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Recent Changes - Test & Collection Guide

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 Recent changes for Aldosterone - blood

Recent changes for Aldosterone - blood

Date
Field
Changed From
Changed To
28th August 2024
Collection & Request Instructions

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

 

Whole blood or plasma stored at 4 Deg C is not suitable

Add-on tests for Aldosterone can be done on samples which have been previously collected and stored at 4 Deg C, for 4 days.

Collection Requirements

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice.

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube.

If Aldosterone and cortisol are requested together (but not renin), then these can be collected in the same EDTA tube, or the same serum tube.

 

Whole blood stored at 4 Deg C is not suitable, separated plasma may be suitable.

Add-on tests for Aldosterone can be done on serum samples which have been previously collected and stored at 4 Deg C, for 4 days.

Processing Instructions

aldosterone alone is not appropriate as an initial investigation. Used as part of protocols available on consultation

Serum/Plasma aldosterone has substantial physiological variation and interpretation may be difficult.

Plasma renin activity is a more useful initial test in the evaulation of hypertension.

Aldosterone alone is not appropriate as an initial investigation. Used as part of protocols available on consultation.

Serum/Plasma aldosterone has substantial physiological variation and interpretation may be difficult.

Plasma renin is a more useful initial test in the evaulation of hypertension.

13th August 2024
Collection & Request Instructions

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

 

 

 

Whole blood or plasma stored at 4 Deg C is not suitable

Add-on tests for Renin and Aldosterone should not be done on samples which have been previously collected or stored at 4 Deg C

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

 

Whole blood or plasma stored at 4 Deg C is not suitable

Add-on tests for Renin and Aldosterone should not be done on samples which have been previously collected or stored at 4 Deg C

23rd May 2023
Laboratory

Referred Test

Biochemistry

Collection & Request Instructions

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

In the laboratory, spin and separate the plasma immediately. Plasma is stable at Room Temperature if analysis is performed on the same day

If the specimen arrives on the weekend or after hours, or if the specimen is referred from an external laboratory, freeze the plasma

EDTA plasma samples from external laboratories should be stored and transported frozen

Whole blood or plasma stored at 4 Deg C is not suitable

Add-on tests for Renin and Aldosterone should not be done on samples which have been previously collected or stored at 4 Deg C

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

In the laboratory, spin and separate the plasma immediately. Plasma is stable at Room Temperature if analysis is performed on the same day

If the specimen arrives on the weekend or after hours freeze the plasma

EDTA plasma samples from external laboratories should be stored and transported frozen

Whole blood or plasma stored at 4 Deg C is not suitable

Add-on tests for Renin and Aldosterone should not be done on samples which have been previously collected or stored at 4 Deg C

External Laboratory

Austin Pathology


 Recent changes for Alpha-1 Antitrypsin - Quantitation

Recent changes for Alpha-1 Antitrypsin - Quantitation

Date
Field
Changed From
Changed To
31st July 2024
Collection & Request Instructions

Sample must be frozen within 48 hrs of collection


 Recent changes for Anti-Heart Antibodies

Recent changes for Anti-Heart Antibodies

Date
Field
Changed From
Changed To
28th September 2023
External Laboratory

Pathwest Lab Med WA


 Recent changes for Anti-Myocardial Antibodies

Recent changes for Anti-Myocardial Antibodies

Date
Field
Changed From
Changed To
28th September 2023
External Laboratory

Pathwest Lab Med WA


 Recent changes for Aspergillus precipitins

Recent changes for Aspergillus precipitins

Date
Field
Changed From
Changed To
23rd November 2023
Frequency

Twice weekly

Weekly

23rd November 2023
Collection & Request Instructions

Immunodiffusion for Aspergillus fumigatus antibodies in allergic Aspergillosis.

Test for Aspergillus fumigatus antibodies.

23rd November 2023
External Laboratory

Monash Pathology

Method

Test performed by Royal North Shore Hospital, NSW

Sent with ICPMR courier


 Recent changes for Caeruloplasmin

Recent changes for Caeruloplasmin

Date
Field
Changed From
Changed To
31st July 2024
Collection & Request Instructions

Sample required to be frozen within 48 hrs of collection


 Recent changes for Cholesterol, Low Density Lipoprotein

Recent changes for Cholesterol, Low Density Lipoprotein

Date
Field
Changed From
Changed To
29th February 2024
Notes

 

LDL is not measured directly, but is calculated using the Friedwald formula:

(LDLC) = (total CHOL) - (HDLC) - (TG/2.2)

This formula cannot be used where TG > 4.5 mmol/L

LDL was previously calculated from triglyceride, cholesterol and HDL cholesterol using the Friedewald formula.


As from 22nd of February 2024, LDL is calculated using the Sampson equation.
Friedewald knew that with increasing triglyceride levels, the calculated LDL-C was progressively falsely lower when compared with the gold standard technique and therefore Friedewald stated LDL-C should not be calculated when triglycerides are > 4.5 mmol/L. With much lower LDL-C levels seen in the statin era, an improved calculation was required, hence the Sampson equation.


Comparing both equations with the gold standard ultracentrifugation method, Sampson LDL-C offers similar or better accuracy than Friedewald LDL-C at any triglyceride level. Sampson LDL-C can also be calculated up to a triglyceride level of 9 mmol/L.


Friedewald: LDL-C = TC – HDL-C – Triglycerides/2.2

Sampson: LDL-C=TC/0.948−HDL-C/0.971−(TG/8.56+TG × non-HDL-C/2140 −TG2/16100)−9.44


The calculation for the Sampson equation is complicated but Friedewald LDL-C can be (easily) calculated from the available lipid results if required.
 

 


 Recent changes for CMV Serology

Recent changes for CMV Serology

Date
Field
Changed From
Changed To
18th January 2023
Notes

IgG and IgM, IgG Avidity Index performed

 

IgG and IgM, IgG Avidity Index performed if IgM is positive

 

18th January 2023
Laboratory

Microbiology

Biochemistry


 Recent changes for Cold Agglutinins

Recent changes for Cold Agglutinins

Date
Field
Changed From
Changed To
11th July 2024
Collection & Request Instructions

Pre heated 6 mL EDTA tube. Tubes,needles and syringes must be pre-warmed at 37oC and specimen placed into a hot box (obtained from the laboratory) and transported to the laboratory immediately. Cold specimens may give erroneous results.

Collect a Hot Box with 2x pre-heated, 6 mL EDTA tube from Pathology Specimen Reception. Sample collection must occur within 10min. Once samples are collected, transport to the laboratory immediately.

Cold specimens may give erroneous results.

Processing Instructions

Specimen must be allowed to settle in 37°C incubator (tubes must NOT be allowed to cool to RT prior to separation). Once seperated, can be stored according to laboratory protocols.

Specimens must be handed to Blood Bank Scientist immediately to place in their waterbath. Please do not leave in the rack.

External Transport Instructions

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

Angliss and Maroondah lab: Once plasma is separated, transportation and storage can be at 4°C.

Frequency

Daily

Mon-Fri

Notes

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

Tubes warmed to 37oC are available from Blood Bank laboratory, Box Hill.

Test performed during business hours.

Test performed during business hours, Monday to Friday.

18th June 2024
Minimum/Paediatric Volume

N/A mL

18th June 2024
Request Group

CAGS

CAGG

18th June 2024
Laboratory

Referred Test

Blood Bank

Volume (Adults)

5 mL

Preferred Container Type

Serum No Gel & EDTA

Pink EDTA (6mL)

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 6 mL EDTA tube. Tubes,needles and syringes must be pre-warmed at 37oC and specimen placed into a hot box (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 allowed to settle in 37°C incubator (tubes must NOT be allowed to cool to RT prior to separation). Once seperated, can be stored according to laboratory protocols.

External Laboratory

Austin Pathology

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°C.

Frequency

As required

Daily

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 Blood Bank laboratory, Box Hill.

Test performed during business hours.


 Recent changes for Copeptin

Recent changes for Copeptin

Date
Field
Changed From
Changed To
1st July 2024
Collection & Request Instructions

Transport ON ICE IMMEDIATELY to lab

Transport specimen at Room Temperature to lab


 Recent changes for Creutzfeldt-Jakob Disease

Recent changes for Creutzfeldt-Jakob Disease

Date
Field
Changed From
Changed To
1st September 2023
Collection & Request Instructions

Requests for Alzheimer's disease - CSF must be collected in a seperate blue capped PP tube, available from Pathology Specimen Reception (CSR).

