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GUIDELINES SPECIMEN COLLECTION
PATHOLOGY DEPARTMENT HOSPITAL SULTANAH NORA ISMAIL
Last Update Feb 2019
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FOREWORD
I am grateful for the opportunity to write this foreword for the new edition of Guidelines
on Collection of Specimens.
Proper collection and storage of specimen are important elements for producing good
quality of result. The clinician and ward staff can assist in maintaining accuracy and speed of
reporting of result by taking suitable specimen before sending to the lab.
This Guideline on Collection of Specimens for Pathology Investigation has therefore
been produced as a handy tool for specialist, medical officers and other medical staff. In the
course of the preparation of these guidelines, good inputs were provided from multiple
disciplines. It is hoped that this guideline would assist them in proper procedure of sending
specimen for pathological investigation. I would like to congratulate Pathology Department
for producing this Handbook.
HOSPITAL SULTANAH NORA ISMAIL,
BATU PAHAT
6
CONTENTS
NO TOPICS PAGE
1 INTRODUCTION 8
2 PUBLISHING COMMITTEE 9
3 PATOLOGY SERVICE 10
4 WORKING HOURS 11
5 CONTACT NUMBERS 12
6 LABORATORY POLICY 14
7 WORK PROCESS FLOW CHART 16
8 REJECTION CRITERIA 17
9 TEST REQUEST FORM 18
10 LIST OF TEST OFFERED 24 HOURS 19
11 HEMATOLOGY 20
12 CHEMICAL PATHOLOGY 25
13 MIRCROBIOLOGY 32
14 IMMUNOLOGY/SEROLOGY 43
15 HISTO PATOLOGY 45
16 CYTOLOGY 46
17 BLOOD TRANSFUSION SERVICE 48
18 MASSIVE BLOOD TRANSFUSION PROTOCOL 51
19 BD VACUINTANER TEST TUBE GUIDE 52
20 BD VACUTAINER® ORDER OF DRAW FOR MULTIPLE TUBE COLLECTIONS 53
21
BLOOD SAMPLE COLLECTION TECHNIQUE
Venipuncture Procedure
Finger stick Procedure
Heel stick Procedure (infants)
Order of Draw
Areas to Avoid When Choosing a Site for Blood Draw
Techniques to Prevent Hemolysis (which can interfere with many tests):
54
22 FACTORS AFFECTING BLOOD TEST RESULTS 57
23 GENERAL LAB REQUEST FORM 60
24 OUTSOURCE TEST 69
25 SURAT ARAHAN 98
7
INTRODUCTION
The Department of Pathology, Hospital Sultanah Nora Ismail consists of five units
of sub-disciplines of Pathology i.e. Hematology, Chemical Pathology (Clinical Pathology
or Biochemistry), Microbiology (which includes TB, Serology, Immunology, Anatomic
Pathology (Histology/ Cytology) and Transfusion Service (Blood Bank), appropriate
with the status of Hospital Sultanah Nora Ismail which is categorized as a hospital with
specialist and one of the training center for the house-officers. The use of routine
investigations in medical practice is widespread and more tests were requested for
each patient, leading to a tremendous increase in utilization of laboratory services.
Therefore, this guideline on collection of specimens was created to ease our
clients in their routine request, to avoid the commonly repeated mistakes that lead
to unnecessary delaying in producing results and systematically classify certain tests
according to units/forms. This is the third edition, in which a few sections have been
updated and additional tests and procedures were provided. This guideline should
be placed at the most accessible place for all staffs, in order for both pathology staff
and clients/hospital staff to reap the full benefits from this guideline for better patient
care. Thank you.
Dr Nani Shahida Binti Sehat
Head,
Department of Pathology
Hematology Specialist
Hospital Sultanah Nora Ismail
8
PUBLISHING COMMITTEE
This simple guideline on collection of specimen is written to assist the clients of
Pathology Department of Hospital Sultanah Nora Ismail in the collection and
dispatch of specimen for pathology investigations in the proper way, thereby
making it easy and appropriate for the lab staff to process the specimens and
produce good and quality results.
It is desired that unnecessary delay and repetitive procedures could be avoided.
Publishing Committee:
Advisor : Dr Azimah bt A. Aziz
Chairman : Dr Nani Shahida Binti Sehat
Members : Dr Haniza Haironi
: Dr Lai Jun Yuan
Dr Noor Ayuni Baker
Dr Valerie Teh
Pn. Norinsiah Sarni
En. Wong Ming Hui
En. Shaharudin Bin Ismail
Pn. Fauziah Bt Abu Bakar
Pn. Ratna Dewi Abd Rahman
Pn. Siti Hajar Chuni
Cik Nadzirah Aziz
En. Julian Chin Hock Chye
En. Abd Razak Ismail
En. Fairuz Ridzlan A Rashid
Pn. Sia Soh Boon
En. Goh Chen Fook
Pn. Noryati Abdul Rahim
9
PATHOLOGY SERVICE
The main Pathology laboratory / Blood Transfusion Services (BTS) are situated on the
2nd floor of new hospital building sharing the same level with CSSD and located 1 level
above the Emergency Department. The Pathology Department consists of the following
units:
Chemical Pathology
Cytology
Hematology
Histopathology
Microbiology
Serology
Blood Transfusion Service
The Department provides services to Hospital Sultanah Nora Ismail, Health Centers as
well as private clinics in Batu Pahat where such services are not available in their
respective places.
10
WORKING HOURS
Normal working hours from 8.00am to 5.00pm.
On-call staffs are available after office hours for the following units:
Chemical Pathology
Hematology
Blood Bank
Microbiology (5pm to 9pm)
11
CONTACTS NUMBERS
LOCATION
DIRECT NO
HEAD OF DEPARTMENT
4309
MEDICAL OFFICER
4324/4311/ 4325
SCIENTIFIC OFFICER
4312/4313/4314/4315
JTMP KANAN 4303
HEMATOLOGY
4285
TRANSFUSION LAB
4327
BLOOD DONATION COUNTER
4318
BIOCHEMISTRY
4328
MICROBIOLOGY
4310
SEROLOGY
4308
HISTOPATHOLOGY/CYTOLOGY
4296
INFECTION CONTROL
4292
SAMPLE RECEIVING COUNTER
4289
12
DIRECT NO HANDPHONE
DR NANI SHAHIDA BINTI SEHAT Ketua Jabatan (Pakar Hematologi)
7141 / 4309 017-3908024
DR HANIZAH HAIRONI Pegawai Peruatan UD54 (Timbalan Ketua Jabatan)
6214 / 4291 012-7662861
DR LAI JUN YUAN Pegawai Perubatan UD52 (Ketua Unit Tabung Darah)
6269 / 4325 018-7814909
DR AYUNI BAKER Pegawai Perubatan UD48 (Ketua Unit Hematologi)
7358 / 4291 016 - 6829222
DR VALERIE TEH CHIN YI Pegawai Perubatan UD44
6258 / 4324 012 - 6677677
PN NORINSIAH SARNI Pegawai Sains (Kimia Hayat) C48
4305 / 4328 012 - 7407092
EN WONG MING HUI Pegawai Sains (Mikrobiologi) C48
4370 014-8865568
EN SHAHARUDIN BIN ISMAIL Pegawai Sains (Kimia Hayat) C44
4212 019 - 2907264
PN FAUZIAH BT ABU BAKAR Pegawai Sains (Mikrobiologi) C44
4211 017 - 7001168
EN JULIAN CHIN HOCK CHYE Pegawai Sains (Mikrobiologi) C41
4315 / 4308 012 - 5328698
EN FAIRUZ RIDZLAN ABD. RASHID Pegawai Sains (Mikrobiologi) C41
4302 / 4308 012 - 7176447
EN ABD RAZAK BIN ISMAIL Pegawai Sains (Biomedikal) C41
4314 / 4285 017 - 7001036
PN RATNA DEWI ABD RAHMAN Pegawai Sains (Mikrobiologi) C41
4313 / 4310 017 - 3670258
PN SITI HAJAR CHUNI Pegawai Sains (Kimia Hayat) C41
4312 / 4328 016 - 3310462
CIK NADZIRAH AZIZ Pegawai Sains (Kimia Hayat) C41
4312 /4328 019 - 3700489
PN SIA SOH BOON JTMP38
4295 012-7789979
EN GOH CHEN FOOK JTMP 36 -Tabung Darah
4319 012-7574779
PN NORYATI ABDUL RAHIM JTMP 36 - Hematologi
4303 010-7686742
HJH NAIMAH BINTI ISHAK JTMP 36 - Mikrobologi & Serologi
4303 013-7364365
13
LABORATORY POLICY
Test Request
1. All requests can be ordered by medical officers, specialist and consultants.
2. Urgent requests must be justified by clinical history, diagnosis and reason for urgency.
Request Form 1. A standard laboratory request form (PER-PAT 301) has been modified according to lab
disciplines and been color coded: pink form for Hematology, blue form for Chemical
Pathology and green form for Microbiology. Besides, for certain special investigation may
require special forms
2. All request forms must be adequately filled and should include identification of the patient
by full name, medical record number, sex, IC number. Relevant medical history, provisional
diagnosis and treatment of the patient should be provided.
3. Tests requested must be clearly written & specific.
4. The requesting doctor must place their signature of on the request form with officer stamp
cop.
5. Separate laboratory request forms and specimens should be provided for different
disciplines of investigations.
6. All laboratory test request must accompany with a lab request form. Verbal request and
adding test request verbally through phone is not allow.
Samples / Specimens 1. Patient’s specimen referred from specialist clinics shall delivered to the main laboratory
counter. Venipuncture shall be carried out in the specialist clinics / ward
2. All wards and other units shall send samples / specimens which have been taken earlier.
3. Samples / specimens of inpatients shall be collected and send to the laboratory by ward
staff.
4. Every specimen container must be adequately labeled. The minimum information on a
label should include the patient’s name and RN / Identification Card number.
5. All specimen containers and request form from each patient shall be put separately into a
biohazard plastic bag before dispatching.
6. Urgent request can be sent to the laboratory as when required. However, ward staff is
discouraged from using the term ‘urgent/stat’ for non-urgent sample as it may interrupt
the work flow in the laboratory.
14
Results
1. All results shall be validated by the responsible officer (Medical Officer / Scientific officer /
MLT).
2. Result shall be made available for collection as soon as they are ready.
3. The printed lab result will be put in the pigeon hole for collection by ward staff. Details of
the lab results are not allow to be convey through phone.
4. For tests require requesting a higher degree of confidentiality e.g. HIV, handling of such
investigations and results shall comply with the existing regulations and procedures.
5. Tracing laboratory result by phone is not allow, all laboratory result will be release officially.
15
WORK PROCESSFLOW CHART
Terima spesimen dan borang
permohonan ujian
Semak dan sahkan
permohonan
Asing & agihkan spesimen serta borang ke unit makmal yang berkenaan
Tampal barkod (jika perlu)
Rekod butiran permohonan dalam sistem LIS
Jalankan ujian mengikut turutan
Sahkan keputusan ujian
Rekod dan cetak keputusan
Dispaj keputusan
Sahkan dan ketik masa penerimaan pada Buku Daftar Penghantaran
Spesimen. ketik masa penerimaan pada borang permohona nujian
TIDAK MENGIKUT KRITERIA
MENGIKUT KRITERIA
SEGERA
RUTIN
Jalankan ujian
serta-merta
YA
TIDAK
Ulangi Ujian
Tolak permohonan dan minta pembetulan / hantar
permohonan ujian yang baru KAUNTER UTAMA
UNIT
MAKMAL
Kenal pasti ujian
Keputusan
meragukan?
Semak borang dan spesimen
16
REJECTION CRITERIA
A PARTIAL REJECTION: Permohonan perlu melengkapkan borang/membuat pembetulan dalam jangka masa 30minit.
1 Ringkasan klinikal / data makmal /diagnosis tidak lengkap
2 Salah boring
3 Spesimen tanpa borang (kecuali tabung darah)
B FULL REJECTION Penolakan penuh di jalankan sekiranya terdapat kriteria berikut
1 Tiada nama / IC pada borang /sampel
2 Kesalahan ejaan nama pesakit / digit IC
3 Tiada Wad
4 Tiada ringkasan klinikal / diagnosis
5 Tiada tarikh / masa pengambilan sampel
6 Tiada tandatangan / cop pegawai perubatan
7 Borang – tiada pendua (eg: Histo/Sito, urine drugs)
8 Borang rosak dan tercemar
9 Label / data pada boring dan specimen tidak jelas/berbeza
10 Salah container
11 Bekas / tiub bocor
12 Borang tanpa specimen
13 Jumlah isi padu sepsimen tidak mengikut standard yang ditetapkan
14 Spesimen tidak sesuai untuk analisa (hemolysed / clotted)
15 Ujian tiada dalam senarai oncall (jika selepas waktu pejabat)
16 Lewat menerima specimen dari tarikh& masa yang ditetapkan
17 Sampel ujian Tabung Darah (GXM, GSH dll) dilabel dengan sticker (Label sampel perlu di tulis tangan)
18 Permohonan duplikasi (Duplicate request)
19 Tiada termujanji bagi ujian khas
17
TEST REQUEST FORM
1) BLOOD BANK
2) PATHOLOGY
UNIT TYPE OF FORM PER PAT 301
COLOUR
HEMATOLOGY PERPAT301/ HEMATOLOGICAL
REQUEST FORM / SPECIFIC FORMS
PINK
CHEMICAL PATHOLOGY
PERPAT301/ SPECIFIC FORMS
BLUE
MICROBIOLOGY/ SEROLOGY GREEN
HISTOLOGY PERPAT301 (2 COPIES)
WHITE CYTOLOGY
CYTOLOGY (Gynae–Pap Smear)
BORANG PS1/ 98 Pindaan 2007
OUTSOURCED TESTS PERPAT301 (2COPIES) OR
SPECIFIC FORMS WHITE
A & E Department PERPAT301 YELLOW
TEST TYPEOFFORM COLOUR
GSH/GXM PPDK WHITE
(Carbonized paper)
COOMB’S TEST
PERPAT 301
WHITE BLOOD GROUPING /Rh
OUTSOURCE TESTS PERPAT 301 (2 COPIES)
18
LIST OF TEST OFFERED 24 HOURS
NO TESTS SAMPLE
1 Renal Profile
4ml blood in Lithium Heparin (green cap) 2 Calcium
3 Magnesium
4 Phosphate
5 Blood Gases 1ml blood in Heparinized Syringe
6 Lactate 2ml blood in Sodium Fluoride (grey cap)
7 Glucose
8 Amylase 4ml blood in Lithium Heparin (green cap)
9 Cardiac Markers (AST, CK, LDH) 4ml blood in Lithium Heparin (green cap)
10 Serum Bilirubin
11 CSF Biochemistry CSF in Bijou Bottle
12 Urine Pregnancy Test (UPT) 20ml urine in urine container
13 Liver Function Test
4ml blood in Lithium Heparin (green cap). STAT request is offered for acute liver failure, pre-eclampsia and severe dengue cases only. Call Pathology MO for urgent
requests for other indications with justification.
14 Urine Paraquat 20ml urine in urine container
15 Full Blood Count (FBC) 2ml blood in K2EDTA (lavender cap)
16 Coagulation Profile (PT, APTT) 1.8ml blood in Sodium Citrate (blue cap)
17 D-Dimer 4ml blood in Lithium Heparin (green cap)
18 Erythrocyte Sedimentation Rate (ESR) 1.28ml blood in ESR tube (black cap)
19 Peripheral Blood Film (PBF) 2ml blood in K2EDTA (lavender cap).
Call Pathology MO for urgent requests with justification.
20 Urine FEME 20ml urine in urine container
21 Urine Microalbumin
22 Stool Occult Blood Stool in stool container
23 CSF FEME CSF in Bijou Bottle
24 CSF Bacterial Culture
25 Rapid HIV 4ml blood in plain tube (red cap). Call Pathology MO for each request with justification.
26 Rapid HBsAg
27 Rapid Anti-HCV
28 Rapid Dengue IgG/IgM 4ml blood in plain tube (red cap)
29 Rapid NS1 Ag
30 Blood Film For Malaria Parasite (BFMP) Thick and Thin Smear
31 Fibrinogen 1.8ml blood in Sodium Citrate tube (blue cap)
32 Corneal / Fungus Scraping Smear slide
19
HE
MA
TO
LO
GY
TEST
NA
ME
CO
NTA
INER
/ V
OLU
ME
LAB
SCH
EDU
LE
TAT
TRA
NSP
ORT
ATI
ON
& R
EMA
RKS
FORM
RE
MA
RKS
REGULAR
URGENT
1 Bl
ood
Film
Mal
aria
lPa
rasi
te (B
FMP)
K 2ED
TA T
ube
(pur
ple
cap)
2m
l O
n ca
ll tim
e on
ly
(9pm
-6am
) 5h
rs
1hrs
R
efer
Mic
robi
olog
y se
ctio
n Fr
esh
smea
r on
glas
s sl
ide
2 BM
A / T
reph
ine
Biop
sy
(Ple
ase g
et
Ap
po
intm
en
t fr
om
Hem
ato
log
ist)
-
- B
y A
ppoi
ntm
ent
(Hem
atol
ogis
t)
5 w
orki
ng
days
1 w
orki
ng
day
HEM
ATO
LOG
Y R
EQU
EST
FO
RM
PP
DK
11
(Pin
k co
lor)
3 C
oagu
latio
n Pr
ofile
(P
T, A
PTT,
INR
) So
dium
Citr
ate
Tube
(b
lue
cap)
1.
8ml
24 h
rs
2 ho
urs
1 ho
ur
PER
PAT
301
(P
INK)
4 D
-Dim
er
Lith
ium
Hep
arin
Tub
e (g
reen
cap
) 4m
l 24
hrs
(P
erm
issi
on fr
om
MO
is n
eede
d)
2 hr
s 1h
rs
5 Er
ythr
ocyt
es
Sedi
men
tatio
n R
ate
(ES
R)
Sodi
um C
itrat
e Tu
be
(bla
ck c
ap)
1.28
ml
24 h
rs
6 Fu
ll B
lood
Cou
nt
(FBC
) K 2
EDTA
Tub
e (p
urpl
e ca
p)
2ml
24 h
rs
2 ho
urs
45 m
in
7 Fi
brin
ogen
So
dium
Citr
ate
Tube
(blu
e ca
p)
1.8m
l 24
hrs
3
hour
s 2
hour
s
20
TEST
NA
ME
CO
NTA
INER
/ V
OLU
ME
LAB
SCH
EDU
LE
TAT
TRA
NSP
ORT
ATI
ON
& R
EMA
RKS
FORM
RE
MA
RKS
REGULAR
URGENT
8 G
6PD
Bl
ottin
g pa
per
Bloo
d sp
ot o
n bl
ottin
g pa
per
8.00
am-1
2 no
on
daily
) -
-
PER
PAT
301
(P
INK)
9 M
ixin
g Te
st
(By a
pp
oin
tmen
t)
Sodi
um C
itrat
eTub
e (b
lue
cap)
1.
8 m
l X 2
tu
bes
Offi
ce H
our O
nly
3 da
ys
1 da
y
PER
PAT
301
(P
INK)
10
Perip
hera
l Blo
od F
ilm
(PBF
) K
2ED
TA T
ub
e
(pur
ple
cap)
2.0m
l
24 h
rs
Fo
r urg
ent P
BF
Ple
ase
info
rm
Pat
holo
gy M
O o
n ca
ll
3 w
orki
ng
days
1 w
orki
ng
day
HEM
ATO
LOG
Y R
EQU
EST
FO
RM
PP
DK
11
(Pin
k co
lor)
11
Ret
icul
ocyt
e C
ount
K 2
EDTA
Tub
e
(pur
ple
cap)
2.
0ml
24 h
rs
2 ho
urs
1 ho
ur
PE
R P
AT 3
01
(PIN
K)
12
Urin
e FE
ME
U
rine
Con
tain
er
(yel
low
cap
)
20m
l
24 h
rs
3 ho
urs
90 m
in
PE
R P
AT 3
01
(PIN
K)
13
Urin
e M
icro
alb
umin
U
rine
Con
tain
er
(yel
low
cap
) 2
hour
1
hour
s
PER
PAT
301
(P
INK)
21
TEST
NA
ME
CO
NTA
INER
/ V
OLU
ME
LAB
SCH
EDU
LE
TAT
TRA
NSP
ORT
ATI
ON
& R
EMA
RKS
FORM
RE
MA
RKS
REGULAR
URGENT
14
Stoo
l Occ
ult B
lood
St
ool C
onta
iner
Stoo
l sa
mpl
e in
st
ool
cont
aine
r
24 h
rs
2 ho
urs
90 m
ins
PER
PAT
301
(P
INK)
15
Scra
ppin
g fo
r Fun
gus
Scra
ppin
g sm
ear o
n gl
ass
slid
e -
On
call
time
only
(9
pm-6
am)
3 ho
urs
2 ho
urs
Ref
er M
icro
biol
ogy
sect
ion
22
NO
RM
AL
HEM
ATO
LOG
Y VA
LUE
HEM
ATO
LOG
Y VA
LUE
FOR
NO
RM
AL IN
FAN
T
Para
met
er
At B
irth
Day
3
Day
7
Day
14
1 m
onth
2
mon
ths
3- 6
mon
th
WB
C x
109 /L
10 –
26
7 -
23
6 –
22
6 -
22
5 -
19
5 -
15
6 –
18
Hb
(g/d
L)
14 –
22
5 -
11
17.1
– 1
7.9
1
6.1
– 1
6.9
1
1.5
– 1
6.5
9
.4 –
13.0
1
1.1
– 1
4.1
Plat
elet
x 1
09 /L
100 –
450
210 -
450
160 –
500
170 -
500
200 –
500
210 -
650
200 -
550
Hct
0
.45
– 0
.75
0.4
5 –
0.6
7
0.4
2 –
0.6
6
0.3
1 –
0.7
1
0.3
3 –
0.5
3
0.2
8 –
0.4
2
0.3
0 -
0.4
0
RB
C x
1012
/L
5.0
– 7
.0
4.0
– 6
.6
3.9
– 6
.3
3.9
– 6
.2
3.0
- 5
.4
3.1
– 4
.3
4.1
– 5
.3
MC
V (fl
) 100 –
120
92 –
118
88 –
126
92 -
116
87 -
113
87 -
113
68 –
84
MC
H (p
g)
31 –
37
31 –
37
31 –
37
31 –
37
30 -
36
27 –
33
24 -
40
MC
HC
(g/L
) 30 -
36
29 –
37
27 –
38
28 -
38
29 –
37
29.5
– 3
5.5
30 –
36
NE
x 10
9 /L
4 –
14
3 –
5
3 –
6
3 –
7
3 –
9
1 –
5
1 –
6
LY x
109 /L
3 –
8
2 –
8
3 –
9
3 –
9
3 –
16
4 –
10
4 –
12
MO
x 1
09 /L
0.5
– 2
.0
0.5
– 1
.0
01.
– 1
.7
0.1
- 1
.7
0.3
– 1
.0
0.4
– 1
.2
0.2
-1
.2
EO x
109 /L
0
.1 –
1.0
0
.1 –
2.0
0
.1 –
0.8
0
.1 –
0.9
0
.2 –
1.0
0
.1 –
1.0
0
.1 –
1.0
RET
%
1.2
– 4
.0
0.5
– 3
.5
0.5
– 1
.0
0.5
– 1
.0
0.2
– 0
.6
0.3
– 0
.5
0.4
– 1
.0
*Extr
ate
d F
orm
Da
cie
& L
ew
is P
ractical H
em
ato
log
y E
leve
nth
Ed
itio
n
201
2
23
REF
EREN
CE
RAN
GE
FOR
FU
LL B
LOO
D C
OU
NT
Pa
ram
ete
r In
fant/C
hild
ren
A
dult
0 d
ay
3-6
month
1yr
2-6
yrs
6-1
2 y
rs
Ma
le
Fem
ale
M
ale
& F
em
ale
WB
C x
10
9 /L
10.0
-26.0
6
.0-1
8.0
6
.0-1
6.0
5
.0-1
5.0
5
.0-1
3.0
-
- 4
.0-1
0.0
Hb (
g/d
L)
14.0
-22.0
11.1
-14.1
11.1
-14.1
11.0
-14
11.5
-15.5
13.0
-17.0
12.0
-15.0
-
Pla
tele
t x
10
9/L
150-4
50
200-5
50
200-5
50
200-4
50
180-4
00
- -
150-4
00
HC
T
0.4
5-0
.75
0.3
0-0
.40
0.3
0-0
.38
0.3
4-0
.40
0.3
5-0
.45
0.4
0-0
.50
0.3
6-0
.46
-
RB
C x
10
12 /L
5
.0-7
.0
4.1
-5.3
3
.9-5
.1
4.0
-5.2
4
.0-5
.2
4.5
-5.5
3
.8-4
.8
-
MC
V (
fl)
100-1
20
68-6
4
72-8
4
75-8
7
77-9
5
- -
83-1
01
MC
H (
pg
) 31-3
7
24-3
0
25-2
9
24-3
0
25-3
3
- -
27-3
2
MC
HC
(g
/L
30.0
-36.0
30.0
-36.0
32.0
-36.0
31.0
-37.0
31.0
-37.0
-
- 31.5
-34.5
RD
W
- -
- -
- -
- 11.6
-14.0
NE
x 1
09 /L
4
.0-1
4.0
1
.0-6
.0
1.0
-7.0
1
.5-8
.0
2.0
-8.0
-
- 2
.0-7
.0
NE
%
- -
- -
- -
- 40-8
0
LY
x 1
09 /L
3
.0-8
.0
4.0
-12.0
3
.5-1
1.0
6
.0-9
.0
1.0
-5.0
-
- 1
.0-3
.0
LY
%
- -
- -
- -
- 20-4
0
MO
x 1
09 /L
0
.5-2
.0
0.2
-1.2
0
.2-1
.0
0.2
-1.0
0
.2-1
.0
- -
0.2
-1.0
MO
%
- -
- -
- -
- 2-1
0
EO
x 1
09 /L
0
.1-1
.0
0.1
-1.0
0
.1-1
.0
0.1
-1.0
0
.1-1
.0
- -
0.0
2 -
0.5
EO
%
- -
- -
- -
- 1
.0 -
6.0
BA
x 1
09/L
-
- -
- -
- -
0.0
5 –
0.1
BA
%
- -
- -
- -
- <
1 –
2%
RE
T
1.2
– 4
.0
0.4
-1
.0
0.3
– 1
.0
0.3
– 1
.0
0.3
– 1
.0
- -
0.5
-2
.5
*Extr
ate
d F
orm
Da
cie
& L
ew
is P
ractical H
em
ato
log
y E
leve
nth
Ed
itio
n
201
2
24
CH
EM
ICA
LP
AT
HO
LO
GY
NO
T
ES
T N
AM
E
SP
EC
IME
N
TY
PE
C
ON
TA
INE
R
VO
LU
ME
L
AB
S
CH
ED
UL
E
TU
RN
AR
OU
ND
TIM
E (
TA
T)
TR
AN
SP
OR
TA
TIO
N
RE
FE
RE
NC
E R
AN
GE
S
RO
UT
INE
U
RG
EN
T
1
Ala
nin
e t
ran
sam
ina
se
(A
LT
) B
loo
d
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
4
ho
urs
-
<
50
U/L
(m
ale
) <
35
U/L
(fe
ma
le)
2
Alb
um
in
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
4
ho
urs
-
3
5-5
2 g
/L
3
Alk
alin
e p
hosp
ha
tase
(A
LP
) B
loo
d
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
4
ho
urs
-
3
0-1
20 U
/L
4
Alp
ha
fe
top
rote
in
(AF
P)
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
5
wo
rkin
g
da
ys
-
R
eq
ue
st
form
with
co
mp
lete
dia
gno
sis
N
ee
ds c
ounte
r sig
n b
y
sp
ecia
list
<7
ng
/mL
5
Am
yla
se
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
2
2-8
0 U
/L
Ran
do
m u
rin
e
U
niv
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
40
-32
1 U
/L
6
Art
eri
al B
lood
Gas
(AB
G)
a)
Blo
od
pH
b
) p
CO
2
c)
pO
2
d)
Bic
arb
on
ate
(H
CO
3)
e)
Ba
se
exce
ss (
BE
) f)
T
ota
l C
O2
g
) O
2 S
atu
ratio
n
Blo
od
Hep
ari
niz
ed
syri
ng
e
1.0
ml
Daily
(2
4h
rs)
- 4
5 m
ins
S
en
d im
me
dia
tely
afte
r co
llectio
n (
with
in 3
0
min
ute
s).
