Ampang PDF

HOSPITAL AMPANG 2021 PATHOLOGY DEPARTMENT
Handbook of Pathology Services
Pathology
Department,
Hospital Ampang
2021
[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 1

Foreword by the Director of Hospital Ampang
Hospital Ampang is a tertiary care center catering to the needs of the patients in the
Ampang and Hulu Langat district and is also the Hematology Referral Center for Malaysia
public hospitals. The laboratory also recognizes as a referral of special protein tests services to
all the hospitals in Malaysia. This entails rigorous and careful medical work for all the staffs in
the hospital to ensure that patient care and management at its best and that the quality of
medical and its supporting services are of optimal standards.
Pathology services are important and key in the swift and rapid diagnosis of patient
conditions in order that the correct and suitable treatment may be administered. Therefore, the
onus is on the Pathology Department to continue improving the standards of their service in
order that the demands and needs of the clients are met. In other words Pathology services are
one of the backbones for patient care.
The Pathology Department has taken big strides in achieving these goals by setting high
standards and by being assessed by Standards Malaysia for MS ISO 15189:2014 and by the
Malaysia Productivity Corporation for 5S. This revision of the Pathology Services Handbook is
another feather in their cap for their efforts in improving the quality of their service.
The objectives of this book are to provide excellent, committed and quality services for
the benefit of their customers and one of the good communication tools as a guideline for
customer satisfaction. It is my sincere hope that they continue to aspire and strive to meet
those goals on a daily basis. I would like to extend my congratulations and thanks to the
Pathology Head of Department, Dato’ Dr Faraizah binti Dato Abdul Karim and her team of
editorial committee members and contributors in their success of preparing, revising, editing
and eventually publishing of the Pathology Services Handbook, 6th edition.
Dr Ghazi Abd Manaf

Director
Hospital Ampang

Foreword by the Head of Pathology Department,

Hospital Ampang.
The Pathology Department Hospital Ampang always strives to deliver the best to our
clients in light of achieving the department’s vision and mission. The Pathology Service
handbook is part of our on-going initiative to satisfy the needs of the clients by providing a
clear, concise, comprehensive and informative guide on tests performed in the laboratory and
those outsourced to other reference laboratories. The book also details the list of tests and
specimen collection as well as rejection criteria so as to guide the clinicians and clients on the
intricacies of testing and what they should do in order to obtain their desired outcome.
This guideline meets the MS ISO 15189/IEC Standards to provide and communicate
information to our clients. Also, this edition of the Service Handbook is the 6th and latest edition
of the already available and older edition and it also boost a completely new format of
presenting the lists of tests as well as a very comprehensive list of specimen containers and
special instructions regarding tests performed in the laboratory and those outsourced. We
sincerely hope that this new presentation format will ease the searches of our clients who will
be using the book as a reference. This handbook will be revised every 3 years or whenever
necessary in order to update information regarding the services provided in Ministry of Health
(MOH).
This edition was re-written with a lot of effort and hard work by the Pathology Service
Handbook Editorial Board. With this in mind, I hereby extend my heartiest congratulations and
appreciation to all the committee members in the development and publication of this
handbook with tireless and determined dedication to improve the quality of service in
Pathology Department, Hospital Ampang.
Dato’ Dr Faraizah binti Dato Abdul Karim

Consultant Pathologist
Head of Pathology Department
Hospital Ampang

HANDBOOK OF
PATHOLOGY SERVICES
Sixth Edition
Pathology Department
Hospital Ampang
Advisor:
Dato’ Dr Faraizah binti Dato Abdul Karim
(Senior Consultant Hematopathologist & Head Department of Pathology)
Co-ordinator:
Dr Roslina Omar
(Chemical Pathologist)
Committee members:
Dr Rashidah Mohamed
Dr Siti Sarah bt. Mustapa
Dr Maizatul Itri bt Che Hashim
Our appreciation also goes to:
All staff of Pathology Department Hospital Ampang who directly or indirectly involved in
production of this handbook.

CONTENTS Pages
Pathology Department Oath, Vision and Mission Statements 6
A. General Operating Policies 6 – 13
B. List Of Tests 14 - 69
C. Special Test Instructions: Chemical Patology 70 – 86
D. Special Test Instructions: Medical Microbiology 87 -100
E. Special Test Instructions: General Haematology 101 - 102
F. Special Test Instructions: Blood Transfusion Service 103– 106
G. Special Test Instructions: Cytology 107 – 109
H. Special Test Instructions: Histopathology 110 – 111
I. Critical Results in Pathology Department 112 – 114
J. List Of Specimen Container/Tubes 115 – 122
K. Specimen Rejection Criteria 123 – 124
L. Special Test Request Forms 125 – 139
M. List of Pathology telephone numbers 140

PATHOLOGY DEPARTMENT OATH

We, the Pathology Department of Hospital Ampang, pledge to provide excellent, committed and
quality services for the benefit of our customers through:
1. Fair, friendly and compassionate treatment for all customers.

2. Provision of clear and complete explanations for all tests when necessary.
3. The use of affordable, appropriate and quality methods in all services provided by
competent staff.
4. Appropriate and prompt handling of all urgent specimens according to the Laboratory
Turn-Around-Time (LTAT) of the department.
5. Maintaining confidentiality and secrecy of all patients’ information.
VISION OF PATHOLOGY DEPARTMENT

To be recognized as a medical laboratory providing quality diagnostic, screening and consultancy
services.
MISSION OF PATHOLOGY DEPARTMENT

We aim to provide our community an efficient, and customer friendly service towards achieving
quality vision through a committed work force, professionalism and research.
A. GENERAL OPERATING POLICIES
1. INTRODUCTION
Pathology Department is one of the Clinical Support Services in Hospital Ampang. It provides
medical laboratory diagnostic and consultation services to the entire clinical services in the hospital
and external health facilities. The diagnostic services comprised of several discipline in medical
pathology, concerned with testing of biological samples obtained from patients and non patient
sample. The department also actively involved in the hospital activities and provides training and
research related to Pathology.
This handbook is designed to be a comprehensive guideline on the Pathology Services in Hospital

Ampang for medical practitioners and healthcare workers during their orientation to the Pathology
Services in Hospital Ampang.

This handbook is also used in the for the purpose of refreshing users on the proper collection,
packaging and transportation of specimens especially for specimens that are to be outsourced for
testing.
This handbook also provides special instructions pertaining to patient preparation for before
collecting a specimen, including type or number of specimens that are needed to be sent to the
laboratory.
This is to ensure meaningful, accurate and timely results are obtained after testing, which are
required in the management of patients.
2. LOCATION
Pathology Department is located on the second floor of the hospital building, adjacent to the IT
Department and CSSD unit. Access to the working areas in the department is limited to authorized
personnel and staff.
3. FUNCTIONS
3.1 To provide diagnostic services in the field of Chemical Pathology, Haematology, Medical
Microbiology, Histopathology, Cytopathology and Blood Transfusion Medicine. These services
are provided to Hospital Ampang, health clinics and other government agencies.
3.2 To provide advisory and consultancy services to customers in matters related to Pathology
services.
3.3 To provide training in technical and analytical skills for laboratory personnel and staff from
other hospitals, health clinics, institution of higher learning and other government agencies.
3.4 To involve in collaborative research and method development in Pathology and other
relevant clinical fields.
4. SCOPE OF SERVICES
The Department of Pathology provides the following services:
Unit Scope
1. Chemical Pathology Routine Chemistry, Endocrinology, Special Protein,
Therapeutic Drug Monitoring (TDM) and Clinical
Toxicology.
2. Haematology General Haematology and Coagulation.
3. Medical Microbiology Diagnostic Bacteriology, Serology, Immunology,

Virology screening, Parasitology and Mycology.
4. Blood Transfusion Immunohaematology and supply of blood products and
irradiated blood components.
5. Histopathology/ Outsourced to Hospital Serdang and HKL.
Cytopathology

The lists of tests offered by Pathology Department include the tests that are outsourced to:
 Hospital Kuala Lumpur Pathology Department (HKL)

 Institute of Medical Research (IMR)
 Institut Perubatan Respiratori (IPR)
 Hospital Serdang Pathology Department
 Hospital Selayang Pathology Department
 Hospital Sungai Buloh Pathology Department
 Hospital Putrajaya Pathology Department
 Makmal Kesihatan Awam Sg Buloh (MKAK)
 The Chemistry Department of Malaysia
For other location or tests, which are not listed in this book, prior arrangement and approval by the
Hospital Director is required.
For any enquiries on our services, please refer to the last page of this handbook for the telephone or
extension numbers of the laboratory units in the Pathology Department. Any written suggestions
or complaints can either be put in the suggestion box located near Counter Receiving Area of
Pathology Department or through formal letter to the Head of Pathology Department Hospital
Ampang..
5. SERVICE HOURS
Urgent Tests (Refer to page 14-69 for the list of tests) is provided as 24 hours service in:
i. Chemical Pathology & Hematology (Integrated Lab)

ii. Microbiology
iii. Blood Transfusion Laboratory
Routine Tests:
iv. Microbiology Laboratory :
- 8.00am until 5.00pm (weekdays, weekends and public holiday)
v. Integrated Laboratory:
vi. Protein Laboratory:
- 8.00am until 5.00pm (weekdays)
vii. Blood Transfusion Laboratory:

24 hours counter service for receiving specimen:

i. Common Receiving Area (CRA) – For all specimens (except for blood transfusion
specimens).
ii. Blood Transfusion Laboratory – For blood and blood components issuance and
tests.
6. QUALITY ASSURANCE & QUALITY IMPROVEMENT ACTIVITIES
The following quality assurance programs are carried out in the department:
 Internal quality control programs in all disciplines.

 External quality assurance participation
 Method validation and evaluation.
 Quality system review and audit.
 Timeliness of result by conducting turn-around-time studies.
 Customer Satisfaction Survey.
 Quality Study-Department Specific Approach
7. SAFETY MEASURES
Strict safety measures are practiced as outlined in Laboratory Safety Manual. Safety measures
should also be adhered to by all clients to ensure no potential hazards to laboratory personnel.
8. TEST REQUEST INSTRUCTIONS
8.1 Laboratory requests are made through HIS except:

i. When system is down
ii. Request from external laboratories
8.2 All tests for referral laboratory shall be accompanied by system generated PER PAT 301 or
other special forms related to the tests.
8.3 All forms must be completely filled and should be signed by the medical officer (or
specialist for certain specific outsourced test) and accompanied by properly labeled
specimens. Relevant information on clinical history, provisional diagnosis and treatment
should be provided. The type of test requested must be clearly indicated. In addition, site of
tissue/specimen taken should be stated for Medical Microbiology, Histopathology and
Cytology.
9. SPECIMEN COLLECTION INSTRUCTIONS
9.1 Specimen collected must be properly labeled

9.2 Specimen must be properly managed i.e. collect and dispatch in system before sending it to
the laboratory.

9.3 Specimen must be dispatched to the laboratory in appropriate container or blood collection
tube as specified and according to transport requirement for the test. (Refer to page 14-69
for the list of tests)
9.4 Specimen container or blood collection tube must be placed in a biohazard plastic bag with
the request form (where applicable) inserted into the pocket of the plastic bag. The pink
biohazard plastic bag is used for urgent test specimen only.
9.5 Routine test specimens can be placed into the clear biohazard plastic bag.
9.6 The blue biohazard plastic bag is mainly reserved for prioritized specimens such as during
outbreak.
9.7 Do not put samples from more than one patient into one biohazard plastic bag.
9.8 Specimen must be send immediately to the laboratory after collection either by pneumatic
tube or porter system.
9.9 Outsource specimens will be dispatched out to the respective referral centre by 9.30 am
during working days. Specimens must reach the laboratory before 9 am. Inability to comply
will result in delay of samples delivery (will be delivered to the respective laboratory on the
next working day).
10. BLOOD COLLECTION PROCEDURE
10.1 Venous blood is preferred.

10.2 To ensure consistent and accurate result, follow strictly the volume of blood required for the
type of test specified or fill blood till the mark on the label (Refer to page 115-117)
10.3 To prevent haemolysis:
 avoid collecting blood from an area of haematoma.
 the site of collection should be allowed to air dry after cleansing with 70%
isoprophyl or ethyl alcohol.
 ensure smooth venipuncture and steady flow of blood into the syringe.
 do not force blood through needle while transferring blood into collection tube.
10.4 Strict aseptic technique should be practiced when performing blood collection for culture and
sensitivity.
10.5 Draw of blood should be in a correct order beginning with blood culture followed by other
routine blood collection tubes. (Refer to page 122)
10.6 Immediately and gently mix blood collection tube by inverting several times. Do not mix
vigorously.
10.7 All clinical waste should be disposed according to standard for clinical waste management.
11 RESULTS/REPORTS
11.1 Results will be released to the LIS/CIS via Hospital Information System after
verification except for confidential result. Confidential result such as all HIV results will only
be released in a hardcopy format to the Head of Department.
11.2 During down time/system off-line, hardcopy of all results will be made available for collection.
11.3 Hardcopy report will be made available for external clients upon request, otherwise report will
be sent through email to respective laboratory hospital.
11.4 All the outsource results will be entered into LIS manually.
11.5 Results exceeding critical limit or findings will be notified to the clinician.
11.6 Any discrepancy between clinical findings and report/results should be conveyed
immediately to relevant Pathology personnel.

12 REJECTION
Please refer to page 124-125 for the rejection criteria list.
13 GENERAL WORKFLOW OF PATHOLOGY DEPARTMENT

Receive specimen from clinics/
wards
Request accepted?
Yes
No
Register and sorting of samples
Inform clinics/ wards Reject

Centrifuge specimen (if needed)
and document specimen
Distribute specimen to
respective units
Protein Integrated Blood Microbiology

lab lab transfusion lab
Outsourced services lab
to
reference
lab
Process and
Results analyze specimen
received
Validation
Results reporting
Print results (if external request :

post the results or place in the KK
pigeon-hole)
End

14 LABORATORY TURN-AROUND-TIME (LTAT)
Priority Details Expected Time After

Specimen Received
Urgent tests  Chemical Pathology (Refer page 13) 45 minutes – 1 hour
 Full Blood Count 45 minutes
 CSF Microscopic Examination, CSF ‘Bacterial 60 minutes

Antigen’ Test, BFMP1st case
( from ED)
 Emergency cross matching - first phase 20 minutes
 Safe O (uncross matched packed cell O) Immediate
 Conversion GSH to GXM 45 minutes
 Full cross matching 45 minutes
Routine tests  All Chemistry Pathology and Hematology  3 hours

specimens
 Full cross matching  2 hours
 Bacterial culture  3-7 days
 Mycology tests  14 days
 Mycobacterium culture  2-8 weeks
 FNAC and ‘Non gynecology’  1 week
Scheduled tests  Chemical Pathology, Hematology (depending  1-4 weeks

on test)
 Immunology and Virology  1 day – 3 weeks

(depending on test,
test done by batches)

15 LIST OF URGENT TESTS / AFTER OFFICE HOURS
Test Name
 Full Blood Count (FBC)
 APTT/PT/INR Ratio
 Urine Biochemistry
 Renal Profile (BUSE, Na, K, Cl and Creatinine)
 Liver Function Test ( ALP, ALT, total bilirubin, total protein and albumin)
 Blood Glucose
 Amylase
 Troponin-I
 CK
 Ammonia
 Arterial/ Venous Blood Gas (ABG/VBG)
 Serum Calcium
 Serum Magnesium
 Serum Creatinine
 Serum Salicylates
 Serum Paracetamol
 Urine Paraquat
 Serum Bilirubin-Total, Direct and Indirect (for Neonatal cases only)
 Beta HCG/Urine Pregnancy Test (for cases suspected Molar pregnancy and Ectopic
Pregnancy)
 CSF Biochemistry

B. LIST OF TESTS
Note:
i) TAT stated are based on working days . For outsource tests, TAT given is referral lab turnaround time, NOT inclusive of
estimated time taken for dispatching of sample to referral lab and the time taken for the result to be reported or printed out
in Hospital Ampang system.
ii) R: Routine. U: Urgent iii)NA: Not Applicable.
1. CHEMICAL PATHOLOGY
LTAT
Specimen Container Volume Perform
No. Test Name Department Instructions (working
Type Type Required Site
days)
A. GENERAL BIOCHEMISTRY
Lithium R: 3 hours
Blood 4ml
Heparin U: 45 mins
Urine Universal Early morning urine collection
1 Albumin 10ml Internal 1 day
(UACR) container is required
Urine, 24 hr as per
1 day
24hr Container collection
Alkaline Lithium R: 3 hours
2 Blood 4ml
Phosphatase Heparin U: 45 mins
Alanine Lithium R: 3 hours
3 Blood 4ml Internal
Transaminase Heparin U: 45 mins
Aspartate Lithium R: 3 hours
4 Blood 4ml Internal
Transaminase Heparin U: 45 mins
By appointment. Please call
6221/6533 before sample
5 Ammonia Blood EDTA 2ml Internal U: 45 mins
collection. Transport to lab
immediately on ice slurry.
Lithium
Blood 4ml
Heparin Internal
R: 3 hours
6 Amylase
Universal U: 45 mins
Urine 10ml
container

LTAT
days)
Heparinised
Arterial, Transport to lab immediately R: 3 hours
7 Blood Gases syringe 1ml Internal
Venous on ice slurry. U: 45 mins
Lithium R: 3 hours
8 Bilirubin, Direct Blood 4ml Protect from light Internal
Heparin U: 45 mins
Lithium R: 3 hours
9 Bilirubin, Total Blood 4ml Protect from light Internal
Heparin U: 45 mins
Lithium
Blood 4ml
Heparin R: 3 hours
Plain gel U: 45 mins
Dialysate 3.5ml
tube
10 Calcium Internal
Universal
Urine, 10 ml/
container/
random/ as per 1 day
24 hr
24hr collection
Container
Lithium
Blood 4ml
Heparin
R: 3 hours
CSF Bijou bottle 1-2ml
U: 45 mins
Plain gel
Dialysate 3.5ml
Chloride tube Internal
11
Universal
Urine 10ml 1 day
container
24 hr as per 1 day
Urine, 24hr
Container collection
Lithium R: 3 hours
12 Creatine kinase Blood 4ml
Heparin U: 45 mins
Plain gel
Dialysate 3.5ml Internal 1 day
tube
13 Creatinine
Lithium R: 3 hours
Blood 4ml
Heparin U : 45 mins

LTAT
days)
Universal 1 day
Urine container 10 ml Early morning specimen
24 hr as per
Urine, 24hr 1 day
24 hr urine
Urine, 24hr Container & as per
Creatinine 24hour urine and blood sample
14 and Blood Lithium collection Internal
clearance both are required. 1 day
Heparin / 4 ml
(blood)
Plain Gel
15 C-Reactive Protein Blood 3.5ml Internal 3 hours
Tube
(CRP)
Bijou
bottle & Require 1 type of sample in 2
16 CSF Biochemistry CSF 1-2ml Internal 1 hour
Fluoride different containers
Oxalate
Estimated
Glomerular
Lithium
17 Filtration Rate Blood 4 ml Internal 3 hours
Heparin
(eGFR)
Creatine Kinase
Isoenzyme (CK-MB) Plain Gel R: 3 hours
18 Blood 3.5ml Internal
Mass Tube U: 1 hour
Lithium
19 Gamma Glutamyl Blood 4ml Internal 3 hours
Heparin
Transferase (GGT)

LTAT
days)
Fluoride R: 3 hours
Blood 2ml
Glucose Oxalate U: 1 hour
20 Internal
Fluoride
CSF 1-2ml U: 1 hour
Oxalate
Iron /
Total Iron Binding Plain Gel
21 Blood 3.5ml Internal 3 days
Capacity (TIBC) Tube
Fluoride
CSF 1-2ml
Oxalate
22 Lactate
Fluoride Send specimen in ice bag Internal U: 1 hour
Blood Oxalate 2ml
Lithium
Lactate Blood 4ml
Heparin
23 Dehydrogenase Internal 3 hours
Peritoneal Universal
(LDH) 3 ml
fluid container
Lithium
24 Lipid Profile Blood 4ml Internal 3 hours
Heparin
Lithium
25 Liver Function Test Blood 4ml Internal 3 hours
Heparin
R: 3 hours
Blood Lithium 4ml
Heparin
26 Magnesium Urine, Universal 10 ml/ Internal
1 day
random container
24 hr as per
Urine, 24hr 1 day

LTAT
days)
Lithium
R: 3 hours
Blood Heparin 4ml
Universal
27 Phosphate Internal
Urine, container/ 10 ml/
1 day
random/ 24 hr as per
24hr Container collection
Lithium R: 3 hours
Blood 4ml
Heparin U: 45 mins
Urine, Universal 10 ml
1 day
28 Potassium random container Internal
24 hr
as per
Urine, 24hr Container 1 day
collection
Plain Gel
Blood 3.5ml
Tube
Bijou bottle R: 3 hours
CSF 1-2ml
U: 45 mins
Body Fluid/ Plain gel
3.5ml
29 Protein, Total Peritoneal tube Internal
Universal
Urine 10ml 1 day
container
24 hr
as per
collection
Protein Creatinine Universal

