CLINICAL BIOCHEMISTRY 69 CLINICAL BIOCHEMISTR

Transcription

04–Biochem pp69-228
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CLINICAL BIOCHEMISTRY
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Contents
INDEX: TEST REPERTOIRE - CLINICAL BIOCHEMISTRY
including DYNAMIC FUNCTION TESTS
INTRODUCTION
......................................
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...................................................................................................................
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THE CLINICAL BIOCHEMISTRY TEST CYCLE
...........................................................
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.......................................................
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.....................................................................................................
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GENERAL INFORMATION / CONTACT DETAILS
QUALITY ASSURANCE
REQUESTING CLINICAL BIOCHEMISTRY TESTS
....................................................
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SUMMARY OF BLOOD SPECIMEN VOLUME REQUIREMENTS ...........................
Adult Patients ...................................................................................................................
Paediatric Patients ..........................................................................................................
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TEST PROFILES ..................................................................................................................
Test Turnaround Time .....................................................................................................
Repeat Requests .............................................................................................................
Clinical Details ..................................................................................................................
Unexpected Results ........................................................................................................
Reference Values ............................................................................................................
Instructions for completion of 24 hour Urine Collections .........................................
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Index: Test Repertoire - Clinical Biochemistry
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ABG (arterial blood gas analysis) 89
ACE (Angiotensin converting enzyme) 89
Acetaminophen (Paracetamol) 89
Acetylcholine Receptor antibodies (ACR antibodies) 90
Acid base studies 90
Acid phosphatase 91
ACTH (Adenocorticotrophic hormone) 91
Acylcarnitine 91
Adenocorticotrophic hormone (ACTH) 92
ADH (Antidiuretic hormone) 92
Adverse (Anaphylactoid) reactions to intravenous drugs: Plasma Tryptase Assay 92
AFP (Alpha-fetoprotein) 93
ALA (delta aminolevulinic acid) 93
Alanine aminotransferase (ALT) 94
Albumin 94
Alcohol (ethanol) 94
Aldolase 95
Aldosterone 95
Alkaline phosphatase 95
Alkaline phosphatase isoenzymes 96
Allergen-specific IgE 96
Alpha-1-acid glycoprotein (orosomucoid) 97
Alpha-1-antitrypsin 97
Alpha-1-antitrypsin phenotyping 97
Alpha-fetoprotein (AFP) 98
ALT (Alanine aminotransferase) 98
Aluminium 98
Amiodarone 99
Amino acids 99
Ammonia 99
Amphetamines 100
Amylase 100
Amyloid A Protein 100
Androgen profile (female patients) 101
Androstenedione 101
Angiotensin Converting Enzyme (ACE) 101
Antidiuretic hormone (ADH) 102
Apolipoprotein E Phenotype 102
Arterial blood gas analysis (ABG) 102
Aspartate aminotransferase (AST) 103
AST (Asparate aminotransferase) 103
Autoantibodies, autoimmune antibodies (Please refer to Serology Section of this Handbook) 103
Azathioprine (for patients about to commence azathioprine, Imuran®, therapy) 103
B2-microglobulin (beta-2-microglobulin) 104
B12 Vitamin (Please refer to Haematology Section of this Handbook) 104
Barbiturates 104
Bence Jones Protein 105
Benzodiazepine (semi-quantitative, serum) 105
Benzodiazepine (semi-quantitative, urine) 105
Beta-hydroxy butyrate 106
Beta 2-glycoprotein-1 (Please refer to the Serology/Immunology Section of this manual) 106
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Beta-2-microglobulin 106
Beta-2-transferrin 106
Bicarbonate (actual; BGA) 107
Bicarbonate (serum/plasma) 107
Bicarbonate (standard) 108
Bile Acids 108
Bilirubin (total) 108
Bilirubin (direct) 109
Biotinidase 109
Blood Gas Analysis 109
BNP (Brain Natriuretic Peptide; NT-proBNP) 110
Bone profile 110
Brain Natriuretic Peptide (BNP; NT-proBNP) 111
BR-MA (alternative CA15.3) 111
C1 Esterase Inhibitor: concentration 112
C1 Esterase Inhibitor: functional assay 112
C3 Complement 112
C4 Complement 113
CA 15.3 (alternative: BR-MA) 113
CA 19.9 (alternative: GI-MA) 113
CA 125 (alternative: OM-MA) 114
Caeruloplasmin 114
Caffeine 114
Calcitonin 115
Calcium (total) 115
Calcium / creatinine ratio in urine 115
Calcium (ionised) 116
Calculus analysis 116
Calprotectin 116
Cannabinoid (THC) 117
Carbamazepine (Tegretol®) 117
Carboxyhaemoglobin 117
Carcinoembryionic antigen (CEA) 118
Cardiac enzyme profile 118
Carnitine (Total and free) 119
Carotene 119
Catecholamines (total) 119
Catecholamine /creatinine ratio 119
CEA (carcinoembryonic antigen) 120
CellCept® (Mycophenolate) 120
CH-50 (whole complement titre) (Please refer requests to the Serology / Immunology Laboratory) 120
Chloride 121
Cholesterol: Total 121
Cholesterol: HDL fraction 121
Cholesterol: LDL fraction 122
Cholinesterase 122
Cholinesterase Phenotype 123
Cholinesterase Genotype 123
Chromogranin A 123
Ciclosporin (cyclosporin) 124
Citrate (citric acid) 124
CK (creatine kinase) 124
CK-MB (Creatine kinase MB isoenzyme) 125
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CO2 (serum/plasma) 125
Cocaine metabolite 125
Compliment 126
Copper 126
Cortisol 126
Cotinine 126
C-peptide 127
C-Reactive Protein (CRP) (Please refer to Serology/Immunology Section of this Handbook) 127
Creatine kinase (CK) 127
Creatine kinase MB isoenzyme (CK-MB) 127
Creatinine 128
Creatinine Clearance 128
Crosslaps (CTx) 129
CRP (C-Reactive Protein) (Please refer to Serology/Immunology Section of this Handbook) 129
Cryoglobulins 129
CSF Glucose 130
CSF Oligoclonal IgG banding 130
CSF Protein 130
CTx (Crosslaps) 131
Cyclosporin 131
Cystine 131
Cystine (white cell concentration) 132
7-Dehydrocholesterol 132
Dehydroepiandrosterone sulphate (DHEAS, DHEA sulphate) 132
Delta Aminolevulinic acid (ALA) 133
Deoxypyridinoline 133
DHEA sulphate (DHEAS) 133
Digoxin 134
Dihydrotestosterone (5-αdihydrotestosterone) 134
1,25 Dihydroxy cholecalciferol (1,25 dihydroxy vitamin D) 134
Dopamine 135
Drink, spiked (suspected case of spiked drink) 135
Drugs of abuse in urine (DAU) Screen 135
eGFR (estimated glomerular filtration rate) 136
Elastase-1 (Pancreatic) 137
Electrolytes 137
Electrophoresis (Serum Protein) 138
Electrophoresis (Urine Protein) 138
Enolase (neurone-specific) 138
Environmental toxicology 138
Epanutin® (Phenytoin) 139
Epilim® (Valproate, valproic acid) 139
Estimated Glomerular Rate (eGFR) 139
Estradiol/Oestradiol 140
Ethanol (alcohol) 141
Ethosuximide (Zarontin®) 141
Ethylene glycol 141
Faecal Fat 142
Fasting Lipid profile 142
Fat globules in urine (Please refer to Histopathology Section of this Handbook) 143
Fatty Acids, very long chain (VLCFA) 143
Ferritin 143
FK 506 (Tacrolimus, Prograf®) 143
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Flecainide (Tambocor®) 144
Fluoxetine (Prozac®) 144
Folate (Folic Acid) (Please refer to Haematology Section of this Handbook) 144
Food Toxicology 144
Follicle stimulating hormone (FSH) 145
Free Light Chains (Kappa and Lambda) in serum 145
Free T3 (triidothyronine free hormone) 145
Free T4 (thyroxine free hormone) 146
Fructosamine 146
FSH 146
Gabapentin (Neurontin®) 147
GAD (Glutamic Acid Decarboxylase) Antibodies 147
Galactose: disorders of galactose metabolism 147
Gamma GT (gamma glutamyl transferase, GGT) 147
Gastrin 148
GGT (gamma GT = gamma glutamyl transferase) 148
GI-MA (alternative: CA19.9) 148
GL-3 149
Glucagon 149
Glucose 149
Glucose (CSF) 150
Glucose Tolerance Test 150, 230
Glutamic Acid Decarboxylase (GAD) antibodies 152
Glutamine 152
Gonadotrophins (FSH, LH) 152
Growth Hormone 152
Gut hormone profile 153
Haemosiderin stain, urine (Please refer to Haematology Section of this Handbook) 153
HbA1c 153
hCG (human chorionic gonadotrophin) 154
HDL-Cholesterol 156
5HIAA 156
HMMA (=VMA) 156
Homocysteine 157
Human Chorionic Gonadotrophin (hCG) 157
Hydroxyindole acetic acid (HIAA) 158
Hydroxy methoxymandelic acid (HMMA or VMA) 158
17-Hydroxy progesterone 158
Hydroxproline 159
IgE (total) 159
IgE (allergen specific) 159
IGF-1 (insulin-like growth factor-1 (somatomedin C) 160
IGF Binding Protein-3 160
IgG, IgA, IgM 160
IgG Subclasses 161
Immunofixation (serum protein) 161
Immunofixation (urine protein) 162
Immunoreactive trypsin 162
Industrial toxicology 162
Insulin 163
Insulin antibodies 163
Insulin C-peptide 163
Insulin-like growth factor-1 (IGF-1 or somatomedin C) 163
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Insulin-like growth factor-1 binding protein 3 (IGF-1 BP3) 164
Iron 164
Iron studies profile 164
Islet cell antibodies 165
Kappa and Lambda Free Light Chains in Serum 165
Keppra® (Levetiracetam) 166
Ketones 166
Lactate 166
Lactate dehydrogenase (LD or LDH) 166
Lambda and Kappa Free Light Chains in Serum 167
Lamictal® (Lamotrigine) 167
Lamotrigine (Lamictal®) 167
LATS replaced by TBII (TSH-binding inhibiting immunoglobulin) 168
Laxatives Screen 168
LD or LDH (Lactate dehydrogenase) 168
LDL-Cholesterol 168
Lead 169
Levetiracetam (Keppra®) 169
Levodopa 170
LFT profile 170
LH 171
Lipase 171
Lipid profile (fasting specimens only) 172
Lipoprotein(a) 172
Lithium 173
Luteinising hormone (LH) 173
Lysosomal enzyme analysis (White cell enzyme analysis) 173
Macroprolactin 174
Magnesium 174
Manganese 175
Mercury 175
Metanephrines 175
Methadone 176
Methaemoglobin 176
Methanol 176
Methotrexate 177
Microalbumin 177
Microalbumin/creatinine ratio 177
Mucopolysaccharides 178
Mycophenolate (CeIlCept®) 179
Myoglobin 179
Mysoline® (Primidone) 179
Neurontin® (Gabapentin) 180
Nicotine metabolite (Cotinine) 180
N-Telopeptide (NTx) 180
Occult blood 181
Oestradiol/estradiol 181
Oligoclonal IgG banding (CSF) 181
OM-MA (alternative: CA125) 182
Opiate 182
Organic Acids 182
Organophosphate and carbamate poisoning 183
Orosomucoid (alpha-1-acid glycoprotein) 183
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Osmolality 183
Osteocalcin 184
Oxalate 184
Oxcarbazepine (Trileptal®) 184
Pancreatic Polypeptide 185
Pancreolaurly test 185
Paracetamol (Acetaminophen) 185
Paraprotein studies 186
Paraquat Screen (dithionite test) 187
Paraquat (quantitative) 187
Parathyroid hormone (PTH) intact 187
Parathyroid hormone related protein (PTHrP) 188
Paroxetine (Seroxat®) 188
PCP (Phencyclidine) 188
pCO2 189
pH (BGA) 189
pH (miscellaneous fluids) 190
Phencyclidine (PCP) 190
Phenobarbital 191
Phenylalanine 191
Phenytoin (Epanutin®) 191
Phosphate 192
Phytanic acid 192
Placental alkaline phosphatase isoenzyme 192
pO2 193
Porphoblinogen 193
Pophyrins 193
Potassium 194
Primidone (Mysoline®) 194
Procollagen peptide Type 3 (PIIINP) 195
Progesterone 195
17-Hydroxy progesterone 195
Prograf® (FK 506, Tacrolimus) 196
Prolactin 196
Prostate Specific Antigen (PSA) 196
Prostate Specific Antigen, Free (fPSA) 197
Protein 197
Protein/Creatine ratio (urine) 197
Protein (CSF) 198
Protein Electrophoresis (Serum) 198
Protein Electrophoresis (Urine) 198
Prozac® (Fluoxetine) 198
PSA (Prostate Specific Antigen) 199
PSA (Prostate Specific Antigen) Free 199
PTH (intact) 199
PTHrP (Parathyroid hormone related protein) 200
Pyruvate 200
Rapamune® (Sirolimus) 201
Reducing substances (semi-quantitative test) 201
Renal profile 201
Renin 202
Rhinorrhoea fluid analysis 202
Sabril® (Vigabatrin) 202
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Salicylate 203
Seroxat® (Paroxetine) 203
Serum Protein Electrophesis 203
Sex hormone binding globulin (SHBG) 203
SHBG (sex hormone binding globulin) 204
Sirolimus (Rapamune®) 204
Sodium 204
Solvent screen for toluene (glue), trichloroethane (Tipex®) and butane 205
Somatomedin C (IGF-1, insulin-like growth factor-1) 205
Spiked drink (suspected case of spiked drink) 205
Steroid Profile 206
Stone analysis (stone with details of source) 206
Sweat Test 207
T3 (triiodothyronine), free hormone 207
T4 (thyroxine), free hormone 208
Tacrolimus (Prograf®, FK 506) 208
Tambocor® (Flecainide) 208
Tau Protein 208
TBG (thyroxine binding globulin) 209
TBII (TSH-binding inhibiting immunoglobulin) 209
Tegretol® (Carbamazepine) 209
Testosterone: males 210
Testosterone: females 210
Testosterone/sex hormone binding globulin (SHBG) ratio 210
Theophylline 210
Thiopurine S-Methyltransferase (Red Blood Cell Thiopurine S-Methyltransferase; TPMT) 211
Thyroglobulin 211
Thyroid hormone profile 211
Thyroid Stimulating Hormone (TSH) 212
Thyroid stimulating immunoglobulin (TBII, TSH-binding inhibiting immunoglobulin) 212
Thyroxine, free hormone (free T4) 212
Thyroxine binding globulin (TBG) 213
TIBC (calculated) 213
Tocopherol (Vitamin E) 213
Topamax® (Topiramate) 213
Topiramate (Topomax®) 214
Toxicology, Environmental 214
Toxicology: Food 214
Toxicology, Industrial 214
Toxins 215
TPMT (Thiopurine S-Methyltransferase) 215
Trace metal monitoring (in patients on nutrition support, especially parenteral nutrition) 215
Transferrin 216
Transferrin saturation 216
Transglutaminase antibodies (Please refer to Serology/Immunology Section of this Handbook) 216
Tricyclic antidepressants (semi-quantitative, serum) 216
Triglyceride 217
Triiodothyronine, free hormone (Free T3) 217
Trileptal® (oxoarbazepine) 218
Troponin I 218
Troponin T (cTnT) 218
Trypsin, immunoreactive 218
Tryptase Assay (plasma) 219
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TSH (Thyroid Stimulating Hormone) 220
TSH-binding inhibiting immunoglobulin (TBII) 220
Type 3 procollagen peptide (P111NP) 220
U & E Profile (urea and electrolytes) 220
Urea 221
Uric Acid (Urate) 221
Urine Protein Electrophoresis 222
Valproate (valproic acid, Epilim®) 222
Vasoactive Intestinal Polypeptide (VIP) 222
Very long chain fatty acids (VLCFA) 223
Vigabatrin (Sabril®) 223
VIP (vasoactive intestinal polypeptide) 223
Viscosity, plasma 224
Vitamin A 224
Vitamin B6: Pyridoxine 224
Vitamin B12 (Please refer to Haematology Section of this Handbook) 224
Vitamin C 224
Vitamin D (25-Hydroxy vitamin D3; 25-Hydroxycholecalciferol) 225
Vitamin D (1,25 dihydroxy = 1,25 Dihydroxy cholecalciferol) 225
Vitamin E (Tocopherol) 225
VMA 226
Volume 226
Weight 226
White cell cystine 226
White cell enzyme analysis (Lysosomal enzyme analysis) 227
Zarontin@ (Ethosuximide) 227
Zinc 227
DYNAMIC FUNCTION TESTS
Glucose Tolerance Test 230
Short Synacthen Test 232
Prolonged (Depot) Synacthen Test 233
Low Dose Overnight Dexamethasone Suppression Test 235
Low Dose 2-Day Dexamethasone Suppression Test 236
Lactose Tolerance Test 237
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Introduction
The Clinical Biochemistry Department uses biochemical knowledge and techniques to
understand human health and to assist in the detection, diagnosis and treatment of
disease.
The Department’s work involves the provision of analytical results and observations and
the conversion of this data into information for the requesting doctor.
The Department provides a comprehensive range of analytical results, observations
and interpretation for the requesting doctor as well as clinical liaison and advice.
The analytical service encompasses indices of fluid balance, liver function, renal
function, carbohydrate and lipid metabolism, and various hormones, proteins, enzymes,
therapeutic drugs, tumour-associated substances and many other chemical and
biochemical compounds.
The provision of a clinical biochemistry service is dependent on highly automated
analytical systems, electronic data processing and information technology.
The Department has an extensive internal quality assurance system and participates in
national and international quality assessment schemes.
The Clinical Biochemistry Service is supported by on-going training programmes and by
research focused on improving patient care.
This section of the handbook is designed to give you an easy to use reference to the
broad range of clinical biochemistry tests and investigations. If you are unable to find
information on what you require, please contact any of the senior members of staff.
The Clinical Biochemistry Test Cycle
The clinical biochemistry test cycle (Figure 1) begins and ends with the doctor-patient
consultation. The cycle consists of sequential cognitive, organisational, action and
analytical processes leading from the initial clinical assessment, through the selection
and requesting of a test, to the performance of the test by the laboratory and ultimately
the integration of the test result into patient care by the requesting doctor.
It consists of a pre-analytical phase (steps 1-6), an analytical phase (steps 7-9) and a
post-analytical phase (steps 10-14).
The cycle should always commence with a clinical question. This question will vary
according to the patient, the clinical setting, the severity of symptoms and the treatment
options. Time spent in the framing and the focusing of the clinical question is very
important and leads to targeted and appropriate laboratory investigations.
The selection of a biochemistry test requires a clear understanding of the question being
asked and of the capability of the test to answer that question.
The value of a biochemistry test depends on its relevance to the problem or question at
hand and the extent to which the test result provides a solution to the problem or an
answer to the question.
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The term biochemistry (bio-chimie) was first coined by the French chemist and
microbiologist, Louis Pasteur (1822-1895). The application of chemistry to the study of
disease has a longer history beginning with the Irish physicist and chemist, Robert Boyle
(1627-1697), who was born in Lismore, Co. Waterford.
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Fig. 1. The Clinical Biochemistry Test Cycle
[1] Doctor – Patient consultation
[14] Effect on patient care
[2] Clinical question
[13] Management decision
or action taken
[3] Selection of
appropriate test
[12] Examination of report
[4] Generation of a
laboratory request
[11] Delivery of report to
requesting doctor
[5] Collection of labelled
appropriate specimen(s)
[10] Generation of report
[6] Transport of request
form(s) and specimen(s)
to laboratory
[9] Authorisation of results
[7] Reception, registration
and preparation of sample
for analysis
[8] Analysis / investigation
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“Many health professionals nowadays feel
the need to carry out every investigation to
make sure that 100% of disease possibilities
are ruled out and this leads to a very definite
overuse of technology. It is often based on
what I would call over-investigation and overtreatment, because of the demand to be
absolutely certain to cover all possibilities.
