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Recent Changes - Test & Collection Guide

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 Recent changes for Activated Partial Thromboplastin Time

Recent changes for Activated Partial Thromboplastin Time

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

 

Specimens from APTT assays on nonheparinized patients are kept at room temperature and centrifuged with with plasma remaining on top of cells in an unopened tube should be tested within 4 hours of the collection time.

Specimens from APTT assays suspected to contain unfractionated heparin are kept at room temperature and centrifuged within 1 hour of collection and the plasma tested within 4 hours of the collection time. If agitation is likely after centrifugation the plasma should be removed from the cells.

 

Specimens from APTT assays on nonheparinized patients are kept at room temperature and centrifuged with with plasma remaining on top of cells in an unopened tube should be tested within 4 hours of the collection time.

Specimens from APTT assays suspected to contain unfractionated heparin are kept at room temperature and centrifuged within 1 hour of collection and the plasma tested within 4 hours of the collection time. If agitation is likely after centrifugation the plasma should be removed from the cells.

Processing Instructions

  • APTT may be falsely shortened if the venesection is traumatic.

 

  • APTT be falsely prolonged if the tube is 'underfilled' or the patient has a raised haemoglobin/haematocrit.

APTT may be falsely shortened if the venesection is traumatic.

 

APTT be falsely prolonged if the tube is 'underfilled' or the patient has a raised haemoglobin/haematocrit.

Notes

Tube filled to label marker and mixed by inversion.

Tube filled to label marker and mixed by inversion.


 Recent changes for Activated Protein C Resistance

Recent changes for Activated Protein C Resistance

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

APCR no longer available ; request alternative test Factor V  Leiden.

APCR no longer available ; request alternative test Factor V  Leiden.

Processing Instructions

Centrifuge the two 3.5 mL citrate tubes and transfer the plasma to a labeled 4 mL plastic tube and re-centrifuge at room temperature (do not use the refrigerated centrifuge).

The double centrifuged plasma is transferred to two 1 mL eppendorf tubes and freeze. 

Centrifuge the two 3.5 mL citrate tubes and transfer the plasma to a labeled 4 mL plastic tube and re-centrifuge at room temperature (do not use the refrigerated centrifuge).

The double centrifuged plasma is transferred to two 1 mL eppendorf tubes and freeze. 

Notes

May identify venous thrombotic risk.

Can be performed on patients taking warfarin and/or heparin.

Screening test for Factor V Leiden but not specific for Factor V Leiden.

See also - Factor V Leiden

 

Tube filled to label marker and mixed by inversion.

Do not use 1 mL citrate tubes.

May identify venous thrombotic risk.

Can be performed on patients taking warfarin and/or heparin.

Screening test for Factor V Leiden but not specific for Factor V Leiden.

See also - Factor V Leiden

 

Tube filled to label marker and mixed by inversion.

Do not use 1 mL citrate tubes.


 Recent changes for ADAMTS-13 Activity Assay

Recent changes for ADAMTS-13 Activity Assay

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Specimen should reach the laboratory ASAP.

Specimen should reach the laboratory ASAP.

Processing Instructions

Centrifuge Sodium Citrate sample ; aliquot a minimum of 0.5 ml of citrated plasma into an appropriate transport tube and freeze at -20 deg C. Processing should be complete within 2 hours of collection.

Frozen specimen is stable and can be sent on the next scheduled courier run ( UNLESS MARKED URGENT - if so send immediately ) 

Aliquot is to be sent to the referral laboratory in a frozen state.

Centrifuge Sodium Citrate sample ; aliquot a minimum of 0.5 ml of citrated plasma into an appropriate transport tube and freeze at -20 deg C. Processing should be complete within 2 hours of collection.

Frozen specimen is stable and can be sent on the next scheduled courier run ( UNLESS MARKED URGENT - if so send immediately ) 

Aliquot is to be sent to the referral laboratory in a frozen state.


 Recent changes for Alzheimers Screen

Recent changes for Alzheimers Screen

Date
Field
Changed From
Changed To
20th November 2017
Collection & Request Instructions

PLEASE ENSURE YOU ARE USING A SPECIAL COLLECTION VIAL (AVAILABLE FROM PATHOLOGY).

INSTRUCTIONS REGARDING THE COLLECTION OF SPECIMENS FOR THIS TEST CAN BE FOUND BY CLICKING HERE

PLEASE ENSURE YOU ARE USING A SPECIAL COLLECTION VIAL (AVAILABLE FROM PATHOLOGY).

 

Processing Instructions

Please read VERY IMPORTANT LAB INSTRUCTIONS by clicking here

Please read VERY IMPORTANT LAB INSTRUCTIONS by clicking here

20th November 2017
Collection & Request Instructions

PLEASE ENSURE YOU ARE USING A SPECIAL COLLECTION VIAL (AVAILABLE FROM PATHOLOGY)

PLEASE ENSURE YOU ARE USING A SPECIAL COLLECTION VIAL (AVAILABLE FROM PATHOLOGY).

INSTRUCTIONS REGARDING THE COLLECTION OF SPECIMENS FOR THIS TEST CAN BE FOUND BY CLICKING HERE

Processing Instructions

Please read VERY IMPORTANT LAB INSTRUCTIONS by clicking here

Please read VERY IMPORTANT LAB INSTRUCTIONS by clicking here


 Recent changes for Anti-Gliadin Antibodies

Recent changes for Anti-Gliadin Antibodies

Date
Field
Changed From
Changed To
7th August 2017
Collection & Request Instructions

Transport at 4oC

Sample must be analysed within 48 hours of collection. Add on test only can be done within 48 hours if sample stored in the fridge.

Processing Instructions

Spin,separate and freeze serum.

External Transport Instructions

Transport frozen.

Frequency

Weekly

Twice weekly


 Recent changes for Anti-Thrombin III

Recent changes for Anti-Thrombin III

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

  • Fill to label marker and mix by inversion.
  • DO NOT use 1 mL citrate tubes.

Fill to label marker and mix by inversion.

DO NOT use 1 mL citrate tubes.

Processing Instructions

Centrifuge and aliquot plasma into labelled Eppendorf tubes and freeze.

  • Results are not valid while the patient is receiving heparin.

Centrifuge and aliquot plasma into labelled Eppendorf tubes and freeze.

Results are not valid while the patient is receiving heparin.

Frequency

Fortnightly

Weekly


 Recent changes for Anti-Thyroglobulin Antibodies

Recent changes for Anti-Thyroglobulin Antibodies

Date
Field
Changed From
Changed To
10th November 2017
Request Group

THYRO

THYG

10th November 2017
Laboratory

Referred Test

Biochemistry

Request Group

THYR

THYRO

External Laboratory

St Vincents Hospital

Frequency

Weekly

Twice weekly


 Recent changes for Anti-Thyroid Peroxidase Antibodies

Recent changes for Anti-Thyroid Peroxidase Antibodies

Date
Field
Changed From
Changed To
10th November 2017
Laboratory

Referred Test

Biochemistry

Request Group

THYR

THYM

Processing Instructions

  • Thyroid Peroxidase (TPO) has been cloned from thyroid microsomes and identified as the primary antigen in 'Anti-Thyroid Microsomal Antibodies'
  • Levels are elevated in almost all cases of Hashimoto's thyroiditis and in the majority of Graves' disease patients (Anti-TSH Receptor Antibody is more specific for Graves' disease)

Thyroid Peroxidase (TPO) has been cloned from thyroid microsomes and identified as the primary antigen in 'Anti-Thyroid Microsomal Antibodies'

Levels are elevated in almost all cases of Hashimoto's thyroiditis and in the majority of Graves' disease patients (Anti-TSH Receptor Antibody is more specific for Graves' disease)

External Laboratory

St Vincents Hospital

Frequency

Weekly

Twice weekly


 Recent changes for Anti-Xa Assay

Recent changes for Anti-Xa Assay

Date
Field
Changed From
Changed To
21st November 2017
Alternative names

Anti-10a, Anti-Factor Xa, Apixaban, Clexane, Fondaparinux, Fragmin, Rivaroxaban

Unfractionated heparin level, Clexane level, Fragmin level, Apixaban level, Rivaroxaban level, Fondaparinux level

21st November 2017
Collection & Request Instructions

Excerise great care in collection and handling of plasma to avoid the release of platelet factor 4 (PF4) which is a potent inhibitor of heparin.

Sampling times

Clexane       3 hr post injection.

Fragmin       3 - 4 hr post injection.

3.5 mL Sodium Citrate tube filled to label marker, mixed by inversion and sent to laboratory immediately.

Do not use 1 ml citrate tubes.

 

Excerise great care in collection and handling of plasma to avoid the release of platelet factor 4 (PF4) which is a potent inhibitor of heparin.

Sampling times

Clexane       3 hr post injection.

Fragmin       3 - 4 hr post injection.

3.5 mL Sodium Citrate tube filled to label marker, mixed by inversion and sent to laboratory immediately.

Do not use 1 ml citrate tubes.

 

Processing Instructions

  • Used for monitoring therapeutic doses of LMW heparin ( Clexane and Fragmin). It is not required for prophylactic doses of unfractionated heparin (use APTT).
  • Centrifuge and separate plasma within 1 hour of collection.

Used for monitoring therapeutic doses of LMW heparin ( Clexane and Fragmin). It is not required for prophylactic doses of unfractionated heparin (use APTT).

Centrifuge and separate plasma within 1 hour of collection.

Notes

If testing is delayed by more than 4 hours: spin separate and freeze plasma (plasma should be double spun)

Specimen rejection: specimens that are under or over filled , specimens that do not meet identification requirements.

If testing is delayed by more than 4 hours: spin separate and freeze plasma (plasma should be double spun)

Specimen rejection: specimens that are under or over filled , specimens that do not meet identification requirements.


 Recent changes for Bethesda Assay

Recent changes for Bethesda Assay

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Filled to label marker and mixed by inversion.

  • This quantifies antibodies to coagulation factors.

Filled to label marker and mixed by inversion.

This quantifies antibodies to coagulation factors.

Processing Instructions

Specimens kept at room temperature, should be centrifuged ASAP and tested within 4 hours from time of specimen collection. If testing is not completed within 4 hours, plasma should be removed from cells and aliquoted (1mL) into Eppendorf tubes, 2 X 1 mL vials per factor inhibitor assay.

Plasma may be frozen @ -20 C for up to 2 weeks or -70 C for up to 6 months. Frost free freezers should not be used.

Specimens kept at room temperature, should be centrifuged ASAP and tested within 4 hours from time of specimen collection. If testing is not completed within 4 hours, plasma should be removed from cells and aliquoted (1mL) into Eppendorf tubes, 2 X 1 mL vials per factor inhibitor assay.

Plasma may be frozen @ -20 C for up to 2 weeks or -70 C for up to 6 months. Frost free freezers should not be used.

Frequency

Fortnightly


 Recent changes for Blood Cultures - Adult

Recent changes for Blood Cultures - Adult

Date
Field
Changed From
Changed To
27th January 2017
Collection & Request Instructions

For patients with suspected bacterial endocarditis, 2 to 3 sets taken at different times should be sufficient to establish a diagnosis.

Collect blood cultures 20 minutes apart. If patient is too ill to wait 20 minutes, prior to administering antibiotics, collect the first set from one site and the second from a different site

Please provide clinical details. Extended incubation is required for query endocarditis, brucellosis or fungal infection.

Transport bottles at room temperature.

 

For patients with suspected bacterial endocarditis, 2 to 3 sets taken at different times should be sufficient to establish a diagnosis.

Collect blood cultures 20 minutes apart. If patient is too ill to wait 20 minutes, prior to administering antibiotics, collect the first set from one site and the second from a different site

Please provide clinical details. Extended incubation is required for query endocarditis, brucellosis or fungal infection.

Transport bottles at room temperature.

 

Processing Instructions

Bottles should be loaded on to the BacT/ALERT analyser as soon as possible. If entry is delayed, store bottles at room temperature.

