00ogy 0000000 phone000 - western diagnostic … · western diagnostic pathology copyright ......

Western0Diagnostic0PathologySection030-0Test0Reference0Manual0(Issue017)Phone:0080931700999

www.wdp.com.au

Western Diagnostic Pathology Copyright - Copying is Not Permitted. ISSUE 17. Section 3, Page 1 of 74

5 HIAA

1. Give patient Form P8 / FRM COLL 7. 2. 1 x 24hour urine container (with acid). 3. Patient must maintain a restricted diet 72 hours prior and during the 24 hour

urine collection. Inform patient of foods to avoid.

FOODS TO AVOID Alcohol Avocado Bananas

Pineapple Kiwifruit Plums Tomatoes Nuts Chocolate Paracetamol

NB: Urine must be collected in acid. Add 20ml of 50% HCl acid to the 24 hour urine container prior to collection. Inform patient that the container contains acid and to exercise caution.

Laboratories 1. Measure total volume and record. 2. Test pH (should be <3) if >3 record pH and organise a recollect

Adrenocorticotrophic Hormone (ACTH)

Check if test is for ACTH Stimulation test - if so, contact Duty Biochemist. 1. Chill EDTA Tubes prior to collection. 2. Collect two (2) EDTA tubes (purple top 4.5mL) 3. Samples must be centrifuged and the plasma separated and frozen within 30

minutes of collection @ LCC. 4. If a cortisol is also requested ensure both samples are collected at the same time.

Alcohol (Blood) - Legal Purposes

Western Diagnostic Pathology is not licensed to perform Blood Alcohol analyses for police or legal purposes. Such samples (usually in a sealed envelope) cannot be accepted. Contact Duty Manager for advice if required.

Aldosterone

1. Collect 1 x SST. 2. Please note if requested with Renin then an additional EDTA (Purple) is

required. See collection requirements under Renin for details on how to collect a Renin specimen .


Amino Acids Chromatography

1. Collect 1 x Heparin and 1 x spot urine. 2. Centrifuge and freeze plasma immediately after collection.

Ammonia

1. Any collection centre without a centrifuge contact Duty Biochemist prior to collection.

2. Collect 5 - 10mL Heparinised blood. 3. Place in an ice bath or refrigerate (DO NOT freeze) 4. Sample must be centrifuged and the plasma separated and frozen within 30

minutes of collection @LCC. 5. Plasma must be transported frozen.

Anti Cochlear Antibodies.

1. 1 x SST Spin, separate and freeze ASAP @ LCC.

Anti Granulocyte Antibody

Contact Duty Laboratory Manager PRIOR to collection. Sample MUST be delivered to RPH before 1400hrs on the day of collection. Performed on Monday to Friday only. 1. Collect 1 x EDTA (Purple) + 1 CLOT.

Anti Heat Shock Proteins.

1. 1 x SST Spin, separate and freeze ASAP.

Anti Mullerian Hormone (AMH)

NT Darwin Repromed patients on Darwin Repromed forms. Spin/ Separate. Send aliquot to DPH Repromed. WA

This test is not Medicare rebatable.

Patients will incur and out-of pocket charge of $50 for this test

Do not take money (patient will be billed).

Patient must acknowledge on request form that they have been informed that test will cost and that they are happy to get a bill.

1 x SST, Spin, separate and freeze @ LCC within 2 hours of collection. Transport frozen

Do not take money.

Anti Rh (D) Antibody Titre

1. Collect 2 x 6ml EDTA-BB (Pink). 2. Request from patient if they have taken any prophylactic Anti D in last 6-8

weeks.


3. Note the answer on the request form.

Arterial Blood Gases

Arterial Blood Gases should only be performed by a Medical Practitioner. An appointment is necessary - Contact Duty Biochemist. This test should preferably be performed at a hospital site.

Avian/ Swine Flu

1. Once aware of request, contact duty or on-call microbiologist as soon as possible.

2. Information from the patient that may be useful to provide to the microbiologist includes:

Requesting doctor and telephone contact

How long patient has been unwell

Where patient has recently travelled and how long has been back in Australia

3. Do NOT attempt to collect ANY specimen from the patient until after you have contacted the duty or on-call microbiologist for advice.

4. Under NO circumstances should nasal aspirate samples be collected from a suspected case. The only specimens that should be collected (after confirmation with microbiologist) are:

throat swabs

nasopharyngeal swabs

blood for serology. 5. A surgical mask should be worn when collecting specimens – if available, a

higher grade of mask [P2N95] should be worn.

Benzodiazepine - ? Overdose

1. FLOX (Grey) or EDTA, 5ml minimum 2. Sent to Chemistry Centre and they charge the patient $360 – not claimable. 3. Price correct at time of printing but may vary. 4. Patient should contact Chemistry Centre for current cost. 5. Results in approximately 5 days.

Beta Hydroxybutyrate

Patient must be hypoglycaemic Full clinical details and current therapy is required to be documented on request form Collect 1 SST, separate plasma, refrigerate sample.

Bile Salts

Patient must be fasting. 1. Collect 1 x SST

Instruct patient to eat a substantial meal and return 2 hours after completing the meal.

2. Collect 1 x SST - 2hr post prandial 3. Must indicate on separated samples which is fasting and which is post prandial.


Bleeding Profile / Time / Screen / Studies

Bleeding Times are no longer performed by WDP. If the word bleeding appears on the request please contact Coagulation at Myaree or the Haematologist to verify what tests are to be performed.

Blood Culture

Principles

Blood cultures are taken to detect if bacteria is present in the patient’s blood stream. Care must be taken to avoid contamination of the sample with bacteria from other sources, eg the patient’s skin or the hands of the blood collector. Key Points for the BioMerieux BacT/Alert blood culture system:

Always inoculate the blood culture bottles FIRST i.e . before distributing the blood into other specimen containers. If multiple tests have been requested, the blood culture bottles must be filled first,

Each set of blood culture bottles requires an aerobic (green top) AND an anaerobic (orange top) bottle.

Multiple blood culture sets may be taken from the same site all at once, unless specified by the requestor. If unsure, contact the Duty Microbiologist for advice.

Inoculated blood culture bottles must be kept at room temperature until they can be sent to the Laboratory.

Paediatric / Neonate Bleeds- Must be placed into the BacT/Alert Yellow Paediatric Blood Culture Bottle.

Difficult collects (low volume) -The BacT/Alert Yellow Paediatric Blood Culture Bottle is recommended for difficult child or adult bleeds.

Check the expiry date of the blood culture bottles before specimen collection.

Bottles showing cloudiness, contamination, seepage or discoloration must not be used.

If an additional set of blood cultures is required, then perform the entire procedure again.

If you require clarification contact your Supervisor or the Duty Microbiologist.


The following manufacturer recommended routines are to be undertaken for all Blood Cultures.


Version Accessed from BioMerieux 14/06/10

BNP / Brain Natriuretic Peptide


Current cost $48 – price may vary, correct at time of going to print (please tell patient this).



1 x EDTA. Spin, separate and freeze within 4 hours @ LCC.

Do not take money.

Bone Marrow Aspiration

If a patient presents with a form requesting this procedure then it must be ascertained that they have made an appointment with a Clinical Haematologist. This should have been done through Patient Reception at Myaree. The patient will require a referral letter from their G.P. if the appointment is to be made.

Bone Metabolic Studies

Give patient Form P3 and explain the following: 1. Instruct patient to fast from 10 PM the night before the test. 2. Patient must remain fasting until the completion of the test the next morning. NB: Patient is permitted water. 3. On the morning of the test instruct the patient to:- a. Go to the toilet and empty their bladder. b. Drink at least two glasses of water (more than 2 glasses is also fine if patient is thirsty).

c. Have nothing to eat or smoke. d. DO NOT DRINK tea, coffee, milk or fruit juice. e. DO NOT take medications including calcium, fluoride or vitamin D or

diuretics tablets until AFTER the test (unless instructed not to by their doctor).

4. Before the patient leaves home they may: a. Patient may empty their bladder if necessary. b. Try to arrive at the Collection Centre on the morning of the test before

10 AM. 5. When the patient arrives ask them to sit quietly for about 10 minutes, then

collect the following specimens:- a. 1 x Spot urine (MSU tube / container) + 1 x UT

b. 2 x SST c. 1 x PPT (white top EDTA) – spin within 24 hours

5. SST samples should be centrifuged (Do NOT freeze). See Ionised Calcium for processing instructions. All samples to be forwarded to Manual Biochemistry for analysis.


Bordetella Pertussis IgA - Nasopharyngeal Aspirate

IgA to this organism can be detected in nasopharyngeal aspirate fluid. If request does not indicate what to collect, contact the doctor / microbiologist. See Nasopharyngeal Aspiration in this section for collection method. If a Nasopharyngeal Aspirate (NPA) cannot be collected then a nasopharyngeal swab (for PCR) plus an SST for Bordetella pertussis IgA serology should be collected.

BRAC 1 & 2 (Breast Cancer Gene)

Patient must be referred to Genetic Counselling by their GP For:

WA patients – KEMH NT Patients – Royal Darwin Hospital

Do not collect any bloods.

Breath Test

This test has a Special test out-of-pocket expense to the patient. Please refer to SPECIAL TESTS under “Billing” in this section for billing instructions and exceptions. You MUST inform the patient of this out of pocket cost Note: Biochemistry performs tests but all enquiries regarding interpretation should

be made to the Duty Microbiologist.

Pre test Instructions

Patient should be advised by doctor to phone and book appointment for this test.

Patient must be fasting for 4-6 hours prior to test (brushing of teeth is permitted)

Patient must have abstained for the required time from the listed restricted medication.

Important Information

This test requires the patient to swallow a capsule containing the substance urea which occurs naturally in all humans. The urea has been labelled with a minute amount of radioactivity (Carbon 14) to perform the test. The dose of radiation is equivalent to the total daily dose we all receive as “background radiation”. 1. This test is not recommended for use in pregnancy. Do NOT proceed with

this test if the patient is pregnant or is likely to be pregnant. 2. This test is unsuitable for use by small children if they cannot inflate the

balloon. 3. Ask patient what medications they are taking. Check list of restricting

medications provided in this manual. 4. Make an appointment. 5. Explain to patient that they are required to fast for 4 hours prior to test.


6. Appointment must be made 3 days in advance to allow for kits to be ordered from Manual Biochemistry.

Procedure

1. Give patient C14 capsule with sufficient water to swallow. 2. Wait 3 minutes and then give patient another 50mL of water. 3. Start timer for 7 minutes, sitting down. 4. When time has expired, have the patient take a deep breath and exhale into

the balloon, until firm. 5. Tie and secure the end of the balloon. 6. Check all paperwork has been completed. 7. The patient may then leave. 8. The balloon and paperwork is to be sent to the Myaree laboratory – Manual

Biochemistry department.

Ordering of Kits

Kits can be ordered via the Manual Biochemistry department.

Medication which restricts the usefulness of Helicobacter Breath Test.

Information compiled in this list is taken from eMIMS August 2011 Edition.

Time restriction Type of medication Generic Name Trade name

During Fasting and Antacids ALU-Tab Medefoam 2

During Test Andrews Tums Antacid Meracote

Antassa Mucaine

De Wits Antacid Powder Mylanta

Dexal Rennie

Eno Salvital

Gastrogel Sigma Liquid Antacid

Gaviscon Titralac

Gelusil

H2 Antagonists Cimetidine GenRx Cimetidine Magicul

Tagamet

Ranitidine Ausran Rani 2

Chemmart Ranitidine Ranital

Chemists’ Own Ranitidine Ranitidine Sandoz

Gastrogel-ranitidine Ranoxyl

GenRx Ranitidine Terry White Ranitidine

Gavilast 12 hour action Ulcaid

Hexal Ranitic Ultac

Ranihexal Zantac

Famotidine Ausfam Pamacid

Chemmart Famotidine Pepzan

Famohexal Pepcidine

Famotidine Sandoz Terry White Famotidine

GenRx Famotidine


Nizatidine Nizac Tazac

Nizaction Tacidine

For 7 Days Prior Proton Pump Inhibitors Esomeprazole Nexium Nexium HP7

Lansozaprole APO-Lansoprazole Lanzopran Zopral Zoton

Omeprazole Acimax Omeprazole GenericHealth

APO-Omeprazole Omeprazole Ranbaxy Tablets

Chemmart Omeprazole Omeprazole Winthrop

GenRx Omeprazole Omepro-GA capsules

Klacid HP7 Ozmep

Losec Pemzo

Maxor Heartburn Relief Pharmacor Omeprazole

Meprazol Probitor HP7

Omepral Terry White Omeprazole

Pantoprazole APO-Pantoprazole Pantoprazole Generichealth

Chemmart Pantoprazole Pantoprazole Sandoz

Gastenz Salpraz Heartburn Relief

Ozpan Somac Heartburn Relief

Panto Sozol

Pantofast Suvacid

Pantoloc Terry White Pantoprazole

Pantoprazole-GA

Rabeprazole Pariet

For 14 Days Prior Cytoprotectives Sucralfate Carafate Ulcyte

For 30 Days Prior Antibiotics Multi-actives Helidac Nexium HP7

Klacid HP7 Probitor HP7

Penicillins Amoxycillin Alphamox Clavulin

(with/out Clavulanic acid)

Amoxil Clavycillin

Amoxycillin-clavulanic acid Curam

Amoxycillin-DP Fisamox

Amoxycillin -GA GenRx Amoxycillin

Amoxycillin generichealth GA-Amclav

Amoxycillin-Ranbaxy Klacid HP7

Amoxycillin Sandoz Ibiamox

APO-Amoxycillin Moxacin

APO-Amoxycillin-clavulanic acid

Maxamox

Augmentin Moxiclav

Bgramin Nexium HP7

Chemmart Amoxycillin Probitor HP7

Cilamox Ranmoxy

Clamoxyl Terry White Amoxycillin Ampicillin Ampicyn Ibimycin

Austrapen


Macrolides Azithromycin Azith Zitrocin Azithromycin Sandoz Zithromax Zedd Clarithromycin APO-Clarithromycin Kalixocin

Chemmart Clarithromycin Klacid

Clarac Klacid HP7

Clarihexal Nexium HP7

Clarithro Probitor HP7

GenRx Clarithromycin Terry White Clarithromycin

Erythromycin DBL Erythromicin Erythrocin

EES MaynePharma Erythromycin

E-Mycin Eryacne Eryc Metronidazole Metronidazole Flagyl Metronide Metrogyl Rozex Tinidazole Fasigyn Simplotan Tetracyclines Doxycycline Chemmart Doxycycline Doxylin

DBL-Doxycycline Frakas

Doryx GenRx Doxycycline

Doxsig MaynePharma Doxycycline

Doxy Terry White Chemist Doxycycline

Doxyhexal Vibramycin

Tetracycline Helidac

Minocycline Akamin Minomycin

Demeclocycline Ledermycin

Tigecycline

Bismuth Bismuth Denol Helidac

Please note that all antibiotics except Vancomycin and Sulfa (Septrin Bactrim etc) should be withheld for 4 weeks for maximal accuracy Doxycycline, Minocycline and Demeclocycline are all a form of Tetracycline

Urea Breath Test On CHILDREN

These are the instructions from TriMed in getting children to perform the BT when they can't swallow the capsule: 1. Check to see if child can breathe into and inflate the balloon - if they can't do this, no point in doing test. 2. Child must either brush teeth with toothpaste or rinse out mouth with medicated mouth


rinse (e.g Listerine) prior to swallowing contents of capsule - this can be done while step 5 below is being performed by collecting staff. This also means that we need to consider supplying collecting centers with mouth rinse for this purpose. 3. Pour 30mL sterile saline into plastic cup 4. Pull BT capsule apart, allow beads to fall into sterile saline in cup 5. Shake for 2-3 mins until beads have visibly dissolved - this is when child should be having mouth rinsed or cleaned. 6 Resulting mixture should look cloudy & green and there may be some settling of material at bottom = starch & sugar within capsule 7. Then get child to drink the mixture 8. After this, follow standard procedure as if child has swallowed capsule.

C-Peptide

1. Patient should be fasting unless specifically requested. 2. Collect 1 x SST tube. 3. Spin and freeze in original SST @ LCC within 4 hours.

Calcitonin

1. Patient should be fasting for a minimum of 8 hours. If patient not fasting, check with Duty Biochemist prior to proceeding with test.

2. Collect 1 x SST tube. 3. Centrifuge and freeze serum within 1 hour of collection @ LCC. * Separated samples MUST be labelled with:

Full name DOB Lab No. Date and time of collection Type of specimen (eg. SST, EDTA)

Calcium / Total Calcium / Corrected Calcium

1. Collect SST using minimum tourniquet pressure. This tube can not be shared with any other test. 2. If a number of tubes are to be collected ensure the calcium is collected first. 3. Release tourniquet pressure and wait approximately 20 seconds before collecting SST sample.

