Laboratory Investigation Request
Referred by Dr.
Patient Name
Clinical Data
:- ---------------------------------------------------------------------------------------------------------------------: ----------------------------------------------------------------------------------------------------------------------: ----------------------------------------------------------------------------------------------------------------------?
Chemistry
?
Hematology
Immunology
?
o
o
o
o
o
o
o
o
o
o
Blood Picture
WBC T & Diff
Platelets count
Reticulocytes
ESR
Blood Group o
Coomb’s direct
Coomb’s indirect
Prothrombin time
PTT
5 Nucleotidase
o
Fibrinogen
Kidney Function
Urea
o Creatinine
Creatinine clearance
Uric acid
o
o
o
o
Protein in 24h Urine
Micro albuminuria
Lipids profile
Cholesterol
o
Triglycerides
HDL
o LDL
Serum Enzymes
Acid phosphatase
o
o
o
o
Z.N. Stain
o
Anti-Sperm Ab.
o
Amylase o Lipase
Cardiac enzymes
CK
o CK-MB
o
o
o
T.B. Culture
Widal test
Brucella test
o
o
o
Anti-thyroglobulin Ab
ASCA IgG, IgA
o
o
o
LDH
o
Helicobacter Pylori Ab&Ag
o
ASMA
o
Troponin T
Electrolytes
o
o
Fasciola Ab.
Entameba Histolytica Ab.
o
o
ASOT
(quantitative)
B2-Microglobulin
o
o
Depaken
Tegratol
o
o
K
Mg
Chloride
Zinc
o
o
o
o
Syphilis RPR
Schistosomal ab.
Chlamydia Ab.
Toxoplasma Ab
o
o
o
o
C.R.P.
(quantitative)
Complement C3 - C4
Imunoglobulin IgA , IgE
Imunoglobulin IgG,IgM,
o
o
o
o
Drugs of Abuse
Opiates
Cannabinoids
Cocaine
o
o
o
TIBC
o
Rubella Ab.
o
Insulin Ab
o
o
o
o
o
o
CMV Ab
Herpes Simplex Ab
Epstein Barr Ab. (EBV)
Mumps Ab.
HIV Ab.
o
o
o
o
o
Islet cell antibodies
LKM-Ab
Paul Bunnel test
Rhumatoid F. (quantitative)
Rose Waller
o
o
o
o
o
Other tests
Pregnancy test in Blood
Stool Occult blood
Fructose in semen
Stone analysis
Pathology & cytology
o
o
o
o
o
Iron
o
Ferritin
Ammonia
Ceruloplasmin.
Lactate
Myoglobin
Auto Immunity Tests
Alpha-1-antitrypsin
AMA
Amyloid A
ANA (ELISA)
ANCA (P&C)
Anti DNA (ds)
Anti Jo-1
Anti Keratin Ab. AKA
Anti Perinuclear factor APF
o
o
o
o
o
o
o
o
o
o
o
Anti SS-A/RO
o
Lupus anticoagulant
Hb electrophoresis
Hb A2
Osmotic fragility
o
o
o
o
Anti SS-B/La
Anti topoisomerase I/SCL-70
Anti-Cardiolipin Ab.
Anti-CCP
o
o
o
o
o
Sickling test
o
Anti-gasteric parietal cell Ab.
o
o
o
G6PD
L.E Cells
o
o
Anti-Gliadin Ab.
o
Rh.
FDP
Micro & Serology
Blood Culture
Urine C & S
Prostatic Ex. C&S
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
o
Blood Glucose
FBS
o 2h PP
Bl. glucose curve
HbA1C
Liver Function
SGPT(ALT) o SGOT(AST)
Protein
o Albumin
Bilirubin T & D
Gamma GT
Alkaline phosphatase
Na
o
Ca++
o
Copper
o
Phosphorus o
o
o
o
o
o
o
o
o
o
o
?
Hormones
T3
Free T3
T4
Free T4
TSH
Parathormone
Prolactin
LH
FSH
E2
Progesterone
DHEA
B-HCG
DHEA-S
Cortisol
VMA
Testosterone
Growth H.
Osteocalcin
Insuline H.
A.F.P
CA 15.3
CA 19.9
PSA total
Tumour Markers
o
CEA
o
CA 125
o
NSE
o
PSA free
o
o
o
o
Anti-glomerular basement m.
o
o
HAV IgM
HBsAg
Hepatitis Markers
o
HAV IgG
o
HBs Ab
o
o
Anti-peroxidase
o
HBeAg
Anti-Phospholipid Ab.
Anti-Smith (sm)
Anti-smith (SM)
o
o
o
HBc IgM
HCV antibody
HEV Ab.
Anti-Thyroid microsomal Ab.
o
HBe Ab
o
o
o
o
Molecular Biology
HCV-RNA PCR
HBV-DNA PCR
TB-DNA PCR
Therapeutic drug Monitoring
o
Epanutin
o
Lithium
‫اﺗﺑﻊ ﺗﻌﻠﯾﻣﺎت اﻟطﺑﯾب اﻟﻣﻌﺎﻟﺞ أو أﺗﺻل ﺑﻧﺎ ﻓﻰ أى وﻗت ﻧﺷرح ﻟك إن ﻛﺎن ﻫﻧﺎك اﺷﺗراطﺎت ﻟﻠﺗﺣﺎﻟﯾل اﻟﻣطﻠوﺑﺔ‬
‫ﻣﻌظم اﻟﺗﺣﺎﻟﯾل ﻣﺛل ﺻورة اﻟدم وظﺎﺋف اﻟﻛﻠﻰ واﻟﻛﺑد واﻟﻬرﻣوﻧﺎت وداﻻت اﻟﻔﯾروﺳﺎت واﻻورام ﻻﺗﺣﺗﺎج ﺻﯾﺎم‬
‫ ﺳﺎﻋﺔ‬١٤-١٢ ‫ ﺳﺎﻋﺔ – ﺗﺣﺎﻟﯾل اﻟدﻫون‬٨- ٦ ‫اﻟﺻﯾﺎم ﺷرطﺎ ﻟﺗﺣﺎﻟﯾل ﻣﺣددة ﻣﺛل اﻟﺳﻛر اﻟﺻﺎﺋم‬
.‫ ﻣﻊ أطﯾب أﻻﻣﻧﯾﺎت ﺑدوام اﻟﺻﺣﺔ‬.‫اﻟﺻﯾﺎم ﻫو اﻻﻣﺗﻧﺎع ﻋن اﻻﻛل واﻟﻣﺷروﺑﺎت وﻟﻛن ﯾﺳﻣﺢ ﺑﺷرب اﻟﻣﺎء‬
( ‫ اﻷﻗﺼﺮ – ﺷﺎرع اﻟﺘﻠﯿﻔﺰﯾﻮن – أﻣﺎم ﺑﺮج اﻟﺘﻠﯿﻔﺰﯾﻮن – ﺷﺎرع ﻋﻠﻰ ﺑﻦ إﺑﻰ طﺎﻟﺐ ) ﻣﺤــﻼت وﻟﯿــــﺪ‬: ‫اﻟﻤﺮﻛﺰ اﻟﺮﺋﯿﺴﻰ‬
٠١١١٠١٠٩٢٢٠ - ٠٩٥/٢٢٨١٩٣٨ - ٠٩٥/٢٢٧٠٦١٩ : ‫ت‬
o
o
o