Bottles should be loaded on to the BacT/ALERT analyser as soon as possible. If entry is delayed, store bottles at room temperature.

Notes


Blood Culture Collection Instructions

Blood Culture Clinical Information

 

 

Blood Culture Collection Instructions

 

Blood Culture Clinical Information


 Recent changes for Blood Group and Antibody Screen

Recent changes for Blood Group and Antibody Screen

Date
Field
Changed From
Changed To
17th October 2017
Notes

  • Group and Hold is valid for a period of 72 hours only.

Group and Hold is valid until Midnight on the third day post collection.


 Recent changes for Bone Marrow Examination

Recent changes for Bone Marrow Examination

Date
Field
Changed From
Changed To
20th March 2017
Collection & Request Instructions

Bont marrow trephine requires at least 4 hours fixation prior to processing. Please consider this for an Urgent trephine result.

Bone Marrow Collection Instructions

Bont marrow trephine requires at least 4 hours fixation prior to processing. Please consider this for an Urgent trephine result.

Bone Marrow Collection Instructions

11th January 2017
Collection & Request Instructions

Bont marrow trephine requires at least 4 hours fixation prior to processing. Please consider this for an Urgent trephine result.

Bone Marrow Collection Instructions

Bont marrow trephine requires at least 4 hours fixation prior to processing. Please consider this for an Urgent trephine result.

Bone Marrow Collection Instructions

Notes

Consult Haematology Registrar to request

Testing available :

  • Aspirate
  • Trephine
  • Microbial culture
  • Cytogenetic analysis
  • Immunophenotypic Analysis (Flow Cytometry)
  • IgH/TCR Gene Rearrangement Studies
  • Other specialised and/or Molecular Studies

Consult Haematology Registrar to request

Testing available :

Aspirate

Trephine

Microbial culture

Cytogenetic analysis

Immunophenotypic Analysis (Flow Cytometry)

IgH/TCR Gene Rearrangement Studies

Other specialised and/or Molecular Studies


 Recent changes for C Peptide

Recent changes for C Peptide

Date
Field
Changed From
Changed To
13th November 2017
Laboratory

Referred Test

Biochemistry

10th November 2017
Collection & Request Instructions

Fasting specimen required, deliver Immediately to the lab.

Fasting specimen required, deliver Immediately to the lab.

Processing Instructions

Transport frozen

Transport frozen

External Laboratory

St Vincents Hospital

Frequency

Weekly

Twice weekly

Method

Spin, separate and freeze

St Vincents run the assay on Wednesdays

Spin, separate and freeze

 


 Recent changes for Cadmium

Recent changes for Cadmium

Date
Field
Changed From
Changed To
13th October 2017
External Laboratory

Australian Clinical Labs (formerly Healthscope)

Alfred Hospital

Frequency

Monthly

Weekly


 Recent changes for Cerebrospinal Fluid - Biochemistry

Recent changes for Cerebrospinal Fluid - Biochemistry

Date
Field
Changed From
Changed To
4th November 2016
Collection & Request Instructions

Please note : to avoid sample deterioration, DO NOT send CSF specimens via the vacuum chute system.

If additional tests required eg. CSF oligoclonal bands, a minimum of 1.0 ml is required.

Collect CSF into three separate, sterile, screw-capped tubes provided (labelled 1,2 & 3)

  • Tube 1 is for Biochemistry (for Protein and Glucose) 0.5ml (10 drops) required 
  • Tube 2 for Cytology 1.0ml (20 drops)  and/or Flow Cytometry (6ml)
    • For Flow Cytometry a minimum of 6ml is required  in Tube 2
    • For Flow Cytometry and Cytology a minimum of 7ml is required in Tube 2     
  • Tube 3 for Microbiology upto 10ml (Full tube)

    If querying CJD the laboratory requires a 4th unopened tube containing at least 1ml of non-bloodstained CSF.

    Xanthochromia investigation requires a 4th tube containing 1ml of CSF .

Please note : to avoid sample deterioration, DO NOT send CSF specimens via the vacuum chute system.

If additional tests required eg. CSF oligoclonal bands, a minimum of 1.0 ml is required.

Collect CSF into three separate, sterile, screw-capped tubes provided (labelled 1,2 & 3)

Tube 1 is for Biochemistry (for Protein and Glucose) 0.5ml (10 drops) required 

Tube 2 for Cytology 1.0ml (20 drops)  and/or Flow Cytometry (6ml)

For Flow Cytometry a minimum of 6ml is required  in Tube 2

For Flow Cytometry and Cytology a minimum of 7ml is required in Tube 2     

Tube 3 for Microbiology upto 10ml (Full tube)

If querying CJD the laboratory requires a 4th unopened tube containing at least 1ml of non-bloodstained CSF.

Xanthochromia investigation requires a 4th tube containing 1ml of CSF .

Method

CSF sample processing:

If Cytology/Flow Cytometry requested  : Tube 1-Biochemistry, Tube 2- Cytology/Flow Cytometry, Tube 3-Microbiology

If Cytology/Flow Cytometry not requested: Tube 1 and 3-Microbiology, Tube 2-Biochemistry

CSF sample processing:

If Cytology/Flow Cytometry requested  : Tube 1-Biochemistry, Tube 2- Cytology/Flow Cytometry, Tube 3-Microbiology

If Cytology/Flow Cytometry not requested: Tube 1 and 3-Microbiology, Tube 2-Biochemistry

Notes

  • Glucose and Protein are determined routinely
  • Glucose result should be compared with plasma glucose taken at the same time
  • Results on blood-stained CSF are unreliable
  • Testing for oligoclonal bands performed on request (serum must also be provided) . If requested on CSF, will not be performed if CJD/protein 14-3-3 positive. Do not send until CJD/14-3-3 result received as negative.

Glucose and Protein are determined routinely

Glucose result should be compared with plasma glucose taken at the same time

Results on blood-stained CSF are unreliable

Testing for oligoclonal bands performed on request (serum must also be provided) .


 Recent changes for Cerebrospinal Fluid - Cytology

Recent changes for Cerebrospinal Fluid - Cytology

Date
Field
Changed From
Changed To
18th August 2016
Collection & Request Instructions

CSF must be delivered to laboratory immediately; cellular degeneration occurs within 30 minutes.

The sample with the least amount of blood is prefered for Cytology.

Collect CSF into three separate, sterile, screw-capped tubes provided (labelled 1,2 & 3)

  • Tube 1 is for Biochemistry (for Protein and Glucose) 0.5ml (10 drops) required 
  • Tube 2 for Cytology 1.0ml (20 drops)  and/or Flow Cytometry (6ml)
    • For Flow Cytometry a minimum of 6ml is required  in Tube 2
    • For Flow Cytometry and Cytology a minimum of 7ml is required in Tube 2     
  • Tube 3 for Microbiology upto 10ml (Full tube)
  • Cytology will not process CSF that is querying CJD - until 14-3-3 protein is confirmed negative.
  • Xanthochromia investigation requires a 4th tube containing 1ml of CSF .

CSF must be delivered to laboratory immediately; cellular degeneration occurs within 30 minutes.

The sample with the least amount of blood is prefered for Cytology.

Collect CSF into three separate, sterile, screw-capped tubes provided (labelled 1,2 & 3)

Tube 1 is for Biochemistry (for Protein and Glucose) 0.5ml (10 drops) required 

Tube 2 for Cytology 1.0ml (20 drops)  and/or Flow Cytometry (6ml)

For Flow Cytometry a minimum of 6ml is required  in Tube 2

For Flow Cytometry and Cytology a minimum of 7ml is required in Tube 2     

Tube 3 for Microbiology upto 10ml (Full tube)

Xanthochromia investigation requires a 4th tube containing 1ml of CSF .

Processing Instructions

Must be stored in the fridge.

 

Must be stored in the fridge.

 

External Transport Instructions

All out of hours specimens from Anglss and Maroondah should be sent to Box Hill ASAP for processing.

After hours cytology CSF can be prepared by microbiology staff. In the event microbiology staff are not in attendance and will not be called in, please call the Anatomical Pathology Scientist on call.

All out of hours specimens from Anglss and Maroondah should be sent to Box Hill ASAP for processing.

After hours cytology CSF can be prepared by microbiology staff. In the event microbiology staff are not in attendance and will not be called in, please call the Anatomical Pathology Scientist on call.

Method

CSF sample processing:

If Cytology/Flow Cytometry requested  : Tube 1-Biochemistry, Tube 2- Cytology/Flow Cytometry, Tube 3-Microbiology

If Cytology/Flow Cytometry not requested: Tube 1 and 3-Microbiology, Tube 2-Biochemistry

Any confusion between the terms cell count and cytology could be cleared up when the cell count is rung through to the requesting doctor by the scientist. At this point it could be determined whether cytology is a genuine request or not (all to be documented in F8 notes). The CSF can then be forwarded expediently to BHH for cytospin if required.

 

 

CSF sample processing:

If Cytology/Flow Cytometry requested  : Tube 1-Biochemistry, Tube 2- Cytology/Flow Cytometry, Tube 3-Microbiology

If Cytology/Flow Cytometry not requested: Tube 1 and 3-Microbiology, Tube 2-Biochemistry

Any confusion between the terms cell count and cytology could be cleared up when the cell count is rung through to the requesting doctor by the scientist. At this point it could be determined whether cytology is a genuine request or not (all to be documented in F8 notes). The CSF can then be forwarded expediently to BHH for cytospin if required.

 

 


 Recent changes for Cholinesterase

Recent changes for Cholinesterase

Date
Field
Changed From
Changed To
10th August 2016
Preferred Specimen Type

Serum

Blood

Preferred Container Type

Serum tube with gel

Pink EDTA (6mL)

Collection & Request Instructions

Genetic testing sample : EDTA  whole blood 5mL minimum

Enzyme testing: Serum  tube 5 mL

Genetic testing sample : EDTA  whole blood 5mL minimum

 


 Recent changes for Coagulation Factor Assays II, V, VII, VIII, IX, X, XI, XII

Recent changes for Coagulation Factor Assays II, V, VII, VIII, IX, X, XI, XII

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Do not use 1.0 mL citrate tubes

Do not use 1.0 mL citrate tubes

Processing Instructions

Specimens kept at room temperature, should be centrifuged ASAP and tested within 4 hours from time of specimen collection.  If testing is not completed within 4 hours, plasma should be removed from cells and aliquoted (1mL) into Eppendorf tubes, 2 X 1 mL vials per factor assay. 

Plasma may be frozen @ -20 C for up to 2 weeks or -70 C for up to 6 months.  Frost free freezers should not be used.

Specimens kept at room temperature, should be centrifuged ASAP and tested within 4 hours from time of specimen collection.  If testing is not completed within 4 hours, plasma should be removed from cells and aliquoted (1mL) into Eppendorf tubes, 2 X 1 mL vials per factor assay. 

Plasma may be frozen @ -20 C for up to 2 weeks or -70 C for up to 6 months.  Frost free freezers should not be used.

Frequency

Weekly


 Recent changes for Coagulation Factor Inhibitor Screen

Recent changes for Coagulation Factor Inhibitor Screen

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Please consult with Coagulation Laboratory: 9895 3485.  Do not use 1.0 mL citrate tubes

Please consult with Coagulation Laboratory: 9895 3485.  Do not use 1.0 mL citrate tubes

Processing Instructions

Specimens kept at room temperature, should be centrifuged ASAP and tested within 4 hours from time of specimen collection.  If testing is not completed within 4 hours, plasma should be removed from cells and aliquoted (1mL) into Eppendorf tubes, 2 X 1 mL vials per factor inhibitor assay. 

Plasma may be frozen @ -20 C for up to 2 weeks or -70 C for up to 6 months.  Frost free freezers should not be used.

Specimens kept at room temperature, should be centrifuged ASAP and tested within 4 hours from time of specimen collection.  If testing is not completed within 4 hours, plasma should be removed from cells and aliquoted (1mL) into Eppendorf tubes, 2 X 1 mL vials per factor inhibitor assay. 

