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QML Pathology
Reference Manual
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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.
Preface 5.0
Mission Statement
1.1
Company History
1.2
2.1
2.13
3.1
3.1
Warfarin Service
3.2
Occupational Pathology
3.4
Vetnostics
3.5
Full Screen
Appendices 12.0
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
6.1
7.0
8.0
9.0
Specimen Storage
4.1
Order of Draw
4.2
4.3
Specimen Containers
4.6
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
Aerobic
bottle
Anaerobic
bottle
Paediatric
mini container
Paediatric
bottle
Tube MUST
be filled to
indicated level
COLLECTION MATERIALS
COLLECTION MATERIALS
COLLECTION MATERIALS
Paediatric
micro container
Paediatric
mini container
Paediatric
micro container
Paediatric
mini container
Paediatric
micro container
Paediatric
micro container
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.
(Pink top)
Blood group
Rh antibodies
Crossmatch (+ EDTAlavender top)
Group & hold serum (+ EDTAlavender top)
HLA B27 testing
Genetics (some)
COLLECTION MATERIALS
COLLECTION MATERIALS
COLLECTION MATERIALS
Tube MUST
be filled to
indicated level
Paediatric
mini container
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)
SPECIMEN CONTAINERS
micro container
mini container
COLLECTION MATERIALS
COLLECTION MATERIALS
COLLECTION MATERIALS
Sterile
container
Yellow monovette
ESR tube
ESR
8hr urine
collection bottle
24hr urine
collection bottle
4.6
4.5
Funnel
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
Sterile
container
COLLECTION MATERIALS
COLLECTION MATERIALS
COLLECTION MATERIALS
Nasopharyngeal tubing
4.9
4.10
Nasopharyngeal aspirate
RSV (Respiratory Syncytial Virus)
Influenza A & B,
Parainfluenza 1, 2, 3, Adenovirus
Bordetella Pertussis PCR
Lithium
Heparin tube
EDTA tube
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
Swabs
COLLECTION MATERIALS
COLLECTION MATERIALS
COLLECTION MATERIALS
4.14
4.13
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
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.
4.16
4.15
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.
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
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)
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.
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.
5.6
PREFACE - BIOCHEMISTRY
PREFACE - biochemistry
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.
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.
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.
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.
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.
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.
PREFACE - CYTOLOGY
PREFACE - CYTOLOGY
PREFACE - cytology
Monolayer Cytology:
5.14
5.13
Nipple Discharge
Label the specimen container 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).
Fluids
Sputum
Collect each specimen in a sterile container. Use one container for each collection.
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.
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
Diagram A
Diagram A
Syringe pistol
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
D
Insert needle into mass
Apply suction
Apply suction
Aspiration Techniques
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
Standard syringe
PREFACE - CYTOLOGY
PREFACE - CYTOLOGY
PREFACE - cytology
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.
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
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.
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
5.20
PREFACE - CYTOLOGY
PREFACE - cytology
SPECIMEN COLLECTION
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.
SPECIMEN PROCESSING
Freezing Serum
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.
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
5.22
PREFACE - ENDOCRINOLOGY
PREFACE - Endocrinology
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
Manager
Mark Blakey
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.
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.
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.
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.
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.
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
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.
CONSTITUTIONAL:
Blood
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).
5.27
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
PRENATAL:
ANDROLOGY
Chorionic Villus
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
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
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
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.
PATERNITY INVESTIGATION
5.30
5.29
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
Age > 50
Age > 50
FBC + E/LFT
APC-Resistance
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
COLLECTION REQUIREMENTS
General
Collection requirements for all tests are individually detailed in the A-Z test listing (6.0).
FBC + E/LFT
ACLA
ACLA
APC-Resistance
II 20210A Mutation
Homocysteine
FBC + E/LFT
ACLA
Factor V Leiden
II 20210A Mutation
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
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.
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
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
5.32
PREFACE - HAEMATOLOGY
PREFACE - HAEMATOLOGY
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.
Information Required:
Present dose
3. Consistency of bone
4. Provisional diagnosis.
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.
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).
5.34
5.33
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.
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
These simple procedures will ensure an optimum pathology report. Where appropriate an
orientating diagram will accompany the report.
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.
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.
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
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.
SKIN BIOPSIES
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.
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.
5.40
PREFACE - Histology
PREFACE - Histology
Punch Biopsy
Consider Culture
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
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.
Technical Details
Pigmented Lesions
PREFACE - Histology
PREFACE - Histology
PREFACE - Histology
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.
5.42
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).
How to Biopsy
Incision Biopsy
Punch Biopsy
Blotchy, macular
3. Local Anaesthesia
1 or 2% lignocaine with 1:100 000 adrenaline is suggested.
Annular
sometimes
unsuitable for punch
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
PREFACE - Histology
PREFACE - Histology
PREFACE - Histology
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.
5.44
5.43
For further information please contact the Histology Department on (07) 3121 4495.
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
Punch Biopsy
with internal plunger
2, 3, 4
Punch Biopsy
without plunger
2, 3, 4, 5, 6, 8
PREFACE - Histology
PREFACE - Histology
PREFACE - Histology
5.46
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.
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:
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.
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,
5.48
PREFACE - IMMUNOLOGY
PREFACE - IMMUNOLOGY
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.
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.
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).
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
PREFACE - IMMUNOLOGY
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
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.
5.50
PREFACE - IMMUNOLOGY
PREFACE - IMMUNOLOGY
Request Form
The following relevant information should always accompany any request for
bacteriological examination:
Coughed sputum
Rectal swab
Urine
Faeces
Throat swab
Ileostomy/colostomy drainage
Urethral swab
Nasopharyngeal swab
PREFACE - MICROBIOLOGY
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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.
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.
5.52
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.
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.
PREFACE - MICROBIOLOGY
Blood Culture
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.
5.54
PREFACE - MICROBIOLOGY
PREFACE - MICROBIOLOGY
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.
Suction
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.
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.
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.
5.55
PREFACE - MICROBIOLOGY
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.
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.
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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
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
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
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
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
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
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
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
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
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
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
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
Autoimmune Disease
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
Measles
Arbovirus
Rickettsia
CMV
Syphilis
Parvovirus
HIV
Streptococcus
CMV
Adenovirus
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
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
17-HYDROXYPROGESTERONE,
SERUM
1-HYDROXYPYRENE, URINE
Endocrinology
Blood/SS tube
1 week
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.
Biochemistry
Biochemistry
Biochemistry
25-HYDROXY
CHOLECALCIFEROL, SERUM
25-HYDROXY VITAMIN D,
SERUM
25-HYDROXY VITAMIN D3,
SERUM
3-HYDROXYBUTYRATE,
SERUM OR PLASMA
Biochemistry
Biochemistry
Biochemistry
4-HYDROXY-3-METHOXY
MANDELIC ACID, URINE
Biochemistry
www.qml.com.au
SPECIMEN CONTAINER
Biochemistry
Biochemistry
Biochemistry
1 week
PATHOLOGY TESTS - A
TEST NAME
1,1,1,TRICHLOROETHANE, BLOOD
1,25-DIHYDROXY
CHOLECALCIFEROL
1,25-DIHYDROXY VITAMIN D,
SERUM
7.0
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Urine/Urine container
2 - 3 weeks
5-H.I.A.A., URINE
Biochemistry
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
Biochemistry
ACE, SERUM
Biochemistry
ACETAMINOPHEN, SERUM
Biochemistry
ACETOACETATE, SERUM
Biochemistry
ACETOACETATE, URINE
Biochemistry
ACETONE, BLOOD
Biochemistry
ACETONE, URINE
Biochemistry
Biochemistry
www.qml.com.au
Biochemistry
PATHOLOGY TESTS - A
TEST NAME
5-ALA, URINE
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.
7.1
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Test is currently unavailable due to withdrawal of the sulphonamines used in the test.
Immunology
Blood/SS tube
1 week
Biochemistry
Amniotic fluid/Plain
plastic tube
1 week
ACETYLCHOLINESTERASE,
RED CELL
Biochemistry
1 day
Biochemistry
Biochemistry
Blood/SS tube
Biochemistry
Haematology
Blood/SS tube
and EDTA tube
24 hours
Endocrinology
Blood/SS tube
and EDTA tube
24 hours
www.qml.com.au
PATHOLOGY TESTS - A
TEST NAME
ACETYLATOR PHENOTYPE,
BLOOD/URINE
ACETYLCHOLINE RECEPTOR
ANTIBODY, SERUM
ACETYLCHOLINESTERASE,
AMNIOTIC FLUID
7.2
PATHOLOGY TESTS - A
PATHOLOGY TESTS
TEST NAME
ACTH, PLASMA
DEPARTMENT
SPECIMEN CONTAINER
Endocrinology
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.
Haematology
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
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
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.
Biochemistry
Blood/SS tube
1 - 2 weeks
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
7.3
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
72 hours
ADENYLSUCCINASE, URINE
Biochemistry
Urine/Urine container
1 - 2 weeks
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
ADRENOCORTICOTROPHIC
HORMONE (ACTH), PLASMA
Endocrinology
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.
Endocrinology
Blood/SS tube
24 hours
Endocrinology
Blood/SS tube
24 hours
Period of amenorrhoea (A=) and estimated date of confinement (EDC) required for
test interpretation.
Immunology
Blood/SS tube
24 hours
AIDS SEROLOGY
Immunology
ALA, URINE
Biochemistry
ALBUMIN, FLUID
Biochemistry
ALBUMIN, SERUM
Biochemistry
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
Fluid/Plain tube/Container
Same day
Synovial fluid/
Plain plastic tube
Same day
7.4
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Urine/Urine container.
No preservative
24 hours
ALBUMIN/GLOBULIN RATIO,
SYNOVIAL FLUID
ALBUTEROL, URINE
Biochemistry
Biochemistry
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
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
ALDICARB (PESTICIDE),
BLOOD
Biochemistry
ALDOLASE, SERUM
Biochemistry
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
7.5
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Endocrinology
1 week
Urine should be refrigerated during the collection period and transported cooled to
the laboratory.
ALDOSTERONE/RENIN RATIO,
PLASMA
Endocrinology
24 hours
ALDRIN (ORGANOCHLORINE
PESTICIDES), BLOOD
ALEPAM, SERUM
Biochemistry
Biochemistry
ALIPHATIC SOLVENTS
Biochemistry
ALKALINE PHOSPHATASE
ISOENZYMES, SERUM
Biochemistry
Blood/SS tube
2 - 3 days
ALKALINE PHOSPHATASE,
FLUID
Biochemistry
Fluid/Plain tube/
Container
Same day
7.6
ALKALINE PHOSPHATASE,
Biochemistry
SERUM
ALKAPTONURIA SCREEN, URINE Biochemistry
ALLEGRON, SERUM
Biochemistry
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.
Immunology
72 hours
ALLOPURINOL, PLASMA
Biochemistry
ALODORM, SERUM
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - A
TEST NAME
ALDOSTERONE,
URINE 24 HOUR
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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.
Endocrinology
Blood/SS tube
1 - 2 weeks
Referred test.
ALPHA THALASSAEMIA
GENE TESTING
Haematology
4 weeks
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
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
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
Biochemistry
Blood/SS tube
1 - 2 weeks
Endocrinology
Blood/SS tube
24 hours
7.7
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
Biochemistry
Biochemistry
Biochemistry
ALT, FLUID
Biochemistry
Fluid/Plain tube/Container
Same day
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
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
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.
7.8
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/Lithium
heparin tube
2 weeks
Biochemistry
Biochemistry
Biochemistry
Biochemistry
AMIODARONE, SERUM
Biochemistry
AMISULPRIDE, SERUM
Biochemistry
AMITRIPTYLINE, SERUM
Biochemistry
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).
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.
1 week
1 month
7.9
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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.
Biochemistry
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
1 - 2 weeks
AMOEBIC SEROLOGY
Immunology
Blood/SS tube
1 week
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
Biochemistry
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
Same day
AMYLO-1,6-GLUCOSIDASE,
BLOOD
Biochemistry
Blood/Lithium
heparin tube
2 weeks
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
7.10
7.10
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Microbiology
Aspirated pus/Anaerobic
transport medium
Up to 7 days
ANAFRANIL, SERUM
Biochemistry
Immunology
Blood/SS tube
72 hours
Genetics
Blood/EDTA tube
1 month
ANDROSTENEDIONE, SERUM
Endocrinology
Blood/SS tube
24 hours
Blood/EDTA tube
1 - 2 months
Blood/SS tube
2 - 3 weeks
Blood/SS tube
24 hours
24 hours
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.
Immunology
Blood/SS tube
4 weeks
Endocrinology
Blood/SS tube
24 hours
Biochemistry
Blood/SS tube
2 weeks
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.
7.11
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
72 hours
Endocrinology
Blood/SS tube
24 hours
Endocrinology
Blood/SS tube
24 hours
Endocrinology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
2 - 4 weeks
Microbiology
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
ANTIBODIES TO TISSUE
ANTIGENS (AUTOANTIBODIES),
SERUM
Immunology
Blood/SS tube
Variable from 24
hours depending
on antibody tests
required
ANTIBODY SCREEN/TITRE,
SERUM
Blood Bank
Blood/Pink top
EDTA tube
24 hours
ANTI-CYCLIC CITRULLATED
PEPTIDE (CCP) ANTIBODY
Immunology
Blood/SS tube
72 hours
www.qml.com.au
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
Endocrinology
2 - 3 weeks
ANTI-GQ1B ANTIBODY
Immunology
Blood/SS tube
2 - 3 weeks
ANTI-HU ANTIBODIES
Immunology
Blood/SS tube
2 - 3 weeks
Biochemistry
Blood/Lithium
heparin tube (EDTA
tube acceptable)
4 weeks
Biochemistry
Urine/Urine container
4 weeks
ANTINUCLEAR
ANTIBODY (ANA), SERUM
Immunology
Blood/SS tube
24 hours
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
Test performed
fortnightly
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.