Calcium Urine Fasting

1. Instruct patient to fast from 2200hrs from the night before the test. 2. Patient must remain fasting until the completion of the test the next morning. NB: Patient is permitted as much water as they wish. 3. On the morning of the test instruct the patient to:- a. Go to the toilet and empty their bladder. b. Drink two glasses of water. c. Have nothing to eat.

d. NOT take any tablets or medicine on the morning of the test - unless instructed by their referring doctor.


eg: If patient is asthmatic they may need to take some bronchodilator aerosol. Patient should bring their usual morning tablets so they may take them as soon as the test has been completed.

4. Before the patient leaves home they should: a. Once again empty their bladder and note the time on the request form 5. Patient should arrive at the collection centre 1.5 to 2 hours later. 6. Collect the following specimen: a. 1 x Spot urine + 1 x UT

Carboxyhaemoglobin

1. Contact Duty Laboratory Manager or Regional Manager / Senior Scientist PRIOR to collection to arrange transport to Mount, Joondalup, Hollywood or Peel Health Campus laboratory within day of collection.

2. Collect 1 x Heparin (green top). 3. Do not centrifuge. DO NOT collect in the Northern Territory – please direct patients to RDH for collection.

Catecholamines (Adults)

Give patient Form P8 / FRM COLL 7 1 x 24hour urine container (with acid). Patient should ideally refrain from taking medication for 24 hours prior to, and during urine collection. Physiological and Psychological stress may affect results.


Laboratories 3. Measure total volume and record. 4. Test pH (should be <3) if >3 record pH and organise a recollect

Catecholamines (Child)

USPOT – frozen – transport frozen

Chromogranin A





1 x CLOT. Spin, separate and freeze within 45 minutes @ LCC.


Do not take money.

Chromosome Studies

Collection: Specimen sterility must be maintained, therefore cytogenetics tubes should be one of the first collected.

Storage and Transport: Specimens should not be frozen, exposed to excessive heat or remain in transit for extended times. Store in fridge or at room temperature (for shorter periods of time).

Exception: Lymph Node specimens must remain at room temperature and be processed URGENTLY. (These specimens are Dr. collect only).

1. Blood for Chromosome Analysis / Studies / Klinefelters

Collect 1 x Heparin (Green Top) – No Gel Note: For Newborns and Difficult Bleeds: A Heparin Microtainer (Green Top) may be used. Specimens from newborns must be processed URGENTLY.

2. Blood for Fragile X Studies

Collect two tubes: 1 x EDTA (Purple Top) – minimum of 4.5mL required and one Heparin tube (Dark Green top) for Chromosome Studies (see above).

3. Blood for FISH Studies (Fluorescence in situ Hybridisation) Collect as for Chromosome Studies (see above). 4. Specimen containers for Amniotic Fluid, Chorionic Villus Samples (CVS),

Products for Conception (POC), and Bone Marrow are now available from the Cytogenetics Department upon request. (These specimens are Dr. collect only).

5. QF – PCR Blood for QF – PCR, collect 1 x EDTA (purple top) 4ml. Amniotic fluid and Chorionic Villus samples (CVS) may also be tested – these specimens are Doctor collect only.

Clostridium Difficile

Instruct patient in the collection of a faeces - (See faeces Micro and Culture). NB: If the request form does not already state antibiotic history, inquire if the

patient has had antibiotic therapy in previous 2 weeks and record on request form.


Coagulation Protocols

Refer to Coagulation Table on following page for number of tubes to collect. If you calculate that you will collect more than 5 citrate tubes - ring Myaree Coagulation 9317 0999. We can probably reduce the number required! Any other queries, please ring. Please note tests marked as $ will incur out of pocket expense to the patient. Check Billing brochure for more details – patient must be informed.

Transport of Samples to Laboratory

1. Platelet function, platelet aggregation, PFA-100, PFA-200:

Freshness of the sample is essential for these tests. These tests must be transported at room temperature – do not put on cool packs or ice bricks.

Platelet Aggregation must be received within 1 hour of collection, and must be collected before 1pm Monday – Friday only. Very specialised test - must ring Myaree Coagulation for permission to proceed.

PFA-100, PFA-200 must be received within 4 hours of collection.

Platelet function can mean either PFA or Platelet Aggregation – must ring Myaree Coagulation to clarify as they have different requirements.

If after acceptable hours or time requirement can not be met, (eg after 1pm for Platelet Aggregation), arrange an alternative collection time or place so that stipulated time frames can be met.

Alternatively, arrange for urgent transportation to the Myaree lab.

2. Samples for routine coag only (Coag profile including PT, APTT, Fibrinogen, TCT):

Send in to Myaree, UNSPUN, at room temperature in blue bag, same day.

If samples will be received at Myaree after 9 pm, they should be placed UNSPUN in a red bag to ensure they are processed same day.

Regional centres in WA: citrates in RED bag, marked urgent.

3. Samples for special coag +/- routine coag tests above (vWF screen, Factors, Thrombophilia, Lupus Anticoagulant, etc):

Send in to Myaree, UNSPUN, at room temperature in blue bag within 10 hours.

If citrates will not reach Myaree within 10 hours, arrange an alternative collection time or place so that stipulated time frames can be met.

Alternatively, the citrates may be spun, separated, and plasma frozen (see WI-COLL-40) at -15°C or colder, then transported on dry ice. “Bar Fridges” and/or Frozen Transport Containers must not be used for coagulation samples.

Collection of Samples 1. Complete the Coagulation Questionnaire (FRM-COLL-43/P1). Remember to Lab

Number this form & fax it as well as the request form. 2. If for thrombophilia testing, prothrombin gene, APCR or FV Leiden also complete

the Genetics Tests Questionnaire (FRM-COLL-31/P34). Remember to Lab Number this form & fax it as well as the request form.

3. If there are multiple tube types follow the correct order of draw (specifically, citrates first).

4. Once collected, transport citrates & any other sample types to the lab as per the current procedure. Remember - platelet function/aggregation studies must be kept at room temperature. All other non-separated citrates should be stored in the fridge until the courier arrives.

5. For frozen samples follow WI-COLL-40 and call lab manager to log the frozen when dispatched on dry ice with the courier.


**Any combination of tests – MAXIMUM 9 citrates (+/- other tubes)**

Screen Requested

Individually requested tests TUBES TIME LIMIT

(HRS) Transport Special instructions

1. Coags, clotting profile, coag screen (includes all tests below)

MAX 2 CIT

24 HRS Blue bag If after 9pm, red bag

INR, PT, Prothrombin Time 1 CIT 24

APTT, PTT, PTTK 1 CIT 24

Fibrinogen 1 CIT 24

TCT, TT 1 CIT 24

2. D-Dimer, DD, FDP 1 CIT 8 Always treat as urgent

3. Thrombophilia, procoagulant, prothrombotic screen $ (includes all tests below)

4 CIT 1 PPT

2 EDTA 1 SST

10 HRS

Blue bag for unspun citrates.

If frozen, dry ice.

If after 9pm, red bag

PPT- must spin within 30 min

1E- Molecular Genetics Sticker

1S- for ACL; as per local protocol

CITS- if more than 10 hours, double spin/separate/freeze as per WI-COLL-40.

ATIII (antithrombin) 2 CIT 10

Protein C $ 2 CIT 10 Patient must not be on warfarin

Protein S $ 2 CIT 10 Patient must not be on warfarin

FVL (factor V Leiden) $ 2 CIT

1 EDTA 10 1E- Molecular Genetics Sticker

Prothrombin Gene (PGM, G20210A, PT Gene) $


aPCR (activated protein C resistance, APC resistance) $

2 CIT 1 EDTA

10 1E- Molecular Genetics Sticker

Lupus anticoagulant (LAC, TTIT)

2 CIT 10 If more than 10 hours, double spin/separate/freeze CITS as per WI-COLL-40.

Antiphospholipid Abs (LAC/ACL)

2 CIT 1 SST

10

1S- for ACL; as per local protocol If more than 10 hours, double spin/separate/freeze CITS as per WI-COLL-40.

Homocysteine (random) 1 PPT 0.5 PPT- spin within 30 minutes

Thrombophilia Gene 2 CIT


4. vWF, vWD, clotting factors, factor studies, bleeding screen, FVIIIc, haemophilia screen (includes tests below)

MAX 3 CIT

10 HRS

Blue bag for unspun citrates.

If frozen, dry ice.

If after 9pm, red bag If more than 10 hours, spin/separate/freeze as per WI-COLL-40.

FVIIIc 3 CIT 10

vWF:Ag 3 CIT 10

Ristocetin Cofactor (vWF Activity, Ricof)

3 CIT 10

CBA 1 CIT 10

FIX, FXI, FXII 2 CIT 10

5. PFA-100, PFA-200, bleeding time 2 CIT 4 HRS Blue Bag DO NOT SPIN; Room temp

***Any combination of tests above – MAXIMUM 5 citrates (+/- other tubes)***

6. Platelet aggregation, platelet function, +/- mepacrine staining

MAX 5 CIT

1 HR Blue Bag

Phone MYA Coags for permission DO NOT SPIN; Room temp. Collect before 1pm M-F ONLY To Myaree within 1 HOUR

7. Other Special Tests MAX 4 CIT

-

PF1,2, TAT, CAT 2 CIT

Anti-FXa, Xa, anti-Xa 1 CIT 4

Anti-platelet antibodies 2 CIT

1 CLOT 24 2 CITS- DO NOT SPIN; To RT MYA

HITT Screening 4 CIT 2 Collect before 12 noon – notify RPH first. Submit vial of heparin used.

Platelet microparticles 1 CIT 2 DO NOT SPIN; To RPH in 2 hours.

Factor Inhibitors, Inhibitor Screen, FII, FV, FVII, FX, FXIII, ADAMTS13, XACT, Xymophen, Xymogen, PAI-1, TAFI, TFPI, Plasma phospholipids

1 CIT each, max 3

4


Cold Agglutinins

Cold agglutinins samples can only be collected in centres with a 37C water bath and a centrifuge.

1. Warm in water bath for 10-20 mins 1 x Clot and 1x EDTA tube to 37C prior to collecting sample.

2. Collect blood into prewarmed tubes. 3. Once collected leave EDTA whole – do not spin. 4. Place Clot tube ONLY into water bath for 30 mins. or until clotted. 5. Centrifuge the Clot tube only and immediately separate the serum from the

clot tube into appropriately labelled tube - specify serum sample. 6. Mark on the form that the sample was collected at 37C and maintained at

37C until separated. 7. Send all tubes and take off with form to Myaree laboratory. 8. For any queries please contact Haematology 9317 0999.

Cord Blood

1. Collect 1 x cord blood (CLOT)

Cord and Maternal Blood

1. Collect 1 x 6ml EDTA-BB (6 mL Pink) from mother. 2. Forward with cord blood (clotted). 3. Please do not separate samples. 4. Label as per Crossmatch sample.

Cortisol

If ACTH also requested, please refer to instructions for ACTH.

Coxsackie Virus PCR

1. Collect 1 x dry throat swab. 2. Collect 1 x faeces sample.

Creatinine Clearance

Give patient Form P8 (24hr Urine Collection Patient Instructions)

1. Instruct patient to collect 24 hour urine (No preservative) 2. 1 x SST tube must be collected within the 24 hours of the urine collection.

Cross Match / Group and Hold

1. Ask whether patient has been transfused or pregnant in the last three months - note on request form.

2. Ask date of operation and which hospital it is to be performed at - note on request form. If the hospital is a:


State Government Hospital - refer the patient to the nearest PathWest collection site for collection of the Crossmatch/Group and hold specimen. Private Hospital - proceed:-

3. If not transfused and not pregnant: Specimen may be collected if it is 7 days or less before the op date. If not

within this time frame, collection of the crossmatch specimen must be deferred and refer to a Senior Scientist in Blood Bank.

4. If transfused / pregnant in last 3 months specimen should be collected 24 hours or less before the op date. If not within this timeframe, collection of the crossmatch specimen must be deferred and refer to a Senior Scientist in Blood Bank.

5. Collect 1 x 4.5 ml EDTA (Purple) and 2 x 6ml EDTA (Pink top) with Full Name, DOB,or URN, Date of collection and Time of Collect. All tubes must be signed by the collector. Certifier must also be signed by collector. If request form does not include certifier then ensure you place “certifier” sticker on form.

N.B. Both these timing limitations are defined in the ASBT Guidelines for Transfusion Testing, The Australian Standard.

Cryoglobulins

Cryoglobulin samples can only be collected in centres with a 37oC waterbath and a centrifuge. 1. Warm in waterbath for 10-20min, 1 x EDTA (Purple) tube and 1 x Clot tube to

37oC prior to collecting the samples. 2. Collect the blood into the warmed tubes. 3. Place both the Clot and EDTA blood samples into a 37oC water bath for at

least 30 minutes. 4. Centrifuge the samples and immediately separate the plasma from the EDTA

tube and the serum from the Clot tube into appropriately labelled 5mL screw top tubes. (Carefully label the tubes with patient name and whether serum or EDTA plasma).

5. Mark on the form that the samples were collected at 37oC and maintained at that temperature until separated.

6. Send the samples and form to the Myaree Laboratory

CSF Oligoclonal Bands

1. CSF (Dr collect only) 2. 1 x SST, centrifuge blood at LCC NB: Both samples must be forwarded to main laboratory together. If other tests

are requested on this CSF sample then “DR ALERT” the Duty Biochemist for test priority.

CSF Rhinorrhoea

1. Collect approximately 0.2 - 0.5mL of nasal fluid. 2. Forward request form and sample for a B2 Transferrin assay.


Cyclosporin

1. Collect 1 x 4.5mL EDTA (Purple). 2. Trough level sample is preferred. Laboratory 3. Do Not centrifuge 4. Keep stable at 4oC

Cytomegalovirus Urine

1. Collect 10 -20mL of midstream clean voided urine in a sterile container. Cytomegalovirus may lose infectivity rapidly thus should be transported to

main laboratory immediately after collection. Contact Duty Laboratory Manager.

Dark Ground Illumination

1. Ulcer sampling is performed at the Myaree laboratory ONLY. 2. No appointment necessary if presenting at main laboratory between 0800 and

1800hrs Monday to Friday. 3. Medical Microbiologist only to perform procedure.

Dexamethasone Suppression Test

1. Contact Patient Reception - Myaree, for the forwarding of appropriate tablets and instructions. (Form P6)

2. The patient is instructed to take 1.0mg (2 x 0.5mg tablets) at night before going to bed eg:- 10.00pm.

3. A blood sample is collected for serum cortisol (1 x SST) the NEXT day at 09.00 am.

Disaccharides.

Freezing ASAP is required. Wrap container in foil and send to Lab ASAP on dry ice. This is a Doctor collect only. Always contact Duty Manager first.

Donovanosis

Donovanosis is most reliably diagnosed by Histological examination of a pinch biopsy of the lesion. If this is not possible, a thick smear can be submitted but, while a positive result is helpful, a negative result does not exclude the diagnosis. Collection of the smear is as follows: 1. Fully expose the lesion and clean all debris and surface material from an

ulcerated area. 2. When the base is exposed and raw it is vigorously scraped with a scalpel,

even if this induces some bleeding. 3. The scrapings are put onto a glass slide so that a distinct opaque area 2 x

1.5cms is apparent to the naked eye. 4. The smear is air dried. Fix the smear for 3 minutes in methanol. If methanol

not available, dispatch unfixed. 5. The patient’s name is written on the opaque end of the slide.


Drug Screen for Hypoglycemics, Laxatives, Purgatives and

Diuretics

Tests for common drugs in these classes. Laxatives: Biscodyl, Rhein, Phenolphthalein. 1. Collect 1 x Heparin (green) 2. Collect spot urine.

Ear Swab

Ear swabs may be indicated for two reasons. Otitis Media - Usually the patient will be a child with a history of ear ache. The pain may have been relieved when there was a discharge from the ear. This occurs because the pus from the middle ear has seeped through the ear drum. The specimen should be collected within 48 hours. 1. Clean away any obvious gunk with a saline moistened swab. 2. Take a second sterile swab. 3. Pull the pinna (ear) upwards and backwards (this straightens the ear canal). 4. Gently push the swab into the ear until all the cotton wool bud is in. 5. Rotate through 360 degrees. 6. Withdraw and let go of the pinna. 7. Make a smear on a new glass slide. 8. Place swab into transport media. Otitis Externa - This is inflammation of the ear canal.