Plasma may be frozen @ -20 C for up to 2 weeks or -70 C for up to 6 months.  Frost free freezers should not be used.

Frequency

Monthly


 Recent changes for Coagulation Studies

Recent changes for Coagulation Studies

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Do not use 1.0 mL citrate tubes

Do not use 1.0 mL citrate tubes

Processing Instructions

  • Fill to label marker and mix by inversion
  • Centrifuge and separate within 60 minutes of collection.

Fill to label marker and mix by inversion

Centrifuge and separate within 60 minutes of collection.

Notes

  • When blood is collected from an arterial line it is necessary to discard the first 20 mL of blood to clear any heparin from the line before collecting the blood for coagulation tests
  • When collection is by vacuum tube, the coagulation tube should be collected second to avoid artefactual shortening of coagulation assays due to trauma of venesection
  • Whe blood is collected for an APTT or Anti-Xa Assay for control of heparin or low molecular weight heparin therapy, it is essential that the citrate tube is sent immediately to the laboratory
  • Tests include : INR, APTT
Do not use 1 ml citrate tubes.

When blood is collected from an arterial line it is necessary to discard the first 20 mL of blood to clear any heparin from the line before collecting the blood for coagulation tests

When collection is by vacuum tube, the coagulation tube should be collected second to avoid artefactual shortening of coagulation assays due to trauma of venesection

Whe blood is collected for an APTT or Anti-Xa Assay for control of heparin or low molecular weight heparin therapy, it is essential that the citrate tube is sent immediately to the laboratory

Tests include : INR, APTT

Do not use 1 ml citrate tubes.


 Recent changes for Cold Agglutinins

Recent changes for Cold Agglutinins

Date
Field
Changed From
Changed To
21st November 2017
Preferred Container Type

EDTA
Plain tube no gel

Serum No Gel & EDTA

Collection & Request Instructions

Pre heated 4 mL EDTA tube and 10 mL plain tube. Tubes,needles and syringes must be pre-warmed at 37oC and specimen placed into a thermos flask ( obtained from the laboratory) and transported to the laboratory immediately. Cold specimens may give erroneous results.

Pre heated 4 mL EDTA tube and 10 mL plain tube. Tubes,needles and syringes must be pre-warmed at 37oC and specimen placed into a thermos flask ( obtained from the laboratory) and transported to the laboratory immediately. Cold specimens may give erroneous results.

Processing Instructions

Specimen must be centrifuged and separated immediately upon receipt (tubes must NOT be allowed to cool to RT prior to separation)

Specimen must be centrifuged and separated immediately upon receipt (tubes must NOT be allowed to cool to RT prior to separation)

External Transport Instructions

Once plasma is separated, transportation and storage can be at 4 degrees.

Once plasma is separated, transportation and storage can be at 4 degrees.

Notes

  • Investigation of cold agglutinin specificity, thermal range and titre by consultation with Haematologist
  • Tubes warmed to 37oC are available from the Core laboratory

Investigation of cold agglutinin specificity, thermal range and titre by consultation with Haematologist

Tubes warmed to 37oC are available from the Core laboratory


 Recent changes for CRE Screen

Recent changes for CRE Screen

Date
Field
Changed From
Changed To
16th October 2017
Preferred Container Type

Faeces-plain pot
Swab - blue top (Amies transport media)

Faeces pot & Blue swab

Optional Container Type

Swab - blue top (Amies transport media)

Collection & Request Instructions

Faeces is the preferred specimen. When not possible a rectal swab AND an inguinal swab should be taken.

Faeces is the preferred specimen. When not possible a rectal swab AND an inguinal swab should be taken.

Method

Test not yet viewable in ehCare

Test not yet viewable in ehCare


 Recent changes for Creatinine - Blood

Recent changes for Creatinine - Blood

Date
Field
Changed From
Changed To
16th February 2017
Processing Instructions

  • Falsely rasied creatinine values may be obtained in therapy with ascorbic acid and in the presence of ketones, alpha-methyldopa, haemolysis or high glucose concentrations
  • Cephalosporins in high concentration also give falsely raised serum creatinine
  • Blood samples for creatinine should not be taken within one hour of i.v. Cephalosporin administration

Falsely rasied creatinine values may be obtained in therapy with ascorbic acid and in the presence of ketones, alpha-methyldopa, haemolysis or high glucose concentrations

Cephalosporins in high concentration also give falsely raised serum creatinine

Blood samples for creatinine should not be taken within one hour of i.v. Cephalosporin administration


 Recent changes for Crossmatching

Recent changes for Crossmatching

Date
Field
Changed From
Changed To
25th January 2017
Collection & Request Instructions

  • Please ensure that an A4 "Request for Blood Products" form is used. To view this request form, click here

http://ehweb02/eh%20intranet/blood/87287%20EH%20pathology%20blood%20-%20new%20A4%20request%20form.pdf

 

  • Alert Blood Bank to any urgent Crossmatches on;

Box Hill - 9895 3487

Angliss - 9764 6135

Maroondah - 9871 3572

Please ensure that an A4 "Request for Blood Products" form is used. To view this request form, click here

http://ehweb02/eh%20intranet/blood/87287%20EH%20pathology%20blood%20-%20new%20A4%20request%20form.pdf

 

Alert Blood Bank to any urgent Crossmatches on;

Box Hill - 9895 3487

Angliss - 9764 6135

Maroondah - 9871 3572

Processing Instructions

  •  

Notes

Crossmatches are valid for a period of 72 hours only.

Specimen labelling is governed by a national guideline - see minimum specimen labeling requirements.

http://ehweb02/eh%20intranet/blood/Zero%20tolerance%20criteria.pdf

Supply of Blood Products for transfusion is dependent on available stock which is managed by the Australian Red Cross Blood Bank. To facilitate Blood Product requests - see Requesting Blood Procedure ( Section 3 of Blood and Blood Component Administration )

  http://ehapp03:90/index.aspx?itemDetails=887

 

Expected times for the provision of blood products can be found by clicking on this link.

 

Crossmatches are valid for a period of 72 hours only.

Specimen labelling is governed by a national guideline - see minimum specimen labeling requirements.

http://ehweb02/eh%20intranet/blood/Zero%20tolerance%20criteria.pdf

Supply of Blood Products for transfusion is dependent on available stock which is managed by the Australian Red Cross Blood Bank. To facilitate Blood Product requests - see Requesting Blood Procedure ( Section 3 of Blood and Blood Component Administration )

  http://ehapp03:90/index.aspx?itemDetails=887

 


 Recent changes for Cryoproteins - Blood

Recent changes for Cryoproteins - Blood

Date
Field
Changed From
Changed To
21st November 2017
Preferred Container Type

Plain tube no gel
EDTA

Serum No Gel & EDTA

Collection & Request Instructions

PLEASE NOTE : One EDTA (purple top) and one Plain serum (red top) tube MUST BE COLLECTED.  All samples must be kept at 37oC in a thermos flask and delivered to the laboratory immediatley.  Both tubes are required for Cryoprotein analysis.

Heated specimen tubes in thermos flask can be obtained from the laboratory.

 

 

PLEASE NOTE : One EDTA (purple top) and one Plain serum (red top) tube MUST BE COLLECTED.  All samples must be kept at 37oC in a thermos flask and delivered to the laboratory immediatley.  Both tubes are required for Cryoprotein analysis.

Heated specimen tubes in thermos flask can be obtained from the laboratory.

 

 

Processing Instructions

Keep the sample in the incubator for 1 hour. Spin and separate serum and plasma into marked aliquot tubes and send at RT.

Keep the sample in the incubator for 1 hour. Spin and separate serum and plasma into marked aliquot tubes and send at RT.


 Recent changes for D-Dimer

Recent changes for D-Dimer

Date
Field
Changed From
Changed To
21st November 2017
Alternative names

FDP, Fibrin Degradation Products

D Dimer, DDimer, Fibrin breakdown products

Collection & Request Instructions

Do not use 1 mL citrate tubes.

Do not use 1 mL citrate tubes.

Processing Instructions

Filled to label marker and mixed by inversion .

Filled to label marker and mixed by inversion .

Frequency

Daily

Notes

FDP assay superseded by D- Dimer assay.

Assay for D-Dimer may be part of the investigation for DIC or venous thrombosis

Do not use 1 mL citrate tubes.

FDP assay superseded by D- Dimer assay.

Assay for D-Dimer may be part of the investigation for DIC or venous thrombosis

Do not use 1 mL citrate tubes.


 Recent changes for Disseminated Intravascular Coagulation

Recent changes for Disseminated Intravascular Coagulation

Date
Field
Changed From
Changed To
21st November 2017
Alternative names

DIC Screen, FDP, Fibrin Degradation Products

DIC Screen, DDimer, D Dimer

Collection & Request Instructions

 

Do not use 1 ml citrate tubes.

Filled to label and mix by inversion .

 

Do not use 1 ml citrate tubes.

Filled to label and mix by inversion .

Notes

  • Includes INR, APTT, Fibrinogen and D-Dimer
  • Consultation is often necessary, so ensure pager number is clearly printed.

 

Includes INR, APTT, Fibrinogen and D-Dimer

Consultation is often necessary, so ensure pager number is clearly printed.

 


 Recent changes for DNA analysis for Thalassaemia (related to Hgb Electrophoresis)

Recent changes for DNA analysis for Thalassaemia (related to Hgb Electrophoresis)

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Send FBE, Iron studies and Hb electrophoresis results.

Send within 24 Hrs.

Results: 95943398

Send FBE, Iron studies and Hb electrophoresis results.

Send within 24 Hrs.

Results: 95943398

Frequency

Monthly


 Recent changes for Euglobulin Clot Lysis Time

Recent changes for Euglobulin Clot Lysis Time

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Fill to label marker and mix by inversion.

Do not use 1 mL citrate tubes.

Transport frozen to reference laboratory

Fill to label marker and mix by inversion.

Do not use 1 mL citrate tubes.

Transport frozen to reference laboratory

Processing Instructions

.

.

Frequency

As required

Monthly

Notes

Pre and post stress test also available for decreased fibrinolysis

Pre and post stress test also available for decreased fibrinolysis


 Recent changes for Factor V Leiden

Recent changes for Factor V Leiden

Date
Field
Changed From
Changed To
21st November 2017
Alternative names

FV-PCR

FV-PCR, Factor V Leiden mutation, FVL


 Recent changes for Factor XIII Assay

Recent changes for Factor XIII Assay

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Filled to label marker and mixed by inversion.

Do not use 1 ml citrate tubes.

Filled to label marker and mixed by inversion.

Do not use 1 ml citrate tubes.

Frequency

As required

Fortnightly

Method

Specimens kept at room temperature, should be centrifuged ASAP and tested within 4 hours from time of specimen collection. If testing is not completed within 4 hours, plasma should be removed from cells and aliquoted (1mL) into Eppendorf tubes, 2 X 1 mL vials per factor assay.

Plasma may be frozen @ -20 C for up to 2 weeks or -70 C for up to 6 months. Frost free freezers should not be used.

Specimens kept at room temperature, should be centrifuged ASAP and tested within 4 hours from time of specimen collection. If testing is not completed within 4 hours, plasma should be removed from cells and aliquoted (1mL) into Eppendorf tubes, 2 X 1 mL vials per factor assay.

Plasma may be frozen @ -20 C for up to 2 weeks or -70 C for up to 6 months. Frost free freezers should not be used.


 Recent changes for Familial mediterranean genetic screen

Recent changes for Familial mediterranean genetic screen

Date
Field
Changed From
Changed To
4th April 2016
Collection & Request Instructions

Room temperature

This test is not covered by Medicare.

Cost for a private patient is $200 

.

Room temperature

This test is not covered by Medicare.

Cost for testing is $250

.

