coronary
atherosclerosis. Please provide clinical and medication details.

CREATINE KINASE
ISOENZYMES, SERUM
CREATINE KINASE, SERUM

Biochemistry

Please refer to CK ISOENZYMES, SERUM.

Biochemistry

Please refer to CK, SERUM.

CREATINE, PLASMA

Biochemistry

Blood/Lithium heparin tube

CREATININE CLEARANCE

Biochemistry

Blood and urine/SS tube and 24 hours


24 hour urine container with
no preservative OR 24 hour
urine container with 25 mL
6M HCl preservative

Record patients height and weight on request form and on urine container.
Refrigerate urine during collection. Collect blood sample at end of 24 hour urine
collection. Send blood and urine sample to laboratory at the same time. Requests
for GFR/calculated GFR do not require urine collection.

CREATININE, FLUID

Biochemistry

Fluid/Plain tube/Container

Test to determine if originates from urine.


Specify source of fluid on sample and request form.

CREATININE, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - C

TEST NAME
C-PEPTIDE SERUM

Please refer to CK ISOENZYMES, SERUM.

3 weeks

Same day

Centrifuge sample and separate plasma where possible. Transport sample on dry ice.

Please refer to E/LFT, SERUM.

Results (07) 3121 4555

7.42

7.42

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Biochemistry

Urine/24 hour urine


24 hours
container with no
preservative or 24 hour urine
container with 25 mL 6M
HCl preservative

Test for completeness of 24 hour collection. Please provide clinical and medication
details. CREATININE ASSAY CAN BE PERFORMED ON PLAIN OR PRESERVED
URINES. Refrigerate from start of collection, and during storage and transport.

CREATININE,
URINE RANDOM

Biochemistry

Urine/Urine container

Test of overall concentration of urine. Please provide clinical and medication


details. CREATININE ASSAY CAN BE PERFORMED ON PLAIN OR PRESERVED
URINES. Refrigerate during storage and transport.

CROSS LINKED
N-TELOPEPTIDES, URINE
CROSSMATCH, BLOOD

Biochemistry

CRP HIGH SENSITIVITY, SERUM

Biochemistry

Please refer to C REACTIVE PROTEIN, HIGH SENSITIVITY, SERUM.

CRP, SERUM

Biochemistry

Please refer to C-REACTIVE PROTEIN, SERUM.

CRYOFIBRINOGEN,
PLASMA AND SERUM

Biochemistry

Please refer to CRYOFIBRINOGEN/CRYOGLOBULINS, PLASMA AND SERUM.

www.qml.com.au

Blood Bank

REPORTING TIME COMMENTS

Same day

PATHOLOGY TESTS - C

TEST NAME
CREATININE,
URINE 24 HOUR

Please refer to N-TELOPEPTIDE, URINE.


Blood/1 Pink top EDTA tube, Same day
1 Lavender top EDTA tube
or urgently

If history of antibodies or transfusion complications collect additional 6 mL. Note


special requests e.g. CMV negative/irradiated. Sample must be signed by patient
or collector to verify patient identity. Complete blue box on request form, collector
to sign Certification statement.

Results (07) 3121 4555

7.43

7.43

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Lithium heparin tube


and a plain tube - no gel

72 hours

CRYOGLOBULINS,
PLASMA AND SERUM
CRYOGLOBULINS/
CRYOFIBRINOGEN,
PLASMA AND SERUM
CRYPTOCOCCUS ANTIGEN,
SERUM OR CSF

Biochemistry

Please refer to CRYOFIBRINOGEN/CRYOGLOBULINS, PLASMA AND SERUM.

Biochemistry

Please refer to CRYOFIBRINOGEN/CRYOGLOBULINS, PLASMA AND SERUM.

Immunology

Blood/SS tube;
Cerebrospinal fluid (5- 10
mL)/CSF collection tubes

Same day

CSF - LEUKAEMIA/LYMPHOMA
CELLS

Haematology

CSF/CSF
collection tubes

Same day

Examination of cytospin preparation for leukaemia/lymphoma cells.

CSF - VIROLOGY

Immunology

CSF/Plain tube
(minimum 0.5 mL required)

1 week

Referred test. Test performed by PCR (Viral culture not routinely performed).
Please request specific tests and include clinical details.

CSF CONTAMINATION, FLUID

Biochemistry

CSF CYTOLOGY

Cytology

www.qml.com.au

Analysis includes Cryofibrinogen. Samples must be taken into tubes pre-warmed


to approximately 37C (e.g. water bath, oven, hold in hand for approximately 5
minutes). Transfer to the central laboratory immediately, keeping specimens at
approximately 37 degrees centigrade, using a vacuum flask or similar. Do not
centrifuge samples. IF UNABLE TO TRANSFER TO LABORATORY AT 37C:
1. Samples must be taken into tubes pre-warmed to 37 degrees centigrade.
2. Allow samples to stand in 37 degrees centigrade water bath for 0.5-1.0 hr to
allow separation of red cells to occur without centrifugation. If a water-bath is not
available, a container of warm water (topped-up frequently) may be used.
3. When separation has occurred, transfer serum and plasma to Falcon tubes and
identify each tube appropriately (i.e. PLASMA - CRY and/or SERUM-CRY).
4. The separated serum and plasma samples may now be transported to the
laboratory at ambient temperature. If these procedures cannot be followed, please
contact the laboratory on (07) 3121 4460 or Branch Laboratory.

PATHOLOGY TESTS - C

TEST NAME
CRYOFIBRINOGEN/
CRYOGLOBULINS,
PLASMA AND SERUM

Please refer to TAU PROTEIN, FLUID.


CSF/Sterile screw top
container

24 hours

For specimen preparation please refer to Cytology Preface (5.15).

Results (07) 3121 4555

7.44

7.44

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Cytology

Fluid/Sterile
screw top container

24 hours

CSF MICROSCOPY
AND CULTURE

Microbiology

Cerebrospinal fluid/Sterile
tubes labelled 1, 2, 3 or 4

Interim
Please provide clinical details including antibiotic therapy and specify if specimen
microscopy report is to be cultured for Mycobacteria, Viruses, Cryptococci or other fungi or exotic
same day. Culture organisms (Nocardia, etc.).
up to 3 days.

CSF MICROSCOPY ONLY

Microbiology

Cerebrospinal fluid/
Sterile tubes labelled
1, 2, 3 or 4

Same day

CSF TRANSFERRIN ASSAY,


FLUID
CYANIDE, BLOOD

Biochemistry

Please refer to TAU PROTEIN, FLUID.

Biochemistry

This test is not available.


THIOCYANATE, BLOOD (metabolite of cyanide) is more appropriate.

CYANIDE, URINE

Biochemistry

This test is not available.


THIOCYANATE, URINE (metabolite of cyanide) is more appropriate.

CYCLIC AMP,
BLOOD AND URINE 24 HOUR

Endocrinology

Blood/SS tube and 24 hour


Urine collection/
Urine collection bottle.
No preservative

4 - 5 weeks

Record patients height and weight on request form. Collect blood sample on return
of urine and forward to laboratory at same time. Total volume of urine is required.
Urine should be refrigerated during the collection period and transported cooled to
the laboratory. Referred test.

CYCLOSPORIN, BLOOD

Biochemistry

Blood/EDTA tube

3 -5 days

Please provide clinical and medication details. Collect sample just prior to next
dose. This test can be performed urgently if required.

CYSTIC FIBROSIS (CF)


SCREENING TEST, BLOOD
CYSTIC FIBROSIS DNA TEST

Biochemistry
Biochemistry

Blood/Refer to specific
collection details

2 - 3 weeks

If patient less than 2 years, collect neonatal screening card. If patient greater than
2 years, collect EDTA blood. If pre-natal testing is required (CF status on unborn
baby), please phone the laboratory on (07) 3121 4420 for instructions.

CYSTINE, URINE

Biochemistry

Urine/24 hour urine


container with 25 mL
6M HCI preservative

2 weeks

Please provide clinical history and medication details.


Refrigerate from start of collection. 24 hour collection is preferred.
Referred test.

www.qml.com.au

For specimen preparation please refer to Cytology Preface (5.15).

PATHOLOGY TESTS - C

TEST NAME
CSF MALIGNANT CELLS

Please refer to NEONATAL SCREENING TEST.

Results (07) 3121 4555

7.45

7.45

PATHOLOGY TESTS - C

PATHOLOGY TESTS

CYTOMEGALOVIRUS (CMV)
SEROLOGY
CYTOTOXIC FOOD TESTING

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Blood/SS tube and


24 - 48 hours
2 x EDTA tubes. Random
(mid-stream) urine/urine
container. Swab/Viral culture
transport medium

Under certain circumstances e.g. suspected antenatal or neonatal infection,


positive CMV IgM serology requires confirmation by virus isolation. Saliva and high
vaginal swabs are required together with blood and urine.

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Specimen
Distribution

Blood/ACD tube

Collection and
transfer only

Results (07) 3121 4555

PATHOLOGY TESTS - C

TEST NAME
DEPARTMENT
CYTOMEGALOVIRUS (CMV) PCR Immunology

7.46

7.46

PATHOLOGY TESTS - C

PATHOLOGY TESTS

DEPARTMENT
Biochemistry

This test is performed on faeces. Please refer to LAXATIVES, FAECES.

DANTHRON, FAECES

Biochemistry

Please refer to LAXATIVES, FAECES.

DAZ GENE ANALYSIS

Genetics

DDE LEVELS
(ORGANOCHLORINE
PESTICIDES), BLOOD
D-DIMER TEST

Biochemistry

DDT LEVELS
(ORGANOCHLORINE
PESTICIDES), BLOOD
DELTA ALA, URINE

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Biochemistry

Please refer to 5-ALA, URINE.

DEMETON (PESTICIDE),
SERUM

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

DENGUE SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

DENTATORUBRALPALLIDOLUYSIAN ATROPHY
(DRPLA) GENETIC TESTING
DEOXYCORTICOSTERONE,
SERUM
DEOXYCORTISOL, SERUM

Genetics

Blood/EDTA tube

1 - 2 months

Incurs non-Medicare refundable fee.

Endocrinology

Blood/SS tube

2 - 5 weeks

Referred test.

Endocrinology

Blood/SS tube

2 - 5 weeks

Referred test.

DEOXYPYRIDINIUM, URINE

Biochemistry

DEOXYPYRIDINOLINE,
URINE

Biochemistry

DEPTRAN, SERUM

Biochemistry

www.qml.com.au

Haematology

SPECIMEN CONTAINER

Blood/Pink top EDTA tube

REPORTING TIME COMMENTS

2 weeks

Incurs non-Medicare refundable fee.


Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Blood/Sodium Citrate tube

Same day

PATHOLOGY TESTS - D

TEST NAME
DANTHRON, BLOOD

Transport to laboratory as soon as possible.

Please refer to DEOXYPYRIDINOLINE, URINE.


Urine/Urine container
(random) or 24 hour
urine container with
no preservative

1 week

An early morning urine specimen is preferred. A 24 hour specimen may be


collected if specifically requested. No preservative. Keep specimen refrigerated
during collection and transport. A highly specific marker of bone resorption used
in investigation and monitoring of osteoporosis, Pagets disease, steroid therapy,
malignancies, inflammatory diseases and metabolic bone diseases.
Please refer to DOXEPIN, SERUM.

Results (07) 3121 4555

7.47

7.47

PATHOLOGY TESTS - D

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Biochemistry

Blood/Plain plastic tube 1 week


no gel (Plastic lithium heparin
tube (no gel) acceptable)

DESMOSINE PYRIDINOLINE,
URINE
DEXAMETHASONE
SUPPRESSION TEST

Biochemistry
Endocrinology

Blood/SS tube
and EDTA tube

48 hours

Collect baseline cortisol specimen between 8am and 10am day 1. Also collect
a baseline EDTA specimen. This is used to perform an ACTH if dexamethasone
suppression test results are abnormal. Give 1 mg oral Dexamethasone at 11pm.
Patient to remain awake for at least 30 minutes post dose to ensure absorption.
Collect second cortisol specimen between 8am and 10am day 2. Note this test must
be varied for shift workers. Please note - for children (<40kgs) give half the dose
(i.e. 0.5mg Dexamethasone) and make a note of it on request form. Please contact
Endocrinology (07) 3121 4439 or Branch Laboratory for test and collection details.

DEXAMETHASONE
SUPPRESSION TEST EXTENDED

Endocrinology

Blood/SS tube
and EDTA tube

48 hours

This test is used as an indicator of stress levels (is used for endogenous depression).
Collect baseline cortisol specimen between 8am and 10am day 1. Also collect an EDTA
at this stage to do an ACTH if results are abnormal. Give 1mg oral Dexamethasone at
11pm. Patient to remain awake for at least 30 minutes post dose to ensure absorption.
Collect cortisol specimens (SS tube) between 8am and 10am, at 4pm and at 10pm day
2. Please ensure tubes are labelled with date, times and PRE or POST. Please contact
Endocrinology (07) 3121 4439 or Branch Laboratory for test and collection details.

DEXAMETHASONE
SUPPRESSION TEST PSYCHIATRIC

Endocrinology

Blood/SS tube
and EDTA tube

72 hours

This test is used as an indicator of stress levels (is used for endogenous depression).
Collect baseline cortisol specimen between 8am and 10am day 1. Also collect an EDTA
at this stage to do an ACTH if results are abnormal. Give 1 mg oral Dexamethasone at
11pm. Patient to remain awake for at least 30 minutes post dose to ensure absorption.
Collect cortisol specimens between 8am and 10am and at 4pm and 10pm day 2.
Please ensure tubes are labelled with date, times and PRE or POST. Please contact
Endocrinology (07) 3121 4439 or Branch Laboratory for test and collection details.

DEXTRONE, URINE

Biochemistry

DHEA, SERUM

Endocrinology

www.qml.com.au

REPORTING TIME COMMENTS


Please provide clinical and medication details, including time and date of last dose.
Collect immediately prior to next dose.
Please refer to DEOXYPYRIDINOLINE, URINE.

PATHOLOGY TESTS - D

TEST NAME
DESIPRAMINE, SERUM

Please refer to PARAQUAT, URINE.


Blood/SS tube

24 hours

Please note date of last normal menstrual period (LNMP).

Results (07) 3121 4555

7.48

7.48

PATHOLOGY TESTS - D

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/Urine container

OCCUPATIONAL Up to 10 working
days NONOCCUPATIONAL
- Up to 4 weeks

Random urine collected at the end of work shift or exposure. PLEASE NOTE: The
preferred collection for Organophosphates is serum. Collect urine only where
specifically required OR permission has been granted to perform the analysis by
the doctor, patient or employer. This analysis attracts a non-Medicare rebatable fee
from the reference laboratory.

DIALYSIS FLUID,
PRE-DIALYSIS

Biochemistry

Dialysis fluid/
Plain plastic tube

Same day 24 hours

Obtained from unopened dialysis fluid bottle.

DIASTASE, URINE

Biochemistry

DIAZEPAM, SERUM

Biochemistry

DIAZINON (PESTICIDE), SERUM

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

DIBUCAINE NUMBER, SERUM

Biochemistry

Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM


(SCOLINE) SENSITIVITY, SERUM.

DICHLOROMETHANE, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

DICHROMATE, BLOOD

Biochemistry

Please refer to CHROMIUM, BLOOD for all details.

DICOFOL (ORGANOCHLORINE
PESTICIDES), BLOOD
DIELDRIN (ORGANOCHLORINE
PESTICIDES), BLOOD
DIELDRIN, BREAST MILK

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Biochemistry

Breast milk/Glass
sterile container

4 weeks

Keep sample cool. Referred test.

DIETARY URIC ACID


EXCRETION TEST

Biochemistry

Blood and Urine/24 hour


urine container with 15 mL
2M NaOH x 4, SS tube x 2

24 hours

Please contact Collections (07) 3121 4450 or Branch Laboratory for specimen
collection details. Baseline 24 Hour urine urate and creatinine clearance must
be established prior to the patient commencing a special low purine diet. See
Biochemistry Appendix (12.12).

DIGITALIS, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - D

TEST NAME
DIALKYL PHOSPHATE
METABOLITES, URINE

Please refer to AMYLASE, URINE.


Blood/Plain plastic tube 1 week
no gel (Plastic lithium heparin
tube (no gel) acceptable)

Collect just prior to the next dose or at least 8 hours after the last dose. Please
provide clinical and medication details, including time and dosage of last dose.

Please refer to DIGOXIN, SERUM.

Results (07) 3121 4555

7.49

7.49

PATHOLOGY TESTS - D

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Biochemistry

Blood/Plain plastic tube Same day


no gel (Plastic lithium heparin
tube (no gel) acceptable)

Please provide clinical and medication details. Collect sample 8-48 hrs after last
dose (preferably immediately before next dose). Record last dose and time taken.

DIHYDROTESTOSTERONE,
PLASMA

Endocrinology

Blood/Lithium
heparin tube

Please keep specimen cold in transit. Referred test.

DIHYDROXY
CHOLECALCIFEROL, SERUM
DIHYDROXY VITAMIN D,
SERUM
DILANTIN, SERUM

Biochemistry

Please refer to 1,25-DIHYDROXY VITAMIN D, SERUM.

Biochemistry

Please refer to 1,25-DIHYDROXY VITAMIN D, SERUM.

DIMETHOATE (PESTICIDE),
SERUM

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

DIPHENYLHYDANTOIN, SERUM

Biochemistry

Please refer to DILANTIN, SERUM.

DIPHTHERIA SEROLOGY
(TOXIN ANTIBODY SCREEN)
DIQUAT, URINE

Immunology

Biochemistry

Blood/Plain plastic tube no gel (Plastic lithium


heparin tube (no gel)
acceptable)

Blood/SS tube

REPORTING TIME COMMENTS

6 weeks

Same day

2 - 4 weeks

Biochemistry

Please provide clinical and medication details including last dosage and time
taken. Take sample just prior to next dose (the timing of sampling for this test is not
obligatory for adult patients with no recent change in medication as there is only
minor in inter dose variation in drug levels).

Referred test.
Please refer to PARAQUAT, URINE.

DIRECT ANTIGEN TEST FOR


Immunology
RESPIRATORY VIRUSES
(INCLUDING RSV, INFLUENZA,
PARAINFLUENZA, ADENOVIRUS)
DIRECT
Blood Bank
ANTIGLOBULIN TEST

Nasopharyngeal aspirate/
Aspirating trap

24 hours

Refrigerate specimen and transport cooled to laboratory as soon as possible.


Results usually available same day for urgent specimens.

Blood/Pink top
EDTA tube

Same day

Please provide provisional diagnosis and medication history.


On neonatal requests provide details of maternal obstetric and transfusion history.

DIRECT COOMBS TEST

Blood/Pink top
EDTA tube

Same day

Please provide provisional diagnosis and medication history.


On neonatal requests provide details of maternal obstetric and transfusion history.

www.qml.com.au

Blood Bank

PATHOLOGY TESTS - D

TEST NAME
DIGOXIN, SERUM

Results (07) 3121 4555

7.50

7.50

PATHOLOGY TESTS - D

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Microbiology

Faeces/Faeces container

48 hours

DISACCHARIDASES,
INTESTINAL BIOPSY TISSUE
DISOPYRAMIDE, SERUM

Biochemistry
Biochemistry

Blood/Plain plastic tube


- no gel

1 - 2 weeks

Please provide clinical and medication details. For monitoring purposes, collect sample
immediately prior to next dose. Record last dosage and time taken. Referred test.

D-LACTATE, PLASMA

Biochemistry

Blood/Lithium
heparin tube

2 weeks

For investigation of intestinal bacterial overgrowth. Referred test.

D-LACTATE, URINE

Biochemistry

Urine/Plain random urine


container or 24 hour urine
container with no preservative

1 week

Keep sample cold during transport. Referred test.

DNA TESTING

Genetics

Blood/EDTA tube

Dependent
on test

Genetics Department tests for a variety of disorders. Some of the rarer disorders
are diagnosed in other laboratories. Many disease mutations are still to be
characterised. Please contact Genetics (07) 3121 4461 or Branch laboratory for
further information.

DNAse B TITRE
(STREPTOCOCCI), SERUM
DONATH LANDSTEINER
ANTIBODY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Haematology

Blood/Refer Haematology
Department

24 hours

Please contact Haematology (07) 3121 4451 or


Branch Laboratory for collection details.

DONOVANOSIS

Cytology

Labelled fixed or unfixed


smear/slide carrier

24 hours

Skin biopsy for Histology may also be appropriate to rule out other pathology.
Refer collection enquiries to QML Pathology Dermatopathologists.

DOPAMINE,
URINE 24 HOUR
DOTHEP, SERUM

Biochemistry

Please refer to CATECHOLAMINES, URINE.

Biochemistry

Please refer to DOTHIEPIN, SERUM.

DOTHIEPIN, SERUM

Biochemistry

www.qml.com.au

Specimen can be refrigerated for up to 48 hours if transport to laboratory is


delayed. QML Pathology no longer performs the Giardia Specific Antigen (GSA) test.
The new procedure is the Direct Immuno Fluorescent Assay.
Please refer to INTESTINAL DISACCHARIDASES, BIOPSY TISSUE.

Blood/Plain plastic tube 1 week


no gel (Plastic lithium heparin
tube (no gel) acceptable)

PATHOLOGY TESTS - D

TEST NAME
DIRECT IMMUNO
FLUORESCENT ASSAY
(GIARDIA)

Collect immediately prior to next dose.


Please provide clinical and medication details, including time and date of last dose.

Results (07) 3121 4555

7.51

7.51

PATHOLOGY TESTS - D

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

72 hours

Biochemistry

Blood/Plain plastic tube 1 week


no gel (Plastic lithium heparin
tube (no gel) acceptable)

DPYD, URINE

Biochemistry

DRUG SCREEN
(BROAD SPECTRUM
INVESTIGATION BY THIN
LAYER CHROMATOGRAPHY),
URINE

Biochemistry

Urine/Urine container

48 hours

If occupational or industry, please refer to DRUG SCREEN (OCCUPATIONAL/


INDUSTRY (AS/NZS4308 GUIDELINES)), URINE. NB: Blood (Plain tube with no
gel or Lithium heparin) in special circumstances only (Occupational/Industry
(AS/NZS4308 Guidelines)), URINE otherwise see below. Requested in cases
concerned with: - monitoring of compliance with therapy - query drug used - drug
rehabilitation program - custody cases - correctional centres - suspected overdose.
We recommend screening for drugs be performed on urine rather than blood, due
to urinary concentration of metabolites. In some cases (e.g. suspected overdose)
blood may be collected, with urine being collected as soon as practicable.
A Chain-of-Custody form is recommended for all medico/legal cases. Please also
refer to the Biochemistry Preface (5.4). Provide clinical, medication and suspected
drug usage details.

DRUG SCREEN
(OCCUPATIONAL/INDUSTRY
(AS/NZS4308 GUIDELINES)),
URINE

Biochemistry

Urine/Urine drug screen


collection kit with tamper
evident packaging

48 hours

Requested in cases concerned with occupational drug screening for drugs of


abuse. The QML Pathology protocol complies with Australian Standard AS4308
for the assay of Cannabinoids, Opiates, Cocaine metabolites, Benzodiazepines,
Sympathomimetic amines. A Chain-of-Custody form should be completed. Additional
classes (methadone, barbiturates, alcohol) should be specifically requested if
required. Please also refer to the Biochemistry Preface (5.4). Confirmation and
quantitation by GC/MS of positive findings may be requested separately.

DRUG SCREEN
(NON OCCUPATIONAL),
URINE

Biochemistry

Urine/Urine drug screen


collection kit with tamper
evident packaging

48 hours

Please refer to DRUG SCREEN (BROAD SPECTRUM INVESTIGATION BY THIN LAYER


CHROMATOGRAPHY), URINE.

DRUG SCREEN, HAIR

Biochemistry

Hair roots/Hair drug screen


collection kit with tamper
evident packaging

2 weeks

Contact Referred Tests Department on (07) 3121 4045 for a hair drug screen
collection kit, containing full collection instructions.

www.qml.com.au

Assay run daily (Monday - Friday).


Collect immediately prior to next dose. Please provide clinical
and medication details, including time and date of last dose.
Please refer to DEOXYPYRIDINOLINE, URINE.

Results (07) 3121 4555

PATHOLOGY TESTS - D

TEST NAME
DOUBLE-STRANDED
DNA ANTIBODY, SERUM
DOXEPIN, SERUM

7.52

7.52

PATHOLOGY TESTS - D

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant


(plastic lithium heparin tube
(no gel) acceptable)

24 hours

DRUG TESTING ON-SITE

Biochemistry

DRUGS,
QUANTITATIVE ASSAY,
SERUM

Biochemistry

DUCENE, SERUM

Biochemistry

Please refer to DIAZEPAM, SERUM.

DUCHENNE MUSCULAR
DYSTROPHY, BLOOD
DURSBAN (PESTICIDE),
SERUM

Biochemistry

Please refer to DYSTROPHIN GENE ANALYSIS, BLOOD.

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

DYSTROPHIN GENE ANALYSIS,


BLOOD

Biochemistry

www.qml.com.au

We recommend that screening for drugs (except alcohol) should be performed on


urine instead of serum, as urine has higher sensitivity due to urinary concentration
of metabolites. However, in some cases (e.g. suspected overdose, or doctor insists
on serum testing) blood may be collected. Urine should always be collected as
soon as practicable. PROVIDE CLINICAL, MEDICATION AND SUSPECTED DRUG
USAGE DETAILS.

PATHOLOGY TESTS - D

TEST NAME
DRUG SCREEN, SERUM

Please contact the Drug Testing Laboratory, Biochemistry, Murarrie on


(07) 3121 4419 for all information on urine, saliva and breath on-site drug testing.
Blood/Plain plastic tube

Blood/EDTA tube

See individual
drugs or Appendix.
Some results
available urgently
when required.

3 - 4 weeks

Therapeutic monitoring, investigation of toxicity etc. Please give full clinical


details including dose and time of last dose. Please refer to individual drug (listed
alphabetically under generic name). See Biochemistry Appendix (12.13) for a full
list of drugs assayed. Contact Biochemistry (07) 3121 4083 or Branch Laboratory
for further details.

Transport at 4C to reach laboratory within 24 hours of collection.


Please provide clinical and medication details. This test detects cases only not suitable for determining carrier status. Referred test.

Results (07) 3121 4555

7.53

7.53

PATHOLOGY TESTS - D

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/SS tube

Same day
or urgently

Reporting time depends on degree of urgency. It is most important that the sample
is collected without venous stasis. The sample must be handled with care to avoid
haemolysis and serum separation must take place within half an hour of collection.
Transport to the laboratory without delay.

EAR, EYE, THROAT SWAB


FOR MICROSCOPY/CULTURE

Microbiology

Swab in Transport Medium

Interim
microscopy report
same day for ear
and eye swabs.
Culture report
48 hours.

Please specify site of collection and provide clinical details including antibiotic
therapy. Specify if specimen is to be cultured for exotic organisms such as
Actinomyces, fungi and/or Mycobacteria. For Chlamydia please use yellow top
Chlamydia culture collection kit.

ECHIS TIME

Haematology

Blood/Sodium citrate tube

Same day

Details of medication required.

ECHO-COXSACKIE
VIRUS SEROLOGY
EFAVIRENZ, PLASMA

Immunology

Blood/SS tube

72 hours

Assay run Tuesday and Friday.

Biochemistry

Blood/EDTA tube

3 weeks

Please provide clinical and medication details. Plasma to be separated and frozen if
sample will not reach the central laboratory within 24 hours of collection. Referred test.

EFEXOR, SERUM/PLASMA

Biochemistry

ELAIDIC/STEARIC ACID RATIO,


PLASMA

Biochemistry

ELECTROLYTES AND
LIVER FUNCTION TESTS,
SERUM
ELECTROLYTES, FAECES

Biochemistry

ELECTROLYTES, SERUM

Biochemistry

ELECTROLYTES, SWEAT

Biochemistry

www.qml.com.au

Biochemistry

PATHOLOGY TESTS - E

TEST NAME
E/LFT, SERUM

Please refer to VENLAFAXINE, SERUM/PLASMA.


Blood/Lithium heparin tube

2 weeks

Please provide family and clinical history. Sample should be forwarded on an ice
brick to arrive at the central laboratory within 4 hours.
If these requirements cannot be met, please separate serum into 6 mL Falcon tube
and store and transport frozen. Referred test.
Please refer to E/LFT, SERUM.

Faeces/Faeces container

24 hours

Please provide clinical and medication details. Keep sample cool during collection
and transport to the laboratory.
Please refer to E/LFT, SERUM.

Sweat/Sweat tube

1 week

Diagnostic test for cystic fibrosis. Please contact Collections (07) 3121 4450 or
Branch Laboratory for appointment. Sweat sodium and chloride measured.

Results (07) 3121 4555

7.54

7.54

PATHOLOGY TESTS - E

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/24 hour urine


container with no
preservative or
Random urine container

24 hours

ELECTROLYTES/UREA/
CREATININE, SERUM
ENDEP, SERUM

Biochemistry

Please refer to E/LFT, SERUM.

Biochemistry

Please refer to AMITRIPTYLINE, SERUM.

ENDOGENOUS ENDORPHINS

Biochemistry

Please phone Biochemistry (07) 3121 4420 or Branch Laboratory for availability.

ENDOMYSIAL ANTIBODY,
SERUM
ENDOSCOPE CULTURE

Immunology

Blood/SS tube

24 hours

Microbiology

Water samples/
Urine container

48 hours for
Please submit washings from air/water, biopsy and
suction channels in separate containers.
bacterial culture
- 14 Days if
mycobacterial
culture is required.

ENDOSCOPE CULTURE FOR TB

Microbiology

Water samples/
Urine container

4 - 6 weeks

ENDOSULFAN
(ORGANOCHLORINE
PESTICIDES), BLOOD
ENDRIN (ORGANOCHLORINE
PESTICIDES), BLOOD
ENTAMOEBA HISTOLYTICA
SEROLOGY
ENTEROVIRUS PCR

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

ENTEROVIRUS SEROLOGY

www.qml.com.au

1 week

Please provide clinical and medication details. 24 hour collection is preferred.


Under rare circumstances or if specifically required, a random urine may be
collected. Urine should be refrigerated during the collection period and transported
cooled to the laboratory.

Assay run daily (Monday - Friday).

Washings from the endoscope channels are collected after cleaning by endoscopy
unit staff at the hospital.

Immunology

Blood/SS tube

Immunology

Skin swabs, CSF/Virocult


1 week
(Green top) and Viral transport
medium (VTM)

Assay run Tuesday.

Immunology

Blood/SS tube

Assay run Tuesday and Friday.

72 hours

PATHOLOGY TESTS - E

TEST NAME
ELECTROLYTES, URINE

Assay run Wednesday.

Results (07) 3121 4555

7.55

7.55

PATHOLOGY TESTS - E

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Microbiology

Dust and other


environmental specimens/
Swab or Sterile container

48 hours

EPILIM, SERUM

Biochemistry

Please refer to VALPROATE, SERUM.

EPINEPHRINE,
URINE 24 HOUR
EPP, SERUM

Biochemistry

Please refer to CATECHOLAMINES, URINE.

Biochemistry

Please refer to PROTEIN ELECTROPHORESIS, SERUM.

EPP, URINE

Biochemistry

Please refer to PROTEIN ELECTROPHORESIS, URINE.

EPSTEIN-BARR VIRUS (EBV)


SEROLOGY
EQUINE MORBILLIVIRUS
ANTIBODIES, SERUM

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

Immunology

Blood/SS tube

2 - 3 weeks

Please provide details of clinical history and exposure.


Referred test.

ERYTHROCYTE PBG
DEAMINASE, BLOOD
ERYTHROCYTE
SEDIMENTATION RATE
ERYTHROPOIETIN ASSAY,
SERUM
ESGRAM, URINE

Biochemistry

ESR, BLOOD

Haematology

ESSENTIAL FATTY ACIDS,


PLASMA
ETHYL ACETATE, BLOOD

Biochemistry

Please refer to FATTY ACID PROFILE, PLASMA.

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

ETHYLENE DI BROMIDE,
URINE

Biochemistry

Please refer to BROMIDE, URINE for details.

www.qml.com.au

PATHOLOGY TESTS - E

TEST NAME
ENVIRONMENTAL SPECIMEN

Please refer to PORPHOBILINOGEN DEAMINASE, RED CELL.

Haematology

Blood/EDTA tube

Same day

Haematology

Blood/SS tube

1 week

Biochemistry

Specimen must reach laboratory within 24 hours of collection. Referred test.


Please refer to PARAQUAT, URINE.

Blood/EDTA tube

Same day

Results (07) 3121 4555

7.56

7.56

PATHOLOGY TESTS - E

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Plain plastic tube no gel or anticoagulant


(Plastic lithium heparin tube
(no gel) acceptable)

2 weeks

Please keep the sample cool and forward to the laboratory without delay.

EUGLOBULIN CLOT LYSIS TIME,


BLOOD

Haematology

Blood/Sodium
citrate tube

24 hours

Patient should be rested for 15 minutes prior to collection and NO tourniquet


should be used. Blood should be placed in melting ice water and delivered to
laboratory within 30 minutes of collection. Please contact Haematology
(07) 3121 4451 or Branch Laboratory for collection details and appointment.

EVEROLIMUS, BLOOD

Biochemistry

Blood/EDTA tube

1 week

Please provide time and date of last dose.

EXAM FOR PARASITES

Microbiology

Sealed container/Slide

Same day

Special collection procedures are required for Scabies, Demodex and Enterobius
(pin worm). Please record the site of the collection on the Request Form. Urine
for Schistosomiasis should be collected between noon and 3.00pm. The terminal
portion of the specimen is the most useful.

EXERCISE GROWTH HORMONE


STIMULATION TEST

Endocrinology

Blood/SS tube

24 hours

Test involves patient exercising for 8-10 minutes and collecting blood before,
immediately after and 10 minutes after exercise. Exercise causes a rise in core body
temperature which stimulates Growth Hormone release. Test is used to exclude Growth
Hormone release and deficiency. Please contact Branch Laboratory for appointment.

EXTENDED CF MUTATION,
BLOOD
EXTRACTABLE NUCLEAR
ANTIGENS (ENA),
ANTIBODIES TO, SERUM
EYE LESION,
MICROSCOPY AND CULTURE

Biochemistry

Blood/EDTA tube

4 weeks

Transport at room temperature. Referred test.

Immunology

Blood/SS tube

48 hours

Assay run daily (Monday to Friday). Please refer to Immunology Appendix (12.35)
for a full list of extractable nuclear antigens.

Microbiology

Swab/Ophthalmology
Microbiology kit

www.qml.com.au

PATHOLOGY TESTS - E

TEST NAME
ETHYLENE GLYCOL,
SERUM/PLASMA

Requirements are determined by clinical factors. Please refer to Microbiology Preface


(5.55) for details and contact Microbiology (07) 3121 4438 or Branch Laboratory.

Results (07) 3121 4555

7.57

7.57

PATHOLOGY TESTS - E

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood, Cerebrospinal fluid,


Synovial fluid/SS tube, 2 x
Plain containers (urine)

72 hours

Assay run Tuesday and Friday.

FABRY HETEROZYGOTE,
BLOOD & URINE

Biochemistry

Whole blood and Urine/2 x


EDTA tubes, 1 x Random
urine container (frozen)

Up to 5 months

Transport blood at 4C. Transport urine on dry ice.

FACTOR II ASSAY, BLOOD

Haematology

Refer to FACTOR VIII ASSAY.

FACTOR IX ASSAY, BLOOD

Haematology

Refer to FACTOR VIII ASSAY.

FACTOR V ASSAY, BLOOD

Haematology

Refer to FACTOR VIII ASSAY.

FACTOR V LEIDEN MUTATION


ANALYSIS

Genetics

FACTOR VII ASSAY, BLOOD

Haematology

FACTOR VIII ASSAY, BLOOD

Haematology

FACTOR VIII INHIBITOR ASSAY,


BLOOD
FACTOR X ASSAY, BLOOD

Haematology

Refer to FACTOR VIII ASSAY.

Haematology

Refer to FACTOR VIII ASSAY.

FACTOR XI ASSAY, BLOOD

Haematology

Refer to FACTOR VIII ASSAY.

FACTOR XII ASSAY, BLOOD

Haematology

Refer to FACTOR VIII ASSAY.

FACTOR XIII ASSAY, BLOOD

Haematology

Refer to FACTOR VIII ASSAY.

FAECAL ELASTASE, FAECES

Biochemistry

Please refer to PANCREATIC ELASTASE 1, FAECES.

FAECAL FAT, TOTAL

Biochemistry

Please refer to FAECES FAT, TOTAL-3 DAY COLLECTION.

FAECAL HAEMOGLOBIN
(HUMAN) - OCCULT BLOOD

Microbiology

www.qml.com.au

Blood/Pink top
EDTA tube

1 week

PATHOLOGY TESTS - F

TEST NAME
F.T.A. (ABS)

Please provide details regarding patients eligibility for Medicare rebate, i.e. proven
venous thrombosis or pulmonary embolism or first degree relative with mutation.
If no history incurs fee to patient.
Refer to FACTOR VIII ASSAY.

Blood/Sodium
citrate tube

Faeces/Faeces container

24 - 48 Hours.
Urgently if
required.

Same day 24 hours

Clinical and medication details please. Document bleeding/bruising history of


patient and any significant family history.
Keep specimen at 4C and MUST reach laboratory within 2 hours of collection.
Please contact Haematology (07) 3121 4451 or Branch Laboratory for details.

The Monoclonal Antibody test for human haemoglobin is routinely performed.


A special diagnostic diet is no longer required for this test. Refrigerate after
collection and transport cooled.

Results (07) 3121 4555

7.58

7.58

PATHOLOGY TESTS - F

PATHOLOGY TESTS

DEPARTMENT

Biochemistry

Faeces/Faeces container

1 week

Please provide clinical and medication details. A controlled fat intake may be required
and each days collection may be collected either into a separate tin or all three days
collected into the one tin (preferred). Use only the tins supplied for collection.
Ensure lids are securely placed on the tins and keep the tins UPRIGHT at all times.
Also instruct the patient to not place foreign objects e.g. nappy liners, plastic bags
etc. in with the sample.

FAECES MICROSCOPY
(OVA, CYSTS, PARASITES)

Microbiology

Faeces/Faeces container

24 hours

Indicate if recent history of travel overseas.


Please refer to Microbiology Preface (5.53).

FAECES MICROSCOPY
AND CULTURE

Microbiology

Faeces/Faeces container

Microscopy same Indicate if recent history of travel overseas or antibiotics.


day, culture report Please refer to Microbiology Preface (5.53).
48 hours

FAECES, CLOSTRIDIUM
DIFFICILE TOXIN

Microbiology

Faeces/Faeces container

Same day 24 hours

Random faeces sample. Refrigerate and transport cooled to laboratory within


24 hours of collection. Please indicate any recent history of antibiotics. If causes
of diarrhoea other than Clostridium difficile are possible or suspected, a faeces
sample for microscopy and culture should also be submitted. The specimen can
be used for up to 3 days if stored at 2 - 8C. Refer to Microbiology Preface (5.54).

FAMILIAL ADENOMATOUS
POLYPOSIS (FAP)
GENETIC TESTING

Genetics

Blood/EDTA tube

Indeterminate

GENETIC COUNSELLING IS REQUIRED BEFORE THE BLOOD SPECIMEN CAN


BE TAKEN. GENETIC COUNSELLING IS AVAILABLE FROM GENETIC HEALTH
QUEENSLAND AT THE ROYAL BRISBANE HOSPITAL ON (07) 3636 1686.

FAMILIAL MEDITERRANEAN
Genetics
FEVER (FMF) GENETIC TESTING

Blood/EDTA tube

6 weeks

Incurs non-Medicare refundable fee.


Patient consent for billing must be marked on the request form.

FASCIOLA HEPATICA SEROLOGY Immunology


FATTY ACID PROFILE,
Biochemistry
PLASMA

Blood/SS tube

2 - 3 weeks

Blood/Lithium
heparin tube
(EDTA tube acceptable)

2 weeks

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to CHROMATOGRAPHY, FAECES.

PATHOLOGY TESTS - F

TEST NAME
FAECAL SUGAR
CHROMATOGRAPHY
FAECES FAT,
TOTAL-3 DAY COLLECTION

Fasting samples are preferred. Family and clinical history must be provided.
The specimen should be refrigerated and transported immediately, cooled, to the
laboratory. The patient will receive an account of approx. $110.00 (approx. $30.15
Medicare rebate) from the referring laboratory. Referred test.

Results (07) 3121 4555

7.59

7.59

PATHOLOGY TESTS - F

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Lithium
heparin tube

2 weeks

Samples must be collected on a MONDAY MORNING ONLY and reach the laboratory no
later than 14:30 hrs. Due to the instability of samples, referral within 48 hours is required.
If these instructions cannot be followed, please phone the laboratory on (07) 3121 4420
or Branch Laboratory. Transport sample to the laboratory on ice. Referred test.

FATTY ACIDS, RED CELL

Biochemistry

Blood/Lithium
heparin tube

1 - 2 weeks

Samples must be collected on a MONDAY MORNING ONLY and arrive at the laboratory
by 14:30 hrs. Due to the instability of samples, referral within 48 hours is required. If
these requirements cannot be followed, please phone the laboratory on (07) 3121 4420
or Branch Laboratory. Transport sample to the laboratory on ice. Referred test.

FATTY ACIDS-VERY LONG


CHAIN, PLASMA

Biochemistry

Blood/Lithium heparin tube

4 weeks

Please provide family and clinical history. Separate plasma from red cells as soon
as possible. Transport to laboratory on dry ice. Referred test.

FENITROTHION (PESTICIDE),
SERUM

Biochemistry

FENTANYL, URINE

Biochemistry

FENTHIONETHYL (PESTICIDE),
SERUM

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

FERRITIN, SERUM

Biochemistry

Please refer to IRON (Fe) STUDIES, SERUM for collection details.

FERROPORTIN
GENE ANALYSIS

Biochemistry

Blood/2 x EDTA tubes

6 - 8 weeks

Patient must complete and sign consent form (QIMR P191) provided by requesting
doctor. Transport to central laboratory on ice - DO NOT FREEZE.

FETAL RED CELL SCREEN


(KLEIHAUER TEST),
MATERNAL BLOOD
FIBRINOGEN, PLASMA

Haematology

Maternal blood/
1 EDTA tube, 2 blood films

Same day
or urgently

Examination of maternal blood for evidence of foeto-maternal transfusion.


FMH test usually performed.

Haematology

Blood/Sodium
citrate tube

Same day

Refer to COAGULATION STUDIES.

FIBRONECTIN, PLASMA

Biochemistry

Blood/EDTA tube

2 weeks

Transport in esky at 4C.

FICAM (PESTICIDE), BLOOD

Biochemistry

FILARIA ANTIBODY, SERUM

Immunology

www.qml.com.au

PATHOLOGY TESTS - F

TEST NAME
FATTY ACIDS, PLATELET

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.
Urine/Urine container

2 - 3 months

Please keep the sample refrigerated or frozen. A random urine is required.

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.
Blood/SS tube

2 - 4 weeks

Referred test.

Results (07) 3121 4555

7.60

7.60

PATHOLOGY TESTS - F

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Haematology

Blood/1 EDTA tube,


2 blood films

Same day

Many species of microfilariae exhibit nocturnal periodicity in the blood of the host
to coincide with the biting habits of the insect vector. This periodicity appears
linked to the circadian rhythm (sleeping habit) of the host and will take about a
week to adjust to a new pattern as would occur in migration to a different time
zone. Optimum time for blood collection in an acclimatised host is 10pm to 4am.

FILARIASIS SEROLOGY

Immunology

Blood/SS tube

2 - 3 weeks

Refer to ADENOVIRUS SEROLOGY for collection details.

FINE NEEDLE ASPIRATE (FNA)


CYTOLOGY

Cytology

Labelled fixed and air


dried smears/Labelled
capped needle and syringe/
Needle rinsings

24 hours

For specimen preparation please refer to Cytology Preface.

FIP1L1-PDGFR (HES)
GENETIC TESTING

Genetics

Blood or Bone marrow/


EDTA tube or min. 1mL bone
marrow in EDTA tube

2 months

Specimen needs to be received by QML Pathology Genetics Department within 24


hours. Please transport and store at room temperature.

FIRST TRIMESTER
DOWNS SCREEN

Endocrinology

Blood/SS tube

48 hours

Tests performed are free BHCG and PAPP-A. This is a first trimester screening test
for Downs Syndrome and is usually done in combination with the patient having
an ultrasound scan measuring the nuchal translucency at 8-13 weeks, 6 days.
The blood test is done 1-2 days before the scan so that our results are ready
for use at their appointment. Note the patients weight and CMP/EDC. See
Endocrinology Appendix (12.23).

FK506, BLOOD

Biochemistry

FLAVIVIRUS SEROLOGY

Immunology

Blood/SS tube

24 hours

FLECAINIDE, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant


(Plastic lithium heparin
tube acceptable)

1 week

Please provide clinical and medication details including time and date of last dose.
Collected sample immediately prior to next dose.

FLUCLOXACILLIN, SERUM

Biochemistry

Blood/Red top tube

3 weeks

Please provide clinical and medication details. Keep sample cool.

FLUCONAZOLE, PLASMA

Biochemistry

Blood/EDTA tube

2 weeks

Please provide clinical and medication details. Keep sample cool.

FLUCYTOSINE, SERUM

Biochemistry

Blood/Lithium heparin tube

1 week

Collect just prior to next dose. Provide clinical and medication details.

FLUID CSF TRANSFERRIN

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - F

TEST NAME
FILARIA, BLOOD

Please refer to TACROLIMUS, BLOOD.