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
Haematology
Blood/Sodium
citrate tube
24 hours
PATHOLOGY TESTS - A
PATHOLOGY TESTS - A
PATHOLOGY TESTS
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
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
7.14
7.14
DEPARTMENT
Biochemistry
APO B, SERUM
Biochemistry
Biochemistry
Blood/SS tube
24 hours
APOLIPOPROTEIN B, SERUM
Biochemistry
Blood/SS tube
24 hours
Blood/SS tube
2 weeks
Blood/Pink top
EDTA tube
1 week
APOLIPOPROTEIN STUDIES,
SERUM
APTT (COAGULATION PROFILE)
Biochemistry
Blood/SS tube
24 hours
Haematology
Blood/Sodium
citrate tube
Same day
Haematology
Blood/Sodium citrate
and EDTA tubes
Same day
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
ARGININE/INSULIN
GROWTH HORMONE
STIMULATION TEST
Endocrinology
Blood/SS tube
24 hours
www.qml.com.au
SPECIMEN CONTAINER
PATHOLOGY TESTS - A
TEST NAME
APO A1, SERUM
7.15
7.15
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
4 weeks
AROMATIC SOLVENTS
Biochemistry
Biochemistry
ARSENIC, BLOOD
Biochemistry
Blood/Lithium
heparin tube (EDTA
tube acceptable)
4 weeks
ARSENIC, HAIR
Biochemistry
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
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
Biochemistry
ASHPLEX 1, BLOOD
Biochemistry
Blood/EDTA tube
4 weeks
ASHPLEX 2, BLOOD
Biochemistry
Blood/EDTA tube
4 weeks
Biochemistry
Blood/EDTA tube
4 weeks
Immunology
Blood/SS tube
24 hours
www.qml.com.au
PATHOLOGY TESTS - A
TEST NAME
ARIPIPRAZOLE, SERUM
Immunology
Blood/SS tube
3 - 4 weeks
Biochemistry
Fluid/Sterile container
Same day
7.16
7.16
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
ASPIRIN, SERUM
Biochemistry
Biochemistry
AST, FLUID
Biochemistry
Biochemistry
Blood Bank
24 hours
ATYPICAL
MYCOBACTERIA MICROSCOPY
AND CULTURE
Microbiology/
Histology
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.
Blood/SS tube
Variable from
24 hours
depending on
antibody tests
required
www.qml.com.au
SPECIMEN CONTAINER
Biochemistry
Immunology
Immunology
Fluid/Plain tube/Container
1 week
Same day
PATHOLOGY TESTS - A
TEST NAME
ASPARTATE TRANSAMINASE,
RED CELL
ASPERGILLUS SEROLOGY
7.17
7.17
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Microbiology
48 hours
AUTOPSY (ADULT/CHILDREN/
NEONATES)
Histology
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
7.18
7.18
PATHOLOGY TESTS - A
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
2 weeks
BARBITURATES SCREEN,
SERUM
BARBITURATES SCREEN,
URINE
Biochemistry
Biochemistry
Immunology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
2 weeks
Genetics
2 weeks
BCL-1 [t(11;14)]
DNA TESTING
Genetics
2 weeks
BCL-2 [t(14;18)]
DNA TESTING
Genetics
2 weeks
Genetics
1 - 2 days
Blood or Bone marrow/
Lithium heparin tube or min.
1mL bone marrow in Lithium
heparin tube
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
2 weeks
7.19
7.19
PATHOLOGY TESTS - B
PATHOLOGY TESTS
DEPARTMENT
BENDIOCARB (PESTICIDE),
BLOOD
Biochemistry
BENZENE, BLOOD
Biochemistry
Biochemistry
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
48 hours
Biochemistry
Blood/EDTA tube
2 weeks
Biochemistry
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
Biochemistry
Biochemistry
Biochemistry
Urine/Urine container or
24 hours
24 hour urine container with
no preservative - random or
24 hour only
PATHOLOGY TESTS - B
TEST NAME
BECKER MUSCULAR
DYSTROPHY, BLOOD
BENCE JONES PROTEIN,
SERUM
BENCE JONES PROTEIN,
URINE
7.20
7.20
PATHOLOGY TESTS - B
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
Biochemistry
Biochemistry
Biochemistry
BETA-ALANINE, SERUM OR
URINE 24 HOUR
Biochemistry
BICARBONATE, FLUID
Biochemistry
BICARBONATE, SERUM
Biochemistry
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.
Biochemistry
Urine/Urine container
Same day
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
7.21
7.21
PATHOLOGY TESTS - B
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/SS tube
Same day
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).
Biochemistry
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
BILIRUBIN, URINE
Biochemistry
BIOCHEMISTRY, CSF
Biochemistry
CSF/Plain tube
Same day
BIOPSY TISSUE
FOR MICROSCOPY
AND CULTURE
Microbiology
BIOPTERIN, URINE
Biochemistry
BIOTINIDASE, PLASMA
Biochemistry
BISCODYL, FAECES
Biochemistry
BISMUTH, BLOOD
Biochemistry
Blood/EDTA tube
2 weeks
BK VIRUS
Immunology
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.
2 weeks
Referred test.
Please refer to LAXATIVES, FAECES.
Test for exposure. Referred test.
7.22
7.22
PATHOLOGY TESTS - B
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Cytology
Fluid/Appropriate sterile
container
24 hours
BLEEDING STUDIES
Haematology
Same day
BLEEDING TIME
Haematology
Same day
Same day
BLOOD CROSSMATCH
Blood Bank
Blood/Pink top
EDTA tube
Same day or
urgently
Microbiology
Interim report
after 2 days.
Final report
after 7 days.
Mycobacteria
report after 6
weeks.
Biochemistry
Arterial blood/
Blood gas syringe
Same day
Biochemistry
Venous Blood/Blood
gas syringe
Same day
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
PATHOLOGY TESTS - B
TEST NAME
BLADDER WASHINGS,
CYTOLOGY
7.23
7.23
PATHOLOGY TESTS - B
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Blood Bank
Blood/Pink top
EDTA tube
24 hours
Blood Bank
Blood/Pink top
EDTA tube
24 hours
Blood Bank
Blood/Pink top
EDTA tube
24 hours
BLOOD TRANSFUSION
REACTION INVESTIGATION,
BLOOD AND URINE
Blood Bank
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.
Haematology
Blood/Sterile vials
available on request
from Haematology
24 hours
BNP, PLASMA
Biochemistry
Blood/EDTA tube
Same day
Microbiology
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
Microbiology
Interim report after Please provide clinical details including antibiotic therapy.
48 hours. Final
Specimen will be cultured for Mycobacteria and fungi.
report 21 days.
Haematology
24 hours
Biochemistry
Blood/SS tube
Same day
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - B
TEST NAME
BLOOD GROUP ANTIBODIES
7.24
7.24
PATHOLOGY TESTS - B
PATHOLOGY TESTS
PATHOLOGY TESTS - B
TEST NAME
BONE SPECIFIC ALKALINE
PHOSPHATASE
BORDETELLA PERTUSSIS PCR
DEPARTMENT
SPECIMEN CONTAINER
Endocrinology
Blood/SS tube
1 week
Immunology
Nasopharyngeal aspirate or
Nasopharyngeal swab (dry)
24 hours
BORDETELLA PERTUSSIS
SEROLOGY
BORON, URINE
Immunology
Blood/SS tube
24 hours
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.
Endocrinology
Blood/SS tube
24 hours
Biochemistry
Blood/EDTA tube
Same day
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
24 hours
Cytology
24 hours
Endocrinology
Blood/SS tube
24 hours
www.qml.com.au
Biochemistry
7.25
7.25
PATHOLOGY TESTS - B
PATHOLOGY TESTS
SPECIMEN CONTAINER
48 hours
Biochemistry
48 hours
BREATH TEST
(CARBON - 14 UREA) FOR
HELICOBACTER PYLORI
Endocrinology
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.
Biochemistry
BRONCHIAL BRUSHING
CYTOLOGY
Cytology
24 hours
BRONCHIAL WASHING
CYTOLOGY
BRONCHIAL WASHINGS,
MICROSCOPY
AND CULTURE
Cytology
Fluid/Aspirating trap
24 hours
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
Immunology
Blood/SS tube
72 hours
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
7.26
7.26
PATHOLOGY TESTS - B
PATHOLOGY TESTS
SPECIMEN CONTAINER
Blood/EDTA tube
Same day
4 - 6 weeks
BUPRENORPHINE SCREEN,
URINE
Urine/Urine container
2 weeks
www.qml.com.au
Biochemistry
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
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
C2, SERUM
Biochemistry
C3 NEPHRITIC FACTOR,
SERUM
Biochemistry
C3, SERUM
Biochemistry
C4, SERUM
Biochemistry
C5, SERUM
Biochemistry
CA 125, SERUM
Endocrinology
Blood/SS tube
24 hours
CA 15-3, SERUM
Endocrinology
Blood/SS tube
24 hours
CA 19-9, SERUM
Endocrinology
Blood/SS tube
24 hours
CA 724, SERUM
Endocrinology
Blood/SS tube
4 - 5 weeks
A marker for stomach tumours. See Biochemistry Appendix (12.4). Referred test.
Genetics
Blood/EDTA tube
4 - 6 weeks
Biochemistry
Blood/EDTA tube
(Lithium heparin
tube acceptable)
1 week
www.qml.com.au
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.
7.28
7.28
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
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***
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
CALCITONIN, SERUM
Endocrinology
Blood/SS tube
1 weeks
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.
Genetics
Blood/EDTA tube
2 months
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
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).
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PATHOLOGY TESTS - C
TEST NAME
CADMIUM (Cd), HAIR
7.29
7.29
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
24 hours
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
Immunology
Blood/SS tube
1 week
Biochemistry
Biochemistry
CARBAMAZEPINE,
SERUM
Biochemistry
CARBARYL (PESTICIDE),
BLOOD
Biochemistry
CARBOHYDRATE DEFICIENT
TRANSFERRIN, SERUM
Biochemistry
Blood/SS tube
1 week
CARBON - 14 UREA
BREATH TEST FOR
HELICOBACTER PYLORI
Endocrinology
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.
Biochemistry
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Same day
or urgently
PATHOLOGY TESTS - C
TEST NAME
CALCIUM, URINE
7.30
7.30
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
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.
Biochemistry
Blood/SS tube
Same day
CARDIOLIPIN ANTIBODY,
SERUM
CARNITINE,
NEONATAL SCREEN
CARNITINE, SERUM
Immunology
Blood/SS tube
72 hours
Biochemistry
Please refer to ACYL CARNITINE, NEONATAL SCREEN for details. Referred test.
Biochemistry
Biochemistry
CAROTENOIDS, SERUM
Biochemistry
Blood/SS tube
24 hours
Genetics
2 days
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).
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PATHOLOGY TESTS - C
TEST NAME
CARBOXYHAEMOGLOBIN,
BLOOD
7.31
7.31
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/Lithium heparin
tube with 1 mg of sodium
metabisulphite added
1 - 2 weeks
CATECHOLAMINES,
URINE
Biochemistry
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.
Haematology
Blood/EDTA tube or
ACD yellow top tube
Same day
CD4/CD8 T LYMPHOCYTE
RATIO, BLOOD
Haematology
24 hours
CDT, SERUM
Biochemistry
CEA (CARCINOEMBRYONIC
ANTIGEN), SERUM
Endocrinology
24 hours
Please provide clinical and medication details. Provide date of previous CEA assay
if patient is being monitored post operatively.
Blood/SS tube or
Plain tube
4 weeks
Haematology
4 weeks
CELLCEPT, PLASMA
Biochemistry
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PATHOLOGY TESTS - C
TEST NAME
CATECHOLAMINES, BLOOD
7.32
7.32
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Collect just prior to next dose. Provide clinical and medication details.
Cytology
48 - 72 hours
For specimen preparation and details of adjunctive tests (ThinPrep), please refer to
Cytology Preface (5.11).
Genetics
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.
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.
Immunology
24 hours
CHLAMYDIA SEROLOGY
SCREEN
CHLORDANE
(ORGANOCHLORINE
PESTICIDES), BLOOD
CHLORIDE, CSF
Immunology
Blood/SS tube
72 hours
CHLORIDE, FAECES
Biochemistry
Faeces/Faeces container
24 hours
CHLORIDE, FLUID
Biochemistry
Fluid/Plain tube/Container
Same day
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
CHLOROETHANE, BLOOD
Biochemistry
www.qml.com.au
Biochemistry
Biochemistry
PATHOLOGY TESTS - C
TEST NAME
CEPHALOSPORINS,
SERUM/PLASMA
7.33
7.33
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
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
CHLORPYRIFOS (PESTICIDE),
SERUM
Biochemistry
Biochemistry
7.34
SPECIMEN CONTAINER
Same day
CHOLESTEROL, SERUM
Biochemistry
Biochemistry
CHOLINESTERASE,
RED CELL
Biochemistry
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PATHOLOGY TESTS - C
TEST NAME
CHLOROFORM , BLOOD
7.34
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
2 weeks
CHROMIUM, URINE
Biochemistry
Urine/Urine container
2 weeks
CHROMOGRANIN A, SERUM
Biochemistry
Blood/SS tube
3 weeks
CHROMOSOMES,
AMNIOTIC FLUID
Genetics
1 - 2 weeks
CHROMOSOMES, BLOOD
Genetics
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
2 weeks
CHROMOSOMES,
CHORIONIC VILLI
Genetics
1 - 2 weeks
CHROMOSOMES,
LYMPH NODE
Genetics
Lymph node/Antibiotic
transport medium
2 - 6 weeks
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PATHOLOGY TESTS - C
TEST NAME
CHOLINESTERASE, SERUM
7.35
7.35
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
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
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
Genetics
Blood/EDTA tube
Indeterminate
Biochemistry
Indeterminate
CILIAL BIOPSY
Histology
Hartmanns Solution
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
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
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PATHOLOGY TESTS - C
TEST NAME
CHROMOSOMES,
PRODUCTS OF CONCEPTION
7.36
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/SS tube
2 weeks
Biochemistry
Blood/SS tube
Same day
CK, SERUM
Biochemistry
Blood/SS tube
Same day
Genetics
1 - 2 months
CLOBAZAM, SERUM
Biochemistry
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
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
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
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PATHOLOGY TESTS - C
TEST NAME
CK ISOENZYMES
ELECTROPHORESIS, SERUM
CK ISOENZYMES, SERUM
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).