S
am
ple
mu
st b
e k
eep
in
co
nta
ine
r w
ith
ice
p
ack.
pH
N
ew
bo
rn:
1 d
ay (
7.2
9-7
.45
)
Ad
ult:
(7.3
5-7
.45
) p
CO
2
C
ord
: A
rte
rial :
40
.6 –
57
.4
V
en
ous :
32
.4 –
43
.6
N
ew
bo
rn:
1 d
ay (
27
- 4
0)
mm
Hg
A
du
lt:
Ma
n:
(35
-48
) m
mH
g
W
om
en
: (3
2-4
5)
mm
Hg
p
O2
C
ord
: A
rte
ria
l :
5 -
30
Ve
no
us :
17
– 4
1
N
ew
bo
rn:
1 d
ay (
54
- 9
5)
mm
Hg
Ad
ult:
(83
-10
8)
mm
Hg
HC
O3
:
C
ord
: A
rte
rial :
19
.8
- 2
4.8
Ven
ous :
16
.3 –
24.5
Ne
wb
orn
: (1
7-2
4)
mm
ol/L
A
du
lt:
(22
-26
) m
mol/L
Ba
se
exc
ess
: (-
2 to
+3
) m
mo
l/L
O
2 s
atu
rati
on
: (9
5-9
8)
%
25
NO
T
ES
T N
AM
E
SP
EC
IME
N
TY
PE
C
ON
TA
INE
R
VO
LU
ME
L
AB
S
CH
ED
UL
E
TU
RN
AR
OU
ND
TIM
E (
TA
T)
TR
AN
SP
OR
TA
TIO
N
RE
FE
RE
NC
E R
AN
GE
S
RO
UT
INE
U
RG
EN
T
7
Asp
art
ate
tr
an
sa
min
ase
(A
ST
) B
loo
d
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
<
50
U/L
(m
ale
) <
35
U/L
(fe
ma
le)
8
Be
ta H
um
an
Cho
rion
ic
Go
na
do
tro
pin
(β
hC
G)
Blo
od
Pla
in tu
be
4.0
ml
Daily
(2
4h
rs)
3 w
ork
ing
d
ays
1 d
ay
A
cce
pta
ble
urg
en
t te
st
for
cert
ain
ca
se
only
.
C
all
Pa
tho
log
y M
O f
or
urg
en
t re
que
sts
.
P
lea
se c
all
lab
ext 4
328
at
lea
st
1 h
ou
r be
fore
se
nd
ing
the
specim
en
.
R
eq
ue
st
form
with
co
mp
lete
dia
gn
osis
N
ee
ds c
oun
ter
sig
n b
y
sp
ecia
list.
<5
mIU
/mL
9
Bili
rub
in (
To
tal, D
irect
&
In
dire
ct)
B
loo
d
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
To
tal b
iliru
bin
A
du
lts:
5-2
1µ
mol/L
Ch
ildre
n:
0-1
da
y:
24
-14
9 µ
mol/L
1-2
da
y:5
8-1
97
µm
ol/L
3-5
da
y:2
6-2
05
µm
ol/L
Dir
ect b
iliru
bin
: <
3.4
µm
ol/L
Ind
irect
bili
rub
in:1
.6-1
7.6
µm
ol/L
10
Bo
dy f
luid
s
bio
ch
em
istr
y
a)
Pro
tein
b
) G
lucose
c)
LD
H
P
leu
ral fluid
P
eri
tone
al
flu
id
A
sp
irate
flu
id
Univ
ers
al
co
nta
ine
r 2
.0 m
l D
aily
(2
4h
rs)
3 w
ork
ing
d
ays
-
Re
fere
nce
va
lu v
ari
es a
cco
rdin
g t
o
flu
id s
am
ple
s a
nd
sho
uld
be
co
mp
are
d t
o s
eru
m
11
Ca
lciu
m
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
2
.20
-2.6
5m
mol/L
Ran
do
m u
rin
e
U
niv
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
-
24
hr
urin
e
24
hr
urin
e
co
nta
ine
r 2
4h
r u
rin
e
co
llectio
n
3
wo
rkin
g
da
ys
-
0.0
-7.5
mm
ol/d
ay
12
Ca
nce
r a
ntig
en
12
5
(CA
12
5)
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
5
wo
rkin
g
da
ys
-
R
eq
ue
st
form
with
co
mp
lete
dia
gno
sis
N
ee
ds c
ounte
rsig
n b
y
sp
ecia
list
<3
5U
/mL
13
Ca
nn
abis
U
rin
e
Univ
ers
al
co
nta
ine
r 2
0-3
0 m
l
3-5
wo
rkin
g
da
ys
-
U
se
Bo
ran
g P
erm
inta
an
Ujia
n P
en
gesa
na
n
Da
da
h D
ala
m A
ir
Ke
ncin
g
-
26
NO
T
ES
T N
AM
E
SP
EC
IME
N
TY
PE
C
ON
TA
INE
R
VO
LU
ME
L
AB
S
CH
ED
UL
E
TU
RN
AR
OU
ND
TIM
E (
TA
T)
TR
AN
SP
OR
TA
TIO
N
RE
FE
RE
NC
E R
AN
GE
S
RO
UT
INE
U
RG
EN
T
14
Ca
rcin
oe
mb
ryo
nic
a
ntige
n (
CE
A)
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
5
wo
rkin
g
da
ys
R
eq
ue
st
form
with
co
mp
lete
dia
gno
sis
N
ee
ds c
ounte
rsig
n b
y
sp
ecia
list
No
n s
mo
ke
r:0
-4.6
ng/m
L
Sm
oke
r:3
.5-1
0ng
/mL
15
Ch
lori
de
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
1
01
-109
mm
ol/L
Ran
do
m u
rin
e
U
niv
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
46
-16
8m
mo
l/L
24
hr
urin
e
24
hr
urin
e
co
nta
ine
r 2
4h
r u
rin
e
co
llectio
n
3
wo
rkin
g
da
ys
-
11
0-2
50
mm
ol/d
ay
16
Ch
ole
ste
rol
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
4
ho
urs
-
0
-5.2
mm
ol/L
17
Co
mp
lem
en
t 3
(C
3)
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
3
wo
rkin
g
da
ys
-
0.9
-1.8
g/L
18
Co
mp
lem
en
t 4
(C
4)
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
3
wo
rkin
g
da
ys
-
0.1
-0.4
g/L
19
Co
rtis
ol
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
5
wo
rkin
g
da
ys
-
Mo
rnin
g:
7-2
5u
g/d
L
Mid
nig
ht:
2-9
ug
/dL
20
CS
F B
ioch
em
istr
y
a)
Pro
tein
b
) G
lucose
c)
Glo
bu
lin
Cere
bro
sp
ina
l flu
id (
CS
F)
Ste
rile
bo
ttle
0
.5-2
.0 m
l D
aily
(2
4h
rs)
- 1
ho
ur
P
lea
se
ca
ll lab
EX
T:
43
28
fo
r ap
po
intm
en
t a
t le
ast
2 h
ou
rs b
efo
re
se
ndin
g C
SF
spe
cim
en
a)P
rote
in:0
.15
-0.4
5g
/L
b)G
lucose
:2.2
-3.9
mm
ol/L
c)G
lob
ulin
: N
eg
ative
21
C-r
ea
ctive
pro
tein
B
loo
d
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
3
wo
rkin
g
da
ys
-
Ad
ults:
<5m
g/L
22
Cre
atinin
e k
ina
se
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
≤1
71
U/L
(m
ale
) ≤1
45
U/L
(fe
ma
le)
23
Cre
atinin
e
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
5
9-1
04 µ
mol/L
(m
ale
) 4
5-8
4
µm
ol/L
(fe
male
)
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
-
24
hr
urin
e
24
hr
urin
e
co
nta
ine
r 2
4h
r u
rin
e
co
llectio
n
3
wo
rkin
g
da
ys
-
Ma
le:
9.2
-20
.7m
mo
l/d
ay
Fe
male
:6.6
-13.9
mm
ol/d
ay
24
Cre
atinin
e c
lea
rance
, u
rin
e
24
hr
urin
e &
b
loo
d
24
hr
urin
e
co
nta
ine
r &
L
ith
ium
h
ep
arin
tub
e
24
hr
urin
e
co
llectio
n
&
4.0
ml (a
du
lt)
3
wo
rkin
g
da
ys
-
Ma
le:
85
-12
5m
l/m
in
Fe
male
:75
-115
ml/m
in
25
Fe
rritin
B
loo
d
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
5
wo
rkin
g
da
ys
30
-40
0n
g/m
L
27
NO
T
ES
T N
AM
E
SP
EC
IME
N
TY
PE
C
ON
TA
INE
R
VO
LU
ME
L
AB
S
CH
ED
UL
E
TU
RN
AR
OU
ND
TIM
E (
TA
T)
TR
AN
SP
OR
TA
TIO
N
RE
FE
RE
NC
E R
AN
GE
S
RO
UT
INE
U
RG
EN
T
26
Fo
llicula
r stim
ula
ting
h
orm
on
e (
FS
H)
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
5
wo
rkin
g
da
ys
-
Wom
an
:
Fo
llicula
r:1m
IU/m
L
Pre
ovu
lato
ry:5
-16
mIU
/mL
Ovu
lato
ry:5
-20
mIU
/mL
Lu
teal:<
8.2
mIU
/mL
Po
st m
en
op
ause
:<1
44
mIU
/mL
M
an
: <
11
mIU
/mL
Ch
ildre
n (
<10
yr)
: <
3.8
mIU
/mL
27
Ga
mm
a g
luta
myl
tra
nsfe
rase
(G
GT
) B
loo
d
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
4
ho
urs
-
<
55
U/L
(m
ale
) <
38
U/L
(fe
ma
le)
28
Glu
cose
a
)Ran
dom
Blo
od
S
ug
ar
(RB
S
b)F
astin
g B
lood
S
ug
ar(
FB
S)
c)T
wo
(2
) h
ou
rs p
ost
pra
nd
ial (2
HP
P))
Blo
od
Flu
orid
e
ED
TA
tu
be
2
.0m
l (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
a)R
an
dom
:<11
.1 m
mo
l/L
b)F
astin
g:
≤6
.0 m
mo
l/L
: N
orm
al
6
.1-6
.9:
Imp
are
d fa
stin
g
g
luco
se
≥7.0
: D
iab
ete
s m
elli
tus
29
He
mo
glo
bin
A1c
(Hb
A1
c)
Blo
od
K2
ED
TA
tu
be
2
.0m
l
3
wo
rkin
g
da
ys
-
<5
.6%
(3
8m
mol/m
ol)
: N
orm
al
5.6
-6.2
% (
38
-44m
mol/m
ol)
: P
re-
dia
bete
s
≥6
.3%
(45m
mo
l/m
ol):D
iabe
tes
≤6
.5%
(48m
mo
l/m
ol):O
ptim
um
g
lyce
mic
co
ntr
ol
30
Hig
h D
ensity
Lip
op
rote
in (
HD
L)
&
Lo
w D
en
sity
Lip
op
rote
in (
LD
L)
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
4
ho
urs
-
HD
L
Ma
n:>
1.4
mm
ol/L
W
om
an
:>1
.7m
mo
l/L
LD
L:<
3.3
mm
ol/L
31
Iro
n &
To
tal Ir
on
B
ind
ing
Ca
pa
city
(TIB
C)
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
4
ho
urs
-
Iro
n
Ma
le:1
2.5
-32
.2µ
mol/L
Fe
male
:10
.7-3
2.2
µm
ol/L
UIB
C:2
7.8
-63
.6 µ
mo
l/L
TIB
C:3
8.5
-95
.8 µ
mo
l/L
32
La
cta
te
Blo
od
Flu
orid
e
ED
TA
tu
be
in
ic
e
2.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
1 h
ou
r
P
lea
se
ca
ll la
b 4
328
fo
r a
pp
oin
tme
nt
S
en
d im
me
dia
tely
afte
r co
llectio
n (
with
in
15
min
ute
s).
S
am
ple
mu
st b
e k
eep
in
co
nta
ine
r w
ith
ice
p
ack.
0.5
-2.2
mm
ol/L
33
La
cta
te
de
hyd
roge
nase
(L
DH
) B
loo
d
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
<
24
7 U
/L (
Ma
le)
<
24
8 U
/L (
Fem
ale
)
28
NO
T
ES
T N
AM
E
SP
EC
IME
N
TY
PE
C
ON
TA
INE
R
VO
LU
ME
L
AB
S
CH
ED
UL
E
TU
RN
AR
OU
ND
TIM
E (
TA
T)
TR
AN
SP
OR
TA
TIO
N
RE
FE
RE
NC
E R
AN
GE
S
RO
UT
INE
U
RG
EN
T
34
Lu
tein
isin
g
ho
rmo
ne
(L
H)
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
5
wo
rkin
g
da
ys
-
Wom
an
:
Fo
llicula
r:1.6
-7.9
mIU
/mL
Pre
ovu
lato
ry:7
.7-2
3 m
IU/m
L
Ovu
lato
ry:1
3-8
3 m
IU/m
L
Lu
teal:0
.7-9
.9 m
IU/m
L
Po
st m
en
op
ause
:13
-46 m
IU/m
L
Ma
n:
0.8
-6.1
mIU
/mL
Ch
ildre
n (
<10
yr)
:<0
.9 m
IU/m
L
35
Ma
gn
esiu
m
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
0
.73
-1.0
6m
mol/L
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
1.7
-5.7
mm
ol/L
24
hr
urin
e
24
hr
urin
e
co
nta
ine
r 2
4h
r u
rin
e
co
llectio
n
3
wo
rkin
g
da
ys
-
3-5
mm
ol/d
ay
36
Mo
rph
ine
R
an
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 2
0-3
0 m
l
3-5
wo
rkin
g
da
ys
-
U
se
Bo
ran
g P
erm
inta
an
Ujia
n P
en
gesa
na
n
Da
da
h D
ala
m A
ir
Ke
ncin
g
37
Pa
raq
uat
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l D
aily
(2
4h
rs)
- 1
ho
ur
N
eg
ative
38
Ph
osph
ate
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
4
ho
urs
4
5 m
ins
0
.81
-1.4
5m
mol/L
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
13
-44m
mol/L
24
hr
urin
e
24
hr
urin
e
co
nta
ine
r 2
4h
r u
rin
e
co
llectio
n
3
wo
rkin
g
da
ys
-
12
.9-4
2m
mo
l/d
ay
39
Po
tassiu
m
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
3
.5-5
.1m
mo
l/L
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
20
-80m
mol/L
24
hr
urin
e
24
hr
urin
e
co
nta
ine
r 2
4h
r u
rin
e
co
llectio
n
3
wo
rkin
g
da
ys
-
25
-12
5m
mo
l/d
ay
40
Pro
lactin
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
5
wo
rkin
g
da
ys
-
3.9
-17
.3 n
g/m
L
41
Pro
sta
te S
pecific
A
ntig
en
(P
SA
), t
ota
l B
loo
d
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
5
wo
rkin
g
da
ys
-
R
eq
ue
st
form
with
co
mp
lete
dia
gno
sis
N
ee
ds c
ounte
rsig
n b
y
sp
ecia
list
<4
ng
/mL
29
NO
T
ES
T N
AM
E
SP
EC
IME
N
TY
PE
C
ON
TA
INE
R
VO
LU
ME
L
AB
S
CH
ED
UL
E
TU
RN
AR
OU
ND
TIM
E (
TA
T)
TR
AN
SP
OR
TA
TIO
N
RE
FE
RE
NC
E R
AN
GE
S
RO
UT
INE
U
RG
EN
T
42
Pro
tein
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
-
66
-83
g/L
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l
1 w
ork
ing
d
ay
-
0.0
-0.1
2g
/L
24
hr
urin
e
24
hr
urin
e
co
nta
ine
r 2
4h
r u
rin
e
co
llectio
n
3
wo
rkin
g
da
ys
-
0.0
-0.1
5g
/da
y
43
Pro
tein
Cre
atin
ine
In
de
x (
PC
I)
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
0.0
-15m
g/m
mo
l cre
atin
ine
44
So
diu
m
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
1
36
-146
mm
ol/L
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
54
-15
0m
mo
l/L
24
hr
urin
e
24
hr
urin
e
co
nta
ine
r 2
4h
r u
rin
e
co
llectio
n
3
wo
rkin
g
da
ys
-
40
-22
0m
mo
l/d
ay
45
Th
yro
id s
tim
ula
ting
h
orm
on
e (
TS
H)
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
3
wo
rkin
g
da
ys
-
0.2
7-4
.20m
IU/m
L
46
Th
yro
xin
e,
fre
e (
FT
4)
Blo
od
Pla
in tu
be
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
3
wo
rkin
g
da
ys
-
12
-22
pm
ol/L
47
Tri
gly
ce
rid
es
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
4
ho
urs
-
<
1.7
mm
ol/L
48
Ure
a
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
(2
4h
rs)
4 h
ou
rs
45
min
s
2
.8-7
.2m
mo
l/L
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
15
0-5
00
mm
ol/L
24
hr
urin
e
24
hr
urin
e
co
nta
ine
r 2
4h
r u
rin
e
co
llectio
n
3
wo
rkin
g
da
ys
-
25
0-5
70
mm
ol/d
ay
49
Uri
c a
cid
Blo
od
Lith
ium
h
ep
arin
tub
e
4.0
ml (a
du
lt)
50
0µ
l (p
ae
d)
Daily
4
ho
urs
-
2
08
-428
µm
ol/L
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l
3 w
ork
ing
d
ays
-
22
00
-55
00
µm
ol/L
24
hr
urin
e
24
hr
urin
e
co
nta
ine
r 2
4h
r u
rin
e
co
llectio
n
3
wo
rkin
g
da
ys
-
14
88
-44
63
µm
ol/d
ay
50
Uri
ne
pre
gn
an
cy t
est
Ran
do
m u
rin
e
Univ
ers
al
co
nta
ine
r 1
0 m
l D
aily
(2
4h
rs)
- 3
0 m
ins
N
eg
ative
30
TEST
PR
OFI
LES
PR
OF
ILE
A
NA
LA
YT
ES
Blo
od
Ure
a S
eru
m E
lectr
oly
te
(BU
SE
)
Ure
a, S
od
ium
(N
a),
Pota
ssiu
m (
K),
Ch
lorid
e(C
l)
Renal P
rofile
U
rea
, S
od
ium
(N
a),
Pota
ssiu
m (
K),
Ch
lorid
e(C
l) a
nd C
reatin
ine
Liv
er
Functio
n T
est
To
tal P
rote
in, A
lbum
in, G
lob
ulin
, Tota
l B
iliru
bin
, A
lan
ine tra
nsa
min
ase (
AL
T)
and
A
lkalin
e p
hosphata
se (
ALP
)
Fastin
g L
ipid
Pro
file
Chole
ste
rol, T
rig
lycerid
e,
Hig
h D
ensity L
ipo
pro
tein
(H
DL
), L
ow
Density L
ipo
pro
tein
(L
DL)
Ca
rdia
c E
nzym
es P
rofile
Cre
atin
ine K
inase(C
K),
Asp
art
ate
Tra
nsam
inase (
AS
T)
and
Lacta
te D
ehyd
rog
en
ase
(LD
H)
Iro
n P
rofile
Ir
on,
Unsatu
rate
d Iro
n B
ind
ing C
ap
acity (
UIB
C)
and
Tota
l Ir
on B
indin
g C
ap
acity
(TIB
C)
Th
yro
id F
un
ctio
n T
est
Th
yro
id S
tim
ula
tin
g H
orm
on
e (
TS
H),
Th
yro
xin
e,
fre
e (
FT
4)
31
MIC
RO
BIO
LOG
Y
CU
LTU
RE
& S
ENSI
TIV
ITY
Fe
w p
arts
of
this
se
ctio
n w
ere
ad
apte
d f
rom
IMR
Han
d B
oo
k. P
leas
e t
ake
no
te t
hat
th
e m
ost
imp
ort
ant
thin
g is
to
avo
id k
illin
g o
f pat
ho
gen
ic
mic
roo
rgan
ism
s o
r co
nta
min
atio
n b
y n
on
-pat
ho
gen
s ca
use
d b
y im
pro
pe
r sa
mp
ling
or
sto
rage
.
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
1.
Thro
at s
wab
•
Sam
ple
po
ster
ior
ph
aryn
x, t
on
sils
an
d in
flam
ed
are
a.
•
Avo
id t
ou
chin
g ch
eeks
, to
ngu
e, u
vula
or
lips.
•
Stu
art’
s Tr
ansp
ort
Med
ia
•
Sen
d w
ith
in 2
hr
at R
T
•
Can
be
hel
d w
ith
in 2
4 h
r, 4
°C
3-4
day
s
PER
PA
T 30
1 (G
REE
N)
2.
Nas
al s
wab
•
To d
etec
t M
RSA
car
rier
.
•
Inse
rt p
re-m
ois
ten
ed s
wab
ab
ou
t 2
cm
into
nar
es.
3.
Nas
op
har
ynx
swab
• In
sert
sw
ab (
nas
op
har
ynge
al s
wab
) vi
a n
ose
. In
ocu
late
m
ediu
m
at
bed
sid
e,
or
pla
ce s
wab
in
tran
spo
rt m
ediu
m.
*No
te: I
f su
spec
t fo
r B
ord
ete
lla, p
leas
e in
ocu
late
into
ch
arco
al t
ran
spo
rt m
ediu
m.
• St
uar
t’s
or
Ch
arco
al*
Tran
spo
rt M
edia
• Se
nd
sw
ab w
ith
in 2
hr
at R
T
• Se
nd
pla
tes
wit
hin
15
min
at
RT
• C
an b
e h
eld
≤ 2
4 h
r, 4
°C
4.
Thro
at s
wab
fo
r C
. d
iph
ther
iae
scre
en
ing
• R
equ
ire
per
mis
sio
n f
rom
MO
bef
ore
se
nd
sam
ple
to
la
b
•
Co
llect
ion
met
ho
d f
ollo
w a
s st
ated
in t
hro
at s
wab
.
• P
lace
th
e sw
ab in
tra
nsp
ort
med
ium
pro
vid
ed.
*N
ote
: Co
nfi
rmat
ion
will
be
do
ne
at IM
R i
f C
. dip
hth
eria
e
is
iso
late
d.
• 1
Am
ies
or
Stu
art’
s Tr
ansp
ort
Med
ia
•
Sen
d t
o la
b a
s so
on
as
po
ssib
le.
1 h
r fo
r G
ram
st
ain
C.
dip
hth
eria
e
(UR
GEN
T)
3
-4 d
ays
for
cult
ure
32
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
5.
Co
nju
nct
iva
swab
• Sa
mp
le b
oth
eye
s w
ith
sep
arat
e s
teri
le, p
re-
mo
iste
ned
co
tto
n o
r al
gin
ate
swab
.
• R
oll
swab
ove
r co
nju
nct
iva.
•
Smea
r sw
abs
on
to g
lass
slid
e fo
r st
ain
ing.
• St
uar
t’s
Tran
spo
rt M
edia
/ G
lass
Slid
e
•
Sen
d s
wab
wit
hin
2 h
r at
RT
4-5
day
s
PER
PA
T 3
01
(GR
EEN
)
6.
Co
rnea
l scr
apin
g
• In
form
lab
to
get
med
ia
•
Ino
cula
te s
crap
ing
dir
ectl
y o
nto
pro
vid
ed m
edia
. •
Ap
ply
rem
ain
ing
mat
eria
l to
cle
an g
lass
slid
es f
or
stai
nin
g. L
et it
dry
fir
st b
efo
re s
end
to
lab
4 ty
pes
of
Bac
teri
al A
gar
are
use
d (
Blo
od
A
gar,
Ch
oco
late
Aga
r, S
abo
ura
ud
Aga
r and
M
acCo
nkey
Aga
r).
Gla
ss S
lide
Ple
ase
lab
el c
orr
ectl
y.
Sen
d p
late
s an
d s
lide
s w
ith
in 1
5m
in
7.
Ear
swab
I
nse
rt a
ste
rile
sw
ab i
nto
ext
ern
al a
ud
ito
ry c
anal
ca
refu
lly u
nti
l re
sist
ance
is m
et.
R
ota
te t
he
sw
ab a
gain
st t
he
ear
mu
cosa
.
Stu
art’
s Tr
ansp
ort
Med
ia
Sen
d s
wab
wit
hin
2 h
r at
RT
3-4
day
s
8.
Tiss
ue
• D
O N
OT
ad
d F
orm
alin
•
Alw
ays
sub
mit
a r
easo
nab
le p
ort
ion
of t
issu
e as
p
oss
ible
(ap
pro
xim
atel
y 5
-10m
g).
No
te: S
wab
fo
r ti
ssu
e C
&S
is N
OT
REC
OM
MEN
DED
.
•
Ster
ile c
on
tain
er
•
Sen
d w
ith
in 1
5 m
in a
t R
T 3
-4 d
ays
33
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
9a)
Cer
eb
rosp
inal
Flu
id
(C&
S)
Ase
pti
cally
co
llect
fro
m l
um
bar
pu
nct
ure
Sen
d t
he
mo
st t
urb
id t
ub
e to
mic
rob
iolo
gy la
b.
*N
ote
: DO
NO
T ST
OR
E IN
IC
E O
R R
EFR
IGER
ATO
R
•
Ster
ile s
crew
cap
pe
d c
on
tain
er/
Bijo
ux/
u
niv
ers
al b
ott
le.
•
Co
llect
3-5
ml
dir
ect
ly i
nto
a s
teri
le
con
tain
er/
tu
be
fo
r at
lea
st 3
sep
arat
e tu
bes
.