1. Clean away any obvious gunk with a saline moistened swab. 2. Take a second sterile swab. 3. Pull the pinna (ear) upwards and backwards (this straightens the ear canal). 4. If you can see reddened skin, sample this area, otherwise - 5. Gently push the swab into the ear until all the cotton wool bud is in. 6. Rotate through 360 degrees. 7. Withdraw and let go of the pinna. 8. Make a smear on a new glass slide. 9. Place swab into transport media. NB: The organisms causing the inflammation will be on the skin surface of the canal. The

organisms growing in the debris may not be relevant.

E.C.G.

The centres to attend are – Joondalup, Mount, Myaree, Duncraig.

Eosinophil Cationic Protein (ECP)

1. Collect 1 x SST 2. Allow to clot for a minimum of 1 hour. 3. Centrifuge and transfer serum into a separate plastic container (this must be done within

20min after the initial 1hr clotting time has expired). 4. Store at 4oC. 5. Indicate on request form: a. Time of collection.

b. Time of separation of serum.


6. Transport to laboratory frozen. * Separated samples MUST be labelled with: Full name DOB Lab No. Date and time of collection Type of specimen (eg. SST, EDTA)

Eye Swab

Conjunctivitis can be caused by bacteria, chlamydia or viruses. Bacterial infections often cause the lids to become sticky and there may be a purulent discharge. Chlamydia infections can cause a sticky eye, which in long standing cases may lead to scarring of the eyelids and eventually to inversion of the eyelids and blindness-trachoma. Viral conjunctivitis usually produces reddened eyes with only a slight discharge, although the eyes may be sticky and gritty. NB: all forms of conjunctivitis can be very infectious. Always remove your gloves and

wash your hands after collecting the specimens. Wash and dry your gloved hands thoroughly between collecting each swab if you may have contaminated them.

Procedure 1. Eye or conjunctival swab for MC&S 2. Pull down the lower lid and take of any pus with the swab (Blue top). Smear the swab

onto the centre of a labelled glass slide. Take a second swab from the everted conjunctiva and then place into a tube of ‘the Transport Swab’. If there is no pus then gently but firmly rub the swab along the inside of the lower lid, from nose to ear, once.

3. Repeat the procedure (if necessary) on the other eye, using completely fresh swabs. 4. Dry swabs for viral PCR are collected similarly and stored at room temperature. 5. Chlamydia swabs are taken by first cleaning away any discharge that may be present,

using a Dacron swab. Then, using an APTIMA swab, swab the lower and then the upper conjunctiva 2-3 times each. Use a separate swab for each eye. Swab the least affected eye first to reduce “customer resistance”.

6. Replace the swab in its transport tube. 7. A dry swab (orange/black top tubes) may be used if APTIMA swab not available. Scrapings for eosinophilia: This test may be requested when allergic conjunctivitis is suspected. The lower eyelid should be everted while the reverse (blunt) end of a sterile scalpel blade is used to gently, evenly but firmly scrape across the conjunctiva. The scalpel blade may be safely held in its foil wrapper, with the sharp point and blade covered. The scrapings are then smeared on one or two labelled glass slides and immediately fixed in 95% ethanol.

Faeces Micro, Culture & Sensitivity / Faeces Multiplex PCR

The detection of pathogenic micro-organisms is most likely to be increased if multiple faeces are collected. If the request is for multiple faeces for M, C & S, then collect two samples, the second being seven days after the first on a separate request form. The patient must be instructed to present the samples when collected and not to store the first waiting for the second. If there is an overnight delay in dispatch of these samples, then store them in the fridge in a biohazard bag.


GIVE THE PATIENT A COPY OF FORM P14 (Faecal specimen collection information sheet). Multiplex PCR (panel FPM) for the detection of the most common enteric bacteria and parasites can be performed when request forms request ‘MCS + PCR’. This assay is only to compliment the MC&S and parasite microscopy and not to be used as a replacement. Normal collection procedures should be exercised 1x Faeces

Faecal Occult Blood (FOB)

FOB rapid testing is used to screen for lower gasterointestinal diseases, such as colorectal cancers and large adenomas that bleed. Testing is usually performed on 3 specimens to increase the sensitivity of the testing process, as cancers can bleed intermittently, and blood may not be uniformly distributed in faecal samples. If the request is for multiple samples, they need to be collected on separate days (daily is fine). The patient should be instructed to return the samples as they are collected. Alternatively, they may be kept in the fridge (2-8degC) for up to 72 hours. GIVE THE PATIENT A COPY OF FORM P33 (FRM-COLL-30) and the correct number of brown top specimen containers with biohazard bags.

Faeces for Parasites (O, C & P)

The detection of pathogenic enteric parasites is most likely to be increased if multiple faeces are collected. If the request is for multiple faeces for parasites, then collect two samples two to four days apart. If a third was requested then collect this sample seven days after the first on a separate request form. The patient must be instructed to present the samples when collected and not to store the first waiting for the second. If there is an overnight delay in dispatch of these samples, then store them in the fridge in a biohazard bag. GIVE THE PATENT A COPY OF FORM P14 (Faecal specimen collection information sheet for brown top containers). If the request is for fixed samples for parasites, then these special containers with SAF fixative inside, will need to be obtained from stores. GIVE THE PATIENT A COPY OF FORM P28 (Faecal specimen collection information sheet for brown and SAF, aqua blue top, containers that will be issued with the SAF containers).

Fine Needle Aspirate - Pathologist Collect

This test has a Special test out-of-pocket expense to the patient. Please refer to SPECIAL TESTS under “Billing” in this section for billing instructions and exceptions. You MUST inform the patient of this out of pocket cost 1. Phone Histotyping for appointment stating which centre patient is able to attend (Myaree,

Joondalup, Duncraig or the Mount). 2. Requirements a. Slide Holder b. Five slides per aspirate with patient’s name and date in pencil. c. Pencil


d. Butterfly needles size 23G x 3/4 x 3 e. Terumo needle size 23G x 1 x 3 f. Terumo needle size 23G x 1 1/4 x 3 g. Terumo needle size 25G x 1 x 3 h. Alcohol wipes x 6 i. 1 x B5 tube, 1 x Clot j. Sharps container k. Container with cotton wool balls l. 20mL syringe m. Syringe holder n. Coplin jar with 95% alcohol 3. Prepare patient by having them remove clothing, depending on area to be aspirated. Have

them lay on examination couch and cover with blanket. 4. Offer them FNA Information Booklet to read.

5. Phone Duty Histopathologist. If possible remain with patient and reassure while waiting for

doctor.

First Trimester Screen

This test has a Special test out-of-pocket expense to the patient. Please refer to the patient to the billing brochure on display for costs. You MUST inform the patient of this out of pocket cost

This test can only be collected at certain ACCs. (Due to certain freezing requirements) Patient must be requested to attend only these centres.

Centres that can collect FTS

Armadale,

Belmont,

Bethesda,

Clarkson,

Beldon

Belridge

Duncraig,

Greenwood,

Hillarys,

Hollywood,

Jandakot.

Joondalup,

Midland Swan,

Morley (Marchant way),

Mount,

Myaree (Blaikie st)

North Perth

Parliament Palace,

Peel Health Campus,

Pinjarra,

Rockingham (Council Ave),

Wembley,

All Regional Collection Centres

1. First Trimester samples may be collected between 8weeks and 13 weeks 6 days, (optimal at 10 weeks). (For first trimester testing, the patient will have an Ultrasound done)

2. Write details of the U/S clinic that the results are to go to.


3. Ask Patient to fill in usual “Patient Information – Down’s Syndrome Screening”. 4. Collect 1 x SST.

5. Spin and freeze in original tube @ ACC within 2 hours.

No exceptions, NEVER send in an unspun/unfrozen tube.

6. Send in Frozen 7. There is no need to mark this test urgent

Do not send patient away without collecting a specimen unless instructed by Lab Manager.

FK-506 (Tacrolimus)

Immunosuppressant drug 1. 1. Collect 1 x EDTA, DO NOT centrifuge / or separate. 2. Indicate : last dose - time, date, amount, on request form. Laboratory 2. DO NOT centrifuge / or separate.

Flu PCR – See Nasal and Throat PCR

Flucloxacillin

1. Record all information about the dose (ie: the route given (oral or IM), when it was given, dosage given and when blood was collected. Also record any other drugs/antibiotics being taken simultaneously.

2. Samples to be collected as PEAK levels: a. IM dose - collect 1 x CLOT 30 minutes post dose. b. Oral dose - collect 1 x CLOT 60 - 90 minutes post dose.

c. Oral dose (Patient taking probenicid/benemid) - collect 1 x CLOT 90 - 120 minutes post dose.

3. Specimen must be transported to Regional Collection Centre/peripheral laboratory (or Myaree) ASAP on an ice brick.

4. Upon arrival, specimen MUST be centrifuged and the serum frozen prior to dispatch. 5. Specimen Reception - Myaree MUST transport this specimen to RPH frozen, ASAP.

Fluoride

Medical: Collect 1 x plastic clotted tube. NB: DO NOT use glass tubes. Commercial/Employment: Collect a spot urine as close as possible to the end of the patients work shift.


Gastrin

1. Patient must be fasting for a minimum of 8 hours. 2. Collect 1 x SST. 3. Centrifuge and freeze serum within 1 hour of collection @ LCC. * Separated samples MUST be labelled with:


Gentamicin/ Tobramycin

Aminoglycosides are toxic. Toxicity is mainly directed at the ear and the kidney. A number of factors influence the incidence of toxicity and these must be considered when using these drugs. The strongest association for ototoxicity is with age. The combined effect of elevated trough levels and prolonged therapy is also an important risk factor for ototoxicity. Detection and correction of elevated trough levels is an important way of preventing nephrotoxicity.

Procedure The requesting doctor must clearly state the nature of the drug treatment regime being used (Conventional, Once daily dose or Modified once daily dosing). Check with the doctor to clarify. If serum creatinine is not indicated on request form and the requesting doctor is present, ask the doctor if he wishes to request creatinine also (have him indicate this on the request form). This creatinine level can be taken on either peak or trough level collections. Note on request form:

time, date and amount of last dose

route - IV or IM

age, height, weight and gender of patient.

Conventional Dosing

1. Collect TROUGH and PEAK levels

Once a Day Dosing

1. Collect 1 x CLOT 6 - 12 hours AFTER the dose.

(NOTE: This is neither a PEAK nor a TROUGH)

Modified Once a Day Dosing

1. Collect TROUGH and PEAK levels. See Section 5, Aminoglycoside Dosing and Levels for more detailed clinical information regarding these tests. Trough Level - Collect 1 x CLOT immediately BEFORE the next dose. Peak Level - Collect 1 x CLOT - 1 hour AFTER intramuscular (IM) dose OR - 30 minutes AFTER completion of infusion (IV)

NB: If a peak level only has been requested - also take a trough level (for medico-legal reasons). The charge to the patient or Medicare is not increased, as it is the same for one or two assays.


Glucagon collection:

Special Tube required - Contact Manual Biochemistry (0.2 mL Trasyol in 4 mL EDTA tube. Stable until Aprotinin (supplied by Sigma) expiry)

Patient fasts overnight. Glucagon tubes may be made up in advance and frozen.

PROCEDURE: Collect 4 mL blood. Mix well. Place tube in ice bath. Spin, separate and freeze plasma

immediately, Transport frozen without delay to the laboratory.

Glucose (Post Prandial/PP)

Post prandial means after a meal. Glucose sample to be collected at a certain time post prandial Glucose - (1hr Post Prandial PP) collect 1 x FLOX (grey) 1 hour after meal Glucose - (2hr Post Prandial PP) collect 1 x FLOX (grey) 2 hour after meal When noting the time of the last meal on the request form - state the time to the nearest half hour.

Glucose Pregnancy Screen (50g or 75g)

NB: The Duty Biochemist must be contacted in the following circumstances PRIOR to collection:

i. There is ANY doubt regarding the GTT request (ie: test required, duration of tests etc.). ii. It is unclear whether a full GTT or a screen is required on pregnant patients.

iii. The doctor has requested insulin or growth hormone in addition to the GTT. iv. A “prolonged” or “extended” GTT is requested.

v. The doctor suspects hypoglycaemia (low blood sugar) in the clinical history

Procedure

1. Complete Form P4 throughout this procedure.

2. Patients should be between 26-32 weeks gestation and in the non-fasting state. No urine samples are necessary. Patients should remain in collection centre during procedure.

3. Instruct the patient to drink the complete 50g (or 75g when specified by the doctor) - glucose load within 5-10 minutes. An extra small glass of water is allowable. Where the glucose dose has not been specified, use 50g glucose load.

4. Begin timing approximately half way through ingestion of the glucose load. 5. Exactly 1 hour later collect 1 x FLOX (Grey) 6. Mark clearly on the request form "75g Glucose Screen" or "50g Glucose Screen".

Glucose Tolerance Test 2 hour

NB: The Duty Biochemist must be contacted in the following circumstances PRIOR to collection if:

1. There is ANY doubt regarding the GTT request (ie: test required, duration of tests

etc.) 2. It is unclear whether a full GTT or a screen is required on pregnant patients. 3. The doctor has requested insulin or growth hormone in addition to the GTT. 4. A “prolonged” or “extended” GTT is requested. 5. The doctor suspects hypoglaemia (low blood sugar) in the clinical history. 6. The patient is a child under the age of 12 years. 7. "If patients present later in the day and there is insufficient time to complete GTT

(2.5 hr generally required) then please advise patient that test is best done in


the morning and if required, contact Duty Biochemist to discuss further with the patient"

.

8. If the patient becomes ill, the test must be aborted and clearly stated on the form

Patient Preparation 1. Patient must be fasting and no food or energy-supplying substances in any form

should be consumed for at least 8 hours prior to the test, but the patient must not be fasted longer than 16 hours. Water is permitted throughout the fasting period. The patient is allowed to consume the normal amount of water they would usually drink in the morning. During the test the patient is only allowed a small sip of water if nauseous.

2. Physical Activity The patient must rest during the test, preferably either sitting or lying in a semi-

recumbent position as lying flat can delay gastric emptying. Patient must remain at Collection Centre for the duration of the test. Observe patient and note any unusual symptoms on GTT form.

3. Drugs A range of drugs may affect the test. Record all drugs on the GTT Patient Data form.

Smoking is not permitted for at least 1 hour before and during the test. 4. Time of Testing

The GTT should be performed in the morning because of decreasing glucose tolerance in the afternoon.

Standard 2 Hour GTT Protocol (To Exclude Diabetes Mellitus) NB: Urine specimens are no longer required, unless indicated by the referring doctor. 1. Collect a fasting blood glucose specimen (fluoride oxalate - grey top tube). 2. Instruct the patient to drink the glucose load (75g) within a 5 minute period (an

extra small glass of water is allowable). For children, contact the Duty Biochemist to obtain the correct dose required (1.75g/kg of body weight to a maximum of 75g). Begin timing approximately half-way through ingestion of the glucose load.

3. Collect further fluoride oxalate blood samples at 1 hour and 2 hour intervals after the glucose load and record appropriate data on GTT Data Sheet (Form P4).

4. Label tubes as F, 1h or 2h with time of collection. 5. Ensure these labels are legible NOTES For Glucose Challenge or Glucose Screens in pregnancy see protocol under Glucose Pregnancy Screen.

Glucose Tolerance Test Extended (3,4,5 hour)

Extended 5 Hour GTT Procedure (To Investigate Hypoglycaemia) 1. Phone the Duty Biochemist (or Senior Scientist in the Regional Centres) for permission to

proceed. 2. Collect a fasting blood glucose specimen (fluoride oxalate - grey top vacutainer tube) and a

fasting insulin sample (gold top SST tube) - no urine samples are required.


3. Instruct the patient to drink the glucose load (75g) within a 5 minute period (an extra small glass of water is allowable). For children, contact the Duty Biochemist to obtain the correct dose required (1.75g/Kg of body weight to a maximum of 75g). Begin timing approximately half-way through ingestion of the glucose load.

4. Collect further fluoride oxalate and SST blood samples at 1,2,3,4 and 5 hours after the glucose load. No urine samples are required and then record data on GTT Data Sheet (Form P4).

5. Label tubes fully as F, 1h or 2h etc., with time of collection. 6. Ensure these labels are legible. 7. Record any patient symptoms and the time observed during the test (symptoms may include

drowsiness, dizziness, nausea, sweating etc.) and forward blood samples to the laboratory. Ensure the patient has something to eat after the test.

NB. Occasionally non-standard extended GTT's (e.g. 6 hours) are requested - contact Duty

Biochemist at Myaree for advice. NOTES

For Glucose Challenge or Glucose Screens in pregnancy see protocol under Glucose Pregnancy Screen.