7.37
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
CMV (CYTOMEGALOVIRUS)
SEROLOGY
COAGULATION STUDIES,
BLOOD
Immunology
Blood/SS tube
24 hours
Haematology
Same day
COBALT, BLOOD
Biochemistry
4 weeks
COBALT, URINE
Biochemistry
Urine/Urine container
1 week
COCAINE METABOLITES
- GCMS CONFIRMATION
Biochemistry
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.
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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
7.38
7.38
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
2 - 3 weeks
CODEINE, SERUM
Biochemistry
2 weeks
CODIPHEN, SERUM
Biochemistry
CODRAL, SERUM
Biochemistry
Biochemistry
1 - 2 weeks
Please protect the sample from light and send to the laboratory without delay.
Referred test.
Blood Bank
Blood/SS tube
pre-warmed to 37C
Same day
Haematology
Blood/Sodium
citrate tube
1 - 4 weeks
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
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.
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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.
PATHOLOGY TESTS - C
TEST NAME
COCCIDIOIDES SEROLOGY
7.39
7.39
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
2 months
Biochemistry
Genetics
Blood/EDTA tube
1 month
Blood Bank
Same day
COPPER, HAIR
Biochemistry
4 weeks
Biochemistry
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
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PATHOLOGY TESTS - C
TEST NAME
COMPLEMENT-C2, SERUM
7.40
7.40
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/SS tube
1 week
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
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
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
Blood/SS tube
72 hours
Biochemistry
7.41
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Faeces/Faeces container
Screen:
1 - 7 days
Quantitation:
1 - 2 weeks
PATHOLOGY TESTS - C
TEST NAME
COPPER, SERUM
7.41
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Endocrinology
Blood/SS tube
24 hours
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
24 hours
C-REACTIVE PROTEIN,
SERUM
Biochemistry
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
Biochemistry
CREATINE, PLASMA
Biochemistry
CREATININE CLEARANCE
Biochemistry
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
CREATININE, SERUM
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - C
TEST NAME
C-PEPTIDE SERUM
3 weeks
Same day
Centrifuge sample and separate plasma where possible. Transport sample on dry ice.
7.42
7.42
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
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
CROSS LINKED
N-TELOPEPTIDES, URINE
CROSSMATCH, BLOOD
Biochemistry
Biochemistry
CRP, SERUM
Biochemistry
CRYOFIBRINOGEN,
PLASMA AND SERUM
Biochemistry
www.qml.com.au
Blood Bank
Same day
PATHOLOGY TESTS - C
TEST NAME
CREATININE,
URINE 24 HOUR
7.43
7.43
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
72 hours
CRYOGLOBULINS,
PLASMA AND SERUM
CRYOGLOBULINS/
CRYOFIBRINOGEN,
PLASMA AND SERUM
CRYPTOCOCCUS ANTIGEN,
SERUM OR CSF
Biochemistry
Biochemistry
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
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.
Biochemistry
CSF CYTOLOGY
Cytology
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PATHOLOGY TESTS - C
TEST NAME
CRYOFIBRINOGEN/
CRYOGLOBULINS,
PLASMA AND SERUM
24 hours
7.44
7.44
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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.
Microbiology
Cerebrospinal fluid/
Sterile tubes labelled
1, 2, 3 or 4
Same day
Biochemistry
Biochemistry
CYANIDE, URINE
Biochemistry
CYCLIC AMP,
BLOOD AND URINE 24 HOUR
Endocrinology
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.
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
2 weeks
www.qml.com.au
PATHOLOGY TESTS - C
TEST NAME
CSF MALIGNANT CELLS
7.45
7.45
PATHOLOGY TESTS - C
PATHOLOGY TESTS
CYTOMEGALOVIRUS (CMV)
SEROLOGY
CYTOTOXIC FOOD TESTING
www.qml.com.au
SPECIMEN CONTAINER
Immunology
Blood/SS tube
24 hours
Specimen
Distribution
Blood/ACD tube
Collection and
transfer only
PATHOLOGY TESTS - C
TEST NAME
DEPARTMENT
CYTOMEGALOVIRUS (CMV) PCR Immunology
7.46
7.46
PATHOLOGY TESTS - C
PATHOLOGY TESTS
DEPARTMENT
Biochemistry
DANTHRON, FAECES
Biochemistry
Genetics
DDE LEVELS
(ORGANOCHLORINE
PESTICIDES), BLOOD
D-DIMER TEST
Biochemistry
DDT LEVELS
(ORGANOCHLORINE
PESTICIDES), BLOOD
DELTA ALA, URINE
Biochemistry
Biochemistry
DEMETON (PESTICIDE),
SERUM
Biochemistry
DENGUE SEROLOGY
Immunology
Blood/SS tube
24 hours
DENTATORUBRALPALLIDOLUYSIAN ATROPHY
(DRPLA) GENETIC TESTING
DEOXYCORTICOSTERONE,
SERUM
DEOXYCORTISOL, SERUM
Genetics
Blood/EDTA tube
1 - 2 months
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
2 weeks
Same day
PATHOLOGY TESTS - D
TEST NAME
DANTHRON, BLOOD
1 week
7.47
7.47
PATHOLOGY TESTS - D
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
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
PATHOLOGY TESTS - D
TEST NAME
DESIPRAMINE, SERUM
24 hours
7.48
7.48
PATHOLOGY TESTS - D
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
DIASTASE, URINE
Biochemistry
DIAZEPAM, SERUM
Biochemistry
Biochemistry
Biochemistry
DICHLOROMETHANE, BLOOD
Biochemistry
DICHROMATE, BLOOD
Biochemistry
DICOFOL (ORGANOCHLORINE
PESTICIDES), BLOOD
DIELDRIN (ORGANOCHLORINE
PESTICIDES), BLOOD
DIELDRIN, BREAST MILK
Biochemistry
Biochemistry
Biochemistry
Breast milk/Glass
sterile container
4 weeks
Biochemistry
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
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.
7.49
7.49
PATHOLOGY TESTS - D
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
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
DIHYDROXY
CHOLECALCIFEROL, SERUM
DIHYDROXY VITAMIN D,
SERUM
DILANTIN, SERUM
Biochemistry
Biochemistry
DIMETHOATE (PESTICIDE),
SERUM
Biochemistry
DIPHENYLHYDANTOIN, SERUM
Biochemistry
DIPHTHERIA SEROLOGY
(TOXIN ANTIBODY SCREEN)
DIQUAT, URINE
Immunology
Biochemistry
Blood/SS tube
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.
Nasopharyngeal aspirate/
Aspirating trap
24 hours
Blood/Pink top
EDTA tube
Same day
Blood/Pink top
EDTA tube
Same day
www.qml.com.au
Blood Bank
PATHOLOGY TESTS - D
TEST NAME
DIGOXIN, SERUM
7.50
7.50
PATHOLOGY TESTS - D
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Microbiology
Faeces/Faeces container
48 hours
DISACCHARIDASES,
INTESTINAL BIOPSY TISSUE
DISOPYRAMIDE, SERUM
Biochemistry
Biochemistry
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
D-LACTATE, URINE
Biochemistry
1 week
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
Haematology
Blood/Refer Haematology
Department
24 hours
DONOVANOSIS
Cytology
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
Biochemistry
DOTHIEPIN, SERUM
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - D
TEST NAME
DIRECT IMMUNO
FLUORESCENT ASSAY
(GIARDIA)
7.51
7.51
PATHOLOGY TESTS - D
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
72 hours
Biochemistry
DPYD, URINE
Biochemistry
DRUG SCREEN
(BROAD SPECTRUM
INVESTIGATION BY THIN
LAYER CHROMATOGRAPHY),
URINE
Biochemistry
Urine/Urine container
48 hours
DRUG SCREEN
(OCCUPATIONAL/INDUSTRY
(AS/NZS4308 GUIDELINES)),
URINE
Biochemistry
48 hours
DRUG SCREEN
(NON OCCUPATIONAL),
URINE
Biochemistry
48 hours
Biochemistry
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
PATHOLOGY TESTS - D
TEST NAME
DOUBLE-STRANDED
DNA ANTIBODY, SERUM
DOXEPIN, SERUM
7.52
7.52
PATHOLOGY TESTS - D
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
24 hours
Biochemistry
DRUGS,
QUANTITATIVE ASSAY,
SERUM
Biochemistry
DUCENE, SERUM
Biochemistry
DUCHENNE MUSCULAR
DYSTROPHY, BLOOD
DURSBAN (PESTICIDE),
SERUM
Biochemistry
Biochemistry
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - D
TEST NAME
DRUG SCREEN, SERUM
Blood/EDTA tube
See individual
drugs or Appendix.
Some results
available urgently
when required.
3 - 4 weeks
7.53
7.53
PATHOLOGY TESTS - D
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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.
Microbiology
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
Same day
ECHO-COXSACKIE
VIRUS SEROLOGY
EFAVIRENZ, PLASMA
Immunology
Blood/SS tube
72 hours
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
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
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.
7.54
7.54
PATHOLOGY TESTS - E
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
24 hours
ELECTROLYTES/UREA/
CREATININE, SERUM
ENDEP, SERUM
Biochemistry
Biochemistry
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.
Microbiology
Water samples/
Urine container
4 - 6 weeks
ENDOSULFAN
(ORGANOCHLORINE
PESTICIDES), BLOOD
ENDRIN (ORGANOCHLORINE
PESTICIDES), BLOOD
ENTAMOEBA HISTOLYTICA
SEROLOGY
ENTEROVIRUS PCR
Biochemistry
Biochemistry
ENTEROVIRUS SEROLOGY
www.qml.com.au
1 week
Washings from the endoscope channels are collected after cleaning by endoscopy
unit staff at the hospital.
Immunology
Blood/SS tube
Immunology
Immunology
Blood/SS tube
72 hours
PATHOLOGY TESTS - E
TEST NAME
ELECTROLYTES, URINE
7.55
7.55
PATHOLOGY TESTS - E
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Microbiology
48 hours
EPILIM, SERUM
Biochemistry
EPINEPHRINE,
URINE 24 HOUR
EPP, SERUM
Biochemistry
Biochemistry
EPP, URINE
Biochemistry
Immunology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
2 - 3 weeks
ERYTHROCYTE PBG
DEAMINASE, BLOOD
ERYTHROCYTE
SEDIMENTATION RATE
ERYTHROPOIETIN ASSAY,
SERUM
ESGRAM, URINE
Biochemistry
ESR, BLOOD
Haematology
Biochemistry
Biochemistry
ETHYLENE DI BROMIDE,
URINE
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - E
TEST NAME
ENVIRONMENTAL SPECIMEN
Haematology
Blood/EDTA tube
Same day
Haematology
Blood/SS tube
1 week
Biochemistry
Blood/EDTA tube
Same day
7.56
7.56
PATHOLOGY TESTS - E
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
2 weeks
Please keep the sample cool and forward to the laboratory without delay.
Haematology
Blood/Sodium
citrate tube
24 hours
EVEROLIMUS, BLOOD
Biochemistry
Blood/EDTA tube
1 week
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.
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
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
7.57
7.57
PATHOLOGY TESTS - E
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
72 hours
FABRY HETEROZYGOTE,
BLOOD & URINE
Biochemistry
Up to 5 months
Haematology
Haematology
Haematology
Genetics
Haematology
Haematology
Haematology
Haematology
Haematology
Haematology
Haematology
Biochemistry
Biochemistry
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.
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
FAECES MICROSCOPY
AND CULTURE
Microbiology
Faeces/Faeces container
FAECES, CLOSTRIDIUM
DIFFICILE TOXIN
Microbiology
Faeces/Faeces container
FAMILIAL ADENOMATOUS
POLYPOSIS (FAP)
GENETIC TESTING
Genetics
Blood/EDTA tube
Indeterminate
FAMILIAL MEDITERRANEAN
Genetics
FEVER (FMF) GENETIC TESTING
Blood/EDTA tube
6 weeks
Blood/SS tube
2 - 3 weeks
Blood/Lithium
heparin tube
(EDTA tube acceptable)
2 weeks
www.qml.com.au
SPECIMEN CONTAINER
Biochemistry
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.
7.59
7.59
PATHOLOGY TESTS - F
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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.
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.
Biochemistry
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
FERRITIN, SERUM
Biochemistry
FERROPORTIN
GENE ANALYSIS
Biochemistry
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.
Haematology
Maternal blood/
1 EDTA tube, 2 blood films
Same day
or urgently
Haematology
Blood/Sodium
citrate tube
Same day
FIBRONECTIN, PLASMA
Biochemistry
Blood/EDTA tube
2 weeks
Biochemistry
Immunology
www.qml.com.au
PATHOLOGY TESTS - F
TEST NAME
FATTY ACIDS, PLATELET
2 - 3 months
2 - 4 weeks
Referred test.