Processing Instructions

DO NOT CENTRIFUGE SPECIMEN

This test requires authorisation by the Neurology Registrar or Neurology Consultant.

CSF Specimens are unsuitable for testing if macroscopically haemorrhagic, xanthochromic, have red blood cell counts < 500/uL, have white cell counts < 10/uL

DO NOT CENTRIFUGE SPECIMEN

This test requires authorisation by the Neurology Registrar or Neurology Consultant.

CSF Specimens are unsuitable for testing if macroscopically haemorrhagic, xanthochromic. Cell count must have red blood cell counts < 500/uL, and white cell counts < 10/uL

Notes

This test requires authorisation by the Neurology Registrar or Neurology Consultant.

In addition, please refer to Eastern Health Infection Control CJD procedure and contact Infection Control prior to performing the Lumbar Puncture

Test is run weekly. Samples received by 4 p.m. Friday will have the result issued by the end of the following week.

 

CSF : Tests for 14-3-3 CSF protein

At least 1 mL of CSF is required in a separate (4th), unopened tube.

Double bag specimen. Must be frozen and transported on dry ice.

Blood : Test for PRNP (Prion protein gene)

5 mLs in EDTA tube

This test requires authorisation by the Neurology Registrar or Neurology Consultant.

In addition, please refer to Eastern Health Infection Control CJD procedure and contact Infection Control prior to performing the Lumbar Puncture

Test is run weekly. Samples received by 4 p.m. Friday will have the result issued by the end of the following week.

 

CSF : Tests for 14-3-3 CSF protein

At least 1 mL of CSF is required in a separate (4th), unopened tube.

Double bag specimen. Note: sample is no longer required to be sent frozen.

Blood : Test for PRNP (Prion protein gene)

5 mLs in EDTA tube


 Recent changes for CSF BioFire Meningitis/Encephalitis Panel

Recent changes for CSF BioFire Meningitis/Encephalitis Panel

Date
Field
Changed From
Changed To
11th September 2023
Collection & Request Instructions

This test required approval from the Clinical Microbiologist. Minimum 200uL/0.2mL of unspun CSF is required for this test.

This test required approval from the Clinical Microbiologist. Minimum 200uL/0.2mL of unspun CSF is required for this test.

CSF collected via lumbar punture only; bloodstained/xanthochromic samples are suitable

Notes

NOTE: Non-K1 E. coli serotypes may be present in a specimen and will not be detected by the BioFire ME Panel.
NOTE: Non-encapsulated strains of Neisseria meningitidis are not detected by the BioFire ME Panel.
NOTE: The BioFire ME Panel does not distinguish between latent and active CMV and HHV-6 infections. Detection of these viruses may indicate primary infection, secondary reactivation, or the presence of latent virus. Results should always be interpreted in conjunction with other clinical, laboratory, and epidemiological information.
NOTE: Patients with a suspicion of cryptococcal meningitis and a negative cryptococcal PCR result, such as by the BioFire ME Panel, should be tested for CrAG.


 Recent changes for D-Dimer

Recent changes for D-Dimer

Date
Field
Changed From
Changed To
8th March 2024
Alternative names

D Dimer, DDimer, Fibrin breakdown products

D Dimer, DDimer


 Recent changes for EBV Serology

Recent changes for EBV Serology

Date
Field
Changed From
Changed To
18th January 2023
Laboratory

Microbiology

Biochemistry


 Recent changes for Erythrocyte Sedimentation Rate

Recent changes for Erythrocyte Sedimentation Rate

Date
Field
Changed From
Changed To
10th May 2023
Volume (Adults)

1.5 mL

1 mL

Minimum/Paediatric Volume

0.5 mL

Preferred Container Type

ESR tube

EDTA
EDTA - Paediatric

Collection & Request Instructions

Using the ESR tube :
Transport specimen at Room Temperature to lab
Sample haemolysis may make this test unreportable

Transport specimen at Room Temperature to lab
Sample haemolysis may make this test unreportable
Samples found to have clots cannot be tested

Collection & Request Instructions

This tube consists of an inner vessel with an outer sleeve.  The outer sleeve MUST remain in place as this is where sample identification (label or handwritten) will be placed. 

Frequency

Daily

Notes

If the ESR test is requested in conjunction with a FBE test request, a single EDTA tube may be shared. In these instances;

Minimum Adult Volume: 1.5 mL

Minimum Paediatric Volume: 1 mL


 Recent changes for Faecal Calprotectin

Recent changes for Faecal Calprotectin

Date
Field
Changed From
Changed To
5th March 2024
Collection & Request Instructions

For non-rebatable tests the out of pocket cost is $60

Sample must be a dedicated collection and be frozen at -20 upon recipept at the laboratory. Sample is stable for 3 days at 2-8 degrees. 

For non-rebatable tests the out of pocket cost is $75

Sample must be a dedicated collection and be frozen at -20 upon recipept at the laboratory. Sample is stable for 3 days at 2-8 degrees. 

5th March 2024
Laboratory

Referred Test

Biochemistry

Collection & Request Instructions

For non-rebatable tests the out of pocket cost is $60

For non-rebatable tests the out of pocket cost is $60

Sample must be a dedicated collection and be frozen at -20 upon recipept at the laboratory. Sample is stable for 3 days at 2-8 degrees. 

External Laboratory

Monash Pathology

1st December 2023
Collection & Request Instructions

For non-rebatable tests the out of pocket cost is $60


 Recent changes for Faecal Occult Blood

Recent changes for Faecal Occult Blood

Date
Field
Changed From
Changed To
19th August 2024
Method

The 3 specimens should collected at 3 different times. Register on 3 lab numbers.

The 3 specimens should collected at 3 different times. 

All three samples from a single patient need to be registered under only one episode number. Please label three tubes with the same container label.


 Recent changes for Flavivirus Serology

Recent changes for Flavivirus Serology

Date
Field
Changed From
Changed To
1st February 2023
Alternative names

Dengue fever serology, Kunjin serology, Murray Valley Encephalitis serology

Dengue fever serology, Kunjin serology, Murray Valley Encephalitis serology, Japanese B encephalitis

Request Group

SDENG, OPCR, (SMVE, SJBE)

SDENG, SMVE, SJBE

31st January 2023
Preferred Specimen Type

Blood

Blood
Serum

Preferred Container Type

EDTA

EDTA
Serum tube with gel

31st January 2023
Request Group

OPCR

SDENG, OPCR, (SMVE, SJBE)

Notes

Procedure detects flaviviruses including Murray Valley encephalitis, dengue and kunjin viruses

PCR testing detects flaviviruses including Murray Valley encephalitis, dengue and kunjin viruses. Dengue specific serology tests for IgG, IgM, and NS1 antigen


 Recent changes for Gastrin

Recent changes for Gastrin

Date
Field
Changed From
Changed To
14th June 2024
External Laboratory

Sydney South West Pathology Service(RPA)

Dorevitch Pathology

12th June 2024
External Laboratory

St Vincents Hospital

Sydney South West Pathology Service(RPA)


 Recent changes for Helicobacter pylori Breath Test

Recent changes for Helicobacter pylori Breath Test

Date
Field
Changed From
Changed To
3rd January 2024
External Laboratory

Monash Pathology

3rd January 2024
Notes

Arrangements can be made through Microbiology, Monash Medical Centre


 Recent changes for Helicobacter pylori Serology

Recent changes for Helicobacter pylori Serology

Date
Field
Changed From
Changed To
27th October 2023
External Laboratory

Victorian Infectious Diseases Reference Laboratory (V.I.D.R.L)

Method

 Contact VIDRL 9342 2649/9342 2650.


