Download Chemical Pathology Unit

PATOLOGI KIMIA
Head of Unit
:
Dr Nur Shafini Binti Che Rahim
Phone
:
+60326155555 ext 5630
1.
INTRODUCTION
The Chemical Pathology Unit provides diagnostic and consultative services to Hospital
Kuala Lumpur for patient management. It also serves as referral centre for all the
hospitals in Malaysia. Our services cover analysis and interpretation of biochemical
changes in body fluids for diagnostics, monitoring and screening of diseases.
2.
SERVICES
Chemical Pathology Unit offers specialized biochemical testing. The list of services
includes:
i.
Endocrine
Thyroid
Function
Catecholamines,
Test,
Extended
Fertility
Test,
Hormone
Serum
and
Urinary
Cortisol,
(Dehydroepiandrosterone
sulphate
(DHEAS), Insulin, C-peptide, Growth Hormone, Adrenocorticotrophic Hormone
(ACTH), Intact Parathyroid Hormone (IPTH))
ii.
Metabolic
HbA1c, Homocysteine
iii.
Protein and Proteomic
Serum and Urine Protein Electrophoresis, Special Protein (Alpha 1 anti-trypsin,
haptoglobin, transferrin, caeruloplasmin, IgG, IgA, Ig M
iv.
Hematological Biochemistry
v.
Toxicology.
Requests are made as either single test or multiple tests in a dynamic function tests.
3.
SERVICE HOURS
Operating hours : 7.30 am – 5.30 pm (Monday – Friday)
URGENT request: Appointment should be made by contacting Pathologist,Medical
Officer and Section in-charge. The request form should be signed or countersigned by
requesting Specialist.
4.
REQUEST FORMS
Request forms for all tests are PERPAT 301 form.
5.
SAMPLE COLLECTION
5.1
BLOOD
Most of tests in chemical Pathology require serum sample that need to be collected in
plain tube. Special requirement needed for certain tests:

For HbA1c test require whole blood sample that need to be collected in EDTA
tube. Request less than 2 months from previous result will be rejected.

For morning serum cortisol: between 8 to 10 am; for midnight serum cortisol:
between 10 to 12 pm.

For fertility test: Progesterone collected at day 21 menstrual cycle, estradiol, FSH
and LH is collected at day 2 to 5 of menstrual cycle.

Certain tests required to be sending in ice such as ACTH.

Serum and Urine Protein Electrophoresis should be send as paired sample for
better interpretation of tests results
5.2
URINE
24 hours Urine Collection
Most quantitative assays are performed on urine specimen collected over 24 hours. The
24 hours timing allows for circadian rhythmic changes in excretion at certain time of day.
Procedure of collection:

The 24 hours urine bottle which contains appropriate preservative for the
required test is available at the Stor Integrasi, Jabatan Patologi. Urine bottle will
be provided on request, with the accompanying request form or note.

On the day of collection, the first urine voided must be thrown away. Time of first
urine voided is the start of the timing for the 24 hour collection.

Collect the second and subsequent voided urine for 24 hour from the timed start
into the 24 hour urine bottle.

For male patient, it is advisable NOT to void the urine directly into the 24 hour
urine bottle. This is to avoid possible chemical burns.

At the end of 24-hours, the last urine voided is collected. For best result,
refrigerate if possible.

Label the bottle as directed and send immediately to the laboratory.

eg. of tests: 24-hours urine cortisol and 24-hours urine catecholamine
24-hours Urine Catecholamines

Please refer to procedure 24 hour urine collection to collect urine for 24hr urine
catecholamines.

For adult minimum 500 mls of urine should be collected. For paediatric samples
urine creatinine will be run for every request.

Please note that, preservative 10 mls of 25% HCl is added into the bottle to
preserve the analytes. It is important for the requesting physician to advise the
patient NOT to discard the preservative.

Instruction on patient preparation and specimen collection

Abstain from bananas, coffee, pineapple and walnuts one day prior to and
during the 24 hour urine collection.

Certain drugs alter the metabolism of catecholamines. It is advisable to stop
such medication at least 5 days prior to urine sampling i.e Alpha2 agonists,
Calcium channel blockers, ACE inhibitors, Bromocriptine, Methyldopa,
Monoamine
oxidase
inhibitors,
Alpha
blockers
and
Beta
blockers,
Phenothiazines and Tricylic antidepressants.