Society, and not just medical practitioners,
will in the future have to decide where to draw
the lines defining what is over-investigation
and over-treatment as clearly as the definition
of under-investigation and lack of treatment.
Defining where that line exists will not be easy
and is a challenge for us all. However, if that
challenge is ignored, we could find ourselves
in a situation where each of us year on year go
through major programmes of screening and
major programmes of treatments for potential
illnesses rather than real illnesses. I am not
sure that this is sustainable from the point of
view of the costs involved, but also because
of the amount of worry that it can cause in
people’s lives.”
Professor Brendan Drumm, Chief Executive Officer,
Health Service Executive. In: Callanan, M., ed. Ireland
2022: Towards One Hundred Years of Self-Government.
Dublin: Institute of Public Administration, 2007.
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General Information
Postal address:
Clinical Biochemistry Department,
Mid-Western Regional Hospital,
Dooradoyle,
Limerick.
Telephone:
(061) 482876
(061) 482877
(061) 482878
(061) 482879
Endocrine laboratory (061) 482245
Out-of-hours service (061) 482257
Fax:
(061) 482362
Key personnel:
Consultant Clinical Biochemist: Dr. Ned Barrett
B.Sc., M.Sc., Ph.D., EurClinChem, FRAMI, Dip Healthcare Mgt.,
Consultant Head of Department;
Adjunct Senior Lecturer of Biochemistry, University of Limerick.
Telephone (061) 482264; mobile 087 299 6940
Chief Medical Scientist: Mr. Philip Kennedy
FAMLS, FIBMS, Cert Healthcare Mgt., Dip Healthcare Mgt.
Telephone (061) 482881
Core Working Hours:
The Clinical Biochemistry Laboratory is fully staffed during the core hours of 10:00-17:30
Monday to Friday and staff will be available for any enquiries you may have.
Out-of-Hours Service:
A restricted range of assays is available as an out-of-hours service outside of the core
working hours. This service is also available on public holidays. The telephone number
for the out-of-hours service is (061) 482257.
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Quality Assurance
The Department is a member of the following external quality assessment schemes:
IEQAS (Irish External Quality Assessment Scheme for Laboratory Medicine) Clinical
Chemistry Scheme
IEQAS for Myocardial Markers (Labquality)
IEQAS for Acid-Base Status and Electrolytes (Labquality)
IEQAS for Faecal Blood (Labquality)
IEQAS for HbA1c
IEQAS for PSA (Labquality)
IEQAS for NT Pro-BNP (Labquality)
IEQAS for Haemoxymeters (Labquality)
UKNEQAS for Clinical Chemistry
UKNEQAS Lipid Scheme
UKNEQAS Monoclonal Proteins
UKNEQAS Total Immunoglobulin E
UKNEQAS Urine Chemistries
UKNEQAS for Paediatric Bilirubin
UKNEQAS for Specific Proteins
UKNEQAS for Sweat Tests
UKNEQAS for HbA1c
UKNEQAS for Thyroid Hormones
UKNEQAS for Peptide Hormones 1
UKNEQAS for Peptide Hormones 2
UKNEQAS Guildford Peptide Hormones
UKNEQAS for Pregnancy Testing (urine HCG)
UKNEQAS for Steroid Assays
UKNEQAS for Tumour Markers
UKNEQAS for Therapeutic Drug Monitoring
UKNEQAS for Toxicology
UKNEQAS for Salicylate and Paracetamol
UKNEQAS for Drugs of Abuse in Urine
WEQAS General Clinical Chemistry
Bio-Rad Tumour Markers
Randox RIQAS Lipid
Randox RIQAS Human Urine
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The Clinical Biochemistry Laboratory is committed to providing requesting doctors with a
service of the highest quality through adherence to laboratory procedures approved by
appropriate regulatory bodies, staff competency, comprehensive internal quality control
procedures, regular quality assurance audits and participation in external quality
assessment schemes.
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Requesting Clinical Biochemistry Tests
TERMS AND CONDITIONS
(1) Requests for clinical biochemistry tests must be made by a registered medical
practitioner or an appropriately qualified healthcare professional acting on the
instructions of a registered medical practitioner.
(2) Issues concerning patient consent for laboratory investigations are the
responsibility of the requesting doctor. The Clinical Biochemistry Laboratory
assumes that specimens submitted to it were obtained with the consent of the
patient for the performance of biochemical analysis to facilitate diagnosis and
treatment.
(3) The clinical biochemistry service provided is intended to assist in the clinical
management of patients and is not provided for medico-legal or forensic
purposes or criminal investigations.
(4) Information provided on the request form and the results of laboratory
investigations will be stored by the laboratory in accordance with the policies of
the Health Service Executive on data storage and document retention.
(5) Requests for tests not performed in this laboratory will be referred to specialist
external laboratories and will involve the communication of patient information
and clinical details to the external laboratory.
(6) The patient identification details given in laboratory reports are drawn from the
Patient Administration Systems of the Health Service Executive and are based
on the information supplied on the request form(s) by the requesting doctor.
(7) Results are reported to the appropriate hospital clinician or general practitioner,
who can then explain their significance to the patient within the context of their
discussions of the clinical problem as a whole.
(8) Laboratory reports are copyright of the Health Service Executive.
(9) Unless a specific request is made, a patient is deemed to accept the usual
procedures of the Clinical Biochemistry Laboratory relating to the storage and
disposal of specimens. Any such specific request made must be practicable,
reasonable and given with sufficient notice.
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Summary of Blood specimen volume requirements
Please refer to the alphabetical test listing commencing on page 71 for specific
information on the requirements for individual tests.
ADULT PATIENTS
General biochemistry tests, for
example any selection from the
following:
Urea, electrolytes, creatinine, liver
“function” tests, cardiac enzymes,
cholesterol, triglyceride, calcium,
phosphate, uric acid, magnesium,
total protein, albumin.
When requesting tests additional
to those listed above, a second
specimen tube is required.
Endocrine and other specialist
tests performed in-house
Glucose
HbA1c
Specialist assays referred to
external laboratories
One serum gel tube
Type: Sarstedt S-Monovette 4.9 mL
Colour code: BROWN
Catalogue number: 04.1935.001
For emergency biochemistry and dialysis
patients use one lithium heparin gel tube.
Colour code: GREEN
Note: glucose can only be assayed in these
tubes if the specimen is received in the
laboratory within one hour of specimen
collection.
Please refer to the specific requirements for
individual tests in the alphabetical listing of
tests commencing on page 71
One glucose (sodium fluoride and EDTA) tube
Colour code: GREY
One EDTA tube
Colour code: MAUVE
Please refer to the specific requirements for
individual tests in the alphabetical listing of
tests commencing on page 71
PAEDIATRIC PATIENTS
The Sarstedt Monovette® enclosed blood collection system used throughout the
hospital has tube sizes available for paediatric specimens. Sarstedt Micro Tubes are
also available for paediatric and neo-natal specimens.
Requesting doctors are advised to liaise with the laboratory in advance of specimen
collection when difficulties in obtaining blood specimens are expected. In these
situations, tests requested should be ranked in order of priority.
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Test Profiles
Notes:
(1) The test profiles defined in the following table are available to requesting
doctors.
(2) A small number of additional profiles have been set up for use by individual
consultants for specific investigations within their area of specialisation.
(3) Only profiles encompassed by (1) and (2) above are recognised by the
Clinical Biochemistry Department. Non-specific and vague statements such as
“bioprofile” should never be used in requesting tests. Likewise, terms such as
“toxicology”, “hormone profile”, “tumour markers” or “routine tests” are vague
and unfocussed and should not be used in requesting tests. The few extra
moments required to carefully specify the tests needed is an integral part of
quality patient care.
Profile name
Assays included in profile
U+E (urea and electrolytes)
Sodium, potassium, chloride, CO2, urea, creatinine.
LFT (liver “function” tests)
Total bilirubin, alkaline phosphatase, gamma GT,
ALT.
CE (cardiac enzymes)
Creatine kinase (CK), lactate dehydrogenase (LD),
AST.
Renal
Sodium, potassium, chloride, CO2, urea, creatinine,
calcium, phosphate, albumin.
Bone
Calcium, phosphate, alkaline phosphatase, total
protein, albumin.
Medical admission basic profile
Sodium, potassium, chloride, CO2, urea, creatinine,
glucose, total bilirubin, alkaline phosphatase, gamma
GT, ALT, calcium, phosphate, total protein, albumin,
uric acid.
Fasting lipid profile
Total cholesterol, LDL-cholesterol, HDL-cholesterol,
triglyceride.
Iron studies (fasting specimen)
Iron, transferrin, transferrin saturation, TIBC.
TFT (thyroid “function” tests)
TSH, free T4.
DAU (drugs of abuse in urine)
Amphetamines, barbiturates, benzodiazepine,
cocaine, methadone, opiate, cannabinoid (THC).
Androgen profile (female)
Testosterone, sex hormone binding globulin and
testosterone/SHBG ratio.
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TEST TURNAROUND TIME
Specimens referred to external specialist laboratories for analysis are dispatched by
courier service as appropriate.
The turnaround times for receipt of hardcopy reports of tests referred to external
specialist laboratories is generally of the order of two to three weeks.
REPEAT REQUESTS
Requesting doctors should note that requests for repeat laboratory testing made too
soon after the previous test has been reported may not add any significant clinical value.
CLINICAL DETAILS
The inclusion of brief clinical details including relevant medication assists the Clinical
Biochemistry Laboratory in providing the most appropriate service for requesting doctors.
UNEXPECTED RESULTS
Artefactual results may arise from difficulties or errors in, for example, sample collection,
the choice of specimen tube, specimen transport or specimen storage. Artefactual results
will also occur when samples are drawn from a site proximal to an infusion, when there
has been prolonged venous stasis during collection or as a result of difficult or traumatic
sample collection.
It is important that the laboratory is informed as soon as possible if results appear to be
inconsistent with the patient’s condition or at variance with previous results.
REFERENCE VALUES
Almost all clinical biochemistry results are reported with reference range values, which in
some cases are gender and age related. The reference range defines the values of a
biochemical test found in 95% of apparently healthy subjects against which the patient’s
value can be compared. The term “reference range” is much more than a replacement
for the old term “normal range”. It requires careful consideration of the characteristics of
the reference population, of how the reference subjects are selected and how their state
of health is assessed. It also requires knowledge of the performance of the analytical
technique used, control of specimen collection and storage and a detailed understanding
of data handling techniques and statistical tools. Almost all of the biochemistry reference
87
The availability of each biochemistry test is given in the alphabetical listing of tests
commencing on page 71. The turnaround time is the anticipated time taken under normal
operating conditions between receipt of the sample in the laboratory and the generation
of the report. The time taken for specimen transport or postal delivery should be added
to this. The turnaround times for assays performed inhouse are detailed in a separate
document entitled “Turnaround times for clinical biochemistry tests performed at the
Mid-Western Regional Hospital” (MP-L-BIO-TAT). It is intended that this latter document
will be updated on a regular basis.
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ranges used by this laboratory are those approved by regulatory bodies such as the
FDA (USA) for the analytical systems we use. The term reference range is free from
connotations of judgment and value and should lead to a more objective interpretation
of laboratory data. The International Federation for Clinical Chemistry and Laboratory
Medicine has developed the concept of reference values and ranges and published
methods for their derivation.
The reference range concept encounters difficulties with a test such as serum cholesterol
since increasing risk of future cardiovascular events is associated with serum cholesterol
values within the reference range, for example, the risk doubles between serum
cholesterol values of 5.2 and 6.7 mmol/L. In this situation, national or international bodies
set target or recommended limits for use in clinical practice.
INSTRUCTIONS FOR COMPLETION OF 24 HOUR
URINE COLLECTIONS
Approved containers for the collection of 24-hour urine are available from the Clinical
Biochemistry Laboratory. Please ensure that the identification label on the container
contains details of the patient’s name, date of birth, hospital number/address and the
name of the requesting doctor.
Depending on the tests requested, the container might require a special preservative in
either liquid or powder form. If required, such preservatives will be provided in the
container by the laboratory. Specific requirements relating to the measurement of
individual urine analytes is given in the alphabetical test listing commencing on page 71
of this handbook. Do not discard any preservative provided or wash out the container.
It is important that the following instructions are carried out with care; otherwise the
results of the tests will be invalid.
Procedure:
(1) Immediately before the beginning of the collection period (usually the morning)
the bladder must be emptied and the urine discarded. Record the time and date
on the container label.
(2) All urine passed during the next 24 hours must be collected and added to the
container.
(3) At the end of the 24-hour period, the bladder must be emptied and the urine
collected added to that already in the container. Record the time and date on
the container label.
After completing the collection, arrange for the delivery of the container to the Clinical
Biochemistry Laboratory accompanied by the laboratory request form or referral letter.
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CLINICAL BIOCHEMISTRY TEST DIRECTORY
ABG (arterial blood gas analysis)
Special requirements or comments:
The specimen should be brought to the Laboratory immediately.
Turnaround time:
Availability of assay: daily, throughout 24 hours.
Reference range:
Adult
pH
pCO2
pO2
Base Excess
Actual Bicarbonate
Standard Bicarbonate
Oxygen Saturation
7.35 - 7.45
4.26 - 5.99 kPa
11.04 - 14.36 kPa
-2.0 - +2.0
22.0 - 26.0 mmol/L
22.0 - 26.0 mmol/L
96 - 97 %
ACE (Angiotensin Converting Enzyme)
Specimen type:
Serum
ACE inhibitors, e.g. captopril, enalapril inhibit ACE activity.
Turnaround time:
Requests for this test are referred to an external specialist laboratory.
Reference range:
The referral laboratory report provides appropriate reference values.
Acetaminophen (Paracetamol)
Specimen type
Serum: see special requirements.
Specimen should be drawn four hours post-overdose and preferably not later than 16
hours. Serum values taken less than four hours post-ingestion are difficult to interpret
due to the possibility of continuing absorption and distribution of the drug and may not
represent the peak level. Note that results are reported in ug/mL.
89
Specimen type:
Arterial blood in air-free heparinised syringe. Blood gas analysis sampling kits are
available in each ward. Immediately after collection, expel any air from the sample and
seal the syringe with the stopper provided in the sampling kit.
Once the sample has been drawn, the blood gas syringe must be labelled with the
patient’s full name, chart number, ward, date and time of collection. Labels suitable for
affixing to blood gas syringes are made available to each ward. These labels display the
URGENT alert message in a prominent manner.
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Turnaround time:
Reference range:
0 – 5 µg/mL (0 – 5 mg/L)
Plasma
paracetamol
(mg/L)
TREATMENT LINES
Plasma
paracetamol
(mmol/L)
Hours after ingestion
Acetylcholine Receptor antibodies (ACR antibodies)
Please refer to Serology/Immunology Section of this manual.
Acid base studies
Specimen type:
available in each ward. Immediately after collection, expel any air from the sample
and seal the syringe with the stopper provided in the sampling kit.
patient’s full name, chart number, ward, date and time of collection. Labels suitable
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for affixing to blood gas syringes are made available to each ward. These labels display
the URGENT alert message in a prominent manner.
Turnaround time:
Reference range:
Adult
pH
pCO2
pO2
Base Excess
Actual Bicarbonate
Oxygen Saturation
7.35 - 7.45
4.26 - 5.99 kPa
11.04 - 14.36 kPa
-2.0 - +2.0
22.0 - 26.0 mmol/L
22.0 - 26.0 mmol/L
96 - 97%
Acid phosphatase
Prostate Specific Antigen (PSA) has replaced this test in the investigation of prostate
disease.
ACTH (Adrenocorticotrophic hormone)
Specimen type:
Contact the Clinical Biochemistry Laboratory before initiating the request so that all
collection requirements can be met.
Collect specimen in ice-cold potassium EDTA tube (=FBC tube) and transport
immediately to the Clinical Biochemistry Laboratory.
Please note that ACTH has a marked circadian rhythm.
Turnaround time:
Reference range:
Acylcarnitine
Specimen type
Four blood spots on a Guthrie Card or whole blood in pediatric lithium heparin specimen
tube.
Appropriate clinical details required.
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Turnaround time:
Reference range:
Adrenocorticotrophic hormone (ACTH)
Specimen type:
Please note that ACTH has a marked circadian rhythm.
Turnaround time:
Reference range:
ADH (Antidiuretic hormone)
Specimen type:
Turnaround time:
Reference range:
Adverse (Anaphylactoid) Reactions to Intravenous Drugs:
Plasma Tryptase Assay
Specimen type:
The preferred specimen is EDTA plasma (at least 1 mL).
It is possible to measure tryptase in serum if EDTA plasma is not available.
The first sample should be taken as soon as possible after commencement of the
reaction and ideally within the first 30 minutes. Further samples should be taken 3, and
24 hours after reaction.
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This documentation should accompany the plasma samples.
Telephone contact: At any stage of the reaction the user of the service is encouraged
to telephone the Protein Reference Unit in Sheffield (00 44 114 271 5552) for advice.
This advice is based on the cumulative experiences of NARCOS in the assessment of
emergency situations. NARCOS provides a 24 hour advisory service via the Hospital
switchboard (00 44 114 243 4343).
Store specimens at approximately +4 degrees Celsius prior to preparation for dispatch to
referral laboratory.
Turnaround time:
Reference range:
AFP (Alpha–fetoprotein)
Specimen type:
Serum
Turnaround time:
Availability of assay: Monday – Friday during core working hours.
Reference range:
0 – 15 ng/mL (non pregnant).
ALA (delta aminolevulinic acid; aminolevulinic acid)
Specimen type:
24-hour urine collection; no preservative.
93
Documentation required
This should be comprehensive, but brief, and should include the following (although any
other factor which the anaesthetist thinks could be a cause of the reaction should be
indicated, eg surgical stimulation, undiagnosed hypovolaemia etc).
•
Surgical procedure,
•
Date of reaction,
•
Drugs administered (including premedication and sequences where possible),
•
Clinical manifestations,
•
Management of reaction and outcome (eg residual effects or death),
•
Previous medical and anaesthetic history if known,
•
Any particular risk factors? (eg known asthmatic, penicillin allergy, anaesthetic
reaction or extremely anxious patient etc),
•
The haematological data (‘routine haematology’ including full differential white
cell count and haematocrit), if available.
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Protect the collection from light and keep refrigerated at 4-8°C.
Appropriate clinical details are also required.
Turnaround time:
Reference range:
Alanine aminotransferase (ALT)
Specimen type:
Serum
This assay is available as part of the liver test profile.
Please ensure that specimens for the assay of transaminase activity (ALT or AST) are
delivered to the Laboratory within 24 hours of sample collection.
Turnaround time:
Reference range:
Females 14 – 54 IU/L; Males 17 – 63 IU/L.
Albumin
Specimen type:
Serum.
Urine albumin: a 24-hour collection is required (no preservative).
For urine albumin the 24-hour collection should be kept cool or refrigerated until complete.
On completion, the collection should be delivered to the laboratory without delay.
Turnaround time:
Availability of assay:
Serum albumin: daily, throughout 24 hours.
Urine albumin: Monday – Friday during core working hours.
Reference range:
Serum albumin: 35 – 48 g/L
Urine albumin: less than 30 mg/24 hours.
Alcohol (ethanol)
Specimen type:
Serum, plasma, urine
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This assay is intended to assist in the clinical management of the patient and is not
provided for medico-legal purposes or in relation to the Road Traffic Acts.
Turnaround time:
Reference range:
Serum or plasma: < 10 mg/dL;
50-100 mg/dL: signs of intoxication;
>100 mg/dL: depression of CNS;
>400 mg/dL: fatalities reported.
Urine: <10 mg/dL
Aldolase
Specimen type:
Serum
Appropriate clinical details are required.