Glycated Haemoglobin (HbA1C)

1. Examine the clinical details section of the request form to determine whether the patient is diabetic or non-diabetic

Clinical Terms Constituting Diabetes

Diabetic DM

Diabetes DM1 or 2

Diabetes Mellitus IDDM

Diet Control MODM, MODY

Gestational Diabetes NIDDM

On Diet

AND / OR

Patient on one of the following drugs:

Daonil Glucophage

Diabinese Insulin

Diaformin Melizide

Diamicron Minidiab

Euglocon Metformin

Glimel Oral Hypoglycaemics

Glipizide Rastinon

Clinical Terms which DO NOT constitute Proven Diabetes

BSL / Raised BSL FHx Diabetes

? Diabetes Family member with diabetes

Diabetes insipidus Glucose intolerance

2. If the clinical history is unclear, please inquire from the patient if they are diabetic.

3. For diabetic patients: i. Write D in the tests requested section of the request form. 4. For non-diabetic patients: i. Write ND in the tests requested section of the request form.


5. Collect 1 x EDTA sample. NOTE: Only NOTE: Only 1 EDTA required for any combination of

FBC/Indices, ESR, Malaria, ICT, RET, HbA1C, RCF, HE

Glycerol Lysis

1. Collect 1 x EDTA sample (sample must be delivered to PathWest on the same day of

collection). Contact Laboratory Manager prior to collection. 2. Contact Laboratory Manager who will: a. Arrange transport

b. Notify Haematology Department PathWest.

Growth Hormone

This test is occasionally requested with a GTT. Please read form carefully. If this occurs - contact Duty Biochemist. 1. Patient should preferably be fasting although if not fasting, still proceed with collection. Note fasting F or non fasting NF on request form. 2. Allow patient to rest (sitting or lying down) for 20 minutes prior to collection. 3. Note RESTED on request form. 4. Collect 1 x SST tube. If IGF is requested, collect an additional SST tube. 5. Centrifuge within 1 hour, separate and freeze serum within 8 hours of collection. It is

preferable to freeze the serum at LCC. If this is not possible, spin and separate serum and place in a red biohazard bag with a spin and freeze sticker.

NB: If patient is reluctant/unable to wait, then collect the sample and note

NOT RESTED on request form.

Haemoglobin + Potassium (Mount Only)

Analysis usually performed from submitted blood gas syringe.

Hair for alopaecia

Collect at least 10 full hair shafts including roots into a urine container.

Heavy Metal Screen

Test Specimen

Zinc (Zn) 1 x EDTA-TE (6mL Navy), Spin and separate

Zinc erythrocyte 1 x EDTA-TE (6mL Navy), Spin and separate

Copper (Cu) 1 x EDTA-TE (6mL Navy), Spin and separate

Selenium (Se) 1 x EDTA-TE (6mL Navy), Spin and separate

Aluminium (Al) 1 x EDTA-TE (6mL Navy), Spin and separate

Cobalt (Co) 1 x EDTA-TE (6mL Navy), Spin and separate

Chromium (Cr) 1 x EDTA-TE (6mL Navy), Spin and separate

Lead (Pb) 1 x EDTA-TE (6mL Navy), whole blood DO NOT spin

Cadimuim (Cd) 1 x EDTA-TE (6mL Navy), whole blood DO NOT spin

Arsenic (As) 1 x EDTA-TE (6mL Navy), whole blood DO NOT spin

Mercury (Hg) 1 x EDTA-TE (6mL Navy), whole blood DO NOT spin

Helicobacter Pylori Specimen Transportation

Any combination – only 1 tube required

Any combination – only 1 tube required


Transportation of gastric biopsy specimens for Helicobacter pylori culture and sensitivity testing at Western Diagnostic Pathology (WDP) 1. Place biopsy tissue in sterile screw top container with 1ml sterile saline 0.9%. Studies have shown that sterile saline is an adequate transport medium1. 2. Complete WDP pathology request form by marking urgent and indicating the sample is gastric biopsy and the test required is Helicobacter pylori culture and sensitivity 3. Endoscopy suite manager/nurse to call Western Diagnostic Pathology (0893170999) Laboratory Manager to arrange URGENT transportation (either by courier or taxi) of specimen to Myaree Laboratory for immediate processing in Microbiology Laboratory. 4. Ideally the sample should reach the laboratory within 2 hours of collection. However delays of up to 24 hours have not had major impacts on diagnostic yield. References: J Clin Pathol 1993;46:561-563

Heparin Induced Thrombocytopenia (HIT/HITTS/HAIT)

See Coagulation protocols Samples must arrive at RPH within 3 hours of collection AND before 2pm Monday to Friday.

Hepatitis (Hep)

Hepatitis A (HAV) and/or Hepatitis B (HBV) and/or Hepatitis C (HCV) or Hepatitis Screen 2 x SST (will cover any combination or just one of the above) (You are taking the extra SST so if we need to do further testing – we have a tube that has not been opened.)

Hep B DNA / HBV DNA 1 X SST

Hep B PCR / HBV PCR / Hep B DNA polymerase 1 X SST

Hep B Viral load / HBV Viral load 1 x SST

Hep C PCR / Hep C RNA Qualitative / HCV PCR 2 x SST

Hep C RNA Quantitative

1 X SST

Hepatitis C Genotyping / HCV Genotype 1 X SST


Hepatitis C Viral Load / HCV Viral Load 1 x SST

Hep D (Delta) 1 x SST

Hep E Serology 1 x SST

Herpes simplex Virus (HSV)/Varicella Zoster Virus (VZV)

PCR test should be done on all patients with lesions. Immunofluorescence is not available. Principle Herpes simplex virus is responsible for “cold sores” (usually HSV type 1) and genital herpes (usually HSV type 2). Infected skin cells obtained by scraping of the parabasal and basal layers (the floor of a blister) of a herpes lesion may be done by PCR. Varicella zoster virus is the virus which causes chicken pox (Varicella) and shingles (Herpes zoster). PCR for identification of this virus should be obtained in the same way as for Herpes simplex virus tests.

Materials 1. Sterile surgical scalpel blade # 15 (Swann Morton) 2. Sterile cotton tipped wooden swab stick. 3. Cleaning alcohol swabs 4. Gloves Note: Items 1,2, 3 & 4 are included in the “Herpes kit”

Procedure PCR for Herpes simplex and Varicella Zoster viruses 1. If there is free pus or exudate on the lesions, remove with a cleaning swab without disturbing

the base of the lesion(s) 2. Expose the base of the lesion(s) by lifting the top of a vesicle (blister), pustule or scab with the

cutting edge of the scalpel blade 3. If pus or fluid is present in the de-roofed lesion swab with the cotton swab, also rubbing the

base of the lesion. 4. Vigorously swab the base of the de-roofed lesion with a sterile swab and return swab to tube. 5. The scalpel blade MUST be disposed into the appropriate sharps container. 6. Clearly label the swab and the specimen request form, INCLUDING the site of origin of the

specimen. 7. Avoid using metal swab sticks NB: The laboratory must be informed immediately if the specimen is to be processed urgently.

NOTES In order to obtain an adequate specimen the scraping may cause some transient pain

If a scalpel blade cannot be used, then a swab will be adequate

ALWAYS take these specimens with gloved hands. Discard the gloves into infectious waste at the end of the procedure and then…

THOROUGHLY WASH YOUR HANDS !


Histamine Blood / Urine

Adult - Urine

1 x 24hour urine container (with acid). Patient must maintain a restricted diet 24 hours prior and during the 24 hour urine collection. Provide clinical and medication details. Inform patient of foods to avoid.

FOODS TO AVOID FRUIT: oranges, bananas, pineapple, avocado, kiwifruit. YOGHURT AND CUSTARD: all preserved dairy foods. VEGETABLES: Tomatoes, tomato paste, tomato sauce, sauerkraut, eggplant. NUTS: All nuts including peanut butter, tahini. SEAFOOD: All fish, squid etc including canned, dried, and salted seafoods. CHEESE: All cheeses and cheese spreads etc. JAMS AND CHUTNEYS: All preserved foods. WINE AND BEER: All fermented beverages. SPREADS AND FERMENTED FOODS: Yeast extract, vegemite, marmite, soysauce, fishpaste. FOODS ALLOWED: A plain diet of meat, chicken, most fresh vegetables, bread, butter, apples, pears, tea, coffee, lemonade, sugar, milk, cereals.


Keep Samples cold during collection and transport to the laboratory. Regional Laboratories Transport frozen

Child - Urine

Random urine collections will ONLY be accepted on small children. If so, the urine must be frozen immediately after collection. Random collections are not recommended on adult patients and will not be accepted for testing. Provide clinical and medication details. Patient must maintain a restricted diet 24 hours prior and during the 24 hour urine collection. Inform patient of foods to avoid.

FOODS TO AVOID FRUIT: oranges, bananas, pineapple, avocado, kiwifruit. YOGHURT AND CUSTARD: all preserved dairy foods. VEGETABLES: Tomatoes, tomato paste, tomato sauce, sauerkraut, eggplant. NUTS: All nuts including peanut butter, tahini. SEAFOOD: All fish, squid etc including canned, dried, and salted seafoods. CHEESE: All cheeses and cheese spreads etc. JAMS AND CHUTNEYS: All preserved foods. WINE AND BEER: All fermented beverages. SPREADS AND FERMENTED FOODS: Yeast extract, vegemite, marmite, soysauce, fishpaste.


FOODS ALLOWED: A plain diet of meat, chicken, most fresh vegetables, bread, butter, apples, pears, tea, coffee, lemonade, sugar, milk, cereals.

Blood

3 x Lithium Heparin Frozen whole (ie - in original tube) ASAP – do not spin No special dietary requirements.

HIV COMBO ( Darwin and Repromed only)

Spin/separate. Aliqout to be sent back to DPH - Repromed

HIV Viral Load Assay

This assay is an important advance in the treatment of HIV and AIDS as it allows the clinician to monitor the amount of virus in the patient and make effective treatment decisions, which improve the outlook for the patient. 1. Collect two EDTA’s (4ml) i.e. need at least 8mls of blood. 2. Spin Separate and freeze the plasma within 6 hours of collection @ LCC (need at least 2mls

plasma). 3. Keep the EDTA with the blood cells in, at room temperature. 4. Send the frozen plasma and the EDTA to the Myaree laboratory. 5. Myaree Specimen Reception will refer the samples to RPH Immunology. * Separated samples MUST be labelled with:

Full name DOB Lab No. Date and time of collection Type of specimen (eg. EDTA)

NOTES Red blood cells contain an enzyme that reduces the viral count in the plasma. The plasma must be separated within 6 hours of collection. The assay uses 2mL plasma. Please make sure that at least 2mL of plasma is frozen for the assay in case the assay has to be repeated.

HLA Typing

This request may be for a HLA-B27 only or for a full HLA typing. Match the clinical details on the patient's request form with the list of diseases and their HLA associations. If there is no match or if no clinical details are given, call the laboratory manager prior to collection.

Clinical Details HLA Association Specimen Required

Ankylosing Spondylitis HLA-B27 x 1 ACD

Anterior Uveitis HLA-B27 x 1 ACD

Arthralgia HLA-B27 x 1 ACD

Arthritis/joint pains HLA-B27 x 1 ACD

Back pain/stiffness HLA-B27 x 1 ACD


Behcet's disease HLA-B5 x 1 ACD

Coeliac disease HLA-DR3 x 1 ACD

Congenital Adrenal Hyperplasia HLA-B47 x 1 ACD

Dermatitis herpetiformis HLA-DR3 x 1 ACD

Haemochromatosis HLA-A3 & B14 x 1 ACD

HLA for Transplant Refer to separate information x 1ACD and x1SST

Iritis HLA-B27 x 1 ACD

Joint pains HLA-B27 x 1 ACD

Juvenile Rheumatoid Arthritis HLA-B27 x 1 ACD

Low back pain HLA-B27 x 1 ACD

Mono-arthritis HLA-B27 x 1 ACD

Narcolepsy HLA-DR2(DQ1) x 1 ACD

Reiter's disease HLA-B27 x 1 ACD

Sacro-iliac pain/stiffness HLA-B27 x 1 ACD

Uveitis HLA-B27 x 1 ACD

HLA Typing for Transplantation HLA-typing for potential tissue or organ donor (also cross-reference with tissue typing) This important information must be given to the patient before collecting the blood samples: HLA-typing to determine suitability for a tissue or organ donor is not funded by Medicare. Usually the recipient's transplant physician will have applied for Federal Funding to search for donors and pay for the HLA-typing. WDP will be happy to collect the samples and courier them to Royal Perth hospital (at no charge). The donor will receive a bill from RPH for around $300 for the tests. This can be forwarded to the recipient's transplant centre for reimbursement. Alternatively the donor can contact the recipient's transplant centre for instructions on how to have the tests collected.

Homocysteine (Random or Fasting)

1. Collect 1 x PPT (white top EDTA) 2. Spin within 30 minutes (no need to separate or freeze)

Homocystine (Urine)

This test is rarely requested. 1. Collect early morning urine.

Huntingtons

Tests for Huntingtons are performed as a family study. 1. Collect 1 x 10mL Heparin and 2x EDTA. 2. LABORATORY INSTRUCTIONS - Send to QEII Clinical Biochemistry.

Influenza PCR- see Nasal and Throat Swab

IGF-1

This test is occasionally requested with a GTT. If this occurs, contact Duty Biochemist.


1. Patient should preferably be fasting, if not fasting, still proceed with collection. 2. Not fasting F or non fasting NF on request form. 3. Note RESTED on request form. 4. Collect 1 x SST tube. 5. Spin only @ LCC, do not freeze * Separated samples MUST be labelled with Full Name, DOB, Laboratory Number, Date and Time of Collection, Type of Specimen (e.g. SST, EDTA).

IGF BP3

This test is occasionally requested with a GTT. If this occurs, contact Duty Biochemist. 1. Patient should preferably be fasting, if not fasting, still proceed with collection. 2. Not fasting F or non fasting NF on request form. 3. Note RESTED on request form. 4. Collect 1 x SST tube. 5. Centrifuge and freeze serum ASAP @LCC. * Separated samples MUST be labelled with Full Name, DOB, Laboratory Number, Date and Time of Collection, Type of Specimen (e.g. SST, EDTA).

Inhibin

1. Collect 1 x SST 2. Spin, Separate and freeze serum within 6 hours of collection @ LCC. * Separated samples MUST be labelled with: Full name, DOB, Lab No, Date and time of collection, Type of specimen (eg. SST, EDTA)

Insulin

Unless specifically requested all insulins are fasting. Even if not specified insulins always have a corresponding glucose 1 Collect 1 x SST (and 1 Fluoride Oxalate for glucose unless already taken) 2 Spin and in freeze original SST @ ACC within 4 hours 3. Send in frozen.

Insulins + GTT

1. As a rule an Insulin is taken with every glucose sample unless specifically stated otherwise

Ionised Calcium / Free Calcium

1. Collect SST using minimum tourniquet pressure. This SST can not be shared with any other test. 2. If a number of tubes are to be collected ensure the calcium is collected first. 3. Release tourniquet pressure and wait approximately 20 seconds before collecting SST sample. 4. This SST cannot be opened. Please mark tube lid with a cross to indicate pristine

tube.

Lactate

Collection Centres 1. Collect x 1 heparin (green) sample.


2. Must be separated and frozen within 15 minutes @ LCC 3. If unable to perform the above, refer patient to a collection site with a centrifuge. 4. Transport sample to laboratory – frozen. * Separated samples MUST be labelled with:


Specimen Reception

From the Myaree specimen reception area, the lactate samples are to be sent to the Mount Hospital laboratory on dry ice or in an ice slurry, for analysis.

Lactate/Pyruvate

See collection for Pyruvate

Lactose Tolerance Test

Patient must be fasting and should rest throughout the procedure

1. A fasting blood glucose (fluoride oxalate/grey top tube) is collected. 2. For adults a 50g dose of lactose (available via Patient Reception -Myaree) is dissolved in

approximately 250ml of water.

NB: If the patient is a child then contact Duty Biochemist to confirm dosage before proceeding. (child dose = 2g/Kg).

3. Blood specimens (fluoride oxalate/grey top tubes) are collected at 30, 60 and 120 minutes

after the lactose is taken. 4. Any abdominal symptoms which develop during the test must be recorded, e.g. abdominal

pain, stomach rumblings, diarrhoea, almost certainly indicate lactose intolerance -note these symptoms on the request form.

Administer the lactose solution to the patient.

A. Adults: Administer the entire 250 ml of the prepared lactose solution (50 grams). The solution must be completely consumed within 5 minutes.