7.60
7.60
PATHOLOGY TESTS - F
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Haematology
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
Cytology
24 hours
FIP1L1-PDGFR (HES)
GENETIC TESTING
Genetics
2 months
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
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
3 weeks
FLUCONAZOLE, PLASMA
Biochemistry
Blood/EDTA tube
2 weeks
FLUCYTOSINE, SERUM
Biochemistry
1 week
Collect just prior to next dose. Provide clinical and medication details.
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - F
TEST NAME
FILARIA, BLOOD
7.61
7.61
PATHOLOGY TESTS - F
PATHOLOGY TESTS
DEPARTMENT
FLUNITRAZEPAM, SERUM
Biochemistry
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
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
FLUORESCENT IN SITU
HYBRIDISATION (FISH)
Genetics
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
Biochemistry
4 weeks
FLUORIDE, URINE
Biochemistry
Urine/Urine container
(random collection) or plain
24 hour urine container
4 weeks
FLUOXETINE, SERUM
Biochemistry
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
Biochemistry
24 hours
PATHOLOGY TESTS - F
TEST NAME
FLUID TAU PROTEIN
7.62
7.62
PATHOLOGY TESTS - F
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Endocrinology
Blood/EDTA tube
24 hours
FOLATE, SERUM
Endocrinology
Blood/SS tube
24 hours
Endocrinology
Blood/EDTA tube
24 hours
Endocrinology
Blood/SS tube
24 hours
Biochemistry
FRAGILE-X-SYNDROME
(FRAXA) MUTATION ANALYSIS
Genetics
Blood/Pink top
EDTA tube
1 week
Endocrinology
Blood/SS tube
1 - 2 weeks
Referred test.
Endocrinology
Blood/SS tube
24 hours
This test is a ratio of total testosterone and sex hormone binding globulin.
Endocrinology
48 hours
FREE CORTISOL,
URINE RANDOM
Endocrinology
24 hours
Biochemistry
Blood/SS tube
1 - 2 weeks
FREE PSA
Endocrinology
Blood/SS tube
24 hours
Endocrinology
Blood/SS tube
24 hours
Please note all Thyroid medication e.g. Propylthiouracil (PTU), Neomercazole (NMZ),
Thyroxine (T4) and Carbimazole (CBZ).
Endocrinology
Blood/SS tube
24 hours
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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
7.63
7.63
PATHOLOGY TESTS - F
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Endocrinology
Blood/SS tube
24 hours
Genetics
Blood/EDTA tube
1 - 2 months
FROZEN SECTION,
TISSUE
Histology
Immediate. Full
report 24 hours
FRUCTOSAMINE, SERUM
Biochemistry
Blood/SS tube
24 hours
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.
Haematology
Blood/EDTA tube
Immediate;
Same day
Haematology
Blood/EDTA tube
Immediate;
Same day
Microbiology
Microscopy - 24
hours; Culture
- up to 4 weeks
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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.
PATHOLOGY TESTS - F
TEST NAME
FREE TESTOSTERONE,
SERUM
7.64
7.64
PATHOLOGY TESTS - F
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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).
Immunology
Blood/SS tube
2 - 4 weeks
Referred test.
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PATHOLOGY TESTS - F
TEST NAME
FUNGAL MICROSCOPY/
CULTURE, SKIN
7.65
7.65
PATHOLOGY TESTS - F
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/EDTA tube
1 week
GABAPENTIN, SERUM
Biochemistry
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.
Blood/SS tube or
Lithium heparin tube
2 weeks
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
GALACTOSE, PLASMA
Biochemistry
GALACTOSE-1-PHOSPHATE
URIDYL TRANSFERASE,
RED CELL
GALACTOSE-1-PHOSPHATE,
RED CELL
GAMMA GT (GAMMA GLUTAMYL
TRANSPEPTIDASE), SERUM
GAMMA GT, FLUID
Biochemistry
Biochemistry
Biochemistry
Biochemistry
Fluid/Plain tube/Container
Same day
GANGLIOSIDE ANTIBODIES
Immunology
Blood/SS tube
2 - 3 weeks
Referred test.
GAS ANALYSIS,
ARTERIAL BLOOD
Biochemistry
Arterial blood/Blood
gas syringe
Same day
GAS ANALYSIS,
VENOUS BLOOD
Biochemistry
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PATHOLOGY TESTS - G
TEST NAME
G6PD QUANTITATIVE ASSAY
8.0
PATHOLOGY TESTS - G
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
24 hours
GASTRIN, SERUM
Endocrinology
Blood/SS tube
1 week
GAUCHERS DISEASE
(SCREENING)
GENITAL MICRO/CULTURE
Genetics
Blood/EDTA tube
1 - 2 weeks
Microbiology
GENITAL SWAB
INCLUDING ANAEROBES
AND GONOCOCCUS
Microbiology
48 hours
Biochemistry
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
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PATHOLOGY TESTS - G
TEST NAME
GASTRIC ASPIRATE
CYTOLOGY
8.1
PATHOLOGY TESTS - G
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
Same day
Blood/SS tube
72 hours
Blood/SS tube or
Fluoride oxalate tube
24 hours
GLUCAGON, PLASMA
Endocrinology
Blood/EDTA tube
with Trasylol
4 weeks
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.
Biochemistry
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.
Biochemistry
24 hours
Same as 2 hour GTT except blood also collected at 3 hours post glucose dose.
Appointment required. Please contact nearest collection centre.
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.
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PATHOLOGY TESTS - G
TEST NAME
GLIADIN ANTIBODIES
(COELIAC DISEASE), SERUM
GLIADIN IGA/IGG SEROLOGY
PATHOLOGY TESTS - G
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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.
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.
Biochemistry
Same day
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
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
GLUTAMINE, SERUM
Biochemistry
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.
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Test for bacterial meningitis. Please refer to BIOCHEMISTRY, CSF for details.
PATHOLOGY TESTS - G
TEST NAME
GLUCOSE TOLERANCE TEST
- GLUCOSE AND GROWTH
HORMONE
8.3
PATHOLOGY TESTS - G
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Biochemistry
GLYCATED HAEMOGLOBIN,
BLOOD
GLYCEROL, PLASMA
Biochemistry
Biochemistry
1 week
GLYCEROL, URINE
Biochemistry
Urine/Urine container
1 week
GLYCOGEN DEBRANCHER
ENZYME, BLOOD
GLYCOLATE, URINE
Biochemistry
Biochemistry
Urine/Urine container
3 - 4 weeks
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
GRAMOXONE, URINE
Biochemistry
GRANULOCYTE ANTIBODY
SCREEN
Haematology
GROWTH HORMONE
SUPPRESSION TEST
(USING GLUCOSE)
GROWTH HORMONE, SERUM
Endocrinology
Blood/SS tube
24 hours
Endocrinology
Blood/SS tube
24 hours
Please state whether fasting or non-fasting and any relevant clinical information.
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PATHOLOGY TESTS - G
TEST NAME
GLUTATHIONE REDUCTASE,
BLOOD
GLYCATED ALBUMIN, SERUM
8.4
PATHOLOGY TESTS - G
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
24 hours
GTT (2 OR 3 HOUR),
PREGNANCY
Biochemistry
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
24 hours
GUSATHION (PESTICIDE),
SERUM
Biochemistry
Endocrinology
GUTHRIE TEST
Biochemistry
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PATHOLOGY TESTS - G
TEST NAME
GTT - INSULIN
AND C-PEPTIDE
24 hours
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
HAEMOGLOBIN (HUMAN),
FAECAL - OCCULT BLOOD
Microbiology
Faeces/Faeces container
Biochemistry
Blood/EDTA tube
24 hours
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
HAEMOGLOBIN, URINE
Biochemistry
Urine/Urine container
24 hours
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SPECIMEN CONTAINER
PATHOLOGY TESTS - H
TEST NAME
Haematology
Blood/EDTA tube
Same day
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.
8.6
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
HAEMOGLOBINOPATHY
STUDIES
Haematology
1 - 3 days
Tests performed Tuesday and Friday. Results available same day of test.
HAEMOLYTIC COMPLEMENT
Immunology
Blood/SS tube
24 hours
HAEMOLYTIC SCREEN
Haematology/
Biochemistry
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
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
HAM TEST
(ACIDIFIED SERUM TEST),
BLOOD
Haematology
Blood/1 SS tube,
1 EDTA tube
24 hours
Immunology
Blood/SS tube
72 hours
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.
Haematology
Blood/EDTA tube
Same day
HCB (ORGANOCHLORINE
PESTICIDE), BLOOD
Biochemistry
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PATHOLOGY TESTS - H
TEST NAME
8.7
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Endocrinology
Blood/SS tube
24 hours
HCG STIMULATION
OF TESTOSTERONE
HCG TITRE, SERUM
Endocrinology
Blood/SS tube
24 hours
Endocrinology
Blood/SS tube
24 hours
Biochemistry
Blood/SS tube
Same day
Patient need not be fasting unless other fasting tests e.g. triglycerides are also required.
Biochemistry
1 week
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.
Haematology
Blood/EDTA tube
Same day
HELICOBACTER
FAECAL ANTIGEN
HELICOBACTER PYLORI
CARBON-14 UREA
BREATH TEST
Immunology
Faeces/Faeces container
2 - 3 weeks
Endocrinology
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
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PATHOLOGY TESTS - H
TEST NAME
8.8
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
2 - 4 weeks
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.
Haematology
Blood/Sodium citrate
tube, EDTA tube
24 hours
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
Same day
HEPATITIS (A OR B)
IMMUNE STATUS
Immunology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
24 hours
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
Immunology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
1 week
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.
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PATHOLOGY TESTS - H
TEST NAME
8.9
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
HEPATITIS B SURFACE
ANTIGEN (HBsAg)
HEPATITIS C ANTIBODY
(HCV Ab)
HEPATITIS C VIRUS
GENOTYPE
Immunology
Blood/SS tube
Same day
Immunology
Blood/SS tube
24 hours
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.
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.
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.
Immunology
Blood/SS tube
1 week
HEPATITIS E VIRUS
Immunology
Blood/SS tube
1 week
HEPATITIS G VIRUS
Immunology
Blood/SS tube
2 - 4 weeks
Referred test.
HEPTACHLOR,
(ORGANOCHLORINE
PESTICIDE), BLOOD
HEPTANE, BLOOD
Biochemistry
Biochemistry
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PATHOLOGY TESTS - H
TEST NAME
8.10
8.10
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
HERBICIDES, URINE
Biochemistry
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
HEREDITARY SPHEROCYTOSIS
BY FLOW
HERPES SIMPLEX SEROLOGY
Haematology
Blood/EDTA tube
Same day
Immunology
Blood/SS tube
24 hours
HERPES SIMPLEX
VIRUS PCR
Immunology
24 hours
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
HERPES ZOSTER
VIRUS PCR
Immunology
1 week
Haematology
Same day
HEXACHLOROBENZENE
(ORGANOCHLORINE
PESTICIDE), BLOOD
HEXOSE-1-PHOSPHATE
URIDYL TRANSFERASE, BLOOD
Biochemistry
Hg, BLOOD
Biochemistry
HGPRT, BLOOD
Biochemistry
www.qml.com.au
Biochemistry
PATHOLOGY TESTS - H
TEST NAME
Blood/Lithium
heparin tube
1 - 2 weeks
8.11
8.11
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
Biochemistry
Biochemistry
Urine/Urine container
3 weeks
HISTAMINE, URINE
Biochemistry
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.
Biochemistry
2 weeks
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
24 - 48 hours
HISTOLOGY MACRO/MICRO
Histology
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
Immunology
HIV GENOTYPE
Immunology
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).
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SPECIMEN CONTAINER
4 weeks
PATHOLOGY TESTS - H
TEST NAME
8.12
8.12
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Indeterminate
Immunology
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).
Haematology
Blood/ACD tube,
SS tube
2 weeks
Haematology
2 weeks
Haematology
2 weeks
Genetics/
Haematology
1 week
Biochemistry
Blood Bank
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
8.13
8.13
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
HOMOCYSTINE, URINE
Biochemistry
Urine/Urine container
1 - 2 weeks
Biochemistry
Urine/Urine container
48 hours
Biochemistry
Cytology
ThinPrep PreservCyt
Collection Vial
2 weeks
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
Endocrinology
Blood/SS tube
24 hours
HUMAN METAPNEUMOVIRUS
Immunology
Respiratory samples,
nasopharyngeal aspirate,
nasal washings/Luki tube
or Sterile container
1 - 2 weeks
www.qml.com.au
PATHOLOGY TESTS - H
TEST NAME
8.14
8.14
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
HUNTINGTONS DISEASE
GENETIC TESTING
Genetics
Blood/EDTA tube
Indeterminate
HVA, URINE
Biochemistry
Genetics
Blood/EDTA tube
3 - 4 weeks
HYDATID SEROLOGY
Immunology
Blood/SS tube
1 week
HYDROCARBON SOLVENTS,
BLOOD
HYDROCARBONS, BLOOD
Biochemistry
Biochemistry
HYDROGEN,
BREATH (MULTIPLE)
HYDROGEN, BREATH (SINGLE)
Biochemistry
HYDROXY CHOLECALCIFEROL
Biochemistry
Biochemistry
HYDROXYINDOLEACETIC
ACID, URINE
Biochemistry
www.qml.com.au
Biochemistry
Endocrinology
Blood/SS tube
48 hours
1 week
Biochemistry
Biochemistry
Biochemistry
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.
8.15
8.15
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
HYDROXYTRYPTAMINE,
Biochemistry
SERUM
HYDROXYTRYPTAMINE,
Biochemistry
URINE
HYPERTONIC CRYOHAEMOLYSIS Haematology
HYPNODORM, SERUM
8.16
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
Blood/Lithium heparin
tube plus EDTA tube
4 weeks
8.16
PATHOLOGY TESTS - H
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
2 weeks
Immunology
Blood/SS tube
2 weeks
Haematology
Blood/EDTA tube or
Lithium heparin tube
Same day
IgA, SALIVA
Biochemistry
Saliva/Plain tube or
Urine container
3 days
IgA, SERUM
Biochemistry
Blood/SS tube
24 hours
IgA, URINE
Biochemistry
Urine/Random
urine container
2 weeks
Immunology
Blood/SS tube
24 hours
IGF-BINDING PROTEIN 3
Endocrinology
Blood/SS tube
3 weeks
Referred test.