Please advice patient to avoid stress, exercise, smoking and pain prior to and
during urine collection.
24-hours Urine Cortisol

Please refer to procedure 24 hour urine collection to collect urine for 24hr
urine cortisol.

6.
Minimum of 500 mls of urine should be collected.
RECEIPT OF SPECIMEN
Specimens will be received at the main counter (Pre-analytical Unit).
7.
REPORTING OF RESULTS
Results will be validated by Chemical Pathologist/Medical Officer/Scientific Officer
according to the test. Test results will be ready according to promised Laboratory
turnaround time (please refer to Section List of Tests).
Current reference intervals will be provided for all results. These may be subject to
variation differentiated by age and sex where important / available.
Reports are dispatched to the respective pigeon hole or posted via mail for referral
external samples.
8.
ENQUIRY OF RESULTS
Enquiry of results can be made to Unit Patologi Kimia by telephone (ext 5284). Enquiry
for result from external customer can be made via tracing letters.
9.
SERVICES AFTER OFFICE HOURS
If test needed after working hours, consultation and agreement from Chemical
Pathologist/ Medical Officer in charged are required.
10.
PROTOCOLS FOR INVESTIGATION OF ENDOCRINE DISORDERS
The protocols listed below are only as guide and are subjected to changes according to
clinician requirement. These protocols are mainly for adult.
10.1
PITUITARY DISORDERS
Assessment of Anterior pituitary Hormone
1. Pituitary Hormone Insufficiency
Anterior pituitary hormones include Growth Hormone (GH), Prolactin, Thyroid
Stimulating Hormone (TSH), Follicle Stimulating Hormone (FSH), Luteinizing Hormone
(LH) and Adrenocorticotrophic Hormone (ACTH). Main abnormalities to look for are
Corticotroph deficiency, Thyrotroph deficiency, Gonadotroph deficiency or Somatotroph
deficiency.
Assessment of Anterior Pituitary Reserve
a)
Initial assessment

Morning serum Cortisol and ACTH or Short Synachten Test

Thyroid Function Test (TSH, FT4)

Prolactin, LH, FSH

GH

Testosterone for man

b)
Estradiol for woman
Combine Anterior Pituitary Stimulation Test (Insulin Stress Test +
Gonadotrophin Stimulation Test)
Procedures:

Fast the patient overnight.

Insert intravenous catheter or intravenous line.

Rest patient for 30 minutes. Take samples for glucose, growth hormone,
cortisol, LH, FSH and TSH (as baseline investigation).

Give insulin 0.1-0.15 unit/kg body weight, 200µg TRH and GnRH 100ug
intravenously.

Collect samples into plain tubes and Glucose tubes and label as follows:
Time
Tests
Tube
0 min (basal)
Glucose
Glucose tube
Cortisol,
GH,
LH, 1 plain tube
FSH,TSH
15 min
Glucose
Glucose tube
20 min
FSH, LH, TSH
1 plain tube
30 min
Glucose
Glucose tube
Cortisol, GH, LH
1 plain tube
45 min
Glucose
(
if
patient Glucose tube
become
clinically/biochemically
(glucose < 2.2 mmol/L)
hypoglycaemic
60 min
Glucose
Cortisol,
Glucose tube
GH,
LH, 1 plain tube
FSH,TSH
90 min
120 min
Glucose,
Glucose tube
cortisol, GH
1 plain tube
Glucose,
Glucose tube
cortisol, GH
1 plain tube
* GH-Growth hormone, LH-Luteinizing hormone, FSH- Follicular stimulating
hormone, TSH – Thyroid Stimulating Hormone
Adapted from Clinical Chemistry Sixth Edition, William J Marshall & Stephen K Bangert,
Mosby, 2008, pg 140.

Label specimens according to sampling time.

Send all samples after test is completed to main counter, Pathology
Department.
Notes:

Plasma glucose level must fall below 2.2 mmol/L and/or clinical signs and
symptoms of hypoglycaemia (sweating, tachycardia etc) must be observed.

Additional intravenous insulin may be given if this does not occur by 30 min
and sampling should be prolonged by another 30 min.