B. Children:

Administer the lactose solution in milliliters according to the body weight dosage chart below (Do not exceed 50 grams of lactose (200 ml of lactose solution). The solution must be completely consumed within 5 minutes.

CHILD KILOGRAMS)

(2.00 gm/kg) (GRAMS)

LACTOSE SOLUTION

(ML)

10 20 80

11 22 88

12 24 96

13 26 104

14 28 112


15 30 120

16 32 128

17 34 136

18 36 144

19 38 152

20 40 160

21 42 168

22 44 176

23 46 184

24 48 192

25 50 200

REFERENCES

1. Caraway, WR, and Watts, NB: Carbohydrates. In: Textbook of Clinical Chemistry. (N Tietz, ed) WB Saunders Co, Philadelphia, pp 814, 1986.

2. McNeely, M. Gastrointestinal digestive diseases. In: Clinical Chemistry, theory analysis and correlation (Kaplan and Pesce, eds) Mosby, St Louis, pp 468-487, 1984.

Lead – 24 Hour Urine

1. Contact Specimen Reception for an Acid washed 24hr urine container. 2. Follow 24hr collection procedure – no preservatives required.

Lipids

If a patient presents to your collection centre and has not been fasting for a routine lipid screen please do not turn them away unless

Dr has written or indicated on the request form that the sample for lipids is to be collected in a fasting state

Clinical history states that the patient has a previous history of elevated triglycerides

Lipids – where the Dr has requested fasting Lipids

Minimum fasting time is 9 hours.

Suggested (not essential) maximum is 15 hours

Patients should NOT be refused a test if the 15 hours is exceeded: Triglycerides may be raised and glucose lower after very prolonged fasts – however patients may still proceed.

Remember to clearly mark on the request form whether the patient is fasting or non-fasting.

Lipids – non-fasting

Collect sample

Remember to clearly mark on the request form whether the patient is fasting or non-fasting.

Listeriosis Culture

Blood - see Blood Culture collection Faeces - x 3 samples (preferably collected on successive days). Give patient Form P14 for

instructions on faecal collection. CSF - Dr collect ONLY.

Long Chain Fatty Acids





Patient must acknowledge on request form that they have been informed that

test will cost and that they are happy to get a bill.

2 x EDTA. Spin, separate and freeze @ LCC, send in frozen

Do not take money.

Lupus Screen

This request may mean Lupus Anti Coagulant or Anti cardiolipin Antibodies or even ANF. (Antinuclear Factor) Contact a Senior Scientist in Haematology, Myaree or Laboratory Manager in Regional

Laboratories. It may be necessary to contact the requesting doctor to clarify exactly what has been requested.

Manganese

To monitor intoxication, deficiency and parenteral nutrition (TPN). 1. Collect 2 x K2EDTA (Navy top) tubes. 2. Do not separate. Urine – Spot Urine

Mantoux [Tuberculin] - (Skin test for tuberculosis)

This test has a Special test out-of-pocket expense to the patient. Please refer to SPECIAL TESTS under “Billing” in this section for billing instructions and exceptions. You MUST inform the patient of this out of pocket cost Restricted to Trained and Accredited staff.

Principle

The Mantoux test is based on a delayed hypersensitivity (cell mediated immunity) reaction [erythema, induration] to intradermal injections of a sterile purified protein derivative [PPD] of a selected Mycobacterium tuberculosis organism. If there is a response, it is usually present in 48 hrs and may persist for up to 7 days. Quantitative tuberculin testing requires intradermal injection on the palmar aspect of the forearm. Precise intradermal injection resulting in a raised blanched wheal is necessary. The reaction is read 2-3 days after inoculation, and measured in mm.

Clinical significance

A positive reaction means that the patient is immune or infected or has been successfully vaccinated (BCG vaccine).

Specimen

The procedure is performed on the patient’s forearm, palmar aspect (i.e. palm facing upwards).

Reagents

PPD – Human (M. tuberculosis) 100 I.U./mL; 0.1mL dose contains 10 IU tuberculin


Equipment

I mL injection syringes with 0.1 mL graduations (do NOT use 2 mL syringes)

26 gauge needle

alcohol wipes

Procedure

Ask patient if has had previous TB skin test, and if so, whether there was a strong reaction. If a history of previous strong reaction, contact duty microbiologist before proceeding with test.

Use alcohol swab to clean palmar aspect (i.e. palm facing upwards) of forearm.

Identify middle third of forearm. Ensure there are no skin blemishes or scars in the vicinity. Identify an area where there are no superficial veins directly underneath the injection site. If necessary, make a temporary mark around the site for easy identification (both for administering the Tuberculin and for reading the reaction later).

Draw up 0.1mL (i.e. 10 units) of Tuberculin PPD. DO NOT USE TUBERCULIN PPD THAT HAS EXCEEDED ITS EXPIRY DATE OR BEEN USED ON A DAY EARLIER THAN THE CURRENT DAY. ALWAYS DISPOSE AMPOULE AT THE END OF EACH DAY.

NEVER RETURN NEEDLE OR ITS SYRINGE TO THE AMPOULE ONCE THE TUBERCULIN PPD HAS BEEN DRAWN OR THE PATIENT HAS RECEIVED THE INJECTION. Failure to observe this may result in serious cross-infection.

Intradermal injection: the uppermost layers of the skin are to be injected. The injection is not to be given subcutaneously as this will obscure any reaction. Care must be taken to ensure that the injection is not given into a vein. The needle is slid into the skin at a low angle, with the bevel facing upwards (see following diagram). The surrounding skin is held tight with your other hand. The needles should pass in deep enough for the hole in the bevel of the needle to just disappear. Slowly inject the 0.1 mL of Tuberculin PPD. This will cause a swelling of about 3mm diameter. If no swelling develops, then the needle is in too deep. If the fluid appears on the skin then you are not in deep enough. If either of these occurs, you must repeat the test on another site on the forearm at least 30mm away from the failed site, or on the other arm.

Mark the request form diagrammatically to indicate where and on which arm the Tuberculin PPD was administered.

Ensure that the form has been given a laboratory number and the test has been entered into the computer as a Mantoux test (panel code MK).

Give the patient a dummy test form with the laboratory number attached.

Make an appointment for the patient to return in 2-7 days (2 days is the preferred time) for reading of the reaction.

Results

The test is read 2-4 days (ideally at 48 hrs) after inoculation, by measuring the 2 transverse diameters (at right angles to each other) of the induration (hardness, lump) and taking the mean of the 2 measurements as the result. This is best done using a medium ball point pen (see diagram). Do NOT measure the erythema (redness) around the induration.

needle Bevel of needle facing upwards i.e. hole visible before entering skin

skin

Cross-section of diameter to

measure

Above view of diameters to measure – IGNORE

redness, only measure swelling

Redness

(erythema)

Pen


Borderline results (5-10mm) should be re-read at 72 hrs post-inoculation

Rarely a strong positive reaction (swelling, vesiculation, ulceration) may occur at the test site. The requesting doctor and duty microbiologist should be informed for symptomatic treatment if this occurs.

Document important patient history details regarding why the patient is having the test on the request form

e.g. history of BCG vaccination

history of exposure to TB history of TB and treatment for TB previous skin tests for TB travel history testing for employment purposes country of birth

Reference ranges

Traditionally, a “positive” reaction is greater than 10mm diameter of induration, a “negative” reaction is less than 5mm diameter, “borderline” is 5-10mm diameter.

Reporting

Results are reported on the MK panel Relevant patient history details as to why they are having the test should be recorded as a free text comment in the MK panel.

Mast Cell Tryptase

Tryptase levels in serum serve as an indicator of mast cell activation and as a marker of allergic mediator release, particularly in suspected cases of anaphylaxis. Blood samples are to be collected within 3 hours of an event occurring. Serum may be sent chilled, however, if not able to send within 48 hours it needs to be spun and frozen – some Doctors may request a one-off tryptase level, this can be taken at any time.

Melioidosis Culture

Blood - see Blood Culture for collection Sputum - see Sputum Culture for collection. Give patient Form P11 for collection instructions Pus - as submitted.

Methaemoglobin

1. Sample must be delivered to Mount Hospital Laboratory, Joondalup Laboratory, Hollywood or Peel Laboratories within 4 hours of collection. Contact the Duty Laboratory Manager to arrange transport.

2. 1 x Heparin (green top). 3. DO NOT centrifuge.

Microarray Analysis/ Array/ Array CGH/ Chromosome

Microarray

Chromosome Microarray Analysis (CMA) 1. Collect 1 x EDTA (purple top) and 1 x Heparin (green top). Tubes can not be shared with any other tests. 2. A patient consent form should be completed by parents/patient (Form P38). 3. A Clinical Submission Form (Form P37) should be completed by the Doctor


Patient consent forms and Clinical submission forms are helpful although not essential Testing can continue without these forms. Please sign tubes and request form. Place red Molecular Genetics sticker around the cap. Storage and transport: Specimens should not be frozen, exposed to excessive heat or remain in transit for extended times. Store in fridge or at room temperature (for shorter periods of time).

Mid Stream Urine

To collect a urine sample which is not contaminated by the bacterial flora which is in and around the urethral opening. When micturition begins the first part of the stream washes away the bacteria present in the lower urethra. Thus the "middle of the stream" is usually clear of contaminants. In post pubertal females the vulva may be so moist that secretions may enter even the midstream urine. Even such minute amounts of vulvo-vaginal secretions can cause false positive microscopic and culture results. Note that this problem is greater in obese and elderly women. These two factors do sometimes go together.

Collection NB: All urine specimens must be refrigerated until handed to courier. NB: Patient instruction forms are also available in a variety of languages. For cases where the

language is a barrier, please attempt to give the patient one of these forms.

NB: Where urines are collected at remote sites and are likely to take greater than 12 hours to arrive at a laboratory:

1. They must be refrigerated. 2. A Dip Slide culture must be inoculated. Store at room temperature prior to transport. 3. A cell count stain / preservative must be used.

Laboratory Managers are to facilitate these items.

The MALE The patient should wash hands thoroughly. Cleaning is not usually required. The uncircumcised male is instructed to retract the foreskin. The first burst of urine is passed into the pan. The paper cup / specimen collection jar is then passed into the stream of urine and half filled. The remaining urine is passed into the toilet. (It is preferable to collect mid stream while continuing to micturate. If this is too difficult the patient may stop and restart) The urine is then poured into the centrifuge tube up to the black indicator line. Close container lid firmly.

The FEMALE Give patient Form P12 for detailed instructions on collection. Mature Females: 1. Wash and dry hands thoroughly. 2. The labia are separated by the patient’s fingers of one hand and kept apart until the specimen has

been collected. 3. Using a sterile water swab the patient wipes over the urethral opening - from front to back.

Discard the swab. 4. Micturition is started allowing the first part to go into the pan. 5. Collect specimen from mid stream (preferably continuous) half filling the paper cup /specimen

container. Remaining urine is passed into the toilet.


6. The urine is then poured into the centrifuge tube to the black indicator line. Close container lid firmly.

7. ALWAYS ask the female patient if she is menstruating and if so instruct her to insert a clean tampon after wiping and then wipe once again (with clean water wipe) collecting as above. Always mark the request form "PATIENT MENSTRUATING".

8. Store urine in refrigerator prior to transport to the laboratory. Note: Collectors should offer to help any patient they suspect may experience difficulty. This may require holding the container in position with a gloved hand.

Prepubertal Females Specimen is collected as above but step ii. (cleaning) can be omitted. Give patient (or guardian) Form P12 and make a cross through step 2 diagram. Paediatric Collection Ensure genital area is free of creams and lubricants. 1. Remove paper backing to expose adhesive.

2. For female use, place opening of bag as to cover upper half of genitalia. 3. For male use, the penis must be projected through the opening of the bag.


4. After urine is obtained remove the bag and fold adhesive surfaces together. 5. Clean lower corner of bag with alcohol wipe and allow to dry. 6. Snip cleaned corner of bag and allow urine to drain into yellow top, labelled

container/ centrifuge tube. 7. Screw lid firmly onto container and discard uribag into biohazard waste container. 8. Place specimen in refrigerator until transported to laboratory. NB: Do Not use this bag for a 24hour collection.


Molecular Genetics

Haemochromatosis Gene

This test has a Special test out-of-pocket expense to the patient. Please refer to SPECIAL TESTS under “Billing” in this section for billing instructions and exceptions. You MUST inform the patient of this out of pocket cost (see price list).

The rules for paying rebates for this test are as follows: Patient has elevated transferrin saturation or elevated serum ferritin on repeated tests OR Patient has a first degree relative with haemochromatosis OR Patient has a first degree relative with homozygosity for the C282Y genetic mutation, or with

compound heterozygosity for the recognised genetic mutations for haemochromatosis. To ensure that your patient receives the Medicare rebate please indicate on the request form the appropriate indication for the test. If no history is stated, no Medicare rebate is payable, and the patient will be charged the fee directly.

Complete Genetic Tests Questionnaire (Form P34).

Collect 1 x 4.5ml EDTA (Purple). Initial tube and sign request form.

Attach Molecular Genetics Sticker to lid of EDTA tube.

Factor V Leiden

This test has a Special test out-of-pocket expense to the patient. Please refer to SPECIAL TESTS under “Billing” in this section for billing instructions and exceptions. You MUST inform the patient of this out of pocket cost (see price list).

Complete Genetic Tests Questionnaire (Form P34)

Complete Coagulation Questionnaire (Form P1)

Collect citrate specimen(s) as per APCR. See section 3 Coagulation Protocols for total citrate requirements and processing

Collect 1 x 4.5mL EDTA (Purple). Initial tube and sign request form

Attach Molecular Genetics Sticker to lid of EDTA tube.

Prothrombin Gene Mutation (G 20210)

This test has a Special test out-of-pocket expense to the patient. Please refer to SPECIAL TESTS under “Billing” in this section for billing instructions and exceptions. You MUST inform the patient of this out of pocket cost (see pricelist)

Complete Genetics Tests Questionnaire (Form P34)

Collect 1 x 4.5mL EDTA (Purple). Initial tube and sign request form.

Attach Molecular Genetics Sticker to lid of EDTA

If part of a Thrombophilia Screen see Section 3 Coagulation Protocols for additional collections.


MOLYBDENUM

Collect 2 x EDTA. Refrigerate. $$$ Special test. Please see Price list

MRSA

NOTE : Use wet swabs only for this test – Wet means the swab is placed into gel medium for transport back to lab. – (eg Stuarts/Blue top)

1. Nostrils - use one swab moistened in sterile water or sterile saline for both nostrils, place swab into

gel for transport back to lab.

2. Throat - one swab, place swab into gel for transport back to lab.

3. Skin Lesions/wounds/all broken skin areas - if present.

Dry lesions-use swab moistened in sterile water or sterile saline, place swab into gel for

transport back to lab..

Discharging/ moist lesions- use one swab, place swab into gel for transport back to lab. Notes:

ONLY use either sterile water OR sterile saline.

Do not use tap or bottled to moisten the swabs

No slides are necessary Reference : Department of Health WA (2005). Control of Methicillin-Resistant Staphylococcus Aureus (MRSA) and Epidemic MRSA (EMRSA) in Hospitals. Operational Circular OP 1922/05 http://www.health.wa.gov.au/circularsnew/circular.cfm?Circ_ID=11910 Last accessed: 18/08/10

MRSA (IHC patients to be admitted to RPH)

1. Collect swabs as per MRSA above and perineum (x 1 swab) 2. Wait at least 5 minutes. 3. Repeat swabs as per MRSA above.

Mucopolysaccharides

1. Collect x1 spot urine. 6 Sample should be kept at 4 degrees and transported to PMH within 24 hrs. 7 If delay in 2, sample can be frozen and transported on dry ice.

Mycobacterium and Acid Fast Bacilli

Early morning urine (or sputum) on consecutive days x 3. 1. Sputum - 3 consecutive first morning collections 2. Urine - 3 consecutive first morning total collection. ie: complete voids

collected in appropriate EMU jars. NB: Other specimens can be requested for Mycobacterium and Acid Fast Bacilli. If in

doubt, contact the Duty Microbiologist. 3. Store samples in refrigerator until transport to laboratory is available.

http://www.health.wa.gov.au/circularsnew/circular.cfm?Circ_ID=11910


Nasal Swab for Bacterial cultures

To determine if the patient is carrying pathogenic organisms (eg:- MRSA or pneumococcus). The medial septum is the area richest in bacteria so the swabbing is aimed at this area. 1. Moisten the swab with sterile water or sterile saline. Have a tissue available for the patient. 2. Insert the swab 1 - 2 cms (until all the cotton wool is in the nose). 3. Press the swab to the centre so it is against the septum. 4. Rotate 360oC clockwise then anticlockwise. 5. Remove and then sample through the other nares in the same way. 6. Place swab in transport medium if available.

