INTRODUCTION

LIST OF TESTS

ROUTINE CHEMISTRY

HORMONES AND TUMOUR MARKERS

  1. INTRODUCTION

The Chemical Pathology Laboratory offers its diagnostic services to all patients of Hospital Kuala Terengganu, district hospitals as well as polyclinics in Terengganu.

The Diagnostic Services provided are:

  1. Routine Services
  2. 24 hour services

The biocemical tests offered vary widely. As the demands for biochemical tests are heavy,user of biochemical service are urged to be selective when requesting service. Requests should be confine to those tests which are useful for the diagnosis or treatment of patients.

Most tests are run daily. Specimen which are arrive in the early morning are proccesed the same day and the results will be ready before the end of the day with the acception of the hormonal assays.
 



 

  1. LIST OF TESTS

ROUTINE CHEMISTRY

* Test is available at out of normal hours of sevice
** Appointment must be made

1.

2.

3.

4.

5.

 6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

Acid Phosphatase/ACP (B)

Alanine Transaminase/ALT/SGPT (B)

Albumin (B)

Alkaline Phosphatase/ALP (B)

Ammonia (B)**

Amylase (B, U, F)*

Aspartate Transaminase/AST/SGOT (B)*

Bilirubin – direct (B)*

Bilirubin – total (B)*

Calcium (B, U )*

Cholesterol – HDL (B)

Cholesterol - total (B)

Chloride (B,U)*

Creatine Kinase/CK/CPK – (B)*

Creatinine (B,U)

Creatinine Clearence (B & U)

17.
 

18.

19.

20.

21.

22.

23

24.

25.

26.

27.

28.

29.

30..
 

Full Examination Microscopic Examination/FEME (F, CSF*)

Fibrinogen (B)*

Glucose (B)*

Glucose Tolerance Test – (B & U)

Iron (B)

Lactate dehydrogenase/LDH (B, F)*

Magnesium (B, U)

Phosphate(inorganic) – (B,U)

Potassium (B,U)*

Sodium (B,U)*

Total Iron Binding Capacity/TIBC (B)

Triglyserides (B)

Urea (B*, U)

Uric Acid (B,U)



 
 

HORMONES & TUMOR MARKERS
 
 

1.

2.

3.

4.

5.

6.

Cortisol (B, U)

Follicle Stimulating hormone/FSH (B)

Glycated Hb/HbA1c (B)

Luteinising hormone/LH – (B)

Progesterone (B)

Prolactin (B)

7.

8.

9.

10.

11.

Prostatic Specific Antigen/PSA - Total (B)

Prostatic Specific Antigen/PSA – Free (B)

Thyroxine, Free /FT4 (B)

Triiodothyronine, Total T3 (B)

Thyroid Stimulating hormone/TSH (B)



 

TDM
 
 

1.

2.

3.

4.

5.

Acetamenophen/Paracetamol (B)*

Carbamazepine (B)

Digoxin (B)

Gentamicin (B)

Netilmicin (B)

6.

7.

8.

9.

10.

Phenobarbital (B)

Phenytoin/Dilantin (B)

Theophylline/Aminophylline (B)

Salicylate (B, U)*

Valproic Acid/Epilim (B)

Notes: B : Blood

U : Urine

CSF: Cerebrospinal Fluid

F: Other Fluids (pleural, peritoneal,ascitic etc.).
 
 
 
 
 
 

FUNCTION/PROFILE TESTS
 
 

1.
 
 
 
 

2.
 
 
 
 

.

3.
 
 
 

4.
 
 
 
 
 

5.
 
 
 

.

BUSE
  • Blood Urea
  • Sodium
  • Potassium
  • Chloride

Liver Function Test / LFT

  • Total Protein
  • Albumin
  • Alkaline Phosphatase
  • Bilirubin – total & direct
  • ALT

Cardiac Enzymes / CE

  • AST
  • CK
  • LDH

Fasting Serum Lipid / FSL

  • Total Cholesterol
  • Triglyserides
  • HDL-Cholesterol
  • LDL-Cholesterol

Renal Function Test / RFT

  • Creatinine
  • Uric Acid
  • Calcium
  • Phosphorus
6.
 