IGF-I (SOMATOMEDIN C)
Endocrinology
Blood/SS tube
24 hours
Specimen
Distribution
Serum/SS tube or
Plain tube (red top)
Collection and
transfer only
Specimen
Distribution
Serum/SS tube or
Plain tube (red top)
Collection and
transfer only
Specimen
Distribution
Serum/SS tube or
Plain tube (red top)
Collection and
transfer only
IgG, SERUM
Biochemistry
Blood/SS tube
24 hours
IgM, SERUM
Biochemistry
Blood/SS tube
24 hours
IMIPRAMINE, SERUM
Biochemistry
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.
8.17
8.17
PATHOLOGY TESTS - I
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/SS tube
24 - 48 hours
IMMUNOFIXATION (PROTEIN),
URINE
Biochemistry
Random urine/Urine
container or 24 hour urine
collection/Urine collection
bottle. No preservative
24 - 48 hours
IMMUNOFLUORESCENCE,
HISTOLOGY
Histology
24 - 48 hours
IMMUNOGLOBULIN D, SERUM
Biochemistry
Blood/SS tube
2 weeks
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
Specimen
Distribution
Collection and
transfer only
INFLUENZA A SEROLOGY
Immunology
Blood/SS tube
24 hours
INFLUENZA B SEROLOGY
Immunology
Blood/SS tube
24 hours
INHIBIN, BLOOD
Endocrinology
Blood/SS tube
2 - 5 weeks
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.
Haematology
Blood/Sodium
citrate tube
Same day
www.qml.com.au
PATHOLOGY TESTS - I
TEST NAME
IMMUNOFIXATION (PROTEIN),
SERUM
8.18
8.18
PATHOLOGY TESTS - I
PATHOLOGY TESTS
DEPARTMENT
Immunology
Blood/SS tube
2 - 3 weeks
Referred test.
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
INSULIN-LIKE GROWTH
FACTOR-I (IGF- I/
SOMATOMEDIN C),
SERUM
Endocrinology
Blood/SS tube
24 hours
INTACT PARATHORMONE,
SERUM
Endocrinology
Blood/SS tube
24 hours
INTERCELLULAR CEMENT
Immunology
SUBSTANCE (ICS) ANTIBODY/
PEMPHIGUS ANTIBODY, SERUM
INTERLEUKIN 2 RECEPTOR
Endocrinology
Blood/SS tube
2 weeks
Blood/SS tube
1 week
INTERLEUKIN 6
Endocrinology
Blood/SS tube
48 hours
INTESTINAL
DISACCHARIDASES,
BIOPSY TISSUE
Biochemistry
www.qml.com.au
SPECIMEN CONTAINER
Biochemistry
Biochemistry
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).
8.19
8.19
PATHOLOGY TESTS - I
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
1 week
INVERSION 16 RT-PCR
Genetics
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.
Haematology
Blood/SS tube
24 hours
Biochemistry
1 week
IRON, FLUID
Biochemistry
Fluid/Plain tube/Container
Same day
Biochemistry
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
Immunology
Blood/SS tube
2 weeks
ISONIAZID, PLASMA
Biochemistry
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
2 weeks
Microbiology
IUD/Sterile container
Up to 7 days
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
8.20
8.20
PATHOLOGY TESTS - I
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Genetics
2 weeks
Genetics
Blood/EDTA tube
1 - 2 months
Biochemistry
Biochemistry
Biochemistry
Blood/SS tube
Same day
Biochemistry
Urine/Urine container
Same day
KINIDIN, SERUM
Biochemistry
KLEIHAUER TEST
(FETAL RED CELL SCREEN),
MATERNAL BLOOD
KUNJIN SEROLOGY
Haematology
Same day
or urgently
Immunology
Blood/SS tube
2 weeks
www.qml.com.au
TEST NAME
JAK 2 MUTATION ANALYSIS
8.21
8.21
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Amniotic fluid/Plain
plastic container
Same day
L-LACTATE, PLASMA
Biochemistry
2 weeks
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
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
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
LAMOTRIGINE, PLASMA
Biochemistry
LAMOTRIGINE, SERUM
Biochemistry
Biochemistry
LANOXIN, SERUM
Biochemistry
LARGACTIL, SERUM
Biochemistry
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.
24 hours
1 week
8.22
8.22
PATHOLOGY TESTS - L
PATHOLOGY TESTS
DEPARTMENT
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
Biochemistry
Same day
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
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
Biochemistry
Blood/EDTA tube
24 hours
Please provide clinical, medication and lead exposure details. Leave as whole blood.
LEAD, HAIR
Biochemistry
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***
Biochemistry
Paint flakes/
Dry sterile screw top
(urine) container
4 weeks
Referred test.
www.qml.com.au
SPECIMEN CONTAINER
Biochemistry
PATHOLOGY TESTS - L
TEST NAME
LAROXYL, SERUM
8.23
8.23
PATHOLOGY TESTS - L
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
LEGIONELLA SEROLOGY
Immunology
Blood/SS tube
24 hours
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
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
LEUKOCYTE ENZYMES,
BLOOD
LEUKAEMIA MARKER STUDIES
Biochemistry
LiCO3, SERUM
Biochemistry
LIDOCAINE, SERUM
Biochemistry
LIGNOCAINE, SERUM
Biochemistry
LINDANE (ORGANOCHLORINE
PESTICIDES), BLOOD
LIPASE, SERUM
Biochemistry
Biochemistry
Blood/SS tube
Same day
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
24 hours
2 weeks
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.
8.24
8.24
PATHOLOGY TESTS - L
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/SS tube
Same day
Biochemistry
Biochemistry
Biochemistry
LIPOPROTEIN PATTERN
(ELECTROPHORESIS), SERUM
Biochemistry
LITHICARB, SERUM
Biochemistry
LITHIUM, SERUM
Biochemistry
Biochemistry
Biochemistry
Biochemistry
Blood/SS tube
Same day
LIVER/KIDNEY MICROSOMAL
ANTIBODY
LOPINIVIR, PLASMA
Immunology
Blood/SS tube
24 hours
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
LP(a), SERUM
Biochemistry
LUCIJET (PESTICIDE),
SERUM
Biochemistry
www.qml.com.au
Blood/SS tube
Blood/SS tube
24 hours
Same day
PATHOLOGY TESTS - L
TEST NAME
LIPID STUDIES, SERUM
8.25
8.25
PATHOLOGY TESTS - L
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Haematology
Blood/Sodium
citrate tube
24 hours
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.
Immunology
Blood/SS tube
3 - 4 weeks
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
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.
8.26
8.26
PATHOLOGY TESTS - L
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Genetics
2 weeks
LYMPHOCYTE MARKER
STUDIES, BLOOD
Haematology
Blood/ACD tube,
EDTA tube, Blood film
24 hours
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
Immunology
Blood/SS tube
72 hours
Biochemistry
2 weeks
LYSOZYME, SERUM
Haematology
Blood/SS tube
24 hours
LYSSAVIRUS SEROLOGY
Immunology
Blood/SS tube
2 - 3 weeks
www.qml.com.au
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
Biochemistry
Blood/Plastic lithium
heparin tube or EDTA tube
2 weeks
MAGNESIUM, SERUM
Biochemistry
Blood/SS tube
Same day
MAGNESIUM,
URINE 24 HOUR
Biochemistry
24 hours
MALARIAL PARASITES
Haematology
Same day
Genetics
Blood/EDTA tube
1 week
MALATHION (PESTICIDE),
SERUM
Biochemistry
MALIGNANT CELLS
Cytology
MALIGNANT HYPERTHERMIA
GENETIC TESTING
MANDELIC ACID, URINE
Genetics
4 - 6 weeks
Biochemistry
Urine/Urine container
3 weeks
Biochemistry
4 weeks
Biochemistry
Blood/SS tube
4 weeks
Biochemistry
Urine/Urine container
4 weeks
Biochemistry
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
Biochemistry
PATHOLOGY TESTS - M
TEST NAME
MACRO CK, SERUM
9.0
PATHOLOGY TESTS - M
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
Biochemistry
MCP, URINE
Biochemistry
Biochemistry
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
Genetics
48 hours
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
Blood/EDTA tube
4 weeks
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.
9.1
PATHOLOGY TESTS - M
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
1 week
Biochemistry
MELLERIL, SERUM
Biochemistry
MENINGOCOCCAL PCR
Immunology
24 hours or same
day if requested
MENINGOCOCCAL SEROLOGY
Immunology
Blood/SS tube
2 - 3 weeks
Biochemistry
Urine/Urine container
2 weeks
MERCURY, BLOOD
Biochemistry
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
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
4 weeks
MERCURY, URINE
Biochemistry
Urine/Urine container
4 weeks
METABOLIC SCREEN
Biochemistry
Urine/Urine container
1 week
METABOLIC SCREEN,
BLOOD
Biochemistry
Blood/Lithium
heparin tube
1 week
METANEPHRINE,
BLOOD
Biochemistry
(MUCOPOLYSACCHARIDES,
9.2
PATHOLOGY TESTS - M
TEST NAME
MELIOIDOSIS SEROLOGY
(BURKHOLDERIA
PSEUDOMALLEI)
MELIPRAMINE, SERUM
www.qml.com.au
PATHOLOGY TESTS - M
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/Lithium
heparin tube
1 - 2 weeks
METANEPHRINE,
URINE 24 HOUR
METASYSTOX (PESTICIDE),
SERUM
Biochemistry
Biochemistry
METHADONE,
BLOOD
Biochemistry
2 - 3 weeks
Please provide clinical and medication details including time and date of last dose.
Do not separate plasma.
METHAEMALBUMIN,
PLASMA
Biochemistry
Same day
METHAEMOGLOBIN
REDUCTASE, BLOOD
METHAEMOGLOBIN,
BLOOD
Biochemistry
4 weeks
Biochemistry
Blood/Lithium heparin
tube or EDTA tube
Same day
METHAEMOGLOBIN,
URINE
Biochemistry
Random urine/
Urine container
Same day
METHOMYL (PESTICIDE),
BLOOD
Biochemistry
METHOTREXATE,
SERUM
Biochemistry
Biochemistry
METHYL CARBOXYLAMIDE
PYRIDONE, URINE
METHYL CHLORIDE, BLOOD
Biochemistry
Biochemistry
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - M
TEST NAME
METANEPHRINE,
PLASMA
9.3
PATHOLOGY TESTS - M
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Urine/Urine container
4 weeks
METHYL HISTAMINE,
URINE
METHYL ISOBUTYL KETONE
(MIBK), BLOOD
METHYL ISOBUTYL KETONES,
URINE
Biochemistry
Biochemistry
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
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.
2 weeks
MEVINPHOS (PESTICIDE),
SERUM
Biochemistry
MEXILETINE, SERUM
Biochemistry
MEXITIL, SERUM
Biochemistry
MIANSERIN, SERUM
Biochemistry
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
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
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
PATHOLOGY TESTS - M
PATHOLOGY TESTS
DEPARTMENT
Biochemistry
MICROALBUMIN/CREATININE
RATIO, URINE
MICROBIAL SEROLOGY
Biochemistry
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
24 hours
MITOCHONDRIAL ANTIBODY,
SERUM
MITOCHONDRIAL DISORDERS
(LEBERS, LEIGHS, MELAS,
NARP), BLOOD
Immunology
Blood/SS tube
24 hours
Biochemistry
Blood/EDTA tube
4 weeks
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.
Haematology
Blood/ACD tube
2 weeks
www.qml.com.au
SPECIMEN CONTAINER
PATHOLOGY TESTS - M
TEST NAME
MICROALBUMIN, URINE
9.5
PATHOLOGY TESTS - M
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Urine/Urine container
8 working days
MOGADON, SERUM
Biochemistry
MOLYBDENUM, BLOOD
Biochemistry
Blood/Lithium heparin
tube or EDTA tube
4 weeks
MONOLAYER CYTOLOGY
(THINPREP)
Cytology
24 - 48 hours
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.
Microbiology
Swab in Stuarts
transport medium
48 hours
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.
Biochemistry
Urine/Urine container
2 weeks
MUCOPOLYSACCHARIDES,
URINE
Biochemistry
Urine/Urine container
MULTIPLE BIOCHEMICAL
ANALYSIS (MBA), SERUM
MULTIPLE ENDOCRINE
NEOPLASIA (MEN1)
GENETIC TESTING
Biochemistry
www.qml.com.au
Genetics
PATHOLOGY TESTS - M
TEST NAME
MOCA, URINE
2 months
9.6
PATHOLOGY TESTS - M
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
24 - 48 hours
MURAMIDASE, SERUM
Haematology
Blood/SS tube
24 hours
MURELAX, SERUM
Biochemistry
Blood/SS tube
2 weeks
Biochemistry
Biochemistry
MYCOBACTERIA
ATYPICAL, MICROSCOPY
AND CULTURE
Microbiology/
Histology
Microscopy
- same day.
Culture - majority
provisionally
identified within
2 weeks
(up to 12 weeks).
MYCOBACTERIUM
TUBERCULOSIS, SPUTUM
MICROSCOPY AND CULTURE
Microbiology
MYCOPHENOLATE, PLASMA
Biochemistry
MYCOPHENOLIC ACID,
PLASMA
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - M
TEST NAME
MUMPS SEROLOGY
2 weeks
Please keep sample cool and transport to the laboratory without delay.
Referred Test.
