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LABORATORY
INFORMATION
HANDBOOK
Department of
Pathology and Laboratory Medicine
Edited by Daylily S Ooi, MBBS, FRCPC & Marg Maddock, ART, MBA
Contents
Telephone list
Critical values
Abbreviations
2
4
Test Information
5-77
Anatomical Pathology, Biochemistry,
Cytology, Hematology, Immunology,
Microbiology, Transfusion Medicine
Cultures
Cytology
FNA Biospy
Serological tests
29
31
37
66
Transfusion Medicine 79-88
Products & Services
Blood and blood Products
Fractionation Products
Appendix
Antibodies
Autoimmune diseases
Chromosomal, DNA,
Genetic Studies
Enzymes
Fluids
Porphyria
82
86
89-102
89
92
93
98
101
102
The Ottawa Hospital 2002
Useful Telephone Numbers
Pathologist On-Call: . . . . . . . . . . . . . . . . . OC 761-4221 (locating); OG 782-9308
Biochemist, Hematopathologist or Microbiologist On Call: . OC 761-4221; OG 737-8222
Riverside Campus Laboratory: . . . . . . . . . . . . . . . . . . . . . . . . . . . 738-8214
Campus
Hours of Operation
Anatomical
OC
(M–F) 0630–1700h
761-4344
Pathology /
Autopsy services
OG
(M–F) 0800–1700h
737-8292
Cyto-Pathology
Biochemistry
and Hematology
Bleeding Time
Bone Marrows
Telephone
OC
(M–F) 0800–1630h
761-4344
OG
(M–F) 0800–1600h
737-8305
OC
24h
761-4247
Special Coag: 798-5555 x14190
OG
24h
737-8300; Stat Biochemistry:
737-8319, Hematology: 737-8275
798-5555 x13520
OC
(M–F) 0800–1630h
OG
(M–F) 0800–1600h
737-8275
OC
(M–F) 0830–1630h
Reports: 761-4254
Booking: 798-5555 x 16216
OG
(M–F) 0800–1600h
Reports: 737-8355
Booking: 737-8275
Immunology
Microbiology
Hepatitis/Virology
OC
(M–F) 0800–1600h
Reports: 761-4247
Inquiries: 798-5555 x 16367
OC
(Daily) 0800–2000h
761-4454
OG
(Daily) 0800–2000h
737-8322
761-4342; 1700–0800: 761-14328
OC
24h
OG
(Daily) 0800–2000h
737-8322
Point of Care
OC
(M–F) 0800–1600h
798-5555 x 13505
Tissue Typing
OG
(M–F) 0730–1630h
TT, Flow cyto: 737-8277
DNA section: 737-8792
Tech cadaveric transplants: 737-8222
Transfusion
Medicine
OC
24h
761-4328
OG
24h
737-8302
Autologous
Transfusion
OC
(M–Thurs) 0730-1530h
798-5555 x17483
Phlebotomy
OC
(M–F) 0800–1600h
798-5555 x 13424
(M–F) 0600–1130
Phlebotomist: (Page) 594-7784
OG
Services
Patient results and
lab information
737-8310
OG
(M–F) 0730-1700h
737-8306
OC
24h
761-4247 or 798-5555 x 16117
for archived (outpt) results
OG
24h
737-8300
This handbook contains information useful for interpretation of laboratory tests
쐌 Expected values (reference intervals) in SI (Systeme Internationale) units.
Where the quoted reference intervals are different from the computer
reports, the latter is the updated version.
쐌 Conversion factors - from traditional units to SI units
쐌 Turnaround times (TAT): For the tests that are available round the clock,
both stat and routine, no TATs are stated. Most automated chemistry and
immunoanalyzer tests are in this category, and have TAT up to 3 hours.
쐌 Interferences stated may be characteristic of the method used. As
methodologies change, some of the information may not be correct.
쐌 Prices: The prices have been included to give you an idea as to the relative
costs of the tests. Single [$] sign tests are relatively cheap and easy to
perform, whereas [$$$$$] tests are usually referred out at a high cost
(>$100) and should be ordered only after consultation with a laboratory
physician or scientist.
쐌 LMS (labour, materials, supervision) units are the basis for OHIP billing by
laboratories. They are used for pricing of laboratory services for
non-clinical testing. At time of publication, one LMS unit is 51.7 cents. Call
the lab to confirm before grant submission.
General Information on laboratory services
For Transfusion Med services, please see under specific section (Page 79)
RESTRICTED TESTS:
Tests that are restricted are noted under Specimen. Consult as appropriate,
failure to do so will delay work on the specimen. When testing is approved,
write on req: “Attention or Approved by (name of staff)”
Tests not listed are not available locally (unless they have been introduced after printing). Some uncommon tests may be available from reference labs;
they are usually expensive and may have special collection requirements.
SAMPLE COLLECTION:
All samples must be labelled (minimum of patient’s name and unique number)
and accompanied by a requisition. If the only identification is the requisition, it
must be physically attached to the specimen container.
Specimens for Transfusion Medicine must be labelled with a Transfusion Medicine requisition label, and accompanied by the requisition signed by
phlebotomist.
Instructions for completion of requisitions, sample labelling and transport, and
types of requisitions are available in the WARD MANUAL.
GETTING RESULTS:
Results are available through the OACIS system, or by phoning the lab.
Continued next page
1
STAT and Critical Results
Biochemistry and Hematology: All critical results (see below and following
pages) are phoned immediately; stat results are printed on expedite printers.
CONFIDENTIALITY
The Department of Laboratory Medicine goes to great effort to safeguard the
confidentiality of laboratory results. For this reason, laboratory staff are not permitted to issue certain sensitive test results by telephone. They also have
instructions to establish the authenticity of the recipient of the message. These
security considerations apply particularly to STD test results.
RESULTS THAT WILL BE PHONED:
MICROBIOLOGY: All preliminary results considered urgent, such as:
쐌 Stat Gram stain results
쐌 CSF Gram stain results
쐌 Results of any staining procedures indicating serious infection
쐌 Positive blood culture results
쐌 Positive CSF culture and susceptibility test results
쐌 Other sterile site culture results
쐌 Positive culture results indicating serious or unusual infection requiring
immediate treatment or special management precautions
CRITICAL VALUES:
Hematology: Result will be phoned immediately to physician or primary
care nurse. For CBC, if parameter has been reported as critical within past 7
days, and remains critical, a repeat call will not be made.
Hemoglobin
Platelets
WBC
Blood film/smear
<50 g/L
>190 g/L
<20 ´109/L
>1000 ´109/L
Granulocytes <0.5 ´109/L
>40 ´109/L
If not previously reported
- Sickle cells, Malarial parasites, Intracellular bacteria
- RBC fragments with thrombocytopenia
INR
>5.0
PTT
>150s
Fibrinogen
Standard anti-Xa
Bleeding time
2
<0.5 g/L
>1.0 U/mL
> 15 min
Biochemistry Critical Values:
Low
pH
Na+
K+
High
<7.10
—
<120 mmol/L
>160 mmol/L
<3.0 mmol/L
(Dialysis pt: predialysis <3.5,
postdialysis <2.5)
>6.0 mmol/L
(predialysis >6.5)
Glucose
<2.0 mmol/L
>28.0 mmol/L
Calcium
<1.50 mmol/L
>3.00 mmol/L
Ionized Ca++
<0.80 mmol/L
>2.00 mmol/L
Magnesium
<0.4 mmol/L
>5.0 mmol/L
Phosphate
<0.4 mmol/L;
predialysis <0.7 mmol/L
—
Bilirubin (Neonates <1m)
>285 umol/L
THERAPEUTIC DRUGS
Acetaminophen
Amikacin
> 1000 umol/L
Predose > 8 mg/L
Carbamazepine
>60 umol/L
Digoxin
>3.3 nmol/L
Ethosuximide
Gentamicin
>1000 umol/L
Predose > 2 mg/L
Lithium
>1.5 mmol/L
Phenobarbital
>200 umol/L
Phenytoin
>100 umol/L
Primidone
>60 umol/L
Procainamide
>70 umol/L
Procainamide + NAPA
>110 umol/L
Salicylate
>4.7 mmol/L
Theophylline
>110 umol/L
Tobramycin
Predose >2 mg/L
Valproic acid
>1000 umol/L
Vancomycin
Predose >15 mg/L
3
Abbreviations
Time
m
w
d
h
min
s
month
week
day
hour
minute
second
Volume
L
mL
litre
millilitre
Number
giga
tera
u (micro)
n (nano)
p (pico)
f (femto)
109
1012
10-6
10-9
10-12
10-15
Measure
g
mol
U
IU
gram
mole
Units
International Units
Vacutainers
PST® (pale green)
SST® (gold)
Dark green
Light blue
Black
Mauve
Red
Royal blue
Cost of analysis:
[$]
< $5
[$$]
$5–14
[$$$]
$15–49
[$$$$]
$50–100
[$$$$$]
> $100
4
Abbreviations
Auto
Automated
AAS
Atomic Absorption Spectroscopy
CBS
Canadian Blood Services
Chem
Chemistry
CV
Coefficient of Variation (Reproducibility) %
EDTA
Ethylenediamine tetraacetic acid
GC
Gas chromatography
HICL
Hospitals-in-Common Laboratory Inc.,
Toronto (Reference Laboratory System)
HPLC
High Performance Liquid Chromatography
IA
Immunoassay
IFIX
Immunofixation
LMS
Labour, Management, Supplies (OHIP billing)
OC
Civic Campus
OG
General Campus
PHL
Public Health Lab
RS
Riverside Campus
RT
Room Temperature
RIA
Radioimmunoassay
TAT
Turnaround Time
TM
Transfusion Medicine
TT
Tissue Typing/DNA/Flow cytometry Lab
2
Appendix
Plasma separator tube, contains lithium heparin
Serum separator tube, contains thrombin activator
Lithium heparin
Sodium citrate (3.2%)
Sodium citrate (buffered), used for ESR
EDTA (potassium or sodium)
No additive
Low metal (contains sodium heparin)
2 See Appendix
TEST INFORMATION:
ABO and Rh TYPING, BLOOD GROUP TYPING
Use: Determine patient ABO & Rh blood group prior to and post transfusion; detect
ABO hemolytic disease of the newborn.
Specimen:
Mauve (7 mL)
Rejection criteria: presence of abn protein, cold
agglutinins; recent transfusions; leukemia, malignancy,
positive direct antiglobulin test. Some bacteria may
interfere with typing.
TAT: Routine 1-3h, Stat 5 min
Lab: TM
Price: [$] LMS 18
ACETAMINOPHEN
Use: For management of overdose only; restricted to ER, ICU, AMA
Specimen:
Therapeutic:
Toxic level:
Half-life:
Serum/plasma
SST/PST
66-199 umol/L
Dependent on time
post-ingestion and
presence of hepatotoxicity (as low as
330 umol/L if >12h).
Conversion factor:
2h (t½ >4h suggestive
of hepatotoxicity)
ug/mL ´ 6.6 = umol/L
Method:
Auto chem, CV 3%.
Lab: Biochem
Price: [$$] LMS 25
ACETONE see KETONES
ACETYLCHOLINE RECEPTOR AB see ANTI-ACETYLCHOLINE RECEPTOR AB
ACTIVATED PROTEIN C RESISTANCE, APC RESISTANCE
Use: Investigation of familial thrombotic tendency (decreased)
Specimen:
Ref Interval:
Plasma
2.0-2.7 (ratio)
Light blue x 3 Transport on ice
Method:
TAT: 10d
Functional test for co-factor.
Lab: Hematol
Price: [$$$]
ADRENOCORTICOTROPIN, ACTH
For ACTH stimulation test - see CORTISOL
Specimen:
Plasma Chilled mauve Transport on ice within 30 min
Ref Interval:
08:00-09:00h 1.3-12.5 pmol/L
Conversion factor:
Comments:
Method:
TAT: 4w
ng/L ´ 0.22 = pmol/L
Ectopic ACTH >44 pmol/L.
IRMA (DiaSorin), CV: 10%
Lab: Biochem
Price: [$$] LMS 120
5
ALANINE AMINOTRANFERASE, ALT, (SGPT)
Specimen:
Serum/plasma
SST/PST
Ref Interval:
14-63 U/L
RS: 5-40 U/L
Method:
Lab: Biochem
ALBUMIN, Serum
Specimen:
Serum/plasma
Ref Interval:
35-48 g/L
Conversion factor:
Method:
Lab: Biochem
2 Enzymes
Auto chem, CV: 3%. Interferences: hemolysis (­)
Price: [$] LMS 5
SST/PST
g/dL ´ 10 = g/L
Auto chem, CV: 2%.
Price: [$] LMS 5
ALBUMIN, Urine (MICROALBUMIN)
Specimen:
Random, 24h or 4h morning (after first void) sample
­Not performed if total protein > 2 g/L.
Expected values:
Adults:
Incr
Overt
Sample
Normal
excretion proteinuria
24h
<14
15-300
>300 mg/d
@
2-23
>23 mg/mmol creat
4h; random <1
@
CDA guidelines: F:<2.8 M<2.0 mg/mmol creat
Children: <3.4 mg/mmol creat
Conversion factor:
Method:
TAT: M-F, 1d
mg/d ´ 0.001 = g/d
Turbidimetry, CV: 8%.
Lab: OC Biochem
Price: [$]
ALDOLASE
Specimen:
Ref Interval:
Serum, not plasma SST/red
Adults: 1-8 U/L
Method:
TAT: 7d
Auto chem, CV: 8%. Interferences: hemolysis (­).
Lab: HICL
Price: [$]
ALDOSTERONE
Specimen:
Serum
SST/red
Ref Intervals:
On normal sodium diet: Supine >8 h: 28-445 pmol/L
Upright >8 h: 110-860 pmol/L
Low body sodium and erect posture ­ aldosterone
Conversion factor:
Method:
TAT: 14d
ng/dL ´ 27.7 = pmol/L
RIA (DPC), CV: 10%
Lab: OC Biochem
Price: [$$$] LMS 120
ALKALINE PHOSPHATASE, ALP
Specimen:
Serum/plasma
Ref Intervals:
Cord blood – 1w:
Infant:
Adolescent:
Adult:
Method:
Lab: Biochem
6
Auto chem, CV: 2%
Price: [$] LMS 5
SST/PST
2 Enzymes
approximates adult values
2-3 ´ adult values
up to 7 ´ adult values
38-126 U/L
ALKALINE PHOSPHATASE ISOENZYMES
Specimen:
Serum/plasma
SST/PST
­Performed only if ALP is > reference interval for age.
Interpretation:
Bone and liver fractions normally present.
Placental isoenzyme present in 3rd trimester.
Method:
TAT: 10d
Agarose gel electrophoresis with lectin
Lab: OG Biochem
Price: [$$] LMS 29
ALKALINE PHOSPHATASE, BONE SPECIFIC, BSAP
Specimen:
Serum/plasma
red/green
Restricted to Endocrinology, others consult Biochemist
th
Ref Interval:
95 percentile: Males
20 ug/L
Females Premenop 14 ug/L
Postmenopausal 22 (median 12) ug/L
Method:
TAT: 4w
Auto IA (Beckman Access®, Ostase®)
Lab: Biochem
Price: [$$]
ALLERGY TESTING see also RADIOIMMUNOSORBENT TEST
Specify allergen – AVIAN (budgie and pigeon), FARMER’S LUNG
Specimen:
Expected value:
Serum
SST/red
Undetected or absent allergen specific IgE (<0.35 kU/L)
Method:
TAT: 30d
Radioallergosorbent assay
Lab: HICL
Price: [$$]
ALPHA-1-ANTITRYPSIN, A1-AT
Specimen:
Serum
Ref Interval:
0.9-1.7 g/L
Conversion factor:
Method:
TAT: 7d
SST/red
mg/dL ´ 0.01 = g/L
Immunonephelometry, CV:7% Interf: lipemia, gross hemolysis.
Lab: OC Biochem
Price: [$$] LMS 12
ALPHA-FETOPROTEIN, AFP, Serum
Use: (1) Monitoring response in liver cancer, not for screening (2) MSS/IPS program
Specimen:
Expected Value:
Serum/plasma
<11 ug/L
Comments:
Up to 20 ug/L in pregnancy, rarely up to 200 ug/L. Open neural
tube defect >400 ug/L. Also ­ in cirrhosis, hepatitis.
ng/mL = ug/L
AutoIA (AxSYM®), CV: 6% Interf: heterophile antibodies (mice)
Lab: OC Biochem
Price: [$$] LMS 45
Conversion factor:
Method:
TAT: 7d (usu Fri)
SST/PST
ALUMINUM, AL3+, Plasma
Specimen:
Plasma
Royal blue top
Restricted to hemodialysis patients; consult Biochemist.
Ref Interval:
<371 nmol/L
Patients on aluminum medications <1,100 nmol/L
Conversion factor:
Method:
TAT: 30 d
ug/L ´ 37.1 = nmol/L
Atomic Absorption Spectroscopy
Lab: HICL
Price: [$$]
7
ALUMINUM, Urine
Specimen:
24h urine in acid-washed bottle (Biochem)
Restricted to hemodialysis patients; consult Biochemist.
Ref Interval:
<928 nmol/d
TAT: 30 d
AMIKACIN
Specimen:
Therapeutic:
Toxic conc:
Lab: HICL
Price [$$]
Serum/plasma
SST/PST
State if pre or post-dose
Predose (mg/L)
Postdose (mg/L)
5 – 10
20 – 35
>8
>35
(Guidelines only, consult Pharmacy)
Conversion factor:
Half-life:
Method:
TAT: M-F, 1d
mg/L ´ 1.71 = umol/L
1.5-15 h
IA (TDx/FLx®)
Lab: OG Biochem
Price: [$$$] LMS 40
AMINO ACIDS SCREEN see METABOLIC SCREEN
AMINO ACIDS QUANTITATION, Serum
Specimen:
Serum/plasma
SST/red/PST
Restricted. Start with Urinary Metabolic Screen.
Method:
TAT: 7d
Column chromatography Pharmacia Biochrom® Amino Acid
Analyzer.
Lab: CHEO Biochem Price: [$$$] LMS 200
AMINO ACIDS QUANTITATION, Urine
Specimen:
24h urine no preservative, or with thymol added
Restricted to neonates.
Cystine ordered separately (see Cystine).
­Performed only if screen positive.
Method:
TAT: 7d
See serum
Lab: CHEO Biochem Price: [$$$] LMS 200
d AMINOLEVULINIC ACID, ALA (includes Porphobilinogen), Urine
Use: Diagnosis of acute porphyrias (acute intermittent, variegata) and lead poisoning.
Specimen:
2 Porphyrias
Ref Interval:
24h urine in brown bottle with 7 g tartaric acid or
Random 50 mL urine - send to lab immediately, or
adjust pH to 5 with tartaric acid.
Protect from light.
ALA:
PBG:
Conversion factor:
Method:
TAT: 14d
8
0 - 50 umol/d
1-5 mmol/mol creat (not reliable if creat < 4 mmol/L)
0 – 9 umol/d
0.1-0.8 mmol/mol creat
ALA: mg/dL ´ 7.63 = umol/L; mg/d ´ 0.763 = umol/d
PBG: mg/d ´ 4.42 = umol/d
BioRad® Ion exchange/colorimetric assay, CV 7%.
Lab: OG Biochem
Price: [$$$] LMS 25
AMITRIPTYLINE see TRICYCLIC ANTIDEPRESSANT QUANT
AMMONIA, NH3
Specimen:
Plasma
PST/dark green on ice
For stat, consult Biochem Lab.
Ref Interval:
> 3m old: 5-30 umol/L
< 3m old: 10-55 umol/L
Conversion factor:
Comments:
Method:
TAT: M-F, 1d.
mg/dL ´ 0.587 = umol/L
At 25oC, ­ in whole blood by 1 umol/L/min.
Dry chemistry analyzer (Vitros®)
Lab: CHEO Biochem Price: [$] LMS 39
AMNIOTIC FLUID see also FETAL LUNG MATURITY
AMNIOTIC FLUID SCAN: DELTA OD450, D450
Specimen:
3 mL amniotic fluid in plain
tube, protect from light with
foil, provide gestational age
Expected value: Zone 1(Modified LILEY
Prediction Curve) see graph
Comments:
Method:
Lab: Biochem
Zone reported only if
gestational age >28 w
Spectrophotometric scan.
Interf: Hemoglobin, meconium
or urine.
Price: [$$] LMS 20
AMYLASE, Serum substitute with Lipase; avail only at RS
Specimen:
Serum/plasma
SST/PST
Ref Interval:
30-110 U/L
TAT: M-F, 1d
Lab: RS Biochem
Price: [$] LMS 5
AMYLASE, Fluid
Specimen:
Pleural or peritoneal fluid. Urine amylase not available.
Interpretation:
Extremely high - pancreatitis, pancreatic pseudocyst.
TAT: M-F, 1d
Lab: RS Biochem
Price: [$] LMS 5
ANDROSTENEDIONE
Specimen:
Serum
SST/red
Fasting sample recommended, for females collect 1w
before or after menstrual period.
Ref Interval:
Males: 1.7-5.2 nmol/L
Females: 1.7-7.0 nmol/L
Conversion factor:
TAT: 2-3w
ng/mL ´ 3.49 = nmol/L (MW 286)
Lab: HICL
Price: [$$] LMS 75
Abbreviations: (complete list on page 4):
TAT
Turnaround time (from time of receipt)
RS
HICL
Hospital-in-Common Lab (Toronto)
OC
LMS
Labour, Management, Supplies (OHIP billing) OG
Riverside Campus
Civic Campus
General Campus
9
ANGIOTENSIN CONVERTING ENZYME, ACE
Specimen:
Serum/plasma
SST/PST not Mauve
CSF
Red
Ref Interval:
11-44 U/L
Comments:
Method:
TAT: 21d
¯ with steroid therapy. Reflects severity of sarcoidosis (91% of
Stage III have elevated concentrations).
á in Gaucher’s disease, leprosy, untreated hyperthyroidism,
psoriasis, amyloidosis, histoplasmosis, mixed CTD.
EMIT, CV: 10%. Interferences: Captopril (¯), heavy metals (¯)
Lab: OC Biochem
Price: [$$]
ANION GAP
Specimen:
Ref Interval:
Calculated from electrolyte values:[Na+] - [Cl-] - [HCO3 -]
5-12 mmol/L (potassium not included in equation)
Comments:
Most proteins are positively charged at physiologic pH, except
for some monoclonal immunoglobulins.
ANTI-ACETYLCHOLINE RECEPTOR ANTIBODIES, ACRA
Specimen:
Serum
SST/red
Restricted to Neurology; others consult Biochemist.
Ref Interval:
<0.4 nmol/L
Comments:
Method:
TAT: 30 d
Positive in >90% active generalized MG, ~60% ocular MG,
<40% in remission.
Radio-receptor immunoassay (IBL)
Lab: HICL
Price: [$$$$$]
ANTI-BETA-2 GLYCOPROTEIN I, B2GP1
Use: Anti-phospholipid antibody syndrome.
Specimen:
Serum
Comments:
TAT: 4w
Present in subgroup with negative anti-ACL and Lupus Ab.
Lab: OG Hematol
Red
ANTIBODIES AGAINST TISSUES see individual antibodies under ANTIANTIBODIES AGAINST ORGANISMS see SEROLOGICAL TESTS
ANTIBODY SCREEN/ IDENTIFICATION
Use: Screening and detection of significant antibodies in patient’s serum, for transfusion and prenatals.
Specimen:
Comment:
Mauve (7mL) Rejection criteria: SST, PST, gross
hemolysis, unlabeled/improperly labeled specimen/requisition
Performed with ABO and Rh grouping as part of the
compatability testing. Patient’s serum is tested against reagent
cells. Antibody is identified for positive screens.
TAT: Routine 1-3h, Stat 45 min
Lab: TM
Price: [$$]
ANTIBODY TITRE
Use: Predict the severity of hemolytic disease of the newborn caused by significant
red blood cell antibodies in maternal circulation.
Specimen:
10
Mauve (7mL) Rejection criteria: SST, PST, gross
hemolysis, unlabeled/improperly labeled specimen/requisition.
Comment:
NOT indicated for antibodies not associated with hemolytic
disease of the newborn. A rising or falling titre is a significant
indicator during pregnancy.
TAT: Routine 24-48h
Lab: TM
Price: [$$]
ANTI-CARDIOLIPIN/ANTIPHOSPHOLIPID ANTIBODIES
Specimen:
Serum SST/red (EDTA plasma also acceptable)
For antiphospholipid synd., also order lupus anticoagulant
Interpretation:
Pos: 15-60 U/mL; Strongly pos: > 60 U/mL 2 Antibodies
Method:
TAT: 10 d
Quantitative ELISA
Lab: OC Imm/OG Hem
Price: [$$$]
ANTI-CENTROMERE ANTIBODIES see Antinuclear antibodies
ANTI-DIURETIC HORMONE, VASOPRESSIN, ADH
Specimen:
Plasma
Chilled PST/dark green
Transport on ice immediately (Add 500 kIU/L Aprotinin if
unable to centrifuge immediately).
Ref. Interval:
<7.5 pmol/L
Method:
TAT: 4w
RIA
Lab: HICL
Price: [$$$]
ANTI-DNASE B ANTIBODIES
Use: Detection of streptococcus pyogenes infection
Specimen
Serum
TAT: 2d
Lab: CHEO Microbiol Price: [$$$] LMS 25
Red
ANTI-dsDNA ANTIBODIES (double stranded)
Specimen:
Serum
SST (min 2 mL)
­ Performed only if ANA positive.
Interpretation:
Pos: 30-50 IU/mL Strongly pos: >300 IU/L
2 Antibodies, Autoimmune disease
Method:
TAT: 10 d
Quantitative ELISA (Sanofi)
Lab: OC Imm
Price: [$$]
ANTI-ENDOMYSIAL ANTIBODIES - see ANTI-TISSUE TRANSGLUTAMINASE
ANTI-EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES, ANTI-ENA
(SS-a/Ro, SS-b/La, RNP) Scl-70, Jo-1 must be requested specifically.
Specimen:
Serum
SST/red
­ Performed only if ANA positive
2 Antibodies, Autoimmune diseases
Interpretation:
ELISA screen:
Neg: Not reactive with SS-a, SS-b, Sm or RNP.
Pos: Antibodies present for antigen(s) indicated in report.
TAT: 1w
Lab: OC Imm
Price: Screen: [$$] Titre [$$$]
ANTI-GLOMERULAR BASEMENT MEMBRANE AB, ANTI-GBM
Specimen:
Serum
SST/red
Interpretation:
Pos >20 EU
2 Antibodies
Method:
TAT: 3d
Indirect immunofluorescence - monkey kidney
Lab: OC Imm
Price: Qual [$$$] Titre [$$$$$]
11
ANTI-HEMOPHILIAC FACTOR see FACTOR VIII ASSAY
ANTI-HISTONE ANTIBODIES
Specimen:
Sample for ANA. ­Performed only if ANA is positive.
Interpretation:
2 Antibodies; Autoimmune diseases
TAT: 14d
Lab: HICL
Price: [$$$]
ANTI-Jo-1 ANTIBODIES See ANTI-EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES
and 2Antibodies; Autoimmune disease
ANTI-MICROSOMAL (THYROID PEROXIDASE) ANTIBODIES
Specimen:
Serum
SST/red
Interpretation:
2 Antibodies
Method:
TAT: 7d
Microtitre particle agglutination with serial dilution. Assay
cross-reacts with thyroglobulin antibodies.
Lab: OC Biochem
Price: [$] LMS 6
ANTI-MITOCHONDRIAL ANTIBODIES see ANTI-TISSUE ANTIBODIES
ANTI-NEUTROPHIL CYTOPLASMIC ANTIBODIES, ANCA
Specimen:
Serum
SST/red (min 3 mL serum)
For rapid screen within 1h - inform lab (798-5555 x16367).
Method:
Interpretation:
TAT: 3d
Screen: Indirect immunofluorescence at 1:20 dil using
ethanol-fixed neutrophils. If cANCA or pANCA pattern, further
testing with formalin-fixed neutrophils and ELISA. See page 90
2 Antibodies for method details and interpretation.
ELISA Pos: >15 U
Lab: OC Imm
Price: Screen [$], Quant [$$$]
ANTI-NUCLEAR ANTIBODIES, ANA
– HOMOGENEOUS, SPECKLED, NUCLEOLAR, PERIPHERAL, CENTROMERE
Specimen:
Interpretation:
Serum
SST/red
Pos: > 1:40
Positives increase with age.
2 Antibodies; Autoimmune diseases
Method:
Indirect immunofluorescence screened using Hep-2 cells at
1:40 dilution, titred if positive.
Lab: OC Imm
Price: Screen [$] Titre [$$]
TAT: 3d
ANTI-PARIETAL ANTIBODIES see ANTI-TISSUE ANTIBODIES
ANTI-PEMPHIGUS/PEMPHIGOID ANTIBODIES
Specimen:
Serum
SST/red
Comments:
TAT: 4d
Negative or positive at ¼ and 1/16 dilutions.
Lab: HICL
Price: [$$]
ANTI-Scl-70 ANTIBODIES see also ANTI-EXTRACTABLE NUCLEAR
ANTIGEN ANTIBODIES
Specimen:
Serum
SST/red
Interpretation:
Significant if undiluted sample is positive (Ouchterlony)
2 Antibodies; Autoimmune diseases
TAT: 2w
12
Lab: OC Imm
Price: Titre [$$$]
ANTI-SMOOTH MUSCLE ANTIBODIES see ANTI-TISSUE ANTIBODIES
ANTI-STREPTOLYSIN O, ASO
Use: Streptococcus pyogenes infection
Specimen:
Serum
Expected result: 0 –125 IU/mL
SST/red
TAT: Analyzed 2x/w Lab: CHEO Biochem
ANTI-THYROGLOBULIN ANTIBODIES order ANTIMICROSOMAL ANTIBODIES
ANTI-THROMBIN ASSAY
Use: Thrombotic diathesis (thrombophlebitis or pulmonary emboli not associated with
trauma, in young patients or without family history of thromboembolism).
Specimen:
Interpretation:
Method:
TAT: 10 d
Plasma
Light blue ´ 3 Transport on ice
Patient not on heparin (interferes with assay)
Normal - 0.85-1.25 U/mL
Borderline low - inherited def (suggest family studies)
Very low – fulminant DIC
Chromogenic functional assay. Antigen assay done on patients
with low functional assay results.
Lab: Hematol
Price: [$$] LMS 55
ANTI-TISSUE (MITOCHONDRIAL, SMOOTH MUSCLE, PARIETAL
CELL) ANTIBODIES
Specimen:
Serum
SST/red (min 3 mL serum)
Interpretation:
Negative; positive sera titred 2 Antibodies
Method:
TAT: 3d
Indirect immunofluorescence using mouse stomach and kidney.
Screened at 1:20 dilution, titred if positive
Lab: OC Imm Price: Screen [$$] Titre [$$$] LMS 35per titre
ANTI-TISSUE TRANSGLUTAMINASE, IgA
Specimen:
Serum
SST/red
Restricted to Gastroenterology; others consult Biochemist
Ref Interval:
< 20 KEU/L
Comment:
TAT: 2w
Transglutaminase is the major autoantigen of endomysium
Lab: HICL (McMaster)
Price: [$$$]
ANTI-Xa ACTIVITY
Use: monitoring patients on standard heparin, LMWH and danaproid therapy
Specimen:
Therapeutic:
Method:
TAT: 1-2d
Plasma
Light blue
Specify anticoagulant patient is on:
· Standard Heparin (unfractionated)
· Low Molecular Weight (LMWH) - Dalteparin (Fragmin)
Enoxaparin (Lovenox), Tinzaparin (Innohep)
· Danaproid (Orgaran)
· Other
Std Heparin: 0.35-0.70 IU/mL
LMWH: range associated with specific type
Chromogenic methodology
Lab: Hematol
Price: [$$$]
13
APO A1 and B not available; APO E See
2 Chromosomal Studies
APPT see PARTIAL THROMBOPLASTIN TIME
ARSENIC, As3+
Specimen:
Restricted; consult Biochemist.