 

7.
 
 
 
 
 
 
 

8.
 
 
 
 
 
 
 

 

Thyroid Function Test / TFT
  • Free T4 
  • Total T3

CSF FEME / Biochemistry

  • Appearance
  • Cell Count
  • Glucose
  • Protein
  • Globulin
  • Chloride

Fluid FEME

  • Appearance
  • Cell Count
  • Glucose
  • Protein
  • Specific Gravity

3. COMMUNICATION

For any inquiry of the service or tests provided, kindly  ring :

         2119 - Laboratory
         2123 - Biochemist
         2120 - Specimen reception counter
 

4. REQUEST FORMS

Completed Biochemical request forms should be signed by Medical Officer and aacompanied by properly collected specimens. Relevant information regarding provisional diagnosis & teratment should be provided. Requests must specify names of tests required. For tests which are not listed in this handbook, kindly contact the Chemical Pathology Laboratory for further information.

5. SPECIMEN COLLECTION

All specimen must be sent in their respective containers as the use of inappropriatecontainers will cause misleading results. The following minimum information must be provided on the labels of the specimens:-

Name of patient
Registration No. or IC No.
Ward / Clinic
Name of test
Date

Blood collected in plain tubes must never be shaken. Blood taken in anticoagulated tubes must be mixed gently and never shaken.
 
 

6.     SPECIMEN CONTAINERS

    Types of specimen containers for biochemical tests:
    (The following containers are supplied by Laboratory receiving Counter)


                i .   Serum Seperation Tubes / SST     -  for blood sample-serum
                ii    Plain Plastic tubes -

               iii .   Heparin Tubes
               iv.    Flouride Oxalate Tubes                 --  for  blood samples – plasma or whole blood
               v.     Potassium Oxalate Tubes

               vi.   EDTA Tubes                                   } for blood sample – whole blood
               vii.   Micro tubes/bullet                         } for peadiatric use)
               viii.   Universal Bottle                            } for urin,PD fluid, other body fluids
               ix.      24h urine bottle                             } for 24h urine collection
 

7. DESPATCH OF SPECIMEN

All specimens should be sent to the Reception Counter, Department of Pathology,HKT

Any incomplete forms, labels, wrong containers, inadequate samples and inappropriate specimen will
be rejected.

8. REPORTING OF RESULTS

As soon as a batch of tests results is completed, they are screened by biochemist. All laboratory results
must pass quality control criteria before they are reported.

All the reports will be placed in the ‘pigeon holes’ located at the Reception Counter, Department of
Pathology,HKT. The results are despatched to the pigeon holes for collection several times in a day.

Ward and clinic staff should come to the laboratory to collect results regularly, preferably once in the morning and once in the afternoon or even more frequently..

Results for polyclinics and distric hospitals will be posted 1-2 times a week.

9. INQUIRY OF RESULTS

Inquiry of urgent results by telephone is permitted but should be kept to minimum so as not to
interrupt work in the laboratory unnecessarily.

10. URGENT REQUEST AFTER OFFICE HOURS

Specimen with completed request forms should be brought to the Biochemistry Laboratory by the ward
staff.

Results will be telephoned back to the ward as soon as the test is completed and all the reports are
despatched to the pigeon holes for collection by the wards.

SECTION B

TABLE OF TEST OFFERED, SPECIMEN REQUIRED AND CHARGE

              1.    ROUTINE CHEMISTRY

     

    TESTS SPECIMEN CONTAINER SAMPLE VOLUME CHARGE
    BUSE – BUN

    - Na/K/Cl

    Blood

    Urine – random

    - 24hr collection

    SST/Plain/heparin tube

    Universal bottle

    24hr urine container

    5ml (neonates: 1.5ml)

    10ml

    24 volume

    G – each test

    G x 4 – BUSE

    Glucose – Fasting/Random/HPPS

    - GTT (fasting, 1hr, 2hr)

    Blood

    Blood

    Urine

    Flouride oxalate tube

    Flouride oxalate tube

    Universal bottle

    3ml (neonates: 1.5ml)