9.7
PATHOLOGY TESTS - M
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Nasopharyngeal aspirate,
nasopharyngeal swab (dry
swab), Sputum/Luki tube or
sterile container or dry swab
24 hours
MYCOPLASMA SEROLOGY
Immunology
Blood/SS tube
24 hours
MYCOPLASMA/UREA
PLASMA ISOLATION
Microbiology
5 days
MYOGLOBIN, SERUM
Biochemistry
Same day
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
MYSOLINE, SERUM
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - M
TEST NAME
MYCOPLASMA PNEUMONIAE
PCR
9.8
PATHOLOGY TESTS - M
PATHOLOGY TESTS
DEPARTMENT
N-1-METHYL NICOTINAMIDE,
URINE
N-ACETYL PROCAINAMIDE,
SERUM
N-ACETYL-GLUCOSEAMINIDASE, URINE
Biochemistry
Biochemistry
Biochemistry
Urine/Plain random
urine container
2 weeks
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
NARCOLEPSY
Haematology
Blood/ACD tube
Indeterminate
NASOPHARYNGEAL ASPIRATE
MICROSCOPY AND CULTURE
Microbiology
Nasopharyngeal Aspirate/
Aspirating trap
NEISSERIA GONORRHOEAE,
MICROSCOPY AND CULTURE
Microbiology
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
Immunology
24 hours
NELFINAVIR, PLASMA
Biochemistry
Blood/EDTA tube
3 weeks
www.qml.com.au
SPECIMEN CONTAINER
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.
9.9
PATHOLOGY TESTS - N
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
2 weeks
NEOPTERIN, URINE
Biochemistry
NEORAL, BLOOD
Biochemistry
Biochemistry
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.
Biochemistry
Blood/SS tube
2 weeks
NEUTROPHIL AB TO
MYELOID PRECURSORS
Haematology
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
24 hours
NEUTROPHIL FUNCTION
STUDIES, BLOOD
Haematology
Blood/EDTA tube,
Plastic lithium heparin tube,
2 blood films, SS tube
24 hours
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
PATHOLOGY TESTS - N
TEST NAME
NEONATAL SCREENING TEST
9.10
9.10
PATHOLOGY TESTS - N
PATHOLOGY TESTS
DEPARTMENT
Biochemistry
NIACIN, URINE
Biochemistry
NICKEL, BLOOD
Biochemistry
4 weeks
NICKEL, URINE
Biochemistry
Urine/Urine container
1 week
NICOTINE METABOLITES,
SERUM
NICOTINE METABOLITES,
URINE
NICOTINE,
URINE RANDOM
NIPPLE DISCHARGE
CYTOLOGY
Biochemistry
Biochemistry
Biochemistry
Cytology
24 hours
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
NMN, URINE
Biochemistry
NORADRENALIN,
URINE
NORADRENALINE,
URINE 24 HOUR
NORDIN TEST,
URINE AND SERUM
Biochemistry
Biochemistry
www.qml.com.au
Biochemistry
SPECIMEN CONTAINER
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.
9.11
9.11
PATHOLOGY TESTS - N
PATHOLOGY TESTS
DEPARTMENT
NORMALISED ANDROGEN
RATIO, SERUM
NORMETANEPHRINE, URINE
Endocrinology
Biochemistry
NORMISON, SERUM
Biochemistry
NOROVIRUS TESTING
Immunology
NORPACE, SERUM
Biochemistry
NORTAB, SERUM
Biochemistry
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
Specimen
Distribution
Blood/Patient presents
with test kit/tubes
Collection and
transfer only
NTX, URINE
Biochemistry
www.qml.com.au
SPECIMEN CONTAINER
Biochemistry
Biochemistry
Biochemistry
Faeces/Faeces container
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.
9.12
9.12
PATHOLOGY TESTS - N
PATHOLOGY TESTS
www.qml.com.au
DEPARTMENT
SPECIMEN CONTAINER
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
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
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
OLANZAPINE, PLASMA
Biochemistry
1 - 2 weeks
Please keep the sample cool and forward to the laboratory without delay.
Biochemistry
Biochemistry
OPIATES - GCMS
CONFIRMATION
Biochemistry
OPTICAL DENSITY,
AMNIOTIC FLUID
Biochemistry
www.qml.com.au
Biochemistry
SPECIMEN CONTAINER
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
2 weeks
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.
9.14
9.14
PATHOLOGY TESTS - O
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Cytology
24 hours
Biochemistry
Urine/Urine container
2 weeks
ORGANOCHLORINE
PESTICIDES, BLOOD
Biochemistry
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
Biochemistry
Urine/Urine container
3 weeks
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
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
3 months
Biochemistry
4 weeks
9.15
9.15
PATHOLOGY TESTS - O
PATHOLOGY TESTS
DEPARTMENT
Immunology
Blood/SS tube
1 week
Biochemistry/
Endocrinology
Blood/SS tube
24 hours
Cytology
Fluid/Sterile screw
top container
24 hours
Collection and
transfer only
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
www.qml.com.au
SPECIMEN CONTAINER
Biochemistry
2 - 3 weeks
PATHOLOGY TESTS - O
TEST NAME
OSTEOPOROSIS MARKERS,
URINE
OVARIAN ANTIBODY
9.16
9.16
PATHOLOGY TESTS - O
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
1 - 2 weeks
Genetics
Blood/EDTA tube
6 - 8 weeks
Haematology
Blood/EDTA tube
Same day
Biochemistry
PANADOL, SERUM
Biochemistry
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
48 - 72 hours
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
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
PARAPROTEIN, URINE
Biochemistry
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.
9.17
9.17
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
Variable from 24
hours to weeks
depending on
agent requested
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
PARATHION
(ORGANOPHOSPHATE
PESTICIDE),
SERUM AND BLOOD
PARATHION (PESTICIDE),
SERUM
Biochemistry
Biochemistry
Endocrinology
Blood/EDTA tube
with Trasylol
2 weeks
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.
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
Immunology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
4 - 6 weeks
www.qml.com.au
PATHOLOGY TESTS - P
TEST NAME
PARASITE SEROLOGY
9.18
9.18
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
Blood/SS tube
48 hours
Haematology
Blood/SS tube
Same day
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.
Biochemistry
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
Immunology
Blood/SS tube
2 weeks
www.qml.com.au
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
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.
9.19
9.19
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
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
Cytology
Fluid/Sterile container
of appropriate size
24 hours
PERITONEAL WASHING
CYTOLOGY
Cytology
Fluid/Sterile container of
appropriate size
24 hours
PERTOFRAN, SERUM
Biochemistry
PERTUSSIS SEROLOGY
Immunology
PESTICIDES
(ORGANOPHOSPHATE/
CARBAMATE), SERUM
PESTICIDES, BLOOD
Biochemistry
PETROL, BLOOD
Biochemistry
PEXID, SERUM
Biochemistry
pH, BLOOD
Biochemistry
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
24 hours
Blood/Lithium heparin
tube and/or SS tube
Faeces/Plain tube
24 hours
9.20
9.20
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Same day
pH, URINE
Biochemistry
Urine/Plain tube
24 hours
PHENOBARBITONE,
SERUM
Biochemistry
Same day
Blood/Plain plastic
6 mL tube - no gel or
anticoagulant (Plastic lithium
heparin tube acceptable)
PHENOLS, URINE
Biochemistry
Urine/Urine container
2 weeks
PHENYLALANINE, SERUM
Biochemistry
2 weeks
PHENYLKETONURIA,
BLOOD
PHENYTOIN, SERUM
Biochemistry
Biochemistry
PHOSDRIN (PESTICIDE)
Biochemistry
PHOSPHATE, FLUID
Biochemistry
Fluid/Plain tube/Container
Same day
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
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
www.qml.com.au
PATHOLOGY TESTS - P
TEST NAME
pH, FLUID
9.21
9.21
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
Biochemistry
Biochemistry
PIGMENTS, URINE
Biochemistry
PKU TEST
Biochemistry
PLASMA VISCOSITY
Haematology
Blood/EDTA tube
24 hours
Haematology
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
Same day
Haematology
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.
Haematology
Same day
Haematology
Blood/Sodium
citrate tube
24 hours
www.qml.com.au
Urine/Urine container
Same day
PATHOLOGY TESTS - P
TEST NAME
PHOSPHOLIPID,
FATTY ACID
9.22
9.22
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Haematology
Same day
PLATELET GLYCOPROTEIN
Haematology
1 week
PLATINUM, BLOOD
Biochemistry
Blood/EDTA tube
2 weeks
Cytology
Pleural fluid/Appropriate
sterile container
24 hours
PML-RAR RT-PCR
Genetics
2 weeks
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
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
9.23
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
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.
Biochemistry
Whole blood/
Lithium heparin tube
or EDTA tube
1 week
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
POTASSIUM, FLUID
Biochemistry
Fluid/Plain tube/Container
Same day
POTASSIUM, PLASMA
Biochemistry
Blood/Lithium
heparin tube
Same day
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
9.24
9.24
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Urine/Random urine
container or plain 24
hour urine container
24 hours
POTASSIUM,
WHOLE BLOOD
Biochemistry
Blood/Lithium heparin
tube and SS tube
24 hours
Cytology
Fluid/Sterile container
of appropriate size
24 hours
Collected by Doctor.
Genetics
1 - 2 months
PREALBUMIN, PLASMA
Biochemistry
2 weeks
Endocrinology
Blood/SS tube
Same day
Endocrinology
Random urine/
Urine container
Same day
PREGNANEDIOL,
URINE 24 HOUR
Endocrinology
4 - 5 weeks
PREGNANETRIOL, URINE
Endocrinology
4 - 5 weeks
PREGNENOLONE, SERUM
Endocrinology
Blood/SS tube
2 - 5 weeks
Referred test.
PRIADEL, SERUM
Biochemistry
PRIMIDONE, SERUM
Biochemistry
Same day
PRO INSULIN
Endocrinology
Blood/SS tube
4 - 5 weeks
PROCAINAMIDE, SERUM
Biochemistry
2 weeks
www.qml.com.au
PATHOLOGY TESTS - P
TEST NAME
POTASSIUM, URINE
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.
9.25
9.25
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
2 weeks
Histology
48 hours
Histology
48 hours
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
PRONESTYL, SERUM
Biochemistry
PROPOXUR (PESTICIDE),
BLOOD
Biochemistry
Endocrinology
www.qml.com.au
Blood/SS tube
24 hours
Biochemistry
Cytology
PATHOLOGY TESTS - P
TEST NAME
PROGESTERONE, SERUM
24 hours
9.26
9.26
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Microbiology
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
Biochemistry
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
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
PROTEIN ELECTROPHORESIS,
URINE
Biochemistry
48 hours
www.qml.com.au
PATHOLOGY TESTS - P
TEST NAME
PROSTATIC SECRETIONS
MICROSCOPY AND CULTURE
9.27
9.27
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
Biochemistry
PROTEIN, CSF
Biochemistry
PROTEIN, FLUID
Biochemistry
Fluid/Plain tube/Container
Same day
Biochemistry
Same day
PROTEIN, SERUM
Biochemistry
Biochemistry
www.qml.com.au
SPECIMEN CONTAINER
Biochemistry
Biochemistry
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.
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
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.
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
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
Blood/SS tube
72 hours
9.29
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Genetics
Blood/EDTA tube
Indeterminate
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
Endocrinology
Blood/EDTA tube
with Trasylol
2 weeks
Biochemistry
2 weeks
Biochemistry
Urine/Random early
morning urine
2 weeks
PURKINJE ANTIBODY
SEROLOGY
PYRETHRINS (SYNTHETIC),
BLOOD
PYREXIA UNKNOWN ORIGIN
(PUO), SEROLOGY
Immunology
Blood/SS tube
2 - 3 weeks
PYRIDOXAL PHOSPHATE,
BLOOD
PYRIDOXINE, BLOOD
Biochemistry
Biochemistry
www.qml.com.au
Biochemistry
Immunology
PATHOLOGY TESTS - P
TEST NAME
PTEN GENETIC TESTING
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).
9.30
9.30
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Haematology
Blood/EDTA tube
4 weeks
Referred test.
PYRUVATE, BLOOD
Biochemistry
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
PATHOLOGY TESTS - P
TEST NAME
PYRUVATE KINASE (SCREEN)
9.31
9.31
PATHOLOGY TESTS - P
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
QT-PCR (BCR-ABL)
Genetics
2 weeks
Biochemistry
1 - 2 days
QUANTIFERON TEST
FOR TB IMMUNITY
Immunology
1 - 2 weeks
Specimen
Distribution
Collection and
transfer only
Specimen
Distribution
Collection and
transfer only
www.qml.com.au
PATHOLOGY TESTS - Q
TEST NAME
9.32
9.32
PATHOLOGY TESTS - Q
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
4 weeks
QUINIDINE, SERUM
Biochemistry
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
9.33
9.33
PATHOLOGY TESTS - Q
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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.
Immunology
Blood/SS tube
24 hours
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.
Haematology
Blood/EDTA tube
Same day
Haematology
Blood/Lithium heparin
tube or EDTA tube
4 weeks
Biochemistry
Haematology
Blood/Sterile vials
available on request
from Haematology
24 hours
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
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.
9.34
9.34
PATHOLOGY TESTS - R
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Cytology
24 hours
RESPIRATORY SYNCYTIAL
VIRUS (RSV) SEROLOGY
RESPIRATORY VIRAL ANTIGEN
TEST (DFA), INCLUDING RSV,
INFLUENZA, PARAINFLUENZA,
ADENOVIRUS
RESPIRATORY VIRUS PCR
Immunology
Blood/SS tube
24 hours
Immunology
Nasopharyngeal Aspirate/
Aspirating trap
24 hours
Immunology
Nasopharyngeal Aspirate or
Nasopharyngeal swab (dry)/
Luki tube or Sterile container
or Viral swab (VIROCULT)
24 - 48 hours
RET PROTO-ONCOGENE
DNA TEST
Genetics
Blood/EDTA tube
8 weeks for
full screen, 4
weeks for known
family mutation
RETICULIN ANTIBODY
Immunology
Blood/SS tube
24 hours
Haematology
Blood/EDTA tube
Same day
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
Endocrinology
Blood/SS tube
1 - 2 months
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.