Nasal and Throat Swab Collection For Respiratory Virus

Collect three specimens (two nasal swabs , one for each nostril, and one throat swab) as follows:

1. OBTAIN MATERIALS

Dry swabs (no gel) OR

Swabs with viral transport medium (VTM) if available

Personal protective equipment (PPE) for the health care worker (HCW): gown, gloves, eye protection (goggles or face-shield), P2 mask (surgical masks don’t give adequate protection), and hand hygiene products

2. PREPARE ROOM

Need a wall that the patient can rest their head against

HCW needs enough space to be able to stand beside the patient (not in front)

Hand hygiene: alcohol-based hand cleanser or handwashing facilities

Assume everything in the room will be contaminated by viral particles

3. PREPARE HEALTHCARE WORKER

Do this before entering the room with the patient

Perform hand hygiene. Put on PPE: gown, P2 mask (perform fit check), goggles/face-shield, and gloves

4. PREPARE THE PATIENT Explain the procedure to the patient

Place the patient with head resting against the wall (standing or sitting)

5. SPECIMEN COLLECTION Nasal swabs

1. Stand at the side of the patient 2. Ensure the patient’s head is resting against the wall 3. Place your non-dominant hand on the patient’s forehead, with your thumb on the tip of

their nose 4. Insert the swab into the closest nostril horizontally, approximately 2 – 3 cm 5. Press the swab towards the nasal septum (the middle bit that separates the nostrils) 6. Rotate the swab through two full turns collecting epithelial cells 7. Use the same swab to repeat the process with the other nostril 8. Place swab back in it’s container, label tube with patient name, collection date and source

(nose)

Throat swab

1. Stand at the side of the patient 2. Ensure the patient’s head is resting against the wall 3. Place your non-dominant hand on their forehead 4. Ask the patient to open their mouth widely and say “ah”

5. Insert the swab into the mouth avoiding any saliva 6. Press the swab against the tonsil area at the back of the throat

7. Rotate the swab through two full turns, collecting epithelial cells


8. Place swab back in it’s container, label tube with patient name, collection date and source (throat)

9. Place swabs in specimen bag

6. REMOVE PPE

Do this after leaving the patient’s room

Remove gloves first and discard, perform hand hygiene

Remove goggles/face-shield and gown, perform hand hygiene

Remove P2 mask (suitable for single-use only)

Perform hand hygiene

7. COMPLETE REQUEST FORM.

Nasopharyngeal Aspiration (NPA)

This procedure is designed to collect fluid and epithelial cells from the nasopharynx. A soft polythene catheter is used. It is less traumatic than a swab. For the patient, it is unpleasant but painless. It may make the patient cough, which can spread virus droplets. For this reason, the collector must wear adequate personal protective equipment (PPE). This method provides a useful diagnostic specimen for the diagnosis of infection with Bordetella pertussis (whooping cough), Mycoplasma pneumoniae, influenza and other respiratory viruses. 1. OBTAIN MATERIALS

Suction kit (check expiry date and packaging) – size 8 (code 452-08-007). Suction pump with tubing

Sterile saline

Tissues


2. PREPARE ROOM


Assume everything in the room will be contaminated by viral particles 3. PREPARE HEALTHCARE WORKER



4. PREPARE THE PATIENT AND/OR THE PATIENT’S PARENT

Explain the procedure to the patient.

5. SPECIMEN COLLECTION

Note on the request form if the patient has consumed anything with in the last half-hour.

Assemble the suction set and pump, ensuring all fittings are firm and are not leaking air

Small children should sit on parent’s (or assistant’s) knee with the child’s back to the parent. Older children or adults can sit on a chair or lie down.

Raise child’s arms so that the upper arms press against their ears and their hands are behind their head. The parent grasps the hands firmly and is instructed not to let go. Older children or adults may place anywhere that is comfortable.


Estimate the length of catheter required to reach the nasopharynx – this is approximately equal to the distance between the nose and the ears. You may wish to mark the catheter for this distance.

Insert the catheter into one nostril until it reaches the nasopharynx

Apply suction and rotate catheter – continuing this while is it slowly withdrawn. The suction can either be started once the catheter reaches the nasopharynx or it can be started beforehand with the tubing kinked until suction is required.

Give the patient some tissues at completion of collection

Once the catheter is removed, there will be a small volume of fluid and epithelial cells in the distal 1 – 2 cms.

Suck not more than 0.5 mL of sterile saline into the trap. This will flush the specimen into the trap.

Remove the tubing and put the lid on the trap, which is now the specimen container.

Label the specimen container with patient name, collection date and source (nasopharyngeal aspirate)

Place specimen tube in specimen bag. 6. REMOVE PPE





Perform hand hygiene 7. COMPLETE REQUEST FORM

Refrigerate specimen until sent to the laboratory.

Nasopharyngeal Swab

The purpose of the swab is usually as for a nasopharyngeal aspirate. The swab is inferior to the aspirate in terms of the volume of diagnostic material, and what tests can be done, however, when suction is unavailable for operating a mucus trap this is an adequate substitute. It is recommended that if the patient is able, then attend a collection centre. This swab is not suitable for Bordetella pertussis IgA. An SST must be also be collected for Bordetella pertussis IgA serology.

Neonatal Bilirubin

The preferred sample type for measurement of bilirubin in neonates and infants up to 1 month of age is a red topped clot tube. A dark green topped lithium heparin tube without gel may also be used, however SST’s and PST’s (types containing gel) should be avoided as the use of these tubes can result in less yield of serum/plasma and can often require a recollect. If possible the tube should also be full (600 uL in a paediatric tube) to avoid the need for recollection.

Neutralising Antibodies to Interferon B

1. 1 x SST 2. Spin and freeze for transport to Westmead @ LCC.


Neutralising Antibodies to Interferon B

3. 1 x SST 4. Spin and freeze for transport to Westmead @ LCC.

NTX

Collect fasting spot urine. Take urine specimen from second void of the day.

Orf

Orf is a skin infection with a member of the pox virus family. The infection is usually acquired from sheep in which species the condition of scabby mouth is caused by the same virus. Other animal derived viruses which may cause similar infections in humans can be acquired from the mouth or breast or salivary secretions or skin lesions of goats, cattle and camels. The Orf virus is not diagnosed by culture but by electron microscopy. 1. With a small scalpel blade, remove material from the central core of the lesion. 2. Wipe this material onto a glass slide (approximately 3 to 5mm diameter). 3. Label slide with patient details. 4. Allow slide to AIR dry. 5. DO NOT fix with heat or alcohol. 6. Place slide in carrier and transport as per routine work to Myaree laboratory. Myaree Laboratory 7. Sample is referred to PathWest for electron microscopy.

Organic Amino Acids.

1 x Hep – spin/separate/ freeze within 4 hours at LCC. Urine – freeze ASAP

Ornithine

Collect 1 heparin on ice. Separate, freeze plasma within 1 hour of collection @ LCC. Freeze urine. Transport frozen.

Osmolality (faecal or stool)

Collect in the same manner as Faeces for Reducing substances. Watery stools only accepted. Phone Biochemist to inform of arrival of specimen.

Osteocalcin

1. Patient should preferably be fasting although if not fasting, still proceed with collection. Note fasting/non fasting on request form.

2. Allow patient to rest (sitting or lying down) for 20 minutes prior to collection. 3. Collect 1 x SST tube 4. Centrifuge and freeze serum within 6 hours of collection @ LCC. * Separated samples MUST be labelled with:



NB: If patient is reluctant/unable to wait, then collect the sample and note "NOT RESTED" on request form.

Ovulation Tracking

This test has a Service fee out-of-pocket expense to the patient if the patient is laboratory/WDP pathologist managed If the patient is managed by the lab / WDP pathologist, please refer to SERVICE FEE under “Billing” in this section for billing instructions and exceptions. You MUST inform the patient of this out of pocket cost Patients for this test, are able to attend ANY WDP collection centre from Monday – Friday but must present in time for the first courier pick up if results are to be available on time. (Saturday and Sunday collections are listed at the end of this item.) Do not send patient away without collecting a sample unless instructed by lab manager. Procedure : 1. Fill out an ovulation tracking (pink) - form with all relevant details. 2. Referring doctor and date of collection must be identified. 3. Request from patient “what day of cycle” they are and indicated on request form

“Day........”. 4. Ask patient how they have been instructed to access the result and note this

information in the clinical details section of the request form. (ie "result to requesting Dr" or "result to pt from lab").

5. Request LH and E2 in test request area. 6. Complete a Medicare voucher as per appropriate paperwork instruction. 7. Collect blood as per appropriate collection procedure - ie: 1 x SST. 8. Ovulation Tracking Requests are to be marked "Process Immediately" so analysis in Myaree is expedited via the urgent bench. NB: All patients requiring tracking on Saturday or Sunday MUST present to either: Duncraig Sat 0800 - 0830 am Sun 0800 am (and Public Holidays) OR Myaree Sat 0730 - 0830 am Sun 0900 am (and Public Holidays)


Pancreatic Polypeptide

1. Patient must be fasting for 8-12 hours. 2. Collect 1 x SST. 3. Spin, separate and freeze @ LCC, transport frozen * Separated samples MUST be labelled with:


Paracetamol

1. All paracetamol requests should be treated as URGENT. 2. Contact Laboratory Manager prior to collection. 3. Collect 1 x Clot 4. Note time since last ingestion (should be minimum 4 hours post ingestion).

Parasite Identification

1. Any specimen submitted or 2. Faecal Parasites - faeces x 3 (preferably successive days)

Parathyroid Hormone

1. Collect 1 PPT (white top EDTA) 2. Spin within 24 hours (no need to separate and freeze) 3. And also collect 1 x SST for concurrent calcium testing (even if not requested) –

please see Calcium in Section 3 for collection instructions

PTH “CDC’ only

Community Health Centre. 1 x EDTA (Purple) Spin/separate within 4 hrs. Arrive at lab ready to be frozen within 12-16 hrs.

Parathyroid Hormone related peptide (PTHrp)

1. Special collection tube required – 4.5ml EDTA tube containing Trasylol obtainable from Manual Chemistry.

2 Special collection tube needs to be cooled prior to collection and kept on ice until centrifugation.

3 Centrifuge separate and freeze immediately @ LCC. 4 Transport frozen * Separated samples MUST be labelled with:

Full name DOB Lab No. Date and time of collection Type of specimen (eg. SST, EDTA).


Pernasal Aspirate (PNA) – See Nasopharyngeal Aspiration

(NPA)

Platelet Antibodies

See Coagulation protocols

PLATELET COUNT ON CITRATED SPECIMEN

On occasion the request form may state “Collect citrate for platelet count” or “FBC (Collect citrate)” or some variation thereof. These patients usually have an ongoing problem with in vitro platelet clumping which, although not in itself of any clinical significance, may affect the accuracy of the platelet count. For some patients this phenomenon is EDTA dependent and collection of citrated blood may resolve the issue AS LONG AS IT IS NOT CENTRIFUGED!!! 1. Collect both EDTA (Purple) and Citrate tubes. 2. Attach a “DO NOT SPIN” sticker to the citrated sample 3. Write “DO NOT SPIN CITRATE” on the request form. 3. Band the EDTA and Citrated samples together for delivery to the processing lab.

Platelet Electron Microscopy

Performed at Mount, Myaree and Duncraig ONLY. 1. Collect 10mL Heparin from patient. 2. Collect 10mL Heparin from "normal" patient. (Control) 3. Spin at 170g for 5 minutes. 4. Remove plasma from both tubes into plain sterile, well labelled take off tubes. 5. Send immediately to Coagulation - PathWest.

Poliovirus Culture

1. Faeces x 3 (preferably on successive days) 2. Refrigerate but DO NOT freeze.

Porphyrins (Blood)

Note: Faeces no longer tested. 1. Collect Monday to Wednesday ONLY 2. 2 x Hep (green top), do NOT spin 3. Protect samples from light (wrap in alfoil). 4. Keep all samples cool. 5. Please also collect a urine for Porphyrins following the instructions below – even if a

urine Porphyrin is not request – both blood and urine musty be tested at the same time.


Porphyrins (Urine)

Note: Faeces no longer tested. 1. 1 x spot urine. DO NOT collect 24hr urine (even if requested). 2. Protect all samples from light (wrap in alfoil). 3. Keep all samples cool. 4. Please also collect blood for Porphyrins following the instructions above – even if a

blood Porphyrin is not request – both blood and urine musty be tested at the same time.

Prolactin / Macroprolactin

1. Allow patient to rest (sitting or lying down) for 20 minutes prior to collection. 2. Note RESTED on request form. 3. Collect 1 x SST. NB: If patient is reluctant/unable to wait, then collect sample and note NOT RESTED on

request form.

Prolactin Serial

1. Allow patient to rest (preferably lying down) for 20 minutes. 2. Collect x 1 SST. 3. Allow patient to rest for another 20 minutes (40 mins total). 4. Collect x 1 SST. 5. Allow patient to rest for another 20 minutes (60 mins total). 6. Collect x 1 SST. IF other times are specified then specimens are collected exactly as stated on request form by referring doctor.

Pro BNP / NT Pro BNP





1 x SST, spin, separate and freeze at ACC – send in frozen.

Pyruvate (Lactate/Pyruvate)

Patient should be fasting. If not, contact Duty Biochemist. Special collection tube (available from Protein Chemistry).

Collectors 1. Add blood to line (1mL) to special lactate / pyruvate tube containing 1mL Acid

(obtained from Manual Chemistry). 2. Mix well, do not spin or separate, send specimen in as is 3. Sample will turn a brown colour.

Laboratory 4. Freeze Supernatent ASAP


QCG (Quantitative BhCG)

1 x SST Do not mark urgent unless:

Marked urgent by the Doctor Clinical notes indicate query ectopic Clinical notes indicate query miscarriage

Quantiferon

Order of Draw ; Special Quaniferon Grey tube , Special Quaniferon Red, Special Quaniferon Purple, Shake vigorously 10 times each tube In-house testing - WDP now performs the Quantiferon Gold ® TB Test at the Myaree Laboratory. The test is only available from Monday to Friday (excluding Public Holidays) at the following WDP locations:

METROPOLITAN WA:

Bentley Rowethorpe Village Bentley, Tranby Way off 4-10 Hayman Road (within Medical Centre) T: 08 6363 6326

Claremont Bethesda Hospital , 25 Queenslea Drive, Claremont T: 08 9385 0037

Duncraig Suite 4 / 60 Arnisdale Road, Duncraig T: 08 9246 5800

Joondalup Joondalup Health Campus, Cnr Grand Blvd & Shenton Ave, Joondalup T: 08 9400 9810

Mandurah Peel Health Campus, 110 Lakes Road, Mandurah T: 08 9531 8510

Myaree 11 Blaikie Street , Myaree T: 08 9317 0709

Nedlands / Hollywood Hollywood Medical Centre, Suite 5 / 85 Monash Avenue, Nedlands T: 08 9389 6017

West Perth / Mount Mount Hospital Laboratory, Suite 11 / 146 Mounts Bay Road, Perth T: 08 9321 3300

REGIONAL WA:

Bunbury 122 Spencer Street, Bunbury T: 08 9791 9240

Busselton 21 Albert Street, Busselton T: 08 9752 2452

Kalgoorlie Corner Cassidy & Egan Streets, Kalgoorlie T: 08 9021 4833


RAST

All requests for RAST testing require a full SST tube or at least two full Micro-SST tubes. If unable to collect this much blood, please contact the Immunology Laboratory on 9317 0920 as a recollect may be required.

Rectal Swab

A swab may be collected from the rectum in an attempt to diagnose sexually transmitted diseases (eg:- Gonorrhoea or Chlamydia) or as a substitute for a faecal specimen in the diagnosis of infective diarrhoea. 1. Place patient in left lateral position with hips and knees flexed. 2. Insert the swab through the anus so that the whole of the cotton wool bud is inside. 3. Sweep the swab around the wall of the rectum to cover as near 360o as possible. 4. Place swab in appropriate transport medium (Chlamydia or Stuart's).

Red Cell Fragility

Take 4.5 ml EDTA (Purple) and notify senior scientist in Haematology at Myaree who will decide whether Flow Cytometry for Hereditary Spherocytosis should be performed. (Red cell fragility at PathWest is a discontinued test).

Reducing Substances (Faeces) (Lactose Intolerance)

Test no longer available – Contact Duty Biochemist

Renin

1. Collect 1 x EDTA (Purple). 2. Centrifuge within 30 mins of collection , separate and freeze plasma immediately @

LCC. 3. For requests for Erect or Supine levels, ensure patient has been walking or sitting

(erect) or lying down (supine) for at least 30 minutes prior to collection. ALWAYS take aldosterone (SST) with Supine and Erect Renins. LABEL CLEARLY each tube supine or erect as appropriate.