Turnaround time:
Reference range:
Aldosterone
Specimen type:
Serum
Appropriate clinical details required. Record specimen collection time and whether
patient was ambulant or recumbent.
Turnaround time:
Reference range:
Alkaline phosphatase
Specimen type:
Serum
Assay is also available as part of the liver and bone test profiles.
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Turnaround time:
Reference range:
Adults: 38 – 126 IU/L
Age range
Serum alkaline phosphatase (IU/L)
Males
Females
Birth - 4 weeks
75 – 316
48 – 406
1 month – 1 year
82 – 383
124 – 341
1 – 3 years
104 – 345
108 – 317
3 – 6 years
93 – 309
96 – 297
6 – 9 years
86 – 315
69 – 325
9 – 12 years
42 – 362
51 – 332
12 – 15 years
74 – 390
50 – 162
15 – 18 years
52 – 171
47 – 119
18 – 100 years
30 – 120
30 – 120
Alkaline phosphatase isoenzymes
Specimen type:
Serum
Turnaround time:
Reference range:
Allergen-specific IgE
Specimen type:
Serum
Each request must be accompanied by completed allergy questionnaire. Appropriate
clinical details are required.
Note: These tests should not be considered diagnostic for a given allergen - they are
merely assays for specific IgE. The medical history and clinical judgment are essential for
assessing the significance and relevance of positive and negative test results.
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Turnaround time:
Reference range:
Alpha-1-acid glycoprotein (orosomucoid)
Specimen type:
Serum
Turnaround time:
Reference range:
Alpha-1-antitrypsin
Specimen type:
Serum
Turnaround time:
Availability of assay: allow seven days for receipt of report.
Reference range:
0.88 – 1.74 g/L
Alpha-1-antitrypsin phenotyping
Specimen type:
Serum
Special requirements
Appropriate clinical details required
Turnaround time:
Reference range:
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Alpha-fetoprotein (AFP)
Specimen type:
Serum
Turnaround time:
Reference range:
0 – 15 ng/mL (non-pregnant).
ALT (Alanine aminotransferase)
Specimen type:
Serum
This assay is available as part of the liver test profile.
Turnaround time:
Reference range:
Females 14 – 54 IU/L; Males 17 – 63 IU/L.
Aluminium
Specimen type:
Whole blood in trace metal-free tube. Trace metal-free needle must be used in
conjunction with trace metal-free tube.
This specimen should be collected first if other tests are requested to avoid
contamination.
Please contact Clinical Biochemistry Laboratory for trace metal-free specimen collection
tube and needle.
Turnaround time:
Reference range:
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Amiodarone
Specimen type:
Serum
Specimen should be drawn at least eight hours after the last dose. Amiodarone is
strongly tissue–bound, leading to a half-life of between 14 and 60 days. There is large
inter-patient variability.
Turnaround time:
Reference range:
Amino acids
Specimen type:
Serum, plasma, urine.
Ensure that specimen is sent to the laboratory without delay.
Serum must be deproteinised for the measurement of sulphur containing amino acids contact Clinical Biochemistry Laboratory.
Turnaround time:
Reference range:
Ammonia
Specimen type:
Take at least 0.5 mL of blood into a lithium heparin specimen tube standing in ice. See
special requirements.
Specimen must be sent to the laboratory immediately.
Plasma must be assayed immediately. Blood for plasma ammonia must be drawn,
delivered to the laboratory and entire assay completed within 60 minutes. Delay will
result in a falsely raised plasma result.
Note: haemolysis will affect the reliability of the result.
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Turnaround time:
Reference range:
Neonatal Period:
Paediatric and adult:
0 – 100 µmol/L
10 – 47 µmol/L
Amphetamines
Specimen type:
Random urine specimen collected without any preservative.
The assay is intended to assist in the clinical management of the patient and is not
provided for medico-legal purposes. The requesting doctor may need to consider
whether a patient might avail of opportunities to alter or interfere with the integrity of the
specimen.
Turnaround time:
Reference range:
The cut-off threshold for a positive result for amphetamine is 1000 ng/mL.
A positive result for amphetamine indicates only the presence of amphetamine and does
not necessarily correlate with the extent of physiological and psychological effects.
A negative result indicates that amphetamines are either not present or are present at
levels below the cut-off threshold for this test.
Amylase
Specimen type:
Serum, urine, fluids.
None.
Turnaround time:
Reference range:
Serum: 36 – 128 U/L
Urine: 0 – 350 U/L
Amyloid A protein
Specimen type:
Serum
Ensure that specimen is sent to the laboratory without delay.
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Turnaround time:
Reference range:
Androgen profile (female patients)
Specimen type:
Serum
Profile includes testosterone, sex hormone binding globulin and testosterone/SHBG
ratio. Appropriate clinical details are required.
Turnaround time:
Reference range:
Testosterone (adult females):
Sex hormone binding globulin (SHBG)
Testosterone/SHBG ratio
0.2 – 3.0 nmol/L
18 – 114 nmol/L
1.0 – 5.2
Androstenedione
Specimen type:
Serum
Morning specimen recommended.
Turnaround time:
Reference range:
Adult males 1.1 – 10.9 nmol/L
Adult females 0.7 – 10.8 nmol/L
Angiotensin Converting Enzyme (ACE)
Specimen type:
Serum
ACE inhibitors, e.g. captopril, enalapril inhibit ACE activity.
Turnaround time:
Reference range:
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Antidiuretic hormone (ADH)
Specimen type:
Collect two specimens in ice-cold potassium EDTA tubes (=FBC tube) and transport
Turnaround time:
Reference range:
Apolipoprotein E phenotype
Specimen type:
EDTA plasma
Turnaround time:
Store specimen at approximately 4 degrees Celsius prior to preparation for dispatch to
Reference range:
Arterial blood gas analysis (ABG)
Specimen type:
Turnaround time:
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7.35 - 7.45
4.26 - 5.99 kPa
11.04 - 14.36 kPa
-2.0 - +2.0
22.0 - 26.0 mmol/L
22.0 - 26.0 mmol/L
96 - 97 %
Reference range:
Adult
pH
pCO2
pO2
Base Excess
Actual Bicarbonate
Oxygen Saturation
Aspartate aminotransferase (AST)
Specimen type:
Serum
This assay is also available as part of the cardiac test profile.
Turnaround time:
Reference range:
15 – 41 U/L
AST (Asparate aminotransferase)
Specimen type:
Serum
This assay is also available as part of the cardiac test profile.
Turnaround time:
Reference range:
15 – 41 U/L
Autoantibodies, autoimmune antibodies
Please refer to Serology Section of this Handbook.
Azathioprine (for patients about to commence azathioprine,
Imuran®, therapy)
Requests for the measurement of Thiopurine S-Methyltransferase activity in patients
about to commence azathioprine therapy.
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Specimen type:
Two specimens of whole blood in potassium EDTA tubes. Specimen should be sent to
the Clinical Biochemistry Laboratory.
Turnaround time:
Reference range:
B2-microglobulin (beta-2-microglobulin)
Specimen type:
Serum, urine.
The measurement of urinary concentrations of beta-2-microglobulin is of limited value
because urine pH<6 is known to degrade this protein in the bladder.
Turnaround time:
Reference range:
B12 (Vitamin B12)
Please refer to Haematology Section of this Handbook.
Barbiturates
Specimen type:
specimen.
Turnaround time:
Reference range:
The cut-off threshold for a positive result for barbiturate is 200 ng/mL.
A positive result for barbiturate indicates only the presence of barbiturate and does not
necessarily correlate with the extent of physiological and psychological effects.
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A negative result indicates that barbiturates are either not present or are present at levels
below the cut-off threshold for this test.
Bence Jones Protein
Specimen type:
Urine. No preservative required: keep refrigerated.
Turnaround time:
Availability of assay: allow three working days for receipt of report.
Reference range:
Bence-Jones protein is normally undetectable.
Benzodiazepine (semi-quantitative, serum)
Specimen type:
Serum
provided for medico-legal purposes.
Turnaround time:
Reference range:
The cut-off threshold for a positive result for serum benzodiazepine is 300 ng/mL.
A positive result for benzodiazepine indicates only the presence of benzodiazepine and
does not necessarily correlate with the extent of physiological and psychological effects.
A negative result indicates that benzodiazepines are either not present or are present at
Benzodiazepine (semi-quantitative, urine)
Specimen type:
specimen.
Turnaround time:
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Reference range:
The cut-off threshold for a positive result for benzodiazepine is 200 ng/mL.
A positive result for benzodiazepine indicates only the presence of benzodiazepine and
does not necessarily correlate with the extent of physiological and psychological effects.
A negative result indicates that benzodiazepine s are either not present or are present at
Beta-hydroxy butyrate
Specimen type:
The Clinical Biochemistry Laboratory must be contacted before initiating the request so
that all collection requirements can be met.
Add 3 mL of 5.1% perchloric acid to the special specimen tube. Weigh tube. Add 0.5 –
1.0 mL of whole blood to the weighed tube. Mix thoroughly by inverting several times.
Weigh the tube and its contents and calculate the exact weight of blood added.
Centrifuge tube at 4 degrees Celsius. Remove supernatant and store at minus 25
degrees Celsius pending dispatch to Referral Laboratory.
Turnaround time:
Reference range:
Beta 2-glycoprotein-1
Please refer to the Serology/Immunology Section of this manual.
Beta-2-microglobulin
Specimen type:
Serum, urine.
The measurement of urinary concentrations of beta-2-microglobulin is of limited value
because urine pH<6 is known to degrade this protein in the bladder.
Turnaround time:
Reference range:
Beta 2 transferrin (Tau Protein; Rhinorrhoea Fluid Analysis)
Specimen type:
Nasal fluid accompanied by 1 mL of serum.
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Turnaround time:
Reference range:
Bicarbonate (actual; BGA)
Specimen type:
Turnaround time:
Reference range:
Adult
pH
pCO2
pO2
Base Excess
Actual Bicarbonate
Oxygen Saturation
7.35 - 7.45
4.26 - 5.99 kPa
11.04 - 14.36 kPa
-2.0 - +2.0
22.0 - 26.0 mmol/L
22.0 - 26.0 mmol/L
96 - 97 %
Bicarbonate (serum/plasma)
Specimen type:
Serum/Plasma
This assay is also available as part of the electrolyte profile.
Turnaround time:
Reference range:
22 – 32 mmol/L
107
This assay differentiates CSF from other biological fluids.
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Bicarbonate (standard)
Specimen type:
Turnaround time:
Reference range:
Adult
pH
pCO2
pO2
Base Excess
Actual Bicarbonate
Oxygen Saturation
7.35 - 7.45
4.26 - 5.99 kPa
11.04 - 14.36 kPa
-2.0 - +2.0
22.0 - 26.0 mmol/L
22.0 - 26.0 mmol/L
96 - 97 %
Bile Acids
Specimen type:
Serum.
Note that plasma is not a suitable specimen type for bile acid determination.
Turnaround time:
Reference range:
Bilirubin (total)
Specimen type:
Serum.
Protect sample from sunlight. This assay is also available as part of the liver test profile.
Turnaround time:
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Reference range:
Adults: 7 – 34 µmol/L
Paediatric values:
Up to 24 hours:
24 – 48 hours:
3 – 5 days:
1 month to adult:
<100 µmol/L
<140 µmol/L
<200 µmol/L
<34 µmol/L
Bilirubin (direct)
Specimen type:
Serum.
Protect sample from sunlight.
Turnaround time:
Reference range:
2 – 9 µmol/L
Biotinidase
Specimen type:
1 mL of whole blood in lithium heparin specimen tube.
The specimen should be surrounded with ice and brought to the laboratory immediately.
Turnaround time:
Reference range:
Blood Gas Analysis
Specimen type:
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Turnaround time:
Reference range:
Adult
pH
pCO2
pO2
Base Excess
Actual Bicarbonate
Oxygen Saturation
7.35 - 7.45
4.26 - 5.99 kPa
11.04 - 14.36 kPa
-2.0 - +2.0
22.0 - 26.0 mmol/L
22.0 - 26.0 mmol/L
96 - 97 %
BNP (Brain Natriuretic Peptide; NT-proBNP)
Specimen type:
Serum
This assay measures N-terminal pro B-type natriuretic peptide in human serum.
This assay is only performed on requests authorised by a consultant.
Turnaround time:
Reference range:
NT-proBNP values need to be interpreted in conjunction with the medical history, clinical
findings and other information. Based on a number of studies, serum NT-proBNP values
below 125pg/mL are considered normal.
Because of the high biological variability in NT-proBNP within an individual, caution
should be exercised in interpreting changes of less than 100% as being related to
medical therapy.
Bone profile
Specimen type
Serum
Profile includes calcium, phosphate, alkaline phosphate, total protein, albumin.
Turnaround time:
Reference ranges:
See individual analytes:
Serum Calcium:
Serum phosphate:
Serum protein:
Serum albumin:
Serum alkaline phosphatase:
110
2.23 – 2.58 mmol/L
0.78 – 1.53 mmol/L
61 – 79 g/L
35 – 48 g/L
38 – 126 IU/L
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Age range
Serum alkaline phosphatase (U/L)
Females
Birth - 4 weeks
75 – 316
48 – 406
1 month – 1 year
82 – 383
124 – 341
1 – 3 years
104 – 345
108 – 317
3 – 6 years
93 – 309
96 – 297
6 – 9 years
86 – 315
69 – 325
9 – 12 years
42 – 362
51 – 332
12 – 15 years
74 – 390
50 – 162
15 – 18 years
52 – 171
47 – 119
18 – 100 years
30 – 120
30 – 120
Males
Brain Natriuretic Peptide (BNP; NT-proBNP)
Specimen type:
Serum
This assay measures N-terminal pro B-type natriuretic peptide in human serum.
Turnaround time:
Reference range:
NT-proBNP values need to be interpreted in conjunction with the medical history, clinical
findings and other information. Based on a number of studies, serum NT-proBNP values
below 125pg/mL are considered normal.
Because of the high biological variability in NT-proBNP within an individual, caution
should be exercised in interpreting changes of less than 100% as being related to
medical therapy.
BR-MA (alternative CA15.3)
Specimen type:
Serum
IMPORTANT WARNING:
This assay is not validated for use as a screening test for cancer. It has regulatory body
approval for the quantitative measurement of BR-MA (CA15.3) antigen in human serum,
as an aid in the detection of recurrence in previously treated stage 2 and stage 3 breast
cancer patients, and in the management of metastatic breast cancer patients by
monitoring disease progression or response to treatment.
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Turnaround time:
Reference range:
0 – 48 U/mL
C1 Esterase inhibitor concentration
Specimen type:
Serum
Turnaround time:
Reference range:
C1 Esterase inhibitor: functional assay
Specimen type:
5 mL of whole blood in sodium citrate tube and 1 mL of serum.
Turnaround time:
Reference range:
C3 Complement
Specimen type:
Serum
Turnaround time:
Reference range:
0.79 – 1.52 g/L
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C4 Complement
Specimen type:
Serum
Turnaround time:
Reference range:
0.16 – 0.38 g/L
CA 15.3 (alternative: BR-MA)
Specimen type:
Serum
IMPORTANT WARNING:
This assay is not validated for use as a screening test for cancer. It has regulatory body
approval for the quantitative measurement of CA15.3 (BR-MA) antigen in human serum,
as an aid in the detection of recurrence in previously treated stage 2 and stage 3 breast
cancer patients, and in the management of metastatic breast cancer patients by
monitoring disease progression or response to treatment.
Turnaround time:
Reference range:
0 – 48 U/mL
CA 19.9 (alternative: GI-MA)
Specimen type:
Serum
IMPORTANT WARNING:
This assay is not validated for use as a screening test for cancer.
Turnaround time:
Reference range:
0 – 39 U/mL
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CA 125 (alternative: OM-MA)
Specimen type:
Serum
IMPORTANT WARNING:
This assay is not validated for use as a screening test for cancer. The regulatory body
approval for this assay states that it is intended strictly for in vitro diagnostic use as an
aid in monitoring the response to therapy for patients with epithelial ovarian cancer, and
in detecting residual ovarian cancer in patients who have undergone first-line therapy
and would be considered for diagnostic second-look procedures.
Turnaround time:
Reference range:
0 – 48 U/mL
Caeruloplasmin
Specimen type:
Serum
Turnaround time:
Availability of assay: allow five working days for receipt of report.
Reference range:
0.15 – 0.60 g/L
Caffeine
Specimen type:
Serum
Draw specimen at a consistent interval for the last dose. Please state exact time of
specimen collection and relationship to the last dose.
Turnaround time:
Reference range:
41 – 72 µmol/L
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Calcitonin
A fasting specimen is required. Collect blood in an ice-cold lithium heparin tube. Mix by
gentle inversion. Specimen should be surrounded with ice and brought to the Clinical
Biochemistry Laboratory immediately.
Turnaround time:
Reference range:
Calcium (total)
Specimen type:
Serum.
For urine calcium assay a 24-hour urine collection is required with 20mL of 6N HCI as
preservative.
Prolonged venous compression during blood collection will increase serum calcium.
Turnaround time:
Serum calcium: daily, throughout 24 hours.
Urine calcium: Monday – Friday during core working hours.
Reference range:
Serum: 2.23 – 2.58 mmol/L
Urine:
3.0 – 8.0 mmol/24 hours.
Important notes:
Albumin is the principal binding protein for calcium. A decrease in serum/plasma albumin
will lead to a fall in albumin-bound calcium and a decrease in total calcium concentration
and vice versa. Therefore serum albumin should always be requested with serum
calcium. Total serum calcium can be ‘adjusted’ to ‘correct’ for changes in serum albumin.
This adjustment of total calcium is to that expected to be present at an albumin
concentration of 40 g/L. The adjustment equation used in this laboratory is as follows:
Adjusted calcium (mmol/L) = {(40 – albumin) x 0.02} + measured calcium.
Calcium / creatinine ratio in urine
Specimen type:
The ratio is determined on the second urine passed in the morning. Acid preservative is
added upon receipt in the laboratory.
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Specimen type:
See special requirements
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The specimen should be brought to the laboratory immediately.
Turnaround time:
Reference range:
Ratio decreases from 0.09 – 2.20 mmol/mmol creatinine at age 0.5-1 year, to 0.04 – 0.80
mmol/mmol creatinine at age 5-7 years.
Calcium (ionised)
Specimen type:
Whole blood in air-free heparinised syringe. Balanced heparin must be used in the
syringe.
Turnaround time:
Reference range:
Whole blood: 1.12 – 1.32 mmol/L.
Calculus analysis
Specimen type:
Stone(s).
Specimen should be washed free of tissue and blood, and submitted in a clean dry
container. Include relevant clinical information.
Turnaround time:
Reference range:
Calprotectin
Specimen type:
Approximately 1 gram of stools. Sample should be kept cool during transport to the
laboratory.
Specimen should be sent to the laboratory immediately.
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Turnaround time:
Cannabinoid (THC)
Specimen type:
specimen.
Turnaround time:
Reference range:
The cut-off threshold for a positive result for cannabinoid is 50 ng/mL.
A positive result for cannabinoid indicates only the presence of cannabinoid and does not
A negative result indicates that cannabinoids are either not present or are present at
Carbamazepine (Tegretol®)
Specimen type:
Serum
Specimen should be drawn before the next oral dose with the patient at steady state.
Turnaround time:
Reference range:
Therapeutic guide: 17 - 51µmol/L
Carboxyhaemoglobin
Specimen type:
available in each ward. Once the sample has been drawn, the blood gas syringe must be
labelled with the patient’s full name, chart number, ward, date and time of collection.
Immediately after collection, expel any air from the sample and seal the syringe with the
stopper provided in the sampling kit.
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Reference range:
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Turnaround time:
Reference range:
0 – 1.5 %
Carcinoembryionic antigen (CEA)
Specimen type:
Serum
IMPORTANT WARNING:
This assay is not validated for use as a screening test for cancer. CEA is almost never
raised in early malignancy.