30 Urine 10ml Spot fresh morning sample. Internal 1 day
Ratio (UPCR) container
Lithium R: 3 hours
31 Renal Profile Blood 4ml Internal
Heparin U: 45 mins

LTAT
days)
Lithium
Blood 4 ml
Serum-Ascites Heparin
32 Albumin Gradients Universal Internal 1 day
(SAAG) Ascites Fluid container 10 ml
Lithium R: 3 hours
Blood 4ml
Heparin U: 45 mins
Urine, Universal 10 ml
1 day
33 Sodium random container Internal
24 hr
as per
collection
Plain gel
34 Troponin I Blood tube 3.5ml Internal 1 hour
Lithium R: 3 hours
Blood 4ml
Heparin U: 45 mins
Plain gel R: 3 hours
Dialysate 2ml
tube
35 Urea Internal
Universal
Urine 10ml
container
1 day
24 hr as per
Urine, 24hr
Lithium
R: 3 hours
36 Urea & Electrolytes Blood Heparin 4ml Internal
U: 45 mins
Lithium
Blood 4ml 3 hours
Heparin
Universal
37 Uric Acid (Urates) Urine, 10 ml/ Internal
container/
random/ as per 1 day
24 hr
24hr collection
Container

LTAT
days)
Universal R: 3 hours
38 Urine Biochemistry Urine 10ml Fresh sample. Internal
container U: 45 mins
Fresh sample /within 2 hrs
Universal
39 Urine Microscopy Urine 10ml after collection. Internal 3 hours
container
Test offer during office hr only.
Urine Pregnancy Universal
40 Urine 10ml Internal R: 3 hours
Test container
U: 45 mins
B. ENDOCRINE
Special K3
Adrenocorticotrophic Transport to lab immediately
41 Blood EDTA 2 ml HKL 5 days
Hormone (ACTH) on ice slurry.
Anti Mullerian
Plain tube
42 Hormone (AMH) Blood 3 ml Require specialist signature IMR 14 days
(without gel)
43 Aldosterone/ Renin Blood EDTA tube 2 ml H Putrajaya 21 days

Beta Human
Chorionic Plain Gel R: 3 hours
44 Blood 3.5ml Internal
Gonadotrophin Tube U: 1 hour
Plain Gel 5 days

C-Peptide Blood 3.5ml HKL
45 Tube
Plain Gel
Blood 3.5ml Internal 3 days
Tube
46 Cortisol 24 hr
as per
Urine, 24hr Container HKL 5 days
collection
Dehydroepiandroste- 5 days
rone Sulphate Plain Gel
47 Blood 3.5ml HKL
(DHEAS) Tube

LTAT
days)
Plain Gel 5 days
Follicle Stimulating
48 Blood Tube 3.5ml HKL
Hormone (FSH)
Plain Gel 5 days
Growth Hormone
49 Blood Tube 3.5ml HKL
(Somatotrophin)
Plain Gel 5 days
50 Insulin Blood 3.5ml HKL
Tube
Insulin-like Growth Plain Gel
51 Blood 3.5ml H Putrajaya 21 days
Factor 1 (IGF-1) Tube
Luteinising Plain Gel
52 Blood 3.5ml HKL 5 days
Hormone (LH) Tube
Methanephrine Urine 24 24 hr as per 24 hours urine volume must be 30 working

53 H Putrajaya
Urine hours Container collection >750 mls for adults days
Plain Gel
54 Oestradiol Blood 3.5ml HKL 5 days
Tube
Plain Gel
Blood 3.5ml
Tube
55 Osmolality Internal 1 day
Universal
Urine 10ml
Container
Parathyroid Transport to lab immediately
56 Blood EDTA 2ml HKL 3 days
Hormone on ice slurry.
Plain tube
Call IKN at ext
57 Procalcitonin Blood tube 3.5 ml IKN 3 days
4128/4127/4126
Plain Gel
58 Progesterone Blood 3.5ml HKL 5 days
Tube
Progesterone, 17
Plain Gel
59 Hydroxy Blood 3.5ml IMR 21 days
Tube

LTAT
days)
Plain Gel
60 Prolactin Blood 3.5ml HKL 5 days
Tube
Plain Gel
61 Testosterone Blood 3.5ml HKL 5 days
Tube
Thyroid Stimulating Plain Gel

Hormone (TSH) Tube
Thyroxine Free Plain Gel

(Free T4) Tube
Tri-lodothyronine
Plain Gel
64 (Free T3) Blood 3.5ml Internal 5 days
Tube
Plain Gel
65 TSH Cord Blood Blood 3.5ml Internal 3 days
Tube
Thyroid Function Plain Gel
Test Tube
Plain Gel
67 Thyroglobulin 3.5ml HKL 7 days
Blood Tube
Thyroglobulin
Plain Gel
68 Antibody Blood 3.5ml H Selayang 10 days
Tube
TSH Receptor
Plain Gel
69 Antibody Blood 3.5ml HKL 10 days
Tube
Thyroid Peroxidase
Plain Gel
70 /Microscomal Blood 3.5ml H Selayang 10 days
Tube
antibody
C. METABOLIC
Plain Gel
71 B 12, Vitamin Blood 3.5ml Internal 3 days
Tube

LTAT
days)
Plain Gel
72 Ferritin Blood 3.5ml Internal 3 days
Tube
Plain Gel
73 Folate Blood 3.5ml Internal 3 days
Tube
74 HbA1c Blood EDTA 2 ml Internal 3 days
Vitamin D, Total
Plain Gel
75 (25 (OH) Vitamin D) Blood 3.5ml H Putrajaya 7 days
Tube
Fructosamine Plain Gel
Tube
D. PROTEIN AND SPECIAL PROTEIN

Alpha-1-
Antitrypsin- Plain Gel
Quantitation Tube
Alpha-1-
Antitrypsin- Plain Gel
78 Blood 3.5ml IMR 20 days
Phenotyping Tube
Alpha 2
Plain Gel
79 Macroglobulin Blood 3.5ml Internal 7 days
Tube
Plain Gel
Serum 3.5ml
Beta-2 Tube
80 Internal 7 days
Microglobulin Urine Universal
10ml
container
Plain Gel
81 Caeruloplasmin Blood 3.5ml Internal 7 days
Tube

LTAT
days)
Plain Gel
82 Complement 3 (C3) Blood 3.5ml Internal 3 days
Tube
Plain Gel
83 Complement 4 (C4) Blood 3.5ml Internal 3 days
Tube
Prepared by
By appointment. Call Protein
84 Cryoglobulin Blood the NA Internal 21 days
lab ext 6216
laboratory
Plain Gel
Blood 3.5ml
Free Light Chain, Tube
85 Internal 7 days
Kappa & Lambda Universal
Urine 10 ml
container
Plain Gel Internal
86 Haptoglobin Blood 3.5ml 7 days
Tube
Immunoglobulin G Internal 7 days
Plain Gel
87 (IgG) Blood 3.5ml
Tube
Immunoglobulin A Internal 7 days
Plain Gel
88 (IgA) Blood 3.5ml
Tube
Immunoglobulin M Internal 7 days
Plain Gel
89 (IgM) Blood 3.5ml
Tube
Immunoglobulin E
Plain Gel
90 (IgE) Total Blood 3.5ml IMR 7 days
Tube
Plain Gel
Immunoglobulin E
91 Blood Tube 3.5ml IMR 10 days
(IgE) Specific
Plain Gel
92 Myoglobin Blood 3.5ml Internal 7 days
Tube

LTAT
days)
For external client:
Please collect urine sample in
Urine Universal
10 ml container containes 200 mg of Internal 7 days
container
sodium bicarbonate (2% final
concentration)
Plain Gel
Blood 3.5ml
Oligoclonal bands Tube
93 Send in pair, serum & CSF Internal 21 days
CSF
Bijou bottle 1-2 ml
Plain Gel
Serum 3.5ml
Protein Tube
94 Send in pair, serum & urine Internal
Electrophoresis Universal 21 days
Urine 10 ml
container
Transferrin Plain Gel
Tube
Transferrin Isoform Plain Gel
96 Blood 3.5ml IMR 20 days
(Phenotyping) Tube
E. TUMOUR MARKERS
Alpha Feto-Protein
97 Blood Plain Gel 3.5ml Internal 7 days
(AFP)
Tube
Cancer Antigen 125
(CA 125)
Tube
Cancer Antigen 15-3
99 Blood Plain Gel 3.5ml HKL 5 days
(CA 15-3)
Tube
Cancer Antigen 19-9
(CA 19-9)
Tube

LTAT
days)
Carcinoembryonic
Antigen (CEA)
Tube
Prostate Specific
102 Antigen (PSA) Blood Plain Gel 3.5ml HKL 5 days
Total/Free Tube
F. THERAPEUTIC DRUG MONITORING (TDM)

Amikacin Plain tube
103 Blood 3.5 ml Internal 1 day
without gel
Carbamazepine Plain tube Send sample with TDM request
104 Blood 3.5 ml HKL 1 day
without gel form
Cyclosporine 1 day
105 Blood EDTA 2 ml Internal
Send sample with TDM request 1 day
Digoxin Plain tube
106 Blood 3.5 ml form HKL
without gel
Everolimus EDTA Batch testing. Send sample with 3 days
107 Blood 2 ml HKL
(blood) TDM request form
Gentamicin Plain tube Internal 1 day
108 Blood 3.5 ml
without gel
Methotrexate (MTX) Blood Plain tube 3.5 ml Internal 1 day
109
without gel
Mycophenolic Acid Blood 2 ml
EDTA Batch testing. Send sample with
110 (MPA) HKL 7 days
(plasma) TDM request form
Blood Plain tube 3.5 ml 1 day
Phenobarbital Send sample with TDM request
111 without gel HKL
form
Phenytoin Blood Plain tube 3.5 ml 1 day
Send sample with TDM request
112 (Dilantin) without gel HKL
form

LTAT
days)
Sirolimus EDTA 2 ml Batch testing. Send sample with 3 days
113 Blood HKL
(blood) TDM request form
114 Tacrolimus Blood EDTA 2 ml Internal 3 days
Plain tube 3.5 ml Send sample with TDM request 1 day
Theophylline
115 Blood without gel form HKL
Plain tube 3.5 ml 1 day

Valproic acid Send sample with TDM request
116 Blood without gel HKL
form
Plain tube 3.5 ml
Vancomycin
117 Blood without gel Internal 1 day
G. TOXICOLOGY
Plain Gel
Acetaminophen/
118 Blood Tube 3.5ml Internal 1 hour
Paracetamol
Plain Gel
119 Alcohol (Ethanol) Blood Tube 3.5 ml HKL 1 day
Do not spin sample.

Flouride MKAK Sg
Blood 2 ml Please write email address in 5 days
oxalate Buloh
request form.
120 Alcohol (Methanol)
Flouride
MKAK Sg
Urine oxalate 3 ml 5 days
Buloh
Plain tube 3.5 ml 1 day
Send sample with TDM request
121 Benzodiazepine Blood without gel HKL
form
Plain Gel
122 Cholinesterase Blood 3.5ml HKL 2 weeks
Tube

LTAT
days)
Universal
123 Paraquat Urine 10ml Internal 1 hour
container
Plain Gel
124 Salicylate Blood Tube 3.5ml Internal 1 hour
For medical case :

Please send both, blood in plain
1.Plain Gel gel tube and in fluoride oxalate
Tube (grey) tube, urine sample is
1. 3.5ml
2.Flouride optional.
Toxicology 2. 2 ml Jabatan
125 Blood/Urine oxalate 30 days
screening 3. 10 ml Kimia
3.Universal For post mortem case :
urine
container To add urine sample in
(urine) universal container, with 2
tubes of blood, in plain gel and
glucose tube
H. TRACE ELEMENTS
Plain Gel
Serum 3.5ml
Tube
126 Copper Universal IMR 14 days
Urine container 20ml
Send in 2-8 0C or keep in -20 0C

Universal MKAK
127 Iodine Urine 10ml if delay 25 days
container Sg Buloh
Lithium
IMR
128 Lead Blood heparin/ 4/2 ml 14 days
EDTA tube
Universal MKAK
129 Mercury Urine 20ml 7 days
container Sg Buloh

LTAT
days)
I. BIOCHEMICAL GENETIC TESTING

Properly dried at room
Acid alpha- 3 circles temperature for 4 hours before
S&S or
Glucosidase of dried putting in plastic bag.
130 Blood Spot Whatmann IMR 15 days
(Pompe) blood Transport at room
903
spot temperature.
Collected 4 hours after last

meal. Centrifuge & freeze
Plasma Heparin tube 2 ml IMR 15 days
immediately. Transport frozen
in dry ice.
Request after consultation
only.
Clean 2 ml of
Collected in sterile bottle
Urine universal random IMR 15 days
131 Amino acid without preservative.
bottle urine
Transport frozen in dry ice.
Clean 1 ml CSF Must be send together with

CSF universal in sterile plasma. IMR 15 days
bottle bottle Freeze immediately. Transport
frozen in dry ice.
Collected in sterile tube, wrap
with aluminum foil to protect
Biogenic Amines Clean
132 CSF 0.5 ml CSF from light. IMR 10 days
microtube
Collected in sterile bottle, wrap

Biogenic Amines
Clean with aluminum foil to protect
133 (screening) Urine 0.5 ml CSF IMR 10 days
microtube from light.

LTAT
days)
3 circles temperature for 4 hours before
Biotinidase enzyme S&S or
of dried putting in plastic bag.
134 activity Blood Spot Whatmann IMR 10 days
blood Transport at room
903
spot temperature.
Freeze immediately. Transport

Carnitine (Plasma 2 ml of
frozen in dry ice.
135 Total & Free) Blood EDTA heparinis IMR 5 days
ed plasma
Collected in bottle without
Delta Amino
24 hrs urine preservative.
136 Laevulinic Acid 24Hr Urine As per IMR 15 days
bottle Transport frozen in dry ice.
Urine (Delta - ALA) collection
Galactosemia
Screening (Total Properly dried at room
3 circles
Galactose & S&S or temperature for 4 hours before
of dried
137 Galactose-1- Blood Spot Whatmann putting in plastic bag. IMR 5 days
blood
Uridyltransferase) 903 Transport at room
spot
temperature.
Homocysteine
Freeze immediately. Transport
138 Total, Plasma EDTA tube 2 ml IMR 10 days
frozen in dry ice.
IEM screening 3 circles
S&S or temperature for 4 hours before
(Amino acids & of dried
139 Blood Spot Whatmann putting in plastic bag. IMR 3 days
acylcarnitines) blood
903 Transport at room
spot
temperature.
IEM Screening Clean 2 ml
140 UTMS Urine universal random Transport frozen in dry ice IMR 15 days
bottle urine

LTAT
days)
Lysosomal Storage 3 circles
S&S or temperature for 4 hours before IMR
disease (LSD) of dried
141 Blood Spot Whatmann putting in plastic bag. 10 days
screening blood
903 Transport at room
spot
temperature.
Mucopolysacharide Collected first morning urine in
Clean 5 ml first
s (GAGs/HRE) (High sterile bottle without IMR
142 Urine universal morning 10 days
ResolutionElectrop preservative.
bottle urine
horesis) Transport frozen in dry ice.
Collected in universal bottle
Clean 5 ml first
Oligosaccharides without preservative. IMR
143 Urine universal morning 10 days
bottle urine
Freeze immediately.
Clean 2 ml Transport frozen in dry ice to IMR
Organic Acids
144 Urine universal random prevent bacterial overgrowth 5 days
bottle urine and loss of volatile substance.

Orotic Acid Clean 2 ml
without preservative. IMR
145 (Orotate) Urine universal random 5 days
bottle urine
Collected 4 hours after last
meal. Centrifuge & freeze IMR
Pipecolic acid
146 Plasma Heparin tube 2 ml immediately. Transport frozen
in dry ice.

Porphyrin/ Clean 5 ml without preservative.
147 Porphobilinogen Urine universal random Protect from light. IMR 10 days
bottle urine Transport frozen in dry ice.

LTAT
days)
Special Collected in sterile wrap with
microtube aluminum foil to protect from IMR
Pterins
148 CSF provided by 0.5 ml CSF light. 10 days
Biochemistry Transport frozen in dry ice.
unit IMR
Collected in sterile wrap with
Clean 2 ml
Pterins (screening) aluminum foil to protect from IMR
149 Urine universal random 10 days
light.
bottle urine
Collected in sterile bottle.
Clean
Sialic acids 2 ml fresh Freeze immediately. IMR
150 Urine universal 10 days
urine Transport frozen in dry ice.
bottle

Clean 2 ml IMR
Succinylacetone without preservative.
bottle urine

Clean 2 ml
S-Sulfocysteine without preservative. IMR
bottle urine
24 hour
Record 24 hrs volume in
5-hydroxy-Indol- urine bottle IMR
24Hr As per request form. 2 ml of urine,
153 Acetic Acid (5 HIAA) with 10 ml 10 days
Urine collection transport frozen in dry ice.
25% HCL
preservative
VLCFA & Phytanic
Freeze immediately.
154 acid Plasma EDTA 2 ml IMR 10 days
Transport frozen in dry ice

2. MEDICAL MICROBIOLOGY

No. Test Name Department Instructions TAT
1 Acanthamoeba PCR Cornea Sterile NA By Appointment with IMR one IMR 3-4 weeks
scrape, container week earlier.
contact lens filled with
sterile saline
2 Acid Fast Bacilli Stain Body Fluid, Sterile 3 ml Specify site of collection. Internal 24 hours
(AFB) Bronchial Container
Alveolar
Lavage (BAL),
Nasopharyng
eal Aspirate
(NPA),
Tracheal
Aspirate,
Urine
3 Acid Fast Bacilli Stain Sputum Sterile 3 ml Collect 3 consecutive early Internal 24 hours
(AFB) Container morning (after rising mouth)
sputum aseptically into the
container.
4 Adenovirus Antigen, Skin Lesion Smears on NA VHKL 1-2 weeks

IFAT slide
5 Adenovirus PCR Blood, Sterile 3 ml Pack specimen in ice IMR 3-4 weeks
Nasopharyng Container
eal Aspirate
(NPA), BAL
6 Adenovirus PCR Throat swab Viral NA To get VTM from lab. Pack IMR 3-4 weeks
Transport specimen in ice
Media (VTM)


7 Air Sampling Air Not NA By Appointment. Internal 3-7 days
Applicable
8 Allergy Testing Blood Gel Tube 5 ml IMR 3-4 weeks

9 Amoebiasis Blood Plain gel tube 5 ml IMR 2-3 weeks
Antibody(Ab)
10 Anti B2 Glycoprotein Blood/ Plain gel 5 ml Sent Immediately to the lab IMR 10 days
1 Serum tube.
11 Anti Double-Stranded Blood Plain gel tube 5 ml Internal 2-4 weeks
DNA (Please Order
ANA screening, If
Homogenous pattern,
Lab will proceed to
test Anti-dsDNA)
12 Anti Mycoplasma Blood Plain gel tube 5 ml Not IgM Internal 1-7 days
pneumoniae Total
Antibody
13 Anti N-Methyl-D- Blood Plain gel tube 5 ml IMR 7 days
Aspartate Receptor
Blood (NMDAR)
14 Anti N-Methyl-D- CSF Bijou bottle 5 ml IMR 7 days
Aspartate Receptor
CSF
15 Anti Phospholipase Blood/Serum Plain gel tube. 5ml IMR 21 days
A2 Receptor (PLA2)
16 Anti voltage gated Blood/ Serum Plain gel tube. 5ml IMR 7 days
potassium chain
serum
17 Anti-Acetylcholine Blood Plain gel tube 5 ml IIMR 21 days
Receptor


18 Anti-Aquaporin 4 CSF Bijou bottle 5m IMR 10 days
19 Anti-Cyclic Blood Plain gel tube 5 ml IMR 21 days

Citrullinated Peptides
20 Anti-Gastric Parietal Blood Plain gel tube 5 ml IMR 2-3 weeks
21 Anti-Glomerular Blood/ Serum Plain tube 5m IMR 10 days

Basement Membrane
(GBM)
22 Anti-Insulin (IgG) Blood/ Serum Plain gel tube. 5ml IMR 14 days
23 Anti-Mitochondrial Blood Plain gel tube 5 ml IMR 2-3 weeks
Ab
24 Antinuclear Ab (ANA) Blood Plain gel tube 5 ml Internal 1-3weeks
25 Anti-Streptolysin ‘O’ Blood Plain gel tube 5 ml Internal 1-3 days
Titre (ASOT)
26 Aspergillus Blood Plain gel tube 5 ml Transport at ambient HSB 1-2
Galactomannan Ab temperature. If delayed, keep at weeks
2-80C
27 Aspergillus Bronchial Sterile 3 ml Transport at ambient HSB 1-2
Galactomannan Ab Alveolar Container temperature. If delayed, keep at weeks
Lavage 2-80C
28 Bacterial Antigen CSF Sterile Internal 1 hour
Test Container
29 BK virus Genome Blood, Urine EDTA tube 5 ml NA Send in ice pack Internal 1-2 weeks
Detection Sterile
container
30 Blood Film For Blood Smears on NA Send 2 slides consist of thin and Internal 1 hour (new
Malaria Parasites slide thick blood smears. Please ensure case) ;
(BFMP) air-dried for 10-20min. Refer 1 - 8 hours
to pages from 109-111 for smear (others)
preparation guideline.


