TOXICOLOGY REFERENCE LABORATORY
Laboratory User Guide
ROOM 708, BLOCK P
PRINCESS MARGARET HOSPITAL
2-10 Princess Margaret Hospital Road
Lai Chi Kok
Tel: 2990 1941
Fax: 2990 1942
http://trl.home
Version 1.0
Effective date: 1/1/09
Contents
CONTENTS ............................................................................................................ 2
INTRODUCTION .................................................................................................. 3
STAFF ...................................................................................................................... 4
HOW TO MAKE LABORATORY REQUEST .................................................. 5
Instruction for Referring Clinician
Instruction for Referring Laboratory
Specimen Collection & Handling
Specimen Reception Hours
Rejection of Requests
Reporting of Results
ALPHABETICAL LIST OF LABORATORY TESTS ...................................... 8
General unknown screening
Heavy metal analysis
Herb and TCM formula identification
Quantitative toxic alcohol analysis
Quantitative cyanide analysis
Quantitative vitamin A analysis
Target screen for animal thyroid tissue
Target screen for corticosteroids
Target screen for erectile dysfunction drug and analogues
Target screen for oral hypoglycemic agents
Target screen for tetramine
Target screen for toxic plant / herbal alkaloids
Target screen for warfarin and superwarfarins
2
Introduction
Background
There are six toxicology laboratories within the Hospital Authority (HA) and on average each serving
the needs of a cluster. Details on distribution and the role of cluster toxicology laboratories (CTLs) are
listed in Appendix A. To better align service arrangement and enhance quality of service, HA has
established a Toxicology Reference Laboratory (TRL) at PMH since March 2004 to support the cluster
toxicology laboratories (CTLs), and in conjunction with the CTLs to cater for the toxicology needs in
HA.
Objectives of TRL
The HA TRL is set up as a tertiary service to serve the following purposes:
(i)
As a toxicology reference laboratory for HA
(ii)
To establish a laboratory for herbal products poisoning
(iii) To provide diagnostic services for new or uncommon toxin / substances of abuse
(iv)
In conjunction with the CTLs, to set up a network to cater for toxicology needs in HA
Services provided by TRL
The menu of services will be updated from time to time. For suspected toxin not on the list, clinicians
are welcome to discuss the needs with TRL. The laboratory request form is shown as per Appendix B.
Referral System
The TRL works as a team with the CTLS. The CTLs serve to provide the initial screening and
supporting on site, with the TRL functions as a back up to the CTLs and provided a referral service.
Clinicians are therefore advised to discuss with their corresponding CTLs which will address the clinical
needs according to the facility available at the CTL. Cases that required the support of TRL will be
directed to TRL accordingly.
TRL Consultation / Enquiry
General enquiry – Tel 2990 1941
Intranet website – http://trl.home
Fax: 29901942
3
Medical Staff
Post
Director & Consultant
Chemical Pathologist
Telephone
2990 1806
E-mail address
ywchan@ha.org.hk
Dr Tony Mak
Deputy Director & Consultant
Chemical Pathologist
2990 1987
makwl@ha.org.hk
Dr WT Poon
Dr Doris Ching
Dr Hencher Lee
Associate Consultant
Resident
Resident
2990 1819
2990 1881
2990 1827
poonwt@ha.org.hk
chingck2@ha.org.hk
leehch@ha.org.hk
Dr Wendy Chan
Dr Sammy Chen
Resident
Resident
2990 1819
2990 1871
chanwt2@ha.org.hk
chenpls@ha.org.hk
2990 1875
2990 1998
2990 1990
2990 1999
2990 1982
laick@pmh.ha.org.hk
ngsw2@ha.org.hk
lamyh@ha.org.hk
cml634@ha.org.hk
2990 1976
2990 1990
2300 7083
wongws@ha.org.hk
chanss02@ha.org.hk
lomh@ha.org.hk
Dr Albert Chan
Scientific Staff
Mr CK Lai
Ms SW Ng
Mr YH Lam
Mr ML Chen
Dr Magdalene Tang
(Honorary) Scientific Director
Scientific Officer (Medical)
Scientific Officer (Medical)
Scientific Officer (Medical)
Scientific Officer (Medical)
Technical Staff
Mr Watson Wong
Ms Suzanne Chan
Ms Vanessa Lo
Ms. Karen Chung
Ms. Jessica Lau
Ms. Pauline Leung
Senior Medical Technologist
Medical Technologist
Medical Technologist
Associate Medical Technologist
Associate Medical Technologist
Associate Medical Technologist
Mr. Simon Poon
Mr. WK Cheung
Ms. Fannie Lee
Ms. XL Yang
Associate Medical Technologist
Associate Medical Technologist
Technical Service Assistant
General Service Assistant
4
How to Make Laboratory Request
Instruction for Referring Clinician
1. TRL request form is available for download at http://trl.home
2. The following information are required:
(a) Patient’s name / HKID / Sex / Age / DOB / Hospital Encounter Number
(b) Requesting location (hospital ward, out-patient clinic etc)
(c)
(d)
(e)
(f)
Name and contact number of referring clinician
Relevant clinical and drug history
Date and time of specimen collection
Specimen type(s)
(g) Test(s) requested
(h) Signature of referring clinician
3. Send the request form and labeled specimens to the Chemical Pathology laboratory in your hospital
who will direct the specimens to TRL
Instruction for Referring Laboratory
1. The following information are to be provided by the referring laboratory:
(a) Report copy to _______ laboratory (If the field is not specified, a report copy will be sent to
Chemical Pathology laboratory of the requesting location),
(b) Specimen laboratory number assigned by the referring laboratory
2. For drug confirmation request, please provide information of the patient and attending clinician as
above together with the name and signature of referring laboratory personnel making the request
3. Send the TRL request form and labeled specimens, to the following address:
Chemical Pathology Laboratory, 11/F, Block G, Princess Margaret Hospital, Kwai Chung
With attention to “Toxicology Reference Laboratory”
5
Specimen Collection and Handling