Please refer to TAU PROTEIN, FLUID.

Results (07) 3121 4555

7.61

7.61

PATHOLOGY TESTS - F

PATHOLOGY TESTS

DEPARTMENT

FLUNITRAZEPAM, SERUM

Biochemistry

Blood/Plain plastic tube


1 week
- no gel or anticoagulant
(EDTA tube or Plastic lithium
heparin tube acceptable)

Please provide clinical and medication details, including time and dosage of last
dose. Collect just prior to the next dose or at least 8 hours after the last dose.

FLUORESCENT IN SITU
HYBRIDISATION (FISH)
FLUORESCENT IN SITU
HYBRIDISATION (FISH)

Genetics

Amniotic fluid

24 hours

Rapid Detection of Fetal Aneuploidy.

Genetics

Blood/Lithium
heparin tube

2 weeks

Testing available for microdeletion syndromes DiGeorge, Williams, Prader-Willi, Angelman, Miller-Dieker, Smith-Magenis.

FLUORESCENT IN SITU
HYBRIDISATION (FISH)

Genetics

Bone Marrow,
Lymph Node

1 - 2 weeks

Probes specific for common Haematological malignancies


e.g. CML Panel of specific probes for CLL and Multiple Myeloma.

FLUORESCENT IN SITU
HYBRIDISATION (FISH)

Genetics

Paraffin Embedded Tissue

1 - 2 weeks

Testing available for HER2/neu gene in breast cancer, and 1p/19q deletions seen
in oligodendromas.

FLUORESCENT TREPONEMA
ANTIBODY ABSORPTION TEST
(FTA-ABS), SERUM
FLUORIDE, BLOOD

Immunology

Blood/SS tube

72 hours

Supplementary test for Syphilis. Referred test.

Biochemistry

Blood/EDTA tube (Lithium


heparin tube acceptable)

4 weeks

Please provide clinical, medication and exposure details.


Referred test.

FLUORIDE, URINE

Biochemistry

Urine/Urine container
(random collection) or plain
24 hour urine container

4 weeks

Please provide details of exposure (clinical and/or occupational). For occupational


monitoring, random samples should be collected Pre- and Post- work shift, unless
directed otherwise. For single exposures, a random urine collected after end of work
shift/exposure is preferred. A 24 hour urine is not the preferred sample. Referred test.

FLUOXETINE, SERUM

Biochemistry

Blood/Plain plastic tube


2 weeks
- no gel or anticoagulant
(EDTA tube or Plastic lithium
heparin tube acceptable)

Please provide clinical and medication details.


Centrifuge and separate serum as soon as possible. Referred test.

FMH TEST

Haematology

Blood/EDTA tube

It is recommended that blood is collected within 12 hours after birth and preferably
before injection of anti D. If anti D has been administered please indicate on the
form. If patient is pregnant note gestation stage. If the test is critically urgent notify
Haematology (07) 3121 4451 of the expected time of arrival.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to TAU PROTEIN, FLUID.

24 hours

Results (07) 3121 4555

PATHOLOGY TESTS - F

TEST NAME
FLUID TAU PROTEIN

7.62

7.62

PATHOLOGY TESTS - F

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/EDTA tube

24 hours

FOLATE, SERUM

Endocrinology

Blood/SS tube

24 hours

FOLIC ACID (FOLATE),


RED CELL

Endocrinology

Blood/EDTA tube

24 hours

FOLIC ACID (FOLATE), SERUM

Endocrinology

Blood/SS tube

24 hours

FOLIDOL (PESTICIDE), SERUM

Biochemistry

FRAGILE-X-SYNDROME
(FRAXA) MUTATION ANALYSIS

Genetics

Blood/Pink top
EDTA tube

1 week

PCR screening test performed initially and if positive/inconclusive, further testing


(Southern blotting) performed at RBH.

FREE ALPHA SUBUNIT, SERUM

Endocrinology

Blood/SS tube

1 - 2 weeks

Referred test.

FREE ANDROGEN INDEX,


SERUM
FREE CORTISOL,
URINE 24 HOUR

Endocrinology

Blood/SS tube

24 hours

This test is a ratio of total testosterone and sex hormone binding globulin.

Endocrinology

24 hour urine collection/


Urine collection bottle.
No preservative

48 hours

Dexamethasone not to be taken 72 hours prior to or during test, unless as part of


a prolonged Dexamethasone Suppression Test. Urine should be refrigerated during
the collection period and transported cooled to the laboratory. Record patients
height and weight.

FREE CORTISOL,
URINE RANDOM

Endocrinology

Random urine collection/


Urine collection bottle. No
preservative (Must not use
acid preservative)

24 hours

Record patients height and weight on request form.

FREE LIGHT CHAINS, SERUM

Biochemistry

Blood/SS tube

1 - 2 weeks

Please provide clinical and medication details.

FREE PSA

Endocrinology

Blood/SS tube

24 hours

A free PSA can not be requested on its own.


It can only be reported in conjunction with a PSA.

FREE T3, SERUM

Endocrinology

Blood/SS tube

24 hours

Please note all Thyroid medication e.g. Propylthiouracil (PTU), Neomercazole (NMZ),
Thyroxine (T4) and Carbimazole (CBZ).

FREE T4, SERUM

Endocrinology

Blood/SS tube

24 hours

TSH is routinely performed. Free T4 will be measured in addition to TSH in certain


patients. Please supply a comprehensive history including exactly what medication
the patient is taking. Please refer to Endocrinology Preface (5.23) for details.

www.qml.com.au

This measures the steady state level unaffected by the fluctuations of dietary
intake or tissue utilisation of folate.
This measures the steady state level unaffected by the fluctuations of dietary
intake or tissue utilisation of folate.

PATHOLOGY TESTS - F

TEST NAME
FOLATE, RED CELL

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

Results (07) 3121 4555

7.63

7.63

PATHOLOGY TESTS - F

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/SS tube

24 hours

FRIEDREICHS ATAXIA GENETIC


TESTING
FRISIUM, SERUM

Genetics

Blood/EDTA tube

1 - 2 months

FROZEN SECTION,
TISSUE

Histology

Biopsy tissue/DRY container


(No formalin)

Immediate. Full
report 24 hours

Please telephone Histology (07) 3121 4495 or


Branch Laboratory for booking.

FRUCTOSAMINE, SERUM

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details.


A medium term assay (approximately 1 month) of diabetic control.

FRUCTOSE,
SEMINAL FLUID

Biochemistry

Seminal fluid/
Semen container

1 week

An instruction sheet can be provided for the patient. Specimen must reach
laboratory within 2 hours of collection. Keep at room temperature. If there is a
delay between sperm count and fructose estimation (e.g. transport to central
laboratory) REFRIGERATE after sperm count has been completed. Please refer to
Genetics Preface (5.30) for full details.

FRUSEMIDE, URINE

Biochemistry

Urine/Urine container

1 - 2 weeks

This test attracts a fee from the referring laboratory, payable by the patient. Please
indicate on the request form if permission or prior arrangement has been granted
by the doctor or patient to perform test.

FSH, SERUM

Endocrinology

Blood/SS tube

24 hours

Please include clinical notes and date of last normal menstrual period (LNMP).
Include information regarding any hormone replacement therapy or contraceptive use.

FULL BLOOD COUNT (FBC),


BLOOD

Haematology

Blood/EDTA tube

Immediate;
Same day

Please see Haematology Appendix (12.32).

FULL BLOOD EXAMINATION


(FBE), BLOOD

Haematology

Blood/EDTA tube

Immediate;
Same day

Transport specimen cooled.

FUNGAL CULTURE (SYSTEMIC)

Microbiology

Tissue, biopsy or body


fluid in a sterile container

Microscopy - 24
hours; Culture
- up to 4 weeks

Please do not add formalin to the sample.

www.qml.com.au

Biochemistry

This test measures a sub fraction of albumin bound testosterone. Collect a fasting
specimen or a specimen at greater than 3 hours post-prandial as food absorption
may influence blood levels.

Please refer to CLOBAZAM, SERUM.

Results (07) 3121 4555

PATHOLOGY TESTS - F

TEST NAME
FREE TESTOSTERONE,
SERUM

7.64

7.64

PATHOLOGY TESTS - F

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Microbiology

Skin scrapings/Paper
envelope, Petri dish, dry
sterile screw top (urine)
container. Include blade
used to collect sample.
Moist sterile swab/
DRY transport tube

Interim
microscopy report
24 hours. Culture
report up to 4
Weeks

Please indicate recent history of therapy. Antifungal therapy should be ceased at least
two days (optimally one week) prior to collection of specimen. Scrape active edge of
lesion. If the lesion is exuding material and painful to scrape, a swab may be collected
as an alternative. Use a dry swab previously moistened with saline to swab the lesion.
Place the swab in a container without transport medium. Refer to Cutaneous Fungal
Culture in Microbiology Preface (5.56) for details of specimen collection, storage and
transport. Blade should be transported in screw top container (NOT paper envelope).

FUNGAL PRECIPITINS, SERUM

Immunology

Blood/SS tube

2 - 4 weeks

Referred test.

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - F

TEST NAME
FUNGAL MICROSCOPY/
CULTURE, SKIN

7.65

7.65

PATHOLOGY TESTS - F

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/EDTA tube

1 week

Do not freeze EDTA.

GABAPENTIN, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant


(EDTA tube or Plastic lithium
heparin tube acceptable)

2 weeks

Please provide clinical and medication details, including time, date and dosage
of last dose. Please collect trough sample just prior to next dose. Please keep the
sample cool and transport to the laboratory without delay. Referred test.

GAD (GLUTAMIC ACID


Immunology
DECARBOXYLASE) ANTIBODIES,
SERUM
GALACTOKINASE, BLOOD
Biochemistry

Blood/SS tube or
Lithium heparin tube

2 weeks

Test run fortnightly. Next day results.


Please provide clinical and medication details.

Blood/Lithium
heparin tube

2 weeks

Please advise Biochemistry (07) 3121 4420 or your Branch Laboratory of expected
arrival time. Send sample without delay.

GALACTOSAEMIA
CONFIRMATION, BLOOD

Biochemistry

Blood/Lithium
heparin tube

1 - 2 weeks

Transport sample refrigerated and must reach laboratory as soon as possible. Please
contact Biochemistry (07) 3121 4420 or Branch Laboratory for details. Referred test.

GALACTOSAEMIA SCREEN,
BLOOD

Biochemistry

Blood/Lithium
heparin tube

1 - 2 weeks

Transport sample refrigerated and must reach laboratory as soon as possible.


Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for details.
Referred test.

GALACTOSE, PLASMA

Biochemistry

Please refer to GALACTOSAEMIA SCREEN, BLOOD.

GALACTOSE-1-PHOSPHATE
URIDYL TRANSFERASE,
RED CELL
GALACTOSE-1-PHOSPHATE,
RED CELL
GAMMA GT (GAMMA GLUTAMYL
TRANSPEPTIDASE), SERUM
GAMMA GT, FLUID

Biochemistry

Please refer to GALACTOSAEMIA SCREEN, BLOOD.

Biochemistry

Please refer to GALACTOSAEMIA SCREEN, BLOOD.

Biochemistry

Please refer to E/LFT, SERUM.

Biochemistry

Fluid/Plain tube/Container

Same day

Specify site of fluid on specimen container and request form.

GANGLIOSIDE ANTIBODIES

Immunology

Blood/SS tube

2 - 3 weeks

Referred test.

GAS ANALYSIS,
ARTERIAL BLOOD

Biochemistry

Arterial blood/Blood
gas syringe

Same day

Please refer to Biochemistry Preface (5.1).

GAS ANALYSIS,
VENOUS BLOOD

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - G

TEST NAME
G6PD QUANTITATIVE ASSAY

Please refer to BLOOD GASES, VENOUS.

Results (07) 3121 4555


8.0

8.0

PATHOLOGY TESTS - G

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Cytology

Fluid/Sterile screw
top container

24 hours

GASTRIC ASPIRATE
MICROSCOPY/CULTURE

Microbiology

Gastric Aspirate/
Sterile screw top
(urine) container

Microscopy
Transport to the laboratory immediately.
phoned same day.
Culture 48 hours

GASTRIC BRUSHING
CYTOLOGY

Cytology

Fixed Smears/Slide carrier


and/or fluid/Sterile screw top
container. Brush in a container
of normal saline

24 hours

For specimen preparation please refer to Cytology Preface (5.16).

GASTRIN, SERUM

Endocrinology

Blood/SS tube

1 week

May collect a fasting specimen, a one hour post-prandial specimen or both


Transport to Endocrinology within 4 hours of collection. Specimen must be kept cold.

GAUCHERS DISEASE
(SCREENING)
GENITAL MICRO/CULTURE

Genetics

Blood/EDTA tube

1 - 2 weeks

Keep at room temperature. DO NOT SPIN. Need family history.

Microbiology

Genital swab or IUD/Swab in 48 hours


bacteriology transport media
or Sterile container (IUD)

Specify site of collection. Transport to the laboratory as soon as possible


(viability of N. gonorrhoeae decreases after several hours).

GENITAL SWAB
INCLUDING ANAEROBES
AND GONOCOCCUS

Microbiology

Swab in Transport Medium

48 hours

For Actinomyces culture IUD should be submitted. Wet preparation performed


for Yeasts and Trichomonas. Gonococcus swab in transport medium should be
forwarded to the laboratory as soon as possible.

GENTAMICIN ASSAY SINGLE DAILY DOSE


(BOLUS DOSE), SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant

Urgently

Please supply details of dose schedule. Collect one sample only 6 - 14 hours
after the dose. Result to be available before next dose due to enable adjustment if
required. QML Pathology will report the serum gentamicin in mg/L, the time and
date of last dose and time since last dose. Based on this data, the recommended
serum level. Please refer to Biochemistry Appendix (12.17).

GESTATIONAL DIABETES
SCREEN

Biochemistry

Blood/SS tube or
Fluoride oxalate tube

Same day

Fasting is not required. At 26-28 weeks gestation, give the patient 50g or 75g
glucose dose - collect sample 1 hour later. Indicate glucose dosage and the time it
was given on request form. If a SS tube is collected, the sample must be centrifuged
after clotting has occurred (no longer than 30 minutes). Nothing should be taken by
mouth after the dose and prior to the blood sample collection except water.

GHRELIN, SERUM

Biochemistry

Blood/SS tube

2 weeks

Patient MUST be fasting.

www.qml.com.au

For specimen preparation please refer to Cytology Preface (5.17).

PATHOLOGY TESTS - G

TEST NAME
GASTRIC ASPIRATE
CYTOLOGY

Results (07) 3121 4555


8.1

8.1

PATHOLOGY TESTS - G

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

48 hours

Immunology

Blood/SS tube

24 hours

GLOBULINS (CALCULATED),
SERUM
GLOBULINS, FLUID

Biochemistry
Biochemistry

8.2

GLOMERULAR BASEMENT
Immunology
MEMBRANE ANTIBODY, SERUM
GLUCAGON STIMULATION
Endocrinology
TEST OF C- PEPTIDE/INSULIN

Assay run daily (Monday - Friday).

Please refer to E/LFT, SERUM.


Fluid/Plain tube or container

Same day

Specify site of fluid on specimen container and request form.

Blood/SS tube

72 hours

Assay run Tuesday and Friday.

Blood/SS tube or
Fluoride oxalate tube

24 hours

Test requires IV administration of glucagon and collection of timed blood samples.


Please contact Collections (07) 3121 4450 or Branch Laboratory for appointment
and Endocrinology (07) 3121 4439 for details.

GLUCAGON, PLASMA

Endocrinology

Blood/EDTA tube
with Trasylol

4 weeks

Patient must be fasting. Special handling and transport required.


Please contact Endocrinology (07) 3121 4439 or Branch Laboratory. Referred test.

GLUCOSE (1HR POST LOAD),


SERUM

Biochemistry

Blood/SS tube or
Fluoride oxalate tube

Same day

Other than for 26-28 weeks of pregnancy, this test is of limited value in the
assessment of glucose tolerance. We do not recommend it as a standard test and
2 hours post 75g load is preferable.

GLUCOSE TOLERANCE TEST


- 2 HOUR, NON-PREGNANCY

Biochemistry

Blood/SS tubes and


Urine/Urine containers

24 hours

Please refer to Biochemistry Appendix (12.9) for pre test dietary requirements and
restrictions. Contact Biochemistry (07) 3121 4420 or Branch Laboratory for further
details. Blood - PRE, 1 and 2 hour POST glucose dose. Urine - PRE and 2 hour
POST glucose dose. Appointment required. Please contact nearest collection centre.

GLUCOSE TOLERANCE TEST


- 3 HOUR

Biochemistry

Blood/SS tubes and


Urine/Urine containers

24 hours

Same as 2 hour GTT except blood also collected at 3 hours post glucose dose.
Appointment required. Please contact nearest collection centre.

GLUCOSE TOLERANCE TEST Biochemistry


EXTENDED (4, 5 AND 6 HOURS)

Blood/SS tubes and


Urine/Urine containers

24 hours

Please refer to Biochemistry Appendix (12.9) for pre test dietary requirements
and restrictions. Investigation of Hypoglycaemia may require a 6 hour GTT.
Please contact Biochemistry (07) 3121 4420, Endocrinology (if serum
insulins are also required) (07) 3121 4435 or Branch Laboratory for advice.
Appointment required. Modified has no specific meaning in this context and
period of sample collection should be specified.

www.qml.com.au

PATHOLOGY TESTS - G

TEST NAME
GLIADIN ANTIBODIES
(COELIAC DISEASE), SERUM
GLIADIN IGA/IGG SEROLOGY

Results (07) 3121 4555


8.2

PATHOLOGY TESTS - G

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/SS tube

24 hours

Please refer to Biochemistry Appendix (12.9) for pre test dietary requirements and
restrictions. Please contact Branch Laboratory or Endocrinology (07) 3121 4439
for details. Appointment required. Please contact nearest collection centre.

GLUCOSE TOLERANCE TEST


- GLUCOSE AND INSULIN

Endocrinology

Blood/SS tube

24 hours

Please refer to Biochemistry Appendix (12.9) for pre test dietary requirements and
restrictions. Appointment required. Please contact nearest collection centre.

GLUCOSE, CSF

Biochemistry

GLUCOSE, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Keep sample refrigerated. Specify site of fluid on specimen container and request form.

GLUCOSE, PLEURAL FLUID

Biochemistry

Pleural fluid/Plain tube

Same day

Please provide clinical and medication details.


Refrigerate sample during storage and transport.

GLUCOSE, SERUM

Biochemistry

Blood/SS tube or
Fluoride oxalate tube

Same day

Please provide clinical and medication details. Note whether fasting or post-prandial
and time of collection. If SS tube is collected, it must be centrifuged within half an
hour. Use GREY FLUORIDE OXALATE TUBE if DELAY IN SEPARATION IS EXPECTED.

GLUCOSE,
SYNOVIAL FLUID
GLUCOSE, URINE

Biochemistry
Biochemistry

Urine/Urine container or
24 hour urine container
with no preservative

Same day

A random collection is preferred. 24 hour collections must be refrigerated whilst


being collected. NB. If a delay in transport to the laboratory is envisaged, prevent
bacterial breakdown by the addition of a crystal of thymol or 150mg of merthiolate.

GLUTAMATE, SERUM

Biochemistry

Blood/SS tube

1 week

Please provide clinical and medication details. The patient must be FASTING.
Please refer to dietary restrictions in Biochemistry Appendix (12.9). Referred test.

GLUTAMIC ACID
DECARBOXYLASE (GAD)
ANTIBODIES, SERUM
GLUTAMIC ACID, SERUM

Immunology

Blood/SS tube

Up to 6 weeks

Please provide clinical and medication details. Specimen should be kept cool
during storage and transport. Referred test.

Biochemistry

Please refer to GLUTAMATE, SERUM.

GLUTAMINE, SERUM

Biochemistry

Please refer to GLUTAMATE, SERUM.

GLUTATHIONE PEROXIDASE,
BLOOD

Biochemistry

Blood/Lithium
heparin tube

1 - 2 weeks

Glutathione peroxidase, red cells AND plasma can be performed on this collection.
Referred test.

GLUTATHIONE PEROXIDASE,
PLASMA

Biochemistry

Blood/Lithium heparin
tube or EDTA tube

1 - 2 weeks

Referred test.

www.qml.com.au

Test for bacterial meningitis. Please refer to BIOCHEMISTRY, CSF for details.

PATHOLOGY TESTS - G

TEST NAME
GLUCOSE TOLERANCE TEST
- GLUCOSE AND GROWTH
HORMONE

Glucose is low in joint infection. Please refer to ALBUMIN, SYNOVIAL FLUID.

Results (07) 3121 4555


8.3

8.3

PATHOLOGY TESTS - G

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to VITAMIN B2, BLOOD for details.

Biochemistry

Please refer to FRUCTOSAMINE, SERUM.

GLYCATED HAEMOGLOBIN,
BLOOD
GLYCEROL, PLASMA

Biochemistry

Please refer to HAEMOGLOBIN A1c (HbA1c), BLOOD.

Biochemistry

Blood/Lithium heparin tube

1 week

Sample must be stored and transported cool.

GLYCEROL, URINE

Biochemistry

Urine/Urine container

1 week

Random urine collection. Transport at 4C. Referred test.

GLYCOGEN DEBRANCHER
ENZYME, BLOOD
GLYCOLATE, URINE

Biochemistry
Biochemistry

Urine/Urine container

3 - 4 weeks

Transport in esky at 4C. Referred test.

GLYPHOSATE, URINE

Biochemistry

Urine/50 mL
urine container

4 weeks

Random urine collected at the end of work shift or exposure. This test attracts a
charge of approximately $175.00 from the reference laboratory, payable by the
patient or their employer. Please indicate on the request form if permission or prior
arrangement has been granted to perform test. Sample must be collected within
48 hours of exposure. Referred test.

GOLD, SERUM

Biochemistry

Blood/EDTA tube

2 weeks

Please provide clinical and medication details. Collect immediately prior to next
dose or at least 8 hrs after last dose. Referred test.

GRAM STAIN

Microbiology

Swab and/or
prepared smear

Same day

Please provide clinical details including antibiotic therapy


and specify site of collection.

GRAMOXONE, URINE

Biochemistry

GRANULOCYTE ANTIBODY
SCREEN

Haematology

Blood/2 EDTA tubes, SS tube 24 hours

Test performed daily. No booking or appointment required.


Please notify Haematology (07) 3121 4451 or your Branch Laboratory of all urgent
specimens and weekend collections.

GROWTH HORMONE
SUPPRESSION TEST
(USING GLUCOSE)
GROWTH HORMONE, SERUM

Endocrinology

Blood/SS tube

24 hours

Please contact Branch Laboratory for appointment.

Endocrinology

Blood/SS tube

24 hours

Please state whether fasting or non-fasting and any relevant clinical information.

www.qml.com.au

PATHOLOGY TESTS - G

TEST NAME
GLUTATHIONE REDUCTASE,
BLOOD
GLYCATED ALBUMIN, SERUM

Please refer to AMYLO-1,6-GLUCOSIDASE, BLOOD for details.

Please refer to PARAQUAT, URINE.

Results (07) 3121 4555


8.4

8.4

PATHOLOGY TESTS - G

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/SS tube

24 hours

Routine GTT pre test preparation including overnight fast. Test duration - 3 hours
with half-hourly blood collections. Glucose, insulin and c-peptide to be assayed.
No urine collection or testing required. Appointment required. Please contact
nearest collection centre.

GTT (2 OR 3 HOUR),
NON-PREGNANCY

Biochemistry

Blood and urine/SS tube


or Fluoride oxalate tube.
Urine container

24 hours

Please refer to GLUCOSE TOLERANCE TEST - 2 HOUR, NON-PREGNANCY.

GTT (2 OR 3 HOUR),
PREGNANCY

Biochemistry

Blood and urine/SS tube


or Fluoride oxalate tube.
Urine container

24 hours

Please refer to Biochemistry Appendix (12.9) for pre test dietary requirements
and restrictions. Contact Biochemistry (07) 3121 4420 or Branch Laboratory for
further details. Blood - PRE, 1, 2 and 3 hour POST glucose dose unless otherwise
specified. Urine - PRE glucose dose only. Appointment required. Please contact
nearest collection centre.

GTT, EXTENDED
OR MODIFIED

Biochemistry

Blood and urine/SS tube


or Fluoride oxalate tube.
Urine container

24 hours

Please refer to GLUCOSE TOLERANCE TEST - EXTENDED (4,5 AND 6 HOURS).

GUSATHION (PESTICIDE),
SERUM

Biochemistry

GUT TUMOUR MARKERS


(CA 19-9, CEA), SERUM

Endocrinology

GUTHRIE TEST

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - G

TEST NAME
GTT - INSULIN
AND C-PEPTIDE

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.
Blood/SS tube

24 hours

Inflammatory or neoplastic conditions of mucinous epithelium see Biochemistry Appendix (12.5).


Please refer to NEONATAL SCREENING TEST.

Results (07) 3121 4555


8.5

8.5

PATHOLOGY TESTS - G

PATHOLOGY TESTS

DEPARTMENT

H G PHOSPHORIBOSYL
TRANSFERASE, BLOOD

Biochemistry

HAEMATOCRIT

Haematology

Blood/EDTA tube

Same day

HAEMOCHROMATOSIS
GENE MUTATION ANALYSIS

Genetics

Blood/Pink top
EDTA tube

1 week

Transport at room temperature or cooled. Advise patient that there will be a nonMedicare rebatable fee if they do not meet the following criteria: a) the patient
has an elevated transferrin saturation or elevated serum ferritin on testing
of repeated specimens; or b) the patient has a first degree relative with
haemochromatosis; or c) the patient has a first degree relative with homozygosity
for the C282Y compound hetrozygosity for recognised genetic mutations for
haemochromatosis. Criteria MUST be stated on the request form by the Doctor.

HAEMOGLOBIN

Haematology

Blood/EDTA tube

Same day

Please see Haematology Appendix (12.31).

HAEMOGLOBIN (HUMAN),
FAECAL - OCCULT BLOOD

Microbiology

Faeces/Faeces container

Same day 24 hours

The Monoclonal Antibody test for human haemoglobin is routinely performed.


Refrigerate after collection and transport cooled.

HAEMOGLOBIN A1c (HbA1c),


BLOOD

Biochemistry

Blood/EDTA tube

24 hours

Please provide clinical and medication details.


Keep sample refrigerated during transport and storage.

HAEMOGLOBIN A1c,
BLOOD
HAEMOGLOBIN
AND SMEAR
HAEMOGLOBIN
ELECTROPHORESIS (EPP),
BLOOD
HAEMOGLOBIN F, BLOOD

Biochemistry

HAEMOGLOBIN GLYCATED,
BLOOD
HAEMOGLOBIN, PLASMA

Biochemistry
Haematology

Blood/Lithium
heparin tube

24 hours

Avoid haemolysis during collection.

HAEMOGLOBIN, URINE

Biochemistry

Urine/Urine container

24 hours

Please provide clinical and medication details. Random sample required.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS


Please refer to HYPOXANTHINE GUANINE PHOSPHORIBOSYL
TRANSFERASE, BLOOD.

PATHOLOGY TESTS - H

TEST NAME

Please refer to HAEMOGLOBIN A1c (HbA1c), BLOOD.

Haematology

Blood/EDTA tube

Same day

Blood films made at time of collection are preferred.

Haematology

Blood/EDTA tube,
blood film

1 - 3 days

Tests performed Tuesday and Friday. Results available same day of test.

Haematology

Blood/EDTA tube

1 - 3 days

Tests performed Tuesday and Friday. Results available same day of test.
Please refer to HAEMOGLOBIN A1c (HbA1c), BLOOD.

Results (07) 3121 4555


8.6

8.6

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

HAEMOGLOBINOPATHY
STUDIES

Haematology

Blood/2 EDTA tubes,


1 blood film

1 - 3 days

Tests performed Tuesday and Friday. Results available same day of test.

HAEMOLYTIC COMPLEMENT

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday to Friday). Separate serum by centrifugation immediately


after collection and decant into a labelled plain plastic tube. Refrigerate during
storage and transport cold. Ideally sample should NOT be shared.

HAEMOLYTIC SCREEN

Haematology/
Biochemistry

Blood/2 EDTA tubes,


blood film and 1 SS tube
are required for initial
screening tests

Same day

Initial screening tests should include FBC, Reticulocyte count, Coombs test,
Bilirubin, LDH and Haptoglobin. Further tests will depend on the results of
screening tests and the provisional diagnosis. Please note that Medicare does not
recognise Haemolytic Screen as an acceptable group of tests.

HAEMOPHILIA
GENETIC TESTING

Genetics

Blood/2 x Sodium citrate


tubes, 4 x EDTA tubes

6 weeks

Please contact Genetics (07) 3121 4461 or Branch Laboratory prior to collection.
Referred test.

HAEMOPHILUS
INFLUENZAE B AB
HAEMOSIDERIN,
URINE RANDOM

Immunology

Blood/SS tube

3 - 4 weeks

Haematology

Random urine/Urine
container

Same day

HAIR, MICROSCOPIC
EXAMINATION

Histology

Hair/Sterile
dry container

24 - 48 hours

50 or more hairs is desirable for telogen counts. Generally performed by clinicians


experienced in the diagnosis and management of alopecia. Hair is obtained by either
(A) gentle stroking or tugging to obtain hair being shed excessively or by (B) forceful
hair pluck. IT IS IMPORTANT to indicate on the request form the method of collection.

HAM TEST
(ACIDIFIED SERUM TEST),
BLOOD

Haematology

Blood/1 SS tube,
1 EDTA tube

24 hours

Test for detection of Paroxysmal Nocturnal Haemoglobinuria (Haemolytic Anaemia). Please


contact Haematology (07) 3121 4451 or Branch Laboratory for details. Flow cytometry for
PNH is the preferred test.

HAND, FOOT AND


MOUTH SEROLOGY
HAPTOGLOBIN, SERUM

Immunology

Blood/SS tube

72 hours

Assay run Tuesday and Friday.

Biochemistry

Blood/SS tube

24 hours

Blood must be collected without haemolysis occurring. Also, avoid agitation of the
blood after collection to avoid causing in vitro haemolysis.

HB WHITE CELL AND DIFF

Haematology

Blood/EDTA tube

Same day

HCB (ORGANOCHLORINE
PESTICIDE), BLOOD

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - H

TEST NAME

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Results (07) 3121 4555


8.7

8.7

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

HCG - TUMOUR MARKER,


SERUM

Endocrinology

Blood/SS tube

24 hours

-HCG can be used as a tumour marker for trophoblastic disease (hydatidiform


mole, invasive mole, persistent mole, partial hydatidiform mole, placental site
trophoblastic tumour and gestational choriocarcinoma). Complete obstetric history is
essential for history is essential for result interpretation. Elevated levels are also seen
in both ovarian and testicular germ cell tumours and some breast carcinomas. When
used in conjunction with AFP, -HCG may prove useful in assessing prognosis,
monitoring therapy and detecting recurrence of gonadal germ cell neoplasms.

HCG STIMULATION
OF TESTOSTERONE
HCG TITRE, SERUM

Endocrinology

Blood/SS tube

24 hours

This test involves an injection of HCG and the measurement of Testosterone.

Endocrinology

Blood/SS tube

24 hours

Note date of last normal menstrual period (LNMP), period of amenorrhoea


(A=) and estimated date of confinement (EDC).

HDL CHOLESTEROL, SERUM

Biochemistry

Blood/SS tube

Same day

Patient need not be fasting unless other fasting tests e.g. triglycerides are also required.

HEAVY METAL SCREEN,


BLOOD

Biochemistry

Blood/EDTA tube (Lithium


heparin tube acceptable)

1 week

Please provide clinical, medication and exposure details and indicate


which heavy metals are required (usually cadmium, lead, mercury).
There are Medicare restrictions on refunding.

HEAVY METAL SCREEN,


URINE

Biochemistry

Urine/Urine container

1 week

Please provide clinical, medication and exposure details (clinical and occupational)
and indicate which heavy metals are required (usually cadmium, lead, mercury).
A random collection is required. Keep sample refrigerated. Medicare restrictions
apply on refunding in this context.

HEINZ BODIES, BLOOD

Haematology

Blood/EDTA tube

Same day

HELICOBACTER
FAECAL ANTIGEN
HELICOBACTER PYLORI
CARBON-14 UREA
BREATH TEST

Immunology

Faeces/Faeces container

2 - 3 weeks

Endocrinology

1 glass vial containing


CO2 trapping liquid

24 hours

It is preferred for the patient to fast before the test, but not necessary. A test dose
is ingested and mouth is rinsed. 20 minutes later, a breath sample is collected in
a glass vial containing CO2 trapping liquid. The glass vial is identified by name,
sealed, placed in a plastic bag and transported cooled to the laboratory where the
activity of the trapped labelled CO2 is measured. Appointment is required for test.

HELICOBACTER PYLORI
SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

www.qml.com.au

PATHOLOGY TESTS - H

TEST NAME

Results (07) 3121 4555


8.8

8.8

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

HENDRA VIRUS SEROLOGY

Immunology

Blood/SS tube

2 - 4 weeks

Referred test. Please provide details of clinical history and exposure.

HEPARIN ANTI FACTOR XA

Haematology

Blood/Sodium
citrate tube

Same day

The specimen must be kept at 4C and delivered to the laboratory within 2 hours. A
coagulation questionnaire card is required, noting the type of heparin the patient is on.

HEPARIN ASSAY, BLOOD

Haematology

Blood/Sodium citrate
tube, EDTA tube

24 hours

Time of collection is important. Please contact Haematology (07) 3121 4451 or


Branch Laboratory for collection details.

HEPARIN COFACTOR II

Haematology

Blood/Sodium
citrate tube

5 weeks

Please contact Haematology (07) 3121 4451 or your Branch Laboratory for details
before collection. Referred Test. NOTE: This test is referred to Austin Hospital.
Inform patient that they will be charged a non-refundable fee of approx. $30 by
Austin Repatriation Hospital.

HEPARIN-INDUCED
AGGREGATION

Haematology

Blood/Sodium citrate tube


or SS tube, EDTA tube

Same day

Clinical and medication details required.


Specimens to arrive at the laboratory within 4 hours.

HEPATITIS (A OR B)
IMMUNE STATUS

Immunology

Blood/SS tube

24 hours

Please note if Hepatitis A or B assay is PRE or POST vaccination.


Assay run daily (Monday to Saturday).

HEPATITIS A IgG ANTIBODY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

HEPATITIS A IgM ANTIBODY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

HEPATITIS ACUTE SEROLOGY

Immunology

Blood/SS tube

24 hours

To determine the appropriate tests please provide clinical details including Liver
Function Studies. If cause unknown the tests performed routinely are HAIgM,
HBsAg, HBcAB and HCV. Others for consideration include EBV, CMV, Toxoplasmosis,
Brucellosis and Leptospirosis. Please refer to Immunology Preface (5.48) or
contact Immunology (07) 3121 4458 or Branch Laboratory for further details.
Assay run daily (Monday to Saturday).

HEPATITIS B CORE
ANTIBODY (HBcAb)
HEPATITIS B CORE IgM
ANTIBODY (HBcAb-IgM)
HEPATITIS B DNA

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

Immunology

Blood/SS tube

1 week

Assay run on Wednesdays. Results next day after testing.

HEPATITIS B SURFACE
ANTIBODY (HBsAb)

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday). Please indicate on request form if Hep B
serology is required for PRE or POST vaccination.

www.qml.com.au

PATHOLOGY TESTS - H

TEST NAME

Results (07) 3121 4555


8.9

8.9

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

HEPATITIS B SURFACE
ANTIGEN (HBsAg)
HEPATITIS C ANTIBODY
(HCV Ab)
HEPATITIS C VIRUS
GENOTYPE

Immunology

Blood/SS tube

Same day

Assay run daily (Monday - Saturday).

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

Immunology

Blood/SS tube

1 week

Assay run on Fridays. Results next day after testing. Note: there is a Medicare
rebate under some circumstances (see Immunology Preface (5.48) for qualifying
conditions.) If patient does not qualify, a non-refundable fee may be charged.
Essential to state on request form if patient qualifies for Medicare rebate.

HEPATITIS C VIRUS RNA,


QUALITATIVE

Immunology

Blood/SS tube

1 - 2 weeks

Note: there is a Medicare rebate under some circumstances (see Immunology Preface
(5.48) for qualifying conditions.) If patient does not qualify, a non-refundable fee may
be charged. Essential to state on request form if patient qualifies for Medicare rebate.

HEPATITIS C VIRUS RNA,


QUANTITATIVE

Immunology

Blood/SS tube

1 week

Assay run on Wednesdays. Results next day after testing. Note: there is a Medicare
rebate under some circumstances (see Immunology Preface (5.48) for qualifying
conditions). The patient should be having a pre or post treatment evaluation and
the test should be requested by or on the advice of a specialist or consultant
physician. Two tests are allowed in a 12 month period. If patient does not qualify,
a non-refundable fee may be charged. Essential to state on request form if patient
qualifies for Medicare rebate.

HEPATITIS D (DELTA) VIRUS

Immunology

Blood/SS tube

1 week

Assay run Wednesday.

HEPATITIS E VIRUS

Immunology

Blood/SS tube

1 week

Assay run Wednesday.

HEPATITIS G VIRUS

Immunology

Blood/SS tube

2 - 4 weeks

Referred test.

HEPTACHLOR,
(ORGANOCHLORINE
PESTICIDE), BLOOD
HEPTANE, BLOOD

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - H

TEST NAME

8.10

8.10

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

HERBICIDES, URINE

Biochemistry

Urine/50 mL urine container

4 weeks

Please provide specific details of particular weedicide patient has been exposed
to. Random urine collected immediately after work shift/exposure. If used as
a screening test cost of this test NOT covered by Medicare. Please phone
Biochemistry (07) 3121 4420 or your Branch Laboratory for current cost details.
Also refer to Biochemistry Appendix (12.18) for a comprehensive list of weedicides/
herbicides. Referred test.

HEREDITARY NEUROPATHY
GENETIC TESTING

Genetics

Blood/EDTA tube

4 - 6 weeks

Specimen to be sent at room temperature within 48 hours.


Patient consent form to be signed before testing.

HEREDITARY SPHEROCYTOSIS
BY FLOW
HERPES SIMPLEX SEROLOGY

Haematology

Blood/EDTA tube

Same day

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

HERPES SIMPLEX
VIRUS PCR

Immunology

Viral Culture Swab (green top)


in transport medium

24 hours

Assay run daily (Monday - Friday).

HERPES VIRUS-6,
HUMAN (HHV-6), BLOOD
HERPES ZOSTER SEROLOGY

Immunology

Blood/SS tube

2 - 4 weeks

Referred test.

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

HERPES ZOSTER
VIRUS PCR

Immunology

Viral Culture Swab (green top)


in transport medium

1 week

Assay run daily (Monday - Friday).

HESS TEST (CAPILLARY


INTEGRITY/FRAGILITY TEST)

Haematology

Same day

Please contact Haematology (07) 3121 4451 or


Branch Laboratory for collection details.

HEXACHLOROBENZENE
(ORGANOCHLORINE
PESTICIDE), BLOOD
HEXOSE-1-PHOSPHATE
URIDYL TRANSFERASE, BLOOD

Biochemistry

Hg, BLOOD

Biochemistry

Please refer to MERCURY, BLOOD.

HGPRT, BLOOD

Biochemistry

Please refer to HYPOXANTHINE GUANINE PHOSPHORIBOSYL


TRANSFERASE, BLOOD.

www.qml.com.au

Biochemistry

PATHOLOGY TESTS - H

TEST NAME

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Blood/Lithium
heparin tube

1 - 2 weeks

Please refer to GALACTOSAEMIA SCREEN, BLOOD.

Results (07) 3121 4555

8.11

8.11

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

HIAA, URINE 24 HOUR

Biochemistry

HIPPURIC ACID, URINE

Biochemistry

Urine/Urine container

3 weeks

Hippuric Acid assay is an index of toluene and xylene exposure.


Specimen should be stored frozen. Random urine is preferred. Referred test.

HISTAMINE, URINE

Biochemistry

Urine/24 hour urine


container with 25 mL
6M HCI preservative

6 - 8 weeks

Please provide clinical and medication details. Low histamine diet required 24
hours prior to and during test. Refrigerate sample during collection and transport
cooled. HISTAMINE, SERUM test not available. Referred test.

HISTAMINE, WHOLE BLOOD

Biochemistry

Blood/Lithium heparin tube

2 weeks

There is currently no Medicare rebate for this test. Referred test.

HISTOLOGY FROZEN SECTION

Histology

Biopsy tissue/DRY
container (No formalin)

Immediate. Full
report 24 hours

Please contact Histology (07) 3121 4495 or Branch Laboratory for booking.

HISTOLOGY IMMUNOFLUORESCENCE

Histology

Skin, Kidney etc./


1. Immunofluorescence
transport medium,
2. 10% Buffered formalin

24 - 48 hours

Two biopsies should be taken or the tissue should be split - half in


Immunofluorescence transport medium and the rest into buffered formalin.
Please refer to Histology Preface (5.38) or contact Histology (07) 3121 4495 or
Branch Laboratory for details.

HISTOLOGY MACRO/MICRO

Histology

Tissue and biopsy


specimens/formalin
containers in a variety
of sizes

24 hours for simple Please ensure the specimen container is labelled with patients full name,
non-complex
type and number of specimens. Refer to Histology Preface (5.35) or contact
specimens. 48 - 72 Histology (07) 3121 4495 or Branch Laboratory for assistance.
hours for complex
specimens.

HISTONE AUTOANTIBODIES

Immunology

Blood/SS tube

2 - 3 weeks

HISTOPLASMOSIS SEROLOGY

Immunology

Blood/SS tube

2 - 3 weeks

HIV 1 AND 2 SEROLOGY

Immunology

Blood/SS tube (extra SS


24 hours
tube if other tests requested)

Assay run daily (Monday to Saturday).


HIV1/HIV2/HIV antigen routinely performed.

HIV GENOTYPE

Immunology

Blood/3 x EDTA tubes

Referred test. Specimen must reach laboratory within 6 hours of collection. If not
possible specimen must be centrifuged, plasma decanted into a plain plastic tube
and frozen. Transport specimen frozen (dry ice).

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS


Please refer to 5-H.I.A.A, URINE.

4 weeks

Results (07) 3121 4555

PATHOLOGY TESTS - H

TEST NAME

8.12

8.12

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

HIV PROVIRAL DNA

Immunology

Blood/2 x EDTA tubes


(5 mL), 1 x SS tube

Indeterminate

Blood tubes to be transported at ROOM TEMPERATURE. Specimens are to be


marked URGENT. Contact the Immunology Department when specimens are
collected and to be sent.

HIV VIRAL LOAD TEST


(HIV VIRAL QUANTITATION)

Immunology

Blood/ACD tube (preferred).


EDTA tube is an acceptable
substitute

1 week

A PCR test that measures viral RNA. The specimen MUST reach laboratory within
6 hours of collection. If this is not possible specimen must be centrifuged, plasma
decanted into a plain plastic tube and frozen. Transport specimen frozen (dry ice).

HLA TISSUE TYPING,


BLOOD

Haematology

Blood/ACD tube,
SS tube

2 weeks

By appointment only. Please contact Haematology (07) 3121 4451 or Branch


Laboratory for collection details or to organise collection. Lithium heparin tube may
be used if ACD tube unavailable. Referred test.

HLA TYPING FOR


COELIAC DISEASE

Haematology

Blood/2 x ACD tubes

2 weeks

By appointment only. Please contact Haematology (07) 3121 4451 or Branch


Laboratory for collection details or to organise collection. Lithium heparin tube may
be used if ACD tube unavailable. Referred test.

HLA TYPING FOR NARCOLEPSY

Haematology

Blood/2 x ACD tubes

2 weeks

By appointment only. Please contact Haematology (07) 3121 4451 or Branch


Laboratory for collection details or to organise collection. Lithium heparin tube may
be used if ACD tube unavailable. Referred test.

HLA-B27 GENETIC TESTING

Genetics/
Haematology

Blood/Pink top EDTA tube

1 week

Test performed daily. No booking or appointment required. Please notify


Haematology (07) 3121 4451 or your Branch Laboratory of all urgent specimens
and weekend collections. Test contributory in suspected cases of ankylosing
spondylitis. Transport cooled or at room temperature.

HMMA, URINE 24 HOUR

Biochemistry

HOLD SERUM FOR


POSSIBLE COMPATIBILITY

Blood Bank

Blood/1 Pink top EDTA tube, Same day


1 Lavender top EDTA tube
for Haematology

HOLO (ACTIVE) B12, BLOOD

Haematology

Blood/SS tube

72 hours

If requested with VITAMIN B12, SERUM a non Medicare rebatable fee of approx.
$25.00 is charged to the patient.

HOMOCYSTEINE, SERUM

Biochemistry

Blood/SS tube

24 hours

Fasting sample is preferred. Spin as usual, definitely within 1.5 hours of collection
and send to the laboratory on ice with the routine courier. If Homocysteine pre and
post methionine load is requested, please refer to METHIONINE LOADING TEST.

www.qml.com.au

PATHOLOGY TESTS - H

TEST NAME

Please refer to CATECHOLAMINES, URINE.

Results (07) 3121 4555

8.13

8.13

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

HOMOCYSTINE, URINE

Biochemistry

Urine/Urine container

1 - 2 weeks

Test for homozygote. Fresh random sample of urine required.


Please transport cooled to the laboratory as soon as possible. Referred test.

HOMOGENTISIC ACID, URINE

Biochemistry

Urine/Urine container

48 hours

Fresh random collection, protected from light.