    3ml each

    10ml

    G – each test

    C – GTT

    Total Protein, Albumin, ALP, ALT, Bilirubin-total & direct, Uric Acid, Creatinine, Calcium, AST, CK, LDH, Phosphate, Cholesterol, Triglyserides, HDL-Cholesterol, Amylase, Magnesium, ACP 
     
     

    Blood

    (Lipid-fasting sample)


     
     

    Plain plastic tube/SST

    3ml (<10tests)

    5ml (>10test)

    G – each test

    C- LFT

    D – Lipid

    Iron, TIBC Blood Plain plastic tube/SST 5ml

    G – each test

    Total Protein, Uric Acid, Calcium, Phosphate, Creatinine

    Creatinine Clearence

    Urin – Random

    - 24hr 

    Urine 

    Blood

    Universal bottle

    24hr urine bottle

    24hr urine bottle

    Plain plastic tube/SST

    10ml

    24hr volume

    24hr volume

    3ml

    G – each test
    LDH Other body fluids Universal bottle 10ml G
    Amylase Urine - Random

    - 24hr

    Other body fluids

    Universal bottle 

    24hr urine bottle

    Universal bottle

    10ml

    24hr volume

    10ml

    G
    Ammonia (appointment must be made) Blood Heparin Tube 5ml (3ml: children) G
    Bilirubin (capillary method)- neonatal jaundice cases Blood Heparinised capillary tube >3/4 capillary tubes volume G
    Fibrinogen Blood Potassium Oxalate tube 5ml G
    FEME CSF

    Other body fluids

    Sterile bijou bottle

    Universal bottle

    2ml

    10ml

    F

            2.   HORMONES, TUMOR MARKERS ETC.

TEST SPECIMEN CONTAINER VOLUME CHARGE
Free T4, Total T3, TSH

Prolactin, FSH, LH

BHCG, CEA, AFP, Ferritine


 
 

Blood

Plain plastic tube

Or

SST

4ml (<5 test)

5ml (>5ml)

E – each test
Progesterone (Day 21 only) Blood

Plain plastic tube

Or SST

3ml E
Cortisol Blood – Random/am/pm

Urine – 24 hr collection

Plain plastic tube

Or SST

24hr urine bottle

3ml

24hr volume

E
Glycated Hb (Hb A1c) Blood EDTA tube 3ml E
Acetamenophen, Carbamazepine, Digoxin, Phenytoin, Phenobarbital, Theophylline, Valproic Acid
Blood

Plain plastic tube

Or

SST

3ml (< 3test)

5ml (>5ml)

E each test
Gentamicin, Netilmicin Blood – pre & post

Plain plastic tube

Or SST

3ml each test E
Salicylate, Blood

Urine

Plain plastic tube/SST

Universal bottle

3ml

10ml

E
Paraquat Urine

Gastric Lavage

Universal bottle

10ml` G

TABLE OF REFERENCE VALUES

(Extracted from ‘product insert’ of reagents kit)

              1.  Routine Chemistries

     

    TEST

    BLOOD/SERUM/PLASMA

    URINE

    Acid Phosphatase/ACP Total:        0 - 9 U/L
    Prostatic: 0 - 3 U/L
     
    Albumin 35 - 50 g/l  
    Alkaline Phosphatase Adult: 39 - 117 U/L
    Children:
     
    ALT/SGPT Up to 37 U/L  
    Ammonia 45 - 115 ug/dl  
    Amylase Up to 220 U/L

    Up to 1000 U/L

    AST/SGPT Up to 37 U/L  
    Bilirubin – total

    - Direct

    Adult: up to 18.8umol/l
    Neonates: <171.1 umol/l
    Up to 4.3 umol/l
     
    Calcium 2.02 - 2.60 mmol/l

    2.50 - 8.0 mmol/24h

    Chloride 99 - 114 mmol/l

    85 - 170 mmol/l

    Cholesterol Low risk: < 5.7 mmol/l
    Suspect Range: 5.7 - 6.7mmol/l
    High Risk: > 6.7 mmol/l
     
    Creatinine Up to 124 umol/l

    5 - 18mmol/24h
    (5000 - 18000umol/24h)