Processing Instructions

Interstate courier- Room Temperature

Department Of Molecular Genetics, Children's Hospital at Westmead, Loading Dock 5, Redbank Road, Northmead, NSW 2152.

For results Tel: 02-98453244

Interstate courier- Room Temperature

Department Of Molecular Genetics, Children's Hospital at Westmead, Loading Dock 5, Redbank Road, Northmead, NSW 2152.

For results Tel: 02-98453244


 Recent changes for Fibrinogen

Recent changes for Fibrinogen

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Fill to label marker and mix by inversion.

Fill to label marker and mix by inversion.


 Recent changes for Flecainide

Recent changes for Flecainide

Date
Field
Changed From
Changed To
7th July 2017
Volume (Adults)

2 mL

4 mL

Preferred Specimen Type

Serum

Blood

Preferred Container Type

Plain tube no gel

EDTA

Collection & Request Instructions

    Pre dose serum is required.  Please note that the collection tube SHOULD NOT contain separation gel.

 

   

Date, time and dose of last dose must be written on request form. 

Separate EDTA sample required.

 


 Recent changes for Full Blood Examination

Recent changes for Full Blood Examination

Date
Field
Changed From
Changed To
21st November 2017
Alternative names

Blood Film, FBE

FBE, Full Blood Examination, Full Blood


 Recent changes for Glucose Tolerance Test

Recent changes for Glucose Tolerance Test

Date
Field
Changed From
Changed To
26th September 2017
Notes

The vast majority of Oral Glucose Tolerance Tests (OGTTs) requested are for the diagnosis of glucose intolerance and should be performed and interpreted according to Australian guidelines with fasting, 1hr and 2hr glucose measurements following a 75g glucose load. A small number of requests require variations in this standard protocol and staff must carefully check the request slip to ensure that the correct protocol is followed and the appropriate specimens collected.

 

Where the doctor has requested  ?OGTT ? fasting and 2hour only? then it is o.k. to omit the 1 hour bloods.

 

?OGTT with insulin? is used to investigate insulin resistance. This requires glucose and insulin levels at each time point (i.e. 0, 1 and 2 hours).

?OGTT with Growth Hormone/ IGF-1? is used to diagnose and monitor Acromegaly. This requires glucose and Growth Hormone/IGF-1 levels at 30, 60, 90 and 120 minutes

 

 

 

 

GLUCOSE TOLERANCE TEST  

Please note : Patient must phone collection centre in advance as an appointment is essential for this test.         

 When GTT is requested with either Insulin, Growth Hormone or IGF-1 (Somatomedin C) it is required that blood is collected for these tests at each GTT time interval (eg. 0, 1 and 2 hr collections for each test)

 Patients are tested for their ability to handle an oral glucose load taken in fasting state by measuring their plasma glucose 2-hours after ingestion.

Patient should be on their normal diet until the day of the test

 The test is done at a time when the patient is free of acute illness

 The test is performed between 0800 and 1000 after a 12-hour overnight fast. Water is permitted during the fasting period but eating, physical activity and smoking must be avoided

 If fasting sample is less than 8mmol/L - proceed with the test

 A 75g glucose load in the form of a single 285 mL bottle of chilled Dextrasol. The time and date of ingestion is noted.

 Ingestion should be completed within 5 minutes.

 Two more venous blood samples are taken at 1-hour intervals, starting exactly 1 hour after completion of ingestion.

The vast majority of Oral Glucose Tolerance Tests (OGTTs) requested are for the diagnosis of glucose intolerance and should be performed and interpreted according to Australian guidelines with fasting, 1hr and 2hr glucose measurements following a 75g glucose load. A small number of requests require variations in this standard protocol and staff must carefully check the request slip to ensure that the correct protocol is followed and the appropriate specimens collected.

 

Where the doctor has requested  ?OGTT ? fasting and 2hour only? then it is o.k. to omit the 1 hour bloods.

 

?OGTT with insulin? is used to investigate insulin resistance. This requires glucose and insulin levels at each time point (i.e. 0, 1 and 2 hours).

?OGTT with Growth Hormone/ IGF-1? is used to diagnose and monitor Acromegaly. This requires glucose and Growth Hormone/IGF-1 levels at 30, 60, 90 and 120 minutes.

26th September 2017
Collection & Request Instructions

GLUCOSE TOLERANCE TEST  

Please note : Patient must phone collection centre in advance as an appointment is essential for

Patient Collection Instructions - English

Patient Collection Instructions - Arabic

Patient Collection Instructions - Burmese

Patient Collection Instructions - Hakha Chinese

Patient Collection Instructions -Simple Chinese

Patient Collection Instructions - Trad. Chinese

Patient Collection Instructions - Dinka

Patient Collection Instructions - Hindi

Patient Collection Instructions - Karen

Patient Collection Instructions - Korean

Patient Collection Instructions - Vietnamese

 

 

Hormone or IGF-1 (Somatomedin C) it is required that blood is collected for these tests at each GTT time interval (eg. 0, 1 and 2 hr collections for each test)

 Patients are tested for their ability to handle an oral glucose load taken in fasting state by measuring their plasma glucose 2-hours after ingestion.

Patient should be on their normal diet until the day of the test

 The test is done at a time when the patient is free of acute illness

 The test is performed between 0800 and 1000 after a 12-hour overnight fast. Water is permitted during the fasting period but eating, physical activity and smoking must be avoided

 If fasting sample is less than 8mmol/L - proceed with the test

 A 75g glucose load in the form of a single 285 mL bottle of chilled Dextrasol. The time and date of ingestion is noted.

 Ingestion should be completed within 5 minutes.

 Two more venous blood samples are taken at 1-hour intervals, starting exactly 1 hour after completion of ingestion.

Please contact laboratory on 9895-3548 for queries relating to GCT and GTT testing.

GLUCOSE TOLERANCE TEST  

Please note : Patient must phone collection centre in advance as an appointment is essential for

Patient Collection Instructions - English

Patient Collection Instructions - Arabic

Patient Collection Instructions - Burmese

Patient Collection Instructions - Hakha Chinese

Patient Collection Instructions -Simple Chinese

Patient Collection Instructions - Trad. Chinese

Patient Collection Instructions - Dinka

Patient Collection Instructions - Hindi

Patient Collection Instructions - Karen

Patient Collection Instructions - Korean

Patient Collection Instructions - Vietnamese

Patients are tested for their ability to handle an oral glucose load taken in fasting state by measuring their plasma glucose 2-hours after ingestion.

Patient should be on their normal diet until the day of the test

 The test is done at a time when the patient is free of acute illness

 The test is performed between 0800 and 1000 after a 12-hour overnight fast. Water is permitted during the fasting period but eating, physical activity and smoking must be avoided

 If fasting sample is less than 8mmol/L - proceed with the test

 A 75g glucose load in the form of a single 285 mL bottle of chilled Dextrasol. The time and date of ingestion is noted.

 Ingestion should be completed within 5 minutes.

 Two more venous blood samples are taken at 1-hour intervals, starting exactly 1 hour after completion of ingestion.

Please contact laboratory on 9895 3471 for queries relating to GCT and GTT testing.

GROWTH HORMONE SUPRESSION TEST (OGTT with Growth Hormone/ IGF-1)

Take baseline samples of blood for IGF-1, glucose and GH.

Give bottle of 75 g glucose (or appropriate amount if paediatric patient) which should be drunk within 5 minutes.

Samples are collected at 30, 60, 90 and 120 minutes for glucose and Growth Hormone. 

 

Notes

The vast majority of Oral Glucose Tolerance Tests (OGTTs) requested are for the diagnosis of glucose intolerance and should be performed and interpreted according to Australian guidelines with fasting, 1hr and 2hr glucose measurements following a 75g glucose load. A small number of requests require variations in this standard protocol and staff must carefully check the request slip to ensure that the correct protocol is followed and the appropriate specimens collected.

 

Where the doctor has requested  ?OGTT ? fasting and 2hour only? then it is o.k. to omit the 1 hour bloods.

 

 

 

?OGTT with insulin? is used to investigate insulin resistance. This requires glucose and insulin levels at each time point (i.e. 0, 1 and 2 hours).

 

 

 

?OGTT with Growth Hormone/ IGF-1? is used to diagnose and monitor Acromegaly. This requires glucose and Growth Hormone/IGF-1 levels at each time point (i.e. 0, 1 and 2 hours).

 

 

 

 

 

 

 

 

 

 

 

GLUCOSE TOLERANCE TEST  

Please note : Patient must phone collection centre in advance as an appointment is essential for this test.         

 When GTT is requested with either Insulin, Growth Hormone or IGF-1 (Somatomedin C) it is required that blood is collected for these tests at each GTT time interval (eg. 0, 1 and 2 hr collections for each test)

 Patients are tested for their ability to handle an oral glucose load taken in fasting state by measuring their plasma glucose 2-hours after ingestion.

Patient should be on their normal diet until the day of the test

 The test is done at a time when the patient is free of acute illness

 The test is performed between 0800 and 1000 after a 12-hour overnight fast. Water is permitted during the fasting period but eating, physical activity and smoking must be avoided

 If fasting sample is less than 8mmol/L - proceed with the test

 A 75g glucose load in the form of a single 285 mL bottle of chilled Dextrasol. The time and date of ingestion is noted.

 Ingestion should be completed within 5 minutes.

 Two more venous blood samples are taken at 1-hour intervals, starting exactly 1 hour after completion of ingestion.

The vast majority of Oral Glucose Tolerance Tests (OGTTs) requested are for the diagnosis of glucose intolerance and should be performed and interpreted according to Australian guidelines with fasting, 1hr and 2hr glucose measurements following a 75g glucose load. A small number of requests require variations in this standard protocol and staff must carefully check the request slip to ensure that the correct protocol is followed and the appropriate specimens collected.

 

Where the doctor has requested  ?OGTT ? fasting and 2hour only? then it is o.k. to omit the 1 hour bloods.

 

?OGTT with insulin? is used to investigate insulin resistance. This requires glucose and insulin levels at each time point (i.e. 0, 1 and 2 hours).

?OGTT with Growth Hormone/ IGF-1? is used to diagnose and monitor Acromegaly. This requires glucose and Growth Hormone/IGF-1 levels at 30, 60, 90 and 120 minutes

 

 

 

 

GLUCOSE TOLERANCE TEST  

Please note : Patient must phone collection centre in advance as an appointment is essential for this test.         

 When GTT is requested with either Insulin, Growth Hormone or IGF-1 (Somatomedin C) it is required that blood is collected for these tests at each GTT time interval (eg. 0, 1 and 2 hr collections for each test)

 Patients are tested for their ability to handle an oral glucose load taken in fasting state by measuring their plasma glucose 2-hours after ingestion.

Patient should be on their normal diet until the day of the test

 The test is done at a time when the patient is free of acute illness

 The test is performed between 0800 and 1000 after a 12-hour overnight fast. Water is permitted during the fasting period but eating, physical activity and smoking must be avoided

 If fasting sample is less than 8mmol/L - proceed with the test

 A 75g glucose load in the form of a single 285 mL bottle of chilled Dextrasol. The time and date of ingestion is noted.

 Ingestion should be completed within 5 minutes.

 Two more venous blood samples are taken at 1-hour intervals, starting exactly 1 hour after completion of ingestion.

27th January 2017
Collection & Request Instructions

GLUCOSE TOLERANCE TEST  

Please note : Patient must phone collection centre in advance as an appointment is essential for this test.       

Patient Collection Instructions - English

Patient Collection Instructions - Arabic

Patient Collection Instructions - Burmese

Patient Collection Instructions - Hakha Chinese

Patient Collection Instructions -Simple Chinese

Patient Collection Instructions - Trad. Chinese

Patient Collection Instructions - Dinka

Patient Collection Instructions - Hindi

Patient Collection Instructions - Karen

Patient Collection Instructions - Korean

Patient Collection Instructions - Vietnamese

 

 

Hormone or IGF-1 (Somatomedin C) it is required that blood is collected for these tests at each GTT time interval (eg. 0, 1 and 2 hr collections for each test)

 Patients are tested for their ability to handle an oral glucose load taken in fasting state by measuring their plasma glucose 2-hours after ingestion.