For acute/ ongoing exposure (avoid shellfish or fish for 5d):
24h urine: acid washed bottle (from Biochem)
Stomach contents: acid washed bottle from Lab
For chronic exposure:
Hair: 1 g cut close to the scalp [1" long, 0.3" dia bunch]
Ref Interval:
Urine: <70 umol/mol creat (total arsenic)
Hair: <1 ug/g (referred to Mayo U.S.)
Urine half-life
Method:
4d
Atomic absorption spectroscopy
TAT: 1w
Lab: HICL/Mayo
Price: [$$$$]
ASCORBIC ACID, VITAMIN C
Specimen:
Plasma
Ref Interval:
Method:
TAT: 10d
Dark green, transport on ice
(store plasma immediately at –80oC)
Males: 10-85 umol/L
Females: 10-110 umol/L
HPLC, CV 8%
Lab: OG Biochem
Price: [$$$]
ASPARTATE AMINOTRANSFERASE, AST, (SGOT)
Specimen:
Serum/plasma
SST/PST
Ref Interval:
15-41 U/L RS: 10-40 U/L
2 Enzymes
Method:
Lab: Biochem
Auto chem, CV 3% Interf: hemolysis (­­)
Price: [$] LMS 5
ASPERGILLUS see RADIOIMMUNOSORBENT TEST (A. fumigatus)
AUTOPSY PATHOLOGY
Refer to “Dealing with Patient Death Package”, a grey folder available at nursing stations. This information package includes Autopsy Consent Form, Certificate of Death
(Form 1), Medical Certificate of Death (Form 16), Organ / Tissue Donation Consent
Form, Checklists for physicians, nursing staff and relatives.
BACTERIAL DIRECT ANTIGEN
Use: Detection of CNS infection when gram stain and culture are negative but CSF
profile is suggestive of bacterial infection.
Specimen:
CSF in Red vacutainer
Restricted; consult Microbiologist.
Lab: CHEO Microbiol
Price: [$$$]
BARBITURATE SCREEN, Urine
Use: For management of overdose patients only
Specimen:
14
Random urine, no preservatives
Restricted to ICU, ER, AMA
Reported as:
Positive: barbiturate present - no indication of drug conc
(dependant on urine concentration and assay cross-reactivity).
Negative: does not exclude presence.
Method:
AutoIA (AxSYMÒ), cal to give pos with secobarbital 200 ug/L.
Assay known to detect the following: amobarbital,
aprobarbital, barbital (low x-reactivity), butabarbital, butalbital,
butobarbital, cyclopentobarbital, pentobarbital, phenobarbital,
secobarbital, talbutal, thiamylal (low), thiopental (low), vinylbital.
No/minimal cross-reactivity with: acetaminophen, diazepam,
methadone, phenytoin, promethazine, salicylate, theophylline.
TAT: Stat or routine. Lab: OG Biochem
Price: [$$] LMS 25
BENZODIAZEPINE SCREEN, Urine
Use: For management of overdose patients only.
Specimen:
Reported as:
Random urine, no preservatives
Restricted to ICU, ER, AMA; others consult Biochemist.
Positive: benzodiazepine present with no indication of
drug conc - dependant on urine conc and assay reactivity.
Negative does not exclude presence.
Method:
AutoIA (AxSYMâ), cal to give pos with nordiazepam at 200 ug/L
No/minimal cross-reactivity with: acetaminophen,
amitriptyline, amoxapine, carbamazepine, diphenhydramine,
promethazine, ethchlorvynol, furosemide, haloperidol,
methaqualone, phenytoin, propoxyphene, secobarbital,
thioridazine, trazodone.
TAT: Stat or routine Lab: OG Biochem
Price: [$$] LMS 25
Concentrations and cross reactivity with assay
(Ellenhorn’s Medical Toxicology, Fenton’s Poisoned Patient, JGDonnelly)
Concb
for pos
Cross-reactivity with assay
(active metabolites; % approx)
Drug
T½ (h)
Alprazolam (Xanax)a
12 (9-15)
200
High (75%); OH-aprazolam
8-19
900
Low
10 (6-28)
1600
25 (10-49)
1000
19-60
650
Low (10%) nor-metabolite (20%),
desmethyldiazepam, oxazepam (high)
Variable (18-62%), demoxepam (low),
nor-clobazam
Low, esp metabolite (30%), 7-NH2
metabolite (15%)
Low
32 (14-61)
200
9-25
400
80
(40-200)
400
Lorazepam (Ativan)
13 (8-25)
600
Medium (36%), desalkyflurazepam
(medium), OH-flurazepam, flurazepam
aldehyde
Medium (30%)
Loprazolam
11 (5-22)
260
High, desmethyldiazepam
Bromazepam
Chlordiazepoxide
(Librium)
Clobazam
Clonazepam
(Rivotril)a
Demoxepam
Diazepam (Valium)
Flunitrazepam
(Rohypnol)
Flurazepam
Medazepam
900
High (90%), nor-diazepam (100%),
oxazepam, 3OH diazepam
Medium
Continued on next page
15
Drug
Concb
for pos
Cross-reactivity with assay
(active metabolites; % approx)
Midazolam (Versed)
2 (1.5-2.5)
Nitrazepam
26 (18-48)
350
Medium (45%), metabolite (15%)
7 (5-13)
200
High (60%)
0.6-2
200
High, desmethyldiazepam
Temazepam
13 (7-17)
320
High (60%), oxazepam
Triazolam (Halcion)
2.5 (2-5)
340
Medium (50%), 1-methyl-OH-triazolam
Oxazepam (Serax)
Prazepam
a
T½ (h)
1-methyl-OH-midazolam
Toxicity occurs at low serum conc (<100 ug/L)
b
Min conc for positive result.
BETA-hCG see CHORIONIC GONADOTROPIN
BETA-2-MICROGLOBULIN
Specimen:
Serum
SST/red
Restricted to OCF and Hematologists.
Ref Intervals:
<60y: <170 nmol/L >60y: <220 nmol/L
Method:
TAT: 14d
IA (IMxâ)
Lab: HICL
Price: [$$]
BICARBONATE, TOTAL CARBON DIOXIDE, tCO2
Specimen:
Serum/plasma
SST/PST
Ref Interval:
22-32 mmol/L
Conversion factor:
Method:
mEq/L = mmol/L
Auto chem, CV 3%. Conc ¯ on standing/storage.
Lab: Biochem
Price: [$] LMS 5
BILIRUBIN, DIRECT, CONJUGATED
Specimen:
Serum/plasma
SST/PST Protect from light
Ref Interval:
2-9 umol/L
RS: 0-8 umol/L
Conversion factor:
Method:
mg/dL ´ 17.1 = umol/L
Auto chem, CV 6%. Interferences: hemolysis (¯).
Lab: Biochem
Price: [$] LMS 5
BILIRUBIN, NEONATAL
Specimen:
Capillary tube, green microtainer not EDTA
Protect from light.
Ref Interval:
Potentially toxic concentrations: >285 umol/L
Method:
Lab: Biochem
Spectrophotometry, CV 3%. Interferences: carotenoids
(therefore not suitable for infants >14d).
Price: [$] LMS 5
BILIRUBIN, TOTAL
Specimen:
Serum/plasma
Ref Interval:
2-20 umol/L
Method:
Lab: Biochem
16
SST/PST (protect from light if delayed)
Auto chem, CV 3%. Interferences: hemolysis (­).
Price:[$] LMS 5
BLEEDING TIME, BT
Use: Platelet function disorders (congenital and acquired), von Willebrand’s disease.
Specimen:
Ref Interval:
Tested at bedside. Phone Hematol (OC:13520, OG:78275).
Patient prep: no ASA or NSAIDS in the previous 10d.
CBC also required.
2.5-9.5min
TAT: M-F, 4h
Lab: Hematol
Price: [$$] LMS 15
BLOOD FILM/SMEAR see FILM
BLOOD GASES and pH, measured O2 saturation
Specimen:
Arterial, venous, mixed venous and cord blood.
Remove air bubbles, remove needle, cap nozzle and label
specimen. Transport on ice.
Venous samples, filled green vacutainer may be used.
Ref Interval:
Adult
Umbilical cord
Arterial
Venous
Arterial
7.36-7.44
7.33-7.41
7.13-7.39
pCO2 mmHg
35-45
38-47
28-66
pO2 mmHg
80-90
20-50
9-38
HCO3 [calculated] mmol/L
22-27
23-27
12-27
± 2.5
± 2.5
-14.0 to 0.4
95-99%
60-85%
pH
Base excess mmol/L
O2 saturation [calculated]
Comments:
For every 10 mmHg of pCO2 change, HCO3- changes by:
Acidosis metabolic: (¯ pCO2) ¯ 8 mmol/L
respiratory: (­ pCO2) ­ 1 mmol/L
Alkalosis metabolic: (­ pCO2) ­ 17 mmol/L
respiratory: (¯ pCO2) ¯ 2 mmol/L
Conversion factor: kPa ´ 7.5 = mmHg
Method:
Ion-selective electrodes, CV 1%, instrument also measures Hb,
COHb, MetHb, whole bld electrolytes, iCa, glucose, lactate.
Factors affecting:
At room temp/h: pH ¯ 0.03, pCO2 ­ 5 mmHg pO2 ¯ 6 mmHg.
At 4oC, pO2 may ­ in plastic syringes (permeability of plastic)
Lab: OC Biochem/OG: CP Lab(ICU)
Price: [$] LMS
Abbreviations: (complete list on page 4):
Auto
Automated
Chem Chemistry Analyzer
CV
Coefficient of Variation (reproducibility)
CoHb Carboxyhemoglobin
MetHb Methemoglobin
Ionized calcium
iCa
min
h
d
w
m
CP
OC
OG
RS
PST
SST
Cardio-Pulmonary
Civic Campus
General Campus
Riverside Campus
Pale Green Top
Gold top
minutes
hour
day
week
month
17
BODY FLUID CELL COUNT
Specimen:
Ascitic, pleural, peritoneal, pericardial, synovial fluid.
Mauve not SST (min 1 mL)
State source and specific tests required.
Test includes:
RBC, WBC count and differential if WBC >10x106/L.
Cultures, cytology and chemical studies must be
requested separately and with separate specimens.
See body fluid CULTURE and CYTOLOGY (Effusions).
Interpretation:
Lymphocytes - assoc with TB, tumours, lymphomas,
lymphatic leukemia, RA, post-pneumonia effusions.
Neutrophils - assoc with acute infective processes.
Eosinophils - assoc with tumors, infarcts, LE, RA, rheumatic
fever, parasites, post-pneumonia effusions, pneumothorax.
Lab: Hematol
Price: [$$]
BONE MARROW ASPIRATE, BONE MARROW BIOPSY
Specimen:
Aspiration and biopsy by medical staff.
Phone Hematol (OC:16216, OG:78275) for technologist.
Patient history information essential for proper morphologic
interpretation. Indicate if cultures, biopsy, cytogenic studies
or special requests needed.
Also order CBC and Retic count (Whole blood in Mauve).
Test includes:
Leishman stain, iron stain. Biopsy: routine stains.
Films available for review in Hematology Lab.
Interpretation:
Normal marrows should contain stainable iron.
Myeloid:Erythroid ratio normally 3 to 1.
Morphologic interpretation reported.
TAT: M-F, 2-3d
Lab: Hematol
Price: [$$]
C1 ESTERASE INHIBITOR, C1-INH
Specimen:
Serum
SST/red
Ref Interval:
0.21-0.39 g/L
Conversion factor:
TAT: 14d
mg/dL ´ 0.01 = g/L
Lab: HICL
Price:[$$] LMS 12
CA-125 see CANCER ANTIGEN 125
CAFFEINE
Use: Monitoring of neonates treated with theophylline for apnea
Specimen:
Therapeutic:
Toxic conc:
Serum
40-100 umol/L
> 250 umol/L
Conversion factor:
Method:
ug/mL ´ 5.2 = umol/L
Syva EMITâ, CV 8%.
TAT: Daily
Lab: CHEO Biochem Price:[$$]
18
SST/red (morning if result same day)
CALCITONIN
Specimen:
Expected Value:
Comments:
TAT: 30 d
Serum Chilled Red Transport on ice
<100 ng/L, may be lower in women.
Following pentagastrin stimulation:
<200 ng/L
C cell hyperplasia/tumour not likely
200-500 ng/L
C cell hyperplasia likely
>500 ng/L
Medullary thyroid carcinoma likely
See 2 Chromosomal Studies - ret proto-oncogene.
Lab: HICL
Price: [$$$] LMS 120
CALCIUM (TOTAL), Ca++
Specimen:
Serum/plasma
Ref Interval:
2.23-2.58 mmol/L
SST/PST
Conversion factor:
Factors affecting:
mg/dL ´ 0.25 = mmol/L
mEq/L ´ 0.5 = mmol/L
Total Ca ¯ 0.2 mmol/L for every 10 g/L ¯ in alb (from 40 g/L).
Method:
Auto chem, CV 2% Interf: EDTA (¯¯), Oxalate (¯).
Lab: Biochem
Price:[$] LMS 5
CALCIUM (TOTAL) 24h Urine
Specimen:
24h urine, no preservative or 20 mL 6M HCl
Ref Interval:
2.5-7.5 mmol/d or <0.1mmol/kg body weight/d
Conversion factor:
TAT: M-F, 1d
mg/d ´ 0.025 = mmol/d
Lab: Biochem
Price: [$] LMS 5
CALCIUM, IONIZED FREE
Specimen:
Whole blood
PST/dark green Filled to line
Low heparin syringe (7 USP/3mL) with bld gas analysis
Serum
SST/red Transport on ice
Ref Interval:
1.15-1.40 mmol/L
Conversion factor:
Method:
Lab: Biochem
mg/dL ´ 0.25 = mmol/L
mEq/L ´ 0.5 = mmol
Ion selective electrodes, CV 1%. Interferences: heparin (¯),
prolonged storage at RT (­) because of pH ¯
Price: [$] LMS 20
CALCULI ANALYSIS, RENAL
Reported as:
Calcium oxalate, calcium phosphate, struvite, calcium
carbonate, uric acid, ammonium urate, cystine or
combination.
Method:
TAT: 21d
Chemical methods for calcium, magnesium, ammonium,
cystine, carbonate, phosphate, urate and oxalate. Interferences:
Silicates, Indinavir can give slight positivity for oxalate test.
Lab: OC Biochem
Price:[$$] LMS 15
CALCULI, BILIARY not available
Abbreviations: (complete list on page 4):
Auto
Automated
Chem Chemistry Analyzer
CV
Coefficient of Variation (reproducibility)
PST
SST
Mauve
Pale green, Li Heparin
Gold, thrombin activator
EDTA
19
CANCER ANTIGEN-125, CA-125
Use: Monitoring ovarian cancer, NOT screening. Elevated in 80% of ovarian cancer.
Specimen:
Expected Value:
Serum
< 35 U/mL
SST/red
Sample at mid cycle
Plasma half-life:
Method:
Following ablative surgery - 5d, prolonged t½ (>20d) is
associated with poorer survival.
­ - up to 3x ULN at menses;in peritoneal inflammatory process
AutoIA (AxSYMâ), CV 6%. Interf: heterophile antibodies to mice.
TAT: 1w
Lab: OG Biochem
Price:[$$]
CANNABINOID SCREEN, TETRAHYDROCANNABINOIDS, THC
Specimen:
Random urine
Reported as:
Positive at 50 ug/L of 11-nor-d-9-tetrahydrocannabinol
-9-carboxylic acid. Also detects 11-nor-d-8-THC-9-COOH
(non-psychoactive major metabolite), 11-OH-d-9-THC, cannabinol
Metabolism:
Bioavailability: oral 5-20%, smoking 18-50%, higher with heavy
use. Peak conc 5-12h after smoking. Mainly hepatic metabolism
with many metabolites, concentrations depend on type of
flower, twigs or oil ingested.
Half-life:
25h (4d after repeated use). May be pos 1-5d after stopping low
use, 3-6d after high use; up to 2m in heavyuse obese subjects
Clinical toxicity:
Disturbance in thought process, time perception, short-term
memory; ataxia. High doses cause disorientation, paranoia,
sensory distortion. Prolonged high dose – sinus tachycardia,
impaired alveolar macrophage activity and lung function.
Method:
AutoIA (AxSYMâ) Cross-reactivity : Nil with cocaine metabolite
(benzoylecgonine), caffeine, codeine, ibuprofen,
nicotine/cotinine, ASA, secobarbital. Cross-reacts with
ketoconazole. Interferences: bleach (¯), detergents.
TAT: M-F, 1d, stat avail.
Lab: OG Biochem Price: [$$] LMS 35
CARBAMAZEPINE
Specimen:
Serum/plasma
SST/PST
Draw trough level (12h after last dose)
Therapeutic:
17-47 umol/L; lower when used with other antiepileptics
Toxic conc:
>60 umol/L, lower for children
Erythromycin can raise concentration and cause toxicity
Conversion factor:
Clinical toxicity:
Peak conc:
Half-life:
Method:
Lab: Biochem
ug/mL ´ 4.2 = umol/L
Mild: diplopia, nystagmus, ataxia, dizziness.
Mod: (42-126 umol/L) somnolence, hallucinations, myoclonus,
hyperreflexia, vomiting, urinary retention, involuntary
movements.
Severe: (>168 umol/L): arrhythmias, coma, respiratory failure,
hypotension. Rarely, hepatic damage, blood dyscrasia,
osteomalacia, hypothyroidism.
4-8h, longer in overdose
16-26h in long term therapy
AutoIA (AxSYMâ), CV 4%. Cross-reactivity: desipramine (++).
Price:[$$] LMS 35
CARBON DIOXIDE, TOTAL see BICARBONATE
20
CARBOXYHEMOGLOBIN, COHb
Specimen:
Whole blood
Dark green or Mauve
Expected levels: Non-smokers: 0-2%
Smokers:
2-10%
Toxic conc:
10-30 %: headache, peripheral vasodilation
30-50 %: severe headache, weakness, dizziness
50-60 %: syncope, coma, fits, Cheyne-Stokes resp.
60-70 %: depressed cardiac and respiratory function
70-80 %: cardiac and respiratory failure, death
Sources:
Smoke - cigarette, auto, fire
Use of paint stripper (methylene chloride) in enclosed space.
Half-life:
5-6h at room air, 1h at 100% O2, 25 min at hyperbaric O2 (3 atm).
Method:
Co-oximetry, CV 2%.
Lab: OC: Biochem, OG: CP Lab (ICU)
Price:[$] LMS 15
CARCINOEMBRYONIC ANTIGEN, CEA
Use: Monitoring metastatic breast cancer on treatment, and metastatic colorectal
cancer on adjuvant therapy post-resection. Not for screening.
Specimen:
Interpretation:
Serum/plasma
SST/PST
Complete CEA (Cancer Ontario) form
Healthy <3.0 ug/L, smokers may have slight increases.
>20 ug/L in symptomatic patient strongly suggestive of
cancer and metastasis.
Following surgery, elevated concentrations beyond 6w is
suggestive of residual tumour.
May be elevated in other malignancies – breast, GI, liver,
lung, ovarian, pancreatic and prostatic cancer.
Method:
AutoIA(AxSYMâ),CV 7%. Interf: heterophile antibodies (to
mice).
TAT: 7d
Lab: OG Biochem
Price: [$$], funded by OCTRF for categories listed above.
CAROTENE, ß-CAROTENE
Specimen:
Serum
Red top, not SST Protect from light with foil
Ref Interval:
1.0-5.5 umol/L
Conversion factor:
Method:
ug/dL ´ 0.019 = umol/L
Manual extraction into hexane. CV 10%.
TAT:14d
Lab: OC Biochem
Price:[$$] LMS 16
CATECHOLAMINES, Plasma
To be done as Clonidine Suppression Test. Indicated when urinary VMA and
metanephrine results are equivocal. Restricted to Endocrinologists.
CATECHOLAMINES, Urine Order VMA, METANEPHRINES; or consult Biochemist
CD4/CD8 see FLOW CYTOMETRY
CEREBROSPINAL FLUID, CSF
see GLUCOSE, TOTAL PROTEIN, LACTATE, OLIGOCLONAL BANDING (includes IgG
and albumin quantitation), CULTURES, CYTOLOGY
21
CEREBROSPINAL FLUID – CELL COUNT
Test Includes:
Appearance, RBC, WBC and diff. if WBC >10 ´ 106/L.
Specimen:
3 sterile Red top (min 1mL each). Label and number tubes
(counts are done on last tube).
To arrive in lab within 1h
Order cytology, cultures, chemistry, serology separately
(tubes 1 and 2 may be used).
Expected values: Appearance: clear, colourless fluid
Leukocytes (mononuclear):
adult:0-10 ´ 10 6/L
neonates: 0-30 ´ 10 6/L
Erythrocyte: <10 ´ 10 6/L
Presence of more than few RBCs may indicate cerebral or
subarachnoid hemorrhage or traumatic tap.
TAT: Stat
Lab: Hematol
Price: [$$]
CERULOPLASMIN, COPPER OXIDASE
Specimen:
Serum
SST/red
Ref Interval:
Adult: 220-580 mg/L
Conversion factor:
Method:
Comments:
TAT: 7d
mg/dL ´ 10 = mg/L
Immunonephelometry (Beckman Immage®), CV 5%. Interf:
marked lipemia
<140 mg/L seen with Wilson’s disease (high liver copper).
­ Seen with infections (late acute-phase protein), liver disease,
oral contraceptive use.
Lab: OC Biochem
Price: [$$] LMS 19
CH100 see COMPLEMENT, TOTAL HEMOLYTIC
CHLAMYDIA TRACHOMATIS see also SEROLOGICAL TESTS
Specimen:
Cervix and male urethral swab (use swab from Chlamydia
PCR collection kit, Amplicor®), or first void urine.
TAT: 4d
Lab: Microbiol
Specimen:
Eye swab, conjunctival scraping. Use Chlamydia
trachomatis MicroTrak collection kit, Syva®, slide from
Microbiol
TAT: 1d
Lab: Microbiol
Price: [$$]
Price: [$$]
-
CHLORIDE, Cl , Serum
Specimen:
Serum/plasma
Ref Interval:
101-111 mmol/L
Conversion factor:
Method:
Lab: Biochem
22
SST/PST
mEq/L = mmol/L
Auto chem, CV 2%. Interf: bromide (­), n-acetylcysteine (­),
L-dopa (¯)
Price: [$] LMS 5
CHLORIDE, Urine
Specimen:
Random or 24h urine collected with no preservative
Ref Interval:
110-250 mmol/d
TAT: Stat, M-F for 24h collects Lab: Biochem
Price: [$] LMS 5
CHLORIDE, Feces
Specimen:
Liquid fecal material only
TAT: M-F, same day
Lab: Biochem
CHOLESTEROL, TOTAL
Specimen:
Serum/plasma
Ref Interval:
Risk for CAD
(NCEP guidelines):
SST/PST
Low
<5.2
Moderate
5.2-6.2
High risk
>6.2 mmol/L
See HDLC for Canadian Working Group guidelines
Conversion factor:
Method:
Lab: Biochem
mg/dL ´ 0.026 = mmol/L
Auto chem, enzymatic. CV 2%.
Price: [$] LMS 5
CHOLESTEROL, HIGH DENSITY LIPOPROTEIN, HDL-C
Specimen:
Serum/plasma
SST/PST
Risk for CAD:
High risk:
<1.0 mmol/L
(NCEP Guidelines)
Negative risk: >1.6 mmol/L
(Canadian Working Group guidelines, CMAJ 2000;162:1441)
Target Levels (all 3)
Risk
factors
Risk level
10y
CAD risk
LDLC (mmol/L)
TC:HDLC
Trig (mmol/L)
> 4 or CAD
Very high
> 40%
<2.5
<4
<2
<3
High
20-39%
<3.0
<5
<2
<2
Moderate
10-19%
<4.0
<6
<2
<1
Low
<10%
<5.0
<7
<3
Conversion factor:
mg/dL ´ 0.026 = mmol/L
Method:
Auto chem, direct enzymatic. CV 3%. Interferences: marked
lipemia (triglycerides >12 mmol/L no result).
Price: [$] LMS 18
Lab: Biochem
CHOLESTEROL, LOW DENSITY LIPOPROTEIN, LDL-C
Calculated using Friedewald equation:
LDL-C = Total Cholesterol – HDLC – Triglyceride/2.2 (all values in mmol/L).
Not reliable with rising triglycerides, and not reported for trig>4.5 mmol/L.
For measured LDL-C see LIPOPROTEIN ANALYSIS by ULTRACENTRIFUGATION
Risk for CAD
Target
Low < 3.4 Mod 3.4-4.1 High >4.1mmol/L (NCEP guidelines)
Low risk pts < 3.5 High risk <2.5 (for detailed targets see HDL-C)
Abbreviations: (complete list on page 4):
NCEP National Cholesterol Education Prgm (NIH)
CAD
Coronary artery disease
CV
Coefficient of Variation (reproducibility)
HICL
Hospital-in-Common (Toronto)
OC
OG
SST
PST
Civic
General
Gold Top
Pale Green Top
23
CHOLINESTERASE, PSEUDOCHOLINESTERASE, PHENOTYPING
Specimen:
Serum
SST (avoid hemolysis)
For phenotyping, collect >48 h after scoline administration.
In organophosphate poisoning, symptoms usually occur at
levels 50-75% of normal (order total only).
Ref Interval:
0 – 6 m:
6 m – 5 yr:
Adults:
25% of adult levels
1.3 to 1.5x adult levels
4.88-12.00 kU/L
Inhibition (%) by
CE
(kU/L)
Genotype
Dibucaine Fluoride
Normal
E u Eu
4.8–12.0
81–86
77–82
Heterozygous
E u Ea
2.3–9.4
67–79
77–83
Homozygous
Scoline
77-85
Sensitivity to
Scoline
rarely sensitive
1:500 sensitive
E u Ef
3.4–8.5
77–82
70–77
1:200 sensitive
Eu E s
3.6–5.6
83–86
77–82
1:1000 sensitive
E a Ea
0.7–3.1
15–25
80–89
very sensitive
Ef E f
3.6
72
54
sensitive
Ea E f
2.7–4.6
54–66
66–70
sensitive
Es Es
0–0.1
3–14
24–48
very sensitive
Comments:
Low conc seen with liver disease and following scoline
administration, plasmapheresis, cardiopulmonary bypass, and
in patients with liver disease
TAT: 7d for typing, total available stat if required
Lab: CHEO Biochem
Price: [$$] LMS 30
CHORIONIC GONADOTROPHIN b-subunit, ß-hCG, Serum
Specimen:
Serum/plasma
SST/PST
Ref Interval:
Female: Premenopausal, nonpregnant: <5 IU/L
Postmenopausal:
<20 IU/L
Weeks from LMP
3–4
IU/L
9 – 130
4–5
75 – 2,600
5–6
850 – 20,800
6–7
4,000 – 100,200
7 – 12
11,500 – 289,000
12 – 16
18,300 – 137,000
16 – 29
1,400 – 53,000
29 – 41
940 – 60,000
Conversion factor:
2nd IS ´ 2 = 1st IRP or 3rd IS, mIU/mL = IU/L
Comments:
Method:
Measures intact and free b-subunit.
Discriminatory zone (using vaginal U/S): 1,000-2,000 IU/L.
AutoIA (AxSYMâ), CV 5%. Interf: heterophile Ab (to mice)
Lab: Biochem
Price: [$$] LMS 30
24
CHORIONIC GONADOTROPIN b-subunit, Urine
Specimen:
Random urine. Note: kits are also available in ER, FMC, E1
PAU, SDCU, Nuclear Med
Comments:
Lab: Biochem
Positive at ~10 IU/L (10-12d after conception).
Price: [$]
CHROMOSOMAL STUDIES see
2 Chromosomal studies
CHYLOMICRONS not available. Chylomicronemia frequently present when
serum triglycerides >15 mmol/L, and when sample reported as lipemic.
CIRCULATING ANTICOAGULANT INHIBITOR - see MIXING TEST
CIRCULATING IMMUNE COMPLEXES not available
CITRATE, Urine
Specimen:
24h urine in 20 mL 6M HCl
Ref Interval:
0.8-6.0 mmol/d (approximates urinary calcium)
Conversion factor:
Method:
TAT: 4 w
mg/dL ´ 52.9 = umol/L
Auto chem, colorimetric assay
Lab: OC Biochem
Price: [$]
CLOMIPRAMINE see TRICYCLIC ANTIDEPRESSANT QUANT
CLOSTRIDIUM DIFFICILE TOXIN TESTING
Use: Major cause of antibiotic-assoc diarrhea and colitis, pseudomembranous colitis.
Specimen:
Stool in sterile screw-top container. In lab before noon.
TAT: M-F, 1d
Lab: Microbiol
Price: [$$]
COCAINE METABOLITES (Benzoylecgonine), Urine
Specimen:
Random urine
Reported as:
Positive for benzoylecgonine (main metabolite) at 0.3 mg/L
Presence of drug indicates previous exposure and does not
correlate with blood concentrations or degree of impairment.
Metabolism:
Well absorbed orally (60-80%, peak 1-1½h), nasally (60-80%,
peak 1-2h), by inhalation (32-77%, peak 3-25 min).
T½: cocaine 0.5-1.5h, benzoylecgonine 5-8 h; positive for 3d
average; ?up to 3w in very high-dosage user.
Clinical toxicity:
Coronary vasospasm, respiratory depression, seizures,
rhabdomyolysis, acidosis, hepatotoxicity, nephrotoxicity.
Method:
AutoIA (AxSYMâ)
쐌 Minimal cross-reactivity with cocaine, ecgonine, and
cocaethylene (formed when cocaine is used with ethanol)
쐌 No cross-reactivity with acetaminophen, alprazolam,
amitriptyline, amoxacillin, atenolol, caffeine, cannabinoid,
carbamazepine, cimetidine, diazepam, doxepine, furosemide,
thiazides, nicotine, phenytoin, theophylline
쐌 Interferences: bleach (¯), detergents
TAT: M-F, 1d; stat avail.
Lab: OG Biochem
Price: [$$]
25
COLD AGGLUTININ SCREEN
Use: Diagnostic in primary atypical pneumonia, mycoplasma pneumonia, hemolytic
anemia, gangrene, cirrhosis, Raynaud’s disease and some viral and infectious diseases.
Specimen:
Comment:
Mauve (7mL)
Titre can be done for antibody quantitation.
Normal healthy individuals have titres to 64
TAT: 24h
Lab: TM
Price: [$] LMS 15
COLLOID OSMOTIC PRESSURE
Specimen:
Serum preferred
whole blood (result ~2mmHg lower)
SST/red (Mauve/dark green for whole blood)
Restricted to ICU and HI; others consult Biochemist.
Ref Interval:
20-36 mm Hg
Conversion factor:
Method:
kPa ´ 7.5 = mm Hg
Colloid Osmometer (Wescor®)
Lab: OC Biochem
Price: [$$]
COMPLEMENT, C3 and C4
Specimen:
Serum
Ref Interval:
C3: 0.8-1.5 g/L
Conversion factor:
Method:
TAT: 7d
SST/red
C4: 0.16-0.38 g/L
mg/dL ´ 0.01 = g/L
Immunoneph (Beckman Immage®), CV: C3 6% C4 3%.