Bac
teri
a >
1 m
l Fu
nga
l ≥ 2
ml
AFB
≥ 2
ml
Vir
us
>1m
l (U
po
n r
equ
est
)
4-5
day
s
PER
PA
T 3
01
(GR
EEN
)
9b
)
Cer
eb
rosp
inal
Flu
id
(FEM
E)
Co
llect
ion
met
ho
d f
ollo
w a
s ab
ove
Sen
d s
amp
le im
med
iate
ly t
o t
he
lab
wit
h T
AT
form
(Q
AP
/CSF
-1).
N
ote
s :
Ap
plic
able
fo
r FE
ME
and
Bac
teri
al a
nti
gen
tes
t.
Form
al r
esu
lt w
ill b
e re
leas
ed t
oge
ther
wit
h C
SF
Bio
chem
istr
y re
sult
N
oti
fy L
ab b
efo
re s
end
sam
ple
P
leas
e se
nd
TA
T su
rvey
fo
rm t
oge
ther
to
avo
id
sam
ple
no
t b
een
pro
cess
ed
1 h
ou
r*
10
. Tr
ach
eal
asp
irat
e
Co
llect
th
e s
pec
imen
th
rou
gh t
rach
eost
om
y, a
pp
ly
suct
ion
to
asp
irat
e th
e sa
mp
le a
sep
tica
lly
Ster
ile c
on
tain
er >
1ml
Sen
d w
ith
in 2
ho
ur
at R
T
3-4
day
s
11
. Sp
utu
m
• Sa
mp
le lo
wer
res
pir
ato
ry s
pec
imen
. Fo
r p
edia
tric
, co
llect
via
su
ctio
n.
•
Co
llect
ind
uce
d s
pu
tum
into
ste
rile
co
nta
iner
.
Ster
ile c
on
tain
er ≥
1ml
Sen
d w
ith
in 2
hr
at R
T
34
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
12
. U
rin
e
Cle
an u
reth
ral a
rea
or
glan
ds
area
wit
h s
oap
.
Co
llect
mid
stre
am u
rin
e w
ith
ou
t st
op
pin
g th
e fl
ow
du
rin
g u
rin
atin
g.
If s
teri
le u
rin
al o
r b
edp
an is
use
d, t
ran
sfe
r in
to
the
ste
rile
bo
ric
acid
co
nta
iner
as
soo
n a
s p
oss
ible
to
avo
id c
on
tam
inat
ion
No
te: U
se s
teri
le c
ont
ain
er (
yello
w c
ap)
if
colle
ctio
n o
f 2
0ml
uri
ne
is i
mp
oss
ible
. P
leas
e se
nd
im
med
iate
ly t
o la
b t
o a
void
co
nta
min
atio
n.
Bo
ric
acid
co
nta
iner
up
to
mar
k ab
ou
t 2
0ml.
Sen
d im
med
iate
ly o
r w
ith
in 2
hr
afte
r co
llect
ion,
at
RT
If d
elay
ed is
exp
ecte
d, s
tore
d a
t 4
oC
bef
ore
se
nd
to
lab
.
3-4
day
s
If n
o g
row
th /
no
t si
gnif
ican
t /
mix
ed
gro
wth
: 1 d
ay
PER
PA
T 3
01
(GR
EEN
)
13
. Su
pra
pu
bic
Uri
ne
Asp
irat
ion
fro
m t
he
bla
dd
er b
y u
sin
g a
nee
dle
as
pir
atio
n t
ech
niq
ue
Use
ful f
or
ped
iatr
ic p
atie
nts
14
. U
rin
e (S
trai
ght
fro
m
cath
eter
) A
llow
ab
ou
t 1
5ml
to p
ass
bef
ore
co
llect
ion
15
. U
rin
e (I
nd
wel
ling
cath
eter
) A
llow
ab
ou
t 1
5ml
to p
ass
bef
ore
co
llect
ion
.
35
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
16
. A
spir
ated
flu
id (
E.g.
: ab
do
min
al a
scit
es,
bile
, jo
int,
p
eric
ard
ial,
per
ito
nea
l, p
leu
ral,
Syn
ovi
al, e
tc.)
Dis
infe
ct
ove
rlyi
ng
skin
w
ith
2
%
iod
ine
tin
ctu
re
Ob
tain
sp
ecim
en v
ia p
ercu
tan
eous
nee
dle
as
pir
atio
n o
r su
rger
y.
Ster
ile c
on
tain
er
Sen
d w
ith
in 2
hrs
, at
RT.
St
ore
flu
ids
for
fun
gal
cult
ure
s at
4ºC
B
acte
ria
> 2
ml
Fun
gal ≥
3m
l A
FB ≥
3m
l
3-4
day
s
(F
un
gus:
5 d
ays)
PER
PA
T 3
01
(GR
EEN
)
17
. P
us
exu
dat
es a
nd
w
ou
nd
sw
abs
Surf
ace
lesi
on
mu
st b
e o
pen
. A
spir
ates
pu
s o
r ex
ud
ate
ase
pti
cally
in
to a
ste
rile
co
nta
iner
.
Ster
ile s
wab
may
be
use
d f
or
littl
e w
ou
nd
an
d p
us
wit
h s
pec
ialis
t ap
pro
val.
*N
ote
: Ti
ssu
e o
r fl
uid
s is
alw
ays
SUP
ERIO
R t
o s
wab
.
Ster
ile c
on
tain
er /
Stu
art’
s tr
ansp
ort
m
ediu
m
Sen
d w
ith
in 2
hrs
at
RT
3-4
day
s
18
. St
oo
l
Fres
h s
too
l (re
com
me
nd
ed):
•
Co
llect
a p
ort
ion
of
fece
s in
clu
din
g m
ucu
s, p
us
or
blo
od
if
p
rese
nt,
p
ut
in s
teri
le c
on
tain
er /
sto
ol
cont
aine
r.
• Fo
r p
aras
ite
exam
inat
ion
, sen
d f
resh
sto
ol i
n s
teri
le
con
tain
er W
ITH
OU
T a
dd
ing
form
alin
.
Ster
ile u
niv
ersa
l co
nta
iner
, sen
d w
ith
in 1
hr,
at
RT
Can
be
hel
d
wit
hin
24
hr
at 4
°C
4-5
day
s
Sen
d t
o H
SAJB
fo
r o
ther
sp
ecie
s th
an
Salm
on
ella
& V
ibri
os
& w
ill t
ake
>1 w
eek
Rec
tal s
wab
: •
Inse
rt s
wab
bey
on
d a
nal
sp
hin
cter
.
• D
ip t
he
swab
wit
h fe
ces
into
AP
PR
OP
RIA
TE tr
ansp
ort
m
ed
ia.
Tran
spo
rt m
ediu
m is
use
d f
or
spec
ific
b
acte
rial
iso
lati
on
: a)
Se
len
ite
F :
For
Salm
on
ella
sp
ecie
s.
b)
Alk
alin
e P
ep
ton
e W
ate
r : F
or
Vib
rio
ch
ole
ra a
nd
oth
er v
ibri
o s
pec
ies.
Tran
spo
rt M
edia
can
be
hel
d w
ith
in 4
8h
r at
RT
36
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
19
. En
do
cerv
ical
sw
ab
• W
hen
Go
noc
occi
is s
usp
ecte
d,
end
oce
rvic
al s
wab
is P
REF
ERA
BLE
th
an v
agin
al s
wab
.
• U
se s
pec
ulu
m w
ith
ou
t lu
bri
can
t.
•
Wip
e th
e ce
rvix
cl
ean
o
f va
gin
a se
cre
tio
ns
and
mu
cus.
•
Ro
tate
a s
teri
le s
wab
, an
d o
bta
in e
xud
ates
fro
m t
he
end
oce
rvic
al g
lan
ds.
•
If n
o e
xud
ates
are
see
n, i
nse
rt t
he
sw
ab
into
th
e
end
oce
rvic
al
can
al a
nd
ro
tate
.
Stu
art’
s tr
ansp
ort
med
ium
Tr
ich
om
on
as
vag
ina
lis a
nd
go
no
cocc
i rem
ain
vi
able
in f
luid
med
ium
.
3-4
day
s
PER
PA
T 3
01
(GR
EEN
)
20
. H
igh
vag
inal
sw
ab
(HV
S)
Use
sp
ecu
lum
wit
ho
ut
lub
rica
nt.
Co
llect
sec
reti
on
s fr
om
th
e m
uco
sa h
igh
in t
he
vagi
nal
can
al w
ith
ste
rile
sw
ab
Stu
art’
s tr
ansp
ort
med
ium
. 3
-4 d
ays
21
. Va
gin
al s
wab
U
se n
orm
al s
alin
e an
d c
lean
vu
lva
area
. Ro
tate
a s
teri
le
swab
an
d o
bta
in e
xud
ates
fro
m t
he
vagi
nal
mu
cosa
.
22
. P
uer
per
al s
epsi
s o
r se
pti
c ab
ort
ion
O
bta
in e
xud
ates
fr
om
en
do
cerv
ical
gl
and
s u
sin
g st
erile
sp
ecu
lum
.
23
. G
on
oco
cci D
etec
tio
n
(Gra
m s
tain
)
Sm
ear
ed d
isch
arge
on
gla
ss s
lide
wit
ho
ut
fixi
ng
wit
h
alco
ho
l.
Le
t it
air
-dry
fir
st
Se
nd
as
soo
n a
s p
oss
ible
in b
ioh
azar
d p
last
ic b
ag
Gla
ss s
lide
1 h
r
37
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
24
. U
reth
ral s
wab
Co
llect
sp
ecim
en a
t le
ast
1 h
r af
ter
pat
ien
t h
as u
rin
ated
. Fe
mal
e:
1st
met
ho
d :
Sti
mu
late
dis
char
ge b
y ge
ntl
y m
assa
gin
g th
e u
reth
ra a
gain
st t
he
pu
bic
sym
ph
ysis
th
rou
gh t
he
vagi
na.
Co
llect
th
e d
isch
arge
wit
h a
ste
rile
sw
ab.
OR
2
nd
met
ho
d :
cle
an t
he
exte
rnal
ure
thra
an
d in
sert
a
ure
thro
gen
ital
sw
ab 2
-4 c
m in
to t
he
ure
thra
. G
entl
y ro
tate
th
e sw
ab,
and
lea
ve in
pla
ce f
or
1-2
sec
on
ds.
W
ith
dra
w t
he
swab
. M
ale:
Fo
llow
2n
d m
eth
od
as
abo
ve.
Stu
art’
s tr
ansp
ort
med
ium
. 3
-4 d
ays
PER
PA
T 3
01
(GR
EEN
)
25
. Fu
ngu
s Ex
amin
atio
n /
sc
rap
ing
for
fun
gus
Hai
r:
Wit
h f
orc
eps,
co
llect
at
leas
t 10
-12
aff
ecte
d h
airs
wit
h
bas
es o
f sh
aft
inta
ct.
Nai
l:
Clip
aw
ay g
ener
ou
s p
ort
ion
of
affe
cted
are
a an
d c
olle
ct
mat
eria
l o
r d
ebri
s fr
om
un
der
nai
l. Sk
in:
Scra
p s
urf
ace
of
skin
at
acti
ve m
argi
n o
f le
sio
n. D
o n
ot
dra
w b
loo
d.
No
te: C
olle
ct s
calp
sca
les,
if p
rese
nt.
Alo
ng
wit
h s
crap
ings
o
f ac
tive
bo
rder
s o
f le
sio
ns.
Ster
ile c
on
tain
er, 1
0 h
airs
St
erile
co
nta
iner
St
erile
co
nta
iner
A
LL S
AM
PLE
Se
nd
wit
hin
15m
in a
t R
T Sa
mp
le o
r w
ith
in
24
hr a
t 4
ºC
≥ 2
day
s (C
and
ida
on
ly)
≥ 5
day
s fo
r fu
ngu
s Fo
r fu
nga
l id
enti
fica
tio
n :
will
be
sen
t to
H
SAJB
/ IM
R
up
on
req
ue
st
( >
1m
on
th)
38
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
1
0.
AFB
Sm
ear
Uri
ne
As
stat
ed in
mid
stre
am u
rin
e
Ster
ile c
on
tain
er w
ith
scr
ew c
ap
Sen
d w
ith
in 2
hr
at R
T
Wit
hin
1
day
.
If r
ece
ived
aft
er
off
ice
ho
ur,
will
p
roce
ed n
ext
day
.
PER
PA
T 3
01
(GR
EEN
)
Spu
tum
, Res
pir
ato
ry s
ecre
tio
n,
Uri
ne
, C
SF,
Bo
dy
Flu
id,
Tiss
ue
Bio
psi
es
As
stat
ed in
pre
vio
us
colle
ctio
n
Ster
ile c
on
tain
er w
ith
scr
ew c
ap
Sen
d w
ith
in 2
hr
at R
T
Spu
tum
If
po
ssib
le c
olle
ct 3
tim
es (
1 m
orn
ing
spec
imen
an
d 2
sp
ot
spec
imen
). E
arly
mo
rnin
g sp
utu
m is
th
e b
est
spec
imen
fo
r A
FB d
ete
ctio
n.
Acc
epta
ble
sp
ecim
en
fo
r sp
utu
m:
Pu
rule
nt
/ M
uco
saliv
ary
/ In
du
ced
-sp
utu
m.
If h
igh
ly s
usp
ecte
d f
or
tub
ercu
losi
s, p
leas
e r
epea
t w
ith
TB
C
&S
or
TB P
CR
.
Ster
ile c
on
tain
er w
ith
scr
ew c
ap
Sen
d w
ith
in 2
hr
at R
T
Blo
od
A
s st
ated
in B
loo
d
Myc
o/f
un
gal b
loo
d b
ott
le: 1
-5m
l In
cub
atio
n
per
iod
: 42
day
s
11
. TB
C&
S
(Oga
wa
Met
ho
d)
Spu
tum
, Res
pir
ato
ry s
ecre
tio
n,
Uri
ne
, C
SF,
Bo
dy
Flu
id,
Blo
od
, Tis
sue
Bio
psi
es
As
stat
ed in
pre
vio
us
colle
ctio
n. N
eed
to
se
nd
on
ce o
nly
. *N
ote
: If
cult
ure
sh
ow
ed
mo
rph
olo
gy r
esem
blin
g M
. tu
ber
culo
sis,
fu
rth
er id
enti
fica
tio
n w
ill b
e d
on
e at
MK
AK
Sg
. Bu
loh
wh
ich
tak
es a
no
ther
1-2
mo
nth
s.
Ster
ile c
on
tain
er w
ith
scr
ew c
ap S
end
wit
hin
2
hr
at R
T (e
xcep
t fo
r B
loo
d w
hic
h n
eed
to
in
cub
ate
in M
yco
/fu
nga
l blo
od
bo
ttle
fir
st)
*4-8
wee
ks
TBIS
20
C
39
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
12
. B
loo
d :
•
Aer
ob
ic
*blu
e ca
p f
or
adu
lt
*w
hit
e ca
p f
or
pea
ds
•
An
aero
bic
*g
old
cap
• M
yco
/fu
nga
l *r
ed c
ap
• D
isin
fect
to
p o
f cu
ltu
re b
ott
le.
Dis
infe
ct
ven
ipu
nct
ure
si
te
and
d
raw
blo
od
.
• P
ress
syr
inge
slo
wly
into
blo
od
cu
ltu
re b
ott
le t
o a
void
hem
oly
sis
and
fal
se p
osi
tive
.
• A
cute
sep
sis:
A s
et
(2 b
ott
les)
fro
m s
ep
arat
e si
tes,
all w
ith
in 1
0 m
in.
• En
do
card
itis
acu
te:
A s
et
(2 b
ott
les)
fro
m s
ites
ove
r
1-2
hr.
• Fe
ver
of
un
kno
wn
ori
gin
: A
se
t (2
bo
ttle
s) f
rom
sep
arat
e si
tes
≥ 1
hr
apar
t.
• R
eco
mm
end
ed: A
set
mea
ns
incl
usi
ve o
f 1
aer
ob
ic a
nd
1 a
nae
rob
ic b
ott
le.
*No
te:
i. P
relim
inar
y re
po
rt is
issu
ed t
o c
linic
ian
aft
er 2
day
s o
f inc
ubat
ion.
The
rea
son
is t
o g
ive
init
ial f
ind
ing
for
clin
icia
n an
d N
OT
TO B
E A
CC
EPTE
D A
S FI
NA
L R
EPO
RT.
ii.
Fi
nal
rep
ort
of
no
gro
wth
of
org
anis
m w
ill b
e is
sued
af
ter
each
incu
bat
ion
per
iod
. iii
. P
osi
tive
gro
wth
may
exh
ibit
aft
er 3
-4 d
ays
of
incu
bat
ion
. It
may
als
o t
akes
sev
eral
day
s fo
r fu
nga
l an
d f
asti
dio
us
org
anis
m.
i. A
ero
bic
& a
nae
rob
ic b
ott
le (
Ad
ult
):
8-1
0m
l ii.
In
fan
t : 1
-3m
l iii
. M
yco
/fu
nga
l bo
ttle
: 1-
5ml
For
anae
rob
ic a
nd
m
yco
/ f
un
gal
ple
ase
cal
l la
b f
irst
fo
r re
qu
esti
ng
bo
ttle
Se
nd
wit
hin
2
hr,
at
RT
*In
cub
atio
n
Pe
rio
d:
Aer
ob
ic &
A
nae
rob
ic :
5
day
s
Fun
gal :
14
day
s M
yco
bac
teri
um
: 4
2 d
ays
PER
PA
T 3
01
(GR
EEN
)
40
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
13
. B
loo
d F
ilms
for
Mal
aria
Par
asit
e (B
FMP
)
• P
rope
rly
dis
infe
ct t
he
site
of
colle
ctio
n. P
rep
are
thic
k &
th
in s
mea
r b
y fi
nge
r p
rick
met
ho
d /
ve
nip
un
ctu
re m
eth
od
/ f
rom
ED
TA t
ub
e. F
inge
r p
rick
is T
HE
BES
T P
RA
CTI
CE.
• A
pp
roxi
mat
ely
3 sm
all d
rop
s o
f b
loo
d is
nee
ded
to
pre
pare
a t
hic
k sm
ear
(th
e si
ze o
f 5
cen
t) a
nd
1 s
mal
l d
rop
of
blo
od
fo
r th
in s
mea
r.
• P
rep
are
bo
th s
mea
r in
1-
3 gl
ass
slid
e (n
ot
fro
sted
). L
et it
dry
fir
st b
efo
re s
end
ing
to la
b. M
ay r
epea
t te
st
un
til 3
tim
es.
• 2
.5m
L o
f B
loo
d in
ED
TA T
ub
e ca
n b
e se
nd
to
geth
er w
ith
BFM
P s
lide
if p
atie
nt
is h
igh
ly s
usp
ecte
d f
or
mal
aria
.
2 h
ou
rs
PER
PA
T 3
01
(PIN
K)
14
. B
loo
d F
ilms
for
Fila
rial
Par
asit
e (F
ilari
asis
)
• P
rope
rly
dis
infe
ct t
he
site
of
colle
ctio
n. O
nly
pre
par
e th
ick
smea
r o
nto
gla
ss s
lide
by
fin
ger
pri
ck /
ve
nep
un
ctu
re /
ED
TA t
ub
e.
• A
pp
roxi
mat
ely
4-5
sm
all d
rop
s o
f b
loo
d a
re r
equ
ired
to
pre
par
e a
thic
k sm
ear
(siz
e: 2
cm x
3cm
). T
hin
sm
ear
is n
ot
req
uir
ed.
• Le
t it
dry
fir
st b
efo
re s
end
to
lab
.
No
te:
Co
llect
ion
of
spec
imen
are
su
gges
ted
be
do
ne
bet
wee
n 8
pm t
o 1
2am
if ly
mp
hat
ic f
ilari
asis
(N
oct
urn
al p
erio
dic
ity)
is s
usp
ecte
d.
• 2
.5m
L o
f b
loo
d in
ED
TA T
ub
e ca
n b
e se
nd
to
geth
er w
ith
th
ick
smea
r sl
ide
if p
atie
nt
is h
igh
ly s
usp
ecte
d
for
fila
rias
is.
2 h
ou
rs
Stan
dar
d B
FMP
slid
e
Stan
dar
d F
ilari
asis
slid
e
41
TEST
NA
ME
CO
LLEC
TIO
N M
ETH
OD
& R
EMA
RK
S C
ON
TAIN
ER /
VO
LUM
E TA
T FO
RMS
15
. TR
O B
ruce
llosi
s
(Blo
od
C&
S)
As
stat
ed p
revi
ou
sly
in b
loo
d
No
te:
*To
sta
te "
TRO
Bru
cello
sis
in r
equ
est
form
(P
ER-P
AT
301
)
to
geth
er w
ith
Bru
cello
sis
form
(IM
R/I
DR
C/B
AC
T/B
RU
CE/
01
) ¥
Fin
al r
epo
rt: S
usp
ecte
d f
or
Bru
cella
sp
ecie
s. F
urt
her
id
enti
fica
tio
n w
ill b
e d
on
e at
IMR
(ta
kes
ano
ther
1
w
eek
i. A
ero
bic
bo
ttle
(A
du
lt):
8-1
0m
l ii.
In
fan
t :
1-3
ml
Se
nd
wit
hin
2
hr,
at
RT
¥ Incu
bat
ion
P
erio
d: 3
-5 d
ays
M
ay u
p t
o m
ore
th
an 7
day
s o
f in
cub
atio
n d
ue
to
dif
ficu
lt t
o g
row
th
(fas
tid
iou
s)
*PER
PA
T 3
01
(G
REE
N)
&
Bru
cello
sis
form
16
. St
erili
ty t
est
a)
CSS
D
b
) P
har
mac
y p
rod
uct
•
Au
tocl
ave
toge
ther
wit
h b
iolo
gica
l in
dic
ato
r tu
be
(Att
est)
•
Sen
d a
no
ther
tu
be
for
neg
ativ
e co
ntr
ol w
ith
ou
t au
tocl
avin
g it
. •
Sen
d p
rod
uct
wit
h r
equ
est
form
as
soo
n a
s p
oss
ible
af
ter
pre
par
atio
n.
2 b
iolo
gica
l in
dic
ato
r tu
bes
2
-5 m
l of
solu
tio
n
3 h
ou
rs
3-4
day
s (I
f n
o g
row
th:
1
day
)
PER
PA
T 3
01
(GR
EEN
/
WH
ITE)
17
. En
viro
nm
enta
l sa
mp
ling
• C
on
sult
wit
h In
fect
ion
Co
ntr
ol t
eam
for
dat
e an
d t
ime
of
sam
plin
g.
• Sa
mp
ling
will
be
do
ne
by
Infe
ctio
n C
on
tro
l tea
m b
efo
re a
nd
aft
er c
lean
ing
of
envi
ron
men
t.
5 d
ays
INFE
CTI
ON
C
ON
TRO
L EN
VIR
ON
MEN
TAL
SUR
VEI
LLA
NC
E FO
RM
42
IMM
UN
OLO
GY
/ S
ERO
LOG
Y
TEST
NAM
E VO
LUM
E &
CO
NTA
INER
LA
B SC
HED
ULE
TA
T FO
RM
1.
An
ti-d
sDN
A
5
ml o
f b
loo
d in
pla
in t
ub
e (A
du
lt)
Fo
r b
aby,
co
llect
0.5
ml i
n
a m
icro
co
nta
ine
r
If A
NA
ho
mo
gen
ou
s p
osi
tive
3-5
day
s
PER
PA
T 3
01
(GR
EEN
)
2.
An
ti-N
ucl
ear A
nti
bo
dy
(AN
A)
Cu
mu
lati
ve
(Wo
rkin
g d
ays
on
ly)
3.
An
ti-S
trep
toly
sin
O (
ASO
T)
4.
a) D
engu
e Ig
M /
IgG
(EL
ISA
) 2
-3 t
imes
per
wee
k 2
-3 d
ays
(ELI
SA)
c)
Rap
id D
engu
e N
S1 o
r Ig
M &
IgG
*S
pec
ify
each
co
mp
on
ent
clea
rly
24
ho
urs
(T
o o
bta
in M
O p
erm
issi
on
fo
r In
-pat
ien
t)
1 h
ou
r (R
apid
)
6.
Myc
op
lasm
a p
neu
mo
nia
e an
tib
od
y (P
A)
2-3
tim
es p
er w
eek
3-5
day
s
7.
Rh
eum
ato
id F
acto
r (R
F)
2
-3 d
ays
8.
RP
R (
syp
hili
s)
9.
TPPA
(T
rep
on
ema
pa
llid
um
par
ticl
e ag
glu
tin
atio
n)
10.
C. d
iffi
cile
An
tige
n
*Nee
d t
o s
end
loo
se s
too
l St
erile
un
iver
sal c
on
tain
er,
sen
d w
ith
in 2
4h
r at
4°C
Li
qu
id, s
emi f
orm
ed
, lo
ose
sto
ol o
nly
Wo
rkin
g d
ays
on
ly
2-3
day
s
11.
Ro
tavi
rus
An
tige
n
Wo
rkin
g d
ays
on
ly
2-3
day
s
12.
Lep
tosp
iro
sis
IgM
(IC
T)
5 m
l of
blo
od
in p
lain
tu
be
(Ad
ult
)
For
bab
y, c
olle
ct 0
.5 m
l in
a
mic
ro c
on
tain
er
Dai
ly
(8am
– 9
pm
on
ly)
1 d
ay
*I
f re
ceiv
ed a
fte
r o
ffic
e h
ou
r, w
ill
pro
ceed
nex
t d
ay.
MK
AK
fo
rm
(MK
AK
-BP
U-U
01)
2
co
pie
s
43
TEST
NAM
E VO
LUM
E &
CO
NTA
INER
LA
B SC
HED
ULE
TA
T FO
RM
13
. R
apid
Hep
atit
is B
& C
5 m
l of
blo
od
in p
lain
tu
be
(Ad
ult
)
For
bab
y, c
olle
ct 0
.5 m
l in
a
mic
ro c
on
tain
er
C
om
ple
ted
clin
ical
his
tory
, ris
k fa
cto
rs,
clin
ical
fin
din
gs o
r o
ther
just
ific
atio
ns
24
ho
urs
(R
equ
ire
per
mis
sio
n f
rom
MO
) 1
ho
ur
PER
PA
T 3
01
(GR
EEN
)
14
. A
nti
-HC
V (
CM
IA)
Cu
mu
lati
ve
(Wo
rkin
g d
ays
on
ly)
No
n-R
eact
ive
sam
ple
: 1
-3 w
ork
ing
day
s
R
eact
ive
sam
ple
: 3
-5 w
ork
ing
day
s
15
. H
Bs
An
tige
n /
HB
sAg
(CM
IA)
16.
HB
s A
nti
bo
dy
/ an
ti-H
Bs
(CM
IA)
14
. A
nti
-HIV
1 &
2 (
CM
IA)
Sen
d w
ith
H
IV9
7 f
orm
15
. R
apid
HIV
2
4 h
ou
rs
(Req
uir
e p
erm
issi
on
fro
m M
O)
1 h
ou
r (v
erb
al o
nly
, will
re
pea
t C
MIA
) Se
nd
wit
h
HIV
97
fo
rm
44
HIS
TOPA
THO
LOG
Y
TEST
NA
ME
VO
LUM
E C
ON
TAIN
ER
LAB
SC
HED
ULE
TA
T FO
RM
1. T
issu
e B
iop
sy
Tiss
ue
in F
ixat
ive
10%
Fo
rmal
in S
olu
tio
n
Un
ive
rsal
bo
ttle
Off
ice
ho
ur
< 2
w
eek
s
PER
PA
T 3
01
(WH
ITE)
*2 c
op
y
2. E
xcis
ed/r
esec
ted
org
an/
tiss
ue
R
ob
ust
co
nta
iner
1
- 2
m
on
th
3. R
enal
Bio
psy
1.