HOMOVANILLIC ACID, URINE

Biochemistry

HPV DNA TYPING

Cytology

ThinPrep PreservCyt
Collection Vial

2 weeks

HSP-70 (HEAT SHOCK


PROTEIN-70), BLOOD
HTLV-1 SEROLOGY

Immunology

Blood/SS tube

2 - 4 weeks

Immunology

Blood/SS tube

72 hours

Assay run Tuesday and Friday. HTLV-1 Serology is now part of the routine
infectious screen for autologous blood transfusions.

HUMAN CHORIONIC
GONADOTROPHIN (HCG)
- QUANTITATIVE, SERUM
HUMAN CHORIONIC
GONADOTROPHIN (HCG) TUMOUR MARKER, SERUM

Endocrinology

Blood/SS tube

24 hours

Note date of last normal menstrual period (LNMP), period of amenorrhoea


(A=) and estimated date of confinement (EDC).

Endocrinology

Blood/SS tube

24 hours

-HCG can be used as a tumour marker for trophoblastic disease (hydatidiform


mole, invasive mole, persistent mole, partial hydatidiform mole, placental site
trophoblastic tumour and gestational choriocarcinoma). Complete obstetric history
is essential for result interpretation. Elevated levels are also seen in both ovarian
and testicular germ cell tumours and some breast carcinomas. When used in
conjunction with AFP, -HCG may prove useful in assessing prognosis, monitoring
therapy and detecting recurrence of gonadal germ cell neoplasms.

HUMAN METAPNEUMOVIRUS

Immunology

Respiratory samples,
nasopharyngeal aspirate,
nasal washings/Luki tube
or Sterile container

1 - 2 weeks

www.qml.com.au

Please refer to CATECHOLAMINES, URINE.


HPV DNA Typing is performed as an adjunct to conventional screening. A cervical
sample is collected and the collection device rinsed in labelled PreservCyt Solution
(available from QML Pathology Collection Centres). If collected simultaneously with
a conventional Pap smear, a request for HPV DNA typing may be made up to 1
month after receipt as the PreservCyt fluid is stored for this time. Relevant clinical
history to be included on request form for patient to be eligible for Medicare rebate.

Results (07) 3121 4555

PATHOLOGY TESTS - H

TEST NAME

8.14

8.14

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

HUNTINGTONS DISEASE
GENETIC TESTING

Genetics

Blood/EDTA tube

Indeterminate

HVA, URINE

Biochemistry

HYBRID GENE TEST

Genetics

Blood/EDTA tube

3 - 4 weeks

Specimen to be sent at room temperature.

HYDATID SEROLOGY

Immunology

Blood/SS tube

1 week

Assay run Wednesday.

HYDROCARBON SOLVENTS,
BLOOD
HYDROCARBONS, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

HYDROGEN,
BREATH (MULTIPLE)
HYDROGEN, BREATH (SINGLE)

Biochemistry

Please refer to BREATH HYDROGEN (MULTIPLE).

HYDROXY CHOLECALCIFEROL

Biochemistry

Please refer to VITAMIN D, SERUM.

HYDROXY METHOXY MANDELIC


ACID, URINE 24 HOUR
HYDROXY PROGESTERONE,
SERUM
HYDROXY VITAMIN D,
SERUM
HYDROXYBUTYRATE
(BETA OR 3), PLASMA
HYDROXYBUTYRATE
(BETA OR 3), SERUM
HYDROXYCHLOROQUINE,
PLASMA

Biochemistry

Please refer to CATECHOLAMINES, URINE.

HYDROXYINDOLEACETIC
ACID, URINE

Biochemistry

www.qml.com.au

Biochemistry

Endocrinology

GENETIC COUNSELLING IS REQUIRED BEFORE THE BLOOD SPECIMEN CAN BE


TAKEN. GENETIC COUNSELLING IS AVAILABLE FROM THE GENETIC HEALTH
QUEENSLAND AT THE ROYAL BRISBANE HOSPITAL ON (07) 3636 1686.
Please refer to CATECHOLAMINES, URINE.

Expired air samples

Blood/SS tube

48 hours

1 week

Please refer to BREATH HYDROGEN (MULTIPLE).

Please provide clinical and medication details.

Biochemistry

Please refer to VITAMIN D, SERUM.

Biochemistry

Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA.

Biochemistry

Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA.

Biochemistry

Blood/Plain plastic
tube - no gel

2 weeks

PATHOLOGY TESTS - H

TEST NAME

Usually peak and post trough samples collected (i.e. pre and 2 hour post tablet).
Transport on dry ice.
Please refer to 5-H.I.A.A, URINE.

Results (07) 3121 4555

8.15

8.15

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

HYDROXYTRYPTAMINE,
Biochemistry
SERUM
HYDROXYTRYPTAMINE,
Biochemistry
URINE
HYPERTONIC CRYOHAEMOLYSIS Haematology
HYPNODORM, SERUM

8.16

REPORTING TIME COMMENTS


Please refer to SEROTONIN, SERUM.
Please refer to SEROTONIN, URINE 24 HOUR.

Blood/EDTA tube

24 hours

Biochemistry

HYPOTHYROIDISM
Biochemistry
CONGENITAL SCREENING TEST,
BLOOD
HYPOXANTHINE GUANINE
Biochemistry
PHOSPHORIBOSYL
TRANSFERASE, BLOOD

www.qml.com.au

SPECIMEN CONTAINER

PATHOLOGY TESTS - H

TEST NAME

Please refer to FLUNITRAZEPAM, SERUM.


Please refer to NEONATAL SCREENING TEST.

Blood/Lithium heparin
tube plus EDTA tube

4 weeks

Transport in esky at 4C. Referred test.

Results (07) 3121 4555

8.16

PATHOLOGY TESTS - H

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

2 weeks

Please provide clinical and medication details.

Immunology

Blood/SS tube

2 weeks

Skin biopsies for immunofluorescence and histology advised.


Please refer to Histology Preface (5.38) for details.

Haematology

Blood/EDTA tube or
Lithium heparin tube

Same day

IgA, SALIVA

Biochemistry

Saliva/Plain tube or
Urine container

3 days

Please provide clinical and medication details. Refrigerate or freeze sample


immediately after collection, and during storage and transport. Please note that
SALIVA is required, not sputum. The saliva should be unstimulated.

IgA, SERUM

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details.

IgA, URINE

Biochemistry

Urine/Random
urine container

2 weeks

Transport in esky at 4C. Referred test.

IgE LEVELS, SERUM

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

IGF-BINDING PROTEIN 3

Endocrinology

Blood/SS tube

3 weeks

Referred test.

IGF-I (SOMATOMEDIN C)

Endocrinology

Blood/SS tube

24 hours

IGG FOOD ALLERGY PANEL 40

Specimen
Distribution

Serum/SS tube or
Plain tube (red top)

Collection and
transfer only

IGG FOOD ALLERGY PANEL 5

Specimen
Distribution

Serum/SS tube or
Plain tube (red top)

Collection and
transfer only

IGG FOOD ALLERGY PANEL 93

Specimen
Distribution

Serum/SS tube or
Plain tube (red top)

Collection and
transfer only

IgG, SERUM

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details.

IgM, SERUM

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details.

IMIPRAMINE, SERUM

Biochemistry

Blood/Plain plastic tube 1 week


no gel (Plastic lithium heparin
tube (no gel) acceptable)

IMIPRIM, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - I

TEST NAME
IA2 ANTIBODIES (A512
ANTIBODIES), SERUM
ICS (INTERCELLULAR CEMENT
SUBSTANCE) ANTIBODY/
PEMPHIGUS ANTIBODY, SERUM
ICT MALARIAL PF TEST

Please provide clinical and medication details. Assay cannot be performed from
glass collection tubes. Collect immediately prior to next dose.
Please refer to IMIPRAMINE, SERUM.

Results (07) 3121 4555

8.17

8.17

PATHOLOGY TESTS - I

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/SS tube

24 - 48 hours

Qualitative test for presence of abnormal or malignancy-associated proteins.


Please provide clinical and medication details.

IMMUNOFIXATION (PROTEIN),
URINE

Biochemistry

Random urine/Urine
container or 24 hour urine
collection/Urine collection
bottle. No preservative

24 - 48 hours

Qualitative test - random urine. Quantitative estimation - 24 hour urine collection.


Urine should be refrigerated during the collection period and transported cooled to
the laboratory.

IMMUNOFLUORESCENCE,
HISTOLOGY

Histology

Skin - Kidney etc./


1. Immunofluorescence
transport medium,
2. 10% Buffered formalin

24 - 48 hours

Two biopsies should be taken or the tissue should be split - half in


Immunofluorescence transport medium and the rest into buffered formalin.
Please refer to Histology Preface (5.38) or contact Histology (07) 3121 4495
or Branch Laboratory for details.

IMMUNOGLOBULIN D, SERUM

Biochemistry

Blood/SS tube

2 weeks

Transport on dry ice.

IMMUNOGLOBULINS, SERUM

Biochemistry

Blood/SS tube

24 hours

Includes IgG, IgA and IgM (but not IgE). Please provide clinical and medication details.

IMMUNOREACTIVE
TRYPSINOGEN, BLOOD
INDINAVIR, PLASMA

Biochemistry
Biochemistry

Blood/EDTA tube

3 weeks

Please provide clinical and medication details. Plasma to be separated and frozen if
sample will not reach the central laboratory within 24 hours of collection. Referred test.

INFECTIOUS MONONUCLEOSIS
SEROLOGY (PAUL-BUNNELL
TEST), SERUM
INFLAMMATORY BOWEL
DISEASE STUDY

Haematology

Blood/SS tube

Same day

Epstein-Barr Virus (EBV) Serology may be helpful if Paul-Bunnell test is negative


and clinical features are suggestive.

Specimen
Distribution

Blood/5 x EDTA tubes

Collection and
transfer only

Keep samples at room temperature. Send sample to laboratory without delay.

INFLUENZA A SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

INFLUENZA B SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

INHIBIN, BLOOD

Endocrinology

Blood/SS tube

2 - 5 weeks

There is currently no Medicare rebate for this test. Referred test.

INORGANIC ARSENIC,
URINE

Biochemistry

Urine/Urine container

2 weeks

Due to the instability of samples, referral must be made on the same day as
collection, hence samples must reach the central laboratory no later than 2.30pm.
Do not collect samples on Friday.

INR - PROTHROMBIN TIME,


BLOOD

Haematology

Blood/Sodium
citrate tube

Same day

Please see Warfarin section in Haematology Appendix (12.32)


for further information.

www.qml.com.au

PATHOLOGY TESTS - I

TEST NAME
IMMUNOFIXATION (PROTEIN),
SERUM

Please refer to NEONATAL SCREENING TEST for details.

Results (07) 3121 4555

8.18

8.18

PATHOLOGY TESTS - I

PATHOLOGY TESTS

DEPARTMENT

INSULIN ANTIBODIES, SERUM

Immunology

Blood/SS tube

2 - 3 weeks

Referred test.

INSULIN TOLERANCE TEST


- FOR CORTISOL RESPONSE

Endocrinology

Blood/SS tube
and EDTA tube

24 hours

The test involves an infusion of insulin and the measurement of cortisol and glucose,
usually investigating Cushings Syndrome. However, other hormones may be done
to exclude other conditions. Please contact Collections (07) 3121 4450 or Branch
Laboratory for appointment, call Endocrinology (07) 3121 4439 for details.

INSULIN, SERUM

Endocrinology

Blood/SS tube

24 hours

Usually fasting unless otherwise required.

INSULIN-LIKE GROWTH
FACTOR-I (IGF- I/
SOMATOMEDIN C),
SERUM

Endocrinology

Blood/SS tube

24 hours

Growth hormone is secreted in a pulsatile fashion and levels fluctuate under


external influences. IGF-I/ Somatomedin C is a relatively long lived stable protein
product of growth hormone action produced mainly by the liver. It may assist
assessment of pituitary regulation of growth. Please consult Endocrinology
(07) 3121 4439 or Branch Laboratory.

INTACT PARATHORMONE,
SERUM

Endocrinology

Blood/SS tube

24 hours

PTH is stable if the specimen is kept cold (4C) for up to 10 hours.


However, hormone activity decreases significantly at room temperature.
Please note on form if kept at room temperature for prolonged periods.

INTERCELLULAR CEMENT
Immunology
SUBSTANCE (ICS) ANTIBODY/
PEMPHIGUS ANTIBODY, SERUM
INTERLEUKIN 2 RECEPTOR
Endocrinology

Blood/SS tube

2 weeks

Skin biopsies for immunofluorescence and histology advised.


Please refer to Histology Preface (5.38) for details.

Blood/SS tube

1 week

Specimen stable for 2 days if kept cold (4C).


If longer, please spin, separate and freeze serum and transport.

INTERLEUKIN 6

Endocrinology

Blood/SS tube

48 hours

Specimen stable for one day if kept cold (4C).


If longer, please spin, separate and freeze serum and transport.

INTESTINAL
DISACCHARIDASES,
BIOPSY TISSUE

Biochemistry

Small intestinal biopsy tissue. 24 hours


Wrap in aluminium foil and
place in a DRY sterile screw
top (urine) container

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

PATHOLOGY TESTS - I

TEST NAME
INSECTICIDES
(ORGANOPHOSPHATE/
CARBAMATE), SERUM
INSECTIGAS (PESTICIDE),
SERUM

Please provide clinical history. Collect this specimen first to avoid any possibility
of contact with formalin. Wrap fresh tissue in aluminium foil, place in a DRY sterile
screw top (urine) container and freeze immediately after collection. Transport on dry
ice. DO NOT PLACE IN FORMALIN. Please refer to Histopathology Preface (5.35).

Results (07) 3121 4555

8.19

8.19

PATHOLOGY TESTS - I

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

1 week

INVERSION 16 RT-PCR

Genetics

Blood or Bone marrow/EDTA 1 month


tube or min. 1 mL bone
marrow in EDTA tube

Specimen needs to be received within 48 hours.

IODINE, URINE

Biochemistry

Urine/Urine container or
2 weeks
plain 24 hour urine container

While 24 hour urine collections are preferred, timed samples or spot urines are
acceptable for initial testing. Keep cool and transport without delay to reach the laboratory
no later than 2.30pm on the day of collection. Collect Monday to Thursday only. There is
currently no Medicare rebate for this test. Referred test.

IRON (Fe) STUDIES, SERUM

Haematology

Blood/SS tube

24 hours

Includes Iron, TIBC, % saturation and Ferritin.

IRON (Fe), URINE

Biochemistry

Urine/24 hour urine


container with no
preservative

1 week

Please provide clinical and medication details.

IRON, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify site of fluid on specimen container and request form.

IRON, LIVER BIOPSY

Biochemistry

Liver biopsy/Dry sterile


screw top (urine) container

2 weeks

Saline washed sample is wrapped in aluminium foil, placed in a DRY sterile screw top
(urine) container and frozen. Transport on dry ice. DO NOT place in formalin. Referred test.

IRON, SERUM

Biochemistry

ISCHAEMIC
EXERCISE TEST

Biochemistry

Blood/7 x fluoride
oxalate tubes, 7 x Lithium
heparin tubes

24 hours

ISLET CELL AB/PANCREATIC

Immunology

Blood/SS tube

2 weeks

ISONIAZID, PLASMA

Biochemistry

Blood/2 x EDTA tubes no gel

3 weeks

Patient must be fasting. The blood samples should be collected 2 hours after the
Isoniazid dose is given. Samples must be centrifuged, separated into 2 x 6 mL
Falcon tubes containing 5 mg Ascorbic acid and frozen IMMEDIATELY (no longer
than 1 hour after collection). Protect from light.

ITRACONAZOLE, SERUM

Biochemistry

Blood/Plain plastic tube


- no gel

2 weeks

Please provide clinical and medication details. Referred test.

IUD FOR CULTURE

Microbiology

IUD/Sterile container

Up to 7 days

Unusual organisms may be isolated e.g. Actinomyces.

www.qml.com.au

Sera on all patients with low Vitamin B12 levels are stored for 2 weeks.
Assay performed once per week.

PATHOLOGY TESTS - I

TEST NAME
INTRINSIC FACTOR ANTIBODY,
SERUM

Please refer to E/LFT, SERUM.


Please contact Biochemistry (07) 3121 4971 or Branch Laboratory for details.

Results (07) 3121 4555

8.20

8.20

PATHOLOGY TESTS - I

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Genetics

Blood or Bone marrow/Pink


top EDTA tube or min. 2 mL
bone marrow in EDTA tube

2 weeks

Transport at room temperature or cooled on ice brick.

KENNEDYS DISEASE (SBMA)


GENETIC TESTING
KEROSENE, BLOOD

Genetics

Blood/EDTA tube

1 - 2 months

Also known as Spinal Bulbar Muscular Atrophy (SBMA).

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

KETONE BODIES, PLASMA

Biochemistry

Please refer to 3-HYDROXYBUTYRATE, SERUM OR PLASMA for details.

KETONE SCREEN, SERUM

Biochemistry

Blood/SS tube

Same day

Semi-quantitative test. Acetoacetate only is detected.

KETONE SCREEN, URINE

Biochemistry

Urine/Urine container

Same day

Semi-quantitative test. Acetoacetate only is detected.

KINIDIN, SERUM

Biochemistry

KLEIHAUER TEST
(FETAL RED CELL SCREEN),
MATERNAL BLOOD
KUNJIN SEROLOGY

Haematology

Maternal blood/1 EDTA


tube, 2 blood films

Same day
or urgently

Immunology

Blood/SS tube

2 weeks

www.qml.com.au

PATHOLOGY TESTS - J/K

TEST NAME
JAK 2 MUTATION ANALYSIS

Please refer to QUINIDINE, SERUM.


Examination of maternal blood for evidence of Foeto-Maternal transfusion.
FMH Test usually performed.

Results (07) 3121 4555

8.21

8.21

PATHOLOGY TESTS - J/K

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

L/S RATIO, AMNIOTIC FLUID

Biochemistry

Amniotic fluid/Plain
plastic container

Same day

Test for fetal lung maturity.


Please provide clinical details including period of gestation.

L-LACTATE, PLASMA

Biochemistry

Blood/Lithium heparin tube

2 weeks

Transport to Central Laboratory on dry ice. Referred test.

LACTATE (PRE+POST STRESS),


PLASMA

Biochemistry

Blood/Fluoride
oxalate tube

Same day

Please contact Biochemistry (07) 3121 4971 or Branch Laboratory for details on
conducting test. NB. DO NOT USE TOURNIQUET OR HAND FLEXING; SIGNIFICANT
FALSE ELEVATION WILL RESULT.

LACTATE DEHYDROGENASE
(LD/LDH) ISOENZYMES,
SERUM

Biochemistry

Blood/SS tube

24 hours

LD-1 may be a useful marker for Seminoma/Dysgerminoma and LD-2 and 3 may
be elevated in epithelial and lymphoid malignancy. LD-5 may be used in place of
alpha Hydroxybutyrate dehydrogenase and Aldolase assays in muscle injury.

LACTATE DEHYDROGENASE
(LD/LDH), SERUM

Biochemistry

LACTATE, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify site of fluid on specimen container and request form.

LACTATE, PLASMA

Biochemistry

Blood/Fluoride
oxalate tube

Same day

Please provide clinical and medication details. NB. DO NOT USE TOURNIQUET OR
HAND FLEXING; SIGNIFICANT FALSE ELEVATION WILL RESULT.

LACTATE, URINE

Biochemistry

Blood/Urine container or
24 hours
plain 24 hour urine container

Urine should be refrigerated after the collection period and


transported cooled to the laboratory.

LACTOSE
TOLERANCE TEST

Biochemistry

Blood/4 x Fluoride
oxalate tubes

Please contact Biochemistry (07) 3121 4971 or Branch Laboratory for dosage
and collection details. NB: Breath Hydrogen may be a more suitable test.

LAMICTAL, PLASMA

Biochemistry

Please refer to LAMOTRIGINE, SERUM.

LAMOTRIGINE, PLASMA

Biochemistry

Please refer to LAMOTRIGINE, SERUM.

LAMOTRIGINE, SERUM

Biochemistry

LANNATE (PESTICIDE), BLOOD

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

LANOXIN, SERUM

Biochemistry

Please refer to DIGOXIN, SERUM.

LARGACTIL, SERUM

Biochemistry

Please refer to CHLORPROMAZINE, SERUM.

www.qml.com.au

PATHOLOGY TESTS - L

TEST NAME

Please refer to E/LFT, SERUM. Avoid haemolysis and prolonged contact of serum with
cells. If stored overnight, blood should be centrifuged to separate serum from cells.

Blood/Plain plastic tube no gel or anticoagulant


(Plastic lithium heparin tube
(no gel) acceptable)

24 hours

1 week

Please provide clinical and medication details, including time,


date and amount of last dose. Collect sample immediately prior to next dose.

Results (07) 3121 4555

8.22

8.22

PATHOLOGY TESTS - L

PATHOLOGY TESTS

DEPARTMENT

LATS (LONG ACTING THYROID


STIMULATOR), SERUM

Endocrinology

Blood/SS tube

4 days

Alternative names include LATS-P (Long Acting Thyroid Stimulator- Protector), TSH
Receptor antibody, TSI (Thyroid Stimulating Immunoglobulin) and TBII (TSH Binding
Inhibiting IgG). Assay of this autoantibody may be useful to monitor patients with
Graves disease while on treatment.

LAXATIVES, FAECES

Biochemistry

Faeces/Faeces container
or urine container

1 week

Transport at 4C.

LD ISOENZYMES, SERUM

Biochemistry

LD, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify site of fluid on specimen container and request form.

LD, PLEURAL FLUID

Biochemistry

Pleural fluid/Plain tube

Same day

Please provide clinical and medication details.


Refrigerate sample during storage and transport.

LD, SERUM

Biochemistry

Please refer to E/LFT, SERUM. Avoid haemolysis and prolonged contact of serum with
cells. If stored overnight, blood should be centrifuged to separate serum from cells.

LD/LDH ISOENZYMES,
SERUM
LD/LDH (LACTATE
DEHYDROGENASE), SERUM

Biochemistry

Please refer to LACTATE DEHYDROGENASE (LD/LDH) ISOENZYMES, SERUM.

Biochemistry

Please refer to E/LFT, SERUM. Avoid haemolysis and prolonged contact of serum with
cells. If stored overnight, blood should be centrifuged to separate serum from cells.

LDL CHOLESTEROL,
SERUM
LEAD, BLOOD

Biochemistry

Please refer to HDL CHOLESTEROL, SERUM.

Biochemistry

Blood/EDTA tube

24 hours

Please provide clinical, medication and lead exposure details. Leave as whole blood.

LEAD, HAIR

Biochemistry

Hair/Dry sterile screw cap


(urine) container

4 weeks

Fill sterile container as full as possible with hair. Clippings from the patients last
hair cut can be used. Please provide full details of long term exposure. Referred
test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

LEAD, PAINT FLAKES

Biochemistry

Paint flakes/
Dry sterile screw top
(urine) container

4 weeks

Referred test.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to AMITRIPTYLINE, SERUM.

PATHOLOGY TESTS - L

TEST NAME
LAROXYL, SERUM

Please refer to LACTATE DEHYDROGENASE (LD/LDH) ISOENZYMES, SERUM.

Results (07) 3121 4555

8.23

8.23

PATHOLOGY TESTS - L

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/Urine container
with no preservative

1 day

LEBERS NEURORETINOPATHY
TEST, DNA PROBE

Biochemistry

LEGIONELLA ANTIBODY

Immunology

Blood/SS tube

24 hours

LEGIONELLA PCR

Immunology

Respiratory aspirate
sputum, Lavage

24 hours

Results usually available same day for urgent specimens.

LEGIONELLA SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

LEGIONELLA URINARY ANTIGEN Immunology

Urine/Urine container

24 hours

Not suitable for routine diagnosis - only useful in cases from suspected
Legionella outbreaks.

LEISHMANIA SEROLOGY

Immunology

Blood/SS tube

2 - 3 weeks

LEPTIN, PLASMA

Biochemistry

Blood/Lithium heparin tube

2 - 3 weeks

Please keep the sample cool and forward to the laboratory without delay. Referred test.

LEPTOSPIRA SEROLOGY

Immunology

Blood/SS tube

72 hours

Assay run Monday and Thursday.

LEUKOCYTE ENZYMES,
BLOOD
LEUKAEMIA MARKER STUDIES

Biochemistry

LiCO3, SERUM

Biochemistry

Please refer to LITHIUM, SERUM.

LIDOCAINE, SERUM

Biochemistry

Please refer to LIGNOCAINE, SERUM.

LIGNOCAINE, SERUM

Biochemistry

LINDANE (ORGANOCHLORINE
PESTICIDES), BLOOD
LIPASE, SERUM

Biochemistry
Biochemistry

Blood/SS tube

Same day

Please provide clinical and medication details.

LIPID ELECTROPHORESIS,
SERUM

Biochemistry

Blood/SS tube

1 week

Patient should have fasted for 12 hours and have abstained from drinking alcohol
for 72 hours (unless otherwise requested). Referred test.

www.qml.com.au

Haematology

Please provide clinical, medication and lead exposure details. A spot urine should
be collected for ORGANIC LEAD (petrol workers). Collect immediately after work
shift where exposure may have occurred. A 24 hour urine collection is required for
post chelation patients.
Please refer to MITOCHONDRIAL DISORDERS (LEBERS, LEIGHS, MELAS,
NARP), BLOOD.

PATHOLOGY TESTS - L

TEST NAME
LEAD (Pb), URINE

Please refer to LYSOSOMAL ENZYMES, BLOOD.


Blood/ACD tube,
EDTA tube, Blood film

Blood/Plain plastic tube no gel or anticoagulant

24 hours

2 weeks

Lithium heparin tube may be used if ACD tube unavailable.

Please provide clinical and medication details especially time of last dose.
Collect just prior to next dose.
Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Results (07) 3121 4555

8.24

8.24

PATHOLOGY TESTS - L

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/SS tube

Same day

LIPID TYPING, SERUM

Biochemistry

LIPOPROTEIN (a), SERUM

Biochemistry

LIPOPROTEIN A1, SERUM

Biochemistry

Please refer to APOLIPOPROTEIN A1, SERUM.

LIPOPROTEIN PATTERN
(ELECTROPHORESIS), SERUM

Biochemistry

Please refer to LIPID ELECTROPHORESIS, SERUM.

LITHICARB, SERUM

Biochemistry

Please refer to LITHIUM, SERUM.

LITHIUM, SERUM

Biochemistry

LIVER BIOPSY COPPER

Biochemistry

Please refer to COPPER, LIVER BIOPSY for details. Referred test.

LIVER BIOPSY IRON

Biochemistry

Please refer to IRON, LIVER BIOPSY for details. Referred test.

LIVER FUNCTION TESTS,


SERUM

Biochemistry

Blood/SS tube

Same day

Includes: Bilirubin (total/conjugated), Alkaline Phosphatase, Gamma GT, ALT AST,


LD, Albumin and Globulins. Please refer to E/LFT, SERUM for details.

LIVER/KIDNEY MICROSOMAL
ANTIBODY
LOPINIVIR, PLASMA

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Biochemistry

Blood/EDTA tube

3 weeks

Please provide clinical and medication details. Plasma to be separated and frozen if
sample will not reach the central laboratory within 24 hours of collection. Referred test.

LOVAN, SERUM

Biochemistry

Please refer to FLUOXETINE, SERUM.

LP(a), SERUM

Biochemistry

Please refer to LIPOPROTEIN (a), SERUM.

LUCIJET (PESTICIDE),
SERUM

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

www.qml.com.au

Includes Cholesterol, Triglycerides and HDL. See Biochemistry Appendix (12.21)


Medicare requires that each test is requested separately on the request.
Please refer to LIPID ELECTROPHORESIS, SERUM.

Blood/SS tube

Blood/SS tube

24 hours

Same day

If a transport delay of more than 2 hours is anticipated centrifuge specimen


to separate red cells from serum and transport cooled to the laboratory.

PATHOLOGY TESTS - L

TEST NAME
LIPID STUDIES, SERUM

Collect sample 12 hours after last dose.


Note time, date and amount of last dose on the request form.

Results (07) 3121 4555

8.25

8.25

PATHOLOGY TESTS - L

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Haematology

Blood/Sodium
citrate tube

24 hours

Transport at 4C. Must reach laboratory within 2 hours of collection. This is a


conditional Medicare item if requested with thrombotic assays. PLEASE NOTE
RESTRICTIONS ON MEDICARE REBATES BELOW. Thrombotic assay requests are
only Medicare refundable if one of the following is stated on the request form by
the patients doctor:
1. That the patient has a personal history of venous thromboembolism (DVT) or
arterial thrombosis (PE);
2. That a first degree relative of the patient has a proven defect in one or more of
the thrombotic test(s) requested and that the particular defect(s) are stated on
the request form; or
3. That the request is to confirm an abnormal or indeterminate result.
IF THE REQUEST IS NOT REFUNDABLE BECAUSE OF THE ABOVE CONDITIONS,
THE PATIENT WILL BE CHARGED A NON-REFUNDABLE AMOUNT. PLEASE INFORM THE
PATIENT IF THE TESTING WILL RESULT IN AN ACCOUNT BEING SENT TO THE PATIENT.

LUTEINIZING HORMONE (LH),


SERUM

Endocrinology

Blood/SS tube

24 hours

Please provide clinical notes and last normal menstrual period (LNMP). Include
information regarding any hormone replacement therapy or contraceptive use.

LYME DISEASE SEROLOGY

Immunology

Blood/SS tube

3 - 4 weeks

Assay run Tuesday and Friday.

LYME DISEASE
WESTERN BLOT
LYMPH NODE CELL
MARKER STUDIES,
TISSUE

Immunology

Blood/SS tube

2 - 3 weeks

Haematology/
Histology

Lymph Node/Antibiotic
Transport Medium,
formalin container,
6 labelled glass slides

24 hours

LYMPHOCYTE FUNCTION
TESTS, BLOOD

Haematology

Blood/2 x Lithium heparin tubes, 2 weeks


1 x SS tube, 1 x EDTA tube

www.qml.com.au

PATHOLOGY TESTS - L

TEST NAME
LUPUS ANTICOAGULANT
SCREEN

Using a sterile technique, dissect the Lymph node free of adherent fat and tissue.
Slice the node into 2mm slices and place a sample in Antibiotic Transport Medium.
With the other slices, make 6 touch imprints onto glass slides, 2 of which are air
dried and 2 are fixed in 95% alcohol or Diff Quik fixative. The remaining two slides
can be forwarded to Haematology with tissue submitted for marker studies. A slice
should be fixed for 6 hours and processed overnight, while the remainder is allowed
to fix in buffered formalin for 24 hours and then placed on a 12 hour processing
cycle. Store cooled and transport cooled to laboratory as soon as possible. Please see
Histology Preface (5.35) for full details. Please contact Histology (07) 3121 4495 or
Branch Laboratory to inform of impending biopsy and for assistance.
Please contact Haematology (07) 3121 4451 or
Branch Laboratory for appointment. Referred test.

Results (07) 3121 4555

8.26

8.26

PATHOLOGY TESTS - L

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Genetics

EDTA Blood, bone marrow,


lymph node, aspirate, tissue

2 weeks

IgH and T-cell receptor (beta and gamma) gene rearrangements.


Incurs fee to patient.

LYMPHOCYTE MARKER
STUDIES, BLOOD

Haematology

Blood/ACD tube,
EDTA tube, Blood film

24 hours

Lithium heparin tube may be used if ACD tube unavailable.

LYMPHOCYTE SUBSET
ANALYSIS (INCLUDES T4/T8
RATIO), BLOOD
LYMPHOGRANULOMA
VENEREUM (LGV) SEROLOGY
LYSOSOMAL ENZYMES,
BLOOD

Haematology

Blood/ACD tube,
EDTA tube, Blood film

24 hours

Lithium heparin tube may be used if ACD tube unavailable.

Immunology

Blood/SS tube

72 hours

Assay run Monday and Wednesday.

Biochemistry

Blood/2 x EDTA tubes

2 weeks

Sample MUST be kept at room temperature. Samples MUST only be collected


Monday - Thursday due to instability of specimen and MUST arrive at Biochemistry,
Murarrie 11.00am at the latest. Please contact Biochemistry (07) 3121 4420 or
Branch Laboratory to advise of expected arrival time or if any queries.

LYSOZYME, SERUM

Haematology

Blood/SS tube

24 hours

LYSSAVIRUS SEROLOGY

Immunology

Blood/SS tube

2 - 3 weeks

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - L

TEST NAME
LYMPHOCYTE GENE
REARRANGEMENT STUDIES

8.27

8.27

PATHOLOGY TESTS - L

PATHOLOGY TESTS

DEPARTMENT

MAGNESIUM, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify site of fluid on specimen container and request form.

MAGNESIUM, RED CELL

Biochemistry

Blood/Plastic lithium
heparin tube or EDTA tube

2 weeks

Please provide clinical and medication details. Do not separate sample.


Transport at 4C. Referred test.

MAGNESIUM, SERUM

Biochemistry

Blood/SS tube

Same day

Please provide clinical and medication details.

MAGNESIUM,
URINE 24 HOUR

Biochemistry

Urine/24 hour urine


container with 25 mL
6M HCI preservative

24 hours

Urine should be refrigerated after the collection period and transported


cooled to the laboratory.

MALARIAL PARASITES

Haematology

Blood/EDTA tube, 4 x slides

Same day

2 x thin film slides and 2 x thick film slides are to be prepared.

MALARIAL PARASITES PCR

Genetics

Blood/EDTA tube

1 week

Speciation of Malaria. Transport at room temperature or cooled on an ice brick.

MALATHION (PESTICIDE),
SERUM

Biochemistry

MALIGNANT CELLS

Cytology

Various sites, samples


and presentations

MALIGNANT HYPERTHERMIA
GENETIC TESTING
MANDELIC ACID, URINE

Genetics

Blood/Lithium heparin tube

4 - 6 weeks

Keep at room temperature.

Biochemistry

Urine/Urine container

3 weeks

Please collect a random urine after work shift or suspected exposure.


Keep the sample refrigerated. Referred test.

MANGANESE (Mn), BLOOD

Biochemistry

Blood/EDTA tube (Lithium


heparin tube acceptable)

4 weeks

Please provide clinical and medication details. Transport in esky at 4C.


Referred test.

MANGANESE (Mn), SERUM

Biochemistry

Blood/SS tube

4 weeks

Please provide clinical and medication details. Transport in esky at 4C.


Referred test.

MANGANESE (Mn), URINE

Biochemistry

Urine/Urine container

4 weeks

Test for excessive exposure. Referred test.

MANNOSE BINDING LECTIN,


WHOLE BLOOD

Biochemistry

Whole blood/EDTA tube

1 - 2 months

Band both samples together and transport on ice to the central laboratory.
There is currently no charge for this test but there is a collection and handling fee
of approximately $40.00. Referred test.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to CK ISOENZYME ELECTROPHORESIS, SERUM.

PATHOLOGY TESTS - M

TEST NAME
MACRO CK, SERUM

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.
See specific specimen or site.

Results (07) 3121 4555


9.0

9.0

PATHOLOGY TESTS - M

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Microbiology

Skin test/0.1 mL
of human PPD

48 - 72 hours

MARCAIN, PLASMA

Biochemistry

MARFAN SYNDROME
GENETIC TESTING
MATRX NTX STUDY

Genetics

Blood/EDTA tube

Up to 9 months

Specimen
Distribution

Urine/Random
urine container

Collection and
transfer only

MBOCA, URINE

Biochemistry

Please refer to MOCA, URINE.

MCAD (MEDIUM CHAIN ACYL


CO A DEHYDROGENASE
DEFICIENCY) TEST,
DNA PROBE
MCAD GENE ANALYSIS

Biochemistry

Please refer to MCAD GENE ANALYSIS.

MCP, URINE

Biochemistry

Please refer to VITAMIN B3, URINE for details.

MCPA (HERBICIDE), URINE

Biochemistry

Please refer to HERBICIDES, URINE

MEAN CELL VOLUME

Haematology

Blood/EDTA tube

Same day

MEASLES PCR

Immunology

Blood, Nasopharyngeal
aspirate, Nasopharyngeal
swab (viral transport medium
or Virocult)

1 week

Referred test.

MEASLES SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

MEC-A GENE ANALYSIS

Genetics

Swab of infected site,


culture/Sterile container

48 hours

Transport at room temperature.

MEDIUM CHAIN ACYL CO A


DEHYDROGENASE DEFICIENCY
(MCAD) TEST, DNA PROBE

Biochemistry

Blood/EDTA tube

2 - 4 weeks

Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for specific
collection details as this may differ quantitatively or qualitatively for different
diseases. Please indicate which diseases are being investigated. Referred test.

www.qml.com.au

Biochemistry

Intradermal injection volar aspect LEFT forearm. Read at 48-72 hours.


Please contact Consultant Pathologist on (07) 3121 4475 for details.
Refer to Microbiology Preface (5.60).
Please refer to BUPIVACAINE, PLASMA for details.

Blood/EDTA tube

4 weeks

Patient consent for billing must be marked on the request form.

PATHOLOGY TESTS - M

TEST NAME
MANTOUX TEST - HUMAN

Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for specific
collection details as this may differ quantitatively or qualitatively for different
diseases. Please indicate which diseases are being investigated. Referred test.

Results (07) 3121 4555


9.1

9.1

PATHOLOGY TESTS - M

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

1 week

Biochemistry

Please refer to IMIPRAMINE, SERUM.

MELLERIL, SERUM

Biochemistry

Please refer to THIORIDAZINE, SERUM.

MENINGOCOCCAL PCR

Immunology

CSF, EDTA plasma/Sterile


container and EDTA tube

24 hours or same
day if requested

MENINGOCOCCAL SEROLOGY

Immunology

Blood/SS tube

2 - 3 weeks

MERCAPTURIC ACID, URINE

Biochemistry

Urine/Urine container

2 weeks

Random urine to be collected at the end of work shift.

MERCURY, BLOOD

Biochemistry

Blood/EDTA tube (Lithium


heparin tube acceptable)

4 weeks

Please provide clinical and exposure details. For occupational inorganic mercury
exposure, spot urine is the preferred sample. Transport in esky at 4C. Referred test.

MERCURY, HAIR

Biochemistry

Hair/Dry sterile screw


cap (urine) container

4 weeks

Please provide clinical and exposure details. Fill sterile container with hair,
as full as possible. Provide full details of long term exposure. Referred test.
***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

MERCURY, NAIL

Biochemistry

Toe and fingernail


clippings/Dry sterile screw
cap (urine) container

4 weeks

Please provide exposure and occupation details.


Cut clean finger and toe nails. Referred test.

MERCURY, URINE

Biochemistry

Urine/Urine container

4 weeks

Please provide details of exposure (clinical and occupational).


A random collection is preferred. However, for occupational inorganic
mercury exposure, spot urine is the preferred sample. Referred test.

METABOLIC SCREEN

Biochemistry

Urine/Urine container

1 week

A random (early morning) collection or during an episode is preferred. Please provide


clinical and medication details. Urine should be refrigerated during the collection
period and transported cooled to the laboratory. Profile includes amino acids (and
organic acids and mucopolysaccharides if the patient is less than 12 years of age).

METABOLIC SCREEN,
BLOOD

Biochemistry

Blood/Lithium
heparin tube

1 week

If presentation is episodic collect during an episode. Please provide clinical and


medication details. The specimen should be transported cooled to the laboratory
as soon as possible. Referred test.

METANEPHRINE,
BLOOD

Biochemistry

(MUCOPOLYSACCHARIDES,

AMINO ACIDS/ORGANIC ACID),


URINE

9.2

PATHOLOGY TESTS - M

TEST NAME
MELIOIDOSIS SEROLOGY
(BURKHOLDERIA
PSEUDOMALLEI)
MELIPRAMINE, SERUM

www.qml.com.au

Assay run Monday.

Please refer to METANEPHRINE, PLASMA.

Results (07) 3121 4555


9.2

PATHOLOGY TESTS - M

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Lithium
heparin tube

1 - 2 weeks

METANEPHRINE,
URINE 24 HOUR
METASYSTOX (PESTICIDE),
SERUM

Biochemistry

Please refer to CATECHOLAMINES, URINE.

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

METHADONE,
BLOOD

Biochemistry

Blood/Lithium heparin tube

2 - 3 weeks

Please provide clinical and medication details including time and date of last dose.
Do not separate plasma.

METHAEMALBUMIN,
PLASMA

Biochemistry

Blood/Lithium heparin tube

Same day

Investigation of intravascular haemolysis. Handle carefully to avoid damaging red


blood cells during collection. Centrifuge and separate plasma from cells immediately.
Decant plasma into a labelled plain plastic tube. Transport cooled to the laboratory.

METHAEMOGLOBIN
REDUCTASE, BLOOD
METHAEMOGLOBIN,
BLOOD

Biochemistry

Blood/Lithium heparin tube

4 weeks

Keep sample cool. DO NOT FREEZE.

Biochemistry

Blood/Lithium heparin
tube or EDTA tube

Same day

Please provide clinical and medication details.


Forward UNOPENED TUBE to lab promptly. DO NOT SEPARATE plasma.

METHAEMOGLOBIN,
URINE

Biochemistry

Random urine/
Urine container

Same day

Random urine sample. Provide clinical and medication details.


Forward to laboratory promptly.

METHOMYL (PESTICIDE),
BLOOD

Biochemistry

METHOTREXATE,
SERUM

Biochemistry

METHYL BROMIDE, PLASMA

Biochemistry

Please refer to BROMIDE, BLOOD and SERUM for details.

METHYL CARBOXYLAMIDE
PYRIDONE, URINE
METHYL CHLORIDE, BLOOD

Biochemistry

Please refer to VITAMIN B3, URINE for details.

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

METHYL ETHYL KETONE,


BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

www.qml.com.au

Tumour marker - phaeochromocytoma.


Please keep the sample cool and forward to the laboratory without delay.

PATHOLOGY TESTS - M

TEST NAME
METANEPHRINE,
PLASMA

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.
1 - 2 days
Blood/Plain plastic
6 mL tube - no gel or
anticoagulant (Plastic lithium
heparin tube acceptable)

Please provide clinical, medication and dosage details.


Following a 4 - 6 hour infusion, serum samples should be collected at 24hrs,
48hrs and 72hrs post infusion. Referred test.

Results (07) 3121 4555


9.3

9.3

PATHOLOGY TESTS - M

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/Urine container

4 weeks

METHYL HISTAMINE,
URINE
METHYL ISOBUTYL KETONE
(MIBK), BLOOD
METHYL ISOBUTYL KETONES,
URINE

Biochemistry

Please refer to HISTAMINE, URINE. Methyl histamine is a dietary derivative.

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

Biochemistry

9.4

METHYLENE CHLORIDE,
Biochemistry
BLOOD
METHYLENE-BIS-2Biochemistry
CHLORANILINE, URINE
METHYLMALONIC ACID, SERUM Biochemistry
METHYLMALONIC ACID, URINE Biochemistry

Urine/Urine container

4 weeks

Urine should be collected at the end of the work shift.


Referred test.

Widely used solvent. Please collect the sample at the end of work shift or exposure.
The sample must be kept cold and forwarded to the laboratory without delay.
No Medicare rebate applicable. Referred test.
Please refer to SOLVENTS, BLOOD for all details.
Please refer to MOCA, URINE.

Blood/SS tube

1 - 2 weeks

Sample must be kept cool and transported to the laboratory without delay. Referred test.

Urine/50 mL urine container

2 weeks

Please provide clinical and medication details.


A random urine collection is required. Referred test.

MEVINPHOS (PESTICIDE),
SERUM

Biochemistry

MEXILETINE, SERUM

Biochemistry

MEXITIL, SERUM

Biochemistry

MIANSERIN, SERUM

Biochemistry

Blood/Plain plastic tube 1 - 2 weeks


no gel or anticoagulant (EDTA
tube or Plastic lithium heparin
(no gel) acceptable)

Please provide clinical and medication details including time and date of last dose.
Collect just prior to next dose. Referred test.

MIBK
(METHYL ISOBUTYL KETONE),
BLOOD

Biochemistry

Blood/Lithium heparin tube

Widely used solvent. Please refer to SOLVENTS, BLOOD for all details.
Collect the sample at the end of work shift or exposure. No Medicare rebate
applicable. Referred test.

MIBK, URINE

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - M

TEST NAME
METHYL ETHYL KETONE,
URINE

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.
Blood/Plain plastic tube no gel or anticoagulant

2 weeks

Please provide clinical and medication details including time and date of last dose.
Collect just prior to next dose.
Please refer to MEXILETINE, SERUM.

2 weeks

Please refer to METHYL ISOBUTYL KETONES, URINE.

Results (07) 3121 4555


9.4

PATHOLOGY TESTS - M

PATHOLOGY TESTS

DEPARTMENT
Biochemistry

Please refer to ALBUMIN, URINE.

MICROALBUMIN/CREATININE
RATIO, URINE
MICROBIAL SEROLOGY

Biochemistry

Please refer to ALBUMIN, URINE.

Immunology

Blood/SS tube

Variable from 24
hours to weeks
depending on
agent requested

MICROSOMAL ANTIBODY,
SERUM (THYROID)
MIDAZOLAM, URINE

Endocrinology

Blood/SS tube

24 hours

Biochemistry

Urine/Urine container

4 weeks

MINERAL TURPENTINE,
BLOOD
MINIMUM INHIBITORY
CONCENTRATION

Biochemistry
Microbiology

In vitro test on isolate

24 hours

Please contact Medical Microbiologist (07) 3121 4436 or


(07) 3121 4475 for further details.