Physician should be in attendance throughout the tests and 50% i.v. dextrose
should be kept by bed side if severe hypoglycemia is documented.

Giving glucose for severe hypoglycemia does not invalidate the test results.

Test is contraindicated for patient with seizure, IHD or cardiovascular
insufficiency and in young children.

c)
Normal ECG is mandatory.
Insulin Stress Test
Procedures:

Similar as Combine Anterior Pituitary Stimulation Test but without GnRH
injection.

Blood samples are taken at 0 minute (basal), 30 minutes and 60 minutes
after insulin injection for glucose, cortisol and growth hormone (GH) as
follows:
Time
0 min (basal)
Tests
Tube
Glucose
Glucose tube
Cortisol, GH
1 plain tube
30 min
Glucose
Glucose tube
Cortisol, GH
1 plain tube
60 min
Glucose
Glucose tube
Cortisol, GH
1 plain tube
 Label specimens according to sampling time.

Send all samples after test is completed to main counter, Pathology
Department.
d)
Gonadotrophin- Releasing Hormones Stimulation Test
Procedures:

Collect samples into plain tubes for LH and FSH (basal sample).

Give 100 ug GnRH.

Collect samples into plain tubes at 15 minutes, 30 minutes, 60 minutes and
90 minutes after GnRH injection for Luteinizing Hormone (LH) and Follicular
Stimulating Hormone (FSH).
Time
Tests
Tube
0 min (basal)
FSH, LH
1 plain tube
15 min
FSH, LH
1 plain tube
30 min
FSH, LH
1 plain tube
60 min
FSH, LH
1 plain tube
90 min
FSH, LH
1 plain tube

Label specimens according to sampling time.

Send all samples to main counter Pathology Department
2. Pituitary surgery assessment
a)
b)
Pre-operative assessment

Morning serum cortisol

Thyroid Function Test (TSH, FT4)

Prolactin, LH, FSH

GH

Testosterone for man

Estradiol for woman
Post-operative assessment (2-4 days after surgery)

Steroid coverage with hydrocortisone is administered immediately before,
during and after surgery.

If adrenal function was normal before surgery, hydrocortisone is stopped on
second or third post-operative day.

c)
24 hours after stopping – take morning blood for cortisol
Follow up assessment ( one month after surgery)

FT4

Testosterone for man

Estradiol for woman

Cortisol and ACTH at 9.00 am and Short Synacthen test, even if function is
subnormal after surgery. ACTH deficiency after surgery is often transient.
After pituitary irradiation, patient should be evaluated at least once per year with
measurement of FT4, estradiol (if female), testosterone (if male), FSH, LH, prolactin,
cortisol, ACTH and Short Synacthen Test.
3. Acromegaly
a)
Screening and biochemical diagnosis

2 tests must be done to attain biochemical diagnosis of active acromegaly.

Measure IGF 1 level according to age-adjusted reference.

Perform oral glucose tolerance test with 75g oral glucose after at least 8
hours of overnight fasting.

Active acromegaly is indicated by elevated IGF 1 and failure of GH to be
suppressed below 1 ng/ml.

GH may not be suppressed in poorly controlled diabetes mellitus, severe
illness, chronic liver disease and chronic kidney disease.
b) Other biochemical tests

Serum prolactin

ACTH and cortisol (morning sample)

TFT

LH, FSH, testosterone (male), estradiol (female) – morning sample

Fasting serum lipids

RP, uric acid

LFT, calcium, phosphate

Urine FEME
Assessment of Posterior Pituitary Hormone
Posterior pituitary secretes vasopressin (ADH) and oxytocin. These hormones are
synthesized in hypothalamus and pass down nerve axons into the posterior pituitary
and released into the circulation.
1.
Diabetes Insipidus (DI)

Lack of ADH caused by pituitary/hypothalamic disease (cranial DI) or failure
of kidney to respond to ADH (nephrogenic DI)

Presented with polyuria –urine volume >3 L/day

common causes of polyuria such as diabetes mellitus , hypokalemia ,
hypercalcemia and diuretic therapy have been excluded

Measure serum and urine osmolality and sodium
If serum osmolality ≥ 295 mOsm/kg, urine osmolality is < 300 mOsm/kg and
sodium ≥145 mmol/l - Diagnosis of Diabetes Insipidus is unlikely and not for
Fluid Deprivation test

a)
If diagnosis is in doubt; perform Fluid Deprivation test
Protocol for Fluid Deprivation Test
Procedure