Tiss
ue
in F
ixat
ive
10%
Fo
rmal
in
Solu
tio
n
2.
Tiss
ue
Bio
psy
mo
iste
ned
wit
h
ph
osp
hat
e B
uff
er S
alin
e
Un
iver
sal B
ott
le
By
Ap
po
intm
en
t >
2w
eek
4. M
usc
le b
iop
sy
Fres
h t
issu
e b
iop
sy w
rap
ped
in
alu
min
um
fo
il U
niv
ersa
l Bo
ttle
in
co
ld ic
e
45
CYT
OLO
GY
TEST
NA
ME
SPEC
IMEN
V
OLU
ME
CO
NTA
INER
M
EDIA
TR
AN
SPO
RTA
TIO
N
LAB
SC
HED
ULE
TA
T FO
RM
1.G
ynae
Pap
sm
ear
- G
lass
slid
e ‘’
fro
sted
’’ 9
5% t
o
96%
alc
oh
ol
Slid
e m
aile
r
Off
ice
ho
ur
Urg
ent:
1 w
eek
Ro
uti
ne:
2 w
ee
ks
PER
PA
T 3
01
(WH
ITE)
2
.No
n g
ynae
Bo
dy
flu
ids
5ml
Un
iver
sal c
on
tain
er
- -
2-4
w
eek
s Sp
utu
m
2ml
CSF
1m
l B
ijou
bo
ttle
3.F
.N.A
.CB
y A
pp
oin
tme
nt
46
TEST
NA
ME
SPEC
IMEN
V
OLU
ME
CO
NTA
INER
CO
LLEC
TIO
N /
TR
AN
SPO
RTA
TIO
N
LAB
SC
HED
ULE
TA
T FO
RM
4. S
emin
al F
luid
An
alys
is
Sem
inal
Flu
id
—
Ster
ile
Co
nta
iner
By
Ap
po
intm
en
t
LAN
GK
AH
1
Tiad
a ak
tivi
ti e
jaku
lasi
/ h
ub
un
g se
xual
d
alam
mas
a 7
2 ja
m
LAN
GK
AH
2
Ko
son
gkan
pu
nd
i ken
cin
g an
da,
kem
ud
ian
b
asu
h d
an b
ilas
tan
gan
dan
zak
ar a
nd
a.
LAN
GK
AH
3
M
engu
mp
ul s
amp
el d
enga
n
“mas
turb
atin
g” d
an e
jaku
lasi
ter
us
ke
dal
am b
ekas
pen
gum
pu
lan
, mem
asti
kan
se
mu
a ai
r m
ani d
ihas
ilkan
dit
angk
ap o
leh
b
ekas
.
J
anga
n g
un
akan
ko
nd
om
ata
u p
elin
cir
kera
na
ini b
ole
h m
enje
jask
an in
tegr
iti
sam
pel
. LA
NG
KA
H 4
K
etat
kan
pen
utu
p b
ekas
sam
pel
LA
NG
KA
H 5
H
anta
r s
pes
imen
ke
mak
mal
sec
epat
m
un
gkin
. (T
idak
mel
ebih
i 1 ja
m d
ari
mas
a p
engu
mp
ula
n)
S
amp
le d
isim
pan
pad
a su
hu
bad
an
Off
ice
ho
ur
3 –
5
wo
rkin
g d
ays
PER
PA
T 3
01
(WH
ITE)
47
BLO
OD
TRA
NSF
USI
ON
SER
VICE
BLOOD TRANSFUSION SERVICE
G
SH
Eme
rge
ncy
Blo
od
P
acke
d C
ell
Pla
tele
t C
ryo
/ F
FP
1.
Ord
erin
g (E
DT
A T
ub
e)
Req
ues
t ac
cord
ing
to
MSB
OS
Sam
ple
will
be
kep
t fo
r 7
2ho
urs
Ple
ase
get
per
mis
sio
n f
rom
Blo
od
Ban
k M
O f
irst
. Fo
r Em
erge
ncy
Blo
od
P
leas
e In
form
th
e M
LT in
blo
od
ban
k fi
rst,
th
en b
rin
g th
e sa
mp
le w
ith
co
mp
lete
ly f
illed
GX
M f
orm
to
blo
od
b
ank.
(B
rin
g al
on
g ic
e b
ox)
P
leas
e ge
t p
erm
issi
on
fr
om
Blo
od
Ban
k M
O
firs
t.
R
equ
est
on
ly w
hen
nee
ded
N
o r
eser
vati
on
is a
llow
ed
2. T
AT
< 3
0 m
ins
1 t
o 2
ho
urs
(T
AT
can
be
> 2
ho
urs
, d
epen
d o
n a
vaila
ble
of
com
pat
ible
blo
od
)
< 3
0 m
ins
1. T
he
du
rati
on
of
pro
cess
ing
will
var
ies
acco
rdin
g to
wo
rklo
ad
2. T
he
abo
ve e
stim
ated
du
rati
on
of
pro
cess
ing
on
ly v
alid
if n
o p
rob
lem
s fo
un
d
du
rin
g A
nti
bo
dy
Scre
enin
g an
d a
vaila
bili
ty o
f co
mp
atib
le b
loo
d.
3. R
efer
ral t
o H
SAJB
/ P
usa
t D
arah
Neg
ara
will
req
uir
ed, i
f p
rob
lem
fo
un
d d
uri
ng
anti
bo
dy
scre
enin
g o
r u
nab
le t
o g
et a
co
mp
atib
le b
loo
d. I
n t
his
sit
uat
ion
, it
may
re
qu
ires
2 —
3 o
r m
ore
wo
rkin
g d
ays
for
the
pro
cess
.
48
BLOOD TRANSFUSION SERVICE
GSH
Em
erg
en
cy B
loo
d
Pac
ked
Ce
ll P
late
let
Cry
o /
FFP
3.C
olle
ctio
nB
loo
d B
ox
wit
h Ic
e
Blo
od
Bo
x
wit
ho
ut
Ice
B
loo
d B
ox
wit
h Ic
e
4.T
ran
sfu
sio
n
Tr
ansf
use
as
soo
n a
s p
oss
ible
C
om
ple
ted
Tra
nsf
usi
on
wit
hin
4 h
ou
r
Ple
ase
retu
rn im
med
iate
ly t
o b
loo
d b
ank
ifn
ot
tran
sfu
se w
ith
in 3
0m
ins
afte
r co
llect
ion
Tran
sfu
se
imm
edia
tely
Tran
sfu
se
imm
edia
tely
aft
er
thaw
ing
5.S
tora
ge
Sh
ou
ld b
e ke
pt
bet
wee
n +
2°C
to
+6
°C
Do
no
t st
ore
at
blo
od
bo
x fo
r m
ore
th
an3
0m
ins
B
loo
d /
blo
od
pro
du
cts
sho
uld
no
t b
etr
ansf
use
if n
ot
sto
re a
t p
rop
er t
emp
erat
ure
for
mo
re t
han
30
min
s
+20
°C t
o 2
4°C
o
n a
gita
tio
r –2
5°C
A
ll b
loo
d p
rod
uct
mu
st b
e re
turn
imm
edia
tely
to
blo
od
ban
k if
no
t tr
ansf
use
, an
d n
ot
allo
wto
sto
re in
clin
ical
ref
rige
rato
r in
war
d a
t an
y ti
me.
St
and
by
blo
od
fo
r o
per
atio
n m
ust
be
sto
re in
OT
blo
od
fri
dge
an
d r
etu
rn im
med
iate
ly t
ob
loo
d b
ank
if n
ot
tran
sfu
se.
49
BLOOD TRANSFUSION SERVICE
TYP
E C
ON
TAIN
ER
TAT
FOR
M
OTH
ER T
ESTS
(A
vaila
ble
Lo
call
y)
Blo
od
Gro
up
ing
and
Rh
Typ
ing
Pla
in T
ub
e (
4m
l)
Urg
en
t <
30m
ins
(wit
h p
erm
issi
on
) N
on
Urg
en
t : 1
- 2
Day
s P
ERP
AT
301
(W
HIT
E)
Co
mb
s’ T
est
U
rge
nt
< 1
ho
ur
(wit
h p
erm
issi
on
) N
on
Urg
en
t : 1
- 2
Day
s
OU
TSO
UR
CED
TES
TS (
HSA
JB /
PU
SAT
DA
RA
H N
EGA
RA
) P
leas
e R
efer
Ou
tso
urc
e Te
st S
ecti
on
(P
age
65
)
An
tib
od
y Id
en
tifi
cati
on
Ple
ase
con
tact
blo
od
ban
k p
erso
nn
el f
or
det
ail i
nfo
rmat
ion
P
ERP
AT
301
(W
HIT
E)
Co
ld A
gglu
tin
atio
n t
est
Pla
tele
t A
nti
bo
dy
50
MASSIVE BLOOD TRANSFUSION PROTOCOL / TDHSNI / VERSION 1 / 1-DEC-2015
MASSIVE TRANSFUSION PROTOCOL (MTP) HOSPITAL SULTANAH NORA ISMAIL, BATU PAHAT
INDICATION: Blood Loss of > 30% blood volume (approximately 1500mls in average adult) within 3 hours or 150ml/min
ACTIVATION OF PROTOCOL Transfusion Laboratory : Ext 4327
Doctor in charge of Patient Transfusion Laboratory
1. Call Transfusion Laboratory, Speak to MLT oncall 2. Provide Necessary Information
Patient Name, IC, Location How urgent the Blood is needed?
3. Activate the Protocol 4. Nominated a Blood Coordinator to ensure blood & blood
components are managed effectively 5. Prepare Blood Request Form & blood sample 6. Immediately rush to Transfusion Laboratory with blood
collection box.
MLT Receive call for Activation of Protocol Document the detail of the contact person
for ongoing communication Prepare and supply Blood Component
according to Protocol MLT to Notified MO Blood Bank MO to notified Specialist, Hemato & Chem
Lab
Cycle The Transfusion
Laboratory will issues Availability of Blood For
Collection
1 Immediately
2 unit Safe “O” or 4 unit Emergency GXM 4 unit thawed FFP (Group AB) Provide Pre transfusion sample (2 tube)
SAFE “O” Immediate
Saline Cross match (Emergency GXM) 30 minutes
Full cross match Blood 1-2 Hours
FFP / CRYO 30 minutes to thaw
Platelets Immediately
The above turnaround time does not include the time taken for
documentation and travelling
2 Repeatable
Cycle
Once above components are collected from the laboratory the Transfusion Laboratory with automatically prepared
Further cross match of 4 unit Emergency GXM 4 units thawed FFP 4 units Platelet 6 units Cryo
THE LABORATORY WILL CONTINUE PREPARE 4 UNIT OF BLOOD & FFP AT A TIME WHILST THE PATIENT BLEEDING
REQUIRMENT : 1. At least 2 large bore IV access
2. Hourly FBC and Coagulation Screen, ABG
3. Pre transfusion sample (2 tube)
4. Each Cycle must have Request Form
5. Additional Fresh Blood Sample (2 tube) will be ask upon request from transfusion lab.
6. ALL use or unused blood/component must be return to transfusion lab
AIM : 1. Temperature > 35 °C 2. PH > 7.2, Base excess < - 6 3. INR <1.5; APTT <42s 4. Platelet > 50 x 10
9L
5. Platelet > 100 x 109L (Multiple trauma / CNS
involves)
PLEASE INFORM THE TRANSFUSION LABORATORY IMMEDIATELY ONCE MTP IS NEEDED TO BE DEACTIVATED!!!
Upon request, if bleeding still persist
51
BD Vacutainer® Venous Blood Collection
Tube Guide
BD Diagnostics Preanalytical Systems 1 Becton DriveFranklin Lakes, NJ 07417 USA
*Invertgently,donotshake **Theperformancecharacteristicsofthesetubeshavenotbeenestablishedforinfectiousdiseasetestingingeneral;therefore,usersmust
validatetheuseofthesetubesfortheirspecificassay-instrument/reagentsystemcombinationsandspecimenstorageconditions.***Theperformancecharacteristicsofthesetubeshavenotbeenestablishedforimmunohematologytestingingeneral;therefore,usersmust
validatetheuseofthesetubesfortheirspecificassay-instrument/reagentsystemcombinationsandspecimenstorageconditions.
BD Global Technical Services: 1.800.631.0174BD Customer Service: 1.888.237.2762www.bd.com/vacutainer
BD, BD Logo and all other trademarks are property of Becton, Dickinson and Company. © 2010 BD Printed in USA 07/10 VS5229-13
Note: BD Vacutainer® Tubes for pediatric and partial draw applications can be found on our website.
For the full array of BD Vacutainer® Blood Collection Tubes, visit www.bd.com/vacutainer.Many are available in a variety of sizes and draw volumes (for pediatric applications). Refer to our website for full descriptions.
BD Vacutainer® Tubes with
BD Hemogard™ Closure
BD Vacutainer® Tubes with
Conventional Stopper Additive
Inversions at Blood
Collection* Laboratory UseYour Lab’s Draw Volume/Remarks
GoldRed/Gray
• Clot activator and gelfor serum separation
5 For serum determinations in chemistry. May be used for routine blood donor screening and diagnostic testing of serum for infectious disease.** Tube inversions ensure mixing of clot activator with blood. Blood clotting time: 30 minutes.
Light Green
Green/Gray
• Lithium heparinand gel for plasmaseparation
8 For plasma determinations in chemistry. Tube inversions ensure mixing of anticoagulant (heparin) with blood to prevent clotting.
Red Red
• Silicone coated (glass)• Clot activator, Silicone
coated (plastic)
05
For serum determinations in chemistry. May be used for routine blood donor screening and diagnostic testing of serum for infectious disease.** Tube inversions ensure mixing of clot activator with blood. Blood clotting time: 60 minutes.
Orange
• Thrombin-based clotactivator with gel forserum separation
5 to 6 For stat serum determinations in chemistry. Tube inversions ensure mixing of clot activator with blood. Blood clotting time: 5 minutes.
Orange
• Thrombin-based clotactivator
8 For stat serum determinations in chemistry. Tube inversions ensure mixing of clot activator with blood. Blood clotting time: 5 minutes.
Royal Blue
• Clot activator(plastic serum)
• K2EDTA (plastic)
8
8
For trace-element, toxicology, and nutritional-chemistry determinations. Special stopper formulation provides low levels of trace elements (see package insert). Tube inversions ensure mixing of either clot activator or anticoagulant (EDTA) with blood.
Green Green
• Sodium heparin• Lithium heparin
88
For plasma determinations in chemistry. Tube inversions ensure mixing of anticoagulant (heparin) with blood to prevent clotting.
Gray Gray
• Potassium oxalate/sodium fluoride
• Sodium fluoride/Na2 EDTA• Sodium fluoride
(serum tube)
8
88
For glucose determinations. Oxalate and EDTA anticoagulants will give plasma samples. Sodium fluoride is the antiglycolytic agent. Tube inversions ensure proper mixing of additive with blood.
Tan
• K2EDTA (plastic) 8 For lead determinations. This tube is certified to contain less than .01 µg/mL(ppm) lead. Tube inversions prevent clotting.
Yellow
• Sodiumpolyanethol sulfonate (SPS)
• Acid citrate dextroseadditives (ACD):Solution A -22.0 g/L trisodium citrate,8.0 g/L citric acid, 24.5 g/LdextroseSolution B -13.2 g/L trisodium citrate,4.8 g/L citric acid, 14.7 g/Ldextrose
8
8
8
SPS for blood culture specimen collections in microbiology.
ACD for use in blood bank studies, HLA phenotyping, and DNA and paternity testing.
Tube inversions ensure mixing of anticoagulant with blood to prevent clotting.
Lavender Lavender
• Liquid K3EDTA (glass)• Spray-coated K2EDTA
(plastic)
88
K2EDTA and K3EDTA for whole blood hematology determinations. K2EDTA may be used for routine immunohematology testing, and blood donor screening.*** Tube inversions ensure mixing of anticoagulant (EDTA) with blood to prevent clotting.
White
• K2EDTA and gel forplasma separation
8 For use in molecular diagnostic test methods (such as, but not limited to, polymerase chain reaction [PCR] and/or branched DNA [bDNA] amplification techniques.) Tube inversions ensure mixing of anticoagulant (EDTA) with blood to prevent clotting.
Pink Pink
• Spray-coated K2EDTA(plastic)
8 For whole blood hematology determinations. May be used for routine immunohematology testing and blood donor screening.*** Designed with special cross-match label for patient information required by the AABB. Tube inversions prevent clotting.
Light Blue
Light Blue
• Buffered sodium citrate0.105 M (≈3.2%) glass0.109 M (3.2%) plastic
• Citrate, theophylline,adenosine, dipyridamole(CTAD)
3-4
3-4
For coagulation determinations. CTAD for selected platelet function assays and routine coagulation determination. Tube inversions ensure mixing of anticoagulant (citrate) to prevent clotting.
Clear
ClearNew
Red/Light Gray
• None (plastic) 0 For use as a discard tube or secondary specimen tube.
52
BD Vacutainer ® Order of Draw for Multiple Tube CollectionsDesigned for Your Safety
Handle all biologic samples and blood collection “sharps” (lancets, needles, luer adapters and blood collection sets) according to the policies and procedures of your facility. Obtain appropriate medical attention in the event of any exposure to biologic samples (for example, through a puncture injury) since they may transmit viral hepatitis, HIV (AIDS), or other infectious diseases. Utilize any built-in used needle protector if the blood collection device provides one. BD does not recommend reshielding used needles, but the policies and procedures of your facility may differ and must always be followed. Discard any blood collection “sharps” in biohazard containers approved for their disposal.
Note: Always follow your facility’s protocol for order of draw
BD, BD Logo and all other trademarks are property of Becton, Dickinson and Company. © 2010 BDFranklin Lakes, NJ, 07417 1/10 VS5729-6
1 Becton Drive
Franklin Lakes, NJ 07417
www.bd.com/vacutainer
BD Technical Services
1.800.631.0174 BD Customer Service
1.888.237.2762www.bd.com/vacutainer
= 1 inversion
BD Vacutainer ® Blood Collection Tubes (glass or plastic)
or
or
or
• Blood Cultures - SPS
• Citrate Tube*
• BD Vacutainer ® SST™
Gel Separator Tube• Serum Tube
(glass or plastic)
• BD Vacutainer® RapidSerum Tube (RST)
• BD Vacutainer ® PST™
Gel Separator TubeWith Heparin
• Heparin Tube
• EDTA Tube
• BD Vacutainer® PPT™
Separator TubeK2EDTA with Gel
• Fluoride (glucose) Tube
8 to 10 times
3 to 4 times
5 times
5 times (plastic) none (glass)
5 to 6 times
8 to 10 times
8 to 10 times
8 to 10 times
8 to 10 times
8 to 10 times
Closure Color Collection Tube Mix by Inverting
* When using a wingedblood collection setfor venipunctureand a coagulation(citrate) tube is thefirst specimen tube tobe drawn, a discardtube should be drawnfirst. The discard tubemust be used to fillthe blood collectionset tubing’s “deadspace” with bloodbut the discard tubedoes not need to becompletely filled. Thisimportant step willensure proper blood-to-additive ratio. Thediscard tube shouldbe a nonadditive orcoagulation tube.
Reflects change in CLSI recommended Order of Draw (H3-A5, Vol 23, No 32, 8.10.2)
53
BLOOD SAMPLE COLLECTION TECHNIQUE
Blood Specimen Collection and Processing The first step in acquiring a quality lab test result for any patient is the specimen collection procedure. The venipuncture procedure is complex, requiring both knowledge and skill to perform. Several essential steps are required for every successful collection procedure:
Venipuncture Procedure: 1. A phlebotomist must have a professional, courteous, and understanding manner in all
contact with all patients.2. The first step to the collection is to positively identify the patient by two forms of
identification; ask the patient to state and spell his/her name and give you his/her birth date.Check these against the requisition (paper or electronic).
3. Check the requisition form for requested tests, other patient information and any specialdraw requirements. Gather the tubes and supplies that you will need for the draw.
4. Position the patient in a chair, or sitting or lying on a bed.5. Wash your hands.6. Select a suitable site for venipuncture, by placing the tourniquet 3 to 4 inches above the
selected puncture site on the patient.
7. Do not put the tourniquet on too tightly or leave it on the patient longer than 1 minute.8. Next, put on non-latex gloves, and palpate for a vein.9. When a vein is selected, cleanse the area in a circular motion, beginning at the site and
working outward. Allow the area to air dry. After the area is cleansed, it should not betouched or palpated again. If you find it necessary to reevaluate the site by palpation, thearea needs to be re-cleansed before the venipuncture is performed.
10. Ask the patient to make a fist; avoid “pumping the fist.” Grasp the patient’s arm firmly usingyour thumb to draw the skin taut and anchor the vein. Swiftly insert the needle through theskin into the lumen of the vein. The needle should form a 15-30 degree angle with the armsurface. Avoid excess probing.
11. Once the needle is inside the blood vessel, apply minimum suction pressure to withdrawblood.
12. Remove the needle from the patient's arm using a swift backward motion.13. Place gauze immediately on the puncture site. Apply and hold adequate pressure to avoid
formation of a hematoma. After holding pressure for 1-2 minutes, tape a fresh piece of gauzeor Band-Aid to the puncture site.
14. Dispose of contaminated materials/supplies in designated containers.
Note: The larger median cubital and cephalic veins are the usual choice, but the basilic vein on the dorsum of the arm or dorsal hand veins are also acceptable. Foot veins are a last resort because of the higher probability of complications.
54
Fingerstick Procedure: 1. Follow steps #1 through #5 of the procedure for venipuncture as outlined above.2. The best locations for fingersticks are the 3rd (middle) and 4th (ring) fingers of the non-
dominant hand. Do not use the tip of the finger or the center of the finger. Avoid the side ofthe finger where there is less soft tissue, where vessels and nerves are located, and wherethe bone is closer to the surface. The 2nd (index) finger tends to have thicker, callused skin.The fifth finger tends to have less soft tissue overlying the bone. Avoid puncturing a fingerthat is cold or cyanotic, swollen, scarred, or covered with a rash.
3. When a site is selected, put on gloves, and cleanse the selected puncture area.4. Massage the finger toward the selected site prior to the puncture.5. Using a sterile safety lancet, make a skin puncture just off the center of the finger pad. The
puncture should be made perpendicular to the ridges of the fingerprint so that the drop ofblood does not run down the ridges.
6. Wipe away the first drop of blood, which tends to contain excess tissue fluid.7. Collect drops of blood into the collection tube/device by gentle pressure on the finger. Avoid
excessive pressure or “milking” that may squeeze tissue fluid into the drop of blood.8. Cap, rotate and invert the collection device to mix the blood collected.9. Have the patient hold a small gauze pad over the puncture site for a few minutes to stop the
bleeding.10. Dispose of contaminated materials/supplies in designated containers.11. Label all appropriate tubes at the patient bedside.
Heelstick Procedure (infants): The recommended location for blood collection on a newborn baby or infant is the heel. The diagram below indicates the proper area to use for heel punctures for blood collection.
1. Prewarming the infant's heel (42° C for 3 to 5 minutes) is important to increase the flow ofblood for collection.
2. Wash your hands, and put gloves on. Clean the site to be punctured with an alcohol sponge.Dry the cleaned area with a dry gauze pad.
3. Hold the baby's foot firmly to avoid sudden movement.4. Using a sterile blood safety lancet, puncture the side of the heel in the appropriate regions
shown above. Make the cut across the heel print lines so that a drop of blood can well upand not run down along the lines.
5. Wipe away the first drop of blood with a piece of clean, dry cotton gauze. Since newbornsdo not often bleed immediately, use gentle pressure to produce a rounded drop of blood.Do not use excessive pressure because the blood may become diluted with tissue fluid.
6. Fill the required microtainer(s) as needed.7. When finished, elevate the heel, place a piece of clean, dry cotton on the puncture site, and
hold it in place until the bleeding has stopped. Apply tape or Band-Aid to area if needed.8. Be sure to dispose of the lancet in the appropriate sharps container. Dispose of
contaminated materials in appropriate waste receptacles.9. Remove your gloves and wash your hands.
55
Order of Draw: Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. The recommended order of draw for plastic vacutainer tubes is:
1. First - blood culture bottle or tube (yellow or yellow-black top)2. Second - coagulation tube (light blue top).3. Third - non-additive tube (red top)4. Last draw - additive tubes in this order:
SST (red-gray or gold top). Contains a gel separator and clot activator.
Sodium heparin (dark green top)
PST (light green top). Contains lithium heparin anticoagulant and a gel separator.
EDTA (lavender top)
Oxalate/fluoride (light gray top) or other additives NOTE: Tubes with additives must be thoroughly mixed. Clotting or erroneous
test results may be obtained when the blood is not thoroughly mixed withthe additive.
Areas to Avoid When Choosing a Site for Blood Draw: Certain areas are to be avoided when choosing a site for blood draw:
Extensive scars from burns and surgery - it is difficult to puncture the scar tissue and obtaina specimen.
The upper extremity on the side of a previous mastectomy - test results may be affectedbecause of lymphedema.
Hematoma - may cause erroneous test results. If another site is not available, collect thespecimen distal to the hematoma.
Intravenous therapy (IV) / blood transfusions - fluid may dilute the specimen, so collectfrom the opposite arm if possible.
Cannula/fistula/heparin lock - hospitals have special policies regarding these devices. Ingeneral, blood should not be drawn from an arm with a fistula or cannula withoutconsulting the attending physician.
Edematous extremities - tissue fluid accumulation alters test results.
Techniques to Prevent Hemolysis (which can interfere with many tests): Mix all tubes with anticoagulant additives gently (vigorous shaking can cause hemolysis) 5-
10 times. Avoid drawing blood from a hematoma; select another draw site. If using a needle and syringe, avoid drawing the plunger back too forcefully. Make sure the venipuncture site is dry before proceeding with draw. Avoid a probing, traumatic venipuncture. Avoid prolonged tourniquet application (no more than 2 minutes; less than 1 minute is
optimal). Avoid massaging, squeezing, or probing a site. Avoid excessive fist clenching. If blood flow into tube slows, adjust needle position to remain in the center of the lumen
56
Facto
rs A
ffecti
ng
Blo
od
Test
Resu
lts
Prop
er s
peci
men
col
lect
ion
and
hand
ling
tech
niqu
es a
re c
ritic
al fo
r acc
urat
e te
st re
sults
. The
follo
win
g ta
ble
sum
mar
izes
err
ors
that
can
occ
ur
in b
lood
spe
cim
en c
olle
ctio
n an
d ha
ndlin
g.