4. Send in frozen. * Separated samples MUST be labelled with:

Full name DOB Lab No. Date and time of collection Type of specimen (eg. SST, EDTA).

Respiratory Virus PCR- see Nasal and Throat Swab

Rotavirus Antigen Detection

1. Faeces (one random sample). Give patient Form P14 for collection instructions.


Salmonella Culture

1. Faeces: Micro Culture and Sensitivity 2. Blood - See Blood Culture collection

Schistosoma Ova in Urine

Maximum ova secretion is between 1200 hrs and 1500 hrs. 1. Collect a 10 - 30mL terminal (end) stream urine between 1200hrs and 1500hrs.

Scraping – Hair

To facilitate the work of the diagnostic laboratories, the following data should be requested for all specimens: 1. Patient name, age, sex 2. Type of specimen (eg:- nail scraping) 3. Anatomical site from which specimen is taken. 4. Short description of lesion. 5. Has patient had any topical treatment or did he/she take any oral antifungal agents? 6. If the answer is "YES", contact a Clinical Microbiologist before collection of specimen. NB: An accurate diagnosis of fungus infections can only be made when adequate

specimens are obtained. Poor quality specimens can often result in incorrect information.

Procedure

1. Collect equipment - sterile jar - yellow top. - scalpel blade No. 22 or No. 23 - alcohol swab - gloves 2. Clean skin thoroughly with 70% alcohol swab. 3. Collect any hairs that are broken off, or attached to crusts within inflammatory areas

or that fluoresce with a bright green-yellow or green white colour under ultra violet light.

4. Remove hairs by the roots from scalp or beard using sterile forceps. Hair clippings should be obtained from affected body hairs. Cut as near to the root as possible.

5. Place at least 10 - 15 pieces of hair in a sterile container.

Scraping - Nail

To facilitate the work of the diagnostic laboratories, the following data should be requested for all specimens: 1. Patient name, age, sex 2. Type of specimen (eg:- nail scraping) 3. Anatomical site from which specimen is taken. 4. Short description of lesion. 5. Has patient had any topical treatment or did he/she take any oral antifungal agents. 6. If the answer is "YES", contact a Clinical Microbiologist before collection of specimen.

Procedure


1. The specimen should be taken from nails which are thickened, discoloured or show a chalky, crumbling appearance.

2. Clean nail thoroughly with 70% alcohol to remove surface micro-organisms. Allow to dry.

3. Scrape as much debris as possible from the under surface of the nail into container or into envelopes. The nail is dead and nerveless - you will not hurt the patient.

4. Obtain as many nail clippings as possible from the infected area and collect specimen in envelope or container.

5. In the presence of exudate in connection with inflamed paronychial tissue, collect exudate by using two swabs. Use one to make a smear and place the other (for culture) in Stuart's transport medium.

Scraping – Skin

To facilitate the work of the diagnostic laboratories, the following data should be requested for all specimens: 1. Patient name, age, sex 2. Type of specimen (eg:- nail scraping) 3. Anatomical site from which specimen is taken. 4. Short description of lesion. 5. Has patient had any topical treatment or did he/she take any oral antifungal agents? 6. If the answer is "YES", contact a Clinical Microbiologist before collection of specimen NB: An accurate diagnosis of fungus infections can only be made when adequate specimens are obtained. Poor quality specimens can often result in incorrect information.

Procedure

1. Collect equipment - sterile jar - yellow top. - scalpel blade No. 22 - alcohol swab - gloves 2. Clean skin thoroughly with 70% alcohol swab.(The alcohol only affects surface

organisms and will not harm the fungi in the layers). Allow the alcohol to dry. 3. Scrape lesion with sterile scalpel blade and collect as many scrapings as possible in

sterile container (yellow top jar). 4. If several lesions are present, scrape several (3 or 4) of them. INCLUDING THE

MOST RECENT ONE. 5. When lesion is round (as in lesions caused by ringworm fungus) with a red and/or

vesicular border and a healing centre, scrape edge of the lesion where the actively growing fungus will be found.

6. When lesion is VESICULAR, remove top of vesicle with a scalpel blade and include it as part of the specimen.

7. When lesion is red, moist and painful (as in Candida infection) scrape the edge of the lesion if possible. If scraping causes too much discomfort to the patient, then collect dried scales from the surface of the lesion.

8. In INTERDIGITAL (Toe Spaces) LESIONS: After cleaning area with 70% alcohol and allowing it to dry, remove as much dead white macerated epidermis from the top of the lesion as possible then scrape and collect the growing edge of the lesion.

9. In the presence of exudate, collect two swabs from the area. Use one to make a smear and place the other swab in Stuart's transport medium or in a test tube containing a small amount of sterile water to prevent it from drying out. Dry swabs should not be sent.

10. In general, swabs are not the best way to collect specimens. Most pathogenic fungi cannot be isolated from specimens collected by swabs: however, using swabs for


collecting oral, vaginal and rectal specimens (as in yeast infection) is practical and convenient.

11. Send collected samples to the laboratory as soon as possible, as some fungi may not survive for an extended period.

Secretory IgA

Saliva – Patient not to eat for 1 hour prior to collection, see below for collection method.

Procedure

Saliva collection. 1. Place a sterile cotton wool ball near the opening of the parotid salivary duct (ie

between the upper gum and the cheek as far back as possible). The child or parent can do this.

2. Keep the cotton wool ball in place for 5-10 minutes until “wet”. With small children, it may be necessary to hold the cotton wool ball in place.

3. Remove cotton wool with forceps or use fingers if the child feels threatened by the forceps.

4. Place the wet cotton wool in a 5mL syringe from which the plunger has been removed, replace plunger then squeeze saliva from cotton wool into a 3DT tube.

5. Store at 4oC. NB Avoid being bitten.

Semen Analysis – Patient Instructions

POST VASECTOMY: Samples may be dropped of at any ACC. Patient Information instructions (supplied by Doctor but also contained in your

Forms File Manual) state that patients contact the ACC to arrange a drop off time.

Arrange this time close to your courier pick up. This is important as samples need to be analysed ASAP. FERTILITY SAMPLES: Only certain ACC’s can receive semen samples for fertility. These are

locations where there is a microscope and trained staff to assess the sample – see attached Patient Information Sheet.

Collector to pass specimen to appropriate Scientist at their location to perform the motility.

The Scientist will then forward the sample to Myaree. If patients present at your ACC and you are not listed on Patient Information

Sheet to receive fertility samples, please contact Duty Manager at Myaree on 9317 0814.

The patient should ring the collection centre to arrange a suitable time and place to bring in the specimen. NOTE: No more than 30 minutes should elapse between collection and delivery to the collection centre as timely examination by the laboratory is required to prevent potential deterioration of the specimen.

Joondalup Health Campus Cnr Grand Blvd and Shenton Avenue 9400 9810 Mandurah – Peel Health Campus 110 Lakes Road 9531 8515 Mount Medical Centre Suite 11, 146 Mounts Bay Road 9321 3300 Myaree 74 McCoy Street 9317 0999 Hollywood 85 Monash Avenue Nedlands (from November 2010) 9346 7101


Regional Laboratories Albany 87 - 89 Albany Highway (08) 9841 6211 Busselton 21 Albert Street (08) 9752 2452 Darwin 59 Winnellie Rd, Winnellie (08) 8901 7900 Kalgoorlie Goldfields Medical Centre Cnr Cassidy and Egan Street

(08) 9021 4833

Collection of Semen Samples 1. Patient is to be given Form P5 for patient instructions and information. 2. Collect specimen between three and seven days after your last ejaculation. 3. Collect the ENTIRE sample by means of masturbation. Other methods such as

interruption of intercourse are not suitable as there can be a loss of the first portion of the specimen.

4. DO NOT use condoms, artificial lubricants, talc’s etc., as these will interfere with the test.

5. Collect the specimen in the specially provided container previously allowed to reach room temperature. DO NOT expose the specimen to extremes of temperature eg:- refrigeration.

Keep at room temperature, generally 20oC. 6. Write patient surname and given name on the label of container, plus date and time

of collection. 7. Specimen should be delivered to the Laboratory or Listed Collection Centre (not at

other specimen collection centres) within 30 minutes of collection. 8. Collection at the Laboratory

The patient may elect to produce the specimen at the laboratory or collection centres. i. Patients are entitled to secure privacy while producing the specimen. ie:- Put

the patient in a room (not a toilet) with blinds/curtains and lockable door. If this facility is not available, refer patient to a more appropriate centre.

ii. It is inadvisable to allow the patient to produce the specimen on site if you are alone.

9. Any questions or discussion with the patient should be carried out discreetly. It is

probably very embarrassing for him. 10. All semen analysis request forms are to be labelled with "Process Immediately"

stickers.

Serotonin (Serum)

1. Collect 1 x Clot (red top). No gel. 2. Centrifuge, separate and freeze ASAP at LCC 3. Transport frozen sample to Sydney Pathology.


Serotonin (Platelet)

1. Collect 4.5mL EDTA (Purple) x 2. Do NOT centrifuge or refrigerate the sample. 2. Specimen must be sent to RPH, Haematology within 12 hours of collection. 3. On Friday specimen must be at RPH by 15.00 hours. Do not collect Saturday,

Sunday or Public Holidays. 4. Collect specimens in the morning. Contact Duty manager to arrange transport.

Snake Venom Detection

1. Performed at Joondalup laboratory. 2. Sample can be blood, urine or a swab from the snake bite site - contact Duty

Biochemist. 3. Patient should be referred to the nearest hospital.

SOLVS (Self Obtained Low Vagina swab) APTIMA swab

collection for Chlamydia, Gonorrhoea & Trichomonas

vaginalis PCR or culture

1. Remove excess mucus from the cervical and surrounding mucosa using the APTIMA cleaning

swab (white shaft in the package with red printing). Discard this swab. 2. Insert the APTIMA specimen collection swab (blue shaft swab in the package with the green

printing) into the cervical canal. 3. Gently rotate the swab clockwise for 10 to 30 seconds in the endocervical canal to ensure

adequate sampling. 4. Withdraw the swab carefully; avoid any contact with the vaginal mucosa. 5. Remove the cap from the swab specimen transport tube and immediately place the specimen

collection swab into the APTIMA transport tube. 6. Carefully break the swab shaft against the side of the tube at the scoreline and discard the top

portion of the swab shaft; use care to avoid splashing of the contents. 7. Re-cap the APTIMA swab specimen transport tube tightly. 9. The endocervical swab for gonococcal smear and culture is another blue top tube- transport

swab. Take the swab and roll it through 360 in the endocervical canal, remove the swab and roll it on a labelled, clean glass slide before placing it in the transport medium of its original tube. Make sure the tube is properly labelled.

Doctors frequently ask for both an endocervical swab (ECS) and a high vaginal swab (HVS).

Collection of vaginal swabs other than High Vaginal Swabs

This may be a useful investigation of a child with vaginal irritation or discharge. In the adult, the preferred technique is to use a speculum and under direct vision collect the HVS and ECS. In children being investigated for possible gonorrhoea or chlamydia, a vaginal swab is sufficient, as the cervix is not infected before puberty, hence speculum examination and endocervical swabs are usually not necessary. The child with vaginal irritation may be infested with threadworm. During collection a worm may become visible. If so, collect the worm on a swab and place in a sterile container for identification in the laboratory.

Procedure 1. This should be as for adults, although very small children may be happier on their mother’s

lap. Make sure you have good visualization before proceeding. 2. Part the labia with the fingers of your gloved left hand. 3. Use a blue top ‘Transport’ swab, you will discard the tube.


4. Gently insert the swab approximately 20 mm into the vagina 5. Roll the swab over the entire circumference of the vaginal wall 6. Withdraw the swab and make a smear for microscopy on a labelled glass slide. 7. Take a second blue top swab for culture for gonorrhoea and place the swab into the

Transport tube. 8. If Chlamydia and/or Gonorrhoea is requested, take a third swab (APTIMA blue shaft swab in

the package with the green printing) and after swabbing, place in a APTIMA transport tube. Note: Remove the cap from the swab specimen transport tube and immediately place the specimen collection swab into the transport tube. Carefully break the swab shaft against the side of the tube at the scoreline and discard the top portion of the swab shaft. Re-cap the swab specimen transport tube tightly.

Sperm Antibodies

Tests for sperm antibodies are usually performed on a sample of blood from the female partner, but occasionally from the male. Specimen: Collect 1x SST In the case of Dr. Ann Jequier’s [JEQJ] patient’s all male partners have the sperm antibody test performed on their semen sample only, and never on their blood sample. Female patients of Dr. Jequier do not have a sperm antibody test. Rarely the doctor may request a test for sperm antibodies on cervical mucous. Specimen: Semen is collected as for Semen Analysis-Infertility. Specimen: Cervical mucous. This is a doctor collect only. Contact the Medical Microbiologist on duty.

Sperm Washing

Darwin and Kalgoorlie ONLY.

Sputum Culture

In medical terms, sputum is the material coughed up from the bronchial tubes. The sputum in a patient with bronchitis or pneumonia will appear purulent (as pus, cream-yellow to green-yellow) and it may appear blood streaked. When the patient coughs sputum into the mouth it becomes surrounded by saliva before it is coughed into the specimen container. This causes difficulty because many of the organisms in the mouth and throat are the ones which cause bronchitis and pneumonia. In the laboratory, the purulent matter (pus) is removed from the clear saliva and cultured to identify the micro-organisms. NB: Sputum sample quality deteriorates at ambient temperature. It is important to refrigerate until sent to the laboratory. Before the patient commences explain the steps of the procedure as listed in the

"Sputum Specimen Collection Information" sheet - Form P11.


On receipt of the specimen 1. Examine the sample through the container, if it appears clear, ask the patient to try

again. 2. Send the original specimen to the laboratory and note on the request form that a

second specimen has been requested. 3. If the second specimen is not satisfactory, note on the request form that this is a

second specimen, collected after advice to the patient. The laboratory will then contact the doctor to suggest an alternative method of collection such as naso-pharyngeal aspiration.

Sputum for Cytology

1. Instruct the patient to collect the specimen as per the Sputum Culture method. 2. The specimen should be kept refrigerated until transport to Myaree. 3. Do not add anything to the specimen. NB: Where Sputum Cytology x 3 is requested, it is recommended that x 3 (three) samples be collected on consecutive days. Where possible, ensure each specimen is sent to the Myaree lab on the day it was taken. If delays are likely, make sure the specimen is kept refrigerated. NOTE: If Doctor did not request sputum x 3 do not collect 3 specimens. Only collect one specimen.


STD Collection Guides

CT – Chlamydia trachomatis

GC – Neisseria gonorrhoeae

TV – Trichomonas vaginalis

SPECIMENS REQUIRED

MSU Yellow

Top

Collection

Pot

APTIMA®

FSU –

Collection kit

Monovette

Blue Gel

Swab

Orange Gel

Swab

APTIMA®

unisex swab

kit

TESTS REQUESTED

UR

IN

E

MS

U - M

id

S

trea

m

FS

U - F

irst S

tre

am

PC

R/N

AA

T - C

T/G

C/T

V

MC&S ●

PCR/NAAT ●

ACR ●

MC&S + PCR/NAAT ● ●

MC&S + PCR/NAAT + ACR ● ● ●

MC&S + ACR ● ●

PCR/NAAT + ACR ● ●

GE

NIT

AL S

WA

B

HV

S/E

CS

/S

OL

VS

Urethra

l

PC

R/N

AA

T - C

T/G

C/T

V

Female MC&S ●

Male MC&S ●

PCR/NAAT ●

Female MC&S + PCR/NAAT ● ●

Male MC&S + PCR/NAAT

● ●

Note: Specimens for CT/GC/TV PCR should be aliquotted into the respective APTIMA transport tube prior to transport to the lab


SWAB DESCRIPTION TEST SITE/s INSTRUCTIONS

Blue Top Gel Swab MC&S Any non-genital

May be left at room temperature except where gonorrhoea or anaerobic infection is suspected

MC&S Female genital

Screening of VRE & MRSA

nose, throat rectal or wound

APTIMA Swab Uni-Sex Collection Kit

PCR / NAAT Chlamydia trachomatis

Neisseria gonorrhoea Trichomonas vaginalis

Genital & non-genital sites

Snap swab at scoreline into APTIMA transport tube and tightly close lid. Store at room temperature after collection

Orange Top Gel Swab MC&S Any non-genital

May be left at room temperature except where gonorrhoea or anaerobic infection is suspected

MC&S Male genital

Screening of VRE & MRSA

nose, throat rectal or wound

Flocked Swab (Dry Flexible Swab) if

available

PCR / NAAT Respiratory Viruses

B. pertussis Herpes Viruses

Adenovirus

Any Store at room temperature

Viral /Bacterial Transport Swab (Dry)

Orange Wire & White Wooden Swabs

PCR / NAAT Respiratory Viruses

B. pertussis Herpes Viruses

Adenovirus

Any Store at room temperature


Sweat Test

1. Performed at Princess Margaret Hospital. 2. Patient needs to make an appointment at the Clinical Investigational Unit. 3. Suggest Duty Biochemist speaks to doctor.