31 Blood film for Blood Smears on NA Thick blood smear from MKAK 2-7days
Microfilaria slide fingerprick taken from 9pm – 12
midnight
32 Blood Film For Blood Smears on NA Send thin blood smear. Air-dried IMR 1 month
Trypanosoma slide the slide for 5 to 10 min
33 Bordetella pertussis NPA or NPA in sterile Pack specimen in ice IMR 1-2 weeks
PCR Nasopharyng container/
eal swab Dacron swab
in Stuart’s
transport
media
34 Borrelia burgdoferi Blood Plain gel tube 5 ml HSB 1-2 weeks
Ab (IgM & IgG)
35 Brucella sp Ab Blood Plain gel tube 5 ml Fresh specimen. To inform lab IMR 1-2 weeks
prior sending sample.
To use special form (refer to page
145)
36 Brucella sp PCR Blood EDTA tube 5 ml IMR 1-2 weeks
37 Burkholderia Blood Plain gel tube 5 ml IMR 1-2 weeks

pseudomallei
Antibody
38 Chlamydia Blood Plain gel tube 3 ml HKL 1-2 weeks
pneumoniae Antibody
39 Chlamydia psittaci- BAL Sterile tube 5 ml HSB 1 -2 days
BAL
40 Chlamydia psittaci- Blood Sterile tube 5 ml HSB 1 -2 days
Blood
41 Chlamydia psittaci- Pleural Fluid Sterile tube 5 ml HSB 1 -2 days
Pleural Fluid


42 Chlamydia psittaci- Sputum Sterile tube 5 ml HSB 1 -2 days
Sputum
43 Chlamydia Blood Plain gel tube 5 ml HSB 1-2 weeks

trachomatis Antibody
44 Chlamydia Genital/eye Smears on NA Smears to be fixed with acetone. HKL 2-3 weeks
trachomatis -IF discharge Teflon slide
45 Clostridium difficile Stool Sterile NA Fresh loose stool required. Internal 1 day
Toxin Container
46 Coeliac Antibodies Serum Plain tube 5 ml IMR 21 days
47 Cryptococcal Antigen CSF Sterile Bijoux 3 ml Internal I hour

bottle
48 Cryptococcal Antigen Blood Plain gel tube 5 ml Internal 2-3 days
49 Culture & Sensitivity Bronchial Sterile NA Internal 3-7 days

Lavage, Container
Nasophary-
ngeal Aspirate,
Tracheal
Aspirate,
Corneal
Scrapping,
Intravascular
Device
Catheter
50 Culture & Sensitivity- Aqueous Sterile 3 ml Internal 3-7 days

Aqueous Fluid Fluid Container


51 Culture & Sensitivity- Blood Blood Culture 5-10 ml for Refer to page 99-101 for Blood Internal 3-7 days
Blood Bottle Adult / 1- Cultures
2 ml for
Pediatric
52 Culture & Sensitivity- Body Fluid Sterile 5 ml Specify site of collection. Internal 3-7 days
Body Fluid Container
53 Culture & Sensitivity- Bone Sterile Not Do not put in formalin Internal 3-7 days
Bone Container Applicable
54 Culture & Sensitivity- Bone Marrow Blood Culture 5-10 ml for Inoculate into a manufacturer Internal 3-7 days
Bone Marrow Bottle Adult / Blood Culture bottle.
1-2 ml for Do not refrigerate.
Pediatric
55 Culture & Sensitivity- Contact Lens Sterile NA Do not put in formalin. Internal 3-7 days
Contact Lens Container
56 Culture & Sensitivity- CSF Sterile Bijoux 3 ml/ 5 Send immediately to lab Internal 3-7 days
CSF bottle/ Sterile mL
Transport
Tube with
Screw Cap
57 Culture & Sensitivity- Ear discharge Amies NA Do not refrigerate. Send Internal 3-7 days
Ear Swab Transport immediately.
Medium
58 Culture & Sensitivity- Environment Sterile Swab NA By Appointment. Internal 3-7 days
Environment Samples
59 Culture & Sensitivity- Eye discharge Amies NA Do not refrigerate. Send Internal 3-7 days
Eye Swab Transport immediately.
Medium
60 Culture & Sensitivity- High Vaginal Amies NA Do not refrigerate. Send Internal 3-7 days
High Vaginal Swab Swab (HVS) Transport immediately.
Medium


61 Culture & Sensitivity- Low Vaginal Amies NA Internal 3-7 days
Low Vaginal Swab Swab (LVS) Transport
Medium
62 Culture & Sensitivity- Nasal Swab Amies NA Mainly for MRSA screening Internal 2-3 days
Nasal Swab Transport
Medium
63 Culture & Sensitivity- Peritoneal Sterile 5 ml Internal 3-7 days
Peritoneal Fluid Fluid Container
64 Culture & Sensitivity- Pus Sterile NA Internal 3-7 days
Pus Container
65 Culture & Sensitivity- Rectal Swab Cary-Blair NA Internal 3-7 days
Rectal Swab transport
medium
66 Culture & Sensitivity- Sputum Sterile 3 ml Internal 3-7 days
Sputum Container
67 Culture & Sensitivity- Stool Cary-Blair NA/ 5 gm Internal 3-7 days
Stool transport
medium /
Fresh stool in
stool
container
68 Culture & Sensitivity- Throat Swab Amies NA Internal 3-7 days
Throat Swab Transport
Medium
69 Culture & Sensitivity- Tissue Sterile NA Internal 3-7 days
Tissue Container
70 Culture & Sensitivity- Urethral Amies NA Do not refrigerate. Send Internal 3-7 days
Urethral Swab Swab Transport immediately.
Medium
71 Culture & Sensitivity- Urine Sterile 5 ml Please indicate method of Internal 3-7 days
Urine Container collection


72 Culture & Sensitivity- Vitreous Tap Sterile 3 ml Internal 3-7 days
Vitreous Tap Container
73 Culture & Sensitivity- Wound Swab Amies NA Specify site of collection. Internal 3-7 days
Wound Swab Transport
Medium
74 Culture &Sensitivity- Pleural Fluid Sterile 3 ml Internal 3-7 days
Pleural Fluid Container
75 Cysticercosis Blood Plain gel tube 5 ml IMR 3-4 weeks
Antibody
76 Cytomegalovirus Blood Plain gel tube 5 ml Internal 1-2 weeks
(CMV) IgG
77 Cytomegalovirus Blood Plain gel tube 5 ml Internal 1-2 weeks
(CMV) IgM
78 Cytomegalovirus Bronchial Sterile 3 ml Send specimen in ice pack Internal 1-2 weeks
(CMV)Genome Alveolar Container
Detection-BAL Lavage
79 Cytomegalovirus Blood EDTA tube 5 ml Send specimen in ice pack Internal 1-2 weeks
(CMV)Genome
Detection-Blood
80 Cytomegalovirus Body Fluid Sterile 3 ml Specify site of collection. Pack Internal 1-2 weeks
(CMV)Genome Container specimen in ice.
Detection-Body Fluid
81 Cytomegalovirus CSF Sterile Bijoux 1 ml Send specimen in ice pack Internal 1-2 weeks
(CMV)Genome bottle/ Sterile
Detection-CSF Transport
Tube with
Screw Cap
82 Dengue IgG Blood Plain gel tube 5 ml HKL 1-2 weeks
83 Dengue IgM Blood Plain gel tube 5 ml Internal 2-7 days


84 Dengue Sero Plain gel tube 5 ml MKAK 2 weeks
Surveillance (For
research)
85 Dengue Serotyping Blood Plain gel tube 5 ml MKAK 2 weeks

(PCR)
86 Dengue Virus Tissue Sterile Bijoux NA Do not put in formalin. Pack IMR 1-2 weeks
Genome Detection- bottle/ Sterile specimen in dried ice. Send
CSF Transport immediately.
Tube with
Screw Cap
87 Dengue Virus Blood EDTA tube 5 ml Send specimen in ice pack IMR 1-2 weeks
Genome Detection-
Blood
88 Dengue Virus Tissue Sterile NA Specify site of collection. Do not IMR 1-2 weeks
Genome Detection- Container put in formalin. Pack specimen in
Tissue dried ice. Send immediately.
89 Dihydrorhodamine Blood (By Lithium 2 ml from For Primary Immunodeficiency IMR 2-3 weeks
test (DHR) Consulatation Heparin patient & (PID) screening, to use special
Only) 2 ml from form from AIRC, IMR (provided in
unrelated Public Folder, Hospital Ampang).
healthy By Appointment in IMR
person (call 03-26162581/26162782 for
appointment).
To call Microbiology lab at
6224/6057 before sending to the
lab.
Please use PINK biohazard
plastic bag. To arrive at
lab by 8.30 am


90 Diphteria PCR Nasopharyng Dacron swab NA To get the swab from IMR 1-2 days
eal/ throat in Stuart’s Microbiology lab. Send in ice pack
swab transport
media
91 Echinococcosis Blood Plain gel tube 5 ml Send immediately. IMR 2-3 weeks
Antibody
92 Enterovirus Antigen, Skin lesion Smears on NA Smears on Teflon coated micro HKL 1-2 weeks
IFAT slide well slide. Air dry the slide for 5-
10 minutes
93 Enterovirus Isolation i) Nasophary- i) NPA: Sterile plastic vial IMR 1 - 10 days

(enterovirus 71, ngeal contain 2-3ml of VTM i) NPA: Mucous secretion in VTM
Coxsackie A and aspiration, ii) NPS:Sterile plastic vial ii) NPS: A flexible, fine shafter
Coxsackie B, ii)Nasophary- contain 2-3ml of VTM polyester swab. Use different
ngeal swab,
Echovirus,Other iii) TS:Sterile plastic vial swab for each nostrils
iii)Throat
noneneroviruses) swab, iv) contain 2-3ml of VTM iii) TS: Sterile swab
Throat gargle, iv) Throat gargle: sterile iv) Nasal swab: Sterile swab. Use
v) BAL , vi) plastic container different swabs for each nostrils
Sputum, v) BAL:sterile plastic tube v) Biopsy: remove portions,
vii)Nasal swab, container about 1.5cm cube of various parts
viii) Organ vi) Sputum :sterile plastic of affected organs
biopsies ix) container x) Rectal swab: Stool on sterile
Pericardial vii) Nasal swab :Sterile swab moistened with distilled
aspiratel x) plastic vial contain 2-3ml water xiStool: >5gm (thumb size)
Rectal swab,
VTM xii)Vesicular swab/scrapings:
xi)Stool xii)
Vesicular viii)organ biopsy: Sterile Swabs to be put into 2-3mls of
Swab/Scraping containers containing VTM VTM
to keep tissue moist
ix)Pericardial aspirate:
sterile plastic vial contain
2-3ml VTM
x) Rectal swab: Sterile


plastic vial contain 2-3ml of
VTM
xi) Stool: Sterile bottle,
xii) Vesicular
swab/scraping: Sterile
plastic vial
94 Enterovirus Genome i) i) NPA: Sterile plastic vial i) NPA: Mucous secretion in VTM IMR 14 - 28 days
Detection Nasopharyng contain 2-3ml of VTM ii) NPS: A flexible, fine shafter
(Inclusive of Pan eal aspiration, ii) NPS:Sterile plastic vial polyester swab. Use different
Entero, EV71 and ii) contain 2-3ml of VTM swab for each nostrils
CA16) Nasopharyng iii) TS:Sterile plastic vial iii) TS: Sterile swab
eal swab, contain 2-3ml of VTM iv) Nasal swab: Sterile swab. Use
iii)Throat iv) Throat gargle: sterile different swabs for each nostrils
swab, palstic container v) Biopsy: remove portions,
iv) Throat v) BAL:sterile plastic tube about 1.5cm cube of various parts
gargle, container of affected organs
v) BAL , vi) Sputum :sterile plastic x) Rectal swab: Stool on sterile
vi) Sputum, container swab moistened with distilled
vii)Nasal vii) Nasal swab :Sterile water
swab, plastic vial contain 2-3ml xiStool: >5gm (thumb size)
viii) Organ VTM
biopsies viii) Biopsy: Sterile
ix) Pericardial containers containing VTM
aspiratel to keep tissue moist
x) Rectal ix)Pericardial aspirate:
swab, sterile plastic vial contain
xi) Stool 2-3ml VTM
x) Rectal swab: Sterile
plastic vial contain 2-3ml of
VTM
xi) Stool: Sterile bottle
95 Epstein Barr Virus Blood Plain gel tube 5 ml Internal 1 weeks
(EBV) IgG


96 Epstein Barr Virus Blood Plain gel tube 5 ml HSB 1-2 weeks
(EBV) IgM
97 Epstein Barr Virus Blood EDTA tube 5 ml Send specimen in ice pack Internal 1-2 weeks
(EBV) Genome
Detection-Blood
98 Epstein Barr Virus CSF Sterile Bijoux NA Send specimen in ice pack Internal 1-2 weeks
Genome Detection- bottle/ Sterile
Transport
Tube with
Screw Cap
99 Epstein Barr Virus Nasopharyng Sterile NA Send specimen in ice pack Internal 1-2 weeks
Genome Detection- eal Aspirate Container
NPA
100 Epstein Barr Virus Tissue Sterile NA Specify site of collection. Do Internal 1-2 weeks
Genome Detection- Container not put in formalin. Pack
Tissue specimen with ice.
101 Extractable Nuclear Blood Plain gel tube 5 ml Hosp. 2-3 weeks
Ag - Scl Selayang
70,Sm,SSB/La,Anti
Jo-1,RNP,SSA/Ro
(ENA)
102 Filarial Serology Blood Plain gel tube 3 ml IMR 2-3 weeks
(Antibody for B.
malayi , W.bancrofti)
103 Flavivirus (Culture) Blood Plain gel tube 5 ml MKAK 2-4 weeks
104 Flavivirus (PCR) Blood EDTA tube 5 ml MKAK 2-4 weeks
105 Fungal Culture Hair, Nail Directly onto NA Internal 14-21 days
an agar plate


106 Fungal Culture- Aqueous Sterile 3 ml Send immediately. Internal 14-21 days
Aqueous Fluid Fluid Container
107 Fungal Culture-Blood Blood Fungal 5-10ml for Internal 14-21 days
Culture Bottle Adult /
1-2 ml for
Pediatric
108 Fungal Culture-Bone Bone Marrow Fungal 3-5ml for Internal 14-21 days
Marrow Culture Bottle Adult /0.5-
1ml for
Pediatric
109 Fungal Culture- Corneal Directly onto NA Send immediately. Internal 14-21 days
Corneal Scrapping Scrapping an agar plate
110 Fungal Culture-CSF Cerebral Bijoux bottle 3ml Internal 14-21 days
Spinal Fluid
111 Fungal Culture-Pus Pus Sterile NA Internal 14-21 days

Container
112 Fungal Culture- Sputum Sterile NA Collect three consecutive early Internal 14-21 days
Sputum Container morning. Send immediately.
113 Fungal Culture- Body Fluid, Sterile 3 ml Send immediately. Internal 14-21 days
sterile Fluid Peritoneal container
Fluid, pleural
fluid,vitreous
fluid
114 Fungal Culture- Tissue Sterile NA Internal 14-21 days
Tissue Container
115 Fungal Culture-Urine Urine Sterile 5 ml Collect early morning midstream Internal 14-21 days
Container urine


116 Fungal Culture- Wound Swab Amies NA Send immediately. Internal 14-21 days
Wound Swab Transport
Medium
117 Fungal PCR-Blood Blood EDTA Tube 2-3 ml Send immediately. IMR 1-2 weeks
118 Fungal PCR-sterile BAL, body Sterile 2-3 ml Send immediately. IMR 1-2 weeks
isolates fluid, Container
aspirates,
CSF, tissue
119 Ganglioside Blood/Serum Plain gel 5 ml IMR 5 days
Antibodies /CSF tube/Bijou
bottle
120 H1N1/H7N9/H5N1( Sputum, BAL, Sterile Send specimen in ice pack HSB 1-2 weeks
PCR) NPA container
121 H1N1/H7N9/H5N1( Nasopharyng VTM NA Send specimen in ice pack HSB 1-2 weeks
PCR) eal or throat
swab
122 Hepatitis A IgG Blood Plain gel tube 5 ml HKL 1-2 weeks
123 Hepatitis A IgM Blood Plain gel tube 5 ml Internal 1-2 weeks
124 Hepatitis B core Ab Blood Plain gel tube 5 ml Internal 1-7 days
Total
125 Hepatitis B core IgM Blood Plain gel tube 5 ml Internal 1-2 weeks
126 Hepatitis B e Blood Plain gel tube 5 ml Internal 1-7 days

Antibody
127 Hepatitis B e Antigen Blood Plain gel tube 5 ml Internal 1-7 days
128 Hepatitis B surface Blood Plain gel tube 5 ml Internal 1-7 days
Antibody


129 Hepatitis B surface Blood Plain gel tube 5 ml Internal 1-7 days
Antigen
130 Hepatitis B Virus Blood EDTA tube 5 ml Send specimen in ice pack HSB 1-2 weeks
DNA Genome
Detection (viral
load)-Blood
131 Hepatitis C Antibody Blood Plain gel tube 5 ml Internal 1-7 days
132 Hepatitis C Blood Plain gel tube 5 ml Send in ice pack. To fill up PER HKL 2-3 weeks
Genotyping PAT 301 form & signed by Gastro
Specialist only.
134 Hepatitis C Virus RNA Blood EDTA tube 5 ml Send specimen in ice pack HSB/ IMR 1-2 weeks
Genome Detection-
Blood (viral load)
135 Herpes simplex 1+2 Blood Plain gel tube 5 ml Internal 1-2 weeks
Virus IgG
136 Herpes simplex 1+2 Blood Plain gel tube 5 ml Internal 1-2 weeks
Virus IgM
137 Herpes simplex 2 Skin lesion Smears on NA Smears on Teflon coated micro HSB 3-4 weeks
Virus Antigen,IFAT- slide well slide. Air dry the slide for 5-
Skin 10 minutes.
138 Herpes simplex Virus CSF , Vesicle Sterile Bijoux 1 ml Send specimen in ice pack Internal 1-2 weeks
(HSV) 1 & 2 Genome fluids bottle/ Sterile
detection Transport
Tube with
Screw Cap
139 Herpes simplex Virus Blood EDTA tube 5 ml Send specimen in ice pack Internal 1-2 weeks
(HSV) 1 & 2 Genome
detection


140 HIV Antibody Blood Plain gel tube 5 ml Internal 2-7 days
(Screening)
HIV Ag/Ab Screening
141 HIV Genome Blood EDTA Tube 5 ml Use special request form (page IMR 2-3 weeks
Detection (cDNA) 148). To send with mother’s
PCR for Peadiatric blood if available. Send
specimen in ice pack
142 HIV RNA PCR Viral Blood EDTA Tube 5ml Send specimen in ice pack HSB 1-2 weeks
Load (Quantitative)
HLA For all request associated with HLA- prior appointment and special form (refer page155-156) are required to send
specimen for this test. Please call 03-26162581 (Unit AIRC, IMR)
143 HLA Typing Allele Blood EDTA Tube 6 ml By Appointment. Transport at IMR 1 month
Specific High room temperature. Use form “
Resolution-PCR HLA-PCR method”
144 HLA A & B Single Blood Plain Tube 10 ml IMR 1 month
Specificity
145 HLA Antibody Blood Plain Tube 10 ml By Appointment. Transport at IMR 1 month
Detection (Donor room temperature. Use form for
Specific Antibody- “request for PRA/DSA test”
DSA)- Luminex
method
146 HLA Antibody Blood Plain Tube 10 ml By Appointment. Transport at IMR 1 month
Screening (Panel room temperature. Use form for
reactive Antibody- “request for PRA/DSA test”
PRA)- Elisa method
147 HLA Antigen Blood Plain Tube 10 ml IMR 1 month
148 HLA Crossmatch- Blood Donor: 18 ml By Appointment. Transport at IMR 1 month

Complement Sodium room temperature. Use special
Dependent Cytoxicity Heparin request form (Request for HLA
(CDC) method Crossmatch Test)