Blo
od C
olle
ctio
n or
H
andl
ing
Tech
niqu
e Po
tent
ial E
rror
C
orre
ct P
roce
dure
N
ot a
llow
ing
alco
hol t
o ai
r dry
af
ter c
lean
sing
the
veni
punc
ture
site
The
intro
duct
ion
of a
lcoh
ol in
to th
e sp
ecim
en m
ay c
ause
he
mol
ysis
. Al
low
alc
ohol
to c
ompl
etel
y ai
r dry
on
skin
be
fore
dra
win
g th
e sa
mpl
e.
Not
follo
win
g th
e or
der o
f dr
aw
Con
tam
inat
ion
from
oth
er a
dditi
ves
coul
d in
terfe
re w
ith te
st
resu
lts. P
last
ic o
r gla
ss s
erum
tube
s co
ntai
ning
a c
lot
activ
ator
may
cau
se in
terfe
renc
e in
coa
gula
tion
test
ing.
Alw
ays
follo
w c
orre
ct o
rder
of d
raw
.
Impr
oper
mix
ing,
incl
udin
g in
adeq
uate
mix
ing
or
vigo
rous
ly s
haki
ng tu
be a
fter
colle
ctio
n
Vigo
rous
sha
king
of t
ubes
can
cau
se h
emol
ysis
.
Inad
equa
te m
ixin
g ca
n ca
use
clot
ting
or p
rese
nce
of c
lots
.
Gen
tly in
vert
tube
s th
e sp
ecifi
ed n
umbe
r of
times
imm
edia
tely
afte
r dra
w:
Blue
top
(Sod
ium
citr
ate)
3
to 4
tim
es
Gol
d to
p (S
ST) a
nd re
d to
p 5
tim
es
All o
ther
tube
s (in
clud
ing
light
gr
een/
min
t (PS
T) a
nd la
vend
er
(ED
TA)
8 to
10
times
U
nder
-fillin
g or
ove
r-filli
ng
tube
s
The
ratio
of b
lood
to a
dditi
ve is
alte
red
whi
ch c
an c
ause
in
corr
ect t
est r
esul
ts.
Exam
ples
:
Und
er-fi
lling
blue
top
sodi
um c
itrat
e tu
bes
for c
oagu
latio
nte
stin
g ca
n dr
astic
ally
alte
r res
ults
.
Ove
r or u
nder
-fillin
g bl
ood
cultu
re b
ottle
s ca
n re
sult
infa
lse
nega
tive
resu
lts.
Allo
w tu
be to
com
plet
ely
fill s
o va
cuum
is
exha
uste
d. E
xcep
tion
is b
lood
cul
ture
s: a
llow
th
e re
quire
d am
ount
of b
lood
to e
nter
bot
tle,
usin
g gu
ide
lines
mar
ked
on b
ottle
to
dete
rmin
e fil
l.
For c
orre
ctly
fille
d bl
ue to
p so
dium
citr
ate
tube
s w
hich
con
tain
a li
quid
ant
icoa
gula
nt, t
he
ratio
of b
lood
to a
ntic
oagu
lant
is 9
:1, w
hich
is
impo
rtant
for a
ccur
ate
test
resu
lts.
57
Facto
rs A
ffecti
ng
Blo
od
Test
Resu
lts
Blo
od C
olle
ctio
n or
H
andl
ing
Tech
niqu
e Po
tent
ial E
rror
C
orre
ct P
roce
dure
C
ombi
ning
two
parti
ally
fille
d tu
bes,
or f
illing
one
type
of
tube
from
ano
ther
type
of
tube
If tw
o di
ffere
nt ty
pes
of tu
be a
re u
sed
(e.g
. lav
ende
r top
into
SS
T tu
be),
inco
rrec
t add
itive
s ca
n in
terfe
re w
ith te
st re
sults
.
If th
e sa
me
type
of t
ube
is u
sed,
the
ratio
of b
lood
to
addi
tive
is a
ltere
d w
hich
can
cau
se in
corr
ect t
est r
esul
ts.
Ope
ning
tube
s ca
n ch
ange
the
pH o
f the
spe
cim
en w
hich
m
ay a
ffect
the
stab
ility
of th
e sp
ecim
en a
nd te
st re
sult.
In a
dditi
on, o
peni
ng tu
bes
of b
lood
with
out t
he u
se o
f pr
otec
tive
equi
pmen
t is
a sa
fety
risk
due
to th
e po
ssib
le
prod
uctio
n of
aer
osol
s or
spi
llage
.
Nev
er c
ombi
ne tw
o tu
bes.
If b
lood
sto
ps
flow
ing
into
the
first
tube
bef
ore
adeq
uate
vo
lum
e is
col
lect
ed, c
olle
ct a
new
tube
.
Leav
e tu
be li
ds o
n to
mai
ntai
n st
abilit
y fo
r so
me
test
s.
Usi
ng a
par
tially
fille
d tu
be
whe
n at
tem
ptin
g an
othe
r ve
nipu
nctu
re.
Loss
of v
acuu
m c
an c
ause
insu
ffici
ent d
raw
Del
ay in
mix
ing
sam
ple
may
cau
se c
lotti
ng o
f spe
cim
en.
Alw
ays
use
a ne
w tu
be w
hen
perfo
rmin
g a
seco
nd v
enip
unct
ure.
Leav
ing
tour
niqu
et o
n lo
nger
th
an o
ne m
inut
e Pr
olon
ged
tour
niqu
et a
pplic
atio
n m
ay re
sult
in
hem
ocon
cent
ratio
n an
d er
rone
ousl
y in
crea
sed
leve
ls o
f pr
otei
n ba
sed
anal
ytes
, pac
ked
cell
volu
me,
or o
ther
cel
lula
r el
emen
ts.
Do
not l
eave
tour
niqu
et o
n fo
r lon
ger t
han
one
min
ute;
rem
ove
as s
oon
as p
ossi
ble
afte
r the
bl
ood
begi
ns to
flow
.
Usi
ng a
win
ged
colle
ctio
n de
vice
(but
terfl
y) a
nd n
ot
rem
ovin
g ai
r in
tubi
ng w
hen
blue
top
sodi
um c
itrat
e tu
be
for c
oagu
latio
n is
the
first
tu
be c
olle
cted
Air i
n th
e tu
bing
will
redu
ce th
e am
ount
of b
lood
dra
wn
and
alte
r the
blo
od to
ant
icoa
gula
nt ra
tio, a
nd c
an c
ause
in
corr
ect t
est r
esul
ts.
Use
a d
isca
rd tu
be (e
ither
ano
ther
blu
e to
p so
dium
citr
ate
tube
or a
spe
cial
BD
dis
card
tu
be) t
o re
mov
e th
e ai
r fro
m th
e tu
bing
, bef
ore
colle
ctin
g sp
ecim
en in
to th
e bl
ue to
p tu
be.
Not
usi
ng a
ppro
ved
proc
edur
es fo
r col
lect
ing
from
a
vasc
ular
acc
ess
devi
ce
(VAD
) (no
te: C
LS s
taff
is n
ot
auth
oriz
ed fo
r VAD
co
llect
ion)
Pote
ntia
l con
tam
inat
ion
of s
peci
men
due
to in
adeq
uate
flu
shin
g of
line
or i
mpr
oper
pre
para
tion.
If
colle
ctin
g fro
m v
ascu
lar a
cces
s de
vice
s,
alw
ays
follo
w a
ppro
ved
proc
edur
es.
58
Facto
rs A
ffecti
ng
Blo
od
Test
Resu
lts
Blo
od C
olle
ctio
n or
H
andl
ing
Tech
niqu
e Po
tent
ial E
rror
C
orre
ct P
roce
dure
C
olle
ctin
g be
low
or a
bove
IV
Col
lect
ing
belo
w o
r abo
ve IV
can
lead
to c
onta
min
atio
n or
di
lutio
n of
spe
cim
en w
ith IV
flui
d w
hich
can
cau
se in
corr
ect
test
resu
lts.
The
IV in
fusi
on m
ust b
e tu
rned
off
for a
m
inim
um o
f thr
ee m
inut
es b
efor
e ve
nipu
nctu
re
from
bel
ow o
r abo
ve IV
.
Col
lect
ing
abov
e IV
is o
nly
done
as
a la
st
reso
rt w
hen
all o
ther
site
s ha
ve b
een
rule
d ou
t, an
d re
quire
s si
gned
app
rova
l of p
hysi
cian
or
nurs
e.
Usi
ng s
yrin
ge fo
r col
lect
ing
the
spec
imen
In
corre
ct te
chni
que
may
cau
se h
emol
ysis
whe
n tra
nsfe
rring
bl
ood
into
the
vacu
tain
er tu
be.
Usi
ng s
yrin
ge to
forc
e bl
ood
into
tube
(ins
tead
of a
llow
ing
vacu
um to
dra
w th
e bl
ood)
can
cau
se u
nder
-fillin
g or
ove
r-fil
ling.
Use
blo
od tr
ansf
er d
evic
e or
18
gaug
e ne
edle
to
tran
sfer
blo
od to
tube
. Allo
w tu
be to
dra
w
bloo
d fro
m s
yrin
ge u
ntil
vacu
um is
exh
aust
ed.
Nev
er fo
rce
bloo
d in
to tu
be.
Exce
ssiv
e re
posi
tioni
ng
(pro
bing
) in
and
out o
f vei
n w
ith n
eedl
e
Prob
ing
can
caus
e he
mol
ysis
.
Con
tam
inat
ion
with
inte
rstit
ial f
luid
can
occ
ur if
the
need
le is
no
t com
plet
ely
in th
e ve
in, w
hich
can
cau
se in
corre
ct te
st
resu
lts.
In a
dditi
on, p
robi
ng c
an c
ause
pat
ient
ner
ve in
jury
.
Ensu
re th
e ne
edle
is p
ositi
oned
cor
rect
ly w
ithin
th
e ve
in.
Trau
mat
ic v
enip
unct
ure
(slo
w
draw
) Tr
aum
a ca
n ca
use
hem
olys
is.
Del
ay in
pro
per m
ixin
g m
ay c
ause
clo
tting
of s
peci
men
.
Rec
olle
ctio
n of
spe
cim
en is
reco
mm
ende
d.
Impr
oper
han
dlin
g N
ot h
andl
ing
spec
imen
s pr
oper
ly (e
.g. n
ot p
laci
ng
spec
imen
s fo
r cer
tain
test
s on
ice)
can
cau
se in
corr
ect t
est
resu
lts.
Follo
w th
e ha
ndlin
g re
quire
men
ts fo
r eac
h te
st
stat
ed in
the
CLS
Gui
de to
Ser
vice
s.
59
GENERAL LAB REQUEST FORM
60
Percuma
UNTUK KEGUNAAN MAKMAL
LAB NO.
1. Nama ( HURUF BESAR) 2. No. Pendaftaran:
3. No. K / P :
4. Jantina :
Lelaki perempuan
5. Umur : 6. Keturunan : 7. Wad / No. Katil :
8. Tarikh Masuk Wad : 9. Pekerjaan : 10. Taraf Perkahwinan : 11. Bayar
12. No. Laporan Dahulu : 13. Butiran penting :
YA TIDAK Jaundice Lymphadenopathy Hepatomegaly Spenomegaly Bleeding Tendency H/O Transfusion
Haematinics:
………………………………….…………………………….…
………………………………………………………………..….
Drug / Chemical History: ……………………..………………
……………………………………………………………………
Data Makmal Terdahulu :
Hb: ………………………………………………………………….…
Platelets………………………………………………………………
TWBC: ……………………………………………………….………
14. Ringkasan Klinikal, Penemuan Pembedahan dan Riwayat
Keluarga :
15. Diagnosis :
16. Kategori Permohonan/ Jenis Ujian :
Patologi kimia Klinikal Hematologi Histologi/
Sitologi Mikrobiologi / Imunologi
Bld. Sugar Bld Count FBP Spesimen Spesimen Ujian Bld Urea ESR BM Asp Sr. Electrolite BFMP Hb. Analysis Bld. Gases Ur. Sugar Coagulation Sr. Bilirubin Ur. Albumin LFT Ur. ME Sr. Creatinine Stool ME
Lain-lain:
17 Pengambilan Spesimen: Tarikh :
Masa : am / pm
18. Nama Doktor:
19. Tarikh : ……………………………………….
( Tandatangan & Cop Doktor)
KEMENTERIAN KESIHATAN MALAYSIA
PERKHIDMATAN PATOLOGI
HOSPITAL SULTANAH NORA ISMAIL
BATU PAHAT
KLINIKAL / HEMATOLOGI
Borang Merah
PER – PAT 301
61
Percuma
UNTUK KEGUNAAN MAKMAL LAB NO.
1. Nama ( HURUF BESAR) 2. No. Pendaftaran:
3. No. K / P :
4. Jantina : Lelaki Perempuan
5. Umur : 6. Keturunan : 7. Wad / No. Katil :
8. Tarikh Masuk Wad : 9. Pekerjaan : 10. Taraf Perkahwinan : 11. Bayar
12. No. Laporan Dahulu : 13. Butiran penting :
YA TIDAK Jaundice Lymphadenopathy Hepatomegaly Spenomegaly Bleeding Tendency H/O Transfusion
Haematinics:
………………………………….…………………………….
………………………………………………………………
Drug / Chemical History:
……………………..……………………………………….….
………………………………………………………………….
Data Makmal Terdahulu :
Hb: ……………………………………………………………
Platelets………………………………………………………
TWBC: ……………………………………………………….
14. Ringkasan Klinikal, Penemuan Pembedahan dan Riwayat
Keluarga :
15. Diagnosis :
16. Kategori Permohonan/ Jenis Ujian :
Patologi kimia Klinikal Hematologi Histologi/ Sitologi
Mikrobiologi / Imunologi
Bld. Sugar Bld Count FBP Spesimen Spesimen Ujian Bld Urea ESR BM Asp Sr. Electrolite BFMP Hb. Analysis Bld. Gases Ur. Sugar Coagulation Sr. Bilirubin Ur. Albumin LFT Ur. ME Sr. Creatinine Stool ME
Lain-lain:
17 Pengambilan Spesimen: Tarikh :
Masa : am / pm
18. Nama Doktor:
19. Tarikh : ……………………………………….
( Tandatangan & Cop Doktor)
KEMENTERIAN KESIHATAN MALAYSIA
PERKHIDMATAN PATOLOGI
HOSPITAL SULTANAH NORA ISMAIL
BATU PAHAT
PATOLOGI KIMIA
Borang Biru
PER – PAT 301
62
Percuma
UNTUK KEGUNAAN MAKMAL LAB NO.
1. Nama ( HURUF BESAR) 2. No. Pendaftaran:
3. No. K / P :
4. Jantina : Lelaki Perempuan
5. Umur : 6. Keturunan : 7. Wad / No. Katil :
8. Tarikh Masuk Wad : 9. Pekerjaan : 10. Taraf Perkahwinan : 11. Bayar
12. No. Laporan Dahulu : 13. Butiran penting :
YA TIDAK Jaundice Lymphadenopathy Hepatomegaly Spenomegaly Bleeding Tendency H/O Transfusion
Haematinics:
………………………………….…………………………….
………………………………………………………………
Drug / Chemical History:
……………………..……………………………………….
………………………………………………………………
Data Makmal Terdahulu :
Hb: ………………………………………………………..
Platelets…………………………………………………..
TWBC: ……………………………………………………
14. Ringkasan Klinikal, Penemuan Pembedahan dan Riwayat
Keluarga :
15. Diagnosis :
16. Kategori Permohonan/ Jenis Ujian :
Patologi kimia Klinikal Hematologi Histologi/ Sitologi
Mikrobiologi / Imunologi
Bld. Sugar Bld Count FBP Spesimen Spesimen Ujian Bld Urea ESR BM Asp Sr. Electrolite BFMP Hb. Analysis Bld. Gases Ur. Sugar Coagulation Sr. Bilirubin Ur. Albumin LFT Ur. ME Sr. Creatinine Stool ME
Lain-lain:
17 Pengambilan Spesimen: Tarikh :
Masa : am / pm
18. Nama Doktor:
19. Tarikh : ……………………………………….
( Tandatangan & Cop Doktor)
KEMENTERIAN KESIHATAN MALAYSIA
PERKHIDMATAN PATOLOGI
HOSPITAL SULTANAH NORA ISMAIL
BATU PAHAT
MIKROBIOLOGI /SEROLOGI
Borang hijau
PER – PAT 301
63
Percuma
UNTUK KEGUNAAN MAKMAL LAB NO.
1. Nama ( HURUF BESAR) 2. No. Pendaftaran:
3. No. K / P :
4. Jantina : Lelaki Perempuan
5. Umur : 6. Keturunan : 7. Wad / No. Katil :
8. Tarikh Masuk Wad : 9. Pekerjaan : 10. Taraf Perkahwinan : 11. Bayar
12. No. Laporan Dahulu : 13. Butiran penting :
YA TIDAK Jaundice Lymphadenopathy Hepatomegaly Spenomegaly Bleeding Tendency H/O Transfusion
Haematinics:
………………………………….…………………………….
……………………………………………………………….
Drug / Chemical History:
……………………..……………………………………..….
…………………………………………………………….…
Data Makmal Terdahulu :
Hb: ……………………………………………………………
Platelets………………………………………………………
TWBC: ………………………………………………………
14. Ringkasan Klinikal, Penemuan Pembedahan dan Riwayat
Keluarga :
15. Diagnosis :
16. Kategori Permohonan/ Jenis Ujian :
Patologi kimia Klinikal Hematologi Histologi/ Sitologi
Mikrobiologi / Imunologi
Bld. Sugar Bld Count FBP Spesimen Spesimen Ujian Bld Urea ESR BM Asp Sr. Electrolite BFMP Hb. Analysis Bld. Gases Ur. Sugar Coagulation Sr. Bilirubin Ur. Albumin LFT Ur. ME Sr. Creatinine Stool ME
Lain-lain:
17 Pengambilan Spesimen: Tarikh :
Masa : am / pm
18. Nama Doktor:
19. Tarikh : ……………………………………… ( Tandatangan & Cop Doktor)
KEMENTERIAN KESIHATAN MALAYSIA
PERKHIDMATAN PATOLOGI
HOSPITAL SULTANAH NORA ISMAIL
BATU PAHAT
PER – PAT 301
64
65
66
No. Makmal: BORANG PERMOHONAN TRANSFUSI DARAH
PERKHIDMATAN TRANSFUSI PERUBATAN
(Mesti dipenuhi dalam dua salinan. Tulis dengan pen mata bulat dan sila tandakan √ dalam petak yang berkenaan.) Nama (Tulis huruf besar) No. Kad Pengenalan
No. Daftar
Hospital
Unit Wad Bangsa Umur Jantina
Pegawai Kerajaan Ya/Tidak
Kelas Bayar/Percuma Pakar Perunding Kumpulan Darah Ada/Tiada
Diagnosa
Sebab transfusi komponen darah Hb % atau keputusan lain yg berkaitan (Plt count etc)
Transfusi darah masa lalu? Ya/Tidak
Jika ‘ya’ sebutkan tarikh transfusi darah yang terakhir
Komplikasi?
Sekiranya pesakit seorang wanita, nyatakan →
Bil. kehamilan
Bil. Lahir Mati Tanda-tanda “Haemolytic Disease of Newborn”
Sampel darah diambil dan dilabel oleh: Saya mengesahkan bahawa saya telah mengenalpasti identiti pesakit dengan bertanya secara langsung* dan memeriksa gelang pengenalan pesakit. Saya juga mengesahkan bahawa saya telah mengambil sendiri sampel darah pesakit tersebut dan melabelkannya dengan serta merta sebaik sahaja ianya diambil. Tandatangan ............................................................. Nama ......................................................................... Jawatan…………………………………………………. Tarikh................................Waktu........................pagi/petang * (atau ahli keluarga / penjaga untuk kes-kes pediatrik dan pesakit yang tidak sedarkan diri)
Units/ mls
WHOLE BLOOD ......................................... PACKED CELLS ........................................ PAEDIPACK ……………………………….. PLATELET CONCENTRATE .................... CRYOPRECIPITATE .................................. FRESH FROZEN PLASMA ........................ CRYOSUPERNATANT……………………...
SPECIAL REQUIREMENT : WASHED............................ FILTERED………………… IRRADIATED…………….. OTHERS : ……………… GROUP, SCREEN & HOLD
Nota: - (1) Sila hantarkan 3ml-5ml sampel darah dalam tiub EDTA. Untuk
makluman, ujian keserasian memerlukan masa 2 jam. (2) Dalam keadaan kecemasan, sila hubungi makmal transfusi darah
untuk pembekalan segera berdasarkan keserasian pada peringkat awal ujian. Darah yang dibekalkan mempunyai risiko ketidakserasian yang kecil. Penggunaan darah tersebut merupakan tanggungjawab pegawai perubatan yang merawat.
(3) Darah yang tidak digunakan perlu dipulangkan dengan kadar
segera ke makmal transfusi kecuali Pegawai Perubatan meminta dipanjangkan tempoh simpanannya di wad.
(4) AMARA N: Setiap transfu si da rah memba wa ris iko infek si.
WARNING: Every blood transfu sion carr ies a small risk of infect ion.
Bekalan diperlukan (a) Serta merta, tanpa ujian keserasian darah (safe O)
(untuk menyelamatkan nyawa) (b) Segera (lihat Nota 2)
(c) Pada ……….. jam…………..pg/ptg
(Lihat Nota 3) (d) Sampel disimpan selama 24 jam.
Saya mengesahkan bahawa sampel darah yang disertakan ini telah diambil daripada pesakit bernama seperti di atas dan dilabelkan mengikut prosedur kerja yang telah ditetapkan. Saya juga mengesahkan bahawa setelah diperiksa, pesakit ini memerlukan/ akan memerlukan transfusi darah.
Tandatangan: ............................................................................... Cop dan Nama Pegawai Perubatan: ......................................................................... (Huruf besar)
KHAS UNTUK KEGUNA AN KAKITANGAN MAKMAL TRANSFUSI DARAH
Permintaan diterima
T/Tangan Anti A
Anti B
Anti AB
Sel A
Sel B
Sel O
Rh D
Kump. Darah
T/Tangan Tarikh & masa
Tarikh........................................... Waktu ..................................pg/ptg
Serum pesakit diserasikan dengan beg darah no.
UJIAN KESERASIAN DARAH
Catatan
R.T.
37ºC
AHG
T/Tangan.
Tarikh & masa
PER-SS-BT 105 (Pind. 1 /2016)
67
PS 1/98(Pindaan 2007) KEMENTERIAN KESIHATAN MALAYSIA
No. Sitologi: PERKHIDMATAN PATOLOGI BORANG PERMOHONAN PAP SMEAR
PAP SMEAR REQUEST FORM
Hospital / Klinik
Hospital / Clinic
BUTIRAN PELANGGAN / CLIENT’S BIODATA
i. Nama / Name : v. Alamat :
ii. No Kad Pengenalan / IC. No Address
iii. Etnik / Ethnicity :
iv. Umur / Age : vi. No Telefon: (Rumah/ Home)
Phone No (Pejabat/ Office)
BUTIRAN SARINGAN / SCREENING INFORMATION i. Tarikh sampel diambil: v. No. sitologi terdahulu: Date sample taken Previous cytology No. ii. Jenis Sampel: Conventional Pap Smear vi. No. patologi terdahulu: Type of sample Liquid-based preparation Previous pathology No.
iii. Bahagian sampel diambil: Serviks / cervix vii. Tempat saringan terdahulu: Sample site Vagina / Vagina Place of previous screening iv. Jenis saringan: Pertama / new viii. Keputusan terdahulu: Type of screening Ulangan / repeat Previous diagnosis
RINGKASAN KLINIKAL / CLINICAL SUMMARY i. Status Hormon: Hamil / Pregnant v. Gejala / Tanda: Tiada / Nil Hormonal status Postpartum / Postpartum Symptom / Sign Lelehan dari faraj / Vaginal discharge Pra-menopos / Pre menopausal Pendarahan luar biasa / Abnormal bleeding Pos-menopos / Menopausal Nyatakan / specify :.............................................. ………………………………………………………. ii. Tarikh Haid terakhir: Last menstrual period vi. Serviks : Biasa / Normal Cervix Luar Biasa / Abnormal
ADR / IUCD Tiada serviks / Absent cervix Hormon / Hormone Nyatakan / Specify:.................................................... Tiada / None vii. Maklumat tambahan: ……………………………………………………………..
iii. Kontraseptif /Terapi hormon:
Contraceptive/ hormonal therapy:
Additional information …………………………………………………………….. …………………………………………………………….. iv. Sejarah Rawatan Kemoterapi / Chemotherapy …………………………………………………………….. Treatment history …………………………………………………………….. Radiasi dibahagian pelvik / Pelvic radiation …………………………………………………………….. Nyatakan tarikh akhir rawatan: …………………………………………………………….. Specify completion date:……………………………… Pembedahan ginekologi / Gynaecology surgery Nyatakan / specify:……………………………………. ………………………………………………………….. Tiada / none
MAKLUMAT PEMOHON / REQUESTING PRACTITIONER
Nama : Jawatan / COP: Name Designation / Stamp Tanda Tangan : Signature
68
SECTION ON
GUIDELINES ON SPECIMEN COLLECTION
FOR OUTSOURCE LABORATORY TESTS
69
(INSTRUCTIONS FOR READERS)
This section was created to help clinician in sending outsource tests. All information in this section was
taken from various sources which are true at the time of printing and will be subject to changes. Further
enquiry or clarification on specimen collection and request forms need to be confirmed with respective unit.
Below are few tips to help you navigate through this sections:
1. Test names are listed in alphabetical order. Ignore any numeric and search the tests by using their
first alphabet. For example, ‘5 HIAA (Hydroxy-Indole-Acetic-Acid)’ located under alphabet H, after
‘HHV6 IgM IgG’. Another example is ‘17-Hydroxycorticosteroids’ which located below ‘Hydatid
Serology’.
2. The list is based on test name, not sample types. Refer sample types under Description column. For
example, if you want to find ‘Urine Electrophoresis’, search below alphabet E. This to ensure you
can also find other sample types of Electrophoresis test, eg. ‘Serum Electrophoresis’, ‘CSF
Electrophoresis’, etc.
3. All autoimmune antibodies are listed as a group. All others listed by the disease / pathogen they
target.
4. Tests that have more than one method (For example: Serology, PCR, Immunofluorescence, etc.) are
listed sequentially. Please practice due care in requesting tests to ensure results reflect the patient’s
clinical presentation and progression as well as being cost-efficient.
5. Any test done at private lab is under responsibility of requesting doctor and need to contact person-
in-charge personally. Payment of the test or specimen delivery by post to be bare by the patient.
Pathology department will ONLY assist on specimen packing (if needed).
6. All information are subject to changes. Further clarification on specimen collection and request
forms need to call respective unit.
Lastly, we hope this section will help in improving the pathology service and management of patient care.
Any comments to improve this book are always welcomed.
PATHOLOGY DEPARTMENT HOSPITAL SULTANAH NORA ISMAIL BATU PAHAT
70
LIST OF OUTSOURCE TESTS
PREREQUISITE FOR SPECIALIST OR MEDICAL OFFICER SINGNATURE
A SPECIAL FORM/OTHER OUTSOURCE LAB
A1AT (Alpha-1-Antitrypsin) Genotyping SERPINA1 nuclear gene sequence
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
ABL1 (other name BCR/ABL1; bcr-abl oncogene; BCR-ABL Kinase Domain Mutation Analysis)
Test by appointment. Special Hematology Lab Requisition with contact no. on the form.