 Recent changes for Hepatitis B Viral Load

Recent changes for Hepatitis B Viral Load

Date
Field
Changed From
Changed To
2nd February 2023
Processing Instructions

Perfomed by Abbott Alinity M

Method

Performed by Abbott Alinity M

2nd February 2023
Assay name

Hepatitis B Quantitation

Hepatitis B Viral Load

Alternative names

Hepatitis B Viral Load

Hepatitis B Viral Load, Hep B

Laboratory

Referred Test

Microbiology

Request Group

HEPBVL

HBVL

Processing Instructions

Contact VIDRL 9342 9615

Perfomed by Abbott Alinity M

External Laboratory

Victorian Infectious Diseases Reference Laboratory (V.I.D.R.L)


 Recent changes for Hepatitis Serology

Recent changes for Hepatitis Serology

Date
Field
Changed From
Changed To
25th September 2024
Processing Instructions

Virus/Test

Test codes Ordered

Notes

Hepatitis A

Hepatitis A IgM

HAM

For acute Hep A

Hepatitis A total

HAV

For previous infection/vaccination

Hepatitis A PCR

HEPAR

For acute Hep A

Hepatitis B

Hepatitis B surface antigen

HBSAG

For acute infection

Hepatitis B surface antibody

HBSAB

For vaccination status

Hepatitis B core antibody

HBCORA

For previous Hep B infection

Hepatitis B core IgM

HBCORM

For acute infection

Hepatitis B “e” antigen/antibody

HEPBE

For Hep B monitoring

Hepatitis B viral load

HBVL

For Hep B monitoring

Hepatitis C

Hepatitis C antibody

HEPC

For Hep C status (acute or chronic)

Hepatitis C PCR

HEPCR

For Hep C status (acute or chronic)

Hepatitis C viral load

HEPCVL

Hep C monitoring

Hepatitis C genotype

HEPCG

Hep C monitoring

Hepatitis D

Hepatitis D antibody

HEPDAB

Hepatitis D status

Hepatitis D PCR

HEPDR

Hepatitis D status

Hepatitis E

Hepatitis E antibody

HEPEG

Hepatitis E status

Method

Virus/Test

Test codes Ordered

Notes

Hepatitis A

Hepatitis A IgM

HAM

For acute Hep A

Hepatitis A total

HAV

For previous infection/vaccination

Hepatitis A PCR

HEPAR

For acute Hep A

Hepatitis B

Hepatitis B surface antigen

HBSAG

For acute infection

Hepatitis B surface antibody

HBSAB

For vaccination status

Hepatitis B core antibody

HBCORA

For previous Hep B infection

Hepatitis B core IgM

HBCORM

For acute infection

Hepatitis B “e” antigen/antibody

HEPBE

For Hep B monitoring

Hepatitis B viral load

HBVL

For Hep B monitoring

Hepatitis C

Hepatitis C antibody

HEPC

For Hep C status (acute or chronic)

Hepatitis C PCR

HEPCR

For Hep C status (acute or chronic)

Hepatitis C viral load

HEPCVL

Hep C monitoring

Hepatitis C genotype

HEPCG

Hep C monitoring

Hepatitis D

Hepatitis D antibody

HEPDAB

Hepatitis D status

Hepatitis D PCR

HEPDR

Hepatitis D status

Hepatitis E

Hepatitis E antibody

HEPEG

Hepatitis E status

Notes

Hepatitis testing – Which test to order?

1. Principles of hepatitis testing


  Consider the incubation periods:

Hepatitis A: 2 - 6 weeks

Hepatitis B: 1 - 6 months

Hepatitis C: 15 days - 5 months

  Types of antibodies:

IgM is detected in recent infection and lasts for about 3 months

IgG alone occurs with past infection, carrier states and vaccination

IgM & IgG occur together in recent infection

2. The jaundiced patient - ?Acute (infectious) hepatitis


  Is this Hepatitis A, B or C?

  Also consider:

EBV, CMV

Non-infectious causes of jaundice (biliary obstruction, medications, alcohol)

3. Testing for acute hepatitis


  HBsAg (hepatitis B surface antigen)

Occurs 2-6 weeks before onset of symptoms

If HBsAg detected, request HBcIgM (hepatitis B core IgM antibody - usually present at onset of symptoms).

  HAV IgM

Occurs with onset of abnormal LFTs

  HCV Ab / Anti-HCV

Present at onset of symptoms in 50 -70% patients

Occurs by 20 weeks in 95% patients

If negative early, repeat if no other cause found

4. Antenatal hepatitis screen


  HBsAg - To detect maternal chronic hepatitis B infection (‘carrier’)

  (HCV antibody only if requested)
 

5. Post Vaccination Check


Hepatitis B vaccination

Check HBsAb (Anti-HBs, hepatitis B surface antibody)

Timing: 4 weeks after 3rd vaccination

If negative, consider checking for HBsAg (hepatitis B surface antigen) carriage

Hepatitis A vaccination

Anti-HAV Total antibody

  Note - There is no hepatitis C vaccination available currently
 

6. Blood or body fluid exposure (eg. needlestick injury / mucosal splash)


  Source (eg. patient):

HBsAg, HCV Ab (Anti-HCV), HIV Ab (Anti-HIV)

  Recipient (eg. healthcare worker):

HBsAb (Anti-HBs) + baseline LFTs if ‘Source’ hepatitis serology positive

Store serum for 2 years

7. Possible hepatitis B ‘carrier’ (chronic hepatitis B infection)

Check HBsAg

If HBsAg detected then check

- HBeAg and HBeAb (Anti-HBe)
- HBV DNA

8. Possible chronic hepatitis C infection

Check HCV Ab (Anti-HCV)

If detected, then check Hep C PCR

9. Tests for patients at risk of blood borne viruses

HBsAg:

If negative check HBcAb (Anti-HBc, hepatitis B core antibody) for previous infection

If detected check HBeAg, HBeAb (Anti-HBe) & HBV DNA to assess infectivity

HCV Ab (Anti-HCV): If detected, check Hep C PCR

Anti-HAV Total antibody: If at risk of hepatitis A prior to immunisation (eg injecting drug users, men who have sex with men).

10. GLOSSARY

10.1 Hepatitis A
HAV Hepatitis A virus
HAV IgM Hepatitis A IgM antibody; Recent infection with Hepatitis A
HAV Total Ab Hepatitis A total antibody; Detects both IgG and IgM antibody
  - Immunity to hepatitis A: post-infection or vaccination (IgG component positive)
  - Will be positive in acute hepatitis A infection (IgM +/- IgG components positive – check HAV IgM if recent infection is suspected)

 

10.2 Hepatitis B
HBV Hepatitis B virus
HBsAg Hepatitis B surface antigen; Indicates virus present (acute infection or chronic ‘carrier’ state
HBsAb/Anti-HBs Hepatitis B surface antibody; Immune to Hepatitis B, post-vaccination or post-infection
HBcIgM/Anti-HBcIgM Hepatitis B core IgM; Recent hepatitis B infection
HBcAb/Anti-HBc Hepatitis B core antibody; Past hepatitis B infection or chronic infection/’carrier’ if HBsAg + . (If recent infection suspected, request HBcIgM).
HBeAg Hepatitis B e antigen; Relatively more infectious
HBeAb/Anti-HBe Hepatitis B e antibody; Less infectious
HBV DNA Hepatitis B viral DNA; Marker of infectivity, used for planning and monitoring treatment
10.3 Hepatitis C
HCV Hepatitis C virus
HCV Ab/Anti-HCV Hepatitis C antibody; Current or past infection with hepatitis C
Hep C PCR Hepatitis C polymerase chain reaction; Evidence of hepatitis C RNA - current infection with hepatitis C
  There is no HCV IgM test available. Hepatitis C genotyping is only available for hepatologists planning treatment

 

 

 
   11. Any Questions?

Call the Core Laboratory 9895 3471 and speak to the Senior Scientist.


Compiled by Dr Mary O'Reilly, Head of Eastern Health Infectious Diseases & Infection Control.

 

Hepatitis testing – Which test to order?

1. Principles of hepatitis testing


  Consider the incubation periods:

Hepatitis A: 2 - 6 weeks

Hepatitis B: 1 - 6 months

Hepatitis C: 15 days - 5 months

  Types of antibodies:

IgM is detected in recent infection and lasts for about 3 months

IgG alone occurs with past infection, carrier states and vaccination

IgM & IgG occur together in recent infection

2. The jaundiced patient - ?Acute (infectious) hepatitis


  Is this Hepatitis A, B or C?

  Also consider:

EBV, CMV

Non-infectious causes of jaundice (biliary obstruction, medications, alcohol)

3. Testing for acute hepatitis


  HBsAg (hepatitis B surface antigen)

Occurs 2-6 weeks before onset of symptoms

If HBsAg detected, request HBcIgM (hepatitis B core IgM antibody - usually present at onset of symptoms).