149 HLA Crossmatch- Blood Patient: Plain 5 ml IMR 1 month
Flow Cytometry Tube
method
150 HLA Crossmatch- Blood Donor: 18 ml By Appointment. Transport at
Flow Cytometry Sodium room temperature. Use special
method Heparin request form (Request for HLA
Crossmatch Test)
151 HLA Paternity Test Blood Patient: Plain 5 ml IMR

Tube
152 HLA Typing Class I Blood Donor- 15 ml IMR 1 month
&II (Loci A , B & DR) Heparin Tube
PCR
153 HLA Typing Class I Blood EDTA Tube 6 ml By Appointment. Transport at IMR 1 month
(Loci A , B & C) –PCR room temperature. Use
form”BMT HLA-Molecular
Typing-PCR”
154 HLA Typing Class II Blood EDTA Tube 6 ml By Appointment. Transport at IMR 1 month
(Loci DR and DQ)- room temperature. Use
PCR form”BMT HLA-Molecular
Typing-PCR”
155 HLA Typing for Blood EDTA Tube 6 ml By Appointment. Transport at IMR 1 month
Disease Association room temperature. Use form “
(B27,B15:02, B05, HLA-PCR method”
others)-PCR
156 Human T- Blood Plain gel tube 5 ml HSB 1-2 weeks
Lymphocyte Virus
(HTLV)1+2Ab
Screening
157 IgE, Specific (per Blood, Serum Plain gel tube 5 ml By Appointment. Transport at IMR 10 days
allergan) room temperature. Use form for
IgE, Total Allergy Unit , IMR


158 Influenzae A Virus i) Plain tube Paeds : Selayang
(PCR) Nasopharyng 5 tests: Blood: 3ml/
Influenzae B Virus eal aspiration, Serum: 0.5ml;
(PCR) ii)
Parainfluenzae 1 Nasopharyng
Virus (PCR) eal swab, Adult :
Parainfluenzae 2 iii)Throat 5 tests: Blood: 5-10 ml/
Virus (PCR) swab, Serum: 1-3ml
Parainfluenzae 3 iv) Throat
Virus (PCR) gargle,
Respiratory Syncytial v) BAL
Virus (PCR) vi) Sputum,
159 Intestinal Protozoa Stool Plain 5 ml Please provide 1 fresh and 1 IMR 3-4 weeks
(E.histolytica, Giardia PVA preserved stool (1 part
instestinalis) faecal mix with 3 parts PVA). 5
gm is equivalent to thumb nail
size
160 Japanese encephalitis Blood i) NPA: Sterile i) NPA: Mucous secretion in VTM
(JE) Serology IgM CSF plastic vial ii) NPS: A flexible, fine shafter polyester swab. MKAK 3-4 weeks
contain 2-3ml Use different swab for each nostrils
of VTM iii) TS: Sterile swab
ii) NPS:Sterile vii) Nasal swab: Sterile swab. Use different
plastic vial swabs for each nostrils
contain 2-3ml
of VTM
iii) TS:Sterile
plastic vial
contain 2-3ml
of VTM
iv) Throat
gargle: sterile
161 Japanese encephalitis CSF Sterile 5 gm (thumb nail size)/5ml diarrhea stool MKAK 1-2 weeks
PCR Container


162 Legionella Antibody Blood Plain gel tube 5 ml MKAK 1-2 weeks
( IgG, IgM)
163 Legionella Antigen Urine Sterile 5 ml Internal 1-3 days
Container
164 Leishmaniasis Blood Plain gel tube 5 ml IMR 3-4 weeks
Antibody
165 Leishmaniasis Bone marrow, Smears on NA By Appointment. Air-dried smear. IMR 1-2 weeks
microscopy Skin ulcer slide
166 Leptospira culture Blood Sodium 2-3 ml Within first 10 days from onset IMR 4 weeks
heparin tube and prior to antibiotics. Use
special IMR form (page 144).
167 Leptospira IgM Blood Plain gel tube 5 ml Internal 1-7 days
168 Leptospira MAT Blood Plain gel tube 5 ml Only if Leptospira IgM IMR 2-3 weeks
positive/inconclusive. Use Lepto
IMR form(page 144).
169 Lymphocyte Subset Blood (By EDTA 5 ml IMR 5 days

Enumeration Test Appointment
(TBNK)/ T and B only)
Cells enumeration
170 Malaria Antibody Blood EDTA tube 2 ml IMR 1 week
171 Measles IgM Nasopharyng Plain gel tube 5 ml MKAK 3-4 weeks
eal Swab,
Throat Swab,
Swab, Urine
172 Measles IgG Blood NPA, Swabs - Urine - 5 MKAK 3-4 weeks
VTM ml
Urine - sterile
container


173 Melioidosis Antibody Blood Plain gel tube 5 ml IMR 5 days
(Burkholderia
pseudomallei )
MERS-CoV Recommende Sterile Transport in blue biohazard HSB 2 days – 1
174 (Coronavirus) PCR d (LRT) : Container plastic bag with ice . week
BAL/ tracheal
aspirate
If LRT Viral Lower Respiratory Tract (LRT)
specimen not Transport specimens are strongly
available: Media (VTM) recommended.
Nasopharyng
eal (NPA),
Oropharynge
al swab and
Throat Swab,
Blood, Plain gel tube Send specimen in ice pack.
Sputum, Positive result will be informed
Pleural Fluid verbally first by referral lab.
and others
175 Mumps IgG Blood Plain gel tube 5 ml HKL 2-3 weeks
176 Mumps IgM Blood Plain gel tube 5 ml HKL 2-3 weeks
177 Mycobacterium C&S Bronchial Sterile 3 ml Send immediately. IPR 10-20

Lavage, Container weeks
Tracheal
Aspirate
178 Mycobacterium C&S Blood TB Culture 5-10 ml for Inoculate into a manufacturer TB Internal & 10-20
– Blood (Adult) Bottle Adult / Culture bottle and send IPR weeks
immediately.


179 Mycobacterium C&S Blood TB Culture 1-2 ml for Specimen will be send to IPR if Internal & 10-20
– Blood (Paediatrics) Bottle Pediatric positive for further testing. IPR weeks
180 Mycobacterium C&S - Body Fluid, Sterile 5 ml Specify site of collection. Send IPR 10-20
Body Fluid pleural fluid, Container immediately. weeks
gastric lavage
181 Mycobacterium C&S - CSF Sterile 0.5 ml Send immediately. IPR 10-20
CSF Container weeks
182 Mycobacterium C&S - Pus Sterile 3 ml Specify site of collection. IPR 10-20
Pus Container weeks
183 Mycobacterium C&S - Sputum Sterile 3 ml Collect 3 consecutive early IPR 10-20
Sputum Container morning (after rising mouth) weeks
sputum aseptically into the
container.
184 Mycobacterium C&S - Urine Sterile 50 ml Collect early morning midstream IPR 10-20
Urine Container urine on 3 consecutive mornings. weeks
185 Mycobacterium C&S- Bone Marrow Sterile 0.5 ml Send immediately. IPR, 10-20
Bone marrow Container weeks
186 Mycobacterium C&S - Tissue Sterile NA Specify site of collection. Do not IPR 10-20
Tissue Container put in formalin. weeks
187 Mycobacterium TB Sputum/PUS Sterile NA Smear negative with: - IPR 1-5 days
Gene Expert container poor/non respond to treatment
-relapsed patient, defaulted
-suspected TB before
bronchoscopy
Clinician to get prior approval
from respiratory consultant in
IPR


188 Mycobacterium TB CSF Sterile NA Suspected TB meningitis IPR
Gene Expert container Clinician to get prior approval
from respiratory consultant in
IPR
189 Mycobacterium TB Tracheal Sterile NA Clinician to get prior approval IPR
Gene Expert Aspirate/BAL container from respiratory consultant in
/Sterile Body IPR
fluid/urine/Ti
ssue/
Nasopharyng
eal Aspirate
190 Mycobacterium TB Bronchial Sterile NA Send immediately. MKAK 10-20

Genome Detection Alveolar Container weeks
Lavage,
Tracheal
aspirate,
sputum, Body
Fluid, CSF
191 Mycobacterium TB Blood Plain gel tube 5 ml MKAK 10-20

Genome Detection- weeks
Blood
192 Mycobacterium TB Tissue, Bone Sterile NA Specify site of collection. Do not MKAK 10-20
Genome Detection- Marrow, Container put in formalin. weeks
Tissue
193 Nipah IgG Blood Plain gel tube 5 ml HKL 2-3 weeks
194 Nipah IgM Blood Plain gel tube 5 ml HKL 2-3 weeks
195 Occult Blood (Haema Stool Sterile NA Internal 1-2 days

Test) Container


196 Opportunistic Stool Sterile 5 gm Provide 1 fresh and 1 PVA IMR 3-4 weeks
Intestinal Parasites Container (thumb preserved stool (1 part faecal mix
(Microsporidium nail with 3 parts PVA).
Isospora, size)/5ml
Cryptosporidium, diarrhea
Protozoan cysts, stool
Helminth ova &
larvae)
197 Panel Anti - Serum Plain gel tube 5ml IMR 14 days
Ganglioside
Antibodies: Anti-
GM1, Anti-GM2, Anti-
GM3, Anti-GM4, Anti-
GD1a, Anti-GD1b,
Anti-GD2, Anti-GD3,
Anti-GT 1a, Anti-GT
1b, Anti-GQ1b, Serum
198 Panel Anti- Blood/ Serum Plain gel tube. 5ml IMR 21 days
Neutrophil
Cytoplasmic
Antibody (ANCA): P-
ANCA, C-ANCA, anti-
MPO, anti-PR3
199 Panel Coeliac Blood/ Plain gel tube. 5ml IMR 21 days
Antibodies: Anti- Serum
Endomysium, Anti
Gliadin, Anti Tissue
Transglutaminase
200 Panel Extractable Blood/ Plain gel tube. 5ml IMR 16 days
Nuclear Antigen Serum
(ENA) antibodies: ds-
DNA, nucleosome,
histone, SmD1,PCNA,


PO(RPP), SSA/R0-60,
SSA/Ro 52, SSB/La,
CENP B, Scl 70, U1-
snRNP, AMA M2, Jo-1,
PM Scl, Mi-2, Ku)
201 Panel Diabetes Blood/ Serum Plain gel tube 5 ml IMR 14 days
Antibodies: Anti-
Glutamic Acid
Decarboxylase (GAD),
Anti-insulinoma-
Associated Antigen 2
(IA2) & Anti Islet
Cells (ICA)
202 Panel Paraneoplastic Blood/ Plain gel tube. 5ml IMR 14 days
Neurological Serum / CSF
Syndrome: Anti-
Amphiphysin, Anti-
Ma, Anti-Yo, Anti-Ri,
Anti-Hu,Anti-CV2
203 Panel Skin Blood/ Plain gel tube. 5ml IMR 14 days
Desmoglein 1 & Anti-
Desmoglein 3
204 Panel Skin Blood/ Plain gel tube. 5ml IMR 10 days
Pemphigoid Serum
Antibodies: Anti-BP
180, Anti BP-230
205 Panel Specific Liver Blood/ Plain gel tube. 5ml IMR 14 days
Antibodies : Anti M2- Serum
3E/BPO,Sp100,PML,g
p210,LC-
1,SLA/LP,Ro-52


206 Panel Tissue Blood/ Plain gel tube. 5ml IMR 14 days
Gastric Parietal Cell
Antibody (APC), Anti
Mitochondrial
Antibodies (AMA),
Anti Smooth Muscle
(ASMA), Anti Liver
Kidney Microsomal
(LKM)
207 Paraneoplastic Blood/ Plain gel 5 ml IMR 14 days
Neurological Serum/ CSF tube/Bijou
Syndrome (PNS) bottle
Antibodies
208 Parvo Virus (IgM & Blood Plain gel tube 5 ml HSB 1-2 weeks
IgG)
209 Parvo Virus DNA Blood Plain gel tube 5 ml MKAK 1-2 weeks
Detection (Viral
Load)
210 Phagocytic Function Blood EDTA tube 2 ml IMR 5 days
Test
211 Phospholipase A2 Blood/ Serum Plain gel tube 5ml IMR 21 days
Receptor Antibody
(anti-PLA2R)
212 Polio Virus/Acute i) i)Stool: Sterile i) Stool: >5gm (thumb size) , IMR 2-3 weeks
Flaccid Paralysis Stool(prefere bottle ii) Rectal swab: Stool on sterile swab
(AFP) Isolation, d)*(to collect ii) Rectal moistened with distilled water ,
Poliovirus-CSF within 14 swab: Sterile iii) TS: Sterile swab
(Culture), days of onset, plastic vial iv) CSF: 0.5mls in sterile container
Poliovirus-Others 2 adequate contain 2-3ml
sample to of VTM,
collect in 24- iii) Throat


48hrs apart) Swab :Sterile
ii)Rectal plastic vial
swab, contain 2-3ml
iii)Throat of VTM
swab, vi) CSF:
iv) CSF sterile
container
213 Poliovirus-stool Stool Sterile For investigations of AFP, need 2 IMR 2-3 weeks
(Culture) Container stool sample 24 hours apart,
within 14 days of onset. To use
special AFP IMR form (refer page
143). Please inform the lab prior
to sending specimen.
214 Respiratory Syncytial BAL MSYG
Virus Ag,IFAT-BAL
215 Respiratory Syncytial NPA MSYG
Virus Ag,IFAT-NPA
216 Respiratory Virus Nasopharyng Sterile 5 ml Send specimen in ice pack HKL 1-2 weeks
Antigen Screening- eal Asp, Container
IFAT (Adenovirus, Bronchial
RSV, influenza A/B, lavage,
parainfluenza 1/2/3 tracheal
aspirate
217 Rheumatoid Factor Blood Plain gel tube 5 ml Internal 1-7 days
(RA Factor)
218 Rickettsia Antibody Blood HSB
(Typhus Antibody)
219 Rickettsia Indirect Blood IMR
Immuno Peroxidase
Test
220 Rotavirus Antigen Stool Sterile NA Send immediately. Internal 1 day
container


221 Rubella IgG Blood Plain gel tube 5 ml Internal 1 week
222 Rubella IgM Blood Plain gel tube 5 ml Internal 1 week
223 Schistosomiasis Blood Plain gel tube 5 ml Send immediately. IMR 3-4 weeks
Antibody
224 Sterility Testing- Biological NA NA Send immediately. Internal 2 days
Biological Indicator Indicator 1 week
225 Stool for Fresh stool Screw lid, air 6g Fresh stool in plain container IMR 5 days
Cryptosporidium spp tight (specimen to reach lab within
Cyclospora spp. and container 24hr at room temperature)
Isospora spp. (DMSO (Before REFERRAL, Initial ID
stain) parasite to determine by
customer)
226 Stool for Fresh stool Screw lid, air 6g Fresh stool in plain container IMR 5 days
Microsporidium sp.. tight (specimen to reach lab within
(Gram Chromothrope container 24hr at room temperature)
stain) (Before REFERRAL, Initial ID
parasite to determine by
customer)
227 T and B cells Blood (fresh) EDTA 2 ml IMR 2-3 weeks
enumeration Test
228 TB Line Probe Assay Sputum Sterile 3 ml For sample with AFB smear MKAK 4 days-1
Container positive week
229 Torches Serology Blood Plain gel tube 5 ml Internal 7 days
230 Toxocara Antibody Blood Plain gel tube 5 ml IMR 3-4 weeks
231 Toxoplasma IgG Blood Plain gel tube 5 ml Internal 1-2 weeks
232 Toxoplasma IgM Blood Plain gel tube 5 ml Internal 1-2 weeks


233 Treponema pallidum- Blood Plain gel tube 5 ml Internal 2-7 days
(TPPA)
234 Treponema pallidum- Blood Plain gel tube 5 ml Send immediately. Internal 1-7 days
RPR (Screening)
235 Trichomonas HVS Amies NA Send immediately. HKL 1-2 weeks
vaginalis Antigen Transport
Medium
236 Varicella zoster Blood EDTA tube 5 ml Send specimen in ice pack Internal 1-2 weeks
Genome detection
237 Varicella zoster CSF, Vesicle Sterile 1 ml Send specimen in ice pack Internal 1-2 weeks
Genome detection fluids Container
238 Viral Culture-BAL Bronchial Sterile NA Send specimen in ice pack. IMR I month
Alveolar Container
Lavage
239 Viral Culture-Blood Blood Sterile 5 ml IMR I month
Container
240 Viral Culture-Body Body Fluid Sterile 3 ml Specify site of collection. Send IMR I month
Fluid Container specimen in ice pack.
241 Viral Culture-CSF CSF Sterile 3 ml Send specimen in ice pack. IMR I month
Container
242 Viral Culture-Others Tracheal Sterile NA Send specimen in ice pack. IMR I month
Aspirate Container
243 Viral Culture-rectal Rectal swab VTM NA Insert swab tips pass the anal IMR I month
swab sphincter and rotate gently. Keep
specimens chilled at all times
244 Viral Culture-Stool Stool Sterile NA Send specimen in ice pack. I month
Container
245 Viral Culture-throat Throat swab VTM NA Swab tonsils and the posterior IMR I month
swab pharynx vigorously. Keep
specimens chilled at all times.


246 Viral Culture-Tissue Tissue Sterile NA Specify site of collection. Do not IMR I month
Container put in formalin. Send specimen in
ice bag.
247 Viral Culture-TRAS Tracheal Sterile NA Send specimen in ice pack. IMR I month
Aspirate Container
248 Viral Isolation Study Bronchial Sterile 3 ml Send specimen in ice pack IMR I month
Lavage, Container
Tracheal Asp,
Nasopharyng
eal aspirate
249 Zika Virus (CSF) CSF Bijoux Sterile 1 ml MKAK 1-2 weeks
Container
250 Zika Virus (Tissue) Tissue Sterile MKAK 1-2 weeks
Container
with Sterile
Saline/VTM
251 Zika Virus PCR Serum AND Plain tube Adult : 5 Fill-in PERT301 form 3copies). MKAK 1-2 weeks
(Blood) Plasma AND EDTA ml BLOOD (Serum and Plasma) AND
Paediatrik: URINE MUST BE SENT
1-3 ml TOGETHER. Send
specimen in ice pack.
252 Zika Virus PCR Amniotic Sterile 3-5 ml MKAK 1-2 weeks
Amniotic Fluid Fluid Container
253 Zika Virus PCR Urine Urine Sterile 5-10 ml MKAK 1 day
Container

3. GENERAL HAEMATOLOGY

No Test Name Department Instructions TAT
Activated Partial Trisodium To mark
Blood Internal R: 3 hours
1 Thromboplastin Citrate Tube on tube
U: 1 hour
Time (APTT)
Trisodium R: 3 hours
Erythrocyte Blood 1.8 ml Internal
2 Citrate Tube
Sedimentation Rate
Fibrinogen Trisodium To mark R: 3 hours

Blood Internal
3 Citrate Tube on tube U: 1 hour
R: 3 hours
4 Full Blood Count Blood EDTA Tube 2.5ml Internal
U: 1 hour
Filter Paper
0.5ml
5 G6PD Screen Blood With blood Internal 1 day
spot
6 G6PD Confirmation Blood EDTA Tube 2.5 mls Internal 14 days
Trisodium To mark
International Blood R: 3 hours
7 Citrate Tube on tube Internal
Normalised Ratio U: 1 hour
(INR)
Prothrombin Time Trisodium To mark
8 Internal 1 hour
Blood Citrate Tube on tube
2.5 ml
CD4/CD8
(To mark Mix by inverting container 6-10
9 Enumeration Test Blood EDTA HKL 10 days
on tube) times
T & B cells 2 ml fresh For PID screening, to follow

10 Enumeration Test Blood EDTA blood instruction as for Phagocytic IMR 2-3 weeks
Function Test

4. MOLECULAR CYTOGENETICS (PRENATAL & CARYOLITE BoBs)
Test Name Specimen Container Volume Perform

No. Department Instructions TAT
Conventional Blood Lithium HKL
1
cytogenetics Heparin For syndrome:Down, (Genetic U:10days
Patau,Edwards,Turner,Cri Du Laboratory) R:3 months
2.5 ml - Chat, To fill
2 Molecular Cytogenetics Blood EDTA Tube 5 ml Klinefelter,Angelman,Prader- Chromosom
Willi,DiGeorge,Smith-Magenis, al Study
Miller-Diecker,Wolf-Hirschhom Form
*TAT subjected to type
of cases etc..Please call
HKL ext:5637 for
further enquiry
6. BLOOD TRANSFUSION SERVICES
Test Name Specimen Container Volume Perform

No. Department Instructions TAT
1 Antibody Screening Blood EDTA Tube 6 ml Internal 2 hours
2 Direct Coombs test Blood EDTA Tube 6 ml Send immediately Internal 2 hours
Blood group & Rh Type Blood EDTA Tube 6 ml Internal 2 hours