The regulatory body approval for this assay states that it is intended strictly for in vitro
diagnostic use in the management of cancer patients and in the assessment of
prognosis.
Turnaround time:
Reference range:
0 – 10 ng/mL
Cardiac enzyme profile
Specimen type:
Serum
Includes CK, LD and AST.
Turnaround time:
Reference range:
See ranges for individual analytes:
CK
Males:
49 – 397 IU/L
Females 38 – 234 IU/L
LD
98 – 192 IU/L
AST
15 – 41 IU/L
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Carnitine (Total and free)
Turnaround time:
Reference range:
Carotene
Specimen type:
Serum
Fasting specimen: protect from light. Appropriate clinical details are required.
Turnaround time:
Reference range:
Catecholamines (total)
Specimen type:
24-hour urine collection; with 20mL of 6 N HCI as preservative.
Relevant clinical details and drug history must be provided with the request.
Turnaround time:
Reference range:
Catecholamine /creatinine ratio (paediatric request;
up to 12 years of age)
Specimen type:
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Specimen type:
1 mL of whole blood in a lithium heparin specimen tube.
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The ratio is determined on a 20 mL urine specimen. Acid preservative is added upon
receipt in the laboratory. Specimen must be brought to the laboratory immediately after
collection.
Turnaround time:
Reference range:
CEA (carcinoembryonic antigen)
Specimen type:
Serum
IMPORTANT WARNING:
This assay is not validated for use as a screening test for cancer. CEA is almost never
raised in early malignancy.
The regulatory body approval for this assay states that it is intended strictly for in vitro
diagnostic use in the management of cancer patients and in the assessment of
prognosis.
Turnaround time:
Reference range:
0 – 10 ng/mL
CellCept® (Mycophenolate)
Specimen type:
2 mL of whole blood in potassium EDTA specimen tube. Send specimen to the laboratory
immediately so that plasma can be separated within two hours.
Special request form for immunosuppressant drug monitoring should be used.
The date and time of specimen collection and the date, time and dosage of the last
mycophenolate dose must be recorded on the request form. Appropriate clinical details
are also required.
Turnaround time:
Reference range:
CH-50 (whole complement titre)
Please contact the Serology / Immunology Laboratory.
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Chloride
Specimen type:
Serum
Turnaround time:
Availability of assay: Daily, throughout 24 hours.
Reference range:
101 – 111mmol/L
Cholesterol: Total
Specimen type:
Serum
Prolonged venous compression during blood collection will increase serum cholesterol.
Turnaround time:
Reference range:
General population reference values: 4.0 – 6.7 mmol/L
In general, total serum cholesterol should be less than 5.0 mmol/L and LDL-cholesterol
should be less than 3.0 mmol/L.
For patients with clinically established cardiovascular disease and patients with diabetes
the treatment goals should be lower: total cholesterol < 4.5 mmol/L and LDL-cholesterol
<2.5 mmol/L.
Treatment goals are not defined for HDL-cholesterol and triglycerides, but HDLcholesterol < 1.0 mmol/L in men and < 1.2 mmol/L in women, and fasting triglyceride
>1.7 mmol/L are markers of increased cardiovascular risk.
In asymptomatic individuals the decision to start treatment depends not only on the
serum lipid levels but also on an assessment of total cardiovascular risk.
Cholesterol: HDL fraction
Specimen type:
Serum
Fasting specimen
Turnaround time:
Reference range:
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<2.5 mmol/L.
Cholesterol: LDL fraction
Specimen type:
Serum
Fasting specimen
Turnaround time:
Reference range:
<2.5 mmol/L.
Cholinesterase
Specimen type:
Serum
Turnaround time:
Reference range:
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Cholinesterase Phenotype
Specimen type:
Serum
Appropriate clinical details required
Turnaround time:
Reference range:
Cholinesterase Genotype
Cholinesterase genotype, plasma cholinesterase genotype, BChE genotype
Specimen type:
5 mL of whole blood in potassium EDTA anticoagulant.
Turnaround time:
Reference range:
Chromogranin A
Specimen type:
Serum
Deliver the specimen to the Clinical Biochemistry Laboratory within 2 hours of
venepuncture.
Upon receipt in the laboratory, centrifuge the specimen without delay. Separate the
serum immediately after centrifugation and store at minus 25 degrees pending dispatch
to referral laboratory.
The separated serum sample must remain frozen during transport to the referral
laboratory.
Turnaround time:
Reference range:
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Ciclosporin (Cyclosporin)
Specimen type:
Whole blood collected in a specimen tube with potassium EDTA as anticoagulant.
Trough levels should be monitored, i.e. 12-18 hours after oral dose, 12 hours after
intravenous dose or immediately prior to the next dose. Do not centrifuge the specimen.
Turnaround time:
Reference range:
Citrate (citric acid)
Specimen type:
24-hour urine collection. No preservative is required. The collection should be kept cool /
refrigerated during the collection period.
On completion, the collection should be delivered to the laboratory without delay.
Do not undertake collection if a urinary tract infection is present.
Turnaround time:
Reference range:
CK (creatine kinase)
Specimen type:
Serum
After the onset of myocardial infarction, the diagnostic window is from the 12th to the
24th hour.
Note that values may be raised by exercise, intramuscular injections and bruising.
Haemolysis interferes with the assay resulting in falsely raised values.
Turnaround time:
Reference range:
Males:
49 – 397 IU/L
Females: 38 – 234 IU/L
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CK-MB (Creatine kinase MB isoenzyme)
Note: the preferred biochemical marker for myocardial infarction is the cardiospecific
protein Troponin-T
Specimen type:
Serum
24th hour.
Turnaround time:
Reference range:
0 – 5.0 ng/mL
CO2 (serum/plasma)
Specimen type:
Serum/Plasma
Turnaround time:
Reference range:
22 – 32 mmol/L
Cocaine metabolite
Specimen type:
provided for medico-legal purposes. The requesting doctor may need to consider whether
a patient might avail of opportunities to alter or interfere with the integrity of the specimen.
Turnaround time:
Reference range:
The cut-off threshold for a positive result for cocaine metabolite is 300 ng/mL.
A positive result for cocaine metabolite indicates only the presence of cocaine metabolite
and does not necessarily correlate with the extent of physiological and psychological
effects.
A negative result indicates that cocaine metabolites are either not present or are present
at levels below the cut-off threshold for this test.
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Complement
Except for C3, C4 and C1-esterase inhibitor please refer requests for the assay of
complement components to the Serology / Immunology Laboratory.
Copper
Specimen type:
conjunction with trace metal-free tube. This specimen should be collected first if other
tests are requested so as to avoid contamination.
For urine copper a 24-hour urine collection without preservative in a metal-free container
is required.
tube and needle.
Turnaround time:
Reference range:
Cortisol
Specimen type:
Serum
Record specimen collection time.
Turnaround time:
Reference range:
7-9am serum cortisol
Midnight serum cortisol
250 – 800 nmol/L
<250 nmol/L
Cotinine
Specimen type:
10 mL of urine collected without a preservative.
Cotinine is the major nicotine metabolite found in urine.
Turnaround time:
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Reference range:
Specimen type:
Serum
Specimen for glucose assay must be drawn at same time. Record specimen collection
time. Specimen should be delivered to the laboratory within four hours of venepuncture.
Turnaround time:
Reference range:
C-Reactive Protein (CRP)
Creatine kinase (CK)
Specimen type:
Serum
24th hour.
Note that values may be raised by exercise, intramuscular injections and bruising.
Haemolysis interferes with the assay resulting in falsely raised values.
Turnaround time:
Reference range:
Males:
49 – 397 IU/L
Females: 38 – 234 IU/L
Creatine kinase MB isoenzyme (CK-MB)
Note: the preferred biochemical marker for myocardial infarction is the cardiospecific
protein Troponin-T
Specimen type:
Serum
24th hour.
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C-peptide
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Turnaround time:
Reference range:
0 – 5.0 ng/mL
Creatinine
Specimen type:
Serum
Urine: 24-hour collection
In the case of blood specimens for creatinine assay, the serum should be separated from
the red blood cells within five hours of venepuncture; otherwise substances are released
from the red blood cells, which cause falsely raised serum creatinine concentrations.
Both a serum specimen and a 24-hour urine collection are required for creatinine
clearance.
Turnaround time:
Serum: daily, throughout 24 hours.
Urine:
Monday – Friday during core working hours.
Reference range:
Adults:
Serum: 35 – 106 µmol/L
Urine:
9.0 – 18.0 mmol/24 hours.
Age-related ranges:
Age range
Serum Creatinine (µmol/L)
Males
Females
Birth - 1 week
53 – 97
53 – 97
1-4 weeks
27 – 62
27 – 62
1-6 months
18 – 35
18 – 35
6 months-1 year
18 – 35
18 – 35
1-18 years
18 – 62
18 – 62
18-100 years
62 – 106
35 – 88
Creatinine Clearance
Specimen type:
Serum and a 24-hour urine collection
Both serum specimen and a 24-hour urine collection are required for creatinine
clearance.
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Turnaround time:
Reference range:
Adults:
Males:
85 – 125 mL/minute/1.73m2 (1.41 – 2.08 mL/s/1.73m2)
Females: 75 - 115 mL/minute/1.73m2 (1.25 – 1.92 mL/s/1.73m2)
For each age decade after 40 years, creatinine clearance falls by approximately 6 – 7
mL/minute/1.73m2.
Crosslaps (CTx)
Specimen type:
Serum
Fasting specimen is strongly recommended. To minimise the influence of day-to-day
variability, it is important to maintain the same collection protocol. Serial samples should
be collected at the same time of day on each occasion, e.g. before breakfast.
The specimen must reach the laboratory within two hours of collection from the patient.
Turnaround time:
Reference range:
CRP (C-Reactive Protein)
Cryoglobulins
Specimen type:
The Clinical Biochemistry Laboratory must be contacted before initiating the request so
that all collection requirements can be met.
Specimen must be collected in a plain Monovette® syringe prewarmed to 37 degrees
Celsius, and maintained at 37 degrees Celsius during clotting, centrifugation and
separation of the serum fraction. Arrangements for the collection of a specimen for
detection of cryoglobulins must always be discussed with the Clinical Biochemistry
Laboratory prior to the commencement of specimen collection.
Turnaround time:
129
In the case of blood specimens for creatinine assay, the serum should be separated from
the red blood cells within five hours of venepuncture; otherwise substances are released
from the red blood cells, which cause falsely raised serum creatinine concentrations.
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Reference range:
The laboratory report provides appropriate reference values.
CSF Glucose
Specimen type:
CSF.
Note that it is Laboratory Policy that all CSF specimens must be delivered to the
Microbiology Department for initial examination and processing.
Turnaround time:
Reference range:
In fasting patients: 2.2 – 3.9 mmol/L.
Result should be interpreted in combination with plasma glucose result. CSF glucose
should be 60 – 70% of the plasma glucose.
CSF Oligoclonal IgG banding
Specimen type:
CSF and serum obtained at the same time.
Turnaround time:
Reference range:
CSF Protein
Specimen type:
CSF.
Special requirements or comments
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Turnaround time:
CTx (Crosslaps)
Specimen type:
Serum
Fasting specimen is strongly recommended. To minimise the influence of day-to-day
variability, it is important to maintain the same collection protocol. Serial samples should
be collected at the same time of day on each occasion, e.g. before breakfast.
The specimen must reach the laboratory within two hours of collection from the patient.
Turnaround time:
Reference range:
Cyclosporin (Ciclosporin)
Specimen type:
See special requirements.
Whole blood collected in specimen tube with potassium EDTA as anticoagulant. Trough
levels should be monitored, i.e. 12-18 hours after oral dose, 12 hours after intravenous
dose or immediately prior to the next dose.
Turnaround time:
Reference range:
Cystine
Specimen type:
24-hour urine collection. No preservative is required.
The collection should be kept cool or refrigerated until complete. On completion, the
collection should be delivered to the laboratory without delay.
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Reference range:
0.150 – 0.450 g/L
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Turnaround time:
Reference range:
Cystine (white cell concentration)
Specimen type:
1-2 mL blood in lithium heparin tube; do not refrigerate or centrifuge, deliver to laboratory
without delay. Monday – Wednesday (only) dispatch to Manchester.
Turnaround time:
Reference range:
7-Dehydrocholesterol (in relation to Smith Lemli Opitz syndrome)
Specimen type:
1 mL serum or plasma.
Turnaround time:
Reference range:
Dehydroepiandrosterone sulphate (DHEAS, DHEA sulphate)
Specimen type:
Serum
Draw specimen in the morning. Appropriate clinical details are required.
Turnaround time:
Reference range:
Adults
Males:
Females:
Females (postmenopausal)
132
2.17 – 15.19 µmol/L
0.95 – 11.67 µmol/L
0.27 – 5.16 µmol/L
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Delta Aminolevulinic acid (ALA)
Specimen type:
24-hour urine collection; no preservative.
Protect the collection from light and keep refrigerated at 4-8°C.
Turnaround time:
Reference range:
Deoxypyridinoline
Specimen type:
Urine
It is recommended that a carefully monitored second void collection is made; patients
should be asked to empty their bladders on waking and discard the urine. Then they
should collect the next specimen (the second morning void) in the urine container (plain
container, no additives). To minimise the influence of day-to-day variability, it is important
to maintain the same collection protocol.
Turnaround time:
Reference range:
DHEA sulphate (DHEAS)
Specimen type:
Serum
Draw specimen in the morning. Appropriate clinical details are required.
Turnaround time:
Reference range:
Adults
Males:
Females:
Females (postmenopausal)
2.17 – 15.19 µmol/L
0.95 – 11.67 µmol/L
0.27 – 5.16 µmol/L
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Digoxin
Specimen type:
Serum
The specimen should be drawn when digoxin is in equilibrium between plasma and the
tissues. The time to equilibrium following either oral or intravenous dose is usually 8 to 12
hours. Note: with normal renal function and regular dosage intervals, it takes 5 to 7 days
to achieve a steady state of digoxin.
Turnaround time:
Reference range:
Therapeutic guide: 1.3 – 2.6 nmol/L
Dihydrotestosterone (5-αdihydrotestosterone)
Specimen type:
Serum (1-2 mL); in the case of neonatal and paediatric requests, the sample volume may
be discussed with the referral laboratory.
Appropriate clinical details are required including a summary of prescribed medication.
The referral laboratory will undertake to assay both testosterone and dihydrotestosterone
in order to advise on the interpretation of the testosterone/5-αdihydrotestosterone ratio.
Turnaround time:
Reference range:
1,25 Dihydroxy cholecalciferol (1,25 dihydroxy vitamin D)
Specimen type:
Plasma is not suitable for this assay.
A fasting specimen is required. The specimen should be protected from light and brought
to the laboratory immediately.
Turnaround time:
Reference range:
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Dopamine
Specimen type:
24-hour urine collection with 20mL of 6N HCI as preservative.
Appropriate clinical details and a list of all current medication are required.
Turnaround time:
Reference range:
Drink, spiked (suspected case of spiked drink)
Important notes:
(1) Requests for analyses relating to a case of alleged spiking of drink must be
made by a registered medical practitioner.
(2) The biochemistry service is provided to assist in the clinical management of the
patient and is not provided for forensic purposes or as part of a criminal
investigation.
(3) Specimens should be collected within 24 hours of the alleged incident.
Specimens collected more than 24 hours after the alleged incident are unlikely
to yield significant findings.
(4) The measurement of the subject’s serum or plasma alcohol should be
considered a prerequisite to any biochemistry investigations of alleged spiking
of drink.
Specimen type:
Serum or plasma and urine
Specimens must be collected within 24 hours of the alleged incident. Specimen collected
more than 24 hours after the event are unlikely to yield significant findings.
No preservative is required for the urine specimen.
Turnaround time:
Reference range:
Drugs of abuse in urine (DAU) screen
Specimen type:
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specimen.
The following drugs are tested for as part of the DAU Profile: amphetamines,
barbiturates, benzodiazepine, cocaine metabolite, methadone, opiate, cannabinoid
(THC).
Turnaround time:
Reference range:
These analytes are reported as Positive or Negative
The cut-off threshold for a positive result for each of the drugs is as follows:
Drug
Cutoff threshold for a positive result
Amphetamines
1000 ng/mL
Barbiturate
200 ng/mL
Benzodiazepine
200 ng/mL
Cocaine metabolite
300 ng/mL
Methadone
300 ng/mL
Opiate
300 ng/mL
Cannabinoid
50 ng/mL
A positive result indicates only the presence of the drug and does not necessarily
correlate with the extent of physiological and psychological effects.
A negative result indicates that the drug either is not present or is present at levels below
the cut-off threshold for this test.
eGFR (estimated glomerular filtration rate)
Specimen type:
Serum
Note: calculation is based on the 4v-MDRD Formula and is only applicable to adults (i.e.
patients >18 years old).
The serum should be separated from the red blood cells within six hours of
venepuncture; otherwise substances are released from the red blood cells, which cause
falsely raised serum creatinine concentrations.
Turnaround time:
Reference range:
> 90 mL/min/1.73m2
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Important notes on Estimated GFR in adults using formulae
(2) Estimates of GFR are unreliable in acute renal failure due to the kinetics of
creatinine accumulation.
(3) GFR estimates between 60 and 89 mL/min/1.73m2 do not indicate CKD unless
there is other laboratory/clinical evidence of disease.
(4) Estimated GFR should be multiplied by 1.212 for African-American patients.
IDMS-traceable MDRD Study Equation for serum creatinine reported in SI units
eGFR (mL/min/1.73 m2) = 175 x (serum creatinine (µmol/L) x 0.011312)-1.154 x (Age)-0.203 x
(0.742 if female) x (1.212 if African American)
The IDMS-traceable MDRD Study equation is for laboratories that use creatinine
methods that have been calibrated to be traceable to IDMS.
Elastase-1 (Pancreatic)
Specimen type:
Approximately 5 grams of stools. Sample should be kept cool during transport to the
laboratory.
Specimen should be sent to the laboratory immediately
Turnaround time:
Reference range:
Electrolytes
Specimen type:
Serum, plasma
The electrolyte panel includes sodium, potassium, chloride, carbon dioxide.
Turnaround time:
Reference ranges:
Sodium:
136 – 144 mmol/L
Potassium:
3.6 – 5.1 mmol/L
Chloride:
101 – 111 mmol/L
Carbon dioxide:
22 – 32 mmol/L
137
(1) Estimated GFR is calculated using the 4v-MDRD Formula (with creatinine
assay calibration traceable to ID-MS).
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Electrophoresis (Serum Protein)
Specimen type:
Serum
Turnaround time:
Reference range:
The laboratory report provides appropriate information.
Electrophoresis (Urine Protein)
Specimen type:
Untimed urine collection or a 24-hour collection. No preservative is required. Keep
specimen refrigerated.
Turnaround time:
Reference range:
Enolase (neurone-specific)
Specimen type:
Serum
Specimen should be sent to the laboratory immediately to allow for freezing of serum to
minus 25 degrees Celsius within 4 hours of specimen collection.
Turnaround time:
Reference range:
Environment toxicology
The Clinical Biochemistry Laboratory does not provide an assay service for
environmental, industrial or occupational toxic agents or chemicals. The most appropriate
agency to contact regarding these matters is the Environmental Protection Agency.;
contact details:
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EPA Headquarters, PO Box 3000, Johnstown Castle Estate, Co. Wexford,
Tel: 053-9160600; Fax:053-9160699; Email: [email protected]; Lo Call: 1890 335599.
Web site: www.epa.ie
Epanutin® (Phenytoin)
Specimen type:
Serum
Specimen drawn before the next oral dose with the patient at steady state.
Turnaround time:
Reference range:
Therapeutic guide: 40 – 79 µmol/L
Epilim® (Valproate, valproic acid)
Specimen type:
Serum
There is no evidence that monitoring serum valproate levels can be valuable in the
management of patients with epilepsy. Studies indicate that concentrations are no better
a guide to clinical response than is dose. Measurement of serum levels may be useful in
the assessment of compliance.