Lab: Biochem
Price: [$$] LMS 12 each
COMPLEMENT, TOTAL HEMOLYTIC, CH100
Specimen:
Serum
SST Transport on ice
Interpretation:
Normal
1:80 and 1:160
Low normal
1:40
Abnormal low
1:5, 1:10, 1:20
Confirm low titres with C3 and C4 quantitation.
Method:
TAT: 7d
Titre at 100% lysis of a standard suspension of sheep RBC.
Lab: OC Imm
Price: [$$] LMS 50
COMPLETE BLOOD COUNT, CBC, HEMOGRAM
Specimen:
Whole blood Mauve (not hemolyzed / clotted)
Microtube (300 uL) for neonates
Reference Intervals:
Males
Females
Units
Leucocytes (WBC)
3.00-10.5
3.00-10.5
x 109/L
130-170
115-155
g/L
Hemoglobin (Hgb)
Hematocrit (Hct)
0.380-0.500 0.350-0.450
Mean Corpuscular Volume (MCV)
80-100
fL
Mean Corpuscular Hgb (MCH)
27-34
pg
315-365
g/L
Mean Corpuscular Hgb Conc (MCHC)
Red Cell Distribution Width (RDW)
Platelet Count
26
11.5 -15.5
%
125-400
x 109/L
Reference Intervals:
RBC Count
Males
Females
Units
4.30-5.60
3.80-5.10
x 1012/L
Granulocytes
2.0-7.5
x 109/L
Lymphocytes
1.0-4.0
x 109/L
Monocytes
0.10-1.00
x 109/L
Eosinophils
0.0-0.5
x 109/L
Basophils
0.0-0.1
x 109/L
TAT: daily
Lab: Hematol
Price: [$$] LMS 16
COPPER, Plasma, Cu++
Specimen:
Plasma
Royal blue (from Biochem)
Ref Interval:
Male:
11.0-22.0 umol/L
Female: 9.0-27.0 umol/L
Conversion factor:
TAT: 14d
ug/dL ´ 0.16 = umol/L
Lab: HICL
Price:[$$] LMS 40
COPPER, Urine
Specimen:
24h urine in acid washed plastic bottle (from Biochem)
Ref Interval:
55-283 nmol/d (­ seen in Wilson’s disease)
Conversion factor:
TAT: 14d
ug/d ´ 16 = nmol/d
Lab: HICL
Price: [$$] LMS 40
CORTISOL, Serum
Specimen:
Serum/plasma
SST/PST
Ref Interval:
08:00h: 165-828 nmol/L 23:00h:~half morning conc
Functional:
Dexamethasone suppression test:(1 mg at midnight)
Expected: 0800 cortisol:<138 nmol/L or >50% drop
testing
Cosyntropin (ACTH) test: 250 ug cosyntropin i.v., collect
samples for cortisol at 0, 30 and 60m
Expected response: cortisol ­ >2x basal level or >200 nmol/L
Conversion factor:
Method:
TAT: 7d
ug/dL ´ 27.6 = nmol/L
AutoIA(Elecsysâ). Interf: prednisolone, methylprednisolone,
6-ß-hydroxycortisol, 21deoxycortisol. Minimal X-reactivity with
dexamethasone, 11 deoxycortisol, prednisone.
Lab: OC Biochem
Price: [$$] LMS 35
CORTISOL, Free Urinary
Sample:
24h urine, no preservative (refrigerated) or in 5 g boric acid
Ref Interval:
30-200 nmol/d
Conversion factor:
Method:
TAT: 7d
ug/d ´ 2.8 = nmol/d
As for serum, following extraction, CV 10%.
Lab: OC Biochem
Price: [$$] LMS 35
COXSACKIE VIRUS see VIRAL CULTURES
C PEPTIDE
Specimen:
Expected Value:
Serum/plasma
red/green not SST/PST
Collect after overnight fast. Restricted; consult Biochemist.
298-1324 pmol/L
TAT: 21d
Lab: HICL
Price: [$$] LMS 60
27
C REACTIVE PROTEIN, CRP
Use: Inflammatory diseases. Not high sensitivity assay used for CAD risk assessment.
Specimen:
Expected Value:
Serum
<8 mg/L
Conversion factor:
Method:
mg/dL ´ 10 = mg/L
Immunonephelometry (Beckman Immage®), CV 3%. IFCC
Standardized. Interferences: lipemia, gross hemolysis
Lab: OC Biochem
Price: [$$] LMS 6
TAT: 7d
SST/red
CREATINE KINASE, CK, Creatine Phosphokinase, (CPK)
Specimen:
Serum/plasma
SST/PST
2 Enzymes
Ref Interval:
Male:
20-215 U/L Female: 20-160 U/L
At CK >3,500 U/L, myoglobinuria may occur.
Method:
Lab: Biochem
Auto chem, CV 5%. Interferences: hemolysis (­).
Price: [$] LMS 5
CREATINE KINASE ISOENZYMES, CK-MB not available, replace with Troponin T
CREATININE, Serum
Specimen:
Serum/plasma
SST/PST
Ref Interval:
Male: 62-106 umol/L Female: 35-88 umol/L
RS: 60-125 umol/L
Conversion factor:
Method:
Lab: Biochem
mg/dL ´ 88.4 = umol/L
Auto chem (rate, Jaffe’s method), CV 2%. Interf: Acetoacetate,
Cefaclor, Cefoxitin, Cephalothin (­), Bilirubin (¯).
Price: [$] LMS 5
CREATININE, Urine
Specimen:
Random or 24h urine with no preservative or 20 mL HCL
Ref Interval:
Male: 7.1-17.7 mmol/d
Female: 5.3-15.9 mmol/d
Conversion factor: mg/d ´ 0.0088 = mmol/d
TAT: M-F, 1d, stat avail
Lab: Biochem
Price: [$] LMS 5
CREATININE CLEARANCE, CrCl, ECC
Specimen:
24h urine + serum/plasma, collected as above
For Cockcroft-Gault CrCl, order CCCGM (males) or CCCGF
(females) with S creat request and include patient’s weight.
Ref Interval:
Male:
1.42-2.08 mL/s/1.73 m2 body surface area
Female: 1.25-1.92 mL/s/1.73 m2 body surface area
Increased in pregnancy and obesity.
Calculation:
ECC = [urine creat (mmol/d)/ serum creat (umol/L)] x 11.6
Results reported are not corrected for surface area.
mL/min ´ 0.017 = mL/s
Lab: Biochem
Price: [$] LMS 15
Conversion factor:
TAT: M-F, 1d
CROSSMATCH see TYPE and CROSSMATCH
Abbreviations: (complete list on page 4):
[$]
<$5
[$$$]
$15-49
[$$$$$] >$100
28
PST
SST
Mauve
Pale green, Li Heparin
Gold, thrombin activator
EDTA
CRYOFIBRINOGEN
Specimen:
Phone (798-5555x16216) for instructions.
Serum+Plasma
Red x 2 + Mauve x 2. Keep warm
Expected Result: Negative at 40°C and 32°C
Method:
Visual screen followed by semiquantitative RID for positives.
TAT: 2d if neg, 7d if pos Lab: OC Imm
Price Screen/Quant: [$/$$$] LMS 5/30
CRYOGLOBULINS
Specimen:
Phone (798-5555x16216) for instructions.
Serum Red x 2
Keep warm
Expected Result: Negative at 40°C and 32°C.
Positives typed for immunoglobulin class and quantitated.
Method:
Visual screen followed by semiquantitative RID for positives.
TAT: 2d if neg, 7d if pos Lab: OC Imm
Price Screen/Quant: [$/$$$] LMS 5/30
CRYPTOCOCCUS DIRECT ANTIGEN TEST
Specimen:
CSF in red vacutainer.
Restricted; consult Microbiologist.
TAT: 1d
Lab: Microbiol
Price: [$$$$]
CULTURES see also VIRAL CULTURES
Routine culture consists of
쐌 Gram’s stain. Negative Gram stains do not mean cultures will be negative.
쐌 Aerobic culture and identification with susceptibility testing of cultured pathogens.
Specific cultures: by specific request (if appropriate) or if source site indicates
anaerobic, Legionella, fungal, Mycobacterial and Mycoplasma infection.
Comments on blood and fluid cultures (see Ward Manual for details)
쐌 Volume of blood (8-10 mL) most important for optimizing blood culture.
쐌 No more than 2 sets (aerobic+anaerobic) of blood cultures in 24h period,
except in endocarditis (collect additional aerobic culture sample).
쐌 Where there is insufficient sample, the aerobic sample is more important.
쐌 Blood cultures: number of isolates relative to number of cultures important.
쐌 Skin commensals, esp coagulase -ve Staphylococci and Corynebacteria
sp., may be pathogenic in presence of foreign body, including i.v. line.
쐌 Sterile sites: all growth reported. Interpret according to clinical findings.
쐌 For sites other than blood, presence of inflammatory reaction useful
indicator of significance.
쐌 Neg cultures do not exclude infection, pos do not always indicate infection.
Susceptibility data for Ottawa Hospital 2001 (% susceptible)
Ps aeruginosa
(non-CF)
Acinetobacter
39
0
0
0
0
0
94
0
0
0
0
0
Cefotaxime
98
98
Ceftazidime
99
98
88
83
Serratia
0
96
Citrobacter
72
Cefazolin
Enterobacter
86
Ampicillin
Klebsiella
E. coli
Coag. neg
Staph
100
Gram negative
Enterococcus
S. Aureus (not
MRSA)
Gram positive
Continued on next page
29
Gram positive
Cefuroxime
Ciprofloxacin
Clindamycin
85
Cloxacillin
100
39
Cotrimoxazole
98
58
Erythromycin
85
34
Gram negative
96
94
96
94
97
84
82
92
87
94
97
93
94
99
72
34
Gentamicin
97
98
98
96
95
88
Meropenem
100
100
100
100
100
97
92
Piperacillin
72
89
72
71
83
77
84
Pip / Tazo
97
94
Penicillin
17
90
Tobramycin
98
98
94
96
Vancomycin
100
100
99
쐌 Avoid using vancomycin and ceftazidime to reduce risk of resistant strains.
쐌 All Enterococci are resistant to cephalosporins.
쐌 The main current resistance problems(worldwide) are: Methicillin-resistant
Staphylococcus aureus (MRSA), Penicillin-resistant Streptococcus pneumoniae
(PRSP), Extended spectrum ß-lactamases (ESBL), Vancomycin-resistant
Enterococcus (VRE), Ampicillin-resistant Enterococcus (ARE), Multidrug-resistant
Mycobacterium tuberculosis (MDR-Tb).
Recently hospitalized (<72h) or Outpatients
쐌
쐌
쐌
C&S x 1 (Shigella, Salmonella, Campylobacter, E. Coli 0157, Yersinia)
Clostridium difficile x 1
Ova & parasites if appropriate
Hospitalized patients - > 72h after admission
쐌
Clostridium difficile x 1
not available; order Parathyroid hormone
CYCLOSPORIN A, CsA
Specimen:
Whole blood
Mauve (Dark green acceptable)
Therapeutic:
Varies with transplant type and time since transplant
Half life:
Clinical toxicity:
Variable
Nephrotoxicity, hepatotoxicity, neurotoxicity, hypertension,
tremors, infection, malignancy, hirsutism, gingival hypertrophy.
Method:
Auto IA (AxSYMâ), CV 8%. Low cross-reactivity with metabolites
AxSYM = 0.73TDx = 0.996 EMIT (varies in patients, dependent
on proportion of metabolites)
TAT: Same day if spec in lab before 10:00h Lab: Biochem
Price: [$$$]
Abbreviations: (complete list on page 4):
Auto
Automated
Chem Chemistry Analyzer
CV
Coefficient of Variation (reproducibility)
HICL
Hospital-in-Common (Toronto)
IA
Immunoassay
30
OC
OG
OG TT
PST
SST
Civic
General
General Tissue Typing
Pale Green Top
Gold Top
CYSTINE, Urine, SCREEN and QUANTITATION
Specimen:
Random or 24h urine (no preservative). State if patient is
Solubility
known cystinuric.
Ref Int:
Cystine: 5-24 umol/mmol creat
Aim for <840 umol/L (regardless
of pH)
Arginine:
1-10 umol/mmol creat
Lysine:
16-72 umol/mmol creat
Ornithine: 2-9 umol/mmol creat
Method:
Sample screened using
cyanide-nitroprusside test, positive
samples are quantitated by IEC
Penicillamine (¯) thiola (¯).
mg/L ´ 4.2 = umol/L
Conversion factor:
TAT: 7d
Lab: CHEO Biochem
Price: [$$$] LMS 8 for screening
CYTOLOGY (See also Fine needle aspiration biopsy)
Specimen:
See table for collection instructions.
Label container/slides with source site, laterality (if
applicable) and patient’s name.
Send to Cytology Lab.
Requisition:
Lab 09 -411390
Provide appropriate clinical information (e.g. differential
Results:
diagnoses; history of malignancy, drugs, radiation therapy,
alcohol abuse; radiographic findings).
Results usually available within 24-48h
Sample Type
Body fluids
(pleural, peritoneal,
pericardial, synovial)
Brushings
(bladder, bronchial,
esophageal, gastric,
oropharyngeal,
ureteral)
Cerebrospinal
fluid
Procedure
OC: Collect in 50 mL disposable screw-top tubes with green
fixative (1 or 2 tubes) – do not use vacutainers
쐌 For synovial fluid crystals, send in red top vacutainer to
Biochem
OG: 25-50 mL in specimen container, add equal vol of 50%
ethanol.
Brush lesional area
OC/OG: Cut ~10 cm above proximal brush tip, remove outer
sheath. Drop immediately into appropriate fixative
쐌 Post-bronchoscopy sputum should be collected as it
sometimes yields more diagnostic cells than during
bronchoscopy.
State source (e.g. LP, shunt)
For suspected lymphoma, send also specimen to Tissue Typing
Lab for surface marker determination.
OC: Collect 2-5 mL red-top vacutainer.
08:30-16:30h Mon-Fri: Send on ice immediately.
After hours, add equal volume of green fixative and fridge.
OG: 2-5 mL in clean plastic tube, add equal volume of 50%
ethanol
쐌
쐌
Cervical/Vaginal see Papanicolaou Smear
Continued on next page
31
Sample Type
Procedure
Nipple discharge
If both breasts, label slides as to laterality and submit
separately, with 2 requisitions
Express material by gentle massage and stroking toward nipple.
Touch droplets with labeled glass slide and drop in 95% ethanol
or use Cytospray®. Continue as long as secretion is obtained.
Sputum – early
Collect on 3 consecutive days, not 24h specimens
Have patient rinse mouth, and cough deeply. Do not collect
saliva.
OC: Collect in wide mouth plastic jar with green fixative.
OG: Collect in plastic container with 50% ethanol
morning DEEP
COUGH spec
Urine – voided,
catheterized bladder,
ureteral
쐌
Voided: collect ~3h after last void. First morning voids are not
suitable (long exposure of cells to urine).
OC: Collect in 50 mL disposable screw-top tube with green
fixative.
OG: collect in plastic container, add equal vol 50% ethanol
쐌 For CMV, viral culture more appropriate.
OC: Collect in Red vacutainer, largest volume possible. Send
immediately to Cytology Lab. Phone 16834/ 13312 to inform lab.
OG: Collect vitreous fluid in plastic container, add equal vol 50%
ethanol. Smear conjunctival scrapings on labeled glass slide and
Cytospray®. Phone 78305/ 72508 to inform lab.
Vitreous fluid/
conjunctival
scrapings
Washings
(bladder, bronchial, esophageal, Gl
tract)
OC: Collect in 50 mL disposable screw-cap tube with green
fixative.
OG: Collect in container with equal volume of 50% alcohol.
CYTOMEGALOVIRUS (CMV) by PCR see also SEROLOGICAL TESTS,
TRANSMISSIBLE DISEASE TESTING, VIRAL CULTURES
Use: Immunocompromised hosts
Specimen:
TAT: 1w
Whole blood
Mauve 7 mL x 2
Lab: CHEO Virology
Price: [$$$$]
Do also EBV and HHV6; for others - discuss with Microbiologist
DANAPROID - see ANTI-Xa
D-DIMER
Use: Detects cross-linked fibrin derivatives. Increased levels associated with DIC,
recent surgery, recent thrombolytic treatment and thrombosis.
Specimen:
Interpretation:
Plasma Light blue Specify anticoagulant if applicable
<200 ug/L is negative for DVT/PE when used with clinical
model
Lab: Hematol
Price: [$] LMS 30
Abbreviations: (complete list on page 4):
Auto
Automated
Chem Chemistry Analyzer
CV
Coefficient of Variation (reproducibility)
32
OC
OG
OG TT
Civic
General
General Tissue Typing
DEHYDROEPIANDROSTERONE SULPHATE, DHEAS
Specimen:
Serum SST/red (Mauve, PST also acceptable)
Ref Interval: (tentative)
Male
Female
20-34y
4.3-13.4
2.7-11.0 umol/L
35-54
1.2-11.6
1.0- 9.1
> 55
0.4- 8.0
0.3- 6.7
Conversion factor:
Method:
ng/mL ´ 0.0027= umol/L
AutoIA (Elecsys®)
TAT: 14d
Lab: OC Biochem
Price: [$$] LMS 40
DEOXYCORTISOL not available
DESIPRAMINE see TRICYCLIC ANTIDEPRESSANT QUANT
DIGOXIN
Specimen:
Therapeutic:
Toxic conc:
Conversion factor:
Half life:
Clinical toxicity:
Method:
Lab: Biochem
Serum/plasma
SST/PST
For trough value draw sample >18h postdose
1.0-2.6 nmol/L (trough)
>3.3 nmol/L (age, hypokalemia, hypoxia, acid-base
balance, thyroid and renal status affect toxicity)
ng/mL ´ 1.3 = nmol/L
26-52h; increased in renal impairment
CVS: arrhythmia, AV dissoc; GI: anorexia, nausea/vomiting,
diarrhoea; CNS: visual, headaches, weakness, psychosis.
AutoIA (AxSYM®), CV 5%. Digibind™(­). fluorescein (­),
digoxin-like immunoreactive factors (­), and digitoxin (slight ­)
Price: [$$] LMS 28
DIRECT ANTIGLOBULIN TEST
Use: Detect in vivo red cell sensitization due to IgG and/or complement. Diagnostic in
autoimmune or non-immune diseases, transfusion reaction or hemolytic disease of
the newborn.
Specimen:
Mauve (7mL)
TAT: Routine 1-3h, Stat 15 min
Lab: TM
Price: [$] LMS
DISACCHARIDASE, INTESTINAL not available
DISOPYRAMIDE restricted – consult Biochemist
DNA TESTING see 2 Chromosomal Studies
DONATH-LANDSTEINER TEST consult Hematologist
DOXEPIN see TRICYCLIC ANTIDEPRESSANT QUANT
DRUG SCREEN see individual assays - BARBITURATES, BENZODIAZEPINES,
CANNABINOIDS, COCAINE, and OPIATES screens. For amphetamine - consult Biochemist.
EOSINOPHIL IN BODY FLUID
Specimen:
Sputum specimen or urine specimen.
Interpretation:
Presence indicates allergic or parasitic disease; increased
in urine in interstitial nephritis.
TAT: M-F, 1d
Lab: Hematol
Price: [$] LMS 3
33
EPSTEIN-BARR VIRUS (EBV) by PCR see also SEROLOGICAL TESTS
Use: Immunocompromised host only
Specimen:
Whole blood
Mauve (7 mL)
CSF
Red top
Store at 4oC
Throat washings:
Patient to cough, gargle with saline
and collect gargle in sterile screw-top bottle; store at 4oC
쐌 Indicate date of onset and clinical condition
쐌 Consult with Microbiologist
TAT: 1w
Lab: CHEO Virology
Price: [$$$$]
ERYTHROPOIETIN
Specimen:
Serum/plasma SST/PST (not EDTA). Transport in iced water
immediately. Recommended sample draw time 07:30-12:00.
Ref Interval:
Restricted; consult Biochemist.
5.0 - 29.5 U/L
Comment:
TAT: 14d
Hemolysed sample or EDTA not suitable
Lab: HICL
Price: [$$]
Specimen:
Serum/plasma
Ref Interval:
(tentative)
Males:
28-156 pmol/L
Females: Follicular 46-807
Ovulatory 315-1828
Luteal
161-774
Pregnancy (1st Trimester) 789 - > 15781 pmol/L
Postmenopausal
<73 pmol/L
Comment:
Conversion factor:
Osteoporosis associated with conc <60 pmol/L
pg/mL ´ 3.67 = pmol/L
Method:
AutoIA (Elecsysâ) Estradiol II. Lowest limit of detection 20
pmol/L.
Lab: Biochem (OC,OG)
Price: [$$] LMS 55
TAT: Daily
SST/PST/Mauve
ESTROGEN-PROGESTERONE RECEPTORS, ER-PR
Specimen:
Breast carcinoma tissue, fresh or in 10% neutral buffered
formalin. The results may be influenced by overfixation,
thus a fresh specimen transported by Stat porter is
preferable. Notify lab (OC: 13531, OG: 72059) prior to
transport to ensure optimal handling of fresh specimens.
Method:
TAT: 4d
Immunohistochemistry (semi-quantitative)
Lab: Surgical Pathology
ETHOSUXIMIDE
Specimen:
Serum/plasma
Therapeutic:
280-710 umol/L
Toxic conc:
>1,000 umol/L
Half-life:
Conversion factor:
TAT: 2d
34
SST/Red/PST/green
33 ± 6 h
ug/mL ´ 7.1 = umol/L
Lab: HICL
Price: [$$] LMS 35
ETHYL ALCOHOL, ETHANOL, ETOH
Specimen:
Serum/plasma
SST/PST
Legal limit:
17 mmol/L = 0.08 g/dL = 80 mg/dL
Toxic conc:
>90 mmol/L coma; >120 death
Consider dialysis at >65 mmol/L
Half-life:
Conversion factor:
Method:
Lab: Biochem
0.24 ± 0.1h, elimination rate: 100 mg/kg/h
mg/dL ´ 0.22 = mmol/L; g/dL ´ 217 = mmol/L
OC: Auto chem, CV 3% Interf: High lactate+LD; OG: AxSYMâ
Price: [$] LMS 43
ETHYLENE GLYCOL
Specimen:
Serum/plasma
SST/PST
­Performed stat only if osmolal gap@ is increased
Toxic conc:
>2 mmol/L, lethal >20, consider dialysis at >8 mmol/L
쐌 Ethanol-load patients while awaiting results
Half-life:
Comments:
Conversion factor:
Method:
Lab: OC Biochem
@
3h (in absence of ethanol)
Ca oxalate crystals in urine consistent with toxicity.
Common source: radiator antifreeze; lethal dose ~100 mL
mg/dL ´ 0.16 = mmol/L
Gas chromatography, performed in conjunction with
isopropanol, methanol, and acetone. CV 10%.
Price: [$$] LMS 45
(2´Na - gluc - urea - ethanol - measured osmolality; if >0, osmolal gap is present).
EUGLOBULIN CLOT LYSIS TIME, CLOT LYSIS TIME
Specimen:
Phone lab (OC:14190, OG:78329) prior to collection.
Light blue
Transport on ice
Expected Value:
Comments:
TAT: M-F, 1-2d
(must be analyzed within 30 min)
>60 min
­ clot lysis seen with severe liver disease, intravascular
coagulation or after streptokinase administration.
Lab: Hematol
Price: [$$] LMS 10
FACTOR ASSAYS (II, V, VII, X, XI, XII)
Specimen:
Plasma
Light blue ´ 3
Transport on ice.
Patient should not be on anticoagulant therapy.
Order INR, PTT and Plt count prior.
Consult strongly recommended.
Ref Interval:
Factor II
0.55-1.55
X
0.70 - 1.70 U/mL
V
0.50-1.50
XI
0.50 - 1.40
VII 0.65-1.65
XII 0.65 - 1.65
Method:
TAT: 10d
Detects specific coagulation factor activity.
Lab: Hematol
Price: [$$] LMS 55 each
FACTOR V Leiden Genotyping See 2 Chromosomal Studies.
Abbreviations: (complete list on page 4):
2
Appendix (pages 89-102)
OC
OG
Civic Campus
General Campus
35
FACTOR VIII ASSAY, ANTI-HEMOPHILIAC, HEMOPHILIA A FACTOR
Specimen:
Plasma
Light blue ´ 3
Transport on ice
Phone Special Coag (OC:14190, OG:78329)
Ref Interval:
0.5-1.50 U/mL
Method:
TAT:10d; Stat 1-2d
Measures specific factor deficiency such as in classic
hemophilia, von Willebrand’s disease.
Lab: Hematol
Price: [$$$] LMS 55
FACTOR VIII or IX INHIBITOR, HEMOPHILIAC INHIBITOR
Specimen:
Serum
Red top x 2
Transport on ice
Comment:
TAT: 10d
1 Bethesda unit = amount that will inactivate 50% of factor activity in 2h
Lab: Hematol
Price: [$$$$$]
FACTOR IX, PTA, HEMOPHILIA B ASSAY
Specimen:
Plasma
Light blue ´ 3
Transport on ice
Arrange for elective surgery patients (OC:14190,
OG:78329).
Ref Interval:
0.7-1.7 U/mL
F IX may be increased in patients on oral contraceptives.
Method:
Measures specific coagulation factor activity.
TAT: M-F, routine 10 d, stat 1-2d
Lab: Hematol
Price: [$$$]
FACTOR XIII, FIBRIN STABILIZING FACTOR
Use: Evaluation of bleeding disorders. Homozygotes may present with umbilical
stump bleeding, life-long bleeding tendency with poor wound healing
Specimen:
Expected Value:
Plasma
Light blue ´ 3
No lysis within 24h
TAT: qual 1-2d, quant 4w
Transport on ice
Lab: Hematol
Price: [$] LMS 5
FATTY ACIDS, VERY LONG CHAIN, VLCFA
Use: Diagnosis of peroxisome biogenesis disorders – Zellweger’s,
Adrenoleukodystrophy, Adrenomyeloneuropathy, Refsum’s Disease
Specimen:
Interpretation:
TAT: 21d
FECAL FAT
Specimen:
Restricted; consult Biochemist.
Serum/plasma
SST or Mauve
Send to Biochem immediately.
­ saturated and monosaturated C26 and C24 aliphatic
acids with ¯ C22:0 seen with peroxisome disorders
Lab: HICL (Chedoke-McMaster)
Price: [$$]
Ref Interval:
3d fecal collect in pre-weighed can (from Biochem)
Patient should be on >75g/d fat during collection.
­Quantitated only in solid or semisolid, dark-coloured
stools if total weight >500 g. Liquid samples not analyzed.
2.0-7.0 g/d
Conversion factor:
TAT: 14d
mmol/d ´ 0.28 = g/d
Lab: HICL
Price: [$$] LMS 72
Testing done:
36
FERRITIN
Specimen:
Ref Interval:
Conversion factor:
Method:
Comments:
Lab: Biochem
Serum/plasma
SST/PST (not Mauve)
Male:
16-320 ug/L
Female: premenopausal 10-190
postmenopausal 10-230
ng/mL = ug/L
AutoIA (AxSYMâ), CV 5%.
Iron deficiency usually associated with levels <10 ug/L. Iron
overload associated with levels >1350 ug/L.
¯ with recent blood loss, unsupplemented pregnancy.
­ in iron therapy, inflammation, malignancy, hepatic disorders,
juvenile rheumatoid arthritis
Price: [$$] LMS 28
FETAL LUNG MATURITY, FLM
Specimen:
Amniotic fluid 1mL, with no visible blood or meconium;
icteric samples cannot be analyzed.
Interpretation:
Immature:
<39 mg surfactant/g albumin
For diabetics
<70
Method:
Lab: Biochem
FIBRINOGEN
Specimen:
Ref Interval:
Functional test: measures surfactant activity (TDxFLxâ) CV 4%.
Interferences: urine (­), blood (¯) and meconium (¯)
Price: [$$]
Plasma
Light blue
Specify anticoagulant patient is on.
1.90-4.50 g/L
Comments:
¯ congenital fibrinogenemia, DIC, fibrinolytic disorders,
severe liver disease
­ with inflammation, pregnancy and oral contraceptive use
Lab: Hematol
Price: [$] LMS 28
FILM, BLOOD SMEAR FOR RBC MORPHOLOGY
Specimen:
Whole blood
Mauve
TAT: 24hr
Lab: Hematol
Price: [$$]
FINE NEEDLE ASPIRATION BIOPSY, FNAB
Requisition:
Lab 09 -411390
Include pertinent clinical information and collection time
Phone for Cytotechnologists
OC: M-F 0830-1530h Phone 16834, 13312 or 17651
OG: M-F 0800-1500h Phone 78305 or 72508
Biopsies in Radiology, OR: Make appointment for Cytotechnologist to attend
Breast:
OC: Breast clinic: make direct smears and rinse needle contents in green fixative.
Other sites: Rinse needle contents in green fixative (50 mL screw-cap tube).
OG: arrange for tech (or expel and rinse needle in 50% ethanol).
Continued next page
37
Lung:
OC: (prep by Radiology Staff)
쐌 For EM and Immunocytochemistry, several passes needed.
쐌 Smears - place aspirate onto labeled glass slide, place another labeled slide over
and work slides back and forth to distribute cells evenly. Separate and place in
Coplin Jar with 95% ethanol.
쐌 Rinse needle in balanced electrolyte solution (50 mL screw-cap tube).
쐌 Send both immediately to Cytology Laboratory.
OG: arrange for Cytotechnologist to attend
Thyroid, Salivary glands, prostate, testes, abdominal, adrenal, kidney, liver,
lymph nodes, pancreas, retroperitoneal tissue, abdominal fat.
쐌 Make appointment for Cytotechnologist to attend
Renal transplants (for rejection, nephrotoxicity, immune activation or infection)
OG: Notify Pathologist and cytotechnologist (78305 or 72508) 24h prior, and the lab
30 min prior to procedure and when abdomen is prepared
FK506 see TACROLIMUS
FLOW CYTOMETRY
All testing by appt only. OC: 16216, OG: 78277. Indicate diagnosis on requisition
Immunophenotyping: Restricted to hematologist/hematopathologist
Use: Diagnosis of leukemias, lymphomas, immunodeficiency, AIDS
Specimen:
Whole blood
OG: Mauve x 1
OC: Mauve x 2 + Dark green (no gel) x 2
Bone marrow:
2 mL in Mauve
Lymph node:
Workshop or McCoy’s medium
Aspirates:
5 mL in Dark green
Fluids:
5 mL in Dark green (Na heparin)
TAT: M-Th am, 1d
Lab: OC Hematol/OG TT
Price: [$$$$$]
CD4 count, CD4/CD8 ratio
Use: Monitor HIV patients
Specimen:
TAT: M-F, 2d
Whole blood
Lab: OG TT
Mauve x 1
Price: [$$$$]
T and B cell Crossmatch
Use: Live donor-recipient compatibility, more sensitive than AHG-CDC test
Specimen:
TAT: M-F, 6-12h
Donor: Mauve x 4
Lab: OG TT
Recipient: Red (10 mL) not SST
Price: [$$$$$]
FOLATE, Serum and Erythrocyte
Specimen:
Serum
SST/red
RBC folate
Mauve or dark green
Ref Interval:
Serum: >15 nmol/L RBC:
215-1292 nmol/L
Conversion factor:
Method:
Comments:
ng/mL ´ 2.266 = nmol/L
IRMA (BioRad), CV 5%. Avoid hemolysis in sample collection.
RBC folate corrected for plasma volume.
Serum folate is not acutely affected by diet and supplements.