9.35
9.35
PATHOLOGY TESTS - R
PATHOLOGY TESTS
SPECIMEN CONTAINER
Amniotic fluid/
Sterile container
Indeterminate
RHEUMATOID ARTHRITIS
SEROLOGY
RHEUMATOID FACTOR (RF),
RA LATEX TEST, SERUM
RIBOFLAVIN, BLOOD
Immunology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
24 hours
RICKETTSIA SEROLOGY
Immunology
RISPERDAL, PLASMA
Biochemistry
RISPERIDONE, PLASMA
Biochemistry
1 - 2 weeks
Please provide clinical and medication details. Keep the sample cool and send to
the laboratory without delay. Referred test.
Haematology
24 hours
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
Biochemistry
ROHYPNOL, SERUM
Biochemistry
Immunology
Blood/SS tube
24 hours
Assay run daily (Monday to Friday, plus Saturday during late Summer).
Microbiology
Faeces/Faeces container
Same day
Immunology
www.qml.com.au
Biochemistry
PATHOLOGY TESTS - R
TEST NAME
DEPARTMENT
RHESUS DNA TESTING (AMNIO) Genetics
72 hours
Biochemistry
24 hours
9.36
9.36
PATHOLOGY TESTS - R
PATHOLOGY TESTS
SPECIMEN CONTAINER
Nasopharyngeal Aspirate/
Aspirating trap
24 hours
Immunology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
24 hours
RYTHMODAN, SERUM
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - R
TEST NAME
DEPARTMENT
RSV (RESPIRATORY SYNCYTIAL Immunology
VIRUS) ANTIGEN - DIRECT
FLUORESCENT ANTIBODY TEST
9.37
9.37
PATHOLOGY TESTS - R
PATHOLOGY TESTS
DEPARTMENT
SAICAR, URINE
Biochemistry
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
SALICYLATE, SERUM
Biochemistry
Same day
Please note time and dosage of last medication. Collect 1-3 hours after oral dose.
Biochemistry
Supervised random
Saliva (10 mL)/Sterile
screw cap container
48 hours
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.
Blood/SS tube
24 hours
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.
1 month
www.qml.com.au
SPECIMEN CONTAINER
Biochemistry
Genetics/
Biochemistry
PATHOLOGY TESTS - S
TEST NAME
SABRIL, SERUM
10.0
10.0
PATHOLOGY TESTS - S
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/EDTA tube
3 weeks
SAROTEN, SERUM
Biochemistry
Sb (ANTIMONY), BLOOD
Biochemistry
Blood/Lithium heparin
tube or EDTA tube
4 weeks
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
Same day
Haematology
24 hours
SCHISTOSOMA SEROLOGY
Immunology
Blood/SS tube
1 week
Biochemistry
Biochemistry
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
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.
PATHOLOGY TESTS - S
TEST NAME
SAQUINAVIR, PLASMA
10.1
10.1
PATHOLOGY TESTS - S
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Urine/24 hour
urine container with
no preservative
4 weeks
Genetics
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.
Genetics
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
SEROQUEL, SERUM
Biochemistry
SEROTONIN, PLATELET
Biochemistry
Blood/2 x 5 mL
EDTA tubes
3 weeks
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
2 weeks
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.
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - S
TEST NAME
SELENIUM, URINE
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
Genetics
2 weeks
Endocrinology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
24 hours
SHORT SYNACTHEN
STIMULATION TEST
Endocrinology
Blood/SS tube
and EDTA tube
24 hours
Genetics
3 weeks
Haematology
Blood/EDTA tube
24 hours
SILVER, BLOOD
Biochemistry
Blood/EDTA tube
4 weeks
SILVER, URINE
Biochemistry
Urine/Urine container
4 weeks
SIMPLIRED D-DIMER
Haematology
Same day
SINDBIS SEROLOGY
Immunology
Blood/SS tube
2 - 3 weeks
SINEQUAN, SERUM
Biochemistry
SINGLE BIOLOGICAL
INDICATOR (AUTOCLAVE)
TEST
Microbiology
www.qml.com.au
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.
10.3
10.3
PATHOLOGY TESTS - S
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/EDTA tube
2 - 3 weeks
Please protect the sample from light, keep cool and send to the laboratory
without delay. Referred test.
Immunology
Blood/SS tube
2 weeks
Immunology
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.
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
Immunology
Blood/SS tube
24 hours
Biochemistry
Biochemistry
SODIUM, CSF
Biochemistry
SODIUM, FAECES
Biochemistry
Faeces/Faeces container
24 hours
SODIUM, FLUID
Biochemistry
Fluid/Plain tube/Container
Same day
SODIUM, SERUM
Biochemistry
SODIUM, SWEAT
Biochemistry
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.
10.4
10.4
PATHOLOGY TESTS - S
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Same day
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
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
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
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.
Biochemistry
Urine/Urine container
24 hours
www.qml.com.au
Biochemistry
PATHOLOGY TESTS - S
TEST NAME
SODIUM, URINE
10.5
10.5
PATHOLOGY TESTS - S
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
Haematology
2 weeks
SPORANOX, SERUM
Biochemistry
Microbiology
Sputum/Sterile dry,
screw top (urine) container
Same day
SPUTUM CYTOLOGY
Cytology
Sputum/Sterile dry,
screw top (urine) container
24 hours
Cytology
Sputum/Sterile dry,
screw top (urine) container
24 hours
SPUTUM MICROSCOPY
AND CULTURE
Microbiology
Sputum/Sterile dry,
screw top (urine) container
Biochemistry
STEROID PROFILE,
RANDOM URINE
Endocrinology
www.qml.com.au
PATHOLOGY TESTS - S
TEST NAME
SPERM ANTIBODIES
(IMMUNOBEAD TEST)
4 - 5 weeks
10.6
10.6
PATHOLOGY TESTS - S
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Endocrinology
4 - 5 weeks
STEROID SCREEN,
URINE
Biochemistry
Urine/Tamper
evident collection kit
Indeterminate
STOCRIN, PLASMA
Biochemistry
Blood/EDTA tube
3 weeks
STREPTOCOCCAL SEROLOGY
Immunology
Blood/SS tube
24 hours
STRONGYLOIDES SEROLOGY
Immunology
Blood/SS tube
1 week
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.
Biochemistry
STYRENE, BLOOD
Biochemistry
SUCCINYLAMINOIMIDAZOLE
CARBOXAMIDE RIBOSIDE,
URINE
SUCROSE LYSIS TEST,
RED CELL
Biochemistry
SUGAR CHROMATOGRAPHY,
FAECES
SUGAR CHROMATOGRAPHY,
URINE
Biochemistry
Biochemistry
Urine/Urine container
1 week
SULPHAEMOGLOBIN, BLOOD
Biochemistry
Blood/Lithium
heparin tube
Same day
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.
10.7
10.7
PATHOLOGY TESTS - S
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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.
Biochemistry
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
Microbiology
24 hours
Cytology
Synovial fluid/Appropriate
24 hours
sterile container and labelled
fixed and air dried smear
preparations
SYNOVIAL FLUID
MICROSCOPY AND CULTURE
Microbiology
Synovial fluid/Plain
sterile container or
Lithium heparin tube
www.qml.com.au
48 hours
PATHOLOGY TESTS - S
TEST NAME
SUPERFICIAL
WOUND SWABS
10.8
10.8
PATHOLOGY TESTS - S
PATHOLOGY TESTS
DEPARTMENT
Immunology
Blood/SS tube
24 hours
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
Biochemistry
PATHOLOGY TESTS - S
TEST NAME
SYNTHETIC PYRETHROIDS,
BLOOD
SYPHILIS SEROLOGY
10.9
10.9
PATHOLOGY TESTS - S
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Genetics
Haematology
Blood/ACD tube,
EDTA tube, Blood film
24 hours
Biochemistry
Blood/EDTA tube
24 hours
TAMBOCOR, SERUM
Biochemistry
Biochemistry
Fluid/Plain tube
24 - 48 hours
Genetics
Blood/EDTA tube
Indeterminate
TB CULTURE
(URINE, SPUTA ETC.)
Microbiology
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
Genetics
TEMAZEPAM, SERUM
Biochemistry
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
PATHOLOGY TESTS - T
TEST NAME
T & B CELL GENE
REARRANGEMENT STUDIES
10.10
10.10
PATHOLOGY TESTS - T
PATHOLOGY TESTS
DEPARTMENT
TERBUTALINE, URINE
Biochemistry
TERSEL, SERUM
Biochemistry
TESTICULAR AUTOANTIBODIES
Immunology
Blood/SS tube
1 week
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.
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
TESTOSTERONE, SERUM
Endocrinology
Blood/SS tube
24 hours
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
TETRACHLOROETHANE,
BLOOD
TETRACHLOROETHYLENE,
BLOOD
TETRAMETHYLHEXADECANOIC
ACID, PLASMA
THALASSAEMIA SCREEN/
STUDIES, BLOOD
Biochemistry
Biochemistry
Biochemistry
www.qml.com.au
SPECIMEN CONTAINER
Biochemistry
Haematology
Next day
following assay
PATHOLOGY TESTS - T
TEST NAME
TEMIK (PESTICIDE), BLOOD
1 - 3 days
10.11
10.11
PATHOLOGY TESTS - T
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
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
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.
Biochemistry
Biochemistry
THEOPHYLLINE PRE/POST
DOSE, SERUM
THEOPHYLLINE, SERUM
Biochemistry
THIAMINE, BLOOD
Biochemistry
THINPREP (MONOLAYER)
CYTOLOGY
Cytology
24 - 48 hours
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
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.
10.12
10.12
PATHOLOGY TESTS - T
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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
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.
Haematology
Same day
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
10.13
10.13
PATHOLOGY TESTS - T
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Cytology
24 hours
Endocrinology
Blood/SS tube
24 hours
THYROID STIMULATING
HORMONE (TSH), SERUM
Endocrinology
Blood/SS tube
24 hours
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.
Endocrinology
Blood/SS tube
24 hours
THYROXINE BINDING
GLOBULIN, SERUM
TIN, BLOOD
Endocrinology
Blood/SS tube
24 hours
Biochemistry
2 weeks
Referred test.
TISSUE AUTOANTIBODIES,
SERUM
Immunology
Blood/SS tube
Variable from 24
hours depending
on antibody tests
required
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
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
PATHOLOGY TESTS - T
TEST NAME
THYROID FNA CYTOLOGY
10.14
10.14
PATHOLOGY TESTS - T
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
TOFRANIL, SERUM
Biochemistry
TOLUENE, BLOOD
Biochemistry
TOLUENE/XYLENE EXPOSURE,
URINE
TOLVON, SERUM
Biochemistry
Biochemistry
TOMACULOUS NEUROPATHY
GENETIC TESTING
TOPAMAX, SERUM
Genetics
TOPIRAMATE, SERUM
Biochemistry
2 weeks
TORCH/TORCHES SEROLOGY
Immunology
Blood/SS tube
24 hours
Biochemistry
Biochemistry
Immunology
Blood/SS tube
2 - 3 weeks
Referred test.
TOXOPLASMA SEROLOGY
Immunology
Blood/SS tube
24 hours
Biochemistry
www.qml.com.au
Blood/EDTA tube
6 weeks
Biochemistry
PATHOLOGY TESTS - T
TEST NAME
TOBRAMICIN, SERUM
10.15
10.15
PATHOLOGY TESTS - T
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Hair/Dry
sterile container
4 weeks
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
TRANSFUSION REACTION
INVESTIGATION,
BLOOD AND URINE
Blood Bank
Same day
Biochemistry
Immunology
Blood/SS tube
24 hours
TREPONEMA PALLIDUM
PARTICLE AGGLUTINATION
TEST (TPPA), SERUM
TRICHLOROACETIC ACID,
URINE
Immunology
Blood/SS tube
24 hours
Biochemistry
Urine/Urine container
2 weeks
TRICHLOROETHANE, BLOOD
Biochemistry
TRICHLOROETHYLENE, BLOOD
Biochemistry
Immunology
24 hours
Dry Swab Note: Aptima Swab, Virocult (viral swab), STM not to be used.
TRICHOMONAS,
EXAMINATION FOR
Microbiology
Swab/Transport medium
Same day
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
10.16
10.16
PATHOLOGY TESTS - T
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
Blood/Lithium
heparin tube
4 weeks
TRIGLYCERIDES, FLUID
Biochemistry
Fluid/Plain tube/Container
Same day
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
1 week
Please provide clinical and medication details, including time and date of last dose.
Collect immediately prior to next dose.
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.
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
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.
10.17
10.17
PATHOLOGY TESTS - T
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
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).
Genetics
1 - 2 months
Biochemistry/
Endocrinology
Blood/SS tube
Immunology
Blood/SS tube
24 hours
TYPHUS SEROLOGY
Immunology
Blood/SS tube
72 hours
TYROSINE, PLASMA
Biochemistry
Blood/Lithium
heparin tube
2 weeks
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).
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
2 - 3 weeks
Please provide clinical and medication details. Random early morning urine
collection preferred. Refrigerate for transfer to laboratory. Referred test.
Biochemistry
1 - 2 weeks
Haematology
Blood/EDTA tube
24 hours
Tests performed Tuesday and Friday. Results available same day of test.