  HAV IgM

Occurs with onset of abnormal LFTs

  HCV Ab / Anti-HCV

Present at onset of symptoms in 50 -70% patients

Occurs by 20 weeks in 95% patients

If negative early, repeat if no other cause found

4. Antenatal hepatitis screen


  HBsAg - To detect maternal chronic hepatitis B infection (‘carrier’)

  (HCV antibody only if requested)
 

5. Post Vaccination Check


Hepatitis B vaccination

Check HBsAb (Anti-HBs, hepatitis B surface antibody)

Timing: 4 weeks after 3rd vaccination

If negative, consider checking for HBsAg (hepatitis B surface antigen) carriage

Hepatitis A vaccination

Anti-HAV Total antibody

  Note - There is no hepatitis C vaccination available currently
 

6. Blood or body fluid exposure (eg. needlestick injury / mucosal splash)


  Source (eg. patient):

HBsAg, HCV Ab (Anti-HCV), HIV Ab (Anti-HIV)

  Recipient (eg. healthcare worker):

HBsAb (Anti-HBs) + baseline LFTs if ‘Source’ hepatitis serology positive

Store serum for 2 years

7. Possible hepatitis B ‘carrier’ (chronic hepatitis B infection)

Check HBsAg

If HBsAg detected then check

- HBeAg and HBeAb (Anti-HBe)
- HBV DNA

8. Possible chronic hepatitis C infection

Check HCV Ab (Anti-HCV)

If detected, then check Hep C PCR

9. Tests for patients at risk of blood borne viruses

HBsAg:

If negative check HBcAb (Anti-HBc, hepatitis B core antibody) for previous infection

If detected check HBeAg, HBeAb (Anti-HBe) & HBV DNA to assess infectivity

HCV Ab (Anti-HCV): If detected, check Hep C PCR

Anti-HAV Total antibody: If at risk of hepatitis A prior to immunisation (eg injecting drug users, men who have sex with men).

10. GLOSSARY

10.1 Hepatitis A
HAV Hepatitis A virus
HAV IgM Hepatitis A IgM antibody; Recent infection with Hepatitis A
HAV Total Ab Hepatitis A total antibody; Detects both IgG and IgM antibody
  - Immunity to hepatitis A: post-infection or vaccination (IgG component positive)
  - Will be positive in acute hepatitis A infection (IgM +/- IgG components positive – check HAV IgM if recent infection is suspected)

 

10.2 Hepatitis B
HBV Hepatitis B virus
HBsAg Hepatitis B surface antigen; Indicates virus present (acute infection or chronic ‘carrier’ state
HBsAb/Anti-HBs Hepatitis B surface antibody; Immune to Hepatitis B, post-vaccination or post-infection
HBcIgM/Anti-HBcIgM Hepatitis B core IgM; Recent hepatitis B infection
HBcAb/Anti-HBc Hepatitis B core antibody; Past hepatitis B infection or chronic infection/’carrier’ if HBsAg + . (If recent infection suspected, request HBcIgM).
HBeAg Hepatitis B e antigen; Relatively more infectious
HBeAb/Anti-HBe Hepatitis B e antibody; Less infectious
HBV DNA Hepatitis B viral DNA; Marker of infectivity, used for planning and monitoring treatment
10.3 Hepatitis C
HCV Hepatitis C virus
HCV Ab/Anti-HCV Hepatitis C antibody; Current or past infection with hepatitis C
Hep C PCR Hepatitis C polymerase chain reaction; Evidence of hepatitis C RNA - current infection with hepatitis C
  There is no HCV IgM test available. Hepatitis C genotyping is only available for hepatologists planning treatment

 

 

 
   11. Any Questions?

Call the Core Laboratory 9895 3471 and speak to the Senior Scientist.

25th September 2024
Request Group

ACHEP

see table below

Processing Instructions

Virus/Test

Test codes Ordered

Notes

Hepatitis A

Hepatitis A IgM

HAM

For acute Hep A

Hepatitis A total

HAV

For previous infection/vaccination

Hepatitis A PCR

HEPAR

For acute Hep A

Hepatitis B

Hepatitis B surface antigen

HBSAG

For acute infection

Hepatitis B surface antibody

HBSAB

For vaccination status

Hepatitis B core antibody

HBCORA

For previous Hep B infection

Hepatitis B core IgM

HBCORM

For acute infection

Hepatitis B “e” antigen/antibody

HEPBE

For Hep B monitoring

Hepatitis B viral load

HBVL

For Hep B monitoring

Hepatitis C

Hepatitis C antibody

HEPC

For Hep C status (acute or chronic)

Hepatitis C PCR

HEPCR

For Hep C status (acute or chronic)

Hepatitis C viral load

HEPCVL

Hep C monitoring

Hepatitis C genotype

HEPCG

Hep C monitoring

Hepatitis D

Hepatitis D antibody

HEPDAB

Hepatitis D status

Hepatitis D PCR

HEPDR

Hepatitis D status

Hepatitis E

Hepatitis E antibody

HEPEG

Hepatitis E status


 Recent changes for Herpes Virus PCR

Recent changes for Herpes Virus PCR

Date
Field
Changed From
Changed To
7th September 2023
Volume (Adults)

0.3 mL

0.2 mL

Notes

Test performed is a multiplex PCR for the following viruses: Herpes simplex 1 virus (HSV-1); Herpes simplex 2 virus (HSV-2); Varicella zoster virus (VZV); Cytomegalovirus (CMV); Enterovirus (EV); human Adenovirus (hAdv). Swabs and CSF samples are performed in-house at Box Hill laboratory, other sample types are referred.

 

Test performed is a multiplex PCR for the following viruses: Herpes simplex 1 virus (HSV-1); Herpes simplex 2 virus (HSV-2); Varicella zoster virus (VZV); Cytomegalovirus (CMV); Enterovirus (EV); human Adenovirus (hAdv). Swabs and CSF samples are performed in-house at Box Hill laboratory, other sample types are referred.

CSF minimum volume for testing: 200uL/0.2mL

7th September 2023
Alternative names

CMV PCR, HSV, HSV I-II, HSV PCR, VZV and CMV NAD, VZV PCR

CMV PCR, HSV, HSV I-II, HSV PCR, VZV and CMV NAD, VZV PCR, Enterovirus PCR, Adenovirus PCR

Laboratory

Referred Test

Microbiology

Request Group

HPCR

HPCR, (ENTPCR, ADEPCR)

Preferred Specimen Type

Cerebrospinal Fluid
Fluid
Tissue
Nasopharyngeal swab
Blood

Swab
Cerebrospinal Fluid
Tissue
Nasopharyngeal swab
Respiratory samples

Optional Specimen Type

Respiratory samples

Blood

External Laboratory

Monash Pathology

External Transport Instructions

Tests included in Monash PCR - Herpes simplex 1 virus, Herpes simplex 2 virus, Varicella zoster virus, Cytomegalovirus, Enterovirus (swabs only), Adenovirus (not faeces)

Specimens tested at Monash-

Swabs (dry or in UTM), Sterile fluids, Respiratory samples, Urine.

Specimens anticoagulated with heparin are unsuitable as heparin inhibits PCR

For other specimens - refer to VIDRL. Tissue, CSF, saliva, serum, Plasma (ACD or EDTA),

If  CSF Herpes and Enterovirus PCR -send to VIDRL.

Refer to Referred Molecular Test Requests WORK-MI-90

Specimens tested at Box Hill - Swabs (dry or in UTM), CSF

Specimens from other sites are referred to VIDRL for testing.

 

 

 

Method

Contact Monash Pathology 9594 4532 or if no answer try Bacteriology 9594 4565 as there is someone rostered 24/7

Tested M, W, F

Routine runs are performed Monday and Thursday. Additional runs for urgent CSF samples are perfomed after discussion with the Clinical Microbiologist.

Notes

This test detects Herpes Simplex Virus 1(HSV-1), Herpes Simplex Virus 2 (HSV-2), Varicella zoster virus (VZV) and Cytomegalovirus (CMV).

 

Test performed is a multiplex PCR for the following viruses: Herpes simplex 1 virus (HSV-1); Herpes simplex 2 virus (HSV-2); Varicella zoster virus (VZV); Cytomegalovirus (CMV); Enterovirus (EV); human Adenovirus (hAdv). Swabs and CSF samples are performed in-house at Box Hill laboratory, other sample types are referred.

 


 Recent changes for Histopathology

Recent changes for Histopathology

Date
Field
Changed From
Changed To
20th October 2023
Processing Instructions

During Business Hours: all Fresh Tissue for histopathology must be brought to the attention of an Anatomical Pathologist in the first instance. After Hours: All Fresh Tissue specimens (with the exception of “products of conception” – including placenta)  the on-call Pathologist must be contacted for further instructions. Products of conception including placenta can be stored in the fridge until the next working day.