Allow fluids overnight before test and give light breakfast with no fluid; no
smoking permitted

Weigh patient

Allow no fluid for 8hours; patient must be under constant supervision

Every 2 hours

-
Weigh patient (stop test is weight falls by > 5% initial body weight)
-
Measure urine volume and osmolality
-
Measure plasma osmolality ( stop test if osmolality >300 )
After 8 hours
-
Allow patient to drink ( no more than twice urine volume of period of fluid
deprivation, to avoid acute hyponatraemia) and give 2 µg desmopressin i.m

Measure urine osmolality every 4 hours for further 16 hours
Interpretation:
Algorithm for the investigation of polyuria.
polyuria
measure:
blood glucose
plasma
creatinine
potassium
calcium
abnormal
diagnosis
normal
fluid deprivation
test
Urine osmolality (mmol/kg) after:
8 h fluid
desmopressin
deprivation
<300
>750
Cranial diabetes
insipidus
<300
<300
Nephrogenic
>750
>750
300-750
<750
diabetes insipidus
Primary polydipsia
Non-diagnostic
Adapted from Clinical Chemistry Sixth Edition, William J Marshall & Stephen K Bangert,
Mosby, 2008, pg 152
10.2 ADRENAL DISORDERS
Disorders of Adrenal Cortex
Adrenal hypofunction (Addison’s Disease)
1.
a.Short Synacthen Test/Cosyntropin Test
 High index of suspicion is required to diagnose adrenal insufficiency.
 Indications for screening:
– Unexplained hyponatremia.
– Prolonged corticosteroid or traditional medication ingestion.
– Bilateral adrenal mass.
 Screening is by doing short synacthen test.
Procedure:

Take blood sample for baseline cortisol level (0 minutes).

Give 250ug cosyntropin (synthetic ACTH) intramuscularly or intravenously.

Take samples at 30 minutes and 60 minutes after injection for cortisol level.
Time
Tests
Tube
0 min (basal)
Cortisol
1 plain tube
30 min
Cortisol
1 plain tube
60 min
Cortisol
1 plain tube
Interpretation:

Normal response is cortisol peak is greater than 550 nmol/l.

Patient with atrophy of adrenal cortex (exogenous steroid / pituitary or
hypothalamic disease) shows slight rise in serum cortisol.
2.
Adrenal Hyperfunction (Cushing’s syndrome)
 Screening tests should be done in patients:
– With multiple and progressive features of Cushing syndrome
–
With adrenal incidentaloma.
–
After excluding exogenous steroid intake.
 Screening tests are:
i.
24-hours urine free cortisol: if less than 380 nmol/day, Cushing
syndrome is excluded and if level is 3-4 times greater than upper limit
normal, suggestive of Cushing syndrome.
ii.
Overnight Low Dose Dexamethasone Suppression Test (OLDDST)

Procedure:
– Give 1 mg dexamethasone orally at 2300 or 2400 hours.
–
Fill up the request form complete with clinical summary and
request test mentioned above.
– Collect blood at 8.00 am the next morning for determination
of serum cortisol and send to main counter, Pathology
Department.

Interpretation: In normal subjects, serum cortisol is suppressed
to less than 50 nmol/l. Serum cortisol level of more than 50
nmol/l can also be seen in cases of stress, obesity, infection,
acute or chronic illness, alcohol abuse, severe depression, oral
contraceptive, pregnancy, estrogen therapy, failure to take
dexamethasone,
or
treatment
with
diphenylhydantoin
phenobarbital (enhancement of dexamethasone metabolism).
iii.
Low Dose Dexamethasone Suppression Test

Procedure:
or
–
At 9.00am on 1st day of test, collect blood for serum cortisol
(basal) and request test mentioned above.
–
Immediately after sampling, give 0.5mg dexamethasone orally
every 6 hrs for 2 days (8 times).
–
Collect blood for serum cortisol 6 hours after last dose of 0.5mg
dexamethasone
and send to main counter Pathology
Department.
Note:

Ensure the times are followed strictly and with full compliance.
Day 1
Sample taken for
serum cortisol.
Day 2
0900 am (basal)
-
Day 3
0900 am
Drug given: 0.5mg 0900 am
dexamethasone
every 6 hours (8
1500 pm
times)
0300 am
0300
dose)
0900 am
-
2100 pm
1500 pm
-
-
2100 pm
-
am
(last
Interpretation:
In normal subjects, serum cortisol will be suppressed to <50nmol/l.