Synacthen Stimulation

This test requires a baseline ACTH and Cortisol level with a 30min and 60min cortisol level. This test must be done by a Medical Practitioner competent in resuscitation and with appropriate resuscitation equipment available on hand. For this reason we cannot offer the test at Myaree. Please contact Duty Biochemist before proceeding with booking as detailed below. This service is offered at Joondalup on Mon, Wed and Friday mornings by Dr S. Ward. Patients are required to make a booking with his receptionist on 9400 9060 to ensure Dr Ward is available. If the test is for Synacthen Stimulation/17OH-Progesterone then collect as per above and take an extra SST (spin within 2 hours) for the sample 17OH-Progesterone.


Throat Swab M C & S

The pathogenic organisms are most likely to be found in the tonsil (or bed if tonsils have been removed) or on the back wall of the throat. When the tonsils or throat are rubbed firmly with a swab the patient will nearly always "gag". (If they do not gag you probably have not been firm enough). It is very important to have a clear view of the tonsils and throat so that you can quickly take the sample before the patient "gags". Procedure 1. Have a good light and a tongue depressor (wooden) available. 2. Request the patient to extend the tongue with the jaw wide apart. 3. Press the patient's chin down with your non-dominant hand. 4. If you have a good view take the swab with your dominant hand. 5. If the view is restricted ask the patient to wobble the tongue from side to side and

then extend it again. 6. If the view is still restricted you will have to use the tongue depressor. Place the

depressor on to the middle of the tongue approximately half way back, using your non-dominant hand. Press the tongue down gently and this should give a good view.

7. If the depressor is too far forward the back of the tongue heaps up making visualisation even worse. On the other hand if it is too far back the patient will "gag".

Sampling Ideally use the swab to rub one tonsil, then across the back of the throat and then the other tonsil on the way out. According to the patients reaction you must judge whether to make a second attempt. Do not be afraid of "being cruel to be kind". The patient wants an answer to their problem.

Throat and Nasal Swab Collection For Respiratory Virus

Collect three specimens (two nasal swabs for both nostrils and one throat swab) as follows:

8. OBTAIN MATERIALS

Dry swabs (no gel) OR

Swabs with viral transport medium (VTM) if available


9. PREPARE ROOM

Need a wall that the patient can rest their head against

HCW needs enough space to be able to stand beside the patient (not in front)


Assume everything in the room will be contaminated by viral particles

10. PREPARE HEALTHCARE WORKER



11. PREPARE THE PATIENT

Explain the procedure to the patient

Place the patient with head resting against the wall (standing or sitting)

12. SPECIMEN COLLECTION


Throat swab

1. Stand at the side of the patient 2. Ensure the patient’s head is resting against the wall 3. Place your non-dominant hand on their forehead 4. Ask the patient to open their mouth widely and say “ah” 5. Insert the swab into the mouth avoiding any saliva 6. Press the swab against the tonsil area at the back of the throat 7. Rotate the swab through two full turns, collecting epithelial cells 8. Place swab back in it’s container, label tube with patient name, collection date and source (throat) 9. Place swabs in specimen bag

Nasal swabs

1. Stand at the side of the patient 2. Ensure the patient’s head is resting against the wall 3. Place your non-dominant hand on the patient’s forehead, with your thumb on the tip of their nose 4. Insert the swab into the closest nostril horizontally, approximately 2 – 3 cm 5. Press the swab towards the nasal septum (the middle bit that separates the nostrils) 6. Rotate the swab through two full turns collecting epithelial cells 7. Use the same swab to repeat the process with the other nostril 8. Place swab back in it’s container, label tube with patient name, collection date and source (nose)

13. REMOVE PPE





Perform hand hygiene

14. COMPLETE REQUEST FORM.

Throat Swab for Cytology

1. Make a smear on a frosted glass slide from the swab, rotating it to ensure maximum deposition of material.

2. Cytofix immediately and label with patient’s name.


Transfusion Reaction Pre/Post

1. These samples should be collected as soon as possible after the reaction is reported and delivered to the Transfusion Laboratory performing the initial Crossmatch.

1 x 4.5mL EDTA (Purple) - for FBE, DCT 1 x 6mL SST - for Bilirubin 1 x 6mL EDTA (Pink) + 1x Clot (red top) -for Group, Antibody Screen & repeat Crossmatch MSU - first urine passed post reaction. Send All empty or partially empty blood units transfused so far to the Transfusion

Laboratory. 2. The testing lab should retrieve the original clot and serum if available.

Triple Test (Down Syndrome and/or Neural Tube Defect

Screening)

This is a test taken during pregnancy to screen for Down Syndrome and other birth defects. It is known as the Triple Test because three (3) separate tests (Free BhCG, Estriol and AFP) are performed to calculate a relative risk of the pregnancy being affected by Down Syndrome, spine bifida and anencephaly. 1. Patients can tested be between 14 - 18 weeks. 2. Complete Triple Test questionnaire - Form P 7. 3. Collect 1 x SST. 4. Contact Duty Biochemist if any problem arises. 5. This test is performed at Princess Margaret Hospital.

Troponin I / Cardiac Enzymes

ALWAYS treat as URGENT Testing lab = Darwin, Joondalup, Hollywood, Myaree/Metro ACCs, Peel 1 x SST VDU code TRU Testing Lab = Alice Springs, Kalgoorlie, Mount Hospital, Albany, Busselton 1 x EDTA Must be to the testing lab within 2 hours If this is not achievable please contact the testing laboratory for instructions (SST to local hospital) VDU code TNI

Typhoid Culture

1. Faeces - x 3 (preferably on successive days). Give patient Form P14 for collection instructions.

2. Blood - see Blood Culture collection.

Urethral Swab

Requests for Urethral Swabs should be referred to the Duty Microbiologist. These collections should not be performed by pathology collectors.


Urine Collection - (24 hour)

Precautions For Urine Collection All 24 hour urine’s requiring acid are to be collected into jars containing 20mL 50% HCI. Please noted that it may be necessary to collect 2 x 24 hour urine’s eg. A request for urinary magnesium and uric acid. Spot urine’s need to have pH adjusted to <3. Due to the dangerous nature of HCI, warning stickers should be placed onto the urine container and the patient needs to be told that the jar contains acid and as such to exercise caution. An initial quantity of these stickers will be supplied to relevant sites and subsequent supplies can be ordered through stores.

Regional laboratories should source HCI through local suppliers and the Metro area should be co-ordinated through the major collection centres where acid can be supplied via Myaree. For LEAD - 24 hour urine - contact Duty Biochemist PRIOR to collection. Test only performed when patient on chelation. Do blood lead instead. 1. The patient is given a clean 24 hour urine container with their name and the test

required printed clearly on the label. 2. Give patient Form P8 - 24hr Urine Collection instructions. 3. When collection is to commence, patient should empty bladder into the toilet, note

the time, and write this clearly on the label with the date for Day 1. 4. From this time on, all urine passed for the next 24 hours is collected into the

container. 5. On Day 2, patient should empty bladder at the same time as commencing the 24

hour collection. This sample is placed in the collection container. 6. Patient writes date and time of completion on label and returns same to Pathology. 7. If urine has to have a preservative added, do this carefully before giving container to

patient. Print in large RED letters that ACID has been added and warn the patient NOT to urinate directly into the container.

Also warn patient not to leave container around children or animals. Collect specimen as above.

8. If request for 24 hour urine is for both (No Preservative and Preservative), two separate 24 hour collections must be obtained.

NB: Ideally, 24 hour urine collections on females should NOT be collected during

menstruation. If there are extenuating circumstances or the request form is marked URGENT, contact the Duty Biochemist.

Urine Collection - Split 24 hours

1. Contact Duty Biochemist to confirm details. 2. Give patient Form P10 - Split 24 hour Urine Collection instructions.

Urine Collection - Timed

1. Give patient Form P9 - Timed Urine Collection instructions. 2. Patient empties bladder into the toilet immediately prior to going to bed. The time is

recorded on the container (eg:- 10.00pm) 3. All urine passed during the night and including that passed on waking the next

morning is collected into the container. 4. The time of the last morning specimen (eg:- 7.00am) is recorded on the container.

Urine Cytology


1. Instruct the patient to collect a urine sample from the 2nd specimen of the morning. A yellow topped MSU jar can be used for this.

2. The specimen should be kept refrigerated until transport to Myaree. 3. Do not add anything to the specimen.

NB: Where urine cytology x3 is requested, it is recommended that x3 (three) samples be collected on consecutive days. Where possible, ensure each specimen is sent to the Myaree lab on the day it was collected. If any delays are likely, make sure the specimen is kept refrigerated. NOTE: If Doctor did not request urine x 3 – DO NOT collect 3 specimens. Only collect one specimen. A spot urine in these circumstances will be sufficient if the patient can produce the specimen on site, otherwise, get them to collect a sample from the 2nd morning specimen as per instruction 1 above.

Urine for PCR – Gono/Chlamydia/TV (APTIMA)

First Stream Urine is the term for the first 10 to 20 mL which comes out as urination commences. This initial volume of urine contains a high concentration of micro-organisms flushed out of the urethra. It is critical that the specimen is not too large as the micro-organisms have the potential be diluted beyond the limits of detection if too much urine is obtained. A First Stream Urine is unsuitable for the diagnosis of bladder or renal infection. The more usual Mid Stream Urine sample is not suitable for the PCR diagnosis of infections caused by Chlamydia trachomatis and Neisseria gonorrhoeae. PCR for Chlamydia trachomatis , Neisseria gonorrhoeae & Trichomonas vaginalis (TV) on First Stream Urine is very sensitive but may occasionally be negative, for example in some women with infection confined to the endocervix. A PCR test may remain positive for several weeks after successful treatment, as dead and damaged organisms may clear slowly. Confirmation of previous positive results may still be possible in these circumstances and may be relevant to counselling. The accuracy of PCR is high, but not a complete substitute for the established conventional methods. The clinician strives to detect all infections. The use of several different types of test allows enhancement of diagnostic accuracy. Procedure 1. Ideally, the patient will not have passed urine for at least an hour. 2. The patient should be instructed to retract the foreskin (males) or spread the labia

(females) and urinate into a sterile container. 3. Before the procedure show the patient an identical urine container holding the

required volume of urine (10 to 20 mL). Mark the upper limit of required urine on the outside of the container. Collection of larger volumes of urines may result in target dilution that may reduce test sensitivity. Female patients should not cleanse the labial area prior to providing the specimen.

4. Transfer approximately 2mls of urine from the yellow top jar to the APTIMA specimen transport tube using the sterile pipette supplied. The correct volume of urine has been added when the fluid level is between the black fill lines on the urine specimen transport tube label – visible in the window of the APTIMA transport tube.

5. Reseal the jar and the APTIMA tube tightly.. 6. When barcoding the specimens apply one barcode label to the APTIMA and attach it

with an elastic band to the yellow top jar. Please ensure that the yellow top and


APTIMA tube are properly labelled and both containers properly sealed before transport to the laboratory.

Minimum level of urine required in yellow top jar - to the AM/PM line. Urine in the APTIMA transport tube must be between the line in clear window.

Urine HMMA

Child USPOT – Freeze ASAP – Transport frozen Adult See Catecholamines

Urine Metabolic Screen

The sample requirement is 10 to 20mL random urine stored frozen and transported on dry ice. If dry ice is not available contact lab manager to order some.

Urine Myoglobin

Urine Myoglobin Not available

Urinary Pyrrole (Kryptopyrroluria Screen)

This test has an out of pocket expense for patients. At the time of printing the cost was $80 out of pocket ($65 for pensioners). The patient MUST be informed of this cost The patient must complete a request/payment form from Safe Analytical with the payment details and this must accompany the sample. DO NOT take money from patient.

1. This sample is a random early morning specimen that must be collected into a jar with ascorbic acid powder.

2. Contact Myaree Referred tests to order Ascorbic acid powder and the request/payment form that the patient must complete.

3. Instruct the patient to abstain from taking any vitamins or mineral supplements for 24hrs prior to collection. Patients should not alter their medications or supplements unless under instruction of their Doctor

4. Once you have received the ascorbic acid power in a urine jar request the patient return early in the morning

5. The patient will need 2 urine jars. One of those urine jars will have the acid powder and will have the word “acid” on the side and one without anything in it.

6. Label both urine jars with the patient details. 7. Give the patient both labelled urine jars and a cup. 8. Instruct the patient to urinate into the cup 9. The patient is then to divide (pour) the urine collected in the cup into the 2 labelled

urine jars. A minimum of 10mls is required in each urine jar.


10. The lids of the urine jars must be done up tightly and the urine in the jar with the acid power must be shaken well to dissolve the powder

11. The patient then hands both urine jars to the collector 12. The collector is to wrap each urine jar IMMEDIATELY in aluminium foil (to protect

from light) and freeze immediately 13. Forward both frozen urine jars and the completed Safe Analytical request/payment

form to Myaree. Transport on dry ice.

Vasoactive Intestinal Polypeptide

1. Special collection tube required - 4.5mL EDTA tube containing 0.2mL of Trasylol obtainable from Manual Biochemistry.

2. Patient should be fasting and the sample must be spun and frozen within one (1) hour of collection at LCC.

* Separated samples MUST be labelled with: Full name DOB Lab No. Date and time of collections Type of specimen (eg. SST, EDTA)

Very Long Chain Fatty Acids




Patient must acknowledge on request form that they have been informed that

test will cost and that they are happy to get a bill.

2 x EDTA. Spin, separate and freeze @ LCC, send in frozen

Do not take money.

Viscosity

Plasma 1. Contact Laboratory Manager concerning transport of the sample, before collect. 2. Collect 3 x EDTA 3. Centrifuge within 6 hours of collection. Store plasma at 4oC. DO NOT FREEZE. Whole Blood 1. Contact Laboratory Manager who will:- a. Arrange transport

b. Contact RPH 2. Collect 1 x EDTA. Store at 4oC. 3. Sample must be at RPH by 1200 hours.

Vitamin B1 / B1 / Thiamine / Red Cell Thiamine

EDTA (Purple), Fasting specimen. Wrap in foil and freeze whole. Transport frozen.


Vitamin B6 / B6 / Pyridoxine / Pyridoxal Phosphate

EDTA (Purple), Fasting specimen. Wrap in foil and freeze whole. Transport frozen.

Vitamin C

Fasting specimen 1. Collect 1x SST 2. Allow SST to clot for 30 min then 3. Immediately spin then 4. Immediately separate and freeze 5. No more than 45 min should elapse between specimen collection and freezing * Separated samples MUST be labelled with:

Full name DOB Lab No. Date and time of collection Type of specimen ( for example EDTA, SST, serum, plasma)

Vitamin K





1 x SST Spin separate and freeze at ACC - protect from light in foil Do not take money.

Wound Swab

For wounds that show signs of infection, microscopic examination and culture of the lesion is carried out to identify the responsible pathogens. Explanation to the patient Explain the purpose of the procedure, and that it will take one to two minutes and may be slightly uncomfortable.

Materials 1 x plain sterile swab 1 x glass slide with holder 1 x swab and transport media Procedure 1. Remove the wound dressing if present. 2. Slide Preparation for Microscopy


a. Open the slide holder and write the patient’s name in pencil on the frosted end of the slide. Handle the slide by the edge as fingerprints spoil the preparation.

b. Using the plain sterile swab, sample the infected area. Avoid the surrounding skin which may harbour different micro-organisms than those present in the lesion.

c. Make a smear by rolling the swab across the glass slide, then discard swab. Allow specimen to dry before placing in the holder.

d. Affix patient identification label or write patient name on the outside of the holder.

3. Transport media specimen. (Blue Top Swab).

a. Sample the infected area with the swab and insert in the tube containing transport media.

b. Complete patient details on the tube label.

NB: If there is insufficient material for two swabs, place the first one (after making the slide preparation) into the transport medium ie: only one swab taken.

Zinc Protoporphyrin (ZPP)

1 x EDTA – BB (6ml – Pink) Wrap in foil

00ogy 0000000 phone000 - western diagnostic … · western diagnostic pathology copyright ......

Documents