During Business Hours (0800-1630hours): ALL Fresh Tissue for histopathology must be brought to the attention of an Anatomical Pathologist in the first instance by the receipting/accepting laboratory. After Hours: All Fresh Tissue specimens (with the exception of “products of conception” – including placenta)  the on-call Pathologist must be contacted for further instructions. Products of conception including placenta can be stored in the fridge until the next working day.


 Recent changes for Kleihauer stain

Recent changes for Kleihauer stain

Date
Field
Changed From
Changed To
8th August 2023
Alternative names

Kleihauer test

Kleihauer test, FMH (feto-maternal Haemorrhage)

Request Group

KL

FMH


 Recent changes for Leucocyte Immunophenotyping

Recent changes for Leucocyte Immunophenotyping

Date
Field
Changed From
Changed To
29th July 2024
Collection & Request Instructions

Transport specimen at Room Temperature to lab

Sample store at Room temperature. Samples are not stable for more than 24 hours. Hence they must be received by the Flow Cytometry lab at Box Hill within normal business hours Monday to Friday.

Cut-off for outpatient sample collection on Fridays is at 11.30 AM and MUST reach the laboratory before 2.00PM.

The panel of markers used will be appropriate to the panel selected and the clinical comments supplied , or as arranged by prior consultation

Transport specimen at Room Temperature to lab

Sample store at Room temperature.

Blood samples for oncology phenotyping  should preferably be maintained at room temperature on the day that they are collected, but if not processed that day, refrigeration for up to 48-72 hours is also acceptable. 

Cut-off for outpatient sample collection on Fridays is at 11.30 AM and MUST reach the laboratory before 2.00PM.

The panel of markers used will be appropriate to the panel selected and the clinical comments supplied , or as arranged by prior consultation


 Recent changes for Lymphocyte subsets

Recent changes for Lymphocyte subsets

Date
Field
Changed From
Changed To
10th July 2024
Frequency

Daily

Mon-Fri


 Recent changes for Malarial Parasites

Recent changes for Malarial Parasites

Date
Field
Changed From
Changed To
8th March 2024
Alternative names

Thick and Thin films

Malaria parasite investigation Thick and Thin films

Processing Instructions

  • Clinical history including details of overseas travel and prophylaxis required
  • An FBE is performed at the same time
  • ICT test (rapid whole blood immunochromatographic test) for the qualitative detection of Plasmodium falciparum and Plasmodium vivax antigens is performed in addition to microscopic examination.

Clinical history including details of overseas travel and prophylaxis required

An FBE is performed at the same time

ICT test (rapid whole blood immunochromatographic test) for the qualitative detection of Plasmodium falciparum and Plasmodium vivax antigens is performed in addition to microscopic examination.

Notes

 

 

 

 


 Recent changes for Measles Serology

Recent changes for Measles Serology

Date
Field
Changed From
Changed To
18th January 2023
Laboratory

Microbiology

Biochemistry

Request Group

SMEA

MEA

Frequency

Daily

Twice weekly


 Recent changes for Methotrexate

Recent changes for Methotrexate

Date
Field
Changed From
Changed To
1st February 2023
Laboratory

Referred Test

Biochemistry

Collection & Request Instructions

Send ASAP (within 24 hrs, 7 days a week). Contact reference laboratory prior to sending the sample.

Testing performed on an as needs basis. 

External Laboratory

Peter MacCallum Cancer Institute

Method

Hand deliover samples to Biochemistry DO NOT load onto the 8100


 Recent changes for Mumps Serology

Recent changes for Mumps Serology

Date
Field
Changed From
Changed To
18th January 2023
Laboratory

Microbiology

Biochemistry

Request Group

SMUM

MUM

Frequency

Daily

Twice weekly


 Recent changes for Muscle Biopsy

Recent changes for Muscle Biopsy

Date
Field
Changed From
Changed To
2nd February 2024
Collection & Request Instructions

Note: This is an URGENT send out test.

Laboratory hours are 9am - 3pm, Monday - Friday.

Specimen must arrive at Alfred Pathology by 4pm.

 

Note: This is an URGENT send out test.

Laboratory hours are 9am - 5pm, Monday - Friday.

Specimens need to be delivered to Leve4 Specimen Reception by 3pm as the specimen must arrive at Alfred Pathology by 4pm.

 

30th December 2022
Collection & Request Instructions

Note: This is an URGENT send out test.

Laboratory hours are 9am - 3pm, Monday - Friday.

 

Note: This is an URGENT send out test.

Laboratory hours are 9am - 3pm, Monday - Friday.

Specimen must arrive at Alfred Pathology by 4pm.

 

External Transport Instructions

Place the specimen in an esky with ice cubes and dispatch immediately.

Place the specimen in an esky with ice cubes and dispatch immediately. Must arrive at Alfred by 4pm.

30th December 2022
Collection & Request Instructions

Note: This is an URGENT send out test.

Laboratory hours are 9am - 5pm, Monday - Friday.

 

Note: This is an URGENT send out test.

Laboratory hours are 9am - 3pm, Monday - Friday.

 


 Recent changes for Neonatal Blood Group Serology

Recent changes for Neonatal Blood Group Serology

Date
Field
Changed From
Changed To
8th March 2024
Alternative names

Neonatal Group & DAT Neonatal Group, Screen and DAT

Request Group

BGN

BGN, GPHN

Collection & Request Instructions

Cord blood or heelprick collection required

Cord blood or heelprick collection required

Must be accompanied by a Blood Bank request form with the declaration signed, timed and dated. The blood tube must also be signed, dated and timed; matching the request slip exactly.

Notes

Includes Neonatal ABO & Rh(D) Blood Group and Direct Coombs TestCord blood or heelprick collection required

Includes Neonatal ABO & Rh(D) Blood Group and Direct Coombs

Cord blood or heelprick collection required. 


 Recent changes for Non Invasive Prenatal Analysis (NIPA)

Recent changes for Non Invasive Prenatal Analysis (NIPA)

Date
Field
Changed From
Changed To
9th July 2024
Alternative names

ffDNA

Request Group

BBREF, RCAG

External Laboratory

Australian Red Cross Blood Service - Reference Red Cell Laboratory

9th July 2024
Laboratory

Unassigned

Referred Test

Collection & Request Instructions

Due to the samples short time limit:

Sample MUST be collected Monday to Wednesday only.

Samples MUST reach BHH Lab by 10am on those days.

Any samples collected outside of these times may be rejected and a recollection asked for.

Processing Instructions

Keep at Room Temperature

External Transport Instructions

Must arrive in QLD within 36 hours on collection

Method

Samples must arrive in QLD within 36 hours of collection.

Samples sent to:  Australian Red Cross Lifeblood QLD

                           44 Musk Ave

                            Kelvin Grove QLD 4059

Samples to be packed as Ambient by an IATA certified person  

Notes

Samples must arrive in QLD within 36 hours of collection.

Samples sent to:  Australian Red Cross Lifeblood QLD

                           44 Musk Ave

                            Kelvin Grove QLD 4059

  

 


 Recent changes for Plasma Cell Flow Cytometry

Recent changes for Plasma Cell Flow Cytometry

Date
Field
Changed From
Changed To
10th July 2024
Frequency

Daily

Mon-Fri

Notes

Samples must be marked 'URGENT', must reach the laboratory as soon as possible. 

All out-of-hours testing requires notification.

Time and date of collection must be recorded on request form.

Whole blood - 1 x EDTA sample, do not spin. Store at room temperature. An FBE and BLOOD FILM must also be requested,  and needs a separate EDTA sample.

Bone marrow aspirate - Sample into  EDTA tube

Tissue - Fresh (if to be shared with other departments for other tests eg. Histopathology or Microbiology) or RPMI fluid (especially if specimen is taken out of hours). This fluid is obtainable from: BH Lab 9895 3884, MH Lab: 9871 3572 or AH Lab: 9764 6136.

CSF/other fluids

Depending on the tests requested, 3-4 separate tubes will need to be provided. Note that the tubes are numbered so that order of collection can be identified – this order should be carefully followed, so that the optimal sample can be used for the requested tests. It is also important to consider the tests that are required, as this will determine how much CSF is needed in each tube. See the matrix below for details.