MITOCHONDRIAL ANTIBODY,
SERUM
MITOCHONDRIAL DISORDERS
(LEBERS, LEIGHS, MELAS,
NARP), BLOOD

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Biochemistry

Blood/EDTA tube

4 weeks

ADULT: Collect 2 x 4 mL EDTA and transport to laboratory at 4C within 12 hours


of collection. CHILD: Collect minimum 2 mL EDTA whole blood and transport to
laboratory at 4C within 12 hours of collection. A neonatal screening card MAY be
collected instead of whole blood. Please contact Biochemistry (07) 3121 4420 for
collection details. This screen includes Lebers Hereditary Optic Neuroretinopathy,
Myoclonus Epilepsy Ragged Red Fibres, Mitochondrial Encephalopathy, Lactic
Acidosis and Stroke-like episodes, Mitochondrial DNA Deletion studies, Neurogenetic
Muscle Weakness, Ataxia and retinitis Pigmentosa, Leighs disease. Referred Test.

MITOCHONDRIAL DISORDERS,
HAIR ROOTS

Biochemistry

Hair roots/Taped to
paper backing with
roots uncovered

Indeterminate

Blood is the preferred sample for this test. Adults and children >2 years: Collect
6-10 hair roots. Secure hairs with sticky tape to paper, leaving roots uncovered.
Children <2 years: Apply blood to Neonatal screening card. Referred test.

MIXED LYMPHOCYTE CULTURE,


BLOOD

Haematology

Blood/ACD tube

2 weeks

Please contact Haematology (07) 3121 4451 or Branch Laboratory for


appointment. Referred test.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Please refer to Immunology Appendix (12.35) for a comprehensive list of antibodies


to microbial and parasitic agents. It is a Medicare requirement that microbial and
parasitic agents be listed individually on the request form. For enquiries please
contact Immunology (07) 3121 4458 or Branch Laboratory.

PATHOLOGY TESTS - M

TEST NAME
MICROALBUMIN, URINE

Transport to central laboratory on ice. Referred test.


Please refer to SOLVENTS, BLOOD for all details.

Results (07) 3121 4555


9.5

9.5

PATHOLOGY TESTS - M

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/Urine container

8 working days

MOGADON, SERUM

Biochemistry

MOLYBDENUM, BLOOD

Biochemistry

Blood/Lithium heparin
tube or EDTA tube

4 weeks

Please provide exposure details. Referred test.

MONOLAYER CYTOLOGY
(THINPREP)

Cytology

Labelled fixed smear/


slide carrier.
Rinse collection device in
labelled PreservCyt Solution

24 - 48 hours

ThinPrep is performed as an adjunct to conventional screening. A conventional Pap


smear must be performed and the collection device rinsed in labelled PreservCyt
Solution (available from QML Pathology Collection Centres). Transport Pap smear
and PreservCyt Solution to the laboratory. This test is a non rebatable fee.

MORPHINE, SERUM
(QUANTITATIVE)

Biochemistry

Blood/Plain plastic
6 mL tube - no gel
or anticoagulant

2 weeks

Please provide clinical and medication details, including time and dosage of
last dose.

MOTOR NEURON
DISEASE FAMILIAL
GENETIC TESTING

Genetics

Blood/EDTA tube

2 months

Transport at room temperature. Please note: This test requires extensive history
and family history to be performed. Family linkages: Require at least two members
with linkage numbers or three known infected members who have been clinically
diagnosed. Patient consent form to be filled out prior to testing.

MRSA SCREEN VRE/ESBL

Microbiology

Swab in Stuarts
transport medium

48 hours

Specify sites: Rectal - ESBL/VRE; Nasal/groin/wounds/axilla - MRSA.

MTHFR (C677T)
MUTATION ANALYSIS

Genetics

Blood/EDTA tube

1 week

Please provide details regarding patients eligibility for Medicare rebate, i.e. proven
venous thrombosis or pulmonary embolism or first degree relative with mutation.

MUCONIC ACID, URINE

Biochemistry

Urine/Urine container

2 weeks

Random urine to be collected at the end of work shift.

MUCOPOLYSACCHARIDES,
URINE

Biochemistry

Urine/Urine container

Screen: Next day, Please provide clinical and medication details.


Quantitation:
Refrigerate for transport to the laboratory.
1-2 weeks
A random urine collection is required.

MULTIPLE BIOCHEMICAL
ANALYSIS (MBA), SERUM
MULTIPLE ENDOCRINE
NEOPLASIA (MEN1)
GENETIC TESTING

Biochemistry

www.qml.com.au

Genetics

Sample to be collected post work shift.


Refrigerate sample and transport to laboratory cooled.
Please refer to NITRAZEPAM, SERUM.

PATHOLOGY TESTS - M

TEST NAME
MOCA, URINE

Please refer to E/LFT, SERUM.


Blood/EDTA tube

2 months

Results (07) 3121 4555


9.6

9.6

PATHOLOGY TESTS - M

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

24 - 48 hours

MURAMIDASE, SERUM

Haematology

Blood/SS tube

24 hours

MURELAX, SERUM

Biochemistry

MURRAY VALLEY (AUSTRALIAN) Immunology


ENCEPHALITIS VIRAL
SEROLOGY
MUSCLE BIOPSY
Histology

Assay run daily (Monday - Friday).


Please refer to OXAZEPAM, SERUM.

Blood/SS tube

2 weeks

Fresh Muscle Tissue 20 mm 24 - 48 hours


x 5 mm/DRY sterile screw
top (urine) container

Serology is referred to Qld Health Scientific Services Laboratory.

Requires Histochemistry and sometimes electron microscopy. Please submit


cooled fresh specimen within 4 hours of surgery - DO NOT place in formalin and
DO NOT freeze. If transport time will exceed 1 hour it is preferable to perform
the biopsy in a location closer to the laboratory. Please refer to Histology Preface
(5.39). Prior notice of biopsy to QML Pathology is desirable.

MUSCULAR DYSTROPHYBECKER/DUCHENNE, BLOOD


MUTABON, SERUM

Biochemistry

Please refer to DYSTROPHIN GENE ANALYSIS, BLOOD.

Biochemistry

Please refer to AMITRIPTYLINE, SERUM.

MYCOBACTERIA
ATYPICAL, MICROSCOPY
AND CULTURE

Microbiology/
Histology

Tissue, sputum, pus/Dry


sterile screw top (urine)
container (NO formalin)

Microscopy
- same day.
Culture - majority
provisionally
identified within
2 weeks
(up to 12 weeks).

If infection by atypical Mycobacteria is suspected in a tissue specimen (e.g. skin)


indicate suspicion and submit specimen in a dry, sterile screw top container (NO
formalin). The laboratory will process for both culture and histology. Note: Tissue
is essential for Histology. Tissue is preferable to pus. Sputum - 3 consecutive early
morning specimens.

MYCOBACTERIUM
TUBERCULOSIS, SPUTUM
MICROSCOPY AND CULTURE

Microbiology

Sputum/Dry, sterile screw


top (urine) container

Microscopy 2 days. Culture


- up to 6 weeks

Sputum - 3 consecutive early morning specimens.

MYCOPHENOLATE, PLASMA

Biochemistry

MYCOPHENOLIC ACID,
PLASMA

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - M

TEST NAME
MUMPS SEROLOGY

Please refer to MYCOPHENOLIC ACID, PLASMA.


Blood/EDTA tube

2 weeks

Please keep sample cool and transport to the laboratory without delay.
Referred Test.

Results (07) 3121 4555


9.7

9.7

PATHOLOGY TESTS - M

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Nasopharyngeal aspirate,
nasopharyngeal swab (dry
swab), Sputum/Luki tube or
sterile container or dry swab

24 hours

This test is only performed on specific request for respiratory Mycoplasma


(Mycoplasma pneumoniae).

MYCOPLASMA SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

MYCOPLASMA/UREA
PLASMA ISOLATION

Microbiology

Genital or urine swab/


Swab in transport medium

5 days

MYOGLOBIN, SERUM

Biochemistry

Blood/Plain tube - no gel


or anticoagulant. Lithium
heparin tube/EDTA tube (no
gel) plasma also acceptable

Same day

Please provide clinical and medication details.

MYOGLOBIN, URINE

Biochemistry

Urine/Urine container

Same day

Random urine sample required. Please provide clinical and medication details.

MYOTONIC DYSTROPHY

Biochemistry

Blood/EDTA tube

4 weeks

Transfer sample at 4C to reach the laboratory without delay. Referred test.

MYSOLINE, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - M

TEST NAME
MYCOPLASMA PNEUMONIAE
PCR

Please refer to PRIMIDONE, SERUM.

Results (07) 3121 4555


9.8

9.8

PATHOLOGY TESTS - M

PATHOLOGY TESTS

DEPARTMENT

N-1-METHYL NICOTINAMIDE,
URINE
N-ACETYL PROCAINAMIDE,
SERUM
N-ACETYL-GLUCOSEAMINIDASE, URINE

Biochemistry

Please refer to VITAMIN B3, URINE for details.

Biochemistry

Please refer to PROCAINAMIDE, SERUM.

Biochemistry

Urine/Plain random
urine container

2 weeks

Freeze specimen immediately after collection.

NALTREXONE,
SERUM or URINE

Biochemistry

Blood/Plain plastic
6 mL tube - no gel or
anticoagulant (Plastic
lithium heparin tube or
EDTA tube acceptable)
or Urine/Urine container

Indeterminate

Keep sample cool and send to the laboratory as soon as possible.


Please contact Biochemistry, central laboratory to check availability.

NARCOLEPSY

Haematology

Blood/ACD tube

Indeterminate

NASOPHARYNGEAL ASPIRATE
MICROSCOPY AND CULTURE

Microbiology

Nasopharyngeal Aspirate/
Aspirating trap

Please provide clinical details including antibiotic therapy and indicate


Interim
microscopy report if specimen is for virology.
- same day.
Routine culture
report - 48 Hours

NEISSERIA GONORRHOEAE,
MICROSCOPY AND CULTURE

Microbiology

Swab in Transport Medium

Interim
Using fine wire swabs collect at least two (2) swabs from the penile urethra
microscopy report or endocervical canal. Contact Microbiology (07) 3121 4438 to arrange rapid
- same day.
transport and processing without delay.
Routine culture
report - 48 Hours

NEISSERIA MENINGITIDIS PCR

Immunology

Blood and CSF/EDTA


tube and Sterile container

24 hours

NELFINAVIR, PLASMA

Biochemistry

Blood/EDTA tube

3 weeks

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

PATHOLOGY TESTS - N

TEST NAME

Please provide clinical and medication details. Plasma to be separated and frozen if
sample will not reach the central laboratory within 24 hours of collection. Referred test.

Results (07) 3121 4555


9.9

9.9

PATHOLOGY TESTS - N

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Capillary blood sample


(heel prick)/Neonatal
screening card

2 weeks

NEOPTERIN, URINE

Biochemistry

Please refer to PTERINS, URINE for details. Referred test.

NEORAL, BLOOD

Biochemistry

Please refer to CYCLOSPORIN, BLOOD.

NEULIN PRE/POST DOSE,


SERUM
NEUROFIBROMATOSIS, TYPE 1
(NF1) GENETIC TESTING

Biochemistry

Please refer to THEOPHYLLINE, SERUM.

Genetics

Blood/EDTA tube or
Lithium heparin tube

1 - 2 months

Keep at room temperature. Please note: This test requires detailed family history for
test to be performed. Family linkages: Require at least two members with linkage
numbers or three known infected members who have been clinically diagnosed.

NEURONE SPECIFIC ENOLASE,


SERUM
NEURONTIN, SERUM

Biochemistry

Blood/SS tube

2 weeks

Centrifuge, separate and freeze serum. Referred test.

NEUTROPHIL AB TO
MYELOID PRECURSORS

Haematology

Bone marrow and blood/3-4 1 month


fresh bone marrow slides,
3-4 normal bone marrow
slides, 1 x SS tube

Marrow collection performed by Haematologist.

NEUTROPHIL ALKALINE
PHOSPHATASE (NAP), BLOOD

Haematology

Blood/EDTA tube,
4 Original blood films

24 hours

Blood films made at time of collection are essential, EDTA interferes with test.

NEUTROPHIL ANTIBODIES,
BLOOD

Haematology

Blood/2 EDTA tubes,


SS tube

24 hours

Test performed daily. No booking or appointment required. Please notify


Haematology (07) 3121 4451 or your Branch Laboratory of all urgent specimens
and weekend collections.

NEUTROPHIL FUNCTION
STUDIES, BLOOD

Haematology

Blood/EDTA tube,
Plastic lithium heparin tube,
2 blood films, SS tube

24 hours

Please contact Haematology (07) 3121 4451 or


Branch Laboratory prior to collection.

NEVIRAPINE, PLASMA

Biochemistry

Blood/EDTA tube

3 weeks

Please provide clinical and medication details. Plasma to be separated and frozen if
sample will not reach the central laboratory within 24 hours of collection. Referred test.

www.qml.com.au

Biochemistry

HEEL PRICK SAMPLE REQUIRED. This screen includes:- Phenylketonuria (PKU),


Congenital Hypothyroidism, Cystic Fibrosis (CF), Galactosaemia. Ensure even
application of infants blood to cover entirely the marked areas of the card. Refer to
the instructions on the card and the Biochemistry Preface. Please note: Card must
be completely air dried and transported in a paper bag or envelope. Referred test.

PATHOLOGY TESTS - N

TEST NAME
NEONATAL SCREENING TEST

Please refer to GABAPENTIN, SERUM.

Results (07) 3121 4555

9.10

9.10

PATHOLOGY TESTS - N

PATHOLOGY TESTS

DEPARTMENT
Biochemistry

Please refer to AMMONIA, PLASMA.

NIACIN, URINE

Biochemistry

Please refer to VITAMIN B3, URINE for details.

NICKEL, BLOOD

Biochemistry

Blood/EDTA tube (Lithium


heparin tube acceptable)

4 weeks

Please provide exposure details. Referred test.

NICKEL, URINE

Biochemistry

Urine/Urine container

1 week

Please provide details of exposure (clinical and occupational).


A random collection is preferred. Referred test.

NICOTINE METABOLITES,
SERUM
NICOTINE METABOLITES,
URINE
NICOTINE,
URINE RANDOM
NIPPLE DISCHARGE
CYTOLOGY

Biochemistry

Please refer to COTININE, SERUM.

Biochemistry

Please refer to COTININE, URINE.

Biochemistry

Please refer to COTININE, URINE.

Cytology

Fixed smear of nipple


discharge/Slide carrier

24 hours

For specimen preparation please refer to Cytology Preface (5.15).

NITRAZEPAM, SERUM

Biochemistry

Blood/Plain plastic
6 mL tube - no gel
or anticoagulant

1 week

Please provide clinical and medication details, including time and dosage of last
dose. Collect just prior to the next dose or at least 8 hours after the last dose.

NITROGEN EXCRETION,
URINE

Biochemistry

Urine/24 hour
urine container with
no preservative

24 hours

Urine should be refrigerated after the collection period


and transported cooled to the laboratory.

NMN, URINE

Biochemistry

Please refer to VITAMIN B3, URINE for details.

NORADRENALIN,
URINE
NORADRENALINE,
URINE 24 HOUR
NORDIN TEST,
URINE AND SERUM

Biochemistry

Please refer to CATECHOLAMINES, URINE.

Biochemistry

Please refer to CATECHOLAMINES, URINE.

www.qml.com.au

Biochemistry

SPECIMEN CONTAINER

Blood and Urine/24 hour


urine container - no
preservative and SS tube

REPORTING TIME COMMENTS

24 hours

PATHOLOGY TESTS - N

TEST NAME
NH3, PLASMA

The patient fasts overnight. The protocol requires fluid ingestion and timed urine
collection. Please contact Biochemistry (07) 3121 4971 or Branch Laboratory for
test and collection details.

Results (07) 3121 4555

9.11

9.11

PATHOLOGY TESTS - N

PATHOLOGY TESTS

DEPARTMENT

NORMALISED ANDROGEN
RATIO, SERUM
NORMETANEPHRINE, URINE

Endocrinology
Biochemistry

Please refer to CATECHOLAMINES, URINE.

NORMISON, SERUM

Biochemistry

Please refer to TEMAZEPAM, SERUM.

NOROVIRUS TESTING

Immunology

NORPACE, SERUM

Biochemistry

Please refer to DISOPYRAMINE, SERUM.

NORTAB, SERUM

Biochemistry

Please refer to NORTRIPTYLINE, SERUM.

NORTRIPTYLINE,
SERUM

Biochemistry

NORVAL, SERUM

Biochemistry

NORVIR, PLASMA

Biochemistry

Blood/EDTA tube

3 weeks

Please provide clinical and medication details. Plasma to be separated and frozen if
sample will not reach the central laboratory within 24 hours of collection. Referred test.

N-TELOPEPTIDE,
URINE

Biochemistry

Urine/Urine container
(random) (preferred) or
24 hour urine container

1 week

A highly specific marker of bone resorption used in investigation and monitoring


of osteoporosis, Pagets disease, steroid therapy, malignancies, inflammatory
diseases and metabolic bone diseases. Please provide details of patient height and
weight. NO dietary restriction is required. A random early morning urine specimen is
preferred. A 24 hour sample can be collected if required. Urine specimen should be
refrigerated during the collection period and transported cooled to the laboratory.

NTPROBNP (CHAT STUDY)

Specimen
Distribution

Blood/Patient presents
with test kit/tubes

Collection and
transfer only

Forward sample to laboratory without delay.

NTX, URINE

Biochemistry

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to CATECHOLAMINES, URINE.

Biochemistry

Please refer to CATECHOLAMINES, URINE.

Biochemistry

Metabolite of Fluoxetine. Please refer to FLUOXETINE, SERUM.


Blood/SS tube

Faeces/Faeces container

Blood/Plain plastic tube no gel or anticoagulant


(plastic lithium heparin
tube acceptable)

24 hours

PATHOLOGY TESTS - N

TEST NAME
NOREPINEPHRINE,
URINE
NOREPINEPHRINE,
URINE 24 HOUR
NORFLUOXETINE, SERUM

1 - 2 weeks

1 week

Please provide clinical and medication details, including time and date of next
dose. Collect immediately prior to next dose.

Please refer to MIANSERIN, SERUM.

Please refer to N-TELOPEPTIDE, URINE.

Results (07) 3121 4555

9.12

9.12

PATHOLOGY TESTS - N

PATHOLOGY TESTS

www.qml.com.au

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/EDTA tube

4 weeks

Biochemistry

Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for specific
collection details as this may differ quantitatively or qualitatively for different
diseases. Please indicate which diseases are being investigated. Referred test.

PATHOLOGY TESTS - N

TEST NAME
NUCLEIC ACID GENETIC
INVESTIGATION FOR INHERITED
DISEASES (CYSTIC FIBROSIS,
LEBERS NEURORETINOPATHY,
MCAD, PHENYLKETONURIA),
DNA PROBE
NUELIN, SERUM

Please refer to THEOPHYLLINE, SERUM.

Results (07) 3121 4555

9.13

9.13

PATHOLOGY TESTS - N

PATHOLOGY TESTS

DEPARTMENT

OB PROTEIN, PLASMA

Biochemistry

OCCULT BLOOD,
FAECES

Microbiology

OCTANE, BLOOD

Biochemistry

OCULAR LESION,
MICROSCOPY AND CULTURE

Microbiology

Swab/Ophthalmology
Microbiology kit

OESTRADIOL, SALIVA

Endocrinology

Saliva/Sterile
container (urine)

2 weeks

Sample must be collected between 7.00am and 10.00am following an overnight


fast. Referred test. Incurs non-Medicare refundable fee.

OESTRADIOL, SERUM

Endocrinology

Blood/SS tube

24 hours

Please provide medication and clinical notes including date of last normal
menstrual period (LNMP). Include information regarding any hormone replacement
therapy or contraceptive use.

OESTRONE, SERUM

Biochemistry

Blood/SS tube

2 weeks

Transport to Central Laboratory on dry ice. Referred test.

OLANZAPINE, PLASMA

Biochemistry

Blood/Lithium heparin tube


(EDTA tube acceptable)

1 - 2 weeks

Please keep the sample cool and forward to the laboratory without delay.

OLIGOCLONAL BAND STUDIES,


CSF
OLIGOSACCHARIDES,
URINE

Biochemistry

ON-SITE DRUG TESTING

Biochemistry

OPIATES - GCMS
CONFIRMATION

Biochemistry

OPTICAL DENSITY,
AMNIOTIC FLUID

Biochemistry

www.qml.com.au

Biochemistry

SPECIMEN CONTAINER

REPORTING TIME COMMENTS


Please refer to LEPTIN, PLASMA.

Faeces/Faeces container

Same day

No need for patient to fast or require a special diet. Refrigerate after collection and
transport cooled. Samples may be stored for 5 days at 25C or 4 weeks at 4C.
Please refer to SOLVENTS, BLOOD for all details.
Requirements are determined by clinical factors. Please refer to Microbiology Preface
(5.55) for details and contact Microbiology (07) 3121 4438 or Branch Laboratory.

PATHOLOGY TESTS - O

TEST NAME

Please refer to PROTEIN ELECTROPHORESIS, CSF for details.


Urine/Urine container

2 weeks

Please collect a random urine after work shift or suspected exposure.


Keep the sample refrigerated. Referred test.
Please contact the Drug Testing Laboratory, Biochemistry, Murarrie
(07) 3121 4419 for all information on urine, saliva and breath on-site drug testing.

Urine/Urine drug screen


collection kit with tamper
evident packaging

48 hours

This is requested in cases concerned with occupational drug screening for drugs of
abuse. The QML Pathology protocol complies with Standards Australia AS/NZS4308
for the assay of cannabinoids, opiates, cocaine metabolites, benzodiazepines and
sympathomimetic amines. A Chain-of Custody form should be completed. Additional
classes (methadone, barbiturates, alcohol) should be specifically requested if
required. Please also refer to the Biochemistry Preface (5.4). Confirmation and
quantitation by GCMS of positive findings may be requested separately.
Please refer to BILIRUBIN, AMNIOTIC FLUID for details.

Results (07) 3121 4555

9.14

9.14

PATHOLOGY TESTS - O

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Cytology

Labelled fixed smear/


Slide carrier

24 hours

For specimen preparation please refer to Cytology Preface (5.19).

ORGANIC ACID SCREEN


(CHROMATOGRAPHY), URINE

Biochemistry

Urine/Urine container

2 weeks

Please provide clinical and medication details. A random urine collection is


required. Referred test.

ORGANOCHLORINE
PESTICIDES, BLOOD

Biochemistry

Blood/Lithium heparin tube

4 weeks

Please provide exposure details, including the names of pesticides the patient
has been in contact with. Please refer to Biochemistry Appendix (12.18) for
a comprehensive list of organochlorine pesticides and synthetic pyrethroids.
If herbicides are also requested, a random URINE must be collected and the
herbicides the patient has been in contact with must be listed. Referred test.

ORGANOPHOSPHATE
PESTICIDES, SERUM

Biochemistry

ORNITHINE
TRANSCARBAMYLASE
DEFICIENCY
OROSOMUCOID, SERUM

Genetics

OROTIC ACID, URINE

Biochemistry

Urine/Urine container

3 weeks

A fresh random urine should be collected and frozen as soon as possible.


Do not allow to thaw. Referred test.

OSMOLALITY, FAECES

Biochemistry

Faeces/Faeces container

24 hours

Please keep the sample cool during collection and transport to the laboratory.

OSMOLALITY, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Please note fluid site on specimen container and request form.

OSMOLALITY, SERUM

Biochemistry

Blood/SS tube

Same day

Please provide clinical and medication details. If urine osmolality is also required,
both specimens MUST be collected at the same time.

OSMOLALITY, URINE

Biochemistry

Urine/Urine container

Same day

Please provide clinical and medication details. A random urine collection is required. If
serum osmolality is also requested, both specimens MUST be collected at the same time.

OSPOLOT, SERUM

Biochemistry

OSTEOCALCIN, SERUM

Endocrinology

www.qml.com.au

PATHOLOGY TESTS - O

TEST NAME
ORAL CAVITY CYTOLOGY

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.
Blood/EDTA tube

3 months

Biochemistry

Patient consent for billing must be marked on the request form.

Please refer to ALPHA-1-ACID GLYCOPROTEIN, SERUM

Please refer to SULTHIAME, SERUM.


Blood/SS tube

4 weeks

Vitamin D dependent, calcium-binding protein synthesized by osteoblasts. It is a


possible marker for bone turnover and may be assayed in metabolic bone disease or
other causes of increased bone turnover. Specimen should reach laboratory within
2 hours of collection. Keep specimen cold and transport on dry ice to Endocrinology
ASAP. There is currently no Medicare rebate for this test.

Results (07) 3121 4555

9.15

9.15

PATHOLOGY TESTS - O

PATHOLOGY TESTS

DEPARTMENT

Immunology

Blood/SS tube

1 week

Refer to ADENOVIRUS SEROLOGY for collection details.

OVARIAN CANCER TUMOUR


MARKERS, SERUM

Biochemistry/
Endocrinology

Blood/SS tube

24 hours

CA 125 - serous carcinoma CA 19-9 - mucinous carcinoma Lactate


dehydrogenase isoenzyme - 1 (LD-1) - dysgerminoma Human chorionic
gonadotrophin (HCG) - choriocarcinoma.

OVARIAN CYST ASPIRATE


CYTOLOGY

Cytology

Fluid/Sterile screw
top container

24 hours

For specimen preparation please refer to Cytology Preface (5.17).

OVPLEX OVARIAN CANCER TEST Specimen


Distribution
OXALATE, URINE
Biochemistry

Blood/1 x SS tube and


1 x EDTA tube

Collection and
transfer only

Transport to Central Laboratory on dry ice.

Urine/24 hour urine


container with 25 mL
6M HCI preservative

2 weeks

Please provide clinical and medication details. Sample MUST be collected into
acid preservative. Urine should be refrigerated during the collection period and
transported cooled to the laboratory. Referred test.

OXAZEPAM, SERUM

Biochemistry

1 week
Blood/Plain plastic
6 mL tube - no gel or
anticoagulant (Plastic lithium
heparin tube acceptable)

Please provide clinical and medication details, including time and dosage of last
dose. Collect just prior to the next dose or at least 8 hours after the last dose.

OXYPURINOL, PLASMA

Biochemistry

Blood/EDTA tube

Keep cool during transport to laboratory. Referred test.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to N-TELOPEPTIDE, URINE.

2 - 3 weeks

Results (07) 3121 4555

PATHOLOGY TESTS - O

TEST NAME
OSTEOPOROSIS MARKERS,
URINE
OVARIAN ANTIBODY

9.16

9.16

PATHOLOGY TESTS - O

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

1 - 2 weeks

P53 DNA TESTING

Genetics

Blood/EDTA tube

6 - 8 weeks

PACKED CELL VOLUME (PCV),


BLOOD
PAINT THINNERS, BLOOD

Haematology

Blood/EDTA tube

Same day

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

PANADOL, SERUM

Biochemistry

Please refer to PARACETAMOL, SERUM.

PANCREATIC ELASTASE 1,
FAECES

Biochemistry

Faeces/Faeces container

4 weeks

This is a non-invasive test for assessing exocrine pancreatic function. Please keep
the sample cool and transport to the laboratory without delay. If there will be a
delay, please freeze the sample.

PANCREATIC POLYPEPTIDE,
SERUM

Biochemistry

Blood/SS tube

2 weeks

Patient should fast overnight. Collect SS tube and centrifuge immediately after
clotting, remove serum into 5 mL plastic tube and freeze. Referred test.

PAP SMEAR

Cytology

Labelled fixed smear/


Slide carrier

48 - 72 hours

For specimen preparation please refer to Cytology Preface (5.11).

PARACETAMOL, SERUM

Biochemistry

Same day
Blood/Plain plastic
6 mL tube - no gel or
anticoagulant (Plastic lithium
heparin tube acceptable)

Please provide clinical and medication details. (a) RANDOM - Collect 1 hour post
dose. Note time of last dose and dosage. (b) OVERDOSE - Collect 1 and 4 hours
after the overdose. Note time of suspected overdose and time of collection.

PARAINFLUENZA SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

PARAPERTUSSIS SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run Monday - Friday. Please note: the assay for Pertussis antibodies also
detects antibodies to Parapertussis.

PARAPROTEIN, SERUM

Biochemistry

Please refer to IMMUNOFIXATION (PROTEIN), SERUM.

PARAPROTEIN, URINE

Biochemistry

Please refer to IMMUNOFIXATION (PROTEIN), URINE.

PARAQUAT, URINE

Biochemistry

www.qml.com.au

Urine/Urine container

2 weeks

Referred test.

PATHOLOGY TESTS - P

TEST NAME
P24 ANTIGEN (HIV), SERUM

Test for toxicity - usually only required in cases of high level poisoning e.g.
ingestion. These analyses are not performed on a routine basis in biological fluids.
This test will only be referred with prior permission from the requesting doctor or
patients employer. Qualitative screen only is performed. Referred test.

Results (07) 3121 4555

9.17

9.17

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

Variable from 24
hours to weeks
depending on
agent requested

Please refer to Immunology Appendix (12.36) for a comprehensive list of antibodies


to microbial and parasitic agents. It is a Medicare requirement that microbial and
parasitic agents be listed individually on the request form. For enquiries please
contact Immunology (07) 3121 4458 or Branch Laboratory.

PARASITES AND
ECTOPARASITES,
EXAMINATION FOR

Microbiology

Faeces/Faeces container
and slide. Skin scrapings,
hairs, nits/Glass slide and
cover slip, sterile screw
top containers

24 - 48 hours

Refer to Microbiology Preface (5.53) for details.


Please contact Microbiology (07) 3121 4438 or Branch Laboratory
for further details of collection and transport.

PARATHION
(ORGANOPHOSPHATE
PESTICIDE),
SERUM AND BLOOD
PARATHION (PESTICIDE),
SERUM

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

PARATHORMONE (PTH) RELATED PEPTIDE, PLASMA

Endocrinology

Blood/EDTA tube
with Trasylol

2 weeks

Special collection and handling of specimen required. Appointment is required in


order to organise special tube with Trasylol added. Please contact Endocrinology
(07) 3121 4439 or Branch Laboratory for details. Referred test.

PARATHORMONE (PTH) INTACT, Endocrinology


SERUM

Blood/SS tube

24 hours

Parathyroid hormone is stable if the specimen is kept cold (4C) for up to 10 hours.
However, hormone activity decreases significantly at room temperature. Please
note on form if kept at room temperature for prolonged periods.

PARATHYROID HORMONE (PTH), Endocrinology


SERUM

Blood/SS tube

24 hours

Parathyroid hormone is stable if the specimen is kept cold (4C) for up to 10 hours.
However, hormone activity decreases significantly at room temperature.
Please note on form if kept at room temperature for prolonged periods.

PARATYPHI SEROLOGY

Immunology

Blood/SS tube

24 hours

PARIETAL CELL ANTIBODY,


SERUM
PARVOVIRUS B19 PCR

Immunology

Blood/SS tube

24 hours

Immunology

Blood/SS tube

4 - 6 weeks

www.qml.com.au

PATHOLOGY TESTS - P

TEST NAME
PARASITE SEROLOGY

Assay run daily (Monday - Friday).

Results (07) 3121 4555

9.18

9.18

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Blood/SS tube

48 hours

Assay run Monday, Wednesday and Friday.

Haematology

Blood/SS tube

Same day

Epstein-Barr virus (EBV) serology may be helpful if Paul-Bunnell test is negative


and clinical features are suggestive.

Biochemistry

Urine/Urine container
(preferred) or 24 hour
urine container with
no preservative

Same day

Test for acute intermittent porphyria. Please provide clinical and medication details.
PORPHOBILINOGEN DECREASES RAPIDLY ON STANDING - forward to laboratory
promptly, keep cool and protect from light during transit. Preferable collection is
during an episode of abdominal pain or neurological disturbance. A random sample
is preferred (not a 24 hour sample). If the patient is collecting a 24 hour urine
for Porphyrins, then a small portion e.g. 20 mL collected separately into a urine
container during an episode would be sufficient for porphobilinogen.

PBG DEAMINASE, RED CELL

Biochemistry

PCB OILS, BLOOD

Biochemistry

Blood/Glass lithium
heparin tube

4 weeks

PCB oils are mainly used in the cooling systems of some electrical transformers.
Please provide exposure details and medication of patient. Keep sample cool
during transport to the laboratory. Referred test.

PEMPHIGOID ANTIBODY/
BASEMENT MEMBRANE ZONE
(BMZ) ANTIBODY, SERUM
PEMPHIGUS ANTIBODY/
INTERCELLULAR CEMENT
SUBSTANCE (ICS) ANTIBODY,
SERUM
PERCHLOROETHYLENE,
BLOOD
PERCHLOROETHYLENE,
URINE

Immunology

Blood/SS tube

2 weeks

Skin biopsies for immunofluorescence and histology advised.


Please refer to Histology Preface (5.38) for details.

Immunology

Blood/SS tube

2 weeks

Skin biopsies for immunofluorescence and histology advised.


Please refer to Histology Preface (5.38) for details.

www.qml.com.au

Please refer to PORPHOBILINOGEN DEAMINASE, RED CELL.

Biochemistry
Biochemistry

PATHOLOGY TESTS - P

TEST NAME
PARVOVIRUS B19 SEROLOGY
(FIFTH DISEASE OR SLAPPED
CHEEK SYNDROME)
PAUL-BUNNELL TEST
(INFECTIOUS MONONUCLEOSIS
SEROLOGY)
PBG (PORPHOBILINOGEN)
SCREEN, URINE

Please refer to SOLVENTS, BLOOD for all details.


Urine/Urine container

4 weeks

Random urine collected at the end of work shift or exposure. This test attracts a
charge of approximately $165.00 from the reference laboratory, payable by the
patient or their employer. Please indicate on the request form if permission or prior
arrangement has been made.

Results (07) 3121 4555

9.19

9.19

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant


(plastic lithium heparin
tube acceptable)

2 weeks

PERITONEAL DIALYSIS
FLUID FOR MICROSCOPY
AND CULTURE

Microbiology

Fluid in sterile
container or peritoneal
dialysis bottle

Interim
Please transport specimen cooled to laboratory as soon as possible after collection.
microscopy report
same day. Culture
report 48 hours

PERITONEAL FLUID CYTOLOGY

Cytology

Fluid/Sterile container
of appropriate size

24 hours

Submit ENTIRE specimen to laboratory as soon as possible.


Please refer to Cytology Preface (5.16).

PERITONEAL WASHING
CYTOLOGY

Cytology

Fluid/Sterile container of
appropriate size

24 hours

Submit ENTIRE specimen to laboratory as soon as possible.


Please refer to Cytology Preface (5.16).

PERTOFRAN, SERUM

Biochemistry

PERTUSSIS SEROLOGY

Immunology

PESTICIDES
(ORGANOPHOSPHATE/
CARBAMATE), SERUM
PESTICIDES, BLOOD

Biochemistry

PETROL, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

PEXID, SERUM

Biochemistry

Please refer to PERHEXILINE, SERUM.

pH, BLOOD

Biochemistry

Please refer to BLOOD GASES, VENOUS.

pH, FAECES

Biochemistry

www.qml.com.au

Biochemistry

Please provide clinical and medication details. Collect just prior to next dose.
Referred test.

PATHOLOGY TESTS - P

TEST NAME
PERHEXILINE,
SERUM

Please refer to DESIPRAMINE, SERUM.


Blood/SS tube

24 hours

Assay run daily (Monday - Friday).


Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,
RED CELL for toxicity.

Blood/Lithium heparin
tube and/or SS tube

Faeces/Plain tube

Organophosphates: Please provide details of organochlorine and/or organophosphate pesticides and


24 hours
circumstances of exposure. Please refer to Biochemistry Appendix (12.18) for a
Organochlorines:
comprehensive list.
4 weeks

24 hours

Collect sample anaerobically and refrigerate until the pH is assayed. Submit to


the laboratory as soon as possible. Request for Faecal Reducing Substances will
include pH (separate sample/data entry of pH not required).

Results (07) 3121 4555

9.20

9.20

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Any biological fluid other than


blood or serum/Plain tube
(Note that FRS includes pH
- separate sample/data entry
not required for pH)

Same day

Collect sample anaerobically and refrigerate until the pH is assayed.


Submit to the laboratory as soon as possible.

pH, URINE

Biochemistry

Urine/Plain tube

24 hours

Collect sample anaerobically and refrigerate until the pH is assayed.


Submit to the laboratory as soon as possible.

PHENOBARBITONE,
SERUM

Biochemistry

Same day
Blood/Plain plastic
6 mL tube - no gel or
anticoagulant (Plastic lithium
heparin tube acceptable)

Please provide clinical and medication details.


Collect sample at least 8 hours after last dose or immediately prior to next dose.

PHENOLS, URINE

Biochemistry

Urine/Urine container

2 weeks

Please provide exposure and occupation details.


Collect random urine immediately after the work shift or exposure. Referred test.

PHENYLALANINE, SERUM

Biochemistry

Blood/Lithium heparin tube

2 weeks

Monitoring of known patients with phenylketonuria. Please provide clinical details.


Fasting samples are preferable. Referred test.

PHENYLKETONURIA,
BLOOD
PHENYTOIN, SERUM

Biochemistry

Please refer to NEONATAL SCREENING TEST.

Biochemistry

Please refer to DILANTIN, SERUM.

PHOSDRIN (PESTICIDE)

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

PHOSPHATE, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify site of fluid on specimen container and request form.

PHOSPHATE, SERUM

Biochemistry

Blood/SS tube

Same day

Please refer to E/LFT, SERUM. Avoid haemolysis and prolonged contact of serum with
cells. If stored overnight, blood should be centrifuged to separate serum from cells.

PHOSPHATE, URINE

Biochemistry

Urine/24 hour urine


container with 25 mL
6M HCI preservative

24 hours

24 hour urine preferred. Urine should be refrigerated during the collection period
and transported cooled to the laboratory.

PHOSPHATE,
WHOLE BLOOD

Biochemistry

Blood/Lithium heparin
tube and SS tube

24 hours

Please provide clinical and medication details.

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - P

TEST NAME
pH, FLUID

9.21

9.21

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Lithium
heparin tube

2 weeks

Fasting samples are preferred. Family and clinical history must be provided.
Clinics should forward sample on an ice brick to arrive at the central laboratory
within 4 hours. If these requirements cannot be met, please separate serum into
6 mL Falcon tube and freeze.

PHOSPHORYLASE B KINASE,
BLOOD

Biochemistry

Blood/Lithium
heparin tube

2 weeks

Transport sample cool. Referred test.

PHYTANIC ACID, BLOOD

Biochemistry

Please refer to FATTY ACIDS-VERY LONG CHAIN, PLASMA.

PHYTANIC ACID, PLASMA

Biochemistry

Please refer to FATTY ACIDS-VERY LONG CHAIN, PLASMA.

PIGMENTS, URINE

Biochemistry

PKU TEST

Biochemistry

PLASMA VISCOSITY

Haematology

Blood/EDTA tube

24 hours

Specimen must NOT be refrigerated.

PLASMINOGEN ACT INHIBITOR,


BLOOD

Haematology

Blood/Sodium citrate tube

2 - 4 weeks

Rest patient for 20 minutes prior to collection. Then collect the specimen without
cuff. These specimens are to reach the Laboratory within 2 hours of collection. If
unable to do this, the specimens are to be double spun and sent frozen.

PLASMINOGEN ACTIVATOR,
BLOOD

Haematology

Blood/Sodium
citrate tube

2 - 4 weeks

PLASMINOGEN ASSAY,
BLOOD

Haematology

Blood/Sodium
citrate tube

24 hours

Patient must rest for 15 minutes prior to collection. Collect without a tourniquet.
Please provide thrombotic history of patient and family members and any
anticoagulant therapy. Specimen must reach laboratory within 2 hours of collection.

PLATELET AGGREGATION
STUDIES, BLOOD

Haematology

Blood/5 Sodium citrate


tubes, 1 EDTA tube

Same day

Specimens must reach laboratory within 5 hours of collection. Please contact


Haematology (07) 3121 4451 or Branch Laboratory for details. DO NOT REFRIGERATE.

PLATELET ANTIBODY SCREEN,


BLOOD

Haematology

Blood/3 EDTA tubes,


1 SS tube, 2 Blood films

24 hours

Test is performed Monday - Friday. For collection late Friday and weekends,
please contact Haematology on (07) 3121 4451 or Branch Laboratory.
Transport at room temperature, NOT on ice.

PLATELET COUNT, BLOOD

Haematology

Blood/1 EDTA tube,


2 blood films

Same day

Please see Haematology Appendix (12.32).

PLATELET FACTOR 3, BLOOD

Haematology

Blood/Sodium
citrate tube

24 hours

Please contact Coagulation Section (07) 3121 4451 or


Branch Laboratory before collection.

www.qml.com.au

Urine/Urine container

Same day

PATHOLOGY TESTS - P

TEST NAME
PHOSPHOLIPID,
FATTY ACID

A random urine collection is required.


Please provide HISTORY OF MEDICATION AND DIET and clinical details.
Please refer to NEONATAL SCREENING TEST.

Results (07) 3121 4555

9.22

9.22

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Haematology

Blood/4 x Sodium citrate


tubes, 1 x EDTA tube

Same day

The specimen must be tested within 5 hours of collection.


Forward with a Coag. questionnaire. DO NOT centrifuge samples.

PLATELET GLYCOPROTEIN

Haematology

Blood/4 x Sodium citrate


tubes, 1 x SS tube

1 week

By appointment with Red Cross Transfusion Service.

PLATINUM, BLOOD

Biochemistry

Blood/EDTA tube

2 weeks

Please provide clinical and exposure details.

PLEURAL FLUID CYTOLOGY

Cytology

Pleural fluid/Appropriate
sterile container

24 hours

Please submit ENTIRE specimen to laboratory as soon as possible.


For specimen preparation please refer to Cytology Preface (5.15).

PML-RAR RT-PCR

Genetics

Blood or Bone marrow/


EDTA tube or min. 2 mL
bone marrow in EDTA tube

2 weeks

Specimen to be received within 24 hours.

PNEUMOCOCCAL
(STREPTOCOCCUS
PNEUMONIAL) SEROLOGY
PNEUMOCOCCAL ANTIBODIES

Immunology

Blood/SS tube

2 - 4 weeks

Referred test.

Immunology

Blood/SS tube

Up to 3 months

PNEUMOCOCCAL ANTIGEN,
URINE
PNEUMOCYSTIS PCR

Immunology

Urine/Urine container

1 - 2 weeks

Immunology

Sputum/Nasopharyngeal
aspirate sterile container

Same day

Blood/EDTA tube

24 hours

Blood/Lithium
heparin tube

2 - 4 weeks

PNH SCREEN FLOWCYTOMETRY Haematology


PORPHOBILINOGEN
Biochemistry
DEAMINASE, RED CELL

9.23

PORPHOBILINOGEN,
URINE
PORPHYRIN PEPTIDE X,
BLOOD

www.qml.com.au

Biochemistry
Biochemistry

PATHOLOGY TESTS - P

TEST NAME
PLATELET FUNCTION
PFA 100

Referred test.

Test for Acute Intermittent Porphyria - useful only if 5ALA or PBG screen positive. Please
contact Biochemistry (07) 3121 4420 or Branch Laboratory before collection. Pretreated sample must arrive at the Reference Laboratory by late morning. Referred test.
Please refer to PBG (PORPHOBILINOGEN) SCREEN, URINE.

Blood/Lithium
heparin tube

2 weeks

Protect from light. Transport to laboratory on ice.

Results (07) 3121 4555

9.23

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Faeces/Faeces container,
no preservative

1 week

Raised with porphyria cutanea tarda and with other rare hepatic porphyrias. Always
provide clinical and medication details, including whether the patient is suffering
from skin and/or neurological symptoms, and include any family history of porphyrin
abnormalities. Refrigerate and protect from light immediately after collection.

PORPHYRIN, PLASMA

Biochemistry

Blood/Lithium heparin tube

3 weeks

Refrigerate and protect from light immediately after collection. Please contact
Biochemistry on (07) 3121 4420 as a Blood Porphyrin may be preferred. Referred test.

PORPHYRIN, RED CELL

Biochemistry

Whole blood/
Lithium heparin tube
or EDTA tube

1 week

Refrigerate and protect from light immediately after collection.

PORPHYRIN, URINE

Biochemistry

Urine/Random
urine container

1 week

Please provide clinical and medication details. Preferred sample - collected during or
immediately after an acute episode of skin rash, pain, neurological or psychological
disturbance etc. Alternatively collect a first morning sample. Any other random sample
may be collected but is the least desirable of the three options. Refrigerate sample
immediately after collection, protect from light and send to the laboratory without delay.

POST OPERATIVE
WOUND INFECTION

Microbiology

Pus/Sterile container,
Swab in Transport Medium

48 hours

Please provide clinical details including site and antibiotic therapy. Please specify
if specimen is to be cultured for exotic organisms, fungi and/or Mycobacteria.
Transport to the laboratory without delay.

POTASSIUM, CSF

Biochemistry

POTASSIUM, FAECES

Biochemistry

Faeces/Faeces container

24 hours

Test for unexplained hypokalaemia - raised with colonic villous adenoma.


Keep sample cool during collection and transport to the laboratory.

POTASSIUM, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify site of fluid on specimen container and request form.

POTASSIUM, PLASMA

Biochemistry

Blood/Lithium
heparin tube

Same day

Plasma potassium is predominantly requested to confirm an elevated serum


potassium when it is suspected that the elevation is due to the SS tube clotting
process. THE SAMPLE MUST BE CENTRIFUGED AS SOON AS POSSIBLE AFTER
COLLECTION AND THEN THE PLASMA SEPARATED FROM THE CELLS IN A
SECOND TUBE. If in doubt, contact the Biochemistry Department (07 3121 4927).