  • Patient should be on their normal diet until the day of the test
  •  The test is done at a time when the patient is free of acute illness
  •  The test is performed between 0800 and 1000 after a 12-hour overnight fast. Water is permitted during the fasting period but eating, physical activity and smoking must be avoided

 If fasting sample is less than 8mmol/L - proceed with the test

 A 75g glucose load in the form of a single 285 mL bottle of chilled Dextrasol. The time and date of ingestion is noted.

 Ingestion should be completed within 5 minutes.

 Two more venous blood samples are taken at 1-hour intervals, starting exactly 1 hour after completion of ingestion.

Please contact laboratory on 9895-3548 for queries relating to GCT and GTT testing.

GLUCOSE TOLERANCE TEST  

Please note : Patient must phone collection centre in advance as an appointment is essential for this test.       

Patient Collection Instructions - English

Patient Collection Instructions - Arabic

Patient Collection Instructions - Burmese

Patient Collection Instructions - Hakha Chinese

Patient Collection Instructions -Simple Chinese

Patient Collection Instructions - Trad. Chinese

Patient Collection Instructions - Dinka

Patient Collection Instructions - Hindi

Patient Collection Instructions - Karen

Patient Collection Instructions - Korean

Patient Collection Instructions - Vietnamese

 

 

Hormone or IGF-1 (Somatomedin C) it is required that blood is collected for these tests at each GTT time interval (eg. 0, 1 and 2 hr collections for each test)

 Patients are tested for their ability to handle an oral glucose load taken in fasting state by measuring their plasma glucose 2-hours after ingestion.

Patient should be on their normal diet until the day of the test

 The test is done at a time when the patient is free of acute illness

 The test is performed between 0800 and 1000 after a 12-hour overnight fast. Water is permitted during the fasting period but eating, physical activity and smoking must be avoided

 If fasting sample is less than 8mmol/L - proceed with the test

 A 75g glucose load in the form of a single 285 mL bottle of chilled Dextrasol. The time and date of ingestion is noted.

 Ingestion should be completed within 5 minutes.

 Two more venous blood samples are taken at 1-hour intervals, starting exactly 1 hour after completion of ingestion.

Please contact laboratory on 9895-3548 for queries relating to GCT and GTT testing.

Processing Instructions

Eastern Health Pathology Collection Rooms:

  • Collect an initial fasting sample and test blood for Glucose level on the Haemacue

 

  •  If results are greater than 8 mmol/L - send urgently to the laboratory for analysis.

 

  • Write on the request form:

Haemacue reading - (write result). Please phone (Phlebotomist name) on (extension number) with result.  

 

  • Laboratory staff please notify;
    1. Phlebotomist on request form and
    2. Senior Scientist if confirmed as > 8 mmmol/L so they can phone requesting Doctor to inform that GTT will be halted.

Eastern Health Pathology Collection Rooms:

Collect an initial fasting sample and test blood for Glucose level on the Haemacue

 

 If results are greater than 8 mmol/L - send urgently to the laboratory for analysis.

 

Write on the request form:

Haemacue reading - (write result). Please phone (Phlebotomist name) on (extension number) with result.  

 

Laboratory staff please notify;

Phlebotomist on request form and

Senior Scientist if confirmed as > 8 mmmol/L so they can phone requesting Doctor to inform that GTT will be halted.

Notes

The vast majority of Oral Glucose Tolerance Tests (OGTTs) requested are for the diagnosis of glucose intolerance and should be performed and interpreted according to Australian guidelines with fasting, 1hr and 2hr glucose measurements following a 75g glucose load. A small number of requests require variations in this standard protocol and staff must carefully check the request slip to ensure that the correct protocol is followed and the appropriate specimens collected.

 

Where the doctor has requested  ?OGTT ? fasting and 2hour only? then it is o.k. to omit the 1 hour bloods.

 

 

 

?OGTT with insulin? is used to investigate insulin resistance. This requires glucose and insulin levels at each time point (i.e. 0, 1 and 2 hours).

 

 

 

?OGTT with Growth Hormone/ IGF-1? is used to diagnose and monitor Acromegaly. This requires glucose and Growth Hormone/IGF-1 levels at each time point (i.e. 0, 1 and 2 hours).

 

 

 

 

 

 

 

 

 

 

 

GLUCOSE TOLERANCE TEST  

Please note : Patient must phone collection centre in advance as an appointment is essential for this test.         

 When GTT is requested with either Insulin, Growth Hormone or IGF-1 (Somatomedin C) it is required that blood is collected for these tests at each GTT time interval (eg. 0, 1 and 2 hr collections for each test)

 Patients are tested for their ability to handle an oral glucose load taken in fasting state by measuring their plasma glucose 2-hours after ingestion.

  • Patient should be on their normal diet until the day of the test
  •  The test is done at a time when the patient is free of acute illness
  •  The test is performed between 0800 and 1000 after a 12-hour overnight fast. Water is permitted during the fasting period but eating, physical activity and smoking must be avoided

 If fasting sample is less than 8mmol/L - proceed with the test

 A 75g glucose load in the form of a single 285 mL bottle of chilled Dextrasol. The time and date of ingestion is noted.

 Ingestion should be completed within 5 minutes.

 Two more venous blood samples are taken at 1-hour intervals, starting exactly 1 hour after completion of ingestion.

The vast majority of Oral Glucose Tolerance Tests (OGTTs) requested are for the diagnosis of glucose intolerance and should be performed and interpreted according to Australian guidelines with fasting, 1hr and 2hr glucose measurements following a 75g glucose load. A small number of requests require variations in this standard protocol and staff must carefully check the request slip to ensure that the correct protocol is followed and the appropriate specimens collected.

 

Where the doctor has requested  ?OGTT ? fasting and 2hour only? then it is o.k. to omit the 1 hour bloods.

 

 

 

?OGTT with insulin? is used to investigate insulin resistance. This requires glucose and insulin levels at each time point (i.e. 0, 1 and 2 hours).

 

 

 

?OGTT with Growth Hormone/ IGF-1? is used to diagnose and monitor Acromegaly. This requires glucose and Growth Hormone/IGF-1 levels at each time point (i.e. 0, 1 and 2 hours).

 

 

 

 

 

 

 

 

 

 

 

GLUCOSE TOLERANCE TEST  

Please note : Patient must phone collection centre in advance as an appointment is essential for this test.         

 When GTT is requested with either Insulin, Growth Hormone or IGF-1 (Somatomedin C) it is required that blood is collected for these tests at each GTT time interval (eg. 0, 1 and 2 hr collections for each test)

 Patients are tested for their ability to handle an oral glucose load taken in fasting state by measuring their plasma glucose 2-hours after ingestion.

Patient should be on their normal diet until the day of the test

 The test is done at a time when the patient is free of acute illness

 The test is performed between 0800 and 1000 after a 12-hour overnight fast. Water is permitted during the fasting period but eating, physical activity and smoking must be avoided

 If fasting sample is less than 8mmol/L - proceed with the test

 A 75g glucose load in the form of a single 285 mL bottle of chilled Dextrasol. The time and date of ingestion is noted.

 Ingestion should be completed within 5 minutes.

 Two more venous blood samples are taken at 1-hour intervals, starting exactly 1 hour after completion of ingestion.


 Recent changes for Glucose-6-Phosphate Dehydrogenase Screen

Recent changes for Glucose-6-Phosphate Dehydrogenase Screen

Date
Field
Changed From
Changed To
21st November 2017
Method

Recently drawn whole blood specimen stored in the refrigerator (less than one week). 

Recently drawn whole blood specimen stored in the refrigerator (less than one week). 

Notes

The results of this assay should be interpreted with the haematological status of the individual in mind at the time of testing. 

Samples which have been determined deficient or intermediate by the screening method should be assayed by a quantitative method.  

The results of this assay should be interpreted with the haematological status of the individual in mind at the time of testing. 

Samples which have been determined deficient or intermediate by the screening method should be assayed by a quantitative method.  


 Recent changes for Glycerol Lysis Test

Recent changes for Glycerol Lysis Test

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

This test is replaced by Spherocytosis by Flow Cytometry.

See - Spherocytosis by Flow Cytometry.

Cost: $150.00 Patient will be charged as non -rebatable test

This test is replaced by Spherocytosis by Flow Cytometry.

See - Spherocytosis by Flow Cytometry.

Cost: $150.00 Patient will be charged as non -rebatable test

Frequency

As required

Weekly


 Recent changes for Haematocrit

Recent changes for Haematocrit

Date
Field
Changed From
Changed To
21st November 2017
Notes

See - Full Blood Examination

See - Full Blood Examination


 Recent changes for Haemoglobin Analysis (including Electrophoresis)

Recent changes for Haemoglobin Analysis (including Electrophoresis)

Date
Field
Changed From
Changed To
21st November 2017
External Transport Instructions

Monash Hb Electrophoresis lab: 95943490

Monash Hb Electrophoresis lab: 95943490

Notes

  • Ethnic origin must be stated to allow appropriate testing
  • FBE and Iron studies should be performed

Specimens must be in the laboratory before 4pm

Send FBE & Iron studies results if available. Send within 24 hrs at Room temperature.

Ethnic origin must be stated to allow appropriate testing

FBE and Iron studies should be performed

Specimens must be in the laboratory before 4pm

Send FBE & Iron studies results if available. Send within 24 hrs at Room temperature.


 Recent changes for Heparin-Induced Thrombocytopenia Syndrome Screen

Recent changes for Heparin-Induced Thrombocytopenia Syndrome Screen

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

The DiaMed Hits screen will detect approx. 85%of HITS positive patients.

  • If clinical indicators are strong but the DiaMed test negative, a serum sample can be forwarded for ELISA testing (HITE) at Monash Medical Centre
  • ELISA testing is only available after consultation with the Consultant Haematologist or Haematology Registrar.

The DiaMed Hits screen will detect approx. 85%of HITS positive patients.

If clinical indicators are strong but the DiaMed test negative, a serum sample can be forwarded for ELISA testing (HITE) at Monash Medical Centre

ELISA testing is only available after consultation with the Consultant Haematologist or Haematology Registrar.

Processing Instructions

  • Laboratory staff at Monash Medical Centre must be informed if the ELISA test is to be done urgently.
  • transport - serum frozen to MMC unless test is to be done same day.
  • (MMC Coagulation: 9594 3489)

Laboratory staff at Monash Medical Centre must be informed if the ELISA test is to be done urgently.

transport - serum frozen to MMC unless test is to be done same day.

(MMC Coagulation: 9594 3489)

Frequency

Weekly

Notes

Plain tube with gel

Keep at room temperature and send to laboratory immediately.   DO NOT FREEZE

Plain tube with gel

Keep at room temperature and send to laboratory immediately.   DO NOT FREEZE


 Recent changes for HIV Serology

Recent changes for HIV Serology

Date
Field
Changed From
Changed To
17th August 2016
Processing Instructions

 

 

 

 

Notes

HIV Combo test - detects antibodies to HIV 1 &/or HIV 2 and p24 antigen

Repeat reactive specimens are referred to VIDRL for confirmation by Western Blot - performed twice weekly

Routine screening test - HIV Combo - detects antibodies to HIV-1 &/or HIV-2 and p24 antigen

HIV Combo test - detects antibodies to HIV 1 &/or HIV 2 and p24 antigen

Repeat reactive specimens are referred to VIDRL for confirmation by Western Blot - performed twice weekly

Routine screening test - HIV Combo - detects antibodies to HIV-1 &/or HIV-2 and p24 antigen


 Recent changes for HLA typing/ HLA typing relative

Recent changes for HLA typing/ HLA typing relative

Date
Field
Changed From
Changed To
20th October 2017
Preferred Container Type

ACD

ACD + Serum

Collection & Request Instructions

Organ Transplants- 40 ml ACD

                                 10 ml Serum (Cytotoxic antibodies)

 Coeliac Paediatric HLA:     4ml EDTA or 5ml in  ACD tube

Please provide correct information of relatives with details of HLA patient. eg: Mother, Father etc.