TUBE 1 is used for Biochemistry and Flow Cytometry. (Centrifuged in the lab – the supernatant is used for Biochemistry analysis (glucose, protein) and the cellular pellet will be used for flow cytometry if required). If tube 3 is bloodstained, take an aliquot for microbiology.

TUBE 2 is used for Cytology

TUBE 3 is for Microbiological analysis (cell count, Gram stain and culture) and any further infectious testing (e.g. viral PCR, mycobacterial PCR and culture, cryptococcal antigen).

TUBE 4 will be required only for;

(a) Creutzfeld-Jacob Disease (CJD) testing OR

(b) Xanthochromia analysis (wrap the tube in foil to prevent sample deterioration due to light).

 

TESTS REQUIRED

MINIMUM REQUIRED VOLUME (mL)

TUBE 1

TUBE 2

TUBE 3

TUBE 4

CHEMISTRY

1.0

 

ADD FLOW CYTOMETRY

Minimum 5.0-7.0

 

 

 

CYTOLOGY

 

1.0-3.0

 

 

MICROBIOLOGY

 

 

1.0-2.0

 

ADD OTHER INFECTIOUS MARKERS

 

 

add 2.0- 5.0-

 

ADD MYCOBACTERIAL CULTURE

 

 

Add 6.0-10.00

 

ADD CJD

 

 

 

1.0

ADD XANTHOCHROMIA

 

 

 

1.0 (foil)

 

Note, the ability to add further tests to a previously collected sample is dependent upon the volume provided. Also, many tests (flow cytometry, cytology) can only be performed on fresh specimens.

 

 

 

Samples must be marked 'URGENT', must reach the laboratory as soon as possible. 

All out-of-hours testing requires notification.

Time and date of collection must be recorded on request form.

Whole blood - 1 x EDTA sample, do not spin. Store at room temperature. An FBE and BLOOD FILM must also be requested,  and needs a separate EDTA sample.

Bone marrow aspirate - Sample into  EDTA tube

Tissue - Fresh (if to be shared with other departments for other tests eg. Histopathology or Microbiology) or RPMI fluid (especially if specimen is taken out of hours). This fluid is obtainable from: BH Lab 9895 3884, MH Lab: 9871 3572 or AH Lab: 9764 6136.

CSF/other fluids

Depending on the tests requested, 3-4 separate tubes will need to be provided. Note that the tubes are numbered so that order of collection can be identified – this order should be carefully followed, so that the optimal sample can be used for the requested tests. It is also important to consider the tests that are required, as this will determine how much CSF is needed in each tube. See the matrix below for details.

TUBE 1 is used for Biochemistry and Flow Cytometry. (Centrifuged in the lab – the supernatant is used for Biochemistry analysis (glucose, protein) and the cellular pellet will be used for flow cytometry if required). If tube 3 is bloodstained, take an aliquot for microbiology.

TUBE 2 is used for Cytology

TUBE 3 is for Microbiological analysis (cell count, Gram stain and culture) and any further infectious testing (e.g. viral PCR, mycobacterial PCR and culture, cryptococcal antigen).

TUBE 4 will be required only for;

(a) Creutzfeld-Jacob Disease (CJD) testing OR

(b) Xanthochromia analysis (wrap the tube in foil to prevent sample deterioration due to light).

 

TESTS REQUIRED

MINIMUM REQUIRED VOLUME (mL)

TUBE 1

TUBE 2

TUBE 3

TUBE 4

CHEMISTRY

1.0

 

ADD FLOW CYTOMETRY

Minimum 5.0-7.0

 

 

 

CYTOLOGY

 

1.0-3.0

 

 

MICROBIOLOGY

 

 

1.0-2.0

 

ADD OTHER INFECTIOUS MARKERS

 

 

add 2.0- 5.0-

 

ADD MYCOBACTERIAL CULTURE

 

 

Add 6.0-10.00

 

ADD CJD

 

 

 

1.0

ADD XANTHOCHROMIA

 

 

 

1.0 (foil)

 

Note, the ability to add further tests to a previously collected sample is dependent upon the volume provided. Also, many tests (flow cytometry, cytology) can only be performed on fresh specimens.

 

 

 


 Recent changes for Plasma Cell Flow Cytometry Panel

Recent changes for Plasma Cell Flow Cytometry Panel

Date
Field
Changed From
Changed To
8th July 2024
Assay name

Leucocyte Immunophenotyping

Plasma Cell Flow Cytometry Panel

Request Group

LYMP, LEUK

Flow

Volume (Adults)

1 mL

Preferred Container Type

EDTA
Sterile Jar

EDTA
Sterile Jar
CSF

Collection & Request Instructions

Sample store at Room temperature. Samples are not stable for more than 24 hours. Hence they must be received by the Flow Cytometry lab at Box Hill within normal business hours Monday to Friday.

Cut-off for outpatient sample collection on Fridays is at 11.30 AM and MUST reach the laboratory before 4.00PM.

Flow cytometric analysis of cells stained by immunofluorescence with a range of antibodies against lymphoid and myeloid markers.

The panel of markers used will be appropriate to the panel selected and the clinical comments supplied , or as arranged by prior consultation

Sample store at Room temperature. Samples are not stable for more than 24 hours. Hence they must be received by the Flow Cytometry lab at Box Hill within normal business hours Monday to Friday.

Cut-off for outpatient sample collection on Fridays is at 11.30 AM and MUST reach the laboratory before 2.00PM.

Flow cytometric analysis of cells stained by immunofluorescence with a range of antibodies against lymphoid and myeloid markers.

The panel of markers used will be appropriate to the panel selected and the clinical comments supplied , or as arranged by prior consultation

Frequency

Daily

Notes

Samples must be marked 'URGENT', must reach the laboratory as soon as possible. 

All out-of-hours testing requires notification.

Time and date of collection must be recorded on request form.

Whole blood - 1 x EDTA sample, do not spin. Store at room temperature. An FBE and BLOOD FILM must also be requested,  and needs a separate EDTA sample.

Bone marrow aspirate - Sample into  EDTA tube

TissueFresh (if to be shared with other departments for other tests eg. Histopathology or Microbiology) or RPMI fluid (especially if specimen is taken out of hours). This fluid is obtainable from: BH Lab 9895 3884, MH Lab: 9871 3572 or AH Lab: 9764 6136.

CSF/other fluids

Depending on the tests requested, 3-4 separate tubes will need to be provided. Note that the tubes are numbered so that order of collection can be identified – this order should be carefully followed, so that the optimal sample can be used for the requested tests. It is also important to consider the tests that are required, as this will determine how much CSF is needed in each tube. See the matrix below for details.

TUBE 1 is used for Biochemistry and Flow Cytometry. (Centrifuged in the lab – the supernatant is used for Biochemistry analysis (glucose, protein) and the cellular pellet will be used for flow cytometry if required). If tube 3 is bloodstained, take an aliquot for microbiology.

TUBE 2 is used for Cytology

TUBE 3 is for Microbiological analysis (cell count, Gram stain and culture) and any further infectious testing (e.g. viral PCR, mycobacterial PCR and culture, cryptococcal antigen).

TUBE 4 will be required only for;

(a) Creutzfeld-Jacob Disease (CJD) testing OR

(b) Xanthochromia analysis (wrap the tube in foil to prevent sample deterioration due to light).

 

TESTS REQUIRED

MINIMUM REQUIRED VOLUME (mL)

TUBE 1

TUBE 2

TUBE 3

TUBE 4

CHEMISTRY

1.0

 

 

 

ADD FLOW CYTOMETRY

Minimum 5.0-7.0

 

 

 

CYTOLOGY

 

1.0-3.0

 

 

MICROBIOLOGY

 

 

1.0-2.0

 

ADD OTHER INFECTIOUS MARKERS

 

 

add 2.0- 5.0-

 

ADD MYCOBACTERIAL CULTURE

 

 

Add 6.0-10.00

 

ADD CJD

 

 

 

1.0

ADD XANTHOCHROMIA

 

 

 

1.0 (foil)

 

Note, the ability to add further tests to a previously collected sample is dependent upon the volume provided. Also, many tests (flow cytometry, cytology) can only be performed on fresh specimens.

 

Other specialised testing (e.g. oligoclonal bands) will be performed using the supplied samples.

Xanthochromia and CJD analysis cannot be performed on a blood-stained sample

Samples must be marked 'URGENT', must reach the laboratory as soon as possible. 

All out-of-hours testing requires notification.

Time and date of collection must be recorded on request form.