3
R:2 hours
For paediatric (< 4months old), to
4 Group & Cross match (GXM) Blood EDTA Tube 6 ml Internal U:1 hour
send mother’s sample.
Group & Rh Phenotype Cross Blood EDTA Tube 6 ml Internal See *
5 match
Group Screen & Hold (GSH) Blood EDTA Tube 6 ml Internal 2 hours
6

Investigation of Transfusion Refer to page 104 for

7 Reaction Post Investigation of Transfusion Internal
Reaction Post
Investigation of Delayed Refer to page 105 for
8 Transfusion Reaction Investigation of Delayed Internal
Transfusion Reaction
Antibody Identification Blood EDTA Tube 6 ml Require 3 samples in 3 different Internal 14 days
9
container
Red cell phenotyping Blood EDTA Tube 6 ml Require 3 samples in 3 different Internal 14 days
10
container
Red cell genotyping Blood EDTA Tube 2.5 ml Require 3 samples in 3 different PDN 28 days
11
container
*Depends on availability of type blood from the National Blood Centre.
7. CYTOLOGY
No. Test name Specimen Type Container Volume Department Perform Schedule Lab TAT
Type Required Instructions site
a) Fluid Universal As collected Send immediately. Hospital Daily Urgent:
1. Non-  Peritoneal container or If delay anticipated, Serdang 3 days
gynaecology:  Pericardial clean container refrigerate at (2-
 Cyst 8°C) Routine:
 Synovial 14 days
 Urine
b) Eye fluid/eye Liquid based As collected Send immediately. Urgent:

washing/ Vitreous cytology vial If delay anticipated 3 days
fluid (by refrigerate at (2- Daily
appointment) 8°C) Hospital Routine:
Serdang 14 days
Vitreous fluid (by
appointment)

c) Cerebrospinal fluid Sterile As collected Send immediately. Urgent:
container / If delay anticipated, 3 days
Hospital
Bijou bottle refrigerate at (2- Daily
Serdang
8°C) . Routine:
14 days
d)Esophageal Sterile As collected Send specimen in Urgent:
washing container ice container. 3 days
Hospital
Daily
Serdang
Routine:
14 days
e) Bronchial brushing 2 smeared 2 smeared Send slide in the Urgent:
slides fixed in slides slide folder/box. 3 days
95% ethyl Hospital
alcohol at Serdang Daily Routine:
minimum of 30 14 days
minutes
f) Bronchial Sterile As collected Send immediately. Urgent:
washing/aspirate container If delay anticipated, 3 days
Hospital
add 50% Etoh 1:1 Daily
Serdang
Routine:
14 days
g) Bronchial alveolar Sterile plain As collected Send immediately. Hospital Daily Urgent:
lavage container Serdang 3 days
Routine:
14 days
h) Sputum Sterile plain As collected Send immediately. Hospital Daily Urgent:
container (3 consecutive *If delay Serdang 3 days
early morning anticipated, add
deep cough 50% Etoh 1:1 or Routine:
specimen) *Refrigerate 14 days
specimen at 4°C up
to 24 hours.

i) Nipple discharge • 1 slide fixed 2 smeared Urgent:
in 95% ethyl slides 3 days
alcohol at
minimum of 30 Routine:
minutes 14 days
• 1 slide air-
dried
2 Gynaecology Conventional smear Smeared fixed Smeared fixed Hospital Daily 28
slide slide Serdang working
days
Liquid Based Cytology LBC vial As collected Hospital Daily 14
(LBC) Serdang working
days
3. Fine Needle Smear on slide. Generally, As collected Send slide in the Hospital Daily Urgent:
Aspiration maximum 6 slide folder/box. Serdang 3 days
(FNAC) smeared slides.
Routine:
Thyroid gland 14 days
and salivary
gland aspirate:
• 2 slides fixed
in 95% ethyl
alcohol
at minimum of
30 minutes
• 4 slides air-
dried
Aspirate from
other
organs/lesions:
• 3 slides fixed
in 95% ethyl
alcohol

at minimum of
30 minutes
• 3 slides air-
dried
Remaining aspirated Remaining As collected Hospital Daily

material material placed Serdang
Material for further in cytofix
ancillary testing solution (for
cell block
preparation
and ancillary
testing if
needed)
Additional
aspirate is
required and
material placed
in cytofix
solution

8. HISTOPATHOLOGY
Container Volume Department Schedule

No. Test Name Specimen Type Perform Site Lab TAT
Type Required Instructions
Routine HPE Formalin* Fixed Leak-proof, (Tissue to Clinical data Urgent
1 - Biopsy Tissue clear container Formalin including Hospital Daily small
- Resected (*10% Neutral ratio: 1:10) provisional Serdang biopsy
specimens Buffered Formalin) diagnosis must be without
- Tissue from completely fill up ancillary
autopsy study:
specimen 3 days
Non
urgent
small
biopsy
without
ancillary
study:
5 days
Routine
specimen
42 days
3 Renal Biopsy Slide Leak-proof, (Tissue to Hospital Daily 14 – 30

(Requiring clear container Formalin ratio: Serdang days
Tissue: 1:10)
Immunofluores 1. Formalin* Fixed Tissue
-cence Study) (*10% Neutral Buffered
Formalin)
2. Fresh Tissue in
phosphate buffer
(Transport in ice)

Container Volume Department Schedule

No. Test Name Specimen Type Perform Site Lab TAT
Type Required Instructions
4 Skin Biopsy Tissue Leak-proof, clear (Tissue to Hospital Daily 14 – 42
(Requiring 1. Formalin* Fixed Tissue container Formalin ratio: Serdang Office hour days
Immunofluorescen (*10% Neutral Buffered 1:10)
ce Study) Formalin)
2. Fresh Tissue in Leak-proof, clear

phosphate buffer container
(Transport in ice)
5 Muscle Biopsy Tissue Plain Container Not Applicable Fresh specimen. Do Histopathology Daily 60 days
(Requiring Enzyme Fresh Tissue Leak-proof, clear not put in Formalin. Unit, Pathology Office hour
Histochemical (Transport in ice) container Appointment with Department,
Study) Pathologist in-charge Hospital Kuala
of HKL Lumpur (HKL)
6 Rectal Biopsy Slide Leak-proof, clear Not Applicable Appointment with Histopathology Daily 7 days
(Requiring Enzyme Fresh Tissue container Pathologist in-charge Unit, Pathology Office hour
Histochemical (Transport in ice) of HKL Department,
Study) Hospital Kuala
Lumpur (HKL)

HOSPITAL AMPANG 2021
PATHOLOGY DEPARTMENT
C. SPECIAL TEST INSTRUCTIONS: CHEMICAL PATHOLOGY
INTRODUCTION
Chemical Pathology services cover pre-analysis, analysis and interpretation of biochemical changes
in serum/plasma and body fluids for diagnostic, monitoring and screening of diseases. It also
provides consultative laboratory services to Hospital Ampang for patient managements.
SERVICES
Common Receiving Area (CRA)
Samples for chemical pathology tests will be received at CRA either by pneumatic tube or via
porter. These samples will be sorted based on tests requested and processed accordingly.
The diagnostic services provided are:

i. Urgent service
These are short turn-around-time tests which are required for immediate patient management as
indicated by the clinician in the eHIS/request form. Service provided 24 hours e.g. Renal Profile,
Blood Gases, Calcium, Glucose, Amylase, Cardiac Enzyme, Neonates Bilirubin and CSF
Biochemistry.
ii. Routine service

These include all the tests that are offered 24 hours and routine test such as Liver Function Test,
Lipid Profile, Magnesium, Thyroid Function test, Anemia Study etc.
iii. Special Service

These are test which require to be run in batches such as HbA1c, Protein Electrophoresis, Special
Protein tests etc.
REQUEST OF TESTS
All chemical pathology tests can be requested from CA (Clinical Access) in Hospital Ampang
Information System (eHIS). Standard request form (PER PAT 301) can be used for external clients
and during eHIS breakdown.

Therapeutic Drug Monitoring (TDM) request form should be used for any outsource TDM request.
Each patient’s request should be accompanied with 2 request forms.
 Make sure all outsourced TDM tests requested in the request form tally with the
orderable test in eHIS to avoid misleading of reporting results later
 Ensure the timing of the sample and the request information is appropriate to
ensure outcome results are accurate and clinically meaningful.
SAMPLE COLLECTION
For special test which are not mentioned, please call the laboratory for specimen instructions or
requirements.
Most chemical pathology tests are performed using serum and plasma heparin samples. Type of
specimen for each test is listed for reference (refer list of test in section B). Proper collection is
essential to provide accurate results for patient management and care. The quality of specimen
provided will determine the quality, reliability and accuracy of the laboratory result.
For collection of specimen for clinical chemistry analysis, minimum tourniquet pressure should be
applied during venipuncture in order to avoid forcing of free fluid from capillaries which may result
in hemoconcentration and spurious elevations of protein and protein bound substance e.g. total
protein, calcium. If possible, tourniquet should be released after no more than one minute from the
initial placement.
Hemolysis can affect clinical chemistry test by interfering with the photometric determination of
the analyte concentration in the sample leading to erroneous results. If considerable hemolysis is
noted, another sample will be requested upon rejection of the first sample.
Avoid mixing or transferring blood from different tubes as certain tubes may contain anticoagulant
substance which will falsely elevated the concentration of certain analyte in the sample.
Avoid collection of blood from limbs being infused with intravenous solution. This will lead to
hemodilution and measurements on these sample produces erroneous results which is not the
actual presentation of the analyte concentration in the specimen.

SPECIAL TEST INSTRUCTION AND COLLECTION PROCEDURE
Arterial Blood Gases

Procedure of collection
i. Use a 1 ml disposable heparinised syringe.
ii. Draw 1 ml of arterial blood. Invert the syringe and remove all air bubbles inside the syringe.
Discard the needle to prevent needle stick injury incidence and recap with special
stopper provided to avoid specimen exposure to air.
iii. Mix well by rolling the syringe between palms to prevent clotting.
iv. Put syringe of blood in slurry ice bath and send immediately to the lab.
Important notes
i. After the blood is drawn into the syringe, any air space or bubbles must be removed.
ii. The specimen must be kept embedded in crushed ice and sent immediately for analysis
(within 30 min). Specimen exceeding this time frame may be rejected.
iii. Specimen should not be sent by pneumatic tube.
iv. The attendant is advised to wait for the result if the eHIS is down, which will be ready
within few minutes.
(24 Hour) 24H Urine Collection

i. The 24 hour urine bottle is available at CRA.
ii. Bring the test ordered barcode to the lab for bottle collection.
iii. On the day of collection, the first urine voided must be discarded. Time of first urine voided
is the start of the timing for the 24 hour collection.
iv. At the end of 24 hour, the last urine voided is collected. For best result, refrigerate sample if
possible.
v. Send the urine sample immediately to the laboratory.
Important notes
 Some 24 hour urine containers contain preservatives. Do not discard the preservative.

Lactate
Collection of satisfactory specimen for lactate analysis requires special procedure to prevent
changes in lactate concentration while and after the specimen is drawn.
i. Patient should be fasting and at complete rest.
ii. A venous specimen is best drawn without a tourniquet or immediately after the tourniquet
has been applied briefly.
iii. If the tourniquet has been applied very long, it should be removed after the puncture has
been performed and blood allowed circulating for at least 2 minutes before the blood is
withdrawn.
iv. 2 ml of blood is collected in a container with sodium fluoride as anticoagulant.
Important notes
i. Sample should be chilled in the ice bath and sent to the laboratory immediately after
collection.
ii. Separation of cell through centrifugation at the laboratory is done within 30 minutes.
iii. Haemolysed specimen may affect the results.
Ammonia
i. A venous specimen is best drawn without a tourniquet or immediately after the tourniquet
has been applied briefly. If the tourniquet has been applied very long, it should be
removed after the puncture has been performed and blood allowed circulating for at
least 2 minutes before the blood is withdrawn.
ii. 2 mL blood in EDTA tube on ice. Send to laboratory on ice within 15 minutes of collection.
For paediatric patients a minimum of 1 mL blood (full micro tube) is required.
Important notes
i. Please notify the laboratory before sample collection for analyzer preparation.
ii. This test must be processed urgently.
iii. Ammonia levels may be elevated due to pre-analytical sources. These include:
Poor collection technique. The skin must be thoroughly cleaned prior to collection.
Haemolysed specimens and prolonged storage (even once frozen) will result in

elevated levels making interpretation difficult. Ammonia can be performed on a

micro-collect, but the slower collection procedure increases the level.
Exogenous sources of ammonia, e.g. smokers (patient or phlebotomist), cleaning
solutions and urine may lead to elevated levels.
G6PD Screening
i. Apply a drop of cord blood to a piece of filter paper.
ii. Avoid thick smear of blood which will cause false positive result.
iii. Allow it to dry completely.
iv. Dispatch to the laboratory in Biohazard plastic bag with barcode attached to the filter paper.
Important notes
Request for G6PD samples will be accepted until 3.00 pm on working days and until 10.00 am on
weekends and public holidays.
HbA1c
2 ml of blood is collected in a container with EDTA as anticoagulant.
Important notes
i. Test should be performed for monitoring of patients diagnosed with diabetes mellitus.
ii. Repeated testing should be done six monthly if stable and 3 monthly if the glycemic control is
poor and recent adjustment in medication being done.
iii. Several condition may affect the HbA1c result (haemolytic anemia, iron deficiency anemia, end
stage renal failure and hemoglobinopathies) leading to possible misinterpretation of the result.
In this condition, blood glucose monitoring or fructosamine is preferrable.

Therapeutic Drug Monitoring

i. Many of these samples require to be taken at a specific time pre(trough) or post(peak)
dose.
ii. Failure to collect the blood at the appropriate time will make it impossible to compare the
measured concentration with the accepted therapeutic range.
iii. Therefore, blood samples should be collected once the drug concentrations have attained
steady-state.
iv. Strictly NO hemolysed serum samples as it will interfere the TDM results.
Important notes
i. All outsourced TDM samples should reach CRA, Pathology Department by 8.00 am every
morning during working days.
ii. Outsourced TDM samples received after 8.00 am will be sending to the referral centres on the
next working day.
iii. All in-house TDM samples received after 4.00 p.m will be tested on the next working days.
iv. TDM testing is not available during weekends and public holidays (except PCM and Salicylate).
Creatinine Clearance Test

i. A 24 hour period of urine collection is recommended.
ii. A careful and accurate 24 hour collection of urine must be ensured.
iii. At the same time during the day, a blood sample is taken for serum creatinine analysis. Both
blood and 24 hour urine sample are sent to the laboratory.
Glucose Tolerance Test

i. Fast the patient overnight.
ii. Collect fasting blood specimen.
iii. Give patient 75g glucose in 250 – 300 ml water and drink within 5 minutes. For children
weighing less than 43 kg should take 1.75g/kg body weight.
iv. Collect a 2nd blood specimen after exactly two hours of glucose consumption.

Important notes
i. GTT is a test to determine the body’s ability to handle glucose. It may be used for screening and
diagnosis of diabetes, prediabetes and gestational diabetes.
ii. For three days prior to the test, the patient must be on a diet containing no less than 200 g of
carbohydrate daily.
iii. Do not perform this test when patient acutely unwell.
iv. The glucose solution for this test should be obtained from the pharmacy.
Serum-Ascites Albumin Gradient(SAAG)

Collect a blood sample and ascites fluid at the same time during the days for albumin measurement.
Important notes
SAAG = (albumin concentration of serum) - (albumin concentration of ascitic fluid).
Serum Protein Electrophoresis

i. Samples shall come in pair (Serum & Urine) especially for screening purpose
ii. Request shall be rejected if only urine sample received.
iii. Strictly NO haemolysed / plasma / aged samples.
CSF Protein Electrophoresis

Serum and CSF from the same patient must be collected at the same day (ideally within 4 hours)
and sent in pair (Serum & CSF) to the lab for analyses
Cryoglobulin
i. Test is offered by appointment to :
a) In patient Hospital Ampang
b) External patient refer for blood taking procedure at FNAC Clinic Hospital
Ampang.

ii. Appointment shall be made to the respective laboratory personnel in Protein lab,
Special Biochemistry Unit Hospital Ampang (03 - 4289 6216)
iii. The particular of requesting physician, patient’s identification and respective
contact number will be recorded.
iv. In charge Laboratory personnel shall contact the patient/requesting physician for
confirmation few days before the appointment date.
v. Blood taking equipment (the tubes, syringe and needle and flask) are incubated at
37oC for at least 24 hours before appointment date.
vi. In charge Laboratory personnel shall attend to the respective site with the flask
containing pre-warmed blood taking equipment on the day of appointment.
a) For External patient, blood sampling procedure will be done at FNAC
Clinic (nearby O&G Clinic) located at level 1, Hospital Ampang by Pathology
Medical Officer.
b) For Inpatient Hospital Ampang, blood taking procedure will be done by
Pathology Medical Officer at the respective ward/clinic
vii. Blood collection must be carried out using instruments and containers provided
viii. Samples will be drawn into two separate tube as follows:
-EDTA tube (sample volume is 2 mls)
-Plain tube without gel (sample volume is 8mls)
ix. Immediately placed all the samples into the flask and transport to Protein lab,
Special Biochemistry Unit, Hospital Ampang for further processing.
Urine Biochemistry
Ensure midstream urine is collected and send immediately for analysis
Urine Myoglobin
Collect 10 ml urine in a container that contains 0.2 g of sodium bicarbonate (2% final
concentration).

PROTOCOLS FOR INVESTIGATION OF ENDOCRINE DISORDERS

The protocols for dynamic test listed below are only as guide and subjected to changes according to
local practices. These protocols are mainly for adult.
PITUITARY DISORDERS
Assessment of Anterior Pituitary Hormone
Pituitary Hypofunction
Pituitary hypofunction include Corticotroph deficiency, Thyrotroph deficicency, Gonadotroph

deficiency or Somatotroph deficiency. In general, GH and gonadotropin secretion (LH before FSH)
are affected before that of ACTH.
Combined Anterior Pituitary Function Test

 Fast the patient overnight and weigh
 Insert and heparinise i.v. cannula
 Draw and discard 1 mL of blood before collecting each sample and heparinize cannula after each
sample is drawn
 After 30 min take basal blood sample and analyze for glucose, cortisol (or ACTH), FSH, LH, TSH,
free thyroxine, GH and testosterone/oestradiol
 Give 200 μg TRH, 100 μg GnRH and 0.15 U/kg body weight soluble insulin
 Take blood samples for analysis as in table below:
 Repeat insulin dose at 45 min if patient has not become clinically hypoglycaemic (plasma
glucose <2.2 mmol/L) and extend sampling accordingly
 Label specimens according to sampling time and send to the lab immediately.
Time of Sample Type Tests Container Type Volume

sampling
0 min Blood Glucose 1 Fluoride Oxalate tube 2ml
Cortisol, GH, LH, FSH, TSH, 2 Plain gel tubes* 3.5ml each
GH
20 min Blood LH, FSH, TSH 2 Plain gel tubes*
Cortisol, GH 2 Plain gel tubes* 3.5ml each
Cortisol, GH, LH, FSH, TSH, 2 Plain gel tubes* 3.5ml each
GH
Cortisol, GH 2 Plain gel tubes* 3.5ml each
Cortisol, GH 2 Plain gel tubes* 3.5ml

Source : Clinical Chemistry 8th edition, William J Marshall & Stephen K Bangert, Mosby
*Cortisol & TSH : internal test, GH, LH & FSH : outsource to HKL
Interpretation of Combined Anterior Pituitary Function Test
Normal response
Cortisol Increment >200 nmol/L
Peak >550 nmol/L (the same criteria
apply if glucagon is used)
GH Peak >5 μg/L
FSH Peak >1.5 times basal concentration
LH Peak >5 times basal concentration
TSH Increment ≥2 mlU/L (elderly)

≥5 mlU/L (young adults)
Insulin Stress Test

Procedures:
 Similar as Combine Anterior Pituitary Stimulation Test but without GnRH injection.
 Blood samples are taken after insulin injection as in table below:
 Label specimens according to sampling time and send to the lab.
Time of Tests Sample type Tube container Volume
sampling
0 min Glucose Blood 1 Fluoride Oxalate tube 2ml
Cortisol, GH Blood 2 plain gel tubes 3.5ml
 Notes: If Insulin Stress Test is not suitable, alternatively can perform Glucagon Stimulation
Test. This test enables assessment of growth hormone deficiency as well.
Glucagon stimulation test

• Fast patient from midnight
• Leave indwelling branula in a cubital fossa vein. (keep patency with heparinised saline )
• Draw sample of blood at 0 min – RBS , cortisol , GH
• For adult patient: give IV glucagon 1mg stat ( 1.5 mg if weight is > 90 kg )
• For paediatric patient : give IV glucagon 15 mcg / kg stat
• Rest patient and draw sample blood for RBS , cortisol and GH at 30 min ,60 min , 90 min and 120
min ( it is optional to sample at 150 min and 180 min )