TAT: 7d
Lab: Biochem
38
Price: [$$] LMS 40
FOLLICLE STIMULATING HORMONE, FOLLITROPIN, FSH
Specimen:
Serum/plasma
SST/PST
Ref Interval:
Male:
1-8 IU/L (2nd IRP 78/549)
Female: Follicular:
4-13
Midcycle:
5-22
Luteal:
2-13
Postmenopausal: 20-138
Method:
TAT: 7d
AutoIA (AxSYMâ), CV 6%. Interf: lipemia (­)
Lab: Biochem
Price: [$$] LMS 28
FRAGMIN - see ANTI-Xa
FREE ERYTHROCYTE PROTOPORPHYRIN see
2 Porphyria
FUNGUS
Specimen:
Blood:
Test:
TAT: days to 4w
Fungal stain performed routinely where appropriate.
Lab: Microbiol
Price: [$$]
Aerobic BAC-T-ALERT bottle.
Indicate fungal culture.
CSF:
Red vacutainer
Skin, hair, Obtain black paper from Microbiol, wrap
nails: specimen securely.
Other sites: Sterile screw-cap container or sterile swab
GAMMA GLUTAMYL TRANSFERASE, GGT, (GGTP)
Specimen:
Serum/plasma
SST/PST
Ref Interval:
7-50 U/L
Comment:
Method:
Lab: Biochem
GASTRIN
Specimen:
Ref Interval:
Comment:
TAT: 4 w
GENTAMICIN
Specimen:
Phenobarbital, warfarin, ethanol may induce GGT. 2 Enzymes
Auto chem, CV 4%. Interferences: moderate hemolysis (­).
Price: [$] LMS 5
Serum SST/red Must arrive in laboratory within 1h.
Fast 10 h for basal level.
Fasting:<90 ng/L
Random: <200 ng/L
­: cimetidine, antral distension, postvagotomy, atropic gastritis, gastric Ca, gastric ulcer, pernicious anemia, renal failure.
Lab: HICL
Price: [$$$] LMS 75
Therapeutic:
Toxic conc:
Serum/plasma
SST/PST
State if pre- or postdose, or random (peak: draw 30 min
post-infusion or 60 min post-injection or oral dose)
Predose <2 mg/L; postdose conc varies, based on use.
Predose >2 mg/L Postdose >10 mg/L
Half-life:
Toxicity:
Conversion factor:
Method:
Lab: Biochem
1.5h (to 15h, prolonged in renal failure)
Nephrotoxicity, ototoxicity, neuromuscular block
mg/L ´ 2.09 = umol/L
AutoIA (AxSYMâ), CV 3%.
Price: [$$] LMS 40
39
GLUCAGON
Specimen:
Ref Interval:
Restricted; consult Biochemist.
Fast 14h. Special collection protocol.
Plasma: prechilled Mauve vacutainer, add aprotinin to
sample. Transport on ice immediately
150-300 ng/L
TAT: 30d
Lab: HICL
Price: [$$]
GLUCOSE-6-PHOSPHATE DEHYDROGENASE, G6PD
Specimen:
Whole blood
Mauve
TAT: M-F, 3d
CBC, RBC Morphology and Retic count must also be ordered
Lab: Hematol
Price: [$$] LMS 65
GLUCOSE, Blood
Specimen:
Serum/plasma
SST/PST
Ref Interval:
Normal
Diabetes control
(CDA Guidelines)
Optimal Suboptimal Inadequate
Fasting:
3.8 - 6.0
4.0 - 7.0 7.1-10.0
>10.0
1-2h post meal: 4.4 - 7.0
5.0 -11.0 11.1-14.0
>14.0
Factors affecting:
Conversion factor:
Method:
Lab: Biochem
At RT, whole blood glucose ¯ ~ 0.5 mmol/h
mg/dL ´ 0.055 = mmol/L
Auto chem, CV 3%, (glucose meters available in most wards).
Price: [$] LMS 5
GLUCOSE, Cerebrospinal fluid
Specimen:
CSF
sterile red top (min 0.5 mL)
Ref Interval:
2.7 – 4.4 mmol/L (~0.6 ´ serum conc)
Lab: Biochem
Price: [$] LMS 6
GLUCOSE TOLERANCE SCREEN for Gestational Diabetes
Use: In pregnant women >25y, or <25y with predisposition (obese, Aboriginal/Hispanic/Asian/African descent, family history or previous history of DM, macrosomia BW
>4 kg).
Protocol:
Interpretation:
(CDA Guidelines)
Between 24-28w gestation. 50 g glucose any time of day
1h: > 7.8 mmol/L – suspicious, suggest tolerance test
> 11.1 mmol/L – gestational diabetes
GLUCOSE TOLERANCE TEST
Patient prep:
At least 150 g carbohydrate for 3d prior. Discontinue meds
(where possible) that affect glucose tolerance.
Do not perform on patients with fasting hyperglycemia
Procedure:
Perform in morning, patient seated and not smoking.
Collect fasting sample (0h), give 75g glucose p.o.(1.75g/kg
BW for children up to 75g). Collect samples at 1 and 2h
post-load. Fridge samples if delivery to lab is delayed.
Continued on next page
40
Expected values:
ADULTS
0h
CDA Guidelines (CMAJ 1998;159:S1-29). Concentrations in mmol/L
Normal
IGT@
Diabetes Mellitus
<6.1
<7.0
> 7.0
1h
2h
Gestational Diabetes
> 5.3
> 10.6
<7.8
7.8-11.0
Random
11.0
> 8.9
> 11.0 + symptoms
If only 1 criteria
met, diagnosis is
impaired glucose
tolerance of
pregnancy
@
IGT=impaired glucose tolerance. Category of impaired fasting glucose (6.1-7.0
mmol/L) does not have ­ microvascular risk, but has ­ risk of DM and CAD.
GLYCATED HEMOGLOBIN see HEMOGLOBIN A1c
GONOCOCCUS, GC
Specimen:
Cervix or male urethra. Sterile swab in transport media. For
other sites, GC screen must be specifically requested
TAT: 2d
Lab: Microbiol
Price: [$]
GROWTH HORMONE, hGH
Specimen:
Serum
SST/red
Ref Interval:
<15 mIU/L
Criteria of GH def in children: <8 mIU/L post stimulation.
Conversion factor:
Method:
TAT: 7d
ug/L ´ 2.25 = mIU/L
IRMA (Nichols Inst), CV 5%.
Lab: OC Biochem
Price: [$$] LMS 40
HAM’S (ACID SERUM, Paroxysmal Nocturnal Hemoglobinuria,
Serum lysis) TEST
Use: Confirmation of intravascular hemolysis. Screen with Sucrose Lysis test.
Specimen:
Yellow ACD + Dark green heparin
Phone Hematol (OG:78329) for appointment.
TAT: M-F, 2d
Lab: Hematol
HAPTOGLOBIN
Specimen:
Serum
Ref Interval:
0.36-1.95 g/L
Conversion factor:
Method:
TAT: 7d
Price: [$$] LMS 18
SST/red
mg/dL ´ 0.01 = g/L
Immunoneph (Immage®), CV: 5%. Interf: marked lipemia
Lab: Biochem
Price: [$$] LMS 15
hCG see CHORIONIC GONADOTROPIN
HDL-C see CHOLESTEROL, HDL
HELICOBACTER PYLORI, H pylori see SEROLOGICAL TESTS
HEMOGLOBIN see COMPLETE BLOOD COUNT
Abbreviations: (complete list on page 4):
TAT
Turnaround time (from time of receipt)
RS
HICL
Hospital-in-Common Lab (Toronto)
OC
LMS
Labour, Management, Supplies (OHIP billing) OG
ACD
Acid Citrate Dextrose
Riverside Campus
Civic Campus
General Campus
41
Hemoglobin A1c, HbA1c, (Glycated hemoglobin)
Specimen:
Whole blood
Mauve/dark green
Ref Interval:
0.048-0.060 (4.8% to 6%)
Optimal control:
Suboptimal:
Inadequate:
Method:
TAT: 2d
<0.070
0.070-0.084
>0.084
Turbidimetric immunoinhibition, CV 4%. No interference from
HbF, S or C.
Lab: Biochem
Price: [$$] LMS 22
HEMOGLOBIN INVESTIGATION, HbA2, HbF and VARIANTS
Specimen:
Whole blood
Mauve
CBC, blood film should also be requested
Expected Value: Hb A2: 1.8-3.6%
3.7-3.9% gray area
4.0-10.0% ß-Thalassemia trait
Hb F: 0.2-2.0%
Comments:
Method:
TAT: 10d
Also detects HbS, C, D, E
Hb A2 ­ in b -Thal minor, may normalize in iron deficiency
HbF: adult levels by the age of 2y. Hb H may not be detected.
If Hb S suspected, order sickle cell screening test
HPLC
Lab: Hematol
Price: [$$$] LMS 34
HEMOGLOBIN, FETAL SCREEN
Use: Determine if blood in fecal material or vomitus is of fetal or maternal origin
Specimen:
Fecal material or vomitus with visible blood.
Restricted to SCN
TAT: 1d
Lab: Biochem
Price: [$] LMS 20
HEMOGLOBIN, PLASMA
Specimen:
Plasma
PST/dark green/EDTA
Use larger needle to avoid hemolysis
State if patient has Ventricular Assist Device (VAD)
Ref Interval:
0-150 mg/L (usually <50 mg/L)
Method:
Spectrophotometric scan, CV 4%. Interferences: bilirubin (¯)
Factors affecting:
Method:
In vitro hemolysis (occurring during phlebotomy or transport)
Spectrophotometric scan, CV 4%. Interferences: bilirubin (¯)
TAT: 2d, (available Stat, but restricted to patients with VAD, COR, CRR, CSU, Urology)
Lab: OC Biochem Price: [$$]
HEMOSIDERIN
Specimen:
Random urine (fresh early morning preferred)
TAT: 1d
Lab: Biochem
Price: [$]
HEPARIN ASSAY - see ANTI-Xa
HEPARIN INDUCED THROMBOCYTOPENIA, HIT
Specimen:
Consult Coagulation Laboratory OC:14190, OG: 78329.
Red top x 2
42
HEPATITIS SEROLOGY see SEROLOGICAL TESTS, TRANSMISSIBLE DIS TESTING
HEPATITIS C by PCR see also SEROLOGICAL TESTS, TRANSMISSIBLE DIS.
Specimen:
Whole blood
Red
Restricted; consult Microbiologist.
TAT: 1w
Lab: CHEO Virology
Price: [$$$$$]
HERPES SIMPLEX VIRUS by PCR
Use: HSV encephalitis
Specimen:
CSF
sterile red top
Restricted; consult Microbiologist. Clinical picture and
CSF profile must suggest diagnosis.
TAT: 1w
Lab: CHEO Virology
HISTAMINE
Specimen:
Price: [$$$$$]
Ref. Interval:
Plasma Chilled Mauve. Transport on ice immediately.
Avoid hemolysis
Restricted; consult Biochemist.
<10 nmol/L
TAT: 30d
Lab: HICL
Price: [$$] LMS 90
HLA ANTIBODY SCREEN, PANEL REACTIVE ANTIBODY (PRA),
LYMPHOCYTIC ANTIBODIES
Use: Used with HLA typing for transplant donor selection
Specimen:
Reported:
Serum
Red (not SST)
Positive results reported as %
TAT: every 2nd Monday of each month, results available 7-10d after.
Lab: OG TT
Price: [$$$$$]
HLA, LYMPHOCYTE, T and/or B CELL CROSSMATCH
Phone OG TT (737-8277) to arrange
Test:
Use
Specimen
TAT
Auto
crossmatch
Detect auto T or B cell antibodies. (Not SST or PST)
Red (10 mL)
If positive, DTT crossmatch to
Dark green (10 mL) x 4
distinguish IgM Ab from IgG
12-24h
Living donors
Determine compatibility of
(related/unrelated) donor and
recipient
48-72h
Cadaveric
donors
Auto-granulocyte Autoimmune diseases – detects
/ lymphocyte Ab autoAb at 15oC and room temp
Red (10 mL)
Dark green (10 mL) x 8
Mauve (5 mL) x 2
8-12h
Red (10 mL)
Green (10 mL) x 4
12-24h
HLA-A, B, C TYPING
Use: Matching for organ transplantation
Specimen:
Whole blood
Green 10 mL (more if WBC low)
By appointment only (737-8277)
TAT: M-F, 2-3d
Lab: OG TT
Price: [$$$$$]
43
HOMOCYST(E)INE
Use: Investigating thrombotic tendency and in patients with premature CAD without
traditional risk factors.
Specimen:
Increased risk:
Factors affecting:
Method:
TAT: 5d
Plasma
Mauve Transport on ice immediately
Overnight fasting specimen preferred
Restricted to Hematologists (for investigation of
thrombophilia); others consult Biochemist.
Males: >13 umol/L Females: >10 umol/L
­ in whole blood on standing; folate, B12 and pyridoxine
deficiencies/antagonists; oral hypoglycemics; renal failure
IA (AxSYMâ), CV 6%
Lab: OC Biochem
Price: [$$]
HOMOGENTISIC ACID
Specimen:
Random urine (freshly voided)
Method:
TAT: 2d
Visual observation of darkening on standing. Other reducing
substances (melanin, phenylketones) may give similar reaction.
Lab: Biochem
Price: [$]
HOMOVANILLIC ACID (HVA), Urine
Specimen:
24h urine in 20 mL 6M HCl (same sample as VMA,
Metanephrines, 5HIAA)
Reference Int:
0–1 y
<15 umol/d
<20 umol/mmol creatinine
2–4 y
<26
<14
5–9 y
<30
<9
10–19 y
<40
<8
>19 y
<46
<5
Method:
TAT: 7d
HPLC, CV 5%
Lab: OG Biochem
Price: [$$$]
HTLV see SEROLOGICAL TESTS, TRANSMISSIBLE DISEASE TESTING
HUMAN IMMUNODEFICIENCY VIRUS, HIV, by PCR see also
SEROLOGICAL TESTING, TRANSMISSIBLE DISEASE TESTING
Specimen:
TAT: up to 2w
Specimen:
TAT: up to 2w
Whole blood Mauve Collect Sun-Wed mornings
Send to Microbiol immediately at room temp. Phone lab
OC: 14454, OG: 78322.
Specimen must arrive in Toronto within 48h.
Lab: PHL
Whole blood
, VLM)
Mauve Send to Microbiol immediately
Lab: CHEO Virology
5-HYDROXYINDOLE ACETIC ACID, 5-HIAA
Specimen:
24h urine collected in 20 mL 6M HCl
Avoid high serotonin diet for 2d prior and during collection;
cough mixtures (guanefesin), acetaminophen, large amts of
coffee, cola, excessive smoking during collection
44
Ref Interval:
<43 umol/d (carcinoids usually excrete >120 umol/d)
Conversion factor: mg/d ´ 5.23 umol/d
Method:
HPLC, CV 5%
TAT: 7d
Lab: OG Biochem
Price: [$$] LMS 50
Serotonin content (ug/g) of foods (Feldman J M et al Am J Clin Nutr 1985;45:639).
High
butternut (400), black walnut (300), English walnut (90), pecans (30),
plantain (30),pineapple (17),banana (15), kiwi (6), plum (6), tomato (3)
Moderate
(1-2 ug/g) avocado(Calif), cantaloupe , date, grapefruit, filbert, brazil-nut
(0.1-1 ug/g) avocado (Fla), broccoli, cauliflower, eggplant, figs, honeydew,
black olives, spinach, almonds
The following ­ excretion by 5 umol/L: ½ banana, 2 kiwi, 1 black walnut, 1½ English
walnuts, 8 pecans, 1 tomato, 1/20 pineapple, 5½ Haas avocados, 170 filberts.
17-HYDROXY PROGESTERONE
Specimen:
Serum
SST/red
Ref Interval:
Male
1.5-7.5 nmol/L Female:
TAT: 14d
Lab: HICL
1.0-13.0 nmol/L
Price:[$$] LMS 60
HYDROXYPROLINE not available, see TELOPEPTIDES
IMIPRAMINE see TRICYCLIC ANTIDEPRESSANT QUANT
IMMUNOFIXATION, IFIX (replaces IMMUNOELECTROPHORESIS)
Specimen:
Serum or urine (random)
SST/red not PST
Order serum PROTEIN ELECTROPHORESIS or urine for LIGHT
CHAINS. IFIX performed if abnormal bands are present and not
previously typed. Provide clinical history.
Method:
TAT: 7d
Sebia Hydrasysâ Tested with: G, A, M, kappa, lambda antisera
Lab: OC Imm
Price: [$$] LMS 120
IMMUNOGLOBULIN E, IgE see also RADIOIMMUNOSORBENT TEST
Specimen:
Serum
SST/red
Ref Interval:
<288 ug/L, (children: 10-20% of adult values)
A low value does not exclude presence of ­ specific IgE Ab
Conversion factor:
Method:
TAT: 4 w
IU/mL ´ 2.4 = ug/L
IA (IMxâ), CV 6%. Measures total IgE.
Lab: OC Biochem
Price: [$$] LMS 28
IMMUNOGLOBULIN G,A,M, IgG, IgA, IgM
Specimen:
Serum
SST/red
Ref Interval:
IgG
7.5–15.6 g/L
IgA
0.8–4.5 g/L
IgM
0.4–2.7 g/L
Method:
TAT: 7d
Immunoneph (Immageâ), CV: 5%. Interf: marked lipemia;
inaccuracies may occur with high conc of monoclonal
immunoglobulin, especially IgM.
Lab: Biochem
Price: [$$] LMS 15 each
45
IgG SUBCLASSES
Specimen:
Serum
Ref Interval:
IgG1
(Adults)
IgG2
IgG3
IgG4
TAT: 3w
SST/red Restricted; consult Biochemist
3.15-8.55 g/L
0.64-4.95 g/L
0.23-1.96 g/L
0.11-1.57 g/L
Lab: CHEO Biochem
Price: [$$$]
IMMUNOPHENOTYPE ASSESSMENT see FLOW CYTOMETRY
INFECTIOUS MONONUCLEOSIS SCREENING TEST, MONOTEST,
MONOSPOT, HETEROPHILE ANTIBODIES
Specimen:
Serum SST/red Also order CBC and Differential.
Comments:
쐌 Detects heterophile antibodies to infectious mononucleosis.
쐌 Titres do not correlate with severity or stage of disease. Usually elevated by
6-10d of illness and may remain detectable for up to 1y (usual 4-8w).
쐌 10% of EBV-induced mononucleosis may not be positive.
쐌 10% may be caused by other agents (CMV, adenovirus, rubella, viral
hepatitis and toxoplasmosis).
쐌 Diagnosis should be made with > 2 of the following:
쐌 typical clinical findings
쐌 typical serologic findings
쐌 Presence of variant lymphocytes in the peripheral blood
TAT: Stat 1h; Routine 24h
INSULIN
Specimen:
Ref Interval:
Conversion factor:
Method:
TAT: 7d
Lab: Hematol
Serum
SST/red Fasting sample preferred.
Fasting: <216 pmol/L (1st IRP 66/304)
Insulin:Glucose ratio <35
mIU/L ´ 7.18 = pmol/L
AutoIA (AxSYMâ), CV 10%. Interference: hemolysis (¯)
Lab: OC Biochem
Price: [$$] LMS 40
INSULIN-LIKE GROWTH FACTOR-1, IGF-1, SOMATOMEDIN-C
Specimen:
Serum
SST/red (Mauve acceptable)
Restricted to Endocrinologists; others consult Biochemist.
Ref Interval:
16-39 y: 122-400 ug/L
40-54 y: 75-306 ug/L
>54 y: 48-225 ug/L
TAT: 14d
Lab: HICL
Price: [$$]
INTERNATIONAL NORMALIZED RATIO, INR
Use: Monitoring coumadin therapy, assessment of liver disease, and screening for
factor deficiency or inhibition in the extrinsic pathway.
Specimen:
Ref Interval:
Target values:
Plasma Light blue (4.5 mL) Specify anticoagulant therapy.
0.9-1.2
For coumadin therapy:
DVT: 2-3, Prosthetic heart value: 3-4
TAT: Stat, 1h; Routine daily, 4h
46
Lab: Hematol
Price: [$$] LMS 12
IRON, Fe++
Specimen:
Serum/plasma
SST/PST
Sample in morning where possible
Ref Interval (am): Males: 11-28 umol/L
Females:
Conversion factor:
Factors affecting:
Method:
Lab: Biochem
7-26 umol/L
ug/dL ´ 0.18 = umol/L
Wide intraindividual variation, conc may fall by 50% in afternoon
Auto chem, ferrozine method, CV 3%. Interf: i.v. iron, hemolysis,
lipemia, desferoxamine (¯).
Price: [$] LMS 34 (includes IBC)
IRON BINDING CAPACITY, IBC, TIBC
Specimen:
Serum/plasma
SST/PST
Ref Interval:
45-75 umol/L.
Iron saturation: Males: 20-55 % Females: 15-50%
Conversion factor:
Lab: Biochem
ug/dL ´ 0.18 = umol/L
Price: [$] LMS 34 (includes Fe)
ISOPROPYL ALCOHOL, ISOPROPANOL
Specimen:
Serum/plasma
SST/PST
­Analyzed stat only if osmolal gap@ is increased
Toxic conc:
Symptoms:
>17 mmol/L
Toxic:
>33 mmol/L
Lethal:
50-68 mmol/L
Conversion factor:
Comments:
g/dL ´ 166 = mmol/L
Lethal dose: 150-240 mL
Common sources: rubbing alcohol, nail polish remover.
Metabolizes to acetone; no toxic metabolites.
Method:
GC in conjunction with ethylene glycol and methanol, CV 5%.
TAT: Stat, routine 1d Lab: OC Biochem
Price: [$$] LMS 40
@
2 ´Na – Glu – Urea – osmolality; gap is increased if >0
17 KETOSTEROIDS and 17-KETOGENIC STEROIDS not available
For assessment of adrenal androgen secretion - serum DHEA sulphate.
For glucocorticoid function - serum cortisol and/or 24h urinary free cortisol.
For adrenogenital syndrome - serum 17-OH progesterone and progesterone.
KETONES, SERUM (Rothera’s test)
Specimen:
Serum/plasma
SST/PST
Interpretation:
Positive 1:32 suggests severe ketonemia.
Method:
Lab: Biochem
Colour reaction with sodium nitroprusside, reported as positive
to highest serial dilution. Detects acetoacetate and acetone,
NOT b-OH-butyrate. False pos with captopril, mesna,
substances with sulphydryl groups.
Price: [$] LMS 3
KETONES, URINE
Note: Roche Diagnostics’ Chemstripâ 5L are available on many wards.
Specimen:
Random urine
Continued on next page
47
Method:
Lab: Biochem
Detects acetoacetate and acetone, not b-OH-butyrate. Pos at
1.5 mmol/L acetoacetate. False pos with captopril, mesna,
substances with sulphydryl groups.
Ketonuria can occur in starvation and isopropanol ingestion.
KLEIHAUER TEST, KLEIHAUER-BETKE STAIN
Use: To determine extent of transplacental fetal to maternal hemorrhage. Volume of
fetal blood is calculated to determine Rh immune globulin dosage
Specimen:
Whole blood (maternal)
Mauve
Expected value: Fetal cells absent, FMH <5 mL
Method:
TAT: daily, 1d
HbF resists acid elution
Lab: Hematol
Price: [$$] LMS 18
LACTATE, LACTIC ACID
Specimen:
Plasma
PST/dark green not SST
Fill tube, transport on ice
Ref Interval:
Venous (at rest): 0.5-2.2 mmol/L
Comments:
Method:
Lab: Biochem
Rises in whole blood with storage.
Auto chem, CV 3%.
Price: [$] LMS 27
LACTATE DEHYDROGENASE, LD, (LDH)
Specimen:
Serum/plasma
SST/PST
Ref Interval:
98-192 U/L (adults) RS: 265-609 U/L
Method:
Lab: Biochem
Auto chem, CV 4%. Interferences: hemolysis (áá)
Price: [$] LMS 10
LACTATE DEHYDROGENASE ISOENZYME not available
LACTOSE INTOLERANCE
Specimen:
Serum/plasma
SST/PST
Protocol:
Collect fasting and 30m after 50g oral lactose load samples
Expected values: In lactose intolerance, glucose increases <1.1 mmol/L
LAXATIVE, URINE SCREEN see PHENOLPHTHALEIN URINE SCREEN
LDL CHOLESTEROL see CHOLESTEROL, LDL
LE CELLS (discontinued, replaced by ANTI-NUCLEAR ANTIBODIES)
LEAD, Blood, Pb
Specimen:
Whole blood Royal blue (from Biochem)
Ref Interval:
Children <16y and premenopausal women:
Normal:
<0.48 umol/L
Potentially toxic:
Not established
Men and postmenopausal women:
Normal:
<0.72 umol/L
Potentially toxic:
>1.90 umol/L
Toxic:
Cut-off for lead industry workers to be removed from workplace:
>1.45 umol/L, premenopausal women >0.48 umol/L
Conversion factor:
TAT: 14d
48
ug/dL ´ 0.048 = umol/L
Lab: HICL
Price: [$$] LMS 40
LEAD, Urine
Specimen:
Ref Interval:
Conversion factor:
TAT: 14d
24h urine collected in acid washed bottle from lab.
Chelation test: 24h urine collected following 1 g Ca-EDTA
<600 nmol/d
Post 1g calcium-EDTA: <5 umol/d
ug/d ´ 4.8 = nmol/d
Lab: HICL
Price: [$$] LMS 40
LECITHIN/SPHINGOMYELIN RATIO not available, use FETAL LUNG MATURITY
LEGIONELLA CULTURE and DIRECT FLUORESCENT ANTIBODY
STAINING see also SEROLOGICAL TESTING
Specimen:
Bronchial washings, chest drainage, lung tissue, pleural
fluid in sterile screw-cap bottle.
Cultures: must be specifically requested (routinely done on
lung tissue).
For fluorescent Ab staining – consult Microbiologist.
TAT: 7d
Lab: Microbiol
Price: [$$$]
:
LEUKEMIA / LYMPHOMA PROFILE see FLOW CYTOMETRY
LEUKOCYTE ALKALINE PHOSPHATASE SCORE, LAP, NAP
Use: Differentiating chronic granulocytic leukemia from reactive conditions
Specimen:
Normal Score:
Capillary blood collected by lab (OC: 13520; OG:78329)
Male:
22-124
Female: 33-149
Factors affecting:
Elevated levels are seen in pregnancy, polycythemia, bacterial
infections and in inflammatory processes.
Lab: Hematol
TAT: M-F, 1-2d
LIGHT CHAINS, Urine
Specimen:
Random urine
Method:
TAT: 4d
Sample concentrated and electrophoresed. Any abnormal
bands, not previously typed, will be identified by immunofixation
with anti-G, A, M, kappa, lambda antiserum.
Lab: OG Biochem/OC Imm
Price: [$$] LMS 50
LIPASE, PANCREATIC
Specimen:
Serum/plasma
Ref Interval:
22-51 U/L
Comments:
Method:
Lab: Biochem
Longer T½ than amylase. Not excreted in urine. Macrolipasemia
very rare; rarely increased in non-GI disorders.
Auto chem, enzymatic colorimetric assay, CV 4%.
Price: [$] LMS 22
Abbreviations: (complete list on page 4):
Auto
Chem
HICL
SST/PST
2 Enzymes
Automated
Chemistry Analyzer
Hospital-in-Common Laboratory (Toronto)
OC
Civic
OG
General
Royal bl Low metal
49
LIPOLYTIC ACTIVITY, POSTHEPARIN, PHLA
Book test with Metabolic Function Testing Lab (798-5555 x16750). Patient must
have normal PTT and INR prior to testing, and not on ASA.
Ref Interval:
Hepatic TG lipase activity: 4-31 umol oleate/mL plasma/h
Lipoprotein lipase activity: 4-26
Total PHLA:
11-55
Method:
Measurement of radio-tagged fatty acids generated by lipase
activity, CV 10%.
Lab: OC Biochem/Function Testing Lab Price: [$$$]
TAT: 21d
LIPOPROTEIN (a) not available
LIPOPROTEIN ANALYSIS by ULTRACENTRIFUGATION
Use: Investigation of hypertriglyceridemia.
Specimen:
Serum
Comments:
Method:
VLDL-C/serum Tg >0.7 suggests Type III hyperlipidemia.
Following ultracentrifugation, triglycerides and cholesterol are
measured in the various fractions.
Lab: OC Biochem/Function Testing Lab Price: [$$$] LMS 50
TAT: 7d
SST/red ´ 3
LIPOPROTEIN ELECTROPHORESIS not available
LITHIUM, Li+
Specimen:
Therapeutic:
Toxic conc:
Conversion factor:
Half-life:
Toxicity:
Serum SST not PST/dark green (contains Li Heparin)
Collect sample >12h post dose or just before next dose.
Trough:
0.5-1.4 mmol/L
Mild toxicity: 1.5-2.5 mmol/L
Serious:
2.6-3.6 mmol/L
Lethal:
>3.6 mmol/L
Toxicity increases with hyponatremia and renal failure.
Method:
mEq/L = mmol/L
14-33h
CNS: tremor, parasthesia, incontinence, slurred speech
blurred vision, headache, seizures, cranial nerve involvement,
somnolence, confusion, coma, acute dystonia.
CVS: arrhythmia, ECG changes, CV collapse.
Renal: albuminuria, oliguria, polyuria, glycosuria, dehydration,
edema; Misc: allergic vasculitis, metallic taste.
Ion-selective electrode, CV 2%.
Lab: OG Biochem
Price: [$$] LMS 10
LOVENOX - see ANTI-Xa
LOW MOLECULAR WEIGHT HEPARIN ACTIVITY see ANTI-Xa
LUPUS ANTICOAGULANT
Use: Investigation of autoimmune processes with thrombophilia, congenital heart
block, recurrent abortion
Specimen:
Plasma Light blue ´ 2
Transport on ice immediately
Anti cardiolipin assay should also be requested.
TAT: 10d
Lab: Hematol
50
Price: [$$] LMS 28
LUTEINIZING HORMONE, LUTROPIN, LH
Specimen:
Serum/plasma
SST/PST
Ref Interval:
Male:
2-12 IU/L (1st IRP 68/40)
Female: Follicular:
1-18 IU/L
Ovulatory:
24-105
Luteal:
1-20
Postmenopausal:15-62
Conversion factor: mIU/mL = IU/L
Method:
AutoIA (AxSYMâ), CV 6%. Interf: lipemia (­)
TAT: 7d; stat avail. Lab: Biochem
Price: [$$] LMS 28
LYMPHOCYTE CROSSMATCH see HLA CROSSMATCH
MAGNESIUM, Serum, Mg++
Specimen:
Serum/plasma
SST/PST
Ref Interval:
0.74-1.03 mmol/L
Therapeutic:
On i.v. MgSO4 1.7-3.1 mmol/L, toxicity risk at >5 mmol/L.
Conversion factor:
Method:
Lab: Biochem
mg/dL ´ 0.41 = mmol/L
Auto chem, CV 3%. Interferences: Moderate hemolysis (­).
Price: [$] LMS 5
MAGNESIUM, Urine
Specimen:
24h urine with no preservative or in 20 mL 6M HCl
Ref Interval:
3.0-5.0 mmol/d
<0.5 mmol/d for hypomagnesemia
Method:
Lab: Biochem
Auto chem, CV 3%. Interferences: Hemolysis (­).
Price: [$] LMS 5
MALARIA SMEAR
Use: Diagnosis of malaria, evaluation of febrile illnesses of unknown origin.
Specimen:
Comments:
Whole blood Mauve top Transport to lab immediately
Note in clinical chart recent travels and history of
malaria (including species).
The laboratory notifies Infection Control of positive cases.