Different laboratory tests require specific specimen containers. Consult this guide for the
appropriate specimen containers for a particular test
All specimens should be tightly capped, checked for leakage and properly labeled with patient’s
name and HKID
For non-biological samples, different specimens should be placed in individual container bags
Please stick the patient’s gum label on the individual container bags instead of the specimens

For drug products, please provide product packaging, insert and multiple pills if available


For herb/plant, please provide unused herbs, herbal broth, remnant and herbal formula if available
All the specimens should be put together into a secondary container bag. TRL request form should
be placed in the carrying pocket of secondary container bag
Do not stick the specimen onto paper or TRL request form

6
Specimen Reception Hours
Monday – Friday
Saturday
9:00am – 5:30pm
9:00am – 1:00pm
In case a typhoon signal No. 8 or above, or a ‘Black’ rainstorm warning is hoisted, laboratory service
will be suspended. Please contact us for the availability of service before sending specimens.
Rejection of Requests
Specimens with one or more of the following conditions will be rejected:
 Spilt specimens or soiled request forms



Biological specimens without specimen collection date
Specimens stuck on request form
Unlabelled or mislabeled specimens


Specimens in wrong containers
Mishandled specimens that are not suitable for processing, e.g. improper transport conditions or
outdated specimens
Specimens with insufficient quantity
Requests with insufficient information to identify the patient and the authorized requester
Tests requested not available
Empty or broken containers




Remarks:
Difficult to replace or critical specimens will be processed but results not released until the problem has
been resolved
Reporting of results


Most results are reported within 7 – 14 days
A hardcopy of report will be printed, at the requesting location and referring laboratory
respectively, when results are ready