Notes:
Adequate response for cortisol > 550 nmol / L
Adequate response for GH > 20 mU / L (9 ng/ ml )
Gonadotropin Releasing Hormone Stimulation Test

Procedures:
• Collect sample for baseline LH and FSH.
• 100ug GnRH is given intravenously.
• Collect samples as follows:
Time of sampling Tests Sample type Tube container Volume

0 min FSH, LH Blood 1 plain gel tube 3.5ml
• Label specimens according to sampling time and send to the lab.
Pituitary Hyperfunction (Growth Hormone excess)
a) Screening and biochemical diagnosis

2 tests must be done to attain biochemical diagnosis of acromegaly and gigantism.
1. Measure IGF 1 level according to age-adjusted reference.
2. Perform oral glucose tolerance test with 75g oral glucose after at least 8 hours of overnight
fasting.
• Active acromegaly is indicated by elevated IGF 1 and failure of GH to be suppressed below 1
ng/ml.
Notes: GH may not be suppressed in poorly controlled diabetes mellitus, severe illness, chronic
liver disease and chronic kidney disease.
Assessment of Posterior Pituitary Hormone
Introduction:
Posterior pituitary secretes vasopressin (ADH) and oxytocin. These hormones are synthesized
in hypothalamus and pass down nerve axons into the posterior pituitary and released into the
circulation. Conditions that are related to ADH alteration include:
1. Diabetes Insipidus (DI)
2. Syndrome of inappropriate antidiuretic hormone (SIAD)

Diabetes Insipidus (DI)

• It occurs due to lack of ADH caused by either pituitary/hypothalamic disease (cranial DI) or
failure of kidney to respond to ADH (nephrogenic DI).
• Patient may presented with polyuria (urine volume >3 L/day). More common causes of
polyuria such as diabetes mellitus, hypokalemia , hypercalcemia and diuretic therapy should
be excluded first.
Initial investigation:
Measure serum and urine osmolality and sodium

• If serum osmolality ≥ 295 mOsm/kg, urine osmolality is < 300 mOsm/kg and sodium ≥145
mmol/l Diagnosis of Diabetes Insipidus is unlikely and not for Fluid Deprivation test.
• If diagnosis is in doubt; perform Water Deprivation test.
Water Deprivation Test

Procedure
• Allow fluids overnight before test and give light breakfast with no fluid; no smoking
permitted
• Weight patient
• Allow no fluid for 8hours; patient must be under constant supervision
Every hour
• Weight patient (stop test is weight falls by > 5% initial body weight)
• Patient empties bladder, measure urine volume and osmolality
Every 2 hourly
Measure plasma osmolality (stop test if osmolality >300)
After 8 hours
if plasma osmolality ≤295 mmol/kg and urine osmolality 750 mmol/kg, normal response: end of
test, allow patient to drink (test can be terminated earlier if this urine osmolality is exceeded)
if plasma osmolality ≥295 mmol/kg, give 2 µg desmopressin intramuscularly and measure urine
osmolality every hour for a further 3 h (and restrict water intake to ≤500 mL over next 8 h)
Interpretation:
Urine osmolality mOsm/kg after

8 hour fluid deprivation Desmopressin
<300 >750 Cranial DI
<300 <300 Nephrogenic DI
>750 not indicated Primary Polydipsia
300-750 <750 Non-diagnostic
If the result is equivocal or non diagnostic, Saline infusion test are performed to assess plasma
vasopression response to hypertonic saline infusion. The response is normal in Cranial DI or
primary polydipsia

2. Syndrome of Inappropriate Antidiuretic Hormone

 Clinical indication: Documented plasma osmolality <or=275mOsm/kg and hyponatremic
<or=130mmol/l
 Exclude cardiac, hepatic, renal, thyroid or adrenal failure, effect of pituitary surgery,
diuretic therapy and medication known to stimulate ADH secretion
 Collect sample as follows and send accordingly to the lab:
Test Name Specimen Type Container Type Volume

Sodium, urine Urine Universal container 10 ml
Osmolality Blood Plain gel tube 3.5ml
Osmolality Urine Universal container 10 ml
Notes:
SIADH is suspected if urine osmolality is inappropriately higher than serum osmolality.
ADRENAL DISORDERS
Adrenal hypofunction (Addison disease)
Screening
• Indications for screening include unexplained hyponatremia, chronic steroid ingestion or
traditional medication and adrenal mass.
• Screening is done by doing Short Synacthen Test as described before.
Adrenal Hyperfunction (Cushing’s syndrome)

Screening should be done in patient with multiple and progressive features of Cushing’s
syndrome, patient with adrenal incidentaloma and after excluding exogenous steroid intake.
Screening tests include:
• Overnight Dexamethasone Suppression Test (ODST)
• Low Dose Dexamethasone Suppression Test (LDDST)
• 24 Hours urine free cortisol (UFC) X 2
Overnight Low Dose Dexamethasone Suppression Test (OLDDST)

Procedure:
• Give 1 mg dexamethasone orally at 2300 or 2400 hours.
• Fill up the request form complete with clinical summary and request test mentioned above.
• Collect blood early morning (e.g. 8.00 am) for determination of serum cortisol and send to the
laboratory.

Interpretation:
In normal subjects, serum cortisol is suppressed to less than 50 nmol/l. Serum cortisol level of
more than 50 nmol/l can also be seen in cases of stress, obesity, infection, acute or chronic illness,
alcohol abuse, severe depression, oral contraceptive, pregnancy, estrogen therapy, failure to take
dexamethasone, or treatment with diphenylhydantoin or phenobarbital (enhancement of
dexamethasone metabolism).
Low Dose Dexamethasone Suppression Test (LDDST)

Procedure:
• At 9.00am on 1st day of test, collect blood for serum cortisol (basal) and request test mentioned
above.
• Immediately after sampling, give 0.5mg dexamethasone orally every 6 hrs for 2 days (8 times)
• Collect blood for serum cortisol 6 hours after last dose of 0.5mg dexamethasone and send to the
laboratory.
Interpretation:
• In normal subjects, serum cortisol will be suppressed to <50nmol/l.
24-hours urine free cortisol

Interpretation:
If the value is less than 300 nmol/day, Cushing syndrome is excluded
If level is 3-4 times greater than upper limit normal, suggestive of Cushing syndrome
After 2 concordantly positive screening tests, localization tests are recommended.
Localization test include:

Plasma ACTH
• Blood should be taken together with serum cortisol at 9am.
• Keep the tube in ice water bath and send to lab for centrifuged and frozen as soon as possible to
avoid falsely low result
Interpretation:
a. ACTH < 5 ng/L (<1 pmol/L): ACTH independent Cushing → proceed with CT scan of
adrenals.
b. ACTH >15 ng/L (>3 pmol/L): ACTH dependent Cushing → proceed with MRI pituitary/ CXR.
c. ACTH 5-15ng/L is less discriminatory and other tests such as HDDST may be helpful.
High Dose Dexamethasone Suppression Test (HDDST)

In ACTH independent Cushing’s syndrome, HDDST may be helpful to distinguish Cushing’s disease
from ectopic ACTH producing tumor.
Procedure:
• 9.00 am on 1 st day of test, blood is taken for serum cortisol
• Immediately after sampling, Dexamethasone 2mg is given orally every 6 hrsfor 48 hrs (9.00 am,
3.00pm, 9.00pm, 3.00am, 9.00am, 3.00pm, 9.00pm, and3.00am on the 2nd day)
• 9.00am on the 3rd day of the test, blood is taken for serum cortisol

Interpretation:
• If serum cortisol is suppressed to < 50% from the baseline, Cushing’s disease is likely with the
sensitivity of 60-80%.
• If in doubt, Inferior petrosal sinus sampling(IPSS) is indicated
Adrenal Hyperfunction (Primary Aldosteronism)
Aldosterone Renin ratio (ARR)- Screening test

Indicated for screening of Primary Aldosteronism among hypertensive patients with spontaneous
or diuretic induced hypokalemia.
Suggested candidates for screening include:

1. Patients with hypertension and hypokalaemia
2. Patients with resistant hypertension
3. Young hypertension age<40year old
4. Patients with adrenal incidentaloma
Principle
The renin aldosterone axis is primarily regulated by renal blood flow. Subjects under investigation
should, therefore, not taking any drugs that interfere with fluid balance and potassium.
Patient preparation
1. Attempt to correct hypokalaemia
o Blood should be collected slowly with syringe and needle (preferably not vacutainer
to minimize risk of spurious raising potassium.
o Avoid fist clenching, avoid using tournique
o Avoid hypokalaemia as it suppresses aldosterone secretion. Give potassium
replacement (slow K) sufficient to raise plasma potassium of >4mmol/L.
2. Subjects should be normally hydrated and has an adequate oral intake of sodium.
3. Drugs to avoid
a) Spironolactone*, amiloride, Triamterene
*Spironolactone must be stopped for 6 weeks
b) Potassium wasting diuretics
c) Product derive from licorice root
4. If ARR testing is not diagnostic after withdrawing above agents and hypertension can be
controlled with non interfering medications, do the test again after 2 weeks of withdrawing
other medications.
a. ACE inhibitors, ARB, Beta blocker, methydopa and clonidine
b. Oral contraceptives and hormone replacement therapy may lower direct renin
concentration and cause false positive ARR
*do not withdraw oral contraceptives unless confident on the effectiveness of
alternative- contraception
5. Drugs that do not interfere with renin aldosterone axis include: Prazosin, Verapamil,
Hydralazine and Terazosin

Procedure:
o Fill up the PER. PAT301 form. Patient’s clinical history, drug history and latest potassium
level is MANDATORY besides other particulars such as patient’s name, IC, MRN, age, gender,
request date and time of collection. Form must be signed by Specialist/ Endocrinologist
only.
o Blood should be collected in the midmorning, after patient has been sitting, standing or
walking for 2 hours and seated for 5-15 minutes. In cases which supine sample is taken,
sample should be collected early in the morning and patient’s posture should be stated
clearly in the request form.
o Collect blood carefully to avoid stasis and hemolysis.
o Collect samples as follows:
Tests Sample type Tube container Volume

Renin Blood 1 EDTA tube 2ml
Aldosterone Blood 1 EDTA tube 2ml

o Keep sample at room temperature (not in ice) and transport immediately to the lab for
centrifugation. Samples should be sent to the lab within 30 minutes of sampling.
o No Ice cooling of the sample prior centrifugation. This may cause cryo activation of pro
renin to renin, leading to falsely raised renin.
Instruction for Lab personnel :

o Samples should be centrifuged ASAP or within 2 hours of collection.
o Transfer the plasma into 2 secondary tubes with minimum volume of 500 uL for each
analyte. Both samples should be frozen ASAP, packed in ice and placed in sturdy insulated
container before sending to referral lab.
Interpretations:
In Hospital Putrajaya, the cut off used are as follows:
 ARR<25- Primary Aldosterone is unlikely
 ARR25-35-Indeterminate, repeat testing could be necessary
 ARR>35- Suggestive of Primary Aldosteronism
Following a positive screening test (elevated Plasma Aldosterone with elevated ARR), proceed to
confirmatory tests.
Saline Suppression Test (SST)- Confirmatory Tests
Patient preparation
1. Stop spironolactone, amiloride 6 weeks prior to scheduled test. Hypertension may be
controlled on alpha blockers (Prazosin, Terazosin) or Calcium Channel blockers (Verapamil
preferred)
2. Check serum potassium within 1 week of test. Ensure normokalemia, preferably serum K >
4mmol/L prior to testing. Patients may require oral potassium replacement (Slow K / Mist
KCl)

Procedure
1. Insert iv cannula and start an intravenous infusion of normal saline 500mls per hour for the
next 4 hours (2 L NS over 4 hours) using an infusion pump. Monitor BP/ HR.
2. On completion of saline infusion, collect blood for plasma aldosterone and request test as
Plasma Aldosterone Post Saline Suppression Test
Interpretation of SST:
Aldosterone < 140pmol/L : Primary Aldosteronism unlikely

Aldosterone 140-280 pmol/L : Indeterminate
Aldosteronism > 280 pmol/L : Probable Primary Aldosteronism
In cases with indeterminate results on SLT, proceed to a second confirmatory test such as
Fludrocortisone Suppression Test (FST)
Adrenal Hypofunction (Adrenal insufficiency/ Addison disease)
Short ACTH Stimulation Test
 Glucocorticoid medication should be ceased for 24 hour prior to test to minimize possible
suppression, or switched to dexamethasone 48 h before the test, because other synthetic
steroids cross-react with laboratory immunoassays for cortisol (and hydrocortisone is
identical to cortisol)
 Draw baseline sample of cortisol at 0 minute
 Give i.m. or i.v. 250 ug ACTH
 Draw samples at 30 and 60 minutes
 Label specimens accordingly and send to the lab immediately.
Interpretation:
Normal response is increment of cortisol by 200 nmol/L from baseline with peak of >550 nmol/L.
failure to respond consistent with adrenal failure, whilst a sluggish response (60min value >30min)
is suggestive of adrenal dysfunction secondary to hypothalamic/pituitary disease or steroid
therapy.
Long ACTH Stimulation Test
 Draw baseline sample of cortisol at 9am and inject 1 mg depot ACTH i.m.
 Draw samples at 3pm
 Draw sample for cortisol next day at 9am
Interpretation:
Primary adrenal insufficiency : No increase in cortisol.
Secondary adrenal insufficiency : Increase in cortisol at 6 h with further increase at 24 h; total
increment >200 nmol/L.

D. SPECIAL TEST INSTRUCTIONS : MEDICAL MICROBIOLOGY
INTRODUCTION
Medical microbiology is an essential component in the infectious disease field and knowledge in
this area is vital to the clinical management of infections. The microbiology laboratory is
particularly involved in the isolation or establishing the causative organisms as well as monitoring
and screening of diseases.
List of Services
Microbiology unit provides the following services:
a) Diagnostic microbiological services which comprise of bacteriology, mycology, parasitology,
virology and basic immunology.
b) Participation in hospital wide infection control activities related to surveillance, control and
prevention of nosocomial infections.
c) Provision of microbiologic studies of the hospital environment and sterility testing.
d) Microbiological investigations for medico-legal case
Request Form
a. All microbiology tests can be requested from CA (Clinical Access) in Hospital Ampang
called Total Hospital Information System (THIS). Standard request form (PER PAT
301) are also can be used for our external clients and if the computer system
breakdown.
b. Most of the outsource tests can use the PER PAT 301 form except for certain tests
which are required to use special request form (refer PUBLIC FOLDER PATHOLOGY or
see page 132-146).The form should include patient’s biodata, clinical features,
indication of test and the appropriate test request and sample type.
General Guidelines for Specimen Collection and Handling

a. The quality of laboratory results depends greatly on the proper collection and handling of
the specimen as well as obtaining satisfactory material for examination.

b. The clinical specimen must be material from the actual infection site and must be collected
with minimum contamination from adjacent tissues, organs or secretions.
c. A sufficient quantity of specimen must be obtained in order to perform the examination

required.
d. Appropriate collection devices, specimen containers and culture media must be used to
ensure optimal recovery of microorganisms.
e. Ideally, the specimen must be collected before the commencement of antibiotic therapy.
f. The specimen container must be properly labeled, placed in a biohazard plastic bag and
accompanied by a completed laboratory request form for outsource sample.
g. Specimens are best transported immediately to the laboratory.
Specific Collection Guidelines

Bacteriology
Blood Cultures and bone marrow aspirate
An Automated blood culture system with different types of bottles (according to age and incubation
requirements) is used:
Adults: Aerobic and anaerobic culture bottle

Volume: 10 ml into each bottle
Pediatric: A single blood culture bottle

Volume: 0.5-5 ml
Fungal C&S: Myco F/Lytic (incubated for 14 days)
TB Blood culture (Mycobacterium): Myco/F Lytic (incubated for 42 days)
For bone marrow aspirate, 1-2 mls of aspirate is required and to be inoculated directly into the
bottles.

Method of collection:
i. Before venepuncture, the skin must be carefully disinfected with alcoholic antiseptic.
ii. Clean the top of the bottle with alcohol swab.
iii. Inoculate the specified volume of blood /bone marrow aspirate into each bottle.
iv. Do not store specimens in the refrigerator.
Note:
In the suspicion of catheter- related blood stream infection (CRBSI), blood drawn from both the line
and peripheral vein are indicated. All samples to be taken at the same setting and labeled
accordingly on the barcode sticker and in the clinical comment column in the eHIS.
Cerebrospinal Fluid (CSF)

i. Collect 3-4 ml of CSF into sterile bijoux bottles for the examination of:
- microscopy and culture for bacterial (Cryptococcus and mycobacterium if indicated)
ii. Send the specimen immediately to the laboratory.
iii. Do not store in the refrigerator.
Genital Samples
High Vaginal Swabs
i. This is NOT for diagnosis of gonorrhoea in female but mainly for candidiasis and
other causes of vaginitis.
ii. Use sterile speculum lubricated with sterile normal saline swab either from the
posterior fornix or the lateral wall of vagina.
iii. Inoculate the swab into Amies transport media.
iv. Send to the laboratory as soon as possible.
Endocervical Swab
i. This is the best specimen for the diagnosis of gonorrhoea and puerperal sepsis.
ii. Under direct vision, gently compress cervix with blades of speculum and use
rotating motion with swab, obtain exudates from the endocervical canal.
iv. Send to the laboratory as soon as possible.

Urethral Discharge (Male)

i. Wipe the urethra with a sterile gauze or swab.
ii. Collect the exudates with a sterile swab. If discharge cannot be obtained by
“milking” the urethra, use a sterile swab to collect material from about 2 cm inside
the urethra
Note: Do not refrigerate swabs
Pus/ Swabs/ Tissue

i. Clean with sterile water or disinfect with mild alcohol antiseptic at the skin area.
ii. Send aspirated pus if available, in a sterile universal container.
iii. Swab is an inferior substitute, and should be sent in an Amies transport medium
iv. Send all tissue for culture in a sterile container. Do not add formalin to the specimen.
Note:
i. A dry specimens may fail to yield organisms in smear and culture.
ii.Surface/superficial swabs of deeply infected lesions (eg.sinus tracts from osteomyelitis,
pressure sores) usually grow surface contaminants like coliforms and pseudomonads.
Respiratory Specimens
Upper Respiratory
Nasal Swab
This is commonly done for screening of MRSA carriage.
i. Moisten a swab with sterile distilled water.
ii. Swab both the anterior nares and insert the swab into the nose and gently rotate
against the nasal mucosa.
Per nasal (Nasopharyngeal swab/aspirate)

This is especially useful for the diagnosis of whooping cough caused by B.pertussis.
Nasopharyngeal swab
i. A special per nasal swab mounted on a soft flexible wire is passed through the
nostril and along the floor of the nasal cavity into the nasopharynx, rotate it and
withdraw.

ii. Replace it in the carrier tube/ bag and send it immediately for processing (suitable
transport media are Amies or Stuart’s)
iii. Use Dafflon or Rayon swab for sampling of PCR testing, and place the swab into Viral
Transport Media (VTM). Do not use cotton swab to take sample for PCR as it may
inhibits the test.
Nasopharyngeal aspirate
i. Gently pass a sterile catheter through one nostril as far as the nasopharynx.
ii. Attach a sterile syringe to the catheter and aspirate a specimen of mucopus.
iii Put into a sterile container and send immediately to the laboratory.
Throat Swab
Submitted primarily for detection of Group A Streptococci (Streptococcus pyogenes)
and also for detection of Bordetella pertussis.
i. Gently depress the tongue with a tongue depressor and rub the sterile swab over
the tonsillar areas and the mucosa on the posterior pharyngeal wall behind uvula.
ii. Gently turn the swab, in contact with the inflamed mucosa or lesion.
iii. Avoid touching the oral mucosa or tongue with the swab.
iv. Place the swab in Amies transport media and send to laboratory immediately.
Lower respiratory
Sputum
i. Collect the sputum early in the morning, after a deep cough or after session of
physiotherapy. If tuberculosis is suspected (PTB), send 3 consecutive specimens (1
specimen per day).
ii. Ask patient to cough deeply and spit directly into a sterile universal container.
iii. The material expectorated should be secretions from the bronchi and not merely
saliva.
iv. If delay is anticipated, store the sample in a refrigerator.
Swabs from mouth, gums and oral cavity

i. Rinse mouth with water before sampling.
ii. Using sterile swab, rub into areas of exudation or inflammation and place into Amies
transport medium.