Organ Transplants- 40 ml ACD

                                 10 ml Serum (Cytotoxic antibodies)

 Coeliac Paediatric HLA:     4ml EDTA or 5ml in  ACD tube

Please provide correct information of relatives with details of HLA patient. eg: Mother, Father etc.


 Recent changes for Immunofluorescence

Recent changes for Immunofluorescence

Date
Field
Changed From
Changed To
2nd August 2017
Alternative names

DIF, IF, Immunofluorescence, Punch biopsy of skin, Renal IF

DIF, IF, Immunofluorescence, IMF, Punch biopsy of skin, Renal IF

Request Group

HIF

HISTO

Preferred Container Type

Not required

Sterile Jar

Collection & Request Instructions

Transport ON ICE IMMEDIATELY to lab

Collection & Request Instructions

Renal IF: The fresh tissue is placed into Michel's transport medium..

Skin IF: If immunofluorescence is required 2 specimens should be taken, one placed in formalin, the other fresh on saline soaked gauze. If Microbiological culture is required, a third fresh specimen should be sent. Fresh tissue should be delivered to the laboratory as soon as possible Mon-Fri during business hours - as this test is refered to Melbourne Pathology. Please call the laboratory on 9895 3884 of impending arrival.

Renal IF: The fresh tissue is placed into Michel's transport medium..

Skin IF: If immunofluorescence is required 2 punch biopsies should be taken, one placed in formalin, the other remains fresh and placed on saline soaked gauze. If microbiological culture is required, a third punch biopsy should be taken. This should also be received fresh on saline soaked gauze.

Fresh tissue for IF should be placed in an eksy on ice and delivered to the laboratory as soon as possible. If there is a short delay in transporation please place tissue in fridge at 40C until the specimen can be sent.

If there is to be a long delay (> 12 hours) in transportation the fresh specimen should be place in Michel's medium

Processing Instructions

RENAL: Only send to Monash Medical Centre when requested by the Pathologist. Otherwise store in the AP fridge for 1 month then discard. Please send a satined H&E slide also.

SKIN: Fresh specimens on saline soaked gauze are sent out for direct immunofluorescence. If sent to the laboratory out of hours call the on call pathologist - they will most likely recommend to put in the fridge. Generally this is not an on-call procedure for scientists to come in and send out - as reporting will not be done until the next working day. If Microbiological culture is required, a third fresh specimen should be sent.

RENAL: IF on renal biopsies is only requested by the renal  pathologist. Otherwise store in the AP fridge for 3 month then discard.

SKIN: Fresh specimens received on saline soaked gauze for IF are now performed in house. If skin specimen is sent to the laboratory out of hours please call the 'on call" pathologist to check that IF is requested. If IF is requested place specimen into Michel's medium. This is found in the fridge in the Anatomical Pathology Laboratory.Place specimen in bucket - "DIF to be frozen". Generally this is not an on-call procedure for scientists to come in for.  If microbiological culture is required, a third fresh specimen should be sent to the microbiology laboratory.

External Laboratory

Melbourne Pathology

External Transport Instructions

 

 

 

 

Method

Renal IF:

Monash Medical Centre Courier times = 10.30am Mon-Fri.

Aantomical Pathology 246 Clayton Road VIC 3066.  Call theLab on 9594 4538 to let them know it is coming. Fax the request form to Paul Crammer on Fax: 9594 6284. Place specimen in esky with ice packs.

Skin IF:

Pathologists have requested that only skins be sent to Melbourne Pathology. Record the details in the macroscopic description: what the pot was ;ebelled, size and appearance of biosp and the fact that it will be sent for referal to Melbourne Pathology.

Phone the laboratory on 9287 7700. Do not use Michel's Transport Medium as requested by the Manager.

103 Victoria Parade Collingwood VIC 3066

 

 

Renal  and Skin IF:  Are now performed at Eastern Health Pathology

 

 

Notes

This biopsy should ideally be taken in the mornning Mon-Fri, so that the specimen can be sent away and tested the same day, otherwise deterioration of the sample may occur and may affect results.

For Skin a minimum 3mm punch biopsy is required for diagnosis. Large biopsies (4mm or greater) may be bisected for immunofluorescence.

Anatomical Pathology do not supply punch biopsy kits.

This biopsy should ideally be taken in the morning Mon-Fri, so that the specimen can be dealt with in the Anatomical Pathology Laboratory otherwise deterioration of the sample may occur and may affect results.

If punch biopsy is taken in the afternoon, the specimen must arrive in the Histology Lab before 5.00. If this is not possible the specimen must be collected into Michel's medium otherwise the deterioration of the specimen may occur which may affect results.

Please contact Anatomical Laboratory on 9895 3477 for collection of Michel's medium.

Skin IF: A 3mm (miniumum diametre) punch biopsy is required for diagnosis. Large biopsies (5mm or greater) may be bisected for IF. Renal IF: A portion of renal core biopsy no smaller than 2 mm is required for diagnosis.

Anatomical Pathology do not supply punch biopsy kits.


 Recent changes for Infectious Mononucleosis Screen

Recent changes for Infectious Mononucleosis Screen

Date
Field
Changed From
Changed To
21st November 2017
Notes

A screening test is positive in approximately 90% of acute IM cases. EBV Serology is required to prove infection when the blood film is suggestive but the IM screen is negative

A screening test is positive in approximately 90% of acute IM cases. EBV Serology is required to prove infection when the blood film is suggestive but the IM screen is negative


 Recent changes for Insulin

Recent changes for Insulin

Date
Field
Changed From
Changed To
10th November 2017
Laboratory

Referred Test

Biochemistry

Collection & Request Instructions

 

Fasting Serum, deliver immediately to the laboratory

 

Fasting Serum, deliver immediately to the laboratory

Processing Instructions

Spin and freeze immediately

Spin and freeze immediately

External Laboratory

St Vincents Hospital

External Transport Instructions

Transport frozen

Transport frozen

Frequency

Weekly

Twice weekly

Notes

  • Interpretation depends on glucose level, body weight and age.
  • Useful in investigation of fasting hypoglycaemia

Fasting serum deliver immediately to the laboratory.

Spin separate and freeze serum.

Interpretation depends on glucose level, body weight and age.

Useful in investigation of fasting hypoglycaemia

Fasting serum deliver immediately to the laboratory.

Spin separate and freeze serum.


 Recent changes for Isohaemagglutinin titre

Recent changes for Isohaemagglutinin titre

Date
Field
Changed From
Changed To
8th July 2016
Alternative names

Anti A titre, Anti B titre Anti-A, Anti-B

Anti A titre, Anti B titre, Anti-A, Anti-B

8th July 2016
Preferred Container Type

Plain tube no gel

Pink EDTA (6mL)

12th May 2016
Preferred Container Type

EDTA large (Blood Bank)

serum


 Recent changes for JAK2 Mutation Analysis

Recent changes for JAK2 Mutation Analysis

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Sample is stable at Room Temperature for at least 24 Hours.

JAK2 is for differentiation of reactive VS clonal myeloproliferative disorders.

Collect a separate sample for this test.

This test is not Medicare rebatable. (Cost $44.00 incl GST)

 

Sample is stable at Room Temperature for at least 24 Hours.

JAK2 is for differentiation of reactive VS clonal myeloproliferative disorders.

Collect a separate sample for this test.

This test is not Medicare rebatable. (Cost $44.00 incl GST)

 


 Recent changes for MTHFR (C677T mutation)

Recent changes for MTHFR (C677T mutation)

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

  • PCR Test.
  • Do not remove cap from tubes.

PCR Test.

Do not remove cap from tubes.

Method

Send entire specimen. Aliquots not accepted.

The specimen must be received in Austin Pathology within 48 hrs of collection

Send entire specimen. Aliquots not accepted.

The specimen must be received in Austin Pathology within 48 hrs of collection


 Recent changes for P1NP

Recent changes for P1NP

Date
Field
Changed From
Changed To
20th March 2017
Collection & Request Instructions

PLEASE NOTE THAT

3 x EDTA SAMPLES ARE REQUIRED

 

 

20th March 2017
Collection & Request Instructions

PLEASE NOTE THAT

3 x EDTA SAMPLES ARE REQUIRED


 Recent changes for Plasminogen

Recent changes for Plasminogen

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Do not use 1 ml citrate tubes.

Fill tube to label and mix by inversion

Do not use 1 ml citrate tubes.

Fill tube to label and mix by inversion

Processing Instructions

Specimens for Plasminogen assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

Specimens for Plasminogen assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

Notes

Not covered by HIC.  Out of pocket expense to paitient.  Approximate cost $50.00 per test

Not covered by HIC.  Out of pocket expense to paitient.  Approximate cost $50.00 per test


 Recent changes for Plasminogen activator Inhibitor

Recent changes for Plasminogen activator Inhibitor

Date
Field
Changed From
Changed To
17th August 2017
Collection & Request Instructions

Transport specimen at Room Temperature to lab

17th August 2017
Laboratory

Referred Test

Unassigned

Volume (Adults)

4 mL

Preferred Specimen Type

Plasma

Blood

Collection & Request Instructions

Do not use 1 ml citrate tubes.

Fill tube to label and mix by inversion

 

 

External Laboratory

Austin Pathology

Method

Platelet free plasma required, double centrifuge before freezing.


 Recent changes for Post Mortem

Recent changes for Post Mortem

Date
Field
Changed From
Changed To
2nd May 2017
Processing Instructions

Perinatal Protocols for Pathology

 

 

 

Method

Pathology Perinatal Protocols

2nd May 2017
Processing Instructions

 

 

Perinatal Protocols for Pathology

 

1st May 2017
External Transport Instructions

Metropolitan Funeral Transfer can be contacted on 0438 054 327 to organise the transfer between hospitals.

Austin Hospitals prefers to use their preferred transport company.

Metropolitan Funeral Transfer can be contacted on 0438 054 327 to organise the transfer between hospitals.

Austin Hospital prefers to use their preferred transport company.

5th September 2016
Collection & Request Instructions

Evolution test codes for tracking purposes: see WORK-AP-58 Histology Data Entry Codes.

Baby < 20 weeks (stored in pathology fridge)

Baby > 20 weeks (store in mortuary)

Adult (mortuary)

Notes

Perinatal post mortem services are Performed at Monash Medical Centre. Contact them Monday to Friday 0900-1700.

Adult post mortem services are done at Austin Hosptial. Contact Austin on 9496-5658.

 

 

 

 

 

16th August 2016
Processing Instructions

 

 

 

 

External Transport Instructions

If transport of the deceased is required between Hospitals or campuses, this can be done by the Funeral Parlour chosen by the family of the deceased.

If family has not yet decided on Funeral Parlour and requires urgent transfer espcially for post mortems, Metropolitan Funeral Transfer can be contacted on 0438 054 327 to organise the transfer between hospitals.

Metropolitan Funeral Transfer can be contacted on 0438 054 327 to organise the transfer between hospitals.

Austin Hospitals prefers to use their preferred transport company.

Notes

Perinatal post mortem services are available from Monday to Friday 0900-1700. Out of hours requests should be directed to the on-call Pathologist.

Adult post mortem services are done at Austin Hosptial. Contact Austin on 9496-5658.

Please refer to Anatomical Pathology Guide - Post-mortem Service

 

Perinatal post mortem services are Performed at Monash Medical Centre. Contact them Monday to Friday 0900-1700.

Adult post mortem services are done at Austin Hosptial. Contact Austin on 9496-5658.