Turnaround time:
Reference range:
Estimated glomerular filtration rate (eGFR)
Specimen type:
Serum
Note: calculation is based on the 4v-MDRD Formula and is only applicable to adults (i.e.
patients >18 years old).
The serum should be separated from the red blood cells within six hours of
venepuncture; otherwise substances are released from the red blood cells, which cause
falsely raised serum creatinine concentrations.
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Turnaround time:
Reference range:
> 90 mL/min/1.73m2
Important notes on Estimated GFR in adults using formulae
(1) Estimated GFR is calculated using the 4v-MDRD Formula (with creatinine
assay calibration traceable to ID-MS).
(2) Estimates of GFR are unreliable in acute renal failure due to the kinetics of
creatinine accumulation.
(3) GFR estimates between 60 and 89 mL/min/1.73m2 do not indicate CKD unless
there is other laboratory/clinical evidence of disease.
(4) Estimated GFR should be multiplied by 1.212 for African-American patients.
IDMS-traceable MDRD Study Equation for serum creatinine reported in SI units
eGFR (mL/min/1.73 m2) = 175 x (serum creatinine (µmol/L) x 0.011312)-1.154 x (Age)0.203 x (0.742 if female) x (1.212 if African American)
The IDMS-traceable MDRD Study equation is for laboratories that use creatinine
methods that have been calibrated to be traceable to IDMS.
Estradiol / Oestradiol
Specimen type:
Serum
This assay has not been validated for use on neonatal samples.
Turnaround time:
Reference range:
Serum Oestradiol (pmol/L)
Females
Follicular phase
Mid-cycle
Mid-luteal phase
Males
550 - 1835
110 - 734
Post-menopausal
< 92
Adult males
<206
Note: lower limit of detection of assay is approximately 73 pmol/L.
140
110 - 551
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Ethanol (alcohol)
Specimen type:
Serum, plasma, urine.
This assay is intended to assist in the clinical management of the patient and is not
provided for medico-legal purposes or in relation to the Road Traffic Acts.
Turnaround time:
Reference range:
Serum or plasma:
50-100 mg/dL:
>100 mg/dL:
>400 mg/dL:
< 10 mg/dL;
signs of intoxication;
depression of CNS;
fatalities reported.
Urine:
<10 mg/dL
Ethosuximide (Zarontin®)
Specimen type:
Serum
Due to the long half-life of ethosuximide, fluctuations in serum concentration are
relatively minor. However, when making comparative measurements, its is advisable that
the sampling time to consistent.
Turnaround time:
Reference range:
Ethylene glycol
Specimen type:
Serum, plasma.
Assay is of value when ethylene glycol ingestion is suspected or when symptoms
indicate that possibility.
Turnaround time:
141
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Reference range:
Note: The out-of-hours toxicology call service at Beaumont Hospital is available to all
hospitals in the Republic of Ireland, however “the service is restricted to checking only for
drugs, which if taken in overdose require a specific antidote or treatment. It is not an aid
to diagnosis nor to allow a patient to be discharged.”
If the assay is required outside of normal working hours the Toxicologist on-call at
Beaumont Hospital must be contacted at 087 2590749.
Faecal Fat
Specimen type:
Quantitative three-day collection is required. A suitable container is available from the
Clinical Biochemistry Laboratory. The specimen should be kept cool. On completion, the
collection should be delivered to the laboratory without delay.
A diet containing 50 grams of fat in the case of children or 100 grams fat in the case of
adults should be consumed daily in the days before and during the collection. Laxatives,
enemas and barium meals should not be taken immediately before or during the
collection.
Turnaround time:
Reference range:
Fasting Lipid profile
Specimen type:
Serum: see special requirements
The patient must be fasting for 10 hours and have been on a stable diet for the previous
two to three weeks Alcohol should not be consumed in the three days before the test.
The profile includes; total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglyceride.
Turnaround time:
General population reference values
Total Cholesterol Reference Range:
4.0 – 6.7 mmol/L
HDL-Cholesterol Reference Range:
1.0 – 2.2 mmol/L
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LDL-Cholesterol Reference Range:
2.5 – 3.5 mmol/L
Note: reference ranges for lipids:
< 2.5 mmol/L.
Treatment goals are not defined for HDL-cholesterol and triglycerides, but HDLcholesterol < 1.0 mmol/L in men and < 1.2 mmol/L in women, and fasting triglyceride >
1.7 mmol/L are markers of increased cardiovascular risk.
Fat globules in urine
Please contact Histopathology.
Fatty Acids, very long chain (VLCFA)
Specimen type:
1 mL of blood in potassium EDTA tube is required; do not refrigerate, deliver to laboratory
without delay.
Turnaround time:
Reference range:
Ferritin
FK 506 (Tacrolimus, Prograf®)
Specimen type:
Whole blood in specimen tube with potassium EDTA as anticoagulant.
143
Triglyceride Reference Range:
0.5 – 2.1 mmol/L
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Trough levels should be monitored.
Turnaround time:
Reference range:
Flecainide (Tambocor®)
Specimen type:
Serum
Turnaround time:
Reference range:
Fluoxetine (Prozac®)
Specimen type:
Serum
Details of dosage regimen required.
Turnaround time:
Reference range:
Folate (Folic Acid)
Food Toxicology
The Clinical Biochemistry Laboratory does not provide an assay service for toxic agents
or chemicals in food or food products. The most appropriate agency to contact regarding
these matters is the Food Safety Authority of Ireland; contact details:
Food Safety Authority of Ireland, Abbey Court. Lower Abbey Street, Dublin 1
Phone 01 817 1300 ; Fax 01 817 1301; Email [email protected]
Web address www.fsai.ie
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Follicle stimulating hormone (FSH)
Specimen type:
Serum
Turnaround time:
Reference range:
Females:
Follicular phase
Mid-Cycle
Mid-Luteal
Post Menopausal
Males:
3 - 12 U/L
6 - 12 U/L
2 - 12 U/L
30 - 120 U/L
0.7 – 11.1 U/L
Free Light Chains (Kappa and Lambda) in serum
This assay is available to consultant haematologists and their teams.
The assay should be regarded as experimental. Important diagnostic and patient
management decisions should not be made on the basis of serum free light chain
assay results only.
Specimen type:
Serum only.
Assay is not available for urine.
Appropriate clinical details are required including reason for request.
Turnaround time:
Reference range:
Free T3 (triidothyronine free hormone)
Specimen type:
Serum.
Turnaround time:
Reference range:
2.7 – 7.0 pmol/L
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Free T4 (thyroxine free hormone)
Specimen type:
Serum
Turnaround time:
Reference range:
9.9 – 20.1 pmol/L
Fructosamine
Specimen type:
Serum or plasma
Appropriate clinical details are required with reasons why HbA1c result is not adequate
for the management of the patient.
Turnaround time:
Reference range:
FSH
Specimen type:
Serum
Turnaround time:
Reference range:
Serum FSH (U/L)
Females
Males
146
Follicular phase
3 – 12
Mid-cycle
6 – 12
Mid-luteal phase
2 – 12
Post-menopausal
30 – 120
Adult male
0.7 – 11.1
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Gabapentin (Neurontin®)
Specimen type:
Serum
Turnaround time:
Reference range:
GAD (Glutamic Acid Decarboxylase) antibodies
Reference range:
Refer to Serology/Immunology Section of this manual.
Galactose: disorders of galactose metabolism
Specimen type:
Note that galactosaemia is included in the National Newborn Screening Programme.
(A) Blood Galactose: (National Neonatal Screening Programme) 4 Blood spots on a
Guthrie card and 2 mL of fresh urine.
(B) Beutler Test (galactose 1-phosphate uridyltransferase assayed on a Guthrie card): 4
blood spots on a Guthrie card
(C) Quantitative enzyme assays (galactose 1-phosphate uridyltransferase;
galactokinase, UDP-galactose epimerase): 3 mL of blood in lithium heparin tube for
enzyme of interest
(D) Monitoring of treatment (Glactose 1-phosphate; galactitol): 2 mL of blood in lithium
heparin tube and 10 mL of urine.
Turnaround time:
Reference range:
Gamma GT (gamma glutamyl transferase, GGT)
Specimen type:
Serum
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This assay is also available as part of the liver test profile.
Turnaround time:
Reference range:
7 – 50 IU/L
Gastrin
Specimen type:
Serum
Patient should be fasting overnight. The specimen should be surrounded with ice and
brought to the laboratory immediately.
Turnaround time:
Reference range:
GGT (gamma GT = gamma glutamyl transferase)
Specimen type:
Serum
This assay is also available as part of the liver test profile.
Turnaround time:
Reference range:
7 – 50 IU/L
GI-MA (alternative: CA19.9)
Specimen type:
Serum
IMPORTANT WARNING:
This assay is not validated for use as a screening test for cancer.
Turnaround time:
Reference range:
0 – 39 U/mL
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GL-3
Specimen type:
Urine
(note: serum/plasma GL-3 assay is no longer available)
Turnaround time:
Reference range:
Glucagon
Specimen type:
Collect 5 mL of blood into an ice-cold EDTA tube containing 0.1 mL of TRASYLOL
(aprotinin; 20,000 klUmL).
brought to the laboratory immediately. Note: haemolysis invalidates this assay.
Turnaround time:
Reference range:
Glucose
Specimen type:
Glucose specimen tube containing fluoride EDTA as anticoagulant.
Record specimen collection time and state whether the specimen is fasting, post-prandial
or part of a glucose tolerance test.
Turnaround time:
149
Explanatory note: this test is used in the management of patients with Fabry
Disease
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Reference range:
General population reference range: 4.1 – 6.6 mmol/L
Fasting venous plasma glucose
World Health Organisation
(WHO) Criteria
Normal
Impaired fasting glucose
Diabetes
American Diabetes Association
(ADA) Criteria
</= 6.0 mmol/L
</= 5.5 mmol/L
6.1 – 6.9 mmol/L
5.6 – 6.9 mmol/L
>/= 7.0 mmol/L
>/= 7.0 mmol/L
Glucose (CSF)
Specimen type:
CSF.
Turnaround time:
Reference range:
In fasting patients: 2.2 – 3.9 mmol/L.
Result should be interpreted in combination with plasma glucose result. CSF glucose
should be 60 – 70% of the plasma glucose.
Glucose Tolerance Test
Specimen type:
Specimens collected in glucose specimen tubes as follows:
Fasting i.e. immediately prior to 75 gram oral glucose load (adult),
and
2 hours post glucose load.
The oral glucose load is 1.75 grams per kilogram ideal body weight to a maximum of 75
grams. The glucose should be dissolved in 300-350 mL of drinking water and consumed
over 5 minutes. Sugar-free lemon and chilling increase palatability and may reduce
nausea. The patient should sit throughout the test.
In order to avoid false positives, patients should receive adequate carbohydrate (at least
150 grams daily) for the three days before the oral glucose tolerance test.
Bookings for oral glucose tolerance test on outpatients may be made with the Laboratory
Phlebotomist at (061) 482270. These tests are preformed on Wednesdays and Fridays.
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Volume of Lucozade to provide the equivalent of 75g anhydrous glucose or 82.5g
glucose monohydrate: 410mL.
For children the recommended test load is 1.75g glucose per kg body weight up to a total
of 75g of glucose, this is equivalent to 9 6mL Lucozade (Energy Original, 70kcal/100mL)
per kg body weight up to a total of 410mL of Lucozade.
Notes on the Oral Glucose Tolerance Test:
•
Unrestricted diet for three days prior to the test, with a daily intake of at least
150g of carbohydrate and usual physical activity; a reasonable carbohydrate
(30-50g) containing meal should be consumed on the evening before the test.
•
8-14 hour overnight fast during which water may be drank.
•
No smoking, eating, drinking or exercise during the test.
•
Fasting blood specimen drawn for glucose measurement (t=0).
•
After collection of the fasting sample, the patient should consume 75g
anhydrous glucose dissolved in 250-300mL of water. The test is timed from the
commencement of the drink. The drink must be consumed in less than five
minutes.
•
The second blood specimen for glucose measurement is drawn two hours after
glucose ingestion (t=120).
Turnaround time:
The waiting time for a glucose tolerance test is about one week.
Reference range:
WHO and ADA Diagnostic Criteria:
Interpretation of 75 gram oral glucose tolerance test
Normal Results
WHO Criteria
ADA Criteria
Time of sample
Venous plasma glucose
mmol/L
Venous plasma glucose
mmol/L
Fasting
≤ 6.0
≤ 5.5
2 hours post
glucose load
< 7.8
< 7.8
≥ 7.0
≥ 7.0
Diabetes Mellitus
Fasting
and/or
2 hours post
glucose load
≥ 11.1
≥ 11.1
< 7.0
< 7.0
Impaired Glucose
Tolerance
Fasting
and
2 hours post
glucose load
7.8 – 11.0
7.8 – 11.0
Fasting
6.1 – 6.9
5.6 – 6.9
2 hours post
glucose load
< 7.8
Impaired Fasting
Glucose
151
The GlaxoSmithKline Lucozade product may be used as a glucose load according to the
following instructions:
Product Details: Lucozade: Energy Original 70kcal/100mL formulation
(website: www.lucozade.com/energy/facts.html)
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Glutamic Acid Decarboxylase (GAD) antibodies
Please refer to Serology/Immunology section of this handbook.
Glutamine
Specimen type:
1-2 mL of blood in a lithium heparin tube.
A specimen for glutamine assay must be sent to the laboratory immediately after it is
drawn.
Turnaround time:
Reference range:
Gonadotrophins (FSH, LH)
Specimen type:
Serum
Turnaround time:
Reference range:
Females
Males
Growth Hormone
Specimen type:
Serum (fasting).
152
Serum FSH (U/L)
Serum LH (U/L)
Follicular phase
3 - 12
0.5 - 18
Mid-cycle
6 - 12
15 - 80
Mid-luteal phase
2 - 12
0.5 - 18
Post-menopausal
30 - 120
16 - 64
0.7 – 11.1
0.8 – 7.6
Adult male
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Turnaround time:
Reference range:
Gut hormone profile
Please refer to specific requirements for individual gut hormones.
Haemosiderin stain, urine
HbA1c
Specimen type:
Whole blood in potassium EDTA tube (as for FBC).
Turnaround time:
Reference range:
HbA1c DCCT/NGSP aligned: 4.0 – 6.0 %
HbA1c traceable to the new IFCC Reference Measurement Procedure:
20 – 42 mmol/mol.
A consensus paper on the worldwide standardization of measurement and reporting of
HbA1c has been published recently by the American Diabetes Association (ADA),
European Association for the Study of Diabetes (EASD), International Federation of
Clinical Chemistry (IFCC) and Laboratory Medicine and the International Diabetes
Federation (IDF). This proposal has accepted that the IFCC Reference Measurement
procedure should be the international method for calibrating all assays used for the
measurement of HbA1c.
The consensus paper proposed six actions, which are reproduced as follows:
“[1] We agree that the HbA1c results should be standardised worldwide, including the
reference system and results reporting.
[2] We agree that the IFCC reference system for HbA1c represents the only valid
anchor to implement standardisation of the measurement.
[3] We agree that the HbA1c assay results be reported worldwide in IFCC units
(mmol/mol) and derived NGSP units (%), using the IFCC-NGSP master equation.
153
Specimen must be brought to the laboratory as soon as possible (less than three hours).
Physiological state (e.g. fasting, sleep, feeding, and activity) should be noted on the
request form.
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[4]
[5]
[6]
We agree that if the ongoing “average plasma glucose study” fulfills its a priori
specified criteria, an HbA1c -derived average plasma glucose (APG) value should
also be reported as an interpretation of the HbA1c result.
We recommend that all clinical guidelines be expressed in IFCC units, derived
NGSP units, and APG.
We agree that these recommendations should be implemented globally as soon as
possible.”
Note:
Relationship Between HbA1c Results From NGSP Network and IFCC Network:
Master Equation: NGSP = (0.915 x IFCC/10) + 2.15
The relationship between HbA1c values expressed in IFCC (mmol/mol) and NGSP/DCCT
(%) units is given in a table on the next page.
References:
ADA, EASD, IFCC Consensus Committee. Consensus statement on the worldwide
standardisation of the HbA1c measurement. Diabetologia 2007;50:2042–3.
Consensus meeting on reporting glycated haemoglobin and estimated average glucose
in the UK: report to the National Director for Diabetes, Department of Health
Ann Clin Biochem 2008; 45: 343–344.
For full information check the web site www.hse.ie/go/diabetes
hCG (human chorionic gonadotrophin)
Specimen type:
Serum
Turnaround time:
Reference range:
Nonpregnant females:
Males:
less than 5.3 U/L
less than 5.3 U/L
Gestational age (weeks)
Weeks since last menstrual period
Serum hCG U/L
1.3 – 2
3.3 – 4
16 – 156
2–3
4–5
101 – 4870
3–4
5–6
1110 – 31500
4–5
6–7
2560 – 82300
5–6
7–8
23100 – 151000
6–7
8–9
27300 – 233000
154
7 – 11
9 – 13
20900 – 291000
11 – 16
13 – 18
6140 – 103000
16 – 21
18 – 23
4720 – 80100
21 – 39
23 - 41
2700 - 78100
HbA1c (NGSP)
%
9.6
9.7
9.7
9.8
9.9
10.0
10.1
10.2
10.3
10.4
10.5
10.6
10.7
10.8
10.8
10.9
11.0
11.1
11.2
11.3
11.4
11.5
11.6
11.7
11.8
11.8
11.9
12.0
12.1
12.2
HbA1c (IFCC)
mmol/mol
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
HbA1c (NGSP)
%
12.3
12.4
12.5
12.6
12.7
12.8
12.9
12.9
13.0
13.1
13.2
13.3
13.4
13.5
13.6
13.7
13.8
13.9
14.0
14.0
14.1
14.2
14.3
14.4
14.5
14.6
14.7
14.8
14.9
15.0
HbA1c (IFCC)
mmol/mol
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
Page 155
HbA1c (NGSP)
%
6.8
6.9
7.0
7.1
7.2
7.3
7.4
7.5
7.5
7.6
7.7
7.8
7.9
8.0
8.1
8.2
8.3
8.4
8.5
8.6
8.6
8.7
8.8
8.9
9.0
9.1
9.2
9.3
9.4
9.5
11:58 AM
HbA1c (IFCC)
mmol/mol
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
13/7/10
HbA1c (NGSP)
%
4.1
4.2
4.3
4.3
4.4
4.5
4.6
4.7
4.8
4.9
5.0
5.1
5.2
5.3
5.4
5.4
5.5
5.6
5.7
5.8
5.9
6.0
6.1
6.2
6.3
6.4
6.5
6.5
6.6
6.7
155
HbA1c (IFCC)
mmol/mol
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Relationship between HbA1c IFCC and NGSP (DCCT) values
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HDL-Cholesterol
Specimen type:
Serum
Fasting specimen
Turnaround time:
Reference range:
< 2.5 mmol/L.
5 HIAA
Specimen type:
24-hour urine collection with 20 mL of 6N HCI as preservative. The presence of acid
preservative is essential.
Turnaround time:
Reference range:
HMMA (=VMA)
Specimen type:
Turnaround time:
Reference range:
156
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Homocysteine
Specimen should be delivered to the laboratory immediately after collection (within 15
minutes). It is necessary for General Practitioners requiring this test to arrange for their
patient to attend the Laboratory’s Phlebotomy Department at the Mid-Western Regional
Hospital.
Turnaround time:
Reference range:
Human Chorionic Gonadotrophin (hCG)
Specimen type:
Serum
Turnaround time:
Reference range:
Nonpregnant females:
Males:
less than 5.3 U/L
less than 5.3 U/L
Gestational age (weeks)
Weeks since last menstrual period
Serum hCG U/L
1.3 – 2
3.3 – 4
16 – 156
2–3
4–5
101 – 4870
3–4
5–6
1110 – 31500
4–5
6–7
2560 – 82300
5–6
7–8
23100 – 151000
6–7
8–9
27300 – 233000
7 – 11
9 – 13
20900 – 291000
11 – 16
13 – 18
6140 – 103000
16 – 21
18 – 23
4720 – 80100
21 – 39
23 - 41
2700 - 78100
157
Specimen type:
At least 2 mL of blood in a lithium heparin tube.