POTASSIUM, SERUM

Biochemistry

Blood/SS tube

Same day

Please refer to E/LFT, SERUM. Avoid haemolysis and prolonged contact of serum with
cells. If stored overnight, blood should be centrifuged to separate serum from cells.

www.qml.com.au

PATHOLOGY TESTS - P

TEST NAME
PORPHYRIN, FAECES

Please refer to BIOCHEMISTRY, CSF for details.

Results (07) 3121 4555

9.24

9.24

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/Random urine
container or plain 24
hour urine container

24 hours

24 hour urine preferred. Urine should be refrigerated during the collection


period and transported cooled to the laboratory.

POTASSIUM,
WHOLE BLOOD

Biochemistry

Blood/Lithium heparin
tube and SS tube

24 hours

Please provide clinical and medication details.

POUCH OF DOUGLAS FLUID

Cytology

Fluid/Sterile container
of appropriate size

24 hours

Collected by Doctor.

PRADER WILLI DNA TESTING

Genetics

Blood/Pink top EDTA tube

1 - 2 months

PREALBUMIN, PLASMA

Biochemistry

Blood/Lithium heparin tube

2 weeks

Test for protein malnutrition. Referred test.

PREGNANCY TEST, SERUM

Endocrinology

Blood/SS tube

Same day

Please note date of last normal menstrual period (LNMP).

PREGNANCY TEST, URINE

Endocrinology

Random urine/
Urine container

Same day

Early morning urine recommended. For urine specimens no preservative or


acid can be added. Monovette urine collection tubes must not be used.

PREGNANEDIOL,
URINE 24 HOUR

Endocrinology

24 hour urine collection/


Urine collection bottle.
No preservative

4 - 5 weeks

Urine should be refrigerated during the collection period and transported


cooled to the laboratory. Referred test.

PREGNANETRIOL, URINE

Endocrinology

24 hour urine collection/


Urine collection bottle.
No preservative

4 - 5 weeks

Total volume to be recorded.

PREGNENOLONE, SERUM

Endocrinology

Blood/SS tube

2 - 5 weeks

Referred test.

PRIADEL, SERUM

Biochemistry

PRIMIDONE, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant


(plastic lithium heparin
tube acceptable)

Same day

PRO INSULIN

Endocrinology

Blood/SS tube

4 - 5 weeks

PROCAINAMIDE, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant

2 weeks

www.qml.com.au

PATHOLOGY TESTS - P

TEST NAME
POTASSIUM, URINE

Please refer to LITHIUM, SERUM.


Please provide clinical and medication details.
Collect sample at least 8 hours after last dose or immediately prior to next dose.

Please provide clinical and medication details, including time and dosage of
last dose. Collect sample just prior to next dose. Test includes assay of N-Acetyl
Procainamide (NAPA), an active metabolite. Referred test.

Results (07) 3121 4555

9.25

9.25

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/SS tube

24 hours

Please provide medical and clinical details, and date of last normal menstrual
period (LNMP).

PROGNOSTIC MARKERS
BREAST CARCINOMA CISH, SISH, CerbB2
(BREAST CANCER TISSUE)
PROGNOSTIC MARKERS
BREAST CARCINOMA PROGESTERONE RECEPTOR
(BREAST CANCER TISSUE)
PROGNOSTIC MARKERS
BREAST CARCINOMA OESTROGEN RECEPTOR
(BREAST CANCER TISSUE)
PROLACTIN, SERUM

Histology

Formalin fixed tissue

2 weeks

Qualitative detection with Immunoperoxidase stain on formalin fixed tissue section,


depending on result, confirmatory studies with FISH/CISH or SISH studies.

Histology

Formalin fixed tissue

48 hours

Qualitative detection with Immunoperoxidase stain on formalin fixed tissue section.

Histology

Formalin fixed tissue

48 hours

Qualitative detection with Immunoperoxidase stain on formalin fixed tissue section.

Endocrinology

Blood/SS tube

24 hours

Please provide date of last normal menstrual period (LNMP) clinical and drug
history. If possible, avoid collecting blood within one hour of the patient rising in
the morning, or early afternoon after lunch, as Prolactin levels may be raised.

PROMINAL, SERUM

Biochemistry

Please refer to PHENOBARBITONE, SERUM.

PRONESTYL, SERUM

Biochemistry

Please refer to PROCAINAMIDE, SERUM.

PROPOXUR (PESTICIDE),
BLOOD

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

PROSTATE SPECIFIC ANTIGEN


(PSA), SERUM
PROSTATIC ACID
PHOSPHATASE, SERUM
PROSTATIC FNA CYTOLOGY

Endocrinology

www.qml.com.au

Blood/SS tube

24 hours

Biochemistry
Cytology

PATHOLOGY TESTS - P

TEST NAME
PROGESTERONE, SERUM

Please refer to ACID PHOSPHATASE (PROSTATIC), SERUM.


Labelled fixed and air
dried smears/Labelled
capped needle and syringe/
Needle rinsings

24 hours

For specimen preparation please refer to Cytology Preface (5.16).

Results (07) 3121 4555

9.26

9.26

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Microbiology

Prostatic fluid in sterile


container

Interim
Please transport to laboratory as soon as possible.
microscopy report Samples may be stored for 72 hours after collection at 2 - 8C.
same day. Culture
report 48 hours

PROTEASE INHIBITOR
PHENOTYPING, PLASMA
PROTEASE INHIBITOR,
PLASMA
PROTEIN C ASSAY,
PLASMA

Biochemistry

Please refer to ALPHA-1-ANTITRYPSIN PHENOTYPE/GENOTYPE, PLASMA.

Biochemistry

Please refer to ALPHA-1-ANTITRYPSIN PHENOTYPE/GENOTYPE, PLASMA.

Haematology

Blood/Sodium
citrate tube

24 hours

Please provide thrombotic history of patient and family members and any
anticoagulant therapy. Must reach laboratory within 2 hours of collection. PLEASE
NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Medicare refundable if one
of the following is stated on the request form by the patients doctor:
1. That the patient has a personal history of venous thromboembolism (DVT) or
arterial thrombosis (PE);
2. That a first degree relative of the patient has a proven defect in one or more of
the thrombotic test(s) requested and that the particular defect(s) are stated on
the request form; or
3. That the request is to confirm an abnormal or indeterminate result.
IF THE REQUEST IS NOT REFUNDABLE BECAUSE OF THE ABOVE CONDITIONS,
THE PATIENT WILL BE CHARGED A NON-REFUNDABLE AMOUNT. PLEASE INFORM THE
PATIENT IF THE TESTING WILL RESULT IN AN ACCOUNT BEING SENT TO THE PATIENT.

PROTEIN ELECTROPHORESIS,
CSF

Biochemistry

CSF/CSF in plain tube.


Collect blood in SS tube

1 week

Please provide clinical details. Blood for serum EPP should also be taken at
this time to maximise information obtainable from this test.

PROTEIN ELECTROPHORESIS,
SERUM

Biochemistry

Blood/SS tube

24 hours

Test for B-cell malignancy such as multiple myeloma. Quantitative.


Please provide clinical and medication details.

PROTEIN ELECTROPHORESIS,
URINE

Biochemistry

Urine/24 hour urine


container with no
preservative or random
urine container

48 hours

Test for B-cell malignancy such as multiple myeloma. Quantitative.


Please provide clinical and medication details. This includes protein electrophoresis
and immunofixation, if warranted. A random collection is preferred. Urine should be
refrigerated during the collection and transported cooled to the laboratory.

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - P

TEST NAME
PROSTATIC SECRETIONS
MICROSCOPY AND CULTURE

9.27

9.27

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

PROTEIN STUDIES, CSF

Biochemistry

Includes protein electrophoresis and immunofixation. Elevated in inflammation within


the CSF and obstruction to CSF flow. Please refer to BIOCHEMISTRY, CSF for details.

PROTEIN, CSF

Biochemistry

Please refer to BIOCHEMISTRY, CSF for details.

PROTEIN, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify site of fluid on specimen container and request form.

PROTEIN, PLEURAL FLUID

Biochemistry

Pleural fluid/Plain tube

Same day

Test used to differentiate inflammatory exudates from transudates of heart failure.


Please provide clinical and medication details. Refrigerate sample during storage
and transport.

PROTEIN, SERUM

Biochemistry

Please refer to E/LFT, SERUM.

PROTEIN, SYNOVIAL FLUID

Biochemistry

Please refer to ALBUMIN, SYNOVIAL FLUID.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to IMMUNOFIXATION (PROTEIN), SERUM.

Biochemistry

Please refer to IMMUNOFIXATION (PROTEIN), URINE.

Haematology

Blood/Sodium
citrate tube

24 hours

Please provide thrombotic history of patient and family members and any
anticoagulant therapy. Must reach laboratory within 2 hours of collection. PLEASE
NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Thrombotic assay requests
are only Medicare refundable if one of the following is stated on the request form
by the patients doctor:
1. That the patient has a personal history of venous thromboembolism (DVT) or
arterial thrombosis (PE);
2. That a first degree relative of the patient has a proven defect in one or more of
the thrombotic test(s) requested and that the particular defect(s) are stated on
the request form; or
3. That the request is to confirm an abnormal or indeterminate result.
IF THE REQUEST IS NOT REFUNDABLE BECAUSE OF THE ABOVE CONDITIONS,
THE PATIENT WILL BE CHARGED A NON-REFUNDABLE AMOUNT. PLEASE INFORM THE
PATIENT IF THE TESTING WILL RESULT IN AN ACCOUNT BEING SENT TO THE PATIENT.

Results (07) 3121 4555

PATHOLOGY TESTS - P

TEST NAME
PROTEIN IMMUNOFIXATION,
SERUM
PROTEIN IMMUNOFIXATION,
URINE
PROTEIN S ASSAY,
PLASMA

9.28

9.28

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/24 hour
urine container with
no preservative

24 hours

PROTHIADEN, SERUM

Biochemistry

PROTHROMBIN (G20210A)
MUTATION ANALYSIS

Genetics

Blood/Pink top
EDTA tube

1 week

Please provide details regarding patients eligibility for Medicare rebate, i.e. proven
venous thrombosis or pulmonary embolism or first degree relative with mutation.

PROTHROMBIN TIME COAG

Haematology

Blood/Sodium
citrate tube

Same day

If for oral anticoagulant therapy, record warfarin dosage and time last tablet was
taken. Please see Haematology Appendix (12.32) for further information.

PROTHROMBIN TIME-INR,
BLOOD

Haematology

Blood/Sodium
citrate tube

Same day

If for oral anticoagulant therapy control, please indicate on the request form:
INR as directed
Rule 3 Exemption.
Please see Haematology Appendix (12.32) for further information.

PROTOPORPHYRIN SCREEN,
FAECES
PROTOPORPHYRIN/
COPROPORPHYRIN, FAECES

Biochemistry

PROZAC, SERUM

Biochemistry

Biochemistry

9.29

PSEUDOCHOLINESTERASE
Biochemistry
TYPING FOR SUXAMETHONIUM
(SCOLINE) SENSITIVITY, SERUM

PSEUDOCHOLINESTERASE,

Biochemistry

SERUM
PSITTACOSIS SEROLOGY

Immunology

www.qml.com.au

Test for glomerular damage and disease. Please provide clinical and medication
details. Urine should be refrigerated during the collection period and transported
cooled to the laboratory. DO NOT collect in acid preservative. 24 hour collection is
preferred, however random may be collected.
Please refer to DOTHIEPIN, SERUM.

PATHOLOGY TESTS - P

TEST NAME
PROTEIN, URINE

Please refer to PROTOPORPHYRIN/COPROPORPHYRIN, FAECES.


Faeces/Faeces container

Screen: 1 - 7
Test for Porphyria Cutanea Tarda, Hereditary Coproporphyria, or Porphyria
days. Quantitation: Variegats. Refrigerate sample. Protect from light. Serum is the preferred sample.
1 - 2 weeks
Please provide clinical and medication details. Referred test.
Please refer to FLUOXETINE, SERUM.

Blood/SS tube

1 day

Test for inherited forms of prolonged scoline paralysis.


Please provide clinical and medication details and FAMILY HISTORY, noting the
names of any previously tested patients. Delay sample collection if the patient
has been exposed to Suxamethonium for up to 14 days prior to the test. This test
includes total enzyme and Dibucaine Number. Fluoride Number is no longer offered.
Please ensure that these are requested if required.
Please refer to CHOLINESTERASE, SERUM.

Blood/SS tube

72 hours

Assay run Tuesday and Friday.

Results (07) 3121 4555

9.29

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Genetics

Blood/EDTA tube

Indeterminate

Store at 4C until transported at room temperature. Patient consent form


for genetic testing is to be completed and signed by patient and clinician.
Form to be sent with sample.

PTERINS, URINE

Biochemistry

Urine/Urine container

2 weeks

The sample must be protected from light and frozen immediately after collection.
Transport to the laboratory frozen. Referred test.

PTH (INTACT)

Endocrinology

Blood/SS tube

24 hours

Once centrifuged specimen is stable if kept cold (4C ) for up to 10 hours. If


longer, separate and freeze serum and transport frozen. Parathyroid hormone is an
unstable hormone and loses 10% of activity after 24 hours at 4C. It loses 30% of
activity after 24 hours at room temperature. Please note on form if kept at room
temperature for prolonged periods.

PTH RELATED PEPTIDE

Endocrinology

Blood/EDTA tube
with Trasylol

2 weeks

Special collection and handling of specimen required. Appointment is required so


that special EDTA tube with Trasylol can be ordered. Please contact Endocrinology
Department on (07) 3121 4439 or Branch Laboratory for details. Forward to the
Central Laboratory on ice. There is currently no Medicare rebate for this test.

PURINE AND PYRIMIDINE,


BLOOD
PURINE AND PYRIMIDINE,
URINE

Biochemistry

Blood/Lithium heparin tube

2 weeks

Forward to the Central Laboratory on ice. Referred test.

Biochemistry

Urine/Random early
morning urine

2 weeks

Please provide clinical and medication details.

PURKINJE ANTIBODY
SEROLOGY
PYRETHRINS (SYNTHETIC),
BLOOD
PYREXIA UNKNOWN ORIGIN
(PUO), SEROLOGY

Immunology

Blood/SS tube

2 - 3 weeks

PYRIDOXAL PHOSPHATE,
BLOOD
PYRIDOXINE, BLOOD

Biochemistry

Please refer to VITAMIN B6, BLOOD for details.

Biochemistry

Please refer to VITAMIN B6, BLOOD for details.

www.qml.com.au

Biochemistry
Immunology

PATHOLOGY TESTS - P

TEST NAME
PTEN GENETIC TESTING

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.


Blood/SS tube

Variable from 24
hours depending
on antibody tests
required

This test comprises a mixture of Viral and Bacterial serologies which clinically are
most likely causes. It is a Medicare requirement that they be listed individually.
See Immunology Preface (5.47) and refer to Immunology Appendix (12.36).

Results (07) 3121 4555

9.30

9.30

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Haematology

Blood/EDTA tube

4 weeks

Referred test.

PYRUVATE, BLOOD

Biochemistry

Blood/Plain tube with


special preservative

1 week

Please contact Biochemistry on (07) 3121 4971 or Branch Laboratory for details
and special collection tube. Provide clinical and medication details. Patient should
have half an hour of rest with no physical activity prior to blood collection.

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - P

TEST NAME
PYRUVATE KINASE (SCREEN)

9.31

9.31

PATHOLOGY TESTS - P

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Q FEVER PCR

Immunology

Blood or Tissue/
EDTA tube

4 - 6 weeks

Q FEVER PREVACCINATION

Immunology

Blood/SS tube

24 hours

Q FEVER PROFILE

Immunology

Blood/SS tube

24 hours

Q FEVER SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

QT-PCR (BCR-ABL)

Genetics

Blood or Bone marrow/Pink


top EDTA tube or min. 1 mL
bone marrow in EDTA tube

2 weeks

Send to Genetics Department within 24 hours.


Please transport and store at room temperature.

QUALITATIVE DRUG SCREEN


(INDUSTRY, OCCUPATIONAL,
DRUG ABUSE ETC.),
URINE RANDOM

Biochemistry

Supervised random urine/


Doxtech security
urine container

1 - 2 days

In cases of occupational drug screen, suspected drug abuse or monitoring of


compliance with therapy or Drug Rehabilitation Programme, urine collection must
be supervised. Chain-of-Custody form must be completed (available from QML
Pathology). Protocol is detailed on Chain-of-Custody form and in the Biochemistry
Preface (5.4) of this manual. The QML Pathology protocol complies with Australian
Standard AS4308. See Biochemistry Appendix (12.13) for a full list of drugs
assayed. Please contact Biochemistry (07) 3121 4419 or Branch Laboratory for
further details.

QUANTIFERON TEST
FOR TB IMMUNITY

Immunology

Blood/TB gold blood


collection tube - 3 tubes
each patient

1 - 2 weeks

Do not centrifuge tubes after collection. Sample to be sent to Immunology


Department ASAP. If cannot reach laboratory within 16 hours, incubate tubes
upright for 16 to 24 hours.

QUEEN MULTI PANEL

Specimen
Distribution

Blood and Urine/Serum 3 x SS tubes, Blood 3 x EDTA tubes, 2 x Fluoride


oxalate tubes, 1 x Lithium
heparin tube, Urine 1 x MSU, 1 x spot urine

Collection and
transfer only

Protect urine and 1 x SS tube from light.

QUEEN PROFILE II PANEL

Specimen
Distribution

Blood and Urine/Serum 2 x SS tubes, Blood 2 x EDTA tubes, 1 x Fluoride


oxalate tube, Urine 1 x MSU, 1 x spot urine

Collection and
transfer only

www.qml.com.au

Clearly indicate on request form that test is for prevaccination screening.

Results (07) 3121 4555

PATHOLOGY TESTS - Q

TEST NAME

9.32

9.32

PATHOLOGY TESTS - Q

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Lithium heparin tube


(no gel or anticoagulant)

4 weeks

Please provide clinical and medication details.


Collect sample prior to next dose.

QUINIDINE, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant


(plastic lithium heparin
tube acceptable)

Same day

Please provide clinical and medication details, including date and time of last dose.
Collect trough sample just prior to next dose. Keep the sample cool and send to the
laboratory without delay.

QUITAXON, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - Q

TEST NAME
QUETIAPINE, SERUM

Please refer to DOXEPIN, SERUM.

Results (07) 3121 4555

9.33

9.33

PATHOLOGY TESTS - Q

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

RABIES VIRUS SEROLOGY

Immunology

Blood/SS tube

3 - 4 weeks

Referred test. A fee is charged for this test, and the patient must agree to this
payment before the test can be performed.

RAPID PLASMA REAGIN (RPR)


- VDRL, SERUM
RAST TEST - ALLERGY,
SERUM

Immunology

Blood/SS tube

24 hours

Supplementary test. Performed if Syphilis EIA test is positive.

Immunology

Blood/SS tube

48 hours

Assay run daily (Monday to Friday). For details of testing, allergens and
Medicare restrictions please refer to Immunology Preface (5.49) and Appendix
(12.37) or contact Immunology (07) 3121 4458 or Branch Laboratory.

RED CELL COUNT

Haematology

Blood/EDTA tube

Same day

RED CELL ENZYMES

Haematology

Blood/Lithium heparin
tube or EDTA tube

4 weeks

RED CELL MAGNESIUM

Biochemistry

RED CELL MASS

Haematology

Blood/Sterile vials
available on request
from Haematology

24 hours

Appointment required. Please contact Haematology


(07) 3121 4451 or Branch Laboratory.

REDUCING SUBSTANCES,
FAECES

Biochemistry

Faeces/Faeces container

24 hours

Test useful in infants for intestinal lactase deficiency. Please provide clinical and
medication details. Collect FRESH sample (ideally should be fluid to semi-fluid). Freeze
specimen and store and transport frozen. Transport to laboratory as soon as possible.

REDUCING SUBSTANCES,
URINE

Biochemistry

Urine/Urine container

Same day

Please provide clinical and medication details. Keep sample cool after collection
and during transport to the laboratory. A random urine collection is required.

RENIN, PLASMA

Endocrinology

Blood/2 x EDTA tubes

24 hours

Samples are stable at room temperature (18-25C) but not lower temperatures:
- unspun - for 24 hours
- as separated EDTA plasma for 5 days, cooling the tubes in the fridge or in transit
has been found to falsely elevate values. Either send whole blood in at room
temperature within 24 hours, or as separated plasma within 5 days. If transit to the
laboratory will take >5 days, contact Endocrinology or Branch laboratory for details
(plasma needs to be snap frozen).

REPTILASE TIME

Haematology

Blood/Sodium
citrate tube

Same day

www.qml.com.au

PATHOLOGY TESTS - R

TEST NAME

Referred test.
Please refer to MAGNESIUM, RED CELL.

Results (07) 3121 4555

9.34

9.34

PATHOLOGY TESTS - R

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Cytology

Sputum, brushings and


washings, FNA/Labelled
fixed smears, appropriate
sterile containers and
aspirating traps

24 hours

For specimen preparation please refer to Cytology Preface (5.15).

RESPIRATORY SYNCYTIAL
VIRUS (RSV) SEROLOGY
RESPIRATORY VIRAL ANTIGEN
TEST (DFA), INCLUDING RSV,
INFLUENZA, PARAINFLUENZA,
ADENOVIRUS
RESPIRATORY VIRUS PCR

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Immunology

Nasopharyngeal Aspirate/
Aspirating trap

24 hours

Refrigerate specimen and transport cooled to laboratory as soon as possible.


Results usually available same day for urgent specimens.

Immunology

Nasopharyngeal Aspirate or
Nasopharyngeal swab (dry)/
Luki tube or Sterile container
or Viral swab (VIROCULT)

24 - 48 hours

PCR test detects RSV, Influenza A&B, Parainfluenza 1 2 3, and Adenovirus.

RET PROTO-ONCOGENE
DNA TEST

Genetics

Blood/EDTA tube

8 weeks for
full screen, 4
weeks for known
family mutation

Store at 4C until transported at room temperature.


Patient consent form for genetic testing is to be completed and signed
by patient and clinician. Form to be sent with sample.

RETICULIN ANTIBODY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

RETICULOCYTE COUNT, BLOOD

Haematology

Blood/EDTA tube

Same day

RETINOL BINDING PROTEIN,


SERUM

Biochemistry

Blood/SS tube or
Lithium heparin tube

1 - 2 weeks

RETINOL, SERUM

Biochemistry

RETT SYNDROME
GENETIC TESTING
REVERSE T3

Genetics

Blood/EDTA tube

3 months

Patient consent for billing must be marked on the request form.

Endocrinology

Blood/SS tube

1 - 2 months

There is currently no Medicare rebate for this test. Referred test.

RHEIN, FAECES

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - R

TEST NAME
RESPIRATORY CYTOLOGY

Ensure sample is protected from light. Transport in esky at 4C. Referred test.
Please refer to VITAMIN A, SERUM.

Please refer to LAXATIVES, FAECES.

Results (07) 3121 4555

9.35

9.35

PATHOLOGY TESTS - R

PATHOLOGY TESTS

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Amniotic fluid/
Sterile container

Indeterminate

Please phone and organise in advance as this is not a routine test.

RHEUMATOID ARTHRITIS
SEROLOGY
RHEUMATOID FACTOR (RF),
RA LATEX TEST, SERUM
RIBOFLAVIN, BLOOD

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

RICKETTSIA SEROLOGY

Immunology

RISPERDAL, PLASMA

Biochemistry

RISPERIDONE, PLASMA

Biochemistry

Blood/Lithium heparin tube


(EDTA tube acceptable)

1 - 2 weeks

Please provide clinical and medication details. Keep the sample cool and send to
the laboratory without delay. Referred test.

RISTOCETIN COFACTOR ASSAY


(VON WILLEBRAND DISEASE),
PLASMA

Haematology

Blood/Sodium citrate tube

24 hours

Please provide clinical and medication details.


Keep specimen at 4C and must reach laboratory within 2 hours of collection.
Please contact Haematology (07) 3121 4451 or Branch Laboratory for details.

RITONAVIR, PLASMA

Biochemistry

Blood/EDTA tube

3 weeks

Please provide clinical and medication details. Plasma to be separated and frozen if
sample will not reach the central laboratory within 24 hours of collection. Referred test.

RIVOTRIL, SERUM

Biochemistry

Please refer to CLONAZEPAM, SERUM.

ROGOR (PESTICIDE), SERUM

Biochemistry

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.

ROHYPNOL, SERUM

Biochemistry

Please refer to FLUNITRAZEPAM, SERUM.

ROSS RIVER VIRUS (RRV)


SEROLOGY
ROTAVIRUS AGGLUTINATION
TEST, FAECES
ROUNDUP, URINE

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday to Friday, plus Saturday during late Summer).

Microbiology

Faeces/Faeces container

Same day

Please specify if culture for other enteric viruses is required.

RPR (RAPID PLASMA REAGIN)


-VDRL, SERUM

Immunology

www.qml.com.au

Biochemistry

PATHOLOGY TESTS - R

TEST NAME
DEPARTMENT
RHESUS DNA TESTING (AMNIO) Genetics

Please refer to VITAMIN B2, BLOOD for details.


Blood/SS tube

72 hours

Assay run Tuesday and Friday.


Please refer to RISPERIDONE, PLASMA.

Biochemistry

Please refer to GLYPHOSATE, URINE.


Blood/SS tube

24 hours

Supplementary test. Performed if Syphilis EIA test is positive.


Assay run daily (Monday - Saturday).

Results (07) 3121 4555

9.36

9.36

PATHOLOGY TESTS - R

PATHOLOGY TESTS

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Nasopharyngeal Aspirate/
Aspirating trap

24 hours

Refrigerate specimen and transport cooled to laboratory as soon as possible.


Results available same day for urgent specimens.
See Microbiology Preface (5.54) for collection details.

RSV (RESPIRATORY SYNCYTIAL


VIRUS) SEROLOGY
RUBELLA SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

RYTHMODAN, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - R

TEST NAME
DEPARTMENT
RSV (RESPIRATORY SYNCYTIAL Immunology
VIRUS) ANTIGEN - DIRECT
FLUORESCENT ANTIBODY TEST

Please refer to DISOPYRAMINE, SERUM.

Results (07) 3121 4555

9.37

9.37

PATHOLOGY TESTS - R

PATHOLOGY TESTS

DEPARTMENT

SAICAR, URINE

Biochemistry

Random early morning


urine/Urine container

2 - 3 weeks

Please provide clinical and medication details. Random early morning urine
collection preferred. Refrigerate for transfer to laboratory. Referred test.

SALBUTAMOL, URINE

Biochemistry

Urine/Tamper-proof
urine container or Urine
container enclosed in a
tamper-evident bag

24 hours

Urine specimen should be collected as per protocol on Chain-of-Custody form


(FORM/BI/07/014), into a tamper-proof container or container enclosed in a
tamper-evident bag. ENSURE CHAIN-OF-CUSTODY FORM IS COMPLETED. The
original copy must always accompany the primary sample to the testing laboratory.
NB: Due to possible legal implications, contact the laboratory (07) 3121 4419 if the
correct procedure cannot be followed.

SALICYLATE, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant


(Plastic lithium heparin
tube acceptable)

Same day

Please note time and dosage of last medication. Collect 1-3 hours after oral dose.

SALIVA DRUG SCREEN,


QUALITATIVE ASSAY

Biochemistry

Supervised random
Saliva (10 mL)/Sterile
screw cap container

48 hours

Please contact Biochemistry (07) 3121 4419 or Branch Laboratory


for further details.

SALIVARY DUCT/GLANDS
ANTIBODY, SERUM
SALIVARY PROGESTERONE

Immunology

Blood/SS tube

2 weeks

Referred test.

Endocrinology

Saliva/Sterile container
(urine)

24 hours

It is recommended that the patient not eat two hours prior to test. Collect
by spitting into the container. The specimen should be kept cool. Record
clinical details e.g. LMP and Hysterectomy. Record medications, e.g. HRT, oral
contraceptive, creams used including the type and when applied.

SALMONELLA TYPHI SEROLOGY Immunology


(WIDAL SEROLOGY)
SAN FILLIPO SYNDROME
Genetics/
GENETIC TESTING
Biochemistry

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Blood and CVS or Amino


fluid/EDTA tube and Sterile
Container (Amino) or
Transport media for tissue

Indeterminate

If the mutation within the family is known, the details of the mutation and,
preferably, how the patient is related to the proband should be stated. Request
inclusion of clinical history. For Prenatal Diagnosis samples should be sent by
overnight courier at room temperature.

SANDHOFF DISEASE GENETIC


TESTING

Blood/EDTA tube and SS


tube

1 month

Transport frozen or at 4C. Specimen to be received within 24 hours.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Genetics/
Biochemistry

Please refer to VIGABATRIN, SERUM.

Results (07) 3121 4555

PATHOLOGY TESTS - S

TEST NAME
SABRIL, SERUM

10.0

10.0

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/EDTA tube

3 weeks

SAROTEN, SERUM

Biochemistry

Sb (ANTIMONY), BLOOD

Biochemistry

Blood/Lithium heparin
tube or EDTA tube

4 weeks

Please provide clinical and medication details.


Urine is the preferred sample for exposure. Referred test.

Sb (ANTIMONY), URINE

Biochemistry

Urine/Urine container

4 weeks

This is the preferred sample for exposure. A random sample is required. Referred test.

SCABIES

Microbiology

QML Pathology collectors


required for specialised
collection procedure

Same day

Refer to Microbiology Preface (5.57) for details.


Please contact Microbiology (07) 3121 4438 or Branch Laboratory
for further details of collection and transport.

SCHIRMER TEAR TEST (TEAR


LYSOZYME CONCENTRATION)

Haematology

Tears/Special tubes provided


by Haematology Department

24 hours

By appointment only. Please contact Haematology (07) 3121 4451 or


Branch Laboratory.

SCHISTOSOMA SEROLOGY

Immunology

Blood/SS tube

1 week

Assay run Wednesday.

SCHUMMS TEST, PLASMA

Biochemistry

Please refer to METHAEMALBUMIN, PLASMA.

SCOLINE SENSITIVITY, SERUM

Biochemistry

Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM


(SCOLINE) SENSITIVITY, SERUM.

SECOND TRIMESTER
DOWNS SCREEN

Endocrinology

Blood/SS tube

48 hours

This test gives a calculated risk for Downs and Spina Bifida at term. Collect
specimen between 15th and 18th week of pregnancy. Includes-Beta HCG, AFP,
Free Oestriol. Please make note of the following:
1: LMP/EDC and/or scan results. 2: Patients weight. 3: Family history of Downs
or Spina Bifida and which family member it was. 4: Is it a single or multiple
pregnancy? 5: Is patient an insulin dependent diabetic?

SELENIUM, BLOOD

Biochemistry

Blood/Lithium heparin
tube or EDTA tube

2 weeks

Please provide clinical, medication and exposure details. NOTE: Selenium blood
analysis will only be performed where both serum AND blood levels are specifically
requested. In all other cases, please collect for Selenium, serum only. Referred test.

SELENIUM, SERUM

Biochemistry

Serum/Trace element
free tube (Navy-top)

1 - 2 weeks

Please provide clinical, medication and exposure details.


If a trace element free tube is unavailable, collect blood into an EDTA or
Lithium heparin tube. Keep sample cool. Referred test.

www.qml.com.au

Please provide clinical and medication details. Plasma to be separated and frozen if
sample will not reach the central laboratory within 24 hours of collection. Referred test.
Please refer to AMITRIPTYLINE, SERUM.

Results (07) 3121 4555

PATHOLOGY TESTS - S

TEST NAME
SAQUINAVIR, PLASMA

10.1

10.1

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/24 hour
urine container with
no preservative

4 weeks

24 hour urine is preferred. Please provide exposure and occupation details.


Urine should be refrigerated during the collection period and transported cooled
to the laboratory. Referred test.

SEMINAL FLUID ANALYSIS

Genetics

Seminal fluid/Plain sterile


container (semen container)

24 hours

Instruction sheet provided for patient. Specimen must reach laboratory within
2 hours of collection. Keep at room temperature. DO NOT REFRIGERATE.
Please refer to Genetics Preface (5.30) for full details.

SEMINAL FLUID MICROSCOPY


(POST VASECTOMY)

Genetics

Seminal fluid/Plain sterile


container (semen container)

24 hours

Instruction sheet provided for patient. Specimen must reach laboratory within
2 hours of collection. Keep at room temperature. DO NOT REFRIGERATE.
Please refer to Genetics Preface (5.30) for full details.

SERAPAX, SERUM

Biochemistry

Please refer to OXAZEPAM, SERUM.

SEROQUEL, SERUM

Biochemistry

Please refer to QUETIAPINE, SERUM for details.

SEROTONIN, PLATELET

Biochemistry

Blood/2 x 5 mL
EDTA tubes

3 weeks

Test for carcinoid syndrome. Collect 2 X 5 mL EDTA tubes - one to be frozen


(as whole blood). Referred test. A marker for carcinoid syndrome. See also 5-H.I.A.A.

SEROTONIN, SERUM

Biochemistry

Blood/SS tube

3 weeks

Test for carcinoid syndrome. Please contact Biochemistry on (07) 3121 4420 or
Branch Laboratory as 5-H.I.A.A, URINE may be preferred test. (Serotonin or 5-HT is
referred test). Transport to laboratory as soon as possible.

SEROTONIN,
URINE 24 HOUR

Biochemistry

Urine/24 hour urine


container with 25 mL
6M HCI preservative

2 weeks

Tumour marker - carcinoid tumour. Uncommonly used. Urine should be refrigerated


during the collection period and transported cooled to the laboratory. Referred test.

SERTRALINE, SERUM

Biochemistry

Blood/Lithium
heparin tube

2 weeks

Please provide clinical and medication details. Please keep the sample cool.

SERUM TRYPASE

Immunology

Blood/SS tube

Results available
on the day the
test is run

Assay run every week. Collect an SS tube 1-3 hours after reaction (anaphylaxis)
or anytime if suspected mastocytosis. Samples need to be separated and serum
frozen within 24 hours of collection. Doctor must supply comprehensive clinical
history, including: 1. Time of onset of anaphylaxis. 2. Drugs or other agents and
time administered before onset of reaction. 3. Clinical details.

SEVIN (PESTICIDE), BLOOD

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - S

TEST NAME
SELENIUM, URINE

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity. Referred test.

Results (07) 3121 4555

10.2

10.2

PATHOLOGY TESTS - S

PATHOLOGY TESTS

PATHOLOGY TESTS - S

TEST NAME
SEX DETERMINING REGION Y
(SRY) GENE ANALYSIS
SEX HORMONE BINDING
GLOBULIN, SERUM
SHIGELLA DYSENTERIAE
SEROLOGY
SHIGELLA FLEXNERI SEROLOGY

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Genetics

Blood/Pink top EDTA tube

2 weeks

Endocrinology

Blood/SS tube

24 hours

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

SHORT SYNACTHEN
STIMULATION TEST

Endocrinology

Blood/SS tube
and EDTA tube

24 hours

Give intramuscular injection of Synacthen (0.25mg/1 mL). Collect blood samples


prior to injection and at 30 and 60 minutes post injection. Please contact Branch
Laboratory for supply of Synacthen ampoule. Also collect an EDTA on the basal
specimen to perform ACTH if these results are abnormal. Please include details of
any corticosteroids taken recently (especially in the past 24 hours).

SHOX GENE ANALYSIS

Genetics

Blood or fixed cell


suspension from blood/
Lithium heparin tube

3 weeks

Patient consent for billing must be marked on the request form.

SICKLE CELL TEST, BLOOD

Haematology

Blood/EDTA tube

24 hours

SILVER, BLOOD

Biochemistry

Blood/EDTA tube

4 weeks

Please provide exposure details. Referred test.

SILVER, URINE

Biochemistry

Urine/Urine container

4 weeks

Please provide exposure details (clinical and occupational). A random collection


is preferred. A 24 hour specimen should only be collected if specifically required.
Referred test.

SIMPLIRED D-DIMER

Haematology

Blood/Sodium citrate tube


or Lithium heparin tube

Same day

Please forward to laboratory as soon as possible.

SINDBIS SEROLOGY

Immunology

Blood/SS tube

2 - 3 weeks

SINEQUAN, SERUM

Biochemistry

SINGLE BIOLOGICAL
INDICATOR (AUTOCLAVE)
TEST

Microbiology

www.qml.com.au

Incurs non-Medicare refundable fee.

Please refer to DOXEPIN, SERUM.


Autoclave test vial

48 hours

The autoclave test vial is collected from the surgery after autoclaving. The vial
may be autoclaved alone or during any other cycle. A complete autoclave test
request form must be completed and submitted with the vial. Please contact the
Microbiology Department (07) 3121 4438 for vials and request books.

Results (07) 3121 4555

10.3

10.3

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/EDTA tube

2 - 3 weeks

Please protect the sample from light, keep cool and send to the laboratory
without delay. Referred test.

SKELETAL MUSCLE ANTIBODY,


SERUM

Immunology

Blood/SS tube

2 weeks

Assay run Thursday (fortnightly).


Results available day after the test is run.

SKIN ALLERGY TEST

Immunology

Skin Prick Test

72 hours

Please refer to the list of QML Pathology Collection Centres which perform special
tests in the Collection Facilities section of this manual (2.13). Please refer to
Immunology Appendix (12.37) for a comprehensive list of Allergens tested.

SKIN SCRAPINGS FOR FUNGI

Microbiology

Preferred container is
a sterile screw capped
container. Scalpel blade
can be included. Other
containers include paper
envelopes and Petri dishes

Interim
microscopy
report 24 hours.
Culture report
up to 4 Weeks

Please indicate recent history of therapy. Antifungal therapy should be ceased at


least 2 days (optimally one week) prior to collection of specimen. Scrape active
edge of lesion. If the lesion is exuding material and painful to scrape, a swab may
be collected as an alternative. Use a dry swab previously moistened with saline to
swab the lesion. Place the swab in a container without transport medium. Refer to
Cutaneous Fungal Culture in Microbiology Preface (5.56) for details of specimen
collection, storage and transport. Blade should be transported in screw top
container (NOT paper envelope).

SMOOTH MUSCLE ANTIBODY,


SERUM
SNAKE BITE IDENTIFICATION

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Biochemistry

Bite site swab (preferred),


2 - 4 hours
urine or blood. Swab/Urine
- sterile urine container.
Blood - Lithium heparin tube
(NOT preferred)

SODIUM VALPROATE, SERUM

Biochemistry

Please refer to VALPROATE, SERUM.

SODIUM, CSF

Biochemistry

Please refer to BIOCHEMISTRY, CSF for details.

SODIUM, FAECES

Biochemistry

Faeces/Faeces container

24 hours

Keep sample cool during collection and transport to the laboratory.

SODIUM, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Specify source of fluid on sample and request form.

SODIUM, SERUM

Biochemistry

Please refer to E/LFT, SERUM.

SODIUM, SWEAT

Biochemistry

Please refer to ELECTROLYTES, SWEAT.

www.qml.com.au

PATHOLOGY TESTS - S

TEST NAME
SIROLIMUS, BLOOD

Please refer to Biochemistry Preface (5.7). SWAB - use cotton swab/bud moisten
with saline or tap water and swab over site of puncture wound/s. A small piece
of clothing may also be used. The swab and/or piece of cloth should be placed in
separate labelled plain containers. URINE - sterile urine container. BLOOD - NOT
preferred but acceptable.

Results (07) 3121 4555

10.4

10.4

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/24 hour urine


container with no
preservative or
random urine container

Same day

Please provide clinical and medication details. 24 hour collection is preferred.


Under rare circumstances or if specifically required, a random urine may be
collected. Urine should be refrigerated during the collection period and transported
cooled to the laboratory.

SOLIAN, SERUM

Biochemistry

Blood/Plain plastic
6 mL tube - no gel
or anticoagulant

4 weeks

Please provide clinical and medication details. Please keep the sample cool.

SOLUBLE MESOTHELIN
RELATED PROTEIN

Biochemistry

Blood/SS tube
or Plain tube

3 weeks

Provide clinical details such as exposure to asbestos.


Keep sample on ice brick for arrival to Biochemistry Department within 24 hours.

SOLUBLE TRANSFERRIN
RECEPTOR, SERUM

Biochemistry

Blood/SS tube

2 weeks

Please keep the sample cool and forward to the laboratory without delay.
Referred test.

SOLVENTS, BLOOD

Biochemistry

Blood/Lithium heparin tube

2 weeks

Please provide exposure and occupation details. Contact Biochemistry (07) 3121 4420
or Branch Laboratory for full list of solvents screened. Keep chilled at all times. Tube
should have minimal air space between top of blood and lid. Referred test. This test
attracts a charge of approximately $100 from the referring laboratory, payable by the
patient or their employer.

SOMATOMEDIN C (IGF-I),
SERUM

Endocrinology

Blood/SS tube

24 hours

Growth hormone is secreted in a pulsatile fashion and levels fluctuate under external
influences. IGF-I/ Somatomedin C is a relatively long lived stable protein product of
growth hormone action produced mainly by the liver. It may assist assessment of pituitary
regulation of growth. Please consult Endocrinology (07) 3121 4439 or Branch Laboratory.

SORBITOL DEHYDROGENASE,
RED CELL
SOTACOR, SERUM

Biochemistry

Blood/Lithium heparin tube

2 weeks

Referred test.

SOTALOL, BLOOD

Biochemistry

Blood/Plain plastic
6 mL tube - no gel or
anticoagulant (EDTA
tube or Lithium heparin
tube acceptable)

1 - 2 weeks

Please provide clinical and medication details including date and time of last dose.
Collect trough sample just prior to next dose. Keep the sample cool and forward to
the laboratory without delay. Referred test.

SPECIFIC GRAVITY, URINE

Biochemistry

Urine/Urine container

24 hours

Random or 24 hour urine acceptable.

www.qml.com.au

Biochemistry

PATHOLOGY TESTS - S

TEST NAME
SODIUM, URINE

Please refer to SOTALOL, BLOOD.

Results (07) 3121 4555

10.5

10.5

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Genetics

Blood/SS tube
and/or Seminal fluid/
Semen container

1 - 2 weeks

FEMALE - serum MALE - serum and seminal fluid. Please refer to Genetics Preface
(5.30) and contact Genetics (07) 3121 4461 or Branch Laboratory for collection
details. Performed fortnightly.

SPINOCEREBELLAR
ATAXIA (SCA1 & SCA2)
GENETIC TESTING
SPONTANEOUS ERYTHROID
COLONIES

Genetics

Blood/EDTA tube

1 - 2 months

Incurs non-Medicare refundable fee.

Haematology

Blood or Bone marrow/


ACD tube or
Bone marrow heparin

2 weeks

SPORANOX, SERUM

Biochemistry

SPUTUM STAIN FOR EOSINOPHILS

Microbiology

Sputum/Sterile dry,
screw top (urine) container

Same day

Specify site of collection.

SPUTUM CYTOLOGY

Cytology

Sputum/Sterile dry,
screw top (urine) container

24 hours

Specimen should be refrigerated and transported cooled to the laboratory as


soon as possible. For specimen preparation please refer to Cytology Preface (5.15).

SPUTUM MALIGNANT CELLS

Cytology

Sputum/Sterile dry,
screw top (urine) container

24 hours

Specimen should be refrigerated and transported cooled to the laboratory as


soon as possible. For specimen preparation please refer to Cytology Preface (5.15).

SPUTUM MICROSCOPY
AND CULTURE

Microbiology

Sputum/Sterile dry,
screw top (urine) container

Please indicate if special examinations are required (e.g. Fungi, Nocardia,


Interim
microscopy report Legionella and Acid-Fast Bacilli). Early morning samples are recommended.
Specimen should be transported cooled to laboratory as soon as possible.
- same day.
Routine culture
report - 48 hours;
Legionella 10 days;
Acid-Fast Bacilli
- up to 6 weeks

STEARIC ACID, PLASMA

Biochemistry

STEROID PROFILE,
RANDOM URINE

Endocrinology

www.qml.com.au

PATHOLOGY TESTS - S

TEST NAME
SPERM ANTIBODIES
(IMMUNOBEAD TEST)

Please refer to ITRACONAZOLE, SERUM.

Please refer to ELAIDIC/STEARIC ACID RATIO.


Random urine/
Urine container

4 - 5 weeks

Urine screen for steroid breakdown products. Elevated levels correspond to


excess production. Used mainly in children. Urine should be refrigerated during
the collection period and transported cooled to the laboratory. Referred test.

Results (07) 3121 4555

10.6

10.6

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

24 hour urine collection/


Urine collection bottle.
No preservative

4 - 5 weeks

Urine screen for steroid breakdown products. Elevated levels correspond to


excess production. Used mainly in children. Urine should be refrigerated during
the collection period and transported cooled to the laboratory. Referred test.

STEROID SCREEN,
URINE

Biochemistry

Urine/Tamper
evident collection kit

Indeterminate

This test is only performed on Defence and Police Force personnel.


A Chain-of-Custody form and justification letter are required. Referred test.

STOCRIN, PLASMA

Biochemistry

Blood/EDTA tube

3 weeks

This test is only performed on Defence and Police Force personnel.


A Chain-of-Custody form and justification letter are required. Referred test.

STREPTOCOCCAL SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

STRONGYLOIDES SEROLOGY

Immunology

Blood/SS tube

1 week

Assay run Wednesday.

STRYCHNINE, BLOOD

Biochemistry

Blood/Fluoride
oxalate tube

4 weeks

Please provide exposure details. This test performed only on legal request. Contact
Biochemistry (07) 3121 4420 or Branch Laboratory for availability. Referred test.

STYRENE EXPOSURE, URINE

Biochemistry

Please refer to MANDELIC ACID, URINE.

STYRENE, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

SUCCINYLAMINOIMIDAZOLE
CARBOXAMIDE RIBOSIDE,
URINE
SUCROSE LYSIS TEST,
RED CELL

Biochemistry

Please refer to SAICAR, URINE.