 

 


 Recent changes for Presenilin 1 Mutation

Recent changes for Presenilin 1 Mutation

Date
Field
Changed From
Changed To
11th March 2016
Collection & Request Instructions

Collect 2 x 4ml EDTA samples - if sent on the same day, they can be stored at RT, if to be sent next day, please store at 2-8 deg.

Collect 2 x 4ml EDTA samples - if sent on the same day, they can be stored at RT, if to be sent next day, please store at 2-8 deg.

External Laboratory

Applied Genetic Diagnostics, Melbourne University

Centre For Traslational Pathology

External Transport Instructions

RT same day

4 deg if overnight

RT same day

4 deg if overnight


 Recent changes for Protein C

Recent changes for Protein C

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Fill to label marker and mix by inversion.

Do not use 1 mL citrate tubes.

2 x 3.5 ml citrate tubes sufficient for Protein C, Protein S and Antithrombin 3.

Fill to label marker and mix by inversion.

Do not use 1 mL citrate tubes.

2 x 3.5 ml citrate tubes sufficient for Protein C, Protein S and Antithrombin 3.

Processing Instructions

Specimens for Protein C assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection. 

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months. 

A frost-free freezer should not be used. 

Specimens for Protein C assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection. 

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months. 

A frost-free freezer should not be used. 

Notes

Results not valid if patient receiving warfarin therapy or with acute thrombotic event.

Warfarin falsely lowers Protein C levels.

Fill to label marker and mix by inversion.

Do not use 1 mL citrate tubes.

2 x 3.5 ml citrate sufficient for Protein C, Protein S and Antithrombin 3.

Results not valid if patient receiving warfarin therapy or with acute thrombotic event.

Warfarin falsely lowers Protein C levels.

Fill to label marker and mix by inversion.

Do not use 1 mL citrate tubes.

2 x 3.5 ml citrate sufficient for Protein C, Protein S and Antithrombin 3.


 Recent changes for Protein S

Recent changes for Protein S

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Fill to label marker and mix by inversion

Do not use 1 ml citrate tubes.

2 x 3.5 mL citrate tubes sufficient for Protein C, Protein S and Antithrombin 3.

Fill to label marker and mix by inversion

Do not use 1 ml citrate tubes.

2 x 3.5 mL citrate tubes sufficient for Protein C, Protein S and Antithrombin 3.

Processing Instructions

Specimens for Protein S assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection. 

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months. 

A frost-free freezer should not be used. 

Specimens for Protein S assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection. 

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months. 

A frost-free freezer should not be used. 

Notes

  • Results not valid if patient receiving warfarin therapy or with acute thrombotic event
  • Warfarin falsely lowers Protein S level.

Fill to label marker and mix by inversion

Do not use 1 ml citrate tubes.

2 x 3.5 mL citrate tubes sufficient for Protein C, Protein S and Antithrombin 3.

Results not valid if patient receiving warfarin therapy or with acute thrombotic event

Warfarin falsely lowers Protein S level.

Fill to label marker and mix by inversion

Do not use 1 ml citrate tubes.

2 x 3.5 mL citrate tubes sufficient for Protein C, Protein S and Antithrombin 3.


 Recent changes for Prothrombin Fragment 1 & 2

Recent changes for Prothrombin Fragment 1 & 2

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Do not use 1 ml citrate tubes.

Do not use 1 ml citrate tubes.

Processing Instructions

Specimens for Prothrombin fragments 1 & 2 assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

Specimens for Prothrombin fragments 1 & 2 assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

Frequency

Monthly


 Recent changes for Prothrombin Time

Recent changes for Prothrombin Time

Date
Field
Changed From
Changed To
21st November 2017
Frequency

Daily


 Recent changes for Reticulocytes

Recent changes for Reticulocytes

Date
Field
Changed From
Changed To
21st November 2017
Notes

An FBE is performed at the same time

An FBE is performed at the same time


 Recent changes for Ristocetin Co-Factor assay

Recent changes for Ristocetin Co-Factor assay

Date
Field
Changed From
Changed To
21st November 2017
Frequency

Weekly


 Recent changes for Selenium

Recent changes for Selenium

Date
Field
Changed From
Changed To
11th August 2017
Collection & Request Instructions

Serum selenium also available. Require serum (Plain tube with gel).

Processing Instructions

Spin and separate plasma.

External Laboratory

Australian Clinical Labs (formerly Healthscope)

Alfred Hospital

Frequency

Fortnightly


 Recent changes for Semen Analysis - Post-Vasectomy

Recent changes for Semen Analysis - Post-Vasectomy

Date
Field
Changed From
Changed To
30th January 2017
Collection & Request Instructions

Patient Collection Instructions

Patient needs to abstain for three days prior to collection.

Note : Specimens must be examined within 1 hour of collection.

Examination is performed at Box Hill Hospital Monday to Friday 8 am to 5pm.

Specimens to be delivered by patient to Box Hill Hospital.

Do not refrigerate - please leave at room temperature.

 

Patient Collection Instructions

Patient needs to abstain for three days prior to collection.

Note : Specimens must be examined within 1 hour of collection.

Examination is performed at Box Hill Hospital Monday to Friday 8 am to 5pm.

Specimens to be delivered by patient to Box Hill Hospital.

Do not refrigerate - please leave at room temperature.

 

Method

If a patient arrives at site other than Box Hill with specimen, ask the patient to deliver the specimen to Box Hill. If not possible explain that the specimen will be forwarded to Box Hill by the next available courier however specimens should be examined within the hour and therefore specimen may need to be recollected.

If a patient arrives at site other than Box Hill with specimen, ask the patient to deliver the specimen to Box Hill. If not possible explain that the specimen will be forwarded to Box Hill by the next available courier however specimens should be examined within the hour and therefore specimen may need to be recollected.

Notes

 

 

 

 


 Recent changes for Skin Bleeding Time

Recent changes for Skin Bleeding Time

Date
Field
Changed From
Changed To
21st November 2017
Notes

  • Rarely indicated
  • By consultation with the Consultant Haematologist or Haemtology Registrar
  • Note that a prolonged SBT doest not predict for surgical bleeding

Rarely indicated

By consultation with the Consultant Haematologist or Haemtology Registrar

Note that a prolonged SBT doest not predict for surgical bleeding


 Recent changes for Skin Fibroblasts for Mitochondrial Enzyme Assay

Recent changes for Skin Fibroblasts for Mitochondrial Enzyme Assay

Date
Field
Changed From
Changed To
21st March 2017
External Transport Instructions

Ttransport with ice pack in an esky.


 Recent changes for Snake Venom test

Recent changes for Snake Venom test

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

  • Specimen Type: Swab from bite site is the best specimen, followed by urine

 

 

Please phone the laboratory to arrange the pick up of the Snake Venom Collection Kit

Box Hill Laboratory – 9895 3489

 

Angliss Laboratory – 9764 6136

Maroondah Laboratory– 9871 3572

The specimen(s) must be collected in the Emergency Department (see following instruction), labelled correctly and sent to Pathology laboratory for analysis.

Specimen Type: Swab from bite site is the best specimen, followed by urine

 

 

Please phone the laboratory to arrange the pick up of the Snake Venom Collection Kit

Box Hill Laboratory – 9895 3489

 

Angliss Laboratory – 9764 6136

Maroondah Laboratory– 9871 3572

The specimen(s) must be collected in the Emergency Department (see following instruction), labelled correctly and sent to Pathology laboratory for analysis.

Processing Instructions

 

The collection kit from Pathology consists of two parts;

  1. Swab and collection container
  2. Reagents

Bite Site Swab:

  • Venom may be detected in a swab from the bite site from skin surrounding fang puncture marks or from tissue exudate gently squeezed from the punctures.

 

  • Carefully remove the lid and dropper from an unused Yellow Sample Diluent vial and moisten the swab in the diluent.

 

  • Thoroughly swab the bite site. Gently squeeze the bite site and swab any tissue exudate released. Do not squeeze roughly.

 

  • Thoroughly agitate the swab in the diluent. The swab may be then removed and discarded or snapped off leaving the cotton section in the vial.

 

  • Replace the dropper and lid, and mix well by inverting several times.

 

Affected Bandage or Cloth Specimen:

  • Cut a small piece of the material (1-1.5cm2) that looks to have blood or tissue exudate on it.

 

  • Carefully remove the lid and dropper from an unused Yellow Sample Diluent vial and using forceps or tweezers place the affected material into the vial.

 

  • Replace the dropper and lid, and mix well by gently inverting several times.

 

  • Alternatively, soak the affected material in approximately 1mL of water or saline to release any venom.

 

  • Carefully remove the lid and dropper from an unused Yellow Sample Diluent vial and transfer the washings using a disposable pipette or syringe.

 

  • Replace the dropper and lid, and mix well by gently inverting several times.

 

Urine Specimen:

  • Carefully remove the lid and dropper from an unused Yellow Sample Diluent vial and fill to the neck with test urine using a disposable pipette or syringe.

 

  • Replace the dropper and lid, and mix well by gently inverting several times.

Plasma or Blood Specimen:

Note: Erroneous reactions resulting in an invalid assay may occur if a whole blood specimen is tested.

 

Blood is not recommended to be tested, but can be if this is the only option.

 

Plasma or serum is the preferred blood based sample, however, whole anticoagulated blood is recommended in urgent situations as this sample does not require centrifugation and is therefore available more rapidly. A plasma or whole blood sample should be used if a bite site or urine specimen is not available.

 

Remove the lid and dropper from an unused Yellow Sample Diluent vial and fill to the neck with serum, plasma or whole blood using a disposable pipette or syringe. Heparin, EDTA, oxalate or citrate anticoagulated samples may be used.

 

Replace the dropper and lid, and mix well by gently inverting several times.

 

 

The collection kit from Pathology consists of two parts;

Swab and collection container

Reagents

Bite Site Swab:

Venom may be detected in a swab from the bite site from skin surrounding fang puncture marks or from tissue exudate gently squeezed from the punctures.

 

Carefully remove the lid and dropper from an unused Yellow Sample Diluent vial and moisten the swab in the diluent.

 

Thoroughly swab the bite site. Gently squeeze the bite site and swab any tissue exudate released. Do not squeeze roughly.

 

Thoroughly agitate the swab in the diluent. The swab may be then removed and discarded or snapped off leaving the cotton section in the vial.

 

Replace the dropper and lid, and mix well by inverting several times.

 

Affected Bandage or Cloth Specimen:

Cut a small piece of the material (1-1.5cm2) that looks to have blood or tissue exudate on it.

 

Carefully remove the lid and dropper from an unused Yellow Sample Diluent vial and using forceps or tweezers place the affected material into the vial.

 

Replace the dropper and lid, and mix well by gently inverting several times.

 

Alternatively, soak the affected material in approximately 1mL of water or saline to release any venom.

 

Carefully remove the lid and dropper from an unused Yellow Sample Diluent vial and transfer the washings using a disposable pipette or syringe.

 

Replace the dropper and lid, and mix well by gently inverting several times.

 

Urine Specimen:

Carefully remove the lid and dropper from an unused Yellow Sample Diluent vial and fill to the neck with test urine using a disposable pipette or syringe.

 

Replace the dropper and lid, and mix well by gently inverting several times.

Plasma or Blood Specimen:

Note: Erroneous reactions resulting in an invalid assay may occur if a whole blood specimen is tested.

 

Blood is not recommended to be tested, but can be if this is the only option.

 

Plasma or serum is the preferred blood based sample, however, whole anticoagulated blood is recommended in urgent situations as this sample does not require centrifugation and is therefore available more rapidly. A plasma or whole blood sample should be used if a bite site or urine specimen is not available.

 

Remove the lid and dropper from an unused Yellow Sample Diluent vial and fill to the neck with serum, plasma or whole blood using a disposable pipette or syringe. Heparin, EDTA, oxalate or citrate anticoagulated samples may be used.

 

Replace the dropper and lid, and mix well by gently inverting several times.