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Hydroxyindole acetic acid (HIAA)
Specimen type:
Turnaround time:
Reference range:
Hydroxymethoxymandelic acid (HMMA or VMA)
Specimen type:
Turnaround time:
Reference range:
17-Hydroxy progesterone
Specimen type:
Serum: The specimen (1.0 – 1.5 mL of blood) should be drawn between 8 and 9 am and
before the day’s medication is taken. Note that serum assay is required for initial
diagnosis of congenital adrenal hyperplasia.
Newly-born should be at least 48 hours old before being tested.
Saliva (for monitoring adequacy of therapy but not for initial diagnosis): For saliva assay,
special collection devices, tubes and instructions are available from the Clinical
Biochemistry Laboratory or the Paediatric Secretaries, Children’s Ark, Mid-Western
Regional Hospital. Contact the Clinical Biochemistry Laboratory before initiating the
request so that all collection requirements can be met.
Blood spot samples on special filter paper cards (for monitoring adequacy of therapy but
not for initial diagnosis): Contact the Clinical Biochemistry Laboratory before initiating the
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Turnaround time:
Hydroxproline
Specimen type:
The patient must avoid food containing gelatin, meat and fish for 24 hours prior to and
during the test. These foods include gelatin-based deserts, ice creams and sweets.
Turnaround time:
Reference range:
IgE (total)
Specimen type:
Serum
Turnaround time:
Reference range:
Adults:
< 87 IU/mL
Children:
0-1 years
1-2 years
2-3 years
3-9 years
< 29 IU/mL
< 49 IU/mL
< 45 IU/mL
< 52 IU/mL
IgE (allergen specific)
Specimen type:
Serum
Requests for allergen-specific IgE must be accompanied by completed allergy
questionnaire. Appropriate clinical details are required.
159
Reference range:
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Note: These tests should not be considered diagnostic for a given allergen - they are
merely assays for specific IgE. The medical history and clinical judgment are essential for
assessing the significance and relevance of positive and negative test results.
Turnaround time:
Allow two/three weeks for receipt of report.
Reference range:
IGF-1 (insulin-like growth factor-1, somatomedin C)
Specimen type:
Serum
The specimen should be brought to the laboratory without delay. Appropriate clinical
details are required.
Turnaround time:
Reference range:
IGF Binding Protein-3
Specimen type:
Serum
Turnaround time:
Reference range:
IgG, IgA, IgM
Specimen type:
Serum
Turnaround time:
160
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Reference range:
Adults:
IgG:
5.3 – 16.5 g/L
IgA:
0.8 – 4.0 g/L
IgM:
0.5 – 2.0 g/L
Age-related ranges:
Age range
(males and females)
IgG (g/L)
IgA (g/L)
IgM (g/L)
Birth – 2 weeks
5.0 – 17.0
0.01 – 0.08
0.05 – 0.20
2 – 6 weeks
3.9 – 13.0
0.02 – 0.15
0.08 – 4.00
6 – 8 weeks
2.1 – 7.7
0.05 – 0.40
0.15 – 0.70
2 – 6 months
2.4 – 8.8
0.10 – 0.60
0.20 – 1.00
6 – 9 months
3.0 – 9.0
0.15 – 0.70
0.40 – 1.60
9 – 12 months
3.0 – 10.0
0.20 – 0.70
0.60 – 2.10
1 – 2 years
3.1 – 13.8
0.30 – 1.20
0.50 – 2.20
2 – 3 years
3.7 – 15.8
0.30 – 1.30
0.50 – 2.20
3 – 6 years
4.9 – 16.1
0.40 – 2.00
0.50 – 2.00
6 – 9 years
4.9 – 16.1
0.50 – 2.40
0.50 – 1.80
9 – 12 years
4.9 – 16.1
0.70 – 2.50
0.50 – 1.80
12 – 15 years
4.9 – 16.1
0.80 – 2.80
0.50 – 1.90
15 – 45 years
5.4 – 16.1
0.90 – 3.40
0.50 – 2.00
Over 45 years
5.3 – 16.5
0.80 – 4.00
0.50 – 2.00
IgG Subclasses
Specimen type:
Serum
Turnaround time:
Reference range:
Immunofixation (serum protein)
Specimen type:
Serum
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Turnaround time:
Reference range:
Immunofixation (urine protein)
Specimen type:
Urine, No preservative required: keep refrigerated.
Turnaround time:
Reference range:
Immunoreactive trypsin
Specimen type:
Serum specimen.
Specimen must be delivered to the Clinical Biochemistry within one hour of collection.
Turnaround time:
Reference range:
Industrial toxicology
contact details:
EPA Headquarters, PO Box 3000, Johnstown Castle Estate, Co. Wexford, Tel: 0539160600; Fax:053-9160699; Email: [email protected]; Lo Call: 1890 335599. Web site:
www.epa.ie
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Insulin
Specimen type:
Serum.
Specimen for glucose assay must be drawn at same time.
Record specimen collection time.
The specimen should be delivered to the Clinical Biochemistry Laboratory within two
hours of collection. Haemolysed specimens are unsuitable for insulin assay.
Turnaround time:
Reference range:
Insulin antibodies
Specimen type:
Serum
Turnaround time:
Reference range:
Insulin C-peptide
Specimen type:
Serum.
Specimen for glucose assay must be drawn at same time.
Record specimen collection time. Specimen should be delivered to the laboratory within
four hours of venepuncture.
Turnaround time:
Reference range:
Insulin-like growth factor-1 (IGF-1 or somatomedin C)
Specimen type:
Serum.
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Turnaround time:
Reference range:
Insulin-like growth factor-1 binding protein-3 (IGF-1 BP3)
Specimen type:
Serum.
Turnaround time:
Reference range:
Iron
Specimen type:
Serum
A fasting specimen is required. Iron specimens must be sent to the Clinical Biochemistry
Laboratory.
Blood should be drawn before other specimens that require anticoagulated tubes.
Serum iron displays a marked circadian rhythm.
Turnaround time:
Reference range:
Adults
Males:
8.1 – 32.6 umol/L
Females:
5.0 – 30.4 umol/L
Iron studies profile
Specimen type:
Serum.
Patient must be fasting.
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Includes iron, transferrin, TIBC and transferrin saturation.
Blood should be drawn before other specimens that require anticoagulated tubes.
Serum iron displays a marked circadian rhythm.
Turnaround time:
Reference range:
Iron
Males:
Females:
8.1 – 32.6 umol/L
5.0 – 30.4 umol/L
Transferrin
Males:
Females:
1.8 – 3.3 g/L
1.9 – 3.8 g/L
TIBC
Adults:
42 – 80 umol/L
Transferrin saturation
Adults:
15 – 45%
Islet cell antibodies
Specimen type:
Serum
Please refer to Serology/Immunology section of this manual.
Kappa and Lambda Free Light Chains in serum
assay results only.
Specimen type:
Serum only.
Turnaround time:
Reference range:
165
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Keppra® (Levetiracetam)
Specimen type:
Serum.
Serum levetiracetam concentrations increase linearly with dose and it is not bound to
plasma proteins. The drug’s elimination is primarily renal, but some non-hepatic enzyme
dependent metabolism occurs that produces pharmacologically inactive metabolites.
The relationship between levetiracetam serum concentrations and clinical effect has not
yet been ascertained, however, the measurement of serum or plasma levetiracetam
concentrations seems to be an aid to individualisation of treatment with this
anticonvulsant drug. Large inter-individual differences exist between the dose/plasma
concentration response of levetiracetam and there is a concentration range within which
the drug is generally effective and unlikely to cause toxicity.
Turnaround time:
Reference range:
Ketones
Specimen type:
Urine.
Test immediately after collection. This test is performed as a ward/surgery side-room test.
Use ward-based urine analysers.
Lactate
Specimen type:
Plasma (fluoride EDTA anticoagulant). i.e. use the same tube as for glucose specimens.
Specimen should be sent to the laboratory immediately after being drawn.
Turnaround time:
Reference range:
0.5 – 2.2 mmol/L
Lactate dehydrogenase (LD or LDH)
Specimen type:
Serum; Pleural fluid, ascitic fluid
Note: haemolysis invalidates the assay.
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daily, throughout 24 hours.
Reference range:
Serum: 98 – 192 U/L
Lambda and Kappa Free Light Chains in serum
assay results only.
Specimen type:
Serum only.
Turnaround time:
Reference range:
Lamictal® (Lamotrigine)
Specimen type:
Serum
Turnaround time:
Reference range:
Lamotrigine (Lamictal®)
Specimen type:
Serum
Turnaround time:
167
Turnaround time:
Serum:
Pleural fluid, ascitic fluid:
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Reference range:
L.A.T.S. replaced by TBII (TSH-binding inhibiting immunoglobulin)
Specimen type:
Serum
Turnaround time:
Reference range:
Laxatives screen
Specimen type:
20 mL of urine, ideally from three consecutive days. Stool specimens may also be used.
Turnaround time:
Reference range:
LD or LDH (Lactate dehydrogenase)
Specimen type:
Serum; Pleural fluid, ascitic fluid
Note: haemolysis invalidates the assay.
Turnaround time:
Serum:
Pleural fluid, ascitic fluid:
Reference range:
Serum: 98 – 192 U/L
LDL-Cholesterol
Specimen type:
Serum
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Fasting specimen
Reference range:
< 2.5 mmol/L.
Lead
Specimen type:
contamination.
tube and needle.
Turnaround time:
Reference range:
Levetiracetam (Keppra®)
Specimen type:
Serum.
Serum levetiracetam concentrations increase linearly with dose and it is not bound to
plasma proteins. The drug’s elimination is primarily renal, but some non-hepatic enzyme
dependent metabolism occurs that produces pharmacologically inactive metabolites.
The relationship between levetiracetam serum concentrations and clinical effect has not
yet been ascertained, however, the measurement of serum levetiracetam concentrations
seems to be an aid to individualisation of treatment with this anticonvulsant drug. Large
inter-individual differences exist between the dose/plasma concentration response of
levetiracetam and there is a concentration range within which the drug is generally
effective and unlikely to cause toxicity.
169
Turnaround time:
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Turnaround time:
Reference range:
Levodopa
Specimen type:
Serum, specimen must be delivered to the laboratory immediately.
Turnaround time:
Reference range:
LFT profile
Specimen type:
Serum
Includes bilirubin, alkaline phosphatase, gamma GT, and ALT.
Please ensure that specimens for the assay of transaminase activity (ALT) are delivered
to the Laboratory within 24 hours of sample collection.
Turnaround time:
Reference range:
See ranges for individual analytes
Total bilirubin reference range:
Adults: 7 – 34 µmol/L
Paediatric values:
Up to 24 hours:
24 – 48 hours:
3 – 5 days:
1 month to adult:
<100 µmol/L
<140 µmol/L
<200 µmol/L
<34 µmol/L
Gamma GT (GGT) Reference range:
7 – 50 U/L
ALT reference range:
14 – 63 U/L
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Alkaline phosphatase reference range:
Adults: 38 – 126 U/L
Age range
Serum alkaline phosphatase (U/L)
Males
Females
Birth - 4 weeks
75 – 316
48 – 406
1 month – 1 year
82 – 383
124 – 341
1 – 3 years
104 – 345
108 – 317
3 – 6 years
93 – 309
96 – 297
6 – 9 years
86 – 315
69 – 325
9 – 12 years
42 – 362
51 – 332
12 – 15 years
74 – 390
50 – 162
15 – 18 years
52 – 171
47 – 119
18 – 100 years
30 – 120
30 – 120
LH
Specimen type:
Serum
Turnaround time:
Reference range:
Serum LH (U/L)
Females
Follicular phase
0.5 - 18
Mid-cycle
15 - 80
Mid-luteal phase
0.5 - 18
Post-menopausal
Males
Adult male
16 - 64
0.8 – 7.6
Lipase
Specimen type:
Serum
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Turnaround time:
Reference range:
Lipid profile (fasting specimens only)
Specimen type:
Serum: see special requirements
The patient must be fasting for 10 hours and have been on a stable diet for the previous
two to three weeks Alcohol should not be consumed in the three days before the test.
The profile includes; total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglyceride.
Turnaround time:
General population reference values
Total Cholesterol Reference Range: 4.0 – 6.7 mmol/L
HDL-Cholesterol Reference Range: 1.0 – 2.2 mmol/L
LDL-Cholesterol Reference Range: 2.5 – 3.5 mmol/L
Triglyceride Reference Range: 0.5 – 2.1 mmol/L
< 2.5 mmol/L.
Lipoprotein(a)
Specimen type:
Serum
The patient should be fasting for 10 hours.
Turnaround time:
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Reference range:
Specimen type:
Serum
Draw specimen at a consistent interval from the last dose, 6-12 hours is recommended.
Turnaround time:
Therapeutic range:
The generally accepted therapeutic range is 0.4 – 1.5 mmol/L.
The range for maintenance therapy is 0.4 – 0.8 mmol/L, but it is lower in the elderly (0.3
– 0.4 mmol/L) and higher in younger patients (0.9 – 1.1 mmol/L).
The range for acute management of manic episodes is 0.8 – 1.3 mmol/L.
Luteinising hormone (LH)
Specimen type:
Serum
Turnaround time:
Reference range:
Serum LH (U/L)
Females
Follicular phase
0.5 - 18
Mid-cycle
15 - 80
Mid-luteal phase
0.5 - 18
Post-menopausal
Males
Adult male
16 - 64
0.8 – 7.6
Lysosomal enzyme analysis (White cell enzyme analysis)
Specimen type:
173
Lithium
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5 mL blood in potassium EDTA tube; do not refrigerate or centrifuge, deliver to laboratory
Turnaround time:
Reference range:
Macroprolactin
Specimen type:
Serum
Macroprolactin is a molecular complex of prolactin and an IgG antibody. It is cleared from
the circulation more slowly than monomeric prolactin. Because of its molecular mass, is
confined to the vascular system and exhibits little biological activity in vivo.
Turnaround time:
Reference range:
Magnesium
Specimen type:
Serum.
For urine assay a 24-hour urine collection is required with 20mL of 6N HCI as
preservative.
Blood specimens for magnesium assay must be collected free of haemolysis.
Turnaround time:
Urine:
Reference range:
Urine:
3.0 – 4.25 mmol/24 hours
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Manganese
contamination.
tube and needle.
Turnaround time:
Reference range:
Mercury
Specimen type:
conjunction with trace metal-free tube. This specimen should be collected first if other
tests are requested to avoid contamination.
Urine: 24-hour collection in metal-free container, no preservatives required.
tube and needle.
Turnaround time:
Reference range:
Metanephrines
Specimen type:
Turnaround time:
Reference range:
175
Specimen type:
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Methadone
Specimen type:
specimen.
Turnaround time:
Reference range:
The cut-off threshold for a positive result for methadone is 300 ng/mL.
A positive result for methadone e indicates only the presence of methadone and does not
A negative result indicates that methadone is either not present or is present at levels
Methaemoglobin
Specimen type:
available in each ward. Once the sample has been drawn, the blood gas syringe must be
Immediately after collection, expel any air from the sample and seal the syringe with the
stopper provided in the sampling kit.
The specimen should be brought to the laboratory immediately.
Turnaround time:
Reference range:
0.4 – 1.5%
Methanol
Specimen type:
Whole blood or serum or plasma.
Turnaround time:
Toxicology Laboratory, Beaumont Hospital, Beaumont, Dublin 9.
Tel: 01 809 2673; 01 809 2671; 01 809 2675
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Beaumont Laboratory operates a strict policy of not transmitting reports by fax.
Reference range:
Methotrexate
Specimen type:
Serum
Sampling time will vary according to the dosing protocol. Details of specimen collection
time, dosage regimen and mode of administration must be included with request.
Turnaround time:
Reference range:
Microalbumin
Specimen type:
24-hour urine collection without preservative.
Early morning urine specimen.
24-hour urine collection is recommended.
Turnaround time:
Reference range:
0 – 20 mg/L
Less than 30 mg/24 hours
0 – 20 µg/minute
Microalbumin/creatinine ratio
Specimen type:
Early morning urine specimen
177
The current out-of-hours toxicology call service at Beaumont Hospital is available to all
hospitals in the Republic of Ireland. “The service is restricted to checking only for drugs,
which if taken in overdose require a specific antidote or treatment. It is not an aid to
diagnosis nor to allow a patient to be discharged.”
Consultant: Dr. W. Tormey
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Turnaround time:
Reference range:
Albumin excretion
Normal
Microalbuminuria
Clinical albuminuria
24-hour collection
mg/24 hours
Spot collection (SI Units)
mg/mmol creatinine
< 30
< 3.4
30 - 300
3.4 – 34.0
> 300
> 34.0
Note: Because of variability in urinary albumin excretion, two or three specimens
collected within a three-month period should be abnormal before considering a patient to
have crossed one of these diagnostic thresholds.
Exercise within 24 hours, infection, fever, congestive heart failure, marked
hyperglycaemia and marked hypertension may elevate urinary albumin over baseline
values.
Mucopolysaccharides
Specimen type:
1-5 mL of urine. Specimen should be sent to the laboratory immediately.
The initial screen (at the Children’s Hospital, Temple Street, Dublin) is for total
glycosaminoglycans. If positive, or if a clinical suspicion exists, electrophoresis is carried
out.
Enzyme analysis is performed at The Willink Biochemical Genetics Unit, Royal
Manchester Children’s Hospital (Tel 00 44 161 7272137 or 7272138) when an abnormal
mucopolysaccharide pattern has been identified in urine. For these investigations, 5 mL
of blood in a potassium EDTA tube is required. Do not refrigerate and deliver to the
Clinical Biochemistry Laboratory immediately. Note that dispatch to Manchester needs to
be on Monday – Wednesday (only). Full clinical details must accompany these requests.
Contact the Clinical Biochemistry Laboratory before initiating such a request so that all
Turnaround time:
Reference range:
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Mycophenolate (CellCept®)
mycophenolate dose must be recorded on the request form. Appropriate clinical details
are also required.
Turnaround time:
Reference range:
Myoglobin
Specimen type:
Serum.
Note assay is not validated for urine myoglobin.
Turnaround time:
Reference range:
Males:
28 – 72 ng/mL
Females:
25 – 58 ng/mL
Mysoline® (Primidone)
Specimen type:
Serum
Specimen should be drawn before the next oral dose with the patient at a steady state.
When making comparative measurements, it is important that the sampling time be
consistent.
Phenobarbital should also be measured since it is an active metabolite of primIdone.
Turnaround time:
Reference range:
179
Specimen type:
EDTA plasma
2 mL of whole blood in potassium EDTA specimen tube.
Send specimen to laboratory immediately so that plasma can be separated within two
hours.
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Neurontin® (Gabapentin)
Specimen type:
Serum
Turnaround time:
Reference range:
Nicotine metabolite (Cotinine)
Specimen type:
10 mL of urine collected without a preservative.
Cotinine is the major nicotine metabolite found in urine.
Turnaround time:
Reference range:
N-Telopeptide (NTx)
Specimen type:
Urine; specimen must be delivered to laboratory without delay.
It is recommended that a carefully monitored second void collection is made; patients
should be asked to empty their bladders on waking and discard the urine. Then they
should collect the next specimen (the second morning void) in the urine container (plain
container, no additives). To minimise the influence of day-to-day variability, it is important
to maintain the same collection protocol.
Turnaround time:
Reference range:
180
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Occult blood
Specimen type:
Stool specimen
The following food should not be consumed in the 3 days before the test: red meat,
radish, and liver.
Turnaround time:
Reference range:
Negative result.
Oestradiol / estradiol
Specimen type:
Serum
This assay has not been validated for use on neonatal samples.