Tracheal Aspirate/Bronchial alveolar lavage (BAL)/bronchial washing /lung aspirate

or biopsy
i. Place specimen into sterile container.
ii. Send specimen to the laboratory immediately.
Note: Tracheostomy is followed by colonization within 24 hours of insertion of the tube.
Results must be correlated with clinical findings such as fever or infiltrate on chest x-ray.
Stool
i. Collect faeces into a sterile/ clean wide-mouthed screw capped plastic container.
ii. If the faeces is in liquid form, fill only to one third of the container (excessive
amount will cause spillage).
iii. Enrichment medium i.e. Alkaline Peptone Water for Vibrios and Selenite F for
Salmonella can be obtained from the laboratory for bedside inoculation.
iv. Send specimen to laboratory immediately.
Note:
a. Rectal swab is a poor second best alternative to faeces. If faeces is impossible to
obtain, cotton swab inserted into rectum is to be collected.
b. For stool clearance culture in cases of typhoid and cholera, stool should only be sent
upon completion of therapy.
Urine Culture
Midstream Urine (MSU)

Male Patients
i. Withdraw the prepuce and cleanse the glands penis with soapy water thoroughly
rinse with water.
ii. Pass first few millimeters of urine to flush out the bacteria from the urethra, then
collect the mid-stream portion in a sterile universal container and close it tightly.
Female Patients
i. Clean the periurethral area and perineum with soapy water and thoroughly rinse
with water
ii. Hold the labia apart during voiding and pass the first few millimeters of urine
iii. Collect the midstream portion in a sterile container and close it tightly

Note:
When culture for tubercle bacilli is required, collect at least 50 ml of early morning
midstream urine on 3 consecutive mornings into sterile container.
Catheterized Urine
i. Clean catheter collection port with 70% alcohol.
ii. Puncture collection port using needle attached to a syringe under strict aseptic
technique.
iii. Aspirate urine and place in a sterile container.
Note:
a. Urine from catheter bags is generally unsuitable for culture.
b. Culturing urinary catheter tip is a waste of time as it is invariably contaminated by
urethral organisms.
Bladder Urine Samples
i. This is obtained via suprapubic aspiration (SPA) or cyctoscopically.
ii. Before SPA, recommended for patient to force fluids until bladder is full.
iii. Urine is collected in a sterile container.
Note:
Specimens should be kept with ice if unable to reach the lab within one hour after collection
Serous Fluid
i. Collect 3-5 ml serous fluid into sterile container for the examination of microscopy
and culture for bacterial.
ii. Send the specimen immediately to the laboratory.
iii. Do not refrigerate.
Mycology
Skin, Nails and Hair
Clean cutaneous and scalp lesions with 70% alcohol prior to sampling as this will improve the
chances of detecting fungus on microscopic examination, as well as reducing the likelihood of
bacterial contamination of cultures. Prior cleaning is essential if ointments, creams or powders
have been applied to the lesion.

Skin, nails and hair specimens should be collected into folded squares of paper or directly onto
an agar plate.
Skin
Material should be collected from cutaneous lesions by scraping outwards from the margin
of the lesion with the edge of a glass microscope slide or a blunt scalpel.
Hair
i. Specimen from the scalp should include hair roots, the contents of plugged follicles
and skin scales.
ii. Hair should be plucked from the scalp with forceps or the scalp is brushes with a
plastic hairbrush and collected onto agar plate.
Nails
i. Nail specimens should be taken from any discolored, dystrophic or brittle parts of
the nail.
ii. Specimen should be cut as far back as possible from the edge of the nail and should
include the full thickness of the nail.
Mouth and Vagina

i. Swabs from the buccal mucosa should be moistened with sterile water prior to the
taking of sample and sent in Amies transport medium.
ii. For vaginal infections, swabs should be taken from discharge in the vagina and from
the lateral vagina walls. Swabs are to be sent to the laboratory in transport medium.
Ear
i. Scraping of material from the ear canal are to be preferred, although swabs can also
be used.
Ocular Specimens
i. Material from patients with suspected fungal infection of the cornea
(keratomycosis) should be collected by scrapping the ulcer. The entire base of the
ulcer, as well as the edges, should be scraped (swabs are not suitable for sampling
corneal lesions).

ii. The material is collected directly onto agar plates for culture and glass slide for
microscopic examination.
Blood
i. Blood culture for fungal isolate is collected in the same manner as for blood culture
for bacterial isolate using a manufacturer fungal bottle (Myco F/Lytic).
ii. The request for fungal culture should be indicated clearly on the request form or
clinical comment. A total of two weeks incubation will be carried out.
Cerebrospinal Fluid (CSF)

i. CSF specimens (3-5 mls) should be collected in a sterile container for microscopy
and culture.
Bone Marrow
i. This specimen is helpful for the diagnosis in a number of deep fungal infection,
including histoplasmosis and cryptococcis
ii. 3-5 ml of aspirated material should be collected and transferred into a manufacturer
blood culture bottle
Pus
i. Pus from undrained subcutaneous abscesses or sinus.
ii. If grains are visible in the pass (as in mycetoma), these must be collected. In
mycetoma, if the crust at the opening of the sinus tracts are lifted, grains can often
be found in the pus underneath.
Tissue
i. If possible, material should be obtained from both the middle and edge of the
lesions.
ii. Small cutaneous, subcutaneous or mucosal lesions can often be excised completely.
iii. Tissue specimens should be placed in a sterile container without formalin.

Specimens for Serological Tests

Serological tests comprise of immunology, serology and virology.
Routine serology/virology (ELISA based method):
i. Draw 3-5 ml of blood into a plain gel tube without anti-coagulants.
ii. Leave clot at ambient temperature.
iii. Dispatch to laboratory within 4. hours after collection of blood for serum separation
by centrifugation
Note:
Haemolysed, icteric or lipaemic specimens invalidate certain tests. If such specimens are
received, the sample will be rejected to assure that results are on clinical value.
Specialized Virology test

a) Direct Antigen Detection (IFAT):
i.Respiratory specimen (sputum, BAL, tracheal aspirate, nasopharyngeal aspirate)
 Place the specimen obtained into sterile container.
ii.Herpes Simplex(HSV) I&II virus, Varicella Zoster (VZV) and Enterovirus specimen
Lesion-samples are suitable from lesion area of oral, genital, skin, cervix and cornea.
 Vesicular lesion-open a cervical lesion with a sterile swab. For oral, genital and skin
lesion use a sterile needle and a sterile swab for sampling. Scrapping or swabbing
material from the base of lesion.
 Ulcerative lesion-remove any pus from the lesion with a sterile swab for sampling
and swabbing material from the base of lesion with sterile swab.
 Dried lesion-lift the crust from the dried lesion with a sterile needle and for
sampling, use a sterile swab to obtained cells at the base of the ulcer.
Specimens are to be collected very carefully as to avoid any contamination of the sampling site and
during slide preparation procedure. Moisten swab with sterile water or saline before collecting
samples and prepare the slides at the bedside.
Special Teflon slide are recommended to be used and is available in the microbiology lab.

Special Diagnostic Test for Transplant Specimens

Serology/virology (ELISA based method):
i. Draw 3-5 mls of blood into a plain gel tube without anti-coagulants.
ii.Leave clot at ambient temperature.
iii.Dispatch to laboratory within 4 hours after collection of blood for serum separation by
centrifugation
Viral Genome Detection (PCR)
a) HBV DNA PCR, HCV RNA PCR, HIV PCR – Quantitative (viral load)
i. Draw 3-5 mls of blood into EDTA tube.
ii. Dispatch to laboratory within 2 hours after collection of blood for plasma separation
by centrifugation.
b) Other virus:
 Blood:
i. Draw 3-5 mls of blood into a plain gel tube without anti-coagulants.
ii.Leave clot at ambient temperature.
iii.Dispatch to laboratory within 2 hours after collection of blood for serum separation
by centrifugation
 CSF, BAL, Bone Marrow, other sterile Body Fluid:

i. Collect a minimum of 0.3ml of sample into a sterile container.
ii.Pack in ice for transport
iii.Send directly to laboratory within 2 hours after collection.
 Tissue Biopsy
i.If possible, specimen should consist of both middle and edge section of the lesional
area.
ii.Specimen of minimum 0.3cm size is appropriate.
iii.Place tissue into empty container. DO NOT add formalin into specimen.
iv.Send directly to laboratory within 2 hours after collection.

Medico legal Cases

Specific Guidelines
i. Specimens should be sealed and send directly to the microbiology laboratory.
ii. Specimens should be sent to the laboratory by a designated personnel.
iii. Chain of custody could be maintained all the times and a record book should
accompany the samples.
Some collective of various tests should follow guidelines as of microbiological requirements
and specific headings are referred.
Autopsy material
Blood:
i. Aspirate 10 ml of blood from right heart through skin and chest wall or (through
unopened heart) from right ventricle after removal of sternum into a set of blood
culture broths or a sterile tube.
ii. Avoid contamination with bacteria from the water faucet with enteric bacteria.
Tissue:
i. Best collected before the body is being handled at earlier stage. Decontaminate the
skin or sear surface of heart or other organ before inserting needle or cutting out
tissue block.
Guidelines on Preparation of Blood Film Malaria Parasite (BFMP)

Blood smear is the gold standard & recommended by WHO.
Why can’t we use blood sample in EDTA tube?
The use of anti-coagulated (EDTA) blood may cause the following:

 smears require longer time to dry (increased turn-around time up to 4 – 6 hours)
 thick smears tend to flake from the slide
 stain quality is affected
 morphology of parasite & RBC may be distorted – may leads to misinterpretation
2 types of blood film/smears prepared on SEPARATE slides should be sent to the laboratory which
are the THICK FILM and THIN FILM SLIDES. For example:
(1) Thick film

(2) Thin film
(1)Specimen Collection
a) Prepare clean glass slides (with frosted a) b) & c)
end).
b) Wear gloves and hold the patient’s left
hand with palm facing upwards.
c) Select 3rd finger from thumb but for
infant – use toe.
d) Clean the finger with a piece of cotton
wool lightly soaked in 70% ethanol. d) & e) f)
e) Dry the finger with a clean cotton swab,
using firm strokes to stimulate blood
circulation.
f) Use sterile lancet to prick the finger.
g) Apply gentle pressure to the finger to
allow the blood to come out.
h) Wipe off the first drop.
g) & h) i)
i) Apply further gentle pressure for more
blood.
(2) Preparation of Thin Film

a) & b)
a) Place blood on clean glass slide near the
frosted end of the slide.
b) Place the spreader slide in contact with
the drop of blood at an angle (~45C).
c) Let the blood spread along the edge of
the spreader slide.
d) Gently push towards the other end of the
slide.
b), c) & d)

(3) Preparation of Thick Film a)

a) Place one drop of blood on clean glass
slide in the middle only.
b) Spread the drop of blood using a corner
of the spreader (slide / coverslip).
c) Spread in one circular direction to make
even thick film size ~ 1 cm diameter (10
cent coin).
d) The right thickness is when the slides
were placed on the newspaper we still b) & c) c)
should be able to read the writing.
d)
(4) Labeling of slides

Print barcode sticker & place it at the
frosted end of the glass slide.
* DO NOT LABEL ON OR BELOW THE
BLOOD FILM!
(5) Drying of slides

a) Air dry the slides on a rack on bench OR
in a slide tray with the cover open.
b) Slides must be dried completely DO NOT SEND WET SMEARS!
before they are packed and transport to
the lab.

E. SPECIAL TEST INSTRUCTIONS : GENERAL HAEMATOLOGY
INTRODUCTION
The services provided include basic haematology tests (Full Blood Count, coagulation profile,
Erythrocyte Sedimentation Rate (ESR) and G6PD).
More specialized haematology tests are provided by the Clinical Haematology Laboratory
(Haematology Department).
SPECIMEN COLLECTION
1.ESR
-1.8 ml blood in sodium citrate tube up to the mark as indicated.
-mix thoroughly by gentle inversion (5-6 times)to avoid clot formation.
-send to the laboratory as soon as possible.
2. Full Blood Count (FBC)

-Collect 2.0-2.5 ml of blood in EDTA tube or up to the mark as indicated.
-mix thoroughly by gentle inversion (8 times)to avoid clot formation.
-send to the laboratory as soon as possible.
3. Coagulation Screen
-please refer to the guideline for collection as below:
Guidelines for Coagulation Profile.
Collection:
- Proper identification of patient with correctly labelled sample
o Includes full name, IC no. / hospital AM no., bar code label
- Must be drawn into a citrate-based anticoagulant tube
o Sodium citrate protects the integrity of plasma sample from protease activity and
minimizes platelet activation
- Must be filled upto the mark on the tube
o For coagulation testing, the proportion of blood to the sodium citrate anticoagulant
volume is 9:1
o Inadequate filling of tube will decrease the ratio and lead to inaccurate results (i.e:
clotting times tends to increase)
- Preferably collected before other test samples are drawn into other test tubes to avoid
contamination of the test sample
- Avoid air introduction into tube
o To avoid under-filling of test tube which can result in sample dilution and may also
provide falsely prolonged clotting time
- Blood should never be transferred from 1 tube to another (even if 2 sodium citrate tubes
are combined)

o To avoid doubling up of anticoagulant citrate levels and further dilution of plasma

sample
o EDTA causes raised PT and APTT
- Mix samples thoroughly (3 to 6 end-over-end tube inversions)
o To avoid false increase in test results
- Avoid mixing samples vigorously
o Leads to in vitro hemolysis or spurious test activation  causes false shortening of
test clotting times
- Collections from arterial / venous lines should include a process for flushing and/or
discarding the initial collection
o To avoid dilution by saline or contamination with heparin
- Avoid use of heparinized needles/tubes to avoid contamination with heparin
- Avoid use of too small or too big a needle size to avoid haemolysed / clotted / or activated
samples
Transport:
- Samples to be sent at ambient room temperature (should neither be transported at
refrigerated nor at high temperature)
- To be sent in as short a time as possible (test should be completed within 4hours of
collection)
o To avoid any effects on labile factors

F. SPECIAL TEST INSTRUCTIONS : BLOOD TRANSFUSION SERVICE
INTRODUCTION
The Blood Transfusion Unit in the Department of Pathology was started in 2006 since the start of
Hospital Ampang operation.
This unit has expanded its service by fully starting the antibody identification section in 2011.
Most of the antibody cases are of the Haematology which includes the haemato-oncology,
transplant and Thalassemia patients.
In 2009, Pathology Department in collaboration with clinicians in Hospital Ampang has produced
the first edition of Hospital Ampang Transfusion Policy which is available in Public Folder
(Pathology) to provide guideline and information about transfusion issue in Hospital Ampang.
REQUEST
Test request is through eHIS and manually. The appropriate form is to be filled up and send
together with specimen. ( List as below)
Test Form
eHIS and Borang permohonan transfusi darah

Group Screen & Hold (GSH)
eHIS and Borang permohonan transfusi darah
Group & Cross match (GXM)
Blood group & Rh Type eHIS
Component request eHIs and Borang permohonan transfusi darah
eHIS and Borang penyiasatan reaksi pemindahan

Investigation of Transfusion Reaction
darah
Post I
eHIS and Borang penyiasatan reaksi pemindahan
Investigation of Transfusion Reaction
darah
Post 2
Anti Human Globulin tests ( Coombs eHIS

test)
eHIS and Borang identifikasi antibodi
Antibody Identification
eHIS and Borang identifikasi antibodi
Cold Agglutinin Titre
eHIS and Borang identifikasi antibody
Red Cell Genotyping
( the request is by Pathology MO/ Pathologist )

SPECIMEN COLLECTION
Generally, venous blood in EDTA bottle is preferred. There is no specific requirement for the
sample except for Cold Agglutinin Titre test, where it should be a fresh sample sent at an optimal
temperature of 37°C.
All specimens will be received and registered at the blood bank counter. The specimens should
not be sent to the main counter of Pathology Department (CRA).
REPORTING OF RESULTS
The results will be automatically released to the eHIS. The senior Medical Laboratory
Technologists (MLT), Scientific Officer, Medical Officer or Pathologist will validate certain results
such as transfusion reaction investigations and antibody identification tests.
Any inquiries or uncertainty regarding the results can directly contact the Medical Officer or
Pathologist.
TRANSFUSION REACTION
If an adverse transfusion reaction is suspected, the transfusion should be stopped immediately. The
doctor in charge of the patient must be informed urgently to assess the patient. Further
management depends on the type and severity of the reaction.
The report of “REACTION TO BLOOD OR PLASMA TRANSFUSION” and “INVESTIGATION OF A
REPORTED TRANSFUSION REACTION” forms must be completed and sent to Blood Bank.
Investigation of Transfusion Reaction Post

 This investigation should be done immediately.
 List of samples taken as follows:
Container
Test Name Specimen Type Volume
Type
Antihuman Globulin Test Blood EDTA Tube 5 ml
Blood group & Rh Type Blood EDTA Tube 5 ml
Group & Cross match (GXM) Blood EDTA Tube 5 ml
Antibody Screen Blood EDTA Tube 5 ml
Renal Profile Blood Lithium 3ml
Heparin
Bilirubin Blood Lithium 3ml
Heparin

Hemoglobin Urine Universal 20ml

container
(from transfused blood bag) Blood Culture 5-10 ml for adult /

Bacterial Culture Bottle 1-2 ml for pediatric
Investigation of Delayed Transfusion Reaction

 Transfusion reaction which happen after 24 hours of transfusion
 List of samples taken as follows:
Test Name Specimen Type Container Type Volume
Blood group & Rh Type Blood EDTA Tube 5 ml
Antibody Screen Blood EDTA Tube 5 ml
Renal Profile Blood Lithium Heparin 3ml
Bilirubin Blood Lithium Heparin 3ml
Hemoglobin Urine Universal container 20ml

PLASMA EXCHANGE PROCEDURE
*REQUEST MUST BE ACCOMPANIED WITH BORANG (PPDK 5-Pin 1/97) AND

SPECIALIST/MO/HO TO INFORM BB MO/ MO-ON-CALL AT LEAST 1 DAY PRIOR TO
TRANSFUSION. REQUEST MUST INCLUDE DATE, TIME, DURATION (DAYS), & VOLUME
REQUIRED FOR EACH TRANSFUSION.
No request over weekend and public holidays until the next working day
SEND REQUEST FORM IMMEDIATELY TO MAKMAL TRANSFUSI DARAH, HA
MAKMAL TRANSFUSI DARAH, HA REQUEST FROM PDN
CLINICIAN TO CONFIRM TIME OF PLASMA

EXCHANGE (1 DAY PRIOR TO PLASMA EXCHANGE)
DAY OF PLASMA EXCHANGE:

WARD STAFF TO CONFIRM TIME OF TRANSFUSION WITH MAKMAL TRANSFUSI DARAH, HA.
MLT TO START THAWING PROCESS

Thawing process takes about 30 mins/per cycle & only 4 units of cryo can be thawed in
1 Cycle/machine.
MLT TO INFORM WARD WHEN PLASMA IS READY
WARD COLLECTS & TRANSFUSES IMMEDIATELY
*Please call MO Makmal Transfusi Darah–on-call for any urgent/change in request

G. SPECIAL TEST INSTRUCTIONS : CYTOLOGY
INTRODUCTION
Cytology is a discipline that involves the morphological study of cells. It is divided into two broad
categories i.e. exfoliative cytology and aspiration cytology. Exfoliative cytology involves
examination of specimens which contain exfoliated cells. The usual specimen received is cervical
smears, sputum, urine, cerebrospinal fluid, pleural fluid, peritoneal fluid and washings of various
sites. Aspiration cytology involves examination of cells that are obtained by fine needle aspiration
and brushings.
LIST OF SERVICES
These services are provided during office hours:
a) Gynecological specimen. (Cervico-vaginal specimen, i.e.: Pap smear)
b) Non-gynecological specimen.
i.Sputum.
ii.Body fluids. (e.g.: urine, CSF, pleural and ascetic fluid)
iii.Nipple discharge.
iv.Brushing. (e.g.: Bronchial / Gastric)
v.Washing. (e.g.: Bronchial / Peritoneal)
c) Fine Needle Aspiration Cytology.
REQUEST OF TEST
a) Requests are made in the computer system.
b) 3 copies of PER-PAT 301 forms needs to be filled for cytological examinations as samples are
sent outsource.
c) Register and manage the specimen in the ward prior to sending it to the lab.
d) For urgent request, please mark the request form as “URGENT” in the right hand corner of the
request.
e) Stick hospital barcode at the right hand side corner of all 3 copies of PER-PAT 301.
f) Fill form completely with clearly written name of doctor in charge (especially the specialist in
charge), so that they would be able to be contacted if there is any inquiry.
g) Clearly indicates the ward/clinic where the sample was taken.
SPECIMEN CONTAINER
a) All specimens for cytological examination should be put in clean universal leak-proof
containers.
b) Slides (Pap smear, nipple discharge, FNA, sputum, etc.) should be placed in slide mailer before
being dispatched to the laboratory.
c) All specimens should have the same identification as that written on the request form.
SPECIMEN COLLECTION