TAT: Preliminary report 4h, speciation: 24h
Lab: Hematol
Price: [$$] LMS 15
MARIJUANA see CANNABINOID SCREEN
MATERNAL SERUM SCREENING, MSS – serum estriol, AFP, ßhCG
Use: Replaced by IPS (see next page)
Specimen:
TAT: 2d
Serum
SST/red
Complete MATERNAL ALPHA-FETOPROTEIN form LAB 273 (08-88)
Lab: CHEO Biochem Price: Funded by MOH
Abbreviations: (complete list on page 4):
TAT
Turnaround time (from time of receipt)
CHEO
HICL
Hospital-in-Common Lab (Toronto)
OC
LMS
Labour, Management, Supplies (OHIP billing) OG
MOH
Ministry of Health & Long Term Care
Children’s Hospital
Civic Campus
General Campus
51
INTEGRATED PRENATAL SCREENING, IPS – Serum PregnancyAssociated Plasma Protein-A (PAPP-A), estriol, AFP, ßhCG
Use: Prenatal screening for neural tube defect and Down’s syndrome. Replaces MSS
Note: Proceed only with the informed choice of patient. High risk patients
(family/past history of NTD or Down’s syndrome) should be referred to
medical geneticist. See 2 Chromosomal Studies
Specimen:
Serum
red
Complete INTEGRATED PRENATAL SCREENING form
Specimen 1: collect between10 and 13+6 wks of gestation
Specimen 2: collect between 15 and 18+6 wks of gestation
TAT: 2d after 2nd specimen is received
MELANIN
Specimen:
Method:
TAT: 2d
Lab: CHEO Biochem
Fresh urine
Observation of urine darkening on standing; other reducing
substances (e.g. phenylketones) may give similar reaction.
Lab: Biochem
Price: [$]
MERCURY, Blood, Hg++
Use: Assessment of organic Hg poisoning. Not useful for assessment of poisoning
from dental fillings or inorganic Hg exposure >4d prior.
Specimen:
Ref Interval:
Whole blood Royal blue (from Biochem)
Restricted; consult Biochemist.
0-50 nmol/L, chronic exposure: up to 1000 nmol/L
Conversion factor:
TAT: 21d
ug/dL ´ 49.9 = nmol/L
Lab: HICL
Price: [$$] LMS 30
MERCURY, 24h URINE
Use: Assessment of ongoing and previous (<4w) exposure to inorganic Hg and Hg
metal (by inhalation). Not useful for assessment of Hg poisoning from dental fillings.
Specimen:
Ref Interval:
24h urine collected in acid washed bottle from Biochem
<20 nmol/d, chronic exposure: up to 2000 nmol/d
­ excretion seen with high fish consumption.
Conversion factor:
TAT: 21d
ug/dL ´ 4.99 = nmol/d
Lab: HICL
Price: [$$] LMS 30
METABOLIC SCREEN, URINE and SERUM
Use: Screen for inborn errors of metabolism - reducing substances, glucose,
ketones, a-ketoacids, homocystine, cystine, tyrosine, phenylalanine,
mucopolysaccharides.
Specimen:
Random urine: collect without preservative or in 0.25g
thymol (min vol 5 mL). Keep refrigerated.
Serum: SST
Restricted to Neonates.
Method:
Screen with chemical tests and chromatography.
If positive amino-acid quantitation will be performed if indicated.
Lab: CHEO Biochem Price: [$$$$]
TAT: 3d
52
METANEPHRINES
Specimen:
24h urine in 20 mL 6M HCl (same sample as VMA, 5HIAA).
No diet restriction; avoid large amounts of caffeine.
Minimum of 2 consecutive collects, preferably during
hypertensive episode.
Ref Interval:
Metanephrines:
Male: 0.2-1.7 umol/d
Female: 0.2-1.2
Normetanephrines: Male: 18-36y: 0.5-3.8 umol/d
>36y: 0.8-4.4
Female: 18-36y: 0.6-2.5
>36y: 0.7-3.4.
Conversion factor:
Comment:
Method:
TAT: 7d
mg/dL ´ 5.5 = umol/d
Higher levels seen in hypertensives, use of MAO inhibitors and
hydralazine derivatives.
HPLC
Lab: OG Biochem
Price: [$$$] LMS 75
METHEMOGLOBIN
Specimen:
Whole blood
Dark green/PST
Transport on ice (MetHb very unstable)
Ref Interval:
<1.5% of total hemoglobin
Method:
Spectrophotometry (hemoximeter)
Lab: OC: Biochem/OG: CP Lab (ICU)
Price: [$] LMS 21
METHOTREXATE
Specimen:
Serum/plasma
SST/PST
State number of hours postdose on requisition
Toxic conc:
On low-dose leucovorin:
at 24h >10 umol/L; 48h >1 umol/L; 72h >0.1 umol/L
Higher toxicity risk if half-life >3.5h during the first 24h
Half-life:
Comment:
Method:
TAT: M-F, 1d.
8-15h (terminal phase)
MTX <0.02 umol/L required for resumption of DNA synthesis.
IA (TDx/Flxâ). Measures some minor metabolites, not 7-OH MTX.
Lab: CHEO Biochem Price: [$$] LMS 35
METHYL ALCOHOL / METHANOL
Specimen:
Serum/plasma
SST/PST
Performed stat only if osmolal gap@ is increased.
Toxic conc:
>10 mmol/L if ethanol is not present.
Consider dialysis at >16 mmol/L
Conversion factor:
Comments:
g/dL ´ 312 = mmol/L; mg/dL ´ 0.3 = mmol/L
Ethanol-load immediately in suspected methanol
poisoning.
Lethal dose: 60-240 mL; 10 mL may cause blindness.
Common sources: windshield washer fluid, gasline
antifreeze.
Method:
GC in conjunction with ethylene glycol and isopropanol. CV 5%
TAT: Stat, routine 1d Lab: OC Biochem
Price: [$$] LMS 40
@
2xNa – Glu – Urea – osmolality; gap is increased if >0
53
METHYLENE TETRAHYDROFOLATE REDUCTASE see
2 Chromosomal Studies
MIXING TEST
Use: to investigate unexplained prolonged INR or APTT.
Specimen:
Plasma
Light blue x 3
TAT: 24h
Lab: Hematol
Price: [$$]
MONOSPOT TEST see INFECTIOUS MONONUCLEOSIS
MUCOPOLYSACCHARIDES see METABOLIC SCREEN
MYCOBACTERIA, ACID FAST BACTERIA, TUBERCULOSIS –
CULTURES, DIRECT MICROSCOPY
Specimen:
Blood in BACTEC 13A bottle (obtain from Micro Lab); all
other specimens in sterile screw-cap bottle.
Collect 3 sputum specimens at least 1d apart, early
morning for urine and sputum
OC: sent to PHL. Direct microscopy will be done on respiratory specimens.
OG/RS: send to Microbiol Lab.
MYCOPLASMA CULTURE see also SEROLOGICAL TESTS
Specimen:
Respiratory specimen: in sterile containers or swabs in
transport medium
Urogenital specimen: as sterile swab in transport medium
TAT: 21d for respiratory, 5d for urogenital
Lab: PHL
MYOGLOBIN, PLASMA not available – consult Biochemist
MYOGLOBIN, URINE
Specimen:
Random urine
Comments:
Detects only frank myoglobinuria. Consider myoglobinuria
if CK >3500 U/L and urine dipstick is positive for blood.
Lab: Biochem
Price: [$$] LMS 30
N-ACETYLPROCAINAMIDE see PROCAINAMIDE
NORTRIPTYLINE see TRICYCLIC ANTIDEPRESSANT QUANT
OCCULT BLOOD
Note: Slides for testing are available on some wards.
Specimen:
Random feces
Method:
Detection of peroxidase activity. Interf: rare-cooked red meat
(­), peroxidase-containing vegetables (­), iron pills (­),
menstrual fluid (­), Vitamin C (¯)
Lab: Biochem
Price: [$] LMS 3
TAT: M-F, 1d
Abbreviations: (complete list on page 4):
TAT
Turnaround time (from time of receipt)
RS
HICL
Hospital-in-Common Lab (Toronto)
OC
LMS
Labour, Management, Supplies (OHIP billing) OG
PHL
54
Riverside Campus
Civic Campus
General Campus
Public Health Lab
OLIGOCLONAL BANDS in Cerebrospinal fluid
Specimen:
CSF (min 1mL) + SST blood
Interpretation:
PAG-isoelectric focusing:
Negative: < 2 typical bands in CSF; or if >2 bands are present,
the bands correspond with bands in serum.
Positive: > 2 typical bands in CSF
Atypical: > 2 bands seen, but pattern not typical. Interpret
in light of clinical findings.
Oligoclonal bands seen in: Multiple sclerosis (85-90%), SSPE
(90%), neurosyphilis (80%), bacterial or viral meningoencephalitis (40%), necrotizing encephalitis, Herpes zoster and
H simplex encephalitis, Guillain-Barre synd., meningeal
carcinomatosis, toxoplasmosis, myasthenia gravis, other
neurologic diseases
Quantitative IgG and albumin measurements:
IgG:
0.010-0.034 g/L
CSF IgG:Albumin
9-26
IgG index
35-69
TAT: 21d
Lab: OG Biochem
Price: [$$$]
OPIATE SCREEN
Specimen:
Random urine
Detects:
Morphine, hydromorphone, codeine, oxycodone
Reported as:
Positive at minimum detection level (>300 ug/L morphine)
Half-lives:
Method:
Note:
TAT: M-F, 1d
Morphine ~2h, Codeine 3h, Heroin 60-90 min.
Assay detects the following (with approx. cross-reactivities of):
codeine (94-120%), heroin (55%), dihydrocodeine (60%),
dihydromorphine (47-108%), ethylmorphine (85%),
hydrocodone (47-120%), hydromorphone (37-114%),
levorphanol (8-79%), 6-monoacetylmorphine (45-96%),
morphine (100%), morphine glucuronide (45%), nalorphine
(0-14%), naloxone (0-3%), oxycodone (0-24%), oxymorphone
(0-18%), thebaine (7-63%), promethazine (0-35%)
No/minimal cross-reactivity: alphaprodine, anileridine,
dextromethorphan, diphenoxylate, meperidine, methadone,
nicotine, pentazocine, promethazine, propoxyphene.
Positive tests can result from poppy seeds ingestion (morphine
content ranges from 2 to 251mg/g)
Lab: OG Biochem
Price: [$$]
OSMOLALITY, Serum
Specimen:
Serum
SST/red
Ref Interval:
280-295 mmol/kg water
Comments:
Method:
Lab: Biochem
Calc osmolality = 2 ´ [Na+] + [urea] + [gluc] (all in mmol/L)
Osmolal gap: measured minus calc osmo; normal <2 mmol/L
Freezing point depression, CV: 2%
Price: [$$] LMS 10
55
OSMOLALITY, Urine
Specimen:
Random or 24h urine (no preservative)
Ref Interval:
50-1400 mmol/kg water (interpret in light of serum osmo)
Lab: Biochem
Price: [$$] LMS 10
OSMOTIC FRAGILITY, ERYTHROCYTE (RED CELL) FRAGILITY
Use: Confirmation of spherocytes in hereditary spherocytosis
Specimen:
Whole blood
Dark green ´ 2
By appointment only (OC:16216, OG:78329) Mon-Thur
Expected values: Mean cell fragility (MCF)
Fresh: 0.40-0.45 % NaCl Incubated:0.47-0.58 % NaCl
Comment:
TAT: M-Th, 2-3d
All causes of spherocytosis (i.e. AIH anemia) give pos results.
Lab: Hematol
Price: [$$$]
OVA and PARASITES
Specimen:
Feces, body fluids in SAF fixative container.
Collect daily or q2-3d x 3
Interference:
TAT: 1-2w
Antacids, antibiotics, barium, bismuth cpds, kaolin, mineral oil.
Lab: Microbiol
Price: [$$]
OXALATE, 24h URINE
Specimen:
24h urine in 20 mL 6M HCl
Ref Interval:
Male: 155-527 umol/d
Females: 128-345 umol/L
Comments:
Conversion factor:
Method:
TAT: 14d
High oxalate foods: rhubarb, spinach, beets, Swiss chard, tea.
mg/d ´ 11.1 = umol/d
Enzymatic (Sigma) assay, CV 8%. Interf: excessive vitamin C.
Lab: OC Biochem
Price: [$$] LMS 40
OXYGEN, pO2 , OXYGEN SAT. see BLOOD GASES and pH
PAP (Papanicolaou) SMEAR
Requisition:
Lab form 09 -411390
Provide information – Date of test; Age; LMP; Day of cycle;
Hormone use; history of malignancy, gyne surgery,
cryosurgery/laser, radiation therapy, chemotherapy;
colposcopic findings; IUCD; abnormal vaginal bleeding;
previous abnormal PAP (give dates).
Procedure
Endocervical sampling and cervical scrape recommended
for collection
in all cases. For lesions of vagina, vulva - scrapings.
쐌 Use non-powdered gloves
of sample:
쐌 Insert speculum without lubricant
쐌 Use an Ayers spatula or similar instrument.
Obtain material:
Cervix: Scrape around the whole squamo-columnar junction.
Endocervix: (this area is very important): Obtain material with (a)
Cytobrush inserted high into cervical os, or (b) endocervical aspiration.
56
Vaginal: Use the paddle end of the spatula to scrape.
Mid portion of lateral wall: for CYTOHORMONAL (Maturation Index)
evaluation (patient must not have douches within past 24h).
Posterior fornix: for DUB or post-menopausal bleeding.
쐌
쐌
쐌
쐌
쐌
Place material from each site on labeled (pt’s name in pencil) slide.
When all sites have been collected, quickly spread material thinly over slide
with paddle end of spatula.
Fix immediately with Cytospray®.
Spread vaginal pool material over fixed posterior fornix scraping and re-fix.
One well prepared slide is better than multiple scanty ones.
Reporting: Common diagnoses in the Bethesda System include:
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
Within normal limits.
Benign cellular changes, e.g., secondary to specific infections (e.g., Candida,
Herpes), radiation therapy, other inflammatory processes.
ASCUS: Atypical squamous cells of undetermined significance. Recommendation
is often made for a repeat smear in 6m.
LSIL: Low grade squamous intraepithelial lesion. Corresponds to HPV effects with
or without CIN 1. Recommendation is often made for colposcopy.
HSIL: High grade squamous intraepithelial lesion. Corresponds to CIN 2 or CIN 3.
Recommendation for Colposcopy.
Positive for malignancy.
Endocervical cell dysplasia or adenocarcinoma in situ. Endocervical curettage or
biopsy should be done.
AGCUS: atypical glandular cells of undetermined significance. Recommendation
for either repeat smear in 6m, endocervical curettage or cervical biopsy.
Cytologically benign endometrial cells in postmenopausal women. Further
investigation, including D&C, if clinically indicated
PARATHYROID HORMONE, INTACT, iPTH
Specimen:
Plasma Mauve (5 mL)
Transport on ice within 45 min
Also order serum calcium.
Ref Interval:
1.6-6.9 pmol/L. Interpret in relation to serum calcium.
Conversion factor:
Method:
TAT: 21d
pg/mL ´ 0.106 = pmol/L
AutoIA (Elecsysâ) Interf: Heterophil Ab to mouse
Lab: Biochem
Price: [$$$] LMS 120
PARTIAL THROMBOPLASTIN TIME, PTT, APTT
Use: (1) Monitor standard heparin therapy (2) Screen for defects in intrinsic pathway.
Specimen:
Plasma
Light blue
Expected values: 24-36s, heparin therapy 60-100s
Comments: Specify anticoagulant therapy
Lab: Hematol
Price: [$$] LMS 14
Abbreviations: (complete list on page 4):
s
seconds
min
minutes
hours
h
days
d
months
m
AutoIA
Interf
CIN
HPV
Automated immunoassay
Interference (analytical)
Cervical intraepithelial
neoplasia
Human papillomavirus
57
PATHOLOGY, SURGICAL TISSUES & BIOPSIES
쐌
쐌
쐌
쐌
Submit in 10% neutral buffered formalin in a container able to accommodate the
tissue and at least 5 volumes of fixative. For suspected malignant lymphoma,
submit fresh tissue moistened with saline (NO FIXATIVE).
Label container with source site, laterality (if applicable), patient’s name and
unique number (addressograph label).
Complete Surgical Pathology Requisition, labeled with patient demographic
information. Provide appropriate clinical information (e.g. differential diagnosis,
history of malignancy, clinical and radiographic findings, etc.).
Send to Surgical Pathology Lab. For fresh tissue not in fixative, send STAT by
porter. Notify lab (OC: 13531; OG 72059) prior to transport.
TAT: small biopsies 24-48h, larger tissues 72h
PHENCYCLIDINE SCREEN not available. Consult Biochemist.
PHENOBARBITAL see also BARBITURATE SCREEN
Specimen:
Serum/plasma SST/PST Draw trough level (12h postdose)
Therapeutic:
65-172 umol/L
Toxic conc:
>200 umol/L; toxicity increases with renal failure.
Consider dialysis at >430 umol/L
Conversion factor:
Half-life:
Clinical toxicity:
Method:
Lab: Biochem
ug/mL ´ 4.3 = umol/L
3-4d
CNS: dizziness, headache, nausea, vomiting, depression,
ataxia, confusion, paradoxical excitation, somnolence
CVS: hypotension
AutoIA (AxSYMâ), CV 6%, cross-reactivities: up to 20% with
p-hydroxyphenobarbital (major metabolite) and its glucuronide
Price: [$$] LMS 35
PHENOLPHTHALEIN URINE SCREEN
Use: Detection of phenolphthalein laxative abuse.
Specimen:
Early morning urine ´ 3, preferably after weekend
Method:
TAT: 3d
Qualitative using detection of colour formation with alkali
Lab: OC Biochem
Price: [$]
PHENYTOIN, DILANTIN
Specimen:
Serum/plasma
SST/PST
Oral: draw trough (12h postdose)
IV: >2h postdose, IM: >4h postdose
Therapeutic:
Trough: 40-80 umol/L
Toxic conc:
>100 umol/L
Conversion factor:
Half-life:
Clinical toxicity:
Method:
Lab: Biochem
58
ug/mL ´ 4.0 = umol/L
20-40 h
CNS: nystagmus, ataxia, hyperreflexia, twitching, dyskinesia,
dysarthria, confusion, dizziness, coma, respiratory depression.
CVS: V Fib, cardiovascular depression. GI: vomiting,
constipation. Dermatologic, hematologic
AutoIA (AxSYMâ), CV 6%, cross-reacts with fosphenytoin (early
metabolite)
Price: [$$] LMS 35
PHOSPHATE, Serum, PO43Specimen:
Serum/plasma
SST/PST
Ref Interval:
0.78-1.53 mmol/L
At <0.3 mmol/L, hemolysis and neuromuscular
complications may occur.
Conversion factor:
Method:
Lab: Biochem
mg/dL ´ 0.32 = mmol/L
Auto chem, CV: 2%
Price: [$] LMS 5
PHOSPHATE, 24h Urine
Specimen:
24h urine with no preservative, or 20 mL 6M HCl.
Ref Interval:
13-42 mmol/d
Conversion factor:
TAT: M-F, 1d
mg/d ´ 0.032= mmol/d
Lab: Biochem
Price: [$] LMS 5
PLASMINOGEN ASSAY
Use: Determines plasminogen and plasmin activity.
Specimen:
Ref Interval:
Plasma
Light blue ´ 3
0.55-1.25 U/mL
Comments:
­ In trauma, MI, malignant diseases
¯ in infants, adv hepatic cirrhosis, DIC, thrombolytic therapy
Lab: Hematol
Price: [$$] LMS 55
TAT: M-F, 10d
Transport on ice
PLATELET AGGREGATION
Use: Von Willebrand’s disease, storage pool disease, Bernard-Soulier syndrome and
other platelet function abnormalities.
Specimen:
Mauve, Hematology consult strongly recommended
Collected by Hematol - call for appt (OC:14190, OG:78329)
쐌 No anti-inflammatory or antiplatelet drugs for 1w prior to
test
쐌 Platelet count should be >75 ´ 109 /L.
쐌 State appropriate clinical and drug history
TAT: Routine M-F, 1-2d
Lab: Hematol
Price [$$$] LMS 12 per additive
PLATELET ANTIBODIES
Use: Test includes platelet typing and antibody determination. Performed on patients
with immune thrombocytopenia, neonatal immune thrombocytopenia (maternal antibodies), platelet refractoriness
Specimen:
Adults: Mauve (30 mL) Children: (Mauve 10 mL)
Comment:
Contact Hematologist on call for booking with CBS.
TAT: 2w, Stat same day
Lab: CBS through TM
PLATELET COUNT see COMPLETE BLOOD COUNT
PNEUMOCYSTIS CARINII
Specimen:
Induced sputum, bronchial wash or BAL (lavage).
Lab: Done in OG Microbiology Lab by direct fluorescent antibody test – Stat
available with approval of Microbiologist.
PORPHOBILINOGEN see AMINOLEVULINIC ACID
59
PORPHOBILINOGEN DEAMINASE, Erythrocytes
Specimen:
Whole blood Dark green Protect from light, do not freeze
Ref Interval:
20-43 umol/L erythrocyte/h
2 Porphyrias
Method:
TAT: 14d
Enzymatic, CV 5%
Lab: OG Biochem
Price: [$$$]
PORPHYRIN, plasma, urine and feces
Specimen:
Plasma (heparinized)
PST/dark green
2 Porphyria
24h urine in 5g Na2CO3 in brown bottle, protect from light
Random urine 50 mL in 0.25g Na2CO3, send immediately (has
to be pH 8)
Feces random
Plasma
Ref Int:
Uroporphyrin I
Uroporphyrin III
Heptacarboxyl III
Hexacarboxyl III
Pentacarboxyl III
Coproporphyrin I
Coproporphyrin III
Copro III: Copro I
Protoporphyrin
Copro I : Proto
nmol/L
0-11
0-3
0-5
0-2
0-2
0-10
0-12
Urine
nmol/d
0-44
0-20
0-16
0-2
0-2
5-90
15-242
2.6-5.3
umol/ mol creat
0.4-3.9
0.0-2.0
0.0-1.3
0.0-0.7
0.0-1.0
0.3-8.5
1.7-26
Feces
nmol/g dry wt
0-5
0-1
0-1
0-1
0-1
0-13
0-12
(not reliable if U
creat <4 mmol/L)
0-38
0.63
Conversion factor:
Uroporphyrin:
ug/d ´ 1.20 = nmol/d;
Coproporphyrin: ug/d ´ 1.53 = nmol/d
Method:
HPLC; CV 5-15%
TAT: Screen: M-F, 1d, Quant: 7d
Lab:OG Biochem Price: [$$$] LMS 75 (blood), 60 (urine), 90 (feces)
PORPHYRIN, ERYTHROCYTE PROTOPORPHYRIN, FEP
Use: Erythropoietic protoporphyria (EPP), lead poisoning and some anemias.
Specimen:
Ref Interval:
Whole blood
Mauve (not SST/PST)
Protect from light
Adult: 0.4-1.0 umol/L RBC
2 Porphyrias
Comments:
Method:
TAT: 7d
Diagnosis of EPP will be confirmed by erythrocyte fluorescence
Solvent extraction, CV 10%
Lab: OG Biochem
Price: [$$$] LMS 75
POTASSIUM, Serum, Whole blood, K+
Specimen:
Serum/plasma
SST/PST
Blood: heparinized syringe (done with blood gas analysis)
Ref Interval:
3.6-5.1 mmol/L (see Critical Values)
Serum > whole blood or plasma because of cellular
release of potassium during clotting.
Conversion factor:
Factors affecting:
Method:
Lab: Biochem
60
mEq/L = mmol/L
Hemolysis (­­), leucocytosis: >100 ´ 109/L (­),
thrombocytosis: >600 ´ 109/L (­).
Ion-selective electrodes, CV: 2%.
Price: [$] LMS 5
POTASSIUM, Urine
Specimen:
Random urine or 24h collected with no preservative
Ref Interval:
Normokalemia: 25-125 mmol/d
Hypokalemia: <35 mmol/d (>10 mmol/L suggests renal
loss, <10 mmol/L suggests ¯ intake or extrarenal loss).
Conversion factor: mEq/d = mmol/d
TAT: Stat; 24h collect – routine M-F Lab: Biochem
Price: [$] LMS 5
POTASSIUM, Feces
Specimen:
Liquid fecal material
TAT: M-F, 1d
Lab: Biochem
PRENATAL SCREEN
Includes ABO and Rh, antibody screen, antibody identification if screen
positive, and antibody titre.
Use: Determine mother’s eligibility for Rh immune globulin, identify the risk and
severity of hemolytic disease of newborn.
Specimen:
Comments:
Mauve (7 mL)
TAT: 1-3h
Lab: TM
See Transfusion Med - Fractionated Products Immune globulin
PRIMIDONE includes PHENOBARBITAL (active metabolite)
Specimen:
Serum/plasma
SST/PST
Therapeutic:
23-55 umol/L
Toxic conc:
>60 umol/L; toxicity increases with renal failure.
Conversion factor: ug/mL ´ 4.6 = umol/L
Half-life (primidone): 4-12h
Clinical toxicity:
Similar to phenobarbital, also dermatologic and hematologic
side-effects.
TAT: M-F, 1d
Lab: HICL
Price: [$$$] LMS 35
PROCAINAMIDE includes N-ACETYL PROCAINAMIDE (NAPA)
Specimen:
Serum/plasma
SST/PST
Draw trough (12h after last dose)
Therapeutic:
Trough: 17-43 umol/L
Toxic conc:
>70 umol/L for procainamide
>110 umol/L for procainamide + NAPA
Toxicity increases with renal and cardiac failure.
Conversion factor:
Comments:
Half-life:
Clinical toxicity:
Lab: HICL
ug/mL ´ 4.3 = umol/L
NAPA (major metab), has antiarrhythmic activity equiv to PA.
“Fast” and “slow” acetylators genetically determined.
In renal impairment NAPA is retained with ¯ PA:NAPA ratio
PA: 3h
NAPA: 6h
CVS: hypotension, bradycardia, wide QRS complex, V Fib,
junctional tachycardia, conduction delay. CNS: lethargy,
confusion, convulsions, psychosis. GI: Nausea/vomiting,
.diarrhoea, bitter taste; Renal: oliguria.
Price: [$$$] LMS 35
61
PROGESTERONE, P4
Specimen:
Serum/plasma
SST/PST
For suspected abnormal pregnancies, order also ß-hCG
Ref Interval:
State previous ßhCG result and LMP on requisition.
Females:
Follicular phase:
0.5-4.5 nmol/L
Luteal phase:
6.0-60.0 nmol/L
Pregnancy – see algorithm for suspected abn pregnancies
Conversion factor: µg/L ´ 3.18 = nmol/L
Method:
AutoIA (Elecsysâ) Progesterone II. CV: <10%.
Lab: Biochem
Price: [$$] LMS 28
쐌 In Assisted Rep Technology patients, <40 nmol/L usually assoc with nonviability
쐌 Clinical judgement must be used in assessing viability of pregnancy.
Ref: Perkins SL, Muataz A-R, Claman P. Progesterone in non-viable pregnancies. Fertil and Steril 2000
PROGESTERONE, 17 HYDROXY see HYDROXY PROGESTERONE
PROGESTERONE RECEPTOR see ESTROGEN-PROGESTERONE RECEPTOR
PROLACTIN
Specimen:
Ref Interval:
Serum/plasma
SST/PST
Male:
2-19 ug/L (3rd IRP 84/ 500)
Female: 1-24 ug/L
Conversion factor: ng/mL = µg/L
Method:
AutoIA (AxSYMâ), CV 6%. Interf: lipemia (­)
TAT: 7d; if required stat, consult lab Lab: Biochem Price: [$$] LMS 28
Abbreviations: (complete list on page 4):
IRP
Turnaround time (from time of receipt)
TAT
Hospital-in-Common Lab (Toronto)
HICL
Labour, Management, Supplies (OHIP billing) OC
LMS
Coeff of Variation (reproducibility)
OG
CV
62
International Reference
Preparation
Civic Campus
General Campus
PROSTATE SPECIFIC ANTIGEN, TOTAL, PSA
Use: Diagnosis and monitoring of patients with prostatic cancer; not for screening.
Specimen:
Serum
SST/red
For patients following radical prostatectomy, order usPSA
(=ultrasensitive PSA, measurable conc will be confirmed)
<4 ug/L (Stanford PSA Reference Material 90:10)
Ref Interval:
Causes of elevations:>100´ ULN:
Prostatic Ca
50´ ULN:
Post biopsy, post TURP
10´:
BPH, acute renal failure, prostatitis
5´:
Ac MI
<2´:
Prostatic massage, rectal examination
Method:
AutoIA (AxSYMâ), CV 6%. Interf: lipemia (­)
TAT: M-F, 1d
Lab: OC Biochem
Price: [$$] LMS 0
PROSTATE SPECIFIC ANTIGEN, FREE or COMPLEXED not available
PROSTATIC ACID PHOSPHATASE , PAP not available
PROTEIN C / PROTEIN S
Use: Recurrent thrombosis/ thromboembolism – congenital deficiency of protein C, S
Specimen:
Ref Interval:
Plasma
Light blue (4.5 mL) ´ 3 Transport on ice
Functional
Antigen
Protein C
0.75-1.45
0.70-1.20
Protein S
0.54-1.17
0.57-1.21
­ Antigen assay performed only if functional assay is abnormal.
Comments:
May be falsely low in patients on oral anticoagulants.
TAT: Functional 10d, Antigen 3w
Lab: Hematol
Price: [$$]
PROTEIN, Serum
Specimen:
Serum/plasma
SST/PST
Ref Interval:
61-79 g/L
RS: 60-85 g/L
Conversion factor:
Method:
g/dL ´ 10 = g/L
Auto chem, CV 4%. Interf:dextran (­), gross hemolysis (­).
Lab: Biochem
Price: [$] LMS 5
PROTEIN, 24h Urine
Specimen:
24h urine collected with no preservative
Ref Interval:
<0.15 g/d
Conversion factor:
Method:
mg/d ´ 0.001 = g/d
Auto chem, CV 5%.
TAT: M-F, 1d
Lab: Biochem
Price: [$] LMS 5
PROTEIN, Cerebrospinal fluid
Specimen:
CSF
sterile red top (min vol 0.5 mL)
Ref Interval:
0.12-0.60 g/L
Conversion factor:
Method:
Lab: Biochem
mg/L ´ 0.001 = g/L
Auto chem, CV 4%. Protein ­ 0.10 g/L per 1000 ´109/L RBC.
Price: [$]
63
PROTEIN ELECTROPHORESIS, Serum, SPE For urine see LIGHT CHAINS
Specimen:
Serum
SST/red, not PST
State if patient on anticoagulants.
Ref Interval:
Albumin:
35-52 g/L
(serum)
Alpha-1-globulins: 1-3
Alpha-2-globulins: 6-11
Beta-globulins:
5-10
Gamma-globulins: 6-14
Conversion factor:
Comments:
Method:
mg/dL ´ 0.01 = g/L
Abnormal bands, not previously typed, will be identified by IFIX.
Fibrinogen, severe hyperlipidemia and hemolysis may give
spurious bands.
OC: Sebia Hydrasys® OG: Beckman Paragon®
TAT: 4d
Lab: OC Imm/OG Biochem Price: [$$] LMS 36
PROTHROMBIN TIME see INTERNATIONAL NORMALIZED RATIO (INR)
PROTHROMBIN VARIANT GENE see 2 Chromosomal Studies
PROTRIPTYLINE see TRICYLIC ANTIDEPRESSANT SCREEN and QUANT
PYRUVATE KINASE, PK
Use: Investigation of hemolytic anemia (rare cause)
Specimen:
Ref Interval:
Whole blood
Mauve
Transport on ice
Normal, subnormal sera will be titred.