Turnaround time:
Reference range:
Serum Oestradiol (pmol/L)
Females
Follicular phase
Mid-cycle
Mid-luteal phase
Males
110 – 551
550 – 1835
110 – 734
Post-menopausal
< 92
Adult males
<206
Note: lower limit of detection of assay is approximately 73 pmol/L.
Oligoclonal IgG banding (CSF)
Specimen type:
CSF and serum obtained at the same time.
Turnaround time:
Reference range:
181
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OM-MA (alternative: CA125)
Specimen type:
Serum
IMPORTANT WARNING: This assay is not validated for use as a screening test for
cancer. The regulatory body approval for this assay states that it is intended strictly for in
vitro diagnostic use as an aid in monitoring the response to therapy for patients with
epithelial ovarian cancer, and in detecting residual ovarian cancer in patients who have
undergone first-line therapy and would be considered for diagnostic second-look
procedures.
Turnaround time:
Reference range:
0 – 48 U/mL
Opiate
Specimen type:
specimen.
Turnaround time:
Reference range:
The cut-off threshold for a positive result for opiate is 300 ng/mL.
A positive result for opiate indicates only the presence of opiate and does not necessarily
correlate with the extent of physiological and psychological effects.
A negative result indicates that opiates are either not present or are present at levels
Organic Acids
Specimen type:
At least 2 mL and ideally 5 mL of urine collected without preservative. The specimen
must be sent to the laboratory immediately so that it can be frozen at minus 25 degrees
Celsius as soon as possible.
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Turnaround time:
Reference range:
Organophosphate and carbamate poisoning
Specimen type:
2 mL of whole blood in fluoride-EDTA tube (glucose specimen tube)
Assay: cholinesterase
Specimen should be sent to the laboratory without delay.
Turnaround time:
Reference range:
Orosomucoid (alpha-1-acid glycoprotein)
Specimen type:
Serum
Turnaround time:
Reference range:
The referral laboratory report provides appropriate referance values.
Osmolality
Specimen type:
Serum; urine (in a plain container without preservative)
Turnaround time:
Reference range:
Serum: 282 – 300 mOsm/kg.
Urine osmolality results should be interpreted in conjunction with the patient’s renal
function, serum osmolality and clinical condition.
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Osteocalcin
Specimen type:
Serum
To minimise the influence of day-to-day variability, it is important to maintain the same
collection protocol. Serial samples should be collected at the same time of day on each
occasion, e.g. mid-morning.
Turnaround time:
Reference range:
Oxalate
Specimen type:
Urine: 24-hour urine collection is required with 20mL of 6N HCI as preservative.
Turnaround time:
Reference range:
Oxcarbazepine (Trileptal®)
Specimen type:
Serum/plasma
Turnaround time:
Reference range:
184
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Pancreatic Polypeptide
brought to the laboratory immediately.
Turnaround time:
Reference range:
Pancreolaurly test
Please consider the more convenient alternative investigation: stool Elastase-1
(Pancreatic)
Specimen type:
A pancreolaurlyl test pack is available from the Pharmacy or from Allphar Services Ltd.,
Belgard Road, Tallaght, Dublin 24. Tel (01) 4041600.
A detailed test protocol for the requesting doctor accompanies the test pack.
A comprehensive patient information sheet is also included in the test pack.
At the end of the test, the Clinical Biochemistry Laboratory should receive two ten-hour
urine collections – one for Day 1 (the test day) and one for Day 2 (the control day).
Turnaround time:
Reference range:
Paracetamol (Acetaminophen)
Specimen type
Specimen should be drawn four hours post-overdose and preferably not later than 16
hours. Serum values taken less than four hours post-ingestion are difficult to interpret
due to the possibility of continuing absorption and distribution of the drug and may not
represent the peak level. Note that results are reported in ug/mL.
Turnaround time:
Reference range:
0 – 5 µg/mL (0 – 5 mg/L)
185
Specimen type:
Collect 5 mL of blood into an ice-cold lithium heparin tube containing 0.1 mL of
TRASYLOL (aprotinin: 20,000 KlU/mL).
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Plasma
paracetamol
(mg/L)
TREATMENT LINES
Hours after ingestion
Paraprotein studies
Specimen type:
Serum and urine (no preservative required; keep refrigerated).
Appropriate clinical details.
Turnaround time:
Reference range:
186
Plasma
paracetamol
(mmol/L)
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Paraquat Screen (dithionite test)
This is a qualitative test and can detect the presence of paraquat in urine down to a level
of approximately 2 mg/L
Turnaround time:
Reference range:
Negative.
Paraquat (quantitative)
Specimen type:
Serum, urine; see special requirements.
This assay is available at the Toxicology Laboratory, Beaumont Hospital, Dublin.
(Telephone 01 809 2673 or 01 809 2675).
The current out-of-hours call service at Beaumont Hospital is available to all hospitals in
the Republic of Ireland. “The service is restricted to checking only for drugs, which if
taken in overdose require a specific antidote or treatment. It is not an aid to diagnosis nor
to allow a patient to be discharged.”
Reference range:
Parathyroid hormone (PTH) intact
Specimen type:
Serum
Serum must be stored at minus 25 degrees Celsius while awaiting analysis.
Turnaround time:
Reference range:
15 – 65 ng/L.
15 – 65 pg/mL.
187
Specimen type:
Urine.
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Parathyroid hormone Related Protein (PTHrP)
Specimen type:
Contact the Biochemistry Laboratory before initiating the request so that all the collection
requirements can be met.
The specimen must be collected into a special PTHrP Cocktail Tube (Nichols
Ref No 38-2182) obtainable from the referral laboratory. On receipt the tube must be
stored at minus 20 degrees Celsius or colder until required for use.
Place the cocktail tube on ice prior to drawing the sample. Do not use the cocktail tube
as a collection tube. Collect the whole blood into a syringe and transfer the sample to the
cocktail tube. Mix thoroughly by inversion. Immediately send the specimen to the
laboratory so that the plasma can be separated from the cells using a refrigerated
centrifuge. Freeze the separated plasma immediately at minus 20 degrees Celsius or
colder. It is essential that the sample reaches the referral laboratory in a frozen state.
The specimen must be stored at minus 20 degrees Celsius or cooler while awaiting
analysis.
Turnaround time:
Reference range:
Paroxetine (Seroxat®)
Specimen type:
Serum
Turnaround time:
Reference range:
PCP (Phencyclidine)
Specimen type:
specimen.
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Turnaround time:
pCO2
Specimen type:
Turnaround time:
Reference range:
Adult
pH
pCO2
pO2
Base Excess
Actual Bicarbonate
Oxygen Saturation
7.35 - 7.45
4.26 - 5.99 kPa
11.04 - 14.36 kPa
-2.0 - +2.0
22.0 - 26.0 mmol/L
22.0 - 26.0 mmol/L
96 - 97 %
pH (BGA)
Specimen type:
189
Reference range:
The cut-off threshold for a positive result for phencyclidine is 25 ng/mL.
A positive result for phencyclidine indicates only the presence of phencyclidine and does
A negative result indicates that phencyclidine is either not present or is present at levels
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Turnaround time:
Reference range:
Adult
pH
pCO2
pO2
Base Excess
Actual Bicarbonate
Oxygen Saturation
7.35 - 7.45
4.26 - 5.99 kPa
11.04 - 14.36 kPa
-2.0 - +2.0
22.0 - 26.0 mmol/L
22.0 - 26.0 mmol/L
96 - 97 %
pH (miscellaneous fluids)
Specimen type and special requirements or comments:
Pleural and peritoneal fluids:
Collect the sample of fluid in a syringe pre-rinsed with 0.2 mL of heparin or in a syringe
from the BGA sampling kit available in wards. Immediately after collection, expel any air
from the sample and seal the syringe with the stopper provided in the BGA sampling kit.
The Laboratory will not, for safety reasons, accept syringes with any form of needle or
resheathed needle attached. Once the sample has been drawn, the syringe must be
Labels suitable for affixing to blood gas syringes are made available to each ward.
These labels display the URGENT alert message in a prominent manner.
The specimen should be surrounded with ice-water and brought to the Laboratory
without delay.
Urine:
Random urine specimen collected without preservative and transported to the laboratory
on ice-water.
Stool:
Fresh stool specimen transport to the Laboratory on ice-water (methodology: aqueous
stool suspension measured with pH indicator paper).
Turnaround time:
Reference range:
Phencyclidine (PCP)
Specimen type:
specimen.
Turnaround time:
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Phenobarbital
Specimen type:
Serum
Turnaround time:
Reference range:
Phenylalanine
Specimen type:
Serum;
24-hour urine collected without preservative.
Turnaround time:
Reference range:
Phenytoin (Epanutin®)
Specimen type:
Serum
Turnaround time:
Reference range:
Therapeutic guide: 40 – 79 umol/L
Note: Approximately 92% of serum/plasma phenytoin is bound to protein.
The binding of phenytoin to serum proteins may decrease in conditions associated with
hypoalbuminaemia. Some drugs, most notably, valproate may displace phenytoin from
serum proteins and increase its free fraction.
191
Reference range:
The cut-off threshold for a positive result for phencyclidine is 25 ng/mL.
A positive result for phencyclidine indicates only the presence of phencyclidine and does
A negative result indicates that phencyclidine is either not present or is present at levels
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Phosphate
Specimen type:
Serum.
Urine: a 24-hour urine collection is required with 20mL of 6N HCl as preservative.
Blood specimens for phosphate assay must be collected free of haemolysis. The serum
must be separated within a period of two hours from venepuncture, since phosphate is
released from red blood cells during the transport and storage of whole blood specimens
thus causing a falsely raised serum phosphate concentration.
Turnaround time:
Urine:
Reference range:
Urine:
15 – 50 mmol/24 hours.
Phytanic acid
Specimen type:
5 mL blood in potassium EDTA tube; do not refrigerate, deliver to laboratory without
delay. Monday-Wednesday (only) dispatch to Manchester. Clinical details required.
Turnaround time:
Reference range:
Placental alkaline phosphatase isoenzyme
Specimen type:
Serum
Turnaround time:
Reference range:
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pO2
Turnaround time:
Reference range:
Adult
pH
pCO2
pO2
Base Excess
Actual Bicarbonate
Oxygen Saturation
7.35 - 7.45
4.26 - 5.99 kPa
11.04 - 14.36 kPa
-2.0 - +2.0
22.0 - 26.0 mmol/L
22.0 - 26.0 mmol/L
96 - 97 %
Porphoblinogen
Specimen type:
Urine; keep cool and protect from light using e.g. aluminium kitchen foil.
Turnaround time:
Reference range:
Pophyrins
“The key to effective investigation of the porphyrias is the appropriate analysis of
correctly chosen samples taken when the patient is symptomatic, taking into account the
clinical presentation.” All Wales Clinical Biochemistry Audit Group: Standards for
Investigation of Porphyria
Specimen type:
193
Specimen type:
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The following specimens are required.
Urine: 20 mL of fresh early morning urine and a 24-hour collection, keep refrigerated
and protect from light using e.g. aluminium kitchen foil.
Stools: 5 – 10 grams specimen, refrigerate and protect from light using e.g. aluminium
kitchen foil.
Blood: Two 2.7 mL blood specimens in potassium EDTA tubes and 2.6 mL blood in one
lithium heparin tube; protect from light using e.g. aluminium kitchen foil.
Turnaround time:
Reference range:
Potassium
Specimen type:
Serum, plasma.
For urine a 24-hour collection is recommended.
Blood specimens for potassium assay must be collected free of haemolysis. The serum
must be separated within a period of two hours from venepuncture, since potassium is
released from red blood cells during the transport and storage of whole blood specimens
thus causing a falsely raised serum potassium concentration.
Turnaround time:
Serum, plasma:
Urine:
Reference range:
Urine:
30 – 100 mmol/24 hours
Primidone (Mysoline®)
Specimen type:
Serum
Specimen should be drawn before the next oral dose with the patient at a steady state.
When making comparative measurements, it is important that the sampling time be
consistent.
Phenobarbital should also be measured since it is an active metabolite of primIdone.
Turnaround time:
Reference range:
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Procollagen peptide Type 3 (P111NP)
Turnaround time:
Reference range:
Progesterone
Specimen type:
Serum
Turnaround time:
Reference range:
Adult females:
Follicular phase:
Mid-luteal:
Post-menopausal:
0.6 – 4.7 nmol/L
18 – 89 nmol/L
< 2 nmol/L
Males:
<1.6 nmol/L
17-Hydroxy progesterone
Specimen type:
Serum: The specimen (1.0 – 1.5 mL of blood) should be drawn between 8 and 9 am and
before the day’s medication is taken. Note that serum assay is required for initial
diagnosis of congenital adrenal hyperplasia.
Saliva (for monitoring adequacy of therapy but not for initial diagnosis): For saliva assay,
special collection devices, tubes and instructions are available from the Clinical
Biochemistry Laboratory or the Paediatric Secretaries, Children’s Ark, Mid-Western
Regional Hospital. Contact the Clinical Biochemistry Laboratory before initiating the
Blood spot samples on special filter paper cards (for monitoring adequacy of therapy but
not for initial diagnosis): Contact the Clinical Biochemistry Laboratory before initiating the
195
Specimen type:
Clotted blood sample. The specimen should be sent to the laboratory immediately. The
sample should be centrifuged and the serum separated within 1-2 hours of collection
(maximum no more than 4 hours).
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Prograf® (FK 506, Tacrolimus)
Specimen type:
Turnaround time:
Reference range:
Prolactin
Specimen type:
Serum
Prolactin levels are increased by stress and by drugs that deplete dopamine or block its
action.
Turnaround time:
Reference range:
Females: 40 – 530 mU/L
Males:
53 – 360 mU/L
Prostate Specific Antigen (PSA)
Specimen type:
Serum; specimen should reach laboratory within eight hours of venepuncture.
This assay has regulatory body approval for the quantitative measurement of PSA in
human serum, as an aid in the detection of prostate cancer when used in conjunction
with digital rectal examination in men aged 50 years or older. This assay is also likely to
be of value as an adjunctive test to aid in the management of prostate cancer patients.
Turnaround time:
Reference range:
Males
Siemens Medical Second Generation Total PSA Assay: 0 – 4.0 ng/mL
Siemens Medical Third Generation Total PSA Assay: 0 – 3.2 ng/mL
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Prostate Specific Antigen, Free (fPSA)
Specimen must be delivered to the laboratory within four hours of venepuncture.
Turnaround time:
Reference range:
Protein
Specimen type:
Serum, plasma;
Urine: untimed urine collection, 24-hour urine collection (no preservative is required but
urine should be kept cool);
Protein may also be assayed in other fluids such as CSF, pleural fluid, ascitic fluid.
Prolonged venous compression during blood collection will increase serum protein.
Turnaround time:
Urine:
Reference range:
Serum:
61 – 79 g/L
Urine:
0.03 – 0.15 g/24 hours
Protein/creatinine ratio (urine)
Specimen type:
Urine: untimed urine collection, 24-hour urine collection.
No preservative is required but urine should be kept cool.
Turnaround time:
Reference range:
Urine protein/creatinine ratio:
< 35 mg/mmol
197
Specimen type:
Serum; specimen must be delivered to the laboratory immediately.
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Protein (CSF)
Specimen type:
CSF.
Special requirements or comments
Turnaround time:
Reference range:
0.150 – 0.450 g/L
Protein Electrophoresis (Serum)
Specimen type:
Serum
Turnaround time:
Reference range:
Protein Electrophoresis (Urine)
Specimen type:
Turnaround time:
Reference range:
Prozac® (Fluoxetine)
Specimen type:
Serum
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Turnaround time:
Reference range:
PSA (Prostate Specific Antigen)
Specimen type:
Serum; specimen should reach laboratory within eight hours of venepuncture.
This assay has regulatory body approval for the quantitative measurement of PSA in
human serum, as an aid in the detection of prostate cancer when used in conjunction
with digital rectal examination in men aged 50 years or older. This assay is also likely to
be of value as an adjunctive test to aid in the management of prostate cancer patients.
Turnaround time:
Reference range:
Males
Siemens Medical Second Generation Total PSA Assay: 0 – 4.0 ng/mL
Siemens Medical Third Generation Total PSA Assay: 0 – 3.2 ng/mL
PSA (Prostate Specific Antigen) Free
Specimen type:
Serum; specimen must be delivered to the laboratory immediately.
Specimen must be delivered to the laboratory within four hours of venepuncture.
Turnaround time:
Reference range:
PTH (intact)
Specimen type:
Serum
Specimen must be delivered to the laboratory immediately.
Serum must be stored at minus 25 degrees Celsius while awaiting analysis.
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Turnaround time:
Reference range:
15 – 65 ng/L.
15 – 65 pg/mL.
PTHrP (Parathyroid hormone Related Protein)
Specimen type:
Contact the Biochemistry Laboratory before initiating the request so that all the collection
requirements can be met.
The specimen must be collected into a special PTHrP Cocktail Tube (Nichols Ref No 382182) obtainable from the referral laboratory. On receipt the tube must be stored at
minus 20 degrees Celsius or colder until required for use.
Place the cocktail tube on ice prior to drawing the sample. Do not use the cocktail tube
as a collection tube. Collect the whole blood into a syringe and transfer the sample to the
cocktail tube. Mix thoroughly by inversion. Immediately send the specimen to the
laboratory so that the plasma can be separated from the cells using a refrigerated
centrifuge. Freeze the separated plasma immediately at minus 20 degrees Celsius or
colder. It is essential that the sample reaches the referral laboratory in a frozen state.
The specimen must be stored at minus 20 degrees Celsius or cooler while awaiting
analysis.
Turnaround time:
Reference range:
Pyruvate
Specimen type:
Add 3 mL of 5.1% perchloric acid to specimen tube. Weigh tube. Add 0.5 – 1.0 mL of
whole blood to the weighed tube. Mix thoroughly by inverting several times. Weigh tube
again and calculate the exact weight of blood added. Centrifuge tube at 4 degrees
Celsius. Remove supernatant and store at minus 25 degrees Celsius pending dispatch to
Reference Laboratory.
Turnaround time:
Reference range:
200
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Rapamune® (Sirolimus)
sirolimus dose must be recorded on the request form. Appropriate clinical details are also
required.
Turnaround time:
Reference range:
Reducing substances (semi-quantitative test)
Specimen type:
Stool: fresh random stool specimen.
Urine: fresh random urine.
Transport specimen(s) to the laboratory as soon as possible; delay may cause falsely
low results. Freeze specimen if testing is delayed.
Turnaround time:
Reference range:
Negative.
Renal profile
Specimen type:
Serum
Includes electrolytes, urea, creatinine, calcium, phosphate, albumin.
Turnaround time:
Reference range:
Serum, plasma
Sodium
136 – 144 mmol/L
Potassium
3.6 – 5.1 mmol/L
Chloride
101 – 111mmol/L
22 – 32 mmol/L
CO2
Urea
2.9 – 7.1 mmol/L
Creatinine
Calcium
Phosphate
Albumin
35 – 106 µmol/L
2.23 – 2.56 mmol/L
0.78 – 1.53 mmol/L
35 – 48 g/L
201
Specimen type:
Whole blood in a potassium EDTA tube (=FBC tube).
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Renin
Specimen type:
Collect specimen in an ice-cold potassium EDTA tube (=FBC tube). The specimen
should be surrounded with ice and brought to the laboratory immediately (<10 minutes).
Record details of specimen collection time, whether the patient was ambulant or
recumbent, and list of all current medication.
Turnaround time:
Reference range:
Rhinorrhoea Fluid Analysis (Beta 2 transferrin; Tau Protein)
Specimen type:
Turnaround time:
Reference range:
Sabril® (Vigabatrin)
Specimen type:
Serum
Specimen drawn before the next oral dose with the patient at steady state. Note: the
serum level correlates with the dose administrated but not with the therapeutic benefit.