Clinical Hematology Lab, Hospital Ampang
Acetylcholine Receptor Antibody PERPAT 301 (2 copies). Allergy & Immunology, IMR
Acid Alpha Glucosidase Refer to : IEM : Acid Alpha Glucosidase
Activated Protein C Resistance Refer to Thrombophilia Profile
Acute Flaccid Paralysis (AFP) Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
Acyl Carnitine Refer to IEM : Acyl Carnitine
Adenovirus IF antigen detection PERPAT 301 (2 copies). For all Serology, HSAJB
Adenovirus PCR PERPAT 301 (2 copies). For baby only Virology, IMR
Adenovirus Serology PERPAT 301 (2 copies). Virology, IMR
Adrenocorticotrophic Hormone (A.C.T.H) PERPAT 301 (2 copies). Biochemistry Unit, HKL
Alagille Syndrome (JAG1) nuclear gene sequence & deletion/ duplication PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Alcohol Blood Kimia 15 Pin. 1/2004 form Chemistry Department, JB
Aldosterone PERPAT 301 (2 copies). Request by specialist only Endocrine, Hosp. Putrajaya
Allergy Testing (RAST) - Specific IgE & Total IGE PERPAT 301 (2 copies). Allergy & Immunology, IMR or
Microbiology, HKL
Alpha feto protein (AFP) PERPAT 301 (Blue) Biochemistry, HSNI
Alpha-1-Antitrypsin PERPAT 301 (2 copies). Molecular Diagnostic, IMR or Drug Lab, HKL
Amebiasis Antibody (Serology) PERPAT 301 (2 copies). Parasitology, IMR
Ammonia PERPAT 301 (2 copies). Test by appointment with lab. Biochemistry, HSAJB
Ammonium chloride (for urinary acidification) PERPAT 301 (2 copies). Core Lab or Paed Lab, HKL
AMT (tetrahydrofolate requiring aminomethyltransferase) mutation nuclear gene sequence
- Non Ketotic Hyperglycinemia (deficiency of the glycine cleavage multi-enzyme system)
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Androstenedione or 17-ketoestosterone or 17-ketosteroid PERPAT 301 (2 copies). Biochemistry, HSAJB
Angelman Syndrome UBE3A nuclear gene sequence & deletion/ duplication PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Angiotensin Converting Enzyme Respective Private Lab form Private Laboratory ANT1 (adenine nucleotide translocase type 1) nuclear gene sequence - Mitochondrial Depletion Syndrome
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Antibody Identification call HSNI Blood Bank's Doctor for appointment
Blood Bank, HSAJB or Pusat Darah Negara (PDN)
Apolipoprotein Ciii PERPAT 301 (2 copies). Molecular Diagnostic, IMR Aquaporin 4 Antibody (Anti-Aq4) PERPAT 301 (2 copies). Allergy & Immunology, IMR Arboviruses PCR PERPAT 301 (2 copies). Virology, IMR ASL (Argininosuccinic acid lyase) nuclear PERPAT 301 (2 copies). Molecular Diagnostic, IMR
71
gene sequence - Urea Cycle Disorder Aspergillus Antigen or galactomannan PERPAT 301 (2 copies). Bacteriology, IMR ASS1 (Argininosuccinic acid synthetase) nuclear gene sequence - Urea Cycle Disorder
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
AUTOANTIBODIES FOR AUTOIMMUNE DISEASES PERPAT 301 (2 copies).
Anti-acetylcholine receptor antibodies Allergy & Immunology, IMR Anti-smooth muscle antibody Allergy & Immunology, IMR Anti-Parietal cell antibodies Allergy & Immunology, IMR Anti-Mitochondrial antibodies Allergy & Immunology, IMR Anti-Neutrophil Cytoplasmic antibodies: P-ANCA / C-ANCA Allergy & Immunology, IMR
Anti-Liver Kidney Microsome antibodies (anti-LKM) Allergy & Immunology, IMR
Anti-Cardiolipin Antibody (IgM & IgG) Allergy & Immunology, IMR Anti-Glomerular Basement Membrane Allergy & Immunology, IMR Anti-Cyclic Citrullinated Protein (CCP) Allergy & Immunology, IMR Coeliac antibodies:
i) Anti-Endomysium ii) Anti-Gliadin iii) Anti-Tissue Transglutaminase
Allergy & Immunology, IMR
Anti-Aquaporin 4 (AQ-4) Allergy & Immunology, IMR Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Allergy & Immunology, IMR
Paraneoplastic Neurological Syndrome Antibodies:
i) Anti-Ma ii) Anti-Yo iii) Anti-Ri iv) Anti-Hu v) Anti-Amphiphysin, vi) Anti-CV2
Allergy & Immunology, IMR
Skin antibodies for Pemphigoid & pemphigus disease:
- Anti-BP180 Anti-BP230 Allergy & Immunology, IMR
Skin antibodies for Pemphigoid & pemphigus disease: - Anti-Desmoglein 1 & 3
Allergy & Immunology, IMR
Ganglioside antibodies (Multifocal motor neuropathy Guillain-Barre Syndrome):
i) Anti-GM1 ii) Anti-GM2 iii) Anti-GM3 iv) Anti-GD1a v) Anti-GD1b vi) Anti-GT1b vii) Anti-GQ1b
Request in a single form Allergy & Immunology, IMR
Specific liver antibodies (Primary biliary cirrhosis):
i) Anti-AMA-M2 ii) Anti-M2-3E/BPO iii) Anti-SP100 iv) Anti-PML v) Anti-gp120
Allergy & Immunology, IMR
Specific liver antibodies (Autoimmune hepatitis):
i) Anti-LKM1 ii) Anti-LC-1 iii) Anti-SLA/LP iv) Anti-Ro-52
Allergy & Immunology, IMR
72
B SPECIAL FORM/OTHER OUTSOURCE LAB
B & T cell Rearrangement Special Hematology Lab Requisition.
Clinical Hematology Lab, Hospital Ampang
Babesiosis PERPAT 301 (2 copies). Parasitology Unit, IMR Basement Membrane Antibody Pemphigoid Antibody Respective Private Lab form Private Laboratory
BCR/ABL1 (other name BCR/ABL1; bcr-abl oncogene; BCR-ABL Kinase Domain Mutation Analysis)
Special Hematology Lab Requisition.
Clinical Hematology Lab, Hospital Ampang
Beta 2 Glycoprotein 1 (B2GP1) Antibody Refer to Thrombophilia Profile
Beta-2 Microglobulin PERPAT 301 (2 copies). Molecular Diagnostic, IMR Biotinidase enzyme Refer to IEM : Biotinidase Enzyme BK Virus PCR PERPAT 301 (2 copies). Virology, HKL BNP (B Type Natriuretic Peptide) Respective Private Lab form Private Laboratory
Bone Marrow Aspiration PERPAT 301 (2 copies). Test by appointment.
Hematology, HSAJB or Hematology, HKL
Bone Marrow Trephine PERPAT 301 (2 copies). Test by appointment.
Hematology, HSAJB or Hematology, HKL
Bone Marrow Trephine Biopsy PERPAT 301 (2 copies). Test by appointment.
Hematology, HSAJB or Hematology, HKL
Bordetella pertussis C&S PERPAT 301 (2 copies). Microbiology, HSAJB or Bacteriology, IMR
Bordetella pertussis PCR PERPAT 301 (2 copies). MKAK Sungai Buloh or Bacteriology, IMR
Borrelia burgdorferi Serology PERPAT 301 (2 copies). Bacteriology, IMR
Brucella Antibody (Serology) Special Brucellosis form (IMR/IIDRC/BACT/BRUCE/01) Bacteriology, IMR
Brucella C&S (Confirmation) Special Brucellosis form (IMR/IIDRC/BACT/BRUCE/01) Bacteriology, IMR
Brucella PCR Special Brucellosis form (IMR/IIDRC/BACT/BRUCE/01) Bacteriology, IMR
Burkholderia pseudomallei Antibody (Melioidosis) PERPAT 301 (2 copies). Bacteriology, IMR
73
C SPECIAL FORM/OTHER OUTSOURCE LAB
C- Peptide (C-Terminal Insulin) PERPAT 301 (2 copies). Core Lab, HKL C1 / Esterase Inhibitor Respective Private Lab form Private Laboratory Ca 125 PERPAT 301 (Blue) Biochemistry, HSNI Ca 15.3 PERPAT 301 (2 copies). Drug Lab, HKL Ca 19.9 PERPAT 301 (2 copies). Drug Lab, HKL Caeruloplasmin (Copper Oxide) PERPAT 301 (2 copies). Drug Lab, HKL Caffeine Respective Private Lab form Private Laboratory
Calcitonin Respective Private Lab form Private Laboratory
Calculi Analysis (Kidney Stone) PERPAT 301 (2 copies). Core Lab, HKL or Biochemistry, HSAJB
Candida Antigen (Candida Mannan Ag) PERPAT 301 (2 copies). Bacteriology, IMR
Carcino embryonic antigen (CEA) PERPAT 301 (Blue) Biochemistry, HSNI Carcinoid Syndrome (5 HIAA) 5-Hydroxy indole Acetic Acid PERPAT 301 (2 copies). Biochemistry, IMR
Cardiolipin Antibody (ACA) PERPAT 301 (2 copies) or Refer Thrombophilia Profile for PDN
Allergy & Immunology, IMR or Pusat Darah Negara (PDN)
Carnitine Refer to IEM : Total & Plasma Carnitine
Cat Scratch Disease Antibody (Bartonella henselae) PERPAT 301 (2 copies). Bacteriology, IMR
Catecholamine PERPAT 301 (2 copies). Hosp. Putrajaya or Core Lab, HKL
CBFB/MYH11
Special Hematology Lab Requisition. Test by appointment. Request by Specialist only
Clinical Hematology Lab, Hospital Ampang
CBS (Cystathionine β-synthase) nuclear gene sequence - Homocystinuria
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
CD3 PERPAT 301 (2 copies). Test by appointment. Hematology, HSAJB
CD34 PERPAT 301 (2 copies). Test by appointment. Request by Specialist only
Hematology, HSAJB
CD4 & CD8
PERPAT 301 (2 copies). Test by appointment. Hematology, HSAJB
CDG (congenital disorder of glycosylation) Genotyping DNA mutational analysis PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Celiac Antibodies: Anti-Endomysium PERPAT 301 (2 copies). Allergy & Immunology, IMR Celiac Antibodies: Anti-Gliadin PERPAT 301 (2 copies). Allergy & Immunology, IMR Celiac Antibodies: Anti-Tissue Transglutaminase (tTG) PERPAT 301 (2 copies). Allergy & Immunology, IMR
Chicken Pox (Varicella / Herpes Zoster) Antibody Refer to Varicella Zoster
Chikungunya IgM / IgG PERPAT 301 (2 copies). MKAK Sungai Buloh
Chitotriosidase Refer to IEM : Plasma/serum Chitotriosidase
Chlamydia Antibodies (pneumonia, trachomatis, psittacii) PERPAT 301 (2 copies). HPSF, Muar or
Serology, HSAJB
Chlamydia IF (antigen) PERPAT 301 (2 copies). Serology, HSAJB or Microbiology HKL
Cholinesterase PERPAT 301 (2 copies). Biochemistry, HSAJB
Chromosome Analysis (Peripheral Blood)
Use Cytogenetics Request Form HKL/HA/TPM/N-1-(1) Test by appointment. Request by Specialist only
Hematology, HKL
74
Chromosome Analysis (Fanconi’s anaemia)
PERPAT 301 (2 copies). Test by appointment. Accompanied with a control sample Matched for age and sex is required
Hematology, IMR
Chromosome Analysis (Turner Syndrome)
LPPKN form Test by appointment. LPPKN (Private Lab)
Chromosome Analysis / cytogenetic (Leukemia or myelodisplasia)
GENETICS request form (2 copies). Test by appointment. Hematology, IMR
Chronic Granulomatous Disease (CGD) Refer to Flow Cytometry detection of gp91-phox for Chronic Granulomatous Disease (CGD)
Citrin Deficiency 1. Screening 2. Large Insertion/deletion DNA mutational analysis
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Clostridium Difficile (C&S) PERPAT 301 (2 copies). Microbiology, HKL Clostridium Difficile (Toxin A&B) PERPAT 301 (2 copies). Microbiology, HSAJB
Cold Agglutination call HSNI Blood Bank's Doctor for appointment Blood Bank, HSAJB
Copper (Cu) PERPAT 301 (2 copies). Toxicology, IMR Corpophophyrin Refer to IEM: Corpophophyrin Coxiella Serology (Q Fever) PERPAT 301 (2 copies). Bacteriology, IMR Coxsackie Virus Antibodies PERPAT 301 (2 copies). Virology, IMR CPEO (Chronic progressive external ophthalmoplegia) - Mitochondrial diseases
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
CPS1 (Carbamyl phosphate synthase I) nuclear gene sequence - Urea Cycle Disorder
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
CPT1A (carnitine palmitoyltransferase) Deficiency nuclear gene sequence
- hypoketotic hypoglycemia PERPAT 301 (2 copies). Molecular Diagnostic, IMR
CPTII (Carnitine palmitoyltransferase II) Deficiency nuclear gene sequence - hypoketotic hypoglycemia
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Creatine kinase Isoenzyme (CK-MB) PERPAT 301 (2 copies). Core Lab, HKL
Cryoglobulin PERPAT 301 (2 copies). Test by appointment
Molecular Diagnostic, IMR or Hematology, HKL
Cryptosporidium Stain (modified ZN stain) PERPAT 301 (2 copies). Core Lab, HKL
Cyclic Citrullinated Peptides (CCP) antibody PERPAT 301 (2 copies). Allergy & Immunology, IMR
Cysticercosis antibody Refer to Taeniasis Serology Cystine Refer to IEM: Urine Cystine
Cytology (FNAC / Aspirate / Fluid) PERPAT 301 (2 copies) with relevant clinical data. HPSF, Muar
Cytology (Pap smear) Pap Smear Request form PS 1/98 Pindaan 2007 with relevant clinical data.
HPSF, Muar
Cytomegalovirus CMV DNA PCR (qualitative)
Obtain permission from Lab first. PERPAT 301 (2 copies). Request by Specialist only with full justifications.
Hospital Sungai Buloh
Cytomegalovirus CMV DNA PCR (quantitative)
PERPAT 301 (2 copies). Request by Specialist only with full justifications.
Virology, HKL
Cytomegalovirus CMV IgG, IgM PERPAT 301 (2 copies). Serology, HSAJB or Virology, HKL
Cytomegalovirus Isolation Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
75
D SPECIAL FORM/OTHER OUTSOURCE LAB
D Titre Antibody call HSNI Blood Bank's Doctor for appointment Blood Bank, HSAJB
D-ALA (Delta Amino Levulinic Acids) PERPAT 301 (2 copies). Dengue (Serotype & PCR) Dengue Serotyping Request form MKAK Sungai Buloh
Dengue RNA PCR (qualitative) PERPAT 301 (2 copies). Test by appointment, Request by Specialist only
Virology, IMR
DGUOK (Deoxyguanosine Kinase Deficiency) nuclear gene sequence - Mitochondrial Depletion Syndrome
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
DHEAS (Dehydroepiondosterone Sulphate) PERPAT 301 (2 copies). Diabetes & Endocrine, IMR
DHP Deficiency (Dihydropyrimidinase deficiency) nuclear gene sequence PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Diabetes mellitus antibodies: i) Anti-Glutamic Acid Decarboxylase (GAD) ii) Anti Islet Cells iii) Anti-Insulinoma-Associated iv) Antigen 2 (IA2) v) Anti-Insulin
PERPAT 301 (2 copies). Request in a single form is possible provided blood volume is sufficient
Allergy & Immunology, IMR
Diphtheria Toxin PCR PERPAT 301 (2 copies). Test by appointment and for surveillance only.
Bacteriology, IMR
Diuretic Hormone Antibody (ADH) Respective Private Lab form Private Laboratory
DNA Analysis Beta globin gene
PERPAT 301 (2 copies). Test by appointment. Complete request form - Please indicate whether patient is
thalassemia major or intermediate. - Patient and Parents’ FBP/ FBC &
Hb Analysis results
Hematology, IMR
DNA Analysis α globin gene (α-thalassemia 1 / 2)
PERPAT 301 (2 copies). Test by appointment with Medical indications:
i. Red cell indices (Mean cell volume and/or Mean cell hemoglobin) below the normal range.
ii. History of a hydrops fetalis baby. iii. Family history of thalassemia iv. Spouse is a thalassemia carrier v. Clinical features of thalassemia vi. Anemia
Hematology, HKL
DNA Extraction & Quantitation DNA mutational analysis
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Down Syndrome Screen Refer to Triple Test DPD (Deoxypyridinoline – D) Part Of Osteoporosis Screen Respective Private Lab form Private Laboratory
76
E SPECIAL FORM/OTHER OUTSOURCE LAB
Echinococcosis Serology PERPAT 301 (2 copies). Parasitology, IMR Echovirus (Enteric Cytopathic Human Orphan) IgM - Genus : Enterovirus
PERPAT 301 (2 copies). MKAK Sungai Buloh
Electrophoresis (protein) Request Form for Multiple Myeloma and Related Disorder Molecular Diagnostic, IMR
ENA (Extractable Nuclear Antigen) specific antibodies:
i) Anti –SSA/Ro ii) Anti SSB/La iii) Anti-Sm iv) Anti-U1RNP v) Anti-Jo1 vi) Anti-Scl-70/Topoisomerase 1 vii) Anti-centromere
PERPAT 301 (2 copies). Allergy & Immunology, IMR
Entamoeba Histolytica (Antibody / PCR) PERPAT 301 (2 copies). Parasitology, IMR
Enterovirus (Pan Entero & EV-71) RT-PCR PERPAT 301 (2 copies). MKAK Sungai Buloh
Enterovirus IF (antigen detection) PERPAT 301 (2 copies). Virology, HKL
Enterovirus Screening Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
Epilepsy (SCN1A) nuclear gene sequence PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Epstein Bar Virus Antibodies IgG, IgM VCA Only PERPAT 301 (2 copies). Serology, HSAJB, or
Virology, HKL
Epstein Bar Virus Antibody IgA VCA/EA PERPAT 301 (2 copies). Serology, HSAJB, or Virology, HKL
Erythropoietin or Hematopoietin Respective Private Lab form Private Laboratory Esterase Inhibitor Respective Private Lab form Private Laboratory
Estradiol / Estrogen PERPAT 301 (2 copies). Biochemistry, HSAJB
ETHE-1 DNA mutational analysis (Ethylmalonic encephalopathy) PERPAT 301 (2 copies). Molecular Diagnostic, IMR
77
F SPECIAL FORM/OTHER OUTSOURCE LAB
Factor 5 Von Willebrands (coagulation) Refer to Hemophilia Screening
Factor 8 & 9 Assays (coagulation) PERPAT 301 (2 copies). Test by appointment. Hematology, HSAJB
Factor V Leiden Refer to Thrombophilia Profile Ferric Cl PERPAT 301 (2 copies). Biochemistry, HSAJB
Fetal Hemoglobin PERPAT 301 (2 copies). Test by appointment.
Hematology, HSAJB or Hematology, HKL
Fibrinogen Concentration Refer to Thrombophilia Profile Filariasis Antibody (Serology) PERPAT 301 (2 copies). Parasitology, IMR FISH Cytogenetic FISH Molecular Cytogenetics BCL-ABL, FISH Molecular Cytogenetics APML-RARA
Test by appointment. Special Hematology Lab Requisition.
Hospital Ampang
Flow Cytometry (Leukemia/Lymphoma/ Myeloma, PNH, CD34, TBNK)
Special Hematology Lab Requisition.
Clinical Hematology Lab, Hospital Ampang
Flow Cytometry detection of gp91-phox for Chronic Granulomatous Disease (CGD)
Special Hematology Lab Requisition. Control is required.
Allergy & Immunology, IMR, Hematology, Hospital Ampang
FLT3/ NPM (nucleolar phosphoprotein B23 or numatrin) mutation
Special Hematology Lab Requisition.
Clinical Hematology Lab, Hospital Ampang
FNAC (Fine Needle Aspiration Cytology) Refer to Cytology
Folate PERPAT 301 (2 copies). Biochemistry, HSAJB
Fragile-X syndrome FRAX A, FRAX A&E, FRAX E PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Free Light Chain (Kappa : Lambda) Ratio PERPAT 301 (2 copies). Biochemistry, Hospital Ampang
Fructosamine PERPAT 301 (2 copies) with complete patient’s history Biochemistry, Hospital Ampang
Fungal DNA PCR PERPAT 301 (2 copies). Bacteriology, IMR
78
G SPECIAL FORM/OTHER OUTSOURCE LAB
GAA (Acid Alpha Glucosidase) nuclear gene sequence - glycogen storage disease type II or
Pompe diseases
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Galactomannan Aspergillus Ag PERPAT 301 (2 copies). Bacteriology, IMR
Galactose Total &GALT Refer to IEM : Total Galactose & GALT
Galactosidase Refer to IEM : Alpha Galactosidase Galatosemia Screen (For Neonates) Guthrie-Phenylalanine For PKU Refer to IEM : Amino Acid Disorder
Gastric Parietal Cell Antibody Refer to Triple Antigen Test GCDH (Glutaric Aciduria type 1) nuclear gene sequence PERPAT 301 (2 copies). Molecular Diagnostic, IMR
GCSH mutation nuclear gene sequence - Non Ketotic Hyperglycinemia (deficiency of the
glycine cleavage multi-enzyme system) PERPAT 301 (2 copies). Molecular Diagnostic, IMR
GFM1 (Elongation factor G 1, mitochondrial) nuclear gene sequence - cause of early fatal progressive
hepatoencephalopathy diseases
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
GLDC mutation nuclear gene sequence - Non Ketotic Hyperglycinemia (deficiency
of the glycine cleavage multi-enzyme system)
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Glomerular Basement Membrane (GBM) Antibody (Goodpasture’s syndrome) PERPAT 301 (2 copies). Allergy & Immunology, IMR
Glucosidase Alpha Refer to IEM : Acid Alpha Glucosidase
Glutamic Acid Decarboxylase Antibody Refer to diabetes antibodies : GAD
Glycosaminoglycan (GAG) Refer to IEM : Urine Glycosaminoglycan
Growth Hormone PERPAT 301 (2 copies). Diabetes & Endocrine, IMR
79
H SPECIAL FORM/OTHER OUTSOURCE LAB
H Inclusion PERPAT 301 (2 copies). Test by appointment. Hematology, HSAJB,
H1N1 PCR Test PERPAT 301 (2 copies). H1N1 Lab, HSAJB HADH nuclear gene sequence (Short Chain 3-Hydroxy acyl CoA Dehydrogenase) - familial hyperinsulinemic hypoglycemia
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
HADHA nuclear gene sequence (Long Chain 3-Hydroxy acyl CoA Dehydrogenase) PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Haemochromatosis Gene Studies (HFE Gene) Respective Private Lab form Private Laboratory
Haemoglobin Analysis (Hb Electrophoresis) – For Thalassaemia
Hematology Request Form (PPDK 11). Test by appointment.
Hematology, HSAJB
Haemoglobin F (quantitative) PERPAT 301 (2 copies). Test by appointment. Hematology, HKL
Haemosiderine PERPAT 301 (2 copies). Test by appointment. Biochemistry, HSAJB
Hams Test (Sucrose Lysis Screen) PERPAT 301 (2 copies). Test by appointment.
Hematology, HSAJB or Hospital Ampang
Hand Foot And Mouth Disease (HFMD) National Enterovirus Surveillance Diagnostic Request Form Virology, MKAK Sungai Buloh
Haptoglobin PERPAT 301 (2 copies). Drug Lab, HKL
Heinz Bodies PERPAT 301 (2 copies). Test by appointment. Hematology, HKL
Helicobacter C&S PERPAT 301 (2 copies). Microbiology, HSAJB Helminth Microscopy PERPAT 301 (2 copies). Parasitology, IMR
Hemophilia Screening PERPAT 301 (2 copies). Test by appointment. Pusat Darah Negara
Hepatitis A Antibody (IgM / Total / Confirmation) PERPAT 301 (2 copies). Serology, HSAJB
Hepatitis B DNA (qualitative PCR) PERPAT 301 (2 copies). Request by specialist only. Full history, findings & justification needed.
Virology, HKL
Hepatitis B DNA (quantitative PCR) Viral Load Virology, HKL
Hepatitis B Confirmation PERPAT 301 (2 copies). Serology, HSAJB Hepatitis B Core Antibody Total PERPAT 301 (2 copies). Serology, HSAJB Hepatitis B Core Antibody IgM PERPAT 301 (2 copies). Serology, HSAJB Hepatitis B e Antibody (HBeAb) PERPAT 301 (2 copies). Serology, HSAJB Hepatitis B e Antigen (HbeAg) PERPAT 301 (2 copies). Serology, HSAJB
Hepatitis C RNA (qualitative PCR)
PERPAT 301 (2 copies). Request by specialist only. Full history, findings & justification needed.
Virology, HKL
Hepatitis C RNA (quantitative PCR) Viral Load PERPAT 301 (2 copies). Virology, HKL
Hepatitis C Auto-LIA Confirmatory test PERPAT 301 (2 copies). Test is run for positive non-high risk patients only.
Serology, HSAJB
Hepatitis C Genotyping Respective Private Lab form Private lab Herpes Simplex Virus PCR / Isolation
PERPAT 301 (2 copies). Full history, findings & justification needed.