SUGAR CHROMATOGRAPHY,
FAECES
SUGAR CHROMATOGRAPHY,
URINE

Biochemistry
Biochemistry

Urine/Urine container

1 week

Please provide clinical details. FRESH random urine sample.


Store and transport frozen. Please also refer to the Biochemistry Preface (5.4).

SULPHAEMOGLOBIN, BLOOD

Biochemistry

Blood/Lithium
heparin tube

Same day

Please provide clinical and medication details. Do not separate plasma.

SULPHONYLUREAS, PLASMA

Biochemistry

Blood/Lithium
heparin tube

4 weeks

Referred test.

SULTHIAME, SERUM

Biochemistry

Blood/Plain plastic
6 mL tube - no gel
or anticoagulant

1 week

Please provide clinical and medication details including time and date of last dose.
Collect sample a minimum of 8 hours after the last dose or immediately prior to
the next dose.

www.qml.com.au

Haematology

Blood/Sodium
citrate tube

PATHOLOGY TESTS - S

TEST NAME
STEROID PROFILE,
URINE 24 HOUR

24 hours
Please refer to CHROMATOGRAPHY, FAECES.

Results (07) 3121 4555

10.7

10.7

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Microbiology

Swab in
Transport Medium

48 hours

SURMONTIL, SERUM

Biochemistry

Please supply clinical history including mode of injury (e.g. dog bite) and specify site
and any recent antibiotic therapy. Indicate if post-operative. Please indicate if exotic
or unusual organisms are suspected. Prompt transport to the laboratory is essential.
Please refer to TRIMIPRAMINE, SERUM.

SUXAMETHONIUM SENSITIVITY, Biochemistry


SERUM

Please refer to PSEUDOCHOLINESTERASE TYPING FOR SUXAMETHONIUM


(SCOLINE) SENSITIVITY, SERUM.

SYMPATHOMIMETIC AMINES GCMS CONFIRMATION

Biochemistry

Urine/Urine drug screen


collection kit with tamper
evident packaging

48 hours

This is requested in cases concerned with occupational drug screening for drugs of
abuse. The QML Pathology protocol complies with Standards Australia AS/NZS4308
for the assay of cannabinoids, opiates, cocaine metabolites, benzodiazepines and
sympathomimetic amines. A Chain-of Custody form should be completed. Additional
classes (methadone, barbiturates, alcohol) should be specifically requested if
required. Please also refer to the Biochemistry Preface (5.4). Confirmation and
quantitation by GCMS of positive findings may be requested separately.

SYNACTHEN
STIMULATION TEST

Endocrinology

Blood/SS tube
and EDTA tube

24 hours

Give intramuscular injection of Synacthen (0.25mg/1mL). Collect blood samples


prior to injection and at 30 and 60 minutes post injection. Please contact Branch
Laboratory for supply of Synacthen ampoule. Also collect an EDTA on the basal
specimen to perform ACTH if these results are abnormal. Please include details of
any corticosteroids taken recently (especially in the past 24 hours).

SYNOVIAL FLUID ANALYSIS

Microbiology

Synovial fluid/Sterile dry


screw top (urine) container,
Lithium heparin tube,
Fluoride EDTA tube

24 hours

Synovial fluid collection kits are provided on request by QML Pathology.

SYNOVIAL FLUID CYTOLOGY

Cytology

Synovial fluid/Appropriate
24 hours
sterile container and labelled
fixed and air dried smear
preparations

For specimen preparation please refer to Cytology Preface (5.19).

SYNOVIAL FLUID
MICROSCOPY AND CULTURE

Microbiology

Synovial fluid/Plain
sterile container or
Lithium heparin tube

Please specify site of collection and previous antibiotic therapy.

www.qml.com.au

48 hours

Results (07) 3121 4555

PATHOLOGY TESTS - S

TEST NAME
SUPERFICIAL
WOUND SWABS

10.8

10.8

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

Immunology

Blood/SS tube

24 hours

SYSTEMIC FUNGAL CULTURE


(TISSUE)

Microbiology

Tissue or Biopsy/
Sterile container

24 hours for
Specimen MUST NOT be in formalin.
microscopy, 4
weeks for culture

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.


The standard EIA screening test is performed daily (Monday to Saturday). If positive,
supplemental Syphilis testing will be performed.

Results (07) 3121 4555

PATHOLOGY TESTS - S

TEST NAME
SYNTHETIC PYRETHROIDS,
BLOOD
SYPHILIS SEROLOGY

10.9

10.9

PATHOLOGY TESTS - S

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Genetics

Bone marrow (EDTA tube)


2 weeks
or Lymph node (EDTA tube)
or Tumour or Blood (Pink top
EDTA tube)

Transport at room temperature or cooled on ice brick.

T LYMPHOCYTE 4/8 RATIO


(LYMPHOCYTE SUBSET
ANALYSIS), BLOOD
TACROLIMUS, BLOOD

Haematology

Blood/ACD tube,
EDTA tube, Blood film

24 hours

Lithium heparin tube may be used if ACD tube unavailable.

Biochemistry

Blood/EDTA tube

24 hours

Please provide clinical and medication details.


Collect a trough sample and transport at 4C.

TAMBOCOR, SERUM

Biochemistry

TAU PROTEIN, FLUID

Biochemistry

Fluid/Plain tube

24 - 48 hours

TAY SACHS GENETIC TESTING

Genetics

Blood/EDTA tube

Indeterminate

TB CULTURE
(URINE, SPUTA ETC.)

Microbiology

Sputum, Urine, Swabs, Pus,


Tissue/Sterile container

Interim microscopy 3 early morning urine and/or sputa are recommended.


report 2 days.
Tissue in sterile container (NOT in formalin).
Culture - 6 weeks

T-CELL RECEPTOR
GENE REARRANGEMENT

Genetics

2 weeks
Bone marrow (EDTA tube)
or Lymph node (EDTA tube)
or Tumour or Blood (Pink top
EDTA tube)

TEGRETOL, SERUM

Biochemistry

TELLURIUM, BLOOD

Biochemistry

Blood/Lithium heparin tube

TEL-PDGFR GENE ANALYSIS

Genetics

Blood or Bone marrow/EDTA 1 - 2 months


tube or min. 2 mL bone
marrow in EDTA tube

Specimen to be received within 24 hours.

TEMAZEPAM, SERUM

Biochemistry

Blood/Plain plastic tube 1 week


no gel. Plastic lithium heparin
tube acceptable

Please provide clinical and medication detail, including time and date of last dose.
Collect just prior to the next dose or at least 8 hours after the last dose.

www.qml.com.au

REPORTING TIME COMMENTS

PATHOLOGY TESTS - T

TEST NAME
T & B CELL GENE
REARRANGEMENT STUDIES

Please refer to FLECAINIDE, SERUM.


Test for CSF contamination of nasal fluids, etc. Please provide clinical details.
Note fluid site on specimen container and request form.

Incurs non-Medicare refundable fee.

Please refer to CARBAMAZEPINE, SERUM.


4 weeks

Please provide exposure details. Referred test.

Results (07) 3121 4555

10.10

10.10

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

TERBUTALINE, URINE

Biochemistry

TERSEL, SERUM

Biochemistry

TESTICULAR AUTOANTIBODIES

Immunology

Blood/SS tube

1 week

Refer to ADENOVIRUS SEROLOGY for collection details.

TESTICULAR BIOPSY
(INFERTILITY INVESTIGATION)

Histology

Biopsy tissue/Bouins
Fixative solution

24 hours

Bouins fixative solution is essential for optimum fixation and preservation of detail.
It is available on request from Histology (07) 3121 4495 or Branch Laboratory.

TESTOSTERONE FREE, SERUM

Endocrinology

Blood/SS tube

24 hours

This test measures a sub fraction of albumin bound testosterone. Collect a fasting
specimen or a specimen at greater than 3 hours post-prandial as food absorption
may influence blood levels.

TESTOSTERONE, SALIVA

Endocrinology

Saliva/Sterile
container (urine)

2 weeks

Referred test. Incurs non-Medicare refundable fee.

TESTOSTERONE, SERUM

Endocrinology

Blood/SS tube

24 hours

Morning specimen is preferred (not essential) and fasting is not required.

TESTOSTERONE, URINE

Endocrinology

Urine/24 hr urine
container. No preservative

2 - 3 weeks

Patient must provide a certificate signed by the requesting doctor that the test is
required for a medical reason e.g. for a tumour, not for athletes.

TETANUS SEROLOGY

Immunology

Blood/SS tube

1 week

Assay run Tuesday.

TETRACHLOROETHANE,
BLOOD
TETRACHLOROETHYLENE,
BLOOD
TETRAMETHYLHEXADECANOIC
ACID, PLASMA
THALASSAEMIA SCREEN/
STUDIES, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

Biochemistry

Please refer to FATTY ACIDS-VERY LONG CHAIN, PLASMA.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Haematology

Please refer to CHOLINESTERASE, SERUM for exposure and CHOLINESTERASE,


RED CELL for toxicity.
Urine/Tamper-proof
urine container or Urine
container enclosed in a
tamper-evident bag

Next day
following assay

Urine specimen should be collected as per protocol on Chain-of-Custody form, into


a tamper-proof container or container enclosed in a tamper-evident bag. ENSURE
CHAIN-OF-CUSTODY FORM IS COMPLETED. The original copy must always
accompany the primary sample to the testing laboratory. NB: Due to possible
legal implications, contact the Central Laboratory (07) 3121 4419 if the correct
procedure cannot be followed.

PATHOLOGY TESTS - T

TEST NAME
TEMIK (PESTICIDE), BLOOD

Please refer to CARBAMAZEPINE, SERUM.

Blood/2 x EDTA tubes, 1


Blood film

1 - 3 days

Tests performed Tuesday and Friday.


Results available same day of test.

Results (07) 3121 4555

10.11

10.11

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/EDTA tube (Lithium


heparin tube acceptable)

4 weeks

Test for toxicity. Please provide clinical and medication details. Referred test.

THALLIUM, URINE

Biochemistry

Urine/Urine container

4 weeks

Test for unusual exposure. Please provide details of exposure (clinical and
occupational). A random collection is preferred. Refrigerate specimen and
transport cooled to laboratory. Referred test.

THC-COOH - GCMS
CONFIRMATION

Biochemistry

Urine/Urine drug screen


collection kit with tamper
evident packaging

Next day
following assay

This is requested in cases concerned with occupational drug screening for drugs of
abuse. The QML Pathology protocol complies with Standards Australia AS/NZS4308
for the assay of cannabinoids, opiates, cocaine metabolites, benzodiazepines and
sympathomimetic amines. A Chain-of Custody form should be completed. Additional
classes (methadone, barbiturates, alcohol) should be specifically requested if
required. Please also refer to the Biochemistry Preface (5.4). Confirmation and
quantitation by GCMS of positive findings may be requested separately.

THEODUR PRE/POST DOSE,


SERUM
THEODUR, SERUM

Biochemistry

Please refer to THEOPHYLLINE, SERUM.

Biochemistry

Please refer to THEOPHYLLINE, SERUM.

THEOPHYLLINE PRE/POST
DOSE, SERUM
THEOPHYLLINE, SERUM

Biochemistry

Please refer to THEOPHYLLINE, SERUM.

THIAMINE, BLOOD

Biochemistry

THINPREP (MONOLAYER)
CYTOLOGY

Cytology

Labelled fixed smear/slide


carrier. Rinse collection
device in labelled
PreservCyt Solution

24 - 48 hours

ThinPrep is performed as an adjunct to conventional screening. A conventional Pap


smear must be performed and the collection device rinsed in labelled PreservCyt
Solution (available from QML Pathology Collection Centres). Transport Pap smear
and PreservCyt Solution to the laboratory. This test incurs a non rebatable fee.

THIOCYANATE, BLOOD

Biochemistry

Blood/Lithium
heparin tube

2 weeks

Test for cyanide exposure. Please provide details of exposure to chemicals. Please
collect the sample immediately after the exposure or work shift. Thiocyanate is the
metabolic product of inactivation of cyanide. Raised in cigarette smokers. Referred test.

www.qml.com.au

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant


(Plastic lithium heparin
tube acceptable)

Same day
or urgently

PATHOLOGY TESTS - T

TEST NAME
THALLIUM, BLOOD

Please note type of medication, sampling times and dosage given. PRE (TROUGH
LEVEL): Immediately prior to next dose. POST (PEAK LEVEL): RAPID RELEASE - 2
hours after dose. SLOW RELEASE - 4 hours after dose (e.g. Theodur).
Please refer to VITAMIN B1, BLOOD for details.

Results (07) 3121 4555

10.12

10.12

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/Urine container

4 weeks

Raised in cyanide exposure including cigarette smoking. The cost of this analysis
is not Medicare refundable. Cost to patient or employer is approximately $100.
Please indicate on request if permission or prior arrangement has been given to
perform test by the requesting doctor, patient or employer. Please provide details of
exposure to chemicals. Collect a random urine as soon as possible after exposure
or work shift. Thiocyanate is a metabolic product of cyanide. Referred test.

THIOPURINE
Biochemistry
METHYLTRANSFERASE, BLOOD

Blood/Lithium
heparin tube

2 weeks

Test for genetically-determined sensitivity to potential for toxic accumulation of


certain drugs. Transport in esky at 4C. Referred test.

THIORIDAZINE, SERUM

Biochemistry

Blood/Plain plastic
6 mL tube - no gel
or anticoagulant

2 weeks

Specimen must be collected into plastic tube and protected from light (wrap in foil
or brown paper). Keep sample cooled and transport to the laboratory without delay.
Referred test.

THROMBIN CLOTTING TIME

Haematology

Blood/Sodium citrate tube

Same day

Keep at 4C. Must reach laboratory within 2 hours of collection.


Refer to COAGULATION STUDIES.

THROMBOTIC ASSAYS - ALL

Haematology

Blood/3 x Sodium
citrate tubes,
1 x EDTA tube

24 hours

Please provide thrombotic history of patient and family members and any
anticoagulant therapy. Must reach laboratory within 2 hours of collection. PLEASE
NOTE RESTRICTIONS ON MEDICARE REBATES BELOW. Medicare refundable if one
of the following is stated on the request form by the patients doctor:
1. That the patient has a personal history of venous thromboembolism (DVT) or
arterial thrombosis (PE); or
2. That a first degree relative of the patient has a proven defect in one or more of
the thrombotic test(s) requested and that the particular defect(s) are stated on
the request form; or
3. That the request is to confirm an abnormal or indeterminate result.
IF THE REQUEST IS NOT REFUNDABLE BECAUSE OF THE ABOVE CONDITIONS,
THE PATIENT WILL BE CHARGED A NON-REFUNDABLE AMOUNT. PLEASE INFORM THE
PATIENT IF THE TESTING WILL RESULT IN AN ACCOUNT BEING SENT TO THE PATIENT.

THYROGLOBULIN ANTIBODY,
SERUM
THYROGLOBULIN, SERUM

Endocrinology

Blood/SS tube

24 hours

Endocrinology

Blood/SS tube

24 hours

www.qml.com.au

PATHOLOGY TESTS - T

TEST NAME
THIOCYANATE, URINE

Used as a tumour marker.

Results (07) 3121 4555

10.13

10.13

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Cytology

Labelled fixed and air dried


smears/Labelled capped
needle and syringe

24 hours

For specimen preparation please refer to Cytology Preface (5.16).

THYROID FUNCTION TESTS,


SERUM

Endocrinology

Blood/SS tube

24 hours

TSH is routinely performed. Free T4 will be measured in addition to TSH in certain


patients. Please supply a comprehensive history including exactly what medication
the patient is taking. Please refer to Endocrinology Preface (5.23) for details.

THYROID STIMULATING
HORMONE (TSH), SERUM

Endocrinology

Blood/SS tube

24 hours

TSH is routinely performed. Free T4 will be measured in addition to TSH in certain


patients. Please supply a comprehensive history including exactly what medication
the patient is taking. Please refer to Endocrinology Preface (5.23) for details.

THYROID STIMULATING
IMMUNOGLOBULIN (TSI),
SERUM

Endocrinology

Blood/SS tube

4 days

Alternative names for this test include LATS, (LONG ACTING THYROID
STIMULATOR) and TSH RECEPTOR ANTIBODIES. Assay of this autoantibody may be
useful to monitor patients with Graves disease while on treatment.

THYROID TISSUE ANTIBODIES,


SERUM

Endocrinology

Blood/SS tube

24 hours

Measure antimicrosomal and antithyroglobulin antibodies


(Thyroid Tissue Antibodies).

THYROXINE BINDING
GLOBULIN, SERUM
TIN, BLOOD

Endocrinology

Blood/SS tube

24 hours

Biochemistry

Blood/2 x EDTA tubes

2 weeks

Referred test.

TISSUE AUTOANTIBODIES,
SERUM

Immunology

Blood/SS tube

Variable from 24
hours depending
on antibody tests
required

Please refer to Immunology Appendix (12.35) for a comprehensive list of


autoantibody tests available. It is a Medicare requirement that autoantibodies
required for testing should be listed individually on the request form. For enquiries
please contact Immunology (07) 3121 4458 or Branch Laboratory.

TISSUE PLASMINOGEN
ACTIVATOR

Haematology

Blood/Sodium
citrate tube

5 weeks

Referred test. NOTE: This test is referred to Austin Hospital. Inform patient that they
will be charged a non-refundable fee of approx. $30 by Austin Repatriation Hospital.

TISSUE PLASMINOGEN
ACTIVATOR INHIBITOR

Haematology

Blood/Sodium citrate tube

5 weeks

Please contact Haematology (07) 3121 4451 or your Branch Laboratory for details
before collection. Referred Test. NOTE: This test is referred to Austin Hospital.
Inform patient that they will be charged a non-refundable fee of approx. $30 by
Austin Repatriation Hospital.

TISSUE TRANSGLUTAMINASE
ABS

Immunology

Blood/SS tube

24 hours

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - T

TEST NAME
THYROID FNA CYTOLOGY

10.14

10.14

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

Biochemistry

Blood/Plain plastic tube Same day


no gel or anticoagulant. Plastic
lithium heparin tube (no gel)
acceptable

TOFRANIL, SERUM

Biochemistry

Please refer to IMIPRAMINE, SERUM.

TOLUENE, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.


For Urine - see HIPPURIC ACID, URINE.

TOLUENE/XYLENE EXPOSURE,
URINE
TOLVON, SERUM

Biochemistry

Please refer to HIPPURIC ACID, URINE.

Biochemistry

Please refer to MIANSERIN, SERUM.

TOMACULOUS NEUROPATHY
GENETIC TESTING
TOPAMAX, SERUM

Genetics

TOPIRAMATE, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant.


Plastic lithium heparin tube
(no gel) acceptable

2 weeks

Please provide medication details. Referred test.

TORCH/TORCHES SEROLOGY

Immunology

Blood/SS tube

24 hours

TORCH includes Toxoplasma, Rubella, CMV, and Herpes serology. TORCHES


includes syphilis as well. Note that TORCH and TORCHES are not recognised profiles
and it is a Medicare requirement that each test be listed individually on the request
form. This testing is no longer recommended as part of a routine antenatal screen.

TOTAL AND FRACTIONATED


PORPHYRIN, URINE
TOTAL ANTIOXIDANT STATUS,
SERUM
TOXOCARA SEROLOGY

Biochemistry

Please refer to PORPHYRIN, URINE.

Biochemistry

Please refer to ANTIOXIDANTS, BLOOD.

Immunology

Blood/SS tube

2 - 3 weeks

Referred test.

TOXOPLASMA SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Saturday).

TRACE ELEMENTS, BLOOD

Biochemistry

www.qml.com.au

Blood/EDTA tube

REPORTING TIME COMMENTS

6 weeks

Biochemistry

Please refer to Biochemistry Appendix (12.15).

PATHOLOGY TESTS - T

TEST NAME
TOBRAMICIN, SERUM

Patient consent for billing must be marked on the request form.


Please refer to TOPIRAMATE, SERUM.

Please refer to individual trace elements.

Results (07) 3121 4555

10.15

10.15

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Hair/Dry
sterile container

4 weeks

TRACE ELEMENTS, URINE

Biochemistry

TRANSFERRIN ISOFORMS,
SERUM
TRANSFERRIN SATURATION,
SERUM
TRANSFERRIN, SERUM

Biochemistry

Blood/SS tube

2 weeks

Keep sample cool during collection and transport to the laboratory. Referred test.

Biochemistry

Blood/SS tube

24 hours

Part of IRON (Fe) STUDIES, SERUM. Includes Iron, TIBC and % saturation.

Biochemistry

Blood/SS tube

24 hours

Please provide clinical and medication details.

TRANSFUSION REACTION
INVESTIGATION,
BLOOD AND URINE

Blood Bank

Blood/Plain plastic tube,


EDTA tube. Urine/
Urine container

Same day

Obstetric, transfusion and drug history essential.


Sample of first urine voided post reaction. Please forward ALL transfused
and partly transfused blood bags to the Blood Bank.

TRANSKETOLASE, RED CELL

Biochemistry

TREPONEMA PALLIDUM EIA,


SERUM

Immunology

Blood/SS tube

24 hours

The standard EIA screening test is performed daily (Monday to Saturday).


If positive, supplemental Syphilis testing will be performed.

TREPONEMA PALLIDUM
PARTICLE AGGLUTINATION
TEST (TPPA), SERUM
TRICHLOROACETIC ACID,
URINE

Immunology

Blood/SS tube

24 hours

Supplementary test. Performed if Syphilis EIA test is positive.

Biochemistry

Urine/Urine container

2 weeks

Please provide exposure and occupation details.


Random urine collected immediately after the work shift or exposure.

TRICHLOROETHANE, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

TRICHLOROETHYLENE, BLOOD

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

TRICHOMONAS PCR - SWAB

Immunology

Dry swab/Dry swab

24 hours

Dry Swab Note: Aptima Swab, Virocult (viral swab), STM not to be used.

TRICHOMONAS,
EXAMINATION FOR

Microbiology

Swab/Transport medium

Same day

Wet mount examination for Trichomonas vaginalis is no longer available.


Trichomonas vaginalis nucleic acid detection by PCR is now performed on
vaginal and urine specimens.

TRICLOPYR, BLOOD

Biochemistry

www.qml.com.au

Please provide exposure and occupation details. Clippings from the patients last hair
cut can be used. Half full dry sterile screw top container. Please specify which trace
elements are required. Broad screen of trace elements in hair is not generally accepted
as being of diagnostic value. Blood may be the preferred sample. Referred test.
Please refer to individual trace elements.

PATHOLOGY TESTS - T

TEST NAME
TRACE ELEMENTS, HAIR

Please refer to VITAMIN B1, BLOOD for details.

Please refer to ORGANOCHLORINE PESTICIDES, BLOOD for details.

Results (07) 3121 4555

10.16

10.16

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Lithium
heparin tube

4 weeks

Qualitative level only. Referred test.

TRIGLYCERIDES, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Usually ordered to confirm suspicion of lymph leakage, e.g. chylous pleural


effusion, ascites, etc. Specify site of fluid on specimen container and request form.

TRIGLYCERIDES, SERUM

Biochemistry

Blood/SS tube

Same day

Fasting sample with no alcohol consumed for the previous 72 hours is preferred
but do not turn patient away if non-fasting unless doctor specifically requests
FASTING. Please refer to E/LFT, SERUM.

TRIMETHYLAMINE, URINE

Biochemistry

Urine/Urine container

3 - 4 weeks

Test for a rare benign disorder characterised by a strong fishy body/urine odour.
Collect early morning urine following fish and egg meal the night before. FREEZE
sample immediately after collection. Do not allow to thaw.

TRIMIPRAMINE, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant.


Plastic lithium heparin
tube acceptable

1 week

Please provide clinical and medication details, including time and date of last dose.
Collect immediately prior to next dose.

TRIPLE TEST (SCREEN)

Endocrinology

Blood/SS tube

48 hours

This test gives a calculated risk for Downs and Spina Bifida at term. Collect
specimen between 15th and 18th week of pregnancy. Includes-Beta HCG, AFP,
Free Oestriol. Please make note of the following: 1: LMP/EDC and/or scan results,
2: Patients weight and family history of Downs or Spina Bifida and which family
member it was, 3: Is it a single or multiple pregnancy?,
4: Is patient an insulin dependent diabetic?

TROPONIN T, SERUM

Biochemistry

Blood/SS tube

Urgently

This test, in the context of investigating chest pain or heart attack, is treated as urgent.

TRYPSIN ACTIVITY, FAECES

Biochemistry

Faeces/Faeces container

1 week

Test of pancreatic exocrine activity. Please provide clinical details. FRESH sample
of faeces required (ideally should be fluid to semi-fluid). Freeze specimen and store
and transport frozen. Transport to laboratory as soon as possible.

TRYPTANOL, SERUM

Biochemistry

TRYPTASE, SERUM

Immunology

TRYPTINE, SERUM

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - T

TEST NAME
TRICRESYL PHOSPHATE,
BLOOD

Please refer to AMITRIPTYLINE, SERUM.


Blood/SS tube

2 - 3 weeks

Test for anaphylactic reaction. Collect a SS tube 2 hours after reaction (anaphylaxis).
Separate serum and FREEZE as soon as possible. Comprehensive clinical history
must be supplied, including: 1. Time of onset of Anaphylaxis. 2. Drugs or other
agents and time administered before onset of reaction. 3. Clinical details.
Please refer to AMITRIPTYLINE, SERUM.

Results (07) 3121 4555

10.17

10.17

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Endocrinology

Blood/SS tube

4 days

Alternative names for this test include LATS (LONG ACTING THYROID STIMULATOR)
and THYROID STIMULATING IMMUNOGLOBULIN (TSI). Assay of this autoantibody
may be useful to monitor patients with Graves disease while on treatment.

TUBERCULOSIS, SPUTUM

Microbiology

Sputum/Dry, sterile
screw top (urine) container

Microscopy - 2
days. Culture up to 6 weeks

Please refer to URINE FOR MTB CULTURE and Microbiology Preface (5.55).

TUMOR NECROSIS FACTOR


RECEPTOR-ASSOCIATED
PERIODIC SYNDROME (TRAPS)
GENETIC TESTING
TUMOUR MARKERS, SERUM

Genetics

Blood/1 x EDTA tube,


1 x ACD tube,
1 x Lithium heparin tube

1 - 2 months

Incurs non-Medicare refundable fee.

Biochemistry/
Endocrinology

Blood/SS tube

TYPHOID FEVER SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

TYPHUS SEROLOGY

Immunology

Blood/SS tube

72 hours

Assay run Tuesday and Friday.

TYROSINE, PLASMA

Biochemistry

Blood/Lithium
heparin tube

2 weeks

Provide clinical details. Transport on dry ice. Referred test.

www.qml.com.au

PATHOLOGY TESTS - T

TEST NAME
TSH RECEPTOR ANTIBODIES,
SERUM

Individual tumour markers are listed alphabetically in the A-Z listing and in the
Biochemistry Appendix (12.5).

Results (07) 3121 4555

10.18

10.18

PATHOLOGY TESTS - T

PATHOLOGY TESTS

DEPARTMENT

UBIQUINONE, PLASMA

Biochemistry

UCCINYLAMINOIMIDAZOLE
CARBOXAMIDE RIBOSIDE
(SAICAR), URINE
UDPG TRANSFERASE,
RED CELL
UNSTABLE HAEMOGLOBIN

Biochemistry

Random early morning


urine/Urine container

2 - 3 weeks

Please provide clinical and medication details. Random early morning urine
collection preferred. Refrigerate for transfer to laboratory. Referred test.

Biochemistry

Blood/Lithium heparin tube

1 - 2 weeks

Please refer to GALACTOSAEMIA SCREEN, BLOOD.

Haematology

Blood/EDTA tube

24 hours

Tests performed Tuesday and Friday. Results available same day of test.

UPG DECARBOXYLASE,
RED CELL
URANIUM, BLOOD

Biochemistry

Blood/Lithium heparin tube

1 - 2 months

Please send to the laboratory without delay. Referred test.

Biochemistry

Blood/EDTA tube

4 weeks

Please provide clinical and exposure details.

URATE CLEARANCE

Biochemistry

Blood and Urine/24 hour


urine, SS tube container
with 15 mL 2M
NaOH preservative

24 hours

Please record patients height and weight on request form.


Patient may be placed on a low purine diet (refer to dietary restrictions in
Biochemistry Appendix (12.12)) 3 days prior to test if requested. Urine should be
refrigerated during the collection period and transported cooled to the laboratory.
Collect blood specimen after urine collection is completed.

URATE, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Test to confirm suspected gouty origin e.g. of joint effusion.


Specify site of fluid on specimen container and request form.

UREA, FLUID

Biochemistry

Fluid/Plain tube/Container

Same day

Test to confirm presence of urine leakage into abnormal site.


Specify site of fluid on specimen container and request form.

UREA, SERUM

Biochemistry

UREA, URINE

Biochemistry

Urine/24 hour
urine container with
no preservative

24 hours

Please provide clinical and medication details. 24 hour collection is preferred,


however random may be collected. Urine should be refrigerated during the
collection period and transported cooled to the laboratory.

URIC ACID, SERUM

Biochemistry

Blood/SS tube

Same day

Test for risk of gout. Values exceeding 0.42 mmol/L (i.e. within the male reference range
- see Biochemistry Appendix (12.7)) may be associated with acute gout. In pregnancy,
test for risk on pre-eclampsia.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS


Please refer to COENZYME Q10, PLASMA.

PATHOLOGY TESTS - U

TEST NAME

Please refer to E/LFT, SERUM.

Results (07) 3121 4555

10.19

10.19

PATHOLOGY TESTS - U

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Urine/24 hour urine


container with 15 mL
2M NaOH preservative
(preferred) or plain 24
hour container if other
tests are requested

24 hours

Test of uric acid excretion to differentiate gout due to urate overproduction from
urate under-excretion. Patient may be placed on a low purine diet (refer to dietary
restrictions in Biochemistry Appendix (12.12)) 3 days prior to test if required. 24
hour collection is preferred, however random may be collected. Urine should be
refrigerated during the collection period and transported cooled to the laboratory.

URINARY ALDOSTERONE

Endocrinology

Urine/24 hour urine


collection bottle.
No preservative.
Aliquot with blue Monovette

1 week

Record 24 hour urine total volume.


No preservative to be added to 24 hour urine container.

URINARY CROSS LINKED


Biochemistry
N- TELOPEPTIDES (NTx,
BONE RESORPTION MARKERS),
URINE 24 HOUR OR RANDOM

24 hour urine collection/


Urine collection bottle.
No preservative. Random
Urine/Urine container

1 week

A highly specific marker of bone resorption used in investigation and monitoring


of osteoporosis, Pagets disease, steroid therapy, malignancies, inflammatory
diseases and metabolic bone diseases.

URINARY TRACT CYTOLOGY

Cytology

Urine and or Bladder


and Ureteric Washings/
Urine container

24 hours

SECOND voided urine specimen of the morning.


For specimen preparation please refer to Cytology Preface (5.15).

URINE FREE CORTISOL,


URINE 24 HOUR

Endocrinology

24 hour urine collection/


Urine collection bottle.
No preservative

48 hours

Dexamethasone not to be taken 36 hours prior to or during test, unless as part of


a prolonged Dexamethasone Suppression Test. Urine should be refrigerated during
the collection period and transported cooled to the laboratory.

URINE MALIGNANT CELLS

Cytology

Urine/Urine container

24 hours

Collect the FIRST part, or all (not mid stream),


of the SECOND or later VOID of the day.

URINE MICROSCOPY
AND CULTURE

Microbiology

Random or early morning


Urine/Monovette urine
container. Collect supra
pubic aspirates into a
sterile container

Interim microscopy Transfer the Monovette to the laboratory as soon as possible.


report same
Refrigerate if an extended delay is expected.
day. Culture and
sensitivity
24 - 48 hours

URINE MTB CULTURE

Microbiology

Urine/70 mL sterile container Microscopy 2


(NOT a monovette)
days; Culture
6 weeks

www.qml.com.au

PATHOLOGY TESTS - U

TEST NAME
URIC ACID, URINE

Submit a full 70 mL container of an early morning sample.

Results (07) 3121 4555

10.20

10.20

PATHOLOGY TESTS - U

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Supervised random urine/


Doxtech security
urine container

1 - 2 days

In cases of occupational drug screen, suspected drug abuse or monitoring of


compliance with therapy or Drug Rehabilitation Programme, urine collection must
be supervised. Chain-of-Custody form must be completed (available from QML
Pathology). Protocol is detailed on Chain-of-Custody form and in the Biochemistry
Preface (5.4) of this manual. The QML Pathology protocol complies with Australian
Standard AS4308. See Biochemistry Appendix (12.13) for a full list of drugs
assayed. Please contact Biochemistry (07) 3121 4420 or Branch Laboratory for
further details.

UROBILINOGEN, URINE

Biochemistry

Urine/Urine container

Same day

Please provide a FRESH random sample and protect from light.


Transport cooled to laboratory as soon as possible.

UROPORPHYRIN, URINE

Biochemistry

UROPORPHYRINOGEN-1SYNTHETASE, RED CELL

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - U

TEST NAME
URINE QUALITATIVE
DRUG SCREEN
(INDUSTRY, OCCUPATIONAL,
DRUG ABUSE ETC.),
URINE RANDOM

Please refer to PORPHYRIN, URINE.


Blood/Lithium heparin tube

2 - 4 weeks

Please contact Biochemistry prior to collection on (07) 3121 4420.

Results (07) 3121 4555

10.21

10.21

PATHOLOGY TESTS - U

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

VAGINAL PAP SMEAR


CYTOLOGY

Cytology

Labelled fixed smear/


Slide carrier

48 - 72 hours

Sample cells from the mid to upper third of lateral vaginal wall with Ayre spatula or
cytobrush and produce a conventional labelled Pap smear. Fix immediately in 95%
ethanol or with Cytofix aerosol spray. Please contact Cytology (07) 3121 4485 or
Branch Laboratory.

VAGINAL/CERVICAL/URETHRAL
CULTURE FOR BACTERIA,
FUNGI, VIRUSES AND
CHLAMYDIA

Microbiology

Swab/Stuarts Transport
Medium (Bacteria, Fungi)/
Viral transport medium/
Chlamydia transport medium
(Aptima Collection)

Routine
microbiology
48 hours,
Chlamydia PCR
24 hours, Viral
PCR 24 hours

Wet preparation performed for Yeasts. Viability of Neisseria gonorrhoeae


decreases after several hours. Please see instructions with kit for PCR techniques.
Forward specimen to laboratory as soon as possible.

VALIUM, SERUM

Biochemistry

VALPROATE, SERUM

Biochemistry

VALPROIC ACID, SERUM

Biochemistry

VANCOMYCIN, SERUM
(TROUGH AND PEAK)

Biochemistry

VANILLYLMANDELIC ACID,
URINE 24 HOUR
VARICELLA ZOSTER DFA SLIDE
(IMMUNOFLUORESCENCE)

Biochemistry
Immunology

Viral Culture
Swab (green top) in
transport medium

24 hours

A slide may be made from the swab if CRITICALLY URGENT.


Testing by PCR is recommended.

VARICELLA ZOSTER SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

VARICELLA ZOSTER VIRUS PCR

Immunology

Viral Culture Swab (green


top) in transport medium

24 hours

Assay run daily (Monday - Friday).

www.qml.com.au

PATHOLOGY TESTS - V

TEST NAME

Please refer to DIAZEPAM, SERUM.


Blood/Plain plastic tube no gel or anticoagulant

Same day

Please provide clinical and medication details including dosage and time of last
dose. Collect just prior to next dose.
Please refer to VALPROATE, SERUM.

Blood/Plain plastic tube no gel or anticoagulant.


Plastic lithium heparin tube
(no gel) acceptable

Same day
or urgently

TROUGH LEVEL: Collect sample just prior to next dose. PEAK LEVEL: Collect
sample one hour after IM injection or 10 minutes after the end of infusion. KINETIC
STUDIES: Please contact the laboratory. Please note time and date of last dose,
dosage and method on request form.
Please refer to CATECHOLAMINES, URINE.

Results (07) 3121 4555

10.22

10.22

PATHOLOGY TESTS - V

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Blood/Glass EDTA tube


with Trasylol preservative

2 weeks

Tumour marker - pancreatic vipoma. Contact Biochemistry


(07) 3121 4420 or Branch Laboratory to order special EDTA tubes containing
Trasylol preservative. This tube must be kept cold until required. If there will be a
delay in collection, store the empty Trasylol tube frozen and thaw immediately prior
to use. Sample must be collected on ice, centrifuged in a refrigerated centrifuge
or chilled centrifuge buckets within 30 minutes and plasma frozen immediately.
Transfer to the laboratory on dry ice. Referred test.

VASOPRESSIN, BLOOD

Endocrinology

Blood/4 x EDTA tubes

2 - 3 weeks

Collect into chilled EDTA tubes. Invert to mix and keep cold (4C) in transit. To
arrive in Endocrinology within 24 hours of collection. If >24 hours, spin EDTA tubes
and separate plasma and transport on ice. Referred test.

VDRL (RPR - RAPID PLASMA


REAGIN TEST), SERUM
VENLAFAXINE,
SERUM/PLASMA

Immunology

Blood/SS tube

24 hours

Supplementary test. Performed if Syphilis EIA test is positive.

Biochemistry

Blood/Plain plastic tube - no


4 weeks
gel (Plastic lithium heparin
tube or EDTA tube acceptable)

VIGABATRIN, SERUM

Biochemistry

Blood/Plain plastic 6
mL tube - no gel or
anticoagulant (EDTA
tube or Lithium heparin
tube acceptable)

VIP, PLASMA

Biochemistry

VIRAL SEROLOGY

Immunology

VIRAMUNE, PLASMA

Biochemistry

www.qml.com.au

2 weeks

PATHOLOGY TESTS - V

TEST NAME
VASOACTIVE INTESTINAL
PEPTIDE, PLASMA

Please provide clinical and medication details. Keep sample cool.

Please provide clinical and medication details.


Keep sample cold. Referred test.

Please refer to VASOACTIVE INTESTINAL PEPTIDE, PLASMA.


Blood/SS tube

Variable from 24
hours depending
on antibody
tests required

Please provide clinical details and nominate specific viruses (a Medicare


requirement) to be tested. Please refer to Immunology Preface (5.49) for a
comprehensive list of viruses. Assay run Monday - Friday.
Please refer to NEVIRAPINE, PLASMA for details.

Results (07) 3121 4555

10.23

10.23

PATHOLOGY TESTS - V

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Immunology

Swabs and secretions from


Throat, Skin vesicles etc.
Urine, Faeces etc. Viral Culture
Swabs/Viral Transport Medium
or 30- 50 mL dry sterile screw
top (urine) containers

1 - 2 weeks

Please keep specimen cool and transport to laboratory as soon as possible.


QML Pathology performs PCR on various viruses. Some tests may also be referred.

VISCOSITY, PLASMA

Haematology

Blood/EDTA tube

24 hours

DO NOT refrigerate prior to testing.

VITAMIN A,
SERUM

Biochemistry

Blood/SS tube
(Lithium heparin
tube acceptable)

1 week

Test for vitamin A deficiency or excess. A fasting sample is required.


Please provide clinical details and medication history. Samples must be
refrigerated and protected from light after collection. Serum/Plasma must
be frozen within 6 hours of collection. Forward to the laboratory without delay.

VITAMIN B1, BLOOD

Biochemistry

Blood/EDTA tube

1 week

Test for thiamine (vitamin B1) deficiency. A fasting sample is required.


Please provide clinical details including medication and protect the sample from
light. Forward to the laboratory without delay.

VITAMIN B12, SERUM

Endocrinology

Blood/SS tube

24 hours

VITAMIN B2, BLOOD

Biochemistry

Blood/EDTA tube

1 week

Test for riboflavin (vitamin B2) deficiency. A fasting sample is required. Please provide
clinical and medication details and protect the sample from light. Whole blood must
be frozen within 6 hours after collection. Forward to the laboratory without delay.

VITAMIN B3, URINE

Biochemistry

Urine/24 hour urine


container with 25 mL
6M HCI preservative

3 weeks

Test for niacin (vitamin B3) deficiency.


Random urine collections are NOT acceptable for analysis. Referred test.

VITAMIN B6, BLOOD

Biochemistry

Blood/EDTA tube

1 week

Test for pyridoxine (vitamin B6) deficiency. A fasting sample is required. Please
provide clinical details and medication history. Samples must be refrigerated and
protected from light after collection. Serum/Plasma must be frozen within 6 hours
of collection. Forward to the laboratory without delay.

VITAMIN C, SERUM

Biochemistry

Blood/SS tube

1 week

Test for ascorbate (vitamin C) deficiency. Please provide clinical and medication
details. A fasting sample is required. Vitamin C is particularly unstable. NB: Serum
should be separated and frozen immediately after clotting and centrifuging.
If unable to separate or centrifuge, the sample may be sent to the laboratory at
4C to be separated and serum frozen within two hours of collection.

www.qml.com.au

Results (07) 3121 4555

PATHOLOGY TESTS - V

TEST NAME
VIRUS DETECTION

10.24

10.24

PATHOLOGY TESTS - V

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Biochemistry

Hair roots/Hair roots (6-10)


taped to piece of paper with
roots left uncovered

4 - 6 weeks

Hair should be plucked from the scalp and placed in an envelope or dry sterile
screw top (urine) container. If hair is unobtainable, collect blood in 1 x 5 mL EDTA
tube (whole blood). Referred test.

VITAMIN D, SERUM

Biochemistry

Blood/Plain plastic tube no gel or anticoagulant

1 week

Test for cholecalciferol (vitamin D) deficiency. A fasting sample is required. Please


provide clinical details and medication history. Samples must be refrigerated and
protected from light after collection. Serum/Plasma must be frozen within 6 hours
of collection. Forward to the laboratory without delay.

VITAMIN E, SERUM

Biochemistry

Blood/SS tube
(Lithium heparin
tube acceptable)

1 week

Test for vitamin E deficiency. A fasting sample is required. Please provide clinical
details and medication history. Samples must be refrigerated and protected from
light after collection. Serum/Plasma must be frozen within 6 hours of collection.
Forward to the laboratory without delay.

VMA, URINE

Biochemistry

VON HIPPEL-LINDAU
GENETIC TESTING

Genetics

Blood/EDTA tube

1 - 2 months

GENETIC COUNSELLING IS REQUIRED BEFORE THE BLOOD SPECIMEN CAN BE


TAKEN. GENETIC COUNSELLING IS AVAILABLE FROM THE GENETIC HEALTH
QUEENSLAND AT THE ROYAL BRISBANE HOSPITAL ON (07) 3636 1686.

VON WILLEBRAND FACTOR


ANTIGEN, PLASMA

Haematology

Blood/Sodium citrate tube

24 hours

Keep sample at 4C. Specimen must reach laboratory within 2 hours of collection.
Rural patients may be referred to nearest Branch Laboratory for specimen
collection. Please contact Haematology (07) 3121 4451 or Branch Laboratory.
Refer to FACTOR VIII ASSAY.

VWF MULTIMER ASSAY

Haematology

Blood/Sodium citrate tube

Up to 3 months

Please contact Haematology (07) 3121 4451 or your Branch Laboratory for details
before collection. Referred test.

www.qml.com.au

PATHOLOGY TESTS - V

TEST NAME
VITAMIN D RECEPTOR
ALLELES, HAIR ROOTS

Please refer to CATECHOLAMINES, URINE.

Results (07) 3121 4555

10.25

10.25

PATHOLOGY TESTS - V

PATHOLOGY TESTS

DEPARTMENT

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

WATER DEPRIVATION TEST

Biochemistry

Blood and urine/SS tube


and Urine container

24 hours

Test for diabetes insipidus - overnight fluid restriction with serum and urine
osmolality in the morning is best initial screen. Note specimens should be collected
simultaneously. Please contact chemical pathologist or Branch Laboratory for details.
This test should be performed under supervision at a special tests collection centre or
Branch Laboratory. Please phone for an appointment.

WEEDICIDES, URINE

Biochemistry

Urine/Urine container

2 weeks

Please provide specific details of particular weedicide patient has been exposed to.
Random urine collected immediately after work shift/exposure. If used as a screening
test cost of this test NOT covered by Medicare. Please phone Biochemistry
(07) 3121 4420 or your Branch Laboratory for current cost details. Referred test.

WHITE CELL COUNT AND


DIFFERENTIAL, BLOOD

Haematology

Blood/EDTA tube
and Blood film

Same day

Blood films made at time of collection are preferred.


Please see Haematology Appendix (12.32).

WHITE CELL COUNT, BLOOD

Haematology

Blood/EDTA tube

Same day

WHITE CELL ENZYMES,


BLOOD
WHOOPING COUGH SEROLOGY
(BORDETELLA PERTUSSIS)
WIDAL SEROLOGY
(SALMONELLA TYPHI)
WOUND SWAB
MICROSCOPY AND CULTURE

Biochemistry

www.qml.com.au

PATHOLOGY TESTS - W

TEST NAME

Please refer to LYSOSOMAL ENZYMES, BLOOD.

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

Microbiology

Swab/Transport Medium

Please provide clinical details including mode of injury (e.g. dog bite), site, antibiotic
Interim
microscopy report therapy and indicate if the wound is post operative. Please indicate if exotic or
same day. Culture unusual organisms are suspected. Prompt transport to the laboratory is essential.
report 48 hours

Results (07) 3121 4555

10.26

10.26

PATHOLOGY TESTS - W

PATHOLOGY TESTS

DEPARTMENT

XANAX, SERUM

Biochemistry

XANTHINE, URINE

Biochemistry

Urine/Urine container

1 - 2 months

A random urine is preferred.


Please store and transport the sample frozen.