    Creatinine Clearence 70 - 140ml/min  
    CK/CPK Up to 190 U/L  
    Fibrinogen 1.5 - 4.5 g/l  
    FEME / Biochemistry

    CSF Appearance: Clear & colorless
    Cell Count: < 5 WBC
    Protein, Total: 1.5 - 4.5 g/l
    Globulin: Negative
    Glucose: 2.2 - 3.89 mmol/l
    Chloride: 120 - 130 mmol/l

     

    Glucose Fasting: 4.1 - 6.3 mmol/l
    Random: 4.4 - 6.6 mmol/l
     
    HDL-Cholesterol MaleFemale
    Low Risk: > 1.4 >1.7 mmol/l
    Suspect Range: 0.9 – 1.4 1.2 - 1.7 mmol/l
    High Risk: < 0.9 <1.2 mmol/l 
     
    Iron Male: 10.6 - 2.3 umol/l
    Female: 6.6 - 26.0 umol/l
     
    LD/LDH 200 - 480 U/L  
    LDL-Cholesterol Low Risk: <5.7 mmol/l
    Suspect Range: 5.7 - 6.7 mmol/l
    High Risk: >6.7 mmol/l 
     
    Magnesium 0.7 - 1.1 mmol/l

    2.1 - 8.22 mmol24h

    Phosphorus Adult: 0.9 - 1.5 mmol/l

    11 - 32 mmol/24h

    Potassium 3.5 - 5.3 mmol/l

    35 - 80 mmol/l

    Protein, Total 66 - 87 mmol/l

    <0.2 g 24h

    Sodium 137 - 151 mmol/l

    30 - 300 mmol/24h

    TIBC Male: 52.1 - 77.0 umol/l
    Female: 49.1 - 88.5 umol/l
     
    Triglyserides Low Risk: <1.7 mmol/l
    Suspect Range: 1.7 - 2.3 mmol/l
    High Risk: >2.3 mmol/l
     
    Urea 2.5 - 6.4 mmol/l  
    Uric Acid Male: 202 - 416 umol/l
    Female : 142 - 339 umol/l
    1. 1.5    - 4.5 mmol/24h
    2. (1500 - 4500 umol/l)

              2.  IMMUNOASSAY - Hormon & Tumor Markers

     

    TEST

    BLOOD/PLASMA/SERUM

    URINE

    AFP (Alpha Fetoprotein) <17 ng.ml  
    BHCG (Human Chorionic Ganadotrophin) < 5 mIU/ml  
    CEA (Carcinoembrionic antigen) < 10 ng/ml  
    Cortisol Am: 165.6 - 828.0 umol/l
    Pm: 82.8 - 441.6 umol/l
    1159.2 - 6016.8 umol/24h
    Ferritine Male: 16.4 - 323.0 umol/l
    Female: 6.9 - 282.5 umol/l
     
    Glycated Hb (HbA1) 4.4 - 6.4%  
    FSH Follicular: 4 - 13 mIU/ml
    Mid Cycle: 5 - 22 mIU/ml
    Luteal: 2 - 13 mIU/ml
    Postmenopausal: 20 - 138 mIU/ml
    Male: 1 - 8 mIU/ml
     
    LH Follicular: 4 - 13 mIU/ml
    Mid Cycle: 5 - 22 mIU/ml
    Luteal: 2 - 13 mIU/ml
    Postmenopausal: 20 - 138 mIU/ml
    Male: 1 - 8 mIU/ml
     
    Prolactin Female: 0.30 - 27.3 ng/ml
    Male: 1.58 - 23.12 ng/ml
     
    Progesterone 13 - 80 nmol/l (Day 21)  
    T4-Free (Thyroxine) 9.2 - 23.8 pmol/l  
    T3-total 0.9 - 2.67 nmol/l  
    TSH 0.40 - 4.67uIU/ml  

3.        IMMUNOASSAY – TDM
 

TEST

USUAL THERAPEUTIC RANGE

Acetamenophen

10 - 20 mg/l

Carbamazepine

4 - 10 mg/l

Digoxin

0.8 - 2.2 ug/l

Gentamicin

Peak: 5 - 12 mg/l
Trough: <2 mg/l

Netilmicin (Neulin)