UPG DECARBOXYLASE,
RED CELL
URANIUM, BLOOD
Biochemistry
1 - 2 months
Biochemistry
Blood/EDTA tube
4 weeks
URATE CLEARANCE
Biochemistry
24 hours
URATE, FLUID
Biochemistry
Fluid/Plain tube/Container
Same day
UREA, FLUID
Biochemistry
Fluid/Plain tube/Container
Same day
UREA, SERUM
Biochemistry
UREA, URINE
Biochemistry
Urine/24 hour
urine container with
no preservative
24 hours
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
PATHOLOGY TESTS - U
TEST NAME
10.19
10.19
PATHOLOGY TESTS - U
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
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
1 week
1 week
Cytology
24 hours
Endocrinology
48 hours
Cytology
Urine/Urine container
24 hours
URINE MICROSCOPY
AND CULTURE
Microbiology
Microbiology
www.qml.com.au
PATHOLOGY TESTS - U
TEST NAME
URIC ACID, URINE
10.20
10.20
PATHOLOGY TESTS - U
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
1 - 2 days
UROBILINOGEN, URINE
Biochemistry
Urine/Urine container
Same day
UROPORPHYRIN, URINE
Biochemistry
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - U
TEST NAME
URINE QUALITATIVE
DRUG SCREEN
(INDUSTRY, OCCUPATIONAL,
DRUG ABUSE ETC.),
URINE RANDOM
2 - 4 weeks
10.21
10.21
PATHOLOGY TESTS - U
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Cytology
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
VALIUM, SERUM
Biochemistry
VALPROATE, SERUM
Biochemistry
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
Immunology
Blood/SS tube
24 hours
Immunology
24 hours
www.qml.com.au
PATHOLOGY TESTS - V
TEST NAME
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.
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.
10.22
10.22
PATHOLOGY TESTS - V
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
2 weeks
VASOPRESSIN, BLOOD
Endocrinology
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.
Immunology
Blood/SS tube
24 hours
Biochemistry
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
Variable from 24
hours depending
on antibody
tests required
10.23
10.23
PATHOLOGY TESTS - V
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Immunology
1 - 2 weeks
VISCOSITY, PLASMA
Haematology
Blood/EDTA tube
24 hours
VITAMIN A,
SERUM
Biochemistry
Blood/SS tube
(Lithium heparin
tube acceptable)
1 week
Biochemistry
Blood/EDTA tube
1 week
Endocrinology
Blood/SS tube
24 hours
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.
Biochemistry
3 weeks
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
PATHOLOGY TESTS - V
TEST NAME
VIRUS DETECTION
10.24
10.24
PATHOLOGY TESTS - V
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
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
1 week
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
Haematology
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.
Haematology
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
10.25
10.25
PATHOLOGY TESTS - V
PATHOLOGY TESTS
DEPARTMENT
SPECIMEN CONTAINER
Biochemistry
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.
Haematology
Blood/EDTA tube
and Blood film
Same day
Haematology
Blood/EDTA tube
Same day
Biochemistry
www.qml.com.au
PATHOLOGY TESTS - W
TEST NAME
Immunology
Blood/SS tube
24 hours
Immunology
Blood/SS tube
24 hours
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
10.26
10.26
PATHOLOGY TESTS - W
PATHOLOGY TESTS
DEPARTMENT
XANAX, SERUM
Biochemistry
XANTHINE, URINE
Biochemistry
Urine/Urine container
1 - 2 months
XANTHOCHROMIA, CSF
Biochemistry
CSF/Plain tube
Same day
XYLENE/TOLUENE EXPOSURE,
URINE
XYLENES, BLOOD
Biochemistry
Biochemistry
XYLOCAINE, SERUM
Biochemistry
Biochemistry
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.
Biochemistry
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
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
www.qml.com.au
SPECIMEN CONTAINER
TEST NAME
10.27
10.27
PATHOLOGY TESTS
DEPARTMENT
ZACTIN, SERUM
Biochemistry
ZERO, URINE
Biochemistry
ZIEHL-NEELSEN STAIN
Microbiology
24 hours
ZINC PROTOPORPHYRIN,
RED CELL
Biochemistry
Blood/EDTA tube,
Lithium heparin tube
or Sodium citrate tube
1 week
ZINC, HAIR
Biochemistry
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***
Biochemistry
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
ZOLOFT, SERUM
Biochemistry
ZYPREXA, PLASMA
Biochemistry
www.qml.com.au
SPECIMEN CONTAINER
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
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
Test Frequency
INR
Unlimited tests up to
6 months of request
FBE, ESR
Up to 6 tests within
6 months of request
Up to 6 tests within
6 months of request
Cis-platinum therapy
Up to 6 tests within
6 months of request
Cyclosporin therapy
Up to 6 tests within
6 months of request
Leflunomide therapy
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
Rockhampton
(07) 4921 2155
Up to 6 tests within
6 months of request
Noosa
(07) 5441 0200
Vitamin D (metabolites or
analogues) therapy
Up to 6 tests within
6 months of request
GoldCoast, Tugun
& Northern Rivers
Ballina
(02) 6686 6424
Townsville
Townsville
(07) 4779 0158
PATHOLOGY TESTS
11.1
11.0
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
Rarely significant
ALT (SGPT)
Potassium
AST (SGOT)
Chloride
Lactate
Dehydrogenase
(LDH)
Rarely significant
Bicarbonate
Calcium
Hyperparathyroidism, malignancy
(including myeloma), vitamin D & A
excess, sarcoidosis, thyrotoxicosis,
milk-alkali syndrome
Anion Gap
Adjusted
Calcium
Glucose
Phosphate
Urea
Total Protein
Creatinine
Renal impairment,
acute muscle wasting
Albumin
eGFR
Not applicable
Renal impairment,
acute muscle wasting
Uric Acid
Globulins
Immunodeficiency and
as for total protein
Iron
Bilirubin Total
Cholesterol
Familial hyperlipidaemia,
hypothyroidism, liver disease,
renal disease, diabetes mellitus
Triglyceride
Bilirubin
Conjugated
Alkaline
Phosphatase
Sodium
Biochemistry
INCREASED
APPENDICIES
12.2
12.1
APPENDICIES
Biochemistry
APPENDICES - Biochemistry
OTHER
*A
lkaline
Phosphatase
Liver (obstruction)
Bone - osteoblastic regenerative
response
Gamma GT
ALT (SGPT)
Liver
+ AST (SGOT)
Liver
*+ L
actate
Dehydrogenase
(LDH)
*+ CK (CPK)
+ CK-MB
Myocardium
Muscle, atypical
(immunoglobulin-bound)
Amylase
Pancreas
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
AST
Liver
ALT
Oesophagus
CA 19.9
Tumour
CEA
MARKER
Biochemistry
MOST COMMON
APPENDICIES
Source: A. Fetah-Moghadam, P. Stieber, 1991 Instit. of Clin. Chem., Klinikum, Grobhadern, Munich, FRG
12.4
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%)
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
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
Carcinoembryonic
Antigen (CEA)
colorectal, gastric,
liver, pancreatic and
breast ca. (all >60%)
Catecholamines,
HMMA (VMA)
phaeochromocytoma,
neuroblastoma
Human Chorionic
Gonadotrophin
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
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
shock, cirrhosis,
hepatic failure
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
> 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
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
<7.8
<8.9
<6.7
<7.8
Impaired Glucose
Tolerance (IGT)
Fasting
<7.0
<7.0
<6.1
<6.1
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
>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
Fasting 5.5 or
2 hours 8.0
Screening
26 - 28
1 hour 7.8
Confirmation
of diagnosis
after positive
screening test
26 - 30
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:
APPENDICIES
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:
Avocado
Plum
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
Eggplant
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.
Wild game
Cauliflower
The patient is required to bring a specimen of urine, however, they should not bring the
first specimen of the morning.
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.
Spinach
Mushrooms
Fish
Aspirin
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
Methocarbamol (Robaxin)
L-DOPA
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
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
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
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
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
Range (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
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
18 hours
20 hours or greater
Biochemistry
APPENDICIES
APPENDICIES
Biochemistry
APPENDICES - Biochemistry
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
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.
pH
LOW
Acidaemia
pCO2
LOW
RAISED
RAISED
Alkalaemia
pCO2
RAISED
LOW
12.19
Biochemistry
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
Other patients are required to meet the lipid levels shown in the following table
after at least six weeks of dietary therapy:
PATIENT CATEGORY
Aboriginal or
Torres Strait Islander patients
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
APPENDICIES
APPENDICIES
Biochemistry
APPENDICES - Biochemistry
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
28 weeks
12.23
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
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
Mid-morning Prolactin
TSH
ACTH and Cortisol
DHEAs, Inhibin, (Urine Steroid Profile)
Hydroxy-Progesterone
ENDOCRINOLOGY
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
12.26
12.25
Normal Ovary
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
12.28
12.27
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
Acquired abnormalities
related to the
leukaemic process
24-48 hours
(diagnostic
CML, ALL, AML)
Acquired abnormalities
related to the
leukaemic process
2 days (diagnostic)
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
Factor V Leiden/
Prothrombin G20210A
7 days
Methylenetetrahydrofolate
Reductase (MTHFR)
7 days
Apolipoprotein E
7 days
Fragile X (FRAXA)
7 days
Y Chromosome
Microdeletion Studies
7 days
HLA-B27
3 days
Clostridium Difficile
2 days
Faecal sample
2 days
3 days
BCR-ABL RQ-PCR
7-14 days
JAK2
7-14 days
7-14 days
GENETICS
Tissue
APPENDICIES
12.30
APPENDICIES
GENETICS
APPENDICES - GENETICS
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
Cord
Year 0-3
Year 4-7
Year 8-999
150-550
150-550
150-500
150-450
15-55 Male
135-180
4.2-6.0
0.38-0.52
80-98
27-35
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
MCHC
RDW
HAEMATOLOGY
APPENDICIES
APPENDICIES
HAEMATOLOGY
APPENDICES - HAEMATOLOGY
100
EMD =
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).
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
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
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
12.33
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
APPENDICIES
Mild - Moderate
Moderate - Severe
Rifampicin
Marked
Statins
Mild - Moderate
Tramal
Moderate
Tegretol
Mild - Moderate
12.34
APPENDICIES
HAEMATOLOGY
APPENDICES - HAEMATOLOGY
Microsomal - thyroid
Adenovirus
Fungal precipitins
Psittacosis
Adrenal
Mitochondrial (AMA)
Rose - Waaler
(Rheumatoid factor)
Haemophilus influenzae
Q fever
Muscle - skeletal
Salivary duct/gland
Arbovirus
Helicobacter pylori
Muscle - smooth
Aspergillus
Hepatitis A
Smooth muscle
Avian precipitins
Hepatitis B
Rickettsiae
Sperm
Hepatitis C
Triiodothyronine (T3)
Bartonella
(Cat Scratch Disease)
Rubella
Hepatitis E
Hepatitis G
Salmonella typhi
and Paratyphoid
Schistosomiasis
HIV - 1 and 2
Shigella
HTLV - 1
Staphylysin
Chlamydia
Coccidiodes
Hydatid
Strongyloides
Coxsackie virus
Influenza A
Cryptococcus
Influenza B
Cytomegalovirus (CMV)
Legionella
Dengue
Leptospira
Tetanus
DNAse B (Streptococci)
Toxocara
Echinococcus (Hydatid)
Lymphogranuloma venereum
(LGV)
Toxoplasma
Measles
Typhus
Melioidosis
Varicella - Zoster
Mumps
Mycoplasma pneumoniae
Neutrophil cytoplasmic
(ANCA) includes cANCA,
pANCA, myeloperoxidase,
Proteinase-3
Nuclear antibody (ANA)
Donath-Landsteiner
Ovarian
Endomysial
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
Histones
Enterovirus
Insulin
Reticulin
Filaria
Parainfluenza
Yersinia
Parapertussis
12.35
Neutrophil
Intrinsic factor
Rheumatoid factor
Rhesus antibodies
Ribosomal
Entamoeba histolytica
Fasciola hepatica
Parvovirus B19
Pertussis (whooping cough)
IMMUNOLOGY
APPENDICIES
12.36
APPENDICIES
IMMUNOLOGY
APPENDICES - IMMUNOLOGY
12.37
Contraindications
Testing is contraindicated in patients with:
Current severe allergic symptoms
Recent anaphylaxis
Unstable asthma
Acute illness
Generalised skin rash
Pregnancy.
IMMUNOLOGY
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
Trees
Eucalyptus
Melaleuca
Wattle, Acacia
Moulds
Alternaria tenuis
Aspergillus fumigatus
Candida albicans
Cladosporium herbarum
Penicillium notatum
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
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
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
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)
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
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
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.
MICROBIOLOGY
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.
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.
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.
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.
APPENDICIES
12.44
APPENDICIES
MICROBIOLOGY
APPENDICES - MICROBIOLOGY
NO
YES
Collect cleaning material and equipment.
APPENDICIES
MICROBIOLOGY
YES
4. B
athe eyes or damaged skin with copious
water and/or sterile saline if applicable
APPENDICIES
MICROBIOLOGY
APPENDICES - MICROBIOLOGY
Is source known
YES
NO
spot cleaning
Wipe up blood spots
immediately with a damp
cloth, tissue or paper towel
using detergent and water.
Obtain consent
from source for
urgent HBsAg,
HepCAb and HIV
serology
Is source HIV
positive
or high risk
12.45
YES
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
12.46
Steriliser chamber
* 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.
CYCLE NUMBER
VIAL LABELS
1C (chamber); 1E (package)
2C (chamber); 2E (package)
3C (chamber); 3E (package)
Control Vial
MICROBIOLOGY
12.47
APPENDICIES
12.48
APPENDICIES
MICROBIOLOGY
APPENDICES - MICROBIOLOGY
APPENDICIES
MICROBIOLOGY
APPENDICES - MICROBIOLOGY
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.