XANTHOCHROMIA, CSF

Biochemistry

CSF/Plain tube

Same day

Keep sample cool and protect from light.

XYLENE/TOLUENE EXPOSURE,
URINE
XYLENES, BLOOD

Biochemistry

Please refer to HIPPURIC ACID, URINE.

Biochemistry

Please refer to SOLVENTS, BLOOD for all details.

XYLOCAINE, SERUM

Biochemistry

Please refer to LIGNOCAINE, SERUM.

XYLOSE EXCRETION TEST


(ADULT)

Biochemistry

Urine/24 hour urine


container with
no preservative

1 week

Test for malabsorption of simple sugars. Please contact laboratory well in advance for
XYLOSE dose and collection details. Urine should be refrigerated during the collection
period and transported cooled to the laboratory. Adult XYLOSE dose 25g given orally.

XYLOSE EXCRETION TEST


(CHILD)

Biochemistry

Urine/24 hour urine


container with
no preservative

1 week

Test for malabsorption of simple sugars. Please contact laboratory well in advance for
XYLOSE dose and collection details. Urine should be refrigerated during the collection
period and transported cooled to the laboratory. Child XYLOSE dose: 5g given orally.

Y CHROMOSOME
MICRODELETION ANALYSIS
AZFa, AZFb, AZFc
YELLOW FEVER VIRUS
SEROLOGY

Genetics

Blood/EDTA tube

1 - 2 weeks

DAZ gene is encompassed within AZFc region.


Incurs non Medicare refundable fee.

Immunology

Blood/SS tube

4 - 6 weeks

Referred test. Note all requests for yellow fever serology must be notified to
the relevant health authorities.

YERSINIA ENTEROCOLITICA
SEROLOGY

Immunology

Blood/SS tube

24 hours

Assay run daily (Monday - Friday).

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS


Please refer to ALPRAZOLAM, SERUM.

Results (07) 3121 4555

PATHOLOGY TESTS - X/Y

TEST NAME

10.27

10.27

PATHOLOGY TESTS - X/Y

PATHOLOGY TESTS

DEPARTMENT

ZACTIN, SERUM

Biochemistry

Please refer to FLUOXETINE, SERUM.

ZERO, URINE

Biochemistry

Please refer to GLYPHOSATE, URINE.

ZIEHL-NEELSEN STAIN

Microbiology

Swab, pus, fluid, urine,


tissue etc./Appropriate
sterile container

24 hours

Please transport specimen to laboratory as soon as possible.


See also TB CULTURE.

ZINC PROTOPORPHYRIN,
RED CELL

Biochemistry

Blood/EDTA tube,
Lithium heparin tube
or Sodium citrate tube

1 week

Test for long-term lead exposure.


May be raised in iron-deficiency anaemia.
Please provide clinical, medication and lead exposure details.

ZINC, HAIR

Biochemistry

Hair/Dry sterile screw


cap (urine) container

4 weeks

Please provide full details of long term exposure. Fill sterile container with hair, as
full as possible. Clippings from the patients last hair cut can be used. Referred
test. ***ANY COLLECTION LESS THAN SPECIFIED WILL BE RECOLLECTED***

ZINC, RED CELL

Biochemistry

Blood/EDTA tube and Trace


metal tube (Navy stopper)

1 week

Serum Zinc must also be collected (trace metal tube) - refer to ZINC, SERUM for
collection details. Leave EDTA tube as whole blood. Please provide clinical details.
Referred test.

ZINC, SERUM

Biochemistry

Blood/Special plain
Vacutainer tube with
navy stopper and no gel

24 hours

Sample must be collected into a trace metal tube (Navy stopper), allowed to clot,
centrifuged and serum removed from cells as soon as possible. Serum must not
be haemolysed.

ZINC, URINE

Biochemistry

Urine/Urine container

4 weeks

Please provide clinical, medication and exposure details. Random collection is


preferred, however 24 hour urine may be collected. Referred test.

ZOLOFT, SERUM

Biochemistry

Please refer to SERTRALINE, SERUM for details.

ZYPREXA, PLASMA

Biochemistry

Please refer to OLANZAPINE, PLASMA.

www.qml.com.au

SPECIMEN CONTAINER

REPORTING TIME COMMENTS

Results (07) 3121 4555

PATHOLOGY TESTS - Z

TEST NAME

10.28

10.28

PATHOLOGY TESTS - Z

PATHOLOGY TESTS

CONTACT DETAILS
DEPARTMENTS
Central Laboratory
(07) 3121 4444
Biochemistry Department
(07) 3121 4420Department
Biochemistry
(07) 3121 4420
Blood Bank
(07)
3876
8371
Blood
Bank
(07) 3876 8371
Cytology Department
(07) 3121 Department
4494
Cytology
(07) 3121 4494
Endocrinology Department
(07) 3121 4439 Department
Endocrinology
(07) 3121 4439
Genetics Department
(07)
3121 Department
4461
Genetics
(07) 3121 4461
Haematology Department
(07) 3121 4451Department
Haematology
(07) 3121 4451
Histology Department
(07)
3121 4426
Histology
Department
(07) 3121 4426
Immunology Department
(07) 3121 4458
Immunology
Department
(07) 3121 4458
Microbiology Department
(07)
3121 4438Department
Microbiology
(07) 3121 4438
Liaison Department
(07) 3121
4943
Liaison
Department
(07) 3121 4943

RULE 3 EXEMPTION
LABORATORIES

Pindara
(07) 5510 0400

Brisbane &
Surrounding Areas
Central Laboratory Brisbane
(07) 3121 4444

Southport
(07) 5668 4444

Greenslopes
(07) 3121 4444

Ipswich,
Darling Downs
& Granite Belt
Ipswich
(07) 3281 8888

North West Everton Park


(07) 3353 0382
St Andrews Spring Hill
(07) 3832 6011
Wesley Auchenflower
(07) 3371 9462
Bundaberg
Bundaberg
(07) 4152 8411
Cairns
Cairns
(07) 4051 8944

Tugun
(07) 5598 0822

Toowoomba
(07) 4638 9149
Kingaroy
Kingaroy
(07) 4162 1499
Mackay
Mackay
(07) 4951 2999
Redcliffe
Redcliffe
(07) 3049 4410

Rule 3 of the Pathology Services Table limits the benefits payable for pathology items
during a single patient episode. Exemptions to this rule have been granted for certain
specified tests in certain clinical circumstances. The exemption is referred to as Rule
3 Exemption. A summary of Rule 3 Exemption circumstances for Out Patients is
given below. In these instances, the request form is valid for the earlier of either test
frequency limit or 6 months.
Patients Clinical
Circumstance

Tests Eligible for


Rule 3 Exemption

Test Frequency

Anticoagulant (Warfarin) therapy

INR

Unlimited tests up to
6 months of request

Cancer patients receiving


bisphosphonate infusions

Calcium, phosphate, magnesium, Up to 6 tests within


urea, creatinine and electrolytes
6 months of request

Chemotherapy for neoplastic disease


Clozaril therapy
Gold therapy
Immunosuppressant therapy
Penicillamine therapy
Sulphasalazine therapy
Ticlopidine hydrochloride therapy

FBE, ESR

Up to 6 tests within
6 months of request

Chronic renal failure of a patient


in a dialysis program conducted
by a recognised hospital

Urea, creatinine and electrolytes

Up to 6 tests within
6 months of request

Cis-platinum therapy

Urea, creatinine and electrolytes

Up to 6 tests within
6 months of request

Cyclosporin therapy

Urea, creatinine and electrolytes

Up to 6 tests within
6 months of request

Leflunomide therapy

E/LFT (or part thereof)

Up to 6 tests within
6 months of request

Lithium therapy

Lithium

Up to 6 tests within
6 months of request

Central Queensland
Emerald
(07) 4982 0306

Sunshine Coast
& Gympie
Buderim
(07) 5441 0200

Gladstone
(07) 4972 2877

Gympie
(07) 5482 1511

Methotrexate therapy

FBE, ESR, E/LFT (or part thereof)

Rockhampton
(07) 4921 2155

Up to 6 tests within
6 months of request

Noosa
(07) 5441 0200

Vitamin D (metabolites or
analogues) therapy

Calcium and albumin

Up to 6 tests within
6 months of request

GoldCoast, Tugun
& Northern Rivers
Ballina
(02) 6686 6424

Townsville
Townsville
(07) 4779 0158

PATHOLOGY TESTS - RULE 3

PATHOLOGY TESTS - CONTACT DETAILS

PATHOLOGY TESTS

Procedure for Rule 3 Exemption


i. Request the pathology test in the normal way with the usual request form.
ii. Specify the number of and frequency of the test.

11.1

11.0

iii. Clearly endorse the form by writing Rule 3 exemption.

DECREASED

INCREASED

DECREASED

Water loss
(e.g. dehydration, diabetes insipidus)
Salt overload
Renal impairment

Water overload
(e.g. cirrhosis, CCF, inappropriate ADH)
Salt loss
(e.g. diuretic therapy, adrenal failure,
gut or sweat loss, renal impairment)

Gamma GT

Hepatitis, biliary obstruction, drugs,


alcohol, renal damage, pancreatitis

Rarely significant

ALT (SGPT)

Liver disease or damage e.g. hepatitis


(>500), non-specific viraemia, drugs,
fatty liver, alcohol, haemochromatosis

Renal failure, vitamin B6 deficiency

Potassium

Oral overload, cell leakage (sepsis


or post-collection), renal disease,
adrenal insufficiency
Acidosis (ketoacidosis, lactic acidosis)

Diuretics, dietary deficiency, renal


tubular disease, steroid excess,
gut loss, insulin effect

AST (SGOT)

Myocardial damage or necrosis, liver


disease, skeletal muscle damage,
muscular dystrophy, haemolysis

Renal failure, vitamin B6 deficiency

Chloride

Dehydration, diarrhoea, pancreatic or


biliary drainage, renal tubular acidosis,
ureterosigmoidostomy

Vomiting, water overload, diuretics


Children - cystic fibrosis

Lactate
Dehydrogenase
(LDH)

Myocardial damage or necrosis, liver


disease, muscle disease, malignancy,
haemolysis, post-collection cell leakage

Rarely significant

Bicarbonate

Respiratory acidosis - lung disease


Metabolic alkalosis - vomiting,
diuretics, oral antacids, steroid excess

Respiratory alkalosis - hyperventilation


Metabolic acidosis - renal failure, liver
failure, diabetes mellitus, diarrhoea,
drugs, dehydration

Calcium

Hyperparathyroidism, malignancy
(including myeloma), vitamin D & A
excess, sarcoidosis, thyrotoxicosis,
milk-alkali syndrome

Low albumin, acidosis, renal


disease, hypoparathyroidism, vitamin
D deficiency, acute pancreatitis
(significant values <2.10 mmol/L)

Anion Gap

Metabolic acidosis - renal or liver


failure, diabetic ketoacidosis,
salicylates, other abnormal acids

Low serum protein, hypercalcaemia

Adjusted
Calcium

As for calcium - Note: if abnormality


is unexplained, ionised calcium assay
avoids protein binding effects

As for calcium with the exception of


low albumin (corrected for changes
in albumin)

Glucose

Non-fasting state, diabetes mellitus,


infection, excess endogenous
or exogenous steroid, burns,
hypokalemia

Excess exogenous or endogenous


insulin, early glucose intolerance,
adrenal or pituitary failure, severe
liver disease, oral hypoglycaemics

Phosphate

Post-collection cell leakage,


haemolysis, renal impairment, severe
illness, acidosis, hypoparathyroidism

Low phosphate intake (e.g. poor diet,


prolonged I.V. therapy) alcoholism,
diuresis, renal tubular disease,
hyperparathyroidism

Urea

Renal impairment, excessive protein


catabolism, GI bleeding, congestive
cardiac failure, dehydration

Protein deficient diet,


diuresis, pregnancy

Total Protein

Multiple myeloma, chronic liver


disease, chronic inflammation or
infection, dehydration

Malnutrition, severe liver disease,


water overload, nephrotic syndrome,
protein-losing enteropathy

Creatinine

Renal impairment,
acute muscle wasting

Chronic muscle wastage

Albumin

Dehydration, tourniquet artifact

eGFR

Not applicable

Renal impairment,
acute muscle wasting

Chronic liver disease,


malnutrition, chronic inflammation,
nephrotic syndrome, protein-losing
enteropathy, burns

Uric Acid

Gout, malignancy, viral infection,


psoriasis, renal failure, toxaemia of
pregnancy, acidosis

Allopurinol, uricosuric drugs,


diuresis, renal tubular disease,
inappropriate ADH

Globulins

HIV infection and as for total protein

Immunodeficiency and
as for total protein

Iron

Bilirubin Total

Adult - Gilbert syndrome, hepatitis,


malignancy, gall stones, cirrhosis,
Dubin-Johnson syndrome
Infants - physiological, biliary atresia,
haemolysis, hepatitis, Crigler-Najjar
syndrome

Not clinically significant

Oral iron, haemochromatosis,


gastrointestinal bleeding

Iron deficiency, infection,


chronic inflammation

Cholesterol

Familial hyperlipidaemia,
hypothyroidism, liver disease,
renal disease, diabetes mellitus

Hyperthyroidism, infection, myocardial


infarction, inherited hypolipidaemias

Triglyceride

Bilirubin
Conjugated

Not clinically significant

Non-fasting state, alcohol intake,


diabetes mellitus,
familial hyperlipidaemia

Malnutrition, fasting state

Biliary obstruction - stones,


malignancy, fibrosis, congenital
intrahepatic cholestasis - drugs,
chemicals, Dubin-Johnson syndrome

Alkaline
Phosphatase

Liver - obstruction, malignancy, hepatitis


Bone - Pagets, malignancy, fracture,
hyper-PTH, period of rapid bone growth
Other - third trimester pregnancy,
transient benign hyperphosphatasia
of childhood

Zinc deficiency, congenital


hypophosphatasia
(not common but important)

Sodium

Biochemistry

INCREASED

APPENDICIES

Common Causes of Abnormal Biochemical Results

12.2

12.1

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

OTHER

*A
 lkaline
Phosphatase

Liver (obstruction)
Bone - osteoblastic regenerative
response

Intestine, placenta, atypical


(immunoglobulin-bound) enzyme

Gamma GT

Liver (obstruction or drugs)

Renal failure, vitamin B6 deficiency

ALT (SGPT)

Liver

Myocardium, skeletal muscle

+ AST (SGOT)

Myocardium, skeletal muscle

Liver

*+ L
 actate
Dehydrogenase
(LDH)

Red blood cells (post-collection


leakage, haemolysis),
myocardium, muscle

Liver, lymphoid and epithelial tissue

*+ CK (CPK)

Myocardium, skeletal muscle,


atypical (macro)

Brain, intestinal smooth muscle

+ CK-MB

Myocardium

Muscle, atypical
(immunoglobulin-bound)

Amylase

Pancreas

Salivary glands, fallopian tubes

differentiate sources of excess activity.

Pancreas

Colon

Ovary

LD
isoenzymes

PSA

Thyroglobulin

Calcitonin

hCG

CA 125

CA 15.3

Cervix

Trophoblast

Liver Damage

Myocardial Damage

Germ cell

++

Prostate

++

Thyroid

Medullary
Ca Thyroid

Breast

These tables list only the common and most important causes for the given abnormal
results. When there is a diagnostic problem, please consult your local QML Pathologist, or
Dr Charles Appleton, Dr Nigel Brown, Dr Julia Chang or Dr Kerry DeVoss on (07) 3121 4444.

12.3

Stomach

Biliary ducts

Relative concentrations of ALT & AST


differ in liver and myocardial disease

AST

Liver

Cardiac markers - Troponin is the most sensitive


and specific marker of myocardial disease/damage.

ALT

Oesophagus

CA 19.9

Tumour

CEA

MARKER

* Isoenzyme subunit fractionation is available to further


+

Tumour markers, those materials whose presence qualitatively or quantitatively signal


the presence of malignancy, offer some hope in the fight against cancer. Some well
defined clinical applications include:
The detection of malignancy
The establishment of prognosis as an aid in differentiation
The monitoring of treatment and the detection of a recurrence.

Biochemistry

MOST COMMON

APPENDICIES

Serum Tumour Markers

Source: A. Fetah-Moghadam, P. Stieber, 1991 Instit. of Clin. Chem., Klinikum, Grobhadern, Munich, FRG

12.4

Tissue Sources of Elevated Enzymes

aFP

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

MAJOR TUMOUR
SOURCE

LESSER TUMOUR
SOURCE

FALSE POSITIVE

ACTH

pituitary basophil
adenoma, oat cell
carcinoma of lung

pulmonary carcinoma

Alpha Fetoprotein

hepatoma,
dysgerminoma
(70%), teratoma,
hepatoblastoma

gastrointestinal (10%)
and brochogenic ca.
(10%)

Beta Human
Chorionic
Gonadotrophin (HCG)

choriocarcinoma
(>80%)
and dysgerminoma
(40%)

seminoma (20%) and


non-trophoblastic ca.
(10%)

Beta 2 Microglobulin

myeloma,
plasmacytoma

CA 125 (cervix,
pancreas, stomach)

epithelial ovarian
cancer (>80%)
pancreatitis, peritonitis

endometrium,
fallopian tube

endometriosis, PID,
CRF

CA 15.3

metastatic breast ca.


(70%)

localised breast ca.


(10%), ovary

non-malignant
liver disease

CA 19.9 (Fetoacinar
Pancreatic Antigen)

pancreas (80%),
gastric (50%),
bile duct (65%),
hepatoma (50%)

colorectal (25%)

cirrhosis, cholangitis
and rarely pancreas
& colorectal
inflammation,
pulmonary fibrosis

Calcitonin

medullary thyroid
carcinoma, carcinoid

liver, lung, renal, breast

Carcinoembryonic
Antigen (CEA)

colorectal, gastric,
liver, pancreatic and
breast ca. (all >60%)

lung, prostate, cervix,


uterus, ovary

Catecholamines,
HMMA (VMA)

phaeochromocytoma,
neuroblastoma

Human Chorionic
Gonadotrophin

Refer Beta HCG

Lactate
Dehydrogenase (LD)
Isoenzymes

seminoma,
lymphoma and
epithelial carcinoma

Paraprotein, Bence
Jones Protein

multiple myeloma
(98%) and
plasmacytoma

non-neoplastic
liver disease

renal or
inflammatory disease

MARKER

MAJOR TUMOUR
SOURCE

LESSER TUMOUR
SOURCE

FALSE POSITIVE

Placental Alkaline
Phosphatase

seminoma (>80%),
ovary, lung, uterus
cancer

smoking

Prostatic Acid
Phosphatase (ACP)

metastatic prostate
(>70%)

Prostate Specific
Antigen (PSA)

prostatic
adenocarcinoma
intracapsular (65%),
metast (90%)

benign prostatic
hypertrophy (30%)

Serotonin, 5-H.I.A.A.

carcinoid tumour

diet, diarrhoea,
coeliac disease

Soluble MesothelinRelated Protein


(SMRP)

Mesothelial tumours mesothelioma

Thyroglobulin

differentiated thyroid
ca.

Vasoactive Intestinal
Polypeptide (VIP)

bronchogenic lung,
pancreatic islet,
neuroblastoma,
thyroid medullary,
phaeochromocytoma

intracapsular prostate
(<30%)

ovarian, peritoneal
tumour

prostatitis and
prostatic massage

Biochemistry

MARKER

APPENDICIES

The More Widely Used Serum Markers

other lung malignancy,


fibrotic lung disease

shock, cirrhosis,
hepatic failure

smoking, acute &


chronic pancreatic,
bowel & breast
disease
non-specific illness,
anti-hypertensive
drugs, syncope

benign disease of
organs, haemolysis
other lymphoid
malignancies

autoimmune
conditions

12.6

12.5

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

Sodium

mmol/L

137 - 147

Potassium

mmol/L

3.5 - 5.0

Chloride

mmol/L

96 - 109

Creatinine

Uric Acid

Total
Bilirubin

mmol/L
mmol/L

Random
Fasting

3.0 - 7.7
3.0 - 6.0

mmol/L

<2 yrs
2-10 yrs
11-20 M
11-20 F
21-50 M
21-50 F
>50 M
>50 F

2.0 - 8.0
2.0 - 7.5
2.5 - 7.5
2.0 - 7.0
2.5 - 8.0
2.0 - 7.0
3.0 - 8.5
2.5 - 7.5

<2 yrs
2-5 yrs
6-10 yrs
11-20 M
11-20 F
21-50 M
21-50 F
>50 M
>50 F

10 - 60
10 - 70
20 - 80
40 - 120
40 - 100
60 - 130
40 - 110
60 - 140
50 - 120

M
F

0.12 - 0.45
0.14 - 0.35

umol/L

mmol/L

umol/L

Chemistry

Units

Conj.
Bilirubin

umol/L

Total Alk.
Phos.

U/L

25 - 33

Bicarbonate mmol/L
Glucose

Normal

Age/Sex/
Rand/Fast.

Normal
0-8

0 - 18 yrs

30 - 300

>18 yrs

30 - 115

ALT

U/L

0 - 45

AST

U/L

0 - 41

GGT

U/L

M
F

0 - 70
0 - 45

LDH

U/L

0 - 9 days
10 days 18 mths
19 mths 3 yrs
4 - 8 yrs
9 - 11 yrs
12 - 14 yrs
15 - 16 yrs
>16 yrs

500 - 1000

Calcium

mmol/L

Phosphate

mmol/L

210 - 470
200 - 400

Chemistry

Cholesterol mmol/L

Triglyceride

Fasting

HDL Chol.
High Risk
Patients
LDL Chol.
High Risk
Patients

2.25 - 2.65

Without
other risk
factor

1.3 - 2.8
1.3 - 2.3

7 days 1 yr

1.1 - 2.3

2 - 5 yrs
6 - 10 yrs
11 - 20 yrs
>20 yrs

1.0 - 2.0
1.0 - 1.9
0.9 - 1.7
0.8 - 1.5

<1 day

7 - 70

2 days
3 days
4 - 5 days
6 days 2 mths
>2 months

17 - 140
17 - 170
17 - 100

Total Protein

g/L

60 - 82

Albumin

g/L

35 - 50

4 - 20

Iron

umol/L

10 - 33

mmol/L

Age/Sex/
Rand/Fast.

Normal

<30 yrs
31-40 yrs
41-50 yrs
51-60 yrs
>60 yrs

3.1 - 6.5
3.6 - 6.7
3.6 - 6.9
3.9 - 7.4
3.6 - 7.3

<30 yrs

0.2 - 1.9

31-40 yrs
41-50 yrs
51-60 yrs
>60 yrs

0.3 - 2.2
0.3 - 2.3
0.3 - 2.3
0.3 - 2.2
0.0 - 4.0

Random

190 - 380
180 - 330
140 - 320
120 - 280
80 - 250

1 day
2 - 6 days

Units

Diab. or
ATSIC
Patient

Biochemistry

Units

Urea

12.7

Age/Sex/
Rand/Fast.

Chemistry

APPENDICIES

Common Biochemistry Reference Ranges/


Flagging Rules

> 1.00

mmol/L

<2.0
<2.6

mmol/L

<6.0

CRP

mg/L

0-6

Transferrin

g/L

1.7 - 3.4

Rheumatoid
Factor

IU/L

Up to 14
(>14 to
IMM
for RW)

Ferritin

ug/L

B 0-15 yrs
M >15 yrs
F >15 yrs

10 - 140
20 - 320
10 - 290

2 - 20

12.8

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

Diagnostic values of the oral glucose tolerance test


Glucose Concentration, mmol/L

Venous
plasma

Capillary
plasma

Venous
whole blood

Capillary
whole blood

Three months after delivery, women with gestational diabetes should have a repeat
75g OGTT. This should be evaluated by standard World Health Organisation criteria
for the non-pregnant state. Women who do not have diabetes mellitus at this time
should still be considered as at risk for developing diabetes mellitus later in life.
Procedure for diagnosis of gestational diabetes

Impaired Fasting
Glucose (IFG)
Fasting

>6.0 and <7.0

>6.0 and <7.0

>5.5 and <6.1

>5.5 and <6.1

2 hr after glucose load

<7.8

<8.9

<6.7

<7.8

Impaired Glucose
Tolerance (IGT)
Fasting

<7.0

<7.0

<6.1

<6.1

2 hr after glucose load

7.8 - 11.0

8.9 - 12.2

6.7 - 9.9

7.8 - 11.0

Fasting value

>6.9

>6.9

>6.0

>6.0

2 hr after glucose load

>11.0

>12.1

>9.9

>11.0

Diabetes mellitus

Gestational Diabetes
Carbohydrate intolerance is recognised to pose a risk during pregnancy and should be
detected if present and treated appropriately. The term gestational diabetes mellitus
applies to all degrees of carbohydrate intolerance (to include both the categories of
impaired glucose tolerance and diabetic response).
The recommendations of the Ad Hoc Working Party to the NHMRC (1991) are as follows:
Recommendations for the screening and diagnosis of glucose intolerance
in pregnancy - gestational diabetes
All pregnant women should be screened for abnormal glucose tolerance between
26 and 28 weeks gestation. The plasma glucose level should be measured one
hour after either a 50g or a 75g glucose load given in a non-fasting state. A value
of 7.8mmol/L after a 50g load or 8.0mmol/L after 75g is regarded as positive.
Women with positive results should receive a full glucose tolerance test.

12.9

These recommendations must not preclude confirmation of diabetes with a 75g OGTT
at any stage of pregnancy if there are clinical features to suggest the diagnosis.

Diagnosis Criteria

Indication

Optimal
Gestation Weeks

Test Performed

Clinical suspicion

Anytime

75g OGTT (fasting)

Fasting 5.5 or
2 hours 8.0

Screening

26 - 28

50g glucose load


(non-fasting) or
75g glucose load
(non-fasting)

1 hour 7.8

Confirmation
of diagnosis
after positive
screening test

26 - 30

75g OGTT (fasting)

Fasting 5.5 or
2 hours 8.0

venous plasma
glucose level (mmol/L)

Biochemistry

The revised criteria for the diagnosis of impaired glucose tolerance and diabetes mellitus
as recommended by a Working Party of the Australian Diabetes Society, The Australasian
Association of Clinical Biochemists and the Royal College of Pathologists of Australasia
(1999) are as follows:

The diagnosis of gestational diabetes should be made before 30 weeks gestation


by the administration in the fasting state of a 75g oral glucose tolerance test
(OGTT). A fasting plasma glucose level of 5.5mmol/L and/or a two hour plasma
glucose level of 8.0mmol/L are diagnostic of gestational diabetes.

APPENDICIES

Glucose Tolerance Test

Dietary Restrictions and Special Diets


General Fasting
On the night before the test:
No food is to be eaten for 8 hours prior to or during the test, however the fasting
period should not be in excess of 16 hours
Water may be consumed (recommended intake - slightly more than usual)
No other fluid (including alcohol) may be consumed
A record of current medication is required.
These instructions should be adhered to unless advised otherwise.
Glucose Tolerance Test
An appointment is required for this test. The patient should phone their nearest
QML Pathology collection centre to make arrangements. A list of collection centres and
phone numbers can be found on the reverse side of the request form.

12.10

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

For three days prior to the test the patient should have an adequate intake of
carbohydrates equivalent to the following (as a minimum) each day:

These food items are known to contain significant quantities of serotonin (a precursor of
5HIAA) and should be excluded from the diet for the three days prior to and including the day
of collection:

4 slices of bread, 1 plate of cereal and 2 medium potatoes. If the patient is on a


reduced, special or low-calorie diet, please inform the collection centre staff.

Avocado

Plum

On the night before the test

Banana

Tomato

It is important for the patient to eat a normal dinner, however, not to eat, chew gum or
drink any fluids (except water) for at least 8 hours before the test. It is preferable they
do not fast for more than 12 hours.

Coffee

Walnuts and pecans

Eggplant

(Briefly - avoid fruit and nuts).

Water may be consumed (recommended intake - slightly more than usual).


The patient should record their height and weight.
Record any recent and current medication.
On the morning of the test
The patient should bring their list of medications, and height and weight details with them.
The patient should not physically exert themself prior to or during the test
(including brisk walking to the clinic).

Smoking may also produce a false positive result. The patient should reduce their tea and
coffee intake for three days prior to and including the day of collection.
Low Purine Diet
If your patient requires a 24 hour urine collection for uric acid, you may choose for them
to follow the diet below for three days prior to their collection:
Avoid the following:

The patient should avoid smoking for an hour prior to and during the test. If this is not
possible then please inform staff.

Organ meats (brain, kidney, liver)

Green peas, dried legumes

Wild game

Cauliflower

The patient is required to bring a specimen of urine, however, they should not bring the
first specimen of the morning.

Poultry (chicken, duck, turkey)

Asparagus

The test will take approximately 2.5 hours (half an hour rest prior to test and two hours
test time). On some occasions the length of the test may be extended.

Meat (beef, lamb, pork, veal)

Spinach

Meat extracts (Bonox, Vegemite)

Mushrooms

Fish

Aspirin

Urine Collection Diet For 5HIAA & Catecholamine

Shellfish

Cocoa.

A variety of drugs and foods are known or are reported to interfere with this particular test.
Therefore, the intake of the following items should be restricted for three days prior to and
during the urine collection:

Wholegrain products

Alcohol

Fruits

Paracetamol.

The following drugs are also known to interfere with the test:
Chlorpromazine

Imipramine (Tofranil)

Promazine

Other anti-depressants

Promethazine and other phenothiazine derivatives


Isoproterenol

Methocarbamol (Robaxin)

L-DOPA

Monoamine Oxidase Inhibitors (Trandate).

The patient should not restrict or cease these drugs unless advised by their referring
doctor. Please note the above list of drugs is not fully comprehensive. If the patient is
currently taking any of the above drugs, they should list these together with a full account
of any other medications.

12.11

Pineapple

Biochemistry

Food

APPENDICIES

Preparation

The following are acceptable for a low purine diet:


Fruit juices
Vegetables (except those above)
Nuts
Cereals, breads (except wholegrain products)
Sweets
Beverages (coffee, tea, carbonated)
Fats
Eggs
Cows milk
Dairy products.

12.12

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

Note:
1. S
 everal categories of drugs are poorly detected. These include oral hypoglycaemics,
most diuretics and anabolic steroid agents.
2. Some drugs are undetectable by routine screening procedures. This group includes
insulin, digoxin and lysergic acid diethylamide (LSD).
Over 500 drugs are listed in the identification library. If you are concerned about a specific
substance, or if the drug of interest is not listed please convey this to the laboratory
either on the request form, or if the matter is sensitive or puzzling please contact
Biochemistry (07 3121 4083) or the nearest branch laboratory. If necessary other testing
can be arranged. The list is not static with new drugs being continually added and old
drugs deleted as they become unavailable. Please refer to our online reference manual
www.qml.com.au for an updated list of drugs.
Alcohol/Ethanol
Amitriptyline and metabolites
Amobarbital/Amylobarbitone
Amphetamine
Amylobarbitone
Barbiturates (generic screen)
Benzhexol
Benzodiazepine metabolites
Butabarbital
Caffeine
Cannabinoids/Tetra hydro cannabinol
Carbamazepine and metabolites
Carisoprodol
Chlordiazepoxide
Chlorpheniramine
Chlorpromazine and metabolites
Cimetidine
Cocaine
Codeine
Desipramine
Dextromethorphan
Diflunisal
Dihydrocodeine
Dilantin

Dimenhydrinate
Diphenhydramine
Dothiepin
Doxepin and metabolites
Doxylamine
Ephedrine/Pseudoephedrine
Erythromycin
Ethanol
Fenoprofen
Flunitrazepam
Fluoxetine
Flurazepam
Glutethimide
Haloperidol
Hydrocodone
Ibuprofen
Imipramine and metabolites
Ketamine
Lignocaine (Lidocaine)
MDMA (Ecstasy)
Mefenamic acid
Meprobamate
Methadone and metabolites
Methamphetamine

Phentermine
Phenylpropanolamine
Polyethylene glycol
Procyclidine
Promazine and metabolites
Propoxyphene and metabolites
Propranolol
Pseudoephedrine/Ephedrine
Pyrilamine
Quinine/Quinidine
Ranitidine
Spironolactone and metabolites
Strychnine
Sympathomimetic amine metabolites
Temazepam
Tetra hydro cannabinol/cannabinoids
Theophylline
Timolol
Trimethoprim
Trimipramine and metabolites
Verapamil and metabolites
Xylocaine/Lignocaine.

Biochemistry

This list represents the drugs of greatest interest to the clinician and those most
readily detected.

Methaqualone
Methocarbamol
Methoxyphenamine and metabolites
Methylprednisolone/Prednisolone
Metoprolol
6-monoacetylmorphine
Morphine
Naproxen
Nicotine and metabolites
Nortriptyline
Orphenadrine
Oxazepam
Oxycodone
Paracetamol
Pentobarbital
Pethidine
Phenacetin
Phencyclidine
Pheniramine
Phenobarbital
Phenolphthalein
Phenothiazine metabolites

APPENDICIES

Qualitative Urine Drug Screen

12.14

12.13

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

(Generic Name)

Serum
After Oral
Half-life (hrs) Dose (hrs)

Antibiotics
Amikacin
1.9-2.8
Gentamicin
1.3(1-3)
Tobramycin
3(2-4)
Vancomycin
3-8
Anticonvulsants
Carbamazepine
31(18-65)
Ethosuximide
54(48-60)
Methsuximide*
1.4(0.7-2.6)*
Phenobarbitone
48-120
Phenytoin
18-24
Primidone*
6-22*
Sulthiame
Valproate
8-12
Benzodiazepines
Clobazam
18
Clonazepam
19-42
Chlorazepate
Diazepam
21-37
Flunitrazepam
19(9-25)
Nitrazepam
25-28
Oxazepam
5-6
Temazepam
7-8
Cardio-active
Amiodarone
2.5-10
Digoxin
36(30-45)
Disopyramide
5-6
Flecainide
12-27
Lignocaine
0.7-2.0
Mexilitine
9(8-17)
N-Acetylprocainamide
6-7
Procainamide
2-5
Quinidine
5-12
Tricyclic
Antidepressants
Amitriptyline
15(9-25)
Clomipramine
23(12-36)
Desipramine
22(12-54)

Absorption Peak

Therapeutic Range

Assay
Frequency

NA
NA
NA
NA

Trough < 5 mg/L Peak up to 25 mg/L


Single Daily dose peak up to 25 mg/L***
Trough < 1 mg/L Peak up to 10 mg/L
Trough < 15 mg/L Peak up to 45 mg/L

On demand
On demand
On demand
On demand

5(2-8)
3(1-4)
1
6-18
8(3-10)
4

8-12 mg/L
40-100 mg/L
10-40 mg/L
15-40 mg/L
10-20 mg/L
5-12 mg/L
8-12 mg/L
60-100 mg/L

Daily
Daily
On demand
Daily
Daily
Daily
Weekly
Daily

1
2
2
1.5
0.5-1.5

200-400 ug/L
25-75 ug/L
100-200 ug/L
400-1500 ug/L
Up to 20 ug/L
30-100 ug/L
200-1400 ug/L
80-200 ug/L

Weekly
Weekly
Weekly
Weekly
Weekly
Weekly
Weekly
Weekly

5(3-6)
1-3
1-3
3(1-6)
0.5-2
2-4
2-4
1
1-4

1.0-2.5 mg/L
0.5-2.0 ug/L
2.0-5.0 mg/L
0.2-1.0 mg/L
1.5-5.0 mg/L
0.8-2.0 ug/L
Summed with procainamide
5.0-30.0 mg/L
1.3-5.0 mg/L

Referred
Daily
Daily
Daily
Daily
Referred
Daily
Daily
Daily

2-4
4
3-6

60-250 ug/L
100-300 ug/L
40-150 ug/L

Weekly
Referred
Weekly

1-4
1-2
1-4

Drug

(Generic Name)
Dothiepin
Doxepin
Imipramine*
Nortriptyline
Trimipramine
Others
Cyclosporin
Lithium
Methotrexate

Paracetamol
Salicylate
Theophylline

Serum
After Oral
Half-life (hrs) Dose (hrs)
24(11-32)
15(8-25)
14(6-20)*
27(15-90)
7.2(4-14)

3
2
4
5
2.5

6-10
1-8
> 10 with liver transplant
17-58
1
2
1-5
2
2
1-3
1-3
0.5-1
2
5(3-9)
2-4

Therapeutic Range

Assay
Frequency

50-200 ug/L
10-120 ug/L
100-300 ug/L
50-170 ug/L
90-150 ug/L

Weekly
Weekly
Weekly
Weekly
Weekly

HPLC-100-300 ug/L**
TDx - 135-400 ug/L**
0.5-1.0 mmol/L
@ 24hr < 5 umol/L
@ 48hr < 0.5 umol/L
@ 72hr < 0.1 umol/L
10-20 mg/L
150-300 mg/L
10-20 mg/L

On demand
Daily
On demand

Biochemistry

Absorption Peak
Drug

APPENDICIES

Quantitative Drug Assays for Therapeutic Monitoring

On demand
Daily
Daily

NOTE:
(i) For IV antibiotic administration peak blood level occurs at the end of injection/infusion.
(ii) For IM injection peak blood level occurs 3060 minutes after injection.
(iii) Trough levels should be measured just prior to next dose.
* Indicates a potential of unexpected toxicity from a major active metabolite with a
half-life longer than the parent drug.
** Values differ with method of assay.

12.16

12.15

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

Poisons and Toxic Substances used in Pest Control


Herbicides/Weedicides

Time Since Dose

Range (mg/L)

less than 6 hours

greater than 5.0 mg/L

6 hours

7.0 mg/L

7 hours

5.7 mg/L

8 hours

4.5 mg/L

9 hours

3.5 mg/L

10 hours

2.8 mg/L

11 hours

2.2 mg/L

Synthetic Pyrethroids (assay: blood/lithium heparin tube).

12 hours

1.7 mg/L

Arsenic
(assay: blood/lithium heparin tube; long term exposure - hair and nail clippings).

13 hours

1.3 mg/L

14 hours

1.1 mg/L

16 hours

less than 0.7 mg/L

18 hours

less than 0.4 mg/L

20 hours or greater

less than 0.3 mg/L

Phenoxyacetic acid group (2,4-D; 2,4,5-T; MCPA; Triclopyr)


(assay: random urine).
Glyphosate (Roundup; Zero)
(assay: urine specimen collected at the end of work shift or exposure).
Paraquat/Diquat (true toxicity irreversibly lethal - assay difficult to arrange).
Pesticides/Insecticides
Organochlorines (DDE; DDT; Endosulfan; Dieldrin/Endrin/Aldrin; Chlordane;
Heptachlor; Lindane) (assay: blood/lithium heparin tube).
Organophosphates (Chlorpyrifos; Malathion; Parathion)
(assay: serum/red cell cholinesterase).

Biochemistry

Recommended Levels for Single Daily Dosage Regime


for Gentamicin

APPENDICIES

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

Carbamates (Carbaryl) (assay: serum/red cell cholinesterase).

(From Antibiotic Guidelines, 9th ed. 1996-97)

Fungicides
Dithiocarbamates (Zineb; Maneb; Mancozeb) (assay: serum/red cell cholinesterase).
HCB (Hexachlorobenzene) - organochlorine (assay: blood/lithium heparin tube).
Rodenticides
Coumarin derivatives (assay: prothrombin time).
Strychnine (assay: blood/fluoride oxalate tube).
Molluscicides

12.18

12.17

Metaldehyde (no assay available).

The value of arterial blood gases in assessing pulmonary gas exchange is well established.
However, blood gas analysis (arterial or venous) may also play a key role in assessing the
acid-base balance of the body. An easy approach to interpretation of this function is
presented below.

Examine the Anion Gap

Interpreting Acid-Base Balance from the Blood Gas Profile

pH

LOW
Acidaemia

pCO2

LOW

Primary Metabolic Acidosis with


Respiratory Compensation
1. Raised Anion Gap
- Fixed or organic acid accumulation
2. Normal Anion Gap
- Bicarbonate loss, Chloride excess

RAISED

Primary Respiratory Acidosis


1. Normal Base Excess
- Acute Respiratory Acidosis
2. Raised (+) Base Excess
- With Metabolic Compensation
3. Lowered (-) Base Excess
-C
 ombined Respiratory and
Metabolic Acidosis

RAISED
Alkalaemia

pCO2

RAISED

Primary Metabolic Alkalosis


with Respiratory Compensation
1. Urine pH > 7.4
- Gastrointestinal acid loss
2. Urine pH < 7.4
- Urinary acid loss

LOW

Primary Respiratory Alkalosis

12.19

1. Normal Base Excess


- Acute hyperventilation
2. Lowered (-) Base Excess
- Hyperventilation with compensation
- Salicylate Therapy

1. Raised Anion Gap


i) Phosphate and sulphate accumulation in renal failure.
ii) Ketoacid generation in insulin-dependent diabetes mellitus.
iii) Lactate accumulation in shock, liver disease, or exertion.
iv) Accumulation of an acidic toxin, drug, or drug metabolite
e.g. in salicylate overdose.
v) Accumulation of an unusual organic acid form inherited blockage of metabolic
pathway e.g. methylmalonic acid.
2. Normal Anion Gap
i) Enteric bicarbonate loss - biliary or pancreatic drainage.
ii) Chloride excess - rapid I.V. infusion of normal saline or urine chloride
reabsorption (ureterosigmoidostomy, ileal conduit).
iii) Renal bicarbonate loss from effective hypoaldosteronism (Adrenocortical failure,
Spironolactone therapy, aldosterone receptor defect).
iv) Renal bicarbonate loss from a tubular resorptive defect (Renal tubular acidosis,
Fanconi syndrome, carbonic anhydrase inhibitor therapy).

Biochemistry

Primary Metabolic Acidosis with Respiratory Compensation

APPENDICIES

Acid-Base Analysis

In categories i) and ii), the urine pH will be less than 5.0, in iii), the pH will be 6.5
or greater, and in iv) the pH will vary depending on the site of the resorptive defect
(proximal or distal tubular) and the state of compensation.
Primary Respiratory Acidosis
Examine the Base Excess
1. Respiratory Acidaemia with Normal Base Excess
Acute respiratory failure, airway obstruction or asphyxia.
2. Respiratory Acidaemia with Raised (+) Base Excess
Long standing or chronic respiratory acidosis (e.g. chronic obstructive lung disease)
with metabolic compensation.
3. Combined Respiratory and Metabolic Acidosis (Low (-) Base Excess)
Seen almost exclusively as a preterminal event.
Primary Metabolic Alkalosis with Respiratory Compensation
Examine the Urinary pH
1. Alkaline Urinary pH (pH 7.5 - 8.2)
This indicates gastrointestinal loss of acid.
i) Protracted vomiting.
ii) Long-term nasogastric suction or gastric fistula.

12.20

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

Primary Respiratory Alkalosis


Examine the Base Excess

Other patients are required to meet the lipid levels shown in the following table
after at least six weeks of dietary therapy:

PATIENT CATEGORY

LIPID LEVELS FOR PBS SUBSIDY

Patients with diabetes mellitus


not otherwise included

Total cholesterol > 5.5mmol/L

Aboriginal or
Torres Strait Islander patients

Total cholesterol > 6.5mmol/L


or
Total cholesterol > 5.5mmol/L and
HDL cholesterol < 1mmol/L

1. Respiratory Alkalaemia with Normal Base Excess


This acute uncompensated respiratory alkalaemia pattern is common, being seen in
anxiety-associated hyperventilation (which may accompany mild asthma, mild chest
or throat constriction or pain).

Patients with hypertension


Patients with HDL cholesterol
<1 mmol/L

Total cholesterol > 6.5mmol/L

2. Primary Respiratory Alkalaemia with Low (-) Base Excess


The metabolic compensation in this case indicates a more prolonged state of
hyperventilation usually associated with respiratory centre stimulation (e.g. by mild
hypoxia in pneumonia, by protracted mild airway obstruction, or by pain or anxiety)
or with overriding of normal respiratory control e.g. with mechanical ventilation.
Respiratory centre stimulation seen with high therapeutic doses of aspirin is an
interesting and not uncommon cause.

Patients with familial


hypercholesterolaemia identified by:
DNA mutation; or
Tendon xanthomata in the patient or a
first or second degree relative
Patients with:
Family history of coronary heart disease
which has become symptomatic before
the age of 60 years in one or more first
degree relatives; or
Family history of coronary heart disease
which has become symptomatic before
the age of 50 years in one or more
second degree relatives.

If aged 18 years or less at treatment


initiation:
LDL cholesterol > 4mmol/L

Patients not eligible under the above:


Men aged 35 to 75 years
Post-menopausal women aged up to
75 years.

Total cholesterol > 7.5mmol/L


or
Triglyceride > 4mmol/L

Patients not otherwise included

Total cholesterol > 9mmol/L


or
Triglyceride >8mmol/L

LIPIDS
PBS Eligibility Criteria for Cholesterol Lowering Drugs from 1 April 2006
Patients identified as being in one of the following very high-risk categories may
commence drug therapy with statins or fibrates at any cholesterol level:
Coronary heart disease which has become symptomatic
Cerebrovascular disease which has become symptomatic
Peripheral vascular disease which has become symptomatic
Diabetes mellitus with microalbuminuria (defined as urinary albumin excretion rate of
>20g/min or urinary albumin to creatinine ratio of >2.5 for males, >3.5 for females)
Diabetes mellitus in Aboriginal or Torres Strait Islander patients
Diabetes mellitus in patients aged 60 years or more
Family history of coronary heart disease which has become symptomatic before the
age of 55 years in two or more first degree relatives

Biochemistry

2. Relatively Acidic pH (pH 5.2 - 7.3)


This indicates renal over secretion of acid.
i) Endogenous mineralocorticoid excess - adrenal or pituitary tumour.
ii) Hypokalaemia - renal potassium conversation is tied to hydrogen ion dumping.
iii) Exogenous steroid administration.