Peak: 5 - 12 mg/l
Trough: < 2 mg/l

Phenobarbital

15 - 40 mg/l

Phenytoin (Dilantin)

10 - 20 mg/l

Salicylate

< 2.2 ng/ml (after 6 hour)

Theophylline (Aminophylline)

Asthma: 8 - 20 mg/l
Neonates Apnea: 6 - 11 mg/l

Valproic Acid

50 - 100 mg/l

DRUG LABORATORY

SECTION A

  1. INTRODUCTION

The role of this laboratory is as follows;

  1. To carry out analysis of drugs of abuse in urine
  1. To provide consultation services the area of drugs testing.
  2. To carry out research in the relevant field.
  1. REQUEST FORM FOR DRUG ANALYSIS

A drug analysis request form which accompanies the urine will allow tha laboratory to check the individual urine against the form to confirm that all specimen collected reach the laboratory.

  1. All requests for drug analysis should be accompanied with a drug analysis request form (Annex )
  2. All requests form should be completed by an authorised officer requesting the drug analysis.
  3. Personnal authorised to request for drug analysis – where possible this should be a qualified Medical Officer. Others who may be authorised are Senior Police Officers, Senior Army Officers and those who are gazetted as Drug Rehabilaization Officers.
  4. Completed form should be signed and stamped with departmental stamp.
  5. Name and Identity Card (IC) number of the suspect should be clearly printed as on his/her identity card.
  6. Name and IC number of the officer supervicing the collection and the person despatching the specimen should be printed clearly.
  1. URINE COLLECTION
  1. The collection of specimens is normally carried out by medical assistant or nurses. Collection ca also be carried out at other sites and done by authorised personnel as follows:
  1. Suitable toilet facilities must be available before collection of urine is considered.
  2. The toilet must be surveyed for any contraband which can be used to invalidate the sample. Toilet facilities can be set up without soap dipenser or cleaning agents.
  3. If adultration by changing the pH of urine is suspected, the laboratory should be notified and request to check the pH.
  4. The volume of urine samples should be at least 25ml . This is to ensure that further analysis ca be carried out to confirm the presence of drugs in the urine.
  5. The person supervising the collection should stand close enough to drug user suspectto see that the urine is genuinly passed out from the person and to see that there is no attempt to falsify the specimens.
  6. After the urine is collected, the bottles should be securely stoppered and labeled as follows:

  7.  

     
     
     
     
     

    Name:
    IC Number:
    Date and time of collection:
    Signature of person supervising the collection:
    Drug Suspected:
    Labelling of bottles should be made in front of the suspect.

  8. The stopper of the bottle should be sealed with sealing wax duly stamped with departmental seal.
  1. SECURITY OF THE SPECIMEN
  1. The security of samples as well as empty cups, request forms, labels and other packing materials is critical.
  2. Suspect should not be allowed to have any involvement in the collection, labelling and packing or transporting of samples to the laboratory.
  3. It is important that the suspect witness tha sealing of the bottle and sign or initial tha seal.
  4. Accurate and complete records of all individuals involved in the urine collection, storage and transport should be maintained.
  5. Specimen label should be afixed to the urine container not to the lid . This will prevent accidental or intentional switching of specimens and identifing labels.
  1. TRANSPORT OF SAMPLES TO DRUG DETECTION LABORATORY
  1. After the request form has been completed, the samples with the forms are given to the despatch person to be sent to the drug detection laboratory.

  2.  

     
     
     
     
     

    Reminder: ‘Suspect’ should never be permitted to transport samples to the laboratory.

  3. In the laboratory, the Medical Laboratory Technologists receive, check the samples against the forms to confirm that all the specimen are received and sign the despatch book.
  4. After examining the samples and request forms, slips found at the bottom of every form should be handed to the person to acknowledge receipt of specimens.
  5. Urine specimen should be stored at 40C and locked if analysis is delayed.
  6. Specimens collected by police /outside personnel should be sent to the laboratory immediately.
  1. REPORTING OF RESULTS

All batch of test results that are completed will be screened by a biochemist before they are reported.