 

Frequency

As required

Daily

Notes

 

 

 

 

 

 


 Recent changes for SOD1

Recent changes for SOD1

Date
Field
Changed From
Changed To
11th March 2016
External Laboratory

Applied Genetic Diagnostics, Melbourne University

Centre For Traslational Pathology


 Recent changes for Tacrolimus

Recent changes for Tacrolimus

Date
Field
Changed From
Changed To
16th January 2017
Laboratory

Referred Test

Biochemistry

Collection & Request Instructions

Pre-dose collection required.

Specimen must arrive at the Box Hill laboratory before 1200 Mon-Fri (for same day dosing), for level check -sample can be collected anytime. The sample must be at the Austin by 2.00 pm for inclusion in the daily run (7 days) - important for dosing patients.

 

 

Pre-dose collection required.

Testing is performed 7 days a week.  To facilitate same day dosing, the specimen must arrive at the Box Hill laboratory before 1400.

 

 

Processing Instructions

Do not spin

Do not spin

External Laboratory

Austin Pathology


 Recent changes for Teicoplanin

Recent changes for Teicoplanin

Date
Field
Changed From
Changed To
16th August 2017
External Laboratory

South Western Area Pathology,Liverpool Hospital

Royal Melbourne Hospital

Frequency

Daily

Notes

SWAPPS (Biochem) No. 02 8738 5088


 Recent changes for Thrombin Clotting Time

Recent changes for Thrombin Clotting Time

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Fill tube to label marker and mix by inversion.

Fill tube to label marker and mix by inversion.

Processing Instructions

Specimens for TCT assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

Specimens for TCT assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

Notes

Used to detect heparin presence/contamination or abnormal fibrinogenFill tube to label marker and mix by inversion.

Used to detect heparin presence/contamination or abnormal fibrinogenFill tube to label marker and mix by inversion.


 Recent changes for Thrombophilia Screen

Recent changes for Thrombophilia Screen

Date
Field
Changed From
Changed To
21st November 2017
Frequency

Weekly

11th August 2016
Collection & Request Instructions

For full thrombophilia screen including INR, APTT, Protein C, Protein S, AT3, LA screen, APCR, Homocystine, Factor V Leiden, PG20210A and ACA:-

5 x 3.5 ml citrate tubes plus 2 EDTA tubes and 1 x serum tube will be required.

For full thrombophilia screen including INR, APTT, Protein C, Protein S, AT3, LA screen, APCR, Homocystine, Factor V Leiden, PG20210A and ACA:-

5 x 3.5 ml citrate tubes plus 2 EDTA tubes and 1 x serum tube will be required.

Notes

May include Protein C functional, Protein S free, Antithrombin III, APCR ratio, Factor V Leiden, Homocystine, Anti-cardiolipin antibodies, Lupus Anticoagulant, Prothrombin mutation.

  • Which tests are most appropriate depends on clinical history
  • Tests need to be listed individually to comply with HIC guidelines

Consult Haematology Registrar or Haematologist.

For full thrombophilia screen including INR, APTT, Protein C, Protein S, AT3, LA screen, APCR, Homocystine, Factor V Leiden, PG20210A and ACA:- 5 x 3.5 ml citrate tubes plus 2 EDTA tubes and 1 x serum tube will be required.

May include Protein C functional, Protein S free, Antithrombin III, APCR ratio, Factor V Leiden, Homocystine, Anti-cardiolipin antibodies, Lupus Anticoagulant, Prothrombin mutation.

Which tests are most appropriate depends on clinical history

Tests need to be listed individually to comply with HIC guidelines

Consult Haematology Registrar or Haematologist.

For full thrombophilia screen including INR, APTT, Protein C, Protein S, AT3, LA screen, APCR, Homocystine, Factor V Leiden, PG20210A and ACA:- 5 x 3.5 ml citrate tubes plus 2 EDTA tubes and 1 x serum tube will be required.


 Recent changes for Tissue plasminogen activator

Recent changes for Tissue plasminogen activator

Date
Field
Changed From
Changed To
17th August 2017
Collection & Request Instructions

Transport specimen at Room Temperature to lab

17th August 2017
Laboratory

Referred Test

Unassigned

Volume (Adults)

4 mL

Collection & Request Instructions

Do not use 1 ml citrate tubes.

Processing Instructions

Specimens for TPA assays kept at room temperature, should be double centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

External Laboratory

Austin Pathology


 Recent changes for Transglutaminase Antibodies

Recent changes for Transglutaminase Antibodies

Date
Field
Changed From
Changed To
7th August 2017
Collection & Request Instructions

Sample must be analysed within 48 hours of collection. Add on test only can be done within 48 hours if sample stored in the fridge.

7th August 2017
Processing Instructions

Spin,separate and freeze serum.

External Transport Instructions

Transport Frozen.

Frequency

Weekly

Twice weekly

Method

Coeliac disease is an autoimmune digestive disease caused by permanent intolerance to gluten. Patients produce several antibodies including gliadin ( an alcohol soluble fragment of gluten), endomysial ( levels diminish quickly if the patient is on a gluten free diet/GFD and this does not form part of routine screening ) and tissue transglutaminase ( levels fall slowly 6-12 months once GFD commenced ). Antibodies correlate with severity of enteropathy. Both IgA and IgG antibodies are produced - note Coeliac patients have increased likelhood to be IgA deficient ( approx. 2% of patients ).

A diagnosis of Coeliac d. should not be based on positive serology tests alone. Where the tests results are uncertain HLA DQ typing can stratify patients to high or low risk. More than 90% are HLA DQ2 positive and , <10% are DQ8 positive. Therefore an individual who is negative is extremely unlikely to have coeliac d.. DQ typing cannot be used as a screen as 40% of the general population also carry these markers.

4.4.11 CR

Coeliac disease is an autoimmune digestive disease caused by permanent intolerance to gluten. Patients produce several antibodies including gliadin ( an alcohol soluble fragment of gluten), endomysial ( levels diminish quickly if the patient is on a gluten free diet/GFD and this does not form part of routine screening ) and tissue transglutaminase ( levels fall slowly 6-12 months once GFD commenced ). Antibodies correlate with severity of enteropathy. Both IgA and IgG antibodies are produced - note Coeliac patients have increased likelhood to be IgA deficient ( approx. 2% of patients ).

A diagnosis of Coeliac d. should not be based on positive serology tests alone. Where the tests results are uncertain HLA DQ typing can stratify patients to high or low risk. More than 90% are HLA DQ2 positive and , <10% are DQ8 positive. Therefore an individual who is negative is extremely unlikely to have coeliac d.. DQ typing cannot be used as a screen as 40% of the general population also carry these markers.

4.4.11 CR


 Recent changes for Urine Iodine

Recent changes for Urine Iodine

Date
Field
Changed From
Changed To
16th August 2017
Alternative names

Iodine-urine

Iodine urine

16th August 2017
Assay name

Urine-Iodine

Urine Iodine

Method

For results: Marion Black (Senior Scientist)

Tel: 9076 3080

16th August 2017
Preferred Container Type

24 hour urine - PLAIN bottle

24 hour urine - PLAIN bottle
Sterile Jar

Optional Container Type

Sterile Jar

16th August 2017
Preferred Specimen Type

24 hour Urine

24 hour Urine
Urine

Optional Specimen Type

Urine

16th August 2017
Volume (Adults)

50 mL

Minimum/Paediatric Volume

5 mL

Preferred Specimen Type

Urine

24 hour Urine

Optional Specimen Type

Urine

Preferred Container Type

Sterile Jar

24 hour urine - PLAIN bottle

Optional Container Type

Sterile Jar

Collection & Request Instructions

The sample collected is to be used for Urine Iodine only.  If other urine tests have been requested (eg Urine Micro and Culture), a second sample pot should be provided.

Preferred specimen is 24 hour urine collection.

If any difficulty of collecting a 24 hour urine collection, spot urine is also acceptable.If other urine tests have been requested (eg Urine Micro and Culture), a second sample pot should be provided.

Processing Instructions

Store 2 - 8 C

External Laboratory

Australian Clinical Labs (formerly Healthscope)

Alfred Hospital

External Transport Instructions

Frozen specimen

Frequency

Weekly

1st April 2016
Collection & Request Instructions

The sample collected is to be used for Urine Iodine only.  If other urine tests have been requested (eg Urine Micro and Culture), a second sample pot should be provided.


 Recent changes for Von Willebrand Multimeric analysis

Recent changes for Von Willebrand Multimeric analysis

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Specimens for vWF multimer analysis assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

Specimens for vWF multimer analysis assays kept at room temperature, should be centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (2 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

Frequency

As required

Monthly


 Recent changes for von Willebrand Screen

Recent changes for von Willebrand Screen

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

Specimens for vWD screening kept at room temperature, should be centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (6 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

Specimens for vWD screening kept at room temperature, should be centrifuged and tested within 4 hours of time of collection.

If testing is not complete within 4 hours, plasma should be removed from the cells (6 X 1 mL Eppendorf tubes) and frozen at -20 C for up to 2 weeks or -70 C for up to 6 months.

A frost-free freezer should not be used.

Frequency

Weekly

Notes

To comply with HIC ruling tests must be requested individually.

2 x Sodium citrate tubes

Includes INR, APTT, von Willebrand Factor, Factor VIII and vW Antigen.

To comply with HIC ruling tests must be requested individually.

2 x Sodium citrate tubes

Includes INR, APTT, von Willebrand Factor, Factor VIII and vW Antigen.


 Recent changes for vWF Activty

Recent changes for vWF Activty

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

.

Do not use 1 ml citrate tubes.

If requested with von Willebrand Factor and Factor VIII collect 2 x 3.5 ml citrate tubes.

.

Do not use 1 ml citrate tubes.

If requested with von Willebrand Factor and Factor VIII collect 2 x 3.5 ml citrate tubes.

Method

vWF activity - Eliza type assay ; monoclonal Ab. which recognises a functional epitope on the vWF antigen.  vWF Activity is used in place of RiCoF which is a technically difficult test to standardise and has poor precision.

 

vWF activity - Eliza type assay ; monoclonal Ab. which recognises a functional epitope on the vWF antigen.  vWF Activity is used in place of RiCoF which is a technically difficult test to standardise and has poor precision.

 

Notes

Tests for von Willbrands Factor may be ordered individually however they would usually be order as a panel ( such as FVIII, vWF Antigen and vWF Activity ) along with supporting tests FBE, APTT, INR, PFA100, Blood group. Where applicable addition tests  such as vWF Multimers may be required.

Tests for von Willbrands Factor may be ordered individually however they would usually be order as a panel ( such as FVIII, vWF Antigen and vWF Activity ) along with supporting tests FBE, APTT, INR, PFA100, Blood group. Where applicable addition tests  such as vWF Multimers may be required.


 Recent changes for Warfarin

Recent changes for Warfarin

Date
Field
Changed From
Changed To
21st November 2017
Collection & Request Instructions

consult haematology registrar prior to sending sample.

consult haematology registrar prior to sending sample.

Frequency

Weekly

Monthly

Method

This test may be useful for monitoring patients whose PT is inconsistent with the prescribed warfarin dose, particularly when failure to comply or surreptitious drug use is suspected.

Note:    This test is not designed for evaluation of the patient with prolonged  bleeding time suspected of exposure to rat poisons in that the assay is not designed to detect superwarfarins ( the result will likely be negative in this case - which in itself may only suggest superwarfarin ingestion as opposed to Warfarin  ). For superwarfarin testing - contact Victorian Forensic Institute.

 

This test may be useful for monitoring patients whose PT is inconsistent with the prescribed warfarin dose, particularly when failure to comply or surreptitious drug use is suspected.

Note:    This test is not designed for evaluation of the patient with prolonged  bleeding time suspected of exposure to rat poisons in that the assay is not designed to detect superwarfarins ( the result will likely be negative in this case - which in itself may only suggest superwarfarin ingestion as opposed to Warfarin  ). For superwarfarin testing - contact Victorian Forensic Institute.