Comments:
TAT: 1w
Blood transfusion within the last 3 m invalidates results
Lab: OG Hematol (78329) Price: [$$]
RADIOIMMUNOSORBENT test for ALLERGEN-SPECIFIC IgE, RAST
Specimen:
Serum
SST/red
Ref Interval:
Undetected or absent allergen specific IgE (< 0.35 kU/L)
Unless otherwise specified, antigen used is A fumigatus.
Testing available against penicillins, dust & mites, foods, animal
proteins, venoms, molds, trees, grasses, and occupational
chemicals (i.e. latex).
TAT: 30 d
Lab: HICL
Price: [$$]
RBC MORPHOLOGY, BLOOD SMEAR - see FILM
REDUCING SUBSTANCES – REDUCING SUGARS, KETOACIDS,
HOMOGENTISIC ACID
Specimen:
Random urine
TAT: M-F, 1d
Lab: Biochem
Price: [$]
Abbreviations: (complete list on page 4):
IFIX
Immunofixation
TAT
Turnaround time (from time of receipt)
LMS
Labour, Management, Supplies (OHIP billing)
Appendix (pages 89-102)
2
64
RS
Riverside Campus
OC
Civic Campus
General Campus
OG
Hospital-in-Common Lab
HICL
OC Imm Civic Immunology
RENIN ACTIVITY, PLASMA, PRA
Specimen:
Plasma
Chilled mauve Transport on ice
Ref Interval:
Mean (SD) in ng/L/s during upright posture
Normotensive
Hypertensive
Control
1.66 (1.0)
0.91 (1.0)
4h post 80 mg furosemide
5.81 (3.3)
1.95 (1.9)
Low sodium intake
8.77 (4.2)
3.38 (4.7)
High sodium intake
0.8 (0.6)
0.56 (0.6)
Angiotensin I RIA kit insert, Rainen Assay System, DuPont Medical Products
Split renal vein PRA: for condition to be surgically correctable
1) Ratio of PRA from the 2 renal veins should be >1.5
2)
Conversion factor:
Factors affecting:
Method:
TAT: 14d
renal v. PRA - IVC PRA
= 0 for normal, ³0. 5 for diseased kidney
IVC PRA
ng/mL/h ´ 0.28 = ng/L/s
Liver disease, oral contraceptives may ¯ angiotensinogen
resulting in lower PRA values. Mineralocorticoid antagonists,
captopril (¯)
RIA quant of angiotensin formed at 37oC, CV: 10-20%
Lab: OC Biochem
Price: [$$$] LMS 75
REPTILASE CLOTTING TIME
Use: Evaluation of disturbance in fibrin formation, dysfibrinogenemia
Specimen:
Plasma
Light blue
Restricted; consult Clinical Hematologist.
Expected values: 18-22s
Comments:
TAT: M-F, 10d
Not affected by heparin
Lab: Hematol
Price: [$$] LMS 10
RETICULOCYTE COUNT, RETIC COUNT
Use: Evaluation of erythropoietic activity and response to hematinic therapy .
Specimen:
Ref Interval:
Whole blood
25-100 ´ 109/L
Mauve
Comments:
TAT: daily, 2d
­ in hemorrhage and hemolytic anemia, ¯ in red cell hypoplasia
Lab: Hematol
Price: [$$] LMS 13
Rh TYPING see ABO and RH TYPING
RHEUMATOID FACTOR, RF
Specimen:
Serum
Expected:
<20 kIU/L
Comments:
Method:
TAT: 7d
SST/red
­ in rheumatoid arthritis, mixed CTD, viral diseases, bacterial
infections
Immunonephelometry (Beckman Immage®)
Lab: Biochem
Price: [$$] LMS 6
65
RISTOCETIN COFACTOR ASSAY
Use: Functional assay for von Willebrand’s factor
Specimen:
Ref Interval:
Plasma
0.5-1.5 U/mL
Comments:
TAT: 10d
Blood group should be specified.
Lab: Hematol
Price [$$$]
RUBELLA IgG
Specimen:
Reported as:
Method:
TAT: 7d
Light blue ´ 3
Transport on ice
Serum/plasma
SST/PST
Absent (antibody <10 IU/L)
Present (antibody >10 IU/L)
AutoIA (AxSYMâ), CV 6%
Lab: OC Biochem
Price: [$$] LMS
SALICYLATE
Use: Management of toxicity only.
Specimen:
Therapeutic:
Toxic conc:
Serum/plasma
SST/PST
<2.2 mmol/L
>4.7 mmol/L, consider dialysis at >5.8 mmol/L
Conversion factor:
Half-life:
mg/dL ´ 0.07 = mmol/L
Dose dependent: Low dose: 2-3h; Therapeutic:12h; High dose:
15-20 h. Enteric coated preps have later/prolonged kinetics
CNS: initial hyperventilation (resp alkalosis), then depression;
vertigo, tinnitus, excitement, confusion, convulsions, coma
CVS: tachycardia Other: flushing, sweating, thirst, metabolic
acidosis, fever, hemorrhage
Auto chem, CV 2%. Interf: hemolysis (¯), Diflunisal (­­­)
Price: [$$] LMS 12
Clinical toxicity:
Method:
Lab: Biochem
SEDIMENTATION RATE, ERYTHROCYTE (WESTERGREN), ESR
Use: Monitor therapy in inflammatory diseases and some malignancies.
Specimen:
Whole blood
Expected values: Males: 0-6 mm/h
Comments:
TAT: Daily
Black
Females: 0-10 mm/h
Asymmetric macromolecules (e.g. gamma globulins,
fibrinogen) cause the most elevations.
Normal range may be slightly higher in elderly patients.
Lab: Hematol
Price: [$] LMS 3
SEROLOGICAL TESTS see also VIRAL CULTURES
Specimen:
Serum
Red
Indicate phase: Acute phase (obtain where possible) or
Convalescent (3-6w)
Requisitions:
Use PHL requisition #97-44 (07/98) except for
왔 Regional Virology Lab (CHEO)/CHEO Microbiol,
n Biochem
✚ Tests also done in TM for transplant donors TAT 6h.
For syphilis: use MOH form#1731-44 (94-10).
CSF for syphilis: collect in Red top vacutainer (sent to PHL)
For acute infections, include date of onset and clinical info
66
Tests available:
Amebiasis
Arbovirus
Ascariasis
ASO (CHEO Biochem)
Bordetella pertussis
Brucella
California Encephalitis
Chlamydia
Coccidioides
왔 Cytomegalovirus (total, IgM)
Echinococcus
Eastern Equine Encephalitis
왔 Epstein Barr (see also EBV)
Anti-HAV (Total, IgM) ✚
HBsAg ✚
Anti-HBs ✚
Anti-HBc (IgG+IgM) ✚
Anti-HBc (IgM)
HbeAg
Anti-HBe
HDV (delta)
HEV
HCV ✚
Helicobacter pylori
Histoplasma
Anti HIV 1, 2 ✚
HIVp24Ag ✚
Anti-HTLV-I/II ✚
Legionella
Leptospira
Lyme disease
왔 Measles
왔 Mycoplasma pneumoniae
Powassan
Q fever
Rickettsia
Rocky Mountain Spotted fever
n Rubella (IgG)
St Louis Encephalitis
Syphilis
Toxocara
왔 Toxoplasma
Trichinella
Tularemia
Typhus
왔 Varicella Zoster
Western Equine
Encephalitis
SEX CHROMATIN, BARR BODIES see 2 Chromosomal Studies
SEX HORMONE BINDING GLOBULIN not available
SICKLE CELL SCREEN, HbS, Solubility test
Use: Rapid method for the detection of hemoglobin S.
Specimen:
Whole blood
Mauve
Also order CBC, Film
Comments:
Does not distinguish between disease (homozygote) and trait
(heterozygote).
Positives confirmed with Hb electrophoresis.
TAT: Stat, 1h; Routine, 1d
Lab: Hematol
Price: [$$] LMS 5
SODIUM, Serum, Na+
Specimen:
Serum/plasma
Ref Interval:
136-144 mmol/L
Conversion factor:
Method:
Lab: Biochem
SST/PST
RS: 135-147 mmol/L
mEq/L = mmol/L
Auto chem, ISE, CV 1%. Interferences: lipemia (¯) unless
cleared before analysis, marked hyperproteinemia (¯)
Price: [$] LMS 5
Abbreviations: (complete list on page 4):
ISE
Ion-selective electrodes
RS
Riverside Campus
67
SODIUM, Urine
Specimen:
Random urine or 24h collected with no preservative
Ref. Interval:
24h: 40-220 mmol/d
Random urine in hyponatremia:
<10 mmol/L suggests extrarenal loss
>20 mmol/L suggests renal loss, hypoaldosteronism
In oliguria: to distinguish between prerenal and acute tubular necrosis:
Prerenal
ATN
U Na+ (mmol/L)
<20
>40
Fractional Na clearance
U Na+ ´ S Creat (unless on diuretics)
S Na+
U Creat
U osmolality (mmol/kg)
<1
>1
>500
<350
U Cl - (mmol/L)
<20
>20
TAT: stat, M-F for 24h collect
Lab: Biochem
Price: [$] LMS 5
SODIUM, Feces
Specimen:
Liquid fecal material
TAT: Stat for random; Routine daily
Lab: Biochem
SOMATOMEDIN-C see INSULIN-LIKE GROWTH FACTOR
STANDARD HEPARIN - see ANTI-Xa
SUCROSE LYSIS TEST
Use: Screen for Paroxysmal nocturnal hemoglobinuria. Do before Ham’s test.
Specimen:
Plasma
Light blue
Call Hematol (OC: 16216 OG: 78329)
TAT: M-F, 1d
Lab: Hematol
Price: [$$] LMS 18
SYNOVIAL FLUID, MICROSCOPIC EXAMINATION for CRYSTALS
Specimen:
Synovial fluid
Lab: OC Biochem/ OG Hematol
Price: [$]
TACROLIMUS, FK506, PrografÒ
Specimen:
Whole blood
Mauve
Therapeutic:
Stable patients 5 – 20 µg/L (varies with transplant type, time
(suggested):
from last dose. Lower for long-term patients).
Half life:
12h ± 4 for liver transplant, (21h ± 8 for healthy volunteers)
Method:
IA (Abbott IMxâ), CV 8%
TAT: M-F, consult lab for stat Lab: OG Biochem
Price: [$$]
TELOPEPTIDES, C-TELOPEPTIDES, cTx
Specimen:
Serum/plasma
Red/Mauve
Collect between 12:00 -15:00 (marked diurnal variation)
Restricted to Endocrinology, others consult Biochemist
Ref Intervals:
(95th percentile)
0.30 ug/L
Method:
TAT: 14d
68
IA (Roche Elecsysâ CrossLapsâ)
Lab: OC Biochem
Price: [$$]
TESTOSTERONE, TOTAL replaced by TESTOSTERONE, FREE
TESTOSTERONE, FREE
Specimen:
Serum
Ref Interval:
20-29 y
30-39
40-49
50-59
³ 60
SST/red
Male
Female
24.1– 94.8 pmol/L 20-59 y
25.0 – 89.3
³ 60
23.5 – 81.7
22.5 – 80.4
21.5 – 74.3
0.5 – 8.1 pmol/L
<6.4
Ooi et al. Clin Biochem 31:15-21
Conversion factor:
Method:
TAT: 7d
ng/dL ´ 34.7 = pmol/L
RIA (DPC Coat-A-Countâ). CV: 10%
Lab: OC Biochem
Price: [$$] LMS 100
THEOPHYLLINE, AMINOPHYLLINE
Specimen:
Serum/plasma
SST/PST
Draw peak concentration (postdose)
쐌 IV loading followed by infusion: 30 min after loading
dose
쐌 PO: rapid dissolving preps: 2h post dose; slow release
preps: 3-7h post dose
Therapeutic:
55-110 umol/L
Toxic conc:
>110 umol/L. Consider dialysis at >300 umol/L
Conversion factor:
Half-life:
Clinical toxicity:
Method:
TAT: M-F, 1d
ug/mL ´ 5.6 = umol/L
7-11h
CNS: restlessness, delirium, tinnitus, flashes of light, tremors,
spasms, convulsions, coma; CV and respiratory collapse
Other: fever, diuresis, dehydration, nausea/vomiting,
coffee-ground vomitus
AutoIA (Abbott AxSYMâ), CV 3%.
Lab: Biochem
Price: [$$] LMS 28
THROMBIN TIME
Use: Determination of severe hypofibrinogenemia and presence of heparin-like anticoagulants, for diagnosis and monitoring of intravascular coagulation and fibrinolysis.
Specimen:
Ref Interval:
Plasma
12-18s
Lab: Hematol
Light blue
Price: [$] LMS 10
THYROGLOBULIN
Specimen:
Serum/plasma
Red/Dark green/Mauve
Sample at >6 w after thyroidectomy or 131I treatment
Ref Interval:
<128 pmol/L (tentative), post total thyroidectomy <2 pmol/L
Conversion factor:
Method:
ng/mL ´ 1.515 = pmol/L
AutoIA (Elecsysâ). Testing for Anti-TG interference available.
TAT: 28d
Lab: Biochem
Price: [$$$] LMS 80
69
THYROTROPIN, THYROID STIMULATING HORMONE, TSH
Specimen:
Serum
SST/red
Ref Interval:
0.32-5.00 mU/L (2nd IRP 80/558)
Conversion factor:
Method:
uU/mL = mU/L or mIU/L
AutoIA (Abbott AxSYMâ), CV 5-8%
TAT: M-F, 1d
Lab: Biochem
Price: [$] LMS 28
THYROTROPIN BINDING INHIBITORY IMMUNOGLOBULIN, TBII,
TSI, LATS
Use: Determining risk of neonatal hyperthyroidism in mothers with Graves’ disease;
diagnosis of euthyroid Graves’ opthalmopathy.
Specimen:
Ref Interval:
TAT: 21d
Serum
SST/red
Restricted; consult Biochemist
Normal <1.0 U/L, elevated >2.0 U/L
Lab: HICL
Price: [$$$$]
THYROXINE BINDING GLOBULIN, TBG
Specimen:
Serum
SST/red
Ref Interval:
150-360 nmol/L
TAT: 14d
Lab: HICL
Price: [$$] LMS 50
THYROXINE, FREE, FT4
Specimen:
Serum/plasma
SST/PST
Ref Interval:
Adult:
9.0-23.0 pmol/L
Pregnancy:
1st trimester:
2nd trimester:
3rd trimester:
Conversion factor:
Factors affecting:
Method:
TAT: M-F, 1d
11.5-19.2 pmol/L
9.3-16.3
8.0-15.2
ng/dL ´ 12.87= pmol/L
(¯) oral contraceptive and phenytoin use, following dialysis.
(­) Heparin therapy (presence of NEFA).
AutoIA (Abbott AxSYMâ), CV 5-10%, Interf:(­) autoantibodies.
No interference from albumin or TBG.
Lab: Biochem
Price: [$$] LMS
TINZAPARIN see ANTI-Xa
TISSUE TYPING see HLA
TOBRAMYCIN
Specimen:
Therapeutic:
Toxic conc:
Conversion factor:
Half-life of drug:
Method:
TAT: M-F, 1d
70
Serum/plasma
SST/PST
State if pre-, postdose or random (peak: draw 30m
post-infusion or 60m post-injection or oral dose)
Predose <2 mg/L; postdose conc varies, based on use.
Predose: >2 mg/L; postdose: >10 mg/L
(guidelines only, consult Pharmacy)
umol/L ´ 0.47 = mg/L
1.5h (to 15h, prolonged in renal failure)
AutoIA (Abbott AxSYMâ), CV 5%
Lab: Biochem
Price: [$$] LMS 40
TRANSFERRIN
Specimen:
Serum
Ref Interval:
1.7-3.6 g/L
Conversion factor:
Method:
TAT: 7d
SST/red
mg/dL ´ 0.01 = g/L
Immunonephel (Beckman), CV: 5% Interf: marked lipemia
Lab: Biochem
Price: [$$] LMS 12
TRANSFUSION REACTION INVESTIGATION (see Transfusion Med)
Includes clerical check, visual specimen inspection, Direct Antiglobulin Test, appropriate laboratory investigation, review by designated transfusion medicine staff.
Specimen:
Comments:
Post-transfusion Mauve (7mL) + Blood bag(s)
Unused units will be re-crossmatched. No additional units
of blood will be issued until investigation is completed.
TAT: 1h (complicated case up to 3h)
Lab: TM
TRANSMISSIBLE DISEASE TESTING
Tests Include: HBsAg, anti-HBs, anti-HBc (total, IgM), HCV, Anti-HAV (total,
IgM), HIV p24 Ag, anti-HIV-1& 2, anti-HTLV-I/II, anti-CMV antibodies (total, IgM)
Specimen:
Comments:
Red 10 mL, (not SST)
HIV is performed only on organ/tissue donors and
recipients. Confirmation is done by Public Health Lab.
TAT: Routine 24-48h, Stat 4h
Lab: TM
TRICHOMONAS VAGINALIS
Specimen:
Vaginal swab (use sterile swab), place in transport medium
TAT: 1-2d
Lab: Microbiol
Price: [$]
TRICYCLIC ANTIDEPRESSANTS (TCA) QUANT see also TCA SCREEN
Specimen:
Serum/plasma
Red (not SST or PST)/Mauve
Restricted to Geriatric Unit and Psychiatry
Therapeutic (nmol/L)
Half-life of Drug
Amitriptyline+Nortriptyline
Results
300–900
17-40h
Clomipraminea+metabolite
500–1300
15-62h
Desipramine
470–1125
12-54h
Doxepin+Nordopexin
540–900
17+6h
Imipramine+desipramine
530–950
9-24h
Nortriptyline
190–570
18-44h
Protriptylinea
270–990
78+11h
Trimipraminea
170–680
16-40h
Comments:
Toxic concentrations >1,700 nmol/L
Method:
Assayed by HPLC. aClomipramine (and des-methyl metabolite),
trimipramine, protriptyline only by special request.
Interferences: SST or PST (¯)
Lab: OG Biochem
Price: [$$$]
TAT: 4d
71
TRICYCLIC ANTIDEPRESSANTS (TCA) SCREEN
Use: Management of suspected overdose only.
Specimen:
Reported as:
Clinical toxicity:
Method:
Lab: Biochem
Serum/plasma
Red top (not SST)/Mauve
Restricted to ER, ICU, AMA
Toxic:>300 ug/L (imipramine)
쐌 Actual conc varies with cross-reactivity of drug
Present: 100 – 299 ug/L (imipramine). May indicate:
쐌 imipramine present in lower than toxic conc or
쐌 potentially toxic conc of other TCAs and related drugs
with lower cross-reactivity.
Negative: <100 ug/L (imipramine).
Toxicity risk correlates with: QRS >0.1sec, cardiac arrhythmias
and conduction defects, altered mental status (GCS <14),
seizures, respiratory depression (<8/min or requiring support),
systolic BP (<90 mmHg).
AutoIA (AxSYM), CV 5%
Assay detects following drugs (approx cross-reactivities):
amitriptyline (90%), 10-OH amitriptyline (10%), clomipramine
(45%, norclomipramine 50%), chlorpromazine (20%),
cyclobenzaprine (50%), desipramine (90%), 2-OH desipramine
(15%), diphenhydramine (60%), doxepine (35%), orphenadrine
(5%), phenothiazine (5%), promethazine (10%), protriptyline
(60%), trimipramine (60%).
No/minimal cross-reactivity with carbamazepine, diazepam,
fluoxetine, lorazepam, maprotiline, sertaline, trazadone.
Price: [$$]
TRIGLYCERIDES, TOTAL
Specimen:
Serum/plasma
SST/PST
Ref Interval:
Fasting (12h): 0.55-1.70 mmol/L
Conversion factor:
Method:
Comment:
Lab: Biochem
mg/dL ´ 0.011 umol/L
Auto chem, CV 3%. Interferences: Glycerol (­, assay does not
blank for endogenous glycerol)
See CWG guidelines under Cholesterol, High Density
Price: [$] LMS 5
TRI-IODOTHYRONINE, TOTAL not available
TRI-IODOTHYRONINE, FREE, FT3
Specimen:
Serum/plasma
SST/PST
Ref Interval:
2.5-5.3 pmol/L
Conversion factor:
Method:
TAT: 3d
pg/mL ´ 1.536 = pmol/L
AutoIA (AxSYMâ), CV 6%.
Lab: OC Biochem
Price: [$$] LMS 28
TRIMIPRAMINE see TRICYCLIC ANTIDEPRESSANT QUANT
TROPONIN I not available, order Troponin T
TROPONIN T, cTnT
Specimen:
Serum/plasma
SST/PST
Ref Interval:
Clinical threshold for AMI<0.10 ug/L, normal <0.01 ug/L
72
Method:
Comments:
Lab: Biochem
IA (Elecsysâ, 3rdGen), CV 6%; <0.01 ug/L value is highly
reproducible. No interference by skeletal TnT.
­ In ESRD especially diabetics (up to 1 ug/L;10% >0.2,
30%>0.1); CHF, other cardiac diseases, sepsis
Price: [$$]
TYPE AND CROSSMATCH (see Transfusion Med section)
Use: Provide compatible units for transfusion
Test includes ABO and Rh, Antibody screen , Compatibility
Specimen:
Comments:
Mauve (7mL) Confirm patient identity; sign, date/time req
For neonates - cord or maternal sample
See Transfusion Med section. Repeat type/crossmatch may
not be needed.
TAT: Routine 1-3h, Stat 45min
Lab: TM
Price: [$] LMS 38
TYPE AND SCREEN (includes ABO and Rh group, Antibody screen)
Use: Pretransfusion testing, patients with negative antibody screen will have blood
assigned prior to issue.
Specimen:
Comments:
Mauve (see Type and Crossmatch)
If positive, two (2) units will be crossmatched automatically.
TAT: Routine 1-3h, Stat 45min
Lab: TM
URATE, URIC ACID, Serum
Specimen:
Serum/plasma
SST/PST
Ref Interval:
Male: 210-450
Female: 145-350 umol/L
RS: 230-480 umol/L
Conversion factor:
Method:
Lab: Biochem
mg/dL ´ 59.5 = umol/L
Auto chem, CV 3%. Interf: bilirubin (¯), mod. hemolysis (­).
Price: [$] LMS 6
URATE, URIC ACID, Urine
Specimen:
24h urine, no preservative. NOT acidified.
Ref Interval:
1.48-4.43 mmol/d
Conversion factor:
TAT: M-F, 1d
mg/d ´ 0.006 = mmol/d
Lab: Biochem
Price: [$] LMS 5
UREA, Serum
Specimen:
Ref Interval:
Serum/plasma
2.9-7.1 mmol/L
Conversion factor:
Method:
Comment:
Lab: Biochem
BUN mg/dL ´ 0.36 = Urea mg/dL x 0.17 =mmol/L urea
Auto chem, CV: 3%
Prerenal failure - Creat:urea <12:1
Price: [$] LMS 5
UREA, Urine
Specimen:
Interpretation:
24h urine with no preservative.
Excretion correlates with protein intake
Conversion factor:
Method:
Lab: Biochem
BUN mg/d ´ 0.036 = Urea mg/d x 0.017 = mmol/d urea
Auto chem, CV: 3%
Price: [$] LMS 6
SST/PST
73
URINE ANALYSIS
Specimen:
Random urine, preferably midstream. State time of
collection. Specimen must arrive in lab within 4h (cellular
Normal:
WBC 3-5 /high power field (HPF); RBC 0-3 /HPF
elements degrade on standing)
Roche Diagnostics’ Chemstripâ 5L (pH, glucose, protein, blood and leukocyte
esterase) avail in many wards. In the laboratory, Combur10 –Testâ is used.
Specimen:
Results:
Random urine, to arrive in 4h if microscopy required
Italicized results are within normal limits
pH
5
Specific Gravity (SG)
1.005 –1.030
6
Protein
Neg
Equivalent to:
Comments:
Inteferences:
Glucose
Comments:
Inteferences:
Comments:
Blood
Equivalent to:
Comments:
Inteferences:
Neg
Neg
0.3
++
1.0
+++
5.0 g/L
6
14
28
56 mmol/L
+
++
1.5
5
+++
>15 mmol/L acetoacetate
Small
Mod
5-10
~50
Large
~250 RBC/uL
Detects hemoglobin, hemolyzed RBCs and myoglobin
(+) High SG, hypochlorite, microbial peroxidases (-) Vit C
Equivalent to:
Interferences:
+
0.15
Most sensitive to acetoacetate.
(+) captopril, mesna; phenylketones and phthalein cmpds
may give red colour
Neg
Bilirubin
Tr
9
Specific for glucose, does not detect other reducing sugars.
Strips exposed to atmosphere (+)
Equivalent to:
Inteferences:
8
Test most sensitive to albumin (0.06 g/L); BJ proteins may
not be detected.
Quaternary ammonium cmpds (antiseptics, detergents),
chlorhexidine (+), Strips exposed to atm (+)
Neg
Ketones
7
+
++
+++
17
50
100 umol/L
(+) Pyridium, Indican (yellow-orange/red colour), (-) Vit C
Normal
Urobilinogen
Inteferences:
Leukocyte (esterase)
17
68
135
203 umol/L
(+) p-aminosalicylic acid
Neg
Equivalent to:
Trace
+
~25
~100
++
500
WBC/uL
Exposed strips may give false negative results
Nitrite
Lab: Biochem
74
Neg
Pos
Price: [$] LMS 2 (Microscopic exam) 5 (Dipstick)
VALPROIC ACID
Specimen:
Serum/plasma
SST/PST
Draw trough level (12h after last dose)
Therapeutic:
350-700 umol/L
Toxic conc:
>1000 umol/L
Conversion factor:
Half-life:
Clinical toxicity
Method:
Lab: Biochem
VANCOMYCIN
Specimen:
Therapeutic:
Toxic conc:
ug/mL ´ 6.9 = umol/L
9-15 h
CNS: sedation, ataxia, headache, nystagmus, diplopia,
asterixis, tremor, dysarthria, dizziness, coma; GI: diarrhoea,
constipation
AutoIA (AxSYMâ), CV 6%
Price: [$$] LMS 35
Serum/plasma
SST/PST
State if pre-, postdose or random (peak: draw 30 min
post-infusion or 60m post-injection or oral dose)
Predose <10 mg/L Postdose 30-40 mg/L
Predose: >15 mg/L Postdose >40 mg/L
(guidelines only, consult Pharmacy)
Conversion factor:
Half-life:
Clinical toxicity:
Method:
Lab: Biochem
mg/L ´ 0.69 = umol/L
4-7.5h
Skin rash, anaphylaxis, chills, fever, ototoxicity, phlebitis, pain at
injection site, nephrotoxicity
AutoIA (AxSYMâ), CV 6%
Price: [$$] LMS 40
VANILLYLMANDELIC ACID, VMA, 4-OH-3-METHOXYMANDELIC ACID
Specimen:
24h urine in 20 mL 6M HCl
Avoid large amounts of caffeine during collection
Restricted - available only by special request
Ref Interval:
Adults: Female: 9-36 umol/d Male: 12-44 umol/d
Conversion factor:
Method:
TAT: 7d
mg/d ´ 5.05 = umol/L
HPLC
Lab: OG Biochem
Price: [$$$] LMS 60
VIRAL CULTURES, DIRECT DETECTION TESTS (EIA, Electron
microscopy) see also SEROLOGY and individual virus
Specimen:
Serum, CSF, body fluids in Red vacutainer
Swabs (eye, rectal, throat)- Virocult swab (Microbiol Lab)
Nasopharyngeal suction, throat washings, stools in sterile
screw- cap bottle
Scrapings from skin, mucous membrane, lesions - Herpes
collection kit (Microbiol Lab)
Tissues
Indicate date of onset and clinical condition on all reqs
CMV:
Collect urine, throat washings, tissues, CSF
Coxsackie:
TAT: 21d
Collect CSF, rectal swab, stool, throat, vesicles
Lab: CHEO Virology
Price: [$$$]
75
VISCOSITY, SERUM (RELATIVE)
Specimen:
Serum (min 2 mL) Red x 2
Expected values: 1.5-2.0 (viscosity is compared to water at 37oC).
TAT: 2d
Lab: OC Imm/ OG Hematol
Price: [$]
VISCOSITY, WHOLE BLOOD
Use: Hyperviscosity syndromes (bleeding, confusion, ¯ visual acuity, hearing) e.g.
Waldenstrom’s macroglobulinemia, hyperglobulinemia.
Specimen:
Ref Interval:
Whole blood
Dark green
Call Hematol Lab (OC:16216) prior to collection.
2.7-5.3 cps
TAT: M-F, 24 h
Lab: Hematol
Price: [$$]
VITAMIN A not available, see CAROTENE
VITAMIN B1 (thiamine), VITAMIN B6 (pyridoxine) – Consult Biochemist
VITAMIN B12
Specimen:
Ref Interval:
Serum
150-675 pmol/L
Conversion factor:
Method:
TAT: 7d
ng/dL ´ 7.38 = pmol/L
AutoIA (AxSYMâ); CV: 6%.
Lab: Biochem
Price: [$$] LMS 28
SST/red not heparinized plasma
VITAMIN C see Ascorbic Acid
VITAMIN D, 25-HYDROXY, 25OH D3
Specimen:
Serum
SST/red
Ref Interval:
40-104 nmol/L, concentrations may be higher in summer
Conversion factor:
Method:
TAT: 14d
ng/mL ´ 2.6 = nmol/L
RIA (DiaSorin), CV 10%
Lab: OG Biochem
Price: [$$]
VITAMIN D, 1, 25-DIHYDROXY, 1, 25 OH D3
Use: Diagnosis of primary hyperparathyroidism, vit D deficiency in CRF.
Specimen:
Ref Interval:
Serum
SST/red
Restricted to Endocrinology; others consult Biochemist
40-140 pmol/L, concentrations may be higher in summer
TAT: 14d
Lab: HICL
Price: [$$$]
VON WILLEBRAND FACTOR ANTIGEN
Use: Differential diagnosis of Hemophilia A and von Willebrand’s disease, and detecting carriers of Hemophilia A
Specimen:
Ref Interval:
Plasma
Light blue ´ 3
Transport on ice
Specify blood group.
Also order Factor VIII and Ristocetin cofactor assays
0.60 – 2.00 U/mL
TAT: 10d
Lab: Hematol
76
Price: [$$]
VON WILLEBRAND MULTIMER ASSAY
Use: Sub-typing of von Willebrand’s disease
Specimen:
Plasma
Light blue ´ 3
Transport on ice
Restricted; consult Coagulation Lab (14190).
TAT: 4 w
Lab: Hematol
Price: [$$$]
XYLOSE ABSORPTION TEST
Protocol:
Call Phlebotomy (OC: 13424, OG: 78306) to arrange 25 g
xylose loading dose.
Specimen:
Collect blood samples (SST/grey): 1h and 2h after load
Collect urine for 5h following xylose dose
Ref Interval:
Serum: Peak conc (1h or 2h sample): 2.2 – 3.7 mmol/L
Urine:
33 – 55 mmol/5h
Conversion factor:
Comments:
TAT: 14d
YEAST
Specimen:
TAT: days – 2w
mg/dL x 0.067 = mmol/L
Serum conc lower in elderly, urine excretion lower in renal
impairment
Lab: HICL
Price: [$$]
Blood in Aerobic BAC-T-ALERT bottle (if routine culture also
requested, fungus will be cultured)
CSF in Red vacutainer
Skin, hair, nails black paper from Microbiol Lab - wrap
securely (sent to PHL for analysis)
All other specimens: sterile screw-cap container or sterile
swab in transport medium
Lab: Microbiol
Price: [$$$]
ZINC, PLASMA
Specimen:
Plasma
Royal blue (from Biochem)
Ref Interval:
9.8-20.2 umol/L
Conversion factor:
TAT: 14d
ug/dL ´ 0.15
Lab: HICL
Price: [$$] LMS 25
Abbreviations: (complete list on page 4):
Laboratories/sites:
Canadian Blood Services
CBS
Appendix (pages 89-102)
2
CHEO Children’s Hospital
Automated
Auto
Hospital-in-Common Lab
HICL
Chem Chemistry
Civic Campus
OC
Coefficient of Variation (Reproducibility)
CV
General Campus
OG
HPLC High performance Liquid Chromatography
IA
Public Health Lab
PHL
Immunoassay
LMS
Riverside Campus
Labour, Management, Supplies (OHIP billing) RS
RIA
Transfusion Medicine
TM
Radioimmunoassay
Room Temp
RT
Turnaround time (from time of receipt)
TAT
77
78
TRANSFUSION MEDICINE (TM)
The Transfusion Medicine Service of the Ottawa Hospital provides
쐌 Transfusion-related and serological tests (see main section under individual
tests)
쐌 a full range of transfusion therapy - see Blood/Blood Products and
Fractionated Products in this section.