APPENDICIES

APPENDICIES

Biochemistry

APPENDICES - Biochemistry

If aged more than 18 years at treatment


initiation:
LDL cholesterol > 5mmol/L
or
Total cholesterol > 6.5mmol/L
or
Total cholesterol > 5.5mmol/L and
HDL cholesterol < 1mmol/L

12.22

12.21

Family history of coronary heart disease which has become symptomatic before the
age of 45 years in one or more first degree relatives.

11 - 13 weeks

15 - 18 weeks

AFP - For neutral tube defects. Offer to patients who had First Trimester Screen.
Please note: If the patient has the Triple Test then AFP is already included.
Triple Test/MSS (AFP, free Oestriol, Total HCG) - For Down Syndrome and
NTD risk. If had FTS, this is not a Medicare rebatable test.
Amniocentesis - FISH Aneuploidy testing: Rapid test for aneuploidy of
chromosomes 13, 18, 21, X and Y performed on fetal cells obtained from
amniocentesis. Results are available within 24-48 hours but results should be
considered interim in nature until confirmed by full fetal karyotype analysis.
- Fetal karyotype: Analysis for follow up of high risk FTS results or other clinical
indications. Allow 10-14 days for fetal karyotype result.
- DNA testing may also be offered for certain inherited genetic conditions.
Discuss these tests with O&G specialist.

18 - 20 weeks

Anomaly Scan - Important follow up of high AFP or high risk NTD results.

26 - 28 weeks

Glucose Challenge in Pregnancy - Non-fasted, 50 grams, 1 hour glucose


test. Follow up results of glucose challenge - if increased do a 2hr GTT. If GTT is
positive then Gestational Diabetes is confirmed. Retest 3 months post partum.
FBC
Blood Group and Antibodies
Iron Studies - (If indicated)

28 weeks

12.23

First Trimester Screen (Free HCG, PAPP-A)


- Results combined with NT to give Down Syndrome risk. AFP not included in
this test, consider at 15-18 weeks. (Note: The window for Nuchal Translucency
screening is 11 - 13 weeks 6 days). Biochemistry component now available
from 8 weeks, providing a dating ultrasound is available.
CVS - FISH Anueploidy testing: Rapid test for aneuploidy of chromosomes 13, 18,
21, X and Y performed on cells obtained from CVS sample. Results are available within
24-48 hours but results should be considered interim in nature until confirmed by full
fetal karyotype analysis.
- Fetal karyotype: Performed on cultured Chorionic Villi may be offered for follow up of
high risk FTS results or other clinical indications. Allow 10-14 days for fetal karyotype.
- DNA testing may also be offered for certain inherited genetic conditions.
Discuss with O&G specialist.

Rh (D) Negative
- Anti D prophylaxis if antibody negative
(see complications in pregnancy for Rh (D) negative women).

34 weeks

35 - 37 weeks

38 weeks
Post Partum

Rh (D) Negative
- Anti D prophylaxis if antibody negative
See complications in pregnancy for Rh (D) negative women (12.25).
Blood Group and Antibodies - See complications in pregnancy for Rh (D)
negative women (12.25).
Low Vaginal Swab - Consider for Group B Strep +/- Rectal Swab.
FBC
Blood Group and Antibody Screen
Rh Negative - Fetomaternal haemorrhage test and Anti D.
TSH - 7-30 days post partum (If Thyroiditis was present earlier in the pregnancy).
Iron Studies - Follow up if iron levels are low during pregnancy.
FBC - Consider for history of excessive tiredness.
Newborn Screening Blood Spot (PKU) - Heel prick test on baby - preferred
time of sample collection is 48 - 72 hours post-partum.

Complications in Pregnancy

ENDOCRINOLOGY

4 - 12 weeks

HCG - Overdue LMP. HCG usually positive by 10-14 days post conception.
If negative, repeat after several days.
FBC
Iron Studies
Blood Group and Antibodies
- (If patient is Rh negative see 12.25 for complications in pregnancy)
HepBsAg, Treponemal Serology and EIA Rubella
+/- Hep C
+/- MSU
Vitamin D - Fasting preferable but not essential
TSH - If clinically indicated
HIV - At Doctors discretion

APPENDICIES

Laboratory Testing: Pregnancy Timeline

Sensitising Events:
For each sensitising event, perform FMH test and administer Rh (D) immunoglobulin.
Sensitising events include:
- Normal delivery
- Ectopic pregnancy
- Miscarriage
- Termination of pregnancy
- Genetic studies such as chorionic villus sampling, amniocentesis, cordocentesis
- Abdominal trauma sufficient to cause fetomaternal haemorrhage
- External cephalic version
- Antepartum haemorrhage.
Threatened Miscarriage:
- Perform serial Quantitative HCG and Progesterone. Discuss with Chemical
Pathologist if required and consider ultrasound scan.
Ectopic Pregnancy:
- HCG: insufficient rise or fall in HCG. Discuss with Chemical Pathologist if required
- Progesterone
- Ultrasound.
Recurrent Pregnancy Loss:
- Products of conception for fetal karyotype
- Parental chromosomes
- Haematological/Immunological tests: Thrombophilia Screen (ATIII, Protein C and S,
aPCR, Lupus Anticoagulant, Anti Cardiolipin antibodies, Homocystine, Prothrombin
Gene). Discuss results with Obstetrician or Clinical Haematologist
- ANA.

12.24

APPENDICIES

ENDOCRINOLOGY

APPENDICES - ENDOCRINOLOGY

Further advice regarding investigations, management and administration of


products should be sought from a Haematologist.
This information has been prepared and published by QML Pathology for the information of referring doctors.
Although every effort has been made to ensure that it is free from error or omission, readers are advised that
the information is not a substitute for detailed professional advice.

Investigation of Hirsutism: A Quick Reference Guide


Polycystic Ovarian Syndrome (PCOS) is common (? 1 in 5-10); rest are rare
1) Exclude Uncommon Causes: - History - Course - Appearance.
Prolactin
Hypothyroidism


Cushings



Adrenal, Ovarian Tumours

Late onset, Partial Adrenal Hyperplasia,

1 in 100 (New York)

? 1 in 1000 - 10,000 (Australia)

Mid-morning Prolactin
TSH
ACTH and Cortisol
DHEAs, Inhibin, (Urine Steroid Profile)
Hydroxy-Progesterone

2) Look for Features of Polycystic Ovarian Syndrome (PCOS)


LH>FSH, yet Oestradiol not high enough to ovulate (<170)
Low sex hormone binding globulin (SHBG)
High androgens/precursors

Testosterone, DHEAs, Androstenedione
Insulin resistance - ? post prandial only
- ? fasting as well
Ultrasound of ovaries: String of pearls appearance
- Uniform cysts 3-6mm peripherally

ENDOCRINOLOGY

Rh (D) Negative Women:


- All patients undergo Blood group and Rh type, together with antibody screen at initial
pregnancy testing
- If previous pregnancy affected by Rhesus disease/haemolytic disease of the newborn,
or presence of anti-D antibodies or other antibodies, consult with specialist obstetrician
- Check antibody screen at 28 and 34 weeks
- If antibody screen negative and in first pregnancy, give: 625 IU (125 g) of Rh (D)
Immunoglobulin at 28 and 34 weeks (iMI)
- Post partum: 625 IU (125 g) minimum of Rh (D) Immunoglobulin post partum within
72 hours (iV), together with testing for fetomaternal haemorrhage (Kleihauer test or
flow cytometry) if cord blood is Rh positive
- For possible fetomaternal haemorrhage - Rh (D) Immunoglobulin within 72 hours,
together with testing for fetomaternal haemorrhage (Kleihauer test) 1st Trimester 250
IU (50 g). Beyond 1st Trimester 625 IU (125 g).

APPENDICIES

APPENDICIES

ENDOCRINOLOGY

APPENDICES - ENDOCRINOLOGY

3) Suggestions
Mid-morning - LH, FSH, Oestradiol, Testosterone, SHBG, Glucose, Insulin, DHEAs
Options - TSH, ACTH, Cortisol, Prolactin, OHP
24hr urine steroid profile
Ultrasound of ovaries
For further information contact Dr Kerry DeVoss, Pathologist (07) 3121 4412
Polycystic Ovarian Syndrome (PCOS)
Comparison of Ovaries

Polycystic Ovary

String of Pearls effect

12.26

12.25

Normal Ovary

Recommended Age Guidelines for Mens Health Testing


AGE:

30s

40s

MALE
SPECIFIC
ISSUES:

Infertility

Erectile
Dysfunction

50s

60s

70s

80s

Energy

ENDOCRINOLOGY

ENDOCRINOLOGY

APPENDICES - ENDOCRINOLOGY

Prostate
Problems

APPENDICIES

APPENDICIES

Gout

Cancers:
(Lung,
Colorectal,
Prostate etc.)

COMMON
CAUSES
OF DEATH:
TESTS:

Cardiovascular
Stroke
Cancer (Lung, Colorectal, Prostate)
Semen
Glucose
Iron
LH
FSH
Testosterone
Prolactin
(?Thyroids)
(?Cortisol)

( )
( )
Cholesterol
Triglycerides
LDL
HDL
Bilirubin
HS-CRP
Homocysteine
Uric Acid

(
(

)
)

PSA
(baseline)

(
(

)
)

PSA
(periodic)

(
(

)
)

PSA
?CEA
?CA19.9

(
(
(
(
(
(

)
)
)
)
)
)

PSA
?CEA
?CA19.9

Note: ? = consider if clinically appropriate

12.28

12.27

For further information please contact:


Dr Kerry DeVoss (07) 3121 4412 or Dr Charles Appleton (07) 3121 4512

Blood
(Constitutional)

Cell Cultured

Reporting time

Lymphocytes

2-3 days
(newborn babies)
14 days (routine)

(Oncology)

Bone Marrow

Blast cells

Myeloid
disorders
Lymphoid
disorders

12.29

Amniotic Fluid

Fetal epithelium

Abnormalities
Detected
Constitutional
(numerical and
structural) abnormalities

7-14 days (routine)

Acquired abnormalities
related to the
leukaemic process

24-48 hours
(diagnostic
CML, ALL, AML)

Acquired abnormalities
related to the
leukaemic process

2 days (diagnostic)

7-14 days (routine)


10 days

Antenatal diagnosis
of chromosomal
abnormalities

Chorionic Villi

Trophoblast and
mesodermal
fibroblasts

10 days

Antenatal diagnosis
of chromosomal
abnormalities

Prenatal FISH
for rapid
aneuploidy
screening

Culture not
required, direct
analysis of
amniocytes or
trophoblast cells

24 hours

Aneuploidy for
chromosomes 13,18,
21, X and Y

Skin and
Fetal Tissues

Fibroblasts
from dermis,
chorionic villi,
membrane, etc.

14 days

Tumour

Variable

14 days

Mostly numerical
abnormalities. Some
structural abnormalities
Acquired abnormalities
related to the
neoplastic process

NOTE: All abnormal amniotic fluid and constitutional results are phoned to the referring
doctor. Abnormal bone marrow, tissue and tumour results are phoned at the discretion
of the Genetics supervisor.

Test

Reporting time

Sample required

Hereditary
Haemochromatosis

3 days

Peripheral Blood EDTA

Factor V Leiden/
Prothrombin G20210A

7 days

Peripheral Blood EDTA

Methylenetetrahydrofolate
Reductase (MTHFR)

7 days

Peripheral Blood EDTA

Apolipoprotein E

7 days

Peripheral Blood EDTA

Fragile X (FRAXA)

7 days

Peripheral Blood EDTA

Y Chromosome
Microdeletion Studies

7 days

Peripheral Blood EDTA

HLA-B27

3 days

Peripheral Blood EDTA

Clostridium Difficile

2 days

Faecal sample

Cat Scratch Disease

2 days

Swab of infected site


Tissue

Malarial Parasite Detection

3 days

Peripheral Blood EDTA

BCR-ABL RQ-PCR

7-14 days

Peripheral Blood EDTA


Bone Marrow Aspirate

JAK2

7-14 days

Peripheral Blood EDTA


Bone Marrow Aspirate

B and T cell Gene


Rearrangement Studies

7-14 days

Peripheral Blood EDTA


Bone Marrow Aspirate
Fresh Tissue
Paraffin embedded tissue

GENETICS

Tissue

Molecular Genetic Tests


Sample Requirements and Reporting Times

APPENDICIES

Cytogenetic Tests Tissues Examined and Reporting Times

12.30

APPENDICIES

GENETICS

APPENDICES - GENETICS

Platelet Reference Ranges

Haemoglobin g/L RCC x1012/L

HCT

MCV fL

MCH pg

Cord

135-200

3.9-5.5

0.42-0.60

98-118

31-37

Day 1-3

145-225

4.0-6.6

0.45-0.67

95-121

31-37

Day 4-7

135-215

3.9-6.3

0.42-0.66

88-126

28-40

Day 8-14

125-205

3.6-6.2

0.39-0.63

86-124

28-40

Day 15-Week 7

100-180

3.0-5.4

0.31-0.55

85-123

28-40

Week 8-13

90-140

2.7-4.9

0.28-0.42

77-115

26-35

Month 3-6

95-135

3.1-4.5

0.29-0.41

74-108

25-35

Month 7-Year 2

105-135

3.6-5.3

0.33-0.39

70-86

23-31

Year 3-6

115-135

3.6-5.3

0.33-0.40

75-88

24-31

Year 7-14

115-155

3.6-5.2

0.33-0.45

78-95

26-34

15-99 Female

115-160

3.6-5.2

0.33-0.46

80-98

27-35

Platelet Count x10 /L


9

Cord

Year 0-3

Year 4-7

Year 8-999

150-550

150-550

150-500

150-450

Initiating Warfarin Therapy


When initiating warfarin therapy the loading of doses should be avoided as it causes
early procoagulant effects, and oscillating INRs that take longer to stabilise than a steady
increase in dose.
QML Pathology uses a formula that factors in each patients age and weight to derive
an individual dose. The formula gives us the Estimated Maintenance Dose (EMD) as
demonstrated below.

15-55 Male

135-180

4.2-6.0

0.38-0.52

80-98

27-35

EMD = square root of [ weight x (100-age) ]

56-70 Male

130-180

4.0-6.0

0.36-0.52

80-98

27-35

71-999 Male

125-180

3.8-6.0

0.34-0.52

80-98

27-35

E.g. for a 75kg, 60 year old

MCHC

(All Ages) 310 - 365

RDW

(All Ages) 11.3 - 15.5

HAEMATOLOGY

Basic Haematology Parameters

APPENDICIES

APPENDICIES

HAEMATOLOGY

APPENDICES - HAEMATOLOGY

100

EMD =

[75 x (100-60)] = [75 x 0.4] = 5.4mg


100

5mg is the recommended starting dose; however, the choice of starting dose may need
to be modified for a number of reasons, such as the patients current medications, which
may interact with warfarin (see upcoming section).

Note: In pregnancy, haemoglobins down to 105 g/L are quite common.

Leucocyte Reference Ranges

Range of Target INRs


Cord

6.0-22.0

0.5-12.5

2.0-9.0

0.2-2.5

Day 1

9.0-34.0

5.0-21.0

2.0-11.0

0.2-2.5

0.1-1.0

Day 2-7

5.0-21.0

1.5-10.0

2.0-17.0

0.2-2.5

0.1-0.8

Day 8-14

5.0-20.0

1.0-9.0

2.5-16.5

0.2-2.0

0.1-0.6

Week 8-Month 6 6.0-17.5

1.0-8.5

4.0-13.5

0.2-1.8

0.1-0.6

Month 7- Year 1

6.0-17.5

1.5-8.5

4.0-10.5

0.2-1.5

0.1-0.6

Year 2

6.0-17.0

1.5-8.5

3.0-9.5

0.2-1.5

0.1-0.6

Year 3 and 4

5.5-15.5

1.5-8.5

2.0-8.0

0.2-1.5

0.1-0.6

Year 5 and 6

5.0-14.5

1.5-8.0

1.5-7.0

0.2-1.5

.04-0.6

Year 7-10

4.5-13.5

1.5-8.0

1.5-7.0

0.2-1.2

.04-0.6

Year 11-16

4.5-13.0

2.0-8.0

1.5-5.0

0.2-1.0

.04-0.4

Year 17-999

4.0-11.0

2.0-7.5

1.1-4.0

0.2-1.0

.04-0.4

Basophils

(All Ages) 0-0.20 x109/L

Note: In pregnancy white cell counts up to 15.0 x109/L are quite common.

12.31

0.1-1.0

Indication

INR

Indication

Type valve

AF

2-3

AVR

Bileaflet/Medtronic Hall

DVT

2-3

AVR

2.5-3

Extensive DVT
PE - Young
PE - Old
 upus
L
Anticoagulant

RF
-ve
+ve

INR
2-3
2.5-3.5

Starr-Edwards/Disc*

+/-ve

2.5-3.5

AVR/MVR

Bioprosthesis

-ve

Aspirin

2.5-3.5

MVR

Any

+/-ve

2.5-3.5

2-3

AVR

Bioprosthesis

+ve

2-3

2.5-3.5

MVR

Bioprosthesis

+ve

2.5-3.5

AVR = Aortic Valve Replacement; MVR = Mitral Valve Replacement; AF= Atrial Fibrillation;
DVT = Deep Venous Thrombosis; PE = Pulmonary Embolism.
* (other than Medtronic Hall)
RF Risk Factors = include AF, previous thromboembolism, LV dysfunction, and hypercoagulable
condition. - depends on strength of anticardiolipin or lupus anticoagulant.

12.32

WCC x109/L Neut x109/L Lymph x109/L Mono x109/L Eos x109/L

Duration of treatment depends on the site of the thrombosis and the risk status of the
patient. Those risks include re-thrombosis and bleeding from the warfarin therapy. To
enable the former to be evaluated adequately, the patient should be tested for the presence
of any inherited or acquired prothrombotic conditions, the most familiar being Factor V
Leiden, but there are others more clinically likely to affect the risks to re-thrombosis.

Warfarin is metabolised by the Cytochrome P450 system. As such there are many
drugs that can cause some change in the INR. However, there are some that have a
marked effect and which patients should be warned about. In general, every time a new
medication is commenced or one is ceased, the patient should tell the warfarin control
centre or their treating doctor, and their INR should be checked. Some medications are
notorious for interfering with warfarin. We have compiled a list of the most common and
important drugs below.

Reversible or
Time Limited Factor
Surgery, trauma,
pregnancy/OCP,
immobilisation,
long haul flight

Spontaneous
(Idiopathic)
No cause found

Higher Risk
Factor V, PT gene
(heterozygous)
above with either
life threatening
thrombosis or
thrombosis in unusual
site (mesenteric,
cerebral vein)

High Risk
Active malignancy,
moderate
antiphospholipid
syndrome, ATIII
def, homozygous
or compound
heterozygous
thrombophilias,
recurrent thromboses

Drug

Aspirin

6-12 months

12-24 months

Indefinite

At the completion of the standard period of anticoagulation, decisions need to be made


regarding anticoagulation:
Should anticoagulation be ceased
Should full anticoagulation continue or

12.33

Should anticoagulation be continued at lower intensity (selected indications)?

Grade of Affect
Moderate - Severe

None*

Moderate

Fluconazole

Marked

Most Antibiotics

Moderate

Flucloxacillin
Keflex

rare increase
Variable often

Moderate
Mild - Moderate
Marked

Metronidazole
NSAIDs

3 months

Affect on INR

Amiodarone

HAEMATOLOGY

Drugs that Interact with Warfarin

APPENDICIES

Duration of Warfarin Therapy

also platelet inhibition

Mild - Moderate

Panadol Regular >4/day

Moderate - Severe

Rifampicin

Marked

Statins

Mild - Moderate

Tramal

Moderate

Tegretol

Mild - Moderate

*but increased risk of bleeding via platelet inhibition


= those drugs which decrease INR

12.34

APPENDICIES

HAEMATOLOGY

APPENDICES - HAEMATOLOGY

Acetylcholine receptor (AChR)

Microsomal - thyroid

Adenovirus

Fungal precipitins

Psittacosis

Adrenal

Mitochondrial (AMA)

Rose - Waaler
(Rheumatoid factor)

Anti streptolysin - O (ASOT)

Haemophilus influenzae

Q fever

Anti nuclear antibody (ANA)


includes pattern description
e.g. homogeneous,
speckled etc.

Muscle - skeletal

Salivary duct/gland

Arbovirus

Helicobacter pylori

Muscle - smooth

Skeletal (striated) muscle

Aspergillus

Hepatitis A

Respiratory syncytial virus


(RSV)

Neuronal Antibodies {(Hu)ANNA-1, (R1)-ANNA-2}


Purkinje Cell Ab-(Yo)

Smooth muscle

Avian precipitins

Hepatitis B

Rickettsiae

Sperm

Barmah Forest virus

Hepatitis C

Ross River virus

Triiodothyronine (T3)

Bartonella
(Cat Scratch Disease)

Hepatitis D (Delta virus)

Rubella

Hepatitis E
Hepatitis G

Salmonella typhi
and Paratyphoid

Herpes simplex - type I and II

Schistosomiasis

HIV - 1 and 2

Shigella

HTLV - 1

Staphylysin

Chlamydia

Human herpes virus 6

Streptococci (ASOT, DNAse B)

Coccidiodes

Hydatid

Strongyloides

Coxsackie virus

Influenza A

Cryptococcus

Influenza B

Syphilis - RPR, TPHA, FTA,


EIA (Total antibody)

Cytomegalovirus (CMV)

Legionella

Teichoic acid (staphylococci)

Dengue

Leptospira

Tetanus

DNAse B (Streptococci)

Lyme disease (Borreliosis)

Toxocara

Echinococcus (Hydatid)

Lymphogranuloma venereum
(LGV)

Toxoplasma

Measles

Typhus

Melioidosis

Varicella - Zoster

Mumps

Widal test (typhoid)

Mycoplasma pneumoniae

Whooping cough (Pertussis)

Avian protein precipitins


Basement membrane zone
(BMZ, Pemphigoid)
Cardiolipin (phospholipid)
Cold agglutinins
DNA (double stranded DNA,
DNA binding)

Neutrophil cytoplasmic
(ANCA) includes cANCA,
pANCA, myeloperoxidase,
Proteinase-3
Nuclear antibody (ANA)

Donath-Landsteiner

Ovarian

Endomysial

Pancreatic islet cell

Extractable nuclear antigens


(ENA) Includes SS-A, SS-B,
RNP, Sm, Scl 70, PM-1, Jo-1

Parathyroid

Filaggrin (Keratin)
Ganglioside (GM-1)
Gliadin
Glomerular basement
membrane
Glutamic acid decarboxylase
(GAD)

Thyroxine (T4)

Bordetella pertussis

Thyroid microsomal

Brucella abortus

TSH receptor

Campylobacter

Parietal cell
Parotid (salivary gland)
Pemphigoid (basement
membrane zone, BMZ)
Pemphigus (intercellular
cement substance, ICS)
Phospholipid (cardiolipin)
Platelet

Candida
Cat Scratch Disease

Echovirus

Granulocyte

Protein tyrosine phosphatase


IA-2 (IA-2)

Histones

Purkinje Cell AB (Yo)

Enterovirus

Insulin

Red cell antigens screen, identification

Epstein - Barr virus (EBV)

Reticulin

Filaria

Parainfluenza

Yersinia

Flavivirus group includes Dengue, Australian


(Murray Valley) encephalitis
and Kunjin

Parapertussis

* Antibodies to other agents may


be available. Please contact
Immunology Department
(07) 3121 4458

Intercellular cement substance


(ICS, Pemphigus)

12.35

Neutrophil

Intrinsic factor

Rheumatoid factor

Islet cell (GAD, IA-2)

Rhesus antibodies

Microsomal - liver, kidney

Ribosomal

NOTE: It is a Medicare requirement that autoantibodies required for testing be listed


individually on the request form.

Entamoeba histolytica

Fasciola hepatica

Parvovirus B19
Pertussis (whooping cough)

NOTE: It is a Medicare requirement that autoantibodies required for testing be listed


individually on the request form.

IMMUNOLOGY

Antibodies to Microbial and Parasitic Agents

APPENDICIES

Antibodies to Tissue Antigens (Autoantibodies)

12.36

APPENDICIES

IMMUNOLOGY

APPENDICES - IMMUNOLOGY

- IgM and IgG

Barmah Forest Virus

- IgM and IgG

Flavivirus (Group) Viruses

- IgM and IgG

Flavivirus Group includes

- Dengue Virus - all sero types


- Australian (Murray Valley) Encephalitis Virus
- Kunjin Virus
- Japanese Encephalitis Virus

NOTE: It is a Medicare requirement that autoantibodies required for testing be listed


individually on the request form.

Skin Tests for Allergy


In patients with allergy due to IgE (e.g. house dust mite allergy, pollen allergy, animal
dander allergy, nut allergy) epicutaneous exposure (skin prick) to relevant allergens
induces a visible wheal and flare reaction due to local mast cell degranulation.
A set of allergens which include pollens, moulds, animal danders, house dust mite and
foods is used for testing. A histamine (positive) control and glycerol saline (negative)
control are also tested to validate the results.
Variables in Skin Allergy Testing
Several factors may influence skin testing. Clinically relevant factors include:
Drugs e.g.:
antihistamines

tricyclic antidepressants

benzodiazepines

beta blockers.
Age
Previous immunotherapy
After viral exanthem.

12.37

Contraindications
Testing is contraindicated in patients with:
Current severe allergic symptoms
Recent anaphylaxis
Unstable asthma
Acute illness
Generalised skin rash
Pregnancy.

Allergy skin testing is performed by appointment at several locations across Brisbane


and our Branch Laboratories.
For further information, please contact our Immunology Department on (07) 3121 4458
or your local QML Pathology Branch Laboratory.

IMMUNOLOGY

Ross River Virus

Patient Preparation
No antihistamines to be taken for seven days prior to test. Many over-the-counter
medications (e.g. decongestants, cough mixtures and sinus mixtures) have
antihistamines; these should be ceased
No creams or moisturisers (including sunscreen) on arms for 48 hours prior to test
Tricyclic antidepressant drugs often have profound 'antihistamine effects' and may
preclude allergy skin testing
Moderate to high dose oral corticosteroids, e.g. Prednisolone 25mg daily or above
will impair skin test reactivity
Asthma sprays such as Ventolin should not be stopped.

APPENDICIES

Arbovirus Screen

RAST Allergen List


Single Allergens
Grasses
Canary grass
Cultivated wheat
Couch (Bermuda)
Johnson grass
Meadow grass
Paspalum
Perennial rye grass
Timothy
Weeds
Common ragweed
Dandelion
Marguerite, Daisy
Plantain
Western ragweed

Epithelia & Animal Proteins


Cat
Dog dander
Dog epithelium
Cow dander
Horse dander
Budgerigar feathers
Chicken feathers
Duck feathers
Guinea pig
Mouse epithelium
Mouse urine protein
Rat epithelia
Rat urine proteins
Sheep epithelium

Trees
Eucalyptus
Melaleuca
Wattle, Acacia

Moulds
Alternaria tenuis
Aspergillus fumigatus
Candida albicans
Cladosporium herbarum
Penicillium notatum

Dust & Mites


House dust mite
- D. pteronyssinus
House dust mite
- D. farinae
House dust

Yellow jacket wasp venom

Insects
Cockroach
Honey bee venom
Mosquito
MUXF3
Paper wasp venom

Foods
Almond
Apple
Banana
Barley
Beef
Blue mussel
Brazil nut
Buckwheat
Cashew
Cheddar cheese
Chicken meat
Chilli pepper (Capsicum)
Cocoa
Coconut
Coffee
Corn (maize)
Crab
Egg white
Egg yolk
Fish (cod)
Garlic
Gluten
Grape
Hazelnut
Melons
(Rockmelon & Honeydew)

Macadamia

12.38

APPENDICIES

IMMUNOLOGY

APPENDICES - IMMUNOLOGY

Cow Milk Proteins


- lactalbumin
- lactoglobulin
Casein
Drugs
Amoxycillin
Ampicillin
Penicilloyl-G
Penicilloyl-V

12.39

Miscellaneous
Chlorhexidine
Latex
Recombinant latex
Suxamethonium
Inhalant Screen
Contains allergens from
the following groups:

Grasses
Weeds
Moulds
House dust mite
Animal epithelia

Multiple Allergens
Grass Pollen Mix
Couch (Bermuda)
Timothy
Meadow
Johnson
Rye
Paspalum
Tree Pollen Mix
Wattle
Olive
Willow
White pine
Eucalyptus
Melaleuca
Weed Pollen Mix
Common ragweed
Mugwort
Saltwort (prickly)
Plantain
Goosefoot
Animal Dander Mix
Cat
Dog
Horse
Cow
Caged Bird Mix
Budgerigar
Canary
Finch
Parakeet
Parrot
Mould Mix
Penicillium
Aspergillus
Cladosporium
Alternaria
House Insects Mix
House dust mite
- D. pteronyssinus

House dust mite


- D. farinae
House dust
Cockroach

Food Mix
Egg white
Milk
Yeast
Soya bean
Peanut
Fish (cod)
Cereal Mix
Wheat
Oat
Buckwheat
Corn
Sesame seed
Fruit Mix
Peach
Kiwi fruit
Rockmelon
Banana
Pineapple
Nut Mix
Peanut
Almond
Coconut
Hazelnut
Brazil nut

Skin Allergen List


Routine Allergen Screen
Pollens
Couch (Bermuda)
Eucalyptus
Johnson grass
Paspalum
Pine
Plantain
Prairie grass (Brome)
Ragweed
Timothy grass
Wattle
Wild oat
Moulds
Alternaria
Aspergillus fumigatus
Aspergillus niger
Botrytis
Cladosporium
hormodendrum
(Herbarum)
Penicillium mould

Epithelial Extracts
Cat fur
Cattle hair
Dog hair
Feather mix
Horse hair
Food Extracts
Cashew
Egg white
Egg yolk
Milk - cow
Peanut
Shellfish
Shrimp
Soy bean
Wheat flour (whole)

Additional Food Allergens


(available on request)








Banana
Chicken
Cod
Lobster
Rice grain
Strawberry
Tomato
Yeast (Baker's Yeast)
7 grass mix

IMMUNOLOGY

Mango
Milk
Mutton
Oat
Onion
Orange
Oyster
Parvalbumin
Peach
Peanut
Pineapple
Pinenut
Pork
Potato
Rice
Rye
Salmon
Sesame seed
Shrimp
Soya bean
Squid
Strawberry
Sunflower seed
Tomato
Tropomysin
Tuna
Walnut
Wheat
Yeast

APPENDICIES

Miscellaneous Extracts
House dust mite
Cockroach

Seafood Mix
Cod
Shrimp
Tuna
Blue mussel
Salmon
Disinfectant Agent Mix
Ethylene oxide
Phthalic anhydride
Formalin/
formaldehyde
Chloramine T
Reactive Chemical Mix
Isocyanate TD1
Isocyanate MD1
Isocyanate HD1
Phthalic anhydride

12.40

APPENDICIES

IMMUNOLOGY

APPENDICES - IMMUNOLOGY

The Doctor or Dentist and Staff

Although all of us suffer from infectious illnesses from time to time, everyone would
agree that the place where help is obtained, the Doctors/Dentists surgery, should not
facilitate transmission of infection. There is a requirement for duty of care by health care
professionals to minimise transmission of infection from person to person by careful
planning, appropriate training, and use of infection control procedures.

The surgery staff and the Doctor or Dentist should be free from infectious illness.

This document is a guide to infection control in Doctors surgeries. It does not cover all
circumstances and readers should rely on their own risk assessments and choice of
remedies required.
For more detailed guidelines see:
Sterilisation/Disinfection guidelines for General Practice (RACGP 2007).
Infection Control in Surgery (Royal Australasian College of Surgeons, 1998, revised 2001).
Human Immunodeficiency Virus and Hepatitis B and the Workplace: National Consensus
Statements, Worksafe Australia Code, 1993.
AS/NZS 4187:2003: Cleaning, disinfecting and sterilizing reusable medical and surgical
instruments and equipment, and maintenance of associated environments in health
care facilities.
AS/NZS 4815:2006: Office-based health care facilities - Reprocessing of reusable medical
and surgical instruments and equipment, and maintenance of the associated environment.
Updated US Guidelines for the Management of Occupational Exposures to HBV, HCV
and HIV and Recommendations for Postexposure Prophylaxis (MMWR: June 2001 Vol
50/No. RR-II).
All procedures should be documented and records of patient encounters, including small
operations lists, equipment performance, etc. should be kept.
This document is a guide for surgeries where minor procedures are performed. Facilities
for major procedures must be similar to those provided by accredited hospitals and
hence are expensive.
Factors to be considered in the control of infection are:
1. The doctor or dentist
2. The surgery staff
3. The patients
4. The physical environment

12.41

5. Disinfection and sterilization of instruments and other appliances.

All health care workers who are exposed to blood should be vaccinated with Hepatitis B
Virus vaccine. Check the serum Anti-Hepatitis B Surface antibodies (Anti HBs Ab) level 2
months after the third dose.
Skin lesions and cuts should be covered with waterproof occlusive dressings.
The surgery staff should be adequately trained in surgical procedures including aseptic
techniques, use of sterilizers etc.
These procedures should be documented. Induction of new staff and refresher training
should be recorded also.
Patients

APPENDICIES

The above concepts have now been reinforced by Government legislation. In Queensland
the relevant act is the Workplace Health and Safety Act 1995. In NSW the relevant act is
the Occupational Health and Safety Act 2000. These acts apply to all work places where
a person is paid to perform work. Breach of the Queensland Act may result in heavy fines
and/or jail of the relevant person.

They should be vaccinated against common organisms, e.g. rubella.

MICROBIOLOGY

Infection Control in Medical Consulting Rooms

Patients with suspected infectious illnesses (e.g. rubella) are best seen at their homes or
should be seen on arrival at the surgery to minimise spread of organisms to others. The
staff should arrange block bookings for pregnant patients and separate patients who
are susceptible to infection (e.g. leukaemic patients) from potential shedders of microorganisms (e.g. children with chicken pox).
Individuals, however, may have circulating transmissible agents such as Hepatitis B virus
(HBV) and Human Immunodeficiency Virus (HIV) without signs or symptoms. The blood
(and some body fluids) of such persons is infectious and thus represents a hazard when
undergoing some medical procedures.
The Centers for Disease Control, USA (MMWR 1989; 38: S6) has developed the strategy
of universal blood and body fluid precautions to address concerns regarding transmission
of HIV in the health care setting. The concept, previously referred to as universal
precautions, is now called standard precautions with additional precautions and
stresses that all patients should be assumed to be infectious for HIV and other
blood-borne pathogens. In the health care setting, standard precautions should be
followed when workers are exposed to blood and other body fluids.
Standard Precautions are recommended for the treatment and care of all patients,
and apply to all body fluids, secretions and excretions (excluding sweat), regardless of
whether they contain visible blood (including dried body substances such as dried blood
or saliva), non-intact skin and mucous membranes.
Standard Precautions include good hygiene practices, particularly washing and drying
hands before and after patient contact, the use of protective barriers which may include
gloves, gowns, plastic aprons, masks, eye shields or goggles, and appropriate handling
and disposal of sharps and other contaminated or infectious waste, and the use of
aseptic techniques.
Additional Precautions are used for patients known or suspected to be infected or
colonised with epidemiologically important or highly transmissible pathogens that
can be transmitted by air borne or droplet transmission or by contact with dry skin or
contaminated surfaces.

12.42

APPENDICIES

MICROBIOLOGY

APPENDICES - MICROBIOLOGY

To minimise the risks of acquiring HIV and HBV during performance of job duties, workers
should be protected from exposure to blood and other body fluids as circumstances
dictate. Protection can be achieved through adherence to work practices designed to
minimise risk. Personal protective equipment (i.e. gloves, masks and protective clothing)
should be used to decrease exposure to hazards.

Blood Collection
(always use gloves and protective glasses)
Preferably use the evacuated blood tube (vacutainer) system.
Discard needle and syringe into sharps bin.

b. Change gloves between patient contacts.


c. Wash hands before and after using gloves.
d. Do not reuse surgical or examination gloves.
e. Use rubber household gloves for housekeeping chores involving potential blood
contact and for instrument cleaning and decontamination. These may be
decontaminated and reused but should be discarded if damaged.
f. Powder free gloves are recommended.

Hand washing Protocol


Meticulous hand washing is essential in order to maintain infection control in the
General Practice.
All staff should routinely wash their hands before and after all contact with
patients, as well as when cleaning up blood and body fluid spills in the surgery, and
removing gloves.

If any blood remains on sample tube stopper clean with an alcohol swab.

Staff should also ensure that they wash their hands before and after eating, smoking
and going to the toilet.

Transport the blood sample safely.

It is also essential that staff dry their hands thoroughly after washing.

Waste Management

Any cuts, abrasions or lesions should be covered at all times with water-resistant
dressings, which should be changed regularly.

Set up proper disposal procedures. Used gloves, swabs, disposable drapes etc. should be
bagged in a biohazard plastic bag (yellow with a black biohazard symbol), sealed and disposed
of appropriately. (See Qld Refuse Management Regulation (No. 1) (amended 1993).
Environmental Protection (Waste Management) Regulation 2000 - Queensland
Under the Environmental Protection Act 1994, a clinical and related waste management
plan is required for healthcare facilities.

Handling Sharps
Take care to prevent injury when handling suture needles, scalpels, sharp instruments.
Do not resheath used needles.

Place all disposable sharp items in an approved container (AS 4031:1992) which should
be located as close as possible to the use area.

12.43

a. Use sterile gloves for procedures involving contact with normally sterile areas of
the body, e.g. wound suturing etc. Use examination gloves (clean but not sterile)
for procedures involving contact with mucous membranes and for other patient
care or diagnostic procedures not requiring sterile gloves e.g. oral, vaginal or
rectal examination.

In the event of a sharps/needlestick injury, documented protocols should outline the


action to be taken by the injured person and the treating doctor.

MICROBIOLOGY

Additional Precautions are used for patients with MRSA, VRE, CJD or active pulmonary
tuberculosis, or where there is an established risk of transmission of infection regardless
of the nature of the procedure being undertaken, or where the procedure itself carries
an established risk of aerosolation, blood accident or staff/patient injury. Additional
Precautions are not required for patients with blood borne viruses such as HIV, Hepatitis
B or Hepatitis C, unless there are complicating factors present, such as pulmonary
tuberculosis, or unless the procedure itself performed on these patients has a known
high risk, such as generation of aerosols.

Guidelines for Gloves

APPENDICIES

Additional Precautions are designed to interrupt transmission of infection by these routes


and should be used in addition to Standard Precautions when transmission of infection
might not be contained by using Standard Precautions alone. Additional Precautions may
be specific to the situation for which they are required, or may be combined where microorganisms have multiple routes of transmission.

Routine Hand Washing Procedure (10-15 seconds)


Remove all rings, watches
and jewellery.

Wet hands with warm water, apply


recommended pH neutral liquid
soap, and lather vigorously.

Wash hands thoroughly beginning


with the palms, then backs of hands,
wrists, fingers, thumbs and between
fingers for 10 to 15 seconds.

Rinse hands thoroughly


under running water.

Turn taps off using paper towel,


if no elbow or foot controls
are available.

Dry hands thoroughly


using paper towel.

12.44

APPENDICIES

MICROBIOLOGY

APPENDICES - MICROBIOLOGY

Always observe standard precautions


Barricade the area around the spill to prevent other persons
going near the spillage.

Has true blood/body fluid


exposure occurred

NO

Complete incident record

YES
Collect cleaning material and equipment.

APPENDICIES

Body Fluid Exposure Procedure

MICROBIOLOGY

Clean up Procedure for Blood and Body Fluids

1. Apply first aid to injury

YES

2. Gently encourage bleeding


Wear heavy duty cleaning gloves and glasses (a plastic apron and
mask should be worn if there is a risk of a splash occurring).

Broken glass needs to be picked up with forceps or


scooped into an approved sharps container.

3. Wash thoroughly in running water

Complete incident record


and medical records

4. B
 athe eyes or damaged skin with copious
water and/or sterile saline if applicable

APPENDICIES

MICROBIOLOGY

APPENDICES - MICROBIOLOGY

Is source known

Never pick up broken glass pieces by hand!

For large spills > 10cms

For small spills < 10cms

YES

NO

spot cleaning
Wipe up blood spots
immediately with a damp
cloth, tissue or paper towel
using detergent and water.

Cover the spill with the


granules. Wait until the
spill has been absorbed
and then use cardboard to
pick up the spill.

Discard all contaminated


materials into medical waste
container for disposal.

Quarantine the affected


area until dry.

See hand washing


procedure (12.44).

Obtain consent
from source for
urgent HBsAg,
HepCAb and HIV
serology

Is source HIV
positive
or high risk

After discarding the


disposable items,
decontaminate all reusable
items, such as forceps and
safety glasses, etc.
After removal of gloves,
hands must be
washed thoroughly.

12.45

Wipe up blood spill


immediately with a damp
cloth, tissue or paper
towel using detergent
and water.

YES

NOTE: Chlorine releasing


granules are a corrosive
agent and may remove
colour from carpet and
soft furnishings.

Obtain immediate
urgent advice
from nearest
Infectious
Diseases
Physicians
regarding HIV
prophylaxis

Plus test
recipient

Urgent baseline
serology testing
for HIV, HepBsAb
(if immunised),
HepBsAg (if not
immunised) and
HepCAb

Not immune
HepB

Immune HepB
No HepB
Immunoglobin or
HepB vaccination

Obtain HepB
Immunoglobin
from Red Cross
Blood Service
within 48 hours.
Offer HepB
vaccination
course

Repeat baseline serology in 3 months

12.46

Contain the spill with


either chlorine releasing
granules or Kitty Litter.

1. OVERVIEW: Validation of your steriliser


requires that you run three consecutive
steriliser cycles. Each cycle must include
two biological indicator vials inside the
steriliser (one inside a pack, the other
outside the pack(s)). The remaining vial
is NOT sterilised, but acts as a control of
storage and transport conditions.

3. Validation of the sterilisation process


should be performed as soon as practical
after the technicians annual service.

4. Preclean, wash and dry the items


for sterilisation.

5. Ensure seven vials received and all have


the same lot/batch number. Label six vials
to indicate their location and cycle number
(see table) and label remaining vial as 'Z' to
be used as a control.

6. Select the most difficult to sterilise pack


and load* and record contents. Place one
indicator (i.e. '1E' for the first cycle) inside
the middle of challenge pack.

Steriliser chamber

7. Put this pack in the steriliser and place


a second indicator vial (i.e. '1C' for the
first cycle) in the coolest position in the
steriliser as identified from heat distribution
studies**. NB: Ensure vial does not come
into contact with metal as it will melt.
Place vial on gauze or paper so that it
does not make contact with the metal of
the autoclave.

Control vial outside


steriliser labelled Z

Vial inside package


labelled E

8. Run the steriliser for one cycle. The


length of the sterilisation period should be
three minutes plus the penetration time ** if
running at 134C.

9. Run two more cycles, repeating steps


4 to 6 each time. Use identical packages
with new indicator vials in the same
positions as before:
2nd cycle use vials labelled 2C and 2E.
3rd cycle use vials labelled 3C and 3E.
The one control vial 'Z' is NOT exposed to
the sterilisation cycle.

10. Keep a record of the date and time the


validation was performed, the time and
temperature for the cycles, the package
contents and the position of the pack(s) in
the steriliser.

11. Complete validation request form and


send along with the seven vials to the
laboratory for processing.

12. Validation does not need to be repeated


for another 12 months unless pack and/or
packaging density change, or the steriliser
undergoes a major service.

* The hardest to sterilise pack possible for your surgery in terms of packaging and pack density. Must also provide the
largest load possible for the steriliser.
** Heat distribution studies and penetration times should be provided by the technician as part of the annual service.

Vial inside chamber in


coolest position labelled C

CYCLE NUMBER

VIAL LABELS

1C (chamber); 1E (package)

2C (chamber); 2E (package)

3C (chamber); 3E (package)

Control Vial

MICROBIOLOGY

Please refer to the RACGP Sterilisation/Disinfection Guidelines


(www.racgp.org.au) for further information.

2. Order autoclave validation test request


form and seven biological indicator vials
through your routine QML Pathology
supply channel.

12.47

Steriliser Chamber with Package and Biological Indicator Vials

APPENDICIES

Validation of your Steriliser


Using Biological Indicator Vials

What to do after validation


After successful validation, biological indicator vials are not required for
routine monitoring of your steriliser. For routine monitoring you must either:
1. R
 ecord cycle parameters (time and temperature) either manually every 30 seconds or
using a printout from the steriliser.
OR
2. Use a Class 4, 5, or 6 chemical indicator.
NB. All packages should include an external Class 1 indicator (autoclave tape)
to identify those packages that have been sterilised.
Quality Control (QC) is performed on all batches of vials before they are distributed
to surgeries.
Further information on the validation of the sterilising process please contact
QML Pathology Microbiology Department on (07) 3121 4438.

12.48

APPENDICIES

MICROBIOLOGY

APPENDICES - MICROBIOLOGY

Symbols for Hazardous Categories

Infectious wastes: bags are yellow with the


internationally recognised biohazard symbol in black.

APPENDICIES

MICROBIOLOGY

APPENDICES - MICROBIOLOGY

Cytotoxic wastes: bags are purple with the cytotoxic


waste symbol (denoting a cell in telophase) which has
already been accepted widely in Australia.

Radioactive wastes: bags are red with the black


internationally recognised radioactivity symbol.

12.49

All chemicals should be labelled with their generic names. This label should indicate
any hazard and describe procedures in the event of an accident, including first aid and
clean up protocols.