Virology, MKAK Sungai Buloh
Herpes Simplex Virus 1&2 IF (antigen detection) PERPAT 301 (2 copies). Serology, HSAJB
Herpes Simplex Virus 1&2 IgG/IgM PERPAT 301 (2 copies). Serology, HSAJB or Virology, MKAK
Herpes Zoster / Varicella Antibodies (IgG/IgM) Refer to Varicella Zoster
80
HHV6 IgM IgG Human Herpes Virus 6A and 6B
Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
5 HIAA (Hydroxy-Indole-Acetic-Acid) IEM Form Biochemistry, IMR
Histopathology (HPE) PERPAT 301 (2 copies) with relevant clinical data. HPSF, Muar
Histoplasma Antibody PERPAT 301 (2 copies). Bacteriology, IMR
HIV Auto-LIA Confirmatory Test PERPAT 301 (2 copies). Test is run for positive non-high risk patients only
Serology, HSAJB
HIV Confirmation (I/II) Western Blot Assay PERPAT 301 (2 copies). Virology, IMR
HIV RNA (quantitative PCR) Viral Load
PERPAT 301 (2 copies). Request by specialist only To include CD4 count and previous viral load result
Serology, HSAJB
HIV-cDNA PCR PERPAT 301 (2 copies). For Baby < 18 months Virology, IMR
HLA B27/ HLA B5 Request for HLA B27/B5 form Test by appointment Transplantation Immunology, IMR
HLA Typing (Molecular Class I and II) for Bone marrow and solid organ transplantation
PERPAT 301 (2 copies). Test by appointment Transplantation Immunology, IMR
HLA Cross matching PERPAT 301 (2 copies). Test by appointment Transplantation Immunology, IMR
HLA Antibody Screening / Antibody Detection PERPAT 301 (2 copies). Transplantation Immunology, IMR
Hollander test (pH) PERPAT 301 (2 copies). Test by appointment Core Lab, HKL
Homocysteine PERPAT 301 (2 copies). Core Lab, HKL Human Papilloma Virus PCR & Culture PERPAT 301 (2 copies). Virology, IMR Hydatid Serology Refer to Echinococcosis 17-Hydroxycorticosteroids Respective Private Lab form Private Laboratory 17-Hydroxyprogesterone PERPAT 301 (2 copies). Diabetes & Endocrine, IMR HTLV (1 & 2) Human T-Cell Lymphotropic Virus 1&2 Confirmatory by Immunoblot
PERPAT 301 (2 copies). Test by appointment Virology, HKL
HTLV (1 & 2) Human T-Cell Lymphotropic Virus 1&2 Antibodies
PERPAT 301 (2 copies). Test by appointment
Virology, HKL or Virology, IMR
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I SPECIAL FORM/OTHER OUTSOURCE LAB
Anti-Insulinoma-associated antigen 2 (IA2) Refer Diabetes mellitus antibody IGF1 (Insulin Like Growth Factor 1) PERPAT 301 (2 copies). Diabetes & Endocrine, IMR
INBORN ERROR METABOLISM (IEM)
Must be accompanied by IEM request form, completed with full clinical details and current drug therapy.
IEM1) Ammonia Biochemistry, HSAJB
IEMST1) Amino Acid spot test Biochemistry, IMR
IEMST2) Acyl Carnitine spot test Biochemistry, IMR
IEMST3) Total Galactose & GALT spot test Biochemistry, IMR
IEMST4) Biotinidase enzyme spot test Biochemistry, IMR
IEM : AMINO ACID DISORDER (IEMAA)
Must be accompanied by IEM request form, completed with full clinical details and current drug therapy.
IEMAA1) Plasma / serum amino acids Biochemistry, IMR
IEMAA2) Urine amino acids Biochemistry, IMR
IEMAA3) CSF amino acids Biochemistry, IMR
IEMAA4) Urine Orotic acids Biochemistry, IMR
IEMAA5) Plasma Homocysteine Biochemistry, IMR
IEMAA6) Urine Cystine Biochemistry, IMR
IEMAA7) Urine Homocystine Biochemistry, IMR
IEMAA8) Urine sulfocysteine Biochemistry, IMR
IEMAA9) Urinary Pterins Biochemistry, IMR
IEM : ORGANIC ACIDURIAS &FATTY ACIDS OXIDATION DEFECTS (IEMOF)
Must be accompanied by IEM request form, completed with full clinical details and current drug therapy.
IEMOF1) Urine Organic acids analysis Biochemistry, IMR
IEMOF2) Urine Succinylacetone Biochemistry, IMR
IEMOF3) Total and free Plasma Carnitine Biochemistry, IMR
IEM : LYSOSOMAL STORAGE DISEASES (IEMLS)
Must be accompanied by IEM request form, completed with full clinical details and current drug therapy.
IEMLS1) Urine GAG/ Glycosaminoglycan Biochemistry, IMR
IEMLS2) Characterization of urinary GAG Biochemistry, IMR
IEMLS3) Plasma /Serum chitotriosidase Biochemistry, IMR
IEMLS4) Alpha Galactosidase Biochemistry, IMR
IEMLS5) Acid Alpha Glucosidase Biochemistry, IMR
IEMLS6) Total and free Sialic Acid Biochemistry, IMR
IEMLS7) Urine oligosaccharide / tetrasaccharide Biochemistry, IMR
IEM : OTHER INBORN ERROR METABOLISM (IEMO)
Must be accompanied by IEM request form, completed with full clinical details and current drug therapy.
IEMO1) Urine Delta ALA Biochemistry, IMR
IEMO2) Urine Porphyrin/ Porphobilinogen/ Corpophophyrin Biochemistry, IMR
82
IEMO1) Plasma VLCFA & Phytanic acids Biochemistry, IMR
IEMO4) Urine 5-HIAA Biochemistry, IMR
Immunoglobulins IgA IgG or IgM PERPAT 301 (2 copies). Molecular Diagnostic, IMR or Biochemistry, HKL
Immunoglobulins IgE (Total & Specific) Refer to Allergy Test
Immunophenotyping for Leukemia/Lymphoma
PERPAT 301 (2 copies). Test by appointment. Hematology, HKL
Indirect Immunoperoxidase for rickettsial (IIP) Serology, HSAJB
Infectious Mononucleosis, Paul Bunnell, Monospot Refer to Epstein Bar Virus
Influenza A / B genome detection PCR Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
Inhibitor Assay PERPAT 301 (2 copies). Test by appointment Hematology, HSAJB
Insulin PERPAT 301 (2 copies). Core Lab, HKL
Insulin G Antibody Refer to Diabetes Antibodies : Anti Insulin G
Intercellular Antibody (Pemphigus) Respective Private Lab form Private laboratory Intrinsic Factor Antibody Respective Private Lab form Private laboratory Islet Cell Antibody Refer to diabetes antibodies : ICA Isospora PERPAT 301 (2 copies). Microbiology, HKL
83
J SPECIAL FORM/OTHER OUTSOURCE LAB
JAK2
Special Hematology Lab Requisition with contact number on the form. Test by appointment.
Clinical Hematology Lab, Hospital Ampang
Japanese Encephalitis IgM, IgG, Antigen Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
Japanese Encephalitis PCR
Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
K SPECIAL FORM/OTHER OUTSOURCE LAB
17-Ketosteroids PERPAT 301 (2 copies). Biochemistry, HSAJB
Karyotyping Cytogenetic Request Form. Test by appointment with HKL Genetic, HKL or Hospital Ampang
Kearn’s Sayre Syndrome PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Kleihauer Tests (For Fetal Cells) PERPAT 301 (2 copies). Test by appointment. Hematology, HSAJB
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L SPECIAL FORM/OTHER OUTSOURCE LAB
Legionella PERPAT 301 (2 copies). Serology, HSAJB Legionella Antibodies PERPAT 301 (2 copies). Serology, IMR
Leigh Syndrome DNA mutational analysis PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Leishmaniasis Microscopy PERPAT 301 (2 copies). Parasitology, IMR Leishmaniasis PCR PERPAT 301 (2 copies). Parasitology, IMR Leishmaniasis Serology PERPAT 301 (2 copies). Parasitology, IMR
Leptospirosis (Culture) MKAK Laboratory Request Form MKAK Sungai Buloh
Leptospirosis (MAT) MKAK Laboratory Request Form MKA JB
Leptospirosis DNA PCR IMR Leptospirosis request form Bacteriology, IMR
Lesch Nyhan Syndrome Mutation analysis & X inactivation analysis PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Leucocytes Alkaline Phosphase Score (LAP Score)
PERPAT 301 (2 copies). Test by appointment Hematology, HSAJB
Leukemia Immunophenotyping PERPAT 301 (2 copies). Test by appointment Hematology, HSAJB
Leukemia molecular diagnostic PERPAT 301 (2 copies). Test by appointment. Request by Specialist only.
Hematology, HKL
Leukemia Translocation Studies (RT-PCR)
PERPAT 301 (2 copies). Haematology, IMR
LHON (Leber’s hereditary optic neuropathy) DNA mutational analysis
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Lipase Respective Private Lab form Private Laboratory
Lipoprotein A / LP (A) PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Lipoprotein Electrophoresis PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Lithium PERPAT 301 (2 copies).
Hospital Permai, JB
Liver Kidney Microsome (LKM) Auto Antibody
PERPAT 301 (2 copies). Allergy & Immunology, IMR
Lupus Anticoagulant PERPAT 301 (2 copies). Test by appointment Hematology, HSAJB
Lyme Disease IgG, IgM Refer to Borrelia burgdorferi
Lymphocyte Transformation Test PERPAT 301 (2 copies). Test by appointment Allergy & Immunology, IMR
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M SPECIAL FORM/OTHER OUTSOURCE LAB
Malaria Antibody (Serology) PERPAT 301 (2 copies). Parasitology, IMR
Malaria PCR
PERPAT 301 (2 copies). - For Mortality case - For confirmation of P. malariae - If clinically indicated malaria but BFMP showed negative
MKAJB or Parasitology, IMR
May Grunwald Giemsa stain (Bone Marrow)
PERPAT 301 (2 copies). Test by appointment Hematology, HSAJB
Measles IgG/IgM & Antigen Detection MEASLES – Borang Permohonan & Ujian Makmal MKAK Sungai Buloh
Measles IgG/IgM only PERPAT 301 (2 copies). Serology, HSAJB
MELAS (Mitochondrial myopathy, encephalomyopathy, lactic acidosis, stroke-like symptoms) DNA mutational analysis
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
MERRF (Myoneurogenic gastrointestinal encephalopathy) DNA mutational analysis
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Methaemoglobin PERPAT 301 (2 copies). Test by appointment Hematology, HKL
Microfilaria Antibodies Refer to filariasis serology Microglobulin – (Beta 2) Refer to Beta 2 microglobulin Microsomal Antibodies (AMC) or TPO antibodies
PERPAT 301 (2 copies). Serology, HSAJB
Mitochondrial Antibodies (AMA) for primary biliary cirrhosis PBC Refer to Triple Antigen Test
Mitochondrial DNA : Gene rearrangement or Gene depletion (DNA mutational analysis)
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Mitochondrial Functional Analysis on OXPHOS enzyme DNA mutational analysis
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
MMAA (Methylmalonic aciduria type A protein, mitochondrial protein) nuclear gene sequence - Methyl Malonic Acidemia
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
MMAB (Cob(I)yrinic acid a,c-diamide adenosyltransferase, mitochondrial enzyme) nuclear gene sequence - Methyl Malonic Acidemia
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
MMACHC (Methyl Malonic Acidemia combined with Homocysteinuria Type C) nuclear gene sequence - Methyl Malonic Acidemia
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Monospot (I.M. / Paul Bunnell) Refer to Epstein Bar Virus MPS III (Type A, B, C, D) (Mucopolysaccharidosis III or Sanfilippo syndrome) DNA mutational analysis
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
MPV17 nuclear gene sequence (Mitochondrial Depletion Syndrome)
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
MSUD (Maple syrup urine disease) DNA mutational analysis
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Mucopolysacharide PERPAT 301 (2 copies). Biochemistry, IMR
Multiple Myeloma Refer to Electrophoresis (protein) Screening profiling
Mumps IgG IgM PERPAT 301 (2 copies). Serology, HSAJB or Virology, HKL
MUT(Methylmalonyl-CoA mutase deficiency) nuclear gene sequence - Methyl Malonic Acidemia
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
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Mycobacterium Tuberculosis Antibody (Quantiferon) Respective Private Lab form Private Laboratory
Mycobacterium Tuberculosis C&S (BACTEC)
PERPAT 301 (2 copies). TB Lab, HSAJB
Mycobacterium Tuberculosis C&S (GeneXpert)
PERPAT 301 (2 copies). Test by appointment and countersign by Respiratory Specialist HSA JB
TB Lab, HSAJB
Mycobacterium Tuberculosis Complex (Line Probe Assay / LPA)
PERPAT 301 (2 copies) with indication:
1. Suspected MDR TB only 2. Relapse case 3. AFB smear MUST be positive
before send 4. Clinical History must be written
on form
MKAJB or MKAK Sungai. Buloh
Mycobacterium Tuberculosis Complex (TB PCR)
PERPAT 301 (2 copies). MKAK Sungai Buloh
Myoglobin PERPAT 301 (2 copies). Biochemistry, HSAJB
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N SPECIAL FORM/OTHER OUTSOURCE LAB
Anti-N-Methyl-D-Aspartate Receptor (NMDAR)
PERPAT 301 (2 copies). Allergy & Immunology, IMR
NADPH-oxidase RT-PCR detection of mRNAs Chronic for Granulomatous Disease (CGD)
PERPAT 301 (2 copies). Allergy & Immunology, IMR
NADPH-oxidase Western Blot detection for Chronic Granulomatous Disease (CGD)
PERPAT 301 (2 copies). Allergy & Immunology, IMR
NARP (Neuropathy, ataxia, and retinitis pigmentosa) DNA mutational analysis
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Neutrophil Cytoplasmic Antibody (ANCA) PERPAT 301 (2 copies). Allergy & Immunology, IMR
Neutrophil Function Test or Phagocytic Function Test
To measure respiratory burst. PERPAT 301 (2 copies). Test by appointment.
Allergy & Immunology, IMR
Nipah Virus IgM Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
Nipah Virus Nucleic Acid Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
NK cell Enumeration PERPAT 301 (2 copies). Test by appointment. Hematology, HKL
NKH (AMT, GLDC & GCSH) DNA mutational analysis Nonketotic hyperglycinemia inborn error metabolism
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
88
O SPECIAL FORM/OTHER OUTSOURCE LAB
17 – oxogenic steroid/oxosteroid PERPAT 301 (2 copies). Biochemistry, IMR 17-OH Progesterone PERPAT 301 (2 copies). Diabetes & Endocrine, IMR Oligoclonal Bands PERPAT 301 (2 copies). Molecular Diagnostic, IMR Oligosaccharide/ tetrasaccharide Refer to IEM : Urine
Oligosaccharide
Organic Acids Refer to IEM : Urine Organic Acids Analysis
Orotic Acids Refer to IEM : Urine Orotic Acid Osmolality PERPAT 301 (2 copies). Biochemistry, HSAJB Osmotic Fragility PERPAT 301 (2 copies).
Test by appointment Hematology, HSAJB
OTC (ornithine carbamoyltransferase) DNA mutational analysis for ornithine transcarbamylase deficiency disease – Urea Cycle Disorder
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Oxalate (Kidney Stone Test) Respective Private Lab form Private Laboratory OXPHOS Deficiency (GFM1) Refer to GFM1 nuclear gene
sequence
89
P SPECIAL FORM/OTHER OUTSOURCE LAB
17-OH Progesterone PERPAT 301 (2 copies). Diabetes & Endocrine, IMR Pancreatic (Islet Cell) Antibodies Refer to Diabetes antibodies Pancreatic Enzymes Respective Private Lab form Private Laboratory Panel Reactive Antibody Refer HLA Screening Parainfluenzae PCR PERPAT 301 (2 copies). Virology, IMR Paraneoplastic Neurological Syndrome (PNS) Antibodies:
i) Anti-Hu ii) Anti-Ri iii) Anti-Ma iv) Anti-Yo v) Amphiphysin vi) CV2
PERPAT 301 (2 copies). Allergy & Immunology, IMR
Paraprotein (quantitative) PERPAT 301 (2 copies). Molecular Diagnostic, IMR Parathyroid Hormone, intact (Primary Hyperparathyroid) PERPAT 301 (2 copies). Diabetes & Endocrine, IMR
Parathyroid Hormone, intact (Renal Failure on Dialysis) PERPAT 301 (2 copies). Diabetes & Endocrine, IMR
Parotid Antibody (Mumps) Respective Private Lab form Private Laboratory
Paroxysmal noctural hemoglobinuria (PNH) PERPAT 301 (2 copies). Test by appointment. Hematology, HKL
Parvovirus B19 IgG/IgM PERPAT 301 (2 copies). Serology, HSAJB Paternal Test DNA Refer to DNA Paternal Test Paul Bunnell (I.M./ Monospot) Refer to Epstein Bar Virus Pearson Syndrome / KSS / CPEO (deletion) DNA mutational analysis
PERPAT 301 (2 copies). Test by appointment. Molecular Diagnostic, IMR
Pemphigus & Pemphigoid (Skin Auto-Antibodies) Respective Private Lab form Private Laboratory
Peroxidase Stain (BMA Slide) PERPAT 301 (2 copies). Test by appointment. Hematology, HSAJB
Phenylketonuria Test For Neonates Refer to IEM : Amino Acid Disorder
Phospholipid Screening Antibody (APS Refer to Thrombophilia Profile.
Phytanic Acid Refer to IEM : Plasma VLCFA & Phytanic acids
Plasminogen Respective Private Lab form Private Laboratory
Platelet Antibodies for thrombocytopenia PERPAT 301 (2 copies). Pusat Darah Negara (PDN)
Plumbum PERPAT 301 (2 copies). Core Lab, HKL
PML/RARA (retinoic acid receptor alpha) Special Hematology Lab Requisition. Test by appointment.
Clinical Hematology Lab, Hospital Ampang
Pneumocystis carinii / jirovecii IF PERPAT 301 (2 copies). Serology, HSAJB or Microbiology, HKL
Pneumocystis carinii / jirovecii oocyst detection PERPAT 301 (2 copies). Bacteriology, IMR
POLG nuclear gene sequence - Mitochondrial Depletion Syndrome Alper’s diseases / CPEO
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Polio (Acute Fluid Paralysis) Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
Pompe Disease (GAA) Refer to GAA nuclear gene sequence
Porphobilinogen PERPAT 301 (2 copies). Biochemistry, HSAJB Porphyrin Screen PERPAT 301 (2 copies). Biochemistry, HSAJB
POST Special Hematology Lab Requisition. Test by appointment.
Clinical Hematology Lab, Hospital Ampang
Prader Willi DNA mutational analysis PERPAT 301 (2 copies). Molecular Diagnostic, IMR
90
Primary Immunodeficiency (T&B Cell Enumeration)
Use Primary Immunodeficiency Screening Form. Test by appointment.
Allergy & Immunology, IMR
Primary Immunodeficiency (Immunoglobulin & Complement Quantitation)
Use Primary Immunodeficiency Screening Form. Test by appointment.
Allergy & Immunology, IMR
Primary Immunodeficiency (Phagocytic Function Test)
Use Primary Immunodeficiency Screening Form. Test by appointment.
Allergy & Immunology, IMR
Prostate Specific Antigen (PSA) - Free PERPAT 301 (2 copies). Request by specialist only Drug Lab, HKL
Prostate specific antigen (PSA) - Total PERPAT 301 (Blue) Biochemistry, HSNI Protein C Refer to Thrombophilia Profile Protein S Refer to Thrombophilia Profile PT20210 A Mutation Refer to Thrombophilia Profile Pterins Refer to IEM : Urinary Pterins PTPNII (Tyrosine-protein phosphatase non-receptor type 11) nuclear gene sequence
- Noonan Syndrome PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Q SPECIAL FORM/OTHER OUTSOURCE LAB
Q Fever Refer to Coxiella
91
R SPECIAL FORM/OTHER OUTSOURCE LAB
Rabies PCR
Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
RB1 (Retinoblastoma) nuclear gene sequence PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Renin PERPAT 301 (2 copies). Hosp. Putrajaya Renin Angiotensin PERPAT 301 (2 copies). Hosp. Putrajaya Respiratory Virus antigen detection (Respiratory Syncitial Virus, Flu A, B, Paraflu, Adenovirus)
Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms for IMR
Serology HSAJB, Virology, HKL
Reticulin Antibody (Celiac) Respective Private Lab form Private Laboratory Reticulin Stain Refer to Bone Marrow Trephine
Rhinovirus Refer to Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
Ricketsial indirect immunoperoxidase Refer to Indirect Immunoperoxidase for rickettsial IIP
RRM2B (Ribonucleoside-diphosphate reductase subunit M2 B) nuclear gene sequence
- Mitochondrial Depletion Syndrome
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Rubella IgG/IgM PERPAT 301 (2 copies). Serology, HSAJB or MKAK Sungai Buloh, or Virology, HKL
RUNX1/RUNX1T1 (other name RUNX1/ETO, AML1/ETO )
Special Hematology Lab Requisition. Test by appointment.
Clinical Hematology Lab, Hospital Ampang
92
S SPECIAL FORM/OTHER OUTSOURCE LAB
SARS Specimen PCR
Refer to Viral antigen/ antibody detection, Isolation and RNA identification for specific organisms
Schistosomiasis Serology PERPAT 301 (2 copies). Parasitology, IMR
Sex Hormone Binding Globulin Refer to : Estrogen/estradiol, Testosterone, Androstenedione
Sialic Acid (Total & Free) Refer to IEM : Total & Free Sialic Acid
Sickling Test PERPAT 301 (2 copies). Test by appointment.
Hematology, HSAJB or Hematology, HKL
Smooth Muscle Antibody Refer to Triple Antigen Test Somatomedin C / IGF-1 (insulin like growth factor 1) PERPAT 301 (2 copies). Diabetes & Endocrine, IMR
SOTO Syndrome (42 exons) DNA mutational analysis PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Specific Liver Antibodies: i) Anti-AMA ii) M2 iii) M2-3E/BPO iv) Sp100 v) PML vi) gp210 vii) LKM1 viii) LC-1 ix) SLA/LP x) Ro-52
PERPAT 301 (2 copies). Allergy & Immunology, IMR
Spinal Muscular Atrophy (SMA) DNA mutational analysis PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Stone Analysis (Renal) PERPAT 301 (2 copies). Biochemistry, HSAJB or Core Lab, HKL
Striated Muscle Antibody (Myasthenia Gravis) Respective Private Lab form Private Laboratory
Strongyloides Antibody Respective Private Lab form Private Laboratory
Succinylacetone Refer to IEM : Urine Succinylacetone
Sulfocysteine Refer to IEM : Urine Sulfocysteine SUOX (Sulfite Oxidase) Deficiency DNA mutational analysis PERPAT 301 (2 copies). Molecular Diagnostic, IMR
SURF-1 DNA mutational analysis (Leigh disease) PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Swab C&S (For Tissue / Pus / Wound) PERPAT 301 (Green) Microbiology, HSNI
93
T SPECIAL FORM/OTHER OUTSOURCE LAB
T3 PERPAT 301 (2 copies). Biochemistry, HSAJB
T&B Cell enumeration (CD4 & CD8) PERPAT 301 (2 copies). Hematology, HSAJB or Hematology, HKL
Taeniasis Serology PERPAT 301 (2 copies). Parasitology, IMR Testosterone PERPAT 301 (2 copies). Biochemistry, HSAJB
Thalassemia molecular diagnostic Refer to DNA Analysis (thalassemia a) for IMR
Thalassaemia (Alpha) Refer to DNA Analysis alpha globin (Thalassemia)
Thrombin Antibody (AT) Refer to Thrombophilia Profile
Thrombin Time PERPAT 301 (2 copies). Test by appointment. Hematology, HSAJB
Thrombophilia Profile Protein C Activity, Protein S Activity, Anti Thrombin Activity (AT), Activated Protein C Resistance (APCR), Factor V Leiden Mutation (FVL), PT20210 A Mutation, Fibrinogen Concentration, D-Dimer, Factor 8, Factor 11, Factor 12
PERPAT 301 (2 copies). Test by appointment. Makmal Hemostasis, Pusat Darah
Negara (PDN)
Thyroglobulin Antibody PERPAT 301 (2 copies). Serology, HSAJB Thyroid Microsomal Antibody (MA) Refer Microsomal Antibody Thyroid Receptor Antibody PERPAT 301 (2 copies). Microbiology, HKL Tissue C&S anaerobe PERPAT 301 (2 copies). Microbiology, HSAJB
TORCHES IgG/IgM Use Torches Program request form for pediatric <5 years Serology, HSAJB or Virology, HKL
Toxicology (poison/drug) Kimia 15 Pin. 1/2004 form Chemistry Department, JB Toxocara Canis (Toxocariasis) Serology PERPAT 301 (2 copies). Parasitology, IMR
Toxoplasma IgG/IgM PERPAT 301 (2 copies). Serology, HSAJB or Parasitology, IMR or Virology, HKL
Transferrin PERPAT 301 (2 copies). Drug Lab, HKL, Molecular Diagnostic, IMR
Transplant chimerism PRE (donor & recipient)
Special Hematology Lab Requisition
Clinical Hematology Lab, Hospital Ampang
Trichinellosis Serology PERPAT 301 (2 copies). Parasitology, IMR Triple Antigen Test
i) Anti-Gastric Parietal ii) Anti-Smooth Muscle iii) Anti-Mitochondrial antibody
PERPAT 301 (2 copies). Allergy & Immunology, IMR
Trypanosomiasis Microscopy PERPAT 301 (2 copies). Parasitology, IMR Tryptase Tests PERPAT 301 (2 copies). Allergy & Immunology, IMR TSH Receptor Antibody Respective Private Lab form Private Laboratory
Tumor Markers Refer to respected test eg. PSA, Ca 19.9 etc
Twinkle nuclear gene sequence - Mitochondrial Depletion Syndrome PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Typhus Refer to Indirect Immunoperoxidase for rickettsial IIP
94
V SPECIAL FORM/OTHER OUTSOURCE LAB
Varicella Zoster DNA PCR (qualitative) Obtain permission from Lab first. PERPAT 301 (2 copies). Request by specialist only
Hospital Sungai Buloh or MKAK Sungai Buloh
Varicella Zoster IgG / IgM PERPAT 301 (2 copies). Serology, HSAJB Varicella Zoster Virus antigen detection IF PERPAT 301 (2 copies). Virology, HKL Viral antigen (general recommendation) PERPAT 301 (2 copies). Virology, IMR
Viral antigen/antibody detection, Isolation and RNA identification for specific organisms
PERPAT 301 (2 copies).