Whole blood - 1 x EDTA sample, do not spin. Store at room temperature. An FBE and BLOOD FILM must also be requested,  and needs a separate EDTA sample.

Bone marrow aspirate - Sample into  EDTA tube

TissueFresh (if to be shared with other departments for other tests eg. Histopathology or Microbiology) or RPMI fluid (especially if specimen is taken out of hours). This fluid is obtainable from: BH Lab 9895 3884, MH Lab: 9871 3572 or AH Lab: 9764 6136.

CSF/other fluids

Depending on the tests requested, 3-4 separate tubes will need to be provided. Note that the tubes are numbered so that order of collection can be identified – this order should be carefully followed, so that the optimal sample can be used for the requested tests. It is also important to consider the tests that are required, as this will determine how much CSF is needed in each tube. See the matrix below for details.

TUBE 1 is used for Biochemistry and Flow Cytometry. (Centrifuged in the lab – the supernatant is used for Biochemistry analysis (glucose, protein) and the cellular pellet will be used for flow cytometry if required). If tube 3 is bloodstained, take an aliquot for microbiology.

TUBE 2 is used for Cytology

TUBE 3 is for Microbiological analysis (cell count, Gram stain and culture) and any further infectious testing (e.g. viral PCR, mycobacterial PCR and culture, cryptococcal antigen).

TUBE 4 will be required only for;

(a) Creutzfeld-Jacob Disease (CJD) testing OR

(b) Xanthochromia analysis (wrap the tube in foil to prevent sample deterioration due to light).

 

TESTS REQUIRED

MINIMUM REQUIRED VOLUME (mL)

TUBE 1

TUBE 2

TUBE 3

TUBE 4

CHEMISTRY

1.0

 

 

 

ADD FLOW CYTOMETRY

Minimum 5.0-7.0

 

 

 

CYTOLOGY

 

1.0-3.0

 

 

MICROBIOLOGY

 

 

1.0-2.0

 

ADD OTHER INFECTIOUS MARKERS

 

 

add 2.0- 5.0-

 

ADD MYCOBACTERIAL CULTURE

 

 

Add 6.0-10.00

 

ADD CJD

 

 

 

1.0

ADD XANTHOCHROMIA

 

 

 

1.0 (foil)

 

Note, the ability to add further tests to a previously collected sample is dependent upon the volume provided. Also, many tests (flow cytometry, cytology) can only be performed on fresh specimens.

 

Other specialised testing (e.g. oligoclonal bands) will be performed using the supplied samples.

Xanthochromia and CJD analysis cannot be performed on a blood-stained sample


 Recent changes for Plasma Free Haemoglobin

Recent changes for Plasma Free Haemoglobin

Date
Field
Changed From
Changed To
27th June 2023
Assay name

Plasma Free Heamoglobin

Plasma Free Haemoglobin

Collection & Request Instructions

Samples must be hand delivered to the lab to avoid shaking, which will falsely raise the plasma free-haemoglobin. Normal operating plasma free-haemoglobin level is < 0.10 g/dL. This is performed 24-hourly whilst on ECMO (routinely taken with the daily blood samples) according to clinical need/ECMO clinician direction.

Samples are taken by passively filling a 10mL syringe carefully from the intra-arterial line access port. Do not connect to a negative pressure “vacutainer” for sampling. The plasma free-haemoglobin collection tube is filled from the syringe after removing the lid, gently injecting blood from the syringe and then replacing the lid. No needles are required.

27th June 2023
Preferred Specimen Type

Plasma

Serum

Preferred Container Type

Serum tube with gel

Lithium heparin no gel


 Recent changes for PML:RARA, RUNX1,CBFB:MYH11 MRD/Screening

Recent changes for PML:RARA, RUNX1,CBFB:MYH11 MRD/Screening

Date
Field
Changed From
Changed To
26th July 2024
Assay name

PML:RARA, RUNX1,CBFB:MYH11 Screening

PML:RARA, RUNX1,CBFB:MYH11 MRD/Screening

Collection & Request Instructions

Samples to be kept at room temperature.

Do not spin.

Do not freeze.

Paediatric EDTA tubes cannot be used for these tests.

Samples to be kept at room temperature.

Do not spin.

Do not freeze.


 Recent changes for Procalcitonin

Recent changes for Procalcitonin

Date
Field
Changed From
Changed To
17th November 2022
Method

All PCT requests must be discussed with the Chemical Pathologist upon receipt in lab, regardless of time of day or day of week. If urgent/Taxi requiring is determined, result must be phoned to the clinician upon receipt - High Risk Result.


 Recent changes for Protein electrophoresis

Recent changes for Protein electrophoresis

Date
Field
Changed From
Changed To
9th July 2024
Laboratory

Referred Test

Biochemistry

External Laboratory

Peter MacCallum Cancer Institute

Notes

Routinely, a qualitative, interpretive report of a capillary electrophoresis is made. It is important to provide adequate clinical information with the request for these interpretations to be meaningful.

comprehensive clincial notes are essential. 

As of 14/06/2024 Serum Protein Electrophoresis performed by Sebia gel electrophoresis at Eastern Health. 


 Recent changes for Q Fever Serology

Recent changes for Q Fever Serology

Date
Field
Changed From
Changed To
23rd November 2023
External Laboratory

ICPMR (Institute of Clinical Pathology and Medical Research)

Method

 

Contact VIDRL 9342 2649 / 9342 2650

Test performed by Institute of Clinical Pathology and Medical Research (ICPMR), NSW

8th February 2023
External Laboratory

Victorian Infectious Diseases Reference Laboratory (V.I.D.R.L)


 Recent changes for Quantiferon TB-Gold

Recent changes for Quantiferon TB-Gold

Date
Field
Changed From
Changed To
13th September 2023
Alternative names

QTFN, Quantiferon TB Gold

Quantiferon, TB Gold, QTFN

Frequency

Twice weekly

Weekly


 Recent changes for RAST

Recent changes for RAST

Date
Field
Changed From
Changed To
23rd May 2023
Collection & Request Instructions

White top tube is the preferred sample.0.2ml of blood required for each allergen.

Blood collection: still can be done after skin allergy testing.

Omega-5-Gliadin, Alpha Gal and Cefaclor : serum send to Melbourne Pathology

IgG 96 Food Allergy test is not a RAST test  It is performed at  Australian Clinical Labs.This test is NOT rebatable and costs approx  $260.

White top tube is the preferred sample.0.2ml of blood required for each allergen.

Blood collection: still can be done after skin allergy testing.

RAST for Omega-5-Gliadin to be sent to Alfred Pathology, Alpha Gal to be sent to Melbourne Pathology.                               Cefaclor and ARAh2 to be sent to Dorevitch Pathology 

IgG 96 Food Allergy test is not a RAST test  It is performed at  Australian Clinical Labs.This test is NOT rebatable and costs approx  $260.

Processing Instructions

Omega-5-Gliadin: send to Melborne Pathology

IgG 96 Food Allergy test is not a RAST test  It is performed at  Australian Clinical Labs.This test is NOT rebatable and costs approx  $260.

 

IgG 96 Food Allergy test is not a RAST test  It is performed at  Australian Clinical Labs.This test is NOT rebatable and costs approx  $260.

 

Method

RAST for Omega-5-Gliadin to be sent to Alfred Pathology, Alpha Gal to be sent to Melbourne Pathology.                               Cefaclor and ARAh2 to be sent to Dorevitch Pathology 


 Recent changes for Renin - plasma

Recent changes for Renin - plasma

Date
Field
Changed From
Changed To
13th August 2024
Collection & Request Instructions

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

Renin is stable in whole blood for up to 6 hours at room temperature.

In the laboratory, spin and separate the plasma. Plasma is stable at Room Temperature for up to 2 days. 

Renin must be frozen at -70 C. if unable to test within 2 days.

Transport plasma at room temperature.

Add-on tests for Renin and Aldosterone should not be done on samples which have been previously collected or stored at 4 C.

 

 

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

Renin is stable in whole blood for up to 6 hours at room temperature.

In the laboratory, spin and separate the plasma. Plasma is stable at Room Temperature for up to 2 days. 

Renin must be frozen at -70 C. if unable to test within 2 days at the Box Hill Laboratory. 

Transport plasma at room temperature.

Add-on tests for Renin and Aldosterone should not be done on samples which have been previously collected or stored at 4 C.

 

 

13th August 2024
Collection & Request Instructions

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

In the laboratory, spin and separate the plasma immediately. Plasma is stable at Room Temperature if analysis is performed on the same day.