After 2 concordantly positive screening tests, localization tests are
recommended, which include:
iv.
Plasma ACTH

Procedure:
– Blood should be taken together with serum cortisol at 9am.
– Keep the tube in ice water bath and send to lab for
centrifuged and frozen as soon as possible to avoid falsely
low result.

Interpretation:
– ACTH < 5 ng/L (<1 pmol/L): ACTH independent Cushing →
proceed with CT scan of adrenals.
– ACTH >15 ng/L (>3 pmol/L): ACTH dependent Cushing →
proceed with MRI pituitary/ CXR.
v.
Bilateral inferior petrosal sinus sampling:

11.
12.
For localization of pituitary tumour (Cushing disease).
REFERENCES

Special Endocrinology Test Protocols for Adults ,Endocrinology Unit, Department
of MedicineHospital Putrajaya, 2010

Clinical Chemistry Sixth Edition, William J Marshall & Stephen K Bangert, Mosby,
2008
CONTACT NUMBERS
Location
Ext.
Direct Line
Bilik Ketua Unit
5630
03-26155630
Scientific Officer Room
5611
03-26155611
Medical Officer Room
7530
03-26157530
Laboratory
5284
03-26155284
TESTS AVAILABLE AT CHEMICAL PATHOLOGY UNIT
(ACCORDING TO ALPHABETICAL ORDER)
NO
TEST
SPECIMEN
TYPE
CONTAINER
VOLUME
TAT
1
Blood
Blood
EDTA tube in
ice
Plain tube
3 ml
2
Adenocorticotrophic Hormone
(ACTH)
Alpha-1-antitrypsin
3
Caeruloplasmin
Blood
Plain tube
3 ml
5 working
days
5 working
days
5 working
days
4
Catecholamines :
Urine
24 hrs urine
container with
10mL of 25%
HCL
24 hrs urine
collection
3 ml
20 working
days
REFERENCE RANGE
≤ 10.2 pmol/L
REMARK
Packed with ice
0.9 – 2.0 g/L
Male : 0.15 – 0.30 g/L
Female : 0.16 – 0.45 g/L
Reference range for 24 hour urine
catecholamines ≥750mL :
Epinephrine : 0.5 - 20ug/24 hrs
Norepinephrine : 15.0 – 80.0ug/24 hrs
Dopamine : 64- 400ug/24 hrs
Reference range for random urine
catecholamines < 750mL
Epinephrine :
< 2 yr : < 75.0 ug/g creatinine
2 – 4 yr : < 57.0 ug/g creatinine
5 – 9 yr : < 35.0 ug/g creatinine
10 – 19 yr :< 34.0 ug/g creatinine
Norepinephrine :
< 2 yr : < 420.0 ug/g creatinine
2 – 4 yr : < 120.0 ug/g creatinine
5 – 9 yr: < 89.0 ug/g creatinine
10 – 19 yr :< 82.0 ug/g creatinine
Rejection criteria :
i) Inadequate urine
collection (Adult <
500 ml
ii) Urine pH > 5.
Dopamine :
< 2 yr : < 3000.0 ug/g creatinine
2 – 4 yr : < 1533.0 ug/g creatinine
5 – 9 yr: < 1048.0 ug/g creatinine
10 – 19 yr :< 545.0 ug/g creatinine
5
Cholinesterase
Blood
Plain tube
3 ml
1 working
day
Male and Children;
Female (≥ 40 years old) :
5320 – 12,920 U/L
Female (16 – 39 years old), not
pregnant, not taking contraceptives :
4260 – 11,250 U/L
6
Cortisol
Blood
Plain tube
3 ml