V1) Adenovirus Antigen Virology, IMR V2) Adenovirus DNA After consultation only Virology, IMR V3) Adenovirus Isolation Virology, IMR V4) Avian Influenza Viruses Isolation (H5, H7 & H9) After consultation only Virology, IMR / State hospital
V6) Avian Influenza Viruses RNA (H5, H7 & H9) After consultation only Virology, IMR / State hospital
V7) Chikungunya Virus Antibody IgG/IgM MKAK Sungai Buloh
V8) Chikungunya Virus Isolation MKAK Sungai Buloh V9) Chikungunya Virus RT-PCR MKAK Sungai Buloh V10) Coronavirus Isolation After consultation only Virology, IMR
V11) Coronavirus RNA After consultation only Virology, IMR
V12) Crimean Congo Hemorrhagic Fever RNA After consultation only Virology, IMR
V13) Cytomegalovirus Isolation Virology, IMR V14) Dengue Virus Isolation After consultation only Virology, IMR V15) Dengue Virus RNA Virology, IMR
V16) Ebola RNA After consultation only Virology, IMR or Other State hospital
V17) Enterovirus HFMD Antigen Virology, IMR V18) Enterovirus HFMD Isolation Virology, IMR V19) Enterovirus HFMD RNA Virology, IMR
V20) Enterovirus Isolation Virology, IMR or MKAK Sungai Buloh
V21) Enterovirus RNA Virology, IMR or MKAK Sungai Buloh
V22) Hantavirus Hemorrhagic Fever with Renal Syndrome (HFRS) RNA After consultation only Virology, IMR
V23) Hantavirus HFRS Antibody IgM/IgG Virology, IMR
V24) Hepatitis A Antibody IgM Virology, IMR V25) Herpes Simplex Virus Antigen Virology, IMR V26) Herpes Simplex Virus Isolation Virology, IMR V27) Herpesvirus Antigen Virology, IMR V28) Herpesvirus Isolation Virology, IMR
V29) Human Influenza Viruses Isolation Virology, IMR
V30) Human Influenza Viruses RNA Virology, IMR V31) Japanese Encephalitis Virus Antibody IgM Virology, IMR
V32) Japanese Encephalitis Virus Isolation After consultation only Virology, IMR
V33) Japanese Encephalitis Virus RNA After consultation only Virology, IMR
V34) Lassa RNA After consultation only Virology, IMR V35) Marburg RNA After consultation only Virology, IMR V36) Nipah Virus Antibody IgG/IgM Virology, IMR
95
V37) Nipah Virus RNA After consultation only Virology, IMR V38) Non-Polio Enterovirus Isolation Virology, IMR V39) Non-Polio Enterovirus RNA Virology, IMR V40) Parainfluenza Viruses Antigen Virology, IMR V41) Parainfluenza Viruses Isolation Virology, IMR V42) Paramyxoviruses Isolation Virology, IMR V43) Polio Virus/Acute Flaccid Paralysis (AFP) Isolation
AFP Case Laboratory Request Form
Virology, IMR
V44) Rabies Virus Antigen After consultation only Virology, IMR V45) Rabies Virus Isolation After consultation only Virology, IMR V46) Rabies Virus RNA After consultation only Virology, IMR V47) Respiratory Syncytial Virus (RSV) Antigen
Virology, IMR
V48) Respiratory Syncytial Virus (RSV) Isolation
Virology, IMR
V49) Rift Valley RNA After consultation only Virology, IMR V50) Rubella Antibody IgG/IgM Virology, IMR V51) SARS Coronavirus Isolation After consultation only Virology, IMR V52) SARS Coronavirus RNA After consultation only Virology, IMR V53) St .Louis Encephalitis RNA After consultation only Virology, IMR V54) West Nile Virus RNA After consultation only Virology, IMR V55) Yellow Fever RNA After consultation only Virology, IMR Vitamin D Deficiency Screening PERPAT 301 (2 copies). Hospital Putrajaya Vitamin B 12 PERPAT 301 (2 copies). Biochemistry, HSAJB
VLCFA (plasma) Refer to IEM: Plasma VLCFA & Phytanic acids
96
W SPECIAL FORM/OTHER OUTSOURCE LAB
Whole Mitochondrial DNA (mt DNA) DNA mutational analysis
PERPAT 301 (2 copies). Molecular Diagnostic, IMR
Whooping Cough C&S /Serology / PCR Refer to Bordetella pertussis
Y SPECIAL FORM/OTHER OUTSOURCE LAB
Yersinia Antibody Respective Private Lab form Private Laboratory
X SPECIAL FORM/OTHER OUTSOURCE LAB
X-inactivation analysis PERPAT 301 (2 copies). Molecular Diagnostic, IMR Xa-Antibody PERPAT 301 (2 copies). Hematology, Hospital Ampang.
Please take note as you proceed:
1. Any request for test done at private lab is under patient's responsibility
2. All information are subject to changes.
3. Information provided in this guidelines are for ward/unit as well as laboratory staffs
4. Further clarification on sampling and request forms, please call respective laboratory
97
SURAT ARAHAN
98
SURAT ARAHAN 1
99
100
SURAT ARAHAN 2
101
SURAT ARAHAN 3
102
Senarai Edaran: 1. Ketua Jabatan dan Penyelia Jururawat Y/M Jabatan Perubatan Am 2. Ketua Jabatan dan Penyelia Jururawat Y/M Jabatan Pembedahan 3. Ketua Jabatan dan Penyelia Jururawat Y/M Jabatan Ortopedk 4. Ketua Jabatan dan Penyelia Jururawat Y/M Jabatan Pediatrik 5. Ketua Jabatan dan Penyelia Jururawat Y/M Jabatan ICU 6. Ketua Jabatan dan Penyelia Jururawat Y/M Jabatan O&G 7. Ketua Jabatan dan Penyelia Jururawat Y/M Jabatan Kecemasan &
Trauma 8. Ketua Jabatan dan Ketua Jururawat Y/M Jabatan Psikiatrik 9. Ketua Jabatan dan Ketua Jururawat Y/M Jabatan Oftalmologi 10. Ketua Jabatan dan Ketua Jururawat Y/M Jabatan ENT 11. Ketua Jabatan dan Ketua Jururawat Y/M Jabatan Bedah Mulut dan
Maksilofasial 12. Pegawai Perubatan Y/M Unit Forensik 13. Ketua Unit Y/M Hemodialisis 14. Ketua Unit Y/M Klinik Pakar 1 15. Ketua Unit Y/M Klinik Pakar 2 16. Ketua Unit Y/M Klinik Pakar 3 17. Ketua Unit Y/M Klinik Pakar 4 18. Ketua Unit Y/M Klinik Pakar 5 19. Ketua Penyelia Jururawat Hospital 20. Ketua Penyelia Hospital
103
ARAHAN KERJA PENGHANTARAN DAN PENERIMAAN SPESIMEN DI KAUNTER PENERIMAAN SPESIMEN JABATAN PATOLOGI, HSNI.
NO. TUGASAN TANGGUNGJAWAB
1. Mengisi borang permohonan makmal PER-PAT
301 yang betul:
Borang Merah Jambu : Hematologi
Borang Biru : Biokimia
Borang Hijau : Mikrobiologi / Serologi
Borang Putih : Sitologi / Histopatologi /
Outsource
Butir pesakit mestilah sama dengan yang tertera di
BHT pesakit dan menggunakan HURUF BESAR
(CAPITAL LETTERS)
Pegawai Perubatan /
Pegawai Perubatan Latihan
Siswazah
2. Menulis butiran pesakit pada bekas spesimen yang
betul, sebagaimana tertera di BHT pesakit.
Pegawai Perubatan /
Pegawai Perubatan Latihan
Siswazah
3. Mengambil spesimen dari pesakit setelah
menyemak tag identifikasi pesakit.
Pegawai Perubatan /
Pegawai Perubatan Latihan
Siswazah
4. Menulis nama pesakit dan ujian makmal di dalam
Buku Daftar Penghantaran Spesimen Jabatan
Patologi, HSNI (BOR/HSNI/PAT/0010).
Had pengisian butiran pesakit yang boleh ditulis di
dalam Borang Daftar Penghantaran Spesimen
hanyalah sebanyak 10 pesakit sahaja. Pihak wad
/ klinik pakar perlu menggunakan helaian / borang
baharu jika pesakit melebihi daripada 10.
Pegawai Perubatan /
Pegawai Perubatan Latihan
Siswazah
5. Memastikan butiran pesakit adalah betul serta
mengira jumlah fizikal spesimen yang dihantar
dengan menulis jumlah spesimen di ruangan
semakan wad (seperti lampiran)
Menurunkan tandatangan pada borang PER-PAT
301 sebagai bukti semakan.
Jururawat /
Penolong Pegawai
Perubatan
6. Penghantaran spesimen bagi 1 pesakit disatukan
semua spesimen bagi mengelakkan keciciran /
kehilangan spesimen.
Contoh: Pesakit A mempunyai 2 spesimen bagi
ujian biokimia, 3 spesimen bagi ujian hematologi
dan 1 ujian Mikrobiologi, maka keenam-enam
spesimen perlu diketipkan / disatukan bagi
memudahkan penyemakan spesimen oleh anggota
Patologi di kaunter penerimaan spesimen.
Jururawat /
Penolong Pegawai
Perubatan
104
7. Borang permohonan ujian, spesimen dan Buku
Daftar Penghantaran dihantar ke makmal.
Klinik-klinik Pakar disarankan untuk menghantar
spesimen secara berperingkat untuk mengelakkan
lambakan spesimen dan memudahkan
penyemakan spesimen oleh anggota Patologi di
kaunter penerimaan.
Contoh: Jam 9.00 / 10.30 / 12.00 dan sebagainya.
Pembantu Perawatan
Kesihatan
8. Menerima borang PER-PAT 301 dan spesimen. JTMP /
Pembantu Perawatan
Kesihatan
9. Menyemak semua borang permohonan ujian dan
spesimen yang diterima di kaunter penerimaan
spesimen Jabatan Patologi.
Penyemak perlu menandakan “” pada setiap
maklumat yang diisi.
Penyemak juga perlu mengira setiap spesimen
yang diterima dan menulis jumlah spesimen
diterima bagi setiap unit di bahagian bawah Buku
Daftar Penghantaran Spesimen (seperti lampiran)
JTMP /
Pembantu Perawatan
Kesihatan
10. Tandatangan Buku Daftar Penghantaran Spesimen
dan “Clocking” masa penerimaan berdekatan
bahagian Tandatangan diterima (seperti lampiran)
JTMP /
Pembantu Perawatan
Kesihatan
11. Masukkan butiran pesakit ke dalam sistem
komputer.
JTMP
12. Ujian makmal siap, laporan keputusan dicetak dan
disahkan.
JTMP /
Pegawai Sains
13. Keputusan makmal dimasukkan ke dalam pigeon
hole wad / klinik pakar yang memohon.
Bagi laporan keputusan yang kritikal / penting akan
dihantar melalui buku dispaj.
JTMP /
Pembantu Perawatan
Kesihatan
14. Keputusan makmal diambil oleh anggota wad /
klinik pakar.
Pegawai Perubatan Latihan
Siswazah /
Pembantu Perawatan
Kesihatan
15. Menyemak butiran pesakit pada borang dengan
yang tertera di BHT dan tandatangan sebagai bukti
semakan.
Pegawai Perubatan
16. Masukkan keputusan makmal ke dalam BHT
pesakit.
Pegawai Perubatan /
Jururawat
105
1. ALI 1/1/2019 35xxxxx CRP Blood C&S FBC
2. CHONG 1/1/2019 35xxxxxx LFT Urine C&S
3. SUBRAMANIAM 1/1/2019 35xxxxxx AFB C&S
JURURAWAT
U29
PPK U11 /
JTMP U29
Jumlah sampel dihantar : 6
Wad / Klinik Pakar xxx
PEG
AW
AI P
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BA
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TIH
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SIS
WA
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4.
5.
6.
7.
8.
9.
10.
CONTOH
1 JAN 2019 08:00 AM
Jumlah sampel diterima : 6
PANDUAN BIRU : TUGASAN WAD / KLINIK PAKAR MERAH : TUGASAN MAKMAL
BUKU DAFTAR PENGHANTARAN SPESIMEN JABATAN PATOLOGI, HSNI DARI WAD/UNIT: ___________________________
Bil Nama Pesakit Tarikh/ Masa
RN / I.C No
Biokimia Mikrob / Sero / TB
Hematologi/Klinikal
Tabung Darah
Histo/ Cyto
MKK* T.T
Sila catatkan jenis ujian permohonan mengikut unit berkaitan di ruang yang disediakan.
*MKK: Masa Keputusan Keluar
Disemak (Untuk diisi oleh anggota wad/unit memohon)
Diterima (Untuk diisi oleh anggota Jabatan Patologi)
Nama: Cop dan Tandatangan: Tarikh: Masa:
Nama: Cop dan Tandatangan: Tarikh: Masa:
PNMB-JB.
106
“BERSATU KE ARAH KECEMERLANGAN PERKHIDMATAN HOSPITAL”
BAHAGIAN PENGURUSAN HOSPITAL SULTANAH NORA ISMAIL BATU PAHAT,JOHOR DARUL TA’ZIM.
MEMO ANTARA UNIT / BAHAGIAN Tel : 07-4363000
Fax : 07-4322544
Email : [email protected]
Ruj. Tuan : Tarikh : 6/7/2014 Ruj. Kami : HSNI PPSM 98/2000/45 JILID 10 ( )
Perkara PENGHANTARAN PESAKIT KE HOSPITAL RUJUKAN BERSAMA DENGAN DARAH / KOMPONEN DARAH
Daripada Dr Azimah A Aziz Pengarah Hospital Sultanah Nora Ismail Salinankepada :
Kepada
Ketua Jabatan Perubatan Ketua Jabatan Peadiatrik Ketua Jabatan Pembedahan Ketua Jabatan Ortopedik Ketua Jabatan O& G Ketua Jabatan ENT Ketua Jabatan Opthamologi Ketua Jabatan Dental Ketua Jabatan Anestiologi Ketua Jabatan Kecemasan Semua Pegawai Perubatan Semua Wad / Unit
1. Pengarah Hospital2. Penyelia Jururawat3. Fail Tabung Darah4. Ketua Jabatan Patologi5. Makmal Tabung Darah
Saya dengan hormatnya merujuk perkara di atas.
2. Untuk makluman, penghantaran pesakit ke Hospital Rujukan bersama dengan darah /
komponen darah tidak dibenarkan. Berikut adalah Tujuan Penambahbaikan:
TUJUAN PENAMBAHBAIKAN
a) Suhu Simpanan darah / komponen darah:
Suhu Simpanan
(°C) Mesti di transfus
Transfusi perlu selasai dalam
masa
Packed Cell / Whole Blood 2 – 6 Secepat mungkin (30min) < 4 Jam
FFP / Cryo < - 20 Segera < 4 Jam
Platelet Concentrate 22 - 24 Segera Secepat mungkin
b) Mengikut garis panduan darah/ komponen darah perlu di transfusi segera selepas dibekalkan,
( tidak melebihi 30min selepas di bekalkan)
c) Darah yang dibekalkan, sekiranya tidak ditransfusi selepas 30min, perlu di pulangkan segera ke
makmal tabung darah.
d) Darah yang disimpan melebihi 30min di luar kawalan suhu, tidak digalakkan ditransfusi kepada
pesakit ( kontaminasi pada darah /komponen tersebut kemukinan berlaku)
SURAT ARAHAN TABUNG DARAH 1
107
“BERSATU KE ARAH KECEMERLANGAN PERKHIDMATAN HOSPITAL”
BAHAGIAN PENGURUSAN HOSPITAL SULTANAH NORA ISMAIL BATU PAHAT,JOHOR DARUL TA’ZIM.
MEMO ANTARA UNIT / BAHAGIAN
Tel : 07-4363000
Fax : 07-4322544
Email : [email protected]
e) Jarak & Masa perjalanan ke Hospital Rujukkan
Hospital Rujukkan
Jarak (km) Anggaran Masa
Perjalanan (Jam)
HSAJB 150 km 1 - 2
HKL 300 km 3 – 4
f) Penghantaran Pesakit bersama dengan darah ke Hospital Rujukan tidak dibenarkan.
g) Sekiranya Transfusi Darah diperlukan dalam perjalanan, anggota yang mengiringi pesakit perlu
memastikan “vital sign” & tanda-tanda reaksi permindahan darah dimonitor dan dicatat,
beg darah & tag darah perlu di bawa balik selepas transfusi, dan dipulangkan ke makmal
tabung darah, HSNI.
h) Bagi pesakit yang memerlukan pembendahan di Hospital Rujukan dan “stanby’ darah diperlukan,
diminta sediakan borang permohonan GXM berserta dengan sampel darah pesakit dan
mendapatkan darah daripada makmal tabung darah hospital rujukan.
i) Keputusan ini dibuat selepas perbincangan dengan Pakar/Pegawai yang menjaga
Perubatan Transfusi darah HSAJB. Sila hubungi Pakar Perubatan Transfusi HSAJB
sekiranya perlu untuk keterangan selanjutnya.
3. Diminta Kerjasama semua Ketua Jabatan / Pakar-Pakar / Pegawai Perubatan / Pegawai
Perubatan Latihan Siswazah mematuhi Penambahbaikan Perkhidmatan Transfusi Darah, Sekian
Terima kasih.
“BERKHIDMAT UNTUK NEGARA”
“PENYAYANG, BEKERJA BERPASUKAN DAN PROFESIONALISMA ADALAH BUDAYA KERJA KITA”
Saya yang menurut perintah, (DR. AZIMAH BINTI A.AZIZ) No. Pendaftaran Penuh : 26242 Pakar Perunding Kanan Perubatan Kesihatan Awam Pengarah Hospital Hospital Sultanah Nora Ismail, Batu Pahat. Dr/tdhsni
> 30min
108
“BERSATU KE ARAH KECEMERLANGAN PERKHIDMATAN HOSPITAL”
HOSPITAL SULTANAH NORA ISMAIL JALAN KORMA, 83000 BATU PAHAT, JOHOR DARUL TA’ZIM.
Tel : 07-4363000
Fax : 07-4322544
Email : [email protected]
Ruj. Tuan : Tarikh : 15/3/2015 Ruj. Kami : HSNI PPSM 98/2000/45 JILID 10 ( )
Perkara PEMULANGAN BEG DARAH BERSAMA DENGAN ”INTRAVENOUS SET’ YANG TELAH DIGUNAKAN KE MAKMAL TABUNG DARAH HSNI
Daripada DR. HJH IZZAH BINTI AHMAD Timbalan Pengarah Hospital
Salinan kepada : 1. Ketua Unit Tabung Darah2. Makmal Tabung Darah3. Matron Heng Jer Soon4. Unit Kawalan InfeksiKepada Ketua Unit/ Ketua Jururawat
semua Wad & Unit
Adalah saya dengan hormatnya merujuk kepada pekara di atas.
2. Sukacita dimaklumkan bahawa untuk mematuhi Policies Kawalan Infeksi (4.6
Blood and Blood Products Transfusion), Makmal Tabung Darah mengambil keputusan,
mulai sekarang diminta semua beg darah selepas transfusi dipulangkan bersama
dengan ‘intravenous set’ & tag darah ke Makmal tabung darah.
3. Tujuan prosedur ini dilakukan adalah untuk mengelakkan penggunaan semula
’intravenous set’ yang telah digunakan untuk transfusi darah dan mengelakkan ’back flow’
berlaku dan mencemarkan ’intravenous drip’ di mana boleh menyebabkan komplikasi
kepada pesakit. (Rujuk Policies ad Procedures on Infection Control,2nd edition 2008 ms
54)
4. Pihak kami berharap agar makluman ini dapat diamalkan dengan berkesan.
Sebarang pertanyaan boleh hubungi unit kawalan infeksi atau Makmal tabung darah.
Sekian, terima kasih.
‘BERKHIDMAT UNTUK NEGARA” ‘PENYAYANG, BEKERJA BERPASUKAN DAN PROFESIONALISMA ADALAH BUDAYA KERJA KITA’
SURAT ARAHAN TABUNG DARAH 2
109
Saya yang menurut perintah,
(DR. HJH IZZAH BINTI AHMAD) No Pendaftaran Penuh : 27388 Timbalan Pengarah Hospital b.p. Pengarah Hospital Hospital Sultanah Nora Ismail, Batu Pahat, Johor drlai/tdhsni
110
LAMPIRAN
111
“BERSATU KE ARAH KECEMERLANGAN PERKHIDMATAN HOSPITAL”
UNIT TABUNG DARAHHOSPITAL SULTANAH NORA ISMAIL
BATU PAHAT, JOHOR.
MEMO ANTARA UNIT / BAHAGIAN
Tel : 07-4363000Fax : 07-4322544email : [email protected]
Ruj. Tuan : Tarikh : 6/4/2014Ruj. Kami : HSNI PBSM 98/2000/45 JILID 9 ( )
Perkara PENAMBAHBAIKAN PERKHIDMATAN TRANSFUSI DARAH, HOSPITALSULTANAH NORA ISMAIL BATU PAHAT
Daripada Dr Azimah A AzizPengarah Hospital Sultanah Nora Ismail Salinankepada :
Kepada
Ketua Jabatan PerubatanKetua Jabatan PeadiatrikKetua Jabatan PembedahanKetua Jabatan OrtopedikKetua Jabatan O& GKetua Jabatan ENTKetua Jabatan OpthamologiKetua Jabatan DentalKetua Jabatan AnestiologiKetua Jabatan KecemasanSemua Pegawai PerubatanSemua Wad / Unit
1. Pengarah Hospital2. Fail Tabung Darah3. Ketua Jabatan Patologi4. Makmal Tabung Darah
Saya dengan hormatnya merujuk perkara di atas.
2. Untuk makluman, “Fresh Frozen Plasma (FFP) & Cryoprecipitate (Cryo)” akan
di “thawed” sebelum dibekalkan kepada wad/unit untuk semua jenis kes. Berikut adalah
Tujuan Penambahbaikan:
TUJUAN PENAMBAHBAIKAN
1. FFP & Cryo perlu di “thawed” dalam suhu terkawal (37°C) untuk memastikan fungsi-
fungsinya terjamin dalam memberi rawatan optimum
2. Kebocoran beg FFP / Cryo dapat dikesan dengan semasa proses pencairan
dilakukan dan dapat di gantikan dengan sertemerta.
3. Risiko “Embolism” semasa tranfusi sekiranya FFP / Cryo tidak di “thawed” mengikut
prosedur.
SURAT ARAHAN TABUNG DARAH 3
112
“BERSATU KE ARAH KECEMERLANGAN PERKHIDMATAN HOSPITAL”
UNIT TABUNG DARAHHOSPITAL SULTANAH NORA ISMAIL
BATU PAHAT, JOHOR.
MEMO ANTARA UNIT / BAHAGIAN
Tel : 07-4363000Fax : 07-4322544email : [email protected]
PEMBERITAHUAN & PERINGATAN
1. Sila maklumkan kepada Makmal Tabung Darang 30minit awal sebelum mengambil
FFP & Cryo untuk proses thawing
2. Makmal tidak akan carikan FFP & Cryo, selagi transfusi tidak diperlukan
3. FFP & Cryo yang sudah di’thawed’ perlu diambil dengan segerah dan transfusi
harus dilakukan serta merta untuk memastikan rawatan optimum kepada pesakit.
4. Pengambilan FFP & Cryo untuk “stanby” tidak dibenarkan
5. Amalan FFP & Cryo di “thawed” di wad / unit / dewan bedah tidak dibenarkan,
kerana akan menyebabkan kontaminasi.
CARTA ALIRAN PERMINTAAN FFP / CRYO
PERMINTAAN FFP/ CRYO
DAPAT KESETUJUAN DARIPADA PEGAWAI
PERUBATAN TABUNG DARAH
PESAKIT PERNAH MENDAPAT TRANSFUSI
DARAH/ ADA REKOD KUMP DARAH?
HANTAR BORANG REQUEST
BARU DENGAN SAMPEL DARAHTIDAK
INFORM TABUNG DARAH30MIN AWAL
SEBELUM KE MAKMAL TABUNG DARAH
PENGAMBILAN FFP/ CRYO DARI
MAKMALTABUNG DARAH
TRANFUSI SERTARMERTA APABILA
SAMPAI KE WAD / UNIT
YA
HANTAR BORANG REQUEST
BARU TANPA SAMPEL DARAH
APABILA TRANSFUSI
DIPERLUKAN
PERHATIAN !!!
*Thawed FFP & Cryo perlu diambil dan
transfus sertemerta
*Jangan inform makmal untuk cairkan
FFP & Cryo, selagi transfusi tidak diperlukan
113
“BERSATU KE ARAH KECEMERLANGAN PERKHIDMATAN HOSPITAL”
UNIT TABUNG DARAHHOSPITAL SULTANAH NORA ISMAIL
BATU PAHAT, JOHOR.
MEMO ANTARA UNIT / BAHAGIAN
Tel : 07-4363000Fax : 07-4322544email : [email protected]
3. Diminta Kerjasama semua Ketua Jabatan / Pakar-Pakar / Pegawai Perubatan /
Pegawai Perubatan Latihan Siswazah mematuhi Penambahbaikan Perkhidmatan
Transfusi Darah,
Sekian Terima kasih
’BERKHIDMAT UNTUK NEGARA”
’PENYAYANG, BEKERJA BERPASUKAN DAN PROFESIONALISMA ADALAHBUDAYA KERJA KITA’
Saya yang menurut perintah,
(DR. AZIMAH BINTI A AZIZ)
No Pendaftaran Penuh : 26242Pakar Perubatan Kesihatan AwamPengarah Hospital Sultanah Nora Ismaildrlai/tdhsni
114
“BERSATU KE ARAH KECEMERLANGAN PERKHIDMATAN HOSPITAL”
PENGURUSAN HOSPITAL SULTANAH NORA ISMAIL
BATU PAHAT, JOHOR.
MEMO ANTARA UNIT / BAHAGIAN
Tel : 07-4363000
Fax : 07-4322544
email : [email protected]
ACCREDITED
HOSPITAL
ACCREDITED
HOSPITAL
Ruj. Tuan : Tarikh : 22/1/2014 Ruj. Kami : HBP PPSM 98/2000/45 JILID 10 ( )
Perkara PENAMBAHBAIKAN PERKHIDMATAN TRANSFUSI DARAH, HOSPITAL SULTANAH NORA ISMAIL BATU PAHAT
Daripada Dr Azimah A Aziz Pengarah Hospital Salinan kepada :
Kepada
Semua Ketua Jabatan Semua Ketua Jururawat / Ketua Unit Semua Wad, Daycare Unit Hemodialysis / ICU / Dewan Bersalin Semua Pegawai Perubatan
1. Pengarah Hospital2. Penyelia Jururawat3. Fail Tabung Darah4. Ketua Jabatan Patologi5. Ketua Unit Tabung Darah6. Makmal Tabung Darah
Saya dengan hormatnya merujuk perkara di atas.
2. Untuk makluman, Unit tabung darah HSNI telah membuat penambahbaikkan bagi
perkhidmatan transfusi darah. Perkara tersebut adalah seperti yang berikut :
WAKTU PENGAMBILAN DARAH UNTUK DI TRANSFUS
Masa Pengambilan Darah Sebab
1 8 : 00am – 1:00pm 2 :00pm – 6:00pm
( Setiap Hari ) Semua Kes
Memastikan semua Pemindahan darah pesakit di wad dapat diselesai selewat lewatnya sebelum 9malam.
2 1:00pm – 2:00pm ( Waktu Rehat ) Urgent / Emergency Kes Sahaja
Hanya seorang staf sahaja yang bertugas di Makmal Tabung Darah
3 6:00pm – 8:00am ( Malam - Pagi)
Urgent / Emergency Kes Sahaja Kes dengan kebenaran Sahaja
3. Oleh yang demikian, diharap semua Ketua Jabatan, Pegawai Perubatan, Pegawai
Perubatan Latihan Siswazah, Ketua Jururawat, Ketua Unit dapat memberikan kerjasama. Segala
pertanyaan boleh menghubungi pihak tabung darah (Ext - 4327)
Sekian, terima kasih.
SURAT ARAHAN TABUNG DARAH 4
115
“BERSATU KE ARAH KECEMERLANGAN PERKHIDMATAN HOSPITAL”
PENGURUSAN HOSPITAL SULTANAH NORA ISMAIL
BATU PAHAT, JOHOR.
MEMO ANTARA UNIT / BAHAGIAN
Tel : 07-4363000
Fax : 07-4322544
email : [email protected]
ACCREDITED
HOSPITAL
ACCREDITED
HOSPITAL
’BERKHIDMAT UNTUK NEGARA”
’PENYAYANG, BEKERJA BERPASUKAN DAN PROFESIONALISMA ADALAH BUDAYA KERJA KITA’
Saya yang menurut perintah,
(DR. AZIMAH BINTI A AZIZ) No Pendaftaran Penuh : 26242 Pakar Perubatan Kesihatan Awam
Pengarah Hospital Sultanah Nora Ismail drlai/tdhsni
116
117
118