(a) Gynecological specimen

i.Take the smear before bimanual examination.
ii.Do not use lubricant on the speculum.
iii.Place spatula at the external os and rotate through 360degrees, lightly scraping the squamo-
columnar junction.
iv.Smear the material onto a clean, labeled glass slide about as thick as a blood film.
v.Immediately place the slide in 95% alcohol for at least 15minutes. If more than one slide is to
be placed in the same container, ensure that they are not placed face to face.
(b) Sputum (Note: to be collected on three consecutive days)

i.Instruct the patient to empty the mouth of all saliva immediately after waking up in the
morning.
ii.Patient should then cough deeply and collect the resulting sputum in the container supplied.
iii.Specimen container should be labeled and dated as per the day of collection, and then sent
immediately to the laboratory.
iv.Do not forget to collect a similar specimen for the next two days.
(c) Urine
i.The requesting doctor must indicate type of urine either voided or catheterized urine.
ii.If voided urine, the patient should discard the first void in the morning and collect the next
voided urine – do not send overnight urine sample as most of the cells in this sample are
degenerated.
iii.Send the urine sample to the laboratory immediately.
(d) Body fluids

i.Specimens are collected in clean containers and dispatched immediately to the laboratory.
ii.If delay of more than 2 hours is anticipated, put in the refrigerator at (2-8°C).
(e) Brushing specimen

- The brush must be rotated gently, and immediately smeared onto a clean slide and fix in 95%
alcohol for 30mins.
(f) Nipple discharge

i.Do imprint smear by placing the labeled slides onto the nipple. Prepare at least 2 smears.
ii.One slide is fixed in 95% alcohol and labeled as ‘fixed’. The other slide is air-dried and labeled
as ‘dry’.
(g) FNAC
i. FNAC clinic is conducted as scheduled every Tuesday and Thursday.
ii.Appointment requests for FNAC should be ordered only by the clinician – the request forms
should be filled legibly, complete with the clinical history and findings. Whenever there is more
than one lump or swelling present, the clinician should indicate which lump/s or swelling/s to
be aspirated. The clinician requesting the FNAC procedure should have his/her name clearly
written on the request form so that they would be able to be contacted if there is any query.

iii.Consent from patient should be taken by the performing practitioner.

iv.FNAC for superficial lesions can be performed either by medical practitioner of the respective
department or pathology department.
v.FNAC for deep seated lesions and as clinically indicated is performed by the radiologist under
radiological guidance on appointment basis every Wednesday.
DISPATCH OF SPECIMEN
a) Specimen for cytological examination should be sent immediately to the common receiving
counter (CRA).
b) Specimen collected after office hours and which are unable to be sent to the laboratory shall be
kept in the refrigerator at 2-8°C. The specimen will be sent out on the following working day to
respective referral lab. Do not freeze specimen.
a) Completed cytology reports are received via email, followed by a printed hardcopy report.
b) These reports will then be keyed-in to the system to be viewed by the requesting doctor.
c) Cases are generally reported within LTAT as mentioned in Table: List of Test; unless the cases
need further studies, second opinion and etc.
ENQUIRY OF REPORTS
a) Enquiry of report over the phone is DISCOURAGED. It is advised to check the results from the
system.
b) It is advisable to enquire in the event the cases are not yet reported within the stipulated time.
SERVICE AFTER OFFICE HOURS

a) No specimen for cytological examination is accepted after office hours.
b) Specimens collected during non-office hours should be refrigerated at 2-8°C before being
dispatched to the laboratory the next day – refrigeration helps in preserving the cell. DO NOT
FREEZE SPECIMEN.

H. SPECIAL TEST INSTRUCTIONS : HISTOPATHOLOGY
INTRODUCTION
Histopathological services are concerned with diagnostic interpretation through macroscopic and
microscopic examination of tissue. This includes the histological assessment of specimen removed
from surgery or at non-surgical biopsy procedures and the investigation of disease at autopsy. In
each case, the diagnostic examination is part of the clinical investigation of the patient and cannot
be performed satisfactorily in isolation. Quality of histopathology interpretation may depend upon
the information written on the request forms.
LIST OF SERVICES
a. Surgically removed tissue.
b. Non-surgically removed tissue.
REQUEST OF TESTS
a) Requests are made in the computer system.
b) 3copies of PER-PAT 301 forms needs to be filled for histological examinations as
samples are sent outsource.
c) Register and manage the specimen in the ward prior to sending it to the lab.
d) For urgent request, please mark the request form as “URGENT” in the right hand corner
of the request.
e) Stick hospital barcode at the right hand side corner of all 3copies of PER-PAT 301.
f) Fill form completely with clearly written name of doctor in charge (especially the
specialist in charge), so that they would be able to be contacted if there is any inquiry.
g) Clearly indicates the ward/clinic where the sample was taken.
SPECIMEN COLLECTION
a) Specimen for routine histological examination is to be fixed in 10% Neutral Buffered
Formalin in suitable leak-proof container. The volume of formalin used is at least 10
times the specimen to be fixed.
b) Do not put large specimen in a small container as this would prevent proper fixation of
the tissue and also distort the specimen.
c) For adequacy of surgical excision in malignant neoplasm, the margins must be marked
accordingly by suture tie / wire or by diagrammatic representation of the excised
specimen.
d) Specimens should have the same identifications as that mentioned in the system or as
written on the request forms.
e) Specimen for frozen section and enzyme histo-chemical studies are to be sent fresh
without fixative in a closed container.
f) Specimen for immunofluorescence studies is to be sent on filter paper moistened with
phosphate buffered solution (PBS) to prevent drying.

DISPATCH OF SPECIMEN
a) Specimen for routine histological examination and immunofluorescence should be sent
directly to the common receiving counter (CRA).
b) Specimens for frozen section are sent immediately upon removal to the laboratory by
ward PPK.
c) All histopathology samples are sent to Hospital Serdang daily except on Saturday,
Sunday and Public Holiday.
a) Completed histopathology reports are received via email, followed by a printed
hardcopy report.
b) These reports will then be keyed-in to the system to be viewed by the requesting doctor.
c) Results of frozen section will be immediately communicated to the surgeon via
telephone, and the report will be made available subsequently in the system.
d) Cases are generally reported within LTAT as mentioned in Table: List of Test; unless the
cases need further studies, second opinion and etc.
ENQUIRY OF REPORTS
e) Enquiry of report over the phone is DISCOURAGED. It is advised to check the results
from the system.
f) It is advisable to enquire in the event the cases are not yet reported within the
stipulated time.
SERVICE AFTER OFFICE HOURS

a) The specimens should be fixed in the usual manner and dispatched to the laboratory.

I. CRITICAL RESULTS IN PATHOLOGY DEPARTMENT

All critical results will be informed.
CHEMICAL PATHOLOGY
ANALYTES LOWER CRITICAL LIMIT UPPER CRITICAL LIMIT
Potassium 2.8 mmol/L 6.0 mmol/L
Sodium 125 mmol/L 155 mmol/L
Calcium 1.5 mmol/L 3.0mmol/L
Osmolality 250 mOsmol/kg 310 mOsmol/kg
Cord TSH - 21 uIU/ml
Ammonia - 100 umol/L
Total Bilirubin (Neonate) - 300 umol/L
GENERAL HEMATOLOGY
ANALYTE LOWER CRITICAL LIMIT UPPER CRITICAL LIMIT
Hemoglobin 8.0 g/dl 19 g/dl
Hematocrit 25% 40%
Platelet 20 K/uL 1000 K/uL
White Cell Count 2.0 K/uL 50 K/uL

(Paediatric)

ANATOMICAL PATHOLOGY
TEST CRITICAL FINDINGS
Unexpected or discrepant findings Unexpected malignancy
Wrong organ removed
Reports of infections Bacterial in heart valves or bone marrow
Organisms in an immune-compromised patient

such as AFB, fungi, viral or protozoa.
Organisms in Cerebrospinal Fluid (CSF)
Unusual organisms or organisms in unusual

sites eg. Amoeba in the eye
Reports on critically ill patients requiring Crescents in greater than 50% of glomeruli in
immediate therapy renal biopsy specimen
Transplant rejections
Cases that have immediate clinical Fat in an endometrial curettage

consequences Mesothelial cells in a heart biopsy
Fat in snare colon biopsy specimens
BLOOD BANK
TEST CRITICAL FINDINGS
Antibody screening test Positive
ABO Blood group Rh Negative blood group

Rare blood group eg. Bombay, Parabombay
MICROBIOLOGY
MICROBIOLOGY TESTS CRITICAL RESULTS

Blood C&S Positive results from Gram Stain and/or culture.
CSF C&S Microscopy result (normal or abnormal) and positive result from
culture.
Acid fast bacilli (AFB) Positive smear and/or culture
Blood film for malaria Positive smear
parasite (BFMP)

MICROBIOLOGY TESTS CRITICAL RESULTS

CSF Cryptococcal or Bacterial Positive
antigens
Cryptococcal Indian Ink Positive
Stool C&S Salmonella typhi, Vibrio cholera, Shigella sp.
Any type of C&S Neisseria meningitidis , Burkholderia pseudomallei, MRSA, ESBL,
MRO,VRE, VISA,VRSA and CRE.
Pernasal swab Bordetella pertusis, Corynebacterium diphtheria.
Legionella Antigen Positive
Abbreviations:
 MRSA: Methycillin-Resistant Staphylococcus aureus
 ESBL: Extended Spectrum Beta Lactamases
 MRO: Multi-Resistant Organism
 VRE: Vancomycin Resistant Enterococcus
 VISA: Vancomycin Intermediate Staphylococcus aureus
 VRSA: Vancomycin Resistant Staphylococcus aureus
 CRE: Carbapenem Resistant Enterobacteriaceae
 CSF: Cerebrospinal fluid
 BAL: Bronchioalveolar Lavage
 SPA: Suprapubic aspirate
THERAPEUTIC DRUG MONITORING
DRUG TOXIC CONCENTRATION
AMIKACIN T > 8.6 umol/l
CYCLOSPORIN (CSA) > 400 ng/mL
GENTAMICIN T > 4.18umol/l
METHOTREXATE 48hrs >1.0 μmol/L

(MTX) 72hrs > 0.2 μmol/L
Random > 0.02 μmol/L
VANCOMYCIN T > 13.8umol/l

J. LIST OF SPECIMEN CONTAINERS/TUBES
Images of the Anti- Specimen Mixing

Test Tube type
container/tube coagulant volume Frequency
INTERGRATED
LABORATORY
Glucose
Sodium
Flouride or Vacuum 2.0 ml 8 times
Potassium
Oxalate
correct filling level
PT, APTT, INR

ratio, D-
Dimer,
Buffer Sodium
3 – 4 times
Fibrinogen, Citrate Vacuum 1.8 ml
DIVC
screening.
Purple cap – Adult- Adult:

FBP, FBC EDTA vacuum 1.0 ml 8 times

Adult
Purple cap - Paediatric- Paediatric:

EDTA 8 times
non 250 – 500
vacuum ul
Paediatric


Test Tube type
RP,BUSE,
Amylase,
Bilirubin,
Serum PCM,
Serum Adult: Adult- Adult:

Salicylate, Plain gel tube Vacuum 3.5 ml 5 times
FSH,LH, with gel
Iron/TIBC.
Adult
correct filling Paeds: Paediatric Paediatric: 5 times

level Lithium - Non 800 ul
heparin vacuum
Paediatric
ESR
Non
1.28 ml -
correct filling level Sod. Citrate vacuum 5 – 6 times
1.8 ml
tube


Test Tube type
ABG
Mixed well
0.6 ml - 1.0 using roller
Heparin mixer or
ml
palm. Send
ASAP to lab
with ice.
BLOOD TRANSFUSION
SERVICES
GXM, GSH, Adult- Adult: 8 times

Blood Vacuum 6.0 ml
Grouping, Pink cap -
Coomb’s test. EDTA
Paediatric- Paeds:
correct filling level Non 2.0 ml 8 times
vacuum
GXM,GSH and
Pink cap - Pink cap Pink cap
Antibody
EDTA (EDTA) - (EDTA - 8
Identification.
6.0 ml times
(1 tiub EDTA
Vacuum
+ 2 plain
tube).
Red cap – Red cap Red cap
Plain without (Plain) – (Plain) –
correct filling
anti coagulant 4.5 ml No need
level
EDTA tube Plain tube

MICROBIOLOGY
Specimen Container Test Volume Comment
LABORATORY
DO NOT add
formalin for
Urine, sterile Urinalysis,
Universal tissue
fluid, tissue, culture and
Sterile NA culture. For
sputum, pus sensitivity,
container molecular
aspirate molecular.
test, to send
with ice pack
Blood, bone Blood

marrow culture
X aspirates bottle: -DO NOT put
Aerobe the sticker
(BLUE onto the
CAP) Blood barcode
Adult: 10
culture and area(X) on the
mls
sensitivity bottle
-mix with
Blood swirling
Blood
culture method
bottle:
Anaerobe
(GOLD
CAP)

MICROBIOLOGY
LABORATORY
Blood for
Blood
paediatric
culture
patient Paed:
bottle:
1-3mls
Paeds
(SILVER
CAP)
Blood
Blood For isolation 1-5 mls
culture Blood culture
of
bottle: bottle:
Mycobacteri
Myco Myco F/Lytic
um(TB) and
F/Lytic (RED CAP)
fungal
(RED CAP)
Swab from To get from

vesicular Viral the lab. Put
Viral
lesion, eye, isolation,PCR the swab into
transport
respiratory – eg. H1N1, NA VTM and send
Media
site eg. MERS-CoV, to the lab in
(VTM)
Nasopharynge adenovirus, ice
al, throat immediately.
swab etc
Amies Culture &

Transport sensitivity
NA
High vaginal, Media for HVS, pus
endocervical, (with swab, tissue

MICROBIOLOGY
LABORATORY
swab charcoal) swab and
throat swab
Plain tube
with gel
Blood (yellow
cap), Serology test 5 mls
without
gel (red
cap)
CORRECT LABELLING OF BARCODE STICKERS
Bahagian Bahagian
hadapan belakang
√
√
Barcode can be seen clearly,
Part of tube still can be seen. Does not interrupt test
√
in a straight line, not folded. flow.

CORRECT LABELLING OF BARCODE STICKER
The recommended way to stick the barcode
PROPER SAMPLE MIXING FOR TUBE WITH ANTI COAGULANT
One Inversion
MIX WELL BY INVERTING TUBE. DRAW VOLUME AND NUMBER OF INVERSIONS ARE OF
CRITICAL IMPORTANCE AND CLINICALLY SIGNIFICANT!!

GUIDE TO ORDER OF DRAW FOR BLOOD SAMPLES
Blood Culture Buffered Plain or Plain Lithium K2 EDTA

Fluoride
Media Sodium Citrate with gel Heparin
1 2 3 4 5 6
(Order of draw recommended by Clinical and Laboratory Standard Institute (CLSI),
previously known as NCCLS)

K. SPECIMEN REJECTION CRITERIA
a) GENERAL
1. Blood clotted
2. Blood haemolysed
3. Contaminated specimen
4. Decomposed specimen
5. Delayed sending the specimen
6. Deteriorated specimen
7. Duplicate order
8. Empty container received
9. Incomplete information
10. Insufficient sample
11. Mislabeling of specimen
12. No label
13. No specimen received
14. Patient detail/ container differ
15. Specimen leakage/ broken/ spill
16. Specimen not accompanied with form (outsource test)
17. Specimen not send in ice
18. Test not offered
19. Test requested is not stated
20. Wrong anticoagulant
21. Wrong container
22. Wrong request form
23. Wrong specimen
24. Wrong transport medium
25. Wrong order
26. “Unmanaged” sample
27. Slide’s label cover the smear
28. Test not ordered
29. Unsuitable sample
30. Excess sample volume
31. Barcode not readable by scanner
b) CHEMICAL PATHOLOGY
1. Icteric serum
2. Lipemic blood received
3. Mucoid specimen
4. ABG received in syringe with needle

c) ROUTINE HAEMATOLOGY
1. Incorrect ratio of blood to anticoagulant
d) MEDICAL MICROBIOLOGY
1. Poor smear for BFMP (too thick/too thin or too small)
2. Poor smear for Microfilaria (too small)
3. Salivary sputum- unsuitable for culture
4. Non sterile container for culture and sensitivity
5. Tissue culture received in formalin
6. Dry swab for culture
7. Foley catheter tip for culture
8. Sample for HBV,HCV and HIV Genome detection or viral load test received in plain tube.
e) PROTEIN
1. Previous request is less than the specified time for HbA1c
2. Previous request is ≤ 3 months for serum & urine protein electrophoresis
3. No serum or urine received for osmolality test
4. Urine pH >6 for urine cathecolamine
5. Urine 24 hours < 750ml
6. Serum is required for electrophoresis. Plasma sample is rejected.
f) HISTOPATHOLOGY
1. Insufficient fixative
2. Wrong fixative

L. SPECIAL TESTS REQUEST FORMS

*(PLEASE NOTE THAT ALL REQUEST FORMS CAN BE FOUND AND PRINTED FROM THE
HOSPITAL AMPANG PATHOLOGY DEPARTMENT FOLDER IN PUBLIC FOLDER)
*This form is used when ordering AFP (Acute Flaccid Paralysis) test for suspected Polio virus
infection case.








*This form is used to request for Immunohaematology tests (Antibody Identification, RBC
Phenotype, Antibody Titration).







M. LIST OF PATHOLOGY TELEPHONE NUMBERS

Hospital Ampang: 03-42896000 Pathology Department Fax number: 03-42806594
Office Ext
Head of Pathology Department and Senior Consultant Pathologist 6046

Personal assistant/general office 6460
Medical Officers Room 6528/6529
General Scientific Officer’s Room 6053
Senior Medical Lab Technologist (U38/U36) 6049
Medical Lab Technologist (U32) 6047
CRA
CRA counter 6221 (24 hours)
MICROBIOLOGY UNIT
Head Unit 6224
Senior Scientific Officer 6057
Microbiology Lab 6464/6463/6462
INTEGRATED/CHEMICAL PATHOLOGY
Head of Unit 6050
Integrated Lab 6533
BLOOD TRANSFUSION LABORATORY
Head Unit 6050
Blood Bank 6054 (24 hours)
SPECIAL PROTEIN LABORATORY
Head Unit 6050
Special Protein Laboratory 6215
Drug Laboratory 6216

Ampang PDF

Uploaded by

Copyright:

Available Formats

You might also like

Ampang PDF

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ampang PDF

Uploaded by

Copyright:

Available Formats

HOSPITAL AMPANG 2021 PATHOLOGY DEPARTMENT

Handbook of Pathology Services

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 1

Foreword by the Director of Hospital Ampang

Dr Ghazi Abd Manaf

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 2

Foreword by the Head of Pathology Department,

Dato’ Dr Faraizah binti Dato Abdul Karim

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 3

Our appreciation also goes to:

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 4

Pathology Department Oath, Vision and Mission Statements 6

A. General Operating Policies 6 – 13

C. Special Test Instructions: Chemical Patology 70 – 86

D. Special Test Instructions: Medical Microbiology 87 -100

E. Special Test Instructions: General Haematology 101 - 102

F. Special Test Instructions: Blood Transfusion Service 103– 106

G. Special Test Instructions: Cytology 107 – 109

H. Special Test Instructions: Histopathology 110 – 111

I. Critical Results in Pathology Department 112 – 114

J. List Of Specimen Container/Tubes 115 – 122

K. Specimen Rejection Criteria 123 – 124

L. Special Test Request Forms 125 – 139

M. List of Pathology telephone numbers 140

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 5

PATHOLOGY DEPARTMENT OATH

1. Fair, friendly and compassionate treatment for all customers.

VISION OF PATHOLOGY DEPARTMENT

MISSION OF PATHOLOGY DEPARTMENT

A. GENERAL OPERATING POLICIES

This handbook is designed to be a comprehensive guideline on the Pathology Services in Hospital

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 6

The Department of Pathology provides the following services:

3. Medical Microbiology Diagnostic Bacteriology, Serology, Immunology,

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 7

 Hospital Kuala Lumpur Pathology Department (HKL)

i. Chemical Pathology & Hematology (Integrated Lab)

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 8

24 hours counter service for receiving specimen:

6. QUALITY ASSURANCE & QUALITY IMPROVEMENT ACTIVITIES

 Internal quality control programs in all disciplines.

8. TEST REQUEST INSTRUCTIONS

8.1 Laboratory requests are made through HIS except:

9. SPECIMEN COLLECTION INSTRUCTIONS

9.1 Specimen collected must be properly labeled

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 9

10. BLOOD COLLECTION PROCEDURE

10.1 Venous blood is preferred.

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 10

13 GENERAL WORKFLOW OF PATHOLOGY DEPARTMENT

Inform clinics/ wards Reject

Protein Integrated Blood Microbiology

Print results (if external request :

[HANDBOOK OF PATHOLOGY SERVICES, 6th Edition] 11

14 LABORATORY TURN-AROUND-TIME (LTAT)

Priority Details Expected Time After

 Full Blood Count 45 minutes