3 working
days
Morning Cortisol
: 171 – 536 nmol/L
Midnight Cortisol
: 64 – 327 nmol/L
Urine
24 hrs urine
container
without
preservative
24 hrs urine
collection
5 working
days
24 hrs Urine Cortisol
: 100 – 379 nmol/24 hrs
5 working
days
10 working
days
298 – 2350 pmol/L
5 working
days
Female (Adult) :
Follicular phase : 45.4 - 854 pmol/L
Ovulation phase : 151 - 1461 pmol/L
Luteal Phase : 81.9 – 1251 pmol/L
Post-menopausal : < 18.4 – 505
pmol/L
7
C-Peptide
Blood
Plain tube
3 ml
8
Dehydroepiondosterone
Sulphate (DHEAS)
Blood
Plain tube
3 ml
9
Estradiol
Blood
Plain tube
3 ml
24 hours urine
collection with
volume ≥500 ml
Male : 2.20 – 15.20 umol/L
Female : 0.95 – 11.70 umol/L
Blood taking at Day
2 to Day 5 menses
Male (Adult) :
94.8 – 223 pmol/L
10
Ferritin
Blood
Plain tube
3.5 ml
10 working
days
Children :
< 1yr : 12 – 327 ug/L
1 – 6 yr : 4 – 67 ug/L
Male :
7 – 17 yr : 14 – 152 ug/L
> 17 yr : 30 – 400 ug/L
Female :
7 – 17 yr : 7 – 84 ug/L
> 17 yr : 13 – 150 ug/L
11
Folate
Blood
Plain tube
3.5 ml
12.0 – 43.9 nmol/L
12
Follicle Stimulating Hormone
(FSH)
Blood
Plain tube
3 ml
10 working
days
5 working
days
Female :
Follicular phase : 3.5 – 12.5 IU/L
Ovulatory phase : 4.7 – 21.5 IU/L
Luteal Phase : 1.7 – 7.7 IU/L
Post-menopausal : 25.8 – 134.8 IU/L
Male (Adult) :1.5 – 12.4 IU/L
Children :
Boys :
< 5 yr : 0.2 – 2.8 IU/L
6 – 10 yr : 0.4 – 3.8 IU/L
11 – 13 yr : 0.4 – 4.6 IU/L
14 – 17 yr : 1.5 – 12.9 IU/L
Girls :
< 5 yr : 0.2 – 11.1 IU/L
6 – 10 yr : 0.3 – 11.1 IU/L
11 – 13 yr : 2.1 – 11.1 IU/L
14 – 17 yr : 1.6 – 17.0 IU/L
13
Free Thyroxine (FT4)
Blood
Plain tube
3 ml
3 working
days
Children :
Newborns : 11.0 – 32.0 pmol/L
6 d – 3 mth : 11.5 – 28.3 pmol/L
Blood taking at Day
2 to Day 5 menses
4 – 12 mth : 11.9 – 25.6 pmol/L
1 – 6 yr : 12.3 – 22.8 pmol/L
7 – 11 yr : 12.5 – 21.5 pmol/L
12 – 20 yr : 12.6 – 21.0 pmol/L
Adults : 12.0 – 22.0 pmol/L
14
Free Triiodothyronine (FT3)
Blood
Plain tube
3 ml
5 working
days
Children :
Newborns : 2.7 – 9.7 pmol/L
6 d – 3 mth : 3.0 – 9.3 pmol/L
4 – 12 mth : 3.3 – 9.0 pmol/L
1 – 6 yr : 3.7 – 8.5 pmol/L
7 – 11 yr : 3.9 – 8.0 pmol/L
12 – 20 yr : 3.9 – 7.7 pmol/L
Adults, euthyroid : 3.1 – 6.8 pmol/L
15
Gamma Glutamyl Transferase
(GGT)
Blood
Plain tube
3 ml
5 working
days
Male : < 60 U/L
Female : < 40 U/L
16
Growth Hormone
Blood
Plain tube
3 ml
10 working
days
Male : ≤ 3 ug/L
Female : ≤ 8 ug/L
17
Haptoglobin
Blood
Plain tube
3 ml
0.30 – 2.00 g/L
18
Haemoglobin A1c (HbA1c)
Blood
EDTA tube
3 ml
5 working
days
3 working
days
19
Homocysteine
Blood
3 ml
Immunoglobulin G (IgG)
Blood