Renin must be frozen at -80 C. Transport plasma at room temperature (Maroondah and Angliss) until it can be placed in -80 C Freezer.(Must be done within 3-4 hours).

Add-on tests for Renin and Aldosterone should not be done on samples which have been previously collected or stored at 4 C.

Renin will not be collected at Healesville Hospital and Yarra Ranges Health Collection Rooms.

Samples from Angliss and Maroondah must be collected within business hours to allow transport to Box Hill via courier.

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

Renin is stable in whole blood for up to 6 hours at room temperature.

In the laboratory, spin and separate the plasma. Plasma is stable at Room Temperature for up to 2 days. 

Renin must be frozen at -70 C. if unable to test within 2 days.

Transport plasma at room temperature.

Add-on tests for Renin and Aldosterone should not be done on samples which have been previously collected or stored at 4 C.

 

 

Processing Instructions

Spin,seperate and freeze (-80 C), transport frozen.

Minimum plasma volume: 500 ul (1mL if aldosterone is also requested)

 

Minimum plasma volume: 500 ul (1mL if aldosterone is also requested)

Notes

Prior to testing, patients should be withdrawn from diuretics, ACE inhibitors, angiotensin II receptor antagonists, beta blockers and calcium channel blockers for 3 weeks. Patients should also be well hydrated, have had 7g/day of salt for one week and have normal plasma potassium and bicarbonate levels.

 Deliver to laboratory ASAP at room temperature

Prior to testing, patients should be withdrawn from diuretics, ACE inhibitors, angiotensin II receptor antagonists, beta blockers and calcium channel blockers for 3 weeks. Patients should also be well hydrated, have had 7g/day of salt for one week and have normal plasma potassium and bicarbonate levels.

 Deliver to laboratory at room temperature

22nd February 2024
Collection & Request Instructions

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

In the laboratory, spin and separate the plasma immediately. Plasma is stable at Room Temperature if analysis is performed on the same day.

Renin must be frozen at -80 C. Transport plasma at room temperature (Maroondah and Angliss) until it can be placed in -80 C Freezer.(Must be done within 3-4 hors).

Add-on tests for Renin and Aldosterone should not be done on samples which have been previously collected or stored at 4 C.

Renin will not be collected at Healesville Hospital and Yarra Ranges Health Collection Rooms.

 

Collection Requirements for both or either tests

Collect into 4 mL EDTA tubes at Room Temperature. Do not collect on ice

If both Renin and Aldosterone are requested together, they can be collected into the same EDTA tube

In the laboratory, spin and separate the plasma immediately. Plasma is stable at Room Temperature if analysis is performed on the same day.

Renin must be frozen at -80 C. Transport plasma at room temperature (Maroondah and Angliss) until it can be placed in -80 C Freezer.(Must be done within 3-4 hours).

Add-on tests for Renin and Aldosterone should not be done on samples which have been previously collected or stored at 4 C.

Renin will not be collected at Healesville Hospital and Yarra Ranges Health Collection Rooms.

Samples from Angliss and Maroondah must be collected within business hours to allow transport to Box Hill via courier.

23rd May 2023
Laboratory

Referred Test

Biochemistry

External Laboratory

Austin Pathology


 Recent changes for Respiratory Virus PCR

Recent changes for Respiratory Virus PCR

Date
Field
Changed From
Changed To
14th February 2023
Method

The following specimens will be referred for testing-

Sputum, Bronchial Washings, Bronchoalveolar Lavages - VIDRL

Swab specimens for Respiratory Multiplex PCR will be referred to Monash Molecular Laboratory

 

The following specimens will be referred for testing-

Sputum, Bronchial Washings, Bronchoalveolar Lavages - VIDRL

As of Feb 2023 swab specimens for Respiratory Multiplex PCR will be tested in-house.

 


 Recent changes for Respiratory Virus PCR - Extended

Recent changes for Respiratory Virus PCR - Extended

Date
Field
Changed From
Changed To
14th February 2023
Preferred Container Type

Viral Transport Media - Nasopharyngeal

Viral Transport Media - Nasopharyngeal
respiratory PCR requirements
Viral Transport Media- Nasopharyngeal

14th February 2023
Preferred Specimen Type

NTS - nose & throat swab
Swab

NTS - nose & throat swab
Respiratory samples


 Recent changes for Rickettsia spp. Screen Serology

Recent changes for Rickettsia spp. Screen Serology

Date
Field
Changed From
Changed To
23rd November 2023
Frequency

Weekly

As required

Method

Test performed by Institute of Clinical Pathology and Medical Research (ICPMR), NSW

Notes

 

Tests for Total Ab, IgM  response to Spotted fever, Typhus and Scrub Typhus groups.

 

Tests for serology response to Spotted fever, Typhus and Scrub Typhus groups.

 

8th February 2023
External Laboratory

Victorian Infectious Diseases Reference Laboratory (V.I.D.R.L)


 Recent changes for Ristocetin Co-Factor assay

Recent changes for Ristocetin Co-Factor assay

Date
Field
Changed From
Changed To
8th March 2024
Frequency

Weekly

Fortnightly


 Recent changes for Soluscopes for sterility testing

Recent changes for Soluscopes for sterility testing

Date
Field
Changed From
Changed To
23rd November 2023
Collection & Request Instructions

Soluscope should be sent to laboratory in sterile container

23rd November 2023
Preferred Specimen Type

Culture

not required

23rd November 2023
Preferred Specimen Type

not required

Culture

Preferred Container Type

Not required

Sterile Jar

23rd November 2023
Frequency

As required


 Recent changes for Stratify JCV

Recent changes for Stratify JCV

Date
Field
Changed From
Changed To
23rd May 2023
Processing Instructions

Samples are be aliquoted and frozen in the barcoded tube supplied in the JCV kit

Notes

Samples are be aliquoted and frozen in the barcoded tube supplied in the JCV kit


 Recent changes for Thiopurine Metabolites

Recent changes for Thiopurine Metabolites

Date
Field
Changed From
Changed To
3rd March 2023
Preferred Container Type

Lithium heparin no gel
EDTA

See Instructions


 Recent changes for Toxoplasma serology

Recent changes for Toxoplasma serology

Date
Field
Changed From
Changed To
18th January 2023
Request Group

STOX

TOX


 Recent changes for Tryptase

Recent changes for Tryptase

Date
Field
Changed From
Changed To
17th September 2024
Assay name

Mast Cell - Tryptase

Tryptase

Alternative names

Tryptase

Mast Cell Tryptase

Volume (Adults)

0.5 mL

Collection & Request Instructions

Stable 48 hours refrigerated,  transport frozen if unable to ensure delivery of sample to the Alfred within 48 hours of collection. .

Separate serum and store frozen - 20 degrees.

Processing Instructions

Spin, separate and freeze serum if unable to ensure delivery of sample to the Alfred within 48 hours of collection. .

Spin, separate and freeze serum

External Laboratory

Alfred Hospital

St Vincents Hospital

Frequency

Weekly

Fortnightly


 Recent changes for Typhoid

Recent changes for Typhoid

Date
Field
Changed From
Changed To
31st January 2023
Alternative names

enteric fever, Typhoid fever

enteric fever, typhoid fever

31st January 2023
Preferred Container Type

Blood Culture

Blood Culture (Adult)
Blood Culture (Paediatric)


 Recent changes for Vitamin B1

Recent changes for Vitamin B1

Date
Field
Changed From
Changed To
18th November 2022
External Laboratory

Australian Clinical Labs (formerly Healthscope)

St Vincents Hospital


 Recent changes for Vitamin B6

Recent changes for Vitamin B6

Date
Field
Changed From
Changed To
18th November 2022
External Laboratory

Australian Clinical Labs (formerly Healthscope)

St Vincents Hospital


 Recent changes for von Willebrand Screen

Recent changes for von Willebrand Screen

Date
Field
Changed From
Changed To
8th March 2024
Laboratory

Unassigned

Haematology

Frequency

Weekly

Fortnightly


 Recent changes for vWF Activty

Recent changes for vWF Activty

Date
Field
Changed From
Changed To
8th March 2024
Laboratory

Referred Test

Haematology

External Laboratory

Austin Pathology

Frequency

Weekly

Fortnightly

Pathology Handbook

Test & Collection Guide

Feedback

Eastern Health Pathology always welcomes the opportunity to improve the service we provide you.