Locations
Phone
OC - Main Bldg basement
761-4328
24h (Stat coverage 23:00-07:00)
OG - Ground floor, Rm 1451 737-8302
24h (Stat coverage 23:00-07:00)
RS - Main floor laboratory
738-8214
Information Booklet
Hours of operation
Daily 07:00-23:00
From 2002 Oct Mon-Fri 07:00-20:00
An information pamphlet (English or French) on the use of human blood and
blood components may be requested from Transfusion Medicine.
TRANSFUSION MEDICINE POLICIES AND PROCEDURES
(see also Product section under Blood Transfusion or the required product)
Orders:
쐌 Use Requisition for Tranfusion Medicine - LAB 03 (Cat: 420175) for
transfusion orders, products and tests.
쐌 If the patient has an Autologous card or a Caution/Transfusion card stating
that he/she has antibodies, Transfusion medicine must be notified.
Sample collection:
쐌 Patient must be identified before blood specimen collection for
Type/Screen/Crossmatch.
쐌 The requisition must be signed by the person collecting the patient
specimen, and dated and timed.
Delivery of Blood Products
쐌 Blood products are picked up from Transfusion Medicine by designated
hospital staff (porters, nurses, physicians, and residents). Person receiving
product has to sign the Issue sheet.
Transfusion procedure
쐌 Patients must be informed (document in patient’s chart) when they receive
any blood product. Available alternate therapies should be discussed with
the patient prior to the transfusion or injection of a blood product.
Patients with low hemoglobin should not be transfused unless they are
symptomatic. Despite screening for viral agents and careful crossmatching,
blood transfusions still cause significant risk to the patient.
쐌 The issue sheet must be signed by two of the staff starting the infusion
to verify the patient and blood product ID.
Continued on next page
79
Documentation
쐌 Progress notes must be written to justify the transfusion of blood products
and to document the clinical condition of the patient before, during and
following transfusion, and any adverse reactions.
TRANSFUSION REACTIONS:
Stop transfusion immediately
Inform TM. Investigations include clerical check, visual specimen inspection,
direct antiglobulin test and other appropirate lab investigation. Designated
TM medical staff will review.
Lab tests:
Comments:
Type
Send post-transfusion sample in Mauve (7 mL) and Blood
bag(s)
Untransfused units will be re-crossmatched. No additional
units will be issued until investigation is completed.
Signs/
Symptoms
Usual
Cause
Febrile
(most
common)
Fever, chills,
rarely
hypotension
Urticarial
(common)
Urticaria, rarely Antibodies
hypotension or to plasma
anaphylaxis
proteins,
IgA antibodies
Anaphylaxis
(very rare)
Bronchospasm
or hypotension
during/post
transfusion
Acute
(intravascular)
hemolytic
Delayed
(extravascular)
hemolytic
80
Management
Antibodies to Mild – may have unrelated cause
leucocytes or 쐌 Treat with antipyretics, restart transfusion
Severe – consider sepsis
plasma
쐌 Stop transfusion and report to TM
proteins
쐌
쐌
IgA def
First
reaction
usually
mild.
Fever, hypotension, hemoglobinuria,
bleeding,
anxiety, chest
pain, flank
pain, ARF
and/or DIC
Usually ABO
incompatibility, rarely
due to other
complementfixing
antibodies
Fever, malaise,
¯ Hgb,
­ Indirect
bilirubin,
Urobili- nogen
Destruction
of donor red
cells by IgG
antibodies in
recipient
Stop transfusion
Give antihistamine (PO or IM); if
severe, epinephrine and/or steroids
쐌 Serological investigation not needed
Prevention: antihistamine before
transfusion; washed red cells if severe or
recurrent.
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
Stop transfusion, report to TM
Treat anaphylaxis
Quantitate IgA and subtype IgA
antibodies
For future transfusions, IgA-deficient
patients should receive washed blood or
IgA deficient blood products
Stop immediately
Hydrate, treat hypotension with fluid
replacement
Induced diuresis
Treat DIC – if renal failure is severe,
dialyse
Do not discard any tubing or blood bags.
Report to TM for complete investigation.
Monitor Hb, renal function, coagulation
profile.
No acute treatment needed usually.
Report to TM – investigation for causative
antibody.
Type
Signs/
Symptoms
Usual
Cause
Management
Transfusion
related
acute lung
injury
(TRALI)
Dyspnea,
pulmonary
edema, normal
pulmonary
capillary
wedge
pressure
HLA or
leucocyte
antibodies;
usually
donor
antibodies
쐌
Circulatory
overload
Headache,
dyspnea, CHF
Large volume
given quickly
쐌
Septicemia
from
infected
blood
Fever, chills,
hypotension
Contaminated blood
product
쐌
쐌
쐌
쐌
쐌
쐌
Support blood pressure and respiration,
may require intubation
Report to TM (to quarantine remaining
components from donor)
Stop transfusion
Give nasal oxygen, diuretics
Stop transfusion immediately
Support blood pressure
Start antibiotics
Return donor unit(s) and tubing to TM for
bacterial culture.
81
BLOOD AND BLOOD PRODUCTS
Use TM requisition (LAB-03). Consult Hematologist if indicated.
AUTOLOGOUS BLOOD TRANSFUSION
Use: In elective surgeries, to eliminate risk of sensitization and transmissible diseases. Especially useful in patients who react adversely to allogeneic blood, have
multiple alloantibodies or rare blood types
To order:
Product:
Infusion:
Physician to refer patient (OC: Autologous Prgm 798-5555 ext
17483, OG: Med Director, CBS 560 7271)
Order Type and Screen (7 mL mauve, see Main section)
450 mL blood is collected from patient every 7d to a maximum
of 4 units (35d). Phlebotomy is done at PAU (OC) or CBS
(OG). Blood is collected in CPDA-1 and leucodepleted. Units
are stored in TM at 4C until required, or discarded at expiry.
See BLOOD TRANSFUSION below.
BLOOD TRANSFUSION See Preamble for Policies and Procedures
Use: Blood replacement.
To order:
Order Type & Screen
New patients: send blood specimen. If antibody positive 2 units of blood will be
crossmatched. Otherwise, blood is available within 5 min following an electronic
cross-match. (This protocol has been adopted to increase blood availability by not
reserving blood for patients not likely to require it).
Patients with previous order: patients who have not been transfused in past 3m
and are not pregnant, the stored sample (stored for up to 6m) can be used. Patients transfused in past 3m or pregnant, sample is stored for 72h only. For
placenta previa patients, sample is stored for 1w.
Preop requests: submit request on day before surgery, preferably before 18:00 as
late orders can cause problems in patients with significant antibodies.
State urgency:
Routine (batch tested). State date and time blood is needed. Usually available in
2h, longer if antibodies present.
ASAP (as soon as possible). These are given priority over routine and unspecified
requests. Nursing unit is notified as soon as blood is ready.
STAT (abbreviated) crossmatch: Blood is available within 45 min of receipt of patient’s sample for Type & Screen. Phone lab (OC: 14328; OG: 78302, RS 88214)
when initiating request.
Emergency uncrossmatched blood. To be used in life-threatening situations
when patient cannot wait 45 min. Group-specific blood can be issued within 5
min. The attending physician or nurse designate must sign the request. A crossmatch is done on the issued blood and the nursing unit informed immediately
should there be any incompatibility.
Emergency O-negative blood. As above, used when patient sample cannot be
obtained. It is issued immediately. Its use is discouraged, especially in non
O-negative patients. It is rare and usually in short supply. Primary resuscitation
82
should aways start with normal saline or Ringer’s lactate. Infusion of cold stored
blood may cause hyperkalemia and/or acidosis.
Infusion:
Use 19 gauge (or larger) needle and a Y-type administration set
with 140-220 micron filter to remove large aggregates and fibrin.
Change administration set with filter every 24h or after every
4 units. Air must never be introduced into the blood bag or
adminstration set because of the risk of air embolism.
Rate: 1.5-2h/unit and within 4h to reduce risk of bacterial
proliferation and hemolysis occurring at RT. Rate depends on
clinical condition of patient. Start slowly and increase rate if
there is no reaction. Speeding infusion by use of pressure may
contribute to hemolysis and should always be supervised by
physician.
Warming of blood: this is not necessary except in:
· Extremely rapid and massive transfusion
· Exchange transfusions in newborns
· Patients with potent cold agglutinins.
Strict control of warming procedures and equipment is required
as RBCs may hemolyse at temperatures above 42C. Blood
warmers should be tested before use, and temperature of blood
monitored during infusion.
Priming/flushing of IV line: do not use incompatible soln
Calcium containing solutions (e.g. Ringer's lactate) promote
clotting by counteracting the Ca-binding effect of citrate
anticoagulant.
Dextrose solutions may cause agglutination of RBC, ¯ RBC
survival and cause acute hemolytic reaction.
PCA (patient controlled anesthetic) pumps for delivery of
narcotics are not permitted to run into lines delivering blood
products.
CRYOPRECIPITATE of ANTIHEMOPHILIC FACTOR/GLOBULIN
Use:Treatment of hypofibrinogenemia (Fbg conc <2 g/L). For specific factor deficiencies, use viral inactivated concentrates.
To order:
Product:
For new patients include order for Type & Screen (7 mL mauve)
1 unit (10 mL) cryoprecipitate contains 80 units F VIII and 250
mg fibrinogen.
Avail: 30 min
Infusion: Infuse within 4h of receipt at 200 mL/h
CRYO SUPERNATANT PLASMA
Use:Replacement fluid for plasmapheresis for TTP
To order:
To order:
For new patients include order for Type & Screen (7 mL mauve)
Plasma after cryoprecipitate is removed. Units of ~ 250 mL.
Avail: 1h
DIRECTED DONATIONS
Use: Parental donation for neonates.
To order: As for autologous blood transfusion.
83
EXCHANGE TRANSFUSION / CORDOCENTESIS
Use: For treatment of severe hemolytic disease of newborn
To order:
Products:
Order under “Other” Blood/Blood Components, stating
purpose.
Also order Type & Screen, Antibody screen, crossmatch of
mother’s blood or cord blood (7 mL mauve)
RBC from CMV negative, < 7d old is irradiated and
reconstituted with AB fresh frozen plasma to a hematocrit of
0.60 (exchange transfusion) or 0.90 (cordocentesis).
Avail: 1h
FRESH FROZEN PLASMA
Use: (a) Treatment of bleeding patients and those with multiple clotting factor deficiencies (PT >17s, PTT >50s) caused by liver disease, defibrination syndromes,
massive transfusions using stored blood, (b) where specific clotting factor deficiency
has not been established, and (c) plasmapheresis in TTP patients
To order:
Product:
For new patients include order for Type & Screen (7 mL mauve).
1 unit (~200 mL) FFP contains all plasma clotting factors
including labile factors (V, VIII)
Avail: 1 h
Infusion: Infuse ASAP after thawing at rate of 200 mL/h. Use within 24h.
GRANULOCYTE TRANSFUSION
Use:Treatment of severely neutropenic patients as temporary support, particularly if
septic
To order:
Product:
Consult Hematologist at 941-2108 (daytime) or 941-3061. The
request must be booked through CBS
Apheresis granulocyte preparation, stored at RT
Avail: 3d
Infusion: slowly over 2-4h (to avoid severe pulmonary reactions)
IRRADIATED PRODUCTS
Use: To reduce risk of graft- versus-host disease (GVHD) in susceptible
immuno-compromised recipients, such as for use in intra-uterine transfusion, premature neonates of low birth weight or with known or suspected congenital
immunodeficiency disorder, transplant recipients, acute leukemia or patients on high
dose chemotherapy and in directed-donation products from first degree relatives or
HLA-matched products.
To order:
Product:
Order under “Other” Blood/Blood components.
Blood and blood products irradiated to destroy lymphocytes.
Avail: 6-8h
Infusion: Transfuse within 30 min over 1.5-2h (no longer than 4h).
PLATELET CONCENTRATE (RANDOM DONOR)
Use:Treatment of bleeding due to thrombocytopenia (plt count <50 x 109/L) or prophylaxis in non-bleeding thrombocytopenic patients (<20 x 109/L).
To order:
84
For new patients include order for Type & Screen (7 mL mauve).
Units required: The average adult dose is 1 U/10 kg. Each unit
should increase an adult’s platelet count by 5-10 x 109/L (1h
post infusion).
Product:
1 unit (50 mL) contains 5.5 x 1010 platelets. Units pooled prior to
issue. Donor plasma should be compatible with recipient’s
RBC.
Avail: 30 min to 1h
Infusion: Rapidly – 1unit in 5 min; pooled 6 units in 30 min
PLATELETS from APHERESIS (SINGLE DONOR)
Use:(a) BM transplant patients are transfused with irradiated, CMV neg single donor
platelets, (b) patients refractory to random donor platelets due to HLA sensitization
are transfused with HLA-matched single donor platelets.
To order:
Product:
Attending physician to arrange with CBS for appropriate
product and informing TM. For new patients include order for
ABO/Rh Group/Crossmatch (7 mL mauve).
Units required: 1 unit should increase an adult’s platelet count
by 30-60 x109 /L.
1 unit (300 mL) contains 3 x 1011 platelets, equivalent to 5-6
units of random donor platelets. Donor plasma should be
compatible with recipient’s RBC.
Avail: Same day
Infusion: Rapidly within 30 min
RED BLOOD CELLS, DEGLYCEROLIZED
Use:For patients with multiple antibodies to high frequency antigens
To order:
Product:
Order under “Other” Blood/Blood component.
Protocol as for BLOOD TRANSFUSION.
Frozen RBC thawed and deglycerolized before infusion
Avail: 24h
Infusion: 1 unit in 1.5-2.0h, and within 4h. For details see BLOOD TRANSFUSIONS
In case of infusion problems, return blood to TM.
RED BLOOD CELLS, RED CELL CONCENTRATE
Use:For patients with symptomatic anemia, anemia not responsive to therapy, for replacement of blood loss
To order:
Product:
Protocol as for BLOOD TRANSFUSION.
Units required: In an adult, 1 unit should increase hemoglobin
by 10 g/L and Hct of 0.03.
1 unit (300-350 mL) contains 200 mL red cell mass and Hct of
0.55 to 0.60.
Avail: within 5 min of completion of type and crossmatch
Infusion: 1 unit in 1.5-2.0h, and within 4h. In case of infusion problems, return blood
to TM.
85
FRACTIONATION PRODUCTS:
Use TM requisition (LAB-03). Consult Hematologist if indicated.
ALBUMIN (5%, 25%)
Use:(a) Correction of acute large scale loss of colloid (hypovolemic shock, burns, patients undergoing peritoneal surgery), (b) plasma exchange and plasmapheresis
Product:
100 ml of 5% albumin (same concentration as plasma, 50 g/L)
or 25% albumin stored at RT. Pentaspan can be use in place of
5% albumin.
Avail: Same day
Infusion: 1 unit in 1.5-2h, complete within 4h
C1 ESTERASE INHIBITOR (HUMAN)
Use:under investigation for management of acute attacks and short-term prophylaxis
of hereditary angioneurotic edema (HANE)
To order:
Consult Hematologist at 941-2108 (daytime) or 941-3061,
Emergency drug release required.
FACTOR VII CONCENTRATE
Use:Treatment of confirmed F VII deficiency in a single emergency
To order:
Product:
Consult Hematologist at 941-2108 (daytime) or 941-3061.
Emergency drug release required.
Dose required: 5,000 U per bleed; 30,000 U per emergency
Recombinant product
Avail: Same day
Infusion: 2 mL/min
FACTOR VIII CONCENTRATE, ANTIHEMOPHILIC FACTOR,
HEMOPHILE FACTOR
Use: treatment of hemophilia A – prevention and control of hemorrhagic episodes
To order:
Product:
For other products (recombinant F VIII, Hemophil M
(Monoclonal F VIII), Porcine C), consult Hematologist at
941-2108 (daytime) or 941-3061. Hemophil M and Porcine C
require emergency drug release.
Lyophilized product stored refrigerated. To reconstitute, bring
diluent to RT for 30 min. Do not refrigerate after reconstitution.
Avail: 15 min
Infusion: Infuse within 3h of reconstitution at 2 mL/min
FACTOR VIII/VON WILLEBRAND FACTOR
Use:Treatment of blood in severe von Willebrand disease (vWD), or in moderate vWD
unresponsive to Desmopressin.
To order:
Product:
Avail: same day
86
Consult Hematologist - emergency drug release required, call
941-2108 (daytime) or 941-3061.
Humate ® (Aventis Behring)
FACTOR IX CONCENTRATE
Use:Treatment of F IX deficiency (Hemophilia B/Christmas Disease), congenital deficiencies of F II, VII and X.
To order:
Product:
For BPL UK, recombinant F IX (Benefix) - consult Hematologist
at 941-2108 (daytime) or 941-3061. Emergency drug release
required for BPL.
Lyophilized pool plasma derivative, rich in factors II, VII, IX and
X. To reconstitute, bring diluent to RT for 30 min. Do not
refrigerate after reconstitution.
Avail: Same day
Infusion: Infuse within 3h of reconstitution at 2 mL/min
FACTOR XIII CONCENTRATE
Use: Treatment and prevention of bleeding in congenital and acquired F XIII deficiency patients
To order:
Product:
Consult Hematologist at 941-2108 (daytime) or 941-3061.
Emergency drug release required.
Fibrogammin®P
Avail: Same day
FIBRINOGEN CONCENTRATE
Use: Treatment of bleeding disorders in hypofibrinogenemia.
To order:
Product:
Consult Hematologist at 941-2108 (daytime) or 941-3061.
Emergency drug release required.
Haemocomplettan®P
IMMUNE GLOBULIN, ANTI-CMV
Use: Prophylaxis against CMV infection
To order:
Consult Hematologist at 941-2108 (daytime) or 941-3061.
Emergency drug release required.
Avail: same day
IMMUNE GLOBULIN, ANTI-RSV
Use: Prophylaxis against respiratory syncytial virus infection
To order:
Product:
Order form from TM. Synagis is obtained directly from Abbott.
RespiGam®, Synagis®
Avail: same day
IMMUNE GLOBULIN, ANTI-VARICELLA ZOSTER, VZIG
Use: Varicella zoster prophylaxis
To order:
Product:
Order under “Other” Fractionation Products
Massachusetts Public Health Biological Laboratories
Avail: 1-2d
IMMUNE GLOBULIN, HEPATITIS B
Use: Hep B prophylaxis, passive protection after exposure to hepatitis B virus
Protocol:
Product:
Measure anti-HBs to determine immune status
Units of 120 ug and 300 ug
Avail: Same day
87
IMMUNE GLOBULIN, INTRAVENOUS, IV IG
Use: Treatment of primary humoral immunodeficiency, ITP, allogeneic bone marrow
transplant, Guillain-Barre syndrome
To order:
Product:
Dose req: 0.2-0.5 g per kg x 5d
Gamimune-N, Gammagard, Iveegam, IGIV
Avail: Same day
Infusion: start at 0.01 to 0.02 mL/kg/ min for 30 min. If patient tolerates it, increase to
0.08 mL/kg/min
IMMUNE GLOBULIN, Rh(D) IMMUNE GLOBULIN, RhIg, Anti-D
Use: (a) to prevent Rh(D) sensitization of Rh neg women at 28 w gestation and within
72 following birth of Rh pos child, abortion or stillbirth, (b) after transfusion of Rh(D)
product positive product to a Rh(D) negative patient, (c) high dose WinRho may be
used in ITP in Rh(D) positive patients.
To order:
Product:
Include order for ABO/Rh Group and Antibody screen (7 mL
Mauve)
Physician responsible for requesting additional RhIg for
postpartum patient with abnormal Kleihauer results.
WinRho, HypRho, RhoGAM
Avail: As soon as Type & Screen completed. For therapeutic abortions, within 30 d
of negative antibody screen.
PENTASPAN
Use: colloid replacement, for plasma volume expansion in place of albumin
Product:
250 mL and 500 mL plastic IV infusion bags. Totally synthetic.
Avail: Same day
PROTEIN C CONCENTRATE
Use: Transfusions in Protein C deficient patients
To order:
Product:
Consult Hematologist at 941-2108 (daytime) or 941-3061.
Emergency drug release required.
German product.
Avail: 2d
PROTHROMBIN COMPLEX
Use: Bleeding disorders
To order:
Product:
Consult Hematologist at 941-2108 (daytime) or 941-3061.
Emergency drug release required.
Prothromplex® TIM4
TISSUE BANK/BONE BANK
Use: provide bone for surgery (mainly Orthopedic)
To order:
Product:
88
Contact TM OC (14328)
Live donor bones (femoral heads), cadaveric bones
Pos
Neg
ELISA
(GPL or MPL)
ELISA
ELISA scr
Ouchterlony
Cardiolipin/
Phospholipid
dsDNA
Extractable nuclear
Ag, ENA (SS-a/Ro,
SS-b/La, Sm, RNP)
Results
Clinical Associations
See Tissue Transglutaminase
Endomysium
Pos – Jo-1
Ouchterlony
ENA (Jo-1) Histadyl
tRNA synthetase
Pos – Scl-70
Ouchterlony
ENA (Scl-70)
Topoisomerase
쐌
쐌
Polymyositis (~20%; predicts pulmonary involvement)
Dermatomyositis
Scleroderma (PSS) 60%, esp with extensive cutaneous or
interstitial pulmonary involvement.
MCTD, mild SLE
SLE
Pos – Sm
Sjogren’s
Pos – RNP
Pos Ss-a/Ro, SS-b/La
Strongly suggestive of SLE
>500
Antibodies in low conc
Possible SLE or other MCTD
Possible SLE
50-500
Does not rule out SLE
30-50
<30 U/mL
Strongly suggestive of SLE or antiphospholipid syndr
>60 U/mL
Generalized MG (>90%), Ocular MG (~60%)
MG in remission (<40%)
Likely SLE or antiphospholipid syndr
쐌
쐌
15-60 U/mL
>0.4 nmol/L
Test
Radioreceptor
assay
Antibody
Cholinesterase Receptor (ACRA)
ANTIBODIES AGAINST TISSUES
Ouchterlony screen
Lupus anticoagulant
(for antiphospholipid
syndr)
Further Testing
APPENDIX
89
90
Antibody
Test
ELISA PR3/MPO
specific screen
Screen with formalin-fixed neutrophils
Likely Goodpasture’s
Graves’ (lower titres)
쐌
Pos
Wegener’s granulomatosis
Systemic vasculitis
PR3 pos
MPO pos
Neg
Possible ANA or atypical ANCA
Systemic vasculitis
Perinuclear
(pANCA)
Neg - not true
pANCA
Wegener’s granulomatosis
Primary biliary cirrhosis
Hashimoto’s (almost always pos and higher titres)
쐌
Observed in normals, esp women, aged
Likely LE; if anti-DNA is neg, likely drug-induced LE
Cytoplasmic
(cANCA)
Neg
IFA with ethanol
fixed at 1:20 dil
Neutrophil cytoplasm
(ANCA)
1:1600–1:25,600
<1:400
Pos
>20 U
10–20 U (borderline) Likely SLE, CTD, systemic vasculitis (than Goodpasture’s)
Goodpasture’s
Goodpasture’s; possible systemic vasculitis, nephritis
Pos
Pos
Clinical Associations
Does not rule out Goodpasture’s
Neg
Results
Pos
Microparticle aggl
ELISA quant
ELISA screen
IFA
Mitochondrium IFA (mouse kidney)
Microsome
(Thyroid
peroxidase)
Histone
Glomerular
membrane
(Anti-GBM)
Further Testing
MPO semiquant
PR3 semiquant
ELISA PR3/MPO specific screen
Confirm with formalin- fixed neutrophils
PR3/MPO specific screen
Nil unless Anti-GBM if needed
ELISA quantitation
ELISA screen
Biopsy
91
Celiac
IFA using mouse stomach
ELISA
Smooth muscle
Tissue Transglutaminase IgA
(replaces Endomysial)
Chronic active hepatitis
IFA using mouse stomach
Parietal cell
Po
Po
<20 KEU/L
Centromere
Peripheral
Nucleolar
Speckled
– Cytoplasmic
Pos: homogenous
s: – Rim
s:
Pernicious anemia or gastritis
Anti-Scl-70
Anti-ENA screen, RF
Anti-Scl-70
PSS
CREST (Calcinosis, Raynaud’s, Esophageal
hypomotility, Sclerodactyly, Telangiectasia)
Anti-ENA screen
Sjogren’s
Anti-dsDNA
MCT
Anti-ENA, Anti Scl-70
Titre
Anti-dsDNA, if neg,
anti-histone and anti-ENA
confirm with anti-tissue Ab
SLE
쐌
쐌
쐌
Anti DNA, ENA if SLE suspected
Further Testing
SS, PSS
SLE
SLE unlikely (2% SLE are –ve)
Systemic vasculitis
Pos
Neg
Indirect Fluorescence assay at 1:40 dil on HEp-2
cells
Clinical Associations
p-ANCA positive, not MPO-specific
Neg
Results
Nucleus
Test
MPO ELISA
(Myeloperoxidase)
Antibody
ANCA (continued)
92
Speckled or
nucleolar (90%)
Scleroderma (Progressive
systemic sclerosis, PSS)
Anti-ENA
Scl-70 (60%), predicts lung involvement;
Sm (<1%), RNP (20%)
SS-A/Ro (10-70%), SS-B/La (15-60%),
Scl-70 (5%)
Other immune complex nephritis and systemic diseases
Lupus glomerulonephritis
Renal vasculitis
Necrotising nephritis
Goodpasture’s
Nephritis:
Wegener’s
Neg
Pos
Jo-1 (~20%), predicts lung involvement
Pos
(2%)
RNP alone
Sm (1%), SSa/Ro, SSb/La low, RNP (5%)
(1%)
(1-5%)
Neg
Polymyositis/dermatomyositis
16-50%
Anti-dsDNA
(70%), if neg, test Sm (30%), RNP (50%), Sm (30%),
anti-histone and SSa/Ro (25-35%), SSb/La (15%),
RNP (50%)
anti-tissue Ab
Rheumatoid arthritis
Centromere
Speckled
Sjogren’s Syndrome (SS)
CREST (Calcinosis, Raynaud’s,
Esophageal hypomotility,
Scleroderma, Telangiectasia)
Speckled
Nucleolar
Mixed Connective Tissue
Disease (MCTD)
(homogeneous
rim), speckled;
(98%)
Nucleolar (26%)
ANA (HE p-2 IFA)
Drug induced SLE
Systemic Lupus Erythematosus
(SLE)
AUTOIMMUNE DISEASES
Neg
p-ANCA
(~85%)
c-ANCA
ANCA
GBM
Neg
>20U
10–20U
10–20U
Other Tests
¯ CH100 during
crisis
Anti-histone
¯C3, ¯C4
+ ¯ CH100
MPO
PR-3
RF
Anti-histone
쐌
쐌
CHROMOSOMAL and DNA STUDIES, MOLECULAR BIOLOGY,
GENETIC STUDIES.
Note: This list is provided for quick information of test availability in the region. The Eastern
Ontario Regional Genetics Program (sited at CHEO) provides clinical assessment, diagnosis and counselling by medical geneticists. (Tel: 737-2275)
Abbrev: CY=Cytogenetics, MG= Molecular Genetics
LHSC – London, KGH – Kingston General, MUMC – McMaster, NYGH – North York General
HSC – Toronto Hosp for Sick Children
Specimens for CHEO must be accompanied by CYTOGENETIC (CY) or MOLECULAR
GENETICS (MG) requisition; for provincial programs: complete MOH requisition.
Testing is expensive, most tests are >$100 each
Sample
Use
Lab
TAT
PRENATAL: Pregnant patients should be referred for Genetic counselling and testing as
appropriate.
쐌
쐌
Constitutional
chromosomal
studies
FISH
Î Chorionic villus (sampled under U/S)
쐌
Ï 20 mg tissue dissected from maternal
tissues
쐌
쐌
Advanced maternal age ( ³ CHEO Î10-14d
35y)
CY
Ultrasound abnormalities
Ï24-72h
(FISH) Enumerating chr 13,
18, 21, X and Y
Ð Aminocentesis fluid:
(sampled under U/S)
Ð10-14d
Ñ Cordocentesis (sampled under U/S)
Ñ 5-7d
POSTNATAL:
쐌
쐌
Constitutional
chromosomal
studies
FISH
Blood – dark green
(10 mL)
쐌
Tissue biopsy in a-MEM
with 1% Pen/Strep
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
CHEO
Turner syndrome
CY
Klinefelter’s syndrome
Psychosis/psychosexual
disorders (males)
Ambiguous genitalia/delayed puberty
Aneuploidies (trisomy 13,
18, 21, others)
Developmental delays, failure to thrive
Multiple congenital anomalies, dysmorphia
Mental retardation, seizures
Screen for mosaicism
2-3w
Chromosome breakage syndromes (e.g. Bloom, Fanconi,
Ataxia telangietasia)
4-6w
Microdeletions (e.g.
Prader-Willi, Angelmen,
DiGeorge/Miller-Dicker, William, Wolf-Hirshhorn, Cri du
chat, retinoblastoma) (FISH)
2-4w
Spontaneous abortions (>3x)
2-3w
93
쐌
쐌
Acquired chromosomal
abnormalities
FISH
Sample
Use
Bone Marrow drawn in
syringes, rinsed in Na
heparin
쐌
Solid tissue in a-MEM
with 1% Pen/Strep
쐌
쐌
쐌
Leukemia
Lymphoma
Solid tumours
Post-transplant (monitor
chromosome changes)
Lab
TAT
CHEO
CY
Blood – Dark green (10
mL)
Angelman Syndrome
Mauve (10 mL)
HNPCC
(research only)
ACD (10 mL) ´ 3
CHEO
MG
3-4w
Colon Cancer
Loeb
Inst
Apo E2,3,4
Dyslipidemia - type III
hyperlipidemia), (Alzheimer’s
8w
E phenotyping)
disease)
OC
Biochem
Breast Cancer
Ovarian Cancer
CHEO
MG
4-8w
Ashkenazi Jewish Screen
Canavan Disease
CHEO
MG
2w
4-6w
Mauve (7 mL) keep at
(PCR, replaces Apo room temp
BRCA1/BRCA2
(research only)
ACD (10 mL) ´ 3
Canavan disease
Mauve (10 mL)
쐌
쐌
쐌
쐌
Charcot Marie
Tooth Type 1A
Mauve (10 mL) ´ 3
Peripheral neuropathy
CHEO
MG
Charcot Marie
Tooth X-linked
Mauve (10 mL) ´ 3
Peripheral neuropathy –
X-linked
MOH
LHSC
Connexin 26
Mauve (10 mL)
Unexplained prelingual
deafness
CHEO
MG
4-6 w
Cystic Fibrosis
Mauve (10 mL) ´ 3
쐌
CHEO
MG
2-3w
쐌
Cystic Fibrosis
Congenital absence of the
vas deferens
Cystinosis
Mauve (10 mL)
CHEO
MG
2-3w
Factor VLeiden
(R506E) (PCR)
Mauve (4 or 7 mL) keep Thrombophilia (resistance of OG TT
at RT. If blue tube
activated Protein C)
CHEO
MG
drawn, send plasma &
packed cells.