21
Immunoglobulin A (IgA)
Blood
Plain tube
3 ml
22
Immunoglobulin M (IgM)
Blood
Plain tube
3 ml
23
Insulin
Blood
Plain tube
3 ml
24
Intact Parathyroid Hormone
(IPTH)
Blood
20 working
days
5 working
days
5 working
days
5 working
days
10 working
days
5 working
days
< 15 umol/L
20
Plain tube in
ice
Plain tube
Plain tube
3 ml
3 ml
NGSP (< 6.5 %) /
IFCC (< 48 mmol/mol) - Optimal
Glycaemic Control
7.0 – 16.0 g/L
0.7 – 4.00 g/L
0.4 – 2.3 g/L
≤ 29.1 uIU/mL
1.3 – 6.8 pmol/L
Packed with ice
25
Iron (Fe)
Blood
Plain tube
3 ml
26
Luteinising Hormone (LH)
Blood
Plain tube
3 ml
10 working
days
5 working
days
5.8 – 34.5 umol/L
Female :
Follicular phase : 2.4 – 12.6 IU/L
Ovulatory phase : 14.0 – 95.6 IU/L
Luteal Phase : 1.0 – 11.4 IU/L
Post-menopausal : 7.7 – 58.5 IU/L
Blood taking at Day
2 to Day 5 menses
Male :
1.7 – 8.6 IU/L
Children :
Boys :
< 1 yr : < 0.4 IU/L
1 – 5 yr : < 1.3 IU/L
6 – 10 yr : < 1.4 IU/L
11 – 13 yr : 0.1 – 7.8 IU/L
14 – 17 yr : 1.3 – 9.8 IU/L
Girls :
< 1 yr : < 0.4 IU/L
1 – 5 yr : < 0.5 IU/L
6 – 10 yr : < 3.1 IU/L
11 – 13 yr : < 11.9 IU/L
14 – 17 yr : 0.5 – 41.7 IU/L
27
Paraproteins / Protein
electrophoresis
Blood
Plain tube
3 ml
Urine
24 hrs urine
container
or
50 ml sterile
container
5 ml
Albumin
: 53.8 – 65.2 % or 32.3 – 39.1 g/L
Alpha-1- globulins
: 1.1 – 3.7 % or 0.7 – 2.2 g/L
Alpha-2-globulins
: 8.5– 14.5 % or 5.1 – 8.7 g/L
10 working
days
Beta globulins
: 8.6 – 14.8 % or 5.2 – 8.9 g/L
Gamma globulins
: 9.2– 18.2 % or 5.5 – 10.9 g/L
Blood and urine
sample must be
sent together.
28
Progesterone
Blood
Plain tube
3 ml
5 working
days
Female :
Follicular phase : 0.6 – 4.7 nmol/L
Ovulatory phase : 2.4 – 9.4 nmol/L
Luteal Phase : 5.3 – 86 nmol/L
Post-menopausal : 0.3 – 2.5 nmol/L
Male (Adult) :
0.7 – 4.3 nmol/L
29
Prolactin
Blood
Plain tube
3 ml
5 working
days
Male : 98 – 456 mIU/L
Female : 127 – 637 mIU/L
30
Testosterone
Blood
Plain tube
3 ml
5 working
days
Female : 0.22 – 2.9 nmol/L
Male : 9.9 – 27.8 nmol/L
31
Thyroid Stimulating Hormone
(TSH)
Blood
Plain tube
3 ml
3 working
days
Children :
Newborns : 0.70 – 15.2 mIU/L
6 d – 3 mth : 0.72 -11 mIU/L
4 – 12 mth : 0.73 – 8.35 mIU/L
1 – 6 yr : 0.70 – 5.97 mIU/L
7 – 11 yr : 0.60 – 4.84 mIU/L
12 – 20 yr : 0.51 – 4.30 mIU/L
Adult : 0.27 – 4.20 mIU/L
32
Transferrin
Blood
Plain tube
3 ml
33
Unsaturated Iron Binding
Capacity (UIBC)
Blood
Plain tube
3 ml
34
Vitamin B12
Blood
Plain tube
3 ml
5 working
days
10 working
days
10 working
days
2.0- 3.6 g/L
Male : 22.3 – 61.7 umol/L
Female : 24.2 – 70.1 umol/L
156 – 698 pmol/L
Blood taking at Day
21 of menses