Turnaround time:
Reference range:
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Salicylate
Peak serum level is reached 1-2 hours after oral administration. Note results are reported
as mmol/L.
Turnaround time:
Reference range:
Therapeutic guide:
Toxic range:
< 1.45 mmol/L
> 2.3 mmol/L
Seroxat® (Paroxetine)
Specimen type:
Serum
Turnaround time:
Reference range:
Serum Protein Electrophesis
Specimen type:
Serum
Turnaround time:
Reference range:
Sex hormone binding globulin (SHBG)
Specimen type:
Serum
203
Specimen type:
Serum
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Turnaround time:
Reference range:
Adult females (non-pregnant):
Adult males:
18 – 114 nmol/L
13 – 71 nmol/L
SHBG (sex hormone binding globulin)
Specimen type:
Serum
Turnaround time:
Reference range:
Adult females (non-pregnant):
Adult males:
18 – 114 nmol/L
13 – 71 nmol/L
Sirolimus (Rapamune®)
Specimen type:
Whole blood in a potassium EDTA tube (=FBC tube).
sirolimus dose must be recorded on the request form. Appropriate clinical details are also
required.
Turnaround time:
Reference range:
Sodium
Specimen type:
Serum, plasma;
Urine: Random urine, 24-hour urine collection, no preservative required.
Blood specimen should be collected free of haemolysis.
Turnaround time:
Serum, plasma:
Urine:
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136 – 144 mmol/L
80 – 250 mmol/24 hours
Reference range:
Serum, plasma:
Urine:
Solvent screen for toluene (glue), trichloroethane (Tipex®)
and butane
Specimen type:
Whole blood or serum or plasma.
Turnaround time:
Toxicology Laboratory, Beaumont Hospital, Beaumont, Dublin 9.
Tel: 01 809 2673; 01 809 2671; 01 809 2675
Beaumont Laboratory operates a strict policy of not transmitting reports by fax.
The current out-of-hours toxicology call service at Beaumont Hospital is available to all
hospitals in the Republic of Ireland. “The service is restricted to checking only for drugs,
which if taken in overdose require a specific antidote or treatment. It is not an aid to
diagnosis nor to allow a patient to be discharged.”
Consultant: Dr. W. Tormey
Reference range:
Somatomedin C (IGF-1, insulin-like growth factor-1)
Specimen type:
Serum.
Turnaround time:
Reference range:
Spiked drink (suspected case of spiked drink)
Important notes:
(1) Requests for analyses relating to a case of alleged spiking of drink must be
made by a registered medical practitioner.
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(2) The biochemistry service is provided to assist in the clinical management of the
patient and is not provided for forensic purposes or as part of a criminal
investigation.
(3) Specimens should be collected within 24 hours of the alleged incident.
Specimens collected more than 24 hours after the alleged incident are unlikely
to yield significant findings.
(4) The measurement of the subject’s serum or plasma alcohol should be
considered a prerequisite to any biochemistry investigations of alleged spiking
of drink.
Specimen type:
Serum or plasma and urine
Specimens must be collected within 24 hours of the alleged incident. Specimen collected
more than 24 hours after the event are unlikely to yield significant findings.
No preservative is required for the urine specimen.
Turnaround time:
Reference range:
Steroid Profile
Specimen type:
Urine: 24-hour urine collection
No preservative is required but urine should be kept cool.
Appropriate clinical details must accompany the request.
Note: this assay is expensive (€300).
Turnaround time:
Reference range:
Stone analysis (stone with details of source)
Specimen type:
Stone(s).
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Specimen should be washed free of tissue and blood, and submitted in a clean dry
container. Include relevant clinical information.
Turnaround time:
Reference range:
Sweat Test
Specimen type:
Sweat.
Bookings for sweat tests may be made with the Laboratory Phlebotomist at (061) 482270
Turnaround time:
Sweat tests are usually performed within one week of booking.
Reference range:
Sweat chloride:
A sweat chloride of less than 40 mmol/L is normal and there is a low probability of cystic
fibrosis.
A sweat chloride concentration between 40 and 60 mmol/L is suggestive but not
diagnostic of cystic fibrosis.
A sweat chloride of greater than 60 mmol/L supports the diagnosis of cystic fibrosis.
These guidelines should be interpreted in the context of the patient’s age and medical
history.
Sweat conductivity using Wescor Sweat-Chek:
Normal:
0 – 60 mmol/L;
Borderline:
60 – 90 mmol/L;
Abnormal:
> 90 mmol/L.
T3 (triiodothyronine), free hormone
Specimen type:
Serum.
Turnaround time:
Reference range:
2.7 – 7.0 pmol/L
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T4 (thyroxine), free hormone
Specimen type:
Serum
Turnaround time:
Reference range:
9.9 – 20.1 pmol/L
Tacrolimus (Prograf®, FK 506)
Specimen type:
Turnaround time:
Reference range:
Tambocor® (Flecainide)
Specimen type:
Serum
Turnaround time:
Reference range:
Tau Protein (Rhinorrhoea Fluid Analysis; Beta 2 transferrin)
Specimen type:
208
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Turnaround time:
Reference range:
TBG (thyroxine binding globulin)
Specimen type:
Serum
With appropriate clinical details.
Turnaround time:
Reference range:
TBII (TSH-binding inhibiting immunoglobulin)
Specimen type:
Serum
Turnaround time:
Reference range:
Tegretol® (Carbamazepine)
Specimen type:
Serum
Turnaround time:
Reference range:
Therapeutic Guide: 17 - 51µmol/L
209
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Testosterone: males
Specimen type:
Serum
Turnaround time:
Reference range:
Adult males:
Males 20-49 years:
Males over 50 years:
8.5 – 42.0 nmol/L
9.9 – 52.4 nmol/L
7.4 – 25.7
Testosterone: females
Specimen type:
Serum
Turnaround time:
Reference range:
Adult females:
0.2 – 3.0 nmol/L
Testosterone/sex hormone binding globulin (SHBG) ratio
Specimen type:
Serum
This ratio is only applicable to female patients.
Turnaround time:
Reference range:
Adult females:
Theophylline
Specimen type:
Serum
210
1.0 – 5.2
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Turnaround time:
Reference range:
40 – 110 µmol/L
Thiopurine S-Methyltransferase (Red Blood Cell Thiopurine
S-Methyltransferase; TPMT)
Specimen type:
For patients about to commence azathioprine (Imuran®) therapy.
Turnaround time:
Reference range:
Thyroglobulin
Specimen type:
Serum
Turnaround time:
Reference range:
Thyroid hormone profile
Specimen type:
Serum
211
Sampling times:
Oral trough: immediately before the next oral dose.
Oral peak: 2 hours after administration of a product with rapid release properties; 4-8
hours after administration of a product with sustained release properties.
Intravenous: (a) prior to intravenous infusion (b) 30 minutes after completion of loading
dose to measure the adequacy of dose; (c) 4-6 hours after beginning continuous infusion
therapy (pre steady state but used to establish a trend) or before the next infusion.
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Panel includes TSH and free T4.
Turnaround time:
Reference range:
TSH:
0.15 – 3.2 mU/L
Free T4
9.9 – 20.1 pmol/L
Thyroid Stimulating Hormone (TSH)
Specimen type:
Serum
Turnaround time:
Reference range:
0.15 – 3.2 mU/L
Thyroid stimulating immunoglobulin (TBII, TSH-binding
inhibiting immunoglobulin)
Specimen type:
Serum
Turnaround time:
Reference range:
Thyroxine, free hormone (free T4)
Specimen type:
Serum
Turnaround time:
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Reference range:
9.9 – 20.1 pmol/L
Thyroxine binding globulin (TBG)
Specimen type:
Serum
With appropriate clinical details.
Turnaround time:
Reference range:
TIBC (calculated)
Specimen type:
Serum
A fasting specimen is required. TIBC specimens must be sent to the Clinical
Biochemistry Laboratory
Turnaround time:
Reference range:
Adults:
42 – 80 µmol/L
Tocopherol (Vitamin E)
Specimen type:
Serum
Protect from light, keep refrigerated.
Turnaround time:
Reference range:
Topamax® (Topiramate)
Specimen type:
Serum
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Turnaround time:
Reference range:
Topiramate (Topomax®)
Specimen type:
Serum
Turnaround time:
Reference range:
Toxicology: Environmental
agency to contact regarding these matters is the Environmental Protection Agency.
Contact details: EPA Headquarters, PO Box 3000, Johnstown Castle Estate, Co.
Wexford, Tel: 053-9160600; Fax:053-9160699; Email: [email protected]; Lo Call: 1890
335599. Web site: www.epa.ie.
Toxicology: Food
The Clinical Biochemistry Laboratory does not provide an assay service for toxic agents
or chemicals in food or food products. The most appropriate agency to contact regarding
these matters is the Food Safety Authority of Ireland; contact details:
Food Safety Authority of Ireland, Abbey Court. Lower Abbey Street, Dublin 1
Phone 01 817 1300 ; Fax 01 817 1301; Email [email protected]
Web address www.fsai.ie
Toxicology: Industrial
contact details:
EPA Headquarters, PO Box 3000, Johnstown Castle Estate, Co. Wexford,
Tel: 053-9160600; Fax:053-9160699; Email: [email protected]; Lo Call: 1890 335599.
Web site: www.epa.ie
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Toxins
TPMT (Thiopurine S-Methyltransferase)
Specimen type:
For patients about to commence azathioprine (Imuran®) therapy.
Turnaround time:
Reference range:
Trace Metal Monitoring (in patients on nutrition support,
especially parenteral nutrition)
Specimen type:
tube and needle.
contamination.
Do not open or centrifuge the specimen tube.
Trace element
Frequency of testing
Zinc
Baseline, then every 2-4 weeks depending on results
Copper
Baseline, then every 2-4 weeks depending on results
Selenium
Baseline if risk of depletion. Need for further testing depends on
baseline value
Manganese
Every 3-6 months if on home parenteral nutrition
Turnaround time:
Reference range:
215
Toxins are poisons produced by living organisms, especially bacteria, Investigations
relating to toxins do not fall within the area of responsibility of the Clinical Biochemistry
Laboratory.
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Transferrin
Specimen type:
Serum
A fasting specimen is required. Transferrin specimens must be sent to the Clinical
Turnaround time:
Reference range:
Adults
Males:
1.8 – 3.3 g/L
Females:
1.9 – 3.8 g/L
Transferrin saturation
Specimen type:
Serum
A fasting specimen is required. Iron studies specimens must be sent to the Clinical
Turnaround time:
Reference range:
Adults:
15 – 45%
Transglutaminase antibodies, Tissue (anti-tTG)
Please refer to Serology/Immunology Laboratory.
Tricyclic antidepressants (semi-quantitative, serum)
Specimen type:
Serum
The cut-off threshold for a positive result for tricyclic antidepressants is 100 ng/mL.
A positive result for tricyclic antidepressants indicates only the presence of tricyclic
antidepressants and does not necessarily correlate with the extent of physiological and
psychological effects. Pharmokinetic studies have shown that there is a marked interindividual variation in the therapeutic and toxic response to tricyclic antidepressants at
similar blood concentrations.
216
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Turnaround time:
Reference range:
Triglyceride
Specimen type:
Serum
Serum triglyceride is subject to major increases following meals and may also be
released after prolonged fasting. A 12-hour fast is essential for meaningful triglyceride
measurements.
Turnaround time:
Reference range:
Triglyceride Reference Range:
General population reference values:
0.5 – 2.1 mmol/L
< 2.5 mmol/L.
Triidothyronine, free hormone (Free T3)
Specimen type:
Serum.
Turnaround time:
Reference range:
2.7 – 7.0 pmol/L
217
A negative result indicates that tricyclic antidepressants are either not present or are
present at levels below the cut-off threshold for this test.
This assay is designed to detect the four major tricyclic antidepressants: amitriptyline,
nortriptyline, imipramine, and desipramine.
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Trileptal® (Oxcarbazepine)
Specimen type:
Serum/plasma
Turnaround time:
Reference range:
Troponin I
Troponin T assay is available – see below.
Troponin T (cTnT)
Specimen type:
Serum.
Two samples should be collected, at admission and 8-12 hours later. The date and time
of the suspected cardiac event should be stated on the request to assist interpretation.
Turnaround time:
Availability of assay: 7.00am to 11.30pm each day.
Reference range:
Less than 0.01 ng/mL
A Troponin T concentration greater than 0.1 ng/mL twelve hours after the onset of chest
pain is suggestive of myocardial infarction. An increased Troponin T concentration
indicates myocardial damage, but not its cause. The diagnosis of ACS/AMI must be
supported with appropriate symptoms and/or ECG changes. In the absence of supportive
clinical findings, other causes of myocardial damage should be considered.
Trypsin, immunoreactive
Specimen type:
Serum.
Specimen must be delivered to the Clinical Biochemistry within one hour of collection.
218
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Turnaround time:
Reference range:
Tryptase Assay (plasma)
Adverse (Anaphylactoid) Reactions to Intravenous Drugs
Specimen type:
The preferred specimen is EDTA plasma (at least 1 mL).
It is possible to measure tryptase in serum if EDTA plasma is not available.
The first sample should be taken as soon as possible after commencement of the
reaction and ideally within the first 30 minutes. Further samples should be taken 3, and
24 hours after reaction.
Documentation required
This should be comprehensive, but brief, and should include the following (although any
other factor which the anaesthetist thinks could be a cause of the reaction should be
indicated, eg surgical stimulation, undiagnosed hypovolaemia etc).
•
Surgical procedure,
•
Date of reaction,
•
Drugs administered (including premedication and sequences where possible),
•
Clinical manifestations,
•
Management of reaction and outcome (eg residual effects or death),
•
Previous medical and anaesthetic history if known,
•
Any particular risk factors? (eg known asthmatic, penicillin allergy, anaesthetic
reaction or extremely anxious patient etc),
•
The haematological data (‘routine haematology’ including full differential white
cell count and haematocrit), if available.
This documentation should accompany the plasma samples.
Telephone contact: At any stage of the reaction the user of the service is encouraged
to telephone the Protein Reference Unit in Sheffield (00 44 114 271 5552) for advice.
This advice is based on the cumulative experiences of NARCOS in the assessment of
emergency situations. NARCOS provides a 24 hour advisory service via the Hospital
switchboard (00 44 114 243 4343).
Store specimens at approximately +4 degrees Celsius prior to preparation for dispatch to
Turnaround time:
Reference range:
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TSH (Thyroid Stimulating Hormone)
Specimen type:
Serum
Turnaround time:
Reference range:
0.15 – 3.2 mU/L
TSH-binding inhibiting immunoglobulin (TBII)
Specimen type:
Serum
Turnaround time:
Reference range:
Type 3 procollagen peptide (P111NP)
Specimen type:
Serum
The specimen should be sent to the laboratory immediately. The sample should be
centrifuged and the serum separated within 1-2 hours of collection (maximum no more
than 4 hours).
Turnaround time:
Reference range:
U & E Profile (urea and electrolytes)
Specimen type:
Serum, Plasma
The U + E panel includes sodium, potassium, chloride, carbon dioxide and urea.
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Turnaround time:
Reference range:
Reference ranges for serum or plasma urea and electrolytes
Serum,
plasma
Urea
Sodium
Potassium
Chloride
Carbon
dioxide
mmol/L
mmol/L
mmol/L
mmol/L
mmol/L
2.9 – 7.1
136 – 144
3.6 – 5.1
101 – 111
22 - 32
Urea
Specimen type:
Serum, plasma;
Urine: 24-hour collection (no preservative required).
This assay is also available as part of the U+E test profile (serum or plasma)
Turnaround time:
Serum, plasma: daily, throughout 24 hours.
Urine:
Reference range:
Serum, plasma:
Urine:
2.9 – 7.1 mmol/L
430 – 710 mmol/24 hours.
Uric Acid (Urate)
Specimen type:
Serum, plasma;
Urine: a 24-hour collection is required ( no preservative, keep cool);
Joint fluid: send specimen to the Microbiology Department for Microscopy (detection of
uric acid crystals).
Turnaround time:
Serum, plasma:
Urine:
Reference range:
Serum:
Males:
286 – 518 umol/L
Females:
155 – 476 umol/L
Urine:
2.8 – 4.4 mmol/24 hours
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Urine Protein Electrophoresis
Specimen type:
Turnaround time:
Reference range:
Valproate (valproic acid, Epilim®)
Specimen type:
Serum
There is no evidence that monitoring serum valproate levels can be valuable in the
management of patients with epilepsy. Studies indicate that concentrations are no better
a guide to clinical response than is dose. Measurement of serum levels may be useful in
the assessment of compliance.
Turnaround time:
Reference range:
Therapeutic guide:
347 – 693 umol/L
Vasoactive intestinal polypeptide (VIP)
Specimen type:
Patient should be fasting overnight.
Collect 3 mL of blood into an ice-cold potassium EDTA specimen tube.
Turnaround time:
Reference range:
222
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Very long chain fatty acids (VLCFA)
Specimen type:
5 mL blood in potassium EDTA tube; do not refrigerate, deliver to laboratory without
delay. Monday- Wednesday (only) dispatch to Manchester.
Turnaround time:
Reference range:
Vigabatrin (Sabril®)
Specimen type:
Serum
Specimen drawn before the next oral dose with the patient at steady state. Note: the
serum level correlates with the dose administrated but not with the therapeutic benefit.
Turnaround time:
Reference range:
VIP (vasoactive intestinal polypeptide)
Specimen type:
Patient should be fasting overnight.
Collect 3 mL of blood into an ice-cold potassium EDTA specimen tube.
Turnaround time:
Reference range:
223
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Viscosity, plasma
Vitamin A
Specimen type:
Serum
Protect from light using e.g. aluminium kitchen foil. Keep refrigerated.
Turnaround time:
Reference range:
Vitamin B6: Pyridoxine
Specimen type:
Whole blood in K-EDTA specimen tube.
Specimen must be sent to the laboratory immediately.
Protect from light, Keep refrigerated.
Turnaround time:
Reference range:
Vitamin B12
Vitamin C
Specimen type:
Note that Vitamin C is highly reactive and easily oxidised.
Collect blood into two 2.6 mL lithium heparin tubes. Deliver the specimen to laboratory
immediately so that further processing can take place to stabilise Vitamin C. This
stabilisation must be completed within 30 minutes of specimen collection.
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Turnaround time:
Reference range:
Vitamin D (25-Hydroxy vitamin D3; 25-Hydroxycholecalciferol)
Specimen type:
Serum
Turnaround time:
Reference range:
Vitamin D (1,25 dihydroxy) (=1,25 Dihydroxy cholecalciferol)
Specimen type:
Serum. See special requirements.
A fasting specimen is required. The specimen should be protected from light using e.g.
aluminium kitchen foil and brought to the laboratory immediately.
Turnaround time:
Reference range:
Vitamin E (Tocopherol)
Specimen type:
Serum
Turnaround time:
Reference range:
225
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VMA
Specimen type:
24-hour urine collection with 20 mL of 6N HCI as preservative.
Turnaround time:
Reference range:
Volume
Specimen type:
Various
Reference range:
Weight
Specimen type:
Various
Reference range:
White cell cystine
Specimen type:
1-2 mL blood in lithium heparin tube; do not refrigerate or centrifuge, deliver to laboratory
Turnaround time:
Reference range:
226
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White cell enzyme analysis (Lysosomal enzyme analysis)
5 mL blood in potassium EDTA tube; do not refrigerate or centrifuge, deliver to laboratory
Turnaround time:
Reference range:
Zarontin® (Ethosuximide)
Specimen type:
Serum
Due to the long half-life of ethosuximide, fluctuations in serum concentration are
relatively minor. However, when making comparative measurements, it is advisable that
the sampling time be consistent.
Turnaround time:
Reference range:
Zinc
Specimen type:
contamination.
tube and needle.
Turnaround time:
Reference range:
227
Specimen type:
228
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CLINICAL BIOCHEMISTRY 69 CLINICAL BIOCHEMISTR

Transcription

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