2w
Fragile X
Mauve (10 mL) ´ 3
CHEO
MG
2-3w
Cystinosis
Unexplained Developmental
Delay
MOH
NYGH
MG
Friedreichs Ataxia Mauve (10 mL)
FSHD
Mauve (10 mL) ´ 3
Hemochromatosis Mauve (4 or 7 mL)
(C282Y and H63D)
Hemophilia A, B
94
Mauve (10 mL)
2w
Facioscapulohumeral
muscular dystrophy
CHEO
MG
Elevated Ferritin,
Hemochromatosis
OG TT
2w
CHEO
MG
2-3w
Hemophilia
MOH
KGH
MG
HLA-B*27
Sample
Use
Lab
Mauve (4 or 7 mL)
Ankylosing spondylitis
OG TT 7-10d
TAT
Narcolepsy
OG TT
Bone marrow patients
OG-TT 1-3 w
(PCR-SSP)
HLA-DRB1*1501 Mauve (4 or 7 mL)
and/or DQB1*0602
7d
(PCR-SSP)
HLA-class 1
(PCR-SSP)
Mauve (4 or 7 mL)
HLA-Class II typing: Mauve (4 or 7 mL)
쐌
쐌
쐌
HLA-DRB
DRB3/4/5
DQB1
Donors and recipient typing OG TT 1-3 w
for bone marrow, renal, heart
allo-transplantation; low and
high resolution allele identification available.
HLA typing of
cadaveric donor
Further HLA typing if
After harvesting of
organs, save 2-3 pieces necessary
3
4 cm of spleen – send
in McCoy’s medium
OG TT 8-12hr
HNPP
Mauve (10 mL) x 3
CHEO
MG
Huntington Disease (IT-15) gene
ACD (10 mL) ´ 3
Hereditary neuropathy with
liability to pressure palsies
4-6 w
CHEO
MG
Leukemia and lymphoma gene translocations and rearrangements
AML1-ETO fusion
gene t(8;21)
(RT-PCR)
Mauve 4 or 7 mL
BCL-IgH fusion
genes,
Mauve (10 mL)
(PCR, for BCL6
RT-PCR)
AML M1/M2
OG TT
2w
BCL1 t(11;14) NonHodgkin’s lymphoma
(BNHL), Mantle cell
lymphoma (MCL)
OG TT
2w
BCL2 t(14;18) - BNHL,
follicular lymphoma, diffuse
large cell lymphoma
OG TT
2w
BCL6 t(3;14) – BNHL, diffuse OG TT
large cell lymphoma, follicular
lymphoma
2w
Bone Marrow 1mL in
Mauve
Bone Marrow: 1mL in
Mauve vacutainer
Lymph node, tissue–
fresh
BCR-ABL fusion
gene t(9;22)
RT-PCR
Mauve (4 or 7 mL)
OG TT
CML, ALL
Breakpoints identified: M-bcr
(b2a2, b3a2;P210) or m-bcr
(e1a2; P190)
2w
Bone Marrow: 1mL in
Mauve
CBFB-MYH11
fusion gene
Inv(16)/t(16;16)
(RT-PCR)
Mauve (4 or 7 mL)
AML M4Eo
OG TT
2w
E2A-PBX1 fusion
gene t(1;19)
(RT-PCR)
Mauve (4 or 7 mL)
B-lineage of ALL (FAB
L1/L2/L3)
OG TT
2w
Bone Marrow: 1mL in
Mauve
Bone Marrow: 1mL in
Mauve
95
IgH (FR3) gene
rearrangement
(clonicity) (PCR)
Sample
Use
Lab
Mauve (4 or 7 mL)
Determine clonicity in B-cell
neoplasms
OG TT
2w
Bone marrow: 1mL in
Mauve
TAT
Lymph node or tissue:
fresh
NPK-ALK fusion
gene t(2;5)
(RT-PCR)
Lymph node or skin
Anaplastic large cell lymbiopsy – fresh, sent in phoma (ALCL)
Workshop (45 mL
RPMI, 45 mL McCoy’s
5A, 10 mL heat-inactivated FCS) or McCoy’s
medium
OG TT
2w
PML-RARA fusion
gene t(15;17)
(RT-PCR)
Mauve (4 or 7 mL)
AML-M3 or acute
promyelocytic leukemia
(APL); S and L forms identified. (AML profile consists of
PML, CBFB and AML1)
OG TT
2w
Bone marrow: 1mL in
Mauve vacutainer
TCR (ß and g)
gene rearrangements (PCR)
Mauve (4 or 7 mL)
T-cell neoplasms, T-ALL
OG TT
2w
B-cell precursor ALL of child- OG TT
hood
2w
Bone Marrow: 1mL in
Mauve
Lymph node, tissue:
fresh
TEL-AML1 fusion
gene t(12;21)
Mauve (4 or 7 mL)
Bone marrow: 1mL in
Mauve
Marfan syndrome Mauve (10 mL)
Family studies only
CHEO
MG
6-8w
MCAD
Mauve (10 mL) or
1mg tissue
Sudden infant death
CHEO
MG
1-2w
MEN2 (ret
protooncogene)
Mauve (15 mL) or ACD Inherited medullary thyroid
(15 mL)
Ca, pheochromocytoma,
Hirschsprung’s disease
MTHFR (C677T) – Mauve (7 mL)
methylenetetrahydrofolate
reductase
Muscular dystrophy – Becker,
Duchenne
Mauve (10 mL) ´ 3
Myotonic dystrophy
Mauve (10 mL) ´ 2
Thrombophilia
(homocysteinemia)
MOH
LHSC
MG
CHEO
MG
2w
MOH
HSC
MG
Myotonia
CHEO
MG
3-4w
Oculopharyngeal muscular
dystrophy
CHEO
MG
1-2w
Neurofibromatosis Mauve (10 mL) ´ 3
Type I
OPMD
96
Mauve (10 mL)
Sample
Use
Lab
PKD autosomal
dominant
Mauve (10 mL) ´ 3
Autosomal dominant
polycystic Kidney disease
type 1 and 2, family studies
only
CHEO
MG
6-8w
Prader Willi syndrome
Mauve (10 mL)
CHEO
MG
3-4w
Prothrombin
(G20210A) (PCR)
Mauve (7 mL) keep at
room temp
CHEO
MG
2w
Rh D typing (PCR)
쐌
쐌
Amniotic fluid: 1.5-10
mL or Cord blood:
Mauve (10 mL) AND
Paternal blood:
Mauve (10 mL)
Thrombophilia (­ prothrombin circulating levels).
Fetal-maternal incompatibility CHEO 7-10 d
[if earlier than 15w gestation,
cells have to be cultured 3w
prior to testing]
MOH
MUMC
Sickle cell disease Mauve (10 mL) ´ 3
CHEO
MG
SMA, types I, II, III Mauve (10 mL) ´ 3
Spinal muscular atrophy
Spinocerebellar
ataxia
Spinocerebellar ataxia type 1, MOH
NYGH
2, 3, 6, 7, 8
MG
Mauve (10 mL)
TAT
Thalassemia - a, ß Mauve (10 mL) ´ 3
2-3w
MOH
MUMC
Prepared with the assistance of Drs HS Wang, N Carson, D Sengar, JG Donnelly
97
Serum ENZYMES: TISSUE SOURCES and HALF-LIVES
@
Content relative to liver, # relative to heart, & relative to serum
Kidney
ALP@
CK#
MM
MB
BB
AST&
ALT&
GGT&
LD&
0.35
<0.1
8-12%
0%
90%
4500
1200
7420
500
1400
130
614
7100
2850
Pancreas
Liver
1.00
Spleen
0.60
< 0.1
Heart
0.12
1.0
74%
0%
76-87% 13-22%
500
145 U/g
26%
700
80
113
0-2%
7800
450
3
400
250
(500 U/g)
Skeletal
muscle
288
87 U/g
(14 U/g)
5.3
99%
<1%
<1%
5000
300
5
500
45
23
Lung
0.52
< 0.1
16-35%
0-1%
64-84%
Brain
0.17
1.2
0%
0%
100%
37
Sm Int
0.38
0.2
3%
1%
96%
70
0.5
2%
0%
98%
Rectum
RBC
Adenylate
kinase
Placenta
0.5
19%
1%
80%
Uterus
0.1
2%
2%
96%
Prostate
< 0.1
3%
3%
94%
Bladder
0.3
2%
6%
92%
Stomach
0.4
3%
3%
95%
Salivary
gl
< 0.1
44%
0%
56%
Serum
Half-lives of other enzymes/proteins:
ALP:
ALT:
Amylase:
AST:
CK:
GGT:
ß-hCG:
LD:
Lipase
PSA:
PAP:
98
Intestine <1h; Bone ~40h, Placenta 170h
2-6d
12–24h
Cytoplasmic 20h; Mitochondrial 35h
Total 12h; MM 20h, MB 10h, BB 3h
3-5d
a: 2–6h
ß: 12–36h
LD1 4-5d; LD5 10h
2-3d
a: 13–20h ß: 2.2–3.2d
a: 0.5–2.5d ß: ~11d
15
7
1
1
32-120
1
1
99
5´
쐌
10´
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
15´
20´
50´
>100´
Upper limit
of Normal
MI, pulmonary
embolism
Myopathies, muscle
trauma
Extrahepatic obstruction
Hemachromatosis
Infectious
mononucleosis
Chronic active
hepatitis
Acute myocarditis
Acute hepatitis
Toxic hepatitis
Heat Stroke
1° liver Ca
Ac and subacute necrosis
AST
쐌
쐌
쐌
쐌
쐌
쐌
Liver Ca - 1° and
mets
Alcoholic hepatitis
Intrahepatic
cholestasis
Infectious
mononucleosis
Acute hepatitis
Hepatic necrosis
ALT
Serum ENZYMES – CAUSES OF ELEVATION
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
CAH
Cirrhosis
Acute hepatitis
Pancreatic Ca
Chronic pancreatitis
Liver mets
Liver cirrhosis
1° liver Ca
Biliary obstruction
GGT
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
Familial
Hepatotoxic drugs
1° Liver Ca
Amyloidosis
Adolescence
Extrahepatic obstruction
Paget’s disease
Osteogenic
sarcoma
Ectopic ALP (Regan)
ALP
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
Bowel infarction
Complications of renal Tx
Pancreatic trauma
Inflammatory bowel
disease
Renal failure
Pancreatic duct
obstr
Acute rejection of
renal Tx
Gastroenteritis
Cholelithiasis
Abdominal trauma
Pancreatic Ca
CBD obstruction
Acute pancreatitis
Pancreatic abscess
Pancreatic
pseudocyst
Lipase
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
CK
MD carriers
Cocaine, heroin
Hypothyroidism
Post-seizures
Parturition
Myopathy
(ßblockers, fibrates,
statins, phenytoin,
Li)
Myositis
Malignant
hyperthermia
Neuroleptic
malignant syndr
Muscular dystrophy
Rhabdomyolysis
100
Subnormal
Marginal
2´
Upper Limit
of Normal
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
AST
Sarcoidosis and infiltration
GI malignancies
CHF
CVA
Hyperthyroidism
DM, DKA
Alcoholic liver
disease
Chronic hepatitis
Cirrhosis (1°, biliary)
Liver mets
Cholestasis,
cholangitis
Eclampsia (HELLP
syndr)
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
ALT
Post-prandial
Physical training
Phenothiazine
B6 deficiency
Daily alcohol use
Statins
Obesity
Severe myopathy
Resolving hepatitis
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
GGT
Diabetes mellitus
Hyperthyroidism
Kidney disease
Hyperlipidemia
Fatty liver
Drug OD
Ca prostate
Extrahepatic obstruction
Alcohol use
Obesity
Drug induction
Lung disease
Familial RA
Myocardial injury
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
ALP
Diurnal variation
Age
Ketoconazole
Hypophosphatasia
Postprandial
Drugs
Intrahepatic biliary
obstr
Ethanol
Estrogens
Drugs – Li,
phenobarb,
phenytoin
Osteomalacia
Ambulation after
immobiliz
Pregnancy
(3rd trimester)
Infectious hepatitis
Fanconi’s
syndrome
Hyperparathyroidism
쐌
쐌
쐌
Lipase
Chronic
pancreatitis
DKA
Opiates
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
쐌
CK
Renal failure
IM injections
Surgery
Macro CK
Acute psychosis
Drugs
CK-BB – Ca UGS,
gastrium; leukemia,
lymphoma, sarcoma;
severe brain injury
Unaccustomed
exercise
Bruising
Metabolic myopathy
Persistent coughing
FLUIDS
(Ref: Glasser L, ed Kaplan/Pesce 1989)
Pleural Fluids
Physical
Exudate
Transudate
Malignant
Cloudy, clots
Clear
May be bloody
> 1.015
< 1.015
SG
pH
Benign
<6: leakage of gastric contents
7.4: not likely TB
Protein (g/L)
Fluid: serum ratio
> 30
> 0.5
< 30
< 0.5
LD (U/L)
Fluid: serum ratio
> 200
> 0.6
Normal
<0.6
Glucose (mmol/L)
>7.3
­ in 50% of pts ­ in 12% of pts
~ serum
Synovial Fluid
Normal
Inflammatory
Septic
Volume (mL)
0.13-3.05
>3.5
>3.5
>3.5
Colour
Clear,
colourless
Yellow–white
Yellow–green
Red–brown
2–100
10–>100
>5
>50
>75
>25
WBC (109/L)
Neutrophils (%)
Hemorrhagic
Total Protein (g/L)
10.7-21.3
−
−
−
−
Glucose
~ serum
<0.6 serum
<0.6 serum
~ serum
Negative
Positive
Negative
Culture
Cerebrospinal Fluid
Cerebral infarction
Hemorrhage
Epilepsy
Appearance
Glucose
Xanthochromic
N
Protein
­
Bloody/xanthochr
N
N or ­
N
N
N
N / xantho
N/¯
­
Fungal/bacterial inf
N
¯
­
Viral infection
N
N
N
N/­
CNS tumour
Viral meningitis
N
N
Xanthochromic
N
­
Hyperosmolar coma
N
­
N
Hypoglycemia
N
¯
N
Trauma
101
102
Test Results
Likely Diagnosis
쐌
쐌
PCT
VP, HCP
쐌
VP, HCP
쐌
쐌
­ Plasma / Urine uroporphyrins
EPP
쐌
PCT
쐌
쐌
VP, HCP
Not EPP
See above (fecal porphyrins)
See above (Urine and plasma porphyrins)
See above (fecal porphyrins)
Erythrocyte fluorescence
Feces: ­ copro-I
Urine: ­­ uro, ­­ heptacarboxyl-III, ­ copro
Plasma: ­­ heptacarboxyl-III
See above (fecal porphyrins)
Feces: ­­ copro (III>I)
Feces: ­ copro, ­­ proto, ± ­ uro-I, ­ copro (III>I)
쐌
쐌
쐌
AIP
VP
Feces: ­­ copro
Feces: ­ copro, ­­ proto
HCP
쐌
In between attacks of HCP
RBC: ¯ PBG deaminase
RBC: ¯ PBG deaminase
Urine: ­­ Uro-I, ­­ uro-III, ­ copro-III, copro-I,­ hepta,
hexa, penta
쐌
In between attacks of VP
Further Testing/Confirmatory
쐌
쐌
In between attacks of AIP
Not acute porphyria
« Plasma / Urine uroporphyrins
­ RBC protoporphyrin
« RBC protoporphyrin
­ PBG ­ ALA
PBG and ALA negative
Hindmarsh JT et al. Clin Biochem 1999;32:609-19
AIP: acute intermittent porphyria, ALA: aminolevulinic acid; EPP: erythrocytic protoporphyria, HCP: hereditary coproporphyria, PBG: porphobilinogen,
PCT: porphyria cutanea tarda, VP: variegate porphyria.
Active skin lesions:
erosions ± bullae
Sun-induced urticaria
or erythema
Acute neurovisceral
± skin lesions
Symptoms
PORPHYRIA Investigation
Abbreviation, Alternate names
Abbreviations, alternate names
1,25 diOH D3
17 b-Estradiol
17-KGS
17-KS
17-OH P4
17-OH Prog
25OHD3
3'UTPT
A1-AT, AAT
ACE
Acid serum
ACRA
ACTH
ADH
AFP
Al
ALP
Alprazolam screen (urine)
ALT
Amitriptyline (quant)
Amitriptyline screen
AML1-ET
Amobarbital screen (urine)
ANA
ANCA
Angelman syndrome
Anti-GBM
Anti-HAV
Anti-HBc
Anti-Hbe
Anti-HBs
Anti-hemophiliac factor
Anti-HIV 1, 2
Anti-HTLV-I/II
Anti-TPO
APC resistance
APPT
As
ASO
AST
ATT
B2GP1
Barbital screen (urine)
BCL-IgH fusion genes
BCR-ABL fusion gene
Becker muscular dystrophy gene
Beta-subunit
BRCA gene
BSAP
BT
Butabarbital screen (urine)
C&S
C1-INH
C3
C4
See:
Vitamin D, 1, 25 di-hydroxy
Estradiol
Not available
Not available
Hydroxyprogesterone
Hydroxyprogesterone
Vitamin D, 25-hydroxy
Chromosomal studies (Appendix)
Alpha-1 antitrypsin
Comments
1, 25 di-hydroxyvitamine D3
17-ketogenic steroids
17-ketosteroids
17-hydroxy progesterone
17-hydroxy progesterone
25-hydroxyvitamin D3
Prothrombin gene
Angiotensin converting enzyme
Ham's test
Anti-acetylcholine receptor antibodies
Adrenocorticotropin
Antidiuretic hormone, vasopressin
Alpha-fetoprotein
Aluminum
Alkaline phosphatase
Benzodiazepine Screen
Alanine aminotransferase
Tricyclic antidepressants quant
Tricyclic antidepressant screen
Chromosomal studies (Appendix)
Barbiturates Screen
Anti-nuclear antibodies
Anti-neutrophil cytoplasmic antibodies
Chromosomal studies (Appendix)
Anti-glomerular basement membrane antibodies
Serological tests
Serological tests
Serological tests
Serological tests
Factor VIII assay
Serological tests
Serological tests
Anti-microsomal antibodies
Activated Protein C resistence
Partial thromboplastin time
Arsenic
Anti-streptolysin O antibodies
Aspartate aminotransferase
Anti tissue transglutaminase
Anti-beta-2 glycoprotein I
Barbiturates Screen
Chromosomal studies (Appendix)
Chromosomal studies (Appendix)
Chromosomal studies (Appendix)
Chorionic gonadotropin, beta subunit
Chromosomal studies (Appendix)
Alkaline phosphatase, bone specific
Bleeding time
Barbiturates Screen
Cultures
C1 esterase inhibitor
Complement 3
Complement 4
Glomerular basement membrane antibodies
Hepatitis A virus Antibodies
Hepatitis B core antibody
Hepatitis B e antibody
Hepatitis B surface antibody
Human immunodeficiency virus antibody
Human T-cell lymphotrophic virus I, II antibody
Activated partial thromboplastin time
Beta-2 glycoprotein 1
Breast carcinoma
Bone specific alkaline phosphatase
Culture and sensitivities
Abbreviation, Alternate names
Abbreviations, alternate names
Ca
CA-125
cAMP
Canavan disease
Cannabis screen (urine)
CBC
CBFB-MYH11 fusion gene
CCCG
CD4 count
CD4/CD8 ratio
CEA
CH100
Charcot Marie Tooth
CK
CK iso
CK-MB
Clomipramine (quant)
Clomipramine screen
Clot lysis time
CMV
Codeine
Codeine screen (urine)
COHb
Conjugated bilirubin
Connexin
CPK
CrCl
CRP
CsA
CSF
cTnT
cTX
Cystic fibrosis gene
Cystinosis gene
DAT
Delta OD
Depakene
Desipramine (quant)
Diazepam screen (urine)
Dilantin
Diphenhydantoin
Doxepin (quant)
dsDNA
Duchenne muscular dystrophy gene
E2
E2A-PBX1 fusion gene
EBV
ECC
EG
ENA
ER-PR
Ethanol, ETOH
FBG
Fe
FEP
See:
Calcium
Cancer Antigen 125
cyclic AMP
Chromosomal studies (Appendix)
Cannabinoid screen
Complete blood count
Chromosomal studies (Appendix)
Creatinine clearance
Flow cytometry
Flow cytometry
Carcinoembryonic antigen
Complement, total hemolytic
Chromosomal studies (Appendix)
Creatine kinase
Replaced by Troponin T
Replaced by Troponin T
Tricyclic antidepressants quant
Tricyclic antidepressant screen
Euglobulin Clot Lysis
Cytomegalovirus
Opiates
Opiate Screen
Carboxyhemoglobin
Bilirubin, direct
Chromosomal studies (Appendix)
Creatine kinase
Creatinine clearance
C reactive protein
cyclosporin A
Cerebrospinal fluid
Troponin T
Telopeptides
Chromosomal studies (Appendix)
Chromosomal studies (Appendix)
Direct antiglobulin test
Amniotic fluid scan
Valproate
Tricyclic antidepressants quant
Benzodiazepine Screen
Phenytoin
Phenytoin
Tricyclic antidepressants quant
Anti-dsDNA
Chromosomal studies (Appendix)
Estradiol
Chromosomal studies (Appendix)
Epstein-Barr virus
Creatinine clearance
Ethylene glycol
Anti-ENA
Estrogen-Progesterone receptors
Ethyl Alcohol
Fibrinogen
Iron
Free erythrocyte protoporphyrin
Comments
Creatinine clearance by Cockcroft Gault formula
Total hemolytic complement
Creatine kinase isoenzyme
Creatine kinase - MB isoenzyme
Creatine phosphokinase
Cardiac troponin T
c-telopeptides
Change in OD at 450 nm
Endogenous creatinine clearance
Abbreviation, Alternate names
Abbreviations, alternate names
Fibrin stabilizing factor
FISH
FK506
FLM
FNA
Fragile X
Fragmin
Friedreichs Ataxia
FSH
FSHD
FT3
FT4
G6PD
GBM
GC
GGT
GGTP
Glycated Hb
GTT
H pylori
Hb
HbA1c
HbA2
HBeAg
HbF
Hbg
HbS
HBsAg
hCG
HCV
HCY
HDLC
HDV
Hemochromatosis gene
Hemoglobin
Hemogram
Hemophilia A factor
Hemophilia B
Hemophilia gene
Hemophiliac inhibitor
Heroin
Heterophile antibodies
HEV
Hg
hGH
HIAA, 5HIAA
HIT
HIV
HNPCC
HVA
Hydromorphone screen (urine)
IBC
iCa
IFIX
Ig
See:
Factor XIII
Chromosomal studies (Appendix)
Tacrolimus
Fetal lung maturity
Fine needle aspiration biopsy
Chromosomal studies (Appendix)
Anti-Xa
Chromosomal studies (Appendix)
Follicle stimulating hormone
Chromosomal studies (Appendix)
Triiodothyronine
Thyroxine
Glucose-6 phosphate dehydrogenase
Anti-glomerular basement membrane antibodies
Gonococcus
Gamma glutamyl transferase
Gamma glutamyl transferase
Hemoglobin A1c
Glucose
Serological tests
Complete blood count
Hemoglobin A1c
Hemaglobin Investigation
Serological tests
Hemoglobin Investigation
Complete blood count
Sickle Cell Screen
Serological tests
Chorionic gonadotropin, beta subunit
Serological tests
Homocysteine
Cholesterol, High density lipoprotein
Serological tests
Chromosomal studies (Appendix)
Complete blood count
Complete blood count
Factor VIII assay
Factor IX
Chromosomal studies (Appendix)
Factor VIII or IX inhibitor
Opiates Screen
Infectious mononucleosis screen
Serological tests
Mercury
Growth hormone
Hydroxy-indole acetic acid
Heparin induced thrombocytopenia
Human immunodeficiency virus
Chromosomal studies (Appendix)
Homovanillic acid
Opiate Screen
Iron binding capacity
Calcium, ionized free
Immunofixation
Immunoglobulin
Comments
Fluorescence in-situ hybridization
Facioscapulohumeral muscular dystrophy
Free triiodothyronine
Free thyroxine
Glomerular basement membrane
Gamma glutamyl transpeptidase
Glucose tolerance test
Helicobacter pylori
Hepatitis B e antigen
Hemoglobin S
Hepatitis B surface antigen
Human chorionic gonadotropin
Hepatitis C virus
High density lipoprotein cholesterol
Hepatitis D virus
Hepatitis E virus
Human growth hormone
5-hydroxy indole acetic acid
Hereditary non-polyposis colorectal cancer
Ionized calcium
Abbreviation, Alternate names
Abbreviations, alternate names
See:
IGF-1
Insulin-like growth factor 1
IgH (FR3) gene
Chromosomal studies (Appendix)
INR
International normalized ratio
IPS
Maternal serum screening
iPTH
Parathyroid hormone
Isopropanol
Isopropyl alcohol
Anti-extractable nuclear antigen antibodies
Jo-1
K
Potassium
L/S ratio
Not available, substitute with Fetal lung maturity
LAP
Leucocyte alkaline phosphatase score
LATS
Thyrotropin binding inhibitory immunoglobulin
LC
Light chains
LD
Lactate dehydrogenase
LDH
Lactate dehydrogenase
LDLC
Cholesterol, low density lipoprotein
LH
Luteinizing hormone
Li
Lithium
LMWH
Lp(a)
Not available
Marfan syndrome
Chromosomal studies (Appendix)
MCAD
Chromosomal studies (Appendix)
MEN2
Chromosomal studies (Appendix)
Methanol
Methyl alcohol
MetHb
Methemoglobin
Mg
Magnesium
Monospot
Infectious mononucleosis screen
Monotest
Infectious mononucleosis screen
Morphine screen (urine)
Opiate Screen
MSS
Maternal serum screening
MTHFR
Methylene tetrahydrofolate reductase
MTX
Methotrexate
Muscular dystrophy gene
Chromosomal studies (Appendix)
Myotonic dystrophy
Chromosomal studies (Appendix)
Na
Sodium
NAP
Leucocyte alkaline phosphatase score
NAPA
Procainamide
Neurofibromatosis Type 1
Chromosomal studies (Appendix)
NH3
Ammonia
Nortriptyline (quant)
Tricyclic antidepressants quant
NPK-ALK fusion gene
Chromosomal studies (Appendix)
O fusion gene
Chromosomal studies (Appendix)
O2 sat
Blood gases
OB
Occult blood
OPMD
Chromosomal studies (Appendix)
Osmo
Osmolality
Oxazepam screen (urine)
Benzodiazepine Screen
Oxycodone screen (urine)
Opiate Screen
P4
Progesterone
PA
Procainamide
Panel reactive antibody
HLA antibody
Paroxysmal Nocturnal hemoglobinuriaHam's test
Pb
Lead
PBG
Porphobilinogen
PBG deaminase
Porphobilinogen deaminase
PE
Protein electrophoresis
Comments
Integrated pregnancy screening
Intact Parathyroid hormone
Lecithin/sphingomyelin ratio
Long acting thyroid stimulator
Low density lipoprotein cholesterol
Low molecular weight heparin
Lipoprotein(a)
Medium chain acyl-CoA dehydrogenase
Multiple endocrine neoplasia 2
Neutrophil alkaline phosphatase score
N-acetyl procainamide
Hereditary neuropathy with pressure palsies
Oxygen saturation
Oculopharyngeal muscular dystrophy
Abbreviation, Alternate names
Abbreviations, alternate names
Pentobarbital screen (urine)
Phenobarbital screen (urine)
PHLA
PK
PKD
PML-RARA fusion gene
PNH test
PO4
PRA
Prader Willi syndrome
Prothrombin gene
Prothrombin time
Protriptyline (conc)
Protriptyline screen
PSA
PT
PTA
PTH
PTT
RAST
Retic count
RF
Rh D typing by PCR
RNP
Rothera's test
Scl-70
Secobarbital screen (urine)
Serax screen (urine)
Serum lysis test
SGOT
SGPT
Sickle cell disease
SMA
Smear
Solubility test
Somatomedin C
SPE
Spinocerebella ataxia
SS-a/Ro
SS-b/La
T and B cell X-match
TBG
TBII
TCA
tCO2
TCR gene rearrangement
TEL-AML1 fusion gene
Temazepam screen (urine)
TG
Thalassemia
THC
Thyroid stimulating hormone
TIBC
Trimipramine (quant)
Trimipramine screen
See:
Comments
Barbiturates Screen
Barbiturates Screen
Lipolytic activity
Post heparin lipolytic acitivity
Pyruvate kinase
Chromosomal studies (Appendix)
Polycystic kidney disease
Chromosomal studies (Appendix)
Ham's test
Phosphate
Either: Panel reactive antibody or Plasma renin activity
Chromosomal studies (Appendix)
Chromosomal studies (Appendix)
International normalized ratio
Tricyclic antidepressants quant
Tricyclic antidepressant screen
Prostate specific antigen
International normalized ratio
Prothrombin time
Factor IX
Parathyroid hormone
Partial thromboplastin time
Radio-allergosorbent test
Radioimmunosorbent test
Reticulocyte count
Rheumatoid factor
Chromosomal studies (Appendix)
Anti-extractable nuclear antigen antibodies
Ribonuclear protein
Ketones
Anti-extractable nuclear antigen antibodies
Barbiturates Screen
Benzodiazepine Screen
Ham's test
Aspartate aminotransferase (AST)
Serum glutamate-oxaloacetate transferase
Alanine aminotransferase (ALT)
Serum glutamate-pyruvate transferase
Chromosomal studies (Appendix)
Chromosomal studies (Appendix)
Spinal muscular atrophy
Film, blood
Sickle Cell Screen
Insulin-like growth factor 1
Protein electrophoresis
Serum protein electrophoresis
Chromosomal studies (Appendix)
Anti-extractable nuclear antigen antibodies
Anti-extractable nuclear antigen antibodies
Flow cytometry
Thyroxine binding globulin
Thyrotropin binding inhibitory immunoglobulin
Thyrotropin binding inhibitory immunoglobulin
Tricyclic antidepressants
Bicarbonate
Total CO2
Chromosomal studies (Appendix)
Chromosomal studies (Appendix)
Benzodiazepine Screen
Either: triglycerides or thyroglobulin
Chromosomal studies (Appendix)
Cannabinoid screen
Tetrahydrocannabinoids
Thyrotropin
Iron binding capacity
Total iron binding capacity
Tricyclic antidepressants quant
Tricyclic antidepressant screen
Abbreviation, Alternate names
Abbreviations, alternate names
TSH
TSI
UA
Valium screen (urine)
Vasopressin
Vitamin C
VLCFA
VLM
VMA
XTT
Zn
See:
Thyrotropin
Thyrotropin binding inhibitory immunoglobulin
Urate
Benzodiazepine Screen
Antidiuretic hormone
Ascorbic acid
Fatty acids
Human immunodeficiency virus
Vanillylmandelic acid
Xylose tolerance test
Zinc
Comments
Thyroid stimulating hormone
Thyroid stimulating immunoglobulin
Uric acid
Very long chain fatty acids
Viral load monitoring
Acknowledgements
Contributors to the first edition (2000) and
Peter Bunting, Susan Commons, Antonio Giulivi, Laurie MacDonald,
Doris Neurath, Ruth Padmore, Baldwin Toye.
This handbook is printed with partial support from
Beckman Coulter Diagnostics, Canada