Patient’s results can be assessed from electronic patient record under “toxicology” directory
Specimens will be kept for three months after analysis
7
Alphabetical list of laboratory tests
General unknown screening
Specimen:
Container:
Volume:
Availability:
Turnaround time:
Indications:
Urine / Clotted blood
Plain bottle
Urine (30 mL); Clotted blood (4 mL)
Weekly
1 – 2 weeks
For comprehensive drug screen and confirmation
Notes:
1. Avoid using blood tubes with gel separators
2. Do not add any preservatives (e.g. boric acid) to urine collection containers
3. Non-biological samples can be accepted for analysis
Heavy metal analysis
Specimen:
Container:
Availability:
Turnaround time:
Indications:
Facial cream / drug product
Acid-washed bottle
Monthly
1 month
To detect exogenous exposure in confirmed heavy metal poisoning
Metals covered:
Aluminium, Arsenic, Cadmium, Copper, Lead, Manganese, Mercury, Selenium,
Zinc
Herb and herbal formula identification
Specimen:
Availability:
Turnaround time:
Indications:
Herbs / herbal formula
Daily
1 to 2 weeks
For suspected herb related toxicity
Quantitative toxic alcohol analysis
Specimen:
Container:
Volume:
Availability:
Turnaround time:
Indications:
Blood toxic level:
Clotted blood
Plain bottle
4 mL
Special arrangement
1 day
For confirmation of toxic alcohol ingestion
Methanol:
> 6.24 mmol/L (20 mg/dL)
8
Ethanol:
> 17.36 mmol/L (80 mg/dL)
Isopropanol: > 6.66 mmol/L (40 mg/dL)
Acetone:
> 3.44 mmol/L (20mg/dL)
Notes:
1. Prior arrangement with the laboratory is necessary
2. Avoid using blood tubes with gel separators
3. Non-biological samples can be accepted for analysis
Quantitative cyanide analysis
Specimen:
Container:
Fluoride blood
Special fluoride bottle container
Volume:
Availability:
Turnaround time:
2 mL (Fill to the blue line mark)
Special arrangement
1 day
Indications:
For suspected cyanide poisoning
Blood toxic level: > 0.5 mg/L
Notes:
1. Prior arrangement with the laboratory is necessary
2. Contact your cluster toxicology laboratory to obtain the special fluoride bottle
3. See the following instruction for sample collection
Instruction for the use of pre-treated bottle for Cyanide determination
** This is a pre-treated fluoride bottle dedicated for the determination
of Cyanide. Please do not use it for glucose assay.
1. Label clearly on the tube with patient’s name, identity card
number and collection date
2. Fill about 2 mL blood up to the blue line marked on the bottle
3. Invert mix gently for 30 seconds
4. Send in ice bath immediately to the chemical pathology
laboratory in your hospital
5.
6.
Upon receipt of blood sample by the local laboratory, store the
whole blood sample frozen and arrange transport with Toxicology
Reference Laboratory
** Sample with even minor clots will affect Cyanide result
Quantitative vitamin A analysis
Specimen:
Clotted blood
9
Container:
Plain bottle
Volume:
Availability:
Turnaround time:
Indications:
4 mL
Special arrangement
1 – 2 weeks
For suspected vitamin A poisoning
Blood ref range:
1-6 y
7-12 y
13-19y
Adult
Notes:
1. Prior arrangement with the laboratory is necessary
0.70-1.51mol/L
0.91-1.71 mol/L
0.91-2.51mol/L
1.05-2.80mol/L
2. Avoid using blood tubes with gel separators
3. Fasting sample is required
4. Protect sample from light
Target screen for animal thyroid tissue
Specimen:
Availability:
Turnaround time:
Indications:
Drug product
Weekly
1 – 2 weeks
To detect the presence of animal thyroid tissue adulteration
Target screen for corticosteroids
Specimen:
Availability:
Turnaround time:
Indications:
Drugs included:
Drug product
Weekly
1 – 2 weeks
To detect the presence of corticosteroid adulteration
Alclometasone Diproprionate, Beclomethasone, Betamethasone, Betamethasone
Diproprionate, Betamethasone Valerate, Budesonide, Clobetasol Proprionate,
Clobetsone Butyrate, Cortisone Acetate, Dexamethasone, Dexamethasone Acetate,
Dexamethasone Phosphate, Diflucortolone Valerate, Flucinolone Acetonide,
Flucinonide, Fludrocortisone Acetate, Flumethasone, Fluorometholone, Fluticasone
Proprionate, Hydrocortisone, Hydrocortisone Acetate, Methylprednisolone,
Mometasone Furoate, Prednisolone, Prednisolone Acetate, Prednisone, Prednisone
Acetate, Triamcinolone Acetonide and Triamcinolone
Target screen for erectile dysfunction drug / related analogue
Specimen:
Drug product
10
Availability:
Weekly
Turnaround time:
Indications:
Drugs included:
1 – 2 weeks
To detect the presence of erectile dysfunction drug / related analogue adulteration
Sildenafil, Homosildenafil, Tadalafil, Vardenafil, Acetildenafil,
Hydroxyacetildenafil, Hydroxyhomosildenafil, Piperidenafil, Aminotadalafil,
2-(2-ethoxy-phenyl)-5-methyl-7-propyl-3H-imidazo[5,1-f]-[1,2,4]triazin-4-one
(vardenafil analogue)
Target screen for oral hypoglycemic agents
Specimen:
Container:
Spot urine / Clotted blood
Plain bottle
Volume:
Availability:
Turnaround time:
Urine (30 mL); Clotted blood (4 mL)
Weekly
1 – 2 weeks
Indications:
Drugs included:
To detect the presence of oral hypoglycemic agents in unexplained hypoglycemia
Glibenclamide, Gliclazide, Glimepiride, Glipizide, Glibornuride, Gliquidone,
Chlorpropamide, Tolbutamide, Acetohexamide, Carbutamide, Tolazamide,
Nateglinide and Repaglinide
Target screen for tetramine
Specimen:
Spot urine / Clotted blood
Container:
Volume:
Availability:
Turnaround time:
Indications:
Plain bottle
Urine (30 mL); Clotted blood (4 mL)
Special arrangement
1 day
For suspected tetramine poisoning
Notes:
1. Prior arrangement with the laboratory is necessary
2. Non-biological samples can be accepted for analysis
Target screen for toxic plant / herbal alkaloids
Specimen:
Container:
Volume:
Availability:
Turnaround time:
Indications:
Toxins included:
Spot urine / Clotted blood
Plain bottle
Urine (30 mL); Clotted blood (4 mL)
Weekly
1 – 2 weeks
To detect the commonly encountered toxic plant / herbal alkaloids
Aconitine and related toxins, Anti-cholinergics, Matrine and related toxins,
11
Ephedrine and related toxins, Strychnine and brucine, Tetrahydropalmatine,
Notes:
Podophyllotoxin, Atractyloside, Cardiac glycosides, Gelsemine and related toxins,
Grayanotoxin, Ricinine
1. Non-biological samples can be accepted for analysis
Target screen for warfarin and superwarfarins
Specimen:
Container:
Volume:
Availability:
Turnaround time:
Clotted blood
Plain bottle
4 mL
Weekly
1 – 2 weeks
Indications:
Drugs included:
For suspected anticoagulant rat poison overdose
Brodifacoum, Bromadiolone, Chlorphacinone, Coumachlor, Coumafuryl,
Coumatetralyl, Difenacoum, Difethalone, Diphacinone, Flocoumafen, Pindone and
Warfarin
Notes:
1. Non-biological samples can be accepted for analysis
12
Appendix A
Cluster Toxicology Laboratories
Distribution
Cluster
Site of CTL
Contact Persons
Telephone Numbers
HKW
QMH
Dr Sidney Tam
28553249
HKE
PYNEH
Mr Y C Lo
25955108
NTE
PWH
Dr Michael Chan
26322326
NTW
TMH
Ms Judy Lai
24685304
KW
PMH
Mr C K Lai
29901875
KC & KE
QEH
Dr Anthony Shek
29586784
Role
Emergency toxicology services
Broad spectrum toxicology screening
Common substance of abuse analysis service
Consultation and interpretation related to the above services
13